Secondhand Smoke (SHS) and Children: A Nurse Cries for Help!
I love advocating for those who are unable to advocate for themselves. It is time to rise and speak up against the horrific effect of secondhand smoke on children and the unborn. Read on to find out the dangers and what you, as a nurse, can do.
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Norma is a 68-year-old lady who grew up with her parents in Florida. For years she has sought help due to various health challenges. Recently she was diagnosed with COPD, a disease of the lungs that affect smokers. This came as a shock because she had never smoked but she remembers that “Both mom and dad smoked till I left the house at twenty years old, 4 cartons a week” she explained to me. The effect this had on her at the time was that she “didn’t want to marry anybody who smoked.” Finding out about this was devastating as she says “I breathe mostly out of my mouth, so I think that has caused me more problems.”
“Tobacco use harms not only individual tobacco users but also others who are exposed through secondhand and thirdhand tobacco smoke exposure,” the American Academy of Pediatrics (AAP) confirms. “More than half of US children are regularly exposed to tobacco smoke” it explains. “There is no safe level of tobacco smoke exposure.” Studies confirm the home setting as the primary source of exposure for children since they are dependent on others who may be smoking. A recent study estimated 37,791 never-smoking children and adult U.S. public housing residents experienced illness and death due to exposure at home. This cost taxpayers a total annual sum of $450m.
This danger is not just in homes as “smoking in a motor vehicle exposes children to high concentrations of tobacco smoke,” AAP says.
With our training as nurses, we should be concerned with health promotion especially for those who cannot speak for themselves. We advocate daily for our patients. We come across children who are brought in with conditions arising from SHS exposure, and this should awaken that advocacy in us to speak for these little ones.
What Exactly is Secondhand Smoke?
Secondhand smoke (SHS) is made up of the smoke that comes from the burning end of a cigarette, cigar, or pipe, and the smoke exhaled by the smoker. It contains more than 7,000 chemicals that are toxic and about 70 that can cause cancer. SHS leads to third-hand smoke (THS). Center for Disease Control (CDC) defines THS as occurring when toxic residue from tobacco smoke adheres to surfaces such as carpets and walls.
AAP explains that THS “… exposes the nonuser by either direct contact and dermal absorption and/or off-gassing and inhalation...” and “… may react with oxidants and other compounds in the environment to yield secondary pollutants.” Living with her parents for twenty years also exposed Norma to THS. This may have further injured her lungs.
Though Norma is seeing the effect of SHS as a senior, AAP explains that “Tobacco smoke exposure harms children from conception forward, either causing or exacerbating the risks of preterm birth, low birth weight, congenital malformations, stillbirth…” It can also cause sudden infant death, childhood obesity, behavior problems, neurocognitive deficits, other respiratory problems, and middle ear infections. Ongoing data suggest that SHS tobacco smoke exposure may not only pose a risk to the development of childhood cancers but “may increase the likelihood of smoking among young adult cancer survivors.”
Available Data
According to the American Lung Association SHS
Causes 150,000 to 300,000 lower respiratory tract infections in infants and children under 18 months, leading to 7,500 – 15,000 annual hospitalizations
Results in 430 sudden infant death syndrome (SIDS) deaths in the United States yearly
Results in fluid buildup in the middle ear causing 790,000 annual doctor’s office visits, and
Above 202,000 asthma flare-ups among children annually
The Problem
Though many states have banned smoking in cars when children are present, there is still no national law to protect these children when they are involuntarily exposed at homes, and also in cars. We have succeeded in crafting laws that prohibit smoking in public places due to its adverse effect but these laws do not include residential areas and cars where children are.
There is also a failure on the part of the society to classify this exposure by parents as an act of abuse. Doing this would hold smoking parents legally accountable for their actions. Child abuse is defined by federal law as:
Quote
any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of serious harm
The exposure of children meets the criteria of child abuse. Smoking constitutes “… an act which presents an imminent risk of serious harm” to the unborn child as well as living child/children. Also not removing the child from exposure constitutes the “failure to act which presents an imminent risk of serious harm.” A study rightly asserts that purposeful and continual exposure of children to a known human carcinogen despite repeated warnings is child abuse. In 2015 Adam Goldstein a professor in family medicine in North Carolina agreed with this and says this is “like drunk driving or leaving children in a hot car unattended.” This is child endangerment! Yet, children continue to be exposed in their homes daily and during drives in the family car.
Based on the Fourth Amendment, you may argue that everyone has a right to privacy for acts occurring within private residences, but that right should only exist as long as it does not infringe on the rights of others. Especially when the “others” are children who are unable to protect themselves from the exercise of that right. The state owes the duty to protect children from acts of parents that can endanger their health significantly. This duty ought to be taken more seriously.
How You Can Help Stop the Effects of Secondhand Smoke on Children
Take time to write members of Congress to enact laws to stop this abuse. If your state already has clean air laws, ask the state member of Congress to amend it to include residential areas and cars where children are. AAP agrees this is one way, “prohibitions on smoking in motor vehicles with children present can be addressed”, in addition to educational interventions.
Nurses could always include smoking cessation interventions for parents who smoke and have children. Meanwhile, they could be taught to consider stepping outside to smoke so they do not endanger their children. Another teaching point could be considering not hiring babysitters who smoke. For those who have children already affected, seek proper medical attention and then seek assistance to quit smoking.
Nurses should educate, and make referrals for parents who repeatedly bring in children presenting with conditions that raise suspicion of exposure. Reports could be made to Social Services to report concerns about continuous exposure of children which could injure the child’s health.
The American Nurses Association (ANA) and other medical associations should fight for laws that will classify such exposure as child abuse. This issue ought to take prominence at an ANA national conference. It is our responsibility as nurses to advocate for those involuntarily placed in harm’s way. We should align ourselves with John Stuart Mill’s classic statement of harm principle which explains that power can be rightly exercised against any member of the society against his will if it is to prevent harm to others, especially if the intervention is shown to be effective in preventing the harm in question. Nurses and nurses’ associations should aggressively advocate for policy changes in the workplace and the nation that would eliminate such exposure.
Concerned citizens who seek nurses' help could be taught to consider petitioning the court to remove the children from the smoking parent’s home to secure a guarantee of no involuntary exposure to recurrent exposure. A study shows that our legal system now recognizes and acts on children’s continued exposure and can terminate parental rights. Furthermore, they are willing to reconsider custody status especially when a child is asthmatic or has other chronic SHS induced conditions.
Conclusion
Prohibiting smoking both in the home and vehicles is the required action to stop the effects of SHS on children. This is the surest way to eliminate SHS in the home and cause less negative health implications for children. The AAP advocates for “Smoke-free homes and smoke-free motor vehicles.” It further argues that “… (it) is one of the most important things that a society can do to protect children’s health.”
Smoking has never been and is not a fundamental right. One more infant or child should not have to suffer these horrific effects because that infant or child also has a fundamental right to live in a safe environment, one that promotes health. We all, as nurses, have a duty to ensure this.
Do you disagree or agree with me? I would love to hear from you! Leave your comments below.
