Casino patrons take a health gamble

STANFORD (US) — Less than two hours of exposure to secondhand smoke in a casino puts patrons and workers at acute risk of developing heart disease, pulmonary disease, and cancer.

In the United States, 88 percent of commercial casinos and nearly 100 percent of tribal casinos allow smoking.

Coronary heart disease is the leading cause of death in the United States and a major cause of disability, costing the country an estimated $151.6 billion in 2007.

Approximately 8 percent of the population 45 to 64 years of age, and 20 percent of those older than 65, suffer from coronary heart disease and are at greater risk from exposure to secondhand smoke. The two age groups have higher gambling rates than those under 45.

A new study, published in the journal Environmental Research examined pollution levels in 66 smoky casinos in five states, three casinos that are smoke-free, and pollution levels outdoors. The study, a continuation of earlier research conducted at 36 casinos in California, added 30 casinos  in four other states.

To make their measurements, researchers entered casinos carrying small monitoring devices tucked inside purses or jackets. Combining new data with previously published measurements from three other states, the team developed nationwide averages and ranges for pollution levels inside casinos.

The study focused on two types of air pollutants blamed for tobacco-related cancers: fine particulate matter, which deposits deep in the lungs, and a group of chemicals called particulate polycyclic aromatic hydrocarbons, or PPAHs, which include at least 10 different carcinogenic compounds.

Results show that gamblers and casino workers in casinos that permit smoking are subject to levels of particulate air pollution 10 times higher than those who visit smoke-free casinos. Ventilation and air cleaning do not control indoor smoke levels.

“The only effective control for secondhand smoke was reducing the number of smokers,” says Lynn Hildemann, professor of environmental engineering and science at Stanford University and the principal investigator for the study.

“The fewer smokers, the less polluted the air. If you switch to a nonsmoking casino, your exposure to harmful fine particulate matter levels indoors will be reduced by 90 percent, and your exposure to carcinogenic PPAH levels will decrease by 80 percent.”

Nonsmoking areas attached to the smoking casinos—including restaurants, where children are allowed—offer little protection, unless they are completely sealed off from the casino, with closed doors and a separate ventilation system. Secondhand smoke seeps in, resulting in pollution levels seven times as high as outdoors.

In more than nine of 10 smoking casinos in the survey, the indoor pollution levels exceed the World Health Organization standard for fine particulate matter.

The three smoke-free casinos surveyed had pollution levels as low as the outdoors.

“Casino patrons are gambling not only with their money, but with their health, and the odds are stacked against them,” says Hildemann.

“Casinos have always been huge draws, but in recent years we’ve seen an increase of family activities tied to casinos. So in addition to seniors, the health risks are starting to reach new, more vulnerable populations, particularly children.”

Casino workers are at even greater risk. Levels of cotinine, a biomarker of tobacco that shows up in human tissue, in casino dealers who are nonsmokers were higher than in 95 percent of the nonsmoking U.S. population. Nevada casino dealers have triple the asthma rates of the general state population.

“Cotinine levels in these nonsmoking workers—who were exposed only while at work—significantly increased between the beginning and the end of their work shift. Similar results have been found in casino patrons with shorter exposures. This is clearly due to secondhand smoke in the casino,” says James Repace, a biophysicist and visiting assistant clinical professor at Tufts University.

The study was funded by the Flight Attendant Medical Research Institute.

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