1. Sick Building Syndrome in Relation to Environmental Tobacco Smoke and Overtime Tetsuya MIZOUE, MD, PhD Dept. of Preventive Medicine, Kyushu University (JAPAN) mizoue@phealth.med.kyushu-u.ac.jp

2. Learning objective To understand the concept and risk factors of sick building syndrome (SBS) To understand the importance of environmental tobacco smoke and overtime as risks of SBS To understand how overtime affects SBS

3. Performance objective Measure prevalence of SBS symptoms using questionnaire Explain the factors that determine the level of ETS exposure in the working population Explain the potential roles of overtime work in the development of SBS

4. Introduction I am an epidemiologist in the field of occupational and environmental health. I first developed an interest in indoor air issues during a stay in Finland. Upon my return to Japan, I noticed that both exposure to environmental tobacco smoke and overwork are potentially significant risk factors for sick building syndrome among Japanese office workers.Finland

5. Sick Building Syndrome Sick Building Syndrome Typical symptoms 1.General malaises: fatigue, headache, nausea, difficulty in concentration 2. Irritation/dryness of the eyes, nose, throat, and skin

6. Risk factors of SBS Building characteristics Indoor environments Working condition Human factors Psychological factors

7. Smoking prevalence in Japan (%) Male Female Source: Japan Tobacco (JT) Inc.

8. Determinants of levels of workplace ETS exposure Smoking prevalence Workplace smoking restriction Tightness of office buildings Room sharing with colleague Working hours

9. Trends of average working hours in Japan Hours worked /year Source: Ministry of Health, Labor and Welfare

10. Epidemiological study Design cross-sectional study, using questionnaire Setting city office buildings in Kitakyushu, Japan Subjects 1281 indoor workers (response rate, 89%) Am J Epidemiol 2001;154:803-8

11. MM040EA MM040EA Örebro questionnaire Designed for epidemiological assessment of indoor air problems Symptoms asked (No. of items) general symptoms (5): fatigue, headache, etc.; symptoms of the eyes (1), nose (1), throat (2), and skin (3) Response options often(weekly), sometimes, no

12. Workplace ETS exposure and SBS symptoms smoker SBS General Nose 0 1 2 3 <11-<4>4Current Odds ratio Daily hours of ETS exposure in nonsmoker

13. How does overtime work increase the risk of SBS? Overtime work SBS Stress Lifestyle

14. Work characteristics and health behaviors according to overtime Hours of overtime worked in the past month <1010-<3030+ Use of a VDT (4 hours +/day) 12.718.432.4 Work overload (often) 6.619.250.7 Sports activity (3 times +/week) 17.015.88.1 Sleep (<6 hours)5.36.422.8

15. Risk of SBS associated with 30 hours or more overtime work Odds ratio

16. Conclusions ETS exposure at work is a risk factor for SBS, particularly for symptoms involving the mucous membrane. Strict restrictions on smoking may prevent SBS symptoms. Long work hours increase the risk of SBS, in part through factors concomitant with overtime.