ARTICLES-HEALTH EFFECTS OF SMOKE EXPOSURE PubMed medline query Page 1 of 2
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JAMA 1998 Dec 9;280(22):1909-14
Bartenders' respiratory health after establishment of smoke-
free bars and taverns.
Eisner MD, Smith AK, Blanc PD
Department of Medicine, Cardiovascular Research Institute,University of California, San Francisco,
USA.
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 (FEV 1) 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 FEV l (0.039 L;
95% Cl, -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 FEV 1 (0.142 L; 95% Cl, 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.
Comments:
. Comment in: JAMA 1998 Dec 9;280(22):1947-9
. Comment in: JAMA 1999 Mar 24-31;281(12):1083
McSH Terms:
httt)://www.ncbi.nlm.nih.L-ov 12/13/1999
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Int Arch Occup Environ Health 1997;69(2):125-33
Effect of 3 hours' passive smoke exposure in the evening on
airway tone and responsiveness until next morning.
Nowak D,Jorres R, Schmidt A, Magnussen H
Krankenhaus Grosshansdorf, Germany.
To study the effect of environmental tobacco smoke (ETS) exposure in the evening on nocturnal
changes in airway tone and responsiveness, 17 subjects with mild asthma(mean+/- SD age, 26 +/- 5
years, FEV 1%pred., 89 +/- 14%) were exposed to either ambient air(sham) or ETS (20 ppm CO) for
3 h(7:00 to 10:00 p.m.). Seven subjects had a history of ETS-induced respiratory symptoms.
Spirometry was performed 2 h before exposure (5:00 p.m.), every 30 min during exposure, and at
11-00 p.m., 3:00 a.m., and 7:00 a.m. The provocative concentrations of methacholine necessary to
decrease FEV 1 by 20%, PC20FEV 1,were assessed at 5:00 p.m., 11:00 p.m., 3:00 a.m., and 7:00 a.m.
Compared with pre-exposure measurements,mean FEV 1 values during and after ETS exposure were
significantly lower than with sham exposure=0.013 and 0.026). This effect, however, was due to a
significant response in single individuals. The higher bronchial responsiveness after ETS than after
sham exceeded one doubling concentration in 4, 5, and 4 patients at 11:00 p.m., 3:00 a.m., and 7:00
a.m., respectively. The opposite effect was observed in 2, 2, and 2 patients,respectively. There was
no statistically significant mean effect of ETS on airway responsiveness during night; however,there
was significant heterogeneity in individual responses (P =0.0002). Patients with and without a
history of ETS-induced symptoms did not show different responses to experimental ETS exposure. In
conclusion, our data suggest that in single adult subjects with mild asthma, acute exposure to ETS in
the evening can produce a deterioration of airway tone and responsiveness during the night, with
wide interindividual variability in the response.
Publication Types:
. Clinical trial
McSH Terms:
. Adult
. Analysis of Variance
. Asthma/physiopathology*
. Bronchial Provocation Tests
. Female
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JAllergy Clin Immunol 1991 Dec;88(6):861-9
Asthmatic responses to passive cigarette smoke: persistence of
reactivity and effect of medications.
Menon PK, Stankus RP, Rando RJ, Salvaggio JE,Lehrer SB
Department of Medicine, Tulane Medical School,New Orleans, LA 70112.
The present study assessed the persistence of cigarette-smoke reactivity and the effects of drug
pretreatment on bronchial responsiveness to environmental tobacco smoke (ETS). Two groups of
subjects were chosen for the study. Group I consisted of 15 atopic smoke-sensitive subjects with
asthma, six of whom were defined "reactors" and nine "nonreactors" to ETS challenge. Group II
consisted of 15 atopic subjects without asthma and with documented upper respiratory tract
symptoms on exposure to ETS. All subjects were challenged for 2 to 6 hours with mechanically
generated ETS in a static inhalation chamber. Five/six subjects in group I, who were previously
demonstrated as reactors 24 months earlier, remained reactive within I to 2 hours of continuous ETS
exposure. Pretreatment with albuterol, cromolyn, and a combination of albuterol and cromolyn 30
minutes before ETS exposure significantly diminished airway reactivity to ETS. All nine previous
nonreactors in group I remained nonreactive despite rechallenge with ETS for up to 6 hours. Group II
subjects challenged under identical conditions did not reveal a significant decline in FEV 1 on
challenge with ETS. These studies demonstrate the persistence of ETS reactivity during a 2-year
period. Although cromolyn sodium and/or albuterol can protect against reactivity, mechanisms of
ETS-induced airway reactivity remain unknown.
McSH Terms:
. Adult
. Albuterol/therapeutic use
. Asthma/physiopathology
. Asthma/etiology*
. Asthma/drug therapy
. Bronchial Provocation Tests
. Comparative Study
. Cromolyn Sodium/therapeutic use
. Female
. Human
. Hypersensitivity, Immediate/physiopathology
. Male
http://www.ncbi.nlm.nih.gov 12/13/1999
a
Respiratory Effects of Secondhand Smoke Page 1 of 2
Respiratory Effects of Secondhand Smoke
To the Editor: The pulmonary function changes reported by Dr
Eisner and colleagues!are quantitatively similar to those previously
observed by our laboratory. In our 5-day environmental room study
on 20 healthy subjects who had never smoked (10 men and 10
women, aged 21-50 years), a 7.33-hour exposure to 179 pg/m3 of
respirable suspended particles of fresh diluted sidestream smoke
generated by a machine that was smoking 1 R41F Kentucky reference
cigarettes resulted in the following exposure-related statistically
significant decreases: forced ventilatory capacity(-1.7%), forced
expiratory volume in 1 second (-1.6%), and forced expiratory flow
[FEFo 2.1 2, subscript indicating the volume segment of 200 mL to
1200 mL in adults] (4.4%). These same subjects may have
experienced an exposure-related increase in epinephrine release as
evidenced by an increase in triglyceride level and decrease in high-
density lipoprotein (HDL)cholesterol level, results consistent with a
sensory-mediated epinephrine-induced mobilization of free fatty
acids and concomitant lowering of HDL. Therefore, it is plausible
that the observed decreases in pulmonary function may have been
related also to sensory-mediated epinephrine release.
Before extrapolating to the long-term clinical effects of reversible
pulmonary function decreases of this magnitude related to
environmental tobacco smoke, additional studies(eg,
bronchoalveolar lavage studies, induced sputum studies,
technetium-labeled radioaerosol of diethylenetriamine pentaacetic
acid lung scans) of the inflammatory status of the upper and lower
airways should be conducted.
Carr J. Smith, PhD
Stephen B. Sears, PhD
R. J. Reynolds Tobacco Company
Winston-Salem, NC
1. Eisner MD, Smith AK, Blanc PD. Bartenders' respiratory health
after establishment of smoke-free bars and taverns. JAMA.
1998;280:1909-1914. MEDLINE
2. Smith CJ, Bombick DW, McKarns SC, Morton MJ, Morgan WT, JA M q
Doolittle DJ. Environmental room human physiology study using Vol e281 jF ia-
fresh diluted sidestream cigarette smoke. In: Proceedings of the
1996 CORESTA Congress; Yokahama, Japan; November 6, Ma,e,4 917
1996:37-48.
In Reply: We are pleased to see that the human exposure data
from the R. J. Reynolds Tobacco Company Bowman Gray Technical
Center also confirm an acute decrement in lung function following
controlled experimental human exposures to sidestream tobacco
smoke. We would encourage Drs Smith and Sears to publish these
htt-P:Hiama.ama-assn.org/issues/v281n12/fulUj1t0324-4.htm1 12/13/1999
Respiratory Effects of Secondhand Smoke Page 2 of 2
IUII ILJ.J 111 IU11. 1 IVYIV UJ VA'./VJUIV VIIGIIIVVI VGLG IIGYV JUIJ I`.'VJLVV
that adults with asthma may experience even greater declines in
airflow following exposure to environmental tobacco smoke,!,z and
a more recent study also observed changes in airway
responsiveness in some asthmatic adults exposed under laboratory
conditions.3 Any association between controlled sidestream tobacco
smoke and triglycerides and HDL may have a variety of correlates,
including circulating catecholamines. One would assume, however,
that increased catecholamines, if anything, would produce
bronchodilation, thus increasing airflow. An earlier chamber study
that specifically investigated the question did not find that subject
suggestibility had a meaningful contribution to the physiologic
responses to secondhand smoke.4 The known direct irritants in
secondhand smoke provide substantial biologic plausibility for acute
airway symptoms and obstruction following this exposure.
Mark Eisner, MD
Paul Blanc, MD, MSPH
University of California, San Francisco
1. Menon PK, Stankus RP, Rando RJ, Salvaggio JB, Lehrer SB.
Asthmatic responses to passive cigarette smoke: persistence of
reactivity and effect of medications. J Allergy Clin lmmunol.
1991;88:861-869. MEDLINE
2. Dauser B, Weber A, Hartman AL, Kreuger H. Effects of a
bronchoprovocation challenge test with cigarette sidestream smoke
on sensitive and healthy adults. Chest. 1993;103:353-358. MEDLINE
3. Nowak D, Jorres R, Schmidt A, Magnussen H. Effect of 3 hours'
passive exposure in the evening on airway tone and responsiveness
until next morning. Int Arch Occup Environ Health. 1997;69:125-133.
MEDLINE
4. Urch RB, Silverman F, Corey P, Shephard RJ, Cole P, Goldsmith
LJ. Does suggestibility modify acute reaction to passive cigarette
smoke exposure? Environ Res. 1988;47:34-47. MEDLINE
httn://iama.ama-assn.orWissues/v28lnl2/fulUiltO324-4.html 12/13/1999
Tourism and Hotel Revenues Before and After Passage of Smoke-Free Restaurant Ordinan.. Page 1 of 2
Tourism and Hotel Revenues Before and After
Passage of Smoke-Free Restaurant
Ordinances
J Stanton A. Glantz, PhD;Annemarie Charlesworth, MA
Context Claims that ordinances requiring smoke-free restaurants
will adversely affect tourism have been used to argue against
passing such ordinances. Data exist regarding the validity of these
claims.
Objective To determine the changes in hotel revenues and
international tourism after passage of smoke-free restaurant
ordinances in locales where the effect has been debated.
Design Comparison of hotel revenues and tourism rates before and
after passage of 100% smoke-free restaurant ordinances and
comparison with US hotel revenue overall.
Setting Three states (California, Utah, and Vermont) and 6 cities
(Boulder, Colo; Flagstaff, Ariz; Los Angeles, Calif; Mesa, Ariz; New
York, NY; and San Francisco, Calif) in which the effect on tourism of
smoke-free restaurant ordinances had been debated.
Main Outcome Measures Hotel room revenues and hotel
revenues as a fraction of total retail sales compared with
preordinance revenues and overall US revenues.
Results In constant 1997 dollars, passage of the smoke-free
restaurant ordinance was associated with a statistically significant
increase in the rate of change of hotel revenues in 4 localities, no
significant change in 4 localities, and a significant slowing in the rate
of increase(but not a decrease) in 1 locality. There was no
significant change in the rate of change of hotel revenues as a
fraction of total retail sales (P=.16)or total US hotel revenues
associated with the ordinances when pooled across all localities
(P=.93). International tourism was either unaffected or increased
following implementation of the smoke-free ordinances.
Conclusion Smoke-free ordinances do not appear to adversely
affect, and may increase, tourist business.
JAMA. 1999;281:1911-1918
Author/Article Information
Author Affiliations: Institute for Health Policy Studies, Department
of Medicine, University of California, San Francisco. ,J A H a
Corresponding Author and Reprints: Stanton A. Glantz, PhD, yoi.
Pax(
http://jama.aina-assn.org/issues/v28ln2O/abs/J*oc8l586.htmi 12/13/1999
Tourism and Hotel Revenues Before and After Passage of Smoke-Free Restaurant Ordinan.. Page 2 of 2
viviawil vi vaiUivwyy, vinvcIOILY vi vauivirna, ..rail i �ai��w�.v, vale
Francisco, CA 94143-0124 (e-mail: lantz medicine.ucsf.edu).
Funding/Support: This work was supported by National Cancer
Institute grant CA-61021 and a gift from Edith and Henry Everett.
Acknowledgment: We thank Jeremiah Paknawin-Moch, MS, for his
comments on the manuscript.
http://jama.ama-assn.org/issues/V28ln2O/abs/joc8l586.html 12/13/1999