Mark J. Travers

Secondhand Exposure to Vapors From Electronic Cigarettes

INTRODUCTION Electronic cigarettes (e-cigarettes) are designed to generate inhalable nicotine aerosol (vapor). When an e-cigarette user takes a puff, the nicotine solution is heated and the vapor is taken into lungs. Although no sidestream vapor is generated between puffs, some of the mainstream vapor is exhaled by e-cigarette user. The aim of this study was to evaluate the secondhand exposure to nicotine and other tobacco-related toxicants from e-cigarettes. MATERIALS AND METHODS We measured selected airborne markers of secondhand exposure: nicotine, aerosol particles (PM(2.5)), carbon monoxide, and volatile organic compounds (VOCs) in an exposure chamber. We generated e-cigarette vapor from 3 various brands of e-cigarette using a smoking machine and controlled exposure conditions. We also compared secondhand exposure with e-cigarette vapor and tobacco smoke generated by 5 dual users. RESULTS The study showed that e-cigarettes are a source of secondhand exposure to nicotine but not to combustion toxicants. The air concentrations of nicotine emitted by various brands of e-cigarettes ranged from 0.82 to 6.23 µg/m(3). The average concentration of nicotine resulting from smoking tobacco cigarettes was 10 times higher than from e-cigarettes (31.60±6.91 vs. 3.32±2.49 µg/m(3), respectively; p = .0081). CONCLUSIONS Using an e-cigarette in indoor environments may involuntarily expose nonusers to nicotine but not to toxic tobacco-specific combustion products. More research is needed to evaluate health consequences of secondhand exposure to nicotine, especially among vulnerable populations, including children, pregnant women, and people with cardiovascular conditions.

A 32-country comparison of tobacco smoke derived particle levels in indoor public places

Objective: To compare tobacco smoke-derived particulate levels in transportation and hospitality venues with and without smoking in 32 countries using a standardised measurement protocol. Methods: The TSI SidePak AM510 Personal Aerosol Monitor was used to measure the concentration of particulate matter less than 2.5 microns in diameter (PM2.5) in 1822 bars, restaurants, retail outlets, airports and other workplaces in 32 geographically dispersed countries between 2003 and 2007. Results: Geometric mean PM2.5 levels were highest in Syria (372 μg/m3), Romania (366 μg/m3) and Lebanon (346 μg/m3), while they were lowest in the three countries that have nationwide laws prohibiting smoking in indoor public places (Ireland at 22 μg/m3, Uruguay at 18 μg/m3 and New Zealand at 8 μg/m3). On average, the PM2.5 levels in places where smoking was observed was 8.9 times greater (95 CI 8.0 to 10) than levels in places where smoking was not observed. Conclusions: Levels of indoor fine particle air pollution in places where smoking is observed are typically greater than levels that the World Health Organization and US Environmental Protection Agency have concluded are harmful to human health.

Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014.

Background Noncigarette tobacco products are evolving rapidly, with increasing popularity in the United States. Methods We present prevalence estimates for 12 types of tobacco products, using data from 45,971 adult and youth participants (≥12 years of age) from Wave 1 (September 2013 through December 2014) of the Population Assessment of Tobacco and Health (PATH) Study, a large, nationally representative, longitudinal study of tobacco use and health in the United States. Participants were asked about their use of cigarettes, e‐cigarettes, traditional cigars, cigarillos, filtered cigars, pipe tobacco, hookah, snus pouches, other smokeless tobacco, dissolvable tobacco, bidis, and kreteks. Estimates of the prevalence of use for each product were determined according to use category (e.g., current use or use in the previous 30 days) and demographic subgroup, and the prevalence of multiple‐product use was explored. Results More than a quarter (27.6%) of adults were current users of at least one type of tobacco product in 2013 and 2014, although the prevalence varied depending on use category. A total of 8.9% of youths had used a tobacco product in the previous 30 days; 1.6% of youths were daily users. Approximately 40% of tobacco users, adults and youths alike, used multiple tobacco products; cigarettes plus e‐cigarettes was the most common combination. Young adults (18 to 24 years of age), male adults and youths, members of racial minorities, and members of sexual minorities generally had higher use of tobacco than their counterparts. Conclusions During this study, 28% of U.S. adults were current users of tobacco, and 9% of youths had used tobacco in the previous 30 days. Use of multiple products was common among tobacco users. These findings will serve as baseline data to examine between‐person differences and within‐person changes over time in the use of tobacco products. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration.)

Tobacco Outlet Density and Demographics in Erie County, New York

Economic literature shows that smokers are responsive to the price of cigarettes and that African American and lower-income smokers are particularly price sensitive.1–4 Tobacco control policies that effectively restrict access and use of cigarettes will raise the cost of the cigarettes themselves as a result of increased costs in obtaining and using cigarettes. For example, zoning restrictions on the number of tobacco outlets in a given area will require smokers to travel greater distances, which has a cost associated with it, to obtain cigarettes. Studies in the alcohol literature indicate that reductions in the physical availability of alcohol products are associated with positive health and behavioral outcomes,5–8 especially in low socioeconomic areas.9,10 No such studies have been performed concerning tobacco retail outlet densities. Given this deficiency in the tobacco literature, we set out to determine whether tobacco outlets were more densely concentrated in areas with lower incomes and more African Americans.

An experimental investigation of tobacco smoke pollution in cars

INTRODUCTION Tobacco smoke pollution (TSP) has been identified as a serious public health threat. Although the number of jurisdictions that prohibit smoking in public places has increased rapidly, just a few successful attempts have been made to pass similar laws prohibiting smoking in cars, where the cabin space may contribute to concentrated exposure. In particular, TSP constitutes a potentially serious health hazard to children because of prolonged exposure and their small size. METHODS The present study investigated the levels of TSP in 18 cars via the measurement of fine respirable particles (<2.5 microns in diameter or PM(2.5)) under a variety of in vivo conditions. Car owners smoked a single cigarette in their cars in each of five controlled air-sampling conditions. Each condition varied on movement of the car, presence of air conditioning, open windows, and combinations of these airflow influences. RESULTS Smoking just a single cigarette in a car generated extremely high average levels of PM(2.5): more than 3,800 microg/m3 in the condition with the least airflow (motionless car, windows closed). In moderate ventilation conditions (air conditioning or having the smoking driver hold the cigarette next to a half-open window), the average levels of PM(2.5) were reduced but still at significantly high levels (air conditioning = 844 microg/m3; holding cigarette next to a half-open window = 223 microg/m3). DISCUSSION This study demonstrates that TSP in cars reaches unhealthy levels, even under realistic ventilation conditions, lending support to efforts occurring across a growing number of jurisdictions to educate people and prohibit smoking in cars in the presence of children.

Secondhand Smoke Transfer in Multiunit Housing

INTRODUCTION The home can represent a significant source of secondhand smoke (SHS), especially for individuals who live in close proximity to one another in multiunit housing (MUH). The objective of this study was to quantify real-time SHS transfer between smoke-permitted and smoke-free living units within the same MUH structure. METHODS Air monitors were used to assess PM₂.₅, an environmental marker for SHS, in 14 smoke-free living units and 16 smoke-permitted units within 11 MUH buildings in the Buffalo, New York, area between July 2008 and August 2009. Air monitors were operated concurrently in both smoke-permitted and smoke-free units within each building. When feasible, additional monitors were stationed in shared hallways and on outdoor patios. Participants completed logs to document activities that could affect air quality. RESULTS Evidence of SHS transfer from smoke-permitted units was detected in 2 of the 14 smoke-free units and 6 of the 8 hallways. Real-time PM₂.₅ plots and participant logs suggest that SHS transfer is a function of many determinants, including ventilation and proximity between units. Following stratification by time of day, median PM₂.₅ levels were greatest between 4:00 PM and 11:59 PM but varied by location: 10.2 μg/m³ in smoke-free units, 18.9 μg/m³ in hallways, and 29.4 μg/m³ in smoke-permitted units. CONCLUSIONS This study documents SHS incursions from smoke-permitted units into smoke-free units and adjacent hallways within the same building. Since many factors appear to impact the amount of SHS transfer between these areas, the implementation of a smoke-free building policy represents the most effective way to ensure that residents of MUH units are not exposed to SHS.

Smoke-free homes and smoking cessation and relapse in a longitudinal population of adults

INTRODUCTION The present study reports on the prevalence of smoke-free homes, the characteristics of participants who adopted a smoke-free home policy, and the association between smoke-free homes and subsequent predictors of smoking cessation. METHODS Data are reported on 4,963 individuals who originally participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed follow-up surveys in 2001 and 2005. The relationship between home smoking policy and smoking behavior was examined with a multivariate regression model. RESULTS Among those who were smokers at the 2001 follow-up, the percentage reporting that no smoking was allowed in their home increased from 29% in 2001 to 38% in 2005. Smokers most likely to adopt smoke-free home policies between 2001 and 2005 were males, former smokers, and those who had lower levels of daily cigarette consumption (among those who continued to smoke), those with higher annual household incomes, and those with no other smokers in the household. Some 28% of smokers with smoke-free homes in 2001 reported that they had quit smoking by 2005 compared with 16% of those who allowed smoking in their homes (odds ratio [OR] = 1.7, 95% CI = 1.4-2.2), and baseline quitters with smoke-free homes also were less likely to relapse (OR = 0.6, 95% CI = 0.4-0.8). DISCUSSION Smoke-free homes are becoming more prevalent, and they are a powerful tool not only to help smokers stop smoking but also to help keep those who quit from relapsing back to smoking.

Indoor air quality in Virginia waterpipe cafés

Introduction A revised indoor air quality law has been implemented in Virginia to protect the public from the harmful effects of secondhand smoke exposure. This legislation contains exemptions that include allowances for smoking in a room that is structurally separated and separately ventilated. The objective of the current study was to examine the impact of this law on air quality in waterpipe cafés, as well as to compare the air quality in these cafés to restaurants that allow cigarette smoking and those where no smoking is permitted. Methods Indoor air quality in 28 venues (17 waterpipe cafés, five cigarette smoking-permitted restaurants and six smoke-free restaurants (five with valid data)) in Virginia was assessed during 4 March to 27 May 2011. Real-time measurements of particulate matter (PM) with 2.5 μm aerodynamic diameter or smaller (PM2.5) were obtained and occupant behaviour/venue characteristics were assessed. Results The highest mean PM2.5 concentration was observed for waterpipe café smoking rooms (374 μg/m3, n=17) followed by waterpipe café non-smoking rooms (123 μg/m3, n=11), cigarette smoking-permitted restaurant smoking rooms (119 μg/m3, n=5), cigarette smoking-permitted restaurant non-smoking rooms (26 μg/m3, n=5) and smoke-free restaurants (9 μg/m3, n=5). Smoking density was positively correlated with PM2.5 across smoking rooms and the smoke-free restaurants. In addition, PM2.5 was positively correlated between smoking and non-smoking rooms of venues. Conclusions The PM2.5 concentrations observed among the waterpipe cafés sampled here indicated air quality in the waterpipe café smoking rooms was worse than restaurant rooms in which cigarette smoking was permitted, and state-required non-smoking rooms in waterpipe cafés may expose patrons and employees to PM2.5 concentrations above national and international air quality standards. Reducing the health risks of secondhand smoke may require smoke-free establishments in which tobacco smoking sources such as water pipes are, like cigarettes, prohibited.

How smoke-free laws improve air quality: A global study of Irish pubs

INTRODUCTION The present study examined indoor air quality in a global sample of smoke-free and smoking-permitted Irish pubs. We hypothesized that levels of respirable suspended particles, an important marker of secondhand smoke, would be significantly lower in smoke-free Irish pubs than in pubs that allowed smoking. METHODS Indoor air quality was assessed in 128 Irish pubs in 15 countries between 21 January 2004 and 10 March 2006. Air quality was evaluated using an aerosol monitor, which measures the level of fine particle (PM(2.5)) pollution in the air. A standard measurement protocol was used by data collectors across study sites. RESULTS Overall, the level of air pollution inside smoke-free Irish pubs was 93% lower than the level found in pubs where smoking was permitted. DISCUSSION Levels of indoor air pollution can be massively reduced by enacting and enforcing smoke-free policies.

Secondhand smoke exposure (PM2.5) in outdoor dining areas and its correlates

Background This study assessed the magnitude of secondhand smoke (SHS) exposure when people smoke in outdoor dining areas and explored conditions influencing exposure levels. Methods Data were gathered from 69 outdoor dining areas in Melbourne, Australia, during April/May 2007. Sitting at tables within 1 metre of an active smoker, the authors measured the concentration of particulate pollution (PM2.5) using TSI SidePak Personal Aerosol Monitors. PM2.5 data were recorded by the monitor at 30-second intervals, and data were collected over an average of 25.8 minutes per venue. Information was collected about the presence of overhead coverings and the number of patrons and lit cigarettes. Results The average background level of PM2.5 was 8.4 μg/m3 (geometric mean (GM)=6.1 μg/m3), increasing to an average of 17.6 μg/m3 (GM=12.7 μg/m3) over the observational period and 27.3 μg/m3 (GM=17.6 μg/m3) during the time that cigarettes were actively smoked near the monitor. There was substantial variation in exposure levels, with a maximum peak concentration of 483.9 μg/m3 when there were lit cigarettes close to the monitor. Average exposure levels increased by around 30% for every additional active smoker within 1 metre of the monitor. Being situated under an overhead cover increased average exposure by around 50%. Conclusions When individuals sit in outdoor dining venues where smokers are present it is possible that they will be exposed to substantial SHS levels. Significant increases in exposure were observed when monitors were located under overhead covers, and as the number of nearby smokers increased. The role of outdoor smoking restrictions in minimising exposure to SHS must be considered.