Introduction

Secondhand smoke (SHS) causes morbidity and mortality among non-smokers.

Objectives

To investigate SHS presence in outdoor areas from 12 European countries and its association with country-level characteristics.

Methods

Cross-sectional study performed in 2017–2018 within the TackSHS project. We conducted a face-to-face survey on a representative sample of the population aged 15 years and older from 12 European countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain. Out of 11,902 participants, 8,562 were non-smokers. SHS presence was assessed in selected outdoor areas and defined as respondents viewing someone smoking the last time they visited each setting within the last 6 months. A ranking score for outdoor SHS presence was assigned to each country based on the SHS presence in each setting. We used Spearman's correlation (r) and the Chi-squared tests to assess the relationship between SHS presence and country-level characteristics.

Results

Except for children's playgrounds (39.5%; 95% confidence interval, CI: 37.6%–41.3%), more than half of non-smokers reported SHS presence in outdoor areas: schools (52.0%; 95%CI: 50.2%–53.7%), stadia (57.4%; 95%CI: 55.4%–59.4%), parks (67.3%; 95%CI: 66.0%–68.5%), hospitals (67.3%; 95%CI: 65.8%–68.7%), public transport stops (69.9%; 95%CI: 68.6%–71.2%), bar/restaurant terraces (71.4%; 95%CI: 70.2%–72.6%), and beaches (72.8%; 95%CI: 71.4%–74.1%). Residents in Latvia showed the highest overall outdoor SHS presence rank, followed by Greece, and Portugal. Outdoor SHS presence was directly correlated to the country's smoking prevalence (r = 0.64), and inversely correlated to the Tobacco Control Scale 2016 overall score (r = −0.62), the socio-demographic index 2017 (r = −0.56), and Gross Domestic Product per capita 2018 (r = −0.47) (p < 0.001).

Conclusions

SHS presence is high in most outdoor areas in Europe, especially in countries with higher smoking prevalence and lower tobacco control performance. To address outdoor SHS exposure, our findings require considering smoking bans along with other strategies to reduce smoking prevalence.

中文翻译：

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欧洲12个国家/地区的室外区域有二手烟

介绍

二手烟（SHS）会导致非吸烟者发病和死亡。

目标

调查来自12个欧洲国家/地区的户外环境中SHS的存在及其与国家/地区级特征的关系。

方法

TackSHS项目于2017–2018年进行了横断面研究。我们对来自12个欧洲国家（保加利亚，英国，法国，德国，希腊，爱尔兰，意大利，拉脱维亚，波兰，葡萄牙，罗马尼亚和西班牙）的15岁及15岁以上人口的代表性样本进行了面对面的调查。在11,902名参与者中，有8,562名非吸烟者。在选定的室外区域对SHS的存在进行了评估，定义为受访者在过去6个月内最后一次访问每个环境时正在观看某人的人。根据每个设置中的SHS存在情况，将户外SHS存在的排名得分分配给每个国家/地区。我们使用Spearman的相关性（r）和卡方检验来评估SHS的存在与国家/地区级特征之间的关系。

结果

除了儿童游乐场（39.5％； 95％置信区间，置信区间：37.6％–41.3％）之外，一半以上的非吸烟者报告在室外区域存在SHS：学校（52.0％； 95％置信区间：50.2％–53.7％） ），体育场（57.4％； 95％CI：55.4％–59.4％），公园（67.3％； 95％CI：66.0％–68.5％），医院（67.3％； 95％CI：65.8％–68.7％），公共交通站点（69.9％; 95％CI：68.6％–71.2％），酒吧/餐厅露台（71.4％; 95％CI：70.2％–72.6％）和海滩（72.8％; 95％CI：71.4％– 74.1％）。拉脱维亚的居民在户外SHS总体表现上最高，其次是希腊和葡萄牙。室外SHS的存在与该国吸烟率直接相关（r = 0.64），与2016年烟草控制量表总体得分（r = −0.62），2017年社会人口统计学指数（r = −0.56）和总值成反比。人均国内生产总值 2018（r = −0.47）（p <0.001）。

结论

在欧洲大多数户外地区，特别是在吸烟率较高和控烟性能较低的国家中，SHS的存在率很高。为了解决室外SHS暴露问题，我们的发现需要考虑禁止吸烟以及其他减少吸烟率的策略。