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SMOKING, OCCUPATION: EITHER, NONE, BOTH?

SMOKING, OCCUPATION: EITHER, NONE, BOTH?. Tee L. Guidotti Department of Environmental and Occupational Health School of Public Health and Health Services The George Washington University Medical Center.

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SMOKING, OCCUPATION: EITHER, NONE, BOTH?

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  1. SMOKING, OCCUPATION:EITHER, NONE, BOTH? Tee L. Guidotti Department of Environmental and Occupational Health School of Public Health and Health Services The George Washington University Medical Center

  2. A fundamental problem in occupational medicine is distinguishing between effects of smoking and effects of occupational exposure • cancer: lung, larynx, pancreas, bladder • heart disease • airways disease • peripheral vascular disease

  3. Smoking and Occupation • confounding in occupational epidemiology • rebuttal in presumptions (scheduled occupational diseases) • individualizing risk profile • confuses impairment (disability) assessment • interactive effects • wellness programs

  4. Many ways in which smoking and occupation may be trade-offs: • smoking may be related to job • smoking may be related to SES • smoking may be interactive with occupational exposure as causes • smoking may contribute proportionately to impairment

  5. Smoking related to the job: • bartenders, sales, drivers • socialization • jobs of high intensity, concentration • jobs with noxious odor • delivery of toxic substances • lead • polymer fume fever

  6. Smoking related to SES: • smoking habit concentrated in lower SES, educational attainment • higher prevalence of smoking • more cigarettes consumed • higher nicotine-content of cigarettes • lower rate of cessation • hazardous occupations concentrated in lower SES

  7. Smoking as a confounder: overrated Example: A population with 40% smokers (x) SMR 200 = RR 2.0 = O/E O = 1(1-x) + 5 (x) , x = 1.25, or 125% E 1 (0.6) + 5(0.4) • Conclusion: to double the risk as a result of confounding alone, there would have to be more smokers than there are workers.

  8. Smoking is known to be interactive with several occupational carcinogens. Best documentation: • asbestos • radon daughters • silica

  9. Smoking and apportionment: • apportionment of causation - population-based - individual care - interaction • apportionment of impairment

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