Smoking bans are good for barkeeps

Oct 18 2010 Published by under Medicine

Barkeep and blogger Scribbler has a piece up giving one bartender's view of New York's smoking ban.  Since I like Scribbler, I wondered what the data say about the effect of smoking bans on his health.  Cigarette smoke has many harmful physiologic effects, and the data are pretty clear that you don't have to be the one holding the cigarette to suffer the consequences.  Tobacco smoke damages lungs and increases vascular inflammation which leads to heart attacks and strokes.   While permanent damage is done to the lungs with smoking, damage slows after quitting.  Lung cancer risk is probably not significantly reduced by quitting in long time smokers, but the risk of dying of heart disease declines very rapidly after quitting, and it is heart disease that is the biggest killer.

Smoking bans appear to reduce the number of cigarettes consumed by smokers, and reduce the amount of smoke that all workers are exposed to.  What about Scribbler?  As a bartender, how is his heath likely to be affected?

A number of studies have looked at this question, and the results are encouraging.  After smoking bans, bartenders and other hospitality workers reported a decrease in respiratory symptoms and improvements in objective tests of lung function.  There are also measurable reductions in some blood measurements of inflammation which may be a marker for cardiac risk.  In New York in particular, the smoking ban led to a rapid decrease in smoke exposure among hospitality workers.  Given what we've seen in other cities, we can expect rapid subjective and objective improvements in health in Scribbler and his comrades due to the smoking ban.  Since we like Scribbler, this is a good thing.

While many may cringe at the paternalistic nature of public health laws, few complain about the availability of clean water and the notable absence of open sewers.  The smoking ban is in the same category.

References

Ockene JK, Kuller LH, Svendsen KH, & Meilahn E (1990). The relationship of smoking cessation to coronary heart disease and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT). American journal of public health, 80 (8), 954-8 PMID: 2368857

Fichtenberg, C. (2002). Effect of smoke-free workplaces on smoking behaviour: systematic review BMJ, 325 (7357), 188-188 DOI: 10.1136/bmj.325.7357.188
Farrelly, M. (2005). Changes in hospitality workers' exposure to secondhand smoke following the implementation of New York's smoke-free law Tobacco Control, 14 (4), 236-241 DOI: 10.1136/tc.2004.008839

Eisner MD, Smith AK, & Blanc PD (1998). Bartenders' respiratory health after establishment of smoke-free bars and taverns. JAMA : the journal of the American Medical Association, 280 (22), 1909-14 PMID: 9851475

Allwright, S. (2005). Legislation for smoke-free workplaces and health of bar workers in Ireland: before and after study BMJ, 331 (7525) DOI: 10.1136/bmj.38636.499225.55

Menzies D, Nair A, Williamson PA, Schembri S, Al-Khairalla MZ, Barnes M, Fardon TC, McFarlane L, Magee GJ, & Lipworth BJ (2006). Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places. JAMA : the journal of the American Medical Association, 296 (14), 1742-8 PMID: 17032987

24 responses so far

  • scribbler50 says:

    Thank you very much, Pal, for the link and the information. And of course thanks for showing concern regarding our health. If you ever get to New York you have a "smoke free" drink coming on me.
    Cheers!

  • Donna B. says:

    "While many may cringe at the paternalistic nature of public health laws, few complain about the availability of clean water and the notable absence of open sewers. The smoking ban is in the same category."

    It's not quite the same category now, though I would agree that the initial bans were. I have no problem with smoking bans in public buildings (and I include privately-owned ones that are open to the public in that category) or in places such as public parks, sidewalks, near entrances that everyone must use, etc...

    But recently, some bans have become punitive, not a matter of public health of non-smokers. (For example, can't smoke anywhere, even if you are alone outdoors and 100 yards from another person.) And frankly, some non-smokers have become just a bit freaky.

    I accompanied my pregnant daughter and her 3 year old to a community play-date for pre-schoolers in a public park last spring. This was in an suburban area that has a pigeon problem and the picnic tables and the concrete under and surrounding them were covered with bird poop.

    Of course the mommies covered the table and one of them even thought to wipe down the benches. But NONE of them (except myself and my daughter) stopped their children from picking up dropped food off the concrete and eating it. I was appalled and gagged several times. (I also had to curb my desire to wipe strings of green snot from two siblings' noses.)

    It was one of these snot-laden kids (he was probably 18 mos old and had crawled under the picnic table several times) who picked up an old, sun-bleached cigarette butt from under a swing that miraculously still contained a single strand of unburned tobacco.

    His mother was keeping a close eye on his activities. She saw him pick something up and went to investigate. Upon finding him removing the single strand of tobacco from the butt, she screamed. Loudly, scaring the poor kid to an immediate screaming, crying fit because he thought he'd done something horribly wrong. (More snot!)

    After she roughly removed the items from his hands, she starts sobbing and saying over and over, "he could have put that tobacco in his mouth!"

    Most of the other mothers rushed to console her. I stole a baby wipe from the nearest package and wiped the boy's nose. Then I stole another and wiped his sister's nose. Then I gave them both a cookie that hadn't been dropped on bird poop, patted the boy on the head and smiled at him... and told my daughter I'd meet her back at the car.

    My grandchildren aren't perfect and their mothers aren't either. But I told my daughter later that I'd ground her even if she was over 30 if I ever caught her either ignoring my grandchildren (and the health of their playmates) or traumatizing them.

    Turns out she was just as appalled as I was.

    But, the problem here is that there is no balance in public health education. Why would most of the mothers ignore the hazard of bird poop and dramatically over-react to a cigarette butt? I'm not saying the cigarette butt was not a hazard, but that it was not more of a hazard than the bird poop. Both should have been treated as hazards.

    My granddaughter dropped just as much food as the rest of the children, but she was perfectly happy to follow my lead and say "bye bye" to the food that hit the ground. (As often happens with toddlers that lead to her intentionally dropping food just to say "bye bye" to it.)

    My point is that much of our society is now way beyond a ban on smoking in public places and is at the point of irrationally demonizing an object along with the people who use it. These are sometimes the same people who will allow their toddler to sip from their beer or wine and think it's cute.

    At the same time, I'm not excusing the jerk who left the butt on the grounds of a public park. What an asshole.

    By now, you have probably guessed that I smoke if you didn't already know that. I'm not stupid and I am completely aware of the risks and hazards I'm taking and facing. And I won't try to come up with reasons why I do it -- I know it's irrational, stupid, risky, and needlessly so.

    But I carry something with me to put my cigarette butts in until I can dispose of them in a trash container. I take care never to smoke around non-smokers.

    Oddly, this has served to make me appreciate 'smoking breaks' as stolen moments of solitude. If smoking is now seen as an anti-social activity, that has likely become one of the reasons I still smoke. It wasn't always that way. I probably started smoking because it was a social activity at the time. (Yeah, I'm old. Old enough that smoking was not only allowed, but common, in hospitals when my youngest child was born.)

    A side note: Most of the time when I'm visiting or staying with someone in the hospital (I have several close elderly relatives) I have found that asking a nurse, respiratory therapist, or EMT about the nearest smoking area gets the the most knowledgeable answers. I am more often than not the only non-employee there. I have also found that employee designated smoking areas are much nicer and cleaner than those for the general public.

    • Rick says:

      If you really are conscientious, why don't you use electronic cigarettes and save everybody the bother? I mean, smoking cigarettes isn't quite like being born gay. One gets hooked onto them sometime in the teen years mostly because of social pressure. This isn't a paternalistic argument and I couldn't care less if you smoked pot because unlike in case of cigarettes, it doesn't hurt me.

      People think I am freak because I can't stand cigarette smoke even in small proportions - and this by the way comes from smokers smoking at 'safe' distance - because I have asthma and multiple sclerosis. Don't you think it would be plain selfish on your part to argue that you be allowed to smoke traditional cigarettes in the park or wherever....

      And by the way, aren't these cigarettes in the particular form that they are available completely gratuitous? What were humans smoking before these cigarettes were invented or manufactured? Sure, some humans were smoking something else but that's precisely my point. Why can't current smokers switch to electronic cigarettes over time?

      • Vicki says:

        Rick--

        For some people's lungs, smoke is smoke. If your argument is that pot doesn't hurt you because (given the legal as well as social climate) other people don't smoke around you, that makes sense, but I also don't care if someone smokes tobacco a long distance from me and then carries the butt away with them. But an asthmatic friend of mine was driven away from an event by people who smoked pot in the hallway, and refused a request not to because it wasn't tobacco. (And then she spent a couple of days recovering from the lung damage.)

      • Donna B. says:

        Rick - I did not argue and would not argue that I or anyone else should be allowed to smoke in a public park. I was arguing for a little balance in the education and reaction to smokers and tobacco (re-read - it wasn't the butt that concerned the mommy, it was the single strand of tobacco.)

      • Stephanie says:

        -Rick

        I am a smoker but I do know alot of people that are not. I do know there are plenty of people who find cigarette smoke disgusting. I do not see the harm in people smoking in a park if they are not just throwing their butts out in the open or smoking next to someone who has asked them to move. I do think that smokers should have a right to smoke just as non-smokers should have the right to be away from second hand smoke. I think the bans are good for this reason and lately more and more establishments are trying to equal things out for everyone.

        I do not know exactly what your are trying to get at with bringing smoking pot into the discussion but I will say just as many people find pot smoke as offensive as cigarette smoke.

        I am all for electronic cigarettes. I believe that this is giving the smoking freedom back to smokers without putting others at risk. I do not feel that a non-smoker should have to endure the same risks as me because I choose to smoke. I just wonder if they will make electronic cigarettes affordable? I think that will have alot to do with how many smokers will try this alternative. I also wonder comparable it will be to an actual cigarette? I believe this will also be a big influence on how well this works. If they are to ocward or not comparable I think they will fail.

    • PalMD says:

      Cigarette butts are a potential serious health hazard, as opposed to a piece of food on the ground. It's very unlikely that eating a dropped sandwich will every hurt a child, but cigarette butts are different. It's unclear how strong a risk they are, but they are categorically different.

      http://www.cdc.gov/mmwr/preview/mmwrhtml/00046181.htm

      • Jojo says:

        If you read the study you posted, the predominant symptom of eating cigarette butts was vomiting. 29% of children who had ingested some or part of a cigarette/butt vomited between one and four times. This was the most severe symptom reported.

        Eating food coated in bird feces (or simply crawling around in the bird feces and then ingesting accidentally) can also cause vomiting (due to infectious agents like salmonella, or simply to the body's instinctive gagging reaction to the presence of animal wastes).... but we'll have to wait on a study investigating kids whose parents let them crawl around in bird feces to see which is worse. :)

      • daedalus2u says:

        The lethal dose of nicotine for a small child is ~10 mg. Cigarettes commonly contain 15-25 mg/cigarette (when ingested, smoking does not transfer all the nicotine in the tobacco), so eating a single cigarette could be fatal to a child.

        http://www.inchem.org/documents/pims/chemical/nicotine.htm#SectionTitle:5.1 Oral

        The liquid nicotine that is used for the electronic cigarettes has enough nicotine that it could be fatal if spilled on the skin (adult or child).

        • Jojo says:

          In the same MSDS, the lethal dose for adults is listed as 30-60mg. Given this one of the following must be true:
          1) you're off in your estimation of the mass of nicotine in a cigarette.
          2) very, very little of the nicotine is transferred during either smoking or ingestion.
          3) Most adult smokers survive "lethal doses" of nicotine on a daily basis (3-6 cigarettes).

          3 is obviously not the case so examine 1 and 2.

          • bluefoot says:

            The amount of nicotine you get at a time is very different smoking vs. ingesting nicotine. The on/off rate on the nicotinic receptors is very fast, as is the rate of metabolism. In a single puff from a cigarette, you are not getting a lethal dose and it's broken down quickly. However, if you ate a cigarette, you would be getting the entire 15 mg at once, rather than spaced out over the time it takes to smoke a cigarette. If you built a contraption to be able to smoke many cigarettes at once, you could conceivably get a lethal dose.

    • James Sweet says:

      I'm with ya on the part about the demonization, and the overreaction to a kid inspecting a cigarette butt... but I'm not with ya on the germophobia. Eating a piece of food that has hit the ground MIGHT give you a tummyache, but probably won't. It's such a low-level risk... not worth worrying too much about.

      • Donna B. says:

        "Normal" ground, yes. This picnic area was closer to the ground at Alcatraz than to that in your ordinary park. Pigeons had sat and shat on the table - it was one of the mesh-looking metal ones - and the concrete under and around the table was carpeted with bird poop.

        Remember also that this woman brought two ill children to play with other children and then ignored some pretty basic hygiene. No one said anything to her about that either -- including me. But I was an out-of-town visitor. And all the children, except my granddaughter, were not even discouraged, much less prevented from crawling under the table to retrieve dropped food.

  • Marcus says:

    Aside from the health issue, how about getting smokers to stop littering. I know it sounds minor but it seems like 90% of smokers just toss the thing on the ground wherever they happen to be. If you actually look at a side walk it seems like half of the pieces of trash are cigarette butts. Basic manners. Clean up after yourself.

    • JM_Shep says:

      I agree with this as a former smoker. I lived in Minneapolis when I smoked, and I never had a problem finding a place to put my butt. When I visited Seattle, it was a whole other story. You'd think in a city that bans smoking in bars and restaurants, they'd put out ash trays (or at least a conveniently placed trash can) where all the smokers hang out. Minneapolis did this but Seattle didn't, and there were tons more butts on sidewalks in Seattle than in Minneapolis.

  • James Sweet says:

    Re: The paternalistic nature of the ban... I had sorta an idea that I felt like would be an interesting compromise balancing the "right" of people to go to a bar and a smoke vs. the obvious public health interest in reducing it (not to mention that the de facto situation prior to the NYS smoking ban didn't really support the "right" of people to go to a bar and not smoke... it would have been one thing if there were a marketplace of smoking and non-smoking bars, but in practice it didn't work like that. I knew of only one bar in the mid-sized upstate city where I live that went 100% smoke-free prior to the ban!)

    Anyway, my wacky plan was: Have a fixed number of "smoking licenses" per county (presumably based on population) and auction them off to places that want to allow smoking. That way, you provide a handful of options for those who insist on smoking in bars, and generate revenue at the same time.

    Of course, that still pretty much fucks the people who happen to be employed by those bars... so that's not very cool. Also, I had this idea when the ban first when into place, and it has turned out that having everybody smoke outside actually works out pretty well after all (not just from a public health standpoint, but it doesn't seem to really ruin smoker's social lives that much, eh?) I say this as someone who, at the time, enjoyed smoking in bars -- that was about the only time I smoked. The ban turned out to be just fine.

    • Donna B. says:

      Casinos were exempted from the ban where I live. Since they employ a large percentage of the hospitality workers whose health was one of the primary reasons for the law, I think the legislators shot that reason down themselves. That led to the ban applying only to bars that also serve food.

      That led to several really good restaurants closing in the entertainment district that had sprung up near the casinos - an area the city had spent considerable money developing. It's basically dead now except for the casinos and a strip club, although the smoking ban was just the final straw not the cause.

      In other parts of the city, several well-established restaurants added on very nice outdoor dining areas where smoking is allowed. Since this expanded the number of seats, they have ultimately profited from the ban. The restaurants downtown didn't have that option open to them for several reasons.

      Not all smoking bans are created equal and some of them didn't benefit barkeeps very much.

      • Lab Rat says:

        Also some non-smokers are friends with smokers, it happens. Having whole areas that are either 'smoking' or 'nonsmoking' is a bit crap if a group of friends are trying to decide which pub to go too...

  • PalMD says:

    Casinos were also exempted here. Bad idea.

  • Clara says:

    You don't have the unlimited right to make rules on private property or in a private business (whatever that racist Ron Paul might like): you can't turn someone away from a bar because of the color of their skin, their gender, or a physical handicap. (You might not be obliged to install an access ramp, but if someone with a cane makes it up your stairs, you can't turn them away because you think they'll make your bar look bad.)

    Property is a social construct. There are sound reasons why we invented it and continue to use it, but it isn't a physical thing in the world the way oxygen or trees are, and it isn't an absolute.

    • Clara says:

      Dear fellow libertarians,

      If there is one thing that we all ought to realize when talking about rights, it is that

      THERE ARE OFTEN CONFLICTS BETWEEN OPPOSING RIGHTS.
      For example, what would you say to smokers, who have children, smoking in their own private homes? Now that isn't forbidden by law. And yet, one cannot help wonder how to balance the parent's right to smoke with the child's right to avoid second-hand smoke? Of-course, the child may not always complain and even take to early smoking. Now if nobody is complaining, there is argument from rights, no question of conflict of rights but for the child's health which could have been far better in a healthier environment - you see the point, don't you?

      We have to choose the right balance between opposing rights of different people keeping the larger picture in perspective - by trying to identify which things are gratuitous and which absolutely important (good health, for example).

      http://www.youtube.com/watch?v=-3iZVPYhAGk&p=A8C7A27A6C7BF698

  • drugmonkey says:

    how come my post was the only one to draw the whack-jobs?
    /sigh

  • PalMD says:

    I know. Hi-larious.