Chapter 7 248 Health effects of smoke-free cars and playgrounds The search of 13 databases resulted in 5,745 records. Based on the aforementioned criteria, after reading 204 articles, five articles that evaluated the introduction of smoke-free policies in cars in the presence of children and met predefined quality criteria were included.12 The evaluations covered smoke-free car policies introduced in the US state of California, several Canadian provinces and England. Over 160,000 children filled in questionnaires about exposure to tobacco smoke in cars. The results of the meta-analysis show that a smoking ban in cars with children on board was followed by a 31% (95% confidence interval (BI) 13-45%) decrease in exposure to tobacco smoke in cars. Meta-analysis of studies that looked at health outcomes was not possible. In addition, we found two more recent studies. A first study evaluated smoke-free car legislation in England, Wales and Scotland, and found a decrease in tobacco smoke exposure among children in cars in the same order of magnitude as the pooled results from the meta-analysis20. A second study evaluated smoke-free car legislation in Scotland. Although no significant changes were previously found in reported respiratory symptoms in children in England21, this recent study showed that hospital admissions for asthma decreased by 1.5% per month (95%- BI: 0.3-2.7%) following legislation targeting smoke-free cars with children.22 For smoke-free playgrounds, we found a single study that evaluated a comprehensive smoke-free policy in Hong Kong.12 This measure covered public indoor spaces as well as public outdoor spaces, including playgrounds, parks, beaches and swimming pools. Although it was not possible to distinguish the impact of the smoke-free policy between different places, this study shows that the policy was followed by a significant decrease in the number of children hospitalised for respiratory infections. Level of public support for smoke-free cars and playgrounds The level of public support may be important in considering expanding smoke-free policies. Using a systematic literature search, we looked for studies that evaluated the degree of public support for new smoke-free policies. A total of 19 studies were included that reported the degree of support for legislation aimed at smokefree cars, and 11 studies for smoke-free playgrounds.14 Meta-analysis showed that 86% (95%-BI: 81-89%) were in favour of legislation for smoke-free cars with children and 79% (95%-BI: 72-85%) were in favour of smoke-free playgrounds.
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