Liu Ruiling, Bohac David L, Gundel Lara A, Hewett Martha J, Apte Michael G, Hammond S Katharine
Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA.
Center for Energy and Environment, Minneapolis, Minnesota, USA.
Tob Control. 2014 Jul;23(4):332-8. doi: 10.1136/tobaccocontrol-2012-050831. Epub 2013 Feb 13.
Despite efforts to reduce exposure to secondhand smoke (SHS), only 5% of the world's population enjoy smoke-free restaurants and bars.
Lifetime excess risk (LER) of cancer death, ischaemic heart disease (IHD) death and asthma initiation among non-smoking restaurant and bar servers and patrons in Minnesota and the US were estimated using weighted field measurements of SHS constituents in Minnesota, existing data on tobacco use and multiple dose-response models.
A continuous approach estimated a LER of lung cancer death (LCD) of 18 × 10(-6)(95% CI 13 to 23 × 10(-6)) for patrons visiting only designated non-smoking sections, 80 × 10(-6)(95% CI 66 to 95 × 10(-6)) for patrons visiting only smoking venues/sections and 802 × 10(-6)(95% CI 658 to 936 × 10(-6)) for servers in smoking-permitted venues. An attributable-risk (exposed/non-exposed) approach estimated a similar LER of LCD, a LER of IHD death about 10(-2) for non-smokers with average SHS exposure from all sources and a LER of asthma initiation about 5% for servers with SHS exposure at work only. These risks correspond to 214 LCDs and 3001 IHD deaths among the general non-smoking population and 1420 new asthma cases among non-smoking servers in the US each year due to SHS exposure in restaurants and bars alone.
Health risks for patrons and servers from SHS exposure in restaurants and bars alone are well above the acceptable level. Restaurants and bars should be a priority for governments' effort to create smoke-free environments and should not be exempt from smoking bans.
尽管人们努力减少二手烟暴露，但全球仅有5%的人口能在无烟餐厅和酒吧中活动。
利用明尼苏达州二手烟成分的加权现场测量数据、现有的烟草使用数据以及多种剂量反应模型，估算了明尼苏达州和美国非吸烟餐厅及酒吧服务员和顾客患癌症死亡、缺血性心脏病（IHD）死亡以及引发哮喘的终生超额风险（LER）。
采用连续方法估算，仅光顾指定无烟区的顾客患肺癌死亡的LER为18×10⁻⁶（95%置信区间为13至23×10⁻⁶），仅光顾吸烟场所/区域的顾客为80×10⁻⁶（95%置信区间为66至95×10⁻⁶），在允许吸烟场所工作的服务员为802×10⁻⁶（95%置信区间为658至936×10⁻⁶）。采用归因风险（暴露/未暴露）方法估算出的肺癌死亡LER相似，对于来自所有来源且二手烟暴露水平平均的非吸烟者，缺血性心脏病死亡的LER约为10⁻²，仅在工作中接触二手烟的服务员引发哮喘的LER约为5%。仅因餐厅和酒吧中的二手烟暴露，这些风险在美国普通非吸烟人群中每年对应214例肺癌死亡和3001例缺血性心脏病死亡，在非吸烟服务员中每年对应1420例新哮喘病例。
仅餐厅和酒吧中的二手烟暴露给顾客和服务员带来的健康风险远高于可接受水平。餐厅和酒吧应成为政府创建无烟环境工作的重点，不应豁免于禁烟令。
