Quantification of ETS-exposure in non-smoking employees - a literature review

Project No. FF-FB 0121


completed 06/2007


- Assessment of association between outer and individual factors and ETS personal exposure for retrospective exposure assessment.
- Use of the exposure assessment to assess relevant thresholds for occupational disease claims


Systematic literature review


In 1998, Environmental Tobacco Smoke (ETS) has been classified as human carcinogen (K1) by the German Research Council (DFG). According to epidemiologic studies the relative risk especially for lung cancer might be doubled in the group of never smokers in the highest exposure category.
Hospitality workers are part of this group and have so far not been protected by the German Workplace Ordinance for the restriction of smoking at the workplace. For the group of workers who are (ex-) smokers, however, no additional increase in risk due to ETS exposure can be defined. In order to implement these results in the German legislation for occupational diseases a valid method is needed to retrospectively assess the cumulative ETS exposure in the hospitality setting. Therefore, a systematic literature review to find such a method that can be applied in the German hospitality sector was done.
Studies assessing ETS exposure by the use of biological markers (e. g., urinary cotinine, DNA-adducts) or questionnaires were excluded. Biological markers are not considered relevant as they assess exposure over the last hours to months only. Self-reported exposure based on questionnaires is also not considered adequate for medicolegal purposes. Therefore, retrospective exposure assessment should be based on mathematical models to approximate past exposure.
For this purpose a validated model developed by Repace and Lowrey was considered relevant. It offers the possibility to assess exposure using parameters which are at hand (like size of the setting, 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. In conclusion, adapting it to the German hospitality sector the model by Repace and Lowrey seems to be a possibility to approximate the cumulative exposure. However, the level of uncertainty has to be taken into account.

Last Update:



Financed by:
  • Deutsche Gesetzliche Unfallversicherung e. V. (DGUV)
Research institution(s):
  • Universität München

-cross sectoral-

Type of hazard:

unfavorable, adverse work environment


Berufskrankheit, Arbeitsumwelt (Belastungen, Gefährdungen, Expositionen, Risiken), Exposition

Description, key words:

literature, Environmental Tobacco Smoke (ETS)-exposure, non-smoking

Further information

Final report: (PDF, 748 kB) Literaturauswertung zur Quantifizierung der Passivrauchexposition bei nie rauchenden Beschäftigten im Gastgewerbe

Annex I (PDF, 266 kB): Ergebnisse der systematischen Literaturrecherche mittels der Datenbank Medline

Quantification of ETS exposure in hospitality workers who have never smoked