[Smoking in cars and motorcycles in Italy over the last decade]

to estimate the prevalence of smoking while driving a car or a motorcycle, and its determinants, and to analyze the trends of these habits before and after the transposition of the European Directive 40/2014 (Legislative Decree 6/2016) adopted in 2016, which bans smoking in cars in the presence of minors.

eight different population-based surveys conducted in Italy by Doxa between 2007 and 2018.

21,807 subjects aged >=18 years, representative of the Italian adult population.

prevalence of smokers who smoke while driving a car, with and without minors, or a motorcycle. Prevalence of non-smokers exposed to second-hand smoke (SHS) in cars, with or without minors. Estimate of multivariate odds ratios (ORs) and 95% confidence intervals (CIs), using multiple logistic regression models adjusted by gender, age, education, geographic area, and year of survey.

the prevalence of smokers who smoked in cars decreased from 69.6% in 2007-2008 to 57.5% in 2016, and to 51.5% in 2017-2018. Those who smoked in cars in presence of minors were 20.9% in 2011-2012 and 11.7% in 2017-2018. The prevalence of smokers who smoked while driving a motorcycle decreased from 15.0% in 2007-2008 to 6.5% in 2017-2018. Smoking while driving a car in presence of minors decreased with increasing age (p=0.004) and education level (p=0.029) and was more frequent in Southern than in Northern Italy (OR 4.40; 95%CI 2.21-8.74). In 2017-2018, 16.2% of non-smokers reported being exposed to SHS in cars. Of these, 42.3% were exposed also in presence of minors.

the tobacco control legislations adopted over the last 15 years, in particular the last one adopted in 2016, have largely contributed in reducing smoking in private vehicles, even in the presence of minors. This notwithstanding, 50% of Italian smokers smoke while driving and more than 15% of non-smokers are exposed to SHS in cars. It is suggested to adopt informative campaigns that inform people about the risks associated with smoking in cars, both for drivers and for passengers, and to increase the fines for those who smoke in cars in the presence of minors or driving a motorcycle.