For most workers, cigarette smoking poses a greater health danger than occupational hazards do, and may greatly compound the risk of lung disease or cancer posed by some harmful substances in the workplace, the surgeon general warned yesterday.
In his annual report to Congress, Dr. C. Everett Koop urged stronger efforts to reduce smoking by all workers, saying that "for the majority of American workers, cigarette smoking represents a greater cause of death and disability than their workplace environment."
He said antismoking efforts are crucial in attempts to reduce chronic lung disease and cancer among workers who might be exposed to hazardous substances such as asbestos, coal dust, silica, cotton dust and radiation, all known to have adverse effects on the lungs.
But, Koop added, "smoking cessation efforts are an adjunct to, and not a substitute for, occupational environmental controls."
The report is the 17th in a series from the Department of Health and Human Services that began with the 1964 report that indicted smoking as the major cause of lung cancer.
The newest report immediately drew fire from the tobacco industry and from organized labor. However,the American Lung Association and the American Heart Association supported the report's findings. The AFL-CIO, long critical of the Reagan administration's occupational health program, issued a statement charging that the report "will seriously set back efforts to protect the health of American workers." It said the report might undermine efforts to control workplace hazards, make it more difficult to obtain compensation for occupationally related diseases, and "be used by those who are responsible for poisoning workers to avoid legal liability."
The Tobacco Institute, the industry trade organization, called it a "political rather than a scientific document" and asked: "Is it intended to shift the focus from workplace hazards to life styles, thus raising questions about obligations to maintain clean workplaces?"
At a news conference yesterday, Koop said the union statement was "a misinterpretation of our report." He said the report was not intended to minimize occupational risk but to make "clear that the elimination of occupationally related chronic lung disease should not, and frequently cannot, proceed without a companion effort to alter smoking behavior in workers."
He said smoking may often combine with occupational exposure to increase the health risks dramatically, with asbestos exposure the best known example.
Among highly exposed asbestos workers who do not smoke, the risk of lung cancer is five times greater than among nonsmokers not exposed to asbestos, Koop said. There is also a 10-fold greater risk among men who smoke but are not asbestos workers. But "the risk is more than 50-fold if the asbestos worker also smokes, and is even higher, almost 90 times, if the asbestos worker smokes more than a pack of cigarettes daily," Koop said.
The report stressed that smoking is far more common among male blue-collar workers than white-collar workers, with a less pronounced difference among working women. The highest rate is among black male blue-collar workers. Overall, 47 percent of blue-collar men smoke -- an even higher percentage among painters, truck drivers and construction workers -- compared to 33 percent among white-collar professionals. Electronic engineers, lawyers and high school teachers smoke the least.
Blue-collar workers have not been as successful in giving up smoking, even though a majority of workers in both groups have made a serious attempt to quit, the report said. And many blue-collar workers start smoking earlier.
Koop, who has called for a "smoke-free society by the year 2000," said he believes that smoking should be banned in the workplace. This should not mean that workers should be fired or discriminated against, he said, but programs should be offered to help them give up the "addictive habit."
He noted that many companies have successfully instituted antismoking efforts. The report said that at least 11 percent of U.S. businesses provide smoking-reduction plans. It said smokers cost their employers about $200 to $500 more annually than nonsmokers and have more work-related accidents, disability payments and absenteeism.