New Resource

Health Effects of Interactions Between Tobacco Use and Exposure to Other Agents

Environmental Health Criteria, No 211
World Health Organization, 1999; xx + 149 pp
(English, with summaries in French and Spanish); ISBN 92-4-157211-6; Order no 1160211

This book evaluates the findings of close to 600 studies aimed at determining whether the health risks associated with tobacco use are enhanced by co-exposure to numerous chemical, biological and physical agents commonly found in the workplace. Co-exposures in the domestic and general environment, which are especially important in newly industrializing countries, are also considered in this comprehensive review. Although all forms of tobacco use are covered, particular attention is given to risks arising from exposure to mainstream and side-stream smoke from cigarettes.

The book has four chapters. The first summarizes what is known about the health risks caused by tobacco use. A brief overview of the history of tobacco use is followed by a detailed explanation of the chemistry of processed tobacco and the many toxic compounds found in tobacco and in mainstream and side-stream smoke. The chapter also includes an overview of all documented acute and chronic adverse effects, including chronic obstructive lung disease, chronic bronchitis, small airways disease, emphysema, pulmonary fibrosis, many forms of cancer and effects on the cardiovascular system. The chapter concludes with a review of evidence demonstrating the health hazards of smokeless tobacco.

The second and most extensive chapter evaluates the evidence on health effects caused by interactions between tobacco smoke and asbestos, non-asbestos fibres, seven inorganic chemicals, five organic chemical agents (including ethanol), four physical agents and seven biological agents (including two widespread infectious agents). The chapter also explains the concept of interaction and how it can be measured, discusses vector effects, whereby cigarettes become contaminated with toxic chemicals in the workplace, and reviews data indicating that tobacco smoking can alter the metabolism of therapeutic drugs and other chemicals.

Chapter three considers whether adverse effects following co-exposure to tobacco smoke and other agents are separate effects or possible interactions. The evaluation draws on data from studies of coal mining, other mineral dusts, fibrous minerals, metals, pesticides and exposure in the rubber and petroleum industries.

The report found evidence for synergism in the production of adverse effects, including cancer, between tobacco smoking and exposure to asbestos, ethanol, silica and radiation. It also found evidence that tobacco smoking affects the health risks of exposure in coal mining, pesticide handling and in the rubber and petroleum industries. In addition, tobacco smoking can increase the risk of byssinosis produced by exposure to cotton dust and of nasal cancer caused by exposure to wood dusts.

On the basis of this evaluation, the final chapter concludes that all possible measures should be taken to eliminate tobacco use, particularly smoking. To avoid interaction with occupational exposure and to eliminate hazards arising from exposure to environmental tobacco smoke, smoking in the workplace should be prohibited. Moreover, since smoking can result in altered responses or adverse reactions to drugs and other treatments, appropriate dose adjustments and patient surveillance should be taken into consideration by clinicians.

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