Protecting Children and Families from Tobacco:

Setting your Tobacco Agenda Tobacco Advocacy and Policy Issues

Susanne E. Tanski, MD, MPHJulius B. Richmond Center of Excellence

AAP Tobacco Consortium Chair

Adolescent and Adult SmokersAdolescent and Adult Smokers

• Know they are addicted and want to quitKnow they are addicted and want to quit

• Many have tried to quit without success Many have tried to quit without success

• Younger smokers less likely to think there Younger smokers less likely to think there are resources to helpare 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

Evidence-based best practices

• Increase price/taxation of tobacco

• Smoking bans and restrictions

• Counseling – reframe expectations of successCounseling – reframe expectations of success– 5A5A’’s - Ask, Advise, Assess, Assist and Arranges - Ask, Advise, Assess, Assist and Arrange– Strict No Smoking Rules - Smoke-free homes and carsStrict 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

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

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

.05

.1.1

5.2

.25

.3

Incid

en

ce,

Ever

Tri

ed

Sm

okin

g

0 50 100 150 200 250

Number of Smoking Occurrences Seen (50 movies)

N = 4538

Smoothed Curve of Incident Smoking VS. Exposure to Movie Smoking at BaselineU.S. Sample

Overall Incidence = 0.12

NOTE: Weights are from random effects analysis

.Overall Estimate

Meta-analysis. Smoking in Movies Studies

Combined Estimate, Cross-Sectional Studies6 Country E.U.7

1.84 (1.66, 2.04)

1.53 (0.84, 2.79)

2.50 (1.70, 3.50)

1.70 (1.16, 2.63)

1.19 (1.01, 1.40)

2.00 (1.30, 3.10)

2.23 (1.19, 4.17)

1.74 (1.41, 2.15)

1.39 (0.69, 2.80)

1.00 (0.60, 1.50)

2.60 (1.70, 4.10)

1.91 (1.35, 2.70)

2.70 (1.10, 6.60)

1.97 (1.75, 2.22)

ES (95% CI)

1.70 (1.40, 2.00)

1.66 (1.37, 2.01)

1.98 (1.35, 2.90)

1.40 (0.95, 2.10)1.80 (1.20, 2.70)

2.28 (1.34, 3.87)

2.71 (1.73, 4.25)

2.30 (1.50, 3.60)

1.72 (1.38, 2.16)

2.20 (1.80, 2.80)

1.73 (1.55, 1.93)

2.00 (1.55, 2.47)

2.70 (1.50, 4.70)

100.00

2.32

4.49

3.90

7.75

%

3.63

2.17

23.94

1.82

3.39

3.57

4.68

1.20

41.92

Weight

7.48

7.24

4.22

4.043.94

2.78

3.48

3.59

34.13

6.71

8.63

6.49

2.50

1.84 (1.66, 2.04)

1.53 (0.84, 2.79)

2.50 (1.70, 3.50)

1.70 (1.16, 2.63)

1.19 (1.01, 1.40)

2.00 (1.30, 3.10)

2.23 (1.19, 4.17)

1.74 (1.41, 2.15)

1.39 (0.69, 2.80)

1.00 (0.60, 1.50)

2.60 (1.70, 4.10)

1.91 (1.35, 2.70)

2.70 (1.10, 6.60)

1.97 (1.75, 2.22)

ES (95% CI)

1.70 (1.40, 2.00)

1.66 (1.37, 2.01)

1.98 (1.35, 2.90)

1.40 (0.95, 2.10)1.80 (1.20, 2.70)

2.28 (1.34, 3.87)

2.71 (1.73, 4.25)

2.30 (1.50, 3.60)

1.72 (1.38, 2.16)

2.20 (1.80, 2.80)

1.73 (1.55, 1.93)

2.00 (1.55, 2.47)

2.70 (1.50, 4.70)

100.00

2.32

4.49

3.90

7.75

%

3.63

2.17

23.94

1.82

3.39

3.57

4.68

1.20

41.92

Weight

7.48

7.24

4.22

4.043.94

2.78

3.48

3.59

34.13

6.71

8.63

6.49

2.50

2.01.0

Mexico

U.S., National SampleU.S., Northern New England

India (Bollywood)

Germany

Glasgow, ScotlandBristol, U.K

Cross-sectional Studies, Smoking Onset

.

U.S. National Sample (A, ES, L)

U.S., Texas (Mexican-American)U.S., National Sample

Scotland (YA, CC)

Mexico

Mexico (A, CS, L

U.S. Internet Sample (YA, CS, CC)

Progression of Smoking

U.S., Northern New England (ages 10-14)Longitudinal Studies, Smoking Onset

Germany

Mexico (A, CS, CC)Germany (A, CS, CC)

U.S., North Carolina (Whites only)

U.S., Northern New England (ages 6-8)

U.S. Northern New England (YA, ES, L)

Combined Estimate, Longitudinal Studies

Combined Estimate, Progression

Risk Estimate for High vs. Low Exposure to Movie Smoking*

NCI MonographNCI Monograph20082008

Page 357

NCI 2008 Conclusion: the First Statement of Causality

WHO 2011endorsed NCI’s

statement of causality

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.”

Smoke Free Movies Smoke Free Movies

• Rate new smoking movies "R"

• Certify no pay-offs

• Require strong anti-smoking ads

• Stop identifying tobacco brands

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.