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Protocol - Pregnancy Status and Tobacco Use

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Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Description:

Population Assessment of Tobacco and Health (PATH) questions that assess number of pregnancies, kinds of complications, pregnancy status, alcohol, average cigarettes per day during pregnancy (not by trimester), and other tobacco product use.

Protocol:

The next questions are about your pregnancy history.

1. Have you ever been pregnant? Please include current pregnancy, live births, miscarriages, abortions, ectopic or tubal pregnancies and stillbirths.

[] 1 Yes

[] 2 No

[] -8 DON’T KNOW

[] -7 REFUSED

2. How many of your pregnancies have resulted in a live birth?

[] 1 |___|___|

[] -8 DON’T KNOW

[] -7 REFUSED

3. For [that birth \ those FILL## births], did any of the following occur? Choose all that apply.

[] 1 Preterm birth (birth of baby less than 37 weeks gestational age)

[] 2 Baby with low birth weight (less than 5 pounds 8 ounces)

[] 3 Baby with birth defects

[] 4 Placenta Previa

[] 5 Placenta Abruption

[] 6 Pre-eclampsia

[] 7 None of the above

[] -8 DON’T KNOW

[] -7 REFUSED

4. Are you pregnant now?

[] 1 Yes

[] 2 No

[] -8 DON’T KNOW

[] -7 REFUSED

5. How many months or weeks pregnant are you? Please enter the number of months or weeks.

[] 1 |___|___| Months

[] 2 |___|___| Weeks

[] -8 DON’T KNOW

[] -7 REFUSED

6. During your [most recent / current] pregnancy, [did you smoke / have you smoked] any cigarettes?

[] 1 Yes

[] 2 No

[] -8 DON’T KNOW

[] -7 REFUSED

7. During your [most recent / current] pregnancy, how many cigarettes [did you smoke/have you smoked] on an average day? A pack usually has 20 cigarettes in it.

[] 1 Less than 1 cigarette a day

[] 2 1 to 5 cigarettes a day

[] 3 6 to 10 cigarettes a day

[] 4 11 to 20 cigarettes a day

[] 5 21 to 40 cigarettes a day

[] 6 41 cigarettes or more a day

[] -8 DON’T KNOW

[] -7 REFUSED

8. During your [most recent/current] pregnancy, [did/have] you [use/used] [TOBACCO PRODUCT LIST]?

[] 1 Yes

[] 2 No

[] -8 DON’T KNOW

[] -7 REFUSED

PROGRAM: [TOBACCO PRODUCT LIST] = A list of all tobacco products the respondent has ever used, excluding cigarettes.

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Women who have given birth

Specific Instructions:

Tobacco product list for Item 8:

1. Cigarettes

2. E-cigarettes

3. Traditional cigars

4. Cigarillos

5. Filtered cigars

6. Pipe filled with tobacco

7. Hookah

8. Snus pouches

9. Smokeless tobacco (such as loose snus, moist snuff, dip, spit or chew)

10. Dissolvable tobacco

11. A nicotine patch, gum, inhaler, nasal spray, lozenge or pill

Chantix, varenicline, Wellbutrin, Zyban, or bupropion

Research Domain Information

Release Date:

February 20, 2015

Definition

These questions ask about pregnancy and tobacco use.

Purpose

To determine tobacco product use during pregnancy.

Selection Rationale

The PATH study collects information on number of pregnancies, kinds of complications, pregnancy status, and alcohol and tobacco use. The protocol collects average cigarette use per day during pregnancy, but is not separated by trimester. It also includes a separate tobacco products use list.

Language

English

Standards

StandardNameIDSource
Common Data Elements (CDE)Tobacco Use Pregnancy Status Questionnaire Assessment Tex4719208CDE Browser

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Population Assessment of Tobacco and Health (PATH) Study, Baseline Adult Extended Interview, pp. 240-245.

www.reginfo.gov/public/do/PRAICList?ref_nbr=201307-0925-001

General References

None

Protocol ID:

720801

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX720801_Ever_Pregnant_IndicatorPX720801010000Have you ever been pregnant? Please include current pregnancy, live births, miscarriages, abortions, ectopic or tubal pregnancies and stillbirths.4Variable Mapping
PX720801_Number_Live_BirthPX720801020000How many of your pregnancies have resulted in a live birth?4Variable Mapping
PX720801_Birth_EventPX720801030000For [that birth \ those FILL## births], did any of the following occur? Choose all that apply.4N/A
PX720801_Pregnant_Now_IndicatorPX720801040000Are you pregnant now?4Variable Mapping
PX720801_Month_Week_PregnancyPX720801050000How many months or weeks pregnant are you? Please enter the number of months or weeks.4N/A
PX720801_Pregnancy_Smoke_Cigarette_IndicatorPX720801060000During your [most recent / current] pregnancy, [did you smoke / have you smoked] any cigarettes?4Variable Mapping
PX720801_Pregnancy_Smoke_Cigarettes_QuantityPX720801070000During your [most recent / current] pregnancy, how many cigarettes [did you smoke/have you smoked] on an average day? A pack usually has 20 cigarettes in it.4N/A
PX720801_Pregnancy_Tobacco_Product_UsePX720801080000During your [most recent/ current] pregnancy, [did/have] you [TOBACCO PRODUCT LIST]? 1. Cigarettes, 2. E-cigarettes, 3. Traditional cigars, 4. Cigarillos, 5. Filtered cigars, 6. Pipe filled with tobacco, 7. Hookah, 8. Snus pouches, 9. Smokeless tobacco (such as loose snus, moist snuff, dip, spit or chew), 10. Dissolvable tobacco, 11. A nicotine patch, gum, inhaler, nasal spray, lozenge or pill, 12. Chantix, varenicline, Wellbutrin, Zyban, or bupropion4N/A