Clearing the air: smoke-free homes & cars - PowerPoint Presentation

Slide1

Clearing the air: smoke-free homes & cars

Dr Laura JonesUKNSCC 9th June 2016

@

drlaurajones

Outline

Part 2: Implementation & enforcement of banning smoking in private vehicles

Part 1: Emerging evidence on secondhand smoke & smoke-free homes

Secondhand smoke exposure

Surgeon General 2006; 2014; Oberg et al. 2011

H

ealth risks well-establishedNo safe level of exposure600,000 global SHS deaths annually

2009-13 : 21 Countries (GATS data)

Children’s exposure at homeRange 4.5% (Panama) to 79% (Indonesia) China, India, Bangladesh, Indonesia & Philippines accounts for 85% of exposure

~508 million children exposed to SHS in the home across 21 countries

2004: 192 Countries Exposure in work places, homes & vehiclesAve. global exposure: 40% children, 35% NS women, 33% NS menHighest exposure: Europe, Western Pacific, South East AsiaMbulo et al. 2016; Oberg et al. 2011

Global exposure to SHS

Adapted from Jarvis

&

Feyerabend

2015English children’s exposure to SHS at home

Intervention evidence

Baxter et al. 2011

12 studies (2 significant)

Conclusion: “mixed-evidence for the effectiveness of interventions to reduce parental environmental tobacco smoke in early infancy”Baxi et al. 201457 studies (14 significant)Conclusion: “the review was unable to determine if any one intervention reduced parental smoking and child exposure more effectively than others

”

Rosen et al. 2014

30 studies (17 in intervention meta analysis)

7% more

children

protected in intervention relative

to control groups

Conclusion: “Interventions to prevent child [SHSe] are moderately beneficial at the individual

level…more

research is needed to

improve intervention

effectiveness and child

[SHS]

measurement”

Parental smoking

Low socio-economic status

Limited education

↑ risk of SHS exposure at homeSingle parent / separated family

More -

ve

parental attitudes to SHS

↓

risk of SHS exposure at home

Conclusion: “this

review has identified potential characteristics that may be important for the development of future secondhand smoke and smoke-free home

interventions”

Intervention recommendations:

Target households not just individuals

Provide tailored / different support to individuals within the household

Promote skill development e.g. negotiationAssets-based approach to harness motivation and steps already taken towards SFH

SHS & SFH SummaryGlobally, millions of children at risk of SHS exposure in the home39% of English children regularly exposedNeed for novel, targeted interventions to support parental home smoking behaviour changeMaximise learning from the evidence base to inform intervention development

Smoking in cars

UK children’s exposure to SHS in cars

Jones et al. 2014;

DoH

2009; ASH 2015; Moore et al. 2015; Kabir e tal. 2009; Bogdanovica et al. 2014 SHS particulate levels (PM2.5) can be much greater in cars than other spacesExceed

WHO 24 hour outdoor air pollution health

limits

Levels

unhealthy even with windows opens/ ventilation system

on

Levels can remain high for several hours

Smoke-free Private Vehicles Regulations: 1st October 2015Two offences under the Health Act (2006):Applies to both driver and any passengers

Applies to private vehicles that are: (a) enclosed, (b) contain more than one person, (c) moving or stationary, (d) located on roads or private land (e.g. driveway)

Offence for

someone to smoke* in a private vehicle with a person under age 18 presentOffence for a driver not to stop someone smoking* in a private vehicle with a person under age 18 present

*ECs and nicotine vaporisers not included in definition of smoking

Penalties & enforcement approach“It is a matter for the discretion of the authorised officer to decide whether or not to take formal enforcement action. The legislation provides that authorised officers may issue FPN to alleged offenders but does not require them to do so”

(CIEH, 2016)

ASH, 2016; CIEH

, 2016; Personal Communication Ian Gray May 2016Advice / verbal warning

Fixed penalty notice (£50)

Proceed to prosecution (fine)

Police and local authorities have the power to enforce the law

Anticipated compliancePositive learning & experience from 2007 smoke-free legislation implementationHigh levels of public supportHigh levels of voluntary compliance & self-enforcementMinimal need for enforcement

Can this be applied to smoke-free private vehicles (2015)

regulations?

DoH Smoke-free England 2008

High levels of public support

pre smoke-free private vehicles (2015) legislation

Image: HISIC 2016 pg. 26; ASH

YouGov Survey 2015

Measuring successDepartment of Health: “measure of success [will be] changes in attitude and behaviour, not the number of enforcement actions”

EvaluationNo formal evaluation to dateFew, in any, other countries with legislation have undertaken robust evaluationsBBC Radio 5 FOI request“No fines or court summonses were issued in the first three months of the law”Early in post-implementation periodNeed time to explore if changes to prevalence, attitude and behaviour

McNeill et al. (2013); Sendzik

et al. unpublished data; BBC News, 2016

National Police Chiefs Council: “in the first three months, police forces will be taking an educational, advisory and non-confrontational approach when enforcing the new legislation…to help build high level of compliance”

SummaryNon-smokers were at risk of exposure to SHS in private vehiclesLegislation introduced in October 2015Need time to assess impact: prevalence of exposure, attitudes and behaviourCIEH guidance available to support the public and authorised officers in England

AcknowledgmentsLinda BauldIan GrayAnn McNeillAmanda FarleyAndy McEwen

L.L.Jones@bham.ac.uk

@

drlaurajones