Indoor Smoking Bans Kick Carcinogens to the Curb

(HealthDay News) -- Bar and restaurant smoking bans are forcing more and more smokers to head for the exit, only to create noxious "smoke zones" on the sidewalk, new research shows.

"In the past few years, we've effectively banned smoking in most public places in many parts of the country, and one unintended result are these 'smoke zones' in front of restaurants and bars," noted study author L.P. Naeher, an assistant professor at the University of Georgia College of Public Health in Athens.

"This is a relatively new phenomenon," he added. "So, we wanted to study it, to see what the smoking exposure is for nonsmoking patrons and for the workers. And what we found is that the level of secondhand smoke in front of restaurants and bars was several times higher than the safety standards established by the EPA's Clean Air Act."

The findings were presented Monday at the American Thoracic Society's International Conference in San Francisco.

Signed into law in 1963, and most recently updated in 1990 and in 2005, the U.S. Environmental Protection Agency's "Clean Air Act" sets national air quality regulations and air pollution standards.

According to the American Lung Association (ALA), the EPA classifies secondhand smoke as a carcinogen containing hundreds of toxic chemicals, including formaldehyde, benzene, vinyl chloride, ammonia and cyanide.

ALA estimates suggest that in the United States about 3,400 lung cancer deaths and upwards of almost 70,000 heart disease deaths occur each year as a result of exposure to secondhand smoke. And last year, a U.S. Surgeon General report revealed that nearly half of all nonsmoking Americans are routinely exposed to secondhand smoke.

In their study, Naeher's group measured the level of pollutants in the air outside several drinking and eating establishments in and around Athens, Ga.

Athens is a college town with more than 100 bars and restaurants, all of which began implementing a full smoking ban in 2005. The team tested air near two bars and two restaurants, plus one location away from restaurants and smokers.

On two consecutive Friday and Saturday afternoons, air sample readings were taken directly outside each locale every 30 seconds. Each of the four establishments had a designated smokers area with or without seating, either outside the main entrance or in an internal courtyard.

The researchers sampled levels of smoking-linked carbon monoxide levels and fine particle matter. The latter, called PM2.5, can penetrate deep into the lung.

The result: the more smokers present in the smoking zones, the greater the amount of carbon monoxide and PM2.5.

Smoking areas outside bars had the highest substance readings, followed by those outside restaurants. Compared with the location away from any of the four establishments, PM2.5 readings were nearly three times as high outside bars and twice as high outside the restaurants.
Naeher stressed that the study readings seemed to correlate exclusively with smokers, not nearby car traffic.
It's tough to asses the exact health hazard posed by the observed curbside pollution levels, Naeher said. But his group is conducting follow-up research that tries to measure that impact, based on urine and saliva samples from people loitering in smoking zones.

In the meantime, one longtime anti-smoking advocate said moves to ban indoor smoking in restaurants and bars are still important.

"The fact is that you're better off having it outside than inside," said Stanton A. Glantz, a professor of medicine and director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. With bans on indoor smoking in place, "the only choice smokers have is to go outdoors," he said. "And while that could cause a problem for people who choose to go to those areas, presumably people who don't smoke are not going to hang out there."

He pointed out that some states, such as California, have also tackled concerns about outside smoking zones by making it illegal to light up within a certain distance of a public facility.

"But even where this isn't regulated, the smoke will get blown away," added Glantz. "And there's good literature that shows that when you make a workplace smoke-free people cut down cigarette consumption overall. So, this is a far better way to go than what we had before."
Naeher agreed.

"It's not illegal to smoke, and when you have smokers, you're going to have secondhand smoke," he acknowledged. "There's no way to get around that. But the real question is, are these levels high enough to pose a danger to health? We don't have a clear answer to that. So, it certainly warrants further investigation."

In related research, a team at Columbia University's Mailman School of Public Health found that nonsmokers living and working in a completely smoke-free environment are two and a half times more likely to say they are in better health than those living without such bans. The findings, which are published in the May/June issue of the Journal of Urban Health, were based on surveys conducted among almost 1,500 Chinese Americans living in New York City.

More information
For more on secondhand smoke, visit the American Lung Association.