Tobacco Smoke Exposure in Indoor and Outdoor Locations in Airports Across Europe and the United States: A Cross-Sectional Study

Abstract

Airports are known to allow exceptions to smoke-free policy by providing DSRs. We found that smoking still occurs in indoor areas in airports, particularly in the context of DSRs. Smoking, moreover, is widespread in outdoor areas and compliance with smoking restrictions is limited. Advancing smoke-free policy requires improvements to the physical environment of airports, including removal of DSRs and implementation of stricter outdoor smoking restrictions.

A Cross-Sectional Study of Tobacco Advertising, Promotion, and Sponsorship in Airports across Europe and the United States

“…A separate paper discusses in detail the relationship between the physical environment of airports, including presence of smoking behavior or cues indoor and outdoor (smokers, smelling smoke, cigarette butts, ashtrays), presence of designated smoking rooms, no-smoking signage, and other factors [19]. Among the airports containing designated smoking rooms, two rooms in Europe showed cigarette advertisements (Camel brand logo appeared in Frankfurt and Munich, and the Munich room was called the “Camel Smoking Lounge”).…”

“…Findings on the physical environment of airports and exposure to secondhand tobacco smoke in indoor and outdoor locations are presented in a separate manuscript [19], and findings on e-cigarettes observed in airports and during flights are presented in a separate manuscript [20]. The Institutional Review Board at the Johns Hopkins Bloomberg School of Public Health approved all study protocols and materials, and this study did not involve human subjects.…”

“…Options for “other” provided an additional space for collectors to fill in qualitative information to describe characteristics of the retail environment, such as store names, and the tobacco brands observed. As part of the parent study on secondhand smoke exposure in airports [19], data collectors counted the number of smokers standing outside of airport entrances or exits. Data were entered from paper forms into an electronic database, and all analyses were performed with Stata (version 13.1, StataCorp, Austin, TX, USA) [23].…”

Exposure to Secondhand Tobacco Smoke at Airport Terminals

“…We assessed this parameter because PM2.5, although an important marker of environmental air pollution [29], can be nonspecific as a surrogate for SHS in settings with multiple pollutants [2, 30], and studies have suggested that the vehicular contribution to urban ambient PM2.5 levels can reach the range of 32–40% [31, 32]. One study of tobacco exposure in airports in the United States and Europe explicitly declined to measure PM2.5 levels, citing this lack of specificity, and instead measured air nicotine levels [33]. However, when compared directly in controlled environments, a single cigarette produced over twice as much particulate emissions as two heavy-duty diesel trucks [34], and three cigarettes produced PM levels ten times greater than a single 2.0 litre diesel engine [35].…”

“…However, despite progress in the enactment of comprehensive indoor smoking bans in many localities, outdoor bans have lagged behind, with controversy surrounding both the legality [43] as well as the effectiveness [44–46] of such ordinances, even if the hazardous nature of outdoor SHS has now been fully established [47]. Nevertheless, it is being increasingly recognized that “outdoor smoking is an important area for advancing smoke-free policy” [33], and calls for total, premise-wide bans in the airport setting are gaining in traction. Indeed, Article 8 of the World Health Organization's Framework Convention on Tobacco Control (FCTC) demands “universal protection by ensuring that all indoor public places, all indoor workplaces, all public transport and possibly other (outdoor or quasi-outdoor) public places are free from exposure to second-hand tobacco smoke” [48].…”