Second-Hand Tobacco Smoke Exposure: Results of Particulate Matter (PM) Measurements at Hospitality Venues in Addis Ababa, Ethiopia

Introduction: In Ethiopia, a comprehensive smoke-free law that bans smoking in all public areas has been implemented since 2019. This study aimed to evaluate compliance with these laws by measuring the air quality and conducting covert observations at 154 hospitality venues (HVs) in Addis Ababa.

Methods: Indoor air quality was measured using Dylos air quality monitors during the peak hours of the venues, with concentrations of particulate matter <2.5 microns in diameter (PM) used as a marker of second-hand tobacco smoke. A standardized checklist was used to assess compliance with smoke-free laws during the same peak hours. The average PM concentrations were classified as good, moderate, unhealthy for sensitive groups, unhealthy for all, or hazardous using the World Health Organization's (WHO) standard air quality index breakpoints.

Results: Only 23.6% of the venues complied with all smoke-free laws indicators. Additionally, cigarette and shisha smoking were observed at the HVs. Overall, 63.9% (95% confidence interval: 56-72%) of the HVs had PM concentrations greater than 15 µg/m. The presence of more than one cigarette smoker in the venue, observing shisha equipment in the indoor space, and the sale of tobacco products in the indoor space were significantly associated with higher median PM concentration levels ( < 0.005). Hazardous level of PM concentrations-100 times greater than the WHO standard-were recorded at HVs where several people were smoking shisha and cigarettes.

Conclusions: Most HVs had PM concentrations that exceeded the WHO average air quality standard. Stricter enforcement of smoke-free laws is necessary, particularly for bars and nightclubs/lounges.