Air Quality Assessment for Second Hand Smoke in Hospitality Venues in Mauritius

1. Air Quality Assessment for Second Hand Smoke in Hospitality Venues in Mauritius Maria J. López, Manel Nebot, Premduth Burhoo, Deowan Mohee, Leelmanee Mousse June 2010 Public Health Agency of Barcelona, Mauritius Institute of Health, WHO

2. Introduction Objectives Methods Results Discussion Passive smoking / Involuntary smoking: Exposure to Environmental Tobacco Smoke (ETS) / Secondhand Smoke (SHS) Secondhand Smoke (SHS): + Mainstream Sidestream

3. Introduction Objectives Methods Results Discussion Composition of SHS • More than 4,000 compounds: • - Carcinogens • - Toxic compounds • - Chemical irritants (Surgeon General, 2006)

4. Introduction Objectives Methods Results Discussion • Health effects (I) • Adults: • - Lung cancer • Coronary heart disease • - Nasal irritation (Causal relationship according to the Surgeon General, 2006)

5. Introduction Objectives Methods Results Discussion • Health effects (II) • Children: • - Low Birth Weight • - Sudden Infant Death Syndrome • Middle ear disease • Lower respiratory illnesses • Lower level of lung function (Causal relationship according to the Surgeon General, 2006)

6. Introduction Objectives Methods Results Discussion Health effects (III) • No safe level of SHS exposure • Dose-response effect • The intensity of the exposure depends on: • Time of exposure • Concentration of SHS (WHO, 2000)

7. Introduction Objectives Methods Results Discussion SHS measurement - Questionnaires Indirect methods - Observational studies - Biomarkers Direct methods - Environmental markers

8. Introduction Objectives Methods Results Discussion Questionnaires • Assess perceived exposure • Exposure (and exposed) characteristics

9. Introduction Objectives Methods Results Discussion Observational studies • Variables related to tobacco consumption: • Number of smokers • Presence of ashes • Tobacco smelt • Number of ashtrays

10. Introduction Objectives Methods Results Discussion Markers (I) • SHS compounds that can be measured. • Objective and precise information. • Markers: • Biological markers: Measured in biological fluids, hair or nails. • Airborne/environmental markers: Measured in the air.

11. Introduction Objectives Methods Results Discussion Markers (II)

12. Introduction Objectives Methods Results Discussion Vapour-phase nicotine as a SHS marker • SHS is the only source of nicotine • Sampling methods simple to use in the field • - Very sensitive techniques of analysis • Nicotine concentrations do vary with source strength • Nicotine concentrations can be correlated with other SHS compounds

13. Introduction Objectives Methods Results Discussion PM2.5 as a SHS marker • Selective SHS marker • Real time measurements • Sampling methods simple to use in the field • - There are air quality standards for air pollution (EPA) • PM2.5 concentrations can be correlated with other SHS compounds

14. Introduction Objectives Methods Results Discussion Evaluation of smoking control policies

15. Introduction Objectives Methods Results Discussion Smoking regulation in Mauritius • New regulation was adopted in Mauritius in November 2008. • It came in force 1st March 2009. • Strengthen regulations under 1999 legislation in order to reduce SHS exposure in: • public transport • private vehicles carrying passengers • public places including hospitality venues

16. Introduction Objective Methods Results Discussion General objective: To assess the levels of SHS in hospitality venues in Mauritius in order to evaluate the effectiveness of the smoke-free regulation

17. Methods

18. Introduction Objectives Methods Results Discussion Study design: Cross-sectional study Fieldwork:December 2009 Sampling:Convenient sample of 60 hospitality venues and shopping malls covering the whole island of Mauritius Type of hospitality venues: - Cafes and tea shops - Bars - Restaurants - Night and private clubs

19. Introduction Objectives Methods Results Discussion • SHS markers: Vapour-phase nicotine and PM2.5 • Vapour-phase nicotine measurement:passive samplers Passive sampler Treated filter

20. Exposure time: 1 week (Fieldwork in Mauritius, December 2009)

21. Introduction Objectives Methods Results Discussion Lab analysis: - Gas cromatography / mass espectrometry Cromatograph

22. Introduction Objectives Methods Results Discussion • PM2.5 measurements: Personal monitor • Measures the particle concentration (mg/m3) each minute • - Time of each measurement: 35 minutes (5 outdoors, 30 indoors). Side Pack AM 510 Personal Aerosol Monitor

23. (Fieldwork in Mauritius, December 2009)

24. Results

25. Introduction Objectives Methods Results Discussion Table 1. Descriptive table.

26. Introduction Objectives Methods Results Discussion Figure 1. Samples with presence of nicotine. Presence* of nicotine (69%) (31%) % of nicotine samples (n=29) *>Limit of quantification

27. Figure 2. Nicotine concentration (μg/m3) μg/m3 1.19 [0.62-2.14] 0.16 [0.06 - 0.27] 0.05 [0.01 - 0.07] 0.03 [<L.Q - 0.05] 0.02 [<L.Q – 0.04] Café/tea shops Bars Restaurants Night/Private clubs Shopping malls 6 5 6 6 6

28. Figure 3. PM 2.5 concentration (μg/m3) μg/m3 375.96 [12.22 – 1240.98] 34.06 [15.86 – 96.64] 17.68 [11.18 – 35.62] 19.24 [11.44 – 41.08] 16.12 [7.28 – 26.26] Café/tea shops Bars Restaurants Night/Private clubs Shopping malls 12 12 12 12 12

29. Table 2. PM2.5 indoor vs. outdoor (μg/m3)

30. Example of measurement of PM concentration in a bar

31. Example of measurement of PM2.5 in a night club.

32. Figure 4. PM2.5 concentration (μg/m3) by sample μg/m3 35%of measurements 35 μg/m3 * Number of samples *National Ambient Air Quality Standard (EPA)

33. Correlation between nicotine and PM2.5 measurements Correlation positive and statistically significant between the PM 2.5 and nicotine measurements (n=29) PM2.5 (μg/m3 ) P <0.05 Nicotine (μg/m3 )

34. Discussion

35. Introduction Objectives Methods ResultsDiscussion Limitations • Potential selection bias • Cross-sectional study (no values before the law to compare) Strengths • High “response rate” • Study measuring two objective (and one specific) SHS marker • Enable comparison with other studies

36. Introduction Objectives Methods ResultsDiscussion Conclusions • In hospitality venues where nicotine was measured, SHS presence was found in 69% of the samples. • However, the nicotine levels found are, in most places, significantly lower than those found in other studies carried out in countries where smoking is still allowed.

37. Introduction Objectives Methods ResultsDiscussion Conclusions • 35% of the PM indoor measurements are higher than the Air Quality Standard published by the U.S. Environmental Protection Agency (35 μg/m3). • In 42% of the venues studied the PM2.5 concentration found indoor is 1.5 or higher than the concentration found outdoor.

38. Introduction Objectives Methods ResultsDiscussion Conclusions • The highest concentrations of both markers have been found in private and night clubs. • In these clubs the PM2.5 concentration is more than 38 times the concentration found outdoor.

39. Introduction Objectives Methods ResultsDiscussion Summary • There is presence of SHS in a considerable number of the venues studied… although the levels of SHS found in most venues are not very high. • There are still some “hot spots”, mainly private and night clubs, with very high levels of SHS that are linked to an important health risk for workers and clients.

40. Introduction Objectives Methods ResultsDiscussion Recommendations • Surveillance and enforcement actions should be done in order to progresively improve the situation. - To monitor the SHS levels (time trends) - Sanctions and follow-up of changes after the sanctions - Information campaigns about the benefits of smokefree environments

41. Thanks!