dCOT2: Changes in the exposure to environmental tobacco smoke in adult population after the approbation of tobacco control laws

Changes in the exposure to environmental tobacco smoke in adult population after the entry into force the Law 28/2005 on health measures for tobacco control (dCOT2 Study)

[Information for the participants]


The exposure to environmental tobacco smoke (ETS) could occur in places of residence (at households of non-smokers), in workplaces, and other public and private places (e.g., recreation and leisure zones such as bars and restaurants). The level of population exposure to ETS derives from epidemiological studies that have used self-reported questionnaires. The prevalence of exposure to ETS among non-smokers varies considerably depending on the country, type of local regulations, and the place of exposure. In Spain, population surveys have not included the measurements of passive exposure until very recently.

Population exposure to ETS possibly have changed after the entry into force of the law on tobacco control health measures, as shown by some studies conducted via telephone interview. This law, that aims to protect non-smokers from ETS and its harmful effects on health, prohibits smoking in all public places and workplaces (unless they are outdoors) with exception for restaurant and hospitality industries until 2010 when the law was amended and smoking at these places was also banned since 2011.

Main objectives

To evaluate the impact of the Law 28/2005 and the Law 42/2010 on the adult non-smokers by comparing the exposure to environmental tobacco smoke in 2011 (reported and measured by saliva cotinine level) to the exposure before the implementation of the Laws (years 2004-2005).

To characterize the exposure to environmental tobacco smoke in a sub-sample of smokers (relationship between individual biomarkers of exposure, measurements of environmental exposure and self-perceived exposure retrieved using questionnaire).


Representative sample of the adult population (≥18 years) of the city of Barcelona. Variables: perceived exposure to environmental tobacco smoke (administered questionnaire) and objective measurement of saliva cotinine levels, during 2011-2012. It will be further compared to the similar sample from an earlier study (2004-2005). In a sub-sample of subjects hair and urine will be examined in order to measure cotinine, polycyclic aromatic hydrocarbons and nitrosamines as well as environmental samples will be obtained at households to measure nicotine, polycyclic aromatic hydrocarbons and nitrosamines.


2009-2011 (extended until 2012).

Financial Support

Grant PI081436 (56.265,00 €, in three annual payments) of the Health Research Fund of the Institute of Health Carlos III (European Regional Development Fund, ERDF).

Research Team

Main results


  1. Sureda X, Fernández E, Martínez-Sánchez JM, Fu M, López MJ, Martínez C, Saltó E. Secondhand smoke in outdoor settings: smokers’ consumption, non- smokers’ perceptions, and attitudes towards smoke-free legislation in Spain. BMJ Open. 2015;5(4):e007554.
  2. Pérez-Ortuño R, Martínez-Sánchez JM, Fernández E, Pascual JA. High-throughput wide dynamic range procedure for the simultaneous quantification of nicotine and cotinine in multiple biological matrices using hydrophilic interaction liquid chromatography-tandem mass spectrometry. Anal Bioanal Chem. 2015 407(28):8463-73.
  3. Sureda X, Martínez-Sánchez JM, Fu M, Pérez-Ortuño R, Martínez C, Carabasa E, López MJ, Saltó E, Pascual JA, Fernández E. Impact of the Spanish smoke-free legislation on adult, non-smoker exposure to secondhand smoke: cross-sectional surveys before (2004) and after (2012) legislation. PLoS One. 2014;9(2):e89430.
  4. Martínez-Sánchez JM, Sureda X, Fu M, Pérez-Ortuño R, Ballbè M, López MJ, Saltó E, Pascual JA, Fernández E. Secondhand smoke exposure at home: assessment by biomarkers and airborne markers. Environ Res. 2014;133:111-6.
  5. Ballbè M, Martínez-Sánchez JM, Sureda X, Fu M, Pérez-Ortuño R, Pascual JA, Saltó E, Fernández E. Cigarettes vs. e-cigarettes: Passive exposure at home measured by means of airborne marker and biomarkers. Environ Res. 2014;135:76-80.
  6. Fu M, Martínez-Sánchez JM, Sureda X, Martínez C, Ballbè M, Baranda L, Riccobene A, Fernández E. Handwritten versus scanned signature on the invitation letter: does it make any difference in participation in a population-based study? Eur J Epidemiol. 2013 Nov;28(11):931-4.


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