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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    • "The predictions of the models agreed well with both environmental studies of atmospheric nicotine in offices, and with clinical epidemiological studies of saliva cotinine in office workers, as well as blood and urine cotinine in various population subgroups (Repace and Lowrey, 1993; Repace et al., 1998). The author has also found them useful in litigation by workers who have been injured by secondhand smoke [e.g., Horseshoe Casino Report, Repace (2006)]. Interestingly, James et al. (2008) cite the Horseshoe Casino Report despite the fact that it was not in the public domain in 2008 but had been submitted in litigation over injury to several dozen casino workers in Hammond Indiana. "
    [Show abstract] [Hide abstract] ABSTRACT: In response to a complaint by workers in Bally’s Casino in Atlantic City, New Jersey, Trout and Decker (1995) conducted a NIOSH Health Hazard Evaluation, measuring workers’ plasma and urine cotinine and both area and personal breathing zone nicotine as well as area RSP. Trout et al. (1998) subsequently published a summary of this data in JOEM, omitting the data on RSP. Using the Rosetta Stone model, I estimated mean and median plasma and urine cotinine values for 14 of 29 Bally’s Casino workers for which adequate data was reported. The model estimates differ from the NIOSH-measured values by 10 to 15% for the medians, and 7 to 17% for the means. This reasonable agreement between theory and experiment suggests that the Rosetta Stone model is useful for estimating the secondhand smoke doses that nonsmoking workers get from workplace secondhand smoke. In addition, the Habitual Smoker model (Repace, 2007), using NIOSH-measured CO2 levels to calculate the range in air exchange rates, and using ASHRAE default occupancy plus U.S. smoking prevalence predicts area air nicotine concentrations for this casino ranging from 5 to 20 μg/m3. By comparison, NIOSH measured area nicotine concentrations ranged from 6 to 16 μg/m3. Based upon these analyses, I conclude that the Rosetta Stone and Habitual Smoker models are useful for estimating nonsmoking workers exposure and dose from secondhand smoke exposure, and in analyzing measured data with a reasonable degree of accuracy. By contrast, an article by James et al. (2008) reviewing the same data suggested that the Rosetta Stone modeling equations yield unacceptably high error rates when estimating workers’ exposures to secondhand smoke RSP and nicotine from cotinine dose. However the article by James et al. (2008) is deeply flawed due to improper methods of calculation of nicotine and cotinine in their use of the Rosetta Stone model. In addition, James et al. (20080 failed to recognize that the RSP data reported in the original Health Hazard Evaluation Report by Trout and Decker (1995) but not included in their published peer-reviewed journal article, was clearly erroneous due to monitor malfunction.
    Full-text · Technical Report · May 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Exposure to secondhand tobacco smoke (SHS) also known as environmental tobacco smoke (ETS) has been well established scientifically as a human health hazard. Despite this and warnings from health agencies, concerns over the economic impact of smoke-free bans have limited political resolve to enact these regulations. Arguments against smoke-free bans include the contention that air filters can eliminate the health risks from SHS exposure. In this study, we assessed the effectiveness of air filters (MERV 4 and MERV 8) commonly used in homes and businesses in reducing the concentrations of total suspended particulates, fine particles and carbon monoxide from SHS as a measure of their potential to reduce the toxicity associated with SHS exposure. Our results demonstrate that these filters are not effective at reducing carbon monoxide levels or PM 2.5, which have been correlated with human health toxicity/disease. Thus, our findings, from a public health perspective, do not support the use of common air filters as a viable alternative to smoke-free bans.
    No preview · Article · Jan 2015 · Environmental Sciences: Processes and Impacts
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    [Show abstract] [Hide abstract] ABSTRACT: While there is increasing support for restricting smoking in restaurants and bars patios, there is limited evidence on the effectiveness of this policy. This study examined the effect of smoke-free patio policy of restaurants and bars on adult second-hand smoke (SHS) exposure. Data were drawn from the 2005-2012 Canadian Tobacco Use Monitoring Survey (n=89,743), a repeated cross-sectional survey of youth and adult. Regression analysis, a quasi-experimental design was used to examine the effect of provincial smoke-free patio policy on self-reported exposure to SHS. Analyses suggest that exposure to SHS on patios of bars and restaurants declined following the adoption of provincial smoke-free patio policy. Relative to pre-policy SHS exposure, regression results showed a reduction in the probability of SHS exposure of up to 25% in Alberta. Similarly, in Nova Scotia, the probability of SHS exposure declined by up to 21%. Analyses stratified by smoking status found similar significant effect on both smokers and non-smokers. Findings suggest that provincial patio smoking ban on bars and restaurants had the intended effect of protecting non-smokers from SHS exposure. This study is consistent with a large body of evidence showing that a strong smoke-free legislation is an effective public health measure. Copyright © 2015. Published by Elsevier Inc.
    Preview · Article · Apr 2015 · Preventive Medicine
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