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Second-hand smoke exposure in indoor and outdoor areas of cafés and restaurants: Need for extending smoking regulation outdoors?
Environ Res. 2016 07; 148:421-428.ER

Abstract

Smoke-free legislation in indoor public places has concentrated smokers in the areas outside building entrances or other outdoor areas. This study assessed the drift of second-hand smoke between outdoor and indoor areas of cafés and restaurants in Barcelona, Spain, and characterized the exposure on outdoor terraces. Using a cross-sectional design, we monitored vapor-phase nicotine in indoor areas and outside entrances simultaneously (n=47), and on some outdoor terraces (n=51). We computed the median nicotine concentration and interquartile range (IQR) to describe the data and performed multivariate analysis to describe nicotine concentration and its determinants. The overall median nicotine concentration indoors was 0.65µg/m(3) (IQR: 0.29-1.17µg/m(3)), with significant differences based on the number of smokers at the entrance (p=0.039). At outside entrances, the overall median nicotine concentration was 0.41µg/m(3) (IQR: 0.21-1.17µg/m(3)). The nicotine concentrations indoors and at the corresponding outside entrances were not significantly different, and the multivariate analysis confirmed the relationship between these variables. On terraces, the overall median nicotine concentration was 0.54µg/m(3) (IQR: 0.25-1.14µg/m(3)), but it increased to 0.60µg/m(3) when a tobacco smell was perceived, 0.72µg/m(3) on closed terraces, 1.24µg/m(3) when there were >6 smokers, and 1.24µg/m(3) when someone smoked >20min. Multivariate analysis confirmed the outdoor terrace area, the season, the type of enclosure, and the number of smokers as the most relevant variables explaining nicotine concentration (R(2)=0.396). These findings show that second-hand smoke exposure exists in indoor areas due to smokers smoking at the outside entrances. In addition, exposure may occur on outdoor terraces when smokers are present and the terrace is enclosed to some extent. Thus, the current Spanish law does not fully protect non-smokers from second-hand smoke and supports extending regulation to some outdoor areas.

Authors+Show Affiliations

Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain. Electronic address: efernandez@iconcologia.net.Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain.Chemistry Area, Agència de Salut Pública de Barcelona, Av. Drassanes, 13, 08001 Barcelona, Spain; Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain.Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.Chemistry Area, Agència de Salut Pública de Barcelona, Av. Drassanes, 13, 08001 Barcelona, Spain; Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain.Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Public Health, School of Medicine, Universitat de Barcelona, C. Casanova 143, 08036 Barcelona, Spain; Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Trav. Les Corts, 131-159 - Pavelló Ave Maria, 08028 Barcelona, Spain.Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain; Evaluation and Intervention Methods Service, Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27131796

Citation

Fu, Marcela, et al. "Second-hand Smoke Exposure in Indoor and Outdoor Areas of Cafés and Restaurants: Need for Extending Smoking Regulation Outdoors?" Environmental Research, vol. 148, 2016, pp. 421-428.
Fu M, Fernández E, Martínez-Sánchez JM, et al. Second-hand smoke exposure in indoor and outdoor areas of cafés and restaurants: Need for extending smoking regulation outdoors? Environ Res. 2016;148:421-428.
Fu, M., Fernández, E., Martínez-Sánchez, J. M., San Emeterio, N., Quirós, N., Sureda, X., Ballbè, M., Muñoz, G., Riccobene, A., Centrich, F., Saltó, E., & López, M. J. (2016). Second-hand smoke exposure in indoor and outdoor areas of cafés and restaurants: Need for extending smoking regulation outdoors? Environmental Research, 148, 421-428. https://doi.org/10.1016/j.envres.2016.04.024
Fu M, et al. Second-hand Smoke Exposure in Indoor and Outdoor Areas of Cafés and Restaurants: Need for Extending Smoking Regulation Outdoors. Environ Res. 2016;148:421-428. PubMed PMID: 27131796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Second-hand smoke exposure in indoor and outdoor areas of cafés and restaurants: Need for extending smoking regulation outdoors? AU - Fu,Marcela, AU - Fernández,Esteve, AU - Martínez-Sánchez,Jose M, AU - San Emeterio,Noemi, AU - Quirós,Nuria, AU - Sureda,Xisca, AU - Ballbè,Montse, AU - Muñoz,Glòria, AU - Riccobene,Anna, AU - Centrich,Francesc, AU - Saltó,Esteve, AU - López,María J, Y1 - 2016/04/28/ PY - 2015/12/31/received PY - 2016/04/19/revised PY - 2016/04/20/accepted PY - 2016/5/2/entrez PY - 2016/5/2/pubmed PY - 2017/4/26/medline KW - Air marker KW - Nicotine KW - Outdoor tobacco smoke KW - Passive smoking KW - Second-hand smoke KW - Smoking ban KW - Tobacco smoke pollution SP - 421 EP - 428 JF - Environmental research JO - Environ Res VL - 148 N2 - Smoke-free legislation in indoor public places has concentrated smokers in the areas outside building entrances or other outdoor areas. This study assessed the drift of second-hand smoke between outdoor and indoor areas of cafés and restaurants in Barcelona, Spain, and characterized the exposure on outdoor terraces. Using a cross-sectional design, we monitored vapor-phase nicotine in indoor areas and outside entrances simultaneously (n=47), and on some outdoor terraces (n=51). We computed the median nicotine concentration and interquartile range (IQR) to describe the data and performed multivariate analysis to describe nicotine concentration and its determinants. The overall median nicotine concentration indoors was 0.65µg/m(3) (IQR: 0.29-1.17µg/m(3)), with significant differences based on the number of smokers at the entrance (p=0.039). At outside entrances, the overall median nicotine concentration was 0.41µg/m(3) (IQR: 0.21-1.17µg/m(3)). The nicotine concentrations indoors and at the corresponding outside entrances were not significantly different, and the multivariate analysis confirmed the relationship between these variables. On terraces, the overall median nicotine concentration was 0.54µg/m(3) (IQR: 0.25-1.14µg/m(3)), but it increased to 0.60µg/m(3) when a tobacco smell was perceived, 0.72µg/m(3) on closed terraces, 1.24µg/m(3) when there were >6 smokers, and 1.24µg/m(3) when someone smoked >20min. Multivariate analysis confirmed the outdoor terrace area, the season, the type of enclosure, and the number of smokers as the most relevant variables explaining nicotine concentration (R(2)=0.396). These findings show that second-hand smoke exposure exists in indoor areas due to smokers smoking at the outside entrances. In addition, exposure may occur on outdoor terraces when smokers are present and the terrace is enclosed to some extent. Thus, the current Spanish law does not fully protect non-smokers from second-hand smoke and supports extending regulation to some outdoor areas. SN - 1096-0953 UR - https://www.unboundmedicine.com/medline/citation/27131796/Second_hand_smoke_exposure_in_indoor_and_outdoor_areas_of_cafés_and_restaurants:_Need_for_extending_smoking_regulation_outdoors L2 - https://linkinghub.elsevier.com/retrieve/pii/S0013-9351(16)30150-5 DB - PRIME DP - Unbound Medicine ER -