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

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.