Secondhand smoke in Pennsylvania casinos: a study of nonsmokers' exposure, dose, and risk

Am J Public Health. 2009 Aug;99(8):1478-85. doi: 10.2105/AJPH.2008.146241. Epub 2009 Jun 18.


Objectives: I assessed air pollution, ventilation, and nonsmokers' risk from secondhand smoke (SHS) in Pennsylvania casinos exempted from a statewide smoke-free workplace law.

Methods: I measured respirable suspended particles (RSPs), particulate polycyclic aromatic hydrocarbons (PPAHs), and carbon dioxide inside and outside casinos; measured changes in patrons' urine cotinine after casino visits; and assessed SHS impact on workers and patrons, using exposure-response models, air quality standards, and odor and irritation thresholds.

Results: PPAH and RSP concentrations in casinos were, on average, 4 and 6 times, respectively, that of outdoor levels despite generous ventilation and low smoking prevalence. SHS infiltrated into nonsmoking gaming areas. Patrons' urine cotinine increased 1.9 ng/mL on average after about 4-hour visits.

Conclusions: SHS-induced heart disease and lung cancer will cause an estimated 6 Pennsylvania casino workers' deaths annually per 10,000 at risk, 5-fold the death rate from Pennsylvania mining disasters. Casinos should not be exempt from smoke-free workplace laws.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Air Pollution, Indoor / statistics & numerical data*
  • Cotinine / urine
  • Humans
  • Models, Statistical
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / mortality
  • Pennsylvania / epidemiology
  • Polycyclic Aromatic Hydrocarbons / urine
  • Prevalence
  • Tobacco Smoke Pollution / statistics & numerical data*
  • Ventilation / statistics & numerical data
  • Workplace / statistics & numerical data*


  • Polycyclic Aromatic Hydrocarbons
  • Tobacco Smoke Pollution
  • Cotinine