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 September 2019)


1. Young K, Regan M and Hammer M. Driver distraction: a review of the literature. Report 206. Clayton, Victoria: Monash University Accident Research Centre, 2003. Available from: http://www.monash.edu.au/muarc/reports/muarc206.pdf

2. McEvoy S, Stevenson M and Woodward M. The impact of driver distraction on road safety: results from a representative survey in two Australian states. Injury Prevention.2006. 12(4):242-7 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586781/pdf/242.pdf

3. Mangiaracina G and Palumbo L. Smoking while driving and its consequences on road safety. Annali di Igiene 2007;19(3):253-67. Available from: http://www.seu-roma.it/annali_igiene/apps/autos.php?id=414

4. Pizza F, Contardi S, Antognini AB, Zagoraiou M, Borrotti M, Mostacci B, et al. Sleep quality and motor vehicle crashes in adolescents. Journal of Clinical Sleep Medicine 2010;6(1):41-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20191936

5. Hutchens L, Senserrick TM, Jamieson PE, Romer D and Winston FK. Teen driver crash risk and associations with smoking and drowsy driving. Accident Analysis & Prevention 2008;40(3):869–76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18460353

6. Brison R. Risk of automobile accidents in cigarette smokers. Canadian Journal of Public Health 1990;81(2):102-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2331646

7. Collins D and Lapsley H. Economic aspects of drug taking and road safety. In Inquiry into the effects of drugs (other than alcohol) on road safety in Victoria. First report incorporating collected papers Melbourne: Road Safety Committee, Parliament of Victoria, 1995. Available from: http://www.parliament.vic.gov.au/rsc/drugs/drugcola.htm

8. Sacks JJ and Nelson DE. Smoking and injuries: an overview. Preventive Medicine 1994;23(4):515-20. Available from: http://www.sciencedirect.com/science/article/pii/S009174358471070X

9. Saadat S and Karbakhsh M. Association of waterpipe smoking and road traffic crashes. BMC Public Health 2010;10:639. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20969795

10. Iacobelli N, Gallus S, Petridou E, Zuccaro P, Colombo P, Pacifici R, et al. Smoking behaviors and perceived risk of injuries in Italy, 2007. Preventive Medicine 2008;47(1):123–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18501413

11. Stutts J, Reinfurt D, Staplin L and Rodgman E. The role of driver distraction in crashes. Report for the AAA Foundation for Traffic Safety 2001 Available from: http://www.aaafoundation.org/pdf/distraction.pdf

12. Leistikow BN, Martin DC and Samuels SJ. Injury death excesses in smokers: a 1990-1995 United States national cohort study. Injury Prevention 2000;6:277-80. Available from: http://injuryprevention.bmj.com/cgi/reprint/6/4/277

13. Wen CP, Tsai SP, Cheng TY, Chan HT, Chung WSI and Chen CJ. Excess injury mortality among smokers: a neglected tobacco hazard. Tobacco Control 2005;14(suppl. 1):i28–32. Available from: http://tobaccocontrol.bmj.com/content/14/suppl_1/i28.full.pdf

14. Leistikow BN, Martin D, Jacobs J and Rocke D. Smoking as a risk factor for injury death: a meta-analysis of cohort studies. Preventive Medicine 1998;27(6):871-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9922070

15. Leistikow BN and Shipley MJ. Might stopping smoking reduce injury death risks? A meta-analysis of randomized, controlled trials. Preventive Medicine 1999;28(3):255-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10072743

16. Leistikow BN, Martin DC and Milano CE. Fire injuries, disasters, and costs from cigarettes and cigarette lights: a global overview. Preventive Medicine 2000;31(2 Pt 1):91-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10938207

17. United States Fire Administration. Facts about smoking and home fires. Emmitsburg, Maryland: USFA. 2007.

18. Markowitz S. Where there's smoking, there's fire: the effects of smoking policies on the incidence of fires in the United States. NBER working paper no.1665. Cambridge, Massachusetts: National Bureau of Economic Research 2010. Available from: http://papers.nber.org/papers/w16625

19. Istre GR, McCoy MA, Osborn L, Barnard JJ and Bolton A. Deaths and injuries from house fires. New England Journal of Medicine 2001;344(25):1911-6. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJM200106213442506

20. O'Connor RJ, Bauer JE, Giovino GA, Hammond D, Hyland A, Fong GT, et al. Prevalence of behaviors related to cigarette-caused fires: a survey of Ontario smokers. Injury Prevention 2007;13(4):237-42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17686933

21. Brusselaers N, Monstrey S, Vogelaers D, Hoste E and Blot S. Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Critical Care 2010;14(5):R188. Available from: http://ccforum.com/content/pdf/cc9300.pdf

22. Chapman S and Balmain A. Time to legislate for fire-safe cigarettes in Australia [Editorial]. Medical Journal of Australia 2004;181(6):292-3. Available from: http://www.mja.com.au/public/issues/181_06_200904/cha10373_fm.html

23. Collins D and Lapsley H. The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. P3 2625. Canberra: Department of Health and Ageing, 2008. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono64/$File/mono64.pdf

24. Hoy M and Morton S. NCIS Database Search. Deaths associated with fires caused by cigarettes between 1 June 2000 and 30 June 2006. Report produced for NSW Fire Brigades. Southbank, Victoria: National Coroners Information System, Victorian Institute of Forensic Medicine, 2006. Available from: http://www.fire.nsw.gov.au/gallery/files/pdf/research/CigDeathsReport_NCIS_3Oct_2006.pdf

25. Smith J, Bullen C, Laugesen M and Glover MP. Cigarette fires and burns in a population of New Zealand smokers. Tobacco Control 2009;18(1):29-33 Available from: http://tobaccocontrol.bmj.com/content/18/1/29.full

26. Weber M. Must nursing home residents who smoke be supervised? Fire in the nursing home. Pflege Zeitschrift 2011;64(2):112-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21384611

27. Lester PE and Kohen I. Smoking in the nursing home: a case report and literature review. Journal of the American Medical Directors Association 2008;9(3):201-3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18294605

28. Knobloch K, Ipaktchi R, Rennekampff H and Vogt P. Hand and facial burns related to liquefied petroleum gas (LPG) refuelling and cigarette smoking. An underestimated risk? Burns 2010;36(7):e140–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20728999

29. Hawkins S, Hunter J and Drew P. Domestic automated air fresheners: a significant burns risk to smokers. Burns 2009;35(7):1036–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18947928

30. Wendling T and Pelletier A. Fatal fires associated with smoking during long-term oxygen therapy--Maine, Massachusetts, New Hampshire, and Oklahoma, 2000-2007. Morbidity and Mortality Weekly Report 2008;57(31):852–4. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5731a3.htm

31. Edelman DA, Maleyko-Jacobs S, White MT, Lucas CE and Ledgerwood AM. Smoking and home oxygen therapy--a preventable public health hazard. Journal of Burn Care Research 2008;29(1):119-22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18182908

32. Rughani MG, Furniss D and Ghosh SJ. Burn injuries from in-car cigarette lighters. Burns 2010;36(3):e21-3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19427128

33. Seidenberg AB, Rees VW, Alpert HR, O'Connor RJ, Giovino GA, Hyland A, et al. Smokers' self-reported responses to the introduction of reduced ignition propensity (RIP) cigarettes. Tobacco Control 2011;Epub ahead of publication. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21752794

34. Seidenberg AB, Rees VW, Alpert HR, O'Connor RJ and Connolly GN. Ignition strength of 25 international cigarette brands. Tobacco Control 2011;20(1):77-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20974622

35. O'Connor RJ, Rees VW, Norton KJ, Cummings KM, Connolly GN, Alpert HR, et al. Does switching to reduced ignition propensity cigarettes alter smoking behavior or exposure to tobacco smoke constituents? Nicotine &Tobacco Research 2010;12(10):1011-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20805292

36. O'Connor RJ, Fix BV, Hammond D, Giovino GA, Hyland A, Fong GT, et al. The impact of reduced ignition propensity cigarette regulation on smoking behaviour in a cohort of Ontario smokers. Injury Prevention 2010;16(6):420-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20643872

37. Cote F, Letourneau C, Mullard G and Voisine R. Estimation of nicotine and tar yields from human-smoked cigarettes before and after the implementation of the cigarette ignition propensity regulations in Canada. Regulatory Toxicology and Pharmacology 2010;Epub ahead of publication. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20303374

38. Alpert HR, O'Connor RJ, Spalletta R and Connolly GN. Recent advances in cigarette ignition propensity research and development. Fire Technology 2010;46(2):275-89. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873202/pdf/nihms122218.pdf

39. O'Connor RJ, Giovino GA, Fix BV, Hyland A, Hammond D, Fong GT, et al. Smokers' reactions to reduced ignition propensity cigarettes. Tobacco Control 2006;15(1):45-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16436405

40. Connolly GN, Alpert HR, Rees V, Carpenter C, Wayne GF, Vallone D, et al. Effect of the New York State cigarette fire safety standard on ignition propensity, smoke constituents, and the consumer market. Tobacco Control 2005;14(5):321-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16183983

41. Laugesen M, Duncanson M, Fraser T, McClellan V, Linehan B and Shirley R. Hand rolling cigarette papers as the reference point for regulating cigarette fire safety. Tobacco Control 2003;12(4):406-10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14660777

42. Barillo DJ, Brigham PA, Kayden DA, Heck RT and McManus AT. The fire-safe cigarette: a burn prevention tool. Journal of Burn Care and Rehabilitation 2000;21(2):162-4; discussion 164-70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10752750

43. Brigham P and McGuire A. Progress towards a fire-safe cigarette. Journal of Public Health Policy 1995;16(4):433-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8907764

44. Brunnemann KD, Hoffmann D, Gairola CG and Lee BC. Low ignition propensity cigarettes: smoke analysis for carcinogens and testing for mutagenic activity of the smoke particulate matter. Food and Chemical Toxicology 1994;32(10):917-22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7959447

45. Botkin JR. The fire-safe cigarette. Journal of the American Medical Association 1988;260(2):226-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3290519