Smoke-Free Air Policies:
Progress, Challenges, and Resources
Mark J. Travers, PhD, MS
Roswell Park Cancer Institute
Buffalo, NY, USA
mark.travers@roswellpark.org
Pre-Conference Workshop
15th World Conference on Tobacco or Health
Singapore
March 19, 2012
1
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
Smokefree
Policies
Proximal Variables
Compliance with
smokefree policies
Incidental Outcomes
Economic impact, home
smoking, cessation behavior
Intermediate
SHS exposure
Distal
Health of Non-smokers
Moderators
SHS awareness / attitudes,
occupation, SES, Tobacco control
policies
SHS: secondhand smoke
SES: socio-economic status
Source: IARC Handbook of Cancer Prevention, Volume 12. Methods for Evaluating 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 (PM 2.5 ) 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 massconcentration
T R A I N I N G C O U R S E AT:
W W W. T O B A C C O F R E E A I R .
ORG
HTTP://VIMEO.COM/CHA
NNELS/84864
PM2.5 Findings Around the World
Source: Hyland et. Al. Tobacco Control 2008.
Bloomington, IN Before and After Clean Indoor Air Law
Fine particle air pollution (PM 2.5 in μg/m3)
1400
Pre-Law 12/10/04
1200
Post-Law 1/21/05
1000
800
600
400
200
0
0
100
200
300
Elapsed Time in Minutes
400
U.S.A.
See next slide
U.S.A.
Greece
India
Argentina
China
Conceptual Framework for the Evaluation of Smokefree Policies
Smokefree
Policies
Proximal Variables
Compliance with
smokefree policies
Incidental Outcomes
Economic impact, home
smoking, cessation behavior
Intermediate
SHS exposure
Distal
Health of Non-smokers
Moderators
SHS awareness / attitudes,
occupation, SES, Tobacco control
policies
SHS: secondhand smoke
SES: socio-economic status
Source: IARC Handbook of Cancer Prevention, Volume 12. Methods for Evaluating Tobacco Control Policies.
Challenges: New and emerging
products
Coal
Head
Tobacco
Body
Hose
Bowl
Water
Mouthpiece
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
P M 2 .5 a n d C a rb o n M o n o x id e in a C o m m e rc ia l W a te rp ip e L o u n g e
S id e p a k P M 2 .5 (c a l fa c to r = 0 .4 0 )
63
C a rb o n M o n o x id e (p p m )
1750
54
1500
45
1250
36
1000
27
750
18
500
250
9
0
0
0
“Hazardous” PM2.5 level
according to USEPA Air Quality
Index (17x higher than “Good”
air quality)
20
40
E la p se d T im e in M in u te s
60
National Ambient Air
Quality standard for
CO (USEPA)
C O (p p m )
3
S id e p a k A M 5 1 0 P M 2 .5 (g /m )
2000
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?