Tobacco Documents Online

9 se on rl=ung aza oervices- Pgen IteQt 3 October 23, 1982 In general, these data suggest that both smokers and nonsmokers are concerned about the effects of tobacco smoke on health, that a majority of people support smoking restrictions, and that the establishment of specific areas for smoking and not smoking is preferable to a complete ban on smoking. In a recent survey at the Red' Cross national headquarters, staff (both smokers and nonsmokers) indicated interest in the following areas related to smoking control: (Total Responses: 176) Designation of no smoking areas Smoking cessation program Other ideas (see below) Individual counseling available Willingness to use own time for activity Willingness to pay money for the activity 43 percent 24 percent 10 percent 9 percent 7 percent 5 percent Smoking control as a component of a health pSgmotion program received more individual suggestions than,anyother component. RECOMMENDATIONS Staff suggests that the Committee on Planning and Services recommend that the Board of Governors approve implementation of the resolution to discourage smoking in common areas, classrooms, meetings, and conferences of the American Red Cross. Conditions for success in implementing the resolution on smoking include: - the involvement of nonsmokers and smokers working together at each facility of the Red Cross to identify specific strategies for discouraging smoking in common areas, meetings, and conferences, - planners of meetings and conferences consistently considering administrative logistics such as posting no smoking signs and announcing times and locations where smoking may take place, flexibility when Red Cross clients experience personal crises such as disas- ters, and encouragement to chapters and national sector to offer smoking cessation programs as part of a full range health promotion program at the worksite. Note: Reference materials and additional background materials will be avail- able at the October meeting of the Committee on Planning and Services. Prepared by: L. F. Barker, M.D. and Lea Edwards, R.N. 5eptember 23, 1982 s

C 10 C References 1. Resolution I, American Red Cross National Convention, St. Louis, Missouri, May 26, 1982. 2. Final Report, 1982 Committee on Resolutions, American Red Cross, June 18, 1982. 3. ?ublic Smoking in Perspective, The Tobacco Institute, July 11982. 4. Environmental Tobacco Smoke and Health, Report from RJ Reynolds, Inc, submitted by JF Abely with letter to JH Holland, August 20, 1982. 5. A Study of Public Attitudes Toward Cigarette Smoking and the Tobacco Industry, The Roper Organization, prepared for The Tobacco Institute, 1978. 6. Kiefhaber A and, Goldbeck W. Smoking: A Challenge to Worksite Health Management, Proceedings of the National Conference on Smoking or Healrch~ American Cancer Society, November 18-21, 1981. 7. Services to Armed Forces and Veterans, and their Families, 1.2: Cigarettes and Other Tobacco Products, Manual on Policy and Instructions. Americaro- Red Cross, Chapter III Section 1, April 20, 1964. 8. Meeting Minutes, American Red Cross Board of Governors, October 1978. 9. Health Services Study, American Red Cross Report and Recommendations to the Board of Governors, January 1981. 10. Brandt EN. Foreword; Health Consequences of Smokin¢, Cancer: A Report of the Surgeon General. United: States Department of Health and Human Services, 1982. 1I. Burns, DM. Involuntary Smoking, Smoking and Health: A Report of the Surgeon General. United States Department of Health Education and Welfare, 1979. 12. Schulman LM. Introduction and Summary, Smoking and Health: A Report of the Surgeon General. United States Department of Health, Education and' Welfare, 1979. 13. Printout: Passive Smoking, Office on 5moking and Health, United States Department of Health and Human Services, 1982. 14. Aronow W. Effect of Passive Smoking on Angina Pectoris The New England, Journal of Medicine. Vol 299 No 1 July 6, 1978, 21-24. 15. Aronow W. Effect of Passive Smoking on the Cardiovascular and Respiratory O Systems, Proceedings of the Third World Conference on Smoking and Health, ~ New York, June 2-5, 1975, 883-890. w O C!1 ' ~

12 C 31. Smoking and the Workplace - A Business Survey, National Interagency Council on Smoking and Health; 1979. 32. Policy on Smoking in HEW Occupied Buildings and Facilities and Policy on Smoking for the Medical Care Facilities of the Department of Defense, Public Health Service, and: Veterans Administration, United States General Administrative Manual. Chapters 1-60, 1978. 33. American Lung Association. Letter from N Doyle to L Barker, February 19, 1982. 34. Novelli W. Promoting the Rights of Nonsmokers, Proceedings of the National Conference on Smoking or Health, American Cancer Society, 1981, 267-268. 35. Health Promotion in the Workplace Survey, American Red Cross, National Headquarters, March 1982. ~

4 Individuals have the right to decide to smoke, yet smoking is identified-as the largest preventable cause of death in America. Smoking contribuges substantial costs to employers and to the country as medical care costs. The health consequences of smoking are therefore not just the problem of the individual. EFFECTS OF PAS5IVE SMOKING ON THE NONSMOKER Nonsmokers breathing the smoke exhaled by a smoker (mainstream smoke) and smoke rising from burning tobacco (sidestream smoke) are "passive smokers." Research on the effects of tobacco smoke on the nonsmoker is at an earlier stage than research on effects of tobacco smoking on the smoker. Scientists are testing the absorption of smoke constituents by the nonsmoker as well, as the short and long-term effects on the nonsmoker's health; some uf these studies, particularly on the long-term effects, are highly controversial. More than 300 articles have been published that identify the constituents of sidestream smoke and, smoke exhaled by the smoker and describe tests on the effect of those constituents on the nonsmoker.l3 Observations from the literature to date include: The constituents of toli~cco smoke are identifiable, and some of them are known carcinogens. Some of these constituents are absorbed by a nonsmoker breathing sidestream smoke. The degree of absorption of constituents necessary to effect long-term harmful' effects is not well established. Tobacco smoke can have acute harmful' effects on persons with chronic cardiovascular problems, corongyytery disease, pulmonary diseases, asthma, and allergies to smoke. Whether absorption of tobacco smoke by healthy nonsmokers over many years can increase the risk of cardiovascular diseases and cancer is controversial, with ar3,41tMA on both sides, and insufficient data for definitive conclusions. Nonsmokei§ 1~~o breath tobacco smoke may have a variety of physical reactions. A scan through abstracts of the literature on passive smoking reveals that the nonsmoker exposed to sidestream smoke in enclosed areas can experience any of the following acute effects: nausea, headache, fainting, burning eyes, irritation of nose and throat, coughing, allergic or asthmatic reactions. These symptoms may also be caused by other environmental conditions, such as motor vehicle and industrial emissions. Smokeis~ experience a higher incidence of respiratory tract infections than nonsmokers. Nonsmokers in their vicinity on a regular basis' would therefore be more frequently exposed to those infections (colds, influenza, pneumonia). 03735048 Constituents of cigarette smoke include gases-such as carbon dioxide, carbon monoxid'Witrogen oxides, and ammonia-and particulates-such as tar, water, and nicotine. Sidestream smoke (smoke from the burning end of the cigarette) has i

C 7 Agenda Iter.:~ 3~ October 23, 1982 Several companies highlighted in the literature have developed model smoking control programs. These include: the Campbell Soup Company, IB+A; Dow Chemical Co., Speedcall Corporation, Control Data, American Telephong and Telegraph, Johns-ytanville, Boeing Aircraft, Ford Motor Company and others. The Federal government has two smoking policies for the workplace. One restricts smoking in buildings and facilities occupied by the Department of Health and Human Services. 'ihe other is a policy on smoking for medical care facilities3~f the Department of Defense, Public Health Service, and Veterans Administration. The Anlyican Lung Association smoking policy, adopted in May 1976, reads as follows: Association staff, board and committee members shall present themselves as nonsmoking exemplars when they represent the organization. Further, in pursuit of the goals to eliminate smoking and to protect the health and' rights of nonsmokers, smoking by board members, staff members and the general public shall be prohibited in association offices. At a 1981 National Conference on Smoking or Health, in New York, sponsored by the American Cancer Society, the workgroup on Smoking Control in the WorkWe recommended these guidelines for establishing a smoking policy in workplaces: a. Employees and representatives from employee groups (unions), where appro- b. priate, should participate in the design and implementation of the policy. Flexibility should be allowed in the implementation of such a policy in each company location. c. Smoking restrictions designed to protect employees from exposure to ciga- rette smoke should be encouraged and implemented to the extent possible. Smoking restrictions should take into account that cigarette smoking can be addictive for some and, therefore, should not be punitive toward employees who are unable to stop smoking. e. A variety of smoking cessation approaches should be made available to all employees and, where possible, dependents and retirees. Participation in smoking cessation programs should be encouraged, but will be voluntary an6 confidential. g• The cost of the programs should be allocated in a manner that does not create an excessive burden on local management. h. Smoking should be restricted in areas where it is known to affect technical equipment or negatively interact with toxic substances. i. Where programs are developed through collective bargaining, the cost of the programs should not be taken into account as part of any employee benefits package.

j. The policy must be supported by all levels of management if it is to be successful. k. The policy should not conflict with, nor be a substitution for, the company's obligation to maintain a safe workplace. 1. Where smoking cessation programs are provided on company time, arrange- ments should be made with participants' supervisors to facilitate participa- tion, yet not significantly alter business operations. State level legislation restraiA smoking in "various enclosed places" in 46 states and the District of Columbia. Recent court c3~ses show a trend in upholding the rights of nonsmokers in workplace settings. Companies are finding that restricting smoking saves money. If a company follows the guidelines above, there should be no grounds for discrimination against hiring smokers. OPINIONS ABOUT SMOKING AND SMOKING RESTRICTIONS A public survey cbnducted by the Roper Organization for The Tobacco Institute in 1978 Vicated' that 90 percent of all persons believed smoking to be harmful to health. Furthermore, that survey reported that- - 58 percent of all adults believe that smoking is hazardous to the nonsmoker's health; when data are broken down, 69 percent of the nonsmokers and 40 percent of the smokers expressed that belief. 60 percent of nonsmokers and 5 percent of smokers report that they find it annoying to be around other smokers. almost no one (2 percent) finds it "pleasant" to be near a person who is smoking. 53 percent of smokers reported that they are either frequently or occasional- ly uncomfortable about smoking in company. 37 percent of smokers reported' that they either do not smoke, look around, first, or ask others if they mind, before deciding whether to smoke a cigarette indoors. Another 11 percent said "it depends." 61 percent of the surveyed population feels that smoking in workplaces or offices should be restricted to separate sections; 67 percent feel smoking should be restricted to separate sections at public meetings; as compared to 91 percent who feel that there should be separate sections in trains, airplanes, and buses.* O W ~ W *Break f Lhese data between smokers and nonsmokers is not available. O C11 l.7 .

SMOKING CONTROL IN THE WORKSITE C from involuntary smoke exposure is a serious public health concern because of the large numbers of nonsmokers in the population who are potentially exposed. Therefore, for the purpose of preventive medicine, prudence dictates that non- smokers avoid exposure to second-hand tobacco smoke to the extent possible. Worksite health promotion programs encompass activities aimed at reducing the risk of illness and injury or premature death due, primarily, to cardiovascular disease, cancer, stroke, mental health problems, and accidents. Activities may involve eucational programs, organizational changes, and environmental support systems. Smoking control, then, is only one component of a health promotion program in the worksite. Other components may include-depending on the health concerns and needs of employer and employees-weight control and nutrition education, stress management, accident prevention, drug and alcohol abuse control, fitness programs, high blood pressure control, and early cancer detection. Smoking is claimed to cause a significant financial buf~en to industry. Each year, over 80 million workdays are lost due to smoking. Smokers have a greater tendency to develop acute respiratory illnesses and suffer from chronic heart and lung diseases. "One-pack-a-day smokers have a1$ percent greater chance of hospitalization than their nonsmoking colleagues." Studies by the American Council of Life Insurance and Health Insurance Association of America indicate that of job-related accidents, "the total accident rate among smokers is twice that of non-smokers, precipit2ged by loss of attention, preoccupation of the hand, eye irritation and c~~ghing." Smoking may increase costs to an organization in the following ways: absenteeism disability insurance health insurance life insurance fire insurance pensions workers compensation retraining building maintenance 6 medical care at the worksite productivity disability work restrictions effects on nonsmokers loss of time on the job turnover recruitment property damage and depreciation liability Estimated annual costs of each smoker to a company plus the costs of building mainte5n% property damage and depreciation range between $624 and $4,789. ' Estimates of savings due to a smoking policy or company-sponsored smoking cessation programs also vary. A summary of evidence that health promotion programs in the worksite can be cost beneficial is included in the book Manaxina ~ealth Promotion in the Workplace by Rebecca Parkinson and Associates. In 1979, The National Interagency Council on Smoking and Health conducted a nationwide survey of businesses about smoking policies and programs. "Approxi- mately 15 percent of United States companies assist their employees to quit smoking." Another third of the "responding companies want to develop or expand smoking control programs for employees." The study surveyed 3,000 United States businesses: the Fortune "double 500" (top 1,000 companies ranked by gross sales), 1,000 medium sized3Fompanies (500-2,200 employees), and 1,000 small companies (50-499 empl'oyees). 1

C Committee on Planning and Services Agenda Item 3 October 23, 1982 Resolution 1(1982) Smoking At the American Red Cross Convention, May 1982, the delegates passed the following resolution, referred to the Board of Governors for action. WHEREAS, a major effort in health promotion and disease and accident prevention has been adopted as a central theme of organizational development in Red Cross in the next decade;and WHEREAS, the weight of medical evidence suggests that smoking of tobacco products can adversely affect the health not only of smokers themselves, but also of non- smokers in the vicinity; NOW THEREFORE, BE IT RESOLVED, that smoking be discouraged in common areas, classroorPs, meetings, and conferences of the American Red Cross. The purpose of this paper is to provide background information about the health effects of smoking and about smoking control programs in the workplace. The paper cites some of the scientific research on smoking effects on health, as well as experiences of other organizations and opinion surveys of smokers and nonsmokers. Smoking control issues to consider include: the effects of smoking on the health of both smoKers and nonsmokers, the trends in smoking control in the workplace, the costs of smoking practices to an employer, and how employees (both smokers and nonsmokers) feel about smoking restrictions. Comments on these issues have come from a variety of organizations. The Office on Smoking and Health (formerly the National Clearinghouse for Smoking and Health) is the Federal Government office most concerned with the health conse- quences of tobacco use. The office was established as part of the United States Public Health Service in March 1978, to provide leadership in education and research, and to serve as a clearinghouse for public and technical information on smoking and health. The Tobacco Institute is a trade association for the tobacco industry. The National Interagency Council on Smoking and Health is a coalition of public and private organizations concerned' with reducing death and disability due to cigarette smoking in the United States. The American Council of Life Insurance and the Health Insurance Association of America include representatives of United States life and health insurance companies. The American Cancer Society,' American Lung Association, and American Heart Associations are the three most prominent voluntary health organizations acting to decrease smoking and its effects.. The Washington Business Group on Health, an organization with a membership of over 190 major corporations, compiles information about health promotion programs in the workplace, including smoking control. University medical schools, business associations such as the Administrative Management Society, private consulting firms, and state public health departments have published numerous reports on smoking and its effects. i

2 The Red Cross also has had the benefit of an analysis of the literature and'the passive smoking issue prepared by the R. ]. Reynolds Company and provided by Mr. Abely. INTENT AND BACKGROUND OF THE RESOLUTION As stated in the background material sent to the 1982 Convention C,=lttee on Resolutiems,the intent of the resolution submitted by the St. Paul Area Chapter was to estabtish a Red' Cross policy that restricts smoking in group settings and common areas of Red Cross facilities. The resolution does not imply that Red Cross volunteer and paid staff should not smoke. Rather, it suggests a strategy for meeting the interests of nonsmokers as well as smokers. The final report of the 1982 Committee on Resolutions states that:2 The Committee recognized the role of the Red Cross in education in.awareness of health hazards as outlined in many of our Health Services programs. A consistent attitude towards health hazard habits is essential to the reinforcement of the course materials relative to smoking. At the same this Committee does not feel it is the role of the Red Cross to legislate public behavior. For this reason we have changed the action part of the resolution submitted by the St. Paul Area Chapter to accomplish the intended goal of the resolution while at the same time not making it a part of Red Cross policy. Concerns expressed about the establishment of a corporate smoking policy include: - There is not enough eviqVe that sidestrearn smoke* is harmful to the health of the nonsmoker. I Restrictions on smoking may be the first step towargs restrictions of other public activities found irritating or unattractive. A company smoking p~olicy will lead to discrimination against hiring individuals who smoke. A company has the legal right to restrict smoking practice.6 Smoking restrictions may cause an adverse volunteer reaction and'decrease in donations from smokers and frome those involved in the tobacco industry. A smoking policy may increase tension among smoking and nonsmoking staff. *Sidestream smoke rises from the burning end' of the cigarette. Mainstream smoke is drawn through the cigarette by the smoker when puffing or inhaling.

C 5 Agb.,da Iten 3 October 23, 1982 higher concentrations of most constituents than mainstream smoke (smoke that the smoker draws through the cigarette when puffing or inhaling). Much more sidestream smoke enters the atmosphere than mainstream smoke because smokers only puff on a 4igarette a few seconds out of the average 12 minutes that the cigarette burns. For example, carbon monoxide is a gas, does not settle out of the atmosphere in an enclosedllspace, and is not removed by most of the standard air filtration systems. Cigarette smoking can raise the concentration of carbon monoxide in the ambient air to much higher than normaL levels. Under certain conditions of poor ventilation, the carbon monoxide level may exceed air quality standards set by the Occupational Safetylend Health Act (OSHA) and by the Environmental Protection Agency (EPA). OSHA regulations apply to occupationab settings, such as factories and office buildings. EPA standards generally apply to outdoor environments. Individuals absorb carbon monox}~e at various rates depending on their distance from someone actively smoking. Carbon monoxide competes with oxygen for binding with hemoglobin, the blood component which normally transports oxygen throughout the body. This is a particular danger for persons with cardiovascular problems. Carbon monoxide increases the risks for a person with coronary artery disease to werience an attack of angina (chest pain due to decreased coronary blood flow). Carbon monoxide, at levels occasionally found in cigarette smoke- filled environments, has been shown to produce deterioration in some ltfsts Of psychomotor performance, especially attentiveness and cognitive function. Studies on long-term inhalation of tobacco smoke by the nonsmoker have reported the following findings regarding the function of small, airways in the lungs. Researchers at the University of California found that passive smokers, smokers who do not inhale, and light smokers all scored similarly on pulmonary function tests. Those swes were 27-75 percent lower than nonsmokers not expose6 to tobacco smoke. At the Harvard Medical School's Channing Laboratory, lung function tests of children (nonsmokers) who live with smoking parents were compared to tests of children who live with nonsmoking pareni~. Children living with smoking parents had significantly diminished lung capacity. Three studies in the recent literature examined whether passive smoking causes lung cancer in nonsmokers. The results of these long-term studies are mixed. A 14-year Japanese study indicated that nonsmoking wives of smoking husbands had higher ra~&s2gf lung cancer than those of nonsmoking wives of nonsmoking husbands. ' However, the scient1ir4 and statistical methods used for this study have received considerable criticism. ' Regarding the controversial research area of long-term risks of passive smoking to the nonsmoker, the 198210Surgeon General's report, The Health Conseouences of Cancer: Smokin , states, Evidence from two of the studies demonstrated a statistically C significant correlation between involuntary smoking and lung W cancer risk in nonsmoking wives of husbands who smoked. A .3 third noted a positive association, but it was not statistically L= significant. While the nature of this association is unresolved, ~p it does raise the concern that involuntary smoking may pose a A carcinogenic risk to the nonsmoker. Any health risk resulting W i