Because November traditionally features the Great American Smokeout Challenge, it provides a timely opportunity to review developments in the battle against tobacco-related illness.

Secondhand Smoke

In a study published in the August issue of the American Journal of Public Health, researchers found that carcinogen levels in nonsmokers who work in restaurants that allow smoking were significantly higher than those among employees in restaurants that did not allow smoking. They estimated that food service workers exposed to secondhand smoke have a 20 percent greater chance of contracting lung cancer than their unexposed peers.


If you’re a smoker and you’ve been thinking of quitting, November offers you the support of The Great American Smokeout Challenge, promoted annually by the American Cancer Society (ACS).

The point of the challenge is to encourage quitting through solidarity. Smokers adopt the national November quit date (third Thursday; this year, November 15), follow guidelines for a successful quit effort, arrange help, inform their families, friends and co-workers and then take the plunge.

Quitting is never easy, but with family and friends’ support and other aids, the tobacco habit can be broken. Quitting has major and immediate benefits, including decreased risk of lung cancer, other cancers, heart attack, stroke and chronic lung disease. Former smokers live longer than continuing smokers. For construction Laborers – who smoke at rates higher than the total population – quitting is even more important due to the extra risk smoking adds to on-the-job exposures to toxic chemicals.

ACS Quit Resources

While state laws banning workplace smoking now protect about 70 percent of American workers from exposure to secondhand smoke, bars and restaurants are uncovered in all but 11 states.

According to the American Lung Association, secondhand smoke is particularly dangerous in family and home situations where children are present. In the United States, 21 million children – about 35 percent of all children – live in homes where residents or visitors smoke on a regular basis.

Somewhere between half and three-quarters of all American children have detectable levels of cotinine, the breakdown product of nicotine, in their blood. Secondhand smoke causes between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months every year, resulting in up to 15,000 hospitalizations. It also causes 430 sudden infant death syndrome (SIDS) deaths each year.   A common cause of fluid build-up in the middle ear is secondhand smoke, and it seriously aggravates asthmatic symptoms in children.

Canadian Tobacco Cessation Progress

As in the U.S., tobacco use remains the most preventable cause of premature death and disease in Canada, according to the Canadian Tobacco Use Monitoring Survey (CTUMS) which provides data to Health Canada, the nation’s federal health department. About 17 percent of all deaths are smoking-related.

The survey found that although 88 percent of current smokers in Canada (about 19 percent of the adult population) had visited a health care provider in the past year, only half were advised to reduce or quit smoking. This finding will be used to spur providers to more consistently engage patients as the nation strives to reduce smoking prevalence by seven percent. In Canada, the taxpayers, through government-financed health care, pay the cost both of tobacco-related disease management and tobacco cessation treatment. Studies document that health care provider advice, alone, can increase cessation rates by as much as five to ten percent.

In 2001, Canada established the goal of reducing smoking prevalence to 20 percent by 2011. The goal was achieved five years early in 2006. Now, the government is shooting for a reduction to 12 percent by 2011.

Smoking and Productivity

Pressure from employers on employees to quit smoking is likely to mount as more studies document the higher costs and lessened productivity of smokers.

A survey of 147 U.S. companies that was published in the Journal of Occupational and Environmental Medicine showed that the annual cost of lost productivity per smoker was about $4,430, compared to $2,623 for nonsmokers and $3,246 for former smokers. The survey asked about health-related absenteeism as well as unproductive hours on the job due to asthma, anxiety and depression, sometimes referred to as “presenteeism.” It did not include other smoking-related costs such as the medical costs of treating smoking-related problems, lost time to smoking breaks, increases in fires or fire insurance costs or early retirements due to smoking-related illness.

Noting that the absentee and presentee costs of former smokers were more in line with nonsmokers than with current smokers, the authors concluded that smoking cessation programs could benefit employers as well as improve the overall health of their workforce.


If you haven’t heard of “Snus,” get ready. Snus is a new tobacco product now being test-marketed in some American cities. It may appeal to Laborers and others who currently chew tobacco, so it is important to understand the product and its dangers.

Snus is smokeless tobacco, packaged in tiny, porous, tea bag-like pouches. As with chewing tobacco, the user tucks it between the cheek and gum. However, snus requires no spitting.

Aficionados claim snus is safer than cigarettes and more discreet. While the lack of smoke gets the product past increasingly common bans on smoking in public places, snus, like all tobacco products, contains nicotine and is at least as addictive as cigarettes.

Snus is banned throughout the European Union, except in Sweden and Norway, which were exempted due to their long snus traditions. It was first used in Sweden more than 200 years ago.

Without smoke, snus does not cause lung cancer, and Swedish men have the lowest rate of lung cancer in Europe. Snus also has lower concentrations of nitrosamines and other carcinogens. This may be because the product is steam-cured rather than fire-cured like tobacco in other products. In clinical trials, snus has been linked to pancreatic cancer, but there is no evidence of higher risk for oral cancer.

Though banned in most of Europe, no U.S. laws bar its sale. Some promoters suggest its widespread introduction in the U.S. could reduce smoking rates and curtail cancer, but critics believe it could become a “gateway” to more smoking, once users become addicted to its nicotine.

Currently, due to tobacco’s well-known and highly criticized health risks, advertising any tobacco products in the U.S. is difficult, especially if a company wants to claim its product is actually “safer” or “less risky” than cigarettes. Because of this restriction, snus has not been broadly advertised, even in the test cities where the product is available. Last month, however, Congress held hearings on a proposal to allow the Food and Drug Administration to regulate tobacco and make rules that might allow tobacco companies to market “reduced-risk” tobacco products. That legislation, however, does not appear to be on a fast track for adoption.

Tobacco Cessation Resources

Smoking continues to be a serious problem for Laborers. The rate is almost twice as high among construction workers as among the population in general, and the risks are more serious due to the synergistic effects of tobacco and toxic exposures in the industry. The LHSFNA’s Health Promotion Division has a long-established program to encourage Laborers and their spouses to quit the habit. Help resources are available online.

[Steve Clark]