Parents abuse children by smoking, group says

The Globe and Mail, By ANDRÉ PICARD, Tuesday, January 21, 2003

Exposing children to second-hand smoke is tantamount to child abuse, the Canadian Lung Association says.

In a controversial statement released Monday to mark Non-Smoking Week, the venerable charitable organization called on parents to stop smoking in the home because they are endangering the health of their children.

"Children who are exposed to second-hand smoke are victims in their own homes — the very environment that is supposed to be safe and protective," said Noel Kerin, an occupational and environmental medicine specialist and medical spokesman for the lung association. The century-old charity was formed to combat tuberculosis, but has turned its attention to a variety of lung issues, including smoking.

"Second-hand smoke is damaging to a child's health and is tantamount to child abuse. The evidence is too compelling to present it in half measures or to worry about political correctness. We have a significant social and health problem that needs public attention and the associated pressure of public intolerance to correct it."

Dr. Kerin said that a child whose mother smokes half a pack of cigarettes daily has double the risk of developing asthma. A child who has asthma who lives in a home where someone smokes will have three times as many asthma attacks, which can require hospitalization and even cause death.

Exposure to tobacco smoke increases children's risk not only of asthma, but of respiratory tract infections, ear infections and sudden infant death syndrome. And children who live with smokers are also more likely to become regular smokers.

"These are children who would otherwise be healthy and the behaviour of an adult is causing a serious disease. There is no other word for that than abuse," Dr. Kerin said.

He said an "adult in that situation can choose not to be abused — they can leave — but a child cannot. These children have to be protected."

He refused to say, however, what sanctions should be applied to parents who smoke in the home, saying that is not the lung association's area of expertise.

In cases of abuse, child-welfare authorities remove children from the home, but the lung association would not say if that is appropriate.

Nico Trocmé, director of the Centre for Excellence for Child Welfare at the University of Toronto and one of Canada's foremost experts on child abuse, said there are "certainly some circumstances where smoking in the home could be considered to be child abuse" but, in general, child-welfare authorities would not view it in that way.

He cited the example of a parent who smoked a lot in front of an asthmatic child, triggering asthma attacks. "In that case, yes, I would say report it to child-welfare authorities," Dr. Trocmé said.

"That's abusive and state intervention is required. But between that and saying all smoking in the home where there is a child is abuse is quite a distance."

Peter Dudding, executive director of the Child Welfare League of Canada, agreed, saying: "Currently, smoking is not grounds that would warrant removal of a child from the home, but that's not to say it shouldn't be. There's a shifting level of knowledge and tolerance in our society about smoking."

He said he hoped the lung association's provocative stand would help get the health message out and make legislative measures moot.

There are 2.4 million Canadian households with children under the age of 12. According to Health Canada's Canadian Tobacco Use Monitoring Survey, children in about 25 per cent of those homes are routinely exposed to second-hand smoke.

According to the World Health Organization, about half the world's children, nearly 700 million, breathe air polluted by tobacco smoke, particularly at home.

The lung association is not the first group to label smoking near children as a form of abuse. In 1997, James Garbarino, an internationally recognized expert on child protection, caused a furor when he made a similar declaration.

And in 2000, researchers at the Ontario Tobacco Research Unit declared that physicians have a duty to encourage parents to quit smoking and to report the abuse to child-welfare authorities if they do not.

Dr. Kerin said the lung association is aware that its strong language will raise eyebrows, but the charity felt it was time to take an unequivocal stand on the dangers of second-hand smoke to children.

"We've been around for 101 years and we've always been at the leading edge on health matters. This seems controversial today, but the rest of society will catch up with us soon," he said.

About 45,000 Canadians die of smoking-related illnesses each year, including more than 1,000 non-smokers who succumb to the effects of second-hand smoke.

An estimated 5.4 million people, or 22 per cent of the population aged 15 years and over, were smokers in 2001, according to Statistics Canada. That's the lowest rate since Health Canada began collecting data in the 1960s. Then, half the population smoked.