Measuring Air Quality to Protect Children from Secondhand Smoke in Cars

doi:10.1016/j.amepre.2006.07.021

American Journal of Preventive Medicine

Volume 31, Issue 5, November 2006, Pages 363-368

https://doi.org/10.1016/j.amepre.2006.07.021 Get rights and content

Background

Secondhand tobacco smoke (SHS) is a major, preventable contributor to acute and chronic adverse health outcomes that affect children disproportionately. The predominant source of SHS among children is domestic exposure, and while up to two thirds of U.S. households have car smoking bans, an unacceptable number of children remain vulnerable. To help promote more effective protection through legislation, health communication strategies, or behavioral interventions, data demonstrating the adverse effect of SHS on air quality in cars are needed.

Methods

Secondhand tobacco smoke in a motor vehicle under actual driving conditions was monitored by measuring respirable suspended particles (RSPs) of less than 2.5 microns in diameter, and carbon monoxide. Forty-five driving trials were conducted, using teams of volunteer drivers and smokers recruited from the general community. Three smoking conditions (nonsmoking baseline, active smoking, and immediate post-smoking period, each 5 minutes) were crossed with two ventilation conditions (windows open, closed) in a 3 × 2 within-sessions factorial design.

Results

The highest mean observed RSP level was 271 μg/m³, which is unsafe, particularly for children. Peak RSP levels were considerably higher. RSPs and carbon monoxide increased significantly from baseline after smoking, and these increases were greatest during the closed ventilation condition, compared with open ventilation.

Conclusions

Private passenger cars are a domestic environment with the potential to yield unsafe levels of SHS contaminants. These data may assist policymakers and health advocates to promote protective strategies to ensure smoke-free domestic environments for children.

Introduction

Secondhand tobacco smoke (SHS) is a toxic air contaminant that contributes to multiple, preventable adverse health outcomes. Among adults, SHS exposure is associated with cardiovascular disease, cancers, and respiratory and reproductive problems.1, 2, 3 Children exposed to SHS show greater likelihood of lower respiratory infections,4, 5, 6 sudden infant death syndrome,7, 8 ear infections,⁹ and severity of asthma symptoms.10, 11 Children may be more vulnerable to SHS-induced respiratory diseases due to smaller airways and greater oxygen demand and, hence, higher respiratory rates, as well as less-mature immune systems. Accordingly, SHS is regarded as a major pediatric problem.⁷ The estimated prevalence of SHS exposure among children varies according to the source of exposure, age of the child, and family smoking behavior. Recent estimates based on national surveys indicate that 35% to 43% of children live in homes where secondhand smoke is present.12, 13, 14 While secondhand smoke exposure in cars is less well investigated, New York state middle school students reported being present in a car with a smoker an average of 1.2 days per week, while high school students reported an average of 1.5 days per week.¹⁵ These frequency estimates were significantly higher among students from smoking households.

Reducing exposure to SHS in the United States has been achieved through evolving strategies that include legislation, public policy, and health communications. Despite recent successes in protecting adults, there is a lack of legislative protection from SHS arising from domestic sources for children. The predominant cause of SHS among children is domestic exposure,16, 17 and most existing protection arises from voluntary individual or family-based smoking restrictions in the home or car. Smoking bans in the home have been shown to contribute to lower urinary cotinine in children.¹⁸ Some three in four homes in California have indoor smoking bans and two thirds of households have car smoking bans.19, 20 Despite the relative benefit of such personal bans, a vast number of children in the United States continue to be exposed to SHS, especially among low-income families, which are less likely to impose domestic bans on smoking.²¹

Secondhand smoke monitoring has been used to document unsafe levels of contaminants, and to focus attention on health risks.²² Findings have more recently been used to enhance support for clean indoor air laws or to confirm the benefits of such laws.23, 24, 25 Air quality monitoring of environments in which children are present has focused on exposure in the home.26, 27 Although high emission concentrations have been found in simulated exposure to SHS in vehicles,28, 29, 30 measures of SHS from passenger cars in a real driving situation have not been published. To help promote protection through legislation, health communication strategies, or behavioral interventions, such data are needed.

This study aimed to simulate children’s exposure to secondhand smoke in a motor vehicle by measuring carbon dioxide and respirable suspended particles (RSPs) of less than 2.5 microns in diameter, under actual driving conditions.

Section snippets

Apparatus

Tobacco smoke concentration was measured by a TSI SidePak AM510 Personal Aerosol Monitor, using a 0.32 calibration factor. This device uses a laser photometer that samples airborne particles in real time. The device was fitted with an impactor to detect RSPs with a mass median aerodynamic diameter of <2.5 microns. The SidePak was zero-calibrated prior to each sampling session and set so that data were averaged and logged over 1-minute intervals. The air flow rate was set at 1.7 L/min. Carbon

Respirable Suspended Particles

Mean (and standard error) real-time plots of RSPs under open- and closed-ventilation conditions are presented in Figure 1. These show substantial increases from baseline in airborne smoke particles during the smoking period. As expected, this increase was greater during the closed-ventilation condition, compared with open ventilation. Dissipation of airborne particles occurred rapidly after the active smoking period ended. The highest peak 1-minute values that comprised each 5-minute

Discussion and Conclusions

These data reveal alarming RSP levels generated from smoking a single cigarette for only 5 minutes in a private car. RSP concentrations were significantly higher than baseline during the smoking and post-smoking measurement periods. As expected, RSP levels were higher under the closed-windows condition than with windows open. The observed interaction between ventilation and smoking phase suggests that greater increases in mean RSP level following smoking were found under the closed-ventilation

References (42)

D.M. Mannino et al.
Involuntary smoking and asthma severity in children: data from the Third National Health and Nutrition Examination Survey
Chest
(2002)
M. Wakefield et al.
Restrictions on smoking at home and urinary cotinine levels among children with asthma
Am J Prev Med
(2000)
G.J. Norman et al.
Smoking bans in the home and car: do those who really need them have them?
Prev Med
(1999)
J.S. Halterman et al.
Do parents of urban children with persistent asthma ban smoking in their homes and cars?
Ambul Pediatr
(2006)
R. Zhou et al.
Comparison of environmental tobacco smoke concentrations and mutagenicity for several indoor environments
Mutat Res
(2000)
P.J. Crocker et al.
Pediatric carbon monoxide toxicity
J Emerg Med
(1985)
Reducing tobacco use: a report of the Surgeon General
(2000)
Respiratory health effects of passive smoking: lung cancer and other disorders, vol. 4
(1993)
Health effects of exposure to environmental tobacco smoke: final report
(1997)
F. Gurkan et al.
The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis
Eur J Epidemiol
(2000)

D.P. Strachan et al.

Health effects of passive smoking. 1Parental smoking and lower respiratory illness in infancy and early childhood

Thorax

(1997)

W. Jedrychowski et al.

Maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke as predisposition factors to acute respiratory infections

Environ Health Perspect

(1997)

H.S. Klonoff-Cohen et al.

The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome

JAMA

(1995)

E.A. Mitchell et al.

Smoking and the sudden infant death syndrome

Pediatrics

(1993)

C.E. Adair-Bischoff et al.

Environmental tobacco smoke and middle ear disease in pre-school age children

Arch Pediatr Adolesc Med

(1998)

J.J. Jaakkola et al.

Environmental tobacco smoke, parental atopy, and childhood asthma

Environ Health Perspect

(2001)

M.A. Schuster et al.

Smoking patterns of household members and visitors in homes with children in the United States

Arch Pediatr Adolesc Med

(2002)

J.L. Pirkle et al.

Exposure of the U.S. population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988–1991

JAMA

(1996)

P.J. Gergen et al.

The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: Third National Health and Nutrition Examination Survey, 1988–1994

Pediatrics

(1998)

Second annual independent evaluation of New York’s tobacco control program: final report

(2005)

K.M. Emmons et al.

Exposure to environmental tobacco smoke in naturalistic settings

Am J Public Health

(1992)

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Secondhand electronic cigarette aerosol in vehicles impacts indoor air quality
2023, Drug and Alcohol Dependence
Electronic cigarette (ECIG) use in vehicles represents a public health concern due to the potential for exposure to high concentrations of particulate matter (PM) and other toxicants. This study examined the impact of ECIG use on air quality in vehicles.
People who reported current ECIG use (n=60; mean age=20.5, SD=2.3) completed a brief survey and a 30-min ECIG use session in their own vehicle. Using a protocol similar to clinical laboratory studies involving tobacco use, participants took 10 directed puffs (i.e., a directed bout with one puff every 30 s for 5 min) followed by a 25-min ad libitum period in which participants took as many puffs as desired. PM 2.5 µm in diameter or smaller (PM_2.5) were measured using aerosol monitors set up to sample air from the breathing zone of the passenger seat and total puffs were recorded. The association between peak PM_2.5 concentration and puff count was examined.
Participants took a median 18 total puffs during the sessions. Median PM_2.5 concentrations increased from 4.78 µg/m³ at baseline to 107.40 µg/m³ after the directed bout. Median peak PM_2.5 concentration was 464.48 µg/m³ and ranged from 9.56 µg/m³ to 143,503.91 µg/m³ (IQR=132.72–1604.68). After removing two extreme outliers for puff count and PM_2.5 concentrations, puff count was significantly correlated with peak PM_2.5 concentration during the ad libitum bout (r=0.32, p=0.015).
ECIG use in vehicles impacts air quality negatively and may pose health risks to those present in vehicles when ECIG use is occurring.
Impact of Airline Secondhand Tobacco Smoke Exposure on Respiratory Health and Lung Function Decades After Exposure Cessation
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Citation Excerpt :
High concentrations of SHS were caused by the high density of smokers, small available airspace per person, inadequate outside air ventilation that decreased over time, and the proximity of flight attendants to passengers, especially during mealtime when smoking increased.24 Exposure of flight attendants to airline SHS was comparable to exposures that continue to occur today in casinos,12,13 bars,14-16 nightclubs,14,15 automobiles,17-19 and even in the home,21 making the findings from this study relevant to people living in regions that lack public smoking bans, as well as those who continue to be exposed in family homes and vehicles.20 The study also underscores the relationship between parental smoking during pregnancy and the increased risk for impaired respiratory health as an adult.
Twenty-five percent to 45% of COPD is caused by exposures other than active smoking. Secondhand tobacco smoke (SHS) has been suggested as an independent cause of COPD, based on its association with increased respiratory symptoms and a small decrease in lung function, but its impact on respiratory health and lung function after exposure cessation has not been explored.
What are the consequences of airline SHS exposure on respiratory health and lung function decades after cessation?
We performed a cohort study involving flight attendants because of their exposure to SHS that stopped > 20 years ago. We included subjects ≥ 50 years of age with > 1 year vs ≤ 1 year of airline SHS exposure (ie, exposed vs unexposed). Respiratory quality of life, as determined by the St. George’s Respiratory Questionnaire (SGRQ), was the primary outcome for respiratory health. Key secondary outcomes included general quality of life (the Rand Corporation modification of the 36-item Short Form Health Survey Questionnaire; RAND-36), respiratory symptoms (COPD Assessment Test; CAT), and spirometry.
The study enrolled 183 SHS-exposed and 59 unexposed subjects. Exposed subjects were 66.7 years of age, and 90.7% were female. They were hired at 23.8 years of age, were exposed to airline SHS for 16.1 years, and stopped exposure 27.5 years before enrollment. Prior SHS exposure was associated with worsened SGRQ (6.7 units; 95% CI, 2.7-10.7; P = .001), RAND-36 physical and social function, and CAT vs unexposed subjects. SHS exposure did not affect prebronchodilator spirometry or obstruction, but was associated with lower postbronchodilator FEV₁ and FEV₁/FVC, total lung capacity, and diffusing capacity of the lungs for carbon monoxide in a subset of subjects. Former smoking and SHS exposure synergistically worsened SGRQ (β = 8.4; 95% CI, 0.4-16.4; P = .04). SHS exposure in people who never smoked replicated primary results and was associated with worsened SGRQ vs unexposed people (4.7 units; 95% CI, 0.7-7.0; P = .006).
Almost three decades after exposure ended, airline SHS exposure is strongly and dose-dependently associated with worsened respiratory health, but less robustly associated with airflow abnormalities used to diagnose COPD.
Investigating the effect of England's smoke-free private vehicle regulation on changes in tobacco smoke exposure and respiratory disease in children: a quasi-experimental study
2019, The Lancet Public Health
Comprehensive tobacco control policies can help to protect children from tobacco smoke exposure and associated adverse respiratory health consequences. We investigated the impact of England's 2015 regulation that prohibits smoking in a private vehicle with children present on changes in environmental tobacco smoke exposure and respiratory health in children.
In this quasi-experimental study, we used repeated cross-sectional, nationally representative data from the Health Survey for England from Jan 1, 2008, to Dec 31, 2017, of children aged up to 15 years. We did interrupted time series logistic or ordinal regression analyses to assess changes in prevalence of self-reported respiratory conditions, prevalence of self-reported childhood tobacco smoke exposure (children aged 8–15 years only), and salivary cotinine levels (children aged 2 years or older) before and after implementation of the smoke-free private vehicle regulation on Oct 1, 2015. Children who were considered active smokers were excluded from the analyses of salivary cotinine levels. Our primary outcome of interest was self-reported current wheezing or asthma, defined as having medicines prescribed for these conditions. Analyses were adjusted for underlying time trends, quarter of year, sex, age, Index of Multiple Deprivation quintile, and urbanisation level.
21 096 children aged 0–15 years were included in our dataset. Implementation of the smoke-free private vehicle regulation was not associated with a demonstrable change in self-reported current wheezing or asthma (adjusted odds ratio 0·81, 95% CI 0·62–1·05; p=0·108; assessed in 13 369 children), respiratory conditions (1·02, 0·80–1·29; p=0·892; assessed in 17 006 children), or respiratory conditions probably affecting stamina, breathing, or fatigue (0·75, 0·47–1·19; p=0·220; assessed in 12 386 children). Self-reported tobacco smoke exposure and salivary cotinine levels generally decreased over the study period. There was no additional change in self-reported tobacco smoke exposure in cars among children aged 8–15 years following the legislation (0·77, 0·51–1·17; p=0·222; assessed in 5399 children). We observed a relative increase in the odds of children having detectable salivary cotinine levels post legislation (1·36, 1·09–1·71; p=0·0074; assessed in 7858 children) and levels were also higher (1·30, 1·04–1·62; p=0·020; ordinal variable). Despite introduction of the regulation, one in 20 children still reported being regularly exposed to tobacco smoke in cars and one in three still had detectable salivary cotinine levels.
We found no demonstrable association between the implementation of England's smoke-free private vehicle regulation and changes in children's self-reported tobacco smoke exposure or respiratory health. There is an urgent need to develop more effective approaches to protect children from tobacco smoke in various places, including in private vehicles.
Netherlands Lung Foundation, Erasmus MC, Farr Institute, Health Data Research UK, Asthma UK Centre for Applied Research, Academy of Medical Sciences, and Newton Fund.
Exposure to car smoking among youth in seven cities across the European Union
2019, Drug and Alcohol Dependence
In the United States and Canada, cars were found to be a major source of harmful secondhand smoke (SHS) exposure among youth. Little is known about the magnitude of this public health problem in European countries. We study SHS exposure in vehicles among adolescents across seven cities of the European Union (EU), with a particular focus on socioeconomic characteristics and smoking in adolescents’ social environment.
Self-reported survey data on SHS exposure in cars during the past seven days was obtained from the 2016/17 cross-sectional SILNE-R study for 14- to 17 year old adolescents in seven EU cities (N = 10,481). We applied two multivariable logistic regression models with sociodemographic characteristics and mediating smoking-related factors.
SHS exposure in cars varied widely across the seven EU cities: 6% in Tampere (Finland), 12% in Dublin (Ireland), 15% in Amersfoort (the Netherlands), 19% in Hanover (Germany), 23% in Coimbra (Portugal), 36% in Namur (Belgium) and 43% in Latina (Italy). Low paternal (OR 1.65, CI95% 1.38–1.98) and maternal (OR 1.40, CI95% 1.16–1.68) educational levels and parental migration (OR 1.37, CI95% 1.14–1.64) backgrounds were correlated with SHS exposure in cars. Other correlates were one’s own or peer smoking and environmental family factors, such as having at least one parental smoker (OR 4.04, CI95% 3.49–4.68) and partial smoking bans at home.
In most of these seven cities, a considerable proportion of youth riding in cars, particularly those from disadvantaged and smoking-permissive backgrounds, is exposed to SHS in cars.
Prevalence and correlates of secondhand smoke exposure in the home and in a vehicle among youth in the United States
2019, Preventive Medicine
Citation Excerpt :
The extent of SHS exposure among this population might be increased by the relatively confined nature of private spaces and the longer durations of exposure (US Department of Health and Human Services, 2006; US Department of Health and Human Services and US Department of Health and Human Services, 2010). Exposure can be particularly high in enclosed environments such as vehicles; a previous study demonstrated that smoking in a car yields unsafe levels of SHS contaminants such as fine particulate matter (PM2.5), carbon monoxide (CO), and nicotine, especially for children, even under realistic ventilation conditions (Sendzik et al., 2009; Rees and Connolly, 2006; Semple et al., 2012; Vardavas et al., 2006). Another study found that the average level of polycyclic aromatic hydrocarbons (PAH), a by-product of burning tobacco products, is markedly higher in vehicles than in enclosed public places such as bars and restaurants (Northcross et al., 2014).
Private settings are major sources of secondhand smoke (SHS) exposure among youth. We measured prevalence and correlates of youth exposures to home and vehicle SHS. The 2016 National Youth Tobacco Survey of U.S. 6th–12th graders was analyzed (n = 20,675). Past-7-day home or vehicle SHS exposures were self-reported. Descriptive and multivariable analyses were performed on weighted data. Among all students, past-7-day SHS exposures were: vehicle (21.4%, 5.56 million); home (21.7%, 5.64 million); home or vehicle (29.0%, 7.50 million); vehicle and home (14.0%, 3.63 million). By household tobacco-use status, home or vehicle SHS exposure was: tobacco-free households, 8.4%; households with combustible-only tobacco users, 59.8%; households with smokeless tobacco/e-cigarette-only users, 21.8%; and households with combined tobacco products usage, 73.9%. Where only the youth respondent but no other household member(s) used tobacco, the measure of association (vs. tobacco-free households) was ~two-fold higher for vehicle SHS exposures (Adjusted Odds Ratio [AOR] = 6.09; 95% Confidence Interval [CI] = 4.93–7.54 than for home SHS exposures (AOR = 3.16; 95%CI = 2.35–4.25). Conversely, where only household member(s) but not the youth respondent used tobacco, the measure of association was over two-fold higher for home SHS exposures (AOR = 22.15; 95%CI = 19.12–25.67) than for vehicle SHS exposure (AOR = 7.91; 95%CI = 6.96–8.98). In summary, nearly one-third of U.S. youth (7.50 million) were exposed to either home or vehicle SHS. Among non-tobacco-using youth with tobacco-using household member(s), the home was a dominant SHS exposure source; among tobacco-using youth with non-tobacco-using household member(s), a vehicle was a dominant exposure source, possibly peers'. Smoke-free environments, including homes and cars, can reduce youth SHS exposure.
Children's right to smoke-free air: Public support in Norway for banning smoking in vehicles with children present
2019, Health Policy
Children have a statutory right to a smoke-free environment, and tobacco control advocates are now considering regulation of smoking behavior in the private sphere. The Norwegian Institute of Public Health has investigated the support for a ban on smoking in cars with children compared to other possible extensions of the tobacco act among the Norwegian public.
A nationwide representative survey (CAWI) of 5543 participants was conducted in 2014–2015. Respondents were asked to consider several possible new tobacco control measures, through selfreported ranking on 5-point scales for each measure. Multiple logistic regression models were applied to control for confounders (i.a. smoking behavior) for the tendency to state full support.
A majority (78 % of all respondents, 61.8% of daily smokers) supported a proposal prohibiting smoking in cars when children are present. This proposal received substantially more support than bans on private balconies, in parks and at public transport stops and work entrances. Full support for the latter proposals varied between 39.9% and 58.1% (between 2.7% and 16.8% among smokers). Differences by smoking status were maintained after multiple controls.
The strong endorsement of the proposal (also provided by the majority of current smokers) suggests high legitimacy and compliance, which means that an implementation could be introduced without serious enforcement problems.

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: No financial conflict of interest was reported by the authors of this article.

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Research articleMeasuring Air Quality to Protect Children from Secondhand Smoke in Cars

Background

Methods

Results

Conclusions

Introduction

Section snippets

Apparatus

Respirable Suspended Particles

Discussion and Conclusions

Chest

Am J Prev Med

Prev Med

Ambul Pediatr

Mutat Res

J Emerg Med

Reducing tobacco use: a report of the Surgeon General

Respiratory health effects of passive smoking: lung cancer and other disorders, vol. 4

Health effects of exposure to environmental tobacco smoke: final report

The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis

Eur J Epidemiol

Health effects of passive smoking. 1Parental smoking and lower respiratory illness in infancy and early childhood

Thorax

Maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke as predisposition factors to acute respiratory infections

Environ Health Perspect

The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome

JAMA

Smoking and the sudden infant death syndrome

Pediatrics

Environmental tobacco smoke and middle ear disease in pre-school age children

Arch Pediatr Adolesc Med

Environmental tobacco smoke, parental atopy, and childhood asthma

Environ Health Perspect

Smoking patterns of household members and visitors in homes with children in the United States

Arch Pediatr Adolesc Med

Exposure of the U.S. population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988–1991

JAMA

The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: Third National Health and Nutrition Examination Survey, 1988–1994

Pediatrics

Second annual independent evaluation of New York’s tobacco control program: final report

Exposure to environmental tobacco smoke in naturalistic settings

Am J Public Health

Research article
Measuring Air Quality to Protect Children from Secondhand Smoke in Cars