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.
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