Secondhand Smoke Concentrations in Hospitality Venues in the Pacific Basin: Findings from American Samoa, Commonwealth of the Northern Mariana Islands, and Guam

Introduction: Secondhand smoke (SHS) from burning tobacco products causes disease and premature death among nonsmokers. Although the number of laws prohibiting smoking in indoor public places continues to increase, millions of nonsmokers in the United States (US) and its territories remain exposed to SHS. This study assessed indoor air pollution from SHS in hospitality venues in three US Pacific Basin territories. Methods: Air monitors were used to assess $PM_{2.5}$, an environmental marker for SHS, in 19 smoke-permitted and 18 smoke-free bars and restaurants in American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), and Guam. Observational logs were used to record smoking and other sources of air pollution. Differences in average $PM_{2.5}$ concentrations were determined using bivariate statistics. Results: The average $PM_{2.5}$ level in venues where smoking was always permitted [arithmetic mean (AM)=$299.98{\mu}g/m^3$; geometric mean (GM)=$200.39{\mu}g/m^3$] was significantly higher (p<0.001) than smoke-free venues [AM=$8.33{\mu}g/m^3$; GM=$6.14{\mu}g/m^3$]. In venues where smoking was allowed only during certain times, the average level outside these times [AM=$42.10{\mu}g/m^3$; GM=$41.87{\mu}g/m^3$] was also significantly higher (p<0.001) than smoke-free venues. Conclusions: Employees and patrons of smoke-permitted bars and restaurants are exposed to dangerous levels of air pollution from SHS, even during periods when active smoking is not occurring. Prohibiting smoking in all public indoor areas, irrespective of the venue type or time of day, is the only way to fully protect nonsmokers from SHS exposure in these environments.