Indoor air quality in a bar/restaurant before and after the smoking ban in

Athens, Greece
Sophia S. Konstantopoulou
a,
, Panagiotis K. Behrakis
b,d,1
,
Andreas C. Lazaris
c,2
, Polyxeni Nicolopoulou-Stamati
c,3
a
Center for Applied Research, Centre of Health and Hygiene, Industrial Hygiene Laboratory of the Hellenic Institute for Occupational Health and Safety (ELINYAE), Greece
b
Harvard School of Public Health, United States
c
University of Athens Medical School, Greece
d
Harvard University, United States
H I G H L I G H T S
PM
0.1
, NO
2
CO, CO
2
, and HCHO concentrations before and after the smoking ban
50% distribution of pollutants from the smoking zones to the smoke-free zones
CO measurements in the post-ban period were less than the detection limit.
Findings will assist in eliminating passive smoking associated risks.
a b s t r a c t a r t i c l e i n f o
Article history:
Received 18 September 2013
Received in revised form 31 October 2013
Accepted 26 November 2013
Available online 22 January 2014
Keywords:
Second hand smoke exposure
Smoking ban
Air quality
In this study we compared indoor air pollutant concentrations in a bar/restaurant in Greece before and after the
enactment of a smoking banlegislation of 2008. This was done to investigate whether the separationof the venue
into smoking and non-smoking areas will have an impact on workers and customers from secondhand smoke
(SHS) exposure (null hypothesis). The study was completed within an 8-month period beginning in March
2010 and ending on November 2010. We compared the average of the measured PM
0.1
concentrations in the
smoking zones between the pre-ban and post-ban periods. Overall reduction in the number of particles was
18% between pre-ban and post-ban periods. The mean of the 36 total CO
2
measurements for the pre- and the
post-ban period was 611 ppm. We calculated the ventilation rates per occupant (Vo in l/s/occ) and found it to
be higher in the post-ban period (19.4 l/s/occ), thus complying with the ASHARAE standard for Vo of 15 l/s/occ
at maximum occupancy, than in the pre-ban period (10.7 l/s/occ). The mean of the 36 total CO measurements
for the pre-ban period was 2 ppm. CO measurements in the post-ban period were less than the detection limit
of 1 ppm. Emissions of nitrogen dioxide and formaldehyde weren't detected in any of the zones. It was observed
there was about 50% distribution of pollutants from the smoking zones to the smoke-free zones. The smoking
ban effect on the occupancy levels was initially reduced by 16%, but based on other similar studies this transition
period will be followed by an increase in the occupancy.
Passive smoking and associated risks were signicantly reduced but not totally eliminated, indicating the need
for stronger enforcement or complete partition between smoking and non-smoking areas.
2013 Elsevier B.V. All rights reserved.
1. Introduction
Environmental tobacco smoke (ETS) has been classied as a lung
carcinogen (International Agency for Research on Cancer, 2002), and
in various studies (Howard and Wagenknecht, 1999; Jaakkola and
Samet, 1999a, 1999b; Surgeon General, 1986; Weiss et al., 1999) has
been shown to have adverse health effects on adults and children.
Several other studies in the USA and in Europe have measured the
pre- and post-lawconcentrations of indoor pollutants (markers of ETS).
Science of the Total Environment 476-477 (2014) 136143
Corresponding author at: Hellenic Institute for Occupational Healthand Safety, Liosion
143 & Theirsiou 6, GR-10445, Attiki Square, Athens, Greece. Tel.: +30 210 82 00 192.
E-mail addresses: konsta@elinyae.gr, skonsta2002@yahoo.gr (S.S. Konstantopoulou),
pbehraki@hsph.harvard.edu (P.K. Behrakis), alazaris@med.uoa.gr (A.C. Lazaris),
aspis@ath.forthnet.gr (P. Nicolopoulou-Stamati).
1
Hellenic Cancer Society, 8, Dorylaiou Street, GR-11521, Athens, Greece. Tel.: +30 210
64 70 056.
2
Department of Pathology, 75, Mikras Asias Street, GR-11527, Goudi, Athens, Greece.
Tel.: +30 210 74 62 167.
3
Department of Pathology, 75, Mikras Asias Street, GR-11527, Goudi, Athens, Greece.
Tel.: +30 210 74 62 163.
0048-9697/$ see front matter 2013 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.scitotenv.2013.11.129
Contents lists available at ScienceDirect
Science of the Total Environment
j our nal homepage: www. el sevi er . com/ l ocat e/ sci t ot env
The WHO Framework Convention on Tobacco Control (WHO FCTC)
and its implementation guidelines have clearly indicated that com-
prehensive smoke-free legislation preventing tobacco smoking in
all indoor public and work places must be implemented to protect
people fromadverse effects, such as lung cancer, coronary heart disease,
and asthma from secondhand smoke (World Health Organization,
2007).
Greece ratied the WHOFCTC onthe 27th January 2006 and enacted
national legislation through law 3730/2008 (Protection of minors from
tobacco and alcohol), thus restricting smoking in public and work places.
This became effective on the 1st of July 2009 following publication of
the above legislation in the ofcial journal of the Greek Government,
FEK A 262/23.12.2008. This legislation obliged all proprietors of hos-
pitality venues to ban smoking except for the case of bars and res-
taurants with oor space from 70 to 300 m
2
to have the right to
designate smoking and non-smoking areas which must be physically
separated from each other. The hypothesis assessed in this study
is that the separation of smoking areas from no smoking areas would
act as a means to protect the health of the non-smokers. According
to Bialous and Glantz (2002), creation of smoke-free workplaces
and public places, not only protects non-smokers from secondhand
smoke, but also was found to reduce cigarette consumption in smoking
areas.
This study evaluates the effect of the smoking ban ordinance in
Athens on reducing exposure to ETS. This was accomplished by measur-
ing ve parameters encountered in ETS in a hospitality venue before
and after the smoking ban took effect. Many other studies have mea-
sured air quality related to ETS (Cesaroni et al., 2008; Ellingsen et al.,
2006; Goodman et al., 2007; Gotz et al., 2008; Heloma and Jaakkola,
2003; Larsson et al., 2008; Mulcahy et al., 2005; Semple et al., 2007;
Valente et al., 2007). It was clear from these studies, that there was a
signicant reduction in the levels of markers, such as nicotine, dust,
benzene and particulate matter, all attributed to smoking.
The goal of this investigation is to quantify the indoor air quality
benets following the indoor smoking ban and provide this information
to decision makers.
2. Experimental materials and methods
2.1. Methodological approach
We compared indoor air quality in a bar/restaurant in Greece before
and after the smoking ban. The particular workplace employed 70
people and was divided in four distinct zones. After the smoking ban,
two of these zones were designated as non-smoking. Five parameters
were measured (ultrane particulate matter, nitrogen dioxide, carbon
monoxide, carbon dioxide and formaldehyde) in all four zones before
and after the ban. Before the beginning of the eld study a cooperation
protocol was signed between the researcher and the director of the
venue.
2.2. Research planning strategy
The indoor workplace (oor plan in Fig. 1) was separated in four
zones, two smoking zones (zones 1 and 2) and two non-smoking
zones (zones 3 and 4). During the course of measuring the above ve
chemical parameters, continuous measurements were also conducted
for air temperature, relative humidity and air velocity. For comparative
purposes, these physical parameters were also measured outdoors.
Image 1 presents a snapshot of the indoor measurements and Image 2
of the outdoor measurements.
The study began on the 31st of March 2010 when the particular bar/
restaurant had not yet complied with the smoking ban regulation. The
study was completed on the 18th of November 2010. During the inter-
vening period we were able to make measurements before and after the
smoking ban was applied by the proprietor. During this eight month
period, a total of 504 measurements were made, without prior notice
and always during peak business hours (17:0021:00) in an effort to
minimize occupancy variations. All of the instruments were calibrated
prior to each day's sampling. During the sampling period, the sites
sampled (61 tables) are shown in Fig. 1.
It was noted that the air ventilation system would be turned on and
off intermittently according to the number of customers, of employees
Fig. 1. Floor plan of the working place with mixed smoking (zones 1 and 2) and non-smoking areas (zones 3 and 4).
137 S.S. Konstantopoulou et al. / Science of the Total Environment 476-477 (2014) 136143
Table 1
Indoor and outdoor measurements of pre-law and post-law applications
a
.
Number Date Indoor measurements Outdoor measurements
Smoking (1 and 2)
and smoke-free
zones (3 and 4)

air
(C)
RH
(%)
V
air
(m/s)
Ultrane particles
(pt/cm
3
)
CO
2
(ppm)
HCHO
(ppm)
CO
(ppm)
NO
2
(ppm)
Occupancy Smokers VR Vo (l/s/occ) Peak CO
2
(ppm)

air
(C)
RH
(%)
V
air
(m/s)
Ultrane particles
(pt/cm
3
)
CO
2
(ppm)
1. 31/3/2010 1 24.0 40 0.1 23,300 549 0 7 b0.5 16 6 9.2 945 21 55 1.5 10,050 401
2. 2 25.0 0.1 23,800 625 0 1 b0.5 21 3
3. 3 23.2 0.1 20,500 487 0 1 b0.5 9
4. 4 22.5 0.1 28,800 505 0 2 b0.5 3
5. 1/4/2010 1 26.5 37 0.1 26,000 533 0 0 b0.5 9 1 16.8 730 22 40 3.0 19,800 432
6. 2 27.0 0.1 39,100 560 0 1 b0.5 18 4
7. 3 26.4 0.1 39,500 528 0 1 b0.5 7
8. 4 25.6 0.2 40,300 542 0 0 b0.5 6
9. 6/4/2010 1 26.2 0.1 34,000 568 0 8 b0.5 20 2 17.9 711 20.5 35 0.6 11,200 432
10. 2 23.8 30 0.1 36,100 581 0 1 b0.5 22 5
11. 3 26.2 0.1 29,000 610 0 2 b0.5 19
12. 4 26.0 0.1 33,900 654 0 1 b0.5 1
13. 8/4/2010 1 26.6 30 0.1 22,100 705 0 1 b0.5 14 5 8.5 1054 21.3 37 0.9 13,300 465
14. 2 25.2 0.1 18,800 534 0 1 b0.5 18 2
15. 3 25.0 0.1 20,400 595 0 1 b0.5 10
16. 4 25.4 0.1 38,900 591 0 2 b0.5 4
17. 9/4/2010 1 26.3 0.1 27,300 786 0 4 b0.5 31 10 6.4 1260 22.8 27 0.4 14,200 479
18. 2 25.8 30 0.1 42,400 670 0 3 b0.5 31 3
19. 3 25.0 0.1 27,000 712 0 2 b0.5 10
20. 4 25.3 0.1 23,900 705 0 4 b0.5 18
21. 10/4/2010 1 26.1 0.1 27,200 688 0 2 b0.5 19 3 8.7 1040 20.2 31 0.5 11,400 462
22. 2 24.2 25 0.1 34,100 635 0 3 b0.5 18 3
23. 3 26.2 0.1 14,200 658 0 2 b0.5 15
24. 4 23.9 0.3 17,500 634 0 1 b0.5 6
25. 11/4/2010 1 24.0 30 0.1 23,700 718 0 1 b0.5 30 4 8.4 1070 20.2 30 1.2 13,600 472
26. 2 25.8 0.1 24,300 688 0 1 b0.5 29 4
27. 3 26.3 0.1 16,200 585 0 2 b0.5 11
28. 4 26.0 0.1 21,900 675 0 2 b0.5 11
29. 17/4/2010 1 25.8 47 0.4 30,300 560 0 2 b0.5 15 5 13.6 806 25.0 44 0.8 13,000 438
30. 2 25.1 0.5 22,200 795 0 5 b0.5 19 2
31. 3 26.3 0.1 46,300 495 0 5 b0.5 6
32. 4 26.0 0.1 34,000 640 0 5 b0.5 8
33. 18/4/2010 1 25.4 45 0.1 14,400 546 0 1 b0.5 21 6 7.1 1161 22.0 54 0.2 6030 452
34. 2 26.0 0.1 28,700 570 0 3 b0.5 22 2
35. 3 26.3 0.1 14,300 530 0 3 b0.5 7 0
36. 4 26.0 0.1 13,800 539 0 4 b0.5 12 0
1
3
8
S
.
S
.
K
o
n
s
t
a
n
t
o
p
o
u
l
o
u
e
t
a
l
.
/
S
c
i
e
n
c
e
o
f
t
h
e
T
o
t
a
l
E
n
v
i
r
o
n
m
e
n
t
4
7
6
-
4
7
7
(
2
0
1
4
)
1
3
6

1
4
3
Mean concentrations in the pre-ban period 25.5 35 0.2 27,172 611 0 2 b0.5 15 4 10.7 975 21.7 39 1.0 12,509 448
37. 24/10/2010 1 24.0 45 0.1 41,900 630 0 0 b0.5 20 0 19.6 734 19.0 50 1.3 32,300 479
38. 2 24.5 0.1 42,900 634 0 0 b0.5 30 0
39. 3 25.6 0.1 24,600 752 0 0 b0.5 16 0
40. 4 26.0 0.1 23,700 600 0 0 b0.5 4 0
41. 25/10/2010 1 24.0 50 0.1 14,500 642 0 0 b0.5 12 0 20.4 724 19.9 60 1.5 26,900 479
42. 2 24.5 0.1 14,900 593 0 0 b0.5 26 0
43. 3 24.6 0.1 20,900 692 0 0 b0.5 9 0
44. 4 25.0 0.1 17,400 573 0 0 b0.5 9 0
45. 29/10/2010 1 23.0 35 0.1 8940 585 0 0 b0.5 9 0 18 733 13.0 60 0.5 21,200 455
46. 2 24.0 0.1 19,200 666 0 0 b0.5 17 0
47. 3 24.6 0.1 21,500 599 0 0 b0.5 6 0
48. 4 24.0 0.1 15,800 570 0 0 b0.5 7 0
49. 30/10/2010 1 25.5 0.1 19,800 576 0 0 b0.5 33 0 6.3 1264 18.0 50 0.5 29,200 470
50. 2 21.0 40 0.1 19,200 683 0 0 b0.5 18 0
51. 3 25.0 0.1 18,400 686 0 0 b0.5 9 0
52. 4 25.0 0.1 19,600 602 0 0 b0.5 6 0
53. 31/10/2010 1 23.0 42 0.1 30,700 710 0 0 b0.5 8 0 10.4 996 16.0 63 1.2 54,600 515
54. 2 24.0 0.1 35,900 682 0 0 b0.5 23 0
55. 3 25.6 0.1 36,500 692 0 0 b0.5 21 0
56. 4 25.0 0,1 41,100 701 0 0 b0.5 12 0
57. 12/11/2010 1 24.5 0.1 24,400 553 0 0 b0.5 6 0 27.8 636 18.0 83 0.1 25,200 456
58. 2 23.0 61 0.1 16,100 567 0 0 b0.5 10 0
59. 3 24.2 0.1 13,500 517 0 0 b0.5 6 0
60. 4 24.0 0.1 25,100 528 0 0 b0.5 8 0
61. 13/11/2010 1 24.5 0.1 20,500 585 0 0 b0.5 17 0 13.8 830 20.0 60 0.1 19,900 467
62. 2 25.0 0.1 15,400 633 0 0 b0.5 23 0
63. 3 24.0 50 0.1 20,800 626 0 0 b0.5 9 0
64. 4 25.0 0.1 15,700 545 0 0 b0.5 8 0
65. 16/11/2010 1 26.2 0.1 30,400 602 0 0 b0.5 12 0 26.7 684 19.0 65 0.6 36,300 497
66. 2 24.0 55 0.1 26,600 582 0 0 b0.5 8 0
67. 3 26.0 0.1 29,900 636 0 0 b0.5 10 0
68. 4 26.0 0.1 27,400 600 0 0 b0.5 8 0
69. 17/11/2010 1 25.0 0.1 20,100 522 0 0 b0.5 10 0 31.8 656 17.0 60 0.7 18,900 499
70. 2 25.6 55 0.1 14,200 540 0 0 b0.5 7 0
71. 3 26.0 0.1 18,200 542 0 0 b0.5 16 0
72. 4 26.0 0.1 24,500 560 0 0 b0.5 9 0
Mean concentrations in the post-ban period 24.6 48 0.1 23,062 611 0 0 b0.5 13 0 19.4 806 17.8 61 0.7 29,389 480
a
The rst 9 days of measurements are referring to pre-ban smoking period and the second 9 days are referring to post-ban smoking period.
1
3
9
S
.
S
.
K
o
n
s
t
a
n
t
o
p
o
u
l
o
u
e
t
a
l
.
/
S
c
i
e
n
c
e
o
f
t
h
e
T
o
t
a
l
E
n
v
i
r
o
n
m
e
n
t
4
7
6
-
4
7
7
(
2
0
1
4
)
1
3
6

1
4
3
and smokers on the premises. These observations were recorded regu-
larly every 15 min in each zone studied. Since these variables were
observed to change every 4045 min, the measurement data were
averaged. The measurement instruments were placed at a height to
monitor air within people's normal breathing zone.
It is hoped, that this eld study will test the efcacy of the recently
issued ban on smoking in public places by taking into account the
estimation of indoor air quality.
2.3. Required instruments
The Hellenic Institute for Occupational HealthandSafety (EL.IN.Y.A.E.)
provides all equipment necessary for executing indoor air quality
control in the workplace.
Measuring instruments used in the eld study were:
TESTO 535 for the measurement for CO
2
within the range from 0 to
9999 ppm with accuracy 50 ppm CO
2
.
GMI Personal Surveyor (portable gas detector) detects and measures
up to three gases, LEL ammable gas, O
2
and CO gas within the
ranges 0 to 100% and 0 to 25% respectively, all with an accuracy
of 5 ppm.
TSI's P-TRAK 8525 Ultrane Particle Counter (UPC) detects in real
time ultrane or nanoparticles, that is particles 0.02 to 1 m in di-
ameter and symbolized as PM
0.1
and counts up to 525,000 pt/cm
3
at a ow rate 1.7 cm
3
/p. The instrument is used to display real-
time particle concentration readings (at 1 second resolution), in
particles per cubic centimeter (pt/cm
3
). Its operation is based on
the condensation particle counting technique using isopropyl al-
cohol.
GASTEC GV110 Piston Pump (100-ml air sample per stroke) and
Gastec Formaldehyde (HCHO) detector tube (91 LL), measures
from 0.05 to 1 ppm with an accuracy of 10% (0.050.3 ppm). The
GASTEC Colour Dosimeter Tubes provide reliable, on-the-spot Time-
Weighted Average (TWA) monitoring of worker exposure to gases
and vapors. The tubes are easy to read witha sharp, clear color change,
providing accuracy with no need for calibration.
NO
2
(nitrogen dioxide) sensor designed by Biosystems with gas
detectors ToxiPro, ToxiLTD and Toxi 3 LTD purchased From
Sperian Instruments.
Casella Whirling Hygrometer (SLING) for measuring relative humidi-
ty. The wet and dry bulb thermometers are held in a slotted frame,
which, when whirled at speed around the handle, give a high and rea-
sonably constant rate of airow. The relative humidity and dew point
is calculated using the tables provided. The instrument accuracy is
about 2% Relative Humidity (dependent on temperature, wet bulb
depression and correction of thermometer errors).
LSI AM4204 Hot Wire Thermal Anemometer to measure the speed of
the air.
3. Results
Table 1 shows the concentrationlevels measuredfor ultrane partic-
ulate matter (PM
0.1
), nitrogen dioxide (NO
2
), carbon monoxide (CO),
carbon dioxide (CO
2
) and formaldehyde (HCHO) for the pre-ban period
(rst 9 days) and the post-ban period (the last 9 days). The outdoor
measurements are also recorded on the table.
3.1. Carbon dioxide (CO
2
in ppm)
One of the most representative indicators that contribute to the
quality of internal air is CO
2
. The only sources of indoor CO
2
are due to
the ambient outdoor levels, occupants and lit cigarettes (Waring and
Siegel, 2007). Assuming a typical human breathing rate is 0.78 m
3
/h
(US EPA, 1997) and 4% of exhaled air is CO
2
(Meyer, 1983), a typical
human emits 51.9 g CO
2
/h. Further, if we assume that a typical cigarette
emits 300 mg CO
2
(National Research Council, 1986) and that it takes,
on average, 6.5 min to smoke a cigarette (Klepis et al., 2003), a typical
cigarette emits 2.77 g CO
2
/h (Waring and Siegel, 2007).
CO
2
, is a by-product of natural gas, thus contributing to CO
2
levels in
smoking area zone 2 adjacent to the kitchen (Fig. 1).
The Threshold Limit Value (TLVs) for Carbon Dioxide in Greece
is stipulated in the Presidential Decree 90/1999, with reference to
European Commission Directive 91/322/EEC On establishing indicative
limit values by implementing Council Directive 80/1107/EEC on the
protection of workers from the risks related to exposure to chemical,
physical and biological agents at work and Commission Directive
96/94/EC establishing a second list of indicative limit values in imple-
mentation of Council Directive 80/1107/EEC and has the value of
5000 ppm.
The mean of the 36 total CO
2
measurements for the pre-ban period
equaled the mean of the 36 total CO
2
measurements in the post-ban
period. On both occasions the average concentrations were found to
be 611 ppm.
Although this value was belowthe TLV of 5000 ppmfor CO
2
, the fact
is that substantial air levels of indoor carbon dioxide may be a problem
have been established by the American Society of Heating, Refrigerating
and Air-conditioning Engineers (ASHRAE).
Repace et al. (2006) refers to Standard 621999 by ASHRAE present-
ing it as the design ventilation engineer's guideline for ventilation rates
in buildings. In this standard, the equation (Eq. (1)),
Cs N=Vo Co 1
is used to estimate the ventilation adequacy based upon an indoor
CO
2
measurement and species the estimation of Cs, the equilib-
rium CO
2
levels in parts per million (ppm) in a venue. In this equa-
tion N is the CO
2
generation rate per person (N = 0.30 l/min, or
5000 ppm-l/s-occupant corresponding to ofce work), Vo is the out-
door air ow rate per occupant in l/s, and Co is the CO
2
concentration
(expressed in parts per million or ppm) in the outdoor air.
Table 1 shows the value of the ventilation rate Vo (l/s/occupant),
as determined from the measured outdoor peak CO
2
value and the
CO
2
concentration using Eq. (1). For example the Vo on 31/3/2010,
was found to be Vo = (5000 / (945 401)). The ASHRAE Standard
recommended value for Vo is 15 l/s-occ at maximumoccupancy, essen-
tially to control human bioefuents. Typically CO
2
concentrations in ac-
ceptable outdoor air range from300 ppmto 500 ppm, and maintaining
a level of 15 l/s-occ should result in a steady-state CO
2
concentra-
tion of about 350 ppm above background. It was noted that the
mean value of Vo (l/s/occ) was found it to be higher in the post-ban pe-
riod (19.4 l/s/occ), thus complying with the ASHARAE standard for Vo
of 15 l/s/occ at maximum occupancy, than in the pre-ban period
(10.7 l/s/occ). Such levels at the pre-ban period are consistent with
poor ventilation. 78% of the Vo measurements in the pre-ban period
and 22% in the post-ban period were lower than the recommended
value of 15 l/s-occ. This indicates that proper ventilation was ignored
in the pre-ban period in an effort to reduce costs.
The American Conference of Governmental Industrial Hygienists
(ACGIH) recommends ventilation rate of 16.5 l/s/person, close to ASHRAE
standard. For levels of carbon dioxide above 1000 ppm, ASHRAE rec-
ommends adjustment of the building's ventilation system (ASHRAE,
1989). The National Institute for Occupational Safety and Health
(NIOSH) considers that indoor air concentrations of carbon dioxide
that exceed 1000 ppm are a marker suggesting inadequate ventilation.
Chart 1 shows the pre-law CO
2
distribution and chart 2 demon-
strates that the separation of smoke and smoke-free environments
doesn't ensure a much clearer atmosphere in smoke-free zones. This
indicates pollutant dispersion in all zones.
There was a statistically positive cross-correlation between CO
2
con-
centrations and the number of people at the venue (P b 0.01). Addition-
ally, there was a statistically positive cross-correlation between CO
2
140 S.S. Konstantopoulou et al. / Science of the Total Environment 476-477 (2014) 136143
concentrations and the people who smoke at the venue (P b 0.05). All
statistical analyses (correlation, regression) were conducted using a
statistical analysis software package: SPSS (Statistical Package for the
Social Sciences) for Windows version 14.A at level of signicance of
p = 0.05.
3.2. Carbon monoxide (CO in ppm)
Carbon monoxide is produced from the partial oxidation of carbon-
containing compounds; it forms when there is not enough oxygen to
produce carbon dioxide (CO
2
), such as when operating a stove or an
internal combustion engine in an enclosed space. In the presence of
oxygen, carbon monoxide burns with a blue ame, producing carbon
dioxide.
Inside a working place the carbon monoxide is emitted from com-
bustion of fuels in the kitchen and as a by-product of tobacco.
The Threshold Limit Values (TLVs) for carbon monoxide in Greece
is stipulated in Presidential Decree 90/1999 with reference to Commis-
sion Directive 91/322/EEC On establishing indicative limit values by
implementing Council Directive 80/1107/EEC on the protection of
workers from the risks related to exposure to chemical, physical and
biological agents at work and Commission Directive 96/94/EC estab-
lishing a second list of indicative limit values in implementation of
Council Directive 80/1107/EEC and has the value of 50 ppm.
The mean of the 36 total CO measurements for the pre-ban period
was 2 ppm. CO measurements in the post-ban period were less than
the detection limit of 1 ppm. Chart 3 shows the pre-ban CO distribution
and chart 4 demonstrates the percentage distribution of carbon mon-
oxide in the four zones. The effects of the ban on CO levels are quite
clear.
3.3. The nitrogen dioxide (NO
2
in ppm)
Nitrogen dioxide is an atmospheric pollutant primarily derived
from industrial processes. Because of its limited solubility, it can in-
ltrate deeply in the lower respiratory tract. Irritation, to the eyes
and nose has been observed to occur with concentrations of NO
2
of
15 ppm. At the 25 ppm level respiratory distress begin, with cough,
with yellow coat or blood, cyanosis, fever, crisis of asthma, increased
respiratory rhythm, bronchitis, pneumonia and pulmonary edema. Re-
ports at 150200 ppm can lead to lethal pulmonary brosis (National
Research Council, 1977; National Institute for Occupational Safety and
Health, 1976).
The Threshold Limit Values (TLVs) for nitrogen dioxide in Greece
is stipulated in Presidential Decree 90/1999 with reference to Commis-
sion Directive 91/322/EEC On establishing indicative limit values by
implementing Council Directive 80/1107/EEC on the protection of
workers from the risks related to exposure to chemical, physical and
biological agents at work and Commission Directive 96/94/EC estab-
lishing a second list of indicative limit values in implementation of
Council Directive 80/1107/EEC and has the value of 5 ppm.
However, because of its harmful effect on the human body, the
American Conference of Governmental Industrial Hygienists (ACGIH)
has cited as maximum concentration (TLVs) the 3 ppm. This was
based in vivo studies (Kosmider et al., 1972) that demonstrate the
harmful effect in the human respiratory systemin a group of 70 individ-
uals that was exposed to nitrogen dioxide from 0.4 ppm to 2.7 ppm
for 68 h daily for 46 years. Based on another epidemiologic study
127 workers (Vigdortschik et al., 1937) who were exposed at levels
below 2.8 ppm NO
2
, cases of chronic bronchitis and emphysema were
reported.
Emissions of nitrogen dioxide weren't detected in any of the zones
(1, 2, 3, and 4). In the kitchen, only, on one particular day, when there
were increased orders for foods, concentrations of 23 ppm were
noted.
3.4. Formaldehyde (HCHO in ppm)
Formaldehyde sources include pressed-wood products, cigarette
smoke and fuel-burning appliances.
Formaldehyde has been classied as a known human carcinogen
(cancer-causing substance) by the International Agency for Research
on Cancer (Baan et al., 2009) and as a probable human carcinogen by
the U.S. Environmental Protection Agency.
In 2011, the National Toxicology Program, an interagency program
of the Department of Health and Human Services, named formaldehyde
as a known human carcinogen in its 12th Report on Carcinogens
(National Toxicology Program, 2011).
Research studies (Hauptmann et al., 2003, 2004, 2009; Freeman
et al., 2009; Pinkerton et al., 2004; Coggon et al., 2003) on workers
exposed to formaldehyde have suggested an association between form-
aldehyde exposure and several types of cancers, suchas nasopharyngeal
cancer and myeloid leukemia.
Formaldehyde wasn't detected above the limit of detection before
and after smoking ban in the venue.
3.5. Ultrane particles PM
0.1
(pt/cm
3
)
PM
0.1
stands for particulate matter suspended in air with an aero-
dynamic diameter of up to 0.1 m, also referred as ultrane particles
(0.1 b ultrane particles N 0.01).
All of the studies available demonstrate that due to their small size,
high number concentration, and relatively large surface area per unit
mass, ultrane particles (UFPs) have unique characteristics, such as
increased adsorption of organic molecules and enhanced ability to pen-
etrate cellular targets in the lung and systemic circulation (Nemmar
et al., 2002; Oberdrster, 1996). Field researchers (Saldiva et al., 2002;
Nel et al., 2001) conrmed that the organic and metal PM components
can induce proinammatory effects in the lung due to their ability to
cause oxidative stress. These studies have shown that cytokines are pro-
duced by these particles as mediators of the inammatory response.
Furthermore, ndings of upregulation of adhesion molecules on airway
vascular endothelial cells amongst healthy subjects and elevated brin-
ogen concentrations in peripheral blood provides some support for
cardiovascular mortality and morbidity (Thun et al., 1999). Either they
are phagocytized by alveolar macrophages and destroyed or they are
systematically absorbed in the blood (Koutselinis, 1997a, 1997b). Ultra-
ne particles are phagocytized less efciently by alveolar macrophages
and therefore are more likely to be internalized by epithelial cells and
translocated to interstitial sites (Ferin et al., 1991). At the same time
inammatory indicators may be upregulated, suggesting that the in-
creased epithelial internalization and access of ultrane particles to
the interstitium triggers an inammatory response there. According to
Valavanidis (2003) the reactive oxygen species (ROS) cause important
damage in lipids of membranes of cells, in proteins and in DNA.
Particle number concentration levels in clean environments are usu-
ally of the order of a fewhundred particles/cm
3
. Clean environments for
the purpose of this study are those, which are not inuenced by human
activities. In urban environments, background particle number concen-
trations range from a few thousand to about 20,000 particles/cm
3
(Morawska et al., 2004).
There are no TLVfor ultrane particles (PM
0.1
). However, researches
(Levy et al., 2002; y Ballara and Marconi, 2008; Lee et al., 2009) have
suggested on the assumption of an 8-h workday, on a 24-h average
basis for the measurements, the following concentration ranges to
categorize the quality of indoor air with respect to ultrane dust: a)
very low: up to 10,000 (pt/cm
3
), b) low: from 10,000 up to 30,000
(pt/cm
3
), c) intermediate: from 30,000 up to 100,000 (pt/cm
3
) and
d) high: N100,000 (pt/cm
3
).
The mean of the 36 total PM
0.1
measurements for the pre-smoking-ban
averaged27,172 pt/cm
3
while the post-banlevels averaged23,062 pt/cm
3
,
141 S.S. Konstantopoulou et al. / Science of the Total Environment 476-477 (2014) 136143
classifying the workplace venue as a low level pollution area with re-
spect to ultrane particles.
Further, we compared the average of the measured PM
0.1
concentra-
tions in the smoking zones between the pre-ban and post-ban periods.
For the pre-ban period the averaged measured concentration in the
smoking zones was 27,656 pt/cm
3
and for the post-ban period for the
same zones, the averaged measured concentrations was 23,091 pt/cm
3
.
This represents 19.8% reduction in the number of ultrane particles.
Similarly, for the non-smoking zones, we found 26,689 pt/cm
3
in the
pre-ban period and 23,033 pt/cm
3
in the post-ban period. In this case,
this represents a 15.9% reduction in the number of ultrane particles.
Overall the reduction in the number of particles in the venue was 18%
between pre-ban and post-ban periods. Other studies that measured
ultrane particulate matter concentrations as indicators of ETS expo-
sure before and after smoking bans describe reductions ranging from
14% to 87% (Minnesota Partnership for Action against Tobacco, 2005;
Valente et al., 2007). Chart 5 shows the pre-lawdistribution of ultrane
particles in the venue and chart 6 shows that the separation of smoke
and smoke-free zones doesn't ensure a much clearer atmosphere in
smoke-free zones. Chart 7 shows the pre-ban and post-ban reduction
of ultrane particles in the venue.
There was a statistically positive cross-correlation between PM
0.1
concentrations and the people who smoke at the venue (P b 0.05).
4. Discussion
The goal of the present study was to investigate whether the separa-
tion of the workplace into smoking and non-smoking zones, has an
impact on secondhand smoke (SHS) exposure for the workers and the
customers. It was conrmed that the results after the ban period in
smoke-free zones 3 and 4 didn't differ signicantly from the smoking
zones 1 and 2. It was observed there was about 50% distribution of pol-
lutants from the smoking zones to the smoke-free zones. Kolokotroni
et al. (1999) evaluated the effectiveness of ventilation and partitioning
to mitigate the effects of passive smoking and determined that ventila-
tion strategies alone, though they do reduce environmental tobacco
smoke (ETS) levels somewhat, are generally not sufcient to reduce
ETS migration into a non-smoking space. Nebot et al. (2005, 2009)
and the US Department of Health and Human Services (2006) also bol-
ster the case that in areas where smoking is prohibited, concentrations
of the indoor pollutants are lower than in areas where smoking is
allowed but they are not zero, because the mechanical systems and sep-
arated areas cannot protect, in absolute terms, the population from
exposure to tobacco smoke. On the other hand, it should be noted that
the differences between exposures in the two zones, demonstrate the
efcacy of the law.
However, the concentrations of SHS components in a space: a) in-
crease as the number of cigarettes smoked increases, 2) decrease with
an increase in ventilation, and 3) decrease in proportion to the rate of
cleaning or removal of SHS components from the air (Ott, 1999).
For 9 days in the pre-ban period, the total number of occupants was
536 people, of which70, smoked (13.1%), while for the last 9 days in the
post-ban period, the number of occupants declined to 462 people that
was a reduction of 16%. Other investigators (Waring and Siegel, 2007;
Ott et al., 1996; Mulcahy et al., 2005) have shown that the smoking
ban effect on the occupancy levels isn't too crucial to cause huge reduc-
tions in patronage. Following a transition period, an increase in occu-
pancy is observed.
Withregards to the indoor microclimatic parameters of temperature
and humidity, ASHRAE (1992) provides guidance in standard 551992
in the design of the venue to maintain proper indoor thermal environ-
ments. The guide recommends temperature ranges of 19.4 C to
24.4 C in winter (heating season) and 22.2 C to 27.2 C in summer
(cooling season). Similarly, the guide suggests to keep relative humidity
above 2030% during the heating season and below 60% during
the cooling season. With regards to this, our ndings aren't within
ASHRAE design parameters. We found that 28% of the measurements
(5 out of 18) were beneath or equal to 30% relative humidity and only
28% (20 out of 72) of the air temperature was at the preferable range.
5. Conclusion
In conclusion, nearly all indicators of ETS exposure that we mea-
sured slightly decreased considerably after the ban; CO concentrations
weren't detected at the post-ban testing. The smoking ban ordinance
can be judged a clear success from the view point of indoor air quality.
Declaration of competing interests
The authors declare that they have no competing interests that are
directly relevant to the content of this article.
Supplementary data to this article can be found online at http://dx.
doi.org/10.1016/j.scitotenv.2013.11.129.
Acknowledgments
We are grateful to Mr. Drivas Spyros, Mr. Radin Lorenzo and
Mr. Kominos Xenofon of the Hellenic Institute for Occupational Health
and Safety (EL.IN.Y.A.E.) who served as observers and supported the
indoor air quality study in the workplace.
References
American Society of Heating, Refrigerating and Air-Conditioning Engineers. ANSI/ASHRAE
551992: thermal environmental conditions for human occupancy. Atlanta, GA:
ASHRAE; 1992.
American Society of Heating, Refrigerating and Air-Conditioning Engineers. Ventilation
for acceptable indoor air quality. ASHRAE Standard 621989, Atlanta, GA 1989; 1989.
Baan R, Grosse Y, Straif K, et al. On behalf of the WHO International Agency for Research
on Cancer Monograph Working Group. A review of human carcinogensart F:
chemical agents and related occupations. Lancet Oncol 2009;10(12):11434.
Bialous SA, Glantz SA. ASHRAE Standard 62: tobacco industry's inuence over national
ventilation standards. Tob Control 2002;11:31528.
Cesaroni G, Forastiere F, Agabiti N, Valente P, Zuccaro P, Perucci CA. Effect of the Italian
smoking ban on population rates of acute coronary events. Circulation 2008;117:
11838.
Coggon D, Harris EC, Poole J, Palmer KT. Extended follow-up of a cohort of British
chemical workers exposed to formaldehyde. J Natl Cancer Inst 2003;95(21):160815.
Ellingsen DG, Fladseth G, Daae HL, et al. Airborne exposure and biological monitoring of
bar and restaurant workers before and after the introduction of a smoking ban.
J Environ Monit 2006;8:3628.
Ferin J, Oberdorster G, Soderholm SC, Gelein R. Pulmonary tissue access of ultrane par-
ticles. J Aerosol Med 1991;4:5768.
Freeman LEB, Blair A, Lubin JH, et al. Mortality from lymphohematopoietic malignancies
among workers in formaldehyde industries: the National Cancer Institute Cohort. J
Natl Cancer Inst 2009;101(10):75161.
Goodman P, Agnew M, McCaffrey M, Paul G, Clancy L. Effect of the Irish smoking ban on
respiratory health of bar workers and air quality in Dublin pubs. AmJ Respir Crit Care
Med 2007;175:8405.
Gotz NK, Van Tongeren M, Wareing H, Wallace LM, Semple S, MacCalman L. Changes in
air quality and second-hand smoke exposure in hospitality sector businesses after
introduction of the English Smoke-free legislation. Am J Public Health 2008;30:
4218.
Hauptmann M, Lubin JH, Stewart PA, Hayes RB, Blair A. Mortality fromlymphohematopoietic
malignancies among workers in formaldehyde industries. J Natl Cancer Inst
2003;95(21):161523.
Hauptmann M, Lubin JH, Stewart PA, Hayes RB, Blair A. Mortality from solid cancers
among workers in formaldehyde industries. Am J Epidemiol 2004;159(12):111730.
Hauptmann M, Stewart PA, Lubin JH, et al. Mortality from lymphohematopoietic malig-
nancies and brain cancer among embalmers exposed to formaldehyde. J Natl Cancer
Inst 2009;101(24):1696708.
Heloma A, Jaakkola MS. Four-year follow-up of smoke exposure, attitudes and smoking
behavior following enactment of Finland's national smoke-free work-place law.
Addiction 2003;98:11117.
Howard G, Wagenknecht L. Environmental tobacco smoke and measures of subclinical
vascular disease. Environ Health Perspect 1999;107(Suppl. 6):83740.
International Agency for Research on Cancer. Tobacco smoke and involuntary smoking.
IARC Monogr 2002;83. [June].
Jaakkola M, Samet J. Occupational exposure to environmental tobacco smoke and health
risk assessment. Environ Health Perspect 1999a;107(Suppl. 6):82935.
142 S.S. Konstantopoulou et al. / Science of the Total Environment 476-477 (2014) 136143
Jaakkola M, Samet J. Workshop on health risks attributable to ETS exposure in the
workplace. Environ Health Perspect 1999b;107(Suppl. 6):8238.
Klepis NE, Apte MG, Gundel LA, Sextro RG, Nazaroff WW. Determining size-specic
emission factors for environmental tobacco smoke particles. Aerosol Sci Technol
2003;37:78090.
Kolokotroni M, Perera MDAES, Palmer J, Currie J, Capper G, Watkins R. Effectiveness of
simple ventilation strategies and partitioning in mitigating the effects of passive
smoking. Build Serv Eng Res Technol 1999;20(2):938.
Kosmider S, Ludyga K, Misiewicz A, Drozdz M, Sagan J. Experimentelle und klinische
Untersuchungen uber emphysembildende Wirkungen der Stickoxide. Zentralbl
Arbeitsmed Arbeitsschutz 1972;12(362).
Koutselinis A. Toxicology. Scientic Medical Publications Parisianou, Volume I, Athens;
1997a.
Koutselinis A. Toxicology. Scientic Medical Publications Parisianou, Volume II, Athens;
1997b.
Larsson M, Bothius G, Axelsson S, Montgomery SM. Exposure to environmental
tobacco smoke and health effects among hospitality workers in Swedenbefore
and after the implementation of a smoke-free law. Scand J Work Environ Health
2008;34:26777.
Levy JI, Dumyahn T, Spengler JD. Particulate matter and polycyclic aromatic hydrocarbon
concentrations in indoor and outdoor microenvironments in Boston, Massachusetts. J
Expo Anal Environ Epidemiol 2002;12:10414.
Meyer B. Indoor air quality. Reading, MA: Addison-Wesley Publishing Company, Inc.;
1983.
Minnesota Partnership for Action against Tobacco, [June 2005]. http://www.thefreelibrary.
com/New+Survey+Findings+Show+Residents+Strongly+Support+Recent+
Smoke-Free-a0133628471. [Assessed June 12, 2012].
Morawska L, Moore MR, Ristovski ZD. Health impacts of ultrane particles, desktop liter-
ature reviewand analysis. Department of the Environment and Heritage, a consultan-
cy funded by the Australian Government; 2004.
Mulcahy M, Byrne MA, Ruprecht A, et al. How does the Irish smoking ban measure up? A
before and after study of particle concentrations in Irish pubs. Proceedings of Indoor
Air 2005; 2005. p. 165962. [Beijing, China].
National Institute for Occupational Safety and Health. NIOSH criteria for a recommended
standard occupational exposure to oxides of nitrogen (nitrogen dioxide and nitric
oxide). Washington, DC: U.S. Department of Health, Education, and Welfare; 1976
[HEW publication No 76149, 195 pp.].
National Toxicology Program. Report on carcinogens. Twelfth Edition, Department of
Health and Human Services, Public Health Service, National Toxicology Program.
http://ntp.niehs.nih.gov/go/roc12. Accessed June 12, 2012.
Nebot M, Lpez MJ, Gorini G, et al. Environmental tobacco smoke exposure in public
places of European cities. Tob Control 2005;14:603.
Nebot M, Lpez MJ, Ariza C, et al. On behalf of the Spanish Smoking LawEvaluation Group.
Impact of the Spanish Smoking Law on exposure to second-hand smoke in of-
ces and hospitality venues: before-and-after study. Environ Health Perspect
2009;117:3447.
Nel AE, Diaz-Sanchez D, Li N. The role of particulate pollutants in pulmonary inamma-
tion and asthma: evidence for the involvement of organic chemicals and oxidative
stress. Curr Opin Pulm Med 2001;7:206.
Nemmar A, Hoet PHM, Vanquickenborne B, et al. Passage of inhaled particles into the
blood circulation in humans. Circulation 2002;105:4114.
Oberdrster G. Signicance of particle parameters in the evaluation of exposure
doseresponse relationships of inhaled particles. Inhal Toxicol 1996;8(Suppl.):
7389.
Ott WR. Mathematical models for predicting indoor air quality from smoking activity.
Environ Health Perspect 1999;107(Suppl. 2):37581.
Ott W, Switzer P, Robinson J. Particle concentrations inside a tavern before and after
prohibition of smoking: evaluating the performance of an indoor air quality model.
J Air Waste Manage Assoc 1996;46:112034.
Pinkerton LE, Hein MJ, Stayner LT. Mortality among a cohort of garment workers exposed
to formaldehyde: an update. Occup Environ Med 2004;61:193200.
Repace JL, Hyde JN, Brugge D. Air pollution in Boston bars before and after a smoking ban.
BMC Public Health 2006;6:266.
Research Council National. Environmental tobacco smokemeasuring exposures and
assessing health effects. Washington, DC: National Academy Press; 1986.
Research Council National. Medical and biologic effects of environmental pollutants.
Nitrogen oxides. Washington, DC: National Academy of Sciences; 1977 [333 pp.].
Saldiva PHN, Clarke RW, Coull BA, et al. Lung inammation induced by concentrated
ambient air particles is related to particle composition. Am J Respir Crit Care Med
2002;165:16107.
Semple S, Maccalman L, Naji AA, et al. Bar workers' exposure to secondhand smoke: the
effects of Scottish smoke free legislation on occupational exposure. Ann Occup Hyg
2007;51:57180.
Surgeon General. The health consequences of involuntary smoking: a report of the Surgeon
General. Washington, DC: U.S. Department of Health and Human Services; 1986.
Su Gil Lee, Xiao Hui Liu, Deemer A, Sanderson Barbara, Pisaniello J, Luigi Dino. Ultrane
particle emissions and exposure measurement in South Australian workplacesa
pilot study. Proceedings of Australian Institute of Occupational Hygienists (AIOH)
Conference, 59 December 2009, Canberra, ACT, Australia; 2009. p. 110. [http://
www.docstoc.com/docs/34684733/Ultrane-Particle-Emissions-and-Exposure-
Measurement-in-South-#. Assessed June 12, 2012].
Thun M, Henley J, Apicella L. Epidemiologic studies of fatal and nonfatal cardiovascular
disease and ETS exposure from spousal smoking. Environ Health Perspect
1999;107(Suppl. 6):8416.
US Department of Health and Human Services. The health consequences of involuntary
exposure to tobacco smoke: a report of the Surgeon General. Atlanta GA: US Depart-
ment of Health and Human Services, Centres for Disease Control and Prevention, Co-
ordinating Centre for Health Promotion, National Centre for Chronic Disease
Prevention and Health Promotion, Ofce on Smoking and Health; 2006.
US Environmental Protection Agency. Exposure factors handbook vol.1F general factors.
Washington, DC: US EPA. US Government Printing Ofce; 1997.
Valavanidis A. Free radicals and mechanisms of carcinogenesis. Athens: Beta Medical
Publications978-960-8071-49-0; 2003.
Valente P, Forastiere F, Bacosi A, et al. Exposure to ne and ultrane particles from
second-hand smoke in public places before and after the smoking ban, Italy 2005.
Tob Control 2007;16:3127.
Vigdortschik NA, Andreeva EG, Matussevistch IZ, Nikulina MM, Frumina LM, Striter VA.
The symptomatology of chronic poisoning with oxides of nitrogen. J Ind Hyg Toxicol
1937;19:46973.
Waring MS, Siegel JA. An evaluation of the indoor air quality in bars before and after a
smoking ban in Austin, Texas. J Expo Sci Environ Epidemiol 2007;17:2608.
Weiss S, Utell M, Samet J. Environmental tobacco smoke exposure and asthma in adults.
Environ Health Perspect 1999;107(Suppl. 6):8915.
World Health Organization. Elaboration of guidelines for implementation of the convention
(decision FCTC/COP1(15)) Article 8: protection fromexposure to tobacco smoke. http://
apps.who.int/gb/fctc/PDF/cop2/FCTC_COP2_7-en.pdf, 2007. [Accessed June 12, 2012].
y Ballara Castellet, Marconi A. Strumenti e tecniche per la misura dell'esposizione a
particelle nanometriche negli ambienti di lavoro. G Ig Ind 2008;Vol. 33.
143 S.S. Konstantopoulou et al. / Science of the Total Environment 476-477 (2014) 136143