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SHOOK, I IARDY& BACON P C. REPORT ON RECENT ETS AND IAQ DEVELOPMENTS February 19, 1993 SHB

REPORT ON RECENT ETS AND IAQ DEVELOPMENTS - IN THIS ISSUE - IN!THE UNITED STATES REGULATORY AND LEGISIATIVE MATTERS •• OSHA is petitioned by the Public Citizen Health Research Group to issue an emer- genry ETS workplace standard, p. 1. •• Secretary of Labor files motion to dismiss latest ASH petition, p. 1. • Senate will consider a bill aimed toward streamlining EPA risk reduction procedures, p. 2. •• PRO-KIDS companion bill introduced in the House, p. 2. ETS-RELATED LITIGATION AGAINST CIGAREITE MANUFACTURERS • Latest activities in Blanchard Broin and Butkr •, p. 13. • Harju is dismissed, p. 7. LEGAL ISSUES AND DEVELOPMENTS • • Workers' compensation experts predict increase in ETS claims in wake of EPA Risk Assessment, p. 8. • Lobbyist threatens to sue under ADA if smoking not banned, p. 8. SCIENTIFICITECHNIGAL ITEMS • "Environmental Tobacco Smoke in Com- mercial Aircraft," p. 9. •"Smoking Policies of Licensed Child Day- Care Centers in the United States," p. 9. OTHER DEVELOPMENTS •• Employers reconsider policy options in wake of EPA Risk Assessment on ETS, p. 9. +• Life insurance carrier to offer discounts to those who work in a smoke-free environ- ment, p. 10. ISSUE 41 • • Restaurateurs explore options following EPA Risk Assessment on ETS, p. 10. MEDIA COVERAGE ••"Something New to Chew Over in the Oval Office," p. 12. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISIATIVE MATTERS • Activity in Canada, China, Hong Kong, Israel, Norway, Sweden and the U.K, beginning on p. 12. LEGAL ISSUES AND DEVELOPMENTs • Australian family law experts predict lawsuits against smoking parents, p. 14. • Smoker fined in the Netherlands challenges smoking ban, p. 14. SCIEN'I7FIC/TECHNICAL ITEMS •"The Heart: A Target Organ for Cigarette Smoking," p.15. "Drug Consumption During the First 18 Months of Life of Infants from Smoking and Non-smoking Families," p. 15. OTHER DEVELOPMENTS • European Community finances sick build- ing syndrome project, p. 16. MEDIA COVERAGE •• U.K artides report smoking bans in the U.S. are imminent, p. 18. * Discussions throughout this Report that bear this symbol contain information about events and activities related to the EPA Risk Assessment on ETS.

- TABLE OF CONTENTS - Issue 41 February 19, 1993 IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTBRS U.S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) [1] # PubGc Interest Group Requests Emergency ETS Standard ................................................... 1 [2) *lISH v. Deparanens ofLabor. Secretary of Labor Asks Court to [3] Dismiss Petition for Review .................................................................................................... . I OSHA Reform Bill Expected to be Introduced at Any Time ................................................... 1 [4] # CIAQ Members Discuss OSHA and EPA Efforts Related to ETS at Most Recent Meeting ............................................ I U.S. ENVIRONMENTAL PROTECTION AGENC.'Y (EPA) [5] Bil1 Introduced to Streamline EPA Risk Reduction Proeedures ................................................2 CONGRESS [6] • Companion PRO-KIDS Legislation is Introduced in the House .......................................... 2 ASHRAH (7) • SSPC 62 Activities at ASHRAE's Winter Meeting ............................................................... 3 CALIFORNIA EPA [8] Cal-EPA Issues Request for Information on ETS .....................................................................3 [9] Amendments Proposed to Proposition 65 ................................................................................3 STATE AND LOCAL GOYERNMENTS [10] Privacy Legislation .................................................................................................... ...............4 [11] ETS-Related State and Local Legislative Activities ...................................................................4 [12) IAQ-Related State and Loml Legislative Activities ...................................................................6 ETS-REIATED LTTIGATION AGAINST CIGARE"ITE MANUFACTURERS [13) Blancha.ok Argument on Motions is Set for March 3 ...............................................................6 [14] Broin: Defendants are Granted Extension to File Brief .............................................................7 [15] # Burler. Plaintiff Serves Deposition Notices on Wholesalers ...................................................7 [16] NarjrG Plaintifl's Claims are Dismissed ....................................................................................7 LEGAL ISSUES AND DEVELOPMENTS [17] * Workers' Comp Experts Predict Increase in ETS Claims ......................................................8 (18] "Smokers' Rights Legislation: Should the State'Butt Out' of the Workplace?" T.W. Scvlco (Student Author), 33 Boston Co/kge L Rev. 879 (1992) ......................................8 [19] # Lobbyist Threatens ADA Lawsuit Against I egislature .......................................................... 8 SCIENTIFIC/TECHNICAL ITEMS UPaOMING MEETINGS (20] "Lliability and Compliance in Indoor Air Quality; MidAtlantic Environmental Hygiene Resource Center, Philadelphia. Pennsylvania. April 1. 1993 ......................................9 ETS FxpOSURE AND MONTPORING [21] 'Passive Smoking and Tobacco Chewing Among Alaska Children: Measuring Saliva Cotinine; R.A. Etzel. D.B. Jones, C.M. Schlife, J.R Lyke, F.W. Spierto, and J.P. Middaugh,loranalofSrnoksrtgRelaud Diaorderr3(2): 161-165. 1992 [See Appendix A] ............................................................................................9 [22] "Subchronic Inhalation Study in Rats Using Aged and Diluted Sidestrrara Smoke from a Reference Cigarette." C.R.E. Coggins, P.H. Ayres, A.T. Mosberg. J.W. SagzrtZ, and A.W. Hayes. Inha/arson Taacicu4W 5: 77-96. 1993 [See Appendix A] ................................9 [23] 'Environmental Tobacco Smoke in CommercialAircraft." Dj. Eatough, F.M. Caka, J. Crawford, S. Braithwaite. LD. Hansen, and E.A. Lewis, ArnrofpherrcEnvironrnens26A(12): 2211-2218. 1992 [See Appendix A] ..................................9 SMOtaNG POUCES AND RELATED ISSUES [24] "Smoking Policies of Licensed Child Day-Care Centers in thc United States," D.E. Nelson, J.J. Sacks, and D.G. Addis, Padiatria 91(2): 460-463.1993 [See Appendix A] ....... 9

Contents Continued, Issue 41 OTHER DEVELOPMENTS [25] * EPA Risk Assessment on ETS Expected to Impact Employer Smoking Policies ....................9 [26] * Life Insurance Firm Offers Discount to Smoke-Free Workplaces ....................................... 1O [27] * Nation's Restaurateurs Face New Concerns in Wake of EPA Risk Assessment on ETS ...... 10 (28] * California Restaurant Chain Implements Smoking Ban ..................................................... 10 [29] Restaurant Chain Claims Smoking Ban Has Not Harmed Business ...................................... 10 (30] Nonsmokers Rights Group Presses for Smoke-free Nightclubs .............................................. 10 (31] -0 Restaurant Guide Prepared in Response to EPA Risk Assessmeni on ETS .......................... 11 (32] ASH Issues National Survey on Smoking and Health ............................................................11 (33] * High School Students Close Teachers' Smoking Lounge .................................................... 11 [34] West Virginia Poll .................................................................................................... .............11 MEDIA COVERAGE [35] "Q and A," Real Estate Desk, The New York Tinter. February 7. 1993 ................................... 11 [36] * "Something New to Chew Over in the Oval Office," R Emmett Tyrrell, Jr., The tY/asbingron Times„ February 7, 1993 ............................................................................... 12 [37] Perfume Ban Sparks Controversy in San Francisco ................................................................12 IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS CANADA (38] 0 Durham Regional Council Seeks Public Input on Smoking Bylaw ..................................... 12 CH INA (39) Government to Consider Extending Smoking Ban ................................................................12 HONG KONG [40] ETS Health Wamings Now Required on Tobacco Products ................................................. 12 ISRAEL NORWAY [41] Smoking Restrictions to be Introduced by Health Minister ................................................... 13 [42] Government Offices in Oslo Adopt Smoking Ban .................................................................13 SWEDEN [43] Smoking Legislation Introduced ............................................................................................13 [44] Stockholm Politicians Consider Restaurant Smoking Ban ..................................................... 13 UNITED KINGDOM [45] Workplace Smoking Control Bill Introduced ........................................................................13 [4G] Smoking Ban Imposed in Health Care Facilities ....................................................................13 [47] Fines Threatened if Voluntary Smoking Bans are not Introduoed .......................................... 13 LEGAL ISSUES AND DEVELOPMENTS AusTRwA [48] Experts Warn of Legal Action Against Smoking Parents ........................................................ 14 THE NEI'HERIANDS [49] Netherlands Smoker Fined in June Challenges Smoking Ban ................................................ 14 NEv ZEAur1D [50] Legal Aid Submission Filed on Behalf of Tobacco Companies ............................................... 14 UNITED KINGDOM [51] Settlement in ETS Case Provokes Widespread Interest .......................................................... 14 [52] ETS "Victim" Hotline Set Up ...............................................................................................14

Contents Continued, Issue 41 SCIENTIFICITECHNICAL ITEMS UPCOMING MFETtNG [531 "Indoor Air Quality and Respiratory Disease," London. England, April 14. 1993 .................15 CARDtovASCULUt ISSUES [54] "The Hean: A Target Organ for Cigarette Smoking " A. Leone, Journal ofSinoEing-Relaud Disorders 3(3): 197-201, 1992 (See Appendix A] ......................... 15 RFSPIRATORY DISFASFS AND CONDITIONS - CHIIDRSN [55] "Drug Consumption During the First 18 Months of Life of Infants from Smoking and Non-smoking Families; A. Hakansson and C: Petersson. B.itirh Jarrsrio! of Gene.al l'yacsice 42: 362-365, 1992 [See Appendix A] ................................ 15 OTHER HFAI.TH ISSUFS [56] "Risk Factors for Atrial Septal Defect," J. Tikkanen and O.P. Heinonen, Faanpean Jorrnal ofEpidtmiology 8(4): 509-515, 1992 [See Appendix A] .............................. 15 OTHER DEVELOPMENTS AvsrRALlw [57] * Shopping Centre to Introduce Smoking Ban ......................................................................15 CANADA ................................................................1 [58] Antismoking Activist Pickets McDonald's ............. CZECHOSLOVAIOA [59] WHO Recommends Smoking Bans to Protect Nonsmokers ................................................. 1 EUROPFAN CAMMIlN17Y [60) EC Finances Sick Building Syndrome Project ........................................................................16 JAPAN [61] Railway Company Adopts Smoking Restrictions ...................................................................16 [62] Antismoking Group Marks Anniversary ................................................................................17 SOUTH AFRIG [63] StitEFines Face Smokers Who Light Up on Public Buses ...................................................... 17 UNITFD KINGDOM [64] Booklet on Indoor Air Quality Attacks ETS ..........................................................................17 (65] Government Funded Project Launches Antismoking Initiatives ............................................. 17 [66] Hospital Announces Intent to Discriminate Against Smokets ................................................ 17 [67] Survey of Doctors Shows Lack of Advice to Patients About ETS ........................................... 17 [68] Supermarket Giant Will Impose Smoking Ban ......................................................................18 [69],Newspaper Promotes Anti-Smoking Campaign .....................................................................18 [70] Teletext Viewers Favor Workplace Smoking Bans .................................................................18 [71] Predictions of Voluntary Workplace Smoking Bans Follow Settlement in Veronica Bland Case .................................................................................................... .....18 [72] ASH Claims More Employers Move to Ban Smoking ........................................................... 18 [73] Major Suburban Rail System Bans Smoking ..........................................................................18 MEDIA COVERAGE CANADA [74] "For Rent: Healthy Building; D. Jones, The Financial Posb January 23, 1993 ..................... 18 UNITED KINGDOM [75] * Financial Tinma Articks Report Smoking Ban Regulations in U.S. are Imminent .............. 18 [76] "Passive Smoking Dsrtgers?," Yarelry d Diseries Courier, January 20. 1993 ........................... 19 [77] 'Health Fascists Try to Stub Me Out," J. di Giovanni, Sunday Tisxm January 31. 1993 ...... 19 APPENDIX A .................................................................................................... ................................................ Articles APPENDIX B .................................................................................................... .................................. CALEPA Letter APPENDIX C .................................................................................................... .............................................U.K. Bill

FEBRUARY 19, 1993 1 REPORT ON RECENT ETS AND IAQ DEVELOPMENTS IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS U. S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) [1] • Public Interest Group Requests Emergency ETS Standard In a letter dated February 5, 1993, the Public Citizen Health Research Group petitioned OSHA to "immedi- ately promulgate an Emergency Temporary Standard to protect workers from [ETS] exposure." Citing the EPA Risk Assessment on ETS, the letter states there is now "widespread acceptance" that ezposureconstitutes a significant health hazard. If OSHA does not issue an emergency temporary standard, Public Citizen will "seriously consider" legal action against the Depart- ment of Labor, according to the letter. The author of the letter was the research group's director Sidney Wolfe. Public Citizen reportedly petitioned OSHA in May 1987 for similar action. See BNA Daily Labor Rcport, February 9,1993. [2] • ASH v. Dcpartment oflabor. Secretary of Labor Asks Court to Dismiss Petition for Review On February 8,1993, Secretary of Labor Robert Reich filed a motion to dismiss the petition for review filed by ASH in December 1992 in the District of Columbia Circuit Court of Appeals. See issue 39 of this Report, January 22, 1993. The Secretary challenges ASH's petition by asserting that OSHA "has not made a final determination concerning the regulation of ETS and continues actively to consider the regulatory action sought by ASH." The Secretary contends that because there is no final agency action to review, the court lacks jurisdic- tion in the matter. In the memorandum supporting the motion to dismiss, the Secretary refers to the 17,000 pages of material received in response to OSHA's Request for Information on indoor air, which is currently under review, and to former Labor Secretary Lynn Martin's directive to "commence rulemaking to address the hazards of occupational exposure to secondhand smoke," issued six days after the January 7 release of the EPA Risk Assessment on ETS. Stt issue 39 of this Report, January 22, 1993. The memorandum notes that OSHA is preparing a report on the regulatory options available for the new Secretary of Labor and states that "Secretary Reich has requested that the report be completed as expeditiously as possible." ASHv. Depan»rent ofLabor, No. 92-1661 (U.S. Court ofAppeals, D.C. Circuit) (filed December 22, 1992). [3] OSHA Reform Bill Expected to be Introduced at Any Time According to published press reports, proponents of OSHA reform legislation are optimistic of passage in the 103d Congress and expect a bill to be introduced in mid- to late February. AFL-CIO representatives say they will push for quick action on the measure. The new bill may be very similar to the OSHA Reform Act introduced in the 102d Congress. That bill passed the labor committees in both chambers of Congress but did not reach the floor of either the House or Senate. The Clinton administration reportedly agrees in principle with OSHA reform legislation. See Daily Labor Repor; February 11, 1993; BNA Washingmn Insider, February 3, 1993. Interagency Committee on Indoor Air Quality (CIAQ) [4] • CIAQ Members Discuss OSHA and EPA Efforts Related to ETS at Most Recent Meeting CIAQ members discussed the release of the EPA Risk Assessment on ETS and OSHA's directive to com-

2 mence rulemaking on ETS at their quarterly meeting on January 21, 1993. Robert Axelrad, director of EPA's Indoor Air Divi- sion, reportedly said at the meeting that EPA's post- risk assessment plans include (i) releasing a brochure and policy guide on ETS, (ii) arranging for outside groups to help spread information about ETS, and (iii) spreading information about ETS internationally. Although the risk assessment apparently will not be published in the Ftderal Register, a data summary will: be entered into EPA's Integrated Risk Information System (IRIS). EPA officials also reported the following: • The Indoor Air Quality Clearinghouse received 1,900 calls the week the ETS risk assessment was released and was continuing to receive more than 1,000 calls per week. In its first three months of operation, the dearinghouse reportedly received more than 5,000 inquiries, many of them dealing with carpet emissions, and distributed more than 3,000 copies of the 1988 document entitled '°The Inside Story, A Guide to Indoor Air Quality." • The agency has formed an inter-office Indoor Air Cluster charged with developing an EPA wide strategy for indoor air. • EPA staff expects federal indoor air legislation to be reintroduced but are uncertain how the bill will fare. An OSHA deputy director, Frank Frodyma, report- edly told the members that OSHA's staff had recom- mended separating ETS from the Request for Informa- tion on indoor air more than a month prior to former Labor Secretary Lynn Martin's February 13 directive to "commence rulemaking to address the hazards of occupational exposure to secondhand smoke." See issue 39 of this Report, January 22, 1993. Frodyma added that OSHA was still deciding whether to seek U.S. Supreme Court review of the Eleventh Circuit opinion vacating the agency's rule setting permissible exposure limits on some 428 indoor air contaminants. See issue 35 of this Report, November 20, 1992. CIAQ is an interagency committee co-chaired by EPA and OSHA. ETSLLAQREPORT, ISSUE 41 U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) [5] Bill Introduced to Streamline EPA Risk Reduc- tion Procedures A bill has been introduced in the Senate that would coordinate the development and implementation of environmental policies at EPA. S. I 10 was introduced in January 1993 by New York Senator Patrick Moynihan (D). Among other things, the bill would establish "guide- lines to ensure consistency and technical quality in risk assessments.° The measure also would create a Com- mittee on Relative Risks, which would rank the relative risks of environmental problems, and a Committee on Environmental Benefits, which would estimate the quantitative benefits of reducing particular risks. Both committees would be independent from the EPA Science Advisory Board. CONGRESS [6] • Companion PRO-KIDS Legislation is Intro- duced in the House On February 2, 1993, Representative Richard J. Durbin (D-111.) introduced the companion bill to the PRO-KIDS legislation that is currently pending before the Senate (S. 261). Although listed in the Congra- sional Rtcord as a companion to S. 261 only, the House measure also incorporates the Senate's PRO-FEDS bill (S. 262). For more information about the Senate bills, see issue 40 of this Report, February 5, 1993. Co-sponsored by 16 Congressmen, H.R 710, like its Senate counterpart, would require federally-funded programs for children under the age of 18 to prohibit smoking in any portion of any indoor facility providing services to children that is not separately ventilated. The EPA would be authorized to promulgate guide- lines for instituting the nonsmoking policy. The House measure would require the imposition of the same smoking policy in every building or other structure owned or leased for use by a federal agency of the executive, legislative and judicial branches. H.R. 710 also contains the PRO-FEDS sections requiring the EPA Administrator to establish an "Environmental

FEBRUARY 19, 1993 Tobacco Smoke Advisory Office" with a director within the Office of Radiation and Indoor Air. The remarks made by Representative Durbin at the time the bill was introduced made reference to the EPA Risk Assessment on ETS. The bill has been referred to the House Committee on Energy and Commerce. ASHRAE [7] • SSPC 62 Activities at ASHRAE's Winter Meeting ETS reportedly was discussed in a number of contexts during the most recent general committee and subcom- mittee meetings of Standing Standards Project Com- mittee 62 (SSPC 62), which is charged with revising ASHRAE Ventilation Standard 62-1989. Some members of the Subcommittee on Source Control and Air Cleaning, citing the EPA Risk Assess- ment on ETS, suggested that the revised ASHRAE ventilation standard should treat ETS as an additional contaminant source requiring additional proteccion/ removal equipment. One member asserted that 15 cfm/person is adequate for occupants' physiological needs and that ETS should be considered an "addi- tional load." That would be a departure from existing Standard 62-1989, which generally calls for uniform prescribed ventilation rates without regard to whether smoking is allowed. Meanwhile, the Health and Comfort Subcommittee discussed whether the revised ventilation standard should deal specifically with ETS. The subcommittee reportedly decided that the issue of ETS should be left to EPA and OSHA. A recurring topic for discussion was the extent to which the ASHRAE ventilation standard should address health issues. Although SSPC 62 Chair Gene Tucker said he preferred a health-based standard, other members of the committee said they felt a health-based standard would be inappropriate and would unneces- sarily lead to liability concerns for those involved in designing and constructing buildings. During the meeting of the general SSPC 62 commit- tee, Ole Fanger of the Technical University of Den- mark reported on a number of projects, including human chamber studies he is conducting on ETS, an 3 ongoing attempt to identify pollution source strengths in selected buildings in eight European countries, and the development of the European Ventilation Guide- lines. According to Fanger, the European guidelines will include three levels of comfort: A. B and C. Fanger compared these levels to automobiles ranging from a Cadillac to a subcompact. Under the guidelines, Fanger said, Europeans will be asked to decide on the quality of IAQ for which they are willing to pay. The above meetings were held on or about January 24, 1993, during the ASHRAE winter meeting in Chicago. The next meeting of SSPC 62 is scheduled for June 27, 1993, in Denver, Colorado. CA1.IFORNIA EPA [8] Cal-EPA Issues Request for Information on ETS On January 28, 1993, the California Environmental Protection Agency issued a Request for Information on ETS. A copy of the form letter used to make the request is attached as Appendix B. The letter says the information generated by the request will be used by the agency's Office of Environ- mental Health Hazard Assessment to evaluate the alleged health effects of ETS. Although the scope of the evaluation is not discussed, a specific request is made for "information on ETS exposure and cancer, repro- duaive/developmental toxicity, and cardiovascular and respiratory effects." Attached to the letter is a bibliography of literature accumulated by Cal-EPA prior to issuing the request. The subject headings for the bibliography are sudden infant death syndrome, neuropshycological and physical development in children, respiratory health effects, otitis media, peri-natal effects, exposure assessment, cancers, and animal experiments. The publication dates for the literature in the bibliography reportedly range from 1968 to early 1992. The letter asks that information be submitted by March 15, 1993. [9] Amendments Proposed to Proposition 65 The required warning for ETS exposure would be expanded to indude "birth defects" and "other repro- ductive harm" under draft amendments to the Proposi-

4 tion 65 warning regulations released by Cal-EPA on January 28, 1993. The draft amendments would require the following warning: "WARNING: This facility permits smoking, and tobacco smoke is known [to the State of California] to cause cancer. Cenain componenu of tobacco smoke are knoum [to the State of CaliforniaJ to cause birth defecas or other reproductive harm." The first sentence is identical to the existing warning. The second sentence, which is shown above in italics, is new. The language in brackets is optional. A workshop will be held on the dtaft amendments on February 25 in Sacramento. Written comments may be submitted until March 1. If a decision is made to move ahead with the amendments, the state must issue a formal proposed regulation for public comment. STATE AND LOCGIL GOVERNMENTS [10] Privacy Legislation The term "privacy legislation" refers to state statutes which protect workers who smoke off the job or, more generally, use legal products or engage in legal activities outside the workplace. • Alaska A bill that would prohibit employers from discriminating against individuals who use legal products in a legal manner outside the workplace was introduced on January 27,1993, and sent to the Senate Committee on Labor and Commerce. On February 3,1993, the bill was reported from the committee without recommendation. See S.B. 69,18th Legislature - lst Reg. Sess. (1993). A House version of the bill'was previously introduced on January 15,1993. • Hawaii A bill relating to fair employment practices provides that employers cannot prohibit legal activities as a condition of employment. The bill was introduced January 27,1993, and sent to the Senate Committees on Education, Labor and Employment, and Judidary. SerS.B. 1360,17th Legislative Session -1st Reg. Sess. (1993). • North Dakota A Senate bill was introduced on January 18, 1993, that would revise state policy against discrimination regard- ETSIrAQREPORT, ISSUE 41 ing participation in any lawful activity off an employer's premises during nonworking hours and to specify lawful activity which is not in direct conflict with the essential interests of the employer. The bill also limits the amount of damages to be awarded when an action is brought for discrimination. On February 8, 1993, the Senate adopted an amendment as recom- mended by the Senate Committee on Judiciary. See S.B. 2367, 53d Legislative Assembly - 1st Reg. Sess. (1993). • Washington A Senate bill was introduced on January 27, 1993, that prohibits employer discrimination for the consumption of lawful products off premises by employees during nonworking hours. It also allows employers to have insurance policies in effect that make distinctions for type of coverage based upon employees' consumption of lawful products. The bill has been sent to the Committee on Commerce and Labor. See S.B. 1365, 53d Legislature - Reg. Sess: (1993). (11] ETS=Related State and Local Legislative Activities • * California Smoking would be banned in state-owned or leased property under, a bill introduced in the State Assembly on February 2, 1993. Introduced by Assemblyperson Jackie Speier (D-South San Francisco), the ban also would repeal a law that allows state departments to adopt their own smoking policies. The bill would not preempt local laws that provide more stringent require- ments. The bill was sent to the Committee on Con- sumer Protection on February 11. SeeA.B. 291, Reg. Sess. (1993-94). According to a press report, Speier pointed to the EPA Risk Assessment on ETS in support of the bill. Similar bills introduced last session were reportedly voted down in committee. See BNA California - Saf ty and Health Report, February 15, 1993. • Hawaii A bill that would require the Department of Human Services to establish rules prohibiting smoking in family child care homes was introduced in the House on January 22, 1993. Under the measure, providers of family child care homes would be able to designate certain rooms in their homes where smoking is permit- ted, provided the rooms are off-limits to the children under their care. See H.B. 432, 17th Legislative Session -1st Reg. Sess. (1993). A second bill, introduced in the

FEBRUARY 19,1993 Senate on January 22, 1993, would prohibit smoking in all group child care homes, group child care centers, and family child care homes during their hours of operation. See S.B. 831, 17th Legislative Session - 1st Reg. Sess. (1993). On January 22, 1993, a bill relating to smoking in restaurants was introduced in the House that would prohibit smoking in certainplace.c open to the public. The measure was sent to the House Com- mittees on Health, Economic Development and Business Concerns, and Judiciary. Ste H.B. 601, 17th Legislative Session -1st Reg. Sess. (1993). A bill introduced on January 21, 1993, provides that each employer in the state shall adopt, implement, and maintain a written smoking policy containing a provision that if any nonsmoking employee objects to the employer about smoke in the employee's work- place, the employer shall attempt to reach a reasonable accommodation. See S.B. 256, 17th Legislative Session - 1st Reg. Sess. (1993). • * Kentucky According to a news report, Governor Brereton Jones (D) signed an emergency regulation on January 27, 1993, that restricts smoking in state-owned buildings and others occupied by state workers. The smoking policy covers Kentucky's 35,000 permanent state employees, as well as seasonal and temporary workers, according to Bonnie Howell, executive director of management and fiscal affairs. Howell reportedly said that the policy is a response, in part, to the EPA Risk Assessment on ETS, as well as theAmericans with Disabilities Act (ADA). Kentucky apparently has had two complaints under the ADA and Howell reportedly says, "We really had no choice but to ban smoking where these people work." She further daims more ADA ao: ommoda tion requests relating to ETS seem likely. The new policy seeks to accommodate the needs of smokers and nonsmokers and, to the extent feasible, provide a designated smoking area in each state building. Agency heads will have the responsibility of establishing smoking areas. Smoking will be allowed only in marked areas in public portions of state facilities. A private office may be designated as a smoking area if ventilation devices designed to remove smoke are installed and if smoking does not occur when nonsmokers are present. See Government Em- ployee Relations Report, February 1, 1993. 5 • * Local Governments in Massachusetts On February 8, 1993, Boston City Councilor Charles Yancey reportedly says he will introduce an ordinance that would require Boston businesses to have a smok- ing policy respecting the rights of both smokers and nonsmokers. If no common ground is found among employees, the ordinance would ban smoking in the workplace. The proposed ordinance would apparently not affect restaurants, bars or at-home workplaces. Yancey is quoted as saying that tobacco use is "`increas- inglydangerous and life-threatening,'" citing the EPA Risk Assessment on ETS. A similar ordinance failed in 1991, but Yancey says due to the ETS risk assessment, there is increased support for the ordinance this time. Massachusetts is reported to be the only state in New England that does not have a law protecting nonsmok- ers from ETS in the private sector. See The Boston Globe, February 9, 1993. • * Minnesota According to a newspaper article, the House Rules and Legislative Committee passed a rule that would immediately prohibit smoking in all public places of thrState Office Building, including the cafeteria and lounges. Smoking would be allowed in private offices until May 31, 1993, at which time a total ban would be instituted. The rule now goes to the full House, where it is expected to pass. The committee chairman, Representative Alan Welle (DFL-Willmer), reportedly told the committee that it didn't have much choice in the matter. "With the Environmental ProtectionAgenry's recent ruling that second-hand smoke can cause lung cancer in nonsmok- ers, there might be the potential for lawsuits if the rule isn't passed,'" he is quoted as saying. Approximately 50 state workers and legislators had apparently presented Welle with a petition calling for the ban. The committee explored the possibility of creating a smoking lounge with special ventilation equipment, but it was reported to have been too expen- sive. See Star Tribune (Minneapolis), February 14,1993. • New York The Assembly has passed a bill that would apply smoking prohibitions to transportation facilities used by pupils regardless of their presence or absence on such facilities. The bill has been sent to the Senate Committee on Education. SeeA.B. 727, 215th General Assembly - 1st Reg. Sess. (1993).

6 • Oklahoma A House bill that would prohibit smoking in licensed nursing homes and day care centers was introduced on February 3, 1993, and was sent to the House Commit- tee on Transportation. The bill provides for penalties of (i) a fine for first offense and (ii) imprisonment in the county jail for not more than 30 days, a fine, or both, for subsequent offenses. See H.B. 1015, 44th Ltgislature - 1st Reg. Sess. (1993). • Tennessee Companion bills that would prohibit smoking in elementary and secondary school buildings were introduced in the House and Senate on February 1, 1993. See H.B. 125 and S.B. 205, 98th General Assembly - 1st Reg. Sess. (1993). • Utah A Senate bill that would require businesses with smoking areas to provide information regarding the alleged health hazards of ETS to employees cxposodto ETS passed the Senate and was sent to the House on February 9, 1993. See S.B. 67, 50th Legislature -GeneralSess. (1993). On January 25, 1993, a bill was introduced to prohibit smoking in public schools or facilities or on property on which those facilities are located. It also provides for designated smoking areas for adults during nonschool hours in private schools. Sea H.B: 136, 50th Legislature - General Session (1993). • * Virginia Two bills were introduced and sent to the House Committee on General Laws on January 28, 1993. One bill would revise provisions of the Virginia Indoor Clean Air Act by prohibiting smoking in any public place or public area, authorizing localities to exceed the standards in the act, allowing proprietors to designate smoke-free buildings, and requiring placement of any smoking areas in such a way that the smoke will not be vented or recirculated into nonsmoking areas. The second bill would require employers to furnish a workplace "free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees, including, but not limited to environmental tobacco smoke as listed by the U.S. Environmental Protection Agency." See H.B. 2431 and H.B. 2393, Reg. Sess. (1992-93). • Wyoming A bill that would ban smoking in state- owned or leased buildings open to the public was introduced on January ETS/IAQREPORT, ISSUE 41 14, 1993. The bill would establish a fine for noncompli- ance and grant the Capitol Building Commission rulemaking authority on this issue. The bill was reported from the Senate Committee on Labor and Federal Rdations with amendment on January25, 1993. Sce S.B. 92, 52d Legislative Session - Gen. Sess. (1993). [12] IAQRdated State and Local Legislative Activities • Massachusetts Two new bills were introduced on January 6, 1993, pertaining to ventilation standards. The first provides minimum ventilation standards in state leased and newly constructed state buildings. See H.B. 772, 178th General Court - Reg. Sess. (1993). The second would require public buildings to meet certain air quality ventilation standards. Both were sent to the Joint Committee on State Administration. SeaH.B. 773, 178th General Court - Reg. Sess. (1993). A third bill, also introduced on January 6, 1993, would establish an interagency coordinating council to address responsi- bility for public health and consumer protection concerning indoor air pollution and other threats. The bill was sent to the Joint Committee on Natural Resources and Agriculture. See H.B. 939, 178th General Court - Reg. Sess (1993). ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [13] Blancha>'i Argument on Motions is Set for March 3 On February 5,1993, ddendants L,iggett and RJ. Reynolds filed a renewed motion to transfer venue along with a motion to strike plaintiffs' first amended com- plaint. Similar motions were filed on February 8 by the wholacaler/distributor defendants. The court has sched- uled argument on the motions for April 30,1993. A eourtrscheduled status conferenee is still set for Matrh 3; counsel for the parties are to meet on March 2. The original plaintiffs in this case, Raye Blanchard and Tamara Reed, are mother and daughter. They allege primary-smoking injuries to Raye Blanchard's late husband, Thomas, who allegedly smoked for more than 50 years, and Raye Blanchard herself, who claims she smoked "for about ten years." In addition, Raye

FEBRUARY 19, 1993 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. Twelve plaintiffs have been added to the case through supplemental and amended petitions. All of the additional plaintiffs' claims appear to relate to active smoking, with one exception. Plaintiff Pamela Kastrin Stephens claims unspecified "lung and respiratory diseases" allegedly caused by exposure to the ETS from the cigarettes smoked by her deceased father. 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 ofwholesalets and retailers. Blanchard, et at v. R.J. Rtynolds Tobacco Company, et at (District Court, Galveston County, Texas) (filed July 31, 1992). [ 14] Broin: Defendants are Granted Extension to File Brief The Court ofAppeal has granted defendants' request for an extension of time within which to respond to plaintiffs' appeal brief on dismissal of the class action allegations. The reply brief in opposition is now due on March 8, 1993. With respect to defendants' petition for certiorari relating to plaintiffs' attempt to depose top company executives, plaintiffs were granted another extension within which to file their response to the petition. The response is now due on February 19. At issue in this case are the claims of 30 flight attendants allegedly injured by occupational exposure to ETS. The injuries allegod by the putative class representatives include lung cancer, breast cancer and unspecified respiratory ailments. The defendants are purported to be the six major U.S. cigarette manufacnuas (plus related entities), United States Tobacco Co., Dosal Tobacco Corp., the Council for Tobacco Research, The Tobacco Institute, and three other trade associations. Brioin, et al v. Phidip Mo»rs, aaL (Circuit Court, Dade County, Florida) (filed October 31, 1991). [15] * Butler. Plaintiff Serves Deposition Notices on Wholesalers On February 4, 1993, plaintifffs served notices to take corporate-representative depositions on four non- 7 tobacco manufacturer defendants. The depositions are currently scheduled for March 25 and 26, 1993. Each defendant is to produce the corporate officer with the most knowledge of, among other things, the EPA Risk Assessment on ETS. On February 5, defendant Brown & Williamson noticed the depositions of three insur- ance company agents. The depositionsare scheduled for March 9. Counsel for plaintifTs, Roe Frazer, was interviewed recently for an article in the Li7al1 Street JournaL The artide, which focused on the impact of the EPA Risk Assessment on ETS, quoted Frazer as saying, "'I think the EPA report is definitely going to have a major impact upon our lawsuit' because the companies will find it harder to argue that the evidence on passive smoking is inconclusive." See Wall StrettJournA January 7, 1993. In this case, Burl Butler alleges that he has lung cancer and other injuries caused by exposure to ETS in the barber shop he has owned and operated for ap- proximately 30 years. His wife, Dean, daims loss of consortium and emotional distress. The defendants are the six major U.S. cigarette manufacturers and four tobacco wholesalers. Butler v. RJ. Reynold+ Tobacco Co., ct 4 (U.S. District Court, Southern District, Mississippi) (filed October 21, 1992). [ 16] Har, jrG PlaintifEs Claims are Dismissed On January 19, 1993, the court granted plaintiff Joseph Harju's motion to dismiss without prejudice. Harju had filed the motion in August 1992. In dismissing the action, the court did not discuss the merits of Harju's motion; instead, the order addressed only a motion to dismiss under Rule 11 which had been filed by defendant McLane Sunwest. The court denied McLane Sunwest's motion to dismiss, stating there was no evidence Harju's claims were duplicitous or that suit was brought "merely to harass the defendants. Conduct forming the basis of the charge of harassment must do more than bother, annoy or vex the complaining party." In the case, plaintiff claims his health was damaged'as a result of ETS exposure while incarcerated in the Arizona State Prison. His claims are based on negli- gence and strict liability. Harju is due to be released

8 from prison in 1997. McLane Sunwest was apparently the only tobacco-related defendant ever served in the action, although several other tobacco companies, wholesalers and distributors had been named. Harju v. State ofArizona (U.S. District Court, Phoenix, Ari- zona) (filed June 4, 1992). LEGAL ISSUES AND DEVELOPMENTS [ 17] • Workers' Comp Experts Predict Increase in ETS Claims According to an insurance journal article, workers' compensation experts around the country are reportedly predicting that the EPA Risk Assessment on ETS will "provide some impetus for aggressive workers' compensa- tion lawyers to file more daims." Industries in which employees are regularly exposed to ETS are likely to be fertile ground for such daims, the experts say. The National Restaurant Association is reportedly seeking a legal opinion from outside counsel regarding the impact of ETS on workers' compensation claims, and the president of the American Correctional Health Services Association in Honolulu expects that prison guards will file more ETS-related daims. Legal and economics experts observe, however, that there are many reasons why such daims will be re- jected, including the requirement in many states' compensation laws that the exposure be "particularly related to the workplace.° Where such daims are rejected, some attorneys predict that the door will be opened to common law tort litigation against employ- ers. See Business Insurance, February 8, 1993. [ 18] "Smokers' Rights Legislation: Should the State 'Butt Out' of the Workplace?" T.W. Sculco (Student Author), 33 Boston College L Rev. 879 (1992) 'Smokers' rights laws° may be appropriate to protect smoking employees, but they should not be used to protect job applicants, the author of this artide claims. "Unlike an employee, an applicant who smokes has not taken any steps in reliance on his or her ability to smoke." ETS/IAQ REPORT, ISSUE 41 Contending that existing smokers' rights laws are "unfair" to employers, the author proposes a model statute that applies to employees but not applicants. Under the model statute, he asserts, "[eJmployers would be able to take into account the health and economic costs of smoking in their hiring decisions, and employees who were permitted to smoke when hired would be protected against unfair employment discrimination." [ 19] * Lobbyist Threatens ADA Lawsuit Against Legislature A lobbyist for an animal rights group reportedly told state legislators in Connecticut that she may file a lawsuit under the Americans with Disabilities Act if they do not ban smoking at the State Capitol and Legislative Office Building. The lobbyist, who allegedly suffers from asthma, daims that the smoke-filled corridors of the legislative complex effectively block her access to the halls of government. Her attorney, Representative Robert Farr (D-West Hartford), has reportedly filed legislation to ban smoking in public buildings and is representing the lobbyist who is one of his constituents, for free. According to press reports, the legislative manage- ment committee has referred the request to a subcom- mittee for further study. See The Harrford Courant, February 5, 1993. In a related story, Richard Daynard, head of the Tobacco Products Liability Project, predicts that the Americans with Disabilities Act will provide a structure for legal action against restaurants that permit smok- ing. According to Daynard, the law should protect those with asthma and heart or pulmonary conditions who are purportedly being denied access to public places where smoking is permitted. His remarks were quoted in an article about Massachusetts restaurants that are considering adopting smoking bans following the release of the EPA Risk Assessment on ETS. The article concludes by publishing the telephone numbers of organizations that can provide a list of the restau- rants in Massachusetts that are smoke free. See The Boston Globe, January 29, 1993.

FEBRUARY 19, 1993 SCIENTIFIC/TECHNICAL ITEMS UPCOMING MEETINGS [20] "Liability and Compliance in Indoor Air Qual- ity," MidAtlantic Environmental Hygiene Resource Center, Philadelphia, Pennsylvania, April 1, 1993 According to promotional materials, this course will stress avoiding liability through prevention of IAQ problems. Topics to be discussed will indude statutory and case law, effactive management-employee communi- cations during an environmental crisis, existing guidelines, and the regulatory outlook in indoor air quality. The MidAtlantic Environmental Hygiene Resource Center was established by EPA in mid-1992 and reportedly offers "the nation's first permanent indoor environmental training programs." See issue 25 of this Report, July 7, 1992. ETS EXPOSURE AND MONITORING [21] "Passive Smoking and Tobacco Chewing Among Alaska Children: Measuring Saliva Cotinine," R.A. Etzel, D.B. ]ones, C.M. Schlife, J.R. Lyke, F.W. Spierto, and J.P. Middaugh, Journal ofSmoking-Rilated Di,sorders 3(2): 161- 165, 1992 [See Appendix A] Saliva cotinine measurements for 85 Alaskan children (threeso six years old) are reported. The authors daim that 44 percent of the children had cotinine levels "consistenr with passive smoking." Moreover, 3 percent apparently actively used smokeless tobacco, based on cotinine measurements. [22] "Subchronic Inhalation Study in Rats Using Aged and Diluted Sidestream Smoke from a Reference Cigarette," GR.E. Coggins, P.H. Ayres, A.T. Mosberg, J.W. Sagartz, and A.W. Hayes, Inbalation Toxu+vlogy 5: 77-96, 1993 [See Appendix A] In this article, R.J. Reynolds researchers report on a 90-day inhalation study in which rats were exposed to aged and diluted sidestrram smoke (ADSS) as a surrogate for ETS. Mild epithelial hyperplasia in the nasal cavity was reported in rats exposed to "exagger- 9 ated" smoke levels; the cellular changes were completely reversible. No histological'dianges were reported for either "typical" or "extremeA exposure categories. Other end points used in the study reportedly showed "no detectable biological activity" ofADSS. [23] "Environmental Tobacco Smoke in Commercial Aircra&," D.J. Eatough, F.M. Caka, J. Crawford, S. Braithwaite, LD. Hansen, and E.A. Lewis, Atmospheric Environment 26A(12): 2211-2218, 1992 [See Appendix A] These researchers report on the development of a model for calculating the concentration of ETS con- stituents in airplane smoking sections, and the "penetra- tion" of ETS into the nonsmoking section. SMOKING POllCES AND REIATED ISSUES [24] "Smoking Policies of Licensed Child Day-Care Centers in the United States," D.E. Nelson, J.J. Sacks, and D.G. Addis, Pediatria 91(2): 460- 463, 1993 [See Appendix A] This study reports on the analysis of data from a national survey of day-care center directors with regard to employee smoking policies, in an attempt to estimate ETS exposure of children attending day-care fadlities. Whi7e the authors report that 55 percent of the centers banned smoking both indoors and out, and 26 percent banned smoking indoors only, they also claim that 752,000 children will be exposed to ETS in those centers where smoking is restricted by place or time, rather than banned This research was presented in November 1992 as an abstract at the Ameri- can Public Health Association Annual Meeting. See Issue 38 of this Report, January 7, 1993. OTHER DEVELOPMENTS [25] • EPA Risk Assessment on ETS Expected to Impact Employer Smoking Policies Employers around the country are reportedly mthink ing their workplace smoking policies in light of the EPA Risk Assessment on ETS. Although many companies restrict smoking to designated rooms or private offices, the lack of separate ventilation, according to the EPA, may be inadequate to protect workers.

10 Spokespersons for Hewitt Associates in Illinois, A. Foster Higgins & Co. in New York, Raytheon Corp. in Massachusetts, Southern California Edison Co. in California, Belz Enterprises in Tennessee, and Dow Chemical Co. are evidently relying upon the EPA risk assessment to either increase smoking restrictions in their own facilities or advise their clients to do so. Some companies are even taking steps to prohibit smoking out of doors. The most successful strategies for implementing new policies, these spokespersons observe, involve effective communications with employees and advance notice of changes. See Business Insurance, February 8, 1993. [26] • Life Insurance Firm Offers Discount to Smoke-Free Workplaces Reliance Standard Life of Philadelphia, Pennsylvania, is reportedly offering discounts on group term life insurance rates for all new policyholders who have a 100 percent smoke-free workplace. According to a Reliance Standard spokesperson, the EPA Risk Assess- ment on ETS suggests that a change to a smoke-free workplace can improve employees' health significantly. Reliance Life expects "mortality will improve by six percent or seven percent, conservatively." To qualify for the discount employers will have to provide a letter verifying the existence of the smoke-free workplace and a copy of the smoking policy, if written. This insurance policy is evidently available in 49 states and the Distria of Columbia. See Life erHealth, February 1, 1993. [27] • Nation's Resrzurateurs Face New Concerns in Wake of EPA Risk Assessment on ETS A trade publication for restaurant owners recently published an anide and commentary which discuss the ramifications of the EPA Risk Assessment on ETS with respect to the restaurant industry. Some restaurateurs reportedly are predicting "rebellion" among nonsmok ing servers who may refuse to serve smoking customers and possible demands among patrons for walled-in smoking sections with separate ventilation. According to general counsel for the Texas Restaurant Association, the EPA risk assessment is likely to fuel demands for more restrictive laws which may eventu- ally lead to a nationwide ban on smoking in all public places. He also noted that the risk assessment may increase smoking-related liability lawsuits against ETS/IAQ REPORT, ISSUE 41 restaurateurs. Hikes in insurance premiums are also regarded as potential fallout from the risk assessment. Various predictions are being made as well about what impact smoking bans will have upon consumers' dining out habits. The commentary concludes by warning defensive restaurateurs "to rethink strategies for dealing with customer and employee health concerns related to secondhand smoke. And with liability risks and awareness levels rising rapidly, we urge operators to tackle this volatile issue before it tackles you." See Nation's Restaurant Nerus Ntwspaper, January 25, 1993. [28] • California Restaurant Chain Implements Smoking Ban Citing the EPA Risk Assessment on ETS and con- cerns about employee and customer health, the president of Norms Restaurants, based primarily in Los Angeles and Orange Counties, announced on February 8, 1993, that smoking will be prohibited in each of its 16 locations, effective immediately. The restaurants, which are open 24 hours a day, evidently expect a temporary drop in sales based upon experience with a nonsmoking faciliry in Bellflower. Long term profits, however, are not expected to suffer. Company head- quarters, where smoking is permitted in executive offices and employee break rooms, will reportedly be exempt from the policy. See Business MrA February 8, 1993; LosAngela Tima, February 12, 1993. [29] Restaurant Chain Claims Smoking Ban Has Not Harmed Business In July 1991, California Pizza Kitchen adopted a smoking ban in all of its 27 company operated stores. According to co-chair and co-founder Larry Flax, the policy has not harmed normal sales growth since that time. The Los Angeles-based pizza and pasta chain reportedly operates restaurants in cities throughout the United States and is the only national restaurant chain that enforces a smoking ban, even on its patios. See PR Neunuwim February 4, 1993. [30] Nonsmokers Rights Group Presses for Smoke- free Nightdubs Americans for Non-smokers' Rights is reportedly trying to convince nightclubs and other music venues

FEBRUARY 19, 1993 to go smoke free. The movement has apparently gained the support of such musicians as Boyz II Men, En Vogue, Linda Ronstadt, John Lee Hooker, Richard Marx, Bobby McFerrin and Tuck & Patti. According to press reports, McFen:in, Tuck & Patti and the Roches, within the past four months, have requested that their shows be smoke free. Ste USr4 Today, February 4,1993. [31] • Restaurant Guide Prepared in Response to EPA Risk Assessment on ETS Public health experts have reportedly published a guide to the 175 restaurants in San Francisco that do not permit smoking. The guide, which is available free of charge, was evidently released in response to the EPA Risk Assessment on ETS. See The San Francisco Chronicle, February 3, 1993. [32] ASH Issues National Survey on Smoking and Health Earlier this month, ASH distributed to those on its mailing list a two-page "National Survey on Smoking & Health." The first two questions in the survey relate to ETS. They ask what action, if any, the government should take with respect to smoking policies in (i) public places and (ii) private workplaces. Four answer choices are provided: Ban all smoking; permit smoking only in separate sections; only enforce decisions made by owners; or do nothing. The other questions in the survey ask whether the government should spend more money on "antismoking education," whether the government should discontinue tobacco subsidies, whether the United States should ban tobacco advertising, and whether the government should require smokers to pay more for health insurance. The cover letter accompanying the survey advocates the use of"citiun-supported legal action" to "guarantee every nonsmoker the right to breathe air unpolluted by tobacco smoke in all public places, induding the workplace." Recipients of the letter are asked to return the completed survey along with a monetary contribution. [33] • High School Students Close Teachers' Smoking Lounge At Wantagh High School in New York, two students responded to the EPA Risk Assessment on ETS by 11 launching a campaign to close the teachers' smoking lounge located across the hall from their afternoon~ calculus dass. By a vote of 88-20, school employees agreed to dose the lounge after the students waged an information and lobbying campaign. The matter may be subject to collective bargaining, however, and the employees' union maintains that a ban must be negotiated. New York City schools and several districts on Long Island are reportedly smoke-free, but it is believed that this is the first time where the impetus to adopt such a policy came from students. See Nrwsday, February 13, 1993. [34] West Virginia Poll According to a newspaper article, a West Virginia poll indicates that 72 percent of residents favor setting aside smoking areas in hotels, motels, the workplace, and restaurants. West Virginians' attitudes apparently dosely parallel national trends revealed in a December 1991 Gallup poll. That survey found 66 percent to 70 percent of people nationwide favor designated smoking areas in public. The poll was conducted by telephone interviews between January 11 and 14, 1993, the week following release of the EPA Risk Assessment on ETS. It was conducted by a polling company for the Charla- ton Daily Mai4 WSAZ Television 3 and Assacsated Fras, using a random sample of 409 West Virginia residents. See Charleston Daily Mai4 February 15, 1993. MEDIA COVERAGE [35] "Q and A," Real Estate Desk, The New York Times, February 7, 1993 A co-op shareholder wrote to The Times asking if she has any right to a smoke-free home. Evidently, fellow shareholders smoke heavily, and the odor of fresh and stale smoke allegedly permeates her home. She said she was writing out of concern for her health. The answer provided was that the only way she could force fellow tenants not to smoke would be if she could prove that "the smoke is so odious that it violates the legal tenet known as the warrant of habitability." Although "environmental problems" such as excessive noise are generally prohibited by co-op by-laws and documents, the chairman of the Council of New York

12 Cooperatives, who was consulted for the response, observed that there have been no known instances of any co-op board taking action to restrict owners from smoking in their own apartments. [36] •"Something New to Chew Over in the Oval Office," R. Emmett Tyrrell, Jr., The Waahington Times, February 7, 1993 In this commentary, the author disputes the findings of the EPA Risk Assessment on ETS, calling it "shoddy science," and discusses the Clintons' decision to ban smoking in the White House. The author states that consistency will require that produce sprayed with pesticides, dectric appliances emitting electromagnetic fields, and chlorinated water be banned as some studies indicate they pose greater health risks than exposure to ETS. When the Washington press corps sought to dispute daims that the Clintons do not smoke by producing photographs depicting President Bill Clinton on his campaign plane with a cigar, the President's press secretary said he doesn't smoke cigars, he dtews on them. Accord- ing to this commentator, our "youthful president" has devised a method of "safe smoking." [37] Perfume Ban Sparks Controversy in San Franctisco With comparisons to the controversy over smoking bans and ETS, attention has been given in the media recently regarding the efforts of San Francisco's mayor and chief administrative officer to make public meet- ings accessible to those who allege they have chemical sensitivities. In November 1992, a memo was report- edly circulated to San Francisco department heads stating, "In order to allow individuals with environ- mental illness or multiple chemical sensitivity to attend the meeting or hearing, individuals are requested to refrain from wearing perfiime or scented products." Proscribed products indude hair mousse, body lotion and clothes that have recently been to the dry cleaners. The cosmetics industry has reportedly been unable to convince the mayor to change the ban, and a similar ban is now being considered in Marin County. On a statewide level, a group that lobbies on behalf of people with alleged chemical sensitivities has apparently asked libraries and schools to subscribe only to "fragrance free publications." Critics and commentators warn that deodorant and soap may be next on the "political ETS/IAQ REPORT, ISSUE 41 correctness" agenda. See The San Francisco Chroniclr, February 3, 1993; Transcript, CBS Evening News, February 12, 1993. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS CANADA [38] • Durham Regional Council Seeks Public Input on Smoking Bylaw The Durham Regional Council reportedly endorsed a model bylaw in December 1992 that would' restria smoking in public places to designated areas. The public health nurse for Durham Region, citing the U.S. EPA Risk Assessment on ETS, said that people are more aware of the alleged health effeccs of ETS exposure now, and residents are being given the opportunity to provide input into the proposed bylaw. A public meeting will be held later this winter on the matter. See The Toronto Star, February 11, 1993. CHINA [39] Government to Consider Extending Smoking Ban Accon3ing to Health and Welfare Secretary Flizabeth Wong Chien Chi-lien, the government is considering whether to extend existing smoking bans to more public places. The bans would be part of a larger package of initiatives designed to discourage smoking. See South China MomingPoA February 4,1993. HONG KONG [40] ETS Health Warnings Now Required on To- bacco Products The government has reportedly adopted new regula- tions which, among other matters, would require health warnings regarding ETS to be printed on tobacco products and cigarette packets. The warnings would state "smoking is harmful to oneself and others." See Sing Tao Daily, January 27, 1993.

FEBRUARY 19, 1993 ISRAEL [41] Smoking Restrictions to be Introduced by Health Minister Health Minister Haim Ramon will reportedly introduce regulations to ban smoking in all workplaces exeept for restricted "smoking rooms.° Although more than 30 percent of Israel's adult population smokes, surveys have shown that a large majority, induding smokers, favors workplace smoking restrictions. Smoking is already reportedly barred in theaters, sports facilities, hospitals, supermarkets, banks, post offices, taxit, buses and deva- tors. 'Me Health Minister is reportedly considering adding "non-residential places where bridge is played," to that list. See TlxJnusalem Posx February 4, 1993. No1NVAY [42] Government OfI'ices in Oslo Adopt Smoking Ban On January 1, 1993, a total smoking ban was report- edly introduced in government offices in the old part of the city of Oslo. Evidently, this is the first area of Oslo in which such a ban has been introduced. See Arbeiderblade>; December 29, 1992. SWEDEN [43] Smoking Legislation Introduced The government has reportedly introduced a tobacco bill that would restrict workplace smoking in nurseries, schools and hospitals. Smoking in these establishments would only be permitted in designated smoking rooms. Restaurants would also be subject to the restrictions; those with more than 50 seats would be required to designate nonsmoking areas. Hotels and similar establishments would reportedly be required to offer nonsmoking rooms. In addition, smoking in public service vehides would be prohibited. Smoking com- partments, however, would be permitted on trains. See Svenska Dagblad4 February 5,1993. [44] Stockholm Politicians Consider Restaurant Smoking Ban Several members of the Stockholm county council have reportedly suggested that Stockholm's restaurants should 13 impose smoking bans during a trial period this autumn. The plan would require that 50 different types of restau- rants provide smoke-free service during certain days of the week. Apparently, this would be done on a rotational basis. See Sr,rnka Dag6ladet, February 1, 1993. UNTTED KINGDOM [45] Workplace Smoking Control Bill Introduced On February 2, 1993, Labour's George Foulkes introduced the "Health and Safety at Work (Tobacco Smoking) Act 1993," in the House of Commons. A copy of the bill is attached as Appendix C. The Act prohibits smoking in enclosed work areas but allows employers to set aside designated smoking areas if they so choose. The Act also provides that an employee shall be deemed unfairly dismissed if such employee is principally fired for refusing to work in a smoking area, or if the employee voluntarily leaves berause the employer fails to provide a smoke-free area. The Secretary of State is charged with, among other things, making regulations: (i) specifying the term "designated" area; (ii) defining which areas will be exempted; and (iii) requiring consultation with em- ployees before deciding which areas are designated. According to press reports, the bill is apparently unlikely to prooad further becau.se of pressures on the parliamen- tary timetable, although MP Foulkes has reportedly challenged the government to allow time for its passage. See Pren Arroriation Neuaf 'tle, Febniary 2, 1993. [46) Smoking Ban Imposed in Health Care Facilities Beginning March 1, 1993, all hospitals, health centers, clinics and offices controlled by the Argyll and Clyde Health Board will reportedly ban smoking. According to a Board spokesperson, contracrs of employment could be terminated if staff members fail to comply with the new policy. Segregated smoking areas are reportedly being recommended. See Glasgow Evening Tirrtes, January 22, 1993. [47] Fines Threatened if Voluntary Smoking Bans are not Introduced In a Commons written reply following Opposition calls for a ban on tobacco advertising, Health Minister

14 Dr. Brian Mawhinney reportedly stated that the government would consider assessing fines of up to 200 pounds if voluntary smoking bans are not imposed in eight out of ten public places by next year. See Today, January 27, 1993. LEGAL ISSUES AND DEVELOPMENTS AUSTRALIA [48] Experts Warn of Legal Action Against Smoking Parents Family law specialists are reportedly predicting that parents who fail to provide their children with a smoke free environment in the home may face restraining orders, particularly in child custody cases where the allegedly- affected child has a brondhial'~problem and there is medical evidence to relate the problem to ETS exposure. Stephen Woodward, executive director of ASH, believes that a pre-existing illness should not be necessary as "the mere risk of lung cancer is sufficient for parents not to smoke around kids." According to Woodward, several individuals in Melbourne have sought his advice on the issue. See Herald-Surn, January 26, 1993. THE NETHERLANDS [49] Netherlands Smoker Fined in June Challenges Smoking Ban A woman who was fined in June 1992, for smoking on a local train in the north of the country has reportedly challenged the smoking ban as having no legal basis. Apparently, only national railway officials can impose a smoking ban in one section of a train. The national railway, reportedly in accordance with the challenge, has decided to allow smoking in the entrance of each com- partment. According to press reports, the national railway may implement a general smoking ban on some types of trains beginning January 1, 1994. SKlk Volkskraru December 24, 1992.. NEW ZEALAND [50] Legal Aid Submission Filed on Behalf of To- bacco Companies Rothmans of Pall Mall Ltd., WD & HO Wills Ltd., and Philip Morris Limited have reportedly filed a ETS/IAQ REPORT, ISSUE 41 submission with the Legal Services Board regarding the funding of possible tobacco litigation in New Zealand. The submission refers to newspaper articles which indicate that ASH is actively seeking plaintiffs with ETS daims to bring lawsuits against the tobacco industry. Although the submission emphasizes the failure of smokers who have brought lawsuits around the world, its arguments regarding the problems for plaintiffs in terms of expense and proving causation, and the many legal defenses that are available to the tobacco companies, are equally applicable to ETS claims. A similar submission was made on behalf of the tobacco companies in Australia. See issue 40 of this Report, February 5, 1993. UNITED KINGDOM [51] Settlement in ETS Case Provokes Widespread Interest The settlement of the Veronica Bland case, which involved a daim of injury from ETS exposure, see issue 40 of this Report, February 5, 1993, has been widely publicized in the media and appears to be spurring interest in further litigation and regulatory activities. One newspaper article observes that ASH is consider- ing supporting legal actions against about 20 different employers who allegedly fail to provide facilities that separate smokers from nonsmokers. The cases report- edly include an office deaner for a Liverpool tobacco company, a bank clerk, and a health authority em- ployee. According to ASH, the most likely "victims" are bar staff, waiters and workers in small offices. See The Guardian, January 28, 1993. There are several additional items in this Report in which reference is made to the Veronica Bland case. They include discrimination against smokers by the Royal Liverpool University Hospital; a Teletext survey of viewers on workplace smoking bans; predictions about funher similar legal actions; and a commentary on antismoking fervor. [52] ETS "Victim" Hotline Set Up In response to the Veronica Bland case, a Bristol law firm has reportedly set up a hotline for "passive smoking victims" to register claims. Solicitors Roger

FEBRUARY 19, 1993 Gibbs and Co. will apparently ask potential daimants to complete a confidential'questionnaire and will then offer a free consultation with the firm. According to one of the firm's partners, the firm will try to provide assistance to those employees who feel they have genuine daims but do not have union support to pursue their daims. See Brisavl EvrningPosA January29,1993• SCIENTIFIC/TECHNICAL ITEMS UPCOMING MEETING [53] "Indoor Air Quality and Respiratory Disease," London, England, April 14, 1993 This one-day conference is expected to focus on respiratory health problems induding asthma and lung cancer, in the context of indoor air quality. Speakers will indude Martin Jarvis, who will present "Exposure to Passive Smoking The Evidence from Measures of Cotinine," and Peter Lee, who will present "Environ- mental Tobacco Smoke and Lung Cancer." Other presentations will focus on scientific considerations on indoor/outdoor air quality, indoor allergens and childhood asthma, airways hypersensitivity, respiratory virus infections, and birds and diseases. The conference is sponsored by Indoor Air Interna- tional in association with the Medical Research Council Toxicology Unit and the Centre for Toxic Waste Management, Imperial College of Science, Technology & Medicine. CARDIOVASCUTAR ISSUES [54] "The Heart: A Target Organ for Cigarette Smokin&" A. Leone, Journal ofSmokingRelated Disorders 3(3): 197-201, 1992 [See Appendix A] The author of this artide reports briefly on several studies on "the role of smoking on the cardiovascular system." He indudes a study of cardiac performance during exercise, in which men were exposed to a "smoking environment." The author daims that the study subjects "showed impaired cardiac performance" when exposed to smoke. 15 RESPIRATORY DISEAASES AND CONDITIONS - CHILDREN [55] "Drug Consumption During the First 18 Months of Life of Infants from Smoking and Non-smoking Families," A. Hakansson and C. Peterssson, British Journal of General Practice 42: 362-365, 1992 [See Appendix A] The authors of this Swedish study report on drug consumption by infants, in relation to "social vari- ables," including parental smoking. They report that infants from smoking families were prescribed signifi- candy more antibiotics than were infants from non- smoking families. Treatment for respiratory tract infections was also reportedly higher in infants from smoking families. OTHER HEALTH ISSUES [56] "Risk Factors for Atrial Septal Defect," J. Tikkanen and O.P. Heinonen, European Journal ofEpidemiology 8(4): 509-515, 1992 [See Appendix A] This study focuses on environmental factors during pregnancy as possible risk factors for atrial septal defect, a malformation of the heart, in infants. The authors present statistically nonsignificant odds ratios for ETS exposure at home or at work. OTHER DEVELOPMENTS AUSTRALIA [57) • Shopping Centre to Introduce Smoking Ban Brookside Shopping Centre in Brisbane will report- odly be the first in the area to introduce a total smok ing ban. The ban will cover shoppers as well as the 1,500 employees at the centre's 107 stores. The ban will go into effect on March 31, 1993, and smoking shelters will be provided outdoors for workers to smoke during their breaks. The policy is reportedly being adopted following successful legal challenges by individuals allegedly claiming injury from ETS expo- sure. Other cenues in the area have no immediate

16 plans to follow Brookside's lead. See North West News, January 20, 1993. In a related story, the manager of the Tweed City Shopping Centre is calling for Tweed City and the Gold Coast to adopt smoking bans in shopping centres. He is apparently pushing for shopping centre owners to impose smoke-free policies in concert and praises the owner of the Pacific Fair Shopping Centre which has announced that smoking bans will be phased in at its 17 properties during the next 12 months. The chairman of the Australian Council of Shopping Centres is reportedly predicting that all centres will be smoke free within a year. Liability issues are apparently foremost among the concerns of shopping centre owners. See Goldcoastrr, January 16, 1993. Westfield's 22 shopping centres are also reportedly considering adopting smoking bans. Apparently, centre owners fear litigation in the wake of the U.S. EPA Risk Assessment on ETS. See Northern News, January 21, 1993. Chermside Shopping Centre, however, has no plans to ban smoking despite the actions being consid- ered or taken by other centres. See Northside Chronicle, January 27, 1993. CANADA [58] Antismoking Activist Pickets McDonald's According to press reports, a McDonald's customer has launched a campaign to force the restaurants to ban smoking. McDonald's reportedly reserves about two- thirds of its seating for nonsmokers and responded to the antismoking picketing activities of customer Bram Cohen by stating that the restaurant will continue to provide smoking areas for those customers who wish to smoke, unless precluded from doing so by law. See The Gazetu (Montreal), February 4, 1993. CZECHOSLOVAKIA [59] WHO Recommends Smoking Bans to Protect Nonsmokers Meeting in Prague, a delegation of the World Health Organization reportedly said the Czech republic should take steps to reduce tobacco smoking in the workplace and in public places to protect nonsmokers from ETS exposure. According to the group, smoking in Czecho- ETS/IAQ REPORT, ISSUE 41 slovakia has "worsened" in the last three years in comparison to the developed countries of Western Europe. See CTKNational News Wire, February 5, 1993. EUROPEAN COMMUNITY [60] EC Finances Siclt Building Syndrome Project The WaU Strret Journal reports that the EC will be largely financing a $1.9 million project to study IAQ in office buildings. The project's goal is reportedly to "defeat Sick Building Syndrome." A 29-year-old Dutch scientist, Dr. Philomena M. Bluyssen, willt apparently be the project coordinator. Bluyssen is said to be a "bit of a star in the arcane world of Indoor Air Quality." She reportedly uses "sophisticated snifl'utg" methods to track down causes of IAQ problems and her "services as a sniffing sleuth are in demand:" The EC project, dubbed the "IAQAudit," will involve training panels of people to snifl'scientificrally and rate the perceived IAQ inside buildings. Each panel will sniff six buildings in each of nine countries. Bluyssen plans to write an IAQ handbook using the data once the project has been completed. A Yale University environmental health professory interviewed for the article, was critical of Bluyssen's methods stating, "There is no dear way to verify whether trained sniffers produce valid results." He said that nasal judgments should be combined with other types of testing. Sa Wall StrertJourna4 February 8,1993. JAPAN [61] Railway Company Adopts Smoking Restrictions East Japan Railway Co. will reportedly begin imple- menting smoking restrictions in its 349 stations near Tokyo and its 24 major stops in eastern Japan within the next month. As early as March 1, 1993, customers will be permitted to smoke only in designated areas. The new policy will reportedly affect some 15 million daily passengers. The company is also reportedly planning to extend the restrictions to 376 other stations where smoking is now permitted during certain hours.

FEBRUARY 19, 1993 According to press reports, smoking bans are already in effect in Sagami Railway Co. stations in Tokyo and in subway stations. Designated nonsmoking sections on the Tokaido Shinkansen super express lines between Tokyo and Hakata, Fukuoka Prefeaure, will appar- ently be increased to 45 percent from the present 30 percent on March 18. See Japan Economic Nni.rwire, February 1, 1993. [62] Antismoking Group Marks Anniversary The "Group to Establish Non-smoking Rights" reportedly marks its 15th anniversary this month. The group lobbies for smoking bans in public places and has proposed launching an antismoking education program in high schools. Begun by a small group of doctors, lawyers and company employees in Tokyo in 1978, the group currently boasts a membership of 100,000. See The Daily Yomiuri, February 5, 1993. Soum AFRICA, [63] Stiff Fines Face Smokers Who Light Up on Public Buses Smoking has reportedly been banned on all public buses in Johannesburg. Violators face fines of up to $650 or six months in jail. See The Star, December 3, 1992. UNITED KINGDOM [64] Booklet on Indoor Air Quality Attacks ETS The Scottish Office of the Environment Department has produced a booklet on IAQ in the home which states: "smoking of course is a major cause of air pollution in the home." The booklet also discusses carbon monoxide, radon, asbestos, dust, mold, lead and other toxic substances. The advice given to homeowners with regard to ETS is to not smoke at home, particularly in the presence of children. Ventila- tion is also recommended, but the booklet concludes that "ventilation alone does not adequately safeguard against exposure to environmental tobacco smoke." [65] Government Funded Project Launches Antismoking Initiatives The West Yorkshire Smoking and Health project has reportedly been launched to introduce more smoke- 17 free areas in the region. The project, funded by the government, will make dean-air awards to pubs and restaurants, will encourage employers to recognize the rights of their nonsmoking employees, and will stress the alleged dangers to nonsmokers from ETS exposure. According to health coordinator Pat Hodgson, some local organizations take the issue seriously, but much more needs to be done to protect nonsmokers. A smoking ban was reportedly introduced on Keighley and District Travel service buses three years ago. See Keighlry Nerus, January 22, 1993. [66] Hospital Announces Intent to Discriminate Against Smokers The Royal Liverpool University Hospital reportedly plans to ask job applicants whether they smoke or drink and will withdraw sickness benefits from those who take time off with smoking or drink-related illnesses. Although smoking is already restricted at the facility, the new policy calls for the adoption of a total smoking ban. Union officials are reportedly promising to fight the changes which they believe have been prompted by the award of damages in the case of Veronica Bland for injury allegedly caused by ETS exposure. See The Indrpendent, February 8, 1993; Sunday Ttlegraph, February 7, 1993. [67] Survey of Doctors Shows Lack of Advice to Patients About ETS The British Medical Association has reportedly surveyed family practitioners trgarding the advice they are giving their patients regarding ecposure of the fetus and young children to ETS. Apparently, doctors wish to help their patients stop smoking but most do not discuss the alleged adverse effects of ETS exposure with their pregnant patients. See The brdepcndent. February 3, 1993. In a related story, it has been reported that a urine test may soon be available that will demonstrate to parents that their children are being exposed to ETS. The test, which measures the level of cotinine and other forms of nicotine in a child's urine, is being developed in the Wolfson Laboratory at the Queen Elizabeth Medical Centre in Birmingham. See The Indeptndtnt, February 2, 1993.

18 [68] Supermarket Giant Will Impose Smoking Ban Supermarket giant Asda will reportedly impose a smoking ban at its head office in Leeds on March 1. An emergency smokeroom on the top floor will apparently be provided for those who wish to smoke, and hypnotists will be brought in to assist staff members who wish to quit. The ban is reportedly being imposed to protect nonsmokers from continuous exposure to ETS. See Prass Association Neu. fih February 5,1993. [69] Newspaper Promotes Anti-Smoking Campaign An advertisement appearing recently in a newspaper encourages anyone who is a"victim of passive smok- ing" to send in for stickers saying "Please Don't Smoke Near Me," which the newspaper and a television program are providing free of charge. The stickers are intended to be used in the home, car, office, or workplace, or are to be given to ftiends. See Today, January 29, 1993. [70] Teletext Viewers Favor Workplace Smoking Bans Some 80 percent of Teletext viewers who were invited to phone in their views on workplace smoking following reports on the settlement neadted in the Veronica Bland case apparently voted "yes" in answer to the question "Should smoking be banned in the workplacd" The poll is one in a regular series carried out by Teletext. Aocording to press reports, a growing number of employers are seeking information on the issue of ETS; the Institute of Personnel Management has said that there has been a"flurry" of requests for its guide Smoking PaGcia at Wonk since news of the Bland story became public The union which represented Bland, NALGO, has also reported numerous requests for information from private companies and insurance companies. See Press Axsociazion Neuxifile, February 1, 1993. [71] Predictions of Voluntary Workplace Smoking Bans Follow Settlement in Veronica Bland Case According to press reports which followed up stories on the settlement reached between Veronica Bland and her employer, offices and factories all over Britain will soon be imposing workplace smoking bans to avoid a "flood of similar actions," and paying out "thousands of pounds to victims of passive smoking." See Today, January 28, 1993. ETS/IAQ REPORT; ISSUE 41 [72] ASH Claims More Employers Move to Ban Smoking According to a press report, Abbey National will join those businesses which ban smoking by establishing a ban in all of its offices beginning in April. A survey found that 80 percent of the staffwere nonsmokers. ASH claims that half of Britain's companies have banned smoking in public areas to avoid the alleged danger of ETS exposure. Barclays Bank reportedly bans smoking during busy periods, and the BBC leaves it up to local managers to decide whether to impose smoking bans. See The London Times, January 28, 1993. [73] Major Suburban Rail System Bans Smoking In January, Network Southeast, a major suburban rail system, reportedly banned smoking on all trains. See Agence France Prase, February 3, 1993. The policy had been under consideration at the end of last year. See issue 37 of this Report, December 18, 1993. MEDIA COVERAGE CANADA [74] "For Rent: Healthy Building," D. Jones, The Financial Pos4 January 23, 1993 Aceording to the author of this artide, some building owners in Halifax are aggressively seeking tenants by marketing the "healthy" IAQ of their buildings. Poor IAQ and "sick building syndrome" are apparently creating problems for building designers, contractors and owners in Canada, and the Building Owners and Managers Association of Canada is reportedly conducting seminars and workshops throughout the nation to inform members about IAQ issues. The author observes that Camp Hill Hospital in Halifax is embroiled in a series of lawsuits regarding liability for renovations in a facility that has allegedly affected the health of some 600 employees. UNITED KINGDOM [75] * Flnancial 7i•mu Articles Report Smoking Ban Regulations in U.S. are Imminent In two articles discussing the alleged health effects of ETS exposure, it was reported that federal regulations

FEBRUARY 19, 1993 will soon be issued in the U.S. as a result of the EPA Risk Assessment on ETS that will "make it mandatory for companies with more than 10 employees to prohibit smoking" in the workplace. According to one of these artides, U.K. employers may join the move to ban smoking in the workplace, although the Confed- eration of British Industry is reportedly adamant that this should be a matter for individual employers to decide. See Financid Times, January 27 & 28, 1993. [7b] "Passive Smoking Dangers?," Yatelry e~rDistrict Courier, January 20, 1993 This artide summarizes the materials being reprinted by the smokers' rights group FOREST which indicate that the studies showing a risk to health from ETS exposure are based upon `bias and shoddy research." The article highlights the fact that the criticism of the ETS studies appeared in an independent report published by Consumrrs'Raearc{z [77) "Health Fascists Try to Stub Me Out," J. di Giovanni, Suuday T:mei; January 31, 1993 In this article, the author observes that the "fervent anti-smoking lobby in America has taken on Orwellian dimensions and it is quickly spreading around the world." She describes a recent visit to the United States where she was generally reviled for smoking in public and subjected to extensivc smoking restrictions. The Veronica Bland case is discussed, as is the workplace smoking bill that was introduced in parlia- ment by Labour MP George Foulkes. The author asserts that anti-smoking activities are taking place throughout the world even though, in her opinion, the medical evidence regarding ETS exposure is unsubstantial. 19

FEBRUARY 19, 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 ETS FxPosuRE AND MONITORING (21] "Passive Smoking and Tobacco Chewing Among Alaska Children: Measuring Saliva Cotinine," R.A. Etzel, D.B. ]ones, C.M. Schlife, J.R. Lyke, F.W. Spierto, and J.P. Middaugh, Journal ofSmoking-Related Disordirs 3(2): 161-165, 1992 "Our study objective was to document passive smoking and the use of smokeless tobacco among young children in rural'Alaska by measuring saliva cotinine concentrations.- 'The study population lived in the Yukon- Kuskokwim delta of western Alaska. The subjects of this study were 106 children, three to six years of age, who were attending Head Start programmes in two rural Alaskan communities.- 'The following five questions about tobacco use were asked: 1) How many people in the household where the child lives smoke cigarettes? 2) About how many packs of cigarettes are smoked a day by all the people in the house where the child lives? 3) About how many hours a day does this child spend indoors in a place where people are smoking? 4) Does this child chew tobacco? 5) About how many times a day does this child chew tobacco?" 'Cotinine was detected in the saliva of 17 (57%) of the 30 children in this study whose parents reported that the children had been exposed to tobacco smoke. Thirteen (38%) children without reported exposure to tobacco smoke had detectable cotinine, biochemical evidence of exposure." A-1 "Most of the children in this study had concentra- tions of cotinine less than 10 ng/mL, comparable with those found in other surveys of passive smokers. Although passive smokers usually have cotinine concentrations below 5 ng/mL, heavy passive exposure can result in levels of more than 10 ng/mL The highest cotinine concentrations previously reported in passively-exposed children were 25 ng/mL and 30 ng/ mL We found it remarkable that three children in this study had concentrations over 100 ng/mL (108.6, 175, and 264 ng/mL). Such high concentrations are incom- patible with passive exposure to tobacco smoke only. There are comparable with cotinine concentrations found in adult users of chewing tobacco, who have an average saliva cotinine concentration of 255 ng/mL ... Thus, we condude that Native Alaskan children's own use of chewing tobacco probably contributed to these high concentrations." `The 13 reportedly unexposed children who had detectable cotinine in their saliva could have been exposed to tobacco products within the previous few days without the parents reporting the exposure or perhaps even being aware of it. Likewise, the 13 reportedly exposed children who had no detectable cotinine may have been cared for by non-smokers during the previous few days." `Both passive smoking and the use of smokeless tobacco are dangerous for young children: This study shows that 44% of 3 to 6-year old children in two rural Alaskan villages have cotinine concentrations consistent with passive smoking, while approximately 3% of them had cotinine concentrations comparable to those of cigarette smokers and users of smokeless tobacco." [22] "Subchronic Inhalation Study in Rats Using Aged and Diluted Sidestream Smoke from a Reference Cigarette," C.RE. Coggins, P.H. Ayres, A.T. Mosberg, J.W. Sagartz, and A.W. Hayes, Inhalatron Toxicology 5: 77-96, 1993 "Male ... rats were exposed 6 hr/day; 5 days/week for up to 18 weeks to aged and diluted sidestream smoke (ADSS), used as a surrogate for environmental tobacco smoke (ETS), at concentrations of 0.1 ("typical"), I ("extreme"), or 10 ("exaggerated") mg of particulates/ m3. ... Animals were exposed nose-only, inside whole- body chambers, to ADSS from the 1 R4F reference cigarette. End points included histopathology, CO

.A-2 oximetry, plasma nicotine and cotinine, dinical pathology, and organ and body weights. The target particulate concentrations were achieved; at the exaggerated exposure they resulted in CO concentra- tions in excess of 50 ppm.... The only pathological response observed was slight to mild epithelial hyperplasia in the rostral nasal cavity, in the exagger- ated exposure group only. No effects were noted at low (typical of measured real-world ETS concentrations) or extreme exposures. The changes were similar in animals killed after 4, 28, or 90 days, and'were also similar to those noted in an earlier experiment with only 14 days duration, indicating that the change does not progress with increased exposure duration from 4 to 90 days. The nasal change was absent in a subgroup of animals kept without further smoke exposure for an additional 90 days, indicating complete reversibility. Overall, the end points used in the study demonstrated that (1) there was no detectable biological activity of ADSS at typical or even l0-fold ETS concentrations, and (2) the activity was only minimal at exaggerated concentrations in one region of one organ only." [23] "Environmental Tobacco Smoke in Commercial Aircraft," Dj. Eatough, F.M. Caka, J. Crawford, S. Braithwaite, LD. Hansen, and E.A. Lewis, Atmospheric Environment 26A(12): 2211-2218, 1992 `There has been an increased interest in determining exposure to ETS in commercial aircraft by quantifying the concentrations of pollutants assoaated with ETS, deter- mining the factors which control the concentrations of ETS present in nonsmoking sections of passenger cabins and devdoping models for predicting ezposure." "We have measured a variety of compounds associ- ated with ETS as well as several non-unique species (Such as PM2.5 and CO) in both smoking and non- smoking sections of aircraft cabins. The spectrum of species and aircraft sampled is intended to provide a database for the development of models for the predic- tion of ETS concentrations in aircraft cabins under a variety of conditions. This paper presents the results obtained from a series of DC-10 flights." "The concentration of most environmental tobacco smoke constituents in the smoking section of an aircraft cabin can be calculated from the frequency of smoking during a flight, the size of the smoking section and ETS/IAQ REPORT, ISSUE 41 ventilation rate. The concentration of nicotine will tend to be overestimated in this calculation due to selective loss of nicotine to cabin surfaccs. The concentration of some constituents (ag. PM2.5 and CO) may be underestimated in the calculation due to contributions of non-ETS sources to these species. CO and NO=, as well as ozone, may be introduced to the aircraft cabin from the inlet air. The rate of penetration of environmental tobacco smoke constituents from the smoking section into the nonsmok- ing section follows a first-onier rate law. The rate of penetration was constant for the various DC-10 aircraft flown in this study. The expected rate of decrease in the concentration ofvarious constituents with distance into the nonsmoking section can be altered by selective removal of compounds by cabin surfaces (e.g. nicotine) or by the presence of non-ETS sources of some species in the nonsmoking section (e.g. CO, PM2.5 or NO). Addi- tional data are needed to determine what variables control the 6rst-0rder penetration of environmental tobacco smoke constituents from the smoking to the nonsmoking sections of a variety of aircraft. The model developed in this paper has been suecessfiilly applied to other data sets. Manuscripts describing this extension of the concepts presented here are being prepared for publication." SMOIaNG PoucES AND REIATED IssuFs [24] "Smoking Policies of Licensed Child Day-Care Centers in the United States," D.E. Nelson, J.J. Sacks, and D.G. Addis, Pcdiatricx 91(2): 460- 463, 1993 "To our knowledge, the smoking policies and levels of exposure of children to ETS in day-care centers are unknown. We reviewed laws regulating smoking in day-care centers and analyzed data from a national sample of licensed child day-care centers to estimate potential ETS exposure among the estimated 3.94 million children 55 years of age regularly cared for in licensed or accredited centers." "The authors analyzed data from a national survey of 2003 directors of licensed child day-care centers to determine employee smoking policies, measure compli- ance with state and local employee smoking regulations for child day-care centers and state dean indoor air laws, and to estimate the extent of exposure to environ- mental tobacco smoke in these settings. Forty states regulated employee smoking in child day-care centers,

FEBRUARY 19,1993 but only three states required day-care centers to be smoke-free indoors. More than 99% of licensed child day- care centers had employee smoking policies that complied with the appropriate state or local smoking regulations. Nearly 55% of centers were smoke-free indoors and outdoors, and 26% were smoke-ftte indoors only." "Most states have regulations limiting smoking in child cay-care centers, but few require smoke-free policies. We found that nearly all licensed child day-care centers had policies that restricted employee smoking while at work, and the majority of these policies required facilities to be either totally smoke-free or smoke-free indoors. Smaller centers, centers located in the West or South, and inde- pendently owned centers were most likely to have srrin- gent employee smoking policies. Most centers had written smoking policies and were willing to hire smokers. Nearly alT centers had employee smoking policies that complied with state or local regulations, although 11 states had no such regulations for licensed child day-care centers." "More than 18% of children attended licensed day- care centers with policies restricting employee smoking to certain times or places. A policy that allows employ- ees to smoke in rooms when children are not present does not adequately protect children from ETS because it takes several hours for ETS to be cleared from an indoor environment. A policy that allows employees to smoke in rooms in which children are prohibited is also unlikely to protect children from ETS. Unless these rooms have a separate air circulation system venting directly to the outdoors (the cost of such a system is prohibitive), ETS will be circulated to all rooms in the buildings. Projecting our results nation- ally (based on 19.1% of the estimated 3.94 million children <_5 years of age who attend licensed or accred- ited day-care centers without smoke-free policies), an estimated 752000 young children are at risk for ETS exposure in these settings." "Although only Alaska, Arkansas, and Minnesota have laws or regulations stipulating that day-care centers be smoke-free indoors, our data suggest that dean indoor air laws and smoking regulations may be associated with more stringent employee smoking policies in day-care centers. If so, the implication is that state or local regulation of employee smoking in day-care centers would effectively reduce the risk of ETS exposure to children in day-care centers." A-3 "There are limitations to our study. Our results may not be applicable to family day-care homes, which are often unregulated, and therefore may be less likely to have or enforce smoke-free policies. The large number of local clean indoor air laws made it impractical to determine center compliance with these laws.... Another limitation is that actual employee smoking practices may differ from reported smoking practices and smoking policies.... Finally, no environmental measurements of ETS exposure were conducted." "Because expoaure to ETS has such serious health consequences for children and there is no known safe level of exposure, parents and pediatricians should insist that day-care centers in their communities be at least smoke- free indoors and, preferably, totally smoke-firee." IN EUROPE & AROUND THE WORLD CARDIOVASCUU+,R ISSUFS [54] "The Heart: A Target Organ for Cigarette Smoking," A. Leone, Journal of Smoking-Related Disordas 3(3): 197-201, 1992 "The purpose of this report is to discuss briefly our previous studies and to prove that cigarette smoking damages the heart." "We studied 19 non-smoking male volunteers. These consisted of nine healthy subjects and 10 patients with previous myocardial infarccion. The volunteers under- went exercise stress testing twice; once in a smoke-free environment and once in a smoking environment (carbon monoxide concentration 30-35 ppm)." "In each studied subject we measured the peak of exercise (Watts), time for recovery to pre-exercise heart rate (min) and plasma (%) and expired carbon monox- ide concentrations (ppm).... Each subject acted as his own control. No healthy volunteer developed chest pain during stress testing, but we stopped the exercise stress testing of four volunteers with a previous myo- cardial infarction in the smoking environment because of warning ventricular arrhythmias."

A-4 "In summary, we reached the following conclusion. Acute exposure to passive smoking impaired cardiac performance of both survivors of infarction and healthy volunteers. Survivors showed a significant reduction of the peak of exercise, prolonged time to recovery to pre- exercise plasma carbon monoxide concentration and ventricular arrhythmias in a smoking environment. Healthy people showed prolonged time to recovery to pre- exercise heart rate in the same environment. Therefore, both groups showed impaired'caniiac perfomiance in a smoking environment, although with different results." "Cigarette smoking has to be considered a potential hazard of daily life. Smoke inhalation, either active (such as smoking a cigarette) or passive (such as breathing indoor smoke), can cause a severe impair- ment of cardiac function. The results we discuss in the present overview justify such a statement." RESPIRATORY DISEIISES AND CONDITIONS - CHILDREN [551 "Drug Consumption During the First 18 Months of Life of Infants from Smoking and Non-smoking Families," A. Hakansson and C. Petersson, Britishjournal of General hractice 42: 362-365, 1992 "The aim of this study was to determine the overall consumption of drugs - particularly antibiotics - in a geographically well defined infant population, from birth up to the routine 18-month check up at the child health clinic. A further aim was to study the association between drug consumption and various social variables, especially the association between 'passive smoking' and the use of antibiotics. In addition, the reliability of the interview method compared with review of medical records was investigated." "The study population comprised 240 infants, of whom 90 were from families where tobacco was smoked by one or both parents and 150 were from non-smoking families. The investigation was carried out retrospectively by interviewing the mothers at the routine 18-month check up at the child health clinic, combined with study of the medical records at the district health centre, and at the paediatric and ear, nose and throat departments of the nearby hospital." ETS/IAQ REPORT, ISSUE 41 "[S]ignificantly more infants had been given antibiotics (or other antibacterial agents) in smoking families than in non-smoking families. Infants in smoking families were also given significantly more nose drops and dimethicone/ dicydomine hydrochloride, than infants in non-smoking families. ...[I]nfants from smoking families had been more affected by respiratory tract infections requiring antibiotics than had infants from non-smoking families in all age groups except the oldest." "At the 18-month check up [in this study], about two thirds of all infants in Teleborg had been given an antibiotic (or other antibacterial agent) on at least one occasion. The Tierp study [published elsewhere] produced rather lower figures - at the age of two years, 569~'0 of Tierp children had received antibiotics on at least one occasion; at the age of one year, the corresponding figure was 33%." "The overall drug consumption of the infants in this study would appear to be relatively high. This tendency to treat even very young infants with medication in cases of sudden illness has been demonstrated in a Swedish study of parent-reported drug consumption." "As regards the association between parents' smoking habits and infant morbidity, particularly respiratory tract infection, the study has demonstrated that infants from smoking families are more often given antibiotics than infants from non-smoking families. The impres- sion that the difference is a real one is strengthened by the higher incidence of respiratory tract infections requiring antibiotic treatment among infants from smoking families in all the three month age groups except the oldest during the first 18 months of the infants' life and by the fact that the cumulative difference between the groups tended to increase as the infants' age increased." OTHER HEALTH IssUEs [56] "Risk Factors for Atrial Septal Defect," J. Tikkanen and O.P. Heinonen, European Journal ofEpidemrology 8(4): 509-515, 1992 "The possible effect of environmental factors during pregnancy on the occurrence of auial septal defect (ASD-secundum) in the offspring was studied in 50 cases and 756 controls. The cases represented all verified ASDs in Finland during 1982-83. The con- trols were randomly selected from all infants born

FEBRUARY 19, 1993 1W during the same period. Case and control mothers were interviewed' by midwives using a structured question- naire approximately three months after delivery. Congenital heart disease was more prevalent among parents of cases than those of controls. Maternal alcohol consumption during the first trimester of pregnancy appeared to double the risk of atrial septal defect (OR = 1.9, CI" = 1.1-3•4). Maternal exposure to chemicals at work during the first trimester was more prevalent among the ASD-group (40.0%) than the control group (26.2%). The risk of ASD was not associated with maternal smoking, or coffee, tea or acetosalicylic acid consumption." "Maternal ecposure to video display terminals, micro- wave ovens, organic solvents, anesthetic gases, pesticides or wood preservatives during the first trimester of pregnancy were not associated with the risk of an atrial septal defect. It is conduded'thac some common physicat and chemical exposuntx during early pregnancy should not necessarily be considered risk factors for atrial septal defect." I"Expo- sure to passive smoking'° was also investigated. For exposure at home, an OR of 1.0 (95% CI 0.5-1.9) was reported; for workplace exposure, the reported OR was 0.5 (95% CI 0.2-1.5).J

•. California Environmental Protection Agency Stnto n( ('nlifnrnia OFFICE OF ENVIRONMENTAL HEALTH HAZARD ASSESSNIENT January 28, 1993 Dear Sir or Madam: Reouest for Information Re¢ardiTtg Environmental Tubacc,..:_ Sm.a',v , . . , ,. ~., :.... ... .~.,.rn,.. The California Environmental Protection Agency's Office of Envirnnnirr-tal Health Hazard Assessment (OEHHA) is writing to request that you },.~. : pertinent information you would like the OEHHA staff to consider as LhFN evaluate the health effects of environmental tobacco smoke (ETS). / We have conducted a reference search on ETS using several d.;:-L' ba<~: `' These references include material published from 1968 to early 1992. 1he attached bibliography lists recent relevant references from this informatioi> search. We are requesting additional pertinent information on ETS, any material that may not be available to the public or that is :,ot ir~:lL,uec in the enclosed bibliography (Enclosure I). Specifically, we are requesting information on ETS exposure and cancer, reproductive/developmental toxicity, and cardiovascular and respiratory effects. We are also interested in the aspects of exposure critical to an understanding of the potential risks of ETS exposure. We would appreciate receiving any information you wish to submit by March 15, 1993. Please send the information to: ETS Health Effects Evaluation Attention: Susan Royo Office of Environmental Health Hazard Assessment 2151 Berkeley Way, Annex 11, Room 408 Berkeley, California 94704 Telephone: (510) 540-2084 Thank.you for your attention to this request. Sincerely, en A. Book, Ph.D. Deputy Director Enclosure ISSUE 41 APPENDIX B 601 North 7th Sueet • P.O. Box 942732 . Sacnmenio. CA 94.3a-7320 •(916) 32s.7372 n -- 0..Uw,.erdNNe..

L nc:Cf::ro ETS BIBLIOGRkPHY Sr„okinz and Sudden Infr:nt Denth Syndrome Bergman AB, Wiesner LA (1976). Re?adonship of passive cigareae-smoldng to Sudden Infant Death Syndrome. Pedfarr.'cs 58:665-668. Haglund B, Cnattingius S (1990). Ci=areue smoking as a risk factor for Sudden Iniant Uc.:ah Syndrome: A popltion-based study. Am J Public Healrh 80:29-32. Hoffman h1, Damus K, Hiilman L, Kronord E (1988). Risk factors for S1DS. Result.s of the National Institute of Child Health and Human Development SIDS Coope dtive Eaidemiolog+cal Study. In: The Sudden Infanr Dea:h Syndrome. Cardiac and Resprrarory Mechanisms and Tntervenrions. Schwartz PJ, Southall DP, Valdes-Dapena M, e4s. .innals NYAcad Sci';33:13-30. Hoffman I-J, De.-Aman DW, Darnus K, van Belle G(1987). Comparison of matched ve:sm unmatched analvsis iit a case-control s:udy of SIDS risk factors. In: American Srarisrtcnl AssociarTon, 19$7 Proceedings of tlu Social Srarisrics Secrion. American Statistical Association, Alexs.idria, VA, pp. 318-323. Le•mak N, van den Berg BJ, Berkwith JB (1979). Sudden Infant Death Syndrome risk factors. Prospective data review. Clinical Pediatrics 18:r.04,1 11. Malloy MH, Ifle:nmsn JC, Land GE, Schramm WF (1988). The association of mate:nal smoldng with age and cause of inftt death. Am J FDidemiol 128:46-55. McGlashan ND (1989). Sudden infant deaths in Tasmania, 1980-1986: A seven-year prospective study. Soc Sd Med 29:1015-1026. Mitchell EA, Scrzaeg R, Stewart AW, Be..roft DMO, Taylor BJ, Ford RPK, Hassa111B, Barry DMI, Allen F.M, Roberts AP (1991). Results from the hrst year of the New Zealand cot death study. NZ Med .1104:71-76. Naeye RL, Ladis B, Drage IS (1976). Sudden Inftr.t Death Syndrome. A prospertive ttudy. Am J Dts Child 130:1207-1210. Nic.ltoll JP, O'Cathcin A (1988). Cigarette smoldng and eariy neonatal death (letter). Br Med J 297:487,, 88. Steek R, Langwor,h IT (1966). The re.ationship of ante.~ata1 and posutatal factors to suddea unexper.ed death in infancy. Cancd Med Asso ,I 94:1165-1171. 0~

Fried PA, O'Connell Chi (1987). A comparison of the effects of prenatal exposure to tobacco, alcohol, cannabis and caffeine on birth size and subsequent growth. Neuroroxicol Teratol 9:79-85. Fried PA, Watkinson B (1988). 12- and 24-month neurobehavioural follow-up of children prenatally exposed to marihuana, cigarettes and alcohol. Neuroro=icol Teratol 10:305-313. Fried PA, Watkinson B (1990). 36- and 48-month neurobehavioural follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol. ! Dev Behav Pedlatr 11:49-58. Garn SM, Petzold AS, Ridella SA, Johnston M (1980). Effect of smoking during pregnancy on Apgar and Bayley scores (letter). Lancet 11:912-913. Goldstein H (1972). Factors influencing the height of seven year old children-Results from the National Child Development Study. Hum Biol 43:91-111. Gusella JL, Fried PA (1984). Effects of maternal social drinking and smoking on offspring at 13 months. Neurobehavloral Tozicol Teratol 6:13-17. Hardy JB, Mellits ED (1972). Does maternai smoking during pregnancy have a long-term effect on the child? Lancet II:1332-1336. Kristjansson EA, Fried PA, Watldnson B (1989). Maternal smoking during prenartcy affects children's vigilance performance. Drug and Alcohol Dependence 24:11-19. Landesman-Dwyer S, R,agozin AS, Little RE (1981). Behavioral correlates of prenatal alcohol exposure: A four-year1ollow-up study. Neurobehavioral Toxicol Teraro11981;3:187-193. Lifschitz MH, Wilson GS (1987). Effects of passive smoking on children's behavioral and cognitive development (abstract). Pediatric Research 21:182A. Maldn 7, Fried PA, Watldnson B (1991). A comparison of active and passive smoking during pregnancy: Long-term effects. Neurotoxicol Teratol 13:5-12. Naeye RL, Peters EC (1984). Mental development of children whose mothers smoked during pregnancy. Obstet Gynecol 64: 6a 1-607. Naeye RL (1981). Influence of maternal cigarette smoking during pregnancy on fetal and childhood growth. Obstet Gynecol 57:18-21. Nichols PL, Chen TC (1981). Ivi'inimal Brain Dysfunction: A Prospe ctive Study. Lawrence Eribaum, Hillsdale, NJ. Rantahilio P, Koiranen M (1987). Neurological handicaps among children whose mothers smoked during pregnancy. Prev Med 16:597-606. Rantakallio P (1983). A follow-up study to the age of 14 of children whose mothers smoked during pregnancy. Acta Paediatr Scand 72:747-753. Rona RJ, Chinn S, Du V Flore~yC(1985). Exposure to cigare:te smoking and children's growth. li+t .l Epidemiol 14:402-409. Rona RJ, Du V Florev C, Clarke GC, Chinn S(1981). Parental smoking at home and height of children. Br Med J 1981283:1363.

Dahms TE, Bolin JF, Slavin RG (1981) Passive smoking. Chest 80:530-5.4. Dekker C, D?]es R, Bartle:t S, Brunel:reef B, Zwanenburg H (1991 Oct) Childhood asthmaa and the indoor environment. Chest 100(4):922-6. Di, kstra L, Houthuijs D, Brunekreef B, Al-l:erman I, Boleij JS (1990 Nov) Respiratory health effects of the indoor environment in a population of Dutch children. Am Rev Respir Dis 142 (5):1172-8. Dodge R (1982) The effects of indoor pollution on Arizona children. Arch Enviror: Health 37:151-155. Ehrlich R, Kattan M, Godbold J, Saltzberg DS, Grimm KT, Landrigan PJ, Lilienfeld DE (1992) Childhood asthma and passive smoking. Urinary cotinine as a biomarker of exposure. Am Rev Resplr Dis 145(3):594-599. Ekwo EE, Weinberger MM, Lachenbruch PA, Huntley WH (1983) Relationship of parental smoking and gas cooking to respiratory disease in children. Chest 662-668. Evans D, Levison ivIJ, Feldman CH, Clark NM, Wasilewski Y, Levin B, Mellins RB (1987) The impact of passive smoking on emergency room visits of urban children with asthma. Am Rev Respir Dis 135:567-572. Fergusson DM, Horwood L), Shannon FT (1980) Parental smoking and respiratroy illness in infancy. Arch Dis Child 55:358-361. Fergusson DM, Honvood LJ, Shannon FT, Taylor B (1981) Parental smoldng and lower respiratory illness in the first three years of life.l Epidemiol Community Healrh 35:180-184. Ferris BG, Ware JH, Berkey CS, Dockery DW, Spiro A, Spelzer FE (1985) Effe: ts of passive smoking on health of children. Environ Health Perspect 62:289-295. Forastiere F, Corbo GM, Michelozzi P, Pistelli R, Agabiti N, Brancato G, Ciappi G, Perucci CA (1992 Feb) Effects of environment and passive smoking on the respiratory health of children. lnt .l Epid emiol 21(1): 66-73. Gortmaker SL, Klein-Walker D, Jacobs FH, Ruch-Ross H (1982) Parental smoking and the risk of childhood asthma. Am J Public Healrh 72(6):574-579. h.ariap S, Davies AM (1974) Infant admissions to hospital and maternal smoking. Lancet 529- 532. Hasseiblad V, Humble CG, Graham MG, Anderson HS (1980) Indoor environmental determinants of lung function in children. Am Rev Respir Dis 123:479-485. Hosein HR, Corey P, Robertson JM (1989 Jun) The effect of domestic factors on respiratory symptoms and FEV1. Iru J Epidemiol 18(2):390-6. Kaplan JD, Calandrino FS, Schuster DP (1992) Effect of smoking on pulmonary vascular permeability. A positron emission tomography study. Am Rev Respir Dis 145(3):712-715. Kasuga H, Hasebe A, Osaka F, Matsuki H (1979) Respiratory symptoms in school children and the role of passive smoking. Tatal ! Erp Clin Med 4(2):101-114.

Martinez FD, Antognoni G, hiacri F, Bonci E, hfidulla F, De Castro G, Ronc:~etti R(1958) Parental smokins enhances bronchial responsiveness in nine-year-old children. Am Rev Respir Dis 138(3):518-523. Masi MA, Hanley JA, Ernst P, Becklake MR (1988) Environmental exposure to tobacco smoke and lung function in young adults. Am Rev Respir Dis 138(2):296-299. McConnochie KM, Roghmann KJ (1989) Wheezing at 8 and 13 years: changing importance of bronchiolitis and passive smoking. Pediatr Pulmonol6(3):138-46. Meltzer SB, Meltzer EO (1991) Harmful health effects of passive smoking. West J Med 154 (4):457-458. Menon P, Rando RJ, Stank-us RP, Salvaggio JE, Lehrer SB (1992 Feb) Passive cigarette smoke-challenge studies: increase in bronchial hyperreactivity. J Allergy Clin Immunol 89(2):560-6. Menon PK, Stankus RP, Rando RJ, Salvaggio JE, Lehrer SB (1991 Dec) Asthmatic responses to passive cigarette smoke: persistence of reactivity and effect of medications. J Allergy Clin Immunol 88(6):861-9. Moessinger AC (1989) Mothers who smoke and the lungs of their offspring. Ann N YAcad Sci 562:101-4. MurraX AB, Morrison BY (1986) The effect of cigarette smoke from the mother on bronchial responisveness and severity of symptoms in children with asthma. J Allergy Clin Immunol 77:575-581. Murray AB, Morrison BY (1988 Oct) Passive smoking and the seasonal difference of severity of asthma in children. Chest 94(4):701-8. Murray AB, Morrison BJ (1989 Sep) Passive smoking by asthmatics: its greater effect on boys than on girls and on older than on younger children. Pediotrics 84(3):4S 1-9. Neuspiel DR, Rush D, Butler NR, Golding J, Bijur PE, Kurzon M (1989) Parental smoking and post-infancy wheezing in children: A prospective cohort study. Am J Public Health 79(2):168-171. Norman-Taylor W (21 April 1972) Dangers for children in smoking families. Community Medicine 32-33. O' Connell FJ, Logan GB (1974) Parental smotdng in childhood asthma. Ann Allergy 32:142- 145. O'Connor GT, Weiss ST, Tager IB, Speizer FE (1987) The effect of passive smoking on pulmonary function and nonspecific bronchial responsiveness in a population-based sample of children and young adults. Am Rev Respir Du 135(4):800-804. Ogston SA, Florey CD, Walker CH (1987) Association of infant alimentary and respiratory illness with parental smoking and other environmental factors. J Epidemiol Communiry Health 41(1):21 25. Oldigs M, Jorres R, Magnussen H (1991) Acute effect of passive smoking on lung function and airway responsiveness in asthmatic children. Pediarr Pubnonol 10(2):123-31.

Somerville SM, Rona RJ, Chinn S (1988) Passive smoking and respiratory conditions in primary school children. J Epidemiol Communiry Health 42(2):105-110. Somerville SM, Rona RJ, Chinn S (1988 Jun) Passive smoking and respiratory conditions in primary school children. J Epidemiol Community Health 42 (2):105- 10. Spitzer WO, Lawrence V, Dales R, Hill G, Archer MC, Clark P, Abenhaim L, Hardy J, Sampalis J, Pinfold SP (1990 Feb) Links between passive smoking and disease: a best- evidence svnthesis. A report of the Working Group on Passive Smoking. Clin Invest Med 13(1):17-42; discussion 43-6. Stankus RP, Menon PK, Rando RJ, Glindmever H, Salva=gio JE, Lehrer SB (1988 Sep) Cigarette smoke-sensitive asthma: challenge studies. J Allergy Clin Inimuno182(3 Pt 1):331-8. Strachan DP, Anderson HR, Bland JM, Peckham C (1988 Mar 26) Asthma as a link between chest illness in childhood and chronic cough and phlegm in young adults. Br Med J (Clin Res Ed) 296(6626):890-3. Strachan DP, Jarvis MJ, Feyerabend C (1990) The relationship of salivary cotinine to respiratory symptoms, spirometry, and exercise-induced bronchospasm in seven-year-old children. Am Rev Respir Dis 142 (1):147-15 1. Tager I(1989) Health effects of involuntary smoking in the workplace. NY State J Med 89(1):27-31. Tager IB (1989) Health effects of passive smoking in children. Chest 96(5):1161-1164. Tager IB (1986) 'Passive smoking' and respiratory health in children-sophistry or cause for concern? [e3itorial]. Am Rev Respir Dis 133 (6):959-961. Tager IB (1988) Passive smoldng--bronchial responsiveness and atopy. Am Rev Respir Dis 138(3):507-509. Tager IB, Segal MR, Munoz A, Weiss ST, Speizer FE (1987) The effect of maternal cigarette smokin; on the pulmonary function of children and adolescents. Analyses of data from two populations. Am Rev Respir Dfs 136(6):1366-1370. Tager IB, Weiss ST, Rosner B, Speizer FG (1979) Effect of parental cigarette smoking on the pulmonary function of children. Am J Epidemiol 110:15-26. Tager IB, Weiss ST, Munoz A, Rosner B, S~eizer FE (1983) Longitudinal study of the effects of maternal smoking on pulmonary function m children. N Engl J Med 309:699-703. Tashkin DP, Clark VA, Simmons M, Re-_ms C, Coulson AH, Bourque LB, Sayre JW, Desels R, Rokaw S (1984) The UCLA popolation s:udies of chronic obstructive respiratory disease. Am Rev Respir Dis 129:891-897. Taylor B, Wadsworth J(1987) Maternal smoking during pregnancy and lower respiratory tr•act illness in early life. Arch DEs Child 62(8):786-791. Tsimoyianis GV, Jacobson MS, Feldman JG, Antonio-Santiago MT, Clutario BC, Nussbaum M, Shenke: IR (1987) Reduction in pulmonary function and increased frequency of cough associated with passive smoking in te:aage athletes. Pediatrics 80:32-36. 8~soss;~o

Woodward A, Douglas RM, Graham NM, hliles H (1990) Acute respiratory illness in Adelaide children: Bresst feeding modifies the effect of passive smoking. J Epidemiol Comnmun Health 44(3):224-230. Yarnell JWG, St Leger AS (1979) Respiratory illness, maternal smoking habit and lung function in children. Br l Dis Chest 73(3):230-236. Young S, Le Souef PN, Geelhoed GC, Stick SM, Turner KJ, Landau LI (1991) The influence of a family history of asthma and parental smoking on airway responsiveness in early infancy. N Eng11 Med 324(17):1168-1173. LOWER RESPIRATORY TRACT DISORDERS: Susceptibile Groups Chen Y (1989) Synergistic effect of passive smokine and artificial feeding on hospitalization for respiratory illness in early childhood. Chest 95(5):1004-1007. Gilljam H, Stenlund C, Ericsson-Hollsing A, Strandvik B (1990 Jul) Passive smoking in cystic fibrosis. Respir Med 84(4):289-91. Klein JD, Dorldn HL, Weiss ST (1989) Epidemiology of environmental tobacco smoke exposure and other respiratory risk factors in apopulatton of children with cystic fibrosis (Abstract]. Am Rev Respir Dis 139(4 Part 2):A565. Murray AB, Morrison BI (1992 Jan) Effect of passive smoking on asthmatic children who have and who have not had atopic dermatitis. Chest 101(1):16-8. Murray AB, Morrison BT (1990) It is children with atopic dermatitis who develop asthma more frequently if the mother smokes. I Allergy Clin Immunol 86(5):732-739. ' Rubin BK (1990) Exposure of children with cystic fibrosis to environmental tobacco smoke. N Ertgl ! Med 323(12):782-788. Schwartz J, Gold D, Dockery DW, Weiss ST, Speizer FE (1990) Predictors of asthma and persistent wheeze in a national sample of children in the United States. Association with social class, perinatal events, and race. Am Rev Respir Dis 142 (3):555-562. LOWER RESPIRATORY TRACT DISORDERS: Adult Crofton J, Masironi R (1989) Chronic airways disease: The smoking component. Chest 96(3 Suppl):349S-355S. Euler GL, Abbey DE, Hodgkin JE, Magie AR (1988 Jul-Aug) Chronic obstructive pulmonary disease symptom effects of long-term cumulative exposure to ambient levels of total oxidants and nitroQen dioxide in California Seventh-Day Adventist residents. Arch Envtron Health 43(4):279-85. Holland WW (1989) Chronic airways disease in the United Kingdom. Chest 96(3 Suppl.):318S-321S. Kalandidi A, Trichopoulos D, Hatza]ds A, Tzannes S, Saracci R (1990) The effect of involuntary smoking on the occurrence of chronic obstructive pulmonary disease. Soz Praventivmed 35(1):12-16.

ENVIRONI`IENTAL TOBACCO SMOKE REFERENCES: OTITIS MEDIA Barr G (1992) Passive smoking and otitis media with effusion [letter]. BM1304(6823):382- 383. Barr GS, Coatesworth AP (1991) Passive smoking and otitis media with effusion. BMJ 303 (6809):1032-1033. Black N (1985) The aetiology of glue ear-A case-control study. Int 1 Ped Ororhinoluryngol 9:121-133. Etzel RA (1987) Smoke and ear effusions [letter]. Pediatrics 79(2):309-311. Green RE, Cooper NK (1991) Passive smoking and middle ear effusions in children of British servicemen in West Germany-a point prevalence survey by clinics of outpatient attendance. .1 R Arrny Med Corps 137(1):31-33. Hinton A.(1992) Passive smoking and otitis media with effusion []etter]. BjW 304(6818):53. Hinton AE (1989) Surgery for otitis media with effusion in children and its relationship to parental smoking.l Laryngol Oro1103(6):559-561. Hinton AE, Buckley G(1988) Parental smoking and middle ear effusions in children.l Laryngol Otol 102 (11):992-996. Iversen M, Birch L, Lundqvist GR, Elbrond 0 (1985) Middle ear effusion in children and the indoor environment: An epidemiological study. Arch Environ Health 40:74-79. Ka11ai1 KT, Rainbolt HR,.Bruntzel MD (1987) Passive smoldng and middle ear problems in Kansas public school children.l Commun Disord 20(3):187-196. Kraemer lvlJ, Richardson MA, Weiss NS, Furukawa CT, Shapiro GG, Pierson WE, Bierman W (1983) Risk factors for persistent middle-= effusions: Otitis media, catarrh, cigarette smoke exposure, and atopy.lAMA 249:1022-1025. Ponka A, Nurmi T, Salminen E, Nykyri E (1991) Infections and other illnesses of children in day-care centers in Helsinki. I: Incidences and effects of home and day-care center var;abk-s. Infecrion 19(4):230-236. Pukander J, Luotonen J, Timonen M, Karma P (1985) Risk factors affecting the ocurrence of acute otitu media among 2-3-year-old urban children. Aua Ozolaryngol (Stockh) 100:260-?6S. Reed BD, Lutz IJ (1988) Household smoking exposure-association with middle ear effusions. Fcm Med 20(6):426-430. Richardson MA (1988) Upper airway complications of cigarette smoking. J Allergy Clin Lnnucnol 81(5 Pt 2):1032-1035. Smith JM (1990) Passive smoking and ear infection petter]. ASHA 32(6-7):3. Strachan DP, Jarvis MJ, Feverabend C (1989) Passive smoking, salivary cotinine ~ concentrations, and middle ear effusion in 7 year old children [see comments]. BMJ ~ 298 (6687):1549-1552. ~ N ~V

. ETS AND PERI-NATAL EFFECTS BIBLIOGP,-kPHY Ahlborg G Jr and Bodin L (1991). Tobacco smoke exposure and pregnancy outcun,: working women. A prospective study at prenatal care centers in Orebro County, Sweden. Am J Epirtemtol 133(4):338-47. Baron JA, La Vecchia C and Levi`F (1990). The andestrogenic effect of cigarette smot;ing in women. Am .T Ob/Gyn 162:502-14. Barrett-Connor E(1990). Smoking and endogenous sex hormones in men and wnonen i,.: ~' Wald and J Baron (eds), Smoking and Hormone-related Disorders. Oxford University 1•rr;s, Oxford, pp. 183-96. Borlee I, Bouckaert A, Lechat MF and Misson CB (1978). Smoking patterns durir,L a:-0 before presnancy: weight, length and head circumference of progeny. Eur,I Obsret, GynecnJ Repro BioTB(~):171-7. Bottoms SF, Kuhnert BR, Kuhner PM, et al. (1982). Maternal passive smoking and fetal serum thiocyanate levels. Am .1 Obster Gynecol 144( 7):787-91. Brooke OG, Anderson HR, Bland JM, Peacock JL and Stewart CM (1989). Effects cs.r birthwe:gitt of smoking, alcohol, caffeine, socioeconomic factors and psychosocial stress. Bnr Med 1298 (6676):795-801. Butier'04? (1991). Commentary on 'Links between passive smoking and disease: a best evidence synthesis-a report of the Working Group on Passive Smking.' Clin Invest Med 14(0`):484-6. Campbell MT, Lewry I and Wailoo M (1988). Further evidence for the effect of passive smoking on neonates. Posrgnrd Med .7 64 ( 75S): 663-5. Chen Y, Pederson LL and Lefcoe NM (1989). Passive smoking and low birthweight ne.rrefl. Lancet 2(8653):54-5. Chirico G, Locatelli F, Rondini G, et al. (1987). Effect of active and passive smoking on vascular reactivity in mothers. Lancer 1(8541):1095-6. Comstock GW and Lunden FE(1967). Parental smoking and perinatsl morta2 ity. am J Obster Gynecol 98(5):708-18. Coultas DB, Peake GT and Sarnet JM (1989). Questionnaire assessmeat of lifetime and recent exposure to environmental tobacco smoke. Am 1 Epidemiol 130(2):338-47. Cui YG, Dong ZW, Liu SB, Zhang SC, Wang Y and 1I XY (1990). Assessment of the mutagenic effect of maternal factors on human chorionic villi by micronucleus test Pro; Clin Biol Res 340B:217-22. Daling JR (1986). Cigarette smoking and primary tubal infe:uffity. In: M. Rosenberg (cxf), Smoking and Reproductive Health. PSG Publishers, Littleton, MA. Davis DL (1991). Pateraa2 smoking and feal health (tetter; commentl. Lcncet 337(8733):123.

MacMahon B, Alpert M and Salber E (1966). Infant w•ei=ht a"•d parental smoking h:al,itc. ~t,,~ J Epidemio182 (3):247-61. Magnus P, Berg K, Bjerkedal T and Nance NVE (19841). Parental determinants of birth weight. Clin Genetics 26:397-t05. Malloy MH, Kleinman JC, Land GH, et al. (1988). The association of maternal smol:it:g wW: age and cause of infant death. Am J Epidemio1128(1):46-55. Mantel N (1992). Re: "Tobacco smoke exposure and pregnancy outcome among women: a prospective study at prenatal care centers in Orebro County, Sweden.' [letter] Mt J Epidemiol 135(7):837-8. Martin TR and Bracken MB (1986). Association of low birth weight with passive sinokt exposure in pregnancy. Am J Epidemiol 124(4):633-42. Mathai M, Vijayasri R, Babu S and Jeyaseelan L (1992). Passive maternal smul:aig ~:r,J birthweight in a South Indian population. Br J Obster Gynaeco199(4):342-3. Mathai M, Skinner A, Lawton K and Weindling AM (1990). Maternal smoking, urinary cotinine levels and birth weight. AustNZJ Obster Gynaecol, 30(1):33-6. Mau G and Netter P (1974). The effects of paternal cigarette smoking on perinatal mortality and the incidence of malformations. Deutsche Medirinuche Moclunschrifr 99(21):1113-8. Nakamura M, Oshima A, Hiyama T, Kubota N, Wada K and Yano K (1988). Effect of passive smoking during pregnancy on birth weight and gestation: A population-based prospective study in Japan. In: Aold M, Hisamichi S, Tominaga S(Eds), Smoking and Health, 1987. Excerpta Medica, International Congress Series 780. Ogawa H, Tominaga S, Hori K, Noguchi K, Kanou I and Matsubara M (1991). Passive smoking by pregnant women and fetal growth. J Epidemiol Comm Hlth 45(2):1 tv3-8. Olsen J(1991). Cigarette smoking, tea and coffee drinking, and subfecundity. Am J Epidemio1133 (7): 734-9. Ovetp~k MD and Moss AJ (1991). Advance Data from Vitr1 and Health Statistics: Number 202. Children's Exposure to Environmental Cigarette Smoke Before and After Rinl~. l,,:zt.!t of Our Nation's Children. NTISLPB91-216549, Issue 20. US Dept of Health and liuman Services. Remmer H (1987). Passively inhaled tobacco smoke: a challenge to toxicology and preventive medicine. .irch Taxico161: 89-104. Rubin DH, Krazilnikoff PA, Leventhal JM, Weile B and Be:ge: A (1986). Effect of passivr smoking on binh-weight. Lancet 2(8504):415-7 Saito R (1991). The smoking habits of pregnant women and their husbands, and the effev nn their infants. Nppon Koshu Eisei Zasshi 38(2):124-31. Samet JM (1991). New effects of active and passive smoking on reproduction? [editorial]. Am J Epidemio1133(4):348-50.

Windham GC, Swan SH, Fenster L (1992). Parental cigarette smoking and the ri~: ^r spontaneous abortion. Am J Epiderniol 135(I2):1394-1403. Yerulshalmy JC (1971). The relationship of parents' cigarette smoldng to outcome of pregnancy-implications as to the problem of inferring causation from observed associations. Am I Epidemio193(6):443-54. Zhang J& Cai WW (1991). Severe vomiting during pregnancy: antenatal correlates an.: fetal outcomes. Epidemiology 2(6):454-7. Zhang J, Savitz DA, Schwingl P et al. (1992). A case-control study of paternal smoldng and birth defects. Int.7 Epid 21(2):273-8.

Coghlin J, Hammon SK, Gann PH (19g9). Development of epidemiologic tools for measuring environmental tobacco smoke exposure. American Journal of Epidemiology 130(4):696-704. Coultas DB, Howard CA, Peake GT, Sl::pper BJ, Samet Jlvi (1987). Salivary codnine levels and involuntarv tobacco smoke exposure in children and adults in New Mexico. Am Rev Respir Dis 136(2):305-9. Coultas DB, Peake GT, Sarnet JM (1989). Questionnaire assessment of lifetime and recent exposure to environmental tobacco smoke. Am J Epidemio1130(2):338-47. Coultas DB, Samet JM, McCarthy JF, Spengler ID (1980). A personal monitoring study to assess workplace exposure to environmental tobacco smoke. Am J Public Health 80(8):988- 90. Coultas DB, Samet JM, McCarthy JF, Spengler JD (1990). Variability of measures of exposure to environmental tobacco smoke in the home. Am Rev Respir Dis 142(3):602-6. Crebelli R, Conti L, Fuselli S, Leopardi' P, Zijno A, Carere A (1991). Further studies on the comutagenic activity of cigarette smoke condensate. Mutat Res 259(1):29-36. Cummings KM, Markello SJ, Mahoney M, Bhargava AK, McElroy PD, Marshall JR (19-)Measurement of current exposure to environmental tobacco smoke. Archives of Environmental Health 74-. Current Intelligence Bulletin 54-Environmental tobacco smoke in the workplace-lung cancer and other health effects. U.S. Dept of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safery and Health, Division of Standards Development and Technology Transfer, Division of Surveillance, Hazards Evaluations, and Field Studies; June 1991. Davis RM (1989). Proposition 65:More w2rning about the risks of tobacco. Journal of the American Medical Association 262(12):1632-1633. Di Giusto E, Eckhard I(1986). Some properties of saliva cotinine measurements in indicating exposure to tobacco smoking. Am J Pub Hlth 76:1245-1246. Djordjevic MV, Brunnemann KD, Hoffmann D (1989). Identification and analysis of a nicotine-derived N nitrosamino acid and other nitrosamino acids in tobacco. Carcinogenesis 10(9):1725-31. Doolittle DJ, Lee CK, Ivett JL, Mirsalis JC, Riccio E, Rudd CJ et al. (1990). Genetic toxicology studies comparing the activiry of sidestrearn smoke from cigarettes which burn or only heat tobacco. Mutar Res 240(2):59-72. Dube MA, Green CR (1982). Methods of collection of smoke for analytical purposes. Recent Advances Journal of Science pp 42-102. Eatough DJ, Benner CL, Bayona JM, Richards G, Lamb JD, Lee ML et al. (1989). Chemical composition of environmental tobacco smoke. 1. Gas-phase acids and bases. Environ Scf Technol23:679-687. Etzel RA (1990). A review of the use of saliva cotinine as a marker of tobacco smoke exposure. Preventive Medicine 19:190- 1107.

Henderson FW, Reid HF, Morris R, Wang OL, Hu PC, Helms RW et al. (1989). Home air nicotine levels and urinary cotinine excretion in preschool children. Am Rev Respir Dis 140(1):197- 201. Hoegg UR (1972)0. Cigarette smoke in closed spaces. EnWronmenral Health Perspectives 2(117-128). Hoffmann D, Adams JD, Brunnemann KD (1987). A critical look at N- nitrosamines in environmental tobacco smoke. To=icol Len 35(1):1-8. Hoffmann D, Melikian AA, Brunnemann KD (1991). Stodies in tobacco carcinogenesis. IARC Sci Publ (105):482-4. International Agency for Research on Cancer (IARC, 1985). Evaluation of the Carcinogenic Risk of Chemicals to Huraans--Tobacco Smoking. IARC Monographs Volume 38, Lyon, France. Ishizu Y (1980). General equation for the estimation of indoor pollution. Environmental ' Science and Technology 14(1254- 1257). Iwase A, Aiba M, IGra S (1991). Respiratory nicotine absorption in non-smoking females during passive smoking. Int Arch Occup Environ Health 63:139-143. Jarvis MJ, Foulds 1, Feyerabend C (1992). Exposure to passive smoking among bar staff. Br J Addict 87(1):111-3. Jarvis MJ, McNeill AD, Bryant A, Russell MA (1991). Factors determining exposure to passive smoking in young adults living at home: quantitative analysis using saliva cotinine concentradons. Inr .l Eoidemiol 20(1):126-31. Jarvis MJ (1989). Application of biochemical intake markers to passive smoking measurement and risk estimation. Mutat Res 2.22(2):101-10. - Jarvis M7, Russell MA, Benowitz NL, Feyerabend C (1988). Elimination of cotinine from body fluids: implications for noninvasive measurement of tobacco smoke exposure. Am J Public Health 78(6):696-8. Jarvis MJ (1981. Uptake of environmental tobacco smoke. IARC Sci Publ (81) p43-58 1987. Jarvis MJ, Tunstall-Pedoe H, Feyerabend C, Vesey C, Saloojee Y(1987). Comparison of tests usedd to distinguish smokers from nonsmokers. AJPH 77(11):1435-38. Jarvis MJ, Russell MAH, Feyerabend C,' Eiser JR, Morgan M, Gammage P et al. (1985). Passive exposure to tobacco smoke: saliva cotinine concentrations in a representative population sample of non-smoking schoolchildren. British Medical Journal 291:927-. Jenkins PL, Phillips TJ, Mulberg FJ, Hui SP (1992). Activity patterns of Californians: Use of and proximity to indoor pollutant sources. .ltmosphericEnvirnnmenr 26A. Leaderer BP (1991). Evaluation of vapor-phase nicotine and respirable suspended particle mass as markers for environmental tobacco smoke. Environ Scf Technol 25:770-777. Leaderer BP (1990). Assessing exposures to environmental tobacco smoke. Risk Anal 10(1):19-26.

Repzce JL (193Z). Environmental carc:r,ogens methods of analysis and exposure measurement. In: Chapter 10 - Indoor Concentrations of Emironmental Tobacco Smoke: Field Surveys, O'Neill IK, Brunnemann KD, Dodet B, Hoffmann D (Eds.) Volume 9 - Passive Smol:ing. International Agency for Research on Cancer. IARC Scientific Publications No. 81, Lyon, France. Repace JL, Lowrey AH (1935). A quantitative estimate of nonsmokers' lung cancer risk from passive smoking. Environlnternationa111:3-22. Repace JL, Lowrey AH (1985). An indoor air qualitv standard for ambient tobacco smoke based on carcinogenic risk. NY Srare J Med 83:381-383. Repace IL and Lowrey AH (1980). Indoor air pollution, tobacco smoke and public health. Science 208(464-472). Riboli E, Preston-Martin S, Saracci R, Haley NJ, Trichopoulos D, Becher H et al. (1990). Exposure of nonsmoking women to environmental tobacco smoke: a 10-country collaborative study. Cancer Causes Control 1(3):243-52. Rickert WS RJ, Collishaw N (1984). Yields of tar, nicotine, and carbon monoxide in the sidestream smoke from 15 brands of canadian cigarettes. American Journal of Public Health 74(3)(228-231). Russell MAH (1987). Estimation of smoke dosage and mortality of nonsmokers from environmental tobacco smoke. Toxicology Letters 35:9-18. Samet JM, Marbury MC, Spengler JD (1987). Health Effects and Sources of Indoor Air Pollution. Part I. American Review of Respiratory Disease 136(6):1486-1508. Scherer G, Conze C, von Meyerinck L, Sorsa M, Adlkofer F (1990). Importance of exposure to gaseous and particulate phase components of tobacco smoke in active and passive smokers. Inr Arch Occup Environ Health 62(6):459-66. Scherer G, Westphal K, Biber A, Hoepfner I, Adlkofer F (1987). Urinary mutagenicity after controlled exposure to environmental tobacco smoke (ETS). Toxicology Letters 35:135-140. Scherer G, Westphal K, Adlkofer F( ). Urinary, mutagenicity, hydroxyphenanthrene, and thioether excretion after expsoure to environmental tobacco smoke. US Environmental Protection Agency (EPA, 1992). Respirarory Health Effiects of Passive Smoking: Lung Cancer and Other Disorders. EPA/600/6-90/006B. EPA Ofnce of Research and Development, Washington, DC. REVIEW DRAFT, DO NOT CITE OR QUOTE. US Environmental Protection Agency (EPA, 1990). Health Eecu of Passive Smoking: Auessment of Lung Cancer In Adults and Respiratory Disorders in Guldren. EPA, Washington, DC US Environmental Protection Agency (EPA, 1990). Environmental Tobacco Smoke: A Guide to workplace smoking policies. US EPA, Indoor air division, Office of Atmospheric and Indoor Air Programs, Office of Air and Radiation. US Environmental Protection Agency (EPA, 1991). Environmental Tobacco Smoke: A Com ndium of Technical Information. US EPA. PRELIMINARY DRAFT - DO NOT CTTE OR QUOTE.

ETS BIBLIOGRAPHY• CANCERS Agapitos E, Delsedime L, Kalandidi A, Katsouyanni K, Mollo F, Riboli E et al. (1991). Correlation of early pathological lesions in the bronchial tre-- with environmental exposures: study objectives and preliminary findings. IARC Sci Publ 1991; (112):263-8. Akiba S, Kato H, Blot WJ (1986). Passive smoking and lung cancer among Japanese women. Cancer Res 46(9):4304-4807. Arundel A, Sterling T, Weinkam 1 (1987). Never smoker lung cancer risks from exposure to particulate tobacco smoke. Environ Int 13(6):409-426. Axelson 0, Andersson K, Desai G, Faoerlund I, Jansson B, Karlsson C et al. (1988). Indoor radon exposure and active and passive smoking in relation to the occurrence of lung cancer. Scand 1 Work Environ Healrh 14(5):286-92. Bartsch H, Caporaso N, Coda M, Kadlubar F, Malaveille C, Skipper P et al. (1990). Carcinogen hemoglobin adducts, urinary mutagenicity, and metabolic phenotype in active and passive cigarette smokers. 1 Natl Cancer Inst 82(23):1826-31. Becker MP (1989). Using association models to analyse agreement data: two examples. Stat Med 8(10): 1199-207. Blot WJ, Fraumeni IF Jr. (1986). Passive smoking and lung cancer. .1 Narl Cancer Inst 77(5):993-1000. Boreili TJ (1991). Passive smoking: statistical bias? [letter]. J Toxicol Clin Toxicol 29(2):293-5. Bos RP, Henderson PT (1984). Genotoxic Risk of Passive Smoking. Reviews on Environntenral Health 4(2):161-178. Bos R, Theuws 7, Henderson P (1983). Excretion of mutagens in human urine after passive smoking. Cancer Lett 19:85-90. Brownson RC, Reif IS, Keefe T7, et al. (1987). Risk facton for adenocarcinoma of the lung. American Journal of Epidemiology 125(1):25-34. Burch JD, Rohan TE, Howe GR, Risch HA, H'ill GB, Steele R et al. (1989). Risk of bladder cancer by source and type of tobacco exposure: a case-control study. Inr J Cancer 44(4):622- Burch PRJ (1986). Does breathing other people's tobacco smoke cause lung cancer? (Letter). British Medical Journal 293(6560):1503. Burch PRJ (1986). Passive Smoldng in Adulthood and Cancer Risk. (Le:ter). American Journal of Epidemiology. 123(2):368-369. February 1986 Language: English. Burch PRY (1985). Lifetime passive smoking and cancer risk (Letter). Lancet 1(8433):866. Burch PRJ, Hiravama T (1981). Passive smoking and lung cancer (Letters). British Medical Journa1282(6273):1393-1394.

Friedm::n GD (1986). Passive smoking in adulthood and cancer risk. (Le::e:). 4nsFrirnn .lourn::l of Epidemiology 123(2):367. Fukuda K, Shibata A (1990). Exposure-response relationships between woodworking, smol: ng or passive smoking, and squamous cell neoplasms of the maxillary sinus. Cancer . Causes Control 1(?):165-8. Gantt R, Lincoln JE (1988). Marriage to a smoker and lung cancer risk (Le:ter). American Journal of Public Health 78(1):99. Gao Y-T, Blot WJ, Zheng W, et al. (1987). Lung cancer among Chinese women. Intetr,ationallournal of Cancer 40(5):604-609. Garfinkel L (1984). Passive smoking and cancer-American experience. Preventive Medicine 13(6): 691-697. Garfinkel L (1981). Time trends in lung cancer mortality among nonsmokers and a note c»r, passive smoking. •lournal of the National Cancer Institute 66(6):1061-1066. Garfinkel L, Auerbach 0, Joubert L(1985). Involuntary smoking and lung cancei: A case-•- control study. Journal of the National Cancer Institute 75(3):463-469. Garfinkel L, Joubert L, Auerbach 0 (1986). Involuntary smoking and lung cancer-some object lessons (Letter). Journal of the National Cancer Institure 76(6):1263. Gray N(1992). Active and passive smoking [editorial]. Med 1 dusr 156(12):826-7. Grundmann E, Muller K-M, Winter KD, Ste:ling TD (1981). Non-smoking wives of heavy smokers have a higher risk of lung cancer (Letters). British Medicallourna1282(F270):1156. Haley NJ, Colosimo SG, Axelrad CM, Harris R, Sepkovic DW (1989). Biochemical validation of self-reported exposure to environmental tobacco smoke. Environ Rcs •19 (1) 1989. 127-•13511 Hammond EC, Selikoff U (1981). Passive smoking arid lung cancer with comments on two new papers. Environmental Research 24(2):444-452. He X, Chen W, Liu Z, Chapman RS (1991). An epide:niological study of lung c.a, ;.c; :~ Xuan Wei County, China: Current progress: Case-control study on lung cancer anci cojt;.ing fuel. Environ Health Perspect 94:9-14. Hdlbe:; D, Nilsson S, HaleY NJ, et al. (1988). Smoking and cervical intracpi,he~o.l neoplasia: nicotine and cotimnein serum and cervical mucus in smokers and nonsmoka s. American Journal of Obstetrics and Gynecology 158(4):910-913. Heller W-D (1983). Lung Cancer and Passive Smoking. (Letter). Lancer 2(R362):1300. Higgins I(1985). Lifetime Passive Smoking and Cancer Risk. (Letter). Lancer 1(8433)-8fi6. 867. Hirava.ma T (1984). Cancer mortality in nonsmoking women with smoking husbands based on a large-scale cohort study in Japan. Preventive Medicine 13(6):680-690. Hiravama T (1988). Duration of exposure as a determinant of lung cancer risk in pasc7ve. smokers. EVVIRON TCHNOL LE'IT 9(7): i31-732.

Johnson RH Jr, Geiger E (1991). Passic•.e cio: rette smoke incre=ses working levels exposures and lung cancer risk to all occupants of the smoker's home. Thiry-Sixth Annual Ndr:nrns~ ,{ the Health Physics Society, Washington, D.C., USA, JULY 21-?6, 1991. Healr;2 60(2):S 19. Kabat GC, Dieck GS, Wynder EL (1986). Bladder cancer in nonsmokers. Cancer 57(2):362- 367. Kabat GC, Wynder EL (1984). Lung cancer in nonsmokers. Cancer 53(5):1214-12? 1. Kalandidi A, Katsouyanni K, Voropoulou N, Bastas G, Saracci R, Trichopoulos D(199i'1. Passive smoking and diet in the etiology of lung cancer among non-smokers. Cancer Causes Control 1(1):15-21. Kastenbaum MA (1984). Consistency of research data on passive smoking and lung car:::er. (Letter). Lancet 1(8391):1406. Katsouyanni K, Trichopoulos D, Kalandidi A, Tomos P, Riboli EA (1991). A casc.•runvoi study of airpoilution and tobacco smoking in lung cancer among women in Athens (Greecc). Prey Med 20(2):271-278. Kawachi I, Pearce NE, Jackson RT (1989). Deaths from lung cancer and ischaemic heart disease due to passive smoking in New Zealand [see comments]. NZ Med 1102(871):337-40. Kawachi I, Pearce N (1989). Passive smoking in New Zealand [letter]. NZ Med 1 102(875):479. Kawachi I, Pearce N (1989). Passive smoking and passive thinking (letter). New Zealand Medical .7ourna1102 (879):593. Kilpatrick SI Jr. (1991). The impact of passive smoking; cancer deaths among nonstnoking women [letter; comment]. Cancer Detect Prev 15(3):256-7. Kilpattick SJ Jr (1992). Re: "Prenatal exposure to parents' smoking and childhood cancer" [letter]. Am J Epidemfol 135(6):712; discussion 714-5. Koo LC, Ho JH -C., Saw D (1983). Active and passive smoking among female lung cancer patients and controls in Hong Kong. Journal of Erperimenral and Clinical Cancer Research 4(2):367-375. Koo LC, Ho JH, Lee N (1985)An analysis of some risk factors for lung cancer in Hong Kong. htternarionallournal of Cancer 33(2):149-155. Koo LC, Ho JH=C, Rylander R (1988). Life-history correlates of environmental tobacco smoke, a study on nonsmoking Hong Kong Chinese wives with smoking versus nonsmoking husbands. Soc Sd Med 26(7):751-760. Krewsld D, Wigle D, Clayson DB, Howe GR (1990). Role of epidemiology in health n:.k assessment. Recent Results Cancer Res 120:1-24. Kuller L, Garfinkel L, Correa P, Haley.N, Hoffmann D, Preston MS, SanDler h ( 19: a). Contribution of passive smoking to respiratory cancer. Environmental Health Perspectives 70:57-69. Lam TH, Kung IT M., Wong CM, et al. (1987). Smoking, passive smoking and histolc,gical types in lung cancer in Hong Kong Chinese women. British Journal of Cancer 56(5): E71 C78.

Liu ZY, He XZ, Chapman RS (1991). Smoking and other risk factors for lung cancer in Xuanwei, China. Int J Epidemio120(1):26-31. ~ MaClure M, Katz RB-A, Bryant MS, Skipper PL, Tannenbaum SR (1989). Elevatcd blixxi levels of carcinogens in passive smokers. Am J Public Health 79(10):1381-1384. Mantel N (1992). Dubious evidence of heart and cancer deaths due to passive smoking. J Clin Epidemio145(8): 809-13. Mantel N (1992). Re: Breast cancer, cigarette smoking, and passive smoking [letter]. am J Epiderniol 133(6):710-2. Mantel N (1987). Lung cancer and passive smoking. (Letter). British Medicallournal 294(6569):440-441. Mantel N (1987). Passive smoking and lung cancer in Swedish women. (Letter). American .lournal of Epidemiology 126(6):1215-1216. Mantel N (1986). Involuntary smoking and lung cancer-some object lessons. (Letter). Journal of the National Cancer Iruritute 76(6):1261-1263. Mantel N (1986). Passive smoking in adulthood and cancer risk. (Letter). Arnerican.lourna: of Epidemiology 123(2):367-368. Miller GH (1990). The impact of passive smoldng: cancer deaths among nonsmoking women (published erratum appears in Cancer Detect Prev 1990;14 (6): 688] [see comments]. Cancer Detect Prev 14(5):497-503. Miller GH (1984). Cancer, passive smoking and nonemployed and employed wives. Westens Journal of Medicine 140(4):632-635. Miller GH, Rutsch M (1981). Non-smoking wives of heavy smol= have a higher risk of lung cancer. (Letters). British Medicallournal 282(6268):985. Pershagen G(1989). Childhood cancr.r and malignancies other than lung cancer related to passive smoldng. Mutat Res 222(2):129-35. Pershagen G, Hrubec Z, Svensson C(1987). Passive smoking and lung cancer in Swedish women. -An 1 Epldemiol 125(1):17- 24. Pershagen G, Svensson C, Hruber Z (1987). Passive smoking and lung cancez in Swedish women. (Letter). American Journal of Epidemiology 126(6):1216-1217. Peto 1, Doll R (1986). Passive smolcing. BrJ Cancer 54(3):381-384. Peto J, Doll R (1986). Passive smoking. (Letter). British Journal of Cancer 54(6):1020- 1021. Preston-Martin S, Yu MC, Benton B, Henderson BE (1982). N -nitroso compounds and childhood brain tumors: A case-control study. Cancer Research 42(12):5240-5245. Pron GE, Burch ID, Howe GR, et al. (1988). The reliability of passive smoking histUties reported in a case-control study of lung cancer. American Journal of Epidemiology 127(2):267-273.

Sandier DP, Comstock GW, Helsing KJ, Shore DL (19S9). Deaths from all causes in non- smokers who lived with smokers. Am J Public Heauh 79(2):16"s-7. Sandler RS, Sandler DP, Comstock GW, Helsing KJ, Shore DL (1988). Cigarette smoking and the risk of colorectal cancer in women. J Narl Cancer Inst 80(16):1329-33. Saracci R, Riboli E(1989). Passive smoking and lung cancer: current evidence and ongoing studies at the International Agency for Research on Cancer. Murar Res 22-1(2):117-27. Shimizu H, Morishita M, Mizuno K, Masuda T, Ogura Y, Santo M, Nishimura M, Kuttithim:, K, Karasawa K, Nishiwaki K (1988). A case-control study of lung cancer in tionsmol-ing women. Tohoku J Erp Med 154(4):389-97. Slattery ML, Robison LM, Schuman KL, French TK, Abbott Ttii, Overall JC Jr, Gaf,cin,.;r Jhi' (1989). Cigarette smoking and exposure to passive smoke are risk factors for cervical cancer [se- comments]. JAUA 261(11):1593-8. Sobue T (1990). Association of indoor air pollution and lifestyle with lung cancer in Osaka, Japan. Int.l Epidemio119(1):S62-6. Sorsa M, Husgafvel PK (1988). Assessment of Passive and Transplacental Exposure to Tobacco Smoke. Methods for Detecting DNA DamaQing Agents in Humans: dpplicatioru in Cancer Epidemiology and Prevention, IARC Scientitic Publication No. 89, H. Bartsch, K. Hernminki, and L K. O'Neill, Editors; Lyon, France, Internationa.l Agency for Research on Cancer, pages 129-132, 13 references. Spiuer WO, Lawrence V, Dales R, Hill G, Archez MC, Clark P, Abenhaim L, Hardy 7, SampaIis J, Pinfold SP, Morgan PP, et al. (1990). Links betweea passive smoking and disezse: a best-evidence synthesis. A report of the Working Group on Passive Smoking. Clinical and Invutigarive Medicine 13(1):17-42; discussion 43-6. Stock SL (1982). Passive smoking and lung cancer. (Letter). Lancet 1(8279): 1014-1015. Stockwell HG, Candelora EC, Armstrong AW, Pinkham PA (1991). Environmental tobac::a smoke and lung cancer in never smoking women. Twenry fourrh annual meeting of the Society for E idemiologic Research, Buffalo, New York, USA, June l 1-14, 1991. Am J Epidemivl 134('~:724-725. Sutton GC, Stock SL (1981). Passive smoking and lung cancer. (Letters). Arirfsh AIcdical Journal2S2(6265):733-734. Svensson C, Pershagen G, Klominek J(1989). Smoking and passive smoking in relation to lung cancer in women. Aua Oncol 28(5):623-9. Trichopoulos D, Kalandidi A, Sparros L, Macmahon B (1981). Lung cancer and passive smoking. Int J Cancer 27(1):1-4. Trichopoulos D, Hatzalds A, Wynder E, Katsou)ranni K, Kalandidi A(1987). 7ime trenus of tobacco smoking, air pollution, and lung cancer in Athens (Greece). F.nviron Res 44(2).1 69- 178. Trichopoulos D, Kalandidi A, Sparros L (1983). Lung cancer and passive smoking: Conclusion of Greek study. (Letter). Lancer 2(8351):677-678. Trichopoulos D, Kalandidi A, Sparros L, MacMahon B (1981). Lung cancer and passive smoking. International Journal of Cancer 2 7(1):1- :. ,

Wioie DT, Collishaw NE, Kirkbride J(1987). Exposure of involuntary smnkers in tcxic components of tobacco smoke. Can 1 Public Health 7S(3):151-154. Williams FL, Lloyd OL (1989). Associations between data for male lung cancer and female breast cancer within five countries. Cancer 64(3):1764-8. Winters TH, Di FIR (1932). Radioactivity in cigarette smoke (Letter). New Englar:J Jou, nnl of Medicine 306(6):364-365. Winters TH, DiFrenza J(1983). Radioactivity and lung cancer in active wid pas5ivr Chesr 84(6):653-654. Wood AA (1990). Passive smoking petter]. BMJ 300(6740):1650. Woodward A (1991). Is passive smoking in the worl.~place hazardous to health? Scandinavian Journal of Work, Envirorvnent and Health 17(5):293-301. Woodward A, McMichael AJ (1991). Passive smoking and cancer risk: the nature and uses of epidemiological evidence. Eur J Cancer 27(11):1472-9. Wu AH, Henderson BE, Pike MC, et al. (1985). Smoking and other risk factors foi* luug cancer in women. Journal of the Narional Cancer Insrfrute. 74(4):747-751. Wu JM (1991). Carcinogen hemoglobin adducts, urin mutagenicity, and metabolic phenotype in active and passive cigarette smokers (letter ~J Natl Cancer Insr 83(13):963. Wu-Williams AH, Dai XD, Blot W, Xu ZY, Sun XW, Xiao HP, Yu SF, Feng YP, Ersho.~ AG, et al. (1990). Lung cancer among women in north-east China. British Journal of Cancer 62(6):982-7. Wu-Wiliiams AH, Samet IM (1990). Environmental tobacco smoke: exposure-response relationships in epidemiologic studies. Risk.lnalysis 10(1):39-48. Wynder EL, Goodman MT (1983). Smoking and lung cancer: Some unresolved issues. Epidemfologic Reviews 5:177-207. Yesner R(1991). Tobacco smoke and risks for non-smokers jletter]. Conn Med 55(7):431. Zang EA, Wynder EL, Harris RE (1989). Exposure to cigarette smoke and cervical canc.cr [leuer; comment]. JAMA 262(4):499.

Chamesud J, Pt:-=,--d R, Chre:ien J, Masse R, Lziuma J (19S2). Lung c: rc:nogenesis during in vivo cig2reae smoking and radon daughter exposure in r:s. Recent Results Cancer Res, 82:1120. Chameaud J., Perraud R., Chre:ien I., Masse R., LaFuma J (1980). Combined Effects of Inhalation of Radon Daughter Products and Tobacco Smoke. In: Sanders C. L. (Editor). Pulmona,v ToYicology of Respirable Parricles 19th Annual Hanford Life Sciences Symposium. Richiand, Washington, October 22 1979. DOE Symposium Se:ies No. 53. Dalbey WE, Nettesheim P, Griesemer R, Caton JE, Guerin iviR (1980). Chronic Inhalation of Cigarette Tobacco Smoke by Rats. Govt Reports Announcements & Index (GRA&I) Issue 25. Dalbey WE, Nettesheim P, Greisemer R, Caton JE., Gue:in MR (1980). Lifetime exposures of rats to cigarret tobacco smoke. DOE Symp. Ser, 1980. Dontenwill W, Chevalier HJ, Harke HP, Klimisch HI, Kuhnigk C, Rerlzeh G, Schneider B (1977). [Studies on the effect of chronic cigarette smoke inhalation in Syrian golden hamste.-s and the importance of vitamin A on morphological alterations after smoke exposure]. Z Krebsfonch 89(2):153-150. Dontenwill W (1976). Bioloa:cal Evaluation of Carcinogens in Tobacco and Tobacco Smoke. In: '%Wer E. L., Hof(jinann D., Gori G. B. (Editors). Modifying the Risk for the Smoker Yolume 1. Proceedings of rhe 3rd World Conference on Smoking and Health. New York June 2-5 1975. DF7.EW Publication No. (NIH) 76-1221. Donteawill WP (1974). Tumorigenic Enect of Chronic Cigarene Smoke Inhalation on Syrian Golden Hamsters. ln: Karbe E. Park JF. (Editors). E.-perfinenral Lung Cancer: Carcinogenesis and Bioossays. International Symposium, Seattle, Washington, June 23-26 1974. New York SpringerVe.-lag. Dontenwill W, Chevalier HJ, F•arke HP, Lafrenz U, Reclaeh G, Schneider B (197-3). Effects of chronic cigarexe-smoke inhalation in Syrian golden hamsters. 1. Nar. Cancer Insr. Fernandez GA, Gonzalez DA, Pe.-ez GS (1985). Asbestos and smoldng. II. Carcinogenesis. Med. Segur. Trab. Feron VJ, Kuper CF, Spit B7, Reuzel PG, Woutersea RA (1985). Glass fibers and vapor phase components of cigareue smoke as cofactors in experimental respiratory tract carcinogenesis. Carcinog Compr Swv, 8 p93-118. Fisher S, Spieg_iha.lde rlder B, Preussman R (1991). Tobacco-spe.ific nitrosamines: Underestimated carcinogens in tobacco and tobacco smoke. Dev Oncol 63:107-24. Gairola G, Gupta RC (1987). Cigarette smoke-induced DNA adducts in the pulmonary tissue of rats following long-term exposure (meedng Abstract). Proc Annu M..es Am Assoe Cancer Res 23:97.

Measure.,ent and Risk Estimation. hlut2tion Rese :rc't Vol. 222 No. 2 pages 101-110 32 references. Jeffery PK, Rogers DF, Ayers MM, Shie:ds PA (1984). Strvcturai aspects of cigarette smoke- induced pulmonary dise :se. Errore Majorana Inr Sci Ser Life Sci 17:1-28. Kea st D, Tam N, Sheppard N, Papadimitriou JM (1985). The role of tobacco smoke iron ore mine dusts viruses and chemicals in experimental cancer. dreh Environ Health. Kendrick J, Ne:tesheim P, Guerin M, Caton J, Dalbey W, Griesemer R, Rubin I, Maddox W (1976). Tobacco smoke inhalation studies in rats. Toxicol App! Pharmacol 37(3):557-569. Khanduja KL, Gupta MP, Dogra SC, Pathak CM (1985). Effect of cigarette smoke inhalation on certain pulmonary and hepatic drug metabolizing enzymes in rat and mouse. Indiart 1. Exp. Biol. Klein RG (1988). Combination effects in inhalation carcinogenesis: Methods and practical implications. Combination Effects in Chemical C.arcinogenesis. Schmahl D (ed.) Weinheim FRG VCH Publishers p. 65-73. Kmoch N, Reznik G, Schleicher A (1976). Inhalation experiments with **1**4C- labe:led cents during cigarette smoke inhalation. Toxicology. Kumar M, Poddar S, Cardenas L, Rao BN (1987). Histopathologic changes in the lungs of rats exposed to inhalation of tobacco smoke or marijuana. Symposium on predictive toxicology held at the 16th Confe.-ence on Environmerttal Toxicology. Toxicology 47 (1- 2):224-225. Leuchtenberger C, Leuchtenberger R (1970). [The efrert of chronic inhalation of fresh cigarette smoke and its gaseous phase upon the development of pulmonary tumors in snel mice]. Z Pravenrivmed 15(6):457-462. Marmorstein J(1986). Lung eanrr. is the increasing incidence due to radioactive polonium in cigarettes? South Med J. Meade PD, Yimashiro S, Farada T, Basrur PK (1979). Influe:= of vitamin A on the laryngeal response of hamsters exposed to cigarette smoke. P.rog E.-p Tumor Res 24:320-329. Nightingale TE, Frasinel C, Swidersky P, Galartaga J(1981). Cigarette smoke inhalation and blood dose markers in beagle dogs. Toxicol App1 Pharmacol 60(3):451-457. Oberdorster G (1989). Assessment of lung cancer risk from inhaled environmental cadmium. Toxicol. Environ. Chem. Oberdorster G (1989). Pulmonary toxicity and carcinog---icity of cadmium. Journal of the Arnerican College of Toxicology 8(7):1351-1263 74 references.

Wehner AP, Stuart BO, Sanders CL (19?9). Inhalation studies with Syrian golden hamsters. Prog. E:p. Tumor Res Volume Date 19777. Wehner AP, Busch RH, Olson RJ (1976). Effects of diethylnitrosamine and cigarette smoke on hamster s. J. Nail. Cancer Inst. Weiss W (1984). Cigarette smoke asbestos and small irregular opacities. Am Rev Respir Dis. WHO Working Group. Formaldehyde. Environmental Health Criteria 89: 219 pp. Zeller WJ, Schmahl D, Ivankovic S (1985). (Inhalation experiments with Syrian golden hamsters: combination of chronic cigarette smoke inhalation and intratrAcheal installation of benzo(a)pyrene, detoxification of cigarette smoke with a charcoal filter] <Original> Inhaladonsexperimente an Syrischen Goldhamstern: Kombination von chronischer Zigarrttenrauch-Inhalation und inttatrachealer Instillation von Be.zzo(a)pyren, Detoxifinerung des Zigarestenrauches durch Kohiefilter. Prax Klin Pneumol.

Heallh ad S&t1 at Work (Tobaoo S.oglag) A -BILL ToamwWIbe HealthaodSafaty st Watetmlld 1974 aa~ topr+orisefvctbeoomr+a~afamokie6isptwa of prort; aod fa oomwed papoz& h~lad by Mr Georgt F"v .nwared bj Mr Rq+Q.SYhLf, Mr Sat Q&rd..4 Mr DOldA2ea. Db Lea* AlaaWt ul,kmjt Af^ MI JaAR Alma4L sirlal.s"4ry, iIr Xasy ucLebA M-r Afii,rteb Dm.ft and Ilmla fift ardereA by T6e House of Casmos, ts bs PdwA?xd Fe6nm)1l93 LoHDo*M.10 JtL IM Ual4d Riqdaof j HIl3O V•rond jein 1251 flum siul ISSUE 41 APPENDIX C a

Xealth mid .ScJery ar Work tTobacco Smokingl i A B I L L TO Amead the Health and Safety at Work etc. Act 1974 so as to A.M im. provide for the control of smoking in places of worlc: and for connected purposes. B E iT ENAC.'tED by the Queen's most Fxodl.at Myest, by and with the advice aad aoaseat of the Lords Spirits~al aad Z~emporal, and Commoas, in this present Parliamcnt asKmbled, and by the authoricy of the ume, as follows:- s 1. After sectlon 1(1)(a) of the prfndpal Act (ptabmiaary provisions) lsmwos oc there shall be iasert.d- pvrpo.a o( "(ai) ea:uuiag that such persoas while .voddag oo aay .oclos.d u~weh•`y pacuses other than susmpt premises arn able to do so fn an 1nm. eavk=meat where :molaai does aot take piaoe; `. 10 2.-(1) After i.cttoa ?(2Xe) of the priadpal Act (uaersl duties of (im.rv dvd.. or employers to their employeas) there shall be losettad- == n 90 "(n the prevendoa of smokini, whether by.mployesa or otber ~s in phu= persoas bavia=aooese to the plan ofwork. is aay pls,ee of.vosk .t.o~ ooasistias of enalosed premises (not being exempt preauses) 13 under the emp1oyes's control eaaept as may be permitted und.r soctioa 9A of tbis Act.". wh~eti it ~ 20) of th. riaeipal Aet, atter tbe word ~•employese• them ast-l-toof a s,non-umokias ~~)Inserted th. words "('~ocludias the 20 & In aeeeica 4 of the pliaatpal Act (general duties of panons ooaoeraed o,vasi dney of with yremiass to persons other than their employoes), a8er tbe words sm*ou "such m..sttt+a". tbei+e shall be iate:zed the words ••(iactudia` measares cooasned oizh tb pre.wmt smo~ on the premises (unless they are exempt p~miu~) by ~~ i° ~asoi = tbem, acoapt as may be pesmittod uader section 9.+~). 51/1 'king '

2 Xealcb mnd Safety at Work (Tobacco S+noktRB) Frrder Drswtiaos 4. After section 9 of tbe priaeipal Act there shall be inserted the u to smokist and tollowln8:- tl+e tishu of .mptoy.... M~stloa of Uwe o~~o~. ~ 9A. sobject to any h.altb and safaty regulations under seaion 15(6Axd) of this Act, an employer, or a person who has eontrol of pramius to whicb .eotioc 4 of this Act S . rohmi" of applies, may desitnate part (but not the wkole) of aplaoe of work as an uea where smoking is petxaittad but nothias in tlais Aot shall require an employer or such a person to desiCsate:ucb an uea. 9& No person iha11 smoke in a place etworiceoati:ting 0 smO1dbe 4'GW ~P""d Wsluu of =Ploye" of eeelosed premisot (not being exempt premises) to which this Act applies except in an area dasitnated under sectica 9A above. 9C,_(1) No employee:M11 bereqw* ed by his contract of employment or otherwise to work In a smoking area. (Z(a) A~~ny~~~loyee sba11 be deemed to have been va~kirly distaiaed for the purposes of the 1978 Act if- (i) be it diimissed and the reason for the dismis:al is his rditsal to work in a smoking area; ot S 0 b. , terminates his conttut of ~poymant witb or without notice and the t+.awn tor *e terminatice k the fallure of his employer ~ vide him with work In a noa- 2S (b) For the purpose of this wbseaton "cwoa" m.ans the ptindpat rrason. (3) Every emplo sitall have tbs right not to haw action (.hoet of taken apinst him by his employer for the purpose o compellins him to work in a' 30 smoking araa. (4) Subsection (1) of section 140 of the 1978 Act -(testtictions on contracting out) shall a to eay n. provision u~wt~by~~ployee is r+equfred to or~o his 35 rpq~'vtr.d b~oontracc tof ~=ploymeat to work on exempt ptemis.r. (6) For tba pmposa of tnis s.crlon- "tb.1978 Aet" menns the Employment Protection 40 (Coasolid.tiostj Act 1975; "noa-amokia~toes" awneso autdt ofany ptomises aa is not a smoldn,8 araa; and "omokms area" m.aas an area dat-ted uader section 9A of tAit Aot aad, ia tb- nre of any 4S tatlyre by the ooatpies of a worlcpLoe to comply with the dutia~ aa to tmolaaa impor~ed on tJyam by.oation 2(3)(j) or, as the as. may be, .eccioa 0 . .. _..,.

XealtJt and Sqf'ety at Work (Tobacco SmokftJ 3 4 of this Aot, the e:pmsion shall include any ~= o pf~~wotJcplace where smokiag reaululy S. After section 1 S(6) of the ptioeipal Act (healtb and safety fLahh a4d safatr 5 regulations) there shall be insated the followiaS,:- "Iteg"111"M 6A The Seaarary of State ihall m,ake haakia and safety rasutsdoat- - (a) with Mpect to the daipatioo of amokin; areas for the purpoies of section 9A of this Act; 10 (b) t~~Catesorios or desciiptions of premises as exempt (c) tpedfylat or providing for the determination of the maximum permitted sise. area or eapaeity of areas designated at to be daignated under swdon 9A in relation ts to the total area or capacity of the premkes of whirh any such area fon= paa; (d) problMtinS the dep'patica of ateat tmder feetfon 9A in such categories of premises as are spaified in the :eswatson.; 20 (e) raquirioS the consultuion of employoes as to the designated umas under motioa 9A and the adoption of non-smoking Polidei in plaoa of work; (f) prnaribiag the design of aigos. gvlng notice of requirements of the provisions of this Act and of the regulations as to 25 smolan~. includiag the wording and symbob to be tued on such sips; (g) makias requirements as to the providon within endoud of work of sips suahas are msntioned in paragrapb d) of msr3 nvmba and ^~._. and in such positions, as may 30 be speoi5od in the rssuLtioaa; and (1~) rmlatin6 or probib~ttisf the provin of ashtraya at the eat~naes to or witbia ando~ed plares of wode". 6. In saetion 33 of the priadpal Act (offeoees)- (a) after snbiecsion (1)(b), ttwe shall be iaurced- 3s "(bb) to contravene Oecaan 9B;"; and the (b) mtheie shall afternserted "(bb~),d "paraWaph" whae it ~c oeenrs 7. In teotloa 53(1) of the psiaeipal Act (sweral iaterpt+statbn of wm-dmenc of Part 1):- ..edoa is at 1974 40 (a) after the dafinitioa of "tLe E:eardve there shall be iaserted- A"" •• «-mPt p:tmisa" mnas premisn spxiSed as eeampt p, in health and safety ra~ulatioae made nader seetioa 1S(6A)(b) of this Aea:"; (b) at the end of the deSaitioa of "pr=ises" there shall be in*eitad 45 "and. for tbepurlposes of so mueh of this Act as :elates to smolda& percdsatan maLo:ad.if tW_art eituated betwem a .: ==~

4 Health and Safety as Work (Tobacco Smok*Y) noar aad a csilia~ or roof gad ate udoaed on all sides by walls oraindows (ctclttsive ofdoors orpaaage araya) extoadia j ftom the door to the cealmg or roof,"; and (C) after the ~L{oII of uiC~f~ploy~ pet3ont" LbGre shall be . Iaserw- 5 aesprmstoa. 1974. a 37. asmokiag" iaeJudes haviag a lighted d~are~te, tisar.pipe or any otbes s:ookia= eqmpmeat and smoke" shi11 be coastrs,ea aacordiagly; '. _. In this Aat, "the priadpal Aec•• maas the Health and SafeTy at Work eic. Act 1974. 0 Short fte. coommencsomw ~ 9.-(1) ?his Act aoay be ¢ited as tbe Hsalth and Safety at Work (rcbaao SmoldaQ) Act 1993. (2) Zhis Act duli eome into forice on such a day as the Saoretary of State may by order made by stuutory iast~tvment appoiat, and differtat days may be appoiaud undsr this snbsecrioa for ditTarat purposa. is (3) Tbis Act shali eactead to Srotlaad.

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