 2007 Johns Hopkins Bloomberg School of Public Health Evaluating Smoke-Free Policies Andrew Hyland, PhD Roswell Park Cancer Institute

 2007 Johns Hopkins Bloomberg School of Public Health Section A General Overview

 2007 Johns Hopkins Bloomberg School of Public Health 3 Images source: Hyland, A. Why Have Smoke-Free Rules? Clean up the air Help smokers quit

 2007 Johns Hopkins Bloomberg School of Public Health 4 Source: California Environmental Protection Agency. (2005). Effects Causally Associated with SHS Exposure Developmental effects  Fetal growth  Low birth weight, sudden infant death syndrome (SIDS), and preterm delivery Respiratory effects  Acute lower respiratory tract infections, asthma induction, chronic respiratory syndromes in children, eye and nasal irritation, and middle ear infections in children

 2007 Johns Hopkins Bloomberg School of Public Health 5 Effects Causally Associated with SHS Exposure Carcinogenic effects  Lung cancer, nasal sinus cancer, and breast cancer Cardiovascular and hematological effects  Heart disease, acute and chronic coronary heart disease morbidity, and altered vascular properties Source: California Environmental Protection Agency. (2005).

 2007 Johns Hopkins Bloomberg School of Public Health 6 “Each Party shall adopt and implement in areas of existing national jurisdiction as determined by national law and actively promote at other jurisdictional levels the adoption and implementation of effective legislative, executive, administrative and/or other measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places” — World Health Organization Source: World Health Organization. (2005). Protection from Exposure to Tobacco Smoke The Framework Convention on Tobacco Control (FCTC), Article Eight: Protection from Exposure to Tobacco Smoke

 2007 Johns Hopkins Bloomberg School of Public Health 7 Nations and States Are Going Smoke-Free Ireland went smoke-free in March, 2004 Norway went smoke-free in June, 2004 Scotland went smoke-free in March, 2006 Uruguay Uganda Image source: Tobacco Scam. (2003).

 2007 Johns Hopkins Bloomberg School of Public Health 8 Nations and States Are Going Smoke-Free England went smoke-free July, 2007 Australia (de facto) Smoke-free Olympics, 2008 Others Image source: Tobacco Scam. (2003).

 2007 Johns Hopkins Bloomberg School of Public Health 9 What Happened in Other Places that went Smoke-Free? Today, many places are going 100% smoke-free Arguments against smoke-free places  SHS not harmful  Bad for business  Choice Case studies  New York  Ireland International Agency for Research on Cancer (IARC): Methods for Evaluating Tobacco Control Policies (see chapter in readings)

 2007 Johns Hopkins Bloomberg School of Public Health 10 General Overview: When Places Go Smoke-Free Evaluation questions  Does SHS exposure decrease and health improve?  Do people comply with the rules?  Does the hospitality economy suffer?  Unintended consequences  Are smokers more likely to seek treatment services and stop smoking?  Smoke more at home?

 2007 Johns Hopkins Bloomberg School of Public Health 11 Does SHS Exposure Decrease and Health Improve? Yes  An approximate 90% reduction in SHS exposure  Reduced nicotine levels  Improved lung function  Reduced adverse symptoms in bartenders

 2007 Johns Hopkins Bloomberg School of Public Health 12 Do People Comply With the Rules? Yes  Adjustment period that can take from days to months  Compliance generally high and increases over time  Lowest compliance in bars and pubs

 2007 Johns Hopkins Bloomberg School of Public Health 13 Does the Hospitality Economy Suffer? No  Twenty-one best-designed studies: zero claimed lost business due to smoke-free laws  Fewer studies in pubs, but evidence points to the same conclusion  Results consistent across Western countries

 2007 Johns Hopkins Bloomberg School of Public Health 14 Unintended Consequences Are smokers more likely to seek treatment services and stop smoking? smoke more at home?  Yes and no, depending on the issue  Smoke-free worksites promote cessation and a large demand for free nicotine replacement therapy (NRT)  Pharmacy NRT sales and quit hotline calls may increase a bit  No increase in smoking or drinking in the home  Effect likely enhanced with greater access to services and media promotion