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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
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

slide2
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
smoking and occupation
Smoking and Occupation
  • confounding in occupational epidemiology
  • rebuttal in presumptions (scheduled occupational diseases)
  • individualizing risk profile
  • confuses impairment (disability) assessment
  • interactive effects
  • wellness programs
many ways in which smoking and occupation may be trade offs
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
smoking related to the job
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
smoking related to ses
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
smoking as a confounder overrated
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.
smoking is known to be interactive with several occupational carcinogens best documentation
Smoking is known to be interactive with several occupational carcinogens. Best documentation:
  • asbestos
  • radon daughters
  • silica
smoking and apportionment
Smoking and apportionment:
  • apportionment of causation

- population-based

- individual care

- interaction

  • apportionment of impairment