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Background Tobacco and non-tobacco-based waterpipe smoking has increased exponentially in many countries in recent decades, particularly among youth and young adults. Although tobacco smoking is banned in many indoor public places, waterpipe smoking, ostensibly non-tobacco, continues in Ontario and other jurisdictions where only tobacco smoking is prohibited. This study assessed air quality and exposure in waterpipe cafes using multiple methods and markers. Methods Indoor (n=12) and outdoor (n=5) air quality was assessed in Toronto, Canada waterpipe cafes from 30 August to 11 October 2012. Real-time measurements of air nicotine, fine particulate matter less than 2.5 microns in diameter (PM2.5) and ambient carbon monoxide (CO) were collected in 2 h sessions. Levels of CO in breath were collected in non-smoking field staff before entering and upon leaving venues. Observations of occupant behaviour, environmental changes and venue characteristics were also recorded. Results In indoor venues, mean values were 1419 mg/m3 for PM2.5, 17.7 ppm for ambient CO, and 3.3 mg/m3 for air nicotine. Levels increased with increasing number of active waterpipes. On outdoor patios, mean values were 80.5 mg/m3 for PM2.5, 0.5 ppm for ambient CO, and 0.6 mg/m3 for air nicotine. Air quality levels in indoor waterpipe cafes are hazardous for human health. Outdoor waterpipe cafes showed less harmful particulate levels than indoors, but mean PM2.5 levels (80.5 mg/m3) were still ‘poor'. Conclusions Staff and patrons of waterpipe cafes are exposed to air quality levels considered hazardous to human health. Results support eliminating waterpipe smoking in hospitality venues indoors and out. [ABSTRACT FROM AUTHOR]

Introduction An unintended consequence of indoor smoking restrictions is the relocation of smoking tobuilding entrances, where non-smokers may be exposed to secondhand smoke, and smoke from outdoor areas may drift through entrances, exposing people inside. Tobacco smoke has been linked to numerous health effects in non-smokers and there is no safe level of secondhand smoke (SHS) exposure. This paper presents data on levels of tobacco smoke inside and outside entrances to office buildings. Methods Real-time air quality monitors were used to simultaneously measure respirable particulate matter (PM2.5; air pollutant particles with a diameter of 2.5 mm or less) as a marker for tobacco smoke, outside and inside 28 entrances to office buildings in downtown Toronto, Ontario, in May and June 2008. Measurements were taken when smoking was and was not present within 9 m of entrances. Background levels of PM2.5 were also measured for each session. A mixed model analysis was used to estimate levels of PM2.5, taking into account repeated measurement errors. Results Peak levels (10 s averages) of PM2.5 were as high as 496 mg/m3 when smoking was present. Mixed model analysis shows that the average outdoor PM2.5 with smoking was significantly higher than the background level (p<0.0001), and significantly and positively associated with the number of lit cigarettes (p<0.0001). The average level of PM2.5 with $5 lit cigarettes was 2.5 times greater than the average background level. Conclusions These findings support smoke-free policies at entrances to buildings to protect non-smokers from exposure to tobacco smoke. [ABSTRACT FROM AUTHOR]

The article focuses on the significant effect of an indoor smoke-free bylaw on bar workers in Toronto, Ontario. It assesses the total time exposure of approximately 79 eligible bar workers to secondhand smoke (SHS), and 49 eligible employees in a control community in Windsor. It affirms that SHS exposure in time and urinary cotinine level towards workers are lessen. In addition, the study that compares the group design involving one intervention community and the comparison community is provided.

Objectives: Heated tobacco products (such as IQOS) and e-cigarettes have been introduced and advertised in a variety of ways despite inconclusive evidence regarding their safety and benefit for smoking cessation. In this study, we examine the awareness, use, and perceived risk of these products among recent smokers. Methods: In 2017, we conducted an online survey of 727 current and recent smokers in Ontario. We asked participants about their awareness, use, and perceived risk of heated tobacco products and e-cigarettes. Results: Among respondents, 10% were aware of heated tobacco products, and 3% had ever used them. Compared to non-ecigarette users, e-cigarette users were more likely to agree with statements that heated tobacco is less harmful than regular cigarettes, e-cigarette use is less harmful than regular cigarettes, and both products can help smokers stop smoking regular cigarettes. Conclusions: Respondents who used e-cigarettes were more likely to have positive perceptions about heated tobacco and may be more susceptible to the marketing of these products. It is important to monitor the use of multiple nicotine products to inform policies and programming for these products. [ABSTRACT FROM AUTHOR]

Objective: We examined menthol cigarette smokers' reactions to Ontario's menthol cigarette ban. Methods: In April 2017, past-year adult menthol cigarette smokers from Ontario, Canada (N = 67; 64.2% women) participated in an online study. Participants generated statements describing their reactions to the ban. Researchers reviewed statements continuously until reaching content saturation, and then removed duplicate statements. Participants sorted the final 79 statements by content similarity and rated each statement from 1 (Definitely NOT true) to 7 (Definitely true). Multidimensional scaling of sorting data generated a cluster map and mean cluster ratings were compared. Results: Seven statement clusters describing reactions to the menthol ban were generated: thoughts about the ban, perceiving the ban as ineffective, emotional reactions to the ban, smoking non-menthol cigarettes, smoking cessation or reduction, alternative menthol cigarette purchasing behaviors, and alternative tobacco use behaviors. Participants rated the thoughts about the ban cluster highest (most true) and alternative tobacco use behaviors cluster lowest (least true). Participants who smoked menthol cigarettes before the ban every day or most days rated clusters higher than pre-ban occasional or rare menthol smokers. Conclusions: Banning menthol cigarettes resulted in reactions including negative feelings about the ban, smoking cessation attempts, and behaviors to find menthol cigarette alternatives. [ABSTRACT FROM AUTHOR]

Objectives Smoke-free policies not only reduce harm to non-smokers, they may also reduce harm to smokers by decreasing the number of cigarettes smoked and increasing the likelihood of a successful quit attempt. However, little is known about the impact of exposure to smoking on patios on smoking behaviour. Design and participants Smokers from the Ontario Tobacco Survey, a longitudinal population representative cohort of smokers (2005-201 1). There were 3460 current smokers who had completed one to six follow-ups and were asked at each follow-up whether or not they had been exposed to smoking on patios in the month. Main outcome measures Generalised estimating equations and survival analysis were used to examine the association between exposure to patio smoking and smoking behaviour changes (making a quit attempt and time to relapse after a quit attempt), controlling for potential confounders. Results Smokers who were exposed to smoking on patios (adjusted incident rate ratio (aIRR) = 0.89; 95% CI 0.81 to 0.97) or had been to a patio (aIRR = 0.86; 95% CI 0.74 to 0.99) were less likely to have made a quit attempt than smokers who had not visited a patio. Smokers who were exposed to smoking on patios were more likely to relapse (adjusted HR=2.40; 95% CI 1.07 to 5.40)) after making a quit attempt than those who visited a patio but were not exposed to smoking. Conclusions Exposure to smoking on patios of a bar or restaurant is associated with a lower likelihood of success in a quit attempt. Instituting smoke-free patio regulations may help smokers avoid relapse after quitting. [ABSTRACT FROM AUTHOR]

Objectives: The province of Ontario, Canada banned menthol in cigarettes and other tobacco products effective January 1, 2017 thereby adding to an existing flavor ban. However, there was an exemption for all flavored e-cigarettes, flavored cigars larger than 6 grams, and alcohol flavored cigars without filters over 1.4 grams. In this paper, we examine the association between use of flavored non-cigarette products and self-reported cigarette smoking cessation after the ban. Methods: We recruited current past-30 day cigarette smokers (N = 913) who were 16 years or older and living in Ontario during September-December 2016 and re-contacted January-August 2018. Results: Both daily and occasional pre-ban menthol cigarette smokers were more likely to use flavored cigar products (adjusted relative rate, RR = 1.53, 95% confidence interval, CI = 1.01, 2.31; adjusted RR = 1.57, 95% CI = 1.06, 2.30) after the ban, while occasional pre-ban menthol cigarette smokers were more likely to use other tobacco products (adjusted RR = 1.25, 95% CI = 1.02, 1.53) or flavored other tobacco products (adjusted RR = 1.56, 95% CI = 1.09, 2.24), conditional on prior use. Conclusions: Menthol smokers prior to the ban were more likely to use other tobacco products, or flavored tobacco products, after the ban. These results suggest that comprehensive menthol bans could be more effective without the option of using flavored tobacco or nicotine products as substitutes. [ABSTRACT FROM AUTHOR]