Secondhand Smoke and Casino Dealers
Simply working in a casino does not mean dealers must gamble with their health. There is nothing lucky about developing a respiratory illness, lung cancer, or heart disease—especially if you are a healthy nonsmoker. Results of new research conducted by the National Institute for Occupational Safety and Health (NIOSH) on secondhand smoke—the exposure of non-smokers to tobacco smoke—confirm that dealers at the casinos investigated were exposed to secondhand smoke. Secondhand smoke, also called environmental tobacco smoke, is a combination of smoke given off by the burning end of a tobacco product and the smoke exhaled by the smoker. Secondhand smoke is made up of approximately 4,000 chemicals, of which about 40 are known to cause cancers.
Longstanding NIOSH policy, consistent with and based on the U.S. Surgeon General's position on secondhand smoke, recommends that workers should not be involuntarily exposed to tobacco smoke. Any exposure to secondhand smoke increases the risk of lung cancer, other respiratory diseases, and heart disease. Studies have shown that even low levels of secondhand smoke exposure can be harmful. The only way to fully protect nonsmokers from secondhand smoke exposure is to completely eliminate smoking in indoor spaces.
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The NIOSH investigation was conducted in response to requests for an evaluation of secondhand smoke from dealers at Bally's, Paris, and Caesars Palace casinos in Las Vegas, Nevada. NIOSH investigators conducted onsite health hazard evaluations to measure casino dealers' exposure to secondhand smoke and to determine whether they reported related health symptoms. Employees were selected to participate in the study if they reported that they did not use any tobacco products, did not live with someone who smokes inside their home, or were not exposed to secondhand smoke in any setting other than their job at the casino. For comparison, a group of administrative and engineering staff who were not exposed to secondhand smoke at their casino job were included in the study.
NIOSH collected urine samples before and after the workers' shifts to determine the levels of two secondhand smoke components, cotinine and NNAL (a cigarette carcinogen) in their urine. Casino dealers were found to have increasing levels of NNAL in their urine over an 8-hour work shift showing that the cigarette smoke and a carcinogen are being taken up into their bodies. NIOSH also conducted air sampling which found that components of secondhand smoke were present in the air of the three casinos. Casino dealers had more respiratory symptoms than the administrative and engineering employees, but differences were not statistically significant.
NIOSH recommended that:
- The casinos should institute casino-wide no smoking policies to eliminate exposure to secondhand smoke and develop smoking cessation programs for casino employees who smoke.
- A physician should evaluate employees with respiratory symptoms related to workplace exposures.
- The casinos should form a health and safety committee that includes employee and management representatives to address workplace health and safety concerns.
- The casinos should also eliminate smoking near building entrances and air intakes to prevent tobacco smoke from entering the work environment. Any modifications of the ventilation systems should be done in adherence with current guidelines.
In addition to scientifically confirming secondhand smoke exposure among the casino dealers, the results of this research also provide additional support for the use of NNAL as a marker of secondhand smoke exposure and will aid other researchers in future studies.
NIOSH would like to hear from you. If your workplace has gone smoke-free, please tell us about the transition. Were there specific steps taken that seemed to make the transition to a smoke-free environment easier?
The complete reports of the casino health hazard evaluations can be found at http://www.cdc.gov/niosh/hhe/reports/pdfs/2005-0201-3080.pdf 
. More information on the Health Hazard Evaluation (HHE) Program is available on the HHE topic page. Information on the health effects of second hand smoke can be obtained from the CDC Office on Smoking and Health and the U.S. Surgeon General's Report on the Health Consequences of Involuntary Exposure to Tobacco Smoke.
—Christine West, RN, MSH, MPH
Lieutenant Commander West of the United States Public Health Service is an epidemiologist assigned to NIOSH in the Division of Surveillance Hazard Evaluations and Field Studies.
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We at [company name removed] were contacted by a casino group asking whether we could alleviate the second hand smoke in their gambling areas and other adjacent indoor facilities some time ago. We do have fan driven ceiling registers that easily replace existing registers and ties into the facility's HVAC system and utilize high efficiency HEPA filters accessible within the room for filter replacement. We never heard back from them but this very inexpensive device could be employed to significantly reduce the secondhand smoke by pressurizing the space and creating more ultra-clean air changes per hour. Obviously, the best solution is non-smoking. We have this being used to provide a focused ultraclean air zone over surgical procedures to dramatically reduce infections.
Posted 6/17/09 at 12:22 pm
We would like to emphasize that the only way to eliminate the health hazards associated with secondhand smoke exposures from indoor environments is to ban smoking.
Note: References to a product or service does not constitute an endorsement of any commercial product by NIOSH or the U.S. government.
Posted 6/25/09 at 11:05 am
Do you have any results for formaldehyde concentrations in the smoking area? If so, can you provide them, or a range?
Posted 6/17/09 at 3:21 pm
Full-shift Personal Breathing Zone (PBZ) and area air sampling for formaldehyde was conducted at Paris, Bally's, and Caesars Palace casinos in the gaming areas where smoking was permitted during swing shift for 4 days. The geometric means were 8.96 ug/m3 and 8.91 ug/m3 formaldehyde from the PBZ and area samples, respectively, for all three casinos combined. PBZ concentrations for formaldehyde ranged from 2.3 to 29 ug/m3 and area concentrations ranged from 2.3 to 36 ug/m3 for all three casinos combined. The OSHA PEL is about 920 ug/m3 and the NIOSH REL is about 20 ug/m3. For more information, please review the full report at http://www.cdc.gov/niosh/hhe/reports/pdfs/2005-0201-3080.pdf.
Posted 6/19/09 at 3:23 pm
No worker should be exposed to secondhand smoke, voluntarily or involuntarily.
Posted 6/18/09 at 11:15 am
I was in Vegas recently and talked to a head bartender who had to have two of her waitresses quit recently. One actually had three people come and pat her belly, then all three lit up right in her face.
Folks must think cocktail waitresses and their unborn are of a different class........disposable.
Posted 6/18/09 at 12:01 pm
I have made a preliminary analyis of your data and arrived at the following conclusions:
* Repace JL, Al-Delaimy WK, Bernert JT. Correlating Atmospheric and Biological Markers in Studies of Secondhand Tobacco Smoke Exposure and Dose in Children and Adults. JOEM 48: 181-194 (2006).
Est. 40-Yr Working Lifetime risk (11 deaths/1000-0.4 ng/ml Pers-40 Yr)(4 ng/ml): R = 110 deaths per 1000
This is 124 times OSHA's Significant Risk Level.
Posted 6/18/09 at 12:25 pm
I work in a casino & the smoke is horrible. And when I was pregnant twice I was shocked how many people still blew the smoke straight in my face, regardless of being pregnant. No remorse of these people! You would think these casinos would put up a non-smoking sign at least for the pregnant people (nope). I pray everyday that someday (in my lifetime) the casinos will all go smoke free!!! Please lets all work together to go smoke free, so we can all be healthy!!
Posted 6/23/09 at 4:26 pm
I have been a casino dealer for over 20 years now and have watched as many of my non-smoking friends have died from cancer. There are even more who have not died, but have been treated for various cancers. All the while the casinos turn a blind eye and continue to pass out free tobacco products to the customers who are smoking less than 3 feet from my breathing space and blowing their smoke in my face.
I admit, I am a smoker. But when I smoke, I do so when I choose to do so. I do not smoke with every breath I take, nor through my nose and eyes.
I would like to quit smoking, but every day when I go into work my employer forces me to smoke throughout my shift. This is like an alcoholic who wants to stop drinking, but their employer forces them to consume alcohol all day at work. How do they quit? I face the same dilemna.
Posted 6/23/09 at 8:28 pm
"The consequences are too real to ignore. After working for more than two decades in a well known casino, [name removed] found that he had become stricken with lung cancer despite never having smoked tobacco products.
[Name removed] was fired from his job after becoming a vocal advocate for the health of other casino workers." - this just unacceptable.
Electronic Cigarettes could be an answer.
Posted 6/24/09 at 12:18 am
I have only worked in the casino for 2 years, and as a non-smoker have started experiences symptoms of a smoker. I am appalled at the smoking situation, and can only compare it to asbestos. Asbestos is PROVEN to cause asbestosis, lung cancer, mesothelioma, and digestive system cancers.
The Environmental Protection Agency (EPA) was required by the Clear Air Act to produce regulations to regulate air pollutants hazardous to health.
These are called the National Emission Standards for Hazardous Air Pollutants. Asbestos is one of these and regulating it was delegated to the Department. Well, CIGERATTE SMOKE AND SECOND HAND SMOKE ARE PROVEN TO CAUSE LUNG CANCER AND OTHER ILLNESSES. Why is it taken so long for the EPA to do something about it??? We know the Casinos aren't going to stand up and do anything about it, those who are high enough on the corporate ladder are simply not exposed to the cigarette smoke and see banning smoking as loosing money. It's obvious that loosing money is more important to the corporate world than the heath of their employees, so instead of fighting a losing battle, it's time to start fighting this with the EPA and Clear Air Act. If Casinos won't take the first steps, then we must push them by bringing the issues up and beyond their controls.
Posted 6/24/09 at 5:15 pm
The smoke is one of the worst parts of the job to endure. I constantly have teary eyes, headaches, and even get a cough from the smoke I am forced to deal with at work. It should be illegal to smoke inside any building and the casinos should be held liable for any and all possible future ailments relating to the environment we are forced to work in.
I applaud your efforts to inform the public of these hazards we endure. I hope it will bring about changes in the future. We all deserve the right to breath clean air.
Posted 6/24/09 at 6:18 pm
I have worked as a dealer in one of the casinos tested for almost 30 years. When I started, I ran min-marathons and was an active athlete.
Today, I have serious bronchial asthma which I take 3 different medications for and miss work due to the smoke irritating my throat and lungs. I have a chronic cough. I have had to get an FMLA just to save my job due to my illness which I acquired from my job but the management does not look favorably at employees with FMLA's. We have been told we cannot fan the smoke away from us even though there are players that blatantly blow it in our face and violations can result in written documentation or termination. There are chip racks with fans available but management has not seen fit to even get those for us, much less the fans mentioned in the first post on this blog. There is "no smoking" everywhere else in the hotel and casino except on the gaming floor and bars for the dealers, bartenders and cocktail waitress' to breathe. There certainly isn't any smoking in the Executive Offices . Why is my health less important than everyone else in this country? The almighty dollar! I know of over 50 people that have worked with me that have contracted cancer—most died! The respiratory problems are off the chart! If all smoking was banned in public then every business would have an equal playing field so why won't our legislators pass the laws we need to stop poisoning us?????? Can you imagine the savings in health care? With this report and the employees getting fed up - I can see many lawsuits coming!
Posted 6/24/09 at 9:59 pm
I read an article that approximately 23% of Americans smoke. In the same article it stated that 70% of the visitors to Vegas smoke while in Vegas. There is a large number of people who are not regular smokers who temporarily pick up the habit while vacationing. Perhaps gaming establishments are encouraging their patrons to smoke. Keeping this in mind, an entire sea change of conscience must occur to remedy this situation. First, the company must truly care about the well-being of it's employees (front-line AND management). Then the corporation has to begin considering the well-being of its clientele. Finally, the machine must determine what it is willing to sacrifice in bottom line to become a good citizen. Perhaps 93 million dollar wage+bonuses will have to become 80 million dollar wage+bonuses. I think that kind of reduction of lifestyle is acceptable to make the lives of thousands more livable. I suppose I am a utilitarian with utopian dreams.
Posted 6/25/09 at 6:12 am
I am a casino gambler in Atlantic City. I go once or twice per month. Smoking in A.C. is regulated by legislation so that only 20% of the gambling floors are to permit smoking and 100% of the lobby areas are to be smoke free.
BIG JOKE !
They smoke where ever they want and no one makes an effort to stop them. Casino employees look the other way and city officials seem to ignore complaints.
If you try to tell a smoker they are smoking in a non-smoking area, some will comply and extinguish the cig. Others will threaten you or tell you to mind your own business.
There were three weeks in October of '08 when A.C. casinos were 100% smoke free. Only during that time was smoking eliminated from casinos with no attempt to violate the ordinance on the part of smokers.
100% smoke free is the only way to go.
Posted 6/26/09 at 8:08 am
I have been a casino dealer for over 30 years. I have a spot on my lung which I get checked every year to determine whether there is any growth. So far, so good. I also smoked for a lengthy period of time, quit in 1979 when I became a dealer at [name removed].
I have approached the head of human resources, several times to have him install table fans (he bragged that he put them in at [another] Casino) Last time I talked to him he said that there was no interest in the fans. Interest, from who? It is the only horrible part of the job breathing in second hand smoke which is usually blown directly into the dealers face by disgruntled players. Fans, can change the atmosphere of the whole casino. Mgt. says that the dealers would be abusive, How?
Posted 6/28/09 at 8:51 am
Casinos seem to be special parties and receive mindless exemptions from the smoking bans. As far as a smoke filled work environment is concerned, minimum requirements should stipulate that respirators be worn by all employees subject to the "hazardous environment". A properly trained and conscientious firefighter would never think of entering into a similar smoke-filled environment without airway protection. I don't get the free passes that are handed to the casinos.
Posted 7/6/09 at 4:30 pm
In the introductory post for this blog topic, Lt. Commander West asserted that: "Longstanding NIOSH policy, consistent with and based on the U.S. Surgeon General's position on secondhand smoke, recommends that workers should not be involuntarily exposed to tobacco smoke."
I read the HHE report on casinos, but didn't see a mention of any such policy, at least not as worded above.
Please provide citations to permit interested readers of this blog to learn when (and in what context) this NIOSH policy was initially established in a formal manner by NIOSH and when (and in what context) it was most recently reaffirmed in a formal manner by NIOSH. Thanks.
Posted 7/7/09 at 11:03 am
Current Intelligence Bulletins (CIBs) are issued by the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention to disseminate new scientific information about occupational hazards, draw attention to a formerly unrecognized hazard, report new data on a known hazard, or disseminate information on hazard control. In June 1991, CIB 54 entitled Environmental Tobacco Smoke (ETS) in the Workplace, Lung Cancer and Other Health Effects was issued to disseminate information about the potential risk of cancer and heart disease in workers exposed to ETS which was based on the 1964 Surgeon General's report on smoking and health and a review of epidemiologic studies on the health effects from ETS exposure. The CIB states that "the best method for controlling worker exposure to ETS is to eliminate tobacco use from the workplace and to implement a smoking cessation program." CIB 54 has not been rescinded, and continues to be referenced when recommending eliminating exposure to secondhand smoke in workplaces.
Posted 7/11/09 at 11:25 am
Now that the NIOSH report is out, Smoke-Free Gaming is working aggressively to get more casino employees and casino patrons (gamblers) on board to get casinos smoke free.
We have learned that the health of the employees, whose health is gravely compromised from breathing secondhand smoke (air pollution) is of little or no concern to their employer. Why? Because casino management is known to fire them at will!
BUT, casinos listen to their customers so that is why we are doing all we can to get the gamblers who hate the smoke to join in our efforts. Guess what? It's working! Professional gamblers are mostly non smokers. They are the ones who complained about the smoke and that is why the World Series of Poker, the World Poker Tour, etc. and poker rooms across the country are non smoking.
We even have an online petition for employees, gamblers and everyone else to sign.
We hope the NIOSH report will be a tool for legal pursuits, more no-smoking policies and more clean indoor air laws.
This is a health issue! Breathing is not a choice!
Posted 7/7/09 at 8:43 pm
My wife and I went to the (name removed) casino in Conn 6 weeks ago. I am an asthmatic, have been all my life. We enjoy gambling there. We usually go twice a year. We stay in the so called no smoking room to gamble. This last time we went,in order to pick up your car when you leave there, you have to go through a large smoking room. I nearly died walking through this room, must have taken me 3 or 4 minutes. By the time I got to the end, exit where the cars are, I was breathless, couldnt breath. From that experience, I developed Chronic Bronchitis, and saw my doctor three times for medication, nebulizer and other lung help. I was disabled with this Chronic Bronchitis for 6 weeks and am just starting to feel normal. As much as I love the casinos, I am deathly afraid of returning to one. I refuse to go through that nightmare again. In my opinion, they should not allow smoking in any of those casinos. Its like a slow death in there.
Posted 7/20/09 at 3:53 pm
Casino workers face a higher risk of heart disease and lung cancer because they work in buildings filled with tobacco smoke. Casinos serve both smoking and nonsmoking customers, balancing the needs of these two distinct sets of patrons, as well as those of our employees who don't smoke, is of paramount importance.
Posted 8/1/09 at 7:50 pm
Unions have been the traditional vehicle in satisfying both employees and companies in health related workplace issues for decades and pro or anti Union supporters can't argue against that fact. Why don't the companies turn to the U.A.W and the T.W.U to work out a solution. There must be a way to protect both health and revenue. Large smoke free areas, better ventilation (with Union inspection), all bronchial illnesses 100% covered with paid sick leave would be a good start.
Posted 8/11/09 at 8:41 pm
There is no denying that both smoking and secondhand smoke are unhealthy. However, having said that what about choice?
Casino employees choose of their own free will whether or not to work a casino. Perhaps that is the highest paying job in the area which does not require a college education or skilled trade however that is still their choice; accept a lower paying job, move to another area or get an education. Last time I check this was still a free country where we choose our own destiny. Nobody is forced to work or gamble in a smoky casino environment. Casinos are a choice not a necessity! It should be up to the owner of the establishment to decide whether or not to become smoke free.
There are MANY behaviors which can be classified as high risk such as sun bathing, eating McDonalds everyday or motocross but that doesn't mean we need legislation to protect us. We all have the freedom to choose and must live the repercussions of our decisions.
Posted 8/13/09 at 8:47 pm
You had to do a study with tax dollars to determine that casino dealers were exposed to second hand smoke? PULEEZE!
"Employees were selected to participate in the study if they reported that they did not use any tobacco products, did not live with someone who smokes inside their home, or were not exposed to secondhand smoke in any setting other than their job at the casino."
Excuse me, I find it hard to believe that they were not exposed to secondhand smoke in any setting other than their job at the casino. Give us a break. If you don't like it, go where it isn't. What happened to the land of the free? If they want to be stupid, let 'em!
Posted 8/5/09 at 1:15 am
I have worked in a casino in Nevada for just over 2 years now. Since I have started we have had approx. 8-10 people contract cancer and many have since died in a short time from being diagnosed. This seems to be a very high number. Also, we have had many illnesses as well. This needs to be checked out.
Posted 10/7/09 at 1:28 pm
Although we have not been able to speak with you to obtain more information about the employees with cancer and their exposures, the following information about occupational cancer clusters may be helpful to you. A cancer cluster is an unusual concentration of cancer cases in a defined area or time.
If you or your coworkers have been diagnosed with an illness potentially associated with exposure to secondhand smoke, you may wish to share our report with a health care provider and discuss the section of the report that documents the presence of a lung carcinogen over a work shift and reported respiratory health effects in the casino dealers. Only a health care provider familiar with your or your coworkers specific medical and work history can make a determination as to whether an illness you are affected with is work-related. Inform your supervisor and/or the individual(s) responsible for workplace safety and health in your facility and then seek care from a health care provider who can evaluate your health symptoms. For more information about occupational cancer and cancer cluster evaluations on the NIOSH website at www.cdc.gov/niosh/topics/cancer/. You can also find information published by the National Cancer Institute about health effects related to exposure to secondhand smoke, at www.cancer.gov/cancertopics/factsheet/Tobacco/ETS and in the U.S. Surgeon General’s Report at www.surgeongeneral.gov/library/secondhandsmoke.
Posted 10/30/09 at 3:38 pm
I hear the only cause for cancer (according to fellow posters) is cigarettes. These casinos are on a very congested street, where it took 12 an hour to pass 1 casino. Of course all this vehicle traffic isn't the problem, has to be the hated smokers; according to Anti smoker advocates theres toxicology or other causes that is plausible for cancer.
Couldn't get a total ban; so to forward your agenda, create a study that will only support your preconceived need. Scary what smokers taxes are paying for, no wonder contraband is not being seen as a crime; if this is science that the taxes are paying for.
PS: No mention that NNAL comes from potatoes, tomatoes, grain, eggplant; how do they account for that confounder? "urinary COT levels adjusted for creatinine for all three casinos combined decreased over an 8-hour shift." How do you account for the dealers telling what they feel in a written survey; then that statement used as a medical opinion, thats scientific & exact.
Posted 10/24/09 at 12:46 pm
Cool Blog, oddly enough I had read a article from september fourth two thousand and four that was remarkably similar to your post.
Posted 11/3/09 at 6:47 pm
Uggh! John and Sharon must be smokers. It is not that eassy for someone to just up and quite there job and take a harder and/or lesser paying job. I work in a casino and hate being expost to nasty stinky smoke. So put that in your ciggeret and smoke it but just don't make me have to breath your "stinkbomb"!
Posted 11/16/09 at 2:30 am
I have been a casino dealer for a few years now in Detroit and I am hearing about this new cigarette that is going to be mandatory called the FSC Cigarette. According to the website, these new cigarettes have more harmful chemical byproducts in them that make the cigarettes go out by themselves and also create more toxins in the smoke. Does the government not realize that implementing these procedures not only affect smokers, but people exposed to second hand smoke as well! Smoking is NOT outlawed indoors everywhere YET, and they shouldn't be making cigarette smoke more harmful until that is accomplished.
Posted 11/17/09 at 2:32 pm