Measuring SHS exposure in public places in Dhaka, Bangladesh in
support of policy development and implementation
M Huq1, M Zaman1, N Kibria2, P Breysse2, S Tamplin2
1World Health Organization, Dhaka, Bangladesh; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Background
• In Bangladesh, 44.7% of men, 1.5% of women
smoke
• About 45% of adults exposed to tobacco
smoke
• Complete ban on smoking in health and
educational institutions
• Smoking banned in selected public places
(like government offices) but allows for
designated smoking rooms
• Smoking currently allowed in restaurants
PM2.5 Concentration (µg/m3)
150
100
Figure 3: Mean concentrations of PM2.5 and
air nicotine in restaurants with evidence of
smoking* from neighboring countries
WHO
Standard
0
Outdoor Air (N=20)
Non-smoking
restaurants (N=6)
Smoking restaurants
(N=15)
Note: One restaurant had a smoking and non-smoking section
and was included in both categories of restaurant types (nonsmoking and smoking restaurants).
300
5.
0
1.4
1.2
1
150
0.8
100
0.6
0.4
50
0.2
0
No. of
samples
2
1.6
200
1.
0
Mean Air nicotine concentration
in smoking restaurants
1.8
250
0.1
0
27
Smoking
restaurants
11
Non-smoking
restaurants
India,
Indonesia
smoke-free
legislation
in place
Bangladesh
India,
Indonesia
smoke-free
legislation
in place
Levels of PM2.5 and air nicotine were highest in Indonesian
restaurants. The lowest levels were in Indian restaurants which is
probably due to the smoke free legislation. Restaurants in
Bangladesh had comparable levels of PM2.5 and air nicotine to
Indonesia.
Air nicotine was detected in nearly all restaurants,
regardless of smoking policy. Levels however , were more
than 2 times higher in restaurants where smoking was
allowed. Any level of air nicotine detected indicates that
tobacco smoking had occurred.
* evidence of smoking is defined as smoking observed,
presence of cigarette butts, and/or smell of smoke
Conclusion
Table 1: PM2.5 and air nicotine concentrations
in non-smoking and smoking restaurants
• Restaurants without smoking policies had
higher levels SHS
% of
•
Air
nicotine
detected
in
most
restaurants
Restaurant
N Mean Min Median Max monitors
Type
even though non-smoking restaurants had
> LOD*
low levels of PM2.5 likely due to sampling
Nontimeframe
6 45.7 24.3 44.7
66.7
--smoking
• Levels of SHS exposure are similar to those
PM2.5
(µg/m3)
found in Indonesia which does not have a
Smoking 15 196.4 11.9 133.5 686.9
--smoking ban
Air
nicotine
(µg/m3)
50
Mean PM2.5 concentration in
smoking restaurants
Bangladesh
Results
200
Figure 2: Air nicotine in restaurants with or
without smoking policies in Dhaka,
Bangladesh
Air Nicotine (µg/m3) note: Log Scale
• PM2.5 monitoring conducted for 30 minutes in
20 restaurants(with or without voluntary no
smoking policy) in Dhaka
• Air nicotine monitors were left for 1 week in
same restaurants
• Smoking behavior also observed
• Evidence of smoking define as smoking
observed (active), presence of cigarettes
butts and/or smell of smoke (past)
250
Results
10.
0
Methods
Figure 1: Mean concentrations of PM 2.5 in
restaurants with and without voluntary smoke
free policies in Dhaka, Bangladesh
Results
Nonsmoking
6
0.5
0.03
0.3
1.5
73
Smoking
15 1.48
0.1
0.8
4.3
100
* Limit of detection (air nicotine monitors)=0.00048 ug/m3
Note: One restaurant had a smoking and non-smoking section
and was included in both categories of restaurant types (nonsmoking and smoking restaurants).
Smoking restaurants had a higher PM2.5 and air nicotine
concentration than non-smoking restaurants. Detectable
levels of air nicotine were found in most restaurants
In Dhaka, the average level of PM2.5 was 197 µg/m3 in smoking
restaurants. This value is almost 8 times as much as the WHO
recommended exposure of 25 µg/m3. Tobacco smoking is a
major contributor of PM 2.5 indoor air pollution in Dhaka
restaurants.
Funding provided by Flight Attendant
Dissemination & Policy Impact
• Current law being amended, expected to
be more comprehensive
• A tobacco control strategic
communication plan being developed;
this will include dissemination of research
findings to both policy makers and the
general public
• In proposed amendment of law
restaurants have been added
• Future monitoring study needs to be done
to assess SHS exposure in other public
places such as offices, schools, hospitals
Medical Research Institute (FAMRI) and the Bloomberg Initiative to Reduce Tobacco Use
Measuring SHS exposure in public places in Chong Qing City, China in
support of policy development and implementation
J Yang1, ZL Dong1, CB Wu2, KL Gu2, P Breysse3, S Tamplin3
1Chinese
Center for Disease Control and Prevention, Beijing, China; 2 Chongqing Health Education Center, Beijing, China,
3Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Background
•
•
•
•
Smoking prevalence in China remains
high: 53% in males and 2.4% in females
About half the population is exposed to
SHS
Only local laws exist, but most allow
designated smoking rooms
Government-owned China National
Tobacco Corporation (CNTC) is the
world’s largest producer of tobacco.
Methods
Results
Table 1: PM2.5 concentrations in indoor
places by evidence of smoking* in
Chong Qing City, China
Building
Evidence* N
PM2.5 concentration
(µg/m3)
Mean
Hospitals
Government
Offices
Restaurants
Min
Median
Max
No
3 105.7 63.0
111.4
162.2
Yes
6 144.3 52.5
149.0
437.8
No
4 161.1 97.3
147.7
247.0
Yes
5 144.9 94.4
130.2
267.8
No
2 128.2 113.8 125.1
142.5
Results
Table 2: Air nicotine concentrations in
indoor places in Chong Qing City, China
Building
% of
# of
# of
monitors
buildings monitors
> LOD*
Air nicotine
concentration
(µg/m3)
Median
Min
Max
Schools
5
29
62
0.08
0.02 1.79
Hospitals
5
42
93
0.26
0.02 5.29
Government
4
25
80
0.23
0.02 4.78
Non-smk section
1
1
100
0.93
0.93 0.93
Smk section
8
14
100
1.35
0.38 6.96
Restaurants
• PM2.5 and air nicotine levels were
Entertainment
Non-smk section
10
17
100
1.21 0.12 11.8
measured at schools, hospitals, government
Yes
8 137.5 57.9 131.8
867.2
Smk section
2
2
100
6.44
4.0 8.88
offices, restaurants and entertainment
No
1 163.8 163.8 163.8
163.8
Entertainment
Note:
Restaurants
and
entertainment
venues
had
smoking
(Smk)
venues in January 2010
Venues
and non-smoking (Non-smk) sections.
Yes
9 185.4 73.6 156.5
385.0
• PM2.5 monitoring was conducted for 30
*LOD = 0.0098 µg/m3
minutes in 38 buildings and air nicotine
* evidence of smoking is defined as smoking observed
Detectable levels of air nicotine were found in all building types.
monitors were put in place for 1 week in
(active), presence of cigarette butts, and/or smell of
High levels of air nicotine were detected in entertainment venues
smoke (past)
35 buildings
in smoking and non-smoking sections.
• Smoking behavior was also observed at
Levels of PM2.5 were highest in entertainment venues followed
by government offices, and areas in the hospitals with smoking Conclusion
these venues
evidence. Areas in hospitals with no smoking evidence had a
• Evidence of smoking defined as smoking
• High ambient air pollution, or other unknown
PM2.5 level lower than that found outdoors.
observed (active), presence of cigarettes
factors, during PM2.5 collection likely
Figure 2: Air nicotine concentration for
butts and/or smell of smoke (past)
influenced findings
buildings in Chong Qing City, China
•
High
levels
of
air
nicotine
were
found
in
a
Results
variety of venue types
Figure 1: Mean concentrations of PM2.5 in
20.0
•
Non-smoking
sections
do
not
eliminate
outdoor air and indoor places by evidence
exposure to SHS
10.0
of smoking* in Chong Qing City, China
•
There
are
no
safe
levels
of
SHS,
development
5.0
180
of a 100% smoke-free policy is essential
Air Nicotine (µg/m3)
note: Log Scale
160
PM2.5 Concentration (µg/m3)
140
120
100
80
Dissemination & Policy Impact
•
1.0
60
40
20
______________________
WHO
standard
•
0.1
0
Outdoor Air
(N=37)
•
Indoor places, Indoor places, Indoor places,
no smoking
past smoking active smoking
evidence (N=10) evidence (N=2) evidence (N=26)
No. of
Samples
* evidence of smoking is defined as smoking observed (active),
presence of cigarette butts, and/or smell of smoke(past)
PM2.5 levels of outdoor and indoor places were greater than
the WHO daily acceptable standard (25 µg/m3). Areas with
active smoking evidence had higher levels compared to
those with past evidence of smoking. In 30 minutes, visitors to
indoor places with evidence of active smoking would be
exposed to more than six times the WHO standard.
29
Schools
42
25
15
19
Hospitals Governments Restaurants Entertainment
Venues
Air nicotine was highest in entertainment venues
(median in smoking areas: 6.4 µg/m3, non-smoking
areas: 1.2 µg/m3), followed by restaurants. Any level
of air nicotine exposure is dangerous to adults and
children.
Funding provided by Flight Attendant Medical
Research Institute (FAMRI) and the Bloomberg
Initiative to Reduce Tobacco Use
•
Despite obstacles, China has been
successful in establishing smoke-free venues
for the Beijing Olympics in 2008 and the
Shanghai Expo in 2010
With concerted efforts, it is possible to
establish 100% smoke-free indoor public
places in China
Local data can be used to improve public
perception of harm caused by smoking
and exposure to SHS and support
establishment of 100% smoke-free law in
Chong Qing City
Next steps include the development and
application of best-practice evaluation
methods to assess the impact of tobacco
control interventions in Chong Qing City and
elsewhere
Measuring SHS exposure in public places in Ahmedabad, India
in support of policy development and implementation
B
1
Modi ,
M
2
Aghi ,
A
3
Baig ,
P.
3
Breysse
S
3
Tamplin
1Government
of Gujarat, India; 2Independent Consultant (Behavior Expert), New Delhi, India,
3Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Background
•
•
•
In India, 33% of males and 1.4 % of females
smoke
Annually nearly 1 million people die due to
tobacco related illnesses
National smoke-free law bans smoking in
indoor workplaces and public places
including open places commonly visited by
public
Airports, hotels and restaurants with
capacity of more than 30 people allow
designated smoking rooms
Methods
•
•
•
•
PM2.5 and air nicotine levels were
measured at hospitals, government
offices, restaurants and entertainment
venues during January-March, 2010
PM2.5 monitoring was conducted for 30
minutes in 28 buildings (schools excluded)
Air nicotine monitors were put in place for
1 week in 34 buildings
Evidence of smoking defined as smoking
observed (active), presence of cigarettes
butts and/or smell of smoke (past)
Results
Figure 1: Mean concentrations of PM2.5 in
outdoor air and in indoor places in
Ahmedabad, India
Figure 2: Air Nicotine concentration by
building type in Ahmedabad, India
Table 2: Observational findings by building in
Ahmedabad, India
5.0
1.0
0.1
500
400
300
200
100
WHO
standard
_______________________________
0
Outdoor Air (N=32)
Indoor places (N=27)
Hookah bars (N=6)
Hookah bars had the highest concentration of PM2.5, six times
higher than indoor places. Levels of PM2.5 in hookah bars are
extremely dangerous. Visitors to these venues would be
exposed to 20 times the daily WHO acceptable standard (25
µg/m3).
Tobacco
Signs
Smokers Butts
smell
prohibiting
observed found
detected smoking
(%)
(%)
(%)
(%)
Building
N
Colleges
5
0
20
20
0
Hospital
5
0
60
60
100
Government
5
60
80
60
80
Restaurants
10
0
0
0
30
Entertainment
4
0
25
25
50
Hookah bars
6
0
0
0
17
All government buildings, a large number of hospitals, and a
third of entertainment venues were not compliant.
Low proportion of signs prohibiting smoking in colleges,
restaurants, entertainment venues and hookah bars.
0.01
Conclusions
No. of
Samples
17
Colleges
40
Hospitals
29
Gov. Blds.
19
Rests.
7
Entertain.
11
Hookah
bars
•
Levels or air nicotine were highest in hookah bars
followed by entertainment and restaurant venues.
•
•
Table1: Air nicotine concentrations by
building type in Ahmedabad, India
Air nicotine
concentration
(µg/m3)
% of
# of
# of
Monitor
Building Type
Median Min Max
Buildings Monitors
s
> LOD*
600
PM2.5 Concentration (µg/m3)
Results
10.0
Air Nicotine (µg/m3) note: Log Scale
•
Results
Colleges
5
17
53
0.01
<LOD 0.2
Hospitals
5
40
40
Government
5
29
55
0.03
<LOD 0.5
Restaurants+
10
19
84
0.1
<LOD 0.5
Entertainment+
4
7
71
0.06
<LOD 4.0
Hookah bars
6
11
100
3.3
0.4 11.4
<LOD <LOD 0.5
•
Hookah bars need to addressed under the
law
Awareness needs to raised of the harms of
hookah
Detectable levels of SHS and non
compliance with the law were found in
colleges, hospitals, government offices
and restaurants
Enforcement remains an issue
Dissemination & Policy Impact
Results to be disseminated through
media coverage and will be used for:
• Sensitization of Policy Makers
• Capacity Building of Law
Enforcement Officials
• Awareness of General Population
about their right of Smokefree air in
public places
* Limit of Detection (LOD) = 0.0073 ug/mL
+ no designated smoking rooms
Levels of air nicotine were highest in hookah bars followed by
restaurants and entertainment venues. Most monitors in the
buildings detected air nicotine.
Funding provided by Flight Attendant
Medical Research Institute (FAMRI) and the
Bloomberg Initiative to Reduce Tobacco
Use
500.0
Measuring SHS exposure in public places in Bogor, Indonesia in
support of policy development and implementation
TS
Background
•
•
•
•
Indonesia has high prevalence of smoking:
65 % of males and 5% of females smoke
97 million non-smokers and 37 million children
are regularly exposed to SHS
Indonesia has neither signed nor ratified the
FCTC
Sub national (e.g. Bogor City) tobacco
control activities have been implemented by
city officials with local and international
partners
Methods
•
•
•
•
•
Junita
Study conducted in Bogor City in August 2009
PM2.5 levels measured at hospitals,
government offices, restaurants
and entertainment venues
Monitoring done in 27 buildings for
30 minutes each
Smoking behavior also assessed
using observational survey
Evidence of smoking defined as
smoking observed(active),
presence of cigarettes butts and/or
smell of smoke (past)
Results
Figure 1: Mean concentrations of PM2.5 in outdoor
air and in indoor places with evidence of smoking*
in Bogor, Indonesia
P
3
Breysse ,
S
3
Tamplin
Results
Results
Figure 2: Mean concentrations of PM2.5 in
buildings with evidence of smoking* in
Bogor, Indonesia
Table 2: Observational findings based on
building type in Bogor, Indonesia
Buildings
N
250
Hospitals
5
60
60
20
200
Government
5
60
80
40
150
Restaurants
8
100
63
88
100
Entertainment
9
89
78
100
350
300
50
__________________________
0
Hospital (N=3)
Government
(N=4)
Restaurants
(N=8)
The majority of entertainment and restaurants had smokers
WHO
present at the time of sampling. Buildings were not 100%
standard smoke-free because there was evidence of smoking in all
building types.
Entertainment
(N=9)
*evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of
smoke (past)
Levels of PM2.5 were higher than the WHO daily
acceptable standard in all building types. Entertainment
venues had the highest levels of PM2.5. Visitors to
entertainment places with smoking evidence would be
exposed to more than 12 times the WHO acceptable
levels of PM2.5.
Table 1: PM2.5 concentrations in indoor
places by evidence of smoking* in Bogor,
Indonesia
Buildings
Evidence* N
PM2.5 concentration
(µg/m3)
Conclusion
•
•
•
Mean
Min
Median
Max
•
Hospitals
5
3
43.8
71.6
17.1
21.5
40.9
54.6
68.3
138.7
Government
Offices
No
Yes
3
4
38.1
75.5
26.4
31.5
37.6
51.2
50.4
16.8
Restaurants
No
Yes
6
8
57.4
78.0
39.6
46.9
55.4
66.2
73.9
118.3
No
Yes
4
9
65.0 56.6
304.4 67.2
63.7
92.9
76.0
1011.6
•
150
100
50
WHO
_______________________________
Entertainment
standard Venues
0
Outdoor Air
(N=53)
Indoor places, no Indoor places,
Indoor places,
smoking
past smoking
active smoking
evidence (N=22) evidence (N=4) evidence (N=27)
*evidence of smoking is defined as smoking observed (active),
presence of cigarette butts, and/or smell of smoke (past)
PM2.5 levels of outdoor air and indoor places were all greater than
the WHO daily acceptable standard (25 µg/m3).
* evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of smoke
(past)
Levels of PM2.5 were highest in entertainment venues, followed
by government offices, restaurants, and hospitals with
smoking evidence. In all buildings, locations with smoking
evidence had higher levels of PM2.5 than those without
smoking evidence
Entertainment venues had highest
levels of SHS and need to be addressed
under strict smoke-free policy
Locations with past smoking evidence
had higher levels of PM2.5
All venue types had visible signs of
smoking suggesting that stronger
enforcement is needed
Dissemination & Policy Impact
•
•
No
Yes
250
200
Butts
found
(%)
Tobacco
smell
detected
(%)
Smokers
observed
(%)
300
PM2.5 Concentration (µg/m3)
2
MKM ,
Union Against Tuberculosis and Lung Disease, Jakarta, Indonesia; 2Bogor City Health Office, Bogor, Indonesia,
3Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
PM2.5 Concentration (µg/m3)
1International
1
Bam ,
•
Widespread media coverage received
Results disseminated to local parliament,
local government, local NGOs, MOH
Mayor of Bogor City signed 100% smokefree regulation in March 2010
Case study on Bogor City’s tobacco
control experience currently being
developed which may serve as a model
sub-national smoke free initiative that
can be replicated in other cities in
Indonesia
Future monitoring should be done to
assess compliance with the smoke-free
policy in Bogor City
This study was conducted by Bogor City Health
Office, International Union Against Tuberculosis
and Lung Disease, and the Johns Hopkins
Bloomberg School of Public Health with
support from the Bloomberg Initiative to
Reduce Tobacco Use
Measuring SHS exposure in public places in Jakarta, Indonesia in
support of policy development and implementation
P Susanti1, D Suhadi2, T Bam 3, P Breysse4, S Tamplin4
1Jakarta
Environmental Management Board, Jakarta, Indonesia; 2Swisscontact Indonesia Foundation, Jakarta, Indonesia; 3International Union Against
Tuberculosis and Lung Disease, Jakarta, Indonesia; 4Johns Hopkins Bloomberg School of Public Health,Baltimore, Maryland, USA
Background
•
•
Results
In Indonesia, 65% of males and 5% of
females smoke
Current law bans smoking in healthcare facilities, educational institutions,
play grounds, places of worship and
public transportation
Table 1: PM2.5 concentrations in indoor places Table 2: Air nicotine concentrations in indoor
by evidence of smoking* in Jakarta, Indonesia places in Jakarta, Indonesia
PM2.5 concentration (µg/m3)
•
•
•
No
Yes
Hospital**
Government
Offices
In August 2009, PM2.5 levels measured
in hospitals, government offices,
restaurants and entertainment
venues in Jakarta
PM2.5 monitoring conducted in 30
buildings for 30 minutes
Air nicotine monitors placed in
34 buildings including those
above as well as schools for 1
week
Evidence of smoking defined as
smoking observed (active), presence
of cigarettes butts and/or smell of
smoke (past)
Restaurant
Entertainment
Venues
No
Yes
No
Yes
No
Yes
10
6
4
50.5
---
30.7
---
46.3 27.9
158.0 50.5
5 50.5 36.0
12 229.3 54.6
7
5
120.2 42.1
229.3 59.9
52.3
--43.4
147.3
54.0
137.4
84.6
100.5
64.5
--63.6
286.7
62.7
1107.8
408.2
942.7
*evidence of smoking defined as smoking observed (active),
presence of cigarette butts, and/or smell of smoke (past).
**Hospitals did not have smoking evidence in any location
Tobacco smoking is a major contributor of PM 2.5 indoor air
pollution in Jakarta entertainment venues, and restaurants,
Levels of PM2.5 were highest in restaurants and entertainment
venues, followed by government offices. Hospitals had a PM2.5
level lower than that found outdoors. There was no evidence of
smoking in the hospitals monitored.
Results
Figure 2: Air nicotine concentration for
buildings in Jakarta, Indonesia
Figure 1: Mean concentration of PM 2.5 by
outdoor air and in indoor places with
evidence of smoking* in Jakarta, Indonesia
5
22
31.8
Hospital
5
26
65.4
0.01
<LOD 0.21
Government
5
35
100
0.30
0.02 4.89
Restaurant
9
Non-smk section
8
10
90
0.26
<LOD 2.32
Smk section
7
7
85.7
0.87
<LOD 8.68
10
Non-smk section
9
15
100
1.71
0.29 8.14
Smk section
3
5
100
4.67
2.90 9.28
***Limit of detection (LOD ) = 0.0037 µg/m3
Note: Restaurants and entertainment venues had smoking (Smk
section) and non-smoking sections (Non-smk section)
Air nicotine was found in all building types with the highest in
entertainment venues and the lowest in schools. High levels of air
nicotine were detected in entertainment venues in smoking and
non-smoking sections.
Conclusion
5.0
•
Air Nicotine (µg/m3)
note: Log Scale
200
1.0
150
100
•
______________________________________
WHO
Standard
0
•
Indoor places, Indoor places, Indoor places,
no smoking
past smoking
active smoking
evidence (N=28) evidence (N=3) evidence (N=18)
0.01
*evidence of smoking defined as smoking observed (active),
presence of cigarette butts, and/or smell of smoke (past)
PM2.5 levels of outdoor air and indoor places were all greater
than the WHO daily acceptable standard (25 µg/m3). In 30
minutes, visitors to indoor places with active smoking
evidence would be exposed to more than 10 times the WHO
daily acceptable level.
No. of
Samples
Designated smoking and non-smoking
sections are not effective in protecting
non-smokers
Air nicotine was detected in all building
types
Areas with active smoking evidence had
higher levels of PM2.5 than areas with past
smoking evidence
Dissemination & Policy Impact
0.1
Outdoor Air
(N=28)
<LOD <LOD 0.55
Entertainment
•
250
% of
# of
# of
monitors
buildings monitors > LOD*** Median Min Max
Schools
20.0
300
PM2.5 Concentration (µg/m3)
Building
•
10.0
50
Air nicotine
concentration
(µg/m3)
Evidence* N Mean Min Median Max
Building
Methods
•
Results
22
26
35
17
20
Schools
Hospitals
Governments
Restaurants
Entertainment
Venues
Air nicotine was highest in entertainment venues, followed by
restaurants, and government offices.
•
Media coverage and results presented to
various policy makers including the
Governor of Jakarta
Governor Regulation No. 88 year 2010 has
been enacted as a revision to the previous
Governor Regulation on Non-Smoking
Places (N0. 75 year 2005)
Data also shared with Ministry of Health
Funding provided by Flight Attendant Medical
Research Institute (FAMRI) and the Bloomberg
Initiative to Reduce Tobacco Use
Measuring SHS exposure in public places in Seoul, Republic of Korea
in support of policy development and implementation
M Lim1, W Yang2, E Park1, B Woo2, J Young1, P Breysse3, S Tamplin3
1National
Cancer Control Institute, National Cancer Center, Goyang, ROK; 2Department of Occupational Health, Catholic University of Daegu, Daegu, ROK;
3Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Background
Results
Results
•
•
Methods
PM2.5 monitoring conducted from MarchMay 2010 in Seoul
In total, 29 buildings including hospitals,
government offices, entertainment venues
and restaurants were monitored for 30
minutes and smoking behavior was also
observed
Evidence of smoking defined as smoking
observed (active), presence of cigarettes
butts and/or smell of smoke (past)
•
•
•
Results
Figure 1: Mean concentrations of PM2.5 in
outdoor and indoor places by evidence of
smoking* in Seoul, Korea
120
PM2.5 Concentration (µg/m3)
Figure 2: Mean concentration of PM2.5 in
In the Republic of Korea, 41% of males
buildings with evidence of smoking* in
and 4% of females smoke
Seoul,
Korea
National Health Promotion Law (2006) bans
smoking in selected public places but with
180
provision for designated smoking rooms
160
Health care facilities and educational
140
institutions have smoke-free policies
•
120
80
60
40
______________________WHO
standard
20
0
Restaurant (N=8)
Entertainment (N=9)
*evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of
smoke (past)
Levels of PM2.5 in restaurants and entertainment venues
were higher than the WHO daily acceptable standard.
Visitors to entertainment venues would be exposed to
more than 6 times the WHO daily acceptable levels of
PM2.5 in 30 minutes.
Evidence* N
PM2.5 Concentration (µg/m3)
80
Hospital
60
Government
standard
Restaurant
0
Outdoor Air (N=38)
Indoor places, no
smoking evidence
(N=21)
All indoor places,
active smoking
evidence (N=17)
* evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of smoke
(past)
PM2.5 levels in outdoor air and indoor places with active
smoking evidence were both greater than the WHO daily
acceptable standard (25 µg/m3). Indoor places with no
smoking evidence had lower levels than the outdoor air.
N
Hospital
5
0
0
0
20
Government
4
0
0
0
0
Restaurant
10
80
40
80
20
Entertainment
10
90
50
90
20
Entertainment places and restaurants had smokers present at
the time of sampling. Governments and hospitals had no
evidence of smoking in any of the locations.
There was a low presence of signage prohibiting smoking.
Conclusion
•
•
•
PM2.5 concentration
(µg/m3)
Mean Min Median Max
20
Signs
prohibiting
smoking
(%)
Building
Table 1: PM2.5 concentrations in indoor
places by evidence of smoking * in Seoul,
Korea
100
_____________________ WHO
Smokers Butts
observed found
(%)
(%)
Tobacco
smell
detected
(%)
100
Building
40
Table 2: Observational findings based on
building type in Seoul, Korea
Entertainment
No
10 19.0
7.3
22.7
25.6
Yes
-
---
---
---
---
No
8
20.4
7.0
21.9
30.8
Yes
-
---
---
---
---
No
2
44.6 18.9
44.6
70.4
Yes
8
44.1 11.0
22.9
180.2
No
1
18.4 18.4
18.4
18.4
Yes
9 158.9 81.6
129.4
292.3
*evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of
smoke (past)
Entertainment places with evidence of smoking had the
highest levels of PM2.5. In restaurants, levels of PM2.5 were
comparable. Levels in government offices and hospital
locations were lower than in the outdoor air.
Smoking was only observed in restaurants
and entertainment venues
Low levels of PM2.5 were detected in
hospitals and government offices
Different levels of awareness among
people and efforts to establish nonsmoking areas might have made a
difference on data on smoking evidence
and level of PM2.5 in restaurants and
entertainment venues versus government
offices and hospitals
Dissemination & Policy Impact
•
•
•
Data from this study may be used by the
government to support the establishment
of the “Tobacco Act” to create more
smoke-free public places
Presenting data from this study to support
a new law to designate smoke-free zones
under regional ordinances
Raising awareness of SHS and its hazard to
non smokers might be possible when the
data is released through newspaper
articles and mass media in collaboration
with the government
Funding provided by Flight Attendant Medical
Research Institute (FAMRI) and the Bloomberg
Initiative to Reduce Tobacco Use
Measuring SHS exposure in public places in Manila, Philippines in
support of policy development and implementation
R Timbang1, A Roda1, P Breysse2, S Tamplin2
of Health, Manila, Philippines; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Background
• In Philippines, 48% (14.6 Million) males and 9%
(2.7 million) females smoke
• Tobacco related annual health care costs
about 43 billion pesos (about 950 million USD)
• Republic Act 9211 (Tobacco Control Act) bans
smoking in healthcare, educational,
government institutions and public
transportation; restaurants and bars may
designate smoking areas subject to
requirements
Methods
• PM2.5 monitoring conducted in 27 buildings
during February-May, 2010 in hospitals,
government offices, restaurants, and
entertainment venues
• Smoking behavior also assessed using
observational survey
• Evidence of smoking defined as smoking
observed (active), presence of cigarettes
butts and/or smell of smoke (past)
Results
Results
Results
Figure 2: Mean concentrations of PM2.5
in buildings with evidence of smoking*
in Manila, Philippines
Table 2: Observational findings by building
type in Manila, Philippines
180
140
100
80
60
40
20
WHO
standard
__________________
0
Government
(N=1)
Hospital (N=1) Restaurant (N=4) Entertainment
(N=6)
*evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of
smoke (past)
Building
Evidence N
PM2.5 Concentration (µg/m3)
120
Hospitals
Government
Offices
60
40
_______________________
WHO
standard
20
0
Outdoor Air (N=46)
Indoor places, no
smoking evidence
(N=34)
All indoor places,
active smoking
evidence (N=12)
* evidence of smoking is defined as smoking observed (active),
presence of cigarette butts, and/or smell of smoke (past)
PM2.5 levels of outdoor air and indoor places with active
smoking evidence were higher than the WHO daily acceptable
level (25 µg/m3). Indoor places with no smoking evidence had
lower PM2.5 levels than outdoor air.
Hospitals
5
20
0
0
20
Government
Offices
5
20
20
0
40
Restaurants
7
57
0
43
29
Entertainment
10
60
10
60
10
Restaurants
Entertainment
Venues
No
9
PM2.5 concentration
(µg/m3)
Mean
27.6
Min Median Max
6.2
18.1
All buildings had some form of evidence of smoking. Most
entertainment venues and restaurants had smokers present.
There was a low presence of signage prohibiting smoking.
Conclusion
•
Levels of PM2.5 were higher than the WHO daily acceptable
standard in hospitals, restaurants, and entertainment
venues. Entertainment venues had the highest levels of
PM2.5. In 30 minutes, visitors to these places would be
exposed to more than 6 times the WHO daily acceptable
level.
140
80
N
120
Figure 1: Mean concentrations of PM2.5 in
outdoor air and indoor places with
Table 1: Concentration of PM2.5 by
evidence of smoking* in Manila, Philippines
building and evidence of smoking in
Manila, Philippines
100
Tobacco
Signs
Smokers Butts
smell
prohibiting
observed found
detected smoking
(%)
(%)
(%)
(%)
Building
160
PM2.5 Concentration (µg/m3)
1Department
70.2
Yes
1
31.5
31.5
31.5
31.5
No
9
25.5
10.2
18.5
53.6
Yes
1
10.6
10.6
10.6
10.6
No
3
22.7
14.4
22.5
31.2
Yes
4
103.4
71.4
104.7
133.1
No
4
40.8
18.3
28.1
88.8
Yes
6
160.3
27.6
156.0
352.2
* evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of smoke
(past)
Entertainment venues with smoking evidence had the
highest PM2.5 levels followed by restaurants with smoking
evidence. Government offices and hospital locations had
the lowest PM2.5 levels.
•
•
•
Active smoking produced higher levels of
PM2.5
 Sampling timeframe a factor – may
miss actual smoking
Entertainment venues had the highest
levels of PM2.5
In 30 minutes, visitors would be exposed to
more than 6 times the WHO daily
acceptable level
Compliance remains an issue and
enforcement needs to be addressed
Dissemination & Policy Impact
•
•
•
•
Provide evidence to local government
units on the impact of SHS in public places
Raise awareness among owners/
managers/operators of public places to
support and promote smoke-free
environments
Conduct similar SHS exposure monitoring
in other regions/local government units
Two local jurisdictions (Davao and Makati)
successfully enforce smoke-free policies;
localized evidence may encourage Metro
Manila to enforce a similar policy as well as
enhance enforcement of the provisions of
Republic Act 9211.
Funding provided by Flight Attendant Medical
Research Institute (FAMRI) and the Bloomberg
Initiative to Reduce Tobacco Use
Measuring SHS exposure in public places in Ubonratchathani, Thailand
in support of policy development and implementation
N Charoenca1, N Kungskulniti1, P Lapvongwatana1, S Hamann2, J Kamrat3, P Breysse 4, S Tamplin 4
University Faculty of Public Health, Bangkok, Thailand; 2Tobacco Control Research and Knowledge Management Center, Bangkok, Thailand; 3Ubonratchathani
Provincial Public Health Office, Thailand; 4Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Background
In Thailand, 41% of men and 2 % of
women smoke
Comprehensive tobacco control policies
are among the best in the region
Smoking is banned in all indoor public
places yet designated smoking rooms
are allowed in certain places and
compliance is not optimum
Thailand Tobacco Monopoly (TTM), which
is state-owned, has majority of the market
share
•
•
•
•
Methods
PM2.5 monitoring conducted in 26
buildings in May 2010 in entertainment
venues, government offices, hospitals and
restaurants
Smoking behavior also assessed using a
observational survey
Evidence of smoking defined as smoking
observed(active), presence of cigarettes
butts and/or smell of smoke (past)
•
•
•
Results
Results
Results
Figure 2: Mean concentrations of PM2.5 in
buildings with evidence of smoking* in
Ubonratchathani, Thailand
Table 2: Observational findings based on
building type in Ubonratchathani, Thailand
45
40
35
25
______________________________
WHO
standard
PM2.5 Concentration (µg/m3)
25
WHO
________________________________standard
15
5
0
0
0
80
Government
5
0
30
10
60
Restaurant
10
0
10
0
70
Entertainment 6
0
0
33
100
20
15
10
5
0
Restaurant (N=1)
Government (N=3)
Entertainment (N=2)
*evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of
smoke (past)
Levels of PM2.5 were higher than the WHO daily acceptable
standard in entertainment venues. In 30 minutes, visitors to
these places would be exposed to almost 2 times the daily
WHO acceptable level of PM2.5.
Building
Evidence N
PM 2.5 concentration
(µg/m3)
Mean
Hospitals
20
No
Yes
10
-
21.0
---
Min
10.0
---
Median Max
13.6
---
54.9
---
Government
Offices
No
Yes
7
3
14.5
15.6
11.1
14.6
13.3
15.9
20.3
16.4
Restaurants
No
Yes
9
1
14.5
13.4
7.4
13.4
8.9
13.4
56.3
13.4
No
Yes
4
2
17.4
46.1
12.7
45.2
16.1
46.1
24.5
46.9
Smokers were not present in any of the buildings sampled.
Except for hospitals, buildings were not 100% smoke-free
because there was evidence of smoking.
Conclusion
At the time of data collection low levels
of PM 2.5 were detected
Results show further education and
enforcement in less densely populated
communities is necessary to ensure WHO
standards for particulate pollution are
fully met
•
•
Dissemination & Policy Impact
•
•
10
5
Entertainment
Venues
0
Outdoor Air (N=31)
Indoor places, no
smoking evidence
(N=30)
Indoor places, past
smoking evidence (N=6)
*evidence of smoking is defined as smoking observed (active),
presence of cigarette butts, and/or smell of smoke (past)
Overall levels of PM2.5 of outdoor air and indoor places were all
lower than the WHO daily acceptable standard (25 µg/m3).
Levels were highest in indoor places with smoking evidence.
Outdoor air and indoor places with no smoking evidence levels
were comparable.
N Smokers Butts Tobacco
Signs
observed found smell prohibiting
(%)
(%) detected smoking
(%)
(%)
Hospital
30
Table 1: Concentration of PM 2.5 by building
Figure 1: Mean concentrations of PM2.5 in
outdoor and indoor places by evidence of and evidence of smoking* in Ubonratchathani,
Thailand
smoking* in Ubonratchathani, Thailand
30
Building
50
PM2.5 Concentration (µg/m3)
1Mahidol
* evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of smoke
(past)
PM2.5 levels were highest for entertainment venues, followed
by hospitals, government offices, and restaurants.
•
Although Thai tobacco control policies
are comprehensive, it is evident not all
venues are compliant
Results will be reported through Tobacco
Control Research and Knowledge
Management Center website and
publications
Authorities will be alerted to the need to
bring special attention to night entertainment venues recently included
as smoke-free public places where citizen
self-enforcement is less likely
Funding provided by Flight Attendant Medical
Research Institute (FAMRI) and the Bloomberg
Initiative to Reduce Tobacco Use
Measuring SHS exposure in public places in Hanoi, Vietnam in support
of policy development and implementation
D
1Centre
•
•
•
•
P
3
Breysse ,
S
3
Tamplin
Results
Table 1: PM2.5 concentrations in indoor
In Vietnam, 52% of males and 2% of
females smoke and half of the general places by evidence of smoking* in Hanoi,
population is exposed to SHS
Vietnam
Smoking is banned in indoor
Building
Evidence* N
PM2.5 concentration
(µg/m3)
workplaces and public places but
Mean
Min Median Max
designated smoking rooms are
No
2 27.0 21.3 27.0 32.8
allowed
Hospitals
Yes
Government-owned Vietnam National
1 224.2 224.2 224.2 224.2
Tobacco Corporation (Vinataba)
No
4
40.2
29.1
40.7
48.0
controls large part of the market share Government
Offices
PM2.5 and air nicotine levels were
measured at hospitals, government
offices, restaurants and entertainment
venues from January - March, 2010
PM2.5 monitoring was conducted for
30 minutes in 28 buildings and air
nicotine monitors were put in place
for 1 week in 33 buildings
Evidence of smoking is defined as
smoking observed (active), presence
of cigarettes butts and/or smell of
smoke (past)
Results
Figure 1: Mean concentration of PM2.5
of outdoor air and in indoor places by
evidence of smoking* in Hanoi, Vietnam
Restaurants
Yes
1
48.5
48.5
48.5
No
6
63.5
28.3
62.3 120.9
Yes
Entertainment
Venues
48.5
4
83.8
67.5
86.3
95.2
No
3
50.1
43.6
44.5
62.1
Yes
7 102.0 33.9
58.5 295.4
* evidence of smoking is defined as smoking observed
(active), presence of cigarette butts, and/or smell of smoke
(past)
Tobacco smoking is a major contributor of PM 2.5 indoor air
pollution in Hanoi entertainment venues and restaurants.
Levels of PM2.5 were highest in entertainment venues followed
by restaurants. Government offices had a PM2.5 level lower
than that found outdoors
Figure 2: Air nicotine concentrations by
building type in Hanoi, Vietnam
Table 2: Air nicotine concentrations in indoor
places in Hanoi, Vietnam
Building
10.0
5
18
28
0.03 0.01 0.2
Hospitals
5
34
56
0.1
Government
5
10
30
70
0.08 0.01 1.5
Non-smk section
6
6
67
1.0
0.3 3.9
Smk section
9
12
100
0.6
0.06 9.1
Entertainment
8
Non-smk section
8
9
78
1.3
0.8 6.2
Smk section
1
6
83
2.5
0.1 4.2
Restaurants
Detectable levels of air nicotine were found in all building types
with the highest in entertainment venues and the lowest in schools.
High levels of air nicotine were detected in entertainment venues in
smoking and non-smoking sections.
Conclusion
•
60
40
__________________________WHO
Air Nicotine (µg/m3)
note: Log Scale
100
80
1.0
•
0.1
•
0
Outdoor Air
(N=34)
Indoor places, no
Indoor places,
smoking evidence active smoking
(N=21)
evidence (N=13)
•
0.01
No. of
Samples
PM2.5 levels of outdoor air and indoor places were all
greater than the WHO daily acceptable standard (25
µg/m3). In 30 minutes, visitors to indoor places with active
smoking evidence would be exposed to more than 4 times
the WHO daily acceptable level.
* evidence of smoking is defined as smoking observed (active),
presence of cigarette butts, and/or smell of smoke (past)
Highest levels of air nicotine found in
entertainment venues and restaurants
Evidence of smoking was found in all types
of venues
Smoking sections are not effective
Need for a comprehensive policy with 100%
smoke-free places that eliminates smoking
sections and protects all people
Dissemination & Policy Impact
standard
20
0.01 0.5
Note: Some restaurants and entertainment venues had smoking
(Smk) and non-smoking (Non-smok) sections.
**LOD = 0.0062 µg/m3
•
•
5.0
Air nicotine
% of
concentration
# of
# of
monitors
3)
(µg/m
buildings monitors
> LOD** Median Min Max
Schools
•
20.0
120
PM2.5 Concentration (µg/m3)
N
2
Huy ,
Results
Methods
•
P
1
Hang ,
for Community Health Research and Development, Hanoi, Vietnam; 2Hanoi Medical University, Hanoi, Vietnam;
3Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Background
•
1
Trang ,
18
Schools
30
34
18
15
Governments Hospitals Restaurants Entertainment
Venues
Air nicotine was highest in entertainment venues followed
by restaurants, hospitals, governments, and schools. Any
level of air nicotine exposure can be dangerous to adults
and children.
•
Smoke free hospital model piloted; to be
replicated by MOH
Comprehensive Tobacco Control Legislation
to be submitted to the National Assembly in
2011
Research findings to be presented in the
meeting of the technical working group on
tobacco control
Results posted on the websites of CCRD,
VINACOSH, and Health Bridge Canada who
are working on tobacco control in Vietnam
Funding provided by Flight Attendant Medical
Research Institute (FAMRI) and the Bloomberg Initiative
to Reduce Tobacco Use