1. WHO European Centre for Environment and Health Survey Methods for Environmental Health Assessments Dorota Jarosinska 1,2, Dafina Dalbokova 1, Michal Krzyzanowski 1 1 WHO-European Centre for Environment and Health, Bonn Office 2 Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland The Future for Our Children ISEE Central Eastern European Chapter Meeting Balatonföldvár, 4-6 September 2003

2. WHO European Centre for Environment and Health Why survey methods for Environmental Health Information system? To increase specificity and sensitivity of the indicator -based reporting focusing on the immediate living environment To generate information not available from the routine data systems, but relevant for the policies

3. WHO European Centre for Environment and Health Why survey methods for Environmental Health Information system? Assessing exposures in the immediate living environment Detecting mild health effects Targeting vulnerable population health

4. WHO European Centre for Environment and Health Air_A1: Composite index of the scope of ETS policies in the WHO European Region Source: WHO Tobacco Control database: http://cisid.who.dk/tobacco/

5. WHO European Centre for Environment and Health Air_A1: Implementation of the ETS policy components Source: EHI pilot project countries: Bulgaria, Germany, Lithuania, Romania, Slovak Rep., Spain, Switzerland

6. WHO European Centre for Environment and Health Reporting obligations: As recognized in the WHO Framework Convention, there are no effective reporting mechanisms at place to assess implementation and effectiveness of the ETS oriented policies. The quality and methodology of existing surveys are not reliable enough to understand and monitor the dynamics of the tobacco use. European countries lack sufficient reporting mechanisms and surveillance systems. Harmonized and reliable monitoring system is needed to allow evaluation of the ETS related policies within and across the countries and facilitate exchange of the comprehensive information. At present, in the EU countries, implementation of the legislations and other effective measures to limit exposure to ETS is not subject of mandatory reporting (). Under the Framework Convention, the countries will work with the WHO and other international and intergovernmental organizations towards establishment of the national surveillance systems, and cooperate with the WHO in the development of the guidelines for defining the collection, analysis and dissemination of tobacco-related surveillance data. No effective reporting mechanisms and surveillance to monitor and evaluate implementation and effectiveness of the ETS policies in the European countries

7. WHO European Centre for Environment and Health Reporting obligations: As recognized in the WHO Framework Convention, there are no effective reporting mechanisms at place to assess implementation and effectiveness of the ETS oriented policies. The quality and methodology of existing surveys are not reliable enough to understand and monitor the dynamics of the tobacco use. European countries lack sufficient reporting mechanisms and surveillance systems. Harmonized and reliable monitoring system is needed to allow evaluation of the ETS related policies within and across the countries and facilitate exchange of the comprehensive information. At present, in the EU countries, implementation of the legislations and other effective measures to limit exposure to ETS is not subject of mandatory reporting (). Under the Framework Convention, the countries will work with the WHO and other international and intergovernmental organizations towards establishment of the national surveillance systems, and cooperate with the WHO in the development of the guidelines for defining the collection, analysis and dissemination of tobacco-related surveillance data. To evaluate ETS policies within and across the WHO European Region Member States harmonized and reliable monitoring system to assess population exposure to ETS is needed Population exposure to ETS – survey methods

8. WHO European Centre for Environment and Health ECRHS II “How many people living in the home smoke inside the home: if one or more, please specify number per day smoked inside the home by the respondent and others” EXPOLIS “Including respondent, how many people in the household (workplace) smoke inside the home (inside the room during working hours); how much do people smoke at home: per day, per week (cigarettes, cigarillos, cigars, pipe tobacco)” Environmental Health in the Danish HIS “How many in the household, including respondent smoke daily at home?” “How many hours a day does respondent spend in the place where he smokes (at home, work, other places), even if he/she is the only smoker?” WHO/GYTS “ In the past 7 days, on how many days people smoked in your presence in your home, places other than home” US NHIS, 1991 “Does anyone smoke cigarettes, cigars, pipes anywhere in this home? On the average, about how many days per week is there smoking anywhere in this house?” US, Kaiser Permanente Health Plan …Time of exposure, assessed by the current average number of hours per week of exposure to tobacco cigarette, cigar, pipe smoke because of smoking of others: at home, small spaces other than home; large indoor areas … Oslo Birth Cohort … Child’s exposure to ETS – living in a home in which one or more inhabitants smoke … Surveys on ETS exposure - examples PHRASING

9. WHO European Centre for Environment and Health A good candidate of survey tool for EH assessment Assessing exposures Detect mild health effects Vulnerable subgroups Well-defined Feasible Validated Cost-effective National and international use

10. WHO European Centre for Environment and Health Surveys for EH assessments WHO Europe approach Selection criteria: Large scale, national and multinational studies Representative Regularly conducted Using validated tools Inventory of the major European surveys addressing issues relevant for EH Information system

11. WHO European Centre for Environment and Health Surveys in Europe Environmental exposures Indoor Air Q. Survey, France EXPOLIS German Environmental Surveys (I,II,III, IV) ECRHS (I, II) ISAAC (I, II, III) HIS, HES Swedish EH Survey Danish EH Survey Health effects

12. WHO European Centre for Environment and Health Surveys for EH assessments WG Meeting Bonn, 18-19 November 2002 Recommended actions to propose a set of well-defined and feasible survey instruments as a part of the EH information system for the 4 th Ministerial Conference, Budapest, 2004 Agreed on the scope of the issues and the survey tools for EH indicator system Selected the best candidates of the survey methods to asses exposures and the health effects, applicable (inter)- and nationally across the WHO European Region

13. WHO European Centre for Environment and Health Surveys for EH assessments WG Meeting, Bonn, 18-19 November 2002 Topics selected: Indoor air quality Housing Respiratory health Noise Annoyance Focus on children’s EH

14. WHO European Centre for Environment and Health Surveys for EH assessments WG Meeting, Bonn, 18-19 November 2002 Recommended several well established survey tools: questionnaires objective measurement Example: respiratory health asthma symptoms in adults: ECRHS asthma symptoms in children: ISAAC

15. WHO European Centre for Environment and Health Surveys for EH assessments WG Meeting, Bonn, 18-19 November 2002 Tasks ahead To complete the process of selecting the most appropriate survey tools Develop the harmonized survey protocol applicable across the Member States To propose a set of the feasible survey methods

16. WHO European Centre for Environment and Health EHI SYSTEM Surveys EH policy needs Tool for integrated assessment

17. WHO European Centre for Environment and Health For more information, please see … http://www.who.dk/document/E79048.pdf EpiMarker, 1 / 2003

18. WHO European Centre for Environment and Health

19. ECRHS II “How many people living in the home smoke inside the home: if one or more, please specify number per day smoked inside the home by the respondent and others” EXPOLIS “Including respondent, how many people in the household (workplace) smoke inside the home (inside the room during working hours); how much do people smoke at home: per day, per week (cigarettes, cigarillos, cigars, pipe tobacco)” Environmental Health in the Danish HIS “How many in the household, including respondent smoke daily at home?” “How many hours a day does respondent spend in the place where he smokes (at home, work, other places), even if he/she is the only smoker?” WHO/GYTS “ In the past 7 days, on how many days people smoked in your presence in your home, places other than home” US NHIS, 1991 “Does anyone smoke cigarettes, cigars, pipes anywhere in this home? On the average, about how many days per week is there smoking anywhere in this house?” US, Kaiser Permanente Health Plan …Time of exposure, assessed by the current average number of hours per week of exposure to tobacco cigarette, cigar, pipe smoke because of smoking of others: at home, small spaces other than home; large indoor areas … Oslo Birth Cohort … Child’s exposure to ETS – living in a home in which one or more inhabitants smoke … Surveys on ETS exposure - examples

20. WHO European Centre for Environment and Health Surveys in Europe Regularly conducted general surveys National Health Interview Surveys (HIS) National Health Examination Surveys (HES) Household surveys National representative surveys addressing EH issues German Environmental Surveys French Permanent Indoor Air Quality Survey Swedish Environmental Health Survey Environmental Health in the Danish HIS Dutch environmental health surveys International projects focusing on specific EH topics ISAAC: International Study on Asthma and Allergies in Childhood ECRHS: European Community Respiratory Health Survey EXPOLIS: Exposure Distribution of Adult Urban Populations Other surveys, within the scope of interest of the EH indicators system Global Youth Tobacco Survey (GYTS) The Survey of English Housing The UK House Condition Surveys Smiley to help communication