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Secondhand tobacco smoke: an occupational hazard for smoking and non-smoking bar and nightclub employees
  1. Miranda R Jones1,
  2. Heather Wipfli2,3,
  3. Shahida Shahrir2,
  4. Erika Avila-Tang1,2,
  5. Jonathan M Samet1,2,3,
  6. Patrick N Breysse2,4,
  7. Ana Navas-Acien1,2,4,
  8. FAMRI Bar Study Investigators
  1. 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  4. 4Department of Environmental Health Sciences at the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Ana Navas-Acien, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Office W7513D, Baltimore, MD 21205, USA; anavas{at}


Background In the absence of comprehensive smoking bans in public places, bars and nightclubs have the highest concentrations of secondhand tobacco smoke, posing a serious health risk for workers in these venues.

Objective To assess exposure of bar and nightclub employees to secondhand smoke, including non-smoking and smoking employees.

Methods Between 2007 and 2009, the authors recruited approximately 10 venues per city and up to five employees per venue in 24 cities in the Americas, Eastern Europe, Asia and Africa. Air nicotine concentrations were measured for 7 days in 238 venues. To evaluate personal exposure to secondhand smoke, hair nicotine concentrations were also measured for 625 non-smoking and 311 smoking employees (N=936).

Results Median (IQR) air nicotine concentrations were 3.5 (1.5–8.5) μg/m3 and 0.2 (0.1–0.7) μg/m3 in smoking and smoke-free venues, respectively. Median (IQR) hair nicotine concentrations were 6.0 (1.6–16.0) ng/mg and 1.7 (0.5–5.5) ng/mg in smoking and non-smoking employees, respectively. After adjustment for age, sex, education, living with a smoker, hair treatment and region, a twofold increase in air nicotine concentrations was associated with a 30% (95% CI 23% to 38%) increase in hair nicotine concentrations in non-smoking employees and with a 10% (2% to 19%) increase in smoking employees.

Conclusions Occupational exposure to secondhand smoke, assessed by air nicotine, resulted in elevated concentrations of hair nicotine among non-smoking and smoking bar and nightclub employees. The high levels of airborne nicotine found in bars and nightclubs and the contribution of this exposure to employee hair nicotine concentrations support the need for legislation measures that ensure complete protection from secondhand smoke in these venues.

  • Nicotine
  • tobacco smoke pollution
  • workplace
  • smoking-caused disease
  • national capacity building
  • prevalence
  • environmental tobacco smoke
  • harm reduction
  • surveillance and monitoring
  • human rights
  • secondhand smoke
  • global health
  • litigation
  • cotinine
  • low/middle-income country

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  • Funding This project was supported by a Clinical Investigator Award from the Flight Attendant Medical Research Institute (FAMRI). MRJ and AN-A were also supported by the US National Cancer Institute (R03CA153959). MRJ was supported by the Cardiovascular Epidemiology Institutional Training from the National Heart, Lung and Blood Institute (T32HL007024).

  • Competing interests None.

  • Ethics approval Johns Hopkins Bloomberg school of Public Health and within country ethic committees.

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

  • Data sharing statement Data from this study are available for reanalysis and for analysis of additional research questions through contact with the study authors.