Can air quality feedback be an effective tool to encourage parents and caregivers to “take smoking right outside”?

Second-hand tobacco smoke (SHS) is a serious cause of ill-health, particularly for children. Smoking indoors leads to high concentrations of SHS and behaviour change interventions have been developed to promote smoke-free homes for children’s benefit. Air-quality feedback – giving parents and caregivers personalised information on the effect of smoking on air pollution at home – has been used in several trials with positive results. A qualitative study was conducted comparing attitudes to SHS and outdoor air pollution. Focus group participants and internet commenters viewed outdoor pollution as a serious health risk, suggesting that comparing SHS to outdoor air pollution could be a promising avenue for increasing awareness about the risks from SHS and promoting behaviour change. An air-quality feedback intervention using a low-cost particle counter was developed and piloted, with lessons from this feasibility study used to develop an innovative intervention using mHealth techniques and remote monitoring for use in a larger trial in four centres around Europe. This study of 68 homes resulted in a statistically significant decline of 17% in measured SHS over the intervention period, but resulted in only eight participants making their homes fully smoke-free. An algorithm was developed to detect smoking in homes using low-cost particulate matter sensors. When tested with data from 144 homes in Scotland, 135 were correctly classified (113 smoking homes, 22 non-smoking homes). Similar predictive rates were achieved in a study of 16 homes in Israel demonstrating that it could be used in different environmental conditions. The algorithm did not enable detection of the periods when smoking occurred in homes. Air-quality feedback can play a role in changing smoking behaviour but may require careful targeting at those with the capability and opportunity to make the change. Future research could use these techniques more widely as part of an “endgame” approach to tobacco control

"How do you know those particles are from cigarettes?": An algorithm to help differentiate second-hand tobacco smoke from background sources of household fine particulate matter

Background Second-hand smoke (SHS) at home is a target for public health interventions, such as air quality feedback interventions using low-cost particle monitors. However, these monitors also detect fine particles generated from non-SHS sources. The Dylos DC1700 reports particle counts in the coarse and fine size ranges. As tobacco smoke produces far more fine particles than coarse ones, and tobacco is generally the greatest source of particulate pollution in a smoking home, the ratio of coarse to fine particles may provide a useful method to identify the presence of SHS in homes. Methods An algorithm was developed to differentiate smoking from smoke-free homes. Particle concentration data from 116 smoking homes and 25 non-smoking homes were used to test this algorithm. Results The algorithm correctly classified the smoking status of 135 of the 141 homes (96%), comparing favourably with a test of mean mass concentration. Conclusions Applying this algorithm to Dylos particle count measurements may help identify the presence of SHS in homes or other indoor environments. Future research should adapt it to detect individual smoking periods within a 24 h or longer measurement period

Monitoring secondhand tobacco smoke remotely in real-time: A simple low-cost approach

Introduction: Secondhand smoke (SHS) in the home is a serious cause of ill-health, especially for children. SHS indoors can be indirectly measured using particulate matter monitors, and interventions have been developed using feedback from these monitors to encourage smoke-free homes. These interventions often use data that are several days out of date, as the data must be downloaded manually from monitors. It would be advantageous to access this information remotely in real-time to provide faster feedback to intervention participants. Methods: Using off-the-shelf computer components and the Dylos DC1700 air quality monitor, a portable internet-connected monitor was developed that can send data to a server remotely. Four of these monitors were tested in homes in Israel to test the reliability of the connection. Data were downloaded from the monitor’s onboard memory and compared to the data sent to the server. Results: Eight homes were monitored for 4 to 6 days, with a combined total count of 44 days. Less than 1% of data was lost, with no outage lasting longer than 1 hour 45 minutes. There was no significant difference in the mean concentrations measured in homes between mobile-transmitted data and data downloaded directly. Conclusions: This system appears to be a reliable way to monitor remotely home air quality for use in intervention studies, and could potentially have applications in other related research. Laboratories that own Dylos DC1700s may wish to consider converting them to such a system to obtain a cost-effective way of overcoming limitations in the Dylos design

Using air quality monitoring to reduce second-hand smoke exposure in homes : the AFRESH feasibility study

ACKNOWLEDGEMENTS This research was supported by a grant from the Medical Research Council’s Public Health Intervention Development scheme. The research team would like to thank Christine Foster and the staff and volunteers of Healthy Valleys, Lanarkshire, for their support in carrying out this work, and Beverley Scheepers and Joanne Buchan of ASH Scotland for their assistance in developing training material. FUNDING Medical Research Council PHIND Grant MR/M026159/1.Peer reviewedPublisher PD

Changes in outdoor air pollution due to COVID-19 lockdowns differ by pollutant: evidence from Scotland

Objectives: To examine the impact of COVID-19 lockdown restrictions in March/April 2020 on concentrations of nitrogen dioxide (NO2) and ambient fine particulate matter (PM2.5) air pollution measured at roadside monitors across Scotland by comparing data with previous years. Methods: Publicly available data of PM2.5 concentrations from reference monitoring systems at sites across Scotland were extracted for the 31-day period immediately following the imposition of lockdown rules on 23 March 2020. Similar data for 2017, 2018 and 2019 were gathered for comparison. Mean period values were calculated from the hourly data and logged values compared using pairwise t-tests. Weather effects were corrected using meteorological normalisation. Results: NO2 concentrations were significantly lower in the 2020 lockdown period than in the previous 3 years (p < 0.001). However, despite UK motor vehicle journeys reducing by 65%, concentrations in 2020 were within 1 µg/m3 of those measured in 2017 (p=0.66) and 2018 (p < 0.001), suggesting that traffic-related emissions may not explain variability of PM2.5 in outdoor air in Scotland. Conclusions: The impact of reductions in motor vehicle journeys during COVID-19 lockdown restrictions may not have reduced ambient PM2.5 concentrations in some countries. There is also a need for work to better understand how movement restrictions may have impacted personal exposure to air pollutants generated within indoor environments

Second-hand smoke: when you work in others' homes, where do their rights end and yours begin?

First paragraph: Imagine someone walking into a cafe, sitting down at a table and lighting up a cigarette. In the UK – and other countries where smoking in indoor public places is banned – that would be almost unthinkable. In the 15 years since smoking bans came into effect across Britain, smoking inside has gone from a fact of life to an aberration, and the nation’s health is all the better for it.https://theconversation.com/second-hand-smoke-when-you-work-in-others-homes-where-do-their-rights-end-and-yours-begin-16289

Second-hand smoke: when you work in others' homes, where do their rights end and yours begin?

First paragraph: Imagine someone walking into a cafe, sitting down at a table and lighting up a cigarette. In the UK – and other countries where smoking in indoor public places is banned – that would be almost unthinkable. In the 15 years since smoking bans came into effect across Britain, smoking inside has gone from a fact of life to an aberration, and the nation’s health is all the better for it

The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons study

Objective To determine secondhand smoke (SHS) concentrations in prisons during the week of implementation of a new, national prisons smoke-free policy. Design Repeated measurement of SHS concentrations immediately before and after implementation of smoke-free policies across all 15 prisons in Scotland, and comparison with previously gathered baseline data from 2016. Methods Fine particulate matter (PM2.5) measurements at a fixed location over a continuous 6-day period were undertaken at the same site in each prison as previously carried out in 2016. Outdoor air quality data from the nearest local authority measurement station were acquired to determine the contribution of outdoor air pollution to indoor prison measurement of PM2.5. Results Air quality improved in all prisons comparing 2016 data with the first full working day postimplementation (overall median reduction −81%, IQR −76% to −91%). Postimplementation indoor PM2.5 concentrations were broadly comparable with outdoor concentrations suggesting minimal smoking activity during the period of measurement. Conclusions This is the first evaluation of changes in SHS concentrations across all prisons within a country that has introduced nationwide prohibition of smoking in prisons. All prisons demonstrated immediate substantial reductions in PM2.5 following policy implementation. A smoke-free prisons policy reduces the exposure of prison staff and prisoners to SHS

Occupational Exposure to Second-Hand Tobacco Smoke: Development of a Job Exposure Matrix

Exposure to second-hand tobacco smoke (SHS) in the workplace has been largely controlled in most workplaces in many countries that have adopted smoke-free laws and regulations. Workers in offices, bars, restaurants, and many other settings have experienced substantial reductions in the frequency and intensity of their exposure to SHS. While current exposure to SHS of most non-smoking adults arises from living with a smoker there are likely to be some jobs where non-negligible exposure to SHS continues to occur. This study describes the development of a simple job exposure matrix (JEM) for SHS exposure for the UK working population in 2020 and identifies that at least 1.04 million workers are likely to be exposed to SHS while performing their job. Occupations with the highest frequency and intensity of exposure include those where workers carry out work tasks in private, domestic settings: including care workers and home carers. This SHS-JEM provides a novel method for assessing occupational exposure to SHS in other countries, and can act as a tool to identify priorities for policies to protect those workers who continue to be at risk from SHS

Protecting children from second-hand tobacco smoke: evidence of major progress but a final push is needed in the UK

First paragraph: We welcome the findings of Tattan-Birch and Jarvis1 in demonstrating a 90% reduction in objective measures of exposure to second-hand tobacco smoke [SHS] among children in England between 1998 and 2018. Their important study uses Health Survey of England [HSE] data on salivary cotinine, as a marker of nicotine intake and SHS exposure, to show that geometric mean values of cotinine reduced from 0.50 to 0.05 ng/ml. Their results additionally show that by 2018 over 93% of children in England were classified as living in a smoke-free home environment. Policymakers in Scotland have achieved similar improvements with a 2014 world-leading target to reduce the proportion of children exposed to SHS at home to under 6% by 2020.2 The change in social norms relating to smoking around children has been significant and well documented3 over the past two decades and, coupled to reductions in adult smoking prevalence, now mean that the majority of children in England have no detectable cotinine in their saliva