Air Quality/Cotinine Studies

Sureda, X.; Fernandez, E.; Lopez, M.J.; Nebot, M., "Second-hand tobacco smoke exposure in open and semi-open settings: a systematic review," Envirionmental Health Perspectives [Epub ahead of print], May 7, 2013.

This paper reviewed studies of secondhand smoke (SHS) levels in outdoor areas and found that, "SHS levels were 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." The study concluded that, "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."

Licht, A.S.; Hyland, A.; Travers, M.J.; Chapman, S., "Secondhand smoke exposure levels in outdoor hospitality venues: a qualitative and quantitative review of the research literature," Tobacco Control 22(3): 172-179, May 2013.

Conclusions: Although highly transitory, outdoor SHS exposures could occasionally exceed annual ambient air quality exposure guidelines. Personal monitoring studies of waitstaff are warranted to corroborate these modeled estimates.

Lopez, M.J.; Fernandez, E.; Perez-Rios, M.; Martinez-Sanchez, J.M.; Schiaffino, A.; Galan, I.; Moncada, A.; Fu, M.; Montes, A.; Salto, E.; Nebot, M., "Impact of the 2011 Spanish smoking ban in hospitality venues: indoor secondhand smoke exposure and influence of outdoor smoking," Nicotine and Tobacco Research 15(5): 992-996, May 2013.

This study concluded that secondhand smoke (SHS) "exposure in hospitality venues dramatically decreased after the 2011 Spanish smoking ban. SHS from outdoor smokers close to entrances seems to drift inside venues. Smoking control legislation should consider outdoor restrictions to ensure complete protection against SHS. "

Gini, M.; Lianou, M.; Chalbot, M.C.; Kotronarou, A.; Kavouras, I.G.; Helmis, C.G., "Quantification of environmental tobacco smoke contribution on outdoor particulate aliphatic and polycyclic aromatic hydrocarbons," Archives of Environmental Contamination and Toxicology 64(3): 347-356, April 2013.

The objective of this study was to identify and quantify the sources of fine particulate aliphatic and polycyclic aromatic hydrocarbons (PAHs) in an urban area in southeastern Europe. A total of 91 urban PM2.5 samples were analyzed by gas chromatography coupled with mass spectrometry for alkanes and PAHs. Exploratory statistical tools were applied to resolve a decreased number of components based on the variation of measurements. Molecular markers and diagnostic ratios were examined to assign retained components to specific sources. The contributions of the sources were estimated by multivariate linear regression. Sources of aliphatic and PAHs hydrocarbons included primary particles from traffic (3.9 ng/m3 for alkanes and 240 pg/m3 for PAHs), evaporative fugitive (4.0 ng/m3 for alkanes and 93 pg/m3 for PAHs), and unburnt fuels and oil residues (1.1 ng/m3 for alkanes and 230 pg/m3 for PAHs). For the first time, we quantified the contribution of environmental tobacco smoke (ETS), which accounted for 5.2 ng/m3 of alkanes and 128 pg/m3 of PAHs. The findings of this study underlined the persistence of ETS and possible exposures to significant quantities of tobacco residues outdoors. Tobacco smoke is known to induce adverse respiratory and cardiovascular illnesses and increased risk for cancer.

Liu, R.; Jiang, Y.; Travers, M.J.; Li, Q.; Hammond, S.K., "Evaluating the efficacy of different smoking policies in restaurants and bars in Beijing, China: a four-year follow-up study," International Journal of Hygiene and Environmental Health [Epub ahead of print], March 14, 2013.

This air quality study concluded that, "Voluntary smoking policy is rarely adopted and cannot protect people from SHS exposure in restaurants and bars. The 2008 Beijing governmental smoking regulation failed to significantly reduce SHS exposure shortly or two years after its implementation. Restricting smoking to designated sections cannot eliminate SHS exposure."

Ghosh, J.K.; Wilhelm, M.; Ritz, B., "Effects of residential indoor air quality and household ventilation on preterm birth and term low birth weight in Los Angeles County, California," American Journal of Public Health [Epub ahead of print], February 14, 2013.

Conclusions. Residential window ventilation may mitigate the effects of indoor air pollution among pregnant women in Los Angeles County, California.

Thornley, S.; Dirks, K.N.; Edwards, R.; Woodward, A.; Marshall, R., "Indoor air pollution levels were halved as a result of a national tobacco ban in a New Zealand prison," Nicotine and Tobacco Research 15(2): 343-347, February 2013.

Conclusions: Our study showed a rapid and substantial improvement in indoor air quality after tobacco was banned at a prison. We conclude that prisoners have reduced their smoking in line with the ban, and that a significant health hazard has been reduced for staff and prisoners alike.

Christophi, C.A.; Paisi, M.; Pampaka, D.; Kehagias, M.; Vardavas, C.; Connolly, G.N., "The impact of the Cyprus comprehensive smoking ban on air quality and economic business of hospitality venues," BMC Public Health [Epub ahead of print], January 27, 2013.

Results: The median level of PM2.5 associated with secondhand smoking was 161 mug/m3 pre-ban and dropped to 3 mug/m3 post-ban (98% decrease, p < 0.0001). Furthermore, in the year following the ban, the hotel turnover rate increased by 4.1% and the restaurant revenue by 6.4%; employment increased that same year by 7.2% and 1.0%, respectively.

Jones, I.A.; St. Helen, G.; Meyers, M.J.; Dempsey, D.A.; Havel, C.; Jacob, III, P.; Northcross, A.; Hammond, S.K.; Benowitz, N.L., "Biomarkers of secondhand smoke exposure in automobiles," Tobacco Control [Epub ahead of print], January 24, 2013.

The abstract of this study stated, "Eight non-smokers were individually exposed to SHS in cars with fully open front windows and closed back windows over an hour from a smoker who smoked three cigarettes at 20 min intervals. The non-smokers sat in the back seat on the passenger side, while the smoker sat in the driver's seat. Plasma cotinine and urine cotinine, 3-hydroxycotinine (3HC) and 4-(methylnitrosoamino)-(3-pyridyl)-1-butanol (NNAL) were compared in samples taken at baseline (BL) and several time-points after exposure. Nicotine, particulate matter (PM2.5) and carbon monoxide (CO) were measured inside and outside the vehicle and ventilation rates in the cars were measured." The authors concluded that, "Brief SHS exposure in cars resulted in substantial increases in levels of tobacco biomarkers in non-smokers. For optimal characterisation of SHS exposure, tobacco biomarkers should be measured within 4–8 h post-exposure. Additional studies are needed to better describe the relationship between tobacco biomarkers and environmental markers of SHS."

Carlsten, C; Dimich-Ward, H.; DyBuncio, A.; Becker, A.B.; Chan-Yeung, M., "Cotinine versus questionnaire: early-life environmental tobacco smoke exposure and incident asthma," BMC Pediatrics 12:187, December 5, 2012.

This study concluded that, "Biomarker- and questionnaire-based assessment of ETS in early life lead to similar estimates of ETS-associated risk of recurrent wheeze and asthma."

This study examined the effect of secondhand smoke exposure in a simulated car setting and examined its impact on pulmonary function. The authors wrote that, "Brief but elevated exposure to sidestream SHS can alter airway resistance, and impedance indicating a potential additional mechanistic pathway between exposure to SHS and the development of respiratory disease."

Centers for Disease Control and Prevention, "Indoor air quality at nine large-hub airports with and without designated smoking areas – United State, October-November 2012," Morbidity and Mortality Weekly Report 61(46): 948-951, November 23, 2012.

This study examined particulate matter levels in airports with and withotu smoking lounges. The authors wrote that, "To assess indoor air quality at the five large-hub U.S. airports with designated indoor smoking areas and compare it with the indoor air quality at four large-hub U.S. airports that prohibit smoking in all indoor areas, CDC measured the levels of respirable suspended particulates (RSPs), a marker for SHS. The results of this assessment determined that the average level of RSPs in the smoking-permitted areas of these five airports was 16 times the average level in nonsmoking areas (boarding gate seating sections) and 23 times the average level of RSPs in the smoke-free airports. The average RSP level in areas adjacent to the smoking-permitted areas was four times the average level in nonsmoking areas of the five airports with designated smoking areas and five times the average level in smoke-free airports. Smoke-free policies at the state, local, or airport authority levels can eliminate involuntary exposure to SHS inside airports and protect employees and travelers of all ages from SHS."

The study concluded that, "Both employees and travelers at airports with designated smoking areas could be at risk for SHS exposure. For example, travelers who do not enter smoking-permitted areas can be exposed to SHS in adjacent areas. Employees who work in smoking-permitted restaurants and bars, or who are required to enter smoking-permitted areas for cleaning, maintenance, or other reasons, also are at risk for SHS exposure. In addition, children who are allowed to enter or wait near smoking-permitted areas might be at risk for SHS exposure. Completely eliminating smoking inside airports is the only way to eliminate SHS exposure for nonsmoking workers and travelers of all ages."

Wilson, T.; Shamo, F.; Boynton, K.; Kiley, J., "The impact of Michigan's Dr Ron Davis smoke-free air law on levels of cotinine, tobacco-specific lung carcinogen and severity of self-reported respiratory symptoms among non-smoking bar employees," Tobacco Control 21(6): 593-595, November 1, 2012.

Conclusions The reduction in the SHS biomarkers cotinine and NNAL and reported improvement in respiratory health demonstrates that the Michigan smoke-free workplace law is protecting bar employee health.

Sureda, X.; Martinez-Sanchez, J.M.; Lopez, M.J.; Fu, M.; Aguero, F.; Salto, E.; Nebot, M.; Fernandez, E., "Secondhand smoke levels in public building main entrances: outdoor and indoor PM2.5 assessment," Tobacco Control 21(6): 543-548, November 1, 2012.

Conclusions Indoor locations where smoking is banned are not completely free from SHS with levels similar to those obtained in the immediate entrances (outdoors) where smoking is allowed, indicating that SHS from outdoors settings drifts to adjacent indoors. These results warrant a revision of current smoke-free policies in particular outdoor settings.

Cochran, C.; Henriques, D.; York, N.; Lee, K., "Risk of exposure to second hand smoke for adolescents in Las Vegas casinos: an evaluation of the Nevada Clean Indoor Air Act," Journal of Health and Human Services Administration 35(2): 231-252, Fall 2012.

The Nevada Clean Indoor Air Act (NCIAA), a non-comprehensive smoke-free law, permits smoking in designated areas of casinos, bars, and taverns. With many Las Vegas casinos catering to all ages, this study was designed to evaluate the efficacy of NCIAA in protecting children from second hand smoke exposure. Using a device that measures ambient air particle matter concentrations, this study sampled the air quality in 15 casino gaming areas and corresponding non-smoking, children-friendly areas. The results indicate that current policy fails to preserve indoor air quality in these children-friendly areas. Furthermore, this research suggests the adoption of a more comprehensive, 100% smoke-free policy as the only effective remedy.

Repace, J.; Zhang, B.; Bondy, S.J.; Benowitz, N.; Ferrence, R., "Air quality, mortality, and economic benefits of a smoke-free workplace law for non-smoking Ontario bar workers, Indoor.Air [Epub ahead of print] September 24, 2012.

This study estimated the impact of a smoke-free workplace by-law on non-smoking bar workers' health in Ontario, Canada, by measuring urinary cotinine levels before and after the law was implemented. From there, the authors extrapolated the air pollution exposure and mortality risks from workplace secondhand smoke.

Klepeis, N.E.; Omoto, J.; Ong, S.; Sahota Omoto, H.; Dhaliwal, N., "Small proportions of actively-smoking patrons and high PM2.5 levels in southern California tribal casinos: support for smoking bans or designated smoking areas," BMC Public Health 12: 819, September 22, 2012.

This study concluded that, "Although fewer than roughly 10% of casino patrons are actively smoking on average, these
individuals substantially increase PM2.5 exposure for all patrons in smoking and unenclosed nonsmoking areas. Nonsmoking areas may be too inconvenient, small, or undesirable to serve a substantial number of nonsmoking patrons. Imposing indoor smoking bans, or contained smoking areas with a maximum capacity of up to 10% of the total patronage, would offer protection from PM2.5 exposures for nonsmoking patrons and reduce employee exposures."

Fiala, S.C.; Morris, D.S.; Pawlak, R.L., "Measuring indoor air quality of hookah lounges," American Journal of Public Health [Epub ahead of print], September 20, 2012.

Many states have implemented smoke-free workplace laws to protect employees and customers from exposure to secondhand smoke. However, exemptions in these laws have allowed indoor tobacco smoking in hookah lounges to proliferate in recent years. To describe the amount of secondhand smoke in hookah lounges, this study measured the indoor air quality of 10 hookah lounges in Oregon. Air quality measurements ranged from "unhealthy" to "hazardous" according to Environmental Protection Agency standards, indicating a potential health risk for patrons and employees.

Patel, V.; Thomson, G.; Wilson, N., "Smoking increases air pollution levels in city streets: observational and fine particulate data," Health & Place 18(5): 1202-1205, September 5, 2012.

This study examined observed smoking and fine particulate levels on a route of shopping streets in a New Zealand City and concluded that "Smoking appeared to be a substantive contributor to fine particulate air pollution in city streets, when compared to levels adjacent to road traffic."

Apsley, A.; Semple, S., "Secondhand smoke levels in Scottish bars 5 years on from the introduction of smoke-free legislation," Tobacco Control 21(5): 511-513, September 2012.

Objective To determine current secondhand smoke (SHS) concentrations in bars previously assessed as part of an evaluation of Scottish smoke-free legislation 5 years ago.

Design Comparison between SHS levels measured in 2006 and 2011 in 39 pubs in 2 Scottish cities.

Methods Fine particulate matter (PM2.5) was measured discreetly for 30 min in each bar on one or two visits 5 years after the previous visit in May/June 2006. These 5-year follow-up visits were undertaken on the same day of the week and at approximately the same time of day. ...

Conclusions These results are one of the longest follow-up of any national smoke-free legislation and indicate that, 5 years after introduction, compliance is high and that the legislation continues to provide bar workers and non-smoking customers protection from SHS.

Gee, I.L.; Semple, S.; Watson, A.; Crossfield, A., "Nearly 85% of tobacco smoke is invisible: a confirmation of previous claims," Tobacco Control [Epub ahead of print], August 25, 2012.

This study examined studies into the percentage of smoke that is visible to the naked eye and stated, "These estimates suggest that approximately 83% of tobacco smoke is in a gaseous form that is not visible, supporting the previously reported estimates of 85%. We also note that recent evidence would suggest that most ETS particulate matter is of <100 nm diameter and, as such, likely to be 'invisible' to the naked eye, further increasing the proportion of ETS by mass that would not be visible to smokers and non-smokers alike. We therefore consider it reasonable for tobacco control campaigns to continue to report that 83% of the harmful components within ETS are invisible."

This article examined salivary cotinine concentrations to characterize secondhand smoke (SHS) exposure among non-smoking hospitality employees (bar and casino employees and musicians who perform in bars) who are exposed to SHS in the workplace. The findings demonstrate that post-shift saliva cotinine levels of hospitality employees who are exposed to SHS in the workplace are significantly higher than controls who work in smoke-free venues. Findings also suggested a statistically significant increase between pre- and post-shift saliva cotinine levels of hospitality employees who are exposed in the workplace. No statistically significant difference was noted across labor categories, suggesting that all exposed employees are at increased risk. The study results indicate that non-smoking hospitality employees exposed to SHS in the workplace have significantly higher cotinine concentration levels compared with their counterparts who work in smoke-free venues.

Lopez, M.J.; Fernandez, E.; Gorini, G.; Moshammer, H.; Polanska, K.; Clancy, L.; Dautzenberg, B.; Delrieu, A.; Invernizzi, G.; Munoz, G.; Precioso, J.; Ruprecht, A.; Stansty, P.; Hanke, W.; Nebot, M., "Exposure to secondhand smoke in terraces and other outdoor areas of hospitality venues in eight European countries," PLoS One 7(8): e42130, August 2012.

Conclusions: Banning indoor smoking seems to displace SHS exposure to adjacent outdoor areas. Furthermore, indoor
settings where smoking is banned but which have a semi-closed outdoor area have higher levels of SHS than those with
open outdoor areas, possibly indicating that SHS also drifts from outdoors to indoors. Current legislation restricting indoor
SHS levels seems to be insufficient to protect hospitality workers – and patrons – from SHS exposure. Tobacco-free
legislation should take these results into account and consider restrictions in the terraces of some hospitality venues to
ensure effective protection.

McCaffrey, M.; Goodman, P.; Gavigan, A.; Kenny, C.; Hogg, C.; Byrne, L.; McLaughlin, J.; Young, K.; Clancy, L., "Should any workplace be exempt from smoke-free law: the Irish experience," Journal of Environmental and Public Health [Epub ahead of print], 2012.

Background. In 2004, the Irish Government introduced national legislation banning smoking in workplaces; with exemptions for "a place of residence". This paper summarises three Irish studies of exempted premises; prisons, psychiatric hospitals and nursing homes. Methods. PM2.5 and nicotine were measured in nursing homes and psychiatric hospitals, in addition to ultrafine particles in the hospitals. In the prisons, officers (n = 30) completed exhaled breath Carbon Monoxide (CO) measurements. Questionnaires determined officers' opinion on introducing smoking prohibitions in prisons. Nursing home smoking policies were examined and questionnaires completed by staff regarding workplace secondhand smoke (SHS) exposure. Findings. Ultrafine particle concentrations in psychiatric hospitals averaged 130,000 per cm3, approximately 45% higher than Dublin pub levels (85,000 per cm3) pre ban. PM2.5 levels in psychiatric hospitals (39.5 ìg/m3) were similar to Dublin pubs (35.5 ìg/m3) pre ban. In nursing homes permitting smoking, similar PM2.5 levels (33 ìg/m3) weremeasured, with nicotine levels (0.57 ìg/m3) four times higher than "non-smoking" nursing homes (0.13 ìg/m3). In prisons, 44% of non-smoking officers exhibited exhaled breath CO criteria for light to heavy smokers. Conclusions. With SHS exposure levels in some exempted workplaces similar to Dublin pubs levels pre ban, policies ensuring full protection must be developed and implemented as a right for workers, inmates and patients.

St. Helen, G.; Bernert, J.T.; Hall, D.B.; Sosnoff, C.S.; Xia, Y.; Balmes, J.R.; Vena, J.E.; Wang, J.S.; Holland, N.T.; Naeher, L.P., "Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in non-smokers," Environmental Health Perspectives [Epub ahead of print], April 6, 2012.

This secondhand smoke exposure study tested urine and salivary cotinine samples among nonsmokers who frequented patios and building entrances of bars and restaurants where smoking is allowed in Athens, Georgia. The authors found that salivary cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) increased significantly in nonsmokers following outdoor secondhand smoke exposure, indicating that such exposure may increase the risk of health effects associated with tobacco carcinogens.

Thornley, S.; Dirks, K.N.; Edwards, R.; Woodward, A.; Marshall, R., "Indoor air pollution levels were halved as a result of a national tobacco ban in a New Zealand prison," Nicotine and Tobacco Research [Epub ahead of print], May 15, 2012.

This air quality study of New Zealand prisons before and after a smokefree policy found that before the policy was implemented, the geometric mean was 6.58 mg/m3 (95% CI = 6.29-6.58), which declined to 5.17 mg/m3 (95% CI = 4.93-5.41) during a cigarette sales ban, and to 2.44 mg/m3 (95% CI = 2.37-2.52) after implementation of the smokefree policy. Regression analyses revealed an average 57 percent (95% CI = 42-68) decline in PM2.5 concentrations, when comparing the before and after periods.

Vardavas, C.I.; Anagnostopoulos, N.; Patelarou, E.; Minas, M.; Nakou, C.; Dramba, V.; Giourgouli, G.; Bagkeris, E.; Gourgoulianis, K.; Pattaka, P.; Antoniadis, A.; Lionis, C.; Bertic, M.; Dockery, D.; Connolly, G.N.; Behrakis, P.K., "Five-year trends of second-hand smoke exposure in Greece: a comparison between complete, partial, and prelegislation levels," Journal of Aerosol Medicine and Pulmonary Drug Delivery [Epub ahead of print], March 6, 2012.

This Greek air quality study found that introduction of a comprehensive clean indoor air law from a partial law led to a significant decline in particulate matter in bars, restaurants, and cafes. Indoor air levels of PM(2.5) attributable to secondhand smoke dropped by 34 percent (137µg/m(3) vs. 90 µg/m(3), p=0.003) following the transition from a partial to a comprehensive law. However, among matched venues, the levels of indoor air pollution were not found to change significantly (218 µg/m(3) vs. 178 µg/m(3), p=0.58).

This Mexican study compared ventilation systems with clean indoor air policies as a means of addressing the health effects of secondhand smoke exposure. The researchers concluded that clean indoor air policies represent the only effective approach to reduce exposure.

This Irish study examined air inside eight pubs, their designated smoking and smokefree areas, and their noncomplying smoking areas. Designated smoking areas had concentrations of benzene which ranged from 5.1-5.4 µg/m3; smokefree areas, 1.42-3.01 µg/m3; and smoking areas in breach of law, 49.5 µg/m3, with corresponding "smokefree" areas, 7.68 µg/m3. The authors wrote that the legal definitions of designated smoking areas were weak and called for more governmental guidance in defining the parameters of those spaces.

This study followed 17 subjects who completed a total of 104 car journeys. Of this sample, 14 were smokers. Journeys averaged 27 minutes and PM2.5 levels averaged 85 and 7.4 mg/m3 during smoking and nonsmoking car journeys, respectively. In smoking journeys, peak PM2.5 averaged 385 mg/m3, with one journey measuring 880 mg/m3. While use of ventilation and open windows was very common during smoking journeys, PM2.5 concentrations were still found to exceed World Health Organization (WHO) indoor air quality guidelines.

This study followed 238 venues in 24 cities in the Americas, Eastern Europe, Asia, and Africa and 625 nonsmoking and 311 smoking employees in the venues. The researchers found, "Median air nicotine concentrations were 3.5 (1.5e8.5) mg/m3 and 0.2 (0.1e0.7) mg/m3 in smoking and smoke-free venues, respectively. Median hair nicotine concentrations were 6.0 (1.6e16.0) ng/mg and 1.7 (0.5e5.5) ng/mg in smoking and nonsmoking employees, respectively. Twofold increase in air nicotine concentrations was associated with a 30% (95% CI 23% to 38%) increase in hair nicotine concentrations in nonsmoking employees and with a 10% (2% to 19%) increase in smoking employees." The researchers called for complete smokefree policies to protect workers from the health effects of secondhand smoke exposure.

Cobb, C.O.; Vansickel, A.R.; Blank, M.D.; Jentink, K.; Travers, M.J.; Eissenberg, T., "Indoor air quality in Virginia waterpipe cafés," Tobacco Control [Epub ahead of print], 2012.

This study compared air quality in 28 venues in Virginia. There were 17 hookah cafes, five cigarette smoking-permitted restaurants, and six smokefree restaurants. The highest mean PM2.5 concentration was observedin hookah cafe´ smoking rooms (374 mg/m3, n¼17) followed by waterpipe cafe´ non-smoking rooms (123 mg/m3, n¼11), cigarette smoking-permitted restaurant smoking rooms (119 mg/m3, n¼5), cigarette smoking-permitted restaurant non-smoking rooms (26 mg/m3, n¼5) and smoke-free restaurants (9 mg/m3, n¼5). Smokefree rooms in hookah cafe´s may expose patrons and employees to PM2.5 concentrations above national and international air quality standards.

This New Zealand study found that air quality in semi-enclosed outdoor areas was variable. When patrons and staff can travel between outdoor smoking areas and smokefree indoor areas, secondhand smoke drift often reduces indoor air quality. The researchers recommended that travel between areas be regulated to maintain indoor air quality and to protect worker health.

Marin, H.A.; Diaz-Toro, E.C., "Reduced exposure to secondhand smoke at casinos in Puerto Rico after the Implementation of a workplace smoking ban in 2007: a pre-post design," Puerto Rico Health Science Journal 30(4): 182-187, December 2011.

This study measured pre- and post-smokefree air law, exposure to secondhand smoke in casinos in Puerto Rico via levels of fine particulate matter in the air and cotinine levels in casino employees. The study concluded that the average level of fine particulate matter in the air decreased by 88.5 percent after the implementation of the smokefree law and that the average cotinine level in nonsmoking employees decreased by 52.1 percent.

This Scottish study examined air quality levels five years after clean indoor air laws were implemented in the country. Average PM2.5 levels measured in a total of 51 bar visits in 2011 were 12 mg/m3 compared to 20 mg/m3 (range 6e104 mg/m3) in the period immediately after the law was implemented in 2006. Fine particulate concentrations in all but two visits in 2011 were comparable to PM2.5 levels measured in outside ambient air on the same day, with 92 percent of visits (n¼47) providing 30 minute average PM2.5 concentrations of less than 25 mg/m3. The researchers concluded that five years after implementation, compliance with the law is high and that the law continues to provide bar workers and nonsmoking customers protection from the health effects of secondhand smoke.

Semple, S.; Garden, C.; Coggins, M.; Galea, K.S.; Whelan, P.; Cowie, H.; Sanchez-Jimenez, A.; Thorne, P.S.; Hurley, J.F.; Ayres, J.G., "Contribution of solid fuel, gas combustion, or tobacco smoke to indoor air pollutant concentrations in Irish and Scottish homes," Indoor Air [Epub ahead of print], October 18, 2011.

This study examined air quality in Irish and Scottish homes and found that homes using solid fuels or gas for heating and cooking mostly had air quality within acceptable levels. Homes where there is secondhand smoke have much poorer air quality.

This air quality study examined outdoor waiting areas and patios of restaurants and bars in downtown Athens, Georgia, a city with a clean indoor air ordinance. The results of the study indicated that secondhand smoke leads to significant increases in PM2.5 outside of restaurants and bars. Although carbon monoxide generated by passersby and motor vehicles can be used as a proxy for secondhand smoke in these outdoor settings, its levels remain relatively low.

Nebot, M.; Sureda, X.; Martinez-Sanchez, J.M.; Lopez, M.J.; Fu, M.; Aguero, F.; Salto, E., "Secondhand smoke levels in public building main entrances: outdoor and indoor PM2.5 assessment," Tobacco Control [Epub ahead of print], September 28, 2011.

This Spanish study found that many indoor locations where there is a smokefree policy still have secondhand smoke. In these cases, there are sometimes levels of secondhand smoke similar to those obtained in building entrances where smoking is allowed. The findings indicated that secondhand smoke from outdoor settings can drift indoors. The researchers stated that their findings warrant a revision of current smoke-free policies in particular outdoor settings.

This report by Repace Associates, Inc. and the Michigan Department Of Community Health, Tobacco Section concluded that Michigan's Dr. Ron Davis Smoke-free Air Law succeeded in reducing geometric mean levels of harmful secondhand smoke fine particle air pollution (PM2.5) by 92 percent for a 78-restaurant sample of hospitality establishments. Prior to the law, 85 percent of restaurants had poor to dangerous air quality standards. Casinos, which are not a part of the law, had unhealthy air before and after implementation.

This air quality study was conducted in Mauritius, the first African nation to adopt a comprehensive clean indoor air policy. It found that 69 percent of the hospitality and shopping mall venues tested still had a presence of secondhand smoke after implementation of the law. The highest concentration of secondhand smoke was found in night clubs.

This air quality study examined air in 50 venues in Mumbai, India, and found that smoking was observed in 36 percent of the venues. PM2.5 levels ranged from 16.97 to 1101.76 µg/m3. The average level of PM2.5 among non-smoking venues was 97.19 µg/m3 and among smoking venues was 363.04 µg/m3. The researchers concluded that PM2.5 levels were high and that much could be done to improve them.

Six Grand Rapids, Michigan, restaurants were monitored for PM2.5 fine particulate matter from secondhand smoke in February 2005 and 2006, prior to the enactment of the state's clean indoor air law, and again in April, 2011, after implementation. The percent reduction in median PM2.5 for all six Grand Rapids restaurants combined was 92 percent, indicating that the vast majority of indoor air pollution in all six venues was due to secondhand smoke. The results in Grand Rapids were consistent with results in Wilmington, Delaware; Boston, Massachusetts; and Western New York.

This paper presented the results of an indoor air quality study in hospitality and entertainment venues in Karachi, Pakistan. The authors found "...unacceptably high levels of PM2.5 exposure associated with secondhand smoke (SHS) at various entertainment venues of Karachi even after 8 years since the promulgation of smoke-free ordinance (2002) in Pakistan."

Repace, J.L., "Air quality in Ann Arbor restaurants: before and after Michigan's Dr. Ron Davis State Smoke-free Law," Bowie, MD: Repace Associates, Inc.; Lansing, MI: Michigan Department Of Community Health, Tobacco Section, June 14, 2011.

Six Ann Arbor restaurant venues were monitored for particulate matter (PM2.5) in February 2005 and 2006, prior to implementation of Michigan's clean indoor air law, and again in April, 2011, after implementation, which was May 1, 2010. The law was responsible for a drop in PM2.5 of about 76 percent to 93 percent. Post-law restaurant means for all six venues tested in the city ranged from from 8.2 to 27.9 µg/m3, and averaged 15.9 µg/m3 (median 15.7 µg/m3). Sampling periods ranged from 31 to 49 minutes.

Three Detroit, Michigan, casinos were monitored for particulate matter (PM2.5) in April 2009, prior to implementation of Michigan's clean indoor air law, and again in May 2011, after implementation, which was May 1, 2010. Casinos were exempt from the law. Secondhand smoke in the three Detroit casinos rose to unhealthy levels both pre and post implementation. Air quality in Detroit casinos remains more polluted than 73 percent of the 91 casinos which permit smoking measured in the US. Air quality in Detroit casinos was 29 times as polluted with PM2.5 as three smokefree casinos in California, Nevada, and Delaware.

Six Detroit, Michigan, restaurants were monitored for particulate matter (PM2.5) in January 2007 prior to implementation of Michigan's clean indoor air law, and again in May 2011, after implementation. Median PM2.5 in the six venues fell 93 percent, indicating that the vast majority of indoor pollution in five of the six venues was from secondhand smoke. The one venue with increased PM2.5 served flaming dishes.

Gleich, F.; Mons, U.; Pötschke-Langer, M., "Air contamination due to smoking in German restaurants, bars, and other venues: before and after the implementation of a partial smoking ban," Nicotine & Tobacco Research [Epub ahead of print], May 26, 2011.

This air quality study examined samples in bars, restaurants and other hospitality venues in Germany pre and post clean indoor air law. The median mass concentration of PM2.5 was reduced by 87.1% in coffee bars, by 88.7% in restaurants, by 66.3% in bars, and by 90.8% in discotheques. Completely smokefree venues had much better air quality than venues which permitted smoking, either venue-wide or in designated areas.

This study examined air quality in Kansas City, Missouri, area casinos. Six casinos permitted smoking indoors while four did not. The six which permitted smoking had an average air quality of 69 mg/m3, which was an Environmental Protection Agency (EPA) rating of "unhealthy." The four which were smokefree had an average air quality of of 22 mg/m3, an EPA rating of "moderate." The separation of smoking and nonsmoking areas did not prevent pollutants from entering nonsmoking areas. A full-time employee in a Kansas City casino which permitted smoking would be exposed to 106 percent of the EPA's average annual limit for particulate matter air pollution during an 8-hour shift of work.

This study from Canada measured particulate matter outside and inside 28 entrances to office buildings in downtown Toronto, Ontario, both when smoking was and was not occurring within nine meters. The study found higher particulate matter when smokers were present. The authors stated that, "These findings support smoke-free policies at entrances to buildings to protect non-smokers from exposure to tobacco smoke."

This study compared air quality in 16 public venues in Jessamine County, Kentucky, which has no smokefree law, and compared the results with measurements in both Lexington and Louisville before and after implementation of their smokefree ordinances. The level of air pollution in the Jessamine County venues was "...7.4 times higher than Lexington and 14.9 times higher than Louisville after implementation of their comprehensive smoke-free laws."

This study measured carbon monoxide (CO) levels at 585 hospitality venues in Sao Paulo, Brazil. Measurements were taken in both indoor and outdoor areas, and pre- and post-implementation of a smokefree ordinance. The exhaled breath of 627 workers in these venues was analyzed. The study concluded that the smokefree ordinance resulted in a significant decrease in the levels of carbon monoxide in the venues and in workers, regardless of whether or not the workers were smokers. The authors speculated that such a decrease in CO levels "...could be causally related to the reduction in cardiovascular events incidence observed in many places where this law has already been adopted."

Agbenyikey, W.; Wellington, E.; Gyapong, J.; Travers, M.J.; Breysse, P.N.; McCarty, K.M.; Navas-Acien, A., "Secondhand tobacco smoke exposure in selected public places (PM2.5 and air nicotine) and non-smoking employees (hair nicotine) in Ghana," Tobacco Control 20(2): 107-111, March 2011.

This study measured airborne particulate matter, nicotine concentrations, and levels of nicotine in the hair of nonsmoking employees in hospitality establishments in Ghana, a nation with no smokefree air law. The study took place in 75 smoking venues and 13 nonsmoking ones. Levels of all items measured were higher in smoking venues. The authors recommended that the nation adopt a smokefree air law.

This study examined air quality in Kansas City, Kansas, bars and restaurants before and after a clean indoor air law was implemented on July 1, 2010. Two locations were smokefree and three permitted smoking prior to implementation. Employees in businesses which permitted smoking were exposed to levels of air pollution two times higher than safe annual levels established by the U.S. Environmental Protection Agency (EPA) due to secondhand smoke. In the locations that permitted smoking, indoor particle pollution levels declined by 89 percent as a result of the clean indoor air law to levels, similar to those found outdoors.

This air quality study conducted in American Samoa, Guam, Commonwealth of the Northern Mariana Islands (CNMI) bars and restaurants found that particulate matter (PM2) concentrations where smoking is permitted [arithmetic mean (AM)=299.98 µg/m3; geometric mean (GM)=200.39 µg/m3] was significantly higher (p<0.001) than smoke-free venues [AM=8.33 µg/m3; GM=6.14 µg/m3]. In venues where smoking was permitted during certain hours, the average level of of PM2 outside of these hours was significantly higher [AM=42.10 µg/m3; GM=41.87 µg/m3] than smokefree venues. The researchers urged for smokefree venues.

Avila-Tang, E.; Travers, M.J.; Navas-Acien, A., "Promoting smoke-free environments in Latin America: a comparison of methods to assess secondhand smoke exposure," Salud Publica de Mexico 52(Suppl. 2): s138-s148, 2010.

This study measured airborne nicotine and respirable suspended particles (PM2.5) in Latin America in public venues and private homes. The authors noted that such studies can be good tools to promote smokefree legislation.

Schoj, V.; Sebrie, E.M.; Pizarro, M.E.; Hyland, A.; Travers, M.J., "Informing effective smokefree policies in Argentina: air quality monitoring study in 15 cities (2007-2009)," Salud Publica de Mexico 52(Suppl. 2): S157-S167, 2010.

This study evaluated indoor air quality in hospitality establishments in Argentina and found that, overall, levels of particulate matters were five times higher in establishments in locales without any smokefree legislation. In venues with designated smoking areas, there was no difference in air quality between the smoking and nonsmoking sections. However, in cities with 100 percent smokefree legislation, air quality was improved.

Bohac, D.L.; Hewett, M.J.; Kapphahn, K.I.; Grimsrud, D.T.; Apte, M.G.; Gundel, L.A., "Change in indoor particle levels after a smoking ban in Minnesota bars and restaurants," American Journal of Preventive Medicine 39(6S1): S3–S9, December 2010.

This study examined air quality in Minnesota bars and restaurants prior to and after the implementation of a smokefree air law. The study concluded that the median reduction in particulate matter in the air was 95 percent.

Marin, H.A.; Diaz-Toro, E., "The effect of the smoke-free workplace policy in the exposure to secondhand smoke in restaurants, pubs, and discos in San Juan, Puerto Rico," Puerto Rico Health Sciences Journal 29(3): 279-285, September 2010.

This study examined air quality in bars, restaurants, and discos in San Juan, Puerto Rico, before and after the implementation of a smokefree air law. The study found that particulate matter in restaurants decreased by 83.6 percent following enactment, while bars and discos experienced a 95.6 percent reduction.

Erazo, M.; Iglesias, V.; Droppelmann, A.; Acuna, M.; Peruga, A.; Breysse, P.N.; Navas-Acien, A., "Secondhand tobacco smoke in bars and restaurants in Santiago, Chile: evaluation of partial smoking ban legislation in public places," Tobacco Control [Epub ahead of print], August 25, 2010.

This study compared air quality in bars and restaurants in Santiago, Chile, before and after implementation of a law that allowed businesses to choose whether or not to allow smoking in some areas of their establishment or to be all-smoking. The authors concluded that, "Exposure to secondhand smoke remains high in bars and restaurants in Santiago, Chile."

Stafford, J.; Daube, M.; Franklin, P., "Second hand smoke in alfresco areas," Health Promotion Journal of Australia 21(2): 99-105, August 2010.

This study measured concentrations of fine particulate matter (PM2.5) in the alfresco areas of 28 cafes and pubs. Data were collected on the number of smokers present during sampling and factors that could influence PM2.5 concentrations. The researchers found that PM2.5 concentrations were significantly increased when there was at least one smoker compared to periods with no smoking (14.25 mug/m3 and 3.98 g/m3, respectively). The authors wrote that, "Smoking increases PM2.5concentrations in outdoor areas to levels that are potentially hazardous to health."

This study found that air quality in restaurants, cafes, bars, and entertainment venues in China, India, Japan, Korea, Malaysia, Pakistan and Sri Lanka had particulate matter (PM) levels which were high because of secondhand smoke. The average indoor PM level was 137mug/m(3), ranging from 46mug/m(3) in Malaysia to 207mug/m(3) in India. The levels were similar to those found in Western countries prior to the adoption of clean indoor air policies. The researchers recommended smokefree policies to protect public health.

This study evaluated the effects of five different ventilation conditions in a car on levels of ultrafine particles (UFP) from secondhand smoke and other pollutants. The authors stated that, "In a typical 30-min commute on urban roadways, the SHS of one cigarette exposed passengers to approximately 10 times the UFP and 120 times the PM2.5 of ambient air. The most effective solution to protect passengers from SHS exposure is to abstain from smoking in the vehicle. Opening a window is an effective method for decreasing pollutant exposures on most urban roadways. However, under road conditions with high UFP concentrations, such as tunnels or busy freeways with high proportion of heavy-duty diesel trucks (such as the 710 Freeway in Los Angeles, CA, USA), opening a window is not a viable method to reduce UFPs."

This study examined air quality and levels of particulate matter inside and outside the 4 smoking rooms located within a medium-sized, regional commercial airport. The rooms each had separate, properly functioning ventilation systems. However, the authors wrote that, "Although there were few smokers in each room, average PM2.5 concentrations inside the smoking rooms were significantly higher than the National Ambient Air Quality Standard for 24 hr (35 mg/m3). Fine particles from secondhand smoke (SHS) leaked to the outside in 3 of the 4 smoking rooms, exposing workers and the public."

This air quality study examined the level of secondhand smoke fine particulate matter in nonsmoking casino restaurants and in smoking gaming areas after enactment of Nevada's Clean Indoor Air Act (NCIAA). The study found that particulate matter and secondhand smoke were not restricted to gaming areas, but also drifted into adjacent areas, "...affecting employees and patrons who may consider themselves safe from SHS exposure. This may include employees in the vicinity of the gaming areas such as cocktail waitresses, security personnel, gaming supervisors, and cashiers, as well as children and adults visiting a casino hotel for nongaming purposes."

This study from Minnesota measured biomarkers of nicotine and carcinogen levels of nonsmoking bar and restaurant employees pre- and post-implementation of the state's smokefree law. The study found, "...significant reductions in both total cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (free plus glucuronidated) after the ban was instituted."

This study measured indoor and outdoor air quality at pubs and bars in Victoria, Australia before and after these establishments went smokefree inside. The authors wrote that, "Indoor smoking bans are an effective means of improving indoor and outdoor air quality in pubs and bars, although the air quality of smoke-free indoor areas may be compromised by smoking in adjacent outdoor areas.

This air quality study evaluated the overall impact of the Smoke-Free Ontario Act implemented May 31, 2006, on secondhand smoke in bars and coffee shops and the impact of removing designated smoking rooms (DSR) on secondhand smoke DSRs. Post law, mean particulate matter and Particulate Polycyclic Aromatic Hydrocarbons (PPAH) levels were reduced by 87 and 94 percent respectively in DSRs. The study found that DSRs did not provide adequate protection from SHS.

This study measured air quality and smoking activity in 36 California Indian casinos, assessing differences in casino size, separation of smoking and non-smoking areas, and area smoker density. The study found elevated levels of particulate matter due to secondhand smoke, particularly in areas where smoking was permitted and in nonsmoking areas with no separation from smoking areas.

This abstract described the findings of an air quality study conducted in the nonsmoking sections of bars and restaurants in Zurich, Switzerland. The authors wrote that, "Smokers and ambient air pollution are the most important sources of fine airborne particulate matter (PM(2.5)) in the non-smoking sections of bars, restaurants, and cafes. Other sources do not significantly contribute to PM(2.5)-levels, while opening doors and windows is not an efficient means of removing pollutants. First, this demonstrates the impact that even a few smokers can have in affecting particle levels. Second, it implies that creating non-smoking sections, and using natural ventilation, is not sufficient to bring PM(2.5) to levels that imply no harm for employees and non-smoking clients."

This Roswell Park Cancer Institute report examined air in Fire Rock Casino in Church Rock, New Mexico, and found that the concentration of unhealthy air in the 4 locations tested was almost 10 times higher than outdoor levels. Only two of the four nonsmoking locations sampled had acceptable levels of air quality. The testers concluded that employees and patrons were routinely exposed to levels of unhealthy air in excess of safe levels established by the Environmental Protection Agency (EPA).

[n.a.], "Tobacco smoke pollution in Oklahoma workplaces: preliminary report," Oklahoma City, OK: Oklahoma Tobacco Research Center, February 2010.
Abstract Unavailable

This report by the Oklahoma Tobacco Research Center at the University of Oklahoma used air quality findings to determine that according to Environmental Protection Agency (EPA) guidelines, secondhand smoke exposure in Oklahoma workplaces such as bars and restaurants was above the recommended level, ventilation systems were not effective, and secondhand smoke was the main cause of indoor pollution. Air in smoking rooms in restaurants and in bars had pollution levels which averaged 380 micrograms of particulate matter per cubic meter of air. The Environmental Protection Agency (EPA) classified air with 151-25 micrograms as hazardous.

This air quality study examined nicotine levels in secondhand smoke in Chennai,Tamil Nadu, India. Testing devices were provided by Johns Hopkins Bloomberg School of Public Health. The study found that all monitors recorded detectable levels of air nicotine in restaurants and schools. In government buildings, hospitals, and entertainment venues, 96, 94, and 80 percent of air nicotine monitors, respectively, were above the detection limit. The highest median levels of air nicotine were found in restaurants and bars.

This abstract summarized the findings of an air quality study conducted in hospitals in Catalonia, Spain, in 2009. The study found that, "Second-hand smoke levels in hospitals were low in most locations, with the highest levels observed in outdoor locations where smoking is allowed (smoking points and entrances). Smoking in main entrances was associated with increased second-hand smoke levels in halls. Use of PM2.5 to evaluate second-hand smoke is feasible and shows a good correlation with airborne nicotine values."

Hall, J.C.; Bernert, J.T.; Hall, D.B.; St Helen, G.; Kudon, L.H.; Naeher, L.P., "Assessment of exposure to secondhand smoke at outdoor bars and family restaurants in Athens, Georgia, using salivary cotinine," Journal of Occupational and Environmental Hygiene 6(11): 698-704, November 2009.

This study measured salivary cotinine levels in nonsmoking subjects aged 21-30 exposed to secondhand smoke (SHS) outside bars and restaurants in Athens, Georgia. The study found that, "Nonsmokers outside restaurants and bars in Athens, Georgia, have significantly elevated salivary cotinine levels indicative of secondhand smoke exposure."

This air quality study examined secondhand smoke exposure by measuring levels of particulate matter at 69 outdoor dining areas in Melbourne, Australia. The study also assessed how varying conditions influenced exposure levels. The study found that sitting at an outdoor dining area where smokers were present increased secondhand smoke exposure and that, "Average exposure levels increased by around 30% for every additional active smoker within one metre of the monitor. Being situated under an overhead cover increased average exposure by around 50%."

Travers, M.J., Indianapolis Air Quality Monitoring Study
Roswell Park Cancer Institute, October 2009

This study assessed indoor air quality in 10 indoor locations in Indianapolis, Indiana. These locations included bars, restaurants, nightclubs, and off-track betting and all locations permitted indoor smoking.

The study found a level of fine particle air pollution that was 11 times higher than in smokefree venues and 12 times higher than outdoor pollution levels in Marion County.

This Swiss study examined air quality in smoking and nonsmoking sections in restaurants, bars, and cafes in the country. Even when nonsmoking and smoking sections are separated into two rooms, particulate matter (PM) in nonsmoking rooms is more than double than PM in completely smokefree venues.

This study provided "an analysis of airborne nicotine measurements collected in 49 low-income, multi-unit residences across the Greater Boston Area." The study also surveyed residents about smoking behavior and examined the impact of air exchange rates, home volume, and sorption and re-emission of nicotine on indoor surfaces on indoor nicotine levels. The study found that secondhand smoke was not contained only in apartments where smokers lived or visited, but was also found in hallways and nonsmoking units.

Smoke-filled Air in Detroit Casinos Deemed Unhealthy
Hazardous Pollution Levels Found in all Venues
July 13, 2009

Lansing, Mich. - Despite the claim that their air ventilation systems address the dangers of secondhand smoke, air quality testing (AQT) conducted in Detroit's three casinos revealed indoor pollution levels that are eight times higher than outdoor air.

The testing at each of Detroit's three casinos was sponsored by the Campaign for Smokefree Air and took place on Saturday, April 18, 2009. The tests measured the amount of tobacco smoke derived fine particle air pollution in each casino. Each location was measured over a 40-minute period using the TSI SidePak AM510 Personal Aerosol Monitor.

"Results from the air quality assessments in each casino reinforce that casinos need to be included in smokefree legislation," said Katherine Knoll, spokesperson for CSA and senior director of advocacy for the American Heart Association. "Casino workers deserve the same protection as any other employee. These workers are unfortunately exposed to high levels of air pollution on a daily basis in order to earn a paycheck." [The MGM Grand issued a press release in rebuttal.]

Connolly, G.N.; Carpenter, C.M.; Travers, M.; Cummings, K. Michael; Hyland, A.; Mulcahy, M.; Clancy, L., "How smoke-free laws improve air quality: a global study of Irish pubs," Nicotine and Tobacco Research 11(6): 600-605, June 2009.

This study examined indoor air quality in 128 Irish pubs in 15 different countries and found that, "Overall, the level of air pollution inside smoke-free Irish pubs was 93% lower than the level found in pubs where smoking was permitted."

This Singaporean research study found that indoor air pollution was 96 percent lower in smokefree venues compared to where smoking was allowed, with bars experiencing the greatest pollution. The researchers argued that smokefree public places reduce secondhand smoke exposure and improve worker and patron health.

Ahrens, D.M., "Indoor air quality in eating and drinking establishments in the City of Milwaukee," Milwaukee, WI: Smokefree Milwaukee Project; University of Wisconsin, Paul P. Carbone Comprehensive Cancer Center, January 2009.

This study examined air quality in 32 eating and drinking establishments in the city of Milwaukee, Wisconsin. The study found that, "The air quality in approximately two-thirds
of these establishments, by the standards of the Wisconsin Department of Natural Resources (DNR) peaked at a level that was at or above the hazardous-level (more than 210 parts of
particulate less than 2.5 micrograms in a cubic meter)."

Hahn, E.J., Lee, K., Robertson, H.E., Vogel, S., Lee, S.; "Indoor air quality in Bowling Green, Kentucky hospitality venues, 2008," University of Kentucky, College of Nursing, October 15, 2008. Abstract Unavailable

This study examined the air quality in eleven hospitality establishments in Bowling Green, Kentucky, and compared the levels of particulate matter to those found in air quality studies conducted in Lexington and Louisville before and after implementation of smokefree ordinances in those two cities. Levels of particulate matter in the Bowling Green venues were "...approximately 9.2 times higher than Lexington's post-law and 18 times higher than Louisville after implementation of their comprehensive smoke-free law."

Dales, R.; Liu, L.; Wheeler, A.J.; Gilbert, N.L., "Quality of indoor residential air and health," CMAJ 179(2): 147-152, July 15, 2008.

This study examined the sources of indoor air pollution, noting that North Americans spend approximately 87 percent of their time indoors. The authors made recommendations to reduce exposure to several pollutants, including cigarette smoke.

[n.a.], "Changes in Air Pollution in Charleston County: pre/post smoking ordinance, executive summary," [Medical University of South Carolina Hollings Cancer Center (HCC)], July 2008.

This study examined levels of air pollution in venues in Charleston, Mt. Pleasant, and North Charleston, South Carolina, and found that air pollution decreased 94% across venues in both Charleston City and Mt. Pleasant following passage of smoke-free legislation. Press Release

Gotz, N.K.; van Tongeren, M.; Wareing, H.; Wallace, L.M.; Semple, S.; MacCalman, L., "Changes in air quality and second-hand smoke exposure in hospitality sector businesses after introduction of the English Smoke-free legislation," Journal of Public Health [Epub ahead of print], July 23, 2008.

Air quality in 49 businesses and salivary cotinine levels in 75 nonsmoking hospitality establishment employees were sampled one month before and after implementation of England's clean indoor air law. Researchers found that indoor particulate matter fell by 95 percent and that salivary cotinine fell by 75 percent after the law went into effect.

Hahn, E.J.; Lee, K.; Vogel, S.; Robertson, H.E.; Lee, S., "Indoor air quality in bingo halls, Lexington, Kentucky, 2008," University of Kentucky, College of Nursing, July 10, 2008.

Indoor air quality was assessed in five bingo halls in Lexington, Kentucky. Fine particulates were measured from February 15 to February 22, 2008, using the TSI SidePak AM510 Personal Aerosol Monitor. The average PM2.5 level from the five locations was compared to the average PM2.5 levels in the Georgetown bingo hall and a sample of Lexington hospitality venues before and after implementation of their smoke-free laws, as well as the National Ambient Air Quality Standard (NAAQS; 35 g/m3) for 24 hours.

Pobutsky, A.; Krupitsky, D.; Kanja, M.L.; Lipsher, J., "Hawai'i air quality monitoring assessment: some effects of Hawai'i's smoke-free work and public places law," Hawaii Medical Journal 67(6): 149-155, June 2008.

A study of fifteen Hawaii bars and restaurants concluded that levels of particulate matter in enclosed venues fell by 90 percent following the implementation of a smokefree air law.

This study compared nicotine concentrations in the air of hospitality establishments in two Italian cities, covered by Italy's smokefree air law, to those in Vienna, Austria, where no smokefree law existed. The authors found that nicotine levels in the Italian venues dropped, but not in the Austrian venues. The authors concluded that hospitality workers exposed to secondhand smoke had a much greater lifetime risk of dying from lung cancer, but that, "The drop of second-hand smoke exposure indicates a substantial improvement in air quality in Italian HPs even after 2 years from the ban."

Proescholdbell, S.K.; Foley, K.L.; Johnson, J.; Malek, S.H., "Indoor air quality in prisons before and after implementation of a smoking ban law," Tobacco Control 17(2): 123-127, April 1, 2008.

This study examined air quality in North Carolina prisons before and after the implementation of a smokefree law. The study found that respirable suspended particles (RSPs), a marker of secondhand smoke, decreased by 77 percent after the smokefree policies were implemented.

Carter, C.L.; Carpenter, M.J.; Higbee, C.; Travers, M.; Hyland, A.; Bode, A.; Thacker, S.; Alberg, A., "Fine particulate air pollution in restaurants and bars according to smoking policy in Charleston, South Carolina," Journal of the South Carolina Medical Association 104(4): 82-85, April 2008.
Abstract Unavailable

This study examined the air quality in 64 bars and restaurants in Charleston County, South Carolina in early 2006. The bars and restaurants were not governed by any smokefree air laws and were free to adopt their own policies. The venues where smoking was permitted were significantly more likely to be either bars or a combination of restaurant/bar. The level of air pollution in venues where smoking as permitted was 18 times higher than in smokefree establishments.

This study found that Minnesota's smokefree air law "...has had a significant impact in reducing exposure and uptake of carcinogens and nicotine in hospitality workers."

University of Wisconsin Population Health Institute; Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, "Analysis of indoor air quality in restaurants and bars in Eau Claire County," Tobacco Free Partnership of Eau Claire County, March 20, 2008.

This study tested indoor air at eight bars and restaurants in Eau Claire County, Wisconsin, and found that, with two exceptions, "the air quality in all of the establishments was by Environmental Protection Agency (EPA) standard, at or above the hazardous-level (120-150 micrograms of fine particulate/cubic meter)."

Hyland, A.; Travers, M.J.; Dresler, C.; Higbee, C.; Cummings, K.M., "A 32-country comparison of tobacco smoke derived particle levels in indoor public places," Tobacco Control [Epub ahead of print], February 26, 2008.

This study examined secondhand smoke and particulate matter levels in bars and restaurants in 32 countries. The authors wrote that, "The results from this study show that levels of PM2.5 in bars, restaurants, transporation venues, and other outlets are at higher levels in countries where smoking is permitted in these venues without restriction. In contrast, countries with comprehensive smoke-free regulations, such as those in Ireland, New Zealand, and Uruguay have PM2.5 levels that are about 89% lower than in countries where smoking is permitted without restriction."

Hahn, E.J.; Lee, K.; Robertson, H.; Vogel, S.; Lee, S.; Peiper, N.C.; Powell, R.W.; Troutman, A., "Indoor air quality in Louisville: did passage of a comprehensive smoke-free ordinance clear the air?," University of Kentucky, College of Nursing and College of Public Health, February 19, 2008.

This study found that a partial smokefree ordinance resulted in exposure to dangerous levels of air pollutants and that "Air pollution in one Louisville venue with an enclosed smoking room (allowed with the partial ordinance) dropped 94% after compliance with the comprehensive smoke-free ordinance. Enclosed, ventilated smoking rooms do not rid the air of dangerous fine particle air pollution."

Travers, M.J., "Iowa air monitoring study: December 2007 to January 2008," Roswell Park Cancer Institute, February 2008. Abstract Unavailable

This executive summary described the results of a Roswell Park Cancer Institute study, which found that air in Iowa bars, restaurants, and casinos where smoking was permitted was 17 times higher in particulate matter than places with smokefree policies. In addition, employees in the venues where smoking is permitted are exposed to unhealthy air according to U.S. Environmental Protection Agency (EPA) guidelines. Samples were taken from 21 Iowa venues from November 2007 to January 2008.

This air quality study of casinos in Colorado before and after implementation of a smokefree law concluded that, "Before the Colorado smoke-free air law covered casinos, the average employee and patron of a Colorado gaming establishment was exposed to an unhealthy level of indoor air pollution, even in nonsmoking restaurants. Once the law went into effect, air quality was 92% better and met the EPA's good rating."

Vardavas, C.I.; Kondilis, B.; Travers, M.J.; Petsetaki, E.; Tountas, Y.; Kafatos, A.G., "Environmental tobacco smoke in hospitality venues in Greece," BMC Public Health [Epub ahead of print], October 23, 2007.

This study measured levels of secondhand smoke "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." The authors found that, "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."

Valente, P.; Forastiere, F.; Bacosi, A.; Cattani, G.; Di Carlo, S.; Ferri, M.; Figa-Talamanca, I.; Marconi, A.; Paoletti, L.; Perucci, C.; Zuccaro, P., "Exposure to fine and ultrafine particles from secondhand smoke in public places before and after the smoking ban, Italy 2005," Tobacco Control 16(5): 312-317, October 2007.

This study found that, "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."

Lee, K.; Hahn, E.J.; Riker, C.; Seithers, P., "Immediate impact of smoke-free laws on indoor air quality," Southern Medical Journal 100(9): 885-889, September 2007.

This study concluded that when venues comply with smokefree air laws, there is an "immediate impact on indoor air quality."

Travers, M.J., "Casino air monitoring study East Saint Louis, Illinois," Roswell Park Cancer Institute, Department of Health Behavior, September 2007.

This study found that the air quality in an East Saint Louis, Illinois, casino was "very unhealthy" for employees and that, "Despite the expensive, state-of-the-art, ventilation system installed at this casino, employees and patrons are exposed to harmful levels of fine particle air pollution as a result of indoor smoking."

Semple, S.; MacCalman, L.; Atherton Naji, A.; Dempsey, S.; Hilton, S.; Miller, B.G.; Ayres, J.G., "Bar workers' exposure to second-hand smoke: the effect of Scottish smoke-free legislation on occupational exposure," Annals of Occupational Hygiene [Epub ahead of print], August 12, 2007.

This study found that, "Most bar workers have experienced very large reductions in their workplace exposure to SHS as a result of smoke-free legislation in Scotland. These reductions have been sustained over a period of 1 year."

Higbee, C.; Travers, M.J.; Hyland, A., "New Mexico air monitoring study: June-August 2007," Roswell Park Cancer Institute, Department of Health Behavior, August 2007.
Abstract Unavailable

This study measured air quality inside twelve New Mexico restaurants, bars, and pool halls before and after the state implemented a smokefree air law. The study found that compliance with the law was 92 percent and that, "The average level of fine particle indoor air pollution declined 87% after the New Mexico law went into effect."

Travers, M.J.; Higbee, C.; Hyland, A., "Fort Wayne Air Monitoring Study May-June 2007," Roswell Park Cancer Institute, July 2007.
Abstract Unavailable

This study assessed indoor air quality in fourteen Fort Wayne, Indiana, bars, restaurants, pool halls, and bowling alleys prior to and after the implementation of a smokefree ordinance. The study found that, "The average level of fine particle indoor air pollution declined 94% after the Fort Wayne ordinance went into effect in those venues that went smoke-free as a result of the law." Compliance in the venues studied was 100 percent.

Semple, S.; Creely, K.S.; Naji, A.; Miller, B.G.; Ayres, J.G., "Secondhand smoke levels in Scottish pubs: the effect of smoke-free legislation," Tobacco Control 16(2): 127-132, April 2007.

This study compared levels of particulate matter, as a marker of secondhand smoke (SHS) levels, in pubs in Scotland before and 2 months after the implementation of a national smokefree air law. The authors found that, "Levels of SHS were reduced in all 53 post-ban visits, with the average reduction being 86%."

Higbee, C.; Travers, M.; Hyland, A., "Arkansas Air Monitoring Study, April-May, 2," Roswell Park Cancer Institute, Department of Health Behavior, May 2006.

This study assessed indoor air quality "in 27 bars and restaurants in Arkansas between April 21, 2006 and May 6, 2006 using the TSI SidePak AM510 Personal Aerosol Monitor. Venues were sampled in Fayetteville and Springdale. Six (22 %) venues sampled were smoke-free and 21 venues were not smoke-free. PM2.5 levels in these 27 locations were compared, and key findings of the study include:

• The level of PM2.5 was 92% lower in the smoke-free venues compared to those venues where smoking was permitted without restrictions. PM2.5 is the concentration of particulate matter in the air less than 2.5 microns in diameter. Particles of this size are released in significant amounts from burning cigarettes and are easily inhaled deep into the lungs, with serious health effects.
• Employees in Arkansas hospitality venues allowing indoor smoking are exposed to levels of particulate matter in excess of levels recommended for outdoor air by the Environmental Protection Agency (EPA) to protect public health. Based on the average PM2.5 level observed in all venues in this study where smoking was allowed (239 µg/m3), full-time bar and restaurant employees are exposed to almost four times the annual EPA exposuree limit of fine particulate air pollution, solely from occupational exposure."

Repace, J., "Air pollution in Virginia's hospitality industry," Bowie, MD: Repace Associates, January 9, 2006.
Abstract Unavailable

This report stated that, "Air quality was monitored in 12 hospitality venues in Virginia (11 smoking and 1 nonsmoking), in 19 outdoor locales, and 5 highway locations located in Richmond, Roanoke City, Dale City, Fredericksburg, and Virginia Beach. Referred to the U.S. Air Quality Index for Particulate Matter pollution (PM2.5), indoor air quality was Code Green (Good) in the single nonsmoking venue, in all outdoor and transit-related locales (city streets, I-95, Powhite Parkway toll booth), and was Code Yellow (Moderate) in the Hampton Roads Tunnel on the upgrade. However, in the smoking venues, air pollution from secondhand smoke (SHS) reached as high as 18 times the level in the Hampton Roads Tunnel to Hazardous (Code Maroon) air pollution emergency levels in one bar, and pollution was at Code Violet (Very Unhealthy) levels in a bingo hall, bowling alley, and 2 pubs, Code Red Unhealthy) in a bar and 2 pubs, and Code Yellow (Moderate) in 3 restaurants. Virginia’s hospitality industry is delivering highly polluted air to its workers and patrons. Tobacco smoke pollution in Virginia is not being – and cannot be -- controlled by ventilation or air cleaning technology, and is a clear and present danger to the health of hospitality workers and patrons."

Repace, J., "Displacement ventilation fails to control secondhand smoke: a 3 pub air quality study," Abstract Accepted for Presentation, 15th Annual International Society for Exposure
Analysis Conference October 30 - November 3, 2005 Tucson, Arizona, 2005.

This paper clearly shows that secondhand smoke particulate matter, if treated simply as respirable dust, cannot be controlled to the level of the U.S. Environmental Protection Agency's National Ambient Air Quality Standards without cleaning the outdoor supply air and using impractical rates of ventilation. This study also shows that if secondhand smoke is treated as the toxin and carcinogen it actually is, using combined lung cancer and heart disease dose-response relationships developed as guidance by Australian ventilation and medical authorities, secondhand smoke cannot be controlled to acceptable levels of risk used by U.S. federal regulatory agencies without tornado-like rates of ventilation. This is true regardless of whether ventilation is used alone or in conjunction with air cleaning.

Repace, J.L.; Homer, M.; Carmella, S.; Travers, M., "Laramie, Wyoming bar patron cotinine study: WYSAC Technical Report No. CHES-517," University of Wyoming Wyoming Survey & Analysis Center, September 2005.

This study tested cotinine in volunteers to determine the air quality in bars and bowling alleys in Laramie, Wyoming, before and after a smokefree ordinance took effect. The study concluded that, "since implementation of the smoking ban in all Laramie workplaces, cotinine levels in bar patrons have dropped nearly 90%."

Travers, M.; Homer, M.; Hyland, A.; Sandefer, R., "Wyoming air monitoring study: WYSAC Technical Report No. CHES-513," University of Wyoming, Wyoming Survey & Analysis Center; Roswell Park Cancer Institute, August 2005.

This study examined indoor air quality in a sample of bars and restaurants in two Wyoming cities, Laramie and Cheyenne. Samples were taken in Laramie before and after a smokefree ordinance took effect, and the authors stated that, "Overall, across both cities the level of indoor air pollution ... was 95% lower in the venues that were smoke-free compared to those where smoking was permitted."

Hahn, E.J.; Rayens, M.K.; York, N.; Dignan, M.; Al-Delaimy, W.K., "Secondhand smoke exposure in restaurant and bar workers before and after Lexington's smoke-free ordinance," University of Kentucky, College of Nursing, July 5, 2005.

This study "examined hair nicotine of 106 employees at nearly 50 randomly selected Lexington bars and restaurants. Hair samples were analyzed four months before the law took effect and then three months after the enactment of the ordinance, which bans smoking in public areas in Lexington. The study found that lower nicotine levels in the hair samples were found even among workers who smoked."

Travers, M.; Hyland, A., "Indiana Air Monitoring Study, December 2004 - January 2005," Roswell Park Cancer Institute, April 2005.

This study examined indoor air quality in hospitality venues in Bloomington, Indiana. The study found that indoor air pollution was 94% lower in the venues that were required to be smokefree, compared to those where smoking was permitted.

This study measured secondhand smoke air pollution in 17 licensed-gambling clubs with smoking and "nonsmoking" areas - defined as separate rooms and/or tables where smoking is not permitted - in New South Wales (NSW), Australia. Smoking caused 86% of inhalable particle air pollution in the smoking sections and caused 71% of the pollution in the nonsmoking sections. The study's authors concludes that designated "no smoking" areas did not eliminate exposure to secondhand smoke, and that smokefree workplace legislation, which protects all workers, is needed in New South Wales.

Repace, J.L., "Estimated mortality from secondhand smoke among club, pub, bar, and tavern workers in New South Wales, Australia," Repace Associates, Inc., April 7, 2004

This case study provides additional explanations and analysis of the Cains, et. al (2004) study, entitled, "Designated 'no smoking' areas provide from partial to no protection from environmental tobacco smoke." It estimates the annual mortality of New South Wales (NSW), Australia, hospitality workers from secondhand smoke exposure in 17 licensed-gambling clubs. The analysis concludes that secondhand smoke exposure on the job is the largest individual cause of premature occupational death among NSW club, pub, and bar industry workers, including common ones such as being hit by a moving vehicle, weapons, falls, and contacts with electricity.

RTI International, “First Annual Independent Evaluation of New York’s Tobacco Control Program,” New York State Department of Health, November 2004.

In less than two hours after New York’s smokefree law went into effect and smoking stopped, the level of respirable particulate matter (PM) dropped to 15 percent of the level on a smoking night in restaurants and bars. Three months after the law became effective, the level of PM dropped by 90 percent in these venues. Prior to the smokefree law’s implementation, New York hospitality employees working an eight hour shift, 250 days a year, were exposed to particulate matter levels seven times greater than the maximum level deemed as acceptable by the U.S. Environmental Protection Agency. In addition, PM dropped an average of 77 percent after the law went into effect in bowling alleys, pool halls, and bingo halls.

Hyland, A., Travers, M., Repace, J., "Hartford Air Monitoring Study, March-April 2004," Roswell Park Cancer Institute, May 2004.

This study assessed indoor air quality in nine bars and restaurants in Hartford, Connecticut, and found a a 76% reduction in particulate matter levels following the implementation of Connecticut's smokefree law.

Anderson, L.G., "Measurements of Environmental Tobacco Smoke in Restaurants and Bars in Denver Phase II: Prepared for Denver Health and Hospital Authority Contract Number E0900," Littleton, CO: Anderson & Associates, June 17, 2004.

When air quality is poor in Denver, Colorado, health officials call it a "brown cloud" day. Officials recommend that people stay indoors, do not drive, and minimize physical activity to avoid health risks caused by inhaling larger than normal amounts of particulate matter. This report by Denver Public Health shows than during a normal shift Denver bar workers inhale particulate matter far worse than the already dangerous levels found on these "brown cloud" days. Even worse, workers may experience even more dangerous air quality found during severe forest fires. (See a graph of the results)

Studies like this one, are a good way to demonstrate that smoke-filled environments pose a dangerous health threat to workers and patrons in the smokiest environments. If your community is going smokefree soon, consider collecting air sample both before and after your new law takes effect. You will them be able to show the drastic improvement in air quality, and provide first hand evidence that your new law protects health. To learn more about how to conduct a similar investigation in your community, please contact us.

"The State of Smoke-Free New York City: A One-Year Review," New York City Department of Health and Mental Hygiene, March 2004.

On March 29, 2004, the New York City Department of Health and Mental Hygiene announced the findings of a report title "The State of Smoke-Free New York City," a one-year review of the economic and health impact of the law.