Smoke-Free Environments in Latin America
What is the issue?
Exposure to second hand smoke (SHS) is a significant but avoidable cause of premature death and disease worldwide. The WHO Framework Convention for Tobacco Control addresses this issue in Art. 8 and in the guidelines. However, some 93% of the world’s population live in countries where they are not fully covered by smoke-free public health regulations1.
The failure to protect people from SHS costs around 600,000 deaths worldwide annually. Almost 50% of these deaths occur in women2.
Research to Practice
Vapor-phase nicotine is a specific tracer for surveillance and quantification of exposure to secondhand smoke, and the measurement methods are particularly useful because they are relatively simple, accurate, and inexpensive. While concentrations do not directly translate to health risks, the finding of nicotine indicates the presence of a toxic mixture.
In Latin America, the Smoke-Free Americas Initiative by the Pan American Health Organization (PAHO/WHO) in 2001 focuses specifically on building capacity to achieve smoke-free environments. As part of this initiative, second hand smoke concentrations were assessed, using nicotine as an indicator. This survey involved a multicountry assessment of nicotine concentration in public places, using a common protocol. The public places selected in capital cities of each country included hospitals, schools, city government buildings, restaurants, bars, and airports.
Time weighted average concentration of secondhand smoke was estimated using a filter badge treated with sodium bisulfate. The sampling devices were left in each location over two weeks. Airborne nicotine was detected in most (94%) locations surveyed, including hospitals, airports, and restaurants; nonsmoking areas did not always effectively protect non-smokers from exposure to secondhand smoke3.
Similar research was performed after the initial one, covering a number of countries of the Region. Some countries repeated the monitoring of nicotine in public places after the enactment of smoke-free legislation, demonstrating the huge effect of 100% smoke-free environments in comparison with partial measures4 5.
The data from Latin America has immediate relevance for public health. The nicotine level monitoring data documents whether smoke is present in key locations. It has been used as a fundamental advocacy tool for promoting 100% smoke-free environments in many countries and has also helped to assess whether control measures appeared to be effective, and also to compare effective measures (100% smoke-free environments) with ineffective partial bans.
At the same time, new lines of research have revealed new aspects of this issue when countries began to document the impact of the smoke-free environments in the incidence of acute myocardial infarction (AMI). Many countries around the world have studied this effect, and now some countries in the region are producing their own results. For example, in Uruguay, where the air nicotine measurements showed a 90% decrease in comparison with the values before the legislation, has shown a 17% decrease of AMI since 2006 when the smoke free legislation was enacted6 7.
In time this new data will help to push for smoke-free environments in countries that have not yet passed such legislation.
This is an excellent example of how research provides feedback for policy development and policy evaluation that in turn promotes the need for more research.
1 WHO Report on the global tobacco epidemic, 2008. Implementing Smoke-free environments, 2009. available at: http://www.who.int/mediacentre/multimedia/podcasts/2009/tobacco_secondhand_smoke_20091211/en/index.html
2 Oberg, M; Jaakkola,M;Woodward A; Peruga A; Pruss-Ustun A. Worldwide burden of disease from exposure to second hand smoke: a retrospective analysis of data from 192 countries. Lancet DOI 10.1016/s0140-6736(10)61388-8. November 26, 2010.
3 Navas-Acien A, et al. Secondhand Tobacco Smoke in Public Places in Latin America, 2002-2003 JAMA. 2004;291:2741-2745
4 Blanco-Marquizo A et al. Reduction of second-hand tobacco smoke in public places following smoke-free legislation in Uruguay Tob Control 2010 19: 231-234
5 Erazo M et al. Secondhand tobacco smoke in bars and restaurants in Santiago, Chile: evaluation of partial smoking ban legislation in public places. Tobacco Control (2010). doi:10.1136/tc.2009.035402
6 Blanco-Marquizo A et al. Reduction of second-hand tobacco smoke in public places following smoke-free legislation in Uruguay Tob Control 2010 19: 231-234
7 Sandoya E et al. Unpublished yet.