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Ventilation in bars, casinos doesn’t control health risk for hospitality workers


But first study of indoor air before and after a smoking ban finds carcinogens eliminated by smoke-free laws

The level of cancer-causing particles is much higher in the air of smoke-filled bars and casinos than on truck-choked highways and city streets, according to the first published comparison of indoor air quality before and after smoke-free workplace legislation. The study, conducted in a casino, six bars and a pool hall in Wilmington, Delaware, is published in the September 2004 Journal of Occupational & Environmental Medicine.

"This research clearly shows that it is far worse for your health to be a bartender or casino dealer in a smoking-permitted establishment than it is to be a turnpike toll collector," says James L. Repace, MSc., the study’s author. "These workers breathe an average of 90% cleaner air after a smoke-free workplace law." Repace, a health physicist, is visiting assistant clinical professor at Boston’s Tufts University School of Medicine and a secondhand smoke consultant based in Bowie, Md. In 2002, Repace received a Robert Wood Johnson Foundation Innovators Combating Substance Abuse award for his ground-breaking work on the effects of secondhand smoke. Funds from the award helped make this study possible.

Repace assessed air quality in the eight hospitality venues on Friday evenings in November 2002 – before Delaware’s smoking ban -- and again in January 2003, two months after the ban took effect. Using state-of-the art monitoring equipment, he measured respirable particulate air pollution (RSP) and particulate polycyclic aromatic hydrocarbons (PPAH), pollutants proven to increase risk of respiratory disease, cancer, heart disease and stroke.

Repace’s findings demonstrate the dramatic effect of Delaware’s smoking ban: Except for residual chalk dust in the pool hall – at 17% of pre-ban levels -- air quality levels post-ban in all venues were indistinguishable from those measured out-of-doors.

Prior to the smoking ban, however, Repace found all eight venues to be heavily polluted. Indoor RSP levels averaged 20 times those in the outdoors and were 4.6 times higher than the level permissible under the U.S. Environmental Protection Agency’s National Ambient Air Quality Standard (NAAQS). The hospitality workers were exposed to RSP levels 2.6 times higher than those Repace measured on diesel-exhaust polluted streets in Boston and on Interstate-95 in Delaware. Carcinogenic PPAH levels pre-ban were five times higher than outdoor levels in Wilmington, and exceeded those measured at an I-95 tollbooth at the heavily trafficked Baltimore Harbor Tunnel.

"Before the ban, secondhand smoke contributed 90% to 95% of the RSP air pollution in the studied venues, and 85% to 95% of the carcinogenic PPAH," says Repace. "This demonstrates conclusively that ventilation does not control the life-threatening pollutants inherent to a smoking environment. Only a smoke-free workplace law can protect the health of these workers."

Few states have taken action to protect hospitality workers; only 14% of states have laws banning smoking in restaurants, bars, casinos and all other workplaces.

According to the federal Agency for Toxic Substances and Disease Registry, people exposed to polycyclic aromatic hydrocarbons (PAHs) for prolonged periods can develop cancer. Ten carcinogenic particulate phase PAHs have been identified in tobacco smoke, representing one-sixth of all known tobacco smoke carcinogens.

Repace has conducted research on indoor air pollution from secondhand smoke for 28 years, and has published more than 60 scientific papers on the topic. Among his major accomplishments, in 1979 he initiated the Environmental Protection Agency’s policy interest in indoor air pollution. In 1980 he identified secondhand smoke as a major source of indoor air pollution in a groundbreaking paper that received international scientific attention. Five years later, he estimated that 5,000 lung cancer deaths per year in the U.S. were caused by passive smoking, in a seminal study.

Innovators Combating Substance Abuse is a national program of The Robert Wood Johnson Foundation that recognizes and rewards those who have made substantial, innovative contributions of national significance in the field of substance abuse. Each award includes a grant of $300,000, which is used to conduct a project over a period of up to three years that advances the field. The program addresses problems related to alcohol, tobacco and illicit drugs, through education, advocacy, treatment and policy research and reform at the national, state and local levels. The Innovators program is run by a national program office at The Johns Hopkins University School of Medicine. For more information on Innovators Combating Substance Abuse, please visit

Dennis Tartaglia | EurekAlert!
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