Quantification of ETS exposure in hospitality workers who have never smoked

Background: Environmental Tobacco Smoke (ETS) was classified as
human carcinogen (K1) by the German Research Council in 1998.
According to epidemiological studies, the relative risk especially
for lung cancer might be twice as high in persons who have never
smoked but who are in the highest exposure category, for example
hospitality workers. In order to implement these results in the
German regulations on occupational illnesses, a valid method is
needed to retrospectively assess the cumulative ETS exposure in the
hospitality environment. Methods: A literature-based review was
carried out to locate a method that can be used for the German
hospitality sector. Studies assessing ETS exposure using biological
markers (for example urinary cotinine, DNA adducts) or
questionnaires were excluded. Biological markers are not considered
relevant as they assess exposure only over the last hours, weeks or
months. Self-reported exposure based on questionnaires also does
not seem adequate for medico-legal purposes. Therefore,
retrospective exposure assessment should be based on mathematical
models to approximate past exposure. Results: For this purpose a
validated model developed by Repace and Lowrey was considered
appropriate. It offers the possibility of retrospectively assessing
exposure with existing parameters (such as environmental
dimensions, average number of smokers, ventilation characteristics
and duration of exposure). The relative risk of lung cancer can
then be estimated based on the individual cumulative exposure of
the worker. Conclusion: In conclusion, having adapted it to the
German hospitality sector, an existing mathematical model appears
to be capable of approximating the cumulative exposure. However,
the level of uncertainty of these approximations has to be taken
into account, especially for diseases with a long latency period
such as lung cancer.