Occupational exposure to environmental tobacco smoke in U.S. adults: Results from the 2000 National Health Interview Sur

1. Occupational exposure to environmental tobacco smoke in U.S. adults: Results from the 2000 National Health Interview Survey Zakia Coriaty Nelson, M.P.H.

2. Environmental tobacco smoke (ETS) • Also referred to as “secondhand smoke” • A mixture of • Sidestream smoke, or smoke emitted from a lighted cigarette, and • Mainstream smoke, or smoke exhaled by a smoker • ETS contains carcinogens, mutagens, and developmental toxicants

3. Environmental Tobacco Smoke • Poses a significant health threat • Cancer • Coronary heart disease • Asthma • Low birth weight • Sudden Infant Death Syndrome (SIDS) • Other health effects

4. Environmental Tobacco Smoke • Widespread exposure • 30%-60% exposure in general population • NHANES III: 87.9% of adult non-tobacco users have detectible serum cotinine • 2000 NHIS: ETS exposure in approximately 27% of U.S. adults

5. Occupational ETS • High density of smokers in immediate work environment • Levels detected in work environments or workers exceed levels associated with serious health effects • Important source of ETS exposure and a public health hazard

6. Study Objectives • Estimate prevalence of exposure to occupational ETS on national level • Evaluate associations with sociodemographic and health-related factors • Investigate differences in exposure among nonsmokers, former smokers, and current smokers

7. Data and Methods • 2000 National Health Interview Survey and Cancer Control module • 32,374 respondents representing over 200 million U.S. adults • Sampling weights used to account for unequal selection probabilities and survey nonresponse

8. Data and Methods • Information collected on • Sociodemographic characteristics • Health-related factors • Personal smoking history • Smoking in the home • Workplace policies restricting smoking • Smoking in the workplace

9. Data and Methods • Crude estimates of percentages and standard errors • Multivariate logistic regression to estimate odds ratios and adjusted percentages • Analyses repeated in subgroups by personal smoking history

10. Data and Methods • Large sample size provides depth for multivariate adjustment and data disaggregation/stratification • Social and behavioral information collected allows for examination of health and policy in a social context

11. Results • 1,984 of 14,099 respondents reported smoking in work area • 14.3% exposed to occupational ETS • Stratified by personal smoking history • 10.4% of never smokers • 13.4% of former smokers • 24.0% of current smokers

12. Results • Overall, associations observed with • Age • Sex • Region of residence in the U.S. • Highest level of education attained • Occupation • Workplace policies restricting smoking • Smoking in the home • Personal history of smoking • Respondent-reported health status

13. Logistic Regression Results: Overall

14. Logistic Regression Results: Overall

15. Logistic Regression Results: Overall

16. Results • Overall, no association with • Race/ethnicity • Place of residence • Marital status • Family income • Citizenship status • Health insurance coverage status

17. Results: Subgroup Analyses • Stratified by personal smoking history, significant decreasing trend in association as education increased • Positive associations were observed with • Being male • Working in a service industry, blue collar, or agriculture/fishing job • A lack of workplace policies restricting smoking

18. Figure 1. Odds ratios of exposure to occupational environmental tobacco smoke in "mainly indoors" workers in relation to highest level of education, by personal smoking history

19. Figure 2. Percentage of "mainly indoors" workers at whose workplace smoking occurred during the last week, by personal smoking history and sex

20. Figure 3. Percentage of "mainly indoors" workers at whose workplace smoking occurred during the last week, by personal smoking history and occupation

21. Figure 4. Odds ratios of exposure to occupational environmental tobacco smoke in "mainly indoors" workers in relation to workplace smoking policies, by personal smoking history

22. Conclusions • Workplace smoking policies likely are efficacious in reducing occupational exposure to ETS • Others disproportionately affected: • Men • Less educated • Service industry and blue collar workers • Those exposed to ETS at home

23. Conclusions • Current smokers • Have high odds of exposure to occupational ETS • May have concurrent high prevalence of additional exposure to ETS at home • May be at even greater risk of serious health conditions

24. Conclusions • Bans on workplace smoking • Reduce exposure of nonsmokers to ETS • Decrease the number of cigarettes consumed daily by current smokers • Increase cessation attempts and successes in current smokers • Workers reporting occupational exposure to ETS dropped from 54% in 1992 to 7% in 1999.

25. Conclusions National-level estimates demonstrate that occupational exposure to ETS continues to pose a threat to the health of the U.S. working adult population

26. Next Steps • Evaluation of interaction between factors associated with occupational ETS • Publication of study results in journal