Paradoxical increase in cigarette smuggling after the market opening in Taiwan.

OBJECTIVES: To assess the magnitude of cigarette smuggling after the market opened in Taiwan. METHODS: Review of tobacco industry documents for references to smuggling activities related to Taiwan and government statistics on seizure of smuggled cigarettes. RESULTS: The market opening in 1987 led to an increase in smuggling. Contraband cigarettes became as available as legal ones, with only a small fraction (8%) being seized. Being specifically excluded from the market-opening, Japan entered the Taiwan market by setting up a Swiss plant as a legal cover for smuggling 10-20 times its legal quota of exports to Taiwan. Smuggling in Taiwan contributed to increased consumption of foreign brands, particularly by the young. Taiwan, not a member of the World Health Organization, was excluded from the East Asian 16-member "Project Crocodile", a regional anti-smuggling collaborative effort to implement the Framework Convention on Tobacco Control. CONCLUSIONS: Taiwan showed a sharp increase in smuggling after market liberalisation. Being excluded from the international community, Taiwan faces an uphill battle to fight smuggling alone. If Taiwan remained as its weakest link, global efforts to reduce tobacco use will be undermined, particularly for countries in the East Asian region.

Effects of flux enhancing polymer on the characteristics of sludge in membrane bioreactor process.

A newly developed membrane performance enhancer (MPE) was used to prevent membrane fouling in a membrane bioreactor (MBR) process. It transpired that 1,000 mg/l of MPE reduced polysaccharide levels from 41 mg/I to 21 mg/I on average under the experimental condition. Repeated experiments also confirmed that 50-1,000 mg/l of MPE could reduce membrane fouling significantly and increase the intervals between membrane cleanings. Depending on MPE dosages and experimental conditions, trans-membrane pressure (TMP) increase was suppressed for 20-30 days, while baseline TMP surged within a few days. In addition, MPE allowed MBR operation even at 50,000 mg/l of total solid and reduced permeate COD. However, no evidence of toxicity for sludge was found from respiratory works.

Role of parents and peers in influencing the smoking status of high school students in Taiwan.

OBJECTIVES: To assess parental influence on smoking behaviour by high school students in an Asian culture and to compare the relative importance of parental and peer influence. METHODS: A 5% nationally representative sample, including 44 976 high school students in 10th to 12th grade (aged 15-18 years) in Taiwan, were surveyed in 1995. Each completed a long self administered questionnaire. Parental influence was measured by examining both parental behaviour (smoking status) and attitudes (perceived "tender loving care" (TLC) by adolescents). Changes in smoking status were used to determine peer influence, defined as the increase in the likelihood of smoking from grade 10 to 12 in a steady state environment. Odds ratios (ORs) were calculated for parental and peer influence, using logistic regression. RESULTS: Adolescents of smoking parents with low TLC had the highest smoking rates and those of non-smoking parents with high TLC had the lowest. The difference was more than twofold in boys and more than fourfold in girls. When either parental smoking status or TLC alone was considered, parental influence was similar to peer influence in boys, but larger than peer influence in girls. However, when smoking status and TLC were considered jointly, it became larger than peer influence for both groups (OR 2.8 v 1.8 for boys and OR 3.9 v 1.3 for girls). CONCLUSION: When parental influence is taken as parental behaviour and attitude together, it plays a more important role than peer influence in smoking among high school students in Taiwan. This study, characterising such relationships among Asian populations for the first time, implies that future prevention programmes should direct more efforts toward the parental smoking and parent-child relationships, and not aim exclusively at adolescents in schools.

Uncovering the relation between betel quid chewing and cigarette smoking in Taiwan.

OBJECTIVE: To describe the characteristics of betel quid chewers and to investigate the behavioural and mortality relations between betel quid chewing and cigarette smoking. METHOD: Prevalence and mortality risks of betel quid chewers by smoking status were calculated, based on the National Health Interview Survey in 2001 and a community based cohort, respectively. Cox's proportional hazards model was used to adjust mortality risks for age, alcohol use, and education. RESULTS: Almost all betel quid chewers were smokers, and most started chewing after smoking. Chewers were predominantly male, mostly in their 30s and 40s, more likely being among the lowest educational or income group, and residing in the eastern regions of Taiwan. On average, betel quid chewers who smoked consumed 18 pieces of betel quid a day, and smoked more cigarettes per day. Far more smokers use betel quid than non-smokers (27.5% v 2.5%), but ex-smokers quit betel quid more than smokers (15.1% v 6.8%). The significantly increased mortality of betel quid users who also smoked, for all causes, all cancer, oral cancer, and cancer of the nasopharynx, lung, and liver, was the result of the combined effects of chewing and smoking. Smokers who chewed betel quid nearly tripled their oral cancer risks from a relative risk of 2.1 to 5.9. Increasing the number of cigarettes smoked among betel quid chewers was associated with a synergistic effect, reflective of the significant interaction between the two. CONCLUSION: To a large extent, the serious health consequences suffered by betel quid chewers were the result of the combined effects of smoking and chewing. Betel quid chewing should not be considered as an isolated issue, but should be viewed conjointly with cigarette smoking. Reducing cigarette smoking serves as an important first step in reducing betel quid chewing, and incorporating betel quid control into tobacco control may provide a new paradigm to attenuate the explosive increase in betel quid use in Taiwan.

Reducing health disparity in Taiwan: quantifying the role of smoking.

OBJECTIVE: To assess the impact of smoking disparities on health disparities, in terms of gap in life expectancy, in Taiwan cities and counties. METHODS: Using the decomposition method of life expectancy, the contribution of each disease category to the life expectancy gap was quantitatively expressed as the number of years of life. The smoking attributable fraction (SAF) was calculated for each city and county based on their respective smoking prevalence and relative risk for each smoking related disease. The smoking attributable gap (SAG) in life expectancy between two sites is the sum of the difference in SAF between two sites for each smoking related disease multiplied by the number of years this disease contributed to the life expectancy gap. RESULTS: Significant health and smoking disparities were present among the 23 cities and counties in Taiwan. These health disparities and smoking disparities were highly correlated (R2 = 0.3676). Generally, the health gap increased with increasing smoking disparity. The disparity in smoking prevalence and intensity among cities and counties in Taiwan was responsible for up to 19% of the health disparity. The health disparity is also highly correlated (R2 = 0.3745) with SAG in life expectancy. CONCLUSIONS: Reducing smoking is important to health, and reducing the smoking disparity is also important for reducing the health disparity observed in Taiwan. The larger the health disparity is, the more important the smoking attributable disparity could be. The reduction of smoking disparities could be a realistic and cost effective way toward reducing health disparities.

Excess injury mortality among smokers: a neglected tobacco hazard.

OBJECTIVE: To assess the mortality risks from injuries for smokers and ex-smokers and to quantify the mortality burden of smoking from injury in Taiwan. METHODS: Smokers' (and ex-smokers') mortality risks from injuries were compared with that of non-smokers in a merged cohort from Taiwan. A total of 64,319 male subjects were followed up for 12-18 years. Relative risks (RR) (adjusted for age and alcohol use) and 95% confidence intervals (CI) for cause specific injury deaths were calculated using the Cox proportional hazard model. Relative risks of injury mortality were also calculated to assess the presence of dose-response relations with daily smoking quantity. RESULTS: Alcohol use adjusted relative mortality risks for all injuries (RR 1.69, 95% CI 1.39 to 2.05) including those from motor vehicle accidents (RR 1.88, 95% CI 1.44 to 2.45) and non-motor vehicle accidents (RR 1.48, 95% CI 1.11 to 1.99) were significantly higher for smokers than non-smokers. Mortality was also increased for most subtypes of non-motor vehicle injuries including falls, fires, and job related injuries. Furthermore, these increases were dose dependent, with the heaviest smokers having the highest risk and the lightest smokers the lowest risk, and ex-smokers, no increase. In 2001, over one fifth (23%) of all male injury deaths in Taiwan was associated with smoking. CONCLUSION: This study demonstrated the significant association between fatal injuries and smoking. This relation adds further weight to smoking cessation campaigns.

Workplace smoking related absenteeism and productivity costs in Taiwan.

OBJECTIVE: To estimate productivity losses and financial costs to employers caused by cigarette smoking in the Taiwan workplace. METHODS: The human capital approach was used to calculate lost productivity. Assuming the value of lost productivity was equal to the wage/salary rate and basing the calculations on smoking rate in the workforce, average days of absenteeism, average wage/salary rate, and increased risk and absenteeism among smokers obtained from earlier research, costs due to smoker absenteeism were estimated. Financial losses caused by passive smoking, smoking breaks, and occupational injuries were calculated. RESULTS: Using a conservative estimate of excess absenteeism from work, male smokers took off an average of 4.36 sick days and male non-smokers took off an average of 3.30 sick days. Female smokers took off an average of 4.96 sick days and non-smoking females took off an average of 3.75 sick days. Excess absenteeism caused by employee smoking was estimated to cost USD 178 million per annum for males and USD 6 million for females at a total cost of USD 184 million per annum. The time men and women spent taking smoking breaks amounted to nine days per year and six days per year, respectively, resulting in reduced output productivity losses of USD 733 million. Increased sick leave costs due to passive smoking were approximately USD 81 million. Potential costs incurred from occupational injuries among smoking employees were estimated to be USD 34 million. CONCLUSIONS: Financial costs caused by increased absenteeism and reduced productivity from employees who smoke are significant in Taiwan. Based on conservative estimates, total costs attributed to smoking in the workforce were approximately USD 1032 million.

Are marketing campaigns in Taiwan by foreign tobacco companies targeting young smokers?

OBJECTIVE: To assess the impact of promotions on cigarette sales in Taiwan after the cigarette market opened to foreign companies, and to assess whether young smokers were targeted by these companies. METHODS: Trends in cigarette sales, advertising expenditure, brand preference, and cigarette consumption were examined for the period following the 1987 opening of the cigarette market. Tobacco industry internal documents from Legacy Tobacco Documents Library of the University of California, San Francisco, were searched for corporate strategies on promoting youth consumption in Taiwan. RESULTS: Between 1995 and 2000, the inflation adjusted advertising expenditures by all foreign firms increased fourfold. Much of the expenditure was spent on brand stretching the Mild Seven (Japan) and Davidoff (Germany) brands in television advertising. By 2000, the market share of foreign cigarettes exceeded domestics by three to one among young smokers and the leading brand preferred by this segment shifted from the most popular domestic brand (Long Life) to a foreign brand (Mild Seven). Furthermore, there was a sudden increase of 16.4% in smoking rates among young adults (from 36.1% to 42.0%) during the first five years after the market opened. This was also accompanied by increased per capita cigarette consumption and decreased age of smoking initiation. Industry documents confirmed the use of strategies targeted at the young. In particular, establishing new point of sale (POS) retail stores or promotional activities at POS were found to be more effective than advertising in magazines. CONCLUSIONS: This study provides evidence that advertising increased with increased competition following the market opening, which, in turn, spurred cigarette sales and consumption. Foreign tobacco companies have deliberately targeted youth in Taiwan and succeeded in gaining three quarters of their cigarette purchases within a decade. Expanding youth consumption will incur excessive future health care costs borne by society. Foreign tobacco companies should be obligated to reimburse these expenses through higher tariffs on cigarettes.

The impact of the cigarette market opening in Taiwan.

OBJECTIVE: To assess the effect of the opening of the Taiwanese cigarette market on cigarette consumption, changes in market share, and the effects on tobacco control efforts. METHODS: With the use of key word "Taiwan", the Legacy Tobacco Documents Library of the University of California, San Francisco, was searched for internal documents related to smuggling activities, promotion of light cigarettes, and market share analyses in Taiwan. Age adjusted smoking rates and cigarette and betel quid consumption before and after market opening were compared. RESULTS: By 2000, the market share of imported cigarettes increased from less than 2% in 1986 to nearly 50%, and per capita cigarette consumption increased 15% following market opening. Because of the sharp increase in smuggling, with contraband cigarettes being as popular as legal imports, and the rapid proliferation of retail outlets, such as betel quid stalls, the market penetration by foreign tobacco companies was greater in Taiwan than among the other Super 301 Asian countries. Aggressive cigarette marketing strategies were associated with a 6% increase in adult male smoking prevalence, and with a 13% increase in the youth rate, within three years after market opening. The market opening also had an incidental effect on increasing the popularity of betel quid. Betel quid chewing has since become a major public health problem in Taiwan. CONCLUSION: The opening of the cigarette market in 1987 had a long lasting impact on Taiwan. It increased smoking prevalence and the market has become dominated by foreign companies. The seriousness of smuggling and its associated loss of revenue by the government, the extent of increased youth smoking and its associated future health care costs, and the increased use of betel quid and the associated doubling of oral cancer mortality rates each pose significant problems to Taiwan. However, the market opening galvanised anti-smoking sentiment and forced the government to initiate and intensify a series of tobacco control efforts.

Smoking behaviour in Taiwan, 2001.

PURPOSE: To examine smoking behaviours in Taiwan and compare those behaviours to those in the USA. METHODS: Using the National Health Interview Survey (NHIS) of Taiwan (2001), a survey of over 20 000 participants, frequencies were calculated for smoking, ex-smoking, quantity smoked, and exposure to environmental tobacco smoke (ETS). Breakdowns by age, sex, and socioeconomic status were also calculated. RESULTS: The ratio of male to female smoking rates was 10.9 to 1 among adults (46.8%/4.3%), but 3.6 to 1 among underage teenagers (14.3%/4.0%). The proportion of underage to adult smokers was three times higher for girls than for boys. Smoking prevalence substantially increased during and after high school years, and peaked in those aged 30-39 years. Smoking rates of high school age adolescents increased more than threefold if they did not attend school or if they finished their education after high school. Low income and less educated smokers smoked at nearly twice the rate of high income and better educated smokers. The smoker/ex-smoker ratio was close to 7. Male daily smokers smoked on average 17 cigarettes/day, and females, 11. Half of the total population, especially infants and women of childbearing age, were exposed to ETS at home. CONCLUSIONS: Taiwan has particularly high male smoking prevalence and much lower female prevalence. The low female prevalence is likely to increase if the current sex ratio of smoking by underage youth continues. The low quit rate among males, the high ETS exposure of females and young children at home, and the sharp increase in smoking rates when students leave school, are of particular concern. These observations on smoking behaviour can provide valuable insights to assist policymakers and health educators in formulating strategies and allocating resources in tobacco control.

The health benefits of smoking cessation for adult smokers and for pregnant women in Taiwan.

OBJECTIVE: To assess the benefits of smoking cessation regarding mortality reduction after smokers quit, and regarding the health of newborns after smoking mothers quit. METHODS: Relative mortality risks (RR) for smokers aged 35 or older who quit years ago were calculated from the follow up of 71 361 civil servants and teachers recruited since 1989. Data from the Pregnancy Risk Assessment Monitoring System in Taipei City were used to calculate the odds ratios of body weights of newborns born to mothers of different smoking status. RESULTS: Mortality risk for ex-smokers was significantly lower than that of current smokers for all causes (18%), all cancer (22%), lung cancer (39%), and ischaemic heart disease (54%). These benefits were not distinguishable initially, up to five years, but by year 17 and thereafter, substantial benefits of cessation accrued. Two thirds of smoking women quit during the first trimester of pregnancy, and only 2.2% of mothers smoked throughout pregnancy. The newborns from smoking mothers were smaller than those from never smoking mothers, but, if these mothers quit early in the first trimester, birth weights were normal. CONCLUSIONS: The health benefits of smoking cessation, rarely reported for Asian populations, have been largely ignored by smokers in Taiwan, where cessation activities have been extremely limited. Findings of this study that risks from smoking can be attenuated or reversed should be widely communicated to motivate smokers to quit. Smokers should quit early, including smoking mothers, and not wait till medical conditions surfaced, to have the maximal benefits of cessation.

Smoking attributable mortality for Taiwan and its projection to 2020 under different smoking scenarios.

OBJECTIVES: To estimate smoking attributable mortality (SAM) in Taiwan for the years 2001 through 2020 under scenarios of reductions in smoking rates by 0%, 2%, 4%, and 10% per year. METHOD: The smoking attributable fraction (SAF) was used to calculate SAM from the risk experience in following up a large cohort (86 580 people) in Taiwan. Smoking rates were based on the 2001 National Health Interview Survey and other national surveys. An average 10 year lag was assumed between smoking rates and subsequent mortality. RESULTS: In 2001, 18 803 deaths, or 1 out of 4 deaths (27%), in middle aged men (35-69 years old) were attributable to smoking. SAM has been increasing and will continue to increase if smoking rates remain constant or even if reduced annually by 2%. SAM would begin to decrease only if rates were to be reduced by at least 4% a year. CONCLUSIONS: The projected SAM in this study illustrates the seriousness of smoking caused mortality. Current efforts in tobacco control would lead to a progressive increase in SAM, unless efforts were doubled and smoking rates reduced by more than 4% a year. The urgency in requiring stronger tobacco control programmes to attenuate the staggering death tolls is compelling.

Mortality patterns among residents in Louisiana's industrial corridor, USA, 1970-99.

BACKGROUND: Because of the high concentration of oil refining and petrochemical facilities, the industrial area of the lower Mississippi River of South Louisiana has been termed the Industrial Corridor and has frequently been referred to as the "Cancer Corridor". AIMS: To quantitatively assess the "Cancer Corridor" controversy based on mortality data available in the public domain, and to identify potential contributing factors to the observed differences in mortality. METHODS: Age adjusted mortality rates were calculated for white and non-white males and females in the Industrial Corridor, Louisiana, and the United States for the time periods 1970-79, 1980-89, and 1990-99. RESULTS: All-cause mortality and all cancer combined for white males in the Industrial Corridor were significantly lower than the corresponding Louisiana population while Louisiana had significantly higher rates than the US population for all three time periods. Cancer of the lung was consistently higher in the Industrial Corridor region relative to national rates but lower than or similar to Louisiana. Non-respiratory disease and cerebrovascular disease mortality for white males in the Industrial Corridor were consistently lower than either Louisiana or the USA. However, mortality due to diabetes and heart disease, particularly during the 1990s, was significantly higher in the Industrial Corridor and Louisiana when compared to the USA. Similar mortality patterns were observed for white females. The mortality for non-white males and females in the Industrial Corridor was generally similar to the corresponding populations in Louisiana. There were no consistent patterns for all cancer mortality combined. Stomach cancer was increased among non-whites in both the Industrial Corridor and Louisiana when compared to the corresponding US data. Mortality from diabetes and heart disease among non-whites was significantly higher in the Industrial Corridor and Louisiana than in the USA. CONCLUSIONS: Mortality rates in the Industrial Corridor area were generally similar to or lower than the State of Louisiana, which were increased compared to the United States. Contrary to prior public perceptions, mortality due to cancer in the Industrial Corridor does not exceed that for the State of Louisiana.

A mortality and morbidity study of refinery and petrochemical employees in Louisiana.

AIMS: To examine the mortality experience of 4221 employees from 1973 to 1999 and the illness absence patterns for 2203 employees from 1990 to 1999 of a chemical and refinery facility in Louisiana. METHODS: Mortality and illness absence data were extracted from the Shell Oil Company's health surveillance system (HSS). The standardised mortality ratio was used as a measure of mortality risk. Morbidity frequency and duration of absence were calculated by age, sex, and four health risk factors (cigarette smoking, high blood pressure, hypercholesterolaemia, and obesity). RESULTS: Male employees experienced a significant deficit in mortality for all causes of death, all cancers, lung cancer, heart disease, and respiratory disease compared with the corresponding US population. Brain cancer was non-significantly increased, with six observed and five expected deaths; mortality from leukaemia was consistently lower than expected. The majority of employees had no illness absences of six days or longer during the 10 year study period. The loss of productivity (in terms of days of absence) was greater for employees with health risk factors. Ever smoking male employees had a 79% increase of heart disease and more than 50% higher rates of respiratory disease and musculoskeletal disorders compared to non-smokers. Smokers were absent 2.9 and 1.6 more days than non-smokers and ex-smokers, respectively. CONCLUSIONS: Regardless of the comparison population, significantly fewer deaths were seen for all causes combined, all cancers, lung cancer, heart disease, or non-malignant respiratory disease. Illness absence rates and duration were higher among employees with health risk factors.

Asbestos related diseases from environmental exposure to crocidolite in Da-yao, China. I. Review of exposure and epidemiological data.

BACKGROUND: Scattered patches of crocidolite, one form of asbestos, were found in the surface soil in the rural county of Da-yao in southwestern China. In 1983, researchers from the West China University of Medical Sciences (WCUMS) discovered that residents of two villages in Da-yao had hyperendemic pleural plaques and excessive numbers of pleural mesotheliomas. AIMS: To review and summarise epidemiological studies, along with other relevant data, and to discuss the potential contribution to environmental risk assessment. METHODS: This report is based on a review of several clinical/epidemiological studies conducted by WCUMS researchers since 1984, which included one cross sectional medical examination survey, one clinical/pathological analysis of 46 cases of mesothelioma, and three retrospective cohort mortality studies. Additional information acquired from reviewing original data first hand during a personal visit along with an interview of medical specialists from Da-yao County Hospital was also incorporated. RESULTS: The prevalence of pleural plaque was 20% among peasants in Da-yao over 40 years of age in the cross sectional survey. The average number of mesothelioma cases was 6.6 per year in the 1984-95 period and 22 per year in the 1996-99 period, in a population of 68 000. For those mesothelioma cases that were histology confirmed, there were 3.8 cases/year in the first period and 9 cases/year in the second. Of the 2175 peasants in this survey, 16 had asbestosis. Lung cancer deaths were significantly increased in all three cohort studies. The annual mortality rate for mesothelioma was 85 per million, 178 per million, and 365 per million for the three cohort studies, respectively. The higher exposed peasants had a fivefold increased mesothelioma mortality compared to their lower exposed counterparts. There were no cases of mesothelioma in the comparison groups where no crocidolite was known to exist in the environment. In the third cohort study, almost one of five cancer deaths (22%) was from mesothelioma. The ratio of lung cancer to mesothelioma deaths was low for all three studies (1.3, 3.0, and 1.2, respectively). CONCLUSIONS: The observation of numerous mesothelioma cases at Da-yao was a unique finding, due mainly to their lifetime exposure to crocidolite asbestos. The finding of cases dying at a younger age and the relatively high ratio of mesothelioma cases to lung cancer could also be another unique result of lifetime environmental exposure to crocidolite asbestos. Although the commercial use of crocidolite has been officially banned since 1984, the incidence of mesothelioma has continued to show a steady increase, particularly among peasants. Since the latency of mesothelioma is approximately 30-40 years, the ban had little effect in the 1990s. The increased awareness and changes in diagnosis over time may also contribute to the increase. Furthermore, exposure to asbestos stoves and walls continued. The government implemented reduction of these exposures. However, from a public health standpoint, the most important issue is the complete avoidance of further exposure to asbestos.

Trends in cigarette smoking among refinery and petrochemical plant employees with a discussion of the potential impact on lung cancer.

OBJECTIVE: To examine trends in cigarette smoking prevalence and intensity among petroleum industry employees over a 22-year period, from 1976 to 1997, and to evaluate the hypothesis that the (about 20%) lower lung cancer mortality, when compared with the general population, among these workers is due to lower average cigarette consumption. METHODS: Self-reported smoking prevalence and intensity (number of cigarettes smoked per day) data were available from the Shell Health Surveillance System for approximately 5,400 employees in the 1970s, 11,000 in the 1980s, and 8,300 in the 1990s. Data were analyzed by gender, time period, and work status (production vs. staff). RESULTS: During the 22-year study period, smoking prevalence dropped significantly in this working population. When compared with the general US population, smoking prevalence trends were very similar. For the entire employee population, smoking prevalence was highest for women working in production (hourly) jobs. While smoking prevalence was higher among production employees than among staff employees, daily cigarette consumption was slightly lower. Cigarette consumption among Shell employees was similar to that in the US in the 1970s, but lower in the 1980s and 1990s. By applying smoking consumption data from the 1970s, the ratio of weighted lung cancer relative risks for Shell employees and the US general population was 0.98. In other words, the lung cancer mortality rate of refinery and petrochemical employees would be adjusted upward by 2% if one were to remove the influence of smoking consumption by Shell employees. CONCLUSIONS: Based on our data, it is unlikely that differences in smoking prevalence and intensity between refinery/petrochemical workers and the general population could account for the lower risk of lung cancer mortality reported in the literature.

Health findings from a mortality and morbidity surveillance of refinery employees.

PURPOSE: To present results from a prospective mortality (1973-1998) and morbidity (1990-1998) surveillance of a refinery population in California. METHODS: Mortality and illness-absence data were extracted from the Shell Oil Company's Health Surveillance System (HSS). Mortality data were compared to the United States, the state of California, and Contra Costa County, where the refinery is located. Morbidity data were compared to other company manufacturing employees. The standardized mortality/morbidity ratio (SMR/SMbR) was used as a measure of risk. Morbidity frequency and duration of absence were calculated by age, sex, and four health risk factors (smoking, high blood pressure, hypercholesterolemia, and obesity). RESULTS: With the United States as a comparison, the all causes combined SMR was 0.84 [95% confidence interval (CI) = 0.78-0.90], and the SMR for all cancer was 0.75 (95% CI = 0.64-0.88). Statistically significant deficits in mortality were found for lung cancer (SMR = 0.60) and leukemia (SMR = 0.26). Morbidity frequency and duration of absence among smokers were substantially higher than those of nonsmokers. Similar results were also noted for obese employees when compared to those of normal weight. CONCLUSIONS: Regardless of the comparison population, significantly fewer deaths were seen for all causes combined, all cancer, lung cancer, and leukemia. The study also showed no increased mortality from cancer of the stomach, kidney, skin, prostate, and brain. The increased morbidity frequency and duration of absence were associated with the presence of known health risk factors. These study findings are useful in setting priorities for medical programs and directing efforts such as health promotion and disease prevention strategies.

A mortality, morbidity, and hematology study of petrochemical employees potentially exposed to 1,3-butadiene monomer.

This three-part study is an update of a previous report that examined the mortality, morbidity, and hematological data of employees from a petrochemical facility in Texas who had potential exposure to 1,3-butadiene monomer. The first part describes the updated cause-specific mortality of 614 workers. Vital status for each cohort member was ascertained through 1998, a 9-year extension of the previous study. The second part is an examination of the morbidity experience of cohort members who were still working during 1992-1998, including 289 of the 614 mortality cohort members. The third part is an evaluation of the hematological results from routine health surveillance and/or medical examinations. Approximately 430 of the 614 employees who had complete blood count (CBC) data as of December 1999 were included in the hematological evaluations. The most recent examination containing CBC data was used and compared with similar data for over 2600 other employees from this facility. Overall mortality during the follow-up period, 1948-1998, was significantly lower than for the local comparison population (standardized mortality ratio (SMR) of 0.55 with a 95% confidence interval (CI) of 0.42-0.70). Mortality for all cancer was also significantly lower (SMR, 0.57; 95% CI, 0.32-0.92). Mortality for all lymphohematopoietic cancer was about the same as the comparison population (SMR, 1.06; 95% CI, 0.22-3.11). None of the cause-specific morbidity was in excess compared with an internal comparison group. There were no differences in the distribution or mean values of hematological variables (e.g. white blood cells, red blood cells, hemoglobin, platelets, mean corpuscular volume) between the butadiene cohort and the comparison group, or between a subgroup of workers in jobs with the highest potential for butadiene exposure (i.e. shipping) and the rest of the butadiene cohort. The findings of this study suggest that the butadiene exposure at this facility in the last 20 years does not pose a health hazard to employees.