Repeatedly exposing children to secondhand smoke is child abuse, argues Adam Goldstein

Purposefully and repeatedly exposing children to secondhand smoke — a known human carcinogen — is child abuse, according to an opinion piece written by Adam Goldstein, MD, MPH, a professor in the Department of Family Medicine at the University of North Carolina School of Medicine. Drawing from his experience as a family physician caring for families with children who have suffered severe respiratory illness due to secondhand smoke exposure, Dr. Goldstein says it is time for society -- including doctors -- to do much more. Dr. Goldstein argues his point in an essay published in the Point/Counterpoint feature in the March/April 2015 issue of Annals of Family Medicine.

"Purposeful and recurrent exposure of children to secondhand smoke by a parent is as abusive as many other commonly accepted physical and emotional traumas of children, like drunk driving or leaving children in a hot car unattended," says Dr. Goldstein, who is director of the UNC School of Medicine's Tobacco Prevention and Evaluation Program (TPEP) and its Nicotine Dependence Program (NDP). "We have cared for too many children hospitalized with asthma and pneumonia, caused in large part to their repeated exposure to secondhand smoke."

Growing societal sentiment exists that secondhand smoke exposure of children should receive greater attention by providers and policy-makers. Options to intervene include counseling of parents that smoke, legislation, and even court relief at times, according to Dr. Goldstein. Texas, Vermont, Washington, and other states and counties — as well as other countries — already prohibit foster parents from smoking around children in cars and homes. "If this is true for foster families and smoking, shouldn't it be the case for all parents? Additional legal protection for young children exposed to secondhand smoke makes common sense," says Dr. Goldstein.

Goldstein discusses how petitions to family courts can protect children from ongoing secondhand smoke exposure when the child suffers from chronic lung illness. "Secondhand smoke exposure decreases lung function and has dozens of carcinogens; yet often the most vulnerable children continue to be exposed, and these children often have no voice."

Evidenced-based guidelines for smoking cessation include physician advice to counsel patients that exposure to secondhand smoke causes cancer and heart disease. In addition to helping patients quit smoking, physicians should advise parents that there is no safe level of exposure to secondhand smoke. Several states, including California, Arkansas and Louisiana ban smoking in cars with young children, and many courts are considering parental smoking as an important factor in deciding child custody cases.

Goldstein proposes that medical professionals take an even more active role in protecting children from secondhand smoke exposure. "It is time for medical professional organizations, such as the American Medical Association, the American Academy of Pediatrics and the American Academy of Family Physicians to endorse policies classifying purposeful exposure of children to secondhand smoke as child abuse."

"We must intervene to stop this abuse," Dr. Goldstein concludes in his essay.