The American Academy of Pediatrics spent a good deal of ink in its journal Pediatrics this month tackling the important public health issue of childhood exposure to tobacco. What’s already known about direct (smoking) and indirect (secondhand and thirdhand) tobacco exposure comes from reams of scientific data collected over decades of social, biochemical, and clinical research: inhaling the smoke from burning tobacco will make you sick, shorten your life, and even kill you. Reading the abstract of this report from the AAP’s Section on Tobacco Control gives one the sense that pediatricians are done kidding around:

Tobacco use and tobacco smoke exposure are among the most important health threats to children, adolescents, and adults. There is no safe level of tobacco smoke exposure. The developing brains of children and adolescents are particularly vulnerable to the development of tobacco and nicotine dependence. Tobacco is unique among consumer products in that it causes disease and death when used exactly as intended. Tobacco continues to be heavily promoted to children and young adults. Flavored and alternative tobacco products, including little cigars, chewing tobacco, and electronic nicotine delivery systems are gaining popularity among youth.


Those are the facts. (The emphasis above is mine.) Here are some other facts the AAP wants you to know:

  • More than half of children in the United States are regularly exposed to tobacco smoke.
  • Tobacco use harms not only individual smokers and users of tobacco products, but also others who get exposed by secondhand and thirdhand exposure of tobacco smoke.
  • 90% of people who become nicotine-dependent are kids 18 and younger. (Non-smoking adults in their 20’s and older seldom look at cigarettes and say, “Yeah, that looks like a good idea.”)


Here is what we know from decades of medical studies in children:

  • There is no level of tobacco exposure which can be considered “safe.” Any exposure, at any level, threatens the health of children.
  • The harm to children begins in the fetus. Maternal exposure to direct or indirect tobacco smoke is known to cause preterm birth, low birth weight, miscarriage, and congenital malformations. Prenatal exposure is also associated with the development of childhood obesity.
  • Exposure to tobacco is associated with sudden infant death syndrome in young babies. (17% of SIDS cases are attributable to tobacco exposure.)
  • Neurocognitive deficits (including ADHD) and behavioral problems have been linked to in-utero and postnatal tobacco exposures.
  • Prenatal exposure to maternal smoking and childhood exposure to secondhand smoke increases the risk of developing asthma. Children suffer more frequent and more severe exacerbations of pre-existing asthma and other chronic lung diseases when exposed to secondhand smoke. Bronchiolitis, a common viral infection which affects mostly infants and toddlers, is a more severe illness in kids who breathe air contaminated by tobacco smoke.
  • The risk of children developing common childhood complications of simple viral colds, such as ear infections, sinus infections, and pneumonias is significantly higher when infants and children are exposed to tobacco smoke.
  • Pediatric exposure to tobacco smoke is a known high-risk factor for the development of cancers in children and adults.
  • Secondhand smoke exposure is associated with decreased kidney function and lung function, and is a factor in the premature development of atherosclerosis (which leads to later heart attacks and strokes) in adolescents.


The long list of policy and public health recommendations is comprehensive, clear, long-overdue, and strongly supported by the social, cultural, and scientific evidence presented in the report:

1. The FDA should regulate all tobacco products to protect the public health.

2. Tobacco control should be adequately funded.

3. Tobacco product advertising and promotion in forms that are accessible to children and youth should be prohibited.

4. Point-of-sale tobacco product advertising and product placement that can be viewed by children should be prohibited.

5. Depictions of tobacco products in movies and other media that can be viewed by youth should be restricted.

6. The promotion and sale of electronic nicotine delivery systems to youth should be prohibited.

7. Tobacco control programs should change the image of tobacco by telling the truth about tobacco.

8. Tobacco product prices should be increased to reduce youth tobacco use initiation.

9. The minimum age to purchase tobacco should be increased to 21 years.

10. Flavoring agents, including menthol, should be prohibited in all tobacco products.

11. Comprehensive smoking bans should be enacted.

12. Smoking in multi-unit housing should be prohibited.

13. Prohibitions on smoking and use of tobacco products should include prohibitions on use of electronic nicotine delivery systems.

14. Children younger than 18 years should be legally prohibited from working on tobacco farms and in tobacco production.

15. Concentrated nicotine solution for electronic nicotine delivery systems should be sold in child-resistant containers with amounts limited to that which would not be lethal to a young child if ingested.


On Friday, we’ll take a look at what the AAP has to say about “ENDS” — electronic nicotine delivery systems. None of it is complementary.