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

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Elapsed Time in Minutes

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e p

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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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1/21/056:14pm

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Indiana Air Monitoring Study: Bloomington, IN, January 21st, 2005

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(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%

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pir

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f P

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.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

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(P

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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

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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

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VENUE62

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Elapsed time in minutes

Fine

par

ticle

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pol

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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

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icro

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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

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s pe

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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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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

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600

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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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Bangkok, Thailand, February 2006

Outdoors on busy Bangkok streets

Restaurant with smoking

Bangkok, Thailand, February 2006

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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

– Mark.travers@roswellpark.org– (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