Denormalization of Tobacco Use and the Role of the Pediatric Health-Care Provider

Denormalization is an array of actions implemented to induce and reinforce the public perception of a health-compromising behavior as socially unacceptable. Active and second-hand tobacco use has substantial adverse effects on children's health. Tobacco has been marketed by associating its use with glamor, success, athleticism, and independence. Strategies for denormalization of tobacco use are designed to influence social norms to promote reduction of smoking behavior in our society. The social ecological model provides the theoretical framework on which these activities are based. Changing social norms about tobacco control requires a multilevel perspective that considers additive and interrelated effects on several levels from the patient to the community. Models for changing social norms about tobacco have focused on reducing tobacco marketing, counter-marketing, restricting smoking in public places, reducing tobacco availability, and supporting tobacco dependence treatment services. As advocates for children's health, pediatricians can and should promote denormalization of tobacco use in their physician patient communications, personal examples set, and in public policy advocacy activities. Pediatric health-care providers can promote denormalization of tobacco use through the following strategies: serve as a role model for a tobacco-free lifestyle, routinely address tobacco issues with pediatric patients, and provide treatment and/or referrals for tobacco prevention and cessation resources. Beyond the clinic, pediatric professionals can support tobacco-free ordinances in their communities and participating in state and national tobacco control campaigns. Wherever possible, training of medical students, residents, fellows, and other pediatric professionals in tobacco counseling and advocacy would contribute to further resources for denormalization of tobacco.