| Interoperability Standards Platform (ISP)

Representing a patient’s smoking behavior.

Data Element
Smoking Status Description Representing a patient’s smoking behaviors. Applicable Vocabulary Standard(s) Applicable Standards (Please confirm or update this field for the new USCDI version) SNOMED International, Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, March 2021 Release View guidance on Applicable Vocabulary Standards and versioning.

Comment

Submitted by EmoryHealthcare on 2026-04-15

Emory Healthcare comments on modifications to Tobacco Use

EHC appreciates the efforts by ONC to build core data elements that recognize the use of smokeless tobacco, chewing tobacco, and vapes. We appreciate the need to balance the alignment of historical data with incorporating new data relevant for clinical and public health work, especially given the different pathways of biological harm. We support the modification of this data element.

Submitted by csnewman on 2026-03-05

Clarify expectations for tobacco use

The updates to the Tobacco Use data element are a positive step, it is unclear what the expectations for exchange truly are. Are the example attributes of tobacco use (duration and frequency of use, mode of consumption, and type of product used) required to be supported by USCDI compliant systems? Do all tobacco products mentioned need to be supported? Please clarify specific expectations for attributes related to tobacco use that must be supported

Submitted by NCQA on 2025-09-29

NCQA recommendation for Smoking Status

Recommendation: Expand the scope of the Smoking Status element to include assessment of all tobacco products, aligned to the FDA definition for tobacco use; modify the element name and description to define the expanded element as assessments of a patient’s tobacco use behaviors including use of smoke, vape, chew, or sniff tobacco products. We also recommend adding duration (number of years of use) and quit date in the list of example data elements for comprehensive tobacco use history. Add LOINC terminology to the vocabulary standards.

Rationale: Tobacco assessment and use status encompasses assessment of broader tobacco product use beyond smoked products/cigarettes defined in the existing ‘Smoking Status’ USCDI element. Comprehensive assessment of tobacco use remains a public health priority and is essential to appropriately providing cessation intervention. Intervention should be provided for any tobacco use, not just smoked products/cigarettes. NCQA recently introduced a new HEDIS® measure to incentivize routine tobacco use screening and cessation intervention; this data is routinely captured with standard terminology.

Submitted by nachcinformatics on 2024-04-16

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.

Submitted by nachcinformatics on 2024-04-16

updated recommendation

Submitted by CDC_DSMH_WG on 2022-04-27

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.

Submitted by CDC_DSMH_WG on 2021-10-07

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

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Data Element

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