Tobacco use and secondhand tobacco-smoke (SHS) exposure are major national and international health concerns. Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with tobacco-use prevention and treatment. Understanding the nature and extent of tobacco use and SHS exposure is an essential first step toward the goal of eliminating tobacco use and its consequences in the pediatric population. The next steps include counseling patients and family members to avoid SHS exposures or cease tobacco use; advocacy for policies that protect children from SHS exposure; and elimination of tobacco use in the media, public places, and homes. Three overarching principles of this policy can be identified: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) the financial and political power of individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional decisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Recommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and play environments, both inside and outside, (2) treatment of tobacco use and dependence through employer, insurance, state, and federal supports, (3) implementation and enforcement of evidence-based tobacco-control measures in local, state, national, and international jurisdictions, and (4) financial and systems support for training in and research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults.

ABSTRACT. Background. As outlined in the Newborn Screening Task Force report published in August 2000, the newborn screening system is more than just testing, but also involves follow-up, diagnosis, treatment, and evaluation. As such, multiple professional and public partners need to be adequately involved in the system to help ensure success. In addition, newborn screening programs are state-based; therefore, policies and procedures vary from state to state. Historically, there has been little uniformity between state newborn screening programs.Objective. To examine the communication practices of state newborn screening programs in the United States, particularly in relation to the medical home.Methods. A facsimile survey of program staff in all US newborn screening programs. Survey data were collected in August 2000.Results. All 51 programs participated. States were questioned about whether or not they had a procedure to identify the infant's medical home before the child's birth. Twelve states (24%) indicated that there was a procedure in place, whereas 39 states (76%) indicated that either no procedure existed or that they were unsure. In contrast, all state programs (except 1) indicated they notified the primary care physician about abnormal results and the need for follow-up. In addition, state programs reported that primary care physicians have responsibilities within the newborn screening system, particularly related to communicating with parents about screen-positive results and coordinating the collection of a second specimen. Thirty states reported that they directly notified parents of screen-positive infants of results and the need for follow-up as well.In regard to informing parents about newborn screening, 45% of states indicated that primary care physicians had some responsibility in informing parents about newborn screening. Most often, parents were informed about newborn screening just before specimen collection, and the most commonly used techniques to educate parents were informational brochures and conversation.Thirty-five states reported that they engaged in longterm tracking of infants after diagnosis confirmation. Only about half of these states provided long-term tracking of all of the conditions included in their state's newborn screening test panel. Of these 35 states that engaged in long-term tracking, 25 reported that they requested patient information from the primary care physician and/or subspecialist about ongoing treatment and follow-up.Conclusions. Newborn screening roles and responsibilities vary tremendously between states. Improvements in communication and better-defined protocols are needed, particularly between state newborn screening programs and the medical home. Many states identified the medical home as having significant responsibilities related to the short-term follow-up of screenpositive infants. Identification of the correct medical home before testing would help to reduce unnecessary time and frustration for state newborn screening programs, especially in the fol...

OBJECTIVES. Visual disorders among preschool-aged children are common, yet screening is infrequent. The purpose of this project was to implement the vision screening recommendations proposed by the Maternal and Child Health Bureau and National Eye Institute Vision Screening in the Preschool Child Task Force: monocular visual acuity and stereopsis testing.METHODS. Four sites fully participated in the implementation of the task force recommendations with 3-and 4-year-old children. Two of the sites worked with primary care practices (testing performed by staff); 2 worked with communitybased programs (testing performed by lay volunteers). Each site tracked number of children screened by age, as well as proportion testable, referred, and with documented follow-up evaluation.RESULTS. Variations in implementation of the recommendations were observed. Successful screening among 3-year-olds ranged from 70% to 93%; referral rates were 1% to 41%, and follow-up rates were 29% to 100%. Successful screening among 4-year-olds ranged from 88% to 98%; referral rates were 2% to 40%, and follow-up rates were 41% to 100%. The proportion of 3-year-olds who were treated was significantly different between the community-based sites (n ϭ 20) and the primary care sites (n ϭ 2). Similarly, the proportion of 4-year-olds who were treated was significantly different between the community-based sites (n ϭ 36) and the primary care sites (n ϭ 11).CONCLUSIONS. The variability across pilot sites in numbers successfully screened and numbers referred suggests that all aspects of preschool vision screening need thorough review before the goal of universal preschool vision screening can be realized. 5 In a joint policy statement with the AAO, the AAPOS, and the American Association of Certified Orthoptists, the AAP recommended that physical inspection of eye functioning and overall eye health begin at birth and that "objective evaluation" of acuity be initiated by 3 years of age. 6 As many as 34 states have endorsed programs for vision screening to improve the rates of preschool vision screening. 7,8 However, there is state-to-state variability regarding whether the programs are mandated, as well as how they are implemented. In addition, studies in primary care settings indicate that few preschool-aged children are screened for vision problems. [9][10][11] In 1998, the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), collaborated with the National Eye Institute (NEI), National Institutes of Health (NIH), and various national and state agencies to review research and policies related to vision screening in preschool-aged children. The specific mission was to determine "useful screens to efficiently detect amblyopia risk factors and other significant problems" and "to provide and evaluate the practicality and effectiveness of ocular screening services for young children, including photoscreening technology." An expert panel, the MCHB/NEI Preschool Vision Screening Task Force, was convened in Septem...