Asking the right questions

about secondhand tobacco smoke exposure

Background: Despite knowledge about the major health effects of secondhand tobacco smoke (SHS) exposure, systematic incorporation of SHS screening and counseling in clinical settings has not occurred.

A three-round modified Delphi Panel of tobacco control experts (physicians, researcher, and Flight Attendant Medical Research board members) was convened to build consensus on the screening questions that should be asked and identify opportunities and barriers to
SHS exposure screening and counseling.

The panel considered:

  1. what questions should be asked about SHS exposure;
  2. what are the top priorities to advance the goal of 
        ensuring that these questions are asked;
  3. what are the barriers to achieving these goals; and
  4. how might these barriers be overcome.

Results: Panelists agreed that both adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from any tobacco products in their usual environment. The panel found that consistent clinician training, quality measurement or other accountability, and policy and electronic health records interventions were needed to successfully implement consistent screening.

Conclusions: The panel successfully generated screening questions and identified priorities to improve SHS exposure screening. Policy interventions and stakeholder engagement are needed to overcome barriers to implementing effective SHS screening.

Implications: In a modified Delphi panel, tobacco control and clinical prevention experts agreed that all adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from tobacco products. Consistent training, accountability, and policy and electronic health records interventions are needed to implement consistent screening. Increasing SHS screening will have a significant impact on public health and costs.

The panel agreed that the main question that health care providers should ask is whether an individual is, or has ever been, exposed to SHS.

Panel members suggested that follow-up should include details that include when, where, how much, and by whom.

“Are you exposed to tobacco smoke, and if so, how? Are you exposed to secondhand tobacco smoke or are you a smoker?”

For children, the recommendation was to ask parents or guardians:

“Does the child spend time or live with anyone who smokes/uses any kind of tobacco product?”

For older school-aged children, adolescents and adults, the recommended questions are:

“Are you exposed to smoke from cigarettes or other tobacco products?” and, if YES: In the last month, have you been exposed to smoke from cigarettes or other tobacco products at home, in a car, at school, at after school activities, sports arenas, etc.?