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Smoke-Free Air Policies: Progress, Challenges, and Resources
Mark J. Travers, PhD, MSRoswell Park Cancer Institute
Buffalo, NY, [email protected]
Pre-Conference Workshop15th World Conference on Tobacco or Health
Singapore March 19, 2012
Countries, States, and Provinces That Have Banned Smoking in Indoor Workplaces and Other Indoor Public Places.
Source: Koh et al. New England Journal of Medicine, 2007.
Smokefree Latin America & the Caribbean
100% national smokefree
Comprehensive national
Sub-national smokefree
Smoking designated areas or no restrictions
Regulation pending
Conceptual Framework for the Evaluation of Smokefree Policies
SHS: secondhand smoke
SES: socio-economic status
Source: IARC Handbook of Cancer Prevention, Volume 12. Methods for Evaluating Tobacco Control Policies.
SmokefreePolicies
Proximal Variables
Compliance withsmokefree policies
Intermediate
SHS exposure
Distal
Health of Non-smokers
Incidental Outcomes
Economic impact, homesmoking, cessation behavior
Moderators
SHS awareness / attitudes,occupation, SES, Tobacco control
policies
http://www.iarc.fr/en/publications/pdfs-online/prev/handbook13/index.php
5 Main Evaluation Outcomes• 1) Public Support• 2) Compliance• 3) Exposure• 4) Health Impact• 5) Economic Impact
MEASURING EXPOSURE TO TOBACCO SMOKE POLLUTION
Cigarettes, cigars and pipes are major emitters of respirable suspended particles less than 2.5 microns (PM2.5) in diameter that are easily inhaled deep into the lungs
TSI SidePak AM510 Personal Aerosol Monitor (weight: ~1 lb)
This device is a real-time laser photometer with a built-in sampling pump that measures airborne particle mass-concentration
TRAINING COURSE AT:WWW.TOBACCOFREEAIR.ORG
HTTP: / /VIMEO.COM/CHANNELS/84864
PM2.5 Findings Around the World
Source: Hyland et. Al. Tobacco Control 2008.
0
200
400
600
800
1000
1200
1400
0 100 200 300 400Elapsed Time in Minutes
Fine
par
ticle
air
pollu
tion
(PM
2.5 i
n μg
/m3 ) Pre-Law 12/10/04
Post-Law 1/21/05
Bloomington, IN Before and After Clean Indoor Air Law
See next slide
U.S.A.
U.S.A.
Greece
India
Argentina
China
Conceptual Framework for the Evaluation of Smokefree Policies
SHS: secondhand smoke
SES: socio-economic status
Source: IARC Handbook of Cancer Prevention, Volume 12. Methods for Evaluating Tobacco Control Policies.
SmokefreePolicies
Proximal Variables
Compliance withsmokefree policies
Intermediate
SHS exposure
Distal
Health of Non-smokers
Incidental Outcomes
Economic impact, homesmoking, cessation behavior
Moderators
SHS awareness / attitudes,occupation, SES, Tobacco control
policies
Challenges: New and emerging products
Mouthpiece
Hose
Body
Bowl
Water
CoalHead
Tobacco
Waterpipe, hookah, narghile
• Common phenomenon in Eastern Mediterranean and South Asian countries…
• Emerging challenge in U.S. and other Western countries, often passes through loopholes in existing smokefree air laws
Waterpipe café in “smokefree” New York State
PM2.5 and Carbon Monoxide in a Commercial Waterpipe Lounge
Elapsed Time in Minutes
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Sid
epak
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510
PM
2.5
(g/
m3 )
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1000
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CO
(ppm
)
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27
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63Sidepak PM2.5 (cal factor =0.40)Carbon Monoxide (ppm)
“Hazardous” PM2.5 level according to USEPA Air Quality Index (17x higher than “Good” air quality)
National Ambient Air Quality standard for CO (USEPA)
E-cigarettes
Johnny Depp in “The Tourist”
Is poor smoke-free law compliance a developing country phenomenon?
• Consider India, Netherlands, Germany
• Consider comprehensiveness of policy and education (i.e. SHS awareness and attitudes)
What are some challenges you face in implementing smoke-free air policies?