The recent article by Lynn McIntyre and colleagues1 provides overlooked evidence supporting the precept presented to the board of directors of the Philip Morris Companies Inc. that “the cigarette will preempt even food in time of scarcity on the smokers' priority list.”2 In fact, McIntyre and colleagues show that Canada's hungry children are more than twice as likely as other children to have a primary caregiver who smokes daily.
Canada's frequently hungry children are up to 6 times more likely than other children to have a parent who smokes daily, if occasional smokers represent a small proportion of the primary caregivers who smoke and who have frequently hungry children. Caregivers who smoke daily may have less money to feed their dependent children than caregivers who smoke occasionally, and they may be more likely to become disabled and lose the ability to earn income.3
If the above associations are causal, daily smoking (and thus the tobacco industry and its political and commercial supporters) may be responsible for 24% of all, and up to 56% of frequent, child hunger in Canada, assuming a 25% prevalence of daily smoking among Canada's primary caregivers.
McIntyre and colleagues could evaluate whether comprehensive tobacco control programs might reduce child hunger by entering occasional and daily smoking into their analyses as candidate preventable causes of occasional and frequent child hunger. In their analyses they should consider that smoking may contribute to child hunger through smoking-attributable caregiver depression,4 ill health and death of caregivers5 and ill health of children. Smoking may also contribute to child hunger through divorce,6 job hunting (involuntary job loss7) and the need for social assistance owing to disability3 or job loss.7