Citizens for Clean Air and Clean Lungs

When Bars Say 'No' To Smoking

December 15, 1998
New York Times

In the line of duty, bartenders are exposed to more than their share of other people's troubles -- and other people's cigarette smoke. But while customers continue to pour out their woes at neighborhood pubs, at least in California they aren't smoking while they do it. The state banned smoking in bars as of last Jan. 1.

Recognizing an opportunity, a team of University of California at San Francisco researchers took advantage of this natural experiment to investigate the respiratory health of bartenders before and after the law went into effect. The results, published in the most recent issue of the Journal of the American Medical Association, indicate that even a month to two months of daily toil in an environment newly free of second-hand smoke can cause a significant reduction in symptoms like coughing, eye and nose irritation and phlegm production, as well as some improvement in lung function.

Long-term exposure to second-hand smoke, according to evidence from more than 35 studies of nonsmokers who live with smokers, increases the risk of lung cancer by about 20 percent. (Active smokers increase their risk by about 2,000 percent.)

But passive smoking has mostly been studied in homes rather than in the workplace, and only a small number of studies have examined the short-term effects of exposure on health.

Some workplaces, of course, are smokier than others. One researcher calculated that second-hand smoke in bars was 3.9 to 6.1 times higher than in other office environments, and pointed to billiard halls, bowling alleys, betting establishments and restaurants as other traditionally smoky environments.

The scientists studied 53 bartenders -- smokers and nonsmokers -- at 25 San Francisco bars, chosen at random.

The bartenders were given a baseline interview and lung-function tests in December 1997. Follow-up interviews and more tests were conducted four to eight weeks after the law took effect.

Of the 39 bartenders who reported respiratory symptoms in the first interviews, 23 said in the second round that the symptoms had abated. Forty-one bartenders initially reported irritation of the eyes, nose, or throat; in the later interviews, 32 said they were symptom free. Their lung function, measured by a portable spirometer, also showed modest improvement.

The benefits of reduced smoke in the workplace seemed to apply equally to smokers and nonsmokers. Forty of the bartenders had a history of smoking, including 24 who still smoked at the time of the study. But "respiratory symptoms and lung function improved in both smokers and nonsmokers," said Dr. Mark Eisner, who led the study.

In their report, the scientists noted that a majority of the bartenders (64 percent) said they "strongly" or "somewhat" disagreed with the smoking ban, making it unlikely that reports of reduced symptoms were inspired by anti-smoking fervor. But 80 percent also said they believed that second-hand smoke had a "slight" or "moderate-to-severe" effect on their health.

Researchers have more difficulty studying passive smoking than active smoking because it is much harder to measure second-hand smoke exposure precisely, said Dr. Geoffrey Kabat, an associate professor in preventive medicine at the State University of New York at Stony Brook. The University of California scientists note that their study has limitations, including the fact that the bartenders' exposure to second-hand smoke is not assessed directly, and the possibility that active smokers in the study may have reduced their smoking outside work, accounting for a reduction in symptoms.

Dr. Ichiro Kawachi, an associate professor at the Harvard University School of Public Health, who has studied second-hand smoke, called the new report "impressive and important."

"We always wonder about customers' exposure to smoking," Dr. Kawachi said, "but of course the people who are most exposed are the people working there."

The United States, Dr. Kawachi said, lags behind other countries in restricting smoking in the workplace.

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