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SHOOK, HARDY&BACoN REPORT ON RECENT ETS AND IAQ DEVELOPMENTS April 2, 1993 SHB

REPORT ON!RECENT ETS AND IAQ DEVELOPMENTS - IN THIS ISSUE - IN! THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS • Indoor Air Quality Act of 1993 is intro- duced in the Senate, p. 1. • Clinton administration will not appeal AFL-CIO v. OSHA, p. 1. • EPA reports to Congress on radon in schools, p. 4. ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS • Defendants file class action appeal brief in Broin, p. 6. • Trial is set for November 1993 in Butlcr, p. 6. • McKinney files suit against cigarette manu- facturers; no decision~yet from Supreme Court, p. 6. • Defendants' dispositive motions are granted in Zwillman, p. 7. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS ISSUE 44 SCIENTIFIC/TECHNICAL ITEMS • Eleven new studies relating to ETS, p. 11. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS • Government activity in Australia, Austria, Canada, Germany, India, Israel, Philippines and the United Kingdom begin on p. 13. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS • Hearings are underway in Wrighr v. Ladbrokes, p. 15. LEGAL ISSUES AND DEVELOPMENTS • BAAF issues guidelines on placing children with smokers, p. 16. OTHER DEVELOPMENTS • Confederation of European Community Cigarette Manufacturers publishes pamphlet on ETS, p. 16. Smoking in pubs and restaurants issue stirs activities in the U.K., p. 17. Airline activities in Bahrain, Iceland, Scandinavia, Switzerland and the U.K, p. 17. • • Details on employees' suit against renovators of Bryn Mawr, p. 7. • LEGAL ISSUES AND DEVELOPMENTS • ASH produces new antismoking pamphlet, p. 8. • Minnesota Attorney General letter opinion on workplace smoking, p. 8. OTHER DEVELOPMENTS • New York will spend $50,000 each for smoking shelters, p. 9. MEDIA COVERAGE • Scientist Ross Brownson has letter published in San Francisco Chronicle, p. 10. MEDIA COVERAGE • "Federal Court Warns Tobacco Institute over Brochure," in AFCO, p. 18. • U.K. civil servant says, "Smokers Forced Me to Quit Job," p. 19. • Discussions throughout this Report that bear this symbol contain information about events and activides related to the EPA Risk Assessment on ETS.

- TABLE OF CONTENTS - Issue 44 April 2, 1993 IN THE iJNITED STATES REGULATORY AND LEGISLATIVE MATTERS CONGRESS [1] *Indoor Air Quality Act of 1993 Introduced in Senate ...........................................................1 U.S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) (2] AFL-CIO v. OSHA: OSHA allows Time for Appeal to Expire .................................................1 [3] Workplace IAQ/ETS Rules Stalled by Vacant Position ............................................................2 [4] ASH v. Department ofLabor: Parties Disagree About Whether to Delay Case ..........................2 [5] OSHA Reform Legislation Garners Criticism and Suppon ......................................................2 IAQ MODEL LAW TASK FORCE [6] Task Force Continues Work on Model Law ............................................................................ 3 U.S. ENViRONMENTAL PROTECTION.AGENCY (EPA) [7] ASHRAE [8] Results of School' Radon Survey Reported to Congress ............................................................4 Critics Charge ASHRAE Standards Reflect Business Interests .................................................4 STATE AND LOCAL GOVERNMENTS [9] [10] Privacy Legislation ............ .................................................................................................... ... ETS-Related State and Local'Legislative Activities ...................................................................5 ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [11] Broirr. Defendants File Briefon Class Action Appeal ......................................................•.......•6 (12] Butltr. TrialCourt Sets Case for November 1993 ....................................................................6 [13] •McKinnty. Prisoner files Suit Against Manufacturers ............................................................6 [14] ZwiUrnarr. Court Grants Defendants' Dispositive Motions ......................................................7 ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS WORKPLACE: IAQ/SICK BUILDING SYNDROME [15] Bensing v. Voirh &Mactavrsh (Philadelphia County Court of Common Pleas, Pennsylvania) (filed February 3. 1993); Skoogfors v. Voith dMacravish (Philadelphia County Court of Common Pleas, Pennsylvania) (filed January 21, 1993) ..........7 COLLECTIVE BARGAINING [16] United Paprrurorkrrr International Union, Local 1279 v. Wisconsin Tittru MiIG, Inc., 1993 U.S. Dist. LEXIS 3348 (U:S. District Court, Eastern District, Wisconsin) (decided March 13. 1993) .................................................................................................... ...8 LEGAL ISSUES AND DEVELOPMENTS [17] *ASH Produces New Antismoking Pamphlet .........................................................................8 [18] *Minnesota Attorney General Opines About Effect of Risk Assessment in the Workplace .......... 8 U.S. INCIDENTS OF SBS/BRI [191 Sick Building Syndrome/Building-Related Illness in Florida, Massachusetts, Missouri and New York .................................................................................................... .......8 OTHER DEVELOPMENTS [20] State to Provide Employees with Smoking Shelters .............................................................••••-9 [21] Centers for Disease Control (CDC) Launches ETS Information Campaign ............................9 [22] Survey Asks About Smoking and Children ............................................................................10 [23) Large Increase in Corporate Smoking Bans Predicted ............................................................ 10 [24] *Children Advised to Change Parents' Smoking Habits ....................................................... 10 MEDIA COVERAGE ~ [25] *"EPA Study on Passive Smoking Stirs Debate and Passions," R. Brownson. ~ The San Francisco Chroniclr. March 19. 1993 ........................................................................10 ~ [26] " T. McNichol, USA Wnkrnd March 28, 1993 .......................... 10 •"Don'r Mind if I Smoke ~ , ~. ~ IV W

Contents Continued, Issue 44 SCIENTTFIGTECHNICAL ITEMS UPCOMING MEETINGS [27] 1993 Annual Summer Toxicology Forum, Given Institute of Pathobiology, Aspen, Colorado, July 12-16, 1993 .......................................................................................11 LUNG CANCER [28)' "Indoor Air Pollution and Lung Cancer in Guangzhou. People's Republic of China," Q. Liu, A.J. Sasco, E. Riboli, and M.X. Hu, AmericanJournal ofBpideniiology 137(2): 145-154, 1993 [Sec Appendix A] .......................... 11 CARDIOVASCULAR ISSUES [29] "Environmental Tobacco Smoke and Coronary Heart Diseue," A.K. Armitage, Journal ofSmoking-Ralated Ditorders 4(1): 27-36, 1993 [See Appendix A] ............................. 1 1 [30] "Passive Smoking and the Risk ofAcute Myocardial Infarction,"'C. La Vecchia, B. D'Avanzo, M.G. Franzosi, and G. Tognoni, The Lancet 341: 505-506, 1993 [See Appendix A] .................................................................................................... ...............11 RESPIRATORY DISEASES AND CONDITIONS - CHILDREN [31) "Rdation of Passive Smoking as Assessed by Salivary Cotinine Concentration and Questionnaire to Spirometric Indices in Children," D.G. Cook, P.H. Whincup, O. Papacosta, D.P. Strachan, M.J: Jarvis, and A. Bryant, Thorax 48: 14-20, 1993 [See Appendix A] ............................................................11 [32] "The Decrease in Severiry of Asthma in Children of Parents Who Smoke Since the Parents Have Been Exposing Them to Less Cigarette Smoke," A.B. Murray and B.J. Morrison, Journal ofAllcsgy and Clinical Immunology 91: 102-110. 1993 [See Appendix A] .................................................................11 [33] "Lung Function. Respiratory Illness, and Passive Smoking in British Primary School Children," R.J. Rona and S. Chinn; Thorax48: 21-25, 1993 [See Appendix A].........12 (34] "HispanirChildren With Asthma: Morbidity." P.R. Wood, H.A. Hidalgo, T.J. Prihoda, and M.E. Kromer, Pediatrics 91: 62-69, 1993 [See Appendix A) ......................12 OTHER HEALTH ISSUES [35] "Editorial: Give a Dog-End a Bad Name," A.D.S. Caldwell, Jourrtal of Smobing-Related Diio>•dsrs 4(1): 1-2, 1993 [See Appendix A] ................................................. 12 ETS EXPOSURE AND MONITORING [36] "Analysis of Tobacco-Specific N-Nitrosamines in Indoor Air," K.D. Brunnemann, J.E. Cox, and D. Hoffmann, Carcinognrrsis 13(12): 2415-2418, 1992 [See Appendix A]'........... 12 [37] "Relationship Between Environmental Tobacco Smoke Exposure and Carcinogen-Hemoglobin Adduct Levels in Nonsmokers," S.K. Hammond, J. Coughlin, P.H. Gann, M. Paul, K. Taghizadch, P.L. Skipper, and S.R. Tannenbaum, Journal of the National Cancer Institute 85(6): 474-478, 1993 [See Appendix A] ................•..-12 [38] •"Environmental Tobacco Smoke,"'A. Rodgman, Regularory Toxicology and Pharmacology 16: 223-244, 1992 [See Appendix A] ............................................................... 12 INDOOR AIR QUALITY [39] "The Effect of Varying Levels of Outdoor-Air Supply on the Symptoms of Sick Building Syndrome," R. Menzies, R. Tamblyn. J.P. Farant. J. Hanlcy„F. Nunes, and R. Tamblyn. The New EnglandJournal ofMedicine 328(12): 821-827, 1993 (Sec Appendix A] ................. 13 [40] "The Sick Building Syndrome In Office Buildings-A Breath of Fresh Air," K. Kreiss, The New England Journal ofMedicine 328(12): 877-878, 1993 [See Appendix A] ................. 13 SMOKING POLICIES AND RELATED ISSUES [41] Letters to the Editor Regarding "Protection from Environmental Tobacco Smoke in California: The Case for a Smoke-Free Workplace," R. Borland, J.P. Pierce, D.M. Burns„E. Gilpin, M. Johnson, and D. Bal, Journal oftheAmerican Mtdical Association 268(6): 749-752, 1992 ............................................................................13

Contents Continued, Issue 44 IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AusTRAlu (42) New South Wales Delays Public Smoking Ban ......................................................................13 (43) Total Smoking Ban Not on Government's Agenda ................................................................14 AUSTRIA [44) Anti-Smoking Bill Drafted .................................................................................................... 14 CANADA [45] Ontario Government Conducts Hearings on Smoking Proposals .......................................... 14' ' [461 Cigarette Package Warnings May Indude ETS Message ........................................................ 14 GEwmArnc [47) Anti-Smoking Activists Draft Legislation ...............................................................................14 INDIA [48] Government Considers Smoking Bans ...................................................................................14 ISRAEL [49] Health Ministry Officials Unprepared to Discuss Workplace Smoking Policies ..................... 15 PHILIPPINES [50] Smoking Restrictions Imposed in Manila ..............................................................................15 UNITED KINGDOM (51l Home Secretary Squclches Attempt to Impose Smoking Ban ................................................. 15 [52) Smoking Bans Considered by Numerous Borough Councils ................................................. 15 ETSlIAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS UNITED KlNGDOM [531 Wright v. Lad6rokrs (Industrial Tribunal, Birmingham, England) (filed December 20, 1991) .................................................................................................... .15 LEGAL ISSUES AND DEVELOPMENTS UNITED KINGDOM [54] "The Smokeless Zone," V. Harpwood, OccupationalHtalth Review, March/April 1993 ........ 16 [55] Adoption Agencies Advised'Not to Place Children With Smokers .........................................16 OTHER DEVELOPMENTS EUROPEAN COMMUNITY [56l *Cigarette Confederation Publishes ETS Pamphlet .........................................................•.---16 UNITED KINGDOM [57] •Symposium on Workplace Smoking Hdd'in Glasgow ........................................................ 16 [581 Union Employees Oppose Complete Smoking Ban ............................................................... 17 [59) Schools Advised to Provide Smoke-frec Environment ............................................................ 17 [60) Pub Owners Refuse to Ban Smoking .....................................................................................17 [61l Study Links Child Snoring to ETS ........................................................................................17 WORID AIRLINE NEWS [62l Bahrain .................................................................................................... ..............................17 [63) Iceland .................................................................................................... ...............................17 (64l Scandinavia .................................................................................................... ........................18 (65l Switzerland .................................................................................................... ........................18 [66] United Kingdom .................................................................................................... ...............18 MEDIA COVERAGE Ausrlw.IA [67) "Federal Court Warns Tobacco Institute Over Brochure," (68] The Aaut.alian Financial Rrvieu, March 11. 1993 ..................................................................18 "Passive Smoking Danger Admitted," M. Date, The Sydnry Morning Herald, Febrtury 26. 1993 .................................................................................................... .............18 UNITED KINGDOM [69]! •"Passive Smoking Landmark," Health and Safrty Information Bulletin 207, March 1993 ....18 [70] "Smokers Forced'Me To Quit Job. Says Clerk," A. Sambidge, Western Daily Prrss, February 20. 1993 .................................................................................................... .............19 [71) "Attitudes to Smoking," P. Madge, The Saftry dHealrh Practitioner, March 1993 ................ 19 APPENDIX A .................................................................................................... .......................:.........Article Summaries APPENDIX B .................................................................................................... ......................................ASH Pamphlet APPENDIX C .................................................................................................... .......Minnesota Attorney General Letter

APRIL 2, 1993 REPORT ON RECENT ETS AND IAQ DEVELOPMENTS IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS CONGRESS [1] •IndoorAir Quality Act of 1993 Introduced in Senate On March 25, 1993, Senator George Mitchell (D- Me.) introduced the Indoor Air Quality Act of 1993 (S. 656). Relying in part upon the EPA Risk Assess- ment on ETS, Mitchell asserted that indoor air, con- tains pollutants such as "tobacco smoke" and that the federal government lacks a coordinated and compre- hensive response to "all the evidence of the health effects and economic costs of indoor air pollution." The bill is virtually identical to measures introduced and passed by the Senate in the 101st and 102d Congress. It would require the appropriation of $48.5 million for each fiscal year from 1992 to 1996. As of this writing, a companion bill had not been introduced in the House. However, recent press reports indicate that such a bill is being prepared by Representa- tive Joseph Kennedy II (D-Mass.) and will be introduced soon. See issue 43 of this Report, March 19, 1993. The Senate bill' does not identify ETS as an indoor air contaminant. It does, however, contain provisions that would require the EPA to publish a list designating "the contaminants that may occur or are known to occur in indoor air at levels which may reasonably be expected to have an adverse impact on human health." Provisions expanding and strengthening indoor air research predominate, and the EPA is authorized to work with federal agencies, industry groups and the states in improving technologies to identify sources of poor IAQ, measure health effects, and mitigate poor IAQ An Office of Indoor Air Quality would be established at the EPA to oversee the IAQ program, which would also indude the publication of informa- tional bulletins. Although ventilation is addressed in the bill, it plays a minor part. Essentially, the EPA would be required to assess the current use and effectiveness ofASHRAE standards and recommend to Congress those standards that would best protect the public health in light of energy conservation goals. A number of federal agen- cies are given responsibilities under the proposal. NIOSH, GSA and the EPA, for example, would be required to develop an indoor air training course on HVAC operation and maintenance, recordkeeping; identification of indoor air pollutant sources, and rcmediation measures. Senator John Chaffee (R RI) cosponsored the measure, and it has been referred to the Committee on Environment and Public Works. Also introduced on March 25 was the Indoor Radon Abatement Act which addresses the alleged health effects of radon gas expo- sure in homes and schools (S. 657). U. S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) [2] AFL-CIO v. OSHA: OSHA allows Time for Appeal to Expire The Clinton administration has apparently dedined to appeal a federal appeals court decision that invali- dated OSHA's occupational air quality standards for some 428 substances involved in the construction, agriculture and maritime industries. The time for appeal expired on March 22, 1993. AFL-CIO v. OSHA (U.S. Court of Appeals, Eleventh Circuit) (decided July 7, 1992; rehearing denied October 22, I992): The appeals court ruled that OSHA could address multiple substances in a single rulemaking, but that it had not adequately quantified the risks associated with individual substances, had failed to establish industry- specific technological or economical feasibility of the individual permissible exposure limits, and had not adequately supported its across-the-board 4-year delay in implementation of the standard.

2 ETS/IAQ REPORT, ISSUE 44 According to press reports, it was undear whether the workplace ETS rulemaking options. ASH u. Depart- Labor Department's failure to appeal was a tactical ment ofLabor (U! S. Court of Appeals, D.C. Circuit) decision or whether the case "may have fallen through (fil ed December 22, 1992). the cracks." Labor Department sources reportedly said that Secretary Robert Reich had recommended the case be appealed. It is anticipated that the outcome of the case will have an impact upon efforts currently underway in Congress to redraw federal job safety laws. Representative William Ford (D-Mich.), sponsor of the House version of OSHA reform legislation, H.R. 1280, reportedly suggested that the court's decision should spur Con- gress to enact OSHA reform promptly. See The Washington Post, March 23, 1993; St. Louis Post Dispatch, March 24, 1993. H.R. 1280, as well as the Senate OSHA Reform bill, S. 575, would legislatively vacate the Eleventh Circuit's decision by directing OSHA to issue an interim f nal regulation giving effect to the proposed exposure limits for the 428 substances. s Summarfes of reactions to OSHA Reform legislation, ftem 5. [3] Workplace IAQ/ETS Rules Stalled by Vacant Position According to press reports, the process of establishing workplace rules on IAQ and ETS is in limbo at OSHA because an assistant secretary in charge of OSHA has not yet been appointed. Apparently, the assistant secretary will be in a position to indicate what policy the new administration wishes OSHA to follow on these issues. According to OSHA's project officer on indoor air and ETS, it is unlikely that OSHA will issue an emergency temporary standard on ETS in response to the latest petition filed by Public Citizen. See issue 41 of this Report, February 19, 1993. OSHA's reluc- tance to do so stems, in part, from its failure to prevail in any court action in which other emergency tempo- rary standards have been challenged. See IndoorAir Quality Update, March 1993. [4) ASH v. Department of Labor. Parties Disagree About Whether to Delay Case On February 16, 1993, ASH requested that the court hold this case in abeyance for 60 days in light of the January 1993 memorandum from then-Secretary of Labor Lynn Martin directing the agency to expedi- tiously report to the incoming Secretary regarding In its motion to the court ASH states, "petitioner believes the public interest would best be served by holding the case in abeyance for 60 days to determine if OSHA will proceed to resolve this matter without the necessity of Court intervention." In the alternative, ASH requests 10 additional days to respond to the Secretary's motion to dismiss. In this case, ASH is seeking an order compelling OSHA to commence a separate rulemaking on ETS. In a response filed to ASH's motion, Labor Secretary William Reich objected to the request to hold the case in abeyance and reiterated the agency's position that the case should be dismissed because there was no final agency action to review. According to the Secretary, ASH's latest motion was a concession that "OSHA is presently considering the precise regulatory relief [ASH] seeks and that allowing the agency an additional period of time to decide the issue is appropriate and reawnable.° The Secretary does not object to the 60-day period requested by ASH should the court grant ASH's motion to hold the case in abeyance, but notes in that regard, "the Secretary makes no representation that the issue whether and how to proceed with the regulation of ETS will be fitlly resolved within that period." On March 6, 1993, ASH filed a reply to the Secretary's response, arguing that OSHA's opposition to its motion "reinforces the finality of the Agency's decision." ASH reiterates many of the arguments made in its initial pleadings with the court and urges the court to either hold the case in abeyance or deny the motion to dismiss and issue a briefing schedule. To date, no further documents have been filed in the case. [5] OSHA Reform Legislation Garners Criticism and Support The introduction of OSHA reform legislation in the House and Senate (H.R. 1280, S. 575), has provoked mixed responses from representatives of employee and business groups and others around the country. A summary of reported comments on the measures follows. • AFL-CIO: Margaret Seminario, director of the department of occupational safety and health, supports

APRIL 2, 1993 the reform legislation, saying "if enacted, it will lay the groundwork for improvements in sakry and health." • Coalition for Occupational Safety and Health (an coalition of employers, trade groups and associations): Peter Lunnie, executive director, agrees that the Occupational Safety and Health Act of 1970 is not perfea, but says "radical reform of the statute" is not warranted. He believes the reform measures "would change its character from one of encouraging voluntary compliance on the part of employers and employees alike to a criminal statute.• • American Society of Safety Engineers: Allen Macenski, acting president4 criticizes the reform measures and says OSHA errs in applying the same standard to every business. "It is ludicrous to require small employers to have written programs and joint labor-management committees," Macenski says. • Employment Policy Foundation (Washington, D.C.- based business research group): The Foundationestimates that the legislation will cost the private sector $51 billion in new costs each year even afcer factoring out the cost savings from averred illnesses and accidents. • Academia: Eula Bingharn, former head of OSHA during the Carter administration, does not see a groundswell of support for OSHA reform. Her re- search shows that part of the problem is that when good jobs are scarce, "workers are afraid to complain because they really need the job." • OSHA insiders: Without an OSHA chief, no one is apparently setting goals and priorities. Secretary of Labor Robert Reich is reportedly spending most of his time helping President Clinton push his economic plan. • New York Committee on Occupational Safety and Health (union-funded research and education group): Joel Shufro, executive director, has "great expectations" with respect to OSHA reform, but regards the failure of the President to appoint someone to head the agency as a significant drawback StrNeusday, March 21,1993. Meanwhile, Republicans in Congress arc reportedly preparing their alternative to the Democrat-backed reform measure and hope to introduce it before hearings are scheduled on the proposal this spring. According to a minority staffer for the House Educa- tion and Labor Committee, the sponsor of the House measure wants the bill considered in August, but many 3 congressional representatives believe it will take two years for the bill to reach both floors. See Daily Report for Exrcutivcs, March 25, 1993. IAQ MODEL LA,tiw TASK FoxcE [6] Task Force Continues Work on Model Law On March 11, 1993, the IAQ Model LawTuk Force met to form a new subpanel charged with devising a "conceptual outline" of a new draft model IAQ law by April2, 1993. The draft law that had been circulated to panel members late in 1992 has apparently been scrapped following extensive criticism. See issue 37 of this Report, December 18, 1992. Organizations that have expressed an interest in or have been participating in the drafting process will receive copies of the outline and will have the opportunity to submit written comments until April 14, 1993. The next meeting of the full panel will be held in Washington, D.C. on April 19, 1993. It is anticipated that an approved outline will be presented at an IAQ conference in Baltimore on April 22. The IAQModel Law Task Force, under the aegis of the Environmental Safery Council of American (ESCA), a private council of individuals daiming representation of business and consumer interests, intends to draft a model law that will be made available as a guide for state, county and municipal lawmakers. Meanwhile, the executive director of the American Industrial Hygiene Association (AIHA) has reportedly withdrawn the organization's support from the Task Force endeavor. In a letter written to ESCA, Director O. Gordon Banks reportedly said AIHA originally agreed to become involved because the group was under the impression that the model law would provide a consensus of scientific evidence that the states could use in formulating IAQ regulations. According to Banks, the model law unveiled at ASHRAE's IAQ'92 seminar in San Francisco did not reflect the recommendations of the scientific task force. Although AIHA is officially dissociating itself from ESCA and the Task Force, it will evidently continue to comment on any future model law activity. See Indoor Air Quality Update, March 1993.

4 U.S. ENVIRONMENTAL PROTECIION AGENCY (EPA) [7] Results of School Radon Survey Reported to Congress On March 18, 1993, the EPA reportedly advised the House Energy and Commerce Committee's panel on health and the environment that radon levels in one of every five public schools in the U.S. exceed the EPA's safery standard. Apparently, the EPA study was based upon an examination of 900 randomly-sele«ed schools and projects that more than 70,000 dassrooms in 15,000 schools have high levels of radon. According to the study, students in approximately 10,000 classrooms are exposed to radiation levels higher than those to which nudear power plant employees are exposed About 11 million students, the survey condudes, are exposed to radon levels that may present a health problem. According to Margo Oge, director of EPA's Office of Radiation and Indoor Air, readings should be taken in first-floor classrooms in every public school. She blamed poor IAQ in schools for posing a threat to children's health and reportedly estimated that most schools could solve their radon problems by taking steps that cost between $3,000 and $30,000. Representative Henry Waxman (D-Cal.), chair of the House subcommittee considering the EPA survey, cautioned parents and teachers not to panic. 'Radon causes lung cancer only after years of exposure," Waxman was quoted as saying. His subcommittee is apparently preparing to draft legislation that will address the alleged radon hazard. Set Los.9ngrles Times, March 19, 1993. ASHRAE [8] Critics Charge ASHRAE Standards Reflect Business Interests ASHRAE, whose indoor ventilation and thermal standards serve as industry guidelines in the absence of IAQ legislation, has reportedly come under attack by unions and public interest activists who are skeptical of standards set by the private sector. Although ASHRAE standards undergo public review before they are finalized, consumer interests, say critics, are rarely represented on the technica] and project committees ETS/IAQ REPORT, ISSUE 44 that draft and revise the standards in light of the comments received. According to the president of an Ohio corporation that recently became involved in the standard setting process for air filters, "the committee setting is controlled by a typical political process. If most [large] i manufacturers apply for membership, the documents will unduly reflect their interests." See Indoor Air Review, March 1993. STATE AND LOCAI. GOVERNMENTS [9] Privacy Legislation On March 29, 1993, Virginia Governor L. Douglas Wilder (D) vetoed a bill that would have prohibited employers from discriminating against any person who uses tobacco products outside of employment. The bill also would have prohibited employers from requiring, as a condition of employment, employees to use tobacco products on the job. Sec S.B. 859, Regular Session (1992-93). In Pennsylvania, a bill was introduced on March 23 that would prohibit discrimination against persons who use lawful products. SecH.B. 956, 176th General Assembly- Reg. Sess. (1993-94). In Massachusetts, a bill was introduced on January 6 that would prohibit employers from requiring as a condition of employment that any employee refrain from smoking or using tobacco outside the workplace or from discriminating against any individual with respect to employment for such activity. See H.B. 1221, 178th General Court - Reg. Sess. (1993). There are, for purposes of this Report, three types of privacy legislation: They provide protection for those who (i) engage in lawful activities, (ii) use lawful products, and (iii) use tobacco products. Bills that would prohibit discrimination against employees who use legal products in a legal manner are under consideration in three states in addition to Pennsylvania, Alaska, Idaho, Iowa, Montana and Nebraska. Bills that would prohibit discrimination against employees who engage in lawful activities away from the workplace are pending in six states: Florida, Hawaii, Iowa, Kansas, North Dakota and Washington. Bills that would prohibit employers from descriminating against employees who use tobacco products specifically are pending in three states: Alabama, Massachusetts and Pennsylvania.

APRIL 2, 1993 [ 101 ETS-Related State and Local Legislative Activities Because ofspace limitations, the following discussion reflects only a portion of the state and local legislative activity related to ETS: The fax communication sheet at the end of this Report may be used to request information about ETS-related legislation not appearing here. • California On March 1, 1993, a bill was introduced tharwould prohibit smoking at any time inside any building owned, leased, or occupied by the legislature. Another bill, introduced February 22. 1993, would authorize a city or county to enforce its ordinance regulating the smoking of tobacco in a private residence licensed as a family day care home during its hours of operation and in those areas of the facility where children are present. The bill prohibits the smoking of tobacco on the premises of a child day care center. See A.C.R. 27 and A.B. 615, Regular Session (1993-94). •Local Governments in California According to a news report, the San Mateo City Council approved a smoking ban in businesses and restaurants that prohibits smoking in bar areas of restaurants where there is no barrier between diners and bar patrons. An earlier version of the measure would have apparently forced bars to reserve half of their seating for nonsmokers and would' have prohib- itcd smoking in private banquet rooms in restaurants. Both provisions were removed. See The San Francisco Chronick, March 16, 1993. The Sausalito City Council postponed voting on an ordinance that would have prohibited smoking in all public places, including bars and outdoor restaurants. According to a news report, bar and restaurant owners opposed the ordinance and claimed they would fight it. See The San Francisco Chronicle, March 18, 1993. •IIIinois On Marcli 10, 1993, a bill was introduced that would prohibit smoking in elementary and secondary schools, municipal teen centers, and all lieensed day care faalities. SeeS.B. 985, 88th General Assembly- Reg. Sess. (1993-94). Several other bills relating to banning smoking in day care facilities have been introduced. See H.B. 1617, H.B. 1540, and S.B. 693. Other bills have been introduced that would prohibit smoking areas in restaurants and would guarantee a smoke-free work- place. SetH.B. 1988 and H.B. 1152. •New Jersey According to a news report, the New Jersey Assembly Environment Committee has stopped a measure that would ban smoking in all restaurants. According to the report, an Assemblywoman said that legislation was necessary because children and nonsmokers frequent restaurants, and because the ETS Risk Assessment found that ETS is reported to be "dangerous." See United Press Inttrnationa4 March 22, 1993. •Ohio According to a news report, the Akron City Council passed a comprehensive smoking ban prohibiting smoking in any city-owned building or vehicle. Mayor Donald Plusquellic was reported to refer to the recent EPA Risk Assessment on ETS when he said that the city had an obligation to protect its workers' health and to insulate the city from lawsuits that could be filed by people who say they contracted lung cancer from City Hall smoke. Also under consideration is a smoking ban in Summit County's main office building and in the County Jail. Under the measure, prisoners at the jail would be allowed to smoke only in the outdoor exercise area. Sre The Plain Dealer, March 19, 1993. •Pennsylvania According to news reports, on March 22, 1993, a bill was introduced that would ban smoking in workplaces, indoor public places and some outdoor facilities. Set Gannett News Service, March 23, 1993, and United Press Intcrnatronal. March 22, 1993. •Rhodc Island On March 18, 1993, a bill passed the House and was sent to the Senate that would prohibit smoking in hallways of elderly housing complexes. Another billiwas introduced on February 24, 1993, that would ban smoking in restaurants. SerH.B. 6748 and H.B. 6715, Regular Session (1993). •Local Governments in Texas According to a news article, the Arlington City Coun- cil is considering an ordinance that would ban smoking in the workplace. According to the news report, the city council member proposing the ordinance said that the recent EPA Risk Assessment on ETS prompted him to push for the new restrictions. Also, employers could not "discriminate, discharge, or in any other manner retaliate against any employee exercising a right created by this ordinance," a draft of the ordi- nance was reported to say. See The Dallas Morning News, March 11, 1993.

6 • Utah Governor Mike Leavitt (R) has recently acted on three bills. On March 15, 1993, the governor signed a bill that provides for procedures regarding,permitting smoking areas. He also signed a bill'that prohibits smoking in public school buildings or facilities or on property on which those facilities are located. The bill provides for designated smoking areas for adults during non-school hours in private schools. See H.B. 53 and H.B. 136. On March 23, 1993, Leavitt vetoed a bill that would have required business establishments with smoking areas to provide information regarding the alleged health hazards of tobacco smoke to employees exposed to ETS. See S.B. 67, 50th Legislature - Gen- eral Session (1993). ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [11] Broin: Defendants File Brief on Class Action Appeal On March 29, 1993, defendanufiled their brief in opposition to plaintiffs' appeal of the trial court's order dismissing the class action allegations of plaintifl•s' complaint. If plaintiffs choose to file a reply brief, the brief would be due on April 19th. In proceedings in the trial court, defendants filed a motion to compel discovery of plaintiffs' medical records. The motion has been set for hearing on April 20. At issue in this case are the daims of 30 flight atten- dants allegedly injured by occupational exposure to ETS. In addition, the husband of one of the flight attendants claims loss of consortium. The 30 atten- dants purport to represent a class of approximately 60,000 other attendants. The injuries alleged by the putative class representatives include lung cancer, breast cancer and unspecified respiratory ailments. Plaintifl•s further allege that occupa- tional exposure to ETS on board aircraft causes at least 22 diseases and a reasonable fear of contracting such diseases. The defendants are purported to be the six major U.S. cigarette manufacturers (plus related entities), UST, Inc., United States Tobacco Co., Dosal Tobacco Corp., the Council for Tobacco Research, The Tobacco Institute, ETS/IAQ REPORT, ISSUE 44 and'three other trade associations. Broin, et aL v. PhiGp Morris, tt aL (Circuit Court, Dade County, Florida) (filed October 31, 1991). [12] Butla: Trial Court Sets Case for November 1993 Plaintiffs' counsel unilaterally scheduled this case for trial on November 29, 1993. Defendants have filed a motion to set aside the trial date, hold a scheduling conference and enter a scheduling order setting deadlines for discov- ery and other matters. In the motion, defendants propose a discovery deadline of August 1, 1994, and a pretrial conference on October 1, 1994. Plaintiffs have since filed a series of motions and scheduled all of them for hearing on April 21. Among other matters, the motions request the following relief: 1. An order compelling discovery; 2. Leave to file a second amended complaint, which would indude additional daims of fraud and conspiracy; and 3. An order scheduling a discovery conference. Plaintiffs propose that the court retain the Novem- ber 1993 trial date, establish a deadline for designat- ing expert witnesses of July 28, 1993, and establish~ a deadline for all discovery of October 28, 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. R.J. ReynolcLt Tobacco Co., et aL (Circuit Court, First Judicial District, Hinds County, Mississippi) (filed October 21, 1992). [13]' *McKinn~y: Prisoner Files Suit Against Manufacturers With an ETS-related civil'rights daim against prison officials already pending in the U.S. Supreme Court, Nevada prisoner William McKinney has filed a second ETS case naming cigarette manufacturers as defendants. The cigarette manufacturers named in plaintiffs complaint include R.J. Reynolds and Brown & Williamson. McKinney's primary allegation against these defendants is that they failed to warn about the

APRIL 2, 1993 alleged health effects of ETS exposure. McKinney also alleges that "toxic smoke ... has now been dassified as a Class "A" carcinogen by the Environmental Protec- tion Agency." As in the civil rights case, which has been pending in the federal court system for more than five years, McKinney's statement of injuries in the newly-filed lawsuit is fairly general. He claims emotional pain, mental anguish, severe headaches, constant nose bleeds, itchy and watery eyes, nasal mucus discharge, and recurring chest pains due to ETS exposure. McKinney v. CM. Produca, lnc., et at (District Court, White Pine County, Nevada) (filed March 3, 1993). In the civil rights case, briefing and oral argument is eomplete, and the Supreme Court could issue its decision at any time. In contrast to the new lawsuit he has filed, McKinney recently was quoted by a newspaper as saying that he would file suit on behalf of smokers if his civil rights case results in a smoking ban in prisons. See issue 42 of this Report, March 5, 1993. [14] Zwillnuan: Court Grants Defendants' Dispositive Motions On March 22, 1993, the court granted all three of defendants' dispositive motions, permanently dismiss- ing The Tobacco Institute and the Council for To- bacco Research from the case and giving plaintiff leave to reassert some of its claims against the two other defendants, Brooke Group, Ltd., and The American Tobacco Company. The order can be broken down into three parts. First, the court ruled that all of plaintiffs' claims against The Tobacco Institute and the Council for Tobacco Research were time barred. 'TI and CTR shall not be named as defendantsA in plaintiffa' next amended complaint, the court ordered. Second, the court also dismissed as time-barred all personal injury-survival claims made on behalf of Mts. Zwillman, all loss of consortium claims by Mr. Zwillman, and all infliction of distress claims made by Mr. Zwillman. Like the dismissal of claims against TI and CTR, the court's dismissal of these daims was with prejudice. Third, based on the New Jersey Products Liability Law and the U.S. Supreme Court's preemption decision in 7 Cipo!loru, the court dismissed without prejudice plaintiffs remaining daims against American and Brooke Group. Plaintiff was given 45 days to refile an amended complaint which complies with those two authorities. This originally was a smoking-and-health case filed by Wolf Zwillman for himself and as the personal representa- tive of his wife, Marjorie, a smoker who allegedly died in 1989 of lung cancer. ETS claims were added in an amended complaint. Based on the allegations in the current complaint and a trial court memorandum, the theory of plaintiffs case appears to be that Marjorie Zwillman's lung cancer was caused by her own smoking as well as the ETS from cigarettes smoked by herself and others. Plaintiff asserts that his ETS claims should be governed by environmental and toxic tort law rather than products liability law. ZwiAman v. Brooke Group Ltd, et aL (U.S. District Court, New Jersey) (filed February 15, 1991; second amended complaint adding ETS claims filed Febniary 13, 1992). Brooke Group is the successor corporation to Liggett & Myers. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS WORKPLACE: IAQ/ SICK BUILDING SYN DROME [15] Beming v. Voith c+rMacravish (Philadelphia County Court of Common Pleas, Pennsylvania) (filed Febrtiaiy 3, 1993); Skoogfurs v. Voith 6- Mactavish (Philadelphia County Court of Com- mon Pleas, Pennsylvania) (filed January 21, 1993) These actions, alleging injuries due to exposure to toxic substances, have been filed against three contrac- tors involved in the renovation of a library building on the Bryn Mawr College campus near Philadelphia. See issue 43 of this Report, March 19, 1993. The sub- stances involved include limestone wash, lacquer, lacquer thinner, latex coating, floor stain, oil stain, paint remover, alkyd sealer, oil base varnish, varnish, paint, bronzing powder and other, solvents. As a result of the defendants' alleged negligence in failing to provide warnings or properly ventilate the areas in which they were working, employees Allyn Bensing and Anne Skoogfors claim they suffer from,

8 among other things, headaches, swollen and bleeding gums, shortness of breath, extreme sinus pain and discomfort, slurred speech, coordination problems, insomnia, increased risk of contracting cancer, other physical and emotional painj mental anxiety, anguish, annoyance, inconvenience, humiliation, embarrassment, and an incapacity to perform her usual daily activities. Both husbands join the complaints with loss of consor- tium daims. The Bensings and Skoogfors each seek compensatory damages in excess of $50,000 on each count and punitive damages in excess of $50,000. Plaintifl's in both actions are represented by Arthur Hankin of Bolger, Picker, Hankin & Tannenbaum. COLLECTIVE BARGAINING' [16] United Paperworkers Internationa! Union, Local 1279 v. A~'uconsin TissueMills, Inc., 1993 U.S. Dist. LFXIS 3348 (U.S. District Court, Eastern District, Wisconsin) (decided March 13, 1993) A U.S. District Court judge has ruled that a grievance filed over a unilateral workplace smoking policy must be submitted to arbitration. The case arose when Wisconsin Tissue Mills designated certain areas in its plant as nonsmoking in 1990. The union claimed that this was a violation of its collective bargaining agree- ment. Reconciling procedural rules about exhaustion of procedures and preconditions to suit, the court granted the union's motion for summary judgment and ordered'submission of the grievance over the smoking policy to arbitration. LEGAL ISSUES AND DEVEIAPMENTS [ 17] *ASH Produces New Antismoking Pamphlet Citing the EPA Risk Assessment on ETS, ASH has prepared a new pamphlet proclaiming that businesses are now "on legal notice of the many dangers of secondhand smoke to workers, customers, and other visitors." A copy of the pamphlet is attached as Appen- dix B. The cover of the pamphlet carries the term "legal notice" in large print and warns that "tobacco smoke is hazardous to the health of nonsmokers, and can cause death and disability from cancer and heart disease." Quotations from news sources and business interests about the risk assessment are induded in the r, 1.31 .n.4- cu:, va..,..i~ v a: r, pamphlet, and ASH provides a list of legal actions individuals can take to recover damages for injuries allegedlytaused by exposure to "enormous concentra- tions of smoke." [18] •Minnesota Attorney General Opines About Effect of Risk Assessment in the Workplace The EPA Risk Assessment on ETS "does not, per se, place a new liability on employers which did not exist before," but it could serve as the basis for regulating workplace smoking, and it might help employees prove a causal relationship between workplace exposure to ETS and an alleged injury, according to an opinion letter issued last month by the Minnesota Attorney General's office. The letter had been requested by a representative of the Minnesota House. A copy of the letter is attached as Appendix C. The letter implies that the evolving definition of "occupational disease" under Minnesota's workers compensation law would have to be extended to include injuries allegedly caused by ETS exposure. The attorney general's office is unaware of any Minnesota cases in which a claimant was awarded benef ts because of ETS exposure, the letter states. "The potential for such cases in the future, however, certainly exists." The letter doses by asserting that "there are steps an employer can take to minimize future potential liability, which steps could indude banning or restrict- ing all smoking at the workplace. Neither federal nor state law would appear to prevent an employer from banning smoking in the workplace or from taking other reasonable steps to assure that other employees arc not exposed to second-hand smoke." U.S. INCIDENTS OF SBS/BRI [19] Sick Building Syndrome/Building Relaud Illness in Florida, Massachusetts, Missouri and New York • J.D. Floyd Elementary, Spring Hill, Florida After health complaints from teachers and students were reportedly registered beginning in the fall of 1992, extensive lAQtesting was conducted on Floyd Elementary School. A parents group calling themselves

APRIL 2, 1993 the Hernando Environmental Action Team (HEAT) has formed to gather information on the problem and to demand action by the school board. Although the complaints continue to persist, the IAQtests have apparently not revealed the source of the problem. The school has tried a number of remedies, including dcaning the HVAC system and stripping carpets. At least a dozen teachers have been tested in the hope of finding a common allergen; those tests were incondusive. Addi- tional IAQ testing has been ordered. Ser S1r Pcrasburg Time% June 10 and 26,1992. • Rowes Wharf Office Highrise, Boston, Masraduusetts A Boston law firm reportedly daimspoor IAQin its office space in a ritzy high-rise is causing illness among office workers. The law firm says it commissioned IAQ testing and results indicate the problem is the building's ventilation system. The building's developer/ manager says it hired Anderson Laboratories to con- duct tests on the carpet the firm had installed and that fumes from the carpet is the culprit. The law firm reportedly says it will break its lease and move out; the building managers say they will sue. See Boston Globe, February 4, 1993. • Dixon Elementary School, Dixon, Missouri Teachers and students reportedly began breaking out in unexplained skin rashes while at school. Those who were afl'ected reported that the symptoms went away after leaving the school. Officials dosed the school to investigate but were never able to identify a specific cause. They did find high dust levels, lack ofvcntila- tion and dead birds in the ceiling. The school was thoroughly deaned and aired out and the rashes have now reportedly disappeared. See Kansas City Star, March 10, 1993. •Roswcll Park Cancer Institute, Bttffalo, New York Asprrgillu.t bacteria has reportedly caused infection among seven patients, two of whom have died. The institute had a similar outbreak in 1983 which was blamed on its ventilation system. In that instance, 10 patients died and four families sued and won judg- ments, daiming the state failed to make repairs even though it knew the system was defective. In the most recent instance, the hospital daims a patient was infected with the bacteria prior to being admined to the hospital. See The Bu„$'alo News, January 25, 1993. 9 • Legislative Office Building (LOB), Albany, New York In a building being dubbed the "L.O.B.-gionnaire's disease," legislators and staffers have been complaining for months about poor IAQ They daim to see black smudges beneath ventilation ducts, say there is no air in the building and that they have health problems as a result. Following health department inspections the Office of General Services failed to adopt any of the recommen- dations for improvement. In response, some legislators say they plan to introduce IAQlegislktion that would require, among other things, more stringent enforcement of IAQ laws. See Ncusday, December 30, 1992. • New York Schools The New York Committee for Occupational Safety and Health (NYCOSH) has reportedly received hundreds of complaints from school employees about indoor air quality. NYCOSH says it has conducted tests on several schools and found a wide range of problems, induding: (i) lack of fresh air; (ii) improp- erly designed and/or maintained ventilation systems; and (iii) inadequate temperature and humidity con- trols. The state school board association says it is unaware of any widespread IAQ problems in New York schools even though teachers' union officials say as many as half may qualify as "sick,°' causing health problems for teachers and students. See Newsday, March 8 and 16,1993. OTHER DEVELOPMENTS [20] State to Provide Employees with Smoking Shelters Aecording to press reports, the srate of New York plans to build shelters for smokers at a cost of $50,000 each at its Taxation and Finance Department offices in Albany. Apparently, the smoking ban that is in efffecr in state office buildings is being ignored by smokers, and nonsmokers have been complaining about the violations and the douds of smoke and litter near entrances where smokers congregate. See The New York Times, March 23,1993. [21] Centers for Disease Control (CDC) Launches ETS Information Campaign The CDC has reportedly instituted a nationwide campaign to warn people about the alleged dangers of

10 ETS exposure and to suggest methods to prevent exposure. The campaign, which is being conducted through print and television public service announce- ments, provides information from the EPA regarding purported ill health effects of ETS on children. The messages apparently contain a toll-free hotline which can be used to obtain a free action guide on ETS and other information. See The Dallas Morning News, March 25, 1993. [22] Survey Asks About Smoking and Children Forty-five percent of those surveyed in Pennsylvania reportedly say they think smoking in the presence of an inEant constitutes a form of child abuse. Sixty-one percent said they think children should not be allowed to be seated in the smoking section of a restaurant. The survey, released by the Rural Services Institute at Mansfield University, reportedlypolied 1,690 Pennsylvanians. See Uniud Press Intmrationa4 March 22, 1993. [23] Large Increase in Corporate Smoking Bans Predicted According to a health consultant based in Maryland who regularly surveys Fortune's Industrial 100 and large diversified service companies regarding their smoking policies, many arn expected this year to join those already banning smoking inside their ccilities. Some one third of the Industrial 100 and half of the service companies surveyed have adopted smoking bans. Employers such as PepsiCo, Federal Express, Du Pont, US West and Ralston Purina currently ban smoking indoors, and Merck, a New Jersey-based drugmaker, reportedly bans smoking anywhere on the property. Washington, D.C. tdecommunications company Comsat apparently reduced the number of smokers in its employ from 25 percent to 10 percent by charging smokers double what nonsmokers arc charged for health insurance. Ser Fonutu, March 22, 1993. [24] •Children Advised to Change Parents' Smoking Habits In a question and answer column appearing in a Houston newspaper, a child who wrote to ask if ETS exposure was hazardous was answered with a referral to the EPA Risk Assessment on ETS. The answer further advised the child to provide the parents with informa- t l J~ inl[ 11i~1• V n l, 1 JJ v L Y-, tion about the alleged hazards of ETS and ask older relatives or a doctor to speak to the parents about the problem. The child was also advised to ask the parents to smoke outdoors if they cannot quit or to smoke in a separate room with the door dosed. See The Houston Chronicle, March 25, 1993. MEDIA COVERAGE [25] •"EPA Study on Passive Smoking Stirs Debate and Passions," R. Brownson, The San Francisco Chronicle, March 19, 1993 Ross Brownson, author of this opinion piece, discusses the EPA Risk Assessment on ETS and dismisses criticisms regarding the reliability of epidemiologic studies by stating, "A modicum of uncertainty on a scientific level cannot justify inaction when it comes to protecting the public's health." Evidently, the commentator believes that smoking should be banned in workplaces, public places, restaurants and anywhere children may be exposed to ETS. He condudes that "smokers should be given the opportunity to smoke as long as it does not endanger the health of nonsmokers and children." Brownson principally authored a study entitled, "Passive Smoking and Lung Cancer in Nonsmoking Women," (Amrrican Journal of Public Health 8Z(111 1525-1530, 1992), which reported no statistically significant risk estimates based on "quantitat'rve" exposure estimates of childhood ETS exposure, household exposure, spousal smoking or workplace exposure. See issue 35 of this Report, November 20, 1991 [26] •"Don't Mind if I Smoke," T. McNichol, USA Weekntd March 28, 1993 In this article, Dave Brenton, editor of the United Smokers Association quarterly, is interviewed and asked about his response to the EPA Risk Assessment on ETS. Brenton reportedly quit his job with Motorola in 1987 when the company established a restrictive smoking policy and has been a smokers' advocate since that time. Brenton questions the reliability of a report that, in his words, "invented a special science to examine one issue, using non-standard methods." USA Wiekend condudes the piece by soliciting votes from readers regarding whether the battle against smoking has gone too far or not far enough. -

APRIL 2, 1993 11 SCIENTIFIC/TECHNICAL (CHD) in nonsmokers. He concludes that the "case for ETS ex osure causin CHD is wholl " unconvincin ITEMS p g g, y and calls for the presentation of a "more balanced point of view" on the issue UPCOMING MEETINGS . [27]' 1993 Annual Summer Toxicology Forum, Given [30J "Passive Smoking and the Risk of Acute Myo- Institute of Pathobiology, Aspen, Colorado, cardial Infarction," C. La Vecchia, B. D'Avanzo, July 12-16, 1993 M.G. Franzosi, and G. Tognoni, The Lancet According to the program for this conference, it will indude a session devoted to ETS. Besides an introduc- tion, there will be presentations on the EPA Scientific Advisory Board Review, the EPA Position, the Alterna tive Viewpoint, and a Panel Discussion. 341: 505-506, 1993 [See Appendix A]' This letter to the editor presents data from a case- control study comparing the risk of acute myocardial infarction (AMI) in nonsmokers married to smokers and nonsmokers married to nonsmokers. Slightly elevated relative risks (1.1-1.3) are reported for mar- riage to a smoker; none achieves statistical significance. LUNG CANCER [28] "Indoor Air Pollution and Lung Cancer in Guangzhou, People's Republic of China," Q. Liu, A.]. Sasco, E. Riboli, and M.X. Hu, Ameri- can Journal ofEpidemiology 137(2): 145-154, 1993 [See Appendix A] A number of possible risk factors for lung cancer are investigated in this case-control study, jointly con- ducted by researchers from China and from IARC. A number of lung cancer risk estimates for measures of home ventilation are presented; the authors conclude that indoor air pollution produced during cooking is a risk factor for lung cancer. They also suggest that spousal smoking may be associated with elevated lung cancer risk. For instance, a point estimate of 2.9 (95% CI 1.2-7.3) is presented for spousal smoking of 20 or more cigarettes per day. The point estimate is based on only 19 cases and 16 controls. CARDIOVASCULAR ISSUES [29] "Environmental Tobacco Smoke and Coronary Heart Disease," A.K Armitage, Journal of Smoking-Related Disorders 4(1): 27-36, 1993 [See Appendix A] In this review anicle, the author examines data concerning claims that ETS exposure may be associ- ated with an increased risk of coronary heart disease RESPIRATORY DISEASES AND CONDITIONS - CHILDREN [31] "Relation of Passive Smoking as Assessed by Salivary Cotinine Concentration and Question- naire to Spirometric Indices in Children," D.G. Cook, P.H. Whincup, O. Papacosta, D.P. Strachan, M.J. Jarvis, and A. Bryant, Thorax48: 14-20, 1993 [See Appendix A] In this British study, two methods for assessing ETS exposure are used: salivary cotinine measurements and responses to questionnaires. The exposure indices are compare& with lung function measurements. The authors report small associations between salivary cotinine and reduced lung function, and also claim that questionnaire data are "as good" as cotinine data in predicting lung function. [32] "The Decrease in Severity of Asthma in Chil- dren of Parents Who Smoke Since the Parents Have Been Exposing Them to Less Cigarette Smoke," A.B. Murray and B.J. Morrison, Journal ofAlkrgy and ClinicalImmunology 91: 102-110, 1993 [See Appendix A] This study reports on a comparison of data on asthma (including lung function) and data on parental smok- ing, for a group of children in Vancouver, Canada. The authors compare children seen before July 1986 with those seen later, and report that parents have decreased

12 the number of cigarettes smoked near their children, which the authors then relate to a decrease in the reported severity of asthma. [33] "Lung Function, Respiratory Illness, and Passive Smoking in British Primary School Children," R.J. Rona and S. Chinn, Thorax 48: 21-25, 1993 [See Appendix A] The authors of this British study examine reported parental smoking, measures of pulmonary function, and symptoms of respiratory conditions in 2,756 children in various areas of Great Britain. They report "inconsistent°' data on parental smoking and children's lung function; the claimed associations vary by child's sex and by which parent reportedly smoked. [34] "Hispanic Children With Asthma: Morbidity," P.R Wood, HA. Hidalgo, T.J. Prihoda, and M.E. Kromer, Pediatrics 91: 62-69, 1993 [See Appendix A] This study reports a variety of data related to asthma in Hispanic children in Texas. Asthma is reportedly associated with substantial respiratory impairment and school absenteeism in the children studied, who came from low-income families. The authors suggest that intervention focus on further education of families and on reducing ETS exposure (44% of the children studied reportedly were exposed to ETS at home). OTHER HEALTH ISSUES [35] "Editorial: Give a Dog End a Bad Name," A.D.S. Caldwell, Journal of Smoking-Rslated Disorders 4(1): 1-2, 1993 [See Appendix A] The managing editor of the Journal of Smoking- Related Disorders comments that questions have "recently been raised" in publications concerning the reliability of data onsome purported risks of ETS exposure and active smoking. He calls for "solid foundations" for scientific arguments, and announces that his journal is seeking support for an "International Congress" on these issues. [A "dog-end" is a British term for a "butt.") ETS EXPOSURE AND MONITORING [36J "Analysis of Tobacco-Specific N-Nitrosamines in Indoor Air," K.D. Brunncrnann, J.E. Cox, and D. Hoffmann, Carcinogenesis 13(12): 2415- 2418, 1992 [See Appendix A] The authors of this study, who have published previously on this topic, report on a method for assessing tobacco-specific N-nitrosamines (TSNA) in indoor air. Based on their measurements, they claim that nonsmokers may be exposed to 0.1-0.3 cigarette equivalents of certain TSNAs, substances that they describe as "highly carcinogenic." [37] "Relationship Between Environmental Tobacco Smoke Exposure and Carcinogen-Hemog)obin Adduct Levels in Nonsmokers," S.K Hammond, J. Coughlin, P.H. Gann, M. Paul, K Taghizadeh, P.L Skipper, and S.R. Tannenbaum, Journal of thr National Cancer Institutt 85 (6): 474-478, 1993 [See Appendix A] In this study, levels of 4-aminobiphenyl-hemoglobin adducts were measured in smoking and nonsmoking pregnant women and compared to estimates of ETS exposure (questionnaire, diary, and personal monitor). The authors report that their data support a relation- ship of increasing adduct levels with increasing re- ported ETS exposure. They daim that this suggests ETS exposure "is related to levels of a known human carcinogen in nonsmokers" (4-aminobiphenyl has reportedly been associated with and increased risk of bladder cancer in exposed workers). S. Katharine Hammond, lead author of the paper, was a member of the SAB committee that reviewed the EPA Risk Assessment on ETS. [38] •"Environmental Tobacco Smoke," A. Rodgman, Regulatory Toxicology and Pharma- cology 16: 223-244, 1992 [See Appendix A] While this anide responds to the first draft of the EPA risk assessment on ETS, it did not become available until late 1992. The author, formerly with R.J. Reynolds, provides an extensive review of the physics and chemistry of ETS. In particular, he examines 43 substances reported to be carcinogenic, which have been claimed to be present in ETS. Rodgman provides extensive data on animal testing,

APRIL 2„ 1993 mutageniciry, exposure and: thresholds, and calls on EPA to review these data with respect to ETS. INDOOR AIR QUALITY [39] "The Effect of Varying Levels of Outdoor-Air Supply on the Symptoms of Sick Building Syndrome," R. Menzies, R Tamblyn, J.P. Farant, J. Hanley, F. Nunes, and R Tamblyn, The New England Journal ofMedicine 328(12): 821-827, 1993 [See Appendix A] Canadian researchers report, in this paper, on a study of 1,500 office workers in four buildings. Ventilation level was experimentally increased in the study, and the authors compared workers' reports of symptoms under the original and new ventilation regimes. They report no effect on workers' perceptions or reports of symp- toms related to the increase in outdoor air supply. [40] "The Sick Building Syndrome In Office Build- ings - A Breath of Fresh Air," K Kreiss, The New England Journal ofMrdicine 328(12): 877- 878, 1993 [See Appendix A] The author of this editorial describes the paper by Menzies, et al., as a"robust" effort that illustrates "sound experimcntal'and epidemiologic methodology" for IAQ research. She calls for multidisciplinary efforts in the field of "sick" buildings, to develop the "woefully undeveloped and unsupported" scientific data in this area SMOKING POLICIES AND RELATED ISSUES [41] Letters to the Editor Regarding "Protection from Environmental Tobacco Smoke in Califor- nia: The Case for a Smoke-Free Workplace," R Borland, J.P. Pierce, D.M. Burns, E Gilpin, M. Johnson, and D. Bal, Jorrrnal of thr Amtrican Medual Association 268 (6): 749-752, 1992 The Journal of the American Medical Association recently published two letters concerning this anide. As discussed in Issue 29 of this Report, August 28, 1992, the authors proposed that 2.2 million Califor- 13 nians were exposed to ETS at work in 1990. They also suggested that "adequate protection" of nonsmokers required that workplaces be smoke-free. Two of the authors have been involved in ETS-related issues: David M. Burns was a member of the SAB committee that reviewed the EPA Risk Assessment on ETS, and Ron Borland is a member of the Anti-Cancer Council in Victoria, Australia. The first letter in the current corre- spondence is from Chris Collett, and is followed by a reply from the authors of the original study, with the exception of Bums. The letters appear in the Journal ofthr American MtdicalArwciatron 269(11): 1388, 1993. Collett, an indoor air quality researcher, proposes that the authors' "condusion does not appear to be justified' by the reported data." In particular, he rcfers to the apparent lack of adequate exposure assessment in the Borland, a al., study. Collett cites his own research group's experience in monitoring ETS levels, and proposes that nonsmoker exposure to ETS can be minimized without prohibiting smoking. Moreover, Collett calls proper ventilation a "key requirement" for minimizing exposure to other compo- nents of indoor air. In their reply, Pierce, et al., comment that Collett's letter "cites studies funded by the tobacco industry." They also state that they "know of no ... safe level of ETS expo- sure." Invoking EPA's recent classification of ETS as a "Group A" carcinogen, Pierce, et al., "take the position that any exposure to ETS at all is to be avoided." They again call for "well-enforced smoke-free worksite policies," citing the daimed low cost of such policies compared to modifications of ventilation systems. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AUSTRA1..lA [42] New South Wales Delays Public Smoking Ban The government of New South Wales has reportedly delayed implementing smoking bans in enclosed public

14 places so that the state can seek further input from the tobacco industry. Two National Party ministers have apparently criticized the legislation on civil liberties grounds, and hoteliers planned to hold a rally to protest the proposed ban on smoking in pubs and clubs. See Sydney Morning Htrald March 24, 1993. [43] Total Smoking Ban Not on Government's Agenda National Parry leader Mr. Tim Fischer reportedly said recently that a Coalition government would not ban smoking altogether as it was a"`democratic right."' Fischer, answering questions in a Mackay shopping centre on March 9, 1993, admitted he had once smoked a cigarette and enjoyed it immensely: See The Australian, March 10, 1993. AUSTRIA [44] Anti-Smoking Bill Drafted The Health Ministry has reportedly submitted a draft bill for approval by the Bunderat which would, among other matters, ban smoking in such public places as office buildings, schools, universities, railway stations, snack bars, restaurants, and hotels. The penalty for violation of the measure would be as high as $8,810. SerXinhua Languagr Niws Service, March 8, 1993. Federal Chancellor Vranitzky has reportedly criticized several parts of the draft tobacco law. According to press reports, he has made it dear that no one will be fined for smoking in a nonsmoking area. See hresse,. March 10, 1993. CANADA [45] Ontario Government Conducts Hearings on Smoking Proposals A three-day public hearing was reportedly held before a government committee during which antismoking activists and business owners presented their respective views on the issue of proposals the Ontario govern- ment is considering to curb tobacco use. Restaurant owners are apparently concerned that smoking restric- tions being considered by the Ontario health ministry will eventually lead to a complete ban on smoking in restaurants, resulting in restaurants going out of ETS/LAQ REPORT, ISSUE 44 business. According to press reports, ETS is expected to be targeted by the NDP government in the spring following public consultation. See The Toronto Star, March 23, 1993. [46] Cigarette Package Warnings May Indude ETS Message On March 19, 1993, Health Minister Benoit Bouchard of Ottawa reportedly proposed new regula- tions that would require cigarette packages to bear labels warning, among other matters, about the alleged danger of ETS exposure to children. One of the proposed messages would state that "tobacco smoke can harm your children," and would be required to appear in bold black and white letters on 25 percent of the two main panels of cigarette packs. Apparently, this is Ottawa's second attempt to pass such labeling regulations. An earlier, attempt reportedly failed when the tobacco companies attempted to block the warn- ings in a Quebec court. That case is presently being appealed by the tobacco companies to the Supreme Court. See Canada NewsWire, March 19, 1993; The Toronto Star, March 20, 1993. GERMANY [47] Anti-Smoking Activists Draft Legislation The German Non-Smokers' Initiative will reportedly seek to introduce legislation later this year into the Bundestag to regulate smoking in workplaces, public buildings, restaurants, public transportation sites, and at public meetings. The draft legislation, which is based upon the law currently in effect in France, has appar- ently garnered promises of support from 45 Bundestag, deputies. The law would reportedly punish offenders with fines of up to $6,000. See The Week in Germany, March 26, 1993. INDIA [48] Government Considers Smoking Bans According to the Minister of State for Health & Family Welfare, the government is proposing legisla tion that would ban smoking in public places. Admin- istrative instructions have already reportedly prohibited smoking in hospitals, schools, conference rooms,.

APRIL 2, 1993 domestic air flights, some train coaches and public transport. See Tobacco International, February 1, 1993. ISRAEL [49] Health Ministry Officials Unprepared to Discuss Workplace Smoking Policies The Knesset Labor and Social Affairs Committee reportedly conducted a meeting on March 15, 1993, to consider the issue of regulation changes that would bar workplace smoking. According to press reports, the committee chair, who is evidently seeking hard data regarding mortality rates among nonsmokers who are exposed to ETS in the workplace and information about attempts by nonsmokers to reach accommoda- tion with their smoking coworkers, berated Health Ministry officials for coming to the meeting without any relevant statistics. The only figures presented at the meeting were apparently provided by the Israel Society for the Prevention of Smoking which reported that 700 nonsmokers die annually as a result of ETS exposure. Health Minister Haim Ramon reportedly initiated the regulation change proposal. See TheJerusalrm Aoss, March 16, 1993. PHILIPPINES [50] Smoking Restrictions Imposed in Manila On March 17, 1993, the mayor of Manila reportedly announced that smoking in all public places is prohibited except in designated smoking zones. Violators will apparently face fines of $12 and/or two days in jail. City officials who break the law can be dismissed from service and face criminal sanctions. See Xinhua General News Savice, March 18, 1993; Manila Bulktin, March 18, 1993. UNITED KINGDOM [51] Home Secretary Squelches Attempt to Impose Smoking Ban Officials at the Home Office reportedly posted notices announcing that as of national No Smoking Day its Queen Anne's Gate headquarters in central. London should become a no-smoking zone. Home Secretary Kenneth Clarke, referred to in the press as the "voice of the saloon bar in Cabinet" due to his 15 "well-known fondness for a pint and cigar," immedi- ately informed the civil servants in the office that he makes the rules and no decisions would be made on the issue without his approval. Meanwhile, Clarke's former ministry, the Department of Health, has dedared its offices to be smoke free with the exception of a few designated rooms. See The Daily Telegraph, March 9, 1993. [52] Smoking Bans Considered by Numerous Bor- ough Councils In the wake of the settlement reached in the Veronica Bland case in which an employee of the Stockport council was awarded benefits for injuries allegedly due to ETS exposure in the workplace, Borough Councils in Walsall, Sedgemoor, Ealing, Slough, West Lothian District, Hereford and Maidstone are reportedly discussing proposals to ban or restrict smoking by staff and visitors in their facilities. A number of newspaper accounts report the actions being taken; they indude articles in Wolverhampton Express d' Star, March 9, 1993; Burnham dHighbridge Mereury, March 2, 1993; and Ealing Recorder, March 4, 1993. These councils join those in Lincoln and Exeter which are also in the process of adopting smoking bans. See issue 43 of this Report, March 19, 1993. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS UNITED KINGDOM [53] Wright v. Ladbnoka (Industrial Tribunal, Binning- ham, England) (filed December 20, 1991) Hearings were reportedly underway in late March in a case involving a bookmaker's cashier who was fired from her job because she violated a company policy which banned smoking behind the counter. See Appendix B to issue 25 of this Report, July 7, 1992. According to testimony presented in the case, Pauline Wright, who is 40 and smokes some 30 cigarettes a day, objected strenuously when the new policy was introduced, but turned down an offer to transfer to a quieter shop where she could smoke. She was fired in July 1991 when her supervisor found her smoking

16 behind the counter in view of the customers. Wright's challenge is reportedly being backed the pro-smoking group FOREST, which sees it as a landmark which may prove that employers cannot impose smoking bans on staff See Press Association Nnusfile, March 25, 1993. LEGAL ISSUES AND DEVELOPMENTS UNITED KINGDOM [54] "The Smokeless Zone," V. Harpwood, Orcupa- tional Health Review, March/April 1993 The author of thisanicle examines the various legal options available to force employers to impose work- place smoking bans. It is conceded that the current legislative occupational safety and health framework will not support successful litigation. The author discusses the Veronica Bland case in which a settlement was reached between the Stockport Metropolitan Borough Council and one of its employees to resolve an allegation of injury due to ETS exposure and shows how it will not serve as legal precedent for other individuals who claim injury due to ETS exposure. The article concludes with a prediction that the pressure to change workplace smoking policies will come from the insurance industry which will likely respond to the first major award against an employer by demanding that companies impose smoking bans. [55] Adoption Agencies Advised Not to Place Chil- dren With Smokers On March 24, 1993, the British Agencies for Adop- tion and Fostering (BAAF) reportedly issued guidelines to adoption workers indicating that it is not in the best interests of children under the age of two to be placed with smokers. BAAF is the umbrella body for 180 fostering and adoption agencies. According to press reports, the guidelines do not have the force of law, but it is anticipated that BAAF's recommendations will be taken up by every agency in the country. Citing statistics which purportedly relate smoking to increased risk of cot death, BAAF director Christine Hammond was quoted as saying, "If there is a choice between a smoking and a non-smoking family, it is t1JlUAll Ktl'VK1:,1JJUt 4fl hard to justify the extra risk of placing a child with the one that smokes." Some four or five couples are usually interested in adopting each of the 1,000 babies avail- able for adoption every year. Smoking will join the list of other factors making families unsuitable for adop- tion, such as age, medical condition, substance abuse and household space. Under-Secretary of State for Health Tim Yeo criti- cized the new policy and was quoted in press reports as saying, "It would be quite wrong for a child to be denied'the chance of a loving home solely because there is a smoker in the household. There is no room for dogma or ideology in any aspect of adoption." See The Independent, March 25, 1993; The Reuter Library Report, March 24, 1993; The Times, March 25, 1993; The Daily Telraph, March 25, 1993; CNN (Tran- script), March 25, 1993. OTHER DEVELOPMENTS EUROPEAN COMMUNITY [56] •Cigarette Confederation Publishes ETS Pamphlet In March 1993, the Confederation of European Community Cigarette Manufacturers (CECCM) published a pamphlet which refutes many of the daims being made about ETS exposure and health. The document links complaints about indoor air quality to ventilation problems and criticizes the EPA Risk Assessment on ETS as "fancy statistical footwork." UNITED KINGDOM [57] •Symposium on Workplace Smoking Held in Glasgow On March 10, 1993, a symposium on "Smoking in the Workplace" was held at the Royal College of Physicians and Surgeons of Glasgow. Some 100 delegates attended the event during which ASH proposals for imposing workplace smoking bans were presented as the optimal way of dealing with the issue. One speaker referred to the EPA Risk Assessment on ETS; another suggested that employers should consider

APRIL2, 1993 a policy of employing only nonsmokers. Delegates were advised regarding the potential legal consequences of failing to protect employees from exposure to ETS.. [58] Union Employees Oppose Complete Smoking Ban According,to press reports, the Leeds Teaching Hospital Trust and its 5,000 union workers have been unable to reach agreement over a union demand for designated smoking areas. Evidently, the Trust abruptly ordered all employees to stop smoking at its facilities as of March 1, 1993. Although the union reportedly supports the policy, it says it is concerned that workers will "sneak away for a fag in a cubby hole and create a fire risk," said a union branch official. According to the chief executive of the Trust, segregated smoking areas have never worked and disciplinary measures will be taken against those who ignore the smoking ban. See Yorkshire EveningPosA March 1, 1993. Meanwhile, hospitals and other health centres in Doncaster will reportedly ban smoking by staff begin- ning October 1, 1993. According to the chief executive of the Doncaster Healthcare Trust, staff members who persistently violate the rules could be dismissed. See Doncaster Free Pres4 March 1993. [591 Schools Advised to Provide Smoko-free Environment Schools in Camden have reportedly been advised that they should provide a smoke-free environment for their staff or they may be liable for prosecution: The advice follows the settlement in the Veronica Bland case which prompted a survey of Camden schools. Appar- ently, a number of the schools do not provide smoke- free staff rooms. See Hampstead er Highgate Fxpress, March 1993. [60] Pub Owners Refuse to Ban Smoking Despite a national survey which reportedly found that most people do not want to be exposed to ETS when they go out for a drink, the majority of pub licensees are apparently not going to introduce smoking bans in their establishments. London pub company Wetherspoons, however, will reportedly introduce nonsmoking areas in all its outlets in the next montlL According to the chairman of the Bath Licensed Victuallers' Association, it is up to individual pub landlords whether to introduce smoke-free areas in 17 their premises. See Bath cr West Evening Chronicle, March 1993; The Star-Shef~'ielc% March 8, 1993. In a related story, a cafe which has banned smoking was recently awarded the "Roy Castle Good'Air Award." The award, named after an entertainer who claims ETS exposure caused his lung cancer, is appar- ently provided by the West Yorkshire Smoking and Health campaign and recognizes eating and drinking establishments that provide smoke-free areas. See Huddenfuld Examiner, March 10, 1993. Meanwhile, Roy Castle and fellow actor Richard Wilson have reportedly joined forces with the manu- facturer of Nicorette nicotine gum and patches to educate the public about the purported dangers of ETS exposure. As part of the campaign, more than 12,000 pharmacies across the country will be stocking leaflets containing information about ETS. See The Standard February 26, 1993. [61] Study Links Child Snoring to ETS According to the researchers at the Churchill Hospital Sleep Clinic in Oxford, children who snore are four times more likely to have a mother who smokes than nonsnorers. Enlarged tonsils are also apparently an important risk factor for snoring. In addition, the study linked aggressive and behavioral problems in children to parental smoking. See The Oxford Times, March 12, 1993. WORLD AIRLINE NEws [62] Bahrain Gulf Air has reportedly announced it will ban smoking on all flights between Bahrain, Oman, Qatar and the United Arab Emirates. A spokesman for the airline says the ban will be in place by the end of March 1993. The spokesman said the measure is in line with directives from WHO on combating smok- ing. See Monryclips, March 15, 1993. [63] Iceland Icelandair will reportedly ban smoking on all its European routes effective April 1, 1993. The airline apparently conducted a test ban and found that a"clear majority" favored nonsmoking flights. See B. T. (Dan- ish Daily), March 7. 1993.

18' [64] Scandinavia Scandinavian Airlines System (SAS) says it will launch smoke-free European flights for a six-month trial period beginning on March 28, 1993. Flights with a maximum of two and one-half hours flying time, approximately 80 percent of SAS European flights, will be smoke free. Passengers will be polled during the trial period before a decision is made to make the bans permanent. See Agence France Presse, March 16, 1993. SAS provides air services in all Nordic countries. [65] Switzerland Crossair will reportedly introduce a smoking ban on flights which use SAAB 340 Ciryliner or Fokker F50 aircraft. The ban, which will go into effect by the end of March 1993, will also apply to flights operated by Crossair on behalf of its parent company, Swissair. See Neue Zuercher Zeitung, February 25, 1993: [66]' United Kingdom Cathay Pacific Airways has announced it will add the London-Hong Kong route to its list of flights where smoking will no longer be permitted beginning May 1, 1993. The route will join other international no- smoking routes, including those from Hong Kong to Australia, New Zealand, North America and routes within southeast Asia. An airline spokesman reportedly said the airline believes it will be in a position to be completely smoke free by 1995. SecXinhua News Agenry, March 17, 1993. 1;1 S/lACZ Kr:YUK1, 1SSU1: 44 court's decision in the case by omitting parts of the opinion in trying to persuade employers that ETS exposure is not a problem and its effects in the com- munity have been overstated. The anide also notes Justice Sheppard's criticism of a statement made during a radio interview by TIA executive director Jerome Mostyn to the effect that there is "no clear, conclusive evidence that passive smoking is injurious to the health of non-smokers." According to Justice Sheppard's opinion, there is no question about the ill effects of ETS exposure on asthmatics. [68] "Passive Smoking Danger Admitted," M. Date, The Sydney Morning Herak February 26, 1993 According to this artide, the Tobacco Institute of Australia has admitted that ETS exposure might cause asthma attacks. The author quotes from a 32-page booklet on workplace smoking published by TIA as follows: "environmental tobacco smoke may tempo- rarily produce or exacerbate symptoms in some asthmatics." Public affairs manager of the New South Wales Anti Cancer Council Stephen Woodward criticized the booklet and reportedly said that employ- ers to whom it has been distributed described it as a joke. Woodward is quoted as saying, "If someone suess you, you cannot tender this document in court in your defence. It is not an expert opinion." The article contains other information from the booklet and concludes with TIA's assertion about the unresolved nature regarding the issue of safe doses for carcinogens. UNITED KINGDOM MEDIA COVERAGE AUSTRALIA [67] "Federal Court Warns Tobacco Institute Over Brochure," TheAurtralian Financial Review, March 11, 1993 This article highlights the warning Justice Sheppard gave TIA in its decision over outstanding matters in the lengthy litigation between AFCO and TIA. See issue 43 of this Report, March 19, 1993. The justice said that a TIA brochure being distributed to employ- ers may have given a distorted impression of the federal [69] •"Passive Smoking Landmark," Health and Safety Information Bulletin 207, March 1993 This arride discusses the issues involved in the Veronica Bland'cxse and observes that there is a dispute over whether the settlement will serve as precedent for other individuals claiming their respiratory problems are caused or exacerbated by workplace exposure to ETS. The Municipal Mutual Insurers, who reportedly advised Bland's employer to settle the case, has apparently claimed since then that the building in which Bland worked had severe ventilation, dust and dirt problems to which Bland was susceptible in addition to ETS. According to a solicitor with the firm representing Bland, a principal issue in future cases may be the date

APRIL 2, 1993 by which employers should have taken action regarding workplace smoking. Local and health authorities, he speculates, due to their specialist knowledge, might be under a greater duty to act on ETS. The article also summarizes the EPA Risk Assessment on ETS and discusses UK employer smoking policies. [70] "Smokers Forced Me To Quit Job, Says Gerk," A. Sambidge, Western Daily PneA February 20, 1993 According to this article, former civil servant Mark Langley was forced to quit his job as an administration officer at the Department of the Environment in Bristol, because he could no longer tolerate the smok- ing of his coworkers. Allegedly told by his personnel manager to put up with the smoke or quit, Langley is reportedly seeking legal advice about seeking compen- sation from his former employers. [71] "Attitudes to Smoking," P. Madge, The Safety e5 Health Practitioner, March 1993 The author of this artide, a nonsmoker who works as an independent consultant in legal liability and insurance, compares attitudes toward smoking in the United Kingdom, the United States and in South Africa. He reports the conclusion of the EPA Risk Assessment on ETS, and states that employers dearly have a duty to protect their employees from ETS exposure. The artide concludes with advice to employ- ers on gradually introducing workplace smoking policies in consultation with employees. 19

APRIL 2, 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. SCIENTIFIC/TECHNICAL ITEMS LUNG CANCER [28] "Indoor Air Pollution and Lung Cancer in Guangzhou, People's Republic of China," Q liu, A.J. Sasco, E Riboli, and M.X. Hu, American Journal of Epidemiology 137(2): 145-154, 1993 "A case-control study comprising 224 male and 92 female incident lung cancer cases and the same number of individually matched hospital controls was con- ducted from June 1983 to June 1984 in Guangzhou, People's Republic of China, to evaluate the association between indoor air pollution and lung cancer risk" "The goal of this study was to evaluate whether there is any relation between indoor air pollution resulting from domestic cooking practices and lung cancer occurrence." "All cases and controls were interviewed in person. The interviewers obtained extensive information about the subject's general demographic characteristics, occupational history, history of respiratory diseases, family cancer history, smoking habits, spouse's smok- ing habits, cooking practices (including domestic fuel use), and residence history. After completing the questionnaire, the interviewer measured the size of the windows and doors that opened onto the outside of the building, thereby providing an estimation of ventila- tion capacity. The ventilation capacity of the kitchen was analyzed separately from that of the rest of the dwelling, hereafter designated the living area." "Marital status, educational level, dialect, occupation, and living area did not differ significantly between cases and controls, although cases had a lower educa- tional level and a smaller average living area than controls. Thus, we controlled for education, occupa- tion, and living area when we analyzed other variables." "As expected, the subjects with lung cancer showed increased frequencies of occupational exposure to hazardous working environments, a history of pulmo- A-1 nary tuberculosis, and a history of chronic bronchitis in both sec groups. When education, occupation, living area, and smoking were controlled' for, the associations of lung cancer with the above risk faaors were not substantially modified among men, but they were attenuated or even disappeared among women, except for exposure to dust. In contrast, the increased risk of lung cancer associated with a family history of cancer, found in univariate analysis, disappeared for both men and womenwhen we controlled for the same variables. Smoking was strongly related in a dose-response manner to the risk of lung cancer in both men and women. ... An increased risk of lung cancer was also observed among nonsmoking women who lived with a husband who smoked the equivalent of 20 or more cigarettes per day. [OR 2.9, 95% CI 1.2-7.3; for husband smoking 1-19 cigarettes per day, OR 0.7, 95% CI 0.23-2.2]," "After adjustment for education, occupation, occupa- tional exposure, pulmonary tuberculosis history, chronic bronchitis history, family cancer history,, amount of smoking per day, and living area, as well as passive smoking (for women only), several variables pertaining to ventilation conditions were strongly associated with lung cancer risk. There was increased risk associated with having a window or door opening from the kitchen into the living area or bedroom, and for cooking in the living area or bedroom. For cooking in the living area or bedroom, the exposure odds ratio was 2.4 (95 percent CI 1.4-4.2) for men and 5.9 (95 percent CI 2.1-16.0) for women. Having windows or doors that opened in different directions so that indoor air could circulate also significantly influenced the risk of lung cancer. The relative risk for lung cancer tended to decrease with increasing size of ventilation openings in living areas and kitchens. For the best ventilated living area as com- pared with the least ventilated, the exposure odds ratio for lung cancer was reduced to only 0.14 (95 percent CI 0.04-0.51) for men and 0.02 (95 percent CI 0.00-0.21) for women. The exposure odds ratios for kitchen ventila- tion were 0.15 (95 percent CI 0.05-0.44) for men and 0.06 (95 percent CI 0.01-0.32) for women, respectively. The differences were statistically significant. A similar trend was found for the ceiling height throughout the apartment, but no dear trend was seen for the floor on which the subject lived " "Passive smoking may also account for some excess risk, although increased risk was only observed in the women living with husbands who smoked heavily. No

A-2 effect was seen for women married to light smokers. This may be explained by the reduced sample size and by the imprecise quantification of passive smoking. The results of other studies in Chinese women have suggested that passive smoking contributes to a slight increase in lung cancer risk." "Since coal use, frequent home cooking,, and lack of an apparatus for extracting fumes are universal in Guangzhou, it was difficult to find a significant difference between any population groups. However, this indicates that severe indoor air pollution exists for most families in Guangzhou, where people live in comparativelyover- crowded conditions with poor ventiIation: Better, ventila- tion of houses could thus play a key role in improvement of the indoor microenvironment, and dissimilar ventila- tion conditions could be responsible for different exposure levels of lung cancer cases and controls. During the study period, there was in most houses no artificial ventilation such as air conditioning, so the indoor microenvironmen- tal conditions depended mainly on natural ventilation. The area of ventilation (as defined by the area of openings to the outside) was a good representative measure of ventilation conditions. This is in agreement with other studies on indoor air pollution showing that the concen- trations of pollutants are greatly affected by ventilation." "In summary, the results of this study suggest that indoor air pollution produced during home cooking is a risk factor for lung cancer in Guangzhou, especially for women, who are more likely to be exposed to coal fumes and cooking oil vapors in the kitchen. This could contribute to the high rate of lung cancer in Chinese women. Further investigations are needed to clarify the precise nature of indoor air pollutants and their carcinogenic mechanisms. It would also be informative to conduct studies by major histologic type, particularly in Chinese women, among whom adenocarcinoma is unusually frequent." CARDIOVASCUTAR ISSUES [291 "Environmental Tobacco Smoke and Coronary Heart Disease," A.K Armitage, fournal of Smoking-Related Disorders 4 (1): 27-36, 1993 "The debate regarding the association between smoking and cardiovascular diseases, especially coro- nary heart disease (CHD) has, during recent years, led to consideration of the possibility that exposure of ETS/tAQ REPORT, ISSUE 44 non-smokers to environmental tobacco smoke (ETS) might increase the risk of such disease. The uncertainty about the existence of such an association is evident." "Twelve epidemiology studies have now been published on which to base a judgment but few details were provided for two of the case-control studies and the studies of Martin et al., Palmer et al. and Butler have only been published as abstracts; full papers are still awaited." "The 12 studies provided 15 different estimates of relative risk for either men or women, and 95% confidence intervals are available for all but two of these. 13 out of 15 indicate a relative risk of > 1, but eight of these have a lower confidence limit of <1, indicative of a non-significant effect. Although the studies suggest an association, because most of the claimed relative risks lie between one and two, Hill's criterion of strength is not satisfied:° "Meta-analysis does not increase the strerrgth of the association, although by reason of narrowing the 95% confidence intervals it may produce a mathematically, though not necessarily biologically, significant relative risk." "Statistically, assuming no systematic bias, it would appear unlikely that 13 out of 15 estimates of relative risk >1 could have arisen by chance. Although some element of consistency amongst the published studies is indicated the possibility of publication bias may have accentuated the consistency of the association." "Clearly, the amounts of nicotine and carbon monox- ide absorbed from ETs are small and it is unlikely that either compound plays any role in the alleged increased relative risk for CHD of non-smokers exposed to ETS. It would be surprising if any other smoke component was absorbed in significant amounts from ETS." "The case for ETS exposure causing CHD is wholly unconvincing because almost all of the accepted 'causational' criteria remain unsatisfied. Of particular concern is the weakness of the association, the likelihood of the existence of publication bias resulting in an overestimate of a very low relative risk, the lack of biological plausibility and the anecdotal nature of dosimetry assessment. At the present time, therefore, one is not able to conclude categorically that ETS is, or is not, harmful in a cardiovascular context. It is debat- able whether the conduct of further epidemiologic studies, frequently recommended, is practical and justified. Small studies are a waste of time and money because at best they can only detect large risk as signifi-

APRIL 2, 1993 cant. Of course it is theoretically possible to conduct a prospective study,... which would control for all confounding variables and involve a sufficient number of subjects to provide reasonable statistical power. However, even large studies cannot distinguish with any certainty between a very low risk and no risk Furthermore, without meaningful measurement of prolonged ETS exposure, results might still be incon- clusive regarding the question of causation. In the meantime, it is wrong that an ETS/CHD health scare has been blown up out of all proportion in the last few years by a passionate anti-ETS health lobby.lnterpre- tive opinions are not proven facts; they must be challenged and a more balanced point of view pre- sented to the general public." [30] "Passive Smoking and the Risk of Acute Myo- cardial Infarction," C. La Vecchia, B. D'Avanzo, M.G. Franzosi, and G. Tognoni, The Lancet 341: 505-506, 1993 "A possible relation between passive smoking and ischemic heart disease has been widely debated over the past decade, and at least 11 studies have been reported on the issue.... Most of these studies showed an increased risk, to a variable extent, of heart disease in never-smokers exposed to passive smoking. Even if the excess risk among non-smokers exposed to passive smoking were of the order of 20-30%, this would have a substantial impact on a public health scale, being respon- sible for a much larger number of deaths than that estimated for passive-smoking-related lung cancer deaths." "A case-control study of acute myocardial infarction (AMI) was done in 1988-89 ... on 916 first episodess ofAMI and 1106 controls in~hospital for acute diseases not related to any known or potential cardiovascular risk factor. From the original sample 113 cases of AMI and 225 controls admitted to the same network of hospitals for acute diseases not related to any known or potential cardiovascular risk factor were identified as currently married never-smokers. Exposure to passive smoking at home was investigated through questions on the spouse's habits, induding smoking status (never-smoker, current, ex), number of cigarettes smoked per day, years the couple had lived together, and, if ex-smoker, time since quitting." "Compared with subjects married to never-smokers, the multivariate relative risks, after simultaneous A-3 allowance for sex, age, education, coffee consumption, body mass index, serum cholesterol, hypertension, diabetes, and family history ofAMI, were 0.91 (95%; CI 0.36-2.28) for subjects married to an ex-smoker and 1.21 (0.57-2.52) for those married to a current smoker. Among subjects with; a current smoker spouse, the RRs were 1.13 (0.45-2.82) for subjects with a spouse smoking less than 15 cigarettes per day, and 1.30 (0:50-3.40) for those with a spouse smoking 15 orr more cigarettes per day." "In this study, information on frequency of consump- tion of 14 selected indicator foods was available: no material differences were evident between subjects who lived with a smoker spouse and those who lived with a non-smoker. Average serum cholesterol concentrations were 207 and 209 mg/dL, respectively." "The interpretation of this study remains inconclusive because of its lack of statistical significance, limited exposure assessment, and potential misclassification of the smoking status of subjects interviewed and their spouses. Still, these results, with the already accumu- lated evidence, are compatible with the hypothesis of a moderate effecc of passive smoking on the risk of myocardial infarction." RESPIRATORY DISEASES AND CONDITIONS - CHILDREN [31] "Relation of Passive Smoking as Assessed by Salivary Cotinine Concentration and Question- naire to Spirometric Indices in Children," D.G. Cook, P.H. Whincup, O. Papacosta, D.P. Strachan, M.J. Jarvis, and A. Bryant, Thorax 48: 14-20, 1993 "In this paper we examine the relation between spirometric indices and passive exposure to smoke in a large sample of children from 10 towns in England and Wales. In particular, we compare salivary cotinine concentrations with questionnaire measures of expo- sure in relation to spirometric indices in an age group, 5.5-7.9 years, where active smoking was unlikely to confound the issue. We measured mid and end expiratory slow rates (FEF., and FEF7) as well as forced vital capacity (FVC) and forced expiratory volume in one second (FEV,) as there is some evidence that these are most affected."

A-4' "Salivary Cotinine Concentration was strongly related to the number of smokers to whom the child was usually exposed. Undetectable cotinine was rare among those exposed to one or more smokers (18/1328 = 1.4%), whereas among those not regularly exposed there was only one reading above 14.7 ng/ml. Thirty five children had cotinine concentrations above 14.7 ng/ml." "All spirometric indices show a tendency for children with higher cotinine concentration to have poorer ventilatory function. For all except the FEV1:FVC ratio these differences were highly significant. The strongest association was with FEF., where each unit increase in cotinine concentration was associated with a fall of 14.3 ml/s." "We ascertained exposure to cigarette smoke from four sources on the basis of the questionnaire: mother, father, others living in the same household, and anyone else looking after the child for more than two hours a week. The independent relationships of each of these sources of exposure to spirometric indices was exam- ined by means of multiple regression analyses in which all sources were included simultaneously. All four sources of exposure tended to be associated with reduced spirometric measures.... Because the effects from the different sources of exposure seemed broadly similar (though few were individually significant) and because there was no clear evidence of dose-response effects with number of cigarettes smoked by mother or father we summarised exposure as the number of sources ... For all indices except FVC there is a clear fall in respiratory functionwith increasing exposure. As with cotinine, the strongest association was with FEF50, the estimated effect being a reduction of 51.0 ml/s for each additional source of exposure. In contrast to cotinine, exposure as assessed by questionnaire was negatively associated with FEV,/FVC:" "We have shown the inverse associations between spirometric indices and both salivary cotinine and a questionnaire measure of passive exposure to smoking. ... What is clear is that, in our data, a questionnaire score that combined several different sources of exposure was as good a predictor of flow rates as a single measurement of cotinine in young children." "In our study there were no statistically significant associations with the smoking habit of the father and only a few spirometric indices were significantly ETS/tAQ REPORT, ISSUE 44 associated with that of the mother. Using a composite score based' on the number of sources of exposure, however, including one from outside the home, we found a clear relation between estimated degree of exposure to tobacco smoke and respiratory function. Nevertheless, the lack of a clear dose-response relation- ship with number of cigarettes smoked per day by the parents and the possibility that the mother's smoking is more important than the father's, which is supported by other studies, suggest that factors that modify exposure, such as the extent to which cigarettes are smoked in the presence of children, need to be taken into account. Our results also emphasize that questionnaire measures need to take account of other sources of exposure." [32] "The Decrease in Severity of Asthma in Chil- dren of Parents Who Smoke Since the Parents Have Been Exposing Them to Less Cigarette Smoke," A.B. Murray and B.J. Morrison, Journal ofAllrrgy and ClinicalImmunology 91: 102-110, 1993 "Since 1983 we have been gathering data on passive smoking and on asthma severity in children who have attended our clinic. From 1983 until 1986 we observed more severe asthma in children of smokers than in those of nonsmokers, but since 1986 there has been a marked lessening in the severity of asthma in children of smokers, their asthma being no more severe than that in children of nonsmokers. It appears likely that much of this improve- ment is the result of the parenu' awareness of the harmful effects of smoke, and a consequent decrease in exposure of asthmatic children to smoke." "Two sets of analyses were performed. The first was a preliminary one to determine whether parents were smoking fewer cigarettes and whether there had been a concomitant lessening in the severity of the children's asthma. After this a second analysis was carried out to assess if the change in asthma severity could be ex- plained by the change in the parents' smoking habits. This was done by integrating the smoking and asthma severity data." "The preliminary set of analyses showed that al- though there was little change in the total number of cigarettes the parents smoked per day when comparing the earlier and later periods, 17 versus 16 by mothers and 20 versus 19 by fathers, the mean number of cigarettes smoked when in the same room as the child

APR1L 2, 1993 decreased markedly, 7 versus 3 by mothers and 5 versus 2 by fathers. Concurrent with the lessened exposure to the mothers' smoke there was a marked improvement in the children's lung function." "Three analyses of covarience were carried out for each of the four measures of asthma severiry.... [S]mokers' children, compared with nonsmokers' children, had greater improvement in asthma score and in spirometric test results across the time period.... [T]his difference across the time periods in smokers' children is decreased if the number of cigarettes smoked when with the child is taken into account, as would be expected if exposure to the parents' cigarette smoke is a reason for the difference." "Eighty percent of the parents who were questioned about their smoking after 1988 said that they had been told by their doctor not to expose their child to smoke, and that they attempted to avoid doing so by smoking outdoors or in another room or by using maneuvers such as smoking by an open window or blowing their smoke into the fire or into the exhaust fan in the kitchen." "Not only was asthma less severe in smokers' children who were seen after July 1986, but also their lung function measurements were no longer lower than those found in nonsmokers' children. This large degree of improvement may be explained by smoke having caused the asthma, as well as aggravating asthma, in some smokers' children." [33] "Lung Function, Respiratory Illness, and Passive Smoking in British Primary School Children," RJ. Rona and S. Chinn, Thorax 48: 21-25, 1993 "In the National Study of Health and Growth (NSHG), a nutritional surveillance system, data were collected on lung function from a substantial subsample of study areas in England and Scotland in 1987 and 1988. The sample induded a range of socioeconomic, ethnic and geographi- cal groups in the population. The aim of the analysis was to assess the contribution of respiratory illness and passive smoking to variation in lung function, with adjustment for potentially confounding social and biological factors. The factors associated with respiratory illness have been reported previously." "Spirometry, in 2756 children aged 6.50-11.99 years, was carried out in a representative sample of English children, an inner city and ethnic minority sample, and A-5 a Scottish sample. Forced vital capacity (FVC); forced expiratory volume in one second (FEV,), and forced expiratory flow rates of 25-75% and 75-85% (FEFZSa5 and FEF75-B5) were measured and standardised scores obtained separately for the English representative sample, the Scottish sample and sub-groups in the inner city sample, white and Afro-Caribbean children and those originating from the Indian subcontinent. Multiple regression analyses were used to assess associa- tions of FVC, FEVV FEF25-75 and FEF7ye5 with the passive smoking and respiratory illness, with adjustment for a large number of potential confounders. Passive smoking was defined in terms of reported number of cigarettes smoked at home by each parent. The respiratory symp- toms and illnesses assessed were wheeze, asthma and bronchitis attacks, cough in the morning, and cough at any other, time as reported by parents." "Inner city white parents smoked most heavily. There were very few children in the Asian groups exposed to smoking in the home of more than 15 cigarettes per day, as smoking is predominantly a male activity in these groups. Only 13 out of 681 Asian mothers were smokers.... For Afro-Caribbean children, maternal smoking was a more important component of total parental smoking because there was a larger percentage of one parent families. In the representative sample, Scottish parents smoked more than English parents." "Most of the independent confounding variables in the analysis were not consistently related to all four measurements of lung function, or were not consistent in boys and girls. The only exceptions were birthweight, which was positively associated with most measures of lung function in both sexes, and study area in boys." "The only significant associations deteaed were between maternal home smoking and reduced FEF2,-n and FEF~5- 115 in boys. Two other associations were of borderline significance in boys - FEV, with maternal home smoking, and FEFi5-75 with total home smoking. Al- though not significantly different from zero, all other regression coefficients of lung function on maternal smoking were negativea In contrast, for paternal smoking at home most of the regression coefficients were posiave. . .. In an analysis induding both sexes, the interaction of sex and passive smoking was not significantly related'to any of the measures of lung function. The differing effect of matemal and paternal smoking was confirmed by an analysis of both sexes."37

A-6 "Afro-Caribbean children had lower lung function values than white children, whether living in inner city areas or from a representative sample, whereas children originating in the Indian subcontinent had lung function values intermediate between those of the Afro-Caribbean and the white children." "We confirm that children whose parents report wheeze or asthma attacks in the child have significantly lower lung function test results than children without these symptoms. This study shows that a large range of potential confounding variables do not reduce the negative significant association between FEV,, FEFZSas' and FEF7s-as and symptoms of asthma." "The associations between passive smoking and lung function were inconsistent. Our results are consistent with many reports which show that: maternal and not paternal smoking is significantly associated with some measures of lung function." "The amount of time spent by each parent with a child can explain the association of the child's lung function with maternal smoking but not paternal smoking:... In this study overcrowding was unrelated to lung function and number of children in the family was related only to FVC in girls, a measure not associ- ated with passive smoking in our study." "On the whole, our study illustrates the difficulties in making generalizations about the association between lung function and passive smoking in childhood The effect of passive smoking on lung function is likely to depend on the amount of time spent by the smoker with the child, the number of cigarettes smoked, and the child's susceptibility. We have included a large number of confounding variables that could have explained a spurious relationship between lung func- tion and passive smoking." "In conclusion, this study has shown that parents' information about a child's asthma is associated with measures of lung function and that passive smoking can affect lung function. Close contact of the smoker with the child may be critical in damaging the growth of the lung. It must be recognised, however, that the mechanism of the association between a child's lung function and maternal smoking but not paternal smoking remains unexplained." ETSLUIQ REPORT, ISSUE 44 [34] "Hispanic Children With Asthma: Morbidity," P.R. Wood, H.A. Hidalgo, T.J. Prihoda, and M.E. Kromer, Pediatrics 91: 62-69, 1993 "A group of Hispanic children with moderate asthma followed in the clinics of the University of Texas Health Science Center at San Antonio were studied. Children aged 6 to 16 years with at least two acute-care visits or one hospitalization for asthma during the previous year were enrolled. Data sources included standardized questionnaires, spirometry, medical records, and school attendance records. Seventy-eight Hispanic children were enrolled in the study. Fifty-two (67%) of children had been hospitalized previously." "The objectives of this cross-sectional study were to (1) describe the morbidity present in Hispanic children with asthma; (2) describe the knowledge, health practices, and perceived barriers to health care of these children and their families; and (3) i identify factors that predict morbidity. This study is important because it provides detailed information about the needs and health status of a group of Hispanic children with asthma and identifies potential areas for intervention." "The families of these children were poor and the majority of parents (62%) had not completed high school. Sixty-three families (81%) had an annual household income of $12000 or less. Fifty-five (71%) children had no health insurance and only 11 (14%) had Medicaid. Most children (78%) lived in two- parent households. Sixty-six households(85%) had four or more members." "Almost all children took medications daily for asthma. The average number of medications that these children received for asthma was 2.8." "[O]nly 45 (58%) [subjects] had three or more [spirometric] maneuvers that met ATS criteria for valid analysis. The spirometric data of these 45 children demonstrated mild to moderate airway obstruction, with a wide range of observed values." "Children experienced a mean of 1.1 days of impairment per week, ie, days during which their sleep was disrupted by asthma symptoms or during which they were unable to participate fully in usual activities. They were absent from school an average of 13 days in the previous year."

APR7L 2; 1993 "Thirty-four children (44%) were exposed to cigarette smoke in the home. Twenty-five (41 °/b) fathers and 14 (18%) mothers living in the home were smokers. Forty-eight (62%) parents identified cigarette smoke as a trigger for their child's asthma. Twenty-four (71 %) of the 34 families with a smoker in the home identified cigarette smoke as a trigger for their child's asthma." "This study documents the burden that asthma of moderate severity places on some Hispanic children and their families. We are aware that the results of this single study require replication and that several meth- odological issues need to be addressed before the results can be interpreted. First, this study was cross-sectional and was performed at a single site." "Some of our findings may be attributable to prob- lems associated with poverty." "Second, . . . the findings cannot be generalized to other children with less severe illness." "Third, although families were quite willing to partici- pate if contacted, many families could not be contacted." "Finally, the small sample size and relatively loww reliability of some of the scales may have contributed to the small effects seen." "This study reveals several potential.targets for intervention. Two factors, knowledge about asthma and exposure to cigarette smoke in the home, were significantly associated with outcome in these children and therefore should be addressed in interventions." "Passive exposure to cigarette smoke was a common finding and was significantly associated with impact of the illness on the family. Inasmuch as the success of smoking cessation interventions has been found to be related to both the number of sessions and the duration of contact with the program, the ongoing relationship of a physician with the parents of a child with asthma may a be good forum for smoking cessation advice.... At a minimum, physicians should encourage children with asthma and their families to limit the child's passive exposure to cigarette smoke." A-7 OTHER HEALTH ISSUES [35j "Editorial: Give a Dog End a Bad Name," A.D.S. Caldwell, Journal of Smoking-Related Disorders4l(1): 1-2, 1993 "'Exposure to tobacco smoke and "well being and health" are incompatible. Discuss.' At first glance, this hypothetical examination question poses no great intellectual challenge. Cause and efFect have been established beyond reasonable doubt, by means of well- designed pro- and retrospective epidemiological studies, between active cigarette smoking and a statisti- cally significant increase in risk in bronchial carcinoma and coronary heart disease (CHD).... Serious ques- tions have, however, recently been raised in this and other journals on the reliability of some data seemingly establishing some of these causal relationships." "If data on active smoking are being occasionally called into question, there are even greater problems concerning passive smoking and environmental tobacco smoke (ETS). Cardiopulmonary disease, asthma, atherogenesis, lung cancer, leukaemia, retarded growth in children - in these and many more in- stances, a case has been made for ETS as a major aetiological factor. But assessing the impact of ETS is an exercise made hazardous by confounding variables lurking around every statistical corner. In the case of CHD, for example, some 300 risk factors have at some time or other been identified - by what means is it possible to unravel these data and point the finger with any degree of confidence at ETS per se as a major causative element?" "In this issue, Dr. Armitage tackles the questionof ETS and CHD, and his analysis of 12 major epidemiological studies leads him to condude that the relationship between ETS and increased risk of CHD 'is not proven.'" "The Journal of Smoking-Related Disorders is firmly behind all efforts to prevent the young from starting to smoke and convincing older people to stop. But we can also see the dangers inherent in overkill and the use of unsubstantiated generalisations. Campaigners are by nature evangelical in their approach - but the scien- tific argument has to be build on more solid founda- tions. To this end, the Editors of the JS-RD together with the publishers, Gardiner-Caldwell Communica- tions (GCC Ltd), are actively canvassing supporr for an

A-8 International Congress which will address some of the issues touched upon above. Anyone who would like further information should contact the Managing Editor directly at GCC Ltd, Macclesfield." ETS EXPOSURE AND MONITORING [36] "Analysis of Tobacco-Specific N-Nitrosamines in Indoor Air," KD. Brunnemann, J.E. Cox, and D. Hoffrrtann, Carcinogenesis 13(12): 2415- 2418, 1992 "A method was developed and applied for the assessment of tobacco-specific NLnitrosamines (TSNA) in indoor air polluted with tobacco smoke." "Several tobacco-specific N-nitrosamines (TSNA) have been identified in tobacco and tobacco smoke. These include N-nitrosonornicotine (NNN), N- nitrosoanatabine (NAT) and 4-(methylnitrosamino)-1- (3-pyridyl)-1-butanone (NNK).. . . Both NNN!and NNK are powerful'carcinogens that induce benign and malignant tumors of the lung, nasal cavity, esophagus, pancreas and/or liver in mice, rats and hamsters. Recently it was suggested that TSNA act as causative agents for lung cancer in active smokers. It was the goal of this study to assess the contribution of TSNA to indoor air pollution." "TSNA levels [were] obtained under different conditions in the test laboratory in which one, two and four cigarettes per 30 min were machine smoked simultaneously:... It is noteworthy that the NNK levels are [about] 10 times higher than those of NNN. ... TSNA values [were] obtained at different indoor sites polluted with environmental tobacco smoke (ETS). The number of cigarettes smoked during the sampling time (3-8 h) was estimated to the best of our ability. NNN levels varied from not detected to 22.8 pg/l while NAT ranged from not detected to 9.5 pg/1. NNK levels ranged from 1.4 to 29.3 pg/1.... Assum- ing a respiratory rate of 101/min, a non-smoker exposed to these concentrations of TSNA may inhale up to 41 ng of NNN and up to 43 ng of NNK in 3 h. Taking as an average value of NNN and NNK in the mainstream smoke of a filter cigarette 360 and 130 ng/ cigarette respectively, this would mean an exposure to NNN of 0.1 and to NNK of 0.3 cigarette equivalents." ETS/IAQ REPORT, ISSUE 44 [37] "Relationship Between Environmental Tobacco Smoke Exposure and Carcinogen-Hemoglobin Adduct Levels in Nonsmokers," S.K Hammond, J. Coughlin, P.H. Gann, M. Paul, K. Taghizadeh, P.L. Skipper, and S.R. Tannenbaum, Journal of the National Cancer Institute 85(6): 474-478, 1993 "Enduonmental tobacco smoke contains more than 20 identified carcinogens to which nonsmokers may be exposed and is the only known environmental source of one of these carcinogens, 4-aminobiphenyl (4-ABP). 4- ABP was found to be a potent bladder carcinogen in workers in the dye industry, where its use has been discontinued for decades. The emissions of 4-ABP are more than 30 times greater in sidestream smoke than in mainstream smoke; therefore, passive smokers might receive substantial doses of this carcinogen. 4-ABP bonds covalently with hemoglobin, and this adduct might serve as a surrogate marker for a biologically effectivc dose." "In a previous study, we reported finding 4-ABP- hemoglobin adducts in the cord blood of babies born to both nonsmokers and smokers. This observation indicates that 4-ABP or its metabolite crosses the human placenta and binds to fetal hemoglobin. The present study examines the relationship between quantitative measures of exposure to environmental tobacco smoke and the levels of 4-ABP-hemoglobin adducts in the same nonsmoking pregnant women reported in the previous study and compares these levels of 4-ABP-hemoglobin adducts to the adduct concentrations found among the same smoking pregnant women reported in our previous study." "We measured exposure to environmental tobacco smoke by using the following three tools that have been described in detail previously: 1) At enrollment, the subject was asked to complete a detailed question- naire, administered by an investigator, on passive smoking exposure during an average week and was asked a subset of questions on two later occasions to evaluate how exposures had changed; 2) the subject was asked to complete a 7-day diary of environmental tobacco smoke exposure; and 3) during the same week that the subjett was completing the diary, the subject was asked to wear a passive monitor to sample the air for environmental tobacco smoke."

APRIL 2, 1993 "Fifty-four pregnant nonsmokers and 20 pregnant smokers were enrolled in this study.... Blood was collected and analyzed for hemoglobin adducts of 4- ABP for 40 of the nonsmokers and 15 of the smokers. The mean level of adducts among the 15 smokers was 184 pg of 4-ABP per gram of hemoglobin, while that for the 40 nonsmokers was 22 pg of 4-ABP per gram of hemoglobin.... In this study and in previous studies, there was no overlap between the values found for smokers and nonsmokers. The actual levds found in any population will depend on the smoking habits of smokers and the passive smoking exposures of nonsmokers, as well as on individual metabolic differences." "To examine whether there was any relationship between the environmental tobacco smoke exposures and the levels of 4-ABP-hemoglobin adducts in nonsmokers, we categorized average nicotine exposure in the third trimester into low, moderate, and high environmental tobacco smoke exposure groups and calculated the median and mean adduct levels in each category.... As environmental tobacco smoke expo- sure increased, so did both the median and the mean 4- ABP-hemoglobin adduct levels.... The relationship between environmental tobacco smoke exposure and adduct levels was stronger in this study than in other studies, probably because we used more complete and objective measures of exposure." "A statistically significant relationship was found between the weekly average exposure to environmental tobacco smoke during the third trimester of pregnancy and the levels of 4-ABP-hemoglobin adducts found at the time of delivery. This relationship remained after subjects with possible to gas stoves, a possible interfer- ence, were removed from the dataset. This result indicates that exposure to environmental tobacco smoke is related to levels of a known human carcino- gen in nonsmokers. The increase is not dramatic, and the public health significance is undear. The following facts, however, indicate that nonsmokers may receive a nontrivial dose of carcinogens from environmental tobacco smoke: 1) The carcinogen 4-ABP was detected in passive smokers at 14% the level found in smokers; 2) this ratio is consistent with the emissions of main- stream smoke and of sidestream smoke; and 3) greater amounts of other carcinogens, e.g., nitrosamines, are also emitted in sidestream smoke than in mainstream smoke. Although bladder cancer among passive smokers has not been studied, the incidence of lung A-9 cancer has been reported to be elevated among non- smokers married to smokers. The relationship between environmental tobacco smoke exposure and 4-ABP- hemoglobin adduct levels contributes to the plausibility of epidemiologic evidence that environmental tobacco smoke is carcinogenic to passive smokers." [38] "Environmental Tobacco Smoke," A. Rodgman, Regulatory Toxicology and Pharmacology 16: 223-244, 1992 "The U.S. Environmental Protection Agency (EPA)) issued two draft documents in which it defined ETS as a carcinogen and designated it as a 'Group A carcino- gen' in an effort to encourage regulation of smoking in the workplace." "Of prime concern to the EPA were 43 smoke and tobacco components which, in one biological system or other and at doses far in excess of those encountered in MS or SS, had been reported as 'tumorigenic.' The EPA assessed the health consequences with regard to lung cancer of the listed 43 components as follows: 'Of the 99 compounds in tobacco smoke that have been studied in detail, at least 43 are complete carcinogens, each able on its own to cause the development of cancer in humans or animals.' This assessment is incorrect since most have not been shown to be (1) tumorigenic to any human tissue or (2) tumorigenic to lung tissue in laboratory animals.... In addition, the few that have produced lung tumors in laboratory animals have do so at dose levels far in excess of those encountered in MS, SS, or ETS." "As a matter of Agency policy, the EPA overlooks the faa that progressive reduction of the dose of an administered material which produced a given effect in a bioassay eventually leads to a level at which no effect is observed. Despite much data to contradict it, the theory to which the EPA subscribes is that the only safe threshold limit value for a material tumorigenic in animals is a 'zero' dose for humans." "When there is evidence to the contrary that a threshold does indeed exist for a compound under investigation, the EPA is required to consider such evidence and not adhere to the presumption of 'no threshold.' This article presents examples of such `evidence to the contrary.'"

A-10 "The failure to produce in MS-exposed laboratory animals the tumor type reported to be associated with smoking in humans is important not only with regards to the biological properties of MS itself but also with respect to that of diluted MS delivered to the caged animals. Early experiments involving 'whole body' exposure to diluted MS closely resemble ETS exposure, albeit at levels substantially greater than those usually encountered with ETS." "If . . . these smoke-inhalation experiments more dosdy resembled passive smoke (or ETS) exposure than human exposure during actual smoking, then substantial evidence is available to demonstrate that exposure to 'passive smoke' (or ETS), more concentrated than that encountered in the human situation, is ineffective in induction of the rumor type supposedly associated with cigarette smoking in humans: Whole body exposure studies ... were designed to determine the effect of MS on laboratory animals, with emphasis on lung cancer induction. Because of the whole body exposure, results are relevant to the evaluation of the biological effects of exposure to concentrated passive smoke. None of these exposures to concentrated passive smoke induced squa- mous cell carcinoma in the test animals." "Comparison of the list of the 4800 or so. identified components in tobacco smoke with various lists of compounds shown to possess inhibitory or anticarcinogenic action in carcinogenesis-type experi- ments with laboratory animals reveals not only that tobacco smoke contains numerous anticarcinogens but also that their levels in smoke far exceed those of the tumorigens in 'The List of 43.'" "ETS is neither MS nor SS. Chemically, MS, SS, and ETS are qualitatively the same but quantitatively different; physically, they differ significantly." "In active smokers, percentage retentions of MS PP [particulate phase], as measured by PP weight loss, range from 50 to 90%, values higher than would be predicted from particle size alone due to coagulation, electrical charge, growth by water condensation, evaporative transfer, and doud effects with the latter two being the most significant. For ETS, the percent- age retention theoretically should be 10-20%; a measured value of 11% has been reported." "Only a few components on 'The List of 43' have been tested experimentally for tumorigenicity to lung ETS/IAQ REPORT, ISSUE 44 tissue via inhalation: ... It is doubtful that any of the 43 components should be included in 'The List of 43.' Examination of information on Hoffmann and Hecht's 431isted components reveals that it is inappropriate to extrapolate from such a list to a relationship between MS exposure and lung cancer induction in smokers or between ETS exposure and lung cancer induction in nonsmokers." "Fairness of public policy requires consideration of all available evidence, especially the evidence in the form of objective scientific data. Selective use of data to support conjectures that, in turn, support preconceived agenda will not lead to defensible policies, and it is certainly reprehensible science. The evidence presented here, if objectively examined by the EPA, should significantly influence its assessment of the ETS issue." INDOOR A]R QUALITY [391 "The Effect of Varying Levels of Outdoor-Air Supply on the Symptoms of Sick Building Syndrome," R. Menzies, R. Tamblyn, J.P. Farant, J. Hanley, F. Nunes, and R. Tamblyn, The New England Journal of Medicine 328(12): 821-827, 1993 "This study was undertaken to test the hypothesis that symptoms of sick building syndrome could be reduced in mechanically ventilated ofFice buildings by increasing the supply of outdoor air from 20 to 50 ft3 (1.4 m3) per minute per person." "A randomized double-blind multiple-crossover trial was conducted to estimate the effect of changes in the out- door-air supply in four office buildings. During three consecutive two-week blocks of time, building ventilation systems were manipulated to deliver an expected 20 or 50 ft3 of outdoor air per minute per person to the indoor environment, corresponding to indoor carbon dioxide concentrations of 1000 or 600 ppm. Within each two- week block, the ventilation level was increased for one week and decreased for the other." "Of 1838 eligible workers in the four buildings, 1546 (84 percent) participated in the study. The supply of outdoor air averaged 7 percent and 32 percent in the ventilation systems and 30 and 64 ft3 (0.85 and 1.8 m3) per minute per person in the work sites at the lower and higher ventilation kvels, respectively: These changes in the

APRIL 2, 1993 supply of outdoor air were not associated with changes in the participants' ratings of the office environment or in symptom frequency (crude odds ratio, 1.0; 95 percent confidence interval, 0.9 to 1.1). Aker work-site measures of ventilation, temperature, humidity, and air velocity were induded in the regression analysis, the adjusted odds ratio was also 1.0 (95 pmrnt confidcrice interval, 0.8 to 1.2)." "On average, a little more than half the participants reported at least one symptom each week, and the proportion reporting symptoms within each two-wnek block was virtually identical at the two levels of ventilation." "The following personal and work-site characteristics were signif cantly associated with the reporting of any symptom: female sex (odds ratio, 1.7; 95 percent confidence interval, 1.5 to 1.9), atopic illness (odds ratio 1.4; 95 percent confidence interval, 1.3 to 1.6), use of the computer for more than four hours each day (odds ratio, 1.3; 95 percent confidence interval, 1.1 to 1.5), working in an open area (odds ratio, 1.1; 95 percent confidence interval, 1.0 to 1.2), and younger age. These characteristics were also associated with the reporting of mucosal or systemic symptoms." "In this study, increasing the supply of outdoor air in mechanically ventilated office buildings was not associated with either improved environmental ratings or a reduction in the number of symptoms reported by the participants. Key features of the design were that three randomized crossover trials of experimental manipulation of outdoor-air supply were conducted, during which the participants, who were unaware of the study intervention, completed standard question- naires under different environmental conditions." "The failure to detect a significant association be- tween the level of ventilation and the number of symptoms reported may have occurred for several reasons. The participants may not have had the sick building syndrome." "The buildings studied may not have been sick." 'The supply of outdoor air in the work sites may have been poorly estimated from measurements of carbon dioxide." "The reduction in the supply of outdoor air may have been insufficient to produce symptoms." "In this study, temperature, humidity, and air velocity varied significantly between work sites and contributed to differences between subjects in the number of symptoms reported." A-11 "In conclusion, the supply of outdoor air was experi- mentally increased, from an average of 7 percent of the total air supply in the ventilation system and 30 ft3 of outdoor air per minute per person at work sites to an average of 32 percent and 64 ft3 of outdoor air per minute per person, respectively, and these increases were associated with significant changes in the concen- trations of contaminants at different work sites. These changes were not associated with the participants' ratings of the environment or with the number of symptoms reported that were considered typical of the sick building syndrome. We believe that this research method can be used in further studies to establish a scientific basis for ventilation and contaminant stan- dards to ensure the health and safety of the majority of North American workers." [40] "The Sick Building Syndrome In Office Build- ings - A Breath of Fresh Air," K Kreiss, The New England fournal ofMedicine 328(12): 877- 878, 1993 "The paper by Menzies and coworkers in this issue of the Journal brings fresh air to the largely untested hypothesis that the sick building,syndrome is related to inadequate ventilation with outdoor air. The authors found that symptoms at work (not necessarily attrib- uted to the building) and dissatisfaction with the environment in the building bore no relation to the rates of ventilation with outdoor air in buildings whose ventilation rates were considerably above not only the current standard but also the pre-energy crisis standard' of 20 ft3 (0.57 m3) per minute per person.... As an experimental study, the work of Menzies et al. is the most robust of these efforts in rejecting the hypothesis that increasing ventilation with outdoor air above the current standard will eliminate the symptoms of the sick building syndrome. This study does not, however, address the more interesting question of whether increased ventilation with outdoor air can reduce the rate of symptoms in buildings with low rates of ventilation." "If increased amounts of outdoor air do not reduce complaints about the quality of the air in buildings whose ventilation rates are already high, what else might cause the sick building syndrome? ... High rates of building-related symptoms are common, but the rates vary substantially among buildings, implying that the causes may be preventable. The correlation be- tween symptoms and measurable contaminants, such as

A-12 ETS/LAQ REPORT, ISSUE 44' formaldehyde, volatile organic compounds, ions, and particulates, is poor, although more work characterizing rnicroenvironments within buildings may be helpful." "At this point, we do not know the cause of the sick building syndrome, and the science to support preven- tion, correction, and the setting of standards is woe- fully undeveloped and unsupported in the United States. The problem requires multidisciplinary efforts in the experimental manipulation of buildings and the epidemiologic characterization of building-related measurements and occupant-related risk factors. The paper by Menzies et al. stands out as an illustration of sound experimental and epidemiologic methodology in the field of indoor-air quality." "Altering the characteristics of a building that are responsible for the sick building syndrome is usually not under the control of dinicians or office workers, and the scope of public health action is limited in the absence of scientifically based standards.... To resolve building-related symptoms, practicing clinicians must enlist the efforts of public health agencies, epidemiolo- gists, ventilation engineers, and building managers to understand specific buildings and the characteristics of building furnishings and ventilation systems that are associated with the well-being of a building's occupants."

STATE OF MINNESOTA OFFICE OF THE AT7URNEY GENERAL HUBERT H. HLWPHREY Ili AM)r.EA• GKNUAL March 22, 1993 Representative Phyllis Kahn Minnesota House of Representatives 369 State Office Building 100 Constitution Avenue St. Paul, NV 55155 Dear Representative Kahn: In your recent letter to Attorney General Humphrey, you advised us that the United States Environmental Protection Agency had declared second-hand tobacco smoke to be a class A carcinogen. Based thereon, you have asked for our opinion regarding the legal liabilities an employer might face for failure to protect workers from second-hand smoke. Specifically, you asked (1) whether employers are now potentially liable for damages if an employee suffers health consequences att=ibutable to second-hand smoke, and (2) whether there are steps an employer could take to protect against future lawsuits from injured workers. In response, it is our opinion that employers do face a potential liability by allowing their employees to be exposed to second-hand smoke in the workplace and, yes, there are steps an employer might take to reduce this potential. The EPA's recent findings, and its declaration that second-hand tobacco smoke is a class A carcinogen does not, per se, place a new lfability on employers which did nQt exist before. It could, however, provide additional justification for stricter regulation of smoke in the workplace under federal and state Occupational Heahh and Safety Laws and Minnesota's Clean Indoor Air Act. As you no doubt are aware, neither the federal or state "OSHA" laws nor the state Clean Indoor Air Act currently provide standards or "tolerance levels" for second-hand smoke in the workplace, nor do they impose liability on an employer for injuries based upon exposure to second-hand smoke. Although we are not aware of any activity at the federal level to provide additional OSHA regulation of second-hand smoke, there apparently are several current proposals to amend the state Clean Indoor Air Act and we assume that second-hand smoke's classificadon as a carcinogen has played a role in promoting this activity. With respect to an employer's direct liability to an employee, second-hand smoke's classification as a carcinogen tnight assist employees in the future in ptoviag a ac usal relationship between smoke in the workplace and resulting Equal OppoAunity Employer ISSUE 44 APPENDIX C ..~._

Representative Phyllis Kahn Page 2 March 22, 1993 disability. In Minnesota, with several complicated exceptions, workers' compensation benefits provide thc exclusive remedy against an employer for injuries which result during the course and scope of employment (work-related). See, Minn. Stat. §§ 176.001, 176.061 (1992). Thus, whether an employer's liability increases due to the allowance of second-hand smoke in the work-place depends upon whether disability resulting therefrom is compensable under the state's workers' compensation law. "Occupational disease," which we assume is the nature of injury which would be claimed due to second-hand smoke, is considered a personal injury under the state's workers' compensation law and if proven to be causally related to work, is subject to the payment of compensation and medical benefits. Minn. Stat. § 176.011, subd. 16 (1992). The statutory definition of "occupational disease" is quite lengthy and provides strict tests which must be met to prove a causal relationship between work and disease. The definition generally includes diseases "arising out of and in the course of employment peculiar to the occupation in whicb the employee is engaged and due to causes in excess of the hazards ordinary of employment." Minn. Stat. § 176.011, subd. 15 (1992). Excluded, however, are "ordinary diseases of life which the general public is equally exposod to outside of employment" unless, "the exposure peculiar to the occupation makes the disease an occupational disease hazard." 1d. The definition goes on to declare that the disease must be traced to the employment as a direct and proximate cause and must be recognized as a hazard "characteristic of and peculiar to the trade or employment and results from a hazatd which the worker was not equally exposed to outside of work." Id. Extensive litigation has occurred in the past over the definitional criteria, in particular, in cases involving exposure to asbestos and silica dust and resulting asbestosis and silicosis and in coronary heart disease cases. We are unaware of any cases in Minnesota which have extended the theories of these cases and awarded benefits due to diseases caused by exposure to second-hand smoke. The potential for such cases in the future, however, certainly exists, and the recognition of second-hand smoke as a carcinogen will enhance an employee's ability to prove a causal relationship between exposure to second-hand smoke at the workplace and resulting disease.l 1 Increased liability may already exist for employers of firefighters. Under Minn. Stat. 1 176.011, subd.15(e), a firefighter who contracts a disabling cancer of a type caused by exposure to a suspected carcinogen, as defined by the International Agency for Research on Cancer is presumed to have an occupational disease if the carcinogen is reasonably linked to the cancer.

Representative Phyllis Kahn Page 3 March 22, 1993 With respect to your second question, the simple answer is, yes, there are steps an employer can take to minimize future potential liability, which steps could include banning or restricting all smoking at the workplace. Neither federal nor state law would appear to prevent an employer from banning smoking in the workplace or from taking other reasonable steps to assure that other employees are not exposed to second-hand smoke. Sincerely, JOHN R. 'IVNHEIM Chief Deputy Attorney General

I ~ Z C 0 01 ~ tlj WHAT EDITORIALS SAY ABOUT THE EPA REPORT EPA-Repoft Sparb Antltteroking Plans: P/alntlfh' Suits May Pe+od FNfns To Bar Smoking - The (EPAJ is countiing mainly on plaintiRs hwyers. rather than regula- tois, to drive businesses lo ban smoking on thek pnmtises, and ttie hwyea are eager to oomply. As a fesult of the EPA's report I'inkifg 'passive' tobacco smoke tb king cancer and other a8rnanls„ a new wave of tobaoco-related tawsuR!f is lllceiy. WaM Street Jounlal "No one would grant his neighbor the right to blow Gny amounts of asbestos Into a room or sprinkle traoes of pesticide onto food. By the same logic, sn+okers have no rigM to spew even more noxious cbuds Into the air around them. The next step has to be a searching examination of how to tighten restrictions on smoking In all public places, and the workplace as weR." New York Times "More and more the owners or operators of public facilities like the Orioles are send- ing tobacco smoke the way of flakMg asbestos - and for the same reason. It Idlls innocsM people." BaHlmae Sun "Smoking Is being slowty pushed farther and faAher out of pubiic plaoes. Given fhe /mdings on passive smoking, snoken and nor-smokers should cooperate to extend the process to private places as wetl " Atbuqueilque Joumal 'I/ indoor smoking Isn't curbed, some people who think they've been put at risk by secondhand smoke may wind up taking their Opniptaklls to f7ollft." Ra1Ngh N.ws & Observer n99S(1RGR v ~ 'G ~ ~ rr rrGT e ~f-Ax ~w...'}( ~Y. JV ~t. ~ "" ~ A 'L~lS 'an z~ 0 0~ E O E os~~: ~Se x ~ 3 » g~ of 3 ~~~~~3~~ s. l ~ n ' .$§sg s~ ~ g o00oooooa 0 a ' '^ 125 S ~. y .aZis~3 ~~ ~ N _ ~~g~iGnn73M < oof~ooooo0 0 Y ^ ~ E o t3 L" 'L~ c ~ Q cgt~ ~~e~ o w x00.6 gC $ ~ s ~ A d ~ o = ~ C ~~~~w~:~~a`a `~~W~SSS~ E z ~hM~noN$o° u. 000000000 eQ LEGAL NO1 IC E PLEASE READ CAREFULLY THIS DOCUMENT CAN PREVENT AN UNNECESSARY DEATH AVOID A LAW SUIT SLASH HEALTH CARE AND OTHER COSTS r WARNING: TOBACCO SMOKE IS HAZARDOUS TO THE HEALTH OF NONSMOKERS, ANO CAN CAUSE DEATH AND DISABILITY FROM CANCER AND HEART DISEASE. / Prnpaied as a pubt c servia by Acfion on Smaking and H.aM (ASH), 2013 H St, hMl. Wa.h. DC 20006. a naoona 1paFaclion anliWnoMinq or9anlae6on wwfNMdi aasisls nontmoMeis U OrkqUp IpNacliosa. Addlb»- al inlomytion and Walbna araftbw. Pwase wib. Ploaso foel frre /o pholocepy this doeum.nt

TOBACCO SMOKE KILLS LEGAL LIABILITY THE IMPACT The Environmental Prokvtion Agency (EPA) has just reported Environmental Tobacco Snake (ETS) is a'Grvup A Can:inogenr; i.e., a ctremicd Nlie asbestos and benzene known to cause kinp cancer deaths In nonsmokers. • The toflowing have also reported that ETS causes lung cancer de8ths in nonsmokers. • M+.rktin Canar Sodry . Am.rinn Hearl Assa.iation . MuAa. Lurq As.oci.tlon . Mwinn Nl.dipr/ AisooiNMn . AnrAw. Pubic H.NN I1swci.tlon • dwmalbnsl Aq..cy tMF R...aFOA on Canwr • National Aead.nry of Sd.nc+N • National CanoeF InstlWt. • N.tionll InstllW. ror Ocwp.aDnd SaNty & H.aIIA • U.S. Pupie Hsalth 5.rvios • WoAd H.aAh Oiqsnastlon Under the new Americans NMh Disabilities Act (ADA), most businesses are required to make a reasonable aocomodation to permit handicapped persons aooess to their onioes and workplaoes. It is now well established that persons sensitive to to- baooo smoke are "handreapped persons" under federal law. (1) Even without the evidence now newly available in the EPA's report which un- doubtedly wiA lead to more cases, workers have been recovering compensation for injuries caused by on-the4ob exposure to driltlng tobacco smoke. They have ob- tained recovery under the common law (2) and statutes nela6ng to workers' compen- sation (3), disability (4), unemployment compensation (5), and disuirnination (6). M inaeasing number (of reshurantiq arn in the process of banning smoldng. lheis is not a chain In the oountry that is not considerirg it today.• National Reetaurant Assocfarion Already, 566A of organizations surveyed are oompletey smoke-froe; by the year 2002, another 40% will have enacted a smoke-free policy. Only 4% said they expected to continue aAowing smoking during the next 10 years. Intmatlonal Facility Manapenant Aasn. 'll's just a matter of lime before smoking Is completely banned in the workplace. Il wiA happen in 10 years - maybe less." National Alliance of Bussnss The U.S. Surgeon General has concluded that "an estimated 53,000 Annericans die each year from exposure to tobacco smoke of others." The EPA has also reported that ETS is particularly dangerous to young chNdren, and that each year it causes them: • 150.004300.000 rrspiralnFy iMections. Indudirq pnMuewenU and blondMtl.  400.0110-1,000.000 aMacks of esMwne • as mary as 26.000 new cases of aswrna . middM ear efhuion (a syrtptan of dissase) NOTE: These and other wldely- pubticized reports of official governmental and privata agen- cies place businesses on legal notice of the many danqers of secondhand smoke to workers, cusbomers, and oth.r visitaors. A A recent Interesting and far-reaching case Involved a school teacher whose chronic obstructive lung disease was caused by smoke drifting Into her second floor class- room from a first floor teachers' lounge. (7) The EPA report Is also Gkely to spur cases brought on behalf of young children brought into the smoking sections of fast- food restaurants, on internatwnal fiighls, and other situations where they suffer asthmatic and other attacks as a result of enormous concentrations of smoke, („tt s..... vw.... vw.. A..a. es F. s.w ss W0wrk nMl Qs.a.O.c.w.. t......veyrF.A.ss.r.s,y, SOF /OO.C HsR /YrdM.1 sftr. 185 Cd /lOf tb* Wy Hl7) Q SM e .. Jd~www ~ • Mw YerM ClF Oprl d N.,ner o«..om.K !.. M v s. ]A .. (I w. 801160 ._ Iws. WA fqMw.Ihrwft. Ai4!!MF lr M (M G/1Q1 (FjS....9.ta,f... Cw..a...w lii-Pp.p".r r.o.0 ~ar4 SO A1d 101 h Go.Ma #N1t AMnw+i.v.IMr.wW,..d Mr N..+.e..cary.«+r+..ftFr6cwu+.. E,W.,.".o...o. .rA 0aW. 306 Cd Mi 1!8 rA. /yw t erl. O. 6. tMq tR swl •.. Cw.h .f Mrr .. F.Y Ewpftwwwid .+1 Mw.M4 1'.esn a C~.a[ 0§O4 .n1 Cys. Aw11rf.. M MwUl p d/yp sY1ft d Cr;wiq FlU M 0ak !77 cI /yY !af I?71f1r Q faM..w ta. Ny.r.IMi/d surw O~wY1VA.1 MA PAS IMO, tA 4W1M. CIMrrYrAnr Q.n.ui..F.. AA..I. h.t "As a result of the EPA ruling, Greyhound Lines Inc. says It plans to reassess a smoking policy that had already grown Increasingly restrictive In nwent years. 'Given the EPA findings, we will seriously consider abandoning smoking for all of our locations." Wan strnet Journal "Men I learned that seoond-Mnd smoke is a known carcinogen with no sate level of exposure, and that air-conditioning simply recirculates it I decided I did not went my famiiy, my customers or my employees to breathe tobaczo smoke. Ten months ago I made all four of my restaurants no smok- ing. . . yet (my restaurants') sales ars about the same. Pasadena ICA) Restaurand Owner Employers can save, on the auerage, over f5000/year in health care, sick leave, and other costs for every emptoyee penuaded to quil. Management World t99S094g

ET$/IAQ REPORT FAX COMMUNICATION SHEET NO7E• If you would like additional information on one of the aories contained in this iscue, or if you have information or ideas that we could incorporate into future icsua, plesse complete and FAX this form. ro: Mark W. Cowing, Esq. FroM: Shook, Hardy & Bacon CompanylTitle FAX 816-421-5547 Telephone: Date•. I would like additional information that may be available on the artides in Issue numbered as follows [indiate the bracketed number next to the anicle headline]: t l [ ] [ l [ ) [ l [ l I l [ ) [ ) [ ~ [ ] [ ] [ ] ~ ~ [ ] [ ~ Name FAX A Address Overnight Delivery Rrgular Mail Ufr..W it ..,:u~O&d( :1P...:.R wuAt &W y NPJ& ,..+c) SHB