Policy Statement—Tobacco Use: a Pediatric Disease Abstract

Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children Policy Statement—Tobacco Use: A Pediatric Disease COMMITTEE ON ENVIRONMENTAL HEALTH, COMMITTEE ON abstract SUBSTANCE ABUSE, COMMITTEE ON ADOLESCENCE, AND COMMITTEE ON NATIVE AMERICAN CHILD HEALTH Tobacco use and secondhand tobacco-smoke (SHS) exposure are ma- jor national and international health concerns. Pediatricians and other KEY WORDS tobacco, smoke, cigarette, environmental tobacco, nicotine, clinicians who care for children are uniquely positioned to assist pa- secondhand, smoke free, cigar, smokeless tients and families with tobacco-use prevention and treatment. Under- ABBREVIATIONS standing the nature and extent of tobacco use and SHS exposure is an SHS—secondhand tobacco smoke essential first step toward the goal of eliminating tobacco use and its AAP—American Academy of Pediatrics DoD—Department of Defense consequences in the pediatric population. The next steps include coun- This document is copyrighted and is property of the American seling patients and family members to avoid SHS exposures or cease Academy of Pediatrics and its Board of Directors. All authors tobacco use; advocacy for policies that protect children from SHS ex- have filed conflict of interest statements with the American posure; and elimination of tobacco use in the media, public places, and Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American homes. Three overarching principles of this policy can be identified: (1) Academy of Pediatrics has neither solicited nor accepted any there is no safe way to use tobacco; (2) there is no safe level or dura- commercial involvement in the development of the content of tion of exposure to SHS; and (3) the financial and political power of this publication. individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional de- cisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Rec- ommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and www.pediatrics.org/cgi/doi/10.1542/peds.2009-2114 play environments, both inside and outside, (2) treatment of tobacco doi:10.1542/peds.2009-2114 use and dependence through employer, insurance, state, and federal All policy statements from the American Academy of Pediatrics supports, (3) implementation and enforcement of evidence-based automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. tobacco-control measures in local, state, national, and international PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). jurisdictions, and (4) financial and systems support for training in and Copyright © 2009 by the American Academy of Pediatrics research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults. Pediatrics 2009;124:1474–1487 BACKGROUND Tobacco use is the leading preventable cause of death and illness in the United States, causing more than 443 000 deaths each year.1 The consequences of tobacco use include harms to the health of the fetus, such as low birth weight and sudden infant death; harms to children from tobacco use and secondhand tobacco-smoke (SHS) exposure, including respiratory illness, infection, and decreased lung function; the up- take and establishment of tobacco use and nicotine addiction by the 1474 AMERICAN ACADEMY OF PEDIATRICS Downloaded from www.aappublications.org/news by guest on September 28, 2021 FROM THE AMERICAN ACADEMY OF PEDIATRICS next generation; fires attributable to fessional membership organizations, -cessation efforts after delivery, (3) smoking; the economic costs of pur- including the Academic Pediatric Asso- counsel parents to prevent and elimi- chasing tobacco and tobacco-use ma- ciation,19 the American Academy of Al- nate children’s exposure to SHS, (4) terials; litter and debris from tobacco lergy Asthma & Immunology,20 the counsel preadolescents and adoles- products; additional cleaning and American Academy of Family Prac- cents to prevent initiation of tobacco maintenance of facilities in which to- tice,21 the American Academy of Pediat- use, and (5) counsel adolescents and bacco is used; the health care and ric Dentistry,22 and the American Med- parents to quit using tobacco. Impor- emotional costs of diseases associ- ical Association.23,24 The policy is tant adjuncts to these efforts include ated with tobacco use and SHS expo- accompanied by 2 technical reports: quitlines and pharmacotherapies for sure; and the costs to families and so- “Secondhand and Prenatal Tobacco tobacco-use cessation.14,27,28 Quitlines ciety because of poor health and lost Smoke Exposure”25 and “Tobacco as a (toll-free telephone-based tobacco use- productivity.2 Substance of Abuse.”26 cessation services that offer evidence- Most tobacco users (ϳ80%) started The AAP recognizes the dangers of to- based information and counseling using tobacco products before 18 bacco use and SHS exposure to chil- support, including referral of the to- years of age.3 Initiation of tobacco use dren’s health. Tobacco control was bacco user to his or her primary care is often instigated by exposure to to- named a strategic priority by the AAP provider for pharmacotherapies) are bacco use by parents or peers, depic- in 2005, and the Julius B. Richmond an effective way to deliver tobacco use- tion in movies and other media, ad- Center of Excellence (www.aap.org/ cessation services.28 Quitlines are avail- vertising targeting children and richmondcenter), dedicated to the able throughout the United States, adolescents, and other environmen- elimination of children’s exposure to Canada, and many other countries. Phar- tal and cultural factors.3–12 The con- tobacco and SHS, was established in macotherapies approved for adult use, nection between children and tobacco 2007 to foster tobacco-control initia- including nicotine-replacement prod- use is so strong that the commissioner tives at the AAP. ucts and medications such as vareni- of the US Food and Drug Administra- cline and bupropion, are extremely effec- tion declared tobacco use a “pediatric TERMS USED AND THEIR tive in promoting tobacco-use cessation disease” in 1995.13 DEFINITIONS when used in conjunction with cessation 14 Tobacco use is a pediatric disease be- The term “tobacco” includes all smoked counseling. cause of the extent of harms to chil- and smokeless forms. The term “tobacco AAP members are uniquely positioned dren caused by tobacco use and SHS control” refers to any and all aspects of to disseminate information about the exposure, the relationship of pediatric efforts to reduce or eliminate tobacco effects of tobacco use and effective tobacco use and exposure to adult to- use in any form, except ceremonial uses, tobacco-control methods through their bacco use, the existence of effective in- where legal. The term “parent” is meant practices and other efforts. In addition to terventions to reduce tobacco use,14 to include anyone acting in the role of practice-based efforts in tobacco con- and the documented underuse of parent, including legal guardians and trol, other roles for pediatricians include those interventions.15 This statement foster parents. “Community” is used participating in community, advocacy, provides guidance for providers of pe- broadly and includes local-, city-, county-, and media campaigns that inform the diatric services, including the Ameri- state-, national-, and international-level public of the harms of tobacco use, SHS can Academy of Pediatrics (AAP) and groups and organizations. exposure, and the risks of tobacco-use its members, and summarizes other initiation; promoting treatment; and AAP policies that have addressed to- THE ROLE OF PEDIATRICIANS IN helping to enact and enforce laws and bacco use and control. TOBACCO CONTROL regulations that limit access to tobacco Because tobacco use has significant ef- Pediatricians have important roles in and promote tobacco control. fects on children and families, its man- efforts to reduce family tobacco use agement has been reviewed in many AAP and SHS exposure. In their practices, TOBACCO CONTROL AND PUBLIC policies and official documents.16–18 The they can (1) provide counseling to ex- POLICY information and recommendations de- pectant parents to quit using tobacco Legislative and regulatory efforts that scribed in this statement are consistent products and avoid SHS exposure dur- have been effective in controlling and with recommendations in the other AAP ing and after pregnancy, (2) assist eliminating tobacco use include clean publications cited as well as with to- new parents in their efforts to con- indoor-air legislation, taxes on tobacco bacco policies from other clinical pro- tinue their tobacco use-abstinence or products, restricting youth access to PEDIATRICS Volume 124, Number 5, November 2009

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