1.  2007 Johns Hopkins Bloomberg School of Public Health Section B Case Study: New York State

2.  2007 Johns Hopkins Bloomberg School of Public Health 2 Case Study: NY State Clean Indoor Air Act (CIAA) Effective July 24, 2003 Requires indoor public places— including bars and restaurants— to be smoke-free Image source: The Rural Three for Tobacco-Free Communities. (2003).

3.  2007 Johns Hopkins Bloomberg School of Public Health 3 What Happens 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?

4.  2007 Johns Hopkins Bloomberg School of Public Health 4 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 pound) Image source: TSI Incorporated. (2007).

5.  2007 Johns Hopkins Bloomberg School of Public Health 5 Measuring Air Quality: www.tobaccofreeair.org

6.  2007 Johns Hopkins Bloomberg School of Public Health 6 Images source: Hyland, A. Measuring Air Quality

7.  2007 Johns Hopkins Bloomberg School of Public Health 7 Images source: Hyland, A. Measuring Air Quality

8.  2007 Johns Hopkins Bloomberg School of Public Health 8 Measuring Air Quality: China Image source: Hyland, A.

9.  2007 Johns Hopkins Bloomberg School of Public Health 9 Image source: Hyland, A. Measuring Air Quality: Greece

10.  2007 Johns Hopkins Bloomberg School of Public Health 10 Image source: Hyland, A. Measuring Air Quality: Romania Romanian colleague carrying the TSI SidePak (in shoulder bag) before setting out to collect data

11.  2007 Johns Hopkins Bloomberg School of Public Health 11 Image sources: (left to right): St. Petersburg Times. (May 23, 2004); Corning Leader. (May 21, 2004); Tacoma News Tribune. (May 21, 2004). Measuring Air Quality: Media Coverage Data from air monitoring studies is used to educate the public about the dangers of secondhand smoke in:  News articles  Editorial support

12.  2007 Johns Hopkins Bloomberg School of Public Health 12 Image source: Chicago Sun-Times. (October 25, 2005.) Measuring Air Quality: Media Coverage

13.  2007 Johns Hopkins Bloomberg School of Public Health 13 Measuring Air Quality: Media Coverage Image source: USA Today. (October 18, 2005).

14.  2007 Johns Hopkins Bloomberg School of Public Health 14 U.S. EPA Air Quality Index Air Quality PM 2.5 (µg/m 3 ) Health Advisory Good≤15None Moderate16–40 Unusually sensitive people should consider reducing prolonged or heavy exertion Unhealthy for sensitive groups 41–65 People with heart or lung disease, older adults, and children should reduce prolonged or heavy exertion Unhealthy66–150 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 151–250 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≥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

15.  2007 Johns Hopkins Bloomberg School of Public Health 15 Worst Forest Fire in Colorado History: June 8, 2002

16.  2007 Johns Hopkins Bloomberg School of Public Health 16 Hayman Fire: Colorado Image source: The American Society for Photogrammetry and Remote Sensing. (2002). Denver

17.  2007 Johns Hopkins Bloomberg School of Public Health 17 Image source: Colorado Department of Public Health. (2002). Hayman Fire: Colorado Visibility in Denver: one day before Hayman Fire

18.  2007 Johns Hopkins Bloomberg School of Public Health 18 Image source: Colorado Department of Public Health. (2002). Hayman Fire: Colorado Visibility in Denver: one day after Hayman Fire Worst PM 2.5 : 4.3 µg/m 3 (24 hour maximum) or 200µg/m 3 (hourly maximum)

19.  2007 Johns Hopkins Bloomberg School of Public Health 19 Indoor Air Quality Improvement Source: adapted by CTLT from The U.S. Center For Disease Control MMWR. (2005).

20.  2007 Johns Hopkins Bloomberg School of Public Health 20 Average Level of PM 2.5 Source: adapted by CTLT from Hyland, A. Original Data. Unpublished.

21.  2007 Johns Hopkins Bloomberg School of Public Health 21 Average Fine Particle Air Pollution by Region Source: adapted by CTLT from Hyland, A. Original Data. Unpublished.

22.  2007 Johns Hopkins Bloomberg School of Public Health 22 Reduced Nicotine Exposure Biomarkers Source: adapted by CTLT from Farrelly, M., et al. (2005).

23.  2007 Johns Hopkins Bloomberg School of Public Health 23 Decreased Reported Symptoms of SHS Exposure Source: adapted by CTLT from Farrelly, M., et al. (2005).

24.  2007 Johns Hopkins Bloomberg School of Public Health 24 Decreased Reported Symptoms of SHS Exposure Source: adapted by CTLT from Farrelly, M., et al. (2005).

25.  2007 Johns Hopkins Bloomberg School of Public Health 25 What Happens 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?

26.  2007 Johns Hopkins Bloomberg School of Public Health 26 Support for the Clean Indoor Air Act in New York State Source: adapted by CTLT from New York State Department of Health. (2004).

27.  2007 Johns Hopkins Bloomberg School of Public Health 27 Reported Smoking in Various Locations Source: adapted by CTLT from New York State Department of Health. (2004).

28.  2007 Johns Hopkins Bloomberg School of Public Health 28 What Happens 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?

29.  2007 Johns Hopkins Bloomberg School of Public Health 29 Predictions of Economic Doom Source: Staten Island Advance. (1995). Eateries say ban on smoking is killing them By CRAIG SCHNEIDER ADVANCE STAFF WRITER Many Staten Island restaurants appear to be obeying the new law to extinguish smoking. But some owners are afraid that, instead of cigarettes, their profits are going up in smoke. “Business is slipping. People like to come in here and have a cigarette and some coffee. Now they can’t.” said Suzette Linde, manager at Mike’s Place in New Dorpe. “Some people are going outside for a smoke. So now we are getting complaints about cigarette butts in the street.” Several restaurant owners said they’ve seen business fall off 10 percent or more since the ban on butts. And they worry there are more blows to come. Nineteen of 20 Staten Island restaurants visited at random by the Advance yesterday appear to be obeying the city’s new anti-smoking ban. Ashtrays are off the tables, no-smoking signs are posted, and waitresses are regularly

30.  2007 Johns Hopkins Bloomberg School of Public Health 30 Likelihood of Patronizing Bars Following CIAA Source: adapted by CTLT from New York State Department of Health. (2004).

31.  2007 Johns Hopkins Bloomberg School of Public Health 31 Likelihood of Patronizing Restaurants following CIAA Source: adapted by CTLT from New York State Department of Health. (2004).

32.  2007 Johns Hopkins Bloomberg School of Public Health 32 Employment in Hospitality Industry: New York Source: adapted by CTLT from New York State Department of Labor and the U.S. Census Bureau ES-202 Data Set (NAICS 722).

33.  2007 Johns Hopkins Bloomberg School of Public Health 33 Employment in Drinking Places: New York, New Jersey Source: adapted by CTLT from the New York State Department of Labor; New Jersey Department of Labor and Workforce Development; US Census Bureau.

34.  2007 Johns Hopkins Bloomberg School of Public Health 34 Liquor Licenses Granted: New York Source: adapted by CTLT from the New York State Department of Health. (2004).

35.  2007 Johns Hopkins Bloomberg School of Public Health 35 What Happens 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?

36.  2007 Johns Hopkins Bloomberg School of Public Health 36 New York State (NYS) Clean Indoor Air Act (CIAA) Record drop in consumption in New York City  Confluence of clean air, tax increase, media campaign, and free nicotine replacement therapy  Hard to sort out the independent effect of clean air  11% consumption drop one year after New York City smoke- free law took effect

37.  2007 Johns Hopkins Bloomberg School of Public Health 37 Relative Risk for Quitting Source: adapted by CTLT from Bauer, et al. (2005).

38.  2007 Johns Hopkins Bloomberg School of Public Health 38 Smoking Cessation Indicators: NRT Sales Source: adapted by CTLT from Metzger, et al. (2005).

39.  2007 Johns Hopkins Bloomberg School of Public Health 39 Smoking Cessation Indicators: Quitline Calls

40.  2007 Johns Hopkins Bloomberg School of Public Health 40 New York State (NYS) Clean Indoor Air Act (CIAA) Image source: The Rural Three for Tobacco-Free Communities. (2003).