Air quality, mortality, and economic benefits of a smoke – free workplace law for non-smoking Ontario bar workers

Repace Associates, Inc, 101 Felicia Lane, Bowie, MD, 20720.
Indoor Air (Impact Factor: 4.9). 04/2013; 23(2):93-104. DOI: 10.1111/ina.12004


We estimated the impact of a smoke-free workplace bylaw on non-smoking bar workers' health in Ontario, Canada. We measured bar workers' urine cotinine before (n = 99) and after (n = 91) a 2004 smoke-free workplace bylaw. Using pharmacokinetic and epidemiological models, we estimated workers' fine-particle (PM 2.5) air pollution exposure and mortality risks from workplace secondhand smoke (SHS). Workers' pre-law geometric mean cotinine was 10.3 ng/ml; post-law dose declined 70% to 3.10 ng/ml and reported work hours of exposure by 90%. Pre-law, 97% of workers' doses exceeded the 90th percentile for Canadians of working age. Pre-law-estimated 8-h average workplace PM 2.5 exposure from SHS was 419 ug/m3 or 'Very Poor' air quality, while outdoor PM 2.5 levels averaged 7 ug/m3 , 'Very Good' air quality by Canadian Air Quality Standards. We estimated that the bar workers' annual mortality rate from workplace SHS exposure was 102 deaths per 100 000 persons. This was 2.4 times the occupational disease fatality rate for all Ontario workers. We estimated that half to two-thirds of the 10 620 Ontario bar workers were non-smokers. Accordingly, Ontario's smoke-free law saved an estimated 5–7 non-smoking bar workers' lives annually, valued at CA $50 million to $68 million (US $49 million to $66 million). Practical Implications Worker's cotinine measurements can be compared with population databases to assess an occupational group's dose of secondhand smoke relative to the general population. Cotinine can be used to estimate secondhand smoke air pollution exposures and risks for workers and evaluate the efficacy of smoke-free workplace laws in terms of lives and social costs saved. Although Canadian bars are now smoke-free, substantial exposure persists on bar patios, and in many other countries, indoor air in bars remains polluted with secondhand smoke.

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    ABSTRACT: Honorable members of the National Assembly, my name is James Repace. I am a physicist. I served 19 years as a senior air policy analyst for the U.S. Environmental Protection Agency in Washington, DC. Now retired, I do consulting on indoor and outdoor air pollution from secondhand smoke. I have published 56 peer-reviewed research papers on the hazard, exposure, dose, risk, and control of secondhand smoke. I strongly support all provisions of Bill 44, including the ban on smoking on outdoor terraces of bars and restaurants, which will protect the health of both nonsmoking bar and restaurant wait staff and patrons. There is a scientific consensus that secondhand smoke poses dire risks to human health. It is a known human carcinogen. It has immediate adverse effects on the cardiovascular system and chronic exposure causes fatal heart disease. There is no known risk-free level of exposure to secondhand smoke. A high proportion of non-smokers report eye irritation, headache, nasal discomfort, coughing, sore throat, or sneezing when exposed to secondhand smoke. Even brief exposures can induce sensory irritation in healthy nonsmokers at very low levels, which increases with duration of exposure. A U.S. study of nonsmokers' body fluids demonstrated that nonsmokers exposed to secondhand smoke on the outdoor terraces of a bar and a restaurant for just 3 hours absorbed significant doses of secondhand smoke fine particles and carcinogens. I calculate from their data that the nonsmokers' fine particulate matter exposure from secondhand smoke constitutes Code Red or Very Poor Air Quality when evaluated by the 3-hour Canadian Air Quality Index. Risk assessment shows that this exposure constitutes a "significant risk of material impairment of health" by the standards of the US Occupational Safety and Health Administration. Separation of the outdoor patios into smoking and nonsmoking sections would only serve to increase the secondhand smoke exposure of the estimated 16,625 nonsmoking Quebec restaurant and bar wait staff who would serve in the smoking sections of bar and restaurant terraces. Nonsmoking sections on terraces would also fail to protect nonsmoking patrons from secondhand smoke carried by the wind from the smoking sections. The results of 13 field studies in as many countries demonstrate that fine particulate matter air pollution on outdoor terraces is overwhelmingly higher than that from heavy street traffic. A study commissioned by The Union of Bar Owners of Quebec asserts that “Air quality on open-air terraces would not be significantly affected by smokers,” by a separation of only 1.5 meters. However, this claim is contradicted by three different U.S. studies which showed that harmful levels of secondhand smoke fine particles and carcinogens from a single cigarette smoked on outdoor terraces occurred at downwind distances ranging from 4 to 7 to 13 meters. Because these secondhand smoke pollutants decline inversely with distance, smoke from multiple smokers will reach out proportionally to greater distances. Thus, the smoking section separation distance of 1.5 meters proposed by The Union of Bar Owners of Quebec must be rejected in favor of a total terrace smoking ban as proposed by Bill 44. Thank You for the opportunity to testify. My remarks are detailed in my written testimony. I would be pleased to answer any questions.