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Protection from exposure to second-hand tobacco smoke. PoLicy recommendations. Better worker health Smoke-free environments are a highly Self-reported respiratory symptoms among effective smoking cessation intervention Irish barworkers decreased by 16.7% one year Smoke-free environments not only protect the after implementation of its smoke-free law.88 health of non-smokers, they also have a bene- ficial impact on reducing smoking. The World A study in California, United States showed a Bank has concluded that smoking restrictions reduction of 59% in negative respiratory symp- can reduce overall tobacco consumption by 4- toms and a reduction of 78% in sensory irritation 10%.95 A more recent review of studies in symptoms in bartenders within eight weeks Australia, Canada, Germany and the United after the implementation of the law requiring States concluded that smoke-free workplaces bars to be smoke-free, compared with symp- result in a reduction in consumption of 29% by toms reported prior to the smoke-free law.89 smokers.96 The review estimated that, on aver- age, smoke-free workplaces reduce consump- In New Zealand, a 2002 studyfound that people tion by 3.1 cigarettes per day per smoker and " working in smoke-free office environments reduce smoking prevalenceby3.8%. This impact were less likely to report respiratory and irri- is greatly attenuated when smoking is allowed tation symptoms than hospitality workers in designated rooms or areas. exposed to SHS in the workplace [smoke-free bars were not implemented until December White not required by any of the taws creating 20041.90 smoke-free environments, more people volun- tary make their homes smoke-free when work- In Scotland, within three months of implement- place and public place laws are imptemented.97 ing smoke-free legislation in 2006, barworkers Smoke-free homes protect workers' children " showed significant early improvements in res- and other family members from SHS and fur- piratory symptoms, objective measures of lung ther increase the likelihood that the smokers y function and systemic inflammation. Asthmatic will successfully quit smoking. bar workers also demonstrated reduced air- way inflammation and improved quality of life. 91 In fact, smoke-free environments can be more cost-effective than programmes targeted specifi- In the United States, in the communities of cally at smoking cessation. One study showed Helena, Montana and Pueblo, Colorado as well that smoke-free environments are nine times as in the Piedmont region of Italy, the number more cost-effective per new non-smoker than w of hospital admissions for heart attacks (acute providing smokers with free nicotine replace- myocardial infarction) dropped by an average ment therapy.9 Indeed, several countries that of 20%h following implementation of strong have recently implemented comprehensive smoke-free workplace and public place tegis- smoke-free laws report declines in tobacco con- tation. There was no decline in admissions in sumption (as measured by tobacco sales data similar communities used as controls. However, or by surveys of smoking prevalence) and/or a r when the smoke-free law in Helena was switch to smokeless tobacco following the repealed under tobacco industry pressure, hos- implementation of the laws.", m0 Some have pital admissions rose to levels seen prior to also reported increases in call volume to r implementation of the law.93, 94 national "quit lines" immediately after imple- mentation, although call volume tends to return to normal after a few months.101 nl h Stan A Glantz, personal communication of the result of a meta-analysis of the three studies. M