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TIiE HEALTH CONSEQUENCES OFINVOLUNTARY SMOKING a report of the Surgeon General 1986 U:S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Ptt1ik Health S.rMcs C«rt«: ro. ar.w ccnbol GMw for H.dtA Prortiotlon ard EdueaMOn Gflk.+e on Smoklnp .nd HrttK AodM1Ys, iA.rYIanO 20a57 W dttiy.Or Sycrwnder af Docvnno.:US W.evm hrv~ Ohc: i'~I.npan. DC 2W02

parents smoke, a stronger relationship exists than if only one parent smokes. What future respiratory burden these findings may represent for these children later in life is not known. As a former pediatric surgeon, I strongly urge parent's to refrain from smoking in the presence of children as a means of protecting not only their children's current health status but also their own. Diseases Other Than Lung Cancer Several studies have provided data on the relationship between ET5 and cancers other than lung cancer and on ETS exposure and cardiovascular disease. However, further research in these areas will be required to determine whether an association exists between E`I'S exposure and an increased risk of developing these diseases. Policies Restricting Smoking In Public Places The growth in our understanding of the disease risk associated with involuntary smoking has been accompanied by a change in the social acceptability of smoking and by a growing body of legisTat'ion, regulation, and voluntary action that addresses where smoking may occur in public. Forty States and the District of Columbia now have some form of legislation controlling or restricting smoking in various public settings. Some States limit smoking to only a few designated areas; however, States are increasingly develbping and implement- ing comprehensive legislation that restricts smoking in many public settings, including the workplace. Nine States have restrictions that cover smoking not only by public employees but also by employees in the private sector. No systematic evaluation of the effects these measures may have on smoking behavior has been conducted„ but there is little doubt that strong public sentiment exists for implementing such restric- tions. A number of national surveys conducted by voluntary health organizations, government agencies, and even the tobacco industry have documented that an overwhelming majority of both smokerss and nonsmokers support restricting smoking in public. Public Health Policy and Ilnvoluntary Smoking The 1986 Surgeon General's Report' on the Health Consequences of Involuntary Smoking clearly documents that nonsmokers are placed at increased risk for developing disease as the result of exposure to environmental tobacco smoke. Critics often express that more research is required, that certain studies are flawed, or that we should delay action until more conclusive proof is produced. As both a physician and a public health

Cigarette smoke is well established as a human carcinogen. The chemical composition of ETS is qualitatively similar to mainstream smoke and sidestream smoke and also acts as a carcinogen in bioassay systems. For many nonsmokers, the quantitative exposure to ETS is large enough to expect an increased risk of lung cancer to occur, and epidemiologic studies have demonstrated an increase& lung cancer risk with involuntary smoking. In ezAr*>;*+±ng a low-dose exposure to a known carcinogen, it is rare to have such an abundance of evidence on which to make a judgment, and given this abundance of evidence, a clear judgment can now be made: exposure to ETS is a cause of lung cancer. The data presented in this Report establish that a substantial number of the lung cancer deaths that occur among nonsmokers can be attributed to involuntary smoking. However, better data on the extent and variability of ETS exposure are needed to estimate the i number of deaths with confidence. Respiratory I}isease Acute and chronic respiratory diseases have also been linked' to involuntary exposure to tobacco smoke; the evidence is strongest in infants. During the first 2 years of life, infants of parents who smoke are more likely than infants of nonsmoking parents to be hospital- ized for bronchitis and pneumonia. Children whose parents smoke also develop respiratory symptoms more frequently, and they show small, but measurable„ differences on tests of lung function when compared with chiidren of nonsmoking parents. Respiratory infections in young children ~ represent a direct health burden for the children and their parents; moreover, these infec- tions, and'the reduction6 in pulmonary function~ found in the school~ age children of smokers, may increase susceptibility to develop lung disease as an adult. Several studies have reported small decrements in the average level of lung function in nonsmoking adults exposed to ETS. These differences may represent a response of the lung to chronic exposure to the irritants in ETS, but it seems unlikely that ETS exposure, by itself, is responsible for a substantial number of cases of clinically significant chronic obstructive lung disease. The small magnitude of the changes associated with ET'S exposure suggests that only individuals with unusual susceptibility would be at risk of develop- ing clinically evident disease from ETS exposure alone. However, ETS exposure may be a factor that contributes to the development of clinical disease in individuals with other causes of lung injury. Cardiovascular Disease A few studies have examined the relationship between involun- tary smoking and cardiovascular disease, but no firm conclusion on

the relationship can be made owing to the limited number of deaths in the studies. OMM r Irritation Perhaps the most common effect of tobacco smoke exposure is ti®sue irritation. The eyes appear to be especially sensitive to irritation by ETS, but the nose, throat, and airway may also be affected by smoke exposure. Irritation has been demonstrated to occur at levels that are similar to those found in real-life situations. The level of irrit'ation~ increases with~ an increasing concentration of smoke and duration of exposure. In addition, participants in surveys report irritation and annoyance due to smoke in the environment under real-life conditions. Determinants of Ezposure Exposure to ETS has been documented to be common in the United States, but addit'ional' data on the extent and determinante of exposure are needed to identify individuals within the population who have the highest exposure and are at' greatest risk. Studies with biological' maskers and measurements of ETS components in indoor air confirm that measurable exposure to ET'S is widespread. How- ever, within exposed populations, levels of cotinine excretion and presumablyETS exposure vary greatly. In a room or other indoor area, the size of the space, the number of smokers, the amount of ventilation, and other factors determine the concentration of tobacco smoke in the air. The technology for the cost-effective filtration of tobacco smoke from the air is not currently available, and because of their small size, the smoke particles remain suspended in the air for long periods of time; thus, the only way to remove smoke from indoor air is to increase the exchange of indoor air with clean outdoor air. The number of air changes per hour required to maintain acceptable indoor air quality is much higher when smoking is allowed than when smoking is prohibited. Environmental tobacco smoke originates at the lighted tip of the cigarette, and exposure to ETS is greatest in proximity to the smoker. However, the smoke rapidly disseminates throughout any airspace contiguous with the space in which the smoking is taking place. Dissemination of smoke is not uniform, and substantial gradients in ETS levels have been demonstrated in different parts of the same airspace. The time course of tobacco smoke dissemination is rapid enough to ensure the spread of smoke throughout an airspace within an 8-hour workday. In the home, the presence of even one smoker can significantly increase levels of respirable suspended particulates. These data lead to the conclusion that the simple separation of smokers and nonsmokers within the same airspace will reduce, but r."'~,i:: 11

for parental, smoking and childhood cancer is also not clear, and evaluation of this association is made difficult by the various definition$ of exposure that have been used; including maternal and paternal smoking before, during, and after the pregnancy. Mothers and fathers who smoke during a pregnancy generally smoked before the conception and continue to smoke after the pregnancy. Thus, an effect of involuntary smoking after birth cannot readily be disti.n- guiahed from genetic or transplacentally mediated effects. Cardlovascu/ar Diseases A causal association between active cigarette smoking and cardio- vascular disease is well established (US DHHS 1983). The relation- ship between cardiovascular disease and involuntary smoking has been e:amined in one case-control study and three prospective studies. In the caee-control, study by Lee and colleagues (1986), described previously, ischemic heart disease cases and controls did not show a statistically aignificant difference in their exposure to involtuatasy smoking, based on the smoking habits of spouses or on an index accounting for exposure at home, at work, and during travel and leisure. In the Japanese cohort study, Hirayama (1984b, 1985) reported an elevated risk for ischemic heart disease (N=494) in nonsmoking women married to amokera • The standardized mortality ratios when the husbands were nonsmokers, ex-smokers or smokers of 19 or more cigarettes per day, and smokers of 20 or more cigarettes per day were 1.0, 1.10, and 1.31, respectively (one-sided p for trend, 0.019). In the Scottish followup study (Gillis et al. 1984); nonsmokers not exposed to tobacco smoke were compared with nonsmokers exposed to tobacco smoke with respect to the prevalence of cardiovascular symptoms at entry and mortality due to coronary heart disease. There was no consistent pattern of differences in coronary heart disease or symptoms between nonsmoking men ezposed to tobacco smoke and their nonexposed counterparts. Nonsmoking women ezpoeed to tobacco smoke exhibited a higher prevalence of angina and major ECG abnormality at entry, and also a higher mortality rate for all coronary dise.ases. However, rates of myocardial infarc- tion mortality were higher for exposed nonsmoking men and women compared with the nonerpoeed nonsmokers. The rates were 31 and 4 per 10,000, respectively, for the nonexposed nonsmoking men and women, and 45 and 12 per 10;000, respectively, for the exposed nonsmoking men and women. None of the differences were tested for statisticaI' significance. Fn the Japanese and the Scottish studies, other known risk factors for cardiovascular diseases, i.e., systolic blood pressure,, plasma cholesterol, were not accounted for in the analysis. 105

n In a study of heart disease, Garland and coworkers (1985) enrolled 82 percent of adults aged 50 to 79 between 1972 and 1974 in, a predominantly, white, upper-middle-class community in San Diego, California. Blood pressure and plasma cholesterol were measured at entry, and all participants responded' to a standard interview that asked about' smoking habits, history of heart' disease, and other health-related variables. Excluding women who had, a previous history of heart disease or stroke or who had ever smoked, 695 currently married nonsmoking women were classified by their husbands' self-reported smoking status at enrollment. After 10!years of followup, there were 19 deaths due to ischemic heart disease; the age-standardize& mortality rates for nonsmoking wives whose hus- bands were nonsmokers, ex-smokers, and current smokers were 1.2, 3.6, and 2'.7, respectively (one-sided p for trend, <_ 010): After adjustment for age, systolic blood pressure, total plasma cholesterol, obesity index, and years of marriage, the relative risk for death due to ischemic heart' disease for women married to current or former smokers at entry compared with women married' to never smokers was 2.7 (one-sided p < 0.10). The study's findings are not convincing from the point of view of sample stability. The total number of deaths due to ischemic heart disease was small, and the denominator in the reLative risk calculation is unstable, based' on the deaths of two women whose husbands had'never smoked. Moreover, it is well established that the risk of coronary heart disease is substantially lower among those who have stopped smoking (US DHHS 1983), although the amount of time required for this change after cessation of smoking is not clear (Kanne11981): In this study, 15 of 19 deaths occurred in nonsmoking women married to husbands who had stopped smoking at entry, and the age-standardize6 rate for ischemic heart disease was highest in this group. The high proportion of deaths in nonsmoking women married to men who became ex-smokers implies that the excess resulted from~ a sustained effect' of involuntary smoking. More detailed characterizations of exposure to ETS an& specific types of cardiovascular disease associated with this exposure are needed before an effect of involuntary smoking on the etiology of cardiovas- cular disease can be established. One study (Aronow 1978a,b) suggested that' involuntary smoking aggravates angina pectoris. This study was criticized because the end point, angina, was based on subjective evaluations and because other factors such as stress were not controlled for (Coodley 1978; Robinson 1978; Waite 1978; Wakehan 1978)i More important, the validity of Aronow's work has been questioned (Budianaky 1983). 106 i Go4

1 Conclusions 1. Involuntary smoking can cause lung cancer in nonsmokers. 2. Although a substantial number of the lung cancers that occur in nonsmokers can be attributed to involuntary smoking, more data on the dose and distribution of ETS exposure in the population are needed in order to accurately estimate the magnitude of risk in the U.S: population. 3. The children of parents who smoke have an increase& frequen- cy of hospitalization for bronchitis and pneumonia during the fast year of life when compared with the children of nonsmok- ers. 4. The children of parents who smoke have an increased frequen- cy of a variety of acute respiratory illnesses and infections, including chest illnesses before 2 years of age and physician- diagnosed bronchitis, tracheitis, and laryngitis, when com- pared;with the children of nonsmokers. 5. Chronic cough and phlegm are more frequent' in children whose parents smoke compared with children of nonsmokers. The implications of chronic respiratory symptoms for respira- tory health as an adult are unknown and deserve further study. 6. The children of parents who smoke have small differences in tests of pulmonary function when compared with the children of nonsmokers. Although this decrement is insufficient to cause symptoms, the possibility that it may increase suscepti- bility to chronic obstructive pulmonary disease with exposure to other agents in adult life, e.g., active smoking or occupation- al exposures, needs investigation. 7: Healthy adults exposed to environmental tobacco smoke may have small changes on pulmonary function testing, but are unlikely to experience cliziically significant deficits in pulmo- nary function as a result of exposure to environmental tobacco smoke alone. 8. A number of studies report that chronic middle ear effusions are more common in young children whose parents smoke than in children of nonsmoking parents. 9. Validated questionnaires are needed for the assessment of recent and remote exposure to environmental tobacco smoke in the home, workplace, and other environments.. 10. The associations between cancers, other than cancer of the lung, and involuntary smoking require further investigation before a determination can be made about the relationship of involuntary smoking to these cancers. 11. Further studies on the relationship between involuntary smoking and cardiovascular disease are ne.eded'in order to 107

iBk of References f i i ABEL, E.L Smoking during pregnancy: A review of effects on growth an& develop ment of offepring. Human Biologv 52(4):593-625, December 1980 ADLKOFER, F., SCfff.RER, G., Von HE£5, U. Passive smoking. (letter). New England Journal o(Mediri,ne 312(11):719-720, March 14,1985: AKIBA,,S., KATO, H., BLOT, W.I. Passive smoking and lung cancer among Japanese women: Canaer Research 46(9):48(34-4807, September 1986. ARONOW, W.S. Effedt of passive smoking on angina pectoris. New England Journal ojllfedicine 299(1}':21-2a, Ju7y 6,1978a. ARONOW, W.S. Effects of passive smoking. (letter). New England Journal of Medieine 299(16):897, October 19,1978b. ~ BACKHOUSE, C.I. Peak expiratory flow in youths with varying cigarette smoking habita. Britiah Medical Journal 1(5954):360-362; February 15, 1975:, BARRON, B.A. The effects of misclassification on- the estimation of relative risk. Biometries 33(2);414-418, June 1977. BECK, G.J.. DOYLE, C.A., SCHACHTER, E.N. Smoking and ltutig function. American Reoieu,,of Rapimtory Disease 123(2),149-155, February 1981.. BERKEY, CS., WARE, J.H„ DOCKERY, D.W., FERRIS, B.G., Jr., SPEIZER, F.E. Indoor air pollution and pulmonary function growth in pread'olescent children. Ameru.+an Journal'o(Epidrmiology 123(2):250-260, February 1986. BEWLEY, B.R., HALI1., 'P:,, SNAITH, A.H. Smoking by primary achoolchildren:. Prevalence and associated respiratory rymptoms. British Journal of' Preventive and Soeial Medicine 27(3):150-153, August 1973. BLACK, N. The aetiology of glue ear: A caee-control study. International Journal of Pediatric Otorhinolaryngology 9(2):I21-133, July 1985. ~ BLAND, M.,, BEWLEY, B.R., POLLARD, V., BANKS, M.H. Effect- of children's and parents'. smoking on respiratory symptoms. Archives of Disease in Childhood . 53(2):100-105, February 1978. I I BLOT, W.J., MaLAUGHLIN; J.K. Practical issues in the design and conduct of caee- oontrol studies: Use of next-of-kin interviews. In: Blot, W.J., Hiraysma, T:, Huel, O.G. (eds). Statistical Iseues in Cancer Epidcmiology. Hiros imo Sanei Publishers, 1985, pp; 4&62: BRINTON', L.A., BLOT, W.J., BECKER, J.A.,, WINN, D.M., BROWDER, J.P., FARMER; J.C., Jr.,, FRAUMENI, J.F.,, Jr. A ceee-control study of cancers of the nasal cavity and paranasal sinus. Americaan Journal- of Epidemiology 119(6):896- 906, June 1984: BRUd+7EKREEF„B., FISCHER, P:,,REM7JdV, B., VAN DER LENDE; R., SCHOUTEN,. J., QUANJER, P. Indoor air pollution and its effect on pulmonary funtion of-adult nonsmoking women: 3. Passive smoking and pulmonary function. InlernationaL JournalofEpidemiology I4(2)a227-230, June 1985, , BRUNNEMANN; K.D., ADAMS, J.D., HO, D.P.S., HOFFZv1ANN,,D. The influence of tobaooo smoke on indoor atmospheres: 2. Volatile and tobacco-apeciEic nitrosa- mines 'rn main- and aideatream smoke and their contribution to indoor pollvtion, Aveaedinga oj the Fourth Joint Conference on Sensing of Enuironnuntal Pollu- tants, New Orleans, 1977. American Chemical Soziety,1978; pp. 876-880. BUDIANSKY, S. Food and drug data fudged. Nature 3d2(5909):56Q, April 14, 1983. BURCH, P.R:J. Passive smoking and lung cancer. (letter). British Medical Journal 282(6273):1393, April 25; 1981. BURCH, P.R.J. Lifetime passive smoking and-eanoer risk. petter): Lancet 1(8433):866, April 13,1985. BURCH, P.R.T. Passive smoking in adulthood and cancer risk. (letter). Ameriaan Journal o(Epid'emiology 123(2):36&969;,February 1986. 109

BURCHFIEL, C.M., HIGGINS, M.W:, KELLER; J:B., HOWART; WF.. BUTLER; W:J., HIGGINS; I.T.T. Passive smoking in childhood; Respiratory oonditions and puimonary function in Tecumseh, Michigan. American Review of Respinstory Disease 133(6);96f-973, June 1986. BURROWS, B., KNUIISOI`i,, R.J., CLSNE; M.G., LEBOWIT'L, M.D. Quantitative relationships between cigaretle smoking and ventilatory function, American Review of Reapirntory,Diseme 115(2):195-2a5; February 1977. BURROWS, B., KNUDSON, R.J., LEBOWITZ, M.D. The relationship of childhood respiratory illness to adult obstructive airway disease. American Review of RapiratoryDiseode 115(5):751-760. May 1977. CAMERON: P., KOSTIN; J.S., ZAKS, J.M., WOLFE,,J:H., TIGHE, G., OSELE'iT. B:, ST"OCK.ER, R., WINTON, J. The health of smokers' and nonsmokers' children. Journal ojAllergy 43(6):336•-341, June 1969. CHAN, W:C., COLBOUitNE, M.J:, FUNG, S.C., HO, H:C. Bronchial cancer in Hong Kong 1976-1977: British Journal of Cancer 39(2):182-192„February'1979. CHAN, W:C:. FUNG, S.C. Lung cancer in nonsmokers in Hong Kong. In: Grundmann, E., Clemmesen, J., Muir, CS. (eds). C'•engraphical Pathology in Cancer Epidemiology. Cancer Campaign{ Vol. 6. New York, Gustav Fischer Verlag, 1982, pp. 199-202. CHARLTON; A. Children's coughs related to parental smoking. Britiah Medical Journal 288f6431):1647-1649; June 2,1984. CHEN, Y., LI, W: X. The effect of passive smoking on children's pulmonary function in Sha.nghai. American Journal ojPublic Health 76(5);515-518, May 1986. COLL.EY. J.R.T. Respiratory dieease in childhood. British Medicnl BkIktin 27(1):9-I4, January 1971.. COLI.EY. J.R.T. Respiratory symptoms in children and parental smoking and phlegm production. British Medical Journnl'2(5912):2L11-204; April'27;1974. COLLEY, J.R.T., HOLLAND, W.W., OORKHILL, R.T: Influence of passive smoking and parental phlegm on pneumonia and bronchitis in early childhood. Lancer I r 2(7888):1031=1034, November 2, 1974. COLLINS, M.H.. MOESSINGER, A.C., KLEINERMAN, J., BASSI, J., ROSSO; P., COI:LINS; A.M., JAM£S, L.S., BLANC, W.A. Fetal' lung hypoplasia associated with materna]'smoking: A morphometric analysis. Pediatric Research 19(4)j408- 412, April 1985. s ~ COMSPOCK, G.W.,, MEYER, M.B., HELSING,, K.J., TO(K]4iAN, M.S. Respiratory effects of household ezposures to tobacco smoke and gas cooking. Am.erican Reuiew of Reapiratory Disease 124(2);143--148, August 1981. COODLEY, A. Effects of passive smoking. (letter).1Jew England Journal, of Medicine 299(16)i897, October 19,1978. CaPELAND, K.T., CHECKOWAY, H., McMICHAEL, AJ., HOLBROOK, RH. Bias due to misclasaification in the estimation of relative risk. American Journel of ~ Epidemiology 105(5):488-495, May 1977. OORREA, P., PICKLE, L.W., FONTHAM, E:, LIN, Y., HAENSZEL. W. Passive smoking and lung cancer. Lancet 2(8350):595-597, September 10,1983. N ~ CRIQUI, M.H. Response bias and risk ratios in epid'emiologic studies. American ~ Journal of Epidemiology 109(4Y.,394399, April 1979. #"1 DAHMS, T:E., BOLIN;, J:F., SLAVIN, R.G. Passive smoking: Efiects on bronchial asthma. Chest 80(5):530-534. November 1981. ~ DODGE, R. The effects of indoor pollution on Arizona children, Archives of ~ Environmental Health 37(3r151-155. May-June 1982. ~ DOLL, R., PETO, R. Cigarette smoking and bronchial carcinoma: Dose and time relationships among regular smokers and lifelong non4mokers: Journal of Epidemiology and ComrnunityHealth 32(4):303-313, December 1978.

DUTAU, G., CORBERAND, J., LEOPHONTE. P., ROCHICCIOLI, P. Maaifeatationa respiratoirea lieea a liinhalation passive de fumme de tabsc chez l'infant d'age prr soolaire (Reapiratory signs aaeocieted with passive inhalation of toaacco smoke in infante)., Le Poumon et le Coeur 35(2);6~, 1979. EKWO;, E.E:, WEINBERGER, M.M., LACHENBRUCH, P.A., HUNTLEY„ W.H. Relationship of parenisl smoking and gas cooking to respiratory diaease in children.,Chert 84(6):662-W, December 1983. FERGUSSON, D.M., HORWOOD, LJ. Parental smoking and respiratory illneaa during early childhood: A aiz year longitudinal study. Pediatric PulmonologD, 1(2):99-106, Msrch-April' 1985. FERGUSSON, D.M., HORWOOD, L.J'., SHANNON, F.T.,, TAYLOR, B. Parental smoking and lower respiratory illness in the firet three yearm of life. Journal of Epidemiology and Community Health 35(3):184-184„September 1981. FEl'ERABEND, C., HIGENBOTTAM, T., RUSSELL, M.A_H. Nicotine conoentratione in urine and saliva of smokers and nonsmokera. British Medical Journal 284(6321):1002-1004„April 3, 1982: FOLL4RT, D., BENOWTTZ, N.L.., BECKER, C.E. Passive absorption of nicotine in airline flight attendants. (letter). New England Journal of 3fesiieine 3W18?:1105, May 6,1983. FRIEDMAN, GD. Passive smoking in adulthood and cancer risk. Qetter): American Journal ojEpidtmiology 123(2):367; February 1986: FRIEDMAN, GD., PETTTI7„D.B., BAWOL, R.D. Prevalence and correlatea of passive smoking. American Journal of Public Health 73(4):401-405, April 1983. GARFINKEL L Time trends in lung cancer mortality among nonsmokers and a note on paasive smoking. Journal o(tlie National Caneerlnstitute 66(6):1061-1066, June 1981. GARFINKEL, L, AUERBACH, 0., JOUBERT. L. Involuntary smoking and lung oancer. A case-control study. Journal of the National Cancrr Institute 76(3):463- 469; September 1985. GARLAND, C., BARREIT-0ONNOR,, E., SUAREZ, L, CRIQUI, M.H., WINGARD, D.L. Effects of passive smoking on iachemic heart diaease mortality, of nonamokera: A ptnspective study. American Journal o(Epidemiology 121(8?:645-&50, May 1985. GII.L.IS, C.R., HOLE, D.J., HAWTHORNE, V.M., BOYLE, P. The etiect of environ- mental tobacco smoke in two urban communities in the weat of Scotland. Europenn Journal ojRespiratory Diseases 65(Suppl. 133);121-126,,1984. GOLD, E., GORDIS, L, TONASCIA, J., SZKLO, M. Risk facton for brain tumors in ehildren; American Journal of Epidemiology 109(3):309-319, March 1979. GORDIS„ L Should dead cases be matched to dead controls? American Journal of Epidemiology L15(1Y.1-6, January 1982.. GORTMAKER, S.L, WALKER, D.K., JACOBS, F.H.,, RUCH-ROSS, H. P.rentali smoking and the risk of childhood asthma American Journal of Public Health 72(6):674-b79, June 1982. ~ GREENBERG, R.A., HALEY,,NJ., EPZEI., RA., LODA, F.A. Measuring the ezposure 0 of iafante to tobacco smoke: Nicotine and cotinine in urine and aaliva. New England Journal o(Medieine 31Q(17):107b-1078, April!26,1984., GREENLAND, S. The effect of mi.cleasification in the presence of covariates. rW~ American Journal orEpidemiokgy112(4):564-669, October 1980. GRL.TFFERMAN, S:,, WA11G,, H.H., DeLONG~ E.R., KIAM„ S.Y.S., DELZELI., ES., FAIJ.ETA,, J.M. Environmental factors in the etiology, of rhabdomyoaarcoma in childhood. Journal of the National Cancer Institutc 68(1):107-113, January 1982. GRUNDMANN, E., MULLER, K.-M.,,WINT`ER; K.D., STERLING, T.D. Non.amoking wives of heavy smokers have a higher risk of lung cancer. (letter). British Medical Journal 282(6270);1156, April 4,1981. 111

HALEY, N.J., HOFFMANN, D. Ana)ysia for nicotine and eotiniae in hair tb determine cigarette smoker statua. Clinical Chemittry 31(10):1598-1600, October 1985. HAMMOND, E.C., SELIi{OFF, IJ. Passive smoking and lung cancer with comments on two new papers. Enuironnunt¢l Research 24(2):444-452, April 1981. HAFZL.AP, S., DAVIES, A.M: Infsat admissions to hospital and maternal, smoking. Lancet 1(7857}.529-,532, March 30;1974'. HARRIS, J.E., DuMOUCHEL, W.H. Nonsmoking wives of heavy smokers have a higher risk of lung cancer. (letter). British Medical Journnl 283(6296):915, October 3, 1981. HASSELBLAD, V., HUMBLE, C.G., GRAHAM, M G., ANDERSON, H.S. Indoor HIRAYAMA, T. Passive smoking and lung cancer. (letter). British Medical Journal' 282(6273)i1393-1394, Aprili25, 1981b. HIRAYAMA, T. Nonsmoking wives of smokers have a higher risk of lung cancer. (letter): British Medicnl Journal 283(6296):916-917, October 3,1981c. HIRAYAMA, T. Nonsmoking wives of smokers have a higher risk of lung cancer. Qetter): British Medical Journal'283(6304)i1465--1466, November 28, 1981d. HIRAYAMA, T. Passive smoking and lung cancer. Consistency of association. (letter): Lancet 2(8.364);1425-1426, December 17,1983. HIRAYAMA, T. Cancer mortality in nonsmoking women with smoking husbands based on a large-scale cobort study in Japan. Preuentiue Medici,iu 13(6):680-690, November 1984a. HIRAYAIISA, T. Lung cancer in Japan: Effects of nutrition and passive smoking. ln: Mizell, M., Correa, P. (eds): Lung Caneer. Causes and Preuention. Deer{ieldi Beach, Florida„VCH,1984b, pp. 175-195. HIRAYAMA, T. Passive smoking: A new target of epidemiology. Journal of Experimental Clinical Medicine 10(4):287-293,1985: HOEGG, U.R. Cigarette smoke ia closed spaces. Environmental Health Perapertiuea (2):177-128„October 1972. HOFFMANN, D., HALBY;, NJ!, ADAM.S, J.D., BRUNNEMANN, K.D.Tobscco sidestream smoke: Uptake by nonsmokers. Preventive Medicine 13(6):6flM17, November 1984. HORWOOD, LJ., FERGUSSON;D.M.,,SHANNON, F:T. Social and familial factors in the development of early childhood usthma. Pediatrics 75(5):859-868, May 1985. HUGOD, C., HAWKINS, L.H., ASTRUP, P. Exposure of passive smokers to tobacco smoke oonstituents. International Archives of Occupational and Environmental Health 42(421-29,1978:, May 1979:, HIGGINS, I. Lifetime passive smoking and cancer risk. (letter), Lancet 1(8433}:866 - 867, April i 13,1985. H]GGINS„ M.W., KJELSBERG, M:, METZNER, H. Characteristics of smokers and nonsmokers in Tecumseh Michigan. Ic The distribution of smoking habits in persons and' families and their relt;tionship to social characteristics. American Journal o(Epidemiology 86(11:45-59, July 1967. HILLER;, F.C. Deposition of sidestream cigarette smoke in the human respiratory tract. Pneacntiue Medicine 13(6):602--607, November 1984. HIKAYAMA, T. Non-smoking wives of heavy smokers have a higher risk of lung cancer A study from Japan. British Medical Journal 282(6259)183-185, January 17,1'981a. eanoer of the testis in young men_ International Journal of Cancer 23(5):598-602,, Respiratory Diseoae 123(5):479--485, May 1981. HENDERSON, B.E., BENTON, B., JING, J:, YU, M.C., PIKE' M.C. Risk factors for environmenta)i determinants of lung function in children. American Reuiew of 112

IIVTERNJITIONAL AGENCY FOR RFSEARCH ON CANCER: ?bb~ Smoking. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, Vol. 38, Lyon„IARC„1986, pp. 163-314. IVERSON„M., BIRCH: L, LUNDQVIST, G.R., ELBROND, O. Middle .ar effusion in children and the indoor environment An epidemiologioal study. Arshioo of Envuonmentnl Health 40(2):74-79, March-Apri1 1985: JARVtS, M.J„ TUNSTALLPEDOE,' H., FEYERABEND, C., VFSEY. C., SALOOJEE, Y. Bioctiemical! market9 of smoke absorption and self-reported exposure to passive smoking. Journal of Epidemiology and Community Health 3&4):335-.939, Decem- ber 1984. JONES: J.R., HIGGINS, I.T.T.,, HIGGINS, M.W., FELLEPJ.B. Effects of oooking fuels on 11ing function in nonsmoking women. Arrhiiea of Enuironmental Health 38(4):219-222, JulyAugust 1983. KABAT, G.C.,, WYN'DER; E.L Lung cancer in nonamoken. Canoer 53(5?:1214-1221, March 1,1984 : KANNEL, W.B. Update on the role of cigarette smoking in coronary artery disease. AmcricanHeart Journa1101(31:319-328, March 1981. KASUGA, H., HASEB£.: A., OSAKA, F., MATSUKII H. Respiratory symptoms in school children and' the role of passive smoking. Tokai Journal of Ezperimental and Clinical Medtcinc 4(2):101-1Q4, April 1979:, KAUFFMANN, F.,,DOCKERY, D.W., SPEIZER; F.E., FERRIS, B.G., Jr. Respiratoryy symptoms and lung function in women with passive and active smoking. (abstract). AmerioaaReoiew ojReapiratory Diaease 133(4, part 2):A157; April 1986. KAUFFMANN, F., TESSIER; J.-F:, ORIOL, P. Adult passive smoking in the home environment: A risk factor for chronic airflow limitation. American Journal of Epidemiology 117(3):269-280, March 1983:, KENTNER, M., TRIEBIG, G., WELTLE, D. The influence of passive smoking on pulmonary function: A study of 1351 office workers. Prruentiue Medicine 13(6):65f-- 6fi9, November 1984. KNOTH, A.,, BOHN, H., SCHIvi1DT, F. Pasaiv rauchen ala Lungenkrebs-Uraache bei Nichtraucherianen (Passive smoking as a causa7 i factor of bronchial carcinoma in female nonsmokers). Medizinische Klinik 78(2):66-69; February 4, 1983: KOO, L.C., HO, J.H.-C., LEE, N. An analysis of some risk factors for lung cancer in Hong Kong. International Journal oFCancer 35(2):149-155, February,15,1985. KOO, L.C., HO, J.H.-C., SAW,, D. Active and passive smoking among female lung cancer patients and controls in Hong Kong. Journal of Esperimental and Clinical Cancer Reacarnh 4(2)h367-375, October-December 1983. KOO, LC., HO, J:H.L.,, SAW, D. Is passive smoking an added risk factor for lung cancer in Chinese women? Journal ojErpcrimental and C'llinical'Canrer Research 3(3k277-283, JulySeptember 1984. KORNEGAY, K.R., KASTENBAUM, M.A. Non-emoking.viveg of heavy smokers have a higher risk of lung cancer. (letter). British Medical Journal 283(6296):914, October 3,1981. IOtAEMER, M.J., RICHARDSON. M.A., WEISS, N.S., FURUKAWA, C.T., SHAPIRO, G.G., PIERSON, W.E., BIERMAN, C.W: Risk factors for persistent middle-sar effusions: Otitis media, catarrh, cigarette smoke exposure, and atopy. Journal of the American Medical Association 249(8):1022-1025, February 2.5, 1983. LEBOWTIZ, M.D. Environmental tobacco.moke: 3.3:,The effects of environmental tobaeoo smoke exposure and gas stoves on daily peak flow ratee in asthmatic and non...thmatic families. European Journal of Rrspiratory Di.eaaer 65(Suppl. 133)90-97,1984. LEBOWLTZ, M.D., ARMET; D.B., KNUDSON, R The effect of peasive smoking on pulmonary function in children. Enuironmtnt International 8(1-6}.371-373, 1982. LEBOWlTZ, MD., BURROWS, B. Respiratory symptoms rzlated to smoking habits of family adults. Chest 69(11:48-50, January 1976. 113

LEE, PN. Non-amoking wives of heavy smokers have a higher riak of lung cancer, (letter): British Medical Jounwl 283(6304):1465-1466, November 28,1981. LEE, P.N. Passive smoking. (letter): Lancet 1(8275};791, April 3,1982a LEE, P.N. Passive smoking. Food and Cosmetics Toxicology 20(2):223-229, April 1982b. LEE, PN: Lifetime paaaive smoking and cancer risk. (letter): ,[ancYt 1(8443):1444'„ June 22;1985: LEE, P.N., CFiAMBERL.AIN, J., ALDERSON, M.& Relationship of passive smoking to risk of lung cancer and other ®oking-aaeociated diseases. Britirh Journal of Canecr bK1Y.97-105, July 1986. 1J:EDER, S.R., CO3tKFIIId„ RT:, IRWIG, L.M., HOLLAND, W.W. Influence of familyy factors on aatkma and wheezing during the first five years of life. British Journal orPAeuentilre and Social Medicine 30(4):213-218, December 1976a. LEEIIER, S.R., COFtKHILL; RT., IRWIG; LM., HOLLAND, W:W: Influence of family, factors on the incidence of lower respiratory illneas during the first year of life. British Journal ojPr+rventive and Social Medicine 30(4)203-212, December 1976b. LEHNERT, G. Roundtable di.cuaaion, Preuentiue Medicine 13(6).730-746, November 1954.. I.EACfEN, M.L, SA.MET, J.M. An aesessment of the validity of questionnaire responses provided by a surviving spouse. American Journal of Epidemiology 123(3):481-489, March 1986. LIM, T.PR Airway obstruction among high school student.. American Review of RespiratoryDisease 108{4)98.5-988, October 1973. MacDONALD, EJ. Nonsmoking wives of heavy smokers have a higher risk of lung cancer. (letter). British Medical Journal 283(6296):917, October 3, 1981a. MacDONALD. EJ. Nonsmoking wives of heavy smokers have a higher risk of lung cancer. (ktter). British Medical Jaurnal 283(6304):1465, November 28, 1981b. MANNING, M.D., CARROLL, B.E.. Some epidemiologica) i aspects of leukemia in children. Journal ojthe NationalCanctr Inatitute 19(6):1087-1094,,December 1957. MANTEIs, N. Nonsmoking wives of heavy smokers have a higher risk of lung canoer. (letter): British Medical Journa1283(6296):914-915; October 3,1981. MANTEL, N. Passive smoking in adulthood and cancxr riek. (letter): American Journal ofEpidemiology 123(2);367-368„February 1986. MARTINEZ, F.,, ANTOGNONI, G., MACRI, F., LEBOWTI"L„ M., AONCHE,'ITI, R Distribution of bronchial responsiveness to a con,trictive drug ia a random pediatric population sample. (abstract); American Review of Respiratory Disease 131(4, part 2)A242, April 1985. MATSUKURA, S., HAMADA,,H.,,SEINO; Y.,,MURANAKA, H., HIGASHI, E. Passive smoking. petter): New England Journal of Medicine 312(111:720-721, March 14, 1985. MATSUKURA„ S., TAMINATO, T., KITANO, N., SEINO, Y., HAMADA, H., UCHIIiASHI, M., NAKAJD4SA, H:, HIRATA, Y. Effects of envisonmental'wbamo smoke on urinary cotinine excretion in nonamokera: Evidence for passive smoking. New England Journal of Medicine 311(13)%828-B,?2, September 27,19&ti. MaCONNOCHIE, K.M., ROGHMANN, K.J. Btnnchiolitib as a possible eauae of wheezing in childhood: New evidence. Pkdiatrica 74(L).1-10, July 1984. McCONNOCMF, K_M., ROGHMANN, KJ., Predicting clinically significant lower respiratory tract illbess in childhood following mild bronchiolitia. American Jounial'ofDisease ojChildren 139(61:62a-631, June 1985. MURRAY, A.B., li6ORRLSON, BJ. The effece of cigarette smoke from the mother on bronchia) responsiveness and severity of symptoms in children with satkima.. Journal ojAlkW and Clinical Immunology 7?(4):575-581, April 1986.. NATIONAL ACADEMY OF SCIENCES. Risk Assessment in the Federal Government:• Managing the Phvoess. Waahi.ngton; D.C., National Academy Press,1983.

NEUTEL, C.1., BUCK, C. Effect of smoking during pregnancy on the risk of cancer in children. Journal of the National Cancer lnatitute 47(1Y59-63, July 1971. 0'OONNOR, G:, WEISS, S.T., TAGF•R, I., SPEIZE&, F.E. The effect of passive smokingg on nonspeciSc bronchial' reeponsivenees in a population sample of children and young adults. (abstract). Clinical Reaearrh 34(2):581A, April 1986. PATHAK, D.R., SAMET, J.M,, HZJMBLE„C;G.,,SKIPPER, B.J. Determinants of lung cancer risk in cigarette smokers in New Mexico. Journal of the National Cancer Institute 76(4):597-604„April 1986. PEDREIRA. F.A., GUANDOLO, V.L., FEROLI, E.J., MELL.A, G.W.,, WEISS, LP. Involuntary smoking and incidence of respiratnry illnese during the first year of life. Pediatria 75(3):594-597, March 1985. PERSHAGEN; G., ZDENEK, H., SVENSSON; C. Passive smoking and lung cancer in Swedish women. A meriaan Journal o f Epidemiology , in prers. PETERS, J.M., FERRIS, B.G., Jr. Smoking, pulmonary funct.ion, and respiratory symptoms in a college-age group. American Revieeo of Raepirntory Disease 95(5):774-782, May,1967. PICKLE, LW., BROWN, L.M.,, BLOT, W.J. Information available from surrogate respondents in case-control interview studies. American Journal of Epidemiology 118(1):99-108; July 1983. Pih4ai; P.E., SILVERMAN, F.,,SFEPHARD, R.J. Physiological effects of acute passive exposure to cigarette smoke. Archiues of Environmental Health 33(0201-213; July-August 1978. PIiPI'ENGER, D.J. Passive smoking. (letter): New England Journal of Medicine 312(11k720, March 14, 1985. PRES'PON-MARTIN; S., YU, M.C., BENTON, B., HENDERSOTI„ B.E. N-nitroso compounds and childhood brain tumors: A easecontrol study. Cancer Reeareh 42(12):5240-5245, December 1982. PULLAN, C.R., HEY, E.N. Wheeang,, asthma, and pulmonary dysfunction 10 years after infection with,respiratory syncytial~virns in infancy. British Medical Journal 284(6330):1665-1fi69; June 5,1982: PUKANDER, J., LUOTONEN„J., TIMONEN; M., KARMA, P. Risk factors affecting the occurrence of acute otitia media among 2-3-year-old urban children. Acta Oto- laryngolica 100(3-4):260-265, September-October 1985. RANTARALLIO, P. Relationship of maternal smoking to morbidity and mortality of the t:hil& up to the age of five. Acta I'aediatriaa Scandinavica 67(5):62L-631,. September 1978. RAWBONE, R.G., KF.EL.ING; C.A., JENKINS, A-, GUZ, A. Cigarette smoking among secondary school children in 1975: Prevalence of respiratory symptoms, knowledge of health hazards, and attitudes to smoking and health. Journal of Epidemiology . and Community Health 32(1):53-58, Marnh 1978. REPACE, J1.., LOWREY, A.H. A quantitative estimate of nonsmokers' lung cancer risk from passive smoking. Environment Internationa111(1);3-22,1985. ROBINSON, B.F. EfTecta of passive smoking: (letter), New England Journal of Medicine 299(16):896, October 19,1978. RUSH, D. Respiratory symptoms in a group of American aecondary, school studenta: The overwhelming association with cigarette smoking. International Journal' of Epidemiology 3(2):153-165, June 1974. RUSSFrLI., M.A.H., FEYERABEND C. Blood and urinary nicotine in nonsmokers. Ianoet 7900(1):179-181„January 25,1975. RUSSEI.I, M.A.H., JARVIS, MJ.,,WEST; R.J: Use of urinary nicatine concentrations to estimate exposure and mortality from passive smoking in non-.mokera. Ern:tish Jourralo(Addiction 81:275-281, 1986. RUT'SCH, M. Non-smoking wives of heavy smokers have a higher risk of lung cancer. (letter). British Medical Journal 282(6268?:985, March 21, 1981. 115

6ACKETf, D.L Bias in analytic reeearch: Journal of Chionic Diaeoaas 32(1-2):Si-63, 1979: SAII7, G., ZALOKAR, J., LELIAUCH„ J., PATOIS, E. Parental smoking related to adenoidectomy and tonsillectomy in children. Journal of Epidtrniolokrr and CorrmmunityHealth 32(2):97-101, June 1978. SALOOJEE,, Y.. VFSEY, C.J., OQLE, P.V., RUSSELL, M.A.H. Carboryhemogl6bin and plaema t6iocyanate:,Complementary indicatora of smoking behaviour? Thonu 37(7):521-525, July 1982. SAMET, J.M:, TAGER I:B:, SPEIZER, F.E. The relationship between respiratoryy illness in childhood and chronic air-flow obetruction in adulthood. Amuiccn Review of Reapinatory A'!.ease 127(4):50&-523, April' 1983. I SANDLER, D.P., EVERSON, R.B:,,RriLCX1X, AJ. Passive smoking in adulthood and cancer risk. American Journal'ojEpi.demiolbgy 121(1):37-48; January 1985: SANDLER, D.P., EVERSON, R.B., WILCOX, A.J~ Passive smoking in adulthood and rancer risk. (letter): Amencan Journol of Epidemiology 123(2):369-370; February 1986: SANDLER, D.P., EVERSON, R:B., WILCOX, A.J:, BROWDER, JY. Canoer risk in adulthood from early life exposure to parents' smoking. Amerioan Journal of l Public Health 75(5r487-•192; May 1985. l ~ ~ SANDLER, D.P., WILCOX, A.J., EVERSON, R.B. Cumulative effects of lifetime ,. passive smoking on cancer risk. Lancet 1(8424):312-314; February 9, 198ua SANDLER, D.P., WILCOX, A.J;, EVERSON, R.B. Lifetime passive smoking and cancer risk. (letter). Lancet 1(8433):867; Apri113;1985b. SCHENKER, M.B., SAMET, J.M., SPEIZER, F.E. Effect of cigarette tar oontent and smoking habits on respiratory symptome in women: American Review ojRespiro- tory Disease 125(6):68"90, June 1982. SCEiENKER, M.B., SAMET, J.M., SPEIZER, F.E. Risk factors for childhood respira- tory disease:, The effect of host factors and home environmental ezposures: American Review ojRapirutory Disease 128(6):1038-1043, December 1983. SCfID.LWG, R.S.F., LETAI, A.D., HUI, S.L., BECK, G.J., SCHOENBERG, J.B., BOUHUYS, A.H. Lung function; respiratory disease, and smoking in families. American Journal ojEpidemiology 106(4):274-283, October 1977. SCHLESSELMAN, JJ:,Case-Contrzrb 5tudiea: DAeaign; Conduct, Analyeii. Monographs in Epidemiology and Bioetatiatics, Vo11 2. New York, Oxford Uhiversity, Press, 1982. SCHMELTZ, L, HOFFMANN; D., WYNDER, E.L. The influence of tobacco smoke on indoor atmospheres: I. An overview. Preventive Medicine 4(1);66-82; March 1975, SEELY, J.E., ZUSKIN, E:, BOUHUYS, A.,Cigarette smoking: Objective evidence for lung damage in teen-agers. Science 172(3984):741-743„May 14,1971. SHEPHARD, R.J., COLLINS, R., SILVERMAN, F. "Passive" exposure of asthmatic subjects to cigarette smoke. Environmental Research 20(2):392.402, December 1979. SIMS, D,G., DOWNHAM, M.A.P.S., GARDNER, P.S., WEBB, J.K.G., WEIGHTMAN, D. Study of 8-year-old children with a history of respiratory syncytial' virus bronchiolitis in infancy. British Medical Journal 1(6104):11-14, January 7, 1978. SPF.IZER, F.E.,,F'ERRLS; B., Jr., BISHOP, Y.M.M., SPENGLER, J. Respiratory disease rates and pulmonary function in children associated with NO, exposure. American Reviewo(,`Respi.atoryDiaeaae 121(l):3-10, January 1980. SPEIZER, F.E., TAGER, I.B. Epidemiology of chronic mucus hypersecretion and obstructive airways disease. Epidemiologic Revuwe 1:124-142, 1979. SPINACI, S., AROSSA, W., BURGIANI, M.,,NORTALE, P., BUOCA, C., DeCONDUS SION, E. The effects of air pollution on the respiratory health of children: A cross- .ectiona] study. Pediatric Pulmonology 1(5):262-266;,1985. STERLING; T.D. Non-amoking wives of' heavy smokers have a higher risk of lung cancer. (letter). British Medical Journal 282(6270):1Q56; April 4, 1981. 116

$PEG4'ART; A., R'EBB~ J., HEVS*1TT, D. A survey of childhood malignancies. Britiah MedicalJournal SO(86);1495-15U8„June 18, 1958. SDJERNFELDT, M., BERGLUND, K., LINDSTEN, J., LUDVIGSSON, J., Maternal smoking during pregnancy and risk of childhood cancer. Lancet 1(8494):1350-1352, June 14; 1986. STOBER, W. Lung dynamice and uptake of smoke conatituents by nonamokera A survey. Preventive Medicine 13(6):589-601„November 1984. SUTPON, G.C. Passive smoking and lung cancer. (letter), Britieh, Medicinl Journal 282(6265):733, February 28,1981. SVENDSEN, K.H., KULLER, LH., NEATON, J.D. Effects of passive smoking in the Multiple Risk Factor Intervention Trihl (MRFTf): Circulation; Part II, No. 4, October 1985. TAGER, LB. Passive smoking and respiratory health in children: Sophistry or cause for concern? American Reuiew of Reapinatory Di.eose 133(6b959-961. June 1986. TAGER„ I B., MUROZ, A., ROSNER, B., WELSS; S.T., CAREY, V.,, SPEIZER, F.E. Effect of cigarette smoking on the pulmonary function of children and adolescents. American Review of Rrapinutory I)iseoae 131(5):752-759, May 1985. TAGER, LB., WELSS; S:T:, MUROZ, A., ROSNER, B., SPEIZER, F.E. L9ngitudinal study of the effects of maternal smoking on pulmonary function in children. New England Journal ojMedicine 309(12):699-703, September 22,1983. TAGER, I.B., WEISS, S.T., BOSNER', B., SPEIZER, F.E. Effect of parental cigarette smoking on the pulmonary function of children: American Journal of Epidemiolo gy 11D(1):15-26, July 1979. TASHKINI D., CLARK, V.A., SIMMONS, M., REEMS„C., COiJLSON, A.H., BOURQUE, L.B., SAYRE, J.W., DEhEIS, R.., ROKAW, S. The UCLA population studies of chronie obstructive respiratory diseaee: 1. Relationship between pa.renta] ~ smoking and children's lung function. American Review of Respiratory Disease 129(6):891-897, June 1984. TRICHOPOULOS, D. Passive smoking and lung cancer. (letter). Lancet 1(8378).'684, March 24, 1984: TRICHOPOULOS, D.,, KAIi.ANDIDI, A., SPARROS, L. Lung cancer and passive amoking Conclusion of Greek study. (letter). Lancet' 2(8351):677-678, September 17,1983. TRICHOPOULOS, D., KALANDIDI, A., SPARROS, L., MacMAFION„B: Lung cancer an&passive emoking.lnternationnl Journal ojCancer 27(1?:1-4, January 15, 1981. TSOKOS;,C:P. N'on-amoking wives of heavy smokers have a higher risk of lung cancer. (letter)! Britiah MedicalJournal283(6344):1464-1465, November 28, 1981. US. DEPARTMENT OF HEALTH, EDUCATION; AND WELFARE:, Smoking and Health.• A Report of the Surgeon GeneraL DHEW Pub. No. (PHS)79-50066. U.S., Department of Health, Education, and Welfare, Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health, 1979. US. DEPARTMENT OF H'EALTH: AND HUMAN SERVICES. Thc Health Conae- quences of Smoking for Women: A Report ojthe Surgeon Gtnennl. U.S. Department of Health and Humsn Services, Public Health Service, Office of the Assistant Secretary for Health„Office on Smoking and Health,1980! US. DEPARTMENT OF HEALTH AND HUMAN SERV7CES:,?7ie Health Conx- quenaea of Smoking.• Caneer. A Report of the Surgeon Genernl. DHHS Pub: No. (PHS)8250179. US. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health; Office on Smoking and Health„1982. US. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Conse- quenees of Smoking: Cardiovascular I3iseaae. A Report of the Surgeon Gentrnl. DHIiS Pub. No: (PHS)84-50204. US, Department of Health and Human Servioes,. Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health. 1983. 117 4 "A

0 ® o © ® ® ® e ® I 4r ;... ® t : . Q ' . y; . ;. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES., Tlu Health Conse. qeuncea of Smoking: Chronic Obdtructive Lung, Diaease. A Report of the Surgeon GeneruC DHHS Pub. No. (PHS)84-50205. US. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, Offiae on Smoking and Heslth:1984. US. PUBLIC HEALTH SERVICE. Smoking and Health. Report of the Advisory Committee to the Surgeon General of the Public Health Serviee. PHS Pub, No. 1103. U:S. Department of Health; Educat.ion, and' Welfare, Public Health Service, Centers for Disease Cflntro1,1964. VAN STEEA'SELMOLL, H.A., VALKENBURG, H.A., VANDENBROUCKE, J.P. Are maternal fertility problems related to childhood leukaemia?lnternational Journal of Epidcmiologv 14(4);555-b59, December 1985. VEDAL, S., SCHENKER, M.B., SAMET, J.M., SPEIZER; F.E. Risk factors for childhood respiratory disease: Analysis of pulmonary function. Amerioan Review of Respitatory Disease 13(K2):187-192, Auguat 1984. VUTUC, C. Quantitative aspects of passive smoking and lung cancer. Prruentive Medicine 13(6)-698-704, November 1984. WA1TE, C.L. Effects of passive smoking; (letter). Ntw England Journal of Medicine 299(16):897, October 19,1978. WAKEHAN, H. Effects of passive smoking. (letter). New England Journal of Medicine 299(16J:8.96, October 19;1978. WALD, NJ., BOREHAM, J., BAILEY, A., RITCHIE, C., HADDOW, J.E., KNIGHT, G. Urinary cotiaine as marker of breathing other people's tobacco smoke. (letter). Lancet 1(837or.230-231, January 28,1984. WALD, NJ., IDLE„M., BOREHAM, J!, BAII.EY', A. Carbon monoxide in breath in relation to smoking and carbozyhaemoglobin levels. Thoraz 36{5)s366-369, May. 1981. WALD, N.I.,, RI'1'CHIE, C. Validatiom of studies on lung cancer it nonsmokers married to smokers. Qetters): Lancet 1(8385):1067, May 12, 1984. WALTER„S., NANCY, N.R., COLLIER, C.R. Changes in fosced ezpiratory spirogram in young male smokers. American Review of Re.sapirutory Disease 119(5)j7I7-724, 1974. WARE, J.H., DOCKERY, D.W.,, SPIRO, A. III, SPEIZER, F.E., FERRIS, B.G., Jr. Passive smoking„Bas cooking, and respiratory health of children living in six cities. American Review of Reapiratory Disease 129(3):36Fr374, March 1984. WEINBERGER, S.E., WEISS; S.T. Pulmonary diseases. In: Burtow;,G.N., Ferris, T.F. (eds): Medical Complirations During Pregnanry. 2nd ad. Philadelphia, W.B. Saunders, 1981, pp. 405-434., WEISS, S:T., TAGER, I.B., MUAOZ, A., SPEIZER, F.E. The nelgtionship of respiratory infections in early childhood to the oecurrence of incre•aeed' levels of bronchiali reeponsivenees and atopy. American Review of Reapirutory I)ieeoae 131(4):573-,578;, April 1985. RCF.ISS, S.T., TAGER, LB., SPEIZER, F.E., ROSNER, B. Persistent wheeze: Its relation to respiratory illness, cigarette smoking, and level of pulmonary function in a population sample of ehildtrn, American Review of Raspiratory Disease 122(5):697- 707, November 1980. WHITE, J.R., FROEB, H.F. Small-airways dysfunction in nonsmokers chronically exposed to tobaooo smoke. New England Journal of' Medicine 302(1Ci)!72Q723, March 27, 1980. , WHITI'EMORE, A., ALTSHULER, B: Lung cancer incidence in cigarette smokers: Further analysia of Doll and Hill's data for British physicians. Biometrica 32(4):80.5-8I6, December 1976. WIF.DEMANN, H.P., MAHLER, D.A., LOKE J:, V11tGULTO, J.A.,, SNYDER, P., MAT'hHAY, R.A. Acute effects of' paasive smoking on lung function and airwayy reactivity in asthmatic subjects. Chest 89(2):180-185; February 1986. 118

WOQLCOC,'K, A.J., PEAT, J.K., LEEDER; S.R, BLACKBURN, C.RB., (ed.J. The development of lung function in Sydney children: Fffects of respiratory illt+ees and amokiag. A ten year study. Eurvpe+an Journal of Respirntory Dire+ara 65(Suppll 132):1-137,1984. WUT A.H., HENDERSON, B.E., PIKE, M.C., YU, M.C. Smoking and other risk factors for lung eancer in women. Jounsal of the Ntitionnl Cancer lnstitutc 74(4r747-751, April 1985: WYNDER, E:L., HOFb'MAN:'N, D. Tbbacao and Tobacco Smokr Studie in Esperimtn- tal Carrino8rncsia. New York, Academic Pre.a,1967. WYNDER; EL STELLMAN. S.D. Comparative epidemiology of tobrooo-o-releted canoers. Caacer8eaearh 37(12):4608-4622, Deoember 1977. YAR1vELL; J.W.G., ST. LDGER, A.S. Ftespiratory iIlae.s, maternal iamokiag hebit; and lung function in children. britiah Jouraal'of Diaenaa ojthe Cheet 73(3):230-236, July 1979. 119

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