Policy Statement: Tobacco Use: A Pediatric Disease
Technical Report: Secondhand and Prenatal Tobacco Smoke Exposure
Technical Report: Tobacco as a Substance of Abuse


Tobacco Use: A Pediatric Disease
The new AAP policy on tobacco confirms the critical need to eliminate tobacco from children’s lives.  Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with prevention and treatment of tobacco use and secondhand smoke exposure.

The policy recommends that all patients and their families be counseled to quit using tobacco in any way and to avoid all secondhand smoke exposure.

Pediatricians are urged to advocate for policies to protect children from secondhand smoke exposure and tobacco marketing, and to eliminate tobacco use from media, public places, and homes.

Other recommendations include:
1) smoke-free home, car, school, work, and play environments, both inside and outside;
2) treatment of tobacco use and dependence;
3) implementation and enforcement of tobacco-control measures; and
4) support for training and research.

Background:

• Tobacco use is the leading preventable cause of death and illness in the United States, causing more than 443,000 deaths each year.

• Tobacco use is a pediatric disease – both youth addiction and children’s secondhand smoke exposure affect children’s lives.

• Nicotine is highly addictive, and addiction can begin almost as soon as use begins, with some users exhibiting signs of dependence with only occasional or monthly use.

• Smoking is greatest among adults who live below the poverty line; secondhand smoke exposure disproportionately affects children living in low-income households.

• Three principles guide the new statement: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) individuals and organizations should support tobacco control and eliminate tobacco use.

AAP calls on pediatricians and pediatric organizations to:

• Change their personal and professional behavior around tobacco.
• Hold conferences and meetings at smoke-free locations in smoke-free jurisdictions.
• Support comprehensive tobacco control and prevention, education, and cessation programs in schools and communities.
• Support clean air and smoke-free environment ordinances and laws, particularly for environments in which children learn, live, and play, such as schools, multiunit housing, public parks, child care settings, public beaches, sidewalks, restaurants, and sporting arenas. These environments should be smoke free even when children are not present.
• When selecting health insurers for employees, businesses (including clinician practices) should select coverage that provides tobacco use and dependence treatment benefits, including tobacco use cessation counseling.

• For patients and families:
• Ask about and document tobacco use and SHS exposure at all clinical encounters.
• Counsel children and parents; emphasize resisting the influence of advertising and rehearsal of peer-refusal skills.
• Both parents and children should be counseled that it is not safe to “experiment” with tobacco because nicotine is so highly addictive and there is no safe way to use tobacco.
• Advise parents to inquire about policies on tobacco use when selecting schools, child care programs, and other venues for their children. There should be no tobacco use in or around the premises, whether or not children are present.
• Advise all families to make their homes and cars completely smoke free, and urge all tobacco users to quit. Provide appropriate advice and counseling to tobacco users. Routinely offer help and referral to those who use tobacco, even if the person is not the patient.

• For policy:
• The use of tobacco products in all indoor and outdoor public places should be prohibited.
• Health care and educational facilities should be completely tobacco free, inside and outside, at all times.
• Clinicians should be trained and skilled in counseling to prevent tobacco use and SHS exposure and the treatment of tobacco use and dependence.
• Treatment of tobacco use and dependence should be available to patients and their families in both inpatient and outpatient settings.
• Proactive “fax-back” quit lines should be implemented in every jurisdiction and should be available through all clinical settings, including pediatric practices.
• Employers should develop or provide access to tobacco use cessation programs for their employees.
• Public and private health insurance policies should provide coverage and reimbursement for comprehensive tobacco cessation treatment, including counseling and medications.

• Marketing and media:
• Sales and distribution of tobacco to youth should be strictly prohibited.
• The sale of tobacco products on the same premises as pharmacies should be eliminated, including pharmacies located in supermarkets.
• Warnings should be prominently displayed on packaging (occupying more than 50% of the front), on advertisements, and on displays at tobacco sales facilities.
• Advertising of tobacco products should be banned from all media, events, and venues, including the Internet.
• Sales of candy cigarettes, cigars, and other products imitating tobacco products or smoking should be banned.
• E-cigarettes should be banned.
• Exposure to and depiction of tobacco use should be reduced or eliminated in films, videos, DVDs, and television programs. The 4 smokefree movies steps include: R rating, no payoffs, no brand exposure, and true counter-messaging antismoking ads.

Other Recommendations:

• Foster families should provide smoke free environments to children.
• Pediatric tobacco control research should be considered a high priority and funded accordingly, especially for training the next generation of investigators in pediatric tobacco control.

About Technical Reports:

Secondhand and Prenatal Tobacco Smoke Exposure
This report discusses the harms of tobacco use and SHS exposure, the extent and costs of tobacco use and SHS exposure, and the evidence that supports counseling and other clinical interventions in the cycle of tobacco use.

Tobacco as a Substance of Abuse
This report emphasizes the need for clinicians caring for pediatric patients to provide tobacco use and exposure prevention and cessation education and advice, screening and counseling, and intervention and referral for patients and their families.


Appendices

Diseases and other adverse health events with which secondhand or prenatal tobacco smoke exposure has been associated

General Tobacco Resources by Category

Resources for Smoke Free Multi-unit Housing


(Please note these resources will be updated on an as needed basis).


Advocacy Brief (coming soon)