This technical report provides the evidence base for the accompanying tobacco clinical report and policy statement. It builds on, strengthens, and expands AAP recommendations from the previous version in 2015. Tobacco use remains the leading preventable cause of disease and death for adults in the United States. The tobacco epidemic takes a substantial toll on children's and adolescent's health, including harms because of prenatal exposure during pregnancy, secondhand and thirdhand exposure during infancy and childhood, and/or direct use during adolescence. Tobacco and nicotine use almost always starts in childhood or adolescence. Almost 40% of children aged 3 to 11 years are regularly exposed to secondhand tobacco smoke, and rates of secondhand exposure to e-cigarette aerosol have increased over the last decade.

Tobacco use remains the leading preventable cause of disease and death for adults in the United States. Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. However, rates of e-cigarette and similar device use among youth are high, and rates of other tobacco product use, such as cigars and hookahs, have not declined. Public policy actions to protect children and adolescents from tobacco and nicotine use, as well as tobacco smoke and aerosol exposure, have proven effective in reducing harm. Effective public health approaches need to be both extended to include e-cigarettes, similar devices, and other and emerging tobacco products and expanded to reduce the toll that the tobacco epidemic takes on children and adolescents.

Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. However, rates of e-cigarette and similar device use among youth are high, and rates of other tobacco product use, such as cigars and hookahs, have not declined. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of secondhand exposure to e-cigarette aerosol have increased over the last decade. Pediatricians are uniquely positioned to help children, adolescents, and their families live tobacco-free lives. Actions by pediatricians can help reduce children's risk of developing tobacco and nicotine use disorder and reduce children's tobacco smoke and/or aerosol exposure.