Passive Smoking and Children - Dissertation Example

?Running Head: Passive Smoking and Children PASSIVE SMOKING AND CHILDREN [Institute’s TABLE OF CONTENTS TABLE OF CONTENTS 2 CHAPTER # 1 – INTRODUCTION 3 Background 3 Research Aims and Objectives 4 Outline of the Thesis 5 CHAPTER # 2 - LITERATURE REVIEW 6 CHAPTER # 3 – METHODOLOGY 12 Data sources 12 Secondary Data Sources 12 Limitations of Research 13 CHAPTER # 4 - FINDINGS, DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS 15 Analysis and Findings 15 Conclusion 19 Recommendations 19 REFERENCES 21 CHAPTER # 1 – INTRODUCTION Background According to the statistics of year 2010, more than 0.6 million people all around the world die due of passive smoking, which means that one out of every 100 deaths in the world occurs due to passive smoking. Out of these 0.6 million people dying due to passive smoking, 40 percent are children (Strauss et al, pp. 267-268, 2010). The data comes from 192 countries of the world, which suggests that almost two thirds of deaths caused by passive smoking in children occur in Africa and South Asia. Furthermore, the World Health Organization suggests almost half of the children in the world that is 700 million children have exposure to secondhand smoke due to 1.2 billion smoking adults (Blair et al, pp. 372-373, 2010). Alone, in United Kingdom, passive smoking is associated with the deaths of almost 10700 people every year. Furthermore, secondhand smoke has been associated with more than “2000 Sudden Infant Death Syndrome (SIDS) deaths every year. More than 17000 children from five years to ten years of age in England and Wales are admitted to hospitals every year due to the various illness caused by the smoking of their parents” (Strauss et al, pp. 267-268, 2010). Even more surprising are the statistics, which claim that almost half of the children between the ages of 4-11 years have exposure to secondhand smoke in their homes (Blair et al, pp. 372-373, 2010). This explains every year almost 40 children die because of passive smoking alone in United Kingdom (Gordon et al, pp. 103-105, 2004). One of the most important reasons behind study this topic is the fact that it is one of most important burning issues all around the world. As mentioned later in the paper as well that, until the late 1970s and early 1980s, there was this widespread belief that smoking only causes harm to the smoker (Yolton et al, pp. 461-465, 2008). In light of the freedom and liberty principles, if the smoker is sane enough to understand the consequences and yet wants to smoke, then the state or law enforcement agencies must not create any barriers in his or her way. However, towards the end of 1980s, experts and researchers had conclusive evidence to prove that smokers were not only causing indirect damage but also direct damage with secondhand smoke to their children, partners, friends, colleagues, and others living in the surroundings (Gordon et al, pp. 103-105, 2004; Strauss et al, pp. 267-268, 2010). Ever since then, the civil society, NGOs, watchdogs and others have been trying to achieve the goal of a smoke free world. This study is another attempt to explore the disastrous impacts of passive smoking, specifically on children belonging from the age group of 5-10 years. Furthermore, the study would also come up with some recommendations to protect these children and solve this problem. Research Aims and Objectives The study revolves around the following research question. “What are effects of passive smoking on children of ages 5-10?” The research would attempt to achieve the following aims and objectives. To explore, investigate and critically analyze the social, economic, psychological, and physical impacts of passive smoking on children belonging from the age group of 5-10. To explore and analyze the long term and short term implications of these effects on children are their families To come up with a handful of recommendations to protect children from the destructive impacts of passive smoking Outline of the Thesis This heading would conclude the first chapter of the thesis that presented a brief background of the topic, research expectations and rationale, research aims and objectives and the outline of the thesis. The next chapter would be the literature review, which would have the aim to discuss briefly the concerned researches, theories, and studies in order to lay down the foundation for the coming chapters and specifically the fourth chapter. The third chapter of methodology will discuss the chosen methodology for the paper, its advantages, and limitations. The last chapter will engage in discussion, critical analysis and would explore the topic into more depths. The chapter would conclude with a conclusion and recommendations obtained in light of the discussion earlier in the chapter. CHAPTER # 2 - LITERATURE REVIEW Smoking has always remained in the spotlight as a societal evil, slow position, or alternative to suicide for the smokers. Extensive researchers and studies have attempted to explore dimensions, impacts, effects, and other dynamics concerned with smoking. However, for many decades, people were in dark regarding the disastrous impact on passive smoking. It has been only three decades since the topic has received significant attention and ink from researchers and experts. It was not until the 1990s when the US officials realized that passive smoking was the third leading preventable causes of death with first being active smoking and the second was alcohol abuse (Woodward & Laugesen, pp. 390-392, 2001). In simple words, passive smoking refers to the process of breathing in the other people’s tobacco smoke originating from cigars, cigarettes, pipes, and other such sources (Marotz, pp. 18, 2008). Quite understandably, secondhand smoke originates from the mouth of the smoker from the air that is breathed back out (exhaled mainstream smoke) and from the tip of the cigarette (side stream smoke). The combination of exhaled mainstream smoke and side stream smoke is also known as Environmental Tobacco Smoke (ETS) (Bernhard, pp. 87-89, 2011). Even if the smoke is not visible or cannot be smelled, it is highly that the smoke would remain in the room for as long as 150 minutes even after with open windows. Even worse is to expose the children with smoke in the air with the windows closed because all the smoke particles would remain concentrated in a very small pace. This is because of the fact that Tobacco smoke has the capability to hand in mid air for long period of time rather than dispersing. The hotness of the smoke rises up in the air but the essence of the Tobacco smoke, instead, cools rapidly (Woodward & Laugesen, pp. 390-392, 2001). There are various ways of measuring the content level of secondhand smoke in air. The indoor air can be tested for determining the nicotine content. Furthermore, the person exposed to secondhand smoke will show high level of cotinine, which is a form of nicotine after breaking it down. This cotinine will appear in the blood, urine, or salvia of the subject (Lee & Forey, pp. 408-410, 2007). On an average, secondhand smoke may contain almost 4000-7000 toxic particles. Out of these 4000-700 toxic particles and gases, almost of 50 of them are known to cause cancer. These include “Arsenic, Benzene, Beryllium, and 1, 3–Butadiene, Cadmium, Chromium, Ethylene oxide, Nickel, Polonium-210, Vinyl chloride, Formaldehyde, Benzo [?] pyrene, Toluene, and others” (Martin & Fabes, pp. 280, 2008). Therefore, even the most conservative sources estimate that if a child remains a secondhand smoke filled room for almost 60 minutes; he or she would inhale toxicants equal to smoking of 10 cigarettes (Jarvis, Goddard & Higgins, pp. 349-352, 2001; Bernhard, pp. 87-89, 2011). In the United States, there are various laws that prohibit smoking in areas where federally funded services are provided to children. There is widespread ban in almost all states of the country on smoking in kindergartens, schools, nurseries and other facilitates where children are present. Yet, statistics indicate that somewhere between 50-75 percent of the children all across the United States have above average or harmful levels of continine present in their blood. Since the year 2007, there has been a ban in all across United Kingdom on smoking in public places and recent opinions indicate that 80 percent of the people support this ban (Yolton et al, pp. 461-465, 2008). One of the most important reasons why young children especially which are between the of ages 5-10 years are more sensitive to effects of passive smoking because of their quick growth and development in the body they are more likely to inhale more and breather much faster. This is why their heart beat rate is also faster than adults are. Therefore, within a given amount of time, they may inhale more smoke thus putting them on more risk of adverse effects of passive smoking (Stratton, pp. 264-265, 2001). There is conclusive research evidence which reveals that children, which have even one parent who smokes at their house and prolonged exposure to that passive smoke may put the child on risk of twice as many respiratory and lung disorders as compared to a normal child. Furthermore, coughs, cold, sore throats, fluid in the ears, tuberculosis, chronic middle ear disease or "glue ear", cardiovascular disorders, loss of sense of smell and others (Lee & Forey, pp. 408-410, 2007; Haustein, & Groneberg, 2009; Bancalari, pp. 185-186, 2008). In United States alone, passive smoking is linked with more than 0.3 million cases of bronchitis, pneumonia, or bronchiolitis in children every year, belonging from the age group of 5-11 years. To be specific, with passive smoking, the risk of lung diseases in children between the age group of 5-10 increases by 24 percent and the risk of heart diseases increases by 25 percent as compared to other children. Most common of these diseases is asthma, which the child is most likely to develop in the coming years of his life (Jarvis, Goddard &Higgins, pp. 349-352, 2001; Hall & Elliman, pp. 105-106, 2006). With a smoking parent, the risk is not only of diseases but research from United Kingdom has shown that children with at least one smoking are 40 percent more likely to be absent from schools due to breathing problems every month (Gilliland et al, pp. 864, 2003). Therefore, the point here is that with passive smoking, every single organ of the child exposed to that smoke is at risk (Hecht, Ye, Carmella, pp. 1110-1111, 2001). One aspect of effects of passive on smoking that has not received much attention and focus of the neurological and cognitive problems that it develops in the child during his or her early years. Without any doubts, the toxic chemicals in secondhand smoke are enough to put hindrances in the proper functioning of the child’s brain, which is extremely vulnerable to these threats (Haustein, & Groneberg, 2009). There is wide list of cognitive and behavioral problems attributed to children who have prolonged exposure to secondhand smoke. They include partial memory loss, difficulty in concentrating or paying attention or short attention span, inability to perform multitasking, mood swings, anger issues and others (Button, Thapar & McGuffin, pp. 159-160, 2005; Yolton, pp. 99-100, 2009; Yolton et al, pp. 461-465, 2008). All these neurological, cognitive, and behavioral problems combine to result in lower academic achievement and performance of students. A study conducted with the help of questionnaires survey from responses of 23052 non-smoking children in Hong Kong from ages 6-12 found out that there was significant relationship between secondhand smoke and children’s academic performance. The study also recorded the data regarding the number of smokers in the house, number of smokers in the neighborhood where child had a possible exposure to, numbers of hours and days during which child is exposed to secondhand smoke and other demographic characteristics. With a 95 percent confidence interval, the study found out that students exposed to secondhand smoke for 1-4 days a week were 14 percent more likely to report poor academic performance. However, children that have exposure to secondhand smoke for 5 days to an entire week are 28 percent likely to report poor academic performance. Furthermore, the findings were also interesting regarding the relationship between the number of smokers in the house and its impact of academic performance. Living with one smoker as compared to no smoker at all meant that students were 10 percent more likely to report poor academic performance. Living with two smokers as opposed to none increased the odds of poor academic performance by 43 percent and the same percentage peaked at 87 percent in case of living with three smokers (Gilliland et al, pp. 864, 2003; Hall & Elliman, pp. 105-106, 2006). Important here to note is that the study mentioned correlation but not causation. Other factors about children exposed to secondhand smoke and their families were common in smoker parents or children that may be the direct cause of lower academic achievement. For example, the study did note the fact that more than 78 percent of these families where children’s academic performance was below average, the families belonged from lower or lower middle social class (Sloan, pp. 10-19, 2004) . Recently, the Royal College of Physicians (RCP) came with an interesting report calculating the economic and social losses incurred by exposure of children to passive smoking. This 200 page report which is the first of its kind to assess the impact of secondhand smoke on children found out that more than 22000 children every year were seeking medical care for asthma and other related diseases which costing the NHS more than 23.3 million Pounds per year. Out of this 23.3 million, 9.7 million represents the cost of doctor visits and 13.6 million is the cost for hospital admissions. Furthermore, the figure of 23.3 million pounds does not include the four million pounds, which represents the cost of drugs for asthma brought for these children every year (Lister, pp. 1, 2010). On the other hand, there are a handful of studies, which have also taken the stance that the association between passive smoking and risk of cancer and other heart related diseases is a weak one. A notable research by James E. Enstrom from University of California and Geoffrey C. Kabat from New Rochelle, New York, USA in the year 2003 amazed the world when he criticized previous studies as biased and questionable and concluded that there is no evidence present, which could identify a strong causation between two variables (Button, Thapar & McGuffin, pp. 159-160, 2005). Within days of its publication, the study made the headlines all over the world with tobacco companies heavily promoting the results of this study trying to prove that secondhand smoke is not that harmful, as propagated in the media. The study even went on to make a comment that these findings are also applicable on children who are in their pre teen years as well and the impact of secondhand smoke on children has been inflated to great heights. Despite the fact that the authors claimed that their research depended on their experience of more than 25 years, their study received strict scrutiny and criticism from almost all sides except for the Tobacco industry. It was later when the details leaked that the researchers received their funding from Phillip Morris, which is a Tobacco company. Furthermore, even before the study was published, American Cancer Society (ACS) whose database was used for completion of this research criticized the methodology used by these researchers and called it as faulty and manipulative (Hecht, Ye, Carmella, pp. 1110-1111, 2001; Haustein, & Groneberg, 2009). Stephen J. Milloy, who is also a junk science commentator at Fox News, has been a very vocal critique of secondhand smoke. Despite his evident ties with the tobacco and oil industry. Milloy believes that there is no conclusive evidence, which could prove the relation between secondhand smoke, and various diseases, which are attributed to it (Jarvis, Goddard &Higgins, pp. 349-352, 2001). CHAPTER # 3 – METHODOLOGY Data sources Without any doubts, the methodology is the heart of any research. Not only a well-crafted research methodology enables the research to achieve high levels of reliability, validity, and authenticity but at the same time, it also allows the study to uncover hidden aspects of the aspects and take the research into so many different dimensions (Eriksson & Kovalainen, pp. 63-68, 2008). Every study has three options in terms of data sources, primary data, secondary data or a mix of both. Primary data refers to first hand data collected by the researchers for a specific purpose. However, if that primary data comes under usage for other purposes or by other researchers, it is labeled as secondary data (Bryman & Bell, pp. 30-32, 2007). Quite understandably, both these data sources have their own advantages and disadvantages. That explains why most researches rely on a mix of both data sources so that gaps in one data source could be filled with the help of other. Nevertheless, in light of the aims and objectives, expected outcomes and limitations of the researcher, secondary data sources appeared to be the most feasible data source to rely on for this research (Eriksson & Kovalainen, pp. 63-68, 2008; Creswell, pp. 95-98, 2009; Pervez & Gronhaug, pp. 106-108, 2005). Secondary Data Sources Secondary data sources are available in form of books, magazines, research journals, newspapers, already published researches and studies, information and statistics available from the researches, publications, and websites of government agencies, civil society, NGOs, universities, trade associations, and others (Creswell, pp. 95-98, 2009). By relying only on secondary data, the study has been able to reap many significant advantages and benefits. First, using only secondary data meant that the researcher that did not have to engage into the lengthy, time consuming, expensive and effort taking process of collecting and analyzing data from scratch. This meant that the researcher had more time and energy at his disposal for evaluating and analyzing the already available data. Second, to some extent, the research has involved in longitudinal analysis, which would not have been possible if this would have been a primary research until and unless this research was covering the data over many years. This longitudinal analysis allowed the research to uncover the changing trends regarding passive smoking over the past three months. Third, by conducting a primary research with the limited resources available to the researcher, it was almost impossible to come up with an extremely reliable and trustworthy study (Bryman & Bell, pp. 30-32, 2007; Pervez & Gronhaug, pp. 106-108, 2005). On the other hand, the researches that are a part of the literature review and which have played an important role in achieving the objectives and coming up with the recommendations were extremely large and funded with by notable organizations. The sample included thousands of respondents within controlled environments. Therefore, those studies have actually helped this thesis to achieve levels of higher authenticity and reliability (Eriksson & Kovalainen, pp. 63-68, 2008; Creswell, pp. 95-98, 2009). Limitations of Research It is important here at this point in the research to acknowledge that despite all the efforts, the research has certain limitations. First, several studies used in this paper are more than five years old. The fact is that round realities are changing every so quickly and there are always some latest developments in the field which provide with new perspectives and dimensions. Second, not all primary researchers are reliable and completely trustworthy despite their claims; scope, funding, and sample size (Eriksson & Kovalainen, pp. 63-68, 2008). In many instances, noted in the literature review, the researchers have tried to tweak, manipulative, and misinterpret the data for supporting their presumptions or hypothesis (Bryman & Bell, pp. 30-32, 2007; Pervez & Gronhaug, pp. 106-108, 2005). Third, in absence of any primary data, the study has tried to catch glimpses from various secondary researches thus expanding its scope onto various different dimensions thus limiting the ability of the research to focus on one single aspect of the effects of passive smoking on children from age group of 5-10 (Creswell, pp. 95-98, 2009). CHAPTER # 4 - FINDINGS, DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS Analysis and Findings Important here to understand is the severity of the cognitive and behavioral impacts of secondhand smoke on children of ages five to ten. Quite understandably, this is the age when children are learning and forming their patterns and images of the world. In light of the learning theory given by Lev Semyonovich Vygotsky, famous Soviet psychologist, a child that has constant exposure of horse riding due to his parents, neighborhood, or other would develop the will to become a horse rider himself. In his early years, he could try to use any stick, ruler, toy, or any other object as its horse and develop the sense of horse riding. However, with the passage of time, with more and more observation, his learning would become stronger. Furthermore, watching his own parents engage in horse riding and getting praise from people would act as a positive reinforces and the child would try to experience the same as soon as he gets the opportunity (Haustein & Groneberg, pp. 96-98, 2009; Hawamdeh, Kasasbeh, & Ahmad, pp. 445-448, 2003). The same is also true in case of secondhand smoke. Children, who are exposed to passive smoking during their early years of life, closely observe these behaviors and develop the will to follow the same path. The point here is that it is highly likely that these children would become smokers themselves in the coming years of their lives. More importantly, since they are familiar with the taste and smell of tobacco, it would be easier for them to stick to the habit even in the absence of any peer pressure thus making it very hard for the child to leave that habit (Yolton, pp. 99-100, 2009). Researchers, experts and observes have agreed that there is no safe level of secondhand smoke for children coming the discussed age group. Therefore, parents or people around children have no logical excuse justifying their smoking based on the argument that it is “too small to hurt” (Hecht, Ye, Carmella, pp. 1110-1111, 2001). Any case of a child exposed to secondhand smoke for prolonged periods due to his parents should be considered as a case of child abuse and must be treated accordingly. There are no doubts in the fact that the impact of passive smoking on children is disastrous. In fact, prolonged exposure to secondhand smoke may mean that the parents are deliberately putting the life of their child at stake (Martin & Fabes, pp. 280, 2008). Such parents should be deprived of the custody of the child until and unless the parent or parents are able to ensure that child does not receive any exposure to secondhand smoke at home or cars. Furthermore, the courts may also use heavy fines on such parents of children who appear to be having problems and diseases having their roots in secondhand smoke. This would serve as an effective negative reinforce of the behavior (Haustein & Groneberg, pp. 96-98, 2009; Bowden & Greenberg, pp. 34-35, 2009). With every passing day, competition in the international arena is becoming more and more ruthless and brutal. Countries are fighting over the scare resources of the world and in such competitive arena, the human resource of any country, its children who would serve, as the future leaders of the country are extremely crucial (Martin & Fabes, pp. 280, 2008). The state spends millions of dollars every year on the health, education and development of children of the country but the evidence regarding secondhand smoke suggests that the investment of children, which are exposed to secondhand smoke, is a total waste. It is the responsibility of the state and the law enforcement agencies to intervene and save the future leaders and human capital of the country (Bowden & Greenberg, pp. 34-35, 2009). Schools should have regular tests of children aiming at finding out the continine level in the blood, urine, or salvia of the children. Any child who is even close to above average level of continine is his or her body; the child must go home with a formal warning or show cause notice from the school, authority of which has to be given by the federal and state authorities (Underdown, pp. 165-166, 2007). Parents or guardians must visit school the next day with written and oral explanation of the reasons behind the high levels of continine levels in the blood of their child. The teachers, counselors, and concerned authorities must sit down with the parents to have detailed discussions and try to figure out the solutions of the problem. The school, with the help of local authorities, must develop systems for repeated visits of parents to school and authorities visiting the home of the child to ensure that he or she is living in a safe environment. However, if any test in the time of the next two years, shows an unusually high level of continine then the guardians or parents must be ready to face legal punishments and fines. In case of repeated offences, the court and authorities must consider depriving the guardian or the parents of the custody of child and charge the parents or guardians with the offence of child abuse (Tarlo, Cullinan & Nemery, pp. 52-56, 2010). Adults, parents and elders should understand that if the child is around or is about to come around in a little while, they should take all possible measures to avoid smoking, whether it is inside in the house or cars. While the child is present in the house, one should take the liberty of going outside and smoke. Furthermore, there is no way that the thought of smoking in the car should come to the mind of the parent with presence of any child. In fact, in many countries, states and regions, there are strict laws that prohibit people from smoking in the cars with a child (Hawamdeh, Kasasbeh, & Ahmad, pp. 445-448, 2003). As the evidence suggests that despite all the separation of smoking areas from nonsmoking areas in any building, ventilation and closing doors does not prevent secondhand smoke from spreading its adverse effects on children. A study carried out by Cancer Research UK and UK Centre for Tobacco Control Studies found out that many parents believed that if their child has gone to sleep and they go to some other room, lock the door, open the windows, and smoke for as long as they can without really harming the child (Underdown, pp. 165-166, 2007). Nevertheless, the study found out that these children were nine times more likely to have exposure to secondhand smoke as compared to other children. Therefore, parents should be extremely careful and thoughtful while deciding on the restaurants, clubs, parks, and other public places where they take their children. They must ensure beforehand that these places are totally smoking free and there is no such division as smoking or non-smoking zones (Tarlo, Cullinan & Nemery, pp. 52-56, 2010; Bowden & Greenberg, pp. 34-35, 2009). All the steps directed towards stopping smoking in parents must have greater emphasis on preventing women and mothers from smoke. By smoking during pregnancy, the mother puts the health and life of the child at risk. There is a huge list of studies and researches, which reveals that if a mother has smoked during pregnancy, the child is much likely to be born with physical, behavioral, mental, and cognitive impairments. Moreover, during the early years of life, especially before the teenage, the child is more likely to spend the biggest portion of his or her time with the mother (Underdown, pp. 165-166, 2007). Furthermore, if the mother is a homemaker then she is even more likely to smoke inside the house because she will find lesser time to go outside as compared to men who have many reasons for the same. In addition, even if the mother wishes, the child would wish to spend most of his or her time with her and if the mother fails to quit smoking then the child would be a at greater risk of secondhand smoke. Therefore, rather spending billions of pounds for firefighting diseases in form of drug costs, hospital costs, and doctor fees, the government should redirect funds in form of investment in teaching and training girls, pregnant women, and mothers to quit smoking for their own good and for the well-being of their children (Yolton et al, pp. 461-465, 2008). Conclusion Towards the end, it is understandable enough to conclude that passive smoking is one of the biggest threats to the children of our society who the country expects to take up the job of becoming the future leaders. Specifically, children belonging from the age group of 5-10 years are the most vulnerable after the newborn children to the risks of passive smoking. Passive smoking has the capability to damage every single organ of their body and cause irreversible damages for the rest of their lives. These children not only suffer from mental, physical, and cognitive problems in their childhood but when in their mid and late teens, these children are two times more likely to become smokers themselves. Recommendations With summing up the discussion, analysis and detailed recommendations presented above, following are the major recommendations in a concise manner. Government officials and lawmakers should recognize that exposing children to prolonged period of secondhand smoking is equivalent to child abuse and must be treated accordingly. Passive smoking in children costs more than 23.3 billion pounds to the NHS every year (Lister, pp. 1, 2010). Rather than wasting this money, local authorities should take the bold step of diverting these funds to training and teaching women, pregnant women, and mothers that they should quit smoking not only for their own good but also for the well being and life of their children. There is no safe level of secondhand smoke and traditional ways of opening windows, ventilation, separate rooms and smoking zones, are not effective enough to protect children. Therefore, parents should quit smoking but if they cannot, even then they should not even think about smoking inside the house for the sake of their child. Even when they take their children, who are in early years of their life, out to restaurants, playgrounds, clubs and other public places, they should make that they are completely smoke free. Under the direct supervision of local authorities, school should conduct quarterly tests of children to test the continine levels in their body. In case of any signs of exposure to passive smoking, the parents should receive a show cause notice, with repeated visits to schools explaining the causes of the same. They must receive training and education about quitting smoking and protecting their children from the destructive impacts of secondhand smoking. A repeat offence must qualify the parents for heavy fines and in case of continuous indication of high continine levels in child’s blood, options must be considered to either deprive the parents from the custody of the child or put charges against them of child abuse. REFERENCES Bancalari, E. 2008. The newborn lung. Saunders/Elsevier. Bernhard, David. 2011. Cigarette Smoke Toxicity: Linking Individual Chemicals to Human Diseases. John Wiley and Sons. Blair, Mitch, Stewart-Brown, Sarah, Waterston, Tony, & Crowther, Rachel. 2010. Child Public Health. Oxford University Press. Bowden, V. R., & Greenberg, C S. 2009. Children and Their Families: The Continuum of Care. 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