Smoke-free air policy: Changing what's in the air and in the body
Travers, Mark Jonathan
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Exposure to tobacco smoke pollution (TSP) is an entirely preventable cause of premature morbidity and mortality. Accurate measurement of TSP is challenging as there are many factors that can intervene to confound the relation between TSP levels, human exposure, and harm associated with TSP. This study presents the results of a series of studies designed to quantify the reliability and validity of the TSI Sidepak AM510 Personal Aerosol Monitor (Sidepak). This dissertation consists of four inter-related studies each intended to assess the reliability, criterion and predictive validity of the Sidepak as a measure of TSP. Study 1 uses a controlled laboratory setting to evaluate the reliability and criterion validity of the Sidepak. Studies 2, 3 and 4 examine the predictive validity of the Sidepak using cross-sectional and longitudinal designs in a range of different real world settings coupled with measures of smoker density and biomarkers of exposure to constituents of tobacco smoke. Findings show the Sidepak is both a reliable and a valid tool for measuring TSP. On the measure of criterion validity, the Sidepak yielded nearly identical TSP levels compared to several other alternative measurement methods. The Sidepak was found to be highly sensitive to TSP and reliable as it demonstrated precisions of less than 2%. As would be predicted, in U.S. hospitality venues with no observed smoking the Sidepak revealed PM 2.5 concentrations 91% (95% C.I.:89%-92%) lower compared to places with observed smoking. A nearly identical reduction in TSP levels is observed when comparing venues before and after implementation of smoke-free air laws. TSP levels measured using the Sidepak were also found to be associated with different biomarkers of smoke exposure as hypothesized. Mean urinary cotinine concentrations in 13 exposed individuals dropped 90% (p<0.001) after the law and mean urinary total NNAL, a tobacco-specific carcinogen metabolite, dropped 92% (p<0.001). TSP exposure, measured with the Sidepak, was correlated with subsequent urinary total cotinine and total NNAL change in exposed individuals (r=0.69, p<0.01 and r=0.41, p<0.01 respectively). In summary, the TSI Sidepak AM510 Personal Aerosol Monitor was found to be both a reliable and a valid tool for measuring TSP.
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