We are not very clever people doing very complicated things, just people worried for the health population trying to provide evidence, to get objective data by using reliable methods People whose work is to provide evidence of what kind of interventions Looking at the population and try to provide evidence of what kind of interventions could improve their quality of life Interventions include public health policies like the tobacco control law
Evidence-based failure of the partial smoking ban: contributions of scientists
“Evidence-based failure of the partialsmoking ban: contributions of scientists” Maria J. López Public Health Agency of Barcelona ICO-WHO Symposia on Tobacco Control July 2012
Smoking workgroup of the Spanish Society of Epidemiology Impact evaluation of the Spanish smoking law implemented in 2006http://seepidemiologia.es/documents/dummy/Monografia-Grupo%20Trabajo%20sobre%20tabaquismo.pdfManel Nebot y Esteve Fernández (coords.), Carles Ariza, Marcela Fu, Iñaki Galán, María José López, Jose M. Martínez, AlbertMoncada, Agustín Montes, Mónica Pérez-Ríos, Esteve Saltó, Anna Schiaffino, María Jesús Soriano
Half full? Half empty? Evidence of what was NOT working... - 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
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. Lopez MJ, Nebot M, Schiaffino A et al. Environmental Health Perspectives, 2009. Tobacco Control, 2012.
Study design: Before-after evaluation study Spanish smoking law (January 2006) Pre-law 6 months 12 months 24 months (October-December)
Study population50 measurements / region:hospitality venues and other workplacesSHS marker:Vapour-phase nicotine Passive sampler
Nicotine concentration (µg/m3) in bars/ restaurants where smoking was banned after the law Concentración de nicotina (µg/m3) - 97% p< 0.001 2.71 [RI 1.39 – 3.77] 0.09 [RI 0.01 – 0.26] Baseline 12 months follow-up* Logarithmic scale n=22
Nicotine concentration (µg/m3) in bars/ restaurants where smoking was allowed after the law Concentración de nicotina (µg/m3) 7,07 [RI 1,86 – 11,78] 5,70 [RI 2,77 – 11,73] p= 0.191 Baseline 12 months follow-up* Logarithmic scale n=33
Nicotine concentration (µg/m3) in bars/ restaurants separated areas after the law Smoking area Non-smoking area p= 0.075 - 89% Concentración de nicotina (µg/m3) p< 0.001Concentración de nicotina (µg/m3) 8.89 [RI 5.28 – 15.61] 5.58 [RI 2.42 – 12.42] 5.58 [RI 2.42 – 12.42] 0.62 [RI 0.34 – 1.40] Baseline 12 months follow-up Baseline 12 months follow-up n=18 n=18 * Logarithmic scale
Study 2: Impact on SHS in hospitality workers and respiratory symptoms Fernandez E, Fu M, Pascual JA et al. Plos One, 2009.
SHS in Hospitality Workers StudyBefore-after study withcomparison group117 non-smokershospitality workers20 hospitality workers inAndorra & PortugalSaliva cotinine samplesand questionnaires
Proportion (%) of respiratory symptoms in hospitality workers Control (Andorra & Portugal) -50.1% (p<0.01) p=0.140 p=0.640 p=0.757 Smoking Areas Smoking allowed Smoking allowed banned 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 studyFieldwork: October- December 2007Sampling: 40 hospitality venues in BarcelonaSHS marker: Particles smaller than 2.5 micrometers (PM2.5) Side Pack AM 510 Personal Aerosol Monitor
PM2.5 concentration (µg/m3) in hospitality venues according to the smoking regulation after the law n Average (SD) pSmoking banned 17 34.4 (14.2) <0.001Smoking allowed 16 182.2 (180.0) Air quality standards 35 µg/m3 (24-hour standard) according to the EPA 25 µg/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.
“Tobacco Control engine” Public Adm Science Citizens