Second Hand Smoke Prevention Policies

Second Hand Smoke Prevention Policies EXECUTIVE SUMMARY AND KEY RECOMMENDATIONS Thank you for the opportunity to make a submission on the Smoke-free Cars Bill in NZ. I am currently a Population Health student at the University of Auckland, an interest which stemmed from my realisation that many illnesses and injuries are largely preventable. With volunteering experience for World Vision NZ, I am also an advocate of children’s health. My approach to health is based upon population health. In the case of smoking, there exists significant population health ramifications: of not only the impact tobacco has on smokers’ health, but of also the dangers of second-hand smoke (SHS) to those around them. This policy is therefore important for not only the wellbeing of children, but also for achieving widespread positive health gain for all New Zealanders. Like many health organisations in NZ, I urge the promotion of a Vision for Tupeka Kore Aotearoa; a tobacco-free New Zealand by 2020 so that future generations of New Zealanders will be protected from exposure to tobacco products and enjoy tobacco-free lives. I support the bill to ban smoking in all vehicles when children are present. Firstly, considerable scientific studies have produced convincing evidence that exposure to SHS in vehicles has serious health consequences for children. Moreover, there are marked deprivation and ethnic inequalities in in-vehicle SHS exposure. Thirdly, the need to protect children, a vulnerable group, from these harms forms the ethical rationale for regulatory action. Finally, ought such a bill be implemented, it would enjoy widespread public support from smokers and non-smokers, adults and children alike. Key Recommendations I recommend that awareness campaigns are needed to highlight the risks associated with SHS, the benefits of maintaining smoke-free cars, and the rationales behind a law banning smoking in vehicles carrying children. I recommend that the government continue supporting media campaigns and other initiatives which encourage smoking cessation. Based on the range of fines imposed in Australia and the fine linked to the safety belt law in NZ, I suggest an on-the-spot fine of $150 be set for those breaching the smoke-free ban. As a more long-term strategy, I recommend that the possibility of restricting smoking in all private vehicles (regardless of whether they are carrying children) to be explored. POLICY STATEMENT The harmful effects that SHS causes to children’s health is well documented. Although the general public is protected by the smoke-free regulations in enclosed public places and workspaces in NZ, most children remain at risk of exposure to high levels of SHS when confined in vehicles. For the purposes of this submission, â€Å"children† refers to anyone under the age of eighteen. In order to reduce children’s exposure to SHS in vehicles, I am championing the Smoke-free Cars Bill, banning smoking in any vehicle with children present. Using supporting evidence, I outline the reasons behind my position below. HEALTH AND WELLBEING RATIONALE Second-hand Smoke SHS is highly toxic; it contains thousands of hazardous chemicals, many of which are cancer-causing (carcinogenic). When non-smokers are exposed to SHS (passive smoking), they also inhale many of the toxins and carcinogenic substances as smokers do. Health Hazards in Children Children are particularly vulnerable to the effects of SHS, as they have smaller airways and lungs, faster breathing rates, and less developed immune systems. For children, exposure to SHS is a known cause of many adverse health consequences. SHS increases the risk of respiratory diseases (such as bronchitis and pneumonia) , middle ear infections , and sudden infant death syndrome . Exposure to SHS is especially harmful for asthmatic children, who experience more severe symptoms and more frequent asthma attacks. SHS can also cause asthma in children with no prior symptoms. An estimated one million asthmatic children in the United States have had their condition worsened due to SHS exposure. Yet, a study reported that only half of the parents of asthmatic children maintained smoke-free vehicles. Children exposed to SHS in vehicles have been found to exhibit nicotine dependence symptoms, even though they had previously never smoked cigarettes. A review by the British Medical Association concluded that there is no safe level of exposure to SHS for children; low levels of exposure are still associated with harmful health effects. Pollution Levels of Smoke in Vehicles Pollution levels from SHS with vehicles reach dangerously high levels that can cause serious health risks for all riders, particularly children. Unhealthy levels of pollution generated from SHS were detected across multiple studies, even with vehicle windows and air vents opened, and the fan set on high. The levels of pollution from SHS a child is exposed to in a fully ventilated vehicle was found to be greater than that of smoke-filled bars and restaurants , and smokers’ homes ; they also exceeded air quality levels on Auckland’s poorest air quality days. The Chartered Institute of Environmental Health found that effects of SHS in vehicles continue to be harmful, long after the smoke had dissipated. This is due to the build-up of chemicals from cigarette smoke, which clings to the carpet and upholstery. In all cases, the studies’ authors recommended the enactment of smoke-free vehicle regulations to protect the health of not only children, but all non-smokers. EQUITY RATIONALE MÄ ori and Pacific Island children were found to have greater SHS exposure in vehicles. This, however, is not a localised phenomenon, as previous studies in the United States found similar ethnic disparities. Martin et al. observed that children of low socioeconomic status have a higher risk of exposure to SHS in vehicles, and therefore, may contribute to health inequities. This is consistent with a study in the United States, which reported that lower income households were less likely to maintain smoke-free cars. Jarvie and Malone concluded that a bill protecting children from SHS in vehicles promotes equity, because children who are already social disadvantaged (of minority populations, and deprived neighbourhoods and families) would derive the most benefits. ETHICAL RATIONALE Children are a Vulnerable Group Legislation is important to protect children because they are a vulnerable, dependent group of individuals, who – unlike adults – are unable to protect or speak for themselves. Preventing smoking by adults in vehicles containing children constrains adults freedom (or autonomy) temporarily, as they would only be restricted in vehicles. However, for children who are unable to protect themselves from SHS exposure, the effects of SHS are serious and permanent. Protecting the Interests of Children Ethicists asserted that adults who choose to smoke in vehicles with children present are not acting in the interests of the child, because their action places children at high risk of serious harm from SHS exposure. This is a circumstance where the interests of children and parents conflict: the health and wellbeing of children, versus adults freedom to smoke in vehicles. Given that SHS exposure is profound in its potential to cause preventable morbidity and mortality among children, the government – as the ultimate guardian of children – has a duty to ban smoking in vehicle with children present. This bill is further supported by ethical principles of non-maleficence and beneficence: it both obliges adults to not inflict harm to children, and promotes the interests of children. INCREASING PUBLIC SUPPORT Numerous studies found that while smokers were less likely to be supportive of smoke-free laws in all vehicles, they were largely supportive of banning smoking in vehicles when children are present. It is fair to conclude that there would be even higher levels of support among non-smokers. The vast majority of people would therefore be calling for and supporting the enforcement of a smoke-free law for vehicles carrying children. Survey data in NZ and overseas alike have indicated that support for laws banning smoking in cars carrying children has been increasing over time. A NZ study found that children expressed negative feelings toward smoking, and were aware that smoking in cars with children present is ‘wrong’. Some specifically stated that smoking should be banned, which suggests that children themselves would be supportive of a bill restricting smoking in vehicles. RECOMMENDATIONS Alongside legislation (which urges responsible behaviour), I recommend that awareness campaigns are needed to highlight the health risks for children associated with SHS, the benefits of maintaining smoke-free cars, and the rationales behind a law banning smoking in vehicles containing children. I recommend that the government continue to support media campaigns by Quitline NZ and other initiatives which encourage smoking cessation, as it is the single most effective way of reducing children’s exposure to SHS without forcing behaviour change. I suggest an on-the-spot fine of $150 be set for those breaching the smoke-free ban. This has been made in consideration of the range of fines imposed in Australia (where there already exists a smoking bans on vehicles carrying children) , as well as the $150 fine associated with breaching the safety belt law in NZ . As a more long-term strategy, I recommend that the possibility of restricting smoking in all private vehicles should be explored, as this would be much more straightforward and practical than a ban limited to smoking in vehicles only if children are present. Exposure to SHS in vehicles is also a significant risk to the health of adults. CONCLUSION Thank you for the opportunity to submit on the Smoke-free Cars Bill in NZ. In this submission, I have outlined the health and wellbeing, equity and ethical rationales, as well as evidence of increasing public support, for why a law banning smoking in all vehicles containing children is required. I have made practical recommendations on how the policy, if implemented, could be improved and strengthened. I look forward to seeing the regulation of smoking in cars as one step closer to realising Tupeka Kore Aotearoa, a tobacco-free New Zealand, by 2020.