Once comprehensive smoke-free policies are adopted, the health benefits are immediate, both among workers and the general population. Levels of indoor air pollution decrease by about 90%, providing significant benefits to respiratory and cardiac health. Ventilation and filtration systems do not eliminate disease risk (Repace 2004, 2005; Travers 2004; Eisner et al. 1998; Farrelly et al. 2005; Allwright et al. 2005; ASHRAE 2005; Americans for Nonsmokers Rights Foundation 2005; Stark et al. 2007; Pell et al. 2008; Hyland et al. 2008; Arheart et al. 2008; Glantz 2008).
Comprehensive smoke-free policies are highly effective in reducing exposure to secondhand smoke and result in improved short-term health outcomes. The particles found in secondhand smoke are very small and are easily inhaled into the lungs. Studies have documented levels of fine particles in bars and restaurants that are about 90% lower in jurisdictions with smoke-free policies compared to those where smoking is permitted (Repace 2004; Travers 2004; Hyland et al. 2008) and a 90% drop in carcinogenic polycyclic aromatic hydrocarbons (Repace 2004). These air quality improvements have health benefits for bar and restaurant staff.
Bartenders in California experienced improvements in lung function and decreases in the frequency of adverse respiratory symptoms shortly after their statewide law took effect in January 1998 (Eisner et al. 1998). A 2007 study found that levels of NNK, a potent cancer-causing chemical that is a by-product of tobacco smoke, in the urine of nonsmoking hospitality staff working in smoky workplaces increased with as little as one hour of exposure to secondhand smoke (Stark et al. 2007). In the months after New York States smoke-free law took effect, hospitality workers experienced large decreases in cotinine, which is a marker for exposure to nicotine, and were less likely to report adverse symptoms such as wheezing, cough, and shortness of breath (Farrelly et al. 2005). In a nationally representative study cotinine levels have decreased from 1988 to 2002 in all worker groups, with the largest reductions in blue collar and service occupations (Arheart et al. 2008). Similar health improvements following Irelands smoke-free law were observed, while the negative health effects of secondhand smoke remained constant in Northern Ireland, which did not implement a smoke-free policy (Allwright et al. 2005). Ten months after Scotlands smoke-free law took effect, admissions for acute coronary syndrome decreased by 17% compared to a 4% decrease in neighboring England that did not have a smoke-free law in effect at the time (Pell et al. 2008). A 2008 review by Glantz estimates that comprehensive smoke-free legislation reduces rates of myocardial infarction in the general population by 19% from his review of the eight studies done to date (Glantz 2008).
Some policymakers have proposed addressing the problem of secondhand smoke in the workplace by requiring businesses to install special ventilation or filtration equipment. ASHRAE, the leading professional society for heating and air conditioning professions, concluded in a 2005 report that at present, the only means of effectively eliminating health risk associated with indoor exposure is to ban smoking activity (ASHRAE 2005). Given the amount of air exchanges required to remove the smoke, there is no practical ventilation method available to render smoke-filled air as safe as fresh outdoor air (Repace 2005).
Filtration technologies do not remove the exposure between the source of the pollutant and the filtration device and, consequently, there is no empirical evidence that they reduce disease risk. Several manufacturers of air handling and filtration equipment have been quoted as saying that filtration technologies will not eliminate the risk of secondhand smoke (Americans for Nonsmokers Rights Foundation 2005).