Assessment of risk for asthma initiation and cancer and heart disease deaths among patrons and servers due to secondhand smoke exposure in restaurants and bars.

BACKGROUND: Despite efforts to reduce exposure to secondhand smoke (SHS), only 5% of the world's population enjoy smoke-free restaurants and bars. METHODS: Lifetime excess risk (LER) of cancer death, ischaemic heart disease (IHD) death and asthma initiation among non-smoking restaurant and bar servers and patrons in Minnesota and the US were estimated using weighted field measurements of SHS constituents in Minnesota, existing data on tobacco use and multiple dose-response models. RESULTS: A continuous approach estimated a LER of lung cancer death (LCD) of 18 × 10(-6)(95% CI 13 to 23 × 10(-6)) for patrons visiting only designated non-smoking sections, 80 × 10(-6)(95% CI 66 to 95 × 10(-6)) for patrons visiting only smoking venues/sections and 802 × 10(-6)(95% CI 658 to 936 × 10(-6)) for servers in smoking-permitted venues. An attributable-risk (exposed/non-exposed) approach estimated a similar LER of LCD, a LER of IHD death about 10(-2) for non-smokers with average SHS exposure from all sources and a LER of asthma initiation about 5% for servers with SHS exposure at work only. These risks correspond to 214 LCDs and 3001 IHD deaths among the general non-smoking population and 1420 new asthma cases among non-smoking servers in the US each year due to SHS exposure in restaurants and bars alone. CONCLUSIONS: Health risks for patrons and servers from SHS exposure in restaurants and bars alone are well above the acceptable level. Restaurants and bars should be a priority for governments' effort to create smoke-free environments and should not be exempt from smoking bans.

Secondhand smoke exposure in the nonsmoking section: how much protection?

INTRODUCTION: Secondhand smoke (SHS) exposure continues to be a problem in bars and restaurants where smoking is permitted. This study measures the relative SHS exposure reduction in nonsmoking sections of establishments that allow some smoking. METHODS: Measurements were conducted simultaneously in the smoking and nonsmoking sections of 14 Minnesota hospitality venues. All of the 16 two-hr visits included photometer measurements of fine particles (PM2.5) and 12 of the visits also included measurements of 4 gas-phase tracers of SHS. RESULTS: The median ratio of nonsmoking/smoking section PM2.5 concentrations was 0.65 with an interquartile range (IQR) of 0.49-0.72. Measurements conducted after implementation of a smoking ban at 13 of the venues resulted in a smoking section PM2.5 post-ban/pre-ban ratio of 0.06 (IQR = 0.02-0.16). The median nonsmoking/smoking section ratios for gas-phase compound were 0.67 (IQR = 0.35-0.78) for pyridine, 0.52 (IQR = 0.30-0.70) for pyrrole, 0.43 (IQR = 0.35-0.84) for 3-EP, and 0.27 (IQR = 0.16-0.47) for nicotine. These results are consistent with the expectations of differential removal: the lowest ratios are for the least volatile, most strongly sorbing gases and the highest ratios for less sorbing gases and PM2.5. CONCLUSIONS: Designated nonsmoking sections in establishments that allow some smoking resulted in a median PM2.5 reduction of 35% compared with a 94% reduction after a smoking ban. The only adequate protection from cigarette smoke exposure is to eliminate smoking in indoor spaces.

Secondhand smoke and smokefree policies in owner-occupied multi-unit housing.

BACKGROUND: Studies have documented movement of secondhand smoke (SHS) between units in multi-unit buildings, but none has focused on owner-occupied units in common-interest communities (CICs). In Minnesota, approximately 170,000 households (8%) live in such units. CIC households may experience long-term SHS exposure because owner-occupants typically live in the same unit for many years. PURPOSE: This study estimated the prevalence of SHS incursion in CICs and assessed residents' attitudes toward SHS incursions and interest in smokefree policies. METHODS: A stratified sample of Minnesota CIC owner-occupants was surveyed in 2009, with analysis in 2010-2011. Data were weighted to account for differing sampling, response, and coverage rates by stratum, then calibrated to population control totals for housing type, age, and smoking status. RESULTS: The response rate was 35.6%, with 495 completions. Twenty-eight percent of households reported SHS incursion into their unit in the preceding 6 months; 59% of these said this bothers them a lot. Only 6% report that their CIC has a smokefree policy for residents' units. Forty-two percent would prefer such a policy whereas 26% would prefer smoking-permitted. Sixty-three percent definitely and 17% probably would choose a no-smoking building over a smoking-permitted building if they were buying a new unit, and 46% would be willing to pay more for such a unit. CONCLUSIONS: Secondhand smoke incursion is common in CICs, and interest in smokefree CICs greatly exceeds the supply. Given the known health risks of SHS exposure, tobacco control efforts in multi-housing should address CICs as well as rental households.

Change in indoor particle levels after a smoking ban in Minnesota bars and restaurants.

BACKGROUND: Smoking bans in bars and restaurants have been shown to improve worker health and reduce hospital admissions for acute myocardial infarction. Several studies have also reported improved indoor air quality, although these studies generally used single visits before and after a ban for a convenience sample of venues. PURPOSE: The primary objective of this study was to provide detailed time-of-day and day-of-week secondhand smoke-exposure data for representative bars and restaurants in Minnesota. METHODS: This study improved on previous approaches by using a statistically representative sample of three venue types (drinking places, limited-service restaurants, and full-service restaurants), conducting repeat visits to the same venue prior to the ban, and matching the day of week and time of day for the before- and after-ban monitoring. The repeat visits included laser photometer fine particulate (PM2.5) concentration measurements, lit cigarette counts, and customer counts for 19 drinking places, eight limited-service restaurants, and 35 full-service restaurants in the Minneapolis/St. Paul metropolitan area. The more rigorous design of this study provides improved confidence in the findings and reduces the likelihood of systematic bias. RESULTS: The median reduction in PM2.5 was greater than 95% for all three venue types. Examination of data from repeated visits shows that making only one pre-ban visit to each venue would greatly increase the range of computed percentage reductions and lower the statistical power of pre-post tests. Variations in PM2.5 concentrations were found based on time of day and day of week when monitoring occurred. CONCLUSIONS: These comprehensive measurements confirm that smoking bans provide significant reductions in SHS constituents, protecting customers and workers from PM2.5 in bars and restaurants.

Secondhand smoke in apartment buildings: renter and owner or manager perspectives.

This study explored the views of Minnesota renters and apartment owners or managers about environmental tobacco smoke (ETS) transfer between units in multifamily buildings and about smoke-free housing. A convenience sample of 49 decision makers who manage 27,116 rental units in Minnesota were aware of some ETS transfer in their buildings, but most felt it was rarely or never a significant factor in tenants' decisions to rent or to move. Most of those who had never designated a building smoke free had little or no interest in doing so, due to concerns that it would increase vacancy rates, constitute discrimination, or engender costs for enforcement. Owners who had already designated smoke-free buildings, however, had seen mostly neutral or positive effects on vacancies, turnover, and time required to manage the buildings, and planned to continue offering them. A total of 48% of households in a random sample of 405 reported that at times ETS enters their apartment from elsewhere; 10% said this occurs often or most of the time. Of those experiencing ETS transfer, 37% said it bothered them a lot or so much that they were thinking of moving. Only a small fraction of renters currently live in smoke-free buildings, but nearly half would be extremely or very interested in doing so. Interest is high across ethnicities, income levels, rent levels, and age groups and regardless of whether the household has children. 54% of respondents would be very likely to choose a smoke-free building, all other things being equal, and 34% would be willing to pay more to live in one.