Study of smoking behavior in asbestos workers

Our plain-English summary of Study of smoking behavior in asbestos workers, by O.Y. Osinubi, A.A. Afilaka, J. Doucette, et al (American Journal of Industrial Medicine, 2002).

The study

• Authors: O.Y. Osinubi, A.A. Afilaka, J. Doucette, A. Golden, T. Soriano, E. Rovner, E. Anselm
• Journal: American Journal of Industrial Medicine
• Published: 2002;41(1):62-9
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Asbestos exposure and concomitant cigarette smoking markedly increase the risk of lung cancer and contribute to the prevalence and severity of pulmonary interstitial fibrosis.

Methods: A cross-sectional survey of 214 asbestos workers was initiated to determine the prevalence of smoking and their readiness to quit smoking using the stage of change theory.

Results: The study was comprised of 61 never smokers (28.5%), 118 ex-smokers (55.1%), and 35 current smokers (16.4%). Reasons for smoking cessation in ex-smokers included perception of ill-health (51%) and knowledge of smoking-asbestos hazards (3.4%). Stage of change of current smokers revealed: precontemplation (26.5%), contemplation (35%), preparation (29%), and action (8.8%). Current smokers had the highest prevalence of small airway obstruction on spirometry.

Conclusions: A detailed smoking history during medical surveillance activities will enable the occupational physician to identify asbestos workers who have difficulty quitting and to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Copyright 2002 Wiley-Liss, Inc.

In plain English

This cross-sectional survey studied smoking among 214 of 225 asbestos workers (laborers, custodians and cleaners; 97.2% men) attending asbestos-related disease surveillance at a Mount Sinai center in New York from November 1997 to March 1998. They averaged 28 years of asbestos exposure; fiber types were not reported. Of the 214, 61 (28.5%) were classified as never smokers (fewer than 100 cigarettes ever, none in the past 12 months), 118 (55.1%) as ex-smokers and 35 (16.4%) as current smokers. 50.8% of ex-smokers said they quit because of symptoms or a medical condition; 3.4% cited the combined asbestos-smoking hazard and none cited an occupational medicine physician's advice. Among 34 current smokers, 26.5% were in precontemplation, 35% contemplation, 29% preparation and 8.8% action. Small airway obstruction on spirometry affected 54% of current smokers, 30% of ex-smokers and 26% of never smokers. Parenchymal scarring on X-ray did not differ significantly by smoking group. The authors concluded these smokers were motivated but found quitting difficult, and proposed cessation counseling and referral during surveillance. Smoking was self-reported and participants were volunteers, limiting generalization.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional survey using an interviewer-administered smoking questionnaire, with review of medical surveillance charts
• Who was studied: 214 of 225 active and retired asbestos workers (95% participation) who attended asbestos-related disease surveillance at the Mount Sinai-Irving J. Selikoff Center for Occupational Health, November 1997 to March 1998. They came from union locals of school and library employees, custodian engineers and laborers. There were 120 laborers, 53 custodians and 41 cleaners. Mean age was 60.5 years, 208 (97.2%) were male, and 73.9% were white.
• Exposure: Occupational asbestos exposure averaging 28.4 years (range 3 to 49 years); fiber types and products were not specified. The main variable studied was cigarette smoking status (never, ex-, current smoker).
• Main results:
  • Of the 214 workers, 61 (28.5%) were classified as never smokers, 118 (55.1%) as ex-smokers and 35 (16.4%) as current smokers. Never smokers were defined as having smoked fewer than 100 cigarettes ever and none in the preceding 12 months.
  • Among ex-smokers, the most frequent reason for quitting was smoking-related symptoms or a medical condition (59 of 118, 50.8%).
  • Only 3.4% of ex-smokers (4 people) gave knowledge of the combined asbestos and smoking hazard as a reason for quitting, and no ex-smoker quit because of advice from an occupational medicine physician.
  • Of 34 current smokers with complete information, 9 (26.5%) were in precontemplation, 12 (35%) in contemplation, 10 (29%) in preparation and 3 (8.8%) in action.
  • Small airway obstruction on spirometry was found in 19 current smokers (54%), 35 ex-smokers (30%) and 16 never smokers (26%); the P value was 0.01.
  • Parenchymal scarring on chest X-ray (ILO 1/0 or above) did not differ significantly by smoking status: never smokers 4 (7.0%), ex-smokers 8 (6.9%), current smokers 5 (14.7%); P = 0.34.
  • Bilateral pleural scarring was most common in ex-smokers: 18 (15.25%), compared with never smokers 1 (1.64%) and current smokers 3 (8.57%); P = 0.02.
• The authors' conclusion: The authors concluded the following. Smoking prevalence in this group was lower than in the general population and lower than among asbestos workers surveyed about 10 years earlier. Knowledge of asbestos-smoking hazards, and advice from an occupational medicine physician, had minimal impact on decisions to quit. Current smokers were highly motivated to quit. The authors proposed that occupational physicians include cessation counseling in routine surveillance and refer workers who have difficulty quitting to comprehensive programs.
• Limitations the authors state:
  • Smoking status was based only on self-report.
  • Participants were a convenience sample of workers who voluntarily attended union-organized medical surveillance, so results cannot be generalized to asbestos workers who do not attend.
  • The relatively small number of subjects likely explains the lack of observed differences in reported lung cancer and other cancers by smoking status.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Lung Cancer, Interstitial Fibrosis, Spirometry.

Related studies

• A pilot study of telephone-based smoking cessation intervention in asbestos workers — O.Y. Osinubi, J. Moline, et al. (2003)
• Healthcare provider smoking cessation advice among US worker groups — D.J. Lee, L.E. Fleming, et al. (2007)
• Effectiveness of postal smoking cessation advice: a randomized controlled trial in young men with reduced FEV1 and asbestos exposure — S. Humerfelt, G.E. Eide, et al. (1998)
• The risk of lung cancer with increasing time since ceasing exposure to asbestos and quitting smoking — A. Reid, N.H. de Klerk, et al. (2006)
• Effectiveness of smoking cessation advice for asbestos workers — A. Johnson, P. Farrow, et al. (2006)
• Smoking prevalence of asbestos workers: a comment — J.H. Lange, K.W. Thomulka (2003)

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