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      Measuring Indoor Air Quality and Engaging California Indian Stakeholders at the Win-River Resort and Casino: Collaborative Smoke-Free Policy Development

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          Abstract

          Most casinos owned by sovereign American Indian nations allow smoking, even in U.S. states such as California where state laws restrict workplace smoking. Collaborations between casinos and public health workers are needed to promote smoke-free policies that protect workers and patrons from secondhand tobacco smoke (SHS) exposure and risks. Over seven years, a coalition of public health professionals provided technical assistance to the Redding Rancheria tribe in Redding, California in establishing a smoke-free policy at the Win-River Resort and Casino. The coalition provided information to the casino general manager that included site-specific measurement of employee and visitor PM 2.5 personal exposure, area concentrations of airborne nicotine and PM 2.5, visitor urinary cotinine, and patron and staff opinions (surveys, focus groups, and a Town Hall meeting). The manager communicated results to tribal membership, including evidence of high SHS exposures and support for a smoke-free policy. Subsequently, in concert with hotel expansion, the Redding Rancheria Tribal Council voted to accept a 100% restriction of smoking inside the casino, whereupon PM 2.5 exposure in main smoking areas dropped by 98%. A 70% partial-smoke-free policy was instituted ~1 year later in the face of revenue loss. The success of the collaboration in promoting a smoke-free policy, and the key element of air quality feedback, which appeared to be a central driver, may provide a model for similar efforts.

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          Cardiovascular effects of secondhand smoke: nearly as large as smoking.

          Joaquin Barnoya, Stanton A. Glantz (2005)
          Secondhand smoke increases the risk of coronary heart disease by approximately 30%. This effect is larger than one would expect on the basis of the risks associated with active smoking and the relative doses of tobacco smoke delivered to smokers and nonsmokers. We conducted a literature review of the research describing the mechanistic effects of secondhand smoke on the cardiovascular system, emphasizing research published since 1995, and compared the effects of secondhand smoke with the effects of active smoking. Evidence is rapidly accumulating that the cardiovascular system--platelet and endothelial function, arterial stiffness, atherosclerosis, oxidative stress, inflammation, heart rate variability, energy metabolism, and increased infarct size--is exquisitely sensitive to the toxins in secondhand smoke. The effects of even brief (minutes to hours) passive smoking are often nearly as large (averaging 80% to 90%) as chronic active smoking. The effects of secondhand smoke are substantial and rapid, explaining the relatively large risks that have been reported in epidemiological studies.
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            Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure-response relationship.

            C. Pope, Richard Burnett, Daniel Krewski … (2009)
            Fine particulate matter exposure from both ambient air pollution and secondhand cigarette smoke has been associated with larger risks of cardiovascular mortality than would be expected on the basis of linear extrapolations of the relative risks from active smoking. This study directly assessed the shape of the exposure-response relationship between cardiovascular mortality and fine particulates from cigarette smoke and ambient air pollution. Prospective cohort data for >1 million adults were collected by the American Cancer Society as part of the Cancer Prevention Study II in 1982. Cox proportional hazards regression models that included variables for increments of cigarette smoking and variables to control for education, marital status, body mass, alcohol consumption, occupational exposures, and diet were used to describe the mortality experience of the cohort. Adjusted relative risks of mortality were plotted against estimated average daily dose of fine particulate matter from cigarette smoke along with comparison estimates for secondhand cigarette smoke and air pollution. There were substantially increased cardiovascular mortality risks at very low levels of active cigarette smoking and smaller but significant excess risks even at the much lower exposure levels associated with secondhand cigarette smoke and ambient air pollution. Relatively low levels of fine particulate exposure from either air pollution or secondhand cigarette smoke are sufficient to induce adverse biological responses increasing the risk of cardiovascular disease mortality. The exposure-response relationship between cardiovascular disease mortality and fine particulate matter is relatively steep at low levels of exposure and flattens out at higher exposures.
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              Biomarkers of environmental tobacco smoke exposure.

              N L Benowitz (1999)
              Biomarkers are desirable for quantitating human exposure to environmental tobacco smoke (ETS) and for predicting potential health risks for exposed individuals. A number of biomarkers of ETS have been proposed. At present cotinine, measured in blood, saliva, or urine, appears to be the most specific and the most sensitive biomarker. In nonsmokers with significant exposure to ETS, cotinine levels in the body are derived primarily from tobacco smoke, can be measured with extremely high sensitivity, and reflect exposure to a variety of types of cigarettes independent of machine-determined yield. Under conditions of sustained exposure to ETS (i.e., over hours or days), cotinine levels reflect exposure to other components of ETS. Supporting the validity of cotinine as a biomarker, cotinine levels have been positively correlated to the risks of some ETS-related health complications in children who are not cigarette smokers. Images Figure 1
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                Author and article information

                Contributors
                Icro Maremmani: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): Int J Environ Res Public Health
                Journal ID (iso-abbrev): Int J Environ Res Public Health
                Journal ID (publisher-id): ijerph
                Title: International Journal of Environmental Research and Public Health
                Publisher: MDPI
                ISSN (Print): 1661-7827
                ISSN (Electronic): 1660-4601
                Publication date (Electronic): 20 January 2016
                Publication date (Print): January 2016
                Volume: 13
                Issue: 1
                Electronic Location Identifier: 143
                Affiliations
                [1 ]Education, Training, and Research, Inc., Scotts Valley, CA 95066, USA; narinderd@ 123456etr.org (N.D.); seowling@ 123456etr.org (S.-L.O.)
                [2 ]Department of Civil and Environmental Engineering, Stanford University, Stanford, CA 94305, USA; viviana.ab@ 123456gmail.com (V.A.-B.); wott1@ 123456stanford.edu (W.R.O.); ruotingever@ 123456gmail.com (R.J.); kccheng@ 123456stanford.edu (K.-C.C.); hildemann@ 123456stanford.edu (L.M.H.)
                [3 ]Neil Klepeis and Associates, Environmental Health Research and Consulting, Aromas, CA 95004, USA
                [4 ]Win-River Resort & Casino, Redding Rancheria, Redding, CA 96001, USA; Gary.Hayward@ 123456win-river.com
                [5 ]Shasta County Public Health Tobacco Education Program, Shasta County Public Health, Redding, CA 96001, USA; nread@ 123456co.shasta.ca.us (N.R.); layton12@ 123456gmail.com (S.L.); smtaylor@ 123456co.shasta.ca.us (S.T.)
                [6 ]Repace Associates, Inc., Secondhand Smoke Consultants, Bowie, MD 20720, USA; repace1@ 123456verizon.net
                [7 ]Buchting Consulting, Oakland, CA 94612, USA; franciscobuchting@ 123456outlook.com
                [8 ]Prevention Research Center, Pacific Institute for Research and Evaluation (PIRE), Oakland, CA 94612, USA; jlee@ 123456PREV.org (J.P.L.); roland@ 123456PREV.org (R.S.M.)
                Author notes
                [* ]Correspondence: pubs1@ 123456klepeis.net
                Article
                Publisher ID: ijerph-13-00143
                DOI: 10.3390/ijerph13010143
                PMC ID: 4730534
                PubMed ID: 26805860
                SO-VID: 3aaaa2fb-d8a3-4f55-a404-35efb64b9773
                Copyright © © 2016 by the authors; licensee MDPI, Basel, Switzerland.
                License:

                This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 15 July 2015
                Date accepted : 13 January 2016
                Categories
                Subject: Article

                ScienceOpen disciplines: Public health
                Keywords: air quality monitoring,smoke-free gambling,native americans,american indians,hospitality business,worker protection policy,occupational exposure reduction,smoking,airborne nicotine,urinary cotinine,pm2.5,secondhand tobacco smoke
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: air quality monitoring, smoke-free gambling, native americans, american indians, hospitality business, worker protection policy, occupational exposure reduction, smoking, airborne nicotine, urinary cotinine, pm2.5, secondhand tobacco smoke

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