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effective in preventing tobacco use among adolescents and young adults (NIH 2006b). In addition, a new Canadian study has raised the possibility that not only do parents influence their children’s future smoking behavior by setting an example, but parents may also physically “prime” their children to become smokers by exposing them to nicotine. The study found that the presence of cotinine in the saliva at a young age was a significant predictor of future smoking addiction (Ubelacker 2005).

Recommendation 9: State health agencies, health care professionals, and other interested organizations should undertake strong efforts to encourage parents to make their homes and vehicles smoke free.

The committee believes that a voluntary approach to reducing parental smoking in homes and vehicles is preferable to a legal prohibition. However, the committee does support otherwise appropriate legal interventions in custody or abuse cases involving parents whose smoking endangers the health of their children.

Outdoor Spaces

Smoking in outdoor spaces is the last frontier in the progressive restriction of smoking and can be expected to be controversial. Bayer and Colgrove (2002) and Chapman (2000) doubt that these restrictions can be defended on the basis of ETS exposure by nonsmokers and therefore contend that banning outdoor smoking is unambiguously paternalistic. Moreover, such bans would be difficult to enforce with an equal hand, and their enforcement would likely create a public backlash against smoke-free policies in general (Chapman 2000). Proponents of outdoor smoking restrictions, on the other hand, argue that such measures are scientifically justifiable because the nature of the atmospheric dispersion of ETS will cause nonsmokers to be exposed to equally high or higher levels of ETS in outdoor environments than they are in indoor environments (Repace 2000). Others point out that banning outdoor smoking has additional benefits, aside from reducing exposure to ETS, including reducing the fire risk, decreasing litter, and protecting the public from nuisance (Bloch and Shopland 2000). Concerns about the offensiveness of smoking are especially pronounced in crowded locations (e.g., on crowded beaches or in parks). Furthermore, the declarative effects of enacting and enforcing these restrictions are substantial because they send a powerful message about the social disapproval of smoking, a message that will not be lost on children and adolescents.

Despite the controversial nature of restrictions in outdoor places, there is a growing movement to institute such bans in California, which has

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