Clearing the air: the evolution of organized labor's role in tobacco control in the United States.

As efforts to make U.S. worksites smoke-free took shape in the 1980s, the tobacco industry sought to defeat them by forming alliances with organized labor. The alliance between the tobacco industry and organized labor was based on framing the regulation of environmental tobacco smoke (ETS) as a threat to jobs, an example of management unilateralism, and an issue that divided smoking and nonsmoking union members. The dynamics of organized labor and tobacco control began to change in the late 1980s with attempts to ban smoking on airlines and in the hospitality industry. Flight attendants, bar and restaurant workers, and casino dealers-all subject to ETS in their work environments-confronted ETS as an occupational health issue. Against the backdrop of increasing awareness of the hazards of ETS, and the acceptance of tobacco control policy, this framing changed the basis of organized labor's role in tobacco control. Because service workers share the workplace with the general public, their occupational health issues are also public health issues. This fact presents new opportunities for coalition building to protect the health of service workers and the public alike.     

公共场所和工作场所环境烟草烟雾暴露及其控制措施研究进展

近年,公共场所和工作场所的环境烟草烟雾暴露已成为目前重要的公共卫生和职业健康问题,本文综述了环境烟草烟雾对健康的影响,公共场所和工作场所环境烟草烟雾的暴露问题,禁烟法规对减少烟草烟雾暴露的作用效果及我国烟草暴露的现状,并对今后需进一步研究的领域进行探讨.     

Predictors of support for environmental tobacco smoke bans in state government

BACKGROUND: Environmental tobacco smoke (ETS) is a major threat to public health, associated with a number of serious diseases, and a leading cause of death. Previous research demonstrates that enactment of government policies mandating clean indoor air is effective in creating more smoke-free public places and decreasing the incidence of smoking. Both researchers and community activists have an interest in understanding the factors that predict support for the regulation of ETS. METHODS: This study examined predictors of support for regulating ETS by surveying 684 city and county public officials in Colorado who were interviewed by phone and mail (response rate 61%). RESULTS: Thirty-five percent of public officials reported that it is a "serious" or "very serious" problem that nonsmokers breathe in other people's cigarette smoke, 21% were "neutral," and 42% said that it was "not serious" or "not serious at all." Results indicated that support for policies to control ETS and promote clean indoor air is significantly more prevalent among public officials who: (1) believe that tobacco use is a serious problem in their community, (2) believe that breathing environmental tobacco smoke is a serious problem for nonsmokers, (3) believe that city and county government should get involved with people's decisions about smoking, (4) support smoking-cessation programs for public employees, and (5) have smoked less than 100 cigarettes during their lifetime. CONCLUSIONS: Both the harms of ETS and legislation to create smoke-free environments remain controversial among local officials. Smoke-free advocates should support officials who believe that ETS is a problem and persuade officials on the harms of ETS and the need for government intervention.     

Legislation on smoking in enclosed public places in Scotland: how will we evaluate the impact?

BACKGROUND: From 26 March 2006, smoking will be prohibited in wholly and substantially enclosed public places in Scotland, and it will be an offence to permit smoking or to smoke in no-smoking premises. We anticipate that implementation of the smoke-free legislation will result in significant health gains associated with reductions in exposure to both environmental tobacco smoke (ETS) and personal tobacco consumption as well as other social and economic impacts. METHODS: Health Scotland in conjunction with the Information Services Division (ISD) Scotland and the Scottish Executive have developed a comprehensive evaluation strategy to assess the expected short-term, intermediate and long-term outcomes. Using routine health, behavioural and economic data and commissioned research, we will assess the impact of the smoke-free legislation in eight key outcome areas--knowledge and attitudes, ETS exposure, compliance, culture, smoking prevalence and tobacco consumption, tobacco-related morbidity and mortality, economic impacts on the hospitality sector and health inequalities. CONCLUSION: The findings from this evaluation will make a significant contribution to the international understanding of the health effects of exposure to ETS and the broader social, cultural and economic impacts of smoke-free legislation.     

Observational survey of smoking provisions in food service establishments--Southeast Health District,Georgia, 2001

In the United States, approximately 38,000 deaths are attributable to second hand smoke (SHS) exposure each year. One of the national health objectives for 2010 is to reduce public exposure to environmental tobacco smoke (ETS) (objective 27.10). To reduce public exposure to ETS, CDC recommends smoking bans and restrictions in public places. Some of the highest reported exposures to concentrations of SHS are found in food service establishments; however, Georgia does not have a state law prohibiting smoking in these places. In March 2001, the director of Georgia's Southeast Health District requested assistance from the state health department in developing a surveillance system of smoking provisions in food service establishments. This report summarizes an observational survey of smoking provisions in food service establishments of Georgia's Southeast Health District in 2001, which found that although 69.4% (506) of all surveyed establishments were completely smoke free, the remaining establishments failed to provide several physical modifications designed to minimize ETS exposure. Public health officials in the Southeast Health District will use survey results to target interventions toward establishments lacking ETS-minimizing provisions.     

How many deaths will it take? A death from asthma associated with work‐related environmental tobacco smoke

BACKGROUND: Despite epidemiologic, experimental and observational data on the association of environmental tobacco smoke (ETS) and adverse health effects, bar and restaurant workers remain exposed to ETS in the majority of states and countries. METHODS: Three public health surveillance systems were used to identify and conduct a follow-up investigation of a reported acute asthma death of a young waitress in a bar. RESULTS: The waitress collapsed at the bar where she worked and was declared dead shortly thereafter. Evaluation of the circumstances of her death and her medical history concluded that her death was from acute asthma due to environmental tobacco smoke at work. CONCLUSIONS: This is the first reported acute asthma death associated with work-related ETS. Recent studies of asthma among bar and restaurant workers before and after smoking bans support this association. This death dramatizes the need to enact legal protections for workers in the hospitality industry from secondhand smoke.     

Adolescent exposure to and perceptions of environmental tobacco smoke

Environmental tobacco smoke (ETS) poses an underappreciated risk to adolescent health. This study examined perceptions of adolescents (n = 574) regarding ETS. About one half (54%) were exposed to ETS the previous week, and one third (30%) were exposed to 3 or more hours of ETS the past week. Concurrently, 29% believed that breathing someone else's cigarette smoke had little or no effect on their health. Most adolescents (56%) believed that smoking should not be allowed in restaurants without bars but were less supportive of prohibiting smoking in restaurants with bars (20%) or in bars (14%). Two thirds (69%) of adolescents believed that the government should be involved in making laws that protect the health of people who work in bars and restaurants. Almost one half (49%) believed that the government should be involved in passing laws that make it illegal for people to smoke in public places. Odds ratios revealed that females, nonwhites, younger students, nonsmoking students, and students who believed that ETS exposure had a moderate or major effect on health were statistically significantly more likely to support clean indoor air ordinances in select locations compared to males, whites, older students, students who smoke, and students who perceived that ETS exposure has little to no effect on health.     

From "taxed" health to excise tax: ethical accountability and the fight for comprehensive tobacco control programs on the national and state levels

Government needs to take an ethical stand on the issue of tobacco control, thereby falling in line with the public administrators, public health advocates, and other public servants who support the passage of excise tax legislation and local ordinances that go beyond state preemption clean indoor air policy. That the excise tax will generate medical and economic benefits is unquestionable. In a similar vein, stronger local smoking bans to reduce levels of environmental tobacco smoke (ETS) will undoubtedly carry significant import for healthier work and leisure environments. What remains dubious is the degree to which the public can count on government support of anti-tobacco initiatives. A theory of administrative accountability is a significant part of assessing an issue that has ethical as well as medical and economic ramifications. This paper outlines the historical and current challenges facing public servants as they wager public health for regional economy.     

Environmental tobacco smoke in hospitality venues in Greece

Background  

Exposure to environmental tobacco smoke is a major threat to public health. Greece, having the highest smoking prevalence in the European Union is seriously affected by passive smoking. The purpose of this study was to measure environmental tobacco smoke (ETS) exposure in the non smoking areas of hospitality venues and offices in Greece and to compare the levels of exposure to levels in the US, UK and Ireland before and after the implementation of a smoking ban.     

A randomized trial to promote health belief and to reduce environmental tobacco smoke exposure in pregnant women

Exposure to environmental tobacco smoke (ETS) is widespread among women in Iran. This study aimed to explore the impact of education on health belief and environmental tobacco smoke exposure in pregnant women. This randomized trial was administrated to 130 pregnant women exposed to ETS. The face-to-face education was provided for the intervention group after completing the questionnaire compiled on the constructs of the health belief model and self-reports of weekly ETS exposure. The theoretical constructs and weekly ETS exposure were compared in the study groups at the intake, third, fourth and fifth sections. In the intervention group, perceived susceptibility/severity and perceived benefits increased and the weekly ETS exposure decreased on the third as opposed to the first section (P < 0.05). Perceived susceptibility/severity and benefits significantly correlated with weekly ETS exposure in the intervention group (P < 0.05). The findings of this study point to the fact that education about the impacts of ETS exposure of pregnant women is an effective way to increase the theoretical constructs according to the health belief model and is associated with a reduction of ETS exposure. But this is not sufficient for making smoke-free homes.     

Science,politics, and ideology in the campaign against environmental tobacco smoke

The issue of environmental tobacco smoke (ETS) and the harms it causes to nonsmoking bystanders has occupied a central place in the rhetoric and strategy of antismoking forces in the United States over the past 3 decades. Beginning in the 1970s, anti-tobacco activists drew on suggestive and incomplete evidence to push for far-reaching prohibitions on smoking in a variety of public settings. Public health professionals and other antismoking activists, although concerned about the potential illness and death that ETS might cause in nonsmokers, also used restrictions on public smoking as a way to erode the social acceptability of cigarettes and thereby reduce smoking prevalence. This strategy was necessitated by the context of American political culture, especially the hostility toward public health interventions that are overtly paternalistic.     

The smoke you don't see: uncovering tobacco industry scientific strategies aimed against environmental tobacco smoke policies

OBJECTIVES: This review details the tobacco industry's scientific campaign aimed against policies addressing environmental tobacco smoke (ETS) and efforts to undermine US regulatory agencies from approximately 1988 to 1993. METHODS: The public availability of more than 40 million internal, once-secret tobacco company documents allowed an unedited and historical look at tobacco industry strategies. RESULTS: The analysis showed that the tobacco industry went to great lengths to battle the ETS issue worldwide by camouflaging its involvement and creating an impression of legitimate, unbiased scientific research. CONCLUSIONS: There is a need for further international monitoring of industry-produced science and for significant improvements in tobacco document accessibility.     

Burden of Household Environmental Tobacco Smoke on Medical Expenditure for Japanese Women: A Population-Based Cohort Study

Background

The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women.

Methods

This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors.

Results

We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum.

Conclusions

We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.Key words: secondhand smoke, tobacco smoke pollution, longitudinal study, environment and public health, health care costs     

Turning free speech into corporate speech: Philip Morris' efforts to influence U.S. and European journalists regarding the U.S. EPA report on secondhand smoke

BACKGROUND: Previously secret internal tobacco company documents show that the tobacco industry launched an extensive multifaceted effort to influence the scientific debate about the harmful effects of secondhand smoke. Integral to the industry's campaign was an effort to derail the Environmental Protection Agency's (EPA) risk assessment on environmental tobacco smoke (ETS) by recruiting a network of journalists to generate news articles supporting the industry's position and pushing its public relations messages regarding the ETS issue. METHODS: Searches of previously secret internal tobacco industry records were conducted online and at the Minnesota Tobacco Document Depository. In addition, searches on the World Wide Web were conducted for each National Journalism Center alumnus. Lexis-Nexis was used to locate news stories written by the journalists cited in this paper. RESULTS: Philip Morris turned to its public relations firm Burson Marsteller to "build considerable reasonable doubt em leader particularly among consumers" about the "scientific weaknesses" of the EPA report. A Washington, DC, media and political consultant Richard Hines was a key player in carrying out Burson Marsteller's media recommendations of "EPA bashing" for Philip Morris. In March 1993, Philip Morris' vice president of corporate affairs policy and administration reported to Steve Parrish, vice president and general counsel of Philip Morris, that their consultant was "responsible for a number of articles that have appeared in em leader major news publications regarding EPA and ETS." In addition to placing favorable stories in the press through its consultant, Philip Morris sought to expand its journalist network by financially supporting a U.S. school of journalism; the National Journalism Center (NJC). Philip Morris gleaned "about 15 years worth of journalists at print and visual media throughout the country em leader to get across [its] side of the story" resulting in "numerous pieces consistent with our point of view." The company planned to "design innovative strategies to communicate [its] position on ETS through education programs targeting policy makers and the media" via the NJC. Finally, journalists associated with think tanks that were financially supported by Philip Morris wrote numerous articles critical of the EPA. CONCLUSIONS: This is the first report, from the tobacco industry's own documents, to show the extent to which the tobacco industry has gone to influence the print media on the issue of the health effects of secondhand smoke. Unfortunately, what we report here is that even journalists can fall victim to well-orchestrated and presented public relations efforts regardless of their scientific validity. It is not clear how various professional media organizations oversee the ethical conduct of their members. Certainly, on the topic of the health effects of secondhand smoke, more scrutiny is warranted from these organizations for articles written by their members lest the public be misinformed and thus ill served.     

公共场所和工作场所环境空气中烟草烟雾污染状况的研究

目的 了解北京市东城区公共场所和工作场所环境中烟草烟雾的暴露情况及其影响因素.方法 于2004年1-2月选取北京市东城区14家公共场所和工作场所,采用被动式尼古丁采样器对场所环境空气中的尼古丁水平进行监测.应用多元线性回归方程对影响尼古丁浓度的因素进行分析.结果 14家公共场所和工作场所中的所有采样点均检测到了尼古丁,其浓度中位数为3.01 μg/m3,浓度范围为0.03～28.72 μg/m3.完全禁烟场所检测到的尼古丁浓度中位数最低,而在无禁烟规定的场所中检测到的尼古丁浓度中位数最高.影响室内空气中尼古丁浓度的因素较多,包括禁烟规定、吸烟人数和房屋面积等,其中吸烟人数是最重要的因素.结论 目前,公共场所和工作场所的环境烟草烟雾暴露已成为重要的公共卫生和职业健康问题,吸烟人数对空气中尼古丁浓度的影响最大.     

The tobacco industry's worldwide ETS consultants project: European and Asian components

BACKGROUND: The tobacco industry has formed regional environmental tobacco smoke (ETS) consultants programs in order to generate controversy on the issue of secondhand smoke (SHS) in Europe, Asia and Latin America. Only those countries in which the industry foresaw SHS restrictions were included. This paper describes the European and Asian components of the tobacco industry's worldwide ETS consultants program. METHODS: A systematic search was carried out of tobacco industry documents available on the Internet between October 2002 and February 2004. RESULTS: Beginning in 1987, Philip Morris assembled an international ETS consultants program in collaboration with other tobacco companies based on their market shares in different regions of the world. The law firm Covington & Burling contacted and hired consultants with a wide range of expertise, usually affiliated with an academic institution, in order to avoid direct contact with the industry. The objective of the program was to influence policy makers, media and the public by providing, through their consultants, 'accurate' (pro-industry) information concerning smoking regulations in public places and workplaces, indoor air quality and ventilation standards, and scientific claims regarding SHS. Consultants also conducted research related to SHS and organized and attended regional and international symposiums related to SHS without acknowledging industry funding. CONCLUSIONS: Despite evidence that the issue of smoke-free environments was close to emerging within the general public throughout the world in the late 1980s, the tobacco industry used its well-organized network of consultants to avoid SHS regulations in most of the world.     

孕妇被动吸烟对新生儿身长、体重的影响

对157例孕产妇进行接触被动吸烟状况的研究及产妇对烟草对人类危害知识和态度进行了调查,并对这些产妇的新生儿进行了身长体重的测量.结果表明,孕妇孕期被动吸烟情况仍然普遍存在,且主要来源于家人、同事及公共场所不同人群的吸烟.     

Towards the world-wide ban of indoor cigarette smoking in public places

In 1984, Dr. C. Everett Koop, then Surgeon General of the US, presented an important speech on the hazards of smoking. In his speech, he stated "The ultimate goal should be a smoke-free society by the year 2000." In addition, the World Health Organization (WHO) has initiated a process to ban smoking globally; on 21 May 2003, at the 56th World Health Assembly, WHO's 192 Member States unanimously adopted the world's first public health treaty, the WHO Framework Convention on Tobacco Control. Although good progress has been made, reaching the ultimate goal is far from certainty. Therefore, it is time to re-visit this crucial public health activity and re-energize the effort to reach this goal. Since numerous reports have been written on the ban of smoking based on benefits to the smokers, the emphasis of our report is on benefits to non-smokers from their exposure to environmental tobacco smoke (ETS). We provide a concise review of the impact of ETS on health and economy. In addition, we examined the different interest groups on supporting and opposing the ban, the role of the government, private citizens and medical professionals on this activity, and certain constraints on implementing the global ban. We also provide some recommendations on how to promote the ban globally. Since cigarette smoking is an unnecessary habit that has devastating consequences around the world, banning of cigarette smoking should be a global mission. A global ban on indoor smoking in public places is an important first step in an international effort to prevent morbidity and mortality caused by tobacco smoking and ETS.     

Real-time measurement of indoor particulate matter originating from environmental tobacco smoke: a pilot study

Short-term measurement of suspended particulate matter has been recently made possible since the release of laser-operating portable instruments. Data of a pilot study of field evaluation of environmental tobacco smoke (ETS) with a portable instrument are reported. We analysed the concentrations of total suspended particle (TSP) and of the fine particles PM10, PM7, PM2.5 and PM1 released indoor from a single cigarette, and their levels inside smoking- and non-smoking-areas of a restaurant. The results indicate that ETS creates high level indoor particulate pollution, with concentrations of PM10 exceeding air quality standards. This kind of field evaluation could allow a more careful assessing of short-term exposure to ETS and its relevance to public health.     

Tobacco industry efforts at discrediting scientific knowledge of environmental tobacco smoke: a review of internal industry documents

STUDY OBJECTIVE: Using tobacco industry internal documents to investigate the use of tobacco industry consulting scientists to discredit scientific knowledge of environmental tobacco smoke (ETS). DESIGN: Basic and advanced searches were performed on the Philip Morris, Tobacco Institute, R J Reynolds, Brown and Williamson, Lorillard, and the Council for Tobacco Research document web sites, with a concentration on the years 1985-1995. Guildford depository files located on the Canadian Council on Tobacco Control website were also searched. The documents were found in searches undertaken between 1 March and 30 June 2000. MAIN RESULTS: The industry built up networks of scientists sympathetic to its position that ETS is an insignificant health risk. Industry lawyers had a large role in determining what science would be pursued. The industry funded independent organisations to produce research that appeared separate from the industry and would boost its credibility. Industry organised symposiums were used to publish non-peer reviewed research. Unfavourable research conducted or proposed by industry scientists was prevented from becoming public. CONCLUSIONS: Industry documents illustrate a deliberate strategy to use scientific consultants to discredit the science on ETS.