Second-Hand Tobacco Smoke Exposure in Open and Semi-Open Settings: A Systematic Review.

Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL
Environmental Health Perspectives (Impact Factor: 7.98). 05/2013; 121(7). DOI: 10.1289/ehp.1205806
Source: PubMed


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), “PM2.5” (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 PM2.5 concentration as an SHS marker. Mean PM2.5 concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m3 at hospitality venues, and 4.60 to 17.80 µg/m3 at other locations. Mean PM2.5 concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m3. 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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Available from: Esteve Fernández, Mar 04, 2014
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    • "Since January 2003 the Italian Government declared a national ban for cigarette smoking in indoor public places and workplaces, but nowadays some health concerns are arising from outdoor secondhand smoke (SHS) exposure for non-smokers, particularly near the public place entrances such as restaurants, bars, facilities of big industrial factories and hospital venues. Several studies in literature confirm the contribution of SHS to the outdoor environmental pollution and to poor air quality1234567891011. Health concerns regard not only never smokers, but also smoker employees. "
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    ABSTRACT: Background: Indoor smoking in public places and workplaces is forbidden in Italy since 2003, but some health concerns are arising from outdoor secondhand smoke (SHS) exposure for non-smokers. One of the biggest Italian Steel Manufacturer, with several factories in Italy and abroad, the Marcegaglia Group, recently introduced the outdoor smoking ban within the perimeter of all their factories. In order to encourage their smoker employees to quit, the Marcegaglia management decided to set up an educational framework by measuring the PM1, PM2.5 and PM10 emissions from heavy duty trucks and to compare them with the emissions of cigarettes in an indoor controlled environment under the same conditions. Methods: The exhaust pipe of two trucks powered by a diesel engine of about 13.000/14.000 cc(3) were connected with a flexible hose to a hole in the window of a container of 36 m(3) volume used as field office. The trucks operated idling for 8 min and then, after adequate office ventilation, a smoker smoked a cigarette. Particulate matter emission was thereafter analyzed. Results: Cigarette pollution was much higher than the heavy duty truck one. Mean of the two tests was: PM1 truck 125.0(47.0), cigarettes 231.7(90.9) p = 0.002; PM2.5 truck 250.8(98.7), cigarettes 591.8(306.1) p = 0.006; PM10 truck 255.8(52.4), cigarettes 624.0(321.6) p = 0.002. Conclusions: Our findings may be important for policies that aim reducing outdoor SHS exposure. They may also help smokers to quit tobacco dependence by giving them an educational perspective that rebuts the common alibi that traffic pollution is more dangerous than cigarettes pollution.
    Full-text · Article · Dec 2015
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    • "• Australia, Canada, New Zealand, United States, Denmark, and Spain. Sureda et al. (2013) "
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    ABSTRACT: Honorable members of the National Assembly, my name is James Repace. I am a physicist. I served 19 years as a senior air policy analyst for the U.S. Environmental Protection Agency in Washington, DC. Now retired, I do consulting on indoor and outdoor air pollution from secondhand smoke. I have published 56 peer-reviewed research papers on the hazard, exposure, dose, risk, and control of secondhand smoke. I strongly support all provisions of Bill 44, including the ban on smoking on outdoor terraces of bars and restaurants, which will protect the health of both nonsmoking bar and restaurant wait staff and patrons. There is a scientific consensus that secondhand smoke poses dire risks to human health. It is a known human carcinogen. It has immediate adverse effects on the cardiovascular system and chronic exposure causes fatal heart disease. There is no known risk-free level of exposure to secondhand smoke. A high proportion of non-smokers report eye irritation, headache, nasal discomfort, coughing, sore throat, or sneezing when exposed to secondhand smoke. Even brief exposures can induce sensory irritation in healthy nonsmokers at very low levels, which increases with duration of exposure. A U.S. study of nonsmokers' body fluids demonstrated that nonsmokers exposed to secondhand smoke on the outdoor terraces of a bar and a restaurant for just 3 hours absorbed significant doses of secondhand smoke fine particles and carcinogens. I calculate from their data that the nonsmokers' fine particulate matter exposure from secondhand smoke constitutes Code Red or Very Poor Air Quality when evaluated by the 3-hour Canadian Air Quality Index. Risk assessment shows that this exposure constitutes a "significant risk of material impairment of health" by the standards of the US Occupational Safety and Health Administration. Separation of the outdoor patios into smoking and nonsmoking sections would only serve to increase the secondhand smoke exposure of the estimated 16,625 nonsmoking Quebec restaurant and bar wait staff who would serve in the smoking sections of bar and restaurant terraces. Nonsmoking sections on terraces would also fail to protect nonsmoking patrons from secondhand smoke carried by the wind from the smoking sections. The results of 13 field studies in as many countries demonstrate that fine particulate matter air pollution on outdoor terraces is overwhelmingly higher than that from heavy street traffic. A study commissioned by The Union of Bar Owners of Quebec asserts that “Air quality on open-air terraces would not be significantly affected by smokers,” by a separation of only 1.5 meters. However, this claim is contradicted by three different U.S. studies which showed that harmful levels of secondhand smoke fine particles and carcinogens from a single cigarette smoked on outdoor terraces occurred at downwind distances ranging from 4 to 7 to 13 meters. Because these secondhand smoke pollutants decline inversely with distance, smoke from multiple smokers will reach out proportionally to greater distances. Thus, the smoking section separation distance of 1.5 meters proposed by The Union of Bar Owners of Quebec must be rejected in favor of a total terrace smoking ban as proposed by Bill 44. Thank You for the opportunity to testify. My remarks are detailed in my written testimony. I would be pleased to answer any questions.
    Full-text · Conference Paper · Sep 2015
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    • "no roofing, no high walls). Sureda and colleagues (2013) also found measured levels of SHS to be generally higher where smoker density was high, smokers were nearby and where the outdoor smoking area was more enclosed. 13 Lower wind speeds are generally associated with higher PM 2.5 concentrations in urban settings. "
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    ABSTRACT: Aim: To examine levels of fine particulates of secondhand smoke (SHS) in outdoor dining/smoking areas and the adjacent indoor dining areas of restaurants to assess possible drift via open windows/doors. Method: We measured fine particulates (PM2.5 mcg/m³) with real-time aerosol monitors as a marker of SHS inside where smoking is banned and outside dining areas (which permit smoking) of eight restaurants in Wellington. We also collected related background data (e.g. number of smokers, time windows/doors were open, etc.). Results: Highest overall mean PM2.5 levels were observed in the outdoor dining areas (38 mcg/m³), followed by the adjacent indoor areas (34 mcg/m³), the outdoor ambient air (22 mcg/m³) and the indoor areas at the back of the restaurant (21 mcg/m³). We found significantly higher PM2.5 levels indoor near the entrance compared to indoor near the back of the restaurant (p=0.006) and in the outdoor smoking area compared to outdoor ambient levels (p<0.001). Importantly, we did not detect a significant difference in mean PM2.5 levels in outdoor smoking areas and adjacent indoor areas (p=0.149). Conclusion: Similar PM2.5 concentrations in the outdoor and adjacent indoor dining areas of restaurants might indicate SHS drifting through open doors/windows. This may especially be a problem when smoking patronage is high, the outdoor dining area is enclosed, and during peak summer season when restaurants generally have all doors and windows opened. Tighter restrictions around outdoor smoking at restaurants, to protect the health of both patrons and staff members, may be needed.
    Full-text · Article · Jun 2014 · The New Zealand medical journal
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