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Order Number 8801682 Assessment of the association between passive smoking and :ung cancer Varela, Luis R., Ph.D. Yale Univrsaity, 1987 300N.ZeebRd. Ann Atbnr, ;.ti =$196

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ASSESSli-~Fi' OF = AS-9JQAiIccr HElY~ PAS5i~7E SMzM~G ADID L:R% CF1N= A Dissertat.ion Presented to the Faculty of the Graduate Bchool of Yale Unive.rsity in Carci.idacy for the Deqree of Doctor of Philosop~ly by Iuis R. Varela Msy 1987

ASS:^,~~.CT AS5ESS= OF TTYE AS.ATiON 3:.:1.'1:.~'.i~ PASSIVE j~C LCt~.l'a .~~ i,ais R. Varela Yale University 1987 acase-control study «as c.arried out to evaiuate the associ..aion aetv*=t-r. Prnst:re to envLrorriental totacoo snnl:e (cessivf- S.mkinQ ) ara 1Lng ca.ncer r i k. The study pcaul ation was c=r~ sed o f 439 cases of lung cancer d.`aSTosed asrrnc, ncn-sr~kp-rs. A11 of these cases s.ere clinically and histologically aonfirnet. Ttr_ c,rorrespondi~na cor~tsols aere drawn frar the !,;--w York State DeDariment of Moror Vehicles anci we=e individually matcilei to the cases on age, sax, countv of residence and previous srrcking history. A.`acr-to-face interview c.P-s aEplied to oerta-n infoinhtion oz ezxr~:are to er.vircmentzl tobacco sr~. No increase in risk ~.as found associated with e=osure to three measuremern.s of snouse saic:ng, or with exposure to cc-worke..~-s " smoking. Cor.ve.rsely, expostse to the srrnke of ot}-.-rs in the housel-old ,as found .c affe--, the ris!t of lur..g cancer. Fbr an e.-oasure to 150 person/years of smo}dna the odds ratio c,P-s found to be 1.86. This effect se--s to be ia:ccer for ~:.derr~id and srsa11 cell turnrs (CR=2.33) t;nan for ack=~tocarcirxxm and otk-P-r ttsrcrs (Of-1.42). Ix=easing P.)~e to c,assive xrnking in soctial situ3tiors was foure to i;e inversely assnciatxl with the risk of lung cancer. The i,rti licat:.on of t" dis fii.ding -- at odds :rith :revious results --,s dSsejssec:.

I am greatly inde~ted to Dr. Dwiaht T. Janericn for providing me with the opcorunity to gart-icipate in the project fran w¢zich the rraterial for t.2is dsse_rtation was derive3. Working with him ;.as not only itttellecv.:a11y stiaailat~ng„ but aiso a scurce of graltifyina professimal and persona;' interaction. 2b the W.K. Kellog bb+mdation I am grateful for providing rne with the financizl assistance to conduct my docr.oral sair3ies. To friends and aaribezrs of the Faculty of the Depar=nent of EPideniology I am thankfui forr their ,xntizucus help and su~xnrt. i1. I

TABLE OF COJT-c',liS Fa;'e TABLE O LISP OF F OCNlI'fIZPS TRBL-. .................... .................... .................... iii vi LIST OF FI041Z~- .................... x Ci-AIf .4 LITE..~AT c~'. u'RE R~.R ZFr7. 1 I BACx=Rm .................... 1 2 z...PZDE2ZTOLCGIC SIL'DIES 5 3 OI'f~e'"t STGDIES 16 4 LABORATJR'z INTt~"'TICATICfLS .................... 20 5 A*7TbAL r'XPERIMENPS 25 6 StOiLTNG AND iiI SIULCGIC TYPE OF U.JZ% CP.PJER .................... 26 C-iAP1'~? :Z TJ . 30 ~I ~ODS . 1 03 7E`T:vE.S ..................... 31 2 SIZE ..................... 33 3 :,0.aTION OF ':~ .S: (IDY ..................... 34 4 ZS'1'ABLI.SH.*t'rNI' OF THE CA= F.Fs~.'RTI:Ki SYST~.*! ..................... 34 5 cZFrIBILITY C9.rP°"2LA FOR CAS.'S 35 ~c. ~_'' =1rY~ OF Q7JI40TS 57 I

1V 7 DA~TA COZ.i~'ZOa ...........:......... 38 8 HISrOLCG?' REVIr'3d ..................... 39 9 A'POS=- VARLA= ..................... 40 9.1 52CUSE SND?ZWI fiAEITS ..................... 41 9.2 c.'7.'IiEtE 2U PASSIVE ..................... 42 ShY3KIAlC' IN THE F3'JUSr^riOM 9.3 PASSIVE &MOEE= IN TfE ..................... 43 S,TJRUKPLA= 9.4 PASSIVE SZV,CEUNS IN SOCIAL. CIRClMSMCM ..................... 43 10 PClI'ENPIALLY CDhTCtJNDINr . ..................... 44 VARIABLrS 11 ANALYSIS ..................... 45 1? .1 ;J=.LSTIC R-MRMSION zDR ..................... 4 7 MA2= CASE-C;QDII4ROL SIt7D= 11.2 ~URE A.S CATD1JitICAL ..................... 48 VAR7ABLfS 11.3 rF~S'OSTIR.E AS CJh'TINIXXTS ..................... 50 VaRZaar.E a-WI9:c -k=. ..................... 54 RF:SJT TS . 1 DESC:RIPTTOtl OF "gLr STJDY ..................... 55 SPttgLE Aiv'D DISIRMJ'PION OF ThE MA'^"-%~.~N3 VP.RZAHLZS ? DISTRSSUI:OU OF 277PWIZALi.Y .................. 59 Cttr'FC3Jtv'DIiCj VARIABL,ES 3 ASMM-<M-~ OF 'IIE .................... 61 OF PASSIVE 39KTtC ON LL't-Z CAN= RISKS

V 3.1 Stl~DK:?v:w FUZ I"5 CF ~ ..................... S?CGSc. 62 3.1. 1 ASaZS. -52Tli' OF 7HE Nt.2,1BER .................... OF CIGAPF"_'IES,'DAY SMCKr?? BY THE SPCUSE 62 3.1.2 NLMBct OF Y"rARS CF ..................... SFYXlS-- Sv=JG 73 3.1.3 Tt7tF.:.~ W,MBER CF CIC;%.REITfS ................. SIiED BY 7HE SPaTSE DURLNG :dP.RR= ?.a :. 82 3.2 PASSIVE _TN EiCL'SEH0L7 91 3.2.1 RfSiJLTS Ut,'DER ASSUIIP`I'ION 1 .................. 92 3.2.2 B.=TS CtCER ASSLi=IXN 2 .................. 102 3.3 ZXPOSU~E 1O 3M0Iu"NG IN ..................... ??HE ~rDRKPT ~. 110 3.4 rX~'U2E TO PASSIVE ..................... SMJKING IN SOIAL CIFCCbLSTfiN= 118 FUD.~. ..................... DISC].ISS ION. 128 BIBLIOll;rx.iY ..................... 156 APFIIIDLY ..................... 165