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Secondhand tobacco smoke exposure in selected public places (PM2.5 and air nicotine) and non-smoking employees (hair nicotine) in Ghana
  1. Wilfred Agbenyikey1,
  2. Edith Wellington2,
  3. John Gyapong2,
  4. Mark J Travers3,
  5. Patrick N Breysse4,
  6. Kathleen M McCarty1,
  7. Ana Navas-Acien4,5
  1. 1Environmental Health Science Department, Yale University School of Medicine, Department of Epidemiology and Public Health, New Haven, Connecticut, USA
  2. 2Research and Development Division, Ghana Health Service, Accra, Ghana
  3. 3Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
  4. 4Department of Environmental Health Sciences and Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Ana Navas-Acien, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W7033B, Baltimore, MD 21205, USA; anavas{at}


Background Secondhand tobacco smoke (SHS) exposure is a global public health problem. Ghana currently has no legislation to prevent smoking in public places. To provide data on SHS levels in hospitality venues in Ghana the authors measured (1) airborne particulate matter <2.5 μm (PM2.5) and nicotine concentrations and (2) hair nicotine concentrations in non-smoking employees. Quantifying SHS exposure will provide evidence needed to develop tobacco control legislation.

Method PM2.5 was measured for 30 min in 75 smoking and 13 non-smoking venues. Air nicotine concentrations were measured for 7 days in 8 smoking and 2 non-smoking venues. Additionally, 63 non-smoking employees provided hair samples for nicotine analysis.

Result Compared to non-smoking venues, smoking venues had markedly elevated PM2.5 (median 553 [IQR 259–1038] vs 16.0 [14.0–17.0] μg/m3) and air nicotine (1.83 [0.91–4.25] vs 0.03 [0.02–0.04] μg/m3) concentrations. Hair nicotine concentrations were also higher in non-smoking employees working in smoking venues (median 2.49 [0.46–6.84] ng/mg) compared to those working in non-smoking venues (median 0.16 [0.08–0.79] ng/mg). Hair nicotine concentrations correlated with self-reported hours of SHS exposure (r=0.35), indoor air PM2.5 concentrations (r=0.47) and air nicotine concentrations (r=0.63).

Conclusion SHS levels were unacceptably high in public places in Ghana where smoking is allowed, despite a relatively low-smoking prevalence in the country. This is one of the first studies to ascertain SHS and hair nicotine in Africa. Levels were comparable to those measured in American, Asian and European countries without or before smoking bans. Implementing a comprehensive smoke-free legislation that protects workers and customers from exposure to secondhand smoke is urgently needed in Ghana.

  • Environmental tobacco smoke
  • public policy
  • surveillance and monitoring

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  • Funding Funding for this project was provided by the Flight Attendant Medical Research Institute (FAMRI); IDRC-Research for International Tobacco Control, Canada; Bloomberg Global Initiative, Johns Hopkins Bloomberg School of Public Health; and the Stolwijck Fellowship, Yale University. The authors, and not the funding sources, are responsible for the design and conduct of the study, the collection, the analysis and interpretation of the data and the preparation of the manuscript.

  • Competing interests None.

  • Ethics approval The study and consent procedures were approved by Ghana Health Service Ethical Review Committee and by Institutional Review Boards at Johns Hopkins Bloomberg School of Public Health and Yale University. Participation of subjects was voluntary and after receiving informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.