1. Clean Indoor Air Laws Protect Hospitality Workers: Evidence From New York State Sara M. Abrams, MPH Martin C. Mahoney, MD, PhD Andrew Hyland, PhD K. Michael Cummings, PhD, MPH 2005 National Conference on Tobacco or Health May 4, 2005 Contact Information: Sara.Abrams@RoswellPark.orgSara.Abrams@RoswellPark.org

2. Secondhand Smoke and Health Effects Secondhand smoke (SHS) contains over 50 known carcinogens. Annually among adult nonsmokers, SHS exposure causes: – 3,000 lung cancer deaths –35,000 deaths from ischemic heart disease Food-service workers have 50% greater risk for developing lung cancer, compared with the general population. Sources: National Toxicology Program, 9 th Report on carcinogens, 2000; MMWR 2002;51(14):300-3; Siegel M. JAMA 1993;270:490-493.

3. Employee Exposure Over 75% of white collar workers, including over 90% of teachers report having smokefree workplaces. Less than half (43%) of 6.6 million food service workers in the US are protected by smokefree policies. –31% of workers directly involved with the public (i.e. supervisors, bartenders, waiters/waitresses, waiter assistants’) Smokefree air laws must include bars and restaurants in their provisions. Source: Shopland et al. J Occup Environ Med. 2004;46:347-356.

4. Smokefree States States with clean indoor air laws include: –CA, DE, NY, CT, ME, MA, RI –MT effective Oct. 1 st. On July 24, 2003, New York State enacted the Clean Indoor Air Act (CIAA), prohibiting smoking in virtually all workplaces, including bars and restaurants.

6. Objectives To examine the changes in secondhand smoke (SHS) exposure among hospitality workers following the passage of the New York State (NYS) Clean Indoor Air Act (CIAA) on July 24, 2003.

7. Methods Cross-sectional population-based study –Non-smoking working adults (bioverified CO < 8ppm) –Baseline and 1-year follow-up interviews –Baseline (n=77) Structured interview measures: –Secondhand smoke exposure (5-day recall) –Tobacco use in past –Respiratory symptoms and recent illness –Occupational history Urinary cotinine measurement –Liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI/MS/MS) –LOD = 0.3 ng/ml

8. Definitions Pre-law vs. post-law –Recruited into study either before or after passage of NYS CIAA (7/24/03) Employment categories –Non-casino hospitality workers Employed in bars, restaurants, bingo halls, or bowling alleys (smoking unregulated before CIAA) –Casino workers Employed in American Indian owned casinos (smoking is unregulated)

9. Demographics Pre-law (n=46) Post-law (n=31) Characteristicn (%) p-value GenderMale20 (43.5)13 (41.9)n.s. Age< 3525 (54.3)16 (51.6)n.s. RaceWhite38 (82.9)25 (80.6)n.s. EthnicityNon-Hispanic45 (97.8)27 (87.1)n.s. Education <=High School or Some College 35 (76.1)18 (58.1)n.s. Marital Status Married13 (28.3)5 (16.1)n.s. Health Insurance Private34 (73.9)24 (77.4)n.s.

10. Median Hours of Secondhand Smoke (SHS) Exposure During 5-Day Recall Among Hospitality Workers at Baseline † † p<0.05 relative to pre-law level. 71%

11. Duration and Source of SHS Exposure During 5-Day Recall by Location Non-casino hospitalityCasino † p<0.01 relative to pre-law level. † 89%

12. Cotinine Levels Among Hospitality Workers at Baseline † p<0.01 relative to pre-law level Employment GroupPre-LawPost-Law % With Non-Detectable Cotinine Levels Non-casino hospitality3.2%65.4% Casino10.0%25.0% Median Cotinine Levels (ng/ml) Non-casino hospitality4.930.3 Casino8.406.49 † †

13. Individual and Median Cotinine Levels Among Hospitality Workers at Baseline Non-casino hospitality † p<0.01 relative to pre-law level Casino †

14. Conclusions Data demonstrates reductions in self-reported SHS exposure among non-casino hospitality workers, following passage of NYS CIAA. –71% decrease for total SHS exposure. –89% decrease for SHS exposures at work. Observed decreases in SHS exposures can be attributed to reductions in work-related exposures. Urinary cotinine levels offer confirmatory support for reduced exposures to SHS. Suggestive of an overall positive impact of CIAA in protecting hospitality workers from SHS.

15. Acknowledgements Study Interviewers: –Jessica Englert, Patti Coppola, Candice Faulring, Lauren Gruber, Lauren Zichitella, Judy Horan This work was supported by the funding from the Flight Attendant Medical Research Institute, and in part by the Roswell Park Cancer Institute Center Support Grant (P30 CA 16056-27). Co-investigators: –Martin C. Mahoney, MD, PhD –Andrew Hyland, PhD –K. Michael Cummings, PhD, MPH