Smoke-free Indoors Research Articles

Exposure Assessment of Environmental Tobacco Aerosol from Heated Tobacco Products: Nicotine and PM Exposures under Two Limited Conditions.

It is too early to provide a clear answer on the impact of exposure to the second-hand aerosol of heated tobacco products (HTPs) in the planning of policy for smoke-free indoors legislation. Here, we conducted a preliminary study to evaluate indoor air quality with the use of HTPs. We first measured the concentration of nicotine and particulate matter (PM2.5) in the air following 50 puffs in the use of HTPs or cigarettes in a small shower cubicle. We then measured these concentrations in comparison with the use equivalent of smoking 5.4 cigarettes per hour in a 25 m3 room, as a typical indoor environment test condition. In the shower cubicle test, nicotine concentrations in indoor air using three types of HTP, namely IQOS, glo, and ploomTECH, were 25.9–257 μg/m3. These values all exceed the upper bound of the range of tolerable concentration without health concerns, namely 3 µg/m3. In particular, the indoor PM2.5 concentration of about 300 to 500 μg/m3 using IQOS or glo in the shower cubicle is hazardous. In the 25 m3 room test, in contrast, nicotine concentrations in indoor air with the three types of HTP did not exceed 3 μg/m3. PM2.5 concentrations were below the standard value of 15 μg/m3 per year for IQOS and ploomTECH, but were slightly high for glo, with some measurements exceeding 100 μg/m3. These results do not negate the inclusion of HTPs within a regulatory framework for indoor tolerable use from exposure to HTP aerosol, unlike cigarette smoke.

Romanian students’ attitude and opinion about the smoke-free indoors law

Abstract The Romanian Parliament approved the first piece of legislation regarding smoking in public places in 2002; smoking was banned in most indoors but allowed in bars and restaurants. The law has been amended several times; the 2016 amendment banned smoking in nearly all indoor public spaces, in indoor workplaces, in playgrounds and on public transport; there are only two exceptions to the law - cells in maximum security prisons and designated rooms in the transit areas of international airports. In this context, we asked 498 students (in Law, Business Administration, Electronics, Languages, Sciences, Medicine, Dentistry, Pharmacy or Nursing), aged 21.93 ± 4.21 years, males and females, to answer a 23-item questionnaire on cigarettes smoking; the questionnaire included seven questions related to the Romanian smoke-free indoors law. A number of 131 students (26.3%) are cigarettes-smokers; there are statistically significant differences among the faculties subgroups (p < 0.01), the highest percent of smokers being in Dentistry (50%) and the lowest - in Languages (13%). Most of the students (N = 466 - 93.6%) agree with the smoke-free indoors law; the disagreement is registered among the smokers (27 vs. 5 non-smokers, p < 0.001). A number of 360 subjects (72.29%) mention they met situations of smoking in public places: in bars/clubs/restaurants (73.3%), staircases of blocks of flats (56.1%), public transport or taxis (44.1%), even hospitals (8.3%) and classrooms (7.7%). In 75.8% out of these situations nobody took attitude; 40 students (11.1%) acted themselves and drew attention (most often successfully) to the smokers about breaking the law. One fifth of the smokers of the group have also smoked/intended to smoke in public places; most of them are students in Electronics and just one - in Law (p < 0.05). Romanian students seem to be content with the ban of indoor smoking. Actions to reduce consumption of tobacco products and to protect public health have to be continued. Key messages Romanian young people seem to be content with the decrease of second hand smoke in indoor public spaces. Intense actions to combat the tobacco epidemic are still needed in Romania.

Prison smoking bans in the United States: current policy, impact and obstacle

Smoking is the leading preventable risk factor of mortality in the United States. The threat of smoking is severer in prisons. Compared with the general US population, prisoners have a higher prevalence of smoking, as well as a higher smoking-related mortality. Nowadays, smoking bans have been enacted in 49 states’ federal correctional facilities, including 100% smoke-free and tobacco-free indoors and outdoors on all grounds (20 states), 100% smoke-free indoors and outdoors on all grounds (1 state), 100% smoke-free and tobacco-free indoors (16 states), and 100% smoke-free indoors (12 states). After implementation, a mortality reduction has been achieved, especially for cancers and respiratory diseases. In addition, a more comprehensive restriction (e.g., smoking and tobacco bans indoors and outdoors) and a longer implementation contribute to a higher reduction of mortality. However, some obstacles should not be ignored, such as the high relapse rate of smoking after release, existence of smoking in smoking-free prisons, nicotine dependence and nicotine withdrawal symptoms led by the bans, potentially high prevalence of mental illnesses among prisoners who also smoke, etc. Given the impact and obstacle of the current smoking bans, the author recommends that: (I) smoking bans should be kept enacting according to the mortality reduction after implementation; (II) more restrictive bans should be considered across the U.S. States, such as smoking-free insides and outsides on the ground; (III) further efforts should be made for reducing the high relapse rate of smoking after release; (IV) other implementations combining with smoking bans should be considered for smoking inmates with mental illnesses.

Association of campus tobacco policies with secondhand smoke exposure, intention to smoke on campus, and attitudes about outdoor smoking restrictions.

College campus tobacco-free policies are an emerging trend. Between September 2013 and May 2014, we surveyed 1309 college students at 8 public 4-year institutions across California with a range of policies (smoke-free indoors only, designated outdoor smoking areas, smoke-free, and tobacco-free). Stronger policies were associated with fewer students reporting exposure to secondhand smoke or seeing someone smoke on campus. On tobacco-free college campuses, fewer students smoked and reported intention to smoke on campus. Strong majorities of students supported outdoor smoking restrictions across all policy types. Comprehensive tobacco-free policies are effective in reducing exposure to smoking and intention to smoke on campus.

Youth exposure to in-vehicle second-hand smoke and their smoking behaviours: trends and associations in repeated national surveys (2006–2012)

ObjectiveTo extend the limited international evidence on youth in-vehicle second-hand smoke (SHS) exposure by examining trends in New Zealand, a country with a national smoke-free goal and indoors smoke-free environment...

Offen et al. Respond

LETTERS SMOKING AND TOBACCO USE WITHIN THE DEPARTMENT OF VETERANS AFFAIRS Offen et al. provide an insightful review of the complexity of enacting tobacco control policy at the federal level, as seen in their case study of the efforts by the US Department of Veterans Affairs (VA) to adopt a smoking ban in VA medical facilities in the early 1990s. 1 As the authors indicated, tobacco use among the US military has traditionally been higher than among the civilian population. 1 In recent years, however, the VA has made great strides in reducing the rate of smoking among veterans served. For veterans enrolled in the VA health care system in 2011, the proportion of smokers was 19.7%, 2 comparable to the 19.0% reported for the United States as a whole in 2011. 3 Although federal law still requires that VA health care facilities provide areas where pa- tients can smoke, 1 progress has been made in reducing exposure to secondhand smoke for both veterans and VA employees. In citing a 2005 VA survey on smoking and tobacco use cessation within the VA, the authors incorrectly stated that one quarter of 783 smoking sites reported by VA facilities were indoors. 1 In fact, Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www. editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu. all 783 smoking sites were outdoor smoking areas or shelters. 4 The 2005 survey actually reported that 36 out of 158 VA facilities (23%) still had an indoor smoking area somewhere at the facility, mainly in nursing homes and in- patient psychiatric units. 4 Although still far from ideal, by 2009 this number had dropped to 19 facilities; 88% had complete indoor smoke-free policies in place. 5 In referring to military and veteran facilities, it is important to note that the Department of Defense (DoD) and the VA are distinct federal executive branch agencies. Their vari- ous policies and initiatives are independent of each other, reflecting the differences in their populations and missions. Thus, in de- scribing the VA tobacco control efforts as a pattern of “advance and retreat,” the authors incorrectly attribute DoD policies and initia- tives to the VA. 1,6 The article they cited discusses DoD initiatives only, not the VA or VA policies. 6 This misperception that the two departments operate as a single unit is not uncommon, but it is one that must be avoided in future studies. j Kim Hamlett-Berry, PhD Dana E. Christofferson, PhD Richard A. Martinello, MD About the Authors The authors are with the Veterans Health Administration, US Department of Veterans Affairs, Washington, DC. Correspondence should be sent to Kim Hamlett-Berry, PhD, Department of Veterans Affairs, 810 Vermont Avenue (10P3B), Washington, DC 20640 (e-mail: kim.hamlett@va. gov). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted April 3, 2013. doi:10.2105/AJPH.2013.301375 Note. The authors certify that there is no financial conflict of interest with any financial organization with interest in the subject matter discussed in the letter. The views expressed here represent those of the authors and not necessarily those of the US Department of Veterans Affairs. Contributors K. Hamlett-Berry and D. E. Christofferson drafted the letter. R. A. Martinello supervised the overall writing and edited the final version. July 2013, Vol 103, No. 7 | American Journal of Public Health Acknowledgments The authors thank Richard Kaslow, MD, for his insightful comments.

Implementation and Enforcement of Tobacco Bans in Two Prisons in North Carolina: A Qualitative Inquiry

Despite the national trend that 90% of prisons have smoke-free indoors policies, compliance and enforcement remain barriers to policy success. Key informant interviews about policy compliance and enforcement were conducted with 10 staff and inmates at two North Carolina prison facilities, one with a complete ban (indoors and outdoors) and one with a partial ban (indoors only). Communication of the tobacco bans was consistent and well understood in both facilities. Barriers to compliance and enforcement, especially in the complete ban facility, included policy ''buy in,'' the emerging black market for cigarettes, staff support, and access to nicotine replacement therapy. Despite these barriers, most informants reported that implementation and enforcement of complete bans is possible with adequate communication about the policy and access to cessation therapy.

Smoking Policies of Licensed Child Day-Care Centers in the United States

The authors analyzed data from a national survey of 2003 directors of licensed child day-care centers to determine employee smoking policies, measure compliance with state and local employee smoking regulations for child day-care centers and state clean indoor air laws, and to estimate the extent of exposure to environmental tobacco smoke in these settings. Forty states regulated employee smoking in child day-care centers, but only three states required day-care centers to be smoke-free indoors. More than 99% of licensed child day-care centers had employee smoking policies that complied with the appropriate state or local smoking regulations. Nearly 55% of centers were smoke-free indoors and outdoors, and 26% were smoke-free indoors only. The best predictors of more stringent employee smoking policies were location in the West or South, smaller size, independent ownership, or having written smoking policies. Despite the presence of strong smoking policies at the majority of licensed child day-care centers, more than 752,000 children in the United States are at risk for environmental tobacco smoke exposure in these settings. Health care professionals and parents should insist that child day-care centers be smoke-free indoors and, preferably, smoke-free indoors and outdoors.