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SlUrRY OF CONCLUSIONS DRAWN FROM STUDIES REVIEWED EXTRAPOLATION FROM ACTIVE SMOKERS © ID THE RELATIVE RISK OF LUNG CANCER IN NON-SMOKING GI.~BJECTS EXPOSED TO ETS Is 1,10 USING RELATIVE URINARY COTININE LEVELS, HOWEVER THE QUESTIONS REMAIN; e ARE DOSE-RESPONSE RELATIONSHIPS LINEAR AT LOW TO AVERAGE DOGES? IS THERE A CONSTANT PROPORTIONALITY OF NICOTINE AND CARCINOGENS IN BOTH MS SMOKE AND ETS? J NO CONCRETE EVIDENCE Bt,rF THERE ARE INDICATIONS THAT INHALED DECAY PRODUCTS (PB210 AND Po210) PLAY A ROLE IN OTHER CANCERS, •? B20002B~

SUMMARY DF CONCLUSIONS DRAWN FROM STUDIES REVIEWED SPOUSAL STUDIES ii FOR 11 OUT nP ]~ GROUPS (8 SEPARATE STUDIES) OF NON SMOKERS EXPOSED TO ETS, THE RELATIVE RISK OF LUNG CANCER EXCEEDS 1.0. HOWEVER THIS IS SIGNIFICANT (P<0.OS) IN ONLY 5 OF THESE GROUPS. O 2. SUMMARy ESTIMATES PLACE RESTIVE RISK OF LUNG CANCER IN NON-SMOKERS AT 1.34, WITH A RANGE OF VALUES 1.15-1.52. , MISCLASSIFICATIDN BIAS DOES NOT ACCOUNT FOR ALL THE INCREASED RISK, RECALCULATI~OF RELATIVE RISK, USING 10, 20, ~O AND 40~ MISCLASDIFICATION RATES YIELDS A MINIMUM RELATIVE RISK OF 1.25 FOR NON-SMOKERS MARRIED TO SMOKERS AND 1.08 FOR NON-SMOKERS MARRIED TO NON-SMOKERS BUT EXPOSED TO ETS.

CALLS FOR FURTHER RESEARCH O EPIDEMIOLOGY 1, LONGITUDINAL STUDIES TO INVESTIGATE EFFECTS OF ETS EXPOSURE ON LUNG FUNCTION - TO CONTROL FOR HOUSING/CLIMATE - TO ASSESS DEVELOPMENT OF AIRWAY HYPER-RESPONSIVENESS, 2, COHORT STUDIES OF NORMAL AND AT-RISK POPULATIONS" - ASTHMATICS - OBSTRUCTIVE LUNG DISORDER PATIENTS - ANGINA AND HEART DISEASE PATIENTS, 3. AssEsS THE INTERACTION BETWEEN ETS AND RADON EXPOSURE, 4, EXAMINE MECHANISMS THROUGH WHICH PATERNAL SMOKING ADVERSELY AFFECTS FETAL GROWTH IN NON-SMOKING MOTHERS - EXCRETION AND ABSORPTION OF ETS - TRANSPLACENTAL METABOLISM, NON-EPIDEMIOLOGY i, DETERMINE THE CARCINOGENIC CONSTITUENTS OF ETS - CONCENTRATIONS IN DAILY ENVIRONMENTS, 2, EXPLORE THE ETIOLOGIC ROLE OF INHALED DECAY PRODUCTS, 3, OUANTIFY THE DOSE-RESPONSE RELATIONSHIP USING BIOLOGICAL MARKERS, 4, ANIMAL STUDIES TO: - EVALUATE TIMING OF PHYSIOLOGICAL CHANGES IN LUNG FUNCTION - ASSESS CHANGES IN CARDIOVASCULAR FUNCTIONS. 6;~000;336S

SICK BUILDING SYNDROME INCIDENTS .-.) NIoSH (1984:203 BUILDINGS) H & W CANADA (1984:94 BUILDINGS) O % VENTILATION 48,3 INSIDE CONTAMINATION 17,7 OUTSIDE CONTAMINATION 10,3 HUMIDITY 4,4 BUILDING FABRIC 3,h HYPERSENSITIVII"Y PNEUMONITIS •3,0 CIGARETTE SMOKING 2.0 NOISE/ILLUMINATION 1,0 SCABIES 0.5 UNKNOWN 9.4 INADEQUATE VENTILATION - POOR AIR CIRCULATION - INADEQUATE OUTDOOR AIR - POOR TBMP,/HUMIDITY OUTDOOR CONTAMINANT - REENTRY BUILDING EXHAUST - VEHICULAR EXHAUST INDOOR CONTAMINANT - COPY MACHINES - TOBACCO SMOKE BUILDING FABRIC - GLUES - FORMALDEHYDE BIOLOGICAL CONTAMINANTS UNKNOWN % 6B 10 5 2 O 15

O IBPACT OF ETS ON INDOOR AIR QUALITY 0DOUR lJ ETS AROUSES ODOUR RESPONSES, OBJECTIONABLE ODOUR GENERATED BY ETS GREATLY EXCEEDS THAT GENERATED BY SIMPLE OCCUPANCY UNDER COMPARABLE CONDITIONS OF OCCUPANCYJ DENSITY, TEMPERATURE AND RELATIVE HUMIDITY. O 1 TOBACCO SMOKE ODOUR IS STABLE OVER TIME, CURRENT VENTILATION AND AIR CLEANING REQUIREMENTS DO NOT REMOVE ODOUR, 3. 0DOUR DERIVES PRIMARILY FROM THE VAPOUR PHASE, 0DOUR GOVERNS REACTIONS OF VISITORS. REACTIONS OF OCCUPANTS. ]RRITATION GOVERNS x G~OOO~3G7

O IRRITATION EYE IRRITATION IS THE MOST IMPORTANT NEGATIVE FACTOR. 2, EYE BLINK CORRELATES WITH SENSORY IRRITATION AT HIGH LEVELS OF ETS (C0~5 PPM), 3, IRRITATION CAN BE ATTRIBUTED TO THE PARTICULATE PHASE, 4, IRRITATION MAY REMAIN AFTER REMOVAL OF IRRITANT, 5, CUTANEOUS SENSITIVITY TO TOBACCO LEAF OR SMOKE EXTRACTS DOES NOT CORRELATE WITH SUBJECTIVE SYMPTOMS, G OOO2 GS

'O VENTILATION 1, Low HUMIDITY EXACERBATES ODOUR AND IRRITATION TO ETS, 1 VENTILATION RATES OF 50-60 CFM PER PERSON ARE REQUIRED TO PROVIDE SATISFACTORY INDOOR AIR QUALITY WHERE ETS IS PRESENT, 3, THERE IS PROBABLY NO PRACTICAL VENTILATION RATE THAT COULD SATISFY 80~ OR MORE NON-SMOKING VISITORS, 4, SEGREGATION OF SMOKER/NON-SMOKERS IS ROT A SOLUTION, fi200023G9

ASHRAE GUIDELINES FOR VENTILATION 0 TARGET : SATISFY 80~ OF VISITORS TO A ROOM, NON-SMOKING: 5-8 CFM PER OCCUPANT, SMOKING : 20-35 CFM PER OCCUPANT, ASHRAE GUIDELINES CONSIDERED INADEQUATE DUE TO: i, BASED ON LITERATURE VALUES, ASHRAE GUIDELINES SATISFY S0-75% VISITORS AND NON-SMOKING OCCUPANTS NOT 80~, 2. NON-SMOKERS HAVE LOWER THRESHOLD VALUES FOR OBJECTIONS WHICH SHOULD TAKE PRECEDENCE, G;~OOOP~.?.70

J SEGREGATION OF SMOKERS / NON-SMOKERS NOT A SOLUTION: i, RATE OF'MIGRATION OF SMOKE FROM SMOKING TO NON-SMOKING AREAS IS UNKNOWN, 0 2. COMMON VENTILATION/FILTRATION SYSTEMS NEGATE ANY BENEFITS OF SEGREGATION, L) G20002371

CALLS FOR FURTHER RESEARCH SUBJECTIVE i, FIELD STUDIEG TO DETERMINE AN APPROPRIATE VISITOR ACCEPTABILITY RATE, 1 INVESTIGATE THE EFFECT OF FILTRATION OF ETS, BOTH PHASES, INCLUDING VENTILATION AND CLEANING SYSTEMS ON ABATEMENT OF DISCOMFORT. 3. DETERMINE APPROPRIATE OBJECTIVE PHYSIOLOGICAL OR BIOCHEMICAL INDICES TO MEASURE IRRITATION, OBJECTIVE i, DETERMINE CONSTITUENTS OF ETS RESPONSIBLE 2. COMPARE NORMAL AND ATOPIC INDIVIDUALS, FOR IRRITATION. m