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SHOOK,HARDY&BACON Pc. REPORT ON RECENT ETS AND IAQ DEVELOPMENTS Fcbruary 5, 1993 SHB

REPORT ON RECENT ETS AND IAQ DEVELOPMENTS - IN THIS ISSUE - IN THE UNITED STATES REGULATORY AND LEGISLATIVE • Artic]es report on scientific criticism of EPA Risk Assessment on ETS, p. 1. • "PRO-KIDS" and "PRO-FEDS" legislation are introduced in the U.S. Senate, p. 1. • BOMA passes resolution supporting federal ban on workplace smoking, p. 2. • NIOSH logs over 27,000 calls after October SBS news story; usuall gets 150 a year, p. 2. • Activity in state and local governments begins on p. 3. ETS-REIATED LITIGATION AGAINST CIGARETTEMANUFACTURERS • Latest activity in Broin, p. 5. ETSfIAQLrTIGATION NoT INVOLVING CIGAREITE MANUFACTURERS • Two prisoner cases are decided, Hemphill and Cookish, p. 6. LEGAL ISSUES AND DEVEIAPMENTS •"Children are Focus in a War to Snuff Secondhand Smoke," p. 6. SCIENTIFIC/TECHNICAL ITEMS • Two upcoming IAQ conferences, p. 6. • "Pulmonary Effects of Environmental Tobacco Smoke Exposure on Asthmatic Subjects," p. 8. • Centers for Disease Control study on cotinine levels in 23,000 persons, p. 8. OTHER DEVELOPMENTS • Customer allegedly stabs waiter to death over smoking, p. 9. ISSUE 40 IN EUROPE & AROUND THE WORLD ETS-REtAATED LrrIGATIoN AGAINSr CIGARETTE MANUFACTURERS • Report on post-decision hearing in TIA v. AFCO, p. 9. • Veronica Bland receives settlement in claim against her U.K employer, p. 10. LEGAL ISSUES AND DEVELOPMENTS • Tobacco companies make submission to legal aid in Australia, p. 11. • Legal aid granted to nonsmoker in the U.K., p. 11. SCIENTIFIC/TECHNICAL ITEMS • Six new studies on respiratory diseases and conditions in children, p. 11. • "Biological Evidence of Significant Exposure to Tobacco Smoke in Children of Smoking Parents,° p. 12. OTHER DEVELOPMENTS • Environmental/animal rights group stages execution of a cigarette in Czechoslovakia, p. 13. • Science museum in the U.K. opens a "Passive Smoking" exhibit, p. 13. MEDIA COVERAGE •"When Your Office Calls in Sick,' p. 9.

- TABLE OF CONTENTS - Issue 40 February 5, 1993 IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) [11 Scientific Criticism of EPA Risk Assesunent on ETS Receives Media Attention ......................1 CONGRESS (2] Senator Lautenberg Introduces PRO-KIDS and PRO-FEDS Iegislation .................................1 BOMA [3] Building Owners and Managers Vow to Support Workplace Smoking Ban ............................. 2 WHITE HoUSE [4] President and Mrs. Clinton Ban Smoking in White House .....................................................2 NIOSH [5] NIOSH Ceases to Log 800 Number Calls ............................................................................... 2 U.S. GENERAL ACC.OUNTING OrF7CE (GAO) [6] GAO Study Reports Continuing Dichotomy Between National Health Policy Objectives and Cigarette Export Goals ..........................................................................2 ASHRAE [7) SSPC-62 Meets DurutgASHRAE Winter Maering .................................................................2 STATE AND LOCAl. GOVERNMEN'IS [8] Privacy Legislation .................................................................................................... ...............3 [9] Other Staoe and Local Legislative Activities Related to ETS .....................................................3 ETS-RELATED LITIGATION AGAINST CIGAREITE MANUFACTURERS [10] B/oatthar.A Scheduling Conference set for March 3, 1993 ........................................................ 5 [11] B.oi,F Defendants Respond to PlaintifFs' Second Amended Complaint ................................... 5 ETS/IAQ LITIGATION NOT INVOLVING CIGARSITE MANUFACTURERS GRADUATE SCHOOL EXPOSURE [12) Beckman v. New York Ciiy Scl.ool of Vfsual Asrs (U.S. District Court, New York) (filed January 16. 1992) .................................................................................................... ....... 6 PRISONER CASES [13] hlenrphfll v. Conuz; 1992 U.S. Dist. LEXIS 20031 (U.S. District Court. Northern District, California) (decided December 8„ 1992) ....................................................6 [14] Cookirh v. Coarmisrio.ur, New Hamprhirr Drpoannu ofCosresionr (District Court, District of New Hampshire) (filed January 1, 1988) ......................................6 LEGAL ISSUES AND DEVELOPMENTS [15] "Children are Focus in a War to Snuff Sccondhand Smoke," C. Scanlan, The Phrladelphra Inguftr., January 24, 1993 ............................................................................ 6 SCIENTIFIC/TECHN1CAi. ITEMS UPCOMING MEETINGS (16] "Indoor Environment'93: Defining Strategies for Effective Indoor Air Management," Baltimore, Maryland, April 21-23. 1993 .........................................................6 [17] The Sixth Annua(National Confenetxe on Indoor Air Pollution, Tulsa. Oklahoma, March 29-31, 1993 ....................................................................................7 LuNG CANCER [18] Letters to the Editor Regarding'Envitonmental Tobacco Smoke: The Price of Scientific Cereainry,' D.M. Burns, Jorarul of the Nssional Cancer Irueituta 84: 1387-1388, 1992 .................................................................................................7 GRDIOVASCULAR ISSUEs [19) "Reduced PlasmaAscorbieAeid Concentrations in Women Regularly Exposed to Environmental Tobacco Smoke (ETS)," D.L Tribbk and S.P. Fortmann, Circulation 86(4): Supplement, 1992 [See Appendix A) ..................................7 RESPIRATORY DISEASES AND CONDITIONS -ADULTS [20] 'Pulmonary Effects of Environmental Tobacco Smoke Exposure on Asthmatic Go Subjects," S.B. Lehrer. CIAR Crrsrntr 2(2): 1, 4, 1992 [See Appendix A] ................................8 --j RFSPIRATORY DISEASES AND CONDITIONS - CHIIDRF2J ~ ~ [21] "Maternal Age as a Risk Factor for Wheezing Lower Respiratory Illnesses in the First Year of Life," F.D. Martinez, A.L Wright, C.J. Holberg, W.J. Morgan, and ~ LM. Taussig, Amerius,r Jownol ofEprdsmioloV 136(10): 1258-1268, 1992 N (See Appendix A] .....................................................:.............................................. ................. 8 ~ OTHER HEAt.'I7i IBStJES [22] 'Clinical Ecology," Council on Scientific Affainti American Medical Association, JournsloftfxArnericanMalitaliSnracfstron268(24):3465-3467, 268(24).3465-3467,............8

Contents Continued, Issue 40 ETS ExPOSUrtE AND MorlrnowNG (23] "Preliminary Dau: Exposure ofPecsons Aged 24 Years to Tobacco Smoke - UnioedSraors, 1988-1991," CesrerrfirDisesreConrraJ Mor6idiryaa.iMorralisy Weekly Rapors 42(2): 37-38. 1993 [See Appendix A) ................................................................ 8 OTHER DEVELOPMENTS [24] Restaurant Customer Faces Murder Charges Following Dispute Over CigaremSmoking....... 9 [25) Califomia Mall Bans Smoking .................................................................................................9 [26] EPA Risk Assessment on ETS Spurs Anti-Smoking Activists in Illinois ...................................9 MEDIA COVERAGE [27) "When Your Office Calls in Sick' K. Griffin, Healrh, Januuy/Febnuary 1993 ........................9 [28] "The Architecture of IllrKss," D. Soeinman, Vegetarian Timex January 1993 ...........................9 IN EUROPE & AROUND THE WORLD ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS AosTtul.u [29) Tobarnv Irutitute ofAstrtralia lld v. Aurtrtlian Fcdeaaaioa ofConrrnner Organuatioru Inc (Full Federal Cousc, Ncw South Wales District Regiscry, Australia) (decided December 17. 1992) ..................................................................................9 ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS UNITFD KINGDOM [30] Ve.»i.ica Bland v. Stockport Meeropotitarr Bo.nudh Council (Manchester) (writ issued June 14, 1991; sercckmenc entered January 27, 1993) ........................................ 10 LEGAL ISSUES AND DEVELOPMENTS AUSTwALu [31] 'Auscnlian Court Decision on Passive Smoking Upheld on Appeal," S. Chapman & S. Woodward, Britirh Media.l Jour7ul, January 9, 1993 ................................ 10 [32] Tobacco Companies Submit Memorandum to Legal Aid Board ............................................ 11 UNITF.D KINGDOM [33] Legal Aid Granted oo Nonsmoker Suing Employer ................................................................11 SCIENTIFIC/TECHNICAL ITEMS RFSPIRATORY DISEISFS AND CflNDIT1ONS - CNILDRFN [34] "Prevalenee ofAsshma in Swiss Childn:n; F.H. Sennhauser and B.H. Guenoerc, European Rapiratory jowrrral5: Supplernenc, 1992 [SeeAppendix A] .................................... 11 [35] "Effecc of Age on Urinary Codnine Level in Young Childn-n," P.N. LeSouef, A.C. Reese, LL Landau, and LR. Jamra, EuropeaARespiramryJournal5: Supplement, 1992 [See Appendix A] .....................................................................................12 [36] `Pusive Smoking and Children's Diseases," K. Pisiewicz and C. Macura, European Reipirauory journal5: Suppiemenr. 1992 [See Appendix A] .................................... 12 [37] 'Urinary Corinine Levels in Primary School Children: Evidence of Exposure to Environmental Tobacco Smoke," E. Dagli, N. Cakan, and A. Araman, European Respira*xyJorrrAal5: Supplemenc, 1992 [See Appendix A] .................................... 12 [38] 'The Prevalence oFInherioed and Environmental Factors in Patients with Aschma,' R. Lyons, S. Snxnan, C.K. Power, and C.M. Burke, Elvopean RerpiramryJounial5: Supplemenc, 1992 [See Appendix A] .....................................................................................12 UNTfED KINGDOM [39] `Passive Smoking Exposure and Urinary Cotinine in Relation to Respiratory Health and Bronchial Responsiveness in Adolescenn:," F. Focasriere, N. Agabiti, V. Dell'Orco, R. Pisnelli, G.M. Corbo, G. Brancato, R. PaciSci, P. Zucarro, and C.A. Peniaci, European RaprraroryJo.rrnal5: Supplement, 1992 [See Appendix A) ............... 12 ETS ExPosvm AND MoNrromc [40] "Biological Evidence ofSign'ifxanc Exposure w Tobacco Smoke in Children of Smoking Paren6,' LM. Galanci and V.M. Godding, Circulation 86(4): Supplement, 1992 [See Appendix A] ........................................................ 12 OTHER DEVELOPMENTS CANADA [41] Montreal Restaurants Ignore No-smoking Law .....................................................................12

Contents Continued, Issue 40 CL6cHOS1!?vAlaA [42] Cigarette Executed in Wenoeslas Square ................................................................................13 UNPPED KINGDOM [43] "Passive Smoldng" Exhibition Opens at Science Museum .....................................................13 [44] Nicotine Sensor Badge Developed For Nonsmokers ............................................................... 13 [45] Smokers Ignore British Rail's Smoking Ban ...........................................................................13 [46] BAT Publishes Workplace Smoking Guide and Smoking Fact Sheer ..................................... 13 Woxl.o A1RUxe NEws (47] Australia .................................................................................................... ............................14 [48] China .................................................................................................... ................................14 [49] Finland .................................................................................................... ..............................14 [50] Iran .................................................................................................... ....................................14 UNfTFm KINGDOM I51] Airplane IAQ co be Invesdgaoed ............................................................................................14 (52] WHO Releases Report on Tobacco or Health Programme .................................................... 14 APPFNDIX A .................................................................................................... .................................Arriele Summaries APPENDIX B .................................................................................................... ...............PRO-KIDS, PRO-FEDS Bills APPENDIX C .................................................................................................... ................................ BOMA Resolution APPENDIX D .................................................................................................... ............. Museum Exhibition Handouss

FEBRUARY 5, 1993 1 REPORT ON RECENT ETS AND IAQ DEVELOPMENTS IN THE UNITED STATES REGULATORY AND LEGISLATNE MATTERS U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) [1] * Scientific Criticism of EPA Risk Assessment on ETS Receives Media Attention Articles appearing in the Invrstor's Business Dailyand The Washington Times discuss the criticisms that have been made of the EPA Risk Asscssment on ETS by scientists and policy analysts both in and outside the tobacco industry. The criticisms reported in the articles challenge the EPA's conclusions by (i) assailing the method of analysis employed in grouping disparate epidemiological studies to achieve a"meta analysis; (ii) challenging the accuracy of epidemiological studies in general, and (iii) taking issue with EPA's change in confidence intervals from 95% to 90%. The editor of EPA Watck consulted for the Investori Business Daily article, is quoted as saying, "It's now open season on whatever contaminant the EPA chooses to label the killer contaminant of the week, with the effea that once again, Americans are going to be stampeded into fearing a substance for reasons which upon dose inspection are scientifically indefensible." The writer of The Washington Times commentary states that "the EPA should not be treated as an impartial source of scientific truth, . . . With every substance EPA dassifies as cancer-causing, the agency increases its budget, gains power and prestige, and opens new vistas for its regulatory activities." See InAntor's Bruinas Da4 January 28, 1993; The Washington I imes, January 25, 1993. A columnist for a metropolitan newspaper devoted a column to the Inuatar's Businas Daily artide. See The Kasuas Clty Star, January 30,1993. • Discussions throughout this Report that bear this symbol contain infortnation about events and activities related to the EPA Risk Assessment on ETS. CONGRESS [2] • Senator Lautenberg Introduces PRO-KIDS and PRO-FEDS Legislation On January 28, 1993, Senator Frank Lautenbcrg (D- NJ) introduced two bills that would expand the role of EPA in regulating ETS while establishing nonsmoking policies at a wide range of federally-related programs and buildings. PRO-KIDS, or the `Preventing Our Kids From Inhaling Deadly Smoke Act of 1993" (S. 261), would require that federally-funded health, social and educa- tional programs for children under the age of 18 prohibit smoking in any portion of any indoor facility providing serviccs to children that is not separately ventilated. A similar measure relating to children under the age of five was introduoed in the 102d Congress but failed to pass. See issue 38 of this Report, January 7, 1993. PRO-FEDS, or the `Preventing Our Federal Building Workers and Visitors From Exposure to Deadly Smoke Act of 1993" (S. 262), would impose the same smok ing policy as S. 261 in every building or other structure owned or leased for use by a federal agency of the executive, legislative or judicial branches. The only exception would apply to any area of a building used primarily as living quarters. Provisions of the PRO- FEDS Act recognize the limitations that could be present in collective bargaining agreements, but require that any inconsistencies be overridden by the legisla- tion within one year after issuance of guidelines by EPA or at the expiration of each agreement. Under both bills, EPA would issue guidelines for instituting and enforcing the nonsmoking policy and would provide information to affected agencies and programs on employee smoking cessation programs and on compliance with the law. Under the PRO- KIDS measure, EPA would also have the authority to issue waivers under specified conditions. The PRO- FEDS legislation requires EPA to establish an "Envi- ronmental Tobacco Smoke Advisory Office" within the Office of Radiation and Indoor Air. The ETS

2 Advisory office, under the guidance of a director, would: (i) participate in outreach and educational programs; (ii) provide information on the "dangers of environmental tobacco smoke;" (iii) establish a telephone hotlinc to provide information on the alleged dangers of ETS; and (iv) "carry out any other function of the Office that the [EPAJ Administrator detumines to be appropriatc.A Senator iautenberg relied to a significant extent upon the EPA Risk Assessment on ETS in justifying the legislation. An EPA press release and newspaper artides discussing the EPA report and the KueperGtigation in Illinois were appended to the Congressional Record at the Senator's request. Senator Lautcnberg introduced the bills on behalf of himself and Senator Tom Harkin (D-Iowa). The text of both S. 261 and S. 262 are attached as Appendix B. BOMA [3] • Building Owners and Managers Vote to Support Workplace Smoking Ban Citing the EPA Risk Assessment on ETS, the Building Owners and Managers Association International (BOMA) reportedly has passed a resolution by unanimous vote to support a federal ban on smoking in the workplace. A copy of the resolution is attached as Appendix C. According to the organization's president, EPA's dassifi- cation of ETS as a"Group A" carcinogen "leaves no doubt that cigarette smoke must be eliminated from the work place to ensure public health. A national ban on smoking will greatly improve the indoor air quality of the nation's office buildings." The resolution was voted on during BOMA's annual winter business meeting. BOMA is a trade association which represents the office building industry. Its members reportedly own or manage more than 5 billion square feet of North American office space. The organization presented a seminar series on improving indoor air quality last year in cooperation with the EPA. See PR Neuaruire, January 22, 1993. WHITE HOUSE [4] President and Mrs. Clinton Ban Smoking in White House ETS/IAQ REPORT, ISSUE 40 statement by Hillary Clincon's press seaetary. The ban also applies to official White House dinners. Reportedly citing concerns about offcttding visiting dignitaries, the Clintons have not yet decided whether they will ban smoking at White House business meetings. See New York T:mr; Febnuary 3, 1993. NIOSH [5] NIOSH Ceases to Log 800 Number Calls According to a press report, NIOSH logged more than 27,000 attempted calls and responded to more than 5,000 requests following a CBS news story on sick building syndrome. Ser issue 34 of this Report, November 6, 1992. The CBS story, which aired on October 12, 1992, broadcast a toll free NIOSH phone numba. Thc agency stopped loggmg the calls in mid-December, at which time they had spoken to more than 5,000 persons with alleged IAQ problems in their school or workplace; 27,000 persons were unable to get through dogged phone lines but were recorded by a computer. According to the article, an ASHRAE official said the agency usually handles about 150 calls per year. Even so, he said NIOSH intends to respond to all complaints it received. See IndoorAir Quality Update, January 1993. U.S. GENERAL ACCOUNTING OFFICE (GAO) [6J GAO Study Reports Continuing Dichotomy Between National Health Policy Objectives and Cigarette Export Goals In a study reportedly released by the GAO on January 5, 1993, it was revealed that the Health and Human Services Department (HHS) has provided assistance to Asian antismoking groups and has supported antismoking programs of international health organizations while, at the same time, HHS ofI'icials have participated in cigarette ttade talks with Taiwan. The GAO report observes that the US. government pursues antismoking policies domestically yet assists U:S. cigarette companies in selling their products abroad. See International Trade Reporter, January 13, 1993. ASHRAE [7] SSPC-62 Meets During ASHRAE Winter The new President and First Iady have announced they will not allow smoking in the residential and non- Meeting office areas of the White House, according to a reported On January 24, 1993, during the ASHRAE Winter

FEBRUARY 5, 1993 Meeting in Chicago, the committee responsible for revising ASHRAE Ventilation Standard 62-1989 considered possible revisions to the standard. The committee's work will continue. STATE AND LOCAL GOVERNMENTS [8] Privary Legislation The term "privacy legislation" refcrs 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. • Alaslca A bill that would prohibit employers from discriminat- ing against individuals who use legal products in a legal manner outside the workplace was introduced on January 15, 1993, and has been sent to the House Committee on Labor and Commerce. See H.B. 62, 18th Legislature -1st Reg. Sess. (1993). • Montana The Senate Labor Committee has reportedly unanimously endorsed a bill that would protect employees who use tobacco or alcohol on their own time from disaimination by employers (S.B. 160). The bill would not, apparently, apply to employees of nonprofit groups which discourage the use of alcohol or tobacco and would not apply to life insurance policies. SecAuoeiated Ptax January 22, 1993. • Nebraska On January 21, 1993, a bill was introduced that would limit certain actions by employers based on a prospective or current employee's use of a lawful product. The measure has been sent to the Legislative Committee on Business and Labor. Ser LB. 696,93d Legislature -1st Reg. Sess. (1993). • V'uginia According to a press report, the legislature will again consider a measure that would prohibit companies from refusing to hire employees who smoke. Similar legislation died in the legislature in 1992, but proponents believe the measure will win passage this year because they have tailored the proposal to address the objections raised a year ago. See The Washingtori Port, January 31, 1993. [9] Other State and Local Legislative Activities Related to ETS • Colorado A bill that would limit the authority of the owners and 3 operators of private businesses to designate nonsmok- ing or smoking areas for employees of those businesses was introduced on January 15, 1993, and sent to the House Committee on State, Veterans and Military Afl^airs. On January 22, 1993, the measure was re- ported from that committee favorably with amend- ment. SaH.B. 1163, 59th General Assembly-1st Reg. Sess. (1993-94). • CoIIIIOetitat The Joint Committee on Labor and Public Employees is considering a measure, introduced on January 15, 1993, that would establish nonsmoking work areas in all business facilities without regard to the number of employees at the facility. See H.B. 5836, Reg. Sess. (1993). Another bill was introduced on January 20, 1993, that would require smoke-free areas in all places of employment. See H.B. 6185, Reg. Sess. (1993). • Delaware A measure that would regulate smoking in food markets was introduced on January 21, 1993, and has been sent to the House Committee on Human Needs and Development. See H.B. 52, 137th General Assem- bly - Reg. Sess. (1993-94). Also being considered by that committee is a measure that would regulate smoking in public and private places and in work- places. See H.B. 33, 137th General Assembly - Reg. Sess. (1993-94). In the aftermath of a new policy that prohibits smoking by guards and inmates in state prisons, the legislature is reportedly considering a bill that would require designated smoking areas in prisons. See S.B. 14, 137th General Assembly - Reg. Sess. (1993-94); Pbiladelphra Inguircr, January 27, 1993. * Hawaii Bills that would regulate smoking in childcare facilities during hours of operation, prohibit smoking in certain places open to the public, and define `employer" with respect to smoking policy, were introduced on January 21, 1993. SerH.B. 81, 97, 98, 216, and 217, 17th Legislative Sess. - 1st Reg. Sess. (1993). • Local Governments in Maryland In the wake of Governor William Schaefer's executive order banning smoking in state-owned buildings, some county officials are reportedly following his example. Apparently, Carroll, Frederick, Harford, Howard, Montgomery and Worcester counties have banned smoking in county-owned offices. The remaining

4 counties allow designated smoking areas. See Balrsnrore Morning Sun, January 27, 1993. • * Minnesota Companion bills that would extend the day care center prohibition on smoking to family or group family day care providers were introduced on January 11, 1993, and have been sent to the Senate Committee on Family Services and the House Committee on Health and Human Services. ScaS.F. 32 & H.F. 29, 78th Legisla tivc Scss. - Reg. Scss. (1993). Another bill reportedly introduced in the House would tighten provisions of the Clean Indoor Air Act by banning smoking in common areas of apartment buildings and condomini- ums, extending the ban to industrial businesses, darifying that "public places" includes unoccupied places, permitting smoking in private offices only if independently ventilated, and requiring restaurants to provide enough nonsmoking seats to accommodate all those who request them. The artide discussing these bills also notes that antismoking activists in the state have been "emboldened" to push legislation that failed last year by the EPA Risk Assessment on ETS. See Star Tribune, January 22, 1993. • New Jersey In February 1993, the legislature will reportedly consider two bills relating to smoking in restaurants. One bill would phase out smoking altogether in three yeass, the other would mandate a nonsmoking section in larger restaurants. See The Sunday Record, January 24, 1993. • New York A measure that would direct the Department of Environmental Conservation to establish standards for acceptable indoor air quality applicable to all public buildings within the state was introduced on January 21, 1993, and has been sent to the Assembly Commit- tee on Environmental Conservation. SeeA.B. 1397, 215th General Assembly- Ist Reg. Sess. (1993). A bill that would apply smoking prohibitions to transpor- tation facilities used by pupils regardless of the presence or absence of the pupils on such facilities was intro- duced on January 11, 1993. The measure was sent to the Assembly Committee on Education and was reported from that committee on January 25, 1993. SeeA.B. 727, 215th General Assembly- 1st Reg. Sess. (1993). ETS/IAQ REPORT, ISSUE 40 • North Dakota A bill that would designate smoking areas passed the House just two weeks after it was introduced on January 11, 1993. The measure is now before the Senate. See H.B. 1246, 53d Legislative Assembly - lst Reg. Sess. (1993). • Oregon A bill that will require certain publicly funded facilities to prohibit the use of tobacco on their premises was sent to the House Committee on Education on January 18, 1993. The measure would authorize local government or state agencies to withhold funding upon violation by the covered faciliry. See H.B. 2480, 67th Legislative Assembly - Reg. Sess. (1993). • Rhode Island A measure that would ban smoking in all restaurants except in lounge areas and that would exempt dough- nut shops was introduced on January 21, 1993, and has been sent to the Senate Committee on Health, Education and Welfare. Sec S.B. 86, Reg. Sess. (1993). • South Carolina A bill that would prohibit smoking in the indoor public areas of all food service establishments was introduced on January 13, 1993, and has been sent to the House Committee on Agriculture and Natural Resources. Sar H.B. 3113, Statewide Sess. (1993). • Local Governments in Texas The Arlington City Council has reportedly tentatively approved a partial ban on smoking at the new Texas Rangers ballpark which will open in 1994, and at Six Flags over Texas and other outdoor facilities. A$1,000 fine will be imposed on violators of the ordinance. Council members also reportedly agreed to study broadening the ban to indude private businesses. See United Press InternationA January 27, 1993. • Utah A measure that would require business establishments with smoking areas to provide information regarding the alleged health hazards of ETS to employees was introduced on January 21, 1993. A measure that would amend the Indoor Clean Air Laws and provide procedures regarding designated smoking areas was introduced and sent to the House Committee on Rules on January 18, 1993. See S.B 67 and H.B. 53, 50th Legislature - General Sess. (1993). According to press reports, these amendments would give Utah the

FEBRUARY 5. 1993 nation's strictest regulation of smoking in public places. Apparently, the bill would allow smoking in bars, restaurants, offices and other public places only if smokers are physically walled ofI'from nonsmokers in areas that are served by independent ventilation systems. Private dub owners say they are opposed to the legislation because it is cost prohibitive. See Grtenwirt, January 22, 1993. • * Virginia According to press reports, the Virginia General Assembly is considering a measure that would tighten smoking restrictions already in place under the Indoor Clean Air Act. Antismoking legislators are reportedly using the EPA Risk Assessment on ETS to support their claims of health hazards. The proposed bill would reportedly eliminate virtually all workplace smoking except where nonsmoking areas have separate ventilation; ban smoking in all public indoor areas; require hotels, motels and restaurants to have nonsmoking rooms and areas; permit local governments to pass stricter laws; and increase penalties for businesses and agencies that fail to post no-smoking signs. Another bill would reportedly dedarr officially that employees have a right to be protected from ETS under the state's worker- safery law. See Tfx Wasbsngton Parx January 31,1993. • Washington A measure that would prohibit smoking in a vehide which contains any passengers under the age of sixteen was introduced on January 15, 1993, and has been sent to the House Committee on Commerce and Labor. See H.B. 1114, 53d Legislature - Reg. Sess. (1993). According to the sponsor of the bill, the law is intended to educate smokers, but would not be enforced fre- quencly. See The Seattle Times, January 22, 1993. ETS-RELATED LITIGATION AGAINST' CIGARETTE MANUFACTURERS [10] Blanchani Scheduling Conference set for March 3, 1993 At the request of plaintiffs, the court has set a schedul- ing conference for March 3 and has ordered all counsel to meet and discuss scheduling matters on March 2. Defendants have served interrogatories and requests for production of documents on all named plaintiffs, indud ing those who were most recently added to the action. 5 The original plaintiffs in this case, Rayc Blanchard and Tamara Reed, arc mother and daughter. They allege primary-smoking injuries to Raye Blanchard's late husband, Thomas, who allegedly smoked for more than 50 years, and Raye Blanchard herself, who daims she smoked "for about ten years." In addition, Rayc 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. Twdve plaintiffs have been added to the case through supplemental and amended petitions. All of the additional plaintilfs' daims 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. 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 of wholesalers and retailers. Blauchar4 et aL v. RJ. Reynolds Tobacco Company, et aL (District Court, Galveston County, Texas) (filed July 31, 1992). [11] Bmin: Defendants Respond to Plaintigs' Second Amended Complaint All of the defendants filed their responses to plaintiffs' second amended complaint on January 22, 1993. All responses were in the form of motions to dismiss, although the grounds for the motions varied. Defendants have requested an extension of time within which to file their reply brief in the dismissal of class action allegations appeal: If granted, the briefwill now be due on March 8. At issue in this case are the claims of 30 flight atten- dants allegedly injured by occupational exposure to ETS. The injuries alleged by the putative class repre- sentatives include lung cancer, breast cancer and unspecified respiratory ailments. The defendants are purported to be the six major U:S. cigarette manufac- turers (plus related entities), United States Tobacco Co., Dasal Tobaceo Corp., the Council for Tobacco Research, The Tobacco Insritute, and three other trade associations. Bmin, et aL v. Pfiilip Morris, rt al (Circuit Court, Dade County, Florida) (filed October 31, 1991).

6 ETS/IAQLITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS GRADUATE SCHOOL EXPOSURE [12] Beckman v. Neuw York City Sc/iool of V'uaalAm (U.S. District Court, New York) (filed January 16, 1992) On January 22, 1993, the mediator filed a report stating that court-ordered mediation had been unsuccessful in resolving any issue in the case and that the unresolved issues should be treated as if thry had not been sent to mediation. In this case, Melissa Beckman alleges that she had to take a medical leave of absence from the graduate school because ETS cxposure allegedly caused her to suffer "repeated blackouts, frequent vomiting, high fevers, infections, weight gain, mood swings and other physical and emotional trauma." Beckman has requested $5 million in actual damages, $5 million in punitive dam- ages, and an injunction to eliminate smoke in the school. PRISONER CASES [13] Hemphill v. Gomes, 1992 U.S. Dist. LEXIS 20031 (U:S. District Court, Northern District, California) (decided December 8, 1992) A U.S. District Court judge has dismissed the claims made by nonsmoking state prison inmates who alleged violations of constitutional rights after prison officials failed to honor their cell change requests. The inmates had styled their action as a"class action" suit and had sought damages of $175,000. The court, however, issued an order dismissing the action without prejudice to an amendment of the oom- plaint for plaintiffs to allege that the "defendants as supervisors failed to properly train or supervise pessonnel, resulting in the harm to plaintiH"x; or that defendants had an official policy or custom which resulted in the harm; or that defendants knew of the alleged misconduct and failed to act to prevent the misconduct." The plaintifl's were given 30 days in which to amend their complaint. [14] Cookisls v. Commaissiorur, New Harnpsfiirr D~epart- mcnt of Corncctions (District Court, District of New Hampshire) (filed January 1, 1988) On January 6, 1993, the U.S. District Court dis- missed this action stating the plaintiff had `voluntarily ETS/IAQ REPORT, ISSUE 40 escaped" from prison and had therefore abandoned the opportunity to prosecute his civil daims. Plaintifl's current whereabouts arc apparently unknown and he had missed several court filing.deadlines. Cookish brought his daim against prison officials based on allegations that ETS exposure subjected him to cruel and unusual punishment and deprived him of his liberty interest without due process. LEGAL ISSUES AND DEVELOPMENTS [15] •"Children are Focus in a War to Snuff Secondhand Smoke," C. Scanlan, The Philadel- phia Inquirer, January 24, 1993 Discussing the EPA Risk Assessment on ETS, this article focuses on alleged health effects of ETS exposure on children. John Banzhaf, director ofASH, and Joseph LaMacchia, founder of Parents Against Second- hand Smoke (PASS), are quoted in the article for their views on protecting children from ETS in the home and in public places. According to LaMacchia, who last year fought a court battle to prevent his ex-wife from smoking in the presence of their son, his goal is "to dog the court system with these cases. All the informa- tion is in, but because of neglectfW, incompetent parents these kids have to suffer in smoke when they don't want to." The views of the tobacco industry are also included in the artide, and information is provided to readers to contact agencies and organizations offering brochures and packets of material on ETS. SCIENTIFIC/TECHNICAL ITEMS UPCOMING MEE'I'INGS [16] "Indoor Environment'93: Defining Strategies for Effective Indoor Air Management," Balti- more, Maryland, April 21-23, 1993 Sponsored by five indoor air quality publications, the conference invites IAQ professionals, building manag- ers, scientists and environmental lawyers to participate in discussions covering the "entire spectrum of indoor

FEBRUARY 5, 1993 air quality related issues." Sessions will include public programs and policy, building management, issues in detection and mitigation, safety and health, and litigation and liability. The safety and health session indudes presentations on "ETS: Health Effects and Recent Research," "Sick Building Syndrome: Prece- dents, Current Litigation, and Predictions," and "Workers Compensation and IAQ." [17] The Sixth Annual National Conference on Indoor Air Pollution, Tulsa, Oklahoma, March 29- 31,1993 The University of Tulsa will host this tonference, which will focus on IAQ issues such as indoor air diagnosticx, federal IAQ policie.c and research, and legal implications of sick building syndrome. Scheduled speakers include Robert Axelrad, Helen Eisenstein, Mark Mason and Harriet Burge. LUNG CANCER [ 18] Letters to the Editor Regarding "Environmental Tobacco Smoke-. The Price of Scientific Cer- tainty," D.M. Burns, Journal ofthe National Cancer Institute 84: 1387-1388, 1992 The Jouraal of tlx National Cancer Institute recently published two letters concerning this editorial, pub- lished at the same time as the Stockwell, et al., case- control study on ETS exposure and lung cancer in nonsmoking women. As discussed in Issue 31 of this Report, September 25, 1992, the author, David M. Burns, called for the development of public policies based on his belief that a causal relationship between ETS exposure and lung cancer has been "clearly established." Dr. Bums is an antismoking activist and a member of the EPA's Science Advisory Board commit- tee that reviewed the Draft Risk Assessments on ETS. The first letter in the current correspondence is from Gio B. Gori, and is followed by a reply from Burns. The letters appear in Journal of the National Cancer Insritutu85(1):66-67, 1993. Gori comments that Burns' original artide suggests that `either the editorialist [Burns] did not read the report carefully or his perception of certainty is a 7 curious one." Gori writes that Stockwell, et al., referred to suggestion, rather than certainty, in their article. He also points out "incongruities" of ETS cpidemiologic studies. In particular, Gori states that the odds ratios reported by Stockwell, et al., "vary from apparent protection to apparent risk," and that the reported results on adenocarcinoma "conflict with the much quoted and larger study of Fontham et al." Gori continues with a reference to potential confounding variables, biases, uncertainties in exposure estimates, and other problems, which he characterizes as "weak- nesses of epidemiologic data." Gori suggests that epidemiology should not be "interpreted in an equivo- cal dialectic context," calling the certainty referred to by Burns "an assertive policy proposition." In his response, Bums describes Gori's letter as °a fine example of the 'reasoning' used by the tobacco industry to delay and confiue the development of scientific certainty." Burns writes that neither the Stockwell, et al., study nor his own editorial implied that the Stockwell, et al., study provided sufficient data to reach scientific certainty. He calls for using "multiple lines of evidence and all of the data available" in judging causality. Burns also accuses Gori of an`ad hominem atrack suggesting that, because I [Bums] agree with the condusion of evey comprehensive scientific review of these data that has been conducted in the last 7 yeus, my position must be based on advocary and cannot be sdentific.'° CARDIOVASCULAR ISSUES [19] "Reduced Plasma Ascorbic Acid Concentrations in Women Regularly Exposed to Environmental Tobacco Smoke (ETS)," D.L Tribble and S.P. Foranann, Circuktion 86(4): Supplement, 1992 [See Appendix A] The authors of this abstract propose that a reduction in levels of the vitamin ascorbic acid may be related to the pathogenesis of heart disease. Based on measurements of plasma ascorbic acid concentrations and diecary ascorbic acid intake in nonsmoking women, the authors report that "passive smokers" had lower plasma ascorbic acid levels, which they suggest "may contribute to increased heart disease risk associated with ETS ecposure."

8 RESPIRATORY DISEASES AND CONDITIONS - ADULTS [20] "Pulmonary Effects of Environmental Tobacco Smoke Exposure on Asthmatic Subjects," S.B. Lehrer, CL4R Currents 2(2): 1, 4, 1992 [See Appendix A] This anicle reports on a test chamber developed by a research team at Tulane University, in which asthmat- ics claiming smoke-sensitivity were txposed to sidestrcam smoke as a surrogate for ETS. The author reports that only 10 percent (17 out of 163 subjects) `reaaed" to side- stream smoke at high smoke levels, corresponding to ETS concentrations that "would be extreme and rarely encoun- tered" in actual environments. RESPIRATORY DISEASFS AND CONDITIONS - CHILDREN [21] "Maternal Age as a Risk Factor for Wheezing Lower Respiratory Illnesses in tbe First Year of Life," F.D. Martinez, A.L Wright, C.J. Holberg, W J. Morgan, and LM. Taussig, American Joxrnal ofEpidimiology 136(10): 1258-1268, 1992 [See Appendix A] This report, part of the Tucson Children's Respira tory Study, reports that maternal age is related to the incidence rate of wheezing lower respiratory infections. Namely, such infections are reportedly more frequent in the offipring of younger mothers. The authors also report a statistically significant odds ratio for maternal smoking as an independent risk factor for wheezing lower respiratory infections. The lead author of the study, Fernando D. Martinez, was a major contributor to the EPA Risk Assessment's section on childhood respiratory diseases and conditions. OTHER HEALTH ISSUES [22] "Clinical Ecology," Council on Scientific Affairs, American Medical Association, Journal of ths American MedicalAssociation 268(24): 3465- 3467, 1992 [See Appendix A] This Council Report, by the American Medical Association, discusses multiple chemical sensitivity ETS/IAQ REPORT, ISSUE 40 syndrome (MCSS), chronic fatigue syndrome, and sick building syndrome, as well as the branch of treatment called clinical ecology. The authors conclude that no studies have established a mechanism or cause for MCSS or have confirmed the efficacy of methods advocated by clinical ecologists. They also recommend that the literature on these topics should be monitored and call on practitioners of clinical ecology to prove the effectiveness of new treatments by controlled dinical trials. ETS ExPOSURE AND MONITORING [23] * "Preliminary Data: Exposure of Persons Aged 2:4 Years to Tobacco Smoke - United States, 1988-1991," Centers for Disease Control, Morbidity and Mortalit.y Weekly Report 42(2): 37-38, 1993 [See Appendix A] This preliminary report by researchers at the Centers for Disease Control (CDC) has received extensive press coverage. It reports on initial results of assays for blood serum levels of cotinine, a metabolite of nicotine, in 800 individuals. The study subjects are a subset of a larger group of 23,000 persons being surveyed as part of the Third National Health and Nutrition Examina- tion Survey (NHANES III). A very sensitive assay methodology was employed, and cotinine was report- edly detected in all individuals tested. The artide implies that all low levels of cotinine are due to ETS exposum Apparently, the CDCs new methodology allows detection of levels of cocinine previously undetectable in many studies. However, the authors do not discuss the possible contribution of diet to cainine levels. Nicotine is found in small amounts in such vegetables as tomatoes and eggplant, and also in oettain forms of tea. In press reports, Dr. James Pirkle of CDC was quoted as saying about the 100 percent detection level, "we really weren't expecting that '" Pirldc also reportedly stated'that the CDC research would address criticisms leveled against the EPA Risk Assessment on ETS concerning doatmentation of numbers of exposed persons and levels of exposure. Pirkle reportedly said that the new methodology "will allow us to figure out the extent of the problem using an objective measure.'" See The New York 7ime.% January 22, 1993.

FEBRUARY 5, 1993 OTHER DEVELOPMENTS [24] Restaurant Customer Faces Murder Charges Following Dispute Over Cigarette Smoldng Toby Titus Wade of Sacramento, California, reportedly faoess a murder charge after he allegedly stabbed a waiter to death in an argument over smoking. According to police, Wade and the waiter began shouting at each other after Wade lit a cigarette and the waiter told him to stop. A dry ordinance reportedly prohibits smoking in restau rants. The confrontation allegedly escalated in a back oflice and the waiter was found stabbed to death after Wade left the restaurant. See Los Angcla Tima, January 13, 1993. [25] • California Mall Bans Smoldng According to press reports, the South Coast Plaza became one of the first indoor shopping malls in the nation to ban smoking in common areas as of February 1, 1993. Restaurants in the Plaza and food court will evidently keep designated smoking areas open. The impetus for the rule, according to a mall spokeswoman, was the EPA Risk Assessment on ETS. See Los Angrrles Tsmet; January 26, 1993. [26] • EPA Risk Assessment on ETS Spurs Anti- Smoking Activists in Illinois A health group coalition, lawmakers and state officials reportedly planned to meet in late January to take steps to strengthen Illinois' public smoking law. The current law, which was enacted in 1989, requires restaurants, hotels and other public places to provide nonsmoking areas. Thosccities, induding Chicago, which passed stricter ordinances before the state law went into eBect in 1990, are exempt from the law. Antismoking activists are reportedly seeking a bill that would give municipalities the right to decide where people can smoke in public, if at all, and they will reportedly use the EPA Risk Assessment on ETS as their `main wexpon" in an `expocted battle" with the tobacco lobby. See Cbicago Tri6une, January 19, 1993; GreenurirK January 20, 1993. MEDIA COVERAGE [27] "When Your Office Calls in Sick," K GaRtt, Health, January/February 1993 In this article, stafl'writer Katherine Griffin discusses 9 sick building syndrome, its probable causes and health consequences, and possible remcdiation measures. Focusing on inadequate ventilation, improper mainte- nance of HVAC systems, and the presence of toxic chemicals and biological contaminants as sources of poor IAQ the article provides specific recommenda- tions for office workers to document sick building problems and find ways to resolve them. Induded are references to EPA publications and a NIOSH hotlinc. The author notes that the EPA will be publishing a list of private IAQ consultants within the next few months, and observes that such businesses are prolifer- ating "like algae in a drain pan." [28] "The Architecture of Illness," D. Steinman, Vegetarian Tima, January 1993 This article profiles the IAQ problems the EPA had with its Waterside Mall headquarters and discusses sick building syndrome issues. Thcauthor addresses causes and effects of poor IAQ and observes that basic HVAC systems maintenance might be the most effeccivc way to reduce exposures to indoor air pollutants. Some of the steps recommended for improving a"sick work space" indude bringing in house plants, improving air circulation and ventilation, using nontoxic deaning products, using a high-efficiency particulate air filter for personal work spaces, organizing other workers and tenants, quitting your job, and filing a lawsuit. The artide condudes by reviewing actions that are being taken on the federal and state levels to improve IAQ. IN' EUROPE & AROUND THE WORLD ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS AUSTRn1.lA [29] • Tobacco bvtttute ofAwnwAa Ltd v. Australian Fideration of Consumer Orgamisatiorss Inc. (Full Federal Court, New South Wales District Registry, Australia) (decided December 17, 1992) During a post-decision hearing conducted before the full Federal Court on February 3, 1993, the court

10 considered, among other matters, whether it would rely upon the EPA Risk Assessment on ETS in deciding AFCO's request to grant an injunction against public statements by TIA about ETS. The court also heard argument addressing the injunctions imposed by Justice Morling, the appropriateness of the declaratory relief sought by AFCO, the question of costs, and TIA's request for leave to rely on a new submission based on the Australian High Court decisions in cases involving free speech rights. A special report on the AFCO decision appears in issue 37 of this Report, December 18, 1992. The court apparently did not issue a ruling at the condusion of the hearing. It did, however, take under advisement (i) whether to grant leave to TIA to argue the free speech issue, and (ii) whether to grant leave to AFCO to put on funher evidence. The court indicated that it would either relist the matter for further consideration or deal with the issue in its reasons for judgment. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS UNITED KINGDOM [30] Ytronica Blmtd v. Stockport Mesropolitan Borough Council (Manchesoer) (writ issued June 14, 1991; settlement entered January 27, 1993) A 36-year-old nonsmoker has reportedly agreed to settle her ETS workplace exposure daim against her employer, the Stockport (UK) Metropolitan Borough Council, for the sum of £15,000 (U.S. $21,600). The settlement was made out of court without an admission of liability. The claimant, Veronica Bland, alleged that she had been exposed to ETS from 1979 until a no-smoking policy was implemented in 1990. Bland daimed that she had been forced to share an office with co-workers who smoked up to 150 cigarettes a day and that this caused her to suffer sneezing, coughing, streaming eyes, and ultimately chronic bronchitis. During a press conference held to announce the setdement, Bland reportedly barely raised her voice above a whisper and claimed her once beautiful soprano singing voice was no longer what it had been. ETSIIAQ REPORT, ISSUE 40 Bland's union, NALGO (National and Local Gov- ernment Officers' Association), brought the suit on her behalf. Although representatives of NALGO reportedly lauded the settlement and predicted that it would force employers to impose workplace smoking bans to avoid future liability, press reports observed that NALGO does not impose a smoking ban in its own offices. Media coverage of the settlement has been extensive, with articles appearing in many U.K publications, and in Australia, the United States and France. Most of the articles acknowledge that the settlement does not create legal precedent, but they suggest that employers will hasten to impose smoking bans to avoid similar litigation. According to ASH, there will be an explo- sion of such lawsuits in the near future. See The Indeprndcnt, January 28, 1993; Daily Tekgrapb, January 28, 1993; The Tinus, January 28, 1993; Sunday Telrgraph, January 31, 1993. It has been reported'that members of Parliament arc calling for the government to impose workplace smoking bans. Secretary of State for Health Virginia Bottomley, however, has ruled out any legislation before 1995, when voluntary smoking policies are expected to be in place in the majority of workplaces. According to ASH, some 80 percent of large compa- nies currently have a workplace smoking policy. See The Irldepcndent, January 28, 1993; Reuter Library Report, January 27, 1993. . Legal Aid GsmUed to Nonsrtnker Sung Ertpbyer, ltem 33. LEGAL ISSUES AND DEVELOPMENTS AusrRAl.tA [31] "Australian Court Decision on Passive Smoking Upheld on Appeal," S. Chapman & S. Woodward, British MedscalJourna4 January 9, 1993 Stephen Woodward, executive director of Australia's Action on Smoking and Health (ASH), and Simon Chapman, a lecturer in community medicine at the University of Sydney, submitted this article following the 77A v. AFCO decision on December 17, 1992. In it, Woodward and Chapman claim the appeal court found the "critical sentence" in the TIA ad, "And yet there is little evidence and nothing which proves

FEBRUARY 5. 1993 scientifically that cigarette smoke causes disease in non- smokers,° was misleading and deceptive. Further, they allege that each of the appeal judges were'emphatic" in their ruling, and that Justice Shepherd "vehemently rejected" TIA's claim in the'critical sentence." Even so, the authors assert, the tobacco industry was handed a`symbolic but fairly meaninglessviccory in having two orders varied. These concerned matters that were a pure technicality ... and a virtual truism." Further they stated, 'the tobacco industry is unrivalled at making silk purses from sows' ears. It still maintains with blithe equanimity its opinion that active smoking, let alone passive smoking, does not cause disease - it has been shown only to have a 'statistical association,' much in the same way that sexual intercourse might be denied to 'cause' pregnancy." The authors note that the 148-page opinion of the Federal Court gives "quite priceless advice to the industry about how it might become more clever in the same ambitions that gave birth to this dumsily worded advertisement. Each judge offers advice, often explicit, on how the offending sentence could have been published without falling prey to a misleading and deceptive charge." Research assistance for the artide was provided by the barrister who appeared for AFCO before Justice Morling and for the full Federal Court appeal. [32] Tobacco Companies Submit Memorandum to Legal Aid Board On January 14, 1993, Philip Morris, Rothmans, and WD & HO Wills reportedly submitted to every state and federal legal aid body a memorandum which attempts to oppose the grant of legal aid in cases which might be brought against cigarette manufacturers by smokers or by those exposed to ETS. Although these "prospeaive defendants" acknowledge that it is unusual to oppose a grant of legal aid before proceed- ings have been commenced, they observe that some solicitors have been advertising to recruit claimants for tobacco litigation and that it seemed appropriate to outline relevant issues for legal aid authorities. One of those advertisements appears in issue 25 of this Report, July 7, 1992. The memorandum makes rekrence to a newspaper article which refers to a possible common law claim by 11 West Australia's 120,000 asthmatics with respect to ETS exposure. For a summary of this article, see issue 34 of this Report, November 6, 1992. Various argu- ments are advanced explaining why a"dass action" of this sort would not succeed. UNITED KINGDOM [331 Legal Aid Granted to Nonsmoker Suing Em- ployer A Midlands office worker who is planning to sue her employer for damages allegedly caused by ETS expo- sure has reportedly been granted assistance from the Legal Aid Board. The claimant, a woman in her fifties, apparently claims she developed asthma and bronchitis after working for five years in an office in which smoking was permitted. Lawyers arc reportedly predicting that there will be a flood of legal claims against employers and parents for ETS exposure in the wake of the Veronica Bland settlement. A barrister with Leigh Day and Company said he has had several preliminary inquiries from people who want to sue their parents. See The lndepcn- dtnt, January 31, 1993. Applications for legal aid submitted by smokers wishing to sue dgarrtte manufacturrrs have been denied . veronica Bland'Setdement, Item 30. SCIENTIFIC/TECHNICAL ITEMS RESPIRATORY DISFASFS AND CONDITIONS - CHILDREN [34] "Prevalence of Asthma in Swiss Children," F.H. Sennhauser and B.H. Guentert, European RespiratoryJourrnal5: Supplement, 1992 [See Appendix A] This absttact, presented at the European Respiratory Society meeting in 1994 nreports on a study to determine the prevalence of childhood asthma in Switzerland. Reportedly, the prevalence of nighttime symptoms, such as cough, chest tightness, and wheeiing, was significantly higher in children of families with smokers.

12 [35] "Effect of Age on Urinary Cotinine Level in Young Children," P.N. LeSouef, A.C. Reese, LI. Landau, and I.R. Jatnes, European Respiratory Journal5: Supplement, 1992 [See Appendix A] These Australian researchers investigate the hypoth- esis that the reported association between parental smoking and respiratory illness in infants is due to increased exposure rather than to claimed increased lung sensitivity. They daim to have found an inverse relationship between urinary cotinine levels and age; that is, younger children (0-2 years) reportedly had cotinine levels strongly associated with the number of cigarettes smoked by their parents. (36] "Passive Smoking and Children's Diseases," K Pisiewicz and C. Macura, European Respiratory Journal5: Supplement, 1992 [See Appendix A] This meeting abstract reports on a study comparing the prevalence of respiratory diseases and symptoms in children living with smokers and nonsmokers in relation to family history of disease. The authors report that "the influence of family history was stronger than that of passive smoking," and attribute this to parents with allergic diseases smoking significantly less. [37] "Urinary Cotinine Levels in Primary School Children: Evidence of Exposure to Environmen- tal Tobacco Smoke," E. Dagli, N. Cakan, and A. Araman, European RespiratoryJournal5: Supplement, 1992 [See Appendix A] These Turkish researchers use questionnaire data and urinary cotinine measurements to examine ETS exposure in school children. Theycondude that'the dose of nicotine received by Istanbul school children from ETS was estimated to be equivalent to I to 5 cigarettes per day." [38] "The Prevalence of Inherited and Environmen- tal Factors in Patients with Asduna," R. Lyons, S. Sreenan, C.K Power, and C.M. Burke, European RespiratoryJournal5: Supplement, 1992 [See Appendix A] Based on questionnaire responses, these researchers in Ireland report that, in their study population, childhood asthma is associated with a family history of asthma or eczema, suggesting an inherited aspect. However, the ETS/IAQ REPORT, ISSUE 40 authors also suggest that environmental factors are related to asthma, based on reports of atisociations between asthma and damp housing or ETS exposure. UNITED KINGDOM [39] "Passive Smoking Exposure and Urinary Cotinine in Relation to Respiratory Health and Bronchial Responsiveness in Adolescents," F. Forasdere, N. Agabiti, V. Dell'Orco, R Piscelli, G.M. Corbo, G. Brancaco, R. Pacifici, P. Zucarro, and CA. Perucci, Exmpean Re.rpiratory Journal5: Supplement, 1992 [See Appendix A] The authors of this study, conducted in Italy, com- pare urinary cotinine measures with questionnaire responses concerning several indices of respiratory health. They condude that urinary cotinine does not provide additional information beyond data produced by questionnaire responses. ETS EXPOSURE AND MONITORING [40] "Biological Evidence of Significant Exposure to Tobacco Smoke in Children of Smoking Par- ents," LM. Galanti and V.M. Godding, Circula- tion 86(4): Supplement, 1992 [See Appendix A] This abstract, prepared by Belgian researchers, reports that urinary eotinine levels in children are correlated with pan:nts' eotinine levels and with the number of cigarettes reportedly smoked per day. The authors daim to find urinary cotinine levels four times higher in children with smoking parents than in non-smoking adults. OTHER DEVELOPMENTS CANADA [41] Montreal Restaurants Ignore No-smoking Law According to press reports, nearly 90 percent of Montreal restaurants do not have the number of nonsmoking seats required by law. Since August 1992, restaurants have been required to set aside half of their seats for nonsmokers or risk fines ranging from $300 to $1,000. The survey, which also revealed that fully one-

FEBRUARY 5, 1993 third of restaurants failed to establish any nonsmoking section, was conducted by a city councillor who reported that his researchers found most restaurant owners were unaware of the bylaw requirements. According to city officials, they have done enough to publicize the bylaw by sending inspectors to al14,000 restaurants in the city and distributing pamphlets and no-smoking signs. Sff The Gazrttc (Montrnal), Janu- ary 23, 1993. CZECHOSLOVAIQA [42] Cigarette Executed in Wenceslas Square Animal S.O.S., an organization with animal rights and environmental concerns, reportedly staged the execution of a cigarette on old town square in Prague on January 17, 1993. The purpose of the event was apparently to bring attention to the interests of non- smokers, animals and nature. Animal S.O.S. reportedly advocates smoke-free workplaces. Su CTKNational Nnus Wire, January 18, 1993. UNITED KINGDOM [43] "Passive Smoking" Exhibition Opens at Science Museum On January 14, 1993, the Science Museum in London held a formal opening of its "passive smoking" exhibition. The assistant director described the exhibi- tion as one in a series intended to cover topical issues of scientific debate which are of interest to the public. A stated aim is to provide a "candid assessment'° of the evidence. The exhibition was reportedly produced with the assistance of three 'independent' experts, Martin Jarvis, Sir Richard Doll and Professor Nicholas Wald. The exhibition consists of display stands, wall charts and a device that permits visitors to test the alleged effects of ETS by measuring the amount of carbon monoxide in their breath. Interactive computer terminals provide visitors with an opportunity to take part in an opinion poll on ETS and to get furrher information from scientific papers. A running display of the average number of people who allegedly die from smoking-related diseases during the course of the exhibition will reportedly be given. 13 On March 10, 1993, National No Smoking Day, the Museum will have special presentations, a dramatic performance for children, and a"table-top" science day where people can take part in experiments to attempt to show whether they have been affected by cigarette smoke. A sampling of the handouts available at the exhibition are attached as Appendix D. [44] Nicotine Sensor Badge Developed for Non- smokers Bedfont Scientific Limited, a company in Kent, is reportedly developing a lapel badge which changes color when it is impregnated with airborne nicotine. The purported purpose of the badge is to measure the cumulative effect of ETS exposure. According to the company's sales and marketing manager, the badges will be sold within the next few months if tests prove successful. They will be marketed under the name Smoke Check and will cost 84 pounds for a packet of 30. See The Indepardcnt, January 31, 1993. [45] Smokers Ignore British Rail's Smoking Ban British Rail passengers who smoke are reportedly defying a smoking ban that was imposed on most South of England lines. Some are tearing down penalty notices as soon as they are posted. Others are lighting cigarettes in spite of the ban. On January 22, 1993, a smoker was stabbed and badly wounded when he lit a cigarette in a nonsmoking compartment to the evident chagrin of his nonsmoking assailant. According to Conservative peer Lord Aldington, who reportedly smokes a pipe and rides the train into London from Kent, the ban is a violation of human rights and he is calling upon the government to intervene. See The Sxrrday Tilegrapk January 24, 1993. [46] BAT Publishes Workplace Smoking Guide and Smoking Fact Sheet BAT has published a workplace smoking guide that emphasizes a fair and cooperative approach to the devel- opment ofsmoking policies in the workplace. Noting that a total smoking ban may be detrimental to office morale and productivity, the guide urges employers to "handle individual complaints as they occur and at the lowest level of supervision. ... Simple modifications to the immediate environment ... might be all that is required. A mutually worked out agreement is the ideal solution."

14 Snrokingg Rrskr asd liroritier is the title of BAT's smok ing fact sheet. This document challenges scientific findings on the health risks associated with cigarette smoke by showing how various studies on all health risk faaors can be contradictory. ETS studies are critidzed as failing to adequately account for other risk factors, and the document condudes by stating that people should be left alone to make their own choices about what they eat, drink or smoke. WoRLD AIRLINE NEws [47] Ausrralia Qantas is reported to be considering a smoking ban on all its flights worldwide. Bans on selected routes will apparently be introduced gradually as the effects on customers are studied. See Sydney Morning Herald January 27, 1993. [48] China China Airlines has reportedly indefinitely postponed its plan to ban smoking on its Taipei-Los Angeles and Taipei-New York routes. The ban was scheduled to go into effect on January 1, 1993. See Indu.rhy Sourrr.r, December 17, 1992. [49] Finland A Finnair spokesman reportedly announced the airline will not consider instituting a smoking ban on international flights. Reasons cited include fear of fires, as smoking passengers might throw cigarette ends into lavatory waste baskets. The spokesman reportedly said an alternative to a total ban would be to allow smoking at certain controlled intervals. See Savon Sanomat, October 15, 1992. [50] Iran Iran Air has reportedly announced it will ban smok ing on international flights less than 150 minutes long. The airline has already banned smoking on all domes- tic flights. See Reutcrr, December 16, 1992. UNTTED KINGDOM [51] Airplane IAQ to be Investigated A British Euro MP has reportedly called for an investigation into the safety and quality of the air ETS/IAQ REPORT, ISSUE 40 inside airplanes following the publication of a newspa per story regarding "sick aircraft syndrome" and the businessman who is threatening to sue a U.S. airline for a virulent form of pneumonia he allegedly con- tracted in-flight. See issue 39 of this Report, January 22, 1993. In his written question, tabled in the Euro- pean Parliament, Edward McMillan-Scott, Conserva tive MEP for York, discusses alleged problems with ozone levels and ETS in cabin air and asks if the Commission is aware thac circulation rates in some aircraft cabins arc below the levels recommended to maintain the health of occupants in buildings. See Sunday Tekgraphs January 17, 1993. [52] WHO Releases Report on Tobacco or Health Prognmme According to the WHO report on its Tobacco or Health Programme, WHO and the International Civil Aviation Organization (ICAO) have begun preparing guidelines for smoke-free travel. ICAO reportedly adopted a resolution in October 1992, "to take necessary measures as soon as possible to restrict smoking progressively on all international passenger flights with the objective of implementing complete smoking bans by 1 July 1996." These agencies are also charged by the World Health Assembly to promote smoke-free travel in all means of public transport. According to the report, lack of financial resources will preclude a meeting of officials responsible for surface transport policies to obtain international consensus on guidelines for smoking control in surface transport, but officials from a few selected national transport agencies will be asked in the coming months to offer their comments on WHO's draft guidelines to ensure their accuracy.

FEBRUARY 5, 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 SCIENTIFIC/TECHNICAL ITEMS CARDIOVASCULAR ISSUES [ 19] "Reduced Plasma Ascorbic Acid Concentrations in Women Regularly Exposed to Environmental Tobacco Smoke (ETS)," D.L. Tribble and S.P. Fortmann, Circulation 86(4): Supplement, 1992 "Oxidative processes have been implicated in the pathogenesis of heart disease, offering a potential explanation for the high risk attributable to smoking. Cigarette smoke contains numerous oxidants, and smokers exhibit reduced circulating concentrations of the antioxidant vitamin ascorbic acid (AA) ... We measured plasma AA concentrations and dietary AA intake in nonsmoking women exposed to 220 hr/wk ETS, i.e., passive smokers (PS), as compared with nonsmokers with 22 hrs ETS cxposure/wk (NS) and active smokers (AS), to assess whether PS also may exhibit suboptimal AA nutriture.... Both PS and AS exhibited reduced plasma AA relative to NS. Reduced plasma AA in PS may be partially due to reduced dietary AA. These results suggest that suboptimal AA nutriture may contribute to increased heart disease risk associated with ETS exposure." RESPIRATORY DISFASES AND CONDITIONS - ADULTS [20] "Pulmonary Effects of Environmental Tobacco Smoke Exposure on Asthmatic Subjects," S.B. Lehrer, CIAR Curr=ts 2(2): 1, 4, 1992 "Our studies have focused on the incidence and characterization of asthmatic responses to environmen- tal tobacco smoke." "[A] dynamic test chamber was developed in which sidestream smoke (SS) test atmospheres, used as a surrogate for ETS, can be precisely controlled for any A-1 desired duration by varying the number of machine- smoked cigarettes and adjusting the air flow. ... The exposure environment within the chamber is composed of the diluted SS from machine-smoked IR4F research cigarettes and is characterized and monitored by concentration measurements of nicotine, respirable suspended partides, and carbon monoocida" "In our study, 163 asthmatics claiming smoke- sensitivity were challenged with SS-ETS for up to 240 minutes. Total suspended particle (TSP) levels ranged 750-2000 uglms and nicotine ranged 250-450 ug/ms. Twenty-eight (28)/163 asthmatics (17%) demon- strated a significant decline in lung function (decrease in FEV, greater than or equal to 20%) after 90 to 240 minutes of exposure. While intermittent exposure to this ETS level is possible in an environment such as a very smoky bar, ETS partide concentrations greater than 300 ug/m3 would be extreme and rarely encoun- tered. A typical indoor level is about 120 ug/m3 or less in smoking environments." "all reactors were sham (SS-ETS absent) challenged in the chamber. Eleven (11)/28 (39%) reactors had a positive sham challenge, were non-specific reactors, and were removed from the group. Thus 17/163 (10%) asthmatics reacted to SS-ETS." "Seven (7) of the 17 SS-ETS reactors were selected for dose-response challenge with decreasing levels of SS-ETS up to 360 minutes at 4 week intervals. No subjects reacted to any SS-ETS levels before 90 min- utes, and 3/7 did not react to levels less than the highest.... No participants demonstrated a significant drop in peak flow rate when monitored overnight." "Our studies showed that about 10% of asthmatics daiming to be smoke sensitive actually demonstrated objective changes in their pulmonary function from high level SS-ETS exposure. These responses do not appear to be related to IgE antibody reactivity to tobacco allergens. Almost 40% of all reactors also exhibited a significant drop in their FEV, in the absence of tobacco smoke which suggests that the nature of some forms of asthma are unstable and that controls are needed when evaluating cigarette smoke- induced responses. Future studies are directed at assessing the role of mediators in ETS-induced asth- matic and extrapulmonary responses, identification of the ETS components that might provoke asthmatic

A-2 responses, and determining the effects of ETS on asthmatic responses to known environmental allergens." RESPIRATORY DISFASFS AND CONDITIONS - CHILDREN [21] "Maternal Age as a Risk Factor for Wheezing Lower Respiratory Illnesses in the First Year of Iife," F.D. Martinez, A.L Wrigh.t, C.J. Holberg, W J. Morgan, and LM. Taussig, American Journal ofEpideniology 136(10): 1258-1268, 1992 "The aim of this report is to examine the relation between maternal age and respiratory morbidity during the first year of life in a well-controlled, longitudinal study conducted in Tucson, Arizona. The Tucson Children's Respiratory Study has been designed as a prospective investigation of the risk factors for lower respiratory tract illnesses in infancy and their relation to chronic obstructive airway diseases later in life. Over 1,200 infants were enrolled at birth, and accurate records of lower respiratory tract illnesses occurring during infanry were kept by their pediatricians and study nurses." For this analysis, mothers were divided into five gtnups acmrding to their age at the time of delivery: less than 21, 21-25, 26-30, 31-35, and more than 35 years." "Mothers were classified as smokers if they reported smoking one or more cigarettes per day. Maternal education was classified as 'high' if the woman had completed more than 12 years of formal education and as `low' otherwise. Marital status were dassified as `unmanied' if mothers were single, separated, or divorced and as 'married' otherwise. Children were classified as `Anglo' if they had a least one white, non- Mexican-American parent and as 'Hispanic' if both parents defined themselves as being of Mexican- American origin." "Infants were dassified as being breast-fed if they had received mother's milk for at least 1 month. In addi- tion, information on day care was elicited during the child's second year, and parents were asked if the infant had spent 9 or more hours a week in the company of other children....[P]arents were asked if the infant had had physician-diagnosed eczema during the first year of life." ETS/IAQ REPORT, ISSUE 40 "At the time of the acute illness, the physicians completed a standardized form on the presence or absence of a number of signs and symptoms.... For the purpose of this study, only the first lower respira- tory tract illness occurring during the first year of life was considered." "There was a significant, inverse relation between incidence rate of lower respiratory tract illnesses in the first year of life and maternal age." "Nonwheezing lower respiratory tract illnesses were unrelated to maternal age after maternal education and birth rank were controlled for." "In addition to maternal age and birth rank, the following variables were independent risk factors for wheezing lower respiratory tract illnesses: maternal smoking (odds ratio (OR) = 1.7, 95 percent CI 1.1- 2.5), use of day care facilities (OR = 1.4, 95 percent CI 1.0-2.0), being Hispanic (OR = 1.6, 95 percent CI 1.0-2.6), and being an unmarried mother (OR = 1.8, 95 percent CI 1.0-3.2): ° "In previous reports based on this population, we have shown that maternal smoking habits, room sharing and feeding practices, cord blood immuno- globulin I:, and lung structure and function are associated with the risk of developing lower respiratory tract illnesses (especially those associated with wheeze) during the first year of life. In this study, we add to the above list a new, important risk factor: younger maternal age. The risk increased linearly with decreas- ing maternal age, but the association was limited to wheezing lower respiratory tract illnesses; there was no relation between maternal age and nonwheezing lower respiratory tract illnesses. It was also stronger for males than for females." "It is reasonable to argue that maternal age may be a proxy for some unknown social factor that we may have failed to consider in our analyses....[O]ur results were independent of ethnicity, marital status, feeding practices, and maternal smoking habits, all of which are known to be related to or to be determinants of socioeconomic status. However, we cannot exclude the possibility that other social or environmental conditions (such as nutrition, quality of the house, and health status of the mother, among others) may have confounded the associations report herein,"

FEBRUARY 5, 1993 "In summary, infants born to younger mothers were reported by their pediatricians to develop clinically important signs of bronchial obstruction during viral infections more often than did those of older mothers. This was in part due to the significant association between lower maternal age and prevalence of known risk factors for wheezing lower respiratory tract ill- nesses. However, the association between maternal age and wheezing lower respiratory tract illnesses persisted after controlling for many of these known risk factors. A better understanding of the factors related to mater- nal age that predispose infants to develop wheezing lower respiratory tract illnesses may help in the preven- tion of this important cause of morbidity during the first year of life." OTHER HEALTH IssuEs [221 "Clinical Ecology," Council on Scientific Affairs, American Medical Association, Journal ofthe American Medical Association 268(24): 3465- 3467, 1992 "Physicians who practice dinical ecology believe that exposure to low levels of environmental substances present in the air or ingested from food and liquids causes in susceptible individuals a variety of ill-defined symptoms affecting nearly every organ system.* 'Most physicians who practice dinical ecology (clinical ecologists) maintain that a number of patients have the multiple chemical sensitivity syndrome (MCSS) ... The lack of a clear definition or diagnostic test for MCSS has made it difficult to estimate its prevalence in the United States." "Clinical ecologists report that significant numbers of people have immune system derangements that increase their sensitivity to low levels of substances in the environment that are innocuous to normal people and are either inhaled or ingested as liquids, foods, or drugs. Exposure to such substances in susceptible individuals is alleged to produce a polysymptomatic disorder that may involve any organ or many organ systems. Predisposing risk factors are said to include infection due to Candida albkans [a fungus], a defi- cient or inadequate diet, and/or food intolerance. The primary complaints of such patients indude allergy-like symptoms, food and chemical intolerance, rhinitis, A-3 difficulty in breathing, depression, headache, fatigue, irritability, insomnia, palpitations, and other cardiovas- cular symptoms." "A subset of MCSS is the Candida hypersensitivity syndrome. Some patients fit the criteria for chronic fatigue syndrome (CFS). Multiple chemical sensitivity is also claimed to be a cause or a contributing factor in the development of a number of recognized diseases and disorders." "Avoidance is a major aspect of therapy; patients are ofien told to ingest a defined or restricted diet or use a rotation diet, to move to another location, to create an environmentally 'safe' room in their home, or in severe cases to be temporarily in special environmental isolation units." "[N]o specific causative agent has been identified for the symptoms occurring in patients with the sick- building syndrome. Symptoms reported in patients with the sick-building syndrome include chest tight- ness, fatigue, headache, malaise, and cough, as well as eye and mucus membrane irritation. The MCSS should not be confused with the sick-building syndrome." "No evidence based on well-controlled clinical trials is available that supports a cause-and-effect relationship between exposure to very low levels of substances and the myriad symptoms purported by clinical ecologists to result from such exposure." "Some patients present to physicians with symptoms that cannot be attributed to any known condition, disorder, or disease. Further, they may have no physical findings or laboratory abnormalities to support a standard diagnosis. The constellation of symptoms presented (eg, depression, fatigue, irritability, difficulty in breathing, headache, gastrointestinal distnss, and food intolerance) resemble those seen in many illnesses." "Based on the reports in the peer-reviewed scientific literature, the Council on Scientific Affairs finds that at this time (1) there are no well-controlled studies establishing a dear mechanism or cause for MCSS; and (2) there are no well-controlled studies providing confirmation of the efficacy of the diagnostic and therapeutic modalities relied on by those who practice dinical ecology."

A-4 "The Council on Scientific Affairs recognizes that the above findings are those existing at one point in time, and welcomes the opportunity to review well-con- trolled studies as they become available. It recommends the following:" "1. That the American Medical Association continue to monitor the published literature on dinical ecology and report on it as appropriate." "2. That those who support a new test, procedure, or treatment must prove by appropriately controlled peer- reviewed trials that it is effective for the purposes for which it is used and that the burden should not be shifted to opponents to prove that a new test or therapy is invalid." ETS ExeosURE AND MoNITORINc [23] "Preliminary Data: Exposure of Persons Aged 24 Years to Tobacco Smoke - United States, 1988-1991,°" Centers for Disease Control, Morbidiry and Mortality Weekly Report42(2): 37-38, 1993 "As part of the Third National Health and Nutrition Examination Survey (NHANES III), CDC's National Center for Environmental Health and National Center for Health Statistics is measuring serum levels of cotinine to assess exposure to tobacco smoke by persons in the United States aged z4 years. This report presents preliminary findings on the first 800 persons in this survey of tobacco-smoke exposure." "NHANES III is being conducted from 1988 through 1994 in 81 counties throughout the United States ... For the two national samples in NHANES III, CDC is measuring serum cotinine levels for approximately 23,000 persons. NHANES III also includes questionnaire data on individual smoking and smokeless tobacco habits, smoking habits of persons in the household, and exposure to tobacco smoke at work" °CDC developed ... [a] method to measure serum cotinine at levels as low as 0.030 nanograms per milliliter (ng/mL). No known substances interfere with the analysis of cotinine using the ... procedure (i.e., the specificity of the analytic procedure for serum cotinine is extremely high). This analytic method ETS/IAQ REPORT, ISSUE 40 allows quantitative measurement of both low levels of tobacco-smoke euposure from environmental tobacco smoke (ETS) and higher levels of acposure from active smoking." "Serum samples have been analyzed for cotinine for 800 persons aged 4-91 years in the NHANES III survey. All (100%) of the 800 persons tested had measurable levels of cotinine in their serum. The frequency distribution of these serum cotinine levels appears bimodal, with one group of persons having cotinine levels greater than 10-15 ng/mL and a second group with levels below 10-15 ng/mL. For the 800 persons tested, serum cotinine levels ranged from 0.030 to 650 ng/mL, a span of more than four orders of magnitude." "Editorial Note: Cotinine in serum results from exposure to nicotine. The most common sources of nicotine exposure are active smoking and exposure to ETS. Appropriate interpretation of serum cotinine levels must also consider other nicotine sources includ- ing nicotine gum, nicotine dermal patches, chewing tobacco, and snuff." "The presence of cotinine in the serum of al1800 persons indicates at least some exposure to nicotine in each of the survey participants. Other investigators have found that levels of serum cotinine greater than approximately 10-15 ng/mL characterize smokers, and serum cotinine levels less than this amount characterize nonsmokers. Serum cotinine levels below 10-15 ng/mL have been attributed to exposure to ETS. Further interpretation of these NHANFS III serum cotinine levels must await analysis of the smoking questionnaire data in the survey." "The new analytic method for measuring serum cotinine and its application in NHANES III affords a rare opportunity to obtain objective estimates of exposure to tobacco smoke in a representative sample of the U.S. population aged 24 years." "CDC is continuing to analyu NHANES III serum samples of cotinine and will publish results of these analyses when the first national probability sample is completed.'°

FEBRUARY 5. 1993 IN EUROPE & AROUND THE WORLD RESPIRATORY DISFASES AND CONDITTONS - CHILDREN [34] "Prevalence of Asthma in Swiss Children," F.H. Sennhauser and B.H. Guentert, Ereropean Respirator yJournal5: Supplement, 1992 "To determine the prevalence of asthma in childhood we performed this first cross sectional survey represen- tative for Switzerland.... The lifetime prevalence of wheeze was 16.5%. The lifetime prevalence of asthma was 6.0%. Only one third of those reporting wheeze also reported a history of asthma." "The prevalence of wheeze and/or asthma in the past 12 months was 9.1 %. Night-time symptoms such as irritant cough, tightness in the chest and wheezing were reportedly significantly more often in households with smokers than in families without smokers. laving in a metropolitan area seems to reflect a risk factor for asthma symptoms at night when compared with families living in the country." [351 "Effect of Age on Urinary Cotinine Level in Young Children," P.N. LeSouef, A.C. Reese, LI. Landau, and I.R. James, European Respira- toryJournal5: Supplement, 1992 "The association between parental history of passive smoking and respiratory illness has been noted to be stronger in infancy than at any other age, suggesting that infants' lungs are more sensitive to tobacco smoke than older individuals. To investigate an alternative hypothesis that the association is due to increased exposure, we studied urinary cotinine levels on 491 children who had been admitted to hospital.... The group of subjects with a diagnosis of bronchiolitis had elevated cotinine levels and were excluded from analysis ... For the remaining 450 subjects, there was a highly significant inverse correlation between age and cotinine levd....[T]here were highly significant associations between cotinine levels and number of cigarettes smoked by mother and father for the 0-2 yr division; most of this effect was related to the mothers' smoking level. In older age division, these associations A-5 were weak or absent. ...[W]e found a strong inverse relation between urinary cotininc and age, and evi- dence of a dose-response relation between quantity smoked and cotinine levd only in the youngest children. These data support the hypothesis that the strong association between parental smoking and respiratory illness in infants is due to increased expo- sure rather than increased lung sensitivity." [36] "Passive Smoking and Childn:n's Diseases," K Pisiewicz and C. Macura, European Respiratory Journal5: Supplement, 1992 "The aim of this study was to compare the prevalence of respiratory tract and allergic diseases and/or their symptoms in children living with smokers and non- smokers in relation to family history." "The analysis of data revealed four different patterns of the impact of passive smoking on the disease. 1) Both positive family history and passive smoking increased the prevalence of the disease. This concerned past bronchitis both in the children themselves and in their siblings, also runny nose - ever and in the last twelve months.... 2) The influence of family history was stronger than that of passive smoking. This was true with allergic conjunctivitis, eczema, laryngitis and asthma. ... 3) Passive smoking resulted in higher prevalence of breathlessness and bronchiolitis only in children with negative family history.... 4) Passive smoking had no influence on the prevalence of wheezing and sinusitis." "Thcprevalence of respiratory diseases in smoking parents was (nonsignificant) higher than in non-smoking parents. Parents with allergic diseases smoke significantly less. Probably the parents suffering from allergic diseases were aware of the potential risk of smoking." [371 "Urinary Cotinine Levels in Primary School Children: Evidence of Exposure to Environmen- tal Tobacco Smoke," E: Dagli, N. Cakan, and A. Araman, European RespiratoryJournal5: Supplement, 1992 "Smoking prevalence and passive exposure to envi- ronmental tobacco smoke (ETS) are estimated to be very high in Turkey. Using a questionnaire, we found out that 75% of the 513 primary school children were exposed to ETS at their homes. We correlated this

A-6 finding with... urinary cotinine measurements ... Mean urinary cotinine concentration of 275 primary school children of nonsmoking families was found to be 237.7 ng/m1t128.4) which was higher than the acceptable nonsmoking, non-exposed level of 100 nglml; which rose to 399.2 ng/m! (±282.2) with only father smoking. If both parents smoked the urinary cotinine concentration of the children were [sic] 484.2 nglml (±210.2). It was conduded that, the dose of nicotine received by Istanbul school children from ETS was estimated to be equivalent to I to 5 cigarettes per day. Our findings both enlighten and constitute yet another example of the passive smoking problem in developing countries, emphasizing the need for urgent action especially in school age groups." [38] "The Prevalence of Inherited and Environmen- tal Factors in Patients with Asthma," R. Lyons, S. Sreenan, C.K Power, and C.M. Burke, Eumpean RespiratoryJournal5: Supplement, 1992 "This study documents the prevalence of potential environmental and heredity risk factors in asthmatic patients." "Those respondents with asthma were significantly more likely to have a mother or sibling with asthma (relative risks 3.09 and 3.12 respectively) or a sibling with eczema (2.45). Familial passive smoking was associated with a relative risk of 1.35. Previous tonsillectomy in asthmatics was associated with a relative risk of 1.7. The risk profile in non asthmatic patients who had never wheezed was similar to asthmatic patients with the addition of a relative risk of 3.24 for paternal asthma and a risk of 1.49 for past smoking status. Those patients who complained of wheeze in the previous year were more likely'to have lived in damp housing - relative risk 3.25. The association of asthma with a family history [of) eczema favours an inherited atopic tendency. The importance of environ- mental factors is emphasized by the association of asthma with damp housing and passive smoking." [39] "Passive Smoking Fxpostre and Urinary Cotinine in Relation to Respiratory Health and Bronchial Responsiveness in Adolesccnts," F Forastiere, N. Agabiti, V. Dell'Orco, R. Pistdli, G.M. Corbo, G. Brancato, R. Pacdfici, P. Zucarro, and CA Perucci, European RerpiratoryJournal5: Supplement, 1992 "We tested whether the association of passive smok- ing with several indexes of respiratory health is high- ETSLIAQ REPORT, ISSUE 40 lighted using a semi-quantitative measure of urinary cotinine.... Urinary cotinine was measured on 600 morning samples.... There were 100 subjects (18.5%) with detectable cotinine. ... Detectable urinary cotinine was associated with 'wheeze with dyspnea' (OR, 2.0; 95% CI, 0.9-4.6), 'wheeze after exercise' (OR, 3.7; 95% CI, 1.4-10.4) and 'physician-diagnosed asthma' (OR 2.3; 95% CI, 0.98-5.4). No association was found between urinary catinine and lung volumes, expiratory flows and bronchial reactivity. Comparable results were found using questionnaire data on passive smoking exposure in the same data-set." "[A) semi-quantitative measure of urinary cotinine does not provide additional information to evidence yielded by questionnaire data. A quantitative measure of urinary cotinine might add futiher insight into the relationship between passive smoking and respiratory health." ETS ExrosURE AND MONITORING [40] "Biological Evidence of Significant Exposure to Tobacco Smoke in Children of Smoking Par- ents," L.M. Galanti and V.M. Godding, Circula- tion 86(4): Supplement, 1992 "Exposure to environmental tobacco smoke is associated with an increased risk of coronary artery disease. To evaluate the importance of household exposure to tobacco smoke in children with smoking parents, urinary cotinine concentration (COTI) was determined in 129 children and their parents.... COTI of children correlated with that of their parents and with the number of cigarettes smoked per day. COTI levels were significantly lower in children with non-smoking parents than in children with smoking parents. This difference was more important in the subgroup of children with chronic respiratory diseases than in healthy subjects, suggesting greater exposure or increased absorption." "Thus, urinary cotinine level is 4 times higher in children with smoking parents than in non-smoking adults. This demonstrates the importance of household passive tobacco smoking in these children."

Remarks by LAUTENBERG (D-NJ) on S. 261 and S. 262 Preventing Our Kids From Inhaling Deadly Smoke (PRO-KIDS) Act of 1993 [CR page S-916, 114 lines] Attributed to LAUTENBERG (D-NJ) By Mr. LAUTENBERG (for himself and Mr. Harkin): S. 261. A bill to protect children from exposure to environmental tobacco smoke in the provision of children's services, and for other purposes; to the Committee on Labor and Human Resources. S. 262. A bill to require the Administrator of the Environmental Protection Agency to promulgate guidelines for instituting a nonsmoking policy in buildings owned or leased by Federal agencies, and for other purposes; to the Committee on Environmental and Public Works. SECONDHAND SMOKE ** Mr. LAUTENBERG. Mr. President, I rise today to introduce two bills to protect Americans against environmental tobacco smoke or secondhand smoke. I am introducing these bills for one simple irrefutable reason; secondhand smoke kills. An EPA report released on January 7, 1993, undeniably confirmed what public health officials have reported for several years, smoking kills those who smoke and those who breathe secondhand smoke. This scientifically peer reviewed report concluded that secondhand smoke was indeed a group A carcinogen, a group that includes toxins such as asbestos, benzene, and arsenic. The evidence is clear that secondhand smoke is taking an enormous toll on the health of Americans, particularly our children. According to the EPA report, 3,000 lung cancer deaths per year among nonsmokers result from exposure to secondhand smoke. Secondhand smoke also causes more than 200,000 lower respiratory tract infections in young children annually, including bronchitis and pneumonia, resulting in 7,500 to 15,000 hospitalizations. Furthermore, secondhand smoke exacerbates asthmatic symptoms in children and is associated with 8,000 to 26,000 new asthma cases in children. In a separate study, the American Heart Association concluded that exposure to secondhand smoke increases the risk of lung cancer, heart disease, and emphysema. They reported that approximately 50 percent of all children are exposed to secondhand smoke. Now that the evidence is in, it is time for the Congress to take action and protect Americans from this deadly substance. In 1990, the Congress passed the Clean Air Act to regulate 189 hazardous air pollutants which were estimated to cause 1,500 deaths per year. Now we must act to regulate an air pollutant which causes at least 3,000 deaths per year. ISSUE 40 APPENDIX B 87805450

The first step we must take is to protect our children, because they are most threatened by secondhand smoke. That is why I am introducing the Preventing Our Kids from Inhaling Deadly Smoke [PRO-KIDS] Act of 1993. PRO- KIDS will protect children from secondhand smoke while they are participating in federally funded children's programs such as Head Start, WIC, Chapter 1, health care, and day care programs. It will require participants in federally funded programs to establish a nonsmoking policy if they provide health services to children under the age of 18 or provide other social services primarily to children under the age of 18, including elementary and secondary education. The legislation I am introducing today to address this threat would require nonsmoking policies that would limit indoor smoking in facilities associated with these federally funded programs to those areas which are not normally used to serve children and which are ventilated separately from these areas. Evidence accumulated by the EPA and other organizations shows that separate ventilation is necessary to prevent secondhand smoke from recirculating through the ventilation system right into the rooms used by the children. In cases where unusual extenuating circumstances prevent total compliance, programs could apply for a partial waiver from this provision if they protect children from exposure to secondhand smoke to the extent possible. This legislation also allows the adoption of the nonsmoking policy to be done through collective bargaining if such an agreement exists. The second piece of legislation that I am introducing today is called PRotecting Our FEderal workers and visitors from Deadly Smoke or PRO-FEDS. This legislation takes an important first step to protect adults from unwanted exposure to secondhand smoke. This legislation expands the nonsmoking policy, that already is in place at the U.S. Department of Health and Human Services and the Environmental Protection Agency, to all buildings owned of leased by agencies of the executive, legislative, and judicial branches of the Federal Government. This would include the White House offices.and the Congress, but not cover Federal buildings which serve primarily as living quarters. This bill also includes a provision that would also allow unions to adopt this requirement through collective bargaining. This legislation also provides an expanded role for the Environmental Protection Agency [EPA] with regard to environmental tobacco smoke. Under this legislation, the EPA will establish guidelines for compliance under this act. This bill also directs the EPA to provide technical assistance to entities which must comply with this act. Under the bill the EPA will conduct an outreach campaign to inform the public about the dangers of environmental tobacco smoke. It also establishes an Environmental Tobacco Smoke Advisory Office within the Office of Radiation and Indoor Air at EPA. With a telephone inquiry hotline, this office will answer inquiries about how to protect people from environmental tobacco smoke. Now that the studies are completed, it is time to take action to protect people from the dangers of secondhand smoke. The Department of Health and Human Services initially banned smoking in all of its buildings because ou 87805452

top health officials understand the danger of environmental tobacco smoke. We've banned smoking on all domestic airplane flights. Children are the most vulnerable members of our society. They depend upon us to protect them and safeguard their health. They are the future of this country. Isn't it time to give our children, especially those who depend on the Federal Government for valuable services like health care and preschool training, the same protection we already afford to airplane travelers and some Federal workers? As a Department of Health and Human Services report notes, "25 years ago, smoking in the workplace and public places was considered a virtual birthright. Today, acceptance of smoking in public places has largely disappeared, replaced by an increasing recognition of the right to breathe air free from the harmful effects of tobacco smoke." We've come a long way, baby. But we still have a way to go. We should prohibit smoking in federally funded institutions which serve children under the age of 18 immediately, so that our children can breath healthy air."We must also expand the smoking ban that already exists at the Department of Health and Human Services and the Environmental Protection Agency to all agencies in the Federal Government. This legislation has been endorsed by the American Heart Association, the American Lung Association, the American Cancer Society, the Association for Respiratory Care, the Association of Maternal and Child Health Programs, the Asthma and Allergy Foundation of America, and the National Coalition for Cancer Research. I ask unanimous consent to have a press release from former EPA Administrator Reilly and a New York Times article entitled "U.S. Ties Secondhand Smoke to Cancer" included in the Record following this statement. I also ask unanimous consent that these bills be printed in full in the Record following this statement. I urge my colleagues to support and cosponsor this legislation. There being no objection, the material was ordered to be printed in the Record, as follows:

Text of Measure -- S. 261 Preventing Our Kids From Inhaling Deadly Smoke (PRO-KIDS) Act of 1993 [CR page S-917, 211 lines] S. 261 Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the "Preventing Our Kids From Inhaling Deadly Smoke (PRO-KIDS) Act of 1993". SEC. 2. FINDINGS. Congress finds that-- (1) environmental tobacco smoke comes from secondhand smoke exhaled by smokers and sidestream smoke emitted from the burning of cigarettes, cigars, and pipes; (2) since citizens of the United States spend up to 90 percent of a day indoors, there is a significant potential for exposure to environmental tobacco smoke from indoor air; (3) exposure to environmental tobacco smoke occurs in schools, public buildings, and other indoor facilities; (4) recent scientific studies have concluded that exposure to environmental tobacco smoke is a cause of lung cancer in healthy nonsmokers and is responsible for acute and chronic respiratory problems and other health impacts in sensitive populations (including children); (5) the health risks posed by environmental tobacco smoke exceed the risks posed by many environmental pollutants regulated by the Environmental Protection Agency; and (6) according to information released by the Environmental Protection Agency, environmental tobacco smoke results in a loss to the economy of over $3,000,000,000 per year. 8780S453

SEC. 3. DEFINITIONS. As used in this Act: (1) Administrator.--The term "Administrator" means the Administrator of the Environmental Protection Agency. (2) Children.--The term "children" means individuals who have not attained the age of 18. (3) Children's services.--The term "children's services" means-- (A)(i) direct health services routinely provided to children; or (ii) any other direct services routinely provided primarily to children, including educational services; and (B) that are funded (in whole or in part) by Federal funds. (4) Secretary.--The term "Secretary" means the Secretary of Health and Human Services. SEC. 4. NONSMOKING POLICY FOR CHILDREN'S SERVICES. (a) Issuance of Guidelines.--Not later than 180 days after the date of enactment of this Act, the Administrator shall issue guidelines for instituting and enforcing a nonsmoking policy at each indoor facility where children's services are provided. (b) Contents of Guidelines.--A nonsmoking policy that meets the requirements of the guidelines shall, at a minimum, prohibit smoking in each portion of an indoor facility where children's services are provided that is not ventilated separately (as defined by the Administrator) from other portions of the facility. SEC. 5. TECHNICAL ASSISTANCE AND OUTREACH ACTIVITIES. (a) Technical Assistance.--The Administrator and the Secretary shall provide technical assistance to persons who provide children's services and other persons who request technical assistance. The technical assistance shall include information-- (1) on smoking cessation programs for employees; and (2) to assist in compliance with the requirements of this Act.

SEC. 6. FEDERALLY FUNDED PROGRAMS. (a) In General.--Notwithstanding any other provision of law, each person who provides children's services shall establish and make a good-faith effort to enforce a nonsmoking policy that meets or exceeds the requirements of subsection (b). (b) Nonsmoking Policy.-- (1) General requirements.--A nonsmoking policy meets the requirements of this subsection if the policy-- (A) is consistent with the guidelines issued under section 4(a); (B) prohibits smoking in each portion of an indoor facility used in connection with the provision of services directly to children; and (C) where appropriate, requires that signs stating that smoking is not permitted be posted in each indoor facility to communicate the policy. (2) Permissible features.--A nonsmoking policy that meets the requirements of this subsection may allow smoking in those portions of the facility-- (A) in which services are not normally provided directly to children; anc (B) that are ventilated separately from those portions of the facility in which services are normally provided directly to children. (c) Waiver.-- (1) In general.--A person described in subsection (a) may publicly petition the head of the Federal agency from which the person receives Federal funds (including financial assistance) for a waiver from any or all of the requirements of subsection (b). (2) Conditions for granting a waiver.--Except as provided in paragraph (3), the head of the Federal agency may grant a waiver only-- (A) after consulting with the Administrator, and receiving the concurrence of the Administrator; (B) after giving an opportunity for public hearing (at the main office of the Federal agency or at any regional office of the agency) and comment; and (C) if the person requesting the waiver provides assurances that are satisfactory to the head of the Federal agency (with the concurrence of the Administrator) that-- (i) unusual extenuating circumstances prevent the person from establishing or enforcing the nonsmoking policy (or a requirement under the policy) referred to in subsection (b) (including a case in which the person shar 8'7805455

space in an indoor facility with another entity and cannot obtain an agreement with the other entity to abide by the nonsmoking policy requirement) and the person will establish and make a good-faith effort to enforce an alternative nonsmoking policy (or alternative requirement under the policy) that will protect children from exposure to environmental tobacco smoke to the maximum extent possible; or (ii) the person requesting the waiver will establish and make a good-faith effort to enforce an alternative nonsmoking policy (or alternative requirement under the policy) that will protect children from exposure to environmental tobacco smoke to the same degree as the policy (or requirement) under subsection (b). (3) Special waiver.-- (A) In general.--On receipt of an application, the head of the Federal agency may grant a special waiver to a person described in subsection (a) who employs individuals who are members of a labor organization and provide children's services pursuant to a collective bargaining agreement that-- (i) took effect before the date of enactment of this Act; and (ii) includes provisions relating to smoking privileges that are in violation of the requirements of this section. (B) Termination of waiver.--A special waiver granted under this paragraph shall terminate on the earlier of-- (i) the first expiration date (after the date of enactment of this Act) of the collective bargaining agreement containing the provisions relating to smoking privileges; or (ii) the date that is 1 year after the date specified in subsection (f). (d) Civil Penalties.-- (1) In general.--(A) Any person subject to the requirements of this section who fails to comply with the requirements shall be liable to the United States for a civil penalty in an amount not to exceed $1,000 for each violation, but in no case shall the amount be in excess of the amount of Federal funds received by the person for the fiscal year in which the violation occurred for the provision of children's services. (B) Each day a violation continues shall constitute a separate violation. (2) Assessment.--A civil penalty for a violatioh of this section shall be assessed by the head of the Federal agency that provided Federal funds (including financial assistance) to the person (or if the head of the Federal agency does not have the authority to issue an order, the appropriate official) by an order made on the record after opportunity for a hearing in accordance with section 554 of title 5, United States Code. Before issuing the order, the head of the Federal agency (or the appropriate official) 87805456 I

shall-- (A) give written notice to the person to be assessed a civil penalty under the order of the proposal to issue the order; and (B) provide the person an opportunity to request, not later than 15 days after the date of receipt of the notice, a hearing on the order. (3) Amount of civil penalty.--In determining the amount of a civil penalty under this subsection, the head of the Federal agency (or the appropriate official) shall take into account-- (A) the nature, circumstances, extent, and gravity of the violation; (B) with respect to the violator, the ability to pay, the effect of the penalty on the ability to continue operation, any prior history of the same kind of violation, the degree of culpability, and a demonstration of willingness to comply with the requirements of this Act; and (C) such other matters as justice may require. (4) Modification.--The head of the Federal agency (or the appropriate official) may compromise, modify, or remit, with or without conditions, any civil penalty that may be imposed under this subsection. The amount of the penalty as finally determined or agreed upon in compromise may be deducted from any sums that the United States owes to the person against whom the penalty is assessed. (5) Petition for review.--A person who has requested a hearing concerning the assessment of a penalty pursuant to paragraph (2) and is aggrieved by an order assessing a civil penalty may file a petition for judicial review of the order with the United States Court of Appeals for the District of Columbia Circuit or for any other circuit in which the person resides or transacts business. The petition may only be filed during the 30-day period beginning on the date of issuance of the order making the assessment. (6) Failure to pay.--If a person fails to pay an assessment of a civil penalty-- (A) after the order making the assessment has become a final order and without filing a petition for judicial review in accordance with paragraph (5); or (B) after a court has entered a final judgment in favor of the head of the Federal agency (or appropriate official), - the Attorney General shall recover the amount assessed (plus interest at currently prevailing rates from the last day of the 30-day period referred to in paragraph (5) or the date of the final judgment, as the case may be) in an action brought in an appropriate district court of the United States. In the action, the validity, amount, and appropriateness of the penalty shall not subject to review. 87805457

(e) Exemption.--This section shall not apply to a person who provides children's services who-- (1) has attained the age of 18; (2) provides children's services-- (A) in a private residence; and (B) only to children who are, by affinity or consanguinity, or by court decree, a grandchild, niece, or nephew of the provider; and (3) is registered and complies with any State requirements that govern the children's services provided. (f) Effective Date.--This section shall take effect on the first day of the first fiscal year beginning after the date of enactment of this Act. SEC. 7. REPORT BY THE ADMINISTRATOR. Not later than 2 years after the date of enactment of this Act, the Administrator shall submit a report to Congress that includes-- (1) information concerning the degree of compliance with this Act; and (2) an assessment of the legal status of smoking in public places. SEC. 8. PREEMPTION. Nothing in this Act is intended to preempt any provision of law of a State or political subdivision of a State that is more restrictive than a provision of this Act.

---------------------------------------- Text Inserted by LAUTENBERG (D-NJ) on S. 261 and S. 262 U.S. Ties Secondhand Smoke to Cancer [CR page S-920, ill lines] Attributed to LAUTENBERG (D-NJ) [From the New York Times, Jan. 8, 1993) U.S. Ties Secondhand Smoke to Cancer (By Warren E. Leary) Washington, January 7.--Secondhand tobacco smoke causes lung cancer that kills an estimated 3,000 nonsmokers a year and subjects hundreds of thousands of children to respiratory disease, the Environmental protection Agency said today in a long-anticipated report. The E.P.A. study, issued after four years and several revisions, should serve as a rallying point for government and private efforts to reduce exposure to environmental tobacco smoke, Federal health officials said. Soon after the report was released, smoking opponents announced several legislative initiatives to place stronger restrictions on smoking in Federal office buildings and other public places. Dr. Louis W. Sullivan, the Health and Human Services Secretary, said the study would be the basis for public health campaigns encouraging nonsmokers to assert their rights to clean air. The tobacco industry continued an attack on the report begun earlier in the week, saying the report was based on inadequate scientific data that was "adjusted to fit policy." The Tobacco Institute called the study "another step in a long process characterized by a preference for political correctness over sound science." "EVIDENCE IS CONCLUSIVE" William K. Reilly, the E.P.A. Administrator, told a news briefing that the report supported a growing scientific consensus that smoking is not just a health risk to smokers but also a significant risk to nonsmokers, particularly spouses and children. "Environmental tobacco smoke, secondhand smoke,-involuntary smoking, passive smoking--whatever you want to call it--has now been shown conclusively to increase the risk of lung cancer in healthy nonsmokers," Mr. Reilly said. "Taken together, the total weight of evidence is conclusive that environmental tobacco smoke increases the risk of lung cancer in nonsmokers." Mr. Reilly said 434,000 people die annually in the United States from g7g05459

diseases caused or aggravated by cigarette smoking, including 140,000 who die from lung cancer. This puts a smoker's risk of developing lung cancer at between 1 in 10 and 1 in 20, compared with a 20-fold lower lung cancer risk for those who have never smoked, he said. The E.P.A. study--which was not based on new research but on previously published studies--concluded that 20 percent of all lung cancers caused by factors other than direct inhalation of cigarette smoke were due to indirect, environmental tobacco smoke. This is a risk of about 1 in 1,000, Mr. Reilly said, higher than that of almost any chemical the agency regulates. INFANTS ESPECIALLY VULNERABLE Higher exposures to secondhand smoke, like that in enclosed homes, small rooms or automobiles, cause higher risks. The spouses of people who smoke at home face a high lung cancer risk of about 2 in 1,000, Mr. Reilly said. Health officials said the danger to infants and children were particularly alarming. These were among the report's findings on the effects of secondhand smoke on children: It increases the frequency and severity of symptoms in 200,000 to 1 million children with asthma and also increases the risk of developing asthma. It causes 150,000 to 300,000 cases of respiratory infections like bronchitis and pneumonia each year in children up to 18 months of age. It also causes fluid buildup in the middle ear, a condition that can lead to ear infections common in children. "It is time for Americans who smoke to make the choice to stop," said Dr. Sullivan, who attended the E.P.A news briefing. "And, in particular, it is irresponsible for smokers to expose young children to the health consequences of the addiction. MORE SMOKING BANS Dr. Sullivan, noting that 26 percent of American adults still smoke, said his department's Center for Disease Control and Prevention would use the report's findings to begin a public information campaign on the dangers of environmental smoke. The "Secondhand Smoke: We're All At Risk" campaign of television and radio commercials and print advertisements will focus on informing about hazards and "stirring people to action," he said. Citing the E.P.A. report, Senator Frank R. Lautenberg of New Jersey and Representative Richard J. Durbin of Illinois announced that they would introduce legislation in both chambers of Congress to ban smoking in all Federal office buildings and in almost all indoor places providing federally 8'7805460 I

financed children's services. The two Democratic legislators, who wrote the bill imposing the 1989 smoking ban on domestic airline flights, said in a statement that the new measure would "protect children from the harmful but invisible threat of environment tobacco smoke." The New York State Health Commissioner, Dr. Mark Chassin, noting that the E.P.A. report now formally classifies environmental smoke as a Group A carcinogen like benzene and asbestos, said Gov. Mario M. Cuomo would submit legislation to ban smoking from all school grounds. He said the proposal would also seek to toughen smoking restrictions in public places and restrict tobacco advertising. "This report should also help convince parents to stop exposing their children to harmful effects of tobacco smoke," Dr. Chassin said. IMPACT ON LIABILITY SUITS The Coalition on Smoking or Health, representing the American Lung Association, the American Heart Association and the American Cancer Society, called on President Bush to heed the E.P.A. report's conclusions and issue an executive order prohibiting smoking in all Federal buildings. Currently, agencies can set their own smoking policies. Richard A. Daynard, a law professor at Northeastern University in Boston who directs the Tobacco Products Liability Project, said the report is "extremely important" for legal action against the tobacco industry. "This basically marks the end of any debate about whether environmental tobacco smoke causes serious, fatal disease among nonsmokers," Mr. Daynard said in a telephone interview. But Brennan Dawson of the Tobacco Institute, an industry trade group that strongly criticized the report, said the majority of studies cited by the E.P.A. do not establish that environmental smoke directly causes any diseases. "And to prove liability, you have to prove causation," she said.

---------------------------------------- Text Inserted by LAUTENBERG (D-NJ) on S. 261 and S. 262 A Dying Smoker's Tale [CR page S-920, 31 lines] A Dying Smoker's Tale Belleville, IL, January 7.--A dying lung-cancer patient who is suing a tobacco company testified today that he began smoking in the fifth grade and continued for most of his life despite health warnings. The 51-year-old plaintiff, Charles Kueper, recalled that he had understood the dangers of smoking "to the point it stunted your growth, was harder to breathe." Mr. Kueper, a retired Army master sergeant and truck driver, is suing the R. J. Reynolds Tobacco Company and the Tobacco Institute, which represents the industry, for unspecified damages in St. Clair County Circuit Court here. He claims the defendants concealed the dangers of smoking through misleading advertising. Mr. Kueper testified that he was already smoking as much as two packs of Winston cigarettes a day when, at the age of 18, he joined the Army in 1959. He did not quit, he said, until late 1990, when doctors told him not to smoke around his wife, who was recovering from surgery. A few months later, in March 1991, he was found to have cancer. Under questioning by his lawyer, Bruce Cook, Mr. Kueper said cigarettes had been an integral part of his life. In 1981, a doctor told him to quit smoking, he said, adding, 'I guess he didn't like what he was hearing" through a stethoscope. Still, the witness testified, he kept smoking. Mr. Kueper, who has said that his doctor does not expect him to live past spring, told the court he had been aware of warning labels on cigarette packs as early as the 1960's but had paid little heed. He said that he had tried to quit smoking several times but that "it's not that easy to quit." The longer he went without a cigarette, he said, "the worse it got."

Text Inserted by LAUTENBERG (D-NJ) on S. 261 and S. 262 EPA Designates Passive Smoking a "Class A" or Known Human Carcinogen [CR page S-921, 93 lines] EPA Designates Passive Smoking a "Class A" or Known Human Carcinogen EPA Administrator William K. Reilly today announced the final conclusions of EPA's assessment on the respiratory health effects of passive smoking. The assessment concludes that Environmental Tobacco Smoke (ETS], also known as secondhand smoke, is a human lung carcinogen, responsible for approximately 3,000 lung cancer deaths annually among U.S. non-smokers. It also concludes that passive smoking results in serious respiratory problems for infants and young children. Announcing the release of the study today in a joint Washington press conference with Dr. Louis Sullivan, Secretary of the U.S. Department of Health and Human Services, Reilly said, "Today's risk assessment adds new peer-reviewed evidence to the growing scientific consensus that smoking is not just a health danger for smokers, but a significant risk for non-smokers, particularly children who are exposed to secondhand smoke. this report will be an invaluable scientific tool for policymakers and health professionals who are wrestling with the problem of exposure to passive smoke. EPA will work closely with the Department of Health and Human Services and other organizations to ensure that officials around the world are made aware of ti. findings of this important study." Tobacco smoke has long been recognized as a major cause of death and disease, especially lung cancer and chronic respiratory disease in smokers. In recent years there has been concern that non-smokers may also be at increased risk as a result of their exposure to the smoke exhaled by smokers and given off by the burning end of cigarettes, pipes or cigars. This smoke contains more than 4,000 substances, at least 43 of which cause cancer in humans or animals and many of which are strong eye or respiratory irritants. The lung cancer findings in EPA's assessment are based on several important analytical findings: first, the chemical and physical similarity of ETS to that inhaled by smokers; second, the known lung carcinogenicity of tobacco smoke to smokers:; third, the known exposure of ETS and uptake by the human body; and fourth, a thorough and comprehensive review of more than 30 studies in both the United States and abroad that examined the relationship between lung cancer and exposure to secondhand smoke in people who never smoked, usually the spouses of smokers. EPA concluded from the total "weight of evidence" of all the studies that ETS increases the risk of lung cancer in non-smokers. The report also cites some of the specific effects of passive smoking on children. The report's conclusions on childhood respiratory health are based on more than 100 studies in children documenting the fact that secondhand smoke is a problem for young children and infants. Some of the effects cite% 87805463 I

ETS exposure causes additional episodes and increased severity of symptoms in asthmatic children. The report estimates that 200,000 to 1 million asthmatics have their condition worsened by exposure to ETS. ETS exposure is a risk factor for new cases of asthma in children who have not previously displayed symptoms. -ETS exposure causes an increased risk of lower respiratory tract infections such as bronchitis and pneumonia in infants and young children. The report estimates that exposure to parents' secondhand smoke will lead to 150,000 to 300,000 cases annually in children up to 18 months old. ETS exposure causes an increased prevalence of fluid in the middle ear, symptoms of upper respiratory tract irritation and a small yet significant reduction in lung function. Following a second review in the summer of 1992, EPA's Science Advisory Board (SAB), fully endorsed the risk assessment, including the conclusions that ETS should be classified as a known human carcinogen (officially called an EPA Group A carcinogen, the Agency's category of greatest scientific certainty for known or suspected carcinogens). The SAB also endorsed findings on other respiratory effects. The SAB suggested relatively minor revisions in its November 1992 letter to the Agency. Those revisions have been made. The SAB is EPA's independent panel of outside scientific advisors that routinely reviews draft EPA reports. EPA also received and reviewed more than 100 comments from the public and integrated appropriate ones into the final risk assessment. EPA has no authority to regulate any type of smoking, nor is EPA's report binding on the policy or regulatory program of any other federal, state or local government agency or any private organization. In cooperation with other government agencies, EPA will carry out an education and outreach program over the next two years to inform the public and policymakers about what they can do to reduce the health risks of ETS as well as other indoor air pollutants. This 530-page report, which has been in development since 1988, has been through extensive review and revisions. It was prepared under authority of Title IV of Superfund (The Radon Gas and Indoor Air Quality Research Act of 1986), which directs EPA to conduct a research and information dissemination program on all aspects of indoor air quality. Today's final report, prepared by the Office of Health and Environmental Assessment in EPA's Office of Research and Development, with major support from the Indoor Air Division of EPA's Office of Air and Radiation, was released in draft to the general public for review and comment in June 1990 and subsequently reviewed by EPA's SAB in December 1990. Copies of the final report "Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders", (EPA/600/6-90/006F) will be available in about three weeks by writing CERI, U.S. EPA, 26 W. Martin Luther King Drive, 87805464

Cincinnati, Ohio 45268; or phoning 513-569-7562 or faxing requests to 513- 569-7566. The report will also be available through the EPA Indoor Air Quality Information Clearinghouse (IAQ INFO) at 1-800-438-4318. Copies will be available for inspection at EPA Headquarters and EPA Regional Office libraries and the Federal Depository Libraries.** ------------------------------------------------------------------------------ 10682052

Text of Measure -- S. 262 Preventing our Federal Building Workers and Visitors From Exposure to Deadly Smoke (PRO-FEDS) Act of 1993 [CR page 5-919, 220 lines] S. 262 Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the "Preventing Our Federal Building Workers and Visitors From Exposure to Deadly Smoke (PRO-FEDS) Act of 1993". SEC. 2. FINDINGS. Congress finds that-- (1) environmental tobacco smoke comes from secondhand smoke exhaled by smokers and sidestream smoke emitted from the burning of cigarettes, cigars, and pipes; (2) since citizens of the United States spend up to 90 percent of a day indoors, there is a significant potential for exposure to environmental tobacco smoke from indoor air; (3) exposure to environmental tobacco smoke occurs in schools, public buildings, and other indoor facilities; (4) recent scientific studies have concluded that exposure to environmental tobacco smoke is a cause of lung cancer in healthy nonsmokers and is responsible for acute and chronic respiratory problems and other health impacts in sensitive populations (including children); (5) the health risks posed by environmental tobacco smoke exceed the risks posed by many environmental pollutants regulated by the Environmental Protection Agency; and (6) according to information released by the Environmental Protection Agency, environmental tobacco smoke results in a loss to the economy of over $3,000,000,000 per year. 878v5466

SEC. 3. DEFINITIONS. As used in this Act: '(1) Administrator.--The term "Administrator" means the Administrator of the Environmental Protection Agency. (2) Executive agency.--The term "Executive agency" has the meaning provided in section 105 of title 5, United States Code. (3) Federal agency.--The term "Federal agency" includes any Executive agency, the Executive Office of the President, any military department, any court of the United States, the Administrative Office of the United States Courts, the Library of Congress, the Botanic Garden, the Government Printing Office, the Congressional Budget Office, the United States Postal Service, the Postal Rate Commission, the Office of the Architect of the Capitol, the Office of Technology Assessment, and any other agency of the executive, legislative, and judicial branches. (4) Federal building.--The term "Federal building" means any building or other structure owned or leased for use by a Federal agency, except that the term shall not include any area of a building that is used primarily as living quarters. (5) Secretary.--The term "Secretary" means the Secretary of Health and Human Services. SEC. 4. NONSMOKING POLICY FOR FEDERAL BUILDINGS. (a) In General.-- (1) Issuance of guidelines.--Not later than 180 days after the date of enactment of this Act, the Administrator shall issue guidelines for instituting and enforcing a nonsmoking policy at each Federal agency. (2) Contents of guidelines.--A nonsmoking policy that meets the requirements of the guidelines shall, at a minimum, prohibit smoking in each indoor portion of a Federal building that is not ventilated separately (as defined by the Administrator) from other portions of the facility. (b) Adoption of Guidelines.-- (1) In general.--As soon as is practicable after the date of issuance of the guidelines referred to in subsection (a), the head of each Executive agency, and the Director of the Administrative Office of the United States Courts shall adopt a nonsmoking policy applicable to the Federal agency under the jurisdiction of the individual that meets the requirements of the guidelines referred to in subsection (a), and take such action as is necessary to ensure that the policy is carried out in the manner specified -.1 g*7gO546'7

the guidelines. (2) Legislative branch.--As soon as is practicable after the date of issuance of the guidelines referred to in subsection (a), the following entities and individuals shall adopt a nonsmoking policy that meets the requirements of the guidelines referred to in subsection (a), and take such action as is necessary to ensure that the policy is carried out in the manner specified in the guidelines: (A) With respect to the House of Representatives (including any office space or buildings of the House of Representatives), the House Office Building Commission. (B) With respect to the Senate (including any office space or buildings of the Senate), the Committee on Rules and Administration of the Senate. (C) With respect to any other area occupied or used by a Federal agency of the legislative branch, the Architect of the Capitol. (3) Certification for executive agencies.--The Administrator of General Services, in consultation with the Administrator, shall review each nonsmoking policy adopted by the head of an Executive agency and shall certify those policies that meet the requirements of the guidelines referred to in subsection (a). In carrying out the certification, the Administrator of General Services shall use a procedure and apply criteria that the Administrator shall establish. Except as provided in subsection (c), if a policy does not meet the requirements of the guidelines, the Administrator of General Services shall-- (A) in a written communication, advise the head of the Executive agency concerning modifications of the policy to meet the requirements; and (B) publish the communication in the Federal Register. (c) Waivers.-- (1) Executive agencies.--The head of an Executive agency may publicly petition the Administrator of General Services for a waiver from instituting or enforcing a nonsmoking policy (or policy requirement) under the guidelines issued pursuant to subsection (a). The Administrator of General Services may waive the requirement if, after consultation with the Administrator, the Administrator of General Services determines that-- (A) unusual extenuating circumstances prevent the head of the Federal agency from enforcing the policy (or a requirement under the policy) (including a case in which the Federal agency shares space in an indoor facility with a non-Federal entity and cannot obtain an agreement with the other entity to abide by the nonsmoking policy requirement) and the head of the Executive agency will establish and make a good-faith effort to enforce an alternative nonsmoking policy (or alternative requirement under the policy) that will protect individuals from exposure to environmental tobacco smoke to the maximum extent possible; or 87805468

(B) the head of the Executive agency will enforce an alternative nonsmoking policy (or alternative requirement under the policy) that will protect individuals from exposure to environmental tobacco smoke to the same degree as the requirement under the guidelines issued pursuant to subsection (a). ,(2) Agencies of the judicial branch.--After consultation with the Administrator, and after providing public notice and reasonable opportunity for public review and comment, the Director of the Administrative Office of the United States Courts may, on the basis of the criteria for a waiver referred to in paragraph (1), make such modifications to the nonsmoking policy required to be carried out pursuant to subsection (b) as the Director determines to be necessary. The Director may not make any modification that violates the criteria for a waiver under paragraph (1). (3) Agencies of the legislative branch.--After consultation with the Administrator, and after providing public notice and reasonable opportunity for public review and comment, the appropriate entity or individual referred to in subparagraphs (A) through (C) of subsection (b)(2) may, on the basis of the criteria for a waiver referred to in paragraph (1), make such modifications to the nonsmoking policy required to be carried out pursuant to subsection (b) as the entity or individual determines to be necessary. The entity or individual may not make any modification that violates the criteria for a waiver under paragraph (1). (d) Collective Bargaining Agreements.-- (1) In general.--In a Federal agency in which a labor organization has been accorded recognition as a bargaining unit pursuant to chapter 71 of title 5, United States Code, the Federal agency shall engage in collective bargaining pursuant to section 7114 of title 5, United States Code, to ensure the implementation of the requirements of this section that affect work areas predominately occupied by the employees represented by the labor organization by the date of the adoption, pursuant to this section, of a nonsmoking policy applicable to the Federal agency. (2) Exemption.-- (A) In general.--If, on the date of enactment of this Act-- (i) a bargaining unit referred to in paragraph (1) has in effect a collective bargaining agreement with respect to which a Federal agency is a party; and (ii) the collective bargaining agreement referred to in clause (i) includes provisions relating to smoking privileges that are in violation of the requirements of this section, the head of the Federal agency may exempt work areas predominately occupied by the employees subject to the collective bargaining agreement from the nonsmoking policy that the Federal agency is required to be carried out unu 87805469

subsection (b) . (B) Termination of exemption.-- (i) In general.--An exemption referred to in subparagraph (A) shall terminate on the earlier of-- (I) the first expiration date (after the date of enactment of this Act) of the collecting bargaining agreement containing the provisions relating to smoking privileges; or (II) the date that is 1 year after the date of issuance of the guidelines. (ii) Implementation of nonsmoking policy after termination date.-- By the applicable date specified in clause (i)(II), the head of each Federal agency shall be required to enforce a nonsmoking policy that meets the requirements of the guidelines issued under subsection (a) in each work area under the jurisdiction of the head of the Federal agency, notwithstanding any collective bargaining agreement that contains provisions that are less restrictive than the nonsmoking policy. SEC. 5. TECHNICAL ASSISTANCE AND OUTREACH ACTIVITIES. (a) Technical Assistance.--The Administrator and the Secretary shall provide technical assistance to the heads of Federal agencies and other persons who request technical assistance. The technical assistance shall include information-- (1) on smoking cessation programs for employees; and (2) to assist in compliance with the requirements of this Act. (b) Outreach Activities.-- (1) In general.--The Administrator, in consultation with the Secretary, shall establish an outreach program to inform the public concerning the dangers of environmental tobacco smoke. As part of the outreach program, the Administrator and the Secretary shall make available to the general public brochures and other educational materials. In establishing the programs under this paragraph, the Administrator and the Secretary shall cooperate to maximize the sharing of information and resources. (2) Environmental tobacco smoke advisory office.-- (A) In general.--The Administrator shall establish within the Office of Radiation and Indoor Air of the Environmental Protection Agency an office, to be known as the "Environmental Tobacco Smoke Advisory Office". The Administrator shall appoint a Director to carry out the functions of the office. 8'78054'70

(B) Duties of the director.--The Director shall-- (i) provide information on smoking cessation; (ii) provide information to assist in compliance with the requirements of this Act; (iii) provide information on the dangers of environmental tobacco smoke to any person who requests the information; (iv) establish a telephone hotline to provide information on the dangers of environmental tobacco smoke; and (v) carry out any other function of the Office that the Administrator determines to be appropriate. SEC. 6. REPORT BY THE ADMINISTRATOR. Not later than 2 years after the date of enactment of this Act, the Administrator shall submit a report to Congress that includes-- (1) information concerning the degree of compliance with this Act; and (2) an assessment of the legal status of smoking in public places. SEC. 7. PREEMPTION. Nothing in this Act is intended to preempt any provision of law of a State or political subdivision of a State that is more restrictive than a provision of this Act.

PR Newswire, January 22, 1993 The full resolution follows: RESOLUTION BEFORE THE BOMA BOARD OF GOVERNORS JAN. 17, 1993 TUCSON, ARIZ. Whereas indoor air quality has been the focus of increased media, legislative and regulatory attention for the past several years, with expectations that the intensity of that attention will significantly increase in the months and years ahead. Whereas indoor air quality, as a market place demand within the commercial real estate industry, requires no regulation, but requires much information to address this situation effectively and efficiently. Whereas BOMA members have long pushed for further research on the sources and causes of indoor air quality problems, and we are adamant about the need for good guidance. We have worked with industry groups, environmental organizations and government officials in coordinating our efforts. We have also demonstrated a strong campaign to develop and distribute sound guidance information to prepare and improve the indoor air quality management programs in the commercial property arena. " Whereas many legislative and regulatory efforts are underway to dilute or redistribute the sources of indoor air contaminants. Whereas BOMA firmly believes that the most effective course of action is to prevent contaminants from being introduced to the workplace in the first place. Whereas tobacco smoke has been identified as a leading cause of indoor air contamination and has generated a great deal of concern within the medical/health coaaaunity. Whereas in light of the EPA's recent classification of second- hand tobacco smoke as a "Class A" carcinogen, BOMA is even more concerned with the consequences to the health and well-being of office tenants, their employees and guests who are exposed to second- hand tobacco smoke in the workplace. Be It Therefore Resolved that BOMA would support a federal ban on smoking in the workplace as part of an overall effort to improve the indoor environment. We do, however, have several concerns with a federal ban -- first and foremost among them is that the enforcement of any ban should not be the responsibility of the nation's building owners and managers. The second concern is that any liability incurred must not apply to the owners and managers of commercial, rentable real estate when smoking does occur after a ban is imposed. CONTACT: Henry Chamberlain or Jeanie Markel of the Building Owners and Managers Association International, 202-408-2686 ORGANIZATION: Building Owners and Managers Association International GEOGRAPHIC: District of Columbia - ORG: BUILDING OWNERS & MANAiC'sERS ASSOCIATION INTERNATIONAL; ISSUE 40 APPENDIX C ~.EXIS~NEXIS®= ~= = LFXIS ~ NEXIS®11 LI=XISon NEXIS®=- = Services of Mead Data Central, Ina

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aaaSory a+d qKhadCmnlM Do we have a Mght to smoke? Over the last decade, there has been a move away from the idea of smoking as a right, to a belief that people have a right to enjoy a smoke- free environment Many people are already concerned about the consequences of passive smoking: recent surveys have shown that over two-thirds of the population believe that living or working with a heavy smoker is 'risky' or 'very risky'. A similar proportion said they were bothered either 'sometimes' or'oRen' by other people's tobacco smoke. Most people now support the introduction of restrictions both on smoking in public places such as cinemas and shops and on public transport. Smrrr hny, six,M AhMRkt - thc cgh/h rcW I491. Ji,MY SV9Mw7 Events There will be a programme of special events on the theme of passive smoking and health in the Museum on National No Smoking Day, 10 March 1993. Further Reading A reading list is available from the information desk in the East Hall. This series of exhibitions is sponsored by Nuclear Electric plc ® Nuclear Electric Science . A series of exhibitions on contemporary science S lt111Nee MYltYM LONDON li yV,il SMOKING MAY P1~~~ DAMP"...= YOUR HEALTH >r•~ - .±;.,... PASSIVE SMOKIN( A new exhibition at thi Science Museurt from 14 )anuary to 14 March 1993 VISITOI INFORMATIO

What is passive smoking? Passive smok ng is the breathing in of Dther people's tobacco smoke Over the last ten years, scientists have carned out many studies that have shown that passive smok ng can cause ill health. How do scientists study the effects of passive smoking? Evidence that passive smoking can affect health has r f~: come from large-scale surveys of non-smokers who are exposed to tobacco smoke and non-smokers who generally are not. Many studies of this sort have been • carned out. While not all of them have shown that [ passive smoking is dangerous, most support the view that passive smoking does increase the nsk of a variety of health problems. These include bronthitis,'glue ear in children, and lung cancer. Passive,smoking can also aggravate respiratory d seases, such as asthma. What Is in tobacco smoke? There are two types of smoke released by a burning cigarette. Mainstream smoke is breathed in and then exhaled by the smoker. Sidestrearn smoke is l n ht th d t i to re ra~ ease s e g air from the burning tip of the c garette. On average, only about 15% of the smoke released is inhaled by the smoker the rest is sidestream smoke. There are over 4000 chemical const tuents in tobacco smoke, many of them poisonous. Forty-three of them are carcinogens - chemicals that cause cancer by making cells grow out of control. Sidestream smoke contains different proportions of chemicals and is more dangerous to health than mainstream smoke. Scientists have shown that passive smokers do absorb chemicals from tobacco smoke. Cotinine is formed by the bady from nicotine, which is found in tobacco smoke. By measuring the levels of cot n ne in the unne of passive smokers, scientists have estimated that people who work in smoke-filled offices 'passively smoke' the equ valent of three to four cigarettes a week. Why is passive smoking bad for us? Many of the chemicals in cigarette smoke are dangerous to the body. As well as carcinogens. there are other chemicals which may cause or make worse respiratory diseases and imtate the linings of the nose, throat and lungs. A major component of s destream tobacco smoke is carbon monoxide, which stops the body using oxygen efficiently. By affecting the blood, tobacco smoke can cause problems with circulation. Scientists have shown that passive smoking increases the risk of some illnesses, including glue ear, but they are not sure why it has this effect. How can we reduce the risk from passive smokingt The Fourth Report of the Independent Scientif c Comm ttee on Smok ng and Health considered a number of measures to reduce the risk to health from tobacco smoke and passive smok ng. These included a reduction in the amounts of tar and nicotine in cigarettes. and in the amount of carbon monoxide given off by each cigarette. However the Report noted that previous attempts to reduce tar and n cotme yield had not affected sidestream smoke. In order to reduce the risk to passive smokers, the Report recommended that ways be considered to limit smoking in public and in enclosed spaces. In Britain most public transport and many public buildings have rules to restnct smoking. Other countnes have introduced more stringent laws prohibiting smoking in public places. Many institutions. includ ng the Sc ence Museum, have banned smoking in the r offices because of the risk to worke-s' health. 944fiS0848

What is passive smoking? Passive smoking is breathing in other people's tobacco smoke. Other people's tobacco smoke is sometimes called environmental tobacco smoke. Why should I he worried? Only 15 per cent of the smoke from a cigarette is inhaled by the smoker - the rest goes into the surrounding air and other people can breathe it in. Breathing air which contains tobacco smoke can be bad for your health. This is because the tiny particles and gases in tobacco smoke contain over 4000 chemicals, many of which are harmful - at least 60 are known to cause cancer. The gases also include carbon monoxide, the poisonous gas that comes out of car exhausts. I ? What is the ettect on my health? A Breathing other people's smoke is uncomfortable and can cause x nose, Ihroat N chest h"atlon X a runny noae and breatldng dlftlcultles x headaches x coughing x diuiness x sneang x nansea and lack ol x red and runnhig eyes concentratlon. If you have a long-term health problem, such as asthma, chronic bronchitis or certain allergies, passive smoking can make it worse. Doctors now say that passive smoking causes serious and sometimes fatal illnesses. The UK Government's Independent i 4 rrrrer. .MaMw IrM f,WA What's in cigarette smoke? Carbon monoxide - the same gas that comes out of car exhausts - is the main gas in cigarette smoke. The smoke also contains over 4000 other chemicals. Some of these have links with cancer in humans - begins: etc. The complete list chloride, cadmium, formaldehyd arsenic, benzene, chromium, nickel, vinyl carbon monoxide, nicotine, nitrogen oxides, 2-nitropropane, hydrogen cyanide, ammonia, dimethyl- amine, 2.5-dimethylamine, ethylamine, methyl- amirre, methylpyrazines, 2-,3-, and 4-methylpyr- idines, 1-methylpyrrolidine, pyridine, pyrrolidine, rrim,*t1..IOmIRa 11trIfM-IIRP erProl- APF.V'lo *.-PtnnP Scientific Committee on Smoking and Health has estimated that several hundred non-smokers die each year from lung cancer caused by passive smoking. The risk of lung cancer from passive smoking is small, but some 50 to 100 times greater than the risk of lung cancer from exposure to asbestos. Also, passive smoking may be linked to heart disease and death from heart attack. 0

What's the effect on children's health? Babies and children who cannot avoid smoke where they live and play are at particular risk. Babies of smokers are much more likely to be taken to hospital with chest trouble in their first year of life than non-smokers' children. Children with a parent who smokes have more chest, ear, nose and throat infections than non-smokers' children. And the more cigarettes smoked at home, the greater the risk to the child. Children exposed to smoke are more likely to develop breathing problems as adults. Unhorn babies are also at risk hm passive sarokhtg. The risk to unborn babies of pregnant women who smoke has been known for many years, but it now seems that unborn babies of pregnant non-smoking women are also at risk if the women are exposed to passive smoking. Women who have been regularly exposed to passive smoking during pregnancy tend to have smaller babies. Being small at birth makes it harder for the baby to make a good start in life. O If you are pregnanl do nel smoNe. 'J Avoid smoky places. 0 Family and iMends should avoid smoking In (ront ol chUdren and pregnant women. Ask yoar gnesta nol to smoMe. 4 t What can I do to clear the air? The trouble with tobacco smoke is that it gets everywhere. Separating smokers and non-smokers in the same room may reduce the level of smoke in the non-smoking area, but this is not enough. Air filters, ventilators or extraction systems may reduce, but do not prevent, ~ .00 exposure to other people's smoke. We must make sure that non-smokers do not have to live or work in smoky conditions by ensuring that all enclosed public places are smoke-free. Where appropriate, separate rooms should be provided for smoking. a------_ ~ MON -- ~~~ ~ _- rW"Mr.rr.". Although many countries in Europe and elsewhere now have laws to ensure that smoking is restricted in public places, the British Government has taken a different approach so far. It encourages restrictions on smoking in public places. But in practice it is TAE PERMA6E OF sAM-FBEf PUBLIC PlACE3 YVORI.OWIUE Khools `COUpes 33!c phcet N enMrmW 33% IqM slnc~es 40% paEac phpt erV80X 4/ NIpMM """Mt Eq mainly left to employers and those who control public buildings and transport to decide whether or not smoking should be restricted.

What can I do about smoking at work? It's at work that most adults will have problems with passive smoking. However, many employers now have policies which guarantee smoke-free working areas. Your legal Mghls The Health and Safety at Work etc Act 1974 makes it the employer's duty to ensure that the working environment is safe. Legally, employers are also under a general obligation to warn employees about dangerous conditions at work and to safeguard Nealrhe~ qct refY ar Wor MApb /qy(.h ~974 ~f Nrpy~ erYrlAq ,TRJr u/Rery RK•s M°„i~i/y, I q'~ R l~tl pk.R„rM ~4.ry~~ ~r~+rll,wr'a ~~' I'rsNh. ,•OYuuxnp, 'nd „,• MMn~ +, •ry rn ~ ~~rnnR ~p Ic nf ~en~ pr d.n /awlol •~O R0 ru^k. "•^'Ix./nnr ~nw, w.n„ll~,ylnWRli~ R~a/ny/ F~1'~I ~IryM"~ ~~h •k~'kndl At ` ~^; 'e ro, their welfare. Non-smokers may be able to sue their employers if they suffer health damage from passive smoking at work. This could include health damage to the unborn children of employees. Industrial tribunals may also offer some protection. Workplace Action Checklist Smokers should keep their smoke away from other people, but non-smokers can take action, too. r If you are an employer, make a healthier workplace and safeguard your legal position. Every company should have a smoke-free working policy. V If you are an employee, talk to your employer and union about passive smoking worries and your desire for a safer workplace. e - 64VS0844g 0 . V If no action is taken and tobacco smoke is polluting your workplace, contact the Environmental Health Department or Health and Safety Inspectorate who can order your employer to remove the pollution or stop work in that area. V If you think your health has been damaged because your employer is not fulfilling his or her duty, contact your union or a lawyer for advice. V If you leave your job because of a smoking problem, you may be able to take your case to an industrial tribunal. Seek legal advice for leaving a job because of a passive smoking problem.. What about smoke in public places? Many places have separate areas for people who wish to smoke. Where smoking policies have been introduced, they have proved very popular with non-smokers and smokers alike. This applies to schools, hospitals, restaurants, buses, cinemas, pubs and many other places where people spend time and may have to put up with a smoky atmosphere. If you're a consumer of any of these services, find out who's in charge and ask them to provide smoke-free areas. If you're a manager who provides a service to the public, introduce a policy which provides smoke-free accommodation - if you have not already done so. Passive smoking is not only unpleasant for most people, it's also a health hazard. Who can help? Contact any of the organisations listed overleaf. They can provide ? information and support. 7 Thb IaINt wn pro0und a a eowboritWb vnntun bT IM UK Mom ffilatlon PiAlatloM Ferom: AfM Actlon en tmoldq rid Nolth SrI W h hUacal Atsodatlon INahh Eftatlba AutlaNty Ikaltli Umtloe Baar1 for Scetlm0 TM Ik.nh Premotloe AomeT lar northern b•elme IIIMIh N'EIII00pb Aplhqily rOP wiltr ouiT

Thcsc cxrganisalions can proviae lurther information: \SII :1ci-u ..u Sun•L-_ and Ilk:'i1h 5-I I Mortimer Street London W I N 7R H Tel: 071-935 3519 Fax: 071-935 3463 ASH Northern Ireland The Ulster Cancer Foundation 40-44 Eglantine Avenue Belfast BT9 6DX Tel: 0232 663281 Fax: 0232 660081 ASH Scottand 8 Frederick Street Edinburgh EH2 2H8 Tel: 031-225 4723 Fax: 031-220 6604 ASH Wale. 142 Whitchurch Road Cardiff CF4 3NA Tel: 0222 614399 Fax:U222 619288 QUIT 102 Gloucester Place London W I H 3DA Tel: 071-487 2858 Fax: 071-935 2650 O Heahh Educat~ion Authoriwy 1991 11581. 185448 290 4 Primed in England 250M 5N2 Il..rlll~ IiJu..~unu 1uUnniu Hamilton House Mabledon Place London WC I H 9TX Tel: 071-383 3833 Fax: 071-387 0550 HerlthEdu.•xrii+n Iioard Inr Scotland. Woodburn House Canaan Lane Edinburgh E10 4SG Tel: 0314-t7 8044 Fax: 031-452 8140 Tht Hralth Prnnxm Uan :#ga•n.. fm \ur~ha•rn lrcland 18 Ormeau Avenue Bclfast BT2 SHS Tel: 0232 311611 Fax: 0232 311711 Flealtli.Pr..mnuan Auth„nt. Im 11'alc. Brunel House 2 Fitzalan Road Cardiff CF2 1 EB Tel: 0222 472472 Fax: 0222 480851 For locadinlorma.non Environmental Health Departments- look in the telephone book under your local District or Borough Council- The Health and Safcty Execvtivo- hued in the telephone book under Health and Safen•. Health Eduptlon or Health Promotion Units- listed in the telephone book under local health authority in,En8land and Vc•a1es; health board in 5cotland and health and personal social senices in Konhem Ireland. ISSttt

Press Notice embargoed until 00.01 Thursday 14 January PASSIVE SMOKING OPENS AT THE SCIENCE MUSEUM . It is estimated that every year about 300 people in the UK die from lung cancer caused by passive smoking. Despite such apparently clear facts, passive smoking is still a controversial topic. Scientific evidence is used to support and deny allegations that passive smoking is harmful to humans. There is much debate about whether or not smokers should be forced to stop smoking in public places. This topical subject is tackled in Passlve Smoking, the latest in the Science Box series of contemporary science exhibitions that opens today, 14 January, at the Science Museum. The exhibition finds that, based on the research available, passive smoking is clearly a health risk but it also points out the difficulty of assessing scientific evidence and the problems of banning smoking in public places. Dr Brian Mawhinney, Minister for Health, who opened the exhibition, said today "Although the vast majority of tobacco related lung cancer deaths occur in smokers, there is now mounting evidence that around one person a day, who does not smoke, dies from the disease as a result of inhaling environmental tobacco smoke over many years." Visitors to the exhibition can test the effects of passive smoking, using a "Smokerlyzer". This is a device that measures the amount of carbon monoxide (CO) in people's breath. Exposure to tobacco smoke raises the amount of CO in the body for a short time. (The results of this test can be affected by exposure to traffic pollution). A life-size human jigsaw shows how passive smoking affects different parts of the body. Using computer interactives, visitors will be able to take part in an opinion poll on smoking and get further information from scientific papers. 1 /cont'd Science Museum, Exhibition Road, London SW7 200 Telephone 071 938 8000 Fax 071 938 8112

~. Tle N.nronal Museumi ~`o( Soe,xe & Il,ckrtitry A specially programmed totaliser will give a running display of the average . number of people who die from smoking related diseases during the course of the exhibition. Wednesday 10 March is National No Smoking day. To mark the occasion the Museum will hold a"table-top"science day where people can take part in experiments to show whether or not thay have been affected by cigarette smoke. Dragon's Breath, a dramatic performance for 7-11 year olds on the theme of smoking and passive smoking will be held. In addition, a special talk on passive smoking will be given by Dr Graham Cope of the Queen Elizabeth Medical Centre, Birmingham. The talk will be aimed primarily at adults and children over 13 years old. On 1 January 1993 the Science Museum introduced a no-smoking policy. . Passive Smoking is the fourth in the Science Box series of contemporary science exhibitions sponsored by Nuclear Electric plc. DNA fingerprinting, lasers and ozone have already been covered in the series. Forthcoming topics include the olympic gold medal-winning LotusSport bicycle and nanotechnology (technology on an atomic scale). Passive Smoking, 14 Jan 1992 - 14 Mar 1993, Science Museum, Exhibition Road, London SW7 2DD. Tel: 071 938 8000. -ends- Note to editors: The Bedfont Micro Smokerlyzer used in the exhibiton can show the amount of carbon monoxide (CO) from tobacco smoke in the body. CO remains in the body for 4-6 hours, so passive smoking can be measured in this period. In the lungs CO is absorbed by haemoglobin. This means that the haemoglobin can not pick up oxygen and carry it in the blood, and there is less oxygen available for use in the body. This is one of the reasons why heavy smokers develop circulatory problems. Press contact: Caroline Nolan Tel: 071 938 8181 / 8192 18188 2/cont'd

~.. u S The National Museum .. ~, of Suence & Industry Background information: ` Research into passive smoking began in the 1970s • 1987 London Underground banned smoking 1991 London Regional Transport banned smoking on buses 1992 Smoking banned on the Paris Metro . ` January 1993 the United States Environmental Protection Agency in the USA announced its belief that in the USA up to 3,000 lung cancer deaths every year are caused by passive smoking ` Breathing other people's cigarette smoke increases the risk of lung cancer by 10-30 °k ` Every year, about 300 people in the UK die from lung cancer caused by passive smoking ` Exposure to tobacco smoke can double the risk of bronchitis and pneumonia in children under one year old ` There is a direct link between passive smoking and "giue ear". Glue ear happens when the fluid formed in the ear cannot drain away. In some cases this may iead to partial or total deafness ` Taken across all studies combined, the increased risk of heart disese due to passive smoking is of the order of 25 per cent in both sexes ` Passive smoking has been shown to increase the risk of lung cancer in adults ` About a third of the cases of lung cancer in non-smokers who live with smokers, and a quarter of the cases of lung cancer in non-smokers in general, may be attributable to passive smoking • Over 4000 chemicals have been identified in tobacco smoke, many of which are classed as poisons ` Nicotine in the body is quickly broken down into cotinine. The level of cotinine in the body is a sensitive indicator of whether a person has been breathing other people's smoke ` Non-smokers who are married to smokers have three times as much cotinine in their blood as people who are not married to smokers ` On average, 300 people in the UK die each day from smoking related diseases 3/

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