Tobacco Documents Online

20 STATISTICS AND RISK ASSESSMENT [76] "Who's Exaggerating?" A.M. Finkel, Discover May: 48-51, 54, 1996 [See Appendix A] OSHA Director of Health Standards Adam Finkel aefends the process of risk assessment in this commen- tary, which appears in a popular scientific magazine. IN EUROPE & AROUND THE WORLD REGION 1-WESTERN EUROPE REGULATORY AND LEGISLATIVE MATTERS [77] Hospital Food Outlets in Ireland Required To Reserve Nonsmoking Areas As of May 1, 1996, the Irish Health Board is requir- ing owners of food outlets in hospitals and clinics to make at least one-half of their seats nonsmoking. According to a press report, the food outlet owners will be responsible for publicizing and enforcing the new rules. See Irish Ira-endent, April 23, 1996. [78] Smoking Ban Suspended in Housing for the Elderly A smoking ban imposed last summer by the Council of the Vale of Glamorgan in communal areas of housing complexes for the elderly has reportedly been suspended following complaints. An investigation is apparently underway into the cost of providing smoking areas. See South Wales Echo, April 23, 1996. [79] European Commission Not Expected To Develop IAQ Legislative Proposals The European Commission reportedly does not foresee developing legislative proposals on IAQ in the immediate future, according to Commissioner Edith Cresson. Cresson apparently made the statement in response to an inquiry by MEP Martina Gredler, who had asked whether the commission intends "to take a pioneering role in the field of indoor pollution through the adoption of a new regulation." "The Community already has a corpus of legislation dealing with worker ETS/IAQ REPORT, ISSUE 123 protection and which covers inter alia air quality within the workplace," Cresson was quoted as saying. Cresson also responded to Gredler's inquiry about "indoor pollution" research conducted by the Joint Research Centre QRC) and the dissemination of its findings. Cresson explained that the JRC research, which has been underway since 1986, is being con- ducted within the framework of the European research network called "the European collaborative action on indoor air quality and its impact on man." She said that its reports had been made widely available through mailings to about 900 researchers, universities and institutes, and that its findings are published in the open scientific literature and are partially contained or cited in the reports of the European collaborative action. See Written Question E-3428195 by Martina Gredler (ELDR) to the Commission; 3428/95ENAnswer Given by Mrs. Cresson on Behalfofthe Commission, February 8, 1996; Journal of the European Communi- ties, April 25, 1996. OTHER DEVELOPMENTS [80] Lancet Editorial Calls for Scrutiny of Discrimi- natory Treatment of Smokers An editorial in a recent issue of The Lancet, while complaining about the government's lack of interest in public health, claims that a local initiative giving preference in adoption to nonsmoking couples deserves the public's most critical scrutiny "lest we risk losing control over our moral choices about health to the prejudices of governments." The editorial also states, "most people might consider it absurd not to allow a couple to adopt a child because they indulge in a habit that although dangerous to their own health poses an unquantifiable and probably tiny threat to-that of their children." According to the editorial, government-funded public health campaigns have had little effect and are giving way to coercive discrimina- tion. See The Lancet, May 4, 1996. [81] British and Australian Scientists Claim Link Between Radio Waves and Allergies A team of British and Australian scientists have reportedly found a possible link between radio waves and allergic reactions, which they claim could explain the large increase in the number of individuals with SHB 93140321

MAY 10, 1996 asthma. The team's findings, which apparently are to be published soon, suggest that the frequencies at which televisions, computers and mobile telephones operate might trigger and/or exacerbate allergic reactions in sensitive lungs. John Holt, a member of the research team, is quoted as stating, "There is no question that factors such as air pollution and other antigens are involved. But I think our findings show that electromagnetic radiation has made it ten times worse." The team of scientists is led by Peter French, medical director at the Centre for Immunology and Cancer Research at St. Vincent's Hospital, Sydney. See The Times, April 30, 1996. [82] British Survey Results Support Nonsmoking Policy A survey of 490 customers of seven pubs in Avon, conducted by the antismoking group called Breathe Easy, has purportedly found that more than 90 percent of the pubs' customers would not object to a nonsmok- ing policy and that 47 percent were more inclined to go to a nonsmoking pub. The findings were criticized by the British smokers' rights group FOREST, as being biased and flawed. According to FOREST, the Breathe Easy survey was conaacted in pubs that already had nonsmoking policies. See The Publican, April 15, 1996. [83] North Yorkshire Policy To Give Nonsmokers Priority in Adopting and Fostering Children City councilors in North Yorkshire, Britain's largest local authority, have reportedly decided to back a policy that would give nonsmokers priority in adopting or fostering children younger than age 2. The council's social services subcommittee was apparently told that ETS can lead to impaired lung growth and slow development. However, the city of York apparently will not be following the policy. The city's assistant director of children's services was quoted as saying that they wanted to avoid any "arbitrary or artificial" barriers to people becoming foster parents. Prior to North Yorkshire's adoption of the policy, the Liberal Democrat chair of its social services subcom- mittee was quoted as stating, "We are a responsible council, and we must consider this as part of our approach on smoking. There will be plenty of discus- sion, but people are more and more aware of the harm 21 caused by smoking, which is increasingly banned in public places." When the proposed policy was announced, the British smokers' rights group FOREST lodged a protest, stating that the proposal was not based on fact and that there is no well-founded scientific foundation for ETS health claims. An editorial in a regional newspaper also argued that such a "hard and fast" ruling could be dangerous. "If someone smokes it does not necessarily make them a better or worse parent...Certainly there is more to parenthood than providing a nicotine free environment," it stated. Further details about the council's proposal appear in issue 122 of this Report, April 26, 1996. See Reuters, Northern Echo, April 23, 1996; Northern Echo, Echo Yorkshire Evening Post, April 26, 1996. [84] French Passenger Indicted for Smoking During Flight A Boston grand jury has reportedly dropped charges against French nightclub owner Regine Choukroun for her involvement in a conflict with airline personnel over her son's smoking during a trans-Atlantic flight. Choukroun's son, Lionel Rotcajg, has apparently been indicted on charges of interfering with an American Airlines crew. Initial reports indicated that Rotcajg had assaulted and threatened the crew in mid-air. Further details about the incident appear in issue 122 of this Report, April 26, 1996. See International Herald Tribune, May 3, 1996. [85] European Parliament Approves "Leaders Against Tobacco" Program European political and social leaders, as well as high-profile individuals from the scientific and artistic communities, will apparently be asked not to smoke in public as part of a "European Leaders Against To- bacco" initiative to be conducted in conjunction with the Europe Against Cancer program. The program, which has been approved by the European Parliament, will involve a media campaign directed by the Euro- pean Commission. The European Leaders initiative was proposed by Euro MP Jose Luis Valverde, who reportedly stated that citizens must be protected from the "negative effects" of tobacco smoke. See Actualidad Tabaquera, April 1996. SHB

22 REGION 2-AUSTRALIA REGULATORY AND LEGISLATIVE MATTERS [86] Woodford Prison Implements Smoking Ban Prisoners and staff will reportedly be banned from smoking anywhere within Woodford prison. A spokes- man for the Queensland Corrective Services stated that the situation would be monitored as concerns aLc ,tt increased tensions in the prison have been expressed by the Prisoners Legal Service, the Civil LibPrries Council and the State Public Services Federation. Previously banned nicotine patches and chewing gum may apparently be permitted. See Proserpine Guardian, March 28, 1996; TVQ10, BTQ7 `News ; April 19, 1996; Courier Mai4 April 20, 1996; Morning Bulletin, Apri122, 1996. REGION 3 JAPAN OTHER DEVELOPMENTS [871 Asahi Will Not Export "Smoklin" Fiber but Other Companies Move Ahead Rejecting an estimated JA$4 to JA$5 billion in potential sales, Asahi Chemical Industry Co., Ltd., has reportedly decided not to export its "Smoklin" deodor- izing f ber to avoid the possibility of becoming embroiled in smoking and health litigation in the United States. A company official was quoted as stating, "It is possible for us to be sued by, for example, lung cancer patients who may mistakenly conclude that the fiber eliminates harmful ingredients." Asahi claims Smoklin fiber can absorb and neutralize 80 to 90 percent of the acetaldehyde, ammonia, acetic acid and other substances found in tobacco smoke. The company developed the fiber in July 1994 and has applied for patents in Japan and other countries. A press report indicates that Asahi's decision not to export the fiber conflicts with advice received from U.S. importers who apparently told Asahi officials that it would face minimal product liability risk in the United States. The company evidently decided not to export the fiber to other countries to avoid trade-discrimination lawsuits by U.S. companies. ETS/IAQ REPORT, ISSUE 123 Other Japanese companies are reportedly moving ahead with products that control ETS and odor. Shiseido, for example, is marketing a product that apparently removes accumulated odors from human hair. Tornex, a Japanese air conditioning manufac- turer, has reportedly developed a device that generates tornado-like air currents to keep ETS from drifting toward nonsmokers. Matsushita Electric Industrial Co. and Sharp Corp. have also introduced fans and air cleaners to control ETS. See The Daily Yomiuri, February 6 and 11, 1996; The Nikkei Weekly, March 18, 1996; The Japan Times, April 25, 1996. REGION 4-EASTERN EUROPE AND THE MIDDLE EAST REGULATORY AND LEGISLATIVE MATTERS [88] Antismoking Law Takes Effect in Poland As of May 1, 1996, a new law took effect that reportedly restricts indoor smoking in workplaces, public buildings, hospitals, schools, sports centers and similar sites to specially designated areas. If such areas are not provided, smoking is prohibited. Violators face fines of up to US$2,000, approximately one-half of the annual wage earned by an average Polish worker. The law also bans tobacco sales at medical and sports centers. See Polish Press Agency, Reuters, United Press Internationa4 May 1, 1996. [89] Iranian Parliament Withdraws Law Banning Smoking in Public Places The Iranian parliament has reportedly withdrawn a law it had passed, which prohibits smoking in public places and the sale of cigarettes on the streets, because of opposition from the Guardian Council. The coun- cil, a senate-like group composed of six theologians and six jurists that reviews parliament decisions before they take effect, had ruled that the law was unconstitutional because it would reduce tax revenues from tobacco sales without finding another source of income. The parliament had narrowly approved the law on April 28, 1996, despite reported spirited opposition from members who smoke. See Agence France Press, 93140323 SHB

MAY 10, 1996 Deutsche Presse Agentur, Reuters, United Press Interna- tiona4 April 28 and May 1, 2, 5, 1996. REGION 5-CANADA REGULATORY AND LEGISLATIVE MATTERS [90] Vaughan To Provide Exemptions to Anti-Smoking Bylaw, While Oshawa, Kanata Consider More Restrictions The city of Vaughan has reportedly created temporary exemptions from what has been called the toughest antismoking bylaw in Canada. As originally drafted, the bylaw would have prohibited smoking in all public places as of May 1, 1996. The city council recently amended the measure, however, to exempt banquet halls, bars and taverns, billiard and bingo halls, and institutional-residential buildings until September 30. The city reportedly plans to develop permanent exemp- tions for these establishments by June 30. Preliminary reports indicate that separately ventilated smoking areas might be permitted in the facilities. Meanwhile, approximately 35 speakers apparently debated plans to increase public smoking restrictions in Oshawa during a recent meeting of the city's fire protection and general purposes committee. City officials are reportedly considering increasing the number of bingo hall tables reserved for nonsmokers from 10 to 15 percent. Opponents of the move contend that the increase would result in reduced business. A spokesman for the Oshawa West Lyons Club reportedly stated that the club raises most of the money it donates to the pediatric diabetic unit at the city's General Hospital from bingo. Without the bingo proceeds, he argued, "It's going to close. These kids are going to suffer." Kanata has reportedly become the sixth municipality in Ottawa-Carleton to support a proposed regional ban on smoking in the workplace. The council condition- ally endorsed the ban, but apparently wants the region to come up with a plan to share the costs for enforcing it. The city council also shelved a proposal to prohibit smoking in restaurants, apparently due to concerns over the legal costs of defending the measure and the possibility it would drive businesses to other cities. The 23 council apparently decided to observe how the Vaughan bylaw faresagainst legal challenges before making a decision. Kanata's current bylaw prohibits smoking in 70 percent of the city's restaurants. See The Ottawa Citizen, April 27, 1996; The Toronto Star, May 2, 1996. [91] Soo Jail Order To Meet Clean Air Regulations Likely To Affect Other Jails in Ontario System Soo provincial jail officials have reportedly been ordered to implement a plan by March 1998 that will ensure that the jail's IAQ is as good as that of commer- cial buildings where smoking is not permitted. The order requires that the first stage of the plan be in effect by June 8, 1996. Corrections Ministry officials have apparently admitted that the order effectively sets the rules for all 45 jails in the province. The order is purportedly based on a finding that scientific consensus links ETS to lung cancer, other respiratory ailments, heart disease, and reproductive system ailments; that there is no safe level of ETS exposure; and that Ontario's workplace safety law requires an employer "to take reasonable precautions in the circumstances for the protection of workers." A Corrections Ministry official is quoted as stating that there are ff..v ways to achieve clean air other than by prohibiting smokin~, adding that separately venti- lated prisoner smoking lounges in most of Ontario's old concrete and limestone jails could not be created at an acceptable cost. Jail management and union officials estimate that 75 to 90 percent of inmates and about one-third of jail guards smoke. See The Toronto Star, April 25, 1996. REGION 6-LATIN AND SOUTH AMERICA REGULATORY AND LEGISLATIVE IVIATTERS [92] Brazil's Justice Tribunal Nullifies Sao Paulo Smoking Fines The chief judge of the Brazilian Justice Tribunal has reportedly stated that all fines imposed by Sao Paulo officials to enforce the city's recently overturned restaurant smoking ban have been nullified. The statement comes in the wake of the tribunal's decision to overrule a September 1995 decree by Mayor Paulo SHB

24 Maluf that prohibited smoking in all Sao Paulo restaurants. The decision to block the fines apparently covers all 50,000 members of the Sao Paulo Hotels, Restaurants, Bars and Food Establishments Federation, and was greeted by celebration in many federation restaurants. Additional information about the tribunal's prior ruling appear in issue 122 of this Report, April 26, 1996. See Sexta-Feira, April 19, 1996. REGION 7-ASIA REGULATORY AND LEGISLATIVE MATTERS [93] Punjab House of Representatives Urges Smok- ing Ban Legislation The Punjab House of Representatives has reportedly passed a resolution recommending that Parliament enact legislation banning the use of tobacco in public places in the state and all forms of tobacco advertising. See Indian Express, March 22 1996. OTHER DEVELOPMENTS [94] Chinese Children s Army To Stop Smokers in Pub:ic Places A year-long publicity campaign, during which 500,000 children will reportedly try to persuade family members to quit smoking and to "stop people who puff cigarettes in public places with 'no-smoking' signs," has been launched, according to a news report. Government officials were quoted as saying, "The youngsters have formed a mini-army of peaceful persuaders in a nationwide drive to curb the increase in the country's smoker population," which is said to number 350 million, or 29 percent of China's 1.2 billion people. Since last year, 26 Chinese cities have banned smoking in public places. Beijing will impose its own ban as of May 15, 1996. See Xinhua News Agency, Agence France Presse, April 30, 1996. ETS/IAQ REPORT, ISSUE 123 WORLD AIRLINE NEWS [95] Air France Flights Feature "Smoker's Bar" All Air France flights between Houston and Paris reportedly feature a "bar fumeur," separate lounge areas for smoking in economy class and in first/business class. With the introduction of the bar fumeur, all assigned seating areas are smoke-free. The bar fumeur, an Air France exclusive, is described as a semi-enclosed _ lounge and bar area equipped with a smoke-extracting fan that draws out fumes and keeps the entire aircraft cabin smoke-free. Air France apparently plans to add the smokers' bars to flights from Paris to Los Angeles, San Francisco and Washington Dulles in June; New York (JFK) in September, and Miami and Newark, New Jersey, in November. See Reuters, Business W7re, March 19, 1996; USA Today, April 2, 1996; The Houston Chronicle, April 14, 1996. SHB

MAY 10, 1996 APPENDIX A The numbers assigned to the following article summaries correspond with the numbers assigned to the synopses of the articles in the texr of this Report. LUNG CANCER [47] "Pulmonary Carcinogenicity of CigarettL Sidestream Smoke in A/J Mice," H.P. Witschi and KE. Pinkerton, The Toxico!ooist30(1, Part 2): 1036, 1996 "A total of 48 male strain A/J mice were exposed to sidestream smoke (SS) generated from Kentucky 1 R4F reference cigarettes (Controls: filtered air). Chamber concentrations were 90 mg/m3 of total suspended particulate, 246 ppm CO and 17 ug/mj of nicotine. Animals were exposed for 20 weeks, 6 hours a day, 5 days a week. After 5 months, half of the animals were killed. We found that at this moment 33% of the SS exposed and 11 % of the controls had lung tumors (tumor incidence and multiplicity not significantly increased). The remaining animals were allowed to recover in air and were killed 9 months after the [beginning] of the experiment. In the SS exposed groups, 20 out of 24 animals (84%) had one or several lung tumors and the average number of tumors per lung was 1.38 [plus/minus] 0.22. Both tumor inci- dence and multiplicity was statistically higher than in controls, where we found an incidence of 38% (9/24) and multiplicity of 0.42 [plus/minus] 0.14. Analysis of cell proliferation in the respiratory tract showed an initially increased, but then decreasing labeling pattern in the epithelia of the airways and a consistently increased labeling patterning in the nasal cavity. Under appropriate conditions, SS thus produces lung tumors in mice." CARDIOVASCULAR ISSUES A-1 [48] "Cardiovascular Disease and Occupational Exposure to Environmental Tobacco Smoke," D.M. Aviado, American Industrial Hygiene Association journal57: 285-294, 1996 "The current article was prepared for submission prior to the OSHA hearings that started in September 1994.... Among the 75 references used in this article, only 25% were included in the OSHA notice, without reference to the other 75%." "In a sealed unventilated enclosure 100 m3 it is possible to estimate the number of cigarettes burning continuously, simultaneously, and completely, to attain the PEL recommended by OSHA. For nicotine the maximum reported SSS collected is 8.2 mg/cigarette. On the basis of PEL (0.5 mg/m3) it would take six burning cigarettes to attain the PEL in the chamber (0.5 x 100 divided by 8.25). However, as noted in the following section, measurements of nicotine levels as ETS in public places are 9333 to 466,666 times less than the PEL. Thus, under actual potential exposure conditions, the dilution of cigarette smoke by the size of enclosure and ventilation means that constituent levels would be hundreds and even hundreds of thousands of times lower than implied by calculation of cigarette equivalents." "Nicotine has the lowest cigarette equivalent among smoke constituents reviewed by the author. Examining the other constituents reported in ETS, only carbon monoxide and nitrogen dioxide have fewer than 100 cigarette equivalents. Phenol has more than 5000; benzene has more than 10,000; toluene, more than 20,000; acetone, more than 200,000; and benzo [a] pyrene, more than 200,000 cigarette equivalents." "[T]he range of published concentrations are consid- erably less than the current accepted PEL, as follows: carbon monoxide, 2.7 to 50 times PEL; nitrogen oxide, 208 to 2778 times PEL; nitrogen dioxide, 66 to 238 times PEL; nicotine, 10 to 500 times PEL; acetone 2000 to 6667 times PEL; benzene, 102 to 1667 times PEL; and benzo[a]pyrene, 262 to 71,852 times PEL." "The 20 chemicals listed ... when individually used in factories below the corresponding PEL, have not been associated with heart disease nor with any adverse SHB

A-2 effect on corresponding target organs, i.e., mucosal surfaces, skin, blood, nervous system, lungs, kidneys, and liver.... A causal association between worker exposure to industrial chemicals and occupational heart disease can only be established by extensive chemical analysis, animal experiments, and human s.udies. The available studies on ETS exposure are inadequate to address causality of occupational heart disease." "The proposed rulemaking regarding ETS in the workplace, since it is based on mortality data on spousal diseases and household smoking without controlled ETS occupational exposure, has no prece- dent in the formulation of work standards." "Repeated attempts to induce coronary atherosclerosis in experimental animals by inhalation of cigarette smoke have failed." "It is the author's opinion that cholesterol feeding experiments may be useful as a model in elucidating secondary influences of hormones, drugs, and chemi- cals on the primary process of atherosclerosis. Such studies, however, are very difficult to interpret, because they involve the simultaneous examination of several potential factors in heart disease. The same general remarks apply to experimental testing of carbon monoxide in levels far exceeding those reported for ETS exposure." "Any reported increase in fibrinogen level in the blood of ETS-exposed subjects may not be relevant to a potential ielationship with coronary atherogenesis." "In vitro studies of platelet aggregation in blood derived from smokers have yielded inconsistent results, which bring into question the applicability of this method to ETS exposure in nonsmokers." "The occurrence of cardiac arrhythmias by industrial chemicals does not support the proposition that because the same chemicals may be reported at minute levels in ETS, then ETS also may lead to the development of heart disease in workers." "Since the proposed rulemaking notice for indoor air quality is for the specific purpose of preventing cardio- vascular and respiratory tract disease, this review concludes by comparing the means used to argue for disease causation by occupational exposure.... For the issue of ETS exposure and coronary heart disease, there are questions and debatable answers as to whether ETS/IAQ REPORT, LSSUE 123 chemical studies, human observations, animal experi- ments, and mechanistic studies support a causal associatior. between ETS exposure and occuF•.tional heart disease." "Regulation of ETS as a complex mixture in the workplace can follow that of other complex mixtures by adopting established work standards for four ETS constituents: nicotine, carbon monoxide, benzo[a]pyrene, and carbon disulfide. Although available data on chemical analysis of ETS in the workplace do not show levels exceeding work standards, it may be necessary for interested groups to decide whether additional mea- surements are necessary, using modern techniques that were not available more than a decade ago." [49] "Prevalence of Coronary Artery Disease and Its Risk Factors in the Urban Population of So;:th and North India," R. Begom and R.B. Singh, Acta Cardiologica L(3): 227-240, 1995 "The present epidemiologic study has shown that the prevalence of CAD [coronary artery disease] was 139 per 1000 in South Indians between 26-65 years of age. CAD was 61.6% greater than in North Indians (86 per 1000) and 26.4% higher than in British (110 per 1000). The prevalence was highest in the 5th decade in both South and North Indians. CAD was more .::)mmon in middle and higher income groups com- pared to lower income groups in both South and North Indians. In both areas, CAD was more common in males than in females." "Hypercholesterolemia, hypertension, diabetes mellitus, smoking and central obesity (in South Asians) are major risk factors of CAD and their role in the pathogenesis of CAD is well established. In the present study, mean body weight, body mass index, waist-hip girth ratio, systolic and diastolic blood pressures in females, diastolic blood pressures in males, blood iipoproteins and fasting glucose were comparable in South Indians and North Indians. However systolic blood pressure in males and 2 hour blood glucose in both sexes were significantly higher in South Indians than in North Indians. Body mass index (in both south and North Indians) was low but the rate of central obesity was very high.... The prevalence of smoking was significantly higher in male South Indians com- pared to North Indians (44.6 vs. 30%). However low fat intake with higher smoking had less adverse effect. SHB 93140327

MAY 10, 1996 The prevalence of CAD was significantly higher among smokers and exsmokers. Passive smoking was more common in South Indian females than North Indiau females. The prevalence of CAD among South Indian females was significantly higher in passive smoking which is an independent risk factor of CAD." [501 "Characteristics of Leisure Time Physical Activity Associated With Decreased Risk of Premature All-Cause and Cardiovascular Disease Mortality in Middle-Aged Men," N. Haapanen, S. Miilunpalo, I. Vuori, P. Oja, and M. Pasanen, American Journal of Epidemiology 143: 870-880, 1996 "The association between leisure time physical activity and the risk of all-cause and cardiovascular disease mortality was analyzed in a Finnish cohort of 1,072 men aged 35-63 years who were followed up for 10 years and 10 months. During the period, 168 deaths were recorded, 93 of which were the result of cardiovascular diseases. Leisure time physical activity was assessed by several measures: 1) a single question combining an estimate of the frequency and intensity of the total amount of leisure time physical activity, 2) a compiled measure of leisure time physical activity derived from three separate questions concerning the intens;ty and frequency of activity, 3) a physical activity energy expenditure index computed as an estimate of weekly energy expenditure for leisure time activity and commuting to work, and 4) 16 separate specified activities of daily living and domestic chores included in the leisure time physical activity index." "The mortality rates for both all causes and cardiovas- cular diseases were highest among people suffering from disease or symptoms that prevented them from participating in physical activity and among current smokers, nonparticipants in working life, and single, divorced, or separated men. Body mass index, physical load at work, alcohol consumption, perceived health status, socioeconomic status, self-reported chronic diseases, and residential status were also considered potential confounders, but these variables did not have a confounding effect in this study." "The age-adjusted all-cause and cardiovascular disease mortality rates were, with the exception of strenuous household activities, highest in the most inactive groups. In comparisons of the mortality attributed to a A-3 sedentary lifestyle and smoking, the age-adjusted all-cause mortality rate of sedentary persons was close to that of current smokers. In the case of cardiovascular disease mortality, the rate for physically sedentary men slightly exceeded that for current smokers." "We can conclude that this 10-year and 10-month follow-up of a representative adult cohort in northeast- ern Finland supports the hypothesis that a low level of physical activity is a risk factor for both all-cause and cardiovascular disease mortality. The observed risk related to inactivity was higher than that in many former studies and close to the relative risk observed in the association between physiologically measured physical fitness and total or cardiovascular disease mortality. The increased risk of death among sedentary men was verified by the leisure time physical activity energy expenditure index and some specific activities of daily living and domestic chores. Because the measures comprehensively describe the subjects' energy expenditure in all leisure time physical activi- ties, they may minimize the possibility of misclassifying subjects' physical activity status. Our results are consistent with recent statements suggest- ing that, for minimum health benefits, energy expenditure in leisure time activities should be at least 700-800 kcal per week. Furthermore, our results are in agreement with the recommendation encouraging individuals to engage in activities requiring up to 2,000 kcal per week for maximum health benefits." [511 "Dietary Antioxidant Vitamins and Death from Coronary Heart Disease in Postmenopausal Women," L.H. Kushi, A.R. Folsom, R.J. Prineas, P.J. Mink, Y. Wu, and R.M. Bostick, New England Journal of Medicine 334: 1156-1162, 1996 "We studied 34,486 postmenopausal women with no cardiovascular disease who in early 1986 completed a questionnaire that assessed, among other factors, their intake of vitamins A, E, and C from food sources and supplements. During approximately seven years of follow-up (ending December 31, 1992), 242 of the women died of coronary heart disease." "This prospective study of postmenopausal women provides evidence of an inverse association of coronary heart disease with the intake of vitamin E from food. Women in the highest quintile of vitamin E intake had SHB

A-4 less than half the risk of death from coronary heart disease of women in the lowest quintile. This inverse association was not seen for the intake of vitamin E from supplements. There was also a suggestion of an inverse association between mortality from coronary heart disease and overall vitamin A intake, but this association was no longer apparent after adjustment for other risk factors. Vitamin C appeared, if anything, to be positively associated with the risk of death from coronary heart disease." "The inverse association of vitamin E intake with the risk of death from coronary heart disease is generally consistent with the findings of a growing number of epidemiologic studies." "Vitamin E intake is also associated with a more healthful cardiovascular risk profile." "[T]he findings presented here do not constitute definitive evidence of an inverse association between Vitamin E intake and mortality from coronary heart disease.... The observations with regard to vitamins A and C are similarly not definitive, but they suggest that increased intake of these vitamins is not likely to lower the risk of death from coronary heart disease." [52] "Cigarette Tar Does Not Promote Arterioscle- rotic Plaque Development," A. Penn, K. Keller, L.C. Chen, A. Nadas, and C.A. Snyder, The Toxicologist30(1, Part 2): 1377, 1996 "We reported previously that a) inhalation of either mainstream or sidestream cigarette smoke (CS) ETS/IAQ REPORT, ISSUE 123 cockerels compared to both the TAR and DMSO groups. There were no significant differences in plaque size between DMSO and TAR cockerels. Although CS is clearly the single greatest known environmental cause of cancer, as well as a major contributor to heart disease, there is little evidence that the tar fraction is the primary source of environmentally relevant, CS toxicants. The results reported here, combined with our previous findings, suggest that the major health threatening components of CS are in the vapor phase." [53] "Randomized Controlled Trial of Vitamin E in Patients with Coronary Disease: Cambridge - Heart Antioxidant Study (CHAOS)," N.G. Stephens, A. Parsons, P.M. Schofield, F. Kelly, K. Cheeseman, M.J. Mitchinson, and M.J. Brown, The Lancet 347: 781-786, 1996 "We tested the hypothesis that treatment with a high dose of alpha-tocopherol would reduce subsequent risk of myocardial infarction (MI) and cardiovascular death in patients with established ischaemic heart disease." "In this double-blind, placebo-controlled study with stratified randomization, 2002 patients with angiographically proven coronary atherosclerosis were enrolled and followed up for a median of 510 days. 1035 patients were assigned alpha-tocopherol (capsules containing 800 IU daily for first 546 patients; 400 IU daily for remainder); 967 received identical placebo capsules. The primary endpoints were a combination of cardiovascular death and non-fatal MI as well as - non-fatal MI alone." promotes aortic arteriosclerotic plaque development; b) "We found that alpha-tocopherol, in a higher dose butadiene, a vapor-phase component of sidestream than in previous studies, reduced the risk of the smoke, promotes plaque development at 20 ppm, only primary trial endpoint (a combination of death and 2X higher than the threshold limit value; and c) non-fatal MI) by 47%. This benefit was due to a individual tar fraction carcinogens in CS either do not reduction in the risk of a non-fatal myocardial infarc- promote plaque development or do so only at high tion of 77% and this_treatment effect was apparent concentrations. Here we asked whether exposures to after 200 days. The effects on the combined endpoint concentrated CS tar promote plaque development. were not due to a reduction in cardiovascular death; Mainstream CS tar ... was solubilized ... and injected indeed, there were more cardiovascular deaths among into cockerels, 1X/wk. Negative controls were injected alpha-tocopherol recipients than among placebo weekly with DMSO and positive controls with 7, 12 recipients. By contrast with the delayed effects of dimethylbenz(a)anthracene (DMBA).... Plaque F,,,u./rr rI„, ;-p^-l ~«t. -- A„p rn sn PY.-psq rNF ~

MAY 10, 1996 must await the results of longer-term multicentre trials designed with mortality as a primary endpoint." "This study could not directly address the mecha- nism by which alpha-tocopherol reduces the risk of myocardial infarction.... However, we believe that inhibition of oxidation is likely to exert its main effects by modification of plaque enlargement or plaque rupture." "Our findings are the first from a prospective clinical trial to be consistent with the lipid oxidation theory of human coronary artery disease. Our findings support the use of a high dose of alpha-tocopherol to prevent non-fatal MI in patients with angina and coronary atherosclerosis, although there was no benefit in terms of cardiovascular death or total mortality." RESPIRATORY DISEASES AND CONDITIONS -- ADULTS - _ [54] "Effect of Active and Passive Smoking on Ventilatory Function in Elderly Men and Women," C. Frette, E. Barrett-Connor, and J.L. Clausen, American Journal of Epidemiology 143: 757-765, 1996 "Although it is well known that pulmonary function declines with age and that this decline is accelerated by cigarette smoking, the effects of such factors are not well established in elderly individuals. The authors examined the effect of active and passive smoking on ventilatory function assessed by spirometry in 1,397 community-dwelling men and women aged 51-95 5 years and observed that active smoking affected ventilatory function into advanced old age." "Of the 176 never smoking men, 59 percent were exposed to smoke at home, as were 75 percent of the 415 never smoking women. Nonsmokers exposed to smoke were significantly younger (in years) than the others. Passive smokers had a FEV, (in liters) similar to never exposed subjects ... Male passive smokers had a lower FVC (in liters) than the nonexposed men, with a difference of borderline significance. No difference was observed in women. No difference in FEFa5-;5 was observed between subjects exposed to smoke at home A-5 in men or in women. Including sex in the model (instead of stratifying) did not change the results, and there %•ss no interaction with sex. The rel-tion of FEV, to age did not differ significantly in those exposed to passive smoking compared with the unexposed. The decrement of FEV, was equal to 38 ml per year in men and 30 ml per year in women." "In this community-dwelling cohort, pulmonary function continued to decrease with age in elderly nonsmoking men and women. Ventilatory function aging was accelerated by active smoking. A beneficial effect of quitting smoking, especially before age 40, was evident. Exposure to passive smoking at home was unrelated to ventilatory function loss." "Studies of passive smoking have ... yielded conflict- ing results. Some authors reported an association between secondary exposure to cigarette smoke and reduced ventilatory function in adults, although the pulmonary function parameters that were found to differ varied in different studies....[D]ifherent results may be explained by the heterogeneity of the methods, such as assessment of tobacco exposure (in the house- hold or at work), the design of the study (case-control or prospective), and the population sample (volunteers or population-based, rural or urban, and young or older individuals). The lack of association between passive smoking and pulmonary function in Rancho Bernardo is consistent with the only other population-based study of passive smoking in older men and women. The failure to demonstrate a clear effect of passive smoking on ventilatory function could be attributable to several factors. Survival bias may underestimate the effect of passive smoking . . . In addition, the typical three-bedroom house for this middle- to upper-middle class cohort, coupled with the temperate climate in Southern California, makes it more likely that nonsmoking spouses receive less exposure to secondhand smoke than might be the case if they lived in smaller residences and were housebound in the winter. In addition, the questionnaire used here did not make a distinction between past and present exposure and did not query exposure to secondhand smoke outside the home. This assessment of exposure to passive smoking was relatively crude, possibly leading to an underestimate of harmful effects. To address the issue of the effects of passive smoking on ventilatory function in the elderly, future studies SHB