Cigarette smoking trends among U.S. working adult by industry and occupation: findings from the 2004-2012 National Health Interview Survey

Global epidemiology of kidney cancer

Kidney cancer (KC) is a disease with a rising worldwide incidence estimated at 400 000 new cases annually, and a worldwide mortality rate approaching 175 000 deaths per year. Current projections suggest incidence continuing to increase over the next decade, emphasizing the urgency of addressing this significant global health trend. Despite the overall increases in incidence and mortality, striking social disparities are evident. Low- and middle-income countries bear a disproportionate burden of the disease, with higher mortality rates and later-stage diagnoses, underscoring the critical role of socioeconomic factors in disease prevalence and outcomes. The major risk factors for KC, including smoking, obesity, hypertension and occupational exposure to harmful substances, must be taken into account. Importantly, these risk factors also often contribute to kidney injury, a condition that the review identifies as a significant, yet under-recognized, precursor to KC. Finally, the indispensable role of nephrologists is underscored in managing this complex disease landscape. Nephrologists are at the forefront of detecting and managing kidney injuries, and their role in mitigating the risk of KC is becoming increasingly apparent. Through this comprehensive analysis, we aim to facilitate a more nuanced understanding of KC's epidemiology and determinants providing valuable insights for researchers, clinicians and policymakers alike.

Occupational exposure to diesel exhaust and head and neck cancer: a systematic review and meta-analysis of cohort studies

Exposure to diesel exhaust (DE) and other fossil fuels in the workplace can cause several health effects including cancer. We conducted a systematic review and meta-analysis of cohort studies examining the association between occupational DE exposure and the risk of head and neck cancer (HNC), including cancer of the oral cavity, pharynx and larynx. We included cohort studies mentioned in the Monograph of the International Agency for Research on Cancer, 2014, on DE. Forest plots of relative risk (RR) were constructed for HNC overall and its anatomical subtypes. A random-effects model was used to address heterogeneity between studies. Fifteen articles were included after removing duplicates and irrelevant reports. The summary RR for DE exposure was 1.08 [95% confidence interval (CI) = 1.01-1.17, P heterogeneity = <0.001] for HNC overall, 0.98 (95% CI = 0.87-1.11) for oral cavity, 1.05 (95% CI = 0.77-1.43) for pharyngeal, 1.15 (95% CI = 0.96-1.38) for oral cavity and pharyngeal combined, and 1.13 (95% CI = 1.03-1.24) for laryngeal cancer. There were elevated RRs for incidence studies of HNC (RR = 1.13; 95% CI = 1.05-1.22, P = 0.001), European studies (RR = 1.13; 95% CI = 1.05-1.23, P = 0.001), and female studies (RR = 1.77; 95% CI = 1.31-2.39, P = 0.003). Our study suggested an association between occupational DE exposure and the risk of HNC, particularly laryngeal cancer. Although residual confounding cannot be ruled out, our results support the importance of controlling occupational DE exposure.

Quantifying weight loss program preferences of men working in trade and labor occupations: A discrete choice experiment

Objective

Men who work in skilled and unskilled trades and labor occupations (i.e., blue-collar occupations), have high rates of obesity and associated comorbidities but are underrepresented in weight loss programs. A first step in engaging this group is to better understand their preferences for weight loss programs.

Methods

Respondents were men working in trade and labor occupations, with overweight/obesity, and an interest in losing weight. A discrete choice experiment was developed, and the data were analyzed using mixed logit model. Respondent characteristics were tested as effect modifiers.

Results

Respondents (N = 221, age (M ± SD) 45.0 ± 12.6, BMI 33.3 ± 6.3, 77% non-Hispanic white) working in a variety of occupations (construction 31%, manufacturing 30%, transportation 25%, maintenance/repair 14%) participated in this study. Results indicate preferences for programs that encourage making smaller dietary changes, are delivered online, and do not incorporate competition. Results were consistent across sensitivity analyses and most respondent groups.

Conclusions

The results suggest specific ways to make weight loss programs more appealing to men in trade and labor occupations. Using experimental methods to quantify preferences using larger, more representative samples would further assist in tailoring behavioral weight loss programs for under-reached populations.

Risks of Leukemia in Various Industrial Groups in Korea: A Retrospective National Cohort Study

It is known that occupational exposure to specific agents is associated with leukemia. However, whether the occupational risks of leukemia differ among various industrial groups remains unclear. Therefore, the purpose of this study was to elucidate the occupational risks of leukemia among different worker groups by industry. Data for a total of 11,050,398 people from the National Health Insurance System's claim data from 2007 to 2015 were analyzed. By cohort inclusion of workers whose industry had not changed for three years and with total workers as a control group, the risk for a specific industry group was expressed as an age-standardized incidence ratio (SIR). Among groups by industry, 'Manufacture of motor vehicles and engines for motor vehicles', 'Sale of motor vehicle parts and accessories', and 'Personal care services' showed significantly higher SIRs. In division analysis, the 'Manufacture of other machinery and equipment' and 'Waste collection, treatment and disposal activities' divisions showed significantly higher SIRs than other divisions. We identified an increased risk of leukemia in workers of certain industries in Korea. Based on the results of this study, it is necessary to create a policy to protect workers at risk of leukemia. Various additional studies are needed to protect workers by revealing more precise relationships between individual hazardous substances, processes, and leukemia.

Effects of electronic cigarettes and hookah (waterpipe) use on home air quality

INTRODUCTION

A major site of secondhand smoke exposure for children and adults is the home. Few studies have evaluated the impact of e-cigarette or hookah use on home air quality, despite evidence finding toxic chemicals in secondhand e-cigarette aerosols and hookah smoke. We assessed the effect of e-cigarette and hookah use on home air quality and compared it with air quality in homes where cigarettes were smoked and where no smoking or e-cigarette use occurred.

METHODS

Non-smoking homes and homes where e-cigarettes, hookah or cigarettes were used were recruited in the New York City area (n=57) from 2015 to 2019. Particulate matter with diameter less than 2.5 µm (PM2.5), black carbon and carbon monoxide (CO) were measured during a smoking or vaping session, both in a 'primary' smoking room and in an adjacent 'secondary' room where no smoking or vaping occurred. Log transformed data were compared with postanalysis of variance Tukey simultaneous tests.

RESULTS

Use of hookah significantly increased PM2.5 levels compared with non-smoking homes, in both the primary and secondary rooms, while use of e-cigarettes increased PM2.5 levels only in primary rooms. Additionally, in-home use of hookah resulted in greater CO concentrations than the use of cigarettes in primary rooms.

CONCLUSIONS

Use of e-cigarettes or hookah increases air pollution in homes. For hookah, increases in PM2.5 penetrated even into rooms adjacent to where smoking occurs. Extending smoke-free rules inside homes to include e-cigarette and hookah products is needed to protect household members and visitors from passive exposure to harmful aerosols and gases.

Estimating 10-year risk of lung and breast cancer by occupation in Switzerland

Introduction

Lung and breast cancer are important in the working-age population both in terms of incidence and costs. The study aims were to estimate the 10-year risk of lung and breast cancer by occupation and smoking status and to create easy to use age-, and sex-specific 10-year risk charts.

Methods

New lung and breast cancer cases between 2010 and 2014 from all 5 cancer registries of Western Switzerland, matched with the Swiss National Cohort were used. The 10-year risks of lung and breast cancer by occupational category were estimated. For lung cancer, estimates were additionally stratified by smoking status using data on smoking prevalence from the 2007 Swiss Health Survey.

Results

The risks of lung and breast cancer increased with age and were the highest for current smokers. Men in elementary professions had a higher 10-year risk of developing lung cancer compared to men in intermediate and managerial professions. Women in intermediate professions had a higher 10-year risk of developing lung cancer compared to elementary and managerial professions. However, women in managerial professions had the highest risk of developing breast cancer.

Discussion

The 10-year risk of lung and breast cancer differs substantially between occupational categories. Smoking creates greater changes in 10-year risk than occupation for both sexes. The 10-year risk is interesting for both patients and professionals to inform choices related to cancer risk, such as screening and health behaviors. The risk charts can also be used as public health indicators and to inform policies to protect workers.

Development of a WeChat-based Mobile Messaging Smoking Cessation Intervention for Chinese Immigrant Smokers: Qualitative Interview Study

Background

Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers’ access to smoking cessation treatment.

Objective

This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally.

Methods

This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Decídetexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers’ barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants’ smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages.

Results

Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment.

Conclusions

Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers.

Chronic Obstructive Pulmonary Disease and U.S. Workers: Prevalence, Trends, and Attributable Cases Associated With Work

INTRODUCTION

Chronic obstructive pulmonary disease is the fourth leading cause of death in the U.S. Workplace exposures are important modifiable contributors to the burden of chronic obstructive pulmonary disease. Among U.S. workers, 19% of chronic obstructive pulmonary disease cases are attributable to workplace exposures. This study examines the trends in chronic obstructive pulmonary disease prevalence during 2012-2018 among workers and assesses the population attributable fraction for chronic obstructive pulmonary disease associated with work by smoking status, industry, and occupation.

METHODS

The 2012-2018 National Health Interview Survey data for workers aged ≥18 years employed during the 12 months before the interview were analyzed in 2019. Annual trends were examined using the Poisson regression model. Multivariate logistic regression was used to calculate adjusted prevalence ORs.

RESULTS

During 2012-2018, an estimated age-adjusted annual average of 4.1% of workers had chronic obstructive pulmonary disease, and prevalence varied by industry and occupation. Overall, chronic obstructive pulmonary disease prevalence increased by an estimated annual average of 1.5% (p<0.05). The prevalence trends increased significantly among workers in the merchant wholesale nondurable and the arts, entertainment, and recreation industries and among financial specialists; supervisors, other food services workers; supervisors, building grounds workers, and maintenance workers; personal care and services workers; supervisors and office and administrative support workers; and motor-vehicle operators and material moving workers. The proportion of chronic obstructive pulmonary disease cases attributable to work was 27.3% among all workers and 24.0% among never smokers.

CONCLUSIONS

Public health efforts to increase the awareness and understanding of chronic obstructive pulmonary disease associated with occupational risk factors are needed to prevent chronic obstructive pulmonary disease among workers, especially among those employed in industries and occupations with increasing prevalence trends.

Patterns and prevalence of daily tobacco smoking in Australia by industry and occupation: 2007-2016

INTRODUCTION

Australian workers' daily tobacco smoking over time was examined by industry, and occupation, to identify factors associated with high/low prevalence.

METHODS

Secondary analyses of 2007, 2010, 2013 and 2016 National Drug Strategy Household Surveys were undertaken (pooled n=49,395). Frequency analyses informed subsequent modelling of select industries and occupations. Four logistic regression models estimated adjusted effects of demographics on daily smoking in industries with high (≥20%) and low (≤15%) daily smoking prevalence, and occupations with high (≥20%) and moderate/low (<20%) daily smoking prevalence.

RESULTS

The sample comprised: 55.7% men; 34.1% 25-39 year olds; 31.4% New South Wales residents; 70.1% metropolitan residents; 66.9% high SES workers; and 70.6% with low psychological distress. Daily smoking prevalence differed by industry and occupation in 2007, generally decreasing between 2007-2016. In high prevalence industries, daily smoking was associated with male gender and age (25-39 year olds); and in low prevalence industries with males and non-metropolitan workers. In high prevalence occupations, daily smoking was associated with males, female non-metropolitan workers, and age 25-39 years; and in moderate/low prevalence occupations with non-metropolitan workers, and negatively associated with females aged 14-24 years. In all models, increased odds of daily smoking were associated with low socio-economic status and very high psychological distress.

CONCLUSIONS

Low socio-economic status and very high psychological distress were risk factors for daily smoking regardless of industry, occupation, or high pre-existing smoking prevalence. Targeted, as well as universal, interventions are required for workplaces and workers with greatest smoking vulnerability and least smoking cessation progress.

IMPLICATIONS

Specific strategies are warranted for identified industries, occupations and subgroups with increased odds of daily tobacco smoking. Industries/occupations with moderate/low smoking prevalence may confer workers some protection but are not without risk; some subgroups in these settings (e.g., non-metropolitan areas), had elevated daily smoking risk. Hence, the following are supported: 1. Universal interventions directed at low socio-economic workers, and workers with very high psychological distress regardless of workplace; 2. Interventions targeted at high prevalence industries; 3. Cessation efforts targeted for young workers in high prevalence industries/occupations, and 4. Focussed interventions addressing specific needs of non-metropolitan at-risk workers in low prevalence industries.

Changing patterns and prevalence of daily tobacco smoking among Australian workers: 2007-2016

OBJECTIVE

To map patterns and prevalence of daily smoking among employed Australians over time.

METHODS

Data from four waves of the triennial National Drug Strategy Household Survey (2007, 2010, 2013 and 2016) were used to assess daily smoking. Frequency analyses and significance testing examined smoking prevalence by sex, age, state, remoteness, Indigeneity, socioeconomic status (SES) and psychological distress. Logistic regression models estimated adjusted effects of demographics on smoking prevalence.

RESULTS

Workers' daily smoking prevalence reduced by 32% between 2007 and 2016. The adjusted model showed the lowest smoking reductions among men and non-metropolitan workers. Other interaction effects showed the highest daily smoking rates for: male workers aged 14-39 years; low SES non-metropolitan workers; and low SES workers aged 40-59 years.

CONCLUSIONS

Specific workplace policies, prevention and intervention strategies are warranted for male workers, especially those aged 14-39; non-metropolitan workers, especially low SES rural workers; and low SES workers especially 40-59-year-olds. Implications for public health: In spite of significant smoking reductions among workers over time, reductions were unevenly distributed. Tailored, innovative workplace prevention and intervention strategies that apply principles of proportionate universalism and address individual, workplace settings and cultural factors are warranted to reduce smoking disparities among male, rural and low SES workers.

Occupational distribution of metabolic syndrome prevalence and incidence differs by sex and is not explained by age and health behavior: results from 75 000 Dutch workers from 40 occupational groups

INTRODUCTION

This study examines the association between 40 occupational groups and prevalence and incidence of metabolic syndrome (MetS), separately for male and female workers, and whether age and health behaviors can explain the association.

RESEARCH DESIGN AND METHODS

Data from 74 857 Lifelines Cohort and Biobank Study participants were used to regress occupational group membership, coded by Statistics Netherlands, on the prevalence and incidence of MetS using logistic and Cox regression analyses. MetS diagnosis was based on physical examinations, blood analysis, and recorded medication use. Information on age, smoking status, physical activity, diet and alcohol consumption was acquired using questionnaires.

RESULTS

Baseline MetS prevalence was 17.5% for males and 10.6% for females. During a median 3.8 years of follow-up, MetS incidence was 7.8% for males and 13.2% for females. One occupational group was associated with an increased MetS risk in both sexes. Six additional occupational groups had an increased risk for MetS among men, four among women. Highest risks were found for male 'stationary plant and machine operators' (HR: 1.94; 95% CI 1.26 to 3.00) and female 'food preparation assistants' (HR: 1.80; 95% CI 1.01 to 3.22).

CONCLUSIONS

Findings suggest that occupational group matters for men and women in MetS development, and that differences in MetS prevalence across occupations are not merely a reflection of selection of metabolically unhealthy workers into specific occupations. The striking sex differences in the occupational distribution of MetS indicate that preventive measures should, with some exceptions, target men and women separately.

Occupational exposure to formaldehyde and risk of lung cancer: A systematic review and meta-analysis

BACKGROUND

Formaldehyde exposure is associated with nasopharyngeal cancer and leukemia. Previously-described links between formaldehyde exposure and lung cancer have been weak and inconsistent. We performed a systematic review and meta-analysis to evaluate quantitatively the association between formaldehyde exposure and lung cancer.

METHODS

We searched for articles on occupational formaldehyde exposure and lung cancer in PubMed, EMBASE, Web of Science, and CINAHL databases. In total, 32 articles were selected and 31 studies were included in a meta-analysis. Subgroup analyses and quality assessments were also performed.

RESULTS

The risk of lung cancer among workers exposed to formaldehyde was not significantly increased, with an overall pooled risk estimate of 1.04 (95% confidence interval [CI], 0.97-1.12). The pooled risk estimate of lung cancer was increased when higher exposure studies were considered (1.19; 95% CI, 0.96-1.46). More statistically robust results were obtained when high quality (1.13; 95% CI, 1.08-1.19) and recent (1.13; 95% CI, 1.07-1.19) studies were used in deriving pooled risk estimates.

CONCLUSIONS

No significant increase in the risk of lung cancer was evident in the overall pooled risk estimate; even in higher formaldehyde exposure groups. Our findings do not provide strong evidence in favor of formaldehyde as a risk factor for lung cancer. However, since risk estimates were significantly increased for high-quality and recent studies, the possibility that exposure to formaldehyde can increase the risk of lung cancer might still be considered.

Understanding Lung Cancer Resources and Barriers Among Worksites With Mostly Male Employees in Eight Rural Kentucky Counties: A Focus Group Discussion

Kentucky has the highest cancer incidence and mortality rates in the United States, and lung cancer is Kentucky's leading cause of cancer deaths. Males in Kentucky have higher lung incidence and mortality rates than females. Through support from the SelfMade Health Network, Kentucky developed a Regional Resource Lead Organization that collaboratively developed a multi-component worksite intervention on lung cancer among male populations. The intervention targets eight Kentucky counties. The first component and focus of this manuscript included focus group meetings with organizational representatives in each county that provide health, educational, and social services to men and worksites. The focus groups discussed four distinct areas: (a) lung cancer-related resources and services in each county; (b) perceived ways men in worksites learn about and access health-related services; (c) identification of potential challenges and barriers to reaching men in worksites; and (d) creation of linkages and potential partnerships between community organizations and worksites. Forty-five organizational representatives participated in the eight focus groups. Most resources and services discussed were related to tobacco treatment. Employers were the most commonly perceived way men learn about and access health-related services, while attitudes and behaviors were the most commonly perceived barriers preventing men from accessing services. The most common potential linkages and partnerships across all areas were community organizations and groups, employers, health-care providers, and mass media. Partnering with employers may provide an opportunity to reach males with lung cancer prevention and control resources and services.

Estimates of the Prevalence, Intensity and the Number of Workers Exposed to Cigarette Smoking across Occupations and Industries in Korea

BACKGROUND

Tobacco smoking affects the incidence of various illnesses such as lung cancer, respiratory diseases, and cardiovascular diseases. In an effort to prevent smoking-related cancers, we aimed to estimate the smoking prevalence, intensity, and number of workers exposed to smoking, which would be specific to the occupational and industrial circumstances in Korea.

METHODS

We used the Korean Working Condition Survey (KWCS) and Korea's Census data. Smoking prevalence and intensity were estimated using the KWCS data. The number of smokers was estimated by multiplying smoking prevalence with the number of workers in the occupation or industry. Smoking prevalence, intensity, and number of smokers were estimated for major, sub-major, and minor groups of occupation and industry.

RESULTS

Of the total labor force in 2010, 52.66% of men and 5.24% of women workers were estimated to be current smokers. Men workers smoked 15.42 cigarettes/day, and women workers 11.29 cigarettes/day. In terms of occupation, "craft and related trades workers" demonstrated the highest smoking prevalence (52.24%). "Managers" smoked the highest number of cigarettes (16.63 cigarettes/day) and "equipment, machine operating, and assembling workers" comprised the largest number of estimated smokers (1,368,726 workers). In terms of industry, "mining and quarrying" had the highest smoking prevalence (69.27%). Those in "construction" smoked the highest number of cigarettes (17.16 cigarettes/day) and those in "manufacturing" comprised the largest number of estimated smokers (1,629,893 workers).

CONCLUSION

Our results may help in setting priorities for smoking prevention-related activities. In addition, these results can be used for epidemiological studies controlling for the effect of smoking by occupation or industry.

Factors associated with different smoking statuses among Malaysian adolescent smokers: a cross-sectional study

BACKGROUND

This study focused on the associations between socioeconomic status (SES) and adolescent smoking among secondary school students (13 to 17 years) in the Federal Territory of Kuala Lumpur, Malaysia. Our objective was to evaluate the relationships between adolescent demographics, socioeconomic status and smoking status.

METHODS

The survey data were based on baseline findings from a cross-sectional study (N = 422 adolescents). Chi-square test was used to assess the relationship between demographic characteristics, socioeconomic status (household monthly income and daily allowance) and adolescent smoking status. Exhaled carbon monoxide (CO) reading and the Hooked on Nicotine Checklist (HONC) were used to evaluate adolescent smoking status. A Multivariate Multinomial Logistic Regression (MMLR) was employed to test selected demographic and socioeconomic predictors of smoking status.

RESULTS

Of the 422 adolescents (M age = 15.58, SD = 1.24), more than half of the participants initiated smoking between 13 to 17 years old (59.0%). A total of 308 (73.0%) were electronic cigarette users, with more than 50% comprising of single users. The mean CO reading was 2.14 ppm with 78.0% of adolescents scoring more than 0 on the Hooked on Nicotine Checklist (HONC). Males and participants aged 15 and 16 years were at increased risks of sole CC smoking. Meanwhile, males, those who are not hooked on smoking and with a non-smoker CO reading were at increased risks of sole EC smoking. Finally, Bumiputeras were at less risk of EC smoking.

CONCLUSIONS

Demographic variables such as age, gender and ethnicity predicted smoking status predicted smoking risk, but not socioeconomic factors. The findings allow policy makers to target specific high-risk demographic groups when designing smoking cessation programs for adolescents.

Tobacco Evidence-Based Practice Implementation and Employee Tobacco-Related Outcomes at Small Low-Wage Worksites

OBJECTIVE

The aim of this study was to assess whether tobacco policy, program, and communication evidence-based practice implementation is associated with employee tobacco outcomes [current smoking; quit attempt; smokeless tobacco (SLT) use; and perceived worksite support for cessation] at small low-wage worksites.

METHODS

We analyzed data from a randomized controlled trial testing an intervention to increase implementation of evidence-based health promotion practices. We used generalized estimating equations to examine relationships between practice implementation and tobacco outcomes.

RESULTS

Communication practice implementation was associated with better perceived worksite support for cessation (P = 0.027). Policy and program implementation were associated with increased odds of being a current SLT user; these findings should be interpreted with caution given small sample sizes.

CONCLUSION

Tobacco communication evidence-based practice implementation was associated with favorable perceptions of worksite support for cessation; more may be needed to change tobacco use behavior.

Public Facility Utility and Third-Hand Smoking Exposure without First and Second-Hand Smoking According to Urinary Cotinine Level

Third-hand smoke (THS) causes pathological changes in the liver, lungs, and skin. THS exposure can be ubiquitous, chronic, and unconscious. However, little is known about THS exposure in public facilities and its susceptible population. This paper aimed to identify which public facilities and socio-demographic groups were especially vulnerable to THS. Data from 1360 adults obtained from Korean National Environmental Health Survey I (2009–2011) were analyzed. To study the sole effect of THS, we restricted the study population to those participants who had never smoked and who had no exposure to second-hand smoke. The assessed variables included the type and frequency of public transportation, frequency of use of 12 different public facilities, and 8 socio-demographic factors. Urinary cotinine was used as a biomarker. T-tests and analysis of variance were used for univariate analyses, while generalized linear regression was used for multivariate analysis. Frequent use of public transportation, bars, internet cafés, and participants with low levels of education, divorced or bereaved, living in multi-unit houses, and with smokers within the family were associated with significantly high urinary cotinine levels. These findings indicate that the frequent use of public transportation, certain public facilities and certain socio-demographic factors can result in high THS exposure.

Skin Cancer Prevention Behaviors Among Agricultural and Construction Workers in the United States, 2015

Introduction

Nearly 5 million people are treated for skin cancer each year in the United States. Agricultural and construction workers (ACWs) may be at increased risk for skin cancer because of high levels of ultraviolet radiation exposure from the sun. This is the first study that uses nationally representative data to assess sun-protection behaviors among ACWs.

Methods

We analyzed data from the 2015 National Health Interview Survey Cancer Control Supplement to examine the prevalence of sun-protection behaviors among ACWs. We calculated national, weighted, self-reported prevalence estimates. We used χ² tests to assess differences between ACWs by industry and occupation.

Results

Most of the 2,298 agricultural and construction workers studied were male (by industry, 72.4% in agriculture and 89.3% in construction; by occupation, 66.1% in agriculture and 95.6% in construction) and non-Hispanic white. About one-third had at least 1 sunburn in the past year. The prevalence of sunscreen use and shade seeking was low and did not significantly differ among groups, ranging from 15.1% to 21.4% for sunscreen use and 24.5% to 29.1% for shade seeking. The prevalence of wearing protective clothing was significantly higher among agricultural workers than among construction workers by industry (70.9% vs 50.7%) and occupation (70.5% vs 53.0%).

Conclusion

Our findings could be used to improve occupational health approaches to reducing skin cancer risk among ACWs and to inform education and prevention initiatives addressing skin cancer. Sun-safety initiatives may include modifying work sites to increase shade and adding sun safety to workplace policies and training. Employers can help reduce occupational health inequities and protect workers by creating workplaces that facilitate sun protection.

Disparities in individual health behaviors between medicaid expanding and non-expanding states in the U.S

Following the roll out of the Affordable Care Act, a significant amount of research has focused on health insurance coverage disadvantages experienced by those in states that chose not to expand Medicaid. This line of research has been used as a way to conceptualize potential disparities in future population health outcomes between states that did and did not expand Medicaid. While health insurance is certainly associated with health outcomes, health behaviors are equally, if not more, important. Therefore, to understand potential future population health outcomes - or lack thereof - this paper examines whether adults in states that did not expand Medicaid are also more likely to engage in health damaging behaviors (i.e. smoking, heavy drinking, physical inactivity, and overweight and obesity) than adults in states that expanded Medicaid. I find that those in states that did not expand Medicaid are more likely to be overweight and obese but are less likely to drink heavily compared to adults in states that did expand Medicaid. In part, higher rates of demographic and socioeconomic disadvantage explain higher rates of health damaging behaviors in states that did not expand Medicaid. This paper raises concerns about added long term consequences for population health and growing health disparities between states that did and did not expand Medicaid. Policy and practice implications of these findings are discussed.

Tobacco product use among workers in the construction industry, United States, 2014-2016

BACKGROUND

Although cigarette smoking has declined among U.S. workers, smoking remains high among construction workers. This study assessed tobacco product use among U.S. construction workers.

METHODS

The 2014-2016 National Health Interview Survey data for U.S. working adults were analyzed.

RESULTS

Of the 10.2 (6.3% of working adults) million construction workers, 35.1% used any tobacco product; 24.4% were cigarette smokers, 8.3% were cigar, cigarillo, pipe or hookah smokers, 7.8% were smokeless tobacco users, 4.4% were e-cigarette users, and 7.6% used ≥2 tobacco product users. Tobacco use varied by worker characteristics, with highest tobacco use (>35%) among those reporting ≤5 years on the job, temporary work status, job insecurity, or an unsafe workplace. Construction workers had higher odds of tobacco product use than non-construction workers.

CONCLUSIONS

Over one-third of U.S. construction workers use tobacco products and disparities exist across sub-groups. Workplace tobacco control strategies could reduce tobacco use among this population.

Changes in the smoking behavior of pregnant women andtheir family members during pregnancy: A cross-sectional study in China

INTRODUCTION

Studies regarding the changes in smoking behavior of pregnant women have been mostly conducted in high income countries but rarely in China. This study thus focused on investigating the changes in smoking behavior among pregnant women and their family members in China, both before and during pregnancy.

METHODS

A cross-sectional study was carried out at nine Women and Children’s Hospitals in Shanghai, China, in 2014. A total of 2831 gestational households were recruited. The chi-squared test, paired sample t-test and logistical regression analysis were used during statistical analysis.

RESULTS

The prevalence of smoking for all household members significantly declined during pregnancy: 76.2% of the pregnant women, 19.2% of their husbands and 14.0% of other family members quit smoking entirely. The average daily cigarette consumption rate decreased from 5.9 to 0.9 among pregnant women, 11.4 to 9.5 for husbands, and 11.4 to 9.5 for other family members (paired sample t-test, p<0.001). The likelihood that husbands continued smoking during pregnancy was significantly lower for those with a shorter history of smoking, had a lower daily cigarette consumption rate and a household registration in Shanghai.

CONCLUSIONS

The prevalence of smoking among pregnant women, husbands and other family members significantly declines during pregnancy. Thus, pregnancy is most likely a key period in which to provide families with health education regarding the effects of smoking, both during the pregnancy period and in general. Intervention programs designed to reduce smoking among husbands during pregnancy should focus on those with a long history of smoking, a high rate of daily cigarette consumption, and those with household registration not in Shanghai.

Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey

BACKGROUND

Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey.

METHODS

General population samples aged 20-44 were randomly selected in 1991-1993 and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework.

FINDINGS

3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0%.

INTERPRETATION

These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.

Disparities in cancer screening by occupational characteristics

Cancer screening patterns according to occupation characteristics in the United States are not well known, but could be used to help inform cancer control efforts. We examined cervical (CC), breast (BC) and colorectal cancer (CRC) screening prevalence and prevalence ratios (PR) by occupational characteristics in 2010, 2013 and 2015 National Health Interview Surveys (NHIS) among eligible US workers (CC women 21-65years; n=20,997), (BC women ≥40years; n=14,258) and (CRC men and women ≥50years; n=17,333). Cervical, breast and colorectal cancer screening prevalence among US workers was 84.0%, 68.9%, and 56.8%, respectively. Unadjusted prevalence ratios for cervical (PR=0.92, 95%CI 0.90, 0.94), breast (PR=0.86, 95%CI 0.83, 0.90) and colorectal cancer screening (PR=0.83, 95%CI 0.80, 0.87) were lower among workers in small (<25 employees) compared to large organizations (≥500 employees). People in food service, construction, production, and sales occupations were 13-26%, 17-28% and 9-30% less likely to be up to date with cervical, breast, and colorectal cancer screening, respectively, compared to healthcare professionals. Adjustment for socioeconomic factors and insurance status eliminated most associations. Disparities in cancer screening by occupational characteristics were mostly attributed to lower socioeconomic status and lack of insurance. These findings underscore the need for innovative public health strategies to improve cancer screening in vulnerable populations.

A comparison of nicotine dependence among exclusive E-cigarette and cigarette users in the PATH study

Electronic cigarettes ("e-cigs") have recently gained in popularity, but their health risks, including dependence potential are unclear. This study analyzed the adult database from the Wave 1 Population Assessment of Tobacco and Health (PATH) Study, a nationally representative survey of tobacco use in the United States, to assess the relative level of dependence among adult, exclusive everyday users of e-cigarettes and cigarettes. Of the total 32,320 observations from the Wave 1 PATH adult database, 3586 (5.9%, weighted) were eligible for our analysis population. Among those who met the eligibility criteria, 156 (4.6%) were exclusive e-cig users, and 3430 (95.4%) were exclusive cigarette smokers. Our results show that e-cig users reported a significantly longer time-to-first-use of the day after waking (measured in minutes) compared to cigarette smokers after adjusting for confounders (adjusted geometric mean [95% confidence limits (CL)]: 29.2 [24.4-34.9] vs. 20.0 [18.7, 21.5]). In addition, cigarette smokers were significantly more likely to consider themselves addicted (Adj. Odds Ratio [95% CL]: 6.9 [4.5-10.7]); have strong cravings (2.9 [1.9-4.2]); find it difficult in the past 12months to refrain from using their product in places where it was prohibited (6.4 [2.9-14.3]); and feel like they really needed to use their product (3.9 [2.4-6.4]). These results are consistent with previous studies, in finding that exclusive daily e-cigarette users are less dependent on their respective product than comparable cigarette smokers.

Smoking and finances: baseline characteristics of low income daily smokers in the FISCALS cohort

BACKGROUND

Financial stress is a barrier to successful smoking cessation and a key predictor of relapse. Little is known about the financial situation of low-income Australian daily smokers. This study aims to describe and investigate associations between the financial functioning, tobacco use and quitting behaviours of low income daily smokers.

METHODS

Low-income Australian adult smokers in the 'Financial Intervention for Smoking Cessation Among Low-income Smokers (FISCALS) randomised clinical trial completed a structured telephone questionnaire.

RESULTS

The median number of cigarettes typically smoked by the 1047 participants was 23 per day. The median spent on tobacco per week was AU$80. Three quarters (73.0%) reported some financial stress and 43.2% reported smoking-induced deprivation. Financial stress was significantly associated with deprivation (IRR: 1.23, 95% CI 1.21, 1.26, p < 0.001). There were no significant associations either between adjusted financial stress or deprivation and motivation to quit or certainty of quit success.

CONCLUSIONS

Financial stress and smoking induced deprivation were prevalent among low-income daily smokers, but they were not associated with motivation to quit. Smoking cessation interventions need to be responsive to the role financial stress plays in reducing quit attempts and increasing relapse.

TRIAL REGISTRATION

Australian and New Zealand Clinical trials Registry ACTRN12612000725864 6/07/2012.

Job Characteristics Associated With Self-Rated Fair or Poor Health Among U.S. Workers

INTRODUCTION

Approximately 60% of the U.S. adult population is employed. Many aspects of a person's job may influence health, but it is unclear which job characteristics are most strongly associated with health at a population level. The purpose of this study was to identify important associations between job characteristics and workers' self-rated health in a nationally representative survey of U.S. workers.

METHODS

Data from the 2010 National Health Interview Survey were used to calculate weighted prevalence rates for self-reported fair/poor health for five categories of job characteristics: occupation; pay/benefits (economic); work organization; chemical/environmental hazards; and psychosocial factors. Backward elimination methods were used to build a regression model for self-reported health with the significant job characteristics, adjusting for sociodemographic variables and health behaviors. Data were collected in 2010 and analyzed in 2012-2016.

RESULTS

After adjusting for covariates, workers were more likely to have fair/poor health if they were employed in business operations occupations (e.g., buyers, human resources workers, event planners, marketing specialists; adjusted prevalence ratio [APR]=1.85, 95% CI=1.19, 2.88); had no paid sick leave (APR=1.35, 95% CI=1.11, 1.63); worried about becoming unemployed (APR=1.43, 95% CI=1.22, 1.69); had difficulty combining work and family (APR=1.23, 95% CI=1.01, 1.49); or had been bullied/threatened on the job (APR=1.82, 95% CI=1.44, 2.29).

CONCLUSIONS

Occupation, lack of paid sick leave, and multiple psychosocial factors were associated with fair/poor health among U.S. workers at the population level in 2010. Public health professionals and employers should consider these factors when developing interventions to improve worker health.

Tobacco-free policies at worksites in Kansas

BACKGROUND

This study sought to examine the relationship between tobacco-free policies at worksites to worksite demographics such as company size and geographic location.

METHODS

Worksites participating in a worksite wellness workshop were asked to complete a worksite wellness instrument, which provided an assessment of their wellness practices already in place in the worksite, including the degree to which tobacco-free policies were in place at the worksite.

RESULTS

At a bivariate level, those more likely to have tobacco-free policies included: urban employers (76.8% versus 50% rural employers, p = 0.0001); large employers (> = 250 employees) (74.3% versus 43.1% small employers (<50 employees), p = 0.0003); and schools (69.4%) and hospitals (61.5%) (versus 35.5%, agricultural/ manufacturing employers, p = 0.0125). At the multivariate level, rural employers (AOR = 0.47, 95% CI 0.23, 0.95) and small employers (AOR = 0.34, 95% CI 0.16, 0.71) had decreased odds, compared to their urban and large employer counterparts, of having tobacco-free policies.

CONCLUSIONS

Rural and smaller employers are less likely to have tobacco-free policies than their urban and large counterparts.

Prevalence and Correlates of Current and Former Smoking among Urban Transit Workers

Transit workers constitute a blue-collar occupational group that have elevated smoking rates relative to other sectors of employed adults in the United States. This study analyzed cross-sectional tobacco survey data from 935 workers (60% African American; 37% female) employed at an urban public transit agency in California. Prevalence of current and former smoking was 20.3% and 20.6%, respectively. Younger workers were less likely than older workers to be current or former smokers. Having a complete home smoking ban was associated with decreased likelihood of being a smoker [odds ratio (OR) = 0.04, 95% confidence interval (CI) = 0.01–0.17], as were neutral views about whether it is easy for a smoker to take a smoking break during their shift (OR = 0.50, 95% CI 0.28–0.88). Current smoking among the sample is > 50% higher than the adult statewide prevalence. Potential points of intervention identified in this study include perceived ease of worksite smoking breaks and establishing home smoking bans. Tailored cessation efforts focusing on older transit workers more likely to smoke are needed to reduce tobacco-related disparities in this workforce.

Factors Associated with Cessation Activities amongst a Multiethnic Sample of Transit Workers

Introduction: Transit workers are a blue-collar occupational group with elevated rates of smoking despite access to free or low-cost cessation services available through their health insurance as a union-negotiated employee benefit. Little is known about the influences on cessation participation in this workforce.

Aims: The purpose of this study is to analyse the factors associated with past-year cessation activities amongst a multiethnic sample of transit workers.

Methods: Cross-sectional tobacco surveys were completed by 935 workers at an Oakland, California, USA-based public transit agency. Data from 190 current smokers (68% African American; 46% female) were analysed. Adjusted odds ratios were calculated to identify factors associated with past-year cessation activity.

Results: Approximately 55% of smokers stopped smoking for one day or longer during the past year in order to quit. Nearly half reported that the most common barrier to quitting was, ‘Not mentally ready to quit because I like smoking’. Workers in the contemplation/precontemplation stage for intention to quit were less likely to have engaged in cessation activities than those in the action/preparation stage (AOR = 0.34). Frequency of coworker encouragement for quitting was positively associated with past-year cessation activities (AOR = 3.25). Frequency of insomnia symptoms was negatively associated with cessation activity participation (AOR = 0.34).

Conclusions: Most transit workers who smoke made a past-year quit attempt. Gaining insight into factors associated with participation in cessation activities can aid worksite efforts to promote cessation and reduce tobacco-related disparities.

Social cohesion and the smoking behaviors of adults living with children

INTRODUCTION

The smoking behavior of adults can negatively impact children through exposure to environmental tobacco smoke and by modeling this unhealthy behavior. Little research has examined the role of the social environment in smoking behaviors of adults living with children. The present study specifically analyzed the relationship between social cohesion and smoking behaviors of adults living with children.

METHODS

Data from the 2009 California Health Interview Survey, a random-digit dial cross-sectional survey of California Adults, were used. Adults living with children reported their levels of social cohesion and smoking behaviors (N=13,978). Logistic regression models were used to predict odds of being a current smoker or living in a household in which smoking was allowed, from social cohesion.

RESULTS

Overall, 13% of the sample was current smokers and 3.74% lived in households in which smoking was allowed. Logistic regression models showed that each one-unit increase in social cohesion is associated with reduced odds of being a current smoker (AOR=0.92; 95% CI=0.85-0.99) and reduced odds of living in a household in which smoking is allowed (AOR=0.84; 95% CI=0.75-0.93), after controlling for sociodemographic characteristics.

CONCLUSIONS

Among adults living with children, higher social cohesion is associated with a lower likelihood of both being and smoker and living in a home where smoking is allowed. Thus, future research is needed to better understand mechanisms that explain the relationship between social cohesion and smoking-related behavior in order to prevent smoking-related health consequences and smoking initiation among children and adults.

Cigarette Smoking Among Working Women of Reproductive Age-United States, 2009-2013

BACKGROUND

Employers play a vital role in promoting and supporting tobacco use cessation among tobacco-using workers. Cigarette smoking during pregnancy is a preventable cause of complications in pregnancy and adverse infant health outcomes.

PURPOSE

To estimate cigarette smoking prevalence and attempts to quit among working women of reproductive age in different industries and occupations using a nationally representative survey.

METHODS

The 2009-2013 National Health Interview Survey data for women of reproductive age (18-49 years) who were working in the week prior to the interview (n = 30855) were analyzed. Data were adjusted for nonresponse and weighted to produce nationally representative estimates.

RESULTS

During 2009-2013, among working women of reproductive age, an estimated 17.3% (95% confidence interval [CI]: 16.7-17.8) and 12.9% (95% CI: 12.4-13.4) were current and former cigarette smokers, respectively. Of women who smoke daily, 44.5% (95% CI: 42.5-46.5) had made a quit attempt for more than 1 day in the year before the interview. Cigarette smoking prevalence was highest among women working in the construction industry (29.2%; 95% CI: 22.8-35.7) and in construction and extraction occupations (34.6%; 95% CI: 23.4-45.9). Among working women who were pregnant at the time of the interview, 6.8% (95% CI: 4.4-9.2) and 20.4% (95% CI: 16.9-24.0) were current and former cigarette smokers, respectively.

CONCLUSIONS

Cigarette smoking prevalence varies by industry and occupation. Intensifying tobacco control efforts in high prevalence industries and occupations could result in higher cessation rates and improvements in health among women of reproductive age.

IMPLICATIONS

This study identified discrepancies in cigarette smoking among women of reproductive age across industries and occupations. In the absence of smoke-free local and state laws, employer-established smoke-free policies and workplace cessation programs are important for achieving reduction of tobacco use among women and for protecting other workers' health. Results in this report may assist in developing educational campaigns targeting women in industries and occupations with high prevalence of cigarette smoking and low percentage of ever-smokers who had quit.

Estimating the Time-Varying Joint Effects of Obesity and Smoking on All-Cause Mortality Using Marginal Structural Models

Obesity and smoking are independently associated with a higher mortality risk, but previous studies have reported conflicting results about the relationship between these 2 time-varying exposures. Using prospective longitudinal data (1987-2007) from the Atherosclerosis Risk in Communities Study, our objective in the present study was to estimate the joint effects of obesity and smoking on all-cause mortality and investigate whether there were additive or multiplicative interactions. We fit a joint marginal structural Poisson model to account for time-varying confounding affected by prior exposure to obesity and smoking. The incidence rate ratios from the joint model were 2.00 (95% confidence interval (CI): 1.79, 2.24) for the effect of smoking on mortality among nonobese persons, 1.31 (95% CI: 1.13, 1.51) for the effect of obesity on mortality among nonsmokers, and 1.97 (95% CI: 1.73, 2.22) for the joint effect of smoking and obesity on mortality. The negative product term from the exponential model revealed a submultiplicative interaction between obesity and smoking (β = -0.28, 95% CI: -0.45, -0.11; P < 0.001). The relative excess risk of interaction was -0.34 (95% CI: -0.60, -0.07), indicating the presence of subadditive interaction. These results provide important information for epidemiologists, clinicians, and public health practitioners about the harmful impact of smoking and obesity.