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Named Organization
AFL-CIO (American Federation of Labor/Congress of Industrial Organiza)
Labor Union
Agricultural Marketing Service
Alcohol, Drug Abuse and Mental Health Administration
American Cancer Society
American Hospital Association
American Medical Association (physicians group)
Professional trade group representing American physicians.
American Public Health Association (Public health organization)
Professional organization for people working in public health
Appropriations Committee
Archives (National Archives and Records Administration)
Baltimore Sun
Boston University
Bureau of Health Education
Campbell-Johnson Limited (British PR firm, worked for BAT)
Canadian Medical Association (CMA)
CBS (Columbia Broadcasting System)
Centers for Disease Control and Prevention (CDC)
Chapel Hill
Chilton Research Services
Clement & Associates
Committee on Interstate and Foreign Commerce
Consumer Product Safety Commission
Dartmouth College
*Department of Health, Education, and Welfare (HEW) (use United States Departmen (use @hew_dept)
*Department of Labor (use United States Department of Labor)
Diamond Shamrock
Emory University
Environmental Defense Fund
Environmental Protection Agency (EPA)
Erasmus University (Netherlands)
Federal Highway Administration
Federal Register (publication)
Food and Drug Administration (FDA)
General Motors Corporation
Government Printing Office (GPO)
Harvard College (Harvard Collge is the undergraduate branch of Harvard Univer)
Harvard Medical School
Harvard School of Public Health
Harvard University
*Health and Human Services (HHS) (use United States Department of Health and Hum (US)
Health Services and Mental Health Administration (U.S. Public Health Service)
Hilton Hotels
International Agency for Research on Cancer (IARC) (WHO cancer research arm)
International Agency for Research on Cancer - The cancer research arm of the WHO. Conducted a multi-center epidemiology study on ETS, initiated in 1988, data collection completed in 1994 and results were published in 1998
John F. Kennedy School of Government
Johns-Manville Corporation
Labor Department (DOL)
Lancet
Los Angeles Times
Massachusetts General Hospital
McGill University (Prestigious Montreal university which cooperated with the in)
Helped the tobacco industry obscure the link between secondhand smoke exposure and illness
Mine Safety and Health Administration
National Center for Health Statistics (Keeps statistics on health-related matters)
Plaintiff
National Clearinghouse for Smoking and Health (NCSH)
NCSH was created in 1964 by the Public health Service. Forerunner of the Office on Smoking and Health. Responsible for creating reports on the health effects of smoking.
National Gypsum (Manufacturer of Asbestos)
National Heart Lung and Blood Institute
National Institute for Occupational Safety and Health NIOSH (NIOSH)
National Institute for Occupational Safety and Health is NIOSH.
National Institute of Education
National Institute of Environmental Health Sciences
National Institute of Occupational Safety and Health
National Institutes of Health
National Institutes of Health (NIH)
National Interagency Council on Smoking and Health
National Technical Information Service
National Toxicology Program
Navy
New York University
Occupational Safety and Health Administration (Held hearings in 1994 to ban smoking in workplaces)
OSHA opened hearings in September 1994 on a proposal that amounts to a virtual ban on smoking in every workplace in the nation
Occupational Safety and Health Administration (OSHA)
Office of Technology Assessment
Office on Smoking and Health
Responsible for creating reports on the health effects of smoking. Created by the Public Health Service.
PPG Industries Inc.
Preventive Medicine (periodical)
Public Citizen ("PC") (Nonprofit consumer advocate organization founded by Ralph Na)
Public Citizen is a nonprofit consumer advocate-action organization founded in 1971 by Ralph Nader.
Roswell Park Memorial Institute
Senate
Subcommittee on Health and the Environment
The Archives of Internal Medicine
The Shield (anti-tobacco and alcohol publication of the 1920s)
Tobacco Institute (Industry Trade Association)
The purpose of the Institute was to defeat legislation unfavorable to the industry, put a positive spin on the tobacco industry, bolster the industry's credibility with legislators and the public, and help maintain the controversy over "the primary issue" (the health issue).
Tobacco Observer (periodical)
U.S. Department of Agriculture
United Auto Workers
United Steelworkers of America (USWA)
University of Athens
University of Colorado
University of North Carolina
University of Texas
University of Toronto
University of Vermont
Washington Star
White House
Yale Medical School
Yale University
Named Person
Bloom, James D.
Bloom, Jim
Brandt, Edward N, Jr., M.D. (Asst. Secretary for Health, U.S. Dept. of Health)
Buren, Abigail Van
Byington, S. John
Calhoun, Faye
Califano, Joseph A., Jr.
Califano, Joseph Anthony, Jr. (Sec. of U.S. Dept. of Health, Education, and Welfare)
Joseph Califano Jr. is the former secretary of Health, Education and Welfare (1977-1979), in Carter's administration (A 5/17/94; WP 4/3/85). He spoke against the tobacco industry on ABC's "Day One" program. He testified before the Waxman subcommittee on 5/17/94. He was an adviser to President Lyndon B. Johnson (AP 5/17/94). He was President of Columbia University's Center on Addiction and Substance Abuse, circa 1994 (AP 5/17/94).
Chappell, Frank
Crawford, Charles
Day, Nicholas
Dement, John
Doherty, Johnny
Early, Joseph D.
Finklea, John
Flood, Daniel J.
Foege, William H., M.D. (CDC Director)
Plaintiff
Gain, G. Weight
Gardner, Hoyt D.
Halperin, William
Higgin, John
Hill, Holly
Hoel, David G.
Hutchings, Robert
Infante, Mark
Kannel, William B.
Kazan, Von
Kennedy, Donald
Kilburn, K.H., Ph.D. (Researched the impact of class on cessation rates)
Knopick, Paul C. (TI, Editor "Tobacco Observer" late '70s-early 80's)
Editor of the Tobacco Institute Newsletter, the "Tobacco Observer"
Kotin, Paul, M.D. (CTR SAB; Associate Prof. of Pathology, USC)
Lee, Frank
Li, Davis
Li, Johnson
Marie, Michael
Martin, James
Michel, Robert H.
Miller, Charles
Miller, Laura A.
Miller, Rufus W.
Mills, Jack
Mintz, Morton (Reporter, Washington Post c. 1971)
Murray, William
Natcher, William H.
Nelson, Harry
Nicholas, Dr.
Numbers, Page
Obey, David
Obey, David R.
Ogden, Horace G.
Panzer, Frederick (TI VP of Issues Management c. 1988)
Vice president of The Tobacco Institute, early 1970's
Perkins, Jimmy L.
Pickelsimer, Claude F.
Pol, William
Pursell, Carl D.
Ranch, Ken Caryl
Richmond, Julius B., M.D. (Former Surgeon General)
co-author of "Health and Growth"Plaintiff
Robbins, Anthony
Robbins, Tony
Roberts, Russell
Rose, Vernon
Rose, Vernon E.
Roybal, Edward R.
Russell, Harold
Schweiker, Richard S. (Secretary of Health and Human Services)
Selikoff, Irving J., M.D. (Conducted landmark 1964 study on asbestos)
Smith, Neal
Snyder, Harry
Stahl, Lesley
Stokes, Louis
Threlkeld, Richard
Upton, Arthur C.
Valley, Clara
Wagner, J.C. (researched asbestos and smoking rates of lung cancer)
West, Joseph
Wolfe, Sidney M.
Wolff, Bruce
Wolff, Bruce S.
Wrenn, Grover
Date Loaded
18 Jul 2005
Box
5204

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Page 1: TI06650307
DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE NATIONAL INSTITUTE OF EDUCATION WASHINGTON, D C 20-~'08 OFFICIAL BUSINESS PENALLY FOR PRIVATE USE. $300 AN EOUAL OPPORTU~'a'TY EMPLOYER POSTAGE AND FEES PAID US DFPARTMENf OF HEW I IEW 398 FIRST CLASS O O ",4
Page 2: TI06650308
DEPARTMENT OF HEALTH, EDUCATIO;~, AI'~D WELFARE OFFICE OF TIIE ASSISTANT SECRETARY FOF~ HEALTH .,- ~ ~~ ~. ~ ) ."t.-- ~"" . ........... ~ 7 ~ c~.l-- e . ~. Paul ~o~k _- ""' -- ~, . - _ -~x~-,~ i Washington, D.C. 20006 Dear Mr. ~oplck: ~Is is an interim response to your various FOI requests for records relating to smoking and health. I greatly regret that you have not received satisfactory responses to your letters. ~closed are ~er~is provided by the Office on Smoking ~d Health thmt subst~tiate the statements ~de by ~r In a "~ ~ "'" ~ ~e ~ey have been correlated with the items as numbered on the clipping from the Washington Star, which you included with one of your requests, as follows: I. Adult Use of Tobacco, 1975 2. Teenmge S~king: l~edlate and Long Te~ Patter~ 3. Same as 2 4. Sa~ as 2 5. Same as 2 6. Advice Data No. 52, Sept. 18, ~979 Adult Use of Tobacco, 1975, and ~nual Report o= Tobacco Statistics, 19~7, p. 25 8. Su~ey of Health Professlon~s: Smoking and Health, 19~5 9. S~me as 1 National Cancer Institute repor~ ii. Hearings before the Subco~Ittee on Health and Envlro~ent p. 67 (data actually extrapolated from NCI's repor~ noted in i0 a~ove) 12. ~e He~th Conseq~nces of Smol~ng, 1971, 1973, and 1977-~8 (copy of reprint of review from 19~9 re~ort) TI08650308
Page 3: TI06650309
Page 2 - l.[r. Paul Knopich 13. Same as 12 above Information on "37 million people dying prematurely because of smoking" is contained in the National Cancer Institute report entitled, "Smoking and Health: a Program to Reduce the Risk of Disease in Smokers." I shall fom.~ard a copy of the report as soon as NCI can copy and fo~ard it. As you know, I have been expecting it for several days. I shall also forward you a copy of the statement which was submitted to the Subcommittee on Health and the Environment and entered in the record (February 15, 1978) as soon as [ receive it. The statement offers the best information available on the role of the Office on Smoking and Health. I understand that staff of the Center for Disease Control have contacted you directly concerning yo,r February 12 req~,est for records pertaining to a five-year study of U.S. smokers. Please contact me at 472-5663 if I can assist you further. Sincerely, Johnny Doherty Freedom of Information Officer Office of Public Affairs Enclosures T106650309
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7 e / acco b sez er March II, 1980 Mr. Russell Roberts Freedom of Information Officer Department of Health, Education & Welfare 200 Independence Avenue, Washington, D.C. 20201 Dear ~r. Roberts: On December II, 1979, I submitted to },our office a Freedom of Information Act request for documents relating to certain public statements made by officials of the Depart- ment of Health, Education, and Welfare relating to smoking and health. On December 19, 1979, ~4r. Doherty of your office wrote to inform me that my request had been referred to the Office of Smoking and Health, which he indicated was the appropriate "action office." On January 4, 1980, Mr. Robert Hutchings, the Associate Director of the Office of Smoking and Health, sent me a letter stating that the documents I had requested were not in his office's files, and that most of them related to events that had occurred before his office was formed. Copies of the letters relating to my request are enclosed. Mr. Hutchings' letter gave no indication whether he took any steps to refer my request to another office that might have the documents I sought. Because I have received no further communications from HEW on this matter, I assume that the Department has taken no further action to respond to my request. ~ request included as detailed information as possible to assist HEW in locating the documents that are sought, and my letter specifically asked that the request be referred to the appropriate office, in accordance with 4~ C.F.R. $ S.51(b). I would greatly appreciate your assistance in locating the proper office and obtaining the documents I requested. T[06650310
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- 2 - The lO-day statutory deadline imposed on the Department for determining whether to comply with ?reedom of Information act requests has already been exceeded by more than two months, and I would therefore appreciate the promptest possible action. If you decide that you will not comply with my request, I ask thai you provide me with a formal denial so that I can take appropriate action to seek review under the Act and the Deoartment's regulations. Sincerely, PK:djs enclosure Paul Knopick Editor TI06650311
Page 6: TI06650312
IDEPARTMENT OF HEALTH. EDUCATION AND WELFARE F~UBIIC H~LTH ~ERVIC~ January 4, 1980 Mr. Paul Knopick The Tobacco Observer 1875 1 Street, Northwest ~¢ashington, D.C. 20006 Dear Mr. Knopick: This is in response to your inquiry of December ii, 1979, addressed to Mr. Russell Roberts. The information that you are requesting is not contained in the files of this office; none of it occurred in this office and all but the last item on the list occurred before the office was organized. Sincerely, Robert Hutchings Associate Director Office on Smoking and Health T106650312
Page 7: TI06650313
DE=ARTME~T OF HEALTH. EDUCATI0~. A~D WELFARE Pubhc Health Ser:~ce Washinglon. CI C 20201 December 17, 1979 ~[r. Paul Knopick The Tobacco Observer 1875 1 Street, ~ashinBton, D.C. 20006 Dear Mr. Knopick: This is to inform you that your Freedom of Informatio~ Act request dated December Ii, 1979 was received in this office today. Since the Public Heal~h Service is comprised of six agencies, each with i~s own Freedom of Information Coordinator, we have forwarded your letter to the appropriate office for expedient handling. The action office is: The Office of SmokinB and Health Mr. Robert HutchinBs, Freedom of Information Coordinator Telephone: (301) 443-5287 If we can be of further assistance, please do not hesitate to contact us. Sincerely, J~hnny D~herty ~ Freedom of Information Officer T106650313
Page 8: TI06650314
T&e -ba cco o eWc'er Ia75 1 STREET. NORTHWEST * WASHI2,~GTON. D.C. 2CCC6 302!457-4373 "December ii, 1979 Mr. Russell Roberts Freedom of Information Officer Department of Health, Education, and ~elfare 200 Independence Avenue, S.W. Washington, D.C. Z0201 Dear Mr. Roberts: Under the provisions of the Freedom of Information Act (5 U.S.C. S 552) and the public information regulations of the Department of Health, Education, and Welfare [45 C.F.R. Part 5), I request the following information. I. Records, reports, and other information in the files of the Department upon which were based statements concerning smoking and health made by Ms. Laura A. Miller, special assistant to the Secretary of Health, Education, and Welfare and reported in a column by Abigail Van Buren which appeared in the Washington Star on July 3, 1978. A copy of that colum~ 'is enclosed. 2. Records, reports, and other information in the files of the Department upon which the Secretary based a statement, made in a January II, 1978, speech to the National Inter- agency Council on Smoking and Health, that "In a major urban area on the west coast, 1 out of 20 children eleven years of age is smoking. Just one year older, at age 13, this figure skyrockets to 1 out of 5." A copy of the speech is enclosed. 3. A copy of a statement concerning the Office on Smoking and Health, its funding, its objectives, and the manner in which it spends its funds which was submitted to TI06650314
Page 9: TI06650315
- Z - the Subaommittee on Labor-Health, Education, and Welfare of the House Appropriations Committee. The statement was quested by Representative Natcher at a hearing before the Subcommittee. A copy of the relevant part of the hearing record is enclosed. 4. The specific suggestions of the more than 40 organi- zations requested to submit recommendations to the Department of Health, Education, and Welfare Task Force on Smoking. A ~op[ of the list of organizations, provided by the Department, is included. If you determine that any portion of the information requested is not available for public disclosure, please identify the information that is withheld and state the legal basis for denying it. If any of the information is not contained in the files of your office, please refer this request to the appropriate office of the Department, in accordance with 45 C.FoR. S 5.51[b). Sincerely, Paul Knopick PK:mmh Enc. T106650315
Page 10: TI06650316
Star Just the facts, dear reader, about smokin By Abigail Va~ Bures ,'$,t • Cigarette smoking was implicated in more thaa 32-0,C00 deaths in smokin~ ~-.~ ~e offsp~g of women ~ho smoke during DEAR READERS: If statistics on ........ , /~re~ancy may ~ snll~rn or devem~mentaL] bore you, sN~ ~Ns coiumn. ~eficient b~ause of their mo~he~' heaw smok- e More uhan 7S p~eht of those who smoke tMay ~ R~ent expeNments have shown that babies ~gan smoking ~fore the age of 2L And ~ ~r- ~ ~bsorb Ncot~e ~iere blab, cent of ~rrent smokers were h~ked by ~e ~me ~their resNrafion ~d other ~ta/si~s. • ey were ~. • ~ Ber%:een 19~8 and 1.o74, the number of teenage smoker~ increased by 50 percent -- from 3 million to 4.5 m/Ilion. 6 Since 1968, the percen~ge of teen-age girls " Dear Abby who smoke has doubled, gvery day, 4,C00 teen- agers become cigarette smok.°rs. O "Uaere arc approximately I00,000 children 1"~ under the age of .13 who smoke regularly. -" ~ If at leezt one parent and one older sibling • . "!smokes, a teenaeer is four times as likely to ~' smoke than if neither did. o ?,lore than 53 million Americans smoke citga- rettes. ¢~ In 1~75 a/one, they sl~ent $14 billion on 620 bil- lion cigarettes. Eighty percent of all adult smokers would like to quit, 0 In 1950, ab6ut ~ pedant of U.S, physici~s smoked. ~y 197S, only 21 ~rcent of physicia~ smoked. O In the United States. D percent of ad~t males and 29 ~rcen[ of adult females smoke cigare~es. e Mo:e than 37 million ~oF[e (one out of eve~ :Lx Amcdcan~ alive todayl ~ill die years earlier t~an they otke~t'~se would because oi I have learned from talking with heavy smokers who are so "severely hooked that they have given up tryh~_~ to quit, that they smoking when [hey were teenage~ because it made the.,n feel "big" and grown-up. And even Mter conclusive e~dence ~'as feared to corffirm the theory that smoP, J.ng contributes to cancer and heart u'ouble, they didn't really vcant to quit because smoking"relm~:ed" them. Others said they continued ~o smoke because every time the7 quit, they gam.ed weight. THERE A.RE numerous suggested me:hods kicking the nicotine habit. They range all the way from hypnosis to tapering off to attending "stop smoMng clinics'" where a jar containing a pair of human lungs c~nsumed by cancer m'=d preserved in formaldehyde is passed around. Acording to those who have "tNed every- thing," the bast way to quit i.s "cold It's never too [ate to quit. But this is a plea to those of you out there who do not srr,~ke. Please, please don't start. If not for y~ur ov~-n ~ake, for the sake of those you love and these who love you. -- Abby P.S. All the above statistics were provided by /Laura A. Miller, special assistant to Segre:ar,.t Joseph C.allfano, the secretary of Hea/th, Educe- r/on and Welfare. I TI06650316
Page 11: TI06650317
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Adult Use of Tobacco - 1975 U. S. Department of Health, Education, and Welfare Public Health Service Center for Disease Control Bureau of Health Education Atlanta, Georgia 30333 National Institutes of Health National Cancer Institute Bethesda, Maryland 20014 JUNE 1976 TI06650318
Page 13: TI06650319
The survey, "Adult Use of Tobacco - 1975", was conducted under the auspices of the N~tional Clearinghouse for Smoking and Health, Bureau of Health Education, Center for Disease Control, Public Health Service, Department of Health, EDucation, and Welfare. This report is issued jointly by the Prevention Branch, Division of Cancer Control and Rehabilitation, National Cancer Institute, which assumed a major responsibility in the preparation of the report, and the Center for Disease Control. The study was conducted by Chilton Research Services under Con- tract CDC 21-74-520. TI06650319
Page 14: TI06650320
CA~LE OF CO,"~S ~NTRODUCTION BACKGROUND DISCUSSION OF FINDINGS Demographic Data A. Age and Sex B. Marital Status C. Socioeconomic Status I. Educational level 2. Occupation 3. Income II. Attitudes A. Smoking and Health B. Remedial Action - General C. Remedial Action - Exemplars D. Remedial Action - Setting Limits E. Present versus Future Orientation F. Fatalistic versus Control Orientation G. Weight Gain Values I. Attitudes Toward Effect on One's Own Bealth III. Perception of Environment A. 20 "Adults You Know" B. Smoking BehaviDr of Family Doctor C. Personal Knowledge of Effect on Health i. Health in General 2. Coronary~eart Disease, Lung Cancer and Emphysema or Chronic Bronchitis IV. Smokin& History PAGE NUMBERS 1 2 4 4 4 5 6 7 7 7 9 9 13 13 13 14 14 14 15 15 15 16 TI06650320
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V. D~sage A. How the Cigarette is Smoked B. Average Number of Cigarettes Smoked Per Day C. Type of Cigarette VI. Other Forms of Tobacco A. Snuff and Chewing Tobacco B. Cigars and Pipes Vll. VIII. Changes in Smoking Behavior Appendix A. Chart i, Proportion of Smokers in Adult Population (1964-1975) B. Factor Scores - Table A C. Health Scores - Table B 17 17 17 18 18 IB 18 19 TI08650321
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I~TRODUCTION In 1964, 1966 and 1970, studies were conducted among the adult (21 and over) population of the United States in order to determine attitudes, knowledge, and behavior related to use of tobacco--especially cigarette smoking. The 1964 study was the first national study in this area and established baseline data. The 1966 and 1970 studies included reinterviews with respondents who had participated in previous studies. All interviews were conducted with adults 21 years of age and over, both cigarette smokers and noncigarette smokers. Since the study of cigarette smoking among adults in the United States in 1970, federal and Drlvate agencies have exerted considerable efforts tD educate smokers about the known adverse effects of smoking oh health. Legislation has been enacted to warn current smokers, to discourage new smokers and to protect nonsmokers. Efforts to discourage smoking, such as placing restric- tions on cigarette advertising, mandatory warning labels on cigarette packs, and increasing taxes on cigarettes, have been made. With a lapse of five years since the last national study, it is necessary to determine what changes in behavior and attitudes have taken place since 1970; therefore, this 1975 study was under- taken. Detailed information is available on respondents who partici- pated in the 1964, 1966 and 1970 studies. By comparing changes in 1975 behavior and attitudes with previous years, these continuing studies provide valuable information about trends on progress of altering smoking behavior. Also, information about attempts to cease or change cigarette smoking Fractices is useful in determining the factors related to stopping cigarette smoking. Finally, the attitudes and perceptions of both smokers and non-smokers provide a description of the national environment in which anti-smoking forces must operate. TI06650322
Page 17: TI06650323
I BACKGROUND Cigarette smoking continues to pose a major public health problem in the United States, in spite of more than ten years of effort on the part of concerned organizations and individuals to counteract it. The extent and nature of the problem are the subject of continued study by the Federal Government. The first national survey was conducted in 1964 and was followed by surveys in 1966, 1970, and the one reported on here, in 1975. Results 1 from the 1964 and 1966 surveys are described in Use of Tobacco, those of the 1970 survey are contained in Adult Use of Tobacco 1970.2 Purpose. The purpose of the 1975 survey was twofold: (i) to evaluate possible changes in knowledge, attitudes, beliefs, and behavior concerning smoking that have taken place since 1970, and (2) to provide in-depth information to all who have a continuing and concerted interest in the problem, so that all smoking programs can be maximally effective. ~. The majority of the interviews were conducted by tele- phone, the remainder in face-to-face interviews in non-telephone households. The data are based on approximately 12,000 interviews of adults 21 and over, all of which were conducted by Chilton Re- search Services of Philadelphia. The telephone samples were randomly selected by a computer from a bank of all possible combinations of area codes, telephone exchanges, and subscriber numbers with a sufficient surplus of selections to allow for the elimination of nonresidence telephones. Standardized questionnaires were administered by trained professional interviewers. The non-telephone samples were designed to allow greater representation in geographic areas known to have a high prevalence of non-telephone households. Definitions. The respondents were classified by smoking status into one of the following categories: Never Smoker - A person who has never smoked as many as as I00 cigarettes (5 packages) in his life. Ever Smoker - A person who ha___~s smoked at least i00 cig- arettes during his lifetime. IU.S. Department of Health, Education, and Welfare, Use of Tobacco: Practices, Attitudes, ~nowledKe, and Beliefs. Public Health Service, July, 1969. 2U.S. Department of Health, Education, and Welfare, Adult Use of Tobacco - 1970. Public Health Service, June, 1973. TI06650323
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Definitions. (continued) • Current Smoker - An ever smoker who now smokes cig@retKes. • Former Smoker - An ever smoker who does not now smoke ciEaret~es, but who once did. .Organization of the Report. The salient results of interest to a wide audience are outlined in the section titled Discussion of Findings. Those with special interests should examine appro- priate tables in more detail. In some cases, comparisons are made with earlier findings; readers concerned with other compari- sons should refer to previous publications. Tl06650324
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D!SC[ISSIOII OF I. Demographic Data A. ~ an__~d Se___~x Between 1970 and 1975, there was a slight decrease in the proportion of adult cigarette smokers in the United States. In 1970, 42.2 percent of adult males reported that they were cigarette smokers while in 1975, 39.3 percent were smokers. The corresponding percentages for females were 30.5 percent in 1970 and 28.9 percent in 1975. Among men, decreases in the proportion of smokers were observed in every age group except the oldest. There was prac- tically no 9hange in the proportion of men aged 65 and over who are cigarette smokers. Among women, there was a small increase in the number of smokers in the youngest age group 21-24 years of age, and a slight increase in the 55 to 64 year old age group. There was no change in smoking behavior of women who were 65 years of age or older. There was a decrease in the proportion of cigarette smokers in all other age groups. In every age group, in both sexes, the proportion of smokers was smaller than would have been predicted from previous data obtained in 1970. Chart I shows the proportion of current smokers in each age and sex category for each of the four surveys. B. Marital Status The majority of the respondents (78 percent of the men and 71 percent of the women) replied that they were married. Since they comprise such a large part of the total population, their smoking rates parallel those of the total population. In the married group there is a slight drop in the proportion of current smokers since 1970Nfrom 40 percent to 38 percent for males, and from 32 percent to 28 percent for females. About the same percentage of males who have never been married and males who are married are current smokers. Single females have a slightly higher rate than those who are married (31 percent and 28 percent respectively). Both males and females show a substantially lower smoking rate than in 1970 (56 percent of single males and 36 percent of single females were current smokers in 1970). T106650325
Page 20: TI06650326
The highest s~oking rates are ar.ong those who are divorced or separated. While only one-third of the respondents who are =~rried and living with spouse are smokers, 60 percent of the men and 50 percent of the women who are divorced or separated are smokers. This represents a substantial decrease from the 1970 data showing that 76 percent of the men who were divorced or separated were smokers, but at the same time, it represents an increase from the 44 percent rate for women reported in that year. Men who are widowed have a slightly lower smoking rate (36 percent) than those who are married (38 percent). Widowed women, however, have a much lower rate (19 percent) of cigarette smoking than do married women (28 percent). This probably re- flects the lower smoking rate among older women. The proportion of smokers among both males and females in this marital category (widowed) is little different from that observed in 1970. To summarize the marital status category, the data show that men and women who are divorced or separated are more likely to be cigarette smokers than are persons who are married, widowed, or single. In all marital categories, a gre~ater proportion of men than of women are smokers. C. Socioeconomic Status i. Educational Level. The smoking rates are lowest for those who never went to high school--37 percent for men and 18 percent for women. Because educational level is related to income, there may be a corollary between income and the cost of cigarettes for persons in this education group. At all other educational levels there is a decided relation- ship between the amount of education and smoking behavior, with a decrease in the proportion of smokers at higher educational levels. Among males, those who attended high school but not college showed 46 percent current smokers, those with some college, 36 percent, and those who graduated from college, 28 percent. Comparable proportions for women are 32 percent, 32 percent, and 21 percent. An examination of quit rates shows that half of the college graduates who ever smoked cigarettes are now former smokers. 2. Occupation. Among males, white collar workers (including sales personnel) are much less likely to be current smokers (36 percent) than are those in all other occupations (47 percent). This finding is consistent with the relationship between educa- tional level and smoking behavior. T106650326
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Two-flf~hs of the w~en in the sanple reported that they are employed outside the home. Of these enployed wozen, one- third are current mzokers, while only 27 percent of those who elasslfy thenselves as housewives are s~okers. This finding failles with previous evidence of greater prevalence of smoking ansng working wo~en. Among the employed women, white collar workers are more likely to smoke than are those in other occupations (34 percent and 32 percent,respectlvely) - a relationship opposite to that found among men. 3. Income. Family income is related to smoking rates with both males and females, but in different ways. Men in relatively affluent families are less likely to smoke while women in this group are mor_.__~e likely to be current smokers. Only 35 percent of the men who reported an annual family income of $20,000 or more are cigarette smokers, while 46 percent of the men in the $7,500-$10,000 range are smokers. Among women, however, there is an increase in smoking from 24 percent for those in families earning under $3,000 to 34 percent for those with incomes of $20,000 or more. II. Attitudes In this part of the survey, respondents were asked the extent of their agreement with each of 19 attitude statements. For each statement, they indicated their preferences by choosing one of the following categories that best represented their attitudes: "strongly agree", "mildly agree", "no opinion", (or "don't know"), "mildly disagree", "strongly disagree". To facilitate interpretation of the data, results are reported here by only three categories: "agree" (the sum of "strongly agree", and "mildly agree") "no opinion", and "disagree" (the sum of "mildly disagree" and "strongly disagree"). In addition, unless otherwise noted, all results in this section are reported for males and females combined, as there are few sex differences in responses to these questions. A. Smokln~ and Health A very large majority of respondents believe that cigarette smoking is detrimental to health, as evidenced by the fact that 90 percent agree that smoking is harmful, 84 percent think it is enough of a health hazard for something to be done about it, and 82 percent believe it frequently causes disease and death. Although the agreement %rith each of these statements was extremely high Sn 1970 (87 percent, 86 percent, and 76 percent,respectlvely), it was even higher in 1975 on ~wo of the three items. Agreement 6 TI06650327
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rose from 87 percent to 90 percent on the statement about smoking being harnful to health, and from76 percent to 82 per- cent on the one concerning disease and death. The slight decrease from 86 percent to 84 percent on the statement concerning the importance of doing something about ~he hazard of cigarette smoking reflects a change among current smokers only, but not for former smokers or those who have never smoked. Even those who are current smokers show a high rate of agree- ment with these three statements. The agreement rate is around 70 percent for the statements on health hazard and disease and death, and 80 percent on the general statement about harmfulness to health. In summary, awareness of the definite relationship between smoking and health has increased greatly over the past decadg. B. Remedial Action - General Most people acknowledge that smoking has harmful effects on health. However, there are still a substantial number who feel that the status quo should not be disturbed. In fact, 42 percent believe that nothing more should be done about cigarettes until the cigarette manufacturers are given a reasonable amount of time to come up with a safer cigarette. While this is a decrease from the 46 percent holding this point of view in 1970, it is surprising that such a large proportion still agree with this. Approximately the same proportion, 40 percent, agree that the general public knows all it needs to know about the effects of smoking on health. In 1970, 43 percent of the public agreed with this statement. This seems to indicate a willingness of more people in having information about the hazards of cigarette smoking disseminated to the public. 0nly about one in five view cigarette smoking as a minor problem, the same as in 1970. C. Remedial Action - Exemplars ~re than three out of every four respondents feel that teachers, doctors and other health professionals should set a goo~ example by not smoking cigarettes. For each of the three groups, there is an increase over that found in 1970. While it is under- standable that fewer smokers than non-smokers agree, it is signifi- cant that almost two out of three smokers feel that members of these groups should set an example. D. Remedial Action - Settin~ ~imits There has been a growing feeling that non-smokers have a right to be allowed to breathe air free from the contaminants in cigarette smoke. The most dramatic change in attitude over the TI06650328
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years is toward the statement, "The s=oking of cigarettes should be allowed in fewer places than it is now". Only 52 percent agreed with this state~zent in 1964 and 1966, but 5? percent agreed in 1970, and 70 percent in 1975. Between 1970 and 1975, this increase took place among current smokers (from 42 percent to 51 percent), among former smokers (from 61 percent to ?7 percent), and among those who have never smoked (68 percent to 82 percent). This means that more than half the smokers at the present time would like to see smoking allowed in fewer places than it is now, despite the fact that there are more and more restrictions on places where people are allowed to smoke. Since so many people would like to see smoking allowed in fewer places, it is not surprising~to find that nearly two-thirds (63 percent) of the respondents say that it is annoying to be near a person who is smoking cigarettes. Ten years ago less than half of the total number of respondents (46 percent) agreed with this, and now even more than a third of the smokers (35 percent) do so. A ban on cigarette advertising was advocated by a little over one- third (36 percent) of the 1964 respondents. By 1970, this had in- creased to 60 percent. Since then, television and radio commercials advertising cigarettes have been banned. Because these two media were the most widely used for advertising cigarettes, it might be presumed that such a ban would satisfy the public. This is not so. In 1975, 56 percent believed that cigarette advertising should be stopped completely. This view is subscribed to by 51 percent of the men and 60 percent of the women. Two out of five smokers would like to see cigarette advertising stopped, perhaps because some smokers who are trying to quit find that the advertisements make it more difficult. A second possibility is that, while they continue to smoke, they are loath to see the younger generation take it up. Because of the growing feeling that smoking should be regulated more stringently, questions were added to the 1975 survey to explore the matter of regulation more fully. First, the question, "Do you favor stronger Federal regulations ~oncerning ~i~rette smoking?" elicited 52 percent "yes" responses rom men ann 0u percent from women. More than 40 percent o~ current smokers even favor such regulations. Another area explored was whether management does or does not have the right to prohibit smoking in its place of business. Only 16 percent of the respondents felt that management should not have the right, while 78 percent thought they should have the right; the other 6 percent were undecided. Eighty percent of the women and 75 percent of the men thought that management should have the right to prohibit smoking. Of those who felt this way, 28 percent be- lieved that they should be able to do this only when smoking is a T106650329
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safety hazard, while 72 percent said they should have this privilege whether it is a safety hazard or not. Respondents were asked if they found it annoying to 5e near a person smoking cigarettes. Those who said "yes" were asked whether they found cigarette smoking more annoying than several other things that might be 5othersome. The majority of these respondents expressed the 5ellef that cigarettes are more annoying than smoking a pipe, cracking knuckles, chewing gum, and humming or whistling. At the same time, a greater number of people said that smoking cigars is more unpleasant than cigarettes, and about the same number found cigarette smoking more annoying than drink- ing alcoholic beverages as found drinking alcoholic beverages more irritating than smoking. E. Present versus Future Orientation Two groups of statements were included in the 1975 survey that do not mention cigarette smoking, but were hypothesized as being related to smoking behavior. One group of statements explores attitudes toward planning ahead as opposed to enjoying the present. Three out of four respondents agree that having money put aside for a rainy day makes them happier than spending it now. More non-smokers than smokers agree with this statement (77 percent and 73 percent,respectively). Three out of four respondents also agree that one of the things they enjoy most is planning ahead. More non-smokers (79 percent) than smokers (72 percent) express agreement with this, and a larger proportion of men (79 percent) than women (74 percent) agree. Less than half (42 percent) of the respondents agree that it is better to just take things as they come than to try to prepare for something that might happen in the future. Again, more smokers than non-smokers tend to be oriented to the present (45 percent and 41 percent,respectively). F. Fatalistic versus Control Orientation Based on the theory that those who continue to smoke tend to believe that they have little or no control over what happens to them, statements were included to test this hypothesis. More smokers than non-smokers believe that what happens to people depends largely on luck or fate (44 percent of smokers and 37 percent of non-smokers agree). There is no difference between former smokers and those who have never smoked. TI06650330
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There was practically no difference between smokers and non-s=okers In agreement with the statement that working hard is no guarantee of success If fate is against you (42 percent and 40 percent,respectlvely). Approximately one in three (32 percent) of the respondents think that the best way to get ahead in life is to have good luck. There was no difference between smokers and non-smokers, but former smokers agreed to a lesser extent. FACTOR SCORES Table A shows mean and standard deviation of scores on six factors, hypothesized and tested through factor analysis techniques of the 18 attitude statements. These scores were obtained by assigning values of i to 5 according to the re- spondent's answer on the Strongly Agree-Strongly Disagree continuum. In most cases, Strongly Agree was assigned a score of 5, Mildly Agree a score of 4, No opinion a score of 3, Mildly Disagree a score of 2, and Strongly Disagree a score of i. There were three statements per factor, and adores on these three- item factors had a range of from 3 to 15. Factor i, called Smoking and Health, measures the extent to which the respondent agrees that there is a causal relationship between smoking and disease. The higher the score, the greater the acceptance of such a relationship. The items in this factor are: a. Cigarette smoking frequently causes disease and death. g. Cigarette smoking is harmful to health. m. Cigarette smoking is enough of a health hazard for something to be done about it. Factor 2, labeled Remedial Action - General, tests the atti- tude for or against "disturbing the status quo." A high score means that the respondent feels that the problem isn't very important; nothing more should be done about it. Items are: d. The general public knows all it needs to know about the effects of smoking and health. j. Nothing more should be done about cigarettes until the cigarette manufacturers are given a reasonable amount of time to come up with a safer cigarette. p. The whole problem of cigarette smoking and health is a very minor one. i0 TI06650331
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Factor 3, Remedial Action - Exemplars, is a measure of the respondent's attitude toward the responsibility for setting a good example by certain authority figures--doctors, persons in various other health professions, and teachers. A high score reflects the feeling that these groups should set a good example by not smoking. Items in this cluster are: b. Teachers should set a good example hy not smoking cigarettes. h. People in the health professions should set a good example by not smoking cigarettes. n. Doctors should set a good example by not smoking cigarettes. Factor 4, Remedial Action - Setting Limits, concerns attitudes toward "doing something about" the cigarette smoking problem. A high score indicates that the respondent is in favor of remedial action. The items making up this cluster are: e. Cigarette advertising should be stopped completely. k. The smoking of cigarettes should be allowed in fewer places than it is now. q. It is annoying to be near a person who is smoking ciga- rettes. Factor 5, Present versus Future Orientation, determines the extent to which a person is willing to delay present gratification for future satisfaction. A high score is indicative of this will- ingness. The first statement in this cluster (f) states the opposite view--a preference for taking things as they are rather than preparing for the future, Therefore, this item is scored in reverse. That is, Strongly Agree was assigned a score of i and Strongly Disagree was given a score of 5. The items are: f. It is better to just take things as they come than to try to prepare for something that might happen in the future. I. Having money put aside for a rainy day makes me happier than spending it now. r. One of the things I enjoy most is planning ahead. Factor 6, Fatalistic versus Control Orientation, is a bipolar measure with "destiny control" at one end and "luck" or "fate" at the other end. Because of the way in which the items are worded, a high score describes a strong feeling of dependence on "luck". Items are: c. What happens to people depends largely upon luck or fate. i. Working hard is no guarantee of success if fate is against you. o. About the best way to get ahead in life is to have good good luck. Ii TI06650332
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The average score on Factor i, Smoking and Health, was higher for non-smokers than for smokers, as might be expected. Even current smokers, however, show a high acceptance of the causal relationship Between smoking and disease, witha mean score of 11.73 out of a possible maximum score of 15. Women obtained slightly higher scores than men. On Factor 2, Remedial Action - General, a high score indi- cates agreement with the attitude that no further action should be taken with regard to cigarette smoking. Current smokers are most inclined to subscribe to this opinion, those who have never smoked next, and former smokers are least likely to agree. Non-smokers have higher average scores on Factor 3, Remedial Action - Exemplars, than do smokers. Smokers are much less likely to agree that people in an exemplar role should refrain from smoking than are non-smokers, perhaps because of smokers' awareness of the difficulties encountered in not smoking. Those who have neve~ smoked are most likely to want these people to set an example. Overall, women have higher scores than men on this factor. On Factor 4, Remedial Action - Setting Limits, higher scores are found among the non-smokers than among the smokers, as would be expected. Women are more likely than men to want to set limits on cigarette smoking. The measure of present versus future orientation, Factor 5, does not relate to attitudes toward cigarette smoking. However, non-smokers are slightly more likely to be future-oriented than are smokers. If we postulate that smokers are reluctant to delay present gratification for future gains and, at the same time, tend to minimize the health hazards of cigarette smoking, the findings from Factors 1 and 5 substantiate the hypothesis. On Factor 6, it was found that former smokers are more in- clined than either current smokers or those who have never smoked to believe that they have control over what happens to them. The fact that they have overcome a difficult habit which current smokers have not done and that never smokers have not had to face lends credence to this finding. To summarize the results of the data, a current smoker is more apt to discount the health hazards of cigarette smoking, to agree that no further action should be taken about smoking, to disagree with statements that certain groups should be exemplary by re- fraining from smoking, to express reluctance with the idea of setting more prohibitive limits on future gratification, and to believe that what happens to them mostly depends on luck or fate. 12 T106650333
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There is a widespread belief that being afraid of gaining a lot of weight keeps people from quitting cigarettes. In fact, 50 percent of the men and 60 percent of the women agree with this statement. Surprisingly enough, more non-smokers than smokers subscribe to this belief (57 percent and 53 percent, respectively). Values In order to obtain some measure of the value the respondent places on "being healthy" compared to other desirable goals in life, a series of forced choices were presented. For example, the respondent was asked, "Which is more important to you, having a good family life or being healthy?" In six of the statements presented, "being healthy" was compared with some other value. There were five "filler" pairs that did not present a choice with "being healthy". In every case, being "healthy" was chosen more often than the other alternative. In order to get an estimate of how much value each respondent places on health, a score was developed by counting the number of times he chose health over the other alternatives. These scores range from zero to six with six representing the greatest concern about health. Among men, former smokers were more likely than never smokers to obtain a score of six, and they (never smokers) were more likely than current smokers to obtain a score of six. Among women, the same proportion of never and current smokers obtained a score of six, with more former smokers obtaining this score. Women in every smoking category were more likely to obtain a score of six than men in the same category. This finding could be expected since women, traditionally, have responsibility for the health and well being of the family. I. Attitudes Toward Effect on One's Own Health I. Two out of three smokers are concerned about the possible effects of cigarette smoking on their health. In fact, one in four smokers is very concerned. There is practically no difference between men and women in response to this question. 2. ~en asked their opinion about the relative hazards of different kinds of cigarettes, 40 percent of the respondents say that some kinds of cigarettes are probably more hazardous to health than other, 52 percent agree that ~iI cigarettes are probably about equally hazardous, while less than 3 percent (mostly smokers) think that cigarettes are probably not hazardous 13 TI06650334
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III. at all. Sr.okers are more likely than non-s=okers to believe that some cigarettes are more hazardous than others <51 percent of the s=okersand 34 percent of the non-smokers). Half of the smokers who think there are differences among kinds of cigarettes believe that the kind they smoke is probably less hazardous to health than others. More women than men (56 percent and 47 per- cen% respectively) subscribe to this. It is true that women tend to smoke cigarettes lower in tar and nicotine than do men. 3. Two-thirds of those with a history of smoking say that they have never been advised by a doctor to quit smoking or to cut down. Among current smokers, a few more women than men (38 percent and 35 percent) report that a doctor has advised them to do something about their smoking. Perception of Environment A. 20 "Adult~ You Know" Respondents have a tendency to overestimate the prevalence of smoking in the adult population. Although fewer than 7 in 20 adults are smokers, nearly half (48 percent) of the respon- dents think that Ii or more of 20 adults they know are smokers. More males than females (53 percent and 43 percent) perceive this number of smokers am6ng 20 adults they know, and more smokers than non-smokers (63 percent and 40 percent) have this perception. The latter might be attributed to two phenomena: (i) Smokers may actually be acquainted with more smokers than non-smokers, and (2) smokers may tend to perceive others as being like themselves, and so overestimate the actual number of smokers among their friends and acquaintances. It is significant to learn that in the five-year period from 1970 to 1975, when there was a slight decrease in smoking prevalence, there was also a corresponding decrease in the~er- Ception of prevalence. Using the arbitrary cutoff of knowing ii or more smokers out of 20, the proportion perceiving this smoking rate dropped from 57 percent to 53 percent among men, and from 46 percent to 43 percent among women. B. Smokin~ Behavior of Famil~ Doctor Of those who reported having a family doctor, 22 percent of the men and 18 percent of the women report that their doctor smokes; 52 percent of the men and 54 percent of the women say he doesn't smoke, and 26 percent of the men and 29 percent of the women really don't know whether their doctor does or doesn't smoke. (Only about 10 percent of the men and 6 percent of the women in the sample re- ported that they do not have a family doctor.) 14 T106650335
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For both sexes, the 1975 data show a decrease in the propor- tion who think their doctor is a smoker. The decrease is from 24 percent to 22 percent a=~ong men and from 22 percent to 18 percent among women. This may reflect a decrease in the preval- ence of smoking among physicians, or it may stem from a change in what the general population believes. Smokers are more likely to report that their doctors smoke than are non-smokers. The percentages are 25 percent and 20 per- cent for men, and 22 percent and 16 percent for women. Whether the doctor actually smokes or not, smokers are more likely to perceive that their doctors smoke. C. Personal Knowledge of Effect on Health i. Health i__~_n General. A little over half (52) percent of the respondents say that cigarette smoking has affected the health of someone they personally know--such as a family member, a friend, themselves, someone at work, or some other acquaintance. This is an increase from 46 percent in 1970, and it may reflect greater knowledge of the harmful effects of smoking. As in 1970, smokers are much less llkely than non-smokers to report that they know someone, including themselves, whose health has been affected by smoking. Only 35 percent of the smokers say that they know someone whose health has been affected by smoking, while 61 percent of non-smokers claim knowlege of someone with a health condition induced by smoking. It is possible that smokers suppress this knowledge in order not to feel too much concern or guilt about their smoking. 2. Personal,knowledge of Someone with Coronary Heart Disease, Lung Cancer, and Emphysema or Chronic Bronchitis. Just as there has been an increase in the proportion who respond positively to the general question about knowing someone whose health has been affected by snoking, there is a corresponding crease in positive responses to two of the three specific diseases they were questioned about that are associated with cigarette smoking. Positive responses to the question about coronary heart disease increased from 47 percent to 53 percent; those to the question about emphysema or chronic bronchitis increased from 50 percent to 56 percent. The proportion reporting that they have known someone with lung cancer remained about the same (33 percent in 1970 and 35 percent in 1975). These increases were evidenced in both sexes and among smokers and non-smokers. 15 TI06650336
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For each of the three diseases, as with the general health question, smokers are much less likely to give a pos~tlve re- sponse than are non-smokers. For example, 47 percent of smokers say they have known someone with coronary heart disease, while 56 percent of non-s~okers say they have. Comparable propor- tlons for lung cancer are 27 percent of smokers and 39 percent of non-smokers; for-emphysema and chronic 5ronchitls, 51 percent and 58 percent. At first glance, we might think that smokers who have kno%m someone with one of these diseases have quit smoking. This explanation is not tenable, however, in view of the fact that there is little difference in the way former smokers answer these questions in comparison with those who have never smoked. Smokers are slightly younger than non-smokers, so that older non-smokers may be more likely to observe these diseases in themselves and in their friends. It is also possible that there is some element of denial and rejection in the smokers' responses. IV. Smokin~ History The questions on smoking history were asked only of former smokers and current smokers. " One-half the males and one-third of the females with a history of smoking were regular smokers at age 17 or younger. Only 6 percent of the males and 18 percent of the females became regular smokers at age 25 or older. ~ Among males, there was a tendency for current smokers to report they started smoking earlier than did former smokers. For example, 53 percent of current smokers reported age 17 or younger as the time they became regular smokers compared with 48 percent of former smokers. Such differences were not observed among females. The majority of current smokers (61 percent) have, at least once, made a serious attempt to stop smoking cigarettes entirely. Of those who have not, about one-half say that if there were an easy way they would try it, about one-fourth say "probably" or "it depends,~' and only one-fourth say "no," they would not try it. So, overall, 9 out of i0 smokers have either tried to quit smoking or would probably do so if there were an easy way to do it. Two-thirds of the men and three-fourths of the women who are current smokers have tried to just cut down the number of cigarettes they allowed themselves without trying to sto~smoking entirely. The proportion of former smokers who have tried this is much smaller--50 percent of the men and 46 percent of the women. 16 TI06650337
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Although a majority of smokers apparently would like to quit, 57 percent say they will either definitely or probably be s=oklng 5 years from now. Very few of the non-smokers (1.5 percent) ex- pect to be doing so. Current smokers are, in general, smoking fewer cigarettes a day now than they were during that period of life when they were smoking their heaviest. Among men, 36 percent now smoke 25 or more cigarettes a day, but at their heaviest, 42 percent were smoking 25 or more a day. Corresponding percentages for female current smokers are 23 percent and 26 percent. On the average, men have smoked cigarettes for more years than have women. Men currant smokers have smoked an average of 24 years compared with 21 years for women. Male former smokers smoked an average of 19 years before they quit; females, an average of 15 years. Most former smokers (70 percent) have not smoked in more than 4 years. Fewer than I0 percent had quit within the year before they were interviewed. Dosage A. How the CiEarette is Smoked. Many current smokers smoke their cigarettes in such a way as to maximize the hazards. For example, more than half say that they draw the smoke into the chest (54 percent), and an almost equal number say that they inhale almost every puff of each cigarette (55 percent). When asked how much of each cigarette they smoke, 44 percent report that they smoke more than half. As a rule, most smokers say that not much of their cigarettes burn without being smoked; fewer than 15 percent say that "a great deal" of the cigarette burns in this way. In general, men smoke in a more hazardous way than do women, and former smokers reported that they did so more than do current smokers. B. Average Number of Ci~rettes Smoked Par Daz An important measure of dosage is the number of cigarettes smoked each day. Men smoke more cigarettes a day than do women, with the average for men being 23 cigarettes a day, and for women 19. This represents no change for the man, but an increase from an average of 17 cigarettes a day for women who were smokers in 1970. While 36 percent of the men smoke 25 or more cigarettes a day, only 23 percent of the women smoke this many cigarettes. Former male smokers are more likely to say they smoked this many cigarettes than do current men smokers. 17 TI06650338
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C. T__~of Cigarette ~ Most current smokers use filter-tlpped klng-size ¢Igarettes (61 percent of the men and 54 percent of the women). More women than ~en tend to smoke lO0mm cigarettes (35 percent and 17 percent, respectively), and also menthol cigarettes (32 percent of the women; 23 percent of the men). Women are more likely than men to buy cigarettes by the carton than by the pack (60 percent and 51 percent,respectlvely). VI. Other Form____~sofTobacco A. Snuff and Chewin~ Tobacco Only 3 percent of the men and i percent of women use snuff, and not many more use chewing tobacco--5 percent of the men and less than 1 percent of the women. A larger proportion of the men, 16 percent, have chewed tobacco in the past but no longer do so. There is very little change since 1970 in the use of either of these forms of tobacco. B. Cigars and Pipes Both of these forms of tobacco are used almost exclusively by men, with only about one-half of one percent of women using either. About 18 percent of the men smoke cigars~ and another 25 per- cent used to smoke them. More current cigarette smokers than non-smokers are cigar smokers (26 percent and 13 percent,respec- tively), while the largest preponderance of ex-cigar smokers (41 percent) is among the former cigarette smokers. More than 35 percent of the ex-cigar smokers quit smoking cigars ten or more years ago, and another 19 percent quit between 4 and 10 years ago. Almost half the men (47 percent) have a history of pipe use, with only about one-fourth of these current pipe smokers. There was a decrease in pipe smoking since 1970, from 18 percent to 12 percent. As in 1970, current cigarette smokers are more likely to be pipe smokers than are former smokers or those who have never smoked. Of those who smoked a pipe at one time and no longer do so, almost half (46 percent) quit I0 or more years ago. 18 TI06650339
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I VII. ChanBes in Smokin~ Behavior During the years that a person smokes cigarettes, he is likely to change his smoking behavior in some way. Fo~ example, 12 percent of the male current smokers have at some time changed to or smoked more cigars, and 18 percent changed to pipe or smoked a pipe more often. Thirteen percent of current smokers Increased the amount of each ciKarette smoked while i0 ~ercent smoked less of each cigarette. Ten percent of the males and 61 percent of the females changed completely, at least once, to a different brand of cigarettes. .I 19 TI06650340
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10,3 9O B0 7O u, 50 r~ ~0 3O 2O I0 0 MALE 21-24 CHART ! PROPORTION OF SMOKERS IN ADULT POPULATION 1964-1975 34 35-44 - 65 & OVER T108650341
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UJ 9O 8O 7O 60 5O CHART I PROPORTION OF SMOKERS IN ADULT POPULATION 1964-1975 - Continued FEMALE LEGEND 1964 1966 1970 1975 4O 30 'N 10 21-24 25-34 35-44 45-54 55-64 65 & OVE R TOTAL AGE T106650342
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FACTOR SCORES - TABLE A Means and Standard Deviations Smoking and Health Male Female Total Remedial Action - General Male Female Total Remedial Action - Exemplars Male Female Total Rcmedlal Action - Setting Limits Male Female Total Present - Future Male Female Total Fa~allstic Control Male Female Total Mean Standard Deviation 13.67 2.06 13,88 2.06 13,81 2.06 7.09 3.24 7.07 3.26 7.08 3.26 12.89 3.05 13,60 2.51 13.36 2.72 11.72 3.13 12,48 2.89 12.23 3.00 11.56 2.57 11.25 2.72 11.35 2.67 7.93 3.59 8.13 3.54 8.06 3.56 Former Mean Standard Deviation 13.56 2.25 13.92 1.87 13.69 2.13 6.87 3.27 6.63 3.15 6.78 3,23 12.69 3.28 12.91 3.12 12,77 3.23 11.22 3.33 11.95 3.16 11.48 3.29 11.74 2.60 11.19 2,89 11,54 2,72 7.65 3.63 7.42 3.47 7.57 3.57 Mean Standard Devlatlo. 11.67 3.33 ii,78 3.29 11.73 3,31 8.23 3.38 8.16 3.34 8,20 3,36 10.62 4,05 10,44 4.07 i0,54 4.06 8.54 3.72 8,62 3.71 8.57 3.71 11.12 2,95 10,55 3.12 10.86 3,04 8.09 3.69 7.91 3.66 8.01 3.68 Total Standard DeVia~lo, 12.85 2,84 13.29 2,63 13,08 2,74 7,47 3.36 7,32 3.31 7°39 3,34 11.94 3.69 12.59 3.42 12,28 3.56 10.32 3,72 11.29 3,62 10,83 3.70 11.44 2,74 11.04 2.88 11,23 2,8? 7,91 3.64 7,96 3.57 7,94 3,61
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HEALTH SCORES - TABLE B (Number of times health is chosen over other values) Means and Standard Deviations Hale Female Total Hean Neve~ Forme~r Standard Mean Standard Deviation Deviation 4.68 1.38 4.78 1.34 4.90 1.24 5.06 1.24 4,82 1.30 4.89 1.31 Current Mean Standard Deviation 4.55 1.43 4,81 1.37 4.66 1.41 Mean 4.66 4.90 4.78 Total S=andard Deviation 1.39 1,29 1,34
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SURVEY OF HEALTH PROFESSIONALS: SMOKI~;G AIID HEALTH, 1975 Summary Report I. INTRODUCT!O~ Background. People in the health professions are the authorities on matters pertaining to health. They are looked to for advice and are expected to be exemplars in preventive medicine. This is certainly true of cigarette smoking. For example, a recent survey of adults showed that more than three out of four feel that doctors should set a good example by not smoking. Thus, it is essential to know how these important exemplars see their roles, how they perceive smoking in relation to diseases, and how they act with regard to cigarette smoking both personally and professionally. Four groups of health professionals were studied in 1975. These are physicians, dentists, pharmacists, and nurses. The same groups had been studied earlier in the period between the spring of 1967 and the summer of 1969. One purpose of the current study was to assess the changes that have taken place during the intervening years. B. Methodology. In each of the four groups, a random sample of ap- proximately 5,000 names was provided by each of the four professional associations (the American Medical Association, the American Dental Association, the American Nurses Association, Inc., and the American Pharmaceutical Association). A questionnaire was sent by mail to each member of the sample, and an abbreviated form of the questionnaire was sent to nonrespondents to the first questionnaire, and again to non- respondents to the second questionnaire. Telephone interviews were then conducted with a sample of those who did not respond to any of the three mailings. The actual number of interviews carried out was 67 percent of the original mailing list of physicians, 73 percent of the dentists, 49 percent of the nurses, and 62 percent of the pharmacists. The main reason for the low rate of nurses was deficiency in the mailing list since 32 percent were either unreachable or, if reached, not cur- rently active as nurses. If appropriate weighting is assigned to those professionals interviewed by telephone, the estimated interview comple- tion rate of those reachable and eligible varies from 95 to 96 percent of each professional group. (See page 2 and Appendix ~ for a more de- tailed description of the methodology.) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE CENTER FOR DISEASE COhlTROL ATLAt~TA, GEORGIA :30333 TI06650345
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Physicians Dantlsts Nurses Pharmacists Original Sample Size 5,422 5,482 4,984 5,716 Actual Number of Completed Question- naires (Mail) plus interviews (telephone) 3,657 4,013 2,429 3,528 (67Z) (73Z) (49%) (62Z) *Estimated % Reachable and Eligible for Response 93% 96% 68% 88% *Estimated Refusals of Original Population 5% 3% 3% 3% *Estimated Completion Rate of Original Population 88% 93% 65% 85% *Estimated Completion Rate of Reach- able and Eligible Population 95% 96% 95% 96% *Estimated by combining mail responses and weighted telephone sample. II. FINDINGS A. Smokin~ Behavior. In three of the four groups the proportion of smokers has decreased markedly since the earlier surveys. Only among nurses has the proportion of smokers stayed at about the same rate as in 1969. The proportion of physicians who smoked dropped from 29.6 percent in 1967 to 21.0 percent in 1975. During the same 8-year period, smoking among dentists decreased from 34.3 percent to 23.3 percent. In 1968, 34.5 percent of pharmacists smoked compared with 27.5 percent in 1975. Nurses were smoking at about the same rate in both surveys--37.3 percent in 1969 and 38.9 percent in 1975. Among physicians, there was little or no difference in smoking behavior by age group; 21 percent of those under 40 are current smokers, and 21 percent of those 40 and over are smokers. Both these proportions repre- sent a substantial decrease from the 1967 survey, when 33 percent of those under 40 and 29 percent of those 40 and over were smokers. The same pattern holds for dentists: in 1975, 24 percent in both the younger and older age groups were current smokers. Both were down from 1967, when 36 percent of those under 40 and 33 percent of those 40 and over were current smokers. Among pharmacists, the decrease in proportion of smokers was more noticeable in the younger age group than in the older. The per- cent of pharmacists under 40 who were current smokers decreased from 36 percent in 1968 to 25 percent in 1975. The corresponding percents for those 40 and over were 35 percent in 1968 and 29 percent in 1975. As the other health professionals do, nurses under 40 show a decrease from 1969 to 1975--from 39 percent to 34 percent. However, 35 percent of the nurses 40 and over were smokers in 1969, and 42 percent were smokers in 1975. This increase reflects the fact that women 40 and over in 1975 includes 2 TI06650346
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women ~'ho were 33 to 40 years of age in 1969 end smoked at a much higher rate than nurses who have since left the profession. In comparing the health professionals with the adult population, in gen- eral, it is appropriate to compare three of the groups with males and one group with females. Physicians in the sample included 92.9 percent male; dentists, 99.2 percent; and pharmacists, 90.0 percent. Nurses included 97.5 percent female. A 1975 national probability sample of adults showed that 39 percent of the males and 29 percent of the females were current smokers. The proportion of smokers in each of the three predominantly male health professional groups was much lower than that of males in the general population, but nurses were smok- ing at a higher rate than women in general. Three out of every five health professionals surveyed had a history of smoking, but the majority in all groups except nursing had quit smoking. The highest quit rate was found among physicians - 64 percent of all those who had ever smoked were former smokers at the time of the 1975 survey. This was closely followed by 61 percent of the dentists and 55 percent of the pharmacists who had once smoked but had quit. These proportions are higher than the quit rate of 43 percent in the male population who had ever smoked. Nurses had a quit rate of 36 percent - slightly above the quit rate of 34 percent of smokers in the female population. Physicians have been the leaders in giving up smoking; 55 percent of former smokers have not smoked in i0 or more years. This compares with 46 percent of former smokers in the male population. Dentists were next in quitting, with 50 percent of former smokers having quit I0 or more years ago. Pharma- cists began quitting at about the same time as other men in the population; 47 percent of former smokers among them quit I0 or more years ago. Women did not start to quit smoking in large numbers as early as men. Of the former smokers among the female population in 1975, only 36 percent had not smoked for i0 or more years. However, like other health professionals, nurses lead their general population group in quitting smoking. Among their former smokers, 43 percent of nurses have not smoked for I0 or more years. Those smokers in the predominantly male professions smoked fewer ciBarettes per day than males in the general population, while there was little difference between nurses and their female counterparts in the general population. As well as smoking fewer cigarettes, physicians, dentists, and pharmacists also tended to smoke cigarettes lower in tar and nicotine than did males in the general population. While one in five in these health professions smoked cigarettes with a "tar" level of 15 mg or below, only one male in eight in the general population smoked these low "tar" cigarettes. Similarly, a larger proportion of nurses smoked low tar cigarettes than do smokers in the general female population. Most health professionals who are still smoking cigarettes started smoking be- fore the relationship between smoking and disease was well known, and a ma- jority of them have made at least one attempt to stop an rates similar to those in the general population of smokers (physicians 63%, dentists 64%, pharmacists 61%, nurses 55%, adult males 64%, and adult females 60%). T106650347
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In su~_ary, changes in the smoP~Ing habits of these groups of health profes- sionals have been towards the reduction of smoking and, for the most part, have exceeded and predated changes in the general population. Nurses were formerly among the heaviest group of smokers in the female population. Now that there is an increasing rate of quitting among older nurses and a reduced rate of taking up smoking by younger nurses, this is beginning to change. B. Relationship Between Cigarette Smoking and Selected Diseases. People in the health professions generally see cigarette smoking as either a major cause or a contributing cause of diseases of the lung. In fact, 9 out of i0 physicians and dentists say that smoking is a major or contributing cause oflung cancer, chronic bronchitis, and pulmonary emphysema. Between 80 percent and 90 percent of pharmacists and nurses agree. In every case, this represents an increase from the population holding these opinions in earlier surveys. Even greater increases were observed in the proportion seeing smoking as a cause of heart disease. The proportion of physicians increased from 71 percent to 78 percent. Corresponding proportions for dentists were 60 percent to 75 percent; for pharmacists, 46 percent to 63 percent; for nurses, 60 percent to 74 percent. The same pattern holds when attributing oral cancer to smoking, with 84% of dentists seeing smoking as a cause. Smaller proportions of nurses (79%), physicians (77%), and pharmacists (66%) attribute oral cancer to cigarette smoking. Again, all these proportions are substantially greater than in earlier surveys. C. Perception of Responsibility as a Health Professional. People in the health professions see cigarette smoking as a serious health hazard. How do they see themselves as serving to reduce the incidence of disease and death caused wholly or partly by smoking? First, they believe it is their responsibility to set a good example by not smoking cigarettes. Ninety-one percent of physicians, 88 percent of dentists, 87 percent of nurses, end 73 percent of pharmacists agree they have this responsibility. The majority also agree it is their responsibility to con- vince people to stop smoking. Three-quarters of physicians and nurses, 61 percent of dentists, and 51 percent of pharmacists subscribe to this. Many in the health professions alse believe they should be more active than they have been in speaking to lay groups about cigarette smoking. In fact, 82 percent of physicians, 74 percent of nurses, and 68 percent of dentists and pharmacists agree they should be more active. Not only do health professionals profess a feeling of responsibility toward their patients' (or customers') smoking, smokers among them have apparently changed their behavior accordingly. Health professionals are much less likely to smoke in the presence of patients or customers than they were in the earlier surveys. In all four professions, more of them report that they never smoke in front of a patient (or customer)(physicians--39% to 54%; dentists 50% to 65%; pharmaclsts--22Z to ~1%; nurses 60~ to 89%). Although a slightly smaller proportion of nurses, compared with doctors and dentists, feel that 4 Tl06650348
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they should set a goed ~<ample, they have the largest proportion who say they do not stoke in front of patients. Perhaps they face more restrictions of where they are allowed to smoke at their places of work. Indeed, 80% of the nurses who are presently employed say that smoking is restricted to certain rites or places, or prohibited entirely, at the place where they work. Just as health professionals feel ~ore strongly that they should be doing something about smoking, they are less pesslmistic than they were earlier about their ability to effect change. For example, in 1967 three-fourths of the physicians agreed that "there is no method around today to really help a smoker who wants to quit but can't do it on his own." By 1975, fewer than half of them agreed with this statement. The proportion of dentists agreeing with it dropped from 58% to 33%. It is interesting to note that nurses have been most optimistic about the possibility of helping people to quit. III. SUMMARY Overall, the results of the surveys are encouraging to those who are interested in seeing a decrease in the incidence of disease and death related to cigarette smoking. Those to whom the public looks to set an example for them have not only made great strides in changing their own behavior, but are, more and more, recognizing their responsibility to their patients and to the general public. In carrying out this re- sponsibility, those who continue to smoke are, for example, refraining from smoking in the presence of patients. Finally, people in the health professions have become less pessimistic about the ability of smokers to effect changes in their behavior. These practices, knowledge, and beliefs should help to assure that the ~ecrease in smoking among Ameri- cans will continue. T106650349
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A PROGRAM TO REDUCE THE RiSK OF DISEASE 1N SMOKERS Acc~,ab~a~ ~esearch Agronomy ,"-' E ,~a..,al; F.,.::luchr.r,' STATUS REPORT--DECEMBER 1977 National Cancer Institute National Heart, Lung, and Blood Institute National Institutes of Health TI06650350
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ANTISMOKING INITIATIVES OF THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE HEARING SUBC0~IMITTEE ON HEALTH A~'D THE EN¥IRON~ENT OF THE ~0NNITTEE 0N HOUSE OF REPItESENThTIVES NINETY-FIFTH COlgGRES~ SECOND SESSION ON SECRETARY CALIFANO'S ANNOUNCE~IENT OF THE DEPART- ~IENT OF HEALTH, EDUCATION, AND V~rELFARE'S NE~r ANTI- SMOKING EFFORT FEBRUARY 1~, 1978 Seria! No. 95-107 Printed for the use of the Committee on Interstate and Foreign Commerce U.$. GOVERN}~Eh'T PRINTING OFFICE TI0665035t
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66 ment on. for in~anee, the banning of sale of cigarettes in public h,fildin~s ? Secretary C.~,r,,r,~-n. ~f,-. Chairman. there were many initiatives that were ~iscussed and on which my opinion was aske~. I thought they wouhl not do any ~o~d. be cm{ntorproductive, were much t~o int busivo as far as Government was concerned. In one case. there was a 8u~¢ostion that we enconra~e ]itiffation a~ainst, tobacco companies. I flmn~ht that. was clearly a totally inappropriate role for ~overnmoni to play and tried ~ focus program on what lhe prnb]em was, children, teena.zer~, subteens, how can we fret at that problem, what can we do to deal with it, and what is appropriate in a democratic society ~ Mr. ~E~s. Yes. I know, too. ~he idea was suffffested that place nicotine under the Controlled Subslances Act, reimbur~ment of smokin~ ce,sation profframs under medicare and medicaid, and a required Public IIoalth Service advertisinz pa~e in ma~azlnos and now~oapers, and also whether it would he apDrop~ate ~o contimle to allow a Federal income fax deduction for the cost. of adverlisin~ of l~a~ flint been punned ~ ~ocrotary ~,¢L1~,xNn. ~ro; ~ rejected that ~fr. Chairman. T sholfld note that tho~e items and many others that. the Chair is familiar with. I asked the task force an}l mr staff to simply ~ive me a list of ovma- single proposal that had b~en mad.~ that people might do semi, good in this arc, a. alld filet is the list from which then0 and many otlwr proposals ,'amo which we winnowed out but I Mr. ~oo~s. ~t s~ems to me what you are proposin~ is most sortable, and in fact i~ almost ~mperhtiw. if we are goin~ to be~in to improve the healflt of tho Amorican people, and particularly toba,oco industry, would not ]m supportiv,, of that program. We find out as we ]~ear them later. I did want to com,ludo by askinz this. I know you stated on paze 4 that it has b0en e~timated that last year more than 820.~ peoph, Jn this country died prematurely frov~ diseases attributable to smo}- in~. Now. what. do you mean by the word attributable~ Is it entirely eau~od hv ~mokin~ or is it a rn~]or eontributor~ ~ocro{arv CAI.I~AXO. I think it is fair to say smokinff is the ma~or eontrihuto~. For example, there wet0, I thinlY, ag.000 people died of hm~ car,e~,r. 7&000 o£ those ~re believe weft, attributable to s~noking. caused lw srnokinz. We ea~ zir,, more detailed numba~ to break that 39(l.o0O people down. [The following informati,m was r~eiv,,d for the record:] It has been 1977 to the Art~ericans. Disease Diseases of th Chronic Bronch Emphysema Arterloscleros Cancer of the Cavity Cancer of the Cancer of the Cancer of the Cancer of the Bronchus, Cancer of Cancer of the Total TI08650352
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banning of sale of cigarettea in public :. Chairman, there were many inRiative~ u which my opinion was as~zed. I thought ~ofl, ba counterproductive, were much tee nent was concerned. a su~e~Hon that we encourage litigation es. I thought flint was clearly a totaUv ove~ment ~o play and f~ed to f~us th~s blem was, children, teenazem, subteens, how m. what can we fie to deal with it, and what :retie society ~ mow, too. the idea was suzge~ed that we ~ Controlled Sub~tances Act, reimbu~ment o~rams under medicare and medicaid, and a Service adve~ising pa~e in magazines and ~hether it would be appropriate to eonfimm ,me tax deduction ~or the cost of advertising ed~ No~ I rejected {h~t. Mr. Chairman. I should and many others that the Chair is familiar ~ force and my staff to simply give me a list real that had been made that' people thought in this area, and that is the list from which ' proposals came which we winnowed out but ms to me what you are proposing is most ~a- is almost imperhtive, i~ we are going to begin [th of the American people, and particularly e prepare is geared to an educational and I don't, kmow how anyone. ]nc]ndin~ the told not be supportive of that program. We will them later, ~clude by askin~ this, I kmow Xou stated on page .stimated that, last year more than 3~0.000 people t p~maturely fro~ diseases attributable to smok- • on mean by the woM attributable? ~s ~t ent.i~ly or ~s it a ma~or contributor? ~-o. I think it is cair to say smoking is the ma~or .xample, there were, ~ thinlY. 89,000 people died 0 of those we believe were attributable to ~g. We can give more detailed num~m to bre," ]e down. information was r~eived for the record:] 67 ~r~c~s. SPec£ftc e~*~"~ of between 3~'~J~r COntributor . ~'~ XOllowlng table: Diseases of the Hear~ 738,170 ~ Chronic Bronchitis/ 199,300 E~hysema 19,910 Ar~erioscleros£s Cancer of the OraI 9~670 Cavity 8,450 Cancer of the Esophagus 6,900 5,910 Cancer of the Pancreas 19,800 2,~70 Cancer of the Larynx 6,930 3,3S0 1,670 89,000 cancer of the ~idnay 7,300 77,870 Cancer of the Bladder 1,460 TOtal 9,800 934,920 3,920 325,720 TI08650353
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ANNUAL REPORT ON TOBACCO STATI ST ! C.S t977 STATISTICAL BULLETIN NO. 605 U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE WASHINGTON, D.C. MAY 1978 TIQ865035z
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2,43I : 2,472 : I~ 1~ : 13 2,353,015 : 2,261,099 : 2,4-~,812 3_/ : ~/ 1,477 1,49~ : 1,330 9~9 1,2~ : 1,~0 1972-73 CIflsretces (Large) .................. 8 Chc~in~, $~okt~g Tobacco, and S~u£~ ........ • TOTAL ....................... . 2,276,$35 : 2,436,978 2,315,G9~ : 2,4~7,$94 3~,~I 1,42~ 1,393 1 2,395,325 Includes prepa~cnt. Tax repeale~ effective January 1, 1966. (Fublic Law Included in ~tscellanc~u~ ~ax colle¢clons. C~llec~ed by Custc~s be~inntng C~tober I, 1951. ~io~ ~o ~obeC l, 1961, cusco~ collection were ~cluded in ~he applicable Table 22. EstL~a~ed ~oual expenditures for cobscco produc~s, by ~ype o( produc~, calendsr years, 1950 - 1977 1/ : s~ll) s~a11) - Snuff : :: : s~all) : sra11) - Snuff : 1~11. DoI~ HI1. DoI. ]ill. Dol. ~il'. Dol. :: M~I. Dol._.._..___~, Nil. Dol. Mil. Dol. ~1. Do1. 1950 : 514 3,586 292 ~,392 :: 1965 : 7~ 7,609 303 8,651 I951 : 526 3,876 283 4,685 :: 1966 : 718 8~113 309 9,140 1952 : 545 4,2~6 282 5,073 :: 1957 : 607 8,572 304 9,582 1953 : 560 4,~36 268 5,264 :: 1958 : 703 9,094 315 lO, lt2 195~ 552 4,292 260 5,1~ :: 1969 : 701 9.404 339 1D,44~ 1955 : 550 4,409 258 5,2~7 :: 1970 : 707 I0,~8 389 1956 : 556 ~,6B1 2~ 5,481 :: 1971 : 709 11,~0 415 12,115 1957 : 562 ~,072 243 5,877 :: 1972 : 720 11,765 425 ~2.910 1958 : 584 5,~1 257 6,182 :: 1973 : 730 12,325 430 13,485 1959 : 629 5,83~ 281 6,764 :: 197~ : 705 13,270 SO0 14,475 1960 : 6~9 6,244 294 7,187 :: 1975 : 680 14,250 575 1961 : 631 6,538 303 7,472 :: 1976 : 655 15,110 625 16,390 1962 : 6~ 6,675 299 7,608 :: 19772/: 600 15.800 700 17,]00 ~963 649 7,055 300 8.~ :: 1978- : 1964 : 765 7,024 324 8,~13 :: 1979 : £~ To~cco S~ua~tm, £conomlcs, Statistics. and Cooperatives Se~'~ce. Table 23.~ns~c£~ per capita o£ co~cco pr~uc~s in the ~lccd SC~Cc~ (~cludlng ove~sea~ forces) for spec£ft~ perils. : Per ~p£~a : Per ~le ~ PC~ Pe~son 18 years y~ :. 18 year~ an~ ov~r : 18 years ~d over • ind over : : : All ~rge Cigars : : : Cigarettes 1/ : Tobacco : ~d I/ ~kin~ ~e~g Snuff 2/ - -- To~cc~ 2/ " Tobacco ~/ : : N~be~ F~nds Po~d~ ~er PO~S P~ds P~ds Ponds : 4~25S 9.37 II,51 I~3.8 2.57 1.19 1.07 : 4,287 9,39 11.12 136.1 2.41 1.13 1.05 .23 : 4,280 8.86 lO.BO 130.7 2.28 1.08 1.~ .23 : 4,186 8.69 10.59 126.5 2.15 1.11 1,05 .21 : 3,993 8.11 10.~ ~.0 2.~1 1,0~ L0~ : 3,985 7.77 9.68 125.3 2.08 1.15 1.~ .19 : 4,037 7.75 9.52 119.2 1.9~ 1.Oh 1.09 .19 : 4,~3 7.95 9.65 1~8,9 1.74 1.~ I.O~ .18 4,1~7 7.92 9.~3 102.4 1.61 .BS 1.10 .18 : ;,141 7.~ 9.40 91.9 1.~7 .~7 1.13 .18 4,121 7.7~ 9.14 82.4 1.32 .Tb 1.15 .17 : 4,092 7~27 8.~l 7~.0 1.20 .75 1.17 .17 B.33 67.9 1.0~ .65 1.22 .I6 1965 1966 1967 1968 1969 1970 1971 1972 1973 197~ 1975 1976 1977 3_/ : 4.060 7.07 l~sce.~ed processins-we£sh~ equivalent. 2~:h~Ishe~-pr~d~c~ welght. S_/ Pxeli~inary. Cc~i]ed fre~ ~b~ Tobacco Situation, Economics, Staeistics, and Cooperative Service. -25- Tl0o650355
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0 O) O~ CD Federal Departments & Welfare:
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3O THB NE'vV YORK TIMES, SUIVDA~; NOV]~MBER 15, l.o~l Rcading, Pa., Workers Tented in Cancer Study READING, Pa., N~, 11 ~ St~ey Sdhweltzer work~ Ms way up In Rcmling Comply f~m ~t~cker helper to machinist. He put tn at ~e l~omvttvv const~ctlon and ~a~tcnancq facility that ~e nGwee- tenet ~[Imad once ~rat~ Now r~ti~, th~ ~-year~Id Mr. Schweltzer s~a~ ~ the sho~ss breath chn~cteNsii~ oI as~stosl~, a ch~nlc and pro~r~slve, b~t gene~lly nnnlaIal, ~Ing oI the lung tI~,ues by tiny a~kc~¢o~ Iibe~. He ~nnot walk up ~taI~ ~out whizing heavily. lie ~nt~ct~ ~e disease, he say~, from Inhaling the asbe.~tos fibers that: Snydor, chairman of Local 6~2 of lhe In. used to fly "like it was snowing" in the] ternatlonal Union of Machinl.~ts and locomotive shops where he worked. And] Aero.~pace Workers, which repre.cPntS tills week he was examined in a newI theworker~. medical study prompted by the discov- ery in this a~a of an unusual numbor of[ Five From One Workshop ca~e~ of the deadly cancer of the Itmg~ Like Mr, Schweltzor, five of the liuing whose only known cause is asbes-[ cer victims worked in the asbe.-,tns- ins. laden workshops whero, tmtll 1955, In the last I0 years, the cancer, me- .ste~.m..locom.o.tives we.re b~ilt,.~n.d, re. ed, acoordlng ~o the National Institute , for 0ccupatlonal Safety and Health. The ] Some 3~ o! the ~ttmated'l~)0 worken normal rate Is less than one Incident a ] who survive from that p~ried were ex. decade in an area ,this size, said Gene ] amined Ior asbestos-related aliments physlctnos from the Job-.~a fety tnqtltulo. The stndy is the first to examine tensively tim effect of as~l~ ~m rail worktxs, said Mr. Snyder of the machln- isLs' union, which represents the n,lirt~ Reading worke~ as well as th~ f.wer ~an 2~ ~ple Conrail empIoyu at a maintenance faeUityhere. As~w~ wa~ heavily U~ed to Insulate the ~ilem on I~omotlvcs and was s~rip~tl iram flm'engin~ during and maintenance work. Be/ore stvam era end~ In the middl~lPr~'s, manya~ ~,~ worke~ we~ in the maintenance sho~ of the rallmad~. Study of Other Worke~ • ' o conduct a ltwo-year national mortality study of railroad building and repair shop work- error. Schweitzer said that when he Ibegan work in 1927 he was more con- ceded about the 2,5-O0-ton cranes and other large equipment. Breathing prob- Itams, ha said, were associated mostly with sulfur from the coal-burning lgtn~' and with soot. ing tile Reading screenings for Fede~'al authorities, has found preliminary evl. ~ ~ donee of "asbestos impact" among.the - railroad workers, said a sI~man for the institute. Detailed ml~rt~ of the findings will not be available for at least two months, and Mr. Schwei~zer ~ald he had not been told the re~u]~ of this examination. .:,: A spokesman for Conmtl ,~ald the rail ,q The unusual incidence of mes~the~ corporation was "coopo.ratin8 with i ....... -~ ........ r~-I by Dr Robia Kat~ , N IOSH" in the screening% even though ,, 1~, In Au~mt 1980, shortly after he ~- matter ¢~ not dr~tym ol e mov~to Reading and o~a~ a private[ Conrail" nince ~e Reading ya~s we~ practice, Dr. Kaplan found the dise~sel not aequtr~l from the b~k~pt Rea~ng in ~o patien~ ~thln a sho~ time. llel Company until 1976.,. got ~ touch with the ~lon, and subs~[ &~bestos c~tino~ to ~,a wld~pmad .j quent renew of county health r~ordsl hazard, acco~lng to F~I health of- dlscl~ the dtspm~ionate rate olI ficials, who ~tlnmt~ last year that ~neer. "~ million workem had some daily ~eupa. Dr. Ma~tn Sepuiv~a, whMs conduct7 tional e~e to ~e substance.
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FOR .RELEASE FRIDAY, OCT. 9, 1981 For further information, contsct: Karen Prupes 312/751-6609 • FORMALDEHYDE SEEN AS POSSIBLE CAUSE OF CANCER IN >~N CHICAGO -- Formaldehyde, a chemical widely used in medical laboratories, home insulation and various manufacturing pro- cesses, may eventually be named a cause of cancer in humans. Rats and mice exposed to formaldehyde fumes have developed in- creased numbers of nasal carcinomas, according to a report in the Journal of the American Medical Association (Oct° 9) from tNe ~ational Institute for Occupational Safety and Health (NIOSH). Although studies to determine the effects of formaldehyde exposure in humans have not yet produced statistically significant results, findings from the animal experiments have some cancer-conscious physicians worried. According to NIOSH, about 1.6 million people, one third of whom are engaged in medical and other health services, may be exposed to formaldehyde. Pathology laboratory workers, for instance, have long been resigned to the itchy eyes, running nose, skin irritations and respiratory distress caused by exposure to The fo~n.~aldehyde used in preserving ~issue specimens. (:~ORE) T106650358
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NIOSH has listed 29 industrial uses for form.aldehyde, in- cluding urea-foam formaldehyde home insulation, printing, brake linings, lubricants, paint pigments, plastic moldings and crease-proof textiles. In 1978, 28 percent of the for- maldehyde consumed in the United States was used to make urea formaldehyde resins used as adhesives in wood products such as particle board, fiber board and hardwood pl~ood. In addition, formaldehyde is used in the preparation of some cosmetics and vaccines and is commonly used as a fumigant and a disinfectant. People living in homes insulated with urea-foam formaldehyde have reported sensitivity. Young children, the elderly, housebound invalids, and expectant mothers.may be particu- larly at risk for toxic reactions to formaldehyde. These groups tend to remain indoors and thus may be exposed for longer periods. The NIOSH report urges physicians to routinely include a patient's occupation in the medical history. Exposure to formaldehyde, it warns, may be more of a.factor than cur- rently realized in common respiratory diseases, such as asthma, and in other conditions, such as allergic derma- titis. TI08650359
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Cited VDTBoom Mufti e d b y Health Fears Ey HARRY NELSON, T~mes Stall Writer Within a few. years, experts pre- dict. video display terminals, the marvelous new electronic work toot. will be almost as common as pencils in offices and homes across the land. A growing number of businesses .~,,,ch as alrhnes, lnsurallee compa m,;s. basins, newspapers and other argJmzations that must process many b~ts of reformation already are finding these "typewriter-tele- vl.¢~on hybmds'" to be almost indis- pensable. With a few pecks at the key- beard, workers :n a mymad of busi- ;:esses now mag:cal!y retrmve bank :;ahmccs or airplane reservations from a pool of thousands, or com- ~ose a story fora newspaper. Paying Family's Bills .':oen this wizard at recording, re- ,-aihng or composing informauon usm~ a keyboard and a televmion :,crc~n connected to a computer will be r)aying household bills and or- ,icrmg grocerms routinely. But a controversy over the fi'c.'~: v:deo d~.,piay term;rials VD".'.:, ~::a:. have on the heaith of • ',"~rke:.~ ;Cn~ ~perate ~.~t'm threat- ,:~ 'o ::~ezmsh an othe:'.v,se bright .\.: tn,:.:r use has increasea. ',.ave the number of worker com- :-;am:~ of eye Jtra;n and eye .~a'Ague. :?u:r,:~ v~s:vn, neck aad hack aches : -:1 a .~u.'7.~er c." Fsychoso~auc 2is- C" far mere se.'~:) l.: concern - - .":..:15 aa:e :entore,J New Uses in Future age r.ow :n u~ in the Umted home ~n Lhe ~ear future. h~t wee}: ~ ~he Nauonal Academy of Sciences m Washington. sc:en- tu~ examined the evzdence sup- per/rag the cataract and other heal~ h claims. They were m general agr£ement thau --The amount of lsnJzing and non-~onJZlng radiation emitted by VDTs ~s tee amall to psse a threat of e:ther cataracm or blr~h defects. However. [hey stud. more studi~ ~houId be done on the effects of long-term e~osure to ultra violet and radio frequency wave lengths, both of which ~e given off by VDTs but at extremely low levels. --Visual fatigue and compl~n~ of aching muscles ~e more common among VDT workers than among non-users but it h~ not been shown that the VDT ,tself is responsible for all of the complaints. The psychological stresses of be- mg confronted v, qth an instrument that is new and perhaps threatening %o many workers appears to play an important role m causing physical complaints to increase. This seems to be especially true for workers who use VDTs for the more routine task& These effects can be enhanced even for workers whose tasks are more interesting if the employers Please see VDT FEABS, Page Continued from First Page has no~ provided the ~ci~ workplace dsz~ ~d The symposi~ ~s p~ of a ~udy ~ing conducted for the National Ins~tute for Occupational Safety ~d Heath by the panel on Impact of Video Viewing on Vi- Xen of Workers, a ~oup compcsed of Nation~ Acade- my of Sciences/National Rese~ch Council members. The possibility that ~Ts cause ea~ac~ w~ first ~sed several ye~ ago by two newspaper e~tors who developed catarac~ at a relatively young age after sev- er~ ye~s of using VDTs. A New York ophthomologmt has test~ed that the cataract, a con~tlon in which the eye's lens ~adu~ly becomes opaque, were indeed caused by the devices. It m well established that the DTes of taxation em~t- ted by ~Ts can cause cat~ac~ when the e~os~e level is sufficiently high. Bu~ no VDT monitored by the matitute has been found to give off :hat much radiation. No sment~t p~Uctpaung in the W~hin~on meeting reded "~ath :hose who specu, ate .,.at ther. ;s a relation- ship between VDTs a~d cataract. "'The evidence for VET ca~ing ca~-ac~ m "e~eme- ly thin'." declm~ed Dr. Alf~d Somme. a W:~er Eye Insutu~e eye Sommer ~md no well de~i~ed ~tudy has wen any evidence that %~T~ cmn cause cat~c~. He added that ao ~cienuEc ]cm~d tket makes a p~cnce cf refem~g TI08650360
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art:cle~ to ether s=en~ for re,.~e:v hef,=re pub2¢a~:n ha~ a~d to publ~h re~r~ on ~e ~en ~eg~d c~ rep~r~ [o da~ H~weven i~ ~ no% p~ble f~r the smenu~ to ca~e- Zonally sta~e tha~ the ~Ts do not ~us~ ca~a~. The reason ~s that ~e needed s~ud~ have not been done for each of ~ne forms of ra~aUon em~:~d by AH ~e stu~es done ~o date by sevem~ prWate and fore~ and U.S. agencies, ~nc:u~ng ~qOSH. show VDT ralston to he well w~[n safe ~Jm~. these studies not close the sub~ec~ beyond doubt. ~z~men~ on Animals For example, the questmn can he rai~ed wheth~ the levels ~at ~e considered too low to cause ca~ac~ when given as a ~ingle dose may he con~dered when the e~sure occurs repeatedly over a permd of time. These so-cNled safe levels have been based mNn- ly on e~eriments on animNs g~ven v~ous doses of X- rays or ultra light or infra red light over a short pedod of t~me. The question leg~umately can be ~ked what would happen ff the annals were e~oscd to lower levels over a much longer permd. No one knows because adequate studies have not been done. esDec~Niy for ultra violet and radio frequency radiation, according tothe scien- t;sts. The only way to be c4r[Mn that ~ong ~erm e~osure does no~ cause d~age ~s to foHo~ m ~arge group of~T operators over a long period of Ume. said Dn Mainste~ o[ ~he Ret,na Foundation ~n Boston.~ ~h~s approach would not be s~mp[e. ~f for no oth- er reason th~n ~he difficulty o[ separat*ng out the VDT effects from those of o%her background sources of rad~m- Other sources o/radiation include sunlight and home uon which mclude sunlight, rocks, home television and a wide variety of other items including fluorescent hg~ts and v~deo games. The amount of ukra violet light of ccrtmn frequencies c,~.lttcd by fluorescent light bulbs, for example, is 10 umes greater than for VDTs, said William Murray. an mstltute scmnust who has conducted a number of field studies on VDT radial:on levels. L~kewme, he said, the level of X-rays is b'areiy., dis=inguishable from back- ground and ,~ mmoum of infrared is f~ below safe standards. It m even more difficult to relate VDTs to birth de- fects. The claims ~hat a causal relationship e~sts was made when four of seven pregnant VDT operators on a Toronto newspaper delivered ~abzes w~th birth defects. Bu~ no properly conducted ~tudy has yet looked into :he potenual problem. Many cf the same difficulties ex- :st ~ with showmg that VDTs cause cap,ace--for ex- ample. ~t m hard to pinpomt which of the m~ad of causes of b,rth defects m re~onstble for a wen defect. Summmg up Cae health consequences of these VDT fm~ngs, Murray ~a~d: "'We feel :here is no h~d to pregnant women or their feu~ses. We feel there is no problem of ~ncreased radmt:cn that m~gh~ occ'~ because of ~e: m~funcuom We feel :hat all makes of ~Ts ~e m~fl~ enough m derek'" ~o :hat no taxation problem Hard to Decide on Facto~ Eeca~e m~: en~ro~mvn~l f~e~vr~ can co~t~bute ;~vcn ca:aract :; e:~re~e~v ~:ff:c~t and ~,T~mnve. it xcu.d rezu:re ::e c~:.~:n cf tens ,:f uhc~ of VDT operators to other office workers over a long peri- od of time, the researchers said. A further complication, according to several scien- tists, has to do with the difficulty of getting the employ- ers' permission and the full cooperation as well as the willingness of a cro~s section of workers to submit themselves to study. The science institute recently completed a five month study of VDT operators who work at the Baltimore Sun. William Halperin, an institute researcher, said that while the resul~ have not yet been tabulated, there is a question whether they will be definitive. The reason is that statisticians have determined that about 1,000 sub- jects would be required to demonstrate a significant in- crease in the number of cataracts that may be due to VDTs but only about 3(D of the F330 Newspaper Guild members agreed to participate in the exams. They had been asked to appear on a Saturday, which most of the workers had off. X-Rays and Home Ovens A much larger study of 4,000 newspaper union work- ers m several locals ranging from New York to Hawaii recently was launched by Mt. Siam Medical School in New York. The long term study on cataracts, eye strain, backaches, birth defects and other potential hazards will take into consideration many factors in addition to whether the worker uses a VDT. Age and sex are two of these and another is the sub- ject's previous ex'posure to radiation--for example, medical X-rays, whether or not he or she has a microw- ave oven and how many hours are spend playing video games or watching televimon. The scientists repeatedly said it will be necessazy to do studies that look at great numbers of factors which may be having an influence on health. Especially in the ease of eye strata, such things as job stress, desk design, job saUsfaction, number of rest peri- ods, age and the amount of control the workers e~oys over his job must also be taken into account, they said. Giving workers more frequent breaks may possibly be more effective than rearranging the office environ- meat. said Sloven Sauter of the Umvermty of Wiscon- sin's Department of Preventive Medicine. "We don't know the specific factors related to VDT worker well bow.g." he doctored. Complaints Compared VChenever workers have been quesuoned in studies about VDT health effects, complaints of eye fatigue and other symptoms of eye strain, as well as muculo skeletal aches and pains %ave overwhelmed all other corn= plaints. Dr. Marvin ~_a.inoff. an institute visiting scientist from ~a--'~'~nlver~l{~.~.-ed numerous studies showln~ that eye comp|alntS--burnin~ eyes. fatigue, blurred v:sion, red eyes--by v;orkers v:ho use VDT.~ for repetitive c:er:.cal tasks were s[gnfficant',y higher :ban for non- VDT workers. However. the inc:dents cf cc~p;ain~s among peopie TI06650361
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who use VDTs to work scientific e.xpertments, program computers or write or edit stories was one-third to one- half fewer than for workers performing less creative tasks. This consistent finding, in the view of some research- ers. indicates that the VDT itself may not be the main problem, although it may worsen some other under- lying factors such as job stress or iob satisfaction. ~lany Questions Un,,nswered Surprisingly to laymen, many questions remain to be answered about the significance to long-term health of eye fatigue, according to Dr. Edward Rinalducci of the Georgia Institute of Techn~i~y~-~h~n~in 6f-~-e sym- posium. "It's a question whether we know more about visual fatigue then we did 30 years ago." he declared. According to.Dainoff. "Eye strain may be related to visual demands but it also may be related to psychologi- cal or job demands." "Something." he sa~do "is different about the VDT worker that has not been seen before.'" One possible difference was offered by a member of the audience during a question and answer peried. It has to do with the act of reading. "What we know about reading a printed page is quite Eye fatigue and musHe pains have been the major complaints: different from what we w:ll need to know about reading a video screen.'" said Dr. Paul Kolers of the University of Toronto. "'What has been learned about reading a book does not apply to the VDT." One difference between reading a printed page and reading from a video screen is that many VDT operators read the letters as :hey are being formed on the screen, whereas the entire page is before the reader of a printed page, Other foe:ors that may enhance video reading fatigue are ~he fuzziness or brightness of the letters on some VDT screens, fiiekenng images, reflections from win- dows or overhead lights and .'.he distance from the oper- ator's eyes to the screen. Concerning the latter factor, it was pointed 9ut that workers who wear bifocals or reading glasses while operating a VDT are apt to sustmn added eye strain cause their readang gla~es, like the l~wer lense on the bffccals, have been ~rescnbed for a viewing distance :~at may not match the distance to the VDT screen. ~n Austrm. sa~d Dr. M~nf:ed Haide~._qf the Umversity ,:f Vienna. :verkers ~,'ho have ~r,~blems focusing :eng" pc=cos ~f ume on the VDT screen are ~ven pre- s,-.r:p~: on Olov Ostberg is an engineering psychologist who works for the Central Organization of Salaried Em- ployees in Sweden, a one-million member organization. He reported on studies sho;~ng that two hours of con- stant viewing of a VDT screen by air traffic controllers caused changes indicating that the eyes were not per- forming optimally. One change was a shift in what ex- perts call the dark focus--the point at which the eye fo- cuses in a dark room in which nothing is visible. The health sigmficance, if any, of the dark focus shift is not known. Several ophthalmologists and optome- trists at the symposium indicated the significance is minor because the focus returns to normal after 15 min- utes of non-viewing. But to Ostberg the fact that the eye performs less well after two hours of viewing means that some preventive action should be taken. In Sweden. he said. VDT opera- tors are required to take a break every two hours. In Norway, he said, a law has been proposed that would limit the amount of time spent on a VDT if the work consists of data entry tasks--the type of work that has elicited the highest percentage of complaints of eye strain. The proposal is that no more than 50% of the workday may be spent on the vIyr and there must be a break every two hours. Whether VDT usage will promote another type of eye problem--nearsightedness--is also controversial. Some researchers speculate that it might. Others insist that any resulting nearsightedness is minor and transitory. The members of the panel who are involved in indus- trial engineering agreed that the quality of images created by most VDTs now being sold by more than manufacturers is poor and that. this might contribute to some of the eye complaints. The reason for the poor.quality, according to Harry Snyder of Virginia Polytechmc Institute, is that the vi- deo parts were designed for home TV sets which nded not satisfy the same high intensity reading demands that VDTs should meet. : Must Make Good Choices : Good ones are available, Snyder said. but they c~st more and most buyers are not technically astute enough to make goed choices. Similarly, according to several experts on lighting, iob organization and other factors affecting the way work- ers adjust to their working conditions, many empioyers attempt to fit the worker to the work environment rath- er than vice versa. : For example, ~t is important that the office furniture be adjustable so that workers who differ ~n s~ze can:be accommodated rather than having to contort their pos- tures in ways that produce aches and pains. Also, the VDTs should be arranged in ways that m~h~- mize glare and reflections from both ~he artific:al light- ing and light from ~nndows and other sources that dan place added stratus on the eyes. : "'There's Io~s of knowledge on the~e mat'.ers." sa~d one e:,Tert. "The 9nncaples have been known for many years but are not being used." T106650362
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YOU: Health "not the people to the" task. The VDTs by them- selves are not bad. It depends on how we use them. The operator, equipment, task and emdron- ment must he dealt with a~ a unit. "Most of the ergonomic principles of workplace design exist now. It's a question of putting them into use, heca~e very soon --within tw~y to five years- the technology of the video workplac~ will be frozen." Added Harry Snyder of VPI: "Be aware that we may be talldng about more than worker satisfac- tion.., hut about a serious legal i~sue, too." Among other suggestions for ~evhting VDT op~mtc~s' discomfort: • Make sure the "work station" i~clud~ a cl'~r that adjusts to different hc<iy dimemion~ and al- lows the u~er to chan~e his or her l:<~ition. • U~ a ~,rDT sy~-~.em that ha~ an ad~u~hle screen separate from the ke.vbcard. • Pro-Stir an armr-e~t or b~ndres~ s,~ tl:e cl:er- atcr can re~Lx anna z_nd han~ k.~m-~n key- TI06650363
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crater to eJevate feet slightly; if desired "tier indirect I~,ht/~ t'or best screen ]uroination and the least glare and "shadow." • Make sure the systero's "scroll/ng~, function is not ~'erky, but has a smooth "Hollywood" foot, on. • Involve users and u~ns in de~i~rim~ t~ sys- • P-,duc~t~ o~emtors in.how to u~e and the s~em for their comfo~. Computer Comrols In Other Countries 'q'he probleras associated with vide~ d~sp~ay ter~ni- na~ are ~in~ s~died at ~ incre~ingly fr~tic ~ "' by gov~nment agenci~, uniom ~d ~vemiti~ ~o~d the world," ~ J~l ~ower in Office ar~: How Your Job Can bla~ Yo~ Sick. "M~t of ~e ~li~t [studio] ~re d~ne ou~ido U~ S~s, pfim~ily in E~o~ co~tfi~ Sw~en, Amtria ~d W~ ~y, which ~ ~-. w~ive govem~nt-spo~" pro~ e~ni~ wide range of o¢~patio~ ~th ~d ~ety ~u~" In S~di~vi~ ~untri~ th~ r~k h~ sul~ in regulations to pro~t workem, ~D Sw~h en~n~ri~ ~yehologist O[ov ~t~ a pion~r in the still~i~ field of"t~ol~ h~th ~ienca ~en is the m~t compu~ c~ ~.the w&ld," no~ 0st~, who ~ ~0 ~r~nt o£Sw~h workem now ~ V~s ex~mively ~d 45 ~nt on VDTa ¢eca~ienally. ~['bese numbers are, of mttrse, gmwingY . Unions are [argely respensibie for prroropting reg- ulations concerning worker safe~. "But you have to understand," says Ostberg, "that our unions are reD" different from these in America. E~ghty-five percent of eligible workers belong to the Central Organization of Salaried Eroployees of Sweden. ~ ~In Sweden, work roust be ~rganized in su~h.a way tha~ the [VDT operator] can intermittently be given periods of rest or work involving more conventionai visual requirements. Eroployers must provid~ eye exams for employes who star~ using VDTs. They must provide eyegla.~es, if required2 Norway has gone "even further," says Os~;berg. '~hey now have recommended a regulation that m, one must work more than 50 percent of their time in front of a VDT." TI06650364
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/I OSHA Backs Off Trying to Fire Cancer Specialist By Morton Mintz Wt.~hl~n Peat ~;~ff Wrltcr The La~ ~p~ment h~ ~t- en a s~pr[~ retreat from i~ pro- ~ firing of a s~iMist in c~r- ca~ing suhs~c~, thereby ~iing a con~e~ion~ inqu~, ~mg ~n- corns over fr~dom of scient~c ex- pression in the ~ admin~tra- tion ~d heading off a prolongM leg~ battle. In a concilia~ let~r Friday ~ the Occupation~ Sdety ~d Heath Admin~tration ~ientist, Dr. Pe~r F. Inf~, OSHA Adminis~a~r Theme G. Auch~r dismi~ ~n- ~d of miarepre~n~tion of the ~ency's position in ~ epis~e ~- relying the c~cin~enic ~nti~ of form~dehyde, ~ ind~tri~ chem- ical. The let~r ~e t~ee wee~ ~r Auch~r ~d Inf~'a ~ contra- of Public Citizen Inc., which repre- sented Infante, hailed "an important victory for scientists and worker~ over the Reagan adminm'tration's efforts to suppress free scientific speech°" Subcommittee Chairman Albert Gore (D-Tenn.) declared "a victory for the integrity of science and for the right of free expre~ion,~ and commended Auchter'a probably "dif- ficult~ but "right" decision. The sub- committee has been trying to "clar- iff' the reasons for the contradictory sworn testimony given by Auchter and Infante'8 supervisor, Dr. Bailns Walker, who recently left to become Michigan's public heath chief. Walker eaid that he had wanted only to caution Infante informally, but that Auchter insisted on a for- mal letter to Infante prop~ing his dismissal. Auchter denied that he had ordered the f~ing. dieted each other's sworn testimony Infants had been targeted by the in a House Science suhcommittee~.F.ormaldeh~de Inst.i~ a trade hearing. ",.;~,,~ro ~r~u-~t~ ~-ff'te-A~chter aide Mark Infante, a GSI5 who has headed Cowtm to complain. Inntitute lawyer OSHA's Office of Carcinogen Idea- S. John Byington challenged tmpub. tification and Classification for 31/z lished New York University Medical years, said he was "delighted" to beCenter research data showing the able to return to "my job of protect- chemical to be a carcin~en in ing the public -- and particularly imals, citing a letter signed by workers." Dr. Sidney M. Wolfe, head \f[k Demo~_ul~, associate ptofe~or of pathology at the center. Since then, however, Dr. Arthur C, Upton~\" former head ofili6-Natl~m'-Canc~rTM Institute who now heads the N.Y.U. departinent whore the resetu~h was done, h~ aocu~d D~mopoul~ -- in a letter to the Consumer Product Safety Commission- of "misrep- resenta~ons," "insocuraci~" and ~tatuments that are ff~llacio~ and ~imply not true." Walker a~es with Infanto that formaldehyde h~ been shown to be a carcinogen in animals and a ¢tm~er risk in humans- the view also of the director of the National Can~er Institute, three other top federal toxicology experts, and the National Institute of Occupational Safety and Health (NIO~H). The attempted fMng began May 12, when Infants protested to the International Agency for P,~m~rch on Caner the ~nclmion of an IARC task force that publisl~ data were inadequat~ for an evaluation of formaldehyde's pc~ibl~ caner risk in humans. His use of an OSHA let- terhead became a reason for the at- tempted firing, but Auehter now says tl~ was ~at mo~t a minor in. fraction." To support his protest, Infante enclo~! a publication of NIOSH, which is not a Labor Department agent. IARC director John Higgin. son charged, and Infante deniM, that Infante was trying to speak for OSHA and had acted improperly. Then came the attempted dis. mit~l letter. Its key charge: Infanto had insubeKllnately misrepresented Auchter'a decision to withdraw OSHA as a c~ponsor of the NIOSH publication. Auchter now admits that "documentation does not exist" for the charge that Infante had been told of the decisions. How many personal tax returns for 1978 reported a taxable income of at least $1 million? Answer tomorrow Friday's Answer The greatest number of travcler~ to the United States come from Can. ado (11.4 million in 1980), according to the U.S. Travel Service. Other nations whose citrons fr~lucntly visit are Mexico (3.2 million), Britain and Japan (1.1 million each) and _,We~t Germ_any (700,000).
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Finslly, I am slightly concernsd about this oc~ion, ths quality of th~s'cient~c~utp-,,t snd develop-.A the Umally scientists don't have laboratories named for first constructir~ relationship ~th the U.S, Dept. of them until they are over the hill. My goodnes-% I like to think each day that I am just getting warmed up." OBEY RAPS ADMINISTRATION FOR HOI:DING "BACK REPOP~ON FORMALDEHYDE DANGER Congressman'David Obey (D.-XVisc.) has criticized the Reagan AdmTr/i~t.f~tioia for refusing to release a report advising workers on ths possible carcinogeni- city of formaldehyde. Obey also blasted H.I-IS Secre- tary Richard Schweiker for firing director of the National Institute for Occupational Safety & Health. Obey inserted into the Congressional Record a statement dripping with sarcasm: "Mr. Speaker, I would like to take just a minute of the House's time to say that I think the Administra- tion is ignoring the supply-side effects of work-re- lated cancer. Each year between 50,000 and 80,000 Americans die of work-related cancers. The dis- savings, compensation, and medical bills which these deaths entail amount to billions of dollars each year, dollars that might otherwise be spent on new plant and equipment. "I believe it is important to point this out, particu- larly in light of two things that the Administration has done in recent days. First, the new Administra- tion has ordered the withdrawal of a current intelli- gence bulletin issued by the National Institute. for Occupational Safety & Health and by the Occupa~ .... tional Safety & Health Administration which simply reports to businessmen, workers, and the general public the results of tests by the Chemical Industry Institute indicating that formaldehyde may cause cancer. This is not a question of government's requir- ing that workers be protected from cancer-causing chemicals; it is simply a question of whether or not workers should be informed. "Second, the Secretary of Health and Human Ser- vices yesterday fired Dr. Tony Robbins, a commis- sioned Public Health Service officer as head of the National Institute for Occupational Safety & Health. Dr. Robbins had served only two years of his six-year term as Institute Dire&or. The six-year term for the NIOSH director came about as a result of an amend- ment offered by Senator Javits to insure that the institute director was selected and allowed to serve based on scientific qualifications rather than partisan politics. In the history of the institute no director has ever before been fired. "Dr. Robbins graduated cure lauds from Yale Medical School in 1966, and he held, in addition, a mzsters in public health from Harvard. He had served as state director of public health in both Vermont and Colorado. In his two years at NIOSH he brought order out of the chaos which ha~ continually plagued t that small agencT since its inception. He improved The Cancer Letter" P;;=_ 6 1 Mzrch 27, 19B1 Labor in the a_~ncy's history. He was, in short, the type of uniquely qualified and dedicated indi~Sdual which government agencies are too rarely able to attract. One ~can only surmise that his fL"ing was made in hopes of ffmding a director whose scientific fund- " ings will be more politically acceptable. I would" therefore IB:e to remind the department and Dr. Robbins' successor that cancer has a negative net im- pact on productivity." . NCI ADVISORY GROUP, OTHER CANCER MEETINGS FOR APRIL, MAY, FUTURE International Symposium on/viarkers for Dhgnos~s and Moni- toring of Human Cancer-April 1-3, Milan. SegtetaHa Scienfi- flea, htituto Nazionale dei Tu.mori, Via V, nezian I, 20133 Milan, Italy. National Prostatic Cancer Review Commlttee-April 2, Ros- well Park Memorial Institute, open 8:30-9 an'n, .Herpes V'a-u_ce~ As Oncogenic Agents-April 2-3, Chapel HRI, N.C. Fifth annual symposium of the Univ. of North Carolina Cancer Research Center. Box 30, biacNider Bldg, UNC School of Medidne, Clu3. p¢l Hill 27514 Control of ~e Phenotypic Expresd~n in Normal & Trans- formed Cells-April 2, Roswell Park continuing education ontology. Diagnosis & Treatment of Neoplastic D~orders-Medical, Sur- gical, Radioth~rapenfie Aspects-April 2-4, Johns Hopkir~ Univ., co.ntaet Program Coordinator, Turner Auditorium Rm 22, 720 Rutland~Ave., Baltimore 21205, 301-955-5880. Marijuarm Therapy Research Workshop-Apra 2, Michigan State Univ. University Club, sponsored by th~ biighigan Ceneer Foundation and Michigan Public Health D~pt. Danid Hoth, chief of NCI's Inwstigational Drug Branch, will be the principal-speaker. Reports will be presented on Michigan's .marijuana therapy research program which involves the study of ma~juarm in treating side effects of chemotherapy in cancer patients. 2nd International Lymphoma Conference-April 5-10, Athens. Sponsored by the Univ. of Athens and.Uni~, of Southern Cali- fornia School of Medicine. J. Parker, D~pt. of Pathology, USC, 2025 Zonal Ave., Los Angele~ 90033. European Regional Conference on Undergraduate Cancer Edu. cation--April 6-9, Geneva. Contact UICC, ~, rue du Consetl- General, 1205 Geneva, Switzerland. 9th International Symposium on the Biological Chax-aeteriz~ fion of Human Tumors-April 7-1 I, Bologna, Italy. Contact W. Davis, IARC, 150 Cour~ Albert-Thomas, 69372, Lyon Codex 2, Franc~. 22nd Annual General Meeting of the BHtiah Assn. for C.anc~ Research-April 13-15, Keele, U.K.M. Moore, BACR, Pater- son Imbs, Chfivtie-Hosp. & Holt Radium Inst., Manchester M20 9BX, U.K.. B|ometry & Ep|demiology Contract Rev~w Committe~- April 16, NIH Bldg 31 Ran 8, open 9-9:30 International Sympodum on Pre'¢entJon of Occupational Cancer-April :21-24, Hdfinki. Epidendology of occupational cancer, methodology of risk evaluation, prevention and con. trol of ri~. Inst. of Occupational H~alth, Haartmaninkatu 1~0290, Hdsinld 29, Finland. Biology of the Interferon System-April 21-24, Erammus Univ., RotleIdam. Nature of interferon in the immun~ system, appli- cation of human int~rferons hi cancer patients. Interferon 1981. ErasmuS.Univ.. P.O. Box 1738, Rotterdam, Netherlands. T106650371
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O drug use; and s=udies of ~ays t~ rani~ulate behavior -- i.e. treatment. The NIDA also often consults cn materials to he used by William Pol!in, M.D., is DirectDr of the ~iDA and o~ the National Council on Drug ~buse, which made a recommendation to the Surgeon General that cigarette packs carry a warning that smoking can be addictive. On a Washington radio station last fall, Pollin, responding to a question on what he thought was the most dangerous drug, said that of 1,900,000 deaths in the U.S. last year more than 325,000 were in part attributable to smoking. He also remarked, "Addicting? You better believe it." 3. Center for Disease Control The CDC administers programs for the control of preventable diseases and other conditions (e.g., childhood lead poisoning); provides consultation to other nations; directs and enforces foreign quarantine activities; supports and assists clinical laboratories; and researches and develops occupational safety and health standards. Director William Fcege, M.D., said in January that tobacco- related illness will be the Third World's major health problem within twenty years. He also claims that bad habits and lack of preventive care are killing more .~ericans than are fatal diseases. Says Foege, "Cigarettes have turned out to be the smallpox of the 1980s and one-half of all traffic deaths are due to alcohol." Cen~er for Health Promotion and Education The CHPE, which is parz of the CDC, is a~mini~tering a $10 million gran~ program to communities and schools intarested in starting health education programs on smoking and drug abuse among youth. Director Horace G. Ogden, M.D., has made no recent comments on smoking and health. He was director of the CDC's Bureau ~_Q~ealth ~ducation prior to taking "National .nstitut_ for Occu~a~ion_l Safety and ~ealth The NIOSH, another branch of the CDC, received $.8 million in 1980 for smoking and health research. En a 1979 re=oft the Institute recommended that the use of and/or carryin~ of'tobacco products in the workplace be curtailed in ~i~uation~ where employees may be exposed to physical or chemical ~ubstances that can interact with ~obacco products. Director ~mthony Robbins, M.D., has no~ ~ade any s~atements on smoking recently. His name has aDzeared in =he press with his comments on asbestos which he fe~[s is unsafe at any level. on smoking but is an ex-pipe smoker. He is also a fundamen- talist Christian and has wasted no time in making his an=i- abortion views known. In the meantime, the post rec~nt!y vacated by Dr. Julius B. Eich~ond is being covered by Acting Assistant Secretary Charles Miller who has spent many years wiuh the agency and Acting Surgeon General and Special'Assistant to the Secretary " Edward N. Brandt, Jr., Vice Chancellor for ~ealth Affairs at the University of Texas. ~ index of PHS offices ~nd instizutes dealing wizh smoking and health is liste~ below. Ti06650372
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ED~TCFR~LS amd in~-re.ased m~'~rcyelist mcr~aliz:., in the USA--I975-197~3. Am J ~bI[¢ HeaIth I~0: 70:579-585. 3. U.S. D:p~ment of Tmns~o~at~on. National Highway ~ety Administration: The Effect el Motorcycle Helmet ~sage on Head Injuries. and the Effect of Usage ~ws on Helmet W~fing Rates--A Prellmina~ Repo~. W~h{ngton, DC, J~u- a~" 1~9. 4. Muller A: Evaluation of the costs and benefits of motorcycle helmet laws. Am J ~bllc Health 19~0; 70:58fi-592. 5. Commonwealth of Pennsylvania: Analysis of the Mandatory Motorcycle Helmet Issue. Hamsburg, PA: Governor's S~ety Council. 1977. p. 302. Appendix E. 6. Wail Street Iou~a|. March 22. 1976. p. 1. IN: Ga~er DW: Ciga- rettes and welfare reform. Emoq¢ Law J 1977; 26:335, 7. Teret S: Testimony on SB ~ b*-fcre the ,Llaryland Senate Com- mittee on Constitutional and Public Law. Januar.~' 15, 19~0. 8. Jacobsen v. Massachusetts, 19"7 U.S. II 9. Nader C: Controlling environmental health h&zards: Corporate power, individual freedom and social control. IN: Public Con- trol of Environmental Health Hazards, EC Hammond and 1 Selikoff(eds.), Ann New York Acad Science 1979; 329:213-220. 10. Baker S: Who bought the cars in which people are injured.'? An exploratory study. Am J Public Health 1969; 69:76-77. Smoking in the Workplace: A Hazard Ignored The health effects of tobacco smoking have been debat- ed ever since its introduction into Europe in the 16th cen- tury. Some thought tobacco had useful medicinal properties: others considered it "'an enemy of the ~tomach.''t A French physician associated oral and lip cancers with smoking as long ago as 1859,-" but a comprehensive review or'all the data on smoking and health was not undertaken until 1961 when the U.S. Surgeon General appointed a scientific committee to study the issue. The committee's 1964 report, Smokb,g and Health, concluded that "'cigarette smoking is a health hazard of sufficient importance in the United States to war- rant remedial action,' "~ and many innovative programs have been implemented during the past decade and a half to in- fo.rm the public of the harmful effects of cigarette smoking and to reduce the prevalence of smoking. Ho~ever, despite some successes in the control ofciga- retie smoking, it is still recognized as ~'the single most im- portant preventable cause of death.''~ In 1979 Smoking and Health report of the Surgeon General states that the decline in the percentage or" adult smokers has not been matched by a decline in the absolute number or" cigarette smokers,~ and HEW Assistant Secretary Julius Richmond hoped the 1979 report would "encourage the medical and public health com- munities to continue their search tbr what the Advisory Committee 15 year~ ago defined as "appropriate remedial ac- tion." "~ As Bennett and Levy point out in their article in this issue of the Journal." the workplace is an important area for continuing "'remedial action" by establishing "'programs and policies that facilitate smoking cessation," and they indicate the need for greater effort in developing workplace programs to reduce smoking. The reasons why more smoking cessation programs have not been implemented in the workplace can be found in the Bennett and Levy article itself. First. the authors view smoking cessation as an "'approach to prevention of non- occupational disease," and second, they feel that "'the re- cent "life-style" trend in preventive medicine, which puts the burden on the individuul to change in order to achieve better health, often does not empha,4ze that changes must be made in the en~'ironmont--in thi~ ca~e. the workplace." Like so many others in the medic:d communit.~, in feder.d regulator'... agencies, in labor, and e'.en m i~du,tt.~, the~, have failed to recognize the crucial role of smoking tn occupational health--not just general health--and that control of smoking in the workplace is an additional method of occupational en- vironmental control, not a substitute for all other.w0rkpl.ace efiqffonm_~nt cha~nges. --~I'h~re are extensive epidemiotogical data verifying the adverse health effects that can result from the interaction be- tween tobacco (cigarette) smoking and exposure to chemical and physical agents in the workplace. In its bulletin Adverse H.._etdtl.t Effects of Smoking and the Occupational ~v~r~Tn- mettt, the National Institute for Occupational Safety .qnd Health (NIOSH) identifies six major ways in which smoking, interacting with agents found in the workplace, affects health.~ Smoking has been shown to have a role in the evolu- tion of occupational health problems such as chronic pulmo- nary disease,~-t: anoxia due to carboxyhemoglobin forma- tion2~ and cancer. 1,1-17 The impact of this interaction is par- ticularly severe because more blue collar workers than white collar workers smoke (51 per cent compared to 37 per cent)t~ and it is precisely the blue collar workers who have a greater opportunity for exposure to potentially hazardous physical and chemical agents in the workplace. From all the data now available, there can be no doubt that elimination of smoking in certain occupational settings would significantly reduce disease occurrence in the workplace. Despite the evidence, the NIOSH position is a rather pallid one--its recommendation being that "'the use of and/ or carrying of tobacco products into the workplace be cur- tailed."u'~ The Occupational Safety and Health Administra- tion (OSHAI has also been timid about smoking in the work- place, to the point of inaction, even though the "'general duty" clause of the Occupational Safety and Health Act of 1970 states in Section 5(a~ that: "'Each employer shall furnish to each of hi~ emt~oyees employment and a place of employment which are free .#ore recognized hazards that are causing or are likely to cause death or ~erious physical harm to his employees.'" OSHA cannot fulfill its mandate without addressing the issue of the adverse effects of smoking. Resistance to the control of smoking in the v,.orkplace is based in part on the fact that smoking has been an accepted element in Western culture for centuries, and in part on hesi- t:ttion to interfere with what is considered to be a personal Ajp__.~ ,;urns IS~0. Vcl. 70 tlo -5 ~ 575 ~" TI06650373
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EC~TQF~;~LS freedom. Objectiun~, by OSHA are that the burden of pre- vention is shifted to the worker, that concentration on the smoking is',ue is an attempt b~" management to avoid com- pliance with workplace standards, and that refusing to hire zmokers may be a violation of equal employment opportu- nity. There may also be some reluctance on OSHA's part to challense labor. Labor too is concerned that smoking control is a "'dodge," but it also sees smoking cessation programs as a possible threat to employment, seniority, established grievance procedures, etc. The first fallacy in ~uch reasoning is the concept that occupational disease prevention is a unilateral responsibili- ty: either of management lotally or of the individual worker, Workplace health and safeD is afi~htt effort, :tad unless there is a Full partnership betv, een labor and management the mu- tual goal of a healthy workplace will be difficult to achieve. Smoking cessation programs do not "'shift the burden" to the worker; rather, they are part of the cooperative and col- laborative effort necessary in occupational environmental control. The second fallacy is that smoking control is a means of avoiding compliance in other areas of workplace health and safety. Employers are still required to meet all applicable workplace standards and are still subject to su~,'eillance and monitoring by OSHA. While there are many who criticize OSHA's effectiveness, it is ludicrous to think that by ban- ning smoking an employer can escape meeting his obliga- tions under the Occupational Safety and Health Act or that workplace regulations will not be enforced by OSHA. What must be recognized is that smoking control is but one more method of maintaining a healthy workplace, and in certain occupational situations it is as necessa~" as every other method. For example, the synergistic effect of cigarette smoking and asbestos exposure is ~uell known. In fact. Sell- koff and Lee have stated: • "It would seem that control of cigarette smoking would have a much greater impact on the incidence of broncho- genie cancer in asbestos workers than further reduction of dust Thus the control of smoking must be part of the overall con- trol of hazards in the workplace. The data on the health effects of smoking, particularly in the occupational setting, are valid, reliable and voluminous, The predictable beneficial impact if smoking is controlled is clear. Until smoking control is effectively incorporated into workplace standards, the opportunity for a substantial bene- ficial impact on morbidity and mortality will be missed. By Address reprint requests to Paul Kotin, MD, Senior Vice Presi- dent for Health, Safety and Envirunment. Johns-Manville Corpora- tion. Ken-Caryl Ranch, Denver. CO S0217. Ms. Gaul is StaffAssoei- ate with the Johns-Manville Corporation. 578 continuing to ignore smuking in the workplace, OSHA, la- bor, and management will continue to condone an t~ccupa- tional hazard. PAUL KOTIN, ~,fD Lo/s AN.VE GAUL, BA REFERENCES 1. The Danjers of Smokir~.g; The Benefits of Quitting. The Ameri- can Cancer Society, New York, 1972, p. 7. 2. Ibid. 3. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. U.S. Department of Health, Education, and Welfare, Public Heakh Service Pub. No. 1103. 1964. 4. Healthy People: The Surgeon General's Report on Health Pro- molion and Disease Prevention. U.S. Department of Health, Education, and Welfare, Public Health Service Pub. No. 79- 55071. 1979, p. 7. 5. Smoking and Health: A Report of the Surgeon General. U.S. Department of Health. Education. and Welfare. Public Health Service Pub. No. 79-50066, 1979, p. A-II. 6. Ibid. p. xv. 7. Bennett D and Levy BS: Smoking policies and smoking cessa- tion programs of large employers in Massachusetts. Am J Public Health 1980; 70:629-631. 8. Ad',erse Health Effects of Smoking and the Occupational Envi- ronment. NIOSH Cu=rent Intelligence Bulletin 31. U.S, Depart- ment of Health, Education, and Welfare, NIOSH Pub. No. 79- 122. 1979. 9. Lednar WM, Tyroler HA, MeMiehael AJ and Shy CM: The oc- cupational determinants of chronic disabling pulmonary disease in rubber workers. J Oct Meal 1977; 19:263-268. 10. Berry G, MeKerrow CB. Molyneux MKB. et ah A study of the acute and chronic change~ in ventilatory capacity of workers in Lancashire cotton miffs. Brit J lad Med 1973; 1:25-36. 11. Merchant JA, Lumsden JC. Kilburn KH, et al: An industrial study of the biological effects of cotton dust and cigarette smoke exposure. J Oct Med 1973; 15:212-221. 12. Kibelstis JA. Morgan EJ, Roger R, et al: Prevalence of bron- chitis and airway obstruction in American bituminous coal min- ers. Am Rev Respiratory Dis 1973; 108:886-893. 13. Jones JG and Waiters DH: A study of carboxyhaemoglobin lev- els in employees at an integrated steelv, orks. Annals nee Hy- giene 1962; 5:221-230, I4. Lundin FE Jr. Wagoner JK and Archer VE: Radon Daughter Exposure and Respiratory Cancer; Quantitative and Temporal Aspects. U.S. Department of Health, Education, and Welfare, PHS, NIOSH and NIEHS Joint Monograph No. 1, 1971. 15. Selikoff IJ. Hammond EC and Churg J: Asbestos exposure, smoking and neoplasia. JAMA 1968; 204,: 106-112. 16. Berry. G. Newhouse ML and Turok bt: Combined effect of as- bestos exposure and smoking on mortality from lung cancer in factory workers. Lancet 1972; 2:476-479. 17. Weiss W and Thcodos PA: Pleuropulmonary disease among as- bestos workers in relation to smoking and type of exposure. J nee Med. 1978; 18:341-345. 18. Ibid, NIOSH Bulletin 3l, pp. 1-2. 19. Ibid. p. 6. 20. Selikoff IJ and Lee DHK: Asbestos and Disease. Academic Press, New York. 1978, p. 336. 70, N,~. 8 T106650374
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61789 Den~er, C~Io~d~ ~a~l. ~UNS Num~.:r North~es~e~ Sb:al and Wire Co.. 121 Wallace Street. Sterling. Illinois DUNS Number C,~32~31~7~uly 2~. 1979. btason Contractors of DuPage County. P.O. Box 1~. Mount ~spect. lllinob DUNS Number ~lfl~24?Z--July 24. 1979. ~edcan Hoech~t Co~oration. Route 2~2- ~ North. Some~lle. New lersey DUNS Number ~57~Tfl~l~ctober 23, 1~79. Boston 9istribulors. a compliance unit of Cook United. Inc., 16501 Rocks~de Road. Cleveland. Ohio ~137, DUNS Number ~ ~724~Janua~ 2% 1980. National Gypsum Company. 41~ First International Building, Dallas, Texan 75270, DUNS Number ~lb~2431--Janua~ 21, lS~. Crown Central Petroleum Corp., One North Charle~. P.O. Box 1168, Baltimore. Ma~land 21203. DUNS Number 24~--blarch ~, 19~. Gust K. Newbe~ Company & Assoc. (out of compliance only ~ Will County and vicinity, Blinois]. 2~ North Ashland Avenue, Chicago. fil~nois ~14, DUNS Number ~9~186~March 25, MM-Ame~ca Regional Ba~aining As~ociatiom 228 Nor~ ~Salle Street, Chicago. Illinois ~1, DUNS Number ~ l~251~March 25,1980. Contractors Association of Will and Grundy Counties, 2~ t& Rusy S~et. Ioliet, ~35, DUNS Number ~l~25~--Ma~h - 25. Residential Cons~uction ~ployers Co~cil, 1~10 Iorie Boulevard, Suite 112, Oak BrooZ Illinois ~521. DUNS Nmber ~1~ ~3~March 25,1~. Koch Fuels. ~c., a compliance unit of Koch Refining Company, P.O. Box 31, Gloucester City, N.J. 0~30, DUNS Number ~April 2,19~. Ch~ch's FBed Chicken. Nc., P.O. Box BH~, San An~nio, Texas 782~, DUNS Number 02-Tfll-7417~Ap~l 2. Monolith Portland Cement Co.. P.O. Box Te~inal Annex, Suite 201, Glendale. California 91202, DUNS Number 55~April 18, 19~. ~dee Cement Company, P.O. Box 122, Dundee, Michigan 48131. DUNS Nmber ~0~5~May 2, Santee Portland Cement Co., S.C. Highway #53. Holly Hill. South Carolina. DUNS Number ~33~g91--May 2. Hyatt Hotels compliance ~it o[ Hyalt Co~oration [which Mcludes all hoteN . o~ed or managed by the Hyatt Co~oration]. 9701 W. Hi,ins Road. Rosemont. Illinois ~18, DUNS Number ~73~77--May 20, 1~. ~ Conditioning and Refrigeration Contracto~ Associafiom 870 Market Street. S,m Francisco. California 94102. DUNS ~umber ~l~254~May 30. I~.st~al Contractors {UMIC, Inc.L P.O. 1~. Tib~ron, California ~920. DUNS F N~mber ~l~255~May 3~. 1~O. ~mh n~ He~ inn Pip,~g Emp]oyer~ C~uncil, ~ Tiburon Blv~ M~I Valley. California ~h~i,ti.~nes]. 155 ~t E~ad SL-eeL th:~ m~o~atice in a Def~:ns,~ Columbus. Oh:o 43215. DUNS Number ~ C~r~lar ~nd Fe,~a~l ~2~c~oher ~. 1~. R~lations N~tional Eiec~cal Con~actors Association [~Dc~e:~::¢,~F::A~t~O: ,43 '~l tOng,m-Columbia Chapt~). ~ 5.W. s:~:s~ co~ Arthur S~eet. Pa~and. Oregon DUNS Number ~l~24~ctober ~. - ....... ~e Eureka Company. 12~ East Bell Street. DEPARTMENT OF HEALTH AND Bloomington, Illinois 61z0a. DUNS Numbe~ HUMAN SERVICES ~1 l~332~Novemher 27.1979. Pordand Association of Plumbing Heatin~ AlcOhOl, Drug Abuse, and Mental and Cooling Con~actors {two Health Administration noncomplyin~ a~reements), ~12 Idaho, Pon]and. Oregon 97201. DUNS Meeting Changes; National Advisow Number ~50~23~November ~, 1979. Council on Drug Abuse and Rape Sheetmetal Association, ~c.. c/o 3434 S,W. Prevention and Control Advisow Water Avenue. Podland. Oregon 97201. Committee DUNS Number 9~X~24g~November 1979. National Adviso~. Couucil on Drug San Diego Contrac~n8 ~the~ Association, Abuse: In Federal Re#ster Doc~ent ~50strow Street. San Diego. CA 92111, ~24538 appearing on page 54142 in DUNS Number 9~l~25~November 27. issue of Thursday. August 14, 1980, 1979. meeting o~ the Na~onal Advisow "All other" compliance ~it o~ Gifford-Hill & Company. Inc. {wMch includes all products Council on Drug Abuse scheduled for exclusive of ~ans~rlatio~ f~Jgation and September 2~26, ~9~, in Con[erence metal buildMg pmducls]. ~35 Stimmons "Room C, ParMa~ Buildin~ has been F~eway. p.o. Box 47127, Dallas, Texas changed to meet in Conference Room 75247, DUNS Number ~792~9~ H, ParMawn Building, 5~ Fishers Lane, December 27, 1979. Rock~e, ~., beginning at 9:~ a.m, Residcmial Pl~bing and Mechanical Rape Prevention and ControI Con~actors of No~ Cal~omia. 1~5 B AdvJso~ Committee: In Federal Register Palos Verdes Mall WaMut Creek, Docment ~27125 appeadn8 on page California ~596, DUNS Nmher ~1~ 2571--May 30, 19~. 58~ M ~e issue of F~day, September Santa Clara Valley Con~acto~ Association, 5, 19~ ~e meeting of ~e Rape 4~ Reed Street, Santa Clara. California ~even~on and Control Advisow 95050, DUNS Number ~l~258~May Co~ittee sched~ed for September 26, 3o. lg~. 19~ in Conference Room G, ParkJawn B~lMgton Nodhem ~ Frefg~t, Inc., a Building has b¢e. changed to meet in compliance ~it of B~l~gton Northern. Coherence Room F, Parklawn Building, Mc., 43~ Von Kazan Avenue. New Poe 5~ Fishers Lane. Rock.lie, MD. Beach, California 9Z~. DUNS Number 0~ ~SS. [Note.--~s is a change in beginning at 9:00 a.m. address and DUNS Number for ~is Dated September 1~, 1980. Company.~Ju]y ~ 19~. ~ A. Connolly. Hotels Division and Hotel-Casinos Division, Committee Monogement O~'icen Alcohol compliance units of Hilton Hotels " Dcug Abuse. ond blental Healt,~ Co~oration. g~ Wilshire Blvd., Beverly AdmiMstra=ion, Hills. Califo~ia ~0. D~S N~ber ~ 69~531 (limited to Hotels Division and l~ Doc ~2~oli File,] ~1~ ~:45 am} Hotel~asinos Division~uly 10.1980. m~n~ CODE Mushy Oil. Domestic Marketing and ~ .,, ~ _ ~ . ....... Refining Division, a compliance ~it of /- Mushy Oil Co~ora~on {excluding foreign/National Institute for Occupational subsidiaries}. 2~ Iefferson Avenue, ~ Safety and Health Dorado. ~kansas 71730, DUNS Nmber ~3712--July 15. 1~0. Grant~ for Research and Har~s-Teeter Supe~arkets, Inc.. a Oemonstratiens Relating to compliance ~it of Ruddick Co~omtion, Reproductive Effect~ From ~17 Chesapeake Drive. P~O. Box 33129. Occupational Hazards Charlotte, N.C. 28~3. D~S Number 9~ l~287--August 13, 19~0. The National Institute for Circle K Co~ora~n, 4~ south 40th S~eet. Occupational Safety and health Phoenix. Arizona. DUNS N~ber ~ {NIOSH} announces ~at competitive 814~August 13. 19~. grant applications are being accepted This supersedes the previous 1/st for research and demonstration projects promulgated by O~P memorand~ o[Juty relating to the identification and 17. lo~]. Changea to that list include the addition of two companies. There are no prevention of reproductive effects from d~letions. Each company's "DUNS Number" occupational hazard~. has now ~een added t~ assist in th~ The knowledge base in the area of identification of the noncompliant com;anF, toxic reproductive haz~ds is still T106650375
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tranzplacental carc.no~en_~sts. con~-nital malforrn ,riCh, mulagenesis. and developm,,ntal abnon~ahhes are among the effects on reproduction that have been rec~gnlz:,d to resuIt ~om toxic occupati~nal ~xposure. Exposure to both men a~d women can produce these effects. Projects approved under ~h~s program must compete ~or funding with research proiecta in oiher areas. The pro~ected NIOSH fiscal 5ear 1981 research ~ant budget is $5.75 million. Gran~s may be supported For up to five years, and may be renewed for an additional period. subject to the competitive review proced~e and availability of f~ds. Gr~tees will he req~ed to cost share a m[nim~ of 5 percent. Authod~ These grits wffi be awarded and ad~istered by NIOSH ~der the research and demons~ation ~ant authority of Section g0[a][l] of ~e Occupa~onal Safe ty and Heal ~ Act of .1970 [29 U.S.C. 66g[a][1)). ~o~am reg~ations applicable to ~ese ~ants are contained in Part 87 of Title 42. Code of Federal Regulations, "Research ~d Demons~ation Grants Pertaining to Occupational Safety ~d Health" ~cept as o~e~ise indicted, the basic gant a~istration policies o~ ~e~ ~hlic Heal~ Se~ice are applicable to • is program. ~is program is not subject to O~ Circ~ar A~5 nor Heal~ Systems Agency Review. EI/~ble Appffcants ~igible applicants may be universities, colleges, resea~h ~stitutions and other public ~d private nonprofit organizations ~dud~g State and local gove~ents, Background Over the past several decades there ~as been a ~eefold ~crease in number ot wome~ employed ~ ~e U.S. workforce. During this period women have been employed in more hazardous occupa~ions including those traditionally rest~ctcd to men. In recent years an i~creasing number of pregnant women have remained on the job until near the end of pre~aacy. Thus, many more women and their ~nhom children are being exposed to chemical, ph3 and psychological hazards of the ;~9rkplace. Despite this fact, veE~ little ~s known ab9ut Lhe impact of such ",po~ures on fatal wastage and growth a-.d development Because of the umque role of women in the reproductive process, expedite. ~o chemical physical hazards has targeted attenHcn " ::~arking ma!~ expoz~d to mutagenic a.;enls also places the h~ahh of his offspring at risk. Other areas of concerns are: 1. Rec~2nition of the potential that exists for harm to the germ cells of parents of both sexes, signaling a need to investigate the possibilty that occupaticaal hazards might affect |he fert'.lity of both men and women; 2. The realization that significant quantities of industrial materials may be broug.ht home in clcthin~ resulting in the potential exposure of non-working pregnant women, making studies of teratogenicL"y of agents to which male workers are exposed as important as studies of infertility and mutagenicityi and :3. The possibility that childhood cancers may be related to pro-natal environmental exposures. Research Goals and Scope The goal of this announcement is to stimulate and encourage high quality research and demonstration grants in the areas of research listed below. These areas are not mutually exclusive. It is anticipated that a given area may cut across several areas. Included under each research area are examples of the types of studies which would be of interest to NIOSH. They are not meant to be restrictive and are cited for illustrative purposes only. 1. Epfdem/alogy sad Bdometry.-- Pro~ects which consider the epidemiologs, of reproduc|ive effects, including altered fertility, spontaneous abortion, fetal deaths, genetic diseases and disorders, and childhood cancer resulting from chemical and physical occupational hazards. Of particular interest are studies where dose-effecl relationships are identified or determined. NIOSH is interested in epidemiological research using a variety of methods or approaches. Such methods include those which generate hypotheses and typically use registries, medical r6cords, or statistics as the primary dais source and those methods which tend to confirm hypothese by demonstrating dose-effect realationship or the prevention of aa effect by interruption of exposure. Specific examples of epidemiolosy studies include: • Studies which identify groups of workers with abnormal reproductive experience ~ad determine probable cause. • Studies t~ determine whether an incidence of infertility, spontaneous abortion, or fetal mortality in the reproductiva exp~.rience of a specific • Studi~s to asses~ the parental empIo~Tn~n! relei~dne.~s of cancer in childhood. • Studies on )mo~ reproductWe hazards to evaluate and compare methodologies and to determine association between endpoints o[ the me~odologies. 2. Ta.x-]caS4~:,:--Wojects to identify reproducHve (mutagenic, leratogecic, eic.] hazards of chemicals to workers and ~o provide an early warning of the possible deleterious eft~cts. Examp'.as include: * Research which develops test systems to detect mutageaic activity of air particulates, chemical mixtures or complexes found in the workplace. - Research to validate h~an ceil mutagenic assay systems. * Wojects which study the possible synergistic effect of mutagenic and teratogenic chemicals produced ia the workplace. - S~dies which evaluate the usefulness of body fluid analysis and cytogenic assay system for assessment of the mutage~c hazard of ~emica!s to workers. 3. ~perfmental ~barata~ Investigstians.--~ojec~ ~o elucidate ~e biochemical and physioIogical mechanisms of activity and nacre of reproductive haz~ds in ~e workplace. Examples ~clude: - Studies io develop and validate scree~ng systems based upon bioche~cal, e~a~ic, or ho~onal components of body fl~ds {e.g., blood, u~e, semen) ~at can be used as reliable Mdices of ~e ~nctional state of ~e reproductive system. * InvestlgaHons to develop, improve. or validate short-ie~ or in witro methods for Iera:ogenesls testing. , Stu~es ofmecha~sms of teratogenesis, with the goal to improve the ability to predict relative teratogeaic poten~al of chemically relied compo~ds or to make inter-species extrapolations of teratogenesis data. - Research on the mechanisms by which abnormalities are induced in sperm head mo~holo~y and the implications of morphological ~anges as indicators of induced mutations or oF impaired reproductive capacity. 4. Control Tee~noA~y--~ojects to develop new and improved methods or equipment to p:eve~ rcp:oductive effects from occu;adu:;M hazards, including: * Studies which idenliYy wo:ke;s potentially or actual:) exposed 1o repmdumive hazards and design new or improved comrol~ for the hazard~. TI06650376
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Federal Re,islet [ Vo]- 45, No. 182 / ~,Yednss~ay, Sepiamher 17, 19~0 ] Notices 61791 • Research whY'oh adapts e>:isting m~thcds, as well as davelop~ new m~cd~ c[ monito~nS and reproductive h~ards in ~e ~orkplace. • Res~a~h which see~:s t~ use ~ova~ve approaches, such a~ alternative materials, en~in~edn~ con~]es, process modi~cation and pro~ective equipment to prevent or suspected reproduc~ve problems. S. Health Educabhn Resea~h Demonst~abn Prejects--~ojects to increase awareness of &e importance reproductive hazards in the wor~lace, such • Development of educational prepares for heal& professionals, and worker educators to increase their awareness o[ &e issues and problems su~o~ns reproductive effects #ore occupational hazards.. Renew ~edu~s and ~e initial renew of applications responsive to &is prepare announcement will be a~ged by &e Di~sion o[ Research Grants, ~. Major factors considered in evaluafi~ each application ~clude: • Tz~ng, expe~ence, and research competence, or promise, of &e applicant[s} to ca~y out &e proposed ~vestiga~ons, and the adequancy of effort {~e} to be devoted to &e project. • Th9 scientist me~t of ~e proposal: The questions proposed for study, research desi~, &e proposed me&odolo~, ~e proposed me&ods for analysis and Inte~retation of data. • Adequa~ and suilabili~o[ &e e~s~g and proposed facilities and resources. • Approp~ateness of ~e requested budget relative to the work proposed. • Adequacy of collaborative anangement{s), if applicable. A Seconda~ review process will be conducted by N[OSH. Factors considered in this review include: • The results of &e initial review: • The si~cance of the proposed research to the research prepare of NIOSH; • National needs and program balance: and • Policy and budgeta~ considera~ons. ~oposals considered to be non- responsive to the te~s outlined M th~s program a~ouncement will be appropriately reassigned for review or ~ed to &e investigator, as indicated. Returned proposals may be "e~sed and resubmitted. .tppll~fion and Award Applications should be submitted Fo~ PH~393 f ,r PH~5161-1-1 State and local sove~ents}. should be available forum th8 institutional busLue~a o£:c~s or from the addres~e~ listed h~low. C~re should taken in foiler.Jag the ~st~ctions ~.ctuded wi~ ~e application m~g ce~ain to ~lffil ~e points identified ~der ~e headin~ "Review C~teria." ~ original and s~x copies and two for State and local ~ove~ents} of ~e application should be sent or delivered to: Applica~n Receipt. Di~sioa of Research Grants, ~, Room 2~, Westwood Build.g, Be~esda, Me.land 2020& A brief cove~ng Ietter must accompany ~e application indicating • at.it is submitted ~ response to program a~ouncement. The ~etable for receiving applications and awarding grants is as follows: Applications received after the deadline date will be considered with the applications received for the followin~ deadline date, Awards will be made based on priority score ranking and emphasis area, as well as, availability of funds. FOR FURTHER INFORMATION CONTACT:. Faye Calhoun, Chief, Grants Administration and Review Branch, National Institute for Occupational Safety and Health. Parklawn Building, Rm. 8-63, 5600 Fishers Lane. Rockvflle, Maryland 20857, telephone: (~o~] Joseph West, Grants Management Officer, National Institute for Occupational Safety and Health, Parkhiwn Building, Rm. 8-29, 5600 FiShers Lane. Rockville, Maryland 20857, telephone: (301) ,;43-3122. [Catalog of Federal Domestic Assistsnce Program No. 33.2.62. Occupational Safety and Health Research Grants} Dated: September 10.19~0. Anthony Robbins, Director, National I~stitute for Occupatio~,~l Safely and He~tth. Office of Human DeveIopment Services Federal AIIotments to States for Personnel Training or Retraining; Promulgation for Fiscal Year 1981 Promulgation is made of the Federal Allotment for personnel training or retraining for Fiscal Year 1~1 for purpo.~es of grants to States under Title XX of the Social Security Act pumuant to Section 2002[a](2) of the Act which places a limitation on Federal matching funds for personnel training and retraining and mandates a formula for allocating such limitation. For Fiscal Year 1981, the Federal matchin~ funds ar~ limited to~ the highest of: • 4 percent of the State's Fiscal Year 1981 allotment for title XX social services or • The actual amount of Federal matching for the amounts spent by the State for training in Fiscal Year 1979. It is hereby promulgated, for purposes of grants to States for personnel trainin8 and retraining under title XX, that the Federal allotment to each of the 50 States and the D.istrict of Columbia for the Fiscal Year ending September 30, 1981, as determined pursuant to the Act on the basis of said formula shag be as set forth below: State A[Io~'nent Tota] ........ ~,_ ..................... $142,747,796 Atabatnl ..........................1,990,562 Alaska ........................................ 214.376 A~zona ............................... 1,924.619 Aiq~ansa~ ........................... 1,662.6,58 Ca~or~ .......................... 11,859,326 Cok:cado .................................. 1.420.310 ConneclJcut. ......................... 11,385,795 Delaware ........................................ Sl 0,128 O,st~Ct O! Colum~a ............................... 358,S35 FIorPJa ............................................... 4.571.59 I Hawa'i ........................................................ 477.I~0 I~a~ ............................................................ 467,053 IIh~ .................................................. &980,731 I~ ............................................. 2,8~8,707 Iowa ............................................................ 1,~0,532 ~n~ ................................................. 1,249.022 Ke~ucky ........................................ 2,~0,587 L~u~a ............................................. Ma~ .......................................... 1 ,~4,~ M~l~d ..................................... 2.203,875 Ma~chu~ .................................. 3,7 ~ 3.551 M~h~,~ ................................. 4.8~.102 M;~ ....................... 2.132.~2 M~ss~p~ ................................... 1.34&953 M~n ............................ 2,585,2~ ~JOn~3 ........................................ 1.178.~5 Nebrn~ .................................... ~2,~ ~ Ham~o ..................... 4~3.330 New C~ ............... 3,897.E~ New Yo¢~ .................................... 15.133.2~6 Ne~h Cmci,~o ................................... 4 057,171 Nc~h D~o~a .................................. 535,531 TI06650377
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Woman's succession of broken ribs ended when she quit her job Fh-st in a series By Josephioe Marcotty St~ff Writer It began three years ago. Susie DuBols came down with a cold, cougl~ed ~ and s~apped a rib. "I didn't know what happened," ~te said. "I |ust suddenly got tbls terrlble pain." A few weeks later, lying on her couch, she took a deep breath ~ and broke another rib. Between the spring of 1976 cad ~e summer of 19"/7 she brol~e another ~ trod another and auo~er ~ 11 in all She beg~n to have vlsimx~ of bur~ing apart like a skeleton in an old slapstick comedy, delldate bones crumbling on impact, "Have you ever broken a rib?" she asked. "| couldn't IHt a milk carton, I couldn't br~sh my hair, I couldn't do anythlng." When ~e rode In her husband's truck she sat surrounded by pillows, dreading every sharp tam, every sudden stop that might cause her more pain. Tl~e doctors had no ~er fur her and dismissed her complaints by trying to convince her that "it _isn't unusu_a. 1:" _ "That doctor said It's quite possible for a middle-aged woman to break her rib by cougl~lng," she said, still enraged by the futility and rite contusion she experienced then. So Dubois, a delicate woman with a cloud of dark l~Ir, finally prescribed her own draStiC but simple remedy. She quit her |oh. Althouglt she never took any action against her employers, Du~Bols is convinced tlmt her fragile bones were the result of Health conthtued on page 8A Health Continued from page IA the cadmium dust she inhaled during the 11 years s~e worked lot Gould, Inc., making small, hermetically sealed nickel.cadmium batteries. There is ~ yet no medical proof tlmt worldag ia Gould's SL Paut plant (931 Vandalla St) affected DuBois's healtlx ~ a~y w~y. The plant ,was -- and is -- well within the le~l stan- dards for cadmium set by the Minne- sota OccupatloneJ SaJety a~d Health AdxrdnL~ration (05]~). MINNEAPOLIS, MINN. TRIBUNE D. 226.899-S. 607,872 MFLS.-ST. PAUl. METROPOLITAN AREA JUL 27 ]E :9 :" • B61 DuBols doesn't need a lot of evi- x deuce: "All I know is that I feel 100 • " • percent better," she said a year after she had quit. No more broken bones, no more cougid~g -- both symptoms of cadmium poL~onln& the experts say. Cadmium L~ Just one of the millions ¢ff chem/cals and other substances absorbed every day by workers on their jobs. Experts know very little about what cadmium can do to the human body, thou@ some suspect that OSItA stan- dards for the metal are too liberal. They know even less about most of me other chemicaL,. And Minnesota, despite its lack of .. ]~e~vy industry and Its reputalion •. a comlmratlvely clean state, has its - Itealth problems. " ~ and chemicals are involved in - asriculture and the graln-processin8 Industry, noted Frank Lee, director • ot the occ'apat/ona/safety and health trainln$ program at the Universqty of . Minnesota's Industr/aJ Relations Cert- . .ter. And cadmium and other toxic ' • substances can be found in other In- - dustrles located l~ere. "Very few industries are hazard. tree," Lee said. "Even office work- ers have their health problems." Some improvements are being made in the employee Iaealth picture, but they &re coming slow]}', and the number of new chemicals is far 8renter than efforts to deal with their effects on workers. ,-\ T[08650378
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Lavlaa Paine sho~ up in lair ~ ~ound the u~on co~c~ ~ S~t~ Included a ~s~ Intend~ to prote~ worke~' heath ~d ~fety, compa~d ~ o~Y I0 ~rcent 1967, accordln~ ~ the B~U But ~e p~ ~ slow, eve~ to.- otis. Only a~ut 4~ of the 2 million c~e~ found in ~e wor~lace have ~en inv~t~ by HIOSH and re.fated by ~te and fede~t OSHA pro~ ~ ~e p~ de.de, accor~t~ to ~. Mor~ver, ~e ~d, ~OSH ~ t~e r~ou~ to layette o~Y ~ wor~p~ce cbemI~ ~ year, ~le ~o~ of ~c~ are ~e fe~e~ ~ve~ent e~c~ ~ even when B prov~ ~er W ~e ~pte who wort ~ IU it ~ ~e y~ for ~e he~n~, ~d ~e debat~ and ~e le~ c~leng~ to ~ completed and of t~ d~ ~ere l~wered c~Y p~ved, ~ou~ a union- low ~ ~e on~ ~o~ r~ommen~- e3xlter exl~'~e tl~n cRncer death~ In ~ ~e~ ~ de~ ~ I~ to 18 ~erce~ o~ ~e tw ~I d~ fro~ ~cer. ~d Ior ~e ~o~ o~ o~er work- d~ C~ ~ ~ her ~n~ ~ ~d for D~ and c~or~em ~ R ~ ~ t~ la~. ~etr m~t~ ~e~ ~ ~ ou ~e~ o~ Ohio aud Peu~~ ~th ~e~r But It ~ ~ave ~ -- and ~in ' ~lle~ tony of ~om ~e ~ffe~ ~e eff~ of long-te~ e~mu~ A ~dy conduct~ by ~e U~tve~lW of W~tn ~een 1974 ~d 1976 show~ ~t 47 percent of ~e 300 DutU~ ~d Su~or ~in ~ndle~ su~eY~ ~d ~ey suffered lung d~ ~ ~m chronic cou~g to ~vere emph~ cent In ~ ave~P poputa~on- ~t Row m~Y worke~ ~ die ~ s ~It of ~onal ~?~ How ~Y ~e ~bled ~ of h~ p~ble~ con~cted on ~ Job? ~ah ~t~1Y, ~e ~ p~ble~? ~OSH ~st~ ~t eve~ 100,000 ~ple In ~e U~t~ . dle ~ s r~It of ~me ~ p~blem. n~ "but we don't ~ow ~ey ~e," ~d ~B A~de~ bead ol ~e h~ ~io~ of ~m ~. ,,~ y~ ~ere were o~y s few d~ re~- ~ ~e ~te ~ not b~tY ~). ~t ne one ~o~" S~ w~ch ~ In c~ of kee~ ~g ~ck of 4~ ~ d~ec~y by ~pa~on ~ ~ow {n ~nl~ or a~cul~ for ~- ple -- but It d~ n~t ~" whe~- ac~dent cr a ~. ~ ~y c~ t~ ~e n~ few ~t even If a com~uter ~ s~It cut at work b a complex proc~. Take ~v~aa Pa)~, for e~mpl~ For ~ae ye~ s~e work~ ~ Du- ~ at the Gould pl~ S~v, t~, found ~at ~er bon~ would s~p der even ~e ~14~ pr~e piing up a char, tl~te~g a ba~ brace, ~er~g fo~ ~ a ~. Du~ Pa~e w~ ~ed ~d found to have exc~ively bl~ leve~ ~d~um in her bl~ ~ ~ ~e ~me she q~t her Job yea~. she t~ ~d ~ck~ lI "one st a ~me;" ~e ~d. "I hu~ for four mon~" ~e ~ "I w~ U~ of hu~ I coul~'t ~e wW ~ ~n~ were I But s~' ~ok~ -- c~m con~n~mtum -- ~d for y~ she ~ on hy~ne, a m~i~on ~a~ ~uld have con~ ut~ ~ her finale ~n~ ~d Dr. Roger Lu~ ~ ph~i~ • e SL Paul-R~y Medl~l Center Occu~o~ He~ ~. ~g to dete~ne whlc~ ff ~y, an e~Ive, ~me~ p~l, medi~ lav~on ~at co~d y~ ~ no ~ce of con~u- slve ~I~ Luc~n ~d. S~ll, she ~ ~g an ~er. Over the y~ she ~ ~d ~p~t~ly ~d biR~ly.~ her f~ly ~tor. She ~d he bad d~ her con- ce~ ~at ~d~um could ~ ~n- ~bu~ns to ~er problem. "He ~d it's no morn ~ W me ~an ci~e~e smog" ~e ~d. "~t ~ey didn't tell me ~Ing a~ut ~d~um w~ I ~ here. I ~o~ but I ~e to do ~at ~e~'s a wa~i~ on ~e pa~e. didn't ~ow about ~e cadmium." S~e compla~ed ~v¢~ ~m~ to company, whic~ m~de some up ~e d~ ~d ~e ~m~ny ~l~ ~ ~r condt~oner, s~e ~Id. ~llo ~id the company ~ce ~ all ~e technalo~ v~cem~ In con~olling ~e ardo~ su~nc~ In ~e Now ~e ~y~ hom~ ~ ~er feet prop~d up to e~ ~e ~n her bac~ She con~n~ Rer of t~ ~d ~I~ to pb)~ to TI0865035
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About the writer: a staff writer for the Tr/bune, ¢peclaliz~ng in labor and l~usiness reporting, since last summer. Befure coming to Minneapolis, she was a reporter in Dayton, Ohio. find cut whether cadmium is the cause of her pain and what it could possibly mean for the future. For both Payne and DuBoLs, fragile bones could be only the beglanin~ "Once present in the body, cadmium can lead to a variety of diseases, in- eluding anemia, high blood pressure and cardiovascular disease, liver and kidney damege, pulmonary and emphysema -- and cancer," accord- ing to the Environmental Defense Fund in lis book on environmental cancer-causing substances, nanl Neglect." Cadmium is a carcinogen in test ant. reals, and studies indicate that it may be one of the most potent metnl- Sic carcinogens yet known," the book charges. Happenstance has provided Payne with some health beaeflis. She is re- ceiving worker's compensation in- suronce because she injured her back at work when she picked up a box of battery parts. If she had in- jured herself while picking up a box at home, she would have bad to prove that her bones were weakened by the cadmium she encountered at work to receive compensation. DuBois is not receiving benefits. She is one o! the unknown number of people who, as Lee said, "fall through the cracks ot the worker compensation system. They are picked up on Socio! Security and o er welfare programs." They Just quit, or die, or go quietly to the hospital, letting medical insurance and other compensation take care of them without trying to discover what made them ill. DuBois is not even a health statistic. But it may be fortunate for DuBois and t~e 1.4 ndllton other workers in the United States who are exposed to c~dmium on the |oh that Payne LS not satisfied with simply accepting her worl~er's compensation henefl~ With Lee's a.~L~nce, she has ~sked that NIO~H do a l~enlth h~ard u.~tio~ cn the Gould Her urdon, L~¢~I I10 of the Inierna- ttonzfl Brotherhood of Electrlcal Workers, ~d ~nld o~ a~eed to c~e~te in ~ vey of ~e ~orke~ ~ we~ ~u~ e~m~m of ~e d~ leve~ in ~e pl~L L~ ~ld t~t SL ~-~Y Medi- ~ ~nte~s ~cup~flo~ medicine de~en~ ~onld ~ ~ll~ to , ~de d~c ~c~ for ~e era. ploys, ~d ~t he wo~d pro~ ~ pmHde ~l~g to ~d employ~ and ~o~ in reco~ ~ug ~d eb~ng he~ p~ble~ In ~e pl~L Dumb, P~e and ~e 1.4 million o~er worke~ ~ ~e U~ted S~t~ who ~ e~d to ~um may~ ~ ~e en¢ ~d out what ~d~ ~n do to ~em ~ perh~ only ~ Lee ~d Pa~e aR ta~cio~ enou~ to p~h for an a~er. But ~ ~ done o~y if ~e workem ~ow of ~e d~er, and if ~e corn- paw ~ ~lHn8 to c~rnle. "~dmi~ should not be ~ly in a d~t fo~" ~d ~11o. "We ~ink our p~t b cl~ but It co~d be ~er." Monda~ When the company won~ tell you what chemicals you're working TI06650380
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Blamed for Anxiety, Painz and Strains S~dy F/nds Workoads Set On Capability o~ Machines Rather Than o~ Humans Using video display terminals can mean B~II [has I~IIR all. Accordl~'g'to a hew fed- era] study, the dam-dlsplay computer units can cause eye strain, blun'ed vision, color l:erceptlon dlf/Icu[tles, sore shoulders, and nnmbness and loss of strenglh 'in users" arms. In addition, VDT users have higher -levels.of anxiety, depresslon, confusion a~d fatlguethan cont~l gmu~.. . ' . :'Offices were 'set up for l~'~le to work ~t typewriters or ~th pencil ar~. paper," says Mtchael Smith o! the Nattefial Institute for Ocou~Eo~[ Safety ~d Health. B~t of- ~es nm~ have more than bye re|Ilion vlyrs ~:cordtug ~o in.trite estimates, end five million to seven ral~n • people' them daily. A~ a result, lighting, window placement and other elements of office de- sign may have to he rethooght...." . .," '. The sa/ety ~m¢~ healihil~tit~'te C~nd~cted the VD~ study" a~' the ~quest of unto~ ~ree newspapere-Tha Oa~dand" ~rlbane. San Francisco r~xaminer and San Francisco Chronl,c~e-anc[ Blt~, ,Shield of California. ,Researchers also fotmd that radiation em|s. stons, long a concern of VD~.ustr$. weren,t so~cient to endanger heaith.+. :. . : • .. • • Vl:rfs .are sold to managements o~ the basis of productivity,''+ Mr..Smith says. When VD'I's ate Installed+ the demami on w~rkers becomes "extremely high.., peo- ple are being worked much too hard, The c~lity of the ~',tchine rather than ~ ~e lmmans,L~ the way-workload requirements different Jo~ are a/footed differently'.:' 2~nl~aPer re~orters h~ fe~w complaints than lnsa~ company employe9 becatme they ha~t +more+ control ove~ how. Ionf they Researc~rs also fo~md" that employes rded m alleviate problems on t~eir own. Some slanted+ their te~ on blocks to ~edu~e glare and eye stralr~ Others II~ured o~t ]mw close to sit to th'e VD~' based on whether th,ey were nearalghted +or far- The study lS+hel~ reviewed by the em- ph~ers and tinlons ~Involv~, and a final re. pen ~ be L~med la~er t~s )~ar. Speke~- men s~y l~e $~Iel~ and the three newspa- pers haven't decfded w~e~er ~o re~eslgn •.eir o~ce~ asa re~uRo! the s~y. 1~ s~rn~ e~cr a~e Examiner. Davfd Cele. sa}~. "'I reca~ t~,t t~ere wei~ TI06650381
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Asbestos standards are urged WASHINGTON (UP1) --' Asbestos poses a "grave danger" to 1.4 million American work- ers and new government standards should be adopted limiting expo- sure to the lowest measurable level, a re- l~ort by two agencies said Thursday. Anthony Robbins, di- rector of the National In- stitute "for Occupational ~ ..... Safety and Health, said the, study confirmed pre- vious findings that no lev- el of exposure to asbestos is safe and that asbestos causes disease -- includ- ing several types of can- cer and lung ailments. The conclusions were in'a Bl-page report on a study by the institute and the Labor Department's Occupational Safety and Health Administration. The report recom. mended that current standards, limiting as- bestos exposure to 2 mil- lion fibers per cubic meter of air, be reduced • to 10~},0~0 fibers. Robbins said that is "'the lowest level which can be accu- rately measured." About 6o0,0~0 tons of as- bestos are used annually in thc United States in such products as floor tiles, cements and brake linings. Institute scientist John Dement said that, "even if we eliminate all new manufacturing of asbes- tos, we will be dealing with asbestos for years to Construction workers still will have to demolish old buildings containing the substance, and ship- ya.rd workers will have to work on vessels coated with it years ago. In a related matter, the U.S. Consumer Product Safety Commission this ~ Ill - - week voted unanimously to grant a petition to ban asbestos paper used pri- marily to insulate hot water pipes and for wall protection near stoves and ovens. Tl0665038:
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KEEP TOBACCO PRODUCTS OUT OF WORKPLACE, NIOSH ADVISES In a Current Intelligence Bulletin, the National Institute for Occu- pational Safety and Health (NIOSH) recommends that the use of and/or carry- ing of tobacco products into the worIcplace be curtailed in situations where employees may be exposed to physical or chemical substances which can interact with tobacco products° Additionally, curtailment of the use of tobacco products in the work- place should be accompanied by simultaneous control of worker exposure to physical and chemical agents, NIOSH said: The Federal agency noted that these recommendations are based on evi- dence which indicates that smoking can act in combination with hazardous agents to produce or increase the severity of a wide range of adverse health effects. Six ways have been identified by which smoking can interact with workplace exposures: HS ADVISOR PAGE 13. Certain toxic agents in tobacco products and~or smoke may also occur in the workplace, thus increasing expo- sure to the agent. Workplace chemicals may be transformed into more harm- ful agents by smoking. Tobacco products may serw. as vectors: by becoming con- t~mi~:~tu*J w~th toxic agents found in the workplace, thus Cac~1~tatin.q entry of the agent into the body by inhalac]on, ~. nge.~tion and~or skin absorption. Smo~cin9 c,_~n contribute to an effect comparable to that which can result from exposure to toxic agents found in the workplace, thus causing an additive "~ioiogZcal effect. Smo~ing may act sgnergistically with toxic agents found ~n the workplace to cau.~e a muc.5 more profound effect then th,~t anticipated simplt2 from the separate influ- ences of the occupational exp~sur(, and smoking. Smoking ma9 contribute to w,J±'kpZace accidents; in a Ilir~C.'--m<)[Ir-,~l StUdy Of job accidents, the tota¢ accident non-smDkers. fl[OSH defines smoking and/or tobacco products as cigarettes, cigars, pipe ~obacco, che~;ing tobacco, and any by-products resulting from their burning and/or use. TI06650383
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NEWS RELEASE CONTENTS Lack of Exercise is Minor Risk Factor in Heart llls .............. Page 2 Hyperbaric Oxygen Chamber Succeeds in Treating Air Bubbles in Body .... Page 3 A~ Sets Annual Meeting on Occupational Health ............... Page 4 TI08650384
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- 2 - FOR II-£~DIATE RELEASE For further information contact: Frank Chappell Office: 312/751-6606 Home: 312/644-2426 LACK OF EXERCISE IS MINOR RISK FACTOR IN HEART ILLS CHICAGO -- Lack of exercise increases a man's risk of heart disease, but not much. High blood pressure, smoking, overweight and high cholesterol are more dangerous risk factors. These are the findings in the latest report from the Framingham Study, a longterm investigation into many aspects of heart disease. The report is in the August issue of an American Medical Association specialty journal, Archives of Internal Medicine. William B. Kannel, M.D., of Boston University School of Nedicine, Framingham, Mass., tells of studies in which 1,909 men and 2,311 women were assessed for level of physical activity, and then observed for 14 years to determine how many suffered heart disease. The effect of being sedentary on death rate is rather modest for men, compared to the effects of other risk factors. For women, the effect is negligible, Dr. Kannel says. Active men live longer than sedentary ones, and have less heart disease, and the doctors by no means belittle the importance of regular exercise, either at work or at play or both. But, "It has not yet been convincingly or consistently established that physical activity is an important determinant of the degree to which the major risk factors exist in the general population. In the Framingham Study, the corrolations between physical activity and the major risk factors of systolic blood pressure,serum cholesterol level, and cigarette compumption are very small." Dr. Kannel reports. Aug. 27, 1979 T106650385
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- 3- FOR I~.~DIATE RELEASE For further information contact: Frank Chappell Office: 312/751-6606 Home: 312/644-2426 HYPERBARIC OXYGEN CHTU4BER SUCCEEDS IN TREATING AIR BUBBLES IN BODY CHICAGO -- A serious and common medical problem is the air bubble. Some 20,000 individuals each year suffer permanent brain damage from an air bubble that gets into the blood stream and reaches the brain. Successful treatment of the air bubble, properly called air embolism, with use of a hyperbaric oxygen chamber is reported in the August issue of an ~merican Medical Association specialty journal, Archives of Neurology. Air emboli have been reported following an injury or surgery, from intravenous therapy, kidney dialysis, some diagnostic procedures requiring injections, oral genital sexual relations in the female, high altitude accidents, and diving accidents, says Jon T. 14ader, M.D., of the University of Texas Medical Branch, Galveston, Texas. Conventional treatment heretofore has been unsatisfactory, resulting in a death rate of 30 per cent, Dr. Mader reports. But with hyperbaric oxygen chamber treatment, the death rate has been held down to 6 per cent. The patient is placed in one of the large chambers designed originally by the U.S. Navy to aid in decompression of divers and submariners who surface too fast from a deep dive. Air pressure is greatly increased in the chamber. Treatment is most effective when begun promptly, but can be of help even after a delay of up to 29 hours, Dr, Mader says. Pressure decreases the size of the bubbles. Inhaling I00 per cent oxygen clears ni£rogen from the blood and accelerates absorption of air bubbles. Chamber treatment lowers ~ressure on the brain by half, and also results in more oxygen reaching brain tissues,-he found. Dr. Mader describes treatment of a 23-year-old woman suffering from an air embolism. Recovery was excellent. Treatment was by a protocol developed by the Na%~T for treating air embolism occurring in submarine escape training. Aug. 27, 1979 TI06650386
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- 4- FOR I~,~DIATE RELEASE For further information contact: Frank Chappell Office: 312/751-6606 Home: 312/644-2426 A~ SETS ANNUAL I~ETING ON OCCUPATIONAL HEALTH CHICAGO -- The 39th Annual Congress on Occupational Health of the American Medical Association will be held Oct. 24-26 at the University of North Carolina at Chapel Hill. Co-sponsor will be the National Institute for Occupational Safety and Health, (NIOSH). Conference program is planned for all health professionals, and will be of particular interest and benefit to the part-time occupational physician, says Jermyn Fo McCahan, M.D., the AMA's director of occupational health and program coordinator for the meeting. A highlight of the program will be presentation of "Physician of the Year Award" by the President's Committee on Employment of the Handicapped at an award banquet. Each year the committee honors a physician for outstanding service to the handicapped. Presentation will be by Harold Russell, chairman of the President's Committee. Proceedings of the Congress will be edited by the ~IA and published by NIOSH as another volume in the shelf of similar books that serve as a reference library for the industrial physician. Opening keynote address on Oct. 24 will be by Anthony Robbins, M.D., NIOSH director, of Rockville, ~.~. Hoyt D. Gardner, M.D., of Louisville, KY., president of the A~4A, will speak on "The Private Practitioner and Occupational Medicine." Other speakers will explore such topics as health problems in the mining industry, women in today's labor force, occupational cancer, small plants and their medical problems and health effects of wood dust Further infOrmatiOn on the congress is available from the Department of Environmental, Public and Occupational Health, American Medical Association, 535 N. Dearborn St., Chicago, IL 60610 # Aug. 27, 1979 T106650387
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CAMPBELL JOHNSON LI~IITED 20 July 1979 Multiple effects of. smoking at work described It has long been recommemded that workers in the rubber and asbestos industries give up smoking or change to a pipe to try to counteract the synergistic effect of smoking and exposure to carcinogens, which is far greater than the sum of the effects of the two separate influences. Now, however, the US Nationa1~ Institute of Occupational Safety and Health (NIOSH) has recommended wider restrictions on smoking in workplaces other than those where asbestos is .used. As well as synergistic effects, }IIOSH describes four other ways in which smoking can interact with. workplace agents to aggravate biological ef-fects: donbling up of exposure to substances such as carbon monoxide; degradation of atmospheric pollutants by the heat from cigarettes; the ability of cigarette smoke to carry toxic chemicals into the lung; and the conventional respirato~ effects of smoking. which can be as great as the respiratory effects caused by some workplace chemic~£~s leading to another additive form of ~action. It has now been found that a non-smoking asbest~s worker had. a 5 times • gmeater risk of contracting lung cancer than a control; a smoking non- asbestos-e.~cposed worker~'s risk was increased ~I times; but a smokin.g asbestos worker ran a risk 53 times gre~te~ than the control. This was discovered by Irving Selikoff at Mount Sinai School of Medicine, Ne~ Yorl=, stud reported at the April "Asbestos 79" conference in London by his co- worker, Dr Nicholas. (Health & Saf~+.v :,t Work. July ~o~o~ TI06650388
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! STATEN IS~AI~O, N.Y. ADVAHCE O. 71,839-$. 75.602 NEW ¥C~K CiTY MET~OPOLITA~ AI~EA Educated non-smoker L~t J'uly. T~uts Ce'nei resigned la~ high sch~h at t~ ~ of ~h~ Chancellor Fran~ J. Macehiarola. C~, a~ ~u~r for ~ years, was f~ ~n~ ~ a p~nci~l t~Hty; C~l was pr~ci~l ot New ~[ ~or five y~ ~o~ ass~ng • e ~fin~ent's ~sition. N~ ~e 57-year~ld ~r ~nt ~• ~w job ~ r of ~e National lnter-agen~ ~, ~e agen~ ~t~ ~e effo~ p~l~ of smo~.among Hk ~jor proj~t ~s ~ set~ng up ~o~1 ~e~n~ on You~ aad Smok- ing ~o ~ held ~ la~ Apr~ in cis~. Cen~ sa~ he is s~l ~g ~e of a~J~st~tJon ~at he ]ea~ in ~e s~l system. He says the new job p~ vid~ h~" ~ ~rt~es ~ ~ave] a~ he {in~s It 'Inte~s~ng, ~cl~g ~Wr ~e ~ou~ ~i~, C~ci he p~ ~ at~ck ~e double ~eat of "~ok~g ~ ~e wc~place," ~, w~ a~ t~t. ~ ~ to T]06650389
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Occupational Health Priorities for Health Standards: The Current NIOSH Approach JIMMY L. PERKINS, MS, AND VERNON E. ROSE, DRPH Abstract: Government agencies responsible for protecting the public from the adverse effects of toxic chemicals must set priorities for research, regulatory action, protocol testing, and monitoring due to the vast number of toxic chemicals and the limited resources available to these agencies. The National Institute for Occupational Safety and Health (NIOSH) must set pri- orities for research on hazards ,encountered in the workplace. Priorities are also utilized by NIOSH in preparing criteria for recommended occupational stan- dards which are forwarded to the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor, for possible promulgation. For various rea- sons, including rapidly changing conditions in the American workplace, NIOSH has instituted a revised priorities program. In the future, NIOSH research and recommended standards activities will focus not only on individual chemicals, but also on industries, occu- pations, chemical classes, and general industrial proc- esses. NIOSH has also implemented a new program which will allow recommended control procedures for certain chemicals to be forwarded to OSHA in a short- er time period than has been experienced previously. (Am. J. Public Health 69:444-449, 1979). Limits and constraints on budget and manpower are the major reasons for assessment of priorities. Whether in gov- ernment, private enterprise, or academia, an orderly and systematic approach to the allocation of resources is neces- sary. For health-oriented government agencies, such as the National Institute for Occupational Safety and Health (NIOSH), the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), priorities for assess- ing the possible health effects of toxic chemicals are a prima- ry concern. More than 9,000 chemicals were commercially produced in the United States in 1970.= Currently the NIOSH Registry of Toxic Effects of Chemical Substances contains over 28,000 chemical entries.~ The Chemical Ab- stracting Service (CAS) has now registered more than 4,000,000 chemicals, and new CAS entries are being made at the rate of 21,000 per month,t' Clearly, these health agencies are faced with a monumental task in developing priorities for research, protocol testing, monitoring, and regulatory ac- tion. Ideally, the assessment of each chemical should be based on several factors. Toxicity, which may include pre- From the National Institute for Occupational Safety and Health. DHEW, Rockvitle, MD. Address reprint req~:ests to Jimmy L. Perkins. MS. 6118 Fairdale. Apt. 65, Houston. TX 77057. This Irap~r. submitted to th~ Journal Ju~ 39, 197,~, ,,~s revised ar, d cepted for p~bl~c~t[on No','emlzer 8. 197& 444 dieted or documented adverse health effects, and the popu- lation at risk, including the extent of that risk, are the most important factors. Other factors with varying degrees of im- portance include production levels; trends in use; environ- mental conversion or fate; adequacy of previous research, testing, or standards setting attempts; and physical charac- teristics such as volatility or physical state. Unfortunately, the data needed to assess the priority of each chemical are not always available. For example, production data are available for only a small percentage of chemicals due to the current proprietary nature of the information.-' Under provi- sions of the 1976 Toxic Substances Control Act,.~ production data should become available to certain agencies for the pur- pose of establishing priorities for evaluation and regulation of chemical substances. The two most important factors used in establishing pri- orities, i.e., toxicity and population at risk, are also the most difficult to assess. Methods used for assessing toxicity have varied considerably. Stephenson4 used the "'Delphi" meth- od, a modified version of which was used by NIOSH as will be subsequently described. In the Delphi approach,~ a panel of experts rank a series of chemicals with or without the aid ~Unpubl_~sh~.d data, Registry ~f To.r~c Effects of Chemical S~b- stat:ces. NIOSH, May 1978. ~Pe~on=el communication, Chemical Abstmzt S¢~ice, P.O. Box 3012, Columbus, OU 43210. ~,1~ 24, AJPH M~y, 1979, VoL 69, N~. 5 TI06650390
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LOS ANGELES COU,~ITY MALFFL:,,CTICE SLOWDO~';N 1 Stab Wound Che,~t 2 hrs .79 2 Head Trauma 4 hrs .55 3 GSWa, Head and Chest 2V= hrs 0 4 Head Trauma 21/2 hrs .03 5 G.I.b He~r~age 2 h~ .06 6 Cipher,s ~/~ hrs 0 7 Pneumonia 1~/~ hm 0 8 He~d Trauma 3V= hm .01 9 He~d Trau~ 1 ~/= hrs .01 10 Carcinoma 3~/, hm 0 11 Head Trauma 2 hrs .03 12 Head Trauma 1 ~/, hm .04 13 CVAc 4~/~ hm .04 14 Head Trauma 1 ~/= hrs ,08 15 Pneumonia 2tlz hrs .05 16 Aerie Aneu~sm 1 hr .05 17 Multiple Trauma 1~/~ hrs .11 18 G.I. Hemo~hage 2V= hrs 0 19 CH~ 2 hrs 20 GS~, Head 1 ~/~ hm 0 21 Renal Disease Vz hr 0 a) GSW = Gunshot Wound b) GI = Gastrointestinal c) CVA = Cerebrovascular Accident d) CHF = Congestive Heart Failure losses to affected hospitals and their employees respectively. Specific health impacts could not be as well defined. Avail- able data indicated a decrease ofag per cent for hospital ad- missions and 42 per cent for surgical procedures as com- pared to a similar period one year earlier. Analyses of popu- lation surveys, paramedic ambulance runs, and emergency room visits did not indicate that the populace of Los Angeles County perceived or experienced any real difficulty in either receiving medical care or receiving il from their usual care sources. An analysis of "'macro" or population mortality figures for Los Angeles County showed no significant change for the strike and non-strike periods. A "'micro" or individual case analysis was conducted on a series of patient transfers to identify and measure any attributable mortality that might have resulted from the MD strike. It was found that there was an overall increase of 41 per cent in patient transfers during the strike and that an esti- mated 9 per cent of the overall mortality experience for the series studied might have been preventable had definitive care been initially rendered. The portion of this preventable mortality that could be attributed to the physicians' strike was estimated to be 29 per cent. This indicated that some other factor or factors such as patient dumping also contrib- uted to the measured attributable mortality. Overall, the study findings support the conclusion that the physicians" strike had a marked financial impact on in- volved hospitals. Collectively, however, the remaining data cannot support a conclusion that the strike significandy im- pacted on the health status and?or mortality experience of the County popalati,on. They do indicate that if there were such impacts, they were very small. Finally, this conclusion, coupted with the estimated number of o]:erative deaths that did not occur as a direct consequence of the strike, suggests that, on balance, the Los Angeles County physicians" strike of January 1976 was responsible for more deaths prevented than lives lost. The data collected did not attempt to measure the personal stress or hardship and lost earnings of patients incident to the postponement of elective operations occa- sioned by the strike. REFERENCES I. Badgley R and Wolfe S: Doctor's Strike. New York: Atherton Press, 1967. 2. Editorial. Crisis in state medicine abroad, Canadian Medical As- sociation Journal, 92:844, 1965. 3. Schwartz H: The public will not tolerate disruptive strikes, Hos- pitals, 49:43-46, 1975. 4. Wolfe S: Worker conflicts in the health field: An overview, In- ternational Journal of Health Services, 5:5-8, 1975. 5. Badgley R: Health worker strikes, International Journal of Health Services, 5:9-17, 1975. 6. Davis LI and Foner M: Organization and unionization of health workers in the United States, International Journal of Health Services, 5:19-26, 1975. 7. Match RK, Goldstein AH and Light HL: Unionization, strikes, threatened strikes, and hopitals, International Journal of Health Services, 5:27-36, 1975. S. Marcus S: The purposes of unionization in the medical profes- sion, International Journal of Health Services, 5:37-42, 1975. 9. Ehrenreich B and Ehrenreich JH: Hospital workers: Class con- flicts in the making, International Journal of Health Services, 5:43-51, 1975. 10. Belmar R and Sidei VW: An international perspective on strikes and strike threats by physicians: The case of Chile, Inter- national Journal of Health Services, 5:53-64, 1975. I1. Bellin LE: The Nursing Home Strike: November 5-12, 1973, Mortality in Seven Struck Free-Standing Nursing Homes. New York City: Department of Health, 1976. 12. How Doctors Feel About Strikes, American Medical News, Chicago, February 23, 1976. 13. Appelbaum A: The meaning of the New York strike, Hospitals, 49:17A-17D, 1975. 14. MeNamara JJ and Greene M: An evaluation ofemergeney room services during the New York City house officer strike, Am Public Health, 66:135-138, 1976. 15. Gonzalez A: Behind the British housestaffstrike, Hospital Phy- sician, 12:32-34, 1976. 16. Housestaffs End Strike in Los Angeles, American Medical News, Chicago. May, 1976. 17. Maddox, D: Doctors' Slowdown, Modem Healthear¢, 5:41-50. 18. Select Committee on Medical Malpractice of the California As- sembly, 1974. Medical Malpractice-Preliminary Report. Sacra- mento, California, 1974. 19. James J: The Mortality Impact of the Medical Malpractice Slow- down in Los Angeles County, January 1976. Doctoral Thesis, UCLA School of Public Health, California, 1976. 20. Times Survey, The Los Angeles Times, January-February 1976. 21. Editor's Note: American Medical News, February 16, 1976. 22. Bunker J and Wennberg J: Operation rates, mortality statistics, and the quality of life, N Engl J Meal, 289:1249-1251, 1973. 23. Frederick L: How Much Unnecessary Surgery? Medical World News, May 3, 1976, 50-65. 24. Roomer MI and Mera JA: Patient-dumplng and other voluntary agency contributions to public agency problems, Medical Care, I i :30--39, t973. 25. De Vise P: C~ok County host:~tal: Bulwark of Chlcago's a~art- Eei:l health system, TEe New Phys£:i:~, 20:394-3~;~, 1971. 26. Ald~.n S: T~e other d,Jral~ing s>n:lrome, Hos~kal Physician, 5:~- 8, 1976. 1979, Vcl. 69, No. 5 443 TI06650391
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of sups:erring data. The g~al is to reach a consensus agree- ment. or at least a narrowing of opinion, through art Rerative process which ~ov, s each ~c~pant to ~e h~w his ~ws fit with thos~ of the group. This m~th~ works best if the number of chemicals to be ranked is limited ~d weIl de- fined. For example, Stephenson ranked 80 ck~mic~s, while NIOSH ranked 475. Brown~ assessed the hazardousness of industries in Allegheny County, Pennsylvania, using reaP- ed data indicating the incidence of eccupation~ illness. This method is simple and straightfo~ard: h~wever, occupation- al illness data should not be relied u~n as a sole f~[or, as the current adequacy and accuracy of illness re~ing is poor and sometimes can be misleading.~ The ~pulation at risk factor includes level of exposure and duration or length of time of exposure. These variables are extremely di~cult to assess. Early attempts to ~in knowledge about chemical exposures in occupational popu- lationss- ~ did not include an assessment of air,me concen- tration or time of exposure. The 1974 NIOSH National Oc- cupational Hazard Survey INOHS)t° defined exposure time as either full-time or pad-dine, paR-time designating four hours or less of exposure per day. No atlempl to assess con- centmtion was made. To simply state that 2,~,0~ people are occupalionafiy exposed to benzene does not address the complex issues of time and concentration. Although these variables can be determined, the effo~ to do so for seve~ thousand chemicals would be a lime-consuming and costly task. Consequently. simple population at risk estimates, such as those made using NOHS dam, normally have to be used, but their limitations should be understood. Obviously, differences exist in the data that each federal agency uses for assessmen~ of chemical priorities. The EPA must consider environmental fate and the possibility of envi- ronmental release. NIOSH is concerned with occupational populations. The FDA must consider therapeutic vs toxic effects of drags. Neve~heless, the major parameters eval- uated by each agency for assessing chemical priorities usufl- ly include population at risk and toxicity, and each agency must concern itseffwitb an enormous number ofchemicfls. Development of the NIOSH Approach As required by the Occupational Safety and Health Act of 1970, N1OSH has attempted to remain cognizant of the large number of commercial chemicals to which varying numbers of workers are exposed. Among other provisions, the Act directs NIOSH to develop and conduct research and experiments which will yield criteria for identifying toxic substances and for developing recommended occupational safety and health standards. These recommended standards, or criteria documents, describe, among other items, safe ex- posure levels and working conditions designed to ensure that "'no employee will suffer impaired health or functional ca- pacities or diminished life expectancy as a result of the work experience.TM Recommended standards are forwarded to the U.S. Department of Labor, Occupational Safety and Health Administration (OSHAI, for promulgation and are al- so available to employers, employees, and government agencies as guides for x'oluntary compliance. AJPH May, 1979. Vol 69, No. 5 OCCUPATIO~,~#,L H=,.~ALTH PR!ORiTIrEs NIOSH's commitment to setting priorities is based on the belief that such a ssstematic approzch is necessaD" to ensure the effective utilization of limited resources, thereby having the greatest cost-effective impact on the he',dth and safety problems facing tl~e working l~Opu[ation. Priorities are established for the selection of subjects, for the preparation of criteria for recommended occupational standards, and for the conduct of laboratory research. These are not necessari- ly independent, as much of the NIOSH research is related to providing necessaD' information for effective preparation of criteria documents. Currently, NIOSH prepares 20 to 24 cri- teria documents per year. The subjects may include individ- ual chemical or chemical or physical agents, classes or groups of agents, industries, occupations, or specific proc- esses within an industry (see Appendices Tables [ and 2L From 1972 until |975, NIDSH compiled three priority lists. While different variables were utilized in compiling each list, population at risk and toxicity of the agent were used as a minimum in all three lists. The 1972 priority lis02 contained 19 sets ofsubstances, each set consisting of five or six subjects having equal priority. Listed were individual toxic agents, including chemicals, mineral dusts, and phys- ical agents. The 1972 priority list was based on a system developed by the staffer the former Bureau of Occupational Safety and Health, which became NIOSH in 1971. Subjective rankings were made by Bureau staff and field industrial hygienists us- ing population at risk, relative toxicity of the hazard, in- cidence of occupational illness, quantity produced, and trend in use. Unfortunately, many of the data were not avail- able for every agent, thereby dictating the use of subjective judgments. In March 1973, a new NIOSH priority list was devel- oped using population at risk and severity of toxic effect as the only criteria. The product of these two numerical factors represented the overall priority factor for each chemical Criteria documents were to be developed on each subject in the order that it occurred on the list. Estimates of population at risk for each of the 475 agents listed were obtained using national estimates extrapolated from the 1970 Occupational Hazard Safety of the Chicago Metropolitan Area.8 As noted earlier, the approach was modeled after the Delphi process, but because of time and resource constraints a modified approach was used. Under contract, a toxicity severity rating was developed for each of the 475 agents based on a series of subjective judgments by a panel of 50 occupationa~ health professionals. Although the severity rat- ings were to include carcinogenicity and other delayed tox- icities, it is probable that the rankings were based more on classical or acute toxicologic factors. Data regarding carcin- ogenicity were not as readily available or abundant in 1972 as at present. Consequently. agenls with notable chronic ef- fects, such as vinyl chloride, received low toxicity ratings. Lack &knowledge as to possible delayed toxic effects con- stantly plagues the assessment of the overall toxicity of chemicals. Based on the 1973 priority list, a third list ,.:,as prepared irt 1975 by NIOSH staff. Three new fi'ctors were considered: 445 T106650392
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AND F:i~ F_. t~ Iz~k of a fede~l occupational st~, and new or re- vised iafo~at[on regarding t~ ~tenti~ h~rd of t~ 475 agents on the I973 list. T~e top 50 h~dous agents subjectively ~nked, and those remaining ~e~ts which ~re ~sitiv~ for at least one of the new f~tors were placed in an u~ranked catego~. Those agents which were negative for all of the three new facto~ were deleted. This list was used by NIOSH until 19~. The three NIOSH priority lists, while se~,ing NIOSH relatively well, have had the following deficiencies. • The sco~ of NIOSH priorities h~ ~en too fimRed. While the 1973 list was the l~gest, i~ contained only 475 agents, one industrial process, and sever~ physical agents. There was no attempt to group structurally related chemical compounds; • The methods used to gene~te some data could be im- proved, e.g., the "'Delphi'" method used to generate severity rankings for the 1973 list. While subjective opinions are sometimes necessa~, they should ~ avoided whenever ob- jective data are available: • Greater involvement of affected groups, including in- dustry, unions, and other gove~ment agencies, w~ n~eded. Such involvement, assuming it came from experienced sources, would provide a broader consideration of the need to develop new or revised standards and would help to sure that NIOSH pfofities reflected priorities of other knowledgeable groups and affected pa~ies; • There was a need for better cooperation between OSHA and NIOSH in the preparation of priority lists: • A formalized process with a schedule of events was not used for priority assessment, which in lurn did not ~low lbr e~ciem, orderl~ planning of research or allocation of funds for that rese~ch: • Priorities for criteria documents were not identified far enough in advance to allow the NIOSH research and grants program to identify significant research activities: the successful accomplishment of which would ~sult in ~tter recommended standards: • Toxicity ratings did not place enough emphasis on chronic or delayed aspects of hazardous agenls and, con- sequently, did not reflect the best estimate of the need for a stand~d b~ed on potential harm to workers. The Current Situation Based on the above, NIOSH decided in 1976 that ira new approach to setting priorities was to work, the problems of past priority systems would have to be thoroughly eval- uated and future problems anticipated and resolved as early as possible. Assessment of chemical priorities would have to be undertaken with consideration of at least three new and important factors. First, industry is using more and more compounds which are unevaluated as to toxic potential. Hopefully the implementation by EPA of the Toxic Substances Control Act will have some impact on the availability of information for substances in use as well as new ones. However, it 446 tmke many ],ears to develop tl:.e ~ecessary information to adequately ewluate the p~tential hazard of the thousands of chemicals now in use. Second, the hazardous properties of most comlzounds for which there are large populations at risk (greater than 100,(100 workers) have been documented by NIOSH. Future work involves updating these documents with new informa- tion and, where necessary, revising the recommendations through a separate effort. Many of the chemicals NIOSH must now consider are specialty chemicals involving rela- tively small numbers of exposed current. Third, population at risk estimates are not available for all commercial chemicals, and where estimates are available, they are difficult to keep current. To address these problems, NIOSH has determined that criteria documents and recommended standards should be prepared for classes of toxicologically and structurally re- lated compounds, and for processes, occupations, or specif- ic industries. Also, a new document, the Special or Emer- gency Occupational Hazard Review will be prepared when the population at risk factor is not large enough to warrant a criteria document, or when a response in a shorter time peri- od is required. These new documents will emphasize meth- ods of controlling exposure rather than environmental (workplace air) limits. These new initiatives will accomplish several important goals. Preparation of criteria documents on chemical classes will increase the population at risk covered by the recom- mended standard and result in a more efficient use of NIOSH resources. By preparing recommended standards for specific industries, processes, and occupations, the health and safety of those workers will be more efficiently protected, and stan- dards will be made less burdensome than if several recom- mended standards were written for only a percentage of the hazardous agents in a particular industry. Coverage of an entire industry will alleviate some compliance problems-- both for industry and OSHA. Preparation of Special or Emergency Occupational Hazard Reviews concentrating on work practices will alert employers and employees more rap- idly to newly discovered hazards of chemicals being used or produced in the workplace. The current NIOSH priorities program involves a multi- step process which includes the use of several data sources and input from various groups, Criteria document subjects are selected three to four years in advance of their prepara- tion so that the planning and conduct of laboratory research can occur. This is especially im0ortant if delayed toxicity or epidemiologie studies are needed. Consequently, during 1979, subjects for criteria documents to be completed in 1983 will be selected, and it is anticipated that this approximate four-year lead time will be maintained. Figure 1 illustrates the procedures and steps followed in setting priorities for a given year. Nominations from numer- ous sources are solicited. Information profiles which contain data relating to exposure, toxicity, production, previous reg- ulation, process engineering, chemical use, and other items deemed necessary for establishing priorities are then devel- oped (see Table 1 ). Comments are requested via notice in the Federal Register and special letters to interested groups. A.JPH/'.~.a¥, 1979, V~t. 69, t'Jo, 5 T106650393
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TABLE 1--SeIect~n CrP.eria and In~=rmeEon Re~:~rted In Prot~!es Occupational Exposure Patterns t'.~;ml~.or workers exposed, Du~t~on of exposure, Lev~] of ex~sure, Exposure to multiple hazards Chemfc~UPhysicat Prope~ies Phy~] state. Form, vo]~titity, stab~ti~, R~actMty, Structure} s~m~lafi~ to known h~a;Ss Biologi~l Effects Chronic toxici~, A~te toxici~, Metabolism and fate in body, O~an system(s) involv~ Pr~ucBon/Use Trends ~ent of pmducti~, Method of use, Probability of ~nt~nued or e~anded use Need for a New or Revi~ Ex~sure Standard I H Nominadons OSHA to NIOSH Request for PuMic Comment Information Profile Development Tentative Selection OSHA Comn~nt l=nml ~Isetion iApproval NIOSH, Dlrect~ FIGURE |--Procedures to Select and Priority Rank Subjects for Cri- terla l~cument Development Many useful suggestions, including additional subjects for consideration, are usually obtained from this solicitation fort, especially from other government agencies. After consultation with OSHA, NIOSH then selects 24 criteria document subjects which include classes of chem- icals, individual chemicals and physical agents, processes, industries, and occupations. The task of selecting a process, industry, or occupation is considerably more complex than that associated whh a single chemical or even a class of chemicals. The primary issues are possible complexities of exposure to multip]e hazards and clear identification of ~e intended scope of the erheria document. Examp!es of proc- ess standards are the recently promulgated OSHA standard on coke ovens, and the current OSHA/NIOSH joint effort for the manufacture and formulation of pesticides. Slll~lmary Setting priorities is a difficult task, requiring good infor- mation coupled with astute scientific judgment. The most im- portant factors to be considered are occupational exposure patterns and biological effects of exposure. NIOSH has pre- pared and recommended to OSHA more than 100 occupa- tional health standards covering more than 200 substances including 1500 registered pesticides.*" Of the 20 to 24 recom- mended standards to be prepared each year in the future, an approximately even distribution for chemical classes, indi- vidual chemical or physical agents, and occupations or in- dustries is anticipated. Priorities for fiscal year (FY) 1983 are currently being developed. NIOSH expects to continuously improve its priority program in order 1o keep abreast of the rapid changes in the problems facing the American worker. REFERENCES I. U.S. Tar~ Commission, Synthetic Organic Chemicals: U.S. Production and Sales, 1960-1970. Government Printing Office, Washington, DC. 2. Howard PH: Establishing environmental priorities for synthetic organle chemicals: focusing on the next PCBs. EPA Publication No. 560-1-75-003. Washington DC, pp. 51-65 (July 1975). 3. Toxic Substances Control Act, Public Law 94-469, 941h Con- gress, October I 1, 1976. 4. Stephenson ME: An approach to the identification of organic compounds hazardous to the environment and human health, Eeotox and Env Saf 1:39-48, 1977. 5. Linstoae I and TuroffM (eds): The Delphi Method: Techniques and Applications. Reading, MA, Addison-Wesley Publishing Co., 1977. 6. Brown NR, et al: Problem severity model and implementation plan for occupational safety and health. Am lad Hyg Assoc 33:813-821, 1972. 7. Rose VE: Reliability and Utilization of Occupational Disease Data. Cincinnati, OH. DHEW {NIOSH) Publication No. 77- 189. US Dept. of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Oc- cupational Safety and Health, June 1977. 8. Occupational Health Survey of the Chicago Metropolitan Area. Cincinnati, OH. U.S. Dept. of Health, Education, and Welfare, Public Health Service, National Institute for Occupational Safety and Health, 1970. 9. KendHek MA, etal: Industrial hygiene survey of metropolitan Denver. Pub Hlth Rep 83:317-322, 1968. I0. National Occupational Hazard Survey, Volume !. Cincinnati, OH. U.S. Dept. of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, May 1970. 11. O~'eupational Safety and Health Act, Public Law 91-596, 91st Congress, December 29, 1970. 12. Hosey AD: Priorities in developing criteria for "'breathing air" standards. J Oecup Med 12:43-46, 1970. ¢Summary listing of recommendations, including plans for fu- ture documents, is avallabl~ from NIOSH (DCDSD), Room 8A-53, 5f:~0 Fishers Lane, R~ckvil[~, MD AJPH May, 1979. VOI. 69, No. 5 4~7 T106650394
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APPENDIX TABLE 1--Criteria Documents and Recommended Standards Transmitted to the U.S. Department of Labor DooJm.e=t Name Acet~len~ CIdorcfcrm (re~i.~d) Hydrogen F/auricle Oxides of Ni~o;=n Ac~l~[de ~]~r~prene Hydrogen Sul~de ~[an Ac~/~nitfite (Eme~ency H~rd Chromic Acid Hydr~uinone Pesticides, M~ufactur¢ ~d Review) ~romlumVl Inor~nie Cy~[des Fo~ula6on of Aldfi~D[eldfn (Special Ch~sene (Special Occupational Inor~nie ~ad Phenol Occupational H~rd Review) H~d Review) Inorganic Lead (revised) ~hosgene Alkanes CoM G~ifi~tion laor~ic Mercu~ Polyc~ofi~ted Biphenyls Allyl Clofide CoM T~ Pr~ucts Inorganic Nickel Refined Petroleum Solvents Ammonia Coke Oven Emissions lsopropyl Alcohol Silica Anesthetic Gases Cotton Dust Ke~ne (Emergency H~ard S~ium Hydroxide Antimony Cresol ~d Cresylic Acid Review) Su~ur Dioxide Arsenic Decomposition ~oducts of Ketones Suffufie Acid Arsenic (revised) Fluoro~rbon Polymers Lo~ing 1,1,2,2-Tetmchloroethane As~stos Dibrom~hloropropane MMathion Tetmchloroethylene Asbestos (revised) (Emergency Hazard Review) Methyl Alcohol Toluene Asphalt Fumes Dinitro-o-eresol 4,4'-Methylenebis (2- Toluene Diisoeyanate Benzene Diisocy~ates chloroaniline) (SpeciM i, 1,1 -Tdchloroethane Benzene (revised) Dioxane OeeupationM H~d Review) Tfiehloroethylane Benzoyl Peroxide DDT {Special Occupational Methyl Parathion Tdchloroe~ylene (Special Benzyl Chloride H~rd Review) Methylene Chloride Occupational H~d Review) Beryllium Epiehlo~hydfin n-Alkane Mono Thiols, Tungsten Compounds Boron Tdfluofide Ethylene Dibromide Cyclohexanethiol, ~d Ultraviolet Radiation Cadmium Ethylene Dichloride Benzenethiol V~adium Compounds C~aryl Ethylene Oxide (SpeeiM Nickel Carbonyl (Special Vinyl Acetate Carbon Black Occupational Hazard Review) Occupational H~ard Review) Vinyl Chloride (Emergency Carbon Dioxide Fibrous Glmss Nitre Acid Ha~d Review) Carbon Disulfide Fluorides Nitdles Vinyl Halides C~bon Monoxide FormMdehyde Nitroglycerine and EGD Xylene Carbon Tetrachlo~de Glyeidyl Ethers Noise Zinc Oxide C~n Tetraehlofide (revised) H~ardous MatedMs Organo-isocyanates Chlorine Hot Environments Organotin Compounds Chlorofo~ Hydrazines o-Tolidine APPENDIX TABLE 2--Criteria Documents and Recommended Standards to be Transmitted to the U.S. Department of Labor FY 1979 Document Name Aliphatic Primary Monoamines Brominated Aromatics Chlorinated Benzenes Coal Liquefaction Cobalt Compounds Fluorocarbons Foundries Furfuryl Alcohol Methyl Chloride Nitrobenzenes Nitrotoluenes Oil Mists Oxalic Acid Paint and Allied Products Manu- facturing Plastics and Resins Manufactur- ing Printing Industry Radiofrequeney and Microwave Radiation Roofing Industry Slaughtering and Rendering Plants Styrcr, e Synthetic Rubber Manufacturing T~c Welding a~d Brazing Wc¢,:l Dust FY 1980 Document Name Aliphatic di and polyamines Aromatic amines Brominated aliphatics Dichloropropane Diesel Emissions Dyeing and Finishing Textiles Hexaehlorobutadiene Hexachloroethane Infrared Radiation Manufacture of Non-metallic Pig- ments and Dyes Monoehloracetie Acid Monochloroethane Pentaehloroethane Pulp and Paper Mills Secondary aiiphatie monoamines Tertiary aliphatic monoamines Telrahydrofuran Trichlnropropanc Ultrasonics Vibration, whole body Wowl Preserving FY 1981 Document Name Alkanolamines Aluminum Compounds Caisson and Tunnel Workers Cement Manufacturing and Use Chlorophenols Epoxides Glycol Ethers Glycols Grain Handlers Hexachlorocyclopentadienc Inorganic Azides Inorganic Chromium (non- hexavalent) Iron Compounds Manganese Compounds Methyl Ethyl Ketone Peroxide Naphthalene Nitrophenols Organic Anhydrides Organophosphosphorus com- pounds (excluding pesticides and fire-relardants) Phthalates Tire M --,zr-.u f~cturing Vinyl Cyclohexen~ Dio~de FY 1982 Document Name Aliphatie Amines Aluminum Reduction Bisphenol A Copper and its Inorganic Com- pounds Dimethyl Sulfoxide Electroplating Ethyl Benzene Ethoxyethanol Explosives and Fireworks Manu- facture Lithium and Compounds Mercaptobenzothiazoles Nitropatatlins Petroleum Refineries Photographic Processing Platinum and Compounds Selenium Solder (Manufacture and Use) Spray PaintingtCoating Tellurium Thioureas Titanium and Compounds Trimethyl benzenes Vinyl T¢I~ene Xy/enols PJPH M~y, 1979, Vok 69, No. 5 TI06650395
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Standards comer NIOSH has published a current intelligence bullelin on the adverse health effects to workers who smoke while on their jobs. The agency urges that employers curtail the use of tobacco products in areas where workers are exposed to phys- ical or chemical substances which may interact with tobacco products. NIOSti recommends; simulta- neous control of worker exposure to physical and chemical agents, citing research data which indicates that smoking ~:an act in combination with haz;u'dous agents to produce or increase the severity of a wide range of adverse he;dth effects. NIOSH identifies tobacco prod- ucts as cigarettes, cigars, pipe to- bacco, chewing tobacco, and any by-products resulting from their burning and/or use. In the intelli- gence bulletin, NIOSH presents several ways smoking may ad- versely act with physical and chem- ical agents found in the workplace: • Workers exposed to toxic chemicals can receive additional exposures from the presence of those toxic chemicals in tobacco products. • The heat generated by burning tobacco can transform chemicals into more harmful substances. • Tobacco products can become contaminated by chemicals used in the workplace, thus increasing the amount of toxic chemicals entering the workers" bodies. • Studies show that smoking contributes to accidents in the workplace. NIOSH has submitted to OSHA a criteria document on vinyl acetate, recommending that worker expo- sures to the substance be limited to a ceiling concentration level of 15 milligrams per cubic meter of air (5 mglcu mJ based on a 15-minute sampling period. 13ecause lhe ,~ubslancc may irri- tate the eyes. nose, tha~al. ~nd skin, NIOSH recommends that emplo.,,- er~ use appropriate work practice~, sanitation procedures, warning labels and posters, personal protec- tive equipment, and educational in- structions to protect worke~. NIOSH estimatex that 7<).(t(~) work- ers are exposed Io the chemical. Vinyl acclale, prepared from pcl- rochemicals, is pt)lymetized and cop~lI, merized with other mono- mer,, to fi~rm a ~.~ide variely ofadhe- ~,ives. paint,~, paper coatings, ptus- lic~,, und re',ins. I)e~pite ~:idespread use of vinyl acetate, only limited exFerimental and epidemiologic data is available. Consequently, the criteria docu- ment calls for additional research on lhe potential adverse health eflkcts from exit)sure to vinyl acetate. Oc enpation~! i~a~ards ~le~eland~ Ohio TI06650396
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STANDARDS CORNER NIOSH has submitted to OSHA a criteria document recommending a reduction of the present exposure limits for n-alkane mono thiols, cyclo hexanethioi, and benzene- thiol. NIOSH recommends that worker exposure to the CI through C12 group tmethane- through dodecane-), and the C16, and CI8 (hexadecane-, ocladecane-) n-al- kane thiois and cyclo hexane- thiol, or any combination of these thiols, be reduced to a ceiling concentration of 0.5 parts per mil- lion (ppm). NIOSH also recom- mends that the concentration of benzenethiol should not exceed 0.5 milligr:~ms per cubic meter of 10.1 p~m) :is a ceiling conccntratiun for any IS-minute period. NIOSH estimates thal workers are exposed to thiols. Tl~iols have the potenlial forcausing i~rilation to mucosal surfaces and damage Io lhe central nervous sys- .era. Since benzenethiol exhibits a greater toxicity, NIOSH warns that brief exposure lo this substance could result in damage to lhe eyes or internal organs. NIOSH advises the use of engi- neering controls and personal pro- tective equipment and clothing to curb exposure levels. Other rec- ommendations call for a medical surveillance program and the reten- tion of ~vorkers" medical records and monitoring records for 30 years. NIOSH has submitted to OSHA a criteria document recommending that the present standard for worker exposure to furfuryl alcohol of 200 milligrams per cubic meter of air as a time-weighted average concentra- tion be continued. However, NIOSH recommends that employers initiate work prac- tices and engineering controls to contain the flammable and explo- sive capabilities of furfuryl alcohol when it is mixed with acids, and urges that skin contact with the sub- stance be minimized. Acute hazards from exposure to furfuryl alcohol include eye, skin, and upper respiratory irritation from direct contact and depression of the central nervous system from inhalation or skin contact, NIOSH reports. Further recommendations call for labeling and posting proce- dures, a respiratory protection pro- gram, an employee education pro- gram, and retention and surveillance of medical records. NIOSH estimates that approxi- mately 9,000 workers are exposed to furfuryl alcohol, a substance widely used in the synthesis offuran resins, and in operations such as the binding of foundr3, core sand. NIOSH recommends that epi- demiologic and animal studies be conducted to further study l~ossible chronic or adverse reproductive ef- fects on workers exposed to furfuryl alcohol. • T106650397
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Technical Information from NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH Contact: J. Hardesty (301)443-2140 NEW NIOSH DIRECTOR NAMED of Health has been selected as Director of HEW's National Institute of Occupational Safety and Health. The announcement was made by HEW Secretary Joseph A. Califano, Jr. on September ii at the first AFL-CIO National Conference on Occupational Safety and Health in Washington, D.C. In his new position~ Dr. Robbins will provide scientific leadership to the Institute which this year has a budget of $66 million and approx- imately 900 employees located in Rockville, Md.; Cincinnati, Ohio; ~[organ- town, W. Va,, and in HEW's i0 regional offices. The Institute conducts and supports research on occupational diseases and health and safety hazards of the workplace. Based on this research knowledge~ the Institute develops health and safety standards and then proposes their use by the Labor Department's Occupational Safety and Health Administration for general industry and by Labor's Mine Safety and Health Administration for mining industries. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Public Health Service. Center for Disease Contrcl 5600 Fishers Lane, Rockville. M~ryl~nd 20857 T106650398
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In addition to serving as Executive Director of the Colorado Department of Health, Dr. Rohbins has been Associate Clinical Professor in the Depart~ent of Preventive Medicine, School of Medicine, University of Colorado Medical Center. "Dr. Robbins is well-kno~rn as a physician, scholar, teacher and public health administrator," Secretary Califano said. "We believe he is a worthy choice for the job of helping build this Nation's occupational health efforts on a secure base of scientific knowledge." Dr. Robbins joined the Colorado Department of Health in 1976 after serving since 1973 as State Health Commissioner for the Vermont Department of Health. During this three year period he also held teaching positions with the College of Medicine of the University of Vermont and Dartmouth College School of Medicine. During 1972 and 1973 he was Director of Professional Relations and Community Health Development for the Northern New England Regional Medical Program. Dr. Robbins worked in Canada from 1970 to 1972, as a National Health Research Junior Scientist, as Director of the Community Health Centre Project for the McGill Centre for 11ealth Care Research, and as an Assistant Professor of the Department of Epidemiology and Health at McGill University. From 1968 to 1970, Dr. Robbins held fellowships at the Center for Community Health and Medical Care of the Harvard Medical School and Harvard School of Public Health, and at Massachusetts General Hospital. Dr. Robbins graduated in 1962 from Harvard College with a B.A. degree, then moved to Yale University School of Medicine where he earned his M.D. degree cu___~m laude in 1966. In 19699 Dr. Robbins received a Master in Public Administration {rom Harvard University's John F. Kennedy School of Government. He is a member of the Health Advisory Committee of the Coniressional Office of Technology Assessment, serves on the National Health Insurance Technical Consultant Panel to HEW's National Center for Health Statistics, and is a member of the Joint Commission on Prescription Drug Use. He also serves on the National Governor's Conference Consortium on Health Planning. Dr. Robbins belongs to the American Public Health Association, is married and has two children. TI06650399
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i How to Assess Cancer Risks '., .. . -. Federal agencies are di d o ua I tie O ' OSTP proposes a centralization of authoritg Fcdetal decision-making in lhe tonlml in calcinugencsis a~d toxicology n;une- of carcinogens is a hot subject Ihat seems ly, FDA, the Nalitmal ('ancc~ Institute. to invile more conlrovclsy ,dl Ihc lime. the N;~lloll;x] ]nMilnle for En~ironmcnlal Disagreement exisls within the govern- llcalth Sciences (NIEItSL and the Na- mcnt ilself over "rancor policy'" antl ce~ litmal lnMilule of Occupalional Safety pccially over ~hcther the st{t.nte~ and Health (NIOSH) are lo po~l[ re- qu,tntifying cavl~e~ ~ isks is fm enough ad- SOUl cos iuld j.in in planning illlll Citl lying ~,:mccd for it to be safely used by ncgnla- out bio:t~t:Ws, imp~uving experimental tory agencies in selling M;mdaltls for hu- methods, collecting cxp~sure d;tla, and illaB exposure Io carcinogens, doing other ~ ot k impo~ lant Io the t cgu- The tiltcolor of the Nalional Cancer lab)r) ,gcnc[es ct,ncctned with cancer Inslitutc (NCI), AHhurC. Uplon, has re- haz.a~ds. "Fhcse agencies are the F~A, ¢cnlly circulaled a memorandum ~:un-~ the Envi~t~mcntal Prolcctitm Agency ing lhat misuse of risk quantific~ttitm~l.;I'A}, t~b~aumaer Producl Rarely cot ld lead Io public hcdlh .... c'd'tMl ol~hes..t~ommissi, i~(CPS(', .), ,'rod Ihe Occupa- Allhough citing no specific instances dff tkmal Safely and ttcalth Adminisl~alion mKuse, Upton has told S~ icnce that het,~OStIA): all are ~cp~escnted ~,n the NTP wtnricd lcsl rcgulalory offi~.ials make the mistake of nfinimizing o'mcer risks on lhc basis of estimates lhal fail Io Icflccl Ihe tmderl~h~g uncertainlics in the malh- cmatical modeling. On the other side of the risk mcnl issue are the government o~cials and scientists, including ~otne at the White ltou~c O~cc of Science and Tcch- m~logy Pot[cy (OSTP), who are aftaid that risk qnantification will either bc ne- glecled by some agencies or misused to overestimale risks in Mq~po~ of cxpo- Mire sldndards lhal are Ioo Mricl and costly. ~ack in February, Frank Pres~. Ihe lhesidcnt's science iadviser, scnl Donald Kennedy, commi~inner of the Food and Drug Adminish'alion (t-I)A), a report* dealing partly with ~isk qtmn fificalion which had juM l~ccn p~cpmcd by OSTP. lls inincipal ~ecommendatitm was lhat mlthority over cancer ~isk sessmenl, now wklely diffused mnung Ihe ~cguhtlory and sdcntific agencies - bc centralized under the N.dional e xCt'lltiVe etmlmitlee. In a letter ;ic¢olrlp;lllyirig the {}N I'P re- po~, Press told Ktmncdy lhal hc aad his Maff ~elc tonfitlcnt Ihat the Nil' ctmld tying tluough the ~ ulk ;d~c:My begun by the regulalory agencies in seeking 1o tablish consistent policies tlu ough an in- leragcncy commiltce. Although nothing much has been done about il yel, this OS'I'P proposal or some varlatitm of may offer the bcsl ho~ of overcoming Since lhe OSI'P it'pt~o ~;is is~lted 4 tent government philosophy and pluaCh 1o cancer lisk assessment has be- come increasingly cvitlc~l. For c~ample, besides the winning memo ¢hculaled by Upton, ~ ho [s ilo Iightx~cight in IllallClS of this kind, a glaring cunllict has had be ~esolved bcl~ccn OSItA. ~hich has re,isled using risk qu;mtific:dion iu ,oiling vlunlbct of other ;~gcncies, such a~ icology Pmglatn (NTP). ~I-DA, and the C,mn¢il on \Vmge :rod The NTP was tl¢:.dcd last fall b) Sec-~' ]~licc Stal~liz:ttion (CWPS). tctaly of llealth. Fduc:ld~m. ;uM V,'rTfare ~,~ Joseph Calif;mo, ;rod Kennedy bccame the fir~t chairman of its cxeculive mitlee. Through this new entity, 11EW agencies ahcady deeply These ,gcncies, .dung ~ith OSI'P, have '~ic~ed ssi~h apptchcn,itm mgu- merits m:~de by OSItA in a£pe.ding Io the Supreme Coma Ihe drcisic, n of a kl~c[ ttllll] 1o ~cj,:ct a 1 I t~i~o~cd benzene -t;m,kt{d bcc:,u~¢ the health l,c~;cfits ~ere not qu,mlif~ed. Ft,gcther ~ith lhe l)cpartnieni of littllcc I:iw)tlS ~11o ,Aill tel,resent it before the high c,mn. OStlA will be presented in such a way as not to indict rink qttanlification as pracliccd by other agencies. Because tli,,agrccmcnts o~cr risk tllmnlific;tliu~ ~ccl~ Io arise Otll of the ~hecr compicxily of the subject, a ~ord ahout ~hal is in~ol~.ed is in triller. Risk a~cssmcnt begins ~ ith a ~clali~cly non- controversial "'qtmlilatfve'" phase in which certain chemicals mc identified as pt~Icnlia[ hnlnan c;trcitmgcns on the basis of cpidcmhqogical studies or, more typi- "~ ':fT ~: " "~ ). v~':'~.:.:5., :?:2 ":':L. Don,dd h'~ tally, the finding of a carcinogenic re- sptmse i~ Icsls whh laboratury aninlals. Expcrls in carcinogenesis slill over ~uch questions as ~hcther rcgnla- Iory agencies sbmdd tegat'~ ~'pro- rooters'" (u~b~tamcs that promote the fo~m:dion of lutnol~ but do nut directly h.ilktle them) as c.ucinugens. Bill there i~ general ;igl~'Clnellt ;tmong the agencies .rod lheir sclentifie advisers that a well- done bioassay or epidemi~logical inves- llgalion tcp~c~ents good ~cicnce, even though (fi~r obvinus reasons) findings flora Icsts with mice or tats cannot verified by e~pcriments ~ith humans. The ~e:tsnn po~hive results From a bit~assay with lab~n;tto~, animals are generally accepled as strong evidence of rotcntial hum;m calchmgcnicily in that vim~ally all known human carclnogcns cause ~an~'er in test anitmds. T106650400
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HEALTH EDUCATI{ >N Mr. NATCHER. Doctor, you are requesting $12,7UO,00tJ for health education programs in 1980. Describe the various types of programs that you are funding with this money and tell us what you hope to achieve by spending this money. Dr. FOF:Oz. Very briefly, Mr. Chairman, that money will be spent, first, grant funds, $4.5 million to States to develop their own capacity in health education. Number two, we will be spending about $2.3 million on sex education to find which methods of the literally dozens that have been used have the best result, and tl~en try to replicate those. We will be spending about $1.5 million on school health curricula in order to improve what children learn in school about preventive medicine. We will be spending about $1 million on patient education. We have a contract with the Rand Corporation and the American Hospital Association to determine how can you improve the kind of education that people get particularly in diabetes, arthritis, the obstructive diseases of the lung, and so forth. We will be spending about $2.7 million on risk reduction pro- grams at place of work, in schools, in health care providing centers. SMOKING AND HEALTH Mr. NATCHER. Doctor, aren't you going to mention the antismok- ing campaign? Are you absolutely eliminating that? You do not mention it. Can I take all the money out? Is it still of a little concern to the Secretary? What about it, Doctor? Dr. FOEOF+. We will continue to be doing work on smoking. Par~ of the grants that will be going to States for their lifestyle health improvement programs wil[ be spent in smoking programs. NIOSH will be spending about $800,000 this year to do research on the synergistic and additive effects of smoking and hazards in the workplace, and of course in the school curricula a fair share of this has to do with smoking education. So we will continue to do work in health education in smoking. Mr. NATCHER. Doctor, for the record give us a breakdown of the dollars that will be allocated to each of the major program areas in the health education activi~, in 1980. [The information follows:] TI06650401
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req~ived t~, rnCi,'.ally t-:,g d+ii~h prOd,titLes for action. The requires a vigilant survey ~orce collec~In~ ob~crvautonal data in a preselected sample of potenC~aXiy high-risk industries. If such a sample is constructed Eo be repr~.::~ntacive of the industry at large~ inforenrinI s~aristics ~or the nation can be derived. The National Occupa~iona~ [iazard Survcy oE 1972-19~4 (NOHS) which developed such infornuation a~ng a sample of nearly 5~000 plants~ has provided £mportattt inputs to the entire range of NIOStt research activities. It ~i11 become increasingly necessary ~o updaEe the results of thac Suwey in order to accurately reflect current conditions. The folmdation of ex'perieuca which was developed during the original National Occupational Hazard's Survey (including statistics, data edlt£ng and analysis, resolution of trade- name product ingredients, and managing a field survey team) will be used to support and guide the planning and imple- mentation of a second national survey. The NONS survey forms, data processing systems, programs and procedures will be critically examined to identify areas where improvements can be made. This program will magnify the National Instltute for Occupational Safety and Healthfs ability to provide employees and the health community an early warning of occupational hazards and to monitor workers in hlgh-risk industries (oil, chemical, etc.). This program will also permit the develop- ment of trend £nfotamatlon based upon comparisons w~th the National Occupational Hazard Survey of 1972-74. Such a base of Informxtlon will provide suport to a wide range of NIOSH activities, and additionally, the programs of other members of the Federal~ State and prlvace occupational ~afety and health co~nunity. S~king - The Occupational Safety and Health Act of 1970 requires employers in the private sectors to provide to each of their employees a place of employment which is free from r~cognlzed hazard~ that are causing, or are likely to cause, death or sarloua physical ham to the employees. It is recognized that there is an enhancement TI06650402
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t DEPARTMENTS OF LABOR AND HEALTH, EDU- CATION AND WELFARE APPROPRIATIONS FOR 1979 THURSDAY, MARCH 8, 1979. DEPARTMENT OF HEALTH, EDUCATION AND WELFARE CENTER FOR DISEASE CONTROL PREVENTIVE HEATH SERVICES WITNESSES DR. WILLIAM H. FOEGE, DIRECTOR, CENTER FOR DISEASE CONTROL JAMES D. BLOOM, EXECUTIVE OFFICER, CENTER FOR DIS- " EASE CONTROL DR. ANTHONY ROBBINS, DIRECTOR, NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH MR. CLAUDE F. PICKELSIMER; JR., DIRECTOR, FINANCIAL MAN- AGEMENT OFFICE, CENTER FOR DISEASE CONTROL BRUCE S. WOLFF, DEPUTY ASSISTANT SECRETARY FOR LEGIS- LATION DESIGNATE WILFORD J. FORBUSH, DEPUTY ASSISTANT SECRETARY, BUDGET ELLEN WORMSER, DIRECTOR, HEALTH BUDGET ANALYSIS Mr. NATCHER. The committee will come to order. We take up at this time the Center for Disease Control of the Department of Health, Education, and Welfare. We have before the committee Dr. William H. Foege, the Director of the Center for Disease Control. Doctor, before you proceed with your statement to the commit- tee, tell us who you have with you. Dr. FOE,S. On my right is Ms. Wormser, Director, Division of Health Budget Analysis; Dr. Tony Robbins, who is the Director of NIOSH; Mr. Jim Bloom, who is the Executive Officer, CDC; and Mr. Claude Pickeisimer, who is head of Financial Management at CDC; and we will be having Mr. Bruce Wolff joining us, who is the Deputy Assistant Secretary for Legislation. Mr. NA~CHER. Thank you, Doctor. We have had a chance to examine your statement. It is an excelleat oae. With your permis- sion, we will insert the statement in the record in its entirety. [The statement follows:] T[06650404
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DEPARTI~IENTS OF LABOR AND H~L\7,H, EDUCATION, 980 HEARINGS BEI~OE E A 8UBC0~I~IITTEE OF THE COMMITTEE 0N APPROPRIATIONS HOUSE OF REPRESENT£TIYES NINETY-SLK]Ttt CONGRESS FIRST S~gSSION" SUBCOMMITTEE ON TIlE DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND ~VELFARE WILLIAM H. NATCHER. Kentucky, Clm[rma. DANIEL J. FLOOD, Pennsylvania ROBERT H. MICHEL, ll~no~ NEAL SMITH, Iowa SILVIO O. CONTE, Massachusetts ~W~D J. PATTEN, New ~ersey GEORGE ~. O'BRIEN, Hlinols DAVID R, OBEY. Wisconsin CARL D. PURSELL, MIchi~n EDWARD R. ROYBAL, Calffor.~ LOUIS STOKES, Ohio JOSEPH D. EARLY, Mas~chuset~ PART 3 HEALTH (Except NationaI Institutes of Health) Alcohol, Drug Abuse, and Mental Health Administration .... 371 Center for Disease Control ................................. 1 Health Resources Administration .......................... 671 HeaLth Services Administration ............................ 149 Office of the Assistant Secretary for Health ................. 943 Public Health Service Overview ............................ 1105 Saint Elizabeths Hospital .................................. 459 Printed for the use of the Committee on Appropriations ~O OOVERNMENT PRINTING OFFICE WASHINGTON : 19~9 TI06650405
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Current 9nte#/ge, e Bu//et OCCUPATIONAL ENVIRONMENT February 5,1979 ADVERSE HEALTH EFFECTS of ~ ~ ~ ~, ~-'/'-- ~-~ , SMOKING and the U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Heeith Service Center for Disease Control National Institute for Occupational Safety and Health TI06650406
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Business i Si0orting hazardous fumes and chemicals m the workplace could he the next step for OSH,~'s inspectors. Caution: Work May Be dous To Your Health ~ Michael Marie ~.~ Busir~ess has not been told to issue that warning to its workers, but the trend is toward stiffer regulations for the nation's workplace& Consider the case of Roy X: 64 years old. less than a year away from retirement, lying in a hospital bed dy- ing of cancer. He will die two days from now. When the hospital physician signs Roy's death certificate, the cause of death will read: complications as a re- sult of cancer. His friends and co-workers won't see it quite that way, however. They know that be never smoked, drank al- coholic beverages infrequently, ate good foods and exercised regularly. They know. in other words, that his lifestyle was not that of the typical cancer victim. They also know that in his job at Brand Name Industries, Roy was regularly in contact with toxic chem- icals. The company° one of the tol~ three in its industry, took precautions to make certain Roy and hs other em- ployees were not exposed to dan- ~erous amounts of those substances. Stringent work rules were enforced. safety equipment was provided, ven- tilating systems operated around clcck and ~.he entire plant wa~ well- mainr~ine& The seed~ of Roy's painful and un- timely death were planted in his body long before he came to Brand Name. Years ago he worked for Schl~ck En- terprises, a marginal operation, with a "pot and a paddle" and no concern about the health and welfare of its workers. There, Roy inhaled the poi- son that two decades later would claim his life Roy's co-workers know little about their dying friend's career at Schlock. They do, however, know Brand Name and they know that, despite the com- pany's safety rules, they are exposed to health hazards at work. The bend of trust between manage- ment and its workers is in jeopardy. Complaints may be filed with the Oc- cupational Safety and Health Admin- istration, bringing Federal inspectors to examine Brand Name's fa~ilitie~ Disciplinary actions against any worker who fails to obey the com- pany's safety rules are apt to spark a work slowdown or a wildcat strike. When new contract talks be~dr~ the union negotiators will probably de- mand that the c~mpany install better ventilation equipment to further re- duce impurities in the plant air, even if the company has little or no cash to pay for such costly improvements. ROy's widow ha~ hired a laws, er. one skilled in products liabiliD- cases. She ~s c~nsidering suing the c~mpany for several million dollars, allegin~ thac ROy and the other workers were not told of the health hazards in the plant. She probably won't win the suit, but then neither will the com- pany. Its insurer will urge Brand Name's managers to accept a less risky out-of-court settlement pro- posed by the widow's attorney. Roy is a fiction. The events sur- rounding his make-believe death are not. They are happening in American industry today and, If history is any indication, will occur with increasing frequency in the near future. Workplace health hazards are fast becoming an issue that management must reckon with, either in the form of new Federal reguiations~ sLx-figure court settlements (which, in turn. boost business' liability insurance costs) or union demands that in- dustry "clean up i~s act." Traditionally, the debate over safe- ty and health hazards in the work- place centered not over whether there were dangers. The issue revolved around who would pay for the injured or ailin~ worker's medical treatment and whether he or she would be c~m- pensated for lost workdays. That's no longer the &sue. thanks to workers' compensation laws, medical insur- ance and paid sick leave. Passage of the Occupational SafeW and Health Act in 1970 shifted the IRON AGE. February '5. t979 19 TI06650407
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em~ha~ to ~e elimination ~f ~ h~ not ~n applied evenly, ~er by ~e gove~ment ~en~ ~ a~ ~ the ~k or by ~m~n~ aw~e of the serious ri~ks ~ life and l~b m ~e~ pI~m ~n~rns a~ut ~e~y have damina~ ~he effor~ ~ ~rrect hamrds in the workplace" ]~ving ~ational heahh problems eider ~or~ or ~verely n~]~ Even ~e Federa~ governmen~ that ~eat "da~" gatherer, has only a v~e notion of the ex~nt of ~copa- tional il~ ~e Bureau of ~r S~t~ti~ for exampl~ no~s ~n i~ r~ ~ on workpl~ injuries and ill- n~ ~n 1~ that r~rding and r~ ~rting jo~re[a~ ailmen~ {s still vi~n ~il for i~ smtiszi~l plow& ~nlike an injury which ~urs at a s~ffic ~ime and can ~ re~i]y d~ ~" the re~rt sm~ "an ~cupa- tiona] illness may develop over a ~ ri~ o~ ye~s. An emp[oyee may leave the ~mblishment where the w~ ~ntr~d or may work for other ~mbfishmen~ and ~ ex~ ~ dif- ferent ~ndi6on~ "Many ~llne~ of ~cupationai ori- On may not be r~i~. To the ex- ~n~ that ~upafiona] ~lln~ses ~e unrecognize~ and therefore unre- ~ the su~ey ~tima~ under- sm~ the~ ~cu~ence" ~e difficulty of ~p~ating indus- trial ilInes~es from a~.idents and in- j~u'ies has affected[ mere than the ur~ on jo~rela~ health problems ~me ~iti~ con~nd there h~ ~n an inherent s~eD" bi~ in ~he rel~ v~t l~sla~on and the manner which h ~ enforc~ m the hwing and ~aining of s~cialis~ ~ dea] with du~ial heahh probtem~ in the vdopment of new ~chnol~ m ~r- r~t workplace h~ds and in ~e work rul~ ~su~ ~ employ~ Although ~t's doubtful ~hat the weight of concern will shift smntially ~ heahh ms,mrs in the ne~ futur~ there is no way ~ deny or overlook the r~s~ng interest workplace health h~ds ~veral r~ ~nt even~ ~fnt ~ this ~en& ~e m~t r~nt w~ ~he pubfi~- t~on of a "Quality of Employment" su~'ey conduc~ for the Dep~tment of Lair by the University of Mich- i~n's Survey R~ch Caner. Over thr~/foarths of ~he res~nd- en~ m the s~rvey said they were ex- ~d m one or more of [3 listed ~- cupationa] health and sa/e~y hands. ~d more ~mpor~nfly, the same ~r- cen~e felt tha~ they should have ei- ther a complete ~ay or a tot m say any decisions involving stops ~ rect workplace h~rds. ~o~ find~n~ ~e ao surpri~ ~p man~ers who deal wi~ ~me of the nation's most powerful labor unions ~e ~e and f~us of their activities regarding occupational heaitri have not yet taken on the characte.--~n~ of a crusada But they are. as one /a~r relations expert says. "'gearing up for tough skir- mishes" with management_ One f/eld where the battle lines are draven is the Occopational Safety and Health Administration's ~OSHA~ new fend exposure s~,~ndard, The new rule slices the maximum permissible ex- posure from 200 micrograms per cub- ic meter of air to 50 micrograms. Union health and sa/ety experts re- portedly are pleased with the rule and. in one instance, have shown a willingness to pick up the industry's challenge to it in the Federal courts. The Lead Industries Association. representing both domestic lead pro- ducers and users, has sued in the U.S. Fifth Circuit Court of Appeals in New OHeans in a bid to overturn the new standard. The United Steelworkers of Amer- ica has countered with its own suit in the Fifth Circuit Court of Appeals in Philadelphia, contending that the new exposure limit is too lenient and should be set at 40 micrograms per cubic meter of air. The Steelworkers" suit is also seen as an effort to re- move the tend standard dispute from what the unions regard as a pro-in- dustry court in New Orleans. Or~zanized labor's new con- sciousness about occupational health 'It is our ethical responsibility.. .' / I~ a .~peec/, to the Chemical Ceyun- illegal practices. cil of Greater SL Lou~,~ l~st ]/ear. J // And obviously some of these B. St. Claw. preside,t of Shel]~ have been deliberate policy deci- Che'm~cul Co., detailed some qf thv challenges that industry cause of the growt~,g concer~, a~t chem~ and thor ~l health h~r~ E.ch m~m~r of the ind~nt~, he saq,~ iu a~ ethical m~mn~ or ~er ~oPer~tme~ into thor acfizdt~es ~e folb~u~ng. ~pted J>om that s~ec£ ~ggest~ns of the steps d~try sh~M ~'e: D~pite all ~e ~tinK ~d t~- i~ all the ~o~m pr~ution~ ~e ~]]y don't know ~hing there is ~ know a~ut many of the ~emi~is we pr~u~ includin~ in ~me ~ h~mful eff~ we did not imbue at ~y s~e of act developmenL Bat unhappily ~ere have a~ widely m~ ~ of n~ligen~ M ~ of ~ing ~em ~ath work- ~ ~ety, ~s af arterial if not sions taken in the cause o£ profit. or simply handing the problem to someone else.... What I would propose is that the industry should consider a number of steps~if we are not already doing so--that might reduce the need for s~me of the extreme regu- latory measures which are being proposed. First, we must make sure that our own organizations understand that we will not support and will openly oppose illegal and unethical pra~iceg We have to mean what we say by placing ethical responsibilities above business advantage, if neces- sary: In other words, we have to say it in the language of everyday business that our staffs under- Next. we have to demonstrate to others in the industry that we are dedicated to and believe in our re- sponsibilities.... I£ we learn that warnings are being ignored, that safety precautions are not being followed, and that workers or con- sumers axe being exposed to un- necessary hazards, we have to con- sider whether we can legally and ethically continue to do business with such customers. Then ~ purchasers, we have a corresponding legal and ethical re- sponsibility to examine our rela- tionships. We have to [ook closely at our purchases if it means a good deal at the expense of health or the en- vironment.... Another area I believe we must examine is waste processinK h' we choose not to build our own waste- handling facilities, I don't believe we can just contract with a waste processor and wash our bands. Some operators may simply dump these toxic materials. • , . It is our ethical responsibility to make sure the ['u'ms we deal with are han- dling these materials properly. . TI06650408
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Fewer job-related illnesses, but more workdays are lost , ....... To*.~I Cases--259 ~ ~~ Los~,;orkd~'~s-1500 Manufa~tunng ~ ~ Total ~ndustW ~ ~ matters could be seen even before OSHA formally announced the lead standard. ESB Ray.O-Vac Corp, an Inco Ltd, subsidiary, weathered a tough fight with its ~'orkers last summer when it stiffened work r~ales for its employees exposed to lead. The new rules prohibited smoking and eating while working and re- quired showers and a change of cloth- ing at the end of each workday. [n dition" workers whose blood lead level rose above 6~ micrograms per decili- ter were told to use facial respirators on the job. Workers at several of the battery maker's plants responded by refusing to work overtime. At the company's Warsaw. Ill. plant, a week-long wild- cat strike was sta~ed to protest the suspension of ~wo women who re- fused ~o wear respirator~ United Auto Workers' officlals complained that ESB was putting the burden for reducing lead exposure on the workers and argued that the com- pany instead should install costly ventilating equipment to reduce ',he amount of lead in the air. The nation's courts offer yet anoth- er indication that the tide on occupa- tional health matters may be turning against industry. In a lawsuit filed in 1974. 445 for- mer asbestos workers charged that they had not been informed about the health dangers that existed in Pitt~- burgh-Corn/rig Corp.'s plant in Tyler. Tex. Four years later, a ~ettlement was reached totaling $20 million. 1"he two parent firms of the Tyler plant, PPG Industries and Coming Glass Work~ paid the lion's share of the settlement, over $14 million. The Federal government, which was at~o named a defendant in the a~- ~est~s workers' suit because two of its agencies had inspected the plant and a third had supplied asbestos to it, paid $5.7 million to the Tyler work- ers. That settlement has spawned a plethora of lawsuits by workers and consumers who have had contact with asbestos. One of these is a $1 bii- lion class action suit on behalf of 5000 shipyard workers. Any belief that this mushrooming litigation on workplace health haz- ards won't roll beyond the borders of the asbestos industry could be both short-sighted and costly. The lead industry, for example, is already under the gun--not only on the .new 50-micrograms air standard announced by OSH.-% but also in the U.S. District Court in Texas. Last month, 15 former employees of RSR Corp., a lead fabricator, filed a $100 million suit on behal2" of the workers at the company's Dallas plant. The suit alleges lead poisoning of the workers and names the corpo- ration, several of its subsidiaries and eight suppliers as defendants. RSR officials have refused to com- ment on the suit at this time. How- ever, the company says it maintains an extensive and ongoing program to monitor employee health. That moni- toring, as well as engineering controls in she plant, are sufficient to protect its employees from excessive lead ex- posure, the company states, The last threads of this ~rend to- ward a new emphasis on occupational health matters can be seen in the ac- tions of OSHA. Hany of the major policy-making steps taken by the Federal agency in the past year have been geared towards health in the workplace. The le~d standard w~ only one of these ~cti~n,~ Preceding it by a year was the agency's proposed policy for controlling potential carcinogens in the workplace. Last July, OSHA is- sued a proposed rule aimed at allow- ing employees access to company medical records--the ~-called "Right To Know" rule which is widely sup- ported by organized labor. The prot~)sed carcinoRen standard has proved particularly troublesome for ~.ndus~ry in two levels` One is the sheer numbers of chemicals desig- nated as suspected carcinogens by the National institute for Occupational Safety and Health (NIOSH~. The oth- er is the complex nature of the rule- making procedures and ~he require- ments under the standard's various categories. The initial list issued by NIOSH in- cluded over 1500 substances m which the Federal agency had found some degree of carcinogenicity. From that list, OSHA last July des- [gnated 269 chemicals to be included in its preliminary Category [ (con- firmed carcinogens} list. Only t16 of those are produced in significant amounts each year. says Grover Wrenn" OSHA's director of health standards development. These would be prime candidates for government regulation. In addition to many hk, hly complex chemical compounds, that list in- eludes ~ome subs:sucks used exten- sively in the metalworking industrie~ Nickel and chromium, for example. The agency's rulemaking proce- dures, on the other hand. are a veri- table labyrinth in which even the best cryptographer could become lost. In brief, ",here are four separate categories into ~'hich a SUSl~ec~ed car- cinogen could be assigned, del:endin~, on the findimzs of human epidemiolo- ~caI studies and/or relevant animal IRON AGE. ~=e~ruar~ 5. ~979 21 TI06650409
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No change in lost workday cases, while cases without time off fell #,lanufactunng ~ Total lndustr~/ ~ Lost ;%'o;kda,~ Cases--10O 8O 1972 1973 1974 1975 1976 1977 6O 1972 1973 1974 110 5O 1975 1976 1977 studies, and on whether the sub- stance is found in U.S. industries. ~Category l~" is for chemicals '~hich the agency says, "are not found in American workplaces, but would oth- erwise be re~ulated."l For those substances classified un- der Category I or Category If, there are separate sets of rules to follow The first is an emergency standard to be set up immediately a/ter a chem- ical is deemed a Category I substance. The standard is to remain in force until the Federal agency establishes permanent rules for handling it. Category If substances will be sub- ject only to permanent rules derived from the agency's model Cancer and other incurable or de- bilitating diseases are shrouded in emotion as well as mystery. There is little likelihood that anyone in in- dustry would condone exposing work- er to known carcinogens and dan- gerous amounts of other toxic chem- But it's extremely difficult to de- termine a dangerous love[ of exposure and whether a particular job or work- place had any influence on an em- ployee's illness. For some ailments, such a~ lead posioning, coal miners' black lung disease and asbestosis, it ~n't difficult to draw a line from the cause t~ the effect. This, however, is more the ex- ception than the rule. More often, the health hazards a worker fac~s on the job are only a fraction of those he or she will encounter each day outside the plant. Smoking, eating and drinking habits, according to one estimate. may cause as much as 75 pot of the new cases of cancer, while occupao tinnal exposures represent only tween 1 and 5 pc~ of all cancer case~ Regulating personal life styles may go a lot further to reduce the cidences of cancer and other diseases That's unlikely. Iris also unlikely that the new emphasis on occupation- al health hazards will aba~e as a re- sult of any slowdown or reversal in the growth of government regu- lations- There are, as noted earlier. other elements in this bend. There is also a recognition by sev- eral top companies in various dustries that this is a matter that cannot be ignored. In one sense, it's a response to the recent history of gov- ernment regulatory activities. In a larger sense, it's a realization that controlling occupational health ha2,- ards is a responsibility of business, as well as a sound fiscal practice. General Motors Corp~ for example, took many steps toward healthier workplaces long before the issue be- came a subject of regulations and court actions. The giant automaker's medical and industrial hygiene de- partments date back to the 1930s, says Dr. Rufus W. Miller, ~ssociate medical director for the corporation. ~nd now include 119 full-dine physi- cians and 700 nurses, as well as ad- ministrative and support personnel In the p~st, t~eating injuries occu- pied the bulk of the GM medical workers' time, he says. But since its inception, the corporate medical de- partment has stressed prevention. Its lead program dates back to the 1930s and in its plants which use asbestos, medical surveillance procedures are strictly enforced and air levels are c~oeely monitored. The GM physicians also wield a great deal of power in the operations of the corporation's plants. Dr. Miller aztd.s. "Our doctors have the authority to stop a job.~ he sa}~ ~,~nd] shut- ring down a line is not popular in the auto industry. The corporation has also compiled a monthly occupational health and safety repor~ for over 18 years Its in- tent, Dr. Miller explains, is not the mere gathering of statistics. Physi- cians trained in occupational medi- cine review the reports to determine job hazards that should be corrected. It is also compiling a computerized medical data base to provide informa- tion about those new materials and other occupational health matters to the physicians at its various facilities. Computerizing medical records is the route Cleveland-based Diamond Shamrock Corp. is following and mar- keting to other industry members. Its software program, named COH:ESS, is designed to provide a total surveil- lance of the health effects of the workplace on the employee, says Dr. R. W. McBurney. vice president and director of the corporation's Health and Envh'onmental ,&ffairs Depart- ment. The steps taken by corporations, like General Motors and Diamond Shamrock, are only examples of what industry as a whole ~s doing t~ con- trol occupational aafety and health hazards. Those two firms are not alone in their efforts. At least one sur,,ey shows manu- facturing's proposed expenditures last year for new ~afety and health facilities were expected to rise more than 20 pct above the outlays made in 19T7. The steel industry, in particular. was expected to boost it~ spending by a whopping 217 pet during 197& _- T[06650410
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The ~OSI:[ Current ~tellizence EuIIetin is the primary product of the Current IntetI/gence System. The purpose of the Current Intelligence Systen~ is to promptly review, evaluate, and supplement new information received by ~IOSH on occu- pational hazards that are either unrecognized or are greater than generally known. The staff of the NIOSH Technicat Evaluatfon and Review ~ranch, Office of Extra- mural Coordination and Special Projects was responsible for the preparation of t.his Bulletin. As warranted by this evaluation, the information is capsulized and disseminated to NIOSH staff, other government asencies, and the occupational health community, including labor~ industry, academia, and public interest groups. With respect to currently "known hazard information this systeua also serves to advise appropriate members of the above groups of recently acquired specific kno~vledge which may have an impact on their programs or perception of the hazard. Above all, the Current Intelligence System ~s designed to protect the health o~ American ~vorl~ers and to allow them to ~vork Jn the safest possible environment. DHEW (NIOSH) Publication No. 79-122 T106650411
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CUR..'~E,'~T I~TELLIGENCE BULLETIN ADVERSE HEALTH EFFECTS OF SMOKING AND THE OCCUPATIONAL ENVIRONMENT February 5, I979 There is increasing evidence of adverse health effects due to the combined actions of tobacco use and exposure to chemical and physical agents in the workplace. The National Institute for Occupational Safety and Health (NIOSH) recommends that the use of and/or carrying of tobacco products into U~e workplace be curtailed in situations where employees may be exposed to physical or chemical substances which can interact with tobacco products. Additionally, curtaibnent of the use of tobacco products in the workplace should be accompanied by simultaneous control of worker exposure to physical and chemical agents. These recommendations are based on evidence which indicates that smo~ng can act in combination with hazardous agents to produce or increase the severity of a wide range of adverse health effects. Six ways have been identified by which smoking can interac~ with workplace exposures, and this Bulletin has been prepared to advise you of the hazards involved. NIOSH requests that chemical producers and distributprs transmit the information in this Bulletin to their customers and employees, and that professional associations and unions inform their ~embers. In this Bulletin, smoking and/or tobacco products are defined as clgarettes, cigars, pipe tobacco, chewing tobacco, and any by-products resulting from their burning and/or u~e. The discussions and illustrations used in this Bulletin .may relate to any one or more of these products. It is important to note that many of the adverse effects can still occur if an exposed tobacco product (contaminated) is subsequently smoked away from the workplace. BACK(~;<OUND The National Institute for Occapational Safety and Health recently prepared a chapter entitled "Interaction Between Smoking and Occupational E:~osures," for SMOKING AND HEALTH- A Report o_f _the Surgeon General- January II, 1979 (I). This Bulletia contains ~ "su~r~ary ~f the ~'nformatioh in the above chapter of Surgeon General's Report. The smoking habits among workers in various occupations provide an opportunity for interaction to occur between smoking and workplace exposure to physical and chemical agents. More blue-collar workers smoke !51%] than white-collar workers TI06650412
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[37~%]. Also, the blue-collar workers have the hi.~hest ris':: for workpIace exposure to hazardous physical and chemical agents. The use of tobacco products and workplace e.xposure to industrial agents increased steadily from 197.0 to 1960. Since 1966 the percentage of blue-collar workers who smoke has decreased while the number of workpIace exposures continues to increase. Studies have shown that more. non-whites[ZZ.5%] work in jobs associated with an increased risk of lung cancer than do whites[13.5%](~-5). Despite increasing recognition that both smoking and workplace exposures con- tribute to the development of certain disease states, few investigators have addressed the ways in which these two factors can interact to produce or enhance disease in workers. Some of the effects historically attributed to smoking may actually reflect interactions between smoking and workplace exposure to physical and chemical agents. These cannot always be quantified, and it should be noted that the six different mechanisms by which smoking may adversely act with physical and chemical agents found in the workplace are not mutually exclusive and several may prevail for any given agent. The six modes of interaction follow. ILLUSTRATIONS OF MODES OF ACTION Certain toxic a~ents in tobacco products and/or smoke may also occur in the work~lace, thus increasin~ exposure to the a~ent. Employees exposed in the workplace to toxic chemicals can receive additional e.xposures from the presence of those toxic chemicals in tobacco products. For example~ cigarette smoking causes increased exposure to carbon monoxide (CO). A CO concentration of 4% (40,000 ppm} in cigarette smoke can lead to a lung CO concentration of 0°04 to 0°05% (400 to 500 ppmL which can produce CO blood concentrations~ as measured by the carboxyhemoglobin (COHb) level~ of 3 to 10% (6-8). Workers are frequently exposed to carbon monoxide as part of their job and workers who smoke in those situations have increased ex-posure to CO. For example, in a study of COHb levels in British steelworkers, the average end- of-shift COHb concentration found in non-smoking blast furnace workers was 4.9~ compared to 1.5% in non-smoking unexposed controls. For heavy cigarette smokers, the average COHb levels were 7.4% for exposed blast furnace workers and 4.0% for unexposed controls (9). The COHb levels of blast furnace workers who smoked were in a critical range. Studies have shown that levels of COHb in excess of 5% can cause cardiovascular changes which are dangerous for persons with coronary heart disease (10-11). Also, since a significant number of workers have coronary heart disease and many smoke, additional occupational exposure to carbon monoxide may increase cardiovascular morbidity and mortality. Other chemicals found in tobacco which workers might be exposed to at their jobs, include: acetone, acrolein, aldehydes (e.g. formaldehyde), arsenic~ cadmium, hydrogen cyanide, hydrogen sulfide, ketones~ lead, methyl nitrite~ nicotine~ nitrogen dioxide, phenol, and polycyclic aromatic compounds (12). T106650413
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.Workplace chemicals may be transformed into more harmful agents .by _smoking. The heat generated by burning tobacco can transform workplace chemicals into more harmful substances. Investigations of outbreaks of polymer fume -fever (PFF) provide a clear illustration of this effect. Polymer fume feyer is a disease caused by inhalation of degradation product fumes from heated Teflon~ (polytetrafluoroethylene). The particular chemical agents responsible for PFF have not been identified~ however, temperatures in excess of 315°C (600°F) have been sufficient to cause their production. It is important to note that the temperature of burning tobacco in a cigarette is approximately 875°C (1600°F) (13,14). This disease is characterized by effects such as chest discomfort, fever, increased number of white blood cells, headache~ chills~ muscular aches and weakness (15). Because these symptoms are similar to those of other diseases~ such as influenza~ polymer fume fever may go undiagnosed. It has been suggested that repeated attacks of polymer fume fever may lead to permanent lung damage (16). One report describes aviation employees whose work involved contact with door seals that had been sprayed with an unspecified fluorocarbon polymer. In one case, a worker smoking during a break realized by the taste of his cigarette that it had become contaminated. Although the worker extinguished the cigarette, he experienced shivering and chills lasting approximately six hours, beginning one-half hour after smoking (17). Another illustrative report describes outbreaks of polymer fume fever among smokers whose hands were contaminated with polytetrafluoroethylene used. as a mold release agent. There was no recurrence of symptoms among these workers after smoking at the plant was prohibited (18). Other examples of workplace chemicals which can possibly be transformed into more toxic substances by smoking after tobacco is contaminated include a number of chlorinated hydrocarbons that have the potential for conversion to phosgene, a highly toxic chemical. Tobacco products may serve as vectors by becomin8 contaminated with toxic agents found in the workplace~ thus facilitatin8 entry of the a~ent into the body by inhalation, ingestion, and/or skin absorption. Tobacco products can become contaminated by chemicals used in the workplace thus increasing the amount of toxic chemicals entering the workers' bodies. The effects of smoking cigarettes contaminated in the workplace with known amounts of tetrafluoroethylene polymer have been studied with the assistance of human volunteers. Nine out of ten subjects were reported to exhibit tS~pical TI08650414
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polymer fume fever symptoms after each had smoked just one c~garette contaminated with 0.40 mg tetra/luoroethylene pol}qner. Some other toxic chemicals found ~n the ~vorkplace, identified in NIOSH criteria documents as potential contaminants of tobacco products include boron trifluoride (20), carbazy1 (21), dinitro-ortho-creosol (ZZ), inorganic fluorides (Z3), formaldehyde (24), lead (Z5,Z6), inorganic mercury (Z7), methyl parathion (ZS), and organotJn (29). 4. Smokin~ may contribute to an effect comparable to that which can result from exposure to toxic agents found in the workplace, thus causin,~ an additive biological effect. Smoking can add to the damaging biological effects which result from exposure to toxic chemicals found in the workplace. For example, combined worker exposure to chlorine and cigarette smoke can cause a more damaging biological effect than exposure to chlorine alone. In a plant producing chlorine by electrolysis of brine, 55 of 139 workers required oxygen therapy at least once during their employment after accidental exposure one or more times to high concentrations of chlorine. The maximal mid-expiratory flow (MMF) values of these workers with accidental chlorine exposures were compared with those of non-exposed smokers and non-smokers. A reduction in normal lung function is indicated by low MMF values, while a normal lung function is reflected by higher MMF values. MMF values decreased when chlorine and smoking were considered as additive toxic agents. Average MMF values in liters per second [L/sec] decreased in the following sequence: unexposed non- smokers [ 4.36], -unexposed smokers [4.13], exposed non-smokers[4.10], and exposed smokers [3.'57] (30). Other agents which can act additively with tobacco smoke include cotton dust (31), coal dust (32,33), and beta radiation (34). _Smoking may act synergistically with toxic agents, found in the workplace to cause a much more profound effect than that anticipated simpI~r from the separate influences of the occupational exposure and smoking. Smoking can interact with worker exposure to toxic materials found in the workplace resulting in more severe health damage than that anticipated from adding the separate influences of the occupational exposure and smoking. Asbestos provides one of the most dramatic examples of severe health damage resulting from interaction between the smoking of tobacco products and workplace exposures. In-a-prospective study of 370--asbestos insulation workers, 24 of Z83 cigarette smokers died of bronchogenic carcinoma during the four year period of the study, while not one of the 87 non-cigarette smokers died of this cancer (35). This study suggested that asbestos wor.hers who smoke have eight times the risk of lung cancer as compared to all other smokers and 9Z times the risk of non-smokers not exposed to asbestos. This same group of insulation workers was restudied five years later, at which time 41 of the 283 smokers had died of bronchogenic cancer. Only 1 of the 87 non- cigarette smokers, a cigar smoker, died of !ung cancer (36). 4 TI06650415
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Other chemicals and physical agents :vhich appear to act ssmer,gistically with tobacco smoke include radon daughters (37), gold mine e.~:posures (38}, and exposures in the rubber industry (39). 6. Smoking may cpntribute to accidents in the workplace. Studies have.shown that smoking contributes to accidents in the workplace. In a nine-month st.udy of job accidents, the total accident rate was more than twice as high among smokers as among non-smokers (40). It has been suggested that injuries attributable to smoking were caused by loss of attention, preoccupation of the hand for smoking, irritation of the eyes, and cough (41). Smoking can also contribute to fire and explosions in occupational settings where flammable and explosive chemical agents are used; however, in many of these areas smoking is prohibited. Some other situations where interaction between smoking and workplace exposure have been hypothesized include: Cadmium - Several studies suggests that exposed smokers had poorer lung function and a higher incidence of urinary abnormalities than did exposed non- smokers (42,43). Chloromethyl Ether - Chronic cough and expectoration showed a dose response relationship with chemical exposure and smoking. For each smoking category, chronic cough was more common for exposed than for unexposed men (44). beta-Napht.hylamine and other Aromatic Amines - There are reports of asso- ciations between cigarette smoking and bladder cancer (45,46). Since aromatic amines, which are known bladder carcinogens, are also found in cigarette smoke (1Z), a smoker who works with this group of gases receives exposure to bladder carcinogens from two sources. The interaction between smoking and exposure to aromatic amines should be further assessed. Research Considerations Studies on the adverse health effects from smoking should take occupational exposures into consideration and vice versa. Whenever possible, studies should include data on exposed and unexposed smokers and non-smokers. Tl~e increasing rates o~ lung cancer in non-white males compared to white males should be investigated further with respect to occupational e.vposures and smoking habits. The change in smoking habits of blue collar workers over the last decade provides an opportunity to more critically assess the contribution of smoking vs. occupational ex~posure to hazardous agents to certain disease states. Cohorts should be identified and followed prospectively for this purpose. 5 TI06650416
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"4. ~'orI:place physical and chemical agents ,~,hich interact ,~ith the smo~dng of tobacco to produce adverse health effects should be identified. 5. Further investigation into the mechanisms of synergism between smocking and occupational exposures is needed. The impact of the-combination of smoking and workplace exposures upon reproductive functions needs further study. 7. The impact of smoking on workplace accidents merits further study. 8. The lack of information on the effect of side stream smoke in the development of occupational disease in non-smoking workers merits attention. 9. The effects of cessation of smoking upon lung cancer risk among those occu- pationally exposed to toxic workplace agents requires investigation. RECOMMENDATIONS The National Iustitute for Occupational Safety and Health (NIOSH) recommends that the use of and/or c~rrying of tobacco products into the workplace be curtailed in situations where employees may be exposed to physical or chemical substances which may interact with tobacco products. Additionally~ curtailment of the use of tobacco products in the workplace should be accompanied by simultaneous control of worker exposure to physical and chemical agents. These recommendations are based on evidence which indicates that smoking can act in combination with hazardous agents to produce or increase the severity of a wide range of adverse health effects. Anth n~.y_~bbins~ MoD. Director T106650417
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REFERENCES I0. II. IZ. U.S. Department 9f Health, Education, and %Velfare, .Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health, _SMOK/-NG AND HEALTH A Report of the Surgeon General, "Interaction Between-Smokin--"--8 and Occupational Expostures", 7-1 to 7-Z5, ~Vashin~ton, D.C. (Prepublication Copy). (January II, 1979). U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Clearinghouse for Smoking and Health. Adult Use of Tobacco 1970 (June 1973). Boucot, K.R., W. Weiss, H. Seid~an, W.J. Carnahan, and D.A. Cooper: The Philadelphia pulmonary neoplasm research project. Basic risk factors of lung cancer in older men. Am. J. Epidemiol. 95(i):4-16 (197Z). Krain, L.S.: The rising incidence of carcinoma of the pancreas - real or apparent? J._. Surg. Oncol. Z(Z):II5-1Z4 (1970). Bridbord, K., J.G. French, aud J.F. Finklea: Toxic materials -respiratory pathways. Proceedings, Internatioual Conference on Cybernetics and Society, September 19-21, 1977. The Institute of Electrical and Electronics Engineers, Inc__:. Catalog No: 77CHlZ59-1 SMC:80-81 (1977). Chevalier, R.B., R.A. Krumholz, and J.C. Ross: ~eaction of nonsmokers to carbon monoxide inhalation. Cardiopulrnonary responses at rest and during exercise. ~T. Am. Med. Assoc. 198:1061-1064 (1966). Judd, H.J.: Levels of carbon monoxide recorded on aircraft flight decks. Aer_.q.~9~. Med. 4Z(3):344-348 (1971). Osborne, J.S., S. Ademek, and M.E. Hobbs: Some components of gas phase o£ cigarette smoke. Anal. Chem. ZS(Z):ZI 1-Z15 (19~6). Jones, J.G., and D.H. Walters: A study of carboxyhaemoglobin levels in employees at an integrated steelworks. Ann. Occup. Hyg. 5_:2Zl-ZS0 (196Z)." _4mderson, E.W., R.J. Andelman, 3.M. Strauch, N.J. Fortuin, and J.H. K_nelson: Effect of lo-~-level carbon monoxide exposure on onset and dul-ation of an~na pectoris. Ann. Intern. Med. 79(I):46-50 (1973). Horvat, M., S. Yoshida, R. Prakash, H.S. Marcus, H.J.C. Swan, and W. Ganz: Effect of oxygen breathing on pacing-induced an~na pectoris and other manifestations of coronary insufficiency. Circulation 45(4):837-844 (197Z). U.S. Department of Health, Education, and Welfare~ Public Health Service: SMOKING AND HEALTH - Report of the Advisory~ Committee to the Surgeon General of ~he Public Health Service, PHS Publication No. 1103 (1964). T106650418
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I3. 14. 15. 16. 19. ZO. ZI. Z3. Adams, ?.LG.F.: Polymer fume fever due to inhalation of fumes of 2oly- tetrafluorethylene. Trans. Assoc. Lnd. Med. Off. 13:Z0-ZI (1963). Touey, G.P., and R.C. Mumpower ]7: Measurement of ~/~e combustion-Zone Temperature of Cigarettes. Tobacco 144(8):18-ZZ (1957). National Institute for Occupational Safety and Health: Criteria for a Recommended Standard .... Occupational Exposure to Decomposition Products of Fluorocarbon Polymers, U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 77-193, National Technical Information Service, PB-Z74-YZ7 (1976). Williams, N., G.W. Atkinson, and A.S. Patchefsky: Polymer-fume fever: Not so benison. J. OccuR. Med. 16(8):519-52Z (I974). Bruton, D.M.: Polymer fume fever. Br. Med. J. 1(5542):757 (1967). Barnes, R., and A.T. Jones: Polymer-fume fever. Med. J. Aust. 2(2):60-61 (1967). Clayton, J.W., Jr.: Fluorocarbon toxicity and biological action. Fluorine Chem. Rev. I(Z):I97-ZSZ (1967). National Institute for Occupational Safety and Health: Criteria for a Recommended Standard .... Occupational Exposure to Boron Trifluoride. U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 77-1Z2, National Technical Lnfor- marion Service, PB-Z74-747 (1976). National Institute for Occupational Safety and Health: Criteria for a Recommended Standard .... Occupational Exposure to Carbary!. U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 77-107, National Technical Information Service, PB-Z73-801 (1976). National Institute for Occupational Safety and Health: Criteria for a Recommended Standard .... Occupational Exposure to Dinitro-Ortho-Cresol. U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH} Pablication No. 78-131 {19787. National Institute for Occupational Safety and Health: Criteria for a Recommended Standard .... Occupational Exposure to Inorganic Fluorides. U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 76-103, National Technical Infor- mation Service, PB-Z46-69Z (197 5). Tl06650419
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ZS. Z6. ZT. ZS. zg. 30. 31. 3Z. National Institute for Occupational Safety and Health: Criteria for a Recommended Standard .... Occupational Exposure to Formaldehyde.. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, .National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 77-126, National Technical Information Service, PB-Z73-805 (1976). Tola, S., and C.H. Nordman: Smoking and blood lead concentrations in lead- e.xposed workers and an unexposed population. Environ. Res. 13:ZS0-ZS5 (1977). Zielhuis, R.L., E.J. Stuik, R.F.M. Herber, H.J.A. Salle, M.M. Verberk, F.D. Posma, and J.E. Jager: Smoking habits and levels of lead and cadmium in blood in urban women. Int. Arch. Occup. Environ. Healt~h 3_9_9:53-58 (1977). National Institute for Occupational Safety and Health: Criteria for a Recommended Standard .... Occupational Exposure to Inorganic Mercury. U.S. Department of Health~ Education, and Welfare, Public Health Service, Health Services and Mental Health Administration, National Institute for Occupational Safety and Health, HSM Publication No. 73-110Z4, National Technical Information Service, PB-222-Z23 (1973). National Institute for Occupational Safety and Health: Criteria for a Recommended Standard .... Occupational Exposure to Methyl Parathion. U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 77-106, National Technical Infor- mation Service, PB-Z74-191 (1976). National Institute for Occupational Safety and Health: Criteria for a Recommeded Standard .... Occupational Exposure to Orsanotin Compounds. U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 77-115, National Technical Infor- mation Service, PB-ZZ3-113 (1976). Chester, E.H., D.G. Gillespie, and F.D. Krause: The prevalence of chronic obstructive pulmonary disease in chlorine gas ~vorkers. Am. Rev. Respir. Di__~s. 99(3):365-373 (1969). Merchant, J.A., -J.C. Lumsden, K.H. Kilb_urn~ W.M..O'Fallon, .J.R. Ujda, -V.H~Germino ~/r., and ~/.D. Han~ilton: " An industrial study of the biological effects of cotton dust and cigarette smoke exposure. 3. Occup. Med. I_~S(3):ZlZ-ZZl (1973). Kibelstis, J.A., E.J. Morgan, R. Reger, N.L. Lapp, A. Seaton, and W.K.C. Morgan: Prevalence of bronchitis and airway obstruction in American bituminous coal miners. Am. Rev. Respir. Dis. 108(4):886-893 (1973). Tl08650420
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33. 34. 35. 36. 37. 38. 39. 40. 41. 4Z. 43. 44. ~ankinson, J.L., R.B. Reger, and W.K.C. Mor~a_u: Maximal expiratory £1ows in coal miners. Am. Rev. Respir. Dis.~. II.__~6(Z):175-180 (1977). Cowdr7, E.V., A. Croninger, S. Solaric, and V. Suntzeff: Combined action of cigarette tar and beta radiation on mice. Cancer 14(2):344-35Z (1961). Selikoff, l.J., E.C. Hammond, and J. Churg: Asbestos Exposure, Smoking and Neoplasia. J. Am. Med. Assoc. Z04(Z):106-112 (1968). Hammond, E.C., and l.J. Selikoff: Relation of cigarette smoking to risk of death of asbestos-associated disease among insulation workers in the United States. In: P. Bogovski, J.C. Gilson, V. Timbrel1, J.C. Wagner, and W. Davis (editors): Biological Effects of Asbestos. In__[. Agen~ Res. Cancer, Scientific Publication No. 8, Lyon, France, 31Z-317 (1973). Archer, V.E., J.K. Wagonner, and F.E. Lundin, Jr.: Uranium mining and cigarette smoking effects ou man. J. Occup. Med. 15(3):Z04-211 (1972). Sluis-Cremer, G.K., L.G. Walters, and H.S. Sichel: Chronic bronchitis in miners and non-miners: An epidemiological survey of a community in the gold-mining area in the Transvaal. Br. /L Ind. Med. Z4(1):1-1Z (1967). Led.nat, W.M., ..H.A. Tyroler, A.J. McMichael and, C.M. Shy: The occupational determinants of chronic disabling pulmonary disease in rubber workers. J. Occup. Med. 19(4):Z63-~.68 (1977). - Yuste, P.C., and M.L. De Guevara: Influencia del fumar en los accidentes ]aboraIes. Encuesta estadistica (The influence of smoking on industrial accidents. A statistical study). Med. Sel~ur. Trab. Z1(84):38-46 (1973). Naus, A., V. Engler, M. Hetychova, and O. Vavreckova: Work injuries and smoking. Ind. Med. Surg. 3._~5110):880-881 (1966). Lauwerys, R., J.P. Buchet, and H. Roels: Une etude de la fonction pulmonaire et renale de travialleurs exposes au cadmium (A study of pulmonary and renal function in workers exposed to cadmium). The 18th International Congress on Occupational Health, Brighton, England, Z79-Z80 (Abstract) (September 14-19, 1975). Materne, D., R. Lauwerys, J.P. Buchet, H. Roels, J. Brouwers, and D. Stanescu: Investigations Sur Les Risques Resultant De L'exposition Au Cadmium Darts Deux Entreprises De Production Et Deux Entreprises D'utilisation Du Cadmium. (Investigations on the risk resulting from exposure to cadmium in two production plants and two plants using cadmium). Cab. Med. Tray. 1~(I-Z):5-76, (March-June 1975). Weiss, W.: Chloromethyl ethers, cigarettes, cough and cancer. J. Occup. Med. 18(3):194-199 (March 1976). 10 TI06650421
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46. 45. Doll, R., \:.P. Vessey, R.W.R. Beasley, A.R. BucMey, E.C. Wear, :.E.W. Wisher, E.J. Gammon, %V. Gunn, G.O. Hughes~ K. Lee, and B. Norman-Smith: \~ortali£y of gas workers-final report of a prospective study. Br. J. ind. Z_~9 (4):394-406 (197Z). Doll, R., R.E.W. Fisher, E.J. Gammon, W. Gtmn, G.O. Hughes, F.H. Tyrer, and W. ~rilson: ,'v|ortality of gasworkers with special reference to cancers of the lung and bladder, chronic bronchitis~ and pneumoconiosis. Br. J. Ind. I%,[ed. Z_~Z(1):I-IZ (1965). II TI08650422
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r CUkfULATIV-E LIST OF ~HOSH CURRENT INTELLIGEI~E BULLETE,4S * t. * 5. * 9- I0. 11. IZ. 13. 14. * 17. * 18. * 19. * Z0. El. * * 23. * Z4. * ZS. Z6. * Z7. * Z8. * 30. * 31. NOTE: Chloroprene Trichloroethylene (TCE) Ethylene Dibromide (EDB) Chrome Pigment Asbestos - Asbestos Exposure During Servicing of Motor Vehicle Brake and Clutch Assemblies - January Z0, 1975 - June 6, 1975 - July 7, 1975 - June P-4, 1975 - October 7, 1975 - October 8, 1976 - August ~, 1975 Hexamethylphosphoric Triamide (HMPA) Polychlorinated Biphenyls (PCBs) 4,4'-Diaminodiphenyl methane (DDM) Chloroform Radon Daughters Dimethylcarbamoyl Chloride (DMCC) Revised Diethylcarbamoyl Chloride (DECC) Explosive Azide Hazard Inorganic Arsenic - Respiratory Protection Nitrosamines in Cutting Fluids Metabolic Precursors of a Known Human Carcinogen, Beta-Naphthylamine Z-Nitropropane Acryloni t rile Z,4-Diaminoanisole in Hair and Fur Dyes Tetrachloroethylene (Perchloroethylene) Trimellitic Anhydride (TMA) Ethylene Thiourea (ETU) Ethylene Dibromide and Disulfiram To,tic Interaction Direct Black 38, Direct Blue 6~ and Direct Brown 95 Benzidine Derived Dyes Ethylene Dichloride (l~Z-Dichloroethane) NIAX ~Catalyst ESN Cnloroethanes - Review of Toxicity V~nyl Halides - Carcinogenicity Glycidyl Ethers Epichlorohydrin Adverse Health Effects of Smoking and Occupational Environment .... - October Z4, 1975 - November 3, 1975 - August Z0, 1976 - January 30, 1976 - March 15, 1976 - May 11, 1976 - July 7, 1976 - July 7, 1976 - August 16, 1976 - September 27, 1976 - October 6, 1976 - December 17, 1976 - April 25, 1977 - July I, 1977 - January 13, 1978 - January 20, 1978 - February 3, 1978 - April ii, 1978 - April 11, 1978 - April 17, 1978 - April 19, 1978 - May ZZ, 1978 - August Zl, 1978 - September ZI, 1978 - October IZ, 1978 - October Ig, 1978 -- - February 5, 1979 Bulletins @1 through #I8 have been reprinted as a NIOSH publication, #78-1Z7, for the convenience of those that desire a complete series of Current Intelli- gence Bulletins. Distribution of this publication and single copies of Bulletins #19 and later are available from NIOSH Publications Dissemination, Division of Technical Services, 4676 Columbia Park~vay, Cincinnati, Ohio 45ZZ6. *Cancer related bulletins Tl08650423
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Job Sa[ety Standards Ordered Where Smokh g Enhances Risks NEW YORK. No~'. 29 (AP~--Itealth, Education and Welfare Secretary .lo- seph A. Califano Jr. ordered z~ew fed- oral safety standards today [or in¢hzs. tries in which smoking increases a worker's chance of disease. The n~*w standards would tighten ~afety restrictions on some companies unless they require workers in cerlain jobs not to smoke at work. Cig~ette smoke is thought to crease the risk o~ certain dlsease.~ particularly caucer--when workers are already exposed to ~ hazardous substance on the job. For example, studies tmtimate that asiatics workers run a three to four tlme~ higher risk of getting lung can- cer than people not exposed to ashes. tea. For asbestos workers who smoke, the risk rises to 92 times more than mmsmokers who don't work with the subslanee. Calit~no said. Califano said he asked the Center for Disease Control and the National lnstihde Ior Occupalional Safety and tlealth to work with the Labor pertinent to prepare the "standards "on an emergency basis." Calif~no said the risk of cancer or other diseases rose for smokers expo- sed to talc in tile rubber industry, to decay produels of the element radon in uranium mlniug and to bOllS in the plastics lndustw. He said those industries would the initial targets of the standards; Califano said he doubted that. tile Occupational Safety and He~Ith Ad- ministratiou, which would wrife, the guidelines, will be able to exclude smokers from certain jobs. T106650424
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H,E,W, GHIEF ORDERS STRIGT TOXIN RIJLES £,~lifano Cites Danger to Industrial! Employees Who Also Smoke By JANE E. BIIODY Joseph A. Califano Jr., ~ ~mm~ of Heal~, ~tk~ and Wei~, ~y o~e~ t~e ~~t of ~g ~d i~stH~ to~. ~c~ ~d=t~, ac~t~ it of "si~steF' a~iug tac~ to 1~ ~ ~d a~l~ into smoki~. Mr..CaB~ ~id ~lt, in i~ the c~s~g num~r of ind~tfial ~tp~s~t a g~tly ~c~a~ rise ~! s~ smok~, Such su~tan¢~ i~la~ as~tos, talc ~d u~ Center for Disease ~t~il ~d ~e tidal I~tute for .~tio~M ~fety{ pm~ment to ~lop, "~ au urgent basis, ~upatlmal ~tanda~ that rake taw ac- ~t ~e ~ fl~k to ~rke~ that smoMng brings to i~mtfl~! h~s." He ~ ~t t~ ~tiw ~d 1~ for ~ample, to ~e =m~is~ ~~.~d ~e~ ~ ~- ~SI~IV, u~ ~ ~ smoke i~ ~~ ~ w~ ~ ~ smo~ ~ m~ ~ ~m ~d add. ~ m ~ ~~, ~h ns ~r- ~ace. Mr. ~Hfam~ an~,~ th~ ~ ~ ~ti~l safety o~er at a m~ng oI ~ the leading cause of all prematura deatiz ~ i n oar nation t~day." "Last year." he mid, "the industry -Jpent some $500 million ~o persuade peo- ple, mostly young people, that smoking is. glamorous and satisfying." He described the advertising as "a seductive, multi- million-dollar mask designed to hide= from America's children and teenagers the skull and cro~ bones that lurks in : every pack of cigarettes." He .~aid that cigarette selhng tech- niqu~m "prey" on such facts a~ the~e: ~ .¢,eveaty-f~ve percent of adtflts who,';mokc acquire the habit betor~ th~ age oi 21; ITS,000 children aged 13 and younger are regular cigarette smokers, and each day 4.000,',:hildren become cigatettesmokers. Mr. Catifano added that virtually no ~me starts smoking after age 30. Rather, most who smoke ~egin long before they have had a chance to e~aluate the risks and make a considered decision. T106650425
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TIlE WALL STREET JOURNAI~, Thursday, Nov. 30, 1978 ~--~--- , ~ . ~--~ Smoki~,g "~o i~e, lru:luded rela~ of HeCtic, gduea~on, and Web ~are, Is expanding hia an~l.,5~t smok- dustl~l ~orkplaee. Mr. ealttano ann~ne~ at a~ed the Ceater and ~a ~a~onal Ins~tute ,}i Occu~a- ~ ~e~ and He~ to work ~th • b'~ Department ae~t ~e ~erea~ fl~k ~ el~et [~k~~r workers e~ t~ ~dus- ~ ot Individual T106650426
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ordered NEW '~'O[tK (UUD -- Government were ordered Wedne:;day al safety s~andards based on the increa~e¢~ risk frotn industrial pollutants among workers wh~ smoka. "We are deeply eerned about this accumu- lating evidence of the dan, gets of streaking combined with indusLriai hazards" m~eh as asbestos and urani- um by~r~luets, sai~ seph A. Califano Jr., tary of Health, E~cation ~md Wel~are. Califano made the order during an address to the American Cancer S~iety. For his war oi; smoking. f:aliiano rcceivcd the Can- ccr Society's Communica- lot of IIope A~va~d a~ its Third Natic:r~al Public In- AL ;he ~'am~ t;me, he an- no=raced that the surgeon ~encral would issue a 1 ,~- page ce]~r~r~ on smo]dn~ and h,~aI~h J:m. H. The second su~ report, i~e said, "will Et~ the most complete and c~m;prehensive documen~ on ~m~khlg ever Calffano did ~o~ ela~- rate on what new industrial standards might be sot. But they might .eventually determine whether or not woekers are allowed to smoke ~n cerlain i~dustrial situations or further cut the allowable percan~g~ p~llutants in those ~itua- A number o[ industries have critwized a re~ent HEW re[tort that said pvrcent 9[ all cancer was related to wCmk. "Our sh~dies of asbestos reveal that exposure ~sbast~;, if combined with s;i~oking, holds a risk d-adly disease up to times g~ eater thaa the "~Exg~:u~ of uranium min~r~ to ~on ~au~;ht~ ~d~cay prc-flur~l, if tini~i greaL~r ~n TI06650427
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~. ~%,000 JAN '!97~" Are smokers more byssinosis prone? A team of researchers at Emory University says it has estab- lished a "strong, definite connec- tion between cigarette smoking and byssinosis." That and other findings result- ed from a 3-yr project to seek a more sensitive screening test for identifying workers with bys- sinotic symptoms, t \ ~'I have yet to ys o c who is a non- smoker." Bradford says the study also points toward hyper-allergenics as being byssinosis prone. "Any- body who is hyper-allergenic and has hay fever, asthma or similar problems certainly has more risk in general to developing lung disease at any time. My guess is that the disease is an allergic reaction and, like any allergy, can develop at different times. The study was spons .o~¢d by a $250,0(30 grant ~om Nicely, and took place in WestPoint Pepper-. ell plants in Georgia and Ala- T106650428
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ADIO TV REPORTS, NC. FOR PROGRAM SbPJECT THE TOBACCO INSTITUTE, INC. CBS Morning News STATION ~ T V \~Network November 30, 1978 CITY Washington, D.C. Secretary Cal ifano~s Anti-Smoking Campaign LESLEY STAHL: The National Cancer Institute says tests show menthol does not cause cancer in animals, but that there is no evidence mentholated cigarettes are any safer than regular brands. RICHARD THRELKELD: For the last couple of years Joseph Califano, the Health and Welfare Secretary, has been" waging war on cigarette smoking, Yesterday he said, "1 will continue to do battle, I will continue to see it as my plain duty," And Califano went on to outline his battle plan at an awards ceremony in New York City. Charles Crawford has more on that. CHARLES CRAWFORD: The award presented by the American Cancer Society honored Joseph Califano as communicator of hope. But the message delivered by the Secretary of Health, Education and Welfare is not very encouraging. That cancer in general and specifically its link to cigarette smoking remain an enormous national health problem. SECRETARY OF HEW, JOSEPH CALIFANO: Cancer is still the second largest cause of death in the United States. Cancer causes 390,000 deaths in this nation each year. Indeed, if there were no cigarette smokers among our population, there would have been some I00,000 fewer deaths from cancer last year. CRAWFORD: Those are the statistics nearly a year after Secretary Califano launched the federal anti-smoking campaign. It's T108650429
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-2- a campaign that has seen a slight decline in smoking among the entire population, but an alarming increase in a younger age group, especial ly among teenage girls. Cal llano now says much more has to be done to educate those who still cling to the habit. SECRETARY CALIFANO: Public attention is critical, It is a critical weapon in the war on cigarette smoking, for 80 per- cent of those individuals who smoke cigarettes want to quit. And the more often they are reminded that cigarette smoking is slow motion suicide the more likely they are to try to quit. CRAWFORD: In addition, Califano is ordering new safety standards where industrial pollutants add considerable risk to workers who smoke. And the Secretary says it's time advertisers face up to their responsibility for making smoking attractive to young people. SECRETARY CALIFANO: Seventy-five percent of the people who smoke in this country that are adults begin to smoke and acquire the habit before they're 21. The cigarette companies know that. I think they target the handsome men and the glamorous women at those children and teenagers in an attempt to get them to start smoking. CRAWFORD: One of the most sobering facts to come out of this conference is that despite all that's been said and done over the past 20 years, today nearly four out of every ten Americans are smokers, some 80 million men, women, and youngsters who are at greatest risk of both cancer and an early death. Charles Crawford, CBS News, New York Ti06650430
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HEW Launches Drive On Toxic Chemicals The government has begun a new campaign to track down and control toxic and cancer.causing chemicals in the environment• HEW Secretary Joseph Califano announced yes- terday that four 'federal agencies have allocated $40 million for the 1979 budget of the government's new National Toxicology Program. The departments are the National Cancer Insti- tute, the National Institute of Environmental Health Sciences, the National Institute for Occupa- tional Safety and Health and the Food and Drug Administration. Cali/ano said that only a few of more than 7 mil- lion existing chemicals have been tested for possi- ble cancer hazar~Is. Yet as many a~ 60,000 are now believed to be .-- or have been -- in commercia.l use in the United States, "The phenomenal technological adwinces in this country have brought with them unfortunate and unforseen byproducts creating serious health haz- ards as in the case of asbestos," Califano said in a statement released in Washington. He is on a four- nation European trip. He referred to asbestos used as a shipbuilding coml~onent to which thousands of American work. ers have been exposed since World War II. It has been shown to'cause lung and other cancer up to 30 years after exposure. In addition to asbestos, other publicized and • highly toxic chemicals include vinyl chloride, used in the manufacture of ~ome plastics and found to cause liver cancer; the insecticide kepone; and the controversial family of PCB (polychlorinated phenyls), used in the manufacture of some elec- tronic components and found to have contami- nated parts of the Great La~es and the Hudson River. Califancl said an estimated 6~I~ to 700 nevr'chemi-" cals are introduced into commerce annually but only about 560 chemicals each.year receive thor- ough government and industry tests. Each con- trolled experiment using animals takes from three to six years and costs at least $300,0fl0. T106650431
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RADIO TV REPORTS, NC. • ~35 W}SCCNSt'4 AVE?,(JE. N W WASNtNGTCN, D C 244.354,~ FOR PROGRAM DATE SUBJECT THE TOBACCO INSTITUTE, INC. News 7 October 25, 1978 6:00 PM Coal Tar Pitch STATI "G~~ " CITY Washington, D.C. RENEE POUSSAINT: It looks as if another common material in our lives may cause cancer. Recent reports have made us wary of the diet sodas we drink, the grilled hamburgers we eat, as well as hair dyes, asbestos and food coloring. News 7's Lark McCarthy has learned that the latest threat comes from the type of roof over many of our heads. LARK McCARTHY: This man is applying a roof to Fairfax Hospital. He and his co-wokers are using a common roofing material called coal tar pitch. Recently, another roofer told their foreman something alarming. no more. MAN: He said, "Ernie, don't touch that coal tar pitch It causes cancer." McCARTHY: The roofer's information is correct. This report from NIOSH, the National Institute for Occupational Safety and Health, concludes coal tar pitch can increase the risk of lung and skin cancer in workers. Touching the pitch causes the greatest danger of developing warts, tumors and sometimes skin cancer. But that green, black, smelly smoke also poses a health hazard. SECOND MAN: It ju'st makes you cough a lot and burns your eyes a lot, you know, and your face, when it gets up in your face, you know, smoke -- that green smoke. It just scares me, you know, to work around it. THIRD MAH: I had problems sleeping at night and then I TI06650432
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-2- can't close my eyes. They burn. that could real l y mess you up. And breathing that stuff, you know, FOURTH MAN: thing peel ing off. Tear my skin, everything, my whole -- every- McCARTHY: Administraters at Fairfax Hospital say they were not aware of any health hazard until News 7 told them. FIFTH MAN: Yes, I think it's kind of peculiar that we would find out about this danger from a news fi Iming crew rather than from some other source, you know. But we were total ly unaware of it until you came out here today. McCARTHY: It is even more peculiar when you check the date on the NIOSH report, September 1977. tllOSH gave this research to the Occupational Safe~y and Health Administration. OSMA has the power to set health standards. I asked an OSHA spokesman what has happened to the report. He told me OSHA has to deal with a whole universe of problems. Some things have to wait, some for years. OSHA hopes to get to the coal report next year. NIOSH estimates 145,000 people work with cancer-causing coal tar products. Lark McCarthy, ~ews 7. T106650433
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H~_aIth Aflministra~ha's e.~_, rt t~ l~d.me a sweeping r.ew p~li~, far re~laang ~.n~r- cau ~sin~ su~atan:es at p!zces cf wor~. The , que~a~n: %;~a~n OSHA ~.an~red a Icn~ nes of canaer-l=-~[icy he~,znn~ ]~t , mer, ",~re.~SP~'~ officials a~.ere to h~r the iO$1:D, officials insist the,, were. In fact, the'$~.'the kearin~ were U~:en m cmsly at the agency that o£ficials at one poin! found it necessary to mLw~onish Erda Bmgham. the agency's director, ~o stop spending so much time listening to testi- mony to the exclusinu of other pressing problems. MeanwhiIe, many of Mrs. Bing. ham's top hands stuck around flu-~u~out the proceedings, the agency re.vs. But other government of~cials, ~ say they sat through the entire i0 weeks of tes- timony, insist that OSHA pohc.~m'mkers were absent during much of ~.e heanngs. Labor Department la~,ers were there, • they say, and O$I-IA officials dropl:ed by from ~ne to time. But generally, t.hey sist. the hearings were dominated b:,' exec- naves of an outside con.~ulting firm called Clement Associates Inc.; that finn had been retained by OSI-L~. to provide sclen- tific expertise in evaluating tesbmony, finding exper~ witnesses mad detenv.ining which substances chould be regulated un- der the proposed cancer ~licy. "It was unfortunate," says one official at the National Institute for Occupational Safety and Health, the federal agency that conducts research for use in OSHA's ~ohcy making. "An owner of some small cleaning establishment would come in and testify about how ~e proposed cancer pol- icy would hart his busines% and nobody in a policymaking capacity at OSHA would be there to hear him." Tl~s bureaucratic debate may seem a littie frivolous. Actually it refleas a more significant question surrounding the gov- ernment's role in diminishing the specter of cancer: ha their efform to make the workplace as safe as possible from carcin- ogens, have OSHA officials ignored scmn- tific arguments that don't .~ppor~ their regulatory Rims? Is policy in this enm- tional area increasingly the product of a k~nd of intellectual hnbreeding with the same pomntial for flawed results as the ge- netic inbreeding of the European aristo- The Role of Clement Many observers in Cmngre~ and mdus- n'y believe OSHA's recent cancer ~earin~s reveal a certain scientific clc~d-minded- hess at the agency. They point particularb, to the role of Clement Assccia~ ,,~ich performed much ef the work that nornmlly would have been performed by officials of NIOSH. Some NIOSH officials feel that OSHA, departing sliarply from ImSt practice, pur- l:¢sely excluded the institute from the pro- eess of shaping the cancer NIOSH offici~s weren't in~ited to tes*~'y last ~unmer's heag.ngs, marl the' ~t:in't even get cuptes of the proposal un~l just before it was released V,b2e~y. they cora- l:lain. "ITIOSH ';as ¢omp~.etely sa:,~ the iastitute's del~,at=.¢ dire~sr. FA- wned Ea~er. "To v~'hat p:n~se, f~r re~m ~ can't Bat c~e~-~ ~m~ &ffe~dy, aEency nat ~wa~ ~ $~,~y ~Vs re~lamw oaSc~k. According ~ ~s ~ew. 0~ • e ~ce of a more ~ha~c ~r~- ~aon, CIement ~iams. OS~'s ms ~elster their ~ by &e agency's mp la~er ~ ~ ~r-~l- icy ~e~ .~n Kefier, ~ ~rk~ closely at ~e Envim~t~ Agen~ wi~ Clement's pr~den~ Jo~ C. Kolojeski. At ~e EPA, ~e two p~ for mmy of ~e s~e ~cies ~at ~e co~rat~ rote OS~'s ~a~r ~s~. Mi th~ has le~ some md~ and ~ke-m~ded o~erve~ u~nde~g In their e~o~s the work~ce a~ sa~e ~os~ible ~rom c~rci~ge~s, have OS HA o~icial~ ~ciemific ar~t~ ~'t s~o~ t~r reg~- to~ ~ims? their views will get full considerat~o"m "I don't see how you can escape the cunclu- sion that the deck is stacked," says U.S. Rep. James Martin of North Carolina. a frequent critic of what he considers over- zealots government efforts m regulate pected carcinogens. "By bypas~g NIOSH and biting instead outside cons-~ltan~s ~th established views on scientifically debata- ble issues, OSIIA raises questions about its commitment to consider all points of view." Rep. Martin considers t~he question an important ~ne because of the OSHA cancer policy's likely significance as a model ~r other agencies. But it's important as because of the nature of the polk-] itself, which is designed to set aside some of abe debate on regulating carcinogens in order to speed up the regulatory process. Essentially, the proposed policy es~b~h two broad categories ot carcino- gens-confirmed and suspected-and. line criteria for determining w~ch sub- sUances ~t into each cate~ry. The pol,:cy also would outiine in general the regula- tory action needed to limit workers' expo- sure to substances the agency c~nsidered carcinogenic. Thus, when OSHA took action on a ~ cific substance, the only issues to be re- solved weald be whether the agency ~ correctly classified it and plzced fl',e pmpriate lirmt ~n workers' ex'~c~m,e to it. This would eliminate the O~t-L%-k~dustry standoff that has tied up the a~.r~"s pa~t subsvance-by-substance reguta~] ap- proach But that's j~t the ~roblem. in the vie-,z of man:." s~en~ts acfi chen~.cal lr.d~a-~ cffcizls. Th.~y c~aterA there's s'/It ~ rc-~m for de,ate cn sort2 z,~-:~ the_ a~'e_n,':y wa.r_~ ~_, ,fd.~_~ e~=ure to ce~ Iow-~c~:cy • ~ ~re must ~e ~t~ ~ ~e l~'~~t "'fe~ble" level. ~ ~dition, ~d~ a<~u~v~ some sden~ befieve ~e O~X wo~d be ~ I~ m ev~g ~e v~" of mse~ch us~ to delete t~e crag ~ten~s of p~c~ m~s. They w~t an ~de~ndent ~el of ~mn- ~ to evMuate @e msem~h ~fore O~ could sse it ~ a b~is [or ~am~ flea. ~d &ey ~so qu~on ~e ~ficy's refiance on an~ t~ to show a su~ce to ~ Bat for eyeD' scien~st who sup~ ~dus~ position, it see~, ~ere's who ~p~ OS~'s Ae~. A~ncy ci~s say that for pa~c~ ~du~s ~ere may ~ ~reshol~ of ~e to ce~a~ cam~oge~. ~at ~e va~ ~m posen to ~m ~ey c~ntend, ~d ~ it's irascible to iden~ a • ~shold for en~re ~pula~o~. ~d~ ~ey ~d, ~me rese~h ~ca~ vaHous ca~ogens may act m ~a- lion '~th each o&er to incre~e ~k. ~d ~ the a~ncy can't ~t a pm~r ~h- old for any ~ven su~ce. ~O'S ~ght? E~ena~ly, ~en, ~d~" ~nten~ O~ is gong ~er ~ i~ re~ato~ preach than scien~c ~owl~ j~es. md OS~ retor~ ~at it m~t ~te@re~ .av~lable mse~ch conse~aavely ~ oAer to save Wee. But ~e problem ~& ~ ~- enafic debate is ~at it's s~ply im~ble to know who's right• Cmcer mse~h pm~ess~ far enough to ~ve ~p~t ~ sides but not f~ enoa~ m We defini- tive weight to either. "It ~comes a matter of t~olo~'. reAly." sa~ a ~OSH officiA. "You prowl much have to t~e it on faRE" The result is ~at a ~ien~fic deMte lost behind ~e sound ~d [u~ of baRle. In re~latow ~lia~, no~qt~t~d- ~g ~l the high-pAc~ tAent ~e muster~ for the c~cer he~ I~ s~- met, the fot~es of m~a~on usu~ly end up hoid~g ~e ~st ca~. ~d it's clear from O~'s approach the current cancer i~ues, ~ w~l ~ pm- nouncemenm by some of i~ offici~s. the agency is gamb~g its ~ on ~erminat~g much of ~e ~ienfific ~te ~a['s ensn~led ~e a~ncy since ~nmg ~ven years a~. "The debate m s~ll yew much ~n my sew scientRic ~es that ~t r~ a~,u~ c~cer." says OSt~'s .~r. Ke~er. "'But on those old ~ ~at tW has ~en r~g &nee &~ co~ c~- h~me. we just won't lis~n to '~ more. The ~ck record is ~at it ~:~ two ye~s to re.ate ea~ ~ce we have to deA 'Xx~ ~ s~ old menm every ~e. Well, ~'d n~ver ~t fm ish~i so we're simply ~u~ '~th ~osa ~ssues.'" TI08650434
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E~TIMATES OF T~E FRACTTON OF CANCER IN T~E gNITED STATES P.ELATED TO OCCUPATIONAL FACTORS Prep~sd by: National CanoaE Institute Na~iona! Institute of Environmental Heal~h Sciences ~ational Institute for Occupational Safety and Health ContributoEs (alphabetical order): Kenneth Brid~M~Ed, M.D., HIOSH PieEre Decoufle, Sc.D., NCI Joseph F. Wrap,i, Jr., M.D., David G. Hoel, Ph.D., NIEHS R~bert N. a~ver, M.~., So.6., NCI David P. ~11, M.D., Ph.D., NIE~, Director ~erto Safflot~i, M.D., NCI ~in A. S=~elde~an, Ph.D., ~hur C. Upton, M.D., NCI, Contributor tO ~he Appendix: Nicholas Day, Ph.D., NCI, IARC 15, 1978 T106650435
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FIRST ANNUAL REPORT TO CONGRESS BY THE TASK FORCE ON ENVIRONMENTAL CANCER AND HEART AND LUNG DISEASE ENVIRONMENTAL POLLUTION AND CANCER AND HEART AND LUNG DISEASE Washington, D.C. August 7, 1978 SEE u.s. Environmantal Protection Agency National Cancer Institute National Heart, Lung and Blood Institute ~~al Institute for Occupational Safety & H~~ National Institute of Environmental Health Sci,]nces T106650436
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A;ri7 2~, L97B cc: H. Kg~negay C. Waite F;~yden W o Shinn TO: Jack Mills ~,~, Kl~epfer So Temko B, Ehringhaus E. Pepples FROM: Fred Panzer M. Kastenbaum D. Hoel ~te attached clipplnE gives the three names being mentioned to hea~'~NlOSH. None of them will be particularly interested in dragging tobacco into the occupational health area, I am told. Also oi interest is Fishbein's ~ssessment of Califano as "a man with an unbelievably massive ego who c~n.not tol~rate any public criticism, however indirect, of himself or his department. FP/pgd ~~ Attachment TI06650437
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OCCUPATIONAL HEALTH & SAFETY Volume 8, No. 8 ~. .... GERSHON W. FISHBEIN, PUBLISHER April 22, 1978 Main Office • 1097 National Press Building • Washington, D.C. 20045 • (202) 347-3868 I " • Publlshed twice • month. Rate: $I O0 pe~ ye=z~ $185 in combJnadon with E~vizonmentat Health Letter R, ROBBINS, ROSE SEEM TO BE LEADING CANDIDATES FOR NIOSH DIRECTOR: If you came up to us in the middle of the night and whispered "who would you say are the leading candidates for the job of NIOSH Director?" we would be obliged to reply, even though asleep: Ed Baler, Dr. Anthony Robbins and Vernon Rose. And. we would add, in alphabetical order only. That doesn't necessarily mean that any of the above will get the job. But as we went to press with this issue on April 21, those three names are heard the most. Dr. William Foege, Director of the Center for Disease Control, is the man who will make the choice and will send it to HEW Secretary Joseph Calffano for approval, with a tip of the hat to Dr. Julius Richmond, Assistant Secretary of HEW for Health, as it goes by. Califano's endorsement of Dr. Foege's choice, whoever he might be, cannot be automatically taken for granted. Califano is perhaps the most unpredictable Secretary in HEW history, a man with an unbeliev- ably massive ego who cannot tolerate any public criticism, however indirect, of himseff or his department (as Dr. John Finklea found out). He could very well have his own choice among his vast acquaintances; at any rate, the new NIOSH Director will be a "t.am" player in the current Administration mold. As they used to say in the White House, you can depend on it. For your information, in case you didn't know, Baier is deputy director of NIOSH and Ro~ is head of health criteria development (both are industrial ~e hygienists) and Dr. Robbins is Colorado Health Officer (a physician). All three would be satisfactory to AFL-CIO, but the Od, Chemtca, & Atomm Workers Unmn, very influential, favors Dr. Robbins. TI06650438
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JOURNAL OF COMMERCE & COMMERCIAL NEW YORK, H.Y. -D 26.856- t~EW YORK CITY ~ETR(~OLITA~ AREA Effects of Toxic Gases Probed An investigation into the effects toxic gase~ may have on diesel-truck drives has been instituted by the Federal Highway Administration. A tentative report indicates that the nitrogen dioxide lev- els in a truck cab commonly exceed the one part per rail* lion maximum standard pro* posed by the National Institut~ o! Occupational Safety & Health. Prolonged high altitude driv- ing, ~k.~i~g, heart and res- piratory ~:ouditions, and vehicle pollution, the FHWA said, results in carbon monox- ide exposure which causes safety problems. Nitric oxide also might be changed into nitrogen dioxide, FHWA noted, and ultimately may form cancer-causing ni- trogen compounds. TI0o600439
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Tobacco Institute Newsletter ~HE I~I:L~FTPY ~',F NEW3W~;HT-~Y ~E'~ELOFMENTS T1066504.40

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