Objectives: To identify the association between heated tobacco product (HTP) smoking and occupational falls, particularly combined with other lifestyle variables, including sleeping duration and comorbidities. Methods: This 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. Results: Occupational 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. Conclusions: Current 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.

Dr. Fujino holds the copyright to WFun with royalties paid from Sompo Health Support Inc., outside of this work. The other authors have no potential conflicts of interest to declare.

This study was partly supported by the Ministry of Health, Labour and Welfare (23EA1003, 23FA1004, 23JA1003, and 23JA1004); UOEH Grant-in-Aid for Collaborative Research between the Institute of Industrial Ecological Sciences and the University Hospital (2022-1) and the Japan Society for the Promotion of Science (JSPS KAKENHI JP22K17401).

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The study was approved by the Ethics Committee of the University of Occupational and Environmental Health, Japan (no. R4-054).

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