Abstract: Second-hand smoke (SHS) has been classified as carcinogenic to humans by the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) [IARC, 2004]. Of the 5.7 million deaths attributable each year to tobacco smoking, more than 600,000 (i.e., around 1% of all deaths worldwide) refer to subjects who never smoked and that prematurely die due to their lifetime exposure to SHS [WHO, 2012].
Italy has been one of the pioneering countries - and the first large country worldwide - to enact a comprehensive smoke-free legislation in 2005. The law, introduced in order to reduce SHS exposure, banned smoking in indoor public places, including restaurants and bars, and in all workplaces [Gallus et al., 2006]. This legislation has had an undisputed success from a public health perspective: it was widely supported and strongly observed, restaurant and bar owners did not experience any dreaded decline in their business, and tobacco smoking (and its detrimental health effects) substantially decreased [Gallus et al., 2006; Gorini et al., 2007]. More importantly, the regulation has been effective in dramatically reducing SHS exposure [Gorini et al., 2007; Martinez-Sanchez et al., 2012]. Most high-income countries followed Italy in the adoption of similar comprehensive smoking ban legislations over the last decade [IARC, 2009]. These regulations and the information campaigns conducted for their enforcement had also the effect to increase the social unacceptability of SHS and consequently the adoption of voluntary home smoking bans [Ferketich et al., 2014; Martinez-Sanchez et al., 2014]. This notwithstanding, in 2010 specific Italian subpopulations were still frequently exposed to SHS, both in public and private places. In particular, 54% of the young (i.e., age 15-24 years) were still exposed to SHS in any settings, 27% in private houses, and 33% in private cars [Martinez-Sanchez et al., 2012].
The relatively high SHS exposure in private cars is of particular concerns. Inside vehicles, in fact, the smoke of one single cigarette causes concentrations of fine particulate matter three times higher than what is considered the threshold of hazard. According to surveys conducted by DOXA (an Italian statistical and opinion research company) in 2011-2012, two thirds of Italian smokers smoked in private cars [Martinez-Sanchez, Gallus et al., 2014]. Despite this, 80% of Italian adults (and 49% of current smokers) supported a smoking ban in private cars, and 93% (and 84% of current smokers) supported such a ban in cars carrying children [Martinez-Sanchez, Gallus et al., 2014]. We therefore welcome the incoming Minister’s Decree banning tobacco smoking in private vehicles in presence of minors or pregnant women.
The risk associated to SHS exposure is still largely underestimated. To give an idea of its harmful effect, we recommend viewing a video realised by colleagues at the National Cancer Institute of Milan, showing how the indoor air pollution generated by one single cigarette is 4 to 6 times higher than that produced by a diesel truck [Ruprecht et al., 2015]. There is a need to further inform the (Italian) population, including in particular smokers with young children, about the harmful effects of SHS, in order to increase the number of smoke-free homes and cars. In this sense, paediatricians or paediatric dentists have today the opportunity to give a major help. Their contribution can imply a minimum effort, e.g., providing informative leaflets, or making available, in the waiting rooms of their clinics, monitors showing informative videos, including the one previously described [Ruprecht et al., 2015].