Secondhand Smoke Still Endangers 20% of Nonsmokers at Work: CDC

Troy Brown, RN

July 18, 2019

Nearly one fifth of nonsmoking employees reported recent exposure to secondhand smoke (SHS) in the workplace, and 10% said they were exposed at least twice per week, putting them at risk for serious health problems, according to researchers from the Centers for Disease Control and Prevention (CDC).

Exposure varied between industries and was significantly lower in states with comprehensive smoke-free laws.

Exposure to SHS increases the risk for heart disease, lung cancer, stroke, and other diseases. "Despite the considerable progress in implementation of smoke-free laws over the past 2 decades, this analysis found that even in states with smoke-free laws in three categories of venues, 8.6% of nonsmoking workers reported frequent workplace SHS exposure," the authors write. "This finding suggests that certain workplaces might be outside the scope of most smoke-free laws."

The report, by Chia-ping Su, MD, and colleagues from the Centers for Disease Control and Prevention, was published online July 12 in Morbidity and Mortality Weekly Report.

The researchers cited earlier data that show that the risks can have lethal consequences. From 2013 to 2014, one quarter of nonsmokers in the United States reported SHS exposure, and an estimated 41,000 deaths among adult nonsmokers were related to SHS exposure. "Furthermore, workplace SHS exposure has been recognized as one of the top occupational hazards that contributes substantially to the prevalence of occupational cancer among nonsmokers," the authors write.

For this report, the researchers used self-reported data from the 2015 National Health Interview Survey Occupational Health Supplement to determine the prevalence of workplace SHS exposure among nonsmokers according to smoke-free policy status in their state and "detailed industry categories and subcategories."

The analysis included adults aged 18 years or older who were employed during the week prior to the interview. The researchers assessed workplace SHS exposure on the basis of responses to the question, "During the past 12 months, while at work, how often were you exposed to tobacco smoke from other people?" Respondents could select from the following answers: "never"; "less than twice a week"; "twice a week or more, but not every day"; and "every day."

The authors defined "any exposure" as any answer other than "never"; "frequent exposure" was defined as exposure that occurred at least twice a week.

"In 2015, 19.9% of nonsmoking workers reported any exposure to SHS at work during the 12 months preceding the interview, and 10.1% reported frequent exposure (twice a week or more)," the researchers write.

The researchers assessed smoke-free policies with respect to three categories of workplace venue: private worksites, restaurants, and bars. They selected these three venues because they "are major sources of SHS exposure for nonsmoking workers."

The investigators studied the following four categories of smoke-free policies: no law or noncomprehensive law (smoking permitted in designated areas or areas with separate ventilation); 100% smoke-free in one venue category; 100% smoke-free in two categories; and 100% smoke-free in all three venue categories (comprehensive).

The overall prevalence of frequent workplacce SHS exposure was significantly lower for those who lived in states with comprehensive smoke-free laws (8.6%) compared with those who lived in states with restrictions in one category of venue (12.2%) or with no restrictions at all (11.0%).

High-Risk Industries

Prevalence was highest among nonsmoking workers in the commercial and industrial machinery and equipment subcategory of the repair and maintenance industries category (65.1%). The next-highest prevalence was among employees in the other transportation subcategory, which included air, rail, pipeline, and scenic and sightseeing transportation (55.8%).

The highest reported number of exposed workers was in the construction industry (2.9 million). "[T]hese industry categories/subcategories include outdoor workplaces and other settings that are unlikely to be protected by smoke-free laws. Identifying specific at-risk workplaces and implementing targeted intervention strategies could help reduce SHS exposure at work and protect workers' health," the authors explain.

From 2000 to 2015, the number of states that instituted smoke-free laws banning smoking in "indoor areas of worksites, restaurants, and bars" rose from none to 27.

National Health Interview Survey data for 2014 to 2016 revealed some form of tobacco use by 34.3% of workers in the construction, 30.4% of workers in the mining, and 30.2% of workers in the transportation industries, the authors write. Higher prevalences of smoking among those working in these industries might result in SHS exposure to their nonsmoking fellow workers.

"A recent study determined that indoor workers who reported working at a worksite having a 100% smoke-free policy had significantly lower odds of smoking combustible tobacco than did those reporting a partial or no smoke-free policy," the authors explain. "Enhanced and sustained efforts to protect nonsmoking workers through comprehensive smoke-free laws and implementation of smoke-free workplace policies by employers can benefit public health."

Among the study's limitations are the fact that the information was self-reported during the interview and so "might be subject to reporting bias." Some workers may reside in a state different from the one they work in, and laws related to smoking may differ between those states. Some study groups were too small for estimates to be reliable, and estimates for those groups were suppressed. Also, some local-level smoke-free policies may protect workers deemed to be unprotected by state-wide laws.

"[The National Institute of Occupational Safety and Health] encourages employers, especially those in industries with high prevalences of SHS exposure, to implement workplace-specific smoke-free policies to complement state and local smoke-free laws to help reduce SHS exposure among workers and protect workers’ health," the researchers write.

The researchers have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. Published online July 12, 2019. Full text

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