Non-smoking Workers Research Articles

Measuring Tobacco Specific Lung Carcinogen among Nonsmoking Hospitality Workers in Richmond Virginia: A Preliminary Evaluation of Exposure before the Smoking Ban

The purpose of this pilot study is to measure the exposure to SHS among Richmond bar and restaurant workers and identify the prevalence of the tobacco-specific lung carcinogen-4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNAL) among nonsmoking bar and restaurants workers. Hair and urine samples were obtained from 40 nonsmoking bar and restaurant workers from Richmond establishments that do not have smoke free policies. Workers' exposure to SHS was estimated through measuring nicotine concentration in hair (NG/MG). Self-reported tobacco use was assessed in addition to performing urine analysis and listing sources and intensity of SHS exposure. Urine specimens were analyzed for total NNAL. Results Hair nicotine ranged from 0.05 to 42.15 ng/mg among workers with an average of 23.3 hours of self reported exposure in workplaces where smoking was permitted, indicating that workers in smoking restaurants and bars are exposed to SHS. Also, 60% of workers had a detectable level of NNAL that ranged from 0.019 to 1.9 PMol/ML. Increased levels of NNAL were mostly associated with the number of continuous hours of a single workplace exposure. In the city of Richmond, most bar and restaurant workers are continuously exposed to SHS in their workplace. To achieve complete protection for all workers and patrons in Richmond, Virginia, smoke free initiatives in all occupational settings are required. This information can be used to advocate for smoke free policies when discussing potential ways to strengthen the law.

The work environment as a source of exposure to secondhand smoke: a study in workers of bars and restaurants of Santiago, Chile

Secondhand smoke (SHS) is an established cause of morbidity and mortality among non-smokers. The workplace is an important source of exposure, especially among workers of restaurants, bars and nightclubs. To estimate the daily occupational exposure to SHS among non-smoking workers of bars and restaurants of Santiago, Chile. Environmental vapor-phase nicotine was measured for 95 non-smoking workers of bars and restaurants of Santiago, using passive personal samplers during a daily work shift and outside the workplace. The median occupational exposure to air nicotine was 9.18 µg/m³ (P25-P75 3.15-25.67 µg/m³). Higher concentrations were found among workers of places with no smoking restrictions (22.72 µg/m³; P25-P75 5.73-34.85 µg/m³), bar workers (20.75 µg/m³, P25-P75 5.03-44.67 µg/m³), waiters (20.57 µg/m³, PP25-P75 5.66-42.73 µg/m3) and bartenders (10.37 µg/m³, P25-P75 9.75-25.67 µg/m³). The median concentration of nicotine outside the workplace was 1.79 µg/m³ (P25-P75 1.02-3.00 µg/m³). Occupational exposure was 4.77 times higher compared to the non-work exposure. Workers of bars and restaurants are exposed to high levels of SHS at the workplace. Moreover, occupational exposure among these non-smoking workers is, in most cases, the main source of daily exposure to this pollutant.

El ambiente laboral como fuente de exposición a humo de tabaco ambiental: Estudio en trabajadores de bares y restaurantes de Santiago, Chile

Secondhand smoke (SHS) is an established cause of morbidity and mortality among non-smokers. The workplace is an important source of exposure, especially among workers of restaurants, bars and nightclubs.To estimate the daily occupational exposure to SHS among non-smoking workers of bars and restaurants of Santiago, Chile.Environmental vapor-phase nicotine was measured for 95 non-smoking workers of bars and restaurants of Santiago, using passive personal samplers during a daily work shift and outside the workplace.The median occupational exposure to air nicotine was 9.18 µg/m³ (P25-P75 3.15-25.67 µg/m³). Higher concentrations were found among workers of places with no smoking restrictions (22.72 µg/m³; P25-P75 5.73-34.85 µg/m³), bar workers (20.75 µg/m³, P25-P75 5.03-44.67 µg/m³), waiters (20.57 µg/m³, PP25-P75 5.66-42.73 µg/m3) and bartenders (10.37 µg/m³, P25-P75 9.75-25.67 µg/m³). The median concentration of nicotine outside the workplace was 1.79 µg/m³ (P25-P75 1.02-3.00 µg/m³). Occupational exposure was 4.77 times higher compared to the non-work exposure.Workers of bars and restaurants are exposed to high levels of SHS at the workplace. Moreover, occupational exposure among these non-smoking workers is, in most cases, the main source of daily exposure to this pollutant.

Silica dust, diesel exhaust, and painting work are the significant occupational risk factors for lung cancer in nonsmoking Chinese men

Background:Few epidemiological studies have explored the associations between occupational exposures and lung cancer in lifelong nonsmoking men.Methods:We obtained lifetime occupational history and other relevant information for 132 newly diagnosed lung cancer cases among nonsmoking Chinese men and 536 nonsmoking community referents. Unconditional multiple logistic regression analysis was performed to estimate the odds ratio (OR) of lung cancer for specific occupational exposures.Results:Significantly increased lung cancer risk was found for nonsmoking workers occupationally exposed to silica dust (OR=2.58, 95% confidence interval (CI): 1.11, 6.01), diesel exhaust (OR=3.47, 95% CI: 1.08, 11.14), spray painting (OR=2.81, 95% CI: 1.14, 6.93), and nonspray painting work (OR=2.36, 95% CI: 1.04, 5.37). Silica dust exposure was associated with a significantly increased risk of adenocarcinoma (OR=2.91, 95% CI: 1.10, 7.68). We observed a positive gradient of all lung cancers and of adenocarcinoma with duration of employment for workers exposed to silica dust and spray painting.Conclusion:This study found an increased risk of lung cancer among nonsmoking Chinese men occupationally exposed to silica dust, diesel exhaust, and painting work.

Workplace exposure to secondhand smoke and its association with respiratory symptoms—a cross-sectional study among workers in Shanghai

ObjectiveTo describe workplace exposure to secondhand smoke (SHS) among different working populations in Shanghai; to identify any association between respiratory symptoms and SHS exposure in these workplaces.DesignCross-sectional survey with a...

The Relationship between Venue Indoor Air Quality and Urinary Cotinine Levels among Semiopen-Air Café Employees: What Factors Determine the Level of Exposure?

Exposure to second-hand smoke (SHS) is increasingly recognized as an occupational hazard to workers in the service industry. In areas of the world with moderate climates, open windows and doors are assumed to provide a work environment with only marginally increased exposures to SHS. We measured indoor fine particulate matter (PM2.5) in 50 semiopen air venues in Greece during the summer. Cotinine levels from a nonsmoking employee of each of these venues were measured from a postshift urine sample. In these semiopen-air venues, the mean level of indoor PM 2.5 levels were 113.5 ± 72.3 μg/m(3). The mean postshift urinary cotinine levels of nonworking workers in these venues was 15 ng/mL. PM2.5 levels were strongly correlated with urinary cotinine concentrations (Spearman's r = 0.914). Linear regression analyses indicated that when taking into account the time of the measurement, the day of the week, for each 1 cigarette/100 m(3) the indoor PM2.5 concentrations increased by 26.6 μg/m(3) [95% confidence interval (CI): 7.6-45.7 μg/m(3), p = 0.007) and urinary cotinine levels of nonsmoking workers increased by 5.0 ng/mL (95% CI: 0.4 to 9.6, p = 0.034). In a sample of bars and restaurants with windows and doors open, indoor PM2.5 concentrations were elevated and increased proportionately to the density of smoking. Cotinine levels of nonsmoking employees increased with indoor PM2.5 concentrations, and also with the density of smoking. Open windows and doors do not protect workers from exposure to second-hand smoke.

Biological monitoring for occupational acrylamide exposure from acrylamide production workers

We conducted a repeated-measurement study to (1) investigate the correlation between occupational exposure to airborne acrylamide (AA) and the time-dependent behavior of urinary AAMA, GAMA2, and GAMA3 and (2) calculate the estimated biological exposure index at the permissible exposure limit (PEL) level of 30 μg/m(3). Forty-four workers were recruited--8 were AA-exposed and 36 were controls. Pre- and post-shift urine samples were collected from the exposed group in parallel with personal sampling for 8 consecutive days and only 1 day for the control group and analyzed using liquid chromatography-electrospray ionization/tandem mass spectrometry (LC-ESI-MS/MS). Post-shift urinary AAMA level was significantly associated with personal AA exposure (p < 0.001), indicating that urinary AAMA was a better AA exposure biomarker. The estimated urinary excretion of AAMA was 3.0 mg/g creatinine for nonsmoking workers exposed to the PEL of 30 μg/m(3). The median GAMA (the sum of GAMA2 and GAMA3)/AAMA ratio for exposed workers was 0.03 (range, 0.005-0.14), relatively lower than that of the nonoccupational group. Although sample size in this study was small, the repeated-measurement data provide useful reference for future studies related to biological monitoring of occupational exposure to AA.

RESPIRATORY DISORDERS AMONG WORKERS IN A TOBACCO FACTORY

Objectives: This work aimed to study respiratory disorders and pulmonary function tests among workers in a tobacco factory along with measurements of levels of serum IgE, and urinary cotinine and studying dust level inside the factory. Subjects & methods: The study was carried out on 79 randomly selected tobacco processing workers in a tobacco manufacturing factory in Menoufia Governorate and 80 voluntarily participating controls. Both groups matched for age, sex, residence, income and educational level and were subjected to a structured chest symptoms questionnaire, clinical chest examination, spirometric measurements and measurements of total serum IgE (IU/ml) and urinary cotinine (ng/ml) by Enzyme Immuno Assay (EIA). Environmental total and respirable dust was measured inside the factory. Results: Tobacco workers reported significantly higher respiratory symptoms and signs (cough, expectoration and wheezes), (P<0.05) as compared with controls and had lower mean values of predicted spirometric measurements (FVC, FEV1 and FEV1/FVC), Phigher among tobacco workers (75.06 + 43.69 and 1422.73 + 1265.59) than controls (57.43 + 38.55 and 84.33 + 82.89, respectively), P < 0.05. Smoker and non-smoker tobacco-exposed workers had statistically significantly lower mean percentage values of predicted of FVC, FEV1 and FEV1/FVC as compared with smoker and non-smokercontrols, (P <0.05). In addition, urinary cotinine and serum Ig E were significantly higher among smoker and non-smoker exposed workers as compared with exposed and non-smoker controls. A negative weak and significant correlation between spirometric measurements and levels of serum Ig E is noted among tobacco workers. Conclusion: The respiratory impairments noted among tobacco processing workers might be due to their exposure to the work environment and sensitization to tobacco dust.

Subclinical nephrotoxicity associated with occupational silica exposure among male Kenyan industrial workers

To determine early signs of renal injury due to occupational silica exposure. Cross-sectional analytical research. Kenyatta National Hospital for the referent population and Clayworks ceramics, bricks and tiles factory for the assessment of occupational silica exposure. Thirty three non-smoking silica-exposed male industrial workers and 38 non-smoking male referents participated in this study. Silica-exposed males excreted significantly increased levels of U.TP, U.Malb, U.ALP, U.y-GT and U.LDH compared to referent males. Among the silica-exposed males, U.Si negatively correlated significantly with age, U.TP correlated significantly to each of U.ALP and U.LDH. However, no correlation was observed between work duration and U.Si. The present study shows that there is associated glomerular and proximal tubular damage among silica exposed workers which is not duration related and is seemingly subclinical and nonprogressive and urinary silica levels appears to be similar in all groups and are not affected by exposure and work duration: the reason for which is unclear.

Immunotoxicity and hematotoxicity induced by tetrachloroethylene in egyptian dry cleaning workers

The immune and hematological systems can be a target for environmental contaminants with potential adverse effects, so the purpose of this study is to provide documentation on immunotoxicity and hematotoxicity of tetrachloroethylene, which is widely used in dry cleaning in Egypt. This study was carried out on 80 adult males. Subjects designated as controls (n = 40) were healthy persons and others were tetrachloroethylene-exposed dry-cleaning workers (n = 40). The controls and tetrachloroethylene-exposed workers were then divided into four equal groups (20 individuals/group): group I, control group never smoking; group II, smoking control group; and groups III and IV, tetrachloroethylene-exposed nonsmoking and smoking workers, respectively. Blood level of tetrachloroethylene, complete blood count, immunoglobulins (IgA, IgM, IgG, and IgE), the total numbers of white blood cells (WBC), and leukocyte differential counts, as well as interferon γ (IFN-γ) and interleukin-4 (IL-4), were measured. The immunotoxicity of tetrachloroethylene appeared in the form of an increase in serum immunoglobulin E in nonsmoking and smoking tetrachloroethylene-exposed workers, while the serum immunoglobulins A, M, and G levels showed no significant change in all studied groups. In addition, our results demonstrated a significant increase in white cell count, lymphocytes, natural killer (NK; CD3+CD16CD56+) cells, and B (CD19+) lymphocytes. The increase in WBC and lymphocytes may be attributed to allergic reaction. Moreover, serum and lymphocytic interlukin-4 levels were significantly increased in nonsmoking and smoking tetrachloroethylene-exposed workers. Tetrachloroethylene exposure is associated with immunotoxicity, which may lead to the augmentation of allergic diseases or appearance of autoimmune reaction.

Chromium in exhaled breath condensate (EBC), erythrocytes, plasma and urine in the biomonitoring of chrome-plating workers exposed to soluble Cr(vi)

Chromium (Cr) levels measured in exhaled breath condensate (EBC-Cr) and urine (Cr-U) at the beginning and end of working shifts were related to those measured in erythrocytes (Cr-RBC) and plasma in 14 non-smoking male chrome-plating workers exposed to Cr(VI) in soluble aerosol form who did not report any significant current or past respiratory disease. Cr-U mainly correlated with Cr-P (Cr in plasma) at the end of the working shift (r(2) = 0.59, p < 0.01), whereas Cr-RBC correlated with EBC-Cr (r(2) = 0.32, p < 0.05); at the beginning of the shift, the only significant correlation was between Cr-U and Cr-RBC (r(2) = 0.74, p < 0.01). The clearance of Cr(iii) arising from Cr(VI) reduction was rapid, thus making Cr-U and Cr-P ideal biomarkers of the most recent exposure, whereas Cr-RBC may represent the fraction of Cr(VI) that reaches the bloodstream in non-reduced form and therefore depends on the airway inhaled dose represented by EBC-Cr. Cr-RBC clearance is slower and not only involves the free diffusion of Cr(iii) from RBC to plasma, but probably also involves more complicated kinetic phenomena involving other tissues and organs, which may explain the correlation between Cr-RBC and Cr-U and the lack of correlation Cr-RBC and Cr-P at least 36 h after the last exposure. In conclusion, our findings reinforce the idea that measuring Cr in EBC can significantly contribute to traditional biomonitoring by providing specific information at the target organ level and integrating our knowledge of Cr toxicokinetics.

Chronic Exposures to Cholinesterase‐inhibiting Pesticides Adversely Affect Respiratory Health of Agricultural Workers in India

The impact of long term exposure to cholinesterase (ChE)-inhibiting organophosphate (OP) and carbamate (C) pesticides on the respiratory health of agricultural workers in India was investigated. Three hundred and seventy-six nonsmoking agricultural workers (median age 41 yr) from eastern India who sprayed OP and C pesticides in the field and 348 age- and sex-matched control subjects with non-agricultural occupations from the same locality were enrolled. Prevalence of respiratory symptoms was obtained by questionnaire survey, and pulmonary function tests were carried out by spirometry. Chronic obstructive pulmonary disease (COPD) was diagnosed by the Global Obstructive Lung Disease (GOLD) criteria, and erythrocyte acetylcholinesterase (AChE) was measured by the Ellman method. Agricultural workers had greater prevalences of upper and lower respiratory symptoms, and appreciable reduction in spirometric measurements. Overall, lung function reduction was noted in 48.9% of agricultural workers compared with 22.7% of control, and a restrictive type of deficit was predominant. COPD was diagnosed in 10.9% of agricultural workers compared with 3.4% of controls (p<0.05 in chi(2) test), and the severity of the disease was greater in agricultural workers. Red blood cell (RBC) AChE was lowered by 34.2% in agricultural workers, and the fall in AChE level was positively associated with respiratory symptoms, lung function decrement and COPD after controlling for education and income as potential confounders. Long-term exposure to cholinesterase-inhibiting agricultural pesticides currently in use in India is associated with a reduction in lung function, COPD and a rise in respiratory symptoms.

Airway inflammation in cement production workers

ObjectiveCement aerosol exposure is associated with increased morbidity of airway disease among exposed workers. Our aim was to compare levels of inflammatory cells and soluble inflammatory markers in induced sputum...

Comparing salivary cotinine concentration in non-smokers from the general population and hospitality workers in Spain

The objective was to compare the pattern of exposure to second-hand smoke (SHS) among non-smokers in the general population and in hospitality workers. We used the adult (16-64 years) non-smokers of two independent studies (general population and hospitality workers) in Spain. We assessed the exposure to SHS by means of questionnaire and salivary cotinine concentration. The salivary cotinine concentration by sex, age, educational level, day of week of saliva collection, and exposure to SHS were always higher in hospitality workers than in the general population. Our results indicated that non-smoker hospitality workers have higher levels of exposure to SHS than general population.

Serum Folate and DDT Isomers and Metabolites Are Inversely Associated in Chinese Women: A Cross-Sectional Analysis

Background: Vitamin nutritional status may influence some xenobiotic metabolism or vice versa.Methods: This analysis examines the relationship between B-vitamin concentrations and 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDT) isomers and metabolites in healthy women. Serum pp′DDT, pp′DDE, pp′DDD, op′DDT, op′DDE, and serum folate, cysteine, and vitamins B6 and B12 were measured in 296 nonsmoking female textile workers (21–34 yr) in Anhui, China. Mean (SD) age and body mass index of this cohort were 24.9 (1.5) y and 19.7 (2.0) kg/m2, respectively.Results: Median pp′DDT, pp′DDE, pp′DDD, op′DDT, and op′DDE were 1.5, 29.2, 0.22, 0.17, and 0.09 ng/g, respectively. Median folate and cysteine were 9.2 and 200.0 nmol/L, respectively. Folate was significantly inversely associated with pp′DDT and pp′DDE: β (95% confidence interval [CI]) = −0.23 (−0.39, −0.07) and −0.20 (−0.36, −0.05), respectively, and it was marginally associated with pp′DDD. Cysteine was significantly inversely associated with pp′DDT, β (95% CI) = −0.69 (−1.00, −0.37); pp′DDE, β (95% CI) = −0.32 (−0.62, −0.02); pp′DDD, β (95% CI) = −0.31 (−0.59, −0.03); and op′DDT, β (95% CI) = −0.35 (−0.68, −0.02).Conclusions: Folate and cysteine are independently inversely associated with DDT isomers, adjusting for vitamins B6 and B12, age, and body mass index. These nutrients may play a role in DDT metabolism; however, it is also possible that DDT may exert a negative impact on folate and cysteine levels. Longitudinal studies are needed to ascertain the direction of this association.

Occupational exposure to bacterial single cell protein induces inflammation in lung and blood

Bacterial single cell protein (BSCP) is used as a protein enrichment in livestock and fish feed, and is extracted from dried bacterial mass. In the production of BSCP, workers are exposed to organic dust containing high levels of endotoxins that may induce acute airway inflammation. However, the long term effect on the airways of such exposure is not known, and we have examined inflammatory markers in induced sputum and blood among BSCP exposed workers. We included 21 non-smoking production workers (age 31–42 (range; mean 35)) without respiratory symptoms and 21 healthy non-exposed references (age 21–52 (range; mean 34)). Airborne endotoxin concentrations were measured, and induced sputum samples and blood samples were collected from the workers and non-exposed references. The airborne endotoxin concentration measured in inhaled air during the work shift was 430 EU/m3 (50–2000) (median (range)). The percentage of neutrophils in induced sputum was 79% (66–93) (median (25th–75th percentiles)) and 31% (25–45) (p < 0.001) for operators and references, respectively. Protein analysis in induced sputum supernatant showed significantly elevated levels of interleukins IL-1β and IL-12 (p < 0.05), while blood analysis showed significantly elevated levels of PDGF-BB (platelet-derived growth factor-BB) and RANTES (regulated upon activation normally T cell expressed and secreted) (p < 0.05). Workers exposed to BSCP had an airway inflammation characterized by a high level of neutrophils. However, only a few cytokines were elevated in lung and blood, which could imply low inflammatory activity suggestive of possible adaptation mechanisms due to daily exposure to BSCP, or that the inflammation reaction was a dose-related response occurring at higher levels.

Global and gene‐specific promoter methylation changes are related to anti‐B[a]PDE‐DNA adduct levels and influence micronuclei levels in polycyclic aromatic hydrocarbon‐exposed individuals

We investigated the effect of chronic exposure to polycyclic aromatic hydrocarbons (PAHs) on DNA methylation states (percentage of methylated cytosines (%mC)) in Polish male nonsmoking coke-oven workers and matched controls. Methylation states of gene-specific promoters (p53, p16, HIC1 and IL-6) and of Alu and LINE-1 repetitive elements, as surrogate measures of global methylation, were quantified by pyrosequencing in peripheral blood lymphocytes (PBLs). DNA methylation was evaluated in relation to PAH exposure, assessed by urinary 1-pyrenol and anti-benzo[a]pyrene diolepoxide (anti-B[a]PDE)-DNA adduct levels, a critical genetic damage from B[a]P. We also evaluated whether PAH-induced DNA methylation states were in turn associated with micronuclei in PBLs, an indicator of chromosomal instability.

Does the workplace-smoking ban eliminate differences in risk for environmental tobacco smoke exposure at work?

A workplace-smoking ban in the Netherlands was introduced on January 1, 2004. Before the ban male and low educated employees were at higher risk for exposure to environmental tobacco smoke (ETS). Effective implementation of the ban should result not only in an overall decline of exposure, but also in the disappearance of systematic differences in exposure between subgroups of employees. Data from a Dutch continuous Internet survey were used. From July 2003 through June 2005, 200 respondents were randomly selected each week. The sample consisted of 11,291 non-smoking, working respondents, aged 16-65 years. ETS exposure decreased among all employees and among subgroups at higher risk before the ban. However, also after the ban, males and low educated employees were still most likely to be exposed to ETS. The workplace-smoking ban was effective in reducing ETS exposure among employees. However, after the ban still 52.2% of non-smoking workers reported to be exposed. We did not find the expected stronger effect among employees who were at higher risk. Both before and after implementation of the ban, males and lower educated employees were about two times more likely to be exposed to ETS.

The Effect of Cement Dust on the Activity of GOT , GPT and ALK Enzymes in Al-Qaim Cement Factory Workers

This research was conducted on a random sample of (58) individuals , (38) of them were directly exposed to cement dust . They were distributed according to units into (9) in oven department , (17) individuals in cement grinding department and (12) in packaging department . Ten individuals were indirectly exposed to cement dust and (10) individuals from inhabitants in villages and suburbs represented the control group . The study aimed at exploring the effect of exposure to cement dust and its side-effect on the activity of (ALK , GPT and GOT) chemobiological parameters of workers in Al- Qaim cement factory , as well as the effect of smoking on increasing the activity these enzymes . Results of the study indicated a significant increases (p<0.05) in the values of GOT (8.1 I.U/L) , GPT (7.4 I.U/L) and ALK (8.2 I.U/L) in direct exposure group . Their values in indirect (administrative) group were ; GOT (5.62 I.U/L) , GPT (7.90 I.U/L) and ALK (7.58 I.U/L) in comparison with the control group which were (3.8 , 2.1 , 3.7 I.U/L) , respectively . In addition to this , the results revealed that the effect of cement dust increased with age and the time duration of exposure to pollutants (cement dust) . These represented the effect of the length of service duration on the value of the activity these enzymes . Moreover , smoking was influential and led to an increase in the activity these enzymes values in smoking working in comparison with non-smoking workers .

Impact of the Spanish Smoking Law on Exposure to Second-Hand Smoke and Respiratory Health in Hospitality Workers: A Cohort Study

BackgroundA smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban.Methods and FindingWe formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p<0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p<0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned.ConclusionsAmong nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health.