CDC Report Reignites Debate About Smoking in Airports

CDC Report Reignites Debate About Smoking in Airports
Rebecca Douglas
Published in: 

Project: Secondhand Smoke Study

Sponsor: Centers for Disease Control & Prevention

Airports Tested: 9 (all large U.S. hubs)

Non-Smoking Airports: Chicago O'Hare Int'l; Fort Lauderdale-Hollywood Int'l; Orlando Int'l; Phoenix Sky Harbor Int'l

Airports with Designated Smoking Areas: Denver Int'l; Hartsfield-Jackson Atlanta Int'l; McCarran Int'l; Salt Lake City Int'l; Washington Dulles Int'l

Methodology: Researchers used air monitors to measure the level of respirable suspended particulates, a marker for secondhand smoke. The median time spent at each site was 30 mins. Test were conducted sometime between 7 a.m. and 11 p.m.; Oct. 19 to Nov. 1, 2012. Airports were not notified the tests would be performed.

Results: The average particulate level in smoking areas was 16 times the average level in nonsmoking areas of airports that allow smoking & 23 times the average level in airports with no-smoking policies. The average level in areas adjacent to smoking areas was 4 times the average in nonsmoking areas at airports that permit smoking elsewhere & 5 times the average level in airports without smoking areas. Particulate levels in the gate areas of both groups of airports were not significantly different.

Complete Report:

Smoking is not permitted anywhere inside the terminals at O'Hare International Airport in Chicago; but guests at Hartsfield-Jackson Atlanta International can light up in 12 designated smoking areas spread throughout all seven concourses. Tampa International takes a somewhat middle-ground approach by providing five outdoor smoking patios. The facilities on the sterile side of TSA checkpoints are enclosed by chain-link fencing for security and outfitted with electric lighters for smokers' convenience.

Ever since the FAA banned smoking on all commercial U.S. flights (a process that spanned from 1988 to 2000), the onus has been on individual airports to set policies that govern passengers on the ground. Customer input and public opinion, often expressed in hyperbole and desperate appeals or demands, simultaneously pulled airports in opposite directions.

Currently, the vast majority of U.S. airports ban smoking inside their terminals. Just five of 29 large hubs allow it (see list, left), and that number will likely continue to drop, as one of the five, Denver International Airport (DIA), is actively transitioning to a smoke-free environment.

Until recently, DIA had four smoking facilities. Three closed at the end of last year with cooperation from their operators; the fourth is scheduled to close in 2018, when the lease for its space expires. Smokin' Bear, the company that operates the fourth and final smoking lounge in conjunction with Timberline Steaks & Grill, was the only concessionaire that didn't agree to toss out its ashtrays - despite appeals from DIA and direct pressure from Denver's mayor.

Underscoring the health orientation of the airport's changes, one of the defunct smoking concessions previously operated by Airport Lounges will become a Jamba Juice stand. The company will turn its other previous smoking lounge into a full-service bar and barbecue restaurant called Aviator's Sports Bar.

An official from Airport Lounges told The Denver Post the new policy at DIA "was a long time coming" and that changes in attitudes toward smoking had caused a drop in business. Airport Lounges also operates Pour La France, a bar and restaurant/takeout location in Concourse B.

Quiz-DIA, which operates the Mesa Verde Restaurant and Bar in Concourse A, is transforming the smoking area inside its facility into a patio and additional seating.

Per usual, the concessionaires are paying for renovations to their airport spaces; DIA is extending the leases of the new non-smoking businesses.

Fueling the Flame

Until recently, domestic and international passengers had largely grown accustomed to different airports having different smoking policies, and operators began receiving fewer comments on the issue. Then a November 2012 report from the Centers of Disease Control and Prevention (CDC) reignited the topic faster than a Zippo lighting a Marlboro.

The report compared the indoor air quality at nine large U.S. hubs - five with designated smoking areas and four that ban all indoor smoking (see Page 60 for both lists). The "smoking airports" came under pressure when the report received national media attention and subsequent coverage in local markets.

CDC researchers found that the areas adjacent to smoking facilities (3-1/4 feet away) were, on average, five times more polluted than the air in nonsmoking airports. The results take direct aim at the strategy of providing designated smoking areas to limit health risks only to willing smokers.

"Separate, ventilated smoking areas are not effective," says Brian King, Ph.D., CDC epidemiologist and lead author of the study. "The only way to eliminate the health risk of secondhand smoke is to remove it completely."

Headlines warned of "health risks at airports allowing smoking" and coverage focused on smoke leaking and seeping from airport smoking rooms.

"Significant secondhand smoke exposure is going on," stresses Tim McAfee, director of CDC's Office on Smoking and Health. "These are unnecessary dangers for airport employees and passengers."

On average, pollutants inside various smoking areas were found to be 23 times higher than levels in gate areas of non-smoking airports. The air quality inside bars and restaurants that permit smoking was found to be even worse. Four such facilities that were tested averaged 34 times more contaminants than the nonsmoking airport group; the most polluted had 69 times more.

"These are not healthy environments for travelers or airport employees," says King. He found the presence of children in some of the enclosed smoking areas particularly troubling.

In contrast, the average air quality in non-smoking gatehold areas of "smoking airports" was found to be comparable to the air quality in gates at airports that ban indoor smoking. Contaminant levels were slightly higher, but researchers characterized them as "not statistically significant."

The report implicates commercial forces in the more problematic results: "Certain tobacco product manufacturers have promoted and paid for separately enclosed and ventilated smoking areas in airports and have opposed efforts to implement smoke-free policies in airports."

Documents chronicling the tobacco industry's involvement with specific airports and airport organizations are posted on the website of The University of California, San Francisco, which maintains the Legacy Tobacco Documents Library. Americans for Nonsmokers' Rights also provides summaries of and links to the documents.

Officials at the airports that were tested did not receive notice the researchers were coming - a standard CDC practice after subjects in early secondhand smoke studies of other industries modified facilities in an attempt to influence test results. As of mid-February, airport officials had not received results regarding the air quality in their facilities. The report listed specific readings for individual airports, but did not identify airports by name. (Tables refer to Airport A, B, etc.)

Together, the five airports that allow smoking boarded about 110 million passengers in 2011. The figure concerns CDC, given the documented health dangers of direct and secondhand smoke, including death and serious illnesses such as heart disease, lung cancer and Sudden Infant Death Syndrome.

Two Masters to Serve

As the world's busiest passenger airport since 1998, ATL holds a key position in the smoking/no-smoking debate; and Aviation General Manager Louis Miller is steadfast about the benefits of providing designated smoking areas. He considers them an important customer amenity - and not just for smoking customers.

"It's a good approach to have separate areas for smokers," Miller explains. "It keeps nonsmokers from being exposed to smoke in restaurants and other areas."

ATL, he notes, gets positive comments about its smoking facilities from both factions: "The smokers really, really appreciate them; but the nonsmokers like them too, because they're not bothered by smoke in other places."

With heavy international passenger loads and fully 70% of its customers connecting to other flights, smoking areas are an especially hot issue at ATL. "If you have passengers coming in from Germany, connecting through to Chicago, they're going to smoke," relates Miller. "If you don't provide a separate area, they'll end up smoking in restrooms and other places they shouldn't."

ATL's designated smoking facilities include two bar/restaurants and 10 enclosed smoking rooms. While all are used regularly, the facilities in the 40-gate international complex are used particularly heavily, notes Miller.

The smoking rooms include exhaust fans that move 6,000 cubic feet of air per minute, and equipment that maintains negative air pressure within the enclosed areas. "The HVAC system is very effective," Miller explains. "Even when the doors open, air is sucked into the rooms from the concourse instead of vice versa. That keeps smoke from washing out into the concourse."

In addition, the rooms are closed during maintenance to minimize smoke exposure for cleaning crews.

Even the airport's curbside spaces are separated, Miller adds. "By keeping the smoking areas away from the entrances, non-smokers don't have to walk through a cloud of smoke to get inside," he notes.

The airport's record 95.49 million passengers in 2012 is a point of pride and achievement for ATL, but cause for concern at CDC, given the airport's smoking policy.

Having run major airports as both a smoker and nonsmoker, Miller brings a unique personal and professional perspective to the issue. Although he kicked the habit nine years ago, Miller remains resolute about the advantages of ATL's smoking facilities.

Clearing the Air

Salt Lake City International Airport (SLC) has glass-enclosed smoking rooms in all five of its concourses. Maureen Riley, executive director of the Salt Lake City Department of Airports, considers the subject largely an issue of balance - specifically, balancing the needs of smoking and nonsmoking passengers.

"I'm not a smoker, and I don't promote smoking; but I acknowledge that there are lots of passengers using our facilities who do smoke," Riley explains.

The CDC estimates about 20% of people in the United States smoke cigarettes. According to data compiled by the World Lung Foundation and American Cancer Society, this places America right at the middle of the pack regarding worldwide cigarette consumption. International passengers at U.S. airports, however, are often accustomed to much less governmental regulation on the activity.

"This is an emotional topic," Riley reflects. "We want to approach it on as scientific a level as possible. We want all of our passengers at Salt Lake City to have the best experience that we can provide - smokers and nonsmokers."

Riley readily credits the operational benefits of having smoking rooms in gatehold areas at SLC. Traffic in security screening lines would increase considerably if connecting passengers (nearly half the airport's total) were required to exit the terminal to smoke. "That's something we definitely want to be proactive about," she emphasizes. "Sending people outside the terminal may work for some airports, but with our footprint, it's just not practical."

Riley also recognizes the predicament that long flights present for smokers. "By the time they get here, some have been traveling for four or more hours," she notes. "Smoking is a powerful addiction. If we don't provide them with (smoking) facilities, they'll gravitate to restrooms or other areas not built for that purpose."

Employee logistics are another key factor. Airport workers who have to leave the building for a smoke break are simply less productive than those with closer options, explains Barbara Gann, public relations and marketing director at SLC. "We receive a lot of positive input about our smoking facilities from other employers, such as TSA, concessions operators and the airlines," notes Gann.

Like Miller at ATL, Riley doesn't foresee eliminating designated smoking areas any time soon. "I might feel more pressure to change if we had more complaints," she acknowledges. "But we receive more thank-yous and testimonials from smokers than we do complaints (about secondhand smoke)."

The airport added doors to the smoking rooms that once lacked them, and each has a separate ventilation system that is cleaned and monitored daily, reports Gann. Routine maintenance and repairs cost about $5,000 per year (labor and materials included).

"Other airports have relationships with tobacco companies that help pay for the smoking areas, but we don't," notes Riley.

While news reports about the CDC study focused on secondhand smoke leaking from airport smoking rooms, Gann considers another section of the report equally important: results that found similar air quality in the boarding areas of airports with and without smoking areas.

"The researchers found the difference to be 'statistically negligible.' Our interpretation of that finding is that the gate areas where passengers congregate are safe from secondhand smoke," she explains.

The lack of specific test results also garnered Gann's attention. "It would be helpful to have our specific results rather than the average from all of the airports tested," she notes. "With those details, there may be simple alterations we could deploy."

No Ifs, Ands or Butts

The smoking ban at O'Hare International (ORD) has been in place so long, recollections of the changeover are all but gone from the airport's institutional memory. "No one really remembers it any other way," notes Gregg Cunningham, spokesman for the Chicago Department of Aviation. "The no-smoking policy at O'Hare was in place long before the current city and state ordinances, so it's been at least a couple of decades ago."

Enforcement, reports Cunningham, is not an issue. Although airport police and aviation security officers have the authority to issue citations for smoking inside the terminals, the ORD Safety and Security Office characterizes such cases as "rare, if ever."

"O'Hare is a busy, 24/7 operation," explains Cunningham. "If someone tries to smoke, it wouldn't necessarily take an officer to address it. Here in Chicago, no-smoking policies are so ingrained into our culture, a passenger or employee would be more likely to say something first."

Regular announcements on the airport's public address system also remind smokers not to light up inside the terminal.

Although the airport receives occasional requests for smoking areas, adding such facilities is not currently being considered, reports Cunningham. Doing so, he adds, would likely be a complicated process, given the city of Chicago's Clean Indoor Air Ordinance and Illinois state law.

To Be Continued

Despite the dispassionate, pragmatic way airport officials explain their individual smoking policies, travelers will likely continue to have passionate feelings about the issue. Even the title of the journal that published the CDC airport study, Morbidity and Mortality Weekly Report, speaks to the issue's gravity.

With no applicable federal law on the books, state or municipal governments and individual airport commissions continue to determine airport smoking policies. In limited cases, international airports in states with comprehensive no-smoking laws - Utah and Colorado, for example - are exempt from certain clean air regulations.

Denver International Airport presents an interesting case study: When Colorado's indoor smoking ban went into effect in summer 2006, casinos and airports were exempt. Casinos voluntarily went smoke-free in 2008, and Denver International Airport is currently transitioning to a smoke-free policy - a process it began months before the CDC airport study was conducted or released.

Denver Mayor Michael Hancock crystallized the city's official sentiment about DIA's smoking lounges in a prepared statement: "While they are legally allowed, we believe the responsible decision is to eliminate these facilities in order to better protect the well-being of everyone who uses the airport."

The airport recently issued a press release on the issue that contained the following statement: "DIA supports Denver Mayor Michael B. Hancock's plans for creating a better, healthier Denver by moving toward becoming a smoke-free facility."

While it's too early to determine if or how CDC's report about secondhand smoke in large U.S. airports will affect the industry, CDC is not involved with the enforcement or creation of smoking regulations. "We provide data on the subject," King explains. "We hope that states and airports will use the data to decrease health risks for the traveling public; but the policies are up to them."

None of the airports contacted for this article anticipated any changes to their current smoking policies.


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