Health Implications of ETS Exposure:
Based upon the chemical constituents found in SHS, the health implications of exposure to this indoor air pollutant are therefore highly significant. It is estimated that each year between 35,000 and 62,000 U.S. deaths occur from cardiovascular disease due to ETS exposure (1) The American Heart Association has identified SHS as a major preventable cause of cardiovascular disease and death. SHS is also estimated to cause approximately 3,000 lung cancer deaths each year in the U.S. and has been implicated in a number of other cancers including cervical, nasal sinus, bladder and most recently breast cancer (1, 5, 6). SHS exposure has also been implicated in causing between 8,000 and 26,000 new cases of asthma and exacerbating between 400,000 and 1,000,000 cases of asthma each year. In 2004 the Centers for Disease Control (CDC) issued a health advisory on SHS exposure which included the statement “Avoid all places that allow smoking.

Exposure to SHS:
Despite the obvious health implications from SHS exposure, many states have not as yet passed smoke-free workplace legislation. As of July 2007, only 15 states have smoke-free workplace laws which include both restaurants and bars (7). These states include Arizona, Colorado, California, Connecticut, Delaware, Hawaii, Maine, Massachusetts, New Jersey, New Mexico, New York, Ohio, Rhode Island, Vermont and Washington. Seven other states including; Illinois, Maryland, Minnesota, Montana, New Hampshire Oregon and Utah have laws in place which will take effect over the next two years which will include both restaurants and bars (7). Florida, Idaho, Louisiana and Nevada have smoke-free laws that include restaurants but not bars. Many states with casino and other gambling institutions such as Montana, Illinois, Louisiana and Nevada, however, exempted these workplaces from their smoking bans. In New Jersey, where the smoking ban currently includes casinos, there is tremendous pressure to change the law in order to exempt the casinos. These exemptions came about due to intense political lobbying and pressure by the gaming institutions and the tobacco industry on these state governments. They claimed catastrophic economic disaster for these companies should smoking bans be placed on them with subsequent loss of taxable revenue impacting the states economy. They also presented ventilation as an alternative solution to smoke-free laws (8). Subsequently exemptions were granted which allowed for a large group of workers to remain exposed to very high levels of SHS even in these states with strong smoke-free workplace laws. This also results in a large number of patrons being exposed. Consequently, a large number of Americans remain exposed to SHS in the workplace despite an increasing number of anti-smoking legislation being passed.

SHS and Air Ventilation Systems:
Those opposed to smoking bans point to ventilation systems as the answer to reducing the harmful effects of exposure to SHS. The May 15th 2006 issue of the Reno Gazette Journal Newspaper reported on a study by this group that showed a dose-dependent relationship between SHS exposure and DNA damage (9). They also reported that these workers were exposed to very high levels of SHS. In this article the president of the American Gaming Association was quoted as saying “Casinos put a lot of money into air conditioning and ventilation systems to try to accommodate smokers and nonsmokers. Any new major hotel-casino in Nevada is going to have the utmost cutting-edge technology designed to drag that smoke out of there so our employees and nonsmoking customers are not affected.” (10). This statement is representative of the public relations these industries and their associations put out for public consumption in order to justify their opposition to smoking bans. The American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE) however released in June of 2005 a position document on SHS stating that “At present, the only means to effectively eliminate health risk associated with indoor exposure is to ban smoking activity (11).

Although complete separation and isolation of smoking rooms can control SHS exposure in non-smoking spaces in the same building, adverse health effects for the occupants of the smoking room cannot be controlled by ventilation. No other engineering approaches, including current and advanced dilution ventilation or air cleaning technologies have been demonstrated or should be relied upon to control health risks from SHS exposure in spaces where smoking occurs…” Surgeon General Richard Carmona released a report in June 2006 stating that “There is no risk-free level of exposure to secondhand smoke”… and “The only way to protect nonsmokers from secondhand smoke is to require smoke-free workplaces and public places. Other approaches such as air ventilation systems and smoking and non-smoking sections do not eliminate exposure to secondhand smoke.” (12). A recently published study from Finland looked at the impact of new smoking restrictions in Finnish restaurants and bars (13). The act restricted smoking in bars and restaurants. Exemptions were made to allow smoking in parts of the bars and restaurants as long as the non-smoking areas remained smoke-free. The study assessed the nicotine levels in 18 establishments before the smoking restrictions went into effect and again after the smoking restrictions went into effect. Nicotine levels were assessed in both the smoking and smoke-free areas of these establishments. Although half of the establishments made structural and ventilation changes in response to the smoking restrictions others did not. The results of this study showed that the difference in SHS levels between smoking and non-smoking sections in these establishments was small. SHS levels were actually greatest in the non-smoking sections in four of the establishments tested. The authors concluded that the smoking restrictions even with structural and ventilation improvements were not sufficient to maintain a smoke-free environment. These results are consistent with the ASHRAE position paper (11). While this public debate over the effectiveness of ventilation systems for SHS is ongoing and affecting public policy, to date there have not been any comprehensive scientific studies looking at the impact of ventilation systems on the health effects of SHS exposure. Thus it is not clear whether the air filtration systems commonly used in buildings (Standard Charcoal or HEPA filters) reduce any of the toxic components found in SHS. A clear need therefore exists to evaluate the effectiveness of these current ventilation systems on the health effects from SHS exposure.

It is well known that cigarette smokers experience airway inflammation and epithelial damage and are at high risk of cardiovascular disease and cancer. One of the potential causes of these health effects has been postulated to be the free radicals either in the tobacco smoke or produced during persistent inflammation. There is strong evidence that SHS causes many of the same health risks in non-smokers. An argument presented by the tobacco industry and their supporters is that air filtration systems are capable of reducing the harmful effects of SHS. The two standard systems used in large establishments are Standard Charcoal Filters or sometimes HEPA filters. In the best case scenarios, these two filter systems are used in combination. There is no evidence that these systems significantly reduce the harmful effects of SHS. Most claims for these air filtration systems in terms of SHS is that they reduce the eye irritation and smell associated with SHS. They have not monitored the impact of these systems on reducing the levels of toxic compounds such as the nitrosamines, pyrenes etc.