Clean Indoor Air Laws Protect Hospitality Workers: Evidence From New York State

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Clean Indoor Air Laws Protect Hospitality
Workers Evidence From New York State

• Sara M. Abrams, MPH
• Martin C. Mahoney, MD, PhD
• Andrew Hyland, PhD
• K. Michael Cummings, PhD, MPH
• 2005 National Conference on Tobacco or Health
• May 4, 2005
• Contact Information Sara.Abrams_at_RoswellPark.org

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Secondhand Smoke and Health Effects

• Secondhand smoke (SHS) contains over 50 known
  carcinogens.
• Annually among adult nonsmokers, SHS exposure
  causes
• 3,000 lung cancer deaths
• 35,000 deaths from ischemic heart disease
• Food-service workers have 50 greater risk for
  developing lung cancer, compared with the general
  population.

Sources National Toxicology Program, 9th Report
on carcinogens, 2000 MMWR 200251(14)300-3
Siegel M. JAMA 1993270490-493.
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Employee Exposure

• Over 75 of white collar workers, including over
  90 of teachers report having smokefree
  workplaces.
• Less than half (43) of 6.6 million food service
  workers in the US are protected by smokefree
  policies.
• 31 of workers directly involved with the public
  (i.e. supervisors, bartenders, waiters/waitresses,
  waiter assistants)
• Smokefree air laws must include bars and
  restaurants in their provisions.

Source Shopland et al. J Occup Environ Med.
200446347-356.
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Smokefree States

• States with clean indoor air laws include
• CA, DE, NY, CT, ME, MA, RI
• MT effective Oct. 1st.
• On July 24, 2003, New York State enacted the
  Clean Indoor Air Act (CIAA), prohibiting smoking
  in virtually all workplaces, including bars and
  restaurants.

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Objectives

• To examine the changes in secondhand smoke (SHS)
  exposure among hospitality workers following the
  passage of the New York State (NYS) Clean Indoor
  Air Act (CIAA) on July 24, 2003.

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Methods

• Cross-sectional population-based study
• Non-smoking working adults (bioverified CO lt
  8ppm)
• Baseline and 1-year follow-up interviews
• Baseline (n77)
• Structured interview measures
• Secondhand smoke exposure (5-day recall)
• Tobacco use in past
• Respiratory symptoms and recent illness
• Occupational history
• Urinary cotinine measurement
• Liquid chromatography-electrospray ionization
  tandem mass spectrometry (LC-ESI/MS/MS)
• LOD 0.3 ng/ml

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Definitions

• Pre-law vs. post-law
• Recruited into study either before or after
  passage of NYS CIAA (7/24/03)
• Employment categories
• Non-casino hospitality workers
• Employed in bars, restaurants, bingo halls, or
  bowling alleys (smoking unregulated before CIAA)
• Casino workers
• Employed in American Indian owned casinos
  (smoking is unregulated)

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Demographics
Pre-law (n46) Post-law (n31)
Characteristic Characteristic Characteristic n () n () p-value
Gender Male Male 20 (43.5) 13 (41.9) n.s.
Age lt 35 lt 35 25 (54.3) 16 (51.6) n.s.
Race White White 38 (82.9) 25 (80.6) n.s.
Ethnicity Non-Hispanic Non-Hispanic 45 (97.8) 27 (87.1) n.s.
Education ltHigh School or Some College ltHigh School or Some College 35 (76.1) 18 (58.1) n.s.
Marital Status Married Married 13 (28.3) 5 (16.1) n.s.
Health Insurance Private Private 34 (73.9) 24 (77.4) n.s.
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Median Hours of Secondhand Smoke (SHS) Exposure
During 5-Day Recall Among Hospitality Workers at
Baseline

plt0.05 relative to pre-law level.
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Duration and Source of SHS Exposure During 5-Day
Recall by Location

Non-casino hospitality
Casino
plt0.01 relative to pre-law level.
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Cotinine Levels Among Hospitality Workers at
Baseline
Employment Group Pre-Law Post-Law
With Non-Detectable Cotinine Levels With Non-Detectable Cotinine Levels With Non-Detectable Cotinine Levels
Non-casino hospitality 3.2 65.4
Casino 10.0 25.0
Median Cotinine Levels (ng/ml) Median Cotinine Levels (ng/ml) Median Cotinine Levels (ng/ml)
Non-casino hospitality 4.93 0.3
Casino 8.40 6.49


plt0.01 relative to pre-law level
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Individual and Median Cotinine Levels Among
Hospitality Workers at Baseline

Non-casino hospitality
Casino
plt0.01 relative to pre-law level
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Conclusions

• Data demonstrates reductions in self-reported SHS
  exposure among non-casino hospitality workers,
  following passage of NYS CIAA.
• 71 decrease for total SHS exposure.
• 89 decrease for SHS exposures at work .
• Observed decreases in SHS exposures can be
  attributed to reductions in work-related
  exposures.
• Urinary cotinine levels offer confirmatory
  support for reduced exposures to SHS.
• Suggestive of an overall positive impact of CIAA
  in protecting hospitality workers from SHS.

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Acknowledgements

• Co-investigators
• Martin C. Mahoney, MD, PhD
• Andrew Hyland, PhD
• K. Michael Cummings, PhD, MPH

• Study Interviewers
• Jessica Englert, Patti Coppola, Candice Faulring,
  Lauren Gruber, Lauren Zichitella, Judy Horan
• This work was supported by the funding from the
  Flight Attendant Medical Research Institute, and
  in part by the Roswell Park Cancer Institute
  Center Support Grant (P30 CA 16056-27).