Study raises concerns about outdoor second-hand smoke

Indoor smoking bans have forced smokers at bars and restaurants onto outdoor patios, but a new University of Georgia study in collaboration with the Centers for Disease Control and Prevention suggests that these outdoor smoking areas might be creating a new health hazard.

The study, thought to be the first to assess levels of a nicotine byproduct known as cotinine in nonsmokers exposed to second-hand smoke outdoors, found levels up to 162 percent greater than in the control group. The results appear in the November issue of the Journal of Occupational and Environmental Hygiene.

“Indoor smoking bans have helped to create more of these outdoor environments where people are exposed to secondhand smoke,” said study co-author Luke Naeher, associate professor in the UGA College of Public Health. “We know from our previous study that there are measurable airborne levels of secondhand smoke in these environments, and we know from this study that we can measure internal exposure.

“Secondhand smoke contains several known carcinogens and the current thinking is that there is no safe level of exposure,” he added. “So the levels that we are seeing are a potential public health issue.”

Athens-Clarke County, Ga., enacted an indoor smoking ban in 2005, providing Naeher and his colleagues and ideal environment for their study. The team recruited 20 non-smoking adults and placed them in one of three environments: outside bars, outside restaurants and, for the control group, outside the UGA main library. Immediately before and after the six-hour study period, the volunteers gave a saliva sample that was tested for levels of cotinine, a byproduct of nicotine and a commonly used marker of tobacco exposure.

The team found an average increase in cotinine of 162 percent for the volunteers stationed at outdoor seating and standing areas at bars, a 102 percent increase for those outside of restaurants and a 16 percent increase for the control group near the library.

Naeher acknowledges that an exposure of six-hours is greater than what an average patron would experience but said that employees can be exposed for even longer periods.

“Anyone who works in that environment—waitresses, waiters or bouncers—may be there for up to six hours or longer,” Naeher said. “Across the country, a large number of people are occupationally exposed to second-hand smoke in this way.”

Studies that measured health outcomes following indoor smoking bans have credited the bans with lowering rates of heart attacks and respiratory illness, but Naeher said that the health impacts of outdoor second-hand smoke are still unknown.

In Naeher’s study, cotinine levels in the volunteers at the bar setting saw their levels increase from an average pre-exposure level of 0.069 ng/ml (nanograms per milliliter) to an average post-exposure level of 0.182 ng/ml. The maximum value observed, however, was 0.959 ng/ml. To put that number into context, a widely cited study has determined that an average cotinine level of 0.4 ng/ml increases lung cancer deaths by 1 for every 1,000 people and increases heart disease deaths by 1 for every 100 people.

Still, the researchers caution that it’s too early to draw policy conclusions from their findings. Cotinine is a marker of exposure to tobacco, Naeher said, but is not a carcinogen. The team is currently planning a study that would measure levels of a molecule known as NNAL, which is a marker of tobacco exposure and a known carcinogen, in people exposed to second-hand smoke outdoors.

“Our study suggests that there is reason to be concerned about second-hand smoke levels outdoors,” said study co-author Gideon St. Helen, who is pursuing his Ph.D. through the university’s Interdisciplinary Toxicology Program, “and our findings are an incentive for us to do further studies to see what the effects of those levels are.”

The study was funded by the Northeast (Georgia) Health District, the Athens (Georgia) Community Wellness Council and the Athens Tobacco Prevention Coalition.

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Have a Happy Lead-Free Holiday

We often hear reports about lead in toys, electrical cords, holiday lights and artificial Christmas trees this time of year. Lead poisoning is very dangerous. Make every attempt to reduce exposure to lead hazards for you and your family.

Lead poisoning damages the brain and central nervous system, which can lead to learning disabilities, seizures or even death. Children are at greatest risk of exposure because they’re more likely to touch things and then put their contaminated hands into their mouths.

Lead may be found in the paint on some imported toys or in some plastics. Using lead in house paint, children’s products, dishes and cookware was banned in the United States in 1978. Lead is still used in other countries and may be found on some imported toys.

Lead may also be in certain plastics where it is used to soften it and make it more flexible. As the plastic is exposed to sunlight, air or detergents, the bond between the lead and plastics breaks down and forms harmful dust.

If you think your child has been exposed to a toy containing lead, remove the toy immediately and ask your healthcare provider about getting your child tested for lead. There will be no visible symptoms of lead poisoning. For information on toy recalls, go to www.cpsc.gov or call (800) 638-2772.

Manufacturers may use lead as part of the polyvinyl chloride insulation around the wiring on strings of lights or the branches of artificial trees. Lead helps stabilize PVC so it doesn’t crack or crumble with age. It also acts as a fire retardant.

To reduce the lead dangers in your home during the holidays, wash your hands after hanging lights and decorations. If you own an older artificial tree and lights, replace them. When shopping for a new tree and lights, be sure to read the warning labels to determine if the products contain lead.

To further reduce your family’s exposure to lead:

Place a doormat by all outside doors and remove shoes outside to prevent tracking in lead dust.
Keep areas where children play clean and dust-free.
Leave lead-based paint undisturbed if it is in good condition.
Use lead-safe practices when removing paint, or hire a professional.
Eat a balanced diet rich in calcium and iron.
While there are many different sources of lead, the primary source of lead poisoning in children is still lead-based paint. There are do-it-yourself lead testing kits available, however, they aren’t very reliable and don’t indicate how much lead is present.

Contact your local University of Georgia Cooperative Extension office at 1-800-ASK-UGA1 for more information on how to safely remove lead from your home.

By Pamela Turner
University of Georgia

Pamela Turner is an Extension housing specialist with the University of Georgia College of Family and Consumer Sciences.

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