Submitted by nedragarrett_CDC on 2022-04-27 CDC's Consolidated Comment "Smoking status" continues to be of high importance for CDC partners, programs, education campaigns, data collection, and scientific analysis and reporting to prevent and reduce smoking. This data supports the vision of a world free from tobacco-related death and disease through advancement of the goals to: prevent initiation; promote quitting; eliminate exposure to secondhand smoke; and advance health equity by identifying and eliminating tobacco product-related inequities and disparities. As such, CDC strongly supports inclusion of “smoking status” in v3 of the USCDI. CDC is concerned about the reclassification of the “smoking status” element into the new “Health Status” class. Tobacco use disorder is a DSM-5 diagnosable substance use disorder with clear diagnostic criteria and clinical practice treatment guidelines. As such, CDC recommends classifying “smoking status” in a “Substance Use” class along with other substance use data elements. In the absence of a “Substance Use” class in the USCDI, CDC recommends retaining “smoking status” as its own class consistent with USCDI v2. CDC also recommends inclusion of the “Tobacco Use” and “Tobacco Product Type” data elements which are more inclusive measures of tobacco use. While the predominant form of tobacco product use in U.S. adults remains cigarettes, e-cigarettes have been the predominant tobacco product used among youth since 2014. Additionally, use of smokeless tobacco is not uncommon among adults nor youth, and has known health effects including cancer, heart disease, and stroke. As such, data regarding the broader spectrum of tobacco product use in clinical data has potential benefit to both healthcare and public health in the vision of a world free from tobacco-related death and disease.