1. Protecting Children and Families from Tobacco: Setting your Tobacco Agenda Tobacco Advocacy and Policy Issues Susanne E. Tanski, MD, MPH Julius B. Richmond Center of Excellence AAP Tobacco Consortium Chair

2. Adolescent and Adult Smokers Know they are addicted and want to quitKnow they are addicted and want to quit Many have tried to quit without successMany have tried to quit without success Younger smokers less likely to think there are resources to helpYounger smokers less likely to think there are resources to help Many clinicians feel unprepared to helpMany clinicians feel unprepared to help With advice, most parents say they would be able to set strict smoking policies

3. Evidence-based best practices Increase price/taxation of tobacco Smoking bans and restrictions Counseling – reframe expectations of successCounseling – reframe expectations of success –5A’s - Ask, Advise, Assess, Assist and Arrange –Strict No Smoking Rules - Smoke-free homes and cars Availability of treatment –Reduced cost for pharmacotherapy treatment –Provider reminder systems –Telephone/web counseling and support Mass media counter-marketing campaigns

4. Community and public health Make tobacco control for children and families a priority –Include secondhand smoke –Headstart, schools, housing, etc. Age of sale restrictions and enforcement Advertising limitations

5. Community and public health Public smoke exposure reduction Smoke Free Housing/Smoke Free Public Housing Reduce social acceptability of smoking Do not allow preemptive efforts by tobacco industry Smokefree Movies

7. .05.1.15.2.25.3 Incidence, Ever Tried Smoking 050100150200250 Number of Smoking Occurrences Seen (50 movies) N = 4538 Smoothed Curve of Incident Smoking VS. Exposure to Movie Smoking at Baseline U.S. Sample Overall Incidence = 0.12

9. NCI Monograph 2008

11. Page 357 NCI 2008 Conclusion: the First Statement of Causality

12. WHO 2011 endorsed NCI’s statement of causality

13. U.S. Surgeon General 2012 Report: Tobacco Use among Youth and Young Adults 920 page evidence review of tobacco use among US youth Chapter 5 conclusion: “The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people.”

14. Smoke Free Movies Rate new smoking movies "R" Certify no pay-offs Require strong anti-smoking ads Stop identifying tobacco brands

15. Artwork by Eun Mi A.© 2009 American Academy of Pediatrics (AAP) Children's Art Contest. Support for the 2009 and 2010 AAP Children's Art Contest was from the Flight Attendant Medical Research Institute.