Children held captive in smoky vehicles

May 1, 2011, American Academy of Pediatrics

It is absolutely unacceptable to subject children to any tobacco smoke exposure in cars, according to the authors of an abstract to be presented Sunday, May 1, at the Pediatric Academic Societies (PAS) annual meeting in Denver.

"An infant strapped into a car seat is involuntarily and intensely exposed to more than 400 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 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 (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 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."

To view the abstract, which will be presented during an AAP Presidential Plenary presentation, go to

Other abstracts based on the CEASE data to be presented on Saturday, April 30, during the PAS meeting include:

"Are Strictly Enforced Smoke-free Home and Car Rules Associated with Parent Quit Attempts?" A strictly enforced no-smoking policy in the home and car was associated with recent quit attempts by parents who smoked. "This research suggests that completely protecting children from tobacco smoke in the home and car may also help parents quit smoking," said lead author Stacia Finch. To view the abstract, go to

"What Factors Are Associated with Smoke-free Homes Among Smoking Parents?" Parents were more likely to report having a smoke-free home if they had a child younger than 10 years old; fewer than three smokers lived in the home; and if parents banned smoking in the car. To view the abstract, go to

"Parent/Smoker Identity Conflict and Readiness to Quit." Parents who agreed with the statement, "My being a smoker gets in the way of my being a parent," were considered to have identity conflict and were more likely to be seriously planning to quit smoking than those who disagreed with the statement. "Interventions that increase identity conflict among parents who smoke might increase their readiness to quit smoking," Dr. Winickoff said. To view the abstract, go to

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