- Email: [email protected]
Youth and Tobacco Use: Nurses Take a Stand
Department
www.jpedhc.org
Legislation and Health Policy
Section Editor Karen G. Duderstadt, MS, RN, PNP University of California— San Francisco School of Nursing, Family Health Care San Francisco, California
Youth and Tobacco Use: Nurses Take a Stand Kelly Buettner-Schmidt, RN, MS
Kelly Buettner-Schmidt, is Principal Investigator of the Tobacco Education, Research and Policy Project (TERPP), Department of Nursing, Minot State University, Minot, North Dakota. Reprint requests: Kelly Buettner-Schmidt, RN, MS, Memorial Hall 535, 500 University Ave West, Minot State University, Minot, ND 58707; e-mail: [email protected]. J Pediatr Health Care. (2005). 19, 396399. 0891-5245/$30.00 Copyright © 2005 by the National Association of Pediatric Nurse Practitioners. doi:10.1016/j.pedhc.2005.09.006
396
Volume 19 • Number 6
INTRODUCTION Tobacco use remains the leading cause of death in the United States (U.S. Department of Health and Human Services [USDHHS], 2004; Mokdad, Marks, Stroup, & Gerberding, 2004), including nonsmokers exposed to secondhand smoke (SHS). Youth are at the greatest risk for the initiation of tobacco use. Experimentation and initiation into tobacco use by youth often leads to addiction, adult smoking, morbidity, and early mortality. Healthy People 2010 identified tobacco use as one of the 10 leading health indicators. Twenty-one tobacco-specific related objectives were developed by Healthy People 2010 with a primary focus on population-based interventions (USDHHS, 2000). Ten objectives address youth directly. Additionally, strategies that reduce adult tobacco use impact social norms, leading to decreased youth tobacco use and decreased exposure to SHS. IMPACT OF TOBACCO USE AND SHS ON YOUTH The health impacts of tobacco use are greater than previously thought; nearly all the body’s organs are affected by smoking. On average, smokers die 13.8 years earlier than nonsmokers and in general have a decreased health status. Youths who smoke have
more respiratory illness, impaired lung growth, chronic coughing, and wheezing and are typically less physically fit (USDHHS, 2004). Secondhand smoke causes significant harm to nonsmokers, including not only cancers but also heart disease morbidity and mortality, and other smoking-related diseases. In children, exposure causes acute lower respiratory tract infections, asthma induction and exacerbation, chronic respiratory symptoms, middle ear infections, and other respiratory illnesses (National Cancer Institute [NCI], 1999). Exposure to SHS and its effects are entirely preventable. After decades of efforts, smoking rates decreased among high school students from 1997 to 2003 (Centers for Disease Control [CDC], 2004). However, a lack of significant declines were noted from 2000 to 2002 in both middle school and high school students (CDC, 2005a). Additionally, while legal protections from exposure to SHS in workplaces and public places have increased, a “substantial portion of U.S. nonsmokers” remain exposed (CDC, 2005b). Efforts to decrease the initiation of tobacco use and exposure to SHS need to continue, building on the momentum of successful and evidence-based strategies, to improve the health of our youth and the nation. Journal of Pediatric Health Care
FIGURE 1. A conceptual approach to tobacco prevention and control. Reprinted with permission from Hopkins, D.P., Briss, P. A., Richard, C. J., et al. (2001). Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine, 20, 16-66. Copyright 2001, American Journal of Preventive Medicine.
EVIDENCE-BASED PREVENTION STRATEGIES Evidence-based strategies have been identified to reduce tobacco use, particularly youth smoking. The Task Force on Community Preventive Services conducted a systematic review of populationfocused strategies and interventions to address the morbidity and mortality of tobacco use. The Task Force published a report on evidence-based prevention strategies, “The Guide to Community Preventative Services: What Works to Promote Health,” also known as the Community Guide is available at www.communityguide.org (Task Force on Community Preventive Service [Task Force], 2005). Figure 1 presents a conceptual approach to tobacco prevention and control and strategies for interventions. Several broad strategies and evidence-based interventions were identified in the Community Guide. Of the recommended interventions, three impact youth smoking and rely on legislative or policy action (Box 1). Journal of Pediatric Health Care
Increasing the Unit Price for Tobacco Products Youth are very sensitive to the cost of tobacco. Increasing the unit price for tobacco by 10% results in a corresponding decrease in youth smoking that ranges from 2% (Task Force, 2005) to 6 –7% (Campaign for Tobacco-Free Kids ([CTFK], 2005a). Additionally, increasing the price of tobacco products reduces overall consumption (Task Force, 2005). Typically, the method of increasing the unit price of tobacco is through increasing taxes on tobacco products, primarily at the state level, either through the state legislative process or via a carefully strategized, well-financed voter initiative/referendum campaign. If the income created by the tobacco tax is directed towards comprehensive tobacco prevention and cessation programs, the impact on the rates of morbidity and mortality caused by tobacco use can be improved. Historically, this intervention has been vehemently opposed by the tobacco in-
dustry and their allies as it affects profits. Several states have already passed a cigarette tax increase. Only 10 states have not increased cigarette taxes since 2002: California, Florida, Iowa, Mississippi, Missouri, North Carolina, North Dakota, South Carolina, Wisconsin, and Texas. Interestingly, the average state tax on cigarettes is 91.2 cents per pack, with major tobacco growing states at 21.5 cents per pack and non-tobacco growing states at 100.5 cents per pack (CTFK, 2005b). Smoking Bans and Restrictions Smoking bans and restrictions alter society’s view of tobacco use from a socially acceptable adult behavior to the recognition that SHS exposure is harmful and a potentially deadly toxin. Limiting the venues where smoking is allowed changes the social norm, changes the way youth view tobacco use, and ultimately decreases the rates of youth initiation into tobacco November/December 2005 397
BOX 1. Recommended interventions that rely on legislative or policy action 1) increasing the unit price for tobacco products (strong evidence of effectiveness); 2) smoking bans and restrictions (strong evidence of effectiveness); and 3) restricting minors’ access to tobacco products when combined with other interventions (sufficient evidence of effectiveness).
use. Additionally, this strategy will reduce overall cigarette consumption (Task Force, 2005). Total indoor smoking bans are preferred over restrictions. Even the best ventilation system in designated smoking areas or rooms does not provide full protections from SHS (Repace, Kawachi, & Glantz, 1999). The scope of the smoke-free movement has advanced. The current goal for local or state law is to protect all people through requiring 100% smoke-free workplaces and public places. Currently, there are nearly 2000 municipalities with some level of local legal protection from SHS; nearly 400 of these require 100% smoke-free environments either in workplaces and/or restaurants and/or bars. Additionally, 12 states have laws requiring 100% smoke-free workplaces and/or restaurants and/or bars, with two more states having laws that will go into effect before the end of 2005 (Americans for Nonsmokers Rights, 2005). Opposition, while often formally not the major tobacco companies, is vocal and politically influential through typical industry allies and front groups. Restricting Minors’ Access to Tobacco Products Addressing youth access as an individual intervention has insufficient evidence to be recom398 Volume 19 • Number 6
mended at this time. Community mobilization when combined with other interventions has sufficient evidence, but not strong evidence of effectiveness, in restricting youth access to tobacco. Addressing youth access via legislation at the state or local level, which includes restricting retailer sales of tobacco to minors and/or restricting youth possession, purchase, or use of tobacco products, has been found to decrease the rate of illegal sales to youth by approximately 34% (Task Force, 2005). Once again, passage of these laws has historically been opposed by the tobacco industry and allies, especially tobacco retailers and their associations.
TOBACCO INDUSTRY STRATEGIES Tobacco industry opposition strategies are numerous and often effective. Typical opposition strategies include discrediting research, organizing and developing smokers’ rights and business front groups, promoting ineffective alternatives, mounting legal challenges, and passing preemptive legislation (NCI, 2000). Direct quotes from the industry and opposition strategy descriptions can be found at www.tobaccofreekids. org and www.no-smoke.org. Some states or communities cannot move forward on policy or legislation as they are “preempted” from doing so. Preemptive legislation typically occurs at a state level and restricts local communities from enacting laws on specific topics. One Healthy People 2010 objective is to eliminate preemption of tobacco control laws (USDHHS, 2000). In the area of smoke-free laws, virtually no progress has been made since 1999. In 1999, 17 states were preempted from passing local smoke-free laws stronger than the state laws; although some states repealed preemption, other state legislatures enacted preemption, resulting in 19 states having
preemptive laws in 2004 (CDC, 2005c). ADVOCACY AND THE ROLE OF NURSES The role of nursing and the power of nurse advocacy to decrease youth smoking and improve the health of our nation should not be underestimated. Nursing has a social obligation to be involved in public policy. The American Nurses Association in the Nursing’s Social Policy Statement (2003) identifies an essential feature of professional nursing as the “influence on social and public policy to promote social justice” (page 5). Individual nurses and nursing organizations can seek out collective action opportunities via participation on tobacco coalitions or by joining the many voluntary organizations, such as The Nightingales, a nurse advocacy group focused on the role of the tobacco industry in contributing to the global epidemic of tobacco-related disease and death. The Nightingales have partnered with teenagers from Essential Action, an organization that assists in developing global partners on public health issues, in demonstrations at the annual Philip Morris/Altria shareholders’ meetings. They provide advocacy-oriented presentations and education about the tobacco industry aimed at ending tobacco advertising and promotion. The group welcomes nurses and nursing students interested in taking on Big Tobacco.
BOX 2. Resources for nurses Tobacco Free Nurses (www. tobaccofreenurses.org) is a website to help nurses themselves quit smoking and has resources to assist nurses in being more effective in helping others. Helping Smokers Quit is a free downloadable HHS guide for nurses on the website.
Journal of Pediatric Health Care
For more information, visit www. nightengalesnurses.org. The role of nursing and the power of nurse advocacy to improve the health of our nation should not be underestimated. Every nurse has the professional responsibility and social mandate to advocate for clients. This responsibility and obligation extends beyond advocating for individual clients only and includes advocacy for local, state, and national legislation and policies, including those that may decrease the initiation of smoking and the deadly impact of tobacco use on the nation’s youth (American Nurses Association, 2003). REFERENCES American Nurses Association. (2003). Nursing’s social policy statement. (2nd ed.). Washington, DC: Author. Americans for Nonsmokers’ Rights. (2005). Overview list: How many smokefree laws? Retrieved August 15, 2005, from http://www.no-smoke.org/pdf/ mediaordlist.pdf. Campaign for Tobacco Free Kids. (2005a). Raising cigarette taxes reduces smoking, especially among kids (and the cigarette companies know it). Retrieved August 15, 2005, from http:// www.tobaccofreekids.org/research/ factsheets/pdf/0146.pdf.
Campaign for Tobacco-Free Kids. (2005b). State cigarette excise tax rates & rankings. Retrieved August 15, 2005, from http://www.tobaccofreekids.org/ research/factsheets/pdf/0097.pdf. Centers for Disease Control & Prevention. (2004). Cigarette smoking among high school students: United States, 1991– 2003. [Electronic Version]. Morbidity and Mortality Weekly Report, 2004, 53(23). Centers for Disease Control and Prevention. (2005a). Tobacco use, access, and exposure to tobacco in media among middle and high school students: United States, 2004. [Electronic Version]. Morbidity and Mortality Weekly Report, 2005, 54(12). Centers for Disease Control and Prevention. (2005b). State smoking restrictions for private-sector worksites, restaurants, and bars: United States, 1998 and 2004. [Electronic Version]. Morbidity and Mortality Weekly Report, 2005, 54(26). Centers for Disease Control and Prevention. (2005c). Preemptive state smoke free indoor air laws: United States, 1999 – 2004. [Electronic Version]. Morbidity and Mortality Weekly Report, 2005, 54(10). Hopkins, D. P., Briss, P. A., Richard, C. J., Husten, C. G., Carande-Kulis, V. G., Fielding, J. E., Alao, M.O., McKenna, J. W., Sharp, D. J., Harris, J. R., Woollery, T. A., Harris, K. W., & Task Force on Community Preventive Services. (2001). Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine, 20, 16-66.
Mokdad, A. H., Marks, J. S., Stroup, D. F. & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. Journal of the American Medical Association, 291,1238-1245. National Cancer Institute. (1999). Health effects of exposure to environmental tobacco smoke: The report of the California Environmental Protection Agency. Smoking and tobacco control monograph no. 10. (NIH Publication. No. 994645). Bethesda, MD: Author. National Cancer Institute. (2000). State and local legislative action to reduce tobacco use. Smoking and tobacco control monograph no. 11. (NIH Publication. No. 004804). Bethesda, MD: Author. Repace, J., Kawachi, I., & Glantz, S. (1999). Fact sheet on secondhand smoke. Paper presented at 2nd European Conference on Tobacco or Health. [Electronic Version]. Retrieved August 25, 2005, from http://www.repace. com/SHSFactsheet.pdf. Taskforce on Community Preventative Services. (2005). The Guide to Community Preventative Services: What Works to Promote Health. New York: Oxford University Press. U.S. Department of Health and Human Services. (2004). The health consequences of smoking: A report of the Surgeon General. Rockville, MD: Author. U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office.
WANTED: CHILDREN’S DRAWINGS The Journal is interested in publishing children’s drawings of their responses to illness, treatment, or encounters with the health care system or personnel. Please enclose the child’s assent/consent and parental consent to have the drawing published and commented on when you submit the drawing. Please send the drawing, along with the child’s age, gender, and pertinent information regarding the child’s condition, and the written consents, to: Bobbie Crew Nelms, PhD, RN, CPNP 3133 Barbara St San Pedro, CA 90731
Journal of Pediatric Health Care
November/December 2005 399
www.jpedhc.org
Legislation and Health Policy
Section Editor Karen G. Duderstadt, MS, RN, PNP University of California— San Francisco School of Nursing, Family Health Care San Francisco, California
Youth and Tobacco Use: Nurses Take a Stand Kelly Buettner-Schmidt, RN, MS
Kelly Buettner-Schmidt, is Principal Investigator of the Tobacco Education, Research and Policy Project (TERPP), Department of Nursing, Minot State University, Minot, North Dakota. Reprint requests: Kelly Buettner-Schmidt, RN, MS, Memorial Hall 535, 500 University Ave West, Minot State University, Minot, ND 58707; e-mail: [email protected]. J Pediatr Health Care. (2005). 19, 396399. 0891-5245/$30.00 Copyright © 2005 by the National Association of Pediatric Nurse Practitioners. doi:10.1016/j.pedhc.2005.09.006
396
Volume 19 • Number 6
INTRODUCTION Tobacco use remains the leading cause of death in the United States (U.S. Department of Health and Human Services [USDHHS], 2004; Mokdad, Marks, Stroup, & Gerberding, 2004), including nonsmokers exposed to secondhand smoke (SHS). Youth are at the greatest risk for the initiation of tobacco use. Experimentation and initiation into tobacco use by youth often leads to addiction, adult smoking, morbidity, and early mortality. Healthy People 2010 identified tobacco use as one of the 10 leading health indicators. Twenty-one tobacco-specific related objectives were developed by Healthy People 2010 with a primary focus on population-based interventions (USDHHS, 2000). Ten objectives address youth directly. Additionally, strategies that reduce adult tobacco use impact social norms, leading to decreased youth tobacco use and decreased exposure to SHS. IMPACT OF TOBACCO USE AND SHS ON YOUTH The health impacts of tobacco use are greater than previously thought; nearly all the body’s organs are affected by smoking. On average, smokers die 13.8 years earlier than nonsmokers and in general have a decreased health status. Youths who smoke have
more respiratory illness, impaired lung growth, chronic coughing, and wheezing and are typically less physically fit (USDHHS, 2004). Secondhand smoke causes significant harm to nonsmokers, including not only cancers but also heart disease morbidity and mortality, and other smoking-related diseases. In children, exposure causes acute lower respiratory tract infections, asthma induction and exacerbation, chronic respiratory symptoms, middle ear infections, and other respiratory illnesses (National Cancer Institute [NCI], 1999). Exposure to SHS and its effects are entirely preventable. After decades of efforts, smoking rates decreased among high school students from 1997 to 2003 (Centers for Disease Control [CDC], 2004). However, a lack of significant declines were noted from 2000 to 2002 in both middle school and high school students (CDC, 2005a). Additionally, while legal protections from exposure to SHS in workplaces and public places have increased, a “substantial portion of U.S. nonsmokers” remain exposed (CDC, 2005b). Efforts to decrease the initiation of tobacco use and exposure to SHS need to continue, building on the momentum of successful and evidence-based strategies, to improve the health of our youth and the nation. Journal of Pediatric Health Care
FIGURE 1. A conceptual approach to tobacco prevention and control. Reprinted with permission from Hopkins, D.P., Briss, P. A., Richard, C. J., et al. (2001). Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine, 20, 16-66. Copyright 2001, American Journal of Preventive Medicine.
EVIDENCE-BASED PREVENTION STRATEGIES Evidence-based strategies have been identified to reduce tobacco use, particularly youth smoking. The Task Force on Community Preventive Services conducted a systematic review of populationfocused strategies and interventions to address the morbidity and mortality of tobacco use. The Task Force published a report on evidence-based prevention strategies, “The Guide to Community Preventative Services: What Works to Promote Health,” also known as the Community Guide is available at www.communityguide.org (Task Force on Community Preventive Service [Task Force], 2005). Figure 1 presents a conceptual approach to tobacco prevention and control and strategies for interventions. Several broad strategies and evidence-based interventions were identified in the Community Guide. Of the recommended interventions, three impact youth smoking and rely on legislative or policy action (Box 1). Journal of Pediatric Health Care
Increasing the Unit Price for Tobacco Products Youth are very sensitive to the cost of tobacco. Increasing the unit price for tobacco by 10% results in a corresponding decrease in youth smoking that ranges from 2% (Task Force, 2005) to 6 –7% (Campaign for Tobacco-Free Kids ([CTFK], 2005a). Additionally, increasing the price of tobacco products reduces overall consumption (Task Force, 2005). Typically, the method of increasing the unit price of tobacco is through increasing taxes on tobacco products, primarily at the state level, either through the state legislative process or via a carefully strategized, well-financed voter initiative/referendum campaign. If the income created by the tobacco tax is directed towards comprehensive tobacco prevention and cessation programs, the impact on the rates of morbidity and mortality caused by tobacco use can be improved. Historically, this intervention has been vehemently opposed by the tobacco in-
dustry and their allies as it affects profits. Several states have already passed a cigarette tax increase. Only 10 states have not increased cigarette taxes since 2002: California, Florida, Iowa, Mississippi, Missouri, North Carolina, North Dakota, South Carolina, Wisconsin, and Texas. Interestingly, the average state tax on cigarettes is 91.2 cents per pack, with major tobacco growing states at 21.5 cents per pack and non-tobacco growing states at 100.5 cents per pack (CTFK, 2005b). Smoking Bans and Restrictions Smoking bans and restrictions alter society’s view of tobacco use from a socially acceptable adult behavior to the recognition that SHS exposure is harmful and a potentially deadly toxin. Limiting the venues where smoking is allowed changes the social norm, changes the way youth view tobacco use, and ultimately decreases the rates of youth initiation into tobacco November/December 2005 397
BOX 1. Recommended interventions that rely on legislative or policy action 1) increasing the unit price for tobacco products (strong evidence of effectiveness); 2) smoking bans and restrictions (strong evidence of effectiveness); and 3) restricting minors’ access to tobacco products when combined with other interventions (sufficient evidence of effectiveness).
use. Additionally, this strategy will reduce overall cigarette consumption (Task Force, 2005). Total indoor smoking bans are preferred over restrictions. Even the best ventilation system in designated smoking areas or rooms does not provide full protections from SHS (Repace, Kawachi, & Glantz, 1999). The scope of the smoke-free movement has advanced. The current goal for local or state law is to protect all people through requiring 100% smoke-free workplaces and public places. Currently, there are nearly 2000 municipalities with some level of local legal protection from SHS; nearly 400 of these require 100% smoke-free environments either in workplaces and/or restaurants and/or bars. Additionally, 12 states have laws requiring 100% smoke-free workplaces and/or restaurants and/or bars, with two more states having laws that will go into effect before the end of 2005 (Americans for Nonsmokers Rights, 2005). Opposition, while often formally not the major tobacco companies, is vocal and politically influential through typical industry allies and front groups. Restricting Minors’ Access to Tobacco Products Addressing youth access as an individual intervention has insufficient evidence to be recom398 Volume 19 • Number 6
mended at this time. Community mobilization when combined with other interventions has sufficient evidence, but not strong evidence of effectiveness, in restricting youth access to tobacco. Addressing youth access via legislation at the state or local level, which includes restricting retailer sales of tobacco to minors and/or restricting youth possession, purchase, or use of tobacco products, has been found to decrease the rate of illegal sales to youth by approximately 34% (Task Force, 2005). Once again, passage of these laws has historically been opposed by the tobacco industry and allies, especially tobacco retailers and their associations.
TOBACCO INDUSTRY STRATEGIES Tobacco industry opposition strategies are numerous and often effective. Typical opposition strategies include discrediting research, organizing and developing smokers’ rights and business front groups, promoting ineffective alternatives, mounting legal challenges, and passing preemptive legislation (NCI, 2000). Direct quotes from the industry and opposition strategy descriptions can be found at www.tobaccofreekids. org and www.no-smoke.org. Some states or communities cannot move forward on policy or legislation as they are “preempted” from doing so. Preemptive legislation typically occurs at a state level and restricts local communities from enacting laws on specific topics. One Healthy People 2010 objective is to eliminate preemption of tobacco control laws (USDHHS, 2000). In the area of smoke-free laws, virtually no progress has been made since 1999. In 1999, 17 states were preempted from passing local smoke-free laws stronger than the state laws; although some states repealed preemption, other state legislatures enacted preemption, resulting in 19 states having
preemptive laws in 2004 (CDC, 2005c). ADVOCACY AND THE ROLE OF NURSES The role of nursing and the power of nurse advocacy to decrease youth smoking and improve the health of our nation should not be underestimated. Nursing has a social obligation to be involved in public policy. The American Nurses Association in the Nursing’s Social Policy Statement (2003) identifies an essential feature of professional nursing as the “influence on social and public policy to promote social justice” (page 5). Individual nurses and nursing organizations can seek out collective action opportunities via participation on tobacco coalitions or by joining the many voluntary organizations, such as The Nightingales, a nurse advocacy group focused on the role of the tobacco industry in contributing to the global epidemic of tobacco-related disease and death. The Nightingales have partnered with teenagers from Essential Action, an organization that assists in developing global partners on public health issues, in demonstrations at the annual Philip Morris/Altria shareholders’ meetings. They provide advocacy-oriented presentations and education about the tobacco industry aimed at ending tobacco advertising and promotion. The group welcomes nurses and nursing students interested in taking on Big Tobacco.
BOX 2. Resources for nurses Tobacco Free Nurses (www. tobaccofreenurses.org) is a website to help nurses themselves quit smoking and has resources to assist nurses in being more effective in helping others. Helping Smokers Quit is a free downloadable HHS guide for nurses on the website.
Journal of Pediatric Health Care
For more information, visit www. nightengalesnurses.org. The role of nursing and the power of nurse advocacy to improve the health of our nation should not be underestimated. Every nurse has the professional responsibility and social mandate to advocate for clients. This responsibility and obligation extends beyond advocating for individual clients only and includes advocacy for local, state, and national legislation and policies, including those that may decrease the initiation of smoking and the deadly impact of tobacco use on the nation’s youth (American Nurses Association, 2003). REFERENCES American Nurses Association. (2003). Nursing’s social policy statement. (2nd ed.). Washington, DC: Author. Americans for Nonsmokers’ Rights. (2005). Overview list: How many smokefree laws? Retrieved August 15, 2005, from http://www.no-smoke.org/pdf/ mediaordlist.pdf. Campaign for Tobacco Free Kids. (2005a). Raising cigarette taxes reduces smoking, especially among kids (and the cigarette companies know it). Retrieved August 15, 2005, from http:// www.tobaccofreekids.org/research/ factsheets/pdf/0146.pdf.
Campaign for Tobacco-Free Kids. (2005b). State cigarette excise tax rates & rankings. Retrieved August 15, 2005, from http://www.tobaccofreekids.org/ research/factsheets/pdf/0097.pdf. Centers for Disease Control & Prevention. (2004). Cigarette smoking among high school students: United States, 1991– 2003. [Electronic Version]. Morbidity and Mortality Weekly Report, 2004, 53(23). Centers for Disease Control and Prevention. (2005a). Tobacco use, access, and exposure to tobacco in media among middle and high school students: United States, 2004. [Electronic Version]. Morbidity and Mortality Weekly Report, 2005, 54(12). Centers for Disease Control and Prevention. (2005b). State smoking restrictions for private-sector worksites, restaurants, and bars: United States, 1998 and 2004. [Electronic Version]. Morbidity and Mortality Weekly Report, 2005, 54(26). Centers for Disease Control and Prevention. (2005c). Preemptive state smoke free indoor air laws: United States, 1999 – 2004. [Electronic Version]. Morbidity and Mortality Weekly Report, 2005, 54(10). Hopkins, D. P., Briss, P. A., Richard, C. J., Husten, C. G., Carande-Kulis, V. G., Fielding, J. E., Alao, M.O., McKenna, J. W., Sharp, D. J., Harris, J. R., Woollery, T. A., Harris, K. W., & Task Force on Community Preventive Services. (2001). Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine, 20, 16-66.
Mokdad, A. H., Marks, J. S., Stroup, D. F. & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. Journal of the American Medical Association, 291,1238-1245. National Cancer Institute. (1999). Health effects of exposure to environmental tobacco smoke: The report of the California Environmental Protection Agency. Smoking and tobacco control monograph no. 10. (NIH Publication. No. 994645). Bethesda, MD: Author. National Cancer Institute. (2000). State and local legislative action to reduce tobacco use. Smoking and tobacco control monograph no. 11. (NIH Publication. No. 004804). Bethesda, MD: Author. Repace, J., Kawachi, I., & Glantz, S. (1999). Fact sheet on secondhand smoke. Paper presented at 2nd European Conference on Tobacco or Health. [Electronic Version]. Retrieved August 25, 2005, from http://www.repace. com/SHSFactsheet.pdf. Taskforce on Community Preventative Services. (2005). The Guide to Community Preventative Services: What Works to Promote Health. New York: Oxford University Press. U.S. Department of Health and Human Services. (2004). The health consequences of smoking: A report of the Surgeon General. Rockville, MD: Author. U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office.
WANTED: CHILDREN’S DRAWINGS The Journal is interested in publishing children’s drawings of their responses to illness, treatment, or encounters with the health care system or personnel. Please enclose the child’s assent/consent and parental consent to have the drawing published and commented on when you submit the drawing. Please send the drawing, along with the child’s age, gender, and pertinent information regarding the child’s condition, and the written consents, to: Bobbie Crew Nelms, PhD, RN, CPNP 3133 Barbara St San Pedro, CA 90731
Journal of Pediatric Health Care
November/December 2005 399