Smokefree cars to protect children and denormalise
smoking: a mini-review of New Zealand literature
The Associate Minister of Health (Hon Tariana Turia) has
signalled interest in the New Zealand Government developing legislation to
protect child health by limiting smoking in cars with
children.1 Such a move would be part of an
international trend that has seen such laws covering most Australian states,
Canadian Provinces and some US States (including
3 It would also be consistent with other
actions to limit hazards and improve safety within cars: compulsory seat belts,
compulsory car seats for infants, and bans on mobile phone use while driving (as
recently enacted by the last National Party-led Government in New Zealand).
Smokefree cars would help reduce the burden of child
illness, given the evidence for the role of secondhand smoke (SHS) in
“sudden infant death syndrome (SIDS), asthma, altered respiratory
function, infection, cardiovascular effects, behaviour problems, sleep
difficulties, increased cancer risk, and a higher likelihood of smoking
initiation”.4 Reducing these impacts
could in turn reduce both private and tax-payer funded health system costs
(given international evidence on SHS impacts on health
costs5–7). It is expected that the move
would help reduce smoking uptake in children by providing positive smokefree
modelling (given New Zealand evidence8 and
To provide background and context to further policy-maker
discussions on this topic, we tabulate the New Zealand literature relevant to
smokefree car policies that we could identify on Medline and on health
organisation websites in New Zealand
findings of studies identified
studies of smoking in cars
observational study in New Zealand (NZ) collected data in 2005 and reported a
4.1% point prevalence of smoking in cars (95%CI: 3.8% to
4.4%).9 It found a higher prevalence of smoking
in cars from a more deprived suburb compared to a less deprived one.
observational study collected data in 2011 and involved the observation of
149,886 vehicles at two sites with different levels of socio-economic
deprivation.3 The mean point prevalence of
smoking in vehicles at the two sites combined was 3.2% (95%CI: 3.1% to 3.3%). Of
those vehicles with smoking, 4.1% had children present. There were marked
gradients in all the smoking patterns seen by deprivation area of observation.
For example, for smoking with children in the car it was 10.9 times (95%CI: 6.8
to 21.3) higher in the more deprived suburb relative to the least deprived
A University of
Otago “smartphone app” for counting smoking in cars has recent data
from a number of NZ settings (data collated online at: http://tobaccofree.nzdis.org/
). As of
early May 2012, over 4100 vehicles were counted, with 2.5% having in-car smoking
occurring. Such smoking is in the presence of others 32% of the time, and
children 6% of the time.
hazard inside the car
experimental study found extremely high levels of fine particulates were
associated with in-car smoking in a NZ
setting.10 This hazard has now been well
documented in the scientific literature (e.g., a study in
telephone survey in 2004 reported that 71% of smokers smoked in their
cars.12 In response to the question
“It’s OK to smoke around non-smokers inside cars if windows are
open”, 64% of respondents “strongly disagreed” and another 12%
slightly disagreed (all 2731 respondents, including non-smokers).
Exposure data in
In the 2009 NZ
Tobacco Use Survey, 6.1% (95%CI: 5.3–7.0) of non-smoking adults
self-reported being exposed to SHS in the car they usually travel in during the
past week.13 Rates were highest in Māori
(14.7%, equivalent to 25,900 people exposed weekly), then Pacific (12.4%,
equivalent to 13,300 people), then European/Other (5.5%, equivalent to 89,200
people) and then Asian (4.9%, equivalent to 14,800 people). After adjusting for
age, the prevalence of this form of SHS exposure in the most deprived areas was
nearly four times higher than in the least deprived areas (13.9% vs 3.5%).
Similar ethnic and deprivation gradients for SHS exposure in cars were apparent
in an earlier Tobacco Use Survey (2006) and in the NZ Health Survey
Sponsorship Council’s (HSC) 2008 Year 10 In-depth Survey found that around
a quarter of students (26.8%) reported that someone had smoked in their presence
while travelling in cars or vans in the seven days prior to the
survey.15 “A higher proportion of
Māori and Pacific students reported that someone smoked around them in cars
or vans in the seven days prior to the survey (45.9% and 35.1%, respectively),
compared with New Zealand European/Pakeha students (20.1%).”
“Students from low decile schools had the highest prevalence of reporting
that someone had smoked around them in cars or vans, compared with students from
mid and high decile schools (39.5%, 29.2% and 14.3%, respectively).”
exposure on subsequent smoking uptake
survey data from the “Keeping Kids Smokefree”
study,8 found that “after controlling for
all variables reported exposure to smoking in cars and homes were significantly
associated with increased risk of initiated smoking (RR 1.87, 95% CI 1.43-2.44,
and RR 1.5, 95% CI 1.13-1.97, respectively). Exposure to smoking in cars was
substantially and significantly associated with risk of current smoking (RR
3.21, 95% CI 1.45-7.08).” The authors noted that “smoking in cars is
under parental control and therefore modifiable”.
data – public and smokers
A study in 1997
involved surveying the public in Wellington. It reported that around a half
(53.5%) thought that “smoking should be banned in cars when there are
passengers”.16 But 94% agreed that cars
with children in them should be smokefree (86% of smokers).
attitudes to smoking in cars (published 2005)
A review article
focused on NZ and published in 2005,17 included
data from a tobacco-industry commissioned survey that reported: “For
private cars, 58% of non-smokers and 18% of smokers wanted no smoking at
all”. An analysis of three national surveys commissioned by the HSC was
also included in this review. The “not at all” response to the
question “People should be able to smoke in private cars” was
reported as: 29% (in 1999); 23% (2001); 41% (2003), (trend: p<0.00001).
(ITC Project, 2007/2008)
“ITC Project” study reported that the overall support by NZ smokers
for smokefree cars containing preschool children was very high at
96%.18 This high support was across all
socio-demographic groups (with no statistically significant differences between
European smokers and smokers who were: Māori, Pacific or
Asian).19 The data also indicate that NZ
smokers have nuanced views around new smokefree areas which sometimes contrasts
with the overwhelming support for smokefree cars e.g., most are supportive of
smokefree outdoor eating areas, council-owned playgrounds, but voice only
minority support for smokefree lifeguard-patrolled beaches and for some of the
outdoor seating areas of restaurants/cafés and
pubs.20 In general however, Māori, Pacific
and Asian smokers (relative to European smokers) are more in favour of new types
of smokefree areas.21
A national HSC
survey of the public in 2008 asked for responses to the statement “smoking
should not be allowed in cars with children under the age of 14 in
them”.22 Overall 91% of respondents
agreed and 49% “strongly agreed”. Similarly, 82% of current smokers
agreed and 33% “strongly agreed”.
data – policy-makers
policy-maker attitudes (2008/2009)
A case study of
NZ policy-makers in 2008/09 (62 politicians and senior officials) covered their
opinions on new smokefree legislation for public and private
places.23 Most interviewees did not favour
regulation of smoking in private places, including in cars.
publication from the same dataset24 reported
some potentially conflicting beliefs and attitudes. For example, there were
“very strong themes of policy-maker concern for the vulnerability of
children and the need for their protection from secondhand smoke; however, there
were mixed reactions to the idea of a smokefree law for cars with children in
them. These themes and mixed reactions spanned both the ‘left’ and
‘right’ political parties.” A lack of policy-maker awareness
in some areas was also identified (e.g., of relatively high “public
support for banning smoking in cars with children and of the progress elsewhere
on such laws...”). Additional aspects of these themes were explored in
another publication.25 It concluded that:
“The results indicate the need for good communication of the acceptability
and benefits of legislative smokefree changes to both the political and public
study interviewed politicians, officials and non-governmental organisation staff
in 2008.26 It also found a lack of support by
interviewees for giving smokefree car legislation a high priority. The authors
argued that there was a need for “more information on the extent of
current child exposure to tobacco smoke in New Zealand cars” and for
“wider dissemination to policy-makers of New Zealand public and smoker
support for banning smoking in cars, and of the progress overseas on smokefree
study of Māori policy-makers (MPs and officials in 2008/09) indicated that
“there was a strong theme that the rights of children clearly outweigh the
individual rights of adults to smoke in privately owned spaces, for instance
homes and cars, and that adults have a duty of care to protect children from
harm.”27 However, despite this there were
mixed views on legislating to ban smoking in cars with children.
study of Pacific policy-makers in 2008 identified a general reluctance to
consider smokefree regulation extensions e.g., to smokefree
cars.28 The authors noted that this finding was
“at odds with surveyed attitudes of Pacific peoples in New
Māori Affairs Select Committee Inquiry into the tobacco industry included a
recommendation in their Report to investigate extending the Smoke-free
Environments Act to legislate against smoking in additional settings including
vehicles (especially those carrying
As detailed in the above table, a large amount of research
has been done in the New Zealand setting around smokefree cars. The overall
thrust of this work is that smoking in cars is an important public health issue
and one that is likely to contribute to health inequalities in New Zealand (both
ethnic inequalities and by area deprivation).
Smokefree car laws have been successfully introduced in
other countries. Furthermore, the evidence indicates that there is high public
support and indeed high smoker support for requiring smokefree cars carrying
children especially in groups most impacted on by smoking e.g., Māori and
Pacific populations. However, although the statements of policy-makers appear to
give the protection of children’s health from proven hazards a high
priority, they have (at least until recently), been less in favour of smokefree
car laws than the public.
The most critical research need now is intervention and
evaluation research, where before and after data collection occurs around a
national smokefree cars law. Such research could assess the impact of the new
- (i) the
occurrence of smoking in cars (especially with children present);
- (ii) denormalisation
relating to acceptability of smoking indoors and exposure of children to SHS;
- (iii) trends
in youth smoking uptake. Monitoring trends in denormalisation are particularly
relevant to informing on-going strategies around the tobacco endgame in this
country and achieving the national goal of “Smokefree New Zealand
Further information is also needed
from overseas jurisdictions where there are smokefree car laws. Nevertheless,
the 2007 smokefree vehicle law in South Australia (which only applies to
vehicles carrying children), was reported to result in an increase in smokefree
vehicles with children from 69% in 2005 to 82% in
of Otago, Wellington, New Zealand
Research Services, Whanganui, New Zealand
Competing interests: Although we do not
consider it a competing interest, for the sake of full transparency we note that
all of the authors have previously undertaken work for health sector agencies
working in tobacco control.
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