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CORK Bibliography: Occupations

72 citations. January 2009 to present

Prepared: March 2012

Achutan C; West C; Mueller C; Bernert JT; Bernard B. Environmental tobacco smoke exposure among casino dealers. Journal of Occupational and Environmental Medicine 53(4): 346-351, 2011. (45 refs.)

Objective: This study quantified casino dealers' occupational exposure to environmental tobacco smoke (ETS). Methods: We measured casino dealers' exposure to ETS components by analyzing full-shift air and preshift and postshift urine samples. Results: Casino dealers were exposed to nicotine, 4-vinyl pyridine, benzene, toluene, naphthalene, formaldehyde, acetaldehyde, solanesol, and respirable suspended particulates. Levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine increased significantly during an 8-hour work shift both with and without adjustment for creatinine clearance. Creatinine-unadjusted cotinine significantly increased during the 8-hour shift, but creatinine-adjusted cotinine did not increase significantly. Conclusions: Casino dealers at the three casinos were exposed to airborne ETS components and absorbed an ETS-specific component into their bodies, as demonstrated by detectable levels of urinary NNAL. The casinos should ban smoking on their premises and offer employee smoking cessation programs.

Alexander LA; Crawford T; Mendiondo MS. Occupational status, work-site cessation programs and policies and menthol smoking on quitting behaviors of US smokers. Addiction 105(Supplement 1): 95-104, 2010. (47 refs.)

Aim: This exploratory study sought to examine the relationships among occupational status, menthol smoking preference and employer-sponsored smoking cessation programs and policies on quitting behaviors. Design: Data for this cross-sectional study were obtained from the 2006 Tobacco Use Supplement to the Current Population Survey (TUS CPS), a large national survey representative of the civilian population, containing approximately 240 000 respondents. The total sample for the current study was 30 176. Measurements: The TUS CPS regularly collects data on cigarette prevalence, quitting behaviors, smoking history and consumption patterns. We performed a logistic regression with 'life-time quitting smoking for 1 day or longer because they were trying to quit' as outcome variable. Independent variables included type of occupation, employer-sponsored cessation programs and policies and menthol status. Findings: When controlling for occupational status and work-place policies, there were no differences for menthol versus non-menthol smokers on quitting behaviors [odds ratio (OR) = 0.98; 95% confidence interval (CI) = 0.83, 1.15]. Service workers were less likely to quit compared with white-collar workers (OR = 0.80; 95% CI = 0.69, 0.94), and those with no employer-sponsored cessation program were less likely to quit (OR = 0.70; 95% CI = 0.60, 0.83). White-collar workers, compared with blue-collar and service workers, were more likely to have a smoking policy in the work area (93% versus 86% versus 88%, respectively). Conclusions: When occupational status and work-place smoking policies are controlled for, smokers of menthol cigarettes in the United States appear to have similar self-reported life-time rates of attempts to stop smoking to non-menthol smokers.

Ao TTH; Sam N; Kiwelu I; Mahal A; Subramanian SV; Wyshak G et al. Risk factors of alcohol problem drinking among female bar/hotel workers in Moshi, Tanzania: A Multi-level analysis. AIDS and Behavior 15(2): 330-339, 2011. (43 refs.)

There is limited information on alcohol problem drinking, which has been associated with sexually transmitted infections (STIs), including HIV, among female bar/hotel workers in Africa. This paper aimed to identify the individual- and facility-level determinants of alcohol problem drinking in this setting. Problem drinking was defined based on the CAGE alcohol screening scale. Multi-level logistic regression was used to identify individual- and facility-level factors associated with problem drinking. About 37.3% of women (N = 1629) were classified as having probable or definite problem drinking. In multi-level analysis, main characteristics associated with problem drinking included: having 3-4 partners in the past 5 years compared to having 1-2, used a condom in the last sex comparing to non-use, history of transactional sex, having more pregnancies, and facilities whose employees do not live on the premises. Interventions which combine alcohol and sexual risk reduction counseling are urgently needed in this population.

Arjomandi M; Haight T; Redberg R; Gold WM. Pulmonary function abnormalities in never-smoking flight attendants exposed to secondhand tobacco smoke in the aircraft cabin. Journal of Occupational and Environmental Medicine 51(6): 639-646, 2009. (53 refs.)

Objective: To determine whether the flight attendants who were exposed to secondhand tobacco smoke in the aircraft cabin have abnormal pulmonary function. Methods: We administered questionnaires and performed pulmonary function testing in 61 never-smoking female flight attendants who worked in active air crews before the smoking ban on commercial aircraft (preban). Results: Although the preban flight attendants had normal FVC, FEV1 and FEV1/FVC ratio, they had significantly decreased flow at mid- and low-lung volumes, curvilinear flow-volume curves, and evidence of air trapping Furthermore, the flight attendants had significantly decreased diffusing capacity (77.5% +/- 11.2% predicted normal) with 51% having a diffusing copacity below their 95% normal prediction limit. Conclusions. This cohort of healthy never-smoking flight attendants who were exposed to secondhand tobacco smoke in the aircraft cabin showed pulmonary function abnormalities suggestive of airway obstruction and impaired diffusion.

Ballenger JF; Best SR; Metzler TJ; Wasserman DA; Mohr DC; Liberman A et al. Patterns and predictors of alcohol use in male and female urban police officers. American Journal on Addictions 20(1): 21-29, 2011. (38 refs.)

In a large sample of urban police officers, 18.1% of males and 15.9% of females reported experiencing adverse consequences from alcohol use and 7.8% of the sample met criteria for lifetime alcohol abuse or dependence. Female officers had patterns of alcohol use similar to male officers and substantially more than females in the general population. Critical incident exposure and posttraumatic stress disorder (PTSD) symptoms were not associated with level of alcohol use. Greater psychiatric symptoms were related to adverse consequences from alcohol use. There was a noteworthy gender by work stress interaction: greater routine work stress related to lower current alcohol use in female officers.

Bartram DJ; Baldwin DS. Veterinary surgeons and suicide: A structured review of possible influences on increased risk. Veterinary Record 166(13): 388-397, 2010. (158 refs.)

Veterinary surgeons are known to be at a higher risk of suicide compared with the general population. There has been much speculation regarding possible mechanisms underlying the increased suicide risk in the profession, but little empirical research. A computerised search of published literature on the suicide risk and influences on suicide among veterinarians, with comparison to the risk and influences in other occupational groups and in the general population, was used to develop a structured review. Veterinary surgeons have a proportional mortality ratio (PMR) for suicide approximately four times that of the general population and around twice that of other healthcare professions. A complex interaction of possible mechanisms may occur across the course of a veterinary career to increase the risk of suicide. Possible factors include the characteristics of individuals entering the profession, negative effects during undergraduate training, work-related stressors, ready access to and knowledge of means, stigma associated with mental illness, professional and social isolation, and alcohol or drug misuse (mainly prescription drugs to which the profession has ready access). Contextual effects such as attitudes to death and euthanasia, formed through the profession's routine involvement with euthanasia of companion animals and slaughter of farm animals, and suicide 'contagion' due to direct or indirect exposure to suicide of peers within this small profession are other possible influences.

Bartram DJ; Sinclair JMA; Baldwin DS. Alcohol consumption among veterinary surgeons in the UK. Occupational Medicine 59(5): 323-326, 2009. (10 refs.)

Aims To investigate alcohol consumption and the prevalence and associations of 'at-risk' drinking among vets in the UK. Methods Alcohol consumption was measured using the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) embedded in a questionnaire which included measures of mental health and psychosocial working conditions, administered to a representative sample of 1796 vets. Scores of >= 4 for women and >= 5 for men were used as an indicator of 'at-risk' drinking. Results The response rate was 56%. Five per cent of respondents were non-drinkers, 32% low-risk drinkers and 63% at-risk drinkers. The estimated odds of at-risk drinking was not significantly different for men and women. A 1-year increase in age was associated with a 2% reduction in the odds of at-risk drinking (OR 0.98, 95% CI: 0.97-0.99, P < 0.01). There was no significant difference across hours worked or on call in a typical week. Lower psychological demands at work were associated with reduced odds of at-risk drinking (OR 0.75, 95% CI: 0.63-0.90, P < 0.01). Conclusions It is estimated that vets drink more frequently than the general population, but consume less on a typical drinking day and have a prevalence of daily and weekly binge drinking that is similar to the general population. The level of alcohol consumption does not appear to be a negative influence on mental health within the profession as a whole.

Beatty AL; Haight TJ; Redberg RF. Associations between respiratory illnesses and secondhand smoke exposure in flight attendants: A cross-sectional analysis of the Flight Attendant Medical Research Institute Survey. Environmental Health 10: 81, 2011. (38 refs.)

Background: Secondhand tobacco smoke (SHS) is associated with increased risk of respiratory illness, cancer, and cardiovascular disease. Prior to smoking bans on airlines in the late 1980s, flight attendants were exposed to a significant amount of SHS. In the present study, we examine associations between flight attendant SHS exposure and development of respiratory illnesses and cardiovascular disease. Methods: Between December 2006 and October 2010, three hundred sixty-two flight attendants completed an online questionnaire with information regarding experience as a flight attendant, medical history, smoking history, and SHS exposure. Rates of illnesses in flight attendants were compared with an age and smoking history matched population sample from NHANES 2005-2006. Logistic regression analysis was used to examine the association of reported medical conditions and pre-ban years of exposure. Results: Compared with the sample from NHANES 2005-2006, flight attendants had increased prevalence of chronic bronchitis (11.7% vs. 7.2%, p < 0.05), emphysema/COPD (3.2% vs. 0.9%, p < 0.03), and sinus problems (31.5% vs. 20.9%, p < 0.002), despite a lower prevalence of medical illnesses including high blood pressure, diabetes, high cholesterol, heart failure, cancer, and thyroid disease. Amongst flight attendants who reported never smoking over their lifetimes, there was not a significant association between years of service as a flight attendant in the pre-smoking ban era and illnesses. However, in this same group, there was a significantly increased risk of daily symptoms (vs. no symptoms) of nasal congestion, throat, or eye irritation per 10-year increase of years of service as a flight attendant prior to the smoking ban (OR 2.14, 95% CI 1.41 - 3.24). Conclusions: Flight attendants experience increased rates of respiratory illnesses compared to a population sample. The frequency of symptoms of nasal congestion, throat or eye irritation is associated with occupational SHS exposure in the pre-smoking ban era.

Bell NS. Health and occupational consequences of spouse abuse victimization among male US army soldiers. Journal of Interpersonal Violence 24(5): 751-769, 2009. (37 refs.)

Little is known about health and occupational outcomes of male spouse abuse victims. In all, 11,294 male spouse abuse victims with a history of spouse abuse perpetration, 3,277 victims without prior spouse abuse perpetration, and 72,855 nonvictims and nonperpetrators were followed for 12 years to assess army attrition and hospitalization risk. In multivariate Cox models controlling for age, race, education, rank, service time, and dependents, victims were at significantly greater risk for early army discharge and hospitalization than were nonvictims particularly hospitalizations for depression, alcohol dependence, and mental health-even when the hospitalization occurred years after the abuse event. Victim-perpetrators had greater risk than did victim-nonperpetrators for both attrition (1.13, 95% confidence interval [ CI] = 1.08-1.18; 1.05, 95% CI = 1.02-1.08, respectively) and hospitalizations (1.45, 95% CI = 1.38-1.52; 1.38, 95% CI = 1.27-1.49, respectively). College education was protective and deserves further inquiry. Male victims need greater support following spouse abuse.

Benson P. Tobacco talk: Reflections on corporate power and the legal framing of consumption. Medical Anthropology Quarterly 24(4): 500-521, 2010. (67 refs.)

This article examines how North Carolina tobacco farmers think about the moral ambiguities of tobacco business. Drawing on ethnographic research with tobacco farmers and archival research on the tobacco industry, I specify the core psychological defense mechanisms that tobacco companies have crafted for people associated with the industry. I also document local social, cultural, and economic factors in rural North Carolina that underpin ongoing rural dependence on tobacco despite the negativity that surrounds tobacco and structural adjustments. This article contributes to our knowledge about tobacco farmers and tobacco farming communities, which is important for tobacco-control strategies. I reflect on ethical and economic paradoxes related to the rise of corporate social responsibility in the tobacco industry, where an official legal framing of consumption, focused on informed adult consumer autonomy and health education, is promoted to undermine more robust public health prevention efforts.

Braverman MT; Aaro LE; Bontempo DE; Hetland J. Bar and restaurant workers' attitudes towards Norway's comprehensive smoking ban: A growth curve analysis. Tobacco Control 19(3): 240-247, 2010. (33 refs.)

Background: Norway passed legislation banning smoking in restaurants, bars and other public spaces in 2004. This study tracks changes in hospitality workers' attitudes towards Norway's ban over three time points, using growth modelling analysis to examine predictors of attitude change. Methods: Participants were a national sample of 1525 bar and restaurant workers. Surveys were conducted, by phone or internet, one month before the ban's implementation and at 4 and 12 months thereafter. Exploratory principal components analysis of nine survey items revealed one primary attitude component. A latent growth model was fitted to the data to examine trajectories of attitude change and individual differences in rate of change. Results: Respondents supported the ban before implementation and increased support at 4 months (p=0.021) and again at 12 months (p=0.001). Concern for one's job followed a quadratic trend, increasing at 4 months and decreasing at 12 months (p<0.001). All demographic categories were associated with attitude increase; rate of increase was greater for females than males. Two within-person variables -- change in smoking status and change in job concern -- strongly predicted (p<0.001) respondents' deviations from their predicted group trajectories, explaining over 70% of residual between-person slope variance. Conclusions: Norway's hospitality workers increased their support of the ban over its first year. The strong influence of the within-person variables leads to two primary policy recommendations. First, support should be provided to assist cessation efforts and prevent relapse. Second, informational campaigns should inform hospitality workers about evidence that smoking bans are not economic threats to the industry.

Burton D; Zeng XX; Chiu CH; Sun JM; Sze NL; Chen YL et al. A phone-counseling smoking-cessation intervention for male Chinese restaurant workers. Journal of Community Health 35(6): 579-585, 2010. (8 refs.)

We sought to develop a smoking-cessation intervention for male Chinese restaurant workers in New York City that required no seeking out by participants; provided support over a relatively long period of time; and was responsive to participants' cultural backgrounds and daily lives. The resulting intervention consisted of a minimum of 9 proactive phone counseling sessions within a 6-month period for each participant recruited at his worksite. All activities were conducted in Chinese languages. The efficacy of this proactive phone-counseling intervention was assessed in a pretest/posttest design comparing baseline smoking with smoking 6 months after the intervention ended. Of 137 male employees recruited at their restaurants, 101 (median age 40.5) participated in the phone-counseling intervention in 2007-2008, with 75 completing the program with at least 9 counseling calls. We found a linear increase in smoking cessation from 0% at Call 1 to 50.7% at Call 9 for 75 men who completed the program, and we found for all 101 participants a 32.7% intent-to-treat cessation rate for 6 months post-end of program, adjusted to 30.8% by saliva cotinine assessments. The results indicate that combining field outreach with phone counseling over an extended period of time can facilitate smoking cessation for population groups whose environments do not support efforts to quit smoking.

Canfield DV; Dubowski KM; Whinnery JE; Lewis RJ; Ritter RM; Rogers PB. Increased cannabinoids concentrations found in specimens from fatal aviation accidents between 1997 and 2006. Forensic Science International 197(1-3): 85-88, 2010. (24 refs.)

The National Institute on Drug Abuse (NIDA) and the Office of National Drug Control Policy (ONDCP) reported a 1.5-fold increase in the delta-9-tetrahydrocannabinol (THC) content of street cannabis seizures from 1997 to 2001 versus 2002 to 2006. This study was conducted to compare the changes, over those years, in blood and urine cannabinoid concentrations with the potency of THC reported in the cannabis plant. Cannabinoids were screened using radioimmunoassay (RIA) for blood and fluorescence polarization immunoassay (FPIA) for urine and confirmed using GC/MS. A total of 95 individuals were found to be using cannabis from a total number of 2769 (3.4%) individuals tested over the period 1997 through 2006. Other impairing drugs were found in 38% of the cannabinoids-positive individuals. The mean concentration of THC in blood for 1997-2001 was 2.7 ng/mL; for 2002-2006, it was 7.2 ng/mL, a 2.7-fold increase in the mean THC concentration of specimens from aviation fatalities, compared to a 1.5-fold increase in cannabis potency reported by the NIDA and ONDCP. The mean age for cannabis users was 40 years (range 18-72) for aviation fatalities. For all blood and urine specimens testing negative for cannabinoids from aviation fatalities, the mean age of the individuals was 50 years (range 14-92). More than half of the fatalities tested were 50 years or older, whereas, 80% of the positive cannabis users were under 50. As indicated by these findings, members of the transportation industry, government regulators, and the general public should be made aware of the increased potential for impairment from the use of high-potency cannabis currently available and being used.

Carey MG; Al-Zaiti SS; Dean GE; Sessanna L; Finnell DS. Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters. Journal of Occupational and Environmental Medicine 53(8): 928-933, 2011. (31 refs.)

Objective: Little attention has been given to factors contributing to firefighters' psychosomatic well-being. The purpose of this descriptive study was to examine such contributing factors in a sample of professional firefighters. Methods: Measures assessing sleep, depression, substance use, social bonding, and quality of life were examined in 112 firefighters. Results: Overall, many firefighters reported sleep deprivation (59%), binge drinking behavior (58%), poor mental well-being (21%), current nicotine use (20%), hazardous drinking behavior (14%), depression (11%), poor physical well-being (8%), caffeine overuse (5%), or poor social bonding (4%). Conclusions: Small-to-medium correlations were identified between sleep deprivation, depression, physical/mental well-being, and drinking behaviors. High-risk behaviors that impact psychosomatic well-being are prevalent in professional firefighters, which require environmental and individual-based health promotion interventions. The inter-correlation relationships between such behaviors, therefore, need to be explored in further details.

Carinci AJ; Christo PJ. Physician Impairment: Is recovery feasible? Pain Physician 12(3): 487-491, 2009. (38 refs.)

Background: Physician impairment is a serious public health issue affecting not only physicians, but also their families, colleagues, and patients. Physician impairment is used most often to refer to substance use disorders, which involve both substance abuse and substance dependence and/or addiction. Objective: This article aims to describe the problem of physician impairment within the context of substance use disorders. The concept of recovery and several strategies for effective recovery are explored. Discussion: Experts now define impairment as an enduring condition that if left untreated is not amenable to remission and cure. In terms of functional capacity, impairment renders the physician unable to provide competent medical services, with serious flaws in professional judgment. Herein, we define the scope of the problem, consider several theories to explain the reason physicians may be prone to develop substance use disorders, discuss diagnosis and reporting, as well as treatment and prognosis, and identify several relapse prevention strategies. Conclusion: Physician impairment is a real and significant public health concern; however, recovery is feasible and the data support favorable odds of recovery and a return to clinical practice among those seeking appropriate treatment, counseling, and relapse prevention strategies.

Cashman CM; Ruotsalainen JH; Greiner BA; Beirne PV; Verbeek JH. Alcohol and drug screening of occupational drivers for preventing injury. (review). Cochrane Database of Systematic Reviews 2009(2): article CD006566, 2009. (40 refs.)

Background: Workforce alcohol and drug testing is commonplace but its effect in reducing occupational injuries remains unclear. Objectives: To assess the effects of alcohol and drug screening of occupational drivers (operating a motorised vehicle) in preventing injury or work-related effects such as sickness absence related to injury. Search strategy: We searched the following databases up to June 2007 (or up to the latest issue then available): MEDLINE, EMBASE, The Cochrane Library, Cochrane Occupational Health Field's specialised register, DARE, PsychINFO, ERIC, ETOH, CISDOC, NIOSHTIC, TRANSPORT, Zetoc, Science Citation Index and Social Science Citation index and HSELINE. We also searched reference lists, relevant websites and conducted hand searching. Selection criteria: Randomised controlled trials (RCTs), cluster-randomised trials, controlled clinical trials, controlled before and after studies (more than three time points to be measured before and after the study) and interrupted time-series (ITS) studies that evaluated alcohol or drug screening interventions for occupational drivers (compared to another intervention or no intervention) with an outcome measured as a reduction in injury or a proxy measure thereof. Data collection and analysis: Two review authors independently extracted data and assessed study quality. We contacted authors of the included studies for further information. Main results: We included two interrupted time-series studies conducted in the. One study was conducted in five large US transportation companies (N = 115,019) that carried passengers and/or cargo. Monthly injury rates were available from 1983 to 1999. In the study company, two interventions of interest were evaluated: mandatory random drug testing and mandatory random and for-cause alcohol testing programmes. The third study focused only on mandatory random drug testing and was conducted on federal injury data that covered all truck drivers of interstate carriers. We recalculated the results from raw data provided by the study authors. Following reanalysis, we found that in one study mandatory random and for-cause alcohol testing was associated with a significant decrease in the level of injuries immediately following the intervention (-1.25 injuries/100 person years, 95% CI -2.29 to -0.21) but did not significantly affect the existing long-term downward trend (-0.28 injuries/100 person years/year, 95% CI -0.78 to 0.21). Mandatory random drug testing was significantly associated with an immediate change in injury level following the intervention (1.26 injuries/100 person years, 95% CI 0.36 to 2.16) in one study, and in the second study there was no significant effect (-1.36/injuries/100 person years, 95% CI -1.69 to 0.41). In the long term, random drug testing was associated with a significant increase in the downward trend (-0.19 injuries/100 person years/year, 95% CI -0.30 to -0.07) in one study, the other study was also associated with a significant improvement in the long-term downward trend (-0.83 fatal accidents/100 million vehicle miles/year, 95% CI -1.08 to -0.58). Authors' conclusions: There is insufficient evidence to advise for or against the use of drug and alcohol testing of occupational drivers for preventing injuries as a sole, effective, long-term solution in the context of workplace culture, peer interaction and other local factors. Cluster-randomised trials are needed to better address the effects of interventions for injury prevention in this occupational setting.

Cerda M; Johnson-Lawrence VD; Galea S. Lifetime income patterns and alcohol consumption: Investigating the association between long- and short-term income trajectories and drinking. Social Science & Medicine 73(8): 1178-1185, 2011. (41 refs.)

Lifetime patterns of income may be an important driver of alcohol use. In this study, we evaluated the relationship between long-term and short-term measures of income and the relative odds of abstaining, drinking lightly-moderately and drinking heavily. We used data from the US Panel Study on Income Dynamics (PSID), a national population-based cohort that has been followed annually or biannually since 1968. We examined 3111 adult respondents aged 30-44 in 1997. Latent class growth mixture models with a censored normal distribution were used to estimate income trajectories followed by the respondent families from 1968 to 1997, while repeated measures multinomial generalized logit models estimated the odds of abstinence (no drinks per day) or heavy drinking (at least 3 drinks a day), relative to light/moderate drinking (<1-2 drinks a day), in 1999-2003. Lower income was associated with higher odds of abstinence and of heavy drinking, relative to light/moderate drinking. For example, belonging to a household with stable low income ($11-20,000) over 30 years was associated with 1.57 odds of abstinence, and 2.14 odds of heavy drinking in adulthood. The association between lifetime income patterns and alcohol use decreased in magnitude and became non-significant once we controlled for past-year income, education and occupation. Lifetime income patterns may have an indirect association with alcohol use, mediated through current socioeconomic conditions.

Chiu YHM; Spiegelman D; Dockery DW; Garshick E; Hammond SK; Smith TJ et al. Secondhand smoke exposure and inflammatory markers in nonsmokers in the trucking industry. Environmental Health Perspectives 119(9): 1294-1300, 2011. (43 refs.)

BACKGROUND: Few studies have directly assessed the association of secondhand smoke (SHS) with cardiovascular disease-related inflammatory markers, and the findings are inconsistent. OBJECTIVES: We assessed the association between SHS exposure and the inflammatory markers high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and soluble inter-cellular adhesion molecule-1 (sICAM-1) in 199 non-smoking U. S. trucking industry workers. METHODS: Participants provided blood samples either by mail (blood drawn at local health care provider near home) or at the work site (blood drawn by research staff on-site) and completed a health and work history questionnaire at the time of blood draw. Exposure to SHS was measured by plasma cotinine concentrations. We used multivariate regression analyses to assess the associations between levels of cotinine and inflammatory markers. RESULTS: The median cotinine level was 0.10 ng/mL (interquartile range, 0.04-0.23 ng/mL). The odds ratios of elevated hs-CRP (above highest CRP tertile, 1.5 mg/L) were 2.85 [95% confidence interval (CI), 1.03-7.89] for the high-cotinine group (> 0.215 ng/mL) and 2.80 (95% CI, 1.11-7.10) for the moderate-cotinine group (0.05-0.215 ng/mL), compared with the low-cotinine group (< 0.05 ng/mL), adjusting for age, sex, race, educational level, obesity, previous smoking history, job title, and medical history. Plasma cotinine levels were not associated with IL-6 or sICAM-1. CONCLUSIONS: SHS exposure, as assessed by plasma cotinine, was positively associated with hs-CRP in this group of blue-collar workers. The strength of the association with hs-CRP depended on the cut points selected for analysis.

Claessen H; Arndt V; Drath C; Brenner H. Smoking habits and occupational disability: A cohort study of 14,483 construction workers. Occupational and Environmental Medicine 67(2): 84-90, 2010. (39 refs.)

Objectives Although smoking causes a variety of diseases and both, a high smoking prevalence and permanent occupational disability are a great burden on the population level, data about the impact of smoking habits on occupational disability are sparse. The objective of this study was to examine the influence of smoking habits on occupational disability among construction workers, an occupational group with particularly high smoking prevalence. Methods The association between smoking and occupational disability was examined during a mean follow-up of 10.8 years in a cohort of 14,483 male construction workers in Wurttemberg, Germany. The cohort was linked to the regional pension register of the German pension fund to identify workers who were granted a disability pension during the follow-up. HRs (Hazard Ratios) were calculated with non-smokers as reference by the Cox proportional hazards model adjusting for potential confounding factors such as age, nationality, type of occupation, alcohol consumption and body mass index. Results Overall, 2643 cases of occupational disability were observed, with dorsopathy (21%) being the most common cause. Clear dose-response relationships were seen between smoking and occupational disability due to all causes, as well as occupational disability due to respiratory, cardiovascular and mental diseases, cancer and dorsopathy. Particularly strong associations were seen between heavy smoking (>= 20 cigarettes/day) and occupational disability due to mental and respiratory diseases (HR 3.25, 95% CL 1.93 to 5.46 and HR 3.26, 95% CL 1.69 to 6.27, respectively). Conclusion: Smoking is associated with increased risk of occupational disability among construction workers, in particular occupational disability due to respiratory, cardiovascular and mental diseases, cancer and dorsopathy.

Coggon D; Harris EC; Brown T; Rice S; Palmer KT. Occupation and mortality related to alcohol, drugs and sexual habits. Occupational Medicine 60(5): 348-353, 2010. (18 refs.)

Background: To identify opportunities for targeted prevention, we explored differences in occupational mortality from diseases and injuries related to alcohol consumption, sexual habits and drug abuse. Methods: Using data on all deaths among men and women aged 16-74 years in England and Wales during 19912000, we derived age- and social class-standardized proportional mortality ratios (PMRs) by occupation for cause of death categories defined a priori as potentially related to alcohol consumption, sexual habits or drug abuse. Results; The highest mortality from alcohol-related diseases and injuries was observed in publicans and bar staff (both sexes) and in male caterers, cooks and kitchen porters and seafarers. Male seafarers had significantly elevated PMRs for cirrhosis (179), 'other alcohol-related diseases' (275), cancers of the liver (155), oral cavity (275) and pharynx (267) and injury by fall on the stairs (187). PMRs for human immunodeficiency virus infection (HIV)/acquired immunodeficiency syndrome (AIDS) were particularly high in tailors and dressmakers (918, 95% CI: 369-1890, in men; 804, 95% CI: 219-2060, in women) and male hairdressers (918, 95% CI: 717-1160). Most jobs with high mortality from HIV/AIDS also had more deaths than expected from viral hepatitis. Of seven jobs with significantly high PMRs for both drug dependence and accidental poisoning by drugs, four were in the construction industry (male painters and decorators, bricklayers and masons, plasterers, and roofers and glaziers). Conclusions: Our findings highlight major differences between occupations in mortality from diseases and injuries caused by alcohol, sexual habits and drug abuse. Priorities for preventive action include alcohol-related disorders in male seafarers and drug abuse in construction workers.

Cunradi CB; Chen MJ; Lipton R. Association of occupational and substance use factors with burnout among urban transit operators. Journal of Urban Health 86(4): 562-570, 2009. (25 refs.)

Burnout is a special type of prolonged occupational stress that is linked with numerous psychosomatic and psychological sequelae and negative job consequences. The purpose of this study is to estimate the contribution of occupational and substance use factors to burnout among a multiethnic sample of urban transit operators (n = 1231). Survey and medical exam data were obtained from participants in the 1993-1995 San Francisco MUNI Health & Safety Study. Burnout was measured with the Maslach Burnout Inventory emotional exhaustion subscale. Occupational factors included frequency of job problems (e.g., equipment, passengers, and traffic), years driving, full or part-time work status, and ergonomic problems (e.g., adjusting the seat, back support, vibration, and rocking or bouncing of seat). Substance use measures were alcohol consumption and smoking status (i.e., current, former, and never smokers). The results of multivariable linear regression analysis showed that job problems (beta = 0.426, p < 0.001), ergonomic problems (beta = 0.138, p < 0.001), and full-time work status (beta = 0.070, p < 0.01) were associated with burnout. Smoking was not significant, but alcohol consumption was positively associated with burnout (beta = 0.067, p < 0.01). Age was negatively correlated with burnout (beta = -0.106, p < 0.001), which may reflect a healthy worker effect. Because aspects of the psychosocial and physical work environments can be modified, the findings have important implications for the prevention of burnout among municipal transit operators.

da Silva FP; de Pinho RSN; de Mello MT; de Bruin VMS; de Bruin PFC. Risk factors for depression in truck drivers. Social Psychiatry and Psychiatric Epidemiology 44(2): 125-129, 2009. (42 refs.)

Objective: Depression is a major public health problem. Work stress is associated with depression and workers whose jobs impose high levels of psychological demands, such as truck drivers, may be at increased risk. The aim of this study was to investigate the prevalence and correlates of depression in truck drivers. Method This was a cross-sectional study of 300 male truck drivers. Presence and severity of depression were assessed by the Mini International Neuropsychiatric Interview followed by the Beck Depression Inventory Short Form. Relevant demographic, clinical and occupational data were collected using a purpose-built questionnaire. Results: The prevalence of depression among truck drivers was 13.6%. Multivariate analysis showed that being 45 years or older had a protective effect (OR = 0.19; P = 0.02), whereas low educational level (OR = 3.03; P = 0.01), use of stimulants (OR = 5.03; P < 0.01) and wage-earning (OR = 2.84; P = 0.01), as opposed to self-employment, increased the risk for depression. Conclusions: Truck drivers are at increased risk for depression when compared to the general population. Efforts to increase awareness of this problem and to limit the use of stimulants, as well as measures to improve job satisfaction, particularly among the wage-earning drivers, may have a positive impact on mental health in these workers.

Dahl MS; Nielsen J; Mojtabai R. The effects of becoming an entrepreneur on the use of psychotropics among entrepreneurs and their spouses. Scandinavian Journal of Public Health 38(8): 857-863, 2010. (28 refs.)

Aims: Entering entrepreneurship (i.e. becoming an entrepreneur) is known to be a demanding activity with increased workload, financial uncertainty and increased levels of stress. However, there are no systematic studies on how entering entrepreneurship affects the people involved. Methods: The authors investigated prescriptions of psychotropics for 6,221 first-time entrepreneurs from 2001-2004 and their 2,381 spouses in the first two years after becoming entrepreneurs in a matched case-control study using linked data from three Danish national registries: The Danish database for Labor Market Research, the Danish Entrepreneurship database and the Danish Prescription database. Results: Entrepreneurs were more likely to fill prescriptions at pharmacies for sedatives/hypnotics (adjusted odds ratio (AOR): 1.45 [95% CI: 1.26-1.66], p < .0001). However, they were less likely to fill prescriptions for antidepressants (AOR: 0.74 [95% CI: 0.59-0.92] p = 0.007). Spouses of these entrepreneurs were also more likely to fill prescriptions for sedatives/hypnotics (AOR: 1.36 [95% CI: 1.10-1.67], p = 0.005). No difference in prescription of antidepressants was found for spouses. Conclusions: This study showed that there was a significant relation between entering entrepreneurship and receiving prescriptions for sedative/ hypnotics both among the entrepreneurs themselves and their spouses, suggesting that entering entrepreneurship may be associated with increased stress for both the entrepreneurs and their families.

Dar R; Rosen-Korakin N; Shapira O; Gottlieb Y; Frenk H. The craving to smoke in flight attendants: Relations With smoking deprivation, anticipation of smoking, and actual smoking. Journal of Abnormal Psychology 119(1): 248-253, 2010. (20 refs.)

In the study, the authors examined the effects of smoking deprivation, anticipation of smoking. and actual smoking on the craving to smoke. Flight attendants who were light to heavy smokers rated their craving to smoke at predetermined time points during a 2-way short flight (each leg 3-5.5 hr) and a 1-way long flight (8-13 hr). In both short and long flights, craving increased gradually and peaked as landing approached. Craving levels at the end of the 1st leg of the short flights were equal to those at the end of the long flight and were much higher than those at the parallel time point in the long flight. In the short flight, craving levels at the beginning of the 2nd leg dropped relative to the end of the 1st leg, both for participants who smoked during the intermission and for those who did not, though the drop was steeper for the former. The results provide additional evidence for the role of psychological factors in determining the craving to smoke in a naturalistic setting.

de Castro AB; Garcia G; Gee GC; Tsai JHC; Rue T; Takeuchi DT. Smoking and the Asian American workforce in the National Latino and Asian American Study. American Journal of Industrial Medicine 53(2, Special Issue): 171-178, 2010. (46 refs.)

Background: Smoking among the Asian American workforce has not been extensively researched. This study examines smoking prevalence among a nationally representative sample of Asian Americans with an emphasis on occupational classification. Methods: Cross-sectional data come form the National Latino and Asian American Study. Multivariate logistic regression analyses were used to determine smoking prevalence by occupation, gender and nativity, among 1,528 participants self identifying as in the labor force. Results Blue collar workers reported the highest smoking prevalence (32%)followed by unemployed (19%), other (17%), service (14%), and white collar (10%). Among both employed males and females, blue collar workers had the highest prevalence (45% and 18%, respectively). By nativity smoking was highest among blue collar workers for immigrants (25%) and highest among the unemployed for U.S. born (16%). Blue collar employment was significantly, associated with being a current smoker (OR = 2.52; 95% CI: 1.23-5.16: P < 0.05) controlling for demographics (e.g., age, gender, ethnic group, nativity, etc.). Conclusions: Findings reveal that smoking differs by occupation among Asian Americans. Future research should examine factors explaining differences while considering gender and nativity.

de Oliveira PPV; Sihler CB; de Moura L; Malta DC; Torres MCD; Lima SMDP et al. First reported outbreak of green tobacco sickness in Brazil. Cadernos De Saude Publica 26(12): 2262-2268, 2010. (21 refs.)

Dermal absorption of nicotine by people harvesting tobacco may cause an acute intoxication called green tobacco sickness. Although Brazil is the second largest producer of tobacco in the world, green tobacco sickness had not been reported in the country to date. We conducted a 1:1 matched case-control study among persons involved in tobacco farming to determine the occurrence of green tobacco sickness in the northeast region of Brazil and to identify the risk factors involved. A case-patient was a person who received a diagnosis by health professional of acute intoxication during the study period and had a cotinine level over 10ng/mL detected by High Performance Liquid Chromatography. We identified 107 case-patients. The main signs and symptoms observed were dizziness, weakness, vomit, nausea and headache. Independent risk factors identified were being male, a non smoker and having worked in the harvest of tobacco leaves. Case-patients had higher median urinary cotinine levels than controls (p < 0.05). Epidemiological and laboratory data indicate for the first time the occurrence of green tobacco sickness in Brazil.

Duraisingam V; Pidd K; Roche AM. The impact of work stress and job satisfaction on turnover intentions: A study of Australian specialist alcohol and other drug workers. Drugs: Education, Prevention and Policy 16(3): 217-231, 2009. (43 refs.)

Aims: A national study was conducted to investigate the extent and nature of job attitudes and well-being of specialist alcohol and other drug (AOD) workers in Australia. As part of that larger study, work stress and job satisfaction and their relationship with turnover intentions were examined. Method: A postal survey measuring working conditions, work stress, job satisfaction, turnover intention and key demographics among specialist frontline workers from AOD treatment services across Australia was undertaken. A total of 1345 responses from workers in 369 participating AOD treatment services were obtained. Findings: Although the majority of workers were satisfied with their jobs, one in five workers reported above average levels of stress. One in five workers also expressed intentions to leave the AOD field. Significant predictors of higher turnover intention were low job satisfaction, high work stress, low workplace social support and negative attitudes towards remuneration. Conclusion: This study was the first attempt to collect empirical data on levels of stress and job satisfaction among the Australian specialist AOD workforce. The findings presented here focus on work stress and job satisfaction and their association with turnover intention. The results indicate cause for concern and have important implications for the development of strategies to minimize turnover and improve the well-being of specialist AOD workers in Australia.

Fernandez E; Fu M; Pascual JA; Lopez MJ; Perez-Rios M; Schiaffino A et al. Impact of the Spanish smoking law on exposure to second-hand smoke and respiratory health in hospitality workers: A cohort study. PLoS one 4(1): e-4244, 2009. (68 refs.)

Background: A smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban. Methods and Finding: We formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p < 0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p < 0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned. Conclusions: Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health.

Galvan FH; Ortiz DJ; Martinez V; Bing EG. The use of female commercial sex workers' services by Latino day laborers. Hispanic Journal of Behavioral Sciences 31(4): 553-575, 2009. (44 refs.)

This article reports the characteristics of Latino day laborers who have sex with female commercial sex workers (CSWs). A sample of 450 day laborers in Los Angeles was used. Multivariate logistic regression was used to determine the association of independent variables with the likelihood of having sex with a CSW. Overall, 26% of the 450 day laborers reported having had sex with a CSW in the previous 12 months. A lower likelihood of having sex with a CSW was found for those with more than 6 years of education and for those who were married and living with their spouses. A higher likelihood of having sex with a CSW was found for those who met the criteria for harmful drinking or drug dependence. Commercial sex work has been associated with sexually transmitted infections and other problems among clients of CSWs and warrants further attention by providers working with day laborers.

Gray MK. Problem behaviors of students pursuing policing careers. Policing 34(3): 541-552, 2011. (27 refs.)

Purpose - The current study aims to examine problematic behaviors of college students who identified policing as their career of choice. Design/methodology/approach - A self-report survey was administered and behaviors such as alcohol and drug use, arrest histories, and self-reported criminality were identified in a sample of 874 undergraduate students, 171 of whom identified policing as their career goal. Findings - Findings indicate that over 60 percent of students (including those interested in becoming police officers) engage in some level of problematic behavior. While policing students engaged in more excessive recent binge drinking, they had a lower rate of arrests and less other-than-marijuana drug use than other students. Research limitations/implications - This research relies on self-reported data and therefore under- or over-reporting may occur. While the sample of policing students has similar characteristics to those of current police officers in terms of sex and race, generalizability issues from the entire sample may be present. Practical implications - Findings suggest the importance of identifying and conveying information to students about problematic behaviors that may prohibit gainful employment. Recruitment implications are discussed for police departments as well as implications for areas of inquiry important for background hiring investigations. Originality/value - The current research explores problematic behaviors of college students in the context of vocational restrictions that students may face from law enforcement agencies. Findings can better prepare students for such vocations and inform hiring agencies of the range of issues from this population of applicants.

Haddock CK; Jitnarin N; Poston WSC; Tuley B; Jahnke SA. Tobacco use among firefighters in the central United States. American Journal of Industrial Medicine 54(9, special isssue): 697-706, 2011. (50 refs.)

Background: This study provides a comprehensive, population-based examination of tobacco use among both career and volunteer firefighters. Methods Data are from a population-based cohort study of randomly selected career (N = 11) and volunteer (N = 13) departments comprised of 677 male firefighters. Results: Unadjusted rates of smoking were 13.6% and 17.4% for career and volunteer firefighters, respectively. Smoking rates were less than a comparable occupational group (military personnel) and adult males in the states represented. Smokers were more likely to have been diagnosed with an anxiety disorder (OR = 5.8; P = 0.010), have an elevated CAGE alcohol problem score (OR = 2.9; P = 0.040), and more likely to report driving after drinking too much (OR = 4.5; P = 0.020) compared to never-smokers. Large percentages of career (18.4%) and volunteer (16.8%) firefighters used smokeless tobacco. Conclusions: Smoking among firefighters is associated with other significant health and safety risks. High rates of smokeless tobacco use suggest that the fire service is an important target for intervention. Thus, despite strong statements against smoking by the fire service, the need to maintain high levels of health and fitness and relatively low smoking rates, a significant proportion of firefighters continue to use tobacco products.

Hart CL; Smith GD; Gruer L; Watt GCM. The combined effect of smoking tobacco and drinking alcohol on cause-specific mortality: A 30 year cohort study. BMC Public Health 10: e-article 789, 2010. (27 refs.)

Background: Smoking and consuming alcohol are both related to increased mortality risk. Their combined effects on cause-specific mortality were investigated in a prospective cohort study. Methods: Participants were 5771 men aged 35-64, recruited during 1970-73 from various workplaces in Scotland. Data were obtained from a questionnaire and a screening examination. Causes of death were all cause, coronary heart disease (CHD), stroke, alcohol-related, respiratory and smoking-related cancer. Participants were divided into nine groups according to their smoking status (never, ex or current) and reported weekly drinking (none, 1-14 units and 15 or more). Cox proportional hazards models were used to obtain relative rates of mortality, adjusted for age and other risk factors. Results: In 30 years of follow-up, 3083 men (53.4%) died. Compared with never smokers who did not drink, men who both smoked and drank 15+ units/week had the highest all-cause mortality (relative rate = 2.71 (95% confidence interval 2.31-3.19)). Relative rates for CHD mortality were high for current smokers, with a possible protective effect of some alcohol consumption in never smokers. Stroke mortality increased with both smoking and alcohol consumption. Smoking affected respiratory mortality with little effect of alcohol. Adjusting for a wide range of confounders attenuated the relative rates but the effects of alcohol and smoking still remained. Premature mortality was particularly high in smokers who drank 15 or more units, with a quarter of the men not surviving to age 65. 30% of men with manual occupations both smoked and drank 15+ units/week compared with only 13% with non-manual ones. Conclusions: Smoking and drinking 15+ units/week was the riskiest behaviour for all causes of death.

Jansson C; Alderling M; Hogstedt C; Gustavsson P. Mortality among Swedish chimney sweeps (1952-2006): An extended cohort study. Occupational and Environmental Medicine 69(1): 41-47, 2012. (31 refs.)

Objectives We extended a cohort study of Swedish chimney sweeps and prolonged follow-up in order to increase power and study those first employed after 1950 when oil began to replace wood as a main fuel for heating in Sweden. Methods Male Swedish chimney sweeps who were members of the national trade union in 1981-2006 were identified (n=1087) and included to a previous cohort of those employed in 1918-1980 (n=5287). All employment histories were updated, and the total extended cohort (n=6374) was linked to the registers of Causes of Death and Total Population and followed for mortality from 1952 through 2006. Standardised mortality ratios (SMRs) were estimated using the Swedish male population as reference. Results 1841 observed deaths resulted in an SMR for all causes of deaths of 1.29 (95% CI 1.24 to 1.36). Mortality was significantly increased for all malignant tumours, oesophageal cancer, bowel cancer, liver cancer, lung cancer, alcoholism, ischaemic heart disease, non-malignant respiratory diseases, liver cirrhosis, external causes and suicides. The lung cancer SMR remained increased, although attenuated, after adjustment for group-level smoking data, SMR of 1.52 (95% CI 1.26 to 1.89). Duration of employment showed no consistent evidence of dose-response associations. Alcohol-related deaths (liver cirrhosis and alcoholism) were not increased among those employed >30 years. Mortality among those employed after 1950 was similar to that of the entire cohort. Conclusions Chimney sweeps are exposed to high levels of toxic substances in the occupation, but excess alcohol and smoking habits were also observed, and the results must be interpreted cautiously. However, group-level data on tobacco smoking indicated that the lung cancer excess only to some extent could be explained by smoking habits, and the increased mortality from oesophageal cancer and ischaemic heart disease among chimney sweeps employed >30 years is less likely to be caused by excess alcohol habits.

Jensen JA; Schillo BA; Moilanen MM; Lindgren BR; Murphy S; Carmella S et al. Tobacco smoke exposure in nonsmoking hospitality workers before and after a state smoking ban. Cancer Epidemiology, Biomarkers & Prevention 19(4): 1016-1021, 2010. (43 refs.)

Secondhand smoke exposure is estimated to account for 3,000 cancer deaths per year. Although several countries and states in the United States have passed comprehensive smoke-free laws to protect all employees, a significant number of workers are still not protected. The purpose of this study was to determine the effects of passing a comprehensive smoking ban that included bars and restaurants on biomarkers of nicotine and carcinogen exposure. The urines of nonsmoking employees (n = 24) of bars and restaurants that allowed smoking before the smoke-free law were analyzed before and after the law was passed in Minnesota. The results showed significant reductions in both total cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (free plus glucuronidated) after the ban was instituted. These results provide further support for the importance of protecting employees working in all venues.

Karlsson T; Stanfors M. In the footsteps of their fathers? Occupational following among Swedish tobacco workers. Continuity and Change 26( Part 1): 45- 68, 2011. (39 refs.)

This article explores the role of kinship in the Swedish tobacco industry of 1898, making use of rich data that cover the entire industry and include both men and women. The focus is on the role of families in labour recruitment, which is often claimed to have been important. In this case, however, it was not the norm to have a father in the same industry. Occupational following was clearly a gendered phenomenon. To follow in the footsteps of fathers was more common among young men than among other groups of workers, and occupational following was associated with higher earnings for male but not for female workers.

Kieling RR; Szobot CM; Matte B; Coelho RS; Kieling C; Pechansky F et al. Mental disorders and delivery motorcycle drivers (motoboys): A dangerous association. European Psychiatry 26(1): 23-27, 2011. (32 refs.)

Objective. - Low and middle-income countries experience an expressive growth in the number of circulating motorcycles, paralleled by an increasing number of traffic accidents. Delivery motorcycles drivers ("motoboys") are generally perceived as accountable for this scenario. Although traffic accidents have a multivariate etiology, mental disorders, such as substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD), are often involved. This paper aims at investigating the prevalence of ADHD, SUD and other mental disorders in a sample of Brazilian motoboys, and additionally, to evaluate the association between psychiatric diagnoses, motorcycle accidents and traffic violation tickets. Method. - A convenient sample of subjects was invited to participate in a cross-sectional assessment including an inventory of traffic accidents and violations. Psychiatric diagnoses were based on semi-structured and clinical interviews. Results. - A sample of 101 motoboys was assessed. Overall, 75% of subjects had a positive lifetime history of at least one psychiatric disorder. SUD was the most frequent diagnosis (43.6% for alcohol, 39.6% for cannabis). ADHD was associated with a higher number of traffic accidents (p = 0.002), and antisocial personality disorder (APD) was associated with a greater number of traffic violations (p = 0.007). Conclusions. - The prevalence of mental disorders was much higher in our sample than in the general population. ADHD and APD, but not SUD, were associated with negative traffic outcomes. These findings have implications for public mental health planning since mental disorders can be both prevented and treated, improving driving behavior and increasing road safety.

Launay M; Le Faou AL; Sevilla-Dedieu C; Pitrou I; Gilbert F; Kovess-Masfety V. Prevalence of tobacco smoking in teachers following anti-smoking policies: Results from two French surveys (1999 and 2005). European Journal of Public Health 20(2): 151-156, 2010. (34 refs.)

Background: French public health policies aimed at reducing smoking were reinforced in France between 1999 and 2004 to decrease tobacco consumption. The consequences of these policies are of particular interest to teachers who play a role model for young people. Depression and alcohol problems were particularly studied as they may influence smoking behaviour. Methods: Two large cross-sectional health surveys conducted in 1999 (N = 2931) and 2005 (N = 3702) included teachers, aged 20-59 years. Smoking status, socio-demographic characteristics, history of depressive episode in the previous year and problems with alcohol were collected using self-administered postal questionnaires. Results: From 1999 to 2005, the prevalence of smoking decreased significantly from 25.7 to 18.2% for men (P < 0.001), from 20.0 to 16.5% (P < 0.001) for women; and the proportion of never-smokers increased. In smokers, the number of cigarettes consumed per day decreased significantly. Multivariate analysis revealed a significant decrease of the risk of being a smoker in 2005 compared with 1999 [odds ratio (OR) = 0.68 for men; OR = 0.78 for women]. Risk factors of smoking were: men aged 20-34 years (OR = 1.81), CAGE score >= 2, (OR = 1.95 for men, 2.12 for women) history of a major depressive episode in the previous 12 months (OR = 1.46 for men, 1.44 for women). Conclusion: Anti-smoking policies resulted in a decrease of teachers' tobacco consumption between 1999 and 2005. However, people with more difficulties in quitting smoking, in particular people with depressive episodes or problems with alcohol, might benefit from comprehensive programmes, including training of health professionals.

Lisa B; Lyndal B; Elias IJ. Heavy vehicle driver fatalities: Learning's from fatal road crash investigations in Victoria. Accident Analysis and Prevention 41(3): 557-564, 2009. (34 refs.)

This study describes the nature and extent of fatal heavy vehicle driver crashes in Victoria between 1999 and 2007 and the factors associated with the crash. A descriptive study was conducted comprising the population of heavy vehicle drivers killed in a road transport crash while operating a vehicle of >= 4.5 tonne Gross Vehicle Mass (GVM) for the purposes of work. Information about the nature of crash, environmental, driver, vehicle and occupational factors were collected from the coroner's death investigation file. Of the 91 deaths identified 61 were eligible for review. All 61 cases were male, solo drivers with a mean age of 44.7 years. Most vehicles were articulated in configuration. One-third of crash scenarios involved a single vehicle leaving the roadway on a straight road. One in every six fatally injured drivers was detected with the presence of stimulants or cannabis. Twenty-two drivers were travelling at excessive or inappropriate speeds for the circumstances. Seatbelt wearing status was documented for only 25 of 61 drivers. This study is the first to comprehensively examine a population of fatally injured heavy vehicle drivers using coroner's investigation files and these findings are consistent with previous, less detailed, Australian research. Information about potential associations between occupational factors and crash risk was limited. Improving driver safety requires incorporation of occupational factors into a standardised approach to heavy vehicle crash investigations.

Lu SQ; Fielding R; Psychology C; Hedley AJ; Wong LC; Lai HK et al. Secondhand smoke (SHS) sxposures: Workplace exposures, related perceptions of SHS risk, and reactions to smoking in catering workers in smoking and nonsmoking premises. Nicotine & Tobacco Research 13(5): 344- 352, 2011. (34 refs.)

Introduction: Smoke-free workplace legislation often exempts certain venues. Do smoking (exempted) and nonsmoking (nonexempted) catering premises' workers in Hong Kong report different perceptions of risk from and reactions to nearby smoking as well as actual exposure to secondhand smoke (SHS)? Methods: In a cross-sectional survey of 204 nonsmoking catering workers, those from 67 premises where smoking is allowed were compared with workers from 36 nonsmoking premises in Hong Kong on measures of perceptions of risk and behavioral responses to self-reported SHS exposure, plus independent exposure assessment using urinary cotinine. Results: Self-reported workplace SHS exposure prevalence was 57% (95% CI = 49%-65%) in premises prohibiting and 100% (95% CI = 92%-100%) in premises permitting smoking (p < .001). Workers in smoking-permitted premises perceived workplace air quality as poorer (odds ratio [OR] = 9.3, 95% CI = 4.2-20.9) with higher associated risks (OR = 3.7, 95% CI = 1.6-8.6) than workers in smoking-prohibited premises. Workers in smoking-prohibited premises were more bothered by (OR = 0.2, 95% CI = 0.1-0.5) and took more protective action to avoid SHS (OR = 0.2, 95% CI = 0.1-0.4) than workers in smoking-permitted premises. Nonwork exposure was negatively associated with being always bothered by nearby smoking (OR = 0.3, 95% CI = 0.1-0.9), discouraging nearby smoking (OR = 0.5, 95% CI = 0.2-1.1), and discouraging home smoking (OR = 0.4, 95% CI = 0.2-0.9). Urinary cotinine levels were inversely related to workers' avoidance behavior but positively related to their perceived exposure-related risks. Conclusions: Different workplace smoking restrictions predicted actual SHS exposure, exposure-related risk perception, and protective behaviors. Workers from smoking-permitted premises perceived greater SHS exposure-related risks but were more tolerant of these than workers in smoking-prohibited premises. This tolerance might indirectly increase both work and nonwork exposures.

Marchand A; Parent-Lamarche A; Blanc ME. Work and high-risk alcohol consumption in the Canadian workforce. International Journal of Environmental Research and Public Health 8(7): 2692-2705, 2011. (65 refs.)

This study examined the associations between occupational groups; work-organization conditions based on task design; demands, social relations, and gratifications; and weekly high-risk alcohol consumption among Canadian workers. A secondary data analysis was performed on Cycle 2.1 of the Canadian Community Health Survey conducted by Statistics Canada in 2003. The sample consisted of 76,136 employees 15 years of age and older nested in 2,451 neighbourhoods. High-risk alcohol consumption is defined in accordance with Canadian guidelines for weekly low-risk alcohol consumption. The prevalence of weekly high-risk alcohol consumption is estimated to be 8.1% among workers. The results obtained using multilevel logistic regression analysis suggest that increased work hours and job insecurity are associated with elevated odds of high-risk alcohol consumption. Gender female, older age, being in couple and living with children associated with lower odds of high-risk drinking, while increased education, smoking, physical activities, and, and economic status were associated with higher odds. High-risk drinking varied between neighbourhoods, and gender moderates the contribution of physical demands. The results suggest that work made a limited contribution and non-work factors a greater contribution to weekly high-risk alcohol consumption. Limits and implications of these results are discussed.

Martinez-Sanchez JM; Fernandez E; Fu M; Perez-Rios M; Lopez MJ; Ariza C et al. Impact of the Spanish smoking law in smoker hospitality workers. Nicotine & Tobacco Research 11(9): 1099-1106, 2009. (42 refs.)

A smoke-free law went into effect in Spain on 1 January 2006, affecting all enclosed workplaces except hospitality venues, where only partial bans were implemented. The objective was to evaluate the impact of the law among hospitality workers who smoke. The study design is a before-and-after evaluation. We formed a cohort at baseline, during the 3 months before the law went into effect, with 431 hospitality workers (222 smokers). From them, 288 were successfully followed-up 12 months after the ban (118 were smokers at baseline). We analyzed the quit rate, the reduction in the number of cigarettes smoked per day, changes in the Fagerstrom Test for Nicotine Dependence (FTND) scores, and changes in salivary cotinine concentrations in smokers from baseline to 1 year after the ban. Among 118 smokers, six (5.1%) quit smoking. Among the 112 remaining smokers, the mean number of cigarettes smoked decreased by 8.9% after the ban (from 17.9 to 16.3 cigarettes/day, p < .01). The proportion of workers with a high nicotine dependence (FTND score > 6) was reduced by half after the ban (19.5% vs. 9.7%, p = .03). Salivary cotinine decreased by 4.4% after the ban (geometric mean 104.3 vs. 99.7 ng/ml, p = .02). No meaningful differences were found in quit rates and the FTND scores according to type of regulation. The Spanish smoking law has had beneficial effects (reduction in number of cigarettes smoked, cotinine levels, and FTND score) among hospitality workers who smoke.

Minov J; Karadzinska-Bislimovska J; Vasilevska K; Risteska-Kuc S; Stoleski S. Effects of passive smoking at work on respiratory symptoms, lung function, and bronchial responsiveness in never-smoking office cleaning women. Arhiv Za Higijenu Rada I Toksikologiju 60(3): 327-334, 2009. (38 refs.)

This cross-sectional study compares respiratory symptoms, lung function, and bronchial responsiveness between 27 office cleaning women exposed to environmental tobacco smoke at work and 57 unexposed controls. The age range of both groups was 24 to 56 years, and none of the women had ever smoked. Information on respiratory symptoms, cleaning work history, and passive smoking in the workplace were obtained with a questionnaire. The subjects also took a skin prick test to common inhalant allergens, a lung function test, and a histamine challenge. Despite smoking restriction in indoor environments, we found a high prevalence of passive smokers in the workplace (32.1%). In these subjects we found a significantly higher prevalence of wheezing with breathlessness (25.9% vs. 8.8%; P=0.036), wheezing without cold (25.9% vs. 7.0%; P=0.016), and breathlessness after effort (29.6% vs. 8.8%;P=0.014) than in control subjects. Objective measurements showed a significantly lower MEF25 (53.6% vs. 63.7%; P=0.001) and a significantly higher prevalence of borderline bronchial hyperresponsiveness (22.2% vs. 7.0%; P=0.044) in the passive smokers in the workplace. This study provides evidence of adverse respiratory effects in office cleaning women associated with passive smoking in the workplace. Our findings support a stricter implementation of the current national law to protect respiratory health of all workers.

Moore RF. The interaction between the Americans with Disabilities Act and drug and alcohol addiction in sports. Sports Lawyers Journal 16(Spring): 231-254, 2009. (193 refs.)

Summary: ... Unlike Thurman's case, Cox's was more like the Rickey Higgins' case than it was the Roy Tarpley case because both Higgins and Cox were not disputing the fact that they recently used the substance that they were suspended for using. ... Case law further establishes that a physical impairment alone is not sufficient to establish discrimination; the impairment must substantially limit one or more of a person's major life activities. ... NFL Policy The National Football League (NFL) policy and program for substances of abuse states that the use of illegal drugs and the abuse of prescription drugs, over-the-counter drugs, and alcohol are prohibited for players in the NFL. ... The only argument against these policies appears to be that after a long-term suspension in most leagues, the commissioner is the sole decision maker responsible for deciding whether or not to reinstate a player. ... Professional sports leagues may need to consider adding a provision that specifically allows for arbitration on the issue of reinstatement for athletes with addiction-related issues. ... Based on these facts, Tarpley claims that he has been discriminated against on the basis of his disability as a recovering drug and alcohol abuser.

Morita I; Sheiham A; Nakagaki H; Yoshii S; Mizuno K; Sabbah W. Is there a relationship between periodontal disease and smoking after adjusting for job classification in Japanese employed males? Oral Health & Preventive Dentistry 9(1): 83-89, 2011. (26 refs.)

Objectives: The objective of this study is to examine whether the well-known association between periodontal disease and smoking persists after adjusting for job classification. Methods: A sample of 16,110 employed Japanese males aged 20-69 years was included in the study. Periodontal examinations were conducted using the Community Periodontal Index. The association between periodontal disease and smoking status was examined using logistic regression adjusting for age, diabetes and job classification. Job classification was based on criteria of the Japanese Ministry of Health, Labour and Welfare. There are nine major job groups: (1) Professional (professionals, specialists), (2) Managers, (3) Office workers (computer operators, clerks, secretaries), (4) Skilled worker (factory workers, construction workers), (5) Salespersons (shop assistants), (6) Service occupations (superintendents, cleaners or car park attendants), (7) Security (guards), (8) Farmers and fishermen, (9) Transport and telecommunication workers (truck drivers). Results: Current and former smokers were more likely to have periodontal disease than non-smokers. Adjusting for job classification attenuated the association between smoking and periodontal disease but did not eliminate the association. The odds ratios for the association between smoking and Community Periodontal Index score 3 or 4 attenuated from 2.25 to 2.04 and from 2.62 to 2.52 for individuals aged 20 to 39 and 40 to 69 years, respectively. The effect of job classification on the association between periodontal disease and smoking was higher among younger participants aged 20 to 39 years. Conclusions: Smoking persisted as an important determinant of periodontal disease after adjusting for job classification in Japanese employed males.

Narenjiha H; Rafiey H; Jahani MR; Assari S; Moharamzad Y; Roshanpazooh M. Substance-dependent professional drivers in Iran: A descriptive study. Traffic Injury Prevention 10(3): 227-230, 2009. (18 refs.)

Objective: To determine characteristics of a nationwide sample of Iranian dependent drug users whose main profession is driving. Methods: Data were derived from a larger study, which aimed to describe pattern of drug dependency in Iran. A driver was defined as a person whose main profession was driving a motor vehicle to earn a living. Nine hundred twenty individuals were interviewed by a trained drug abuse team in all provinces of Iran during a 5-month period, from April to August 2007. Socioeconomic characteristics, substance abused, and high-risk behaviors were collected by a checklist. Results: All drivers were male and their mean ( standard deviation) age was 35.1 ( 8.6) years. Opioids (434 cases, 46.8%) and kerack (256 cases, 27.6%) were the two most common drugs used. Except for buprenorphine, which was used via intravenous injection, inhalation was the dominant method of us in other substances including opioids (56%), heroin (51.4%), kerack (80.1%), methamphetamine (73.9%), and cannabis (77.8%). Extramarital sexual relationships (414 cases, 45%) and nonfatal intoxication (362 cases, 39.3%) were the two most frequent high-risk behaviors. Conclusions: There are people with drug dependencies who drive for living in Iran. Deterrence programs through screening and random drug testing at police stations and legislation regarding charges of drugged drivers and prohibition from driving for long time periods are essential priorities in traffic safety.

Nebot M; Lopez MJ; Ariza C; Perez-Rios M; Fu M; Schiaffino A et al. Impact of the Spanish smoking law on exposure to secondhand smoke in offices and hospitality venues: Before-and-after study. Environmental Health Perspectives 117(3): 344-347, 2009. (38 refs.)

BACKGROUND/OBJECTIVES: A smoking law was passed by the Spanish Parliament in December 2005 and was enforced by 1 January 2006. The law bans smoking in all indoor workplaces but only in some hospitality venues, because owners are allowed to establish a smoking zone (venues > 100 1132) or to allow smoking without restrictions (venues < 100 m(2)). The objective of the study is to assess the impact of the Spanish smoking law on exposure to secondhand smoke (SHS) in enclosed workplaces, including hospitality venues. MATERIALS AND METHODS: The study design is a before-and-after evaluation. We studied workplaces and hospitality venues from eight different regions of Spain. We took repeated samples of vapor-phase nicotine concentration in 398 premises, including private offices (162), public administration offices (90), university premises (43), bars and restaurants (79), and discotheques and pubs (24). RESULTS: In the follow-up period, SHS levels were markedly reduced in indoor offices. The median decrease in nicotine concentration ranged from 60.0% in public premises to 97.4% in private areas. Nicotine concentrations were also markedly reduced in bars and restaurants that became smoke-free (96.7%) and in the no-smoking zones of venues with separate spaces for smokers (88.9%). We found no significant changes in smoking zones or in premises allowing smoking, including discotheques and pubs. CONCLUSIONS: Overall, this study shows the positive impact of the law on reducing SHS in indoor workplaces. However, SHS was substantially reduced only in bars and restaurants that became smoke-free. Most hospitality workers continue to be exposed to very high levels of SHS. Therefore, a 100% smoke-free policy for all hospitality venues is required.

Public Domain

Nordfjaern T. Relapse patterns among patients with substance use disorders. Journal of Substance Use 16(4): 313-329, 2011. (38 refs.)

The aim of the study was to examine the time interval from treatment to relapse among patients with substance addiction. Some of the risk factors related to this interval were investigated. The sample (n = 352) was recruited from 16 substance addiction treatment facilities in four Norwegian counties. The respondents replied to a questionnaire either at waiting lists, when starting treatment, upon treatment completion or 3-12 months after treatment. Among these respondents, 160 patients had experienced a relapse after their prior treatment. Cox regression models showed that the relapse risk peaked during the first months after treatment. Older and employed patients had lower probabilities of early relapses. Patients who had an addiction pattern dominated by stimulants or cannabis had lower probabilities of early relapses compared with those who used opiates or alcohol. Inpatient treatment of short and long durability was associated with a longer time interval from treatment to relapse. Aftercare should be intensified during the first months after treatment. Treatment follow-up should be individually differentiated and target patients with higher risk of relapse. Interventions could aim to target adolescents and facilitate occupational activities for the patients before they leave the facilities.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Cigarette Use among Adults Employed Full Time, by Occupational Category. (September 24, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (1 refs.)

Highlights: Based on data from 2006 to 2008, an estimated 33.6 million full-time employees aged 18 to 64 smoked cigarettes in the past month. Of the 22 major occupational categories, the highest rates of past month cigarette use among full-time workers aged 18 to 64 were found in the food preparation and serving-related occupations (44.7%) and the construction and extraction occupations (42.9%); the occupational categories with the lowest rates were the education, training, and library occupations (12.3%) and the life, physical, and social science occupations (15.4%). Among full-time employees, the rate of past month cigarette use was higher among those aged 18 to 25 (40.1%) than among those in older age groups. Among those aged 18 to 25, rates were especially high in the construction and extraction occupations (51.6%); the installation, maintenance, and repair occupations (50.3%); and the food preparation and serving-related occupations (50.2%). The lowest rates, across all age categories, are among the educational and library professions.

Public Domain

Oladehinde MK; Adegbehingbe BO; Adeoye AO; Onakoya AO. Central nervous system stimulants: Effect on visual functions and occurrence of road traffic accidents. Annali Italiani di Chirurgia 80(1): 43-48, 2009. (26 refs.)

OBJECTIVE: To determine the influence of the use of central nervous system (CNS) stimulants on visual functions and occurrence of road traffic accidents (RTA) amongst commercial drivers. DESIGN: A cross-sectional study in which two hundred and fifteen consecutive drivers were interviewed and their eyes examined. SETTINGS: Ife Central Local Government Area (LGA) of Osun State, Nigeria. MATERIALS AND METHODS: Out of the estimated 270 commercial drivers registered in the four major parks of the LGA, 215 consecutive drivers participated in the survey. Questionnaires were administered by face-to-face interview and the drivers' eyes examined by the authors. RESULTS: The prevalence of visual impairment (visual acuity < 6118) in the better eye without correction was 3.3%, and there was a significant association between uncorrected visual acuity impairment in the better eye and RTA (p 0.0152). The prevalence of refractive error was 8.4%, but none of these drivers wear corrective glasses. Alcohol consumption is common (57.7%) amongst the drivers, and there was a significant association between alcohol consumption and RTA (p = 0.00124). There was also a significant association between the use of CNS stimulants (kolanut, marijuana and cigarette) and RTA (p = 0.005). CONCLUSION: It was therefore concluded that visual impairment in the better eye, alcohol consumption and the use of other CNS affecting substances contribute to the occurrence of RTA among the drivers.

Padilla MB; Guilamo-Ramos V; Godbole R. A syndemic analysis of alcohol use and sexual risk behavior among tourism employees in Sosua, Dominican Republic. Qualitative Health Research 22(1, special issue): 89-102, 2012. (57 refs.)

The Dominican Republic has high rates of HIV infection and alcohol consumption. Unfortunately, little research has been focused on the broader sources of the synergy between these two health outcomes. We draw on syndemic theory to argue that alcohol consumption and sexual risk behavior are best analyzed within the context of culture and economy in Caribbean tourism spaces, which produce a synergy between apparently independent outcomes. We sampled 32 men and women working in the tourism industry at alcohol-serving establishments in SosAa, Dominican Republic. Interviewees described alcohol consumption as an implicit requirement of tourism work, tourism industry business practices that foster alcohol consumption, and an intertwining relationship between alcohol and sexual commerce. The need to establish relationships with tourists, combined with the overconsumption of alcohol, contributed to a perceived loss of sexual control, which participants felt could impede condom use. Interventions should incorporate knowledge of the social context of tourism areas to mitigate the contextual factors that contribute to HIV infection and alcohol consumption among locals.

Panasiuk L; Mierzecki A; Wdowiak L; Paprzycki P; Lukas W; Godycki-Cwirko M. Prevalence of cigarette smoking among adult population in eastern Poland. Annals of Agricultural and Environmental Medicine 17(1): 133-138, 2010. (36 refs.)

Cigarette smoking is the strongest modifiable factor, which shortens the life span and deteriorates the quality of life. It increases the risk of development of cancer, cardiovascular and respiratory system diseases. The objective of the study was evaluation of the prevalence of cigarette smoking among the adult population of the Lublin Region, and investigation of the relationship between nicotinism and respondents' place of residence, and other selected socio-economic factors. Data concerning the cigarette smoking habit was obtained from 3,993 people - 2,447 females and 1,546 males; 23.0% of respondents in the study were smokers - 35.6% of males and 15.1% of females. The percentage of male smokers was similar in rural and urban areas. Urban females were smokers more often than those living in rural areas. A decrease was noted in the difference which has been observed to-date between the percentage of urban and rural female smokers. The highest percentage of smokers occurred among the population aged 41-50, while the lowest - among the youngest and the oldest respondents. The percentage of smoking farmers was lower than that of respondents performing non-agricultural occupations, also among rural inhabitants. Those who were occupationally active were smokers more frequently than those not engaged in occupational activity. The lowest percentage of smokers was noted among respondents who had the highest education level, while the highest percentage was observed among those who had vocational education.

Pearson J; Windsor R; El-Mohandes A; Perry DC. Evaluation of the immediate impact of the Washington, DC, smoke-free indoor air policy on bar employee environmental tobacco smoke exposure. Public Health Reports 124(Supplement 1): 135-142, 2009. (32 refs.)

Objective. On January 2, 2007, the Washington, D.C., City Council banned smoking in restaurants and bars. We sought to determine the immediate impact of the ban on cotinine-confirmed environmental tobacco smoke (ETS) levels and respiratory symptom reports of a random sample of bar employees. Methods. We conducted an assessment of 66 employees from 41 randomly selected bars in December 2006, a month before the ban went into effect. After analyses of baseline data, 52 employees were eligible and 49 of them (94%) had a post-ban assessment in February 2007. Three participants were excluded due to high cotinine levels at the post-ban assessment, yielding a final sample size of 46 bar employees. ETS exposure levels were documented using saliva cotinine analyses by tandem liquid chromatography and mass spectrometry. Employee respiratory and sensory symptoms reports were assessed by a standardized, validated form: the International Union Against Tuberculosis and Lung Disease Bronchial Symptoms Questionnaire. Employee ETS exposure reports at work were eliminated after the ban. Results. Sensory symptoms reports (at <= 4 weeks) declined significantly by 70% to 100% (p=0.0016); respiratory symptoms results were inconclusive due to a lack of data. Saliva cotinine medians declined significantly by 70% (p<0.0001), from a pre-ban mean of 2.11 nanograms per millileter (ng/mL) to a post-ban mean of 0.29 ng/mL, confirming reports of no ETS exposure at work. Conclusion. We concluded that the indoor air law was effective, eliminating employee ETS exposure reports, dramatically reducing their cotinine levels, and almost eliminating reports of sensory symptoms.

Perdikaris P; Kletsiou E; Gymnopoulou E; Matziou V. The relationship between workplace, job stress and nurses' tobacco use: A review of the literature. International Journal of Environmental Research and Public Health 7(5): 2362-2375, 2010. (44 refs.)

The aim of this study was to provide a summary of the existing published knowledge on the possible relationship between the workplace as a stressor factor and nurses' tobacco use. A systematic review of the literature from 1995 to 2009, using the MEDLINE database took place. Studies, that referred to nurses' smoking habit exclusively or as a part of the study, were included in the review. 491 studies were retrieved and their titles/abstracts were examined systematically. Twenty one studies were retrieved for further consideration by a comprehensive literature review. Ten studies fulfilled the eligibility criteria and they were examined further. There is a conflict on the possible relationship between workplace as a stressor factor and nurses' smoking habits, because there is no evidence on if the nurses' work environment causes smoking initiation.

Pidd K; Roche AM; Buisman-Pijlman F. Intoxicated workers: Findings from a national Australian survey. Addiction 106(9): 1623-1633, 2011. (46 refs.)

Aims: To identify prevalence of alcohol and drug use and intoxication at work. Participants: A total of 9828 Australian workers >= 14 years old. Setting Australia 2007. Measurements Work-place alcohol use and drug use, intoxication at work, industry and occupation of employment. Design Secondary analysis of a large nationally representative survey involving descriptive and weighted multivariate logistic regressions. Findings Differential patterns were identified by drug type, worker characteristics and occupational setting, controlling for demographic variables. Nearly 9% of workers surveyed (8.7%) usually drank alcohol at work and 0.9% usually used drugs at work. Attending work under the influence of alcohol was more prevalent (5.6%) than attending work under the influence of drugs (2.0%), and significantly more likely among young, male, never married workers with no dependent children. Hospitality industry workers were 3.5 times more likely than other workers to drink alcohol and two to three times more likely to use drugs at work or attend work under the influence of alcohol or drugs. Other high-risk industries and occupations included construction, financial services, tradespersons and unskilled workers. Conclusion: More than one in 20 Australian workers admit to having worked under the influence of alcohol and almost one in 50 report attending work under the influence of psychoactive drugs. The rates are higher for some industries, such as the hospitality industry, than others.

Quintiliani L; Yang M; Sorensen G. A process evaluation of tobacco-related outcomes from a telephone and print-delivered intervention for motor freight workers. Addictive Behaviors 35(11): 1036-1039, 2010. (14 refs.)

Interventions are needed to address the high prevalence of tobacco use among blue-collar, motor freight workers in the United States. In the present study, we conducted an evaluation of the Gear Up for Health study to evaluate which intervention components associated with this print- and telephone counseling-based tobacco intervention were associated with affecting psychosocial indicators of future quitting, number of quit attempts, and quitting tobacco. The sample is comprised of 64 baseline tobacco users. The intervention components evaluated were receipt of nicotine replacement therapy (NRT), aspects of the counseling calls, the targeted and tailored print materials, and goal setting. The results indicated that several intervention components were related to tobacco cessation, and less frequently related to psychosocial indicators (i.e. intention and self-efficacy) and quit attempts. A higher percentage of those who quit using tobacco, versus not quitting, thought the number of calls were just right (100% vs. 75%), received NRT (87% vs. 56%), read most or all of the materials (100% vs. 70%), found the materials to be very helpful (87% vs. 30%), set tobacco goals (93% vs. 58%) and met these goals (100% vs. 44%) (p <= 0.05 for all). These results may be used in planning future interventions and indicated that perceptions of materials, call number, and call content may be more important than absolute call number or duration. Thus, the number and duration of counseling calls may be flexible and determined in response to the needs of participants.

Quintiliani LM; Stoddard AM; Ebbeling CB; Pereira LK; Sorensen G. Associations of diet behaviours and intention to eat healthily with tobacco use among motor freight workers. Public Health 123(8): 565-567, 2009. (10 refs.)

The article discusses a study on the relationship of diet behaviours and intention to eat healthily with tobacco use among workers in the motor freight sector. The study, which involved over-the road truck drivers, pick-up and delivery truck drivers, and dockworkers, aims determine whether tobacco users have poor healthy dietary behaviours and intention eat healthily as compared to non-smokers. Results show that smokers have lower intake of fruits and vegetables and are less motivated to eat healthily.

Rachiotis G; Karydis I; Drivas S; Hadjichristodoulou C. Pattern of smoking habit among Greek blue and white collar workers. International Journal of Environmental Research and Public Health 6(6): 1812-1817, 2009. (19 refs.)

The aim of our study was to investigate the prevalence of smoking in a Greek working population. A questionnaire regarding smoking habit was collected from 1,005 out of 1,200 blue and white-collar employees (response rate: 84%). The overall smoking prevalence was 48.4% and did not differ by sex, age, education, and occupation. The mean cigarette consumption per day was 25.54, with no difference observed by occupation. The above-mentioned findings, if confirmed by further research, are alarming and inconsistent with the prevalent pattern of smoking habits in the West.

Reijula JP; Reijula KE. The impact of Finnish tobacco legislation on restaurant workers' exposure to tobacco smoke at work. Scandinavian Journal of Public Health 38(7): 724-730, 2010. (25 refs.)

Aims: To evaluate the impact of Finnish tobacco legislation concerning restaurants, questionnaire surveys were carried out four times between 1999 and 2007. Their purpose was to assess the effects of the legislation on employees' exposure to tobacco smoke in bars and restaurants in Finland before the total prohibition of smoking. Methods: National questionnaire surveys on reported exposure to tobacco smoke among restaurant workers were conducted in 1999, 2001, 2003, and in the spring of 2007 just before the total smoking ban. Results: The data show that smoking is more common among restaurant workers than in the Finnish population in general. Reported exposure to tobacco smoke in bars and restaurants declined slowly after the launch of the renewed Tobacco Act. Between 1999 and 2007, it decreased from 73% to 43% among waiters who were exposed for over four hours per work shift and from 93% to 67% among bartenders. At the same time, non-exposed waiters increased from 15% to 39% and bartenders from 5% to 10%. The number of daily smoked cigarettes, however, remained the same among restaurant workers during the seven-year follow-up. Conclusions: We conclude that the reform of the Finnish tobacco legislation in 2000, which did not totally prohibit smoking in restaurants, decreased the exposure to environmental tobacco smoke but was not sufficiently effective in protecting restaurant workers from occupational exposure to tobacco smoke.

Renner JA; Karam-Hage M; Levinson M; Craig T; Eld B. What do psychiatric residents think of addiction psychiatry as a career? Academic Psychiatry 33(2): 139-142, 2009. (10 refs.)

Objective: The authors attempt to better understand the recent decline in the number of applicants to addiction psychiatry training. Methods: The Corresponding Committee on Training and Education in Addiction Psychiatry of APA's Council on Addiction Psychiatry sent out a 14-question anonymous e-mail survey to all postgraduate-year 2 (PGY-2) through PGY-4 APA Members-in-Training. The questions explored residents' beliefs and attitudes toward addiction psychiatry and sought their opinion on how training in addiction psychiatry can be made more attractive to them. Results: Of 2,511 eligible psychiatric residents surveyed nationally, 276 (10.6%) residents responded to the survey. Residents who responded had a generally positive impression of addiction psychiatrists but expressed much less favorable attitudes toward the practice of addiction psychiatry. Respondents provided three major subsets of suggestions: employment security and compensation, optimize PGY-1-4 addiction training, and fellowship training issues. Conclusion: These findings may be used to improve addiction psychiatry training and recruitment.

Rhodes SD; Bischoff WE; Burnell JM; Whalley LE; Walkup MP; Vallejos QM et al. HIV and sexually transmitted disease risk among male Hispanic/Latino migrant farmworkers in the southeast: findings from a pilot CBPR Study. American Journal of Industrial Medicine 53(10): 976-983, 2010. (39 refs.)

Background: Little is known about the HIV and sexually transmitted disease (STD) risk behaviors of Hispanic/Latino farmworkers. This study was designed to describe risk factors for HIV and STD infection, explore personal characteristics associated with condom use, and evaluate the feasibility of collecting self-report and biomarker data from farmworkers. Methods: Self-report and biomarker data were collected from a sample of male farmworkers living in 29 camps in North Carolina during the 2008 growing season. Results: Over half of the 100 male workers, mean age 37.1 (range 19-68) years, reported binge drinking during the past 12 months. Forty percent of those who reported having had sex during the past 3 months indicated that they were under the influence of alcohol. Knowledge of HIV and STD transmission and prevention was low. Among the 25 workers who reported having had sex during the past 3 months, 16 and 2 reported using a condom consistently during vaginal and anal sex, respectively, and nearly 1 out of 6 workers reported paying a woman to have sex. Two workers tested positive for syphilis. Conclusions: Farmworkers in this sample demonstrated significant HIV and STD risks; however, when exploring potential bivariate associations with consistent condom use no statistically significant associations were identified perhaps due to the small sample size. Because it was feasible to collect self-report and biomarker data related to HIV and STDs from Hispanic/Latino farmworkers, research needed to further explore risks and develop interventions to reduce disease exposure and transmission among this vulnerable population.

Schoenwald SK; Hoagwood KE; Atkins MS; Evans ME; Ringeisen H. Workforce development and the organization of work: The science we need. Administration and Policy in Mental Health and Mental Health Services Research 37(1-2, special issue): 71-80, 2010. (40 refs.)

The industrialization of health care, underway for several decades, offers instructive guidance and models for speeding access of children and families to clinically and cost effective preventive, treatment, and palliative interventions. This industrialization --i.e., the systematized production of goods or services in large-scale enterprises --has the potential to increase the value and effects of care for consumers, providers, and payers (Hayes and Gregg in Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. Academic Press, San Diego, 2001), and to generate efficiencies in care delivery, in part because workforce responsibilities become more functional and differentiated such that individuals with diverse educational and professional backgrounds can effectively execute substantive clinical roles (Rees in Clin Exp Dermatol, 33, 39-393, 2008). To date, however, the models suggested by this industrialization have not been applied to children's mental health services. A combination of policy, regulatory, fiscal, systemic, and organizational changes will be needed to fully penetrate the mental health and substance abuse service sectors. In addition, problems with the availability, preparation, functioning, and status of the mental health workforce decried for over a decade will need to be addressed if consumers and payers are to gain access to effective interventions irrespective of geographic location, ethnic background, or financial status. This paper suggests that critical knowledge gaps exist regarding (a) the knowledge, skills, and competencies of a workforce prepared to deliver effective interventions; (b) the efficient and effective organization of work; and (c) the development and replication of effective workforce training and support strategies to sustain effective services. Three sets of questions are identified for which evidence-based answers are needed. Suggestions are provided to inform the development of a scientific agenda to answer these questions.

Schoj V; Alderete M; Ruiz E; Hasdeu S; Linetzky B; Ferrante D. The impact of a 100% smoke-free law on the health of hospitality workers from the city of Neuquen, Argentina. Tobacco Control 19(2): 134-137, 2010. (31 refs.)

Objectives The objective of this study was to evaluate the impact of 100% smoke-free environment legislation on respiratory and sensory irritation symptoms and respiratory function among bar and restaurant workers from the city of Neuquen, Argentina. Methods: Pre-ban and post-ban studies without a comparison group in an Argentinean city were conducted. A baseline survey and spirometric measurements were performed with a total of 80 bar and restaurant workers 1 month before (October 2007) and 3 months after (March 2008) the implementation of the new 100% smoke-free legislation. Results: A significant reduction in secondhand smoke exposure was observed after the enactment and enforcement of the new legislation, and an important reduction in respiratory symptoms (from a pre-ban level of 57.5% to a post-ban level of only 28.8%). The reduction of sensory irritation symptoms was even higher. From 86.3% of workers who reported at least one sensory irritation symptom in October 2007, only 37.5% reported the same symptoms in March 2008. Also, data obtained by spirometry showed a significant forced vital capacity increase. Conclusions: Consistent with other studies, 100% smoke-free legislation improved short-term health outcomes in the sample and should be implemented nationwide. Furthermore, undertaking this study has been highly important in promoting 100% smoke-free environment legislation at the workplace as a legitimate right of hospitality workers, and in reducing social acceptance of designated smoking areas in bars and restaurants.

Sekulic D; Peric M; Rodek J. Substance use and misuse among professional ballet dancers. Substance Use & Misuse 45(9): 1420-1430, 2010. (21 refs.)

This study investigated substance use and misuse among 16 female and 9 male Croatian ballet professionals in 2008 using an original questionnaire. We analyzed social, personal, activity-and training-related, and educational factors, and criteria such as: binge alcohol drinking, cigarette smoking, appetite suppressant consumption, analgesic use, and actual and potential "doping" habits. Frequency tables and rank-order correlation were calculated. More than one third of the male dancers reported binge drinking, while 20% of the females smoked more than a box of cigarettes per day. Almost 25% of these dancers will use "doping" if it will ensure successful ballet performance, regardless of negative health consequences. In males, the risk of potential "doping" behavior increased with age. In females, education level was negatively related to cigarette smoking, but positively correlated to potential "doping" habits and behavior. In both genders, religiousness was the factor negatively related to the following: (1) potential "doping" behavior and (2) belief that "doping" exists in professional ballet. Results suggest that there is evident need for more specific medical and/or psychological services in professional ballet. The study's limitations are noted.

Sherman SG; Reuben J; Chapman CS; Lilleston P. Risks associated with crack cocaine smoking among exotic dancers in Baltimore, MD. Drug and Alcohol Dependence 114(2-3): 249- 252, 2011. (20 refs.)

Background: There is a dearth of research focusing on sex work in exotic dance clubs. We conducted a cross-sectional study to examine the prevalence and correlates of crack cocaine smoking among a sample of exotic dancers. Methods: The "block," a historical red-light district in downtown Baltimore, MD, is comprised of 30 adult-entertainment establishments. Between 01/09 and 08/09, we conducted a survey with exotic dancers (N = 98). The survey explored demographic, and drug and sexual/drug risk behaviors. Bivariate and multivariate analysis was conducted using Poisson regression with robust variance estimates to examine correlates of current crack smoking. Results: Crack cocaine smokers compared to non-crack cocaine smokers were significantly more likely to report: older age (29 vs. 23 years, respectively, p < 0.0001); being White (79% vs. 50%, respectively, p = 0.008); having been arrested (93% vs. 67%, respectively, p = 0.008); daily alcohol consumption (36% vs. 17%, p = 0.047); current heroin injection (57% vs. 13%, p < 0.001); and current sex exchange (79% vs. 30%, p < 0.001). In the presence of other variables, crack cocaine smokers compared to non-crack cocaine smokers were significantly older, more likely to report current heroin injection, and more likely to report current sex exchange. Discussion: We found high levels of drug use and sexual risk behaviors as well as a number of risks behaviors associated with crack cocaine smoking among this very under-studied population. Targeted interventions are greatly needed.

Smith D; Leggat PA; Speare R. The latest endangered species in Australia: A tobacco-smoking veterinarian18. Australian Veterinary Journal 88(9): 369-370, 2010. (18 refs.)

The results of a tobacco smoking survey conducted among veterinarians in Queensland, Australia, during 2007 are presented. Of the 567 participants only 3% reported being current smokers, 24% were ex-smokers and 73% had never smoked. The prevalence of smoking was similar among males and females, and the highest smoking rate was reported among veterinarians aged 31-40 years. However, the rate of never-smokers was strongly and negatively correlated with age, and the proportion of ex-smokers increased with age. Encouragingly, the results from this study suggest that tobacco use has all but disappeared from the Australian veterinary profession in recent years.

Stimmel B. Anesthesiologists and fentanyl: Fact or fancy? (editorial). Journal of Addictive Diseases 29(3): 279-279, 2010. (3 refs.)

Syamlal G; Mazurek JM; Malarcher AM. Current cigarette smoking prevalence among working adults-United States, 2004-2010 (Reprinted from MMWR, vol 60, pg 1305-1309, 2011). Journal of the American Medical Association 306(19): 2086-2091, 2011. (10 refs.)

Cigarette smoking is among the most important modifiable risk factors for adverse health outcomes and a major cause of morbidity and mortality. Current cigarette smoking prevalence among all adults aged �18 years has decreased 42.4% since 1965, but declines in current smoking prevalence have slowed during the past 5 years (declining from 20.9% in 2005 to 19.3% in 2010) and did not meet the Healthy People 2010 (HP2010) objective to reduce cigarette smoking among adults to �12% . Targeted workplace tobacco control interventions have been effective in reducing smoking prevalence and exposure to secondhand smoke; therefore, CDC analyzed National Health Interview Survey (NHIS) data for 2004--2010 to describe current cigarette smoking prevalence among currently working U.S. adults by industry and occupation. This report describes the results of that analysis, which found that, overall, age-adjusted cigarette smoking prevalence among working adults was 19.6% and was highest among those with less than a high school education (28.4%), those with no health insurance (28.6%), those living below the federal poverty level (27.7%), and those aged 18--24 years (23.8%). Substantial differences in smoking prevalence were observed across industry and occupation groups. By industry, age-adjusted cigarette smoking prevalence among working adults ranged from 9.7% in education services to 30.0% in mining; by occupation group, prevalence ranged from 8.7% in education, training, and library to 31.4% in construction and extraction. Although some progress has been made in reducing smoking prevalence among working adults, additional effective employer interventions need to be implemented, including health insurance coverage for cessation treatments, easily accessible help for those who want to quit, and smoke-free workplace policies.

Public Domain

Vinnikov D; Brimkulov N; Shahrir S; Breysse P; Navas-Acien A. Excessive exposure to secondhand tobacco smoke among hospitalitality workers in Kyrgyzstan. International Journal of Environmental Research and Public Health 7(3): 966-974, 2010. (18 refs.)

The aim of this study was to assess the levels of secondhand smoke (SHS) exposure of men and women in public places in Kyrgyzstan. This cross-sectional study involved 10 bars and restaurants in Bishkek the capital city of Kyrgyzstan. Smoking was allowed in all establishments. Median (interquartile range) air nicotine concentrations were 6.82 (2.89, 8.86) mu g/m(3). Employees were asked about their smoking history and exposure to SHS at work. Employees were exposed to SHS for mean (SD) 13.5 (3.6) hours a day and 5.8 (1.4) days a week. Women were exposed to more hours of SHS at work compared to men. Hospitalitality workers are exposed to excessive amounts of SHS from customers. Legislation to ban smoking in public places including bars and restaurants is urgently needed to protect workers and patrons from the harmful effects of SHS.

Wang LM; Wheeler K; Bai L; Stallones L; Dong YM; Ge J et al. Alcohol consumption and work-related injuries among farmers in Heilongjiang Province, People's Republic of China. American Journal of Industrial Medicine 53(8): 825-835, 2010. (35 refs.)

Background: Alcohol consumption has been found to be associated with work-related injuries among workers around the world, but this association has not well been studied among agricultural workers in China. Methods: This population-based survey aimed to study the association between alcohol use and work-related agricultural injury. Farmers in a northeastern province of China were questioned about work-related injury in the past year (May 2007 April 2008), alcohol use, farming practices, and sociodemographic factors. The Chi-square test and logistic regression analyses were used to investigate the role of alcohol drinking in agricultural injuries. Results: Among 2,050 farmers who completed the survey, the 12-month prevalence of work-related injury was 12.2%. The leading external cause of injury was exposure to mechanical force. The odds of injury among farmers with past month drinking, who drank distilled spirits, and reported intoxication were respectively 1.77 (95% CI = 1.27-2.47), 1.89 (95% CI = 1.35 2.66), 2.12 (95% CI = 1.42-3.11). The odds of injury also significantly increased with greater average amounts of pure alcohol per day, with increased frequency of drinking per week, and with greater reported years of drinking. Each alcohol use variable was associated with injury in logistic regression models while controlling for sex, age, years of farm work, months of farm work in the past 12 months, driving a motor vehicle, and agricultural machinery use. Conclusions: We found a significant association between alcohol consumption and work-related injuries among farmers. Our findings stress the need for culturally appropriate interventions which affect alcohol use and prevent injuries among Chinese farmers.

Yasmin S; Afroz B; Hyat B; D'Souza D. Occupational health hazards in women beedi rollers in Bihar, India. Bulletin of Environmental Contamination and Toxicology 85(1): 87-91, 2010. (41 refs.)

We studied the health problems of 197 female beedi rollers in Patna, Bihar, India to ascertain the effects of beedi rolling on health. The study found that more than 70% of the beedi rollers suffered from eye, gastrointestinal and nervous problems while more than 50% of the respondents suffered from respiratory problems, mostly throat burning and cough. More than 75% of the respondents faced osteological problems. Total RBC, WBC and platelet counts of the beedi rollers were significantly lower in comparison to the control subjects. Differential leucocyte count showed significantly risen lymphocytes and eosinophils and lowered neutrophils and monocytes in the beedi rollers as compared to the control group. Haemoglobin levels were lower among beedi rollers compared to the control group. SGPT (ALT) enzyme concentration, a parameter of liver dysfunction was significantly higher in the beedi rollers as compared to the control group. Thus, the study concluded that beedi rolling may cause significant health hazards.

Yildiz AN; Karadag O; Gonen MO; Gurel F; Ilhan B; Inel M et al. Knowledge and attitude of taxi drivers on the new legislation for smoke-free taxis: An occupational health perspective. Pakistan Journal of Medical Sciences 26(1): 111-116, 2010. (15 refs.)

Objective: Taxi drivers carry significant risks related to occupational health and safety. Exposure to second-hand tobacco smoke is known to be one of those health risks. As legislations for smoke-free taxis become more widespread throughout the world, this study aimed to assess knowledge and attitude of taxi drivers on the new legislation for tobacco control introduced in Turkey recently. Methodology: The study population consisted of 135 taxi drivers from 22 different taxi stations in Ankara Turkey. Data of the descriptive study was collected in October, 2008 through face-to-face interviews with a standart questionnaire. Descriptive statistics were used to summarize data, whereas chi-square was used to compare groups. Results: All the study participants were male with a mean age of 47.2+/-11.8 years. More than half of the taxi drivers (59.3%) were found to be current smokers. Although level of knowledge and attitude of taxi drivers on the new legislation were favorable in general, some difficulties and barriers were found to be present in implementation of the ban. Most of the smoking drivers were found to continue smoking in their taxis. About 80.0% of the drivers stated their concern of losing out on clients' satisfaction if they restrict smoking in their taxis. Conclusion: Taxi drivers and clients' knowledge, attitudes and behaviors are important determinants in successful implementation of legislations for smoke-free taxis.

Zhu JF; Tews MJ; Stafford K; George RT. Alcohol and illicit substance use in the food service industry: Assessing self-selection and job-related risk factors. Journal of Hospitality & Tourism Research 35(1): 45-63, 2011. (56 refs.)

The present study examines alcohol and illicit substance use in the food service industry with a generalizable national sample. Specifically, using the National Longitudinal Survey of Youth, this research examines whether previous substance use predicts employment in food service and assesses the impact of job-related factors including cumulative experience, occupational differences, compensation, shifts worked, and holding multiple jobs on substance use. The results demonstrate that a modest self-selection effect does exist and that bartenders, employees who receive tipped compensation, and those who hold multiple jobs engage in greater substance use. These findings are discussed along with implications for practitioners and opportunities for future research attention.