Data Element
Secondhand Smoke Exposure
Description

Assessment of a patient’s exposure to smoke emitted from tobacco products used by others.
Submitted By: Nedra Y Garrett / CDC
Data Element Information
Use Case Description(s)
Use Case Description Secondhand tobacco smoke (SHS) exposure can be a trigger for asthma symptoms and exacerbations, particularly in pediatric patients. Asthma trigger management is, therefore, necessarily inclusive of screening for, and mitigating, secondhand smoke exposure. Assessment of secondhand smoke exposure may occur through multiple channels, including in inpatient and ambulatory healthcare settings, and through public health programs such as state asthma programs affiliated with the National Asthma Control Program. Exchange of such information serves multiple purposes:
o At the point of clinical care, SHS exposure assessment can be exchanged between health systems (e.g., emergency department to primary care clinician) to facilitate clinical decision support, case management, and patient care continuity.
o In community settings, SHS exposure assessment can be exchanged between community health programs and health systems (e.g., community-based asthma educator or school nurse to primary care clinician) to facilitate clinical decision support, patient education efforts, and continuity of patient care.
o At the population level, SHS exposure assessment can be aggregated for use in surveillance, to support program operations and evaluation, and to guide public health action with the goals of reducing SHS exposure and the burden of asthma-related health emergencies.
Estimate the breadth of applicability of the use case(s) for this data element Secondhand smoke exposure screening is clinically important for all patients, including pediatric patients and patients with asthma. In 2020, over 25 million people, including 4.2 million children, had current asthma; approximately 40% of these individuals reported an asthma attack in the last year. Every year, 1 in 6 children with asthma visits the Emergency Department, and 1 in 20 is hospitalized, due to asthma. More than 40% of children who go to the emergency room for asthma live with someone who smokes. Additional stakeholders for this proposed data element include: healthcare providers (including both primary care and a wide range of subspecialties); community-based care providers; payers; state, tribal, local, and territorial departments of health; and federal health agencies.
Use Case Description Secondhand tobacco smoke (SHS) exposure is a known cause of coronary heart disease and stroke. Cardiovascular disease (CVD) risk factor mitigation necessarily includes screening for, and mitigating, secondhand smoke exposure, particularly for patients who are recovering from an acute cardiovascular event. Assessment of secondhand smoke exposure may occur in multiple settings, including inpatient and ambulatory healthcare settings, cardiopulmonary rehabilitation settings, and home healthcare settings. Exchange of such information serves multiple purposes:
o At the point of clinical care, SHS exposure assessment can be exchanged between health systems (e.g., hospital to cardiopulmonary rehabilitation program) to facilitate clinical decision support, case management, and patient care continuity.
o In community settings, SHS exposure assessment can be exchanged between community health programs and health systems (e.g., primary care to home health program) to facilitate patient education efforts, and continuity of patient care.
o At the population level, SHS exposure assessment can be aggregated for use in surveillance, to support program operations and evaluation, and to guide public health action with the goals of reducing SHS exposure and mitigation of CVD risk factors, morbidity, and mortality.

Estimate the breadth of applicability of the use case(s) for this data element Secondhand smoke exposure screening is clinically important for all patients, including patients at high risk for cardiovascular disease. Each year in the US, nearly 34,000 people die from heart-disease caused by secondhand smoke exposure. Internationally, it has been estimated that about 15% of acute myocardial infarctions could be caused by SHS exposure. Additional stakeholders for this proposed data element include: healthcare providers (including primary care, subspecialist, and ancillary service clinicians); community-based care providers; payers; state, tribal, local, and territorial departments of health; and federal health agencies.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) Exposure to Second Hand Tobacco Smoke: SNOMED 16090371000119103
History of Exposure to Second Hand Tobacco Smoke: SNOMED 699009004
No Known Exposure to Second Hand Tobacco Smoke: SNOMMED 711563001
Second hand smoke exposure CPHS (Children’s preventive health services) LOINC: 39243-1

https://www.findacode.com/snomed/16090371000119103--exposure-to-second-hand-tobacco-smoke.html; https://browser.ihtsdotools.org/?perspective=full&conceptId1=699009004&edition=MAIN/2022-08-31&release=&languages=en;https://loinc.org/39243-1/;
Additional Specifications HL7 FHIR – Core Observation Social History
http://build.fhir.org/ig/HL7/US-Core/StructureDefinition-us-core-observation-social-history.html
and
HL7 FHIR – Core Observation Survey
http://build.fhir.org/ig/HL7/US-Core/StructureDefinition-us-core-observation-survey.html
Current Use In limited use in production environments
Supporting Artifacts The proposed data element has already been implemented in some EHRs; at least two major EHR vendors currently include some form of secondhand smoke exposure assement in their software.
Relevant Projects, Uses, and Strategies that align, support and benefit national efforts from this data element include, are but not limited to:
• Healthy People 2030. Social determinants of health have a major impact on people's health and well-being — and they're a key focus of Healthy People 2030.
· CDC NCCDPHP has strengthened efforts to address SDOH and health equity in 5 key areas related to the Healthy People 2030 SDOH goals that complement existing work and were related to chronic disease outcomes. These include tobacco.
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns HIPAA would apply; no other privacy or security concerns
Estimate of Overall Burden Implementation burden is not anticipated to be beyond that of establishment of any new data element.
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 0 - Data element is captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration.
Criterion #3
Maturity - Current Exchange		 Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.

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