Tobacco in the Workplace
The number of workers who smoke tobacco or are exposed to secondhand smoke in the workplace has declined over the past several decades. However, many workers remain susceptible to the harms of tobacco smoking.
The percentage of workers who smoke tobacco cigarettes varies by industry and occupation. The highest percentages of workers who smoke are in the following industries.1
- Mining (30%)
- Accommodation and food services (30%)
- Construction (29.7%)
Smokeless tobacco use is relatively frequent among workers2 in:
- Mining (18.8%)
- Wholesale trade (8.9%)
- Construction (7.9%)
Using emerging tobacco products, including hookah and electronic vaping products (EVPs) such as e-cigarettes, has increased in recent years. E-cigarettes were introduced in the United States in 2007, so little is known about long term health effects. In 2014, an estimated 5.5 million working adults were current e-cigarette users.3 Many states have laws to prohibit smoking and tobacco use in the workplace. As of December 2022, 17 states have passed laws that specifically prohibit e-cigarette use in the workplace.4
Employers can also enact policies that restrict smoking and tobacco use in the workplace. In a survey of employees in the United States, nearly half of respondents (48.4%) reported that their employer had a written policy addressing e-cigarette use and majority (73.5%) supported e-cigarette-free workplaces, including the majority of current e-cigarette users (53.5%).5
Syamlal G, Mazurek J, Malarcher A . Current cigarette smoking prevalence among working adults – United States, 2004-2010. J Am Med Assoc; 306(10): 2086-2091.
Mazurek J, Syamlal G, King B, Castellan R . Smokeless tobacco use among working adults – United States, 2005-2010. MMWR; 62(22): 477-482.
Syamlal G, Jamal A, King B, Mazurek J . Electronic cigarette use among working adults – United States, 2014. MMWR; 65(22): 557-561.
Smoking by Industry, Occupation, & Gender
Tobacco cigarette smoking is the leading cause of illness and death in the U.S.1-4 In a study of U.S. adults, results showed 19.6% of workers smoked overall. Current cigarette smoking was highest among the following groups:
- Workers with less than a high school education (28.4%)
- Workers with no health insurance (28.6%)
- Workers living below the federal poverty level (27.7%)
- Workers aged 18–24 years (23.8%)
Cigarette smoking by industry ranged from 9.7% in education services to 30.0% in mining. For occupations, smoking ranged from 8.7% in education, training, and library jobs to 31.4% for construction and extraction workers.5
Of an estimated 19 million workers in the healthcare and social assistance sectors, 16% reported cigarette smoking6. In the accommodation and food services sector7, 25.9% of an estimated 9.3 million workers reported smoking.
Researchers examined gender differences for smoking by occupation using 2004-2011 National Health Interview Survey data for working adults 18 years or older. Data showed an estimated 22.8% men and 18.3% women workers were current smokers8. Of these workers, 38.9% of women worked as supervisors in construction and extraction occupations, while 40.5% of the men worked in extraction occupations. Although, more women in the healthcare and social assistance sector reported smoking (16.9%) than men (12.6%)6.
CDC. The health consequences of smoking—50 years of progress: a report of the surgeon general, 2014. Atlanta GA: USDHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. www.surgeongeneral.gov/library/reports/50-years-of-progress/exec-summary.pdf
CDC. Current cigarette smoking among adults—U.S., 2011. MMWR Morb Mortal Wkly Rep 2012;61(44):889–94.
CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses—U.S., 2000–2004. MMWR Morb Mortal Wkly Rep 2008; 57 (45):1226–8.
USDHHS. Health consequences of smoking: a report of the Surgeon General. cdc.gov/tobacco/data_statistics/sgr/2004/.
Syamlal G, Mazurek JM, Malarcher AM . Current cigarette smoking prevalence among working adults – United States, 2004-2010. Morbidity and Mortality Weekly Report (MMWR) 60(38); 1305-1309
Syamlal G, Mazurek JM, Storey E, Dube SR . Cigarette smoking prevalence among adults working in the health care and social assistance sector, 2008-2012. J Occup Environ Med Oct; 57(10): 1107-1112.
Syamlal G, Jamal A, Mazurek JM . Current cigarette smoking among workers in accommodation and food services – United States 2011-2013. Morbidity and Mortality Weekly Report (MMWR) 64(29); 797-801.
Syamlal G, Mazurek JM, Dube SR . Gender differences in smoking among U.S. working adults. Am J Prev Med. Oct;47(4) 467-475.
Electronic Vaping Products
Electronic vaping products (EVPs) include:
EVPs are devices that deliver aerosolized nicotine, flavorings, and/or other chemicals into the lungs of users. Using EVPs is sometimes referred to as “vaping.” A typical EVP device contains three main components: a battery, a heating element, and a cartridge or tank that holds the vaping liquid or e-liquid.1 Some newer devices look like universal serial bus (USB) sticks and are disposable or have a disposable pod containing e-liquid. The e-liquid is a chemical solution of nicotine, propylene glycol and glycerin. It can also contain flavorings.2-4
When a user takes a puff from an EVP, the e-liquid is heated by the heating element and forms particles and gases. The particles and gases go into the user’s lungs, some remain in their lungs, and a portion of the mixture is exhaled. Both EVP users and people around them are exposed to potentially hazardous chemicals. 5,6
Chemicals produced by EVPs can include carcinogens such as aldehydes, polycyclic aromatic hydrocarbons, and other chemicals. Various organic and flavoring compounds can also be produced when using EVPs that are irritating to the lungs.9 Flavoring compounds include 2,3-pentanedione and diacetyl, which NIOSH has linked to causing obliterative bronchiolitis, a devastating lung disease in workers.4 They are also thought to influence development of many tobacco-related diseases, such as:
- Cardiovascular disease
- Chronic obstructive pulmonary disease (COPD)
- Cancer 10,11
Some e-cigarettes are used to deliver aerosolized illicit drugs such as cannabis, methamphetamines, and cocaine to the user. By adding the illicit drug to the e-liquid, it may alter the characteristic of the drug (such as smell), making it difficult to know if a person is using an illicit drug.13
There is also a risk of burns following spontaneous combustion of the lithium battery in the devices.12
Using EVPs is rising among adults in the United States.7,8 As of 2019, e-cigarettes were used by approximately 4.5 to 5.5% of adults in the U.S.7,8 Potential health risks to users or bystanders exposed to secondhand smoke from EVPs is still under investigation.
Grana R, Ling P, Neal B, Glantz S . Electronic Cigarettes. Circulation; 129: 1972-1986.
Barrington-Trimis J, Samet J, McConnell R . Flavorings in electronic cigarettes an unrecognized respiratory health hazard? J Am Med Assoc; 312: 2493-2494.
Brown J, Luo W, Isabelle L, Pankow J . Candy flavorings in tobacco. Brown et al. N Eng J Med; 370:2250-2252.
Allen J, Flanigan S, LeBlanc M, Vallarino J, MacNaughton P, Stewart J, Christiani D . Flavoring chemicals in e-cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a sample of 51 products, including fruit, candy, and cocktail-flavored e-cigarettes. Environ Health Perspect. E-printhttp://ehp.niehs.nih.gov/15-10185/
Czogala J, Goniewicz M, Fidelus B, Zielinska-Danch W, Travers M, Sobczak A, . Secondhand exposure to vapors from electronic cigarettes. Nic Tobac Res; 16:655–662.
Ranpara A, Stefaniak AB, Fernandez E, Lebouf RF. Effect of puffing behavior on particle size distributions and respiratory depositions from pod-style electronic cigarette, or vaping, products. Front. Public Health. 9: Article 750402 (2021).
Kianersi S, Zhang Y, Rosenberg M, Macy JT. Prevalence of e-cigarette use (2016 to 2018) and cigarette smoking (2012 to 2019) among U.S. adults by state: An interactive data visualization dashboard. Drug Alcohol Depend. 2021 Jan 1;218:108361.
MMWR Morb Mortal Wkly Rep. 2020 Nov 20;69(46):1736-1742. Tobacco Product Use Among Adults – United States, 2019. doi: 10.15585/mmwr.mm6946a4
Eshraghian EA, Al-Delaimy WK. A review of constituents identified in e-cigarette liquids and aerosols.Tob Prev Cessat. 2021 Feb 10;7:10.
Bitzer ZT, Goel R, Reilly SM, Elias RJ, Silakov A, Foulds J, Muscat J, Richie JP, Jr. Effect of flavoring chemicals on free radical formation in electronic cigarette aerosols. Free Rad Biol Med. 120:72-79 (2018).
Stefaniak AB, LeBouf RF, Ranpara AC, Leonard SS. Toxicology of flavoring-and cannabis-containing e-liquids used in electronic delivery systems. Pharmacol Ther. 2021 Aug;224:107838.b.
Walsh K, Sheikh Z, Johal K, Khwaja N . Case Report: Rare case of accidental fire and burns caused by e-cigarette batteries. BMJ Case Rep. doi:10.1136/ bcr-2015-212868
Breitbarth AK, Morgan J, Jones AL E-cigarettes – An unintended illicit drug delivery system. Drug Alcohol Depend. 192:98-111 (2018).
Smokeless tobacco includes:
- Chewing tobacco
Because the tobacco is not smoked, many perceive it as being safer than smoking. However, smokeless tobacco still contains highly addictive nicotine and many of the same harmful chemicals found in cigarettes. Smokeless tobacco can cause:
- Mouth cancer
- Esophageal cancer
- Oral disease
Smokeless tobacco use may also increase the risk of death from heart disease and stroke.
Workplace Smoke-Free Policies
Legislation has been adopted by 27 states and the District of Columbia requiring non-hospitality workplaces, restaurants, and bars to be completely smoke-free. These statewide comprehensive smoke-free laws protect 58.7% of the US population.9 These laws are in addition to local comprehensive smoke-free laws.
- In 1997, smoking was prohibited in all federal government buildings and aircrafts by Executive Order 13058 “Protecting Federal Employees and the Public from Exposure to Tobacco Smoke in the Federal Workplace.” In 2008, the General Services Administration (GSA) issued the Federal Management Regulation Amendment 2008- 08banning smoking in courtyards and within 25 feet of doorways on GSA-controlled properties.
- The Occupational Safety and Health Administration (OSHA) regulates workplace exposures through 29 CFR 1910.1000Air contaminants, which does not allow exposures from chemical compounds found in tobacco smoke to exceed certain levels.
- The Mine Safety and Health Administration (MSHA) adopted policy 30 CFR 75.1702, which states that persons shall not smoke, carry smoking materials, matches, or lighters underground, or smoke in areas that could cause fire or an explosion. The rule also states that the operator shall establish a program to ensure this policy is followed.
Employers can implement company specific smoke-free policies in the absence of or in addition to legislation. Even with smoke-free laws and policies, one in ten nonsmoking U.S. workers continue to report regular exposure to secondhand smoke while at work.10 Workplace secondhand smoke exposure:
- Is more common among men than women.
- Decreases with age and educational achievement.
- Is more widespread among blue-collar workers and in industries such as mining and construction.10,11,12
Exposures are associated with chronic diseases such as lung cancer, coronary heart disease, and stroke. Secondhand smoke can also cause adverse reproductive effects, including low birth weight, when mothers are exposed during pregnancy.13
Intervention and Cessation Program Resources
Worker health and well-being is vital for establishing a healthy and safe workforce. Addressing the risks of smoking and tobacco use in the workplace and providing tobacco cessation programs for employees can improve overall health of individuals.
NIOSH’s report, Current Intelligence Bulletin 67: Promoting Health and Preventing Disease and Injury Through Workplace Tobacco Policies, is aimed at preventing occupational illness related to tobacco use and secondhand smoke and improving the general health and well-being of workers. In the report, NIOSH recommends that all workplaces become tobacco-free, and employers make tobacco cessation programs available to workers.
The following resources provide information on intervention and cessation programs and guidance for employers and employees.
The Centers for Disease Control and Prevention (CDC)
- Workplace Health Promotion
Workplace programs and policies to help reduce health risks and improve the quality of life for workers.
- Smoking & Tobacco Use
Guidance for tobacco users that includes information on nicotine dependence, the health benefits of quitting, and ways to quit.
- Quit Smoking
CDC’s website provides smoking cessation information and resources for state tobacco control programs and public health professionals.
U.S. Department of Health and Human Services
Guidance provided by the National Institutes of Health – National Cancer Institute for smoke-free support and information.
The American Lung Association
- Stop Smoking
The American Lung Association provides extensive information on smoking facts, how to quit, and freedom from smoking.
American Nonsmokers’ Rights Foundation . Overview list—how many smokefree laws? Available at: http://www.no-smoke.org/pdf/mediaordlist.pdf. Accessed July 29, 2016.
Calvert GM, Luckhaupt SE, Sussell A, Dahlhamer JM, Ward BW . The prevalence of selected potential hazardous workplace exposures in the US: findings from the 2010 National Health Interview Survey. Am J Ind Med. 56(6):635-646.
Alker H, Fitzsimmons K. On-the-Job Exposure to Environmental Tobacco Smoke (ETS) in Massachusetts. Boston: Massachusetts Department of Public Health; 2013.
The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General . Atlanta, GA: US Department of Health and Human Services
Fujishiro K, Stukovsky KD, Roux AD, Landsbergis P, Burchfiel C. Occupational gradients in smoking behavior and exposure to workplace environmental tobacco smoke: the Multi-Ethnic Study of Atherosclerosis. J Occup Environ Med. 2012; 54(2):136—145.