View In:
ArcGIS Online Map Viewer
Name: chatham_tobacco_initial_assessment
Display Field: objectid
Type: Feature Layer
Geometry Type: esriGeometryPoint
Description:
Service Item Id: 5188ee9d07ea40deae20038894e3388b
Copyright Text:
Default Visibility: true
MaxRecordCount: 1000
MaxSelectionCount: 0
Supported Query Formats: JSON, geoJSON, PBF
Min Scale: 0.0
Max Scale: 0.0
Supports Advanced Queries: true
Supports Statistics: true
Use Standardized Queries: true
Supports ValidateSQL: true
Supports Calculate: true
Extent:
XMin: -180.0
YMin: -90.0
XMax: 180.0
YMax: 90.0
Spatial Reference: 4326
(0)
LatestVCSWkid(0)
Drawing Info:
Renderer:
Simple Renderer:
Symbol: Style: esriSMSCircle
Color: [255, 0, 0, 255]
Size: 8.0
Angle: 0.0
XOffset: 0
YOffset: 0
Outline:
[255, 255, 0, 255] Width: 1
Label: Tobacco Cessation Program Initial Assessment Form
Description: Survey Data Locations
Transparency: 0
Labeling Info:
Feature Draw Order:
Advanced Query Capabilities:
Supports Statistics: true
Supports OrderBy: true
Supports Distinct: true
Supports Pagination: true
Supports TrueCurve: false
Supports Returning Query Extent: true
Supports Query With Distance: true
Supports Sql Expression: true
Supports Query With ResultType: true
Supports Returning Geometry Centroid: false
Supports Binning LOD: true
Supports Query With LOD Spatial Reference: true
Supports Percentile Statistics: true
Supports Having Clause: true
Supports Count Distinct: true
Supports Time Relation: false
Supports Sql Format: false
Supports Query Analytic: true
Supports Query With Current User: true
HasZ: false
HasM: false
Has Attachments: false
HTML Popup Type: esriServerHTMLPopupTypeAsHTMLText
Type ID Field:
Fields:
-
objectid
(
nullable: false, editable: false, defaultValue: null, length: 4, type: esriFieldTypeOID, alias: ObjectID
)
-
globalid
(
nullable: false, editable: false, defaultValue: null, length: 38, type: esriFieldTypeGlobalID, alias: GlobalID
)
-
appt_date
(
nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Appointment Date, type: esriFieldTypeDate
)
-
client_name
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Client Name, type: esriFieldTypeString
)
-
street_address
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Street Address, type: esriFieldTypeString
)
-
city
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: City, type: esriFieldTypeString
)
-
zip_code
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Zip Code, type: esriFieldTypeString
)
-
phone_number
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Contact Phone Number, type: esriFieldTypeString
)
-
email
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Email Address, type: esriFieldTypeString
)
-
contact_best
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Best Method & Time for Contact, type: esriFieldTypeString
)
-
emergency_contact
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Emergency Contact, type: esriFieldTypeString
)
-
ok_contact_all
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is it okay for us to contact you at all of the above locations?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
no_contact_where
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please specify where NOT to contact you, type: esriFieldTypeString
)
-
ok_text
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is it okay to contact you via text for appointment reminders?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dob
(
nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Date of Birth, type: esriFieldTypeDate
)
-
age
(
nullable: true, editable: true, defaultValue: null, alias: Age, type: esriFieldTypeInteger
)
-
gender
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Gender, type: esriFieldTypeString
, Coded Values:
[female: Female]
, [male: Male]
, [non_binary: Non-binary / Third gender]
, ...2 more...
)
-
gender_self_describe
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please self-describe your gender, type: esriFieldTypeString
)
-
has_children
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you have children living with you?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
children_asthma
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do any of your children have asthma?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
race_ethnicity
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What race/ethnicity best describes you?, type: esriFieldTypeString
, Coded Values:
[white: Caucasian / White]
, [asian: Asian]
, [aian: American Indian / Alaskan Native]
, ...4 more...
)
-
race_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please specify your race/ethnicity, type: esriFieldTypeString
)
-
education
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Highest level of education completed, type: esriFieldTypeString
, Coded Values:
[grade11_or_less: Grade 11 or less]
, [hs_diploma_ged: High school diploma or GED]
, [some_college: Some college / Technical school]
, ...4 more...
)
-
work_status
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: How would you describe your work status? (Select all that apply), type: esriFieldTypeString
)
-
insurance
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What type of health insurance do you have?, type: esriFieldTypeString
, Coded Values:
[medicare: Medicare]
, [medicaid: Medicaid]
, [both: Both Medicare and Medicaid]
, ...3 more...
)
-
program_referral
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: How did you learn about our cessation program?, type: esriFieldTypeString
)
-
note_tobacco_use
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Over the past 6 months, indicate the type(s) of tobacco used and average amount per day., type: esriFieldTypeString
)
-
tobacco_types
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What type(s) of tobacco have you used in the past 6 months?, type: esriFieldTypeString
)
-
qty_cigarettes
(
nullable: true, editable: true, defaultValue: null, alias: Cigarettes per day, type: esriFieldTypeDouble
)
-
qty_little_cigars
(
nullable: true, editable: true, defaultValue: null, alias: Little cigars per day, type: esriFieldTypeDouble
)
-
qty_cigars
(
nullable: true, editable: true, defaultValue: null, alias: Cigars per day, type: esriFieldTypeDouble
)
-
qty_pipe
(
nullable: true, editable: true, defaultValue: null, alias: Pipefuls per day, type: esriFieldTypeDouble
)
-
qty_smokeless
(
nullable: true, editable: true, defaultValue: null, alias: Cans/pouches per day (smokeless tobacco), type: esriFieldTypeDouble
)
-
qty_snus
(
nullable: true, editable: true, defaultValue: null, alias: Snus per day, type: esriFieldTypeDouble
)
-
qty_ecig
(
nullable: true, editable: true, defaultValue: null, alias: E-cigarettes (mL or pods per day), type: esriFieldTypeDouble
)
-
tobacco_other_type
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Other tobacco type (please specify), type: esriFieldTypeString
)
-
qty_other
(
nullable: true, editable: true, defaultValue: null, alias: Other tobacco — amount per day, type: esriFieldTypeDouble
)
-
age_first_use
(
nullable: true, editable: true, defaultValue: null, alias: Age when you first started using tobacco regularly, type: esriFieldTypeInteger
)
-
tobacco_brand
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What brand of tobacco do you normally use?, type: esriFieldTypeString
)
-
uses_menthol
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you use menthol?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
first_cig_timing
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: How many minutes after waking do you smoke your first cigarette?, type: esriFieldTypeString
, Coded Values:
[immediately: Immediately upon waking]
, [5_to_30: 5–30 minutes]
, [31_to_60: 31–60 minutes]
, ...1 more...
)
-
wakes_for_tobacco
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you sometimes wake up at night to use tobacco?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
nights_per_week
(
nullable: true, editable: true, defaultValue: null, alias: How many nights per week do you wake for tobacco?, type: esriFieldTypeDouble
)
-
caffeinated_drinks
(
nullable: true, editable: true, defaultValue: null, alias: How many caffeinated drinks do you have per day (coffee, tea, soda)?, type: esriFieldTypeInteger
)
-
main_triggers
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What are your main triggers for tobacco/nicotine use?, type: esriFieldTypeString
)
-
craving_times
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: When do you crave tobacco the most? (Select all that apply), type: esriFieldTypeString
)
-
craving_driving_time
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What time of day do you typically crave tobacco while driving?, type: esriFieldTypeString
)
-
craving_break_time
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What time of day do you crave during work breaks?, type: esriFieldTypeString
)
-
quit_intent
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you planning to stop using all tobacco?, type: esriFieldTypeString
, Coded Values:
[already_stopped: Yes — I have already stopped]
, [at_this_appointment: Yes — at this appointment]
, [within_30_days: Yes — in the next 30 days]
, ...3 more...
)
-
quit_date_already
(
nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Date you last used tobacco, type: esriFieldTypeDate
)
-
readiness_scale
(
nullable: true, editable: true, defaultValue: null, alias: On a scale of 1–10, how ready are you to quit in the next 6 months?, type: esriFieldTypeInteger
)
-
importance_scale
(
nullable: true, editable: true, defaultValue: null, alias: On a scale of 1–10, how important is it to you to quit in the next 6 months?, type: esriFieldTypeInteger
)
-
confidence_scale
(
nullable: true, editable: true, defaultValue: null, alias: On a scale of 1–10, how confident are you that you can stop using all tobacco?, type: esriFieldTypeInteger
)
-
quit_attempts
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: How many serious quit attempts have you made?, type: esriFieldTypeString
, Coded Values:
[0: 0 — No prior attempts]
, [1: 1]
, [2: 2]
, ...3 more...
)
-
longest_quit
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the longest you have stayed quit?, type: esriFieldTypeString
)
-
longest_quit_year
(
nullable: true, editable: true, defaultValue: null, alias: What year did you stay quit the longest?, type: esriFieldTypeInteger
)
-
past_quit_methods
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What did you use to help you quit in the past? (medicine, counseling, etc.), type: esriFieldTypeString
)
-
relapse_reason
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Why did you relapse?, type: esriFieldTypeString
)
-
nrt_past
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What medications/NRT did you use in past quit attempts?, type: esriFieldTypeString
)
-
nrt_past_helpful
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What worked well or helped most? Describe any side effects., type: esriFieldTypeString
)
-
nrt_current
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What nicotine replacement therapy or medications are you considering now?, type: esriFieldTypeString
)
-
nrt_other_specify
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please specify other medication/therapy, type: esriFieldTypeString
)
-
household_smokers
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Who else in your household smokes or uses tobacco? (Select all that apply), type: esriFieldTypeString
)
-
household_smokers_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please specify other household members who smoke, type: esriFieldTypeString
)
-
social_smokers
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: How many of your family/friends (not living with you) smoke or use tobacco?, type: esriFieldTypeString
, Coded Values:
[none: None]
, [few: A few]
, [many: Many]
, ...1 more...
)
-
smoking_in_home
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is smoking or tobacco use allowed inside your home?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
smoking_in_car
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is smoking or tobacco use allowed inside your vehicle?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
work_smoking_policy
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is smoking allowed where you work?, type: esriFieldTypeString
, Coded Values:
[inside_outside: Yes — inside and outside]
, [outside_only: Yes — outside only]
, [no: No]
, ...1 more...
)
-
smokes_at_work
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you smoke during the workday?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
note_medical
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please answer YES or NO for current or past diagnoses., type: esriFieldTypeString
)
-
dx_depression
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Depression, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_anxiety
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Anxiety, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_schizophrenia
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Schizophrenia, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_bipolar
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Bipolar Disorder, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_seizure
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Seizure / Convulsions / Epilepsy, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_heart_attack_30d
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Heart attack within the last 30 days, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_stroke_30d
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Stroke or TIA (Temporary Stroke) within the last 30 days, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_pregnant
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Currently pregnant, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_under18
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Under 18 years of age, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_arrhythmia_6mo
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Diagnosed within the last 6 months with very rapid or irregular heartbeat requiring change in activities or medication, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_angina_6mo
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Diagnosed within the last 6 months with serious or worsening angina (chest pain), type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_nrt_rash
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Previous generalized rash over entire body related to NRT, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_patch_reaction
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Previous adverse reaction to patch medication or adhesive tape, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_jaw_dental
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Jaw or dental problems that limit chewing (gum only), type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_bupropion_nrt
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Planning to use Zyban/Bupropion along with NRT (patch, gum, lozenges), type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_uncontrolled_bp
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Have high blood pressure not controlled by medication, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_breastfeeding
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Currently breastfeeding (if female), type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_planning_pregnancy
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Planning pregnancy within 3 months (if female), type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
medical_comments
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Additional comments about medical history, type: esriFieldTypeString
)
-
note_mh
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Over the past TWO WEEKS, how often have you been bothered by the following?, type: esriFieldTypeString
)
-
phq_little_interest
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Little interest or pleasure in doing things, type: esriFieldTypeString
, Coded Values:
[not_at_all: Not at all]
, [several_days: Several days]
, [more_than_half: More than half the days]
, ...1 more...
)
-
phq_feeling_down
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Feeling down, depressed, or hopeless, type: esriFieldTypeString
, Coded Values:
[not_at_all: Not at all]
, [several_days: Several days]
, [more_than_half: More than half the days]
, ...1 more...
)
-
phq_anxious
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Being anxious, nervous, restless, or fidgety, type: esriFieldTypeString
, Coded Values:
[not_at_all: Not at all]
, [several_days: Several days]
, [more_than_half: More than half the days]
, ...1 more...
)
-
tension_physical
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you have physical signs of excess tension (headaches, difficulty sleeping, upset stomach)?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
tension_explain
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please explain your tension symptoms, type: esriFieldTypeString
)
-
ok_contact_provider
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is it okay for the tobacco treatment facilitator to contact your medical provider to discuss your quit plan (via fax/phone)?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
-
provider_name_location
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Provider's Name and Location, type: esriFieldTypeString
)
-
additional_info
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please provide any additional information that may be helpful, type: esriFieldTypeString
)
-
created_user
(
nullable: true, editable: false, defaultValue: null, length: 255, alias: created_user, type: esriFieldTypeString
)
-
created_date
(
nullable: true, editable: false, defaultValue: null, precision: 1, length: 29, alias: created_date, type: esriFieldTypeDate
)
-
last_edited_user
(
nullable: true, editable: false, defaultValue: null, length: 255, alias: last_edited_user, type: esriFieldTypeString
)
-
last_edited_date
(
nullable: true, editable: false, defaultValue: null, precision: 1, length: 29, alias: last_edited_date, type: esriFieldTypeDate
)
Templates:
-
Name: New Feature
Description:
Prototype:
Drawing Tool: N/A
Capabilities: Create,Editing,Sync,Uploads
Sync Can Return Changes: true
Is Data Versioned: false
Supports Rollback On Failure: true
Supports ApplyEdits With Global Ids: true
Supports ApplyEdits By Upload Id: true
Edit Fields Info:
- Creation Date Field: created_date
- Creator Field: created_user
- Edit Date Field: last_edited_date
- Editor Field: last_edited_user
Ownership Based Access Control:
- Allow Others to Update: true
- Allow Others to Delete: true
- Allow Others to Query: true
Supports Query With Historic Moment: false
Supports Coordinates Quantization: true
Child Resources:
Supported Operations:
Query Attachments
Query Analytic
Query Top Features
Query Bins
Apply Edits
Add Features
Append
Validate SQL
Generate Renderer
Return Updates
Metadata
Update Metadata