OBJECTIVES: Assess the prevalence of current asthma, asthma attacks/episodes, and asthma-related emergency room (ER) visits by industry and occupation and estimate the proportion of current asthma cases associated with employment during 2020-2021. METHODS: The 2020-2021 National Health Interview Survey data for persons aged ≥18 years who were employed at any time during the 12 months prior to the interview were analyzed. RESULTS: An estimated 12.7 million US working adults had current asthma. Of those, 40% had an asthma attack/episode and 8.6% had an asthma-related ER visit. Prevalence varied by sociodemographic characteristics, industry, and occupation. Highest asthma prevalence was among workers in the administrative, support, waste management, and remediation industry and the community and social services occupation. Nearly half of workers with current asthma in the arts, entertainment, and recreation industry and arts, design, entertainment, sports, and media occupations reported having an asthma attack/episode. Workers in the accommodations and food services industry and food preparation and serving related occupation had the highest asthma-related ER visits. The proportion of current asthma cases attributable to employment was estimated to be 9.2% by industry and 12.2% by occupation. CONCLUSION: An estimated 1.2-1.5 million asthma cases among workers might be attributable to employment by industry and occupation. Disparities in asthma prevalence, asthma attacks/episodes and asthma-related ER visits among workers exist. These findings underscore the importance of early identification of asthma cases in relation to work and implementation of targeted interventions (including, training and education, personal protective equipment use, health surveillance, workplace policies), especially among workers employed in industries and occupations with elevated asthma prevalence.

BACKGROUND: Asthma, a chronic respiratory disease, is associated with high economic burden. This study estimates per-worker medical and incremental medical costs associated with treated asthma by socioeconomic and demographic characteristics, industries, medical events, and sources of payments for workers aged ≥18 years. METHODS: We analyzed Medical Expenditure Panel Survey data from 2018 to 2020 to assess medical costs for treated asthma among workers using the International Classification of Diseases, Tenth Revision, Clinical Modification code for asthma (J45). We used two-part regression models to estimate medical and incremental medical costs controlling for covariates. All results are adjusted for inflation and presented in 2022 US dollar values. RESULTS: An estimated annual average of 8.2 million workers out of 176 million had at least one medical event associated with treated asthma. The annualized estimated per-worker incremental medical costs for those with treated asthma was $457 and was highest among: those in the age group of 35-44 years ($534), in the western region ($768), of Hispanic ethnicity ($693), employed in the utility and transportation industries ($898), males ($650), and for inpatient admissions ($754). The total annualized medical costs of treated asthma was $21 billion and total of incremental medical costs was $3.8 billion. CONCLUSION: Findings of higher incremental medical costs for treated asthma among workers in certain socioeconomic, demographic, and industry groups highlight the economic benefit of prevention and early intervention to reduce morbidity of asthma in working adults. Our results suggest that the per-person incremental medical costs of treated asthma among workers are lower than that for all US adults.

INTRODUCTION: Over 30 million U.S. working adults use tobacco, and tobacco use varies by occupation. Limited information is available on employment characteristics and tobacco use prevalence. The purpose of this study was to describe the prevalence of current tobacco use by employment characteristics and occupation group among U.S. working adults. METHODS: This cross-sectional study used 2021 National Health Interview Survey data for currently working adults (n=16,461) analyzed in 2023. Multivariable logistic regression was used to estimate adjusted odds of tobacco use by employment characteristics and occupation group. RESULTS: In 2021, 20.0% of working adults used tobacco. Any tobacco use was significantly lower among workers who were offered workplace health insurance (aOR=0.86, 95% CI=0.77-0.97), had paid sick leave (aOR=0.81, 95% CI=0.73-0.91), and government vs. private employment (aOR=0.61, 95% CI=0.52-0.70). Any tobacco use was significantly higher among workers who usually worked ≥35 hours per week vs. did not usually work ≥35 hours per week (aOR=1.21, 95% CI=1.06-1.39), worked a rotating or 'some other' shift vs. daytime shift (aOR=1.19, 95% CI=1.02-1.38), experienced schedule instability (aOR=1.17, 95% CI=1.03-1.31), and worked while physically ill in the past 3 months (aOR=1.25, 95% CI=1.11-1.41). Tobacco use by employment characteristics also varied by occupation group. CONCLUSIONS: Current tobacco use varied according to employment characteristics and occupation group. Findings from this study could inform workplace tobacco cessation interventions and policies (e.g., access to paid sick leave or insurance coverage) to better support tobacco cessation and overall worker health.

BACKGROUND: Work-related asthma (WRA), a preventable occupational disease, can result in adverse health outcomes and employment disability, including decreased productivity, lost workdays, and job loss. Early identification of WRA cases and avoidance of further exposures is crucial for optimal management. OBJECTIVE: We estimate WRA prevalence among US workers by selected sociodemographic characteristics, industry, and occupation groups and assess the differences in adverse health outcomes, preventive care, and lost workdays between persons with WRA and those with non-WRA. METHODS: The 2020 National Health Interview Survey (NHIS) data for working adults aged ≥18 years employed in the 12 months before the survey were analyzed. Prevalence, and adjusted prevalence ratios with 95% confidence intervals were estimated using multivariate logistic regression. RESULTS: Of the estimated 170 million US adults working in the past year, 13.0 million (7.6%) had asthma. Among workers with asthma, an estimated 896,000 (6.9%) had WRA. WRA prevalence was highest among males, workers aged ≥55 years, those with no health insurance, those living in the Midwest, and those employed in the accommodation, food, and other services industry, and in production, installation, transportation, and material moving occupations. Workers with WRA were significantly more likely to use preventive medication and rescue inhalers, and to experience adverse health outcomes and lost workdays than workers with non-WRA. CONCLUSION: Early identification of WRA cases, assessment of workplace exposures, and implementation of targeted interventions that consider the hierarchy of controls are critical to preventing future WRA cases and associated adverse health consequences.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted workers in certain industries and occupations. The infection risk for SARS-CoV-2 and future respiratory viruses in the workplace is a significant concern for workers, employers, and policymakers. The current study describes the differences in COVID-19 mortality by sex and industry/occupation among working-age U.S. residents in 49 states and New York City. METHODS: The 2021 National Vital Statistics System (NVSS) public use multiple-cause-of-death data for U.S. decedents aged 15‒64 years (working-age) with information on usual industry and occupation were analyzed in 2022. Age-standardized COVID-19 death rates for selected demographic characteristics and adjusted proportional mortality ratios (PMRs) were estimated by sex and by usual industry and occupation. RESULTS: In 2021, 133,596 (14.3%) U.S. decedents aged 15‒64 years had COVID-19 listed as the underlying cause of death; the highest COVID-19 death rate was among persons aged 55‒64 years (172.4/100,000 population) and males (65.5/100,000 population). Among males, American Indian or Alaskan Native and among females, Black or African American had the highest death rates. Hispanic males had higher age-adjusted death rates than Hispanic females. Working-age male decedents in the public administration (PMR=1.39) and management of companies & enterprises industries (PMR=1.39) and community and social services occupations (PMR=1.68) and female decedents in the utilities industry (PMR=1.20) and protective services occupation (PMR=1.18) had the highest PMRs. CONCLUSIONS: COVID-19 death rates and PMRs varied by sex, industry, and occupation groups. These findings underscore the importance of workplace public health interventions, which could protect workers and their communities.

BACKGROUND: Exposure to respirable coal mine dust can cause pneumoconiosis, an irreversible lung disease that can be debilitating. The mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by occupation, by geographic region) from surface coal mines and surface facilities at U.S. underground mines during 1982-2017 were summarized. METHODS: Mine Safety and Health Administration (MSHA) collected and analyzed data for respirable dust and a subset of the samples were analyzed for quartz content. We calculated the respirable dust and quartz concentration geometric mean, arithmetic mean, and percent of samples exceeding the respirable dust permissible exposure limit (PEL) of 2.0 mg/m3, and the average percent of quartz content in samples. RESULTS: The geometric mean for 288 705 respirable dust samples was 0.17 mg/m(3) with 1.6% of the samples exceeding the 2.0 mg/m(3) PEL. Occupation-specific geometric means for respirable dust in active mining areas were highest among drillers. The geometric mean for respirable dust was higher in central Appalachia compared to the rest of the U.S. The geometric mean for respirable quartz including 54 040 samples was 0.02 mg/m(3) with 15.3% of these samples exceeding the applicable standard (PEL or reduced PEL). Occupation-specific geometric means for respirable quartz were highest among drillers. CONCLUSION: Higher concentrations of respirable dust or quartz in specific coal mining occupations, notably drilling occupations, and in certain U.S. regions, underscores the need for continued surveillance to identify workers at higher risk for pneumoconiosis.

Chronic obstructive pulmonary disease (COPD), a progressive lung disease, is characterized by long-term respiratory symptoms and airflow limitation (1). COPD accounts for most of the deaths from chronic lower respiratory diseases, the sixth leading cause of death in the United States in 2020.* Workplace exposures and tobacco smoking are risk factors for COPD; however, one in four workers with COPD have never smoked (2-4). To describe COPD mortality among U.S. residents aged 15 years categorized as ever-employed (i.e., with information on their usual industry and occupation), CDC analyzed the most recent 2020 multiple cause-of-death data() from 46 states and New York City.() Among 3,077,127 decedents, 316,023 (10.3%) had COPD() listed on the death certificate. The highest age-adjusted** COPD death rates per 100,000 ever-employed persons were for females (101.3), White persons (116.9), and non-Hispanic or Latino (non-Hispanic) persons (115.8). The highest proportionate mortality ratios (PMRs)() were for workers employed in the mining industry (1.3) and in food preparation and serving related occupations (1.3). Elevated COPD mortality among workers in certain industries and occupations underscores the importance of targeted interventions (e.g., reduction or elimination of COPD-associated risk factors, engineering controls, and workplace smoke-free policies) to prevent COPD from developing and to intervene before illness becomes symptomatic or severe.

Objectives. To explore previous COVID-19 diagnosis and COVID-19 vaccination status among US essential worker groups. Methods. We analyzed the US Census Household Pulse Survey (May 26-July 5, 2021), a nationally representative sample of adults aged 18 years and older. We compared currently employed essential workers working outside the home with those working at home using adjusted prevalence ratios. We calculated proportion vaccinated and intention to be vaccinated, stratifying by essential worker and demographic groups for those who worked or volunteered outside the home since January 1, 2021. Results. The proportion of workers with previous COVID-19 diagnosis was highest among first responders (24.9%) working outside the home compared with workers who did not (13.3%). Workers in agriculture, forestry, fishing, and hunting had the lowest vaccination rates (67.5%) compared with all workers (77.8%). Those without health insurance were much less likely to be vaccinated across all worker groups. Conclusions. This study underscores the importance of improving surveillance to monitor COVID-19 and other infectious diseases among workers and identify and implement tailored risk mitigation strategies, including vaccination campaigns, for workplaces. (Am J Public Health. 2022;112(11):1599-1610. https://doi.org/10.2105/AJPH.2022.307010).

BACKGROUND: Asthma-COPD overlap (ACO) is a respiratory condition with more severe respiratory symptoms, poorer quality of life, and increased hospital admissions compared with asthma or COPD alone. OBJECTIVES: Estimate asthma, chronic obstructive pulmonary disease (COPD), and ACO prevalence among workers by industry and occupation and assess physical and mental health status, healthcare utilization, among workers with ACO. METHODS: The 2014-2018 National Health Interview Survey (NHIS) data for working adults aged ≥18 years employed (sample n = 99,424) in the 12 months prior to the survey were analyzed. Age-adjusted ACO, COPD and asthma prevalence and prevalence ratios adjusted for age, sex, race and smoking status were estimated. RESULTS: During 2014-2018, of the estimated 166 million (annual average) US workers, age-adjusted asthma, COPD, and ACO prevalence was 6.9%, 4.0%, and 1.1%, respectively. ACO prevalence was highest among workers aged ≥65 years (2.0%), females (1.6%), current smokers (1.9%), those living below the federal poverty level (2.3%), and workers in the accommodation and food services (1.6%) industry and personal care and service (2.3%) occupations. Workers with ACO had more frequent (p < 0.05) physician office visits, emergency department visits; and were more likely to be in poorer mental health, obese, have more lost workdays, more bed days, and comorbidities compared to workers with asthma alone and workers with COPD alone.Conclusion: Higher ACO prevalence among worker groups and increased healthcare utilization underscores the need for early identification of asthma and COPD, assessment of potential workplace exposures, and implementation of tailored interventions to reduce ACO among working adults.

We assessed coronavirus disease vaccination and intent and knowledge, attitudes, and beliefs among essential workers during March-June 2021. Coverage was 67%; 18% reported no intent to get vaccinated. Primary concerns were potential side effects, safety, and lack of trust in vaccines, highlighting the importance of increasing vaccine confidence in this population.

Introduction: Chronic obstructive pulmonary disease is the fourth leading cause of death in the U.S. Workplace exposures are important modifiable contributors to the burden of chronic obstructive pulmonary disease. Among U.S. workers, 19% of chronic obstructive pulmonary disease cases are attributable to workplace exposures. This study examines the trends in chronic obstructive pulmonary disease prevalence during 2012–2018 among workers and assesses the population attributable fraction for chronic obstructive pulmonary disease associated with work by smoking status, industry, and occupation. Methods: The 2012–2018 National Health Interview Survey data for workers aged ≥18 years employed during the 12 months before the interview were analyzed in 2019. Annual trends were examined using the Poisson regression model. Multivariate logistic regression was used to calculate adjusted prevalence ORs. Results: During 2012–2018, an estimated age-adjusted annual average of 4.1% of workers had chronic obstructive pulmonary disease, and prevalence varied by industry and occupation. Overall, chronic obstructive pulmonary disease prevalence increased by an estimated annual average of 1.5% (p<0.05). The prevalence trends increased significantly among workers in the merchant wholesale nondurable and the arts, entertainment, and recreation industries and among financial specialists; supervisors, other food services workers; supervisors, building grounds workers, and maintenance workers; personal care and services workers; supervisors and office and administrative support workers; and motor-vehicle operators and material moving workers. The proportion of chronic obstructive pulmonary disease cases attributable to work was 27.3% among all workers and 24.0% among never smokers. Conclusions: Public health efforts to increase the awareness and understanding of chronic obstructive pulmonary disease associated with occupational risk factors are needed to prevent chronic obstructive pulmonary disease among workers, especially among those employed in industries and occupations with increasing prevalence trends. © 2021

Exposures to dust, vapors, or fumes (DVF) are associated with chronic bronchitis (CB) and emphysema. The 2007-2012 National Health and Nutrition Examination Survey data were used to estimate age-standardized prevalence of CB and emphysema among ever-employed adults by exposure status and industry and occupation groups. Age-standardized CB and emphysema prevalence were 2.3% and 1.9%, respectively. Of the estimated 111 million U.S. workers exposed to DVF, 2.7% reported CB and 2.8% reported emphysema. Workers in the "accommodation, food services" industry and "food preparation, serving related" occupations were more likely to report CB and emphysema. Current findings indicate that workplace exposures may be associated with high prevalence of CB and emphysema in certain industry and occupational groups. Early diagnosis and identifying associated workplace exposures are important steps in CB and emphysema prevention efforts.

Objective: To assess healthcare utilization, lost work days, and bed days among workers with chronic obstructive pulmonary disease (COPD) by industry and occupation. Methods: The 2014-2018 National Health Interview Survey (NHIS) data were analyzed. Results: Among workers with COPD the highest odds of reporting an emergency room (ER) visit and lost work days were observed among workers aged &gt;=65 years, females, those with no health insurance, and current combustible tobacco users. Workers with COPD in the information industry and computer and mathematical occupation reported highest odds of an ER visit and utilities industry workers reported highest odds for lost work days. Conclusions: The high healthcare utilization and lost work days among workers with COPD in certain industries and occupations underscores the importance of continued surveillance and tailored interventions to reduce disease burden and improve worker health.

Electronic cigarettes (e-cigarettes) heat a liquid to produce an aerosol that usually contains nicotine, flavors, and other chemicals and that is inhaled by the user (1). E-cigarette aerosols generally have a lower number and level of harmful toxicants than conventional cigarettes; however, e-cigarette aerosols can contain harmful ingredients, including ultrafine particles, volatile organic compounds, and heavy metals (1,2). The U.S. Surgeon General has determined that evidence is inadequate to conclude that use of e-cigarettes, in general, increases smoking cessation (3). During 2014–2016, an estimated 5.2 million U.S. workers were current e-cigarette users, and prevalence of e-cigarette use was higher among workers in certain industries and occupations (4). To estimate recent national prevalence of e-cigarette use among U.S. workers, CDC analyzed 2017–2018 National Health Interview Survey (NHIS) data for adults aged ≥18 years who were employed during the week before the interview. Among an estimated 156 million U.S. workers, 5.3 million (3.4%) were current e-cigarette users (i.e., “every day” or “some days” use), approximately one half of whom also currently used combustible tobacco products. Current e-cigarette use was highest among males, non-Hispanic Whites, those aged 18–24 years, those with no health insurance, those reporting poor or fair physical health, and those who currently used other tobacco products. Prevalence of e-cigarette use was highest among workers in the accommodation and food services industry and in food preparation and serving-related occupations. Continued surveillance of e-cigarette use in the United States, including among workers, is important to inform the development and implementation of evidence-based strategies to minimize population risks of use of e-cigarettes while continuing to explore their potential usefulness for cessation among adult cigarette smokers (2,3). To maximize the health of workers, employers can integrate comprehensive and effective tobacco cessation programs into workplace health promotion programs (4,5).

Asthma and chronic obstructive pulmonary disease (COPD) are respiratory conditions associated with a significant economic cost among U.S. adults (1,2), and up to 44% of asthma and 50% of COPD cases among adults are associated with workplace exposures (3). CDC analyzed 2011-2015 Medical Expenditure Panel Survey (MEPS) data to determine the medical expenditures attributed to treatment of asthma and COPD among U.S. workers aged >/=18 years who were employed at any time during the survey year. During 2011-2015, among the estimated 166 million U.S. workers, 8 million had at least one asthma-related medical event,* and 7 million had at least one COPD-related medical event. The annualized total medical expenditures, in 2017 dollars, were $7 billion for asthma and $5 billion for COPD. Private health insurance paid for 61% of expenditures attributable to treatment of asthma and 59% related to COPD. By type of medical event, the highest annualized per-person asthma- and COPD-related expenditures were for inpatient visits: $8,238 for asthma and $27,597 for COPD. By industry group, the highest annualized per-person expenditures ($1,279 for asthma and $1,819 for COPD) were among workers in public administration. Early identification and reduction of risk factors, including workplace exposures, and implementation of proven interventions are needed to reduce the adverse health and economic impacts of asthma and COPD among workers.

BACKGROUND: Respirable crystalline silica (RCS) can potentially cause silicosis, lung cancer, and renal failure. The current study estimates the percentages of workers potentially overexposed to concentrations of RCS dust and silicosis proportional mortality rates (PMRs) by industry. METHODS: Occupational Safety and Health Administration compliance inspection sampling data for RCS collected during 1979 to 2015 were used to estimate percentages of workers exposed. The results were used in combination with US Census Bureau estimates to produce industry specific worker population estimates for 2014. Estimates of the numbers and percentages of workers exposed to RCS concentrations at least 1, 2, 5, and 10 times the National Institute for Occupational Safety and Health recommended exposure limit (REL) were calculated by industry using the 2002 North American Industry Classification System. Silicosis PMRs by industry were estimated using National Center for Health Statistics multiple cause of death data. RESULTS: RCS concentrations/workers exposed were highest in the poured concrete foundation and structure contractors; commercial and institutional building construction; and masonry contractors. Approximately 100 000 workers were exposed above the RCS REL, and most (79%) worked in the construction industry. Tile and terrazzo contractors (12%); brick, stone, and related construction merchant wholesalers (10%); masonry contractors (6%) and poured concrete foundation and structure contractors (6%) were the highest percentages of workers potentially overexposed. PMRs were highest for the structural clay product manufacturing and the foundries industries. CONCLUSION: Percentages of workers exposed to RCS varied by industry and in some industries workers are exposed over 10 times the REL. Exposures can be reduced below the REL by implementing the hierarchy of controls.

Secondhand tobacco smoke (SHS) exposure contributes to ill health and disease, including heart disease, lung cancer, and stroke (1). Although cigarette smoking has declined among U.S. workers, workplace exposure to SHS remains high, particularly among workers in certain industries, such as construction (2,3). Implementation of smoke-free laws has proven to be beneficial in reducing SHS exposure in general (1). CDC analyzed data from the 2015 National Health Interview Survey (NHIS) Occupational Health Supplement to assess the prevalence of self-reported workplace SHS exposure among nonsmoking workers by smoke-free policy status in the workers' states of residence and in detailed industry categories and subcategories. In 2015, 19.9% of nonsmoking workers reported any exposure to SHS at work during the 12 months preceding the interview, and 10.1% reported frequent exposure (twice a week or more). Nonsmoking workers who resided in states with comprehensive smoke-free laws in all three categories of venues (private worksites, bars, and restaurants) were least likely to report frequent exposure to workplace SHS. Nonsmoking workers employed in the commercial and industrial machinery and equipment repair and maintenance industry reported the highest prevalences of any workplace SHS exposure (65.1%), whereas the construction industry had the highest reported number of exposed workers (2.9 million); these industry categories/subcategories include outdoor workplaces and other settings that are unlikely to be protected by smoke-free laws. Identifying specific at-risk workplaces and implementing targeted intervention strategies could help reduce SHS exposure at work and protect workers' health.

Carbonaceous nanomaterials (CNMs) are universally being used to make commodities, as they present unique opportunities for development and innovation in the fields of engineering, biotechnology, etc. As technology advances to incorporate CNMs in industry, the potential exposures associated with these particles also increase. CNMs have been found to be associated with substantial pulmonary toxicity, including inflammation, fibrosis, and/or granuloma formation in animal models. This study attempts to categorize the toxicity profiles of various carbon allotropes, in particular, carbon black, different multi-walled carbon nanotubes, graphene-based materials and their derivatives. Statistical and machine learning based approaches were used to identify groups of CNMs with similar pulmonary toxicity responses from a panel of proteins measured in bronchoalveolar lavage (BAL) fluid samples and with similar pathological outcomes in the lungs. Thus, grouped particles, based on their pulmonary toxicity profiles, were used to select a small set of proteins that could potentially identify and discriminate between the toxicity profiles associated within each group. Specifically, MDC/CCL22 and MIP-3beta/CCL19 were identified as common protein markers associated with both toxicologically distinct groups of CNMs. In addition, the persistent expression of other selected protein markers in BAL fluid from each group suggested their ability to predict toxicity in the lungs, i.e., fibrosis and microgranuloma formation. The advantages of such approaches can have positive implications for further research in toxicity profiling.

BACKGROUND: This study summarized the mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by district, and by occupation) from underground coal mines during 1982-2017. METHODS: Respirable dust and quartz data collected and analyzed by Mine Safety and Health Administration (MSHA) were summarized by year, coal mining occupation, and geographical area. The older (before August 2016) 2.0 mg/m (3) respirable dust MSHA permissible exposure limit (PEL) was used across all years for comparative purposes. For respirable dust and quartz, geometric mean and percent of samples exceeding the respirable dust PEL (2.0 mg/m (3) or a reduced standard for samples with >5% quartz content) were calculated. For quartz samples, the average percent quartz content was also calculated. RESULTS: The overall geometric mean concentration for 681 497 respirable dust samples was 0.55 mg/m (3) and 5.5% of the samples exceeded the 2.0 mg/m (3) PEL. The overall respirable quartz geometric mean concentration for 210 944 samples was 0.038 mg/m (3) and 18.7% of these samples exceeded the applicable standard. There was a decline over time in the percent of respirable dust samples exceeding 2.0 mg/m (3) . The respirable dust geometric mean concentration was lower in central Appalachia compared to the rest of the United States. However, the respirable quartz geometric mean concentration and the mean percent quartz content were higher in central Appalachia. CONCLUSION: This study summarizes respirable dust and quartz concentrations from coal mine inspector samples and may provide an insight into differences in the prevalence of pneumoconiosis by region and occupation.

Tobacco smoking is a major risk factor for chronic obstructive pulmonary disease (COPD), a debilitating respiratory condition with high mortality and morbidity (1,2). However, an estimated 24% of adults with COPD have never smoked (3,4). Among these persons, 26%-53% of COPD can be attributed to workplace exposures, including dust, fumes, gases, vapors, and secondhand smoke exposure (4-6). To assess industry-specific and occupation-specific COPD prevalence among adults aged >/=18 years who have never smoked and who were employed any time during the past 12 months, CDC analyzed 2013-2017 National Health Interview Survey (NHIS) data. Among an estimated 106 million workers who had never smoked, 2.2% (2.4 million) have COPD. Highest prevalences were among workers aged >/=65 years (4.6%), women (3.0%), and those reporting fair/poor health (6.7%). Among industries and occupations, the highest COPD prevalences were among workers in the information industry (3.3%) and office and administrative support occupations (3.3%). Among women, the highest prevalences were among those employed in the information industry (5.1%) and in the transportation and material moving occupation (4.5%), and among men, among those employed in the agriculture, forestry, fishing, and hunting industry (2.3%) and the administrative and support, waste management, and remediation services industry (2.3%). High COPD prevalences in certain industries and occupations among persons who have never smoked underscore the importance of continued surveillance, early identification of COPD, and reduction or elimination of COPD-associated risk factors, such as the reduction of workplace exposures to dust, vapors, fumes, chemicals, and exposure to indoor and outdoor air pollutants.

INTRODUCTION: Workplace tobacco control interventions reduce smoking and secondhand smoke exposure among U.S. workers. Data on smoke-free workplace policy coverage and cessation programs by industry and occupation are limited. This study assessed smoke-free workplace policies and employer-offered cessation programs among U.S. workers, by industry and occupation. METHODS: Data from the 2014-2015 Tobacco Use Supplement to the Current Population Survey, a random sample of the civilian, non-institutionalized population, were analyzed in 2018. Self-reported smoke-free policy coverage and employer-offered cessation programs were assessed among working adults aged >/=18 years, overall and by occupation and industry. Respondents were considered to have a 100% smoke-free policy if they indicated smoking was not permitted in any indoor areas of their workplace, and to have a cessation program if their employer offered any stop-smoking program within the past year. RESULTS: Overall, 80.3% of indoor workers reported having smoke-free policies at their workplace and 27.2% had cessation programs. Smoke-free policy coverage was highest among workers in the education services (90.6%) industry and lowest among workers in agriculture, forestry, fishing, and hunting industry (64.1%). Employer-offered cessation programs were significantly higher among workers reporting 100% smoke-free workplace policies (30.9%) than those with partial/no policies (23.3%) and were significantly higher among indoor workers (29.2%) than outdoor workers (15.0%). CONCLUSIONS: Among U.S. workers, 100% smoke-free policy and cessation program coverage varies by industry and occupation. Lower smoke-free policy coverage and higher tobacco use in certain industry and occupation groups suggests opportunities for workplace tobacco control interventions to reduce tobacco use and secondhand smoke exposure.

OBJECTIVE: The objective of the study is to examine associations between use of specific pesticides and lifetime allergic rhinitis and current asthma in US primary farm operators. METHODS: The 2011 Farm and Ranch Safety Survey data from 11,210 primary farm operators were analyzed. Pesticide use on the farm was determined using an affirmative response to the question of whether the operator ever mixed, loaded, or applied pesticides on their farm in the 12 months prior to the interview. Operators who answered "yes" were further asked about the specific trade name and formulation identifiers of the product they used and personal protective equipment (PPE) used. Data were weighted to produce national estimates. Adjusted prevalence odds ratios (PORs) were calculated using logistic regression. The referent group included operators who did not use any pesticides in the 12 months prior to the interview. RESULTS: Of an estimated 2.1 million farm operators, 40.0% used pesticides, 30.8% had lifetime allergic rhinitis, and 5.1% had current asthma. Insecticide and herbicide use were significantly associated with lifetime allergic rhinitis and current asthma. The use of 2,4-dichlorophenoxyacetic acid (POR = 1.5; 95% CI 1.2-1.9) and carbaryl (POR = 2.3; 1.4-3.7) was significantly associated with lifetime allergic rhinitis. Of operators using pesticides, 64.9% used PPE the last time they mixed, loaded, or applied pesticides. CONCLUSIONS: Pesticide use was associated with lifetime allergic rhinitis and current asthma among farm operators. Further studies are needed to clarify the dose-response relationship between pesticide use and adverse respiratory health effects.

BACKGROUND: Although cigarette smoking has declined among U.S. workers, smoking remains high among construction workers. This study assessed tobacco product use among U.S. construction workers. METHODS: The 2014-2016 National Health Interview Survey data for U.S. working adults were analyzed. RESULTS: Of the 10.2 (6.3% of working adults) million construction workers, 35.1% used any tobacco product; 24.4% were cigarette smokers, 8.3% were cigar, cigarillo, pipe or hookah smokers, 7.8% were smokeless tobacco users, 4.4% were e-cigarette users, and 7.6% used >/=2 tobacco product users. Tobacco use varied by worker characteristics, with highest tobacco use (>35%) among those reporting </=5 years on the job, temporary work status, job insecurity, or an unsafe workplace. Construction workers had higher odds of tobacco product use than non-construction workers. CONCLUSIONS: Over one-third of U.S. construction workers use tobacco products and disparities exist across sub-groups. Workplace tobacco control strategies could reduce tobacco use among this population.

OBJECTIVES: Youth on farms are at risk for injuries and illnesses, including asthma, which continues to disproportionately affect minority groups. METHODS: For this study, the 2008 Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS) data were used to estimate the prevalence of asthma among youth aged 0-19 years living on racial minority-operated farms. Youth were considered to have a lifetime diagnosis of asthma based on an affirmative response to the question "Has he/she ever been diagnosed as having asthma by a health professional?" RESULTS: In 2008, of the estimated 37,400 youth (0-19 years) who lived on racial minority operated farms, 11% had asthma. Asthma prevalence was highest among males (13%) and youth 10-19 years of age (12%). Asthma prevalence among youth varied by race, ranging from 13% among household youth living on Black/African American operated farms to 7% among youth living on Asian/Native Hawaiian/Pacific Islander operated farms. In 2008, nearly half (46%) of household youth (0-19 years) worked on the farm. The odds of having asthma were higher among working youth compared with non-working youth (POR, 1.5; 95% CI: 1.3-1.8). CONCLUSION: Disparities in asthma among youth living or working on racial minority-operated farms were observed. These findings may assist agricultural safety and health researchers, practitioners, and educators in identifying and designing targeted interventions to reduce asthma burden among youth on racial minority-operated farms.

In 2010, an estimated 8.2% of U.S. adults had current asthma, and among these persons, 49.1% had had an asthma attack during the past year (1). Workplace exposures can cause asthma in a previously healthy worker or can trigger asthma exacerbations in workers with current asthma* (2). To assess the industry- and occupation-specific prevalence of current asthma, asthma attacks, and asthma-related emergency department (ED) visits among working adults, CDC analyzed 2011-2016 National Health Interview Survey (NHIS) data for participants aged >/=18 years who, at the time of the survey, were employed at some time during the 12 months preceding the interview. During 2011-2016, 6.8% of adults (11 million) employed at any time in the past 12 months had current asthma; among those, 44.7% experienced an asthma attack, and 9.9% had an asthma-related ED visit in the previous year. Current asthma prevalence was highest among workers in the health care and social assistance industry (8.8%) and in health care support occupations (8.8%). The increased prevalence of current asthma, asthma attacks, and asthma-related ED visits in certain industries and occupations might indicate increased risks for these health outcomes associated with workplace exposures. These findings might assist health care and public health professionals in identifying workers in industries and occupations with a high prevalence of current asthma, asthma attacks, and asthma-related ED visits who should be evaluated for possible work-related asthma. Guidelines intended to promote effective management of work-related asthma are available (2,3).

In 2015, an estimated 18.4 million U.S. adults had current asthma, and 3,396 adult asthma deaths were reported (1). An estimated 11%-21% of asthma deaths might be attributable to occupational exposures (2). To describe asthma mortality among persons aged 15-64 years,* CDC analyzed multiple cause-of-death datafor 1999-2016 and industry and occupation information collected from 26 states( section sign) for the years 1999, 2003, 2004, and 2007-2012. Proportionate mortality ratios (PMRs)( paragraph sign) for asthma among persons aged 15-64 years were calculated. During 1999-2016, a total of 14,296 (42.9%) asthma deaths occurred among males and 19,011 (57.1%) occurred among females. Based on an estimate that 11%-21% of asthma deaths might be related to occupational exposures, during this 18-year period, 1,573-3,002 asthma deaths in males and 2,091-3,992 deaths in females might have resulted from occupational exposures. Some of these deaths might have been averted by instituting measures to prevent potential workplace exposures. The annual age-adjusted asthma death rate** per 1 million persons aged 15-64 years declined from 13.59 in 1999 to 9.34 in 2016 (p<0.001) among females, and from 9.14 (1999) to 7.78 (2016) (p<0.05) among males. The highest significantly elevated asthma PMRs for males were for those in the food, beverage, and tobacco products manufacturing industry (1.82) and for females were for those in the social assistance industry (1.35) and those in community and social services occupations (1.46). Elevated asthma mortality among workers in certain industries and occupations underscores the importance of optimal asthma management and identification and prevention of potential workplace exposures.

Cigarette smoking has declined considerably among U.S. adults over several decades (1); however, increases have occurred in the use of noncigarette tobacco products in recent years, and the use of multiple tobacco products has become common among current users of noncigarette tobacco products (2,3). Differences in tobacco use have also been observed across population subgroups, including among working adults (2,4). CDC analyzed National Health Interview Survey (NHIS) data for 2014-2016 to describe the most recent prevalence estimates of current (every day or some days) tobacco product use among working U.S. adults by industry and occupation. Among working adults, 22.1% (32.7 million) currently used any form of tobacco; 15.4% used cigarettes, 5.8% used other combustible tobacco (cigars, pipes, water pipes or hookahs, very small cigars, and bidis), 3.0% used smokeless tobacco, and 3.6% used electronic cigarettes (e-cigarettes); 4.6% (6.9 million) reported current use of two or more tobacco products. By industry, any tobacco use ranged from 11.0% among education services to 34.3% among construction workers; current use of two or more tobacco products was highest among construction workers (7.1%). By occupation, any tobacco use ranged from 9.3% among life, physical, and social science workers to 37.2% among installation, maintenance, and repair workers; current use of two or more tobacco products was highest among installation, maintenance, and repair workers (10.1%). Proven interventions to prevent and reduce tobacco product use, including current use of multiple products, among working adults are important (5,6). Workplace tobacco-control interventions have been especially effective in reducing cigarette smoking prevalence (7).

Malignant mesothelioma is a neoplasm associated with occupational and environmental inhalation exposure to asbestos fibers and other elongate mineral particles (EMPs). Patients have a median survival of approximately 1 year from the time of diagnosis. The latency period from first causative exposure to malignant mesothelioma development typically ranges from 20 to 40 years but can be as long as 71 years. Hazardous occupational exposures to asbestos fibers and other EMPs have occurred in a variety of industrial operations, including mining and milling, manufacturing, shipbuilding and repair, and construction. Current exposures to commercial asbestos in the United States occur predominantly during maintenance operations and remediation of older buildings containing asbestos. To update information on malignant mesothelioma mortality (5), CDC analyzed annual multiple cause-of-death records for 1999-2015, the most recent years for which complete data are available. During 1999-2015, a total of 45,221 deaths with malignant mesothelioma mentioned on the death certificate as the underlying or contributing cause of death were reported in the United States, increasing from 2,479 deaths in 1999 to 2,597 in 2015 (in the same time period the age-adjusted death rates section sign decreased from 13.96 per million in 1999 to 10.93 in 2015). Malignant mesothelioma deaths increased for persons aged ≥85 years, both sexes, persons of white, black, and Asian or Pacific Islander race, and all ethnic groups. Despite regulatory actions and the decline in use of asbestos the annual number of malignant mesothelioma deaths remains substantial. The continuing occurrence of malignant mesothelioma deaths underscores the need for maintaining measures to prevent exposure to asbestos fibers and other causative EMPs and for ongoing surveillance to monitor temporal trends.

OBJECTIVE: The aim of this study was to examine tobacco use among working adults at least 18 years of age. METHODS: The 2012 to 2014 National Health Interview Survey (n = 105,779) was used to estimate prevalences for cigarette smoking, other combustible tobacco use, and smokeless tobacco use and prevalence odds ratios (PORs) for any tobacco product use among working adults at least 18 years of age, by industry and occupation. RESULTS: Of the estimated 144 million currently employed adults, 17% were cigarette smokers, 7.0% other noncigarette combustible tobacco users, and 3.4% smokeless tobacco users. Odds of using tobacco varied by sociodemographic characteristics and by industry and occupations. CONCLUSIONS: Disparities in tobacco use exist among working adults. Continued implementation of proven interventions to prevent and reduce all forms of tobacco use among U.S. workers is warranted, particularly among those workers with a higher burden of use.

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver a heated aerosol, which typically contains nicotine, flavorings, and other additives, to the user. The e-cigarette marketplace is rapidly evolving, but the long-term health effects of these products are not known. Carcinogens and toxins such as diacetyl, acetaldehyde, and other harmful chemicals have been documented in the aerosol from some e-cigarettes (1-3). On May 5, 2016, the Food and Drug Administration (FDA) finalized a rule extending its authority to all tobacco products, including e-cigarettes.* The prevalence of e-cigarette use among U.S. adults has increased in recent years, particularly among current and former conventional cigarette smokers (4); in 2014, 3.7% of all U.S. adults, including 15.9% of current cigarette smokers, and 22.0% of former cigarette smokers, used e-cigarettes every day or some days (5). The extent of current e-cigarette use among U.S. working adults has not been assessed. Therefore, CDC analyzed 2014 National Health Interview Survey (NHIS) data for adults aged ≥18 years who were working during the week before the interview, to provide national estimates of current e-cigarette use among U.S. working adults by industry and occupation. Among the estimated 146 million working adults, 3.8% (5.5 million) were current (every day or some days) e-cigarette users; the highest prevalences were among males, non-Hispanic whites, persons aged 18-24 years, persons with annual household income <$35,000, persons with no health insurance, cigarette smokers, other combustible tobacco users, and smokeless tobacco users. By industry and occupation, workers in the accommodation and food services industry and in the food preparation and serving-related occupations had the highest prevalence of current e-cigarette use. Higher prevalences of e-cigarette use among specific groups and the effect of e-cigarette use on patterns of conventional tobacco use underscore the importance of continued surveillance of e-cigarette use among U.S. working adults to inform public health policy, planning, and practice.