Tobacco in the Workplace

More than half a century has passed since the first Surgeon General’s Report on the health consequences of smoking. Over that 50-year period, cigarette smoking in the U.S. has declined by more than 50% among all U.S. adults. However, tobacco use continues to be the most frequent cause of preventable death and is responsible for about 480,000 premature deaths annually in the U.S. More than 16 million U.S. adults live with a disease caused by smoking. CDC’s “Winnable Battle” of reducing tobacco use targets this important public health problem.

To help address occupational aspects of this important health issue, NIOSH has issued the Current Intelligence Bulletin (CIB) “Promoting Health and Preventing Disease and Injury through Workplace Tobacco Policies.” The CIB provides contemporary recommendations based on the Total Worker Health^TM philosophy of optimizing workers’ health and well-being by augmenting interventions to protect against occupational injury and disease with other beneficial public health interventions.

Tobacco remains an important hazard for people who work. Overall, about 20% of U.S. workers smoke and about 20% of nonsmoking workers are exposed to secondhand smoke (SHS) at work. The prevalence of smoking varies widely across occupations and industries, approaching or exceeding 30% or more in construction, mining, and accommodation and food services workers. In these same industries nonsmoking workers are also likely to report exposures to SHS. Although only about 3% of U.S. workers overall use smokeless tobacco, workers who cannot smoke at work because of flammable or explosion hazards may be more likely to use smokeless products. For example, approximately 20% of workers in the mining industry use smokeless tobacco.

Tobacco use causes a range of debilitating and fatal diseases in adults. Examples of diseases caused by cigarette smoking include lung and many other types of cancer, cardiovascular disease, chronic obstructive pulmonary disease, reproductive effects such as impaired fetal development, congenital orofacial defects and low birth weight, and many other conditions. Secondhand smoke is a risk factor for lung cancer, coronary artery disease, and asthma exacerbation. Use of smokeless tobacco can cause oral and other types of cancer and maternal use can have reproductive effects, including stillbirth and reduced birth weight.

In addition to the risks of personal tobacco use or exposure to secondhand smoke, tobacco use by workers can increase, sometimes dramatically, the likelihood and the severity of occupational disease. For example, the combined risk of smoking and asbestos exposure for developing lung cancer is greater than the sum of each risk by itself. Tobacco products can potentially become contaminated with workplace hazards such as lead, resulting in worker exposures. Tobacco use can also be a risk for injury, for example by igniting flammable materials or by creating a distraction during operation of motor vehicles or heavy equipment.

Use of e-cigarettes and other electronic nicotine delivery systems (ENDS) is an emerging issue. They were introduced into the U.S. in 2007 and by 2013 about 1 in 3 current U.S. adult smokers reported ever having used them. Although insufficient time has passed to understand the long term effects of exposure to the airborne particles and gases created by using these devices, a number of professional organizations have recommended that they be included in bans on smoking in public places. In the CIB, NIOSH recommends including ENDS among the items prohibited in a smokefree workplace.

In addition to the health benefits of going tobacco free, there are also economic benefits. One financial editor estimated in 2007 that a typical pack-a-day smoker who is spending nearly $2,000 annually just to purchase cigarettes could instead amass more than $1 million by investing that amount each year from ages 18 to 65 in an individual retirement account. Smokers are also at risk from the potentially devastating financial effects of smoking-related sickness and death and damage to property from cigarette smoke or residential fires. There are also financial benefits to employers. It has been estimated that the annual cost to employ a smoker is, on average, $5,816 greater than the cost to employ a nonsmoker when considering aggregate cost and productivity impacts associated with smoking breaks, absenteeism, presenteeism, healthcare expenses, and pension benefits.

Since 1972, NIOSH has made specific recommendations regarding tobacco use in the workplace. Major NIOSH recommendations in the new CIB include the following:

• At a minimum, establish and maintain smoke-free workplaces that protect those in workplaces from involuntary, secondhand exposures to tobacco smoke and airborne emissions from e-cigarettes and other electronic nicotine delivery systems. Ideally, smoke-free workplaces should be established in concert with tobacco cessation support programs. Smoke-free zones should encompass (1) all indoor areas without exceptions (i.e., no indoor smoking areas of any kind, even if separately enclosed and/or ventilated), (2) all areas immediately outside building entrances and air intakes, and (3) all work vehicles. Additionally, ashtrays should be removed from these areas.
• Optimally, establish and maintain entirely tobacco-free workplaces, allowing no use of any tobacco products across the entire workplace campus.
• Comply with current OSHA and MSHA regulations that prohibit or limit smoking, smoking materials, and/or use of other tobacco products in work areas characterized by the presence of explosive or highly flammable materials or potential exposure to toxic materials. To the extent feasible, follow all similar NIOSH recommendations.
• Provide information on tobacco-related health risks and on benefits of quitting to all employees and other workers at the worksite (e.g., contractors and volunteers).
• Provide information on employer-provided and publically available tobacco cessation services to all employees and other workers at the worksite.
• Offer and promote comprehensive tobacco cessation support to all tobacco-using workers and, where feasible, to their dependents. Provide employer-sponsored cessation programs at no cost or subsidize cessation programs for lower-wage workers to enhance the likelihood of their participation.
• Develop, implement, and modify tobacco-related policies, interventions, and controls in a stepwise and participatory manner. Get input from employees, labor representatives, line management, occupational safety/health and wellness staff, and human resources professionals.
• Make sure that any differential employment benefits policies that are based on tobacco use or participation in tobacco cessation programs are designed with a primary intent to improve worker health and comply with all applicable federal, state, and local laws and regulations.
• All workers, including workers who use tobacco and nonsmokers exposed to SHS at their workplace should know the occupational safety and health risks associated with their work, including those that can be made worse by personal tobacco use, and how to limit those risks.

The CIB “Promoting Health and Preventing Disease and Injury through Workplace Tobacco Policies” provides much additional background information and the entire set of NIOSH recommendations for employers and workers.  For a multimedia introduction to this topic, we encourage you to watch the recent Total Worker Health^TM Webinar Series presentation (now available for viewing) titled “Preserving Lung Health: At Work and Beyond,” which features many of the key findings from the CIB.

David Weissman, MD

Dr. Weissman is Director of the NIOSH Division of Respiratory Disease Studies.