Northwest Ohio Environmental Tobacco Smoke Study Results Findings Relative to Economic Impact, ETS Related Contaminants, and Morbidity.

Northwest Ohio Environmental Tobacco Smoke Study Results

Findings Relative to Economic Impact, ETS Related Contaminants, and Morbidity

Introductions Welcome – Mike Renner, TUPCF executive

director Findings - Dr. James H. Price, Lead

researcher for Toledo economic and scientific studiesDr. Farhang Akbar-Khanzadeh, ETS Exposure

Principle InvestigatorDr. Sadik Khuder, Morbidity Principle Investigator

Background – Toledo Toledo CIA ordinance effective 8/24/03

Prohibits smoking in any public indoor placeExemptions include:

Entire rooms/halls rented for private functions Retail tobacco stores Bars with serving areas smaller than 245 sq. ft Membership associations Smoking lounges

Background – Bowling Green Bowling Green CIA ordinance effective 2/4/02

Prohibits smoking in any public indoor placeExemptions include:

Restaurants w/ bars where smoking contained w/in separate room

Bars can permit/prohibit smoking at their discretion Bowling alleys can permit/prohibit smoking at their

discretion

Research Goals

Develop test methods to measure the impact of CIA ordinances on health and the economy of Toledo and Bowling Green

Benefit other Ohio communities in their efforts towards the passage of a comprehensive CIA ordinance

Research Parameters

Significant sample size for each studyEconomic impact – studied about 700 bars,

restaurants and bowling alleysMorbidity study – referenced hospital

admissions/discharge data over 4.5 years Acknowledge limitations for each of the

studies

Post-Ordinance Findings Revealed

Economic impact of smoke-free public places

ETS exposure post ordinance Impact on local morbidity rates

Key Findings Economic Impact:

There appears to be no statistically significant difference in the economic stress indicator of bars, restaurants and bowling alleys in these communities following the establishment of their clean indoor air ordinances when compared to control cities.

ETS Related Contaminants: Designs of separate smoking lounges in the establishments

included in this research were not completely effective in containing all environmental tobacco smoke related containments. (Smoking lounges were established to allow smoking within designated enclosed rooms within businesses.)

Morbidity: Study results showed a 54% reduction in the rate of acute heart

attack admissions in Bowling Green, compared to Kent which showed a 34% reduction in the same post ordinance period.

Economic ImpactJames H. Price, PhD, MPH

Professor of Public Health, University of Toledo

Joseph A. Dake, PhD, MPH Wayne State University

Jan Ruma, MEd, CFRE Hospital Council of Northwest Ohio

Pam Butler, MPH Hospital Council of Northwest Ohio

Economic Impact Study – Purpose

Compare short-term financial effects of two communities with clean indoor air ordinances versus two control communities Clean indoor air ordinance – Toledo and Bowling Green Control communities – Youngstown and Kent

Determine whether the economic stress indicators of businesses in suburban communities’ have been reduced since the urban ordinance Pre and post implementation assessment of Toledo CIA

ordinance compared to Maumee, Perrysburg & Sylvania

Composition of Economic Stress Indicator Available data on

payment performance information Type of industry Size (number of employees) Corporate structure Public records Time in business under the same management Net profit after taxes Financial ratios (liquidity ratios, efficiency ratios, and profitability ratios)

Utilizing Financial data to categorize businesses into one of five groups: Group one = lowest probability of economic stress Group five = highest probability of economic stress

Economic Impact Study – Methods

No statistically significant impact on the economic stress indicators of bars, bowling alleys, and restaurants in Toledo or restaurants in Bowling Green were found for cities with CIA ordinances when compared to their control cities

Economic Impact Study – Results

Economic Impact Study – Results:Toledo and Youngstown

Toledo

Youngstown

Restaurants

First Half 2003 First Half 20040.5

2.5

2.0

1.5

1.0

3.0 Bars

First Half 2003 First Half 20040.5

2.5

2.0

1.5

1.0

3.0

Bowling Alleys

First Half 2003 First Half 20040.5

2.5

2.0

1.5

1.0

3.0

1.25 1.44

1.681.59

1.23

1.651.25

1.00

1.611.55

1.631.62

Economic Impact Study – Results:Toledo and Suburbs

Toledo

Maumee

Perrysburg

Sylvania

Bars

First Half 2003 First Half 20040.5

2.5

2.0

1.5

1.0

3.0

First Half 2003 First Half 2004

0.5

2.5

2.0

1.5

1.0

3.0

Restaurants

1.001.00

1.581.45 1.441.25

1.59 1.68

2.50 2.50

1.761.72

1.33

1.33

1.531.37

Economic Impact Study – Results:Bowling Green and Kent

Restaurants

0.5

1

1.5

2

2.5

3

Q1_03 Q2_03 Q3_03 Q4_03 Q1_04 Q2_04

Bowling Green Kent

Potential Limitations of the Economic Stress Study

Lack of long-term historical economic stress indicators for the cities

It may be that the economic stress levels of the businesses may have changed, but the measurement used was not sensitive enough to detect the changes

The financial stress of clean indoor air ordinances may be cumulative over years and this effect may be delayed

This study did not investigate the historical trend of new businesses opening and existing businesses closing (concurrent validity)

Only group data is reported; individual establishments may have been affected

Impact of Post-Ordinance ETS Exposure

Farhang Akbar-Khanzadeh, PhD Professor of Public Health, Medical College of Ohio

Sheryl Milz, PhD Assistant Professor of Public Health, Medical College of

Ohio

April Ames, MS Student, Medical College of Ohio

Sara Spino, MS Student, Medical College of Ohio

Christopher Tex, MPH Student, Medical College of Ohio

ETS Exposure Study – Background

Both ordinances in Toledo and Bowling Green provide allowances for separate smoking dining lounges in certain restaurant/bar establishments

ETS Exposure Study – Purpose

Examine whether the allowance of separate smoking lounges fully protects the public and employees in these establishments

Four bars and restaurants in Toledo and Bowling GreenOne in each city that allowed smokingOne in each city that did not allow smoking

Note: a sample of 9 bars and restaurants in Toledo and Bowling Green indicated that the sites sampled were representative of settings in these two cities

Control environments included a non-smoking office building and outdoors

ETS Exposure Study – MethodsStudy Size

ETS indicators monitored included: Nicotine 3-ethenylpyridine (3-EP) Respirable suspended particles based on Solanesol

(Sol-PM) Ultraviolet particulate matter (UVPM) Fluorescent particulate matter (FPM) Total respirable suspended particulate matter (RSP)

ETS Exposure Study – MethodsMonitoring

A total of 98 integrated active air samples were collected49 samples for nicotine and 3-EP49 samples for ETS-related particulate matters

In each of the above category: 14 personal samples inside restaurants 28 replicate area samples inside restaurants 2 area samples within office building 5 area samples collected outdoors

ETS Exposure Study – MethodsSample Size

ETS Exposure Study – Results

Results suggested that designs of smoking lounges of those restaurants studied were not effective in containing all environmental tobacco smoke within their walls

Nine out of eleven smoking restaurant/bar establishments examined, including the two used in this study, were in violation of one or more provisions of clean indoor air ordinances

ETS Exposure Study – Results

In smoking restaurants ETS-related contaminants were: Significantly higher in the smoking dining rooms than

in the non-smoking dining rooms Significantly higher in the non-smoking dining rooms

than in the control environment Not significantly different from those found in the

corresponding non-smoking and smoking dining rooms of the smoking restaurant/bar settings investigated pre-CIA ordinance

ETS Exposure Study – Results

In non-smoking restaurants/bars ETS contaminants were: Comparable to those determined in the

control (outdoors and non-smoking office) environment

Significantly lower than those found in both the smoking dining rooms and non-smoking dining rooms of the two smoking restaurant/bar establishments

ETS Exposure Study – ResultsN

ico

tine

Con

cent

ratio

n U

g/m

3

Sol

-PM

Con

cent

ratio

n U

g/m

3

UV

PM

Con

cent

ratio

n U

g/m

3

FP

M C

once

ntra

tion

Ug/

m3

0

15

10

5

20

25

Control NS Restaurant

NS in S Restaurant

S in S Restaurant

10

60

50

30

20

40

70

Control NS Restaurant

NS in S Restaurant

S in S Restaurant

Control NS Restaurant

NS in S Restaurant

S in S Restaurant

Control NS Restaurant

NS in S Restaurant

S in S Restaurant

120

100

80

60

40

2020

40

60

80

100

0

0

0

ETS Exposure Study – Limitations Whether the air handlers were being used

appropriately Whether the establishments were in

compliance at all times with the clean indoor air ordinances

This study did not compare separate smoking rooms to smoking areas within the same rooms as non-smoking sections

The results of this study suggest that the exemptions in the CIA Ordinances in the two cities of Toledo and Bowling Green have still left some unhealthy working and dining environments

To fully protect employees or patrons 100%

smoke-free policies should be established and enforced

ETS Exposure Study – Conclusions

Impact on Morbidity Relative to ETS

Sadik Khuder, PhDProfessor of Public Health, The Medical College of Ohio

Sheryl Milz, PhDAssistant Professor of Public Health, The Medical College of Ohio

Timothy Jordan, PhDAssistant Professor of Public Health, The University of Toledo

Kathy Silvestri, MPHThe Hospital Council of NW Ohio

Pam Butler, MPHThe Hospital Council of NW Ohio

Morbidity Impact Study – Purpose

Develop method for data collection and analysis to measure health effects of clean indoor air ordinancesObtain and establish baseline ETS-related

morbidity statistics for Toledo and Bowling Green

Obtained hospital discharge data from January 1999 –June 2003

Selection Criteria: Cities with clean indoor air ordinances

Bowling Green and Toledo Analysis included:

Separate analysis for youth <18 and adults 18-93 Specific focus on acute heart attacks in adults

Morbidity Impact Study – Methods

Decrease in Morbidity Due to AMI in BGMorbidity Impact Study – Results

Mor

bidi

ty R

ate

Per

1,0

00 P

opul

atio

n

.2

.4

.6

.8

1.0

1.2

1.4

1.6

1.8

1/99 –6/99

1/01 – 6/01

1/00 –6/00

7/99 – 12/99

7/00 – 12/00

7/01 – 12/01

1/02 – 6/02

1/03 – 6/03

7/02 – 12/02

Bowling Green Kent

Limitations May not necessarily be a sustainable change over

time Small number of admissions for diseases

potentially related to ETS exposure Prevented stratified analysis by age, gender, race and

other variables Unable to account for multiple admissions for the

same condition Greater than one-year delay in reporting morbidity

through hospital discharge data

Recap of Key Findings Economic Impact:

There appears to be no statistically significant difference in the economic indicator data of bars, restaurants and bowling alleys in Toledo and restaurants in Bowling Green following the establishment of their clean indoor air ordinances when compared to control cities.

ETS Related Contaminants: Designs of separate smoking lounges in the establishments

included in this research were not completely effective in containing all environmental tobacco smoke related containments. (Smoking lounges were established to allow smoking within designated enclosed rooms within businesses.)

Morbidity: Study results showed a 54% reduction in the rate of acute heart

attack admissions in Bowling Green, compared to Kent which showed a 34% reduction in the same post ordinance period.

Q&A