Presentation Transcript
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
A fundamental problem in occupational medicine is distinguishing between effects of smoking and effects of occupational exposure : 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