Secondhand smoke exposure and risk following the Irish smoking ban: an assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars

Objective: To investigate whether the Irish smoking ban has had an impact on secondhand smoke (SHS) exposures for hospitality workers. Design, setting, and participants: Before and after the smoking ban a cohort of workers (n = 35) from a sample of city hotels (n = 15) were tested for saliva cotinine concentrations and completed questionnaires. Additionally, a random sample (n = 20) of city centre bars stratified by size (range 400–5000 square feet), were tested for air nicotine concentrations using passive samplers before and after the ban. Main outcome measures: Salivary cotinine concentrations (ng/ml), duration of self reported exposures to secondhand smoke, air nicotine (µg/cubic metre). Results: Cotinine concentrations reduced by 69%, from 1.6 ng/ml to 0.5 ng/ml median (SD 1.29; p < 0.005). Overall 74% of subjects experienced decreases (range 16–99%), with 60% showing a halving of exposure levels at follow up. Self reported exposure to SHS at work showed a significant reduction from a median 30 hours a week to zero (p < 0.001). There was an 83% reduction in air nicotine concentrations from median 35.5 µg/m³ to 5.95 µg/m³ (p < 0.001). At baseline, three bars (16%) were below the 6.8 µg/m³ air nicotine significant risk level for lung cancer alone; at follow up this increased to 10 (53%). Conclusions: Passive smoking and associated risks were significantly reduced but not totally eliminated. Exposure to SHS is still possible for those working where smoking is still allowed and those working where smoke may migrate from outdoor areas. Further research is required to assess the true extent and magnitude of these exposures.     

Exposure of hospitality workers to environmental tobacco smoke

OBJECTIVE: To determine quantitatively the extent of exposure of hospitality workers to environmental tobacco smoke (ETS) exposure during the course of a work shift, and to relate these results to the customer smoking policy of the workplace. SUBJECTS: Three categories of non-smoking workers were recruited: (1) staff from hospitality premises (bars and restaurants) that permitted smoking by customers; (2) staff from smokefree hospitality premises; and (3) government employees in smokefree workplaces. All participants met with a member of the study team before they began work, and again at the end of their shift or work day. At each meeting, participants answered questions from a standardised questionnaire and supplied a saliva sample. MAIN OUTCOME MEASURES: Saliva samples were analysed for cotinine. The difference between the first and second saliva sample cotinine concentrations indicated the degree of exposure to ETS over the course of the work shift. RESULTS: Hospitality workers in premises allowing smoking by customers had significantly greater increases in cotinine than workers in smokefree premises. Workers in hospitality premises with no restrictions on customer smoking were more highly exposed to ETS than workers in premises permitting smoking only in designated areas. CONCLUSIONS: Overall, there was a clear association between within-shift cotinine concentration change and smoking policy. Workers in premises permitting customer smoking reported a higher prevalence of respiratory and irritation symptoms than workers in smokefree workplaces. Concentrations of salivary cotinine found in exposed workers in this study have been associated with substantial involuntary risks for cancer and heart disease.     

Validity of self reports in a cohort of Swedish adolescent smokers and smokeless tobacco (snus) users

Objective: To validate self reports of cigarette and smokeless tobacco (snus) use in a prospective cohort of adolescents. Design: A cross sectional analysis of a cohort sub-sample. Setting: County of Stockholm, Sweden. Subjects: 520 adolescents in the final grade of junior high school (mean age 15.0 years). Main outcome measure: Concordance between self reported tobacco use and saliva cotinine concentration. Results: Using a cut point of 5 ng/ml saliva cotinine to discriminate active tobacco use, there was a 98% concordance between self reported non-use in the past month and cotinine concentration. The sensitivity of the questionnaire compared to the saliva cotinine test, used as the gold standard, was 90% and the specificity 93%. One hundred and fifteen out of 520 subjects (22%) reported monthly tobacco use. Among these, 67% (46/69) of the exclusive cigarette smokers, 82% (23/28) of exclusive snus users, and 94% (15/16) of mixed users (cigarettes + snus) had cotinine concentrations above 5 ng/ml. Among subjects reporting daily use 96% (64/67) had saliva cotinine concentrations above the cut point. Exclusive current cigarette users were more likely to be classified discordantly by questionnaire and cotinine test compared to snus users (odds ratio 3.2, 95% confidence interval 1.2 to 8.6). Conclusion: This study confirms the reliability of adolescents'' self reported tobacco use. In a context of low exposure to environmental tobacco smoke a cut off for saliva cotinine of 5 ng/ml reliably discriminated tobacco users from non-users. Irregular use of tobacco in this age group probably explains the discrepancy between self reported use and cotinine concentrations.     

Secondhand smoke exposure and C-reactive protein levels in youth.

Using data from the National Health and Nutrition Examination Survey (NHANES, 1999-2002), we examined the association of secondhand tobacco exposure, estimated by serum cotinine, with serum C-reactive protein (CRP) concentrations in nonsmoking participants, aged 6-18 years. The association between serum cotinine and serum CRP was analyzed using multiple linear regression, with adjustment for other study variables. All analyses used weighted data and adjustments for design effects. Multiple regression analysis indicated that a change in serum cotinine of 0.5 ng/ml was associated with a 0.96 mg/dl change in CRP (95% CI=0.93-1.00), even after adjustment for age, white blood cell count, and body mass index percentile. We found a significant association between secondhand smoke exposure, assessed by serum cotinine, and elevated serum CRP among nonsmoking youth. Secondhand smoke exposure may pose an important long-term cardiovascular risk for children and adolescents.     

Changes of knowledge, attitudes, beliefs, and preference of bar owner and staff in response to a smoke-free bar law

Design: Bar owners and staff were random selected and telephone interviewed in June 1998, shortly after a smoke-free bar law was enacted, and October 2002. Similar instruments were used in both surveys to collect data on attitudes related to secondhand smoke (SHS) and behaviours related to the smoke-free bar law.

Participants: 651 and 650 respondents worked for either stand alone bars or combination bars.

Measures: Preference of working in a smoke-free environment, concerns of the effect of SHS, and how to comply with the law.

Results: The percentage of bar owners or staff working in stand alone bars who prefer to work in a smoke-free environment increased from 17.3% in 1998 to 50.9% in 2002 (p < 0.001). Significantly more respondents (45.5%) working in stand alone bars were concerned about the effects of SHS on their health, comparing to 21.6% in 1998 (p < 0.001). When patrons smoked in the bar, 82.1% of stand alone bar owners or staff in the 2002 survey would ask them to stop or to smoke outside, increased from only 43.0% in the 1998 survey (p < 0.001).

Conclusion: A positive and significant attitudinal change related to the smoke-free bar law occurred among California bars.

     

Legislation reduces exposure to second-hand tobacco smoke in New Zealand bars by about 90%

Aim

To measure exposure to second‐hand smoke (SHS) in New Zealand bars before and after comprehensive smoke‐free legislation enacted on 10 December 2004.

Methods

Cotinine is the main specific metabolite of nicotine and a well‐established biomarker for SHS exposure. We measured cotinine levels in saliva of non‐smoking volunteers before and after a 3 h visit to 30 randomly selected bars in 3 cities across the country. Two measures of cotinine before the smoke‐free law change during winter and spring 2004, and two follow‐up measurements in the same volunteers and venues during winter and spring 2005, were included.

Results

Before the smoke‐free law change, in all bars and in all volunteers, exposure to SHS was evident with an average increase in saliva cotinine of 0.66 ng/ml (SE 0.03 ng/ml). Increases in cotinine correlated strongly with the volunteers'' subjective observation of ventilation, air quality and counts of lit cigarettes. However, even venues that were judged to be “seemingly smoke free” with “good ventilation” produced discernable levels of SHS exposure. After the law change, there remained some exposure to SHS, but at much lower levels (mean saliva cotinine increase of 0.08 ng/ml, SE 0.01 ng/ml). Smoking indoors in bars was almost totally eliminated: in 2005 only one lit cigarette was observed in 30 visits.

Conclusions

Comprehensive smoke‐free legislation in New Zealand seems to have reduced exposure of bar patrons to SHS by about 90%. Residual exposures to SHS in bars do not result from illicit smoking indoors.Before December 2004, smoking was prohibited in most, but not all, workplaces in New Zealand. Bars, restaurants and hotels were not required to be smoke free. This changed on 10 December 2004 when the Smokefree Environments Amendment Act 2003 came into force. Since that time, smoking is not permitted in any indoor place of work. After Ireland, which passed its legislation in March 2004, New Zealand was one of the first countries to introduce national, comprehensive smoke‐free legislation.The purpose of this study was to measure the impact of this legislation on personal exposures to second‐hand smoke (SHS) in New Zealand bars. Previous papers^1,2,3 have described exposures of bar workers in Ireland, New York and Scotland before and after legislation. The effects of reduced exposures to SHS on the respiratory health of employees in this industry have also been documented.^3,4 However, we know of no other study that has examined the effects of smoke‐free laws on exposures of the patrons of bars and hotels. In an earlier publication,⁵ we have described in greater detail the analytical methods and findings at baseline.     

Secondhand smoke exposure in Mexican discotheques.

This study describes the impact of exposure to secondhand smoke for subjects who spend time in a discotheque, by comparing within-subject baseline and postexposure urinary cotinine levels. A total of 100 nonsmoking volunteers from a central region of Mexico provided a urine sample before entering a discotheque and another sample an average of 6 hr after the end of exposure. Concentrations of cotinine and its metabolite, trans-3'-hydroxycotinine, were measured in the urine by liquid chromatography-mass spectrometry. In females the average preexposure level of urinary cotinine was 2.2 ng/ml, and the average postexposure level was significantly higher, at 15.7 ng/ml. In males the average preexposure level of cotinine was 3.7 ng/ml, compared with 49.1 ng/ml in the postexposure assessment. The highest postexposure values were found in men younger than 22 years old with a value of 469.5 ng/ml. Exposure to secondhand smoke is a serious health risk. Our findings are important given that many of our subjects were exposed to substantial amounts of secondhand smoke in discotheques, as evidenced by the high urinary cotinine and 3'-hydroxycotinine concentrations. These findings support the need to prohibit smoking in discotheques to protect nonsmokers' health.     

Exposure to fine and ultrafine particles from secondhand smoke in public places before and after the smoking ban, Italy 2005

Background

A smoking ban in all indoor public places was enforced in Italy on 10 January 2005.

Methods

We compared indoor air quality before and after the smoking ban by monitoring the indoor concentrations of fine (<2.5 μm diameter, PM_2.5) and ultrafine particulate matter (<0.1 μm diameter, UFP). PM_2.5 and ultrafine particles were measured in 40 public places (14 bars, six fast food restaurants, eight restaurants, six game rooms, six pubs) in Rome, before and after the introduction of the law banning smoking (after 3 and 12 months). Measurements were taken using real time particle monitors (DustTRAK Mod. 8520 TSI; Ultra‐fine Particles Counter‐TRAK Model 8525 TSI). The PM_2.5 data were scaled using a correction equation derived from a comparison with the reference method (gravimetric measurement). The study was completed by measuring urinary cotinine, and pre‐law and post‐law enforcement among non‐smoking employees at these establishments

Results

In the post‐law period, PM_2.5 decreased significantly from a mean concentration of 119.3 μg/m³ to 38.2 μg/m³ after 3 months (p<0.005), and then to 43.3 μg/m³ a year later (p<0.01). The UFP concentrations also decreased significantly from 76 956 particles/cm³ to 38 079 particles/cm³ (p<0.0001) and then to 51 692 particles/cm³ (p<0.01). Similarly, the concentration of urinary cotinine among non‐smoking workers decreased from 17.8 ng/ml to 5.5 ng/ml (p<0.0001) and then to 3.7 ng/ml (p<0.0001).

Conclusion

The application of the smoking ban led to a considerable reduction in the exposure to indoor fine and ultrafine particles in hospitality venues, confirmed by a contemporaneous reduction of urinary cotinine.     

Public opinion on smoke-free policies in restaurants and predicted effect on patronage in Hong Kong

BACKGROUND: The Hong Kong government has proposed legislation for smoke-free policies in all restaurants and bars. This is opposed by certain sections of the catering industry. OBJECTIVE: To assess public opinion on smoke-free restaurants and to estimate changes in patronage. DESIGN: A population based, cross sectional random digit dialling telephone survey conducted from November 1999 to January 2000. SETTING AND PARTICIPANTS: 1077 randomly selected subjects age 15 years or over (response fraction of 81.6%). RESULTS: 68.9% (95% confidence interval (CI) 66.2% to 71.7%) supported a totally smoke-free policy in restaurants. Experiences of discomfort or symptoms from second hand smoke in restaurants were common. The majority (77.2%, 95% CI 74.7% to 79.7%) anticipated no change in their frequency of use of restaurants after a smoke-free policy. Increased use was predicted by 19.7% (95% CI 17.3% to 22.1%) of respondents, whereas 3.2% (95% CI 2.2% to 4.4%) stated that they would dine out less often. In multivariate analyses, non-smokers (adjusted odds ratio (OR) 4.9), people who ate three times or less per week in restaurants as compared to those who ate >10 times per week (OR 2.1), those who had previous experience of discomfort from exposure to passive smoking in restaurants (OR 2.8), or who had avoided restaurants in the past because of smoking (OR 1.9), were more likely to support a totally smoke-free policy in restaurants. Smoke-free policies do not appear to have an adverse effect on restaurants, and may increase business by a considerable margin. CONCLUSION: This comprehensive survey-the first in Asia-shows strong community support for smoke-free dining and predicts an overall increase in the patronage of restaurants after the introduction of legislation for totally smoke-free restaurants.     

Accuracy of parental reporting of secondhand smoke exposure: The National Health and Nutrition Examination Survey III.

The accuracy of parental reports of youth secondhand smoke exposure has received limited attention in the research literature. Such reports were compared to serum cotinine levels among participants of the National Health and Nutrition Examination Survey III who were aged 4-16 years. Likely smokers with serum cotinine values of 14 ng/ml or more and self-reported tobacco users were excluded from the analysis (n = 87), leaving 2,524 youth participants. One adult guardian, typically the parent, was asked to identify household smokers and estimate the number of cigarettes smoked in the home. Using cotinine levels of at least 0.2 ng/ml as the criterion, we found the sensitivity and specificity of any reported smokers in the home to be .65 and .92, respectively. Spearman correlations between cotinine levels and the number of smokers and the number of cigarettes consumed in the household were .67 and .68, respectively, and varied little across subgroups, including age, gender, and ethnicity of the child as well as household poverty status and educational attainment of the parent. Parental reports of household smoking alone fail to capture all youth secondhand smoke exposures, but they correlate well with cotinine levels when expressed as the number of household smokers or the number of cigarettes smoked in the household. Additional research is needed to determine whether reliance on parental reports of secondhand smoke exposure leads to bias in studies examining health outcomes in children and adolescents. Also, additional research is needed to better determine the level of secondhand smoke exposure that is biologically important in children and adolescents.     

Smoke-free laws and secondhand smoke exposure in US non-smoking adults, 1999-2002

Objectives

To investigate the relationship between smoke‐free law coverage and secondhand smoke (SHS) exposure in the United States non‐smoking adult population.

Design

We used data from the 1999–2002 National Health and Nutrition Examination Survey, a cross‐sectional survey designed to monitor the health and nutritional status of the US population. Serum cotinine levels were available for 5866 non‐smoking adults from 57 survey locations. Each location was categorised into one of three groups indicating extensive, limited, and no coverage by a smoke‐free law.

Main outcome measures

The proportion of adults with SHS exposure, defined as having serum cotinine levels ⩾ 0.05 ng/ml.

Results

Among non‐smoking adults living in counties with extensive smoke‐free law coverage, 12.5% were exposed to SHS, compared with 35.1% with limited coverage, and 45.9% with no law. Adjusting for confounders, men and women residing in counties with extensive coverage had 0.10 (95% confidence interval (CI) 0.06 to 0.16) and 0.19 (95% CI 0.11 to 0.34) times the odds of SHS exposure compared to those residing in counties without a smoke‐free law.

Conclusions

These results support the scientific evidence suggesting that smoke‐free laws are an effective strategy for reducing SHS exposure.     

Effect of local restaurant smoking regulations on progression to established smoking among youths

Background: While smoke-free restaurant laws are intended to protect the public from secondhand smoke exposure, they may also discourage smoking among adolescents. There is no evidence from longitudinal studies to test this hypothesis. Objective: To examine the effect of local restaurant smoking regulations on progression to established smoking among adolescents. Design, setting, and subjects: A cohort of 2623 Massachusetts youths, ages 12–17 years at baseline, was interviewed via random digit dial telephone survey in 2001–2002 and followed up two years later. A generalised estimating equations (GEE) logistic regression analysis was used and controlled for potential individual, household, and town level confounding factors. Main outcome measure: Progression to established smoking during the two year follow up period (defined as having smoked 100 or more cigarettes in one''s life). Results: Compared to youths living in towns with weak regulations, those living in towns with strong regulations (complete restaurant smoking bans) had less than half the odds of progression to established smoking (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.24 to 0.66). The association was stronger for youths in towns with strong regulations in effect for two or more years (OR 0.11, 95% CI 0.03 to 0.37), although it was still present for those in towns with strong regulations in effect for less than two years (OR 0.55, 95% CI 0.33 to 0.90). No relationship was found between living in a town with a medium restaurant smoking regulation (restriction of smoking to enclosed, separately ventilated areas) and rates of progression to established smoking. Conclusions: Local restaurant smoking bans may be an effective intervention to prevent youth smoking.     

Gesundheitliche Risiken durch Tabakrauchbelastung in Gastronomiebetrieben

Tobacco smoke is a complex mixture of thousands of components. Some 250 of these are toxic or carcinogenic. Exposure to second-hand smoke is associated with an increased risk of cardiovascular diseases, stroke, respiratory diseases, and lung cancer. In Germany every year more than 3300 persons are dying from diseases caused by second-hand smoke. In German hospitality venues, where actually smoking is allowed, there is a high exposure to second-hand smoke. Experience from other countries, where the hospitality industry is already smoke-free, shows that smoke-free policies ameliorate the air quality and the health of hospitality workers. Separated smoking rooms as well as ventilation and filtration means are no alternative to completely smokefree environments. Eingegangen: 21. Mai 2007; angenommen 30. Mai 2007     

Smoke-free cafe in an unregulated European city: highly welcomed and economically successful

Objective: In a unique setting with two identical cafes, which only differed in their smoking ordinances, this study assessed the influence of smoking policies on the choice of the cafe, investigated regulatory preferences among customers, and evaluated the claim that smoking cafes have better sales performance in a city without smoking bans.

Methods: In a parallel assessment, customers of both cafes answered a questionnaire. Sales were compared and air pollutants were measured to confirm air quality differences.

Results: The two customer groups (n = 177) differed only with regard to smoking status (p < 0.01). The smoking regulation was the most often cited selection criterion (83%). In the non-smoking café, 89% indicated that they were usually annoyed by smoke in coffee houses, and 62% would avoid or leave cafes for this reason. Two thirds stated that all cafe/restaurants should offer the opportunity of a smoke-free environment. However, almost half stated that mandatory regulations are not needed and that customers should make individual arrangements based on tolerance and courtesy. Those who were informed about the health effects of secondhand smoke were more likely to call for clear policies. Whereas sales showed no differences, tips were 22% (p < 0.001) higher in the non-smoking cafe.

Conclusion: In a generation raised in smoking friendly environments, customers paradoxically ask for a landmark shift towards smoke-free opportunities, while substantially adhering to the tobacco industry paradigm of promoting "tolerance" rather than smoke-free policies. Given the clear preference of a large number of customers, hospitality businesses could, however, greatly profit from offering smoke-free environments even in the absence of regulatory policies.

     

Diagnostic accuracy of NicAlert cotinine test strips in saliva for verifying smoking status.

Semiquantitative immunoassay technology, in the form of rapid test strips, offers a less time-consuming and less costly alternative to other methods of verifying self-reported smoking status, such as gas chromatography-nitrogen phosphorus detection (GC). Unfortunately, information on the validity and reliability of some test strips in urine and saliva samples is not always available. This paper describes the diagnostic accuracy of one type of test strip currently available (NicAlert cotinine test strips; NCTS). GC was used as the reference standard and saliva as the sample medium. The study involved 86 people (41 smokers and 45 nonsmokers) aged 18 years or over, who were able to understand written English and provide written consent. Pregnant women, women with infants less than 6 weeks old, and people who had eaten 30 min prior to sample collection were excluded. Two saliva samples were collected simultaneously from each participant, with one sample tested using NCTS and the other by GC analysis. People with at least 10 ng/ml cotinine (in both tests) in their saliva were considered smokers. NCTS were found to have a specificity of 95% (95% CI 89%-100%), a sensitivity of 93% (95% CI 85%-100%), a positive predictive value of 95% (95% CI 89%-100%), and a negative predictive value of 93% (95% CI 86%-100%). The use of NCTS is a valid and reliable method, compared with GC, to test saliva samples for verification of smoking status.     

Gesundheitliche Risiken durch Tabakrauchbelastung in Gastronomiebetrieben

Tobacco smoke is a complex mixture of thousands of components. Some 250 of these are toxic or carcinogenic. Exposure to second-hand smoke is associated with an increased risk of cardiovascular diseases, stroke, respiratory diseases, and lung cancer. In Germany every year more than 3300 persons are dying from diseases caused by second-hand smoke. In German hospitality venues, where actually smoking is allowed, there is a high exposure to second-hand smoke. Experience from other countries, where the hospitality industry is already smoke-free, shows that smoke-free policies ameliorate the air quality and the health of hospitality workers. Separated smoking rooms as well as ventilation and filtration means are no alternative to completely smokefree environments.     

Smoke-free air policies: past, present and future

Smoke-free policies have been an important tobacco control intervention. As recently as 20 years ago, few communities required workplaces and hospitality venues to be smoke-free, but today approximately 11% of the world's population live in countries with laws that require these places to be smoke-free. This paper briefly summarises important milestones in the history of indoor smoke-free policies, the role of scientific research in facilitating their adoption, a framework for smoke-free policy evaluation and industry efforts to undermine regulations. At present, smoke-free policies centre on workplaces, restaurants and pubs. In addition, many jurisdictions are now beginning to implement policies in outdoor areas and in shared multiunit housing settings. The future of smoke-free policy development depends on credible scientific data that documents the health risks of secondhand smoke exposure. Over the next 20 years smoke-free policies will very likely extend to outdoor and private areas, and changes in the types of tobacco products that are consumed may also have implications for the nature and scope of the smoke-free policies of the future.     

Exposure to secondhand smoke in Germany: air contamination due to smoking in German restaurants, bars, and other venues.

This study quantified exposure to secondhand smoke in German restaurants, bars, and entertainment venues by determining the concentration of respirable suspended particles measuring 2.5 microm or less (PM2.5) in indoor air. The measurements were taken using an inconspicuous device placed on the investigator's table in the venue. The concentration of particulate matter in the indoor air was measured for a minimum of 30 min. A total of 39 restaurants, 20 coffee bars, 12 bars, 9 discothèques, and 20 restaurant cars in trains were visited throughout Germany from September 30 to October 31, 2005. The readings disclosed a median PM2.5 of 260 microg/m3 and an arithmetic mean PM2.5 of 333 microg/m3. Median values were 378 microg/m3 in bars, 131 microg/m3 in cafes, and 173 microg/m3 in restaurants. The highest medians were measured in discothèques and restaurant cars, with values averaging 432 microg/m3 and 525 microg/m3 PM2.5, respectively. This study was the first to show the magnitude and extent of exposure to secondhand smoke on such an extensive scale in Germany. The contaminated air due to smoking is a human carcinogenic and major health hazard, which would be prevented most effectively and completely by implementing a ban on smoking. This study is important for the ongoing national debate in Germany as well as for debates in all countries without smoke-free air legislation, which includes most countries around the world.     

Exposure to second-hand smoke air pollution assessed from bar patrons' urinary cotinine.

We used physical and pharmacokinetic modeling to estimate personal exposures to respirable particle (RSP) and carcinogenic particulate polycyclic aromatic hydrocarbon (PPAH) air pollution from second-hand smoke (SHS) from the increase in urinary cotinine of eight patrons of three bars in Bismarck, North Dakota. We compared SHS-RSP levels to the U.S. Air Quality Index (AQI), used to forecast outdoor air pollution conditions. We measured smoker density and air exchange rates to generalize our results. Urinary cotinine increased by an average of 4.28 ng/ml to 6.88 ng/ml to 9.55 ng/ml above preexposure background from 6-hr exposures in the three bars. Corresponding estimated SHS-RSP levels were, respectively, 246 microg/m3, 396 microg/m3, and 549 microg/m3, comparable to those measured in 6 Wilmington, Delaware, bars and in 14 western New York bars. Estimated personal SHS-RSP air pollution exposures for the eight subjects, when converted to the 24-hr averaging time of the AQI, were "code red" (unhealthy). Measured outdoor air quality RSP levels for the same period were 1%-3% of the indoor RSP levels in the three bars, and were AQI "code green" (healthy). Estimated SHS-PPAH levels were comparable to peak 3-hr PPAH levels reported at a highway tollbooth. Bismarck cotinine-estimated SHS-RSP varied with smoker density, as did measured SHS-RSP levels in smoking bars in Delaware and New York. Our results show that smoking in bars produces levels of personal air pollution for bar patrons that merit air pollution alerts when sustained in the outdoor air.     

A cross country comparison of exposure to secondhand smoke among youth

Secondhand smoke or environmental tobacco smoke is a combination of smoke from a burning cigarette and exhaled smoke from a smoker. This substance is an involuntarily inhaled mix of compounds that causes or contributes to a wide range of adverse health effects, including cancer, cardiovascular diseases, respiratory infections, adverse reproductive effects, and asthma. This paper presents findings from Global Youth Tobacco Surveys (GYTS) conducted in 132 countries between 1999 and 2005. GYTS data indicate that a large proportion of students in every World Health Organization Region are exposed to secondhand smoke at home (43.9%) and in public places (55.8%), and many have parents (46.5%) or best friends who smoke (17.9%). GYTS data have shown widespread and strong support among students for bans on smoking in public areas all over the world (76.1%). Countries should engage this positive public health attitude among youth to promote and enforce policies for smoke-free public places and workplaces, including restaurants and bars.