Exposure to secondhand smoke and excess lung cancer mortality risk among workers in the "5 B's": bars, bowling alleys, billiard halls, betting establishments, and bingo parlours

Objective: To review existing data on exposure to secondhand smoke in bars, bowling alleys, billiard halls, betting establishments, and bingo parlours (the "5 B's") as assessed by ambient nicotine air concentration measurements and to estimate the excess lung cancer mortality risk associated with this exposure. Data sources: Using the Medline, Toxline, and Toxnet databases, the internet, and bibliographies of relevant articles, we identified studies that reported measurements of ambient nicotine concentrations in the 5 B's. Study selection: Studies were included if they reported a mean concentration of ambient nicotine measured in at least one of the 5 B's. Data extraction: We calculated a weighted average of nicotine concentrations in each of the 5 B's. We then estimated the working lifetime excess lung cancer mortality risk associated with this exposure, as well as with exposure at the upper and lower limits of the range of mean exposures reported in all of the studies in each establishment category. Data synthesis: Nicotine concentrations in the 5 B's were 2.4 to 18.5 times higher than in offices or residences, and 1.5 to 11.7 times higher than in restaurants. At these exposure levels, estimated working lifetime excess lung cancer mortality risk from secondhand smoke exposure for workers in the 5 B's is between 1.0-4.1/1000, which greatly exceeds the typical de manifestis risk level of 0.3/1000. Conclusions: Workers in the 5 B's have high levels of occupational exposure to secondhand smoke and must be included in workplace smoking regulations.