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Health Hazards of Respirable Dusts 103

4. Recognizing characteristics of various coal types, e.g., the rank effect, silica contents, and
bioavailability of silica.
5. Lifestyle intervention programs including cessation of smoking and routine medical
surveillance.

Items 2, 3, and 4 will be discussed in the following chapters, but item 5 is discussed
here.

7.4 Lifestyle Intervention Program

It is now well established that the lifestyle of the miner and his or her personal suscep-
tibility to coal mine dust injury play important and determining roles in the occurrence of
CWP [18,19]. In a typical year, a miner may spend about a quarter of his or her time in
the work environment. The remainder of the hours in the year is spent away from the
mine. Lifestyle practiced outside the mine is likely to have a greater impact on the
miner’s health now because respirable dust levels are quite low in the work environment.
By emphasizing healthy lifestyles, offering wellness programs, and providing for
certain preventative examinations, the employers can hope to reduce the cost of health
care by intervening with the employee before the disease becomes manifest. Essential
parts of a lifestyle intervention program should include cessation of smoking, good
nutrition, and medical surveillance for early detection of personal susceptibility.
Cessation of smoking is perhaps the most important step in elimination of CWP.
Coal miners must not smoke either on the job or at home because there is over-
whelming evidence to prove that smoking and exposure to dust particles (coal and
other particles) have a synergistic effect on the development of occupational respira-
tory diseases [10]. Finally, all coal miners should participate in routine medical surveil-
lance that not only includes radiographic chest examinations and spirometry but also
looks for early symptoms of high rate of dust deposition and retention in the lungs. For
example, measuring the presence of iron in the lungs using sophisticated equipment,
such as superconductive quantum interference device or acoustic reflection techniques
[20], could provide a measure of individual susceptibility. Individuals with diminished
ability to clear the inhaled dust must use protective devices, e.g., air helmets, or be
located in outbye areas where ambient dust concentration is substantially lower. A ho-
listic approach is needed to finally eradicate this dreaded disease. It consists of the
following four steps:
1. Better personal exposure monitoring.
2. Better engineering control of respirable dust.
3. Recognizing unique characteristics of coal (such as, rank, silica content, and iron content).
4. Enforcement of lifestyle intervention programs.

The latter involves cessation of smoking, good nutrition, and medical surveillance
to detect individual susceptibility to CWP and provide adequate safeguards.
A concerted effort as proposed has eliminated CWP in some countries and may
reduce or even eliminate it in the rest of the coal-mining countries of the world.