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Legislation for smoke-free workplaces and health of bar workers in Ireland: before and after study

BMJ 2005; 331 doi: (Published 10 November 2005) Cite this as: BMJ 2005;331:1117

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  1. Shane Allwright (sllwrght{at}, senior lecturer in epidemiology1,
  2. Gillian Paul, research fellow1,
  3. Birgit Greiner, senior lecturer in epidemiology and public health2,
  4. Bernie J Mullally, research associate2,
  5. Lisa Pursell, senior researcher3,
  6. Alan Kelly, senior lecturer in biostatistics1,
  7. Brendan Bonner, manager4,
  8. Maureen D'Eath, researcher3,
  9. Bill McConnell, director5,
  10. James P McLaughlin, senior lecturer in physics6,
  11. Diarmuid O'Donovan, senior lecturer in social and preventive medicine3,
  12. Eamon O'Kane, director7,
  13. Ivan J Perry, professor of public health2
  1. 1 Department of Public Health and Primary Care, University of Dublin, Trinity College, Trinity College Centre for Health Sciences, AMNCH, Tallaght, Dublin 24, Republic of Ireland
  2. 2 Department of Epidemiology and Public Health, University College Cork, Brookfield Health Sciences Complex, Cork, Republic of Ireland
  3. 3 Department of Health Promotion, National University of Ireland, Galway, Republic of Ireland
  4. 4 Western Investing for Health Partnership, Londonderry BT47 6FN, Northern Ireland
  5. 5 Department of Public Health Medicine, Western Health and Social Services Board, Londonderry BT47 6FN
  6. 6 School of Physics, University College Dublin, Belfield, Dublin 4
  7. 7 Derry Healthy Cities, The Old Nursing Home, Altnagelvin Hospital, Londonderry BT47 6SB
  1. Correspondence to: S Allwright
  • Accepted 7 October 2005


Objectives To compare exposure to secondhand smoke and respiratory health in bar staff in the Republic of Ireland and Northern Ireland before and after the introduction of legislation for smoke-free workplaces in the Republic.

Design Comparisons before and after the legislation in intervention and control regions.

Setting Public houses in three areas in the Republic (intervention) and one area in Northern Ireland (control).

Participants 329 bar staff enrolled in baseline survey; 249 (76%) followed up one year later. Of these, 158 were non-smokers both at baseline and follow-up.

Main outcome measures Salivary cotinine concentration, self reported exposure to secondhand smoke, and respiratory and sensory irritation symptoms.

Results In bar staff in the Republic who did not themselves smoke, salivary cotinine concentrations dropped by 80% after the smoke-free law (from median 29.0 nmol/l (95% confidence interval 18.2 to 43.2 nmol/l)) to 5.1 nmol/l (2.8 to 13.1 nmol/l) in contrast with a 20% decline in Northern Ireland over the same period (from median 25.3 nmol/l (10.4 to 59.2 nmol/l) to 20.4 nmol/l (13.2 to 33.8 nmol/l)). Changes in self reported exposure to secondhand smoke were consistent with the changes in cotinine concentrations. Reporting any respiratory symptom declined significantly in the Republic (down 16.7%, −26.1% to −7.3%) but not in Northern Ireland (0% difference, −32.7% to 32.7%). After adjustment for confounding, respiratory symptoms declined significantly more in the Republic than in Northern Ireland and the decline in cotinine concentration was twice as great.

Conclusion The smoke-free law in the Republic of Ireland protects non-smoking bar workers from exposure to secondhand smoke.


  • Contributors All authors reviewed and approved the final version of this manuscript. SA conceptualised the study and was involved in and coordinated all aspects of the study, performed most of the analyses, wrote all drafts of the paper, and is guarantor. GP participated in design, preparation of study materials and protocol, data collection, data entry/editing, interpretation, and preparation of drafts. BG and LP participated in design, preparation of study materials and protocol, interpretation, and preparation of drafts. BJM participated in design, preparation of study materials and protocol, data collection, data entry/editing, and preparation of drafts. AK was statistical adviser, conducted statistical modelling, and participated in the interpretation. MD'E participated in data collection, data entry/editing, and commented on drafts. EO'K participated in design and data collection and commented on drafts of the manuscript. JPMcL participated in the research design and protocol preparation and commented on drafts. DO'D participated in the research design and protocol preparation, contributed to preparation of study materials, and commented on drafts. BB, BMcC, and IJP participated in design and commented on drafts.

  • Funding Office of Tobacco Control through the Research Institute for a Tobacco Free Society (Republic of Ireland); the National Cancer Institute of the United States (R01 CA90955); Irish Cancer Society; Irish Heart Foundation; Health Service Executive, Western Area, and Western Investing for Health Partnership (Northern Ireland). Mandate Trade Union provided two prizes for a draw.

  • Competing interests SA is a member of the Board of the Irish Office of Tobacco Control (unpaid position). IJP is chairman of the Irish Research Institute for a Tobacco Free Society.

  • Ethical approval Research ethics committee of the Faculty of Public Health Medicine, Royal College of Physicians of Ireland; the St. James's Hospital and Federated Dublin Voluntary Hospitals joint research ethics committee; the clinical research ethics committee of the Cork Teaching Hospitals; and the healthcare committee and senior management team of the Western Health and Social Services Board and the Western Investing for Health Partnership.

  • Accepted 7 October 2005
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