Prevention of Secondhand Smoke Exposure: Practice

Policy Objective: Prevention of Secondhand Smoke Exposure

Setting: Practice

Below, you will see a list of goals for this policy objective. Click on the specific goal to read strategies you can use to achieve that goal in this setting.

Countering Industry Messaging

Use effective tobacco counseling techniques

Clinicians should be clear in their messages about tobacco use and secondhand smoke exposure with both children and families. Adult tobacco users should be advised to quit and given proper materials to do so, or at the very least, encouraged to work with the clinician to think of ways to protect the rest of the family from the toxins in secondhand smoke. Helpful cessation materials may include the state quitline, websites, text-to-quit programs, apps, in-person programs and nicotine replacement therapy such as medication, patches, lozenges or gum.

The adoption of smoke-free rules in homes and cars is one way a tobacco user who will not quit can still protect the rest of the family. Adolescent tobacco users should also be advised to quit, and given age-appropriate motivators to do so. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.

If the exposure to secondhand smoke is not under the parent’s control, the clinician should encourage the parents to consider having a discussion with the person causing the secondhand smoke exposure. If the parents seem anxious about facilitating this conversation, the clinician should suggest that they bring the smoker(s) to an appointment so that the dangers posed to the family from secondhand smoke can be discussed.

Clinicians should understand, and be prepared to discuss, that some patients and family members may be dual tobacco product users, or part of a demographic group which puts them at a higher risk for tobacco use.

Recommended by:

AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
AAP policy statement– Electronic Nicotine Delivery Systems
AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 42, 48, 50
CDC– Health Equity in Tobacco Prevention and Control
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 1,2,3,4,5,7,8,9,10,11,12,13,14,15,16,17,19,20,22,30,34,35,36,37,38
Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- pages 2,6,7-8,57-60,88-89,134,231-40
U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Owners/Management Agents of Federally Assisted Public and Multi-family Housing
U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Residents of Federally Assisted Public and Multi-family Housing
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O

For more information:

AAP Julius B Richmond Center–  Counseling Parents About Smoking Cessation
AAP Julius B Richmond Center– Quit Resources for Children and Adolescents
AAP Julius B Richmond Center– Tobacco Control and Specific Populations
Public Health Law Center– Vehicles
Talk to your Patients.org–  Don’t be Silent About Smoking

Promote prevention of tobacco use

Adolescents can initiate tobacco use for many reasons: their friends dare them to, they are curious, or they see tobacco used in the media. Tobacco users often start early: 9% of US high school students report that they have smoked a whole cigarette by age 13, and 88% of future daily smokers have their first cigarette by age 18. Adolescents are also becoming more diverse in their tobacco use: according to the 2014 National Youth Tobacco Survey, 13% of high school students reported current use of two or more tobacco products in 2014. It is important to promote messages of healthy, tobacco-free lifestyles in this population. Be aware that some demographic groups are at higher risk for tobacco use. Know who these groups are, and stress prevention when interacting with them. If a patient reports that they do not use tobacco products, congratulate them for making a wise decision.

Recommended by:

AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
AAP policy statement– Electronic Nicotine Delivery Systems
AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 42
CDC– Health Equity in Tobacco Prevention and Control
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 1,2,3,4,5,7,8,9,10,11,12,13,14,15,16,17,19,20,22,30,34,35,36,37,38
Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention W

For more information:

AAP Julius B Richmond Center– Tobacco Control and Specific Populations
CDC– Youth Tobacco Prevention
Food and Drug Administration (FDA)– The Real Cost
Truth Initiative– Truth Campaign

Tobacco Product Sales Restrictions

Enact policies that prohibit tobacco sales on the premises

Clinicians should not make it easy for a person trying to quit, or an adolescent who is contemplating initiating tobacco use, to gain access to cigarettes or other tobacco products. Management should prohibit the sale of tobacco products on the premises and eliminate vending machines that sell tobacco products. If there is a pharmacy on-site, it should not sell tobacco products. If the practice has a public-use computer with internet service, tobacco purchasing and other online merchant websites, including daily deal and other third-party vendor sites, should be blocked to prevent online, unmonitored tobacco sales.

Recommended by:

AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 22
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 1,2,3,4,5,7,8,9,10,11,12,13,14,15,16,17,19,20,22,30,34,35,36,37,38
Surgeon General report– Reducing Tobacco Use, 2000- page 23

For more information:

AAP Issue Brief– Tobacco Product Control
Americans for Nonsmokers’ Rights– Tobacco-Free Pharmacies
ChangeLab Solutions– A Prescription for Health: Tobacco Free Pharmacies
Food and Drug Administration–Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco
Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities
World Health Organization (WHO)– Guidelines for implementation of Article 13 of the WHO Framework Convention on Tobacco Control (Tobacco advertising, promotion and sponsorship)

100% Tobacco-free Policies

Medical and health facilities should be completely tobacco free, inside and outside, at all times, including all buildings, grounds, parking lots, satellite facilities, vehicles and temporary venues

Encourage management to enact a tobacco-free policy for the property, and to not allow anyone to use tobacco products on the premises. The policy should not allow employees to use tobacco products in a company or personal vehicle. When someone smokes or uses a tobacco product on the property (even in their own vehicle), it violates the tobacco-free environment rule and creates a double-standard that undermines the policy. Management and employees should be firm about this policy, and enforce it. The policy should include the use of smokeless forms of tobacco like chewing tobacco or dip, and electronic nicotine delivery systems which include e-cigarettes.

Recommended by:

AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
AAP policy statement– Electronic Nicotine Delivery Systems
AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 4 and 5
Surgeon General report– The Health Consequences of Involuntary Exposure to Tobacco Smoke, 2006- pages 16, 650
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention P

For more information:

AAP Issue Brief– Tobacco-free Environments
Americans for Nonsmokers’ Rights– Tobacco-Free Pharmacies
Centers for Disease Control and Prevention– Healthier Worksite Initiative
ChangeLab Solutions– A Prescription for Health: Tobacco Free Pharmacies
ChangeLab Solutions– Model Ordinance: Comprehensive Smokefree Places
Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
Partnership for a Tobacco-Free Maine– Smoke-free Workplaces
Public Health Law Center– Vehicles
Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities

Support clean-air and smoke-free environment ordinances and legislation in communities and states

All places where children and adolescents learn, live, play and work (eg, schools, universities, child care settings, restaurants, public parks, multi-unit housing, sporting arenas, airports and vehicles) should be smoke free, in order to discourage smoking initiation, as well as to prevent exposure to secondhand and thirdhand smoke.

Children and adolescents with chronic conditions (eg, asthma) face significant health harms from tobacco use and secondhand smoke exposure. Those who suffer from chronic conditions, which are often not visible, could be at an even greater risk for adverse reactions if environments are not smoke or tobacco free. Smoke-free laws should include electronic nicotine delivery systems (ENDS, or e-cigarettes), as secondhand vapor from these products contains some of the same chemicals as secondhand smoke.

Warning: The tobacco industry is well-known for its effective marketing schemes and retaliation tactics. The industry battles pending smoke-free or clean air ordinances by contending that such laws will negatively impact business owners, or that the use of proper ventilation will alleviate secondhand smoke exposure. The industry also lobbies for preemption laws that take power from local governments, which is where tobacco control advocates typically are the most successful. Be aware of these tactics when looking to take action on this recommendation.

Recommended by:

AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
AAP policy statement– Electronic Nicotine Delivery Systems
AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 6, 50
CDC– Health Equity in Tobacco Prevention and Control
CDC Morbidity and Mortality Weekly Review, February 25, 1994– Guidelines for School Health Programs to Prevent Tobacco Use and Addiction- Recommendation 1
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 4
Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 460
Surgeon General report– Children and Secondhand Smoke Exposure, 2007- pages 6, 70-71, 88-89
Surgeon General report– Reducing Tobacco Use, 2000- page 261
U.S. Department of Health and Human Services– Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan for the US Department of Health and Human Services- Strategic Action 1
U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Owners/Management Agents of Federally Assisted Public and Multi-family Housing
U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Residents of Federally Assisted Public and Multi-family Housing
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention P

For more information:

AAP Julius B Richmond Center - Solving the Puzzle: A Guide to Pediatric Tobacco Control– Community 
AAP Issue Brief– Tobacco-free Environments
American Nonsmokers' Rights Foundation– Smoking Policies in the 35 Busiest US Airports
Americans for Nonsmokers’ Rights– Going Smokefree in Your Community
Campaign for Tobacco-Free Kids– Smoke-Free Laws
ChangeLab Solutions– Model Ordinance: Comprehensive Smokefree Places
Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
Public Health Law Center– Vehicles
University of Michigan– Smoke-free Campus Supervisor's Toolkit

For more information about tobacco industry tactics:

Americans for Nonsmokers’ Rights– Advice to Business Owners
Americans for Nonsmokers’ Rights– Economic Impact
Americans for Nonsmokers’ Rights– Tobacco’s Dirty Tricks
CDC Morbidity and Mortality Weekly Review, March 18, 2005- Preemptive State Smoke-free Indoor Air Laws--United States, 1999--2004
Surgeon General report– The Health Consequences of Involuntary Exposure to Tobacco Smoke- page 11

Last Updated

04/29/2021

Source

American Academy of Pediatrics