Tobacco Documents Online

6 LEGAL ISSUES AND DEVELOPMENTS [17] "Environmental Tobacco Smoke and Its Effect on Children: Controlling Smoking in the Home," A.D. Schwartz, Boston College Environ- mentalA,,(~'airs Law Review, 20: 135-171 (1993) This student-written comment discusses the alleged health effects of ETS exposure on children and explores the possible legislative and.judicial approaches that can be taken to prevent parents and caretakers from smoking in the presence of children in the home. The author cites extensively to ASH publications and refers to early drafts of the EPA Risk Assessment on ETS in building her case in support of in-home control of smoking behavior. After noting that the state has a legitimate interest in protecting children's health, the author concedes that problems with enforcement would ultimately foil any attempt by courts or legisla- tures to prevent parents from exposing their children to ETS. [18] "Protecting Job Opportunities of Smokers: Fair Treatment for the New Minority," D.W. Garner, Seton Hall Law Review, 23: 417-458 (1993) Southern Illinois University law professor Donald Garner analyzes the laws enacted in more than half the states since 1989 that protect smokers from job discrimination. Garner's anti-tobacco bias is evident in this article, even as he expresses sympathy for individu- als "mired in an addiction reckoned by the Surgeon General to be similar to that produced by heroin and cocaine. " Garner criticizes the statutes he discusses and says he fears that some legislatures are erring in according to smoking the status of a civil right. He proposes legisla- tion that would prohibit discrimination against only those smokers who are qualified to do the job and would permit employers to refuse to hire smokers whose rates of absenteeism hinder job performance. His proposal would also permit employers to charge smokers higher rates for health insurance and would exempt from coverage small businesses, businesses that have a "rational work related reason" for refusing to hire smokers, and businesses engaging in activities that pose a particular health risk for smokers. Garner appears to be uncomfortable with the total exclusion of smokers from employment opportunities ETS/IAQ REPORT, ISSUE 45 and discusses the privacy infringement which goes hand in hand with employment discrimination practices. He does, however, believe that smoking should be discouraged by government policies and that anti-smoking activists should focus their attention on tobacco companies rather than on smokers. OTHER DEVELOPMENTS [19] Off-the-job Smoking is Survey Subject The Society for Human Resource Management reportedly surveyed its members regarding whether off-the-job activities such as smoking should be used as a basis for employment decisions. The society, which represents the interests of some 50,000 members in the human resource profession, found that of the 467 members responding, more than 75 percent believe that smoking ofF the-job should not be a faaor in employment decisions. More than 77 percent of those surveyed, however, apparently believe that employers should have the right to charge smokers more for health care premiums. Sa PR Newswire, Apri15, 1993. [20] Hot Line Provides ETS Information The Maryland Cancer Control Program has report- edly established a toll-free hot line for residents to obtain information on the alleged effects of ETS exposure, among other matters. The hot line is appar- ently pan of a three-year campaign to reduce the state's cancer mortality rate. See Balt imort Morning Sun, April 6, 1993. [21] Insurer Offers Discounts for Workplace Smok- ing Bans According to press reports, Sun Life of Canada Insurance Co. is offering U.S. companies five percent discounts on their group life premiums if they offer their employees one or more wellness programs, including smoking bans and smoking cessation pro- grams. See Ntwrday, March 28, 1993. [22] Restaurant Bans Smoking In Bar According to a news report, the Islands Restaurant in Manhattan Beach, California, as well as all 12 of the

APRIL 16, 1993 other restaurants in the chain, imposed a ban on smoking in both its bar and restaurant areas. According to the report, the decision followed a release of the EPA Risk Assessment on ETS. See Los Angeles Times, Apri12, 1993. MEDIA COVERAGE [23] "A Dying Breed," 20/2g April 2, 1993 This segment of the ABC News telecast, 20/24, featured interviews with smokers who have been forced by nonsmoking policies in public places, workplaces, restaurants and public transportation to limit their consumption of cigarettes to their homes or out of doors. One smoker stated that nonsmokers harass her when she does smoke by accusing her of killing babies. Other smokers, who refused to be identified for the program reportedly due to pressure from employers and family, were quoted as saying that nonsmokers will emit an "unrelenting light cough" when smokers light up in the smoking section of restaurants. John Banzhaf, executive director of ASH, appeared on the program and predicted that by the year 2000 smoking would be outlawed in virtually all public places. Moderator Hugh Downs noted that bans or restrictions are already in place around the country and reported that in Pennsylvania, a proposal has been made to ban smoking in vehicles where children under the age of 15 are passengers. [24] "No-smoking Bill Example of Government 'Nannyism,'" LT. Izumi, Sacramento Sunday Union, March 28, 1993 Lance Izumi, director of a California-based think tank, writes in this opinion piece that pressure from consumers, and not legislative mandate, should drive the demand for and establishment of smoke-free indoor environments. Ixumi criticizes the EPA Risk Assessment on ETS as an example of "politic.ally correct statistical manipulation," and argues that a bill pending in the California legislature that would ban smoking in any enclosed workplace, including restau- rants, hotels and bars, would cripple the tourism industry and the state economy. 7 A discussion of the bill, A.B. 13, appears in issue 42 of this Report, March 5, 1993. The bill is currently pending in an Assembly committee. [25] "Smokers Run Out of Room; More Smokers Find Thernsdves Out in the Cold," D. Tofig and M. Swift, TIx Hartfnrrl CourmM March 29, 1993 This attick discusses the latest measures being taken by Hartford business and eating establishments to eliminate ETS from indoor environments. Apparently the EPA Risk Assessment on ETS has been a factor for those business owners who have decided to impose total smoking bans. A.C. Peterson restaurants report- edly adopted a smoking ban beginning April 16 in response to the risk assessment. According to a state representative who has proposed legislation to ban smoking in all public buildings, smoking bans may ultimately result from litigation, even if the legislature fails to act to protect nonsmokers from ETS exposure. SCIENTIFIC/TECHNICAL ITEMS LUNG CANCER [26] NCI Study Suggests Lung Cancer Risk Associ- ated with Dietary Fat Press reports indicate that initial data from a study funded by the national Cancer Institute suggests that nonsmoking women whose diet includes a high consumption of fatty foods are at an increased risk for lung cancer. Michael Alavanja, study director, apparently pre- sented his data at a meeting of the American Cancer Society on March 30, 1993. The study was conducted in Missouri, and consisted of a review of reported cases of lung cancer. Some 600 nonsmoking cases and 1,400 controls were studied with respect to their dietary habits. Reportedly, women with a"high-fat° diet, defined as more than 40 percent of daily calories from fat, had an approximately four-fold risk for lung cancer, compared to women with a lower percentage of fat in the diet.

8 [27] "Estimating a Summarized Odds Ratio Whilst Eliminating Publication Bias in Meta-analysis," M. Sugita, M. Kanamori, T. Izuno, and M. Miyakawa, Japanese Journal of Clinica! Oncology 22: 354-358, 1992 [See Appendix A] The authors of this study present a statistical method for calculating the reported relative risk from epidemiologic studies that have not been published. Using this theoretical approach to quantifying publica- tion bias, they suggest that unpublished studies could reduce the summary relative risk generated by meta-analysis of a subset of the studies on spousal smoking and lung cancer. CARDIOVASCULAR ISSUES [28] "Inhalation of Sidestream Smoke Accelerates Arteriosderotic Plaque Development," A. Penn and CA. Snyder, Toxicologist 13: 408, 1993 [See Appendix A] The authors of this abstract report on an experiment in which cockerels (young male chickens) were exposed to sidestream smoke. They report that exposed birds developed larger arterial plaques, although the inci- dencc of plaque formation was not affected. RESPIRATORY DISEASES AND CONDITIONS - ADULTS [29] "'Tobacco Smoke Allergy:' A Fallacy?" J.J. Musmand, M. McCants, M. Lopez, P. Menon, and S. Lehrer, Annals ofAlkrgy70: 55, 1993 [See Appendix A] In this abstract, the authors describe a study in which asthmatic patients were experimentally exposed to ETS, as well as being assessed for an allergic response to tobacco leaf and smoke extracts. They report no correlation between reactivity to the extracts and pulmonary response following ETS exposure. [30] "The Nasal Response to Environmental Tobacco Smoke," J.J. Musmand, M. White, M. Lopez, M.A. Kaliner, and S.B. Lehrer, Journal ofA&-rgy and Clinical Immunology 91 (1 Part 2), 1993 [See Appendix A] ETS/IAQ REPORT, ISSUE 45 In this abstract, the authors report on an ETS exposure study assessing pulmonary function, "nasal secretory response," and subjective reports of symp- toms in eight asthmatics. Reportedly, while subjective symptoms were "significant," there were no significant changes in the other, more quantifiable, parameters. RESPIRATORY DISEASES AND CONDITIONS - CHILDREN [31] "Lung Function, Pre- and Post-natal Smoke Exposure, and Wheezing in the First Year of Life," I.B. Tager, J.P. Hanrahan, T.D. Tosteson, R.G. Castile, R.W. Brown, S.T. Weiss, and F.E. Speizer, American Review of Respiratory Disease 147: 811-817, 1993 [Sec Appendix A] Based on data for 97 infants whose pulmonary function was first assessed before six months of age, the authors report that infants who had a wheezing lower respiratory infection (LRI) in the first year of life were likely to have had reduced levels of lung function prior to the illness. They suggest that maternal smoking during pregnancy is associated with LRI, but report that nonmaternal ETS exposure was not associated with an excess risk of LRI. OTHER HEALTH ISSUES [32] "Ethnic Differences in Mortality from Sudden Infant Death Syndrome in New Zealand," E.A. Mitchell, A.W. Stewart, R. Scragg, R.P.IG Ford, B.J. Taylor, D.M.O. Beaoft, J.M.D. Thomp- son, LB. Hassall, D.M J. Barry, E.M. Allen, and A.P. Roberts, British Medical Journa1306: 13-16, 1993 [See Appendix A] In another publication based on the New Zealand cot death study, the authors analyze potential sudden infant death syndrome (SIDS) risk factors in Maori and non-Maori infants. They report that the higher risk of SIDS among Maoris is related to several lifestyle factors, induding a higher prevalence of maternal smoking.

APRIL 16, 1993 ETS EXPOSURE AND MONITORING [33]' "Passive Smoking and Urinary Cotinine Levels in Young Children," C.C. Johnson, E.L Peterson, and D.R. Ownby, Journal ofAllmgy and ClinicalImmunology91 (1 Part 2), 1993 [See Appendix A] This abstract, scheduled to be presented at a March 1993 meeting, reports on a comparison of reported exposure to smokers and urinary cotinine levels in 103 children. Reportedly, the data on exposure could be used to predict cotinine level. [34] "Urinary Cotinine Excretion at Work," S. Willers, I. Bensryd, G. Skarping, and S. Skerfving, Indoor Environment 1: 373-376, 1992 [See Appendix A] This meeting abstract (fiom "Indoor Air Interna- tional," April 28-30, 1991, in Athens, Greece) reports on urinary cotinine measurements from persons reportedly exposed to ETS at home or at work. The authors report higher cotinine levels in persons work- ing in a cafe or a restaurant, as compared to an office. [35] "Tobacco-Spedfic and Volatile N-Nitrosamines in Environmental Tobacco Smoke of Offices," H. I{lus, H. Begutter, G. Scherer, A.R Tricker, and F. Adlkofer, Indoor Environmart 1: 348-3 50, 1992 [See Appendix A] In thisatudy, nitrosamines were measured in a "poorly ventilated" office in Vienna. The authors report levels of tobacco-specific nitrosamines in this office that, they note, correspond to a"`worst-case' situation." They calculate substantially lower exposures based on "real-lik conditions." [36] "Chronic Sidestream Cigarette Smoke Exposure Causes Lung Injury in Rabbits," M.L. Witten, P.M. Joseph, RC. Lantz, D.S. Iarzrtts, W.K Jung, and C.A. Hales, Indoor Envisivnmrnt 1: 341-347, 1992 [See Appendix A] In this study, a small number of rabbits were experi- mentally exposed to sidestream smoke over a 20-day period. Based on their reported measurements of lung clearance, white blood cell count, and metabolic products, the authors propose that the exposure "can induce lung injury." 9 INDOOR AIR QUALITY [37J "Indoor Air Quality Management: A State of the Art Review and Identification of Research Needs," P.M. Bluyssen, Indoor Environrntnt 1: 326-334, 1992 [See Appendix A] The author of this paper summarizes the conclusions and recommendations generated by participants in a 1991 workshop of the Commission of European Communities. Focusing on indoor air quality manage- ment, the workshop induded reviews of the "state of the art" and future research needs. [38] "Building-Related Asthma in Denver Office Workers," RE. Hoffman, RC: Wood, and K Kreiss, American Journal of Public Health 83 (1): 89-93, 1993 [See Appendix A] Based on two individual case reports of building-related lung diseasc, the authors of this study instituted a survey of employees in the building where the cases worked. They report an excess of respiratory disease among workers in the building, but could not elucidate the etiology of the problem, although they note that the ventilation system did not appear to be involved, [39] "Health and Indoor Climate Complaints of 7043 Office Workers in 61 Buildings in the Netherlands," T. Zweers, L Preller, B. Brunekreef, and J.S.M. Boleij, Indoor Air 2: 127-136, 1992 [See Appendix A] In this paper, Dutch researchers report on question- naire data collected from office workers concerning health complaints, personal and workplace characteris- tics, and indoor dimate complaints. These data are analyzed with respect to some IAQ measurements and building characteristics (e.g., ventilation systems). Overall, the authors report a higher prevalence of reported symptoms in air-conditioned buildings, plus associations between complaints and gender, work satisfaction, and personal control of workplace tem- perature.

10 IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AUSTRALIA [40] New South Wales (NSW) Government Backpedals on Proposed Smoking Ban The NSW government has reportedly decided it will no longer press for a complete ban on smoking in public places by 1998. A press report indicates the decision was made following a meeting with Australian Hoteliers' Association representatives. The president of the association reportedly said that the outcome of the meeting with the minister for industrial relations was to work toward voluntary measures that would result in a smoke-free environment in public places. See Sydney Morning Herald March 27, 1993. Meanwhile, the Australian Medical Association's New South Wales president reportedly criticized the hoto- liers for opposing the proposed ban on smoking in endosed public places. See Daily Telegraph Mirror, March 26,1993. In a related story, it has been reported that the Elephant's Foot hotel in Surry Hills, became Sydney's first nonsmoking pub at the beginning of April: See Sydney Morning Herald March 27, 1993. [41] MP Complains About Smoking Ban Camden MP Liz Kemohan reportedly objects to the smoking ban that has been proposed for Parliament House by Health Minister Ron Phillips. She appar- ently believes that State MPs should be given a special exemption from the rule, and was quoted as saying, "I am not convinced about passive smoking. It is abso- lutely degrading and disgusting the way people have to go out on the footpath to have a cigarette." Kernohan reportedly views a ban as an attack on personal free- dom and the work of a vocal minority. See Sun Hcrald, April 4, 1993; Daily Telegraph Mirror, Apri16, 1993. ETSIIAQ REPORT, ISSUE 45 BELGIUM [42] Royal Decree To Accommodate Smokers and Nonsmokers A Royal Decree regulating the use of tobacco in the workplace will reportedly be published at the end of April. According to the decree, the interests of smokers and nonsmokers must be taken into consideration, and any measures adopted must be based on mutual tolerance, respect of individual freedom and courtesy. Employers are directed to take steps to eliminate any nuisances due to ETS. See IDT, April 1, 1993. Meanwhile, Miet Smet, the Minister of Employment and Labour, has reportedly announced that she will soon force all employers to take measures to reduce the harm allegedly caused by smoking in the workplace. See Rtutrrs, March 29, 1993. POLAN D [43] Health Commission Proposes Smoking Ban The Health Commission of the Christian National Union has reportedly prepared a bill which would, among other matters, ban smoking in schools, hospi- tals, workplaces and restaurants. See Polrsh News Bulletin, March 31, 1993. SWEDEN [44] Parliament Schedules Consideration of Anti-smoking Measure The New Tobacco Act has reportedly been presented to Parliament and will be considered by that body on May 27, 1993. Under the proposal, smoking would be restricted to designated areas in nurseries, schools and health care facilities and on means of public tnnsporta- tion. The measure would also require hotels to make smoke-free rooms available and would require that restaurants seating more than 50 patrons to establish smoke-free areas. With regard to workplaces, the bill would require that employers and employees work together to achieve smoke-free premises. The introduc- tion of the Act is discussed in issue 41 of this Report, February 19, 1993.

APRIL 10, 1993 UNITED KINGDOM [45] ETS Booklets Available in House of Commons Library Junior Health Minister Dr. Brian Mawhinney recently reported to the House of Commons that three booklets on ETS are currently available in the Library. They are (i) the Department of the Environment's "Code of Practice on Smoking in Public Places;" (ii) the Health and Safety Executive's "Passive Smoking at Work;" and (iii) "Passive Smoking A Health Hazard," published by a consortium of statutory and voluntary organizations. According to Dr. Mawhinney, the Health Education Authority's booklet, "Passive Smoking Questions and Answers," is being reprinted and a copy will be placed in the Library. See Hansard (House of Commons Report), March 12, 1993. [46]' More Local Councils Decide to Adopt Smoking Restrictions Among those local councils reportedly adopting or considering adopting smoking restrictions are Buckinghamshire, Thanet and Kent County Councils, Edinburgh District Council and Wolverhampton Council. According to press reports, heated debate in Buckinghamshire was responsible for preventing officials there from adopting a total ban. See Bucks Free Aress, March 16 & 19, 1993; Isle of Thanet Gazette, March 1993; Wolverhampton Express & Star, March 1993; Edinburgh Evening News, March 1993. ETS-RELAI'ED LITIGATION INVOLVING CIGARETTE MANUFACTURERS AUSTRALIA [47] Tobacco Institute ofAu.+tralia Limited a. Stepfien Woodward (Supreme Court, New South Wales) (filed April 15,1993) The Tobacco Institute filed suit against Stephen Woodward on April 15, 1993. In its Statement of Claim, TIA alleges Woodward made certain misrepre- sentations to the media relating to the Full Federal 11 Court's decision in the AFCO case, among other things, in violation of the NSW Fair Trading Act of 1987. The statement alleges that Woodward is a well-known anti-smoking advocate who provides consulting services to AFCO, is Executive Director of Action on Smoking and Health (ASH) and Director of the NSW Cancer Council. TIA seeks injunctive relief, a declaration that the representations made by Woodward were misleading under the Fair Trading Act, correction of the represcn- tations in the media, and costs. For particulars alleged in the case, the Statement of Claim is attached as Appendix C. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS AUSTRALIA [48] Camerrnn v. Qantas Airrvays Limited (Federal Court, New South Wales) (filed April 7, 1993) A woman who daims that a shopping trip to Bangkok was ruined when she was forced to travel there on a Qantas flight seated next to a heavy smoker, filed an action on April 7, 1993, in Federal Court against the airline for pain and suffering. Leonie Cameron, 50, of Sydney, daims that her request for a nonsmoking seat was denied and she spent eight hours exposed to ETS, which allegedly caused her to contract bronchitis. Cameron is seeking unspecified damages, injunctive relief, and a declaration that Qantas engaged in unconscionable, misleading or deceptive conduct in permitting smoking and its aircraft. The airline reportedly gave Cameron a voucher for another trip to Bangkok, but she apparently decided to sue based upon what she has called "the principles involved." See Sydnry Morning Herald Courirr-MaiZ and Telrgraph-Mirror, April 7, 1993. Cameron is represented by Roland Everingham of the Cashman and Partners law firm. Cashman and Pan= ners represented the plaintiffs in the AFCO and Scholem cases. The action was filed under a procedure which permits anyone with a similar complaint to join. Cashman and Partners has reportedly heard from three

12 other individuals who are interested in joining the group action, although one of the three has different health problems that are not purportedly related solely to ETS exposure. See Daily Telegraph, April 8, 1993. UNITED KINGDOM [491 Wnght v. Ladbrokes (Industrial Tribunal, Birming- ham, England) (filed December 20, 1991) On March 26, 1993, panel members of a Birming- ham industrial tribunal reportedly finished hearing evidence in the case of a betting shop employee who was fired for smoking at work in violation of a smoking ban for employees. See issue 44 of this Report, April 2, 1993. According to press reports, a decision as to whether Pauline Wright was unfairly dismissed will be forthcoming in the next several weeks. See Covtntry Evening Telegraph, March 27, 1993. OTHER DEVELOPMENTS AUsrRALIA [50] Fast Food Restaurants Ban Smoking According to press reports, Hungry Jack's and Kentucky Fried Chicken have announced plans to ban smoking in their outlets. Hungry Jack's apparently provided designated smoking areas, but has decided to scrap them because they proved unsatisfactory. See Sunday Mai4 April 4, 1993. CANADA [51] Health and Welfare Considered Smoking Shelter for Employees Health and Welfare Canada seriously considered several options recently that would protect smoking employees in Ottawa from the elements, including construction of a separate building for smokers, according to documents obtained by the press under the Access to Information Act. Smoking was banned in all government buildings on January 1, 1989, and when a new deputy minister took office in October 1992, he was apparently disturbed about public ETS/IAQ REPORT, ISSUE 45 servants smoking around entrances or on loading docks, buffeted by wind and snow. The proposal was evidently scrapped when senior department officials decided that a smoking shelter would send the wrong message to the public. Health and Welfare Canada administers Canada's antismoking laws. See The Ottawa Citizen, April 6, 1993. EUROPEAN COMMUNITY (EC) [52] Anti-tobacco Groups Plan Cancer Week Initiative The Cancer Education Coordinating Group, Europe Against Cancer and ASH are reportedly planning their initiative for this year's Cancer Week, which will be held from October 11-17, 1992. The initiative, entitled "Breathing Space," is apparently designed to help organizations and individuals develop the skills to lobby for smoke-free policies and premises. The initiative will also encourage increased social awareness about ETS. See Europe Against Cancer, March 1993. [53] ETS Survey Shows Strong Support for Smoking Restrictions Although only 52 percent of Europeans believe that ETS can cause serious illness, some 82 percent would like to see smoking restrictions implemented in public places and 88 percent are in favor of the segregation of smokers and nonsmokers in the workplace, according to a survey conducted in the 12 EC member states. The survey also showed that only 38 percent of nonsmokers "often" or "sometimes" ask smokers to stop smoking in their presence, and that 72 percent of smokers "often" or "sometimes" refrain from smoking in order not to disturb others. The survey was appar- ently based upon oral interviews of 12,800 people over the age of 15. The survey was conducted in autumn 1992 and has just been released. See Press Association Newsfile, March 30, 1993; The Reuter European Community Report, March 29, 1993. INDIA [54] ETS is Topic of Public Seminar During a public seminar hdd recently in New Delhi, representatives of the Heart Care Foundation of India reportedly said that ETS is more dangerous than the

APRIL 16„1993 mainstream smoke inhaled by smokers. The vice chairman of the foundation reportedly discussed the alleged health effects on children exposed to ETS and suggested that smoking be banned in government offices. According to press reports, doctors in India are now calling for ETS to be dedared a carcinogen. See Xinhua General News Service, April 11, 1993. SWEDEN [55]' Swedish Tobacco Publishes Booklets on Smoking Svenska Tobaks (Swedish Tobacco) has reportedly published booklets that, among other matters, promote common courtesy and tolerance between smokers and nonsmokers by means of humorous text and cartoons. The company is also promoting a contest among students at Sweden's largest design schools to create an ashtray for public areas. See Tobacco Reporter, March 1993. UNITED KINGDOM [56] Oxfordshire Children Respond to ETS Survey According to press reports, nine of ten Oxfordshire children surveyed do not like to be near smokers, particularly in cars and buses. Anti-tobacco group OxASH reportedly conducted the survey which included 250 students between the ages of nine and 11. A spokesperson for OxASH was quoted as saying the children "expressed their views strongly and showed an understanding of the health risks of smoking and of passive smoking." The survey also revealed that some ten percent of the children had apparently tried smoking. See Witney Gatette, March 18, 1993. [57] Smokers Found Under Hospital Beds Iighting Up A smoking ban introduced two years ago at Walsgrave Hospital in Coventry has reportedly resulted in patients smoking under their beds and blankets, in bathrooms and in store cupboards. According to the general manager of the hospital, an effort will be made, for safety reasons, to accommodate smoking patients in spite of the ban, and a place will be found for them to smoke. See Cmirutry Esrning Telegraph Mareh 24, 1993. 13 [58] Smoking Ballot to be Held The Faculty of Advocates in Edinburgh, Scotland, is reportedly planning to hold a ballot on smoking. Accord- ing to press reports, advocate Siggi Bennett, a former smoker, is urging his colleagues to ban smoking in their Parliament House headquarters. Leading advocate Donald Findlay QC is apparently opposed to implementation of a smoking ban. Quoted in the press, Findlay said "I'd like to ban the people who'd like to ban smoking. There's no bigger hypocrite than an ec-smoker." See The Daily Telrgraph, March 29, 1993. [59] FOREST Publishes Guide to U.K Airlines that Permit Smoking The Freedom Organisation for the Right to Enjoy Smoking Tobacco (FOREST) hu published a new guide for smoker-friendly aircraft entitled "Travel in Tolerance." FOREST'evidently conducted a survey of airlines with offices in the United Kingdom and indudes a table in its guide listing popular destinations and whether smoking is permitted or banned on domestic or international flights to those locations. The lists also contain information on the reasons given for the smoking bans and whether the traveler is informed at check-in that smoking is banned on the flight. WORLD HEALTH ORGANIZATION (WHO) [60] WHO Releases Advisory Kit for "World No-Tobacco Day" WHO has issued its advisory kit for its sixth annual World No-Tobacco Day, which will be held on May 31, 1993. The theme of the event is "Health Services: Our Wmdow to a Tobacco-free World." Activities will apparently be directed toward raising the awareness of workers in the health care field about the alleged health eff'occs of ET S and smoking. WHO will be promoting smoke-free health premises for patients, visitors and staff

APRIL 16, 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 [27] "Estimating a Summarized Odds Ratio VVhilst Eliminating Publication Bias in Meta-analysis," M. Sugita, M. Kanamori, T. Izuno, and M. Miyakawa, Japanese Journal of Clinrcal Oncology 22: 354-358, 1992 "Publication bias is a recognized phenomenon, i.e. studies with statistically significant results are more likely to be published than those finding no difference between the groups studied. Summarized odds ratio calculated fiom odds ratios of published studies in a meta-analysis may be overestimated because of publica- tion bias. This is a significant problem in research areas involving weak associations between causes and results. The magnitude of publication bias in a given research area cannot be determined directly. The present study enables us to calculate the summarized odds ratio of hypothetical unpublished studies from odds ratios of published studies indirectly....We can then estimate summarized odds ratio in all studies, which indude not only those published but also those unpublished. When these studies are homogeneous in quality and their odds ratios homogeneous in quantity, the method can eliminate publication bias." "In a meta-analysis, a summarized odds ratio with its 95% CI was calculated using the odds ratios and 95% CIs of fifteen published epidemiological studies on the relation between exposure to environmental tobacco smoke (ETS) and risk of lung cancer. [We calculate] the summarized odds ratio R to be 1.27 and its 95% CI, 1.53-1.05 ° "From the results of the fifteen published epidemio- logical studies, the method employing in the present study revealed the odds ratio of the hypothetical unpublished study to be 1.01 and its 95% CI, 1.44- 0.71. The summarized odds ratio 1.21, of all studies, induding not only those published but also hypotheti- cal unpublished studies, and its 95% CI, 1.42-1.02, were also calculated." A-1 "For review work, especially meta-analyses in a given research area where there is a weak association between a cause and its result, nonpublication of some studies where no significant differences have arisen between the groups studied is a notable problem. In the epide- miological area concerned with the relation between ETS and lung cancer, it is thought that some studies, where there was no statistically significant result, have not been published. Published studies in a given research area may sometimes not be random samples from the population. The summarized odds ratio of published studies in an epidemiological area is consid- ered to be greater than that of unpublished studies. Results of unpublished studies cannot be obtained directly. The odds ratio of a set of unpublished studies, however, can be obtained indirectly using the method of the present study." "The summarized odds ratio of the fifteen published epidemiological studies for the relation between ETS and lung cancer with its 95% CI was calculated to be statistically significant in the meta-analysis. It is considered to be overestimated because of publication bias. The method of the present study gave the sum- marized odds ratios of the unpublished studies and all studies with their 95% CIs. The summarized odds ratio of all studies in epidemiology for the relation between ETS and lung cancer was barely statistically significant in the meta-analysis when the unpublished studies were added to the published studies for the calculation. The present study also revealed the weight percentage of the unpublished studies to be 21.6%. It is impossible to confirm whether or not the values calculated in the present study are dose to the true values. These calculated values can, however, be considered acceptable." "The method of the present study, by which the summarized odds ratio of all studies can be indirectly estimated, is therefore a useful one, providing all the studies used for the calculation in the meta-analysis are of good quality. When the quality of some studies is good and that of others poor, or when some studies are prospective and others arc retrospective, i.e. the study quality is heterogeneous, meta-analysis is not a valid tool. In such a situation the present method is also useless."

A-2 CARDIOVASCULAR ISSUFS [28] "Inhalation of Sidesueam Smoke Accelerates Arteriosderotic Plaque Development," A. Penn and C.A. Snyder, Toxicologist 13: 408, 1993 "Exposure to environmental tobacco smoke (ETS) has been blamed for 40,000 excess deaths from heart disease annually in the U.S. In cockerels, chemical carcinogens accelerate development of fibromuscular aortic arteriosclerotic plaques. These cockerel plaques exhibit histological, morphological and molecular similarities to fibromuscular plaques in human coro- nary arteries. To test whether inhalation of sidestream smoke (SS; the principal component of ETS) affects plaque development, cockerels were exposed in inhala- tion chambers to SS or filtered air, 6h/day, 5 days/wk from 6-22 weeks of age.... Plaque sizes were increased significantly along the lengths of the aortas of SS- exposed animals as compared to controls, while plaque incidence and compared to controls, while plaque incidence and distribution were not altered signifi- cantly. Thus, in this model system, daily exposure to SS early in life is sufficient to accelerate arteriosclerotic plaque development." RESPIRATORY DISEASES AND CONDITIONS - ADULTS [29] "'Tobacco Smoke Allergy:' A Fallary?" J.J. Musmand, M. McCants, M. Lopez, P. Menon, and S. Lehrer, Annals ofAUergy70: 55, 1993 "Many physicians diagnose 'tobacco smoke allergy' in patients with asthma or rhinitis by skin testing with tobacco leaf extracts although there is no basis for this practice. To investigate whether an IgE-mediated reaction to environmental tobacco smoke (ETS) is a cause of asthma, 58 asthmatics underwent a 4 hr inhalation challenge with ETS in an environmental chamber. Pulmonary function was obtained pre- and during challenge....All subjects were skin tested with 16 acroallergens as well as with a commercial tobacco leaf mix (CTLE), and a tobacco leaf (TLE) and tobacco smoke extract (TSE) prepared in our labora- tory. 7/58 displayed a significant drop in FEV, during the 4 hr challenge and not during a control challenge (reaccors).... Of reactors, 7/8 (88%) were atopic...218 ETS/IAQ REPORT, ISSUE 45 (25%), 1l8 (13%) and 2/8 (25%) reacted to CTLE, TLE, and TSE. Of those who did not manifest a significant change in FEV, (non-reactors), 43/50 (86%) were atopic; 11/50 (22%), 7/50 (14%), and 2/ 50 (4%) reacted'to CTLE, TLE, and TSE.... The lack of correlation between skin test reactivity to tobacco leaf or smoke extracts with an objective pulmonary response to ETS does not support an IgE mediated mechanism.... The pattern of pulmonary response (mean onset after 1.8 hours of exposure) is also not consistent with a Type I allergen reaction. In conclu- sion, our tests do not support the concept of a 'tobacco smoke allergy' or the use of tobacco leaf extract in its diagnosis and treatment " [30] "The Nasal Response to Environmental Tobacco Smoke," J.J. Musmand, M. White, M. Lopez, M.A. Kaliner, and S.B. Lehrer, Journal ofAllergy and Clinicallmmunology9l (1 Part 2), 1993 "To investigate the basis of upper respiratory symp- toms after exposure to environmental tobacco smoke (ETS), 8 asthmatic subjects, 6 of whom are atopic, underwent a 4 hr ETS exposure in a dynamic environ- mental challenge chamber during which markers of nasal secretatory response were assayed....The samples were analyzed for levels of total protein (TP), albumin (A), lacroferrin (LF), lysozyme (LZ), and IgG. Subjects' FEV, and subjective symptoms were obtained at baseline and at 1/2 hr intervals during the challengea...Subjective scores of nasal congestion, nasal drip, eye irritation, breathing difficulties, and symp- toms overall increased significantly during the challenge.... None of the nasal lavage substances assayed demonstrated significant change in their levels. FEV, also did not change significantly in any of the subjects. These results indicated a lack of nasal secre- tory response during a prolonged ETS exposure, despite significant subjective symptoms. Further study will investigate the nasal response in subjects who demon- strate a significant change in FEV, in response to ETS."