Tobacco Documents Online

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