Active and passive tobacco exposure: a serious pediatric health problem. A statement from the Committee on Atherosclerosis and Hypertension in Children, Council on Cardiovascular Disease in the Young, American Heart Association.

This review defines the substantial pediatric morbidity from tobacco use, including health effects on the cardiovascular system, the respiratory system, the fetus and newborn, and risk-taking behaviors of adolescents. More recent research suggests effects may extend to other areas, including reports that cigarette smoking decreases breast milk production in mothers, byproducts of tobacco use are transmitted in breast milk, exposure to passive smoking may alter children's intelligence and behavior, and passive smoke exposure in childhood may be a risk factor for developing lung cancer as an adult. Primary prevention is the most effective strategy to decrease the prevalence of smoking. Those who never smoke never become addicted to nicotine and never have to quit. Secondary prevention must also be emphasized, because children whose parents smoke are exposed to health risks and are themselves more likely to smoke in the future. Parental health can be improved by smoking cessation. To accomplish the goals of primary and secondary prevention, the aggressive public health strategy directed at both parents and children should be expanded. This strategy requires the strong support of physicians, with emphasis on prevention in practice, support of public health initiatives, medical and public policy, and the conduct of high-quality research.