Another Anti-Smoking Group Calls Smoking Around Children a Clear Form of Child Abuse

In a letter published recently in The Telegram (St. Johns), the Alliance for the Control of Tobacco (Newfoundland and Labrador) calls smoking around children a clear form of child abuse:

"High-profile instances of child abuse get attention — and certainly they should get attention — but it is, indeed, time to see smoking in vehicles and homes in the presence of children for what it really is: a clear form of child abuse. A recent report from the U.S. Surgeon General clearly states that there is no safe amount of secondhand smoke. The report indicates that breathing even a little secondhand smoke can be dangerous. Further to this, it states that children are more likely to have lung problems, ear infections and severe asthma from being around smoke, and secondhand smoke causes heart disease and lung cancer. ... The days of ignoring this form of child abuse should be no more."

The Rest of the Story

The major fallacy in the argument that smoking around children is a form of child abuse is that secondhand smoke does not necessarily cause harm to children - it increases the risk of ear infections, respiratory infections, and asthma. This failure by a number of anti-smoking groups to recognize the distinction between risk and harm is a dangerous one, and would lead to us categorizing as child abuse a wide range of parental behaviors - not just smoking.

A second fallacy in the argument is that the intention of the behavior is not viewed to be relevant. Child abuse is not being defined as knowingly inflicting harm upon a child, but as any behavior that increases health risk, whether the intention is to cause harm or not. This failure to distinguish between intentional infliction of harm and any exposure to increased risk is also dangerous.

What the Alliance for the Control of Tobacco is essentially arguing is that any time a parent exposes their child to an increased risk of health problems, that is child abuse. No harm need be done. Even a small increase in risk equates to child abuse.

By that definition, allowing a child to eat peanut butter prior to age 3, which is known to significantly increase the risk of potentially deadly peanut allergy, would be a clear form of child abuse. So would not breastfeeding an infant, which has been well-documented to decrease the risk of a host of medical problems. Allowing a child to play contact sports would also be child abuse. So would placing a child's car seat on the side of the back seat, rather than in the middle (the side locations significantly increase risk compared to the middle position).

Can you imagine a maternal and child health organization coming out and publicly suggesting that failing to breastfeed your child is a form of child abuse? Such a group would be instantly attacked and condemned. So should the Alliance for the Control of Tobacco for this particular statement.

The Alliance also fails to consider the fact that child abuse entails an intentional infliction of harm. If the harm occurs by accident or without knowledge of potential harm, it is not child abuse. For example, if you accidentally leave a bottle of vitamins on the kitchen table and a child swallows them, you will not be charged with child abuse. If you intentionally put a bottle of vitamins on the floor - hoping that the child will swallow them - that is child abuse. Consideration of the state of mind of the parent is critical to the definition of child abuse.

However, the Alliance is defining child abuse in a way that ignores the state of mind of the parent. If you smoke around your child, that is child abuse, regardless of whether you even know that secondhand smoke is potentially harmful to your child.

This, too, is a dangerous argument to make. Can you imagine a health organization calling on all parents who serve their kids nuts prior to age 2 to be treated as child abusers, even if those parents were not aware that this behavior increases the likelihood of serious allergies to nuts? They would be instantly attacked and condemned. So should the Alliance for the Control of Tobacco for this particular statement.

Interestingly, the Alliance seems to exempt from child abuse the intentional exposure of one's children to secondhand smoke produced by other smokers. If you smoke around your children, that is child abuse; however, if you bring your kids to a smoky restaurant, the Alliance is not suggesting that is child abuse. This exposes the weakness of their argument.

The rest of the story is that the anti-smoking movement is treading into dangerous territory. In our zeal to extract revenge on smokers, to punish them, and to condemn them, we are actually setting a dangerous precedent that could completely destroy parental autonomy. If policy makers actually listen to what these anti-smoking groups are saying, it will cause great harm to our children. But it will prevent ear infections!

Another Policy Maker Says Smoking Around Children is Child Abuse

According to a Fox News article, an Arizona state lawmaker has publicly stated that smoking in the vicinity of a child is child abuse. He offered that comparison as justification for a bill he has proposed which would ban smoking in cars with children.

According to the article: "An Arizona lawmaker has proposed making smoking in a vehicle with anyone 17 and younger a crime that can get drivers pulled over and lead to fines of $50 or more per child. 'We already protect children from child abuse,' said Rep. David Schapira, who is proposing the new law, the first bill filed in the House of Representatives in anticipation of the upcoming legislative session. 'I think if you are smoking in a vehicle, to me that is child abuse.'"

The Rest of the Story

While I have dealt with this issue in detail before, let me summarize the two main reasons why smoking around a child is not, and should not be considered, child abuse.

First, child abuse generally refers to actions that directly harm a child. While secondhand smoke increases the risk of adverse health outcomes, it does not directly and necessarily cause harm. There is an important difference between risk and harm. There are many behaviors that increase a child's risk for adverse health outcomes. However, we do not consider these to be child abuse because they do not directly and necessarily cause harm.

For example, feeding a child large portions of high-fat, greasy foods increases the child's risk of developing adverse health outcomes, such as obesity and its sequelae. Feeding a child large quantities of food containing trans-fats increases the risk for later cardiovascular disease. Allowing a child to play hockey increases that child's risk for severe head and neck injuries. Allowing a child to ride in a lawn tractor greatly increases the child's risk for loss of limbs.

But none of these behaviors are considered to be child abuse because they only increase risk. They do not directly and necessarily cause harm to the child.

In some rare circumstances, exposing a child to secondhand smoke could be construed as necessarily causing direct harm. For example, if a child has severe asthma that is known to be triggered by secondhand smoke, then exposing that child to secondhand smoke could reasonably be construed as causing harm. However, this is not the argument that Rep. Schapira is making. He is not restricting his definition of child abuse to such cases.

Second, child abuse is an act of volition. It occurs intentionally. You cannot really back into child abuse. The parent who beats their child is intentionally inflicting harm. It is intentional, by definition. If a child accidentally drops their child while playing with them, that is not child abuse. If the same parent drops the child intentionally, that is child abuse. The difference is intention, and that's perhaps the key element of child abuse.

The overwhelming majority of parents who expose their children to secondhand smoke are not intentionally trying to harm their kids. Many of them do not know that secondhand smoke is harmful. Many of them do not believe that secondhand smoke is harmful, even if they are aware of public health statements to the contrary. Others may understand that it can be harmful, but simply don't think that it will harm their particular children. Still others may have observed that it doesn't appear to cause health problems in their children based on exposure experiences in the past.

Again, smoking around a child who is known to have asthma which is triggered by secondhand smoke could be an exception to this. If a parent knows that smoking around their child is likely to trigger an asthma attack, then doing so can be reasonably considered to be an intentional act of abuse. But again, there is no restriction of Rep. Schapira's definition of child abuse to such a situation.

The rest of the story is that in order to be considered child abuse, smoking around children would have to: (1) necessarily and directly cause harm to all children who are exposed; and (2) be an intentional act conducted with awareness that the behavior will cause harm.

Neither of these two essential conditions is met. Thus, smoking around children is not and should not be considered to be child abuse.

I would like to close by suggesting that the failure of some lawmakers and a number of anti-smoking groups and advocates to appreciate this distinction not only results in a flawed definition of child abuse, but it is also dangerous. We cannot afford to lose our ability to differentiate between parental behaviors that intentionally vs. unintentionally cause harm to children. The actions of these lawmakers and advocates is working towards blurring that distinction and undermining our ability to make this differentiation.

I can only hope that some anti-smoking group - somewhere - will publicly condemn these efforts to define child abuse in a way that includes smoking around children -- other than the rare situation where a parent knows his or her child is an asthmatic who will suffer an attack if exposed to tobacco smoke.

I have not the slightest bit of hope that a U.S. anti-smoking group will do this, however. I believe that the thinking in tobacco control is so narrow that groups are unable to see any aspect of child welfare or any societal values other than whether or not kids are exposed to tobacco smoke.

New Zealand Health Group Calls Smoking By or Around Pregnant Women Child Abuse

A New Zealand health group - the Maori Heart Foundation - is arguing that smoking by or around a pregnant woman is child abuse.

The Foundation issued a press release yesterday which stated:

"Smoking during pregnancy, or smoking around a pregnant women is yet another form of child abuse, the Maori Heart Foundation Te Hotu Manawa Maori (THMM) said today. ... As an organisation, we'’ve looked at the definitions of child abuse, and there'’s no doubt in our mind that smoking during pregnancy, and smoking around your children constitutes physical abuse. When we look at legal and policy guidelines, it'’s very clear that smoking during pregnancy is abusive to children. Child Abuse means the harming (whether physically, emotionally or sexually) ill-treatment, abuse, neglect or deprivation of any child or young person. Physical Abuse is any act or acts that result in inflicted injury to a child or young person."

The Rest of the Story

There are a number of severe problems with this argument. First, it confuses the concepts of injury (harm) and risk. There is little doubt that smoking during pregnancy increases the risk of a number of adverse health conditions. But it doesn't necessarily cause harm. As the Foundation itself admits, physical abuse is an act that results in inflicted injury. Since smoking during pregnancy or around a pregnant woman does not usually inflict injury, it is not physical abuse.

It is important to recognize that by the Foundation's definition of child abuse, any woman who takes a drink of alcohol during pregnancy is a child abuser. There is strong evidence that alcohol use during pregnancy increases the risk of adverse health outcomes. Any woman who drives in a car during pregnancy is also a child abuser. Riding in a car increases the risk of injury and death. So does changing cat litter while pregnant, another form of child abuse according to the Maori Heart Foundation's definition. And I don't even want to talk about pregnant women who eat raw fish. That increases the risk of intestinal infection, which could cause adverse consequences that harm the fetus, and represents child abuse, according to the Foundation's definition.

You can see how dangerous this type of argument is. If we adopted such a definition here, as suggested by Action on Smoking and Health, Smokefree Pennsylvania, and a number of other anti-smoking groups and advocates (they have argued that smoking around a child is a form of child abuse), then any parent who allows their child to ride on a roller coaster is a child abuser. Letting your child play hockey is a serious form of child abuse. Parents of children who are allowed to play football are also child abusers, according to this argument.

A second problem with the argument is that it would treat people who smoke around children, or pregnant women who smoke, in the same way as people who beat their children. If we are unable to see a world of difference between these, then we have some serious problems that could truly put our children at risk. Ultimately, society addresses child abuse by removing children from the custody of their parents. Resorting to such an approach to deal with smoking would be a tragedy and would cause every bit as much harm to children as is being caused by tobacco smoke.

Third, the argument that smoking during pregnancy is child abuse rests on making and enforcing a societal decision, that must be accepted by all, that life begins at conception. This is the ultimate infringement upon personal freedoms and rights. It essentially destroys the autonomy of women, and ends the concept of abortion rights. It is a particularly dangerous and alarming sequela of the kind of argument that the Maori Heart Foundation is making.

A fourth flaw in the Foundation's argument is that child abuse and physical abuse are terms that generally imply an intent to cause harm. The action that causes the harm is the primary intention of the perpetrator.

For example, when someone beats a child, the primary intent of the action was to beat the child. It is not the case that hitting the child was a secondary, unfortunate side effect of some other primary action.

But in the case of smoking around a child or a fetus, it is not the primary intent of the alleged perpetrator of the "child abuse" to injure the child or fetus. The injury, if it does occur, happens as an unfortunate, unintended secondary consequence of the primary action, which was simply to smoke.

This is also why driving with kids in a car at 60 miles an hour on a crowded Los Angeles freeway is not child abuse, nor is changing a cat litter and getting toxoplasmosis, which can result in severe neonatal injury or death. The primary intention of the act of driving was not to injure a child, it was to get somewhere. Similarly, the primary intention of changing the cat litter was not to harm the neonate; it was to change the cat litter.

This is not the case with beating or sexually abusing a child, where the beating or the forced sex is the primary intent of the action, not a secondary, unintended consequence.

Apparently, those of us in tobacco control are unable to make these important distinctions. But we had better learn, and pretty quickly.

I hope that other anti-smoking groups will condemn this approach to the problem of smoking during pregnancy and exposure of children to secondhand smoke. But as I said earlier today, I'm not holding my breath.

Leading Physician in UK Calls Smoking in Cars with Children a Form of Child Abuse

Dr. Steve Field, a UK physician who is the chairman of the Royal College of General Physicians, has stated that smoking in a car with a child is a form of child abuse. He has also claimed that parental smoking kills more young children than all other forms of unintentional injuries.

According to an article at BBC News: "Parents who smoke in cars in front of small children are "committing a form of child abuse", a leading GP has said. Professor Steve Field, chairman of the Royal College of General Practitioners, has condemned society's attitudes to food, alcohol and cigarettes. In a letter to the Observer newspaper, he said parents had to take more responsibility for their children's health - and set a good example. He said irresponsible behaviour led to high levels of disease and early death. ... Professor Field, who represents 42,000 GPs across the UK, added: "I suppose the same people also smoke at home in front of their children. Evidence from the US indicates that more young children are killed by parental smoking than by all other unintentional injuries combined."

The Rest of the Story

I'm not aware that any significant number of young children are killed by parental smoking, much less more children than are killed by all other unintentional injuries combined. While secondhand smoke has been linked with deaths from sudden infant death syndrome, this affects infants - not young children. So the first problem is that Dr. Field is disseminating false, or at least very misleading information.

The second problem is that there are a number of severe problems with his argument that smoking in a car with a child is a form of child abuse.

First, this argument confuses the concepts of harm and risk. There is little doubt that secondhand smoke exposure during young childhood increases the risk of a number of adverse health conditions. But it doesn't necessarily cause harm. In contrast, child abuse is an act that results in inflicted injury - there is direct, immediate, and definite harm. Since smoking around a child does not usually inflict injury, it is not child abuse.

It is important to recognize that by Dr. Field's definition of child abuse, any woman who takes a drink of alcohol during pregnancy is a child abuser. There is strong evidence that alcohol use during pregnancy increases the risk of adverse health outcomes. Any woman who drives in a car with a child is also a child abuser. Riding in a car increases the risk of injury and death. So does changing cat litter while pregnant, another form of child abuse according to Dr. Field's logic. And I don't even want to talk about parents who serve their children raw fish. That increases the risk of intestinal infection, which could cause adverse consequences, and represents child abuse, according to Dr. Field's definition.

You can see how dangerous this type of argument is. If we adopted such a definition here, as suggested by Dr. Field, then any parent who allows their child to ride on a roller coaster is a child abuser. Letting your child play hockey is a serious form of child abuse. Parents of children who are allowed to play football are also child abusers, according to this argument.

A second problem with the argument is that it would treat people who smoke around children in the same way as people who beat their children. If we are unable to see a world of difference between these, then we have some serious problems that could truly put our children at risk. Ultimately, society addresses child abuse by removing children from the custody of their parents. Resorting to such an approach to deal with smoking would be a tragedy and would cause much more harm to children than is being caused by tobacco smoke in the first place.

A third flaw in Dr. Field's argument is that child abuse and physical abuse are terms that generally imply an intent to cause harm. The action that causes the harm is the primary intention of the perpetrator.

For example, when someone beats a child, the primary intent of the action was to beat the child. It is not the case that hitting the child was a secondary, unfortunate side effect of some other primary action.

But in the case of smoking around a child, it is not the primary intent of the alleged perpetrator of the "child abuse" to injure the child. The injury, if it does occur, happens as an unfortunate, unintended secondary consequence of the primary action, which was simply to smoke.

This is also why driving with kids in a car at 60 miles an hour on a crowded Los Angeles freeway is not child abuse, nor is changing a cat litter and getting toxoplasmosis, which can result in severe neonatal injury or death. The primary intention of the act of driving was not to injure a child, it was to get somewhere. Similarly, the primary intention of changing the cat litter was not to harm the neonate; it was to change the cat litter.

Hopefully, other physicians and anti-smoking groups worldwide will condemn these comments made by Dr. Field. Because if we are unable to differentiate between child abuse and exposure of children to secondhand smoke, we are going to end up causing far more harm to children's welfare than would be caused by secondhand smoke.

To be clear, I am not minimizing the hazardous effects of secondhand smoke exposure on children. However, equating this with child abuse minimizes the tragic effects of actual child abuse on its victims. It is an inappropriate, incorrect, insensitive, and irresponsible comparison.

ASH Serious About Charging Parents who Smoke Around Children with Child Abuse

In a letter sent to the editor of the New York Times and released on the Action on Smoking and Health (ASH) web site, ASH calls on physicians who suspect that parents of their pediatric patients are smoking in the presence of these children after being informed of the health risks be reported to authorities for investigation of child abuse.

The letter comes in response to a June 14 Wall Street Journal column by a pediatrician who argued that smoking around children is "a legal form of child abuse." The pediatrician writes: "I've had patients leave my practice because we've told them that they were harming their children's health and their own by smoking. ... I feel bad for the kids, but I don't miss dealing with their stubborn parents. I'd like to see what six months in a non-smoking foster home would do for the breathing of some of my pediatric asthma patients. Maybe that would be a wake-up call for their parents."

ASH writes: "Dr. Brewer writes very movingly about children brought to his office with serious breathing problems and other conditions caused by parents smoking around them, and says that talking -- even "a more assertive approach" -- often doesn't get them to change their behavior, which he characterizes as "a legal form of child abuse." It is!

We recommend that if talking doesn't work, physicians should file a formal complaint of suspected child abuse (or child neglect or reckless endangerment) the same as they would if a child were regularly being subjected to other toxic and carcinogenic substances like asbestos or benzene. Courts and social welfare agencies are beginning to react, and have issued thousands of orders prohibiting smoking in a car or home when a child is present.

The law not only requires physicians to report cases of suspected child abuse, but also shields them from legal liability for doing so."

The Rest of the Story

I have already discussed the numerous reasons why treating smoking around children as child abuse is a terrible idea and why it would cause irreparable harm to many kids, not the least of which is the fact that the ultimate remedy in child abuse proceedings - removal of children from their parents - would be a disastrous outcome for children exposed to secondhand smoke.

Here, I want to make several points. First, the argument that the pediatrician makes reveals exactly why ASH's recommendation, if heeded, is likely to harm childrens' health. He mentions that patients have left his practice because he has told them they were harming their children by smoking. Can you imagine what would happen if parents were to be reported to authorities for smoking around their children? They would be extremely reluctant to present to physicians for medical care for their kids. The action that ASH is recommending would essentially eliminate or severely limit access to needed health care for large numbers of the nation's children.

Second, it is quite scary to me that a physician is actually suggesting that kids should be removed from their parents as a health promotion intervention. There are lots of ways available to us in public health to motivate people to change health behaviors, but forcibly breaking up families and removing children from their parents is not one of them.

Third, you cannot have a "legal" form of child abuse. By definition, child abuse is illegal. So if you want to make smoking around children a form of child abuse, then by definition, smoking around children must be unlawful. If ASH is admitting that smoking around children is entirely lawful, then there is no argument that it should be reported to authorities as child abuse. It clearly is not. What ASH would have to argue is that smoking around children is actually not lawful under current child abuse law.

You can't have it both ways. You can't try to avoid being shunned by the public by arguing that you are not suggesting that smoking around children is unlawful, but then suggest to physicians that they should report parents who are complying with the dictates of law for child abuse.

The very fact that these groups acknowledge that smoking around children is lawful demonstrates the recognition by society that child abuse laws are not and were never intended to apply to widely recognized legal behaviors like smoking. We cannot and should not re-interpret laws in such a wild manner simply because some fanatical anti-smoking groups are unable to understand the attributes of child abuse.

Finally, it is important to note that ASH is actively pushing this aspect of the anti-smoking agenda. And that nobody in the anti-smoking movement is speaking out against them. This means that treating parents who smoke around their children as child abusers is now officially a part of the anti-smoking agenda. That's an agenda with which I don't want to be associated.

Anti-Smoking Organization Trying to Scare Smokers into Thinking They May Lose Custody of Their Children; Calls Smoking Near Children "Child Abuse"

"Smokers May Lose Custody of Children as a Result of New Study" boasts the headline of a press release issued by Washington, D.C.-based Action on Smoking and Health (ASH).

The release continues: "Decisions Already Denying Custody to Smoking Parent Likely to Multiply in Light of New Evidence of Harmfulness of Tobacco Smoke to Kids."

According to ASH, "parents who exposed children to tobacco smoke have in fact lost custody, and the release of this new study is likely to accelerate this trend... Any other condition or practice in homes which killed almost 300 children each year and made four million sick enough to require a doctor would be immediately condemned as a form of child abuse. ... such complaints [child abuse complaints] are warranted in many cases by existing law, and [ASH] urges physicians, school nurses, and even grandparents to file them where appropriate."

In another press release, ASH claims that: "Parental Smoking Kills 6,200 Kids Each Year and Costs $8.2 Billion; But Law is Finally Beginning to Crack Down on Major Form of Child Abuse; At Least 15 States Will Take Away Custody if Necessary to Protect Kids."

This press release refers to parental smoking as "the most prevalent form of child abuse."

And it encourages people outside of the home, including "a doctor, a school nurse, a grandparent, or even a neighbor" to "file a complaint of suspected child abuse, neglect, or endangerment where smoking in the presence of the child creates a significant health risk." And significant health risk, according to ASH's statement, includes "hay fever," "allergies," and "recurrent ear infections."

According to yet another press release issued by ASH: "ASH pioneered the concept of arguing that deliberate exposure of children to secondhand tobacco smoke can constitute child abuse, and possible grounds for the revocation of custody."

And now, ASH has put out a propaganda piece in which it tries to provoke divorced or separated parents to fight back against their spouse if their spouse smokes by using the spouse's smoking around the child as a means to gain custody:

The piece is entitled "How You Can Fight Back if Your Spouse Smokes Around Your Child" and it solicits donations for ASH by trying to entice divorced or separated parents to donate to ASH in order to obtain access to secret information that ASH has prepared that "you and your lawyer can use as ammunition" to try to gain custody over your child, regardless of whether your obtaining custody is in the best interests of the child.

Please note, however, that "this information is available only to member-supporters of Action on Smoking and Health (ASH). ... Once you join - which you can do conveniently on-line -- you will receive by e-mail the user name and password you need to unlock this valuable information." Only after becoming a member of ASH can you "access the information about protecting your rights as a nonsmoking parent."

The Rest of the Story

First let me say that there are probably some isolated situations in which a smoking parent does smoke around a child with severe asthma and despite being warned about the child's asthma attacks being precipitated by exposure to tobacco smoke, continues to smoke around that child. I do not doubt that such behavior could be termed abusive to the child and that if the abusive parent were involved in a custody dispute, this would be a major and possibly even definitive consideration in that dispute.

However, to claim that parental smoking is a "major form of child abuse" is going a bit far, don't you think?

Certainly, before making such a loaded claim, I would insist that ASH provide documentation to support its assertion that parental smoking is a major form of child abuse. How many situations have there been such as I've presented above, where a child with asthma is repeatedly and intentionally exposed to secondhand smoke by a parent, even in the face of a warning from a physician that the child is sensitive to that smoke and an asthma attack will be triggered if the parent smokes in the presence of that child?

ASH refers to a number of anecdotal cases, but I think you need to document this before making a claim that implies that parental smoking is a major form of child abuse.

But ASH doesn't stop there (stop doesn't seem to be a word in its vocabulary). It refers to parental smoking not merely as a major form of child abuse, but as ""the most prevalent form of child abuse."

Now that claim clearly requires some documentation. It requires, at least, a comparison of the number of cases of child abuse due to intentional and severely harmful secondhand smoke exposure compared to the number of cases of child abuse from other causes.

But the absurdity and irresponsibility of ASH's claims do not end there.

ASH implies that the deaths of 6,200 kids each year from parental smoking represents a form of child abuse. In fact, it uses that precise statistic to back up its claim that parental smoking is a major form of child abuse.

But those deaths are essentially all from SIDS (sudden infant death syndrome), a disease entity in which the infant dies suddenly and without any warning and there is no apparent underlying abnormality or disease that would tip off the parents that the infant might be a potential SIDS victim.

So how can you blame the parents for those deaths? How can you call this a form of child abuse? Moreover, you can never be sure exactly what the cause of SIDS in a particular infant was. So who is ASH to suggest that anyone who smoked around their child and whose child died of SIDS has committed child abuse?

It's rather cruel and inhumane if you ask me. Isn't it enough that the parents of a child who died from SIDS have to suffer with one of the greatest losses imaginable? Do we have to torture them by suggesting that they are child abusers? Do we have to suggest that they should not have had custody of their children (if they were divorced or separated) based on the way they behaved?

Moreover, ASH is encouraging physicians, nurses, school nurses, grandparents, and even neighbors to file child abuse complaints against parents who smoke in the presence of their children.

Is this the kind of society that we want? Do we want our neighbors (and God forbid our parents and in-laws) snooping around and monitoring all of our parenting behaviors?

And where do we draw the line in defining what constitutes abusive behavior and behavior that would argue for taking custody away from a parent?

If I fail to put sunscreen on my child because I don't think we're going out for a long time, but then we get distracted and my child ends up with a severe sunburn, am I a child abuser? Have I just ruined my chances of retaining custody of my child if I get divorced or separated?

What about taking my kids to McDonalds and letting them eat Big Macs and french fries. Haven't I just contributed to them being at increased risk of obesity? What about feeding them tater tots? Perhaps my neighbor who smells those tater tots sizzling in the pan should call DSS immediately.

What about exposing a kid to lead paint? I treated probably 30-40 kids for lead poisoning during my time as a medical student, and virtually all of them got lead poisoning because their parents allowed them to eat peeling paint chips. Some of these kids required hospitalization, some had life-threatening illness, and all were at high risk of severe neuropsychological problems. Are these parents child abusers? Should these parents, most of whom were single parents and many of whom were separated or divorced, have lost custody of their children because of this?

In fact, I am quite sure that beyond any reasonable doubt, exposure to lead paint chips was the predominant source of "child abuse" that I observed during my pediatric experience. It was far more of a problem than exposure to secondhand smoke. If ASH really wants to recruit parents to fight back against their spouses, how about trying to make lead poisoning an issue in child custody disputes. That's a winner if I've ever heard of one.

Some of the examples of supposed child abuse that ASH provides - smoking around a kid with hay fever - for example, leave a lot to be desired. In fact, some of them seem less severe of a health hazard then the examples I've given above. I, for example, had severe hay fever as a kid, but was not at all sensitive to secondhand smoke. My parents smoked in my presence anyway. Does that make them child abusers? If so, then all kids should have child abusers for parents, because mine did a pretty darn good job (of course I'm talking about my two sisters!)

Look -it's one thing to conduct an educational campaign designed to try to educate parents about the hazards of secondhand smoke and the potential hazardous effects of exposing their children to secondhand smoke. I'm all for campaigns to urge parents not to smoke in the presence of their children and to try to protect their kids from secondhand smoke exposure as much as possible.

But this is way more than an educational campaign. For one, ASH is using scare tactics. It seems to me that they are literally trying to scare the daylights out of smokers and make them feel like their smoking may cause their children to be seized from them. I don't think I'm exaggerating. I think it's a very real fear. Add to that the irresponsible and undocumented claims that ASH makes and what you have is anything but a legitimate public health campaign.

Plus, if it is so critical that parents be educated about the most prevalent form of child abuse out there in an effort to prevent it, then how can ASH possibly justify withholding critical information from the public unless they make a financial contribution to ASH. What if they don't want to? What if they can't afford it? (and many of the parents who most need to know the facts are those who are least able to afford making a donation)

I just can't see a public health group using the enticement of free legal ammunition as a ploy to try to recruit new members to their organization. People should join ASH because they want to join ASH, not because they have been coerced into joining because they have been enticed into "buying" free legal counsel.

But perhaps the most disturbing aspect of this story to me is the apparent lack of respect for the parent-child bond that ASH shows, and the lack of understanding that secondhand smoke is not the be-all and end-all of what determines what is in the best interests of a child.

ASH is clearly advertising to help parents obtain custody of their children by using smoking by the other parent as ammunition in the courtroom. That is certainly the legal right of a parent. But it is not a public health issue. It is an issue for the judge to decide based on the best interests of the child in the case.

I really don't like the idea of ASH intruding upon court cases which should be all about, and only about, determining what is in the best interests of the child. There is no way ASH can know that. And providing this kind of legal ammunition could well result in a judgment that is not in the best interests of the child.

I have no problem with ASH providing information about the health effects of secondhand smoke on children, but to intervene and try to make this an issue in custody battles, to try to rile up divorcing parents to take it out on their spouses by making this issue a dominant one, to try to scare parents into thinking their children may be taken away from them because they smoke, and to suggest that this is the most important form of child abuse to address is both irresponsible and, I think, likely to be damaging.

And if this weren't enough...

... where ASH does appropriately provide information about the health effects of secondhand smoke...

...it provides misleading information at that. But that's a different story.

On Parental Smoking, Child Abuse, and Heelys

What does parental smoking have to do with child abuse? Several anti-smoking groups and many tobacco control advocates consider smoking in the presence of children to be a form of child abuse and want this behavior to be banned, fined, and otherwise treated similarly to recognized forms of child abuse.

What does parental smoking have to do with allowing one's child to use heelys? Both are parental decisions - behaviors - that expose their kids to health risks. Secondhand smoke increases the risk for ear and respiratory infections as well as asthma and asthma exacerbation. And new research published in the journal Pediatrics reveals that allowing your kids to wear heelys places them at significant risk of "broken wrists, arms and ankles; dislocated elbows and even cracked skulls."

What does allowing one's child to use heelys have to do with child abuse? Absolutely nothing, I'm sure almost everyone would agree.

The Rest of the Story

The problem is, however, that according to the reasoning being used by anti-smoking groups to support classifying smoking around children as child abuse, allowing children to wear heelys is also a form of child abuse.

By arguing that smoking around children - a behavior that increases a child's risk for certain health complications - is child abuse, anti-smoking groups are advancing the argument (whether they realize it or not) that exposing children to increased health risks constitutes child abuse. Thus, according to the new research, allowing a child to wear heelys, which has now been documented to increase the risk of injuries ranging from broken wrists to broken skulls, would also constitute child abuse. But we all recognize that assertion to be ridiculous.

Equally ridiculous, therefore, is the assertion that smoking around children, except in some rare circumstances, is child abuse.

Why is it, then, that some anti-smoking groups appear eager to single out smoking as the one parental behavior that increases health risks that is to be considered a form of child abuse, while excusing all other parental behaviors and decisions that put children at significant risk of injury, illness, or disease?

I can contemplate several possible explanations.

One possibility is that these anti-smoking groups are so narrow-minded in their thinking and perspective that they simply cannot think beyond secondhand smoke as a threat to childrens' health. Smoking is the only thing that is harming children; thus, it is the only parental behavior that needs to be considered as child abuse.

A second possibility is that anti-smoking groups are aware that there are many other risks to which parents expose their children, but that for some reason, smoking is a unique risk and the only one that constitutes child abuse. While the reasons for such a perspective are not clear to me, it is plausible that these groups have such a disdain for the idea of smoking around children that this is clouding their thinking. But I have to question whether having such a narrow and specific disdain for smoking around children is reflecting some sort of underlying hatred of smokers - a hatred that does not exist toward parents who expose their kids to all kinds of other significant and sometimes even more severe health risks.

I also wonder whether this seemingly unique disdain toward parents who smoke reflects to some extent a view of social class inferiority. Could it be that smokers are considered to be a lower social class, and thus that they carry less respect and more disapproval as a class?

Either way, it seems to me that anti-smoking groups are in a major conundrum. Either they are so narrow-minded that they have lost their sense of perspective on child health and welfare such that they are no longer qualified to be able to make reasonable policy recommendations, or they are participating (albeit unconsciously) in class discrimination and possibly social injustice.

Most disturbing to me is the fact that none of the anti-smoking groups or advocates supporting the idea of treating smoking around children as child abuse have yet responded - substantively - to my arguments. It appears that they have no interest in defending the consistency or integrity of their views and proposals.

In other words, this is a crusade.

Unfortunately, it is a crusade that is increasingly losing its public health and social justice grounding. It is a crusade that increasingly is coming to conflict with basic principles of public health and social justice. It is a crusade that is beginning to embrace the ideas of class inferiority and outright class discrimination.

It is a crusade that I can no longer be a part of.

Staten Island Advance Op-Ed Argues that Smoking Around Children is a Form of Child Abuse

In an op-ed column published Tuesday in the Staten Island Advance, New York family court Judge Daniel Leddy argues that smoking around children is a form of child abuse because it causes a protracted impairment of an exposed child's lung function. Further, he argues that New York City should adopt a bill introduced by Councilmember James Gennaro which would prohibit smoking in cars when minors are present because it would simply ensure that this form of abuse is not allowed.

According to Judge Leddy: "Abuse is more serious than neglect, although either can result in the removal of a child from his parents. The distinction generally rests on the nature of the injuries sustained by the child or the potential injuries of which he was placed at risk. To constitute abuse, they must involve a "protracted impairment" of physical health or a "protracted impairment of the function of any bodily organ." Because of the long-term implications for even healthy children, it could well be argued that parents who expose their children to secondhand smoke subject them to both a substantial risk of a protracted impairment of their health, and a protracted impairment of the function of their lungs. ... Gennaro's proposal thus complements existing New York State law insofar as it would require parents to protect their children from this preventable health hazard. Privacy concerns about his proposal do not withstand scrutiny."

The Rest of the Story

There are two serious flaws in Judge Leddy's argument.

First, it is not true that healthy children exposed to secondhand smoke necessarily suffer protracted impairment of their lung function. It is certainly a risk of exposing a child to secondhand smoke, but exposure does not necessarily translate into harm. It translates into an increased risk of adverse effects on lung function. Specifically, childhood secondhand smoke exposure increases the risk for asthma and for decrements in lung growth and function. But risk is not the same as harm, and as Judge Leddy himself acknowledges, to be a form of child abuse, smoking around children would have to result in protracted harm.

I think it would be a grave mistake to consider smoking around children to be a form of child abuse. If we deem as child abuse the failure to protect one's child from exposures that merely increase the risk of adverse health consequences, then there is a long list of parental behaviors that would fall into the category of child abuse. These include the following behaviors, each of which represents a failure on the part of parents to protect their children from exposures which significantly increase the risk of potentially serious adverse health consequences:

• repeatedly feeding your child high-fat, high trans-fat, fast foods and sweetened juices and soda;
• allowing your child to watch hours and hours of television every day, get no exercise, and take part in no physical activities;
• allowing your child to play hockey;
• allowing your child to drink alcohol; and
• allowing your child to drive in a car late at night.

In addition to placing a host of common parental behaviors that put their children at increased risk of severe health consequences into the category of child abuse, one has to ask the question: Does it really protect healthy children to allow the government to take them away from their parents in order to protect them from secondhand smoke exposure? Is it somehow more beneficial to deprive a child of their parents than to allow the child to be at increased risk of ear infections? If we treat smoking as a form of child abuse, this is exactly the judgment we are making.

The second flaw is the argument is that the characterization of smoking around children as child abuse justifies a law which bans smoking in cars with children present. If, as Judge Leddy argues, exposing children to secondhand smoke is child abuse, then it is abusive whether it takes place in a car or in the home. If smoking around children really is child abuse, then there is nothing to justify the argument that smoking around a child is acceptable in the home, but not in a car. If privacy concerns truly do not withstand scrutiny, then there is no justification for not interfering in the home as well as in the car to "further children's legitimate right to an environment that safeguards their health and promotes their wellbeing."

In fact, it seems that if one truly believes that smoking around children is child abuse and that privacy concerns do not withstand scrutiny, then it becomes unconscionable that the New York City Council would fail to protect children from exposure to secondhand smoke in the home. And it should be noted that exposure in the home is by far the predominant source of children's tobacco smoke-related health problems. Car exposure does not even begin to compare to home exposure.

If New York City lawmakers are sincerely concerned about protecting children from the hazards of secondhand smoke exposure, then they must have the courage to face the difficult issue of household secondhand smoke exposure. There are a number of interventions, short of removing children from homes and criminalizing their parents, which have proven to be effective. Programs that educate parents about these hazards, encourage them to smoke outside, and provide financial support and services to actually help parents quit smoking are reasonable measures. But treating smokers as child abusers is neither justified nor wise.

Major Anti-Smoking Group Wants Parents Who Smoke Around their Children Referred to Authorities for Child Abuse

A major national anti-smoking group is publicly calling for parents who smoke in the presence of their children to be treated as child abusers. The group - Action on Smoking and Health (ASH) - is calling smoking in the presence of children the most prevalent form of child abuse and wants parents who smoke around children to be investigated as child abusers.

ASH is telling the public that those who smoke around their kids are literally poisoning them and is urging doctors who treat children exposed to secondhand smoke at home to refer their parents to authorities for investigation and potential prosecution as child abusers. ASH also wants teachers to refer their students to authorities so that their parents can be investigated and treated as child abusers if the teacher suspects the child is being exposed to secondhand smoke in the home.

Although noting that smoking in the presence of children may be especially problematic when the affected child has pre-existing conditions such as asthma that make him or her especially sensitive to tobacco smoke, ASH suggests that parents be investigated as child abusers merely for smoking in the presence of a child, even if the child is healthy. ASH claims that secondhand smoke exposure during childhood doubles an individual's risk of lung cancer and that physicians have a duty to report such parents as child abusers. In fact, not referring the parents to the court system for investigation and treatment as child abusers constitutes "maltreatment," according to ASH, since it is inexcusable to force a child to bear this increased risk of lung cancer.

ASH defends its position, in part, by noting that one couple "had their 10-year old child removed to a foster home because they left him alone for a few hours in the afternoon." ASH also argues that while the individual effects of secondhand smoke exposure may not be anywhere near the effect of physical or sexual abuse, "the cumulative effects of this form of child abuse may be more serious (in terms of lives affected, dollar costs, etc.) than the much smaller number who are victims of more traditional forms of child abuse."

ASH does suggest that parents be given one warning before they are referred to the criminal justice system for investigation and potential prosecution.

In cases where there is not another adult living in the home to confirm that secondhand smoke exposure is taking place, ASH recommends that the suspected parent's child be forced to submit a blood, urine, or saliva sample for cotinine determination to prove conclusively that the child was being exposed to high levels of secondhand smoke.

According to ASH:

"As a new weapon to protect innocent nonsmokers, and to be sure parents are aware of the deadly dangers their smoking poses for their children, ASH Executive Director John Banzhaf recently suggested in a major medical address that physicians are legally as well as morally justified in filing complaints of 'child abuse' or 'child neglect' in situations where parental smoking creates serious risks for minors. ... Parents may be investigated as child abusers if they smoke in the presence of their infants or young children, especially if the minors have asthma, hay fever, allergies, or other conditions making them especially sensitive to secondhand tobacco smoke, suggested ASH Executive Director John Banzhaf. ... Calling smoking in the presence of infants and children 'the most prevalent yet least reported form of child abuse,' Banzhaf said that deliberately exposing minors to a substance which doubles their risk of contracting lung cancer -- and may cause them to go into respiratory distress -- is inexcusable, and that doctors can no longer stand idly by while their young patients are 'literally being poisoned by their parents.' ...

Even in situations where immediate physical harm cannot yet be detected, physicians may nevertheless be justified in reporting their suspicions for evaluation by the authorities, says Banzhaf. Noting a recent study in the New England Journal of Medicine proving that parental smoking can literally double a child's risk of eventually contracting lung cancer, he suggests that forcing a child to bear those risks constitutes 'maltreatment.' After all, he says, if a doctor found out that a child was being needlessly exposed to significant levels of asbestos, benzene, radioactive particles or other proven carcinogens at home, he would certainly be justified in taking action before a malignancy was detected, and tobacco smoke contains all of those substances as well as thirty other chemicals known to cause cancer.".

The Rest of the Story

I am pressed to think of anything the anti-smoking movement is doing which is more inappropriate, more narrow-minded, scarier, and more destructive than this latest action by ASH.

What ASH is doing, in the name of protecting our children, is presenting the very real threat to parents who smoke that their children may be taken away from them. And ASH is trying to create the even more appalling possibility that children may be removed from their loving parents and placed into foster care because an anti-smoking group was worried that, based on the results of a single unconfirmed study, those kids faced a doubling of their lung cancer risk.

In what possible way is it in the best interests of a child to remove him or her from the care of their parents simply to protect them from a potential health risk? I think it's awful when a child suffers an ear infection or upper respiratory infection or develops hay fever because their parents smoke, but could it possibly be better for the child's welfare to remove her from the parents?

Sure - ASH is putting on the public veneer of claiming that they don't want the children to be removed from parents - they simply want court orders that the parents not be allowed to smoke in the presence of the children - but what happens when a parent violates the court order? And since ASH is calling on these parents to be treated as child abusers under the current laws, and current laws call for removal of children from their parents when court orders are violated and the abuse is repeated, ASH is apparently willing to take the risk that there will be some children removed from their parents in order to protect what they see as millions of kids from the unacceptable fate of suffering some increased health risks due to secondhand smoke exposure.

We don't need the courts to tell parents not to smoke in front of their children. That's what public health organizations are for. The courts are in place to enforce the law. And the law which ASH is asking be applied to a large number of smoking parents is one which forces, or at very least allows, the judicial system to remove children from custody of their parents if the abuse continues.

This action by ASH is disturbing for many reasons.

First, I find the comparison of smoking to child abuse to be insensitive to the very real problems and trauma caused by real physical, sexual, and emotional abuse of children. It makes a mockery of the real problem of child abuse to even consider smoking around children to be in the same category. It is like spitting in the face of child abuse survivors throughout the nation.

To take that trauma and the life-long debilitation and suffering that it can cause and suggest that it is in the same category as an increased risk of an ear infection or hay fever is an affront to anyone who has suffered or even knows someone who has been a victim of parental physical or sexual abuse.

Second, it is dangerous to suggest that putting children at increased risk of a health problem represents child abuse. It is scary to think that I, as a parent, may be guilty of child abuse and risk losing the custody of my children because I fail to protect them from an exposure which increases their risk of, but does not necessarily cause, a particular health problem.

This reasoning would allow us to treat serving tater tots to children as being a form of child abuse. What about parents who take their kids out to McDonalds most nights for dinner? That clearly increases the risk of obesity and other serious medical problems, many of which are far more serious than many of the risks posed by secondhand smoke. Shouldn't that also be considered a form of child abuse, if exposing a child to secondhand smoke is?

Third, it is frighteningly dangerous to suggest that parents may lose custody of their children in the absence of definitive proof that their actions caused the child's physical harm. Even in cases where a child suffers recurrent ear infections and a physician suspects that exposure to secondhand smoke in the home may be causing these infections, we have no way to prove that the infections are directly attributable to the secondhand smoke.

Not so when a child suffers vaginal laceration from sexual abuse. There is no alternative possibility of what caused that (assuming that definitive evidence is available, which the courts require). Is ASH seriously telling me that I am a child abuser if my child has an ear infection because my tobacco smoke may have contributed to an increased risk of that ear infection.

And it is even more frightening to consider that ASH wants us to treat as child abuse the mere increase in risk of disease posed by an exposure. And at such a low level. And without adequate documentation that the risk is real. One study reported in a journal found a doubling of lung cancer risk among children exposed to secondhand smoke at home. Based on that, ASH is willing to call me a child abuser if I exposed my child to that potential risk.

Since the overall risk of lung cancer is so small, in the overwhelming majority of cases there will be no harm done. Yet all of these parents are child abusers and need to be handled by the criminal justice system?

ASH has simply got to be out of its mind.

And let me say right now that I do not believe that there is any convincing evidence that childhood exposure to secondhand smoke increases the subsequent risk of lung cancer. What ASH is relying upon is a single study and the result could well be due to the fact that children exposed to secondhand smoke are more likely to have other lung cancer risk factors. There is certainly not enough evidence to conclude that childhood exposure to secondhand smoke causes lung cancer.

And even more frightening, I could use the same logic as ASH does to suggest that parents who DON'T smoke around their children are child abusers. After all, one study that is widely cited by anti-smoking groups demonstrated a significant decrease in lung cancer risk among children who were exposed to secondhand smoke in the home. By ASH's reasoning, this means that parents who don't smoke are putting their kids at an increased lung cancer risk and should be reported to authorities for investigation and possible prosecution as child abusers.

Fourth, does not our family court system have more pressing issues to deal with than whether a child might get an ear infection or hay fever because their parent smokes around them? The courts are already overburdened trying to deal with existing cases of severe physical, sexual, and emotional abuse. And our foster care system is already burdened with trying to place victims of this abuse in loving homes.

This is all we need - teachers and doctors flooding the Department of Social Services with phone calls telling them that they think someone might have smoked a cigarette in the house last night because they can smell the scent of tobacco smoke on the kids' clothes. I'm sure all the real child abuse victims will appreciate having their pressing issues delayed because the judge needs to deal with the possibility that a parent might have smoked in the vicinity of a child.

Fifth, the social class issue here is just terribly disturbing. ASH is trying to get away with this because the population they are largely talking about is not an upper class one. We know that education is the strongest correlate of smoking behavior and we know that the types of situations that ASH is addressing are more likely to occur in less educated (i.e., lower social class) families and communities. This is just another example of trying to coerce, control, and punish the lower social class rather than providing them with assistance, services, and resources which might actually help decrease social class disparities.

Sixth, this action by ASH will almost certainly harm childrens' health by decreasing access to medical care for those who need it most. We know full well that children who are victims of physical or sexual abuse are less likely to receive needed medical care because parents are afraid of being reported to authorities if the abuse is detected.

All we need is for parents to be afraid of bringing their kids in for ear infections, respiratory infections, or asthma because they are afraid they may be reported to authorities if it is suspected that their smoking may have contributed to these health problems. You want to see some REAL serious health problems among children? Just start taking ASH's advice and scaring parents into thinking they will be turned over to authorities if a doctor suspects they have smoked around their children. Then we'll have a mess on our hands because children who most need medical care will not be getting it because of parental fear.

Some way to try to decrease distrust of the medical system by a large population of families who do not currently seek medical care when they should because they distrust the medical system.

And I'm afraid this is a race issue as well. We know that African-Americans, in general, tend to be less trusting of the medical system (and for very good reason, as those who are familiar with Tuskegee or even with the unequal medical treatment of blacks by physicians are aware). It is African-American children, I suspect, who will largely suffer decreased medical care access if we increase the fear and distrust of the medical establishment by placing an undue threat of referral to authorities for smoking.

Are there parents who are treated as child abusers for some pretty minor offenses (such as leaving a 10-year old home alone for a few hours). Yes, there are. But does that mean that equally minor offenses should also be treated as child abuse, as ASH argues, or that this is wrong and we need to fix the system?

Perhaps the most treacherous argument ASH makes is that although individual harm from secondhand smoke might not be severe, as it is in physical or sexual abuse, the cumulative effects on society in terms of the number of lives affected and the amount of dollars spent on medical care are and therefore justify treating smoking around children as child abuse.

Do you mean to tell me that although I am not severely harming my child, I am a child abuser because the costs of treating the health effects of secondhand smoke, on a population level, are high?

Frankly, that kind of thinking is sick. We have to punish individuals as child abusers for actions which may not be particularly harmful simply because the cumulative effect of everyone taking those actions is costing money and increasing health care costs. By that notion, I should be treated as a child abuser if I have a glass of wine with my dinner because while that wine may not have a particularly detrimental effect on my child's welfare, the cumulative effects of alcohol use by parents in the population is causing society millions of dollars and adversely affecting millions of kids' lives.

Someone is going to make the argument that secondhand smoke exposure among children is a terrible problem and we need to do something about it. I agree. So let's provide education about the effects of secondhand smoke on children and support to help parents quit smoking or to promote the idea of smoke-free homes. But invoking the criminal justice system to deal with the problem is not the way to go.

Someone is also probably going to make the argument that ASH is an isolated, fanatical group and does not represent the anti-smoking movement. However, the problem is that if no anti-smoking groups come out and condemn this action, then ASH is in fact representing the anti-smoking movement. They are only a fanatical fringe group if the rest of the movement treats them this way. If we don't condemn what they are doing, then we are in fact condoning it, and it becomes a part of the mainstream of the tobacco control movement.

But I can tell you now that no anti-smoking group, at least here in the U.S., will condemn ASH's action. It's not that there are no groups which disagree with this stupidity. It's simply that no group is willing to speak out publicly, because the mentality of the movement does not allow it.

No one wants to risk losing their funding, no one wants to risk being viewed as being on the "wrong" side, no one wants to risk being cast as a traitor. Believe me, I know what happens to you when you are critical of anything that the anti-smoking movement is doing. You don't want to go there.

And the anti-smoking groups won't. They'll remain silent and let ASH go ahead and trash the entire tobacco control movement, casting us all in the public's eye as fanatical, over-zealous, narrow-minded, misguided crusaders who are more interested in punishing smokers and making their lives miserable than truly interested in improving the welfare and well-being of the most vulnerable in our society.

And unfortunately, since no anti-smoking group will speak out against this, I think the public is going to end up being right. I'm afraid this is who we are.

Rest of the Story Calls for Immediate Retraction of American Lung Association Ad and for a Public Apology to the Nation's Physical Abuse Victims

The Rest of the Story is today calling on the American Lung Association to immediately retract and remove from the airwaves its "Abuse" anti-smoking television advertisement and to issue a public apology to all victims of physical abuse for extreme insensitivity and offensiveness (ad also discussed here).

The television commercial begins by showing the exterior of a house with the door open. Through the door, you can hear a father yelling viciously at a child. The child is obviously in great peril and terribly fearful.

"No, daddy, no. Stop it!" the child screams. Clearly, the child is being physically beaten and abused.

The camera pans in on the living room, where to the viewer's surprise, there is no beating going on. Instead, a father is smoking while his children sit calmly watching television.

The narrator then states: "Exposing your children to the dangers of secondhand smoke is in fact abuse. A message from the American Lung Association."

The Rest of the Story

I find this to be an extremely disturbing spot. It is almost unbearable for me to watch, but terribly upsetting to find out at the end that the piece is actually making a mockery out of child abuse, rather than treating the issue with sensitivity and respect.

How dare the American Lung Association compare the horrors of child abuse and the severe, immediate, and irreversible physical and emotional damage that it does to the increased risk of ear and lower respiratory tract infections in children.

Does the American Lung Association not appreciate the difference between risk and harm. Physically beating a child is child abuse because it invariably causes harm. The harm is intentional, it is immediate, it is severe, and it is irreversible. You cannot physically abuse a child without causing harm.

In contrast, exposing a child to secondhand smoke does not necessarily cause harm. What it does is increase the risk of certain health problems. In all but very rare cases, the infliction of any harm is not intentional. In most cases, any harm done is reversible and not particularly severe (although it can be in some cases). But the most important point is that with smoking around a child we are talking about increasing that child's risk, by a relatively modest degree, of certain health conditions.

With physical child abuse, we are talking about inevitable, severe, irreversible harm.

To compare the two in this way is a profound disservice to physical abuse victims. It shows an overwhelming disrespect and insensitivity to these individuals. After all, if smoking around children is equivalent to child abuse, then the message being sent is that being physically abused is no more serious than merely being exposed to a little secondhand smoke.

The commercial does not present a very specific situation of a child with asthma, for example, whose asthma is severely exacerbated by secondhand smoke, and whose parents continually smoke around that child despite clearly being warned about the consequences. This is one situation where smoking around a child could be considered abuse because in this specific (and in my experience as a physician - extremely unusual) situation, the harm is definite and can be viewed as being intentional.

Instead, the commercial makes a very general statement about smoking around your children.

It is important to recognize that in the majority of cases, smoking around children does not have any severe health consequences. It is not an issue of harm, but of risk. And thus, the categorization of smoking around a child as child abuse fails definitively.

This advertisement is so offensive that I call for its immediate retraction and removal from the airwaves. I also call on the American Lung Association to publicly apologize to all victims of true child abuse for minimizing and trivializing the pain, suffering, and emotional havoc that their being physically abused has wrought in their lives.

There's no question that childhood exposure to secondhand smoke is a significant public health problem. But characterizing parents who smoke around their children as child abusers is not an appropriate way to address the problem. Perhaps we could start by providing adequate smoking cessation services and health insurance coverage of these programs for those smokers who want to quit. Then perhaps we could provide more education to parents so that they are aware of the health effects of smoking on young children.

But to address the problem by rubbing salt in the wounds of physical abuse victims is disgraceful.

These ads cannot be retracted soon enough.


(Thanks to JustTheFacts for the tip).


UPDATE: May 25, 2007; 3:45 p.m. -- The American Lung Association, upon being informed of the "Abuse" television advertisement that is circulating on YouTube, has immediately pulled the spot and ceased its circulation on YouTube and all other sources. Apparently, the spot was produced by an ALA-affiliate and the national office was not aware of, and did not approve, the ad. Immediately upon being informed about the ad, the American Lung Association's national office, under the direction of CEO and President John Kirkwood, pulled the ad and expressed its apologies. I applaud Mr. Kirkwood and the American Lung Association for responding immediately and definitively, and for expressing their thoughtful sentiments and apology. The statement from Mr. Kirkwood is posted here.

Is Using Crib Bumpers Child Abuse? Yes -- According to Reasoning of Some Anti-Smoking Groups

According to the reasoning used by several anti-smoking groups and a number of anti-smoking advocates to argue that smoking around infants and children is a form of child abuse, the use of crib bumpers (soft cushioning placed around the edges of a crib to prevent an infant from bumping or trapping their head against the crib bars) can also be considered to be child abuse.

A new study published in the Journal of Pediatrics has concluded that the use of crib bumpers significantly increases the risk of infant death by suffocation or strangulation. According to the researchers: "Many infants lack the motor development needed to free themselves when they become wedged between the bumper pad and another surface." The article reports that "soft bumpers meant to prevent babies from bumping or trapping their heads against the hard bars of a crib can strangle or suffocate the infants."

Some anti-smoking groups and advocates have argued that smoking around infants and children is a form of child abuse (post #1; post #2; post #3; post #4; post #5; post #6; post #7; post #8; post #9) because the secondhand smoke exposure increases the risk of ear infections, respiratory infections, asthma and other respiratory problems, and sudden infant death syndrome (SIDS).

One of the most prominent national anti-smoking groups - Action on Smoking and Health (ASH) - states on its web site that smoking around children is "the most prevalent and dangerous form of child abuse."

Since the use of crib bumpers also significantly increases the risk of infant death, the reasoning used by these anti-smoking groups and advocates would also lead to the conclusion that using crib bumpers is a form of child abuse.

The Rest of the Story

This exposes the danger of confusing risk and harm, and of conflating with child abuse parental behaviors that merely increase the risk of an adverse health outcome, but do not cause direct and immediate damage.

Most of us (perhaps all of us) would acknowledge that using crib bumpers is certainly not equivalent to child abuse. Yet the reasoning that would support such a classification is precisely the same reasoning being used to support the classification of smoking around children as a form of child abuse.

This is yet another example of where anti-smoking groups have abandoned sound reasoning. It is another example of how the anti-smoking movement has been transformed into a crusade.

Anti-Smoking Group Says Repeatedly Exposing Children to Secondhand Smoke is Child Abuse

According to Smokefree Pennsylvania, if you frequently take your kids out to restaurants, you may be a child abuser. If those restaurants allow smoking, then according to Smokefree Pennsylvania, you are indeed a child abuser.

Yesterday, Smokefree Pennsylvania stated that "Repeatedly exposing a child to hazardous tobacco smoke pollution is child abuse."

This means that if you repeatedly take a child to a restaurant that allows smoking (thus exposing your child to hazardous tobacco smoke pollution), you are a child abuser.

It also means that if you take your child over to a friend's house and that friend smokes, you are abusing your child.

Or that if your Uncle Henry is a smoker and you don't kick him out of the house when he wants to light up at family get-togethers because you don't want to hurt his feelings, you are abusing your child if these family functions are repeated.

It also means that if you do not believe that secondhand smoke is harmful and you smoke in the presence of your child without any intent to harm the child, you are a child abuser.

And it means that if you are not aware that secondhand smoke is harmful to your child, you are a child abuser if you smoke around the child, even though you had no knowledge that your smoke was harming the child.

And it also means that if there is no evidence that secondhand smoke exposure is causing any health problems for your children (they are not getting ear or respiratory infections or developing asthma because of it), you are still abusing your children if you repeatedly smoke around them.

It means that if you take your kid to New England Patriots games and you visit the concession stands, you are a child abuser (since it is almost impossible to avoid smoke exposure at Pats games if you visit the concession stands).

The Rest of the Story

I view this as a very important story because it demonstrates the current mentality of the anti-smoking movement. It is truly a crusade. It is a narrow-minded movement with blinders on that is unable to see any values beyond not smoking. It is a movement for which not smoking has moral, and not just health value. Most importantly, it is a movement that has been overtaken by fanaticism, by which I mean zeal unchecked by reason.

After all, reason would tell you that exposing a child to secondhand smoke is not, in and of itself, a form of child abuse. Only overzealous thinking that is unchecked by reason would lead one to a conclusion that virtually every parent in the 1980s and earlier was a child abuser (since exposure of children to secondhand smoke in that era was virtually ubiquitous).

It is this lack of reasoning that precludes me from considering myself a part of the current anti-smoking movement. As a scientist and a trained policy analyst, I just cannot divorce myself from reason, argumentation, and development of solid foundations, bases, and justifications for policy positions.

The end result of the abandonment of reason is not only an incorrect and absurd definition of child abuse. It is also what amounts to an offensive and insensitive statement that could well offend anyone who actually has been a victim of child abuse or anyone who knows and loves someone who has been such a victim.

Anti-Smoking Group Supports Arrest and Imprisonment of Adults Who Smoke in Cars with Children

According to an article in the North Platte Telegraph, a Nebraska anti-smoking group is supporting efforts to charge adults who smoke with children in their cars as child abusers, making them subject to arrest and possible imprisonment.

Spurred on by the release two weeks ago of the Surgeon General's report on the health hazards of involuntary smoking, the North Platte police department is pursuing the possibility of treating smoking in a car with children as child abuse and is considering arresting such individuals and charging them with child abuse, which is a crime (a misdemeanor) which carries with it a penalty of up to one year in jail and/or a fine of $1,000.

According to the article: "In response to a recent report from the U.S. Surgeon General about the dangers of second-hand smoke, local police officials report they are preparing to crack down on drivers who expose their children to second-hand smoke. 'It is evident when reviewing this report that second-hand smoke around children is the most insidious form of child abuse,' said North Platte Police Chief Martin Gutschenritter. 'We simply did not feel we could overlook it.'" ...

"'With that in mind, we are researching to determine whether law enforcement has probable cause to arrest anyone exposing children to second-hand smoke inside a vehicle,' Gutschenritter said. He added the police department is working with the county attorney to determine if smoking in a vehicle with children present would be considered child abuse. ... 'If you look at the state statute regarding child abuse, and if you look at the Surgeon General's report, we believe that it's a clear violation,' Gutschenritter said. 'The fact that the injury isn't immediate, we feel is irrelevant.' Child abuse is a Class I misdemeanor, which carries a penalty of up to one year in prison and/or a $1,000 fine. This would be considerably harsher than failing to buckle up a child in a vehicle - an offense punishable by a $25 fine."

In response to this proposal, an anti-smoking group - the Lincoln County Tobacco Coalition - expressed its support, apparently stating: "We applaud any type of tobacco prevention initiatives." According to the article, "the Lincoln County Tobacco Coalition supports any efforts that help reduce children's exposure to second-hand smoke because it is a proven fact that second-hand smoke is hazardous to the health of children."

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The anti-smoking movement is now literally supporting the "smoking police." They want, quite literally, for the police to go around and arrest people for smoking in the presence of children. In this case, the Lincoln County Tobacco Coalition is supporting a measure that could well result in the imprisonment of adults who puff on a cigarette in a car with children present.

Do you mean to tell me that to prevent the mere risk of some ear infections and respiratory infections, the Lincoln County Tobacco Coalition is willing to support the imprisonment of parents, removing them from their kids for a period of up to one year? You can't be serious. It is far more devastating, to be sure, for children to have a parent removed from them, than for the child to be at increased potential risk of an ear or upper respiratory infection.

It's preposterous that a parent who fails to buckle up their child in a car is punished with just a $25 fine, but smoking in that same car may soon result in a $1,000 fine and possible imprisonment. Failing to buckle a child in a seat belt will almost certainly result in severe harm in the case of a major car accident. And it could result in the death of the child. But in most cases, smoking in the car does nothing more than slightly increase the risk of minor health problems like ear and upper respiratory infections.

It is not surprising to me that at least one police force has taken the bait set by a number of anti-smoking advocates and groups and supported treating smokers who smoke around children as child abusers. But it is still surprising to me that the tobacco control coalition would support such a proposal, rather than condemn it as representing an undue intrusion into privacy and as placing children at risk of real and inevitable harm by allowing their removal from their parents.

This does represent a dangerous intrusion into personal privacy and autonomy. It literally is the smoking police watching over us. It is the beginning of a slippery slope that leads the police right into our homes. There's no real qualitative difference between a private car and a home. So if the police can start arresting me on the spot for smoking in my car with children inside, what is to stop them from starting to arrest me for smoking in my own home?

In fact, there is no justification for them not to do this, if smoking around children is child abuse. And there's no justification for the Lincoln County Tobacco Coalition not to support the entrance of smoking police into the home.

I'll be honest. When I used to hear smokers' rights groups talking about "the smoking police," I thought it was a profound exaggeration, that anti-smoking groups were not supporting anything of the sort, and that the whole argument was basically a bunch of crap. Unfortunately, I appear to have been quite wrong.

Not only is the prospect for the smoking police alive and well, but we in tobacco control are supporting this unwarranted intrusion into the privacy and autonomy of American citizens.

Believe me, we don't want to go there. Not if we are to remain a free country. Not if we are to retain our autonomy as parents.

In public health, we shouldn't be willing to trade definite harm to children for reducing merely the risk of disease. We in tobacco control better learn the difference between risk and harm, and quite quickly. Otherwise, we may end up causing irreparable harm to the very children who we claim we are trying to protect.

Car Smoking Ban Supporters Call Smoking in Cars Worse Than Child Abuse, State that Secondhand Smoke is as Bad as Active Smoking

According to an article in Newsday, two New York legislators who are supporting the state's proposed ban on smoking in cars carrying children under 16 years of age have issued the following one-two punch of arguments in support of their position:

Assemblyman Ivan Lafayette, the sponsor of the car smoking ban bill, was quoted as stating that smoking in a car with a child is worse than child abuse (slapping a child in the face): "I think smoking in a car with a child has a more lasting effect than giving a child a slap in the face," said Assemblyman Ivan Lafayette, D-Queens. "They're both horrible things, but one is going to kill the child ... I know that's a hard comparison, but that's the reality of it."

Assemblywoman Sandra Galef, who is sponsoring a separate bill which would ban smoking in playgrounds, stated: "The scientific reports say that secondhand smoke has as much of a negative effect on your health as smoking directly. And we certainly want to be sure we keep smoke away from children who don't have the opportunity to walk away from it, and I think adults have to learn more responsible behavior around children."

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What more can I say about Assemblyman Lafayette's statement than to condemn it as being disgusting and completely insensitive to, and dismissive of, all those who have been victims of child abuse.

How can one suggest that physically abusing a child is no worse than exposing a child to secondhand smoke? How can one suggest that physically abusing a child results in effects that last for a much shorter time than a child breathing in secondhand smoke?

Anyone who has experienced abuse as a child or treated victims knows that the effects of childhood physical abuse last a lifetime. Anyone who is abused suffers harm. That harm is severe and in some respects irreparable.

In contrast, the majority of children who are exposed to secondhand smoke in cars do not suffer any long-term effects. There is an increased risk of ear infections and lower respiratory tract infections. But to compare that to child abuse?

It appears that at least some car smoking ban supporters are having a difficult time making a distinction between risk and harm. While physically abusing a child causes immediate, direct, severe, and intentional harm, smoking around a child merely increases the risk of adverse health consequences. And in almost all cases, that increased risk is not intentional.

To equate intentional infliction of direct injury with the unintentional imposition of increased health risks is unwarranted.

And in this case, it is also disrespectful, insensitive, and damaging.

Is this what is really behind car smoking bans? It has to make you wonder.

While not disgusting or insensitive, Assemblywoman Galef's argument is scientific rubbish. It is manifestly untrue that secondhand smoke exposure is as bad as active smoking. Clearly, active smoking has a far more detrimental effect on one's health than secondhand smoke exposure.

The relative risk of lung cancer associated with active smoking is about 17, yet only about 1.3 for passive smoking. Active smoking is a major cause of emphysema and chronic bronchitis (chronic obstructive lung disease), while secondhand smoke has not yet been shown to cause these conditions. Active smoking causes cancer of many other organs besides the lung, while secondhand smoke has been shown to be a cause only of lung and nasal sinus cancer.

To suggest that secondhand smoke is as harmful as active smoking is to undermine the public's appreciation of the hazards of active smoking. Do we really want smokers to believe that the health effects of their smoking are really only as bad as if they were exposed to secondhand smoke? A statement like that may generate headlines and scare people into supporting a car smoking ban, but it is false and damaging to public health messages about the hazards of smoking.

Of course, another problem with Galef's argument is that children cannot walk away from secondhand smoke in the home either. So if secondhand smoke is really as bad as active smoking, then how can we possibly allow parents to smoke around their children in the home? The New York smoking ban legislation chooses not to regulate smoking in the home, allowing parents to hold their kids captive and expose them to the equivalent of active smoking.

Why is it that parents must learn "more responsible behavior around children" in their cars, but not in their homes? Is it the harm being done to children that bothers our legislators, or is it just seeing the parents smoking that is the problem?

When one sees arguments in favor of a public policy deteriorate to this level, one should take a good hard look at the validity of the position in support of the policy. If this is the best that supporters can come up with, then I'm afraid I cannot find their position to be at all compelling.

One thing is for certain: the arguments being advanced by these car smoking ban proponents do cause harm. Harm to real victims of child abuse. And harm to public health efforts to educate the public about the hazards of smoking.

Anti-Smoking Advocate Pushing to Make Smoking Around Kids a Form of Child Abuse

According to a news article posted last Thursday on the web site of Portland Oregon's ABC affiliate - KATU - a Washington State anti-smoking advocate who was behind the state's initiative that banned smoking in bars and restaurants is now calling for making smoking around kids a form of child abuse.

According to the article, entitled "Doctor Pushes to Make Smoking An Act of Child Abuse," Dr. Chris Covert-Bowlds, a physician who heads an anti-smoking coalition (Tobacco Free Whatcom County), is active with the American Lung Association of Washington, and who played a major role in the Washington statewide ban on smoking in workplaces, including bars and restaurants, "is a member of the informal, unorganized and quiet movement toward making it a criminal act to smoke around kids."

According to the article: "The physician is the father of Washington's new sweeping anti-smoking law for public places. He believes protecting children from smoking parents is next."

The article quotes Dr. Covert-Bowlds as stating: "I think eventually there will be legislation to say that exposing kids to smoke in your own home is not right."

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And removing children from their parents who smoke in the home would benefit these kids exactly how?

Frankly, this is one of the most disturbing things I have seen occur in the anti-smoking movement in a long time. Equating smoking around children with child abuse would be the most devastating and damaging thing that could possibly be done to these children - far worse than the exposure to the secondhand smoke itself.

It's one thing to be at an increased risk of developing an upper respiratory infection, middle ear infection, or asthma, but quite another to be seized from the custody of your loving parents.

Classifying smoking around kids as a form of child abuse would open the door to placing these children under the scrutiny of child protection services, and ultimately, to removing them from the custody of their parent or parents who smoke in their presence.

And that would be a complete disaster; it would be a true tragedy for these children. I can't think of anything that could possibly be worse for the health and welfare of these kids.

While I wholeheartedly agree that children should be protected from secondhand smoke exposure, tearing them away from their families is not a reasonable means to achieve this desired end.

Moreover, making smoking around children a criminal offense opens the door to making all kinds of parental behavior criminal offenses. Should parents go to jail because they fail to put sunscreen on their kid and the child gets a sunburn? Should parents be charged with a crime if they are caught eating at Burger King and feeding their kids greasy french fries? Should it be a crime to let your kid watch television all day and not get any physical activity? Should parents be sent to jail when their kids are admitted to the hospital for treatment of lead poisoning that they obtained by eating peeling paint chips?

Criminalizing smoking in the home is an unwarranted intrusion into privacy as well as parental autonomy. It has no place in our free society.

And anti-smoking advocates and groups that are pushing to criminalize smoking around kids in the home are threatening to destroy any respect that this country has for privacy rights. There is something here a lot more important than health that is at stake.

Privacy and autonomy are not all that anti-smoking advocates and groups which support making smoking around children a form of child abuse are threatening to destroy. They are also threatening to destroy the lives of these children. It is shameful that they propose to do this in the name of helping these kids in any way.

The rest of the story here is that the anti-smoking movement is completely losing sight of its means because of its overwhelming and unchecked zeal to achieve its desired ends. Sure, protecting kids from secondhand smoke is an important goal, but to do so by removing kids from their parents or by making their parents criminals is not the way to go about it.

I well recognize that "protecting kids" is now supposed to justify everything the anti-smoking movement does, but this is getting ridiculous. When these kids are removed from their parents to live in foster homes, what are we going to tell them: "It's for your own good?"