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w Protection from exposure to second-hand tobacco smoke. Poticy recommendations. r w there are open doors and windows or intake vents. Smoking can also be problematic in"quasi-outdoor" environments, which are common in warm-climate countries and which are much less likely to have solid structures clearly delimiting indoor and outdoor space. Common problems include: s Fig. 1 The "outdoor" addition to a club in New South Wales, • Smoke drifting into indoor areas from out- Australiawhere the law currently allows smoking in this door smoking areas that lead directly into type of outdoor area. (Photo courtesy of ASH Australia/ indoor spaces with open doors and windows. considerations. At the very least, these areas A study in Ireland that found that exposure to should not be specifically designated as smok- tobacco smoke had decreased significantly ing areas, which will make it simpler to deal among hospitality sector workers following with them when, after indoor areas have been implementation of Ireland's smoke-free law smoke-free for long enough, the public also discovered that bars with designated out- demands that the adjacent outdoor areas be door smoking areas had significantly higher smoke-free. concentrations of ambient nicotine than those without outdoor smoking areas.82 Effects of smoke-free environments on health and tobacco use • Difficulty in distinguishing between indoor and Smoke-free environments drastically reduce outdoor spaces for purposes ofimplementa- toxins in the air and are associated with tion and enforcement,83,84,85,e6 For example, measurable rapid increases in health among business owners may build covered patios, workers previously exposed to SHS. partially enclosed tents or similar spaces to circumvent indoor smoking restrictions. Immediate drops in pollution levels In Irish bars, levels of fine particles in the air • Allowing smoking in quasi-outdoor areas (PM2.51, which reach deep into the lung and where people have to work may expose them damage the lung and heart, dropped by 83% to significant levels of SHS and unaccept- following the implementation of the smoke-free able risks to health. Under some conditions, law. Nicotine in the air also fell by 83% and the levels of exposure may be comparable to median time per week of exposure to SHS those indoors.14 reported by workers fell from 30 hours to 0 hours.87 Experience in New South Wales, Australia, " demonstrates the types of difficulties that may This reduced exposure to SHS led to lower be encountered with "quasi-outdoor" areas. Its amounts of the toxins in the smoke appearing current law allows smoking in outdoor areas, in the bodies of non-smoking hospitality work- which are defined as "maximum 75% enclosed." ers. Carbon monoxide in the breath of bar As a result, many businesses are building "out- workers was also measured and was found to door" seating areas, such asthe one illustrated have decreased by 45% among non-smokers in Fig. 1, that meet this definition. and by 36% among ex-smokers.87 Cotinine concentrations in saliva, which indicate the Universal effective protection from SHS may level of smoke toxins people absorb into their therefore require making certain outdoor or bodies from the SHS exposure, felt by 69% in quasi-outdoor areas smoke-free, with workers non-smoking hospitality sector workers fol- health, equity and enforceability being the key lowing implementation of the law. M M