AAP Voices Blog

I am old enough to remember when smoking was ubiquitous. From restaurants to airplanes to my grandmother’s house, the smell of cigarette smoke lingered everywhere. Then a shift occurred. Tobacco settlements, anti-smoking policies, and effective campaigns changed the narrative. Smoking became stigmatized, recognized as a detrimental habit with well-known health risks. As a young pediatrician, I rarely encountered teenage smokers, and as a mother, my children were oblivious to the concept of smoking. It was a public health triumph.

However, the landscape shifted again with the rise of vaping. It started with products like JUUL, and now it seems like there is a new vape shop at every strip center I pass. Initially marketed as harmless, many teenagers embraced vaping without understanding its harm. I had several patients tell me, “But I’m just vaping flavored water.” Suddenly, I found myself treating a 17-year-old patient who came to me after a hospitalization from a lung injury due to vaping, a 16-year-old patient who woke up with headaches every morning because he was going into nicotine withdrawal every night, and a 15-year-old patient who asked me what I thought about these new Zyn nicotine pouches.

It is easy for trends like this to make me feel despondent. The tobacco and vaping industries have deep pockets and highly addictive products. Nevertheless, as pediatricians, we're committed to confronting this challenge head-on. We've succeeded in the past, and we can do so again.

The American Academy of Pediatrics (AAP) offers a clear roadmap through its A-C-T model: Act to promote youth tobacco cessation.

Ask: We must routinely inquire about nicotine and vaping usage during every clinical encounter with pre-teen and teen patients.

Counsel: Offering guidance and support to youth who use these products, encouraging them to quit and setting achievable goals. If they are using, have them set a quit date within two weeks.

Treat: Providing comprehensive treatment, including behavioral support and, when appropriate, pharmacological interventions. Behavioral support may include programs such as Quitlines or text to quit programs.

Transitioning from an era of low teen tobacco use to grappling with the vaping epidemic has been a learning curve for many of us. Thankfully, the AAP provides valuable resources to aid in this endeavor. One particularly useful tool is the web-based decision support system, assisting pediatricians in crafting effective counseling and treatment strategies for patients struggling with nicotine addiction.

Despite the frustration of revisiting this issue, my memories from medical school of patients suffering from smoking-related illnesses serve as a poignant reminder of our mission in pediatrics: disease prevention. Let's rally together, commit to the work, and ACT to prevent and treat tobacco product use among our youth. It's a struggle we've dealt with before, and with determination and unity, it's one we can effectively handle again.