3.19 Smoking and accidents

Last updated: 2011
Suggested citation: Bellew, B & Winstanley, MH. 3.19 Smoking and accidents. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2011. Available from http://www.tobaccoinaustralia.org.au/chapter-3-health-effects/3-19-smoking-and-accidents

This section covers two sorts of accidents: accidents caused by the distraction of smoking while engaged in driving or other activities, and burns caused by cigarettes or sustained in fires caused by discarded cigarettes. For further information about measures to reduce cigarette-caused fires, see Chapter 12, Attachment A12.2 concerning reduced fire risk cigarettes.

3.19.1 Smoking, motor vehicle crashes and other injuries

Driver distraction is an important cause of motor vehicle crashes.1 Loss of concentration (thinking about other things or daydreaming), adjusting controls for accessories in the car, and being distracted by passengers or people or events outside the car are common causes of driver distraction.2 In research from New South Wales and Western Australia examining driver distraction and road safety, 10% of drivers reported that they had smoked during their most recent driving trip of five minutes or more duration, ahead of 9% who had used mobile telephones and 6% who had eaten while driving.2 A study using video analysis of people driving while smoking suggests an average of measured driving distraction time to be about 12 seconds, or enough to cover a distance of 160 m at a speed of 50 km/h. The authors suggest that distraction of drivers through smoking may be greater in the case of mobile phone use and that it constitutes a remarkable risk for road safety.3 A small study conducted among Italian adolescents compared those who had not experienced any motor vehicle accidents with those having one or more crash; it reported that the latter were more likely to be tobacco users and the adjusted analyses found that tobacco use was independently predictive of a motor vehicle accident (OR 3.2, p< 0.0001).4 Similarly, North American research among teenagers and young adults found that being a current smoker was associated with having been in a crash,5 while Canadian researchers found that smokers are more likely to have a car crash than non-smokers, whether or not they are actually smoking at the time of the incident.6 The Canadian study speculates that as well as the distraction factor, smokers may suffer physiological impairment due to smoking, or that there may be underlying behavioural differences between smokers and non-smokers that contribute to the difference in crash data.6 Whatever the explanation, Australian reviews have concluded that smoking while driving increases the risk of having a motor vehicle crash.1, 7 This is consistent with findings from an earlier review by North American researchers that smokers are 1.5 times more likely than non-smokers to have a motor vehicle crash.8 Being a waterpipe and/or cigarette smoker was found to predict the number of traffic crashes in an adjusted analysis within a recent study of drivers in Iran.9 Other Italian research has estimated that about 7% of car injuries in that country may involve a subject who smokes while driving,10 while analysis of US motor vehicle crash data concluded that distraction caused by smoking may be responsible for almost 1% of car crashes over the five-year period 1995–1999, or about 12 780 crashes.11 Smokers are also more likely to be die from injury in motor vehicle crashes and other types of accidents, including those involving falls, fires and other unintentional injuries.12-14 Possible reasons for this include the effects of smoking on physical performance (such as strength, agility, balance and speed) and recovery from physical trauma (such as post-operative complications and wound healing).14 A meta-analysis of randomised, controlled trials was conducted to examine whether cigarette smoking causes, and smoking cessation prevents, excessive injury burden. Intervention (cessation) was associated with pooled estimated injury risk reduction of 35% within the trials (RR 0.65; 95% CI, 0.36–1.19) and of 32% (RR 0.68; 95% CI, 0.43–1.09) with additional follow-up in two of the three studies; it should be noted that these associations were only of borderline statistical significance.15

3.19.2 Burns and fires caused by tobacco use

Cigarettes and cigarette lighters have been shown to be a major cause of burn injury; globally they are responsible for one million fires per year.16 In the US, fires and burns are among the top 10 leading causes of unintentional death, with thousands of deaths occurring annually; the majority of these deaths and injuries occur in residential fires, and smoking has been identified as the leading cause of home fire deaths in the US.17, 18 Some data suggest that the rate of injuries is higher for fires that were started by smoking, heating equipment, or children playing with fire (relative risk, 2.6).19 There is evidence that reductions in smoking and increases in cigarette prices are associated with fewer fires.18 Smokers engage in behaviours such as smoking in bed and leaving lit cigarettes unattended that may place them at an increased risk of cigarette-caused fires; in a Canadian study 1 in 4 smokers admitted to leaving lit cigarettes unattended in the previous month, while 15% admitted to smoking while in bed.20 It is a sad irony that smoking also compromises the prognosis of patients with severe burn injury.21

Smoking is conservatively estimated to be the direct cause of at least 4574 fires in Australia each year, the real number probably being much higher.22 It is estimated that in 2004–05, 24 people died in Australia due to fires caused by cigarettes, and that nearly a quarter (23%) of all deaths caused by fire are due to cigarette use.23 The National Coroners' Information System has reported that between the financial years 2000–01 and 2005–06, 67 deaths were caused in Australia by cigarette-related fires.24 The authors of this report emphasise that this is highly likely to be an under-representation of the true number of deaths, particularly for the more recent years reported, since cases not concluded or as yet uncoded in their national database are not accounted for in the data. In a recent New Zealand study (conducted among callers to the national smoking cessation service) 6.8% reported one or more fires caused by cigarettes, 60% described at least one cigarette-caused burn and 5.2% reported burns which required medical attention.25 Studies have emphasised the particular fire risk associated with smoking in long-term care settings such as nursing homes,26, 27 and in relation to the usage of certain highly flammable products such as liquid petroleum gas (LPG),28 automatic air-fresheners,29 or equipment used for home oxygen therapy.30, 31 In-car cigarette lighters have also been reported as a cause of burn injuries.32

The role of smoking-related materials in causing fires has led to demands for tobacco manufacturers to introduce 'reduced ignition propensity' (RIP) cigarettes, which only burn while being actively inhaled upon, as opposed to when they are left idling between puffs, or after they have been discarded.22 Research into the ignition propensity of cigarettes has grown, notably during the past decade.22, 33-45 Among the research results are the important findings that RIP cigarettes do not adversely impact public perceptions about the need for safety,33 appear to reduce consumption although resulting in small increases in smoker exposure to the compound phenanthrene,35 may have little change in the carcinogenic aspects of particulate matter44 and tend to reduce risk behaviours such as leaving a cigarette burning unattended and smoking in bed.36 Recently a systematic review of the public health, scientific, technological, trade literatures and internal industry information has been made available following the Master Settlement Agreement between US states and tobacco companies. It reveals that the industry has made advancements in understanding the key parameters involved in cigarette smouldering combustion and ignition of substrates, developing new cigarette and paper wrapper designs to reduce ignition propensity, including banded and non-banded cigarette paper approaches, assessing toxicology, and measuring performance. It is possible that this technical knowledge, now in the public domain, will in the future allow further improvements in the fire safety aspects of cigarettes.38

For further discussion about regulation of tobacco products, see Chapter 12.

Relevant news and research

For recent news items and research on this topic, click here.(Last updated November 2018)

References

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