Secondhand smoke in hospitals of Catalonia (Spain) before and after a comprehensive ban on smoking at the national level Esteve Fernández a,b,c, ⁎, Marcela Fu a,b,c , Cristina Martínez a,b , Jose M. Martínez-Sánchez a,d , María J. López e,f,g , Anna Martín-Pujol a,b , Francesc Centrich f,h , Glòria Muñoz h , Manel Nebot d,e,f , Esteve Saltó b,i,j a Tobacco Control and Research Unit, Cancer Prevention and Control Department, Institut Català d'Oncologia-IDIBELL; L'Hospitalet de Llobregat, Spain b Catalan Network for Smoke-free Hospitals; L'Hospitalet de Llobregat, Spain c Department of Clinical Sciences, Campus of Bellvitge, Universitat de Barcelona; L'Hospitalet de Llobregat, Spain d Department of Experimental and Health Sciences, Universitat Pompeu Fabra; Barcelona, Spain e Evaluation and Intervention Methods Unit, Agència de Salut Pública de Barcelona; Barcelona, Spain f CIBER Epidemiología y Salud Pública (CIBERESP); Spain g Program in Public Health and Methodology of Research, Universitat Autònoma de Barcelona; Bellaterra, Spain h Laboratory of Public Health, Agència de Salut Pública de Barcelona; Barcelona, Spain i Public Health Department, Ministry of Health, Generalitat de Catalunya; Barcelona, Spain j Department of Public Health, Universitat de Barcelona; Barcelona, Spain abstract article info Available online 19 September 2008 Keywords: Passive smoking Tobacco smoke pollution Environmental tobacco smoke Airborne nicotine Hospitals Smoking ban Objective. To assess changes in secondhand smoke exposure by means of airborne nicotine concentrations in public hospitals of Catalonia (Spain) before and after a comprehensive national smoking ban. Methods. We monitored vapor-phase nicotine concentrations in 44 public hospitals in Catalonia (Spain) before the smoking ban (September–December 2005) and one year after (September–December 2006). We installed 5–7 sampling devices per hospital for 7 days in different places (228 pairs of samples), and 198 pairs of samples were available for the final analysis. Results. The median nicotine concentration declined from 0.23 μg/m 3 (interquartile range: 0.13–0.63) before the law to 0.10 μg/m 3 (interquartile range: 0.02–0.19) after the law (% decline =56.5, p b 0.01). We observed significant reductions in the median nicotine concentrations in all hospital locations, although secondhand smoke exposure was still present in some places (main hospital entrance, emergency department waiting rooms, fire escapes, and cafeterias). Conclusions. Secondhand smoke in hospitals has decreased after the ban. Assessment of airborne nicotine concentrations appears to be an objective and feasible system to monitor and reinforce the compliance of smoke-free legislations in this setting. © 2008 Elsevier Inc. All rights reserved. Introduction On January 1st 2006, Spain was the seventh European country after Finland, Ireland, Norway, Malta, Italy and Sweden that enacted a comprehensive regulation to prevent and control smoking. Smoking is banned in all indoor public workplaces, public transport, hospitality venues (with some exceptions), schools and universities, retail stores and shopping centers, as well as hospitals and other health care facilities (Fernandez, 2006). Although smoking in hospitals was already partially banned by previous regional and national laws, there was in fact a scarce fulfillment. Some hospitals opted to be smoke-free on their own initiative or in coordinated efforts such as the European Network for Smoke-free Hospitals and national networks (Fiore and Jorenby, 1992; Garcia et al., 2006). Beside some flaws of the new Spanish law regarding restaurants, bars and pubs (Fernandez, 2006; Toledo, 2006), smoking is now totally banned in any location within hospitals and health care buildings, eliminating smoking rooms, smokers' cafeterias and smokers' areas within cafeterias. Since 2000, in Catalonia (Spain), the Catalan Network for Smoke-free Hospitals has granted practical guidance on implementing comprehensive tobacco control policies to the hospitals voluntarily affiliated to the Network (Mendez et al., 2004; O'Riordan, 2005) and provides continuous counseling to become a smoke-free hospital. The main areas of action concern ensuring the compliance of the norm, providing tobacco control training, designing and applying cessation programs addressed to professionals, patients and visitors, and guaranteeing common follow-up and evaluation (Garcia et al., 2006; Martinez et al., 2008). Preventive Medicine 47 (2008) 624–628 ⁎ Corresponding author. Tobacco Control and Research Unit, Cancer Prevention and Control Department, Institut Català d'Oncologia, Av Gran Via s/n Km 2.7 08907 L'Hospitalet de Llobregat (Barcelona), Spain. Fax: +34 93 2607956. E-mail address: efernandez@ico.scs.es (E. Fernández). 0091-7435/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2008.09.003 Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed