12121

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Published on December 11, 2007

Author: Garrick

Source: authorstream.com

SMOKING, OCCUPATION: EITHER, NONE, BOTH? :  SMOKING, OCCUPATION: EITHER, NONE, BOTH? Tee L. Guidotti Department of Environmental and Occupational Health School of Public Health and Health Services The George Washington University Medical Center A fundamental problem in occupational medicine is distinguishing between effects of smoking and effects of occupational exposure :  A fundamental problem in occupational medicine is distinguishing between effects of smoking and effects of occupational exposure cancer: lung, larynx, pancreas, bladder heart disease airways disease peripheral vascular disease Smoking and Occupation:  Smoking and Occupation confounding in occupational epidemiology rebuttal in presumptions (scheduled occupational diseases) individualizing risk profile confuses impairment (disability) assessment interactive effects wellness programs Many ways in which smoking and occupation may be trade-offs: :  Many ways in which smoking and occupation may be trade-offs: smoking may be related to job smoking may be related to SES smoking may be interactive with occupational exposure as causes smoking may contribute proportionately to impairment Smoking related to the job: :  Smoking related to the job: bartenders, sales, drivers socialization jobs of high intensity, concentration jobs with noxious odor delivery of toxic substances lead polymer fume fever Smoking related to SES: :  Smoking related to SES: smoking habit concentrated in lower SES, educational attainment higher prevalence of smoking more cigarettes consumed higher nicotine-content of cigarettes lower rate of cessation hazardous occupations concentrated in lower SES Smoking as a confounder: overrated :  Smoking as a confounder: overrated Example: A population with 40% smokers (x) SMR 200 = RR 2.0 = O/E O = 1(1-x) + 5 (x) , x = 1.25, or 125% E 1 (0.6) + 5(0.4) Conclusion: to double the risk as a result of confounding alone, there would have to be more smokers than there are workers. Smoking is known to be interactive with several occupational carcinogens. Best documentation::  Smoking is known to be interactive with several occupational carcinogens. Best documentation: asbestos radon daughters silica Smoking and apportionment: :  Smoking and apportionment: apportionment of causation - population-based - individual care - interaction apportionment of impairment

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