1. Conducting Indoor Air Quality Studies Mark Travers, M.S. Roswell Park Cancer Institute

2. Evaluation of Clean Indoor Air Law ImplementationPublic Health Impact Adverse Side Effects Support or Opposition Compliance Exceptions to Law (Waivers) Direct Effects Indirect Effects Economic Impact

3. Evaluation of Clean Indoor Air Law Public Health Impact Direct Effects Decrease indoor air pollution Reduce exposure to carcinogens and toxins Improve health and reduce incidence of tobacco smoke related diseases

4. Tobacco Control Model of Nicotine Addiction Agent Vector Host Tobacco Products Tobacco Product Manufacturers; Other Users Smoker/Chewer Incidental Host Environment Familial, Social, Cultural, Political, Economic, Historical, Media Involuntary Smoker Source: Orleans & Slade, 1993

5. Paradigm for Tobacco Control s Price/economic s Smoke-free air s Media s Cessation activities s Prevention activities s Regulation/Liability t Access t Marketing Individual

6. Adult Per Capita Cigarette Consumption and Major Smoking and Health Events – United States, 1900-2003 Source: United States Department of Agriculture; 2002 and 2003 estimates are preliminary End of WW II 1 st Smoking-Cancer Concern Fairness Doctrine Messages on TV and Radio Non-Smokers Rights Movement Begins Federal Cigarette Tax Doubles Surgeon General’s Report on ETS 1 st Surgeon General’s Report 1 st World Conference on Smoking and Health Broadcast Ad Ban 1 st Great American Smoke-out OTC Nicotine Medications Master Settlement Agreement Great Depression

7. Price Smoke- free Air Treatment Counter Marketing Components of Smoking Vaccine

10. Measuring Air Quality Cigarettes, cigars and pipes are major emitters of respirable suspended particles less than 2.5 microns (PM 2.5 ) in diameter that are easily inhaled deep into the lungs TSI SidePak AM510 Personal Aerosol Monitor (weight: 1 lb) This device is a real-time laser photometer with a built-in sampling pump that measures airborne particle mass- concentration

11. Why PM 2.5 ? Very sensitive marker of ETS Can monitor and record data in real time Relatively inexpensive equipment Marker of the more than 4,000 chemical in ETS –E.g. 2,000:1, PM 2.5 :PAH Meaningful measure: there are PM 2.5 standards in place to protect public health –The EPA has set standards of 15 μg/m 3 as the average annual level of PM 2.5 exposure and 65 μg/m 3 24-hour exposure in order to protect the public health

12. US EPA Air Quality Index Air Quality Air Quality Index PM 2.5 (  g/m 3 ) Health Advisory Good0-50≤15 None. Moderate51-10016-40 Unusually sensitive people should consider reducing prolonged or heavy exertion. Unhealthy for Sensitive Groups 101-15041-65 People with heart or lung disease, older adults, and children should reduce prolonged or heavy exertion. Unhealthy151-20066-150 People with heart or lung disease, older adults, and children should avoid prolonged or heavy exertion. Everyone else should reduce prolonged or heavy exertion. Very Unhealthy 201-300151-250 People with heart or lung disease, older adults, and children should avoid all physical activity outdoors. Everyone else should avoid prolonged or heavy exertion. Hazardous≥301≥251 People with heart or lung disease, older adults, and children should remain indoors and keep activity levels low. Everyone else should avoid all physical activity outdoors.

13. Why use the TSI SidePak Personal Aerosol Monitor? All the reason on the previous slide and, Convenient small size –Can easily be placed discretely in a small bag

14. This picture shows an example of the bag used to carry the SidePak and QTrak instruments during air monitoring

15. Limitation of PM 2.5 as a Marker of ETS Not specific to tobacco smoke; other sources include cooking, vehicles, ambient/background levels Can minimize this weakness with a pre-post study design

16. Calibration The TSI SidePak Personal Aerosol Monitor uses a built-in pump to bring air past a laser. The particles in the air scatter the light from the laser and the device determines the mass concentration of particles based on the amount of scattering. These types of devices must be calibrated with the specific type of aerosol (tobacco smoke) that you are measuring.

17. SidePak Factory Calibration Certificate

18. Calibration: Unadjusted Data Repace, J., Respirable particles and carcinogens in the air of Delaware hospitality venues before and after a smoking ban. Journal of Occupational and Environmental Medicine, 46:9, 887-905. Oct. 10 th 2003 Bowie, MD

19. Calibration: Adjusted Data Oct. 10 th 2003 Bowie, MD

20. Piezobalances and SidePak (Factory-Calibrated) Elapsed Minutes

21. Piezobalance and SidePak (Custom-Calibrated)

22. Measuring Air Quality TSI Q-Trak Plus Indoor Air Quality Monitor Measures 4 indoor air quality parameters –Temperature –Humidity –Carbon Monoxide –Carbon Dioxide Not essential to do these studies but does provide many advantages

23. Study Design Longitudinal or Pre-Post –Compare the same venues before and after they go smoke-free Cross-sectional –Compare smoke-free cities with cities that allow smoking –Compare smoke-free venues to smoking venues in the same city

24. Venue Selection Depends on your study goals Random Sample –Difficult logistically –With small sample size results might not be generalizable Convenience Sample –More feasible –Can target types of venues that would be affected by a new policy

25. Measurements and Observations PM 2.5 from SidePak Average number of people Average number of burning cigarettes Volume of room using sonic measure Temp, humidity, CO, CO 2 from Q-Trak

26. Time Activity Pattern

27. Can calculate… Average smoker density –Average number of burning cigarettes per 100m 3

28. With a QTrak You Can Calculate… Ventilation estimate –From CO 2, average number of people, room volume

29. Results Cross sectional study design –Multi-City Air Monitoring Study

30. Multi-City Air Monitoring Study: Philadelphia, PA April 10 th, 2004 All venues are smoking venues with observed smoking in all venues 4/10 7:01pm 4/11 1:41am VENUE 42 VENUE 43 VENUE 44 VENUE 45 VENUE 46 VENUE 47 VENUE 48

31. Multi-City Air Monitoring Study: New York City, NY April 17 th, 2004 All venues are smoke-free by law and no smoking was observed in an venue 4/17 6:43pm 4/18 2:38am VENUE 56 VENUE 57 VENUE 58 VENUE 59 VENUE 60 VENUE 61 VENUE 62

32. Multi-City Air Monitoring Study: New York City, NY April 17 th, 2004 and Philadelphia, PA April 10 th, 2004

33. Average Level of PM 2.5 by City

35. Results Pre-post study design –Indiana Air Monitoring Study –Western New York Air Monitoring Study Travers, M.J., et al., Indoor Air Quality in Hospitality Venues Before and After the Implementation of a Clean Indoor Air Law-Western New York, 2003. Morbidity and Mortality Weekly Report (MMWR), 2004.

36. Indiana Air Monitoring Study December 2004 to January 2005 Indiana Tobacco Prevention and Cessation Roswell Park Cancer Institute

37. VENUE 1a VENUE 2a VENUE 3a VENUE 4a VENUE 5a VENUE 6a VENUE 7a VENUE 8a Indiana Air Monitoring Study: Bloomington, IN, December 10 th, 2004 12/10/04 6:00pm 12/11/04 1:20am

38. VENUE 1b VENUE 2b VENUE 3b VENUE 4b VENUE 5b VENUE 6b VENUE 7b VENUE 8b 1/21/05 6:14pm 1/22/05 1:34am Indiana Air Monitoring Study: Bloomington, IN, January 21 st, 2005

39. Bloomington, IN Before and After Clean Indoor Air Law

40. annual PM 2.5 standard (15μg/m 3 ) 24-hour PM 2.5 standard (65μg/m 3 ) 89% 95%

41. Indoor Air Quality Before and After the New York State Clean Indoor Air Law in Western New York Hospitality Venues, July to September 2003 Mark Travers, 1 Michael Cummings, 1 James Repace, 2 Andrew Hyland 1 1 Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute; Buffalo, New York 2 Repace Associates, Inc.; Bowie, Maryland

42. Change in Air Quality in Western New York Bars and Restaurants After Implementation of the New York State Clean Indoor Air Law Before Law: Average = 412 μg/m 3 After Law: Average = 27 μg/m 3 Only venue with active smoking during post-law sampling Mean size of venue = 365m 3 Mean pre-law active smoker density = 1.38 cigs/100m 3

43. Change in Air Quality in Western New York Large Recreation Venues After Implementation of the New York State Clean Indoor Air Law Before Law: Average = 101 μg/m 3 After Law: Average = 18 μg/m 3 Mean size of venue = 3,530m 3 Mean pre-law active smoker density = 0.22 cigs/100m 3

44. Average Particle Concentration versus Average Smoking Density r=0.421

45. Average Particle Concentration versus Average Smoking Density by Ventilation 1.0<ACH<2.1 ACH  1.0 ACH  2.1 r=0.908 r=0.834 r=0.832

46. Results Case studies –One bar/restaurant after smoking ban goes into effect –One bar with a designated smoking room

47. Air Quality Over Time in a Western New York Bar Normal smoking night of July 18 th Limited smoking night of July 23 rd Midnight July 24 th, smoking stops, new law in effect

49. Influencing Policy Decisions Media Politicians The Public

54. Summary The TSI SidePak is a is scientifically valid and effective tool for real-time PM 2.5 monitoring in SHS studies Can show immediate, direct causal link between smoking and fine particle air pollution With some expert training and guidance lay persons can collect data in their own communities Simple environmental monitoring studies can be powerful in policy debates

55. Equipment Availability Rent –Ashtead Technologies –http://www.ashtead-technology.com/http://www.ashtead-technology.com/ Buy –TSI Inc. –http://www.tsi.comhttp://www.tsi.com Borrow –Roswell Park Cancer Institute

56. Contact Mark Travers –Roswell Park Cancer Institute –Mark.travers@roswellpark.orgMark.travers@roswellpark.org –(716) 845-5881 work –(716) 868-4784 cel –(716) 845-8487 fax

57. Summary- What you have to do Prepare SidePak (3 steps) –Charge battery –Clean and grease the impactor –Zero calibrate Start logging data (record the time!) Lock the SidePak keypad Visit venues and record observations –Times of entry, counts and exit –Count # people every 15 minutes –Count # burning cigarettes every 15 minutes –Take notes on who, what, where, and when –Measure room volumes (use sonic measure) –A few descriptive sentences on each place Buy something in each place you visit (be a patron) Try and spend at least 5 minutes outside between venues

58. Summary- What you have to do When you’re done monitoring, unlock the SidePak keypad Stop logging (record the time!) Turn off the device, don’t forget to recharge it for next time Connect SidePak to PC and download the data from the device Enter your notes/observations into an Excel spreadsheet

60. Chicago Air Monitoring Study 2005 National Conference on Tobacco of Health

61. METHODS Conducting Indoor Air Quality Studies - Training –Over 50 registrants –30 Volunteer researchers –Groups of 2-5 volunteers What did we ask of participants? –Visit Chicago bars and restaurants for at least 30 minutes –Place a TSI SidePak AM510 Personal Aerosol Monitor to measure air quality in a bag with a small tube protruding to sample the air –Record additional observations

62. METHODS Outcome Measures –Respirable Suspended Particles (RSPs) less than 2.5 microns in diameter (PM 2.5 ) –Observations every 15 minutes in each establishment Number of people present Number of burning cigarettes Volume (Zircon DM S50 Sonic Measure) Data Collection –Convenience sample of 37 bars and restaurants –Wednesday and Thursday night (6pm to 12 midnight) –Average duration of 44 minutes

63. Average Levels of Indoor Air Pollution

64. NCTH Air Monitoring Investigators

65. Global Assessment of Secondhand Smoke Air Pollution Provide collaborators in 20 countries with equipment, training and expert support Develop global scorecard Present results at 2006 WCTH in Washington, DC

66. Prospective Countries United States Canada Venezuela Brazil Uruguay United Kingdom Ireland Scotland France Spain Germany Switzerland Italy India Malaysia Thailand China Hong Kong South Korea Australia New Zealand Japan Austria Belgium Poland Hungary Russia Greece Turkey Syria Saudia Arabia Egypt Tunisia Côte d’Ivoire Nigeria