title: Impact of the Spanish smoke-free legislation on adult, non-smoker exposure to secondhand smoke: cross-sectional surveys before (2004) and after (2012) legislation.
abstract: BACKGROUND
  In 2006, Spain implemented a national smoke-free legislation that prohibited smoking in enclosed public places and workplaces (except in hospitality venues). In 2011, it was extended to all hospitality venues and selected outdoor areas (hospital campuses, educational centers, and playgrounds). The objective of the study is to evaluate changes in exposure to secondhand smoke among the adult non-smoking population before the first law (2004-05) and after the second law (2011-12).
  
  
  METHODS
  Repeated cross-sectional survey (2004-2005 and 2011-2012) of a representative sample of the adult (≥ 16 years) non-smoking population in Barcelona, Spain. We assess self-reported exposure to secondhand smoke (at home, the workplace, during leisure time, and in public/private transportation vehicles) and salivary cotinine concentration.
  
  
  RESULTS
  Overall, the self-reported exposure to secondhand smoke fell from 75.7% (95%CI: 72.6 to 78.8) in 2004-05 to 56.7% (95%CI: 53.4 to 60.0) in 2011-12. Self-reported exposure decreased from 32.5% to 27.6% (-15.1%, p<0.05) in the home, from 42.9% to 37.5% (-12.6%, p=0.11) at work/education venues, from 61.3% to 38.9% (-36.5%, p<0.001) during leisure time, and from 12.3% to 3.7% (-69.9%, p<0.001) in public transportation vehicles. Overall, the geometric mean of the salivary cotinine concentration in adult non-smokers fell by 87.2%, from 0.93 ng/mL at baseline to 0.12 ng/mL after legislation (p<0.001).
  
  
  CONCLUSIONS
  Secondhand smoke exposure among non-smokers, assessed both by self-reported exposure and salivary cotinine concentration, decreased after the implementation of a stepwise, comprehensive smoke-free legislation. There was a high reduction in secondhand smoke exposure during leisure time and no displacement of secondhand smoke exposure at home.
authors.affiliation: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain ; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.
authors.forename: Xisca
authors.initials: X
authors.lastname: Sureda
authors.affiliation: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain ; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain ; Biostatistic Unit, Department of Basic Science, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Satn Cugat del Valles, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Martínez-Sánchez
authors.affiliation: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain ; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: Fu
authors.affiliation: Bioanalysis Research Group, Neuropsychopharmacology Programme, IMIM-Hospital del Mar Research Institute, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Pérez-Ortuño
authors.affiliation: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain ; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain ; Catalan Network of Smoke-free Hospitals, Insitut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain ; Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain ; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain ; Catalan Network of Smoke-free Hospitals, Insitut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Carabasa
authors.affiliation: Evaluation and Interventions Methods Service, Agència de Salut Pública de Barcelona, Barcelona, Spain ; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Agència de Salut Pública de Barcelona, Barcelona, Spain ; Institut d'Investigació Biomèdica-IBB Sant Pau, Barcelona, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: López
authors.affiliation: Public Health Agency, Ministry of Health, Generalitat de Catalunya, Barcelona, Spain ; Department of Public Health, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Saltó
authors.affiliation: Bioanalysis Research Group, Neuropsychopharmacology Programme, IMIM-Hospital del Mar Research Institute, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain ; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Pascual
authors.affiliation: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain ; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain ; Catalan Network of Smoke-free Hospitals, Insitut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003367:Cotinine / Q000737:chemistry; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance; D012463:Saliva / Q000737:chemistry; D057566:Self Report; D012907:Smoking / Q000453:epidemiology*; D013030:Spain / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine