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Secondhand Tobacco Smoke in Public Places in Latin America, 2002-2003

JAMA [06/09/04]

By Ana Navas-Acien, MD, MPH; Armando Peruga, MD, DrPH; Patrick Breysse, PhD; Alfonso Zavaleta, MD; Adriana Blanco-Marquizo, MD; Raul Pitarque, MD; Marisol Acuña, MD; Katya Jiménez-Reyes, MD; Vera L. Colombo, MD; Graciela Gamarra, MD; Frances A. Stillman, EdD; Jonathan Samet, MD, MS

Context  The success of measures to restrict smoking in indoor environments and the intensity of enforcement vary among countries around the world. In 2001, the Pan American Health Organization (PAHO) launched the Smoke-Free Americas Initiative to build capacity to achieve smoke-free environments in Latin America and the Caribbean.

Objective  To assess secondhand smoke concentrations in public places in the capital cities of Argentina, Brazil, Chile, Costa Rica, Paraguay, Peru, and Uruguay in conjunction with the Smoke-Free Americas Initiative.

Design and Setting  Multicountry assessment of vapor-phase nicotine concentrations using a common protocol in all 7 Latin American countries. A total of 633 sampling devices were placed for 7 to 14 days in 1 hospital, 2 secondary schools, 1 city government building, 1 airport (2 in Argentina), and restaurants and bars in each country.

Main Outcome Measure  Concentrations of airborne nicotine.

Results  Airborne nicotine was detected in most (94%) of the locations surveyed. By country, Argentina and Uruguay had the highest median concentrations in most environments (eg, in hospitals: 1.33 [interquartile range {IQR}, 0.51-3.12] µg/m³ and 0.8 [IQR, 0.30-1.69] µg/m³, respectively). Overall, bars and restaurants had the highest median concentrations (3.65 [IQR, 1.55-5.12] µg/m³ and 1.24 [IQR, 0.41-2.48] µg/m³, respectively). Nicotine concentrations were also found in a number of key, sentinel buildings, including 95% (155/163) of hospital samples (in the physicians' and nurses' stations the median was 0.27 [IQR, 0.02-1.94] µg/m³), schools, government buildings, and/or airports in most countries.

Conclusions  The finding of airborne nicotine in critical locations in Latin America provides a basis for enforcing smoke-free initiatives and for strengthening the protection of the public from unwanted exposure to secondhand smoke.

Author Affiliations: Institute for Global Tobacco Control and the Department of Epidemiology (Drs Navas-Acien, Stillman, and Samet) and Department of Environmental Health Sciences (Dr Breysse), Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Pan American Health Organization, Washington, DC (Dr Peruga); Department of Biochemistry, Molecular Biology and Pharmacology, Universidad Peruana Cayetano Heredia and CEDRO, Lima, Perú (Dr Zavaleta); Intendencia Municipal, Montevideo, Uruguay (Dr Blanco-Marquizo); Ministry of Health at the moment of the study, presently, UATA, Buenos Aires, Argentina (Dr Pitarque); Tobacco Unit, Ministry of Health, Santiago, Chile (Dr Acuña); IAFA, San Jose, Costa Rica (Dr Jiménez-Reyes); INCA, Rio de Janeiro, Brazil (Dr Colombo); Tobacco Unit, Ministry of Health, Asunción, Paraguay (Dr Gamarra).