December Indoor Air Quality in Bars and Restaurants Before and After Implementation of the Smoke Free Wisconsin Act, 2010

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1 December 2010 David Ahrens 1 Jessica Steinhoff 2, Randall Glysch 3 Nathan R. Jones 1 Indoor Air Quality in Bars and Restaurants Before and After Implementation of the Smoke Free Wisconsin Act, UW Carbone Cancer Center, Tobacco Surveillance and Evaluation 2 Wisconsin Clearinghouse for Prevention Resources, Tobacco Control Resources Center for Wisconsin 3 Wisconsin Division of Public Health, Tobacco Prevention and Control Program Website Acknowledgement: This analysis and report are based on data collected by the staff and members of community-based tobacco control coalitions from throughout the state. The UW Carbone Cancer Center s Tobacco Surveillance and Evaluation Program is a contractor of the Wisconsin Division of Public Health, Tobacco Prevention and Control Program under which this report was issued. Thanks to Cynthia Musial and Tana Feiner for assistance coordinating data collection and site visits.

2 Executive Summary The purpose of this research was to determine the effect of the Smoke-Free Wisconsin Act on air quality in bars and restaurants. The common standard of measurement of air quality is the amount of fine particulates or particles in the air. Tobacco smoke is the largest contributing factor to fine particulate matter indoors. Fine particulate matter is defined as particles smaller than 2.5 microns, or about one tenth the width of a human hair. The small size of the particles is significant because they are able to penetrate deep into lung tissue and the walls of arteries causing damage. Air quality was tested in 214 bars and restaurants where smoking was allowed in 41 counties in every region of Wisconsin between April 2 and June 18, 2010, prior to the implementation of the smoke-free air law. The average air quality in 80% of these establishments was at or above the unhealthy level (more than 35 micrograms of fine particulate matter/cubic meter) according to Wisconsin Department of Natural Resources (DNR) standards (See Figure 1). Overall, one in five establishments (21%) was found to have hazardous air quality; one in four (28%) was found to have very unhealthy air quality; and one in three (38%) was found to have unhealthy air quality determined by levels of fine particles measured in the air. Following enactment of the Smoke-Free Wisconsin Act on July 5, 2010, smoking was prohibited in bars and restaurants as well as all other enclosed workplaces. A total of 183 sites whose average air quality was found to be unhealthy, very unhealthy or hazardous during tests conducted prior to the smoke-free air law enactment were re-tested between September and October, In most cases, these sites were re-tested on the same day of the week and time of day to assure comparable conditions. Tests conducted after enactment of the law found a sharp and nearly uniform reduction in establishments with unhealthy air. Overall, we measured a 92% reduction in the mean particulate matter detected in the air in eating and drinking establishments that had unhealthy air before the smoke-free law went into effect. Only six out of 183 tested sites had unhealthy or worse quality air and in only one site was the air hazardous.

3 Background and Introduction Since the 1986 U.S. Surgeon General s Report, The Health Consequences of Involuntary Smoking 1 first made Americans aware of the dangers of secondhand smoke, public understanding of its health consequences has grown. Despite this increase in knowledge, in Wisconsin, secondhand smoke is estimated to cause more than 800 lung cancer and heart disease deaths each year while thousands more are made seriously ill by asthma, allergic attacks and chronic disease. 2 While smoke-free workplaces are increasingly the norm, bars and restaurants are among the last public places where smoking is usually allowed. As a result, these establishments commonly have extremely high levels of secondhand smoke, typically at levels that are multiples of the Environmental Protection Agency (EPA) allowable daily exposure limit. 3 As a result of the exposure to secondhand smoke, many employees suffer from respiratory symptoms and have impaired lung functions. 4 The air quality in Wisconsin s bars and restaurants presented a serious health risk for patrons and employees because: There is no safe level of exposure to environmental tobacco smoke. It is not possible for patrons and employees to determine the level of environmental tobacco smoke in any specific establishment. Patrons and employees may believe they are not exposed to unsafe levels of secondhand smoke because of the presence of ventilation and air conditioning systems. However, these systems do not reduce pollutants to safe levels and are used primarily to remove offensive odors and visible particles. Bars and restaurants may contain very high levels of dangerous pollutants for long periods after the last cigarette has been extinguished. Some employees are likely to be engaged in on-going strenuous physical activity while working in highly hazardous air quality conditions. Similarly, patrons may dance or bowl which causes exertion and increased breathing of toxins. 3

4 Children, who are most susceptible to smoke-related illness, cannot choose to avoid smoke-filled environments. In 1992, the City of Madison enacted the first smoke-free restaurant ordinance in Wisconsin. The measure applied to establishments requiring a restaurant license and whose alcohol sales were less than 33% of their gross receipts. In subsequent years, similar ordinances were passed in much of La Crosse County, the City of Eau Claire and numerous other communities across the state. In 2003, Madison passed the first ordinance in Wisconsin that required all workplaces, including bars, to be smokefree. By 2008, Appleton, Eau Claire, Fond du Lac and Marshfield passed similar comprehensive ordinances. In May 2009, Governor Jim Doyle signed Act 12 (the Smoke-Free Wisconsin Act). The law went into effect on July 5, Act 12 prohibits smoking in most indoor public places and workplaces including public buildings, bowling centers, hotels and motels and restaurants and taverns. Methods Prior to the implementation of the Smoke-free Air Act, a convenience sample of 214 bar and restaurants where smoking was allowed in 41 counties in each region of the state were selected. The test sites were selected because they were representative of a class of establishment such as a restaurant-bar combination, restaurant only and bar only. These establishments were visited primarily during the evening hours between April 2 and June 18, After the Smoke-Free Wisconsin Act took effect on July 5, 2010, a second round of air quality tests was conducted in establishments where the average scores in the initial tests were greater than 35 micrograms/cubic meter (). These tests were conducted from August 28 through October 23. Tests were conducted by personnel trained in air quality testing methods. Each monitoring team spent approximately 30 minutes in each establishment. The number of people inside the venue, the number of patrons and the number of cigarettes burning were recorded every 15 minutes during air sampling. A TSI SidePak AM510 Personal Aerosol Monitor was used to sample and record the level of fine particles that are 2.5 microns or smaller (PM2.5) in micrograms per cubic 4

5 meter. It is used to measure and record in real-time the level of fine particulate matter in the air. The SidePak was zero-calibrated prior to each use. The equipment recorded particulate levels every second and records the average particulate level at one minute intervals. The monitor was located at different locations within the main areas of each establishment to get a sample of readings. The Ambient Air Quality Index of the Department of Natural Resources (DNR) is the standard for air quality analysis. (See Figure 1) The national standard from which the DNR standard is based on was established in 2005 by the EPA. On April 1, 2008, the DNR slightly modified (lowered) the standard for ozone and fine particulates. The pollutants measured under these standards are considered harmful to public health and the environment. The primary standard for a healthy level of fine particulate matter (defined as less than 35 micrograms of particulates smaller than 2.5 microns in a cubic meter) is the limit set to protect public health, including the health of sensitive populations such as asthmatics, children and the elderly. The standard for annual exposure to fine particulate matter, that is the average of the different rates of exposure over one year, is 15 micrograms per cubic meter. Air samples were taken outside of the establishments to obtain a baseline measure. This recording helps assure that the air quality measured inside is not polluted air that has infiltrated from the outside. The measures of the ambient or outside air consistently indicated healthy air with fine particulate matter measured at less than 10 micrograms per cubic meter. Data from the SidePak was downloaded by field testers and sent to the University of Wisconsin Comprehensive Cancer Center s Tobacco Surveillance and Evaluation Program which analyzed the data and prepared this report. The establishments monitored for air quality are not identified by name, only by general area and type, in this report. We do not identify the establishments because there is no reason to believe air quality in the monitored eating and drinking establishments, all of which allowed smoking before the Smoke-Free Wisconsin Act went into effect, had more or less polluted air than any other establishment that allowed smoking not included in the sample. Previous research has shown that any establishment that allows smoking can have dangerous levels of pollutants at any time which presents a health risk to staff and patrons. 5

6 Results Prior to implementation of the Smoke-Free Wisconsin Act, the mean air quality in all establishments that allowed smoking was very unhealthy, with fine particulate matter levels measured at 160 micrograms/cubic meter. After implementation of the law, the average air quality level was good with small particulate matter levels of 13 micrograms/cubic meter - a 92% reduction in mean small particulate levels (See Figure 2. See Appendix A for mean air quality results from all counties before and after the implementation of the Smoke Free Wisconsin Act). Prior to the implementation of the law, only 13% of the sites had air quality that was either good or satisfactory. After implementation, 97% of the tested sites had good or satisfactory air quality (See Figures 3 and 4). Of the 214 sites tested before the Act, only 31 establishments had air particulate levels at the good or satisfactory level (<35 micrograms/cubic meter). The other 183 sites had air quality that was unhealthy, very unhealthy or hazardous: one-fifth of the establishments (21%) that allowed smoking prior to the Smoke-Free Wisconsin Act were found to have air with fine particulate matter at or above the level considered hazardous to health; just over a quarter of establishments (28%) had air quality rated very unhealthy; and just over a third of establishments (38%) had air quality rated unhealthy. Of the 183 sites tested after the enactment of the SFA, only six establishments registered air pollutants in excess of 35 micrograms/cubic meter and had unhealthy air. The air particulate levels in these establishments were 37, 42, 55, 90, 160 and 272 micrograms/cubic meter. Based on these levels and written reports of the on-site testers, there is evidence to conclude that smoking was occurring in each of these sites or immediately outside and had a door open. As noted in Table 1 below, there were substantial changes in average particulate levels and air quality in counties where establishments were tested. Counties that reported only one establishment were excluded from this table. 6

7 Table 1: Average air quality (micrograms/cubic meter) in bars and restaurants before and after enactment of the Smoke-Free Law. County Average Air Quality Before SFA Average Air Quality After SFA Adams Ashland Bayfield Brown Dodge Douglas Jefferson Juneau 66 3 Kenosha 92 9 Kewaunee La Crosse Lincoln Manitowoc Marquette Milwaukee City Milwaukee County Oneida Outagamie Ozaukee Polk Portage 49 6 Racine Richland 99 3 Rock Rusk St. Croix

8 Vilas 71 5 Washington Waukesha Winnebago Wood County-level average air quality ranged from a high of 404 micrograms/cubic meter in Bayfield County to 49 in Portage and St. Croix County before the ban. Thirteen counties had average air quality that was hazardous. Bayfield at 404 micrograms/cubic meter and Dodge at 393 micrograms were found to have average levels almost twice the threshold level of hazardous. The average air quality in six counties was at the very healthy level including Ozaukee County with 200 micrograms/ cubic meter and Rusk County at 197- nearly at the uppermost threshold of 209 micrograms/ cubic meter. The average air quality level in 12 counties was unhealthy. The lowest level among these counties, Portage and St. Croix counties had an average of 49 micrograms/ cubic meter. Although these measurements may seem low in the context of this study, air quality at this level in the outdoor (ambient) air would be among the worst days of the year in any region of the state. Following enactment of the law, 30 of 31 counties had average air quality levels that were good (0-14 micrograms/cubic meter) or satisfactory (15-34). Only one county, Manitowoc, had air quality that was on average, unhealthy due to a single establishment that allowed smoking had very unhealthy levels of small particulate. Appendix B provides graphs of the actual readings at one-minute intervals in selected counties. These data indicate the wide range of variation between counties and between each establishment. The differences within each site were much greater before enactment of the SFA than afterwards when air particulate levels were generally flat. For example, air quality in an establishment in the Milwaukee and Ozaukee counties sample differed in a single establishment by over 200% as the air testing team moved from one location to another during the test. Differences in air quality between establishments that allowed smoking were also substantial. As indicated in data from Waukesha County, the average particulate levels in one establishment were more than three times higher than hazardous (750 8

9 micrograms/cubic meter) and the air quality in another venue tested had unhealthy (47 micrograms/cubic meter) air. Air quality was much more uniform after the SFA. The brief spikes in unhealthy air quality tended to be recorded at the beginning and end of tests when the air testing team walked through an entrance area where smokers were congregated. Often the smoke air flow entered the initial space of the bar or restaurant. Discussion The results of the statewide examination of air quality in bars and restaurants before and after the implementation of the Smoke-free Act indicated an extraordinary improvement in air quality due to a high level of compliance with the new law. The decrease in mean fine particle concentration is similar to reductions in other areas after a smoking ban, such as 92% reduction observed in Scotland, 84% reduction in Western New York 5 and 93% reduction in Lexington, Kentucky. 6 Assuming that the establishments that had good or satisfactory levels of particulates prior to implementation of the Smoke-Free Wisconsin Act continued to have those levels, the compliance rate among establishments that were primarily bars and restaurant-bars was 97%. This compares very favorably with reported 73% and 69% compliance rate in bars in smoke-free communities in the US and Canada, respectively. 7 In 2002 (four years after enactment of the Smoke-free law), a random sample of inspections in Los Angeles found compliance at 76% in bars and 99% in bar/restaurants. 8 There is a dose-response relationship to both incidental and chronic exposure to passive smoking related to cardiovascular and respiratory diseases and cancer. For individuals such as bar and restaurant workers who are exposed to high levels of tobacco smoke for long periods of time, the additional risk of illness and death is substantial. In one study, non-smokers living in a household with 2 or more smokers had a 75% greater risk of lung and other cancers, a 150% greater risk of emphysema and twice the risk of stroke compared to a non-smoker relatively unexposed to high levels of smoke. 9 Given the extraordinarily high levels of smoke found in many of the establishments, it is probable that the additional risks of disease and subsequent death are multiples of those cited above. 9

10 A study of the effects of secondhand smoke exposure of bartenders in Wisconsin bars found that non-smoking bartenders reported eight upper respiratory symptoms associated with exposure (wheezing, shortness of breath, cough first thing in the morning, cough during the rest of the day, cough up phlegm, red or irritated eyes, runny nose and sore or scratchy throat). The bartenders also reported significant improvement in relief from all of the symptoms one month after the implementation of the smoke-free policies. 10 It has been established by many earlier studies that implementation of smoke-free conditions at either the individual establishment level or throughout political jurisdictions will result in substantial reductions in indoor pollutants and improvements in air quality. 11 While there are significant esthetic and safety benefits to eliminating secondhand smoke, the most significant reason for smoke-free air is the elimination of health detriments caused by such exposure. 10

11 References 1. Centers for Disease Control and Prevention. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA; Washington DC, Umland MA, Palmerscheim KA, Ullsvik JC, Wegner MV. Burden of Tobacco in Wisconsin. University of Wisconsin Comprehensive Cancer Center. Madison, WI: February Pechacek T, Repace J, Caraballo R., Cummings K M., Travers M, Hyland A, Babb S. Indoor air quality in hospitality venues before and after implementation of a clean indoor air law - Western New York, Morbidity and Mortality Weekly Report, 2004 (Vol. 53) (No. 44) Palmersheim KA, Remington PL, Wegner MV. The impact of a smoke-free ordinance on the health of bartenders: one year later. Surveillance Brief. Paul P. Carbone Comprehensive Cancer Center Madison, WI. 5. Travers ML, et. al Indoor air quality in hospitality venues before and after implementation of a clean indoor air law- Western New York, Morb Mortality Wkly Rep Nov 12;53(44): Lee K, Hahn EJ, Pieper N, Okoli CT, Repace J, Troutman A. Differentional impacts of smoke-free laws on indoor air quality. J Environ Health 2008 Apr, 70(8) Borland R, Yong H-H, Siapush M, Hyland A, et.al. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) four-country survey. Tob Control 2006;15:iii-iii Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long term compliance with California s smoke-free workplace law among bars and restaurants in Los Angeles County. Tob Control 203;12: McGhee M, Ho S, Schooling M, Ho L., et.al. Morality associated with passive smoking in Hong Kong. BMJ 2005;330: and Hedley AJ, McGhee S, Repace JL Wong L, Yu M. Risks for heart disease and lung cancer from passive smoking by workers in the catering industry. April Toxicol. Sci. 90(2): Palmersheim KA, Remington PL, Gundersen DF. The impact of a smoke-free ordinance on the health and attitudes of bartenders. Tobacco Surveillance and Evaluation Program, University of Wisconsin Comprehensive Cancer Center, Madison, WI: February, Repace JL, Hyde JN, Bugge D. Air pollution in Boston before rand after a smoking ban. BMC Public Health 2006,6;266 and Repace JL. Respirable particles and carcinogens in the air of Delaware hospitality venues before and a smoking ban. Jl OEM 2004, 46:

12 Figure 1: Air quality thresholds for fine particles (2.5 microns and smaller) in micrograms/cubic meter, DNR, micrograms/cubic meter Hazardous > 210 Very Good/Satisfactory

13 Figure 2: Average small particulate (< 2.5 micrograms/cubic meter) for all tested bars and restaurants before and after enactment of Smoke-Free Act Very 140 micrograms/cubic meter) Good 0 Before Smoke-Free Act After Smoke-Free Act 13

14 Figure 3: Pre-implementation air quality in bars and restaurants that allowed smoking before the Smoke-Free Wisconsin Act, April-June, 2010 Good/ Satisfactory 13% Hazardous 21% 38% Very 28% Number= 214 April-June

15 Figure 4: Post-implementation air quality in bars and restaurants that allowed smoking before the Smoke-Free Wisconsin Act and were found to have unhealthy or worse quality air in pre-implementation tests, August-October, 2010 Good/Satisfactory 97% Hazardous: 0.5% Very : 0.5% : 2% Number = 180 August- October 15

16 Appendix A 16

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37 Appendix B Adams County Hazardous Micrograms/Cubic Meter :35 21:38 Avg Air Quality Before SFA: :41 21:44 21:47 21:50 21:53 21:56 21:59 22:02 22:05 22:08 22:11 Avg Air Quality After SFA: 3 22:14 Time Data Recorded 22:17 22:20 22:23 22:26 22:29 22:32 22:35 22:38 22:41 22:44 22:47 22:50 22:53 22:56 22:59 Very Good 37

38 Ashland County Very 140 Micrograms/Cubic Meter Avg Air Quality Before SFA: Avg Air Quality After SFA: 3 Good 0 21:00 21:03 21:06 21:09 21:12 21:15 21:18 21:21 21:24 21:27 21:30 21:33 21:36 21:39 21:42 21:45 21:48 21:51 21:54 21:57 22:00 22:03 22:06 22:52 22:55 22:58 23:01 23:04 23:07 23:10 23:13 23:16 23:19 23:22 Time Data Recorded 38

39 Bayfield County Avg Air Quality Before SFA: Hazardous Micrograms/ Cubic Meter :33 21:34 21:35 21:36 21:37 21:38 21:39 21:40 21:41 21:42 21:43 21:44 21:45 21:46 Avg Air Quality After SFA: 7 21:47 Time Data Recorded 21:48 21:49 21:50 21:51 21:52 21:53 21:54 21:55 21:56 21:57 21:58 21:59 22:00 22:01 22:02 22:03 Very Good 39

40 Brown County Micrograms/ Cubic Meter :54 21:02 21:10 Avg Air Quality Before SFA =220 21:18 21:26 21:34 21:42 21:50 21:58 22:06 22:14 22:22 22:30 Avg Air Quality after SFA = 8 22:38 Time Data Recorded 22:46 22:54 23:02 23:10 23:18 23:26 23:34 23:42 23:50 23:58 0:06 0:14 0:22 0:30 0:38 Hazardous Very Good 40

41 Dodge and Jefferson Counties Micrograms/Cubic Meter Avg Air Quality Before SFA: 372 Hazardous Avg Air Quality After SFA: 3 Very Good 15:36 15:42 15:48 15:54 16:00 16:06 17:23 17:29 17:35 17:41 17:47 18:39 18:45 18:51 18:57 19:03 19:37 19:43 19:49 19:55 20:01 20:07 21:43 21:49 21:55 22:01 Time Data Recorded 41

42 Douglas County Micrograms/Cubic Meter :52 21:07 21:22 Avg Air Quality Before SFA: 278 Avg Air Quality After SFA: 32 21:37 22:17 22:32 22:47 21:31 21:46 22:01 22:16 22:31 22:46 Time Data Recorded 23:01 23:16 23:31 23:46 0:01 20:39 20:54 21:09 22:07 22:22 22:49 23:04 23:31 23:46 Hazardous Very Good 42

43 Juneau and Richland Counties 250 Hazardous 200 Micrograms/Cubic Meter Avg Air Quality Before SFA: 88 Very :32 20:41 20:50 20:59 21:26 21:35 21:44 21:53 22:02 22:18 22:27 22:36 22:45 Time Data Recorded Avg Air Quality After SFA: 3 22:54 20:52 21:01 21:10 21:19 21:51 22:00 22:09 22:18 22:27 22:36 23:44 23:53 Good 43

44 Kenosha and Racine Counties Very Micrograms/ Cubic meter :44 18:52 19:00 Avg Air Quality Before SFA: 70 19:08 19:19 19:27 19:35 19:43 19:51 20:27 20:35 20:43 20:51 20:59 21:09 21:17 21:25 21:33 21:41 Avg Air Quality After SFA: 7 Time Data Recorded 21:49 21:57 22:07 22:15 22:23 23:34 23:42 23:50 23:58 18:16 18:24 18:32 18:40 Good 44

45 Kewaunee County Hazardous Micrograms/cubic meter :37 20:43 Avg air quality before SFA: 214 Avg air quality after SFA: 2 20:49 20:55 21:01 21:07 21:13 21:19 21:25 21:40 21:46 21:52 21:58 22:04 22:10 22:15 Time Data Recorded 22:21 22:27 22:33 22:39 22:45 22:51 23:42 23:48 23:54 0:00 0:06 Very Good 45

46 La Crosse County Micrograms/ Cubic Meter Avg Air Quality Before SFA: 346 Hazardous Very 0 Avg Air Quality After SFA: 6 8:04 8:11 8:18 8:25 8:32 8:39 8:46 20:11 20:18 20:25 20:32 20:39 20:52 20:59 21:06 21:13 21:20 21:27 21:34 21:41 21:48 21:55 22:02 22:18 22:25 22:32 22:39 22:46 22:53 23:00 23:07 23:14 23:21 23:28 23:35 Time Data Recorded 46

47 Manitowoc County Micrograms/ Cubic Meter :44 20:49 Avg Air Quality Before SFA: 314 Avg Air Quality After SFA: 37 20:54 20:59 21:04 21:09 21:14 21:19 21:24 21:29 21:34 21:39 22:10 22:15 22:20 22:25 22:30 22:35 22:40 22:45 22:50 22:55 23:00 23:05 23:10 23:15 Hazardous Very Good 47

48 Marquette County micrograms/ cubic meter Avg air quality before SFA: :59 19:06 19:13 19:20 19:27 19:34 19:41 19:48 19:55 Avg air quality after SFA: 14 20:49 20:56 21:03 21:10 21:17 21:24 21:31 21:38 21:45 21:52 21:59 22:06 22:23 22:30 22:37 22:44 Good 48

49 Milwaukee City Very 140 Micrograms/ Cubic Meter :20 18:25 18:30 Avg Air Quality Before SFA: 103 Avg Air Quality After SFA: 13 18:35 18:55 19:00 19:05 19:10 19:15 19:20 19:29 19:34 19:39 19:44 19:49 19:54 20:02 20:07 20:12 20:17 20:22 Time Data Recorded 20:29 20:34 20:39 20:44 20:49 20:54 17:25 17:30 17:35 17:40 17:45 18:25 18:30 18:35 Good 49

50 Milwaukee and Ozaukee Hazardous Micrograms/ Cubic Meter Avg Air Quality Before SFA: 170 Very Avg Air Quality After SFA: 7 19:32 19:43 19:54 20:25 20:36 21:04 21:15 21:47 21:58 22:09 22:36 22:47 23:19 23:30 23:41 13:55 14:06 14:17 14:58 15:09 15:20 16:29 16:40 16:51 17:02 17:25 17:36 17:47 18:27 18:38 Good 50

51 Oneida and Lincoln Counties Hazardous Micrograms/ Cubic Meter :43:47 17:52:47 18:01:47 18:10:47 18:19:47 18:28:47 18:37:47 18:46:47 18:55:47 19:04:47 20:12:07 20:21:07 20:30:07 20:39:07 Avg Air Quality Before SFA: 105 Avg Air Quality After SFA: 8 Time Data Recorded 18:52:36 19:01:36 19:10:36 19:19:36 19:28:36 19:37:36 19:46:36 19:55:36 20:16:16 20:25:16 20:34:16 20:43:16 21:14:50 21:23:50 21:32:50 21:41:50 22:12:39 22:21:39 22:30:39 22:39:39 Very Good 51

52 Outagamie County Micrograms/ Cubic Meter Avg Air Quality Before SFA: 251 Hazardous Very Avg Air Quality After SFA: 10 Good 17:47 17:52 17:57 18:02 18:07 18:12 18:17 18:22 18:34 18:39 18:44 18:49 18:54 18:59 19:49 19:54 19:59 20:04 20:09 20:14 20:19 20:45 20:50 20:55 21:00 21:05 21:10 21:15 Time Data Recorded 52

53 Polk County Hazardous 300 Micrograms/Cubic Meter :37 21:41 Avg Air Quality Before SFA: 184 Avg Air Quality After SFA: 10 21:45 21:49 21:53 21:57 22:01 22:05 23:09 23:13 23:17 23:21 23:25 23:29 Time Data Recorded 23:33 10:27 10:31 10:35 10:39 10:43 10:47 10:51 Very Good 53

54 Rusk County Micrograms/ Cubic Meter Avg Air Quality Before SFA: 197 Hazardous Very Avg Air Quality After SFA: 18 Good 21:40 21:43 21:46 21:49 21:52 21:55 21:58 22:01 22:04 22:07 22:10 22:13 22:18 22:21 22:24 22:27 22:30 22:33 22:36 22:39 22:42 22:45 22:57 23:00 23:03 23:06 23:09 23:12 23:15 23:18 23:21 Time Data Recorded 54

55 St. Croix County Micrograms/ Cubic Meter Avg Air Quality Before SFA: Good Avg Air Quality After SFA: :55 19:00 19:05 19:10 19:15 19:20 19:25 19:30 20:03 20:08 20:13 20:18 20:23 20:28 20:23 20:28 20:33 20:38 20:43 20:48 20:53 21:38 21:43 21:48 21:53 21:58 22:03 22:08 22:13 22:18 Time Data Recorded Washington County Hazardous Micrograms/Cubic Mtr :20:41 18:31:41 18:42:41 Avg Air Quality Before SFA: :53:41 19:04:41 19:15:41 19:26:41 19:37:41 19:48:41 19:59:41 20:10:41 20:21:41 20:32:41 Avg Air Quality After SFA: 5 Time Data Recorded 20:43:41 20:54:41 21:05:41 21:16:41 21:27:41 21:38:41 21:49:41 22:00:41 22:11:41 22:22:41 22:33:41 22:44:41 22:55:41 23:06:41 Very Good 55

56 56

57 Waukesha County Micrograms/ Cubic Meter Hazardous :20 18:27 18:34 Air Quality Before SFA = :41 18:48 19:20 19:27 19:34 19:41 19:48 19:55 20:51 20:58 21:05 21:12 Air Quality After SFA= 5 21:44 21:51 21:58 22:05 22:24 22:31 22:38 22:45 22:52 22:22 22:29 22:36 22:43 22:50 23:17 23:24 23:31 23:38 Very Good 57

58 Winnebago County Hazardous Micrograms/ Cubic Meter :20 PM 6:27 PM 6:34 PM Avg Air Quality Before SFA: 238 6:41 PM 6:48 PM 6:55 PM 7:02 PM 7:09 PM 7:16 PM 7:22 PM 7:29 PM 7:36 PM 7:43 PM 7:50 PM 7:56 PM Avg Air Quality After SFA: 2 Time Data Recorded 8:03 PM 8:10 PM 8:17 PM 8:24 PM 8:31 PM 8:50 PM 8:57 PM 9:04 PM 9:11 PM 9:18 PM 9:31 PM 9:38 PM 9:45 PM 9:52 PM Very Good 58

59 Wood and Portage Counties 200 Very 150 Micrograms/ Cubic meter :48 19:57 20:06 Avg Air Quality Before SFA: 73 Avg Air Quality After SFA: 4 20:15 20:24 20:33 21:02 21:11 21:20 21:29 20:06 20:15 20:24 20:33 20:42 Time Data Recorded 20:51 21:00 21:09 22:03 22:12 22:21 22:30 22:39 22:48 23:07 23:16 23:25 23:34 20:45 20:54 21:03 21:12 Good 59

60 References 1 Centers for Disease Control and Prevention The health consequences of smoking: a report of the Surgeon General. Atlanta, GA; Washington DC, Umland MA, Palmerscheim KA, Ullsvik JC, Wegner MV. Burden of Tobacco in Wisconsin. University of Wisconsin Comprehensive Cancer Center. Madison, WI: February Pechacek T, Repace J, Caraballo R., Cummings K M., Travers M, Hyland A, Babb S. Indoor air quality in hospitality venues before and after implementation of a clean indoor air law - Western New York, Morbidity and Mortality Weekly Report, 2004 (Vol. 53) (No. 44) Palmerscheim KA, Remington PL, Wegner MV. The impact of a smoke-free ordinance on the health of bartenders: one year later. Surveillance Brief. Paul P. Carbone Comprehensive Cancer Center Madison, WI. 5 Travers ML, et. al Indoor air quality in hospitality venues before and after implementation of a clean indoor air law- Western New York, Morb Mortality Wkly Rep Nov 12;53(44): Lee K, Hahn EJ, Pieper N, Okoli CT, Repace J, Troutman A. Differentional impacts of smoke-free laws on indoor air quality. J Environ Health 2008 Apr, 70(8) Borland R, Yong H-H, Siapush M, Hyland A, et.al. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) four-country survey. Tob Control 2006;15:iii-iii41 8 Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long term compliance with California s smoke-free workplace law among bars and restaurants in Los Angeles County. Tob Control 203;12: McGhee M, Ho S, Schooling M, Ho L., et.al. Morality associated with passive smoking in Hong Kong. BMJ 2005;330: and Hedley AJ, McGhee S, Repace JL Wong L, Yu M. Risks for heart disease and lung cancer from passive smoking by workers in the catering industry. April Toxicol. Sci. 90(2): Palmersheim KA, Remington PL, Gundersen DF. The impact of a smoke-free ordinance on the health and attitudes of bartenders. Tobacco Surveillance and Evaluation Program, University of Wisconsin Comprehensive Cancer Center, Madison, WI: February, Repace JL, Hyde JN, Bugge D. Air pollution in Boston before rand after a smoking ban. BMC Public Health 2006,6;266 and Repace JL. Respirable particles and carcinogens in the air of Delaware hospitality venues before and a smoking ban. Jl OEM 2004, 46:

Chicago Air Monitoring Study. Mark Travers, MS Andrew Hyland, PhD Department of Health Behavior Roswell Park Cancer Institute

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