産業衛生とタバコ 労働災害とタバコ メンタルヘルスとタバコ 糖尿病と職場の受動喫煙 検診異常所見率とタバコ 2009年3月4日

Presentation on theme: "産業衛生とタバコ 労働災害とタバコ メンタルヘルスとタバコ 糖尿病と職場の受動喫煙 検診異常所見率とタバコ 2009年3月4日"— Presentation transcript:

1 産業衛生とタバコ 労働災害とタバコ メンタルヘルスとタバコ 糖尿病と職場の受動喫煙 検診異常所見率とタバコ 2009年3月4日
松崎道幸（日本禁煙学会理事）

2 労働安全とタバコ 労働災害とタバコ 喫煙で労災増加 受動喫煙でも増加の可能性

3 労働災害発生要因 喫煙 短期 雇用 飲酒 インド化学工場調査．2008年 7.29倍 2.51倍 1.01倍
1: Ind Health Apr;46(2): Factors of occupational injury: a survey in a chemical company. Saha A, Kumar S, Vasudevan DM. Occupational Medicine Division, National Institute of Occupational Health, Gujarat, India. Chemical industries being the seat of dangerous occurrences frequently resulting in injuries, an occupational injury surveillance study was initiated involving 307 permanent and 419 temporary workers in a chemical company to understand the contribution of different possible factors on injury causation. Risk calculation was undertaken in relation to every individual factor using univariate and multivariate analysis techniques. Workers of lower age were found to be more susceptible to accidents (as evidenced by negative correlation coefficient), though non-significantly. Lower job duration (experience) had a significant impact on injury causation (correlation coefficient , p<0.05). Alcohol habit could not show any significant impact but smoking/chewing habit showed significant effect (OR, 7.29: 95% CI, ) on accident occurrence. Nature of job had no significant impact but nature of employment was found to have considerable effect on the causation of injuries. Temporary nature of employment was at greater risk (OR, 2.51: 95% CI, ) in comparison to permanent workers. PMID: [PubMed - indexed for MEDLINE] 短期 雇用 1.01倍 飲酒 Saha et .al. Factors of occupational injury: a survey in a chemical company. Ind Health Apr;46(2):152-7.

4 30歳未満 1.47倍 現職5年未満 1.43倍 不眠症 1.30倍 喫煙 1.27倍 労働災害発生リスク 2004年 フランス鉄道従業員
2004年　フランス鉄道従業員 30歳未満　　　 1.47倍 現職5年未満　 1.43倍 不眠症　　　　　 1.30倍 喫煙　　　　　　　 1.27倍 1: J Occup Health Jul;46(4): Correlates of occupational injuries for various jobs in railway workers: a case-control study. Chau N, Mur JM, Touron C, Benamghar L, Dehaene D. National Institute for Health and Medical Research (Inserm), Unit 420, Faculté de Medecine, Vandoeuvre-lès-Nancy, France. Few studies have simultaneously addressed the role of occupational factors, individual characteristics and living conditions in occupational injuries, and to the best of our knowledge none on railway workers. This survey assessed the roles of these factors in various types of injuries and for various jobs in French railway workers. This case-control study was conducted on 1,305 male workers with an occupational injury during a one-year period and 1,305 male controls. A standardized questionnaire was administrated by an occupational physician. Data were analyzed by the logistic regression method. The significant factors found for all the injuries combined were: young age (<30 yr) (adjusted odds ratio 1.47, 95% CI ), 5 yr or less in present job (1.43, ), sleep disorders (1.30, ), current smoker (1.27, ), and no do-it-yourself or gardening activity (1.23, ). Young age, sleep disorders, and smoking were common for several types of injuries. The role of these factors differed between various job categories. Among injured workers sick leaves of eight days or over were more frequent in current smokers and overweight subjects. In conclusion, young age, lack of experience, job dissatisfaction, sleep disorders, smoking, and lack of physical activity increase the risk of occupational injuries. The risks induced were related with jobs. Preventive measures concerning work conditions and these factors could be conducted in railway workers generally, and especially in workers most at risk. The occupational physician could make workers more sensitive to these risks and help them to improve their living conditions during medical examinations. PMID: [PubMed - indexed for MEDLINE] 30歳未満　1.47 現職5年未満　1.43 不眠症　1.30 喫煙　1.27 1: J Occup Health Jul;46(4): Correlates of occupational injuries for various jobs in railway workers: a case-control study. Chau N, Mur JM, Touron C, Benamghar L, Dehaene D. National Institute for Health and Medical Research (Inserm), Unit 420, Faculté de Medecine, Vandoeuvre-lès-Nancy, France. Few studies have simultaneously addressed the role of occupational factors, individual characteristics and living conditions in occupational injuries, and to the best of our knowledge none on railway workers. This survey assessed the roles of these factors in various types of injuries and for various jobs in French railway workers. This case-control study was conducted on 1,305 male workers with an occupational injury during a one-year period and 1,305 male controls. A standardized questionnaire was administrated by an occupational physician. Data were analyzed by the logistic regression method. The significant factors found for all the injuries combined were: young age (<30 yr) (adjusted odds ratio 1.47, 95% CI ), 5 yr or less in present job (1.43, ), sleep disorders (1.30, ), current smoker (1.27, ), and no do-it-yourself or gardening activity (1.23, ). Young age, sleep disorders, and smoking were common for several types of injuries. The role of these factors differed between various job categories. Among injured workers sick leaves of eight days or over were more frequent in current smokers and overweight subjects. In conclusion, young age, lack of experience, job dissatisfaction, sleep disorders, smoking, and lack of physical activity increase the risk of occupational injuries. The risks induced were related with jobs. Preventive measures concerning work conditions and these factors could be conducted in railway workers generally, and especially in workers most at risk. The occupational physician could make workers more sensitive to these risks and help them to improve their living conditions during medical examinations. PMID: [PubMed - indexed for MEDLINE] Related Links Relationships between certain individual characteristics and occupational injuries for various jobs in the construction industry: a case-control study. [Am J Ind Med. 2004] PMID: Determinants of accident proneness: a case-control study in railway workers. [Occup Med (Lond). 2006] PMID: Relationships of working conditions and individual characteristics to occupational injuries: a case-control study in coal miners. [J Occup Health. 2004] PMID: Relationships of job, age, and life conditions with the causes and severity of occupational injuries in construction workers. [Int Arch Occup Environ Health. 2004] PMID: Contributions of occupational hazards and human factors in occupational injuries and their associations with job, age and type of injuries in railway workers. [Int Arch Occup Environ Health. 2007] PMID: Chau et al. Correlates of occupational injuries for various jobs in railway workers: a case-control study. J Occup Health Jul;46(4):

5 喫煙による労働災害リスク増加 2.91 (1.00-8.42) 2.52 (1.79-3.55) 1.53 (1.13-2.07)
報告･対象･調査法 喫煙者の労働災害リスク （非喫煙者=1） 調整因子 Wenら(2005年) 前向き調査 公務員･教師64319名(男性100%) 2.91 ( ) 年令･飲酒習慣 Olecknoら（1987） 症例対照調査 労災入院患者869名（男性82％） 2.52 ( ) 年令・性・飲酒習慣 Gauchardら（2003） 鉄道労働者854名（男性100％） 1.53 ( ) 年令・肥満指数・職業経験・飲酒習慣・ストレス・身体症状・不安・うつ病・収入 Ryanら(1992) 郵便労働者2537名（男性66%） 1.40 ( ) 年令･性･人種･薬物使用･運動習慣･職業分類 Chauら（2004） 建設労働者1768名（男性100％） 1.27 ( ) 年令・職業経験・身体活動度・身体障害・不眠症 独立行政法人 労働安全衛生総合研究所論文の表を松崎改変 1: Soc Sci Med Nov;63(9): Epub 2006 Jul 25. Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. Nakata A, Ikeda T, Takahashi M, Haratani T, Hojou M, Fujioka Y, Araki S. National Institute of Occupational Safety and Health, Japan. Active smoking is a risk factor for occupational injury, whereas its association with passive smoking is unknown. To evaluate the contribution of active and passive smoking to non-fatal occupational injury in manufacturing sectors, 2302 randomly selected workers aged years working in 244 small- and medium-scale enterprises in Yashio city, Japan, were surveyed by means of a self-administered questionnaire. Smoking history, exposure to passive smoking, and occupational injury were evaluated by self-report. Exposure levels to passive smoking were assessed separately at work and at home as never, occasional, or regular exposure. Overall, 61.4% of men and 22.3% of women were current smokers. Among never smokers, 62.2% of men and 68.6% of women reported exposure to passive smoking either at work or home. Prevalence of occupational injuries was 36.2% for never, 43.3% for former, and 41.2% for current smokers among men and 19.7% for never, 22.2% for former, and 25.2% for current smokers among women. Among never smoking men, odds ratios (ORs) of occupational injury were 2.11 when regularly exposed to passive smoking at work or at home (p=0.025), 2.27 at work (p=0.015), and 3.08 at home (p=0.106), in comparison to never smoking men who were never exposed to passive smoking either at work or at home (referent group). These associations were attenuated to be non-significant, after controlling for potential confounders. Never smoking men with occasional exposure to passive smoking were not significant ORs ( ). In contrast, current and former smoking men had significant increases in adjusted ORs ( ). In women exposed to smoking there was a non-significant increase in occupational injury. The present study indicates an expected increase in the risk of, occupational injury for current and former smoking men and suggests that exposure to passive smoking is a possible risk factor for never smoking men. PMID: [PubMed - indexed for MEDLINE] Related Links Active and passive smoking and depression among Japanese workers. [Prev Med. 2008] PMID: Passive and active smoking and breast cancer risk in Canada, [Cancer Causes Control. 2000] PMID: Passive smoking as well as active smoking increases the risk of acute stroke. [Tob Control. 1999] PMID: The prevalence and correlates of occupational injuries in small-scale manufacturing enterprises. [J Occup Health. 2006] PMID: Correlates of active and passive smoking in the California Teachers Study cohort. [J Womens Health (Larchmt). 2004] PMID: Nakata A et al. Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. Soc Sci Med Nov;63(9):

6 喫煙習慣別労働災害リスク 労働災害リスク 非喫煙者 喫煙者 1.58 1.00
対象：非致死性労働災害・八潮市中小企業製造業労働者2302名･無作為抽出 独立行政法人 労働安全衛生総合研究所．東京大学．2006年 労働災害リスク 1.58 1.00 独立行政法人 労働安全衛生総合研究所 男性　　　　　　　労災リスク 非喫煙者376（27）　　1.00 禁煙者171（12）　　　1.99（ ） 喫煙者869（61）　　　 1.57（ ） 　　 合計1416 1: Soc Sci Med Nov;63(9): Epub 2006 Jul 25. Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. Nakata A, Ikeda T, Takahashi M, Haratani T, Hojou M, Fujioka Y, Araki S. National Institute of Occupational Safety and Health, Japan. Active smoking is a risk factor for occupational injury, whereas its association with passive smoking is unknown. To evaluate the contribution of active and passive smoking to non-fatal occupational injury in manufacturing sectors, 2302 randomly selected workers aged years working in 244 small- and medium-scale enterprises in Yashio city, Japan, were surveyed by means of a self-administered questionnaire. Smoking history, exposure to passive smoking, and occupational injury were evaluated by self-report. Exposure levels to passive smoking were assessed separately at work and at home as never, occasional, or regular exposure. Overall, 61.4% of men and 22.3% of women were current smokers. Among never smokers, 62.2% of men and 68.6% of women reported exposure to passive smoking either at work or home. Prevalence of occupational injuries was 36.2% for never, 43.3% for former, and 41.2% for current smokers among men and 19.7% for never, 22.2% for former, and 25.2% for current smokers among women. Among never smoking men, odds ratios (ORs) of occupational injury were 2.11 when regularly exposed to passive smoking at work or at home (p=0.025), 2.27 at work (p=0.015), and 3.08 at home (p=0.106), in comparison to never smoking men who were never exposed to passive smoking either at work or at home (referent group). These associations were attenuated to be non-significant, after controlling for potential confounders. Never smoking men with occasional exposure to passive smoking were not significant ORs ( ). In contrast, current and former smoking men had significant increases in adjusted ORs ( ). In women exposed to smoking there was a non-significant increase in occupational injury. The present study indicates an expected increase in the risk of, occupational injury for current and former smoking men and suggests that exposure to passive smoking is a possible risk factor for never smoking men. PMID: [PubMed - indexed for MEDLINE] Related Links Active and passive smoking and depression among Japanese workers. [Prev Med. 2008] PMID: Passive and active smoking and breast cancer risk in Canada, [Cancer Causes Control. 2000] PMID: Passive smoking as well as active smoking increases the risk of acute stroke. [Tob Control. 1999] PMID: The prevalence and correlates of occupational injuries in small-scale manufacturing enterprises. [J Occup Health. 2006] PMID: Correlates of active and passive smoking in the California Teachers Study cohort. [J Womens Health (Larchmt). 2004] PMID: 非喫煙者 喫煙者 Nakata A et al. Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. Soc Sci Med Nov;63(9):

7 非喫煙者の労働災害リスク：受動喫煙状態別
対象：非致死性労働災害・八潮市中小企業製造業労働者2302名･無作為抽出独立行政法人 労働安全衛生総合研究所．東京大学．2006年 有意差はないが,傾向が覗える 労働災害リスク 1.72 1.11 1.00 独立行政法人 労働安全衛生総合研究所 1: Soc Sci Med Nov;63(9): Epub 2006 Jul 25. Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. Nakata A, Ikeda T, Takahashi M, Haratani T, Hojou M, Fujioka Y, Araki S. National Institute of Occupational Safety and Health, Japan. Active smoking is a risk factor for occupational injury, whereas its association with passive smoking is unknown. To evaluate the contribution of active and passive smoking to non-fatal occupational injury in manufacturing sectors, 2302 randomly selected workers aged years working in 244 small- and medium-scale enterprises in Yashio city, Japan, were surveyed by means of a self-administered questionnaire. Smoking history, exposure to passive smoking, and occupational injury were evaluated by self-report. Exposure levels to passive smoking were assessed separately at work and at home as never, occasional, or regular exposure. Overall, 61.4% of men and 22.3% of women were current smokers. Among never smokers, 62.2% of men and 68.6% of women reported exposure to passive smoking either at work or home. Prevalence of occupational injuries was 36.2% for never, 43.3% for former, and 41.2% for current smokers among men and 19.7% for never, 22.2% for former, and 25.2% for current smokers among women. Among never smoking men, odds ratios (ORs) of occupational injury were 2.11 when regularly exposed to passive smoking at work or at home (p=0.025), 2.27 at work (p=0.015), and 3.08 at home (p=0.106), in comparison to never smoking men who were never exposed to passive smoking either at work or at home (referent group). These associations were attenuated to be non-significant, after controlling for potential confounders. Never smoking men with occasional exposure to passive smoking were not significant ORs ( ). In contrast, current and former smoking men had significant increases in adjusted ORs ( ). In women exposed to smoking there was a non-significant increase in occupational injury. The present study indicates an expected increase in the risk of, occupational injury for current and former smoking men and suggests that exposure to passive smoking is a possible risk factor for never smoking men. PMID: [PubMed - indexed for MEDLINE] Related Links Active and passive smoking and depression among Japanese workers. [Prev Med. 2008] PMID: Passive and active smoking and breast cancer risk in Canada, [Cancer Causes Control. 2000] PMID: Passive smoking as well as active smoking increases the risk of acute stroke. [Tob Control. 1999] PMID: The prevalence and correlates of occupational injuries in small-scale manufacturing enterprises. [J Occup Health. 2006] PMID: Correlates of active and passive smoking in the California Teachers Study cohort. [J Womens Health (Larchmt). 2004] PMID: なし 時々あり 常にあり 職場の受動喫煙 Nakata A et al. Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. Soc Sci Med Nov;63(9):

8 メンタルヘルスとタバコ うつ状態とタバコ 喫煙でうつ病リスク増加 職場の受動喫煙でうつ状態悪化

9 喫煙者はうつ病になりやすい：日本人男性 6.5＊ うつ病罹患率％ ＊(p<0.05) 2.7 2.4 非喫煙者 禁煙者 喫煙者
1: J Occup Health Nov;46(6): Relationship between smoking and major depression in a Japanese workplace. Takeuchi T, Nakao M, Yano E. Department of Hygiene and Public Health, Teikyo University School of Medicine, Japan. PMID: [PubMed - indexed for MEDLINE] Related Links Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? [J Affect Disord. 2005] PMID: Relationship between metabolic syndrome and cigarette smoking in the Japanese population. [Intern Med. 2006] PMID: [Frequency of smoking, drinking, and substance use and their relationship to psychiatric comorbidity in children and adolescents with depression] [Psychiatr Hung. 2006] PMID: Work stress as a risk factor for major depressive episode(s). [Psychol Med. 2005] PMID: Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. [Am J Psychiatry. 2006] PMID: 大うつ病頻度（％） 　　　　男　　　女 喫煙者　6.5　　7.4 禁煙者　2.4　　18.8 非喫煙者2.7　　2.8 (p<0.05) 非喫煙者 禁煙者 喫煙者

10 喫煙者と職場受動喫煙者は 「うつ」のリスクが高い Nakata 他. 米国国立労働安全衛生研究所．2008年．
対象:東京近郊労働者2770名．(大半が製造業) 1: Prev Med May;46(5): Epub 2008 Feb 9. Active and passive smoking and depression among Japanese workers. Nakata A, Takahashi M, Ikeda T, Hojou M, Nigam JA, Swanson NG. Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA. OBJECTIVE: To assess the relation of passive and active smoking to depressive symptoms in 1839 men and 931 women working in a suburb of Tokyo in METHOD: Self-reported smoking history and exposure to passive smoking (no, occasional, or regular) at work and at home. Depressive symptoms according to the Center for Epidemiologic Studies Depression Scale, with a cut-off point of 16. RESULTS: Compared to never smokers unexposed to passive smoking, never smokers reporting regular and occasional exposure to passive smoking at work had increased depressive symptoms. The adjusted odds ratios (aORs) were 1.92 (95% confidence interval (CI) 1.14, 3.23) for regular exposure and 1.63 (95% CI 1.08, 2.47) for occasional exposure. Current smokers had significantly increased depressive symptoms (aOR ranging from 2.25 to 2.38) but former smokers had only marginal increases of depressive symptoms (aOR ranging from 1.43 to 1.55). Gender did not modify the effects of active/passive smoking on depressive symptoms. CONCLUSION: Passive smoking at work and current smoking appear associated with higher levels of depressive symptoms. PMID: [PubMed - indexed for MEDLINE] Related Links Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. [Soc Sci Med. 2006] PMID: Clinically relevant levels of depressive symptoms in community-dwelling middle-aged African Americans. [J Am Geriatr Soc. 2004] PMID: Passive and active smoking and breast cancer risk in Canada, [Cancer Causes Control. 2000] PMID: Active smoking, household passive smoking, and breast cancer: evidence from the California Teachers Study. [J Natl Cancer Inst. 2004] PMID: Association of active and passive smoking with sleep disturbances and short sleep duration among japanese working population. [Int J Behav Med. 2008] PMID: Nakata et al. Active and passive smoking and depression among Japanese workers. Prev Med May;46(5):451-6.

11 能動喫煙と職場の受動喫煙は 「うつ」のリスクを高める うつ状態リスク 喫煙者 非喫煙者 2.25 ＊ ＊有意差あり 1.63 ＊ 1.00
Nakata 他. 米国国立労働安全衛生研究所．2008年． 対象:東京近郊労働者2770名．(大半が製造業) Nakata A et al. Active and passive smoking and depression among Japanese workers. Prev Med May;46(5):451-6. うつ状態リスク 2.25 ＊ ＊有意差あり 1.63 ＊ 1.00 職場受動喫煙なし非喫煙者1.00 職場受動喫煙あり非喫煙者1.63 ( ) 禁煙者1.43( ) 喫煙者2.25( ) 1: Prev Med May;46(5): Epub 2008 Feb 9. Active and passive smoking and depression among Japanese workers. Nakata A, Takahashi M, Ikeda T, Hojou M, Nigam JA, Swanson NG. Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA. OBJECTIVE: To assess the relation of passive and active smoking to depressive symptoms in 1839 men and 931 women working in a suburb of Tokyo in METHOD: Self-reported smoking history and exposure to passive smoking (no, occasional, or regular) at work and at home. Depressive symptoms according to the Center for Epidemiologic Studies Depression Scale, with a cut-off point of 16. RESULTS: Compared to never smokers unexposed to passive smoking, never smokers reporting regular and occasional exposure to passive smoking at work had increased depressive symptoms. The adjusted odds ratios (aORs) were 1.92 (95% confidence interval (CI) 1.14, 3.23) for regular exposure and 1.63 (95% CI 1.08, 2.47) for occasional exposure. Current smokers had significantly increased depressive symptoms (aOR ranging from 2.25 to 2.38) but former smokers had only marginal increases of depressive symptoms (aOR ranging from 1.43 to 1.55). Gender did not modify the effects of active/passive smoking on depressive symptoms. CONCLUSION: Passive smoking at work and current smoking appear associated with higher levels of depressive symptoms. PMID: [PubMed - indexed for MEDLINE] Related Links Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. [Soc Sci Med. 2006] PMID: Clinically relevant levels of depressive symptoms in community-dwelling middle-aged African Americans. [J Am Geriatr Soc. 2004] PMID: Passive and active smoking and breast cancer risk in Canada, [Cancer Causes Control. 2000] PMID: Active smoking, household passive smoking, and breast cancer: evidence from the California Teachers Study. [J Natl Cancer Inst. 2004] PMID: Association of active and passive smoking with sleep disturbances and short sleep duration among japanese working population. [Int J Behav Med. 2008] PMID: なし　　　　　　あり 職場の受動喫煙 喫煙者 非喫煙者

12 受動喫煙と糖尿病 職場の受動喫煙で糖尿病倍増

13 2008年04月03日朝日新聞

14 職場の受動喫煙で糖尿病リスクが８１％増加：日本
3.4年追跡調査。日本　HIPOP-OHP study.調整因子:年齢、性、BMI、運動習慣、飲酒、糖尿病家族歴、血圧、健診受診歴、甘味飲料摂取、野菜摂取、脂肪摂取 糖尿病発病リスク 1.99 ＊ 1.81 ＊ ＊有意差あり 1.00 1: Diabetes Care Apr;31(4): Epub 2008 Jan 30. A prospective study of passive smoking and risk of diabetes in a cohort of workers: the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study. Hayashino Y, Fukuhara S, Okamura T, Yamato H, Tanaka H, Tanaka T, Kadowaki T, Ueshima H; HIPOP-OHP Research Group. Collaborators: Okayama A, Sakata K, Tsuji K, Yoshita K, Takebayashi T, Kikuchi Y, Nakagawa H, Miura K, Chiba N, Yanagita M, Kodama K, Kasagi F, Nishi N, Kusaka Y, Saitoh S, Nakamura M, Naito Y, Nakamura Y, Watanabe M, Nakamura Y, Babazono A, Tamura U, Minai J, Yamagata Z, Urano S, Kinoshita F, Saitoh I, Tanihara S, Tamaki J, Tochikubo O, Nakayama T, Fukuhara S, Fujieda Y, Naito M, Mizushima S, Miyoshi Y, Tada T, Yoshida T, Ide M. Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Sakyo-ku, Kyoto , Japan. OBJECTIVE: We investigated the impact of active smoking and exposure to passive smoke on the risk of developing diabetes. RESEARCH DESIGN AND METHODS: Data were analyzed from a cohort of participants in the High-Risk and Population Strategy for Occupational Health Promotion Study (HIPOP-OHP) conducted in Japan from 1999 to Active and passive smoking status in the workplace was evaluated at baseline. RESULTS: Of 6,498 participants (20.9% women), a total of 229 diabetes cases were reported over a median 3.4 years of follow-up. In the workplace, compared with zero-exposure subjects, the multivariable-adjusted hazard ratios of developing diabetes were 1.81 (95% CI , P = 0.028) for present passive subjects and 1.99 ( , P = 0.002) for present active smokers. CONCLUSIONS: In this cohort, exposure to passive smoke in the workplace was associated with an increased risk of diabetes after adjustment for a large number of possible confounders. 【調整因子】年齢、性、BMI、運動習慣、飲酒、糖尿病家族歴、血圧、健診受診歴、甘味飲料摂取、野菜摂取、脂肪摂取 なし　　　　　　あり 職場の受動喫煙 喫煙者 非喫煙者 Hayashino（京大）ら　 Diabetes Care Apr;31(4):732-4.

15 耐糖能異常出現リスク： 受動喫煙で35％、能動喫煙で65％増加：米国 糖尿病発病リスク 喫煙者 非喫煙者 なし あり 受動喫煙 1.65 ＊
18-30 才男女15年追跡調査．米国CARDIA研究.調整因子:性、年齢、人種、学歴、収入、血圧、中性脂肪、飲酒、BMI、喫煙状態の変化　尿中コチニンで受動喫煙状態判別 1.65 ＊ 1.35＊ 1.00 1: BMJ May 6;332(7549): Epub 2006 Apr 7. Erratum in: BMJ Jun 3;332(7553):1298. Comment in: BMJ May 6;332(7549): Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study. Houston TK, Person SD, Pletcher MJ, Liu K, Iribarren C, Kiefe CI. Deep South Center on Effectiveness Research, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA. OBJECTIVE: To assess whether active and passive smokers are more likely than non-smokers to develop clinically relevant glucose intolerance or diabetes. DESIGN: Coronary artery risk development in young adults (CARDIA) is a prospective cohort study begun in with 15 years of follow-up. SETTING: Participants recruited from Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California, USA. PARTICIPANTS: Black and white men and women aged years with no glucose intolerance at baseline, including 1386 current smokers, 621 previous smokers, 1452 never smokers with reported exposure to secondhand smoke (validated by serum cotinine concentrations 1-15 ng/ml), and 1113 never smokers with no exposure to secondhand smoke. MAIN OUTCOME MEASURE: Time to development of glucose intolerance (glucose > or = 100 mg/dl or taking antidiabetic drugs) during 15 years of follow-up. RESULTS: Median age at baseline was 25, 55% of participants were women, and 50% were African-American. During follow-up, 16.7% of participants developed glucose intolerance. A graded association existed between smoking exposure and the development of glucose intolerance. The 15 year incidence of glucose intolerance was highest among smokers (21.8%), followed by never smokers with passive smoke exposure (17.2%), and then previous smokers (14.4%); it was lowest for never smokers with no passive smoke exposure (11.5%). Current smokers (hazard ratio 1.65, 95% confidence interval 1.27 to 2.13) and never smokers with passive smoke exposure (1.35, 1.06 to 1.71) remained at higher risk than never smokers without passive smoke exposure after adjustment for multiple baseline sociodemographic, biological, and behavioural factors, but risk in previous smokers was similar to that in never smokers without passive smoke exposure. CONCLUSION: These findings support a role of both active and passive smoking in the development of glucose intolerance in young adulthood. Publication Types: Multicenter Study Research Support, N.I.H., Extramural PMID: [PubMed - indexed for MEDLINE] 【調整因子】adjustment for baseline sociodemographic factors (age, sex, race, years of education, family income (year 5)) and for baseline biological and behavioural factors—systolic blood pressure, triglycerides, alcohol consumption, body mass index, and change in smoking (starting for never smokers and previous smokers and stopping for current smokers) collected during follow-up 性、年齢、人種、学歴、収入、血圧、中性脂肪、飲酒、BMI、喫煙状態の変化 なし　　　　　　あり 受動喫煙 喫煙者 非喫煙者 Houstonら: BMJ May 6;332(7549): 　

16 職場を完全禁煙にすると喫煙者が減り、受動喫煙も減るためであろう
禁煙の職場ほど働く人が健康。 完全禁煙で異常率が半減 職場を完全禁煙にすると喫煙者が減り、受動喫煙も減るためであろう

17 産衛誌2005; 47: 139–141

18 異常所見率 職場の喫煙規制別 検診異常率 高脂血症 肥満 完全禁煙 分煙 自由喫煙 異常所見率（全体） 肝機能異常 高血圧 高血糖
産衛誌2005; 47: 139–141 ％ 60 異常所見率 職場の喫煙規制別 検診異常率 秋田大学調査　2005年 40 高脂血症 肥満 肝機能異常 20 高血圧 　　　　　　　完全禁煙　分煙　自由喫煙 検診有所見率　35.7　　　59.1　　72.4 高血圧　　　　　　 3.4　　　12.9　　17.9 肝機能異常　　　 6.3　　　15.1　　20.3 高脂血症　　　 　　　29.0　　33.3 高血糖　　　 　3.4　　 　6.7　　10.0 心電図異常　 　0.0　　　 7.3　 　9.5 肥満　　　　　 　　　15.3　 21.4 難聴（4khz） 　0.0　　　 　12.9 難聴 高血糖 心電図異常 完全禁煙 分煙 自由喫煙 職場の喫煙規制状況

19 結論 喫煙は、労働災害、うつ病、糖尿病のリスクを大きく増やす 健診異常所見率は完全禁煙の職場の労働者において最低である 雇用者の禁煙と職場の完全禁煙を推進することが産業衛生上の重要緊急課題である 産業医が自ら禁煙の手本を示すことが期待される