1. 1 Smoke-Free Air Policies: Progress, Challenges, and Resources Mark J. Travers, PhD, MS Roswell Park Cancer Institute Buffalo, NY, USA mark.travers@roswellpark.org Pre-Conference Workshop 15th World Conference on Tobacco or Health Singapore March 19, 2012

2. Countries, States, and Provinces That Have Banned Smoking in Indoor Workplaces and Other Indoor Public Places. Source: Koh et al. New England Journal of Medicine, 2007.

4. Smokefree Latin America & the Caribbean 100% national smokefree Comprehensive national Sub-national smokefree Smoking designated areas or no restrictions Regulation pending

5. Conceptual Framework for the Evaluation of Smokefree Policies SHS: secondhand smoke SES: socio-economic status Source: IARC Handbook of Cancer Prevention, Volume 12. Methods for Evaluating Tobacco Control Policies. Smokefree Policies Proximal Variables Compliance with smokefree policies Intermediate SHS exposure Distal Health of Non-smokers Incidental Outcomes Economic impact, home smoking, cessation behavior Moderators SHS awareness / attitudes, occupation, SES, Tobacco control policies

6. http://www.iarc.fr/en/publications/pdfs-online/prev/handbook13/index.php

8. 5 Main Evaluation Outcomes 1) Public Support 2) Compliance 3) Exposure 4) Health Impact 5) Economic Impact

9. MEASURING EXPOSURE TO TOBACCO SMOKE POLLUTION  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

10. TRAINING COURSE AT: WWW.TOBACCOFREEAIR. ORG HTTP://VIMEO.COM/CHA NNELS/84864 WWW.TOBACCOFREEAIR. ORG HTTP://VIMEO.COM/CHA NNELS/84864

11. PM 2.5 Findings Around the World Source: Hyland et. Al. Tobacco Control 2008.

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

13. See next slide U.S.A.

15. Greece

16. India

17. Argentina

18. China

19. Conceptual Framework for the Evaluation of Smokefree Policies SHS: secondhand smoke SES: socio-economic status Source: IARC Handbook of Cancer Prevention, Volume 12. Methods for Evaluating Tobacco Control Policies. Smokefree Policies Proximal Variables Compliance with smokefree policies Intermediate SHS exposure Distal Health of Non-smokers Incidental Outcomes Economic impact, home smoking, cessation behavior Moderators SHS awareness / attitudes, occupation, SES, Tobacco control policies

20. Challenges: New and emerging products Mouthpiece Hose Body Bowl Water Coal Head Tobacco

21. Waterpipe, hookah, narghile Common phenomenon in Eastern Mediterranean and South Asian countries… Emerging challenge in U.S. and other Western countries, often passes through loopholes in existing smokefree air laws Waterpipe café in “smokefree” New York State

22. “Hazardous” PM 2.5 level according to USEPA Air Quality Index (17x higher than “Good” air quality) National Ambient Air Quality standard for CO (USEPA)

23. E-cigarettes Johnny Depp in “The Tourist”

24. Is poor smoke-free law compliance a developing country phenomenon? Consider India, Netherlands, Germany Consider comprehensiveness of policy and education (i.e. SHS awareness and attitudes)

25. What are some challenges you face in implementing smoke-free air policies?