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Attitudes to smoking on submarines: Results of a questionnaire study

Military Medicine, Jul 2002 by Norris, William D

An anonymous survey to assess the attitudes to smoking of men serving on two Trident Nuclear submarines was conducted by questionnaire. A total of 244 questionnaires were completed, representing 87% of the two crews. Thirty-two percent of respondents declared themselves to be smokers, 69% were nonsmokers, and of these, 31% were ex-smokers. Attitudes of all respondents to an enforced ban of smoking on submarines indicated that 55% felt that it would be justifiable, 46% felt that it would be unfair, 42% felt that it was uncalled for, 46% thought that it would be illegal, and 47% thought that a ban was about time. The separate opinions of smokers and nonsmokers were polarized, whereas the overall results indicate indifferent attitudes of crew members. Further research into the atmospheric effects of environmental tobacco smoke on a submarine is required.

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Introduction

Smoking in the work place has been the focus of much medical and legal discussion during the past 20 years. Changes in attitudes to smoking and a greater awareness of the health risks associated with environmental tobacco smoke (ETS) have caused many authorities and employers to ban smoking from the work place.1 Recent legislation has placed the onus on the employer to provide a smoke-free environment for employees; in fact, employers may be subject to prosecution if they do not do so.2 In the past, smoking in the United Kingdom's armed forces may have been facilitated to a certain degree by the availability of duty-free cigarettes and tobacco. The practice of providing duty-free cigarettes and tobacco continues on Her Majesty's ships and submarines today.

Nuclear submarines, like any other submarine that remains submerged for long periods of time, constitute a completely isolated atmosphere when at sea on patrol. Therefore, the ventilation and air purification systems must be capable of producing oxygen, removing carbon dioxide and other gaseous contaminants such as hydrogen and carbon monoxide, and removing odors and particulate contaminants.

Given that a submarine may be required to remain submerged for up to 12 weeks with no access to the atmosphere, stringent restrictions are applied to substances that can be used on board. This is to prevent contamination of the submarine's atmosphere beyond predetermined limits, which would pose a health threat to personnel on board. Therefore, any material on board with toxicological or odorous characteristics has been assigned a maximum permissible concentration that must not be exceeded during a patrol.3 Should this concentration be exceeded, the submarine is required to ventilate to the atmosphere. If this occurred during a patrol, the submarine's requirement to remain undetected, and consequently the patrol aim, may be compromised.

Tobacco smoke has long been regarded as an acceptable contaminant on submerged submarines. The authors, as medical officers on submarines, became aware of increasing concern from crew members regarding the potential health effects to nonsmoking submariners. Nevertheless, there is currently no published evidence on the level of ETS contamination of the submarine atmosphere and whether this poses a threat to the health of nonsmoking submariners on board.

Smoking is restricted to certain areas on submarines at the commanding officer's discretion. This is an attempt to minimize the direct exposure of nonsmokers to ETS. These areas usually consist of one compartment forward and one aft of the reactor compartment. Smoking is not allowed in any accommodation or communal areas. However, because of the constricted space, it is not possible to provide a dedicated smoking area; therefore, all compartments in which smoking is permitted will be manned for varying amounts of time during the day by smokers and nonsmokers.

Cigarette smoke is a source of thousands of contaminants; some studies estimate the number to be up to 100,000, and currently, 3,000 to 4,000 have been identified.4 Carbon monoxide, particulates (such as tar, polyaromatic hydrocarbons, and nicotine), and volatile organic compounds (such as benzene, toluene, and formaldehyde) are considered to be the most important contaminants with respect to health as a result of their known carcinogenic properties. In addition their presence may increase the requirement to purify the submarine atmosphere.5

Although the risks of smoking to health are well documented, the evidence for health risks as a result of ETS exposure, although growing, has not been fully evaluated. Wahlgren et al. cite involuntary smoking as the third leading cause of death in the general populations and Dockery and Trichopoulos identify tobacco smoke as an environmental carcinogen.7 Recent studies have documented an increased risk of developing lung cancer as a result of ETS exposure,8,9 and one study puts the risk at as much as a 25% increase over that of matched controls after exposure to ETS at work.

There are additional reports of increased incidence of ischemic heart disease and stroke in association with ETS exposure, 11,12 and a recent study suggested a link with neoplastic and chronic nonneoplastic nasal and sinus diseases." There is also strong evidence of a correlation with sudden infant death syndrome, with one study finding that having a mother who smoked doubled the risk of sudden infant death. 14 Other studies have found that with increased exposure to passive smoking at work, there are increased absences from the work place, doctor consultations, and use of certain medications.15 More comprehensive studies are required to fully elucidate the effect of passive smoking on health.

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Attitudes to smoking on submarines: Results of a questionnaire study

Military Medicine, Jul 2002 by Norris, William D

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