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SHOOK, HARDY& BACON REPORT ON RECENT ETS AND IAQ DEVELOPMENTS May 28, 1993 SHB

REPORT ON RECENT ETS AND IAQDEVELOPMEI*iTS - IN THIS ISSUE - I` THE UNITED STATES REc-.I'LATORI' AND LEGISLATIVE MATTERS • Fairness in Tobacco and Nicotine Regula- P- tion Act of 1993 is introduced in Congress, 1. • Senate holds hearings on IAQ Act of 1993, p. 1. • Defendani s motion to dismiss is denied in ASH v. Department qf Labor, p. 2. ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS • Broiii plaintiffs' request for a stay is denied, p. 4. • Motions to dismiss are filed by defendants in Mclunney, p. 5. ETS/IAQ LITIGATION NOT INVOLNItiG CIGARETTE M:A.tiUF.ACTURERS • Updates on suits against fast-food restaur rants and carpet industry; p. 5. • Damages are awarded to woman claiming co-workers ignored'smoking ban. Stotko, p. 6. LEGAL ISSUES AND DEVELOPMENTS • NBC airs story on smoking and child custody, p. 6. • New Jarsry Trial Lawyer articles talk about ETS litigation, p. 6. OTHER DEVELOPT<tENTS/MEDIA COVERAGE • Insurance industry says IAQ complaints are psychosocial, p. 8. • "Carpet Industry Facing Toxic Concerns," p. 9. SCIENrI'IFIC/TECHNICAL ITEMS ISSUE 48 • "Childhood Asthma and Indoor Environ- mental Risk Factors," p. 10. •"Measurement of Cabin Air Quality Aboard Commercial Airliners," p. 11. "Effects of Ventilation on Smoking Lounge Air Quality," p. 11. IN EliROPE & AROUND THE WORLD REGI'LATORI' AND LEGISLATIVE MATTERS • Activity in Australia, Austria, Canada, Sweden, Tonga and the United IGngdom. p. 12. LEGAL ISSUES AND DEVELOPMENTS • "Tobacco Firms Aim to 'Stifle' Legal Actions," p. 14. OTHER DEVELOPMENTS/MEDIA COVERAGE •"No Problem! An Economic Perspective on Smoking," is published by FOREST, p. 15. • International Union Against Cancer releasess series of fact sheets on tobacco, p. 15. •°Freedom Fighters" in the U.K. defi• train smoking ban, p. 15.

- TABLE OF CONTENTS - Issue 48 May 28, 1993 IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS 103D Co.cRFSs 111 , Representatives Svnar and Durbin ]rttroduce Fairness in Tobacco and Nicotine Regulation Act of 1993- ....... ................ .................... ............... ................... .......................... 1 (2] Senate Subcommittee Holds fAQ Bill Hearings .......... ..................... ............. .................... _...... 1 [3] House Smoking Accommodation Policv May Affecr Legislation ................... ........................... I U.S. OCC[:PAT10NAL SAFETY AND HEALTH ADMINISTRATION'(OSHA) [41 ASH v. lJsparrmenr ofGibor. No. 92-1661 (US. Court of Appeals, D.C: Circuit) (filed Decembcr 22. 1992) .................................................................................................... ... 2 (5] Kennedti Says OSHA Reform !vieasures Have Good Chance of Passage ..................................2 CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) (6J CDC Schedules Meeting to Discuss ETS Exposure in the Workplace ..................................... ~ ASHRAE (7] ASHRAE Committee Chair Says Nb Surprises in Draft Ventilation Standard ......................... 2 STATE AND LOCAL GOVERNMENTS (8] Some State OSHA Plans Roll Back Worker Exposure Limits .................................................. 3 (9] Florida Considers Rules to Implcment Clean Indoor Air Act ................................................... . I (101 ETS-Rdated State and Local Legislati.r Activities ................................................................... 3 ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS (1 1] Blanchard: Hearing on Defendants' Venue Motions Continued .............................................. e (12] Brain: Plaintiffs' Request for a Stay Denied ...................................... .............. ................ .........~ (13] Burltr.• Discoven• .................................................................................................... ................. ~ ~ (14] Aicl4rn.tev: Motions to Dismiss Filc& ............................ ............................. ......... ............ ......... ETSIIAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS AMERICAN V9'ITH DISABILITIES ACT (ADA) ('15] Sraron o. lY'errdlci Old Fashlowed H.amburgrrf oflVtu• York. Inc.. Nb. 3:93C1'-G66 (U.S. District Court. Connecticut) (filed March 30, 1993) ..................................................... ~ IAQ. CARPET EMtSSIO'.vS (16) Horvtll r: Sl+au, Industries. hic.. 93-CV-2068 (U.S: DistricrCourc. Eastrrn District. Pennsylvania) (filed April 19. 1993) ........................................................................................ ~ WORKPLaCE: HARASSMENT (1,'.] Srorko r-: Dakora Counrv (Dakota Counrv. Minnesota)',(decided';tiav -. 199,;a ........................ 6 PRISONER CASE (18] Starrfreld u: Hqv. 1992 Ky. App. LEXIS 228 (Supreme Court. Kenruck}-) (discretionary review denied April 14. 1993) ........................ ....... ................. ..................... ......t. LEGAL ISSUES AND DEVELOPMENTS [19) Television Broadcast Addresses Child Custodv Cases and Smoking .................... ......... ............t, [20]' ASH Creates Form Letter for ADA Complaints to Restaurants ................ ............................... b [21) New Jersey Magazine for Trial Lawyers Issucs'Call to Arms' for ETS Litigatibn .....................6 (22) Smoker Is Assaulted in Restaurant ............................................ .............................. ............ .....- (23) "Resurrecting an Old Cause of Action for a Nevc Wrong: Battery as a Toxic Tort," ...- C.J. McAuliffe (Student Author). 20 Ermrronrnnrral,$/Trirs 265 (1993) ........ ........................ [24] U:S. Supreme Court Decision Expected Soon in Case Involving the Admi.,sihilic.• of Scientific Evidence .............................................. ................................................................ OTHER DEVELOPMENTS (25) Polls in Virginia and Kentucky Cover !\'orkplace Sntokinl; lssues ...........................................8 [261 Restaurants Study, Ban on Smoking .........................................................................................S (2Z] Insurance Industn- Views IAQ Complaints as Psvchosos:ial 1'hcnomrtnou ............. 8 1281 Doctor Who Bans Smoking Turns Away Paticnrs Who Smokr ................................................ )

Contents Continued, Issue 48 MEDIA COVERAGE [29]' "Carpet Ihdustrv Facing Toxic Concerns; at Least 500 People Say New Carpeting (301 Has Made Them Sick." J. Fried, ThcPhiLadrlphia /nquirrr, May 9, 1993 ................................`j' "Smoking Shifts to Front Burner of Property Issues," T.J. Howard, 1311 The Chicago Tri6une.,May 16, 1993 ........................................................................................9 "Workplace Issues: Smoking in the Vi.'orkplace," Fair Employment Practices Guidelines (April 25, 11993) .................................................................................................... ...................9 (32] "Les Miserable ... The Wretched,,the Doomed, the Hard-core Smokers." J'. Adams, Tht Couritr Journa4 April 25. 1993 ........................................................................................ 9 SCIENTIFIC/TECHNICAL ITEMS UPCOMING MEETINGS [33] "Twenr.--sixth Annual Meeting for the Society for Epidcmiologic Research (SER):" (34] Kevstone. Colorado. June 16-18, 1993 .................................................................................. 10 "Third International Conference on Preventive Cardiolog.-." Oslo. Nor.a-ay. June 27'-July 1, 1993 .................................................................................................... ......... lo. RESPIRATORY DISEASE AND CONDITIONS - ADULTS [35] "Long-Term Ambient Concentrations ofToral Suspended Particulates. Ozone. and Sulfur Dioxide and Respiratory Symptoms in a Nonsmoking Population." D.E. Abbey. F. Petersen. P.K. Mills. and W.L. Beeson: Archivrr of Environmental Htalth 48(l)t 33-46. 1993 [See Appendix A] ................................................. 10 RESPIRATORY DISEASES AND CONDITIONS - CHILDREN [36] "Childhood Asthma and Indoor Environmental Risk Factors." C. Infantc-Rivard. American Journal ofEpidrmiologp 137(8): 834-844. 1993 (See Appendix A) .......................... 10 [37) "Indoor Nitrogen Dioxide and Childhood Respiratory Illness." L.S. Pilotto and R.M. Douglas. Auttralian fournal ofPuhlic Health 16( 3): 245-250. 1,992 (See Appendix A] ....... 10 ['38) "The Relationship of RSV-Specific Immunoglobulin E Antibod.-Responces in Infancy. Recurrent Wheezing. and Pulmonary Function at Age 7-8 Years." R.C. VC'elliver ................ ] 0 and L. Duff,v. Pediatric l'ulmonologt• 15: 19-27. 1993 [See Appendix A] '.... ............. OTHER HEALTH ISSUES [39] "Protracted Secretorv Otiris Media. The Impact of Familial Factors and Dav-Care Center Attendance." F. Rasmussen„lnttr,tation.rlJot.rnal ofPrdiatric Otor/yinoGrryngology. 26: '9-3 7. 1993 (See Appendix A]'. ........................................................ 1 1 INDOOR AIR QUALITY [40] "Measurement of Cabin Air Quality Aboard Commercialiqirliners." N.L. Nagda. [411 M.D. Koontz. A.G. Konheim: and S.K. Hammond, Atmotphnic Environment 26A(li2)`. '_203-2210. 1992 [See Appendix A] ........................ ........ I "Effects of Ventilation on Smoking Lounge Air Quality.,- P.R. Nelson. R.B. Hege. 42] J.M. Conner. G•B Oldaker, and H.E. Straub. In: Measurement ofTosir and Rrlattd Air Pollutants. Proceedings of the 1992 U!S. EPA/A&WMA International Symposium. Pittsburgh. Air & Waste Management Association. 89-94, 1993 [See Appendix A) ..............................................................................................1 1 "Ventilation and Indoor Air Quality in Finnish Daycare Centers." R. Ruorsalainen. N. Jaakkola, and J.J.K. Jaakkola. Environment lnrrrnario.ur119: 109-1 1~9. 1 993 [See Appendix A] ........................ ....................................................................................... ... 1 1 [431 Indoor Allergens: Assessing and Controlling Adverse Health Etlects. Committee on the Health Effects of Indoor Allergens, Institute of Medicine. A.M. Pope. R. Patterson. and H. Burge (eds.). Washington„ ASJtional Academ), Prers. 1993 ........................................... 1 I IN EUROPE & AROUND THE WORLD -4 REGULATORY AND LEGISLATIVE MATTERS ~ AUSTRALIA ~ (44) Rebel MPs Stall Plan to Implement Parliament Smoking Restrictions ................................... 12 00 AUSTRIA N 1451 Coalition Reaches Compromise on Tobacco Law ...................................................-•••••••••••••• 12

Contents Continued, Issue 48 CANADA [I46] Smoking Restrictions Considered in East York .........................................•.•-,....-..----•.--..,--.-.-] 2 ['47] Scarborough Approvcs in Principle Total Smoking Ban .......................................... -.•.--......... ,1 2 SV['EDElV (48) Debate Over Health Effects of ETS Heats Up ..................................................•-.•-.•..---•••.••.-- 1 3 KI1+:GDOM OF TONGA (49] Government Considers Smoking Ban .................................................................................... 1 3 UNITED KINGDOM [50] Southend Debates Smoking Policy ........................................................................................ 1 3 [51'] Barrow Councillors Disobey Ban They Adopted ................................................................... 1.3 (52), Health Board Adopts Smoking Restrictions ........................................................................... 13 (53] AntismokingCampaign for Children Launched .................... ............................................... 13 LEGAL ISSUES AND DEVELOPMENTS UNITED KINGDOM [54] "Tobacco Firms Aim to'StiFle' Lcgal Acrions." R. Taylor. Yorksl.irr Rost - Leeds. April 21. 1993; "MP on 'Disgraceful' Cigarette Companies." R. Taylor. and "Cigarette Ash in the Works." Editorial 1'orkshrre /'osr - Leedf, April 22. 1993 ....................... 1.4, REPI.'BLIC OFIRElAND [55] Tobacco Companies Make Legal Aid Submissions ...................... .......................................... ]-}' OTHER DEVELOPMENTS Al.'.STRALIA [56) Council Requests Comments on ETS Publication ................................................................. 1-1 (57] Business Makes Smoking Condition of Employment .............. .............................................. 1 i (58] Doctor Links Parental Smoking to Development of Childhood Asthma ................................ 1-4 (59) Smoke-free Restaurants to Be Identitied With New Logo ...................................................... I i [60] Perfume ltlav Join ETS as Public Health Concern ................................................................. I~ SWITZERIA`vD (611 International Union Releases Fact Sheet on ETS ................................................................... 1 S UNITED KIT:GDOM (62) FOREST Publishes Article by Economic Analyst .................................................................. 1j; [G3] Tobacco "Freedom Fighters" Defi• Train Smoking Ban ......................................................... I'~ [64] Leading Bridge Club Bans Smoking .............. .... . . . . . .. . . ... .. . . . . .. . . ... . . . . ... . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . .. . . I : MEDIA COVERAGE UNITED KINGDOM (65] "Only a Smoke Screen: Why Cigarettes are Not Rcallv the \'illains." C. Turner.. Doncaster Star. April ?0. 1993 ....................... ................................................ ........................ ,lYs APPENDIX A .................................................................................................... ................ .............. Article Summarie. .

\LAl''_8l 1993 I REPORT ON RECENT ETS AND IAQ DEVELOPMENTS IN! THE UNITED STATES REGULATORl' AN!D LEGISLATIVE MATTERS 103L) CONGRESS [1]I, Representatives Synar and Durbin Introduce Fairness in Tobacco and Nicotine Regulation Act of 1993 All aspects of cigarette manufacturing and marketing would be regulated by the U.S. Food and Drug Administration (FDA) under the provisions of the Fairness in Tobacco and Nicotine Regulation Act of 1993 (H.R. 2147); introduced on May 18. 1993, byy two Democratic Representatives, Mike Synar of Oklahoma and Richard Durbin of Illinois. The text of the Act indudes "findings" that "environ- mental tobacco smoke is a cause of disease in nonsmok- ers"; that the "labeling of tobacco products is inadequate to provide smokers and nonsmokers alike with full and complete information about tobacco products"; and that "there is no listing of chemical constituents found in mainstream and sidestrearn smoke (induding benzene, arsenic, cyanide, etc.)." In addition to complying with the requirements of the current Cigarette Labeling and Advertising Act, cigarette packaging would have to include "a warning and information about the dangers associated with environmental tobacco smoke" as well as "a list of chemical additives and constituents found in tobacco products and tobacco smoke." The Act would also, among other things: (i) require the FDA to promulgate a regulation requiring that all additives used in the manufacture of tobacco products be "safe"; (ii) require tobacco product manufacturers to pay the costs of their own regulation under the new chapter, at whatever level Congress specifies; (iii)) replace the statutory carbon monoxide warning for cigarettes with an addiction warning; and (iv) repeal the preemption provision of the Federal Cigarette Label and Advertising Act, 15 U.S.C. § 1334(b). At about the time the bill was introduced, the Coalition on Smoking or Health released a poll which purportedly found that 68 percent of Americans believe the FDA should regulate tobacco and that 75 percent feel that warnings about the ETS exposure should be added to cigarette packages. As of this writing, a companion bill had not been introduced in the Senate. [2] Senate Subcommittee Holds IAQ Bill Hearings The Nuclear Regulation Subcommittee of the Senate Environment and Public Works Committee held hearings on May 21 and May 25 to consider the Indoor Air Quality Act of 1993 (S. 656) and the Indoor Rad'on Abatement Act of 1993 (S. 657). EPA Deputy Administrator Robert Sussman and Represen- tative Joe Kennedy (D-Mass.) testified. See The Reuter Washington Report, May 21, 1993; BNA Daily Rtport for Evrcutiver, May 24, 1993. Kennedy. who has introduced his own Indoor Air Quality Act in the House (H.R. 1930), says he has met with EPA Administrator Carol Browner and White House officials, whom~he says agree that indoor air quality is a priority issue. The House measure must pass through three committees, and, without support from the Bush Administration, the bill stalled' in committee in past years. Kennedy reportedly believes that the committee logjam will be broken this year. See Statrs News Serrice May 19, 1993. [3] House Smoking Accommodation Policy May Affect Legislation The smoking policies recently addressed in House office buildings and on the House side of the Capitol mav have satisfied those Congressmen who had been calling for complete bans. Representative Jim Traficant (D-Ohio), who introduced legislation to ban smoking in all federal buildings (H.R. 881): apparently met recently with Speaker of the House Thomas Foley (D-Wash.) to discuss the new smoking

, policy and his bill. According to a press report. Traficant expects the bill to be marked up soon and anticipates that it will be amended during mark-up to permit designation smoking areas in federal buildings. In a related development, the ranking member of the Rules and Administration Committee in the Senate, Ted Stevens (R-.R1laska), told the press that he does not anticipate that any measures will be taken in the Senate to establish any official smoking or nonsmoking policy. See RoQ'Call May 13, 11993. U.S. OCCUPATIONAL SAFETY AND HEALTH ADttINISTRATION (OSHA) (4] ASH v. Department of Labor, No. 92-1661 (U.S. Court of Appeals, D.C. Circuit) (filed December 22, 1992) On May 20, 1993, the Court of Appeals issued an order denying the Department of Labor's motion to dismiss this action. In the suit, ASH seeks to overturn .vhat it had characterized as a denial by OSHA of its request to commence a separate rulemaking on ETS. In denying the motion, the court specifically found that the October 30, 1992, letter from OSHA re- sponding to ASH's request for rulemaking "meets the criteria of a final, reviewable order." In thatlener, then-Acting OSHA Director Dorothy Strunk stated that nothing would be gained by separating the issue of ETS from other indoor air quality issues. See issue 34 of this Report, November 6, 1992. The court has also granted ASH's request to hold the case in abeyance for 60 days and directed the parties to file motions to govern further proceedings "within 60 days of the date of this order." ASH had filed the abeyance request in light of then-Secretary of Labor Lynn Martin's directive to the agency to prepare a report for the incoming Secretary outlining separate rulemaking options for ETS. See issues 39, 41, 42, and 44 of this Report, January 22, February 19, March 5, and April 2, 1993. [5]', Kennedy Says OSHA Reform Measures Have Good Chance of Passage Prospects for passage of the Occupational Safety and Health Reform Act (H.R. 1280, S. 575) in this Congress are "very, very good,° according to Massa- ETS/IAQ REPORT, ISSUE 48 chusetts Senator Edward Kennedy. The only roadblock to passage, according to Kennedy, is scheduling, because the "first order of business" in the Senate will be the economic and national health care programs. Kennedy acknowledged the failure of Labor Secretary Robert Reich to endorse the bill in House testimony on April 28, but said he expects that the Clinton administration will strongNy back the measure. He is also quoted as saying that the bill is "a high priority with the administration." See BNA Washington Insider. May 12, 1993. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) [6] CDC Schedules Meeting to Discuss ETS Exposure in the Workplace ETS exposure in the workplace will be the focus of a meeting of the CDC's Interagency Committee on Smoking and Health. scheduled'for June 23, 1993. in Washington. D.C. The meeting will be open to the public. See 58 Fed. Reg. 29227 (May 19, 1993). In January 1993, simultaneously with the release of the EPA Risk Assessment on ETS, the CDC launched a multimedia public information program relating to the alleged health effects of ETS. The CDC is within the Department of Health and Human Services (HHS). HHS then-secretary Louis Sullivan announced the program in a joint press conference with then-EPA Administrator William Reilly. Sullivan said HHS had adopted certain "goals regarding secondhand smoke to be achieved by the year 2000." According to Sullivan, those goals include the following: reducing by half the percentage of children living in a home with one or more smokers; establishing tobacco-free environments in all public schools; and passing legislation in all stares that "prohibit or strictly limit smoking in the work- place and in enclosed public places." See issue 38 of this Report, January 7. 1993. ASHRAE [7] ASHRAE Committee Chair Says No Surprises in Draft Ventilation Standard Revisions that are being considered for ASHRAE 62- 1989 will reportedly not be startling or revolutionary.

N1A1' 28; 1993 The biggest changes could include a discussion of residential ventilation, a section on HVAC operation and' maintenance, and greater emphasis on a procedure to make adjustments to pollutant concentrations with variable ventilation rates. This according to W. Gene Tucker. chair of the ASHRAE committee that is reviewing the ASHRAE Standard 62-1989, Ventilation for ,-Icceprablt Indoor Air Quality. Tucker told the press that the committee hopes to have the first draft of the standard ready for ASHRAE's annual meeting this June in Denver, Colorado. The committee is apparently planning to have a version ready for public comment by 1995. See IndoorAir Qiralitl• L pdrre, May 1993.. STATE AtiD LOCAL GOVER:`ME:`TS [8] Some State OSHA Plans Roll Back Worker Exposure Limits A number of states that have state OSHA plans have reportedly decided to roll exposure limits back to the levels set bv OSHA in 1971. This, reportedly, in the wake of a decision by the U.S. Court of Appeals for the Eleventh Circuit to invalidate federal OSHA exposure limits for some 400 hazardous substances (AFL-CIO n. OSHA, see issue 35 of this Report, November 20, 1992). Other states that are required to keep pace with federal OSHA standards.vill, nonetheless, continue to enforce the limits that have been overturned by the court. According to a press report, among those states which .vill enforce the more stringent standards are California and Connecticut (only with respect to public employ- ces): In Oregon, regulators will reportedly temporarily revert to the 1971 standards until they can determine which of the more stringent exposure limits adopted by the state predated the 1989 federal OSHA rulemaking. See BNA Daily Labor Report, May 12, 1993. [9] Florida Considers Rules to Implement Clean Indoor Air Act The Florida Department of Health and Rehabilitative Services conducted rule development workshops in April and May to consider draft rules that would implement the provisions of the state's smoking restrictions statute, the Clean Indoor Air Act. Com- mentary on the draft rules was solicited by the depart- 3 ment from interested parties. The draft rules (i)'specifv what acts constitute violations of the statute;, (ii) adopt procedures to be followed by government personnel in responding to complaints about smoking or inspecting, workplaces and public places for violations of the statute; and (iii) impose certain fines for first, second and third violations. The statute, which has been in effect since 1988.. restricts smoking to designated areas in public places, prohibits smoking in places such~ as elevators, school buses, waiting rooms, and day care centers, and requires that employers adopt smoking policies desig- nating smoking and nonsmoking areas that accommo- date the interests of smokers and nonsmokers. Com- mon areas in workplaces, however, may not be desig- nated as smoking areas. Fines for violations of the statute cannot exceed 5100 for a first offense and S500 for subsequent offenses. [10]. ETS-Related State and Local Legislative Activities • California According to a news report, a bill was defeated in California that would have allowed lawsuits against tobacco manufacturers by people claiming they had been harmed by exposure to ETS. Backers of the bill had relied in part on the EPA Risk Assessment on ETS. In the past, similar bills had failed in the Assembly Judiciary Committee because of a 1987 agreement among insurers, trial lawyers and', doctors to refrainn from passing any type of tort reform legislation. Now that the agreement has expired, the bi11~s backers had hoped that the legisiation would be approved. See The Recorder, May 11 and Mav 1'3, 1993. On May 13, 1993, the Assembly passed two measures that would prohibit smoking in state buildings. including the Capitol. The first bill affects buildings owned or leased by the state, including prisons, courts, and University of California and California State Universiry classrooms. Governor Wilson had previ- ously issued an executive order prohibiting smoking in buildings under his administration's jurisdiction, but the order had not included universities, the judiciary or the legislature. The second measure passed prohibits smoking in buildings owned, leased or occupied' by the legislature. including the Capitol, floors of both houses, commit-

ETS/IAQ REPORT. ISSUE 48 tee hearing rooms, offices, hallways, stairwells. restau- rants and' bathrooms. The bill's sponsor reportedly said the EPA Risk Assessment made it clear that the Capitol should be smoke-free. "If there were ever an argument that smokers are doing it to themselves and no one else is affected, this report and the seven years of reports that have preceded it put that issue to rest," he was quoted to say. SeeA.B. 291 and A.C.R. 27', Regular Session (1i993-94) and Sacramento Bee. May 11, 1993, C'nited Press Inuernationaa! May 13, 1993, The San Francisco Chronicle, May 14, 1993, Los Angeles Times, May 15. 1993. • Local Governments in California The City Council of San Carlos passed an ordinance on May 10 that will prohibit smoking in restaurants, private workplaces and public transit waiting areas with shelters. The ordinance goes into effect June 10. Exemptions were provided for bars, private residences, bowling alleys, pool halls and conference or meeting rooms in hotels. Work- places.vhere all employees smoke and agree to allow smoking in the building also were exempted. Outdoor restaurants will be required to reserve half their seating for nonsmokers. Smoking will be allowed in restaurants having separate, enclosed smoking rooms with separate ventilation systems. See The San Francisco Chronich, April 28 and May 12, 1993. ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [ 11 ] Blancharrk Hearing on Defendants' Venue Motions Continued The hearing on defendants' motions to transfer venue and motions to strike, scheduled for May 20„ 1993, has been continued to July 1, 1993. Most defendants have now filed responses to plaintiffs' interrogatories and document requests. Three of the 14 plaintiffs in this case presently allege injury from exposure to ETS. Raye Blanchard and Tamara Reed, mother and daughter, both claim damages for unspecified "illness and disease" allegedly resulting from exposure to the ETS from cigarettes smoked''by Raye's deceased husband, Thomas, and by Raye herself, who claims she smoked "for about ten years." The third ETS plaintiff, Pamela Kastrin Stephens, claims unspecified "lung and respiratory diseases" allegedly caused by exposure to the ETS from the cigarettes smoked by her deceased father. The named defendants are purported to be the six major U.S. cigarette manufacturers, The Tobacco Institute, the Council for Tobacco Research, and a number of wholesalers and retailers. Blanchard, et al., v. R.J. Reynolds To6acco Company, et al.' (District Court, Galveston Counry: Texas) (filed July 31, 1992). [12j Broire Plaintiffs' Request for a Stay Denied At a hearing on May 17, 1993, Judge Robert Kaye denied plaintiffs' motion for a stay of the case before the triatcourt while the two appeals im the case are being resolved. Plaintiffs filed the motion for a stay on May 14. Plaintiffs have appealed the trial court's order dismissing the class action allegations in their com- plaint, while seven defendants have filed a petition for writ of certiorari to review the trial court's order denying,their motions to quash deposition notices served on senior executives of six of the defendants. At the same hearing, Judge Kaye granted in part the motions to dismiss filed by The Tobacco Institute and the Florida Tobacco and Candy Association. The court dismissed the strict liability, negligence and breach of implied warranty claims against both defendants in plaintiffs' amended complaint but denied the motions to dismiss as to the fraud and'conspirac}• counts. Judge Kaye also denied the motions to dismiss the fraud'and conspiracy counts in plaintiffs' amended complaint that were filed by the Council for Tobacco Research and the Tobacco Merchants Association. Also on May 17, 1993, Judge Kaye issued an order that dismissed the claims filed by plaintiffs Bonita Baker and Terry Casto. Baker's claims were dismissed due to Lorillard's renewed motion for sanctions. while Casto sought a voluntarily dismissal of her claims. Plaintiffs have filed motions for protective order regarding the depositions of plaintiffs Gary Haves and Valerie Gibson. scheduled for June 2 and June 16. They are the first plaintiffs scheduled for depositions. At issue in this case are the claims of 28' fliQht atten- dants allegedly injured by occupational exposure to ETS. In addition, the husband of one of the flight attendants claims loss of consortium. The attendants purport to represent a class of approximately 60.000.

MA1' '_2i. 1993 ~ Injuries alleged by the putative class representatives include lung cancer, breast cancer and unspecified respiratory ailments. Plaintiffs 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 manufacrurers (plus related entities), UST. Inc.,. United States Tobacco Company, Dosal Tobacco Corp., the Council~ for Tobacco Research, The Tobacco Insti- tute. and three trade associations. Broin, et al., v. Philip .4lorris, et al. (Circuit Court, Dade County, Florida) (filed October 31, 1991). [13] Butler. Discovery The deposition of plaintiff Dean Butler, the wife of plaintiff Burl! Butler, was taken as scheduled on May 19 and 20. 1993. Mrs. Butler alleges loss of consortium as a result of Mr. Butler's lung cancer. Mr. Butler claims his lung cancer was caused by exposure to ETS in the barbershop he owned and operated for approxi- matehy 30 years. As of this writing, a status hearing was still scheduled' for May 28 on plaintiffs' various motions, including their motion for a discovery conference, their motion for leave to file a second amended complaint. and several motions relating to discovery matters. It is possible that a trial date will be set at this hearing. The defendants in this case consist of the six major U.S. cigarette manufacturers and'several local retailers. Butltr v. R.J. Rcn•nold~ Tobacco Company, etaL (Circuit Court. Hinds Countv, Mississippi) (filed October 21, 1992). (14) McKinney. Motions to Dismiss Filed Brown & Williamson and R.J. Reynolds recently filed separate motions to dismiss the complaint with prejudice based on the court's lack of subject matter jurisdiction over the allegations against them. Plaintiff William McKinney, who is a prisoner in a Nevada jail, contends that defendants failed to warn of the alleged health effects of ETS exposure. He claims emotional pain, severe headaches, itchy and watery eyes, and recurring chest pains as a result of his expo- sure to ETS; McKinney v. C.AM. Products, Inc., et al. (District Court, White Pine Counry, Nevada) (filed March 3, 1993). Mr. McKinney is also the plaintiff in a civil rights case against Nevada prison officials regarding his exposure to ETS while incarcerated. The U.S. Supreme Court heard argument in the case earlier this year; a decision is expected within the next month: ETS/IAQ LITIGATION NOT' INVOLVING CIGARETTE MANUFACTURERS A\fERIG1N \Y'1TH DIS,\-BILIT[ES ACT (ADA) [15] Staron v. Wendy's Old Fashioned Hamburgers of New York, Inc., No. 3:93CV-666 (U.S. District Court, Connecticut) (filed March 30, 1993) . On May 11, 1993. Wendv's filed its answer to the discrimination complaint filed under the ADA by two children who allegedly suffer from asthma and a woman who allegedly suffers from lupus to force the defendant to adopt a smol:ing ban as an accommodation of their "disabilities." The defendant specifically denies that it owns or operates a Wendy's Restaurant at any location in Hartford County,,but asserts that of its restaurants in Connecticut. all are in compliance.vith applicable federal. state and local laws with respect to smoking. Other defenses asserted include (i) failure to state a claM upon which relief can be granted: (ii) lack of standing: (iii) the absence of any requirement under the ADA for restaurants to ban smoking: and (i.-) "[t]he issues raised by plaintiff in~ the Complaint are essentially political in nature. and therefore are matters for legislative rather than judicial resolution.° As of this writing, the defendants in the related ADA cases of Staron m McDonald s Corp. and Staron :,. Burger King Corp. had not yet filed their responses. IAQ: C.aRrET EmissiONS [16] Howell v. Shaw Industries, Inc., 93-CV-2068 (U.S. District Court, Eastern District, Pennsyl- vania) (filed April 19, 1993) Three of four defendants in this class action involving damages allegedly caused by toxic emissions from ~ carpeting have, bv stipulation, extended the time to file their answers until June 2. 1993.

(s As of \iav 18, nothing hadbeen filed in the docket on behaif.of defendant Shaw Industries, Inc. to extend the time for responding to the complaint, nor had Shaw vet filed its answer. For a discussion of the plaintiffs' allega- tions. see issue 46 of this Report, April 30, 1993. WORI:PL-~CE: HARASSME!vT [ 17] Srotko v. Dakota County (Dakota County, Minnesota) (decided May 7, 1993) A jury has reportedlyv awarded $117;000 in damages and S33,000 in lost wages to a county employee who claimed she had been harassed after complaining that co-workers .vere ignoring a smoking ban. Man, Stotko, a county dispatcher, evidently told her supervisors on January6, 1991, that employees were continuing to smoke in spite of a building-wide ban that had gone into effect on January 1. According to her attorney. Stotko s co-workers then ceased passing essential -. information to her, left her alone in the office during busy times, and would not speak to her when she greeted them. Stotko eventuallyy quit working as a dispatcher. According to a press report, this case is the first to be decided by a jury for harassment over enforcement of the State Clean Indoor Air Act. In a related develop- ment, legislative employees have apparently been told to stop harassing an employee who complained that the no-smoking law is not being enforced in the Capitol. See Star Tribune. May 9, 1993. PRISONER CASE [18]' Stanfield v. Hay, 1992 Ky. App. LEXIS 228 (Supreme Court, Kentucky) (discretionary review denied April 14, 1993) The Supreme Court of Kentucky has denied an application for discretionary review filed by a county jail inmate who alleged that his constitutional and civil rights were being violated by a prison smoking ban. In so ruling, the Supreme Court upheld a Courrof Appeals decision which found no violations of peti- tioner David Stanfield's rights. See issue 36 of this Report. December 4, 1993. L•TS1dAQ REPORT. ISSUE 48 LEGAL ISSUES AND DEVELOPMLNTS [19] Television Broadcast Addresses Child Custodv Cases and Smoking During a May 18, 1993, broadcast of NBC Nightly News, the issue of children being removed from the custody of smoking parents in divorce actions was addressed. The report featured the cases of Timothy Badao and K.C. Mitchell. Badao's visitation rights with his son were reportedly cut to four days a month by a judge who agreed with the boy's mother that smoking was aggravating the boy's asthmatic condition. Mitchell evidentlyy losr custody of her som solely because she smoked. During the report, a pediatrician was quoted as saying "it's welP known that it doubles the incidence of SIDS, which is Suddem Infant Death Syndrome, if one of the parents smokes." See.ti'BC Nightly News, May 18, 1993. [20] ASH Creates Form Letter for ADA Complaints to Restaurants In its most recent publicatiom ASH has includ'ed a form letter for those who are "so sensitive to tobacco smoke that exposure in a public place causes them difficulties with breathing or eating." The letter, according to ASH, will make it possible at a later time to file "a more formal'complaint" with the Department of )ustice under the Americans with Disabilities Act (ADA) against proprietors of public places such as restaurants who refuse to impose smoking bans. The form letter warns its recipient that "persons sensitive to tobacco smoke are entitled to protection under disability laws. Please understand that if you do nothing to remedy the problem, I may be forced to take legal action." The letter further discusses the litigation pending against fast-food restaurants in UIS. District Court in Connecticut, and advises the recipi- ent to contact ASH for "further information concern- ing your possible legal liabilities for refusing to curtail smoking." See ASH Smoking and Health Review; March-April 1993: [21]' New Jersey Magazine for Trial Lawyers Issues 'Call to Arms' for ETS Litigation Claiming "the tobacco lobby is no better than a ~ common criminal," the May 1993 issue of Nrw firse1

MAY _'R; 1!993 Tzial Lneverexhorts its readers to initiate ETS litiga- tion against cigarette manufacturers and other defen- d'ants. "Trial lawyer associations and every public interest law firm should use their contacts around the country to find plaintiffs who are harmed by second- hand smoke and get their claims before the judiciarv," the magazine asserts in an editorial. The editorial relies heavily on the EPA Risk Assessment on ETS and claims that ETS exposure "causes 30 times as many lung cancer deaths as all other cancer causing air pollutants regulated by the EPA." Including the editorial„the issue contains three articles related to tobacco litigation. In the second article, which deals with parental smoking, the author advances this hypothetical situation: A nonsmoking, divorced mother, who has custody of her five-year old daughter, files a motion with the New Jersey Family Court to enjoin the child's father from smoking in his daughter's presence. According to the hypothetical, "[t]he child is in good health, but returns home to her mother even' Sunday night [after weekend'visitation with the father] with her clothes smelling slightly from cigarette smoke." The author says sucLa case is unprecedented in reported New Jersey decisions but that he feels the injunction may properly be granted. "[A]ny constitu- tional' right a parent has with regard to his or her children is subject to the best interest of the children," he asserts. "Any inconvenience caused by a court- ordered smoking ban is, by any reasonable stretch of the imagination, more than outweighed by the benefits which accrue to a child through clean air in a smoke- free environment." To support his daim that ETS exposure increases a child's risk of illness, the author cites a 1991 report from the Department of Health and Human Services, a 1992 statement from the American Cancer Society and the EPA risk assessment. The third article focuses not on ETS issues, but on preemption and the Cipollone decision by the U'.S. Supreme Court. "[T]he court has finally removed the preemption shield that has given cigarette manufactur- ers unparalleled success in defending against claims based on state law,"'the author contends. The New Jerrey Trial Lawyer is the second legal publication in as many months to attempt to foster ETS litigation. The April 1993 issue of the I»door Pollution Law Report was devoted primarily to ETS litigation. See issue 47 of this Report, May 14, 1993. [22] Smoker Is Assaulted in Restaurant A woman sitting in the smoking section of a Man= land restaurant was reportedly struck several times by a man when she refused to put out her cigarette at his request. The alleged assailant, a 47-year-old attorney. has been charged with criminal assault„witka trial date set for June 9, 1993. See Baltimore Sun, May 21, 1993. [231 "Resurrecting an Old Cause of Action for a New Wrong: Battery as a Toxic Tort," C.J. McAuliffe (Student Author), 20 Environmental Affairs 265 (1993) This article addresses the difficulties plaintiffs face in proving causation in toxic tort litigation. The author suggests that actions in battervwould overcome this hurdle for plaintiffs because plaintiffs do not have to prove physical injury to satisfy the harmful contact element of a battery cause of action, i.e., the body's contact with certain substances can by itself constitute the injury. The author cites a student law review article about "Smoker Batterv'" and asserts that the intent element of battery is satisfied where the smoker continues to smoke after being told to stop. [24] U.S. Supreme Court Decision Expected Soon in Case Involving the Admissibility of Scientific Evidence A decision by the U.S. Supreme Court is expected before the end of June in a products liabilin• case in w•hi&the parties have asked the Court to decide the appropriate standard for the admissibility of scientific evidence. Daubert v. Merrell Dow Pharmaceuticals, lnc., No. 92-102 (U.S. Supreme Court) (review granted 10/ 13/92). The petitioners in the case are two minors born with limb reduction birth defects, who allege that a prescrip- tion drug taken by their mothers during pregnanc.•, Bendectin, caused their birth defects. Bendectin is an anti-nausea medication. At the trial court level, plaintiffs"causation evidence consisted primarily of expert testimony based upon in vitro studies, in vivo (animal) studies, chemical struc- ture analysis. and a reanalysis of existing epidemiologic

8 studies. Defendant offered affidavit testimom• to establish that, based upon the available literature of more than 30 published studies involving more than 130,000 patients, no published epidemiologic study demonstrated a statistically-significant association bern•een Bendectin and birth defects. The district court granted a motion for summary judgment filed bv Merrell Dow. holding that plaintiffs must provide statisticalh•-significant epidemiologic evidence of causation in order to meet their burden of proof and that an unpublished reanalysis offered by one of plaintiffs' experts was inadmissible. The U.S. Court of Appeals for the Ninth Circuit affirmed, stating that the reanalysis did not meet the requirements of general acceptance in the scientific communirv: To the Supreme Court, petitioners argued that the Federal Rules of Evidence eliminate any, n-pe of "general acceptance rest" for excluding'scientific evidence. Respondent Merrell Dow contended that the Federal Rules of Evidence require the specific testi- monv of each expert witness to have an adequate foundation, judged by the accepted standards of the expert's field. Briefing is complete, and oral argument was held on March 30, 1993: One of the amici curiae who filed a brief supporting the pharmaceutical company was Alvan Feinstein,, professor of medicine and epidemiology at Yale University and the author of "Justice, Science and the 'Bad Guvs,"' an editorial about ETS andscience. In his brief, Dr. Feinstein argued that significance testing and confidence intervals are necessary tools for evaluating the stability of the numbers being examined in epidemiologic data. He stated: "I can think of no better sav to allow `junk science' into the courtroom than to remove the constraints that demand numerical stability for data. If researchers can choose confidence intervals in an ad hoc manner, without justifying their selection of appropriate boundary values according to accepted scientific standards, the result will'be confidence games, not confidence intervals." Professor Feinstein also stated that reanalysis of epidemiological data may be an accept- able scientific method if subjected to established scientific standards and the rigors of peer review. ETS/IAQ REPORT. ISSUE 48 OTH ER D EVELOPIMENTS [25) Polls in Virginia and Kentucky Cover Work- place Smoking Issues According to a survey conducted by Mason-Dixon Political-Media Research Inc., 66 percent of Virginians favor laws banning smoking,in indoor places. Sixry-one percent also favored laws protecting the rights of smokers, requiring employers to provide smoking areas for employ - ees and barring discrimination against employees who smoke. See [Y/rrshington Times, May 10, 1993. According to a poll of 801 adults conducted by a newspaper in l:entucky, 50 percent said smoking should be banned at indoor workplaces. Some 22 percent of respondents reportedly stated'that there were no smoking restrictions in their places of emplo.-- ment, down from 33 percent in 1990. According to the survev, attitudes about smoking prohibitions did not van' between tobacco-growing counties and other counties. See The Courier JournaL April 25; 1993. [26] Restaurants Study Ban on Smoking A number of restaurant operators in Spokane are considering joining together to ban smoking in their establishments. Consideration of a ban is due in part to recent reports of the alleged effects of exposure to ETS. Vocal nonsmokers are also a motivating force. The restaurant's employees reportedly have conducted surveys and found that most customers would not be bothered by a smoking ban. See Journal of &usirress- Spokane, April 15, 1993. [27] Insurance Industry Views IAQ Complaints as Psychosocial Phenomenon At a recent meeting of an insurance industrv trade association, a risk manager from Oregon reportedly told emplovers that workers' compensation is a"tailed social policy that does more harm than good." The risk manager blamed the media for creating illnesses that do not really exist and'declared that the issue of indoor air quality "has been put to bed as largelv a psychosocial phenomenon." He added that employers should'get tough with employees who are out sick and that workers too often~blame the workplace for illnessess they would have had anyway. See Narimra! Llnder-

:%L-kY 28. 1993 writer, hroperry GCasualty/Risk & Benefits Management Edirro,t. Mav 3. 1993. [28] Doctor Who Bans Smoking Turns Away Patients Who Smoke Dr. Mark Jameson of Hagerstown, Maryland, reportedly opened his private practice in March and not only banned smoking in his office, but decided to limit his practice to nonsmokers. Jameson, who is a former director of health services for the Washington County Health Department, apparently believes that he has no duty to take care of patients who are suffer- ing from "their deliberate act." See Associated Press, May 13, 1993. MEDIA COVERAGE [29] "Carpet Industry Facing Toxic Concerns: at Least 500 People Say New Carpeting Has Made Them Sick," J. Fried, The I'hiladtlphia Inquirer, May 9, 1993 This article highlights current developments in~the controversy over the alleged health effects of new carpeting. Recent events mentioned in the article include the release of the results of Anderson Laborato- ries mice experiments, the EPA's decision to investigate carpet emissions, and the filing of a lawsuit in Philadel- phia against three major carpet makers. The article asserts that at least 500 people have complained to the Consumer Product Safety Commission that new wall,- to-wall carpeting has made them sick. [30] "Smoking Shifts to Front Burner of Property Issues," T.J. Howard, The Chicago Tribune, May 16, 1993 This article examines how the public pressure for stricter smoking policies affects building owners and' operators in the Chicago area, who must try to keep both tenants and employees happy. According to the artide, 52 office buildings inside the Chicago Loop, or about 20 percent of the total, prohibit smoking entirely. Another 112 buildings, or 42 percent, prohibit smoking in the lobbies and corridors. , 9 The owners and operators say their decisions about smoking polices are influenced by BOMA's recommenda- tiomof a ban on smoking in~the workplace, the EPA Risk Assessment on ETS, and the perceived threats of lawsuits by persons alleging injury from ETS exposure. As employers curtail smoking, the article states, building owners and managers are often charged with policing the issue and providing alternatives for smokers, such as outside smoking areas or separately-ventilated lounges. A relatively new alternative discussed in the artide is a smoking trailer. The Williams Scotsman Group. a Baltimore-based manufacturer of portable office space. plans to market designated smoking facilities - trailers with enhanced ventilation svstems. [31] "Workplace Issues: Smoking in the Workplace," Fair Employment Practices Guidelines (April 25, 1993) This article discusses a number of workplace smoking issues including the alleged costs to employers of emplo.-- ing smokers, the respective rights that both smokers and nonsmokers may have under the Americans with Disabili- ties Act. discrimination against smokers in hiring prac- tices, and adoption of.vorkplace smoking policies. The article includes a summary of the EPA Risk .+lssessmenr on ETS and discusses the wavs in which some states are responding to the risk assessment. [32] "Les Miserable ... The Wretched, the Doomed, the Hard-core Smokers," J. Adams, The Courier- Journar; April 25, 1993 This artide presents, in a playscript format. information about smoking policies that are being adopted by Louis- ville, Kentucky, businesses and the effect those policies are having upon smokers who are being forced to smoke out of doors. The writer has one of the characters observe that he or she "can't stand the smoke even on the sidewalks" and that perhaps smoking should'be banned everywhere except on a particular bridge.

10 SCIENTIFIC/TECHNICAL. ITEMS UPCO\MING IM4 EETINGS [33] "Twenty-sixth Annual Meeting for the Society for Epidemiologic Research (SER)," Keystone, Colorado, June 16-18, 1993 According to the preliminarv program, this meeting will include presentations entitled "Influence of Maternal Smoking. Paternal Smoking, and Involuntary Maternal' Smoking Exposures on Oral Cleft Defects," by G.M. Shaw: "Previous Reproductive Cancer as a Risk Factor for Lung Cancer in Lifetime Nonsmoking Women," by G. Kalsat; "Dietary B-Carotene and Lung Cancer Risk in Nonsmokers," by S.T. Mayne; "A Case-control Study of Childhood and Adolescent Household Passive Smoking and the Risk of Female Lung Cancer," bv F. Wang; and "Effects of Maternal Smoking and Childhood Respiratory Illness on Pulmonary Function in Young Adults: the CARDIA Study," by J. Dunn. One symposium will include three papers on meta-analysis. [34] "Third International Conference on Preventive Cardiology," Oslo, Norway, June 27-July 1, 1993 According to the program for this conference, it will include an entire session on ETS and cardiovascular disease. Lars Wilhelmsen will present "Is There a Threshold Valve?"; Robert Beaglehole will present "Updating Epidemiological Evidence"; Stanton Glantz will present "Updating Experimental Evidence"; and Richard Peto will present "How Many Victims?" RESPIRATORY DISEASE AND CONDITIONS - ADULTS [35] "Long-Term Ambient Concentrations of Total Suspended Particulates, Ozone, and Sulfur Dioxide and Respiratory Symptoms in a Nonsmoking Population," D.E. Abbey, F. Petersen, P.K Mills, and W.L. Beeson, Archives ofEnvironmental Health 48(1): 33-46, 1993 [See Appendix A] This study discusses long-term follow-up of a non- smoking cohort of Seventh-Day Adventists in Califor- ETS/IAQ REPORT, ISSUE 48 nia. ETS is not mentioned. The authors report statisti- cally significant increased risks of certain respiratory conditions associated with outdoor air pollutant levels. RESPIRATORY DISEASES AND CONDITIONS - CHILDREN. [36] "Childhood Asthma and Indoor Environmental Risk Factors," C. Infante-Rivard, American Journal of Epidemiology 137(8): 834-844, 1993 [See Appendix A] Based on a case-control study of children in Montreal, Canada, this author reports a statisticallv significant risk of asthma associated with "mother's heavv smoking." A number of potential risk factors for asthma were also identified. [37]' "Indoor Nitrogen Dioxide and Childhood Respiratory Illness," L.S. Pilotto and R.M. Douglas, Australian Journal of Public Health 16(3): 245-2 50, 1992 [See Appendix A] In this review article, the authors discuss epidemiologic data on nitrogen dioxide, which the.• describe as an emission from gas-fired appliances and a component of tobacco smoke, and childhood respira- tory illness. Thev conclude that additional research is needed to "determine if there is a health risk" associ- ated with exposure to nitrogen dioxide. [38] "The Relationship of RSV-Specific Immuno- globulin E Antibody Responses in Infancy, Recurrent Wheezing, and Pulmonary Function at Age 7-8 Years," R.C. Welliver and L. Du1R,, Pediatric Pulmonology 15: 19-27, 1993 [See Appendix A] Respiratory syncytial virus (RSV) has been related to childhood respiratory infections. In this paper, the authors investigate pulmonary function in children who had had bronchiolitis attributable to RSV: Thev conclude that "passive smoking" may be more impor- tant in determining the outcome of bronchiolitis than the severity of the RSV infection itself.

NLM`'_8', 1993 OTHER HEALTH ISSUES [39] "Protracted Secretory Otitis Media. The Impact of Familial Factors and Day-Care Center Atten- dance," F. Rasmussen, International fournal of Pediatric Otorhinolaryngology, 26: 29-37, 1993 [See Appendix A] This article reports on a Swedish cohort study assessing possible risk factors for otitis media (requiring t.Tttpanotomy tube insertion). The authors suggests that attendance at a day-care center or having a sibling with the condition were associated with an increased risk of otitis media. Parental smoking was reportedly not associated with the incidence of otitis media. INDOOR AI R QUALITY [40] "Measurement of Cabin Air Quality Aboard Commercial Airliners," N.L. Nagda, M.D. Koontz, A.G. Konheim, and S.K. Hammond, Atmospheric Environment 26A(12): 2203-2210, 1992 ['See Appendix A] This study reports data on levels of ETS and other substances in airliners, collected as part of the 1989 Department of Transportation study on airliner cabin air qualiry. The authors suggest that ETS "migrated" into nonsmoking areas, and report that CO, and humidity could "pose potential comfort problems" for occupants. [41] "Effects of Ventilation on Smoking Lounge Air Quality," P.R. Nelson, R.B. Hege, J.M. Conner, G.B Oldaker, and H.E. Straub. In: Measurement of Toxic and Rrlated Air Pollutants, Proceedings of the 1992 U.S. EPA/A&WMA International Symposium. Pittsburgh, Air & Waste Manage- ment Association, 89-94, 1993 [See Appendix A] Researchers from RJ. Reynolds report on a "test" smoking lounge in which various ventilation configura- tions were evaluated. Acceptable air quality was reportedly achieved at ventilation rates suggested by ASHRAE. [421 "Ventilation and Indoor Air Quality in Finnish Daycare Centers," R. Ruotsalainen, N. Jaakkola, and J.J.K. Jaakkola, Environment International 19: 109-119, 1993 [See Appendix A] This Finnish study presents data collected on ventila- tion rates, temperature, humidity, indoor air constitu- II ents, and perceptions of indoor air quality: The authors conclude that, in generai, indoor air quality in Finnish daycare centers could be improved, citing inadequate ventilation as one of the major problems. [43] Indoor Allergens: Assessing and Controlling Adverse Health Effects, Committee on the Health Effects of Indoor Allergens, Institute of Medicine, A.M. Pope, R. Patterson, and H. Burge (eds.), Washington, National Academy Press, 1993 "Indoor allergens constitute a substantial public health problem„" according to this recendy-released report. Moreover, "[t]he economic and social impacts of allergic disease in the United States are significant," and include absenteeism from work and school. The Institute of Medicine prepared this "assessment of the public health significance of indoor allergens" in response to a request from "several agencies of the federal government." Identified sponsoring agencies were EPA; the National Institute on Allergy and Infectious Disease; the National Heart. Lung, and Blood Institute; the National Institute of Environmen- tal Health Sciences; and the Agency for Toxic Sub- stances and Disease Registrv. The committee that prepared the report included engineers, aerobiolo,ists. epidemiologists, psychologists and physicians. ~ The primary objectives of the study were "to identih- airborne biological and chemicall agents found indoors that caa be directly linked to allergic diseases.° "to assess the health impacts of these allergens," and'"to determine the adequacy of the knowledge base thar is currently available on this topic." The report includes a summary of available data, a list of consensus recom- mendations designed to improve awareness and education, and a research agenda describing long-term research needs. Using currently available data, the committee esti- mates that "one out of five Americans will experience allergy-related illness at some point during their lives and that indoor allergens will be responsible for a significant share of these cases." They estimate that 50 million Americans experience hay fever and other allergic diseases, and that 20-30 million have asthma. Related to the latter estimate, the report indicates that the estimated cost of illness related! to asthma was $6.2 billion in 1990.

12 The committee lists the following "major sources" of indoor allergens: house dust mires, fungi and'other microorganisms, domestic pets (cats and dogs), cock- roaches, and "reactive allergenic chemicals" contained in some household' produas. ETS is discussed in the committee's description of the process of developing :illeroic disease. Wliile some persons have claimed to experience "tobacco smoke allergy," the committee classes ETS among "nonallergenic agents." Nevertheless, they suggest that nonallergens can interact with allergens in the development of sensitization in an~ individual. In particu- lar, the report states: "Exposure to nonallergens that irritate the respiratory tract (e.g., environmental tobacco smoke) can promote the development of allergic reactions and disease." With regard to control of alkrgen-caused disease, the committee advocates avoidance of exposure. They state: "The reduction andlor elimination of human exposure is probably best achieved by simultaneouslv controlling allergen sources and improving building ventilation, i.e., the design, operation, and mainte- nance of heating, ventilation, and air-conditioning (HVAC) systems." IN, EUROPE & r'1ROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AuSTRALIA [44] Rebel MPs Stall Plan to Implement Parliament Smoking Restrictions According to a press report, plans to impose a partial smoking ban in the New South Wales Parliament have been set back six months following stiff opposition from "rebel" MPs. The restrictions will now go into effect on January 1, 1994. See Daily Telegraph Mirror,. Ntay 19, 1993. In a related story, control of the New South Wales Parliament was apparently taken from its two presiding officers and given to a new MP-run committee in the wake of contention over issues such as smoking. See Srdney Morning Herald, May 17, 1993. ETS/IAQ REPORT: ISSUE 48 Meanwhile, MPs in South Australia are apparently defying a ban on smoking that was imposed in Parlia- ment offices during its last session. See Adelaide Advertiser, May 12, 1993. AUSTRIA [45]' Coalition Reaches Compromise on Tobacco Law According to a press report, the parties of Austria's ruling coalition have reached a compromise on a new tobacco law. Among other matters, there will appar- ently be no provision in the measure imposing the originally-planned smoking ban in official buildings. schools, universities and on public transport. See Der Standard May 14, 1993. CANADA [46] Smoking Restrictions Considered in East York The East York Council was reportedly scheduled to consider a smoking restriction by-law at its May 17 meeting. Some three vears of community consultation apparently preceded development of the by-law which would require the designation of smoking areas or the creation of completely smoke-free environments in all East York workplaces. The measure, if adopted, will go into effect on May 31. World No-Tobacco Day: Workplaces and public places will reportedly have one year to make the transition. See Caitarda Newsu%'ire. May 13, 1993. [47] Scarborough Approves in Principle Total Smoking Ban According to a press report, Scarborough has become the first municipality in Canada to call for a total smoking ban in all enclosed public places induding bars, restau- rants, pool halls, bingo parlors and meeting places. Council reportedly voted to approve the ban in principle, but it will not go into effect until a bvlaw• laying out the terms is approved by Queen's Park later this vear. The mayor urged Council to approve the policy and reportedly said it would be good for the city's image. Opposition to the policy reportedly came from representatives of bingo halls who said it would put them out of business. See The Toronto Star. May 20, 1993.

\LA1•.,.'_8. 1993. SWEDE^: [;48] Debate Over Health Effects of ETS Heats Up On the eve of the May 27, 1993, parliamentary vote on the New Tobacco Act,,the press reported findings from the United States that traces of nicotine were found' in 99 percent of 5,000 individuals tested by the Centers for Disease Control and Prevention (CDC). Apparently, Sveyzska Dagbladet was the first newspaper to have seen preliminary results at this stage of the CDC study, which will eventuallv anahze blood tests from 23;000 people. Head of the stud.•• Dr. James Pirkle• evidently admitted that cotinine traces originating from foods such as instant tea could have been picked up by the sensitive instruments that are being used to anahze blood'1 samples. "Traces are very small in these foods, and diet could very well be an insignificant factor," he said; "but we must make sure that there are no ques- tion marks whatsoever hanging over this survey." The press also reported the findings of the EPA Risk Assessment on ETS. According to Margaretha Haglund of the Medical Research Council, the CDC survey and the EPA report demonstrate that "passive smoking is much more widespread than we had thought" and that "passive smoking produces much the same damage as active smoking." See Svenska Dagbladet, May 1993. It is unknown what impact this information will have on the vote in Parliament. The New Tobacco Act would not require the imposition of total smoking bans in public places or restaurants and would permit employees and their employers to develop mutually agreeable smoking policies. See issue 45 of this Report, April 16, 1993. KINGDOM OF TONGA [49] Government Considers Smoking Ban The King and Legislative Assembly are considering legislation that would ban smoking in enclosed public places, government buildings, workplaces, shopping centers, restaurants and'on public transport. Also being considered are cigarette package warnings that would change every six months and that would include the statements "Protect children: don't make them breathe 13 your smoke" and "Smoking damages the health of those around you." UNITED KINGDONf [50] Southend Debates Smoking Policy Proposals to ban smoking in various authority-run buildings in Southend were reportedly defeated after heated debate. Supporters of the measure cited the 1974 Health and Safety Act which purportedly imposes a duty upon the council for the health and safety of its employees. Opponents apparently resisted the proposals by arguing that Council should not be dictating to others about the issue. See Southend Evening Echo, April 28, 1993. [51 ] Barrow Councillors Disobey Ban They Adopted According to a press report, the personnel committee in Barrow was told that the only individuals breaking, the ban on smoking that was adopted in March are the councillors who voted to adopt it. A representative of FOREST is quoted as saying, "It is what you.t•ould expect from these sort of people - on the one hand they behave like prudish health fascists and on the other hand they ignore the rules anyway." See Xortb Western Evening 1L1arG April 16, 1993. [52] Health Board Adopts Smoking Restrictions The Borders Health Board has reportedly approved' a policy that will restrict smoking by emplovees too designated breaks in special areas. Visitors and contrac- tors will not be permitted to smoke in any health board premises, but patients can continue to smoke if they are long-term residents or if thev are short-term patients who are unable to stop smoking. Staff will have discretion to permit smoking by those patients and relatives who find themselves in "ven• stressful situations." The policy will apparently be implemented in stages, and employees will have until October 31', 1993, to adjust to the restrictions. See Berkwicksliire News, April 15, 1993. [53] Antismoking Campaign for Children Launched Health chiefs in Gloucestershire have reportedlv backed a campaign created by the Royal College of Physicians which, among other matters, says children

ETS/IAQ REPORT, ISSUE 48 have a right (i) to schools, youth clubs and public places that are smoke free; (ii) to be brought up in a home that is smoke free; and (iii) to be free from the effects of tobacco in the womb. Children are appao- enthy being encouraged to join a "Smokebusters" club and will work to persuade others to stop smoking. See Gloucester Crtizxn, April 30, 1993. LEGAL ISSUES AND DEVELOPMENTS UNITED KINGDOM REPUBLIC OF IRELAND [55] Tobacco Companies Make Legal Aid Submissions On May 24, 1993, several U.K. cigarette manufacturers made submissions to the Northern Ireland Legal Aid Department stating their opposition to granting such aid. The submissions were made in response to reports that some lawyers were preparing legal aid applications on behalf of employees who claim their employers failed to protect them from the alleged health effects of ETS exposure in the workplace. (54]' "Tobacco Firms Aim to 'Stifle' Legal Actions," R.. Ta},lor, Yorkahire Post - Leeds, April 21, 1993; "MP on `Disgraceful' Cigarette Companies," R Taylor, and "Cigarette Ash in the Works," Editorial Yorkshire Post - Leeds, April 22, 1993 These press items discuss the significance of the action taken by tobacco companies in the United Kingdom to forestall the granting of legal aid to employees who are seeking to recover damages for workplace exposure to ETS. The tobacco companies have filed documents with the legal aid board, urging it not to grant assistance in these cases. See issue 42 of this Report, March 5, 1993. A spokesperson for ASH is quoted as saying that the measures taken by the tobacco companies "show the desperate lengths they will go to. Thev re saying they are prepared to interfere in every passive smoking case against an employer and attempt to strangle them at birth." Conservative MP Jerry Haves is evidently .vriting to the Lord Chancellor's office to protest the industry action. He argues that the tobacco companies should not "blatantly interfere in the process of justice," and is calling for a thorough investigation. Haves has also served as a spokesperson for ASH. Although recognizing that the tobacco companies have a legitimate right to intervene with the legal aid board, the editorial characterizes the action taken by the industry as "naked bullying by the rich and power- ful," and questions "how their shareholders feel about being associated with such a crew." The writer evi- dendy believes that the fairest way to deal with the issues is for a test case to proceed in court. OTHER DEVELOPIMENTS AL'STRALIA [56] Council Requests Comments on ETS Publication The National Health and Medical Research Council has published a notice indicating it is establishing a working partv to update its 1986 publication, "Effects of Passive Smoking on Health." In the notice, which was published in a newspaper ad, individuals interested in the topic are invited to submit comments by June 22. 1993. Comments should be directed to: Health Care Com- mittee, National Health and Medical Research Council, GPO Box 9848, Canberra ACT 2601. See Ik%ekend Australian. Mav 22-23, 1993. [57] Business Makes Smoking Condition of Employment It has been reported that one Ipswich business is requiring its employees to accept ETS exposure as part of their employment conditions. Evidently, a doctor..•ho was treating a nonsmoking patient for a chest condition learned of the requirement. The patient reportedly worked in an office where 25 of 30 employees were smokers. See Quen:sland Times, May 11, 1993. [58] Doctor Links Parental Smoking to Development of Childhood Asthma According to a press report, Dr. David Hill, writing in the Medical Journal of Australia, has purportedly found evidence in worldwide studies for a link between parental smoking and the development of asthma in children. See Gladstone Observer, Mav 12, 1993.

MAl' '_8. 1993 [59] Smoke-free Restaurants to Be Identified With New Logo According to a press report, those restaurants that have adopted smoking bans or have set aside nonsmok- ing areas will be identified byy a logo which features the combination of symbols for eating utensils with the international nonsmoking symbol on the plate. See Daily Telegraph Alirror, IVfay 19, 11993. [60] Perfume May Join ETS as Public Health Concern According to a press report, perfumes may follow ETS as the next alleged public health hazard in Austra- lia. Publicity is being given to a 575,000 damage payment that was made by Bloomingdale's in the U'.S& to a woman who claimed she had been hospitalized'w•ith an asthmatic attack after being sprayed with perfume. The press is also discussing the San Francisco ban on perfumed products at public meetings and a church that has apparently set aside four odorless pews. See SrandaY Telegraph, May 23, 1993. SNVITZERLAti D [61] International Union Releases Fact Sheet on ETS The Geneva-based International Union Against Cancer has released a series of fact sheets on tobacco. Among the "fact sheets"' is a document entitled Policies to protect the rights of non-smokers. Each "fact sheer" develops a specific theme, provides practical advice to implement a strategy relevant to the theme's goal and concludes with a recommendation. The "fact sheets" were evidently prepared with the support of ASH-UK, the American Cancer Society and the Anti-Cancer Council of Victoria, Australia: UNITED KINGDOM [62] FOREST Publishes Artide by Economic Analyst The smokers' rights organization FOREST has recentlyy published an article entitled "No Problem' An Economic Perspective on Smoking" by Dr. Kevin Dowd, an economic analyst. The article, concluding that claims by antismoking activists regarding smoking as an economic burden are specious, contains a brief 15 mention of ETS issues. Dowd cautions that those studying the issue of ETS must distinguish between ETS and the smoke that a smoker inhales before trying to establish whether there are any adverse effects due to ETS exposure. He also states "there is still no convinc- ing evidence in favour of the adverse health effects of passive smoking." An introduction to the article by Lord Harris of High Cross notes that the trend of general intolerance that has been directed at smokers is part of "the widespread tendency to identify such private behaviour as a public problem' for which the `solution '. is to 'summon up Leviathan to stamp it out'." Lord Harris: new slogan is "Anti-smokers can damage }our freedom - and their own." [63] Tobacco "Freedom Fighters" Defy Train Smoking Ban On Mav 1:7, 1993, members of PUFFS (Passengers Uhired for Freedom to Smoke): reportedly took over the rear carriage of a commuter train and lit pipes and cigarettes to protest a smoking ban introduced on Network SouthEast's Great Eastern division. Accord- ing to Network SouthEast, anyone who continues to deh• the ban will face f nes of up to 400 pounds. See The Times, May 18, 1993, In a related storv, a rail users' H•atchdoggroup has reportedly criticized British Rail's decision to ban smoking on most Nkrwork SouthEast routes. Accord- ing to the group. railway managers are ignoring the demands of a "significant minoritv° of commuters. See Daily Telegraph, itilay' 20, 1993. [64] Leading Bridge Club Bans Smoking The ACOL Bridge Club in Hampstead has report- edly introduced a smoking ban which has provoked a number of resignations. The club has placed its future in the hands of a world and European bridge cham- pion who: according to press reports, "has a virulent dislike of the weed." The manager of the London School of Bridge who is quoted in the article observed that bridge players tend to smoke a lot, but that students at the school are not allowed to smoke "in. the hope that they won't develop the habit of pufting while they play." See The Daily Telegraph, May 22, 1993.

16 ETSlIAQ REPORT. ISSUE 48 MEDIA COti'ERAGE UNITED KINGDOM [''65] "Only a Smoke Screen: Why Cigarettes are Not Really the Villains," C. Turner, Doncaster Star, Apri120, 1993 This article, written by a representative of the To- bacco Ad.•ison• Council, discusses the role of ventila- tion in controlling indoor air quality problems. The author points out that the majority of "sick" building problems are not caused by tobacco smoke and that banning smoking will not "banish all the other unseen constituents in the indoor air - many of them of considerable concern."

M41' 28; 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. RESt'IR-xTOR1' DISEASE AND CONDITIONS - ADULTS [35] "Long-Term Ambient Concentrations of Total Suspended Particulates, Ozone, and Sulfur Dioxide and Respiratory Symptoms in a Non- smoking Population," D.E. Abbey, F. Petersen, P.K. Mills, and W.L Beeson, Archives of Environmental Health 48(1): 33-46, 1993 "Seventh-Day Adventists (SDAs) provide a unique population in which to evaluate health effects of ambient air pollutants.... In California; ... SDAs live in areas that differ greatly with respect to concentra- tions of ambient air pollutants; therefore„variabiliry in exposure enhances power to detect alteration in risk." "Ten-year follow-up data are now available on this cohort and are reported herein. In this article, we present associations between long-term cumulative ambient concentrations of total suspended particulates, ozone, and sulfur dioxide and the following adverse health effects: (1) new cases in 1987 of definite symp- toms of AOD [airway obstructive disease], chronic bronchitis, and asthma in those who did not have definite symptoms in 1977, and (2) the change in severity of these symptom complexes (1977-1987)," "This article focuses on TSP and ozone, both of which are high in Southern California. The effects of SO, are also addressed." "[O]ur study had determined statistically significant increased risks of definite symptoms of AOD and chronic bronchitis to be associated with ambient concentrations of TSP above 100 ug/m' and increased risks of asthma with ambient concentrations above 150 ug/m'. This confirms the prudence of the federal standard of 75 ug/mj for TSP. Long-term ambient concentrations of ozone in excess of 10 pphm were significantly associated with development of new cases of asthma in men and with increases of severity of asthma in non-sex-specific analyses. These results need to be considered in future decisions regarding standard A-1 setting for ozone. A future paper will!add'ress the health effects of particulates of less than 10 micron diameter in this cohort in relation to recently established standards for that pollutant." RESPIRATORY DISEASES AND CONDITIO`S. - CHILDREN [36] "Childhood Asthma and Indoor Environmental Risk Factors," C. Infante-Rivard, American Journal ofEpidemiology 137(8): 834-844, 1993 [See Appendix A] "Indoor environmental factors that have received the most attention in the past are tobacco smoke and directly or indirectly measured nitrogen dioxide, mainly from gas appliances. The present study consid- ered these and other, less frequently studied potential risk factors for their relation to the incidence of asthma among 3- and 4-year-old children. The objective of the study was to estimate the contribution to asthma incidence of chemical, physical, and biologic indoor environmental factors, as well as family histon, of asthma and past infections, after accounting for personal susceptibility. A case-control study was carried out to meet this objective." "In a case-control studyy carried out in Montreal, Quebec, Canada, between 1988 and 1990, indoor environmental factors were studied in relation to the incidence of asthma among,3- and 4-year-old children. Cases, whose parents were recruited at a hospital emergency room, were children who had a first-time diagnosis of asthma made by a pediatrician. Controls were chosen from family allowance files and were matched with case children on age and census tract. A telephone interview was administered to the children's parents. A... subsample was chosen to wear a nitro- gen dioxide monitoring badge during a 24-hour period. Multiple conditional logistic regression analysis showed that after personal susceptibility factors were controlled for, the following were independent risk factors for asthma: the mother's heavy smoking (odds ratio (OR) = 2.77, 95% confidence interval (CI) 1.35- 5.66), use of a humidifier in the child's room (OR = 1.89, 95% CI 1.30 - 2.74), and the presence of an electric heating system in the home (OR = 2.27. 95°0 CI 1.42-3.65). The presence of other smokers in the home was not quite significant (OR = 1.82, 95°'o CI'

A-2 0.98-3:38). A history of pneumonia, the absence of breast feeding, and a family history of asthma were also significant risk factors. In a separate unmatched multivariate analysis of subjects who had worn the nitrogen dioxide badge, there was a dose-response relation between nitrogen dioxide (in~parts per billion)) and asthma. These results confirm the role of suscepti- bilitv factors in asthma and show that indoor environ- mental factors contribute to the incidence of asthma." °In the literature, there appears to be no other incident density case-control study of new cases of asthma diag- nosed by pediatricians among 3- and 4-year old children. Previous studies were largely cross-sectional in design and included elementary school-aged children (generally aged 6-14 vears) who, according to parental reporting, had asthma or a closely related'respiratory problem such as wheezing or whistling, or had had some type of chest illness in the previous year. However, most of the poten- tial risk factors for childhood asthma considered in the present report have been studied before." "Increased risk in this study may be due to children being younger and belonging to a narrower age group than children in most previous studies and to the physi- cian diagnosis of disease, which is likely to have been much more uniform than that in any other study." "In conclusion, this incident density case-control study showed that even after accounting for personal susceptibility; family history,,past infections, and factors related to the indoor environment contribute significantly to the incidence of asthma. For future studies to have a greater impact on public health, it will be necessary to assess exposure-response relations and to relate findings to suggested protective standards. Obtaining reliable quantitative measurements will be the challenge to future studies." [37] "Indoor Nitrogen Dioxide and Childhood Respiratory Illness," LS. Pilotto and R.M. Douglas, Australian Journal of Pu61ie Health 16(3): 245-250, 1992 "Nitrogen dioxide is produced from the combustion of fossil fuels and as an emission from gas-fired apPlr ances, and is also a component of tobacco smoke. Nitrogen dioxide has been shown in experimental animals to be toxic to the respiratory tract. A number of recent studies have suggested that children exposed to significant levels of nitrogen dioxide in the home may ETS/IAQ REPORT, ISSUE 48 be more susceptible to respiratory illness than children exposed to normal ambient levels. Respiratory illness is a major cause of morbidity in children everywhere.° "This report will focus on the epidemiological evidence of association between NO, exposure and respiratory symptomatology and infection~in children„who are likely to be more susceptible to air pollution than adults. The current Australian experience is reviewed and recommen- dations for future direction are given."' "[IAJIl studies which relied on ambient NO, levels as measures of exposure found a positive relationship." "In the studies using gas for cooking at home as a measure of NO_ ... exposure, mixed results were found. These studies mainly involved cross-sectional study designs with retrospective parental questionnaires to determine symptom and illness histories." "Mixed results have also occurred in the few studies that measured indoor NO, levels and attempted to estimate personal levels of exposure." "In studies measuring ambient NO, levels only, caution is needed' in interpreting a positive association between polluting gases and respiratory illness to NO,." "The World Health Organisation recommends maxi- mum levels of.0.08 ppm over 24 hours and 0.21 ppm over one hour for ambient NO, exposure. The NHMRC (recent recommendation) accepts that `NO,,may cause clinical effects in some individuals above 0.3 ppm hourly average'. The Australian experience would indicate that a significant number of people are exposed to more than 0.16 ppm of NO, hourly on average and that a large number may be exposed to more than 0.3 ppm of NO,. especially in school classrooms.°' "Serious doubts exist, for reasons already explained, about the interpretation of the previously reported studies which used ambient monitoring and gas cooking as surrogate measures of personal NO_ exposure.... [O]verall interpretation of these conflicting results [is] difficult and does not provide adequate epidemiological evidence from which to set a maximum hourly or 24- hourly average indoor goal for NO,." "Such research is needed to determine if there is a health risk associated'with exposure to low-level NO,. If there is no determined health risk, it would be unfair to impose arbitrary restrictions that mav be financially detrimental to many organ isations."

AtAY28; 1i993 [38] "The Relationship of RSV-Specific Immuno- globulin E Antibody Responses in Infancy, Recurrent Wheezing, and Pulmonary Function at Age 7-8 Years," R.C. Welliver and L. Du(I'y, Pediatric Pulmonology 15: 19-27, 1993 "The principal hypothesis to be tested in the present study was that RSV-IgE responsiveness in infancy might be related to recurrent wheezing through 7-8 years of age. Additionally, risk factors of interest (family history of asthma, passive exposure to cigarette smoke throughout early childhood, and skin test reactivity to common allergens at ages 7-8 years) were evaluated for their relationship to recurrent wheezing and pulmonary function. Finally: bronchodilators were administered at the time of pulmonary function testing to determine if small airway dysfunction following bronchiolitis was at least partially reversible." "[A]ssociation of RSV-IgE responses with the develop- ment of any wheezing following bronchiolitis was ob- served in this study and it extended this observation to aQe 7-8 years. All 9(100°l0) subjects with current wheezing at age 7-8 years and 16 of 25 (64%) subjects without current wheezing had manifested RSV-IgE responses in infancy. This difference is not statistically significant, but the number of subjects studied provided a statistical power of less than 70% to dete+ct a difference." "In general, RSV-IgE responses in infancy were unrelated to pulmonary function in later childhood. This may have been expected, since numerous factors influence the development of lung function during childhood. However, among children with wheezing through age 7=8, RSV-IgE responses in infancy were quite strongly correlated with comparatively good pulmonary function. It is difficult to conceive a mechanisms by which RSV-IgE responses in infanry, which have been associated with greater severity of initial illness, could'have resulted in improved pulmo- nary function at age 7-8 years, and then only in currently wheezing children." "[I]n the present study decreased pulmonary function at age 7-8 years was associated with evidence of atopy as well as with passive exposure to cigarette smoke during childhood. In addition, airway hyperreactivity at age 7-8 years was related to the presence of 2 or more positive skin tests. These findings are not surpris- ing, given the abundant evidence suggesting that both passive exposure to cigarette smoke and childhood A-3 asthma adversely affect lung function during childhood and adult life. Nevertheless, they suggest that atopy and passive smoking are important determinants of abnormal lung function which might otherwise be attributed to RSV infection itself. ... Taken together, all studies suggest that atopy and passive exposure to cigarette smoke may play a greater role in determining the long-term outcome of RSV bronchiolitis than the severity of the initial RSV infection itself." "Together with the results of other studies, our data suggest that factors unrelated to the severity of the initial RSV infection itself significantly influence the development of recurrent wheezing or pulmonan- function abnormalities. If our findings are correct, RSV vaccine strategies should be directed at protecting infants at high risk for severe illness at the time of initial RSV infection.° OTHER HEALTH ISSC'ES [39] "Protracted Secretor,v Otitis Media. The Impact of Familial Factors and Day-Care Center Atten- dance," F. Rasmussen, IntrrnationalJournal of Pediatric Otorhinolaryngology, 26: 29-37, 1993 "This study's objective was to assess the impact of familial factors, day-care center attendance, and passive smoking on the incidence of protracted secretory otitis media (SOM). An unselected cohort of 1306 Swedish~ children were followed from birth: to 7 years of age. Information about physician visits and insertions of tympanostomy [sic] tubes for SOM was collected at the ENT-departments in one Swedish counry.° "The research questions directing this population based cohort study are: (a) How large is the cumulative incidence of protracted SOM among Swedish pre- school children? (b) Does the risk for protracted SOM increase if a sibling has or has had the same health problem? and (c) Are the type of day-care and parents' smoking habits risk factors for protracted SOM?" "The children were divided into three groups accord- ing to their mothers''smoking habits: Mothers who smoked 10 or more cigarettes per day throughout their child's first 4 years of life, mothers who were non- smokers during the child's first 4 years, and the remaining group. No significant differences were found between any of these groups of children."

A- + "Anahyses which included only thetwo-parent families were also performed. No difference was present in proportions treated with tvmpanostomyy tubes between the children whose mothers and fathers were non- smokers, those whose mothers and fathers had smoked 10 or more cigarettes per day and children from the remain- ing two-parent families." "The risk for protraaed' SOM increased four times if a sibling had had the same disease. When interpreting this finding it is important to keep in mind that the form of da.=care and'parents' smoking habits were taken into account in the multivariate analysis." "[T]he present studv clearly shows that familial factors are important in the etiology of protracted SOM. The intra-familial associations can no[ be explained by similari- ties among siblings with respect to form of day-care or passive smoking in the home. The pathophysiological mechanisms behind these intra-familial associations remain~to be identified by future research." "Younger siblings of children with protracted SOM comprise a risk group for the same disease. While previous t.7rtpanometric studies have shown that enrollment in a DCC [day care center] comprises a risk factor for single short episodes of SOM, the present study has confirmed attendance in DCCs as a risk factor for protracted SOM. Attendance in DCC is thus not suitable for children with protracted SOM. This form of day-care is even less appropriate if an older sibling to the child with protracted SOM has or has had the same disorder." INDOOR AIR QUAL.IT• [I40] "Measurement of Cabin Air Quality Aboard Commercial Airliners," N.L. Nagda, M.D. Koontz, A.G. Konheim, and S.K. Hammond, Atnwspheric Environment 26A(12): 2203-2210, 1992 "Between April and'June 1989, 92 randomly selected flights were monitored to determine prevailing levels of environmental tobacco smoke (ETS) and'other pollutants in the airliner cabin environment. The monitored flights included 69 smoking flights, 8 of which were interna- tional, and 23 nonsmoking flights, all of which were domestic. Selected ETS contaminants (nicotine, respirable suspended particles and carbon monoxide), as well as ozone, microbial aerosols, carbon dioxide and other environmental variables were measured in different parts of airliner cabins." ETS/IAQ REPORT, ISSUE 48' "This paper reports on methods used for and results of air quality measurements conducted in the study; evalua- tion of health risks due to ETS, other pollutants and cosmic radiation as well as assessment of mitigation strategies are included in a DOT report." "Levels of ETS contaminants monitored~during,the study were substantially higher in smoking sections of the aircraft than in nonsmoking areas, and these levels were strongly correlated with observed smoking rates. There was some evidence of ETS migration to the no-smoking boundary region near the smoking section, particularly for RSP concentrations in this region that were related to smoking rates and distance from the smoking section, Monitored CO, levels were sufficiently high and monitored humidity levels were sufficiently low to pose potential comfort problems for aircraft occupants. Ozone levels on all monitored flights were well w•ithin: existing standards for airliner environments, and monitored levels of microbial aerosols were below those in residential environments that have been character- ized through cross-sectional studies." [41] "Fffects of Ventilation on Smoking Lounge Air Quality," P.R. Ntlson, R.B. Hege, J.M. Conner, G.B Oldaker, and H.E.Straub. In: Measurement of Tozrc and Relaud Arr 1'ollutants, Proceedings of the 1992 U.S. EPA/A&WMA International Symposium. Pittsburgh, Air & Waste Manage- ment Association, 89-94, 1993 "An experimental smoking lounge (test lounge) was constructed and various ventilation configurations ..•ere evaluated. The lounge was evaluated at maximat occupancy (14 smokersYand ventilated' at 60 CFX1 per occupant (ASHRAE Standard 62-1989). Concentra- tions of CO, CO„ and RSP were monitored ... Occupants rated the air quality in the lounge as being acceptable for most of the configurations. Smoking did not contribute significantly to CO, concentrations. Smoking had a small effect on CO concentrations; the average increase was less than 1.5 ppm. RSP concentra- tions ranged from 365 to 642 ug/'m' and'were consis- tent with smoking activity. ... Overall, ETS concen- trations were lowest when the air within the test lounge was well mixed. Results from the test lounge were compared to those obtained in a smoking lounge in~an office building. Concentrations of nicotine and RSP were an order of magnitude lower in the smoking

kLAY ?8. 1993 lounge in the office building under normal occupancy and use conditions than they were in the test lounge." "Acceptable air quality, as defined by occupant satisfac- tion, can be achieved in a smoking lounge using conven- tional air distribution at ventilation rates suggested by ASHRAE. True displacement ventilation was not achieved'... Although displacement ventilation can be effective for ETS removal, such systems must be carefully 'designed to achieve the desired air flow charaaeristics." "Investigations conducted in a test room under maxi- mum occupancy conditions may be used'to determine relative differences between test configurations and provide an upper limit on the ETS concentrations obtainable. However, ETS component concentrations measured~ in a test lounge under those conditions may greath• overestimate typical ETS concentrations which would be found' in that lounge under typical operating conditions. At highi ventilation rates, the removal rate for gas and particulate phase compound's may be affeated by air distribution. As a result, two or more indicators may be needed to quantify exposure to gas and particulate phase compounds in ETS." [42] "Ventilation and Indoor Air Quality in Finnish Daycare Centers," R. Ruotsalainen, N. Jaakkola, and j.J.K Jaakkola, Environment Internationa! 19: 109-119, 1993 "The purpose of this study was to assess the performance of ventilation and the indoor air qualityy of Finnish daycare centers and to evaluate the effect of ventilation and building design on indoor air quality. A random sample of 30 daycare centers in the city of Espoo (part of the Helsinki metropolitan area) was selected for the study. The measurements during October and November 1990 consisted of air flows, temperature, relative humidity, concentrations of CO,, VOC and formaldehyde, and odor: intensity. The measurement period was one day." "The air flows in the 83 children's rooms varied remark ably. The range was 0-11 Us per person and the average was 3.8 Us per person.... The Finnish guide value of 5 Us per person was achieved in 30% of the rooms. The exhaust air flows varied from 0 to 4 Usm'; only 18% of the children's rooms achieved the Finnish guide value of 2 Usmz." "The CO, concentration measured in the 83 children's rooms when occupied varied from 400 to 2500 uUL A-5 (ppm).... In the majority of the rooms (96%), the metabolical CO, concentration was below the Finnish~ guide value of 1500 uUL In 18% of the rooms, the CO, concentration was above 100 uUL, which is considered as the comfort limit." "The odor intensity evaluate&by two members of a trained panel varied in the 83 children's group rooms when occupied from 0.5 to 8.... The main source of the odor was human bioeflluents. In most rooms, the re- searchers also judged the air~ stuffy and unacceptable." "The range of measured formaldehyde concentrations was 0.002-0.038 mg/m'. The concentrations were well below the Finnish guide value of 0.15 mg/m'." "The relative humidity varied from 7 to 66%. The outdoor thermal conditions are the main factor influenc- ing the relative humidin• of the indoor air." "The results indicate that the indoor air qualin• in the majority of Finnish daycare centers does not satisfv the existing guide values, although there are some daycare centers with good air quality. The ventilation is inadequate in most of the davcare centers. This leads to the accumulation of carbon dioxide, which is an indicator of the accumulation of other indoor air pollutants. The average air flows of the mechanical ventilation in the day-care centers varied from nonex- istent to above design values." "The percentage of nursing workers perceiving unpleas- ant odors in the 30 davcare centers studied varied from 20% to 100%.° "Mold odor was reported by 6% of the nursing.vorkers: in two daycare centers over half of the workers and in three centers one worker experienced~ mold odor. These daycare centers had also suffered water damage. Water damage and moisture problems appeared in 70°a of the daycare centers." "[P]erceptions of poor indoor air quality are quite common. The frequency of mold odor and moisture problems indicated microbiological growth, which may have respiratory health effects. Thus there are both good and bad daycare centers in all tvpes of buildings. We consider that the study addresses an important public health issue and we intend through further . analysis to estimate the effect of poor indoor air qualin, on the health and comfort of workers and children inn daycare centers."

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