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SHOOK, HAR,nY& BACON P c. REPORT ON RECENT ETS AND IAQ DEVELOPMENTS January 22, 1993 SHB

REPORT ON RECENT ETS AND IAQ DEVELOPMENTS - IN THIS ISSUE - IN THE UNITED STATES REGUTATORY AND LEGISLATIVE MATTERS • OSHA directed to commence rulemaking on workplace smoking, p. 1. • ASH files new court petition to force OSHA action on workplace smoking, p. 1. • Centers for Disease Control campaign: "Stop Being a Passive Victim," p. 2. ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS • In Blanchard plaintiffs file first amended petition, p. 4. • In Broin, plainti8s file brief in class action appeal, p. 4. ISSUE 39 IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS • In Canada, smokers gather signatures to repeal Ottawa's workplace smoking ban, p.8. • In Hong Kong, antismoking lobbyists base call for smoking bans on U! S. EPA Risk Assessment on ETS, p. 8. LEGAL ISSUES AND DEVELOPSIEN-rS • International airline traveler threatens suit against United Airlines after allegedly contracting viral pneumonia, p. 9. SCIENTIFIC/TECHti1CAL ITEMS "Factors Associated with Bronchial Hyperresponsivencss in Australian Adults and Children," p. 9. "Atopy and Environmental Factors in Upper Respiratory Infections: An Epidemiological Survey on 2304 School Children " p. 9. "Passive Smoking and Hearing Loss in Infants," p. 10. • ETS/IAQLITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS • • A Pennsylvania woman allegedly sues a restaurant for assault and battery because of alleged exposure to ETS, p. 5. • SCIE'.?IFIC/TECHNiCAL ITEMS • "Passive Smoking Increases Experimental Atherosclerosis in Cholesterol-fed Rabbits," P.5. OTHER DEVELOPMENTS • Nursing home accreditation to include smoking issues, p. 6. OTHER DwELOPMwTS • In Canada, a business advises smokers not to apply for employment, p. 10. MEDIA COVERAGE • "Children's Frequent Illnesses Part of Growing Up," p. 6.

- TABLE OF CONTENTS - Issue 39 January 22, 1993 IN' THE UNITED STATES REGULATORY AND LEGISIATIVE MATTERS U.S. OCCUPATIONAL SAfETY & HEALTH ADMINISTRATION (OSHA) [ 1] OSHA Directed to Commence Rulemaking on Workplace Smoking ......................................1 (2] ASH Files New Petition to Force-0SHA Action on Workplace ETS .......................................1 (3l' U:S. Chamber of Commerce to Propose Draft of OSHA Rcf'orm ............................................ 2 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) (4] New Health Secretary Expresses Smoking Views .....................................................................2 (5l Centers for Disease Control and Prevention Launch Nonsmoker Campaign ...........................2 STATE AND LOCAL GOVERNMENTS [6), (7) Privacy Legislation .................................................................................................... ............... 3 Other State and Local'Legislative Activities Relatcd to ETS ..................................................... 3 ETS-RBLATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [8] Blarrchard Plaintiffs File First Amended Petiuon .....................................................................4 (9) Brnin: Plaintiffs File Brief in Class Action Appeal ....................................................................4 ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS ASSAULT AND BATTERY (10] Pennsylvania Woman Sues Restaurant .....................................................................................5 LABOR REIATIONS 1111 Dnig Plarrics e Gtau Carrrpany, Inc. (National Labor Relations Board) (decided December 16, 1992) .................................................................................................. 5 SCIENTIFIC/TECHNICAL ITEMS CARDIOVASCULAR ISSUES (12) "Passive Smoking Increases Experimental Atherosclerosis in Cholecterol-fed Rabbits," B: Q. Zhu, Y.-P. Sun, ILE. Sievers, W.M. Isenberg, S.A. Glantz, and W.W. Parmky, Journal af the Amerrrarr College of Cardiolagy 21(1): 225-232, 1993 .......................................... 5 OTHER HEALTH IssuEs [13] "Maternal Cigarette Smoking DuringPregnanry: A Risk Factor forChitdhood Strabismus,° R.B. Hakim and J.M. Tielsch, Arrhiurr ojOpbrhalmology 110: 1459-1462, 1992 [See Appendix A].................................................................................................. .................... ...................................................... 5 INDOOR AIR QUALITY [14l "Engineering Controls for Clean Air in the Office Environment," M.J. Ellenbecker, Cli+oirr in Chert Medicir'x 13(2): 193-199, 1992 [See Appendix A) ........................................... 5 OTHER DEVELOPMENTS [15l Nursing Home Accreditation to Include Smoking Issues .........................................................6 (16] Environmental Consulting Firm to Write IAQTattbook ................................................... ..... 6 (17] Michigan Lung Association Conducts Workplace Smoking Seminar .......................................6 MEDIA COVERAGE [19] "Children's Frequent Illnesses Part of Growing Up," B.A. Epstein, Sa AerertLurg Tima. January 11, 1993 .....................................................................................6 [19]'USA Weekend Focuses on Indoor Air Pollution and Health ...................................................7 1201 "No Smoking Rules Forcing Employees to Cut Baek," S. Ross, The Rertrer Bserirreir Rtport January 5, 1993 ............................................................................. 7

Contents Continued, Issue 39 IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AuSTwu.u CANADA [211 Municipalities Near Toronto Consider Toughening Smoking Restrictions ..............................7 [22] Smokers Gather Signatures to Repeal Ottawa's Workplace Smoking Ban ................................ 8 CZECHOSLOVAKIA HONG KONG [23] Antismoking Lobbyists Call For Smoking Bans ....................................................................... 8 ToaxEY [24] Official Calls for Smoking Bans ...............................................................................................8 UNITED KINGDOM [25] Health Minister Warns Antismoking Legislation May be Introduced ......................................8 LEGAL ISSUES AND DEVELOPMENTS [26] International Airline Traveler Threatens Suit AgainsrUnited Airlines .....................................9 SCIENTIFIC/TECHNICAL ITEMS CARDIOVASCUlAR ISSUES (27] "Serum Lipids & Lipoprotcin Profiles of Cigarette Smokers & Passive Smokers," J. Whig. C.B. Singh, G.L. Soni, and AK. Bansal, Indian Jor.rna! ofMrdical Rexarch 96(B): 262-287, 1992 [See Appendix A] .................................................................... 9 RFSPIRATORY DISEASES AND CONDITIONS - CHILDREN [281'"Factors Associated with Bronchial Hyperresponsiveness in Australian Adults and Children," J.K. Peat. C.M. Salomc, AJ. Wookock, European Rrspirasory Joarna! 5:; 921-929, 1992 [See Appendix A] ............................................................................ 9 [29] "Atopy and Environnxntal Factors in Upper Respiratory Infections: An Epidemiological Survey on 2304 School Children," E. Porro, P. Calarnita, I. Rana, L Montini, and S. Criscione, huernarionalJorrrnalofPedia:ric Ororhinolaryngology24: 111-120, 1992 [See Appendix A] .................................................................................................... .................9 (30) "Circadian Rhythm of Peak Expiratory Flow in Children Passively Exposed and Not Exposed to Cigarette Smoke." R. Casale, G. Natali, D. Colantonio. P. Pasqualetti. Thorax 47: 801-803, 1992 [See Appendix A] .................................................... 9 OTHER HEALTH ISSUES [31] "Passive Smoking and Hearing Loss in Infants,° R.A. Lyons, IrisbMedicalJor.rnal85(3): 111-112, 1992 [SecAppendixA] ............................................... 10 OTHER DEVELOPMENTS AUSTRALIA [32) Solomon Airlines Imposes Smoking Ban ......................... ...................................................... 10 CANADA [33] ETS Objectives Revcaled as Part of National Non-Smoking Week ........................................ 10 [34] i Business Advises Smokers Not to Apply for Employment ...................................................... 10 [35] Nonsmokers Publish Dining Guide .......................................................................................10 [36] Woodstove Users Warned of Health Risks .............................................................................10 APPENDIX A .................................................................................................... ................................Anicle Summaries APPENDIX B ................................................................................................Secr etary Martin Memo and Press Release APPENDIX C .................................................................................................... ........... HHS ETS Campaign Materials

JANUARY 22, 1993 1 REPORT ON RECENT ETS AND IAQ DEVELOPMENTS IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS U.S. OCCL'PATIONAL SAFETY & HFALTH ADMINISTRATION (OSHA) [1]' OSHA Directed to Commence Rulemaking on Workplace Smoking On January 13, 1993, six days after the EPA released its Risk Assessment on ETS and one week before leaving office, then-Labor Secretary Lynn Martin directed OSHA "to commence rulemaking to address the hazards of occupational exposure to secondhand smoke." She instructed!the agency to prepare a report for current Labor Secretary Robert Reich (who was confirmed by the Senate on January 21) that would provide rulemaking alternatives and analyze "the evidence in terms of the threshold OSHA must meet in order to regulate." Martin urged OSHA to consider all information about the alleged health effects of ETS, including the EPA risk assessment. As to the latter, she noted that EPA focused upon the "home environment" and that OSHA would need to "examine these concerns and determine how they apply to the workplace." Currently, there are no federal rules regulating smoking in privately-owned, non-industrial workplaces. Published press reports indicated that after the ETS tisk assessment was released, former Secretary of Health and Human Services Louis Sullivan and others tried to persuade President Bush to sign, before he left office, a proposed executive order banning smoking from federal agency offices, but the order was not signed. Martin said the review of workplace smoking issues would include information received in response to the Request for Information on indoor air quality, issued in September 1991, but that continued action with respect to ETS issues would be "apart from the indoor air quality rulemaking." She was quoted as saying, "'If we look at a rulemaking without separating [ETS issues] we'll be at about [the year] four billion and ten before we get a rule.'" See Daily Labor Report, January 15, 1993. With respect to the RFI, she said OSHA's Office of Health Standards is currently completing its analysis of the 1,200-plus responses in the public docket. Before delivering the above directive to OSHA, Martin requested several policy options with respect to ETS issues. According to one media report, Martin "expressed interest in more dramatic action - such as proposing regulations or an emergency temporary standard limiting ETS exposure - but OSHA officials had responded that such measures could not be supported by available evidence on the work-related'' hazards of breathing secondhand smoke." See Daily Labor Report, January 15, 1993. Like President Bush and most appointees of his administration, Martin relinquished her government post on January 20 with the inauguration of President Bill Clinton. Copies of Martin's press release and memorandum to former Acting OSHA Director Dorothy Strunk are attached as Appendix B. [2] ASH Files New Petition to Force OSHA Action on Workplace ETS On December 22, 1992, Action on Smoking and Health (ASH) filed a petition for review in the District of Columbia Circuit Court of Appeals seeking, among other matters, to overturn OSHA's recent denial of ASH's request that the agency initiate separate rulemaking proceedings for ETS in the workplace. ASH's written request was made on July 31, 1992. OSHA's denial came in an October 30, 1992, letter to ASH from then-Acting OSHA Director Dorothy L Strunk, in which Strunk stated that nothing would be gained by separating the issue of ETS from other indoor air quality issues. Sce issue 34 of this Report, November 6, 1992.

2 The ASH petition: also seeks the regulation of ETS as a potential carcinogen pursuant to the alleged mandate of the OSHA Cancer Policy and claims that OSHA has unreasonably delayed making a determination about initiating rulemaking proceedings on workplace ETS exposure following its September 1991 issuance of a Request for Information on indoor air quality (RFI). ASH requests that the court remand the matter to OSHA for further consideration of ASH's petition for the regulation of ETS in the workplace and that a timetable be set for OSHA compliance. Submitted to the court with its petition for review is a request by ASH that the case be heard by the same panel of judges which considered ASH's previous petitions against OSHA. ASH notes that, in a January 1992 order, the panel "clearly contemplated that there might be the need for further review and adjudication. That order was issued 'without prejudice to renewal of petitioner's request in the event that OSHA unreason- ably delays resolution of this matter following receipt of comments'" to the RFL Sce BNA Daily Labor Report, January 7, 1993. ASH v. Department of Labor, No. 92-1 G61 (U.S. Court ofAppeals, D.C. Circuit) (filed December 22, 1992). [3] U.S. Chamber of Commerce to Propose Draft of OSHA Reform The U.S. Chamber of Commerce is reportedly drafting its own version of job safety reform legislation. According to Steve Bokat, the Chamber's vice presi- dent and general counsel, the Chamber will probably not release its draft until after it sees the legislation being considered by Democrats in Congress and the approach of the new Labor Secretary Robert Reich. According to the head of the coalition, the coalition is still interested in discussing OSHA reforms with labor and Congressional leaders, but emphasized that the bill introduced in the last Congress should not be the starting point for discussion. As noted in issue 32 of this Report, October 9, 1992, the Comprehensive Occupational Safety and Health Reform Act of 1992 died in the last Congress without moving beyond the committee level. Bokat has reportedly stated during testimony before the House Education and Labor Committee that the ETS/1AQ REPORT, ISSUE 39 Chamber opposed the mandatory safety programs and joint committees and expansion of criminal penalties that were a part of last year's reform legislation. The Chamber did support, however, provisions requiring more timely reporting of fatal and serious accidents,, stronger worker protections in imminent danger situations and pay for employees accompanying OSHA inspectors during safety inspections. See BNA Current Davclopments, December 21, 1992. U.S. DEPARTMENT OF HEALTH AND HUmw SERVICES (HHS) [4] New Health Secretary Expresses Smoking Views During her confirmation hearings before the Senate Labor Committee, HHS Secretary Donna Shalala reportedly pledged that she would be an avid cam- paigner against smoking. Shalala daimed that when she was chancellor at the University of Wisconsin, she was most noted for "firing the football coach and ending smoking in all publirbuildings." Although Shalala evidently did not address the EPA's Risk Assessment on~ETS during her confirmation hearings, she did say that she would work to find "powerful incentives" to help turn people away from smoking. Srs AP, January 15, 1993. Shalala was confirmed by the Senate on January 21, 1993. [5] Centers for Disease Control and Prevention Launch Nonsmoker Campaign As announced by then-HHS Secretary Louis Sullivan during the January 7 press conference for the release of the EPA Risk Assessment on ETS, the Centers for Disease Control and Prevention have launched a multimedia information campaign entitled "Stop Being a Passive Victim." The campaign includes a guide book that offers suggestions to nonsmokers. Among the suggestions are recommendations that employees ask their employers to look into health insurance that rewards the company for being smoke free, that nonsmokers write letters to restaurants with smoking sections and request that they ban smoking altogether, and that nonsmokers tell guests in their homes that they may not smoke there. A toll-free telephone number is provided for individuals to order free copies of the booklet, which also discusses the alleged hazards of ETS exposure. See Gannett News

JANUARY 22, 1993 Service, January 7, 1993. Other materials from the campaign are attached as Appendix C. STATE AND LOCAL GOVERN9v[ENTS [6] Privacy Legislation The term "privacy legislation" refers to state statutes which protect workers who smoke off the job or, more generally, use legal products or engage in legal ~ activities outside the workplace. • District of Columbia On January 5, 1993, Mayor Sharon Pratt Kelly reportedly signed a measure which prohibits employers from dis- criminating against smokers. Washington, D.C., joins the twenty-eight states that currently have privacy laws; a 29th state provides protection to workers by executive order. Ste The Washington Tima, January 7, 1993. • Massachusetts A bill that would prohibit employers from discriminat- ing against applicants or employees for the use of tobacco products outside the course of employment reportedly passed the House on December 22, 1992, and was sent to the Senate. See H.B. 3857, 177th General Court - Regular Sess. (1992). [7] Other State and Local Legislative Activities Related to ETS • California A bill that would prohibit employers from permitting smoking in enclosed places in the workplace was sent to the Assembly Committee on Labor and Employment on January 14, 1993. SeeA.B. 13, Regular Sess. (1993). • Mississippi On January 6, 1993, two bills that would prohibit smoking in certain public indoor areas were reportedly introduced and sent to the House Committee on Public Health and Welfare. See H.B. 184 and H.B. 185, 162d Legislature - Regular Sess. (1993). On the same date, a bill that would prohibit smoking in state office buildings was reportedly introduced and sent to the House Committee on Public Buildings, Grounds and Lands. See H.B. 181, 162d Legislature - Regular Sess. (1993). • Montana The Senate State Administration Committee is report- edly considering a measure that would end a require- 3 ment that all state buildings have a designated smoking area. See USA Today,January 1'4,1993. • New Hampshire Already among those states with tough antismoking legislation, New Hampshire will apparently broaden current smoking restrictions on July 1, 1993, applying them to private-sector businesses, hotels, motels, resorts, convention centers, inns and restaurants seating more than 50 patrons. Smoking was already prohibited in public schools, day care centers, grocery stores, malls, beauty salons, hospitals, elevators, and public transporta- tion. Smoking restrictions requiring designated smoking areas or bans were in effect for theaters, banks, sports facilities, stores, office buildings and all public or govern- mental buildings. See The Union Leader, January 7, 1993. A bill that would require each county superior court- house to have a separate nonpublic smoking area for crime victims and their families was reportedly intro- duced on January 6, 1993, and sent to the House Committee on the Judiciary. Set H.B. 160, 153d Legislative Sess. (1993-1994). • New York During his "Message to the Legislature" on January 7, 1993, Governor Mario Cuomo (D) announced that he would seek legislation this year to prohibit smoking on all school grounds and to expand smoking prohibitions in places where children typically meet. The chairman of the Assembly's Health Committee has reportedly endorsed the governor's proposals. See UPl, January 7, 1993. • Obio Governor George Voinovich (R) has issued an execu- tive order banning smoking in all state buildings and vehicles, whether owned or leased by the state. Accord- ing to published press reports, residential areas of state universities and other institutions, such as prisons, will be exempt from the ban. No implementation date has apparently been set, but it is expected that the ban will take effect after the Department of Administrative Services meets with state employees. Apparently, the union representing the 37,000 state workers will not oppose the move, but will request that the state assist workers who wish to quit smoking. See UPI, January 10, 1993. • Oklahoma A bill that would prohibit smoking in licensed nursing homes and day care centers was reportedly prefiled on December 21, 1992. SeeH.B. 1015, 44th Legislature - 1st Regular Sess. (1993).

4 • Wisconsin According to the director of the Wisconsin Initiative on Smoking and Healthi the organization is working with state legislators to enact laws that would restrict smoking in public places. In a recent study released by the group, it was reported that nearly 25 percent of Milwaukee area restaurants are violating state laws by failing to set aside areas for nonsmokers. Some of the restaurant owners surveyed by the study apparently said they were unaware that state law requires that restaurants seating 50 or more patrons must have a nonsmoking section. State Senator Fred A. Risser (D-Madison) daimed to be disappointed in Milwaukee's lack of compliance and said that patrons should complain to their district attorneys if they want a nonsmoking section in a restaurant. See UPI, January 8, 1993. • Local Governments in California Ventura County Public Health Services officials are reportedly trying to convince cities in the county to enact anti-smoking legislation in light of the release of the EPA Risk Assessment on ETS. Apparently, Santa Paula and Fillmore are the only cities in the county which do not prohibit smoking in public buildings or reserve at least 50% of restaurant tables for nonsmok- ers. According to a senior health educator with the county's Tobacco Education and Control Center, the Center is working with residents of Thousand Oaks, who are lobbying to strengthen the city's current smoking restrictions. SeeLorAngelrs Tima,January8, 1993. • Local Governments in Washington The Snohomish County Health District Board report- edly learned on January 12, 1993, that it cannot mandate smoking bans in restaurants as it lacks the authority to supersede state law on the issue. Evidently, one of the county's health officers had considered proposing that the district require all restaurants to be smoke free in order to obtain a business license. See The Srattlr Times, January 14, 1993. ETS-RELATED LITIGATION'AGAINST CIGARETTE MANUFACTURERS [8] Blanchard Plaintiffs File First Amended Petition On January 11, 1993, plaintiffs filed a First Amended Petition purporting to add the daims of nine new ETS/IAQ REPORT, ISSUE 39 plaintiffs. The total number ofplaintiffs now stands at 14, three of whom are making daims individually and as the representative of a decedent. All of the new plaintiffs' claims appear to relate to active smoking, with one exception. Plaintiff Pamela Kastrin Stephens claims unspecified "lung and respiratory diseases" allegedly caused by exposure to the ETS from the cigarettes smoked by her deceased father, George Kastrin (whose widow has made a daim individually and as his representative). The original plaintiffs in this case, Raye Blanchard and Tamara Reed, are mother and daughter. They allege primary-smoking injuries to Raye Blanchard's late husband, Thomas, who allegedlysmoked for more than 50 years, and Raye Blanchard hetself, who daims she smoked "for about ten years." In additionj Raye Blanchard and Tamara Reed'both claim damages for unspecified "illness and disease" allegedly resulting from exposure to the ETS from cigarettes smoked by Thomas and Raye Blanchard. Prior to the amended petition filed on January 11, plaintifls filed a First Supplemental Petition purporting to add three additional plaintifffs, each ofwhom daim injury from active smoking. The named defendants are purported to be the six major U.S. cigarette manufacturers, The Tobacco Institute, the Council for Tobacco Research, and a number ofwholesalers and retailers. Blanchar~ a a1 v. R.J. Reynolds Tobacco Com- pany, etaL (District Court; Galveston County, Texas) (filed July 31,1992). [9] Broin: Plaintiffs File$rief in Class Action Appeal On January 11, 1993, plaintifis filed their opening briefon their appeal of the dismissal of their dass action allegations. Defendants' brief in response is due February 10. With respect to defendants' petition for certiorari relating to plaintif35' attempts to depose top company executives, plaintiffs sought an extension - until Febru- ary 9- to file their response to the petition. Both the appeal of the dismissal of the dass action allegations and the petition for certiorari are pending in the Third District Court of Appeal. In the trial court, plaintiffs filed a second amended complaint containing amended fraud and conspiracy counts against the Council for Tobacco Research and the Tobacco Merchants Association on January 7, 1993. Both CTR and TMA had been dismissed by the court on November 2.

JAN UARY 22, 1993 As to defendants' written discovery requests, unsigned responses to interrogatories have now been submitted for 26 of the 30 plaintifffs. Ten of those responses were submitted after the December 21 deadline established by the trial court. Plaintiffs made no effort to extend the deadline. At issue in this case are the claims of 30 flight atten- danu allegedly injured by occupational exposure to ETS. The injuries alleged by the putative dass representatives induded lung cancer, breast cancer and unspecified respiratoryy ailments. Thedefendants are purported to be the six major U.S. cigarette manufaaurets (plus related entities), Unite& States Tobacco Co., Dosal Tobacco. Corp., the Council for Tobacco Research, The Tobacco Institute, and three other trade associations. Bmin, cr aL v. Phikp Morr'u, et aL (Circuit Court, Dade County, Florida) (filed Oaober 31,1991): ETS/IAQ LITIGATION NOT INVOLVING CI GARETTE IvIAN UFACTURERS ASSAULT AND BATTERY [10] Pennsylvania Woman Sues Restaurant According to published press reports, a Pennsylvania woman is suing a restaurant in Allegheny County, Pa., for assault and battery because of alleged exposure to ETS. The woman, Diana Andromalos-Dale, reportedly claims that she suffered a severe asthmatic attack after the restaurant seated her near smokers, despite her request to dine in a nonsmoking area. See The Wall StnerJournai, January 7, 1993. LABOR RELATIONS [ 11] Drug Plastics 6 Glau Company, Inc. (National Labor Relations Board) (decided December 16, 1992) The Board has reportedly affirmed the decision of an administrative law judge that the employer lawfully discharged an employee for violating its policy against smoking on the production floor while production was in progress. Although the Board rejected the employee's claim that he was discharged because of his union organizing activities, it did affirm a finding that 5 the employer committed unfair labor practices in the context of the union's organizing campaign. See BNA Daily Labor Report, January 14, 1993. SCIENTIFIC/TECHNICAL ITEMS CARDIOVASCUlAR IssUEs [12] "Passive Smoking Increases Experimental Athero- sderosis in Cholesterol-fed Rabbits," B.-Q. Zhu, Y: P. Sun, R.E Sievers, W.M. Isenberg, S.A. Glantz, and W.W. Parmley, Journal ofrlxAnuri- can Collegr of Cardiology 21(1): 225-232, 1993 A paper based on this study, which was presented at the American H'eart Association Meeting in November 1992, has now been published! It is essentially un- changed from the manuscript previously excerpted. See Issue 36 ofthis Report, December 4, 1992. OTHER HEALTH ISSL`ES [13] "Maternal Cigarette Smoking During Preg- nancy: A Risk Factor for Childhood Strabis- mus," R.B. Hakim and J.M. Tielsch, Archives of Ophthalmology 110: 1459-1462, 1992 [See Appendix A] The authors report on a case-control study investigat- ing a daimed association between childhood strabis- mus(i.e., "'cross-eye") and prenatal risk factors. The authors report that maternal smoking during preg- nancy was associated with an elevated risk of strabis- mus. Moreover, they claim that maternal smoking during pregnancyand'exposure to paternal smoking was associated with an even higher risk. INDOOR AIR QUALITY [14] "Engineering Controls for Clean Air in the Office Environment," M.J. F1lenbecker, Clfnics in ChtstMediciru 13(2): 193-199, 1992 [See Appendix A] The author of this study reviews basic characteristics of "building engineering control systems" and how they might contribute to occupant health and comfort.

6 He advocates increased ventilation and maintenance of HVAC systems to alleviate complaints of poor indoor air quality in the workplace. OTHER DEVELOPMENTS [15], Nursing Home Accreditation to Include Smoking Issues According to a newswire report, the nation's principal health-care accrediting body reportedly voted at its January 1993 Board of Commissioners' meeting to , impose smoking restrictions upon the more than 1,000 nursing homes it accredits. The action reportedly was taken to reduce bed fires and prevent interference with the care of respiratory patients. Although nursing home residents are exempt from the ban, the Joint Commis- sion on Accreditation of Healthcare Organizations will require that accredited facilities prohibit staff and visitors from smoking. The ban is scheduled to become effective on January 1, 1994. The Commission is a private, non-profit group that surveys health facilities to determine if they meet industry standards. Lack of accreditation does not affect a nursing home's ability to obtain~reimbursement for Medicare and Medicaid, but it can reportedlyy impact a facility's ability to obtain loans and low insurance rates. The policy will only affect a small' percentage of the nation's 20,000 nursing homes. The Commission had previously imposed smoking restrictions on some 5,000 hospitals and mental care facilities. This policy was reportedly modified follow- ing criticism from psychiatrists who said some mentally ill patients smoke to relieve stress. Mentally ill indi- viduals, long term care residents, prison psychiatric patients, and post-acute head trauma patients will now be permitted to smoke without practitioner authoriza- tion under the commission's restrictions. Sce AP, January 16, 1993. [16] Environmental Consulting Firm to Write IAQ Textbook Gobbell Hays Partners Inc., a Nashville-based architectural, engineering and environmental consult- ETS/IAQ REPORT, ISSUE 39 ing firm, has reportedly signed a contract with McGraw-Hillito publish what the firm believes will be the first comprehensive textbook on IAQ for students and professionals. According to Gobbell presidenr, Ronald V. Gobbell, students and professionals arc currently not getting training on IAQ issues. Gobbell previously consulted on an asbestos manual for build- ing operators that was prepared by the EPA and the U.S. General Services Administration. See Nashvilk Busiruss Jousna4 December 7, 1992. [17] Michigan Lung Association Conducts Work- place Smoking Seminar The American Lung Association of Michigan report- edly held a seminar on workplace smoking on January 20, 1993, in Southfield. Entitled "Smoking in the Workplace in the 1990s," the seminar was expected to deliver the message that Michigan businesses must take action to reduce the alleged threat of ETS in the workplace. According to published press reports, faculty participants were to include representatives of the state department of public health, a health consult- ing firm, a law firm and a hospital! S« PR Nrwswire, January 8, 1993. MEDIA COVERAGE [18] "Children's Frequent Illnesses Part of Growing Up," B.A. Epstein, Sti Perershurg Times, Janu- ary 11, 1993 Dr. Bruce A. Epstein, a St. Petersburg pediatrician, claims in this opinion piece that "children who live with tobacco smokers suffer a type of child abuse." Epstein makes this assertion within the context of explaining that nearly all children suffer six to eight colds per year during the first five years of life. He attributes their susceptibility to illness to the following: immature immune systems; allergies; direct exposure to other sick children in day care, preschool'and nurseries; and indirect exposure from older siblings who are in school. Epstein believes, however, that ETS exposure is the "most notorious" of additional risk factors predis- posing children to illness and insists that parents, grandparents and babysitters not smoke in a confined area in the presence of children.