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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of PM<span class="elsevierStyleInf">2&#46;5</span> concentration &#40;&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41;<span class="elsevierStyleItalic">&#44;</span> on a logarithmic scale<span class="elsevierStyleItalic">&#44;</span> by type of venue compared to baseline street levels&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A national comprehensive smoke-free legislation came into force in Chile in 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It banned smoking in all enclosed and semi-enclosed areas of all workplaces and public places&#44; including the hospitality sector&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The enforcement efforts during the year following the entry into force of the current smoke-free legislation led to a high compliance with the law&#44; overall and in the hospitality sector&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> which was associated with a sudden and significant decline of myocardial infarction in 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> These efforts included a surge of inspections in 17&#44;406 of the approximately 40&#44;000 existing venues in the hospitality sector in the country&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Presently enforcement efforts in Chile are fading&#46; By 2016&#44; last year for which governmental enforcement information is available&#44; smoke-free law inspections in hospitality venues were cut in half &#40;8196&#41; while the number of annual public health control activities was in that year similar to that of 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Moreover&#44; the WHO reported that&#44; compared to 2014&#44; the compliance with the smoke-free law in the hospitality sector in 2018 remained substantial but had declined&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> These data raise questions about how enforcement of the Chilean smoke-free law can be improved&#46; This paper draws attention to how using a simple and low-cost surveillance inquiry may help focus the use of scarce inspection resources to improve compliance with the law in the hospitality sector&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Approach</span><p id="par0020" class="elsevierStylePara elsevierViewall">We suspected that there remained significant pockets of noncompliant places in the hospitality sector&#44; where venues are expected to be less compliant&#44; based on previous international evidence&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Within the hospitality sector&#44; we assumed that the venues most likely to be non-compliant would be those catering to young adults and operating outside regular office hours in which inspectors are much less likely to conduct routine inspections&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional exposure assessment of night entertainment venues in two well-known areas of concentration of this commercial activity in the Greater Santiago&#44; Chile&#44; in November 2018&#46; Eligible venues were establishments making their revenue mostly from the sale of beverages&#44; including alcoholic drinks&#44; although customers may also consume small dishes and appetizers&#46; Venues included bars&#44; pubs&#44; cabarets&#44; night-clubs&#44; and discos&#44; opened at least between 00&#58;00 and 3&#58;00 on Fridays&#44; Saturdays&#44; and Sundays&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To identify potential participating venues&#44; a sampling frame of establishments was constructed&#44; based on information provided by students of our university or available on the internet&#46; We listed a total of 128 potential venues&#44; of which we selected randomly 30&#46; In each selected venue&#44; we measured levels of respirable particles &#8804;2&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;m in diameter &#40;PM<span class="elsevierStyleInf">2&#46;5</span>&#41;&#44; a well-established marker of tobacco smoke&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> We used three TSI SidePak AM510 Personal Aerosol Monitors&#44; hand-held optical instruments that monitor particle size and mass concentration in real-time&#46; They were set to a one-second sampling interval&#46; The three monitors were previously calibrated in an experiment with a gravimetric BAM-1020 instrument that measures and records airborne particulate concentration levels using the principle of beta-ray attenuation&#46; The calibration factors derived from the experiments were 0&#46;37&#44; 0&#46;39&#44; and 0&#46;39 for each of the monitors&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Six trained observers entered incognito each venue in pairs and sampled the air for at least 30<span class="elsevierStyleHsp" style=""></span>minutes&#44; moving discreetly around the public areas of the establishment&#44; avoiding getting too close to active sources of particulate matter&#44; such as people actively smoking or kitchen entrances if there were any&#46; Observers recorded if there was any tobacco smoking at the time of the visit&#46; The total number of smokers could not be recorded&#44; given that many venues were very dimly lighted&#44; and not all areas of the venues could be visited without being noticed or causing security concerns&#46; Only the data from 25 of the 30 selected venues are reported because the data from four venues were not logged-in appropriately&#44; and the data from one was discarded since the air was contaminated with stage fog&#44; which raised the level of particulate matter spuriously&#46; The air from streets surrounding each of the venues was also sampled concurrently for about 20<span class="elsevierStyleHsp" style=""></span>minutes to set the background PM<span class="elsevierStyleInf">2&#46;5</span> concentration for comparison purposes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We used boxplots to describe medians &#40;M&#41; and interquartile ranges &#40;IQR&#41; of PM<span class="elsevierStyleInf">2&#46;5</span> concentration &#40;&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41; in the venues&#44; overall and stratified by selected characteristics&#46; We compared median PM<span class="elsevierStyleInf">2&#46;5</span> concentration by these characteristics and with background levels using non-parametric Kruskall-Wallis and U-Mann Whitney tests&#44; at a 5&#37; significance level&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Smoking where prohibited by law was observed in 36&#37; of the venues visited&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> presents the boxplots of PM<span class="elsevierStyleInf">2&#46;5</span> concentration separately for venues where smoking was and was not observed&#44; by type of venue &#40;bars&#44; pubs&#44; and cabarets vs&#46; discos and nightclubs&#41; and on the street&#44; which served as a reference benchmark&#46; The median PM<span class="elsevierStyleInf">2&#46;5</span> concentration on the street was 9<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;IQR&#58; 5-22<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41;&#46; In non-smoking venues &#40;those where smoking was not spotted at the time of the observation&#41;&#44; the median PM<span class="elsevierStyleInf">2&#46;5</span> concentration &#40;M<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#59; IQR&#58; 7-26<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41; was 1&#46;4 times higher than on the street&#46; In smoking venues &#40;those where smoking was witnessed at the time of the observation&#41;&#44; the median PM<span class="elsevierStyleInf">2&#46;5</span> was more than 13 times higher &#40;M<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>122<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#59; IQR&#58; 58-230<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41; than on the street&#46; Differences between median PM<span class="elsevierStyleInf">2&#46;5</span> concentration in smoking and non-smoking venues were statistically significant&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">We also compared the median PM<span class="elsevierStyleInf">2&#46;5</span> concentration in venues where dancing is their signature activity&#44; such as discotheques and nightclubs&#44; with that in the rest of venues&#46; Compared to the street&#44; the median value of PM<span class="elsevierStyleInf">2&#46;5</span> was three times higher in bars and similar venues &#40;m<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#59; IQR&#58; 10-78<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41; and more than five times higher in disco and night club venues &#40;m<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#59; IQR&#58; 19-165<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41; &#40;all p values &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Chile introduced a comprehensive smoke-free law when the smoking prevalence was still high &#40;&#62;35&#37;&#41; compared to when other countries introduced similar national or subnational laws that were almost self-enforcing&#46; Countries with higher smoking prevalence&#44; although having reasonable overall compliance with smoking bans&#44; tend to have more compliance issues<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> in some sectors or pockets of venues&#44; particularly in the hospitality sector&#46; Hence the importance of an effective enforcement infrastructure and effort&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The results of our approach show that finding pockets of venues with suboptimal compliance is possible&#46; In the case of Chile&#44; we were able to point out the night entertainment venues not only as a type of business with a significant proportion of noncompliant venues &#40;36&#37;&#41;&#44; but also with harmful levels of PM<span class="elsevierStyleInf">2&#46;5</span>&#44; 13 times above the background street levels&#46; WHO Air Quality Guidelines consider that long-term breathing of air with PM<span class="elsevierStyleInf">2&#46;5</span> concentration above 10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;annual outdoor average&#41; significantly increases the mortality of exposed persons&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The same approach can be followed to find additional pockets of non-compliance&#46; For example&#44; anecdotal evidence points to the need for finding such pockets in higher education institutions and small-size workplaces&#44; or among specific administrative subnational jurisdictions&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Until now&#44; a massive effort to inspect all types of venues in the hospitality sector has had limited results in decreasing the self-reported proportion of exposure to second-hand smoke at workplaces&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> However&#44; this study shows that a simple and affordable approach &#8212;the cost of this study&#44; personnel expenses&#44; and entry fees to venues&#44; was approximately USD 700&#8212; targeting clusters of venues at high risk for violation of the smoke-free law may improve the use of scarce local inspection time and resources&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Editor in charge</span><p id="par0075" class="elsevierStylePara elsevierViewall">Carlos &#193;lvarez Dardet&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Authorship contributions</span><p id="par0080" class="elsevierStylePara elsevierViewall">A&#46; Peruga&#58; conceptualization&#44; investigation&#44; formal analysis&#44; and writing original draft preparation&#46; M&#46; Fu&#58; methodology&#44; resources&#44; and writing&#44; reviewing and editing&#46; X&#46; Molina&#58; conceptualization&#44; investigation&#44; data curation&#44; and writing&#44; reviewing and editing&#46; E&#46; Fern&#225;ndez&#58; methodology&#44; resources&#44; and writing&#44; reviewing and editing&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0085" class="elsevierStylePara elsevierViewall">WHO&#44; the University del Desarrollo&#44; and the Catalan Institute of Oncology-WHO Collaborating Center for Tobacco Control all contributed with funds&#46; The Tobacco Control Research Group &#40;AP&#44; MF&#44; EF&#41; is partially supported by the Ministry of Universities and Research&#44; Government of Catalonia &#40;2017SGR319&#41;&#44; and EF is partially supported by the Instituto de Salud Carlos III&#44; Government of Spain &#40;INT16&#47;00211 and INT17&#47;00103&#41;&#44; co-funded by the European Regional Development Fund &#40;FEDER&#41;&#46; The authors did not enter into an agreement with any of the funders that may have limited their ability to complete the research as planned&#46; The authors had full control of all primary data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The initial high level of compliance with the Chilean comprehensive national smoke-free law in 2013 is fading&#44; particularly in the hospitality sector&#46; This paper draws attention to how using a simple and low-cost surveillance inquiry may help focus on the use of scarce inspection resources to improve compliance with the law in the hospitality sector&#46; We conducted a cross-sectional assessment of second-hand smoke exposure in night entertainment venues in Santiago&#44; Chile&#44; by measuring particulate matter of less than 2&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;m &#40;PM<span class="elsevierStyleInf">2&#46;5</span>&#41;&#46; Smoking where prohibited by law was observed in 36&#37; of the venues visited&#46; Venues where smoking was spotted at the time of the observation had a median PM<span class="elsevierStyleInf">2&#46;5</span> concentration 13 times higher than background concentration on the street&#46; The study shows that a targeted approach for inspection to find pockets of venues with suboptimal compliance is feasible and affordable&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El alto nivel inicial de cumplimiento de la Ley integral chilena de ambientes libres de humo de 2013 se est&#225; desvaneciendo&#44; particularmente en el sector de la restauraci&#243;n&#46; Este documento muestra c&#243;mo una encuesta de vigilancia simple y econ&#243;mica puede ayudar a mejorar el uso de recursos de inspecci&#243;n escasos para mejorar el cumplimiento de la ley en dicho sector&#46; Se realiz&#243; una evaluaci&#243;n transversal de la exposici&#243;n al humo de tabaco ajeno en locales de entretenimiento nocturno en Santiago&#44; Chile&#44; midiendo el nivel de part&#237;culas menores de 2&#44;5<span class="elsevierStyleHsp" style=""></span>&#956;m &#40;PM<span class="elsevierStyleInf">2&#46;5</span>&#41;&#46; En el 36&#37; de los locales visitados se fumaba donde lo proh&#237;be la ley&#46; Los locales en los que se fumaba ten&#237;an una concentraci&#243;n mediana de PM<span class="elsevierStyleInf">2&#46;5</span> 13 veces mayor que la concentraci&#243;n en la calle&#46; El estudio muestra que una vigilancia enfocada en la inspecci&#243;n de lugares con cumplimiento sub&#243;ptimo es factible y asequible&#46;</p></span>"
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