Policy Statement—Tobacco Use: A Pediatric Disease

Tobacco use is the leading preventable cause of death and illness in the United States, causing more than 443 000 deaths each year.
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 uptake and establishment of tobacco use and nicotine addiction by the next generation; fires attributable to smoking; the economic costs of purchasing tobacco and tobacco-use maerials; litter and debris from tobacco products; additional cleaning and maintenance of facilities in which tobacco is used; the health care and emotional costs of diseases associated with tobacco use and SHS exposure; and the costs to families and society because of poor health and lost productivity.
Most tobacco users (80%) started using tobacco products before 18 years of age.
Initiation of tobacco use is often instigated by exposure to tobacco use by parents or peers, depiction in movies and other media, advertising targeting children and adolescents, and other environmental and cultural factors.3–12 The connection between children and tobacco use is so strong that the commissioner of the US Food and Drug Administration declared tobacco use a “pediatric disease” in 1995.
Tobacco use is a pediatric disease because of the extent of harms to children caused by tobacco use and SHS exposure, the relationship of pediatric tobacco use and exposure to adult tobacco use, the existence of effective interventions to reduce tobacco use,14 and the documented underuse of those interventions.15 This statement provides guidance for providers of pediatric services, including the American Academy of Pediatrics (AAP) and its members, and summarizes other AAP policies that have addressed tobacco use and control. Because tobacco use has significant effects on children and families, its management has been reviewed in many AAP policies and official documents.16–18 The information and recommendations described in this statement are consistent with recommendations in the other AAP publications cited as well as with tobacco policies from other clinical professional membership organizations, including the Academic Pediatric Association, the American Academy of Allergy Asthma & Immunology,20 the American Academy of Family Practice, the American Academy of Pediatric Dentistry,22 and the American Medical Association.
The policy is accompanied by 2 technical reports: “Secondhand and Prenatal Tobacco Smoke Exposure”and “Tobacco as a Substance of Abuse.”The AAP recognizes the dangers of tobacco use and SHS exposure to children’s health. Tobacco control was named a strategic priority by the AAP in 2005, and the Julius B. Richmond Center of Excellence (www.aap.org/ richmondcenter), dedicated to the elimination of children’s exposure to tobacco and SHS, was established in 2007 to foster tobacco-control initiatives at the AAP.