AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 46:170–179 (2004) Reducing Occupation-Based Disparities Related to Tobacco: Roles for Occupational Health and Organized Labor Elizabeth M. Barbeau, ScD, MPH, 1,2 Deborah McLellan, MHS, 1 Charles Levenstein, PhD, MSOH, 3 Gregory F. DeLaurier, PhD, 3 Graham Kelder, JD, 1 and Glorian Sorensen, PhD, MPH 1,2 Background Persistent and growing occupation-based disparities related to tobacco pose a serious public health challenge. Tobacco exacts a disproportionate toll on individuals employed in working class occupations, due to higher prevalence of smoking and exposure to secondhand smoke among these workers compared to others. Methods We provide an overview of recent advances that may help to reduce these disparities, including research findings on a successful social contextual intervention model that integrates smoking cessation and occupational health and safety, and a new national effort to link labor unions and tobacco control organizations around their shared interest in reducing tobacco’s threat to workers’ health. Conclusions Implications of these efforts for future research and action are discussed. Am. J. Ind. Med. 46:170 – 179, 2004. ß 2004 Wiley-Liss, Inc. KEY WORDS: tobacco control; organized labor; occupational health; health protection-health promotion INTRODUCTION The prevalence of current smoking shows a clear and inverse occupational gradient. Tobacco exacts a dispropor- tionate toll on individuals employed in working class occupations, due to higher prevalence of smoking and exposure to secondhand smoke among these workers compared to others. The United Kingdom’s new occupa- tional classification schema, explicitly ‘‘constructed to measure employment relations and conditions of occupa- tions,’’ and employing five categories that span from ‘‘managerial and professional’’ (Class 1) to ‘‘semi-routine and routine’’ (Class 5) [Office for National Statistics, United Kingdom, 2003], was used to examine the prevalence of current smoking among the total US adult employed population in 2000. Prevalence was highest among workers in classes 4 and 5 (36.8 and 32.4%, respectively) and lowest among workers in class 1 (17.8%) [Barbeau et al., 2004]. Similar gradients were observed for the three largest racial/ ethnic groups in the US (non-Hispanic Whites, non-Hispanic Blacks, and Hispanics), and for women and men. These differences in smoking prevalence by occupation persisted even when controlling for income, education, race/ethnicity, age, and gender, thereby indicating an important and distinct relationship between current smoking and occupational ß 2004 Wiley-Liss, Inc. 1 Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massa- chusetts 2 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts 3 Department of Work Environment, University of Massachusetts Lowell, Massachusetts Contract grant sponsor: American Legacy Foundation, Consortium on Organized Labor and Tobacco Control; Contract grant number: 6263; Contract grant sponsor: National Cancer Institute; Contract grant numbers: 5 RO1CA68087, 5 P01CA75308; Contract grant sponsor: Larry and Susan Marx Foundation. *Correspondence to: Elizabeth Barbeau, Center for Community-Based Research, Dana- Farber Cancer Institute, 44 Binney Street, Boston, MA 02115. E-mail: elizabeth_barbeau@dfci.harvard.edu Accepted 20 March 2004 DOI10.1002/ajim.20026. Published online in Wiley InterScience (www.interscience.wiley.com)