Int. J. Environ. Res. Public Health 2009, 6 4. Discussion 704 This population survey on beliefs and adaptations about climate change, including the use of remote car starters, did not intend to measure the determinants of that behaviour, the impact of such use on car idling, the levels of air pollutants, nor the impact of pollutants on the health of the population. The survey is broadly representative of the Québec adult population for the variables presented in Table 2. It also brings to light that among the 83.8% of respondents used a car – which is very close to the percentage of 81% of Québec households reported in the Canadian Households and Environment Survey [21] – approximately one-third used a remote car starter in winter. Furthermore, using a remote car starter in winter was not influenced by smog warnings. From a public health standpoint, these results are of concern for several reasons. Firstly, vehicle exhaust from idling (related in part to the use of remote car starters) contribute to air pollution and climate change [28]. Even in densely populated city centers where many people use public transport (such as Montréal in this survey), outdoor air quality can be severely affected by vehicle idling, at the local (ex. around schools) or community level [7-11]. Concerning greenhouse gases (GHG), between 1990 and 2005, Canada’s transport sector has increased its share of emissions by 33% and is responsible for the equivalent of 32% of the total observed GHG emissions growth [29]. Air pollution – of which primary sources include vehicle exhaust – is known to cause a variety of adverse health effects, ranging from minor illnesses to emergency room visits, hospital admissions and premature death [30-32]. For example, for the Québec regions where complete data on atmospheric pollution was available in 2002 (covering roughly half of the population of Québec, or 3,6 million people), exposure to fine particulates, ozone and nitrous oxides was associated (using prudent assumptions) to 1,974 premature deaths, 414 emergency room visits for respiratory problems, 38 emergency room visits for cardiac problems, and to 246,705 days with asthma symptoms [33]. Currently, specific and periodic monitoring of vehicle idling (including the part related to remote car starter use) and its impact on atmospheric pollutants and GHG emissions does not exist in Canada. Secondly, as found in this study, using a remote car starter does not seem to be influenced by the smog warnings and preventative recommendations issued by Environment Canada through the media and other initiatives. Incentive and voluntary programs such as Info-Smog and the Auto$mart Program have been in existence respectively since 1994 [34] and 1998 [6], apparently with little behavioural impact [35]. Moreover, there were only 61 Canadian municipal and community initiatives against motor vehicle idling in 2005, among the more than 3,000 Canadian municipalities. Only 26 of these initiatives were considered as regulatory, either by governing idling specifically, or by including clauses against it in other existing regulations [5,36]. The remaining 35 initiatives were of the voluntary-approach type to behavioural change, such as public education campaigns or incentive programs. Thirdly, in this study, the prevalence of use of a remote car starter was higher for women than for men, allophones and francophones than for anglophones, in more rural than urban regions. Possible explanations for such variations could include higher perceived intensity of cold for women [37] or allophone (ex. immigrants from tropical countries) [38], distinct clothing habits (ex. clothing consisting of fabrics providing less efficient retention of the heat given off by their bodies, such as rayon [39]), or even the fact of living in a region characterized by colder winters (ex. regions 2 and 8,