Chapter 7 252 protect many young people, especially those from lower socioeconomic families, from the harmful effects of tobacco smoke.9 Current figures on younger children’s exposure to tobacco smoke in cars are lacking. The health benefits of smoke-free playgrounds have not yet been quantified. Also, there are currently no Dutch figures are available on the extent and frequency of exposure to tobacco smoke in playgrounds. A European study found that smoking occurred in one in five playgrounds.25 Further research may help to picture the effects of smoke-free policies for outdoor public spaces on tobacco smoke exposure among children. The extent to which smoke-free legislation contributes to improving health may differ between cars and playgrounds. First, differences may occur due to variation in concentrations of tobacco smoke inhaled. When smoking in cars, extremely high concentrations of pollutants circulate in a small enclosed space, even when ventilated.8 Smoking outdoors dilutes smoke particles, so children in a playground inhale relatively smaller amounts of tobacco smoke. However, even with lower exposure to tobacco smoke, there are detrimental consequences: there is no safe level of exposure to tobacco smoke.26 In addition, seeing smokers can normalise smoking behaviour.27 The advice is therefore also to smoke out of sight of children. Smoking if quitting is not (yet) successful. Second, differences in health gains can be expected due to variation in compliance with smoke-free policies. Cars and playgrounds differ as cars are private enclosed spaces and playgrounds are public outdoor spaces. As a private space, a car is more difficult to regulate than a playground, as there is an invasion of privacy. Nevertheless, this intrusion can be justified by invoking public health and children’s rights.28 Third, enforcement of policies can also create differences in health gains. Enforcing policies that apply to private property, such as cars, and to public outdoor spaces, such as playgrounds, can be challenging.12 In England, for example, only one fine was issued in the year after smoke-free car legislation was introduced.21 Despite initial objections from the police and limited hand- having, the introduction of smoke-free cars did lead to a significant decrease in children’s exposure to tobacco smoke in cars.20 The interviews revealed that monitoring the impact and making scientific insights accessible can help prevent negative messages about enforcement from dominating the debate. It is therefore wise to invest in research when innovative smoke-free policies are implemented in the Netherlands.
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