Clean Indoor Air Laws Protect Hospitality Workers: Evidence From New York State

Sara M. Abrams, MPHMartin 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.org

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, 9th Report on carcinogens, 2000; MMWR 2002;51(14):300-3; Siegel M. JAMA 1993;270:490-493.

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.

Smokefree States• States with clean indoor air laws include:

– CA, DE, NY, CT, ME, MA, RI– MT effective Oct. 1st.

• On July 24, 2003, New York State enacted the Clean Indoor Air Act (CIAA), prohibiting smoking in virtually all workplaces, including bars and restaurants.

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.

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

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)

DemographicsPre-law (n=46)

Post-law (n=31)

Characteristic n (%) n (%) p-value

Gender Male 20 (43.5) 13 (41.9) n.s.

Age < 35 25 (54.3) 16 (51.6) n.s.

Race White 38 (82.9) 25 (80.6) n.s.

Ethnicity Non-Hispanic 45 (97.8) 27 (87.1) n.s.

Education<=High School or Some College

35 (76.1) 18 (58.1) n.s.

Marital Status

Married 13 (28.3) 5 (16.1) n.s.

Health Insurance

Private 34 (73.9) 24 (77.4) n.s.

Median Hours of Secondhand Smoke (SHS) Exposure During 5-Day Recall Among Hospitality Workers at Baseline

18.019.820.8

6.0

0.0

5.0

10.0

15.0

20.0

25.0

Non-casino hospitality Casino

Ho

urs

Pre-Law

Post-Law

†

† p<0.05 relative to pre-law level.

71%

Duration and Source of SHS Exposure During 5-Day Recall by Location

5.32.4

16.719.1

3.2

3.0

1.3

0.30.5

1.4

12.3

0.0

0.0

5.0

10.0

15.0

20.0

Pre-Law Post-Law Pre-Law Post-Law

Ho

urs Other

Work

Home

Non-casino hospitality Casino

† p<0.01 relative to pre-law level.

†

89%

Cotinine Levels Among Hospitality Workers at Baseline

† p<0.01 relative to pre-law level

Employment Group Pre-Law Post-Law

% With Non-Detectable Cotinine Levels

Non-casino hospitality 3.2% 65.4%

Casino 10.0% 25.0%

Median Cotinine Levels (ng/ml)

Non-casino hospitality 4.93 0.3

Casino 8.40 6.49

†

†

Individual and Median Cotinine Levels Among Hospitality Workers at Baseline

8.40 6.49

0.3

4.93

0.1

1

10

100

log

Co

tin

ine

(n

g/m

l)

Pre-Law

Post-Law

Median

Non-casino hospitality

† p<0.01 relative to pre-law level

Casino

†

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.

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