Do Indoor Smoking Bans Protect Bar Workers from Secondhand Smoke

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Do Indoor Smoking Bans Protect Bar Workers from
Secondhand Smoke?

• Roberta Ferrence, Bo Zhang, Susan Bondy
• Ontario Tobacco Research Unit, University of
  Toronto
• More Smoke-Free Air Bi-National Tobacco Control
  Series, Part 2, June 3, 2009 Buffalo

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Background

• Second Hand Smoke (SHS)
• gttoxic as smoke inhaled by smokers
• causes cancer, heart and respiratory disease
• Known cause of breast cancer in younger women
• Bar and Restaurant Workers
• Absorb considerable amounts of SHS
• Higher respiration rates due to active work
• Lengthy periods of exposure

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Health Concerns

• Current indoor smoke free legislation reduces SHS
  exposure and associated risks
• However, SHS exposure still occurs in hospitality
  venues because smoking still permitted on patios
  and at doorways
• Outdoor exposure, especially within 2m, can be as
  great as indoors (Klepeis et al., 2007)
• Even brief (30 mins) exposure to real-world
  levels of SHS leads to sustained vascular injury
  (Heiss et al., 2008)

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Study Objective

• To determine if bar workers are adequately
  protected from SHS by a smoking restriction act
  that prohibits indoor smoking in public
  workplaces, including bars and restaurants, but
  allows smoking on unenclosed restaurant and bar
  patios

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Methods

• Sample
• Non-random purposive sample
• 25 bars selected from lists of public licensed
  establishments in Toronto
• No prior observation of smoking
• Serious bars, where patrons go mainly for
  drinking, rather than eating
• Contiguous patio 8 tables no awning

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Methods

• Air Quality Data
• Used a matched and calibrated pair of compact
  real-time monitors (EcoChem PAS 2000CE) to
  measure carcinogenic particulate polycyclic
  aromatic hydrocarbons (PPAH) at 30 sec intervals
• Wind Data
• A real-time hot wire anemometer used to record
  air flow (0.01 m/s threshold) at 30 sec intervals

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Methods

• Data Collected
• After May 31, 2006 implementation of Smoke-Free
  Ontario Act
• August 17 - September 16, 2006
• Air Sampling
• Busy evening shifts
• Thurs-Sat

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Methods

• Background Readings
• Continuous readings 5 mins
• Park, side street, courtyard or parking lot
• 100 meters from venue or other smoking
• Venue Readings
• Collected simultaneously INSIDE bar away from
  kitchen and OUTSIDE on patio in busiest area
  where smoking allowed
• Continuously for at least 20 mins

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Analysis

• Descriptive Analyses
• mean, median, min and max for PPAH level by lit
  cigarettes
• Mixed Effects Linear Models
• accounting for repeated-measures design to
  examine PPAH level by lit cigarettes
• Log-transformed data used, as PPAH values were
  positively skewed

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Results Descriptive

• No-smoking Measures
• Collected from all 25 bars for 10 of the
  measurement period
• Smoking Measures
• Collected from all 25 bars for 90 of the
  measurement period

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PPAH level and wind measurements, Toronto bar
patio
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PPAH Level and Wind Measurements for a Toronto
Bar Patio
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PPAH level (ng/m3) on Patios (n25)
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Results Descriptive

• On Patios
• Mean and Median PPAH levels positively correlated
  with lit cigarettes

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PPAH Level (ng/m3) inside Bars (n25)
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Results Descriptive

• Inside Bars
• Median but not Mean PPAH level increased with
  increasing numbers of lit cigarettes
• Mean indoor PPAH level higher when smokers on
  patios than when no smokers

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Mixed Model Analysis of PPAH (ng/m3) by Lit
Cigarettes (linear trend)
PPAH levels significantly associated with
lit cigarettes on outdoor patios but not inside
bars
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Exposure Concerns

• SHS Exposure for 2 h in airport smoking area with
  mean respirable suspended particulate (RSP) 78
  µg/m3 (equivalent to PPAH 26.4 ng/m3)
  significantly decreased long-term measures of
  heart rate variability, which may increase
  cardiovascular disease and death
• Current Study
• PPAH levels on patios with 5 lit cigs gt26.4
  ng/m3 when smokers present on patios
• Bar workers working on a patio were exposed to
  this high level of PPAH (mean26.4 ng/m3) for 4.8
  hrs in an
• 8 h shift

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Implications for Policy and Education

• Even with indoor bans, workers not protected from
  SHS exposure when smoking permitted on outdoor
  patios
• Need for complete bans on patios and adjacent
  areas to complement indoor smoking bans and
  provide adequate protection
• Public education should accompany legislative
  change to inform and motivate bar workers and
  owners, as well as patrons