Vol. 22, No. 6
Publication from the World Health Organization
Health Effects of Interactions between Tobacco Use and Exposure
to Other Agents, Environmental Health Criteria No. 211 1999, xx
+ 149 pages (English, with summaries in French and Spanish), ISBN 9-
4-157211-6, CHF 36.-/ USD 32.40; In developing countries: CHF 25.20,
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
coexposure to numerous chemical, biological, and physical agents commonly
found in the workplace. Coexposures 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 sidestream 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 sidestream 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
fibers, seven inorganic chemicals, five organic chemical agents (including
ethanol), four physical agents, and seven biological agents (including
two widespread infectious agents). The chapter also includes an explanation
of the concept of interaction and how it can be measured, a discussion
of vector effects (whereby cigarettes become contaminated with toxic
chemicals in the workplace), and a review of data indicating that tobacco
smoking can alter the metabolism of therapeutic drugs and other chemicals.
Chapter 3 considers whether adverse effects following coexposure 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. The report 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 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, the report
concludes that smoking in the workplace should be prohibited. Moreover,
because 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.