1

Smoke-Free Air Policies: Progress, Challenges, and Resources

Mark J. Travers, PhD, MSRoswell Park Cancer Institute

Buffalo, NY, USAmark.travers@roswellpark.org

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

0 20 40 60

Sid

epak

AM

510

PM

2.5

(g/

m3 )

0

250

500

750

1000

1250

1500

1750

2000

CO

(ppm

)

0

9

18

27

36

45

54

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?