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December 29th, 2011:

Lung function and exposure to workplace second-hand smoke during exemptions from smoking ban legislation: an exposureeresponse relationship based on indoor PM2.5 and urinary cotinine levels

ABSTRACT
Background The effects of workplace second-hand
smoke (SHS) on lung function remain uncertain because
of a lack of objective measures for SHS exposures.
Objective To determine whether an
exposureeresponse association exists between lung
function and two different markers of SHS based on
indoor fine particulate (PM2.5) and urinary cotinine levels
in non-smoking catering workers.
Design A cross-sectional study during a 1.5-year
exemption of licensed catering premises from smokefree
legislation.
Participants 186 non-smoking catering workers aged
18e65 years in Hong Kong were recruited. A declared
non-smoking status was accepted in workers with
exhaled breath carbon monoxide levels <6 ppm and
urinary cotinine levels <100 ng/ml.
Main outcome measures Lung function measures of
forced expiratory volume in 1s (FEV1 in litres), forced vital
capacity (FVC in litres) and forced expiratory flow as
25e75% of FVC (FEF25e75 in l/s) were recorded.
Results Indoor fine particulate (PM2.5)
concentrations were 4.4 times as high in smoking
premises (267.9 mg/m3) than in non-smoking premises
(60.3 mg/m3) and were strongly associated with the
probability of permitted smoking (R2¼0.99). Smoking
was the dominant source of particulates (R2¼0.66).
Compared with workers exposed to the lowest indoor
PM2.5 stratum (<25 mg/m3), lung function was lower in
the three higher PM2.5 strata (25e75, 75e175,
>175 mg/m3) with FEV1 “0.072 (95% CI “0.123 to
“0.021), “0.078 (95% CI e0.132 to “0.024), “0.101
(95% CI “0.187 to “0.014); FEF25e75 “0.368 (95% CI
“0.660 to “0.077), “0.489 (95% CI “0.799 to
“0.179), “0.597 (95% CI “0.943 to “0.251); and
FEV1/FVC (%) “2.9 (95% CI “4.8 to “1.0), “3.2 (95%
CI “5.1 to “1.4) and “4.4 (95% CI “7.4 to “1.3),
respectively. Urinary cotinine was associated positively
with indoor PM2.5 but negatively with lung function.
Consistently lower values for lung function per unit
increase of indoor PM2.5 were found.
Conclusion Lung function is inversely associated with
workplace SHS. Workplace exemptions and delays in
implementing smoke-free policies and current moves to
relax legislation are a major threat to the health of workers.

ABSTRACTBackground The effects of workplace second-handsmoke (SHS) on lung function remain uncertain becauseof a lack of objective measures for SHS exposures.Objective To determine whether anexposureeresponse association exists between lungfunction and two different markers of SHS based onindoor fine particulate (PM2.5) and urinary cotinine levelsin non-smoking catering workers.Design A cross-sectional study during a 1.5-yearexemption of licensed catering premises from smokefreelegislation.Participants 186 non-smoking catering workers aged18e65 years in Hong Kong were recruited. A declarednon-smoking status was accepted in workers withexhaled breath carbon monoxide levels <6 ppm andurinary cotinine levels <100 ng/ml.Main outcome measures Lung function measures offorced expiratory volume in 1s (FEV1 in litres), forced vitalcapacity (FVC in litres) and forced expiratory flow as25e75% of FVC (FEF25e75 in l/s) were recorded.Results Indoor fine particulate (PM2.5)concentrations were 4.4 times as high in smokingpremises (267.9 mg/m3) than in non-smoking premises(60.3 mg/m3) and were strongly associated with theprobability of permitted smoking (R2¼0.99). Smokingwas the dominant source of particulates (R2¼0.66).Compared with workers exposed to the lowest indoorPM2.5 stratum (<25 mg/m3), lung function was lower inthe three higher PM2.5 strata (25e75, 75e175,>175 mg/m3) with FEV1 “0.072 (95% CI “0.123 to”0.021), “0.078 (95% CI e0.132 to “0.024), “0.101(95% CI “0.187 to “0.014); FEF25e75 “0.368 (95% CI”0.660 to “0.077), “0.489 (95% CI “0.799 to”0.179), “0.597 (95% CI “0.943 to “0.251); andFEV1/FVC (%) “2.9 (95% CI “4.8 to “1.0), “3.2 (95%CI “5.1 to “1.4) and “4.4 (95% CI “7.4 to “1.3),respectively. Urinary cotinine was associated positivelywith indoor PM2.5 but negatively with lung function.Consistently lower values for lung function per unitincrease of indoor PM2.5 were found.Conclusion Lung function is inversely associated withworkplace SHS. Workplace exemptions and delays inimplementing smoke-free policies and current moves torelax legislation are a major threat to the health of workers.

Download PDF : thoraxjnl160291 1..9

Risks for Heart Disease and Lung Cancer from Passive Smoking by Workers in the Catering Industry

Workers in the catering industry are at greater risk of exposure
to secondhand smoke (SHS) when smoke-free workplace policies
are not in force.We determined the exposure of catering workers to
SHS in Hong Kong and their risk of death from heart disease and
lung cancer. Nonsmoking catering workers were provided with
screening at their workplaces and at a central clinic. Participants
reported workplace, home, and leisure time exposure to SHS.
Urinary cotinine was estimated by enzyme immunoassay. Catering
facilities were classified into three types: nonsmoking, partially
restricted smoking (with nonsmoking areas), and unrestricted
smoking. Mean urinary cotinine levels ranged from 3.3 ng/ml in
a control group of 16 university staff through 6.4 ng/ml (nonsmoking),
6.1 ng/ml (partially restricted), and 15.9 ng/ml (unrestricted
smoking) in 104 workers who had no exposures outside
of work. Workers in nonsmoking facilities had exposures to other
smoking staff. We modeled workers’ mortality risks using average
cotinine levels, estimates of workplace respirable particulates, risk
data for cancer and heart disease from cohort studies, and national
(US) and regional (Hong Kong) mortality for heart disease and
lung cancer. We estimated that deaths in the Hong Kong catering
workforce of 200,000 occur at the rate of 150 per year for a 40-year
working-lifetime exposure to SHS. When compared with the
current outdoor air quality standards for particulates in Hong
Kong, 30% of workers exceeded the 24-h and 98% exceeded the
annual air quality objectives due to workplace SHS exposures.
Key Words: secondhand smoke; passive smoking; urinary
cotinine; heart disease; lung cancer; catering workers; Hong Kong.

Workers in the catering industry are at greater risk of exposureto secondhand smoke (SHS) when smoke-free workplace policiesare not in force.We determined the exposure of catering workers toSHS in Hong Kong and their risk of death from heart disease andlung cancer. Nonsmoking catering workers were provided withscreening at their workplaces and at a central clinic. Participantsreported workplace, home, and leisure time exposure to SHS.Urinary cotinine was estimated by enzyme immunoassay. Cateringfacilities were classified into three types: nonsmoking, partiallyrestricted smoking (with nonsmoking areas), and unrestrictedsmoking. Mean urinary cotinine levels ranged from 3.3 ng/ml ina control group of 16 university staff through 6.4 ng/ml (nonsmoking),6.1 ng/ml (partially restricted), and 15.9 ng/ml (unrestrictedsmoking) in 104 workers who had no exposures outsideof work. Workers in nonsmoking facilities had exposures to othersmoking staff. We modeled workers’ mortality risks using averagecotinine levels, estimates of workplace respirable particulates, riskdata for cancer and heart disease from cohort studies, and national(US) and regional (Hong Kong) mortality for heart disease andlung cancer. We estimated that deaths in the Hong Kong cateringworkforce of 200,000 occur at the rate of 150 per year for a 40-yearworking-lifetime exposure to SHS. When compared with thecurrent outdoor air quality standards for particulates in HongKong, 30% of workers exceeded the 24-h and 98% exceeded theannual air quality objectives due to workplace SHS exposures.Key Words: secondhand smoke; passive smoking; urinarycotinine; heart disease; lung cancer; catering workers; Hong Kong.

Download PDF : Toxicol. Sci.-2006-Hedley-539-48

Still hazy after all these years

Clear the Air says:

To the Liquor Licensing Board / FEHD

There is currently no level playing field in the licensed bar business and some restaurants also.

The TCO issues  most of its fixed penalty tickets at the railway station and in game centres, not bars.

That is because they are  way understaffed and cannot patrol – they act on complaints several days after the complaints are received.

They can only act against the smokers and not the persons permitting the smoking on licensed premises.

That is daft.

TCO are massively undermanned to be able to cover the whole of Hong Kong.

The Liquor Licensing Board should get proactive and add a ‘o smoking allowed‘ condition to all liquor licences , condition 7.

Having an idle law on the lawbooks without 100% enforcement capability is pointless and inadequate.

The problem will stop tomorrow if  ten simple words are added to each licence making the licensees comply with the anti smoking laws of Hong Kong.

To omit to do so will cost people (bar staff) their health and lives.

23% of the 7,000 tobacco related deaths in Hong Kong per year are from passive smoking.

The LLB has the right to impose conditions on all liquor licences.

Existing condition of all Hong Kong  liquor licences:

7.        The licensee shall not permit any person to occupy or use any

portion of the premises for any immoral or illegal purpose, (just add) including the carrying or use of a lighted tobacco product . As simple as that. Ten words.

A message to the Liquor Licensing Board –‘Be proactive or step away and let someone else do the job.’

South China Morning Post – 29 Dec. 2011

Inconsistent implementation of the smoking ban frustrates many bar and restaurant operators

For at least six years, from the time anti-smoking legislation for restaurants and bars was first discussed, owners have complained that a ban will kill their businesses, staff have fretted over job losses and smokers have grumbled about the lack of choice.

Despite the pessimism, Hong Kong’s dining scene remains as dynamic as ever, five years after the ban took effect in restaurants. Today, operators mostly fall into three camps – those who have accepted the smoking ban and even endorse it; those who dislike the ban and believe business has been negatively affected; and those who are flouting the law.

There are many venues in which smokers are still lighting up, despite the government imposing a complete smoking ban inside entertainment venues, a ban that the Health Department’s Tobacco Control Office claims to be enforcing.

“Hong Kong has a smoking ban indoors? I didn’t know that,” quips Kenny Lee Kun-yee, a member of the Wan ChaiDistrict Council who supported the extension of the ban two years ago. “Just last night I was at a Chinese restaurant in Causeway Bay and people were smoking at the table across from me.”

The Health Department, however, says the ban has been a success.

“We follow up on every smoking complaint by inspecting all venues concerned,” says the department’s public relations officer, Chris Cheung Chi-man. “Aside from reacting to complaints, we make unannounced inspections, especially at the restaurants and bars located above the ground floor, which we call `black spots’.”

Grant Baird, group operations director for Epicurean Group, which operates restaurants, bars, and hybrids of the two such as Jimmy’s Kitchen in Central and Tsim Sha Tsui, Agave in Wan Chai, and The Peak Lookout, disagrees.

“We don’t really see [smoking] inspectors any more,” he says. “They were around the first year, but they’ve become virtually invisible today. “Maybe [the inspectors] know there’s not going to be a problem at major establishments in high-profile areas, and are focusing on bars and restaurants in high rises,” he says.

But according to nearly a dozen Hong Kong smokers who frequent restaurants and bars that allow smoking, the inspectors are nowhere to be found in those locations either.

“It doesn’t even feel like I’m breaking the law when I smoke during dinner,” says Christine Ko Wan-ting, who cites the Prince Restaurant in Causeway Bay and Hoi Yeung Seafood Restaurant in Jordan’s Sino Cheer Plaza as among those with smoking rooms.

These venues are not even hidden on an upper floor inside an inconspicuous building, like most smoking bars are.

“They’re legitimate businesses that are quite out in the open,” says Leslie Lau Ho-man, who works in marketing and is another frequent smoker. “It’s a joke for the [Tobacco Control Office] to pretend they’re out there shutting these places down when every Chinese hotpot restaurant has a smoking room.”

This inconsistent enforcing of the law frustrates restaurant operators who obey the law.

“I wouldn’t say the smoking ban itself has hurt our business,” says Baird. “But the unfair ruling of the law does.”

Kevin McBarron, owner of the bars Devil’s Advocate and The Canny Man, calls the ban pathetic.

Most nameless, local Chinese bars and restaurants still allow smoking, he says, but the Western bars that have a brand name and reputation are forced to suffer.

“There is no evidence, anywhere, that receipts for bars and restaurants have gone up,” he says. “I can provide evidence that my bar receipts have gone down.”

Linda Kwan, marketing and PR director of Cafe Deco group, which runs more than 45 restaurants and bars across town, says the company supports the ban.

“We’re not the first country in the world to put that law in place,” she says. “I don’t think the ban ever affected restaurants that much, smokers are used to `butting out’ before sitting down to eat anyway.”

Cafe Deco didn’t suffer a significant drop in business due to the ban, but Kwan says that may be because most of their restaurants have outdoor spaces and patios.

The El Grande chain, operator of restaurants and bars such as Grappa’s and East End Brewery, experienced a drop in business of up to 20 per cent at some of its venues.

John Robertson, the company’s marketing director, says, “Sales have come back, but the ban still hurts some bars and restaurants. It hurts them because the ban is not enforced properly, and thus the responsible operations who comply with it suffer, while the irresponsible ones reap the benefits by getting new customers. This unintended effect of punishing responsible bars while rewarding irresponsible ones is something that people who champion the existing measures have overlooked, and their blithe public statements about the positive effects such measures have had on bars misleads the public.”

Baird says there has been a slow climb back from Epicurean’s initial drop in restaurant receipts.

“I think people are just getting used to it,” he says. “If anything, the new problem for us now is customers smoking outside and then dropping butts on the floor right in front of restaurant entrances.”

James Middleton, chairman of Clear the Air’s anti-tobacco committee, says he always knew the smoking ban wouldn’t negatively affect business too much. He points to official data to prove his point.

According to statistics from the Hong Kong Census and Statistics Department, overall restaurant receipts this year are up HK$3.7 billion from 2006, before the initial loose smoking legislation came into force.

But these figures cover a much wider spectrum and don’t necessarily show the whole picture, says Poon Chi-wai, a statistical officer at the department.

“Our report doesn’t exclusively cover restaurants, but also hotel food services and even street vendors,” Poon says. “It also focuses on revenue only, without factoring in expenses, so the numbers are not net profits.”

Middleton, a hardline anti-tobacco activist who has been observing the government’s efforts at tobacco control for years, isn’t thrilled with the way the smoking ban has been implemented, either.

“The chances of [smokers] being caught by [Tobacco Control Office] are minimal,” he says.

However, 6,500 penalty citations were issued this year, stemming from 19,000 inspections, according to Cheung.

Middleton doesn’t accept these figures, and says the penalty should focus on the owners and landlords.

“The onus has to be on them,” he says. “Right now only the smokers themselves are penalised if caught, but if the owners faced similar penalities they would snuff out smoking completely.”

Other countries such as the US and Britain have harsher punishment for venues that break smoking laws, says Middleton, pointing to several overseas cases in which large venues lost their licence for violating the law.

“Hong Kong should do the same and force businesses to follow the law or lose their licence,” he says.

Lee, of the Wan Chai District Council, says she’s mostly satisfied with the ban so far, despite the obvious breaking of the law.

“The smoking ban has raised awareness and has caused a lot of people to smoke less or quit,” she says. “A complete crackdown on smoking is unrealistic.

“What more can the government do? It is understaffed, and smaller bars will suffer huge business drops if there is no smoking.”

Greg Yu Kin-wai, a non-smoker who works in IT, agrees.

“We’ve snuffed out enough smoking so that most of us can be free from smoke most of the time,” he says. “And that’s good enough. No law is ever going to go unbroken, anywhere.”

But as long as there is smoking indoors, there’s a huge health risk for workers, says Anthony Hedley, chair professor of community medicine at the University of Hong Kong.

“Several years ago we examined the levels of contamination of the body fluids of hospitality workers by cancer- and heart disease-causing tobacco chemicals,” he says. “The result showed their bodies were saturated with toxic substances and were more likely to develop lung cancer and heart diseases.”

There is no reason to trade off health for the preferences of smokers, he adds.

Baird says his staff are more than thankful they no longer have to inhale second-hand smoke, while several waitresses from local cha chaan teng in Mong Kok, Wan Chai, and Sai Ying Pun all say they prefer to work in a smoke-free environment.

Ko says: “Right now, we have what seems to be a smoke-free dining scene on the surface, but if you dig deep enough you can find places to smoke. And that’s how it should be. That’s how it is with every law around the world. You can never completely shut something out, it’ll end up causing those who’ve been shut out to revolt.”

Clockwise from top left: drinkers smoke in Lan Kwai Fong before the ban; many bars display no-smoking compliance notices; health inspectors distribute ''no smoking'' leaflets at a restaurant; Grant Baird, of Epicurean Group, says the ban is inconsistent.

Clockwise from top left: drinkers smoke in Lan Kwai Fong before the ban; many bars display no-smoking compliance notices; health inspectors distribute ”no smoking” leaflets at a restaurant; Grant Baird, of Epicurean Group, says the ban is inconsistent.

Still hazy after all these years