Secondhand Smoke Found in 94 Percent of Public Places in Latin America

Researchers from the Johns Hopkins Bloomberg School of Public Health, the Pan American Health Organization and other institutions have found carcinogenic secondhand smoke in a significant number of public places throughout Latin America. Smoke-free, indoor environments are one way nonsmokers can avoid premature death and disease as a result of exposure to secondhand smoke. The scientific evidence supports the 2001 Pan American Health Organization’s Smoke-Free Americas initiative, which was established to achieve smoke-free, indoor environments in Latin America and the Caribbean. The study researchers documented the extent and location of exposure to smoke in indoor locations in seven capital cities. They also identified the most critical areas for control. The study, “Secondhand Tobacco Smoke in Public Places in Latin America, 2002-2003” was published in the June 9, 2004, issue of the Journal of the American Medical Association (JAMA).

“These data for Latin America have immediate relevance for public health and medical professionals and for the governmental entities responsible for protecting the public from unwanted exposure to secondhand smoke. Nicotine was detected in most of the places we surveyed and nonsmoking areas did not effectively protect nonsmokers,” said Ana Navas-Acien, MD, MPH, lead author of the study and a graduate student in the School’s Department of Epidemiology.

Secondhand smoke concentrations were assessed in Argentina, Brazil, Chile, Costa Rica, Paraguay, Peru and Uruguay. The researchers tested samples from 633 locations, which were chosen to represent areas where people frequently worked or spent time, such as secondary schools, bars, restaurants, hospitals, city government buildings and airports. In 94 percent of the testing locations, airborne nicotine was detected.

Although the levels of nicotine varied from hospital to hospital and within each hospital, nicotine was present in 95 percent of the hospitals studied. Argentinean hospitals had the highest levels (1.33 ug/m3). Secondary schools had a low median concentration of nicotine. However, it was detected in 78 percent of the schools tested. Argentina and Uruguay had the highest concentrations of nicotine in government buildings. The overall median concentration in restaurants was 1.24 ug/m3. Bars had the highest concentration of any of the locations, with a median of 3.65 ug/m3. The researchers also found an obvious presence of nicotine in nonsmoking sections in restaurants.

The authors suggest in their study that instituting smoke-free environments in government buildings may be useful as a model and impetus to expanding smoke-free policies to other workplaces in Latin America. They also propose that enforcing current smoking bans in hospitals should be required as a component of any accreditation process for health care facilities. The levels of nicotine found in bars and restaurants pose a health risk to the workers who are continuously exposed to secondhand smoke. The researchers suggest that all occupational settings should be smoke-free.

Patrick Breysse, PhD, MHS, study co-author and professor in the School’s Department of Environmental Health Sciences, said, “This study provides an important basis for developing and evaluating tobacco control programs aimed at reducing exposure to secondhand smoke. For example, we were able to detect secondhand smoke exposure in hospitals where smoking was supposedly banned, suggesting that smoking bans are not being effectively enforced.”

Dr. Navas-Acien said that the study has already had an impact on governmental policy. In Uruguay, the government cited the study in a recent decree that aims at creating smoke-free health care facilities.

The study was funded by the Pan American Health Organization and the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.

Ana Navas-Acien, MD, MPH, Armando Peruga, MD, DrPH, Patrick Breysse, PhD, Alfonso Zavaleta, MD, Adriana Blanco-Marquizo, MD, Raul Pitarque, MD, Marisol Acuna, MD, Katya Jimenez-Reyes, MD, Vera L. Colombo, MD, Graciela Gamarra, MD, Frances A. Stillman, EdD and Jonathan Samet, MD, MS, co-authored the study.