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Exposure to environmental tobacco smoke (ETS) has adverse health effects for both children and adults.1–3 Southern European countries have not had the same level of ETS control measures as other western countries. The purpose of this study was to assess current ETS exposure in several locations in Barcelona, Spain.
We collected airborne nicotine with 31 diffusion monitors containing sodium bisulfate coated filters.4,5 Between September 1999 and March 2000 different locations were chosen from among the following 18 sites in Barcelona: five underground (subway) stations (n = 5, one measurement in each station); two restaurants (n = 3, one of the restaurants, located in one of the two teaching hospitals referred to below, had measurements taken from smoking and non-smoking areas); two large stores (n = 4, two measurements in each store); two teaching hospitals (n = 4, two measurements from newborns inpatients and paediatrics outpatients departments from one hospital, and two from emergency rooms and radiography emergency departments from the other hospital); one medical school (n = 5), one official language school (n = 2); one secondary school (n = 1); one general practice (n = 2); one public health centre (n = 1); and three households (n = 4, one smoker's home and two non-smoker's households). Nicotine concentrations for the three field blanks all corresponded to airborne concentrations of less than 0.02 μg/m3.
Monitors were left exposed for periods ranging from 7–13 days, since a minimum period of seven days was required to have a valid measure with passive monitors. One trained investigator completed a standard form with data concerning the date and time, placement and removal, exposure area, ventilation and distribution patterns, and distance from the person smoking nearby. The highest air nicotine concentration was found in restaurants, showing a mean of 12.4 μg/m3 (10.6–15.0 μg/m3). The air nicotine concentrations in a secondary school and in a smoker's household were 9.5 μg/m3 and 7.9 μg/m3, respectively. In department stores, the average air nicotine concentration was 2.8 μg/m3 (range 0.4–6.2 μg/m3). ETS exposure in the language school showed a mean nicotine concentration of 2.3 μg/m3 (range 1.7–3.0 μg/m3). Other results are presented in table 1.
Although these results need to be interpreted within the limitation of having only 31 measurements and a non-random sample, this is the first attempt to obtain an objective measure of ETS exposure in public places in Barcelona. The data may also provide at least an initial insight into the situation in other southern European countries where measurements of ETS exposure are not common. Restaurants showed high concentrations, including two measurements obtained from hospital canteens where the average nicotine concentrations showed no significant difference between smoking and non-smoking areas (15.0 and 11.5 μg/m3, respectively). This may reflect a lack of compliance or a weak physical separation between the two areas, and is especially serious since it involves hospitals. Nicotine concentrations in restaurants were found to be double those found in a smoker's household. Other studies have shown higher concentrations of nicotine in workplaces, including restaurants, as compared to smokers' homes6–8. Our measurements are consistent with and even higher than those found in other studies where mean concentrations ranged from 2–6 μg/m3 in offices and from 3–8 μg/m3 in restaurants.8
Since all areas in our study were sampled 24 hours a day for at least a full week, concentrations were probably much higher during time of occupancy—that is, when non-smokers, especially children, were exposed. The fact that collection of data was made during the winter means that the results may have been less influenced by open windows. The finding of lower concentrations of nicotine in health centres and medical schools, where several local policies are being put in place, is encouraging.
The results of this study are intended to raise awareness of involuntary exposure to ETS and the need to enforce compliance with legislation. Such legislation already exists in Catalonia, affecting the public transport system, health and education centres, and large department stores, where smoking is not allowed except in designated areas.9 Smokefree policies not only protect non-smokers from second hand smoke, they also create an environment that makes it easier for smokers to stop.
We especially wish to thank Charles Perrino and Pablo Villegas from the School of Public Health, University of California, Berkeley, and the Institute for Global Tobacco Control at the Johns Hopkins School of Public Health, Baltimore, for its support in carrying out this study.