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It’s been almost 35 years since Joseph A. Califano, Jr., former Secretary of the U.S. Department of Health, Education and Welfare (DHEW) which became the U.S. Department of Health and Human Services (DHHS), announced the government’s Initiative on Smoking and Health. This was an amazing event, considering so many people in the United States smoked. At that time, people smoked at work, at home, in restaurants, in hospital waiting rooms and movie theaters, in public buildings and even on airplanes. Cigarettes cost in the neighborhood of 50 cents a pack. Respiratory diseases, lung cancer and heart disease were on the rise, as were the insurance and lost-time costs to employers of sick employees with smoking-related ailments—but there was little discussion of the effects of “passive smoke” and the damage it inflicts on the very young.

Recently, it struck me how concept-changing that announcement was. Mr. Califano, a lawyer (and former senior partner of the lawfirm of Williams, Connolly and Califano), on leaving DHEW/DHHS didn’t let the argument stop with his departure from the Carter administration. He took on the big tobacco companies in the real world and aimed in legal battles to change the laws that permitted smoking in public buildings, with the express purpose of lowering the numbers of people who suffer from respiratory ailments due to smoking, including the very young. June 21, 2011, the U.S. Food and Drug Administration (FDA) unveiled the final graphic warning labels it will print on cigarette packs for sale—a far cry from the mild warning of yore: “The Surgeon General says, “Cigarette smoking may be hazardous to your health.’”

Yet during the past 35 years, it has taken more than mild warnings to get people to focus on what happens to kids in smoking environments, and I’m not sure we haven’t understated the warnings. When out and about, I too often see young mothers holding a baby and a cigarette. And I wonder, what can they be thinking, and do they know that young children and toddlers are especially sensitive to the effects of secondhand smoke? Their bodies are still growing and developing and they breathe faster then adults and therefore inhale proportionately more smoke. So moms and dads who smoke around their kids are essentially setting up their children for possible smoking-related breathing problems.

Research shows that kids who grow up in households where one or both parents smoke, have twice the amount of respiratory and lung disorders, and in some cases have been hospitalized due to smoking-related disorders. They also experience greater absenteeism and there have been studies which suggest that children exposed to more passive smoke may have more behavioral problems than children who are not exposed to passive smoke. It took decades for most of the public to accept that smoking is related to cancer – that smoking causes health problems in formerly healthy individuals.

The goal should be for all to connect the dots between smoking and respiratory problems, so that eventually people will stop smoking around children.

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