Impact of the Spanish Smoking Law on Exposure to Secondhand Smoke in Offices and Hospitality Venues: Before-and-After Study
Nebot, Manel, Lopez, Maria J., Ariza, Carles, Perez-Rios, Monica, Fu, Marcela, Schiaffino, Anna, Munoz, Gloria, Salto, Esteve, Fernandez, Esteve, Environmental Health Perspectives
BACKGROUND/OBJECTIVES: A smoking law was passed by the Spanish Parliament in December 2005 and was enforced by 1 January 2006. The law bans smoking in all indoor workplaces but only in some hospitality venues, because owners are allowed to establish a smoking zone (venues > 100 [m.sup.2]) or to allow smoking without restrictions (venues < 100 [m.sup.2]). The objective of the study is to assess the impact of the Spanish smoking law on exposure to secondhand smoke (SHS) in enclosed workplaces, including hospitality venues.
MATERIALS AND METHODS: The study design is a before-and-after evaluation. We studied workplaces and hospitality venues from eight different regions of Spain. We took repeated samples of vapor-phase nicotine concentration in 398 premises, including private offices (162), public administration offices (90), university premises (43), bars and restaurants (79), and discotheques and pubs (24).
RESULTS: In the follow-up period, SHS levels were markedly reduced in indoor offices. The median decrease in nicotine concentration ranged from 60.0% in public premises to 97.4% in private areas. Nicotine concentrations were also markedly reduced in bars and restaurants that became smoke-free (96.7%) and in the no-smoking zones of venues with separate spaces for smokers (88.9%). We found no significant changes in smoking zones or in premises allowing smoking, including discotheques and pubs.
CONCLUSIONS: Overall, this study shows the positive impact of the law on reducing SHS in indoor workplaces. However, SHS was substantially reduced only in bars and restaurants that became smoke-free. Most hospitality workers continue to be exposed to very high levels of SHS. Therefore, a 100% smoke-free policy for all hospitality venues is required.
KEY WORDS: evaluation, hospitality sector, secondhand smoke, smoking law, workplaces. Environ Health Perspect 117:344-347 (2009). doi:10.1289/ehp.11845 available via http://dx.doi.org/ [Online 19 September 2008]
Exposure to secondhand smoke (SHS) has been recognized as a risk factor for a variety of diseases among exposed adults, including coronary heart disease and lung cancer. SHS exposure also causes respiratory symptoms and infections, asthma exacerbations, and an increased risk of sudden infant death syndrome in children (California Environmental Protection Agency 1997; International Agency for Research on Cancer 2004; U.S. Department of Health and Human Services 2006). Nonsmokers are known to be exposed to significant air pollution burdens from indoor smoking (Repace and Lowrey 1980). Current estimates suggest that SHS exposure might be responsible for as many as 19,400 annual deaths among nonsmokers in Europe alone (Smoke Free Partnership 2006). In Spain, a recent study has estimated a minimum of 1)228 annual deaths among non-smokers (Lopez et al. 2007). In response to this growing evidence, smoke-free programs and policies have been widely promoted and implemented in public places and at the workplace. These initiatives have consistently shown clear benefits in several measures, including improving symptoms, self-reported health, and productivity (Borland et al. 1992; Chapman et al. 1999; Eisner et al. 1998).
In Europe, a growing number of countries have already adopted smoking regulations, although the overall approach to tobacco control differs (Joossens and Raw 2006; Spinney 2007). Most countries have banned smoking at the workplace, but there are large differences in policies focusing on the hospitality sector. The case of Italy is notable: Although a smoking ban in bars and restaurants that allowed smoking under several conditions was passed in 2005, in practice, only 1% of these venues has allowed smoking since the law came into force (Gorini et al. 2007).
Nowadays, there is widespread consensus that smoking control policies have represented a major step forward in protecting nonsmokers from SHS, thus producing a substantial gain in public health. …