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

Am J Health Promot. 2014 May-Jun;28(5):316-20. doi: 10.4278/ajhp.120912-ARB-445. Epub 2013 Aug 23.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Child, Preschool
  • Cotinine / blood*
  • Female
  • Humans
  • Infant
  • Lead Poisoning / diagnosis
  • Male
  • Parents / psychology*
  • Pilot Projects
  • Smoking / epidemiology*
  • Smoking / psychology
  • Smoking Cessation / psychology
  • Smoking Cessation / statistics & numerical data
  • Tobacco Smoke Pollution / adverse effects*
  • Tobacco Smoke Pollution / analysis*


  • Tobacco Smoke Pollution
  • Cotinine