Provider Perspectives on Adding Biomarker Screening for Tobacco Smoke Exposure to Lead Screening at Well-Child Visits

Winta Ghidei, Gail Brottman, Eline Lenne, Tukhanh Quan, Anne Joseph

Research output: Contribution to journalArticlepeer-review


Introduction Measurement of cotinine, a biomarker of tobacco smoke exposure, can accurately identify children at risk of health consequences from secondhand smoke. This study reports perspectives from pediatric health care providers on incorporating routine cotinine screening into well-child visits. Methods Key informant interviews (N = 28) were conducted with pediatric primary care providers: physicians, nurse practitioners, and registered nurses. Results Themes identified in the interviews included the following: (a) Cotinine screening would assess children's exposure to tobacco smoke more reliably than parental report; (b) Addressing positive cotinine screening results might require additional resources; (c) Wheezing and a history of emergency department visits increased the salience of cotinine screening; and (d) A better understanding of the significance of specific cotinine test values would improve utility. Discussion Pediatric providers see advantages of biomarker screening for tobacco smoke exposure at well-child visits, especially for children with wheezing, but have concerns about limited capacity for follow-up with parents.

Original languageEnglish (US)
Pages (from-to)342-349
Number of pages8
JournalJournal of Pediatric Health Care
Issue number3
StatePublished - May 2017

Bibliographical note

Funding Information:
This work was funded by ClearWay Minnesota grant RC-2014-0016.

Publisher Copyright:
© 2016 National Association of Pediatric Nurse Practitioners

Copyright 2017 Elsevier B.V., All rights reserved.


  • Cotinine
  • pediatric primary care
  • pediatric well-child visit
  • secondhand smoke
  • tobacco smoke exposure reduction


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