Tuesday, December 2, 2008

Health

USN Current Issue

One Puff Above the Limit

By Bernadine Healy M.D.
Posted 2/4/07

Rest easier, robbers. The cops have some new villains to track down. They're called smokers. Recently, police in Bangor, Maine, took on the job of ticketing people spotted puffing on cigarettes in their cars if children under 18 are onboard. Last year, Arkansas and Louisiana enacted similar bans, and many other states, including New Jersey, New York, California, Kansas, and Utah, are considering them. Some propose fines as high as $500-and jail time.

To be sure, public policies like advertising bans and smoke-free public places have been highly effective in reducing exposure to second-hand smoke. And the goal of these new laws is just as laudable. But this particular anti-smoking campaign has more than libertarians concerned that government is going too far in policing behavior and trouncing privacy. Next, the health police could ticket parents for buying children junk food or for letting them get too much sun at the beach. A more practical and immediate concern, however, may be whether enlisting the police to punish smokers will improve children's health.

Smoking is an ugly habit. It pollutes the air with toxic vapors that can be inhaled by innocent bystanders. This seems to explain why nonsmoking spouses of smokers face a small but increased chance of lung cancer. For children, as pointed out by the surgeon general's 2006 report "The Health Consequences of Involuntary Exposure to Tobacco Smoke," homes filled with smoke increase youngsters' risk of respiratory problems like bronchitis, pneumonia, and asthma attacks. The report also revealed that Mom's smoking has a greater negative effect than Dad's. But it's not just smoking during pregnancy that can do damage. The lungs of infants and toddlers are also vulnerable to passive smoke, a risk that trails off and disappears as children grow older and move into their teens. What does not disappear, however, is a child's risk of becoming an active smoker, facing a greater chance of cancer and heart disease later on in life.

There are few data on smoking in cars per se. The danger is inferred because of smoke concentration in a contained space. You might also infer that people so into their cigarettes that they have to light up in the confines of a car represent a pretty hard-core group of smokers. Smoking them out of their cars will only drive these tobacco addicts to light up more in their kitchens and family rooms, out of sight or reach of the health police.

Singled out. But even among those who have not yet become addicted, the threat of a ticket may not be a deterrent. Over the past 20 years, more than 30 states have enacted laws imposing hefty fines, court appearances, loss of driver's licenses, school suspensions, or other penalties on teenagers caught buying, possessing, or using tobacco. But these penances haven't worked very well. Neither policymakers nor police are enthusiastic about punitive approaches, and the laws are often enforced in an erratic and seemingly selective way. This suggests another problem for the smoking police: The odds are that the adults they will be singling out for smoking in cars with underage passengers will be disproportionately poor, uneducated, and female, as today's smokers are tilted toward lower incomes and less formal schooling. And even though more men smoke than women, more often than not, women will be the ones ferrying young children around in cars. They're called Moms. So be real. Will a $500 fine or 30 days in jail improve the well-being of these often-disadvantaged mothers and their children?

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