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Protecting Kids From Tobacco’s Harms: AAP Policy Explained

​​​​By: Brian Jenssen, MD, FAAP

Parents want their children to live long, healthy lives. This means helping kids embrace good habits early and warning them about choices that will harm them, including tobacco use.

We've made real progress since the mid-1960s, when a key government report held cigarette smoking responsible for a 70% increase in mortality among smokers vs. nonsmokers. But tobacco use is still the single greatest cause of preventable deaths in the U.S.—and our kids are definitely at risk. In fact, 90% of tobacco users began using the substance before age 18, a time when the body and brain are especially vulnerable to addiction.

The American Academy of Pediatrics (AAP) sees the explosion of new tobacco and nicotine products as a serious threat to child and teen health. Here's why we strongly support measures that will help keep these products out of kids' hands and make it easier for those who develop tobacco use disorder to get the treatment they need to quit.

Why we're concerned about kids & tobacco

Cigarettes are not the only threat to our kids' health.

More than 16% of high school students report current use of a tobacco product—​and many use more than one kind. Roughly 2.5 million young people used e-cigarettes in 2022, breathing in toxins and fine particles known to damage lung tissues and cause cancer. Hundreds of thousands of kids smoked hookah​, equivalent to smoking 100 cigarettes in a typical one-hour session. And nearly 1 in 10 middle schoolers and 2 in 10 high schoolers used some form of smokeless tobacco and little cigars (often flavored) are a growing favorite among young smokers.

There is NO safe form of tobacco, especially for growing brains and bodies.

Tobacco products contain nicotine, the highly addictive substance that makes it so hard to quit once kids start. Nicotine use in adolescence can harm parts of the brain that control attention, learning, mood and impulse control. There's also evidence that kids who use nicotine will face greater risks of other substance use disorders later in life. Even though e-cigarettes (vapes) are technically tobacco-free, most contain nicotine derived from tobacco. That's why the Food and Drug Administration (FDA) classifies them as a tobacco product.

Makers of tobacco products are spending billions to reach our kids.

Fruit and candy flavorings, celebrity endorsements and campaigns on Instagram, TikTok, YouTube and Snapchat are just some of the tactics used to entice kids to try tobacco-based products. Earlier restrictions on cigarette ads don't apply to these products, so marketers are also free to advertise in mainstream media. Retail displays, event sponsorships, free samples and even scholarship contests have been used to engage young consumers.

AAP tobacco policy recommendations to help young people live healthier lives

As pediatricians, we have taken a strong stand in favor of laws, programs and practices that will keep children and teens from using tobacco products and help them quit if they do. We align with health officials, parents, caregivers and educators who recognize the lifelong health risks of tobacco use and want to encourage kids to live tobacco-free.

Here what we recommend:

  • Kids should have access to effective treatment programs that can help them quit. Right now, many insurers do not cover tobacco treatment for people under 18. Regulations that require coverage for these services, and reimbursement for health provid​ers who prescribe these services, will help young people break the tobacco habit early in life. Programs should be geared to the needs of young people to ensure they work.

  • We need more research on how to prevent early tobacco use. New studies can help us pinpoint the best ways to persuade kids to avoid tobacco (or quit). We urgently need research focused on kids living in communities where racism, discrimination and stigma are high, because these young people are disproportionately harmed by tobacco.

  • Price increases should be used to discourage kids from using tobacco. Studies show that youth and young adults are 2 to 3 times more sensitive to higher prices than adults. Higher taxes on tobacco will keep many from ever using tobacco taking up the habit while providing revenues to support tobacco control programs.

  • The FDA should regulate all tobacco and nicotine products. The Family Smoking Prevention and Tobacco Control Act gave the FDA the authority to do this in 2009. However, delays in reviewing the health impact of e-cigarettes and other products have given manufacturers a head start in marketing to young people. We encourage the FDA to set strict product standards, review new tobacco products before they hit the market and require new warning labels to discourage young users.

  • We need to enforce tobacco control laws already on the books. In 2019, Congress raised the legal age for purchasing all tobacco products to 21. But unless we hold retailers strictly accountable, the law will have little effect.

  • Added flavors, including menthol, should be banned from tobacco products. More than 80% of young people say the first tobacco product they ever tried was flavored. When asked why they use tobacco products, including vapes (which offer thousands of flavor choices), they consistently say they like the taste. Blocking manufacturers from using flavor additives will make these products less appealing to kids.

  • Comprehensive tobacco-free laws should be adopted to protect kids wherever they live, learn, play, work and visit. In many countries, regulations and practices that reduce secondhand and thirdhand smoke have been linked with lower rates of premature birth, asthma and other health problems in children. Regulations and guidance that keep our cars, homes, schools and other spaces smoke-free will safeguard kids' health.

  • Ads for tobacco products should not be visible to kids. Closing legal loopholes that allow manufacturers to promote e-cigarettes and other tobacco products, especially online, will reduce the chances that kids will try them. Restrictions on retail displays, celebrity endorsements, free samples and ads placed in music, entertainment and sports venues can help stop the normalization of tobacco use.

  • Kids should not be able to buy tobacco products online or from vending machines. These options make it too easy for them to get around the federal law banning tobacco purchases before age 21.

  • Images of tobacco use that kids can see in movies and media should be restricted. Currently, adolescents see about 275 instances of tobacco use in PG-13 movies every year. Reducing that to 10 or fewer exposures can reduce adolescent smoking by an estimated 18%.

  • Youth prevention programs should not be in the hands of tobacco companies. JUUL, a popular brand of e-cigarette, has promoted a curriculum that promised to support kids' health. But a 2018 study found the program failed to fully explain the health risks of e-cigarettes. Programs run by government agencies or non-profit advocacy groups are less likely to gloss over the harms of tobacco products, especially for kids.

  • Teens should not work on tobacco farms or in tobacco-related industries. Children and adolescents can suffer serious health effects when they breathe in airborne toxins or absorb them through the skin when handling tobacco leaves.

Parents are a powerful force in preventing youth tobacco use.

Parents and caregivers are a child's first teachers. They are also the caring, involved grownups who make healthy choices for their families. You can support your child's health now and throughout a lifetime by:

  • Minimizing your own tobacco use or quitting altogether with help from your physician, family, friends and free programs that can support you every step of the way.

  • Talking to kids about tobacco use early, which can help them put tobacco ads, images and social pressures in context and explore ways to say no.

  • Join with other parents, educators and adults to share ideas for encouraging young people to choose a tobacco-free lifestyle.

  • Asking your pediatrician for support whenever you're worried about tobacco and your child's health. Your child's doctor is ready to help you open positive conversions with your child about tobacco at every age and stage of their development.

More information

About Dr. Jenssen

Brian Jenssen, MD, MSHP, FAAP, is lead author of the AAP's Protecting Children and Adolescents From Tobacco and Nicotine policy statement and accompanying technical report. Dr. Jenssen is a pediatrician and researcher at Children's Hospital of Philadelphia (CHOP) and an assistant professor in the Department of Pediatrics at the University of Pennsylvania.

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American Academy of Pediatrics Section on Nicotine and Tobacco Prevention and Treatment and Committee on Substance Use Prevention (Copyright © 2023)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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