Journal of Pediatric Health Care
Volume 24, Issue 2 , Pages A13-A14, March 2010

NAPNAP Position Statement on Prevention of Tobacco Use and Effects in the Pediatric Population

Article Outline

 

The National Association of Pediatric Nurse Practitioners (NAPNAP) firmly supports the prevention of exposure to and use of tobacco in children of all ages and believes that pediatric health care providers can play a vital role in these efforts. Tobacco use, smoke and smokeless, and second-hand smoke exposure are associated with serious health hazards for young people. Tobacco use remains the leading cause of preventable morbidity and mortality in the United States, resulting in more than 1200 deaths each day or 443,000 deaths per year and an annual cost of more than $96 billion in health care expenditures. Nationally, smoking results in more than 5.1 million years of potential life lost each year (Centers for Disease Control and Prevention, 2008).

Environmental tobacco smoke (ETS) exacts a heavy toll on the health and well-being of unborn fetuses, infants, children, and adolescents (Hymovitz et al., 2005). Adverse health effects in infants have been linked to pre- and postnatal exposure to tobacco smoke in their homes. Such effects include sudden infant death syndrome, preterm delivery, and reduction in birth weight. Middle ear disease, cough, wheezing, increased severity of asthma, and reduced lung function in school-aged children also are associated with parental smoking (Fagnano et al., 2008, Gerald et al., 2009, United States Department of Health and Human Services, 2006). Children and adolescents who are exposed to smokers in their household are three times more likely to initiate smoking themselves (Winickoff et al., 2005). More than 5000 children die yearly as a result of tobacco smoke exposure (three times the number of deaths caused by all childhood cancers) (Winickoff et al., 2005).

Reducing tobacco use is a shared responsibility of federal, state, and local governments, the public health community, the health care system, the private sector, and individual communities (Eriksen, Green, Husten, Pedersen, & Pechacek, 2007). The Institute of Medicine (IOM) has called for an end to the disease epidemics caused by tobacco use through system interventions including implementation of smoking restrictions and smoking bans, increase in cigarette taxes, licensure and monitoring of cigarette outlets, restrictions in advertising, and government regulation of tobacco products and packaging (IOM, 2007). Full implementation of best practice guidelines (Fiore et al., 2008) and research-based interventions could accelerate the reduction in tobacco use among youth and adults; prevent disease, disability, and death; increase productivity; and lower health care costs (IOM, 2007).

Pediatric health care providers play an important role in reducing tobacco use through individualized clinical interventions for smoking cessation (Fiore et al., 2008) and system-level strategies that reduce tobacco smoke exposure. Current recommendations include education and counseling on harms of tobacco smoke exposure, screening and treatment of all tobacco users, documenting smoking status, providing advice to quit smoking, and assisting clients with smoking cessation strategies (Fiore et al., 2008). System-level strategies include support of initiatives to raise tobacco taxes and protect non-smokers through comprehensive policies in the community or state for smoke-free environments. Public and private insurance coverage for treatment, funding to develop and support sustainable media campaigns that facilitate quitting, and robust patient support programs also are needed (Fiore et al., 2008). Federal control and regulation of tobacco products is necessary to reduce the morbidity and mortality related to tobacco use (Husten, 2008).

NAPNAP strives to protect all children from negative effects of tobacco use and exposure through advocacy, educational efforts, treatment, and research by:

•Supporting all state and national level legislation and/or regulatory efforts that curb advertisement and sale of tobacco products targeted at children, adolescents, and young adults; aim to reduce environmental tobacco smoke exposure; and control and regulate all tobacco products to decrease morbidity and mortality related to tobacco use and tobacco smoke exposure.

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

•Working within all school communities to provide input into policies aimed to achieve tobacco- and smoke-free environments.

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

•Encouraging pediatric health care providers 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.

•Encouraging pediatric health care providers to counsel caregivers about the risks to the child related to parental smoking, including the facts about the risks to the child from second-hand smoke and exposure to nicotine from clothing, hair, and furniture.

•Encouraging pediatric health care provider educational programs to include tobacco prevention and tobacco cessation strategies in the curriculum.

•Encouraging pediatric health care providers to continually update their skills in tobacco prevention and smoking cessation strategies.

•Providing smoking cessation interventions including evaluation, education, and counseling (Woody, DeCristofaro, & Carlton, 2008).

NAPNAP is the professional organization representing pediatric nurse practitioners who are advanced practice nurses providing pediatric care and who promote optimal health for children through leadership, practice, advocacy, education, and research. NAPNAP sees the onset of tobacco use as a pediatric issue that will continue to affect the health and welfare of children and families. Additionally, NAPNAP takes a strong stance against all tobacco use and exposure in children and supports efforts aimed at tobacco prevention in children.

The National Association of Pediatric Nurse Practitioners would like to acknowledge the contribution of the following individuals to the 2009 revision of this statement: Julie Novak, DNSc, MA, RN, CPNP ; Yvonne Yousey, PhD, CPNP; Dolores C. Jones, EdD, RN, CPNP, CAE (Staff); Heather Keesing, MSN, RN, APRN (Staff).

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References 

  1. Centers for Disease Control and Prevention . Smoking—attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. Morbidity and Mortality Weekly Report. 2008;57(45):1226–1228
  2. Eriksen MP, Green LW, Husten CG, Pedersen LL, Pechacek TF. Thank you for not smoking: The public health response to tobacco-related mortality in the United States. In:  Ward JW,  Warren C editor. Silent victories: The history and practice of public health in twentieth-century America. New York: Oxford University Press; 2007;p. 423–436
  3. Fagnano M, Conn KM, Halterman JS. Environmental tobacco smoke and behaviors of inner-city children with asthma. Ambulatory Pediatrics. 2008;8(5):288–293
  4. Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence clinical practice guideline: 2008 update. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 2008;
  5. Gerald LB, Gerald JK, Gibson L, Patel K, Zhang S, McClure LA. Changes in environmental tobacco smoke exposure and asthma morbidity among urban school children. Chest. 2009;135(4):911–916
  6. Husten C. Tobacco use: Ending the epidemic. MEDSURG Nursing. 2008;17(5):345–354
  7. Hymovitz N, Schwab J, Haddock CK, Pyle S, Moore G, Meshberg S. The pediatric resident training on tobacco project: Baseline findings from the Parent/Guardian Tobacco Survey. Preventative Medicine. 2005;41:334–341
  8. Institute of Medicine . Ending the tobacco problem: A blueprint for the nation. Washington, DC: National Academies Press; 2007;
  9. United States Department of Health and Human Services . The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006;
  10. Winickoff JP, Berkowitz AB, Brooks K, Tanski SE, Geller A, Thomson C, et al. State-of-the-art interventions for office-based parental tobacco control. Pediatrics. 2005;115:750–760
  11. Woody D, DeCristofaro C, Carlton B. Smoking cessation readiness: Are your patients ready to quit?. Journal of American Academy of Nurse Practitioners. 2008;20(8):407–414

 Adopted by the National Association of Pediatric Nurse Practitioners' Executive Board on October 3, 2009. This statement replaces the 2004 NAPNAP Position Statement on Prevention of Tobacco Use and Effects in the Pediatric Population.

 All regular position statements from the National Association of Pediatric Nurse Practitioners automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

 Correspondence: NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633.

PII: S0891-5245(09)00319-8

doi:10.1016/j.pedhc.2009.10.004

Journal of Pediatric Health Care
Volume 24, Issue 2 , Pages A13-A14, March 2010

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