Protecting Children From Tobacco, Nicotine, and Tobacco Smoke

October 28, 2015

Webinar Presenters

• Karen Wilson, MD, MPH, FAAPChair, AAP Section on Tobacco Control

• James Baumberger, MPPAssistant Director, AAP Department of Federal Affairs

Protecting Children From Tobacco, Nicotine, and Tobacco Smoke

Karen Wilson, MD, MPH, FAAPChair, AAP Section on Tobacco Control

2009 Policy Statement

“Tobacco Use: A Pediatric Disease”

“Clinical Practice Policy to Protect Children

From Tobacco, Nicotine, and Tobacco

Smoke”

“Public Policy to Protect Children From Tobacco, Nicotine, and

Tobacco Smoke”

2015 Policy Statements

A lot Has Happened in 6 Years!

• Evidence of early nicotine dependence in teens

• Documented benefits of smoke-free air laws (vehicles, multi-unit housing, outdoor air, indoor air)

• Evolution of technology

• Federal Action on Tobacco Control

• E-cigarettes

• Section on Tobacco Control

Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke

New Topics Discussed• Lasting harm to fetus• Thirdhand smoke• Expansion of EHR • 2As + R

Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke

New Topics Discussed• More prevalent use of alternative products• Dual use• Media influence (social media, movies)• Tobacco 21

Protecting Children From Tobacco, Nicotine, and Tobacco Smoke

• Technical Report for both policy statements

• Document and grade harm caused by tobacco– Strong– Good– Fair

• Document and grade evidence for clinician and policy maker actions– Strong Recommendation– Recommendation– Option– No Recommendation

Electronic Nicotine Delivery Systems

• New Policy Statement

• Overview of science, threat to child health

• Recommendations to clinicians, policy makers

Key Themes

• In utero tobacco exposure increases risk of adverse fetal outcomes and can have long lasting adverse health effects for the child.

• Even brief advice can increase smoking cessation rates.

• Implement systems to identify and offer counseling, treatment, treatment recommendations, and/or referral for tobacco-dependent parents.

• Although adolescent tobacco use in the United States has decreased substantially since the 1970s, it remains a considerable problem.

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

• It is imperative that policy makers at the international, national, state, and local levels allocate resources and take action.

Tobacco 21

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

ENDS- Key Themes

• ENDS companies have marketed their products with claims of being “healthier” and “safer” than conventional cigarettes; these claims have not been scientifically validated.– ENDS do not emit merely “harmless water vapor”– ENDS should not be recommended for smoking cessation

• Children should not be exposed to ENDS or ENDS solution, including ENDS aerosol– Clinicians should be familiar with symptoms of nicotine

poisoning

• Reduce youth access to and demand for ENDS– Purchase age– Flavor prohibitions– Sales– Advertising and Media depictions– Tax

Age of Tobacco Purchase

Prohibits tobacco purchase until age 21

Prohibits tobacco purchase until age 19

E-Cigarette Laws

Includes e-cigarettes in state Clean Indoor Air laws

Prohibits sale of e-cigarettes to minors under 18

Prohibits sale of e-cigarettes to minors and includes e-cigarettes in Clean Indoor Air laws

Child-Resistant Packaging on Liquid Nicotine Products

Requires child-resistant packaging on liquid nicotine products

AAP Division of State Government Affairs Resources

www.aap.org/stateadvocacy

AAP Division of State Government Affairs

800.433.9016, x 7799

stgov@aap.org

www.aap.org/stateadvocacy

Summary

• “Tobacco is unique among consumer products in that it severely injures and kills when used exactly as intended.”

• Tobacco is still a pediatric disease.

Resources• AAP Policy Statements- bitly.com/AAPpolicy

– Tobacco coding fact sheet (with ICD-10, e-cigarette info)– Fact sheets– E-cigarette infographic– Tobacco Prevention Policy Tool– Talking points (AAP login required)– Policy Issue briefs

• AAP Section on Tobacco Control- aap.org/sotco– Membership free for AAP members– $20 for non-members– Help shape Academy policy and education

Public Policy to Protect Children from Tobacco, Nicotine, and Tobacco Smoke:

Opportunities for Federal Advocacy

James Baumberger, MPPAssistant Director

AAP Department of Federal Affairs

October 28, 2015Washington, DC

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.

Recommendations

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.

Recommendations

Tobacco Control Act• Family Smoking Prevention and Tobacco Control Act of 2009:

Broad authority for the FDA to regulate tobacco• Immediate authority over cigarettes and smokeless tobacco• FDA required to “deem” additional tobacco products subject

to its authority through rulemaking• E-cigarettes, liquid nicotine, cigars, hookah, etc. remain

outside of FDA authority

ImmediateAuthority:

No Authority Without FDA Rulemaking:

“Deeming” Rule• April 2011: FDA starts work on developing “deeming” rule• April 2014: FDA published proposed rule• October 2015: Final rule arrives at White House for final

review

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.

Recommendations: What’s in “Deeming”✔

✔

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.

Recommendations: What’s Not in “Deeming”

✘✘

✘

✘

FDA Regulation• AAP actions:

• Urged the Administration to move faster• Submitted comments on the proposed rule, urging additional

policies in the rulemaking to protect child health

• What you can do:• Call the White House at 202-456-1111 and ask them to act now to

protect children from tobacco products through FDA regulation• Email that White House here: http://bit.ly/1Wg9ZeQ

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.

Recommendations

Preventing Liquid Nicotine Poisoning• July 2015: FDA published request for comments on

• Child-resistant packaging• Nicotine exposure warnings

• Congress considering Child Nicotine Poisoning Prevention Act (S. 142/H.R. 3242) to require Consumer Product Safety Commission-enforced child-resistant packaging

• AAP actions:• Urged action by the FDA on poisoning• Led 44 groups in letter to FDA in response to request

for comments• Championed and endorsed S. 142/H.R. 3242

• What you can do:• Email your members of Congress, ask them to

co-sponsor S. 142 and H.R. 3242• AAP members: federaladvocacy.aap.org

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.

Recommendations

Tobacco to 21 Act

• October 2015: Tobacco to 21 Act (S. 2100/H.R. 3656) introduced to raise national tobacco purchase age from 18 to 21

• AAP actions:• Championed and endorsed

S. 2100/H.R. 3656

• What you can do:• Contact your members of Congress and

ask them to co-sponsor the Tobacco to 21 Act

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.

Recommendations

Smoke-free Public Housing• May 2015: White House received HUD proposal on smoke-free public housing• AAP actions:

• Encouraged HUD to move forward• Met with White House to urge action

• What you can do:• Upon publication of proposed rule, submit comments

Questions?

Artwork by Jacqueline M. © 2013 American Academy of Pediatrics (AAP) Children's Art Contest. Support for the 2009, 2010, and 2013 AAP Children’s Art Contest was from the Flight Attendant Medical Research Institute.