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Lisa Black

Pediatricians are encouraged to view tobacco use through a broader lens and help connect family members with smoking cessation resources

The American Academy of Pediatrics in a new report recognizes the structural forces perpetuating tobacco use and urges pediatricians to view tobacco as a social determinant for children’s health, providing guidance on how to identify and provide support to family members who use tobacco products.

Although many view tobacco use as solely a personal choice, the AAP clinical report, “Health Disparities in Tobacco Use and Exposure: A Structural Competency Approach,” published in the January 2021 Pediatrics (published online Dec. 21) details systemic forces that contribute to tobacco use and dependence. These include the deliberate targeting of groups by the tobacco industry, lack of enforcement of age-for-sale laws, inferior access to health insurance and health care, poor access to cessation resources, and economic stress.

“Research tells us that 90% of adults who smoke started smoking before they turned 19, and that the teenage brain is more susceptible to addiction,” said Jyothi Marbin, MD, FAAP, lead author of the clinical report, written by the AAP Section on Tobacco Control.

“While tobacco use has declined, the e-cigarette and vaping industry has ramped up, using the same techniques to target vulnerable populations and get them hooked. This perpetuates a cycle of chronic disease and addiction that is extremely hard to escape.”

The AAP recommends that pediatricians screen adolescents for tobacco use and provide resources and treatment for tobacco dependence.  Pediatricians can discuss preventing initiation of tobacco and e-cigarette use with children and adolescents. The health care provider is also encouraged to systematically screen children for secondhand smoke exposure and support family members who smoke with tobacco cessation.

Additionally, pediatricians can add address the structural issues perpetuating tobacco use by becoming involved with policy and advocacy initiatives.

Parents who have a primary care provider should also be advised to seek additional counseling and support from that clinician. If caregivers are unable to stop smoking, pediatricians should advise maintaining smoke-free clothing, homes, and cars.

“Some see tobacco use as a personal choice among adults, but when you look at it through a broader lens, you really see the aggressive forces working to target the very people who can least afford the health and economic repercussions of smoking,” Sophie J. Balk, MD, FAAP, a co-author of the report, said. “These are often families in poverty, with poor access to health insurance and health care, let alone smoking cessation resources.”

The AAP recommends that evidence-based smoking-cessation counseling techniques be integrated into curricula for medical students and residents so that trainees become familiar with behavioral and pharmacologic strategies to help people stop smoking.  Discussions about prevention also are key.

Pediatricians can take action at local, state, and federal levels to support initiatives aimed at addressing structural barriers that perpetuate intergenerational cycles of tobacco dependence and health disparities.

Related policies include:

Information for parents is available here:


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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