How much does Environmental Tobacco Smoke Contribute to the Building Symptom Index?

Abstract

Environmental tobacco smoke (ETS) has been identified as one of the factors associated with the symptoms of the sick building syndrome (SBS). We investigated the role of ETS in an office building during the phased introduction of a smoking ban. Over a two-year period we measured symptoms using a validated questionnaire, environmental nicotine levels and salivary cotinine as a biological marker of nicotine absorption in a stratified systemic sample of 375 office employees (91% response rate). In addition, 26 persons from a non-smoking office were studied as a control group. This report describes the findings derived from a cross-sectional analysis of the initial baseline data. Amongst the validated nonsmokers, symptoms increased with increasing nicotine exposure from ETS (r= 0.165 p < 0. 01), supporting the role of ETS in the SBS. Smokers reported significantly fewer symptoms than non-smokers, as has been found before, but were exposed to higher levels of airborne nicotine as expected. We suggest that this factor, along with the misclassification of smoking status, may have obscured an association between ETS exposure and the SBS in previous studies. An analysis of the findings after implementation of the smoking ban should provide further information on how much of the SBS is attributable to ETS in this study population.