Second-hand smoke and indoor air quality in public places in Gaza city

Abstract

Second-hand smoke is a major cause of preventable disease and death in the Eastern Mediterranean Region. To assess how second-hand smoke impacts air quality, respirable suspended particles (PM 2.5 ), which are emitted during cigarette and waterpipe smoking, were measured inside and outside of 18 smoking and 5 nonsmoking public venues in Gaza city. Median PM 2.5 level inside the smoking venues was 117 µg/m 3 , which exceeds the WHO guidelines for daily PM 2.5 exposure (25 µg/m 3 ) by more than 4-fold. The median level inside the smoking venues (117 µg/m 3 ) was significantly higher than outside the venues (43 µg/m 3 ), and significantly higher than the median level inside non-smoking venues (40 µg/m 3 ). By contrast, particulate levels outside non-smoking venues (35 µg/m 3 ) did not differ from the corresponding levels inside (40 µg/m 3 ). To protect employees and the public from second-hand smoke exposure, policies prohibiting smoking in public places are needed in Gaza city. Tabagisme passif et qualité de l'air intérieur dans des lieux publics de la ville de GazaRÉSUMÉ Le tabagisme passif est une cause majeure de morbi-mortalité évitable dans la Région de la Méditerranée orientale. Pour évaluer l'impact du tabagisme passif sur la qualité de l'air, les particules respirables en suspension (PM 2,5 ) émises pendant la consommation de cigarettes et de pipes à eau ont été mesurées à l'intérieur et à l'extérieur de 18 lieux publics fumeurs et 5 lieux publics non-fumeurs de la ville de Gaza. Le taux de PM 2,5 moyen à l'intérieur des lieux fumeurs était de 117 µg/m 3 , un taux plus de quatre fois supérieur aux recommandations de l'Organisation mondiale de la Santé pour l'exposition quotidienne aux particules fines (25 µg/m 3 ). Le taux intérieur médian des lieux fumeurs (117 µg/m 3 ) était nettement supérieur au taux extérieur (43 µg/m 3 ) et significativement supérieur au taux intérieur médian des lieux non-fumeurs (40 µg/m 3 ). En revanche, les taux de particules à l'extérieur des lieux non-fumeurs (35 µg/m 3 ) et à l'intérieur de ces mêmes lieux (40 µg/m 3 ) étaient similaires. Afin de protéger les employés et le public de l'exposition au tabagisme passif, des politiques interdisant le tabagisme dans les lieux publics sont nécessaires dans la ville de Gaza.

PM<SUB>2.5</SUB> as a marker of exposure to tobacco smoke and other sources of particulate matter in Cairo, Egypt

“…Recent studies from the Middle East region that used comparable study designs to ours have documented similarly elevated levels of one to two orders of magnitude in venues such as waterpipe cafes compared to those where tobacco smoking was banned. 16,19,20 In contrast, other studies have reported differences between venues that were slightly smaller than those in our study. For example, recent air monitoring in seven cities in the United States found PM 2.5 to be 82% lower in smoke-free hospitality settings than in venues where smoking was permitted.…”

“…9 Exposure to ETS from waterpipes, which are typically smoked in social settings, including cafes, bars, and restaurants, may be of particular concern for workers in such establishments, who often have low levels of protection due to inadequate smoking regulations in some countries. 10–16 The World Health Organization's Framework Convention on Tobacco Control calls on governments to ‘protect all persons from exposure to tobacco smoke’, rather than just specific populations such as children or pregnant women. This protection should be extended, according to Article 8 to, ‘indoor workplaces, public transport, indoor public places and…other public places’.…”

Secondhand smoke emission levels in waterpipe cafes in Doha, Qatar

“…Moreover, Hammal et al 34 observed mean indoor PM 2.5 levels of 264 μg/m 3 arising from the use of tobacco-free ‘herbal’ WP products. The particulate matter levels detected among WP cafes in Qatar also compare closely with those observed in non-smoke-free public venues (predominantly containing cigarettes) reported elsewhere in the EMR, and throughout the world 21 28 35 36…”

Secondhand smoke in waterpipe tobacco venues in Istanbul, Moscow, and Cairo

“…We did not identify many significant associations between venue characteristics and SHS levels. Other studies of SHS in waterpipe tobacco venues have reported positive associations between smoker density and mean PM 2.5 (Abuelaish et al, 2013; Al Mulla et al, 2014; Cobb et al, 2013; Saade et al, 2010; Zaidi et al, 2011; Zhang et al, 2013). …”

“…Environmental Protection Agency, 2013; World Health Organization, 2014). Other studies of waterpipe tobacco venues in the US (Cobb et al, 2013; Fiala et al, 2012; Zhang et al, 2013; Zhou et al, 2014), Qatar (Al Mulla et al, 2014), Lebanon (Saade et al, 2010), Pakistan (Zaidi et al, 2011), and Palestine (Abuelaish et al, 2013) have all found elevated PM 2.5 concentrations, with mean concentrations ranging from 117 μg/m 3 to 1,419 μg/m 3 .…”