title: Lung function and exposure to workplace second-hand smoke during exemptions from smoking ban legislation: an exposure-response relationship based on indoor PM2.5 and urinary cotinine levels.
abstract: BACKGROUND
  The effects of workplace second-hand smoke (SHS) on lung function remain uncertain because of a lack of objective measures for SHS exposures.
  
  
  OBJECTIVE
  To determine whether an exposure-response association exists between lung function and two different markers of SHS based on indoor fine particulate (PM(2.5)) and urinary cotinine levels in non-smoking catering workers.
  
  
  METHODS
  A cross-sectional study during a 1.5-year exemption of licensed catering premises from smoke-free legislation. Participants 186 non-smoking catering workers aged 18-65 years in Hong Kong were recruited. A declared non-smoking status was accepted in workers with exhaled breath carbon monoxide levels <6 ppm and urinary cotinine levels <100 ng/ml.
  
  
  METHODS
  Lung function measures of forced expiratory volume in 1s (FEV(1) in litres), forced vital capacity (FVC in litres) and forced expiratory flow as 25-75% of FVC (FEF(25-75) in l/s) were recorded.
  
  
  RESULTS
  Indoor fine particulate (PM(2.5)) concentrations were 4.4 times as high in smoking premises (267.9 μg/m(3)) than in non-smoking premises (60.3 μg/m(3)) and were strongly associated with the probability of permitted smoking (R(2)=0.99). Smoking was the dominant source of particulates (R(2)=0.66). Compared with workers exposed to the lowest indoor PM(2.5) stratum (<25 μg/m(3)), lung function was lower in the three higher PM(2.5) strata (25-75, 75-175, >175 μg/m(3)) with FEV(1) -0.072 (95% CI -0.123 to -0.021), -0.078 (95% CI -0.132 to -0.024), -0.101 (95% CI -0.187 to -0.014); FEF(25-75) -0.368 (95% CI -0.660 to -0.077), -0.489 (95% CI -0.799 to -0.179), -0.597 (95% CI -0.943 to -0.251); and FEV(1)/FVC (%) -2.9 (95% CI -4.8 to -1.0), -3.2 (95% CI -5.1 to -1.4) and -4.4 (95% CI -7.4 to -1.3), respectively. Urinary cotinine was associated positively with indoor PM(2.5) but negatively with lung function. Consistently lower values for lung function per unit increase of indoor PM(2.5) were found.
  
  
  CONCLUSIONS
  Lung function is inversely associated with workplace SHS. Workplace exemptions and delays in implementing smoke-free policies and current moves to relax legislation are a major threat to the health of workers.
authors.affiliation: The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China.
authors.forename: Hak-Kan
authors.initials: HK
authors.lastname: Lai
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Hedley
authors.forename: James
authors.initials: J
authors.lastname: Repace
authors.forename: Ching
authors.initials: C
authors.lastname: So
authors.forename: Qiu-Ying
authors.initials: QY
authors.lastname: Lu
authors.forename: Sarah M
authors.initials: SM
authors.lastname: McGhee
authors.forename: Richard
authors.initials: R
authors.lastname: Fielding
authors.forename: Chit-Ming
authors.initials: CM
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000395:Air Pollutants, Occupational / Q000032:analysis / Q000633:toxicity*; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis; D003367:Cotinine / Q000652:urine; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D005511:Food Handling; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis / Q000331:legislation & jurisprudence; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity*; D012147:Restaurants / Q000331:legislation & jurisprudence; D012907:Smoking / Q000331:legislation & jurisprudence; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000032:analysis / Q000331:legislation & jurisprudence; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult
chemical_list: D000395:Air Pollutants, Occupational; D052638:Particulate Matter; D014028:Tobacco Smoke Pollution; D003367:Cotinine