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Mark D. Eisner, MD; Alexander K. Smith, BS; Paul D. Blanc, MD, MSPH

JAMA. 1998;280:1909-1914.

Context.— The association between environmental tobacco smoke (ETS) exposure and respiratory symptoms has not been well established in adults.

Objective.— To study the respiratory health of bartenders before and after legislative prohibition of smoking in all bars and taverns by the state of California.

Design.— Cohort of bartenders interviewed before and after smoking prohibition.

Setting and Participants.— Bartenders at a random sample of bars and taverns in San Francisco.

Main Outcome Measures.— Interviews assessed respiratory symptoms, sensory irritation symptoms, ETS exposure, personal smoking, and recent upper respiratory tract infections. Spirometric assessment included forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC) measurements.

Results.— Fifty-three of 67 eligible bartenders were interviewed. At baseline, all 53 bartenders reported workplace ETS exposure. After the smoking ban, self-reported ETS exposure at work declined from a median of 28 to 2 hours per week (P<.001). Thirty-nine bartenders (74%) initially reported respiratory symptoms. Of those symptomatic at baseline, 23 (59%) no longer had symptoms at follow-up (P<.001). Forty-one bartenders (77%) initially reported sensory irritation symptoms. At follow-up, 32 (78%) of these subjects had resolution of symptoms (P<.001). After prohibition of workplace smoking, we observed improvement in mean FVC (0.189 L; 95% confidence interval [CI], 0.082-0.296 L; 4.2% change) and, to a lesser extent, mean FEV₁ (0.039 L; 95% CI, -0.030 to 0.107 L; 1.2% change). Complete cessation of workplace ETS exposure (compared with continued exposure) was associated with improved mean FVC (0.287 L; 95% CI, 0.088-0.486; 6.8% change) and mean FEV₁ (0.142 L; 95% CI, 0.020-0.264 L; 4.5% change), after controlling for personal smoking and recent upper respiratory tract infections.

Conclusion.— Establishment of smoke-free bars and taverns was associated with a rapid improvement of respiratory health.

From the Department of Medicine, Divisions of Pulmonary and Critical Care Medicine (Dr Eisner) and Occupational and Environmental Medicine (Dr Blanc), Cardiovascular Research Institute (Drs Eisner and Blanc), and School of Medicine (Mr Smith), University of California, San Francisco.

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