Public Health Concern- Smoking and Child Development.

The health of our children is subject to many harmful pollutants and other public health concerns. One public health concern that I feel very strongly about is that of exposure to smoking. The CDC states that “Tobacco use remains the single largest preventable cause of death and disease in the United States.” (Center for Disease Control, 2017) Additionally, the CDC states that “Cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths from exposure to secondhand smoke” (Center for Disease Control, 2017) While these statistics do not differentiate adults and children, further research tells us that smoke exposure has significant effects on all stages of child development. Specifically, this is a public health concern because exposure for pregnant women has been linked to reduced birthweight, increased risk of urinary tract and limb malformations and potential risks to lung function. (Berger, 2015) Additionally, exposure of young children to smoke has been linked to poor executive functioning, attention deficits, and learning delays throughout childhood. (Pagani & Fitzpatrick, 2016) Smoking is an issue I am strongly against and unwilling to waiver. For these reasons and more, it is a choice that I simple cannot understand.

While individual studies are each specific in what they refer to as exposure to smoke, often meaning tobacco smoke; I feel every type of smoking that exists falls into the public health concern category. I believe there is enough potential for known and unknown risk to each type of smoke to including cigarettes, cigars, pipes, vape, and anything else new on the smoking market, as a public health concern. I have not focused my research on the hazards of other oral methods of tobacco use; however, it is known that the risks there are much greater for the user and the biggest risk to children is that of a social reference.

First and foremost I personally cannot understand any parent today smoking anything around their children or anyone else’s child. We as an American society know enough, even with the most basic of knowledge, to recognize that this is at the very least unhealthy. Even if one were to distance the actual smoke away from children, the stench remains, and the mere visual of watching loved ones smoke is a factor in creating the next generation of smokers. In fact, a study of 3,000 children and their parents found that the risk of the child becoming a smoker was reduced by 40% when parents quit smoking, and was 70% less likely when parents never smoked. (Bricker et al., as cited in Bottorff et al., 2013) The article goes on to detail a study of 28 parent dyads and how the adults constantly revise their approaches and justifications for smoking as parents (Bottorff, Oliffe, Kelly, Johnson, & Chan, 2013). Interesting, disgusting, disturbing, and sad were my thoughts. The study included narratives of their two year old child mimicking smoking with a crayon, justified with how the child does not understand what smoking is yet, and they told them it was yucky; which is certainly a contradiction. Also, when their older children begged them to stop the unhealthy habit, they justified that by thinking that means their child will be less likely to smoke themselves (Bottorff, Oliffe, Kelly, Johnson, & Chan, 2013). Clear evidence of addiction and an extreme level of selfishness in my opinion. The entire study was full of notes of parents explaining to themselves and their interviewer how they would quit when they really needed to, but that time kept being pushed back. Another point I gathered from the study was that mothers who quit while pregnant, took up the habit after birth, and acted vigilant in keeping all second hand smoke away from the infant, all eventually slacked on their attempts to protect the child as they grew in those first three years. One example of an excuse being parents breaking the no smoking inside rule when they were hosting friends (Bottorff, Oliffe, Kelly, Johnson, & Chan, 2013).  How does that make sense? You are not willing to inconvenience your friends with a simple step outside in the cold rule, you would rather your child suffer? Honestly, I found zero actual logic, and zero understanding or empathy for these parents. The entire article made me sad and angry. 

I wonder if the parents in the above study would have finally made the choice to quit if they were given the chance to read the study of brain development and academic repercussions of exposure to second hand smoke published by Pagani and Fitzpatrick. In a longitudinal study of Canadian children from the age of five months old through age ten, they determined that exposure to smoke had negative effects on children’s classroom behavior. Specifically, those exposed to “early childhood household smoke showed proportionately less classroom engagement, which reflects task-orientation, following directions, and working well autonomously and with others.” (Pagani & Fitzpatrick, 2016) As these types of executive skills are necessary for school and adult life it is easy to imagine long-term effects. A few examples as stated by the authors are that these results can be precursors for future struggles such as dropping out of high school, as well as risky and unhealthy life choices. (Pagani & Fitzpatrick, 2016) The article is actually a wealth of information, which I wish I could share with every smoker I meet.

The American Academy of Pediatrics published a Policy Statement in regards to the need for action against this public health concern. (Pediactrics, 2015) The AAP concluded that tobacco smoke is harmful to children’s health, and that tobacco dependence is a pediatric disease; thus, to protect children’s health “Pediatricians can and should take actions to protect children and adolescents from tobacco dependence and tobacco smoke exposure.” (Pediatrics, 2015) They identify tobacco dependence as “one of the most common severe chronic illnesses of adolescents and adults.” (Pediactrics, 2015) Therefore, they emphasize the importance of the need for funded training for health care providers in treating tobacco dependence. (Pediactrics, 2015) I would love for pediatricians to take a more active role in this problem, and for them to have the ability to help smoking parents understand and then quit for the sake of everyone’s health.

As it seems for some the health concern for our children, our world’s future, are not enough incentive to make changes in regards to the public health issue of smoking, maybe the staggering financial costs of its consequences will encourage movement toward better policies as well as training, educational, preventative, and treatment programs. The American Academy of Pediatrics has gathered financial data for the extreme costs of childhood exposure to smoke, estimating medical costs in the USA to be $260 million per day (Best et al., as cited by Pagani & Fitzpatrick, 2016) Further financial costs could be determined when considering parental lost wages for school absenteeism due to the health concerns connected to exposure to smoking. (Pagani & Fitzpatrick, 2016) That is BILLIONS every year! BILLIONS!

We are on the right path. Around the world, and in the US, smoke-free legislation has been decreasing the rates of second hand smoke exposure in public places such as transportations, restaurants, parks and schools. Still, Smoking in private areas such as one’s home or car are much less regulated. (Blanch, et al., 2013) Recently, Blanch and colleagues published the results of their multi-level intervention against exposure to second hand smoke in several schools in Spain. (Blanch, et al., 2013) They determined their intervention had modest result in reducing exposure to second hand smoke at home, school, and in vehicles; and that while not a hugely successful intervention, any decrease is a positive effect for those children involved. (Blanch, et al., 2013) Their study seemed to lead them to the same conclusion as that of myself, Pagani, and the AAP, which is that we certainly have room for improvement; and now that public smoking is less prevalent, that improvement can be accomplished by targeting private smoking through education, and regulations. (Pagani & Fitzpatrick, 2016) (Blanch, et al., 2013) (Pediactrics, 2015) I could not agree more.

References

Berger, K. S. (2015). The Developing Person Through Childhood. New York: Worth Publishers.

Blanch, C., Fernandez, E., Martinez-Sanchez, J., Ariza, C., Lopez, M. J., Moncada, A., . . . RESPIR_NET Research Group, T. (2013, November). Impact of a multi-level intervention to prevent secondhand smoke exposure in schoolchildren: A randomized cluster community trial. Preventative Medicine, pp. 585-590 https://doi.org/10.1016/j.ypmed.2013.07.018.

Bottorff, J. L., Oliffe, J. L., Kelly, M. T., Johnson, J. L., & Chan, A. (2013). Reconciling Parenting and Smoking in the Context of Child Development. Qualitative Health Research, 1042-1053 DOI: 10.1177/1049732313494118.

Center for Disease Control. (2017, June 20). Current Cigarette Smoking Among U.S. Adults Aged 18 Years and Older. Retrieved from: https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html

Pagani, L. S., & Fitzpatrick, C. (2016). Early Childhood Household Smoke Exposure Predicts Less Task-Oriented Classroom Behavior at Age 10. Health Education & Behavior, pp. 584-591 DOI: 10.1177/1090198115614317.

Pediactrics, A. A. (2015, November). Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke. Pediactrics, p. Retrived from: http://pediatrics.aappublications.org/content/136/5/1008.