title: Secondhand smoke in Pennsylvania casinos: a study of nonsmokers' exposure, dose, and risk.
abstract: OBJECTIVE
  I assessed air pollution, ventilation, and nonsmokers' risk from secondhand smoke (SHS) in Pennsylvania casinos exempted from a statewide smoke-free workplace law.
  
  
  METHODS
  I measured respirable suspended particles (RSPs), particulate polycyclic aromatic hydrocarbons (PPAHs), and carbon dioxide inside and outside casinos; measured changes in patrons' urine cotinine after casino visits; and assessed SHS impact on workers and patrons, using exposure-response models, air quality standards, and odor and irritation thresholds.
  
  
  RESULTS
  PPAH and RSP concentrations in casinos were, on average, 4 and 6 times, respectively, that of outdoor levels despite generous ventilation and low smoking prevalence. SHS infiltrated into nonsmoking gaming areas. Patrons' urine cotinine increased 1.9 ng/mL on average after about 4-hour visits.
  
  
  CONCLUSIONS
  SHS-induced heart disease and lung cancer will cause an estimated 6 Pennsylvania casino workers' deaths annually per 10,000 at risk, 5-fold the death rate from Pennsylvania mining disasters. Casinos should not be exempt from smoke-free workplace laws.
authors: Repace Associates Inc, Bowie, 20720, USA. repace@comcast.net
authors: James L
authors: JL
authors: Repace
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000706:statistics & numerical data*; D003367:Cotinine / Q000652:urine; D006801:Humans; D015233:Models, Statistical; D009784:Occupational Diseases / Q000453:epidemiology* / Q000401:mortality; D010414:Pennsylvania / Q000453:epidemiology; D011084:Polycyclic Aromatic Hydrocarbons / Q000652:urine; D015995:Prevalence; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*; D014691:Ventilation / Q000706:statistics & numerical data; D017132:Workplace / Q000706:statistics & numerical data*
chemical_list: D011084:Polycyclic Aromatic Hydrocarbons; D014028:Tobacco Smoke Pollution; D003367:Cotinine