Smoking Ban a Breath of Fresh Air For Bar Workers

DUNDEE, Scotland, Oct. 10 -- A smoking ban in enclosed places here had a quick effect on bar workers.

Just two months after the start of the smoking ban last March, bar workers showed significant improvements in respiratory function and lower systemic inflammation, reported researchers here.

No longer exposed to second-hand smoke, asthmatic bar workers in particular had a significant improvement in their quality of life, wrote Daniel Menzies, M.D., of Ninewells Hospital and Medical School, and colleagues, reported in the Oct. 10 issue of Journal of the American Medical Association.

Within 30 days of the ban going into effect, non-smoking bartenders and waiters who had spent an average of nine years working in smoke-saturated pubs and restaurants had a noticeable reduction in sensory symptoms such as red or irritated eyes, sore throat, nasal itch, rhinitis, and sneezing.

Within two months, respiratory symptoms such as wheeze, shortness of breath, cough, and phlegm had begun to abate, and spirometry readings and inflammatory cell counts improved, wrote Dr. Menzies and colleagues. In addition, asthmatic bar workers had less airway inflammation.

"The report by Menzies et al confirms and amplifies previous research demonstrating reduced secondhand smoke exposure and decreased respiratory symptoms among restaurant and bar workers after smoke-free workplace mandates were enacted in the United States, Ireland, Norway, and New Zealand," wrote Mark D. Eisner, M.D., M.P.H., of the University of California San Francisco, in an accompanying editorial.

"In addition, one study suggests that workplace smoking bans are associated with reduced incidence of acute myocardial infarction," Dr. Eisner wrote. "Taken together, there is compelling scientific evidence that smoke-free workplace legislation is rapidly effective in improving the health of workers."

Anticipating the start of the smoking ban in Scotland on March 26, the investigators identified bar employees in Dundee and Perth in eastern Scotland, and invited them to participate. They enrolled 105 workers with no history of respiratory problems other than asthma or rhinitis, and 77 completed the study.

The volunteers were tested one month before the ban was implemented, and again at one and two months after it went into effect, for respiratory and sensory symptoms, spirometry, serum cotinine, peripheral inflammatory cell count, asthma quality-of-life scores, and exhaled nitric oxide levels.

They found in the per-protocol analysis that the percentage of bar workers with respiratory and sensory symptoms dropped from 79.2% pre-ban to 53.2% at one month (total change, ?26%, 95% confidence interval, ?13.8% to ?38.1%, P

"This study clearly demonstrates that the recent introduction of legislation in Scotland prohibiting smoking in enclosed public places has led to a rapid and marked improvement in the health of bar workers," the investigators wrote. "Indeed, on average employees had been working in a bar for more than nine years, but improvements in health were evident only one month after the introduction of a smoke-free policy."

Employees and customers alike benefit from workplace smoking bans, Dr. Eisner noted in his editorial, adding that bans help boost smoking cessation rates as well.

"Those who continue to smoke reduce their daily cigarette consumption, he wrote."Shortly after the Irish smoke-free workplace legislation went into effect, a substantial proportion of smokers quit smoking (15%), and many attributed their smoking cessation to implementation of the law. Smoke-free workplace laws, by reducing passive and active smoking, will lead to substantive health benefits for the population."