The American Academy of Pediatrics is urging more action to protect children from the harms of tobacco and nicotine in clinical and public policy statements published online in Pediatrics.

In the clinical policy statement, AAP offers a series of recommendations for pediatricians and other health care providers to guide the identification of potential issues, as well as how they can be treated upon discovery (Pediatrics. 2015 Oct. 26 [doi: 10.1542/peds.2015-3108]).

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“There is no safe level of tobacco smoke exposure, and teenagers and children must be protected from its harmful effects,” Dr. Karen M. Wilson, section head of pediatric medicine at Children’s Hospital, Aurora, Colo., and chair of the AAP Section on Tobacco Control said in a Oct. 23 telebriefing prior to the release of the statements. “If current trends continue, 5.6 million of today’s youth will die prematurely from tobacco and smoking,” she said.

The AAP recommends an inquiry about tobacco use and tobacco smoke as part of health supervision visits, as well as visits for diseases that may be caused or exacerbated by tobacco smoke exposure. Parents should be asked who is smoking around a child and where, and children and adolescents should be asked about cigarettes and other kinds of tobacco and nicotine products (i.e., e-cigarettes) they have may have tried or are actively using.

The recommendations are backed by a technical report that provides the evidence base to support AAP’s clinical and policy statements, also published online in Pediatrics (2015 Oct. 26 [doi: 10.1542/peds.2015-3110]).

Furthermore, guidance of tobacco prevention should be given, including messages that experimenting with tobacco use is not safe.

“Messages should start as early as children are developmentally ready to understand them, usually approximately 5 years of age,” AAP said in the statement. Messages that may resonate more with adolescents include the effect of tobacco use on appearance, breath, and sports performance; lack of benefit for weight loss; how much money they would have to spend to continue their tobacco addiction; and how the tobacco industry deceives them, AAP said.

“Adolescents are particularly susceptible to nicotine,” Dr. Wilson noted. “Even low levels of exposure to nicotine and tobacco can worsen asthma or negatively impact IQ scores in young children,” she said.

Adolescents should be offered tobacco dependence treatment if they want to stop, although the use of pharmacotherapy is not as strong a recommendation.

“Research on pharmacotherapy of moderate to severe adolescent tobacco dependence is limited by short courses of treatment, high rates of nonadherence, and high rates of relapse after discontinuation of therapy,” the statement notes, adding that adolescents can be offered pharmacotherapy “appropriate to the severity of his or her tobacco dependence and his or her readiness to change as part of a tobacco dependence treatment plan.”

Patients and parents/caregivers should be given information on quiting resources such as 1-800-QUIT-NOW or the texting service SmokefreeTXT. However, one recommendation to avoid is the use of electronic nicotine delivery systems as a treatment for tobacco dependence.

The statement also notes there is an “increased risk of suicidal ideation and suicide both among continuing smokers and among those being treated for tobacco dependence” and the potential for neuropsychiatric symptoms with tobacco dependence treatment should be considered.

Finally, if tobacco exposure cannot be eliminated, guidance should be given to help reduce a child’s exposure to tobacco smoke.

AAP also released a policy statement on e-cigarettes in general and broader tobacco use. (Pediatrics. 2015 Oct. 26 [doi: 10.1542/peds.2015-3222]).

“We are particularly alarmed and concerned about electronic cigarettes because we believe they have the potential to addict a new generation of youths to nicotine,” Dr. Wilson said. “We know that youths who may not have been smoking combustible cigarettes, but who start with electronic cigarettes are then more likely to go on and smoke combustible tobacco, which concerns us that they may continue on because we know that people who start to use nicotine and smoke cigarettes before the age of 21 [years] are far more likely to become adult chronic smokers.”

The AAP policy statement on electronic nicotine delivery systems (ENDS) recommends active screening for ENDS use in particular that echo many of the overall tobacco screening and treatment recommendations. The organization also lent support to a number of public policy initiatives, including banning sale of e-cigarettes to those under 21 years; FDA oversight and regulation; banning of flavored liquid nicotine and advertising that can be viewed by youths; and packaging restrictions to prevent accidental ingestion by children.

More broadly, in the public policy statement, AAP is calling for FDA to regulate all tobacco products and to make sure the agency is adequately funded for regulatory activity; stricter advertising guidelines; higher prices to discourage initiation by youth; and wider smoking bans, including in multiunit housing (Pediatrics. 2015 Oct. 26 [doi: 10.1542/peds.2015-3109]).

gtwachtman@frontlinemedcom.com

AAP urges greater action in protecting children from tobacco and nicotine