Prevention of Youth Initiation of Tobacco Use: School/Child Care

Policy Objective: Prevention of Youth Initiation

Setting: School/Child Care

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

Implement strategic counter-advertising campaigns with culturally relevant messages

School districts, child care centers and institutions of higher learning have an opportunity to develop or partner with community or public health-based health communication initiatives targeted toward youth and young adults to spread anti-tobacco messages. Schools and institutions of higher learning can offer access to this target audience, as well as innovative mechanisms for reaching this target audience (eg, blogs, text messages, school-based publications, dormitories). Counter-advertising campaigns, combined with school-based education, can strengthen youths’ ability to resist tobacco initiation. Effective messaging should be applicable to all audiences, bridging the gap between race, gender, sexual orientation, and social group.

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– 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 31
CDC– Health Equity in Tobacco Prevention and Control
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 13
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- pages 602, 812
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
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
Campaign for Tobacco-Free Kids– Kick Butts Day
Food and Drug Administration (FDA)– The Real Cost
Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
Truth Initiative– Truth Campaign

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

Implement evidence-based anti-tobacco curricula in schools for students at all levels of education

Children and adolescents need skills to discourage tobacco use, resist peer influences and counter aggressive tobacco industry advertising tactics. Early childcare settings; schools; and trade schools, colleges, and universities should integrate a comprehensive curriculum designed to provide this information to their students and parents. Evidence-based curricula, combined with counter-advertising media campaigns, can strengthen youths’ ability to resist tobacco initiation.

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– 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 31
CDC Morbidity and Mortality Weekly Review, February 25, 1994– Guidelines for School Health Programs to Prevent Tobacco Use and Addiction- Recommendations 2, 3, 4, and 5
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 13
Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- pages 602, 812
Surgeon General report– Reducing Tobacco Use, 2000- page 85
World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention W

For more information:

AAP Issue Brief– Tobacco Control Funding
American Cancer Society– Child and Teen Tobacco Use
Campaign for Tobacco-Free Kids– Kick Butts Day
CDC– Health Education Curriculum Analysis Tool
CDC– Registries of Programs Effective in Reducing Youth Risk Behaviors
Food and Drug Administration (FDA)– The Real Cost
Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals

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

Tobacco-Free Schools

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

Children and adolescents spend much of their day in educational settings. Implementing tobacco-free policies will reduce the dangers of secondhand and thirdhand smoke exposure and the risk of modeling tobacco use by those adults with whom children and adolescents spend much of their day.

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. Hookah, electronic nicotine delivery systems (including e-cigarettes), smokeless tobacco, and flavored tobacco products should be included in such policies, as they are popular with youth.

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- Recommendations 8 and 9
Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
Surgeon General report– Reducing Tobacco Use, 2000- page 261

For more information:

AAP Issue Brief– Tobacco-free Environments
Americans for Nonsmokers’ Rights– Going Smokefree: Colleges and Universities
Campaign for Tobacco-Free Kids– Smoke-Free Laws
CDC– School Health Index
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
Maryland Department of Health and Mental Hygiene– The Cigar Trap
Public Health Law Center– Vehicles
University of Michigan– Smoke-free Campus Supervisor's Toolkit
U.S. Department of Health and Human Services– Tobacco-Free College Campus Initiative

Eliminate Branded Promotional Items

Enact policies that prohibit tobacco-branded promotional items, as well as the promotional distribution of tobacco products in all educational institutions

Allowing tobacco- and/or electronic nicotine delivery system-branded promotional items and promotional distribution of tobacco products by schools and institutions of higher learning (eg, early childcare settings; schools; and trade schools, colleges, and universities), implies support for use of tobacco products by students and parents.

Branded promotional items typically include things like beach towels, t-shirts, lighters, water bottles, pens and other common items that may be from or include the text or logo of a tobacco brand or company. 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
National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 8
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

Tobacco Product Sales Restrictions

Eliminate sales of tobacco products from all schools, including early childcare settings; schools; and trade schools, colleges and universities

Tobacco sales should be strictly monitored and enforced to assure that children and adolescents do not have easy access to any tobacco products. One way to do this is to remove the sale of tobacco products from educational facilities, including early childcare settings; schools; and trade schools, colleges and universities.

Sales of tobacco products at schools, institutions of higher learning, or school events removes protections needed to assure underage youth do not have access to tobacco products. Vehicles for unsupervised purchase of tobacco products, such as vending machines and online merchants, including daily deal sites and other third-party vendors, should be eliminated. If a facility has public/open access computers, these types of websites should be blocked, as they may enable youth to purchase tobacco products without face-to-face age verification.

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– Reducing Tobacco Use, 2000- page 261

For more information:

AAP Issue Brief– Tobacco-free Environments
AAP Issue Brief– Tobacco Product Control
CDC– School Health Index
Tobacco Control Legal Consortium– Point-of-Sale Strategies: A Tobacco Control Guide
Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
U.S. Department of Health and Human Services– Tobacco-Free College Campus Initiative

100% Tobacco-Free Policies

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.

Early childcare settings; schools; and trade schools, colleges and universities are also workplaces for teachers, administrators and support staff, who should also be protected from the risks posed by secondhand and thirdhand smoke exposure.

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– 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

For more information:

Americans for Nonsmokers’ Rights– Going Smokefree in Your Community
American Nonsmokers' Rights Foundation- Smoking Policies in the 35 Busiest US Airports
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
U.S. Department of Health and Human Services– Tobacco-Free College Campus Initiative

For More Information about tobacco industry tactics:

Americans for Nonsmokers’ Rights– Advice to Business Owners
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

Eliminate Self-Service Displays and Vending

Eliminate tobacco product-dispensing vending machines from all early childcare settings; schools; and trade schools, colleges and universities

Tobacco sales should be strictly monitored and enforced to assure that children and adolescents do not have easy access to any tobacco products. One way to do this is to eliminate vehicles for unsupervised purchase of tobacco products from educational facilities (ie, early childcare settings; schools; and trade schools, colleges and universities), such as vending machines and online merchants, including daily deal sites and other third-party vendors.

If a facility has public/open access computers, these types of websites should be blocked, as they may enable youth to purchase tobacco products without face-to-face age verification. Unsupervised purchase of tobacco products at schools, institutions of higher learning, or school events removes protections needed to assure underage youth do not have access to tobacco products.

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– Reducing Tobacco Use, 2000- page 261

For more information:

AAP Issue Brief– Tobacco Product Control
CDC– School Health Index
U.S. Department of Health and Human Services– Tobacco-Free College Campus Initiative

Media and Advertising Restrictions

Do not show movies or TV shows that portray tobacco imagery or use

Many people do not realize that even a small amount of tobacco imagery in what children watch can play a role in how tobacco use is viewed by children. Children imitate those around them, and this behavior extends to the use of tobacco products. Educational facilities should only show movies or TV shows where the portrayal of tobacco use is historically accurate or appropriately shows the negative consequences of tobacco use (health, social, financial, emotional), and consider showing a strong anti-smoking ad (not produced or funded by a tobacco company) prior to these exceptions.

Just because a movie is rated for children, it does not necessarily indicate that it contains no tobacco use. In 2014, 36% of G, PG, or PG-13 rated top-grossing movies in the US contained tobacco imagery. Specific to PG-13 films, 46% of top-grossing films contained tobacco imagery. Audiences for youth-rated films are larger than audiences for R-rated films, and more youth-rated films than R-rated films are released each year. In 2014, PG-13 films accounted for 56% of in-theater tobacco exposure, while R-rated films delivered 43%.

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
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 2
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
AAP Issue Brief– Tobacco Product Control
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

Last Updated

05/05/2021

Source

American Academy of Pediatrics