concentration was an important factor in the analysis and found that it did not affect the study results.


Smoking Ban and Exposure Information

On January 10, 2005, Italy implemented a nationwide smoking ban in all indoor public places, including offices, retail shops, cafés, bars, restaurants, and discotheques. Smoking was not banned in private houses or specifically equipped public areas (for example, the law had requirements for exempted areas, including ventilation systems that create negative pressure and a requirement for doors) (Vasselli et al., 2008).

Although no exposure data are available on the specific populations, some general compliance and monitoring data are available from before and after implementation of the ban. Gallus et al. (2006) found that of 3,114 people ages 15 years or older who were surveyed in Italy, almost 90% perceived that the ban was observed in bars, and 70% had that perception for workplaces. As reported by Gorini et al. (2005) in a letter to a journal editor, the median concentration of nicotine in the vapor phase of samples from four pubs and three discotheques in Florence decreased to an average of 3.2% of the pre-ban median: from 138.9 μg/m3 (range, 33.0–276.5 μg/m3) to 4.5 μg/m3 (range, 1.7–8.7 μg/m3). Valente et al. (2007) measured fine and ultrafine particles in 40 establishments in Rome and urinary cotinine in nonsmoking employees of the establishments before and after implementation of the ban. The average concentration of PM2.5 particles (particles smaller than 2.5 μm in aerodynamic diameter) decreased from 119.3 μg/m3 before the ban to 38.2 μg/m3 (p < 0.005) 2–3 months after implementation and to 43.3 μg/m3 (p < 0.01) 11–12 months after implementation. The average concentration of ultrafine particles also decreased but to a smaller extent, from 76,956 particles/cm3 before the ban to 38,079 particles/cm3 (p < 0.0001) and 51,692 particles/cm3 (p < 0.01) 2–3 months and 11–12 months after implementation, respectively. Urinary cotinine in the employees decreased from an average of 17.8 ng/mL (95% CI, 14–21.6 ng/mL) before the ban to 5.5 ng/mL (95% CI, 3.8–7.2 ng/mL) and 3.7 ng/mL (95% CI, 1.8–5.6 ng/mL) 2–3 months and 11–12 months after implementation, respectively. Those data indicate that the smoking ban resulted in a decrease in exposure to secondhand smoke.

Published Results on Acute Coronary Events

Three publications report on acute coronary events after implementation of the Italian smoking ban (Barone-Adesi et al., 2006; Cesaroni et

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