Children and smokers in cars: Differences across two NZ city areas Oceania Conference - October 2011 Vimal Patel, George Thomson, Nick Wilson george.thomson@otago.ac.nz Department of Public Health, University of Otago, Wellington

Aims To compare the point prevalence of smoking and SHS exposure in vehicles: For areas: Between two areas of contrasting socioeconomic status in NZ Over time: Between 2005 and 2011

Background: SES difference in SHS exposure in NZ cars In 2010 NZ survey of 14-15 yr students: In four most deprived deciles 33% report exposure to SHS in cars In two least deprived deciles 14% report exposure to SHS in cars Most deprived 2.4 more exposed

Methods During Feb-April 2011 we observed in Wainuiomata and Karori (high/low deprivation areas in Wellington, New Zealand)

Observation sites Wainuiomata Karori (low dep) (Deciles 7-9: (Deciles 1-4: 30% smoking) 11% smoking)

What we observed Smoking in vehicles Whether the smokers were with: others children (Later) Adults and children in all vehicles, to get vehicle occupancy rates per site

Results 149,886 vehicles were observed Point prevalence of any smoking in cars: 3.9 times more in Wainuiomata (high dep area) . For vehicles with children: 10.9 times greater in Wainuiomata

Children and smoking in cars in 2011 Karori vs. Wainuiomata Conclusions Observing smoking in vehicles provides an objective indicator of the different smoking behaviours, especially around children, within a society. This study further supports the evidence from New Zealand and internationally that those from high deprivation areas are much more likely to be exposed to SHS. If such people are being exposed to SHS in the confined space of vehicles, then it could be argued that home exposure is even more likely. Increasing the prevalence of smokefree vehicles has a number of benefits. Besides reducing the SHS hazard to both non-smokers and smokers themselves (and probably the risk of vehicle crashes), smokefree vehicles help normalise smokefree behaviour. The much higher exposure for those in more deprived areas in New Zealand, by observation, census, and survey data, with apparently widening disparities, indicates that the current educational approach is not particularly effective for protecting the more deprived from SHS in vehicles. While social marketing is highly desirable as part of an overall approach, the stronger signal about SHS hazards that legislation gives (along with the accompanying unpaid media publicity) may be the most effective and cost-effective way to markedly improve protection for the most deprived.

Car smoking changes: 2005-2011 39% reduction in the low dep area - Karori (2.0% to 1.2%) 24% reduction in the high dep area – Wainuiomata (6.4% to 4.9%)

Discussion The SES gradients (3.9+ RR) were far greater than in survey (2.4 RR) and census (2.7 RR) data Why? Point prevalence v survey One week recall problem for self-report survey? Greater ‘normality’ affects survey report?

Why use car observations? A way to measure ‘private’ smoking: Vehicles are uniquely: confined and ‘private’ observable from the outside Helps triangulation of survey data

Policy implications Large and widening socioeconomic gulf in exposure to SHS in vehicles: Need for more effective tobacco control efforts for those in SES deprived areas Need for greater protection of children in cars Children are influenced by the extent and normality of smoking around them

Smokefree car laws Support: In 2007–2008 survey of NZ smokers, 96% supported smokefree car regulation when young children were in the car (Thomson et al., 2008 121(1285):139-40) Precedent: At least 11 states/provinces in Australia, Canada, and USA have smokefree car laws to protect children Effect: After 2007 South Australia smokefree law, survey increase in smokefree cars with children: 69% in 2005 to 82% in 2008 . (Hickling, Miller, & Hosking, Oceania Tobacco Control Conference. 2009: Darwin)

Acknowledgements Cancer Society of New Zealand for funding The other observers: Catherine Jones, Losa Moata’ane, and Priyesh Patel Dr James Stanley who provided statistical advice and support Contact: george.thomson@otago.ac.nz