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. Author manuscript; available in PMC: 2015 Sep 26.
Published in final edited form as: Asian Pac J Cancer Prev. 2011;12(11):2881–2885.

Secondhand Smoke Concentrations in Hospitality Venues in the Pacific Basin: Findings from American Samoa, Commonwealth of the Northern Mariana Islands, and Guam

Brian A King 1,2,*, Shanta R Dube 1, Jean Y Ko 2,3
PMCID: PMC4583773  NIHMSID: NIHMS722035  PMID: 22393958

Abstract

Introduction

Secondhand smoke (SHS) from burning tobacco products causes disease and premature death among nonsmokers. Although the number of laws prohibiting smoking in indoor public places continues to increase, millions of nonsmokers in the United States (US) and its territories remain exposed to SHS. This study assessed indoor air pollution from SHS in hospitality venues in three US Pacific Basin territories.

Methods

Air monitors were used to assess PM2.5, an environmental marker for SHS, in 19 smoke-permitted and 18 smoke-free bars and restaurants in American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), and Guam. Observational logs were used to record smoking and other sources of air pollution. Differences in average PM2.5 concentrations were determined using bivariate statistics.

Results

The average PM2.5 level in venues where smoking was always permitted [arithmetic mean (AM)=299.98 μg/m3; geometric mean (GM)=200.39 μg/m3] was significantly higher (p<0.001) than smoke-free venues [AM=8.33 μg/m3; GM=6.14 μg/m3]. In venues where smoking was allowed only during certain times, the average level outside these times [AM=42.10 μg/m3; GM=41.87 μg/m3] was also significantly higher (p<0.001) than smoke-free venues.

Conclusions

Employees and patrons of smoke-permitted bars and restaurants are exposed to dangerous levels of air pollution from SHS, even during periods when active smoking is not occurring. Prohibiting smoking in all public indoor areas, irrespective of the venue type or time of day, is the only way to fully protect nonsmokers from SHS exposure in these environments.

Keywords: Tobacco smoking, secondhand smoke, air pollution, health policy, public smoking bans

Introduction

Exposure to secondhand smoke (SHS) from burning tobacco products causes lung cancer and heart disease in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children (USDHHS, 2006). Even brief exposure to SHS can cause cardiovascular disease and lead to acute cardiac events (USDHHS, 2010). In the United States (U.S.), 25 states and one territory have enacted comprehensive policies that prohibit tobacco smoking in all indoor public areas, including worksites and hospitality venues such as restaurants and bars (CDC, 2010a; ANR, 2011). The implementation of such policies significantly reduces SHS exposure (USDHHS, 2006) and can have an immediate and sustained impact on smoking related outcomes, including decreased incidence of heart attacks in the general population (Lightwood & Glantz, 2009). However, the millions of nonsmokers who reside in areas not covered by comprehensive smoke-free policies remain susceptible to SHS exposure. The need for such policies is particularly vital in U.S. Pacific Basin territories, where tobacco control resources are limited (Allen & Clark, 2007) and most recent estimates of adult smoking prevalence (territory range: 24.0%–41.0%) (ASG & WHO, 2007; Rasanathan & Tukuitonga, 2007; CDC, 2010b) are markedly higher than in the mainland U.S. (state range: 9.8%–25.6%) (CDC, 2010c).

The U.S. Pacific Basin territories of American Samoa, CNMI, and Guam currently have partial smoke-free policies that prohibit smoking in some, but not all, indoor public areas (ANR, 2011). In 2005, the Legislature of Guam enacted the Natasha Protection Act (Public Law 20–80), which prohibits smoking in all stand-alone restaurants, but exempts bars and certain worksites. In CNMI, the Smoke-Free Air Act of 2008 (Public Law 16–46) prohibits smoking in all worksites and stand-alone restaurants, but exempts all stand-alone bars and certain attached bar areas of restaurants once the kitchen ceases meal service. Most recently, the Legislature of American Samoa enacted the American Samoa Smoke Free Environment Act (Public Law 31), which prohibits smoking in all restaurants and bars effective January 2011, but exempts certain private worksites.

Fine particulate matter with a diameter of less than 2.5 microns (PM2.5) has previously been used to assess indoor concentrations of SHS in hospitality venues in multiple countries (Hyland et al., 2008; Connolly et al., 2009). Particles of this size are emitted in significant quantities during tobacco combustion and can easily be inhaled deep into the lungs (Travers et al., 2004). To protect public health, the U.S. Environmental Protection Agency (EPA) currently recommends that average annual and 24-hour outdoor PM2.5 exposure should not exceed 15 μg/m3 and 35 μg/m3, respectively (USEPA, 2006).

The objective of this study was to determine the extent and magnitude of PM2.5 concentrations within a sample of smoke-free and smoke-permitted bars and restaurants in American Samoa, CNMI, and Guam. Since locally salient research documenting the health impact of SHS in the Pacific Basin has been limited (Allen & Clark, 2007), the findings of this study could help inform the strengthening and retention of comprehensive public indoor smoke-free policies in these three territories and throughout the Pacific region.

Materials and Methods

Site Selection

Data were collected between December 6th and 19th, 2010, in a sample of 37 hospitality venues throughout American Samoa, CNMI, and Guam. A convenience sample approach was employed to select a range of venues based upon smoking policy, type, and size. The sample consisted of stand-alone restaurants, stand-alone bars, and restaurants with attached bars. Only venues that were open to the public, covered by a ceiling, and at least 75% enclosed by side walls were included in the sample.

Procedures

All venues were assessed during peak business hours (11:00 AM to 1:00 AM) on varying days of the week. All data were collected by trained local volunteers under the direct supervision of research personnel. Upon entering each venue, the volunteers placed concealed air monitoring equipment in a central location near the height at which a person breathes air. The concentration of fine particulate air pollution was then continuously assessed for a minimum of 30 minutes inside each venue. In addition, volunteers recorded the number of persons and burning cigarettes in each venue at 15 minute intervals. They also determined and recorded the dimensions of each venue.

Equipment

TSI SidePak AM510 Personal Aerosol Monitors® (TSI, Inc., St. Paul, Minnesota) were used to assess indoor levels of respirable suspended particulate (RSP) in real-time. This device is a scientifically validated instrument that has previously been used to quantify levels of SHS in public areas, including bars and restaurants (Repace, 2004; Travers et al., 2004; Connolly et al., 2009). The device functions via an interior sampling pump which draws continuously streaming aerosol into a sensing chamber where it is illuminated by a laser light. Particulate in the aerosol stream scatters this light, which is then quantified by a photometer and converted to the mass concentration of the aerosol. The specific class of RSP assessed was PM2.5, or fine particulate matter with a diameter less than 2.5 μm. Prior to each use, the device was zero calibrated in accordance with the manufacturer’s specifications and set to a flow rate of 1.7 liters per minute and a log interval of 1-minute.

Measures

The primary outcome of interest was the average concentration of PM2.5 in smoke-permitted and smoke-free venues within each venue and territory. “Smoke-Permitted” was defined as the allowance of smoking in an indoor area of the venue during some or all business hours, whereas “smoke-free” was defined as the prohibition of smoking in all indoor areas of the venue, regardless of the time of day.

Within each venue, the presence of “active smoking” was also determined, which was defined as any instance in which at least one individual was observed smoking a lit cigarette in any indoor area during the monitoring period. Additional measures included the volume of the venue (m3) as calculated from the recorded room dimensions, average number of persons present, and average number of burning cigarettes. Active smoker density was also determined for each venue by dividing the mean number of burning cigarettes by the venue volume.

Data Analysis

Data were downloaded using TrakPro v. 3.41 (TSI, Inc., St. Paul, MN) and analyzed using PASW Statistics v. 18.0 (SPSS, Inc., Chicago, IL). In accordance with previous assessments of PM2.5 associated SHS, data were multiplied by a standard calibration factor of 0.32 (Travers et al., 2004; Connolly et al., 2009). This calibration factor was determined in a controlled experiment in which the TSI SidePak® was collocated with gravimetrically standardized instruments used in past SHS exposure studies (Repace, 2004).

Both arithmetic and geometric mean PM2.5 concentrations (μg/m3) were calculated for each venue and territory following categorization by three types of policy status: (i) smoke-permitted and active smoking observed, (ii) smoke-permitted and no active smoking observed, and (iii) smoke-free and no active smoking observed. Due to the nonparametric nature of the data, a Mann-Whitney U-Test was used to determine statistically significant differences between categories. A Wilcoxon Signed Rank Test was also used to determine differences within a single venue assessed during two separate periods. To evaluate the extent to which air quality levels were associated with active smoking, a Spearman Rank Correlation Coefficient (rs) was used to determine the correlation between average PM2.5 concentrations and active smoker density.

Results

Air quality was assessed in 19 smoke-permitted venues and 18 smoke-free venues throughout American Samoa (smoke-permitted, n=3; smoke-free, n=9), CNMI (smoke-permitted, n=8; smoke-free, n=5), and Guam (smoke-permitted, n=8; smoke-free, n=4). Among the 19 smoke-permitted venues, 2 were assessed during a time of the day in which smoking was not allowed and 1 was assessed both before and during the time period when smoking was allowed. The average monitoring duration was 37 minutes in smoke-permitted venues (range=30–58 minutes) and 45 minutes in smoke-free venues (range=30–63 minutes).

The Table shows select characteristics of the sample by venue and territory. No active smoking was observed in either the 18 smoke-free venues or 3 smoke-permitted venues assessed when no smoking was allowed. In contrast, active smoking was observed in all 17 smoke-permitted venues in which smoking was always allowed. The average venue volume was 811 m3 (geometric mean (GM)=435 m3; range=84–6000 m3) in smoke-free venues, 452 m3 (GM=398 m3; range=195–700 m3) in smoke-permitted venues with no smoking observed, and 905 m3 (GM=543 m3; range=96–4495 m3) in smoke-permitted venues with smoking observed. The average number of persons present was 24 (GM=17 persons; range=6–115) in smoke-free venues, 25 (GM=24 persons; range=14–36) in smoke-permitted venues with no smoking observed, and 24 in smoke-permitted venues with smoking observed (GM=19 persons; range=7–83).

Table 1.

Summary Characteristics and Average PM2.5 Concentrations in Smoke-Permitted and Smoke-Free Hospitality Venues: American Samoa, Guam, and Commonwealth of the Northern Mariana Islands

ID Territorya Venue Type Venue Volume (m3) Average Persons in Venue Average Burning Cigarettes Active Smoker Densityb Average Venue PM2.5 [μg/m3] Average (GMa) Territory PM2.5 [μgm3]
Smoke-Free
 No Active Smoking Observed
  1 AS Restaurant 189 9 0.00 0.00 15.22
  2 AS Restaurant 360 9 0.00 0.00 12.57
  3 AS Restaurant 630 59 0.00 0.00 10.10
  4 AS Bar 162 9 0.00 0.00 7.22
  5 AS Restaurant/Bar 120 16 0.00 0.00 6.49
  6 AS Restaurant/Bar 84 10 0.00 0.00 5.72
  7 AS Restaurant 405 17 0.00 0.00 5.43
  8 AS Restaurant 800 10 0.00 0.00 4.11
  9 AS Restaurant 504 12 0.00 0.00 2.95 7.09 (6.09)
  10 CNMI Restaurant 315 6 0.00 0.00 15.06
  11 CNMI Restaurant 960 25 0.00 0.00 10.17
  12 CNMI Restaurant/Bar 368 9 0.00 0.00 5.16
  13 CNMI Restaurant/Bar 210 11 0.00 0.00 3.78
  14 CNMI Restaurant/Bar 6000 26 0.00 0.00 1.56 6.51 (4.66)
  15 GU Restaurant 315 37 0.00 0.00 24.79
  16 GU Restaurant 1932 115 0.00 0.00 12.84
  17 GU Restaurant 900 14 0.00 0.00 3.75
  18 GU Restaurant 350 33 0.00 0.00 2.39 12.76 (8.63)
  Overall Average (GMa) 811 (435) 24 (17) 0.00c 0.00c 8.33 (6.14)
Smoke-Permitted
 No Active Smoking Observedd
  19e CNMI Restaurant/Bar 462 14 0.00 0.00 45.73
  20 CNMI Restaurant/Bar 195 25 0.00 0.00 41.78
  21 CNMI Restaurant/Bar 700 36 0.00 0.00 38.16 42.10 (41.87*)
  Overall Average (GMa) 452 (398) 25 (24) 0.00c 0.00c 42.1 (41.87*)
 Active Smoking Observedd
  22 AS Bar 96 7 1.67 1.74 224.11
  23 AS Restaurant/Bar 210 8 1.75 0.83 65.26
  24 AS Restaurant/Bar 1656 9 1.00 0.06 34.38 99.18 (64.71*)
  25 CNMI Bar 700 83 5.00 0.71 734.05
  26 CNMI Bar 196 12 1.33 0.68 478.05
  27 CNMI Bar 910 24 1.33 0.15 251.27
  28 CNMI Bar 263 19 2.00 0.76 192.46
  29 CNMI Bar 2025 56 4.00 0.20 119.01
  19e CNMI Restaurant/Bar 462 9 0.67 0.15 92.28 304.7 (230.3*)
  30 GU Bar 400 20 3.33 0.83 863.51
  31 GU Bar 240 26 4.67 1.95 495.89
  32 GU Bar 312 20 2.33 0.75 408.87
  33 GU Bar 891 20 1.00 0.11 366.17
  34 GU Bar 600 9 2.00 0.33 324.54
  35 GU Bar 4495 38 2.67 0.06 323.91
  36 GU Bar 1680 34 2.33 0.14 302.10
  37 GU Bar 252 13 1.00 0.40 26.19 382.04 (290.80*)
  Overall Average (GMa) 905 (543) 24 (19) 2.24 (1.91) 0.58 (0.35) 300.0 (200.4*)
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a

AS, American Samoa; CNMI, Commonwealth of the Northern Mariana Islands; GM, Geometric Mean; GU, Guam;

b

Average number of burning cigarettes per 100 cubic meters;

c

Geometric mean not calculated;

d

Venues were assessed when smoking was prohibited (before 10 PM);

e

Venue was assessed when smoking was permitted (after 10 PM) and prohibited (before 10 PM);

*

p<0.001, Mann-Whitney U-Test, compared to “smoke-free and no active smoking observed”

Among all three territories combined, the average PM2.5 concentration in the 18 smoke-free venues was 8.33 μg/m3 (geometric mean (GM)=6.14 μg/m3). Following stratification by territory, the average concentration in smoke-free venues was greatest in Guam (12.76 μg/m3; GM=8.63 μg/m3), followed by American Samoa (7.09 μg/m3; GM=6.09 μg/m3), and CNMI (6.51 μg/m3; GM=4.66 μg/m3).

The average PM2.5 concentration in the 3 smoke-permitted venues assessed when no smoking was allowed was 42.1 μg/m3 (GM=41.87 μg/m3), which was significantly higher (p<0.001) than the smoke-free venues (8.33 μg/m3; GM=6.14 μg/m3). In addition, there was a significant (p<0.001) two-fold increase in average PM2.5 observed in the smoke-permitted venue (ID 19) assessed both before (45.73 μg/m3; GM=45.73 μg/m3) and during (92.28 μg/m3; GM=91.03 μg/m3) the period smoking was allowed.

The overall average PM2.5 concentration in smoke-permitted venues in which smoking was observed was 299.98 μg/m3 (GM=200.39) and significantly higher (p<0.001) than average concentrations in smoke-free venues (8.33 μg/m3; GM=6.14 μg/m3). The average concentration in these smoke-permitted venues was greatest in Guam (382.04 μg/m3; GM=290.80 μg/m3), followed by CNMI (304.74 μg/m3; GM=230.32 μg/m3), and American Samoa (99.18 μg/m3; GM=64.71 μg/m3), all of which were significantly higher (p<0.001) than average concentrations within each territory’s respective smoke-free venues.

In the 17 smoke-permitted venues in which active smoking was observed, the average number of burning cigarettes was 2.24 (GM=1.91; range=0.67–5.00), which corresponds to an active smoker density of 0.58 cigarettes per 100 cubic meters (GM= 0.35; range= 0.06–1.95). In contrast, no burning cigarettes were observed in the smoke-free venues, resulting in an active smoker density of 0.00. Among all of the assessed venues, average PM2.5 concentrations were significantly correlated (p<0.001) with active smoker density, both overall (rs=0.82) and stratified by territory (American Samoa, rs=0.76, p=0.004; CNMI, rs=0.86, p<0.001; Guam, rs=0.87, p<0.001).

Discussion

This study demonstrates that employees and patrons of smoke-permitted bars and restaurants are exposed to indoor air pollution from secondhand tobacco smoke, even during periods when active smoking is not occurring. Since separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot effectively eliminate SHS (USDHHS, 2006), prohibiting smoking in all public indoor areas, irrespective of the venue type or time of day, represents the only way to fully protect nonsmokers from SHS exposure in these environments.

In the present study, the average PM2.5 levels in venues where smoking was always or sometimes permitted were significantly higher than levels in 100% smoke-free venues. Since the duration of air monitoring in each venue was approximately one hour or less, these PM2.5 levels are not directly comparable to the current 24-hour average exposure standards established by the U.S. Environmental Protection Agency (USEPA, 2006). However, assuming the observed levels were analogous to daily levels, the geometric mean PM2.5 level in venues where smoking was always (200.39 μg/m3) or sometimes (41.87 μg/m3) permitted exceeded the average 24-hour EPA standard of 35 μg/m3. In contrast, the geometric mean PM2.5 level in smoke-free venues (6.14 μg/m3) was acceptable according to the EPA standard.

Strengthening current smoke-free policies in American Samoa, CNMI, and Guam to prohibit smoking in all indoor public areas, including all worksites, restaurants, and bars, should improve the health and well-being of employees and patrons. Research suggests that the implementation of smoke-free policies can lead to reduced respiratory symptoms (Eisner et al., 1998; Farrelly et al., 2005) and tobacco consumption (Fichtenberg & Glantz, 2002) among bar and restaurant workers, as well as the reduced incidence of heart attack among the general public (IOM, 2009). Moreover, the implementation of such policies should not have an adverse impact on business. Economic studies report either neutral or positive effects of comprehensive smoke-free policies on bar and restaurants sales and employment (Scollo et al., 2003).

To our knowledge, this study is the first to quantify SHS exposure in hospitality venues throughout American Samoa, CNMI, and Guam. Strengths of this study include the use of a scientifically validated monitoring instrument capable of real-time data acquisition, as well as the inclusion of venues with varying levels of size, patronage, and smoking restrictions. However, some study limitations should be noted. First, PM2.5 is not specific to tobacco smoke and can be produced directly from other sources such as cooking and ambient particles. Nonetheless, these exogenous factors would presumably be present in both smoke-free and smoke-permitted venues. Moreover, a significant correlation was observed between smoking density and PM2.5 in the assessed venues, thus indicating that observed differences in average PM2.5 are most likely attributable to SHS. Second, PM2.5 was assessed in a convenience sample of bars and restaurants due to the lack of a comprehensive list of venues throughout each territory. Although this may limit the generalizeability of the findings, the observed PM2.5 levels are consistent with previous assessments of smoke-free and smoke-permitted venues throughout multiple countries (Hyland et al., 2008; Connolly et al., 2009). Finally, it was not possible to statistically adjust for ventilation or tobacco smoke infiltration from outdoor areas. However, previous research suggests that the impact of ventilation does not account for marked differences in PM2.5 levels between smoke-permitted and smoke-free venues (Repace, 2004).

Despite these limitations, the findings of this study provide compelling evidence that a 100% smoke-free policy is an effective method to reduce SHS exposure in public indoor environments throughout American Samoa, CNMI, and Guam. In addition to characterizing PM2.5 concentrations in additional venue types throughout these territories, future studies should more intensely examine the extent of air quality in public indoor environments before and after the implementation of comprehensive smoke-free policies.

Acknowledgments

The authors gratefully acknowledge Rebecca Robles (Department of Public Health, Commonwealth of the Northern Mariana Islands), Va’a Tofaeono (Community Cancer Coalition, American Samoa), and Roselie Zabala (Department of Public Health and Social Services, Guam) for coordinating data collection in each respective territory. The authors also acknowledge MaryBeth Welton (CDC) for serving as a logistical liaison to the territories.

Footnotes

The authors have no conflict of interest to declare.

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