Tobacco Smoke Exposure in Indoor and Outdoor Locations in Airports Across Europe and the United States: A Cross-Sectional Study

Conduct a systematic evaluation of indoor and outdoor areas of selected airports, assess compliance and identify areas of improvement with smoke-free policies in airports. Cross-sectional observational study conducted at 21 airports in Europe (11) and the United States (10). Using a standardized pro...

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Bibliographic Details
Published in:Nicotine & tobacco research 2017-11, Vol.19 (12), p.1482-1490
Main Authors: Stillman, Frances A., Soong, Andrea, Pang, Yuanjie, Zheng, Laura, Garcia-Esquinas, Esther, Lopez, Maria Jose, Navas-Acien, Ana
Format: Article
Language:English
Subjects:
Adult
Airports - legislation & jurisprudence
Airports - standards
Cross-Sectional Studies
Europe - epidemiology
Humans
Male
Original investigations
Smoke-Free Policy - legislation & jurisprudence
Tobacco Smoke Pollution - analysis
Tobacco Smoke Pollution - legislation & jurisprudence
Tobacco Smoke Pollution - prevention & control
Tobacco Smoking - adverse effects
Tobacco Smoking - legislation & jurisprudence
Tobacco Smoking - prevention & control
United States - epidemiology
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Summary:Conduct a systematic evaluation of indoor and outdoor areas of selected airports, assess compliance and identify areas of improvement with smoke-free policies in airports. Cross-sectional observational study conducted at 21 airports in Europe (11) and the United States (10). Using a standardized protocol, we assessed compliance (smoking, cigarette butts, smoke smell), and the physical environment (signage, ashtrays, designated smoking rooms [DSRs], tobacco sales). Cigarette butts (45% vs. 0%), smoke smell (67% vs. 0%), ashtrays (18% vs. 10%), and DSRs (63% vs. 30%) were observed more commonly indoors in Europe than in the United States. Poor compliance indoors was related to the presence of DSRs (OR 4.8, 95% CI 0.69, 33.8) and to cigarettes sales in pre-security areas (OR 6.0, 95% CI 0.57, 64.7), although not significantly different. Smoking was common in outdoor areas of airports in Europe and the United States (mean (SD) number of smokers 27.7 (23.6) and 6.3 (7.7), respectively, p value < .001). Around half (55%) of airports in Europe and all airports in the United States had some/partial outdoor smoking restrictions. Exposure to secondhand smoke (SHS) remains a public health problem in major airports across Europe and in some airports in the United States, specifically related to the presence of DSRs and SHS exposure in outdoor areas. Airports must remove DSRs. Research is needed in low- and middle-income countries and on the effectiveness of outdoor smoking-restricted areas around entryways. Eliminating smoking at airports will protect millions of people from SHS exposure and promote social norms that discourage smoking. Airports are known to allow exceptions to smoke-free policy by providing DSRs. We found that smoking still occurs in indoor areas in airports, particularly in the context of DSRs. Smoking, moreover, is widespread in outdoor areas and compliance with smoking restrictions is limited. Advancing smoke-free policy requires improvements to the physical environment of airports, including removal of DSRs and implementation of stricter outdoor smoking restrictions.
ISSN:1462-2203
1469-994X
DOI:10.1093/ntr/ntw238