Secondhand smoke exposure levels in outdoor hospitality venues: a qualitative and quantitative review of the research literature

Abstract

Objective This paper considers the evidence on whether outdoor secondhand smoke (SHS) is present in high enough levels of hospitality venues to potentially pose health risks, particularly among employees of such establishments. Data Sources Search strings in PubMed and Web of Science included combinations of environmental tobacco smoke, secondhand smoke, or passive smoke AND outdoor, yielding 217 and 5,199 results, respectively through June, 2012. Study Selection Sixteen studies were selected based on abstract review that either entirely or partly measured outdoor SHS exposures (particulate matter (PM) or other SHS indicators). Data Extraction The methods used to measure SHS indicators, particularly PM, were assessed for inclusion of extraneous variables that may affect such measurements or the corroboration of ambient levels with known standards. Data Synthesis The magnitude of SHS exposure (PM2.5) is dependent on the number of smokers present, proximity to the measuring device, outdoor enclosures, and wind. Under specific conditions, peak outdoor PM2.5 levels can be comparable to those recorded in indoor smoky environments. Using data from both observational and experimental studies, annual excess PM2.5 exposure of full-time waitstaff at outdoor smoking environments could average 4.0 to 12.2 μg/m3 under variable smoking conditions. Conclusions Although highly transitory, outdoor SHS exposures could occasionally exceed annual ambient air quality exposure guidelines. However, such exposures are likely to be higher for occupationally exposed individuals compared to patrons due to repeated and cumulative outdoor SHS exposures. Personal monitoring studies of waitstaff are warranted to corroborate these modeled estimates.

Exposure to Secondhand Smoke and Attitudes Toward Smoke-Free Workplaces Among Employed U.S. Adults: Findings From the National Adult Tobacco Survey

“…Nonetheless, nearly one-quarter of workers believed smoking should never be allowed in outdoor areas of workplaces, which is consistent with previous assessments of population-level attitudes toward smoke-free outdoor areas (Thomson, Wilson, & Edwards, 2009). Research suggests that outdoor SHS exposure can exceed acceptable air quality standards (Licht, Hyland, Travers, & Chapman, 2013), and smoking restrictions are increasingly being adopted in outdoor areas, including health care facilities, transport settings, universities, parks, beaches, and within specified distances from building entryways (ANRF, 2013c; Thomson et al, 2009). …”

Assessment of the smoke-free outdoor regulation in the WHO European Region

“…Previous studies have shown that non-smokers are exposed to SHS in outdoor areas where smoking is allowed (Licht, et al, 2013, Sureda, et al, 2013), and that SHS concentration is higher in outdoor locations such as bus stops, stadiums, bars and restaurants. In addition, when smoking is allowed in entrance areas, smoke-free indoor locations have high levels of SHS (Licht, et al, 2013, Sureda, et al, 2013).…”

Is a smoking ban in UK parks and outdoor spaces a good idea?

“…In a 2013 review I worked on, 17 the only studies we found were of real world or simulated outdoor exposure in crowded settings such as bar patios, beer gardens, and bus shelters. No studies looked at exposure in parks or on beaches-almost certainly because researchers with any knowledge of airborne exposures would appreciate that such exposures would be so small, dissipated, and transitory as to be of no concern.…”