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Environmental Tobacco Smoke Exposure Among Casino Dealers

Achutan, Chandran PhD; West, Christine MSN, RN, MPH; Mueller, Charles MS; Bernert, John T. PhD; Bernard, Bruce MD, MPH

Journal of Occupational and Environmental Medicine: April 2011 - Volume 53 - Issue 4 - p 346–351
doi: 10.1097/JOM.0b013e318212235f
Original Articles: CME Available for this Article at

Objective: This study quantified casino dealers’ occupational exposure to environmental tobacco smoke (ETS).

Methods: We measured casino dealers’ exposure to ETS components by analyzing full-shift air and preshift and postshift urine samples.

Results: Casino dealers were exposed to nicotine, 4-vinyl pyridine, benzene, toluene, naphthalene, formaldehyde, acetaldehyde, solanesol, and respirable suspended particulates. Levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine increased significantly during an 8-hour work shift both with and without adjustment for creatinine clearance. Creatinine-unadjusted cotinine significantly increased during the 8-hour shift, but creatinine-adjusted cotinine did not increase significantly.

Conclusions: Casino dealers at the three casinos were exposed to airborne ETS components and absorbed an ETS-specific component into their bodies, as demonstrated by detectable levels of urinary NNAL. The casinos should ban smoking on their premises and offer employee smoking cessation programs.

From the National Institute for Occupational Safety and Health (Drs Achutan and Bernard and Ms West and Mr Mueller), Cincinnati, Ohio; University of Nebraska Medical Center (Dr Achutan), Nebraska Medical Center, Omaha, Neb; and National Center for Environmental Health (Dr Bernert), Centers for Disease Control and Prevention, Atlanta, Ga.

Address correspondence to: Chandran Achutan, Department of Environmental, Agricultural, and Occupational Health, 985840 Nebraska Medical Center, Omaha, NE 68198; E-mail:

Chandran Achutan, Christine West, Charles Mueller, John T Bernert, and Bruce Bernard have no financial interest related to this research.

The JOEM Editorial Board and planners have no financial interest related to this research.

©2011The American College of Occupational and Environmental Medicine