Objective
This paper considers the evidence on whether outdoor secondhand smoke (SHS) is present in high enough levels of hospitality venues to potentially pose health risks, particularly among employees of such establishments.
Data Sources
Search strings in PubMed and Web of Science included combinations of environmental tobacco smoke, secondhand smoke, or passive smoke AND outdoor, yielding 217 and 5,199 results, respectively through June, 2012.
Study Selection
Sixteen studies were selected based on abstract review that either entirely or partly measured outdoor SHS exposures (particulate matter (PM) or other SHS indicators).
Data Extraction
The methods used to measure SHS indicators, particularly PM, were assessed for inclusion of extraneous variables that may affect such measurements or the corroboration of ambient levels with known standards.
Data Synthesis
The magnitude of SHS exposure (PM2.5) is dependent on the number of smokers present, proximity to the measuring device, outdoor enclosures, and wind. Under specific conditions, peak outdoor PM2.5 levels can be comparable to those recorded in indoor smoky environments. Using data from both observational and experimental studies, annual excess PM2.5 exposure of full-time waitstaff at outdoor smoking environments could average 4.0 to 12.2 μg/m3 under variable smoking conditions.
Conclusions
Although highly transitory, outdoor SHS exposures could occasionally exceed annual ambient air quality exposure guidelines. However, such exposures are likely to be higher for occupationally exposed individuals compared to patrons due to repeated and cumulative outdoor SHS exposures. Personal monitoring studies of waitstaff are warranted to corroborate these modeled estimates.