Smacking link to adult cancers improbable

'Smacking or shouting at children boosts their risk of developing cancer, heart disease and asthma, British researchers have claimed' The Sun informs us. The researchers argue that trauma during childhood can cause long-term harmful biological effects…

‘Smacking increases cancer risk’, the Daily Express boldly reports, while The Sun believes that smacking can also increase the risk of asthma or heart disease. These reports exaggerate a piece of research that has significant limitations.

The news is based on a study that asked a sample of Saudi Arabian adults with cancer, asthma or heart disease how frequently they had been physically punished or verbally insulted as a child (referred to in the papers as smacking and shouting).

The researchers then looked at whether there was a link between the two, comparing these adults with healthy controls. They found that reported physical punishment and insult was associated with an increased risk of developing adult cancer, asthma and heart disease.

The researchers speculate that regular beatings and insults create a sense of threat in a child and this may then trigger stress responses that may have long-term biological consequences.

Despite the interesting nature of this study, it is subject to a number of significant limitations, such as:

  • self-reported information
  • the cultural differences between Saudi Arabia and Western countries may mean that the results are not applicable here (the researchers say beating is legal and more culturally acceptable in Saudi Arabia)

There are likely to be extensive confounding factors associated with the likelihood of being physically punished as a child and risk of later disease which the study has not taken into account.

Overall, this study does not provide conclusive evidence that smacking directly causes chronic diseases such as cancer.


Smacking and the law

Under the terms of the 2004 Children’s Act, mild smacking to serve as “reasonable chastisement” is allowed. However, any physical punishment that results in bruising, swelling, cuts, grazes, or scratches is illegal and can result in up to five years in jail.

Where did the story come from?

The study was carried out by researchers from the University of Plymouth in Devon. Sources of funding were not reported. The study was published in the peer-reviewed Journal of Behavioural Medicine.

The story was picked up by the Daily Express, Daily Mail and other media, the findings were exaggerated and the headlines misleading. The media reports did not take into account the important limitations of this study.


What kind of research was this?

This was a cross-sectional study of Saudi Arabian adults diagnosed with either cancer, asthma, or cardiac disease, and a group of healthy controls. The researchers asked the participants about the physical punishments and verbal insults from parents that they had experienced as a child, to see whether there was any relationship between this and their diseases in adulthood. As childhood punishments are likely to have occurred before adult disease development it would, in theory, be possible to establish a cause and effect association.

However, the most important limitation in this study is that any association seen between the two is likely to be influenced by extensive confounding factors (socioeconomic, environmental and lifestyle factors) which this study has not been able to take into account.

An issue as complex as the effects of parenting on the health outcomes of a child is likely to be subject to a wide range of confounding factors. For example, children who were often smacked for perceived naughty behaviour may have had poor impulse control that could have persisted into adulthood, leading them into behaviours that have adverse effects on their health, such as smoking.

However, based on the limited data provided in the study it is impossible to confirm any theories that the findings may suggest.

According to the researchers, physical punishment is illegal in 24 countries either at school or in the child’s home and in 94 countries (including the UK) it is illegal in school but ‘reasonable’ physical punishment is permitted by parents.

The researchers report that in the US and some countries in the Middle East and Asia, physical punishment is legal in school and in the home. They say that the use of beating and insults is an acceptable parenting style in Saudi Arabia, where this study took place. The researchers report that in Saudi Arabia, physical punishment in schools was banned in 1996, but that physical punishment remains legal in the home. The UK has stopped short of an outright ban on smacking, allowing parents to physically chastise their children without causing “reddening of the skin”.

The authors report that no other studies have examined the effects of physical punishment on adult physical health. It is very difficult to apply the findings of this study in Saudi Arabia to other countries with social and cultural differences.


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