evidence-based failure of the partial smoking ban: contributions of scientists
DESCRIPTION
Maria José López Public Health Agency of Barcelona ICO-WHO Symposium 2012TRANSCRIPT
“Evidence-based failure of the partial smoking ban: contributions of scientists”
Maria J. López
Public Health Agency of Barcelona
ICO-WHO Symposia on Tobacco Control
July 2012
Scientists...
The Spanish smoking law (January, 2006)
- Tobacco sales
- Tobacco advertisement
- Tobacco consumption:
-Smoking ban in workplaces
- Partial restrictions in hospitality venues
Impact of the law...
http://seepidemiologia.es/documents/dummy/Monografia-Grupo%20Trabajo%20sobre%20tabaquismo.pdf
Manel Nebot y Esteve Fernández (coords.), Carles Ariza, Marcela Fu, Iñaki Galán, María José López, Jose M. Martínez, Albert Moncada, Agustín Montes, Mónica Pérez-Ríos, Esteve Saltó, Anna Schiaffino, María Jesús Soriano
Smoking workgroup of the Spanish Society of Epidemiology
Impact evaluation of the Spanish smoking law implemented in 2006
Half full? Half empty?
- Decrease on SHS exposure in workplaces
-No differences (or even decrease) on SHS exposure prevalence at home
-Increase in support to the law
-No decrease on hospitality volume of sales
Evidence of what was NOT
working...
3 studies focused on the partial ban in
hospitality sector...
Study 1: Impact on SHS levels in workplaces and hospitality venues
Nebot M, Lopez MJ, Ariza C et al.
Environmental Health Perspectives, 2009.
Lopez MJ, Nebot M, Schiaffino A et al.
Tobacco Control, 2012.
Study design: Before-after evaluation study
Spanish smoking law
(January 2006)
Pre-law
(October-December)
6 months 12 months 24 months
Study population
50 measurements / region:
hospitality venues and other workplaces
SHS marker: Vapour-phase nicotine
Passive sampler
- 97%
p< 0.001
Baseline 12 months follow-up
n=22
Co
nce
ntr
aci ó
n d
e n
i co
tin
a (µ
g/ m
3 )
2.71 [RI 1.39 – 3.77]
0.09 [RI 0.01 – 0.26]
Nicotine concentration (g/m3) in bars/ restaurants where smoking was banned after the law
* Logarithmic scale
p= 0.191
Baseline 12 months follow-up
n=33
Co
nce
ntr
aci ó
n d
e n
i co
tin
a (µ
g/ m
3 )7,07 [RI 1,86 – 11,78] 5,70 [RI 2,77 – 11,73]
Nicotine concentration (g/m3) in bars/ restaurants where smoking was allowed after the law
* Logarithmic scale
- 89%
p< 0.001
p= 0.075
Baseline 12 months follow-up
n=18
Baseline 12 months follow-up
n=18
Co
nce
ntr
aci ó
n d
e n
i co
tin
a (µ
g/ m
3 )
Co
nce
ntr
aci ó
n d
e n
i co
tin
a (µ
g/ m
3 )
* Logarithmic scale
5.58 [RI 2.42 – 12.42] 5.58 [RI 2.42 – 12.42]8.89 [RI 5.28 – 15.61]
0.62 [RI 0.34 – 1.40]
Smoking area Non-smoking area
Nicotine concentration (g/m3) in bars/ restaurants separated areas after the law
Study 2: Impact on SHS in hospitality workers and respiratory symptoms
Fernandez E, Fu M, Pascual JA et al.
Plos One, 2009.
Before-after study with comparison group
117 non-smokers hospitality workers
20 hospitality workers in Andorra & Portugal
Saliva cotinine samplesand questionnaires
SHS in Hospitality Workers Study
Co
tin
ine
(ng
/ml)
, lo
g s
cale –63.7%
(p<0.01) p=0.126 p=0.406
Smoking banned
Areas Smoking allowed
p=0.937
Control(Andorra & Portugal)
Smoking allowed
Cotinine concentrations (ng/ml) in hospitality workers
n=32 n=22 n=63 n=20Baseline
12 months follow-up
-50.1% (p<0.01) p=0.140 p=0.640 p=0.757
Smoking banned
Areas Smoking allowed Smoking allowed
Control(Andorra & Portugal)
Proportion (%) of respiratory symptoms in hospitality workers
n=32 n=22 n=63 n=20
Study 3: PM2.5 levels in hospitality venues after the law
Villarroel N, López MJ, Sánchez-Martínez F et al.
Gaceta Sanitaria, 2011.
Study design: Cross-sectional study
Fieldwork: October- December 2007
Sampling: 40 hospitality venues in Barcelona
SHS marker: Particles smaller than 2.5 micrometers (PM2.5)
Side Pack AM 510 Personal Aerosol Monitor
n Average (SD) p
Smoking banned 17 34.4 (14.2)
<0.001Smoking allowed 16 182.2 (180.0)
PM2.5 concentration (g/m3) in hospitality venues according to the smoking regulation after the law
Air quality standards
35 g/m3 (24-hour standard) according to the EPA
25 g/m3 (anual average) according to the European Comission
Conclusions
Different scientific studies showed, consistently, that most hospitality workers (and costumers) were still exposed to SHS after the law.
The evidence supported a complete ban on smoking in hospitality sector.
The work of the scientific community has been essential in providing evidence and objective data that contributed to the modification of the 2006 law.
Science
Citizens
Public
Adm
“Tobacco Control engine”
Thank you!