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Bar workers’ health and environmental tobacco smoke exposure (BHETSE): symptomatic improvement in bar staff following smoke-free legislation in Scotland
  1. J G Ayres1,
  2. S Semple1,2,
  3. L MacCalman2,
  4. S Dempsey2,
  5. S Hilton3,
  6. J F Hurley2,
  7. B G Miller2,
  8. A Naji1,
  9. M Petticrew4
  1. 1
    Department of Environmental and Occupational Medicine, Liberty Safe Work Research Centre, Aberdeen, UK
  2. 2
    Institute of Occupational Medicine, Riccarton, Edinburgh, UK
  3. 3
    MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  4. 4
    Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, London, UK
  1. Professor Jon G Ayres, Institute of Occupational & Environmental Medicine, School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK; j.g.ayres{at}


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

Design: Longitudinal study following bar workers from before legislation introduction, at 2 months after introduction and at 1 year 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: Of the 191 (51%) workers seen at 1-year follow-up, the percentage 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, effects being greater at 2 months, probably partly due to seasonal effects. Excluding respondents who reported having a cold at either baseline or 1 year, the reduction in respiratory symptoms was similar although greater for “any” 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). Wheeze (48% to 31%, p = 0.006) and breathlessness (42% to 29%, p = 0.038) improved significantly in smokers. There was no relationship between change in salivary cotinine levels and change in symptoms.

Conclusions: Bar workers in Scotland reported significantly fewer respiratory and sensory symptoms 1 year after their working environment became smoke free. As these improvements, controlled for seasonal variations, were seen in both non-smokers and smokers, smoke-free working environments may have potentially important benefits even for smokers.

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  • Competing interests: None.

  • Funding: This study was funded by a grant from NHS Health Scotland. MP was funded by the Chief Scientist Office of the Scottish Executive Department of Health at the time the study was undertaken.

  • ▸ Additional information is published online only at

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