PolicyLab

Tobacco use is the leading preventable cause of disease and death in the U.S and use almost always starts in childhood or adolescence. Based on 2022 data, 11.3% (more than 3 million) of all students reported current use of any tobacco product, including 16.5% (2.51 million) of high school and 4.5% (530,000) of middle school students. 

The tobacco epidemic takes a substantial toll on the health of all pediatric populations, including infants, children, adolescents, and young adults, and the harm begins in utero. As a pediatrician and tobacco control researcher who works with youth and their parents and caregivers, I’ve seen the serious health impacts these products have on families.

For those reasons, colleagues and I recently updated the American Academy of Pediatrics (AAP) policy statement, “Protecting Children and Adolescents from Tobacco and Nicotine,” which reflects the latest evidence in the field. On this World No Tobacco Day, I’ll share a recent policy advancement in this space, and I’ll highlight several key evidence-based policy approaches still needed that those who care about children can advocate for or enact to protect children, adolescents and their families from the harms of tobacco. 

A Policy Change to Protect Youth 

In December 2019, Congress passed a federal law to raise the sales age for all tobacco products to 21. “Tobacco 21” is now the law of the land across the U.S. and applies to all retail establishments with no exceptions. The law penalizes retailers for selling tobacco products to youth but does not penalize youth who purchase, possess or use tobacco products. It was the culmination of research identifying these laws as effective with high levels of public support. 

This remains a huge policy victory to protect children and adults from tobacco use. But there’s still more work to be done. 

Three Pediatric-focused Policy Opportunities

First and foremost, effective public health approaches need to go beyond cigarettes to include e-cigarettes, similar devices, and other and emerging tobacco and nicotine products, and should be expanded to reduce the toll that the tobacco epidemic takes on our children. The Food and Drug Administration (FDA), which has the authority to regulate all tobacco and nicotine products to protect public health, should prohibit all flavor ingredients, including menthol, in all tobacco and nicotine products. Tobacco companies have historically used flavored products to target youth and, in particular, youth from communities that have experienced high levels of discrimination and stigma. Prohibiting all flavors in all tobacco and nicotine products is a policy approach that protects children and promotes social justice and racial equity. 

Second, funding must be appropriately directed for tobacco use prevention, screening and treatment specifically for pediatric populations. Despite receiving billions of dollars each year (estimated at approximately $27 billion in 2021) through tobacco company settlement money and tobacco taxes, most states only use a small percentage of these funds to support tobacco prevention and treatment programs for children and adolescents. 

Third, states and/or local jurisdictions must enact comprehensive tobacco-free laws that prohibit use of all tobacco and nicotine products (including cigarettes, e-cigarettes and similar devices) in all places where children and adolescents live, learn, play, work and visit. 

Finally, the AAP policy also highlights several additional evidence-based recommendations, including: 

• Tobacco and nicotine product prices should be increased to reduce child and adolescent tobacco use initiation.
• Enforce the tobacco product sales age of 21 years
• All tobacco and nicotine product advertising and promotion in forms that are accessible to children and adolescents should be prohibited.
• Tobacco control research should be considered a high priority and funded accordingly, from both government and private sources.
• Depictions of tobacco and nicotine products in movies and other media, such as content through streaming platforms, that can be viewed by children and adolescents should be restricted. 
• Tobacco industry-sponsored mass-media and school-based tobacco control programs should be prohibited.
• Child and adolescent tobacco control programs should incorporate antitobacco themes of health effects and industry manipulation.

Through the promotion of evidence-based policy strategies like Tobacco 21, pediatricians, pediatric researchers, parents, and individuals who care about the health of children have pushed back against tobacco companies to help children, adolescents and their families live tobacco-free lives. Continued policy advocacy can help prevent new addiction, end the tobacco epidemic and promote a tobacco-free future. 

If you’re interested in learning more about these recommendations, you can access the AAP policy statement here.