Monday, December 10, 2007

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.

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