From Tobacco Info No. 2 - September 2010
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Government urged by doctors group to ban smoking on restaurant and bar patios

by Joe Strizzi

Hospitality workers and patrons continue to be exposed to dangerously high levels of second-hand cigarette smoke, says Physicians for a Smoke-Free Canada (PSC), a national health organization, and it is calling on provincial and municipal governments to make restaurant and bar patios smoke-free, and to be quick about it, according to a May 25 press release.

“Canadian researchers have assembled compelling evidence to demonstrate that laws to keep restaurant patios smoke-free are necessary to protect the health of workers and the public,” said Neil Collishaw, research director at PSC. “Yet, eight in 10 Canadians live in a community where such measures are not in place.”

Four provinces (Newfoundland and Labrador, Prince Edward Island, Nova Scotia and Alberta), the Yukon Territory and several cities in British Columbia, Ontario and Alberta, as well as other municipalities across Canada, have legislation that provides protection from second-hand smoke on restaurant patios. Together, these communities help safeguard 6.8 million Canadians.

On the other hand, 24.7 million Canadians live in areas where no such protection exists, and PSC, a group of Canadian physicians whose aim is to decrease tobacco-caused illness through the reduction of smoking and exposure to second-hand smoke, argues that this needs to change because second-hand smoke is dangerous.

The compelling evidence

Second-hand smoke is the smoke smokers exhale and the smoke emitted from a smouldering cigarette containing some 4,000 chemicals, over 60 of which are known to cause cancer. Medical authorities, such as the World Health Organization, contend that there is no safe level of exposure to second-hand smoke. In 1992, the US Environmental Protection Agency classified second-hand smoke as a Class A carcinogen, the most dangerous category of cancer-causing agents.

Many people mistakenly believe that there is no health risk from second-hand smoke outdoors, as the smoke will simply dissipate into the atmosphere or blow away. The truth, according to PSC’s examination of numerous studies, is that when there is no wind, cigarette smoke will rise and then fall, saturating the immediate area with second-hand smoke. When there is a breeze, cigarette smoke can travel in multiple directions, exposing people down-wind. Depending on various factors such as the number of smokers and cigarettes smoked, non-smokers can be exposed to as much second-hand smoke in outdoor areas, like restaurant patios, as they were in indoor restaurants that allowed smoking in the past.

Researchers in Victoria, BC monitored tobacco smoke levels in outdoor public places where smokers were present, including restaurant and bar patios, and sidewalk cafes. Descriptive statistics including the outdoor smoking area (OSA) size, percent of OSA with a roof above, percent of enclosed wall space, average number of patrons, average number of burning cigarettes, and average cigarette proximity were reported for each venue and averaged for all venues. The results of the study entitled Environmental Tobacco Smoke in Indoor and Outdoor Public Places and conducted by the BC Provincial Health Services Authority in 2006 showed that being close to smokers outdoors resulted in similar levels of exposure to smoke as spending the same amount of time in a smoky tavern, which surpasses accepted health standards. A comparable review in 2007 by the Roswell Park Cancer Institute showed similar results.

“With as few as three cigarettes being smoked, the air quality was very similar on those patios [where smoking was permitted] to that which used to be found in indoor premises with no restrictions on smoking,” said Richard Stanwick, chief medical health officer with the Vancouver Island Health Authority.

Outdoor smoking areas at restaurants and other venues also cause problems for the people inside. According to a study conducted by Kennedy, Travers, Hyland and Fong, smoke drifts indoors from outdoor places that permit smoking. The researchers from Waterloo, Ontario conducted experiments on the effect of as few as eight cigarettes on a typical restaurant patio that had no roof, walls, awning or umbrellas. Researchers repeated the experiments 46 times under different wind conditions and in each case found that when cigarettes are smoked, the air quality in the patio area falls considerably. The study, entitled Tobacco Smoke Pollution on Outdoor Patios, found that measurements of air particulates, which contain chemicals that cause cancer and heart disease, were also four times higher than a non-smoking patio.

“We now know that it is not enough to ban smoking inside restaurants, and that outdoor spaces must also be kept smoke-free,” said Neil Collishaw.

These studies are not unique to Canada. Stanford University researchers, writing in the May issue of the Journal of the Air and Waste Management Association, concluded that a non-smoker sitting a few feet down-wind from a smouldering cigarette is likely to be exposed to substantial levels of contaminated air for brief periods of time.

A study in Ireland conducted by Mulcahy, Evans, Hammond, Repace and Byrne in 2005, and published in the peer-reviewed journal Tobacco Control by the British Medical Journal Group, found that those who worked in bars with outdoor smoking areas, and were not otherwise exposed to second-hand smoke, had much higher blood nicotine levels than those who worked in bars without outdoor smoking areas.

Progress is never ending

The Canadian Community Health Survey (CCHS) conducted by Statistics Canada shows that the number of Canadians who reported being exposed to second-hand smoke in public places fell by half between 2003 and 2009, from 3.99 million (20% of people 12 years of age or older) reporting past month exposure in 2003, to 2.26 million (10%) in 2009.

“Enormous progress has been made since Victoria, BC became Canada’s first jurisdiction to ban smoking in bars, restaurants, bingo halls and other public areas in 1999,” said Collishaw. “But the job of protecting workers and the public is not yet done.”

A study published in Circulation, Journal of the American Heart Association in September 2009 by Lightwood and Glantz pooled the results of approximately 20 different studies in multiple cities or regions across Europe and North America. The researchers found that when legislation was implemented that banned smoking in workplaces and other areas, hospital admissions for heart attacks dropped rapidly, by about 20%, and improved over time.

A team from the Research Institute for a Tobacco Free Society in Dublin, Ireland studied environmental tobacco smoke exposure in the city’s 42 pubs, and tested 73 bar workers who volunteered to take part. According to the study published in the American Journal of Respiratory and Critical Care Medicine in 2007, the workplace smoking ban has improved air quality in pubs, as well as bar workers’ health, with an 83% reduction in air pollution, an 80% reduction in cancer-causing agents and an improvement in the lung function of bar workers. “These results confirm that the approach of a total ban on smoking in the workplace is successful in reducing the exposure of workers,” said Luke Clancy, research leader.

PSC’s call for improved protection of restaurant workers from cigarette smoke was made last May, on the fourth anniversary of the death of Heather Crowe, a non-smoking Ottawa waitress whose lung cancer was attributed to exposure to cigarette smoke at work and who successfully campaigned for changes to the law to protect hospitality and other workers from exposure to smoke.

“Hospitality workers will continue to be victimized by laws that allow them to be exposed to higher levels of cancer-causing chemicals than are permitted by law for any other sector, until outdoor workplaces are also smoke-free,” said Collishaw.

PSC aims to protect youth

Protecting young people from cigarette smoke in public places is another motivator for PSC. In a report entitled Exposure to second-hand smoke in Canada in 2008, PSC recounts findings from the CCHS that 16.8% of young Canadians aged 12-19 report being exposed to second-hand smoke at home or in public places, the highest exposure of any age group.

“Children are almost twice as likely to report being exposed to second-hand smoke as the general population,” said Collishaw. “Because young people’s bodies are still developing, exposure to cigarette smoke may be particularly harmful in those years.”

Collishaw added that researchers have found many problems with second-hand smoke and children, including an increased rate of heart disease and respiratory failure. In addition, girls who are exposed to second-hand smoke during puberty, when their breast tissue is growing, are at increased risk of early breast cancer.