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Purpose: Excessive paper dust during paper production may harm the workers' respiratory health. We wanted to assess the inhalable paper dust levels and its determinants among paper industry workers., Methods: A study was conducted in Ethiopia to assess the level of personal inhalable paper dust exposure among four paper mills. A total of 150 samples were collected using the IOM sampler attached to Side Kick Casella pumps at a flow rate of 2 L/min. The samples were analyzed in Nemko Norlab, Norway. Linear mixed-effect models were applied to identify determinants of inhalable paper dust., Results: The geometric mean of personal inhalable paper dust was 3.3 mg/m 3 with 80% of the measurements exceeding the Swedish occupational exposure limit (OEL) of 2 mg/m 3 . The linear mixed-effects model showed that the level of dust was 28% higher when using high-speed than when using low-speed rewinding machines, while paper mills with an average of more than four machines per job group had 22% higher exposure than paper mills with a lower number of machines. Furthermore, working in packing and preparation was associated with higher dust exposure than in other areas., Conclusions: The dust exposure levels were above the Swedish OEL for 80% of the samples. This indicates that preventive measures should be established in the industry. The exposure model identified high-speed rewinding machines, a high number of machines, and work in preparation and packing as associated with high levels of paper dust exposure., Competing Interests: Declarations Ethical approval Ethical clearance was obtained from the Institutional Review Board of the College of Health Science Addis Ababa University number 079/22/SPH and from the Regional Committee for Research Ethics South East Norway, number 2022/521268. After the purpose and the importance of their participation were explained informed consent was taken from each study participant. Privacy and confidentiality of information given by each participant were kept properly and personal identifiers were removed. Conflict of interest The authors declare that they have no competing interests., (© 2024. The Author(s).)