Levels of second hand smoke in pubs and bars by deprivation and food-serving status: a cross-sectional study from North West England

Neighborhood Disadvantage and Lung Cancer Incidence in Ever-Smokers at a Safety Net Health-Care System: A Retrospective Study

BACKGROUND

Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. The goal of this study was to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors.

METHODS

A cohort of ever-smokers aged ≥ 55 years was assembled from 19 years of electronic health record data from our academic community health-care system. Patient demographic characteristics and other measures known to be associated with lung cancer were ascertained. Patient addresses at their index visit were geocoded to the census block group level to determine the area deprivation index (ADI), drawn from 5-year estimates from the American Community Survey. A multivariate Cox proportional hazards model was fit to assess the association between ADI and time to lung cancer diagnosis. Tests of statistical significance were two-sided.

RESULTS

The study included 19,867 male subjects and 21,748 female subjects. Fifty-three percent of the patients were white, 38% were black, and 5% were Hispanic. Of these, 1,149 developed lung cancer. After adjusting for known risk factors, patients residing in the most disadvantaged areas had a significantly increased incidence of lung cancer compared with those in the least disadvantaged areas (hazard ratio, 1.29; 95% CI 1.07-1.55).

CONCLUSIONS

Census-derived estimates of neighborhood conditions have a powerful association with lung cancer incidence, even when adjusting for individual variables. Further research investigating the mechanisms that link neighborhood conditions to lung cancer is warranted.

Indoor fine particle (PM2.5) pollution exposure due to secondhand smoke in selected public places of Sri Lanka

BACKGROUND

Secondhand smoke accounts for a considerable proportion of deaths due to tobacco smoke. Although the existing laws ban indoor smoking in public places in Sri Lanka, the level of compliance is unknown.

METHODS

Fine particulate matter (PM(2.5)) levels in 20 public places in Colombo, Sri Lanka were measured by a PM monitor (Model AM510-SIDEPAK Personal Aerosol Monitor). Different types of businesses (restaurants, bars, cafés, and entertainment venues) were selected by purposive sampling. Only the places where smoking was permitted were considered.

RESULTS

The average indoor PM(2.5) ranged from 33 to 299 µg/m(3). The average outdoor PM(2.5) ranged from 18 to 83 µg/m(3). The indoor to outdoor PM(2.5) ratio ranged from 1.05 to 14.93. In all venues, indoor PM(2.5) levels were higher than the Sri Lankan ambient PM(2.5) standard of 50 µg/m(3). All indoor locations had higher PM(2.5) levels as compared to their immediate outdoor surroundings.

CONCLUSION

The study highlights the importance of improving ventilation and enforcing laws to stop smoking in public places.

Policy guidance on threats to legislative interventions in public health: a realist synthesis

Background

Legislation is one of the most powerful weapons for improving population health and is often used by policy and decision makers. Little research exists to guide them as to whether legislation is feasible and/or will succeed. We aimed to produce a coherent and transferable evidence based framework of threats to legislative interventions to assist the decision making process and to test this through the 'case study' of legislation to ban smoking in cars carrying children.

Methods

We conceptualised legislative interventions as a complex social interventions and so used the realist synthesis method to systematically review the literature for evidence. 99 articles were found through searches on five electronic databases (MEDLINE, HMIC, EMBASE, PsychINFO, Social Policy and Practice) and iterative purposive searching. Our initial searches sought any studies that contained information on smoking in vehicles carrying children. Throughout the review we continued where needed to search for additional studies of any type that would conceptually contribute to helping build and/or test our framework.

Results

Our framework identified a series of transferable threats to public health legislation. When applied to smoking bans in vehicles; problem misidentification; public support; opposition; and enforcement issues were particularly prominent threats. Our framework enabled us to understand and explain the nature of each threat and to infer the most likely outcome if such legislation were to be proposed in a jurisdiction where no such ban existed.

Specifically, the micro-environment of a vehicle can contain highly hazardous levels of second hand smoke. Public support for such legislation is high amongst smokers and non-smokers and their underlying motivations were very similar - wanting to practice the Millian principle of protecting children from harm. Evidence indicated that the tobacco industry was not likely to oppose legislation and arguments that such a law would be 'unenforceable' were unfounded.

Conclusion

It is possible to develop a coherent and transferable evidence based framework of the ideas and assumptions behind the threats to legislative intervention that may assist policy and decision makers to analyse and judge if legislation is feasible and/or likely to succeed.

Recent contributions of air- and biomarkers to the control of secondhand smoke (SHS): a review

Since the publication of the US Surgeon General Reports in 1996 and 2006 and the report of the California Environmental Protection Agency in 1999, many reports have appeared on the contribution of air and biomarkers to different facets of the secondhand smoke (SHS) issue, which are the targets of this review. These recent studies have allowed earlier epidemiological surveys to be biologically validated, and their plausibility demonstrated, quantified the levels of exposure to SHS before the bans in various environments, showed the deficiencies of mechanical control methods and of partial bans and the frequently correct implementation of the efficient total bans. More stringent regulation remains necessary in the public domain (workplaces, hospitality venues, transport sector, etc.) in many countries. Personal voluntary protection efforts against SHS are also needed in the private domain (homes, private cars). The effects of SHS on the cardiovascular, respiratory and neuropsychic systems, on pregnancy and fertility, on cancers and on SHS genotoxicity are confirmed through experimental human studies and through the relationship between markers and prevalence of disease or of markers of disease risk.

Socioeconomic variation in the prevalence, introduction, retention, and removal of smoke-free policies among smokers: findings from the International Tobacco Control (ITC) Four Country Survey

INTRODUCTION

Exposure to secondhand smoke causes premature death and disease in non-smokers and indoor smoke-free policies have become increasingly prevalent worldwide. Although socioeconomic disparities have been documented in tobacco use and cessation, the association between socioeconomic status (SES) and smoke-free policies is less well studied.

METHODS

Data were obtained from the 2006 and 2007 Waves of the International Tobacco Control Four Country Survey (ITC-4), a prospective study of nationally representative samples of smokers in Canada, the United States, the United Kingdom, and Australia. Telephone interviews were administered to 8,245 current and former adult smokers from October 2006 to February 2007. Between September 2007 and February 2008, 5,866 respondents were re-interviewed. Self-reported education and annual household income were used to create SES tertiles. Outcomes included the presence, introduction, and removal of smoke-free policies in homes, worksites, bars, and restaurants.

RESULTS

Smokers with high SES had increased odds of both having [OR: 1.54, 95% CI: 1.27-2.87] and introducing [OR: 1.49, 95% CI: 1.04-2.13] a total ban on smoking in the home compared to low SES smokers. Continuing smokers with high SES also had decreased odds of removing a total ban [OR: 0.44, 95% CI: 0.26-0.73]. No consistent association was observed between SES and the presence or introduction of bans in worksites, bars, or restaurants.

CONCLUSIONS

The presence, introduction, and retention of smoke-free homes increases with increasing SES, but no consistent socioeconomic variation exists in the presence or introduction of total smoking bans in worksites, bars, or restaurants. Opportunities exist to reduce SES disparities in smoke-free homes, while the lack of socioeconomic differences in public workplace, bar, and restaurant smoke-free policies suggest these measures are now equitably distributed in these four countries.

Will cardiovascular disease prevention widen health inequalities?

Simon Capewell and Hilary Graham review different population strategies for preventing cardiovascular disease and conclude that screening and treating high-risk individuals may be ineffective and widen social inequalities.

Quantification of ETS exposure in hospitality workers who have never smoked

BACKGROUND

Environmental Tobacco Smoke (ETS) was classified as human carcinogen (K1) by the German Research Council in 1998. According to epidemiological studies, the relative risk especially for lung cancer might be twice as high in persons who have never smoked but who are in the highest exposure category, for example hospitality workers. In order to implement these results in the German regulations on occupational illnesses, a valid method is needed to retrospectively assess the cumulative ETS exposure in the hospitality environment.

METHODS

A literature-based review was carried out to locate a method that can be used for the German hospitality sector. Studies assessing ETS exposure using biological markers (for example urinary cotinine, DNA adducts) or questionnaires were excluded. Biological markers are not considered relevant as they assess exposure only over the last hours, weeks or months. Self-reported exposure based on questionnaires also does not seem adequate for medico-legal purposes. Therefore, retrospective exposure assessment should be based on mathematical models to approximate past exposure.

RESULTS

For this purpose a validated model developed by Repace and Lowrey was considered appropriate. It offers the possibility of retrospectively assessing exposure with existing parameters (such as environmental dimensions, average number of smokers, ventilation characteristics and duration of exposure). The relative risk of lung cancer can then be estimated based on the individual cumulative exposure of the worker.

CONCLUSION

In conclusion, having adapted it to the German hospitality sector, an existing mathematical model appears to be capable of approximating the cumulative exposure. However, the level of uncertainty of these approximations has to be taken into account, especially for diseases with a long latency period such as lung cancer.

Assessing the effects of the introduction of the New Zealand Smokefree Environment Act 2003 on acute myocardial infarction hospital admissions in Christchurch, New Zealand

OBJECTIVE

To examine trends in Acute Myocardial Infarction (AMI) hospital admissions in Christchurch, New Zealand before and after the implementation of the New Zealand Smokefree Environments Act 2003 in December 2004.

METHODS

Data on AMI hospital admissions to Christchurch Public Hospital were extracted for the period 2003 to 2006. Poisson regression was used to calculate rate ratios by comparing for AMI rates of hospital admissions before (2003/04) and after (2005/06) the introduction of the Smokefree legislation, and to assess whether there was a significant change over time.

RESULTS

The introduction of the smokefree legislation was associated with a 5% reduction in AMI admissions. The 55-74 age group recorded the greatest decrease in admissions (9%) and this figure rose to 13% among never smokers in this group. Reductions were more marked for men. Adding the effects of area deprivation increased the reduction to 21% among 55-74 year olds living in more affluent (quintile 2) areas. Overall however, the statistical association of changing levels of AMI admissions with smoking status and with deprivation was not consistently significant.

CONCLUSION

At this early stage following the smokefree legislation, there are hints emerging of a positive impact on AMI admissions but these suggestions cannot yet be treated with certainty. Further research could usefully evaluate the longer-term effects of smoking legislation on the prevalence of smoking and exposure to second hand smoke, especially in more deprived urban communities.

The impact of Ontario smoke-free legislation on secondhand smoke in enclosed public places

Many studies have evaluated the impact of indoor smoking bans on secondhand smoke (SHS) exposure. No studies have assessed the impact of a smoking ban on SHS in enclosed areas outside separately ventilated, designated smoking rooms (DSRs). This study evaluated the overall impact of the Smoke-Free Ontario Act implemented May 31, 2006, on SHS in bars and coffee shops and the impact of banning DSRs on SHS outside DSRs. Air particulate matter (PM) and carcinogenic particulate polycyclic aromatic hydrocarbons (PPAH) were measured in May 2006 before the ban inside and outside DSRs in Toronto venues (13 coffee shops and 14 bars) that allowed smoking only in DSRs, and in Windsor venues (10 coffee shops and 10 bars) where smoking was allowed in shared spaces. Measurements were repeated 2 months post-ban. Air quality index values (AQIs) were calculated. Mixed model analysis was applied, taking into account measurement errors for repeated measures. Post ban, mean PM and PPAH levels were reduced by 87% (from 494 to 67 mm(2)/m(3)) and 94% (from 196 to 11 ng/m(3)), respectively, inside Toronto DSRs. Mean PM and PPAH levels were reduced by 10% (from 124 to 111 mm(2)/m(3)) and 46% (from 45 to 24 ng/m(3)), respectively, outside Toronto DSRs. In all Windsor venues, mean PM and PPAH levels were reduced by 83% (from 488 to 81 mm(2)/m(3)) and 90% (from 107 to 10 ng/m(3)), respectively. All reductions were statistically significant (p < 0.0001). In Toronto venues, the AQI was reduced from the "very unhealthy" range inside DSRs and the "moderate" range outside Toronto DSRs to the "good" range, and in Windsor venues from the "unhealthy for sensitive groups" range to the "good" range post-ban. Pre-ban PPAH levels including those outside Toronto DSRs may be associated with cardiovascular injury. DSRs did not provide adequate protection from SHS. The Smoke-Free Ontario Act produced a significant and firm reduction in SHS exposure in venues both with and without DSRs.

Hungarian indoor air quality study

Célunk az volt, hogy összehasonlítsuk a dohányzó és nemdohányzó beltéri közösségi helyek légszennyezettségszintjét Magyarországon. Itthon még nem készült ilyen tanulmány. Módszer: TSI SidePak AM510 Personal aerosolmonitorral mértük a 2,5 mikrométer átmérőnél kisebb részecskék (PM 2,5 ) koncentrációját 6 kocsma, 5 étterem, 11 kávézó és 20 egyéb helyiség környezeti levegőjében Budapesten és Zalakaroson 2008. január és augusztus között. Eredmények: Azon a 26 helyen, ahol dohányoztak, az átlag-PM 2,5 -szint 102,3 μg/m 3 (tartomány: 3–487 μg/m 3 ); a nemdohányzó 16 hely átlagértéke pedig 5,1 μg/m 3 (tartomány: 0–28 μg/m 3 ) volt. Következtetések: A magyarországi dohányzó beltéri közösségi helyeken a mért kisméretű részecske koncentrációja 18-szor volt magasabb, mint azokon a helyeken, ahol nem dohányoztak. Közel minden esetben a mért értékek túllépték az Egészségügyi Világszervezet (World Health Organization) és a US Environmental Protection Agency által az emberi egészségre károsnak tartott tartományt.

Scottish smoke-free legislation and trends in smoking cessation

AIM

To investigate trends in smoking cessation before and after the introduction of Scottish smoke-free legislation and to assess the perceived influence of the legislation on giving up smoking and perceptions of the legislation in smokers.

DESIGN, SETTING AND PARTICIPANTS

Longitudinal data on smoking cessation were obtained from 1998 to 2007 on a cohort of 3350 Scottish adults aged between 50 and 75 years at baseline. All members of the cohort were participating in a clinical trial of aspirin in people at moderately increased risk of cardiovascular events. A subgroup of 474 participants who had smoked in the year prior to the introduction of legislation in March 2006 also completed a questionnaire on the influence and perceptions of the smoke-free legislation following its introduction.

MEASUREMENTS

Smoking status was recorded yearly, including dates of quitting and restarting. Participants who gave up smoking for at least 3 months were recorded as having quit smoking. The questionnaire included scales on whether the smoke-free legislation had helped/influenced cessation, made the individual think about/prompt them to quit and perceptions of the legislation.

FINDINGS

The odds of smokers quitting annually increased throughout the 7-year period prior to introduction of the smoke-free legislation to 2 years afterwards (odds ratio 1.09, 95% confidence interval 1.05-1.12, P<0.001). During 2006, the pattern of quarterly quitting rates changed, with an increase in quit rates (to 5.1%) in the 3-month period prior to introduction of the legislation (January-March 2006). Socio-economic status was not related to smoking cessation. In the subgroup completing the questionnaire (n=474), 57 quit smoking between June 2005 and May 2007 and 43.9% of these said that the smoke-free legislation had helped them to quit. Most (>70%) smokers were positive about the legislation, especially those from more affluent compared with more deprived communities (P=0.01).

CONCLUSIONS

The Scottish smoke-free legislation was associated with an increase in the rate of smoking cessation in the 3-month period immediately prior to its introduction. Overall quit rates in the year the legislation was introduced and the subsequent year were consistent with a gradual increase in quit rates prior to introduction of the legislation. Socio-economic status was not related to smoking cessation, but individuals from more affluent communities were more positive about the legislation.

Changes in air quality and second-hand smoke exposure in hospitality sector businesses after introduction of the English Smoke-free legislation

BACKGROUND

To monitor and disseminate the short-term effects of the English Smoke-free legislation on air quality and employee exposure in businesses of the hospitality industry.

METHODS

Indoor particle concentrations and salivary cotinine levels were measured in businesses in the hospitality sector and non-smoking employees one month before and after the implementation of the legislation. Results were immediately released to the media to announce the improvements in air quality and employee exposure to the wider public.

RESULTS

Measurements were collected in 49 businesses and from 75 non-smoking individuals. Indoor PM(2.5) concentrations decreased by 95% from 217 microg/m(3) at baseline to 11 microg/m(3) at follow-up (P < 0.001). Salivary cotinine in employees was reduced by 75%, from 3.6 ng/ml at baseline to 0.9 ng/ml at follow-up (P < 0.001). The findings were presented to the public through press releases and interviews and were cited in over 20 media articles.

CONCLUSION

The project demonstrates the positive effects of the English Smoke-free legislation on air quality and second-hand smoke exposure in the hospitality industry sector. We believe that quick and positive feedback to the public on the effects of smoking restrictions is essential when introducing public health legislation such as the Smoke-free legislation.

Particulate matter exposure during domestic work in Nepal

AIMS

To measure particulate matter (PM) exposure of people involved in domestic work (i.e. housework by a resident, not paid work) in urban and rural Nepal, with exposure to biomass smoke in the rural areas, and to examine the performance of photometric devices in collecting these data. This paper details the results of these measurements and derives calibration factors for two photometric devices compared to gravimetric measures.

METHODS

Between April 2006 and February 2007, respirable dust and PM(2.5) levels were measured over a 24-h period in 490 households in a range of urban and rural settings in the Kathmandu valley of Nepal. Sampling was carried out by photometric and gravimetric methods with the co-located gravimetric data used to derive a calibration factor for the photometric devices.

RESULTS

The time-weighted average (TWA) (24 h) respirable dust levels measured by gravimetric sampler ranged from 13 to 2600 microg m(-3) in the rural settings and 3 to 110 microg m(-3) in the urban settings. The co-located photometric and gravimetric devices indicate that the SidePak Personal Aerosol Monitor device required a calibration factor of 0.48 and 0.51 for rural and urban data, respectively, whereas the DustTrak device required a factor of 0.31 and 0.35 for rural and urban settings to correct for the particle size and density of the biomass smoke. The photometric devices provide time history data on PM concentration levels and generally indicate two distinct peaks around a morning and early evening cooking time.

CONCLUSIONS

Those involved in domestic work in rural Nepal are exposed to average respirable dust concentrations of approximately 1400 microg m(-3). Converted to an 8-h TWA, this equates to more than the current UK limit for respirable dust (4000 microg m(-3)). Homemakers, primarily women, spend a large proportion of their lives indoors in these high respirable dust concentrations and these exposures are likely to produce respiratory illness. Exposure can be controlled by the use of different fuel types and/or the use of flued stoves.

A 32-country comparison of tobacco smoke derived particle levels in indoor public places

OBJECTIVE

To compare tobacco smoke-derived particulate levels in transportation and hospitality venues with and without smoking in 32 countries using a standardised measurement protocol.

METHODS

The TSI SidePak AM510 Personal Aerosol Monitor was used to measure the concentration of particulate matter less than 2.5 microns in diameter (PM(2.5)) in 1822 bars, restaurants, retail outlets, airports and other workplaces in 32 geographically dispersed countries between 2003 and 2007.

RESULTS

Geometric mean PM(2.5) levels were highest in Syria (372 microg/m(3)), Romania (366 microg/m(3)) and Lebanon (346 microg/m(3)), while they were lowest in the three countries that have nationwide laws prohibiting smoking in indoor public places (Ireland at 22 microg/m(3), Uruguay at 18 microg/m(3) and New Zealand at 8 microg/m(3)). On average, the PM(2.5) levels in places where smoking was observed was 8.9 times greater (95% CI 8.0 to 10) than levels in places where smoking was not observed.

CONCLUSIONS

Levels of indoor fine particle air pollution in places where smoking is observed are typically greater than levels that the World Health Organization and US Environmental Protection Agency have concluded are harmful to human health.

Exposure to environmental tobacco smoke in German restaurants, pubs and discotheques

In contrast to other countries, there is an on-going debate but still no smoke-free legislation in Germany. Exposure to environmental tobacco smoke (ETS) in hospitality venues is assumed to be high, but air quality data are lacking. Therefore, the aim of our study was to perform a comprehensive exposure assessment by analysing the indoor air concentration of toxic or carcinogenic ETS compounds in restaurants, pubs, and discotheques. Active sampling of indoor air was conducted for 4 h during the main visiting hours in 28 hospitality venues. Polycyclic aromatic hydrocarbons (PAH), volatile organic compounds (VOC), aldehydes/ketones, and cadmium were analysed. In addition, particle mass concentration was assessed with two different methods and particle number concentration (PNC) was determined. Median nicotine levels were 15 microg/m(3) in restaurants, 31 microg/m(3) in pubs, and 193 microg/m(3) in discotheques. Across these three sampling site categories median levels of 3-ethenylpyridine ranged from 3 to 24 microg/m(3), median levels of benzene from 8 to 20 microg/m(3), median levels of cadmium from 3 to 10 ng/m(3), and median levels of the sum of 16 PAH according to US-EPA from 215 to 375 ng/m(3), respectively. Median PM(2.5) mass concentration assessed gravimetrically varied between 178 and 808 microg/m(3) and PNC between 120,000 and 210,000 particles per cm(3) in restaurants, pubs, and discotheques. The majority of the particles had a size of 0.01-0.5 microm. Concentrations of ETS compounds were always highest in discotheques. The strong correlation between ETS-specific markers (nicotine, 3-ethenylpyridine) and PM(2.5), PAH, VOC, aldehydes/ketones, and cadmium indicated ETS as main source of these toxic or carcinogenic substances. In conclusion, indoor air concentrations of ETS constituents were high in German hospitality venues and represented a substantial health threat. Effective measures to protect patrons and staff from ETS exposure are necessary from a public health point of view.

Secondhand smoke levels in Scottish pubs: the effect of smoke-free legislation

OBJECTIVE

To compare levels of particulate matter, as a marker of secondhand smoke (SHS) levels, in pubs before and 2 months after the implementation of Scottish legislation to prohibit smoking in substantially enclosed public places.

DESIGN

Comparison of SHS levels before and after the legislation in a random selection of 41 pubs in 2 Scottish cities.

METHODS

Fine particulate matter <2.5 microm in diameter (PM2.5) was measured discreetly for 30 min in each bar on 1 or 2 visits in the 8 weeks preceding the starting date of the Smoking, Health and Social Care (Scotland) Act 2005 and then again 2 months after the ban. Repeat visits were undertaken on the same day of the week and at approximately the same time of the day.

RESULTS

PM2.5 levels before the introduction of the legislation averaged 246 microg/m3 (range 8-902 microg/m3). The average level reduced to 20 microg/m3 (range 6-104 microg/m3) in the period after the ban. Levels of SHS were reduced in all 53 post-ban visits, with the average reduction being 86% (range 12-99%). PM2.5 concentrations in most pubs post-ban were comparable to the outside ambient air PM2.5 level.

CONCLUSIONS

This study has produced the largest dataset of pre- and post-ban SHS levels in pubs of all worldwide smoke-free legislations introduced to date. Our results show that compliance with the Smoking, Health and Social Care (Scotland) Act 2005 has been high and this has led to a marked reduction in SHS concentrations in Scottish pubs, thereby reducing both the occupational exposure of workers in the hospitality sector and that of non-smoking patrons.

Environmental tobacco smoke in hospitality venues in Greece

BACKGROUND

Exposure to environmental tobacco smoke is a major threat to public health. Greece, having the highest smoking prevalence in the European Union is seriously affected by passive smoking. The purpose of this study was to measure environmental tobacco smoke (ETS) exposure in the non smoking areas of hospitality venues and offices in Greece and to compare the levels of exposure to levels in the US, UK and Ireland before and after the implementation of a smoking ban.

METHODS

Experimental measurements of particulate matter 2.5 microm (PM2.5), performed during a cross sectional study of 49 hospitality venues and offices in Athens and Crete, Greece during February - March 2006.

RESULTS

Levels of ETS ranged from 19 microg/m3 to 612 microg/m3, differing according to the place of measurement. The average exposure in hospitality venues was 268 microg/m3 with ETS levels found to be highest in restaurants with a mean value of 298 microg/m3 followed by bars and cafes with 271 microg/m3. ETS levels were 76% lower in venues in which smoking was not observed compared to all other venues (p < 0.001). ETS levels in Greek designated non-smoking areas are similar to those found in the smoking sections of UK hospitality venues while levels in Ireland with a total smoking ban are 89% lower and smoke-free communities in the US are 91 - 96% lower than levels in Greece.

CONCLUSION

Designated non-smoking areas of hospitality venues in Greece are significantly more polluted with ETS than outdoor air and similar venues in Europe and the United States. The implementation of a total indoor smoking ban in hospitality venues has been shown to have a positive effect on workers and patrons' health. The necessity of such legislation in Greece is thus warranted.

National smokefree law in New Zealand improves air quality inside bars, pubs and restaurants

Background:

We aimed to: (i) assess compliance with a new smokefree law in a range of hospitality settings; and (ii) to assess the impact of the new law by measuring air quality and making comparisons with air quality in outdoor smoking areas and with international data from hospitality settings.

Methods:

We included 34 pubs, restaurants and bars, 10 transportation settings, nine other indoor settings, six outdoor smoking areas of bars and restaurants, and six other outdoor settings. These were selected using a mix of random, convenience and purposeful sampling. The number of lit cigarettes among occupants at defined time points in each venue was observed and a portable real-time aerosol monitor was used to measure fine particulate levels (PM_2.5).

Results:

No smoking was observed during the data collection periods among over 3785 people present in the indoor venues, nor in any of the transportation settings. The levels of fine particulates were relatively low inside the bars, pubs and restaurants in the urban and rural settings (mean 30-minute level = 16 μg/m³ for 34 venues; range of mean levels for each category: 13 μg/m³ to 22 μg/m³). The results for other smokefree indoor settings (shops, offices etc) and for smokefree transportation settings (eg, buses, trains, etc) were even lower. However, some "outdoor" smoking areas attached to bars/restaurants had high levels of fine particulates, especially those that were partly enclosed (eg, up to a 30-minute mean value of 182 μg/m³ and a peak of maximum value of 284 μg/m³). The latter are far above WHO guideline levels for 24-hour exposure (ie, 25μg/m³).

Conclusion:

There was very high compliance with the new national smokefree law and this was also reflected by the relatively good indoor air quality in hospitality settings (compared to the "outdoor" smoking areas and the comparable settings in countries that permit indoor smoking). Nevertheless, adopting enhanced regulations (as used in various US and Canadian jurisdictions) may be needed to address hazardous air quality in relatively enclosed "outdoor" smoking areas.

Air pollution in Boston bars before and after a smoking ban

BACKGROUND

We quantified the air quality benefits of a smoke-free workplace law in Boston Massachusetts, U.S.A., by measuring air pollution from secondhand smoke (SHS) in 7 pubs before and after the law, comparing actual ventilation practices to engineering society (ASHRAE) recommendations, and assessing SHS levels using health and comfort indices.

METHODS

We performed real-time measurements of respirable particle (RSP) air pollution and particulate polycyclic aromatic hydrocarbons (PPAH), in 7 pubs and outdoors in a model-based design yielding air exchange rates for RSP removal. We also assessed ventilation rates from carbon dioxide concentrations. We compared RSP air pollution to the federal Air Quality Index (AQI) and the National Ambient Air Quality Standard (NAAQS) to assess health risks, and assessed odor and irritation levels using published SHS-RSP thresholds.

RESULTS

Pre-smoking-ban RSP levels in 6 pubs (one pub with a non-SHS air quality problem was excluded) averaged 179 microg/m3, 23 times higher than post-ban levels, which averaged 7.7 microg/m3, exceeding the NAAQS for fine particle pollution (PM2.5) by nearly 4-fold. Pre-smoking ban levels of fine particle air pollution in all 7 of the pubs were in the Unhealthy to Hazardous range of the AQI. In the same 6 pubs, pre-ban indoor carcinogenic PPAH averaged 61.7 ng/m3, nearly 10 times higher than post-ban levels of 6.32 ng/m3. Post-ban particulate air pollution levels were in the Good AQI range, except for 1 venue with a defective gas-fired deep-fat fryer, while post-ban carcinogen levels in all 7 pubs were lower than outdoors.

CONCLUSION

During smoking, although pub ventilation rates per occupant were within ASHRAE design parameters for the control of carbon dioxide levels for the number of occupants present, they failed to control SHS carcinogens or RSP. Nonsmokers' SHS odor and irritation sensory thresholds were massively exceeded. Post-ban air pollution measurements showed 90% to 95% reductions in PPAH and RSP respectively, differing little from outdoor concentrations. Ventilation failed to control SHS, leading to increased risk of the diseases of air pollution for nonsmoking workers and patrons. Boston's smoking ban eliminated this risk.