J Epidemiol Community Health 64:554-556 doi:10.1136/jech.2008.086256
  • Short report

Impact of tobacco control policies on exhaled carbon monoxide in non-smokers

  1. Isabella Annesi-Maesano1,2
  1. 1INSERM, Paris, France
  2. 2UPMC Univ Paris 06, Paris, France
  3. 3Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, England, UK
  4. 4Service de Pneumologie, Pitié-Salpêtrière, UPRES EA 2397, UPMC Univ Paris 06, OFT France
  1. Correspondence to Dr Isabella Annesi-Maesano, Epidemiology of Allergic and Respiratory Diseases Department (EPAR), UMR S 707 INSERM & UPMC Paris 6, Medicine's School Saint-Antoine, 27, rue Chaligny, 75571 Paris CEDEX 12, France; annesi-maesano{at}
  1. Contributors BD initiated the study, contributed to the design of the study and was responsible for data collection as president of French office for tobacco prevention (OFT). ST, JPP and IAM were responsible for data management and statistical analysis, plan of data and wrote the paper. BD and MJJ contributed to interpretation of findings. All authors provided critical comments to the paper and gave final approval of the version to be published.

  • Accepted 10 December 2009


Background Passive smoking is a serious health risk in non-smokers. The strength of tobacco control policies of the EU countries vary. This study aimed to investigate the relationship between secondhand smoke exposure, as assessed by exhaled carbon monoxide (eCO), and the strength of national tobacco control policies, in non-smokers in the EU.

Methods Data were provided from the EU campaign ‘HELP: for a life without tobacco’ during national events settled in the 27 EU countries in 2006–2007. Individual information on age, gender, and eCO was obtained from 58 919 self-reported non-smokers. The strength of national tobacco control policies was scored by the Tobacco Control Scale (TCS). The relationship between eCO and TCS score was investigated using ecological and multilevel approaches.

Results Both analyses reported a significant linear decrease in eCO per unit increase in TCS score, with a smaller estimation resulting from the multilevel analysis (β=−0.03 ppm, 95% CI −0.04 to −0.02 vs −0.05, −0.02 to −0.08).

Conclusion The present study confirms, in a large European non-smoker population, the relevance of strong antismoking policies in reducing exposure to passive smoking. The findings give further reason to encourage European countries to strengthen their tobacco control policies to protect non-smokers from secondhand smoke.


  • Funding BD manages the Office Français de Prévention du Tabagisme (OFT), a non-governmental organisation, that received partial funding from the European Union for this study.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.