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Lung function and exposure to workplace second-hand smoke during exemptions from smoking ban legislation: an exposureeresponse relationship based on indoor PM2.5 and urinary cotinine levels

ABSTRACT
Background The effects of workplace second-hand
smoke (SHS) on lung function remain uncertain because
of a lack of objective measures for SHS exposures.
Objective To determine whether an
exposureeresponse association exists between lung
function and two different markers of SHS based on
indoor fine particulate (PM2.5) and urinary cotinine levels
in non-smoking catering workers.
Design A cross-sectional study during a 1.5-year
exemption of licensed catering premises from smokefree
legislation.
Participants 186 non-smoking catering workers aged
18e65 years in Hong Kong were recruited. A declared
non-smoking status was accepted in workers with
exhaled breath carbon monoxide levels <6 ppm and
urinary cotinine levels <100 ng/ml.
Main outcome measures Lung function measures of
forced expiratory volume in 1s (FEV1 in litres), forced vital
capacity (FVC in litres) and forced expiratory flow as
25e75% of FVC (FEF25e75 in l/s) were recorded.
Results Indoor fine particulate (PM2.5)
concentrations were 4.4 times as high in smoking
premises (267.9 mg/m3) than in non-smoking premises
(60.3 mg/m3) and were strongly associated with the
probability of permitted smoking (R2¼0.99). Smoking
was the dominant source of particulates (R2¼0.66).
Compared with workers exposed to the lowest indoor
PM2.5 stratum (<25 mg/m3), lung function was lower in
the three higher PM2.5 strata (25e75, 75e175,
>175 mg/m3) with FEV1 “0.072 (95% CI “0.123 to
“0.021), “0.078 (95% CI e0.132 to “0.024), “0.101
(95% CI “0.187 to “0.014); FEF25e75 “0.368 (95% CI
“0.660 to “0.077), “0.489 (95% CI “0.799 to
“0.179), “0.597 (95% CI “0.943 to “0.251); and
FEV1/FVC (%) “2.9 (95% CI “4.8 to “1.0), “3.2 (95%
CI “5.1 to “1.4) and “4.4 (95% CI “7.4 to “1.3),
respectively. Urinary cotinine was associated positively
with indoor PM2.5 but negatively with lung function.
Consistently lower values for lung function per unit
increase of indoor PM2.5 were found.
Conclusion Lung function is inversely associated with
workplace SHS. Workplace exemptions and delays in
implementing smoke-free policies and current moves to
relax legislation are a major threat to the health of workers.

ABSTRACTBackground The effects of workplace second-handsmoke (SHS) on lung function remain uncertain becauseof a lack of objective measures for SHS exposures.Objective To determine whether anexposureeresponse association exists between lungfunction and two different markers of SHS based onindoor fine particulate (PM2.5) and urinary cotinine levelsin non-smoking catering workers.Design A cross-sectional study during a 1.5-yearexemption of licensed catering premises from smokefreelegislation.Participants 186 non-smoking catering workers aged18e65 years in Hong Kong were recruited. A declarednon-smoking status was accepted in workers withexhaled breath carbon monoxide levels <6 ppm andurinary cotinine levels <100 ng/ml.Main outcome measures Lung function measures offorced expiratory volume in 1s (FEV1 in litres), forced vitalcapacity (FVC in litres) and forced expiratory flow as25e75% of FVC (FEF25e75 in l/s) were recorded.Results Indoor fine particulate (PM2.5)concentrations were 4.4 times as high in smokingpremises (267.9 mg/m3) than in non-smoking premises(60.3 mg/m3) and were strongly associated with theprobability of permitted smoking (R2¼0.99). Smokingwas the dominant source of particulates (R2¼0.66).Compared with workers exposed to the lowest indoorPM2.5 stratum (<25 mg/m3), lung function was lower inthe three higher PM2.5 strata (25e75, 75e175,>175 mg/m3) with FEV1 “0.072 (95% CI “0.123 to”0.021), “0.078 (95% CI e0.132 to “0.024), “0.101(95% CI “0.187 to “0.014); FEF25e75 “0.368 (95% CI”0.660 to “0.077), “0.489 (95% CI “0.799 to”0.179), “0.597 (95% CI “0.943 to “0.251); andFEV1/FVC (%) “2.9 (95% CI “4.8 to “1.0), “3.2 (95%CI “5.1 to “1.4) and “4.4 (95% CI “7.4 to “1.3),respectively. Urinary cotinine was associated positivelywith indoor PM2.5 but negatively with lung function.Consistently lower values for lung function per unitincrease of indoor PM2.5 were found.Conclusion Lung function is inversely associated withworkplace SHS. Workplace exemptions and delays inimplementing smoke-free policies and current moves torelax legislation are a major threat to the health of workers.

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