Form:	MSA Eligibility v1.3

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 773)
* 773	Visit code (Go To: 795)
	Permissible Values (value): BLN1 (1)
	BLN2 (2)
	BLN3 (3)
	BLN4 (4)
* 795	Proposed study group (Go To: 422)
	Permissible Values (value): Control Group 1 (1)
	Control Group 2 (2)
	Cases Group 3 (3)
* 422	EDRN Site ID (Go To: 423)
* 423	EDRN Protocol ID (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 807)
* 807	Date of baseline visit: (Go To: 794)
* 794	Date of birth: (What is your date of birth?) (Go To: 441)
* 441	Ever smoke cigarettes regularly, at least one a day for a year or more? (Did you ever smoke cigarettes regularly, at least one a day for a year or more?) (Go To: 443)
	Permissible Values (value): No (0) (Go To: 1284)
	Yes (1)
	Unknown/refused (9)
* 443	Currently smoke at least one cigarette a day? (Do you currently smoke cigarettes regularly, at least one a day?) (Go To: 445)
	Permissible Values (value): No (0) (Go To: 444)
	Yes (1)
	Unknown/refused (9)
444	Age quit smoking cigarettes? (How old were you when you permanently quit smoking cigarettes?) (Go To: 445)
445	Average number of cigarettes smoked per day? (During the time you have smoked, on average, how many cigarettes did you smoke per day?) (Go To: 442)
442	Age first began smoking cigarettes regularly, at least one a day? (How old were you when you began smoking cigarettes regularly, at least one a day?) (Go To: 1284)
* 1284	In the past five years, has participant received radiotherapy for cancer? (In the past five years, have you ever had radiotherapy for cancer?) (Go To: 1285)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
* 1285	In the past five years, has participant received systemic chemotherapy for cancer? (In the past five years, have you received systemic chemotherapy for cancer?) (Go To: 923)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
* 923	Has participant ever had any of the following intravesical therapies or agents? (Have you ever had any of the following intravesical therapies or agents?) [Check all that apply.] (Go To: 1207)
	Permissible Values (value): BCG (Bacillus of Calmette & Guerin) (1)
	Alpha interferon (2)
	Mitomycin (3)
	Gemcitabine (4)
	Thiotepa (5)
	Gene therapy, specify: (6) (Go To: 928)
	Unknown/refused (9)
	None (44)
	Other, specify: (97) (Go To: 927)
* 928	Gene therapy (Specify) (Go To: 1207)
* 927	Intravesical therapy (Other, specify) (Go To: 1207)
* 1207	In the past five years has the participant had cancer [other than superficial urothelial (TCC) bladder cancer or basal/squamous cell skin cancer confirmed by a doctor? (In the past five years have you had cancer [other than bladder cancer or basal/squamous cell skin cancer confirmed by a doctor?) (Go To: 1205)
	Permissible Values (value): No (0)
	Yes (1)
* 1205	Has participant ever had a GU cancer [prostate, kidney, penile] confirmed by a doctor? (Have you ever had prostate, kidney, or penile cancer confirmed by a doctor?) (Go To: 806)
	Permissible Values (value): No (0)
	Yes (1)
* 806	Has participant ever worked in any of the following industries for at least one year? (Have you ever worked in any of the following industries for at least one year?) [Read list] (Go To: 880)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
* 880	Have you ever had any of the following genitourinary symptoms? (Check all that apply.) (Go To: 881)
	Permissible Values (value): Urinary frequency (frequent, strong urges to urinate) (1)
	Urinary urgency (need to urinate more frequently than usual) (2)
	Urinary incontinence (leaking urine) (3)
	Urinary retention (difficulty completely emptying the bladder) (4)
	Dysuria (pain when urinating) (5)
	None (44) (Go To: 887)
881	Are you currently experiencing any of the following genitourinary symptoms? (Check all that apply.) (Go To: 887)
	Permissible Values (value): Urinary frequency (frequent, strong urges to urinate) (1)
	Urinary urgency (need to urinate more frequently than usual) (2)
	Urinary incontinence (leaking urine) (3)
	Urinary retention (difficulty completely emptying the bladder) (4)
	Dysuria (pain when urinating) (5)
	None (44)
* 887	Have you ever had any of the following devices inserted into your urinary tract? (Check all that apply.) (Go To: 888)
	Permissible Values (value): Urinary stent(s) (1)
	Urinary catheter(s) (2) (Go To: 1283)
	None (4) (Go To: 1070)
* 1283	Was the urinary catheter inserted within the past month? (Go To: 1286)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
* 1286	Was the urinary catheter inserted due to a genitourinary condition or symptom (i.e., prostatitis, hematuria, urinary retention)? (Go To: 888)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
888	Do you currently have any of the following devices inserted into your urinary tract? (Go To: 1070)
	Permissible Values (value): Urinary stent(s) (1)
	Urinary catheter(s) (2)
	None (4)
* 1070	Have you ever been told by a doctor that you have any of the following genitourinary conditions? (Check all that apply.) (Go To: End of Form)
	Permissible Values (value): [Males only] BPH (Benign prostatic hypertrophy) (1)
	Hematuria (blood in the urine) (2)
	[Males only] Prostatitis (an inflamed prostate) (3)
	Urinary tract infection (4)
	Pyelonephritis (kidney infection) (5)
	Urethritis (inflammation of the urethra) (6)
	Other type of genitourinary tract infection (7)
	Urinary stones (8)
	None (44)
897	Have you completed treatment for a urinary tract infection that was diagnosed within the past 3 months? (Go To: 1069)
	Permissible Values (value): No (0)
	Yes (1)
1069	Has a doctor told you that you currently have any of the following genitourinary conditions? (Check all that apply.) (Go To: End of Form)
	Permissible Values (value): [Males only] BPH (Benign prostatic hypertrophy) (1)
	Hematuria (blood in the urine) (2)
	[Males only] Prostatitis (an inflamed prostate) (3)
	Pyelonephritis (kidney infection) (5)
	Urethritis (inflammation of the urethra) (6)
	Other type of genitourinary tract infection (7)
	Urinary stones (8)
	None (44)
898	Is participant's International Prostate Symptom Score (IPSS) greater than 12? (Go To: End of Form)
	Permissible Values (value): No (0)
	Yes (1)