Exposure to environmental tobacco smoke (ETS) is a potential occupational carcinogen according to guidelines of the Occupational Safety and Health Administration (OSHA) carcinogen policy (1). Exposure to ETS in the workplace may represent a substantial contribution to lifetime ETS exposure (2). For many persons, ETS irritates the conjunctiva of the eyes (accompanied by reddening, itching, and increased lacrimation) and the mucous membranes of the nose, throat, and lower respiratory tract (accompanied by itching, coughing, and sore throat) (3). As part of the 1988 National Health Interview Survey-Occupational Health Supplement (NHIS-OHS), CDC measured the degree of discomfort caused by ETS in the workplace. The NHIS-OHS collected information on cigarette smoking, workplace smoking restrictions, and perceived discomfort caused by ETS at the workplace. This report summarizes survey findings and describes efforts to reduce ETS at the workplace.

The 1988 NHIS-OHS was a cross-sectional household interview survey of approximately 44,000 adults (aged greater than or equal to 18 years) representative of the U.S. civilian, noninstitutionalized population. The data were adjusted for nonresponse and weighted to provide national estimates. Ninety-five percent confidence intervals were calculated using standard errors generated by the Software for Survey Data Analysis (SUDAAN) (4). The survey asked the following question of employed respondents (i.e., persons who reported they had a job during a 2-week period immediately before being interviewed): "Is smoking allowed in your place of work other than in designated areas?" Respondents who reported that smoking was allowed in designated (if any) and other areas were asked: "Do you find that cigarette smoke in the workplace causes you no discomfort, some discomfort, moderate discomfort, or great discomfort?"

Based on the survey findings, among 114.1 million employed adults in 1988 (who reported that their workplace was not in their home), 40.3% worked in locations where smoking was allowed in designated (if any) and other areas. Among 79.2 million employed nonsmokers (former and never smokers *) (who reported their workplace was not in their home), 28.5 million (36.5%) worked at places that permitted smoking in designated (if any) and other areas. Of these, 12.4 million (43.5%) reported some or moderate discomfort and 4.5 million (15.7%) reported great discomfort ** from ETS at the workplace (Table 1). Of 16.7 million current smokers ***, 2.5 million (15.0%) reported at least some degree of discomfort from ETS at the workplace.

Among nonsmokers, workplace ETS exposure was more likely to be reported as a cause of discomfort by never smokers (63.6%) than by former smokers (51.4%) and by women (69.0%) than by men (53.9%) (Table 1). Nonsmokers in younger age categories were more likely than older nonsmokers to report discomfort from ETS. Prevalence of any discomfort was generally similar by race and ethnicity. The likelihood of any discomfort from ETS increased directly by level of education, from 44.1% among nonsmokers with fewer than 12 years of education to 69.6% among college graduates. Reported discomfort was more prevalent among nonsmoking white-collar workers (65.1%) and persons in service occupations (62.5%) than among nonsmoking blue-collar workers (50.0%) and persons in agricultural/fishing occupations (44.0%).

Reported by: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Health Interview Statistics, National Center for Health Statistics; Surveillance Br, Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: In 1986, 85% of never smokers and 74% of former smokers in the United States reported that the smoke from another person's cigarette was annoying to them (5). The degree of reported discomfort from ETS among the approximately 28.5 million U.S. nonsmokers during 1988 -- who have either little or no protection from ETS at the workplace -- may reflect the perceived harmfulness of exposure to another person's tobacco smoke (6), actual ETS exposure, and persons' individual sensitivity to ETS.

The NHIS-OHS findings are consistent with previous reports that employees who had either limited or no restrictions against smoking in their worksites indicated they were at least somewhat exposed to ETS at work (5). In addition, in worksites without highly restrictive smoking policies, most workers may be exposed to ETS because the separation of smokers and nonsmokers within the same air space may reduce -- but not eliminate -- the exposure of nonsmokers (3,5).

Two important considerations influence interpretation of the findings in this report. First, because this survey included only employees for whom smoking was permitted in the workplace in both designated (if any) and other areas, the results probably underestimate the number of U.S. nonsmokers in 1988 who experienced discomfort from ETS at the workplace (i.e., employees who experienced discomfort from ETS despite more restrictive worksite smoking policies (5) were not included in this survey). Second, these findings are based on self-reported data and perceptions of discomfort have not been validated, even though self-reported workplace exposures of nonsmokers has been validated biochemically (7).

In June 1991, CDC's National Institute for Occupational Safety and Health (NIOSH) recommended that employers assess conditions that may result in worker exposure to ETS and take steps to reduce exposures to the lowest feasible concentration (1) either by prohibiting smoking in the workplace or designating separate areas for smoking, with separate ventilation. NIOSH also recommended that employers 1) distribute information about the harmful effects of smoking and the benefits of quitting; 2) offer smoking-cessation classes to all workers; and 3) establish incentives to encourage workers to stop smoking (1). Two national health objectives for the year 2000 include efforts to prohibit or severely restrict smoking at work. The first is to increase to at least 75% the proportion of worksites that have a formal smoking policy that prohibits or severely restricts smoking at the workplace (objective 3.11). The second is to enact in the 50 states comprehensive laws on clean indoor air that prohibit or strictly limit smoking in the workplace and enclosed public places (e.g., health-care facilities, schools, and public transportation) (objective 3.12) (8).

The Environmental Protection Agency is reviewing the health effects of ETS exposure (9), and OSHA is considering regulatory options regarding indoor environmental quality (10). Enacting and adhering to workplace policies and regulations regarding worksite exposure to ETS can reduce employee discomfort and the exposure to carcinogens and other toxic substances from ETS.

References

1. CDC. Current intelligence bulletin #54: environmental tobacco smoke in the workplace; lung cancer and other health effects. Cincinnati: US Department of Health and Human Services, Public Health Service, CDC, 1991; DHHS publication no. (NIOSH)91-108.

2. Cummings KM, Markello SJ, Mahoney MC, Marshall JR. Measurement of lifetime exposure to passive smoke. Am J Epidemiol 1989;130:122-32.

3. CDC. The health consequences of involuntary smoking: a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, CDC 1986; DHHS publication no. (CDC)87-8398.

4. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.30 (Software documentation). Research Triangle Park, North Carolina: Research Triangle Institute, 1989.

5. CDC. Passive smoking: beliefs, attitudes, and exposures -- United States, 1986. MMWR 1988;37:239-41.

6. Pierce JP, Hatziandreu E. Tobacco use in 1986: methods and basic tabulations from Adult Use of Tobacco Survey. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1990; publication no. OM90-2004.

7. Haley NJ, Colosimo SG, Axelrad CM, Harris R, Sepkovic DW. Biochemical validation of self-reported exposure to environmental tobacco smoke. Environ Res 1989;49:127-35.

8. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

9. US Environmental Protection Agency. Health effects of passive smoking: assessment of lung cancer in adults and respiratory disorders in children--review draft. Washington, DC: US Environmental Protection Agency, Office of Health and Environmental Assessment, Office of Atmospheric and Indoor Air Programs, May 1990; publication no. EPA/600/6-90/006A.

10. US Department of Labor, Occupational Safety and Health Administration. Occupational exposure to indoor air pollutants; request for information. Federal Register 1991;56:47892-7.

• Former smokers reported they had smoked at least 100 cigarettes during their lifetime and did not smoke at the time of the survey interviews. Never smokers reported they had smoked fewer than 100 cigarettes during their lifetime. ** Percentages and population estimates exclude the 155 (1.5%) of the 10,565 respondents who did not respond to the question on degree of discomfort. *** Current smokers reported they had smoked at least 100 cigarettes during their lifetime and they smoked at the time of the survey interviews.

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