All Ireland Bar Study and
Dublin Bar Study
On the 29th March 2004 the Irish government
introduced a comprehensive
workplace smoking
ban to protect the health of workers. RIFTFS co-ordinated a number of studies to
evaluate the impact the ban had on levels of ETS, benzene and the respiratory
health of bar workers. In a sample of 42 bars staffing levels, customer
numbers and smoking rates were analyzed along with ETS and Benzene. In 12 Dublin bars ultrafine particles
levels were measured as well as PM2.5 particles. In a study of the respiratory
health of bar workers, 81 workers were tested pre and post ban.
The fieldwork for
these projects was completed in 2005 and preliminary reports of findings were
available. In 2006 further statistical analysis of research findings was done by
Ms Mary Dunne, RIFTFS statistician. In particular Ms Dunne explored the use of
Questionnaires, Environmental Markers and Bio-markers for monitoring ETS
exposure. Her review validated the questionnaires and instruments used in
monitoring ETS exposure in the above studies.
The findings from these studies were very positive and have now been published
in peer reviewed journals.
Re-testing of Bar Workers
The positive results of pulmonary function tests on bar workers showed some
surprising changes which challenge the expected effects of ETS on lung
mechanics. The studies were carried out from
6 to 12 months after the ban but the time course and duration and
magnitude of the changes are unknown. For this reason two years after the ban in
late 2006 work commenced on the re-testing of bar workers. This work continued
throughout 2007. 73 workers were invited for retesting.
Full pulmonary function studies and exhaled breath carbon monoxide (CO) is
being conducted along with respiratory symptom questionnaire.
Re- testing of the bar workers is now complete and in 2008 these data will be
analyzed. Results will be written up and will be published and
disseminated along with previous findings.
Study of ETS Exposure in Cars
Environmental tobacco smoke (ETS) is a major preventable contributor to acute
and chronic adverse health outcomes that affect children disproportionately.
A number of international studies have been conducted examining the levels of
ETS produced while volunteers have smoked in cars. Studies have also looked at
attitudes and behaviours to establishing smokefree cars and in the home.
RIFTFS have already conducted research to estimate the prevalence of ETS
exposure in cars. This was done through an examination of traffic
monitoring video footage, provided by Dublin City Council and by direct
observation.
It is planned to extend these surveys in 2008.
Study of Exempted Workplaces/Psychiatric
Hospitals and Prisons
Introduction
One of the main objectives of this research is to investigate Environmental
Tobacco Smoke (ETS) exposure levels in special hospitals (psychiatric) within
the Republic
of Ireland where there is
an exemption to the smoking ban.
The exposure measurements are used to quantify and address the following
questions:
-
How do exposure levels in
locations where a ban is in operation, compare to hospitals and other areas
which are exempted from the ban, and
-
How do these exposure levels
compare with pre and post ban levels in a selection of dwellings?
Methodology
In order to complete the objectives,
the following indoor air quality metrics were recorded and logged within each
hospital for a period of minimum 2-3 hours per ‘smoking area’.
-
The
measurement of airborne particles (both concentration and mass) inside
designated ‘smoking areas’ of these hospitals
-
The
measurement of carbon monoxide (CO) gas levels in each location.
-
The
measurement of nicotine in the air in each location using passive samplers.
In conjunction with these measurements, the following factors were qualitatively
assessed: (a) the number of subjects present within these ‘smoking areas’ and
the number of subjects smoking, (b) the structural characteristics of the
‘smoking area’, such as the presence of windows or any active ventilation
systems.
Study of Exempted Workplaces/Psychiatric
Hospitals and Prisons
One of the main objectives of this research is to investigate Environmental
Tobacco Smoke (ETS) exposure levels in special hospitals (psychiatric) within
the Republic
of Ireland where there is
an exemption to the smoking ban.
The exposure measurements are used to quantify and address the following
questions:
-
How do exposure levels in
locations where a ban is in operation, compare to hospitals and other areas
which are exempted from the ban, and
-
How do these exposure levels
compare with pre and post ban levels in a selection of dwellings?
Methodology
In order to complete the objectives,
the following indoor air quality metrics were recorded and logged within each
hospital for a period of minimum 2-3 hours per ‘smoking area’.
-
The
measurement of airborne particles (both concentration and mass) inside
designated ‘smoking areas’ of these hospitals
-
The
measurement of carbon monoxide (CO) gas levels in each location.
-
The
measurement of nicotine in the air in each location using passive samplers.
In conjunction with these measurements, the following factors were qualitatively
assessed: (a) the number of subjects present within these ‘smoking areas’ and
the number of subjects smoking, (b) the structural characteristics of the
‘smoking area’, such as the presence of windows or any active ventilation
systems.
ISAAC Study
ISAAC, the International Study of Asthma and Allergies in childhood, was formed
in 1991 to facilitate research into asthma, allergic rhinitis and eczema by
promoting a standardised methodology. ISAAC is a unique project which has
attracted worldwide interest and unprecedented large scale participation.
This study is a follow up on
the Irish arm of an international study carried out in 1995 – the International
Study of Asthma and Allergies in Childhood (ISAAC study).
Over 10 years on, the new
follow-up study for Ireland
is aiming to find out just how much things have changed since the original ISAAC
study. The smoking part of the study is focusing on the effects of both
cigarette smoking, and passive smoking. Parental smoking is a known cause of
asthma while smoking is a known trigger of asthma. Our previous ISAAC study
showed bronchitic symptoms in smoking children and non smoking children exposed
to smoking in the home. In this regard the survey is assessing
prevalence of smoking in 3000 schoolchildren but also secondhand smoke exposure
at home, in cars and smoking among siblings and friends. The relationship
between smoking and respiratory symptoms in general as well as asthma is being
assessed. The strength of this study is that this is the 3rd
time this survey has been performed and this will allow us to look at the
possible effect of the workplace ban.
This study is being
undertaken by RIFTFS in collaboration with the Asthma Society of Ireland.
Statistical Analysis of Existing Prevalence
Data
A paper has been prepared by Ms Mary Dunne, statistician, which presents studies
outlining the prevalence of smoking in
Ireland. All known studies since the
1970s are presented with the prominence given to studies undertaken in the last
15 years. Firstly, findings from a European/ International perspective are
outlined, highlighting how Ireland
performs in relation to other countries. Secondly, the results from a number of
other national prevalence studies are described and finally studies conducted at
local and regional level throughout the country are reviewed.
It is important to bear in
mind that these studies are not homogeneous; rather they vary in terms of
methodology, sample size, types of questions asked, geographical location as
well as the specific age-groups surveyed. It is therefore difficult to make
meaningful comparison between the studies. Nonetheless, it is useful to
examine the findings of each study in the light of what has been found in other
studies conducted nationally and across Europe.
This paper has been reviewed by the RIFTFS scientific sub committee and a number
of revisions have been recommended
Smoking and Health Inequalities
This paper prepared by Ms
Dunne, presents studies outlining the relationship between smoking and health
inequalities in Ireland. All known studies since
the 1970s are presented.
Evidence suggests that mortality from tobacco related causes is higher in Ireland
than in other EU countries. Standardised death rates from circulatory system
diseases were 21% higher in
Ireland
than the EU-15 average in 2001, while mortality rates from diseases of the
respiratory system were more than twice the EU-15 average. In 2001, mortality
rates in general were 16% higher in Ireland than the EU-15 average but since
diseases of the circulatory and respiratory systems accounted for approximately
half of all deaths in Ireland in 2001 (and about 44% in the EU-15 on average) it
is clear that tobacco related illness is a problem with particular relevance
here. For women standardized death rates from malignant neoplasms of
larynx and trachea/bronchus/lung were 58% higher in Ireland than the EU-15 average.
This paper has been reviewed by the RIFTFS scientific sub committee and they
suggested approaching IPHI which has a special interest in the topic
Professor Luke Clancy met with Dr.
Helen McEvoy of the IPHI and they agreed that RIFTFS and IPHI have developed a
collaborative project to further this important subject.
Economic Factors Effecting Smoking
Ms Dunne prepared a paper examining Consumer Price Index (CPI) and tax on
cigarettes
This paper gives a summary of the
-
rationale for
tobacco taxation
-
the situation
regarding receipts on tobacco products according to statistics issued by the
Revenue Commissioners
-
the Consumer
Price Index (CPI) and its use as a benchmark for inflation
-
the European
Legislation on excise duties for tobacco
This paper was reviewed by the RIFTFS scientific sub committee and it was agreed
that RIFTFS collaborate with ASH Ireland to convene a conference on this
subject where all the relevant partners could take part. This conference was
titled “Taxation health & Tobacco” and was held in Dublin in June 2007
A study of Environmental Tobacco Smoke
exposure within exempted premises -Nursing Homes as defined in the Pubic Health
Acts 2002&2004.
In 2006 RIFTFS submitted a research proposal titled “A study of Environmental
Tobacco Smoke exposure within exempted premises -Nursing Homes as defined in the
Pubic Health Acts 2002 & 2004” under the MRCG/HRB joint awards
scheme. The Principal Investigator for the project is Dr
Pat Goodman, Lecturer in the Physics
Department in DIT, Kevin Street,
Dublin. The application was successful and RIFTFS
received €15,089 from the HRB/MRCG scheme for Year 1 of
the project. Matching funding is being provided by RIFTFS.
Project Overview
When the highly successful workplace smoking ban came into force in 2004, there
were a number of areas which were exempted from the ban. One could argue
that staff working in such exempted areas as prisons, psychiatric hospitals and
nursing homes are being unfairly treated by continuing to be exposed to ETS
while going about their daily duties. This study will examine 40 Nursing Homes
in order to determine levels of exposure to Environmental Tobacco Smoke (E.T.S.)
for both staff and occupants. This will involve using equipment to measure
particulate levels in the smoking areas within the premises. Measurements
will also be conducted in other areas which are designated as no smoking areas.
These particulate exposure measurements will be determined by use of an Aerocet
531 monitor (or similar device), which will monitor continuously for two or more
hours in a room where the consumption of Tobacco products takes place. In
addition benzene concentrations will also be monitored using passive absorption
diffusion tubes. The number of people smoking, the dimensions of each
room, the presence and or use of ventilation systems will also be recorded,
together with any other sources of particulates such as cooking etc. A
questionnaire will also be used to further determine exposure of staff to E.T.S.
with regard to if they are smokers or non-smokers, and some other details.
There will be at least two visits to each venue as part of the exposure
assessment. A qualitative and quantitative questionnaire will be carried out on
the staff and will determine exposure outside of work and attitudes towards
tobacco consumption.
The effect of the Irish workplace smoking ban
on birth weight and gestational age at birth.
In 2006 RIFTFS submitted a research proposal titled “The effect of the Irish
workplace smoking ban on birth weight and gestational age at birth” under the
MRCG/HRB joint awards scheme. This is a collaborative project with RIFTFS and Dr
Sean Daly Consultant Obstetrician and Gynaecologist in the
Coombe
Hospital in
Dublin. The application was successful and RIFTFS
received €50,000 from the
HRB/MRCG scheme for this year long project.
Project Aim
This study aims to assess the effect of the smoking ban on birth weight,
gestational age at birth and preterm/ premature birth
Project Overview
Research shows that exposure to Environmental Tobacco Smoke (ETS) can have
harmful effects on the unborn infant. There are foetal effects to pregnant women
who do not smoke but who are exposed to ETS, for example an excess risk of
20-50% for low birth weight (LBW) at term. Infants with LBW, defined as
weighing less than 2,500 g at birth, have a higher risk of subsequent infant
morbidity, mortality, and longer-term childhood and adult adverse consequences.
There is evidence to link prenatal ETS exposure with low birth weight, preterm/
premature birth and intrauterine growth retardation (IUGR). A small decrement in
birth weight (e.g., 25 to 50 g) may not be clinically significant for an
otherwise healthy infant, but may put infants who are already compromised by
other health conditions or risk factors at even higher risk. All babies
born preterm are at risk for serious health problems as the earlier a child is
born, the less she will weigh, the less developed her organs will be, and the
more complications she is likely to face.
In addition, exposure may increase the risk of spontaneous abortion, sudden
infant death syndrome, and development of childhood cancers and cognition and
behavioural problems.
The proportion of babies of low birth weight (below 2,500 grams) increased from
close to 4 per cent of all births in
Ireland
in 1993 to almost 5 per cent in 2002. The rate of low birth weight among
unskilled manual groups was twice that of the professional groups in the early
1990s (see background section).
In March 2004 the workplace smoking ban was introduced in Ireland. This made it illegal to smoke
in almost all workplaces with a few exceptions which include prisons and nursing
homes. This study aims to assess the effect of the smoking ban on birth weight,
gestational age at birth and preterm/ premature birth.
Smoking Cessation Services in
Ireland
– An evaluation of services available and their effectiveness.
In 2006 RIFTFS submitted a research proposal titled “Smoking Cessation Services in
Ireland
– An evaluation of services available and their effectiveness”. This is s
two year project, the application was successful and RIFTFS received a €30,000
Partnership award from the
HRB scheme for Year one in 2006 and €30,000 for year two in 2007.
Project Aim
The aim of this research project is to assess the range, the availability and
the effectiveness of smoking cessation services throughout the country.
RIFTFS is undertaking this work in partnership with the Health Promoting
Hospital Network, the Institute
of Public Health and the
HSE.
Project Overview
Tobacco is the major preventable cause of death and chronic disability in Ireland today and a major cause of
health inequality. Tobacco related cardiovascular and respiratory diseases and
cancer cause approximately 6,500 deaths p.a. in Ireland. Evidence suggests that
mortality from tobacco related causes is higher in Ireland than in other EU countries
(Burke et al., 2004). A recent study found that, between 1985 and 2000,
Coronary Heart Disease (CHD) mortality rates in Ireland fell by 47% in those aged 25–84
and 25.6% of the observed decrease in mortality was attributed to declining
smoking prevalence (Bennett et al. 2006).
Smoking prevalence has been decreasing since the 1980’s with the current
national rate being 24% (OTC /TNS MRBI). Rates among women are increasing
whereas among young men they are decreasing (HBSC 2001/02). The 1998
European Community Household Panel Survey found that young Irish women (aged
16-24) had prevalence rates of 35% (2nd highest of the 11 countries)
for those with “low” educational attainment compared to 24% for those with
“high” educational attainment. The 2000 ECHP found that there have
actually been increases in smoking among lower income and social class groups.
Smoking among manual working class groups are twice those of professional and
managerial groups. The fact that many studies show that smoking is more
prevalent in the lower socio-economic groups suggests that tobacco control
policies should focus specifically on these groups.
Tobacco is highly addictive and the difficulties associated with quitting are
well documented.
In the government’s strategy document, “Towards a tobacco Free Society”, a key
strategic objective is to significantly increase the number of people who stop
smoking each year. A key method of achieving this target is the provision
of cessation programmes to assist smokers to quit. The Minister for Health and
Children launched the National Smoking Cessation campaign, ‘Every Cigarette is
Doing You Damage’ in November 2003. Smoking cessation services are
available throughout Ireland
and are provided in both community and hospital settings. Different types of
services exist and are provided by health care professionals and community
workers.
Smoking cessation interventions are effective and are extremely cost effective
(Tilson et al. 2004).
The aim of this research project is to assess the range, the availability and
the effectiveness of smoking cessation services throughout the country.
Smoking Prevalence in the
Gay and Lesbian Community.
It was decided to gather prevalence data on minority groups in Ireland to enable better targeting of
resources and services, one of the groups identified was the Irish Gay and
lesbian Community. In consultation with a statistician a mini
questionnaire was produced covering areas such as age at which smoking
commenced, amount smoked at present, desire to quit, number of quit attempts,
aids services or medications used to aid cessation attempts. The best
circulation method available to us was through the GCN Magazine which was
conducting a general survey of its readership both on line and in magazines
purchased. After consultation with GCN Magazine it was agreed that our questions
be included in their survey.
In 2007 the survey was completed and statistical analysis of the findings was
performed. Findings were presented at the ECToH Conference in
Basel in October 2007, which stated that in
Ireland
smoking in the Gay/Lesbian community is related to income age and S/E group as
is found in the general population. There is no evidence in this country
to suggest that smoking is significantly more common in this community when due
care is taken to match for these demographic data.
Development of a PhD studentship on the
Economics of Tobacco Control
The workplace smoking ban
introduced into Ireland
in March 2004 and has subsequently been shown to be an effective public health
policy measure. It is argued however to have a negative economic impact on
the hospitality industry and on the economy overall. To examine this issue
further RIFTFS undertook to fund a PhD studentship and in December 2006
Ms Laura Maran was appointed as a PhD student under the direction of Prof
Charles Normand, Professor of Health Policy and Management, Trinity College
Dublin. It is planned that RIFTFS will fund the studentship for a further year
to November 2008.
European
Network of Smoking Prevention/ Media Studies
Under the ENSP Framework Project Scheme 2004 – 2005, the Research Institute for
a Tobacco Free Society (RIFTFS) undertook a comprehensive health impact
assessment of the Workplace Tobacco Ban in
Ireland. As part of this project RIFTFS collaborated
with the School
of Communications in DCU
and a study of the media coverage of the Irish workplace smoking ban was
conducted with the aims of analyzing the themes and trends of the coverage
generally as well as evaluating the effectiveness of the pro-ban advocates’
communication campaign. The study provides potential lessons for public health
advocates seeking to engage in the policy process more effectively through the
news media. The findings can be used to increase awareness of the
strategies used by the hospitality and tobacco industries to counteract any
campaign for a workplace smoking ban.
The study was completed in 2007 and results of the study showed that the pro-ban
strategy to consistently and repeatedly frame the ban as a worker safety and
public health issue proved effective.
The anti-ban lobby almost entirely avoided health and scientific arguments. They
did succeed temporarily in diverting the focus of the ban away from health using
economic, political and legislative arguments. In addition the anti-ban lobby
used tactics similar to those used fighting other international bans.
Emphasis of negative economic impact, erosion of cultural or national identity
and freedom of choice were arguments frequently used against the ban.
fMRI Study to Examine Neurocognitive Processes in Nicotine
Dependence
The goal of this research is to investigate the role of
specific neurocognitive processes in nicotine dependence. The processes in
question are those involved in the control of behaviour and have been associated
with specific cortical loci including the anterior cingulate cortex and
dorsolateral prefrontal cortex. Using functional Magnetic Resonance
Imaging (fMRI), a non-invasive technique for visualising brain function in
vivo, we will investigate:
if neurocognitive deficits that have previously been
observed in abusers of drugs other than nicotine are present in nicotine
dependent individuals;
if the presence or magnitude of these deficits are
predictive of relapse for those nicotine dependent individual enrolled in
smoking cessation programmes.
This research is being carried out in partnership with Dr
Hugh Garavan, Director of Functional Imaging,
Institute of Neuroscience,
Trinity College Dublin and Professor Luke Clancy, Director General, RIFTFS
The Development of an agreed national
definition of a smoker and a telephone survey instrument capable of delivering a
national estimate of smoking prevalence by sex, age and socio-economic group.
Project Aim
To create an agreed definition of a smoker, and to develop a telephone survey
instrument capable of delivering a national estimate of smoking prevalence by
sex, age, socio-economic group and HSE Regional area.
Project Overview
Tobacco is the major preventable cause of death and chronic disability in Ireland today and a major cause of
health inequality. Tobacco related cardiovascular and respiratory diseases and
cancer cause approximately 6,500 deaths p.a. in Ireland. Evidence suggests that
mortality from tobacco related causes is higher in Ireland than in other EU countries
(Burke et al., 2004). A recent study found that, between 1985 and 2000,
Coronary Heart Disease (CHD) mortality rates in Ireland fell by 47% in those aged 25–84
and 25.6% of the observed decrease in mortality was attributed to declining
smoking prevalence (Bennett et al. 2006).
Smoking prevalence has been decreasing since the 1980’s at least, but the rate
is slowing since the mid-1990s, particularly among women. Rates among
young Irish women are higher than the international average (HBSC 2001/02; ESPAD
2003). The 2000 ECHP found that there have actually been increases in
smoking among lower income and social class groups. Smoking among manual working
class groups are twice those of professional and managerial groups.
Tracking changes in smoking prevalence over time provides important information
in aiding current primary prevention efforts and in predicting future adult
disease consequences. The EU Council Recommendation on prevention of smoking and
on initiatives to improve tobacco control, 2002, recommends that member states
continue developing strategies and measures to reduce the prevalence of smoking,
such as general programmes to overcome tobacco addiction. To evaluate and
monitor the effectiveness of these strategies (workplace smoking ban, taxation,
cessation strategies, labeling and packaging etc.) it is crucial that we can
accurately measure prevalence and disseminate the results nationally and
internationally.
The main national studies that have sampled the whole population (rather than
young people only) and have attempted to measure the prevalence of smoking in
Ireland (SLÁN, the OTC/ TNS mrbi survey, the Drug Use in Ireland and Northern
Ireland Drug Prevalence Survey and the ECPH (European Community Household Panel
Survey based on the Living in Ireland Panel Survey (LII)) have found differing
results for smoking prevalence. These studies used different methodologies
and samples and asked different questions to elicit information on smoking
prevalence.
We therefore propose to create an agreed definition of a smoker, and to develop
a telephone survey instrument capable of delivering a national estimate of
smoking prevalence by sex, age, socio-economic group and HSE Regional area.
Differences in prevalence and patterns of tobacco use in specific population
subgroups can be used to demonstrate the need for focused interventions.
Prevalence of Smoking in Immigrants – Polish
There are 250,000 eastern European Immigrants in
Ireland. Most of these are within the 18
to 35 age group. It is also known that the prevalence of smoking in
Ireland
within this age group has increased. Research relying on large population
surveys has largely ignored the hetrogenicity in tobacco use patterns that
exists within racial and ethnic groups especially by immigrant status. It
is therefore of great importance to identify the smoking prevalence within this
group of Immigrants. This will allow for better targeting of resources and
services
Construction Workers Health Trust CWHT-
Prevalence of smoking
In 2008 it is planned that RIFTFS will develop a new health questionnaire for
completion by construction workers. This will focus on smoking and the
smoking habits of construction workers. It is hoped that on completed of the
questionnaires RIFTFS will input the data and data analysis will be performed. A
project report will then be compiled with the aim of improving smoking cessation
services for construction workers.