1. Young people’s exposure to and perceptions of smoking in cars and associated harms in the UK Laura Jones, Crawford Moodie, Anne-Marie MacKintosh and Linda Bauld UKNSCC London 27 th June 2013

2. Introduction  Source of secondhand smoke (SHS) exposure  SHS particulate level (PM 2.5 ) much greater in cars than other spaces  No legislation around smoking in private vehicles in the UK  76% of UK adults (including 54% of daily smokers) support a ban on smoking in cars carrying children under 18 years  86% of 8-15 year olds want the government to stop people smoking in cars carrying children Populus Survey 2009; YouGov 2009

3. Prevalence of exposure in the UK  15% of UK adult smokers report smoking in cars when travelling with children (ITC 2007/8)  15% of Irish 13-14 year olds self-reported exposure to SHS in cars (2007)  35% of English 8-13 year olds self-reported their parent/s smoked in the car with them (2009)  51% of English 8-15 years olds self-reported being in a car with a smoker (BLF 2011) Populus Survey 2009; Kabir et al 2009; European Commission 2007; Jarrold et al 2011

4. Health risks  General SHS exposure risks well established  Some evidence for specific risks from exposure in cars –allergic & respiratory symptoms –persistent wheeze –hay fever symptoms –symptoms of nicotine dependence (at adolescence) –early initiation of smoking Sly et al 2007; Kabir et al 2009; Belanger et al 2008 ; Glover et al 2011

5. Youth views on smoking in cars  1009 English 8-13 year olds –76% worried that their parents smoking in the car was damaging to their own health –When travelling with smokers  73% don’t like it and wished their parents would stop  31% would ask the smoker to stop  24% were too embarrassed to say anything  9% were too scared to say anything Populus Survey 2009; Jarrold et al 2011

6. Aim  To explore UK adolescents’ perceptions of smoking in cars and awareness of the potential harms associated with such exposure  Wave 6 Youth Tobacco Policy Survey  11-16 year olds from UK households  Face to face interviews & self- complete questionnaire Sample

7. Measures  Smoking status  Age; sex; social grade; smoking by parents, siblings and friends  Frequency of exposure  Tolerance  Perceived risk of harm  Support for a ban  Descriptive data weighted for age, gender & social grade  Bivariate analysis (chi square)  Logistic regression Analysis

8. Sample characteristics  Total n = 1373  51% 11-13 years/ 49% 14-16 years  50% female  66% low SES (C2DE)  Smoking status –9% regular smoker –17% occasional/tried/used to smoke  Smoking network –46% had one or more parent that smokes –22% had siblings that smoke –46% had friends that smoke

9. Frequency of exposure

10. Exposed vs. never exposed Adjusted OR (95% CI)p Parental Smoking Neitherref<0.001 Either or both4.93 (3.80, 6.38)<0.001 Not sure/not stated/no mum/dad1.52 (0.93, 2.48)0.09 Sibling Smoking None/no siblings/not statedref0.008 Any siblings smoke1.55 (1.12, 2.15) Close Friends Smoking None/not statedref<0.001 Any smoke1.67 (1.26, 2.20) Smoking status Regular smokerref0.04 Occasional/used to/tried0.56 (0.32, 1.00)0.05 Never smoker0.48 (0.28, 0.85)0.01 Social Grade ABC1ref0.02 C2DE1.35 (1.05, 1.74) Adjusted for all other variables in the model

11. Tolerance of exposure

12. Dislike vs. don’t mind/indifferent Adjusted for all other variables in the model Adjusted OR (95% CI)P Smoking status Regular smokerref<0.001 Occasional/used to/tried7.20 (3.85, 13.48)<0.001 Never smoker21.71 (11.85, 39.76)<0.001 Frequency of being exposed to smoking in cars More than once a weekref<0.001 Once a week or less1.29 (0.88, 1.89)0.20 Never4.13 (2.78, 6.12)<0.001 Gender Maleref0.36 Female1.15 (0.85, 1.54) Social Grade ABC1ref0.09 C2DE0.77 (0.57, 1.04) Age Later adolescence (14 to 16 years)ref0.003 Early adolescence (11 to 13 years)1.60 (1.17, 2.19)

13. Perceived risk of harm Composite harm score based on four items: (1)Perceived effect on health of non-smokers (2)Perceived effect on health from breathing others smoke in the car (windows closed) (3)Perceived effect on health from breathing others smoke in the car (windows open) (4)Extent to which smoking in cars increases the risk of having a road accident

14. Harmful vs. not harmful/indifferent Adjusted for all other variables in the model Adjusted OR (95% CI)P Smoking status Regular smokerref<0.001 Occasional/used to/tried1.83 (1.08, 3.10)0.03 Never smoker3.27 (1.99, 5.37)<0.001 Frequency of being exposed to smoking in cars More than once a weekref<0.001 Once a week or less1.12 (0.73, 1.72)0.60 Never3.49 (2.16, 5.62)<0.001 Gender Maleref0.02 Female1.53 (1.08, 2.17) Social Grade ABC1ref0.09 C2DE0.72 (0.50, 1.05) Age Later adolescence (14 to 16 years)ref0.001 Early adolescence (11 to 13 years)2.01 (1.35, 2.98)

15. Support for a ban

16. Supportive of ban vs. not supportive/indifferent Adjusted for all other variables in the model Adjusted OR (95% CI)P Smoking status Regular smokerref<0.001 Occasional/used to/tried2.78 (1.08, 3.10)0.03 Never smoker6.92 (4.30, 11.15)<0.001 Frequency of being exposed to smoking in cars More than once a weekref<0.001 Once a week or less1.22 (0.82, 1.82)0.33 Never3.19 (2.11, 4.84)<0.001 Gender Maleref0.01 Female1.51 (1.10, 2.06) Social Grade ABC1ref0.47 C2DE0.89 (0.64, 1.23) Age Later adolescence (14 to 16 years)ref0.001 Early adolescence (11 to 13 years)1.78 (1.27, 2.51)

17. Results summary  47% of UK adolescents reported being exposed to smoking in cars  73% disliked travelling with smokers  86% perceived exposure to be harmful  84% support a ban on smoking in cars carrying children < 16 years

18. Discussion  Adolescent smoking status significantly influenced likelihood of exposure, perceived risk of harm and support for a ban –Encircled by a social network of smokers –Social acceptability of smoking in cars may be increased –Conditioned to social norm of smoking therefore perceive less harm

19. Summary  Many UK adolescents report exposure  Health risks well established  Adolescents’ oppose exposure in cars, perceive it to be harmful and support a ban  Need for further consideration to be given to legislative options

20. l.l.jones@bham.ac.uk This study was supported by Cancer Research UK grant number C312/A8721