Smart Parenting XXV: "Yes, Virginia, Second and Third Hand Smoking is Child Abuse"
A recent Google Alert on Psychology referenced an article addressing the effects of exposure to tobacco smoke titled - I pray facetiously as a question - "Is Secondhand Smoke Child Abuse?"1 The answer is obviously: "Yes!" Even those who would argue contra-wise would at the very least maintain that exposing children to secondhand smoke is a "moral failure" that needs addressing by mental health practitioners. I would be remiss if I did not add a couple of increasingly occurring unhealthy, and thus abusive, habits related to smoking: vaping, a recently emerging health hazard, and even some culturally sanctioned perilous practices such as 'hookah' smoking.
The Theology of the Custody of One's Body
In Old Testament Sacred Scripture we read God's words regarding our ancestral parents and from them to all of mankind: "And He said: Let Us make man to Our image and likeness: and let him have dominion over the fishes of the sea, and the fowls of the air, and the beasts, and the whole earth, and every creeping creature that moveth upon the earth." (Gn 1: 26). In the scriptural account of creation, the bringing forth of living creatures and mankind specifically occurs in the latter "days," or epochs of creation. St. Basil (329–379 AD) in his Homilies on the Six Days (epochs) of Creation [The Hexaemeron]ii reflects on the value and dignity of the living creatures, (cattle ox wolf, dog etc.) "Let the earth bring forth the living creature. Thus when the soul of brutes ... was born by the command of God. ... But each animal is distinguished by peculiar qualities." This being so, the dignity and worth of man is so much higher.
St. Basil tells us "Man, a celestial growth, rises superior to them as much by the mould of his bodily conformation as by the dignity of his soul." The dignity and worth of mankind has profound moral implications and responsibilities. Once again St. Basil informs us: "When we consider the natural and innate care that these creatures without reason take of their lives we shall be induced to watch over ourselves and to think of the salvation of our souls; or rather we shall be the more condemned when we are found falling short even of the imitation of brutes."
The deleterious health effects of second and third hand smoke
The Center for Disease Control notes that the smoke in tobacco is composed of more than 7,000 chemicals; over hundreds of them are toxic.iii In a recent article in the Annals of Family Medicine, Goldstein (2015)iv summarized the scientific findings on the health effects of secondhand smoke. Among the consequences of the pernicious smoking habit is the exposing of others to multiple smoke-related diseases, including asthma and pneumonia. Secondhand smoke (SHS) is also associated with sudden infant death syndrome, lung cancer and heart disease. It should also be noted that adults exposed to secondhand smoke have a higher risk for cerebrovascular accident (Stroke).v
Previously, little social, public health or ethical-moral attention has been given to the victims of Third Hand Smoke (THS). What is especially egregious about exposing others to THS, especially children, is the involuntary nature of the exposure. In this regard the National Institute of Health indicates:
THS exposure results from the involuntary inhalation, ingestion, or dermal uptake of THS pollutants in the air, in dust, and on surfaces. Such exposure includes inhalation exposure to compounds re-emitted into the air from indoor surfaces and particles resuspended from deposits, and dermal and ingestion exposure to compounds partially derived from cigarette smoke and resulting particles that have settled, deposited, and accumulated on surfaces.vi
The special case of electronic cigarettes (vaping)
Electronic cigarettes (e-cigarettes) are personal nicotine delivery systems (ENDS). A battery powers a heating element that atomizes an aerosol - vaporizes aerosols - usually containing glycerin, glycol, nicotine, propylene and various flavorings, which are then inhaled.
One concern of researchers is that of the delivery and exposure to particulate matter. The nicotine in vaping is delivered "by creating an aerosol of ultrafine particles".vii A study conducted by Williams et al (1958) found that through both smoking e cigarettes and exposure to secondhand vapor the "metal nanoparticles can deposit into alveolar sacs in the lungs, potentially causing local respiratory toxicity and entering the bloodstream."viii
One of the marketing strategies used by e-cigarette manufacturers is to promote their health benefit over conventional cigarettes. Unfortunately, this does not take into consideration that nicotine is highly addictive and that it has adverse effects on human brain development, especially in children and adolescents.ix
The special case of Hookahs
Hookahs are implements to vaporize and smoke various substances such as flavored tobaccos (e.g., apple, cherry chocolate, mint). The Center for Disease Control (CDC) notes there is a wide misconception that hookah smoking is less unhealthy than cigarette smoking.x Contrarily, this is far afield from the truth. Cigarette smoking and hookah smoking share the same health risks and the subsequent secondhand and thirdhand effects. In fact, the World Health Organization (WHO) has labeled Hookah smoking "a serious potential health hazard."xi
In heavy and long term use of hookahs Sajid, Chaouachi & Mahmoud (2008) found elevated levels of carcinoembryonic antigen (CEA), which is associated with various health conditions including colorectal carcinoma, gastric carcinoma, pancreatic carcinoma, lung carcinoma, breast carcinoma, and medullary thyroid carcinoma, and various non-neoplastic conditions such as ulcerative colitis, pancreatitis, cirrhosis, COPD, Crohn's disease, and hypothyroidism.xii
Moral Implications of these findings
This article started with the spiritual reflection that we are made in God's image and called to be like Him. Furthermore, we are to care for all creation. Mankind, being created in God's image, is the summit of His creation of the material cosmos. If we are to care for the earth and its creatures, how much more, therefore, are we required to care for ourselves and all around us. To be blind to the ill effects of our unhealthy actions to ourselves and to those around us is to be blind indeed.
We can apply Our Lord's words on sin to our sinful effects of any kind of smoking: firsthand cigarette smoking, the effects of second and thirdhand smoke and the proliferation of e-cigarettes and hookah delivery systems. "Or how canst thou say to thy brother: Brother, let me pull the mote out of thy eye, when thou thyself seest not the beam in thy own eye? Hypocrite, cast first the beam out of thy own eye; and then shalt thou see clearly to take out the mote from thy brother' s eye." (Lk 6:42).
It should be noted that there are three levels of falling short, missing the mark, also known as sinfulness, in this regard. First is the physical exposure to the teratogens in smoke, second is the psychological modeling that prompts others to sinful behaviors (Morelli, 2009)xiii, and third is the spiritual scandal of having others observe our breaking God's commandment. Did not Our Lord tell us: "Woe to the world because of scandals. For it must needs be that scandals come: but nevertheless woe to that man by whom the scandal cometh." (Mt 18:7" In this regard it behooves us to follow the counsel of St. Paul: "But judge this rather, that you put not a stumblingblock or a scandal in your brother' s way." (Rm 14: 13)
iv [Goldstein, A.O. (2015) Is exposure to second hand smoke child abuse? Yes. Annals of Family Medicine. 13 (2)103-104.]
vii [Ostro, B., Feng, W.Y., Broadwin, R., Green S., Lipsett, M. (2007). The effects of components of fine particulate air pollution on mortality in California: results from CALFINE. Environ Health Perspect. 115:13–19.]
viii [Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PLoS One. 2013;8:e57987.]
ix [Liao C-Y, Chen Y-J, Lee J-F, Lu C-L, Chen C-H. Cigarettes and the developing brain: picturing nicotine as a neuroteratogen in clinical and preclinical studies. Tzu Chi Med J. 2012;24:157–161.] It may be noted that a teratogen refers to any agent that interferes with normal embryonic development. A neuroteratogen specifically targets neural-brain development.
xi ["WHO Study Group on Tobacco Product Regulation (TobReg) an advisory note Waterpipe tobacco smoking: dangerous health effects include risk to public safety if used by multiple users, research needs and recommended actions by regulators, 2005" (PDF).]
xii [Sajid, Khan; Chaouachi, Kamal; Mahmood, Rubaida (24 May 2008). "Hookah smoking and cancer: carcinoembryonic antigen (CEA) levels in exclusive/ever hookah smokers". Harm Reduction Journal (Harm Reduction Journal) 5 (1): 19. doi:10.1186/1477-7517-5-19. PMC 2438352. PMID 18501010.]