Assessing exposure to secondhand smoke in restaurants and bars 2 years after the smoking regulations in Beijing, China.

UNLABELLED: Field observation of patron smoking behaviors and multiple sampling approaches were conducted in 79 restaurants and bars in Beijing, 2010, 2 years after implementing the governmental smoking regulations. Smoking was observed in 30 visits to 22 of the 37 nominal non-smoking venues during peak patronage times and six visits to four of the 14 nominal non-smoking sections. The median area secondhand smoke (SHS) concentrations during peak patronage time were 27, 15, 43, and 40 µg/m(3) in nominal non-smoking venues, non-smoking sections, smoking sections, and smoking venues, respectively, as indicated by the difference between indoor and outdoor PM2.5 levels; and 1.4, 0.6, 1.7, and 2.7 µg/m(3) , respectively, as indicated by airborne nicotine. In the 27 venues with sampling of different approaches and over different time periods, the median nicotine concentration was 1.8 µg/m(3) by one-hour peak patronage-time sampling, 1.1 µg/m(3) by 1-day active area sampling, 2.5 µg/m(3) by 1-day personal sampling, and 2.3 µg/m(3) by week-long passive sampling. No significant differences in nicotine levels were observed among venues/sections with different nominal smoking policies by all sampling approaches except during peak patronage time. This study showed that the 2008 Beijing governmental smoking restriction has been poorly implemented, and SHS exposures in Beijing restaurants and bars remain high. PRACTICAL IMPLICATIONS: The 2008 Beijing governmental smoking restriction requires large restaurants to designate no less than 50% of their dining area as non-smoking, without defining 'large' or specifying how the designated smoking sections and non-smoking sections should be separated. Two years after its implementation, smoking is still commonly observed in nominally non-smoking restaurants and bars and in designated non-smoking sections, and both patrons and servers are exposed to high concentrations of secondhand smoke. These results indicate that the Beijing governmental regulation fails to protect the population from SHS exposure in restaurants and bars and that more efforts are needed to pass stronger smoking regulations and ensure better compliance in Beijing, China.

Secondhand smoke transfer and reductions by air sealing and ventilation in multiunit buildings: PFT and nicotine verification.

UNLABELLED: Surveys suggest that transfer of secondhand smoke (SHS) between units in multiunit residential buildings is common, but measured data are rare. This study was undertaken to quantify bulk air transfer between units and document transfer of SHS species before and after treatments that sealed boundaries between units and provided a minimum amount of continuous exhaust ventilation of each unit. Six buildings in Minnesota were studied. Treatments were performed in clusters of up to eight units in each building, including zero to two units occupied by smokers. Bulk air transfer was quantified through passive perfluorocarbon tracer (PFT) gas tests. SHS transfer was evaluated using passive nicotine sampling. The median fraction of air entering a unit that came from other units tagged with PFTs ranged from 0.021 in a new condominium building to 0.353 in a 1930s duplex, with an overall median of 0.041. Treatments provided a median decrease of 29% in the fraction of transferred air and reduced PFT concentrations by about 40%, because of increased ventilation of both source and target apartments. Nicotine was transferred at only one-sixth the rate of PFTs. Involuntary exposure to SHS can be reduced but not eliminated by modifying existing, occupied multiunit buildings. PRACTICAL IMPLICATIONS: Recent studies of secondhand smoke exposure in multiunit housing indicate transmission of SHS constituents from smokers' units to those occupied by nonsmokers. A straightforward solution for this problem is to eliminate air leakage transfer between these units. This study describes a 2-year investigation of air sealing and ventilation improvements in six multiunit buildings located in a heating-dominated climate region of the US. The results quantify the reduction in interunit transfer of air between smokers' and nonsmokers' units. While it is possible to reduce the transfer when done with care, it is extremely difficult to eliminate these flows unless the buildings are vacated and extensively rebuilt. Eliminating air leakage between smokers' and nonsmokers' units is not a practical means of solving SHS transmission in an existing building.

Indoor concentrations of nicotine in low-income, multi-unit housing: associations with smoking behaviours and housing characteristics.

OBJECTIVE: An analysis of airborne nicotine measurements collected in 49 low-income, multi-unit residences across the Greater Boston Area. METHODS: Nicotine concentrations were determined using passive monitors placed in homes over a one-week sampling period and air exchange rates (AER) were sampled using the perfluorocarbon tracer technique. Residents were surveyed through a questionnaire about smoking behaviour and a visual inspection was conducted to collect information on housing characteristics contributing to secondhand smoke (SHS) exposure. Using a mass balance model to account for the air exchange rate, volume of the home and sorption and re-emission of nicotine on indoor surfaces, the effective smoking rate (SR(eff)) was determined for each residence. RESULTS: Nicotine levels ranged from the limit of detection to 26.92 microg/m(3), with a mean of 2.20 microg/m(3) and median of 0.13 microg/m(3). Nicotine measurements were significantly associated with the number of smokers in the household and the number of cigarettes smoked in the home. The results of this study suggest that questionnaire reports can provide a valid estimate of residential exposure to tobacco smoke. In addition, this study found evidence that tobacco smoke contamination in low-income housing developments is not limited to homes with smokers (either residing in the home or visiting). The frequent report of tobacco smoke odour coming from other apartments or hallways resulted in increased levels of nicotine concentrations and SR(eff) in non-smoking homes, suggestive of SHS infiltration from neighbouring units. CONCLUSION: These findings have important implications for smoking regulations in multi-unit homes and highlight the need to reduce involuntary exposure to tobacco smoke among low-income housing residents.

The scientific basis of tobacco product regulation.

This report presents the conclusions and recommendations of TobReg from its fourth meeting, where the Study Group deliberated on a number of topics in the field of tobacco product regulation and produced the following advisory notes and recommendations: an advisory note on smokeless tobacco products: health effects, implications for harm reduction and research needs; an advisory note on 'fire safer' cigarettes: approaches to reduced ignition propensity; a recommendation on mandated lowering of toxicants in cigarette smoke: tobacco-specific nitrosamines and selected other constituents; and a recommendation on cigarette machine smoking regimens. The four sections of this report address these four issues, and the Study Group's recommendations are set out at the end of each section. Its overall recommendations are summarized in section 5.

Passive smoking, NAT2 polymorphism, and breast cancer risk in Israeli Arab women: a case-control study.

BACKGROUND: The effect of passive smoking (PS) on breast cancer (BC) is controversial, and may be modified by polymorphism of the N-Acetyl-transferase (NAT) 2 enzyme which is involved in tobacco carcinogen metabolism. We aimed to evaluate the relationship between PS and BC by NAT2 variants in Arab-Israeli women, a unique population with low active smoking rates, and high exposure to PS. METHODS: A population-based case-control study was carried out on non-smoking 137 prevalent breast cancer patients and 274 population-based controls, aged 30-70 years. Data on past and current PS, sociodemographic, and other characteristics were retrieved through interviews, and buccal smears were provided for NAT2 analyses. Logistic regression models adjusting for potential confounders assessed the odds ratios (ORs) and 95% confidence intervals (95% CI) of the association between PS and BC. RESULTS: Ever PS was associated with increased BC risk: OR = 2.22, 95% CI 1.28-3.87. Higher lifetime PS exposure was associated with higher BC risk: Compared to never exposed women, women exposed to PS most of their lives had a threefold higher BC risk (OR = 3.16, 95% CI 1.70-5.87, P trend < 0.001). NAT2 polymorphism did not modify these associations. CONCLUSIONS: PS exposure in non-smoking Israeli Arab women is significantly associated with increased risk for BC, potentially allowing for specific intervention; NAT2 polymorphism does not modify this association.

Relationship between environmental tobacco smoke exposure and carcinogen-hemoglobin adduct levels in nonsmokers.

BACKGROUND: A potent bladder carcinogen for workers in the dye industry, 4-aminobiphenyl (4-ABP), is present in environmental tobacco smoke and has been shown to bond covalently with hemoglobin. PURPOSE: The goal of this study was to examine the relationship between exposure to environmental tobacco smoke and levels of 4-ABP-hemoglobin adducts in nonsmoking pregnant women and to compare adduct levels in those women with levels in smoking pregnant women. METHODS: A questionnaire on smoking and exposure to environmental tobacco smoke was administered to 15 pregnant women who smoked cigarettes and 40 who did not smoke. Exposure was quantified for 1 week with a personal diary and by air sampling with a monitor worn by each woman. The monitor collected nicotine by passive diffusion to a filter treated with sodium bisulfate, and the deposit on the filter was analyzed by gas chromatography. Aliquots of maternal blood and cord blood collected during delivery were analyzed for 4-ABP-hemoglobin adducts by gas chromatography with negative ion chemical ionization mass spectrometry. RESULTS: The mean adduct level in smokers (184 pg of 4-ABP per gram of hemoglobin) was substantially higher than that in nonsmokers (22 pg/g). This difference was statistically significant. Among nonsmokers, the levels of 4-ABP adducts increased significantly with increasing environmental tobacco smoke level (P = .009). Those in the lowest exposure category (< 0.5 micrograms/m3 weekly average nicotine) had median 4-ABP-hemoglobin adduct levels of 15 pg of 4-ABP per gram of hemoglobin, while those in the highest exposure category (> or = 2.0 micrograms/m3) had median levels of 26 pg/g. Nonsmokers in this study had a median adduct level of 20 pg/g, and smokers had a median level of 143 pg/g. CONCLUSIONS: 4-ABP-hemoglobin adduct levels in nonsmokers were 14% of the levels in smokers, which is consistent with findings of 20% in two other studies. Nonsmokers may receive a nontrivial dose of carcinogens from environmental tobacco smoke proportional to their exposure to environmental tobacco smoke. IMPLICATION: The relationship between environmental tobacco smoke exposure and 4-ABP-hemoglobin adduct levels supports epidemiologic evidence that environmental tobacco smoke is carcinogenic to passive smokers.

4-Aminobiphenyl hemoglobin adducts in fetuses exposed to the tobacco smoke carcinogen in utero.

Maternal-fetal exchange of a potent tobacco-related human carcinogen, 4-aminobiphenyl, was studied in smoking (n = 14) and nonsmoking (n = 38) pregnant women. N-Hydroxy-4-aminobiphenyl, the active metabolite of 4-aminobiphenyl, forms chemical addition products (adducts) with hemoglobin. Levels of 4-aminobiphenyl hemoglobin adducts were measured in maternal-fetal paired blood samples obtained from smoking and nonsmoking women during labor and delivery. Carcinogen-hemoglobin adducts were detected in all maternal and fetal blood samples. Levels of such adducts were significantly higher (P less than .001) in maternal and fetal blood samples from smokers: the mean 4-aminobiphenyl hemoglobin adduct level was 92 +/- 54 pg/g of hemoglobin in blood samples from fetuses of smokers, and 17 +/- 13 pg/g of hemoglobin in blood samples from fetuses of nonsmokers; the mean maternal 4-aminobiphenyl hemoglobin adduct level was 183 +/- 108 pg/g of hemoglobin in smokers, and 22 +/- 8 pg/g of hemoglobin in nonsmokers. Fetal carcinogen-adduct levels were consistently lower than maternal levels: the mean maternal to fetal ratio was 2.4 +/- 1.1 in smokers and 1.9 +/- .98 in nonsmokers. Fetal 4-aminobiphenyl hemoglobin adduct levels were strongly associated (correlation coefficient [r2] = .51, P = .002) with maternal 4-aminobiphenyl hemoglobin adduct levels when paired samples from smoking mothers were analyzed. A measure of third-trimester tobacco smoke exposure based on number of cigarettes smoked per day, amount of each cigarette smoked, and depth of inhalation was associated (r2 = .59, P = .029) with maternal 4-aminobiphenyl levels but not with fetal 4-aminobiphenyl levels. This study demonstrates that a potent tobacco-related carcinogen, 4-aminobiphenyl, or its active metabolite, N-hydroxy-4-aminobiphenyl, crosses the human placenta and binds to fetal hemoglobin in concentrations that are significantly higher in smokers than in nonsmokers.

Secondhand smoke exposure and risk following the Irish smoking ban: an assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars.

OBJECTIVE: To investigate whether the Irish smoking ban has had an impact on secondhand smoke (SHS) exposures for hospitality workers. DESIGN, SETTING, AND PARTICIPANTS: Before and after the smoking ban a cohort of workers (n = 35) from a sample of city hotels (n = 15) were tested for saliva cotinine concentrations and completed questionnaires. Additionally, a random sample (n = 20) of city centre bars stratified by size (range 400-5000 square feet), were tested for air nicotine concentrations using passive samplers before and after the ban. MAIN OUTCOME MEASURES: Salivary cotinine concentrations (ng/ml), duration of self reported exposures to secondhand smoke, air nicotine (microg/cubic metre). RESULTS: Cotinine concentrations reduced by 69%, from 1.6 ng/ml to 0.5 ng/ml median (SD 1.29; p < 0.005). Overall 74% of subjects experienced decreases (range 16-99%), with 60% showing a halving of exposure levels at follow up. Self reported exposure to SHS at work showed a significant reduction from a median 30 hours a week to zero (p < 0.001). There was an 83% reduction in air nicotine concentrations from median 35.5 microg/m3 to 5.95 microg/m3 (p < 0.001). At baseline, three bars (16%) were below the 6.8 microg/m3 air nicotine significant risk level for lung cancer alone; at follow up this increased to 10 (53%). CONCLUSIONS: Passive smoking and associated risks were significantly reduced but not totally eliminated. Exposure to SHS is still possible for those working where smoking is still allowed and those working where smoke may migrate from outdoor areas. Further research is required to assess the true extent and magnitude of these exposures.

Environmental tobacco smoke exposure in public places of European cities.

BACKGROUND: Exposure to environmental tobacco smoke (ETS) has important public health implications. The results of the first European multi-centre study that measured ETS exposure in a range of public places (transport, educational settings, and leisure facilities such as bars and restaurants) are presented. METHOD: Nicotine vapour phase was measured using ETS passive samplers containing a filter treated with sodium bisulfate. RESULTS: Bars and discos are the places with the highest concentrations of nicotine from ETS, median ranging from 19 to 122 microg/m(3). Restaurants had the next highest values. Concentrations of nicotine generally range from 0.1-5 microg/m(3) in airports, and from 0.5-10 microg/m(3) in train stations. Nicotine was also found in schools and universities, yet schools tended to have the lowest concentrations compared to all the other public places sampled. In hospitals levels were generally below 5 microg/m(3). CONCLUSIONS: Although there is some variability between cities, this study shows that tobacco smoke is present in most of the studied public places. The study also showed that in areas where smoking is prohibited, concentrations of nicotine are lower than in areas where smoking is allowed but they are not zero. The results of this study indicate that policies should be implemented that would effectively reduce levels of tobacco smoke in public areas.

Exposure of U.S. workers to environmental tobacco smoke.

The concentrations of environmental tobacco smoke (ETS) to which workers are exposed have been measured, using nicotine or other tracers, in diverse workplaces. Policies restricting workplace smoking to a few designated areas have been shown to reduce concentrations of ETS, although the effectiveness of such policies varies among work sites. Policies that ban smoking in the workplace are the most effective and generally lower all nicotine concentrations to less than 1 microg/m3; by contrast, mean concentrations measured in workplaces that allow smoking generally range from 2 to 6 microg/m3 in offices, from 3 to 8 microg/m3 in restaurants, and from 1 to 6 microg/m3 in the workplaces of blue-collar workers. Mean nicotine concentrations from 1 to 3 microg/m3 have been measured in the homes of smokers. Furthermore, workplace concentrations are highly variable, and some concentrations are more than 10 times higher than the average home levels, which have been established to cause lung cancer, heart disease, and other adverse health effects. For the approximately 30% of workers exposed to ETS in the workplace but not in the home, workplace exposure is the principal source of ETS. Among those with home exposures, exposures at work may exceed those resulting from home. We conclude that a significant number of U.S. workers are exposed to hazardous levels of ETS.

Health effects of gasoline exposure. I. Exposure assessment for U.S. distribution workers.

Personal exposures were estimated for a large cohort of workers in the U.S. domestic system for distributing gasoline by trucks and marine vessels. This assessment included development of a rationale and methodology for extrapolating vapor exposures prior to the availability of measurement data, analysis of existing measurement data to estimate task and job exposures during 1975-1985, and extrapolation of truck and marine job exposures before 1975. A worker's vapor exposure was extrapolated from three sets of factors: the tasks in his or her job associated with vapor sources, the characteristics of vapor sources (equipment and other facilities) at the work site, and the composition of petroleum products producing vapors. Historical data were collected on the tasks in job definitions, on work-site facilities, and on product composition. These data were used in a model to estimate the overall time-weighted-average vapor exposure for jobs based on estimates of task exposures and their duration. Task exposures were highest during tank filling in trucks and marine vessels. Measured average annual, full-shift exposures during 1975-1985 ranged from 9 to 14 ppm of total hydrocarbon vapor for truck drivers and 2 to 35 ppm for marine workers on inland waterways. Extrapolated past average exposures in truck operations were highest for truck drivers before 1965 (range 140-220 ppm). Other jobs in truck operations resulted in much lower exposures. Because there were few changes in marine operations before 1979, exposures were assumed to be the same as those measured during 1975-1985. Well-defined exposure gradients were found across jobs within time periods, which were suitable for epidemiologic analyses.

Measurement of environmental tobacco smoke exposure among adults with asthma.

Because the morbidity and mortality from adult asthma have been increasing, the identification of modifiable environmental exposures that exacerbate asthma has become a priority. Limited evidence suggests that exposure to environmental tobacco smoke (ETS) may adversely affect adults with asthma. To study the effects of ETS better, we developed a survey instrument to measure ETS exposure in a cohort of adults with asthma living in northern California, where public indoor smoking is limited. To validate this survey instrument, we used a passive badge monitor that measures actual exposure to ambient nicotine, a direct and specific measure of ETS. In this validation study, we recruited 50 subjects from an ongoing longitudinal asthma cohort study who had a positive screening question for ETS exposure or potential exposure. Each subject wore a passive nicotine badge monitor for 7 days. After the personal monitoring period, we readministered the ETS exposure survey instrument. Based on the survey, self-reported total ETS exposure duration ranged from 0 to 70 hr during the previous 7 days. Based on the upper-range boundary, bars or nightclubs (55 hr) and the home (50 hr) were the sites associated with greatest maximal self-reported exposure. As measured by the personal nicotine badge monitors, the overall median 7-day nicotine concentration was 0.03 microg/m(3) (25th-75th interquartile range 0-3.69 microg/m(3)). Measured nicotine concentrations were highest among persons who reported home exposure (median 0.61 microg/m(3)), followed by work exposure (0.03 microg/m(3)), other (outdoor) exposure (0.025 microg/m(3)), and no exposure (0 microg/m(3); p = 0.03). The Spearman rank correlation coefficient between self-reported ETS exposure duration and directly measured personal nicotine concentration during the same 7-day period was 0.47, supporting the survey's validity (p = 0.0006). Compared to persons with no measured exposure, lower-level [odds ratio (OR) 1.9; 95% confidence interval (CI), 0.4-8.8] and higher-level ETS exposures (OR 6.8; 95% CI, 1.4-32.3) were associated with increased risk of respiratory symptoms. A brief, validated survey instrument can be used to assess ETS exposure among adults with asthma, even with low levels of exposure. This instrument could be a valuable tool for studying the effect of ETS exposure on adult asthma health outcomes.

Smoking at home: the impact of smoking cessation on nonsmokers' exposure to environmental tobacco smoke.

Nonsmokers who live with smokers are at increased risk for chronic disease. This study evaluated the impact of eliminating smoking in the home on nonsmokers' environmental tobacco smoke (ETS) exposure. Nonsmokers participated in measurements of their ETS exposure before and after the smoker in their home quit smoking. A matched comparison group of nonsmokers from nonsmoking homes was also included. ETS exposure was assessed using passive nicotine monitors, an exposure diary, and a questionnaire. Nonsmokers from smoking homes had significantly higher exposure to ETS than those from nonsmoking homes. There was a 60% reduction in nicotine levels following smoking cessation by the household smoker. However, there were still detectable levels of nicotine measured at posttest. These results have important implications for individual risk reduction and public health policy.

Measuring secondhand smoke exposure in babies: the reliability and validity of mother reports in a sample of low-income families.

The reliability and validity of mother's reports of their infants' exposure to secondhand smoke (SHS) were examined in an ethnically diverse sample of low-income, low-education families (N = 141 mothers). At baseline and posttest, smoking mothers reported about their infants' SHS exposure at different locations and by different sources during the previous week. Findings show that mothers can give reliable accounts of the degree to which they contribute to their babies' SHS exposure. Mothers are able to differentiate between their own smoking behavior and the extent to which they expose their infants. Consistent with the overall exposure pattern, exposure caused by the mother and exposure occurring at home showed the strongest associations with biological and environmental measures. These findings suggest that smoking mothers can provide reliable and valid reports of the degree to which their infants are exposed to SHS.

Sister-chromatid exchanges in lymphocytes from styrene-exposed boat builders.

Sister-chromatid exchanges (SCE) were measured in peripheral blood lymphocytes from 40 workers in the boat-building trade. Twenty of these workers were exposed to significant amounts of styrene. The mean air concentration of styrene in the breathing zone of the boat builders was 209 mg/m3 in the 7 exposed current smokers and 230 mg/m3 in the 13 exposed non-smokers. Urinary styrene metabolites were also measured and the mean mandelic acid/creatinine ratios in the exposed, smokers was 275 mg/g, and in the exposed, non-smokers 323 mg/g. The SCE frequency in lymphocytes from the styrene-exposed group did not differ from that in the controls, although smoking significantly induced SCE in these workers.

Measuring personal exposure to airborne mutagens and nicotine in environmental tobacco smoke.

The exposure of individuals to environmental tobacco smoke (ETS) is of increasing public health concern because epidemiological studies have associated passive smoking with increased risk of a variety of adverse health effects among non-smokers including lung cancer. As a way to measure individual exposure to the mutagenic compounds in the complex mixture of ETS, we used a sensitive Salmonella/microsome micro pre-incubation (microsuspension) assay to detect mutagenicity of particulate matter collected on filters from low volume (1.7 1/min flow rate) personal sampling pumps. Airborne nicotine was collected concurrently as a marker for ETS exposure. In pilot-field studies, individual exposure to ETS was measured in two separate indoor environments in which smokers were present: a gambling casino and a bingo parlor. Total suspended particulate matter (TSP) was collected on filters worn near the breathing zone of non-smoking individuals. Sampling times ranged from 40 min to 6 h. All extracts of filters had detectable levels of mutagenic activity (TA98, +S9) resulting in airborne mutagenic activity concentrations of 500-5000 rev/m3. The mutagenic activity of the filters from the casino and bingo parlors was significantly correlated with total particulate matter per filters (n = 12; Rho = 0.85, p less than 0.01) and with airborne nicotine per filter (n = 12; Rho = 0.95, p less than 0.01). The microsuspension assay was sufficiently sensitive to detect the mutagens associated with extracts of particulate matter from low volume samples (0.2-0.6 m3) in these indoor environments over a relatively short sampling time, and could be useful in studies of personal exposure to the mutagens in environmental tobacco smoke. Further, airborne nicotine concentrations were highly correlated with airborne mutagenicity and the mutagenic activity associated with ETS could therefore be estimated by the concentrations of nicotine.

A new carbon monoxide occupational dosimeter: results from a worker exposure assessment survey.

The LBNL/QGI occupational carbon monoxide (CO) dosimeter (LOCD), a new, inexpensive CO passive sampler, was field-validated in an occupational exposure assessment study in the Moscone Convention Center (MCC) in San Francisco, CA in January, 1997. The LOCD measures time-weighed-average (TWA) CO exposures from 10 to 800 parts per million hours (ppm h; accuracy +/- 20%; precision 10 ppm h). This device represents a major improvement over currently available low-cost personal CO monitors. At the MCC, over 1000 workers set up and remove exhibitions. Forty propane-powered forklifts moved materials throughout the 42,000 m2 of exhibit halls. Diesel truck emissions enter the building via three internal underground loading docks. The LOCD was used to measure 154 worker exposures on 3 days. Sampler performance was compared to a standard method at 15 fixed sites. The geometric mean (GM) of all 154 exposures was 7 ppm (geometric standard deviation (GSD) = 1.6); 10% of the exposures was 10 ppm or more. Dock Walkers and Forklift Operators had the highest exposures (maximum = 34 ppm) with GM (GSD) of 9 (1.7) and 9 (1.6) ppm, respectively. Attendants and Installer/Decorators had the lowest exposures with GMs of 6 (1.6) and 7 (1.4), respectively. The Cal/OSHA personal exposure limit for CO is 25 ppm time-weighted average (TWA).

Exposure in a household using gasoline-contaminated water.

Contamination of drinking water with petroleum products is an increasingly common problem. Physicians are often asked to advise patients about such exposures. This study assessed household exposure from gasoline-contaminated drinking water in a New England household. A sampling strategy was designed to estimate inhalation and ingestion exposure to benzene and three other aromatic hydrocarbons typically found in gasoline-contaminated water. The estimated inhaled doses of all agents were similar to the estimated ingested dose. Over half the inhaled dose of all four agents was associated with shower activities as was over half the estimated total dose by all routes of exposure. Under these conditions, discontinuing ingestion of water contaminated with these agents may decrease the dose of benzene by less than one third, whereas discontinuing both ingestion and showering may decrease the dose of benzene by over three quarters. This limited study suggests that routes of exposure other than ingestion are important and should receive attention in the regulatory and risk-assessment process.

Double jeopardy: workplace hazards and behavioral risks for craftspersons and laborers.

PURPOSE: To address three specific questions in a sample of craftspersons and laborers: (1) Do craftspersons and laborers exposed to workplace hazards have higher behavioral risks, such as smoking and high-fat diets, than those with few job risks? (2) Compared to workers with few job risks, do workers exposed to risks on the job have higher intentions to reduce their behavioral risks? (3) Does concern about the level of exposure to risks on the job increase workers' intentions to reduce behavioral risks? DESIGN: A cross-sectional self-administered survey was conducted in participating worksites. SETTING: Twenty-two predominantly manufacturing worksites in Massachusetts. SUBJECTS: Craftspersons and laborers responding to the survey and employed in these 22 worksites (completion rate = 61%, N = 1841). MEASURES: By using standardized items, this survey measured self-reported exposure to workplace hazards, concern about job exposures, smoking status, fat and fiber intake, readiness to quit smoking, plans to reduce fat intake, plans to eat more fruits and vegetables, and sociodemographic variables. RESULTS: Workers reporting exposure to chemical hazards on the job were significantly more likely to be smokers than were unexposed workers, even when results were controlled for gender. Compared with unexposed workers, smokers exposed to chemical hazards were significantly more likely to be thinking of quitting or taking action to quit, when results were controlled for gender, race, and education. Among workers exposed to occupational chemical hazards, concern about this exposure was significantly associated with intentions to decrease fat intake and increase fruit and vegetable intake, and, among men, intentions to quit smoking. CONCLUSIONS: Efforts aimed at integrating health promotion and health protection are needed to address simultaneously the job risks and personal risks these workers face.

A model for worksite cancer prevention: integration of health protection and health promotion in the WellWorks Project.

OBJECTIVES: To describe a theoretic approach and rationale for the integration of health protection and health promotion in worksite cancer prevention programs and to describe an intervention study designed to implement this integration. METHODS: Twenty-four worksites were recruited to participate in this randomized, controlled study. The theoretically based intervention model integrates health promotion and health protection through (1) joint worker-management participation in program planning and implementation, (2) consultation on worksite changes, and (3) educational programs targeting health behavior change. RESULTS: Although the primary purpose of this paper is to describe a theoretic approach to the integration of health promotion and health protection, preliminary results are also noted. In these predominantly manufacturing worksites, many workers faced the double jeopardy of exposures to occupational carcinogens and personal risks such as smoking or poor dietary habits. Production workers' job responsibilities frequently limited their full participation. Barriers to participation were identified early in the project, and strategies were developed to facilitate maximal worker involvement and worksite changes. CONCLUSIONS: Lifestyle changes such as smoking cessation or dietary changes may be more effectively promoted among blue collar audiences when programs also encourage management actions to reduce occupational exposures. Public health professionals trained in health promotion and health protection must work together to effectively address the health concerns of this population.