James Repace

The Smoke You Don't See: Uncovering Tobacco Industry Scientific Strategies Aimed Against Environmental Tobacco Smoke Policies

OBJECTIVES This review details the tobacco industrys scientific campaign aimed against policies addressing environmental tobacco smoke (ETS) and efforts to undermine US regulatory agencies from approximately 1988 to 1993. METHODS The public availability of more than 40 million internal, once-secret tobacco company documents allowed an unedited and historical look at tobacco industry strategies. RESULTS The analysis showed that the tobacco industry went to great lengths to battle the ETS issue worldwide by camouflaging its involvement and creating an impression of legitimate, unbiased scientific research. CONCLUSIONS There is a need for further international monitoring of industry-produced science and for significant improvements in tobacco document accessibility.

Second-hand smoke exposure and blood lead levels in U.S. children.

Background: Lead is a component of tobacco and tobacco smoke, and smokers have higher blood lead levels than do nonsmokers. Methods: We examined the relation between second-hand smoke exposure and blood lead levels in a nationally representative sample of 5592 U.S. children, age 4–16 years, who participated in the Third National Health and Nutrition Examination Survey (1988–1994). Linear and logistic regression modeling was used to adjust for known covariates. Results: Geometric mean blood lead levels were 1.5 &mgr;g/dL, 1.9 &mgr;g/dL, and 2.6 &mgr;g/dL for children with low, intermediate, and high cotinine levels, respectively. The adjusted linear regression model showed that geometric mean blood lead levels were 38% higher (95% confidence interval [CI] = 25–52%) in children with high cotinine levels compared with children who had low cotinine levels. The logistic regression models showed that children with high cotinine levels were more likely to have blood lead levels ≥10 &mgr;g/dL than were children with low cotinine levels (odds ratio [OR] = 4.4; CI = 1.9–10.5). Conclusions: Second-hand smoke could be associated with increased blood lead levels in U.S. children aged 4-16 years.

Measurement of fine particles and smoking activity in a statewide survey of 36 California Indian casinos

Despite Californias 1994 statewide smoking ban, exposure to secondhand smoke (SHS) continues in Californias Indian casinos. Few data are available on exposure to airborne fine particles (PM2.5) in casinos, especially on a statewide basis. We sought to measure PM2.5 concentrations in Indian casinos widely distributed across California, exploring differences due to casino size, separation of smoking and non-smoking areas, and area smoker density. A selection of 36 out of the 58 Indian casinos throughout California were each visited for 1–3 h on weekend or holiday evenings, using two or more concealed monitors to measure PM2.5 concentrations every 10 s. For each casino, the physical dimensions and the number of patrons and smokers were estimated. As a preliminary assessment of representativeness, we also measured eight casinos in Reno, NV. The average PM2.5 concentration for the smoking slot machine areas (63 μg/m3) was nine times as high as outdoors (7 μg/m3), whereas casino non-smoking restaurants (29 μg/m3) were four times as high. Levels in non-smoking slot machine areas varied: complete physical separation reduced concentrations almost to outdoor levels, but two other separation types had mean levels that were 13 and 29 μg/m3, respectively, higher than outdoors. Elevated PM2.5 concentrations in casinos can be attributed primarily to SHS. Average PM2.5 concentrations during 0.5–1 h visits to smoking areas exceeded 35 μg/m3 for 90% of the casino visits.

The effect of cigar smoking on indoor levels of carbon monoxide and particles

To provide new information on environmental tobacco smoke (ETS) levels from cigars, we conducted three types of experiments: (1) Measurements of carbon monoxide (CO) during 15 controlled experiments in an office where several cigar brands were machine-smoked; (2) Measurements of CO or respirable suspended particles (RSP) and particle-bound polycyclic aromatic hydrocarbons (PAH) in a residence where two cigars were smoked by a person; and (3) Measurements of CO during two studies at cigar social events (where there were up to 18 cigars being smoked at a time) in which an investigator wore a concealed personal exposure monitor. Average concentrations of CO at the cigar social events were comparable to, or larger than, those observed on a freeway during rush hour traffic. A mass balance model that has been used successfully to predict ETS from cigarettes is used in this paper to obtain CO, RSP, and PAH emission factors (emission rate [mg/min], total mass emitted [mg], and emissions per mass smoked [mg/g]). The calculated emission factors show that the cigar can be a stronger source of CO than the cigarette. In contrast, the cigar may have fewer emissions of RSP and PAH per gram of consumed tobacco than the cigarette, but its size and longer smoking time results in greater total RSP and PAH emissions than for a single cigarette.

Lung function and exposure to workplace second-hand smoke during exemptions from smoking ban legislation: an exposure–response relationship based on indoor PM2.5 and urinary cotinine levels

Background The effects of workplace second-hand smoke (SHS) on lung function remain uncertain because of a lack of objective measures for SHS exposures. Objective To determine whether an exposure–response association exists between lung function and two different markers of SHS based on indoor fine particulate (PM2.5) and urinary cotinine levels in non-smoking catering workers. Design A cross-sectional study during a 1.5-year exemption of licensed catering premises from smoke-free legislation. Participants 186 non-smoking catering workers aged 18–65 years in Hong Kong were recruited. A declared non-smoking status was accepted in workers with exhaled breath carbon monoxide levels <6 ppm and urinary cotinine levels <100 ng/ml. Main outcome measures Lung function measures of forced expiratory volume in 1s (FEV1 in litres), forced vital capacity (FVC in litres) and forced expiratory flow as 25–75% of FVC (FEF25–75 in l/s) were recorded. Results Indoor fine particulate (PM2.5) concentrations were 4.4 times as high in smoking premises (267.9 μg/m3) than in non-smoking premises (60.3 μg/m3) and were strongly associated with the probability of permitted smoking (R2=0.99). Smoking was the dominant source of particulates (R2=0.66). Compared with workers exposed to the lowest indoor PM2.5 stratum (<25 μg/m3), lung function was lower in the three higher PM2.5 strata (25–75, 75–175, >175 μg/m3) with FEV1 −0.072 (95% CI −0.123 to −0.021), −0.078 (95% CI –0.132 to −0.024), −0.101 (95% CI −0.187 to −0.014); FEF25–75 −0.368 (95% CI −0.660 to −0.077), −0.489 (95% CI −0.799 to −0.179), −0.597 (95% CI −0.943 to −0.251); and FEV1/FVC (%) −2.9 (95% CI −4.8 to −1.0), −3.2 (95% CI −5.1 to −1.4) and −4.4 (95% CI −7.4 to −1.3), respectively. Urinary cotinine was associated positively with indoor PM2.5 but negatively with lung function. Consistently lower values for lung function per unit increase of indoor PM2.5 were found. Conclusion Lung function is inversely associated with workplace SHS. Workplace exemptions and delays in implementing smoke-free policies and current moves to relax legislation are a major threat to the health of workers.

Identifying and quantifying secondhand smoke in source and receptor rooms: logistic regression and chemical mass balance approaches

Identifying and quantifying secondhand tobacco smoke (SHS) that drifts between multiunit homes is critical to assessing exposure. Twenty-three different gaseous and particulate measurements were taken during controlled emissions from smoked cigarettes and six other common indoor source types in 60 single-room and 13 two-room experiments. We used measurements from the 60 single-room experiments for (i) the fitting of logistic regression models to predict the likelihood of SHS and (ii) the creation of source profiles for chemical mass balance (CMB) analysis to estimate source apportionment. We then applied these regression models and source profiles to the independent data set of 13 two-room experiments. Several logistic regression models correctly predicted the presence of cigarette smoke more than 80% of the time in both source and receptor rooms, with one model correct in 100% of applicable cases. CMB analysis of the source room provided significant PM2.5 concentration estimates of all true sources in 9 of 13 experiments and was half-correct (i.e., included an erroneous source or missed a true source) in the remaining four. In the receptor room, CMB provided significant estimates of all true sources in 9 of 13 experiments and was half-correct in another two.

Measuring Indoor Air Quality and Engaging California Indian Stakeholders at the Win-River Resort and Casino: Collaborative Smoke-Free Policy Development

Most casinos owned by sovereign American Indian nations allow smoking, even in U.S. states such as California where state laws restrict workplace smoking. Collaborations between casinos and public health workers are needed to promote smoke-free policies that protect workers and patrons from secondhand tobacco smoke (SHS) exposure and risks. Over seven years, a coalition of public health professionals provided technical assistance to the Redding Rancheria tribe in Redding, California in establishing a smoke-free policy at the Win-River Resort and Casino. The coalition provided information to the casino general manager that included site-specific measurement of employee and visitor PM2.5 personal exposure, area concentrations of airborne nicotine and PM2.5, visitor urinary cotinine, and patron and staff opinions (surveys, focus groups, and a Town Hall meeting). The manager communicated results to tribal membership, including evidence of high SHS exposures and support for a smoke-free policy. Subsequently, in concert with hotel expansion, the Redding Rancheria Tribal Council voted to accept a 100% restriction of smoking inside the casino, whereupon PM2.5 exposure in main smoking areas dropped by 98%. A 70% partial-smoke-free policy was instituted ~1 year later in the face of revenue loss. The success of the collaboration in promoting a smoke-free policy, and the key element of air quality feedback, which appeared to be a central driver, may provide a model for similar efforts.