Oregon Air Monitoring Project. March - April, 2006

Transcription

1 Oregon Air Monitoring Project March - April, 6 Cheryl Higbee, MPH Mark Travers, MS Andrew Hyland, PhD Department of Health Behavior Roswell Park Cancer Institute May 6 1

2 Executive Summary Indoor air quality was assessed in 17 bars and restaurants in Oregon between March 1, 6 and April 1, 6, using the TSI SidePak AM51 Personal Aerosol Monitor. Venues were sampled in Bend, Coos Bay, Corvallis, Eugene, Hillsboro, Hood River, Medford, Oregon City, Pendleton, Portland, Salem, and Springfield. Thirty-eight (36%) venues sampled were smoke-free and 69 venues were not smoke-free. PM 2.5 levels in these 17 locations were compared, and key findings of the project include: The level of PM 2.5 in smoking venues was 7 times higher than the level in nonsmoking venues. PM 2.5 is the concentration of particulate matter in the air less than 2.5 microns in diameter. Particles of this size are released in significant amounts from burning cigarettes and are easily inhaled deep into the lungs, with serious health effects. Employees in Oregon hospitality venues allowing indoor smoking are exposed to levels of particulate matter in excess of levels recommended by the Environmental Protection Agency (EPA) to protect public health. Based on the average PM 2.5 level observed in all venues in this project where smoking was allowed (224 µg/m 3 ), fulltime bar and restaurant employees are exposed to over three times the annual EPA exposure limit of fine particulate air pollution, solely from occupational exposure. Introduction Secondhand smoke (SHS) contains at least 25 chemicals that are known to be toxic or carcinogenic, and is itself a known human carcinogen, 1 responsible for an estimated 3, lung cancer deaths annually in never smokers in the U.S. as well as over 35, deaths annually from coronary heart disease in never smokers and respiratory infections, asthma, Sudden Infant Death Syndrome, and other illnesses in children. 2 Although population-based data show declining SHS exposure in the U.S. overall, SHS exposure remains a major public health concern that is entirely preventable. 3,4 Because policies requiring smoke-free environments are the most effective method for reducing SHS exposure in public places, 5 Healthy People 21 Objective encourages all states and the District of Columbia to establish clean indoor air laws, and to enforce smoking restrictions in public places and worksites. 6 Currently, 12 states (California, Connecticut, Delaware, Maine, Massachusetts, Montana, New Jersey, New York, Rhode Island, Utah, Vermont, and Washington), the District of Columbia and Puerto Rico, which represent approximately 31% of the US population, have passed comprehensive clean indoor air regulations that cover virtually all indoor worksites including bars and restaurants. The purpose of the Oregon Air Monitoring Project was to examine indoor air quality in a sample of hospitality venues in Oregon, and to assess the relation between indoor air pollution and the presence of on-premise smoking. It was hypothesized that indoor air would be less polluted in those venues where smoking is prohibited and where smoking does not occur, than in those places where smoking is present. 2

3 Methods Overview Between March 1 and April 1, 6, indoor air quality was assessed in 17 bars and restaurants in Oregon. Thirty-eight (36%) venues sampled were smoke-free and 69 venues were not smoke-free. Procedure for Selection of Cities and Venues to be Sampled One-hundred seven (17) smoking and non-smoking bars and restaurant-bars in twelve cities across Oregon were chosen for indoor air testing: Bend (1 venues), Coos Bay (1), Corvallis (5), Eugene (5), Hillsboro (8), Hood River (5), Medford (1), Oregon City (8), Pendleton (9), Portland (27), Salem (5) and Springfield (5). These cities were chosen because of their broad distribution across Oregon, and because each houses a large number of bars and restaurant-bars. Within these cities, twenty-three random geographic points were selected using ArcGIS (ESRI, Redlands, CA). Only bars and restaurant-bars licensed by the Oregon Liquor Control Commission as of January 18, 6, and within a mile's radius of a random point, were eligible for the sample. Within each radius, at least one of each type of venue being tested was selected whenever possible. Testing was done in the evening, from about 5: p.m. through midnight and later. Tested sites were in urban, suburban, and rural areas and included blue collar, middle class, and upscale establishments. Appendix 1 presents some general descriptive information on the size and occupancy of each venue. Measurement Protocol The average time spent in each venue was 38 minutes (range, 19 minutes to 73 minutes). The number of people inside the venue and the number of burning cigarettes were recorded every 15 minutes during sampling. These observations were averaged over the time inside the venue to determine the average number of people on the premises and the average number of burning cigarettes. The Zircon DM S4 Sonic Measure (Zircon Corporation, Campbell, CA) was used to measure room dimensions and hence the volume of each of the venues. The active smoker density was calculated by dividing the average number of burning cigarettes by the volume of the room in meters. A TSI SidePak AM51 Personal Aerosol Monitor (TSI, Inc., St. Paul, MN) was used to sample and record the levels of respirable suspended particles (RSP) in the air. The SidePak uses a built-in sampling pump to draw air through the device and the particulate matter in the air scatters the light from a laser to assess the real-time concentration of particles less than 2.5µm in micrograms per cubic meter, or PM 2.5. The SidePak was calibrated against a light scattering instrument, which had been previously calibrated and used in similar studies. In addition, the TSI SidePak AM51 Personal Aerosol Monitor 3

4 SidePak was zero-calibrated prior to each use by attaching a HEPA filter according to the manufacturer s specifications. Secondhand smoke is not the only source of indoor particulate matter, but PM 2.5 monitoring is highly sensitive to it. While ambient particle concentrations and cooking are additional sources of indoor particle levels, smoking is by far the largest contributor to indoor air pollution. 14 Furthermore, there is a direct link between levels of RSP and polycyclic aromatic hydrocarbons (PAH), known carcinogens in cigarette smoke, with RSP levels being approximately 3 orders of magnitude greater than PAH s. 14 PM 2.5 is the concentration of particulate matter in the air smaller than 2.5 microns in diameter. Particles of this size are released in significant amounts from burning cigarettes, are easily inhaled deep into the lungs, and are associated with pulmonary and cardiovascular disease and mortality. The equipment was set to a one-minute log interval, which averages the previous 6 onesecond measurements. Sampling was discreet in order not to disturb the occupants normal behavior. The monitor was generally located in a central location on a table or bar and not on the floor so the air being sampled was within the occupants normal breathing zone. For each venue, the first and last minute of logged data were removed because they are averaged with outdoors and entryway air. The remaining data points were averaged to provide an average PM 2.5 concentration within the venue. Trained volunteers in Oregon did the sampling, and Roswell Park Cancer Institute staff analyzed the data. Ventilation and/or Air filtration systems in tested venues were not evaluated. It is assumed that in the 17 venues tested, a variety of ventilation/air filtration systems existed. Ventilation and air filtration systems are not viable methods of removing secondhand smoke or particulates from the air. The American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) adopted a position document stating: At present, the only means of effectively eliminating health risks associated with indoor exposure is to ban smoking activity No other engineering approaches, including current and advanced dilution ventilation or air cleaning technologies, have demonstrated or should be relied upon to control health risks from ETS [environmental tobacco smoke][sic] exposure in spaces where smoking occurs Because of ASHRAE's mission to act for the benefit of the public, it encourages elimination of smoking in the indoor environment as the optimal way to minimize ETS exposure. 7 Using current indoor air quality standards, ventilation rates would have to be increased more than a thousand-fold to reduce cancer risk associated with ETS to a level considered acceptable to federal regulatory agencies. Such a ventilation rate is impractical since it would result in a virtual windstorm indoors. 8,9 4

5 Statistical Analyses The primary goal was to assess the difference in the average levels of RSP in places that were smoke-free and places that were not. The mean RSP levels are reported across all of the venues sampled and these are compared with the mean levels of all venues in the entire sample that were smoke-free and those that were not. The comparison between smoking and smoke-free venues is replicated for each type of venue. Statistical significance is assessed using the Mann-Whitney U-test. Descriptive statistics including the venue volume, number of patrons, and average smoker density (i.e., number of burning cigarettes) per 1 m 3 are reported for each venue and averaged for all venues. In addition, real time plots are presented to show the level of PM 2.5 throughout the duration of sampling for each city. These graphs demonstrate the changes in the level of PM 2.5 that occurs over time as the SidePak was brought into smoking and non-smoking venues. One graph is presented per city per day. In cases where sampling was done on more than one day in a given city, one of these days was randomly selected to be included as a real time plot. 5

6 Results Across all 17 bars and restaurants sampled in this project, there were 38 venues where smoking was not allowed and the average RSP level in these venues was 31 µg/m 3. Smoking was allowed in 69 venues, and the average RSP level in these venues was 224 µg/m 3 (Figure 1). The level of indoor air pollution was 86% lower in the venues that were smoke-free compared to those where smoking was permitted, and this difference was statistically significant (p<.1) as determined by the Mann-Whitney U-test. Figure 1. Average Level of Indoor Air Pollution in Tested Oregon Establishments 3 PM 2.5 in micrograms per cubic meter Smoking Allowed (N=69) 31 (N=38) 1 Outdoors* *6 Average for Oregon (Washington, Jackson, Multnomah and Lane Counties). 6 US EPA AirData report generated April 7, 6 from There were two venues included in the project that were smoke-free, but at the time of the sampling, notes were made that the ovens were noticeably smoky and that this may contribute to higher levels of PM 2.5 in these venues. The average level of RSP level in smoke-free venues, excluding these two venues, was 19 µg/m 3. The average volume of venues sampled was 72 m 3 and was comparable between places where smoking was prohibited and where it was not (819 m 3 vs. 666 m 3, respectively); however, the average smoker density was greater in venues where smoking was not restricted by local law (1.4 burning cigarettes per 1 m 3 vs.. burning cigarettes per 1 m 3 ). 6

7 The locations visited were also stratified by type of location with the strata being smokefree restaurant-bars, smoking restaurant-bars, smoke-free bars, and smoking bars. The number of locations in each group, the average size, average number of people present, average number of burning cigarettes, average active smoker density and average PM 2.5 level are all shown in Table 1. Table 1. Average Oregon Indoor Air Pollution Levels by Type of Venue Avg Type Sample size Volume (m3) Avg #ppl Avg #cigs Avg. Smk Density* PM2.5 (ug/m^3) Smoking Restaurant-Bar Restaurant-Bar Smoking Bar Bar *Average number of burning cigarettes per 1m 3. Figure 2 shows the average indoor air pollution levels, as determined by PM 2.5 levels, in the different types of locations as well as the average PM 2.5 level in outdoor air in Oregon. Four of the eleven counties in this project had at least one outdoor PM 2.5 monitoring site using the EPA s Federal Reference Method for measuring PM 2.5. The year-to-date average PM 2.5 level from each of these sites, as of April 7, 6 was found at and they were averaged to determine the average outdoor PM 2.5 level as a comparison for this project. The US EPA air quality index is shown in Appendix 2. 7

8 Figure 2. Average Level of Indoor Air Pollution in Tested Oregon Establishments by Type of Venue PM2.5 in micrograms per cubic meter Smoking Bars (N=36) 2 Bars (N=11) 181 Smoking Restaurant-bars (N=33) 36 Restaurantbars (N=27) 1 Outdoors* EPA maximum safe exposure** *6 Average for Oregon (Washington, Jackson, Multnomah and Lane Counties). 6 US EPA AirData report generated April 7, 6 from ** EPA maximum safe 24-hour exposure (65µg/m 3 ). As seen in Figure 2, the average indoor PM 2.5 concentration in the smoke-free sites was only slightly higher than the average outdoor concentration in Oregon. The level of PM 2.5 was 13 times higher in bars where smoking was allowed compared to smoke-free bars. The level of PM 2.5 was 5 times higher in restaurants where smoking was allowed compared to smoke-free restaurants. Figure 3 shows the average annual occupational exposure among employees of tested establishments in Oregon. If an employee were exposed to the levels of indoor air pollution seen in the tested establishments for eight hours every day, five days a week for 5 weeks per year, and they were not exposed at all outside of work, then their annual occupational exposure would be what is shown in Figure 3. The average annual indoor PM 2.5 concentration in the smoke-free sites was under the EPA maximum safe annual exposure standard, while in the smoking sites it exceeded this standard. 8

9 Figure 3. Average Annual Occupational Exposure Tested Oregon Establishments PM2.5 in micrograms per cubic meter Smoking Bars Bars Smoking (N=36) (N=11) Restaurant-bars Restaurant- bars (N=33) (N=27) *6 Average for Oregon (Washington, Jackson, Multnomah and Lane Counties). 6 US EPA AirData report generated April 7, 6 from ** EPA maximum safe average annual exposure (15µg/m 3 ). Average PM 2.5 level in tested Oregon establishments for the hours worked by a full-time employee in one year. EPA maximum safe exposure** Details on the level of indoor air pollution are presented in Figures Results from the real-time PM 2.5 plots throughout the duration of sampling for each community reveal the following three general trends: 1) much higher levels of indoor air pollution are observed in venues where smoking is permitted; 2) low levels are observed outdoors before and after sampling inside each venue; and 3) peak exposure levels in some venues can reach levels far in excess of the average recorded level. 9

10 Figure 4 4 Oregon Air Monitoring Study - Bend PM2.5 level in micrograms per cubic meter 3 1 Venue B (Avg. PM 2.5 = 123) Venue D (Avg. PM 2.5 = 14) Venue A Venue E (Avg. PM 2.5 = 27) Venue C (Avg. PM 2.5 = 12) (Avg. PM 2.5 = 6) Elapsed time in minutes 1

11 Figure 5 PM2.5 level in micrograms per cubic meter Oregon Air Monitoring Study Coos Bay All venues allowed smoking Venue D (Avg. PM 2.5 = 675) Venue E (Avg. PM 2.5 = 224) Venue B (Avg. PM 2.5 = 221) Venue A (Avg. PM 2.5 = 86) Venue C (Avg. PM 2.5 = 34) Elapsed time in minutes 11

12 Figure 6 PM2.5 level in micrograms per cubic meter Oregon Air Monitoring Study Corvallis All venues are smoke-free Venue A (Avg. PM 2.5 = 14) Venue B Venue C Venue D Venue E (Avg. PM 2.5 = 7) (Avg. PM 2.5 = 7) (Avg. PM (Avg. PM 2.5 = 6) 2.5 = 1) Elapsed time in minutes 12

13 Figure 7 PM2.5 level in micrograms per cubic meter Oregon Air Monitoring Study Eugene All venues are smoke-free Venue D Venue C (Avg. PM 2.5 = 4) Venue A Venue B (Avg. PM 2.5 = 27) Venue E (Avg. PM 2.5 = 8) (Avg. PM 2.5 = 25) (Avg. PM 2.5 = 16) Elapsed time in minutes 13

14 Figure 8 Oregon Air Monitoring Study Hillsboro PM2.5 level in micrograms per cubic meter Venue C (Avg. PM 2.5 = 976) Venue A (Avg. PM 2.5 = 282) Venue B (Avg. PM 2.5 = 344) Venue D (Avg. PM 2.5 = 23) All venues allowed smoking Venue E (Avg. PM 2.5 = 378) Elapsed time in minutes 14

15 Figure 9 Oregon Air Monitoring Study Hood River 4 PM2.5 level in micrograms per cubic meter 3 1 Venue D (Avg. PM 2.5 = 11) Venue A Venue C (Avg. PM 2.5 = 28) (Avg. PM 2.5 = 12) Venue B Venue E (Avg. PM 2.5 = 8) (Avg. PM 2.5 = 7) Elapsed time in minutes 15

16 Figure 1 PM2.5 level in micrograms per cubic meter Oregon Air Monitoring Study Medford Venue D (Avg. PM 2.5 = 316) Venue E (Avg. PM 2.5 = 34) Venue A Venue B Venue C (Avg. PM 2.5 = 18) (Avg. PM 2.5 = 6) (Avg. PM 2.5 = 17) Elapsed time in minutes 16

17 Figure 11 PM2.5 level in micrograms per cubic meter Oregon Air Monitoring Study Oregon City Venue D Venue C (Avg. PM 2.5 = 478) (Avg. PM 2.5 = 562) Venue B (Avg. PM 2.5 = 99) Venue A (Avg. PM 2.5 = 6) Elapsed time in minutes 17

18 Figure 12 PM2.5 level in micrograms per cubic meter Oregon Air Monitoring Study Pendleton All venues allowed smoking Venue A (Avg. PM 2.5 = 246) Venue B (Avg. PM 2.5 = 32) Venue C (Avg. PM 2.5 = 39) Venue D (Avg. PM 2.5 = 484) Venue E (Avg. PM 2.5 = 22) Elapsed time in minutes 18

19 Figure 13 PM2.5 level in micrograms per cubic meter Oregon Air Monitoring Study Portland All venues allowed smoking Venue B (Avg. PM 2.5 = 226) Venue C (Avg. PM 2.5 = 17) Venue D (Avg. PM 2.5 = 142) Venue A (Avg. PM 2.5 = 44) Venue E (Avg. PM 2.5 = 637) Elapsed time in minutes 19

20 Figure 14 Oregon Air Monitoring Study Salem PM2.5 level in micrograms per cubic meter Venue E (Avg. PM 2.5 = 295) Venue C (Avg. PM 2.5 = 226) Venue D (Avg. PM 2.5 = 121) Venue A (Avg. PM 2.5 = 32) Venue B (Avg. PM 2.5 = 8) Elapsed time in minutes 2

21 Figure 15 PM2.5 level in micrograms per cubic meter Oregon Air Monitoring Study Springfield Venue A (Avg. PM 2.5 = 32) Venue B (Avg. PM 2.5 = 25) Venue D (Avg. PM 2.5 = 467) Venue C Venue E (Avg. PM 2.5 = 277) (Avg. PM 2.5 = 297) Elapsed time in minutes 21

22 Details on the level of indoor air pollution for each city included in the project are presented in Figure 16. These levels are also compared with levels seen in 5 smoke-free cities in the U.S. The 5 cities are Buffalo, NY, New York City, Laramie, WY, Bloomington, IN, and Hartford, CT. 1,11 The lowest levels of indoor air pollution were found in Corvallis and Eugene, where comprehensive clean indoor air laws exist. The indoor air pollution levels here were close to what is found outdoors. Figure 16. Average Level of Indoor Air Pollution in Tested Oregon Establishments by City Bend (N=1) Coos Bay (N=1) Corvallis (N=5) Eugene (N=5) Hillsboro (N=8) Medford (N=1) Oregon City (N=8) Pendleton (N=9) Portland (N=27) Salem (N=5) Springfield (N=5) Outdoors* Cities** *6 Average for Oregon 6 US EPA AirData report generated April 7, 6 from **Average PM 2.5 level in 49 venues in 5 smoke-free cities in the United States. 22

23 Discussion The EPA cited over 8 epidemiologic studies in creating a particulate air pollution standard in In order to protect the public health, the EPA has set limits of 15 µg/m 3 as the average annual level of PM 2.5 exposure. The average PM 2.5 level across all locations sampled in Oregon where smoking was allowed was 224µg/ m 3. For full-time employees in these venues, their average annual PM 2.5 exposure would be 51µg/ m 3 (assuming exposure to 224µg/ m 3 on the job, exposure to zero particles off the job, and a 4 hour work week). The EPA average annual PM 2.5 limit is exceeded more three-fold due solely to their occupational exposure. Based on the latest scientific evidence, the EPA staff currently proposes even lower PM 2.5 standards to adequately protect the public health, 13 making the high PM 2.5 exposures of people in smoking environments even more alarming. Previous studies have evaluated air quality by measuring the change in levels of respirable suspended particles (RSP) between smoke-free venues and those that permit smoking. Ott et al. did a study of a single tavern in California and showed an 82% average decrease in RSP levels after smoking was prohibited by a city ordinance. 14 Repace studied 8 hospitality venues in Delaware before and after a statewide prohibition of smoking in these types of venues and found that about 9% of the fine particle pollution could be attributed to tobacco smoke. 15 Similarly, in a study of 22 hospitality venues in Western New York, Travers et al. found a 9% reduction in RSP levels in bars and restaurants, and 84% reduction in large recreation venues such as bingo halls and bowling alleys, and even a 58% reduction in locations where only SHS from an adjacent room was observed at baseline. 16 A cross-sectional study of 53 hospitality venues in 7 major cities across the U.S. showed 82% less indoor air pollution in the locations subject to smoke-free air laws, even though compliance with the laws was less than 1%. 17 Other studies have directly assessed the role SHS exposure has on human health. One study found that respiratory health improved rapidly in a sample of bartenders after a state smoke-free workplace law was implemented in California, 18 and another study reported a 4% reduction in acute myocardial infarctions in patients admitted to a regional hospital during the 6 months that a local smoke-free ordinance was in effect. 19 The effects of even brief (minutes to hours) passive smoking on the cardiovascular system are often nearly as large (averaging 8% to 9%) as chronic active smoking. The effects of secondhand smoke are substantial and rapid, explaining the relatively large health risks associated with secondhand smoke exposure that have been reported in epidemiological studies. 16 Farrelly et al. also showed a significant decrease in both salivary cotinine concentrations and sensory symptoms in hospitality workers after New York State s smoke-free law prohibited smoking in their worksites. 2 The hazardous health effects of exposure to secondhand smoke are now well-documented and established in various independent research studies and numerous international reports. The body of scientific evidence is overwhelming: there is no doubt within the international scientific community that secondhand smoke causes heart disease, lung cancer, nasal and sinus cancer, sudden infant death syndrome (SIDS), asthma and middle 23

24 ear infections in children and various other respiratory illnesses. Secondhand smoke exposure is also causally associated with stroke, low birthweight, spontaneous abortion, negative effects on the development of cognition and behavior, exacerbation of cystic fibrosis, and cervical cancer. Secondhand smoke is not the only source of indoor particulate matter, but PM 2.5 monitoring is highly sensitive to it. Ambient particle concentrations and cooking are additional sources of indoor particle levels, although smoking is by far the largest contributor to indoor air pollution. 12 Previous air monitoring in 49 venues in 5 smokefree cities has found an average level of 16 micrograms per cubic meter in smoke-free venues, while in Oregon we found an average of 31 micrograms per cubic meter in smoke-free venues. However, two smoke-free venues included in this average were noted to have particularly strong cooking odors, leading us to conclude that the higher levels were due to sources other than secondhand smoke. The average PM 2.5 level in smoke-free venues, excluding those where other sources of air pollution were noted, was 19 micrograms per cubic meter. Conclusions Hospitality venues allowing indoor smoking in Oregon are significantly more polluted than both indoor smoke-free sites and outdoor air in Oregon. Workers in the locations sampled in this project are exposed to pollution levels more than 3 times higher than the annual EPA exposure standard for fine particle air pollution in place to protect the public health. This project demonstrates that workers and patrons are exposed to harmful levels of a known carcinogen and toxin. Policies that prohibit smoking in public worksites dramatically reduce secondhand smoke exposure and improve worker and patron health. Acknowledgments This work was funded by the Flight Attendant Medical Research Institute (FAMRI) and the Oregon Department of Human Services. Many thanks to the numerous volunteers who conducted air tests across Oregon. 24

25 References 1. National Toxicology Program. 9th Report on Carcinogens. Research Triangle Park, NC: U.S. Department of Health and Human Services, National Institute of Environmental Health Sciences;. 2. CDC. Annual smoking-attributable mortality, years of potential life lost, and economic costs United States, ; MMWR 2;51(14): US Department of Health and Human Services. Second national report on human exposure to environmental chemicals. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Environmental Health, U.S. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Washington, D.C.: US Government Printing Office,. 5. Hopkins DP, Briss PA, Ricard CJ, Husten CG, Carande-Kulis VG, Fielding JE, et al. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med 1;2(2 Suppl): Office of Disease Prevention and Health Promotion. U.S. Department of Health and Human Services. Healthy People 21: Volume II (second edition). Accessed 12/29/5 from 7. Samet, J.; Bohanon, Jr., H.R.; Coultas, D.B.; Houston, T.P.; Persily, A.K.; Schoen, L.J.; Spengler, J.; Callaway, C.A., "ASHRAE position document on environmental tobacco smoke," American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), [5]. 8. Repace, J., "Smoking in the workplace: ventilation. In: Smoking Policy: Questions and Answers, no. 5.," Seattle: Smoking Policy Institute, [n.d.]. 9. Repace, J., "An air quality survey of respirable particles and particulate carcinogens in Delaware hospitality venues before and after a smoking ban," Bowie, MD: Repace Associates, Inc., February 7, Travers MJ, Cummings KM, Hyland A, Repace JL, Pechacek TF, Caraballo R, et al. Indoor Air Qin Hospitality Venues Before and After Implementation of a Clean Indoor Air Law, Western New York, 3. Morbidity and Mortality Weekly Report 53(44), Hyland A, Travers MJ, Repace JL. 7 City Air Monitoring Study, March-April 4. RosCancer Institute, May US Environmental Protection Agency. National ambient air quality standards for particulate matter; final rule. Federal Register 1997;62(138): Environmental Protection Agency. January 5 Draft Staff Paper for Particulate Matter Fact Sheet. Accessed 1/24/ Ott W, Switzer P, Robinson J. Particle concentrations inside a tavern before and after prohibition of smoking: evaluating the performance of an indoor air quality model. J Air Waste Manag Assoc 1996;46: Repace JL. An air quality survey of respirable particles and particulate carcinogens in Delaware hospitality venues before and after a smoking ban. In: Repace Associates, Inc.; Travers MJ, Cummings KM, Hyland A, Repace JL, Pechacek TF, Caraballo R, et al. Indoor Air Quality in Hospitality Venues Before and After the Implementation of a Clean Indoor Air Law Western New York, 3. Morbidity and Mortality Weekly Report 53(44), Hyland A, Travers MJ, Repace JL. 7 City Air Monitoring Study, March-April 4. Roswell Park Cancer Institute, May Eisner MD, Smith AK, Blanc PD. Bartenders' respiratory health after establishment of smokefree bars and taverns. JAMA 1998;28(22): Sargent RP, Shepard RM, Glantz SA. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study. BMJ. 4 Apr Farrelly MC, Nonnemaker JM, Chou R, Hyland A, Peterson KK, Bauer UE. Change in hospitality workers exposure to secondhand smoke following the implementation of New York s smoke-free law. Tobacco Control. 5;14:

26 Appendix 1. Summary of Each Location Visited, Oregon Venue # City Smokefree? Type Volume (m3) Avg #ppl Avg #cigs Avg. Smk Density* Avg PM2.5 (ug/m^3) 1 Portland No Bar Portland No Bar-Restaurant Portland No Bar-Restaurant Portland No Bar Portland No Bar-Restaurant Coos Bay Yes Bar-Restaurant Coos Bay No Bar-Restaurant Coos Bay No Bar-Restaurant Coos Bay Yes Bar-Restaurant Coos Bay No Bar-Restaurant Portland No Bar-Restaurant Portland Yes Bar-Restaurant Portland No Bar Portland No Bar Pendleton No Bar-Restaurant Pendleton No Bar Pendleton No Bar Pendleton No Bar-Restaurant Pendleton No Bar Eugene Yes Bar-Restaurant Eugene Yes Bar-Restaurant Eugene Yes Bar Eugene Yes Bar Eugene Yes Bar Salem No Bar-Restaurant Salem Yes Bar-Restaurant Salem No Bar Salem No Bar Salem No Bar Oregon City Yes Bar-Restaurant Oregon City No Bar Oregon City No Bar Oregon City No Bar Oregon City Yes Bar-Restaurant Oregon City No Bar Oregon City No Bar-Restaurant Oregon City No Bar Portland No Bar Portland Yes Bar-Restaurant Medford Yes Bar-Restaurant Medford Yes Bar-Restaurant Medford No Bar-Restaurant Medford No Bar Medford No Bar Medford Yes Bar-Restaurant Medford Yes Bar-Restaurant Medford Yes Bar-Restaurant Medford No Bar Medford Yes Bar Portland No Bar Portland No Bar-Restaurant Portland No Bar Portland No Bar-Restaurant

27 Appendix 1 Continued. Summary of Each Location Visited, Oregon Venue # City Smokefree? Type Volume (m3) Avg #ppl Avg #cigs Avg. Smk Density* Avg PM2.5 (ug/m^3) 55 Portland No Bar Springfield Yes Bar-Restaurant Springfield Yes Bar-Restaurant Springfield Yes Bar Springfield No Bar Springfield No Bar Pendleton No Bar-Restaurant Pendleton No Bar-Restaurant Pendleton No Bar-Restaurant Pendleton No Bar Coos Bay No Bar-Restaurant Coos Bay No Bar-Restaurant Coos Bay No Bar Coos Bay No Bar Coos Bay No Bar Portland No Bar Portland No Bar-Restaurant Portland No Bar-Restaurant Portland No Bar-Restaurant Portland No Bar Portland No Bar Hood River No Bar-Restaurant Hood River Yes Bar-Restaurant Hood River Yes Bar-Restaurant Hood River Yes Bar Hood River Yes Bar-Restaurant Hillsboro No Bar-Restaurant Hillsboro No Bar Hillsboro No Bar Hillsboro No Bar-Restaurant Hillsboro No Bar-Restaurant Hillsboro No Bar-Restaurant Hillsboro No Bar-Restaurant Hillsboro No Bar-Restaurant Portland No Bar Portland Yes Bar-Restaurant Portland Yes Bar-Restaurant Portland Yes Bar Portland No Bar Corvallis Yes Bar Corvallis Yes Bar Corvallis Yes Bar Corvallis Yes Bar Corvallis Yes Bar Bend Yes Bar-Restaurant Bend No Bar-Restaurant Bend Yes Bar-Restaurant Bend No Bar-Restaurant Bend Yes Bar-Restaurant Bend No Bar-Restaurant Bend Yes Bar-Restaurant Bend Yes Bar-Restaurant Bend No Bar-Restaurant Bend No Bar *Average number of burning cigarettes per 1m 3. 27

28 Appendix 2. US EPA Air Quality Index Air Quality PM2.5 (mg/m3) Good 15 None. Health Advisory Moderate 16-4 Unusually sensitive people should consider reducing prolonged or heavy exertion. Unhealthy for Sensitive Groups People with heart or lung disease, older adults, and children should reduce prolonged or heavy exertion. Unhealthy People with heart or lung disease, older adults, and children should avoid prolonged or heavy exertion. Everyone else should reduce prolonged or heavy exertion. Very Unhealthy (Alert) People with heart or lung disease, older adults, and children should avoid all physical activity outdoors. Everyone else should avoid prolonged or heavy exertion. Hazardous 251 People with heart or lung disease, older adults, and children should remain indoors and keep activity levels low. Everyone else should avoid all physical activity outdoors 28