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      Assessing the effect of Michigan's smoke-free law on air quality inside restaurants and casinos: a before-and-after observational study

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          Abstract

          Objectives

          To assess the effect of Michigan's smoke-free air (SFA) law on the air quality inside selected restaurants and casinos. The hypothesis of the study: if the SFA law is effectively implemented in restaurants and casinos, there will be a significant reduction in the particulate matter PM 2.5 measured in the same establishments after the law is implemented.

          Setting

          Prelaw and postlaw design study.

          Participants

          78 restaurants in 14 Michigan cities from six major regions of the state, and three Detroit casinos.

          Methods

          We monitored the real-time PM 2.5 in 78 restaurants and three Detroit casinos before the SFA law, and again monitored the same restaurants and casinos after implementation of the law, which was enacted on 1 May 2010.

          Primary and secondary outcome measures

          Concentration measurements of secondhand smoke (SHS) fine particles (PM 2.5) were compared in each restaurant in the prelaw period to measurements of PM 2.5 in the same restaurants during the postlaw period. A second comparison was made for PM 2.5 levels in three Detroit casinos prelaw and postlaw; these casinos were exempted from the SFA law.

          Results

          Prelaw data indicated that 85% of the restaurants had poor to hazardous air quality, with the average venue having ‘unhealthy’ air according to Michigan's Air Quality Index for PM 2.5. Postlaw, air quality in 93% of the restaurants improved to ‘good’. The differences were statistically significant (p<0.0001). By comparison, the three casinos measured had ‘unhealthy’ air both before and after the law.

          Conclusions

          The significant air quality improvement in the Michigan restaurants after implementation of the SFA law indicates that the law was very effective in reducing exposure to SHS. Since the Detroit casinos were exempted from the law, the air quality was unchanged, and remained unhealthy in both prelaw and postlaw periods.

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          Most cited references18

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          Health effects of fine particulate air pollution: lines that connect.

          Efforts to understand and mitigate thehealth effects of particulate matter (PM) air pollutionhave a rich and interesting history. This review focuseson six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There hasbeen substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidiity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonaryhealth. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.
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            Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure-response relationship.

            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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              Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004.

              (2008)
              Cigarette smoking and exposure to tobacco smoke are associated with premature death from chronic diseases, economic losses to society, and a substantial burden on the United States health-care system. Smoking is the primary causal factor for at least 30% of all cancer deaths, for nearly 80% of deaths from chronic obstructive pulmonary disease, and for early cardiovascular disease and deaths. In 2005, to assess the economic and public health burden from smoking, CDC published results of an analysis of smoking-attributable mortality (SAM), years of potential life lost (YPLL), and productivity losses in the United States from smoking during 1997-2001. The analysis was based on data from CDC's Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) system, which estimates SAM, YPLL, and productivity losses based on data from the National Health Interview Survey and death certificate data from the National Center for Health Statistics. This report presents an update of that analysis for 2000-2004, the most recent years for which source data are available. The updated analysis indicated that, during 2000-2004, cigarette smoking and exposure to tobacco smoke resulted in at least 443,000 premature deaths, approximately 5.1 million YPLL, and $96.8 billion in productivity losses annually in the United States. Comprehensive, national tobacco-control recommendations have been provided to the public health community with the goal of reducing smoking so substantially that it is no longer a significant public health problem in the United States.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2015
                16 July 2015
                : 5
                : 7
                : e007530
                Affiliations
                [1 ]The Michigan Department of Community Health, Division of Chronic Diseases, Lansing, Michigan, USA
                [2 ]Repace Associates, Inc , Bowie, Maryland, USA
                Author notes
                [Correspondence to ] Dr Farid Shamo; shamof@ 123456michigan.gov
                Article
                bmjopen-2014-007530
                10.1136/bmjopen-2014-007530
                4513515
                26185176
                7a02cf4b-0041-41df-b2a6-b2655ea50175
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 23 December 2014
                : 12 May 2015
                : 14 May 2015
                Categories
                Health Policy
                Research
                1506
                1703
                1694
                1724
                1734

                Medicine
                public health,smoking and tobacco
                Medicine
                public health, smoking and tobacco

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