Xisca Sureda (Madrid, 38 years old) believes that the debate about a ban on tobacco on terraces, which the Ministry of Health has revived, should be over. In recent years, this epidemiologist, together with the Public Health and Epidemiology Research Team of the University of Alcalá, has participated in several studies to verify the presence of tobacco on terraces and to quantify the smoke exposure of users and workers. And they have shown that levels in most of these spaces exceed the air quality limits suggested by the World Health Organization (WHO). His investigation focused on Madrid, but there are also similar investigations in Barcelona and other European capitals. The conclusions can easily be applied to any Spanish city.
Questions. What was the first study you conducted on tobacco on terraces?
Answer. With the change in tobacco regulations in 2011, smoking in outdoor areas such as playgrounds, hospital facilities, schools, etc. was banned for the first time in Europe. And smoking was also prohibited on terraces that had an awning or more than two walls. What we had observed was that there was a breach of regulations as smoking was taking place on all terraces, regardless of the number of walls. We wanted to observe the presence of tobacco on these terraces and make objective measurements of particles and nicotine.
Q What did they check?
R. We visited 200 terraces and found that consumption was over 90%. This means that there were smokers or signs of tobacco use, such as cigarette butts, inside them.
Q Are the amounts of smoke you measured classified as harmful?
R. The average exceeded the 10 micrograms of particles per cubic meter set by the WHO guide, which has already been found to have adverse health effects. And the larger the areas of the terraces became, the higher their level became. In almost closed rooms, the values were higher than those we had observed indoors when smoking was still possible.
Q And that even though it was already banned there at the time.
R. Yes, but the regulations are not being followed.
Q Did you also notice smoke on the completely open terraces?
R. Particle or nicotine levels are also recorded. It depends a lot on the weather conditions. That is, on a windy day it was very difficult to detect concentrations because it is very difficult to detect them with the meter. It also depends on how many smokers are there at the time the measurement is taken. But regardless of these conditions, you can almost always detect nicotine or particulate matter levels.
Q Harmful quantities?
R. Any exposure is harmful to health. Obviously, more errors are observed at higher levels, but none are safe. When we talk about terraces, in certain circumstances these may not be that high, but there is a group of people who are constantly exposed to these low levels, such as hospitality workers. There are also children, pregnant women, the elderly… vulnerable populations where even low levels of exposure can have adverse health effects. It's not just about how much you're exposed to on the terrace, but there's a very important aspect, namely the denormalization of consumption. What we have seen is that as soon as a regulation is implemented that prohibits smoking in a space of any kind, the regulation is accepted and then consumption in that place is denormalized, which also leads to a denormalization of consumption in the Generally leads and contributes to reducing tobacco consumption.
Q Has it been observed that there is less smoking in countries where outdoor smoking is banned?
R. We have the example of Australia, where smoking outdoors is banned. Neither do some states in the United States, for example California. These are countries with extremely progressive tobacco policies. And this leads to a very low prevalence of consumption. But the effect arises from the measures taken as a whole, not from a single one. There must be comprehensive reform. It is a group of unified policies, with the price increase, the advertising ban, the uniform packaging, the equating of e-cigarettes with tobacco, which represent access to consumption by young people… This group contributes to reducing the prevalence.
Q Smoke-free rooms are always the most controversial measure.
R. Yes, there was the same discussion with the previous law. The measure introduced in 2011 was also said to have had a detrimental impact on the economy of the hospitality sector, but this was not the case. We have a policy evaluation study that showed this did not happen. The industry said there would be a shift in tobacco use to households, but it turns out that wasn't the case either. Now it's more of the same. During the pandemic, smoking was banned on the terraces of many autonomous communities, which did not stop people from going out. Everyone had an endless desire to go to bars. We are a company that uses bars and restaurants and we are not going to stop there because smoking is prohibited on the terraces.
Q They are about to publish a study on hotel workers' perceptions of tobacco regulations.
R. It was very strange because we conducted interviews with hotel employees on terraces that had an awning and more than two walls, terraces where, according to regulations, smoking was not allowed. We wanted to examine the use of these terraces by smokers and non-smokers, as well as workers' knowledge of the regulations. One of the results we have seen is that the terrace is considered a smoking area.
Q What does that mean?
R. Those of us who use the terraces assume that the people who smoke there have a right to do so. Although I can't complain about the neighbor's tobacco smoke bothering me.
Q Even in rooms where it is already forbidden.
R. Of course, the workers didn't even know the rules, they didn't know it was forbidden. The smoker's right takes precedence over the non-smoker's right, and it seems that people have assumed this. They received few complaints from customers who were bothered by the smoke and the solution they gave them was to go inside. Furthermore, they did not feel that there was a risk to their health or that of the people using this space.
Q How far do you think the ban on smoking outdoors should go?
R. The working group of the Spanish Society of Epidemiology, where I also work, asked us for a position. We believe that a fundamental point of the reform is that it should not extend exclusively to terraces, which, apart from cars, are the most controversial point, since it is a private space. We have proposed extending the offer to outdoor sports facilities, universities and smoke-free beaches. There is some experience with this last measure in certain autonomous communities where it works perfectly. The main problem there is the environmental pollution caused by cigarette butts.
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