2007 Johns Hopkins Bloomberg School of Public Health Secondhand Tobacco Smoke in Public Places Ana...

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

Secondhand Tobacco Smoke in Public PlacesSecondhand Tobacco Smoke in Public Places

Ana Navas-Acien, MD, PhD, MPHJohns Hopkins Bloomberg School of Public Health

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

Section ASection A

Smoke-Free Environments

3 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health

Learning Objectives

Discuss the main direct and indirect benefits of smoke-free environments

View creating smoke-free environments as a key strategy for tobacco control worldwide

Describe policy relevant methods to track exposure to secondhand tobacco smoke in public places and to evaluate smoke-free policies

Provide country and state examples with complete smoke-free policies in public places


WHO Framework Convention on Tobacco Control

Article 8: Protection from Exposure to Tobacco Smoke “Parties recognize that scientific evidence has

unequivocally established that exposure to tobacco smoke causes death, disease, and disability”

“Each party shall adapt and implement, in areas of existing rational jurisdiction as determined by national law, and actively promote at other jurisdictional levels the adoption and implementation of effective, legislative, 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”

Source: World Health Organization. (2005).


Why Are Smoke-Free Environments Important?

Smoke-free environments prevent death and disease

Direct health benefits Protect nonsmokers from the health consequences of

involuntary exposure to tobacco smoke Less people exposed to tobacco smoke less

disease

Indirect health benefits Motivate smokers to quit and reduce tobacco

consumption Reduce the number of people initiating smoking

Less people smoke less disease


Source: Fichtenberg and Glantz. (2002).

Evidence Supporting Smoke-Free Workplaces

Systematic review of 26 studies found that smoke-free workplaces were associated with: Reduction in smoking prevalence =

3.8% (95% CI*: 2.8%, 4.7%) Reduction in cigarettes/day among

smokers = 3.1 (95% CI*: 2.4, 3.8) Limitation: cross-sectional evidence

*CI: confidence interval


Evidence Supporting Smoke-Free Workplaces

Source: Bauer, et al. (2005).

Impact of Worksite Smoking Policies (Three Levels) on Quitting and Amount Smoked

Quitting Amount smoked

Worksite smoking policy (1993–2001)

No. of responden

ts

Quit, Raw %

OR(95% CI)

Unadjusted mean

CPD†

No. of responden

ts

weight(95% CI)

Level 1: maintained or changed to smoking allowed everywhere

93 20.1 Reference 21.8 88 Reference

Level 2: maintained or changed to smoking in designated areas

335 27.41.73 (0.96, 3.11)

19.8 262–0.82

(–0.96, 1.21)

Level 3: maintained or changed to smoking prohibited

1,391 30.51.92* (1.11, 3.32)

16.9 1,038–2.57

(–4.40, –0.59)*

*P < .05; †CPD = cigarettes per day


Positive Health Impact of Smoke-Free Environments

Source: Navas, A. (2007).


Impact on Cardiovascular Health

Source: adapted by CTLT from Bartecchi, et al. (2006).


Impact on Respiratory Health

Source: Menzies, et al. (2006).

Symptoms and Spirometry Before and After Introduction of the Smoking Ban (N=77)

Before Ban

1 Month After Ban

Change from Baseline (95% CI)

P Value

Symptoms, % (No.)

Any 79.2 (61) 53.2 (41)–26 (–13.8 to –

38.1)<.00

1

Respiratory 62.3 (48) 41.5 (32)–20.8 (–7.6 to –

33.9).005

Sensory 71.4 (55) 40.3 (31)–31.2 (–18.1 to –

44.3)<.00

1

No. of symptoms, median (IQR)

2 (1 to 4) 1 (0 to 3) –1 (–2 to 0) .001

FEV1, mean (SE), %

Entire cohort96.6

(2.26)104.8 (2.53)

8.2 (3.9 to 12.4)<.00

1

Otherwise healthy98.7

(2.52)104.4 (2.94)

5.7 (1.0 to 10.3) .04

Asthma90.3

(4.86)106.1 (5.06)

15.7 (5.7 to 25.7) .008

CI=confidence interval; FEV1=forced expiratory volume in the first second; IQR=interquartile range


Other Reasons to Support Smoke-Free Environments

Large public support for smoke-free legislations

Support increases when legislation passes In Ireland, support for a total ban in workplaces

increased from 40% before the ban to 65% after the smoking ban*

No economic damage to business Best designed studies report no impact or a positive

impact of smoke-free legislations in bars and restaurants on sales or employment†

Strong opposition of tobacco industry

Source: *Fong, et al. (2006); †Scollo, et al. (2003).


Challenge to Smoke-Free Policies: Industry Tactics

Industry promotes ineffective policies Accommodation Ventilation

Influence on legislation

Negation or minimization of health effects

Image source: adapted by CTLT from Tobacco Atlas 2nd Edition. (2006); Text source: Ramsey S. (2002).

“If smoking were banned in all workplaces, the

industry’s average consumption would

decline… and the quitting rate would increase…

Clearly, it is most important for PM to continue to support accommodation for

smokers in the workplace.”

- Philip Morris, 1992


Challenge to Smoke-Free Policies: Industry Tactics

“According to PAHO, the report reveals that tobacco companies hired scientists throughout Latin America and the Caribbean to misrepresent the science linking second-hand smoke to serious diseases, while cloaking in secrecy any connection of these scientists with the tobacco industry”

—S. Ramsey, 2002


Reasons Why Smoke-Free Environments Are Important

Protect nonsmokers

Help smokers to quit and to reduceconsumption

Denormalization of tobacco use to reduceinitiation of tobacco by youth

Large support for smoking bans by population

No economic damage to business

2007 Johns Hopkins Bloomberg School of Public Health Secondhand Tobacco Smoke in Public Places Ana...

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