Exposure to secondhand smoke and excess lung cancer mortality risk among workers in the "5 B's": bars, bowling alleys, billiard halls, betting establishments, and bingo parlours.
OBJECTIVE
To review existing data on exposure to secondhand smoke in bars, bowling alleys, billiard halls, betting establishments, and bingo parlours (the "5 B's") as assessed by ambient nicotine air concentration measurements and to estimate the excess lung cancer mortality risk associated with this exposure.


METHODS
Using the Medline, Toxline, and Toxnet databases, the internet, and bibliographies of relevant articles, we identified studies that reported measurements of ambient nicotine concentrations in the 5 B's.


METHODS
Studies were included if they reported a mean concentration of ambient nicotine measured in at least one of the 5 B's.


METHODS
We calculated a weighted average of nicotine concentrations in each of the 5 B's. We then estimated the working lifetime excess lung cancer mortality risk associated with this exposure, as well as with exposure at the upper and lower limits of the range of mean exposures reported in all of the studies in each establishment category.


RESULTS
Nicotine concentrations in the 5 B's were 2.4 to 18.5 times higher than in offices or residences, and 1.5 to 11.7 times higher than in restaurants. At these exposure levels, estimated working lifetime excess lung cancer mortality risk from secondhand smoke exposure for workers in the 5 B's is between 1.0-4.1/1000, which greatly exceeds the typical de manifestis risk level of 0.3/1000.


CONCLUSIONS
Workers in the 5 B's have high levels of occupational exposure to secondhand smoke and must be included in workplace smoking regulations.
Siegel
M
M
Boston University School of Public Health, Social and Behavioral Sciences Department, Boston, Massachusetts 02118, USA. mbsiegel@bu.edu
Skeer
M
M
D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality*; D009784:Occupational Diseases / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D011634:Public Health; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D017132:Workplace
D014028:Tobacco Smoke Pollution