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Smoke-free Foster Care: Isn’t it About Time?

posted on Thu, Jul 14 2011 8:27 am by Kerry Cork


You’ll forgive me if I sound a bit testy today. Perhaps it’s the political climate and this tendency for folks to outdo themselves in overlooking the obvious. A lot of that’s going around these days.  In public health, myopia about cause and effect can be dangerous, even fatal. Take the issue of smoke-free foster care, for example.

It’s pretty basic, really:

  1. Exposure to secondhand smoke is bad. It damages the body and can directly lead to chronic disease, such as heart attacks, strokes and cancer.
  2. It’s really bad for babies and kids. Their still-developing bodies are particularly susceptible to the toxic chemicals in tobacco smoke. (See Sudden Infant Death Syndrome; bronchitis, pneumonia and related potentially fatal respiratory infections; frequent and severe asthma attacks; eye and ear infections; risk of type 2 diabetes, heart disease, stroke and lung cancer. You get the idea.)
  3. And for infants and children with special health needs – kids whose health is already compromised – secondhand smoke is really, really bad. It can not only cause life-threatening disease, but premature death.
  4. An estimated 80 percent of the more than 400,000 kids who live in foster homes in the U.S. have at least one chronic medical condition. A high number of these children suffer from serious respiratory problems, such as asthma. (In fact, nearly one quarter have three or more chronic problems, such as diabetes, HIV and tuberculosis.) For such vulnerable youngsters, living in a home environment with smokers can be toxic.


Now here’s where the cause and effect business comes in.

We know that the safest way – in fact, the only way – to eliminate the health risks associated with indoor exposure to tobacco smoke is to prohibit all smoking activity. As a result, eighteen states to date have passed laws or regulations prohibiting smoking in foster homes (with most also covering smoking in vehicles transporting foster children, and a few covering outdoor areas within the range of homes). Several other states are considering similar legislation.

But that leaves close to thirty states that still allow children in a foster care environment to be exposed to the hazards of tobacco smoke. This, at a time when nearly half the U.S. population is covered by local and state laws prohibiting smoking in workplaces, bars and restaurants. And at a time when health care costs are skyrocketing. (Sidebar: In the foster care system, guess who typically covers the children’s medical costs? The state and federal government. When foster children, either with or without chronic health conditions, are exposed to secondhand smoke, they’re more likely to experience medical needs that result in additional costs to the government – costs that are only likely to continue as these kids age out of the foster care system.)

So, what’s preventing more states from passing smoke-free foster care policies? The state, after all, has the legal authority, responsibility and moral obligation to protect the health, safety and welfare of its youngest residents, and a special duty to protect those children in its charge – those considered “wards of the state.” (Even the National Foster Parent Association, organized in 1972, which represents thousands of foster families nationwide, has gone on record strongly endorsing smoke-free foster care policies.)

The most common arguments raised against smoke-free foster care seem to be misguided concerns that the requirements will violate privacy and autonomy rights, pose enforcement challenges or reduce the number of foster parents in the state. In the eighteen states that have enacted smoke-free policies in foster homes, some of these issues were raised initially, but none posed a problem in the long run. For a discussion of these arguments and the overall issue of smoke-free foster care legislation in the U.S., check out the Public Health Law Center’s Smoke-free Foster Care:  Policy Options and the Duty to Protect. A fact sheet and policy options overview are also available on the Center’s Web site.

At the end, it comes down to the willingness of state and local authorities to make a public health decision that benefits a uniquely vulnerable population. Smoke-free foster care preserves health, protects children and saves costs. It makes sense. And in thirty states or so, it’s long overdue.

This information was developed by Kerry Cork, staff attorney at the Tobacco Control Legal Consortium and Public Health Law Center.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

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