Bar Workers' Health and Environmental Tobacco Smoke Exposure (BHETSE)

A collaboration between: the Department of Occupational and Environmental Medicine (DEOM), University of Aberdeen; the Institute of Occupational Medicine (IOM); and the MRC Social and Public Health Research Unit (SPHRU), University of Glasgow.

Principal Investigator: Professor Jon Ayres

Lead Researcher: Dr Sean Semple

Study Aims

  • To assess changes in air quality in bars following the introduction of smoke-free legislation in Scotland.
  • To assess changes in bar workers' second-hand smoke (SHS) exposure, and self-reported respiratory and sensory symptoms and objective measures of lung function post-legislation.
  • To test associations between changes in SHS exposure and respiratory health.
  • To assess bar workers' attitudes to the smoke-free legislation and to prohibition of smoking in their workplace, and their perceptions of the risk to their health of SHS exposure.

Study Design

Longitudinal study with the following components:

  • Air quality measurement: Covert measurement of PM2.5 (air-marker of SHS) in a random sample of 41 pubs in 2 Scottish cities immediately before implementation of legislation with repeat measures taken 2 months post-legislation.
  • Respiratory health and attitudes of bar workers: Study of cohort of 371 bar workers recruited from 72 bars in 5 areas in Scotland with data collection by questionnaire at baseline (January-March 2006) and at follow-up 2 months post-legislation and one year post-baseline. Lung function measures which were taken together with samples of saliva were also collected for testing for cotinine - a bio-marker of SHS exposure in non-smokers.
  • Main outcomes included: PM2.5 (ambient air and personal monitoring); salivary cotinine; self-reported SHS exposure; self-reported respiratory and sensory symptoms; lung function measures (FEV1 and FVC); and attitudinal measures.

Research Instruments and Protocols

Some questions have been based on the International Union Against Lung Disease and Tuberculosis (IUALDT) questions and those for the Ireland study 'legislation for smoke-free workplaces and health of bar workers in Ireland: before and after study' BMJ, doi:10.1136/bmj.38636.499225.55, (Published 17 October 2005).

Main Outcomes

  • There was an 86% reduction in PM2.5 with air quality in pubs comparable to outdoor ambient air 2 months post-legislation.
  • In a small sub-sample of bar-workers, full-shift personal exposure to PM2.5 showed average reductions of 86% between baseline and 2 months post-legislation.
  • One year post-baseline, salivary cotinine concentrations in bar workers fell by 89% from 2.94 ng/ml to 0.41ng/ml.
  • In smokers salivary cotinine fell by 12%.
  • For the whole cohort, duration of reported workplace SHS exposure in previous 7 days fell from 28.5 hours pre-legislation to 0.83 hours post-legislation.
  • There was a reduction in prevalence and number of self-reported respiratory and sensory symptoms in both non-smokers one year post-baseline. However, there was no measureable increase in lung function as measured by either forced expiratory volume (FEV1) or forced vital capacity (FVC).
  • Support for the legislation increased from 69% to 79% and concerns about the impact of the legislation on business fell from 49% to less than 20%.

Publications

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