Tobacco Implementation Guide-Subject Characteristics
Any Subject Characteristics
* Were subject characteristics collected?	No  Yes
Subject Chacteristics
What is the subject's education level?	Choose Did not complete Secondary School or Less than High School Some Secondary School or High School Education High School or Secondary School Degree Complete Associate’s or Technical Degree Complete; College or Baccalaureate Degree Complete Doctoral or Postgraduate Education
What is the subject’s employment status?	Full-time  Part-time  Not Employed
What is the subject's income?	<100% poverty guideline  100-200% poverty guidelines  >200% poverty guidelines;
What is the subject's marital status?	Choose Never Married Married Divorced Legally Separated Widiwed
What is the subject's national origin status?
What is the subject’s military status ?	No Military Service  Active Service  Veteran
Was the subject exposed to second hand smoke ?	Choose No Exposure to Second Hand Smoke Exposure at Home Only Exposure at work only Exposure at Work and Home
What was the age of the subject when they started smoking?	Choose 16-24 years 25-34 years 45–64 years 65 years and older
Did the subject have any tobacco cessation counseling?	No  Yes
What is the longest duration of previous abstinence from tobacco use?	Choose ≤7 days 8–28 Days 1–6 months >6 Months

* Mandatory field