In response to this directive the Legislative Reform Working Group (LARGE), of the National Public Health Partnership (NP) has developed a national response to passive smoking in enclosed public places and workplaces. This component of the overall national response to passive smoking is intended to provide a suite of resources that acclimates best practice legislation in this area. A second component of the overall national response will focus on the issue of children's exposure to TEST. This background paper forms part of the national response to TEST exposure in public places and workplaces. While the Commonwealth government has taken a leading role in this development, the enactment of legislation regarding passive smoking remains the responsibility of the States and Territories.
Information is therefore presented to assist Jurisdictions in the continuing development of their own responses to this issue, including: definition of passive smoking and composition f TEST; the health effects of TEST; exposure levels; the public health risk associated with TEST; public opinion on passive smoking; and current TEST management strategies. Composition AT E I TEST consists of two types of smoke, namely: smoke from the burning cigarette, or sidestroke smoke, which accounts for most of the tobacco smoke in a room of smokers; and smoke exhaled (exhaled mainstream smoke). Although the chemical composition of TEST differs from the smoke inhaled by active smokers, both contain a similar range of substances with known toxic and carcinogenic effects. Sidestroke smoke is produced t lower temperatures than mainstream smoke and contains higher levels of tobacco burned per milliard than mainstream smoke and more of a range of compounds, including a number of carcinogens.Health effects of environmental tobacco smoke A review of the research shows that TEST exposure can cause respiratory illness, asthma and can predispose to allergic assassination in children, contributes to the risk of sudden infant death syndrome, and significantly increases the risk of cardiovascular disease, stroke, lung cancer and respiratory disease in adults.
Maternal TEST exposure is associated with adverse pregnancy outcomes and an increased risk of central nervous system tumors in children. These effects are dose- related. A number of studies have shown that workplace exposure to TEST is comparable to home exposure, particularly when assessing the risk of lung cancer. Furthermore, the risk to health, for example the risk of lung cancer, may be seriously underestimated in studies where additional sources of TEST exposure were not assessed or accounted for.With this information, Jurisdictions will be able to continue to develop their own responses to the issue of passive smoking, by adapting the national response to local circumstances and systems as they see fit.
This approach would also facilitate jurisdictional action in a key strategy identified in the National Tobacco Strategy 1999 to 2002-03. It is noted, however, that by endorsing the national response, jurisdictions do not commit to implementing any of its recommendations. Exposure levels The proportion of total exposure to TEST that occurs in public places and at work differs between one population and another and with changing smoking patterns.In 1997, the NRC estimated that, in recent years, workplace exposure in Australia has been equivalent to, or greater than, home exposure. The harm from passive smoking upends on both the time spent in that environment and the concentration of TEST in the airspace. This is in turn affected by the size of the space, the number of cigarettes smoked there in a given time and the ventilation rate.
In certain occupational settings, these factors combine to create a substantial risk of harm from TEST. Levels of exposure are hard to measure precisely. Three types of measures have been used: biological markers; personal monitoring; and direct environmental monitoring.Current TEST management strategies Whilst there are a range of current TEST management strategies, including personal avoidance, individual company restrictions on workplace smoking, local incentive schemes and occupational health and safety considerations, these are inconsistent and ineffective in the widespread prevention of TEST exposure. Surveys have shown that businesses would prefer a legislative 'level playing field'. They indicate that legislation would be an effective and publicly well-supported way, of reducing the public health risk of TEST exposure.
This indicates that Jurisdictions might need to consider the role of legislation in fully addressing the issues of passive smoking. Workers in some industry sectors experience greater health risks due to levels of TEST exposure; for example, casino workers and hospitality industry workers have been identified as high-risk groups.Researchers in the United States have calculated that typical levels of airborne nicotine in public places range from 1 to 100 micrograms per cubic meter of air (peg/mm). Exposure to an average of 7. 5 peg/mm of nicotine for 40 years corresponds to a probability for passive-coincidences mortality of 1 per 1000 from lung cancer and 1 per 100 from heart disease.
This is considerably higher Han the United States Environmental Protection Agency (SEEPS)-recommended 'acceptable' risk level of 1 per 1,000,000 for environmental carcinogens and toxins in air, water and food. Public health risk Investigation of the potential health risk of TEST highlighted its seriousness because of the large numbers of people affected combined with the high individual risk to health from TEST exposure.Furthermore, there is no evidence of a safe exposure level and there are no national or international exposure standards. Public opinion Public opinion on passive smoking has been examined in some detail. Studies have consistently shown that more than 75% of Australians believe that passive smoking causes ill health.
The majority of Australians are aware of the health risks of passive smoking and supportive of measures to control TEST exposure in enclosed public places and workplaces. While there is an increasing trend for smokers workplace policies there are anomalies in the provision of non-smoking areas particularly in the hospitality industry.One reason for the restricted spread of smokers policies in the hospitality industry is that many hospitality industry proprietors are concerned about he loss of custom, which they believe would be associated with the provision of non- smoking areas. 1 Introduction 1.
1 Passive smoking: a national response The National Public Health Partnership (NP), which embodies a commitment by Commonwealth State and Territory governments to work together to address public health issues, includes in its memorandum of understanding the principles that: each community or population subgroup should have a number of key areas. The strategy highlights the need to reduce people's exposure to environmental tobacco smoke (TEST) as a key area for action and includes as a ajar objective the establishment of smokers environments as the norm'.The national response to TEST in enclosed public places and workplaces is in four parts: this background paper (National Response to Passive access to strategies, services and activities which optimism their health; each community or population subgroup should have access to a healthy and safe environment, including clean air and water, and adequate food and housing; and a supportive legal and political environment is integral to the public health effort. A national response to passive smoking was foreshadowed by the Minister for Health ND Aged Care DRP. Michael Walbridge when he announced, in response to the 1997 National Health and Medical Research Council's scientific information paper on passive smoking, that passive smoking was a major public health issue warranting a national response.
In response to the Minister's announcement and considering the principles of the NP memorandum of understanding, the Legislative Reform Working Group (LARGE) of the NP has developed a national response to passive smoking in enclosed public places and workplaces. This component of the national facilitates best practice legislation in this area. A second component of the national response will focus on the issue of children's exposure to environmental tobacco smoke. The development of the national response is consistent with the Commonwealth Government's response to the Report of the Senate Community Affairs Committee (SCADS 1997), in which the Commonwealth Government agreed to work with State and Territory governments to develop guidelines addressing passive smoking and to promote best practice legislation.The first component of the national response provides guidelines for Jurisdictions considering legislation to restrict TEST n enclosed public places and workplaces, or for Jurisdictions wishing to assess the scope and effectiveness of existing legislation. This component supports the National Tobacco Strategy 1999 to (CHAD 1999), which provides a framework for national action in smoking In Enclosed Puddle Places Ana workplaces: A Background Paper); statement of the guiding principles for developing legislation (Guiding Principles for Smoke-Free Public Places and Workplaces Legislation); examples of core provisions (Smoke-Free Public Places Legislation: Examples of Core Provisions); and Reference Material for Regulation Impact Analysis.
2 Aim of this background paper This background paper complements the other documents in the first component of the national response (TEST in enclosed public places and workplaces) by providing an analysis of the impact of passive smoking on public health. The approach addresses both governmental responsibilities for public TEST exposures and community education to support TEST protection. The context for this approach is presented by considering: definition of passive smoking and composition of TEST; the health effects of TEST; exposure levels; public health risk of TEST; public opinion on sieve smoking; and current TEST management strategies. Jurisdictional action in undertaking a key strategy for the National Tobacco Strategy 1999-2002-()3.It is noted, however, that by endorsing the national response, 1 'Governments have a responsibility to legislate to control exposure to tobacco smoke in public spaces' (WHO 1999). 1.
3 Why now? Scientific reports on the association between passive smoking and respiratory disease in children began to appear in the sass. Public awareness grew during the early sass as more studies were published, which linked TEST exposure and disease. A majority of Australians indicated that they supported restrictions on smoking in enclosed public places and workplaces. By the mid-sass, passive smoking was known to be a health risk for nonsmokers, causing respiratory disease and lung cancer.Major health and medical authorities called for people to be protected from TEST in enclosed public places and workplaces.
For example, both the United States Surgeon General (US Dept of Health and Human Services 1986) and the Australian National Health and Medical Research Council (NRC 1987) considered that legislation should be introduced restricting smoking in workplaces and enclosed public places. The first laws restricting smoking to protect nonsmokers' health were enacted in the early and mid-sass in the states of Arizona and Minnesota in the unlace states. Slice teen, ten under Ana strengthen AT sun laws nave Increased Australian Senate Community Affairs References Committee report (1995) recommended that smoking be prohibited in enclosed public places.This included office, factory, shop or other workmates, shopping centers, restaurants, theaters, hotels and sporting venues. Despite progress since the sass, there are anomalies in the provision of nonsmoking areas.
Concerns over loss of trade have restricted the spread of smokers policies in the hospitality industry. Smokers workplace policies have had a greater impact in large organizations, in the public sector and in white- collar workplaces than in other types of workplaces. Since the first NRC report (1987) on passive smoking and health, a body of evidence has emerged about the health effects of, and the meaner of reducing, TEST exposure.For example, the World Health Organization (WHO) highlights the 'real and substantial threat to child health' posed by TEST exposure and urges governments to take legislative action to help revert this (WHO 1999). This has also been a time of extensive public education and debate, with strengthening public support for smokers environments.
In 1994, the Commonwealth, State and Territory ministers for health agreed to target the year 2000 for enclosed public places to become smokers. They recommended that State and Territory governments introduce legislation to achieve this (CADDISH 1994). In 1997, DRP Michael Walbridge, the Minister for Health and Aged Care, announced that passive smoking was a major public health issue in need of a national response (Walbridge 1997).The National Tobacco Strategy (NUTS) endorsed y the Ministerial Council on Drug Strategy and released in June 1999 identified reducing exposure to TEST through establishing smoke free public places as the norm as a key strategy. 2 2 Passive Smoking and Environmental Tobacco Smoke 2. 1 What is passive smoking? This smoke is known as 'environmental tobacco smoke' (TEST).
2. 3 Environmental tobacco smoke as an indoor air pollutant Indoor air pollution is now considered to be the major source of exposure and risk for many airborne contaminants (Brown 1997, Miller et al 1998). TEST is recognized as a significant component of the toxic air contaminants that people are exposed to indoors. This has been highlighted by a number of national and international bodies.The United Kingdom Building Research Establishment 2.
2 What is environmental tobacco smoke? IS consists AT two types AT smoke: smoke Trot ten During cigarette (slipstream smoke) and smoke exhaled by active smokers (exhaled mainstream smoke). Sidestroke smoke accounts for most of the tobacco smoke found in a room in which people have been smoking. Although the chemical composition of TEST differs from the smoke inhaled by active smokers, both contain a similar range of substances with now toxic and carcinogenic effects (US Department of Health and Human Services 1986). Tobacco smoke contains over 4000 compounds of which approximately 60 are known or suspected carcinogens.Of these, at least 50 are present as particles of 0.
01-1. 0 micrograms in size (NRC 1997), and the remainder are in a gaseous or vapor phase (Hitachi et al 1997). As TEST 'ages' with time, constituents of the particle phase shift to the vapor phase (WHO in press). Sidestroke smoke is produced at lower temperatures than mainstream smoke and contains higher levels of tobacco urine per milliard, and also more of the following compounds (NRC 1997, Winsomely et al 1995). Inconvenience compounds: identified TEST as one of the most significant health risks in commercial buildings (after radon, which is not a significant public health problem in Australia) (Raw and Hamilton 1995).
The United States Environmental Protection Agency (SEEPS) found that TEST is the largest source of particulate indoor air pollution, and is the major combustion source for human exposure to mutagens and carcinogens (Elates 1990). The California Environmental Protection Agency con- eluded that TEST is an important source of exposure to toxic air contaminants indoors (California Environmental Protection Agency 1997). Australia's Environmental Health Strategy, Environ- mental Health in Australia: Towards a National Strategy (SCADS 1998), noted that most Australians spend about 90% of their time indoors, and are exposed to serious indoor pollutants including TEST.There is little scientific information about the effects of TEST exposure in confined outdoor settings, but exposed individuals, particularly those with asthma and other preexisting ailments and conditions, have reported detrimental effects on their health from such exposure. 2 2 The following explanation of the behavior of tobacco smoke in the outdoor environment has been provided by James Repack: 'If a smoke plume is significantly hotter than the surrounding air, the plume will rise; however, if the plume has a small cross-section, as for the smoke from a cigarette, it will rapidly cool and lose its upward momentum and then will tend to subside as the combustion gases are heavier than air. Thus, in the case of no wind, the cigarette plume will rise to a certain height and then descend.
Where there s wind, the amount of thermally induced plume rise is inversely proportional to the wind velocity - doubling the wind velocity will halve the plume rise. (Repack, Repack Associates Inc. , MD, USA, peers com 1997) ammonia carbon monoxide nicotine Carcinogenic compounds: benzene, Benz(a)anthracite and Benzedrine (polypropylene aromatic hydrocarbons) 2- nameplate, 2-naphthalene, 4-moneylenders (aromatic enamels) nickel polonium-210 N-maltreatment 3. 1 Adverse health effects There is consistent evidence that breathing TEST by nonsmokers can cause bronchitis, ammonia and other chest illnesses in children, and can increase the risk of cardiovascular disease, lung cancer and other lung diseases in adults (see Section 3. 2).The evidence for the harmful effect of TEST exposure in children is particularly strong and children are exposed to TEST in a range of indoor environments, including public places.
However, the present discussion focuses mainly on adult exposure in enclosed public places and workplaces.
