Introduction to the Special Issue: Tobacco Control Strategies for Medically At-Risk Youth

Tobacco use and exposure to secondhand smoke (SHS) are significant behavioral health problems that can result in a range of well-documented negative health consequences for children and adolescents (Gold et al., 1996; Prokhorov, Emmons, Pallonen, & Tsoh, 1996; US Department of Health and Human Services [USDHHS], 2000). The American Academy of Pediatrics (AAP) has issued a number of policy statements in the past 5 years that have identified tobacco prevention and cessation as well as SHS reduction as issues that are crucial to children’s health (AAP, 2001; Winickoff, Hillis, Palfrey, Perrin, & Rigotti, 2003b). Likewise, current national health objectives (Healthy People 2010) include reducing the initiation of tobacco use among children and adolescents, increasing cessation attempts by current smokers, and reducing the proportion of youngsters who are regularly exposed to tobacco smoke in the home (Centers for Disease Control and Prevention [CDC], 2004; USDHHS, 2000). The most recent US Surgeon General’s report has also brought the topic of children’s involuntary exposure to SHS to the national forefront once again (USDHHS, 2006). Although these are important health objectives for all children, they are especially important for children with a chronic illness, whose risks for tobacco-related health problems are magnified because of their vulnerable health status. Disease and treatment-related complications and toxicities that accompany many childhood chronic illnesses are likely to be exacerbated by cigarette smoking and exposure to SHS. High-risk groups include, but are not limited to children with medical conditions including asthma, cancer, cancer survivors, cystic fibrosis, diabetes, and those with elevated cardiovascular risk factors. There is a critical need to examine and evaluate tobacco prevention and control efforts for medically at-risk children and adolescents, as the estimates of morbidity and mortality attributable to tobacco use and SHS exposure in these vulnerable populations are likely significant. Investigators from a broad array of disciplines, with research agendas in tobacco control and health promotion, were invited to submit manuscripts for this special issue. Authors were selected that represented a balanced, yet broad cross-section of expertise in that they worked with children across different disease groups as well as healthy children. No forum has existed, to date, for the purpose of providing an exchange of information among researchers conducting tobacco-related studies with pediatric populations. Clearly, there are gaps in existing knowledge and a lack of focus on critical issues that could significantly advance the field. The articles presented in this special series provide a critical evaluation of the medical, psychological, behavioral, and public health aspects of tobacco control initiatives for children with chronic medical conditions and identify challenges for future pediatric tobacco control research. The goal of this issue was to expand tobacco control research efforts beyond the primary medical settings to medically at-risk children treated in specialty clinics. The articles in this series are organized around four content areas: (a) developmental and psychosocial aspects of cigarette smoking onset and prevention; (b) smoking cessation; (c) reduction of SHS exposure; and (d) outcomes/endpoints for tobacco trials and related measurement issues. This special issue provides evidence of scientific progress to date in these respective areas and also addresses future tobacco initiatives. Several recurrent