Neil Osterweil

November 18, 2013

BOSTON — A substantial proportion of blue collar workers smoke on the job, whether they want to or not.

Although more people than ever are enjoying clear, smoke-free air at work, a "remarkable" number of those in blue collar trades are still exposed to the harmful effects of environmental tobacco smoke (ETS), report investigators from the Commonwealth of Massachusetts.

Overall, the number of Massachusetts workers exposed to ETS declined from a high of 8.6% in 2004, when a smoke-free workplace law was enacted, to 5.4% in 2010. Nevertheless, more than one third of nonsmokers employed in installation, repair, and maintenance occupations still have to inhale someone else's smoke, say Kathleen Fitzsimmons, MPH, and colleagues from the Massachusetts Department of Public Health.

Approximately 1 in 5 nonsmoking workers in the fields of construction and extraction and in transportation and material moving are also exposed to ETS on the job.

In contrast, only about 3% of nonsmokers in white collar, office-based jobs have to cope with ETS, the investigators found.

"There is no risk-free level of environmental tobacco smoke," Fitzsimmons said here at the American Public Health Association (APHA) 141st Annual Meeting.

Heart Disease, Lung Cancer

A 2006 report from the Office of the US Surgeon General noted that ETS causes heart disease and lung cancer in adults and that smoke-free workplaces are an effective means of reducing ETS exposure among nonsmokers and of reducing smoking among workers in such environments.

In 2004, Massachusetts became the third state, behind Delaware and New York, to enact a Smoke-Free Workplace Law. The law specified that all enclosed workplaces with 1 or more employees have to be smoke-free, with the exception of private residences or hotel guest rooms.

To see whether the law was effective at protecting nonsmokers and reducing smoking by their coworkers, the investigators reviewed data from the Massachusetts portion of the Behavioral Risk Factor Surveillance System (BRFSS), a random-digit, landline-based survey of adults aged 18 years and older, conducted annually in all states.

The BRFSS collects self-reported data on respondents' health risk factors, chronic conditions, behaviors, and public health issues. The survey data are weighted to represent the population at large.

For the purpose of the study, Fitzsimmons and colleagues defined ETS at work as exposure to another's tobacco smoke for at least 1 hour in the past week, and a current smoker as someone who smoked at least 100 cigarettes in the past and currently smokes every day or on most days. The researchers used 2002 US Census Occupation codes to identify and group employees by job categories.

They found that ETS at work for nonsmokers was highest among nonwhite workers compared with whites (7.6% vs 4.9%), among men vs women (7.1% vs 3.6%), and among workers aged 18 to 44 years compared with those aged 45 years and older (6.8% vs 3.8%).

ETS prevalence among nonsmokers was highest in the fields of installation, repair, and maintenance (eg, security alarm installers, auto body repairers, heating contractors, and telecommunication and cable television installers), at 37.4%.

Nonsmoking workers employed in construction and extraction trades (carpenters, stonemasons, electricians, roofers, asphalt workers, etc) also had a high prevalence of ETS on the job, at 22.6%.

Similarly, nonsmokers who toil in transportation and material-handling jobs (bus and taxi drivers, gas station operators, parking lot attendants, waste collectors) had an ETS prevalence of 19.8 at work.

Table. ETS Prevalence at Work Among Nonsmokers, 2010

Job Type Percentage
All workers 37.4
Construction and extraction 22,6
Transportation and material moving 19.8
Service 7.7
Office and administrative support 3.4
Management, business, financial 3.0
Professional and related 3.0
Other 3.7

Source: 2010 Massachusetts BRFSS

Unenclosed Workplaces

Although it is unclear why workers in these specific occupation groups should be at greater risk than those in other occupations, it may be that they work in environments not covered by law, such as construction sites or private homes, or that they work in environments that are covered by the smoke-free workplace law but where it may be difficult to enforce, such as trucks or other service vehicles, the investigators speculate.

The findings are consistent with those of a nationwide survey of a nationwide health interview survey, which found ETS exposures of 28.5% for construction and extraction workers; 21.1% for those in installation, maintenance, and repair; and 16.9% for those in transportation and material moving. The authors of that study also found a higher prevalence of ETS at work among male, nonwhite, and younger workers ( Am J Industrial Med. 2013;56;6:635-646).

The study raises interesting public health issues regarding the definition of a workplace and on-the-job protection for nonsmoking workers, comments Anthony J. Alberg, PhD, MPH, professor of public health sciences at the Medical University of South Carolina in Charleston.

If you're going into someone else's house to do your work and they smoke, then what are you going to about that? Dr. Anthony J. Alberg

"If you're going into someone else's house to do your work and they smoke, then what are you going to about that?" he said to Medscape Medical News.

Overall, however, the data on the decline in occupational ETS exposure are encouraging, although he would have expected to have seen a steeper decline after the enactment of smoke-free workplace laws, Dr. Alberg said.

He notes that the high-risk occupations cited "are where you would expect to see a high prevalence of smokers, because over time, smoking has become more and more concentrated in lower-socioeconomic-status groups, and those were lower-income jobs."

The study was supported by the Massachusetts Department of Public Health. Fitzsimmons is an employee of the agency but disclosed no relevant financial relationships. Dr. Alberg have disclosed no relevant financial relationships.

American Public Health Association (APHA) 141st Annual Meeting: Abstract 286317. Presented November 4, 2013.


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