Five-Year Trends of Second-Hand Smoke Exposure in Greece: A Comparison Between Complete, Partial, and Prelegislation Levels

Background: Our aim was to assess second-hand smoke (SHS) exposure in hospitality venues after the smoke-free legislation implemented in September 2010 in Greece and to compare with when a partial ban was in place and in 2006 when no ban was in place. Methods: Hospitality venues were prospectively assessed for their indoor concentrations of particulate matter (PM2.5) during the partial ban phase (n = 149) and the complete ban phase (n = 120, 80% followed up), while overall and matched by venue comparisons were also performed (no ban vs. partial ban vs. complete ban). Comparisons with previously collected data in 2006 when no ban was in place also was performed. Results: Indoor air levels of PM2.5 attributable to SHS dropped following the transition from a partial to a complete ban by 34% (137 mu g/m(3) vs. 90 mu g/m(3), p = 0.003). This drop was larger in bars (from 195 mu g/m(3) to 121 mu g/m(3)), than in cafes (124 mu g/m(3) vs. 87 mu g/m(3)) or restaurants (42 mu g/m(3) vs. 39 mu g/m(3)). PM2.5 concentrations between 2006 (no ban) and the partial ban of 2010 were also found to decrease by 94 mu g/m(3); however, among matched venues, the levels of indoor air pollution were not found to change significantly (218 mu g/m(3) vs. 178 mu g/m(3), p = 0.58). Comparing the 2010 complete ban results (n = 120) with previously collected data from 2006 when no ban was in place (n = 43), overall PM2.5 concentrations were found to fall from 268 mu g/m(3) to 89 mu g/m(3), while a matched analysis found a significant reduction in PM2.5 concentrations (249 mu g/m(3) vs. 46 mu g/m(3), p = 0.011). Conclusion: The complete ban of smoking in hospitality venues in Greece led to a reduction in SHS exposure, in comparison to when the partial ban or no ban was in place; however, exposure to SHS was not eliminated indicating the need for stronger enforcement.