Smoking
Smoking Ban Associated With Rapid Improvement In Health Of Bar Workers in Scotland
By JAMA
Oct 11, 2006 - 5:11:00 AM

Bar workers in Scotland showed significant improvements in respiratory symptoms and lung function within 2 months following a ban on smoking in confined public places, according to a study in the October 11 issue of JAMA.

Exposure to secondhand tobacco smoke is a major worldwide public health issue, according to background information in the article. The effects on individuals has been difficult to measure, but a number of studies have established an increased risk of coronary artery disease, cerebrovascular disease and lung cancer, and the 2006 report by the U.S. surgeon general highlighted the causal relationship between secondhand smoke and premature death. In addition, for patients with preexisting respiratory conditions such as asthma, secondhand smoke leads to poorer disease control and more frequent hospital admission.

As the harmful effects of secondhand smoke become more widely appreciated, a number of countries have attempted to limit the health risks to the population at large by prohibiting smoking in public. On March 26, 2006, Scotland introduced a legislative ban on smoking in enclosed public places. One group of people most likely to benefit from this legislation is bar workers, who are exposed to high levels of secondhand smoke as part of their occupation.

Daniel Menzies, M.B.Ch.B., and colleagues from Ninewells Hospital and Medical School, Dundee, Scotland examined the effect of the recently introduced smoke-free legislation on bar workers� health in Scotland. The study, conducted in Tayside, Scotland from Feb. - June 2006, initially included 105 nonasthmatic and asthmatic nonsmoking bar workers, of whom 77 completed the study. The participants were evaluated for respiratory symptoms (wheeze, shortness of breath, cough, and phlegm) and sensory symptoms (red or irritated eyes, painful throat and nasal itch, runny nose, and sneeze), and also had pulmonary tests and blood tests performed before the ban and at 1 month and 2 months after the ban went into effect.

The researchers found that a total of 79.2 percent (n = 61) of the bar workers experienced respiratory or sensory symptoms before the introduction of the smoke-free policy, whereas 1 month afterward, 53.2 percent (n = 41) reported these symptoms, a decline of 26 percent. At 2 months after introduction of the smoke-free policy, this improvement was maintained, with 46.8 percent of participants reporting any symptom (a decrease of 32.4 percent from baseline). There were also improvements on certain measurements of lung function and reductions in serum cotinine (metabolized nicotine) levels. Asthmatic bar workers also had less airway inflammation and an increase in quality of life scores.

In an accompanying editorial, Mark D. Eisner, M.D., M.P.H., of the University of California, San Francisco, comments on the erroneous arguments made against banning smoking in certain places.

�Three common arguments are advanced against mandating smoke-free bars, restaurants, and other hospitality businesses. Each is fallacious. First, laws to prevent smoking in bars will not be effective. Four years after the California ban on smoking in bars, adherence with the law was high: 99 percent of bars in restaurants and 76 percent of freestanding bars were smoke-free. Near perfect adherence has been reported in Boston, Ireland, and New Zealand. Second, the general public will not accept smoke-free bars and restaurants. In fact, a series of international studies shows that most people do support smoke-free bars and restaurants. Moreover, public opinion becomes increasingly positive following smoke-free legislation. Third, smoke-free laws will cause bars and restaurants to lose money. Using sales tax and other objective financial data, studies now conclusively demonstrate that bars, restaurants, and hotels do not lose revenue after becoming smoke-free. In fact, some of these studies actually show a growth in income. In sum, smoke-free legislation is effective, accepted by the public, and has no negative economic impact.�

�Mandating smoke-free workplaces will decrease secondhand smoke exposure and will improve respiratory health, prevent chronic disease, and extend life span. Important salutary health effects occur in as little as 1 month after cessation of secondhand smoke exposure. The comprehensive body of research documenting the serious adverse health effects of passive smoking provides a powerful rationale for prohibiting smoking in all public places. The time has come to clear the air,� Dr. Eisner writes.

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