1038

TOBACCO AND ASBESTOS LITIGATION

SIR,-If Dr Goffe (Oct 4, p 811) is correct and public perceptionand awareness of risk are the main reasons behind the replacementof the asbestos industry, then one might expect workers

occupationally exposed to asbestos to be well informed about thesecomplications. Preliminary results of a study in this unit do notsuggest that the asbestos worker is well informed about the healthrisks associated with asbestos. Of 201 men occupationally exposedto asbestos and in varying degrees to cigarette smoke, 121 werecertain that asbestos had affected their health, 56 were unsure, and24 did not consider their exposure to be harmful. Cigarettes werethought to have been harmful by 81, 26 were unsure, but 94 werecertain that smoking in their case had no effect. The reason for thesedifferent opinions within this group may well be related to the typeof patient involved but the figures accord in principle with Goffe’sview that the perception of risk has been skewed towards asbestos.When the men were asked to name conditions thought related to

asbestos or cigarette smoking a different pattern emerged:Asbestos No Cigarette smokzng NoAsbestosis 71 (35-3%) Lung cancer 142 (70-6%) )Lung cancer 54f’26’S% J Bronchitis/emphysema 58 (28-9%) JNone known 59 29% Heart disease 39 ( 19 4 % )Chest/lung disease 31 (15-5%) Chest/lung disorder 27 (13,4%)Cancer 28(13-9%) Cancer 11 (5’4%)Mesothelioma 10 (4-9%) Stroke/vascular disease 8 (3-9%)Pleural thickening 2 Hypertension 1

Skin disease 2 Pulmonary tuberculosis 4

Asbestos not harmful 1 Others (9 conditions) 18Others (6 conditions) 15 None known 4

Our results suggest that, despite their earlier opinions on whetherasbestos or smoking had been harmful, these workers were moreaware of the risks of cigarette smoking. It was very unusual for aman not to mention at least one known complication (usually lungcancer) of smoking, whereas almost one-third (29-3%) were unableto state any complication of asbestos. The awareness ofmesothelioma in this area is perhaps less than one might expect, butit is not surprising that lung cancer was mentioned frequendy.1 Thelack of awareness of heart disease as a complication of cigarettesmoking deserves comment. Most of the conditions grouped as"others" are not those which are usually related to either asbestos orsmoking. Pulomonary tuberculosis is noted separately as an

example of these misconceptions.Most of the men were unable to mention at least one of the

accepted complications of cigarettes or asbestos, but in general morecomments were made about cigarettes.Some of the methods employed by groups opposed to the use of

carcinogenic substances have been criticised2 and these methodsmay also be implicated in the decline of asbestos, although ourresults do not suggest that public perception or knowledge is

responsible.Centre for Respiratory Investigation,Glasgow Royal Infirmary,Glasgow G31 2ES

KENNETH ANDERSONF. MORAN

1. Kemp I, Boyle P, Swains M, Muir C, eds. Atlas of cancer in Scotland 1975-1985:Incidence and epidemiological perspective (IARC Sci Publ no 72). Oxford: OxfordUniversity Press, for WHO, IARC, and cancer registenes of Scotland, 1985.

2. Peto R. Distorting the epidemiology of cancer: the need for a more balances view.Nature 1980; 284: 297-300.

TOBACCO: UK AND CHINA

SIR,-Each year in Britain, tobacco is estimated’ to kill over100 000 people, while alcohol is estimàted2 to kill "only" about4000. Such estimates are, of course, subject to substantial

uncertainty, and the varied pleasures and miseries that may beassociated with alcohol further complicate assessment of its totaleffects on the public health. Still, the Royal College of Psychiatrists,whose report2 you referred to (Oct 18, p 931), is quite wrong tosuppose alcohol to be the greater public health issue. In terms ofpurely physical ailments, tobacco is vastly more important thanalcohol.

This is true not only in developed countries such as Britain(where male smoking has been widespread long enough for its fulleffects now to be apparent) but also in developing countries such asChina, where male cigarette usage has only recently become

comparable with that in Britain. In 1975, despite their very differentsizes, Britain and China each recorded about 30 000 lung cancerdeaths. Application of the British 1975 rates to the projectedChinese 2025 population, however, predicts that by then China willbe recording about 900 000 lung cancer deaths a year-plus,perhaps, even larger numbers of tobacco-induced deaths from otherdiseases. (Most of those who will be killed by tobacco in 2025 are, ofcourse, already alive now.) In this context, the relative importance ofdifferent causes of death should not be reversed.

Clinical Trial Service Unit,Radcliffe Infirmary,Oxford OX2 6HE RICHARD PETO

1. Health or Smoking? London: Royal College of Physicians, 1983.2. Alcohol: Our Favourite Drug. London: Royal College of Psychiatrists, 1986.

ASSAULT RATES AND UNEMPLOYMENT

SIR,-Research into the socioeconomic background of assault inthe UK, apart from special groups such as battered wives andchildren, has been neglected, though Home Office crime statisticssuggest an association between employment status and violence.Under-reporting of assault, a problem in some surveys wouldlargely be overcome in a hospital-based study.We therefore surveyed the 294 consecutive assault victims who

attended the accident-and-emergency department, Bristol RoyalInfirmary (the only casualty department serving central and southBristol), during the first six months of 1986. Demographic factorsrecorded included employment status and electoral ward (based on1966 ward boundaries, for which population, unemployment rates,and social and material deprivation indicators were known3). Yates’corrected chi-squared and Fisher’s exact tests were applied to testfor differences in the rates of assaults among the unemployed andthe rest of the population. These tests also compared the prevalenceof unemployment among those assaulted with that among those notassaulted.There was a significant difference (p < 0001) between the assault

rate in the unemployed (1/344) and that in the rest of the population(1/2232).

Assaults were more frequent in the unemployed than in the rest ofthe population not only in wards of high social deprivation but alsoin wards with little social or material deprivation, as judged by carownership, children receiving free school meals, households withfewer rooms than persons, unemployment, and households withelectricity disconnected (all 1981 figures, see table). Furthermore,the link between unemployment and victimisation was not

significant in persons from some of the more deprived wards.

ASSAULT RATES BY ADDRESS (ELECTORAL WARD) AND INDEX OFSOCIAL DEPRIVATION FOR WARD

*1 = least deprived, 18 = most deprived.