Bar workers’ Health and Environmental Tobacco Smoke Exposure (BHETSE): Symptomatic improvement in bar staff following smoke-free legislation in Scotland

Jon G Ayres ^1*, Sean Semple ¹, Laura MacCalman Dr², Scott Dempsey ², Shona Hilton ³, Finton J Hurley ⁴, Brian G Miller ⁴, Audrey Naji ¹ and Mark Petticrew ⁵

¹ University of Aberdeen, United Kingdom
² Institute of Occupational Medicine, United Kingdom
³ MRC Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
⁴ Institute of Occupational Medicine, Edinburgh, United Kingdom
⁵ Public & Environmental Health Research Unit, London School of Hygiene & Tropical Medicine, United Kingdom

^* To whom correspondence should be addressed. E-mail: j.g.ayres{at}bham.ac.uk.

Accepted 24 October 2008

Abstract

Objective: To examine changes in the health of bar workers after the introduction of smoke-free legislation.

Design: Longitudinal study following bar workers from before the introduction of legislation (26th March 2006), at 2 months after introduction and again at 1 year post-baseline to control for seasonal differences. Setting: Bars across a range of socio-economic settings in Scotland.

Participants: 371 bar workers recruited from 72 bars. Intervention: Introduction of smoke-free legislation prohibiting smoking in enclosed public places, including bars. Main outcomes measures: Change in prevalence of self-reported respiratory and sensory symptoms.

Results: 371 bar workers were recruited prior to introduction of the legislation. Of the 191 (51%) seen at 1-year follow-up the percentage of those reporting any respiratory symptom fell from 69 to 57% (p=0.02) and for sensory symptoms from 75 to 64% (p=0.02) following reductions in exposure. Reductions in the percentage of those reporting respiratory symptoms were greater at two months, probably due at least in part to the effect of season. Excluding respondents who reported having a cold, either at baseline or at one year, the reduction in respiratory symptoms was similar, although the reduction was greater for "any" reported sensory symptom (69% falling to 54%; p=0.011). For non-smokers (n=57) the reductions in reported symptoms were significant for phlegm production (32% to 14%, p=0.011) and red/irritated eyes (44% to 18%, p=0.001). There was no clear relationship between baseline salivary cotinine levels, or change in salivary cotinine levels, and change in symptoms.

Conclusions: Bar workers in Scotland report significantly fewer respiratory and sensory symptoms one year after their working environment became smoke-free. These improvements, controlled for seasonal variations, were seen in both non-smokers and in smokers, and indicate that smoke-free working environments may have potentially important benefits even for smokers.