ITC protocol for measuring exposure to
secondhand tobacco smoke
Mark Travers, MS
Andrew Hyland, PhD
Roswell Park Cancer Institute
Outline of Presentation
• FCTC, Health effects of SHS exposure
• Effects of smoke-free air policies
• Results of air quality studies
• Why measure air quality?
• How to measure air quality using the TSI Sidepak – ITC protocol
• What you can do and how we can help
Why go smokefree?- SHS harmful
- Lung cancer, heart disease, adverse respiratory effects in kids, and now breast cancer in younger women
- FCTC, Article 8 - Protection from exposure to tobacco smoke
- “Each Party shall adopt and implement in areas of existing national jurisdiction as determined by national law and actively promote at other jurisdictional levels the adoption and implementation of effective legislative, executive, administrative and/or other measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.”
Effects Causally Associated with ETS Exposure
Developmental EffectsFetal Growth: Low birthweight and decrease in birthweight
Sudden Infant Death Syndrome (SIDS)Pre-term delivery
Respiratory EffectsAcute lower respiratory tract infections in children (e.g. bronchitis and pneumonia)
Asthma induction and exacerbation in children and adultsChronic respiratory symptoms in children
Eye and nasal irritation in adultsMiddle ear infections in children
Carcinogenic EffectsLung cancer
Nasal sinus cancerBreast cancer in younger, primarily premenopausal women
Cardiovascular and Hematological EffectsHeart disease mortality
Acute and chronic coronary heart disease morbidityAltered vascular properties
Source: Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant . California Environmental Protection Agency, Air Resources Board, Office of Environmental Health Hazard Assessment. June 2005.
Effects with Suggestive Evidence of a Causal Association with ETS Exposure
Reproductive and Developmental EffectsSpontaneous Abortion, Intrauterine Growth Retardation
Adverse Impact on Cognition and BehaviorAllergic Sensitization
Decrease pulmonary function growthAdverse effects on fertility or fecundability
Cardiovascular and Hematological EffectsElevated risk of stroke in adults
Respiratory EffectsExacerbation of Cystic Fibrosis
Chronic respiratory symptoms in adults
Carcinogenic EffectsCervical Cancer
Brain Cancer and lymphomas in childrenNasopharyngeal cancer
All cancers – adult and child
Source: Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant . California Environmental Protection Agency, Air Resources Board, Office of Environmental Health Hazard Assessment. June 2005.
Price
Smoke-free Air
Treatment
CounterMarketing
Components of Smoking Vaccine
Evaluation of Smoke-free Air Law
Implementation Public Health Impact
Adverse Side Effects
Support or Opposition
Compliance
Exceptions to Law (Waivers)
Direct Effects
Indirect Effects
Economic Impact
Evaluation of Smoke-free Air Law
Public Health Impact
Direct Effects
• Decrease indoor air pollution
• Reduce exposure to carcinogens and toxins
• Improve health and reduce incidence of tobacco smoke related diseases
Evaluation of Smoke-free Air Law
Public Health Impact
Direct Effects
Indirect Effects
• Promote cessation
• Decrease consumption
Measuring Air Quality
• 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)
Why PM2.5?
• Very sensitive marker of ETS• Can monitor and record data in real time• Relatively inexpensive equipment• Marker of the more than 4,000 chemical in ETS
– E.g. 2,000:1, PM2.5:PAH
• Meaningful measure: there are PM2.5 standards in place to protect public health– The EPA has set standards of 15 μg/m3 as the average
annual level of PM2.5 exposure and 65 μg/m3 24-hour exposure in order to protect the public health
US EPA Air Quality Index
Air QualityAir Quality
Index PM2.5
(g/m3) Health Advisory
Good 0-50 ≤15 None.
Moderate 51-100 16-40 Unusually sensitive people should consider reducing prolonged or heavy exertion.
Unhealthy forSensitive Groups
101-150 41-65 People with heart or lung disease, older adults, and children should reduce prolonged or heavy exertion.
Unhealthy 151-200 66-150 People with heart or lung disease, older adults, and children should avoid prolonged or heavy exertion. Everyone else should reduce prolonged or heavy exertion.
VeryUnhealthy
201-300 151-250 People with heart or lung disease, older adults, and children should avoid all physical activity outdoors. Everyone else should avoid prolonged or heavy exertion.
Hazardous ≥301 ≥251 People with heart or lung disease, older adults, and children should remain indoors and keep activity levels low. Everyone else should avoid all physical activity outdoors.
Hayman Fire – Worst in Colorado History, June 8 2002
Denver June 9, 2002
Denver’s visibility – before Hayman fire
Denver’s visibility – 1 day after Hayman fire
Worst PM 2.5 - 43 µg/m3 (24-hr max) or 200 µg/m3 (hourly max)
Results
• Pre-post study design– Indiana Air Monitoring Study– Western New York Air Monitoring Study
Travers, M.J., et al., Indoor Air Quality in Hospitality Venues Before and After the Implementation of a Clean Indoor Air Law-Western New York, 2003. Morbidity and Mortality Weekly Report (MMWR), 2004.
Indiana Air Monitoring StudyDecember 2004 to January 2005
Indiana Tobacco Prevention and Cessation
Roswell Park Cancer Institute
0
200
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1200
1400
0 100 200 300 400
Elapsed Time in Minutes
Fin
e p
art
icle
air
po
llu
tio
n (
PM
2.5 i
n μ
g/m
3)
VENUE1a
VENUE2a
VENUE3a
VENUE4a
VENUE5a
VENUE6a
VENUE7a
VENUE8a
Indiana Air Monitoring Study: Bloomington, IN, December 10th, 2004
12/10/046:00pm
12/11/041:20am
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600
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1000
1200
1400
0 100 200 300 400
Elapsed Time in Minutes
Fin
e p
art
icle
air
po
llu
tio
n (
PM
2.5
in μ
g/m
3 )
VENUE1b
VENUE2b
VENUE3b
VENUE4b
VENUE5b
VENUE6b
VENUE7b
VENUE8b
1/21/056:14pm
1/22/051:34am
Indiana Air Monitoring Study: Bloomington, IN, January 21st, 2005
0
200
400
600
800
1000
1200
1400
0 100 200 300 400
Elapsed Time in Minutes
Fin
e p
arti
cle
air
po
lluti
on
(P
M2
.5 in
μg
/m3) Pre-Law 12/10/04
Post-Law 1/21/05
Bloomington, IN Before and After Clean Indoor Air Law
Average Level of Indoor Air Pollution Before and After Implementation of Clean Indoor Air Legislation,
Bloomington, IN
347
371814 14
0
100
200
300
400
500
Pre-Law Post-Law Post-Law Compliant(n=6)
Avera
ge P
M2
.5 level (μ
g/m
3)
Smoking allowed pre-law (n=7)
Non-smoking (n=2)
annual PM2.5 standard(15μg/m3)
24-hour PM2.5 standard (65μg/m3)
89% 95%
Indoor Air Quality Before and After Indoor Air Quality Before and After the New York State Clean Indoor Air the New York State Clean Indoor Air Law in Western New York Hospitality Law in Western New York Hospitality
Venues, July to September 2003Venues, July to September 2003
Mark Travers,1 Michael Cummings,1 James Repace,2 Andrew Hyland1
1Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute; Buffalo, New York
2Repace Associates, Inc.; Bowie, Maryland
-98%
-80%
-98%
-84%
-86%
-89%
-98%
-98%-95%
-73%
-91%
-96%
-95%-84%
0
200
400
600
800
1000
1200
1400
Res
pir
ab
le S
usp
end
ed P
art
icle
s (μ
g/m3 o
f P
M2
.5)
Change in Air Quality in Western New York Bars Change in Air Quality in Western New York Bars and Restaurants After Implementation of the and Restaurants After Implementation of the
New York State Clean Indoor Air LawNew York State Clean Indoor Air Law
Before Law: Average = 412 μg/m3
After Law: Average = 27 μg/m3
Only venue with active smoking during post-law sampling
Mean size of venue = 365m3
Mean pre-law active smoker density = 1.38 cigs/100m3
Results
• Cross sectional study design– Multi-City Air Monitoring Study– Global Irish Pub Study
– Global Air Monitoring Study
Multi-City Air Monitoring Study: Philadelphia, PA April 10th, 2004
0
200
400
600
800
1000
1200
0 50 100 150 200 250 300 350 400
Elapsed time in minutes
Fin
e p
art
icle
air
po
lluti
on
(P
M2.
5 in
μg
/m3 )
All venues are smoking venues with observed smoking in all venues
4/107:01pm
4/111:41am
VENUE42
VENUE43
VENUE44
VENUE45
VENUE46
VENUE47
VENUE48
Multi-City Air Monitoring Study: New York City, NY April 17 th, 2004
0
100
200
300
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500
600
0 50 100 150 200 250 300 350 400 450 500
Elapsed time in minutes
Fin
e p
art
icle
air
po
lluti
on
(P
M2.
5 in
μg
/m3 )
All venues are smoke-free by law and no smoking was observed in an venue
4/176:43pm
4/182:38am
VENUE56
VENUE57
VENUE58
VENUE59
VENUE60
VENUE61
VENUE62
0
200
400
600
800
1000
1200
0 50 100 150 200 250 300 350 400
Elapsed time in minutes
Fine
par
ticle
air
pol
lutio
n (P
M2.
5 in
μg/
m3)
New York City
Philadelphia
Multi-City Air Monitoring Study: New York City, NY April 17 th, 2004 and Philadelphia, PA April 10th, 2004
Average Level of PM2.5 by City
104 94
26 27
293
392
254 231
25
343
0
100
200
300
400
500
Hartfo
rd
L.A.(a
ll ve
nues)
L.A.(c
omplia
nt ven
ues)
Buffalo
Baltim
ore
Was
hingt
on, D
C
Philadelp
hia
Hobok
en
New Y
ork C
ity
Galve
ston
PM
2.5
in m
icro
gram
s p
er c
ub
ic m
eter
Global Irish Pub Study
• Indoor air quality was assessed in 128 Irish pubs in 15 countries, between January 21, 2004 and March 10, 2006
• The level of air pollution inside Irish pubs located in smoke-free cities was 93% lower than the level found in pubs in cities allowing indoor smoking
Current participating countries (n=38)
Global Air Monitoring Study
Average Fine Particle Air Pollution by Country
197
393
66
380
318276
168
420
154169
262212
459
215
464
171
275285
197210
328
29 14
0
100
200
300
400
500
600
Irelan
d
New Z
ealan
d
Armen
ia
Belgium
Canad
a
Franc
e
German
y
Greec
eLa
os
Leba
non
Mala
ysia
Pakist
an
Poland
Portug
al
Roman
ia
SpainSyr
ia
Thaila
nd
Tunisi
a
United
King
dom
United
Sta
tes
Urugu
ay
Vietna
m
PM
2.5
in m
icro
gra
ms
pe
r c
ub
ic m
ete
r
No National Smoke-free Air Law National Smoke-free Air Law
Results
• Case studies– One bar with a designated smoking room
0
100
200
300
400
500
600
ug
/m3
PM
2.5
Enter barExit bar
Average in 20 smoke-free venues = 27 g/m3
Average in non-smoking part of bar = 192 g/m3
Air Monitoring in a Bar Receiving a Smoking WaiverAir Monitoring in a Bar Receiving a Smoking WaiverAir monitor was placed in the middle of the bar (non-smoking area), 15 feet from the door to the smoking room
Door to smoking room opened and left open for 4 minutes Door to smoking room opened
Saturday, February 28th, 2004
0
100
200
300
400
500
600
ug
/m3
PM
2.5
Enter barExit bar
Average in 20 smoke-free venues = 27 g/m3
Average in non-smoking part of bar = 192 g/m3
Air Monitoring in a Bar Receiving a Smoking WaiverAir Monitoring in a Bar Receiving a Smoking WaiverAir monitor was placed in the middle of the bar (non-smoking area), 15 feet from the door to the smoking room
Door to smoking room opened and left open for 4 minutes Door to smoking room opened
Saturday, February 28th, 2004
Why measure air quality?
• Quantify exposure, determine risk
• Educate the public and policy makers
• Evaluate smoke-free air policies
• Generate media attention
• Data from air monitoring studies is used to educate the public about the dangers of secondhand smoke.
• News articles• Editorial support
How to measure air quality using the TSI Sidepak
• How does it work?• Important issues to be aware of
– Calibration Factor
– Flow rate
• How to prepare and operate the Sidepak• Measurements and observations• Advantages• Limitations
The training course at www.tobaccofreeair.org
Schematic of a Laser Photometer
Calibration
• The TSI SidePak Personal Aerosol Monitor uses a built-in pump to bring air past a laser.
• The particles in the air scatter the light from the laser and the device determines the mass concentration of particles based on the amount of scattering.
• These types of devices must be calibrated with the specific type of aerosol (tobacco smoke) that you are measuring.
SidePak Factory Calibration Certificate
Calibration: Unadjusted Data
0
1000
2000
3000
4000
5000
0 50 100 150 200
Elapsed time in minutes
PM
2.5
in m
icro
gram
s pe
r cu
bic
met
er
MIE dataRAM(calibrated referenceinstrument)SidePak AM510
Repace, J., Respirable particles and carcinogens in the air of Delaware hospitality venues before and after a smoking ban. Journal of Occupational and Environmental Medicine, 46:9, 887-905.
Oct. 10th 2003 Bowie, MD
Calibration: Adjusted Data
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2000
0 50 100 150 200
Elapsed time in minutes
PM
2.5
in m
icro
gram
s p
er c
ub
ic
met
er
MIE dataRAM
0.32*SidePak
Oct. 10th 2003 Bowie, MD
Flow Rate
• The flow rate needs to be set at 1.7 liters per minute in order for the 2.5 micron impactor to work properly
Flow Rate Calibration
• The flow rate can be calibrated with either a simple rotameter or a primary calibrator.
• The flow rate will already be calibrated on the equipment we provide!
How to Prepare and Operate the Sidepak
• 1) Charge Battery
• 2) Clean and grease the impactor
• 3) Zero calibrate the Sidepak
• 4) Log (record) data into memory
• 5) Download data from Sidepak to the PC
1) Charge battery
2) ) Clean and grease the impactor
3) Zero Calibrate the Sidepak
4) Set Sidepak to log (record) data into memory
5) Download data from Sidepak to the computer
The TSI SidePak is small and can be used for discrete sampling
Romanian researcher carrying the TSI sidepak (in shoulder bag)
Kang using a Sidepak to sample Durty Nellies Irish Pub in Beijing, China
Measurements and Observations
• Use a sonic measure to determine the size (volume) of the rooms you sample
Measurements and Observations
• Take notes on your location, times of entry and exit, counts every 15 minutes of number of people and number of burning cigarettes
• Take descriptive notes as well
Waterloo, Canada
Greece
Average Particle Concentration versus Average Smoking Density
0
200
400
600
800
1000
1200
1400
1600
0.00 1.00 2.00 3.00 4.00
Average Smoking Density (burning cigs per 100m3)
Ave
rage
PM
2.5
(mic
rogr
ams
per
cu
bic
met
er)
r=0.421
Average Particle Concentration versus Average Smoking Density by Ventilation
0
200
400
600
800
1000
1200
1400
1600
0.00 1.00 2.00 3.00 4.00
Average Smoking Density (burning cigs per 100m3)
Ave
rage
PM
2.5
(mic
rogr
ams
per
cu
bic
met
er)
1.0<ACH<2.1
ACH 1.0
ACH 2.1
r=0.908
r=0.834
r=0.832
Limitations of PM2.5 as a Marker of SHS
• Not specific to tobacco smoke; other sources include cooking, vehicles, ambient/background levels
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50
100
150
200
250
0 40 80 120 160 200 240 280
Elapsed time in minutes
PM
2.5
lev
el i
n m
icro
gra
ms
pe
r c
ub
ic m
ete
r
Bangkok, Thailand, February 2006
Outdoors on busy Bangkok streets
Restaurant with smoking
Bangkok, Thailand, February 2006
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750
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1250
1500
1750
2000
0 40 80 120 160 200 240 280 320 360 400 440 480 520
Elapsed time in minutes
PM
2.5
lev
el i
n m
icro
gra
ms
pe
r c
ub
ic m
ete
r Outdoors on busy Bangkok
streets
Restaurant with smoking
Pub Pub Pub
What you can do
• Collect SHS exposure data in your own country to:– Generate relevant local data for use in your own
country– Inform the debate on smoke-free air policy– Contribute to the Global Air Monitoring Study
How we can help
• Provide training on equipment use and data collection
• Provide equipment for you to use (Sidepaks)• Help in study design• Analyze data and generate reports• Help generate media attention in your results• WWW.TOBACCOFREEAIR.ORG
How we can help• Small grants are available from the ITC
project to help you get started.• See the RFP in your packet – focused
projects in specific areas• Data should inform policy debates• <$10,000 USD, 5-10 awards made• 6 page proposals due September 1• Submit online at www.tobaccofreeair.org
Summary
• The TSI SidePak is a is scientifically valid and effective tool for real-time PM2.5 monitoring in SHS studies
• Can show immediate, direct causal link between smoking and fine particle air pollution
• With some expert training and guidance you can collect data in your own country
• Simple environmental monitoring studies can be powerful in policy debates
Equipment Availability
• Rent– Ashtead Technologies– http://www.ashtead-technology.com/
• Buy– TSI Inc.– http://www.tsi.com
• Borrow– Roswell Park Cancer Institute
Contact
• Mark Travers– Roswell Park Cancer Institute, Elm and Carlton
Streets, Buffalo, NY 14222 USA
– [email protected]– (716) 845-5881– (716) 845-8487 fax
Website
• www.tobaccofreeair.org• Training course• Protocols• Templates• Examples of reports• Examples of media• Latest results• Other links and resources
END