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Cars far worse than bars for second-hand smoke

A single cigarette smoked in a stationary car with its windows closed can produce a very high level of second-hand smoke. Dr Charmaine Gauci explains.

Smokers often think that keeping the window open in a car while they are smoking will not affect the other passengers in the car. Yet experimental models show that in a moving car with windows open, the level of second-hand smoke produced by a single cigarette can be as high as seven times the average level of a smoky bar.

The health impact of being exposed to second-hand smoke is well established. Second-hand smoke consists of a mixture of gases and fine particles that is either emitted from a burning cigarette, cigar, or pipe, or exhaled by smokers. In all, second-hand smoke contains at least 250 toxic chemicals, including more than 50 carcinogens.

A number of countries have legislated banning of smoking in public places. This had an impact to varying degrees in different settings and different populations. Smoking in cars has been given particular attention as levels of second hand smoke in cars can be extremely high.

Research from Canada showed that the car’s confined spaces are particularly dangerous because second-hand smoke caused by smoking reaches a toxic level quickly, even if one attempts to open the windows or operate the ventilation system.

Other experimental studies in Canada highlighted that a single cigarette smoked in a stationary car with its windows closed can produce a level of second-hand smoke 11 times higher than the level found in an average bar. In a moving car with windows open, the level of second-hand smoke produced by a single cigarette can be as high as seven times the average level of a smoky bar.

Various studies highlight the dangers from second-hand smoke in children, including sudden infant death syndrome and acute respiratory illness, among others

An experimental investigation of tobacco smoke pollution in cars, researchers noted that in the condition with the least airflow (motionless car, window closed) levels of fine respirable particles (known as PM2.5) were over 100 times greater than the US Environmental Protection Agency’s 24-hour standard for fine particle exposure and 15 times the EPA’s “hazardous” rating.

Second-hand smoke exposure is particularly harmful for children because they have smaller lungs and weaker immune system. Children are a vulnerable group who cannot decide for themselves and are dependent on the actions of their caregivers.

As a vulnerable group, children cannot protect themselves from second-hand smoke exposure inside private vehicles because they are often not aware of the health risks; even if they were, they cannot communicate or may be too afraid to ask to leave the car.

Various studies highlight the dangers from second-hand smoke in children, including sudden infant death syndrome, acute respiratory illness, chronic respiratory symptoms, asthma and exacerbation of asthma, impaired lung functioning, recurrent otitis media and childhood cancer.

An international review of surveys from North America, the UK and Australasia found a majority (76 per cent) of the public supported the introduction of smoke-free car laws. In four of the jurisdictions examined (Victoria, California, New Zealand, and South Australia) levels of public support were in excess of 90 per cent. Regulation of smoking in cars in the presence of children has shown to have an impact: after the introduction of the ban in Canada the prevalence decreased from 43 per cent in 2005 to 28 per cent in 2010.

Malta legislates

Malta introduced a legislative measure to ban smoking in private vehicles in the presence of children as from January 2017. This will further build on the legislative measures already present and will be supported by an information campaign and by smoking cessation support services.

Dr Charmaine Gauci is Superintendent of Public Health, Ministry of Health.

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