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HomeMy WebLinkAboutCOM 0732.002 2008-2010Measuring Air Quality to Protect Children from Secondhand Smoke in Cars Vaughan W Rees, PhD, Gregory N Connolly, DA11), N11F1 Background: Secondhand tobacco smoke (SHS) is a major, preventable contributor to ante arid chronic adverse health outcomes that affect children disproportionately The predominant source of SHS among children is domestic exposure, and while up to two thirds of U S households have car smoking bans. an unacceptable number of children remain vulnera- ble. To help promote more ellect ive protection through legislation, health onmmu strategies, on behavioral it terve Mitts, data demonstrating the adverse effect of SI IS on an quality in etas are needed Methods: Secondhand tobacco 5111okt In a motut vehicle under actual driving conditions was monitored by measuring respirable suspended particles (RSPB) of Tess than 2 5 microns m diameter, and carbon monoxide. Forty -tine driving trials were conducted, using teams of volunteer drivers and smokers nutted from the general community Three smoking conditions (nonsmoking baseline, active smoking, and immediate post- smukrng period. each 5 mnmes) wete crossed with two ventilation cn11(11(10115 (wi nduws Open. closed) in a 3 X 2 within - sessions factorial design Results: The highest mean observed RSP level was 271 pcg /m whim is unsafe, particularly for childi en. Peak RSP levels wcrc considerably higher. RSPB and carbon monoxide increased significantly from baseline after smoking, and these increases were greatest during the closed ventilation condition, compared with open ventilation Conclusions: Private passenger cars are a domestic environment with the potential lu yield unsafe levels Of SHS cost :unnlalts. These data may assist policvmakers and health advocates to promote protective strategies to ensure smoke -fre dumestit environments for children (Am . 1 }'rev :led 206,31(5).363 -368) © 2006 Alma u an journal ul I'rcvcwnr Mt(hcnc Introduction S econdhand tobacco smoke (51 is a toxic tut' contaminant that contributes to multiple, pre- ventable adverse health °incomes. Among adults, SHS exposure is associated with cardiovascular disease, cancers, and respiratory and reproductne problems 1_4 Children exposed to SHS show greater likelihood of lower respiratory tnfecuons,' - " sudden infant death syndrome! 8 ear infecuons, and severity of asthma symptoms 1",u Children may be more vulnerable to SHS- induced respiratory diseases due to smaller airways and greater oxygen demand and, hence, higher respi- ratory rates, as well as less - nature immune systems Accordingly, SHS is regarded as a major pediatric problem.' The estimated prevalence of SHS exposure among children varies according to the source of exposure, age of the child, and family smoking bchav- Flom the 11an ru d School of Public Health, 1)n•IStun of Public Ilea! th Piacuce, Boston, Massachusetts Address correspondence and reprint tequcsts to Vaughan W Rees, Inision of Public Health Planate, Hanard School tit Public Health, Landmark Budding, Lt' el 3 Fast, 677 Hununglun Ave, Boston MA 1)2115 E nrestchspb hatvaul edu Am Prev Mrd 20(16, :31(5) © 2006 American Journal of Preventive Medinne • Publ nhtd by Elsevier Inc for Recent estimates based on national surveys indicate that 35% to 43% of children Inc • in homes where secondhand smoke is present 11 While secondhand smoke exposure in cars is less well investigated, New York state middle school students reported being present in a car with a smoker an average of 1.2 days per week, while high school students reported an average of 1 5 clays per week. These frequency estimates were significantly higher among students from stoking households Reducing exposure to SHS in the United States has been achieved through evolving strategies that include legislation, public policy, and health communications. Despite recent successes 111 protecting adults, there is a lack of legislative protection from SKIS arising from domestic sources for children. The predominant cause of 51-15 among children is domestic exposure, I and most existing protection arises from voluntary individ- ual or family-based smoking restrictions in the Ronne or car. Smoking bans in the home have been shown to contribute to lower urinary cutininc in children.' Some three in four homes 111 California have indoor smoking bans and two thirds of households have car smoking bans 10.20 Despite the relative benefit of such 0749- 3797 /06 /$—see front Matter 363 ti dui 10.1016,/j ameelisaki WW1 Ref. To: Ref. Dote personal bans. a vast number of children tit the C'nued St:ucs ronnnuc to be exposed to SHS, especially among low-income families, which are Icss likely to impose domestic bans on smoking 21 Secondhand smoke monitoring has been used to document unsafe levels of contaminants, and to focus attention on health risks. Findings have more recently been used to enhance support for clean indoor air laws or to confii m the benefits of such laws." Air quality monitoring of environments in which children are • present has focused on exposure In the home. = b•i Although high emission concentrations have been found in simulated exposure to SHS in vchtcles. measures of SHS from passenger cars in a real driving situation have not been published To help promote protection through legislation, health communication strategies, or behavioral interventions, such data are needed. This study aimed to simulate children's exposure to secondhand smoke in a motor vehicle by measuring carbon dioxide and respirable suspended particles (ASPS) of Icss than 2 5 microns in diameter, under actual driving conditions. Methods Apparatus Tobacco smoke concentration was measured by a TSI SilePak AM51(1 Personal Aerosol Monitor, using a (1.32 calibration factor This device uses a user photometer that samples airborne particles in real time. The device was fitted with an impactor to detect RSI's with a mass 'netball cut! odynamic diameter of <2 5 microns. The SidePak was zero—calibrated prior to each sampling session and set so that data were averaged and logged over 1-minute intervals The air blow rate was set at 1.7 1.1intl. Carbon monoxide was monitored fired using a 181 Q-Teak Plus Indumn Air Quality Ptonitu, This Instru- ment :dco prondes real -time data collection and slum age and was sCl to log data at 1-minute ma tends. The Si(IcPak and Q - Trak were housed in a modified mart car restrainer seat and positioned m the rear passenger seat opposite the driver's side of the vehicle Also located 111 the seat was a digital clock m ensure standardization of measiue- ment periods for each session. A 2 -foot length of clear, nonreactive tubing was attached to the air intake inlet on the SidePak, and the open end of the tube was positioned at the simulated head position of an infant in the car seat. Three cars were used to conduct data-collection sessions a 1991 1-Ionda Civic sedan, a 1986 Toyota Tercel, and a 2005 Honda Civic: sedan The internal volumes of these vehicles, according to the malufarmrem s, weir 2152 1., 2588 1., and 2293 1., nupect tvely. All vehicles were owned and di hen by smokers, and each had a history of being used for smoking Study Design A 3 (smoking phase) X (ventilation) within- sessions factorial design was employed This enabled a comparison between nonsmoking baseline and smoking conditions within the same session, thus enabling better cunt col of ambient envi- 1 ental conditions the three smoking conditions were nonsmoking baseline, active smoking, and immediate post- smoking period The two ventilation conditions wet e em- ployed to represent likely real -hie driving conditions. Venti- lation "open" tequi red all four windows to be lowered half way, 01 approximately 25 cm This arrangement allowed fora high degree of air flow. Ventilation "closed" required only the smoker's side window to be lowered 5 cm It is plausible that this mining is of used by smokers under inclement weather conditions, such as ram or cold The chosen ventilation cunchtions therefore reflected a range of driver ventilation seaimgs that were easily replu Air quality measurements were sampled in 1 -minute blocks and averaged noel the whole. 5- minute sampling period Procedure Three teams, consisting of two volunteers each, were re- r runc(l frunt thy general community to drive a vehicle to city traffic while generating secondhand smoke under controlled conditions Each leant comprised a nunun :urd driver and smokei Hence, the mdn tdual unit of measurement was the smoking trial, rather than research participant. Forty -live driving "trials" were conducted. Data were col- lected hum within the vehicle while each driving ram followed a standard route designed to encounter light urban traffic The route cum pt ised a section of a major arterial road in the city of Boston, Plassachusetts, which allows continuous traffic flow without impediment by traffic signals The posted speed hoot on this route is 40 mph, and the study drivers were required to maintain speed between 30 and 40 inph Drivers performed three, 23 -mile circuits of this roadway. which took an avci age of 57 nunuLes to eunhplrte. In each dm icing trial, oeasurenients were obtained with the open - windows conchtion first, followed by the c losed- windows condition This order was employed so that the rate of dissipation of secondhand smoke to a vehicle with windows closed could be monitored (data not reported here). After an approximate l0 -minute stabihzu period mm which drivers O egun to 1 local tiaflic to teach the designated toadway, a 5- nunute baseline measurement period was siai tedl Immedi- ately following this, the person designated as smoker ht a single cigarette and smoked ad lib for 5 minutes (active smoking period), :after w time the unused portion of the cigarette w extinguished. Air monitoring then continued for 5 minutes (post-smoking [synod) A 15-minute washout period was then performed to n (dare or eliminate the secondhand smoke, by driving with windows open. Alter this, die car windows were phi ed m the ventilation-closed setting, and the procedure was repeatecl, beginning with a new 5- n baseline The procedure is summarized in Table 1. Car air conditioning and heating and/or ventil:mon sys- tems, including internal air re'cy'cling, were not used during the (hang trials so as to reduce additional sinners of rmabihty in internal air quality The story was conducted doting the summer months when the ambient air tempera - lute allowed drivers w operate comful tidily under both open - and closed-windows conditions. Institutional review board approval fox the study was granted 1311 March 15. 2005 (Federal Assurance Ill 364 American journal of Preventive Medicine, Volunie 31. Number 5 www.;gpm- online.riet Table 1. Summary of the sttidv pi or edure Time (minutes) 0 -10 10 10-15 15 -20 20-25 25 25 -40 40 40 -45 45-50 50 -55 55 Action Driver navel 10 study route Ciuuuenr e open -phase monitoring Baseline Smoke one rigatcue Post- smoking monitoring Cease monitoring Washout period Commence closed -phase monitoring Baseline Smoke one cigarette Post- smoking muunui mg Cease monitoring Ventilation Upon Open Open Open Open Closed (:1i scd Closed FWA00002642). The study was conducted and data analyzed in 2005 and 2106 Data Analysis fhc mans outcome etnables were RSPB of 2 2 5 micron diam- eter tit less (pat salary manta 1P\12-,I and carbon monoxide (CO, parts pen nulhun 1ppm 1) cuncentrantus, tmdei r ourh- 11011S of Open and ckmed vcnulauon Data were averaged over 1- minute blocks to create a mean PIs1_ -, measure wuhu1 each measurement period Two-way within - groups analyses of variance (ANOVA) wire employed to Ira main effrr is and mieraruons of the exper- imental factors Factors employed were smoking phase (base- line, smoking, post-smoking) and ventilation (winch ms open or dosed) Peat son's pi oduct- montrnt correlations fur!mired samples, using pairwise deletion of missing cases, were used to detenlllllle %whether changes in RSPs and C0 from then baseline values r °vaned similarly Results Respirable Suspended Particles Mean (anti standard error) real -tints plots of RSPs under open- and rinsed- ventilation conditions are pre- sented in Figure 1. 'These show substantial increases from baseline in airborne smoke particles during the smoking period. As expected, this increase was greater during the closed - ventilation condition, compared with open ventilation. Dissipation of airborne panicles oc- curred rapidly after the active smoking period ended. The highest peak 1- minute values that comprised each 5- minute measurement period mean are presented as dashed lines in Figure 1. These values demonstrate higher RSP concentrations than the overall 5- minute mean. A two -way ANOVA revealed significantly higher RSPs under the closed - ventilation condition than the coil- parson open - ventilation condition (F[1.44]= 29.03, p= 0.001). Similarly. there was a highly significant main effect of smoking phase (F[2.88]= 25.7(1, p <0.001), indicating an overall change in average RSP levels across the baseline, smoking, and post - smoking phases. The senulation —phase interaction also was significant (/[2,881 °' 14 60, p <0 001) Carbon Monoxide Mean (std standard error) CO levels are presented m Figure 2. Data from two driving trials were lost due to equipment malfunction, resulting in mailable CO data from 43 driving trials for analysis. Data were analyzed using two-way ANOVA for the main effects of smoking phase and ventilation There was a significant main effect of venulanon (F[ 1,421 .24 1 p<0.001). with CO higher through the closed condition There was a significant overall change in CO arising from smoking phase (F[2,84]= 16 p<0.00I), with the significant venula- uon —phase interaction (F[2,84]= 1374, p<0.001) indi- cating that CO level differed among the measurement phases according to ventilation condition. A post -hoc analysis was used to explore the nature of the significant interaction between smoking phase and ventilation on Ihis measure. To determine whether the opened and closed levels of ventilation were each influ- encing C :O levels under the smoking -phase conditions, an analysis of simple eflecis was applied. Under the closed- venulauon condition, CO levels increased signifi- cantly across the Three smoking phases (F[2,84] =1838, 000 500 400 2 ▪ s a 300 3 • 200 100 =Open window o Closed window n Peak value open window o Peak value dosed window 1 o -• s 2( l: Baseline Smoking • • Smoking phase (5 min mean) b Figure 1. Mean RSP values fin open- and dosed- venultion r unrlitiuns riming three phases of measurement (peak values shown in dashed hoes) 1'01, particulate matter, 1LS1', respuable suspended particles Nave ntbet 2006 Ann 1 I'nev Med 2006,31(5) 365 3 U 7 7 : _ '— =Open window i =Closed window -+- Peak value open , 6 window p -.o. Peak value dosed! window ! : 5 4 2 6 Baseline • • Discussion and Conclusions - -a T 1 ta t Smoking Post -smoking Smoking phase (5 min mean) Figure 2. Mean CO values for open- and closed- ventilation conditions during thine phases of measurement (peak values shown in clashed lines) CO, carbon monoxide p<0.001). However, CO levels cdid not change ari,ss the open - ventilation condition (FI2,84)<1.00, p= 054), sug- gesting that the significant interaction between ventila- tion and smoking phase was determined only by the increase in C:O xuoss the closed - ventilation condition. Correlations Between Variables Pcarson's product - moment correlations for paired s:i ples were used to explore potential correl in in- creases in RSPB and CO from their respective baselines. For each variable, baseline data were subtracted flout the smoking and post - smoking phases. Significant correla- tions were observed between mean RSP :u id CO concen- trations dunng the smoking (,, -, =0609, p<0 001) and post - smoking (r. =(! 310, p= (1.043) phases under closed- ventilation conditions. Correlati between the two out- come variables under the open - ventilation rondmon were not significant (p<0 068) These data reveal :darning RSP levels generated fr smoking a single cigarette for only 5 minutes in a private car RSP concentrations were significantly higher than baseline during the smoking and post- 366 American Journal of Preventive Medicine, Volume 31, Number 5 smoking measurement periods As expected, RSP levels were higher under the closed - windows condition than with windows open. The observed interaction between ventilation ;nut smoking phase suggests that greater inci cases in mean RSP level following smoking were lound under the closed - ventilation condition, which l urther underscores the role of (external) ventilation on air quality. Wile smoking, mean RSP cuncentrauons or 272 p.g /m ` (closed) and 51 µg /in (open) were attained, with even higher peak levels observed briefly (505 p.g /m closed. and 104 µg /u open). These RSP levels can be better contexlualued when considered against recent studies of bars that allow smoking, using similar methodology A ocean PM_ concentration of 206 µg /m was found among 27 bars in eastern Massachu- setts, while a mean concentration of 412 p.g /m observed m 14 bars in western New York state. Health standards that would enable adequate characterization of risk from SHS- generated RSPs, based on present data, are not available However, the U.S Environmen- tal Protection Agency's air quality index rates 24- hour exposure to PM.,., concentrations of >40 tzg /m as "unhealthy for sensitive groups," such as children and the elderly, and >250 p.g /m ` as "hazardous" for all individuals. The current RSP measurements, obtained from the simulated position of an infant's head in a child - restraint seat, highlight the potentially serious threat to children's health presented by secondhand smoke in private cars under normal driving conditions. A significant increase in CC) oho was observed follow- ing smoking under the closed - ventilation condition Like the RSP measure, CO levels were higher during the closer(- ventilation condition, and showed an ui- crease in ppm level from baseline. However. this in- crease was not observed under the open - ventilation condition, which maintained ppni levels close to base- line. The failure to observe an increase m CO during the open - ventilation phase may also explain the ab- sence of a correlation between changes in CO and RSPs under the open - ventilation condition. The reason for the lack of an increase in (X) under the open- ventilation condition is unclear This very light gas - phase compound ought be more easily removed or dilutes( by air flow than heavier particles such as RSPB. While the maximum observed levels (peak CO =6 ppm) were not high enough to cause short -term health risks, this observation underscores the fact that second- hand smoke presents potentially dangerous contami- nants beyond fine particle (RSI') exposure. CO is a poisonous gas, which may cause coma and death in large amounts, but among infants is known to induce lethargy and Toss of alertness even in small quantities." Some caution should be used in the interpretation of these findings The present observations were made under die xe!atively arbitaiv ventilation conditions of windows open and dosed. BeCalLse secondhand smoke wtisti% :ypn,Kinhnc net Studies of air quality have shown that Indoor domes- tic environments ran be a solace of dangerous second- hand smoke contaminants for children 2 j ,2 ' Private passenger cars can now be included as another domes- tic environment with the potential to yield high levels of SHS contaminants under normal conditions of use. Prolonged or repeated exposure to the RSP levels observed in the present study is unsafe for children Air quality measurement in smoking environments, to- gether with communication of the health risks of SHS. have been used to promote smoke-free environments. Data such as those reported here should be used by policy - makers and health advocates to promote protec- tive strategies, Including legislation, personal health behavior interventions. and broad - ranging health com- munications, to ensure smoke -free domestic environ- ments for children. mcawn•s welt' significantly higher during the dosed - windo\\s condition, it right be implied that open windo\rs or adequate \'el1nib doll in .1 nun mg vehicle help to !maintain 5115 exposure at an acceptable Ie%el The significant !lain effects of smoking phase on RSPs and (X). together with interactions between %emulation anti smoking phase, indicate that smoking uncle! (loth open- and closed - ventilation conditions resulted in increased SFIS, although the increase was greater un- der the dosed condition. Further research is required to understand whether drivers manipulate ventilation o reduce SHS, either by use of open windows or internal vehicle ventilation systems. To increase control of potential sources of variation, this study did not attempt to manipulate internal ventilation, such as fresh-air Intake or air conditioning Until such research is conducted, it should be «included that smoking in cars under typical driver and traffic conditions provides potentially unsafe secondhand smoke exposure Respirable suspended particles and CO t an also arise from other sources, most notably traffic emissions. Both are by-products 01 the combustion 01 fossil fuels. and art present in vehicle exhaust Therefore, huh types of con tin Milan t could ar se from leakage of exhaust unto the interior of the vehicle or from ambient traffic conditions. While this source cannot be ruled out conclusively, the observation of low baseline levels of RSPs and CO, even under the closed -ve ndation condi- tion, suggests than vehicle emissions played a negligible. role In the observed increases in air contaminants Furthermore, RSPs and CO covaried in a predictable manner according to ventilation and smoking phase. suggesting that they were attributable to the smoking Source Legislation banning smoking in cars with young children present was adopted recently in Arkansas (Act 13, 2(106) and Louisiana (Act 838, 20061. Ks of this writing, smoking bans in cars with children has been introduced, but not vet finally passed, in the states of California (A131569- AB2997 -04), Georgia (1 IRI 13H - 05), Michigan (I- IB5085 -05, HB5107 -05). New Jersey (A2717- 05), New fork (Al 75 -05), Pennsylvania (1-IBI963 -06), and Vernon, (1-1329 -05). Calls have been !made for similar legislation in Australia. " -3 i While some basic car- safety behaviors, such as the compulsory use of scat belts and child restraints, are widely legislated, there is a concern that legislation affecting private smoking behavior may constitute an unwell ranted intrusion on personal privacy. Roberts et al. have shown that precisely this sort of legislation could receive popular support in some jurisdictions. Effective alternative strat- egies also are available, including smoking- cessation Interventions, behavioral interventions that do not require gultling, and health communication cam- paigns (e.g., Car and Home Smoke Free Zone» I Don't Pass Gas' r Nove•nlher 2006 Am ( Prey Med 2006.31(5) 367 We gratefully acknowledge the support of the Flight Atten- daut Medical Research Institute (FAM RI), which provided funding uncler a Distinguished Professorship awarded to CNC We also thank Ur Carrie Carpenter for expert advice on this project, Jonathan Nadel for assistance wth data collection, and Colin Benjamin ja( kson for .assistance with manuscript pre par anon. No financial conflict of interest was reported by the authors or this article References 1 0 S Ilcpat mien. of Health and Human Sauces Rrduc mg mimics) use .1 report of the Surgeon General Atlanta (:.A. Centers for I)nra.• Gnmil end Pictentiun, National (1•nii tut Cluonic Disease Prevention and 1 health Nonunion, 2000 2 1; S Environmental nolecnon Agent' Respirator, health elle( is of passive smoking lung canto :Ind other disorder.. soh 4 Washington 00 0 S mepamnent if Health and Ilunt.m Srni cs, C 5 Lnv1ronmrmal Prot•r inn Agent. 1993 3 (ahtunua Environmental I'ioterium Agency Ilcahh effects of expowtrr to ern tommental tobacco smoke hn.d report Sauamento CA Office of li nt omnruul Health Masao' •tit. 1'1 4 Curkan F. Rnal A, Dagh L. Kara koc F The eflect of passive smoking tin 111r dew lot m of rectoramr, snit vial ru its bronrluohus Eui 1 Epiteunol 2000,16 M5-8 5 Stad Ill'. Cook ix; Health diet s tit passive bmuk 1 Paternal smoking and lower reins dlnrss in infancy and early anddhlnd hnras 1997.52'005 -14 b Icdnt bowvkn W. Flak E Matti nal smoking during ptcgnen■ and postn.nal 10.1/051111 w envuunnienI.d tobacco •nmkr as pretlupumlion !actors to acute iespr:uoi7 mlertions Lamont Health I'erspecn 1997.101 302 -6 kion,ll -(uhrn 11S. Ldel•vut Sl., LJknwur L.S. et al 'I he dint of pmtie smoking and wb.lit0 cspwme 1l n igh breast milk on suclden infant death scadwrte IA ?1A 1995,273 7(15-8 8 Min hill L.A. Ford RI'. Stewat l .ASV. et al Smoking and the smith 0 mlant death s)ndrnntr. I'e,hati us 11193.91 S93 -6 9 Adair-Btu h,IICE, Saust RS Lnninuuenlal tobacco smoke and middle net dnr.ue in pit-- school age t hddren Ash Pcdtan Adnlesc Aled 11)118.132 127 -33 10 Mannino 1)51, Hama DM, Redd 50. Involuntary smoking and asthma sesrnry in children data from the Third National I health and Nun non E IM111: ion Sines Chest 20112.122 4119 -15 11 laakkule fl. Naf t.ul I'. Magnus 1' E it onmenLd Iobaun smoke. mu enul atop)', and childhood asthma Fuviron 1Itahh l'cmpcat 21HII,II0 57 -82 12 Si hosier. SIA, Franke T, I'Ilann CIt Smoking }.twins of household meinbu and vntlnra m homes with child' en in the Guyed Shoes Al x11 Ped,an Ad Med 2002.156 1095 -100 14 Pirkl• II . Mega! KAI, Burnt rt yr. Kim UI. Evt I li:\, M r RR E■pn.ure ,l the L S population w , 5 Icomm. ntal tobat n smoke the Ihnd National 1 kalih and Nomtrn11 hsanun.mtn Sum.). 1988 -1991 IAAIA 1'1'11 ,271 1243-40 14 (.t (gen P1. Dixie: IA, MI.Iurt tat. Dauts u\1., Ont Ipr, k .111 I In hui do 1I 1'l , n5w rr1111n 111.11 whaccn whlkr 1 xposm' 011 ILt u'spr,unn 111'.111 of Iuidu11 2 month. through ro ■ . o..Ig, 111 On tint 1i Stan. Ilurd National Ili ab11 .111 Nutt mon F s.hhwntion Suit es. 1(188 -1994 1'ediat- nu199M.101 Available nt www pediau us •rg /rgi /coniuni/folI /IUI/ 21t8 15 \ox Volk S1.I11 1), µ,vent ill 111 H1,11111 Setond animal 1111 pt udun evalu.mon of New Pod Whit CO 11111110I 111 091 lord report Albans' New fork Sian. nepaltinent 01 1kalth. 20115 11. Lmm■iu I'SI..\bruln 1)11. 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Abr anti I)/3 Smoking at home the impact of .moki.g tvssatioi 011 nonsmoker' expo 'mu e i,1 nal]°unwi nab tobacco smoke I Ie,(1ih Ps)(Iwl 1994.13 316-20 19 ItOm K.M, I Iar11nond SK, Elva II., Veb1 cr w F. Evans IE. Minn roe Al) A Lmdonwcd tr iad It 1('01111' p.s.ne smoke expo.un' 111 lom•iinonte house- holds with young chilli en 14dnn It 2001.108 I8 -24 411 Grhrmao CA, Hon ell M1 Pr otect11lg nluld Ft horn environmental wbar to enmlt IL'TSl rspovur ,l ir al uvvx S1' 01111e Tel Res 2(1(13.5289 -301 41 Slow 1., Hun 111riwn1, 1,(Ial.rs. W Car and home spoke lice 70111' A ?spoil on the Imo onmen611 Tobacco Smoke and Quldu'n Iiojcu 2001-20115 St Mary t61cc'i Council NSW, 2(1(11 42 Amen( an 1 agar) Foundation I1on'1 pats gas, 2000 Available al. www don tp,nsg,s otg 368 American journal oI' Preventive Medicine, Volume 31, Number 5 www atpm- online net 1 The American Heart Association mission is: Building healthier lives Irce of cardiovascular d'scases and stroke Serving Hawaii since 1948 For information on the AHA's educational or research programs. contact your nearest AHA office. or visa our web site at www sine- ca•ihead ere, Honolulu County 667 Ala Monria Blvd Suite 600 Honolulu. HI 96813 -5485 Phone 808 - 5387021 Fax 808 -538 -3443 Maui County J Walter Cameron Censer 95 Mahalani Street. No 13 Wailuku, HI 96793.2598 Phone 808 - 244 -7185 Fax 808 - 242 -1857 Hawaii County: 400 Hualani Street, Ste 15 Hilo. HI 96720 -4344 Phone 808- 961 -2825 Fax 808.961.2827 Kauai County (serviced by the Oahu office) Toll -Free 1- 866 - 2053256 The American heart Association strongly supports Bill 216, "Relating to Prohibition of Smoking in Certain Places... The both of research on the dangers of smoking has long been acknuw lodged by health and science experts. However, in recent years, research focus has been extended to the dangers of being exposed to secondhand smoke and that growing body of research has been eye - opening to the point that many have shown that breathing secondhand smoke is not only deadly. but that it can he more dangerous than smoking The California Environmental Protection Agency released In 2005 a report on the health effects of secondhand smoke based on 0 body of more than 1.000 research studies that went through four years of intense scientific. public and independent review. In the report, among other things. the report found a causal Ink heayeen secondhand smoke exposure and pro -tern delivery, asthma Induction in adults (the link between asthma induction In children had already been well established), a 70 percent increase In risk for breast cancer in younger. primarily premenopausal women, and altered vascular properties. Asa result of the report, California became the first state to declare scconhand smoke a toxic air pollutant. The decision by the California Air Resources Board put secondhand smoke In the same category as diesel exhaust. arsenic and benzene and blasted it for 4,000 deaths each year In California from lung cancer and heart disease alone. Also in 2005, a study done at the University of California at San Francisco (UCSF) found that non - smokers exposed to secondhand smoke are negatively affected in a much higher dose to response ratio than are smokers Another UCSF study released in November 2006, showed that Philip Morris Tobacco Company had done extensive animal research on secondhand smoke at 0 secret laboratory in Germany and founcl it to he more toxic to non - smokers than inhaled cigarette smoke is to a smoker. The three -year review of Philip Morris documents shade public by the multi -state settlement with the tobacco industry showed that the company clicl experiments on rah, which are less sensitise to smoke than humans. The documents show that Philip Morris scientists learned that secondhand smoke is chemically different than mainstream smoke inhaled by a smoker. The smoke drifting off the lit end of a cigarette releases larger, more poisonous molecules than those inhaled at the filter end. The (heating that takes place in the process of smoking a cigarette helps to break down some toxins Secondhand smoke was found to he three times snore toxic to tissue culture cells than mainstream spoke. The effects of secondhand smoke on the cardiovascular system are substantial and immediate Within 5 minutes of exposure to secondhand smoke blood platelets become stickier. Within 15 minutes of exposure. scarring of the blood vessel walls occurs causing plaque that leads to atherosclerosis to adhere more easily. Within 30 minutes of exposure. the risk for heart attack doubles. Please remember the American Heart Association in your will American 1leart American Stroke Association. i Association. Liam and Lite.. Serving Hawaii • Please remember the American Heart Association in your will American Heart American Stroke Associ non. l Association. Learn and Inv- Serving Hawaii In 2008. the CDC asked the Institute of Medicine to convene a committee to assess the relationship between secondhand-smoke exposure and effects on the heart. The committee evaluated three relationships: • The association between secondhand- smoke exposure and cardiovascular disease, especially coronary heart disease: • The association between secondhand -smoke exposure and acute coronary events (heart attacks). and • The association between smoking bans and heart attacks The IOM reviewed I I key international studies and concluded that data consistently demonstrates that secondhand -smoke exposure increases the risk of coronary heart disease and heart attacks and that smoking bans reduce heart attacks. Given the prevalence of heart attacks. and the resultant deaths, smoking bans save norc than half a million lives each year in the U.S alone The savings. as measured in human lives. is undeniable. Another study, published in the journal Environmental Health Perspectives in 2005 used the Third National Health and Nutrition Examination Survey (NHANES 111). conducted from 1988 to 1994. to investigate the relationship between environmental tobacco smoke exposure and cognitive abilities among U.S children and adolescents 6 -16 years of age. The findings of that studs confirmed pre sous research indicating an inverse relationship with ETS exposure and cognitive outcomes. The authors also provided new information indicating that ETS is neurotoxic at extremely low levels. Exposure to ETS in U.S. children therefore has substantial public health impact beyond asthma, otitis media, and other widely recognized adverse consequences. According to population estimates employing the appropriate sampling weights. they estimated that over 2 1 9 million American children are at risk for ETS - related reading deficits. Only recently a new danger related to tobacco smoke emissions began to emerge, a danger tensed "third -hand smoke " A Lawrence Berkeley National Laboratory (Berkeley Lab) study published in February 2010 fount) that nicotine in third -hand smoke, the residue from tobacco smoke that clings to virtually all surfaces long after a cigarette has been extinguished, reacts with the conunon indoor air pollutant nitrous acid to produce dangerous carcinogens known as tobacco specific nitrosanines (TSNAs). Nitrous oxide is approved for use as a food addurve. specifically as an aerosol spray propellant. Its most common uses in this context are in aerosol whipped cream canisters. cooking sprays, and as an inert gas used to displace oxygen, to inhibit bacterial growth. when filling packages of potato chips and other similar snack foods. Therefore, children exposed to nicotine in an automobile or home and then exposed to nitrous oxide can be exposed to TSNAs through either inhalation of dust or the contact of skit with carpel or clothes. The study's findings indicate that opening a w inflow or deploying a fan to ventilate the roost while a cigarette burns does not eliminate the hazard of third -hand smoke. Lara Guida co-author of that study was quoted: "Smoking outside is better than smoking indoors but nicotine residues will suck to a smoker's skin and clothing. Those residues follow a smoker back inside American Heart American Stroke Association.' Association. Learn and Lie.. Serving Hawaii and get spread everywhere. The biggest risk is to young children. Dermal uptake of the nicotine through a child's skin is likely to occur w hen the smoker returns and if nitrous acid is in the air. which it usually is, then TSNAs will be formed... "Whereas the sidestream smoke of one cigarette contains at least 100 nanogratns equivalent total TSNAs, our results indicate that several hundred nanograms per square meter of nitrosamines may he formed on indoor surfaces in the presence of nitrous acid," said the study's lead- author M )hantad Sleiman. " we sec in this study is that the reacuuns of residual nicotine with nitrous acid at surface interlaces are a potential cancer hazard. and these results may be just the tip of the iceberg." said Kmnlcsh Asotra of the University of California's Tobacco - Related Disease Research Program, which funded the study. "We know that these residual levels of nicotine may build up over time alter several smoking cycles, and we know that through the process of agig. third -hand smoke can become more toxic over time." says Hugo Destaillats. a co- author of the study and a chemist with the Indoor Environment Department of Berkeley Lab's En ironmental Energy Technologies Division. "Our work highlights the importance of third -hand smoke reactions at indoor interfaces. particularly the production of nmrosammmes with potential health impacts " An estimated 53.000 non - smokers die each year in the United States as a result of secondhand smoke exposure. including over 35.000 from coronary heart disease associated with secondhand smoke exposure. The American Heart Association urges legislators to support the passage of Bill 216 Smoking and its inherant dangers n a choice that should he limited to adults. Children should not he subjected to those dangers as a result of the poor health choices made by the adults that surround then. Respectfully submitted, Donald 13 Weisman Hawaii Communications and Marketing /Government Affairs Director Please remember the American Heart Association in your will Nicotine in cars adds support for ban against smoking and driving: study - The Canadian Press August 26, 2009 Sheryl Ubelacker Nicotine levels are "strikingly higher" in smokers' cars than in non - smokers' vehicles, and even exceed those found in public or private indoor spaces where tobacco use is allowed, a study has found. Researchers at the Johns Hopkins Bloomberg School of Public Health tested air nicotine concentrations in smokers' vehicles and found they were twice as strong as levels measured by other studies in public and -or private places and up to 50 per cent higher than measurements taken in restaurants and bars that permit smoking. "We're interested in what the second -hand smoke exposure might do to a non - smoker travelling in a car with a smoker," said senior author Dr. Patrick Breysse. "And it seems like the car is probably the last environment where people have begun to think about the risk of second -hand smoke exposure." "The car represents a unique sub - environment because it's a confined space and the opportunity for elevated exposures, even though they're for a shorter period of time, the exposures are greater," Breysse said from Baltimore, adding that children are particularly at risk. "So it's probably something we need to be worried about." The researchers studied the vehicles of 17 smokers and five non- smokers who commuted to and from work for 30 minutes or longer. Two passive airborne nicotine samplers were placed in the vehicles - one on the front passenger seat headrest and one in the back seat behind the driver - for a 24 -hour period. In all, they analyzed 44 samplers. "And we found that for each cigarette smoked in the car, there was about a doubling in the airborne nicotine concentration," said Breysse, noting that the study took into consideration the size of each vehicle and the use of ventilation. "Most people drive with the windows up and the air conditioning on," he said. "We found that rolling the windows half -way down reduced the exposure ... but not as low as we expected." The researchers, whose work is published Tuesday in the British Medical Association journal Tobacco Control, tested nicotine because it is a good marker for the other chemicals found in second -hand smoke. Other studies have measured air -borne particles of toxic and cancer- causing chemicals known to be emitted from smoking, but those levels can be skewed by other sources, including those pumped into the environment from surrounding traffic. "Nicotine is very unique to second -hand smoke exposure," he said. "So by measuring that, we're sure we're assessing what the contribution of the smoke is." Dr. Peter Selby, clinical director of the addictions program at the Centre for Addiction and Mental Health in Toronto, said the research confirms what other studies have shown, that there is significant exposure to second -hand smoke in confined spaces - and a car's no different. "It's a pivotal study in the sense that it helps raise the awareness of many health professionals as well as policy makers that we need to do something about this issue around smoke in cars," said Selby, who was not involved in the research. Many countries have introduced legislation banning smoking in public places, but most do not apply to tobacco use in cars. In Canada, Nova Scotia and Ontario are among the provinces that prohibit smoking in vehicles carrying children. Because of their smaller lungs and faster breathing rate, children are especially at risk from the effects of second -hand smoke, he said. "I think we need to do something clearly for the involuntarily exposed, for example children," Selby said. "But there's only so much you can legislate. There's also public education that's required around this." "It's not to say that adults are not affected either. We know they are ... including smokers themselves, who often tell us they have great difficulty quitting because once they get back into their car, they often feel triggered to have a smoke." "So we have to help them break those connections." In fact, participants in the U.S. study were asked to complete a questionnaire on their attitudes toward health risks from second -hand smoke in cars and legislation to ban the practice. All agreed that smoking in vehicles posed a health risk to passengers. Among the smokers, 53 per cent said that being unable to smoke in the car would help them to kick the habit and 93 per cent said vehicles should be smoke -free on a voluntary basis. Only seven per cent said vehicles should be smoke -free by legislation. "We need to have a concerted effort to address smoking in cars and the risks associated with non - smoking passengers," said Breysse. "And I think this (study) provides additional evidence suggesting that smoking should be banned in cars, with children in particular." Source: Secondhand tobacco smoke concentrations in motor vehicles: a pilot study Tobacco Control 2009; Published Online First: 25 August 2009. M R Jones, A Navas - Acien, J Yuan, P N Breysse httn : / /tobaccocontrol.bmi•com /... Editor's note: The PDF of this article is available. Please send your request to shatensteins(7u,svmnatico.ca and kindly remember to include the name of the full citation (study title, joumal and authors' names) and your e-mail address in the body of your message.