Tobacco and Smoking

Tobacco Use, Prevention and Cessation

Tobacco use (cigarettes, cigars, snuff, chewing tobacco, and other tobacco products) is documented as the leading preventable cause of death and illness in our nation. The number of deaths (more than 400,000 annually) caused by tobacco use is greater than the combined number of deaths due to AIDS, alcohol, automobile accidents, murders, suicides, drugs and fires.

Nicotine, a key ingredient in tobacco products, is an addictive drug. Tobacco use by and around children and adolescents is of particular concern due to increased risk for addiction and passive exposure. Smoking is a known cause of cancer, heart disease, stroke and chronic obstructive pulmonary disease. Special dangers exist for specific subpopulations of smokers such as pregnant women who suffer higher rates of spontaneous abortions, stillbirths, premature births and low birth weight babies.

The American Academy of Family Physicians strongly encourages all of its members and staff to personally avoid tobacco use. The AAFP urges its members to:

  • save lives by working toward elimination of all tobacco use;
  • document use of tobacco products in patient charts;
  • work cooperatively with other health professionals to provide cessation counseling and other treatments;
  • discourage tobacco use in all public and workplace settings; and,
  • list tobacco as a cause on death certificates when appropriate.

The AAFP acknowledges that some religious practices involve the ceremonial use of tobacco.

The AAFP has no direct association with organizations involved in the manufacture of tobacco products and urges its members to avoid such association.

The AAFP supports this policy by prohibiting the use of tobacco products in all AAFP buildings, at all meetings sponsored by the AAFP, and by physicians and staff representing the AAFP. The AAFP encourages constituent chapters to prohibit the use of tobacco products in their offices, and at constituent chapter sponsored meetings. Finally, the AAFP encourages the use of smoke free meeting and conference space whenever possible.

The Framework Convention on Tobacco Control (FCTC): Because of the devastating shift in tobacco-related morbidity, mortality, and health care costs projected to fall upon the world's developing nations, the AAFP joins WONCA and other healthcare organizations in support of the FCTC, the World Health Organization health treaty on tobacco control, and urges its ratification by the US Senate and signature by the President.

Tobacco Advertising: The AAFP opposes all forms of advertisement of tobacco products for human consumption especially the direct or indirect marketing of tobacco products to children. It commends sources that provide information on the hazards of smoking and tobacco products to the public, including the direct or indirect marketing of tobacco products to children. Whenever possible, the AAFP will place advertising material and develop relationships with publications that do not accept tobacco advertising. If advertising must be placed in publications that carry tobacco advertising, the publication must assure that adjoining page(s) do not promote tobacco or alcohol. The AAFP also urges removal of corporate tax deductions for the advertising of tobacco products.

The AAFP strongly supports labeling of all tobacco products warning potential users of health hazards and believes such labeling should be prominently displayed on packaging and advertisements with clear wording.

Community Education: The Academy recommends tobacco prevention and cessation programs, such as TAR WARS that discourage tobacco use, counter tobacco advertising, and teach skills to resist those influences, for all elementary and secondary students. The Academy urges members to become involved in teaching tobacco prevention and cessation programs within their schools and community.

Treatment of and Payment for Tobacco Use: The AAFP supports health plan coverage and appropriate payment for evidence-based physician services for treatment of tobacco use. The AAFP recommends that all tobacco users in the United States be aware of the existence of and have barrier-free access to all evidenced-based FDA-approved therapies and counseling as described in the US Public Health Service's 2008 update of the Clinical Practice Guideline: Treating Tobacco Use and Dependence, released May 2008.

Distribution and Sales: The AAFP recognizes that the majority of states have laws restricting the sale of cigarettes to minors and commends those states. It urges the federal government or all states to enact laws restricting the sale of tobacco products to individuals under the age of 18 and these laws be strictly enforced. The AAFP further urges legislation raising the legal age for the purchase of tobacco products from 18 to 21 years of age and requiring active enforcement of age-at-sale for tobacco purchases. The AAFP supports requiring that all tobacco products be placed behind sales counters in retail stores. It opposes the sale of cigarettes and tobacco products via the Internet and vending machines and supports legislation to ban such sales. Further, the Academy strongly opposes the promotional distribution of free cigarettes and tobacco products, supports legislation designed to prohibit such distribution, and urges that such laws be strictly enforced.

Sales of Tobacco Products by Facilities that Provide Health Care Services: Facilities that provide direct health care services, pharmacies, and related institutions are integral parts of our healthcare system, with the overt and/or implicit goal of improving the health of their patrons. The sale of tobacco products is an inherent conflict of interest for such facilities, given that tobacco use represents the leading cause of death in the United States and contributes greatly to the nation’s excess healthcare costs. Several Canadian provinces and the cities of San Francisco and Boston have banned the sales of tobacco products in retail pharmacies. The AAFP supports a ban on the sale of tobacco products in facilities that provide clinical patient care services, pharmacies, and retail outlets housing health clinics. The AAFP urges its constituent chapters to support state and local laws to this end, and the AAFP will advocate for federal legislation on this issue.

Food and Drug Administration (FDA) Regulation of Tobacco Products: Given that nicotine is an addictive drug, the FDA must have full jurisdiction over all tobacco products and nicotine delivery devices and be permitted to use the same procedures to regulate tobacco. Further, FDA decisions should be subject to the same standard of review that generally applies under the Food, Drug and Cosmetic Act. The tobacco industry should respond to the same regulatory forces that govern other similar industries and should not be able to choose the amount of regulation they accept. Further, the FDA should have authority to regulate the manufacture, sale, labeling, distribution and marketing of tobacco products and nicotine delivery devices including products such as nicotine water.

Health Care Facilities: The AAFP calls on its members to act in their local areas and hospitals to implement and enforce restrictions on tobacco use on hospital premises and other health care facilities making them tobacco-free premises with no designated smoking areas.

Medical Education: The AAFP strongly encourages all family physicians to participate in CME activities/programs related to prevention or cessation of tobacco use and provides current educational materials to members at www.askandact.org. All medical school and residency training programs should provide in-depth, effective education in prevention and cessation of tobacco use.

Passive Smoking: The AAFP strongly supports the prohibition of the use of tobacco products in all public places. Family physicians should advise their patients, especially those with cardiovascular diseases or other chronic disease, to avoid establishments that permit smoking and to request that family members do not smoke in the patient's home or vehicle. Family physicians should specifically address the problems of exposure of children to tobacco smoke, as well as encourage cessation of adult household members. The AAFP will urge all employers to provide smoke-free work and breaktime environments for their employees and incentives for employees who participate in cessation programs.

Smoking in Movies: The AAFP supports efforts to reduce the impact of smoking in movies on youth tobacco initiation, and calls on the film industry to adopt the following voluntary steps:

  1. Require movies containing scenes depicting smoking to have an “R” rating. The only exceptions should be when the presentation of tobacco clearly and unambiguously reflect the dangers and consequences of tobacco use or is necessary to represent the smoking of a real historical figure.
  2. Require producers to certify on screen that no one on the production received anything of value in consideration for using or displaying tobacco.
  3. Require strong anti-smoking ads before any movie with tobacco use, regardless of rating.
  4. Stop identifying tobacco brands.

Taxation and Subsidies: The AAFP recognizes that most states and the federal government tax cigarettes and believes that increasing taxes on tobacco provides a major disincentive to potential buyers, especially youth. The Academy encourages the development of health education programs funded by a dedicated tax on cigarettes. Further it strongly opposes all federal price support of the tobacco industry. The AAFP supports its state chapters as they seek to ensure that funds from the Master Settlement Agreement and/or excise taxes on tobacco products be used for tobacco prevention, cessation, education, and other elements of comprehensive tobacco control. Suggested spending levels from the Centers for Disease Control and Prevention’s “Best Practices for Comprehensive Tobacco Control Programs” should be followed in funding of these activities across the nation. (2003) (2009 COD)