An F2c Triblogology-part 1
The objective of this tri part series of blogs is to take a critical look at the recent ‘evidence review’ on the impact of smokefree legislation in England authored by Professor Linda Bauld for Her Majesty's Government.
Linda Bauld, The UK Government's scientific adviser on tobacco control and Vice-chair of Cancer Research UK's Tobacco Advisory Group who wrote the ‘evidence’ report.
The main part of the review focused on bars and bar workers. The review, according to its author, set out to examine the following:
How air quality and bar workers’ SHS exposure changed over time;
Whether bar workers experienced any improvements in their respiratory health following introduction of the restrictions;
The impact of smokefree legislation on the Hospitality Industry. (*This will be covered in the third part of this blog series).
Exposure of bar workers to Second Hand Smoke (SHS).
A small sample of bar workers from 46 bars in England had lung function and saliva tests taken at the start of the legislation (phase 1), then after two months (phase 2) and finally at one year after the legislation (phase 3).
Not surprisingly, SHS exposure decreased at phase 2 because the Health Act 2006 expressly prohibited smoking inside public venues and work premises. As far as smoke is concerned, even to the layman, it dropped from a level that the Health and Safety Executive deemed to be acceptable to almost zero, that is assuming the law was enforced rigidly since no one should be smoking there.
However the level of exposure to SHS increased between phase 2 and phase 3. No explanation was given in the review.
It is surprising that standard saliva tests for cotinine were used. It is well known in scientific circles that such tests can be prejudiced simply by eating a cheese and tomato roll, or chips as both tomatoes and potatoes contain cotinine - a fact omitted in this report and which casts doubt on the review findings.
Changes in respiratory health of bar workers since the smokefree legislation.
With regard to whether bar workers have experienced changes in their respiratory health, it appears that any evidence is inconclusive. The ‘study’ on the health of the bar workers consisted of just 178 people being given a questionnaire to ‘self report’ their respiratory and other symptoms over the same 3 phases .
All the data was ‘self reported’ through all three phases, an extremely unreliable method of data-collection in an industry where staff turnover is so high. Very few of the subjects actually completed each phase so there is little or no consistency in the data.
Whether bar workers experienced any improvements in their respiratory health following introduction of the restrictions is a matter for conjecture as the figures quoted could be open to interpretation that there was either a dramatic deterioration in bar workers' health following the ban, or that their health slightly improved!
The review states that 178 people ‘self-reported’ at phase 1 of the study, with 119 of them reporting respiratory and other symptoms.
One year later, at phase 3, just 63 people were left in the study and we are not told whether these were the bar workers who had reported respiratory symptoms at phase 1 or the ones who had been lost to the study at this final phase.
We are told that 40% of the remaining 63 bar workers ‘self-reported’ respiratory and other symptoms at phase 3 of the study; again we are not told if these 25 bar workers were self-reporting respiratory and other symptoms at the beginning of the study.
If 40% of bar-workers still ‘self-reporting’ respiratory and other symptoms one year after the ban in their workplace then this must throw grave doubts on 'second hand smoke' being a cause of respiratory or any other symptoms, in the first place. Outside pollutants have a massive bearing on our respiratory system. Britain's air pollution contributes to 50.000 deaths every year.
It appears that the ‘health of bar workers’ was deemed to have improved based solely on the self-reports of just a handful of people.
As of the time of writing, the English Health of Bar Workers study is still not publicly available, despite having been paid for by public money.
Children's Exposure to 'second-hand smoke'.
Another section of the review reports on children’s exposure to SHS, but is severely hampered by incomplete data. This review [the Bauld report] claims that fewer children are exposed to SHS, which implies that fewer people are smoking at home. They are certainly not smoking in pubs, but they are smoking somewhere and the only permissible indoor place is the home.
Despite the claims of ever growing numbers of ‘quitters’ the tobacco industry continues to thrive and prosper as any legitimate business should, even without those who legitimately buy their tobacco abroad and those who buy on the black market. Both areas are thriving due to excessive taxation on tobacco products - so just where are all these smokers smoking? This review does not enlighten us.
The review also states that 'SHS' exposure in the home had decreased by 70% (since 1996) up to the start of smokefree legislation. This trend is analysed in some depth - mainly, we suspect, because the authors were stuck for something meaningful to say about the post-ban period and its impact on childhood exposure to tobacco smoke. With only six months' worth of post-ban data, most of it showing a flattening trend, what could they say?
Instead, Bauld moves outside the remit of this review. By highlighting the correlation between high-pressure, anti-smoking publicity (pre-ban) and the (pre-ban) fall in childhood exposure, she cleverly forces another Lansley U-turn.
This 'Evidence' Review is based on nothing of the kind and serves only to justify the continued erosion of our adult leisure pursuits by Public Health.
*To be continued…