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
4 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
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).
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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
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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
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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
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Positive Health Impact of Smoke-Free Environments
Source: Navas, A. (2007).
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Impact on Cardiovascular Health
Source: adapted by CTLT from Bartecchi, et al. (2006).
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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
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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).
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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
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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
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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