Monday, April 11, 2011

Arkansas Bans Smoking in Cars With Children Under 14, Claiming It Will Spare Them From Secondhand Smoke Exposure

In 90 days, smoking in cars with children under 14 years old will be illegal in Arkansas, thanks to legislation enacted by the state legislature last week. It is already illegal to smoke in cars with infants and children under age 6; the legislation extends the ban to include smoking in cars with children up to age 13.

According to an article on the KSPR (Springfield, Missouri ABC affiliate) web site: "90 days from now your vehicle will not longer be your castle, if you will. Arkansans already can't smoke in the car if a child in a car seat is a passenger; Arkansas legislators say tweaking that law will spare more than 270,000 children from exposure to secondhand smoke."

According to another article, the director of the Arkansas Department of Health supported the law, stating: "Perhaps some of the worst exposure is in an automobile."

The legislation was widely supported by anti-smoking groups, including the American Cancer Society, which advocates state laws banning smoking in cars with children under age 18.

The Rest of the Story

The truth is that this law will not spare 270,000 children from secondhand smoke exposure. It may spare them from exposure during the minutes they are in a car, but it will not spare them exposure during the hours upon hours that they are in the home.

If these groups are sincere about standing up to protect the health of children, and if they are willing to interfere with parental autonomy in private vehicles by banning smoking in those vehicles, then why are these groups not proposing or supporting bans on smoking in the home? After all, the home - not the car - is the greatest source of secondhand smoke exposure for children who live with smokers.

The state health department director is mistaken in arguing that the worst exposure is in the car. He is confusing concentration of exposure with dose. The dose of exposure is equal to the concentration of exposure multiplied by the duration of exposure:

Dose = Concentration x Duration

While the concentration of secondhand smoke in cars can be very high, the duration of this exposure is short compared to the duration of exposure in the home. And you can bet that if parents are smoking in cars with children, they are most likely also smoking in the home.

By not supporting a ban on smoking in homes with young children, I believe that these politicians, policy makers, and anti-smoking groups are actually being hypocritical and displaying a lack of sincerity, as well as a subordination of public health protection to politics.

My own position is that although smoking in cars with children is unfortunate, the government should not interfere with parental autonomy to make decisions about their children's health risks unless those risks are immediately life-threatening (such as not wearing a seat belt or car seat) or if the behavior causes harm to the child (e.g., abuse or neglect). I do not support smoking bans in the home for this reason. However, I also do not support bans on smoking in cars for the same reason. It would be hypocritical of me to argue for smoking bans in cars with children, but to oppose such policies in homes with children.

Sometimes the most difficult decisions in public health are ones in which we must accept the fact that many parents put their children at risk of health problems. We can still intervene to try to prevent this from happening with educational and persuasion campaigns, but coercive measures that interfere with parental autonomy when the child is not in a situation of direct, life-threatening risk or actual harm are not justified.

While the policy makers and health groups supporting the smoking ban in cars with children are well-intentioned, I believe they are also being insincere in their stated intention of protecting the health of these children. They want to protect them from high, but short-term exposure in cars, but they are perfectly willing to subject those kids to long-term exposure to secondhand smoke in the home.

The problem is that once you regulate the smoking behavior of parents in the presence of their children, you have asserted jurisdiction over the issue. If you fail to ban smoking in the presence of children in the home, you now share responsibility for subjecting children to this exposure. Why? Because you could have acted to prevent such exposure, but you failed to do so.

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