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Strong empirical evidence has demonstrated the negative health consequences caused by exposure to second-hand smoke (SHS).1 In New Zealand, the Smoke-free Environments Act 1990 and the Smoke-free Environments Amendment Act 2003, ban smoking in workplaces, schools, early childhood education and care centres, public transports, indoor areas of hospitality venues (eg, bars, restaurants, cafes and casinos), and other locations.2,3 However, exposure to SHS in private settings continue to represent a public health challenge.Studies focusing on the impact of SHS exposure in cars4-6 and residual tobacco smoke in cars7,8 provide specific evidence for the importance of reducing SHS exposure in cars. For example, an evidence review found that smoking in cars increased the concentration of atmospheric and biological markers of SHS. The authors also noted that the concentration found in cars was significantly higher than those measured in bars and clubs prior to when smokefree laws came into force.4At least five New Zealand studies have estimated the prevalence of SHS exposure in people s homes and in private vehicles through self-report.9-13 For example, in the 2012/13 New Zealand Health Survey (NZHS), respondents were asked whether anyone smoked in their home, and in the car they usually travelled in.10 Among non-smoking adults (aged 15+ years), 4% reported that there were people smoking in their homes, and 3% reported people smoking in cars. Exposure was significantly higher among young adults, for example, 9% of 15-19-year-olds, and 7% of 20-24-year-olds reported people smoking in the cars they usually travelled in (compared with 3% overall). Children (aged 0-14 years) represent another vulnerable group, with 6% of them exposed to SHS in homes and 5% in cars.10An annual survey of Year 10 students used a different measure to assess SHS exposure. In 2012, 23% reported past 7-day SHS exposure in cars a steady and significant drop from 31% in 2006.9 The New Zealand arm of the International Tobacco Control (ITC-NZ) Study offered different information by asking smokers to indicate whether they smoked in cars with non-smokers, and 75% said they never did.14Apart from the self-reported data from both smokers and non-smokers, adding to the evidence is four published papers that have reported the point prevalence of smoking in cars in New Zealand using observational data.15-18 However, the generalisability of these studies is restricted by the sampling that only covers a limited geographical area.Notwithstanding this limitation, the overall findings are consistent: 1) point prevalence of smoking is lower in cars carrying children than those that do not,15-17 and, 2) there is a higher point prevalence in more socio-economically deprived areas.15-18 One study has tracked changes in the point prevalence of smoking in cars over time, and found a significant decrease from 6.4% in 2005, to 3.4% in 2013, in Wainuiomata, Wellington.15To address the harm caused by SHS exposure in cars, a number of countries and jurisdictions (eg, Australia, some jurisdictions in Canada and the US, and South Africa) have banned smoking in cars when children are present, and positive outcomes were found post-implementation (reduced SHS exposure, increased prevalence of smokefree cars).19,20 In New Zealand, there is currently no legislation restricting smoking in private vehicles. The Mori Affairs Select Committee report recommended that the Government investigate extending the Smoke-free Environments Act to legislate against smoking in certain areas, such as vehicles, vehicles carrying children, and specific public places (such as playground, parks and beaches),21 and in response the New Zealand Government proposed to explore extending current smokefree restrictions to include vehicles.22Alongside the Government s intention to explore options around restricting smoking in private vehicles, there is also strong public support for banning smoking in cars where children are present. Importantly, a repeated cross-sectional national survey found a consistently high level of support was found among respondents of different social and population groups, and smoking status.23,24 Specifically, the 2014 data from the Health and Lifestyles Survey (HLS) showed that 97% of New Zealand adults support banning smoking in cars when there are children in them,24 an increase from 93% in 2012.23 A high level of public support for smokefree cars legislation was also found in another survey of New Zealand adults,25 and the ITC-NZ Study of current smokers.This study supplements previous New Zealand studies14,25,26 by updating the information around support for smokefree cars legislation among smokers and recent quitters. By using a wide range of measures (including smoking behaviour in cars, exposure to other people s smoking in cars, knowledge of SHS exposure, and support for smokefree cars legislation), this study also extends the existing knowledge by providing a more comprehensive assessment of the context around smoking in cars.MethodsInstrumentsThis study focuses on 2014 New Zealand Smoking Monitor (NZSM) results from smokers and recent quitters to extend the findings from the previous studies conducted in New Zealand that provide a perspective on smoking in cars. The NZSM is a fortnightly monitor (n=180) implemented since 2011, and fieldwork is delivered using computer-assisted telephone interviewing (CATI). Each interview lasts about 10 minutes. Ethics approval was obtained from the New Zealand Health and Disabilities Ethics Committee (Ref: 13/CEN/99).The questionnaire has two components. The core component covers a range of smoking- and cessation-related topics and socio-demographic information, while the questions in the non-core component change every quarter to address emerging issues in tobacco control. This paper reported on the non-core questions on smoking in cars, in the field between August and October 2014.Respondents who had smoked in the past 2 weeks (n=269) were asked if they had smoked in a list of locations during the past 2 weeks. The list included outside their home, inside their home, inside a car when they were the only person in it, and inside a car when there were other people in it. All respondents (n=364) were asked if they were exposed to SHS inside a car in the past 2 weeks.Finally, all respondents indicated their agreement level to a list of five statements using the following response options: strongly agree; agree; neither agree nor disagree; disagree; and strongly disagree: The dangers of second-hand smoke have been exaggerated It s OK to smoke around other people inside cars if there are windows open It s OK to smoke inside cars when there are no other people in them Smoking in cars should be banned while children are in them Smoking in cars should be banned at all time. ParticipantsResponses were gathered from a sample of New Zealand adult smokers or recent quitters (aged 18 years or over) who took part in the NZSM. A quota system was in place to ensure the sample consisted of three groups (n=60 per group, per fortnight), differentiated by participants current and past 3-month quitting behaviours:non-attempters: daily smokers who had not made a quit attempt lasting 24 hours or longer in the past 3 monthsrecent quit attempters: daily smokers who had made a quit attempt lasting 24 hours or longer in the past 3 monthsserious quitters: ex-smokers or current smokers who had smoked regularly in the past 3 months, but had not smoked daily in the past 30 days, and they intended to stay smokefree in the next 3 months.The NZSM uses a self-refreshing panel design. Respondents are maintained on the panel and interviewed up to six times. Those who drop out from the sample, either because they had completed six interviews or withdrawn, are replaced by new respondents. This study reports on data collected over five fortnights from 3 August to 11 October 2014.During the study period, 364 respondents completed a total of 900 interviews. To ensure the behaviour and views of the participants are only captured once in the analysis, only the first set of responses collected from each participant were included.Sampling procedureRespondents were recruited through two methodologies. Non-attempters and recent quit attempters were recruited from a telephone-based omnibus survey, where a nationally represented sample of New Zealand adults aged 18 or over were recruited via random digit dialling. Respondents who were eligible to take part in the NZSM were asked for permission to be re-contacted, and they were then invited to take part at a subsequent phone call.Due to the small incidence rate of serious quitters at a population level, this sample was recruited through the national Quitline client database. Each fortnight, a random sample of Quitline callers were invited to take part in the NZSM. Callers must have given prior consent for releasing their names and contact details. Potential respondents were contacted over the phone, the interviewers asked for their informed consent, and screened for eligibility. Despite the different recruitment methods, all participants were interviewed by the same fieldwork company.AnalysisThe analysis was undertaken using STATA IC 13.1. Questions using an agreement/disagreement scale were dichotomised whereby agree and strongly agree responses were combined to indicate agreement with the statements. For all questions, participants who could not form an opinion (said they don t know), or refused to answer, were excluded from the analysis for that particular question (up to 3% of total responses).We first compared responses by the socio-demographic variables and past 3-month quit attempt status using crude odds ratios (OR). Multiple logistic regression models were then used to control for potential confounding (presented as the adjusted odds ratios/ AOR).ResultsSample characteristicsSocio-demographic characteristics of the sample, stratified by their recent quit attempts, are described in Table 1.Table 1: Socio-demographic characteristics by recent quit status. Non- attempters n=126 Recent quit attempters n=117 Serious quitters n=121 Gender Male 44.4 43.6 50.4 Female 55.6 56.4 49.6 Ethnicity Mori 19.8 24.8 24.0 Non-Mori 80.2 75.2 76.0 Age group 18-24 years 4.0 10.3 12.4 25-44 years 51.6 52.1 35.5 45-64 years 33.3 29.1 45.5 65+ years 11.1 8.5 6.6 Household equivalised income* Low $0-$34,600 22.2 32.5 29.8 Med $34,601-$66,500 34.1 33.3 27.3 High $66,501+ 39.7 23.9 24.0 Unspecified 4.0 10.3 19.0 Household composition Single adult 19.8 15.4 24.8 Multiple adults no children 38.1 28.2 28.1 With children 42.1 56.4 47.1 *Household equivalised income was calculated using an established formula that took into account the number and the age of children (0-18 years) residing in the household.14Smoking at homeTable 2 presents the association between socio-demographic characteristics, household composition and quit attempt status, and whether people smoked inside/outside their home and inside their car. Among those who had smoked in the past 2 weeks, 95% smoked outside their home, while only 28% did so inside their home.Table 2: Smoking in home or cars in the past 2 weeks (proportion, odds ratio (OR) and adjusted odds ratio (AOR), n=269.Statistically significant differences at p<0.05 are denoted in bold.In the univariate models, being in a single adult household compared to a household with children, and being a serious quitter as opposed to a non-attempter, were associated with a reduced odds of smoking outside the home. Correspondingly, being in an older age group (aged 45+ years) compared to those aged 18-24 years, having a low income compared to a high income, and households without children, were associated with increased odds of smoking inside the home. After adjustment, except for the increased olds of smoking inside the home for those from a single adult household compared to a household with children, these associations remained. Furthermore, the odds of smoking inside the home became statistically significantly higher for non-attempters compared with serious quitters.Smoking in carsAmong those who had smoked in the past 2 weeks, 63% smoked inside a car when they were the only person in it, while 27% smoked when there were also other people present.In the univariate models, having a medium or high income, compared to those having a low income, had increased odds of smoking inside a car when they were the only person in it. Increased odds were also found among non-attempters when compared with recent quit attempters and serious quitters. After adjustments, these associations remained.In the univariate models on smoking around other people in a car, Mori compared with non-Mori, those aged 18-24 years compared with those aged 65+ years, those in a household with children compared with those living on their own, had increased odds of reporting this behaviour. After adjustment, the differences by ethnicity and household composition were no longer statistically significant.Exposure to second-hand smoke in a carOne-third of the respondents reported being exposed to SHS inside a car in the past 2 weeks (see Table 3). In the univariate models, Mori when compared with non-Mori, those aged 18-24 years compared with their older counterparts, non-attempters compared with serious quitters, had increased odds of reporting being exposed. After adjustment, these associations remained.Table 3: Exposure to second-hand smoke inside a car in the past 2 weeks (proportion, OR and AOR), n=364. Exposure to second-hand smoke inside a car in the past two weeks % OR AOR Overall 32.8 - Gender Male 34.7 Ref Ref Female 31.1 .85 (.55-1.32) .80 (.50-1.29) Ethnicity Mori 47.6 Ref Ref Non-Mori 28.5 .44 (.26-.73) .42 (.24-.74) Age group 18-24 years 62.5 Ref Ref 25-44 years 33.9 .31 (.14-.67) .27 (.11-.63) 45-64 years 29.8 .25 (.11-.57) .26 (.11-.62) 65+ years 9.4 .06 (.02-.25) .07 (.02-.30) Household equivalised income* Low $0-$34,600 27.5 Ref Ref Med $34,601-$66,500 36.5 1.52 (.85-2.71) 1.34 (.71-2.51) High $66,501+ 32.7 1.28 (.71-2.33) 1.08 (.55-2.11) Unspecified 35.9 1.48 (.67-3.25) 1.28 (.54-3.05) Household composition Single adult 20.5 .52 (.27-1.00) 1.07 (.49-2.34) Multiple adults no children 40.0 1.34 (.83-2.19) 1.40 (.78-2.49) With children 33.1 Ref Ref Quit attempt status Non-attempters 36.5 Ref Ref Recent quit attempters 37.6 1.05 (.62-1.76) .93 (.53-1.64) Serious quitters 24.2 .55 (.32-.96) .43 (.23-.81) Statistically significant differences at p<0.05 are denoted in bold.Knowledge of harmsThree questions were used to assess knowledge of harm relating to SHS exposure, and two of them were specifically around smoking in cars. Three in 10 (30%) respondents agreed with the statement that The dangers of second-hand smoke have been exaggerated (see Table 4). Only 13% agreed that It s OK to smoke around other people inside cars if there are windows open, while half of the respondents agreed that It s OK to smoke inside cars when there are no other people in them.Table 4a: Agreement with the statements that assessed knowledge level and support for policy on smokefree cars (proportion and AOR) n=364Statistically significant differences at p<0.05 are denoted in bold.Table 4b: Agreement with the statements that assessed knowledge level and support for policy on smokefree cars (proportion and AOR) n=364. Smoking in cars should be banned while children are in them Smoking in cars should be banned at all times % OR AOR % OR AOR Overall 92.0 - 29.0 - Gender Male 90.5 Ref Ref 22.2 Ref Ref Female 93.4 1.48 (.69-3.18) 1.54 (.69-3.45) 35.1 1.91 (1.20-3.05) 2.00 (1.20-3.33) Ethnicity Mori 90.4 Ref Ref 30.5 Ref Ref Non-Mori 92.5 1.32 (.56-3.10) 1.88 (.73-4.87) 28.6 .91 (.53-1.56) 1.06 (.57-1.95) Age group 18-24 years 96.9 Ref Ref 28.1 Ref Ref 25-44 years 92.9 .42 (.05-3.36) .33 (.04-2.85) 23.2 .77 (.33-1.81) 1.05 (.41-2.71) 45-64 years 89.3 .27 (.03-2.13) .22 (.03-1.83) 35.1 1.38 (.59-3.24) 1.98 (.78-5.05) 65+ years 93.8 .48 (.04-5.62) .47 (.03-6.34) 35.5 1.41 (.48-4.08) 2.03 (.59-6.95) Household equivalised income* Low NZ$0- $34,600 94.1 Ref Ref 39.6 Ref Ref Med NZ$34,601- $66,500 91.3 .66 (.23-1.87) .67 (.22-2.04) 27.0 .56 (.32-1.00) .67 (.36-1.25) High NZ$66,501+ 91.6 .68 (.23-1.99) 1.04 (.33-3.32) 19.6 .37 (.20-.69) .50 (.25-1.00) Unspecified 90.0 .56 (.15-2.11) .47 (.11-1.93) 33.3 .76 (.35-1.66) .69 (.30-1.61) Household composition Single adult 91.8 .60 (.21-1.76) .42 (.11-1.55) 30.6 .89 (.49-1.60) .60 (.28-1.31) Multiple adults no children 87.8 .39 (.16-.93) .38 (.14-1.02) 21.7 .56 (.33-.96) .57 (.30-1.07) With children 94.9 Ref Ref 33.1 Ref Ref Quit attempt status Non-attempters 88.9 Ref Ref 12.8 Ref Ref Recent quit attempters 91.5 1.34 (.57-3.14) 1.22 (.50-3.02) 31.9 3.19 (1.66-6.14) 3.02 (1.53-5.95) Serious quitters 95.9 2.90 (1.01-8.32) 3.40 (1.07-10.77) 43.0 5.13 (2.72-9.70) 5.07 (2.56-10.04) Statistically significant differences at p<0.05 are denoted in bold.The only factor that consistently predicted knowledge level was gender, with female respondents being more wary of the impact caused by exposure to SHS (ie, reduced odds of showing agreement with the misbelief). Differences by quit attempt status were observed for two out of three measures, with serious quitters having increased odds of agreeing with the statements.While the differences by age did not reach statistical significance for any of the comparisons on knowledge of harms (possibly due to the small sample size), there are some indicators that young adults (aged 18-24 years) were less informed about the harms relating to smoking in cars.Support for legislationThe large majority of respondents (91%) agreed that smoking in cars should be banned when children are present. This high level of support was universal across all social and population groups, despite some statistically significant differences by household composition and quit attempt status.In contrast, only 30% agreed that smoking in cars should be banned at all times. Differences by gender, household composition and quit attempt status were found. For example, female respondents were more likely to support a total ban than males.DiscussionThrough smokers self-report, we found that smoking in cars was c

Summary

Abstract

Aim

Exposure to second-hand smoke (SHS) poses serious health consequences to non-smokers, and normalises smoking. Currently, there is no legislation restricting smoking in private cars in New Zealand. This paper supplements previous New Zealand studies on exposure to SHS in cars by examining smokers and recent quitters knowledge and behaviours towards smoking in cars, and their support for two possible smokefree cars policy options.

Method

The New Zealand Smoking Monitor is a fortnightly survey that uses a self-refreshing panel approach. The questionnaire contains smoking- and cessation-related questions, including eight non-core questions addressing smoking in homes or cars. These questions were answered by 364 respondents in 2014. Responses were compared by socio-demographic variables and recent quit attempt status.

Results

Smoking in cars was common among the respondents in our sample: 63% had recently smoked in a car when they were the only person in it, and 27% had done so when there were other people present. Some groups of respondents exhibited information gaps around the harms (eg, compared with males, females had reduced odds of agreeing with the false statement: it s OK to smoke inside cars if there are windows open, OR=0.41, 0.21-0.78); however, support for banning smoking in cars if there are children in them was consistently high across different sub-groups (92% overall).

Conclusion

Our data show the importance of providing specific information around the danger of smoking in cars, and strategies to enforce a complete smokefree rule in cars. Legislation may be required to further protect children from SHS exposure.

Author Information

- Judy Li, Research and Evaluation, Health Promotion Agency, Wellington; Sarah Nelson, Research and Evaluation, Health Promotion Agency, Wellington; Rhiannon Newcombe, Research and Evaluation, Health Promotion Agency, Wellington; Darren Walton, Adjunct

Acknowledgements

- We thank the NZSM respondents and UMR Research for conducting the fieldwork. We also acknowledge the Ministry of Health as the funder of the NZSM.-

Correspondence

Judy Li, Research and Evaluation, Health Promotion Agency, Wellington

Correspondence Email

enquiries@hpa.org.nz

Competing Interests

Nil.

'-- Office on Smoking and Health. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. (Centers for Disease Control and Prevention, 2006). New Zealand Government. Smoke-free Environments Act 1990. (Ne

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Strong empirical evidence has demonstrated the negative health consequences caused by exposure to second-hand smoke (SHS).1 In New Zealand, the Smoke-free Environments Act 1990 and the Smoke-free Environments Amendment Act 2003, ban smoking in workplaces, schools, early childhood education and care centres, public transports, indoor areas of hospitality venues (eg, bars, restaurants, cafes and casinos), and other locations.2,3 However, exposure to SHS in private settings continue to represent a public health challenge.Studies focusing on the impact of SHS exposure in cars4-6 and residual tobacco smoke in cars7,8 provide specific evidence for the importance of reducing SHS exposure in cars. For example, an evidence review found that smoking in cars increased the concentration of atmospheric and biological markers of SHS. The authors also noted that the concentration found in cars was significantly higher than those measured in bars and clubs prior to when smokefree laws came into force.4At least five New Zealand studies have estimated the prevalence of SHS exposure in people s homes and in private vehicles through self-report.9-13 For example, in the 2012/13 New Zealand Health Survey (NZHS), respondents were asked whether anyone smoked in their home, and in the car they usually travelled in.10 Among non-smoking adults (aged 15+ years), 4% reported that there were people smoking in their homes, and 3% reported people smoking in cars. Exposure was significantly higher among young adults, for example, 9% of 15-19-year-olds, and 7% of 20-24-year-olds reported people smoking in the cars they usually travelled in (compared with 3% overall). Children (aged 0-14 years) represent another vulnerable group, with 6% of them exposed to SHS in homes and 5% in cars.10An annual survey of Year 10 students used a different measure to assess SHS exposure. In 2012, 23% reported past 7-day SHS exposure in cars a steady and significant drop from 31% in 2006.9 The New Zealand arm of the International Tobacco Control (ITC-NZ) Study offered different information by asking smokers to indicate whether they smoked in cars with non-smokers, and 75% said they never did.14Apart from the self-reported data from both smokers and non-smokers, adding to the evidence is four published papers that have reported the point prevalence of smoking in cars in New Zealand using observational data.15-18 However, the generalisability of these studies is restricted by the sampling that only covers a limited geographical area.Notwithstanding this limitation, the overall findings are consistent: 1) point prevalence of smoking is lower in cars carrying children than those that do not,15-17 and, 2) there is a higher point prevalence in more socio-economically deprived areas.15-18 One study has tracked changes in the point prevalence of smoking in cars over time, and found a significant decrease from 6.4% in 2005, to 3.4% in 2013, in Wainuiomata, Wellington.15To address the harm caused by SHS exposure in cars, a number of countries and jurisdictions (eg, Australia, some jurisdictions in Canada and the US, and South Africa) have banned smoking in cars when children are present, and positive outcomes were found post-implementation (reduced SHS exposure, increased prevalence of smokefree cars).19,20 In New Zealand, there is currently no legislation restricting smoking in private vehicles. The Mori Affairs Select Committee report recommended that the Government investigate extending the Smoke-free Environments Act to legislate against smoking in certain areas, such as vehicles, vehicles carrying children, and specific public places (such as playground, parks and beaches),21 and in response the New Zealand Government proposed to explore extending current smokefree restrictions to include vehicles.22Alongside the Government s intention to explore options around restricting smoking in private vehicles, there is also strong public support for banning smoking in cars where children are present. Importantly, a repeated cross-sectional national survey found a consistently high level of support was found among respondents of different social and population groups, and smoking status.23,24 Specifically, the 2014 data from the Health and Lifestyles Survey (HLS) showed that 97% of New Zealand adults support banning smoking in cars when there are children in them,24 an increase from 93% in 2012.23 A high level of public support for smokefree cars legislation was also found in another survey of New Zealand adults,25 and the ITC-NZ Study of current smokers.This study supplements previous New Zealand studies14,25,26 by updating the information around support for smokefree cars legislation among smokers and recent quitters. By using a wide range of measures (including smoking behaviour in cars, exposure to other people s smoking in cars, knowledge of SHS exposure, and support for smokefree cars legislation), this study also extends the existing knowledge by providing a more comprehensive assessment of the context around smoking in cars.MethodsInstrumentsThis study focuses on 2014 New Zealand Smoking Monitor (NZSM) results from smokers and recent quitters to extend the findings from the previous studies conducted in New Zealand that provide a perspective on smoking in cars. The NZSM is a fortnightly monitor (n=180) implemented since 2011, and fieldwork is delivered using computer-assisted telephone interviewing (CATI). Each interview lasts about 10 minutes. Ethics approval was obtained from the New Zealand Health and Disabilities Ethics Committee (Ref: 13/CEN/99).The questionnaire has two components. The core component covers a range of smoking- and cessation-related topics and socio-demographic information, while the questions in the non-core component change every quarter to address emerging issues in tobacco control. This paper reported on the non-core questions on smoking in cars, in the field between August and October 2014.Respondents who had smoked in the past 2 weeks (n=269) were asked if they had smoked in a list of locations during the past 2 weeks. The list included outside their home, inside their home, inside a car when they were the only person in it, and inside a car when there were other people in it. All respondents (n=364) were asked if they were exposed to SHS inside a car in the past 2 weeks.Finally, all respondents indicated their agreement level to a list of five statements using the following response options: strongly agree; agree; neither agree nor disagree; disagree; and strongly disagree: The dangers of second-hand smoke have been exaggerated It s OK to smoke around other people inside cars if there are windows open It s OK to smoke inside cars when there are no other people in them Smoking in cars should be banned while children are in them Smoking in cars should be banned at all time. ParticipantsResponses were gathered from a sample of New Zealand adult smokers or recent quitters (aged 18 years or over) who took part in the NZSM. A quota system was in place to ensure the sample consisted of three groups (n=60 per group, per fortnight), differentiated by participants current and past 3-month quitting behaviours:non-attempters: daily smokers who had not made a quit attempt lasting 24 hours or longer in the past 3 monthsrecent quit attempters: daily smokers who had made a quit attempt lasting 24 hours or longer in the past 3 monthsserious quitters: ex-smokers or current smokers who had smoked regularly in the past 3 months, but had not smoked daily in the past 30 days, and they intended to stay smokefree in the next 3 months.The NZSM uses a self-refreshing panel design. Respondents are maintained on the panel and interviewed up to six times. Those who drop out from the sample, either because they had completed six interviews or withdrawn, are replaced by new respondents. This study reports on data collected over five fortnights from 3 August to 11 October 2014.During the study period, 364 respondents completed a total of 900 interviews. To ensure the behaviour and views of the participants are only captured once in the analysis, only the first set of responses collected from each participant were included.Sampling procedureRespondents were recruited through two methodologies. Non-attempters and recent quit attempters were recruited from a telephone-based omnibus survey, where a nationally represented sample of New Zealand adults aged 18 or over were recruited via random digit dialling. Respondents who were eligible to take part in the NZSM were asked for permission to be re-contacted, and they were then invited to take part at a subsequent phone call.Due to the small incidence rate of serious quitters at a population level, this sample was recruited through the national Quitline client database. Each fortnight, a random sample of Quitline callers were invited to take part in the NZSM. Callers must have given prior consent for releasing their names and contact details. Potential respondents were contacted over the phone, the interviewers asked for their informed consent, and screened for eligibility. Despite the different recruitment methods, all participants were interviewed by the same fieldwork company.AnalysisThe analysis was undertaken using STATA IC 13.1. Questions using an agreement/disagreement scale were dichotomised whereby agree and strongly agree responses were combined to indicate agreement with the statements. For all questions, participants who could not form an opinion (said they don t know), or refused to answer, were excluded from the analysis for that particular question (up to 3% of total responses).We first compared responses by the socio-demographic variables and past 3-month quit attempt status using crude odds ratios (OR). Multiple logistic regression models were then used to control for potential confounding (presented as the adjusted odds ratios/ AOR).ResultsSample characteristicsSocio-demographic characteristics of the sample, stratified by their recent quit attempts, are described in Table 1.Table 1: Socio-demographic characteristics by recent quit status. Non- attempters n=126 Recent quit attempters n=117 Serious quitters n=121 Gender Male 44.4 43.6 50.4 Female 55.6 56.4 49.6 Ethnicity Mori 19.8 24.8 24.0 Non-Mori 80.2 75.2 76.0 Age group 18-24 years 4.0 10.3 12.4 25-44 years 51.6 52.1 35.5 45-64 years 33.3 29.1 45.5 65+ years 11.1 8.5 6.6 Household equivalised income* Low $0-$34,600 22.2 32.5 29.8 Med $34,601-$66,500 34.1 33.3 27.3 High $66,501+ 39.7 23.9 24.0 Unspecified 4.0 10.3 19.0 Household composition Single adult 19.8 15.4 24.8 Multiple adults no children 38.1 28.2 28.1 With children 42.1 56.4 47.1 *Household equivalised income was calculated using an established formula that took into account the number and the age of children (0-18 years) residing in the household.14Smoking at homeTable 2 presents the association between socio-demographic characteristics, household composition and quit attempt status, and whether people smoked inside/outside their home and inside their car. Among those who had smoked in the past 2 weeks, 95% smoked outside their home, while only 28% did so inside their home.Table 2: Smoking in home or cars in the past 2 weeks (proportion, odds ratio (OR) and adjusted odds ratio (AOR), n=269.Statistically significant differences at p<0.05 are denoted in bold.In the univariate models, being in a single adult household compared to a household with children, and being a serious quitter as opposed to a non-attempter, were associated with a reduced odds of smoking outside the home. Correspondingly, being in an older age group (aged 45+ years) compared to those aged 18-24 years, having a low income compared to a high income, and households without children, were associated with increased odds of smoking inside the home. After adjustment, except for the increased olds of smoking inside the home for those from a single adult household compared to a household with children, these associations remained. Furthermore, the odds of smoking inside the home became statistically significantly higher for non-attempters compared with serious quitters.Smoking in carsAmong those who had smoked in the past 2 weeks, 63% smoked inside a car when they were the only person in it, while 27% smoked when there were also other people present.In the univariate models, having a medium or high income, compared to those having a low income, had increased odds of smoking inside a car when they were the only person in it. Increased odds were also found among non-attempters when compared with recent quit attempters and serious quitters. After adjustments, these associations remained.In the univariate models on smoking around other people in a car, Mori compared with non-Mori, those aged 18-24 years compared with those aged 65+ years, those in a household with children compared with those living on their own, had increased odds of reporting this behaviour. After adjustment, the differences by ethnicity and household composition were no longer statistically significant.Exposure to second-hand smoke in a carOne-third of the respondents reported being exposed to SHS inside a car in the past 2 weeks (see Table 3). In the univariate models, Mori when compared with non-Mori, those aged 18-24 years compared with their older counterparts, non-attempters compared with serious quitters, had increased odds of reporting being exposed. After adjustment, these associations remained.Table 3: Exposure to second-hand smoke inside a car in the past 2 weeks (proportion, OR and AOR), n=364. Exposure to second-hand smoke inside a car in the past two weeks % OR AOR Overall 32.8 - Gender Male 34.7 Ref Ref Female 31.1 .85 (.55-1.32) .80 (.50-1.29) Ethnicity Mori 47.6 Ref Ref Non-Mori 28.5 .44 (.26-.73) .42 (.24-.74) Age group 18-24 years 62.5 Ref Ref 25-44 years 33.9 .31 (.14-.67) .27 (.11-.63) 45-64 years 29.8 .25 (.11-.57) .26 (.11-.62) 65+ years 9.4 .06 (.02-.25) .07 (.02-.30) Household equivalised income* Low $0-$34,600 27.5 Ref Ref Med $34,601-$66,500 36.5 1.52 (.85-2.71) 1.34 (.71-2.51) High $66,501+ 32.7 1.28 (.71-2.33) 1.08 (.55-2.11) Unspecified 35.9 1.48 (.67-3.25) 1.28 (.54-3.05) Household composition Single adult 20.5 .52 (.27-1.00) 1.07 (.49-2.34) Multiple adults no children 40.0 1.34 (.83-2.19) 1.40 (.78-2.49) With children 33.1 Ref Ref Quit attempt status Non-attempters 36.5 Ref Ref Recent quit attempters 37.6 1.05 (.62-1.76) .93 (.53-1.64) Serious quitters 24.2 .55 (.32-.96) .43 (.23-.81) Statistically significant differences at p<0.05 are denoted in bold.Knowledge of harmsThree questions were used to assess knowledge of harm relating to SHS exposure, and two of them were specifically around smoking in cars. Three in 10 (30%) respondents agreed with the statement that The dangers of second-hand smoke have been exaggerated (see Table 4). Only 13% agreed that It s OK to smoke around other people inside cars if there are windows open, while half of the respondents agreed that It s OK to smoke inside cars when there are no other people in them.Table 4a: Agreement with the statements that assessed knowledge level and support for policy on smokefree cars (proportion and AOR) n=364Statistically significant differences at p<0.05 are denoted in bold.Table 4b: Agreement with the statements that assessed knowledge level and support for policy on smokefree cars (proportion and AOR) n=364. Smoking in cars should be banned while children are in them Smoking in cars should be banned at all times % OR AOR % OR AOR Overall 92.0 - 29.0 - Gender Male 90.5 Ref Ref 22.2 Ref Ref Female 93.4 1.48 (.69-3.18) 1.54 (.69-3.45) 35.1 1.91 (1.20-3.05) 2.00 (1.20-3.33) Ethnicity Mori 90.4 Ref Ref 30.5 Ref Ref Non-Mori 92.5 1.32 (.56-3.10) 1.88 (.73-4.87) 28.6 .91 (.53-1.56) 1.06 (.57-1.95) Age group 18-24 years 96.9 Ref Ref 28.1 Ref Ref 25-44 years 92.9 .42 (.05-3.36) .33 (.04-2.85) 23.2 .77 (.33-1.81) 1.05 (.41-2.71) 45-64 years 89.3 .27 (.03-2.13) .22 (.03-1.83) 35.1 1.38 (.59-3.24) 1.98 (.78-5.05) 65+ years 93.8 .48 (.04-5.62) .47 (.03-6.34) 35.5 1.41 (.48-4.08) 2.03 (.59-6.95) Household equivalised income* Low NZ$0- $34,600 94.1 Ref Ref 39.6 Ref Ref Med NZ$34,601- $66,500 91.3 .66 (.23-1.87) .67 (.22-2.04) 27.0 .56 (.32-1.00) .67 (.36-1.25) High NZ$66,501+ 91.6 .68 (.23-1.99) 1.04 (.33-3.32) 19.6 .37 (.20-.69) .50 (.25-1.00) Unspecified 90.0 .56 (.15-2.11) .47 (.11-1.93) 33.3 .76 (.35-1.66) .69 (.30-1.61) Household composition Single adult 91.8 .60 (.21-1.76) .42 (.11-1.55) 30.6 .89 (.49-1.60) .60 (.28-1.31) Multiple adults no children 87.8 .39 (.16-.93) .38 (.14-1.02) 21.7 .56 (.33-.96) .57 (.30-1.07) With children 94.9 Ref Ref 33.1 Ref Ref Quit attempt status Non-attempters 88.9 Ref Ref 12.8 Ref Ref Recent quit attempters 91.5 1.34 (.57-3.14) 1.22 (.50-3.02) 31.9 3.19 (1.66-6.14) 3.02 (1.53-5.95) Serious quitters 95.9 2.90 (1.01-8.32) 3.40 (1.07-10.77) 43.0 5.13 (2.72-9.70) 5.07 (2.56-10.04) Statistically significant differences at p<0.05 are denoted in bold.The only factor that consistently predicted knowledge level was gender, with female respondents being more wary of the impact caused by exposure to SHS (ie, reduced odds of showing agreement with the misbelief). Differences by quit attempt status were observed for two out of three measures, with serious quitters having increased odds of agreeing with the statements.While the differences by age did not reach statistical significance for any of the comparisons on knowledge of harms (possibly due to the small sample size), there are some indicators that young adults (aged 18-24 years) were less informed about the harms relating to smoking in cars.Support for legislationThe large majority of respondents (91%) agreed that smoking in cars should be banned when children are present. This high level of support was universal across all social and population groups, despite some statistically significant differences by household composition and quit attempt status.In contrast, only 30% agreed that smoking in cars should be banned at all times. Differences by gender, household composition and quit attempt status were found. For example, female respondents were more likely to support a total ban than males.DiscussionThrough smokers self-report, we found that smoking in cars was c

Summary

Abstract

Aim

Exposure to second-hand smoke (SHS) poses serious health consequences to non-smokers, and normalises smoking. Currently, there is no legislation restricting smoking in private cars in New Zealand. This paper supplements previous New Zealand studies on exposure to SHS in cars by examining smokers and recent quitters knowledge and behaviours towards smoking in cars, and their support for two possible smokefree cars policy options.

Method

The New Zealand Smoking Monitor is a fortnightly survey that uses a self-refreshing panel approach. The questionnaire contains smoking- and cessation-related questions, including eight non-core questions addressing smoking in homes or cars. These questions were answered by 364 respondents in 2014. Responses were compared by socio-demographic variables and recent quit attempt status.

Results

Smoking in cars was common among the respondents in our sample: 63% had recently smoked in a car when they were the only person in it, and 27% had done so when there were other people present. Some groups of respondents exhibited information gaps around the harms (eg, compared with males, females had reduced odds of agreeing with the false statement: it s OK to smoke inside cars if there are windows open, OR=0.41, 0.21-0.78); however, support for banning smoking in cars if there are children in them was consistently high across different sub-groups (92% overall).

Conclusion

Our data show the importance of providing specific information around the danger of smoking in cars, and strategies to enforce a complete smokefree rule in cars. Legislation may be required to further protect children from SHS exposure.

Author Information

- Judy Li, Research and Evaluation, Health Promotion Agency, Wellington; Sarah Nelson, Research and Evaluation, Health Promotion Agency, Wellington; Rhiannon Newcombe, Research and Evaluation, Health Promotion Agency, Wellington; Darren Walton, Adjunct

Acknowledgements

- We thank the NZSM respondents and UMR Research for conducting the fieldwork. We also acknowledge the Ministry of Health as the funder of the NZSM.-

Correspondence

Judy Li, Research and Evaluation, Health Promotion Agency, Wellington

Correspondence Email

enquiries@hpa.org.nz

Competing Interests

Nil.

'-- Office on Smoking and Health. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. (Centers for Disease Control and Prevention, 2006). New Zealand Government. Smoke-free Environments Act 1990. (Ne

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Strong empirical evidence has demonstrated the negative health consequences caused by exposure to second-hand smoke (SHS).1 In New Zealand, the Smoke-free Environments Act 1990 and the Smoke-free Environments Amendment Act 2003, ban smoking in workplaces, schools, early childhood education and care centres, public transports, indoor areas of hospitality venues (eg, bars, restaurants, cafes and casinos), and other locations.2,3 However, exposure to SHS in private settings continue to represent a public health challenge.Studies focusing on the impact of SHS exposure in cars4-6 and residual tobacco smoke in cars7,8 provide specific evidence for the importance of reducing SHS exposure in cars. For example, an evidence review found that smoking in cars increased the concentration of atmospheric and biological markers of SHS. The authors also noted that the concentration found in cars was significantly higher than those measured in bars and clubs prior to when smokefree laws came into force.4At least five New Zealand studies have estimated the prevalence of SHS exposure in people s homes and in private vehicles through self-report.9-13 For example, in the 2012/13 New Zealand Health Survey (NZHS), respondents were asked whether anyone smoked in their home, and in the car they usually travelled in.10 Among non-smoking adults (aged 15+ years), 4% reported that there were people smoking in their homes, and 3% reported people smoking in cars. Exposure was significantly higher among young adults, for example, 9% of 15-19-year-olds, and 7% of 20-24-year-olds reported people smoking in the cars they usually travelled in (compared with 3% overall). Children (aged 0-14 years) represent another vulnerable group, with 6% of them exposed to SHS in homes and 5% in cars.10An annual survey of Year 10 students used a different measure to assess SHS exposure. In 2012, 23% reported past 7-day SHS exposure in cars a steady and significant drop from 31% in 2006.9 The New Zealand arm of the International Tobacco Control (ITC-NZ) Study offered different information by asking smokers to indicate whether they smoked in cars with non-smokers, and 75% said they never did.14Apart from the self-reported data from both smokers and non-smokers, adding to the evidence is four published papers that have reported the point prevalence of smoking in cars in New Zealand using observational data.15-18 However, the generalisability of these studies is restricted by the sampling that only covers a limited geographical area.Notwithstanding this limitation, the overall findings are consistent: 1) point prevalence of smoking is lower in cars carrying children than those that do not,15-17 and, 2) there is a higher point prevalence in more socio-economically deprived areas.15-18 One study has tracked changes in the point prevalence of smoking in cars over time, and found a significant decrease from 6.4% in 2005, to 3.4% in 2013, in Wainuiomata, Wellington.15To address the harm caused by SHS exposure in cars, a number of countries and jurisdictions (eg, Australia, some jurisdictions in Canada and the US, and South Africa) have banned smoking in cars when children are present, and positive outcomes were found post-implementation (reduced SHS exposure, increased prevalence of smokefree cars).19,20 In New Zealand, there is currently no legislation restricting smoking in private vehicles. The Mori Affairs Select Committee report recommended that the Government investigate extending the Smoke-free Environments Act to legislate against smoking in certain areas, such as vehicles, vehicles carrying children, and specific public places (such as playground, parks and beaches),21 and in response the New Zealand Government proposed to explore extending current smokefree restrictions to include vehicles.22Alongside the Government s intention to explore options around restricting smoking in private vehicles, there is also strong public support for banning smoking in cars where children are present. Importantly, a repeated cross-sectional national survey found a consistently high level of support was found among respondents of different social and population groups, and smoking status.23,24 Specifically, the 2014 data from the Health and Lifestyles Survey (HLS) showed that 97% of New Zealand adults support banning smoking in cars when there are children in them,24 an increase from 93% in 2012.23 A high level of public support for smokefree cars legislation was also found in another survey of New Zealand adults,25 and the ITC-NZ Study of current smokers.This study supplements previous New Zealand studies14,25,26 by updating the information around support for smokefree cars legislation among smokers and recent quitters. By using a wide range of measures (including smoking behaviour in cars, exposure to other people s smoking in cars, knowledge of SHS exposure, and support for smokefree cars legislation), this study also extends the existing knowledge by providing a more comprehensive assessment of the context around smoking in cars.MethodsInstrumentsThis study focuses on 2014 New Zealand Smoking Monitor (NZSM) results from smokers and recent quitters to extend the findings from the previous studies conducted in New Zealand that provide a perspective on smoking in cars. The NZSM is a fortnightly monitor (n=180) implemented since 2011, and fieldwork is delivered using computer-assisted telephone interviewing (CATI). Each interview lasts about 10 minutes. Ethics approval was obtained from the New Zealand Health and Disabilities Ethics Committee (Ref: 13/CEN/99).The questionnaire has two components. The core component covers a range of smoking- and cessation-related topics and socio-demographic information, while the questions in the non-core component change every quarter to address emerging issues in tobacco control. This paper reported on the non-core questions on smoking in cars, in the field between August and October 2014.Respondents who had smoked in the past 2 weeks (n=269) were asked if they had smoked in a list of locations during the past 2 weeks. The list included outside their home, inside their home, inside a car when they were the only person in it, and inside a car when there were other people in it. All respondents (n=364) were asked if they were exposed to SHS inside a car in the past 2 weeks.Finally, all respondents indicated their agreement level to a list of five statements using the following response options: strongly agree; agree; neither agree nor disagree; disagree; and strongly disagree: The dangers of second-hand smoke have been exaggerated It s OK to smoke around other people inside cars if there are windows open It s OK to smoke inside cars when there are no other people in them Smoking in cars should be banned while children are in them Smoking in cars should be banned at all time. ParticipantsResponses were gathered from a sample of New Zealand adult smokers or recent quitters (aged 18 years or over) who took part in the NZSM. A quota system was in place to ensure the sample consisted of three groups (n=60 per group, per fortnight), differentiated by participants current and past 3-month quitting behaviours:non-attempters: daily smokers who had not made a quit attempt lasting 24 hours or longer in the past 3 monthsrecent quit attempters: daily smokers who had made a quit attempt lasting 24 hours or longer in the past 3 monthsserious quitters: ex-smokers or current smokers who had smoked regularly in the past 3 months, but had not smoked daily in the past 30 days, and they intended to stay smokefree in the next 3 months.The NZSM uses a self-refreshing panel design. Respondents are maintained on the panel and interviewed up to six times. Those who drop out from the sample, either because they had completed six interviews or withdrawn, are replaced by new respondents. This study reports on data collected over five fortnights from 3 August to 11 October 2014.During the study period, 364 respondents completed a total of 900 interviews. To ensure the behaviour and views of the participants are only captured once in the analysis, only the first set of responses collected from each participant were included.Sampling procedureRespondents were recruited through two methodologies. Non-attempters and recent quit attempters were recruited from a telephone-based omnibus survey, where a nationally represented sample of New Zealand adults aged 18 or over were recruited via random digit dialling. Respondents who were eligible to take part in the NZSM were asked for permission to be re-contacted, and they were then invited to take part at a subsequent phone call.Due to the small incidence rate of serious quitters at a population level, this sample was recruited through the national Quitline client database. Each fortnight, a random sample of Quitline callers were invited to take part in the NZSM. Callers must have given prior consent for releasing their names and contact details. Potential respondents were contacted over the phone, the interviewers asked for their informed consent, and screened for eligibility. Despite the different recruitment methods, all participants were interviewed by the same fieldwork company.AnalysisThe analysis was undertaken using STATA IC 13.1. Questions using an agreement/disagreement scale were dichotomised whereby agree and strongly agree responses were combined to indicate agreement with the statements. For all questions, participants who could not form an opinion (said they don t know), or refused to answer, were excluded from the analysis for that particular question (up to 3% of total responses).We first compared responses by the socio-demographic variables and past 3-month quit attempt status using crude odds ratios (OR). Multiple logistic regression models were then used to control for potential confounding (presented as the adjusted odds ratios/ AOR).ResultsSample characteristicsSocio-demographic characteristics of the sample, stratified by their recent quit attempts, are described in Table 1.Table 1: Socio-demographic characteristics by recent quit status. Non- attempters n=126 Recent quit attempters n=117 Serious quitters n=121 Gender Male 44.4 43.6 50.4 Female 55.6 56.4 49.6 Ethnicity Mori 19.8 24.8 24.0 Non-Mori 80.2 75.2 76.0 Age group 18-24 years 4.0 10.3 12.4 25-44 years 51.6 52.1 35.5 45-64 years 33.3 29.1 45.5 65+ years 11.1 8.5 6.6 Household equivalised income* Low $0-$34,600 22.2 32.5 29.8 Med $34,601-$66,500 34.1 33.3 27.3 High $66,501+ 39.7 23.9 24.0 Unspecified 4.0 10.3 19.0 Household composition Single adult 19.8 15.4 24.8 Multiple adults no children 38.1 28.2 28.1 With children 42.1 56.4 47.1 *Household equivalised income was calculated using an established formula that took into account the number and the age of children (0-18 years) residing in the household.14Smoking at homeTable 2 presents the association between socio-demographic characteristics, household composition and quit attempt status, and whether people smoked inside/outside their home and inside their car. Among those who had smoked in the past 2 weeks, 95% smoked outside their home, while only 28% did so inside their home.Table 2: Smoking in home or cars in the past 2 weeks (proportion, odds ratio (OR) and adjusted odds ratio (AOR), n=269.Statistically significant differences at p<0.05 are denoted in bold.In the univariate models, being in a single adult household compared to a household with children, and being a serious quitter as opposed to a non-attempter, were associated with a reduced odds of smoking outside the home. Correspondingly, being in an older age group (aged 45+ years) compared to those aged 18-24 years, having a low income compared to a high income, and households without children, were associated with increased odds of smoking inside the home. After adjustment, except for the increased olds of smoking inside the home for those from a single adult household compared to a household with children, these associations remained. Furthermore, the odds of smoking inside the home became statistically significantly higher for non-attempters compared with serious quitters.Smoking in carsAmong those who had smoked in the past 2 weeks, 63% smoked inside a car when they were the only person in it, while 27% smoked when there were also other people present.In the univariate models, having a medium or high income, compared to those having a low income, had increased odds of smoking inside a car when they were the only person in it. Increased odds were also found among non-attempters when compared with recent quit attempters and serious quitters. After adjustments, these associations remained.In the univariate models on smoking around other people in a car, Mori compared with non-Mori, those aged 18-24 years compared with those aged 65+ years, those in a household with children compared with those living on their own, had increased odds of reporting this behaviour. After adjustment, the differences by ethnicity and household composition were no longer statistically significant.Exposure to second-hand smoke in a carOne-third of the respondents reported being exposed to SHS inside a car in the past 2 weeks (see Table 3). In the univariate models, Mori when compared with non-Mori, those aged 18-24 years compared with their older counterparts, non-attempters compared with serious quitters, had increased odds of reporting being exposed. After adjustment, these associations remained.Table 3: Exposure to second-hand smoke inside a car in the past 2 weeks (proportion, OR and AOR), n=364. Exposure to second-hand smoke inside a car in the past two weeks % OR AOR Overall 32.8 - Gender Male 34.7 Ref Ref Female 31.1 .85 (.55-1.32) .80 (.50-1.29) Ethnicity Mori 47.6 Ref Ref Non-Mori 28.5 .44 (.26-.73) .42 (.24-.74) Age group 18-24 years 62.5 Ref Ref 25-44 years 33.9 .31 (.14-.67) .27 (.11-.63) 45-64 years 29.8 .25 (.11-.57) .26 (.11-.62) 65+ years 9.4 .06 (.02-.25) .07 (.02-.30) Household equivalised income* Low $0-$34,600 27.5 Ref Ref Med $34,601-$66,500 36.5 1.52 (.85-2.71) 1.34 (.71-2.51) High $66,501+ 32.7 1.28 (.71-2.33) 1.08 (.55-2.11) Unspecified 35.9 1.48 (.67-3.25) 1.28 (.54-3.05) Household composition Single adult 20.5 .52 (.27-1.00) 1.07 (.49-2.34) Multiple adults no children 40.0 1.34 (.83-2.19) 1.40 (.78-2.49) With children 33.1 Ref Ref Quit attempt status Non-attempters 36.5 Ref Ref Recent quit attempters 37.6 1.05 (.62-1.76) .93 (.53-1.64) Serious quitters 24.2 .55 (.32-.96) .43 (.23-.81) Statistically significant differences at p<0.05 are denoted in bold.Knowledge of harmsThree questions were used to assess knowledge of harm relating to SHS exposure, and two of them were specifically around smoking in cars. Three in 10 (30%) respondents agreed with the statement that The dangers of second-hand smoke have been exaggerated (see Table 4). Only 13% agreed that It s OK to smoke around other people inside cars if there are windows open, while half of the respondents agreed that It s OK to smoke inside cars when there are no other people in them.Table 4a: Agreement with the statements that assessed knowledge level and support for policy on smokefree cars (proportion and AOR) n=364Statistically significant differences at p<0.05 are denoted in bold.Table 4b: Agreement with the statements that assessed knowledge level and support for policy on smokefree cars (proportion and AOR) n=364. Smoking in cars should be banned while children are in them Smoking in cars should be banned at all times % OR AOR % OR AOR Overall 92.0 - 29.0 - Gender Male 90.5 Ref Ref 22.2 Ref Ref Female 93.4 1.48 (.69-3.18) 1.54 (.69-3.45) 35.1 1.91 (1.20-3.05) 2.00 (1.20-3.33) Ethnicity Mori 90.4 Ref Ref 30.5 Ref Ref Non-Mori 92.5 1.32 (.56-3.10) 1.88 (.73-4.87) 28.6 .91 (.53-1.56) 1.06 (.57-1.95) Age group 18-24 years 96.9 Ref Ref 28.1 Ref Ref 25-44 years 92.9 .42 (.05-3.36) .33 (.04-2.85) 23.2 .77 (.33-1.81) 1.05 (.41-2.71) 45-64 years 89.3 .27 (.03-2.13) .22 (.03-1.83) 35.1 1.38 (.59-3.24) 1.98 (.78-5.05) 65+ years 93.8 .48 (.04-5.62) .47 (.03-6.34) 35.5 1.41 (.48-4.08) 2.03 (.59-6.95) Household equivalised income* Low NZ$0- $34,600 94.1 Ref Ref 39.6 Ref Ref Med NZ$34,601- $66,500 91.3 .66 (.23-1.87) .67 (.22-2.04) 27.0 .56 (.32-1.00) .67 (.36-1.25) High NZ$66,501+ 91.6 .68 (.23-1.99) 1.04 (.33-3.32) 19.6 .37 (.20-.69) .50 (.25-1.00) Unspecified 90.0 .56 (.15-2.11) .47 (.11-1.93) 33.3 .76 (.35-1.66) .69 (.30-1.61) Household composition Single adult 91.8 .60 (.21-1.76) .42 (.11-1.55) 30.6 .89 (.49-1.60) .60 (.28-1.31) Multiple adults no children 87.8 .39 (.16-.93) .38 (.14-1.02) 21.7 .56 (.33-.96) .57 (.30-1.07) With children 94.9 Ref Ref 33.1 Ref Ref Quit attempt status Non-attempters 88.9 Ref Ref 12.8 Ref Ref Recent quit attempters 91.5 1.34 (.57-3.14) 1.22 (.50-3.02) 31.9 3.19 (1.66-6.14) 3.02 (1.53-5.95) Serious quitters 95.9 2.90 (1.01-8.32) 3.40 (1.07-10.77) 43.0 5.13 (2.72-9.70) 5.07 (2.56-10.04) Statistically significant differences at p<0.05 are denoted in bold.The only factor that consistently predicted knowledge level was gender, with female respondents being more wary of the impact caused by exposure to SHS (ie, reduced odds of showing agreement with the misbelief). Differences by quit attempt status were observed for two out of three measures, with serious quitters having increased odds of agreeing with the statements.While the differences by age did not reach statistical significance for any of the comparisons on knowledge of harms (possibly due to the small sample size), there are some indicators that young adults (aged 18-24 years) were less informed about the harms relating to smoking in cars.Support for legislationThe large majority of respondents (91%) agreed that smoking in cars should be banned when children are present. This high level of support was universal across all social and population groups, despite some statistically significant differences by household composition and quit attempt status.In contrast, only 30% agreed that smoking in cars should be banned at all times. Differences by gender, household composition and quit attempt status were found. For example, female respondents were more likely to support a total ban than males.DiscussionThrough smokers self-report, we found that smoking in cars was c

Summary

Abstract

Aim

Exposure to second-hand smoke (SHS) poses serious health consequences to non-smokers, and normalises smoking. Currently, there is no legislation restricting smoking in private cars in New Zealand. This paper supplements previous New Zealand studies on exposure to SHS in cars by examining smokers and recent quitters knowledge and behaviours towards smoking in cars, and their support for two possible smokefree cars policy options.

Method

The New Zealand Smoking Monitor is a fortnightly survey that uses a self-refreshing panel approach. The questionnaire contains smoking- and cessation-related questions, including eight non-core questions addressing smoking in homes or cars. These questions were answered by 364 respondents in 2014. Responses were compared by socio-demographic variables and recent quit attempt status.

Results

Smoking in cars was common among the respondents in our sample: 63% had recently smoked in a car when they were the only person in it, and 27% had done so when there were other people present. Some groups of respondents exhibited information gaps around the harms (eg, compared with males, females had reduced odds of agreeing with the false statement: it s OK to smoke inside cars if there are windows open, OR=0.41, 0.21-0.78); however, support for banning smoking in cars if there are children in them was consistently high across different sub-groups (92% overall).

Conclusion

Our data show the importance of providing specific information around the danger of smoking in cars, and strategies to enforce a complete smokefree rule in cars. Legislation may be required to further protect children from SHS exposure.

Author Information

- Judy Li, Research and Evaluation, Health Promotion Agency, Wellington; Sarah Nelson, Research and Evaluation, Health Promotion Agency, Wellington; Rhiannon Newcombe, Research and Evaluation, Health Promotion Agency, Wellington; Darren Walton, Adjunct

Acknowledgements

- We thank the NZSM respondents and UMR Research for conducting the fieldwork. We also acknowledge the Ministry of Health as the funder of the NZSM.-

Correspondence

Judy Li, Research and Evaluation, Health Promotion Agency, Wellington

Correspondence Email

enquiries@hpa.org.nz

Competing Interests

Nil.

'-- Office on Smoking and Health. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. (Centers for Disease Control and Prevention, 2006). New Zealand Government. Smoke-free Environments Act 1990. (Ne

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