title: Cooking smoke and respiratory symptoms of restaurant workers in Thailand.
abstract: BACKGROUND
  Restaurant workers are at risk from exposure to toxic compounds from burning of fuel and fumes from cooking. However, the literature is almost silent on the issue. What discussion that can be found in the literature focuses on the potential effects from biomass smoke exposure in the home kitchen, and does not address the problem as occurring in the workplace, particularly in restaurants.
  
  
  METHODS
  This was a cross-sectional survey of 224 worker from 142 food restaurants in the Tha Pho sub-district of Phitsanulok, a province in Thailand. The standard questionnaire from the British Medical Research Council was used to collect data on chronic respiratory symptoms, including cough, phlegm, dyspnea, severe dyspnea, stuffy nose in the participating workers. Data on their health symptoms experienced in the past 30 days was also asked. A constructed questionnaire was used to collect exposure data, including type of job, time in the kitchen, the frequency of frying food, tears while cooking (TWC), the type of restaurant, fuel used for cooking, the size and location of the kitchen, and the exhaust system and ventilation. The prevalence of the symptoms was compared with those obtained from 395 controls, who were neighbors of the participants who do not work in a restaurant.
  
  
  RESULTS
  In comparison to the control group, the restaurant workers had twice or more the prevalence on most of the chronic health symptoms. Men had a higher risk for "dyspnea", "stuffy nose" and "wheeze" while women had higher risk of "cough". A Rate Ratio (RR) of susceptibility was established, which ranged from 1.4 up to 9.9. The minimum RR was for women with "severe dyspnea" (RR of 1.4, 95%CI 0.8, 2.5) while the men showed the maximum RR of 9.9 (95%CI 4.5-22.0) for "wheeze". Possible risk factors identified were job description, job period, size of restaurant, kitchen location, type of cooking oil, hours of stay in the kitchen area, number of fry dishes prepared, frequency of occurrence of TWC, and additional cooking at home. Working for 6-10 year increased the risk of "cough" with an Odd Ratio (OR) of 3.19 (P < 0.01) while working for more than 10 years increased the risk of "cough" (OR = 3.27, P < 0.01), "phlegm" (OR = 3.87, P = 0.01) and "wheeze" (OR = 2.38, P = 0.05). Working as a chef had a higher risk of "cough" by 2.33 (P = 0.01) as comparing to other jobs. Workers in a relatively large restaurant using 4 or more stoves had increased risk of "wheeze" with OR of 3.81 (P < 0.01) and "stuffy nose" with OR of 3.56 (P < 0.01). Using vegetable oil increased the risk of "stuffy nose" by 2.94 (P < 0.01). Every 10 h of stay in the kitchen area was associated with a minimal increase in the risk of "cough", "wheeze" and "symptoms in the past 30 days" by 1.15 (P = 0.02), 1.16 (P = 0.01) and 1.16 (P = 0.02), respectively.
  
  
  CONCLUSIONS
  Restaurant workers are at risk of respiratory symptoms caused by exposure to toxic compounds from cooking fumes. Job description, job period, size of restaurant, kitchen location, type of cooking oil, hours of stay in the kitchen area, number of fry dishes prepared, frequency of occurrence of TWC, and additional cooking at home were the predictive factors. Workplace Health and Safety protection of restaurant worker is urgently needed and the issue should receive more public attention.
authors.affiliation: Department of Natural Resource and Environment, Faculty of Agriculture, Natural Resource and Environment, Naresuan University, 99 Moo 9, Thaphao sub-district, Amphur Muang, Phitsanulok, 65000, Thailand. cjuntara@gmail.com.
authors.forename: Chudchawal
authors.identifier: http://orcid.org/0000-0003-0321-5325
authors.initials: C
authors.lastname: Juntarawijit
authors.affiliation: Faculty of Nursing, Naresuan University, Phitsanulok, Thailand.
authors.forename: Yuwayong
authors.initials: Y
authors.lastname: Juntarawijit
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D003296:Cooking; D003371:Cough / Q000139:chemically induced / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012135:Respiratory Sounds / Q000209:etiology; D012147:Restaurants; D012906:Smoke / Q000009:adverse effects*; D013785:Thailand; D017132:Workplace
chemical_list: D000395:Air Pollutants, Occupational; D012906:Smoke
keywords: Cooking fumes; Health symptoms; Kitchen smoke; Respiratory health; Restaurant health and safety; Restaurant workers