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Boey CPH, Quaye SED, Cook AR, Seow WJ, van der Eijk Y. Secondhand smoke in the densely populated urban setting: A cross-sectional survey of exposure, knowledge, attitudes, and respiratory symptoms. INDOOR AIR 2022; 32:e13069. [PMID: 35762238 DOI: 10.1111/ina.13069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/10/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Secondhand smoke (SHS) remains a common health threat in densely populated, urban settings. We estimated the prevalence of exposure and associated respiratory symptoms, knowledge, attitudes, and behaviors in a multi-ethnic, weighted sample of Singapore residents using a cross-sectional survey of 1806 adults. We weighted data to match the national population in terms of gender, ethnicity, and education level and analyzed data using descriptive statistics, bivariate analyses, multiple linear and logistic regressions, and a multinomial logistic regression model. About 88% of respondents reported regular SHS exposure. Nearly 57% reported exposure to neighbors' SHS at home. Respiratory symptoms were reported by 32.5% and significantly associated with exposure to daily (AOR = 2.63, 95% CI = 1.62-4.36), non-daily (AOR = 1.75, 95% CI = 1.14-2.77), and neighbors' (AOR = 1.37, 95% CI = 1.07-1.76) SHS. More knowledge of SHS was associated with male gender (β = 0.28, p = 0.0009) and higher household income (linear trend; p = 0.0400). More negative attitudes to SHS were associated with older age (linear trend; p < 0.0001). Engaging in behaviors to avoid SHS was associated with a more negative attitude to SHS (AOR = 1.09-1.23). SHS exposure is common in Singapore's densely populated setting and associated with respiratory symptoms, even if exposure is non-daily or from neighboring homes.
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Affiliation(s)
- Clement Peng Hee Boey
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sharon Esi Duoduwa Quaye
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Jain RB. Rates of exposure to environmental tobacco smoke from various indoor environments among US children and nonsmoker adolescents and adults. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:17002-17011. [PMID: 29627962 DOI: 10.1007/s11356-018-1891-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
Data from National Health and Nutrition Examination Survey for 2013-2014 were used to compute rates of exposure (ROE) to environmental tobacco smoke (ETS) from various indoor environments among US children and nonsmoking adolescents and adults. In a typical week in USA, 473,000 infants (ROE, 11%), 3.36 million children aged 1-5 years (ROE, 16.4%), and 4.59 million children aged 6-11 years (ROE, 18.6%) are exposed to ETS from indoor environments only. ROE among children was found to be highest by inhaling tobacco smoke inside home, riding in a car, and when visiting other people's homes. In a typical week, 4.1 million nonsmoking adolescents (ROE, 29.2%) were being exposed to ETS. For every one adolescent smoker, 2.4 nonsmoker adolescents were being subjected to ETS exposure. Both non-Hispanic White (NHW) and non-Hispanic Black (NHB) nonsmoking adolescents had higher ROE (p < 0.01) than Hispanics (HISP) and non-Hispanic Asians (NHAS). Also, in a typical week, 16.8 million nonsmoking adults (ROE, 29.2%) were being exposed to ETS. For every adult smoker, 0.7 nonsmoker adult was subjected to ETS exposure. Both NHW and NHB nonsmoking adults had higher ROE (p < 0.01) than HISP and NHAS and males had higher ROE than females (p < 0.01).
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National and State-Specific Attitudes toward Smoke-Free Parks among U.S. Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090864. [PMID: 27589779 PMCID: PMC5036697 DOI: 10.3390/ijerph13090864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 07/31/2016] [Accepted: 08/26/2016] [Indexed: 11/17/2022]
Abstract
Outdoor places, such as parks, remain a source of secondhand smoke (SHS) exposure. We assessed attitudes toward smoke-free parks among U.S. adults. Data came from the 2009-2010 National Adult Tobacco Survey, a landline and cellular telephone survey of noninstitutionalized adults aged ≥18 in the 50 U.S. states and D.C. Descriptive statistics and logistic regression were used to assess the prevalence and sociodemographic correlates of attitudes toward smoke-free parks, overall and by current tobacco use. Overall, 38.5% of adults reported favorable attitudes toward complete smoke-free parks; prevalence ranged from 29.2% in Kentucky to 48.2% in Maine. Prevalence of favorable attitudes toward smoke-free parks was higher among nonusers of tobacco (44.6%) and noncombustible-only users (30.0%) than any combustible users (21.3%). The adjusted odds of having a favorable attitude were higher among: women; Hispanics and Black non-Hispanics, American Indian and Alaska Native non-Hispanics, and other non-Hispanics; those with an unspecified sexual orientation; and those with children aged ≤17 in the household, relative to each characteristics respective referent group. Odds were lower among: any combustible tobacco and noncombustible-only tobacco users; adults aged 45-64; and those with some college or an undergraduate degree. Opportunities exist to educate the public about the benefits of smoke-free outdoor environments.
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Jain RB. Exposure to second hand smoke at home and work among nonsmokers. CHEMOSPHERE 2015; 135:225-232. [PMID: 25965001 DOI: 10.1016/j.chemosphere.2015.04.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 03/24/2015] [Accepted: 04/22/2015] [Indexed: 06/04/2023]
Abstract
Exposure to second hand smoke (SHS) is associated with adverse health effects. This study was undertaken to assess comparative levels of exposure to SHS at home and work among nonsmokers aged ⩾12 years. Data from National Health Examination Survey for 1999-2010 were analyzed to estimate exposure to SHS. Total number of subjects included in the study was 24,791. Those who self-reported not having used any tobacco products during the last five days were considered nonsmokers for the purpose of this study. Serum cotinine levels were used as the outcome variable to indicate the level of exposure to SHS. Adjusted serum cotinine levels for those with no exposure to SHS, exposure to SHS at work only, exposure to SHS at home only, and exposure to SHS at home and work were 0.047 (0.044-0.050)n g/mL, 0.055 (0.047-0.064) ng/mL, 0.522 (0.401-0.678) ng/mL, and 0.485 (0.280-0.0840) ng/mL respectively. Public efforts to reduce exposure to SHS at home should be strengthened.
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Affiliation(s)
- Ram B Jain
- 33 Woodbury Lane, Sanford, NC 27332, USA.
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Hall ME, Williams RD, Hunt B. Assessment of Attitudes Regarding Tobacco-Free Campus Policy and Secondhand Smoke Exposure Among College Students, Faculty, and Staff. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2014.945671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hood NE, Bernat DH, Ferketich AK, Danesh D, Klein EG. Community Characteristics Associated With Smokefree Park Policies in the United States. Nicotine Tob Res 2014; 16:828-35. [DOI: 10.1093/ntr/ntu007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Jones I, St Helen G, Meyers M, Dempsey DA, Havel C, Jacob P, Northcross A, Hammond SK, Benowitz NL. Biomarkers of secondhand smoke exposure in automobiles. Tob Control 2014; 23:51-7. [PMID: 23349229 PMCID: PMC3670969 DOI: 10.1136/tobaccocontrol-2012-050724] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The objectives of this study were: (1) to characterise the exposure of non-smokers exposed to secondhand smoke (SHS) in a vehicle using biomarkers, (2) to describe the time course of the biomarkers over 24 h, and (3) to examine the relationship between tobacco biomarkers and airborne concentrations of SHS markers. METHODS Eight non-smokers were individually exposed to SHS in cars with fully open front windows and closed back windows over an hour from a smoker who smoked three cigarettes at 20 min intervals. The non-smokers sat in the back seat on the passenger side, while the smoker sat in the driver's seat. Plasma cotinine and urine cotinine, 3-hydroxycotinine (3HC) and 4-(methylnitrosoamino)-(3-pyridyl)-1-butanol (NNAL) were compared in samples taken at baseline (BL) and several time-points after exposure. Nicotine, particulate matter (PM2.5) and carbon monoxide (CO) were measured inside and outside the vehicle and ventilation rates in the cars were measured. RESULTS Average plasma cotinine and the molar sum of urine cotinine and 3HC (COT+3HC) increased four-fold, urine cotinine increased six-fold and urine NNAL increased ∼27 times compared to BL biomarker levels. Plasma cotinine, urine COT+3HC and NNAL peaked at 4-8 h post-exposure while urine cotinine peaked within 4 h. Plasma cotinine was significantly correlated to PM2.5 (Spearman correlation rs=0.94) and CO (rs=0.76) but not to air nicotine. The correlations between urine biomarkers, cotinine, COT+3HC and NNAL, and air nicotine, PM2.5 and CO were moderate but non-significant (rs range = 0.31-0.60). CONCLUSIONS Brief SHS exposure in cars resulted in substantial increases in levels of tobacco biomarkers in non-smokers. For optimal characterisation of SHS exposure, tobacco biomarkers should be measured within 4-8 h post-exposure. Additional studies are needed to better describe the relationship between tobacco biomarkers and environmental markers of SHS.
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Affiliation(s)
- Ian Jones
- Department of Psychiatry, University of California, Los Angeles, CA
| | - Gideon St Helen
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA
| | | | - Delia A. Dempsey
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Science. San Francisco General Hospital and the Departments of Medicine, Bioengineering & Therapeutic Sciences and Psychiatry, University of California, San Francisco, CA
| | - Christopher Havel
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Science. San Francisco General Hospital and the Departments of Medicine, Bioengineering & Therapeutic Sciences and Psychiatry, University of California, San Francisco, CA
| | - Peyton Jacob
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Science. San Francisco General Hospital and the Departments of Medicine, Bioengineering & Therapeutic Sciences and Psychiatry, University of California, San Francisco, CA
| | - Amanda Northcross
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, CA
| | - S. Katharine Hammond
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, CA
| | - Neal L. Benowitz
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Science. San Francisco General Hospital and the Departments of Medicine, Bioengineering & Therapeutic Sciences and Psychiatry, University of California, San Francisco, CA
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Hwang J, Lee K. Determination of Outdoor Tobacco Smoke Exposure by Distance From a Smoking Source. Nicotine Tob Res 2013; 16:478-84. [DOI: 10.1093/ntr/ntt178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Leung R, Mallya G, Dean LT, Rizvi A, Dignam L, Schwarz DF. Instituting a smoke-free policy for city recreation centers and playgrounds, Philadelphia, Pennsylvania, 2010. Prev Chronic Dis 2013; 10:E116. [PMID: 23845177 PMCID: PMC3711557 DOI: 10.5888/pcd10.120294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background In the United States, more than 600 municipalities have smoke-free parks, and more than 100 have smoke-free beaches. Nevertheless, adoption of outdoor smoke-free policies has been slow in certain regions. Critical to widespread adoption is the sharing of knowledge about the policy development and implementation process. In this article, we describe our experience in making City of Philadelphia recreation centers and playgrounds smoke-free. Community Context Of the 10 largest US cities, Philadelphia has among the highest rates of adult and youth smoking. Our objectives for an outdoor smoke-free policy included protecting against secondhand smoke, supporting a normative message that smoking is harmful, motivating smokers to quit, and mitigating tobacco-related sanitation costs. Methods The Philadelphia Department of Public Health and the Department of Parks and Recreation engaged civic leaders, agency staff, and community stakeholders in the following steps: 1) making the policy case, 2) vetting policy options and engaging stakeholders, and 3) implementing policy. Near-term policy impacts were assessed through available data sources. Outcome More than 220 recreation centers, playgrounds, and outdoor pools became smoke-free through a combined mayoral executive order and agency regulation. Support for the policy was high. Estimates suggest a policy reach of 3.6 million annual visitors and almost 850 acres of new smoke-free municipal property. Interpretation Localities can successfully implement outdoor smoke-free policies with careful planning and execution. Such policies hold great potential for reducing exposure to secondhand smoke, promoting nonsmoking norms, and providing additional motivation for residents to quit smoking.
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Affiliation(s)
- Raymond Leung
- City of Philadelphia, Department of Public Health, 1401 JFK Blvd, Rm 600, Philadelphia, PA 19102, USA.
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Sureda X, Fernández E, López MJ, Nebot M. Secondhand tobacco smoke exposure in open and semi-open settings: a systematic review. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:766-73. [PMID: 23651671 PMCID: PMC3701994 DOI: 10.1289/ehp.1205806] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 05/01/2013] [Indexed: 05/06/2023]
Abstract
BACKGROUND Some countries have recently extended smoke-free policies to particular outdoor settings; however, there is controversy regarding whether this is scientifically and ethically justifiable. OBJECTIVES The objective of the present study was to review research on secondhand smoke (SHS) exposure in outdoor settings. DATA SOURCES We conducted different searches in PubMed for the period prior to September 2012. We checked the references of the identified papers, and conducted a similar search in Google Scholar. STUDY SELECTION Our search terms included combinations of "secondhand smoke," "environmental tobacco smoke," "passive smoking" OR "tobacco smoke pollution" AND "outdoors" AND "PM" (particulate matter), "PM(2.5)" (PM with diameter ≤ 2.5 µm), "respirable suspended particles," "particulate matter," "nicotine," "CO" (carbon monoxide), "cotinine," "marker," "biomarker" OR "airborne marker." In total, 18 articles and reports met the inclusion criteria. RESULTS Almost all studies used PM(2.5) concentration as an SHS marker. Mean PM(2.5) concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m(3) at hospitality venues, and 4.60 to 17.80 µg/m(3) at other locations. Mean PM(2.5) concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m(3). SHS levels increased when smokers were present, and outdoor and indoor SHS levels were related. Most studies reported a positive association between SHS measures and smoker density, enclosure of outdoor locations, wind conditions, and proximity to smokers. CONCLUSIONS The available evidence indicates high SHS levels at some outdoor smoking areas and at adjacent smoke-free indoor areas. Further research and standardization of methodology is needed to determine whether smoke-free legislation should be extended to outdoor settings.
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Affiliation(s)
- Xisca Sureda
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
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St.Helen G, Holland NT, Balmes JR, Hall DB, Bernert JT, Vena JE, Wang JS, Naeher LP. Utility of urinary Clara cell protein (CC16) to demonstrate increased lung epithelial permeability in non-smokers exposed to outdoor secondhand smoke. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2013; 23:183-189. [PMID: 22805990 PMCID: PMC3507333 DOI: 10.1038/jes.2012.68] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 04/19/2012] [Indexed: 05/30/2023]
Abstract
The objective of this study was to assess the utility of urinary Clara cell protein (CC16) as a biomarker of increased lung epithelial permeability in non-smokers exposed to outdoor secondhand smoke. Twenty-eight healthy non-smoking adults visited outdoor patios of a restaurant and a bar where non-participants smoked and an open-air control with no smokers on three weekend days in a crossover study; subjects visited each site once for 3 h. Urine samples were collected at baseline, immediately post exposure and next morning, and analyzed for CC16. Changes in CC16 across location types or with cigarette count were analyzed using mixed-effect models, which included all subjects and stratified by gender. Urinary CC16 was higher in males (n=9) compared with females (n=18) at all measurement occasions (P<0.002), possibly reflecting prostatic contamination. Urinary CC16 from pre-exposure to post-exposure was higher following visits to restaurant and bar sites compared with the control among females but this increase did not reach statistical significance. Post-exposure to pre-exposure urinary CC16 ratios among females increased with cigarette count (P=0.048). Exposure-related increases in urinary CC16 were not seen among males. In conclusion, urinary CC16 may be a useful biomarker of increased lung epithelial permeability among female non-smokers; further work will be required to evaluate its applicability to males.
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Affiliation(s)
- Gideon St.Helen
- The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA, USA
| | - Nina T. Holland
- The University of California, Berkeley, Division of Environmental Health Sciences, School of Public Health, Berkeley, CA, USA
| | - John R. Balmes
- The University of California, Berkeley, Division of Environmental Health Sciences, School of Public Health, Berkeley, CA, USA
- University of California, Department of Medicine, Division of Occupational and Environmental Medicine, San Francisco, CA, USA
| | - Daniel B. Hall
- The University of Georgia, Department of Statistics, Athens, GA, USA
| | - J. Thomas Bernert
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John E. Vena
- The University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics, Athens, GA, USA
| | - Jia-Sheng Wang
- The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA, USA
| | - Luke P. Naeher
- The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA, USA
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Licht AS, Hyland A, Travers MJ, Chapman S. Secondhand smoke exposure levels in outdoor hospitality venues: a qualitative and quantitative review of the research literature. Tob Control 2012; 22:172-9. [PMID: 23220937 DOI: 10.1136/tobaccocontrol-2012-050493] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This paper considers the evidence on whether outdoor secondhand smoke (SHS) is present in hospitality venues at high levels enough to potentially pose health risks, particularly among employees. DATA SOURCES Searches in PubMed and Web of Science included combinations of environmental tobacco smoke, secondhand smoke, or passive smoke AND outdoor, yielding 217 and 5,199 results, respectively through June, 2012. STUDY SELECTION Sixteen studies were selected that reported measuring any outdoor SHS exposures (particulate matter (PM) or other SHS indicators). DATA EXTRACTION The SHS measurement methods were assessed for inclusion of extraneous variables that may affect levels or the corroboration of measurements with known standards. DATA SYNTHESIS The magnitude of SHS exposure (PM2.5) depends on the number of smokers present, measurement proximity, outdoor enclosures, and wind. Annual excess PM2.5 exposure of full-time waitstaff at outdoor smoking environments could average 4.0 to 12.2 μg/m3 under variable smoking conditions. CONCLUSIONS Although highly transitory, outdoor SHS exposures could occasionally exceed annual ambient air quality exposure guidelines. Personal monitoring studies of waitstaff are warranted to corroborate these modeled estimates.
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Affiliation(s)
- Andrea S Licht
- Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, New York, USA.
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López MJ, Fernández E, Gorini G, Moshammer H, Polanska K, Clancy L, Dautzenberg B, Delrieu A, Invernizzi G, Muñoz G, Precioso J, Ruprecht A, Stansty P, Hanke W, Nebot M. Exposure to secondhand smoke in terraces and other outdoor areas of hospitality venues in eight European countries. PLoS One 2012; 7:e42130. [PMID: 22870289 PMCID: PMC3411634 DOI: 10.1371/journal.pone.0042130] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 07/03/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Outdoor secondhand smoke (SHS) concentrations are usually lower than indoor concentrations, yet some studies have shown that outdoor SHS levels could be comparable to indoor levels under specific conditions. The main objectives of this study were to assess levels of SHS exposure in terraces and other outdoor areas of hospitality venues and to evaluate their potential displacement to adjacent indoor areas. METHODS Nicotine and respirable particles (PM2.5) were measured in outdoor and indoor areas of hospitality venues of 8 European countries. Hospitality venues of the study included night bars, restaurants and bars. The fieldwork was carried out between March 2009 and March 2011. RESULTS We gathered 170 nicotine and 142 PM2.5 measurements during the study. The median indoor SHS concentration was significantly higher in venues where smoking was allowed (nicotine 3.69 µg/m3, PM2.5: 120.51 µg/m3) than in those where smoking was banned (nicotine: 0.48 µg/m3, PM2.5: 36.90 µg/m3). The median outdoor nicotine concentration was higher in places where indoor smoking was banned (1.56 µg/m3) than in venues where smoking was allowed (0.31 µg/m3). Among the different types of outdoor areas, the highest median outdoor SHS levels (nicotine: 4.23 µg/m3, PM2.5: 43.64 µg/m3) were found in the semi-closed outdoor areas of venues where indoor smoking was banned. CONCLUSIONS Banning indoor smoking seems to displace SHS exposure to adjacent outdoor areas. Furthermore, indoor settings where smoking is banned but which have a semi-closed outdoor area have higher levels of SHS than those with open outdoor areas, possibly indicating that SHS also drifts from outdoors to indoors. Current legislation restricting indoor SHS levels seems to be insufficient to protect hospitality workers--and patrons--from SHS exposure. Tobacco-free legislation should take these results into account and consider restrictions in the terraces of some hospitality venues to ensure effective protection.
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Affiliation(s)
- Maria J López
- Public Health Agency of Barcelona, Barcelona, Spain.
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St Helen G, Bernert JT, Hall DB, Sosnoff CS, Xia Y, Balmes JR, Vena JE, Wang JS, Holland NT, Naeher LP. Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in nonsmokers. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1010-6. [PMID: 22484462 PMCID: PMC3404659 DOI: 10.1289/ehp.1104413] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 04/06/2012] [Indexed: 05/02/2023]
Abstract
BACKGROUND With an increase in indoor smoking bans, many smokers smoke outside establishments and near their entrances, which has become a public health concern. OBJECTIVES We characterized the exposure of nonsmokers to secondhand smoke (SHS) outside a restaurant and bar in Athens, Georgia, where indoor smoking is banned, using salivary cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). METHODS In a crossover study, we assigned 28 participants to outdoor patios of a restaurant and a bar and an open-air site with no smokers on three weekend days; participants visited each site once and stayed for 3 hr. We collected saliva and urine samples immediately before and after the visits (postexposure) and on the following morning and analyzed samples for cotinine and total NNAL, respectively. Regression models were fitted and changes in biomarkers were contrasted between locations. RESULTS Postexposure and preexposure geometric mean salivary cotinine concentrations differed by 0.115 ng/mL [95% confidence interval (CI): 0.105, 0.126)] and by 0.030 ng/mL (95% CI: 0.028, 0.031) for bar and restaurant visits, respectively. There were no significant post- and preexposure differences in cotinine levels after control site visits, and changes after bar and restaurant site visits were significantly different from changes after control site visits (p < 0.001). Results comparing next-day and preexposure salivary cotinine levels were similar. Next-day creatinine-corrected urinary NNAL concentrations also were higher than preexposure levels following bar and restaurant visits [1.858 pg/mg creatinine higher (95% CI: 0.897, 3.758) and 0.615 pg/mg creatinine higher (95% CI: 0.210, 1.761), respectively], and were significantly different from changes after the control visits (p = 0.005). CONCLUSION Salivary cotinine and urinary NNAL increased significantly in nonsmokers after outdoor SHS exposure. Our findings indicate that such exposures may increase risks of health effects associated with tobacco carcinogens.
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Affiliation(s)
- Gideon St Helen
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia 30602-2102, USA
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Klein EG, Bernat DH, Forster JL. Young adult perceptions of smoking in outdoor park areas. Health Place 2012; 18:1042-5. [PMID: 22784775 DOI: 10.1016/j.healthplace.2012.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 06/05/2012] [Accepted: 06/07/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Smoking restrictions in recreational settings are established to promote anti-smoking norms and reduce exposure to secondhand smoke. Outdoor smoke-free policies are increasing, yet little is known about the perceptions of such restrictions. METHODS Data were collected from a population-based sample of young adults (n=2289) in upper Midwestern United States. Cross-sectional multivariate logistic regression was used to assess predictors of the perceived difficulty to smoke in outdoor park areas. RESULTS Living in an area with a smoke-free park policy was associated with a 1.4 times higher odds of perceiving difficulty to smoke compared to those living in an area without such a policy, after controlling for past month smoking, physical activity, age, and gender. Both smokers and non-smokers living in an area with a smoke-free park policy had higher odds of perceiving difficulty to smoking in park areas (OR=1.6 and 1.3 respectively) compared to smokers and non-smokers living in areas without such policies. CONCLUSION Banning smoking in park areas was associated with a heightened perception of difficulty in smoking for young adult smokers and non-smokers.
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Affiliation(s)
- Elizabeth G Klein
- Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210, United States of America.
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Hahn EJ, Fallin A, Darville A, Kercsmar SE, McCann M, Record RA. The three Ts of adopting tobacco-free policies on college campuses. Nurs Clin North Am 2012; 47:109-17. [PMID: 22289402 PMCID: PMC4345127 DOI: 10.1016/j.cnur.2011.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article describes a 3-pronged compliance strategy to implement a tobacco-free campus policy at 1 large, land grant public university in the South, and evaluates its impact on outcomes and costs. Although there has been a recent wave of tobacco-free colleges, policy restrictiveness and implementation vary, and compliance remains a challenge. The 3 Ts strategy (Tell-Treat-Train) involves regular, consistent communications, access to tobacco treatment medications and counseling, and ongoing training of supervisors and student leaders. Administrative support, access to tobacco treatment, campus buy-in, sustained communications, and careful implementation planning are critical to instituting a tobacco-free university policy.
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Affiliation(s)
- Ellen J Hahn
- Kentucky Center for Smoke-free Policy, Tobacco Policy Research Program, University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA.
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Smoking in urban outdoor public places: Behaviour, experiences, and implications for public health. Health Place 2010; 16:961-8. [DOI: 10.1016/j.healthplace.2010.05.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 05/31/2010] [Accepted: 05/31/2010] [Indexed: 11/24/2022]
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