Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries

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/m 3 and increased during nighttime (1.45 IQR:0.65–4.79 μg/m 3 ), in enclosed venues (2.97 IQR:0.80–5.80 μg/m 3 ), in venues with more than two smokers (2.79 IQR:1.03–6.30 μg/m 3 ), in venues in countries with total indoor smoking bans (1.20 IQR:0.47–4.85 μg/m 3 ), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49–5.34 μg/m 3 ). 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.

Evaluation of a smoke-free beaches intervention in Barcelona: a quasi-experimental study

“…This result mirrors what has been described in terraces of hospitality venues. 28 Moreover, the increase of older users in smoke-free beaches after the intervention may show a positive effect on a vulnerable population.…”

Secondhand smoke in the densely populated urban setting: A cross‐sectional survey of exposure, knowledge, attitudes, and respiratory symptoms

“…These high exposures could be due to the fact that, in Singapore, many open‐air F&B establishments still have smoking sections and designated smoking areas are typically in the form of open‐air areas 36 . Such segregation strategies are, as research has consistently found, ineffective at protecting people from SHS, 2 and may be especially ineffective in densely populated cities where smokers are in close proximity to others 9,17–24 . In New York City, for instance, non‐smokers' nicotine exposures were found to be higher than the national average despite smoking rates in New York City being lower than the national average 29 .…”

“…36 Such segregation strategies are, as research has consistently found, ineffective at protecting people from SHS, 2 and may be especially ineffective in densely populated cities where smokers are in close proximity to others. 9,[17][18][19][20][21][22][23][24] In New York City, for instance, non-smokers' nicotine exposures were found to be higher than the national average despite smoking rates in New York City being lower than the national average. 29 This may partly explain why the majority (60%) of our participants reported that they reconsider visiting leisure outlets, such as bars and restaurants, to avoid SHS.…”

“…While countries have made significant strides in making indoor public places smokefree, 15 people remain exposed to SHS in places not covered by smokefree legislations such as public transport stops and outdoor dining areas, 16 with high SHS exposures reported where smokers are in close proximity to others 9,17–24 . Multi‐country surveys of SHS exposure estimate that 49% of children under age 15 25 and 17% to 73% of adults 26 are exposed to SHS at home.…”

Smoke-free spaces: a decade of progress, a need for more?

“…46 The precise definition of these open or semiopen spaces has become a key enforcement issue of smoke-free laws in these places because of the difficulties in interpreting and implementing the law around smoking in such outdoor areas. 47 Nicotine and PM 2.5 concentrations in these settings 48 are usually significantly lower than in indoor settings due to air movement and dilution, and there are potentially major differences globally: walking past a smoker on a windswept Scottish beach may lead to considerably lower exposure when compared with sitting next to a group of smokers on a terrace outside on a still, warm evening in a Mediterranean country.…”