Comprehensive smoke-free legislation in England: how advocacy won the day

Objective

To examine how a government committed to a voluntary approach was forced by an effective advocacy coalition to introduce comprehensive smoke‐free legislation.

Methods

A diary was kept from the start of the campaign in 2003, backed up by journal and press articles, and information downloaded from the web. Regular public opinion polls were also carried out to supplement government surveys and polls conducted by the media.

Results

The 1997 Labour Government was committed to a voluntary approach to deal with the problem of secondhand smoke. By 2003, efforts to persuade government to introduce regulation of workplace secondhand smoke through a health and safety code of practice with exemptions for the hospitality trade, had failed. Despite a lack of support from the government, including the health minister, a new strategy by health advocates focusing on comprehensive workplace legislation was able to succeed.

Conclusions

In a democracy it is crucial to develop public knowledge and belief in the extent of the risks of secondhand smoke. Gaining public and media support for the issue can ensure that government has to take action and that the legislation will be enforceable. The interests of the tobacco industry and the hospitality trade differ and this can be used to gain hospitality trade support for comprehensive national legislation in order to ensure a level playing field and protection from litigation.     

Secondhand smoke levels in Scottish pubs: the effect of smoke-free legislation

Objective

To compare levels of particulate matter, as a marker of secondhand smoke (SHS) levels, in pubs before and 2 months after the implementation of Scottish legislation to prohibit smoking in substantially enclosed public places.

Design

Comparison of SHS levels before and after the legislation in a random selection of 41 pubs in 2 Scottish cities.

Methods

Fine particulate matter <2.5 μm in diameter (PM_2.5) was measured discreetly for 30 min in each bar on 1 or 2 visits in the 8 weeks preceding the starting date of the Smoking, Health and Social Care (Scotland) Act 2005 and then again 2 months after the ban. Repeat visits were undertaken on the same day of the week and at approximately the same time of the day.

Results

PM_2.5 levels before the introduction of the legislation averaged 246 μg/m³ (range 8–902 μg/m³). The average level reduced to 20 μg/m³ (range 6–104 μg/m³) in the period after the ban. Levels of SHS were reduced in all 53 post‐ban visits, with the average reduction being 86% (range 12–99%). PM_2.5 concentrations in most pubs post‐ban were comparable to the outside ambient air PM_2.5 level.

Conclusions

This study has produced the largest dataset of pre‐ and post‐ban SHS levels in pubs of all worldwide smoke‐free legislations introduced to date. Our results show that compliance with the Smoking, Health and Social Care (Scotland) Act 2005 has been high and this has led to a marked reduction in SHS concentrations in Scottish pubs, thereby reducing both the occupational exposure of workers in the hospitality sector and that of non‐smoking patrons.Public health policy in a growing number of countries has moved to control non‐smokers'' exposure to secondhand smoke (SHS), with recent legislation introduced in Ireland, Italy, Spain and Norway. The Smoking, Health and Social Care (Scotland) Act 2005 to ban smoking in substantially enclosed public places was implemented on 26 March 2006 with the aim of protecting non‐smokers from the health effects of SHS.¹A recent review of occupational exposure to SHS suggested that workers in the hospitality sector have among the highest exposures to SHS of all occupational groups.² Data on exposure to SHS across a wide range of entertainment establishments indicated that airborne nicotine concentrations were up to 18.5 times higher than in offices or domestic residences.³ Studies have shown that non‐smoking bar workers have salivary cotinine levels four times those of non‐smokers who live with partners who smoke.⁴ Data from New Zealand indicate that non‐smoking hospitality workers in establishments that permit smoking have salivary cotinine levels between 3 and 4 times those of non‐smoking workers in smoke‐free premises.⁵ One estimate indicates that between 1500 and 2000 non‐smokers'' deaths per year in Scotland can be attributed to SHS exposure.⁶ It has been suggested that SHS exposure may lead to the deaths of over 50 hospitality sector workers in the UK each year.⁷The introduction of smoke‐free legislation in other countries has been shown to dramatically reduce SHS levels. A recent analysis of the effect of the Norwegian legislation⁸ showed that total dust levels in 13 bars and restaurants reduced from an average level of 262 to 77 μg/m³, a 70% reduction, whereas a study in the USA indicated that respirable dust levels in a selection of 8 hospitality venues reduced to approximately 9% of the pre‐ban level.⁹ Similar work in New York State in a mixture of bars and restaurants measured levels of particulate matter <2.5 μm in diameter (PM_2.5), and found that mean levels decreased from 412 to 27 μg/m³ (93.5%).¹⁰ Mulcahy et al¹¹ measured changes in airborne nicotine levels as a result of the Irish smoking ban. Their study of 20 pubs showed nicotine reductions of approximately 83%.Although there are currently no air quality standards for PM_2.5 in the UK, both the US Environmental Protection Agency (EPA) and the World Health Organization (WHO) have issued air quality guidance for outdoor air pollution levels measured in PM_2.5.^12,13 The US EPA air quality guidance is divided into bands, and for PM_2.5 these bands are arranged at cut points of <15.4 μg/m³ (good), 15.5–40.4 μg/m³ (moderate), 40.5–65.4 μg/m³ (unhealthy for sensitive groups), 65.5–150.4 μg/m³ (unhealthy), 150.5–250.4 μg/m³ (very unhealthy) and >250.5 μg/m³ (hazardous). The US EPA standard for PM_2.5 has a 24 h averaged target of 65 μg/m³, with an annualised average of 15 μg/m³. The WHO recently revised its outdoor air quality guidance and now recommends a 24 h average limit of 25 μg/m^3, with an annual average not exceeding 10 μg/m³ measured in PM_2.5.¹³This paper describes our methods of measurement of SHS concentrations in a selection of Scottish pubs and examines the changes in SHS levels that occurred as a result of the implementation of the ban on 26 March 2006. It forms part of a comprehensive evaluation strategy to measure the effects of the introduction of the Scottish smoke‐free legislation.¹⁴     

Costs of employee smoking in the workplace in Scotland

BACKGROUND: Employers have responded to new regulations on the effects of passive smoking by introducing a range of workplace policies. Few policies include provision of smoking cessation intervention. OBJECTIVE: To estimate the cost to employers of smoking in the workplace in Scotland to illustrate the potential gains from smoking cessation provision. Costs vary with type of smoking policy in place; therefore, to estimate these costs results from a survey were combined with evidence drawn from a literature review. STUDY DESIGN: A telephone survey of 200 Scottish workplaces, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 1996. Additional evidence was compiled from a review of the literature of smoking related costs and specific smoking related effects. RESULTS: 167 completed responses were received, of which 156 employers (93%) operated a smoking policy, 57 (34%) operated smoke free buildings, and 89 (53%) restricted smoking to a "smoke room". The research literature shows absenteeism to be higher among smokers when compared to non-smokers. The estimated cost of smoking related absence in Scotland is pound40 million per annum. Total productivity losses are estimated at approximately pound450 million per annum. In addition, the resource cost in terms of losses from fires caused by smoking materials is estimated at approximately pound4 million per annum. In addition, there are costs from smoking related deaths and smoking related damage to premises. CONCLUSION: This study shows how smoking cessation interventions in the workplace can yield positive cost savings for employers, resulting in gains in productivity and workplace attendance which may outweigh the cost of any smoking cessation programme.     

Fusarium mycotoxins in milling streams from the commercial milling of maize imported to the UK,and relevance to current legislation

A study in three large commercial UK maize mills showed that Fusarium mycotoxins, such as deoxynivalenol, zearalenone and fumonisins present at mill intake, are distributed in milling streams approximately according to their occurrence in the maize seed structure. Fractions derived from the endosperm tended to contain the lowest levels of mycotoxins. Concentrations of mycotoxins within the endosperm are also related to the particle size. However, the products derived from the embryo or outer seed layers contained the highest mycotoxin levels being concentrated up to five times or more, although these components are normally used for animal feed or industrial use. The general pattern of mycotoxin distribution found when milling French and Argentinean maize was similar, although very variable, and it is concluded that this variability stems from different milling strategies used at each mill and from the nature and condition of each consignment of maize. Mycotoxins in maize grits (particle sizes >500 µm) were usually reduced by the greatest amount when compared with the whole maize, while flour (≤500 µm) could be both reduced or increased depending on the mill and consignment. Thus, in most situations mycotoxin concentrations in whole maize that meet European Commission legislation on intake should give rise to levels in milled ingredients that should also do so. However, this was not always true in some ingredients, especially for fumonisins in those fractions with particle size ≤500 µm.     

12个城市的卷烟产品评吸指标间相关性分析

摘要: 以评吸人员对12个城市进行评吸收集后得到的3900个数据为材料,研究了评吸中4类特性11个指标,其中包括香气特性（香气韵调,香气质,香气量,谐调性等4个指标）、烟气特性（浓度,劲头等2个指标）、口感特性（刺激性,湿润度,干净度,回味等4个指标）、杂气特性（即杂气指标）之间的典型相关分析以及4类评吸特性中11个指标之间的简单相关分析。结果表明:1.由简单相关分析看出11个评吸指标间均存在极显著的线性正相关关系,并且在香气韵调、香气质、香气量3个指标之间,香气韵调与杂气,湿润度与干净度存在高度正相关,其余指标间只存在低度和中度正相关。2.由典型相关分析和简单相关分析综合反映的香气特性与烟气特性的相关性主要可由谐调性、香气量与浓度间相关代表,烟气特性与口感特性的相关性主要可由浓度与湿润度及回味间相关代表,烟气特性与杂气特性的相关性主要可由浓度与杂气间相关所代表,香气特性与杂气特性的相关性主要可由香气韵调与杂气间相关代表,口感特性与杂气特性的相关性主要可由干净度、湿润度及回味与杂气间相关代表。3.由于香气特性与口感特性间多指标综合影响,所以利用香气特性第1典型变量得分来预测口感特性第1典型变量得分的回归方程来表示,且从散点图上也可观察到显著的线性关系。研究结果可为进一步研究评吸指标性状间的相互关系提供参考。      

Econutrition: implementation models from the Millennium Villages Project in Africa

Econutrition integrates environmental health and human health, with a particular focus on the interactions among the fields of agriculture, ecology, and human nutrition. Soil loss and degradation and human undernutrition are major barriers to economic development in Africa. A primary aim of the Millennium Villages Project in Africa is to meet the Millennium Development Goals by integrated multisectoral interventions in health and nutrition, agriculture, and environmental sustainability in hunger and poverty hot spots in Africa. Econutrition is only one example of how interdisciplinary approaches are not only critical to alleviating extreme poverty but also fundamental to linking basic science understanding in multiple areas. Human health and agricultural productivity gain, and the costs of the gains are lowered, when we take the opportunity to apply different disciplines through cross-sectoral, thematically linked interventions.     

Seasonal variations in the initiation of smoking among adolescents.

Numerous studies have identified a variety of reasons that youths give for starting smoking. Few efforts have been made, however, to identify seasonal variations in initiation. This study was an attempt to fill that void. We examined data from 342 youths participating in a mandated smoking education and cessation program in Texas. Data were collected based on responses to questions in participant workbooks, including an item asking participants about the month in which they started smoking. A total of 47% of the participants indicated that they started smoking in May through August (chi2 = 91.42, df = 3). Post-hoc analyses indicated that significantly more youths than expected began smoking in May and June, whereas significantly fewer youths than expected began smoking in September and November. Unsupervised time out of school during the first months of summer vacation is a period of increased danger for smoking initiation. The significantly lower rates during September seem to be related to the beginning of school.     

Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomised controlled trial in Scotland

OBJECTIVE—To evaluate a training workshop for community pharmacy personnel to improve their counselling in smoking cessation based on the stage-of-change model.
DESIGN—A randomised controlled trial of community pharmacies and pharmacy customers.
SETTING—All 76 non-city community pharmacies registered in Grampian, Scotland, were invited to participate. Sixty-two pharmacies (82%) were recruited.
SUBJECTS—All the intervention pharmacy personnel were invited to attend the training; 40 pharmacists and 54 assistants attended. A total of 492 customers who smoked (224 intervention, 268 controls) were recruited during the 12-month recruitment period (overall recruitment rate 63%).
MAIN OUTCOME MEASURES—The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one, four, and nine months.
RESULTS—The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel, 85% (113) compared with 62% (99) of the controls (p<0.001). The former also rated their discussion more highly; 34% (45) of the intervention customers compared with 16% (25) of the controls rated it as "very useful" (p = 0.048). Assuming non-responders had lapsed, one-month point prevalence of abstinence was claimed by 30% of intervention customers and 24% of controls (p = 0.12); four months' continuous abstinence was claimed by 16% of intervention customers and 11% of controls (p = 0.094); and nine months' continuous abstinence was claimed by 12% of intervention customers and 7% of controls (p = 0.089). These trends in outcome were not affected by potential confounders (sex, age, socioeconomic status, nicotine dependence, and type of nicotine replacement product used) or adjustment for clustering.
CONCLUSIONS—The intervention was associated with increased and more highly rated counselling, and a trend toward higher smoking cessation rates, indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets.


Keywords: community pharmacy; health education; smoking cessation     

Dietary exposure estimates of 30 elements from the UK Total Diet Study

Dietary exposures of consumers to 30 elements (aluminium, antimony, arsenic, barium, bismuth, boron, cadmium, calcium, chromium, cobalt, copper, germanium, gold, iridium, iron, lead, lithium, manganese, mercury, molybdenum, nickel, palladium, platinum, rhodium, ruthenium, selenium, strontium, thallium, tin and zinc) estimated from the UK 1994 Total Diet Study are reported, and compared with those from previous UK Total Diet Studies and those from other countries. Dietary exposure estimates were generally low and, where comparisons are possible, similar to those from other countries and below the relevant Provisional Tolerable Weekly Intakes and Provisional Maximum Tolerable Daily Intakes. For most of those elements included in previous UK Total Diet Studies, dietary exposures have declined.