Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.
Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA.
Nicotine Tob Res. 2021 Jan 7;23(1):57-62. doi: 10.1093/ntr/ntz125.
Despite knowledge about major health effects of secondhand tobacco smoke (SHS) exposure, systematic incorporation of SHS screening and counseling in clinical settings has not occurred.
A three-round modified Delphi Panel of tobacco control experts was convened to build consensus on the screening questions that should be asked and identify opportunities and barriers to SHS exposure screening and counseling. The panel considered four questions: (1) what questions should be asked about SHS exposure; (2) what are the top priorities to advance the goal of ensuring that these questions are asked; (3) what are the barriers to achieving these goals; and (4) how might these barriers be overcome. Each panel member submitted answers to the questions. Responses were summarized and successive rounds were reviewed by panel members for consolidation and prioritization.
Panelists agreed that both adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from any tobacco products in their usual environment. The panel found that consistent clinician training, quality measurement or other accountability, and policy and electronic health records interventions were needed to successfully implement consistent screening.
The panel successfully generated screening questions and identified priorities to improve SHS exposure screening. Policy interventions and stakeholder engagement are needed to overcome barriers to implementing effective SHS screening.
In a modified Delphi panel, tobacco control and clinical prevention experts agreed that all adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from tobacco products. Consistent training, accountability, and policy and electronic health records interventions are needed to implement consistent screening. Increasing SHS screening will have a significant impact on public health and costs.
尽管人们已经了解到二手烟草烟雾（SHS）暴露对健康的重大影响，但在临床环境中系统地进行 SHS 筛查和咨询尚未实现。
召集了一个由三位烟草控制专家组成的三轮改良 Delphi 小组，以就应询问的筛查问题达成共识，并确定 SHS 暴露筛查和咨询的机会和障碍。该小组考虑了四个问题：（1）应询问哪些关于 SHS 暴露的问题；（2）推进确保提出这些问题的目标的首要任务是什么；（3）实现这些目标的障碍是什么；（4）如何克服这些障碍。每位小组成员都对这些问题提交了答案。对答复进行了总结，并由小组成员审查了连续几轮的答复，以进行整合和优先排序。
小组成员一致认为，在临床就诊期间，应通过询问患者是否在其日常环境中暴露于或曾经暴露于任何烟草制品的烟雾来对成人和儿童进行筛查。小组发现，需要进行一致的临床医生培训、质量测量或其他问责制，以及政策和电子健康记录干预，以成功实施一致的筛查。
小组成功生成了筛查问题，并确定了改善 SHS 暴露筛查的优先事项。需要采取政策干预措施和利益相关者参与，以克服实施有效 SHS 筛查的障碍。
在改良 Delphi 小组中，烟草控制和临床预防专家一致认为，在临床就诊期间，应通过询问患者是否在其日常环境中暴露于或曾经暴露于任何烟草制品的烟雾来对所有成人和儿童进行筛查。需要进行一致的培训、问责制以及政策和电子健康记录干预，以实施一致的筛查。增加 SHS 筛查将对公共卫生和成本产生重大影响。
