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Although adult smoking rates in the US are at their lowest levels on record, more must be done to keep kids from using tobacco, according to a new set of policy statements of the American Academy of Pediatrics.
The statements, released Monday, are the first update to the association’s tobacco policy since 2015. They are based on the latest science and better reflect how many kids are now using e-cigarettes as more kid-friendly products have flooded the market. .
AAP policy statements are created by expert pediatricians to help leaders design more effective public health policy and to guide physicians on how to keep children safe—in this case, from tobacco.
Researchers have been telling Americans for generations that tobacco products are bad for them, but nearly 200 American children start smoking every day, according to the US Centers for Disease Control and Prevention..
Tobacco use is the No. 1 preventable cause of death in the United States, says the CDC.
Rates of children using e-cigarettes are high, says the AAP, and the use of hookahs and cigars has not decreased. However, pediatricians point out, traditional cigarette smoking has declined over the years.
Specifically, in 2022, nearly 5% of middle school students and about 17% of high school students reported some form of current tobacco use, According to the Centers for Disease Control and Prevention. In 2021, about 11% of high school students and 34% of high school students said they had ever tried tobacco.
These “attempt rates” are important because most adult smokers started smoking at young ages, according to the CDC.
And smoking rates remain disproportionately high in certain communities, including those who are Black, Hispanic, Native American, Alaska Native, or LGBTQ+.
In its updated policy statements, the AAP continues to encourage pediatricians to screen for tobacco use as part of a child’s regular checkup. A talk about tobacco should begin no later than age 11 or 12, the report says.
For children who want to quit tobacco, pediatricians should refer them for behavioral interventions such as counseling or prescribing nicotine replacement therapyIt has been shown to be effective with children who are moderately or severely addicted to tobacco.
That practice has changed over the years, according to Dr. Susan Walley, co-author of the new policy statements. In medical school, she said, her professors he didn’t talk much about smoking except to tell people to quit.
“We now know that it is an addiction and a chronic medical illness. Telling someone to just quit smoking would be like telling someone with diabetes, ‘You just need to think about improving your blood sugar.’ We’ve learned a lot,” said Walley, a pediatrician at Children’s National in Washington, DC.
The new report notes that children who smoke cigarettes should not be encouraged to use e-cigarettes as an alternative. Some experts have argued that e-cigarettes are a good smoking cessation tool, but the AAP says the evidence is lacking.
At the checkup, pediatricians should also ask caregivers about their smoking habits and make recommendations. Nearly 40% of children are regularly exposed to secondhand smoke, says the AAP, and the use of caregivers is the leading reason children are exposed to secondhand smoke.
In children, secondhand smoke can cause respiratory and ear infections and asthma attacks. Since 1964, more than 2.5 million non-smokers have died from health problems caused by exposure to secondhand smoke, According to the Centers for Disease Control and Prevention.
The AAP urges the US Food and Drug Administration to improve regulate all tobacco and nicotine products and the federal government to fund child-specific tobacco prevention, detection, and treatment programs.
Despite getting almost $27 billion from a settlement on tobacco and tobacco taxes This year, states are reducing programs designed to keep kids from using tobacco products and help people quit smoking, according to the Campaign for Tobacco Free Kids.
The AAP recommends raising the prices of tobacco products, as higher prices may deter young users.
Taxes are also considered one of the most effective ways to reduce smoking, particularly among children, studies have found. Yet Congress hasn’t raised federal tobacco taxes in 14 years. He federal cigarette tax it’s still $1.01 per package and tax vary for other tobacco products. No state increased its cigarette taxes in 2022 either.
The AAP policy statements on tobacco recommend a total ban on flavoring, including menthol.
In April, the FDA proposed removing two tobacco products popular with children: flavored cigarettes and menthol cigarettes. But it could be years before that becomes a reality, since even if that rule is finalized this year, manufacturers will likely sue to stop it from taking effect.
Tobacco companies have long used menthol to mask off-flavors in their products. Studies show which makes the products more attractive to new users and makes it more difficult for people to quit smoking.
Tobacco companies are also frequently introducing flavored products into child-friendly disposable vapes in flavors like blue raspberry and tart apple.
“Unfortunately, they also have very, very high levels of nicotine. Only the tobacco products themselves have really exploded. Part of it is lack of regulation, and on top of that, there are these new oral nicotine products that are unfortunately gaining a lot of popularity among our youth,” Walley said.
Walley is optimistic that more kids can quit smoking or not at all, but knows that pediatricians have their work cut out for them, based on what their children tell him about school.
“I am the father of three children, and when I hear about my children [that] They don’t want to go to the bathroom because people will be vaping there, it just breaks my heart that they don’t get a bathroom break all day because of that,” he said. “Kids being so addicted that they have to sneak to the bathroom, or are vaping in class wearing some covert clothing, shows that this really is a public health crisis.
“We at the AAP want to make sure that people remember that this is one of the most changeable things in terms of the social determinants of health,” Walley said. “We can’t really control a lot of the social determinants of health, but if you use tobacco or if you start to do so, that’s something we can do something about.”