Journal of Pediatric Health Care
Volume 18, Issue 2 , Pages A30-A31, March 2004

Prevention of tobacco use in the pediatric population☆

Article Outline

 

Tobacco use, both smoke and smokeless, and second-hand smoke are associated with serious health hazards for young people. There are now thousands of scientific studies linking tobacco exposure and smoking to a pervasive range of health problems. Tobacco use remains the leading preventable cause of death in the United States, causing more than 440,000 deaths each year and resulting in an annual cost of more than $75 billion in direct medical costs. Nationally, smoking results in more than 5.6 million years of potential life lost each year (CDC, 2003).

Substantial progress is being made toward achieving the national health objective for 2010 of reducing cigarette smoking rates among high school students (CDC, 2002). Yet, smoking in 18—24-year-olds, especially on college campuses, has increased (Rigotti, Lee, & Wechsler, 2002). Risk factors from smoking, as well as reasons for initiating and continuing smoking, vary by age, gender and ethnicity. Most children, adolescents, and college students are unaware of the addictive nature of tobacco products.

Adverse health effects have been linked to involuntary exposure of children to tobacco smoke including causation and exacerbation of asthma, upper respiratory irritation, decrease in lung function, middle ear disease, Sudden Infant Death Syndrome, and lung cancer (Brown, 2001, Cook and Strachan, 1999, Dybing and Sanner, 1999, Li et al., 1999, Mannino et al., 2001). Additionally, cotinine, a by-product of nicotine, has been found at harmful levels in infants and children who live with smokers (Blackburn et al, 2003). Developing fetuses and newborns have special risks, including pregnancy complications, premature birth, low-birth weight infants, stillbirth, and increased infant mortality (Gaffney, 2001).

Pediatric primary health care providers play an active role in anti-tobacco activities. Interventions include prevention and treatment of childhood and adolescent tobacco use, protection of patients from harmful effects of environmental tobacco smoke, and encouragement of smoking cessation among children, adolescents, and parents (Stein et al., 2000, Bricker et al., 2003). Reducing youth smoking requires community based comprehensive, effective, and sustainable tobacco-control programs to reduce the appeal of tobacco products, including the following interventions: youth-oriented mass media campaigns, increased tobacco excise taxes, smoke-free policies for schools and other community venues, greater regulation of tobacco products, reductions in youth access to tobacco products, and school-based health programs to reduce tobacco use and addiction (CDC, 2002).

NAPNAP endeavors to:

•Support legislation and/or regulatory efforts that curb advertisement of tobacco products targeted at young children, adolescents, and young adults.

•Support coalitions and groups supporting NAPNAP's position such as ENACT (Effective National Action to Control Tobacco) and the Campaign for Tobacco-Free Kids.

•Encourage nurse practitioner educational programs to include tobacco prevention and tobacco cessation strategies in the curriculum.

•Work within campus communities to provide input into policies aimed to achieve tobacco/smoke-free environments.

•Encourage PNPs to provide anticipatory guidance for parents and pre-adolescents on the addictive nature of tobacco, the risks of addiction with “social smoking” and the health hazards of tobacco products.

•Encourage PNPs to ask about tobacco use behavior, advise the child/ adolescent regarding the importance of quitting, assist the user in enrolling in a cessation program, and arrange follow-up.

•Encourage health care providers to counsel parents and caregivers about the risks to the child related to parental smoking. Education needs to include the facts about the risks to the child from second hand smoke and exposure to nicotine from clothing, hair and furniture.

•Encourage PNPs to continually update their skills in tobacco prevention and smoke cessation strategies, realizing that prevention is a more successful strategy than smoke cessation; however, both strategies should be utilized (CDC, 1999).

NAPNAP, as the professional organization that advocates for children, sees the onset of tobacco use as a pediatric issue that will continue to impact the health and welfare of children and families. NAPNAP takes a strong stance against tobacco use and exposure in children and supports efforts aimed at tobacco prevention in children.

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Acknowledgements 

The National Association of Pediatric Nurse Practitioners would like to acknowledge the contribution of the following individuals to the 2004 revision of this statement: Julie Novak, DNSc, RN, MA, CPNP, Coordinator; Dolores C. Jones, EdD, RN, CPNP, CAE; Sue Hume MS, RN, CS; Margo N. Swanson Bushmiaer, MNSc, CSN, RNP; Yvonne Yousey MSN, CPNP

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References 

    References
  1. Blackburn C, Spencer N, Bonas S, Coe C, Dolan A, Moy R. Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey. British Medical Journal. 2003;327(7409):257
  2. Bricker J, Leroux BG, Peterson A, Kealey KA, Sarason IG, Andersen MR, et al. Nine-year prospective relationship between parental smoking cessation and children's daily smoking. Addiction. 2003;98(5):585–593
  3. Brown ML. The effects of environmental tobacco smoke on children: Information and implications for PNPs. Journal of Pediatric Health Care. 2001;15(6):280–286
  4. CDC . Best practices for comprehensive tobacco control programs—August 1999. U.S. Department of Health and Human Services. Atlanta, GA: Author; 1999;
  5. CDC . Trends in cigarette smoking among high school students-United States, 1999-2001. MMWR. 2002;51:409–412
  6. CDC. (2003). OSH Summary for 2002. Available online at: www.cdc.gov/tobacco/overview/oshsummary02.htm
  7. Cook DG, Strachan DP. Health effects of passive smoke: Summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax. 1999;54(4):357–366
  8. Dybing E, Sanner T. Passive smoking, sudden infant death syndrome, and childhood infections. Human Exposure Toxicology. 1999;18(4):202–205
  9. Gaffney KF. Infant exposure to environmental tobacco smoke. Journal of Nursing Scholarship. 1999;33(4):343–347
  10. Li JS, Peat JK, Xaun W, Berry G. Meta-analysis on the association between environmental tobacco smoke exposure and the prevalence of lower respiratory tract infection in early childhood. Pediatric Pulmonology. 1999;27(1):5–13
  11. Mannino D, Moorman J, Kingsley B, Rose D, Repace J. Health effects related to environmental tobacco smoke exposure in children in the United States. Archives of Pediatric and Adolescent Medicine. 2001;115:36–41
  12. Rigotti NA, Lee JE, Wechsler H. U.S. college students' use of tobacco products: results of a national survey. Journal of the American Medical Association. 2002;284(6):699–705
  13. Stein R, Haddock C, O'Byrne K, Hymowitz N, Schwab J. The pediatrician's role in reducing tobacco exposure in children. Pediatrics. 2000;106(5):1–17

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Further reading 

  1. U.S. Environmental Protection Agency (1999) Children and Secondhand Smoke. U.S. Environmental Protection Agency, Office of Research and Development, Office of Air and Radiation. EPA/IAQ-0123. Author.

☆ Reprint requests: NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633.Adopted by the National Association of Pediatric Nurse Practitioners' Executive Board on 01/22/04 © 2004 National Association of Pediatric Nurse Practitioners. Cherry Hill, NJ. All rights reserved. Designation: Regular (5 year review)

PII: S0891-5245(04)00005-7

doi:10.1016/j.pedhc.2004.02.001

Journal of Pediatric Health Care
Volume 18, Issue 2 , Pages A30-A31, March 2004

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