 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 2 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

 2007 Johns Hopkins Bloomberg School of Public Health 3 Secondhand Tobacco Smoke in Public Places Source: Navas-Acien, et al. (2004).

 2007 Johns Hopkins Bloomberg School of Public Health 4 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

 2007 Johns Hopkins Bloomberg School of Public Health 5 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 ArgentinaUATA BrazilINCA ChileMinistry of Health Costa RicaIAFA ParaguayMinistry of Health PeruCEDRO UruguayLocal Government of Montevideo HondurasIHADFA MexicoNational Institute of Public Health PanamaMinistry of Health GuatemalaFoundation Aldo Castañeda

 2007 Johns Hopkins Bloomberg School of Public Health 6 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

 2007 Johns Hopkins Bloomberg School of Public Health 7 Nicotine (µg) Air volume (m 3 ) 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).

 2007 Johns Hopkins Bloomberg School of Public Health 8 Fieldwork CountryTime of Sampling Total Number of Samples % Samples Nicotine Detected ArgentinaNovember, BrazilDecember, ChileOctober, Costa RicaDecember, HondurasOctober, MexicoFebruary, PanamaNovember, ParaguayFebruary, PeruJuly, UruguayNovember, Source: Navas, et al. (2004).

 2007 Johns Hopkins Bloomberg School of Public Health 9 Air Nicotine Concentrations (µg/m 3 ) in Public Places Source: adapted by CTLT from Navas-Acien, et al. (2004).

 2007 Johns Hopkins Bloomberg School of Public Health 10 Air Nicotine Concentrations (µg/m 3 ) in Restaurants Source: Navas-Acien, et al. (2004); Image source: New York City Department of Health and Mental Hygiene. Air Nicotine Concentrations (µg/m 3 ) in Restaurants in 10 Countries* Smoking policyNMedian (IQR) † No policy (0.32–2.44) Smoking section (0.43–2.31) Nonsmoking (0.20–1.10) Smoking ban70.07 (0.003–0.10) * Countries: Argentina, Brazil, Chile, Costa Rica, Paraguay, Peru, Uruguay, Honduras, Mexico and Panama † IQR: interquartile range

 2007 Johns Hopkins Bloomberg School of Public Health 11 Air Nicotine Concentrations (µg/m 3 ) in Hospitals Source: adapted by CTLT from Tobacco Atlas 2 nd Edition. (2006).

 2007 Johns Hopkins Bloomberg School of Public Health 12 Air Nicotine in Public Places: Media Impact

 2007 Johns Hopkins Bloomberg School of Public Health 13 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 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”

 2007 Johns Hopkins Bloomberg School of Public Health 14 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

 2007 Johns Hopkins Bloomberg School of Public Health 15 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

 2007 Johns Hopkins Bloomberg School of Public Health 16 Source: adapted by CTLT from Navas-Acien, et al. (2004). Air Nicotine Concentrations (µg/m 3 ) in Public Places

 2007 Johns Hopkins Bloomberg School of Public Health 17 Smoke-Free Countries Source: adapted by CTLT from Koh, H.K., et al. (2007).

 2007 Johns Hopkins Bloomberg School of Public Health 18 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

 2007 Johns Hopkins Bloomberg School of Public Health 19 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).