Children held captive in smoky vehicles

"An infant strapped into a car seat is involuntarily and intensely exposed to more than 400 toxic chemicals in tobacco smoke," said abstract co-author Jonathan P. Winickoff, MD, MPH, FAAP. "They have no voice and no choice in whether their parents smoke in the car."

Dr. Winickoff and his colleagues conducted the analyses to determine the prevalence of tobacco smoke exposure in cars among children and to examine factors associated with parents strictly enforcing a ban on smoking in their cars.

Parents were invited to participate in a survey after their children had been seen for a well or sick visit at one of seven pediatric practices in six states. Parents who smoked were asked if they had a car, whether they had smoking rules in their car, their child's age and if their pediatrician advised them to have a smoke-free car. Parents were considered to have a strictly enforced car smoking ban if they reported having a smoke-free car rule and that no one had smoked in their car for the past three months.

The results are based on a Pediatric Research in Office Settings (PROS) trial called the Clinical Effort Against Secondhand Smoke Exposure (CEASE), which addressed parental smoking. PROS is a network of pediatric primary care practices established by the American Academy of Pediatrics (AAP) to conduct research on child health problems.

Results showed that 146 of 528 parents who smoked (28 percent) reported having a smoke-free car rule, and 114 (22 percent) reported having a strictly enforced car smoking ban. Factors associated with having a smoking ban included having a younger child and smoking fewer cigarettes per day.

Of the parents who reported smoking in their car, 52 percent said smoking occurred with children present. Only 14 percent of parents said they were advised by a pediatric health care provider to have a smoke-free car.

"Because they have smaller air passages than adults, infants and children are more sensitive to chemicals in tobacco smoke and suffer increased asthma attacks and severe respiratory infections," said Dr. Winickoff, CEASE principal investigator and associate professor of pediatrics at MassGeneral Hospital for Children.

"Coupled with the finding that few pediatric health care providers advise against smoking in cars, these results highlight the need for improved pediatric interventions, public health campaigns and health policy regarding smoke-free car laws to protect children from tobacco smoke toxins," he said. "Setting strict rules about never smoking in cars will benefit the whole family and help reduce tobacco use nationally."