title: Second-hand smoke exposure in indoor and outdoor areas of cafés and restaurants: Need for extending smoking regulation outdoors?
abstract: Smoke-free legislation in indoor public places has concentrated smokers in the areas outside building entrances or other outdoor areas. This study assessed the drift of second-hand smoke between outdoor and indoor areas of cafés and restaurants in Barcelona, Spain, and characterized the exposure on outdoor terraces. Using a cross-sectional design, we monitored vapor-phase nicotine in indoor areas and outside entrances simultaneously (n=47), and on some outdoor terraces (n=51). We computed the median nicotine concentration and interquartile range (IQR) to describe the data and performed multivariate analysis to describe nicotine concentration and its determinants. The overall median nicotine concentration indoors was 0.65µg/m(3) (IQR: 0.29-1.17µg/m(3)), with significant differences based on the number of smokers at the entrance (p=0.039). At outside entrances, the overall median nicotine concentration was 0.41µg/m(3) (IQR: 0.21-1.17µg/m(3)). The nicotine concentrations indoors and at the corresponding outside entrances were not significantly different, and the multivariate analysis confirmed the relationship between these variables. On terraces, the overall median nicotine concentration was 0.54µg/m(3) (IQR: 0.25-1.14µg/m(3)), but it increased to 0.60µg/m(3) when a tobacco smell was perceived, 0.72µg/m(3) on closed terraces, 1.24µg/m(3) when there were >6 smokers, and 1.24µg/m(3) when someone smoked >20min. Multivariate analysis confirmed the outdoor terrace area, the season, the type of enclosure, and the number of smokers as the most relevant variables explaining nicotine concentration (R(2)=0.396). These findings show that second-hand smoke exposure exists in indoor areas due to smokers smoking at the outside entrances. In addition, exposure may occur on outdoor terraces when smokers are present and the terrace is enclosed to some extent. Thus, the current Spanish law does not fully protect non-smokers from second-hand smoke and supports extending regulation to some outdoor areas.
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: Fu
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain. Electronic address: efernandez@iconcologia.net.
authors.forename: Esteve
authors.initials: E
authors.lastname: Fernández
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Martínez-Sánchez
authors.affiliation: Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Noemi
authors.initials: N
authors.lastname: San Emeterio
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Quirós
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
authors.forename: Xisca
authors.initials: X
authors.lastname: Sureda
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Ballbè
authors.affiliation: Chemistry Area, Agència de Salut Pública de Barcelona, Av. Drassanes, 13, 08001 Barcelona, Spain; Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain.
authors.forename: Glòria
authors.initials: G
authors.lastname: Muñoz
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Riccobene
authors.affiliation: Chemistry Area, Agència de Salut Pública de Barcelona, Av. Drassanes, 13, 08001 Barcelona, Spain; Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Centrich
authors.affiliation: Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Public Health, School of Medicine, Universitat de Barcelona, C. Casanova 143, 08036 Barcelona, Spain; Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Trav. Les Corts, 131-159 - Pavelló Ave Maria, 08028 Barcelona, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Saltó
authors.affiliation: Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain; Evaluation and Intervention Methods Service, Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: López
mesh_terms: D000393:Air Pollutants / Q000032:analysis*; D016902:Air Pollution, Indoor / Q000032:analysis; D002947:Cities; D004784:Environmental Monitoring; D033161:Government Regulation; D006801:Humans; D009538:Nicotine / Q000032:analysis*; D012147:Restaurants; D012907:Smoking / Q000331:legislation & jurisprudence*; D013030:Spain; D014028:Tobacco Smoke Pollution / Q000032:analysis*
chemical_list: D000393:Air Pollutants; D014028:Tobacco Smoke Pollution; D009538:Nicotine
keywords: Air marker; Nicotine; Outdoor tobacco smoke; Passive smoking; Second-hand smoke; Smoking ban; Tobacco smoke pollution