Smoking In Indoor Public Places Research Articles

Effect of Second-Hand Smoke Exposure on Establishing Urinary Cotinine-Based Optimal Cut-Off Values for Smoking Status Classification in Korean Adults.

Regulations for banning smoking in indoor public places and workplaces have increased worldwide in recent years. A consecutive Korean National Health and Nutrition Examination Survey (KNHANES) between 2008 and 2018 showed a trend toward significant decreases in self-reported tobacco smoke exposure and measured urinary cotinine concentrations. We established and compared each optimal cut-off value for assessing the effect of second-hand smoke (SHS) exposure on establishing urinary cotinine-based cut-off values for smoking status classification in a population setting controlled for racial and cultural diversity, using four KNHANES datasets consisting of the 2008, 2011, 2014, and 2018 surveys. A total of 18,229 Korean participants aged >19 years with measured urinary cotinine concentrations were enrolled. Self-reports of current smoking status showed that the prevalence of current smokers decreased from 22.9% to 18.2% between 2008 and 2018. During this period, the median value of urinary cotinine in nonsmokers decreased from 5.86 µg/L to 0.48 µg/L, whereas the median value showed no remarkable decrease in current smokers. The AUC-based optimal cut-off values of urinary cotinine concentration for distinguishing current smokers from nonsmokers decreased from 86.5 µg/L to 11.5 µg/L. Our study showed that decreased SHS exposure would result in decreased optimal cut-off values for distinguishing current smokers from nonsmokers. In addition, the study suggests that the range of urinary cotinine concentration to define SHS exposure for the trend monitoring of populationof SHS exposure is appropriate between 0.30 µg/L and 100 µg/L. In addition, our study showed the importance of determination of cotinine concentration, which would have allowed us to avoid mistakes in qualification to the study group in an increased use of e-cigarette setting.

The impact of comprehensive tobacco control policies on cardiovascular diseases in Beijing, China.

China has a high smoking prevalence, but lacks effective tobacco control interventions. In 2015, comprehensive policies that incorporated all six aspects of MPOWER were implemented in Beijing and were considered the strictest tobacco control policy implemented in China to date. Decreases in the prevalence of active smoking and secondhand smoke (SHS) exposure were observed thereafter. This study aimed to evaluate the impact of Beijing's 2015 tobacco control policy package on cardiovascular diseases (CVDs). Interrupted time-series study. Beijing, China. A total of 17.7 million employees enrolled in Urban Employee Basic Medical Insurance (UEBMI) between January 2013 to June 2017. Beijing's 2015 comprehensive tobacco policy package, combining a complete ban on smoking in indoor public places, cessation support, more comprehensive bans on advertising, and tax rises. The main outcome was hospital admissions for all CVDs and five major cause-specific CVDs, including ischaemic heart disease (IHD), heart failure (HF), heart rhythm disturbances (HRDs), stroke and other cerebrovascular diseases (CBDs). The absolute number and proportion of reductions in the number of hospital admissions after the policies are reported. A total of 419 875 hospital admissions for CVD were identified. In total, 13.4% [95% confidence interval (CI)=11.5%, 15.3%] of hospital admissions for CVD were averted by the tobacco control policies. For major cause-specific CVDs, significant hospital admission reductions occurred for IHD (5.4%, 95% CI=2.6%, 8.3%), stroke (21.2%, 95% CI=17.8%, 24.6%) and other CBDs (25.9%, 95% CI=20.8%, 31.0%), but not for HF (4.7%, 95% CI=-4.2%, 13.5%) or HRDs (4.7%, 95% CI=-2.9%, 12.3%). Beijing's 2015 tobacco control policy package appears to have been associated with a more than 10% reduction in all cardiovascular hospital admissions, including a more than 20% reduction in admissions for cerebrovascular diseases.

Changes in tobacco use patterns and motivation to quit related to the new smoke-free legislation in the Czech Republic.

Smoke-free policy belongs to key public health instruments to promote health in populations. In 2017, new comprehensive smoke-free law prohibiting smoking in indoor public places was implemented. We aimed to measure changes in tobacco smoking patterns and changes in motivation to quit in adult smokers prior to and after the new smoke-free legislation came into force. We conducted a prospective cohort study prior to and post the implementation of Act No. 65/2017 Coll. Self-reported questionnaires were administered to 131 adult smokers by trained nurses in general practitioner offices in Prague. We analysed changes in cigarette consumption per day; ratio of cigarettes smoked in pub, street, work and home; and motivation to quit using regression modelling. We found a statistically significant decrease in the daily consumption of cigarettes (an average of 1.7 cigarettes per day, P<0.001, d=0.34). Smoking in indoor public spaces decreased to almost zero, while tobacco consumption in outdoor public spaces (such as streets and squares) increased by nearly 20%. We observed statistically significant increase of motivation to quit smoking (P=0.021, d=0.21). The study brings valuable indication of the desired public health impact related to key legislative change in the Czech Republic.

Resident-Initiated Smoking Ban Surveillance: Text Mining of Shanghai Public Service Hotline Data

Background: On March 1st, 2017, the Amendment of Regulations of Shanghai Municipality on Smoking Control in Public Places was formalized in Shanghai. Since then, this comprehensive smoke-free law prohibits smoking in indoor public places, workplaces, and public transport. To reinforce this law, the 12345 platform was introduced as an avenue for residents to report smoking violations. Methods: Throughout March 2017, the hotline back-end server had logged a total of 6,937 telephone text records. All records were collected, and text data were analyzed by natural language processing. The analysis of text data has gone through several steps, namely data masking, missing data deletion, data deduplication and No Dictionary Cutting Word arithmetic. Furthermore, we established a keyword corpus and a MySQL database for our research. Findings: Compared to the average monthly call sheets (1655 call sheets) between 2016 and 2018, the call sheets established in March 2017 alone was as high as 6,927. Residents were more willing to call the hotline for complaining and consulting in the month after the comprehensive smoking ban was enacted. The locations of the smoking violation reported mainly concentrated in the public workplace, food services, leisure industry, and hotels. Interpretation: The promulgate of the Amendment of Regulations of Shanghai Municipality on Smoking Control in Public Places has successfully garnered the attention and participation of the public. Nevertheless, further effort in strengthening the implementation and enforcement by relevant tobacco control agencies is still needed. Targeted management strategy, a pivotal future research direction, is needed to enforce the smoking band in the most reported location. Funding: This project was supported by National Social Science Fund of China (Grant No. 17BSH056). Declaration of Interest: All authors have no conflicts of interest on this study. Ethical Approval:The primary data in this study was provided by the department of shanghai health hotline. At the same time, the study was approved by the department of shanghai health hotline. In this study, subjects' identities were concealed, i.e. anonymous. For protecting the participants’ confidentiality and privacy, this study did not collect the caller’s personal information.

Abstract 033: Associations of Smoke-Free Policies With Blood Pressure Changes in the Coronary Artery Risk Development in Young Adults Study

Introduction: Laws banning smoking in indoor public places have been associated with reductions in second-hand smoke exposure and cardiovascular disease among non-smokers. Second-hand smoke exposure has been associated with hypertension in prior studies. However, it is unknown whether smoke-free policies are associated with changes in blood pressure. Hypothesis: We tested the hypothesis that living in an area with a smoke-free policy banning smoking in restaurants, bars, and/or other workplaces is associated with reductions in systolic and diastolic blood pressure among non-smokers. Methods: Longitudinal data from 2,896 non-smoking participants of the Coronary Artery Risk Development in Young Adults (CARDIA) Study (aged 18-30 at enrollment, 1985-2011, 14,193 person-exam-years) were linked to state, county, and local 100% smoke-free policies in bars, restaurants, and/or non-hospitality workplaces based on participants’ census tract of residence at each exam. Fixed-effects linear regression estimated associations of each type of smoke-free policy (restaurant, bar, workplace) with within-person changes in systolic and diastolic blood pressure (SBP and DBP). Models adjusted for time-varying covariates: exam year (categorical), socio-demographic (education, income, marital status), health-related (body mass index, total physical activity, alcohol use), and policy (state cigarette tax, self-reported ban on smoking in their workplace) covariates, and interactions of baseline covariates (age, sex, race, field center) with exam year to account for differences in blood pressure patterns that were associated with these characteristics (p&lt;0.05 for all interactions). Blood pressure values were adjusted to reflect antihypertensive medication use (+10 mmHg for SBP, +5 mmHg for DBP for those on medication). Results: At baseline, mean SBP was 110.5 mmHg and mean DBP was 69.3 mmHg. By year 25, a majority of participants were exposed to smoke-free policies in restaurants (1,759 of 2,264, 78%), bars (1,536 of 2,264, 68%), and other workplaces (1,518 of 2,264, 67%). Smoke-free policies were associated with within-person reductions in SBP and DBP in fully adjusted models (expressed as average change between exams in mmHg). Mean reductions in SBP were -0.77 (95% CI: -1.51, -0.02) for restaurant policies, -0.73 (95% CI: -1.54, 0.08) for bar policies, and -0.79 (95% CI: -1.51, -0.08) for workplace policies. Mean reductions in DBP were -0.67 (95% CI: -1.27, -0.06) for restaurant policies, -0.54 (95% CI: -1.20, 0.11) for bar policies, and -0.86 (95% CI: -1.44, -0.28) for workplace policies. Conclusions: Smoke-free policies in restaurants and other workplace are associated with within-person reductions in systolic and diastolic blood pressure among non-smokers. These results suggest an additional health benefit of these policies beyond those previously described in the literature.

Cardiovascular Events Following Smoke-Free Legislations: An Updated Systematic Review and Meta-Analysis.

Legislations banning smoking in indoor public places and workplaces are being implemented worldwide to protect the population from secondhand smoke exposure. Several studies have reported reductions in hospitalizations for acute coronary events following the enactment of smoke-free laws. We set out to conduct a systematic review and meta-analysis of epidemiologic studies examining how legislations that ban smoking in indoor public places impact the risk of acute coronary events. We searched MEDLINE, EMBASE, and relevant bibliographies including previous systematic reviews for studies that evaluated changes in acute coronary events, following implementation of smoke-free legislations. Studies were identified through December 2013. We pooled relative risk (RR) estimates for acute coronary events comparing post- vs. pre-legislation using inverse-variance weighted random-effects models. Thirty-one studies providing estimates for 47 locations were included. The legislations were implemented between 1991 and 2010. Following the enactment of smoke-free legislations, there was a 12 % reduction in hospitalizations for acute coronary events (pooled RR: 0.88, 95 % CI: 0.85-0.90). Reductions were 14 % in locations that implemented comprehensive legislations compared to an 8 % reduction in locations that only had partial restrictions. In locations with reductions in smoking prevalence post-legislation above the mean (2.1 % reduction) there was a 14 % reduction in events compared to 10 % in locations below the mean. The RRs for acute coronary events associated with enacting smoke-free legislation were 0.87 vs. 0.89 in locations with smoking prevalence pre-legislation above and below the mean (23.1 %), and 0.87 vs. 0.89 in studies from the Americas vs. other regions. The implementation of smoke-free legislations was related to reductions in acute coronary event hospitalizations in most populations evaluated. Benefits are greater in locations with comprehensive legislations and with greater reduction in smoking prevalence post-legislation. These cardiovascular benefits reinforce the urgent need to enact and enforce smoke-free legislations that protect all citizens around the world from exposure to tobacco smoke in public places.

Association between current asthma and secondhand smoke exposure in vehicles among adults living in four US states

ObjectiveMany states have implemented laws prohibiting tobacco smoking in indoor public places. However, private settings remain a major source of secondhand smoke (SHS) exposure for many people. We assessed the...

How smokers may react to cigarette taxes and price increases in Brazil: data from a national survey

BackgroundDespite being the third largest tobacco producer in the world, Brazil has developed a comprehensive tobacco control policy that includes a broad restriction on both advertising and smoking in indoor public places, compulsory pictorial warning labels, and a menthol cigarette ban. However, tax and pricing policies have been developed slowly and only very recently were stronger measures implemented. This study investigated the expected responses of smokers to hypothetical price increases in Brazil.MethodsWe analyzed smokers’ responses to hypothetical future price increases according to sociodemographic characteristics and smoking conditions in a multistage sample of Brazilian current cigarette smokers aged ≥14 years (n = 500). Logistic regression analysis was used to examine the relationship between possible responses and different predictors.ResultsIn most subgroups investigated, smokers most frequently said they would react to a hypothetical price increase by taking up alternatives that might have a positive impact on health, i.e., they would “try to stop smoking” (52.3%) or “smoke fewer cigarettes” (46.8%). However, a considerable percentage responded that they would use alternatives that would reduce the effect of price increases, such as the same brand with lower cost (48.1%). After controlling for sex age group (14–19, 20–39, 40–59, and ≥60 years), schooling level (≥9 versus ≤9 years), number of cigarettes per day (>20 versus ≤20), and stage of change for smoking cessation (precontemplation, contemplation, and preparation), lower levels of dependence were positively associated with the response “I would try to stop smoking” (odds ratio [OR], 2.19). Young age was associated with “I would decrease the number of cigarettes” (OR, 3.44). A low schooling level was strongly associated with all responses.ConclusionsTaxes and prices increases have great potential to stimulate cessation or reduction of cigarette consumption further among two important vulnerable populations of smokers in Brazil: young smokers and those of low educational level. The results from the present study also suggest that seeking illegal products may reduce the impact of increased taxes, but does not eliminate it.

Factors associated with parental smoking in the presence of school-aged children: a cross-sectional study

BackgroundIn 2009, the Tobacco Hazards Prevention Act (Taiwan) was amended to more effectively restrict smoking in indoor public places and workplaces in Taiwan. However, the lack of prohibitions for smoking in private homes may place family members at increased risk for exposure to environmental tobacco smoke (ETS). The aim of our study was to determine the factors associated with parental smoking in the presence of children at home.MethodsIn 2010, we performed a cross-sectional study of factors associated with parental smoking in the presence of children at home in Taiwan using self-administered questionnaires. Quota sampling was used to select five primary schools from four different regions of Taiwan. Parents were surveyed to identify parental smokers and 307 parental smokers were selected for participation in our study. Questionnaire data regarding parental smoking in the presence of children at home and related interactions among family members were analyzed. Hierarchical logistic regression was used to determine the best-fit model for examining the relationships among the variables related to parental smoking in the presence of children at home.ResultsTwo-thirds of parents who smoked reported smoking in the presence of their children. The results of the hierarchical logistic regression analysis identified the smokers’ compliance with their family’s antismoking responses, mutual agreement with smoking bans, daily smoking, smoking more than 20 cigarettes per day, the education level of the parental smoker, and the annual family income as determinants of smoking in the presence of children at home.ConclusionsHouseholds with smoking parents should be targeted for interventions to encourage the adoption and enforcement of home smoking bans. Educational interventions that promote smoke-free homes for children and provide support to help parents stop smoking are critical factors in reducing the frequency of children’s ETS exposure in the home.

Tobacco control in the Middle East

On Sept 3, 2012, Lebanon introduced legislation prohibiting smoking in indoor public places. Hefty fines are mandated for individuals and businesses that flout the law. A couple of years ago, Syria enacted similar measures—the first country in the region to do so. A visit from WHO in the winter of 2010 confirmed that the Syrian ban was indeed being implemented, but the events of the past 18 months or so make it unlikely that this is still the case. Neighbouring Lebanon is in a better position to police its smoking ban.

Swiss vote “no” to comprehensive smoking ban

Switzerland has rejected a national ban on smoking in indoor public places. The proposal was put to the population in a referendum held on Sunday, Sept 23. Turnout was low, but the outcome was in little doubt. 66% of respondents voted against amending the federal constitution so as to outlaw smoking in all enclosed public venues. Geneva was the only one of 26 cantons to vote in favour of the proposal (and then only by a narrow margin). Switzerland now joins Germany, Romania, and the Czech Republic in failing to enact such legislation.

England's legislation on smoking in indoor public places and work‐places: impact on the most exposed children

To examine whether English legislation to make virtually all indoor public places and work-places smoke-free on 1 July 2007 displaced smoking into the home and hence increased the proportion of children exposed to levels of second-hand smoke known to be detrimental to health. Repeated cross-sectional study with data from 10 annual surveys undertaken from 1996 to 2008. England. Nationally representative samples of non-smoking children aged 4-15 years old living in private households. Salivary cotinine, parental smoking status, whether smoking is allowed within the house, socio-demographic variables. The proportion of children exposed to damaging levels of second-hand smoke (defined as those with cotinine levels >1.7 ng/ml) has fallen over time, from 23.5% in 1996 to 12.6% in 2008. The legislation was not associated with further changes in the proportion of children above this threshold-the odds of having cotinine >1.7 ng/ml did not change after adjustment for the pre-legislative trend and confounders (odds ratio: 1.0, 95% confidence interval: 0.78, 1.4). Non-significant associations were also found when examining children by parental or household smoking status. Legislation to prohibit smoking in indoor public places and work-places does not increase the proportion of children exposed to damaging levels of second-hand smoke. Even in a country with a strong tobacco control climate, a significant proportion of children remain highly exposed to second-hand smoke and future policies need to include interventions to reduce exposure among these children.

A 32-country comparison of tobacco smoke derived particle levels in indoor public places

Objective: To compare tobacco smoke-derived particulate levels in transportation and hospitality venues with and without smoking in 32 countries using a standardised measurement protocol. Methods: The TSI SidePak AM510 Personal...

Effects of the Tobacco Products Control Amendment Act of 1999 on restaurant revenues in South Africa--a survey approach.

To investigate the impact of the restrictions on smoking in indoor public places on the financial situation of the hospitality industry. A telephone survey was undertaken of 1011 restaurants, selected by searching public-access Internet databases. Fifty per cent of surveyed restaurants spent an average of R67 000 (median of R25 000) to comply with the clean indoor air legislation. The capital cost for the remaining 50% of restaurants was zero. The impact on restaurant revenues was limited: 59% of restaurants reported no change in revenue, 22% an increase and 19% a decrease as a result of the legislation. Franchised restaurants experienced a net gain in revenue (34% reporting an increase, 16% reporting a decrease, and 50% reporting no change), although on average they incurred more costs to comply with the legislation than independent restaurants. On average, independent restaurants reported a decrease in their revenues as a result of the legislation (21% reporting a decrease, 13% reporting an increase, and 66% reporting no change). Ninety-two per cent of respondents believed that their restaurants complied with the legislation. The new smoking policies have been well accepted by nonsmokers (nearly 100%) and smokers (87%) alike. Despite the hospitality and tobacco industries' claim that the law restricting smoking in restaurants would have very detrimental financial consequences, the retrospective evidence does not support this.

TALKING ABOUT…

TALKING ABOUT…

Business as usual for smoke-free places.

Nearly two years after Ireland became one of the first countries to strictly enforce a comprehensive ban on smoking in indoor public places, including bars, cafes and restaurants, more countries are taking tough--and not-so-tough--action against passive smoking. A few weeks before the ban came into force in Ireland, Dublin banker Jimmy Fogarty asked the barman at his local pub: What are you going to do when the ban comes in? Breathe, the barman replied. The ban has since been embraced--albeit reluctantly--by Ireland's hospitality industry, though wholeheartedly by staff working in the sector. However, some studies have shown to be unfounded industry representatives' fears that business would dip. A study partially funded by Ireland's Office of Tobacco Control (OTC) that was published in the Irish Journal of Medical Science in July reported that the number of customers in 38 Dublin public houses had increased by 11% since the ban. Predictably, tobacco industry-sponsored studies say otherwise. But for publicans and clients, it's still business as usual. At Mulligans pub in the centre of Dublin, manager Gary Cusack said that the number of clients dipped during the first three months after the ban, but soon picked up to the usual levels after that: for our staff, they're delighted, as the work environment is a lot healthier now. Mulligans is one of the many pubs that created an outdoor area to keep smokers happy and now welcomes a new clientele: families with children. The Irish ban, which came into force in March 2004, was not so much to encourage people like Fogarty to give up smoking, but to protect people like his barman, according to Nigel Fox, an OTC spokesman. According to OTC statistics, there has been a slight reduction in the proportion of the population that smokes since the ban, from 25.5% in March 2004 to 24% in June 2006. An OTC study published in November 2005 showed a decline in exposure to second-hand smoke and a decline in respiratory symptoms in non-smoking bar staff in pubs. The tough measures were taken after Ireland signed up to WHO's Framework Convention on Tobacco Control, the world's first legally binding public health accord, in September 2003. It was not the first to be tough on smoking. Singapore introduced laws restricting smoking in public places and prohibiting tobacco advertisements in the 1970s. In 1986, the Ministry of Health launched a programme for smoking control, with the motto: Towards a Nation of Non-Smokers. Bans have been strictly enforced in two US states: California (1998) and New York (2003). New South Wales in Australia banned smoking in public places in 2000. But since the treaty's adoption, the number of countries taking tough action has grown fast. As of November 2006, 139 plus the European Union bloc of 25 countries had become parties to the treaty. These countries are required to impose a comprehensive ban on tobacco advertising, promotion and sponsorship with in five years. The treaty requires parties to adopt and implement effective legislative and other measures providing for protection from exposure to tobacco smoke in public places. Failure to comply with the Convention's terms can expose countries and individuals in those countries to potentially costly criminal or civil legal action. In 2001, Israel became one of the first countries to impose a ban on smoking in public places, but enforcement has been weak. This year Israel, as party to the WHO Framework Convention, became one of the first countries to see successful legal action based on the treaty, when a pregnant woman sued a restaurant owner for allowing smoking. The list of countries with smoking bans in public places is growing. But facing pressure to enact weaker prohibitions, some have imposed only partial bans that allow smoking in limited circumstances in bars, cafes and restaurants. …

Talking about…

Talking about…

"The case for clean indoor air"

In 2004, a Tsunami in South Asia killed more than 180,000 people and the world recoiled in shock and disbelief. In 2005 an earthquake in Pakistan killed close to 100,000 and the world was devastated. These are truly terrible disasters that continue to claim lives, and we are rightly horrified by their scope and scale.

Le contrôle du tabac en Afrique du Sud

The aim of this paper is to briefly describe South Africa's experience in tobacco control, and to highlight some of the lessons that are applicable to other developing countries. South Africa's tobacco control strategy is based on two main pillars: (1) rapidly increasing excise taxes on tobacco, and (2) comprehensive legislation, of which the most important features are banning all tobacco advertising and sponsorship, and prohibition of smoking in public and work places. As a result of the increases in the excise tax, the real (inflation-adjusted) price of cigarettes has increased by 115% between 1993 and 2003. Aggregate cigarette consumption has decreased by about a third and per capita consumption has decreased by about 40% since 1993. Despite the decrease in cigarette consumption, real government revenue from tobacco excise taxes has increased by nearly 150% between 1993 and 2003. Some important lessons can be drawn from South Africa's experience in tobacco control. Firstly, strong and consistent lobbying was required to persuade the government to implement an effective tobacco control strategy. Country-specific research, drawn from a variety of disciplines, was used to back up and give credibility to the lobbyists' appeals. Secondly, rapid increases in the excise tax on cigarettes are particularly effective in reducing tobacco consumption. An increase in the excise tax increases the price of cigarettes, which in turn reduces cigarette consumption. In South Africa a 10% increase in the real price of cigarettes decreases cigarette consumption by between 6 and 8%. Similar results have been found for many other developing countries. Thirdly, while an increase in the excise tax is generally regarded as the most effective tobacco control measure, tobacco control legislation also plays an important role in a comprehensive tobacco control strategy. Bans on tobacco advertising and bans on smoking in public and work places denormalise and deglamorise smoking, and are likely to make other tobacco control interventions more effective. Fourthly, the industry would typically claim that they want to be constructive partners in drafting "reasonable and sensible" tobacco control legislation. In South Africa's experience, when they were involved in the drafting process in 1993, the role of the industry was to delay and water down the legislation. In drafting an amendment to the original legislation in 1998, the industry's views were largely ignored, and the result was a more comprehensive and effective piece of legislation. Fifthly, tobacco control legislation, particularly laws banning smoking in indoor public places, is largely self-enforcing. It does not require heavy-handed police intervention, as is typically claimed by the industry. The legislation clarifies and explains that the rights of non-smokers to clean air supersede the right of smokers to smoke. Smokers typically refrain from smoking where smoking is not allowed.