Smoking Ban Clears the Air in Irish Pubs

DUBLIN, April 16 -- It is easier to breathe these days in Ireland's legendary pubs since a national ban on smoking in the workplace went into effect.

Within a year of the 2004 ban, the smoke had cleared from Irish pubs, leaving behind an 83% reduction in indoor air pollution, an 80% drop in airborne carcinogens, and substantial respiratory health benefits for bar workers.

So found Luke Clancy, M.D., of the Research Institute for a Tobacco Free Society here, and colleagues, in a meticulous pre- and post-ban study of 42 Dublin pubs and 73 pub staff.

Nearly a third fewer bar workers reported respiratory symptoms after the ban, the investigators reported in the April issue of the American Journal of Respiratory and Critical Care Medicine.

The study supported assertions of smoke-free advocates that the that comprehensive smoke-free laws are having the intended effect, according to an editorial by Fiona Godfrey, B.A., L.L.M., of the European Respiratory Society in Brussels, Belgium.

It "adds to the evidence from other studies that what smoke-free advocates have said all along is true: comprehensive smoking bans in bars dramatically reduce the levels of fine-particulate matter, chemicals, and gases in the air and improve bar workers' health," she wrote.

The study included a representative sample of pubs in Dublin that the researchers visited to monitor air quality for at least three hours at each location from October 2003 to March 2004 before the ban. Each was visited again at the same time of day, day of week, and month one year later.

As markers of secondhand smoke pollution, the researchers measured concentrations of fine particulate matter 2.5 m or smaller and 10 m or smaller, which includes substances shown to increase mortality. Respectively, levels dropped 83.6% (2.2 versus 17.8 g/m³, P<0.01) and 36.9% (17.1 versus 27.8 g/m³, P=NS).

As a marker of carcinogenic substances from cigarettes, they measured benzene in 26 of the pubs. Indoor levels fell 80.2% (1.6 versus 14.0 g/m³, P<0.01) to concentrations similar to those in ambient outdoor air in Dublin.

"The reduction of benzene may be an indication of a reduction in the many other known carcinogens in secondhand smoke and may contribute to a reduction in lung cancer," the researchers wrote.

The researchers observed no smoking in any of the bars after the ban.

To measure health effects from indoor pollution reduction, bar staffers recruited through a trade union volunteered to attend a pulmonary function laboratory before and after the ban. They underwent full lung-function studies, had measurement of exhaled breath carbon monoxide and the nicotine exposure biomarker salivary cotinine, and completed questionnaires on smoke exposure and respiratory symptoms.

All participants were men (mean age 48) who worked full time at a pub. They averaged 28.4 years of environmental tobacco smoke exposure at work. While the majority of these workers supported the ban, a few opposed it or were initially undecided (65, five, and three, respectively). Eight were current smokers.

Among the health findings, the researchers reported:

• Drops in self-reported smoke exposure in the workplace (down 99%, 0.42 versus 40.5 hours preban), outside of work (down 42%) and in total (down 90%).
• Forced vital capacity increased significantly from 92.0% to 95.0% predicted (P<0.01).
• Exhaled breath carbon monoxide levels fell 79% among nonsmokers.
• Salivary cotinine levels decreased 81% among nonsmokers (0.6 versus 5.1 ng/mL, P<0.0001).
• Among nonsmokers, self-reported coughing improved both in the morning (17% versus 32%, P=0.04) and during the rest of the day (34% versus 55%, P<0.01).
• Fewer nonsmokers reported phlegm production after the ban (40% versus 68%, P<0.01).
• The total number-smokers and nonsmokers included-reporting any respiratory symptoms fell from 86% to 61% (P<0.01).
• The total reporting any lung, eye, or throat irritant symptoms was cut in half (43% versus 87%, P<0.01).

These immediate health benefits are likely to be joined by reductions in heart attacks, chronic obstructive pulmonary disease, asthma, and cardiovascular disease over time, Dr. Clancy and colleagues said.

With such benefits now proven, it's little surprise that other countries are considering the same move. Already this year, the District of Columbia, Belgium, and Lithuania have instituted smoking bans with Northern Ireland, England, Wales, and even France planning to join over the next year or so.

"The impact of the Irish ban has been enormous in Europe," Godfrey wrote in the editorial. An estimated five to 10 million premature deaths from smoking could be prevented if all European Union countries were to adopt a similar law, she added.

Sixteen U.S. states, the District of Columbia, and thousands of communities have banned smoking in public places, according to the American Cancer Society.

There are caveats to all this optimism, though, Godfrey points out.

"Although the health of the nonsmoking and ex-smoker barmen improved significantly," she wrote, "the respiratory health of the smokers in the study continued to decline, with the exception of the findings on irritant sensitivity."

Given their reduction in smoke exposure, "this is a disappointing finding," she added.

Furthermore, while other studies have shown that smoking is 1.4% less prevalent in Ireland since the ban, "there are signs that smoking rates are edging up again," she noted.

"These figures underline the fact that no one measure, however successful, can on its own drive down smoking prevalence."