There are currently 63 tribal (Native American) casinos in California, which employ over 50,000 workers, with up to 10 more casinos under construction
]. Close to one third of these casinos are located in populous southern California. Currently, only one tribal casino in California is entirely smoke-free (Lucky Bear Casino). While smoking prohibitions in California went into effect for non-tribal gaming clubs in January 1998, gaming facilities are controlled by tribal sovereign entities and are not subject to California state law unless the law is included in an agreement, known as a “Compact”, between state or local governments and the tribe. As a result, patrons visiting tribal casinos are likely to receive exposure to secondhand tobacco smoke (SHS) pollutants, including airborne fine particles with diameters under 2.5 microns (PM2.5
). Elevated concentrations of PM2.5
are a well-known indicator of the presence of SHS
], and PM2.5
has its own well-established adverse health effects
The predominant contribution of smoking to indoor levels of PM2.5
and other pollutants in casino air throughout California and elsewhere has been documented by a number of investigators. These studies show clear physical evidence of smoking causing substantial exposure to SHS in both smoking and certain designated nonsmoking areas of casinos. Jiang et al.
] surveyed PM2.5
levels in 36 different California Indian casinos, finding an average concentration of 63
in smoking slot areas, a value which was 9 times higher than mean outdoor levels. Nonsmoking areas without complete physical air separation were not protective, with PM2.5
levels still reaching, on average, nearly 30
. York and Lee
] measured PM2.5
in nonsmoking restaurants of 16 Nevada casinos, reporting average levels of 31
, with average levels of 48
in smoking gaming areas. Repace
] measured particle levels (respirable suspended particles, RSP; and particle-bound polycyclic aromatic hydrocarbons, PPAH) in eight Delaware casinos, finding that the health of casino patrons and staff was endangered -- the casino air contained 20 times more RSP, on average, than outdoor background levels. The RSP and PPAH particles were eliminated by 85% to 95% after the implementation of indoor smoking bans in the Delaware casinos. Repace et al.
] studied PM2.5
in 66 casinos around the US, grouping results from new and prior investigations
] and found that indoor (smoking) and outdoor levels were approximately lognormally-distributed with geometric means of 54 and 4
, respectively. Levels in three nonsmoking casinos averaged 3
, indicating most or all of the PM2.5
in the smoking casinos arose from tobacco smoke emissions. In a study of 17 Australian social and gaming clubs, Cains et al.
] measured PM10
and nicotine in general-use and designated “no smoking areas”. They found that levels in nonsmoking areas could be lower by 50%, but reductions were not as significant as the protection obtained from a complete smoking ban.
Biological measures of casino employees and patrons further demonstrate the effects of smoking in casinos on air quality, health risk, and dose. Urinary cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) are commonly-used biomarkers with sensitivity and specificity for discriminating tobacco smoke exposure
]. Trout et al.
] found that casino employees had higher cotinine levels than a representative sample of the US population. Cotinine increased significantly more during the casino work shift than in other work places. Repace
] found casino patrons had increased cotinine levels. In a recent study of employee exposures in three Las Vegas, Nevada casinos, Achutan et al.
] performed a survey consisting of biological (urine) samples from 124 dealers for cotinine, total NNAL, and creatinine analysis, and full-shift area and personal breathing zone air samples (n = 113 of the dealers) for nicotine, various volatile organic compounds (VOCs), PAH’s, and RSP. They found average nicotine (geometric mean, GM = 6.7
) and particle levels (GM = 41
) similar to what other casino investigators have found. Casino dealers were found, via the biomarker NNAL, to be exposed to a known carcinogen, tobacco-specific nitrosomine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Achutan et al., therefore, conclude that the only way to eliminate this specific health risk is to ban smoking in casinos. Anderson et al.
] found, similarly, that casino patrons excreted NNAL and were, thus, exposed to NNK.
Evidence observed in Nevada casinos indicates that smokers represent a small minority of total casino patrons. Responding to apparent industry claims that smokers comprise more than 50% of all casino patrons, Pritsos et al.
] measured the density of smokers relative to the total number of gamblers in 18 Nevada casinos in Las Vegas, Reno/Sparks, and Lake Tahoe, implementing a similar methodology to that described by Repace and Lowrey
]. The results of their study indicated that the overall percentage of active smokers in Nevada casinos was 6.7%, which, when adjusted by a factor of 3
], resulted in estimated smoker prevalence of 20%, 22%, and 16% for the Las Vegas, Reno/Sparks, and Lake Tahoe casinos, respectively (20.2% overall). As noted by Pritsos et al.
], these values are comparable to the reported 2005 smoker prevalence for the total US population of 20.9%
]. The factor of 3, used by Pritsos et al. and Repace and Lowrey, assumes an average of 2 cigarettes smoked an hour with a cigarette duration of 10
minutes, on average, which results in an average active-smoking period of 20
min per hour or 1/3 of the time. Thus, assuming a random smoking process, cross-sectional measures of the number of active smokers may observe 1/3 of actual smokers, on average.
As noted by Timberlake et al.
], tribal casinos are of special interest in California, because they represent the last substantial California indoor setting where employees and patrons can be exposed to SHS. Timberlake et al.
], reporting on the results of the 2008 California Tobacco Survey regarding SHS exposure and SHS avoidance behavior of casino patrons, find that 17.6% of casino patrons smoke and 10.4% of non-patrons are smokers, 60.8% of patrons attempt to avoid SHS by moving about the casino, 67.2% of respondents support a smoking ban, and the likelihood of visiting a casino with physical separation between smoking and nonsmoking areas is associated with avoidance of SHS in never-smokers.
Following the work in Nevada and California by Pritsos et al.
], Jiang et al.
], as well as other researchers discussed above, the present study used on-site visits to directly measure the proportion of patrons in southern California tribal casinos, who are actively smoking at any point in time, and thus are responsible for exposures to PM2.5
experienced by the bulk of casino employees or other patrons -- in either smoking or nonsmoking areas. Using measures of available gaming machines or tables, as well as original measures of PM2.5
in the casinos (and taken from Jiang et al.
]), we report and discuss the relationship of active-smoker proportions to derived patron occupancy, the relative occupancy of smoking versus nonsmoking areas, and the level of potential protection from PM2.5
exposure that is currently offered to casino patrons by nonsmoking areas.