feat: Add smokeless_tobacco to medical_histories (#5651)

**Story card:**
[sc-16397](https://app.shortcut.com/simpledotorg/story/16397/add-a-field-in-the-db-for-smokeless-tobacco)

## Because

The program team wants to track this.

## This addresses

- adding this to the DB
- exposing it via the API

## Test instructions

suite tests

Author: igbanam

app/controllers/api/v3/medical_histories_controller.rb

@@ -46,6 +46,7 @@ def medical_histories_params
         :hypertension,
         :diagnosed_with_hypertension,
         :smoking,
+        :smokeless_tobacco,
         :cholesterol,
         :created_at,
         :updated_at

app/models/medical_history.rb

@@ -14,7 +14,8 @@ class MedicalHistory < ApplicationRecord
     :receiving_treatment_for_diabetes,
     :diabetes,
     :diagnosed_with_hypertension,
-    :smoking
+    :smoking,
+    :smokeless_tobacco
   ].freeze
 
   MEDICAL_HISTORY_ANSWERS = {
@@ -32,6 +33,7 @@ class MedicalHistory < ApplicationRecord
   enum hypertension: MEDICAL_HISTORY_ANSWERS, _prefix: true
   enum diagnosed_with_hypertension: MEDICAL_HISTORY_ANSWERS, _prefix: true
   enum smoking: MEDICAL_HISTORY_ANSWERS, _prefix: true
+  enum smokeless_tobacco: MEDICAL_HISTORY_ANSWERS, _prefix: true
 
   scope :for_sync, -> { with_discarded }
 

app/schema/api/v3/models.rb

@@ -308,6 +308,7 @@ def medical_history
          hypertension: {type: :string, enum: MedicalHistory::MEDICAL_HISTORY_ANSWERS.keys},
          diagnosed_with_hypertension: {type: :string, enum: MedicalHistory::MEDICAL_HISTORY_ANSWERS.keys},
          smoking: {type: :string, enum: MedicalHistory::MEDICAL_HISTORY_ANSWERS.keys},
+         smokeless_tobacco: {type: :string, enum: MedicalHistory::MEDICAL_HISTORY_ANSWERS.keys},
          cholesterol_value: {type: :number},
          deleted_at: {"$ref" => "#/definitions/nullable_timestamp"},
          created_at: {"$ref" => "#/definitions/timestamp"},

app/transformers/api/v3/medical_history_transformer.rb

@@ -6,6 +6,7 @@ def to_response(medical_history)
         .except("user_id")
         .except(*MedicalHistory::MEDICAL_HISTORY_QUESTIONS.map { |question| "#{question}_boolean" })
         .tap { |params| params["smoking"] ||= "unknown" }
+        .tap { |params| params["smokeless_tobacco"] ||= "unknown" }
     end
 
     def from_request(medical_history_payload)

app/validators/api/v3/medical_history_payload_validator.rb

@@ -11,6 +11,7 @@ class Api::V3::MedicalHistoryPayloadValidator < Api::V3::PayloadValidator
     :hypertension,
     :diagnosed_with_hypertension,
     :smoking,
+    :smokeless_tobacco,
     :cholesterol,
     :created_at,
     :updated_at

db/migrate/20250814092225_add_smokeless_tobacco_to_medical_histories.rb

@@ -0,0 +1,5 @@
+class AddSmokelessTobaccoToMedicalHistories < ActiveRecord::Migration[6.1]
+  def change
+    add_column :medical_histories, :smokeless_tobacco, :string
+  end
+end

db/structure.sql

@@ -641,7 +641,8 @@ CREATE TABLE public.medical_histories (
     hypertension text,
     receiving_treatment_for_diabetes text,
     smoking text,
-    cholesterol integer
+    cholesterol integer,
+    smokeless_tobacco character varying
 );
 
 
@@ -8663,6 +8664,7 @@ INSERT INTO "schema_migrations" (version) VALUES
 ('20250619152733'),
 ('20250619195214'),
 ('20250619222520'),
-('20250619225935');
+('20250619225935'),
+('20250814092225');
 
 

spec/controllers/api/v3/medical_histories_controller_spec.rb

@@ -79,6 +79,18 @@ def create_record_list(n, options = {})
         expect(response_body["medical_histories"][0]["smoking"]).to eq "unknown"
       end
     end
+
+    context "non-nullable smokeless_tobacco" do
+      let(:patient_in_request_facility) { build(:patient, registration_facility: request_facility) }
+      it "defaults smoking to 'unknown'" do
+        create(:medical_history, :without_smokeless_tobacco, patient: patient_in_request_facility)
+        set_authentication_headers
+        get :sync_to_user
+        response_body = JSON(response.body)
+        expect(response_body["medical_histories"][0]["smokeless_tobacco"]).not_to be nil
+        expect(response_body["medical_histories"][0]["smokeless_tobacco"]).to eq "unknown"
+      end
+    end
   end
 
   describe "#sync_from_user" do

spec/factories/medical_histories.rb

@@ -11,6 +11,7 @@
     hypertension { MedicalHistory::MEDICAL_HISTORY_ANSWERS[:no] }
     diagnosed_with_hypertension { MedicalHistory::MEDICAL_HISTORY_ANSWERS[:no] }
     smoking { MedicalHistory::MEDICAL_HISTORY_ANSWERS[:no] }
+    smokeless_tobacco { MedicalHistory::MEDICAL_HISTORY_ANSWERS[:no] }
     cholesterol { 123 }
     device_created_at { Time.current }
     device_updated_at { Time.current }
@@ -26,6 +27,7 @@
       hypertension { MedicalHistory::MEDICAL_HISTORY_ANSWERS[:unknown] }
       diagnosed_with_hypertension { MedicalHistory::MEDICAL_HISTORY_ANSWERS[:unknown] }
       smoking { MedicalHistory::MEDICAL_HISTORY_ANSWERS[:unknown] }
+      smokeless_tobacco { MedicalHistory::MEDICAL_HISTORY_ANSWERS[:unknown] }
     end
 
     trait :hypertension_yes do
@@ -68,6 +70,10 @@
     trait :without_smoking do
       smoking { nil }
     end
+
+    trait :without_smokeless_tobacco do
+      smokeless_tobacco { nil }
+    end
   end
 end
 

swagger/v3/swagger.json

@@ -2485,6 +2485,14 @@
             "unknown"
           ]
         },
+        "smokeless_tobacco": {
+          "type": "string",
+          "enum": [
+            "yes",
+            "no",
+            "unknown"
+          ]
+        },
         "cholesterol_value": {
           "type": "number"
         },
@@ -2658,4 +2666,4 @@
       "name": "X-PATIENT-ID"
     }
   }
-}
+}