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Periodic Survey #42 Pediatricians' Practices Regarding Patients' Exposure to Environmental Tobacco Smoke (ETS)

American Academy of Pediatrics
Division of Health Policy Research 


Presented at the American Public Health Association annual meeting, November 2000

Karen G. O'Connor, Division of Health Policy Research, American Academy of Pediatrics, Elk Grove Village, IL, and Ruth A. Etzel, MD, PhD, Human Health Sciences Division, Food Safety & Inspection Service, Washington, DC.

Research Objective: To explore pediatricians' information gathering and documentation practices regarding patients' exposure to environmental tobacco smoke (ETS), and perception of the effect of ETS on the health of their patients and practice community.

Study Design: A self-administered, eight-page questionnaire was mailed in 1999 to a random sample of 1,623 U.S. members of the American Academy of Pediatrics through the Periodic Survey of Fellows (response rate=58%). Responses from post-residency pediatricians who provide direct patient care were analyzed (N=761). The survey explored the frequency with which pediatricians inquire about smoking and exposure to ETS among adolescent patients with asthma, chart documentation practices regarding all patients' exposure to ETS, and pediatricians' perception of the effect of ETS on the health of their patients as well as their practice community.

Principal Findings: About half of pediatricians (51%) ask adolescent patients with asthma about smoking and exposure to ETS in the home at every visit. Pediatricians in urban inner cities are significantly more likely to inquire about exposure to ETS at every visit than pediatricians in other practice areas (64% inner cities, 48% other urban, 46% suburban, 52% rural, p>.01). Nearly 6 out of 10 pediatricians (58%) in hospital/clinic practices make inquires about exposure to ETS at every visit compared to 53% of those in solo practices and 45% of those in group practices (p=.05). More pediatricians who treat asthmatic adolescents are aware of the need to ask about exposure to ETS at every visit than those who do not see such patients (52% v 46%, p<. 05).

A majority of pediatricians (72%) say they routinely record exposure to tobacco smoke on their patients' charts. However, responses vary by practice setting: 75% of pediatricians in group practices document exposure to ETS in patients' charts compared to 69% of pediatricians in solo practices and 65% of those in hospital/clinic settings (p=.05) Presence of adolescent patients with asthma also affects pediatricians' documentation practices. Three fourths of pediatricians (75%) who treat adolescents with asthma routinely document all patients' exposure to ETS compared to 47% of pediatricians with no asthmatic adolescent patients (p<.001).

Pediatricians rate cigarette smoke as the greatest environmental hazard in their practice community. On a 5-point scale where 1=highest priority, the mean score for priority assigned to the reduction or control of cigarette smoke in their practice community was 1.2; the next highest ranking community environmental health concern was lead paint (M=2.2). Similarly, among 11 environmental hazards listed, pediatricians believe cigarette smoke has the greatest impact on the health of their patients: on a 5-point scale where 1=greatest effect, the mean score for effect on health was 1.4. The next highest score for effect on patients' health (M=2.5) was for molds in the home.

Conclusions: Most pediatricians are aware of the effects of tobacco smoke on patient and community health, and routinely inquire about and document patients' exposure to ETS. However, information gathering and documentation practices vary based on practice area and setting, as well as presence of adolescent patients with asthma.

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