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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.

JANUARY 22, 1993 [19] USA Weekend Focuses on Indoor Air Pollution and Health USA Weekend recently published a series of anicles answering reader questions about sick building syn- drome, ETS, radon, and other alleged sources of poor indoor air quality. Readers had been asked in Septem- ber 1992 to submit written questions on these and other related subjects. See issue 30 of this Report, September 14, 1992. Bob Axelrad, director of EPA's indoor air division, was consulted for this special issue and was quoted as saying, ""The EPA does not have a mandate to regulate indoor environments. Whether Congress will give us a mandate to do more, we don't know. Regulation would be tough: There's a gap between what people report and what science is able to document.'" USA Weekendwriters generally recommended increasing ventilation and keeping home and office as clean and dry as possible to limit exposure to indoor air pollutants. On the issue of ETS exposure, USA Wrek end claimed significant adverse health consequences to children of parents who smoke and said the American Lung Association advises parents who smoke to limit smoking to rooms away from children. The artides also gave specific recommendations regarding dry cleaning fluids, office equipment fumes, furniture off-gassing, household cltaners, asbestos, radon, and carpet fumes. An additional article outlined the ways in which newborns and young children allegedly can be affected by the indoor environment and proposed ways in which parents could reduce exposures, induding airing out new clothes and bedding, purchasing used furnish- ings, and not smoking. The incidence of SIDS (sudden infant death syndrome) was related to synthetic chemicals and decreased levels of ventilation during winter months. Electromagnetic fields and food safery were also discussed in this issue. See USA Wnkrnd, January 3, 1993. [20] "No Smoking Rules Forcing Employees to Cut Back," S. Ross, The Rtuter Busiruss Rtport, January 5, 1993 Employees interviewed for this article reported that they have significantly cut back on their use of tobacco products in response to workplace smoking restrictions that have been imposed either by government regula- 7 tions or private-sector policy. In addition, some smokers have cut back due to heightened peer pressure at work. According to surveys conducted by various antismoking organizations, some 500 municipalities across the United States have smoking restrictions in public places and one out of every three U.S. compa- nies now limits or bans workplace smoking. Stiff fines in some locations have apparently motivated smokers to obey workplace smoking restrictions. According to the antismoking group, Smokenders of Phoenix, Arizona, complaints from nonsmokers are the main reason for the increase in smoke-free working environments, although the companies adopting such policies are also reportedly concerned with health, safety, cost and liability issues. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AUSTRALIA In Queensland, the Woorabinda Aboriginal Council has reportedly introduced a smokefree zone policy which bans smoking from all offices and endosed areas in town. Su Rockhampson Morning Bulletin, January 4, 1993: CANADA [21] Municipalities Near Toronto Consider Tough- ening Smoking Restrictions According to published press reports, municipalities in the Toronto metro area are considering emulating Toronto's tough new stance against smoking as reflected in the antismoking measure that went into effect in that city on January 1, 1993. See issue 38 of this Report, January 7, 1993. Although smoking is restricted or banned in some metro locations, local health officials and antismoking activists arc reportedly considering seeking the amendment of local ordinances to either meet or exceed Toronto's restrictions. See The Toronto Star, January 5, 1993.

8 [22] Smokers Gather Signatures to Repeal Ottawa's Workplace Smoking Ban Unhappy with the Ottawa workplace smoking bylaw that went into effect on July 1, 1992, the Smokers' Freedom Society has reportedly collected more than 7,000 signatures on a petition for repeal of the measure. The bylaw requires that designated smoking areas be separately v,entilated, and smokers' rights activists say that this means smoking has been effectively banned in workplaces. The city's licensing and enforcement branch has apparently received some 70 requests for investigations of offices and public places since the bylaw went into effect. See The Ottawa CrtiZen, January 8, 1993. In a related story, managers of bingo, billiard and bowling establishments in Nepean are eoncerned'that a similar bylaw which went into effect on January 1, 1993, will hurt their business if it is enforced. Like Ottawa's bylaw, Nepean's antismoking measure restricts smoking to 50 percent of the area in restaurants and shopping mall food courts. Smoking is outlawed completely in the common area of any mall, barber shop, laundromat, restroom, elevator, escalator and stairway. Unlike Ottawa's law, however, the city of Nepean applies the 50 percent restriction to bingo parlors, bowling alleys and billiard halls. According to one bingo hali man- ager, the 10 percent area that has been set aside for nonsmokers has never been filled. See The Ottawa Citizen, January 8, 1993. CZECHOSLOVAKIA According to published press reports, a proposal to ban smoking in the Czech assembly building failed by a narrow margin at the close of the 20th and final session of the 200-seat Czech National Council in spite of its support by Deputy Czech Premier Jan Kalvoda, who reportedly referred to the bill as a real gem. See BBCSummary of World Broadcasts, January 1, 1993. HONG KONG [23] Antismoking Lobbyists Call For Smoking Bans Citing the U.S. EPA Risk Assessment on ETS, the executive director of the Council on Smoking and Health (COSH) has reportedly urged the government to institute a smoking ban in banks, Kai Tak airport, MTR stations and shopping centers. Apparently, a smoking ban already ETS/IAQ REPORT, ISSUE 39 applies to public transport and certain public places, but COSH would like it to be extended to commercial building foyers and govemmenr departments frequently visited by the public. COSH has also reiterated' iu call for a ban on smoking in restaurants and urged the govern- ment to list "passive smoking" on death certificates as a cause of death. According to published press reports, the Hongkong Bank extended a five-branch pilot program and began providing smoke-free queues in 30 of its branches on January 11. 1993. Customer response will be studied to see if the policy will be expanded to include all 241 of the bank's branches in the territory. See South China Morning Post, January 8, 1993. TuR1cEX [24]' Official Calls for Smoking Bans The president of the Turkish Green Crescent has reportedly called for a law banning smoking in public places. President Selahattin Kaptanagasi believes that the number of smokers in Turkey, approximately 20 million, would double if nonsmokers exposed to ETS were counted in their number. Apparently, Turkey ranks fourth in the world in tobacco consumption, and news reports associate 160,000 deaths per year to smoking-related illnesses. See Xinhua General News Service, January 7, 1993. UNITED KINGDOM [25] Health Minister Warns Antismoking Legislation May be Introduced Speaking at the opening of an ETS exhibition at the London Science Museum on January 14, 1993, Health Minister Dr. Brian Mawhinncy reportedly daimed that legislation to control smoking in the workplace and public transport would be introduced if voluntary targets on nonsmoking in public places are not met. In its White Paper, The Health of the Nation, the government apparently stated that at least 80 percent of public places should be covered by nonsmoking policies by 1994, and the majoriry ofworkplaces by 1995. According to Mawhinney, the Department of Health is studying the EPA Risk Assessment on ETS and it "'may well affect the way we take forward our future plans.'" See The Indrpcn- dtni; January 15,1993.

JANUARY 22„ 1993 LEGAL ISSUES AND DEVELOPMENTS [26]' International Airline Traveler Threatens Suit Against United Airlines Businessman Jonathan Bloch is reportedly consider- ing bringing a class actionlawsuit against United Airlines for illness allegedly caused by inadequate air circulation. Apparently, Bloch contracted viral pneu- monia two weeks after he returned to his home in north London from a trip to Hawaii aboard United Airlines. He claims he was hospitalized after being bedridden for 10 days and that hospital doctors suggested that the plane was the source of his infeaion, According to a letter written by one of Bloch's doctors, "It is likely that you picked up your infection on the aircrafn . . . This is based on the frequent observation that many patients who travel by air tend to go down with respiratory tract infections within a few days afterwards." The doctor added, however, that "it would be virtually impossible to prove conclusively that your particular mycoplasma was caught during the flight." Bloch evidently daims that airlines are attempting to save fuel by cutting back on the number of times they recirculate air within the cabins. He is gathering evidence that such practices cause illness. Experts on the subject such as Farrol Kahn, who recently wrote the book Why FlyingEndangrrs YourHr.akh, apparently believe that cabin environment can increase the risk ofcontagious diseases. See Sunday Tilegraph, January 10, 1993. SCIENTIFIC/TECHNICAL ITEMS CARDIOVASCUI:nR ISSUF.S [27] "Serum Lipids & Lipoprotein Profiles of Cigarette Smokers & Passive Smokers," J. Whig, C.B. Singh, G.L Soni, and A.K Bansal, Indian Journal ofMedical Researcb 96(B): 282-287, 1992 [See Appendix A) This study, conducted in an Indian population, reports nonsignificant elevations in cholesterol and triglycerides in men reporting ETS exposure. The authors daim that the high density lipoprotein cholesterol/low density lipopro- tein ratio was lowered in "passive smokers," and further 9 daim that this suggests an increased risk ofcoronary heart disease in exposed persons. IZESPIRATORY DISEASES AND CONDITIONS - CHILDREN [28] "Factors Associated with Bronchial Hyperresponsiveness in Australian Adults and Children," J.K. Peat, C.M. Salome, A.J. Woolcock, European RespiraroryJournal5: 921- 929, 1992 [See Appendix A] In this Australian study, 4,366 children and 878 adults were studied for bronchial hyperresponsiveness, a measure of airway abnormality associated with the clinical diagnosis of asthma. While the authors report that parental asthma, history of respiratory illness, and being born in Australia were significantly associated with bronchial hyperresponsiveness, parental smoking was reportedly not associated. [29] "Atopy and Environmental Factors in Upper Respiratory Infectionx An Epidemiological Survey on 2304 School Children," E Porro, P. Caiamita, I. Rana, L Montini, and S. Criscione, lntmui tionalJournal ofPediatric Otorhinoluryngology 24: 111-120, 1992 [SeeAppendix A] This epidemiologic study is based on questionnaire responses from the parents of Italian school children concerning factors possibly related to upper respiratory infections. The authors report that family history of asthma or chronic bronchitis appear to be important predisposing factors. They also claim that "passive smoking" is related to ear troubles, such as otitis. [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] This study measured circadian rhythm, i.e., an approxi- matdy 24-hour rycle, in pulmonary function measure- ments in Italian school children. The authors claim that children exposed to cigarette smoke reportedly exhibited changes in the circadian rhythm, which they interpret as an early indication of airway obstruction.

10 OTHER HEALTH I'SSUES [31] "Passive Smoking and Hearing Loss in Infants," R.A. Lyons, Irish Mcdical Journa185 (3): 111- 112, 1992 [See Appendix A] This study reports on data collected on hearing loss and the condition of the eardrum from infants sched- uled to attend a developmental examination. Report- edly, infants exposed to cigarette smoke were approxi- mately five times more likely to have a hearing deficit. The author condudes that his reported findings support the position that ETS exposure causes middle ear problems. OTHER DEVELOPMENTS AUSTRAI,IA [32]' Solomon Airlines Imposes Smoking Ban Solomon Airlines has reportedly announced that it will ban smoking on all of its flights beginning February 1, 1993. SetS)rlnryMorningHeralW January 1,1993. CANADA [33] ETS Objectives Revealed as Part of National Non-Smoking Week As part of Canada's National Non-Smoking Week held during the week of]anuary 18, 1993, the govern- ment of Ontario reponedlyannounced that it has three objectives related to tobacco, among which is the protection of nonsmokers from ETS exposure. See Canada NewsWire, January 8, 1993. [34] Business Advises Smokers Not to Apply for Employment Safeway Electric Co. in Winnipeg, Manitoba, has reportedly advised smokers that it will not hire them even if they otherwise qualify for the job. According to owner Michael Andruchuk, many of the company's contracts involve nonsmoking locations and smokers hired in the past have broken promises not to smoke on the job. Civil rights groups have apparently criti- cized the restriction, but there is no legislation prohib- ETS/IIAQ REPORT, ISSUE 39 iting discrimination against smokers. Ser Xinhua Gcneral News Service, January'4, 1993. [35] Nonsmokers Publish Dining Guide The AIRSPACE Non-smokers' Rights Society, a non- profit, nonsmokers' advocacy group based in British Columbia, is reportedly preparing a new edition of its Breathers'Dining Guide for publication. The current edition lists 235 eating establishments in British Columbia that are smoke free. More names will be added to the list, and, when published, the guide will be available to the public free of charge. See The Vancouver Sun, January 11, 1993. [36] Woodstove Users Warned of Health Risks Public health officials have reportedly become concerned'about known and suspeaed'carcinogens in wood smoke. Because smoke spillage into homes from wood-burning units has been blamed for serious indoor air pollution and related health problems, different levels of government arc apparently looking for ways to reduce wood smoke pollution levels through legislation. See The (Montrtal)~Gazurtt, January 3, 1993.

JAN UARY 22, 1993 APPENDIX A The numbers assigned to the following article summaries correspond with the numbers assigned to the synopses of the articles in the text of this Report. IN THE UNITED STATES OTHER HEALTH ISSUES [13] "Maternal Cigarette Smoking During Preg- nancy: A Risk Factor for Childhood Stnbis- mus," R.B. Hakim and J.M. Tielsch, Archives of Ophtbalmology 110: 1459-1462, 1992 "Strabismus is a common disorder in children that requires intensive therapy and costly surgery. Strabis- mus is thought to be a defect in central nervous system control." "The etiology of nonrestrictive strabismus is not well understood but is presumably related to factors affect- ing the normal development of the oculomotor control mechanism....[L]ittlc work has been done to exam- ine epidemiologic risk factors for adverse pregnancy outcomes and their association with risk of strabismus. ... Because of smoking's wide range of effeas, we hypothesized that it could play a role in the develop- ment of this abnormality. Herein, we present results form a population-based study of maternal smoking and risk of strabismus among their offspring." "A population based case-control study was con- ducted to investigate the association between child- hood strabismus and prenatal risk factors including maternal smoking. Ai1 incident cases of strabismus diagnosed during a 21-month period, ... in nine metropolitan area pediatric ophthalmology centers were selected for study (n=377). Controls were chil- dren born on the same day and in the same hospital as the cases (n=377). Data collection included in inter- view with the biologic mother and abstraction of obstetric and neonatal birth records." "Exposure to secondary smoke was associated with esotropia ["crass-eye"] when the mother smoked during pregnancy. Conversely, when the mother did not smoke during pregnancy, there was no increased risk of esotropia when she was exposed to her spouse smoking or to significant amounts of smoke from other sources." A-1 "Results from this studyd'emonstrate an association between maternal smoking during pregnancy and esotropia among offspring. While birth weight seemed to modifythe effect of maternal smoking on risk of esotropia, there was little evidence of an association between exotropia ["wall.•eye," where the eye looks outward] and maternal smoking after stratification byy birth weight." "The finding that exposure to secondary smoke elevates the already elevated risk associated with maternal smoking suggests a synergistic effect between maternal and secondary smoke exposure during pregnancy. However, the lack of an elevated risk due to secondary smoke when the mother is a nonsmoker suggests a maternal barrier that may be protecting the fetus. Also, this lack of an association between esotropia and secondary smoke exposure among nonsmoking mothers may indicate that postnatal exposure to tobacco smoke is not a risk factor for esotropia. These results agree in part with a previous study that found the lowest birth weight among infants whose parents both smoked." "While a direct causal role for maternal smoking in the etiology of strabismus cannot be proved based solely on observational data, the consistency of the findings, the strong biologic plausibility, and the relation of smoking to other adverse pregnancy out- comes and developmental impairments strengthen the argument that this is a direct etiologic effect." INDOOR AIR QUALITY [14] "Engineering Controls for Clean Air in the Office Environment," M.J. Ellenbecker, Clinics in Cbest Medidne 13(2): 193-199, 1992 "Because the quality of the office environment is strongly affected by the quality of the air in that environment, the use of engineering controls to provide clean air to buildings plays an important role in determining people's health and comfort. The major topics described in this article include the basic charac- teristics of building engineering control systems in the office environment and how these characteristics contribute to occupant health and comfort." "The primary engineering control for ensuring good air quality is the building heating, ventilation, and air-

A-2 conditioning (HVAC) system. These systems are designed primarily to provide an environment with adequate comfort for building occupants. This involves controlling the temperature and humidity within an acceptable range and providing sufficient fresh outside air to limit odors. Until recently, health concerns have been less imponantn The energy crisis of the early 1970s, however, forced building managers to look closely at the energy used by HVAC systems.$ecause the primary expenditure is the energy required to condi- tion the fresh outside air drawn in by such systems, building managers decreased fresh air flows as much as possible and complaints of poor air quality increased dramatically. Many such complaints fall into the discom- fort category, but a large number concern ill health such as headaches, sore throats, or nasal congestion. The modern- day HVAC system designer and the occupational health specialist thus must concern themselves with developing an environment that is both comfortable and healthy and must provide such an environment at a reasonable cost." "The usual first reaction of a building manager when receiving a complaint of poor office air quality is to try to find the culprit. He or she then spends what is invariably a large amount of money trying to measure something in the air that might cause the problem. It has been the author's experience that money spent in this way is usually wasted, because little or nothing is learned from the measurements. It is usually better to skip the identification phase and move directly to assessing and improving the building ventilation systems. The most effective step in improving office air quality is almost always to increase the amount of fresh air being supplied to work areas; consequently, this is the first thing that building managers should try." "The disadvantage of increasing fresh air supply, of course, is cost. Each cubic foot of fresh air that is brought into a building must be heated in the winter and cooled in the summer. The indoor air quality specialist is frequently put in the position of lobbying for increased air flow, where the well-defined cost of such an increase is balanced against the uncertain likelihood that air qualiry complaints will decrease. Frequently, such an adversarial situation can be avoided by redistributing the fresh air already being supplied to the building. The ventilation survey may indicate that some parts of the building are receiving too little fresh air, but other areas are receiving too much. In these cases, air flow can be redistributed, with ETS/IAQ REPORT, ISSUE 39 no increase in energy costs but with an overall im- provement in air quality." Besides increasing fresh air supply, the second fruitful tactic for improving office air quality is to improve the maintenance of the ventilation systems. As discussed previously, poor maintenance frequently is the source of air quality complaints, and in such cases improve- ment in maintenance will bring an immediate decrease in complaints of poor air quality." IN EUROPE & AROUND THE WORLD CARDIOVASCUlAR ISSUES [27] "Serum Lipids & Lipoprotein Profiles of Cigarette Smokers & Passive Smokers," J. Whig, C.B. Singh, G.L Soni, and A.K. Bansal, Indian fournal of Medical Raearch 96(B): 282-287, 1992 "Very little attention has been paid to the effect of passive smoking on serum lipids and lipoproteins. In view of the fact that [a] large population in India is exposed to passive smoking, the present study has been undertaken to know the effea of passive smoking on serum lipids and lipoproteins compared to that in chronic smokers and control subjects." "Serum lipids and lipoproteins of 50 active and passive smokers were compared with levels in 25 control subjects. Active smoking resulted in an increase in total cholesterol (T) and triglycerides (Ts) as compared to control group. The passive smokers also showed relatively higher levels but the effect was not significant. Active smoking raised the low density lipoprotein cholesterol (LDL) and very low density lipoprotein cholesterol (VLDL) levels whereas high density lipoprotein cholesterol (HDL ) content was lowered, thus resulting in decreased ratios of HDL' /T~ and HDL./LDL~ The passive smokers also showed slightly higher levels of LDL and VLDL but lower levels of HDL< and a lower HDL</LDL< ratio." "Since the ratio of HLDJLDL! is also significantly lower amongst passive smokers, it indicates that not

JANUARY 22, 1993 only active smokers but also subjects who are in contact with active smokers are at a relatively higher risk of developing atherosclerosis. The lower degree of risk amongst passive smokers compared to that amongst active smokers could be due to the filteration [sic] ; of smoke in the lungs of the smokers. Some of the components like nicotine and tar are deposited in the lungs of active smokers and therefore the passive smokers are exposed to a lower density of harmful components....[TJhe levels of serum lipids and lipoproteins were altered in passive smokers in such a manner that it may have a deleterious effect on [the] cardiovascular system." "The passive smokers also show relatively less altered lipid and lipoproteins, in a trend'similar to that of smokers. The alteration in the individual value of lipids and lipoproteins is not significant in [theJ case of passive smokers but the results are significant only in case of ratios of HDL~/Tc and HDLC/LDL.. As decrease in this ratio is responsible for the development of atherosclerosis, the results indicate that even the passive smokers are at a relatively higher risk of developing coronary heart disease " RESPIRATORY DISFASES MND CONDITIONS - CHILDREN [28] "Factors Associated with Bronchial Hyperresponsiveness in Australian Adults and Children," J.K. Peat, C.M. Salome, A.J. Woolcock, European Respiratory Journal 5: 921-929, 1992 "In the last decade, population studies of asthma have focused on the measurement of bronchial hyperresponsiveness (BHR), because it is the single, objective measure of airway abnormality that is strongly associated with a clinical diagnosis of asthma. Although the measurement lacks sensitivity and, to a lesser extent, specificity as a marker of asthma, it has proved to be a useful indicator of the severity of current disease that is independent of diagnostic patterns and symptom aware- ness. Because there are both regional and racial differ- ences in the prevalence of BHR, which relate to differences in the prevalence of respiratory symptoms, the study of BHR in populations is likely to provide objective evidence for the aetiology of asthma and, as such, has an important role." A-3 "We have measured the distribution of BHR in four population samples of children living in different regions of Australia, and in one population sample of adults.... In this paper, we report the relationship of BHR to atopy, age and sex. In addition, we examine the influence of early respiratory illness, race, country of birth, dietary fish, parental smoking and a parental history of asthma on the prevalence of BHR in chil- dren, and the influence of smoking history on the prevalence of BHR in adults." "Atopy to common allergens and age are the most important independent predictors of BHR. In adults, smoking history and gender (being female) were also important. In children, a parental history of asthma and respiratory infection in the first 2 yrs of life had a significant influence on BHR and, after taking these factors into account, being born outside Australia and regular fish meals both had a protective effect against BHR. We did not find a significant effect of parental smoking, race (Caucasian/Asian); gender or region (coastal/inland)." "It is thought that differences in the prevalence of BHR between countries and races result from a combination of genetic and environmental influences. Our finding that children born in Australia had a higher prevalence of BHR, adjusted for other factors including race, than children born in other countries raises some interesting questions.... Because race was not a risk factor for BHR in these populations, there is reduced possibility that genetic factors are predominant and an increased possibility that BHR has a largely environmental aetiology. Children born in Australia may be exposed to an additional allergen load that is most effeccive in causing BHR early in life, but this hypothesis remains to be tested." "The presence of BHR is obviously influenced by a variety of genetic, physiological and environmental risk factors of which atopy remains the most important known factor in both adults and children. This, taken with the evidence of a higher prevalence of BHR in children born in Australia and a lower prevalence in children on a 'protective' dict, suggests that environ- mental influences are very important. It is vital that future epidemiological studies collect information on both BHR and asthma from populations living in~ regions with markedly different environments, for

A-4 which the risk factors can be measured accurately. Such investigations are likely to provide invaluable insights into the aetiology and prevention of asthma." [29] "Atopy and Environmental Factors in Upper Respiratory Infections: An Epidemiological Survey on 2304 School Children," E. Porro, P. Calamita, 1. Rana, L. Montini, and S. Criscione, International Journal of Pediatric Otorhinolaryngology 24: 111-120, 1992 "Upper respiratory infections (URI) during the first years of life are mostly viral in origin. However, a number of observations suggest the influence of both predisposing and triggering factors. Atopy in particular seems to play an important role as do environmental factors. Many children with early symptoms such as blocked or runny nose are likely to become skin- positive later in life to antigens.... A standardized questionnaire was administered to 2304 schoolchildren in order to ascertain the URI frequency and to corre- late it with family and environmental factors and with results of prick tests for main allergens in our climate. Results showed a wide overlapping of URI and lower respiratory illnesses (in particular, asthma), which are widely distributed in the families of patients. Passive smoking and the quality of housing are the main triggering environmental factors.° "Amongst the predisposing faaors in URI, family history of asthma and chronic bronchitis appear to be relevant: the definition of these ... parameters in our study (occurrence of one or more affected relatives) does not permit the evaluation of the relative role of 'genetic' and 'environmental' factors (the latter refer- ring to common negative family environment)." "Passive smoking is often cited as a contributory factor in respiratory troubles but according to the present investigation it does not appear to exert a major influence in nose troubles, emerging only in the case of ear troubles. In our opinion the role of passive smoking should not be underestimated as a triggering factor of URI. A correlation between nasal and'ear infection is well known and both are affected by the same factors. It is therefore probable that only the most severe and relapsing cases of nasal infection lead to recurrent otitis, while passive smoking may be a prominent factor in the severity of these cases." ETS/IAQREPORT, ISSUE 39 [30] "Circadian Rhythm of Peak Expiratory Flow in Children Passively Exposed and Not Exposed to Cigarene Smoke," R. Casa]e, G. Natali, D. Colantonio, P. Pasqualetti, Thorax47: 801-803, 1992 "This study aimed to investigate whether children exposed to passive smoking, assessed by questionnaire and urinary cotinine values, show greater variation in the circadian rhythm of the peak expiratory flow (PEF) than children not exposed to cigarette smoke." "Questionnaires completed' by 60 primary schoolchil- dren aged 10-11 years were analyzed and 20 children (12 boys and 8 girls) exposed to passive smoking were identified. These children were matched for sex and age with 20 respondents who had not been exposed to cigarette smoke." "The mean value of urinary cotinine concentration was 1.85 umolll in unexposed children and 3.44 (0:52) umol/l in exposed subjects." "Both groups showed diurnal fluctuations in PEF values with a peak in the afternoon. PEF showed a significant circadian rhythm for both the unexposed and the exposed children." "The circadian rhythm of PEF in the exposed children differed from that of unexposed children ... Since any change in the normal circadian ~ pattern of any variable can seen [sic] as abnormal and as a step towards clini- cally symptomatic disease, the increased PEF rhythm amplitude may be a measure of early airway obstruction in response to passive smoking." OTHER HEALTH IssuEs [31] "Passive Smoking and Hearing Loss in Infants," R.A. Lyons, Irirh Medical Journa185(3): 111-112, 1992 "The aim of this study was to determine whether passive exposure to smoke is also associated with hearing deficits in infants, the majority of which are due to obstruction of the eustachian tube with consequent middle earlydysfunaion." "A cohort of infants due to attend their first scheduled developmental examination in a socially deprived area where [sic] chosen as the study group. As part of the examination hearing was assessed ... and the tympanic membranes inspected,"

)ANUA,RY22,1993 "73% of mothers were current smokers and smoked on average 17.8 cigarettes per day. Overall 77% of infants were exposed to cigarette smoke." "Infants who were exposed to cigarette smoke were nearly five times more likely to have a hearing deficit and were three times as likely to have visible abnor- malities of the tympana.° "This is the first study to report an association between passive exposure to cigarette smoke and hearing loss in infants." "The prevalence of hearing deficit in the non exposed group was 10% compared to 49% in the exposedd group. If the association reported here is causal then 75°l0 of hearing deficits in this cohort could be attrib- uted to exposure to cigarette smoke. The results of this study support the hypothesis that passive exposure to cigarette smoke is a cause of middle ear effusion and hearing loss in children."

. VSDL: 93-16 CONTACT: Carol Kccain FOR REL?.ASE: IlQiEDIATE OFFICE s 202/219-5a23 THLJRSDAY, JANUARY 14 , 1993 CONTACT: Douglas Fuller OFFICE : 202/219-6027 Department Of Labor United States Office of Information Washington, D.C. 20210 STATEMENT DY sECi1LTARY OF LksOjt LYNN ]RARTIN As part of our commitment to improve vorkplaee health and safety, today I am directing OSHk as soon as possible consistent with applicable statutory requirements and executive orders, to commence rulemaking that addresses the hazards of occupational exposure to secondhand smoke. This is an issue that requires our immsdiate attention. There is a growing body of evidence that exposure to secondhand tobacco smoke is hazardous to the health of nonsmokers. The EPA's report on the effects of passive smoke in the home environment is a major contribution to this evidence. OSHA's Office of Health Standards is currently completing its analysis of.the responses to our recent request for information about issues related to indoor air quality. A qreat deal of the information received in response to that request relates specifically to the hazards of exposure to environmental tobacco smoks in the workplace. OSHA will continue to evaluate this information and the EPA report, and incorporate the material into its consideration of this issue. Tb. action we are taking today is apart from the indoor air quality rulemakinq. The EPA report focuses an the home environment. It raises troubling concerns about the effects of passive smoke. OSAA must examine these concerns and determine how thsy apply to the workplace. So I have asked OSHA to proceed expeditiously and comprehensively. J1s a first step to implement my directive, OSHA will prepare a report for the incoming secretary. This report will discuss the extent of the hazard, describe the rulemakinq alternatives available to the Departm:nt and provide a basis for determining the most effective rulemakinq eourse. -more- ISSUE 39 APPENDIX B

specifically, the report will include an analysis of the evidence in terms of the threshold OSHA must mset in order to regulate. It will also discuss any special pertinent issues, such as means of applying evidence obtained from studies of exposure to tobacco smoke in the home to workplace settings. Our actions should be dictated by scientific evidence, and not by emotions or special interests. This approach allows OSHA to best understand how to move ahead.with a proposed rule. II Th n ormation wi be mavai a e to sensory ~mpa r3 e~- individuals upon request. Voice Phone: 202-219-6060, TDD Message Rsfsrral Phone: 1-800-326-2577. The text of th s re ease is ava a e at no cost to cal er from the Department of Labor electronic bulletin board, LABOR NEWS, at 1-800-597-1221 or locally at 202-219-4784. 300, 1200 or 2400 HATJD; Parity: None; Data Bits - 8; Stop Bit - 1. Voice phone: 202-219-7343.

I U.S. DEPARTMEN7 OF LABOR iiGRt'iARY OF LA/QR WAiHMQtnN. D.G. JAN 13 193 NEMOwwMM FOR DoAOTM STRONx lROM: LYHN MARTINZ,--0` SUB.TECT: Enviromental tobacco smoke in the workplace I appreciate our recent discussions on the growing body of evidence that exposure to secondhand tobacco saoke is hazardous to the health of nonsmokers. I understand that OSHA's Office of Health standards is currently completing its analysis of the responses to our recent Request for Information about issues related to indoor air quality, and that a great deal of the information received in response to that request relates specifically to ths hazards of exposure to environmental tobacco smoks in the workplace. As you know, the Environs.ntal Protsction Agency has sent the Departm.nt_its recent rs.port. dno othi= pis4rders. I would like OSHA to study that report and incorporate the msterial in it into its consideration of this issue. By this mamorandum, I am also directing OSHA, as soon as possible consistent vith applicable statutory requirements and executive orders, to commence rulemaking to address the hazards of occupational exposure to secondhand ssoke. As a first step to implement this directive, OSHA should prepare a report for the incoming Secretary. This report should discuss the extent of the hazard, describe the rulemakinq alternatives available to the Department, and provide a basis !or determining the most effective rulemaking course. Specifically, it should include an analysis of the evidence in terms of the threshold OSI;A must meet in order to regulate, and discuss any special issues that are pertinent, such as means of applying evidence obtained from studies of exposure to tobacco smoke in the home to vorkplace settings. I believe that resolution of this issue is one of the most significant matters facing OSHA, and I ask you to direct your staff to treat this project as one of the Department's highest priorities. -A...

Facts About Secondhand Smoke Some of the key facts about secondhand tobacco smoke and its dangers are summarized below. Use them to Inform yout family and friends and to work for smoke free policies in your community. ' General • . , Secondhand smoke is a cause of disease, Including lung canoeir, in healthy nonsmokers. Each year secondhand smoke kills an estimated 3,000 adult nonsmokers from lung ' cancer. Secondhand smoke causes,30 times as many lung cancer deaths as all regulated air pollutants oombined. Secondhand smoke causes other respiratory problems In nonsmokers: coughing, phlegm, chest discomfort, and reduced lung function. For many people, secondhand smoke causes reddening, itching, and watering of the eyes. About eight out of 10 nonsmokers report they are annoyed by others' cigarette smoke. More than 4,000 chemical compoeutds have been identified in tobacco smoke. Of these, at least 43 are lanown to cause caneer in humans or animals. At high exposure levels, nicotine is a potent and potentially lethal poison. Secondhand smoke is the only source of nicotine in the air. Nonsmokers exposed to cigarette smoke have in their body fluids significant amounts of nicotine, carbon monoxide, and other evidence of secondhand smoke. Three out of four nonsmokers have lived with smokers, and nearly half (45 percent) are , worried that secondhand smoke might cause them serious health problems. More than 90 percent of Americans favor restricting or banning smoking in public places. ' ISSUE 39 APPENDIX C US. DEPARTMENT OF HEALTH & HUMAN SERVICES (DC Pubtic H.akh S.wic.

Forty-six states and the District of Columbia in some manner restrict smoking in public places. These laws range from limited prohibitions, such as no smoking on school buses, to comprehensive clean indoor air laws that limit or ban smoking in virtually all public places. 0 Laws restricting smoking in public places have been implemented with few problems and at little cost to stwre and local government. Smoking policies may have multiple benefits. Besides reducing exposure to secondhand smoke, such policies may alter smoking behavior and public attitudes about tobacco use. Over time, these changes may contribute to a significant reduction in U.S. smoking rates. Children Each year, exposure to secondhand smoke causes 150,000 to 300,000 lower respiratory tract infections (such as pneumonia and bronchitis) in U.S. infants and children younger than 18 months of age. These infections result in 7,500 to 15,000 hospitalizations yearly. Chronic cough, wheezing, and phlegm are more frequent in children whose parents smoke. Children exposed to secondhand smoke at home are more likely to have middle-ear disease and reduced lung function. Secondhand smoke increases the number of asthma attacks and the severity of asthma in about 20% of this country's 2 million to 5'million asthmatic children. Each year, U.S. mothers who smoke at least 10 cigarettes a day can actually cause between 8,000 and 26,000 new cases of asthma among their children. . - A recent study found that infants are three times more likely to die from Sudden Infant Death Syndrome (SIDS) if their mothers smoke during and after pregnancy. Infants are twice as likely to die from SIDS if their mothers stop during pregnancy and then resume following birth.

Workplace Workers exposed to secondhand smoke on the job are 34% more likely to get lung cancer. The simple separation of smokers from nonsmokers within the same airspace may reduce, but cannot eliminate, the exposure of nonsmokers to secondhand smoke. There is no safe level of exposure to a cancer-causing substance. Survey responses indicate that at least 4.5 million American workers experience great discomfort from exposure to secondhand smoke. The best method for controlling worker exposure. to secondhand smoke is to eliminate tobacco use from the workplace and implement a smoking oesaation program to support smokers who decide to quit. About 85% of businesses had adopted some form of smoking policies in 199I, up from 36% in 1986. US. DEPARTMENT OF HEALTH & HUMAN SERVICES CIK Pubtic H.a1th Selvia ".o" :OM

Secondhand Smoke in Your Home We spend n1oQ+e time 3n our homes than anywhere else. So the thought of cancer- causing chemicals circulating throughout our houses and apartments can be quite unse.ttling. Yet, aooqrding to the Environmental Protection Agency, that is exactly what happens when someone lights a cigarette in your home. ' Those most affected by secondhand smoke are children. Because their bodies are still developing, exposure to the poisons In secondhand smoke puts children in danger of severe respiratory diseases and can hinder the growth of their lungs. On top of that, the effects can last a lifetime. Ventilation systems In homes cannot filter and circvlate air well enough to eliminate secondhand smoke. Blowing smoke away from children, going into another room to smoke, or opening a window may help reduce dlildren's exposure but will not protect them ffrom the dangers of secondhand smoke. Benefits of a Smoke Free Home The greatest benefit, of course, is that you will remove all the health risks associated with secondhand tobacco smoke. Plus: * When your home Is smoke-free it will smell much better. , * Your food will taste better. • * You'll spend less time, energy, and money cleaning your curtains, walls, windows, and mirrors. * Your insurance rates may be lower - check with your insuranee company. • Even your pets will behappier. For example, secondhand smoke increases the risk of lung canoer in dogs. , vs. DEPARTMENT OF HMJH & HUMAN sERVICEs Public H.akn s«wo. CDC .~..~.~.~.~ . smfftlvx~

How to Make (and Keep) Your Home Smoke-Free It may feel awkward at first to tell people not to smoke in your home - no one wants to make their guests uncomfortable - but if you simply explain the facts about secondhand smoke, they should understand completely. Tell them that for the sake of your family's health, you simply cannot allow smoking in your home. Have gum or mints available as an alternative to lighting up. If visitors absolutely must smoke, tell them they can do so outside. If someone In your household smokes, be sympathetic and understanding =but encourage them to quit. Let them know that cigarette smoke affects everyone, not just them. Let them know you care and you want to help. Again, if they absolutely must smoke, tell them they can do so outside. . Don't Forget Schools and Day Care Make sure your child's school and day care programs are smoke-free. And insist that babysitters not smoke around your children. . flc ~ . m ~ - ,~ N ~ ca

Secondhand Smoke in the Workplace The Occupational Safety and Health Act of 1970'promises job safety and health protection for workers by providing safe and healthful working conditions. The Environmental Protection Agency now states that exposure to secondhand smoke greatly increases the chances of developing lung cancer and other serious respiratory problems. In general, ventilation or filtration of air in the workplace to remove secondhand smoke is futile.It's like trying to filter a lake to control water pollution. The only viable approach to protect nonsmokers Is source control: making the entire building smoke free or restricting smoking to a separately ventilated area that nonsmokers never have to enter. Your health should never be placed in jeopardy for the convenience of smoking employees. The right to breathe safely is more important than the right to smoke. Benefits of a Smoke-Free Workplace The greatest benefit is, of course, the removal of all the health risks associated with secondhand tobacco smoke. You'll also experience the immediate benefit of a better- smelling workplace. The business Itself will realize several benefits from a smoke-free policy: * The company protects itself from possible lawsuits from nonsmoking employees affected by secondhand smoke. * Every smoker costs his or her company at least $1,000 a year because of decreased productivity and increased health care costs. Much of this money may be saved If a smoke-free policy is instated. And management will no longer have to waste its time and energy on the smoking issue. U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Public H.aKh S.nia CDC .oportsuram

* The company's life, health, and fire insurance premiums may be lower if smoking is not allowed on the premises. * The company will realize other cost savings because computer equipment, furniture, carpets, and other furnishings last longer and need less maintenance in a smoke-free environment. . * Most companies document an improvement in employee morale after establishing a nonsmoking policy. A recent survey found that only 5% of Americans oppose any smoking resti3ctions in the workplace. * A well planned smoking policy sends the message that the coalpany Is concerned about the health and well being of its employees. * Most smokers want to quit, and workplace restrictions can provide another reason to stop. How to Get Your Workplace to Be Smoke-Free . Speak with, or write a memo to the person in charge of making company policies. Be sure to indude the facts about the health hazards of secondhand smoke. Position yourself as someone who is not bringing a complaint or a problem, but a solution. Then help provide the right solution for your work environment. • If you have co-workers who smoke, be sympathetic and understanding and support their efforts to quit Let them know that tobacco smoke affects everyone, not just them. Work with them to design a smoke-free plan that everyone can live with. Also be sure your company's benefits administrator looks into insurance plans that offer premium breaks for smoke-free workplaces. Many national and local health organizations provide expert help in establishing smoke-free workplace policies. Consult the resource list in this guide or call the Office on Smoking and kiealtty CDC, for a copy (1-800-CDG1311).

Secondhand Smoke in Restaurants When eating out, you want to be comfortable and enjoy your food. You certainly don't want your dining spoiled by toxic chemicals floating around in the air. Yet, according to the Environmental Protection Agency, that's exactly what happens when someone lights a cigarette. Restaurants that allow smoking can have six times the pollution of a busy highway. Secondhand smoke has many of the same poisons as the air around tomc waste dumps. Don't be fooled. Restaurants that have separate smoking and nonsmoking sections cann,ot eliminate your exposure to the tmdns from secondhand smoke. Ventilation systems are designed to efficiently circulate air within an enclosed environment, not to filter and clean it. Trying to have a smoke-free section of a restaurant is like trying to have a chlorine-free section of a swimming pool. Benefits of a Smoke-Free Restaurant The greatest benefit, of course, is the removal of all the health risks associated with. secondhand tobacco smoke. Plus: * Clean air makes the food smell and taste better. * Your clothes and hair won't smell like stale smoke after you've left the restaurant. ' * You71 be more likely to return to that restaurant because it is smoke free. Surveys show that 80 to 90% of nonsmokers ask to be seated in the nonsmoking section of restaurants when one is available. How to Approach Restaurants to Become Smoke-Free Talk to or write a letter to the owners or managers of your favorite restaurants. Explain the facts about secondhand smoke. Tell them that it doesn't make much sense for a restaurant to go to great lengths to protect its food from contamination, yet still allow smoking. For example, why would a manager prohibit cooks from smoking in U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES ~L`r .Pubfic H.aQh S.rvios °" ~ . 'p1"°

the cooking area, yet allow people to smoke in the dining room? Encourage your friends to take this action with their favorite restaurants. The more that people are aware of the dangers of secondhand smoke, the more successful we'll all be at eliminating our exposure to it. If any restaurants in your community have not even established separate nonsmoking sections, ask them to do so - as a good first step. In restaurants that have such divisions, always ask to be seated as far as possible from where people are smoking. That is especially important if there are children with you. Be Aware of Tobacco Industry Arguments Tobacco companies, often acting behind restaurant association "front" groups, try to convince restaurants that they will lose business if they prohibit smoking. There is no evidence from any city that has passed a 100% smoke-free restaurant ordinance that such measures hurt business. Some restaurants even report an improvement in business, thanks to attracting more nonsmoking customers who want to avoid smoky restaurants. It helps to remember that three fourths of adult Americans do not smoke.

Secondhand Smoke and the Local Media The Environmental Protection Agency's dassi5cation of secondhand smoke as a "Group A" carcinogen (known to cause cancer in humans) •is newsworthy enough to bring to the attention of the media. There are several ways of voicing your conoerns and being heard. Call in to radio talk shows. Write letters to the editors of your local newspapers. You may even want to contact your local TV stations. Benefits of Getting the Media Involved The more that people pre aware of the dangers of secondhand smoke, the better chance we all have of reducing our exposure to it. And the more we reduce that exposure, the healthier well be. The facts about secondhand smoke speak for themselves. If you get the media on your side to publicize these facts, we'll all be better off. How to Involve the Media ' Radio Talk Shows. Call and ask to speak with the station's producer. He or she will first want to hear an overview of the subject matter. If you cart, fax the information so the station can have it on hand. If the station can tie in a local "angle" (related happenings, 'events, or human interest accounts in the community), the chances of getting air time are much better. Suggest a local expert who would be available to discuss issues relating to secondhand smoke, such as a local pediatrician, family doctor, cancer specialist, or respiratory therapist If you know what program you or the expert would like to be on, suggest it to the producer. If you don't know, the producer should be able to identify which program would be most appropriate. Contact your local hospital, cancer society, lung associatim or other health groups. They can help you line up experts and give you other help you need in working with ' the station. U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES PubGc H"M Swvioa CDC

Letters to the Editor. The key here is to write an original letter expressing your concerns. Personalizing your letter is more effective than sending in someone else's form letter from a mass letter-writing campaign - newspapers are more interested in your own thoughts. Highlighting facts and experiences from your community will increase the chances of your letter being printed. Newspaper Articles. Also talk with the editors of your local newspaper and try to persuade them to write editorials In support of nonsmoking polides. Team up with a local health organization to interest the newspaper's health br community affairs reporter In writing a news or•feature article about secondhand smoke and what your community is doing about it. Television. Television is a little more difficult to work with, since broadcast time is starm and expensive. The.best way to get started is by writing the community affairs director. State the facts about secondhand smoke and explain why it's important for the station to address this Issue. Most stations cover public issues on Saturday or Sunday mornings, so a local angle increases your chances of getting a response. Also consider working with a local health organization to explore developing a talk show for the community access station of your local cable TV system.

Tips for Effective Letters A brief, to-the-point letter is a good way to raise the issue of secondhand smoke with an employer, restaurant owner, day care director, and others. An effective letter ",should follow an outline like the one below: 1. State your purpose: Your goal is to have a nonsmoking policy instituted. State recent facts from the Environmental Protection Agency and other Information found in this guide. Secondhand smoke is now officially a"Group A" carcinogen (known to cause cancer in humans). 2. Explain why secondhand smoke Is an Important problem: State reasons why you and everyone in your community should be guarded against the effects of secondhand smoke. Mention the special vulnerabilities of children and the permanent effect It can have on their lung development. , 3. Support your opinion with facts: Tailor your facts to the particular area in which you want to see a smoking policy instituted. Remember that the facts are on your side - they are your ammunition. 4. Be clear about what action you are looking for. Be sure to state clearly what action you would like to see, such as a total ban or the designation of a restricted smoking area. , 5. Explain how you intend to help the cause: You need to be willing to back up your opinion with specific,actions that will help initiate this policy. Ask what else you can do to help change things. : Some additional tips: ' 4 Be firm and get your point aanss - but at the same time note that you understand and sympathize with smokers, who must fight a powerful addiction. Emphasize the Importance of a smoking policy for the health of nonsmokers as well as smokers who are lpolcing for a reason to quit. • Follow up your letter with a phone call. U.8. DEPARTNAENT OF HEALTH & HUMAN SERVICES ' CI)C Pub4c H.afth S.rvb. '01O` . '°"°

Organizations With More Information Lsted below are selected organizstions that provide Information about the effects of secondhand smoke, assistana in establishing smakefree polides, and advice on dcpping smoking. Office on Smoking and Health , Centers for Disease Control and Prevention msilstop K 50 4770 Buford Highway, N.E. ~ Atlanta, GA 30341-3724 1-B004=-1311 (copies of actian guide on secondhand smoke) (404) 488-•5705 (other informatim) bormation a6out smokingand HaaItli induding pamphds, pasterr, and wkW#c r+epivrts. Action on Smoking and Health 2013 H Sheet, N.W. Washingtoq, DC 20006 (2A2) 659-4310 In/ormatiori aboat avaridy of smoking and hmlth issues, with afocus on noassmoking Iams and paTiaes. American Cancer Sodety 1599 Clifton Road, N.B. Atlanta, GA 30329 1-800-ACS-2345 • -Information and aduaativn programs on toGoxo and secnndhand amokc iaidiaiduaI and graup atop-smoting yrograrns• . American Heart Association National Center TtTS Greenville Avenue Da11as, TX 75231 (Z14) 373-6300 Or contact your local Heart Association in the white pages of the phone book. -Smoking information and eduaationp^W=for sdwoLs, uiorkplam and haalth care faalities. Aaxrlcan Lung Association 1740 Br+aadway New York, NY 10019-4274 (212) 315-5700 Or contact your 1oed1 Iung Association In the white pages of the phone booh. , h*rnwtion and pnogmma an smoking pnarntivn, assatian, and tlie piotectioa of aaismoJren'tiglrts. AatierZcaac for Nonsawkeas' Bigbts Snite J . 2530 San Pablo Avenue Berkekq, CA 9l702 (510) 841-3m Jnfornadioa to help argrosimtions and iadiaiduals pm eTm iadoor air ordinm&oe4 impiemart roorlcpiaae reguTat+ons, and deaelap aunrkPiaae snioking policies. US. DEPARTMENT OF HEALTH & HUMAN SERVICES CE)C PubGc Fi.aRh Servio. :OO.WW"M

Ettv~rona~eatil Protection Apncy . Indoor Air Quality Information Caeuinghouse P.O. Baa 37133 washingtot,, DC 20013-7133 1-800438-4318 ' -!fWrrustion abnut saaottdhmid smake and irrdoa ait' pollutiat. Group Agaiod Smokas Pollution (GASP) , P.O. Box 632 • . I Colkse Park MD 20740 (301) 4.59-'l791 Information and programs aboat sewndhand smoke mrd ehc estableshmait and aifcroanrnt of riaumoking faws andpoli6es. March of Dimes Bi:th Defects POundatlon 1275 Mamaroneck Avenue White Plains, NY 10605 (914) 428-7100 bftrnrrtiori a6ad PnoTdng md fiaalth autuding the effects of awkmg durmg pe8nwtq • National Cancer Institute Bnilding 31, Room 10A24 9000 RodcvIlk Pilae Bethesda,l4ID ?A892 1-8004-CANCER -hormatkn aboad snwhng and hoatft sfap-ar~g tdephone coroisekag. ~ National Heart, Lung, and Blood Institute Information Center PO Box 30105 Bethesda, MD Z0824-0105 (301) 951-M60 bftmation abard smohn& haart draw m,d lumg disew NatOnal Institutc for Oocupationat Safety and Health 4676 Columbia Parkway Cindnnati, OH 4S22&1998 ~ 1-800-3*-NIOSH Infartaation ort tecandhand smwb and offia waqdmnal aaft and /u+alth praWcncs. ' . State and Local Health Departmeart. Check the government section ot the phone book for current munbesa and addtesxs. Infan,ation on :,nokri,g and Imattli m,d eziating onabing regulations.

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