Friday, June 16, 2006

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.

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