Occupational fall incidence associated with heated tobacco product smoking and lifestyle behaviors: a nationwide cross-sectional study in Japan

ObjectivesTo identify the association between heated tobacco product (HTP) smoking and occupational falls, particularly combined with other lifestyle variables, including sleeping duration and comorbidities. MethodsThis web-based nationwide cross-sectional study (September-November 2023) involved 18,440 current workers (mean age, 43 years; women, 43.9%) in Japan. The primary outcome was occupational fall incidence in the past year. The secondary outcome was fall-related fractures. Smoking status was categorized as never, former, or current smokers; current smokers further classified into exclusive cigarette, exclusive HTP, and dual smokers (both cigarettes and HTPs). Other behavioral factors and covariates included alcohol consumption, sleep duration, physical activity, comorbidities, body mass index, hypnotics/anxiolytics use, and sociodemographic variables. Incidence ratios (IRs) and 95% confidence intervals (CIs) for occupational falls were estimated using multilevel Poisson regression with robust variance. ResultsOccupational falls and fall-related fractures were reported by 7.3% and 2.8% participants, respectively, in the past year. Younger workers were more likely to experience occupational falls. Compared with never smokers, current smokers had higher occupational fall incidence (IR = 1.36, 95% CI: 1.20-1.54), with exclusive HTP (IR = 1.78) and dual smokers (IR = 1.64) showing particularly elevated incidences. Similar patterns were observed for fall-related fractures. Elevated IRs were also observed for other lifestyle variables, including short sleep duration and diabetes, with the strongest associations found among younger workers. ConclusionsCurrent smoking, particularly HTP use, and lifestyle behaviors were significantly associated with occupational falls in Japan. These findings highlight the importance of lifestyle modifications to prevent occupational falls. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSIndividual lifestyle behaviors, including physical activity, sedentary behaviors, and sleep quality, are associated with the risk of falls. However, the association between the risk of falls and smoking habits, including heated tobacco product (HTP) use, which has emerged as a public health concern in Japan, remains poorly understood. What this study addsCurrent smoking, particularly HTP use, is associated with occupational falls. How this study might affect research, practice or policySmoking cessation can be considered a modifiable behavior for occupational fall prevention. Further studies are needed to investigate the relationship between smoking and the incidence of falls.