Double standards on child health and smoking in cars ban

Following the decision that smoking in cars could now be outlawed south of the border it was refreshing to see from Zoe Williams in the Guardian some criticism of double standards on smoking. This is the highlight:

Almost all the Tories so fervently against smoking in cars are simultaneously pretty sanguine about foodbanks. Six weeks ago nearly 300 MPs voted against a motion calling on the government to reduce dependency on emergency food aid. It is difficult to observe, without the option of yelling and swearing, how disingenuous this is, how slimy and mawkish for a government happy to live with the idea of people living in squalor, in fuel poverty, going hungry, suddenly to find itself unable to bear the idea of a child in a smoky car.

Williams gets flak from readers about this. It's clearly aimed at all benefiting all kids, not just poor ones and the poor shouldn't be spending their money on cars anyway (or tobacco). But here and elsewhere she points out that Westminster MPs are highly selective in their view of what damages children's prospects and interests.

In perspective: secondhand smoke is implicated in one in five cases of sudden infant death. Since smoke is more intense in a small, enclosed space, it is logical to assume that babies are more endangered by smoking in cars than by smoking elsewhere.

However, the smoking figures are almost always in constellation with other factors – factors surrounding or inherent to the child, from poor housing to low birth weight. Birth weight is of course related to smoking in pregnancy, but again other factors, such as maternal education, age and class, have an impact. A study in Ohio found mould spores in the lungs of sudden infant death victims; and midwives regularly say that mould is dangerous. Kia Stone, a young mother profiled in the Guardian's Breadline Britain series 18 months ago, lost her daughter shortly afterwards. A large mushroom was still growing out of the damp plaster in the bedroom when she got home from the autopsy.

Nobody even collects figures for mould as a risk factor – separate from damp and leaks. Bedrooms that are too hot are also a factor, as is frequent house moving, and living in overcrowded conditions, B&Bs or hostel accommodation. The connection isn't made – presumably through sheer lack of interest – that buildings in which people can't control the heating are often too hot or too cold.

Never take your ability to adjust the central heating for granted! This points to an area of public health (cot death) in which there is no interest in pursuing certain lines of research. When I grew up in the 1970s we were taught that bad housing contributed to poor health, but now the agenda is all about blaming the impoverished for bad choices.

More crudely, is it sensible to assume that what Westminster votes for is aimed to benefit anyone's health? (this question refers not to the general UK population but to its rulers).

Proposed Smoking (Children in Vehicles) (Scotland) Bill: Consultation document published.

You can find the consultation document here. Questions are near the back and the deadline is 5 pm on 30 August 2013.

As one might expect the document makes case for a law criminalising the act of smoking in a car where people under 16 are present, applicable to people 16 years and over. It is supported with statements from health charities and (unlike the consultation on removing the smoking ban exemption in mental health facilities that took place in 2009), this one is at least referenced. However the whole document is shamelessly partisan, and just a little illogical accepting both the doctrinaire idea that there is 'no safe level' of passive smoke exposure, and guidance set by WHO or the EPA as permissible exposure.

I haven't yet read this in detail but note their mention the Environmental Protection Agency (EPA) twenty-four hour guideline of 35 µg/m³ for particulate matter. The line of argument adopted claims that the EPA standard applies to concentrations during any time period. I believe the arguments that Michael J. McFadden puts forward here demolishes this argument effectively, showing that the EPA would not recognise values as collected in the research cited in evidence as evidence that standards had been breached, because the least concentrated particulate levels have to be averaged out over 24 hours.

Scotsman declares smoking ban in cars 'a step too far'.

Read here.

The recommendation to ban smoking in cars is made on the basis of research by Aberdeen scientists (as the Evening Express declares proudly), at the Scottish Centre for Indoor Air, which found that:

levels of harmful pollutants were 11 times higher in “smoking” cars when compared with “non-smoking” cars.

It seems odd, to say the least, to generalise about smoking cars, as if they all contained equal amounts of smoke, were all of the same size and all subject to the same variable conditions (same number of windows open, vents open to the same degree, and so on).

And although I agree with the Scotsman's leader position on this, their report tells us,

Some experts claim smoking in cars exposes non-smokers to high levels of second-hand smoke which has 23 times more toxins than a busy smoke-filled room. Previous studies have revealed at least three in ten smokers light up in their cars when there are other people present.

The same critique can be applied here. There is no standard exposure in a room, which can vary in size, occupancy, air insulation and all other factors pertinent to exposure to contaminants. More significantly this reporting shows no awareness that the British Medical Journal apologised around a year ago for claiming that  cars were 23 times more toxic than a bar. They issued an alternative statement: 'the concentration of toxins in a smoke-filled vehicle could be up to 11 times greater [yes, 11 times greater] than that of a smoky bar' (see this link). Quelle coincidence!

The background to the story popping up last year was an announcement of a study carried out by SCIA (link above), which announced the dangers of smoking in cars, where concentrations of toxins were higher than the 'safe level' of outdoor air exposure recommended by the WHO. This is discussed here in some detail (thanks to Michael J. McFadden for assistance), but this part, concerning the relevance of outdoor exposure levels to measuring secondary smoke in cars, is the most damning:

While it is true that according to agencies such as the US EPA that urban, automotive, and industrial air pollution has been shown to be unhealthy or even dangerous when it reaches higher levels for periods of 24 hours or more, it is also true that the EPA doesn’t set standards for FPM 2.5 for shorter periods because there is no sound medical reason to believe that shorter episodes of such exposures actually pose a threat to health.  When the SCIA takes readings during car journeys that typically last less than several hours and tries to apply the EPA’s 24 hour standards to those readings, it is explicitly violating the very guidelines of the EPA itself. [These guidelines outlined in the linked post above]

The Scottish Indoor Air Centre's aims are somewhat distressingly focussed on SHS levels, declaring that its priority is:

1. Increasing our understanding of exposure to secondhand smoke in homes and cars (particularly with respect to children’s exposure) and its health effects; exploring possible interventions to reduce exposure in these microenvironments. We believe that the provision of real-time exposure data to smokers is likely to be a very effective mechanism of behavioural modification. [Emphasis added]

It is fully involved in the National Lottery-funded project Refresh and ASH Scotland in their bid to encourage smoke-free homes. Hence its emphasis on behavioural change.

The Scotsman is to be applauded for not supporting this move. There is no reason to support it.

LATE EDIT
I've just come across an account that contains a direct link to the SCIA study (pdf), with some interesting extracts.

Table 2 presents the descriptive statistics of the mean and maximum PM2.5 found during smoking and non-smoking journeys, while Figure 1 shows the time-weighted average (TWA) PM2.5 for each journey, by participant. PM2.5 concentrations in 3 of the non-smoking journeys exceeded the 25 μg/m3 WHO guidance level for indoor air [16], while this occurred in all smoking journeys for between 11 and 100% of the journey time (53% of the time, on average). [emphasis added]

That was one result they didn't shout about. Even with a short car journey the levels of non-smoke contaminants can exceed the EPA 24-hour standard (but this time duration is, according to the standard, is too short to have health implications).

The study also indulges in reinventing the EPA standards:

We have used the WHO PM2.5 guidance level as a comparison as this as the WHO has recently stated that the value can be applied both to indoor and outdoor exposures [16]. The comparison to this guidance should be done with some caution as this health-based value is based on a 24 hour time-weighted average. Clearly the exposures during car journeys we have measured are all much shorter than a 24-h averaging period but given recent work suggesting that there may be no safe level of exposure to SHS [18] we think that the use of the WHO indoor air standards for PM2.5 is a reasonable health-based method of comparison. [emphasis added]

Since the guideline explains carefully (para 28) how to calculate whether the EPA standard is valid for periods shorter than 24 hours this seems to be taking a liberty!

(Read on also about the SCIA's finding about 23, or 11, times as toxic as a smoky bar claim: 'our data do not support this claim nor the BMA's retraction'.)

Smoking can damage the resale value of your car (but we'll clean it up for you)

I observed this, posted on Facebook by Action on Smoking and Health. On the face of it, it just tells you how smelly smoking makes your car – en passant, drawing attention to the BMA's proposals to ban smoking in cars.  But it concludes:

“You are likely never to get rid of the smoking smell completely, but a comprehensive interior clean from a professional automotive cleaning specialist should make a big difference. This clean may cost you in the region of £150, but should help ensure it attracts interest from buyers in the first instance, and will ultimately help achieve a better price for the car,” [Peter Grøftehauge, Autorola’s chief executive] added.

 You can really trust ASH not to spot when somebody's jumping on the bandwagon for a fast buck, can't you? For valeting services, look no further.

Scotland discusses smoking ban in cars

Wednesday's Scotland Tonight featured a discussion on the smoking issue. Attacking the ban was, unusually, a university lecturer (rather than a campaigner, professional or otherwise), and defending it was a member of the BMA.

The clip is here – following the interview, after a few moments' silence, the presenter reads a couple of comments that have been emailed to the show.

I could not argue with any of Dr Stuart Waiton's major points: that doctors expect policy to be based on the latest piece of research, the moralistic tone they adopt on health issues, the zero-tolerance obsession about risk ...

As for Dr Gary Hamilton from the BMA: suggesting a discussion between Dr Waiton and the relatives of the 44 people who died of passive-smoke-induced lung cancer in any given year on obsessive attitudes to risk is fairly disingenuous, since he does not know who these people are. He does not know who the people are who allegedly died, because they are the product of a mathematical model, not actual deaths observed empirically. It's not as if he were offering an employer the opportunity to discuss the absurdity of wearing safety helmets with the families of people who had suffered fatal head injuries at work. Reprimanding Dr Waiton for accepting the risk of secondary smoke is far easier than remembering the United Kingdom's appalling record in air pollution generally.

Dr Hamilton comments that we can 'save 33 children from dying a year'. Since there is no direct evidence that secondary smoke causes diseases, even supposing that children are exposed to harm from smoke, there is also no evidence that their deaths occur when they are still children, or even that they occur prematurely.

Unfortunately Dr Hamilton was not asked to explain why protection of children has lagged behind protection of adults, when children are presented as more vulnerable and the environments in which they are exposed to smoke 23 times more lethal. (Or 11 times more lethal. They're making it up as they go.)

Dr Hamilton refused to be drawn on whether the BMA wishes to ban tobacco completely.

The issue goes to the Scottish Parliament next Thursday (24 November) in an oral question (question 12).

Thinking of the children?

How can anyone possibly believe that these people care about children: the BMA and all who think like them? I posted this today:

We were prevented from smoking in bars because - to quote the authorities - there is NO SAFE LEVEL of secondary smoke. We were actually *prevented* from doing it, even in private clubs between consenting adults - not just discouraged or shown the dangers, but told YOU WILL NOT DO IT BECAUSE IT IS COMPLETELY lethal and UNACCEPTABLE to expose even consenting adults to it. 

Then after a few years we are told that exposure in cars was 23 times more lethal and we should stop doing it in cars. Five years later - *twenty-three times more lethal in a car* - and we know how children have no choice. This is not concern about children ... if they were so concerned about children a ban in cars would have come years ago. This is just using children as a propaganda tool in the next stage of restrictions on smokers. Twenty-three times more lethal than a level of danger so great that we were forbidden by law from taking the risk. (Note that they have quietly reduced this 23 to 11, but not before the public was fed a grossly inflated version.) 

I think Robert Dow has it right on the button.  

A car is smaller than a bar, but there would usually be no more than two people smoking in the car, and most people would not smoke continuously in a car if they smoke at all. In a bar the upper number of smokers depends entirely on the size of the room, and also ventilation factors also vary so enormously that nobody could take this as a scientific measure. This is typical of the so-called science on secondary smoke. It is based not on measured amounts of anything, but guesswork and generalisations.

(I've just heard Amanda Sandford tell George Galloway on Talksport that she doesn't think the time is right for an outright ban in motor cars (bless the BMA, for letting Action on Smoking and Health be seen as moderate on a smoking issue). Even though passive smoke exposure is eleven times greater than in a smoky bar and children don't get a say, there should be no ban, just a debate.)