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Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries.
Environ Res. 2021 09; 200:111355.ER

Abstract

OBJECTIVE

Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants.

METHODS

Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants.

RESULTS

Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) μg/m3 and increased during nighttime (1.45 IQR:0.65-4.79 μg/m3), in enclosed venues (2.97 IQR:0.80-5.80 μg/m3), in venues with more than two smokers (2.79 IQR:1.03-6.30 μg/m3), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 μg/m3), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 μg/m3). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues' degree of enclosure.

CONCLUSIONS

Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.

Authors+Show Affiliations

Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain.Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona, Feixa Llarga, S/n, 08907, L'Hospitalet de Llobregat, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain.Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona, Feixa Llarga, S/n, 08907, L'Hospitalet de Llobregat, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain.Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy.Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy.Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, Scotland, UK.Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, Scotland, UK.TobaccoFree Research Institute Ireland, Dublin, Ireland.TobaccoFree Research Institute Ireland, Dublin, Ireland.Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy.Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy.George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Str., Athens, 10557, Greece.George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Str., Athens, 10557, Greece.Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Via Cosimo Il Vecchio, 2, 50139, Florence, Italy.Universidad Politécnica de Cartagena (UPCT), Plaza Cronista Isidoro Valverde, S/n, 30202, Cartagena, Spain.Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Hospital Universitario La Princesa (IISP), Diego de León, 62, Planta 6, 28006, Madrid, Spain; Universidad Autónoma de Madrid (UAM), Ciudad Universitaria de Cantoblanco, 28049, Madrid, Spain; Instituto Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain.Smoke-free Life Coalition, Slivnitsa Blvd, 257, 1202, Sofia, Bulgaria.OFT Conseil, Office Français de Santé et Bien-être Au Travail, Rue Gobert, 12, 75011Paris, France.Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, 280, 69120, Heidelberg, Germany; Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50923, Cologne, Germany.Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena, 5, 02-781, Warsaw, Poland; The Foundation Smart Health - Health in 3D, Warsaw, Poland; Collegium Civitas, 1 Defilad Square, 00-901, Warsaw, Poland.Instituto de Educação, Universidade do Minho, 4710-057, Braga, Portugal.Healthy Romania Generation 2035 Association, Bucharest, Romania.Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain. Electronic address: mjlopez@aspb.cat.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34022230

Citation

Henderson, Elisabet, et al. "Secondhand Smoke Exposure Assessment in Outdoor Hospitality Venues Across 11 European Countries." Environmental Research, vol. 200, 2021, p. 111355.
Henderson E, Continente X, Fernández E, et al. Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries. Environ Res. 2021;200:111355.
Henderson, E., Continente, X., Fernández, E., Tigova, O., Cortés-Francisco, N., Gallus, S., Lugo, A., Semple, S., Dobson, R., Clancy, L., Keogan, S., Ruprecht, A., Borgini, A., Tzortzi, A., Vyzikidou, V. K., Gorini, G., López-Nicolás, A., Soriano, J. B., Geshanova, G., ... López, M. J. (2021). Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries. Environmental Research, 200, 111355. https://doi.org/10.1016/j.envres.2021.111355
Henderson E, et al. Secondhand Smoke Exposure Assessment in Outdoor Hospitality Venues Across 11 European Countries. Environ Res. 2021;200:111355. PubMed PMID: 34022230.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries. AU - Henderson,Elisabet, AU - Continente,Xavier, AU - Fernández,Esteve, AU - Tigova,Olena, AU - Cortés-Francisco,Nuria, AU - Gallus,Silvano, AU - Lugo,Alessandra, AU - Semple,Sean, AU - Dobson,Ruaraidh, AU - Clancy,Luke, AU - Keogan,Sheila, AU - Ruprecht,Ario, AU - Borgini,Alessandro, AU - Tzortzi,Anna, AU - Vyzikidou,Vergina K, AU - Gorini,Giuseppe, AU - López-Nicolás,Angel, AU - Soriano,Joan B, AU - Geshanova,Gergana, AU - Osman,Joseph, AU - Mons,Ute, AU - Przewozniak,Krzysztof, AU - Precioso,José, AU - Brad,Ramona, AU - López,Maria J, AU - ,, Y1 - 2021/05/19/ PY - 2021/02/10/received PY - 2021/04/20/revised PY - 2021/05/17/accepted PY - 2021/5/23/pubmed PY - 2021/9/7/medline PY - 2021/5/22/entrez KW - Airborne nicotine KW - Hospitality venue KW - Outdoor KW - Smoke-free policies KW - Tobacco-smoke pollution SP - 111355 EP - 111355 JF - Environmental research JO - Environ Res VL - 200 N2 - OBJECTIVE: Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants. METHODS: Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants. RESULTS: Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) μg/m3 and increased during nighttime (1.45 IQR:0.65-4.79 μg/m3), in enclosed venues (2.97 IQR:0.80-5.80 μg/m3), in venues with more than two smokers (2.79 IQR:1.03-6.30 μg/m3), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 μg/m3), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 μg/m3). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues' degree of enclosure. CONCLUSIONS: Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues. SN - 1096-0953 UR - https://www.unboundmedicine.com/medline/citation/34022230/Secondhand_smoke_exposure_assessment_in_outdoor_hospitality_venues_across_11_European_countries_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0013-9351(21)00649-6 DB - PRIME DP - Unbound Medicine ER -