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CIS 09-896 Håkansta C.
Workplace smoking
This working paper has been prepared to create a knowledge base for further activities in the area of promoting and implementing smoke-free workplaces. It seeks to emcourage discussion among policy-makers, campaigners, trade unionists, employers and other interested in promoting smoke-free workplaces. Contents: the problem; legislative aspects; good practices carried out by governments, workers and employers; elements for achieving smoke-free workplaces.
ILO Publications, International Labour Office, 1211 Genève 22, Switzerland, 2004. v, 71p. Illus. 84 ref. [in English]

CIS 06-1055 Di Martino V., Gold D., Schaap A.
Managing emerging health-related problems at work - SOLVE: Stress, Tobacco, Alcohol and Drugs, HIV/AIDS, Violence
Cómo abordar los problemas emergentes relacionados con la salud en el trabajo - SOLVE: estrés, tabaco, alcohol y drogas, VIH/SIDA, violencia [in Spanish]
Spanish translation of a training package abstracted under CIS 03-1118. SOLVE is an interactive educational programme designed to assist in the development of policy and action to address psychosocial issues at the workplace. Stress, alcohol and drugs, violence (both physical and psychological), HIV/AIDS and tobacco all lead to health-related problems for the worker and lower productivity for the enterprise or organization. Taken together, they represent a major cause of accidents, fatal injuries, disease and absenteeism at work in both industrialized and developing countries. SOLVE focuses on prevention in translating concepts into policies and policies into action at the national and enterprise levels. This training package (folder and CD-ROM) provides the foundation for a five-day interactive training course with a goal to give participants the knowledge and skills to formulate a comprehensive policy and strategies to address these issues in the workplace. (See also CIS 01-746).
Ministerio de Trabajo y Asuntos Sociales, Subdirección General de Información, Administrativa, y Publicaciones, Agustín de Bethencourt, 11, 28003 Madrid, Spain, 2004. Loose-leaf folder. Approx 211p. Illus. Bibl. ref. + CD-ROM.

CIS 06-1054 Drugs: Know the facts, cut your risks
Drogues: savoir plus, risquer moins [in French]
This book provides information on the nature, effects and potential health hazards of various psychoactive substances. Guidance is also given on the health and social risks of substance abuse and on sources of help for people with alcohol and other drug problems.
Comité permanent de lutte à la toxicomanie, 970 rue de Louvain Est, Montreal, Quebec H2M 2E8, Canada, 2004. 207p. Illus. Bibl.ref.

CIS 06-918 Smoking policy
Politique en matière de tabac [in French]
This information sheet summarizes the legal responsibilities of employers with respect to passive smoking in Belgium. Employers are required to implement the necessary measures for limiting the use of tobacco within the enterprise. The main legal provisions are highlighted and the seven steps of an anti-smoking action plan at the place of work are presented.
PREVENT, rue Gachard 88, Bte 4, 1050 Bruxelles, Belgium, Sep. 2004. 2p. Illus.

CIS 05-158 Kurihara N., Wada O.
Silicosis and smoking strongly increase lung cancer risk in silica-exposed workers
It remains controversial whether silica is a human lung carcinogen. A literature search was performed on papers published from 1966-2001 which epidemiologically reported on the relationship between silica/silicosis and lung cancer. Papers which did not exclude the effects of asbestos and radioactive materials including radon were removed. Based on the selected papers, the lung cancer risks from silica, silicosis and non-silicosis with exposure to silica were summarized by meta-analysis. The pooled relative risks were 1.32 for silica, 2.37 for silicosis and 0.96 for non-silicosis with exposure to silica. Since some papers on silica did not exclude silicosis, the risk due to silica itself may be smaller than 1.32. It was less possible that silica exposure directly increases lung cancer risk. On the other hand, the relative risk of 2.37 for silicosis suggested that silicosis increases lung cancer risk. The meta-analysis also revealed that cigarette smoking strongly increased the lung cancer risk in silicotic patients (relative risk, 4.47).
Industrial Health, July 2004, Vol.42, No.3, p.303-314. Illus. 67 ref. [in English]

CIS 04-409 Dangman K.H., Storey E., Schenk P., Hodgson M.J.
Effects of cigarette smoking on diagnostic tests for work-related hypersensitivity pneumonitis: Data from an outbreak of lung disease in metalworkers
Following an earlier outbreak of hypersensitivity pneumonitis among a group of metalworkers, a re-examination of data of the 61 patients seen in connection with the outbreak was carried out to explore possible effects of cigarette smoking on the clinical tests used to diagnose hypersensitivity pneumonitis. It is concluded that cigarette smoking can affect the physical examination findings, spirometry and electron spin resonance spectroscopy changes associated with hypersensitivity pneumonitis, making these tests less sensitive and specific, and potentially obscuring the diagnosis. Such changes may contribute to the apparent "protective" effect of smoking on the development of hypersensitivity pneumonitis.
American Journal of Industrial Medicine, May 2004, Vol.45, No.5, p.455-467. Illus. 68 ref.

CIS 04-340 Zitting A
Radiographic small lung opacities and pleural abnormalities in relation to occupational asbestos exposure, smoking history and living environment in Finland
The aim of this study was to investigate the prevalence of radiographic abnormalities of the lungs and pleura according to the ILO International Classification of Radiographs of Pneumoconioses in the adult Finnish population, to estimate the association of past asbestos exposure, smoking history and living environment with theses abnormalities, and to analyse the intra- and inter-observer variation in the main radiographic findings. Results indicate that occupational asbestos exposure plays an important role in the aetiology of radiographic pleural and pulmonary abnormalities, and that small lung opacities produced by asbestos do not differ in size or shape from those caused by smoking. Classification of small lung opacities was subject to observer variation.
Finnish Institute of Occupational Health, FIOH-Bookstore, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland, 2004. 61p. Illus. Bibl.ref. Price: EUR 18.00.

CIS 04-420
World Health Organization (WHO)
IARC monographs on the evaluation of carcinogenic risks to humans - Volume 83: Tobacco smoke and involuntary smoking
In a previous IARC Monograph on Tobacco Smoking (Vol.38, see CIS 89-350), a certain number of cancers were identified as caused by cigarette smoking. In the present report, the studies reviewed by the Working Group show sufficient evidence for a additional association between cigarette smoking and cancers of the nasal cavities, nasal sinuses, oesophagus, stomach, liver, kidney and uterine cervix, as well as myeloid leukaemia. There is evidence of synergy between smoking and several occupational causes of lung cancer (arsenic, asbestos and radon). Secondhand tobacco smoke includes the same carcinogens and toxic substances produced by active smoking. Non-smoking spouses of smokers, as well as non-smoking workers exposed to secondhand tobacco smoke at the workplace are at a statistically-significant increased risk of lung cancer. Overall, the Working Group concludes that exposure to secondhand tobacco smoke is carcinogenic in humans (Group 1).
World Health Organization, Distribution and Sales Service, 1211 Genève 27, Switzerland, International Agency for Research on Cancer (IARC), 150 cours Albert Thomas, 69372 Lyon Cedex 08, France, 2004. xiv, 1452 pages. Illus. Bibl.ref. Index. Price: USD 40.00


CIS 06-500 Caborn J., Gold D.
An overview of selected references related to SOLVE
This literature survey reviews selected studies on psychosocial issues in the workplace. The five main issues considered are stress, violence, alcohol and drug use, HIV/AIDS and tobacco consumption. The impact of these issues on the workplace is outlined and their interrelationships are discussed in detail. The review supports the integrated approach adopted in the SOLVE methodology for the management of psychosocial issues in the workplace.
InFocus Programme on Safety and Health at Work and the Environment (SafeWork), International Labour Office, 1211 Genève 22, Switzerland, Mar. 2003. 67 ref. [in English]

CIS 05-356 Su Y.M., Su J.R., Sheu J.Y., Loh C.H., Liou S.H.
Additive effect of smoking and cotton dust exposure on respiratory symptoms and pulmonary function of cotton textile workers
Two surveys to investigate the prevalence of byssinosis among cotton textile workers were conducted, the first (1991) enrolling 169 workers and second (1996) 175. The synergistic effect of smoking on cotton dust exposure was also evaluated. Although the difference in prevalence of abnormal pulmonary function between the first (38.5%) and second study (38.9%) was not statistically significant, smokers had a significantly higher frequency than nonsmokers in both surveys. A significant trend existed between cotton dust levels and the frequency of abnormal lung function. The frequency of respiratory symptoms and the prevalence of severe byssinosis in the second survey were significantly lower than in the first survey. This was due to the remodelling of this old cotton mill. The prevalence of respiratory symptoms and byssinosis in smokers was significantly higher than in nonsmokers in the first survey. These results indicate that smoking potentiates the effect of cotton dust exposure. The second study reveals that a high prevalence of byssinosis still existed in this Taiwanese cotton mill, although the prevalence was declining. Smoking was found to show an additive effect on cotton dust exposure.
Industrial Health, Apr. 2003, Vol.41, No.2, p.109-115. 24 ref.

CIS 04-746 Machado Godoi A.M.
Survey on the use of drugs among industrial workers
Levantamento sobre uso de drogas entre trabalhadores da indústria [in Portuguese]
The objective of this research, which involved 2657 workers in 34 Brazilian enterprises, was to study the consumption patterns of alcohol, tobacco and narcotics among industrial workers, as well as the factors related to this consumption, the awareness of workers concerning the consumption of these substances and their opinion concerning preventive actions. The study showed in particular that 38.7% of the workers smoked (42.1% of the men and 28.3% of the women), 78.7% regularly drank alcohol, close to 87% had taken at least one pharmaceutical drug during the previous year and 10.5% consumed illegal narcotics. Most workers were favourable to receiving information at the place of work on substance abuse.
Serviço Social da Indústria (SESI), Departamento Nacional SBN, Quadra 1 Bloco C, Edifício Roberto Simonsen, CEP 70 040-903 Brasília, Brazil, 2003. 57p. 9 ref.

CIS 04-426
National Occupational Health and Safety Commission (Worksafe Australia)
Guidance note for the elimination of environmental tobacco smoke in the workplace
This guidance document replaces the one on passive smoking issued in 1994 (see CIS 95-271). Contents: environmental tobacco smoke as a risk to OSH; elimination of environmental tobacco smoke; implementation of a workplace policy on tobacco smoking. In appendices: a model policy for a smoke-free workplace; supplementary information on health and legal matters in Australia.
Australian Government Publishing Service, GPO Box 84, Canberra ACT 2601, Australia, 2003. x, 26p. 24 ref. [in English]

CIS 03-1756 Wakefield M., Trotter L., Cameron M., Woodward A., Inglis G., Hill D.
Association between exposure to workplace secondhand smoke and reported respiratory and sensory symptoms: Cross-sectional study
The purpose of this work was to assess the relation between exposure to second-hand smoke (SHS) at work and reported respiratory and sensory symptoms. Data was collected by means of a cross-sectional telephone survey of 382 non-smokers working in indoor workplaces. After controlling for potential confounders, exposure to SHS at work was significantly associated with an increased risk of wheeze (odds ratio OR=4.26), frequent cough (OR=2.26), sore eyes (OR=3.77) and sore throat (OR=2.70). Among workers who had not experienced a cold in the past four weeks, strong dose-response relationships were found between increasing levels of exposure to SHS at work and morning cough, frequent cough, sore eyes and sore throat, and a positive relationship for wheeze. These findings provide compelling evidence that non-smoking indoor workers are adversely affected by exposure to SHS at work, and underline the importance of workplace smoke-free policies in protecting the health of workers.
Journal of Occupational and Environmental Medicine, June 2003, Vol.45, No.6, p.622-627. Illus. 26 ref.

CIS 03-1788 Johnsson T., Tuomi T., Hyvärinen M., Svinhufvud J., Rothberg M., Reijula K.
Occupational exposure of non-smoking restaurant personnel to environmental tobacco smoke in Finland
Environmental tobacco smoke (ETS) exposure levels in different restaurant types in Finland were assessed before the National Tobacco Act restricting smoking in restaurants was activated. Exposure to ETS was determined by measuring nicotine in the breathing zone of non-smoking restaurant workers and by quantification of the nicotine metabolites cotinine and 3-hydroxycotinine in the urine of these workers during a whole work week. Altogether 23 workers from 15 restaurants were included in the study. The geometric mean (GM) breathing-zone nicotine level was 3.9µg/m3. The GM cotinine and trans-3'-hydroxycotinine level in urine were 3.3ng/mg(creatinine) and 15.3ng/mg(creatinine), respectively. The exposure to ETS of restaurant workers in dining restaurants was clearly lower than that of workers in pubs and nightclubs as indicated by all ETS-markers used in the present study. During the work week, the cotinine and 3'-hydroxycotinine levels in urine of the study subjects increased. The correlation between breathing zone nicotine and urine cotinine and hydroxycotinine was 0.66 for both compounds. Post-shift cotinine and hydroxycotinine levels were not significantly higher than pre-shift levels. The study indicates that measures to restrict ETS exposure in restaurants are needed.
American Journal of Industrial Medicine, May 2003, Vol.43, No.5, p.523-531. Illus. 56 ref.

CIS 03-1636 McCurdy S.A., Sunyer J., Zock J.P., Antó J.M., Kogevinas M.
Smoking and occupation from the European Community Respiratory Health Survey
To examine smoking prevalence among occupational groups in the European Union, the European Community Respiratory Health Survey (ECRHS) was conducted in 1992-93. The survey involved 14,565 subjects from 14 participating countries. Among the findings, there was an approximately twofold range in smoking prevalence by occupation. For occupational groups with at least 50 subjects, the highest smoking prevalence was seen in metal-making and treating for men (54.3%) and cleaners for women (50.7%). Smoking prevalence by occupation persisted even when adjusted for age, country, and age at completion of education. Smoking was also increased among occupations with high exposure to mineral dust and gas or fumes. In conclusion, smoking rates vary significantly by occupation, and prevention efforts in the workplace should focus on occupations with high smoking prevalence and large employment bases.
Occupational and Environmental Medicine, Sep. 2003, Vol.60, No.9, p.643-648. 21 ref.

CIS 03-1790 Rodríguez-Artalejo F., Lafuente Urdinguio P., Guallar-Castillón P., Garteizaurrekoa Dublang P., Sáinz Martínez O., Díez Azcárate J.I., Foj Alemán M.
One year effectiveness of an individualised smoking cessation intervention at the workplace: A randomised controlled trial
The objective of this case-control study was to assess the effectiveness of a smoking cessation intervention in the workplace. Cases were given structured counselling at the first visit, nicotine patches for three months and three sessions of counselling for reinforcement of abstinence over a three-month period. The control group was subjected to short sessions of antismoking advice. The trial was carried out among 217 smokers of both sexes, aged 20-63 years, motivated to quit smoking and without contraindications for nicotine patches, who were employees at a public transport company and at two worksites of an electricity company. The main outcome measure was self-reported tobacco abstinence confirmed by carbon monoxide in expired air ≤10ppm. The rate of continuous abstinence at 12 months was 20.2% for the intervention group versus 8.7% for the control group. The effectiveness of the intervention did not vary substantially with age, tobacco dependence, number of cigarettes smoked per day, number of years of tobacco consumption, degree of desire to quit smoking, time spent with smokers, subjective health and presence of tobacco-related symptoms. Weight gain at 12 months was similar for both groups.
Occupational and Environmental Medicine, May 2003, Vol.60, No.5, p.358-363. Illus. 47 ref.

CIS 03-1286 Hoffmann R.
Passive smoking at the workplace
Tabagisme passif sur les lieux de travail [in French]
On the basis of epidemiological studies and other scientific knowledge, national and international health organizations classify secondary tobacco smoke as being a human carcinogen. It is also associated with heart diseases. Smoking prohibitions at the place of work have been in existence for a long time in Germany. They were justified on the basis of fire and explosion hazard prevention or for reasons of hygiene, and are found in certain technical regulations. However, they were not specifically intended to protect non-smokers. In April 2000, the German parliament petitioned the government to improve the protection of non-smokers at the place of work. A new provision of the German labour code now requires employers to ensure sufficient protection of their non-smoking employees, leaving them however free in the choice of measures to be adopted.
Cahiers de notes documentaires - Hygiène et sécurité du travail, 3rd Quarter 2003, No.192, p.29-34. 25 ref.

CIS 03-1308 Heloma A.
Impact and implementation of the Finnish Tobacco Act in workplaces
This report, originally a thesis submitted at the Tampere School of Public Health (Finland), presents a study aimed at describing the baseline situation of employee exposure to environmental tobacco smoke (ETS) and employee smoking habits before the 1994 revision of the Finnish Tobacco Act and to evaluating the impact and the implementation of the legislation in large and medium-sized workplaces both short-term and long term. Data were collected by the means of questionnaires, nicotine measurements in indoor air and a field study. The results showed a clear decrease in employee exposure to ETS in workplaces one year after the legislation took effect. The nicotine concentrations in indoor air were consistent with the decreasing trend of ETS exposure of employees. In the four-year follow up, a steadily-reducing exposure of employees was observed. The daily smoking prevalence had decreased considerably after the law was implemented and remained low, but it did not decrease any further than the initial drop following the enforcement of the law. A literature review of the tobacco epidemic and smoking prevalence is also presented in this report.
Finnish Institute of Occupational Health, Publication Office, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland, 2003. 62p. Illus. 165 ref.

CIS 03-1118 Di Martino V., Gold D., Schaap A.
Managing emerging health-related problems at work - SOLVE: Stress, Tobacco, Alcohol and Drugs, HIV/AIDS, Violence
Gérer les problèmes émergents liés à la santé dans le monde du travail - SOLVE : Stress, violence, alcool et drogue, VIH/sida, tabagisme [in French]
SOLVE is an interactive educational programme designed to assist in the development of policy and action to address psychosocial issues at the workplace. Stress, alcohol and drugs, violence (both physical and psychological), HIV/AIDS and tobacco all lead to health-related problems for the worker and lower productivity for the enterprise or organization. Taken together, they represent a major cause of accidents, fatal injuries, disease and absenteeism at work in both industrialized and developing countries. SOLVE focuses on prevention in translating concepts into policies and policies into action at the national and enterprise levels. This training package (folder and CD-ROM) provides the foundation for a five-day interactive training course with a goal to give participants the knowledge and skills to formulate a comprehensive policy and strategies to address these issues in the workplace. (See also CIS 01-746).
ILO Publications, International Labour Office, 1211 Genève 22, Switzerland, 2003. Loose-leaf folder. Approx.120p. Illus. Bibl.ref. + CD-ROM.

CIS 03-650 Mizoue T., Miyamoto T., Shimizu T.
Combined effect of smoking and occupational exposure to noise on hearing loss in steel factory workers
This study was carried out to examine the possible synergy of smoking and exposure to noise on hearing loss. Data from periodic health examinations for 4624 steel company workers and they included audiometry testing and information on smoking habits. Occupational exposure to noise was estimated from company records. Logistic regression was used to examine the dose-response association between smoking and hearing loss. The prevalence rate ratio (PRR) of hearing loss was calculated for each combination of smoking level and noise exposure factor, taking non-smokers not exposed to occupational noise as a reference population. It was found that smoking was associated with increased odds of high-frequency hearing loss. The PRR for high-frequency hearing loss among smokers exposed to occupational noise was 2.56, while the PRR for smokers not exposed to noise was 1.57 and the PRR for non-smokers exposed to noise was 1.77. The synergistic index was 1.16. Smoking was not associated with low-frequency hearing loss.
Occupational and Environmental Medicine, Jan. 2003, Vol.60, No.1, p.56-59. 23 ref.


CIS 03-1826 Health without tobacco: Technical and methodological guide - Programme for a tobacco-smoke free environment
Salud sin tabaco: Guía técnica-metodológica - Programa Ambientes Libres del Humo de Tabaco [in Spanish]
As part an anti-smoking drive, the Chilean government has implemented a programme entitled "Tobacco smoke-free environments". A technical guide first describes the damages caused by smoking, with emphasis on the risks to women, followed by prevention strategies for controlling smoking at the workplace and the approach for obtaining the accreditation of workplaces as being smoke-free environments. A directory lists 502 organizations and enterprises having publicly declared being "smoke-free", classified by region and locality. Smoke-free environments are signalled with a board on which it is written "breathe deeply".
Gobierno de Chile, Ministerio de Salud, Santiago, Chile, 2002. 181p, Illus. 37 ref. (technical guide); 57p. (directory).

CIS 03-1976 Ringen K., Anderson N., McAfee T., Zbikowski S.M., Fales D.
Smoking cessation in a blue-collar population: Results from an evidence-based pilot program
A prototype smoking cessation programme was designed and implemented among 935 unionized carpenters in the US state of Washington. The programme consisted of counselling and medication including nicotine patch, nicotine gum and Bupropion. Assessment of outcomes was performed through a telephone survey 12 months following the enrolment date. The overall quit rate was 27.5%. The savings in reduced lifetime tobacco-related medical costs for the participants who quit are estimated to be 15 times the cost of the programme. These results strongly suggest that smoking cessation programmes can be effective even in such hard-to-reach populations as itinerant workers in the building trades, provided that the programme is designed to suit their needs and their environment. Based on these findings, health plans need to consider whether they are at risk of violating their fiduciary duties if they fail to offer smoking cessation benefits.
American Journal of Industrial Medicine, Nov. 2002, Vol.42, No.5, p.367-377. Illus. 29 ref.

CIS 02-1664 Schabath M.B., Spitz M.R., Delclos G.L., Gunn G.B., Whitehead L.W., Wu X.
Association between asbestos exposure, cigarette smoking, myeloperoxidase (MPO) genotypes, and lung cancer risk
The objective of the study was to determine whether genetic factors such as polymorphic metabolic/oxidative enzyme myeloperoxidase (MPO) could modulate individual susceptibility to asbestos-associated carcinogenesis. Restricted fragment length polymorphism-polymerase chain reaction analysis identified the MPO genotypes in 375 lung cancer cases and 378 matched controls. Detailed information regarding smoking, occupational history and exposures were obtained through interviews. Asbestos exposure was associated with a significantly elevated risk (odds ratio (OR) 1.45). However, G/G carriers who were exposed to asbestos had an OR of 1.72 while that of A-allele carriers (G/A+A/A) was 0.89. All three risk factors (MPO genotypes, asbestos exposure and smoking) were analysed for combined effects. Heavy smokers with the G/G genotype and a history of asbestos exposure demonstrated a significant elevated risk estimate (OR 2.19, while the A-allele carriers with the same exposure profile were at a lower risk for lung cancer (OR 1.18). The A-allele genotypes demonstrated similar protective effects for all exposure profiles.
American Journal of Industrial Medicine, July 2002, Vol.42, No.1, p.29-37. 37 ref.

CIS 02-1782 Wortley P.M., Caraballo R.S., Pederson L.L., Pechacek T.F.
Exposure to secondhand smoke in the workplace: Serum cotinine by occupation
To examine workplace exposure in the United States to second-hand smoke by occupation, data from the Third National Health and Nutrition Examination Survey (1988 to 1994), a nationally representative sample of the non-institutionalized population was analysed. The analysis was restricted to 4952 employed nonsmoking adults who reported no home exposure to cigarette smoke. Occupations were assigned to 40 groups and seven 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/labourers (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.
Journal of Occupational and Environmental Medicine, June 2002, Vol.44, No.6, p.503-509. 30 ref.

CIS 02-826 Zitting A., Husgafvel-Pursiainen K.
Health effects of environmental tobacco smoke
Collection of articles on the health effects of passive smoking, covering the following topics: passive smoking exposure in Finland in 2000; long-term trends in occupational and non-occupational passive smoking exposure in Finland; biomarkers for the assessment of passive smoking exposure; passive smoking and risk of lung cancer risk; passive smoking and risk of cardiovascular disease; effects of passive smoking on the respiratory health of adults; effects of passive smoking on the respiratory health of children; effects of passive smoking on reproductive health.
Scandinavian Journal of Work, Environment and Health, 2002, Vol.28, Suppl.2, p.3-96 (whole issue). Illus. Bibl.ref.

CIS 02-989 Osinubi O.Y.O., Afilaka A.A., Doucette J., Golden A., Soriano T., Rovner E., Anselm E.
Study of smoking behavior in asbestos workers
A cross-sectional survey of 214 asbestos workers was initiated to determine the prevalence of smoking and their readiness to quit smoking. The study involved 61 never smokers (28.5%), 118 ex-smokers (55.1%), and 35 current smokers (16.4%). Reasons for smoking cessation in ex-smokers included perception of ill-health (51 %) and knowledge of smoking-asbestos hazards (3.4%). Stage of change of current smokers revealed: pre-contemplation (26.5%), contemplation (35%), preparation (29%), and action (8.8%). Current smokers had the highest prevalence of small airway obstruction on spirometry. A detailed smoking history during medical surveillance activities will enable the occupational physician to identify asbestos workers who have difficulty quitting and to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.
American Journal of Industrial Medicine, Jan. 2002, Vol.41, No.1, p.62-69. 27 ref.


CIS 02-1802 Muzi G., Dell'Omo M., Crespi E., Madeo G., Monaco A., Curradi F., Diodati R., Abbritti G.
Smoking in the workplace: Study at a hospital in central Italy
L'abitudine al fumo di tabacco nei luoghi di lavoro. Studio in un'Azienda Ospedaliera dell'Italia centrale [in Italian]
Report of a survey in a general hospital in Central Italy on the smoking habits of 2743 employees. The prevalence of smokers was quite high in both men (36.0%) and women (36.7%). The highest prevalence was found among ward orderlies (45.2%) and nurses (38.9%), the lowest among doctors (26.3%). The role of industrial physicians in combating smoking is emphasized.
Medicina del lavoro, Jan.-Feb. 2001, Vol.92, No.1, p.54-60. Illus. 19 ref.

CIS 02-783 Breton R.A., Vyskocil A.
Smoking and blood cadmium concentrations in young pre-employees
Smoking is the main source of cadmium, a known human carcinogen, among young adults. The objective of this study was to determine blood and urine cadmium levels of young adults occupationally exposed to cadmium in relation to number of cigarettes smoked and sex. Data were gathered for 132 young adults (smokers and non-smokers, men and women) by means of a questionnaire and blood and urine analyses. There were no statistical differences between smokers and non-smokers in urine cadmium concentrations, whereas blood cadmium levels in young adult smokers were 11 times higher than in non-smokers. An increase in blood cadmium without any changes in urine cadmium could be explained by the accumulation of cadmium in tissues. After 20 to 40 years of smoking, and without exposure to any other source of cadmium, it is expected that smokers would reach the urinary level of 5µg/g creatinine that would warrant job reassignment away from cadmium exposure. Further thought needs to be given to reassignment policies and work practices for smokers and non-smokers with respect to cadmium exposure.
Central European Journal of Occupational and Environmental Medicine, 2001, Vol.7, No.1, p.22-25. 7 ref.

CIS 02-852 Bang K.M., Kim J.H.
Prevalence of cigarette smoking by occupation and industry in the United States
To estimate the prevalence of cigarette smoking by occupation and industry in the US, data from the third National Health and Nutrition Examination Survey (NHANES III), 1988-1994 was used. Included in NHANES III are data on the cigarette smoking status, occupation, industry, and other demographic information of US non-institutionalized civilians obtained through household interview surveys. The study population included 20,032 adults aged 17 years and older. To estimate the prevalence of cigarette smoking across occupation and industry groups, the Survey Data Analysis (SUDAAN) software was used. It was found that the prevalence of cigarette smoking was highest among transport occupations, construction laborers, and vehicle mechanics and repairers, and lowest among teachers. Among industry groups, the construction industry had the highest prevalence of cigarette smoking.
American Journal of Industrial Medicine, Sep. 2001, Vol.40, No.3, p.233-239. 20 ref.

CIS 01-746 Di Martino V., Gold D., Schaap A.
SOLVE - Stress, Tobacco, Alcohol and Drugs, HIV/AIDS, Violence: Managing emerging health-related problems at work
Folder with five leaflets on common psychosocial issues that may affect safety and health in the workplace.
International Labour Office, InFocus Safework, 1211 Genève 22, Switzerland, 2001. 5 brochures. Illus.

CIS 01-832 Lee P.N.
Relation between exposure to asbestos and smoking jointly and the risk of lung cancer
To review evidence of the relationship between the combined effect of exposure to asbestos and smoking on the risk of lung cancer, 23 studies epidemiological studies were analysed, comparing the risk of lung cancer in subjects unexposed to asbestos or smoking, exposed to asbestos only, to smoking only, or to both. Eight studies provided insufficient data. Asbestos exposure was associated with a significantly increased risk in non-smokers in six of the remaining studies and with a moderate increase in a further six. In two of the three studies that found no increase, asbestos exposure was insufficient to increase risks in smokers. In 30 of 31 data sets analysed, risk in the combined exposure group was greater than predicted by the additive model. Asbestos exposure multiplies risk of lung cancer by a similar factor in non-smokers and smokers.
Occupational and Environmental Medicine, Mar. 2001, Vol.58, No.3, p.145-153. 37 ref.

CIS 01-501 Otsuka R., Watanabe H., Hirata K., Tokai K., Muro T., Yoshiyama M., Takeuchi K., Yoshikawa J.
Acute effects of passive smoking on the coronary circulation in healthy young adults
Cross-sectional study involving 30 healthy Japanese men (mean age: 27 years; 15 non-smokers and 15 active smokers). Various measures of heart function were taken before and after 30min exposure to environmental (passive) tobacco smoke. Passive smoking did not affect heart rate, blood pressure or basal coronary flow velocity in either group. However, mean coronary flow velocity reserve (CFVR) was significantly higher in non-smokers than in active smokers before exposure to passive smoking (4.4 vs. 3.6), while this difference disappeared after such exposure (3.4 vs. 3.3). As a lowering of CFVR is an important sign of endothelial dysfunction, this finding provides direct evidence of the harmful effects on the circulatory system of exposure to passive smoking.
Journal of the American Medical Association, 25 July 2001, Vol.286, No.4, p.436-441. Illus. 41 ref.


CIS 02-1843 Dautzenberg B
Fighting smoking in the enterprise: A guide
La lutte contre le tabac en entreprise: le guide [in French]
This guide is aimed at all persons involved in fighting smoking in the workplace. It provides useful information and describes practical projects in the area of smoking prevention and helping workers quit smoking, information on legislation and information on managing conflicts. It comprises four parts: reasons for fighting tobacco consumption in the workplace (health hazards, passive smoking, tobacco-free enterprises, nicotine-based substitution products); how to help smokers quit (information, weaning, anxiety and depressive disorders), legal context (legislation and regulations against smoking in France, consensus conference on the means of helping to quit smoking). Appendices include texts of various laws on fighting tobacco consumption.
Editions Margaux Orange, 20 rue du Mail, 75002 Paris, France, 2000. xviii, 194p. Illus. Index.

CIS 02-495 Kodawaki T., Watanabe M., Okayama A., Hishida K., Ueshima H.
Effectiveness of smoking-cessation intervention in all of the smokers at a worksite in Japan
In Japan, the prevalence of smoking among males and females was 56.1% and 14.2%, respectively, in 1997. This study describes a smoking-cessation intervention in a radiator manufacturing factory. All 263 male smokers were randomly allocated either to an intervention group (132) or a control group (131). Subjects in the intervention group received individual counseling by a doctor, and participated in group discussions during the five-month intervention. Subjects in the control group received equivalent delayed intervention for four months. The cessation rate after the original intervention was 12.9% and 3.1% in the intervention and control groups, respectively. Among those who once succeeded in quitting, 48.6% maintained cessation at the long-term survey. Overall, the cessation rate was 8.4% and the prevalence of smoking among males significantly decreased from 62.9 to 56.7%.
Industrial Health, Oct. 2000, Vol.38, No.4, p.396-403. Illus. 23 ref.

CIS 01-1125 Heloma A., Kähkönen E., Kaleva S., Reijula K.
Smoking and exposure to tobacco smoke at medium-sized and large-scale workplaces
A questionnaire survey on smoking prevalence and indoor air quality (IAQ) measurements were performed in 10 medium-sized and large-scale workplaces. The questionnaire was distributed to all (1,471) workers. IAQ measurements were performed in 4-7 locations in each workplace. Altogether, 1,027 (70%) employees, of whom 31% were women, responded to the questionnaire. Prevalence of daily smokers was 28.3% (32.3% for men and 22.9% for women). The prevalence was highest among workers in the service sector (32.7%) and lowest in offices (21.6%). Among smokers, 86% of men and 75% of women smoked inside the building. Exposures greater than one hour to environmental tobacco smoke were highest in industry (66.3%) and lowest in services (42.6%). Non-smokers complained more often than the regular smokers about the spreading of tobacco smoke to non-smoking areas, and than felt that workplace smoking was a significant discomfort. Mean concentration of nicotine was highest in service environments (3.0µg/m-3) and lowest in offices (0.6µg/m-3).
American Journal of Industrial Medicine, Feb. 2000, Vol.37, No.2, p.214-220. Illus. 19 ref.

CIS 01-831 Larkin E.K., Smith T.J., Stayner L., Rosner B., Speizer F.E., Garshick E.
Diesel exhaust exposure and lung cancer: Adjustment for the effect of smoking in a retrospective cohort study
The extent that cigarette smoking may confound the relationship between diesel exhaust exposure and lung cancer was assessed in a retrospective cohort study of 55,395 U.S. railroad workers followed from 1959 to 1976. The relative risk (RR) of lung cancer due to diesel exhaust was indirectly adjusted using job-specific smoking data from a case-control study of railroad workers who died between 1981-1982 and from a survey of 514 workers who had responded to a mail survey in 1982. Adjustment factors were developed based on the distribution of job-specific smoking rates. The unadjusted RR for lung cancer was 1.58 for workers aged 40-44 in 1959, who experienced the longest possible duration of exposure, and the smoking adjusted RR was 1.44. After considering differences in smoking rates between workers exposed and unexposed to diesel exhaust in a relatively large blue-collar cohort, there were still elevated risks of lung cancer in workers in jobs with diesel exhaust exposure.
American Journal of Industrial Medicine, Oct. 2000, Vol.38, No.4, p.399-409. 33 ref.

CIS 01-378
Health and Safety Executive
Passive smoking at work
Tobacco smoke contains small droplets of tar together with nicotine and a wide range of gases including carbon monoxide, ammonia, hydrogen cyanide and acrolein, as well as small amounts of substances which been shown in laboratory tests to induce cancer in animals. Studies have shown that passive exposure to tobacco smoke (passive smoking) can cause lung cancer in non-smokers. It also causes acute irritant effects on the eyes, throat and respiratory tract, and can aggravate asthma. This booklet provides guidance to employers on action to prevent passive smoking, and recommends the introduction of a policy to control smoking at the workplace. The current legal situation in Britain is highlighted. Replaces CIS 91-423.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, Rev.ed., May 2000. 12p. Illus. 4 ref.

CIS 01-539 Cherniack M., Clive J., Seidner A.
Vibration exposure, smoking, and vascular dysfunction
A total of 601 shipyard workers (current and former users of pneumatic tools) was evaluated subjectively for cold-related vascular symptoms, and tested by cold challenge plethysmography. Follow-up testing was done on 199 members of the severely affected subgroup of smokers and non-smokers, many of whom had stopped smoking in the interval between tests. Effects of smoking and stopping smoking were assessed. Symptoms and measured abnormal vascular responses were more severe in smokers. Smokers were almost twice as likely to have more severe vasospasm than were non-smokers. 53 subjects who stopped smoking during the interval between tests improved, and were indistinguishable from non-smokers similarly exposed to vibration. Additional physiological benefits of stopping smoking were still apparent at further follow up examination, one year later. Improvements seen on plethysmography were not accompanied by improvements in symptoms, which remained unaffected by smoking.
Occupational and Environmental Medicine, May 2000, Vol.57, No.5, p.341-347. 33 ref.


CIS 01-1742 Scherer G., Adlkofer F.
Environmental tobacco smoke - Determining the exposure to hazardous substances for assessing the risk to health from passive smoking
Tabakrauch in der Raumluft - Erfassung der Schadstoffbelastung durch Passivrauchen zur Bewertung des gesundheitlichen Risikos [in German]
Cigarette smoke in ambient air consists mostly of smoke generated by the incandescent cone or exhaled by smokers. The physical, chemical and toxicological properties of these two constituents are considerably different. For this reason, the evaluation of the risk linked to the exposure to tobacco smoke must be carried out on the basis of the various substances present in the smoke. Several detection methods have been developed and validated. The examination of the weighted average values of the various harmful substances contained in cigarette smoke in ambient air show that the exposure of non-smokers to toxic and genotoxic substances contained in cigarette smoke is relatively low. This hypothesis is validated by monitoring of nitrosamine and its metabolites in the biological liquids of passive smokers.
Gefahrstoffe Reinhaltung der Luft, Nov.-Dec. 1999, Vol.59, No.11-12, p.435-443. Illus. 109 ref.

CIS 01-1490
VDI Gesellschaft Technische Gebäudeausrüstung
Technical concepts with respect to air for smoking and nonsmoking zones
Lufttechnische Konzepte für Raucher- und Nichtraucherzonen [in German]
Proceedings of a German Association of Engineers (VDI) conference on the design of ventilation systems for smoking and nonsmoking zones in buildings, held at Fulda on 25 Feb. 1999. Topics covered: legal situation protecting nonsmokers; recommendations for ventilation in buildings having both smoking and nonsmoking zones; characteristics of tobacco smoke; air purification; separation of ventilation air flows from smoking and nonsmoking zones; ventilation techniques; perception of cigarette smoke in the air and degree of acceptance by smokers and nonsmokers. Filters for smoke elimination have proven to be unsatisfactory so far.
VDI Verlag, Postfach 10 10 54, 40001 Düsseldorf, Germany, 1999. 107p. Illus. Bibl.ref. Price: DEM 78.00.

CIS 00-1610 Ueno S., Hisanaga N., Jonai H., Shibata E., Kamijima M.
Association between musculoskeletal pain in Japanese construction workers and job, age, alcohol consumption and smoking
A cross-sectional epidemiologic study was conducted to determine the prevalence of self-reported musculoskeletal pain (MSP) in construction workers and identify associations between MSP and job, age, alcohol consumption and smoking. Risk factors for total pain and for relatively severe pain in the hand/arm (RS-HAP), shoulder, and low-back (RS-LBP) were estimated by multiple logistic regression analysis. The results showed that musculoskeletal pain was significantly associated with age, and that the odds ratios (ORs) for relatively severe musculoskeletal pain increased almost linearly with age. Regarding the occupation, compared with architects whose work is presumed to be sedentary, almost all ORs for non-sedentary construction jobs were significantly high. Current smokers of 20 cigarettes a day or more had significantly higher ORs for RS-HAP and RS-LBP than for persons who never smoked.
Industrial Health, Oct. 1999, Vol.37, No.4, p.449-456. Illus. 37 ref.

CIS 00-1657 Chapman S., Borland R., Scollo M., Brownson R.C., Dominello A., Woodward S.
The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States
Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption in Australia and the United States are reviewed. The number and cost of cigarettes forgone are calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States.
American Journal of Public Health, July 1999, Vol.89, No.7, p.1018-1023. 50 ref.

CIS 00-895 Shaffer H.J., Vander Bilt J., Hall M.N.
Gambling, drinking, smoking and other health risk activities among casino employees
A sample of full-time casino employees was surveyed about gambling, drinking, smoking and other health risk behaviours. Respondents were also asked about their use of the employee assistance program (EAP) and perceived obstacles towards using the EAP. Casino employees were found to have a higher prevalence of past-year pathological gambling behaviour than the general adult population, a lower prevalence of past-year problem gambling and a higher prevalence of smoking, alcohol abuse and depression. The majority of non-smoking respondents in this sample were exposed to second-hand smoke. Employees reported low participation in the company's EAP. The results of this study suggest that casino management should consider improving problem gambling screening for employees who visit EAPs, even if employees present other problems (e.g., alcohol problems) as their primary concerns, increasing employees' awareness of EAPs, increasing health promotion and education through channels other than company EAPs, and creating smoke-free working areas.
American Journal of Industrial Medicine, Sep. 1999, Vol.36, No.3, p.365-378. 37 ref.

CIS 00-257 McSweeney K.P., Congleton J.J., Kerk C.J., Jenkins O., Craig B.N.
Correlation of recorded injury and illness data with smoking, exercise, and absolute aerobic capacity
The correlation between reported injury and illness occurrence, estimated absolute aerobic capacity, exercise and smoking was investigated in a sample of 212 young male manual material handlers from the Southeastern, Midwest, and Western areas of the United States. Results indicate a significant association with exercise and absolute VO2max. No significance was noted with smoking and absolute VO2max. Significant associations were observed with smoking and injury and higher total lost workdays injuries and illnesses. Overall, this study supports evidence from existing literature that data obtained via questionnaire is valid, as demonstrated by the self-report of exercise and corresponding higher aerobic capacity, obtained via objective measurement. Additional support is verified by the association of smoking and injury. One deviation from the existing literature is that smoking did not appear to have an adverse impact on aerobic conditioning.
International Journal of Industrial Ergonomics, May 1999, Vol.24, No.2, p.193-200. Illus. 38 ref.

CIS 00-81 Working with smokers
Travailler avec des fumeurs [in French]
Roken op het werk [in Dutch]
Information booklet on tobacco smoking at work, with reference to legislation in Belgium. Contents: overview; enterprise policies; strategic options (prohibition of smoking, taking into consideration local conditions, consulting and involving workers, evaluation and follow-up of the chosen policy); complementary measures; the situation in practice; list of useful addresses. Replaces CIS 97-71.
Ministère fédéral de l'emploi et du travail, 51 rue Belliard, 1040 Bruxelles, Belgium, Feb. 1999. 23p. 4 ref.

CIS 00-155 Lindgren T., Willers S., Skarping G., Norbäck D.
Urinary cotinine concentration in flight attendants, in relation to exposure to environmental tobacco smoke during intercontinental flights
24 cabin attendants (C/A) and one pilot, all non-smokers and without exposure to environmental tobacco smoke (ETS) in the home, were studied in order to measure and compare urinary cotinine concentration (U-cotinine) before, during and after work on intercontinental flights with exposure to ETS. Information on age, gender and occupation was gathered, as well as possible sources of ETS exposure in other places, outside work and during previous flights, during a 3-day period prior to the investigation. Urine samples were taken before departure, on board, and after landing. The median U-cotonine was 3.71µg/g crea before departure and 6.37µg/g crea after landing. Tobacco smoking in commercial aircraft may cause significant exposure to ETS among C/A working in the aft galley, despite high air exchange rates and spatial separation between smokers and non-smokers. Since smoking in commercial aircraft may result in an involuntary exposure to ETS among non-smokers, it should be avoided.
International Archives of Occupational and Environmental Health, Oct. 1999, Vol.72, No.7, p.475-479. 35 ref.

CIS 99-1480 Tobacco, alcohol and hand hygiene
Tabac, alcool et hygiène des mains [in French]
Roken, alcohol and handen wassen [in Dutch]
Topics: alcoholism; Belgium; data sheet; legislation; passive smoking; personal hygiene; plant safety and health organization; smoking; training material.
PREVENT, rue Gachard 88, 1050 Bruxelles, Belgium, 1999. 4p. Illus. 5 ref.


CIS 99-1588 Eisner M.D., Smith A K., Blanc P.D.
Bartenders' respiratory health after establishment of smoke-free bars and taverns
A cohort of bartenders was interviewed before and after prohibition of smoking in all bars and taverns by the state of California. Spirometric assessment included forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). At baseline, all 53 bartenders reported workplace environmental tobacco smoke (ETS) exposure. After the smoking ban, self-reported ETS exposure at work declined from a median of 28 to 2 hours per week. Thirty-nine bartenders initially reported respiratory symptoms. Of those symptomatic at baseline, 23 no longer had symptoms at follow-up. Forty-one bartenders initially reported sensory irritation symptoms. At follow-up, 32 of these subjects had resolution of symptoms. After prohibition of workplace smoking, improvement in mean FVC was observed and, to a lesser extent, mean FEV1. Complete cessation of workplace ETS exposure was associated with improved mean FVC and mean FEV1 after controlling for personal smoking and recent upper respiratory tract infections. Topics: California; cohort study; controlled smoking; dose-response relationship; exposure evaluation; maximal expiratory flow; one-second forced expiratory volume; passive smoking; pulmonary function; respiratory diseases; smoking; spirometry; ventilatory capacity; waiters, waitresses and bartenders.
Journal of the American Medical Association, Dec. 1998, Vol.280, No.22, p.1909-1914. 65 ref.

CIS 99-554 Phillips K., Bentley M.C., Howard D.A., Alván G.
Assessment of environmental tobacco smoke and respirable suspended particle exposures for nonsmokers in Prague using personal monitoring
Air samples were collected from the breathing zone of nonsmokers wearing personal monitors for 24h. Samples were analysed for respirable suspended particles, nicotine, 3-ethenylpyridine and environmental tobacco smoke (ETS) particles. Saliva cotinine analyses were also undertaken to confirm the nonsmoking status of the subjects. Highest exposures were apparent for office workers both working and living in smoking environments. Findings suggest a significant contribution to overall ETS particle and nicotine levels from the workplace where smoking takes place. Topics: airborne dust; cotinine; nicotine; Czech Republic; determination in air; determination in saliva; exposure evaluation; passive smoking; personal sampling; respirable dust.
International Archives of Occupational and Environmental Health, Sep. 1998, Vol.71, No.6, p.379-390. Illus. 24 ref.

CIS 99-344 Trinkhoff A.M., Storr C.L.
Work schedule characteristics and substance use in nurses
Administrative attention to the interplay of work schedules on workers along with consideration of competing family/home demands could lead to more healthful scheduling. In addition to substance use, working longer night and rotating shifts might be related to other health behaviors and conditions that should be examined in the future. Topics: alcoholism; drug dependence; night work; nursing personnel; questionnaire survey; shift work; smoking; social aspects; work organization; work time schedules; work-rest schedules.
American Journal of Industrial Medicine, Sep. 1998, Vol.34, No.3, p.266-271. Illus. 27 ref.

CIS 98-1376 Trout D., Decker J., Mueller C., Bernert J.T., Pirkle J.
Exposure of casino employees to environmental tobacco smoke
Topics: cotinine; nicotine; casinos; determination in air; determination in blood; determination in urine; exposure evaluation; passive smoking; respirable dust.
Journal of Occupational and Environmental Medicine, Mar. 1998, Vol.40. No.3, p.270-276. 29 ref.

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