The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth.

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.

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In epidemiologic studies of the relation between circumcision and sexually transmitted infections, it is necessary to rely on self-report of circumcision status. The purpose of this 2002 study in Houston, Texas, was to determine whether adolescent males could make correct self-reports. During physical examinations, adolescents were asked whether they were circumcised. The authors then examined the adolescents' genitalia. Circumcision status was recorded as complete (glans penis fully exposed), partial (glans partly covered), or uncircumcised (glans completely covered). The mean age of the 1,508 subjects was 15.0 (standard deviation, 1.63) years; 64% were Black, 29% Hispanic, and 7% White. Forty-nine percent had full, 1% partial, and 50% no circumcision. Of the 738 fully circumcised subjects, 512 (69%) considered themselves circumcised, 54 (7%) considered themselves uncircumcised, and 172 (23%) did not know. Of the 751 uncircumcised youth, 491 (65%) described themselves as uncircumcised, 27 (4%) reported being circumcised, and 233 (31%) did not know. The sensitivity of self-report among those who thought they knew their status was 90.5%, and the specificity was 94.8%; 27% did not know their status. In this population, self-report of circumcision status did not result in accurate information mainly because many adolescents were unsure of their status.

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