“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.

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