Secondhand Tobacco Smoke Exposure in Open and Semi-Open Settings: A Systematic Review

Abstract

Background: Some countries have recently extended smoke-free policies to particular outdoor settings; however, there is controversy regarding whether this is scientifically and ethically justifiable.Objectives: The objective of the present study was to review research on secondhand smoke (SHS) exposure in outdoor settings.Data sources: We conducted different searches in PubMed for the period prior to September 2012. We checked the references of the identified papers, and conducted a similar search in Google Scholar.Study selection: Our search terms included combinations of “secondhand smoke,” “environmental tobacco smoke,” “passive smoking” OR “tobacco smoke pollution” AND “outdoors” AND “PM” (particulate matter), “PM2.5” (PM with diameter ≤ 2.5 µm), “respirable suspended particles,” “particulate matter,” “nicotine,” “CO” (carbon monoxide), “cotinine,” “marker,” “biomarker” OR “airborne marker.” In total, 18 articles and reports met the inclusion criteria.Results: Almost all studies used PM2.5 concentration as an SHS marker. Mean PM2.5 concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m3 at hospitality venues, and 4.60 to 17.80 µg/m3 at other locations. Mean PM2.5 concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m3. SHS levels 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.Conclusions: 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.

Secondhand smoke exposure within semi-open air cafes and tobacco specific 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) concentrations among nonsmoking employees

“…Our findings identified an association between exposure to SHS in semi open areas and NNAL concentrations, a novel association, within a situation very common in warm Mediterranean environments. A number of factors have been identified to influence exposure to SHS within indoor and outdoor settings such as the number of cigarettes being smoked, the position of smokers relative to the measurement device (or subject) and wind conditions, which can lead to substantial variation in average exposures [6]. The clustering of smokers and thus strengthen our findings.…”

“…NNAL concentrations within subjects have been associated with a higher risk for developing lung cancer among smokers, indicating its use as a biomarker of lung cancer risk among smokers [4,5]. While research has extensively associated secondhand smoke (SHS) concentrations with particulate matter less than 2.5 microns (PM 2.5 ) and human biomarkers, the impact of occupational exposure to SHS in semiopen cafes and TSNA uptake remains relatively unexplored [6][7][8].…”

Factors Influencing Hookah Smoking in High School Students

“…(10). Nargile consumption among young people around the world increased too much in the last decade (11). The prevalence of nargile smoking ranges from 6-34% in adolescents in the Middle East, and 5-17% among American adolescents (11).…”

“…The prevalence of nargile smoking ranges from 6-34% in adolescents in the Middle East, and 5-17% among American adolescents (11). Also, the nargile smoking has increased globally and threatens to become the second biggest global epidemic after cigarettes (11)(12)(13).…”

Exposure to second hand smoke at home and work among nonsmokers

“…There have been studies that have assessed the exposure to SHS in some of these sources, for example, in automobiles (King et al, 2012;Kabir et al, 2009;McIntire et al, 2014) and at bars (Kalkhoran et al, 2013). A recent review reports on the exposure to SHS in open and semi-open settings (Sureda et al, 2013). However, because of many unaccounted for sources of exposure to SHS and variations in the exposure levels within these sources, it is not possible to conjecture what may be the additional levels of exposure to SHS beyond what is reported in this communication.…”