2007 Johns Hopkins Bloomberg School of Public Health Section B Assessing Secondhand Smoke Exposure in Public Places.

2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health

Section BSection B

Assessing Secondhand Smoke Exposure in Public Places

2 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health

Assessment of Secondhand Tobacco Smoke

Surveys and questionnaires

Biomarkers in saliva, urine, hair, serum (cotinine)

Indoor air concentration of tobacco constituents (nicotine) and air particulate matter (PM 2.5) Useful for tracking the impact of clean indoor air

policies and smoke-free initiatives Accurate and reliable estimate Media and policy impact


Secondhand Tobacco Smoke in Public Places

Source: Navas-Acien, et al. (2004).


Images source: Smoke Free Americas. (2007).

Smoke Free Americas Initiative

Launched by PAHO in 2001 to mobilize action to create smoke-free communities, workplaces, and homes

Planned activities Information dissemination Training and training tools Support for smoke-free

communities Policy relevant research


Tobacco Control Program, Pan American Health Organization

Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health

Country collaborators

Collaborative Effort

Country collaborators

Argentina UATA

Brazil INCA

Chile Ministry of Health

Costa Rica

IAFA

Paraguay Ministry of Health

Peru CEDRO

Uruguay Local Government of Montevideo

Honduras IHADFA

Mexico National Institute of Public Health

Panama Ministry of Health

Guatemala

Foundation Aldo Castañeda


Source: Navas-Acien, et al. (2004).

Design and Population

Cross-sectional exposure survey to measure airborne nicotine concentrations in public places of major Latin American cities(~ 100 samples/city): Secondary schools (low-middle socioeconomic status) Tertiary hospitals City government buildings Airports Restaurants (traditional and fast-food) Bars (taverns/nightclubs)

Common/standardized protocol

Training workshop


Nicotine (µg)

Air volume (m3)

Nicotine (µg)

Sampling rate (Lpm) minutes=

* Method developed by Hammond SK and Leaderer BP. (1987)

Air Nicotine Assessment

Vapor-phase nicotine collected with a filter badge treated with sodium bisulfate (1 or 2 weeks)

Collected nicotine extracted from the filter and analyzed by gas chromatography with nitrogen-selective detection

Time-weighted nicotine concentration* Gas-chromatograph

Nicotine sampler

Image sources: Institute for Global Tobacco Control. (2007).


Fieldwork

Country Time of SamplingTotal Number

of Samples% Samples

Nicotine Detected

Argentina November, 2002 89 100

Brazil December, 2002 90 83

Chile October, 2002 96 97

Costa Rica December, 2002 83 90

Honduras October, 2003 101 82

Mexico February, 2004 100 82

Panama November, 2003 95 46

Paraguay February, 2003 90 87

Peru July, 2002 88 97

Uruguay November, 2002 100 100

Source: Navas, et al. (2004).


Air Nicotine Concentrations (µg/m3) in Public Places

Source: adapted by CTLT from Navas-Acien, et al. (2004).


Air Nicotine Concentrations (µg/m3) in Restaurants

Source: Navas-Acien, et al. (2004); Image source: New York City Department of Health and Mental Hygiene.

Air Nicotine Concentrations (µg/m3) in Restaurants in 10 Countries*

Smoking policy

N Median (IQR)†

No policy 54 1.15 (0.32–2.44)

Smoking section

32 1.30 (0.43–2.31)

Nonsmoking 20 0.66 (0.20–1.10)

Smoking ban 7 0.07 (0.003–0.10)

* Countries: Argentina, Brazil, Chile, Costa Rica, Paraguay, Peru, Uruguay, Honduras, Mexico and Panama

† IQR: interquartile range


Air Nicotine Concentrations (µg/m3) in Hospitals

Source: adapted by CTLT from Tobacco Atlas 2nd Edition. (2006).


Air Nicotine in Public Places: Media Impact


Air Nicotine in Public Places: Policy Impact Uruguay

Uruguay - Decreto 16/03/04 - SE CONSIDERAN LAS DEPENDENCIAS SANITARIAS DEL PAÍS AMBIENTES 100% LIBRES DE HUMO DE TABACO

[…]

CONSIDERANDO: I. que según datos de la Organización Panamericana de la Salud, del 10% al 15% de

las muertes producidas por enfermedades tabaco dependientes en las Américas se producen en no fumadores como consecuencia de la exposición pasiva al humo de tabaco

II. que los resultados del Estudio de Vigilancia de la Exposición al Humo de Tabaco realizado en Uruguay en centros asistenciales, liceos, oficinas públicas y otros, a instancias de la Organización Panamericana de la Salud y del Instituto para el Control Mundial del Tabaco de la Universidad Johns Hopkins de los Estados Unidos de Norteamérica (julio 2003), demostraron que en todas las áreas estudiadas existían niveles importantes de contaminación por humo de tabaco

[…]

ATENTO: a lo dispuesto por el artículo 2°. de la Ley N°9.202 de 12 de enero de 1934- Orgánica de Salud Pública

EL PRESIDENTE DE LA REPÚBLICA DECRETA: Artículo 1°.- Dispónese que todas las dependencias sanitarias del país, tanto

públicas como privadas, son consideradas "Ambientes 100% Libres de Humo de Tabaco”


Limitations and Strengths

Limitations Sampling locations selected on a convenience basis Limited number of samples in each city Comparability across countries cannot be completely

assured Measurements done on a continuous basis

(underestimation of exposure during time of occupancy) Only public places were surveyed

Strengths Multi-country approach Standardized protocol Use of a validated method to quantify exposure Data useful at different levels: institution, city, country, and

regional/global level


Conclusions for Latin America

As of 2002–2003 Nicotine detected in most places that were surveyed

(including hospitals and schools) Nicotine was high in restaurants/bars in all countries Nonsmoking sections in restaurants ineffective Indication that smoke-free policies and enforcement

reduce exposure to secondhand smoke

Since the time of the study Uruguay became the first country in the Americas to be

smoke-free Buenos Aires passed a citywide ordinance that covers

most—but not all—bars and restaurants


Source: adapted by CTLT from Navas-Acien, et al. (2004).

Air Nicotine Concentrations (µg/m3) in Public Places


Smoke-Free Countries

Source: adapted by CTLT from Koh, H.K., et al. (2007).


FCTC: Smoke-Free Environments

Parties to the FCTC have committed themselves to protect their population from the harmful effects of tobacco smoke

The most effective initiative is to completely eliminate exposure to tobacco smoke in indoor environments

Protect all people in all public places


Summary

Assess secondhand tobacco smoke in public places to: Evaluate exposure Contribute to promote and enforce

smoke-free legislations

“There is no risk-free level of exposure to secondhand smoke”

“Eliminating smoking from indoor spaces fully protects nonsmokers from exposure to secondhand smoke”

Source: U.S. Surgeon General’s Report. (2006).

2007 Johns Hopkins Bloomberg School of Public Health Section B Assessing Secondhand Smoke Exposure in Public Places.

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