Tobacco Implementation Guide_Tobacco Usage History
Tobacco Usage History
What is the object?
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
Tobacco Product Used
*
What is the type of tobacco product used by the subject?
Smoked Tobacco Product
Smokeless Tobacco Product
What was the brand name of the tobacco product?
Is this the subject's usual brand of tobacco product?
Usual Brand
Not Usual Brand
What was the duration of use of the tobacco product ?
What is the unit?
Is the tobacco use ongoing?
No
Yes
What is the end date?
01 Jan 2000
*
Mandatory field