Monday, May 22, 2006

IN MY VIEW: Making it Unlawful to Smoke Around Children Could have Detrimental Effect on Childrens' Health, Especially Among Disadvantaged Populations

There has recently been a push within the anti-smoking movement calling for the regulation of smoking around children in private homes to protect them from the hazards of secondhand smoke exposure. At least one major anti-smoking advocate has called for criminalization of smoking around children in the home, a major anti-smoking group supports banning smoking in homes with foster children present, and a number of advocates and groups have called for treating smoking around children as a form of child abuse and/or for the referral of parents who smoke around children to social services agencies or family courts.

While I have already argued against these proposals on a number of grounds not directly related to health, such as violation of parental autonomy, undue intrusion into privacy, and blind fanaticism that views a few ear infections as more important than preserving the ability of a child to remain with his or her loving parents and is willing to rip families apart in order to pursue its narrow aims, here I argue that the proposed policy could well harm the health of many children, especially the most disadvantaged, by inserting a nearly-insurmountable barrier to their obtaining appropriate medical care.

The Rest of the Story

By making it unlawful to smoke around one's children in a private home, imposing criminal or even civil penalties, referring parents who smoke around their children to authorities, or treating smoking around children as a form of child abuse, we would actually be imposing a huge barrier to children's access to appropriate medical treatment for conditions that are associated with secondhand smoke exposure.

The reason is simple: Parents who smoke around their children are going to be very reluctant to present to medical authorities if they are afraid they may be penalized, face criminal sanctions, be referred to social service agencies or the court system, or risk having their children taken away from them.

This problem is particularly important among children in already disadvantaged communities, where lack of health insurance and other barriers are now interfering with parents seeking appropriate care of their children's medical conditions. Based on my own experience, the emergency room is often used as a source of what should be primary care for many disadvantaged children. Existing fear of medical authorities, in some communities, already hinders parents from seeking medical attention for their children unless it is absolutely necessary.

This is why we often do not see children with ear infections in the doctor's office until the condition has progressed to become a more widespread infection and we often don't see asthmatic children until they are unable to breathe and need more extreme treatment then if they presented for medical treatment at an earlier stage.

To get a glimpse of what might occur if smoking around children were made unlawful, just look at what is happening in the field of immigrant health, where it is well-documented that many immigrant families (including children) are reluctant to present to medical authorities because of fear that the status of undocumented immigrants may be revealed and reported to authorities (see this Health Affairs article to see data on the lack of access of immigrants and children of immigrants to health care).

The rest of the story is that while some anti-smoking groups are promoting making it unlawful to smoke around children in order to protect childrens' health, such a policy would likely harm the health of large numbers of children by reducing their access to health care by creating fear among parents that they will be penalized, criminalized, or lose their children if they present for medical care and their smoking around children is found to be a cause of the child's health problem.

This is likely to be a particular problem among children who are already disadvantaged, and in communities where existing barriers to health care access are already undermining the health of our nation's children.

This is another example of the dangers of narrow-minded thinking that focuses on just one problem without maintaining a broader perspective on the public's health, especially factors that influence the health and well-being of children living in disadvantaged families or communities.

The anti-smoking movement needs to broaden its perspective or we may well end up seriously harming the very citizens who we are purporting to be helping.

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