Involuntary smoking in the restaurant workplace. A review of employee exposure and health effects.
OBJECTIVE
To determine the relative exposure to environmental tobacco smoke for bar and restaurant employees compared with office employees and with nonsmokers exposed in the home (part 1) and to determine whether this exposure is contributing to an elevated lung cancer risk in these employees (part 2).


METHODS
MEDLINE and bibliographies from identified publications.


METHODS
In part 1, published studies of indoor air quality were included if they reported a mean concentration of carbon monoxide, nicotine, or particulate matter from measurements taken in one or more bars, restaurants, offices, or residences with at least one smoker. In part 2, published epidemiologic studies that reported a risk estimate for lung cancer incidence or mortality in food-service workers were included if they controlled, directly or indirectly, for active smoking.


METHODS
In part 1, a weighted average of the mean concentration of carbon monoxide, nicotine, and respirable suspended particulates reported in studies was calculated for bars, restaurants, offices, and residences. In part 2, the relative lung cancer risk for food-service workers compared with that for the general population was examined in the six identified studies.


RESULTS
Levels of environmental tobacco smoke in restaurants were approximately 1.6 to 2.0 times higher than in office workplaces of other businesses and 1.5 times higher than in residences with at least one smoker. Levels in bars were 3.9 to 6.1 times higher than in offices and 4.4 to 4.5 times higher than in residences. The epidemiologic evidence suggested that there may be a 50% increase in lung cancer risk among food-service workers that is in part attributable to tobacco smoke exposure in the workplace.


CONCLUSIONS
Environmental tobacco smoke is a significant occupational health hazard for food-service workers. To protect these workers, smoking in bars and restaurants should be prohibited.
Siegel
M
M
University of California, Berkeley/University of California.
D016902:Air Pollution, Indoor / Q000706:statistics & numerical data; D006798:Housing; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology*; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D012147:Restaurants; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000706:statistics & numerical data*; D017132:Workplace
D014028:Tobacco Smoke Pollution