A public ban on smoking in cars in England and Wales has led to fewer children being exposed to cigarette smoke, according to new analysis.
England and Wales banned smoking in cars carrying children in 2015, with Scotland introducing a ban the following year. But to date, the impact of the legislation on children's exposure to cigarette smoke has been unclear.
In a review of responses from thousands of children in England and Scotland, researchers from Imperial College London found the ban in England was associated with an absolute reduction of 4.1% in the number of children who reported exposure to cigarette smoke.
If children see people smoking around them, they are far more likely to take up the habit themselves. Our study shows that policies such as a public ban on smoking in cars help to break that cycle Dr Nick Hopkinson NHLI, Imperial College London
The researchers say their findings, published in the journal Thorax, show how such policies can be effective in reducing exposure and are likely to have had lasting impacts on child health.
Dr Anthony Laverty, from the School of Public Health at Imperial and first author on the paper, said: "Like the smoking ban introduced to pubs and restaurants, banning smoking in cars increasingly 'denormalises' the act of smoking for children.
"This has a dual effect, not only reducing the amount of second-hand smoke they are exposed to but also reducing the amount of smoking they see. Given how vulnerable children are to second-hand smoke, reducing their exposure to cigarette smoke will likely result in improved health."
Survey data
In the analysis, the Imperial team looked at more than 16,000 responses from two large health surveys of school-aged children in England and Scotland. They focused on self-reported answers over time to questions such as 'In the past year, how often were you in a car with somebody smoking?'.
The results revealed an overall downward trend in the proportion of children aged 13-15 years old who reported being exposed to cigarette smoke.
Self-reported regular exposure to smoke in cars were 6.3% in 2012, 5.9% in 2014 and 1.6% in 2016 for England, compared with 3.4%, 2.2%, and 1.3% in Scotland, revealing a significant drop in England following the introduction of the ban.
banning smoking in cars increasingly 'denormalises' the act of smoking for children Dr Anthony Laverty School of Public Health, Imperial College London
They also found that girls and children from deprived backgrounds were more likely to report exposure.
According to the team, previous analyses of the impact of the smoking ban in the UK have found a weaker link, but the comparison with Scottish data and addition of markers of deprivation strengthen their new analysis.
Dr Laverty explained: "Using data from self-reported surveys always carries a margin of error, but we're confident these responses give a good picture of what these children are experiencing and the changing trend."
Dr Nick Hopkinson, from Imperial's National Heart and Lung Institute, who led the research, said: "We know that smoking in enclosed spaces, such as a car, can be harmful to the health of others – particularly children, who may be more susceptible to respiratory conditions.
"But there is also an association with smoking uptake to take into account. If children see people smoking around them, they are far more likely to take up the habit themselves. Our study shows that policies such as a public ban on smoking in cars help to break that cycle and help to reduce the harms associated with tobacco."
The research was supported by the National Institute for Health Research (NIHR).
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'Impact of banning smoking in cars with children on exposure to second-hand smoke: a natural experiment in England and Scotland' by Anthony Laverty et al. is published in Thorax.
