USNews: Sue MDs When Kids of Smokers Go Hungry / / What's the Best Remedy When Smokers Starve Their Kids to Feed Their Habit?

Action on Smoking and Health (ASH) [http://ash.org/] Americ\'s First Antismoking Organization

2008-11-04 18:56:50 - U.S. News and World Report features a new study showing that children often go without food for entire days or longer, especially in the homes of smokers, where the chances that they will experience such "severe food insecurity" is 3 times higher than in homes without smokers, even after adjusting for income.
health.usnews.com/articles/health/healthday/2008/11/04/smokers-h ..

Recognizing that raising cigarettes taxes to address the problem might be counterproductive, it also cites two other approaches which involve suing physicians for failing to report "child abuse" when children are exposed to tobacco smoke, and failing to provide effective treatment for smokers -- both suggested by public interest law professor John Banzhaf of Action on Smoking and Health (ASH).
www.pr-inside.com/kids-starve-so-smokers-can-puff-r894985.htm

Banzhaf says millions of smokers are starving - or at least significantly under-feeding - their children just to indulge their smoking habit. More specifically, in low income households, 1 in 3 children live with a smoker, and 25% of the children experience "food insecurity," the technical term for lack of access to sufficient food.

This is not surprising since the report also shows that families with at least 1 smoker spend up to 20% of their income on tobacco. "This is both shocking and outrageous, especially since the typical price for a pack of cigarettes ($4) would buy several meals for their child," says Action on Smoking and Health (ASH).

Among all children in homes with smokers - including both low- and high income families - 17% were "food insecure" and 3.2% were "severely food insecure," a rate over 3 times higher than comparable homes without smokers. These comparisons were made even after adjusting for household income.

In other words, says Professor John Banzhaf of ASH, poor families with smokers are more than three times as likely to have children going entire days or longer without eating. In addition, over 25% of households with smokers experienced food insecurity, so adults as well as children are victims of the smokers.

Unfortunately but not surprisingly, although the AMA article advocates increasing the cigarette tax - a step which, while helpful for many - will also increase the problem for millions of children, it totally fails to even mention two effective strategies which could be implemented at virtually no cost by the medical profession itself.

The first would be to persuade physicians to report as suspected "child abuse" instances where parents smoke at home in the presence of children - especially children who already have asthma, sinusitis, or other conditions which make them especially sensitive and susceptible.

This single step would provide a tremendously powerful incentive for parents to quit, thereby protecting the children not only from the dangers of smoke, but also the major problems of having insufficient food.

Indeed, notes Banzhaf, a law professor at George Washington University Law School, smoking around children is increasingly being termed "child abuse," a term which can include subjecting a child to any significant unnecessary health harm or risk, and laws already require doctors to report any suspected child abuse.

For example, in Massachusetts it includes "all but the most negligible or de minimis injuries to children." The law states that it is designed "to insure that the children of the commonwealth are protected against the harmful effects resulting from the absence, inability, inadequacy or destructive behavior of parents or parent substitutes."
no-smoking.org/june06/06-20-06-1.html

In Michigan, "child abuse" means "harm or threatened harm by a person to a child's health or welfare which occurs through nonaccidental physical . . injury . . or maltreatment." "Child neglect," which also must be reported, includes "placing a child at an unreasonable risk to the child's health or welfare by failure of the parent, legal guardian, or person who has custodial care of the child to intervene to eliminate that risk when that person is able to do so and has knowledge of the risk."

"Since smoking by parents has been found to kill thousands of children every year, and to cause hundreds of thousands of episodes of asthma and other diseases, it is hard to argue that it isn't as serious as other common forms of children abuse, such as feeding a child unrefrigerated perishable foods or leaving a young child at home an unreasonable length of time," argues Banzhaf.
ash.org/parentskillkids

Another approach would be to take steps against the majority of physicians who refuse to follow established clinical practice guidelines which require them not only to thoroughly warn smoking patients about the dangers of smoking, but to also provide effective treatment. One journal and the NYC Health Dept. have even gone so far as to suggest that the best - and perhaps the only - way to motivate most of them would be to bring malpractice actions where medical problems result.
tobaccocontrol.bmj.com/cgi/eletters/15/6/447

It is estimated that this single step would get hundreds of thousands of smokers to quit and save 40,000 lives annually - not to mention the added benefit of protecting other family members not only from carcinogenic and deadly secondhand tobacco smoke, but also from the dangers of living on a starvation diet.

"Physicians have a legal duty to all their patients, even if the parents or the parents' health insurance is paying the bill," says Banzhaf, and this includes reporting situations when parental smoking is making a child ill. "Physicians also have a legal duty to provide effective treatment for patients who smoke. Perhaps it's time for the AMA to go beyond preaching to others, and first get its own house in order about America's number one preventable killer."

PROFESSOR JOHN F. BANZHAF III
Executive Director and Chief Counsel
Action on Smoking and Health (ASH)
2013 H Street, NW
Washington, DC 20006, USA
(202) 659-4310 // ash.org