Smoke Free Bars and Taverns Improve Bartenders' Respiratory Health


smoking in bar   Summarized by J.W. Jenne, M.D.
MASCOT Representative

A nearly flawless prospective study has just been published in the Journal of the American Medical Association (JAMA) about the acute beneficial effects of removal from environmental tobacco smoke (ETS) on the respiratory health of bartenders [1].

This paper is also useful in reviewing the conflicting studies on the acute effects of ETS, in contrast to the strong epidemiological evidence of long term effects on lung cancer and atherosclerotic cardiovascular disease; it also contains many references.

Fifty-three volunteering bartenders from 25 bars were interviewed and underwent spirometry (forced expired volumes of air) prior to and following institution of the smoking ban in California bars and taverns. Exposure to ETS averaged 28 hours per week before, and two hours per week after the ban.

Particular attention was paid to (1) bronchial ("respiratory") symptoms of wheezing, dyspnea (shortness of breath), morning cough, cough during the rest of the day or night and phlegm production, and (2) "sensory irritation symptoms" of red, teary or irritated eyes, runny nose, sneezing or nose irritation, and sore or scratchy throat. These were noted during the previous four weeks before the ban and in the first and second months afterwards. Nine participants (17%) had a history of physician-diagnosed asthma, and nearly half (45%) were current smokers.

The most dramatic findings were the very significant reduction in cough, phlegm and sensory irritation symptoms. Wheezing also occurred less often. Before the ban, 39 bartenders (74%) initially reported respiratory symptoms. At follow-up, 23 of these (59%) no longer had symptoms. Forty-one bartenders (77%) initially reported sensory irritation symptoms.

At follow-up, 32 of these (78%) had resolution of symptoms. Even smokers improved. There was also improvement in mean forced vital capacity (FVC) of 0.189 L (4.2% change) and mean forced expiratory volume in one second (FEV-1) of 0.039 L (1.2%). These increased to 6.8 % and 4.5% where complete cessation of ETS exposure occurred. The figures are consistent with many studies in smokers with values in a normal range when simply quitting smoking.

It must be stressed that bars have four to six times higher peak levels of ETS than most other non-smokefree workplaces. Hence these results represent the worst extreme. Also, two deficiencies in the study are that interviewers could not be blinded, and subjects might also have expected these results. Yet, the fact that most subjects were initially biased against the ban somewhat mitigates the latter criticism. This study will be a strong argument against exposure to constant environmental tobacco smoke.

[1] Eisner MD, Smith AK, Blanc PD. Bartenders' respiratory health after establishment of smoke-free bars and taverns. JAMA, Dec. 9, 1998, 280: No. 22, 1909-1914.

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Health of Bartenders Improves Rapidly When Bars Become Smoke-free
Journal of the American Medical Association Abstract - December 9, 1998