Prevention of Youth Initiation of Tobacco Use: Practice

Policy Objective: Prevention of Youth Initiation of Tobacco Use

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.

Media and Advertising Restrictions

Discuss the impact of tobacco imagery in the media with patients and families

Many patients and families may not realize that even a small amount of tobacco imagery in movies, television shows and video games can influence their desire to try tobacco products. Studies have shown that smoking in movies accounts for roughly 37% of all tobacco use initiation, and that in 2014, 36% of youth-rated movies (G, PG, PG-13) contained tobacco imagery. Clinicians should discuss these statistics with patients and families, and encourage parents to screen for tobacco content, and/or to have conversations with their children about the tobacco content that they view in media ("That character is smoking a lot. Do you think his friends are bothered by the smell and smoke when they hang out with him?" etc).

Despite recommendations, many media production companies do not rate their products (eg, movies, television shows or video games) for tobacco use or imagery. Current recommendations are to rate films, games, or movies depicting tobacco imagery/use (including electronic nicotine delivery systems) with adult ratings unless the item portrays the negative consequences of tobacco use, or depicts the use in a historically accurate representation. Some parents may assume if a film, TV show or game is rated for children, any harmful material is mentioned with the rating, but in the case of tobacco products, this is not true.

Recommended by:

AAP policy statement– Electronic Nicotine Delivery Systems
AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 37-38
Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 602
Surgeon General report– Reducing Tobacco Use, 2000- pages 20-21
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E

For more information:

AAP Julius B Richmond Center– Smoke-free Movies and Media
Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Review, July 15, 2011– Smoking in Top-Grossing Movies-- United States, 2010
Knock Tobacco Out of the Park
President’s Cancer Panel Annual Report, 2006-2007– Part 3: Reducing Cancer Risk by Eliminating Exposure to Tobacco Use and Exposure- pages 88-90, 114
Smoke Free Movies

Enact policies that prohibit tobacco advertisement on the property

Tobacco advertising, such as signage and billboards that advertise tobacco products (including electronic nicotine delivery systems) or companies, should not be allowed on the property. The tobacco industry heavily markets its products to populations affected by tobacco-related disparities. Marketing, advertising and promotional strategies are often directed at low-income, minority and young adult populations. Do not display magazines or other media with tobacco advertisements or with any “prevention campaigns” from tobacco companies. Studies have shown that youth tobacco prevention campaigns, when sponsored by tobacco companies, do not prevent tobacco use; prevention campaigns aimed at parents can actually promote tobacco use by youth.

Warning: The tobacco industry is well-known for its effective marketing schemes and hidden-meaning campaigns. The industry frequently releases youth prevention and adult cessation programs that appear to be benign, but have been shown to do more harm than good. Be aware of these programs 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- page 22
CDC– Health Equity in Tobacco Prevention and Control
Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 602
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E

For more information about tobacco industry tactics:

Americans for Nonsmokers’ Rights– Tobacco’s Dirty Tricks
Campaign for Tobacco-Free Kids– Big Surprise: Tobacco Company Prevention Campaigns Don’t Work; Maybe It’s Because They Are Not Supposed To
The Rise and Fall of Tobacco Media Campaigns, 1967-2006

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 pellets or orbs, chewing tobacco or dip, and 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:

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
Public Health Law Center– Vehicles
U.S. Department of Health and Human Services– Tobacco-Free College Campus Initiative

Be an example of a healthy, tobacco-free lifestyle

Follow and support tobacco-free policies in public places and multi-unit housing. If you smoke or use a tobacco product, try to quit. If that's not possible, use the tobacco products outside, in designated areas. Closing the door to trap smoke in one room or using a window or fan to get smoke out does not work. Smoke can travel through walls, plumbing, or ventilation systems. It is important to keep homes and cars smoke free; some populations, such as children, the elderly, people with disabilities or pregnant women are more likely to experience negative health effects from smoke exposure.

Recommended by:

AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 9
Surgeon General report– Children and Secondhand Smoke Exposure, 2007- page 6
Surgeon General report– The Health Consequences of Involuntary Exposure to Tobacco Smoke, 2006- pages 616-17
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

For more information:

Public Health Law Center– Vehicles
Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities

Make tobacco-free financial decisions

Do not support tobacco companies with your financial actions. Patronize only smoke-free businesses, including hotels and restaurants. Be sure that your personal financial holdings do not support tobacco stocks, and if they do, divest your holdings. Do not promote companies who have a history of funding from or partnership with tobacco companies.

Recommended by:

AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control

For more information:

AAP Julius B Richmond Center– Tobacco companies and stocks to avoid
Americans for Nonsmokers’ Rights– Restaurants

Countering Industry Messaging

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– 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- Recommendation 14
Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 602
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

Encourage parents to talk to their children about the risks of using tobacco, even if they use it themselves

Factors that may influence a child to initiate tobacco use include peer pressure, curiosity, tobacco imagery in the media and the lack of knowledge about the harm of tobacco products. It is important for parents to begin discussions about tobacco use with their children early on, to educate them about the negative health effects and to express their own stance on tobacco use. Even if a parent is a tobacco user, he/she can still promote a healthy lifestyle by having an honest conversation with the child about the pitfalls and challenges associated with tobacco use. These actions are protective behaviors that may prevent an adolescent from initiating tobacco use.

Recommended by:

AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 14
Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 602
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention W

For more information:

AAP HealthyChildren.org– Talk to your Teen about Drugs- And Keep Talking
AAP Julius B Richmond Center– Effects of Tobacco on Children

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 Web sites, 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
AAP policy statement– Electronic Nicotine Delivery Systems
Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 22
CDC– Health Equity in Tobacco Prevention and Control
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 12
Surgeon General report– Reducing Tobacco Use, 2000- page 23

For more information:

AAP Issue Brief– Tobacco Product Control
ChangeLab Solutions– A Prescription for Health: Tobacco Free Pharmacies
World Health Organization (WHO)– Guidelines for implementation of Article 13 of the WHO Framework Convention on Tobacco Control (Tobacco advertising, promotion and sponsorship)

Eliminate Branded Promotional Items

Enact policies that prohibit endorsements or products from tobacco companies

Tobacco-related items should be eliminated from the practice to ensure that messages or products of tobacco companies are not promoted. These items typically include free promotional items made by tobacco and/or electronic nicotine delivery systems companies, like beach towels, t-shirts, water bottles, pens or other common items. When using these items, a person becomes a walking billboard for an industry that is responsible for more than 480,000 deaths each year.

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 22
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E

For more information:

AAP Issue Brief– Tobacco Product Control

Last Updated

03/26/2021

Source

American Academy of Pediatrics