DHHS publication ; no. (NIOSH)

Various NIOSH criteria documents on individual hazardous industrial agents, from asbestos [NIOSH 1972] through hexavalent chromium [NIOSH 2013a], have included specific recommendations relating to tobacco use, along with other recommendations to eliminate or reduce occupational safety and health risks. In addition, NIOSH has published two Current Intelligence Bulletins focused entirely on the hazards of tobacco use. CIB 31, Adverse Health Effects of Smoking and the Occupational Environment, outlined how tobacco use - most commonly smoking - can increase risk, sometimes profoundly, of occupational disease and injury [NIOSH 1979]. In that CIB, NIOSH recommended that smoking be curtailed in workplaces where those other hazards are present and that worker exposure to those other occupational hazards be controlled. CIB 54, Environmental Tobacco Smoke in the Workplace: Lung Cancer and Other Health Effects, presented a determination by NIOSH that secondhand smoke (SHS) causes cancer and cardiovascular disease [NIOSH 1991]. In that CIB, NIOSH recommended that workplace exposures to SHS be reduced to the lowest feasible concentration, emphasizing that eliminating tobacco smoking from the workplace is the best way to achieve that. This current CIB 67, Promoting Health and Preventing Disease and Injury Through Workplace Tobacco Policies, augments those two earlier NIOSH CIBs. Consistent with the philosophy embodied in the NIOSH Total Worker Health(TM) Program [NIOSH 2013b], this CIB is aimed not just at preventing occupational injury and illness related to tobacco use, but also at improving the general health and well-being of workers. Conclusions: 1. Cigarette smoking by workers and SHS exposure in the workplace have both declined substantially over recent decades, but about 20% of all U.S. workers still smoke and about 20% of nonsmoking workers are still exposed to SHS at work. 2. Smoking prevalence among workers varies widely by industry and occupation, approaching or exceeding 30% in construction, mining, and accommodation and food services workers. 3. Prevalence of ENDS use by occupation and industry has not been studied, but ENDS has grown greatly, with about 1 in 3 current U.S. adult smokers reporting ever having used e-cigarettes by 2013. 4. Smokeless tobacco is used by about 3% of U.S. workers overall, but smokeless tobacco is used by more than 10% workers in construction and extraction jobs and by nearly 20% of workers in the mining industry, which can be expected to result in disparities in tobacco-related morbidity and mortality. 5. Tobacco use causes debilitating and fatal diseases, including cancer, respiratory diseases, and cardiovascular diseases. These diseases afflict mainly users, but they also occur in those exposed to SHS. Smoking is substantially more hazardous, but use of smokeless tobacco also causes adverse health effects. More than 16 million U.S. adults live with a disease caused by smoking, and each year nearly a half million die prematurely from smoking or exposure to SHS. 6. Tobacco use is associated with increased risk of injury and property loss due to fire, explosion, and vehicular collisions. 7. Tobacco use by workers can increase, sometimes profoundly, the likelihood and the severity of occupational disease and injury caused by other workplace hazards (e.g., lead, asbestos, and flammable materials). 8. Restrictions on smoking and tobacco use in specific work areas where particular high-risk occupational hazards are present (e.g., explosives, highly flammable materials, or highly toxic materials that could be ingested via tobacco use) have long been used to protect workers. 9. A risk-free level of exposure to SHS has not been established, and ventilation is insufficient to eliminate indoor exposure to SHS. 10. Potential adverse health effects associated with using ENDS or secondhand exposure to particulate aerosols and gases emitted from ENDS remains to be fully characterized. 11. Policies that prohibit tobacco smoking throughout the workplace (i.e., smoke-free workplace policies) are now widely implemented, but they have not yet been universally adopted across the United States. These policies improve workplace air quality, reduce SHS exposure and related health effects among nonsmoking employees, increase the likelihood that workers who smoke will quit, decrease the amount of smoking during the working day by employees who continue to smoke, and have an overall impact of improving the health of workers (i.e., among both nonsmokers who are no longer exposed to SHS on the job and smokers who quit). 12. Workplace-based efforts to help workers quit tobacco use can be easily integrated into existing occupational health and wellness programs. Even minimal counseling and/or simple referral to state quitlines, mobile phone texting interventions, and web-based intervention can be effective, and more comprehensive programs are even more effective. 13. Integrating both occupational safety and health protection components into workplace health promotion programs (e.g., smoking cessation) can increase participation in tobacco cessation programs and successful cessation among blue-collar workers. 14. Smokers, on average, are substantially more costly to employ than nonsmokers. 15. Some employers have policies that prohibit employees from using tobacco when away from work or that bar the hiring of smokers or tobacco users. However, the ethics of these policies remain under debate, and they may be legally prohibited in some jurisdictions.NIOSHTIC No 20046002Foreword -- Executive summary -- Abbreviations -- Acknowledgements -- 1. Background -- 2. Tobacco Use by Workers and Secondhand Smoke Exposures at Work -- 3. Health and Safety Consequences of Tobacco Use -- 4. Preventive Interventions -- 5. Conclusions -- 6. Recommendations -- References \u2013 Appendix.Prevention and ControlOccupational HealthCurrentNIOSH8/24/2015NIOS