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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries
Author(s): Henderson, Elisabet
Continente, Xavier
Fernández, Esteve
Tigova, Olena
Cortés-Francisco, Nuria
Gallus, Silvano
Lugo, Alessandra
Semple, Sean
Dobson, Ruaraidh
Clancy, Luke
Keogan, Sheila
Ruprecht, Ario
Borgini, Alessandro
Tzortzi, Anna
O'Donnell, Rachel
Keywords: Tobacco-smoke pollution
airborne nicotine
smoke-free policies
hospitality venue
Issue Date: Sep-2021
Date Deposited: 15-Jun-2021
Citation: Henderson E, Continente X, Fernández E, Tigova O, Cortés-Francisco N, Gallus S, Lugo A, Semple S, Dobson R, Clancy L, Keogan S, Ruprecht A, Borgini A, Tzortzi A & O'Donnell R (2021) Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries. Environmental Research, 200, Art. No.: 111355.
Abstract: Objective Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants. Methods Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants. Results Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) μg/m3 and increased during nighttime (1.45 IQR:0.65-4.79 μg/m3), in enclosed venues (2.97 IQR:0.80-5.80 μg/m3), in venues with more than two smokers (2.79 IQR:1.03-6.30 μg/m3), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 μg/m3), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 μg/m3). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues’ degree of enclosure. Conclusions Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.
DOI Link: 10.1016/j.envres.2021.111355
Rights: This article is available under the Creative Commons CC-BY-NC-ND license ( and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed. For commercial reuse, permission must be requested from the publisher.
Notes: Additional co-authors: Vergina K. Vyzikidou, Giuseppe Gorini, Angel López-Nicolás, Joan B. Soriano, Gergana Geshanova, Joseph Osman, Ute Mons, Krzysztof Przewozniak, José Precioso, Ramona Brad, Maria J. López,
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