Protecting children from tobacco-related harm in private vehicles

Restricting tobacco smoking in public places is a key part of WHO recommendations to reduce tobacco-related harm.1WHOWHO report on the global epidemic: offer help quit use: executive summary. World Health Organization, Geneva2019Google Scholar The population health benefits this intervention are well established and include reductions preterm birth hospital admissions for respiratory disorders both children adults.2Faber T Kumar A Mackenbach JP et al.Effect control policies perinatal child health: systematic review meta-analysis.Lancet Public Health. 2017; 2: e420-e437Summary Full Text PDF PubMed Scopus (86) Google Although smoke-free legislation most often considered as applying bars, restaurants, workplaces, specifies eight separate locations, including government facilities transport.1WHOWHO Some jurisdictions have also applied restrict inside private vehicles where present. Such justified by trying denormalise near children, very high air concentration toxins upon within cars, even when windows open.3Raoof SA Agaku IT Vardavas CI secondhand smoke exposure car: attributable changes atmospheric biological markers.Chron Respir Dis. 2015; 12: 120-131Crossref (17) proportion school-aged being regularly exposed cars ranges from 6–43% across seven European cities.4Mlinarić M Schreuders Mons U Kunst AE Exposure car among youth cities Union.Drug Alcohol Depend. 2019; 204107561Crossref (3) support regulations generally high,5Fu Castellano Y Tigova O al.Correlates smokers: cross-sectional study six countries EUREST-PLUS ITC EUROPE SURVEYS.Tob Induc 16: A17PubMed they currently place only around 15 worldwide, with some these at subnational level. Following England Wales, December, 2016, Scotland was third UK country implement ban carrying children. In Lancet Health, Daniel Mackay colleagues6Mackay DF Turner SW Semple SE Dick S Pell Associations between vehicle childhood asthma Scotland: an interrupted time-series analysis whole-population data.Lancet 2021; (published online July 15.)https://doi.org/10.1016/S2468-2667(21)00129-8Summary (2) findings their quasi-experimental examining effects measure emergency authors used same dataset previous paper that examined 2014 national campaign protect second-hand home environment, called Take it Right Outside (TiRO).7Turner D homes 2020; 5: e493-e500Summary (12) They time series approach using data all unplanned infections over 19-year period, included gastroenteritis condition, did stratified analyses age group area deprivation. keeping relatively uncommon, there been few examinations impacts such regulations. Márta Radó colleagues' identified five studies links children's exposure, one reporting outcomes.8Radó MK Mölenberg FJM Westerberg LEH outdoor areas 15.)https://doi.org/10.1016/S2468-2667(21)00097-9Summary Meta-analysis ten estimates four found immediate 31% (95% 13–45) reduction vehicles, but low number precluded examination subgroup effects, little consideration hard clinical outcomes individual studies. address gaps evidence base. results linked Scottish 1·49% 0·27–2·69) monthly decline younger than 5 years, above underlying trend. No significant impact older or seen. This preschool positive finding, absolute might be moderate avoided per year. Given exacerbations do not require admission hospital, paucity less serious cases managed community indicates probably underestimate. robust design attempt range competing factors, other interventions drive down period. These TiRO campaign, which focus group,7Turner updated now concludes resulted demonstrable benefits. represents advance lacks exposure—the presumed intermediate variable—which would useful avenue more research. However, slightly different designs datasets introduction reduced before implemented intervention.9Laverty AA Hone Vamos EP al.Impact banning smoke: natural experiment Scotland.Thorax. 75: 345-347Crossref (11) Scholar, 10Faber Mizani MA Sheikh Reiss IK Been JV Investigating effect England's regulation disease children: study.Lancet 4: e607-e617Summary Protecting harmful essential regulating important given extremely levels toxins. Alongside existing showing measures can cars,8Radó provides further impetus accelerate implementation similar globe. should comprehensive control, includes covering workplaces if already place. Importantly, specific produce additional laws, despite compliance incomplete known challenges enforcement.10Faber Additional evaluations strengthen base assessing identifying effective approaches increasing facilitating enforcement policies. We declare no interests. dataAlthough affect severe overall group, associated requiring trend designed smoke. Similar prohibiting contain adopted countries. Full-Text Open Access