PERIODIC SURVEY OF FELLOWS
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.