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Persuading parents to adopt smoke-free policies in their homes and cars provides an opportunity for furthering the multiple goals of tobacco control in a morally compelling context. Clean air rules in homes and cars protect children from highly injurious toxic exposures, facilitate smoking cessation by parents and other family members who smoke, and reduce the rate of smoking initiation by teenagers, especially when clean air laws are combined with parental monitoring and authoritative messages (even by parents who smoke).

Protecting Children from ETS

Not surprisingly, the most important source of ETS exposure to young children is parental smoking (DHHS 2006; Jordaan et al. 1999). National data indicate that although the percentage of U.S. children exposed to secondhand smoke in the home declined substantially throughout the 1990s, about 25 percent of children between the ages of 3 and 11 years still live with at least one smoker (DHHS 2006; TIPS 2006b). Furthermore, young children of smoking mothers continue to be exposed to ETS at a higher level than any other group of nonsmokers (Behan et al. 2005).

Children who are regularly exposed to ETS are at greater risk for a variety of respiratory ailments, including asthma, bronchitis, and pneumonia (AAP 1986; DiFranza and Lew 1996; Etzel 1997; Gortmaker et al. 1982; Mannino et al. 1996). In addition, such children are also at risk of suffering cognitive impairments. Yolton and colleagues, for instance, estimated that more than 21.9 million children are at risk of reading deficits due to exposure to secondhand smoke. They also found that exposure to smoke is associated with deficits in math and visuospatial reasoning (Yolton et al. 2005). Exposure to ETS has also been linked to serious conditions in infants, such as low birth weight and SIDS (ANR 2005; DHHS 2006). The children of smokers also miss more days of school because of illness than the children of nonsmokers (Mannino et al. 1996). Overall, annual health care costs as a direct result of children’s passive exposure to tobacco smoke is in the range of $5 billion (Aligne and Stoddard 1997).

The demonstrable health risks of persistent smoke exposure in the home has led many courts to take parental smoking into account in custody and visitation disputes (see Pierce v. Pierce, 860 N.E.2d 1087, Ohio Ct. App. 2006). These orders typically direct smoking parents to refrain from smoking in the home when children are present and sometimes up to 48 hours before they will be present (Banzhaf 2005). Some commentators have argued that, at least under some circumstances, smoking in the home can amount to child endangerment or medical neglect warranting assertion of family court jurisdiction as a basis for mandating changes in parental behavior (Chinnock 2003). Several jurisdictions at both the local and state

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