BACKGROUND-AIM:
At the time of this study, the primary smoke-free law in Bosnia and Herzegovina (FBiH), the ‘Law on the Control and Restricted Use of Tobacco, Tobacco Products, and Other Smoking Products in FBiH’, did not sufficiently address the dangers of secondhand smoke exposure in public places. While prohibiting smoking in all closed public spaces, the Law permits designated smoking areas. There was no smoke-free legislation in the Republika Srpska at the time of this study. An air quality monitoring (AQM) assessment in indoor public places was conducted to highlight the need for a stronger and better enforced smoke-free law across the country. This AQM study aimed to assess the air quality in indoor public places in Bosnia and Herzegovina during implementation (FBiH) or prior to passage of a smoke-free law (Republika Srpska).

METHODS:
From May to July 2024, an AQM study was conducted across two cities in FBiH (Sarajevo and Mostar) and one in the Republika Srpska (Istoèno Sarajevo) to compare the levels of air pollution in locations where smoking was observed to air pollution in venues with no smoking. A total of 33 indoor locations, including restaurants, pubs, pastry shops and hookah bars, were tested using a SidePak Aerosol Monitor 520.

RESULTS:
Data was collected from 33 venues across Sarajevo (n=17), Mostar (n=13), and Istoèno Sarajevo (n=4). The geometric mean PM2.5 of all monitored venues where smoking, ENDS, HTP, and/or hookah use was observed was 72.9 ìg/m3, 95% CI [46.2, 115.1]. In places with any indoor tobacco or nicotine use, levels of PM2.5 were over 2.9 times higher than in places without smoking or nicotine use (average level 72.9 ìg/m3 vs. 25.1 µg/m3). Where hookah specifically was used, the PM2.5 was 8.6 times higher (average level of 217.5 ìg/m3). The average air quality in venues with any tobacco or nicotine use was categorized as ‘Unhealthy’ according to the U.S. EPA’s Air Quality Index. The geometric mean PM2.5 was higher across venues in the Republika Srpska (88.7 ìg/m3, 95% CI [20.4, 386.4]) than in FBiH (61.3 ìg/m3, 95% CI [39.4, 95.3]).

CONCLUSIONS:
The air quality of indoor public places where smoking takes place is unhealthy and poses significant health risks. FBiH and the Republika Srpska should adopt and enforce smoke-free legislation that requires all parts of all indoor public places to be 100% smoke-free, in alignment with the WHO’s FCTC Article 8 and its Guidelines.