A Pilot study of concurrent lead and cotinine screening for childhood tobacco smoke exposure: Effect on parental smoking

Purpose. To investigate whether a biomarker screening approach for tobacco smoke exposure (TSE) conducted concurrently with lead screening at well-child visits would increase parental smoking cessation and implementation of home smoking restrictions. Design. Observational, quasi-experimental. Setting. Pediatric clinic in Minneapolis, Minnesota. Subjects. Eighty parents who smoked and their children presenting for well-child visits. Intervention. Children in the intervention group had serum cotinine measured with lead screening. Laboratory results were sent to providers and parents and a counselor proactively contacted parents to offer an eight-session telephone intervention to help parents stop smoking. The comparison group, a historical control, received usual care. Measures. Parental smoking, engagement in tobacco treatment, and home and car smoking policies 8 weeks later. Analysis. Mean/standard deviation for continuous data or frequency/percentage for categorical data. Results. Eighty-four percent of eligible parents agreed to have their child tested for TSE along with lead testing. Measurable cotinine was identified in 93% of children. More parents in the intervention group received tobacco treatment than in the comparison group (74% vs. 0%) and more parents reported 7-day point-prevalent abstinence from smoking at 8 weeks (29% vs. 3%). Conclusion. These data demonstrate the feasibility of adding cotinine measurement to routine well-child lead screening to document TSE in small children. Data suggest providing this information to parents increases engagement in tobacco treatment and prompts smoking cessation.