Impact of the Spanish smoking law on exposure to second-hand smoke and respiratory health in hospitality workers: A cohort study

Esteve Fernández, Marcela Fu, José A. Pascual, María J. López, Mónica Pérez-Ríos, Anna Schiaffino, Jose M. Martínez-Sánchez, Carles Ariza, Esteve Saltó, Manel Nebot, Anna Martín, Josep Maria Borràs, Stephanie Rania, Jorge Twose, Francesca Sánchez-Martínez, Francesc Centrich, Glòria Muñoz, Eulàlia Serrahima, Araceli Valverde, Meia FaixedasFrancesc Abella, Enric Rovira, Raúl Pérez, Begoña Alonso, María Isolina Santiago, María Jesús García, Míriam Otero, Arturo López, Elena Tejera, Magdalena Borrás, Juan A. Ayensa, Ernesto Pérez, Francisco Carrión, Pepa Pont, José A. Lluch, Elena Pérez, M. Eugenia López, Sonia Álvarez, M. Emma del Castillo, Fernando Martín, Blanca M. Benito, José Antonio Riesco, Isabel Marta, Almudena García, Carmen Estrada, Virgilio Blanco, Ana Esteban, M. Ángeles Hessel, José Precioso, Margarida Coll

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Background: A smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban. Methods and Finding: We formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p<0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p<0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned. Conclusions: Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health.

Original languageEnglish (US)
Article numbere4244
JournalPloS one
Issue number1
StatePublished - Jan 23 2009

ASJC Scopus subject areas

  • General


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