Approaches to measuring SHS exposure: Italy

1
Approaches to measuring SHS exposure Italy
Austria Before and After Study

• Giuseppe Gorini, Epidemiologist, MD
• Occupational and Environmental Epidemiology Unit
  - CSPO , FLORENCE, ITALY
• e-mail g.gorini_at_cspo.it

2
Italian smoking ban - I

• in indoor spaces including hospitality venues and
  workplaces, unless they have
• a separate room, with a size less than half of
  the size of the whole premise,
• closed by automatic sliding doors
• with a negative pressure of at least 5 Pascal
• provided by very powerful forced ventilation
  (flow rate of at least 30 litres per second per
  person, considering a crowding rate of 0.7
  persons per square meter)

3
Italian smoking ban - II

• Fines 27.5-275 10 times higher for subjects
  responsible of enforcing the law in each public
  place.
• Since August 2005, owners of hospitality premises
  were no more responsible to enforce the
  legislation.
• In the survey conducted in 2005 amongst the
  owners of 1,641 hospitality premises, lt1
  reported to have built smoking areas, because of
  the high cost due to the tight standards on air
  quality.

4
Nicotine Tobacco-specific, sensitive personal
monitor or environmental monitorflow rate 2.4
mL/min gas chromatography (GC/MS) in Barcelona
Labmean values in the sampling perioddetection
limit 0.01 µg/m3
Second-hand smoke exposure markers - 1
5
Drop of Nicotine concentration (in µg/m3) in
Hospitality Premises immediately after the
ban1. Florence 4 Pubs, 3 Discos
Gorini, J Occup Environ Med, 2005
6
PM Measurements
Aerocet 531 counts individual particles using
scattered laser light and calculates the
equivalent mass concentration. All five
important mass size ranges (PM1, PM2.5,PM7, PM10,
and TSP) are displayed NOT tobacco-specific (air
pollution outdoor, cooking,heating systems
indoor) Its possible to measure in real time
(e.g., minute by minute) Met One Instruments,
USA
7
Drop of PM concentration (in µg/m3) in Italian
Hospitality Premises immediately after the
ban2. Milan Trieste PM2.5 concentration
-82 in Milan -73 in Trieste Ruprecht,
Tominz Invernizzi, Epidemiol Prev, 2006
8
Italy Austria Before and After Study - 1

• Comparison of nicotine concentration before and
  AFTER 2 YEARS from the introduction of the ban in
  the Intervention (Italy) and Control (Austria)
  countries.
• Settings 19 Austrian (Vienna) and 28 Italian
  (Florence, Belluno) hospitality premises before
  and after the Italian ban. Post-ban samples were
  also collected in 27 hospitality premises in
  Turin, Milan, Naples.

9
Italy Austria Before and After Study - 2

• Pre-ban measurements in Florence, Belluno, and
  Vienna, were collected in winter 2002 or in
  winter 2004 for 2 multicenter studies on SHS
  exposure in a sample of European cities (Athens,
  Barcelona, Belluno, Bratislava, Florence, Oporto,
  Ørebro, Paris,Vienna, Warsaw)
• Nebot, Tob Control, 2005
• Gasparrini, Epidemiol Prev, 2006.

10
Results Italy (Florence, Belluno), before
after - 1
11
Results Italy, before after - 2
12
Results Austria - 1
13
Results Austria, overall - 2
14
Results Italy, Discos Pubs, before after
15
Results Italy, Restaurants, before after
16
Results Italy, post-ban measurements in Milan,
Turin, Naples
17
Results Italy, post-ban measurements in Milan,
Turin, Naples - 2
18
Cigarette Sales in Italy (millions of Kg)
Source Tobacco Observatory Newsletter, Ref
Editor, Milan, Italy
19
Cigarette Sales in Italy - 2

• The Newsletter is funded by BAT, the buyer in
  2003 of the former Italian state-owned tobacco
  manufacture, and owner of 30 of cigarette market
  share in Italy, second only to Philip Morris.
• The Newsletter reported that the lowest level of
  cigarette sales since 1998 in Italy was recorded
  in 2005.
• Considering that in 1990s a significant amount of
  cigarettes arrived in Italy through smuggling
  (black market), cigarette sales in 2005 were the
  lowest recorded in 30 years.

20
Outdoor Winter Smoking Covered Eating Places

• The newsletter partly attributed the increase in
  cigarette sales in 2006 to these areas built by
  many premises from winter 2005-2006.
• These areas have a roof, three transparent
  plastic walls or glass walls, and a heating
  system. Usually removed in other seasons.
• In January-March 2005, immediately after the
  Introduction of the ban, when it was just
  recorded the lowest levels of cigarette sales, no
  similar outdoor areas were available in Italian
  premises.

21
Outdoor Winter Smoking Covered Eating Places
22

• We measured nicotine concentration in 3 outdoor
  spaces (6 measurements) with a median value of
  8.28 µg/m3

23
Smoking Prevalence in Italy
2004 26.2 2005 25.6 2006 24.3 2007
23.5 2004-2007 -reduction-10.3
Gallus, Prev Med, 2007 (in press)
24
Acknowledgements - 1
Moshammer H, Neuberger M. Wien University Nebot
M, Lopez MJ, Serrahima E. Public Health Agency of
Barcelona Galeone D. Ministry of Health,
Rome Sbrogiò L, Tamang E, Marcolina D,
Venice Gasparrini A, Fondelli MC, CSPO, Florence
Giordano L, Charrier L, Piccinelli C, Coppo A,
Di Stefano F, DElia P, Molinar R. CPO,
Turin Invernizzi G, Ruprecht A. National Cancer
Institute, Milan Russo Krauss P. Health Authority
of Naples
25
Acknowledgements - 2

• Funders
• Ministry of Health Centre for Diseases Control,
  Rome, Italy.
• European Commission in the framework of the
  Europe Against Cancer programme as part of the
  European Network for Smoking Prevention (ENSP)
  Framework Project application n. 2003307, and n.
  S12.324433 (2001 CVG-008).