Research Impact of the Spanish Smoking Law on Exposure to Secondhand Smoke in Offices and Hospitality Venues: Before-and-After Study Manel Nebot,1,2,3 Maria J. López,1,3,4 Carles Ariza,1,3 Mónica Pérez-Ríos,3,5,6 Marcela Fu,2,7 Anna Schiaffino,8 Gloria Muñoz,1 Esteve Saltó,9 and Esteve Fernández,2,7 on behalf of the Spanish Smoking Law Evaluation Group* 1Public Health Agency, Barcelona, Spain; 2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; 3Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER ESP), Spain; 4PhD Programme in Public Health and Methodology of Biomedical Research, Universitat Autònoma de Barcelona, Barcelona, Spain; 5Department of Preventive Medicine, and 6Department of Health, Xunta de Galicia, Santiago de Compostela, Spain; 7Catalan Institute of Oncology and Institute of Biomedical Research of Bellvitge, L’Hospitalet de Llobregat, Spain; 8Municipal Health Institute, City Council of Terrassa, Terrassa, Spain; 9Department of Health, Generalitat de Catalunya, Barcelona, Spain Background /o Bjectivs : A smoking law was passed by the Spanish Parliament in December 2005 and was enforced by 1 January 2006. The law bans smoking in all indoor workplaces but only in some hospitality venues, because owners are allowed to establish a smoking zone (venues > 100 m2) or to allow smoking without restrictions (venues < 100 m2). The objective of the study is to assess the impact of the Spanish smoking law on exposure to secondhand smoke (SHS) in enclosed workplaces, including hospitality venues. Materils : The study design is a before-and-after evaluation. We studied workplaces nad Methods and hospitality venues from eight different regions of Spain. We took repeated samples of vapor- phase nicotine concentration in 398 premises, including private offices (162), public administration offices (90), university premises (43), bars and restaurants (79), and discotheques and pubs (24). r sulte : In the follow-up period, SHS levels were markedly reduced in indoor offices. The median decrease in nicotine concentration ranged from 60.0% in public premises to 97.4% in private areas. Nicotine concentrations were also markedly reduced in bars and restaurants that became smoke- free (96.7%) and in the no-smoking zones of venues with separate spaces for smokers (88.9%). We found no significant changes in smoking zones or in premises allowing smoking, including disco- theques and pubs. c onclusi : Overall, this study shows the positive impact of the law on reducing SHS in indoor workplaces. However, SHS was substantially reduced only in bars and restaurants that became smoke-free. Most hospitality workers continue to be exposed to very high levels of SHS. Therefore, a 100% smoke-free policy for all hospitality venues is required. k ey words : evaluation, hospitality sector, secondhand smoke, smoking law, workplaces. Environ Health Perspect 117:344–347 (2009). doi:10.1289/ehp.11845 available via http://dx.doi.org/ [Online 19 September 2008] Exposure to secondhand smoke (SHS) has been recognized as a risk factor for a variety of diseases among exposed adults, including coronary heart disease and lung cancer. SHS exposure also causes respiratory symptoms and infections, asthma exacerbations, and an increased risk of sudden infant death syn- drome in children (California Environmental Protection Agency 1997; International Agency for Research on Cancer 2004; U.S. Department of Health and Human Services 2006). Nonsmokers are known to be exposed to significant air pollution burdens from indoor smoking (Repace and Lowrey 1980). Current estimates suggest that SHS exposure might be responsible for as many as 19,400 annual deaths among nonsmokers in Europe alone (Smoke Free Partnership 2006). In Spain, a recent study has estimated a mini- mum of 1,228 annual deaths among non- smokers (López et al. 2007). In response to this growing evidence, smoke-free programs and policies have been widely promoted and implemented in public places and at the workplace. These initiatives have consistently shown clear benefits in several measures, including improving symptoms, self-reported 344 health, and productivity (Borland et al. 1992; Chapman et al. 1999; Eisner et al. 1998). In Europe, a growing number of countries have already adopted smoking regulations, although the overall approach to tobacco con- trol differs (Joossens and Raw 2006; Spinney 2007). Most countries have banned smoking at the workplace, but there are large differ- ences in policies focusing on the hospitality sector. The case of Italy is notable: Although a smoking ban in bars and restaurants that allowed smoking under several conditions was passed in 2005, in practice, only 1% of these venues has allowed smoking since the law came into force (Gorini et al. 2007). Nowadays, there is widespread consen- sus that smoking control policies have rep- resented a major step forward in protecting nonsmokers from SHS, thus producing a sub- stantial gain in public health. However, some questions remain unanswered regarding the assessment of the impact of these policies in specific contexts. First, most studies have been carried out as pretest/post-test comparisons and have examined only short-term effects. Therefore, the mid- and long-term effects of these regulations remain unclear. Moreover, these studies have used a variety of indicators, including biomarkers (e.g., cotinine in saliva), airborne markers (e.g., nicotine or respiratory suspended particles), self-reported exposure, and health effects (e.g., respiratory symp- toms). These indicators measure different dimensions of SHS exposure and have differ- ent validity. Among airborne markers, mea- surement of nicotine in vapor phase has been widely used because of its specificity, because SHS is the only source of nicotine in the air (Hammond 1993; Rothberg et al. 1998). This method has been used to evaluate the impact of smoking bans in the workplace (Heloma and Jaakkola 2003) and the hospitality sec- tor (Gorini et al. 2005; Mulcahy et al. 2005) and has revealed significant changes after the implementation of new policies, even in a small number of venues. Spain implemented a ban prohibiting smoking in all indoor workplaces in January 2006 (Fernandez 2006; Ministerio de Sanidad Address correspondence to M. Nebot, Agència de Salut Pública de Barcelona, Plaza Lesseps 1, Barcelona 08023, Spain. Telephone: (34) 93-238-4562. Fax: (34) 93-217-3197. E-mail: mnebot@aspb.es *Agència de Salut Pública de Barcelona: M. Nebot, C. Ariza, M.J. López, F. Sánchez-Martínez, F. Centrich, G. Muñoz, E. Serrahima; Institut Català d’Oncologia: E. Fernández, M. Fu, J.M. Martínez- Sánchez, A. Martín, J.M. Borràs, S. Rania, J. Twose, A. Schiaffino; Generalitat de Catalunya: E. Saltó, A. Valverde, M. Faixedas, F. Abella, E. Rovira; Xunta de Galicia: M. Pérez-Ríos, B. Alonso, M.I. Santiago, M.J. García, S. Veiga; Govern de les Illes Balears: A. López, E. Tejera, M. Borrás, J.A. Ayensa, E. Pérez; Generalitat Valenciana: F. Carrión, P. Pont, J.A. Lluch; Gobierno de Cantabria: M.E. López, S. Álvarez, M.E. del Castillo, F. Martín, B.M. Benito; Junta de Extremadura: J.A. Riesco; Comunidad de Madrid: I. Marta, A. García, C. Estrada, V. Blanco; Gobierno de La Rioja: A. Esteban, M.Á. Hessel; Universidade do Minho: J. Precioso; Acadèmia de Ciències Mèdiques d’Andorra: M. Coll (study coordinator). We thank the Spanish Society of Epidemiology, the Spanish Ministry of Health, and the Public Health Directorate of each participating autonomous community. This study was partially funded by the Ministry of Health Instituto de Salud Carlos III (FIS PI052293) and supported by the Department of Health of each participating autonomous region. The authors declare they have no competing financial interests. Received 23 June 2008; accepted 19 September 2008. ovlume 117 | number 3 | March 2009 • Environmental Health Perspectives