Exposure to secondhand smoke in the workplace: serum cotinine by occupation

To examine workplace exposure to secondhand smoke by occupation, we analyzed data from The Third National Health and Nutrition Examination Survey (NHANES III) (1988 to 1994), a nationally representative sample of the noninstitutionalized population. The analysis was restricted to 4952 employed nonsmoking adults who reported no home exposure to cigarette smoke. Occupations were assigned to 40 groups and 7 categories. Among the categories, geometric mean serum cotinine (ng/mL) ranged from 0.09 for farming/forestry/fishing occupations to 0.22 for operators/fabricators/laborers (median, 0.16). The lowest values were observed among farmers and nursery workers (0.06) and the highest among waiters (0.47). Between 1988 to 1991 and 1991 to 1994, the overall geometric mean cotinine and the proportion reporting that they could smell smoke at work decreased significantly. In conclusion, workplace exposure to secondhand smoke varied by occupation, and decreases in exposure occurred between 1988 to 1991 and 1991 to 1994.     

Media and secondhand smoke exposure: results from a national survey

OBJECTIVES: To investigate whether associations between anti-secondhand smoke (SHS) media, social cognitions about SHS, and home restrictions on smoking follow patterns observed in smoking behavior. METHODS: Based on a nationally representative sample of 2348 US adults drawn from the American Legacy Foundation's American Smoking and Health Survey, we tested relationships among scales of anti-SHS media, social cognitions, and home restrictions. RESULTS: We found anti-SHS media and SHS cognitions, as well as social cognitions and home restrictions, to be significantly associated. Social cognitions mediated the relationship between anti-SHS media and home restrictions. CONCLUSIONS: Previously observed relationships between media, social cognitions, and smoking also exist for SHS. Anti-SHS media campaigns to increase home restrictions may help to reduce SHS exposure.     

Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in nonsmokers

Background: With an increase in indoor smoking bans, many smokers smoke outside establishments and near their entrances, which has become a public health concern.Objectives: We characterized the exposure of nonsmokers to secondhand smoke (SHS) outside a restaurant and bar in Athens, Georgia, where indoor smoking is banned, using salivary cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).Methods: In a crossover study, we assigned 28 participants to outdoor patios of a restaurant and a bar and an open-air site with no smokers on three weekend days; participants visited each site once and stayed for 3 hr. We collected saliva and urine samples immediately before and after the visits (postexposure) and on the following morning and analyzed samples for cotinine and total NNAL, respectively. Regression models were fitted and changes in biomarkers were contrasted between locations.Results: Postexposure and preexposure geometric mean salivary cotinine concentrations differed by 0.115 ng/mL [95% confidence interval (CI): 0.105, 0.126)] and by 0.030 ng/mL (95% CI: 0.028, 0.031) for bar and restaurant visits, respectively. There were no significant post- and preexposure differences in cotinine levels after control site visits, and changes after bar and restaurant site visits were significantly different from changes after control site visits (p < 0.001). Results comparing next-day and preexposure salivary cotinine levels were similar. Next-day creatinine-corrected urinary NNAL concentrations also were higher than preexposure levels following bar and restaurant visits [1.858 pg/mg creatinine higher (95% CI: 0.897, 3.758) and 0.615 pg/mg creatinine higher (95% CI: 0.210, 1.761), respectively], and were significantly different from changes after the control visits (p = 0.005).Conclusion: Salivary cotinine and urinary NNAL increased significantly in nonsmokers after outdoor SHS exposure. Our findings indicate that such exposures may increase risks of health effects associated with tobacco carcinogens.     

Framing of Australian newspaper coverage of a secondhand smoke injury claim: Lessons for media advocacy

This paper focuses on newspaper coverage of the Marlene Sharp legal case in Australia, concerning a non-smoking bar worker who was awarded damages for laryngeal cancer caused by passive smoking. All Australian metropolitan and Victorian regional newspaper coverage of the case was obtained from a commercial media monitoring agency for the month of May 2001, yielding 100 articles for analysis. A qualitative text analysis was conducted on newspaper articles, coding for content, tone and frame. Coverage of the outcome of the Marlene Sharp case was predominantly positive for tobacco control, with positive coverage (45% of articles) outweighing negative coverage (13% of articles) by a factor of 3 to 1. The most commonly occurring frame (27% of articles) advanced the view that legislation to protect workers from secondhand smoke is appropriate, even overdue, and encouraged the government to create smoke-free policies to protect workers. Other common frames positive for tobacco control included ‘smoking as socially unacceptable’ (9%) and ‘smoking as a societal problem’ (9%). Of articles framed negatively for tobacco control, ‘individual rights’ (5%) and ‘system cynicism’ (5%) were most common. Legal cases present special opportunities for public health media advocates to bring a human face to the need to progress passage of smoke-free policies.     

Mortality among lifelong nonsmokers exposed to secondhand smoke at home: cohort data and sensitivity analyses

Evidence is growing that secondhand smoke can cause death from several diseases. The association between household exposure to secondhand smoke and disease-specific mortality was examined in two New Zealand cohorts of lifelong nonsmokers ("never smokers") aged 45-77 years. Individual census records from 1981 and 1996 were anonymously and probabilistically linked with mortality records from the 3 years that followed each census. Age- and ethnicity-standardized mortality rates were compared for never smokers with and without home exposure to secondhand smoke (based on the reported smoking behavior of other household members). Relative risk estimates adjusted for age, ethnicity, marital status, and socioeconomic position showed a significantly greater mortality risk for never smokers living in households with smokers, with excess mortality attributed to tobacco-related diseases, particularly ischemic heart disease and cerebrovascular disease, but not lung cancer. Adjusted relative risk estimates for all cardiovascular diseases were 1.19 (95% confidence interval: 1.04, 1.38) for men and 1.01 (95% confidence interval: 0.88, 1.16) for women from the 1981-1984 cohort, and 1.25 (95% confidence interval: 1.06, 1.47) for men and 1.35 (95% confidence interval: 1.11, 1.64) for women from the 1996-1999 cohort. Passive smokers also had nonsignificantly increased mortality from respiratory disease. Sensitivity analyses indicate that these findings are not due to misclassification bias.     

Second-hand smoke at work: the exposure, perceptions and attitudes of bar and restaurant workers to environmental tobacco smoke

OBJECTIVES: To investigate the knowledge of, and perceptions, attitudes and exposure to second-hand smoke (SHS) of staff in the New Zealand hospitality industry. METHOD: Face-to-face interviews with bar staff, waiters, and bar and eating-place managers and owners in Wellington during the 1999-2000 summer. An analysis was made of the 1999 New Zealand Electoral Roll to find the number of those most exposed to SHS. RESULTS: 435 interviews with full data recovery were completed at 364 locations; 59% of interviewees were exposed to SHS, including 77% of those at licensed premises. More than half of those exposed to workplace smoke reported irritation from SHS to their throat or lungs. Less than a third were aware of the risk of strokes from SHS. Three-quarters of interviewees wanted some sort of smoking restriction in bars. CONCLUSIONS: The majority of interviewees were at risk of premature death and disease because of exposure to workplace smoke, and had an incomplete knowledge of the dangers to which they were exposed. More than 5,000 similar workers in New Zealand appear to share this risk. Implications: This industry needs legislation to make it smoke free.     

Association between respiratory tract diseases and secondhand smoke exposure among never smoking flight attendants: a cross-sectional survey

Background  

Little is known about long-term adverse health consequences experienced by flight attendants exposed to secondhand smoke (SHS) during the time smoking was allowed on airplanes. We undertook this study to evaluate the association between accumulated flight time in smoky airplane cabins and respiratory tract diseases in a cohort of never smoking flight attendants.     

Exposure to and annoyance with second-hand smoke in Switzerland: results of the Tobacco Monitoring survey

Summary. Objectives: To present selected results on exposure to secondhand smoke and experienced annoyance with second-hand smoke in the Swiss population, particularly in restaurants and in the workplace. Methods: The data were collected as part of the Swiss Survey of Tobacco Use (“Tobacco Monitoring”) commissioned by the Swiss Federal Office of Public Health. It is a representative, continuous survey of tobacco consumption among 14- to 65-year-olds in Switzerland. Since January 2001, four times a year a new sample of 2 500 persons has been taken (i. e. 10 000 participants annually). The survey was conducted using standardized telephone interviews in German, French and Italian. Results: Approximately half of the working population in Switzerland is exposed to second-hand smoke in the workplace. In restaurants, cafes and bars, nearly 9 out of 10 people are exposed to environmental tobacco smoke. Non-smokers in particular report annoyance with second-hand smoke. Conclusions: The Swiss population has a high level of exposure to second-hand smoke. There is a need for public health educational programs and legislation aiming at banning smoking in public areas and in the workplace.

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Zusammenfassung. Passivrauch-Exposition und subjektiv empfundene Bel?stigung durch Tabakrauch in der Schweiz: Resultate der Schweizerischen Umfrage zum Tabakkonsum (Tabakmonitoring) Fragestellung: Im vorliegenden Artikel finden sich ausgew?hlte Ergebnisse zur Passivrauchexposition der Schweizer Bev?lkerung sowie zur dadurch hervorgerufenen, subjektiv empfundenen Bel?stigung. Insbesondere wird auf das Passivrauchen in Gastst?tten und am Arbeitsplatz eingegangen. Methoden: Die Daten wurden im Rahmen der Schweizerischen Umfrage zum Tabakkonsum (Tabakmonitoring) erhoben. Mit dem Tabakmonitoring wird der Tabakkonsum der 14- bis 65-j?hrigen Wohnbev?lkerung der Schweiz repr?sentativ und kontinuierlich erfasst. Seit Januar 2001 wird in jedem Quartal ein neues Sample mit 2 500 Personen gezogen, so dass pro Jahr die Antworten von insgesamt 10 000 Befragten zur Verfügung stehen. Die Befragung erfolgt mittels vollstandardisierter Telefoninterviews in deutscher, franz?sischer und italienischer Sprache. Ergebnisse: Rund die H?lfte der Erwerbst?tigen in der Schweiz ist am Arbeitsort dem Passivrauch ausgesetzt. In Restaurants, Cafés und Bars sind es fast neun von 10 Personen, die dem Tabakrauch anderer ausgesetzt sind. Vor allem die tabakrauchexponierten Nichtraucherinnen und Nichtraucher fühlen sich dadurch stark bel?stigt. Schlussfolgerungen: Die Schweizer Bev?lkerung hat eine hohe Passivrauchexposition. Einerseits sollte das Wissen über die Sch?dlichkeit des Passivrauchens verst?rkt der ?ffentlichkeit vermittelt werden. Andererseits braucht es gesetzliche Massnahmen zum Schutz der Nichtraucher, insbesondere in Gastst?tten und am Arbeitsplatz.

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Résumé. Exposition à la fumée passive et impression subjective de gêne provoquée par le tabagisme passif en Suisse: Résultats de l’enquête suisse sur le tabagisme (“Monitorig Tabac”) Objectifs: Présenter une partie des résultats concernant l’exposition de la population suisse au tabagisme passif et l’incommodation ressentie, ce spécialement dans les lieux publics et sur le lieu de travail. Méthodes: Les données sur le tabagisme passif sont issues du “Monitorig Tabac”. Elles permettent de recenser de manière permanente et représentative la consommation de tabac chez les personnes agées de 14 à 65 ans domiciliées en Suisse. Depuis janvier 2001, un échantillon de 2 500 personnes est tiré trimestriellement (soit 10 000 personnes par an). Le sondage est effectué au moyen d’entretiens téléphoniques entièrement standardisés en fran?ais, allemand et italien. Résultats: Environ la moitié de la population active en Suisse est exposée au tabagisme passif. Dans les restaurants, les cafés et les bars, près de neuf personnes sur 10 subissent le tabagisme des fumeurs. Ce sont en particulier les personnes nonfumeuses qui se sentent fortement dérangées par le tabagisme passif. Conclusions: La population suisse est largement exposée au tabagisme passif. L’information concernant les effets du tabagisme passif devrait être renforcée. Des bases légales permettant une protection des non-fumeurs, en particulier dans les espaces publics et sur le lieu de travail, devraient être créées.

     

Exposure to environmental tobacco smoke and absence from work in women in Nis, Serbia

Exposure to environmental tobacco smoke leads to very serious health effects, especially on the respiratory system. The objective of this paper was to estimate the influence of passive smoking on absence from work because of respiratory problems in women. The study sample consisted of 497 women aged 40-56 who live in an area with identical outdoor air pollution. Environmental tobacco smoke exposure was recorded in 346 women. Data about respiratory symptoms in women were entered into a structured questionnaire. Statistics tests showed no significant difference of living conditions, keeping pets, hereditary predisposition among women. The occurrence of congested nose (OR = 3.47; 95% Cl = 1.38-9.01), nasal secretion (OR = 3.48; 95% Cl = 1.38-9.02) and sinusitis (OR = 2.88; 95% Cl = 1.22-6.89) was significantly higher in women who were exposed to environmental tobacco smoke. Primary health care need for respiratory symptoms due to the effect of passive smoking is higher in the exposed women. Passive smoking can be a risk factor for the appearance of respiratory symptoms and illness in women that causes absence from work.     

Stress at work: a review of Australian research

This paper reviews Australian research into occupational stress. The context of organizational life in Australia is outlined, including the attitudes and values that have conditioned stress research. Empirical studies of occupational stress and health are reviewed, and new psychobiological studies which index stress by urinary hormonal analysis (catecholamines, cortisol) are detailed. The use of stress management programs at the workplace is discussed within the context of Australian industrial relations and workers' compensation developments.     

Exposure to benzene at work and the risk of leukemia: a systematic review and meta-analysis

Background  

A substantial number of epidemiologic studies have provided estimates of the relation between exposure to benzene at work and the risk of leukemia, but the results have been heterogeneous. To bridge this gap in knowledge, we synthesized the existing epidemiologic evidence on the relation between occupational exposure to benzene and the risk of leukemia, including all types combined and the four main subgroups acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML).     

Recent contributions of air- and biomarkers to the control of secondhand smoke (SHS): a review

Since the publication of the US Surgeon General Reports in 1996 and 2006 and the report of the California Environmental Protection Agency in 1999, many reports have appeared on the contribution of air and biomarkers to different facets of the secondhand smoke (SHS) issue, which are the targets of this review. These recent studies have allowed earlier epidemiological surveys to be biologically validated, and their plausibility demonstrated, quantified the levels of exposure to SHS before the bans in various environments, showed the deficiencies of mechanical control methods and of partial bans and the frequently correct implementation of the efficient total bans. More stringent regulation remains necessary in the public domain (workplaces, hospitality venues, transport sector, etc.) in many countries. Personal voluntary protection efforts against SHS are also needed in the private domain (homes, private cars). The effects of SHS on the cardiovascular, respiratory and neuropsychic systems, on pregnancy and fertility, on cancers and on SHS genotoxicity are confirmed through experimental human studies and through the relationship between markers and prevalence of disease or of markers of disease risk.     

Tobacco use and secondhand smoke exposure during pregnancy: an investigative survey of women in 9 developing nations

Objectives. We examined pregnant women''s use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa.Methods. Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005.Results. At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home.Conclusions. Pregnant women''s tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.Tobacco use is widely recognized as one of the leading threats to global health.¹ Historically, the prevalence of smoking among women in the developing world has been very low, in part because of strong cultural constraints against women''s smoking; approximately 50% of men in developing nations smoke cigarettes, compared with 9% of women.² Averting an increase in the prevalence of smoking among women in developing nations is widely recognized as a significant public health opportunity.^3,4Pregnant women are a priority population for tobacco control efforts because both cigarette smoking and smokeless tobacco use during pregnancy pose serious risks to fetal health. Smoking during pregnancy may cause preterm delivery, low birthweight, and sudden infant death syndrome; smokeless tobacco use during pregnancy has been associated with stillbirth, preterm birth, and reduced birthweight.^5–8 Maternal tobacco use is also likely to expose infants and children to secondhand smoke (SHS) and to provide a role model for children''s use of tobacco. Intervening during pregnancy is also important because of the health risks to the woman, who potentially has many years of remaining life. For cigarette smoking, these health risks include lung and other cancers, coronary heart disease and stroke, and chronic obstructive pulmonary disease; health risks from smokeless tobacco products include oral and pancreatic cancer.^9,10The US National Institute of Child Health and Human Development''s Global Network for Women''s and Children''s Health Research consists of 10 research units chosen for scientific merit that are focused on improving maternal and children''s health in the developing world. To determine whether pregnant women''s tobacco use and SHS exposure are emerging public health issues, the Global Network undertook an investigative survey of pregnant women''s knowledge, attitudes, and behaviors regarding tobacco use and SHS exposure. Here we report findings on pregnant women''s experimentation with and use of tobacco products, their perceptions of the social acceptability of tobacco use by women, and their and their young children''s exposure to SHS.     

Current Australian nosocomial infection surveillance activities: a survey of Australian Infection Control Association (AICA) members

In July 2000, a national survey of the Australian Infection Control Association (AICA) membership was conducted to determine current surveillance activities in a range of health care facilities. A questionnaire was mailed to all AICA members within Australia (n=1336) and achieved a response rate of 41 per cent (n=551). Data were analysed using non-parametric statistics. Open-ended questions were manually coded and summarised.Findings from this study revealed that one third of infection control practitioners working in infection control have no formal qualifications in this specialty. Health care facilities engaged in significantly more hours of surveillance if they were hospitals (rather than residential care or other facilities; p<0.0001), were public facilities (p<0.0001) and were located in metropolitan (p<0.0001) or regional areas (p=0.001). There was also a significant positive relationship between, hours of surveillance conducted and the size of the facility (p<0.0001). Fifty nine per cent of facilities used the Australian Council on Healthcare Standards definitions for nosocomial infections. Approximately three quarters of the facilities surveyed did not use computer programs for surveillance of infections or body substance exposures. Only 59 per cent of the facilities reported implementing preventive strategies based on surveillance programmes. These findings indicate the need for additional strategies to support facilities in designing and conducting surveillance programmes and implementing appropriate interventions.     

Inmate exposure to secondhand smoke in correctional facilities and the impact of smoking restrictions

This study was undertaken to measure the passive smoking exposure of prisoners at three correctional facilities in the US and to evaluate the effectiveness of a ban on smoking in reducing these exposures at two of these facilities. The average weekly concentration of nicotine was measured in fixed locations within the correctional facilities using passive samplers. Samples were collected before and after a smoking ban was instituted, and after the policy was modified to allow smoking outdoors. Samples were collected in the living areas, near where inmates slept and watched TV, and in selected central facilities, including dining halls, visiting rooms, booking areas, and learning centers. Average weekly concentrations of nicotine were measured in 84 locations while smoking was allowed; changes in these concentrations were measured with 112 weekly samples 4 and 9 months after the policy restricting smoking was implemented The average concentrations of nicotine were high while smoking was allowed: most living and sleeping areas averaged 3-11 microg/m(3), but the gym that was used as a bunkroom averaged 25 microg/m(3); these values compare to an average of 2 microg/m(3) in the homes of smokers. The smoking ban significantly reduced nicotine concentrations in the living areas (P<0.01 at facility A and P<0.05 at facility B) to averages of 1.5-2.2 microg/m(3); all postban samples were less than 5 microg/m(3). In conclusion, secondhand smoke concentrations in correctional facilities can be quite high; however, policies banning smoking are effective in reducing, but not eliminating, these exposures.