The Model State Indoor Air Quality Act.

This Viewpoint discusses how poor indoor air quality can affect health and examines the Model State Indoor Air Quality Act, which provides science-based regulatory standards aimed at ensuring public indoor environments provide healthy air.

Tobacco control policies and smoking cessation treatment utilization: A moderated mediation analysis.

BACKGROUND: Tobacco policies, including clean indoor air laws and cigarette taxes, increase smoking cessation in part by stimulating the use of cessation treatments. We explored whether the associations between tobacco policies and treatment use varies across sociodemographic groups. METHODS: We used data from 62,165 U.S. adult participants in the 2003 and 2010/11 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who reported smoking cigarettes during the past-year. We built on prior structural equation models used to quantify the degree to which smoking cessation treatment use (prescription medications, nicotine replacement therapy, counseling/support groups, quitlines, and internet resources) mediated the association between clean indoor air laws, cigarette excise taxes, and recent smoking cessation. In the current study, we added selected moderators to each model to investigate whether associations between tobacco polices and smoking cessation treatment use varied by sex, race/ethnicity, education, income, and health insurance status. RESULTS: Associations between clean indoor air laws and the use of prescription medication and nicotine replacement therapies varied significantly between racial/ethnic, age, and education groups in 2003. However, none of these moderation effects remained significant in 2010/11. Higher cigarette excise taxes in 2010/2011 were associated with higher odds of using counseling among older adults and higher odds of using prescription medications among younger adults. No other moderator reached statistical significance. Smoking cessation treatments did not mediate the effect of taxes on smoking cessation in 2003 and were not included in these analyses. CONCLUSIONS: Sociodemographic differences in associations between clean indoor air laws and smoking cessation treatment use have decreased from 2003 to 2010/11. In most cases, policies appear to stimulate smoking cessation treatment use similarly across varied sociodemographic groups.

Effectiveness of Indiana's Statewide Smoke-Free Indoor Air Law in Reducing Prevalence of Adult Cigarette Smoking.

Indiana recently implemented a statewide smoke-free indoor air law that has prohibited smoking in both restaurants and non-hospitality workplaces. Evidence for the effectiveness of the recent statewide smoke-free indoor law may persuade 14 states that do not have any statewide smoke-free laws to enact such laws. We evaluated the effectiveness of Indiana's State Smoke-Free Air Law, implemented July 2012, in reducing adult smoking prevalence. We analyzed samples of U.S. adults using a nonequivalent control group design with multi-year, cross-sectional data from the 2011-2016 Behavioral Risk Factor Surveillance System ( N= 2,259,014). Four state groups with different levels of comprehensiveness in regard to statewide smoke-free indoor air laws in 2011-2016 served as the comparison groups, namely those with: (1) no law; (2) a partial law (prohibiting smoking in either one or two of these three settings, namely non-hospitality workplaces, restaurants, and bars); (3) a comprehensive law (prohibiting smoking in all non-hospitality workplaces, restaurants, and bars); and (4) those that changed from a partial to a comprehensive law. We used a difference-in-differences approach with multiple logistic regressions to assess the net effect of the policy with a secular trend removed. The decline rate of cigarette smoking in Indiana was steeper, from 21.2% in 2011-2012 to 17.8% in 2013-2016, than in states in our four comparison groups, which suggests a significant reduction in adult cigarette smoking prevalence above and beyond the downward secular trend observed. All the comparison groups showed higher odds of cigarette smoking than Indiana (adjusted odds ratios range from 1.08 to 1.16). Although a long-term effect of Indiana's State Smoke-Free Air Law has yet to be evaluated, current data indicate that such a policy appears to be effective in reducing smoking prevalence. The implementation of statewide smoke-free indoor air laws in all restaurants and non-hospitality workplaces may help reduce smoking rates in the 14 states that still do not have any statewide smoke-free indoor air laws.

Disseminating a Smoke-free Homes Program to Low Socioeconomic Status Households in the United States Through 2-1-1: Results of a National Impact Evaluation.

INTRODUCTION: Given homes are now a primary source of secondhand smoke (SHS) exposure in the United States, research-tested interventions that promote smoke-free homes should be evaluated in real-world settings to build the evidence base for dissemination. This study describes outcome evaluation results from a dissemination and implementation study of a research-tested program to increase smoke-free home rules through US 2-1-1 helplines. METHODS: Five 2-1-1 organizations, chosen through a competitive application process, were awarded grants of up to $70 000. 2-1-1 staff recruited participants, delivered the intervention, and evaluated the program. 2-1-1 clients who were recruited into the program allowed smoking in the home, lived in households with both a smoker and a nonsmoker or child, spoke English, and were at least 18 years old. Self-reported outcomes were assessed using a pre-post design, with follow-up at 2 months post baseline. RESULTS: A total of 2345 households (335-605 per 2-1-1 center) were enrolled by 2-1-1 staff. Most participants were female (82%) and smokers (76%), and half were African American (54%). Overall, 40.1% (n = 940) reported creating a full household smoking ban. Among the nonsmoking adults reached at follow-up (n = 389), days of SHS exposure in the past week decreased from 4.9 (SD = 2.52) to 1.2 (SD = 2.20). Among the 1148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p < .0001), with no differences by gender. CONCLUSIONS: Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies. IMPLICATIONS: Dissemination of this brief research-tested intervention via a national grants program with support from university staff to five 2-1-1 centers increased home smoking bans, decreased SHS exposure, and increased cessation rates. Although the program delivery capacity demonstrated by these competitively selected 2-1-1s may not generalize to the broader 2-1-1 network in the United States, or social service agencies outside of the United States, partnering with 2-1-1s may be a promising avenue for large-scale dissemination of this smoke-free homes program and other public health programs to low socioeconomic status populations in the United States.

Associations between public e-cigarette use and tobacco-related social norms among youth.

IMPORTANCE: E-cigarette use in public places may renormalise tobacco use. OBJECTIVE: To measure associations between e-cigarette use in public places and social norms among youth. DESIGN: Cross-sectional survey. SETTING: School-based. PARTICIPANTS: 24 353 never tobacco users in US 6th-12th grades who completed the 2016-2017 National Youth Tobacco Surveys. EXPOSURE: Individuals were classified as exposed in public places within the past 30 days to: (1) neither e-cigarette secondhand aerosol (SHA) nor combustible tobacco secondhand smoke (SHS); (2) SHA only; (3) SHS only; and (4) both SHA and SHS. OUTCOMES: Outcomes were overestimation of peer e-cigarette use (a measure of descriptive norms), harm perception and susceptibility. Data were analysed using descriptive statistics and logistic regression (p<0.05). RESULTS: Overall prevalence of SHS and SHA exposure in public places was 46.6% and 18.3%, respectively. SHA exposure in public places was associated with increased odds of overestimating peer e-cigarette use (adjusted OR (AOR): 1.83; 95% CI 1.29 to 2.58) and decreased odds of perceiving e-cigarettes as harmful (AOR: 0.63; 95% CI 0.51 to 0.79), compared with those exposed to neither emission. SHA exposure in public places was also associated with increased susceptibility to using e-cigarettes (AOR: 2.26; 95% CI 1.82 to 2.81) and cigarettes (AOR: 1.51; 95% CI 1.20 to 1.90). E-cigarette harm perception was lower among students in jurisdictions with no comprehensive clean indoor air laws (AOR: 0.79; 95% CI 0.71 to 0.88) or cigarette-only laws (AOR: 0.88; 95% CI 0.78 to 0.99) than in those prohibiting both cigarette and e-cigarette use in public places. CONCLUSIONS: Prohibiting both e-cigarette and cigarette use in public places could benefit public health.

Evaluation of the Effectiveness of Comprehensive Smoke-Free Legislation in Indoor Public Places in Shanghai, China.

This study evaluated compliance with the comprehensive smoke-free law in public indoor places introduced in Shanghai in March 2017. Observations and PM2.5 monitoring over 30 min intervals in 8 types of the venue were conducted three times: within a month before implementation and 3- and 12-months post implementation. Observations of evidence of smoking decreased from 66.2% before legislation to 52.8% three months after (p = 0.002) and 49.7% one year after (p < 0.001). The density of lit cigarettes also reduced significantly after implementation (p < 0.001). When adjusting for outdoor, indoor PM2.5 levels were significantly lower after the legislation, but only by a small amount (three months later: -0.27, p = 0.08; one year later: -0.12; p = 0.03). Evidence of compliance was weakest in farmer's markets and bars, and smoking in male toilets did not change significantly. The reduction in smoking was affected by the management performance of their obligations. The comprehensive smoke-free law led to modest reductions in smoking and PM2.5 levels as a result, but from levels suggesting quite high levels of pre-compliance. However, compliance was limited in some areas, suggesting more effort is required on management to gain better compliance in some places like farmer's markets, bars, and toilets.

Inclusion of electronic nicotine delivery systems in indoor smoke-free air policies and associated vaping behavior.

INTRODUCTION: Despite an ongoing debate over regulations of use of electronic nicotine delivery systems (ENDS) in public places, fourteen U.S. states or territories banned use of ENDS in indoor areas such as workplaces, restaurants, or bars (aerosol-free policies), as of March 31 ,2018. However, there is a paucity of studies on state-level aerosol-free policies. This study aimed to investigate the relationship between statewide aerosol-free policies and U.S. adults' ENDS use. METHODS: We analyzed data from the 2016 Behavioral Risk Factor Surveillance System, a nationally representative sample of U.S. adults (N = 240,849, ages 18-59 years), using multilevel logistic regressions, taking into account clustering of individuals within a state. We conducted stratified analyses by age groups to examine if the association between aerosol-free policy and ENDS use would be different between different age groups of adults. RESULTS: Adults living in the states with an aerosol-free policy were less likely to use ENDS compared with those living in the states without an aerosol-free policy, controlling for individual- and state-level covariates (adjusted odds ratio = 0.79, 95% confidence interval = 0.64, 0.97). Stratified analyses showed that the association varied by age group; the statewide aerosol-free policies was associated with lower odds of ENDS use only in adults aged 25-59 but not young adults (aged 18-24). CONCLUSIONS: The results supported enforcement of prohibiting ENDS as well as traditional tobacco product indoor areas as a means of ENDS use prevention. Our findings also confirmed that young adults should be a priority target population for ENDS use prevention policies and programming efforts.

Smoke-free prisons in England: indoor air quality before and after implementation of a comprehensive smoke-free policy.

OBJECTIVES: High levels of particulate pollution due to secondhand smoke (SHS) have previously been recorded in English prisons. As part of an evaluation to ascertain whether a new comprehensive smoke-free policy introduced in the first four prisons in England was successfully implemented, this study compares indoor air quality on prison wing landing locations three months before and three months after going smoke-free. DESIGN: An indoor air quality monitoring study, comparing SHS levels before and after a comprehensive smoke-free prison policy. SETTING: The first four prisons in England to implement a comprehensive smoke-free policy. PRIMARY AND SECONDARY MEASURES: We compared concentrations of airborne particulate matter <2.5 microns in diameter (PM2.5), as a marker for SHS, on wing landing locations three months before and three months after the smoke-free policy was implemented. Static battery operated aerosol monitors were used to sample concentrations of PM2.5 on wing landings. RESULTS: After discarding data from monitors that had been tampered with we were able to analyse paired data across four prisons from 74 locations, across 29 wing landing locations, for an average sampling time of five hours and eight minutes. When comparing samples taken three months before with the paired samples taken three months after policy implementation (paired for prison, day of the week, time of day, wing location and position of monitor), there was a 66% reduction in mean PM2.5 concentrations across the four prisons sampled, from 39 to 13 µg/m³ (difference 26 µg/m³, 95% CI 25 to 26 µg/m³). CONCLUSION: Prison smoke-free policies achieve significant improvements in indoor air quality. A national smoke-free policy would therefore be an effective means of protecting prisoners and staff from harm due to SHS exposure in the prison environment.

Clean indoor air laws, cigarette excise taxes, and smoking: Results from the current population survey-tobacco use supplement, 2003-2011.

There was an increase in the number and coverage of state and local clean indoor air laws in the US during the past fifteen years. These laws coincided with increases in federal, state, and local cigarette excise taxes. In light of these changes, the objective of this study was to examine the association between clean indoor air laws, cigarette excise taxes and smoking patterns between 2003 and 2011. Using data on 62,165 adult participants in the 2003 and 2010/2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we examined the association of state and county workplace, bar, and restaurant clean indoor air laws and cigarette excise taxes with quitting and current every-day smoking. Between 2003 and 2011, quitting increased and daily smoking among those who continued to smoke decreased significantly. Participants living in states and counties with higher excise taxes and more comprehensive clean indoor air laws had a higher likelihood of quitting and lower likelihood of everyday smoking. Based on the assumption of no uncontrolled confounding, changes in taxes and laws accounted for 64.8% of the increase in smoking cessation and all of the reduction in everyday smoking. Implementation of state and county-level clean indoor air laws and cigarette taxes appears to have achieved the intended goal of encouraging smokers to either quit or reduce their frequency of smoking.

The German approach to regulate indoor air contaminants.

Indoor air quality (IAQ) and exposure to indoor chemicals are widely discussed in terms of personal discomfort and health risks. In contrast to ambient air and working environments, legally binding regulations are only partially established for indoor contaminants, and other available European guidelines are limited. To correct these deficits, the German Committee on Indoor Guide Values (AIR), formerly known as the Ad hoc Working Group (Ad hoc AG), performed health assessments of indoor air contaminants. The main tasks were to develop toxicologically based indoor air guide values, health-based guideline values, and reference values largely based on the 95th percentile of the concentrations found in a reference population. Here, we provide a comprehensive overview of the indoor air values set in Germany and discuss the basis of their derivation. This overview includes a description of legally binding standards, indoor air guide values for 38 substances or groups, and guidelines for TVOC (total volatile organic compounds), particulate matter, and carbon dioxide as well as risk-related guidelines for carcinogenic substances.

Impact of Public Smoking Bans on Social Inequalities in Children's Exposure to Tobacco Smoke at Home: An Equity-Focused Systematic Review.

INTRODUCTION: A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children's secondhand smoke (SHS) exposure at home. METHODS: Five databases were electronically searched for articles on children's SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children's SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot. RESULTS: Eight studies gave results on the impact of public smoking bans on social inequalities in children's SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure. CONCLUSIONS: First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children's SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation. IMPLICATIONS: There are substantial social inequalities in children's SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children's SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children's SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children's SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.

A practical approach to limit the radiation dose from building materials applied in dwellings, in compliance with the Euratom Basic Safety Standards.

Individuals receive a significant part of their radiation exposure indoors. We anticipate that this exposure is likely to increase in the near future, due to a growing use in the building industry of recycled materials and materials previously regarded as waste. Such materials often contain elevated levels of natural radionuclides. Directive 2013/59/Euratom ('Basic Safety Standards', BSS) pays comprehensive attention to indoor exposure from natural radionuclides, but proper implementation of all corresponding BSS regulations is not straightforward, especially when regarding the regulation of building materials containing so-called Annex XIII materials. In this paper, we discuss the most relevant deficiencies in the BSS and present a practical approach to cope with these. Our most important observation is that adequate methods for assessing the annual dose due to gamma radiation from building materials are not provided by the BSS. This is in particular difficult because compliance of single building materials has to be tested, but the corresponding BSS reference level refers to gamma radiation emitted by all building materials present in a room. Based on a simple model of three layers of building materials, we present a set of operational conditions for building materials, either used for construction purposes ('bulk layers') or for the finishing of walls, floors and ceilings ('superficial layers'). Any customary combination of building materials meeting these conditions will stay below the BSS reference level for gamma radiation. This statement holds for the middle of a reference room, but is not always the case close to the walls, especially when low density materials with a relatively high content of natural radionuclides are present at the inner side of the room. This can be avoided by applying more strict conditions for those kind of materials than presented in this paper. We further focus on the indoor exposure to thoron progeny. Building materials that pass the test for gamma radiation can still be a significant source for indoor air concentrations of thoron progeny. When the average annual thoron inhalation dose were to be restricted to 1 mSv a-1 - a level comparable to the BSS reference level for gamma radiation - the activity concentration of Ra-224 in (especially porous) building materials used for wall finishing purposes should be limited to a value of typically 50 Bq kg-1. Even if our suggested approach of the BSS regulations is fully implemented, it still allows for a significant increase in the average radiation exposure in dwellings due to external radiation and thoron progeny. However, the situation will be worse if a less strict interpretation of the BSS regulations will be applied.

Radon in Schools: A Brief Review of State Laws and Regulations in the United States.

Exposure to Radon, a colorless, naturally occurring radioactive gas, is one of leading causes of lung cancer, and may pose a significant long-term risk for school age children. We examined the regulations and statutes in each US state related to radon in schools to delineate key features of policies and discrepancies among states that may have public health implications. Search terms such as "radon", "school", "mitigation", "certification", "licensing", and "radon resistant new construction" were used to scan current statutes from each state legislature's website and regulations from official state government websites for relevant regulatory and statutory requirements concerning radon in schools. State regulations related to the testing, mitigation, and public dissemination of radon levels in schools are inconsistent and the lack of nationwide indoor radon policy for schools may result in unacceptably high radon exposure levels in some US schools. We highlight the features and discrepancies of state laws and regulations concerning radon in schools, and offer several constructive means to reduce risks associated with radon exposure in school children.

Translating research to policy at the NCSE 2017 symposium "Microbiology of the Built Environment: Implications for Health and Design".

Here, we summarize a symposium entitled "Microbiology of the Built Environment: Implications for Health and Design" that was presented at the National Council for Science and the Environment (NCSE) 17th National Conference and Global Forum in January 2017. We covered topics including indoor microbial exposures and childhood asthma, the influence of hospital design on neonatal development, the role of the microbiome in our premise (i.e., building) plumbing systems, antibiotic resistance, and quantitative microbial risk assessment. This symposium engaged the broader scientific and policy communities in a discussion to increase awareness of this critical research area and translate findings to practice.

The emission of BTEX compounds during movement of passenger car in accordance with the NEDC.

The results of the research in the field of benzene, toluene, ethylbenzene and xylene isomers (BTEX) concentrations in exhaust gases of spark ignition engines under different operating conditions are presented in this paper. The aim of this paper is to gain a clearer insight into the impact of different engine working parameters on the concentrations of BTEX. The experimental investigation has been performed on the SCHENCK 230 W test stand with the controlled IC engine. The engine operating points have been chosen based on the results of a simulation and they are considered as the typical driving conditions according to the New European Driving Cycle. Concentration levels of BTEX compounds in exhaust gas mixtures have been determined by gas chromatography technique by using the combination of Supelcowax 10-Polyethylene glycol column and the PID detector. Based on the experimental research results, the emission model of BTEX compounds has been defined by the simulation of movement of a Fiat Punto Classic passenger car in accordance with the NEDC cycle. Using the results obtained within the simulation, the official statistics on the number of gasoline-powered cars on the territory of the Republic of Serbia and the European Commission data on the annual distance traveled by car, the amounts of BTEX compounds emitted annually per car have been estimated, as well as the emissions of the entire Serbian car fleet.