title: Second-hand smoke in mental healthcare settings: time to implement total smoke-free bans?
abstract: BACKGROUND
  Second-hand smoke is associated with adverse health effects. Many countries have extended smoke-free policies to public buildings and workplaces such as hospitals, but mental health units have usually been exempted from complete smoke-free bans. The objective of this study was to evaluate second-hand smoke levels in mental health units with different types of smoking bans. Method We conducted a cross-sectional study to evaluate second-hand smoke in 64 mental health inpatient units (95.5% of the all such units) in Catalonia, Spain. We measured air concentrations of particulate matter <2.5 μm (PM2.5) as a marker of second-hand smoke in different locations at each unit.
  
  
  RESULTS
  The geometric mean (95% confidence interval) of the PM2.5 concentration was 8.81 μg/m(3) (8.06-9.56) in units with indoor and outdoor smoking bans, 13.80 μg/m(3) (13.23-14.36) in units with indoor smoking bans that allowed smoking in outdoor areas, 24.29 μg/m(3) (23.50-25.03) in units with indoor smoking rooms and 51.00 μg/m(3) (49.83-52.04) in units that allowed smoking in common indoor areas (P < 0.05). The regression model adjusted for confounding variables showed a linear increase of PM2.5. The PM2.5 concentration in smoking rooms was 286.50 μg/m(3) (283.95-288.89).
  
  
  CONCLUSIONS
  Only units with indoor and outdoor smoking bans had PM2.5 levels below the standard recommended WHO levels of 10 μg/m(3). Units with more permissive smoking policies had PM2.5 levels from second-hand smoke that have harmful health effects.
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Ballbè
authors.forename: Xisca
authors.initials: X
authors.lastname: Sureda
authors.forename: Jose M
authors.initials: JM
authors.lastname: Martínez-Sánchez
authors.forename: Esteve
authors.initials: E
authors.lastname: Saltó
authors.forename: Antoni
authors.initials: A
authors.lastname: Gual
authors.forename: Esteve
authors.initials: E
authors.lastname: Fernández
mesh_terms: D016902:Air Pollution, Indoor / Q000032:analysis*; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D004784:Environmental Monitoring; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007878:Legislation as Topic; D008297:Male; D052638:Particulate Matter / Q000032:analysis*; D061845:Smoke-Free Policy; D013030:Spain; D014028:Tobacco Smoke Pollution / Q000032:analysis* / Q000706:statistics & numerical data
chemical_list: D052638:Particulate Matter; D014028:Tobacco Smoke Pollution
keywords: Tobacco smoke pollution; hospitals; mental health services; policy; smoking