The effect of environmental factors on precocious puberty in children: a case-control study.

BACKGROUND: Recently the prevalence of precocious puberty development is increasing among Chinese children. Proper understanding of the risk factors for precocious puberty in children is pivotal as could help to improve children's health. This study aims to evaluate the effect of environmental factors on precocious puberty in children. METHODS: We matched the cases and controls by age at the ratio of 1:1 (201 cases and 201 controls) for girls and 1:4 (24 cases and 96 controls) for boys. We used conditional logistic regression to explore the effect of environmental factors on precocious puberty, and a random forest model to identify the most important risk factor. RESULTS: In the multivariate regression, cesarean section (OR = 1.99, 95% CI: 1.05, 3.76), child body mass index [BMI] (OR = 1.25, 95% CI: 1.10, 1.43), maternal BMI (OR = 1.13, 95%CI: 1.01, 1.26), and exposure to secondhand smoke several times a month but less than once a week (OR = 4.09, 95%CI: 1.79,9.35), and almost every day (OR = 6.48, 95% CI: 2.14, 19.56) were risk factors for precocious puberty in girls. While maternal height (OR = 0.82, 95% CI: 0.75, 0.88), paternal height (OR = 0.91, 95% CI: 0.85, 0.98), bedtime at night (OR = 0.30, 95% CI: 0.17, 0.51), and night sleep (OR = 0.43, 95% CI: 0.21, 0.86) were protective factors. In boys, only exposure to secondhand smoke several times a month but less than once a week (OR = 7.94, 95% CI: 1.25, 50.33) was a risk factor for precocious puberty. In the random forest model, Child BMI was the most important risk factor for precocious puberty in girls. CONCLUSIONS: Our findings suggest that environmental factors were associated with precocious puberty in children, particularly in girls.

Second-hand smoke and fine particulate matter exposures among multi-unit housing residents in Singapore: A pilot study.

Globally, approximately 1.2 million deaths among non-smokers are attributed to second-hand smoke (SHS) per year. Multi-unit housing is becoming the common type of residential dwelling in developed cities and the issue of neighbour SHS is of rising concern especially as 'Work From Home' became the norm during and post COVID-19 pandemic. The objective of this pilot study is to measure and compare the air quality of households that are exposed to SHS and unexposed households among smoking and non-smoking households in Singapore. A total of 27 households were recruited from April to August 2021. Households were categorized into smoking households with neighbour SHS, smoking households without neighbour SHS, non-smoking households with neighbour SHS, and non-smoking household without neighbour SHS. Air quality of the households was measured using calibrated particulate matter (PM2.5) sensors for 7-16 days. Socio-demographic information and self-reported respiratory health were collected. Regression models were used to identify predictors associated with household PM2.5 concentrations and respiratory health. Mean PM2.5 concentration was significantly higher among non-smoking households with neighbour SHS (n = 5, mean = 22.2, IQR = 12.7) than in non-smoking household without neighbour SHS (n = 2, mean = 4.1, IQR = 5.8). Smoking activity at enclosed areas in homes had the lowest PM2.5 concentration (n = 7 mean = 15.9, IQR = 11.0) among the three smoking locations. Exposure to higher household PM2.5 concentration was found to be associated with poorer respiratory health. A 'smoke-free residential building' policy is recommended to tackle the issue of rising neighbour SHS complaints and health concerns in densely populated multi-unit housing in Singapore. Public education campaigns should encourage smokers to smoke away from the home to minimize SHS exposure in household members.

Investigating the epidemiological and economic effects of a third-party certification policy for restaurants with COVID-19 prevention measures.

This study investigates the effects of a third-party certification policy for restaurants (including bars) that comply with indoor infection-prevention measures on COVID-19 cases and economic activities. We focus on the case of Yamanashi Prefecture in Japan, which introduced a third-party certification policy that accredits facilities, predominantly restaurants, that comply with the designated guidelines. We employ a difference-in-differences design for each of our epidemiological and economic analyses. The estimation results show that, from July 2020 to April 2021, the certification policy reduced the total number of new infection cases by approximately 45.3% (848 cases), while increasing total sales and the number of customers per restaurant by approximately 12.8% (3.21 million Japanese yen or $30,000) and 30.3% (2909 customers), respectively, compared to the non-intervention scenarios. The results suggest that a third-party certification policy can be an effective policy to mitigate the trade-off between economic activities and infection prevention during a pandemic, especially when effective vaccines are not widely available.

The Association of Tobacco Smoking, Second-hand Smoke, and Novel Tobacco Products With COVID-19 Severity and Mortality in Italy: Results From the COSMO-IT Study.

BACKGROUND: Despite the robust evidence of an excess risk of coronavirus disease 2019 (COVID-19) severity and mortality in ever smokers, the debate on the role of current and ex-smokers on COVID-19 progression remains open. Limited or no data are available on the link between electronic cigarette (e-cigarette), heated tobacco product (HTP) and second-hand smoke (SHS) exposure and COVID-19 progression. To fill this knowledge gap, we undertook the COvid19 and SMOking in ITaly (COSMO-IT) study. METHODS: A multi-centre longitudinal study was conducted in 2020-2021 in 24 Italian hospitals on a total of 1,820 laboratory-confirmed COVID-19 patients. We estimated multivariable odds ratios (OR) and 95% confidence intervals (CI) to quantify the association between smoking-related behaviours (ie, smoking status, e-cigarette and HTP use, and SHS exposure) and COVID-19 severity (composite outcome: intubation, intensive care unit admission and death) and mortality. RESULTS: Compared to never smokers, current smokers had an increased risk of COVID-19 mortality (OR 2.17; 95% CI, 1.06-4.41). E-cigarette use was non-significantly associated to an increased risk of COVID-19 severity (OR 1.60; 95% CI, 0.96-2.67). An increased risk of mortality was observed for exposure to SHS among non-smokers (OR 1.67; 95% CI, 1.04-2.68), the risk being particularly evident for exposures of ≥6 hours/day (OR 1.99; 95% CI, 1.15-3.44). CONCLUSION: This multicentric study from Italy shows a dismal COVID-19 progression in current smokers and, for the first time, in SHS exposed non-smokers. These data represent an additional reason to strengthen and enforce effective tobacco control measures and to support smokers in quitting.

Smoke-free homes in Poland during the COVID-19 pandemic - a nationwide cross-sectional survey.

OBJECTIVES: Secondhand smoke exposure causes serious health problems. Banning smoking in public venues decreases exposure to secondhand smoke. However, the implementation of smoke-free rules in a private setting (including homes) is largely voluntary. This study aimed to assess the prevalence and characteristics of voluntary smoke-free home rules in Poland during the COVID-19 pandemic as well as to identify factors associated with the voluntary implementation of smoking bans at home. MATERIAL AND METHODS: This cross-sectional survey was conducted in March 2022 with a nationally representative sample of 1090 individuals aged ≥18 years in Poland. Data were collected using a computerassisted web interviewing (CAWI) technique. The research tool was an original questionnaire developed for the purpose of this study. RESULTS: Nationally, 60.6% of individuals had total ban on smoking in home (100% smoke-free home rules), 34.0% had implemented a partial smokefree home rule and 5.4% had not implemented any smoke-free home rules. Over three-quarters of non-smokers (76.8%) and only one-fifth of smokers (20.7%) had adopted a full smoke-free home rule. In multivariate logistic regression analysis, males (OR = 1.65, 95% CI: 1.22-2.22, p < 0.01), non-smokers (OR = 13.78, 95% CI: 9.80-19.38, p < 0.001), respondents who had higher education (OR = 1.57, 95% CI: 1.15-2.14, p < 0.01) as well as those who lived alone (OR = 2.44, 95% CI: 1.52-3.90, p < 0.001) had higher odds of having a 100% smoke-free home rule. CONCLUSIONS: This study demonstrated the negative impact of the COVID-19 pandemic on the implementation of smoke-free home rules in Poland. Less than two-thirds of the Polish population has adopted a total smoke-free home rule, with significant gaps between smokers and nonsmokers. Information on current voluntary smoke-free rules will be useful for further implementation of the smoke-free law in Poland. Int J Occup Med Environ Health. 2023;36(1):84-95.

Eastern Mediterranean Health Journal [2022; Vol.28, Issue 11]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region.

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région.

SARS-CoV-2 suppression and early closure of bars and restaurants: a longitudinal natural experiment.

Despite severe economic damage, full-service restaurants and bars have been closed in hopes of suppressing the spread of SARS-CoV-2 worldwide. This paper explores whether the early closure of restaurants and bars in February 2021 reduced symptoms of SARS-CoV-2 in Japan. Using a large-scale nationally representative longitudinal survey, we found that the early closure of restaurants and bars decreased the utilization rate among young persons (OR 0.688; CI95 0.515-0.918) and those who visited these places before the pandemic (OR 0.754; CI95 0.594-0.957). However, symptoms of SARS-CoV-2 did not decrease in these active and high-risk subpopulations. Among the more inactive and low-risk subpopulations, such as elderly persons, no discernible impacts are observed in both the utilization of restaurants and bars and the symptoms of SARS-CoV-2. These results suggest that the early closure of restaurants and bars without any other concurrent measures does not contribute to the suppression of SARS-CoV-2.

Residential secondhand smoke in a densely populated urban setting: a qualitative exploration of psychosocial impacts, views and experiences.

BACKGROUND: People remain exposed to secondhand smoke, a serious health hazard, inside their home as households face challenges in setting no-smoking rules or are exposed to secondhand smoke drifting in from neighbouring homes. This study explores the psychosocial impacts, views, and experiences with residential secondhand smoke in a densely populated urban setting.  METHODS: In-depth online or face to face interviews with 18 key informants who had been involved in public discourse, policy, advocacy or handling complaints related to residential secondhand smoke, 14 smokers, and 16 non-smokers exposed to secondhand smoke inside their home. All participants were residents of Singapore, a densely populated, multi-ethnic city-state. Interview transcripts were coded in NVivo using a deductive and inductive coding process. FINDINGS: Secondhand smoke has wide-reaching impacts on physical and psychosocial wellbeing, even if smokers tried to minimise secondhand smoke. Feelings of anxiety and stress are generally tied to feeling discomfort in one's personal space, a perceived lack of control over the situation, resentment towards smokers, and concerns over the health effects. Family, community, and cultural dynamics add complexities to tackling the issue, especially in patriarchal households. Secondhand smoke exposure from neighbours is considered a widespread issue, exacerbated by structural factors such as building layout and the COVID-19 pandemic. Resolving the issue amicably is considered challenging due to the absence of regulations and a reluctance to stir up conflict with neighbours. While smokers took measures to reduce secondhand smoke, these were described as ineffective by other participants. Smokers appeared to have contrasting views from other participants on what it means to smoke in a socially responsible manner. CONCLUSION: Given the wide-reaching psychosocial impacts of residential secondhand smoke, there is a case for stronger interventions, especially in densely populated urban settings where it is more difficult to avoid.

Men smoke less under the COVID-19 closure policies: The role of altruism.

This study examines whether people smoked more under the Coronavirus Disease 2019 (COVID-19) closure policies which trapped them at home with their families. In such circumstances, the pleasure from smoking could be more tempting than usual, but at the same time smokers' families are more likely to be victims of passive smoking. This study uses temporal and regional variations in policy strengths with data from the Oxford COVID-19 Government Response Tracker project (OxCGRT) to examine the impact of COVID-19 closure policies on smoking behaviors. With longitudinal data from the China Family Panel Studies (CFPS) in 2018 and 2020, we find diminished smoking behaviors among Chinese male adults when the government implemented strict public health policies for the COVID-19 pandemic. People with more conscientiousness personality traits or stronger pro-family attitudes tend to smoke less as policy stringency increases.

[Epidemiologic evidence on the role of hospitality venues in the transmission of COVID-19: A rapid review of the literature]. / Evidencia epidemiológica acerca del rol de la hostelería en la transmisión de la COVID-19: una revisión rápida de la literatura.

OBJECTIVE: To review the scientific epidemiologic evidence on the role of hospitality venues in the incidence or mortality from COVID-19. METHOD: We included studies conducted in any population, describing either the impact of the closure or reopening of hospitality venues, or exposure to these venues, on the incidence or mortality from COVID-19. We used a snowball sampling approach with backward and forward citation search along with co-citations. RESULTS: We found 20 articles examining the role of hospitality venues in the epidemiology of COVID-19. Modeling studies showed that interventions reducing social contacts in indoor venues can reduce COVID-19 transmission. Studies using statistical models showed similar results, including that the closure of hospitality venues is amongst the most effective measures in reducing incidence or mortality. Case studies highlighted the role of hospitality venues in generating super-spreading events, along with the importance of airflow and ventilation inside these venues. CONCLUSIONS: We found consistent results across studies showing that the closure of hospitality venues is amongst the most effective measures to reduce the impact of COVID-19. We also found support for measures limiting capacity and improving ventilation to consider during the re-opening of these venues.

Eastern Mediterranean Health Journal [2022; Vol.28, Issue 5]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région.

Securing Smokefree Laws Covering Casinos and Bars in Louisiana via Messaging, Continuous Campaigning and Health Coalitions.

In this paper, we examine efforts by health organizations seeking comprehensive smokefree ordinances over Louisiana casinos and bars between 2010 and 2020 to determine best practices for increasing coverage. Bars and casinos remain less protected from secondhand smoke compared to other workplaces in the United States. Casino behavior is compared to the Policy Dystopia Model (PDM), a tobacco industry strategy framework. We performed a historical case study using snowball searches for news on the Access World News Database and the internet. We performed web searches using the names of key actors, organizations, and locations and interviewed nine participants. Starting in 2010, the Louisiana Campaign for Tobacco-Free Living ran ordinance campaigns supplemented by an ongoing statewide smokefree media initiative. Utilizing consistent strategies, including promoting performers as cultural emblems deserving protection, health organizations coalesced in New Orleans during 2014 and Baton Rouge in 2016 and 2017 to pursue ordinances. The coalitions secured ordinances in Louisiana's population and tourism centers despite business resistance. Organizations obtained 30 smokefree laws across Louisiana by 2021. Casinos used PDM strategies to resist ordinances, indicating the framework may predict strategies by non-tobacco entities resisting tobacco control. Louisiana shows that ongoing local campaigns, social justice themes and cultural messaging with coalitions in cities can secure smokefree laws covering casinos and bars and that local ordinance campaigns are a viable method for advancing smokefree protections over those venues in states where the state legislatures are resistant to action.

Association Between Passive Smoking and Health Among Chinese Nurses: A Cross-Sectional Study.

This study aimed to investigate the association between passive smoking and physical and psychological health in Chinese nurses. Participants of this cross-sectional study comprised 2,484 non-smoking nurses. Passive smoking and demographic information were assessed using a self-administered questionnaire. Physical, psychological, and overall health status of nurses were measured using the Cornell Medical Index (CMI) health questionnaire. Multivariate-adjusted odds ratio (OR) and 95% confidence interval (CI) for nurses' health were estimated by exposure to passive smoking using unconditional logistic regression models. A total of 1,219 nurses (49.07%) were exposed to passive smoking. Of these, 609 (24.52%), 160 (6.44%), and 587 (23.63%) nurses had poorer physical, mental, and overall health, respectively. After adjusting for other confounding factors, compared with the non-passive smoking group, passive smoking was associated with poor physical (OR = 1.51, 95% CI: 1.25-1.83), mental (OR = 1.48, 95% CI: 1.07-2.07), and overall (OR = 1.58, 95% CI: 1.30-1.93) health of nurses, respectively. We also carried out subgroup analyses stratified by age, department, and professional title, which showed that most findings supported the main results. This study demonstrated that exposure to passive smoking was a risk factor for overall decreased physical and mental health status among Chinese nurses.

Maternal Secondhand Smoke Exposure Enhances Macrosomia Risk Among Pregnant Women Exposed to PM2.5: A New Interaction of Two Air Pollutants in a Nationwide Cohort.

Background: Fine particulate matter (PM2.5) is one of the most common outdoor air pollutants, and secondhand smoking (SHS) is an important source of inhalable indoor air pollution. Previous studies were controversial and inconsistent about PM2.5 and SHS air pollutants on neonatal birth weight outcomes, and no studies assessed the potential interactive effects between PM2.5 and SHS on birth weight outcomes. Purpose: To investigate the interaction between gestational PM2.5 and SHS air pollution exposure on the risk of macrosomia among pregnant women and examine the modifying effect of SHS exposure on the association of PM2.5 air pollution and birth weight outcomes during pregnancy. Methods: Research data were derived from the National Free Preconception Health Examination Project (NFPHEP), which lasted 3 years from January 1, 2010, to December 31, 2012. At least 240,000 Chinese women from 220 counties were enrolled in this project. PM2.5 exposure concentration was obtained using a hindcast model specific for historical PM2.5 estimation from satellite-retrieved aerosol optic depth. Different interaction models about air pollution exposure on birth weight outcomes were established, according to the adjustment of different confounding factors and different pregnancy stages. The establishment of interaction models was based on multivariable logistic regression, and the main confounding factors were maternal age at delivery and pre-pregnancy body mass index (BMI) of participants. SHS subgroups analysis was conducted to further confirm the results of interaction models. Results: In total, 197,877 participants were included in our study. In the full-adjusted interaction model, maternal exposure to PM2.5 was associated with an increased risk of macrosomia in whole, the first-, second-, and third trimesters of pregnancy (p < 0.001). The interactive effect was statistically significant between maternal exposure to PM2.5 and SHS on the risk of macrosomia in the whole (interaction p < 0.050) and the first-trimester pregnancy (interaction p < 0.050), not in the second (interaction p > 0.050) or third trimester (interaction p > 0.050) of pregnancy. The higher frequency of SHS exposure prompted the stronger interaction between the two air pollutants in the whole pregnancy and the first-trimester pregnancy. Conclusions: In the whole and first-trimester pregnancy, maternal exposure to SHS during pregnancy enhanced the risk of macrosomia among pregnant women exposed to PM2.5 air pollutants, and the interaction became stronger with the higher frequency of SHS exposure.

Parental Knowledge, Attitude, and Practice on Tobacco Use, Smoking Cessation, and Children's Environmental Tobacco Smoke Exposure.

Background: Environmental tobacco smoke (ETS) exposure in children ranks one of the major public health problems in our time. Poor parental knowledge, attitude, and practice (KAP) on ETS often contribute to worse exposure of the kids. Thus, we aimed to document parental KAP regarding tobacco use, smoking cessation and children's ETS exposure, and to analyse how knowledge and attitude relate to practice. Methods: Self-administered KAP questionnaires were distributed to smoking parents recruited from the pediatric unit at the Prince of Wales Hospital, which provides pediatric service to a population of 1.2 million in Hong Kong. The 60-item questionnaire had a range of 0-38 for knowledge, 0-44 for attitude, and 0-40 for practice. Descriptive analyses were performed for KAP response, regression analyses were performed for the exploration of associations and identification of predictive indicators. Results: 145 smoking parents (mean age: 38.0 ± 6.7 yrs.; male: 85.5%) were included. Less than half (39.3%) of them reported a smoke-free policy at home. Among those parents who had private cars, less than half (45.2%) of them had smoke-free policy in their car that they never smoked in the car. Only 25.5% of the participants correctly answered ≥70% of the knowledge questions, and 11.8 % of the participants gave favorable responses to ≥70% of the attitude questions. The total knowledge and the total attitudes score were positively associated (r = 0.49, 95% CI: 0.35-0.79, p < 0.001), yet they were only modestly correlated with parental practice on children's ETS exposure. By multivariate regressions, potential predictive factors for more favorable parental KAP included higher household income, lower parental nicotine dependence level and breastfeeding practice. Conclusions: Parental KAP related to tobacco use and children's ETS exposure needs improvement to address the significant gap between recommended and actual practice. The weak association between knowledge and practice suggested that parental education alone is not adequate to combat ETS exposure in children.

Impact of workplace smoke-free policy on secondhand smoke exposure from cigarettes and exposure to secondhand heated tobacco product aerosol during COVID-19 pandemic in Japan: the JACSIS 2020 study.

OBJECTIVES: Promoting smoke-free policies is a key intervention for reducing secondhand smoke (SHS) exposure. During the COVID-19 pandemic in Japan, many indoor smoking spaces in workplaces were closed. This study aimed to reveal the association between a workplace smoke-free policy and SHS exposure among non-smoking employees, distinguishing between SHS exposure from cigarettes and exposure to secondhand heated tobacco product (HTP) aerosol, which have recently become popular in Japan. DESIGN AND SETTING: We used data from the Japan COVID-19 and Society Internet Survey conducted in August-September 2020. PARTICIPANTS: Among the 25 482 eligible respondents, 8196 non-smoking employees were analysed. PRIMARY OUTCOME MEASURE: Multivariable logistic regression models were used to examine the impact of smoke-free policies in the workplace. RESULTS: Compared with complete smoking bans, the ORs and 95% CIs for workplace SHS exposure at least once a week from cigarettes were 2.06 (95% CI: 1.60 to 2.65) for partial bans with no longer available smoking spaces, 1.92 (95% CI: 1.63 to 2.25) for partial smoking bans with still available smoking spaces and 5.33 (95% CI: 4.10 to 6.93) for no smoking bans. The corresponding ORs and 95% CIs for exposure to secondhand HTP aerosol were 4.15 (95% CI: 3.22 to 5.34), 2.24 (95% CI: 1.86 to 2.71) and 3.88 (95% CI: 2.86 to 5.26), respectively. CONCLUSIONS: The effect of partial bans was limited, and temporary closure of smoking spaces might contribute to increased exposure to secondhand HTP aerosol. Complete smoking bans in the workplace were reaffirmed to be the best way to reduce SHS exposure from cigarettes and exposure to secondhand HTP aerosol.