Smoking Status and Tobacco Use

Health Status Assessments: Smoking Status

https://www.healthit.gov/isa/taxonomy/term/811/draft-uscdi-v5

NACHC supports HL7 recommendation to change the name of Smoking Status to Tobacco Assessment and Use.  Not all tobacco products are combustible like cigarettes.  This category should include the noncombustible products as well, such as e-cigarettes.  Both the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) refer to the broader category of Tobacco Use.  Please see:

https://www.cdc.gov/chronicdisease/resources/publications/factsheets/tobacco.htm

https://www.fda.gov/consumers/minority-health-and-health-equity-resources/tobacco-use

In addition, HL7 recommends duration (number of years of use) and quit date included in the list of example data elements. The duration is used to calculate the number of pack years, which is important for quality measurement and understanding risk.  In addition, knowledge about when someone quit smoking helps to understand risk for other diseases.

updated recommendation

updated recommendation

CDC's Consolidated Comment

• "Smoking status" continues to be of high importance for CDC partners, programs, education campaigns, data collection, and scientific analysis and reporting to prevent and reduce smoking. This data supports the vision of a world free from tobacco-related death and disease through advancement of the goals to: prevent initiation; promote quitting; eliminate exposure to secondhand smoke; and advance health equity by identifying and eliminating tobacco product-related inequities and disparities. As such, CDC strongly supports inclusion of “smoking status” in v3 of the USCDI.
• CDC is concerned about the reclassification of the “smoking status” element into the new “Health Status” class. Tobacco use disorder is a DSM-5 diagnosable substance use disorder with clear diagnostic criteria and clinical practice treatment guidelines. As such, CDC recommends classifying “smoking status” in a “Substance Use” class along with other substance use data elements. In the absence of a “Substance Use” class in the USCDI, CDC recommends retaining “smoking status” as its own class consistent with USCDI v2.
• CDC also recommends inclusion of the “Tobacco Use” and “Tobacco Product Type” data elements which are more inclusive measures of tobacco use. While the predominant form of tobacco product use in U.S. adults remains cigarettes, e-cigarettes have been the predominant tobacco product used among youth since 2014. Additionally, use of smokeless tobacco is not uncommon among adults nor youth, and has known health effects including cancer, heart disease, and stroke. As such, data regarding the broader spectrum of tobacco product use in clinical data has potential benefit to both healthcare and public health in the vision of a world free from tobacco-related death and disease.

CDC Unified Comment: California Department of Public Health

 Smoking Status: Smoking, tobacco use, alcohol use, and illicit drug use are found in multiple areas of the record ( e.g. Smoking Status, Substance Use, and Social History). Recommend streamlining all substance use items in the same part of the record, preferably the Substance Use section. 

• Simply recording smoking status is insufficient given the evolving types of nicotine products and dual use and should be replaced with response to the question, “In the PAST 12 MONTHS, how often have you used any tobacco product (for example, cigarettes, vapes, cigars, pipes, or smokeless tobacco)?” Values of frequency are to be identified as appropriate. 

• Follow-up questions on types and frequency of tobacco products used (e.g. cigarettes, vapes, cigars, pipes, smokeless tobacco) 

• Specific response on marijuana use similar to the tobacco question: "In the PAST 12 MONTHS, how often have you used any marijuana product (for example, smoked, vaped, dabbed, or ingested)?" 

• Follow-up questions on types and frequency of marijuana products used 

• Last report of active alcohol use 

• Last report of recreational opioid use 

• Last report of methamphetamine use