Since 1974, NIOSH has recommended the banning of silica sand for use in abrasive blasting and that a substitute material be used. Although the United Kingdom outlawed sand in abrasive blasting in 1949, an estimated 100,000 American workers involved in abrasive blasting remain at risk for silicosis, a clearly preventable disease. In 1992 NIOSH heard of the premature death from silicosis of a 55 year old sandblaster in Cleveland. Followup revealed several additional workers at the same worksite with silicosis, including a 37 year old man who required an oxygen tank and had never heard of silicosis until his diagnosis. NIOSH issued an Alert nationwide to notify other workers of the risk of silicosis. The Alert described 99 cases of silicosis in sandblasting employees. The victims ranged in age from 23 to 55 and worked in conditions common at sandblasting worksites. Abrasive blasting, which uses compressed air or steam to force abrasive particles onto a surface, is a common process for removing paint from metal, finishing tombstones, and etching glass. Workers inhale airborne particles that become embedded in the lungs. Symptoms of silicosis include shortness of breath, fever, and difficulty breathing with exertion. Short of banning silica and substituting an alternative, NIOSH recommends that sandblasting workers use cabinets that permit workers to operate machines from outside through armholes; avoid eating, drinking, or smoking in the blasting area and wash hands after blasting; wear washable or disposable clothes; undergo regular medical examinations and X-rays; and wear proper respiratory protection.