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SHOOK, HARDY& BACO N REPORT ON RECENT ETS AND IAQ DEVELOPMENTS July 9, 1993 Tv r. ..r N ~ ~ © W SHB ~

REPORT ON RECENT ETS AND IAQ DEVELOPMENTS - IN THIS ISSUE - IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS • Federal court deadline apptnaehes for OSHA to outline rulemaking options, p. 1. • Surgeon General supports ETS warning labels, p. 2. • Los Angeles bans smoking in all restaurants, p. 2. ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS • Hearing on venue motions postponed in ISSUE 51 IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS • No smoking for South Australian taxi drivers, p. 10. • Ministry of Ptrblic Health in Kuwait bans smoking in health care facilities, p. 10. • Workplace restrictions are proposed in. Finland, p. 10. ETS/1AQ LITIGATION NOT INVOLVING CIGARETPE MANUFACTURERS • Child custody case filed in Australia, p. 111. Blrtncharcr; p, 3. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE M.'\NUFACTURERS. • Child custody suic in New Jersey, p. 4. • Carper suit Howell may be consolidated with, others, p_ 5. LEGAL ISSUES AND DEVELOP4-lEAITS • Dauberr"junk science" unanimous Supreme Court decision, p. 5. OTHER DEVELOPMENTS/MEDIA COVERAGE • Smokers form new policical parry in Australia, p. 12. • Australian, restaurant closes following, imposition of smoking ban, p: 12. • British Telecom tightens its smoking accommod'ation, policy, p. 12.. • "Anti-Fragrance Lobby Seeks to Clear the Air," p. 13. OTHER' DEVELOPMENTS • Anderson labs tests mattress emissions on mice, p: 6. • ALA releases IAQ survey results, p. 6. SCIENTIFIC/TECHNICAL ITEMS • "Recent Developments in the Epidemiology N 11r of Lung Cancer," p 7 ..r ~ • "Risk Factors for Cardiovascular Disease in ~ Non-Smokers," p. 7. ~ • "Passive Exposure to Tobacco Smoke and ~ " ~ Respiratory Symptoms in Adults, p. 8. ~ • Four new studies relating to childhood respiratory conditions, p. 8. Ir' +~

1 - TABLE OF CONTENTS - Issue 51 July 9, 1993 IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS U.S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION'(O'SHA), [Il] Agency Official Says ETS Rulcmaking Decision Imminent .....................................................1 [I2] OSHA Considers Workplace Warnings About ETS Exposure ................................................. 1' 103m CONGRESs (3) House Opens Debate on BiIIIWiih Smoking Resrrictions....................................................•.-• 1! [4) Joint Resolution on Disabilities Introduced ................................:..............•....•--.•-•••••••••.•••••••••2 U.S.. SURGEON GENERAL [5) Surgeon General Supports ETS Warning Labels ......................................................................2 [6J ETS-Related'State and Local Legislation ..................................................................................2 ETS-RELATED LITIGATION!AGAII*JST CIGARETTE MANUFACTURERS [7) Blanchard Hearing on Venue Motions Postponed ............................................................-••.•• 3 [8] Voth: Responses are Filed by Brown & Williamson ......................................................•••••••---. 4 ETSIIAQ LITiGATION NOT INVOLVING CIGARETTE MANUFACTURERS CHILD CUSTODY [9] Montufor v. Navrot (Superior Court, Camden, New Jersey) (motion filed June 1!993) ............. 4 WORKPIACE: PERSONAL INJURY [10] Stupak v. Prndcnticl Insurance Co. No. 93L 007115 (CircuitCourt, Cook County, Illinois) (filed June, 1993) .--•-•••••••••-••.••••••••••••••-••••••••••••.-••••••• •4' WORKPLACE: COLLECTiVE BARGAINING [ 11 ] Civil Servicr Employees Ass'n, Inc., Local 1000, AFSCM'E, AFL-CIO v. Public Employment Relations Board 1!993 N.Y:,App. Div. LEXIS 6599 (Supreme Court of New York) (d'ecided June 24„ 1993) ........................................... .-•••••••.-..-•4 IAQ: CARPET EMISSIONS [12) Hosurll u Shaw Industries Inc., 93-CV-2068 (U.S. District Court, Eastern District, Pennsylvania) (filed April' 19, 1993) ...........................--...............................---......................... 5 WORKPLACE:IA.QLSICK BUIIDING. SYNDROME [i13] Bloomquist v. Wapello County (Iowa Supreme Court) (decided April 21, 1993) ....................... 5 PRISONER CASE [14) Perdue v. Leis (Hamilton County Common Pleas Court, Ohio) (decided June 1993) .............. 5 LEGAL ISSUES AND DEVELOPMENTS [15] Daubert v. Marrell Dow Pharmacruticals: Inc., No: 92-102 (U!S. Supreme Court) (decided June 28,,1993) .................................................................................................... ...... 5 OTHER DEVELOPMENTS [16] Mattress Emissions Allegedly Injure Mice ................................................................................6 [17]; MEDIA COVERAGE Few Regard 1AQas Serious Health Problem ............................................................................6 [18] "Smoking Ban," CNN Sonya Live, July 1„1'993 ................... ............................................... ....6. SCIENTIFIC/TECHNICAL ITEMS LUNG CANCER [19] "Recent Developmencs in the Epidemiology of Lung Cancer," G.C. Kabat, Seminars in Surgical'Oncology 9: 73-79, 1993 [See Appendix A] ..............................................7 [20] "A Case-Concro]Study of Childhood and Adolescent Household Passive Smoking and the Risk of Female Lung Cancer," Wang, F.L., Love, E.J., and Dai„X.D., Abstracts of the 1993 Annual Meeting of'the Society for Epidemiologic Research, Keystone, Colorado, Abstract No. 301, 1993 (See Appendix A] .............................................. 7

Contents Continued, Issue 51 CARDIOVASCULAR ISSUES [21] Rirk Factors For Cardibvascular Diseare in Non-smo!<erf; D:F. Weetman and D. Wood (eds.). Basel, Karger, 1993 .......................................................................................7 RESPIRATORY DISEASES AND CONDITIONS - ADULTS [22] "Passive Exposure to Tobacco Smoke and Respiratory Symptoms in Adults," P. Leuenberger, J. Schwartz, U. Ackermann-Liebrich, and Sapaldia Team, Anrrrican Review ofRespiratory Disease 147(4 Part 2): A368, 1993 [See Appendix A] ............... 8 [23] -Effect of 3 Hours Passive Smoke Exposure in the Evening on Airway Tone and Responsiveness Until the Next Morning in Mild Asthmatics," D. Nowak, R. Jorres, A. Schmidt, and H. Ivlagnussen, Amarican Rcvinu ofRespiratory Disease 147 (4 Part 2): A214, 1993 [See Appendix A] ................................................................................8 RESPIRATORY DISEASES AND CONDITIONS - CHILDREN. [24]I "ABO Groups and Passive Smoking Exposure Influence Lung Function in Children and Adolescents," G.M. Corbo, F. Forastiere, N. Agabiti, R. Pistelli; V. Dell'Orco, P:,Angeloni, M.L. Aebischer, M. Purpura, C.A. Perucci, and'G. Ciappi, American Review ofRcspiratory Disease 147(4 Part 2): A214', 1993 [See Appendix A] .............................. 8 [25]1 "Middle Ear Diseases in Relation to Acopy and Nasal Metachromacic Cells in Infaney,"' K. Innder, M.P. Borres, and'B. Bjorkscen, InrcrnarionalJournalofPtdiatric0' torhirtolaryngology 26: I-9; 11993 [See Appendix A) ........... .......................................................8' [26]', "A Longitudinal Study of Parental Smoking and Childien's Pulmonary Functiom from 6 to 18 Years," X. Wang, D. Wypij, D. Gold, D.W. Dockery, F:E. Speizer, J.H'. Ware, and B.G. Ferris„American Reviruw ofRsspirato.J Uisrasc 147' (4 Parc 2): A2d 3', 1993 [See Appendix A] ................................................................................9, [27) "Analysis of Potential'Confounding Variables in Epidemiologic Studies ofPi rental/Household Smoking and Respiratory Health in PreschoollChildren," P. Wicorsch and R.J. Wicorseh, IndoorEnvironment2:,71-91, 1993 [See Appendix A] ...................................... 9 OTHER CANCER [28] "Maternal Active and Passive Smoking During Pregnancy and' the Risk of Childhood Brain Tumor (BT)." G. Filippini, M. Farinotci;,G. Lovicu4 S. Pteston-Marcin, and P_ Boyle, Ncuroingy 43('4): A331 (680P), 1993 [See Appendix A] ..................................... 9 ETS EXPOSURE AND MONITORING [29] "N'inety-Day Inhalation Study in Rats„Using Aged'and Diluted Sid'estream Smoke from~a Reference Cigarette:,DNA Adducts and Alveolar Macrophage Cytogcnetics," C.K. Lee, B.G. Brown, E.A, Reed„C.R.E. Coggins, D.J. Doolittle, and A.W. Hayes, Fundamentalcnd'Applied Toxicology 20: 393-401, 1993 [See Appendix A]I.............................. 9 [30] "EnvironmentallTobacco Smoke Exposure of Young,Children as Assessed Using a Passive Diffusion Device for Nicotine," R. Williams, A. Collier, and J. Lewtar, Indoor Environment 2: 98-104, 1993 (See Appendix A]I...----.....•....•.....••.••••••-•••••.•-•••-•••••••-••••••9 INDOOR AIR QUALITY [31]', "Indoor Air Pollution from Combustion Sources in Developing Countries," G.B. Leslie and V. Haraprasad, Indbor Environment 2: 4-13, 1993 [See Appendix A] .................................9 [32]I "Airborne Carcinogens," JL Lewtas, Pharmacology d ToxicoGrgy72 (Suppl. 1): S55-S63, 1993 [See Appendix A]i .........................................................................10, [33] "Health Effects from Adverse Indoor Air Quality: An Evaluative Approach Using Toxicolbgical Principles," M'.J'_ Reasor and Iv1,R. Montgomery, Indoor Environment 2: 1 18-121 „ 1993 [See Appendix A] ....................................................... 10 [34] "Airborne8ndotoxin and Sick Building Syndrome," K.B. Tecuw, C.M_J.E. Vandenbroucke- Grauls, and J. Verhoef, Pediatric Research 33(4 Part 2): 420A. 1993 [See Appendix A) .......... 10 IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AUSTRALIA [1351 Taxi Drivers Face Smoking Ban ............................................................................................ 10 CANADA [36] Calgary Smoking Bylaw Goes into Effect ............................................................................... 10

Contents Continued, Issue 51 Kuwwrr [371 Public Health Ministry Bans Smoking in Hospitals ............................................................... 10 FINIAND [3S] MAr..+rsiA [39]' Health Minister Proposes Increased Workplace Smoking Restrictions ................................... 10 Kuala Lumpur to Enforce Smoking Ban ................................................................................ 11' SOUTH~ AFRICA [401 Parliament Approves Smoking Ban ........................................................................................ 1 1 UlVITED K7NGDOM [41] MP Seeks Smoking Restrictions in Palace of Westminster .....................................•..•••.•-••••••. 11 [42] Taxi'Smoking Ban Proposal to be Introduced ........................••.-•-•.---••••-•••.-.--.••••••~.-•••.••••--••• 11 ETS-RELATED LITIGATION INVOLVING CIGARETTE MANUFACTURERS AUSTRALIA [431 TIA v. Stephen Woodward (Supreme Court, Equiry Division, New South Wales)~ (filed April 15, 1993) .............................................................................. 11 ETS/IAQ LITIGATION NOT INVOLVING CIGA.RE'ITE MANUFACTURERS AusTxw3:1w [44} Father Seeks Order to PrevenrEx-wife's Smoking ....................................................... .......... 11 OTHER DEVELOPMENTS AUSTRAC.IA [45] Smokers Form New PoliticallParry ........................................................................................ 12 [46] Nonsmoking Pub Forced to Rescind Ban .............................................................................. 12 [47] I [4$]1 Restaurant Clbses After Imposing Smoking Ban .................................................................... 12 Tobacco Lobby Plans Media Campaign on Smoking Bans .................................................... 12 [49) Health Unit to Publish Pamphlet on ETS and Asthma .......................................................... 12 CANADA [50], Smoking Restrictions Create Market for Reusable Cigarettes ................................................. 12 UNITED I'CINGDOM [51] British Telecom Imposes Workplace Smoking Restrictions ................................................... 1 MEDIA COVERAGE CANADA [52] "AntilFragrance Lobby Seeks to Clear the Air," P. Orwen,. The Toronto Star, June 22, 1993 .................. .................................................... ...................... 13 APPENDIX A .................................................................................................... .............................Article Summaries APPENDIX B .... ........ ................................................................................................... ......................................California A.B. 13, A.B. 996

JULY 9, 1993 1 REPORT ON RECENT ETS AND IAQ DEVELOPMENTS IN THE UNITED STATES REGULATORY AND LEGISLATIVE IviATTERS U.S. OCCUPATIONAL SAFETY AND HEALTH ADMm1ISTRATlON (O'SHA). [;1]' Agency Official Says ETS Rulemaking Decision Imminent According to a press report, a senior OSHA official has said that the agency will decide how to proceed on regulating ETS in the workplace in time to meet a July 119, 1993, federal court deadline. The deadline arose in ASH'v: Department of Labor, No. 92-1661 (U.S. Court of Appeals, D.C. Circuit) (filed December 22, 1992), when the court granted ASH''s request forr a 60-day abeyance to give OSHA an opportuniry to outline rulemaking,options for the incoming Secretary of Labor. For a discussion of the court's order in~ the case see issue 48 of this Report, May 28', 1993'. Frank Frodyma, OSHA's acting deputy director for policy, reportedly stated that Labor Secretary Robert Reich will make a decision on the issue soon. Accord- ing to unnamed administration officials, Reich "has the guts" to push for tough new measures to restrict smoking. It has also been reported that EPA Adminis- trator Carol Browner will soon be issuing recommen- dations for restricting workplace smoking. See The Reuter Business Report, J',une 23, 1993. [2] OSHA Considers Workplace Warnings About ETS Eitposure According to a press report, OSHA is considering, as part of an overall agency rulemaking on ETS, a provision that would require employers to issue warnings to workers about the purported health risks associated with ETS. The warning would apparently notify workers about the alleged hazards detailed in the EPA Risk Assessment on ETS. Speaking at a June 23, 1993, meeting of the Interagency Committee on Smoking and Health, Frank Frodyma, acting director for OSHA policy, reportedly stated that enforcement options under consideration by OSHA indude requiring employer health warnings and issuing citations under the general duty dause of the Occupa- tional Safety and Health Act. According to Frodyma, the agency is continuing to review the comments submitted to OSHA in response to its request for information on indoor air, and Labor Secretary Robert Reich~has not yet decided whether to initiate a separate rulemaking for ETS. Surgeon General Antonia Novello, who also attended the meeting,,evidentlyagreed'that employers should warn workers about the alleged risks of ETS exposure in the workplace. See BNA Daily LaborReport, June 24, 1993. 103D CONGRESS [3] House Opens Debate on Bill With Smoking Restrictions On June 29, 1993, the House reportedly opened debate on an appropriations bill which wc`"d require that "none of the funds in this Act shall be available to pay administrative expenses of WIC [Women, Infants,, and Children] clinics except those that have an an- nounced policy of prohibiting smoking witliin~ the space used to carry out the program." (H.R. 2493). See Associated Press, J une 29„ 1993. The measure passed the House and was received in the Senate on Jlune 30, 1'993, where it was read twice and referred to the Committee on Appropriations. WIC is a federally funded special supplemental food program authorized under the Child Nutrition Act of 1966: The program helps pregnant and nursing women, their infants and children up to the age of five with nutrition~and immunizations. To the extent that WIC is a federalNy funded health program involving children under~ the age of 18, smoking would be restricted M WIC facilities serving such children under Senator Frank Lautenberg''s (D-NJ) PRO-KIDS (S. 261) legislation which is still pending in committee. For a discussion of the provisions of S. 261, see issue 40 of this Report, February 4, 1993. 2024702319

2 [4] joint Resolution on Disabilities Introduced On June 22, 1993, Senator Daniel Inouye (D- Hawaii)i introduced a joint resolution that would, designate September 29, 1993 and September 28,. 1994, as "National Barrier AwarenessDays."'Although the measure does not specify whether those with purported ETS sensitivity are to be considered dis- abled, it, does note that some 43 million Americans have an identifiable disability and that 80~percent of Americans will experience some form of disability during tlieir lives. The measure has been referred' to the Committee on Judiciary. U.S. SURGEON! GENERAL [5] Surgeon General Supports ETS Warning Labels Outgoing Surgeon General Antonia Novello has reponedlysaid~that her office could decide to include warning labels about the purported dangers of ETS exposure on cigarette packs. Novello will soon be replaced by Arkansas Health Commissioner Joycelyn~ Elders if Elders is confirmed by the Senate. But Novello apparently pledged to continue her anti- tobacco activities once she leaves her post. According to a press report, Novellb supports legislation currently being considered by Congress that would ban smoking in all, federal buildings (H.R. 881), and she stated, chat the Clinton administration is considering whether it will issue an executive order to ban smoking in all executive branch buildings. See The Reuter Business Report, June 23, 1993. [,6]I ETS-Related State andLocal Legislation - California According to news reports, the Senate Health and Human Services Committee defeated A.B. 13 in its first hearing on June 30, 1993. The measure would have prohibited smoking in workplaces, restaurants, malls and other public places, warehouses and other industrial facilities, hotels, motels, and airports and other transportation facilities. The bill's sponsor, Terry Friedman (D-Encino), plans to bring the bill back to the Senate committee for a second vote later in July. Friedman reportedly argued that evidence linking ETS to cancer leaves businesses vulnerable to workers' compensation~ claims. Opponents of the bill worried that a smoking ban wouU harm~ the state''s convention ETS/IAQ REPORT, ISSUE 51 and tourism industry, and would be difficult or impossible to enforce. A rival bill, A.B. 996 also had been scheduled to be heard' by the Senate Health and Human Services Committee, but the bill's sponsor, Curtis Tucker, allegedly asked for a week's delay "because he didn't feel' like presenting it." See The San Francisco Chronicle and Sacramento Bee, July 1, 1993. A BNA chart comparing the provisions of A. B. 13 and A.B. 996 is attached as Appendix B. In a related' matter, the League of California! cities announced its opposition to A.B. 996, claiming that the bill's prevention of cities' enacting new or stricter antismoking controls represents state intrusion, in the cities"abiliry to respond; to the interests of its citizens. The league's president was quoted as saying, "The league does not object to a statewide smoking standard as long as it does non preempt the ability of cities to enact stricter measures." League studies allegedly show that since December 1992, 60 cities and counties have adopted or are considering adopting locali smoking, ordinances. The league claims that more than 40 of these would be preempted; if A.B. 996 passes, and has announced its support for A.B. 13. See Business Wire, June 28„ 1993. * Local Governments in California On June 24, 1993, Los Angeles Mayor Tom Bradley signed into law a bill that prohibits smoking in all indoor restaurants. Outdoor eating areas, private clubs,, bars, separate bars in restaurants,,and nightclubs are exempt. The law will go into effect in 30 days. Accord- ing to news reports, those in favor of the ban pointed! to~the EPA Risk Assessment on ETS in supporro of rhei'r efforts. See Los Angeles Times; The New York Times, and~ The Christian Science Monitor, June 25, 1993, and Morning Edition, The Los Angeles Times,, and The San Diego Union-Tribune, June 24, 1993. The status of the new law is uncertain because the State Legislature is considering A.B. 996 that would, if passed's override local antismoking laws passed' after April 1, 1993, and impose a single statewide standard for smoking in public places. Meanwhile, a newly-formed group of Los Angeles restaurant and hotel operators, the Los Angeles H'ospi- taliry Coalitions has launched a petition drive in opposition to the city's new smoking ban. The coali-

JULY 9, 1993 tion fears losing business to restaurants and hotels in nearby cities that have fewer smoking restrictions. The coalition is asking diners to sign petitions in restaurants all over Los Angeles in an effort to gather the needed 58,275 signatures by a July 24 city charter-imposed deadline. The coalition supports A.B. 996 which would override the Los Angeles ordinance and allow restaurant owners to designate smoking areas. See Los Angeles Tirrus, July 3, 1993. Elsewhere, in the adjacent city of Long Beach, the City Council, is reportedly considering a proposal to strengthen the current ordinance that prohibits smoking in municipal buildings and most! offices to include restaurants and other public places. The proposal would also require outdoor restaurants and bars to reserve 75 percent of their areas for nonsmok- ers. The council' has referred the proposal to its Legisla- tive Committee for further review- The matter will come before the full council again in a month. The measure is similar to an antismoking ordinance that won unanimous approval from the city council in 1991. It woul'd have prohibited'smoking in restaurants as of January 4 1994, but the law never took effect due to a successful petition drive. The council replaced the ordinance with the less restrictive version now in effect. See Los Angeles Times, July 1, 1993. Also in California, Mayor Robert D. Breton of Mission Viejo has reportedly proposed a measure to prohibit smoking im restaurants and workplaces. OnNy bars, outdoor patio~areas and nightdubs would be exempt. Breton was quoted as saying, "With ~ greater awareness of scientifically proven data on the negative impact of secondhand smoke ... the public just won't stand for (smoking) in public areas." See LosAngeles Times, June 26, 1993. • Local Governments in Maryland The Howard County Council failed to override the County Executive's veto of a measure that would have prohibited smoking in most public places. City Councilman C. Vernon Gray planned to revive the ordinance by introducing,a similar bill. A public hearing,is tentatively sched'uled'for July 19, 1993, with a full council vote scheduled' for July 22. The Restau- rant Association of Maryland opposes the legislation, arguing that the county should wait for statewide restrictions to be enacted. See The Washington Post, June 24, 1993. 3 • Local Governments in Michigan According to a news report, on June 17, 1993, the Wayne County Commissioner introduced an ordi. nance to prohibit smoking at Wayne County Detroit Metropolitan Airport except in designated enclosed areas. The Commissioner was quoted' to say that "enviconmental and medical research overwhelmingly demonstrates that exposure to secondhand smoke poses significant health risks. ...°' Hearings will be held on the proposed ordinance, and, if approved by the commissioners, could take effect by mid-July. See PR Newswire, June 16, 1993. • Local Governments in Nbrth Carolina The North Carolina Restaurant Association says it will challenge the authority of the Wake County Health Board to impose smoking restrictions in theaters, malls and workplaces, according to a press report. An attorney for the association is reported to say that it will go to court over the matter. The health board voted 9-1 in a special meeting, allegedly to adopt new laws before a possible state law was enacted preventing local governments from regulating smoking. That legislation has passed the House and is pending in the Senate. The Board of Health~ reportedly said~ it acted to protect public health and: that their hand was strength- ened~by the EPA Risk Assessment on~ETS. SeeAssoci- ated Press;June 24, 1993. ETS-RELATED LITIGATION AGAINST CIGARETTE MAh1UFACTURERS [7] Blancharzi Hearing on Venue Motions Post- poned Argument scheduled for July 1, 1993, on defendants' motions to transfer venue and motions to strike was postponed. The matters are now scheduled for argu- ment on September 13, 1'993. Three of the 14 plaintifl's in this case presently allege injury from exposure to ETS. Raye Blanchard and Tamara Reedi mother and daughter, both daim damages for unspecified "illness and disease" allegedly resulting from exposure to ETS fromcigarettes smoked by Raye's deceased husband, Thomas, and~by Raye herself, who daims she smoked "for about ten years." The third ETS plaintiff, Pamela Kastrin Stephens, claims unspecified

4 "lung and respiratory diseases" allegedly caused by exposure to ETS from cigarettes smoked by her deceased Father. The named defendants are purported to be the six major U.S. cigarette manufarnuers, The Tobacco Institute, the Council for Tobacco Research, and a number of wholesalers and retailers. Blancharr>; et al' v. RJ. Rcynoldr Tobacco Company, etaC (District Court, Galveston County,,Texas) i(filed July 31, 1992). [8] Yoth. Responses are Filed by Brown & Williamson On July 5, 1993, Brown & Williamson filed its responses to plaintiffs request for leave to amend his complaint and request for preliminary injunctive relief. No hearing dates have yet been scheduled on those matters. Brown & Williamson's motion to dismiss, filed, June 14, is on the court's calendar for July 26 but is not scheduled for oral argument. Frank Voth, who is incarcerated in the Oregon State Penitentiary, alleges that his civil rights have been violated' as a result of his exposure to ETS. He claims that he has "incurred permanent health damage and is at risk of death" as a result of ETS exposure. Defen- dants in Voth are purported to be Forsyth Tobacco Products, R.J. Reynolds and Brown & Williamson. i/oxli v. Forsytb Tobacco Products, et aL (Uhited States District Court, Oregon) (filed April 27, 1993). ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS CHILD CUSTODY [9] Montufor v. Navrot (Superior Court, Camden, New Jersey) (motion filed June 1993) The divorced father of a 10-year-old boy has reportr edly filed a motion in a New Jersey Superior Court seeking to have his ex-wife's home declared smoke free. According to a press report, Francis Montufor says m his motion that his ex-wife and her new husband are habitual chain smokers and that the smoke in their home is a health hazard to their son. The motion alsoo apparently alleges that other family members who spend' "virtualty all their time" in her home, are alsoo chain smokers. ETS/IAQ REPORT, ISSUE 51 Margaret Navrot, the boy's mother, has custody of the child, with the exception of alternate weekends and Monday nights. She claimed in a newspaper interview that she and her husband had actually quit smoking and that her family members do not spend all their time in her home. Acc.ording to Montufor's attorney; the boy has not complaine& about the cigarette smoke. A hearing has reportedly been scheduled on the motion for July 23,. 1993. See The Phil'a~lelphia Inquirer, June 30, 1993: WORTCPLACE: PERSONAL INJURY [10] Stupak v. Prudential Insurance Co. No. 93L. 007115 (Circuit Court, Cook County, Illinois) (filed June, 1993) A former Prudential insurance salesman has filed a lawsuit against the company seeking $30,000 in compensatory and $1 million~ in punitive damages for emotional distress he allegedly suffered when his demands for a smoke-free work environment were ignored. Gregory Stupak claims he was under a doctor's orders to avoid ETS following an angioplasry procedure, that he was harassed when he complained about the smoke, and'that he was forced to enter therapy with a psychologist because of the situation. Stupak contends the off ce in which, he worked was fille6with "excessive cigarette smoke"' in spite of smoking restrictions and! that his requests for a transfer to a smoke-free office were refused. Stupak is making claims for intentional and negligentt infliction of emotionall distress and for wrongfull discharge. He daims that he was placed on disability by his psychologist and was terminated "apparently because of hisdisabiliry."'Stupak is represented' by David A. Axelrad and Associates. WORKPLACE: COLLECTIVE BARGAINING [111 Civil Service Employees Ass'n, Inc., Loca! 1000, AFSCME, AFL-CIO v., Public Employment Relations Board, 1993 N.Y. App. Div. LEXIS 6599 (Supreme Court of New York)' (decided June 24, 1993) The New York Supreme Court has upheld a smoking ban instituted by the Department of Health in its Roswell Park Memorial Institute facility in Erie

JULY 9, 1993 County, New York. The union petitioner had filed an improper practice charge against the employer in 1988, after negotiations over a smoking policy reached an impasse and the employer adopted a totall ban on smoking in all indoor areas, entrances and in the employer's vehicles. The court determined that on the basis of the union contract and subsequently approved smoking guidellnes,, the union had waived its right to negotiate smoking policies. IAQ CARPET EMISSIONS [ 12] Howell v. Shaw Ind'ustries, Inc., 93-CV-2068 (U.S. District Court, Eastern District, Pennsyl- vania) (filed April 19, 1993) On June 2, 1993, the plaintiffs in this class action filed a motion to consolidate two other identical actions and coordinate pretrial proceedings. The action invo}ves alleged injuries from toxic carpet emissions. Tle other cases, which were also filed in the U.S. District Court for the Eastern District of Pennsylvania, are Lay v. Arnutrong World Industries; Inc. and McBride v. Galaxy Carpet Mi11s,. Inc.. Howell defendants World Carpets,, Inc. and The Carpet andi Rug Institute have filed memoranda in, opposition~ to the plaintiffs' motion to consolidate. Also in Howel4 a stipulation extending the rime to answer the complaint until'June 11, 1993, has been filed, but as of June 21,,tkie defendants had not yet filed their answers. On~ Jktne 4 all of the defendants filed motions to transfer venue and to dismiss the complaint pursuant to Rule 12 of the Federal Rules of Civil Procedure. On June 116 The Carpet and Rug Institute filed a motion to stay discovery pending disposition of the defendants' motions. For a discussion of the plaintiffs"allegations, see issue 46 of this Report, Apri130; 1993. WORKPLACE: IAQISIQC BULDING SYNDROME. [13] Bloomquist v. Wapello County (Iowa Supreme Court) (decided Apri121, 1993) The Iowa Supreme Court has upheldd a jury's verdict awarding damages to state and county employees who suffered injury as a result of exposure to the pesticide, Dursbans which was allegedly sprayed improperly in their workplace to control a flea problem while ventilation was below acceptable standards. The trial court had granted 5 the defendants' motions for judgment not witltistanding the verdict on the grounds that (i) the plaintiffs had failed to present epidemiologicallevidence to prove causation; (ii) the defendants did not owe a duty of care to the plaintiffs; and (iii) there was insufficient evidence that future nursing and related expenses would be incurred. In its most significant determination, the Supreme Court held that epidemiological evidence is not required to establish causation in a "toxic tort" case. The court xknowledged that such evidence may not be available or reliable with respect to particular substances. "In our view," the court stated, "while epidemiological evidence is helpful, it should not be held to be an absolute require- ment in esrablishing causation." The court also observed that the "[a]'ncestors of Dursban have long been known and were in fact used to exterminate prisoners in Nazi Germany." The case was reversed in~ pan, affirnied in part and remanded for reinstatement of the verdicts and to resolve an issue regarding a settlement with one of the defendants. PRISONER CASE [14] Perdue v. Leis (Hamilton County Common Pleas Court, Ohio) (decided June 1993) A trial court judge has reportedly dismissed the lawsuit filed by a prisoner~ who sought to overturnia jail smoking ban on constitutional grounds. Former prisoner Robert Perdue apparently filed the action when a smoking ban went into effect in the Hamilton County Justice Center in Ohio. According to a press report, the judge ruled that there is no constitutional right for a person to smoke, the case was moot because Perdue was no longer in jail, and the sheriff has the authority to make rules for the jaili. See United Press Internationar; June 23, 1993. LEGAL ISSUES AND DEVELOPMENTS [,15] Daubert v. Merrell D+ow Pharmaceuticals, Ine., No. 92-102 (U.S. Supreme Court) (decided June 28, 1993) A unanimous U.S. Supreme Court has decided that the "general acceptance" test for the admissibility of

6. expert testimony, first espoused in Frye v. United Stares;. 54 App. D.C: 46, 293 F.2d 1013 (1923), has been superseded by the Federal Rules of Evidence. The parties in this products liability action had asked the Court to decided the appropriate standard for the admissibility of scientific evidence. Petitioners, two minor children and their parents, alleged that the children's serious birth defects had been~caused by the mothers' prenatal ingestion of Bendectin, an anti-nausea prescription drug marketed by the respondent. The Eleventh Circuit Court of Appeals, upholding the grant of respondent's motion for summary judgment, had rejected as not generally acceptable the testimony of petitioners' experts, whoo based'their conclusion that Bendectin can cause birth~ defects on animal studies, chemical structure analyses and an unpublished"reanalysis" of previously pub- lished epidemiological studies. For a more detailedl discussion of the Daubertcase, see issue 48 of this Report, May 28, 1993: Reversing the Court of Appeals decisions seven Justices attempted to articulate limitations on the admissibility of evidence under Rule 702. They stated, "the trial judge must ensure that any and all scientific testimony or evidence admitted is not only relevant, but reliable."' Factors for the trial judge t,, :-sider in evaluating relevance and reliabiliry will indude: (i)' Can the theory or technique be (or has it been) tested.'; (u) Has t;he theory or technique been subjected to peer review and publication?; (iii) `Y+'hat is the known or potential rate of error?; (iv) Are there standards controlling the technique's operation and were theymaintained?;~ and (v)Psthere "general accep- tance" of the scientific technique? Chief Justice Rehnquist, joined by Justice Stevens, agreed that Frye has been supersededd by the Fed'eral. Rules, but disagreed with those parts of the majority opinion which attempted to establish guidelines governing the admissibility of scientific evidence.. OTHER DEVELOPMENTS [16] Mattress Emissions Allegedly Injure Mice Anderson Laboratories, which gained notoriety testing carpet emissions, has reportedly tested emissions from three types of mattresses. Of the 12 mice sub- ETS/1AQ REPORT, ISSUE 51 jected to the mattress test, one apparently died and the others suffered marked pulmonary and neurological damage. According to a spokesperson~ for the lab, the testing has not been extensive enough to draw "any definite conclusions." The Consumer Product Safety Commission (CPSC) has reportedly received "a few dozen" mattress-related complaints and suspects that the formaldehyde-based permanent press ticking used to cover the mattresses may be causing the problem. According to the CPSC, symptoms of affected individuals include coughing, watery eyes and skin rashes. An industry trade associa- tion~ has evidently chosen an independent laboratory to conduct in-depth studies. See Indoor Pollution Law Repm June 1993. [17] Few Regard IAQas Serious Health Problem A Gallup Organization polll conducted for the American Lung Association has reportedly shown that only 24 percent of Americans consider indoor air quality to be a serious health problem. In contrast, some 901percent of those surveyed apparently believe that outdoor air pollution is hazardous to human health. Forty percent of the survey respondents report- edly believe that air pollution at work is a serious problem, and 83: percent say they support, federal indoor air quality guidelines for all workers and workplaces. See Research Alrrt, May 21, 1993. MEDIA COVERAGE [18] "Smoking Ban," CNN! Sonya Live, July 1, 1993 The merits of the EPA Risk Assessment on ETS were discussed on this cable television broadcast that addressed the issue of public smoking legislation. Guests on the program, included Glenn Barr, deputy to the author of the public smoking ban measure in Los Angeles, Jerry Farber, owner of an Atlanta night clubb that went out of business after a smoking ban was introduced, and Fred Phillis, vice president of a smokers' rights group. Six individuals who called during the program to air their comments on govern- mentally imposed smoking bans were unanimous in their support of such legislation.

JU1.Y~9, 1993~ SCIENTIFIC/TECHNICAL ITEMS LUNG CANCER [19] "Recent Developments in the Epidemiology of Lung Cancer," G.C. Kabat, Seminars in Surgical (?ncolov 9: 73-79', 1993 [See Appendix A] This review focuses ondevelopments in the epidemiol- ogy of lung cancer that have occurred in the last ten years. The author calls smoking and occupational exposures "important risk factors" for lung cancer, and identifies other possible risk factors or risk modifiers, including diet, personal characteristics, andn radon in the home. With regard to ETS, the author, Geoffrey C. Kabat, a member of the SAB committee that reviewed the EPA's draaft risk assessment on ETS, describes "challenges" confronting the epid'emiologic studies of ETS, induding bias, confound- ing, and exposure assessment. Nevertheless, he proposes tliat it is "biologically plausible that heavy ETS exposure over long periods," including childhood exposures, could "increase the risk of lung cancer." [20] "A Case-Control Study of Childhood and Adoles- cent Household passive Smoking and the Risk of Female Lung Cancer," Wang, F:L, Love, E.J!, and Dai, XD., Abstracts of the 1993 Annual Meeting of the Societyfor Epidemiologic Research, Key- stone, Cc,norado, Abstract No. 301, 1993 [See Appendix A] I A case-control study of women in Harbin, China, is the subject of this abstract. Reportedly, lung cancer risk was statistically significantly increased for household exposure to maternal smoking prior to the age of 14. For exposure under the age of seven, a statistically significant risk estimate of 3.46 (95 percent CI 1.80-6.65) was reported. The abstract does not indicate whether these analyses were restricted to nonsmoking women, or if they included both smokers and nonsmokers. Also, while the study included 114 cases, the sample sizes for the individuall analyses are not provided: CARDIOVASCULAR ISSUES [21] Risk Factors For Cardiovascular Disease in Non- smokers, D. F. Weetman and D. Wood (eds. ). Basel, Karger, 1993 This book contains the proceedings of an interna- tional workshop on risk factors for cardiovascular 7 disease in nonsmokers. This one-day workshop was held on May 11, 1991, at, the University of Sunderland, Washington, United Kingdom. The proceedings are grouped into three sections: (1) mechanisms, which presents papers on biological processes involved in atherosclerosis, sudden death, myocardial infarction and arrhythmias; (2) intrinsic factors, which includes discussions of heredity and gender, reduced respiratory function, hypertension and diabetes; (3) environmental factors, which includes discussions of dietary fat and cholesteroli exercise, stress, lead exposure, and exposure to carbon monoxide (CO) and' environmental tobacco smoke (ETS). The paper on CO and the one on ETS raise questions about whether~ exposure to these substances is associ- ated with cardiovascular disease risk. The paper on carbon monoxide exposure as a risk factor for cardio- vascular disease was by F.J.C. Roe (Consulltant in Toxicology, Wimbledon Common, Lond'on, UK). Roe argues that intermittent exposure to carbon monoxide and the resulting increased levell of carboxyhemoglobin (COHb), such as might be observed in cigarette smokers, is not likely to affect healthy individuals. Although it has not been proven that intermittent low peak levels of COHb do no permanent harm, it seems likely that the healthy body can compensate for them completely. (p. 120)' With regard to heart disease patients and! low level exposure to carbon monoxide or to ETS, Roe com- ments on the difficulty in interpreting the relevant studies, and the potential biases in this sort of research stemming from stress and subjective reactions. A difficulty with the interpretation of laboratory studies [relating to CO exposure in heart disease patients] is that simply being in an investigative laboratory is stressful for subjects with compromised! cardiovascular function. The release of catecholamines as a result of this stress and the consequential increase in blood pressure is apt to complicate the interpreta- tion of the findings in such studies. The same problem virtually prevents any meaningful' investigation of the possible effects of CO derived from other people's tobacco smoke on cardiovascular parameters in either normal subjects or patients with existing cardiovascular disease. The characteristic smeil' of tobacco serves to inform the subject when he/she is being exposed to CO as distinct from uncontaminated air, and if he/she has

8 been conditioned to believe that environmental tobacco smoke is dangerous, fear or annoyance caused by the smell of it may trigger off a rise in blood pressure.. (p. 121)~ In discussing potential CO exposure from ETS, Roe emphasizes that previous studies in this area have employed unrealistically high levels of exposure. M he extreme conditions of high smoke and CO concentrations used by some investigators are unrealis- tic. (p. 124) Roe concludes as follows: There is no clear evidence that exposure to CO is associated with an increased incidence of any form of cardiovascular disease. (p. 125) The paper on environmental tobacco smoke exposure was wrinen by Donald F. Weetman (School of Health Sciences, University of Sunderland, UK). His review focuses on the epid'emiologicall literature. He concludes: It is not possible to conclude that a risk to cardiovas- cular health has been established from the epidemio- logical studies considered in this paper. Each of the studies is flawed in at least one major way. If there are to be more studies, and the importance of cardiovascu- lar diseases suggests there should be, one can only hope that they will be conducted in a careful and objective way. (pp. 134-135)' RESPTRATORY' DISEASES AND CONDITIONS - ADULTS [22]I "Passive Exposure to Tobacco Smoke and Respiratory Symptoms in Adults," P.. Leuenberger, J!. Schwarti, U. Ackermann- Liebrich, and Sapaldia Team,, American Review of Respiratory Disease 147(4 Part 2): A368, 1993 [See Appendix A] This recent meeting abstract describes a study of self-reported respiratory symptoms in Swiss adults. Based on reponedly elevated risks of wheezing, bronchitis symptoms, dyspnea, and asthma, the authors claim that their data support a causal association between ETS exposure and'respiratory symptoms. ETS/IAQ REPORT, ISSUE 51 [I23] "Effect of 3 Hours Passive Smoke Exposure in the Evening on Airway Tone and Responsiveness Uhtil the Next Morning in Mild Asthmatics," D. Nowak, R. Jorres, A. Schmidt, and H. Magnussen, American Review ofRespiratory Disease 147(4 Part 2): A214, 1993 [See Appendix A] In this study, 17 asthmatics, including seven claiming a history of "ETS-induced upper respiratory symp- toms," were experimentally exposed to ETS. The authors report that ETS exposure in~ the evening may be associated with a small, but variable, deterioration of airway tone and responsiveness during the night. RESPIRATORY' DISEASES AND CON'~DITIONS~ - CIHIiLDRE~N~ [24] "ABO Groups and Passive Smoking Exposure Influence Lung Function in Children and Adoles- ,:r.ts," G.M. Corbo, F. Forastiere, N. Agabiti, R Pistelli, V. Dell'Orco, P. Angeloni, M.L. Aebischer, M. Purpura, CA Perucci, and G. Ciappi, Ameri- can Review of Respiratory Disease 147(4 Part 2): A214, 1993 [See Appendix A] In this abstract, Italian researchers report on a stud'y in whicK genetic markers for blood groups were examined along with reported ETS exposure and measures of lung function in child'ren. They report that individual susceptibility to passive smoking may be related to ABO groups and Lewis system,"'two:blood grnoup markers. [25] "Middle Ear Diseases in Relation to Atopy and Nasal Metachromatic Cells in Infancy," IC. Irander, M.P. Borres, and B. Bjorksten, Interna- tional Journal of l"ediasric Otorhinolaryngology 26: 1-9, 1993 [See Appendix A] Although this study examines middle ear disorders like otitis media with respect to atopy (a tendency to; develop allergies), the authors present data on reported ETS exposure and respiratory tract infections as well. They claim that children reportedly exposed to ETS had'statistically significantly more respiratory tract infections than did reportedly nonexposed children, but that middle ear problems were not associated with ETS exposure.

JULY 9„ 1993 . [26] "A Longitudinal Study of Parental Smoking and Children's Pulmonary Function from 6 to 18 Years," X. Wang, D. Wypij, D:. Gold, D.W. Dockery, F.E. Speizer, J.H. Ware, and B.G. Ferris, American Review of Respiratory Disease 147(4 Part 2)t A213, 1993 [See Appendix A] Modeling techniques were used to examine parental' smoking and lung function~ in children in the study reported in this abstract. The authors clhim that their data support a "fixed deficit" in pulmonary function related to earlier exposure and! an "additional deficit" related to current exposure. [27], "Analysis of Potential Confounding Variables in Epidemiologic Studies of Parental/Household Smoking and Respiratory Health in Preschool Children," P. Witorsch and R. J. Witorsch, Indoor Envirnnment 2: 71-91, 1993 [See Appendix A] In a! review paper, the authors examine 41 epidemiologic studies on parental or household smoking and respiratory symptoms or diseases in children under the age of five years. They conclude that~ the studies vary widely in their approach to considering 21 potential confounding factors. The authors suggest that a more consistent and comprehen- sive approach to confounders should be implemented in future studies in this area. See issue 49 of this Reporo, June 111, 1993s for a similar analysis by these authors, focusing on studies on older childrem OTHER CANCER [28] "Maternal Active and Passive Smoking During Pregnancy and the Risk of Childhood Brain Tumor (BT)," G. Filippini, M. Farinotti, G. Lovicu, S. Preston-Martin, and P. Boyie, Neurology 43(4): A331 (680P), 1993 [See Appendix A] This abstract reports on a study of childhood brain tumors in a population in northern Italy. The authors report that mothers' "heavier passive exposure" to ETS during pregnancy was associated with a statistically significant risk of brain tumor in their offspring,(RR = 2.4, 95 percent CI 1.2-4.7), One of the study's au- thors, Susan Preston-Martin, coauthored a previous study on this topic. 9 ETS EXPOSURE AND MONITORING [29] "Ninety-Day Inhalation Study in Rats, Using Aged and Diluted Sidestream Smoke from a Reference Cigarette: DNA Adducts and' Alveolar Macrophage Cytogenetics," C:IC. Lee, B.G. Brown, E.A. Reed, C.R.E. Coggins, D.J.. Doolittle, and A.W. Hayes, Fundamental and Applied Toxicology 20: 393-401, 1993 [See Appendix A] In this paper, scientists from~ R.J. Reynolds report on an experiment in which rats were exposed to aged and diluted sidestream smoke as a surrogate for ETS. After a 90-day exposure period, the authors report that increased levels of DNA adducts were observed at several anatomical sites for the highest exposure concentration, which corresponded to a"100-fold exaggerated" concentration of the particulate matter reported in indoor environments where smoking is taking place. The authors report that there were no chromosomal .° errations in alveolar macrophage cells at any exposure. [30] "Environmental Tobacco Smoke Exposure of Young Children as Assessed Using a Passive Diffusion Device for Nicotine," R. Williams, A. Collier, and J. Lewtas, Indvor Environment 2: 98-104, 1993 [See Appendix A] This paper presents data on indoor air nicotine levels assessed by personal monitor and stationary monitor in a group of North Carolina children under the age of three. The authors report that their methodology was successful in this population, and indicate that a future paper will discuss nicotine uptake, metabolism, and excretion. INDOOR AIR QUALITY [31] "Indoor Air Pollution from Combustion Sources in Developing Countries," G.B. Leslie and V. Haraprasad, Indoor Environment2: 4-13, 1993 [See Appendix A) The authors of this review paper contrast indoor air quality in developedcountries (where air conditioning, product emissions, radon, and ETS are topics of discussion) to indoor air quality in developing coun-

10 tries. In the latter, air conditioning is not generally available; wood,,coal, kerosene and other fuels are burned indoors„ producing very smoky conditions; and outdoor air,, used for ventilation purposes, is often highly polluted with motor vehicle emissions. [32]', "Airborne Carcinogens," J. Lewtas, Pharmacol- ogy d' Toxicolog 72(Suppl. 1): S55-S63, 1993 [See Appendix A] This article reviews data on substances identifie& inn indoor and outdoor air that may be carcinogenic. In the course of the discussion, the author claims that ETS and radon~ "are the major sources of cancer risk from indoor exposures," and that ETS "is the largest source of elevated human exposures to carcinogenic particles and gases in indoor environments." [331 "Health Effects from Adverse Indoor Air Qual- ity: An Evaluative Approach Using Toxicological Principles," M.J. Reasor and M.R. Montgom- ery, Indoor Environment 2: 118-121, 1993 [See Appendix A] The authors of this "Opinion" piece present a scientific approach, based upon general principles of toxicology, for evaluating claims of heaith effects related to chemical exposures in "sick" buildings. They call for analyses to indude the temporal nature of the exposure and claimed effect, the toxicologicall proper- ties of the chemical in questions the total dose received by the person, and the possibility of alternative causes. [341 "Airborne Endotoxin and Sick Building Syn- drome," K.B. Teeuw, C.M.J.E. Vand'enbroucke- Grauls, and J. Verhoef, Pediatric Research 33(4 Part 2): 420A, 1993 [See Appendix A] i The authors of this Dutch study report on measure- ments of indoor air quality parameters in 12 mechani- cally ventilated and seven naturally ventilated build- ings. They report that concentrations of endotoxin, a bacterial product, were six- to seven-fold higher in the "sick" buildings included in their study set. ETSIIAQ REPORT, ISSUE 51. IN EUROPE & AROUND THE WORLD REGULATORY'AND LEGISLATIVE MATTERS AUSTRALIA [35] Taxi' Drivers Face Smoking Ban On August 30; 1993, a smoking ban will reportedly go into effect in South Australia's 1000-plus fleet of taxis and hire cars. Under the ban, drivers will not be permitted to smoke inside their cars, even if passengers are not present. The ban will apparentl'y be enforced by Metropolitan Taxi-Cab Board inspectors and the police. Fines for infractions can be as high as $500. See Adel'aide Sunday Mair; July 4, 1993.. CANADA [36] Calgary Smoking Bylaw Goes into Effect On July 1, 1993, Calgary's tough~anrismoking bylaw reportedly went into effect. The bylaw bans smoking in public places except in designated areas and requires every employer to adopt a written smoking policy. The city employee who will handle complaints about noncompli- ance reportedly does not know how or by whom~ the byl'aw will be enforced. See Calgary Herald, July 2, 1993: KUWAIT [37] Public Health Ministry Bans Smoking in Hospitals The Ministry of Public Health has reportedly banned smoking in hospitals and medical centers. Patients and their visitors will be subject to the directive, and all hospital and clinic directors have been asked to install no-smoking signs in wards, outpatient clinics and waiting places. See Moneyclsps, June 15, 1993.. FII*1LAND [38] Health Minister Proposes Increased Workplace Smoking Restrictions The Minister of Health and Social Affairs has report- edly proposed legislation that wouldd restrict smoking

JULY 9, 1993 in the workplace to separate facilities with dedicated ventilation systems. At this time, smoking restrictions in the country are largely self-imposed in public places and'workplaces. See Helsingen Sanomat,,July 1, 1993. MALAYS IA [39] Kuala Lumpur to Enforce Smoking Ban According to a press report, the city hall of Kuala Lumpur will be enforcing a bylaw adopted in 1992, which forbids smoking in Independence Square. The square is apparently located in central Kuala Lumpur and commemorates Malaysia's history of indepen- dence. Eating, drinking, climbing the flagpole, lying down or sleeping in the Square are also prohibired, See Xinhua Genera! News Service, June 24, 1993. SOUTH AFRiCA [40] Parliament Approves Smoking Ban According to a press report, the South African Parliament passed a Tobacco Products Control Bill on June 16, 11993. . Among other matters, the bill report- edly bans smoking in certain places. See Medical Research Councz4 June 17, 11993. UNITED KINGDOM [41] MP' Seeks Smoking Restrictions in Palace of Westminster According to a press report, Woolwich MP'John Austin- Walker is calling for new restrictions on smoking in the Palace of Westminster. The MP is apparently concerned about the health of parliamentary stafFand says that Commons authorities could be breaching health and safety laws by exposing employees to ETS in the work- place. See Evening Srandard' June I0; 1993. [I42]' Taxi Smoking Ban Proposal to be Introduced During a recent session of Parliament, junior trans- port minister Steven Norris reportedly pledged to introduce a measure letting taxi drivers ban smoking in their cabs at the earliest "suitable legislative opportu- nity." See PressAssociation Newsfile, July 2, 1993. i r ETSIRELATED LITIGATION INVOLVING CIGARETTE MANUFACTURERS AUSTRALIA [43]', TIA v. Stephen Woodward (Supreme Court, Equity Division, New South Wales) (filed April 15, 1993) Woodward has to yet formally filed a defense in this matter, although his solicicors, Cashman & Partners, did forward a draft defense to TIA's solicitors in May 1:993. TIA requested that the court expedite the matter, and a hearing was held on that request on July9; 1993. A further hearing will be held on August 13, 1993' If the court grants the request, ii is expected that hearings will be held on the merits of the case in September 1993. Otherwise, the matter may not be heard for another year and'a hal£ TIA has, in the interim, dropped the claim in its complaint that Woodtvard°s statements about "all'of the medical and scientific evidence" were n-__sleading and deceptive. Following the decision~ of the Fulll Federal Court in AFCO v. TL4, see issue 46 of this Report, April' 30, 1993. TIA filed aa action against Stephen Woodward„the Executive Director of ASH, alleging that Woodward had made misleading and deceptive statements regarding: (i) the nature and extent of the AFCO judgmenr (ii)' the nature and extent of the EPA Risk Assessment oa ETS;; and (iii)' that "all of the medical and scientific evidence" demonstrates that passive smoking causes lung cancer and respiratory disease in young children. The action is based upon the New South Wales Fair Trading Act and seeks a declaration and! restraining order regarding Woodward's misleading and deceptive statements, a corrective advertisement and' costs. ETS/IAQ LITIGATION' NOT INVOLVING CIGARETTE MANUFACTURERS AUSTRALIA [441 Father Seeks Order to Prevent Ex-wife's Smoking According to a press report, an Adelaide man is seeking an injunction in Family Court to stop his ex-

' 12 wife from smoking in the presence of their two chil- dren. The injunction, is apparently being sought under the Family Law Act and is reportedly believed to be the first filed in any court in the country. See Courier Mai4 July 7, 1993. OTHER DEVELOPMENTS AUSTRALIA [45] Smokers Form New Political Party According to a press report, a new political party known as The Human Equality and Rights Organization (HERO) will field candidates at the next South Australian election. The party apparently represents the interests of smokers, and HERO founder Peter Vervoorn reportedly said he would introduce legislation~ to witlidraw workpiace smoking bans if he were elected as an MP: Vervoorn would also recommend commissioning independent and controlled research on the effects of ETS exposure. See Midweek Truth, June 30, 1993. [46] Nonsmoking Pub Forced to Rescind Ban The Elephant's Foot hotel in Surry Hills has report- edly been forced' to lifi the ban on smoking which ir adopted in April 1993. The pub, which was the only dfinking establishment im Sydney to adopt a nonsmok ing policy, had~ apparently lost about 25 percent of its business foll'owing the ban. See Daily Telegraph Mirror, June 26, 1993. [47] Restaurant Closes After Imposing Smoking Ban Little Mure's at Battery Point, reportedly closed its doors after it suffered a business lbss following the imposition of a smoking ban on the premises. According to a spokesper- son for the facility; "We found that those who applauded loudest when~ the restaurant became smokefree, weren't there." See Hob'an Mercury; July 1, 1993. [48] Tobacco Lobby Plans Media Campaign on Smoking Bans The tobacco lobby is reportedly planning a media campaign in Asia that will feature smoking bans and' restrictions that are in effect in Qantas aircraft, public ETS/IAQ REPORT, ISSUE 51 transport, hotels and restaurants. Australia's tourist industry and Sydney's hope of hosting the 2000 Olympics are apparently threatened by the campaign. See Sunday Mail;, June 27, 1993. Meanwhile, the Eastern Sydney Area Health Service has conducted a survey which reportedly reveals that 75 percent of suburban restaurants have considered or alreadyintrod'uced nonsmoking,areas. Fifty percent of those responding to the survey apparently indicated that they favored legislation to ban smoking com- pletely. See Sydney Morning Hera,ld June 26, 11993. [49]I Health Unit to Publish Pamphlet on ETS and Asthma According to a press repon, the West Moreton Regional Health Promotion Uhit is seeking input from the public on a pamphlet, it will produce regarding the purported effects of ETS on, those suffering from asthma: The unit is apparently attempting to increase public awareness about the issue. See Queensland Times, July 1, 1993. CANADA [501 Smoking Restrictions Create Market for Reus- able Cigarettes Rothmans, Benson & Hedges, Inc. has reportedly introduced a brand of cigarettes that will permit smokers subject to smoking bans and restrictions to save partially smoked cigarettes for later resmoking. The packaging apparently contains storage tubes and snippets for trimming cigarette ends, and each cigarette has a twisting filter so that the second half of the cigarette will taste the same as the first. In Canada, smoking is prohibited in many public places. Such restrictions and the high price of cigarettes, due to heavy taxes, have evidently caused some 50 percent of smokers to put out their cigarettes and later resmoke them. See The Reuter Business Reportq June 21, 1993; The New York Times~ June 24, 11993. . UNITED KINGDOM [51] British Telecom Imposes Workplace Smoking Restrictions In July 1993, the second phase of British Telecom's smoking policy will reportedly be implemented. (

JULY 9, 1993 According to a press report, smoking will not be permitted during work hours, smoking rooms will only be available during meal and rest breaks, and smoking on the street outside company buildings will be discouraged'. See The Daily Trlcgraph, June 21, 1993. MEDIA COVERAGE CANADA [52J "Anti-Fragrance Lobby Seeks to Clear the Air," P. Orwen, The Toronto Star, June 22, 1993 This article highlights the case of a nurse who won a workers' compensation award for chemical hypersensi- tivity after she was allcgedly injured on the job when a coworker sprayed her with perfume. According to the author, the Workers' Compensation Board of Ontario has received about 20 chemical hypersensitivity claims since 1984. Steps taken by business proprietors and~ some local! governments in the United States to ban fragrances are discussed, and it is reported that San Francisco's plan to create aroma-free zones was scrapped after city officials met with members of the cosmetic and toiletry industries. The author asserts that the American with Disabilities Act "recognizes chemical sensitivity as a handicap," and daims that the Act was responsible for some restaurants and municipalities adopting perfume bans. 13.

JULY 9. 1993 APPENDIX A The numbers assigned to the following article summaries correspond with the numbers assigned4o the synopses of the articles in the text of this Report. LUNG CANCER ['19] "Recent Developments in the Epidemiologgof Lung Cancer," G.C. Kabat, Seminars in Surgical' Oncology 9: 73-79, 1993 "Lung cancer is currently the leading cause of cancer death in the United States and also the most common tumor worldivide. Changes in the distributiomof histologic types over the past two decades in the United States, as well as high rates of lung cancer inn certain subpopulations, require explanatiom While cigarette smoking and specific occupational exposures are firmly establlshed! as imponant risk factors for lung cancer, recent work provides evidence that other factorss may play a role either as independent risk factors or as modifiers of the effect of smoking. This paper~ reviews the epidemiology of lung cancer, with an emphasis on developments in the past decade." "In 198 11, two reports were published purporting to show that the nonsmoking wives of smoking husbands had a significantly increased risk of lung cancer relative to the nonsmoking wives of nonsmoking husbands. Since then over 30 studies of the issue of environmen- tal tobacco smoke (ETS) and lung cancer have ap- peared. A metanalysis [sic] carried out by the National Research Council in 11986 foundl that the summary relative risk for lung cancer of nonsmoking womenn whose husbands smoked, relative to nonsmokers, was 1.34' (95% confidence interval 1.184.53)." "Epidemiologic studies of passive smoking are confronted bya number of challenges: the rarity of lling cancer occurring in never-smokers; the greater dilution of ETS compared to smoke inhaled by the active smoker; the difficulty of obtaining accurate exposure information by means of self-reports; the lack' of a biological marker for long-term exposure; misclassification of smokers as nonsmokers; and' the possibility of confounding by other risk factors, including diet or, in places like China, exposure to cooking fumes. There is inconsistency among the existing studies as to the presence/absence of an association; the histologic types of lung cancer for A-1 which an association~ is observed; the sex in which an associating is observed; and the timing of exposure (i.e., childhood versus adulthood)." "In spite of these problems, given the chemical composition of ETS and what is known about the effects of active smoking, it is biologically plausible that heavy ETS exposure over long periods, and~perhaps particularly in those exposed in childhood, can increase the risk of lung cancer. The largest study to date of lung cancer in nonsmoking women [Fontham, et all]I, indicates that women whose husbands smoked had an increased relative risk for lung cancer (odds ratio = 1.3; 95%:confidence interval 1.0-1.7) and for adenocarcinoma (odds ratio = 1.5; 95% confidence interval 1i.1-2.0) after adjustment for socioeconomic variables. A significant trend' in the odds ratio for adenocarcinoma was seen with increasing number of pack-years of the husband's smoking, In the highest exposure group (> 80 pack-years) the odds ratio was 1.7 (95% con6dence interval 0.8-3.5)'. Other ETS exposures in adulthood (in the household, on the job, and in social settings), were also associated with increased risk of lung cancers but exposure in childhood was not."' "Two points emerge form this brief review of the epidemiology of lung cancer. First, although smoking, and secondarily occc~. ~tion, are major establlshed risk factors, other factors, including other environmental exposures and host susceptibility are likely to play a role either as independent riskfactors or synergistically with smoking or occupational exposure. As noted in the introduction, the occurrence of lung cancer in certain groups and recent changes in the distribution of histologic types represent a challenge to funher research." [20] "A Case-Control Study of Childhood and Adolescent Household Passive Smoking and the Risk of Female Lung Cancer," Wang, F.L., Love, E:J., and Dai, X.D., Abstracts of the 1993 Annual Meeting of the Society for Epidemiologic Research, Keystone, Colorado, Abstract No. 301, 1993 "To evaluate the risk of female ]ling cancer from passive smoking (PS), a 1:1 matched case-control study was conducted in Harbin, China. One hundred and fourteen females with primary lung cancer, aged 30 to 69 years, and their hospital-based controls were interviewed using an standard questionnaire. The controls ?I =.~;z .

A-2 were patients without cancer, from the same hospital as the cases and' matched on age (± 5 years), residential area and lifetime smoking habits. Information on PS was collecte& by each residence for each of the following periods: 0-6, 7- 14, 15-22, 23-30 and 31-69 years.° "The risk of lung,cancer was increased for household exposure under the age of 14 years to maternal smoking (odds ratio, OR = 2.70, 95% CI = 1.49-4.88), but not for exposure to paternal smoking (OR = 1.40, 95 % CI = 0.79-2.50). The risk was highest in those exposed under the age of seven (OR = 3.46, 95% CI = 1.80- 6.65) and! was also significant at ages 7-14 (OR = 3.08, 95% CI = 1.62-5-57)1 and 15-22 (OR = 3.10,, 95% CIi = 1.52-6.3 1). The OR increased withithe amount of passive smoking. These findings suggest, that PS, particularly during childhood, increases the risk of female lung cancer and that the assessment of PS should be done by different periods of exposure." R,ESPIRATOP,Y DISEASES AND CONDITIONS - ADULTS [22] I"Passive Exposure to Tobacco Smoke and Respiratory Symptoms in Adults," P. Leuenberger, J. Schwartz, U. Ackermann- Liebrich, and Sapaldia Team, American Review of Respiratory Disease14T(4 Part 2); A368, 1993 "The association between passive exposure to tobacco smoke and respiratory symptoms was examined in a sample of 4193 never smoking adults. They constituted the never smoking subsample of a random sample of adults in eight areas in Switzerland: Information on passive smoking exposure an& standardized questions on respira- tory symptoms were obtained via a questionnaire adminis- tered by trained examiners. After controlling for age, sex, town, body mass and parental, [sic] and sibling asthma; passive smoking exposure was associated with an elevated risk of wheezing apart from colds (OR = 1.93, 95% CI = 1.40-2.65), an elevated risk of bronchitis symptoms (OR = 1.66, 95% CI = 1.29-2.12), an elevated risk of dyspnea (OR = 1.39, 95% CI = 1.16-U.66); and'art elevated risk of physician diagnosed asthma (OR = 1.31, 95% CI, = 0.99- 1.73), It was not associated4ith any increased risk of hayfever. When exposure to passive smoking was dassified into categories, the number of hours of passive smoking showed a more significant association with wheezing, dyspnea, bronchitis symptoms and asthma, and a gradient ETS/IAQ REPORT, ISSUE 51 of risk for wheezing, dyspnea and asthma by categories of hours etposed; after controlling for the covariates. Asthma and dyspnea also showed a gradient of risk with categories of number of smokers the subject was exposed to, and bronchitis symptoms showed a gradient of risk with categories of years of exposure. While recall' bias is always a potential problem in cross sectional studies such as this one, the gradient of responses with dose and the low level of publicity about potential effects of passive smoke exposure in Europe, suggest that there is a causal associa- tion between ~ passive smoking exposure and respiratory symptoms." [23] "Effect of 3 Hours Passive Smoke Exposure in the Evening on Airway TI one and Responsive- ness Until the Next Morning in Mild Asthmat- ics," D. Nowak, R. Jorres, A. Schmidt, and H. Magnussen, American Review ofRespiratory Disease 147(4 Part 2): A214, 1993 "Short-term exposure to environmental tobacco smoke (ETS)' is not necessarilyassociatedlwich immediate changes in airway tone and responsiveness. However, in~a subgroup of asthmatic patients, an increase of airway responsiveness several hours later was observed. To study the effect of ETS exposure in the evening on nocturnal ehanm of airway tone and responsiveness, 17 atopic asth,.,aticswere exposed'to either ambient air (Sham), or ETS for 3 hrs. [Seven] subjects had a positive history of ETS-induced upper respiratory symptoms." "[O]lur data suggest that in mild adult asthmatics, acute exposure to ETS in the evening may produce a small deterioration of airway tone and responsiveness during the night, albeit with large interindividual variabifiry in the response." RESPIRATORY DISEASES AND CONDITIONS - CHILDREN [24] "ABO Groups and Passive Smoking Exposure Influence Lung Function in Children and Adolescents," G.M. Corbo, F. Forastiere, N. Agabiti, R. Pistelli, V. Dell'Orco, P'. Angeloni, M.L. Aebischer, M. Purpura, CA. Perucci, and' G. Ciappi, American Review of Respiratory Disease 147(4 Parr 2)t A214, 1993 "Previous reports have suggested that in COPD, a smoking-related- disease, low lung function is not

JULY 9, 19933 equally distributed over the blood groups (A, B, AB, 0) and the Lewis system. As part of the second survey on respiratory health among children: and adolescents in Latium-Italy, we studied'the relationship between genetic markers (ABO groups, Lewis system, Kell system, Rh system)4 passive smoking and lung function....Those exposed to passive smoking had significantly lower FEVI/FVC% than unexposed. B carriers had higher FEVI7FEVC% than 0 carriers AB carriers had significant [sic] lower FVC and FEVi than O carriers; the effect was evident„however, only among AB carriers exposed to passive smoking in comparison with 0 carriers exposed to passive smoking. The deleterious effect of passive smoking on FEV1/FVC% was more evident among the Lewis system subgroup A+B-. No differences were found'regarding to [sic] the Kell system and the Rh system, also when passive smoking was considered The results suggest that lung function values are different in the blood groups and that the individual susceptibiliry to passive smoking may be related toA.BO groups and Lewis system," [25] "Middle Ear Diseases in Relation to Atopy and Nasal'Metachromatic Cells in Infanc}r," K. Irander, M.P. Borres, and B. Bjorksten, Interna- tional Journal of Pediatric Otorhinolaryngology 26: 1-9, 1993 "In this part of the study we have analysed the morbidity in respiratory tract infections and middle ear diseases in relation~ to atopy and metachromatic cell findings. We have also analysed to what extent the findings were modified by certain environmental [fac- tors]', e.g., exposure to tobacco smoke and animal dander." "Exposure to tobacco smoke was related to an increased number of respiratory tract infections. Thus, the mean number of episodes were 13.7 among the smoke exposed~ children and 9.4' episodes among non- exposed. Middle ear morbidity was not significantly Influenced [sic] by smoke exposure (data not shown):" "There was an increased tendency to develop allergy in the respiratory tract in infants exposed to tobacco smoke and to animal dander. Asthma was thus ob- served in 6 of the 23 children exposed! to animal dander (26%) and in 7 of the 41 non-exposed children (17%). Six of 16 ('37%)' children exposed to tobacco smoke suffered from allergic asthma, as compared with 7 of 48 non-exposed (15%). However, the differences A-3 between exposed and non-exposed groups did not reach statistical significance." "The incidence of atopic dermatitis was similar inn children exposed and not exposed to tobacco smoke or animal dander." "We observed a significantly increased number of episodes of acute middle ear infections, as well as an increased number of individuals suffering from pro- longed episodes of middle ear effusions in children who developed allergy in the respiratory tract. Atopic children with only skin manifestations did not differ in this respect from non-atopic children. There was also a relation between middle ear diseases and a family history of atopy." "In conclusion, the study shows that middle ear morbidity during the first 18 months of life is associ- ated with atopy, if manifestations occur in the respira- tory tract. There is also a relation between middle ear morbidity and presence of nasal metachromatic cells, and cell findings at 3 months of age were predictable [sic] of later middle ear infections. Passive exposure to tobacco smoke is related'to more infections in the respiratory tract and a tendency to asthma development." [26] "A Longitudinal Study of Parental Smoking and Children's Pulmonary Function from 6 to 18 Years," X. Wang, D. Wypij, D. Gold, D.W. Dockery, F.E. Speizer, J.H. Ware, and B.G. Ferris, American Review of Respiratory Disease 147(4 Pan 2)c A213, 1993 "The association between parental cigarette smoking and children's pulmonary function was investigated in. 8,794 non-smoking white children from the Harvard Six Cities Study, followed annually by questionnaire and spirometry. Exposure to maternal and paternal smoking was each divided into three components: exposure im the first 5 years of life, cumulative exposure ~ between age 6 and the year prior to each visit, and' r^,r maternal smoking reported at each visit....Models best ~ predicting pulmonary function level included' current ~ maternal smoking and exposure in the first 5 yr of life, r-~ but did not include cumulative exposure between age 6~,r and the year prior to each visit or paternal smoking.. co~ Adjusting for exposure in the first 5 yr of life, for each ~:J pack per day smoked, current maternal smoking was 'A associated with 0.36% reduction in FEV,, a 0.25W reduction in FEVIIFVC, and a 0.81% reduction im

A-4 FEF2s75% in children 6 to 10 yrs. The effects were similar and remained! significant in children 11-18 yrs. Adjusting for current maternal smoking, those exposed to maternal smoking in the first 5 years of life had significantly larger FVC, and smaller ratio of FEV,/ FVC and' FEF2s.75% than those not exposed. The effect of earlychildhood~ exposure appeared to be fixed at least up to 18 yrs. Significantly slower growth rates of FVC and FEV, were observed in relation to maternal current smoking in children 6-10 years, but not in older children. We conclude that among school age children, the decrement, in pulmonary function level associated with maternal smoking appear [sic] to be a combination of a fixed deficit related to earlier (includ- ing in utero) exposure and an additional deficit relate& to current exposure. To the degree that the effects of early passive smoking persist or accumulate throughout childhood, they may represent important predictors of development of COPD in adult life, particularly among those who take up personal cigarette smoking." [27]I "Analysis of Potential Confounding Variables in Epidemiologic Studies of Parental/Household Smoking and Respiratory Health in Preschool Children," P. Witorsch and R.J. Witorsch, Indoor Environment 2: 71-91, 1993 "In this analytical study, aspects of the design of 41 epidemiologic studies pertaining to the relationship between parental/household smoking and the preva- lence of respiratory symptoms and certain illnesses in preschool children (0-5 years old) were examined using a systematic protocol developed previously for a similar analysis of epidemiologic studies in school-age or older children. Wide variability was observed from study to study in the consideration of 21 predetermined potential confounding variables. While the socioeco- nomic status (SES), family health history, subject's personal health history, family size, age and gender were considered in 50% or more of the studies, indoor pollution (other than gas stove usage), day care use, animal exposures, stress, dampness/cold, season, occupational exposures, nutritional status of the subject, and maternal smoking during pregnancy were considered infrequently (in<25% of thestudies)'or not at all. A wide variation was also observed from study to study in the array of confounders considered. When evaluated on the basis of number of confounders considered per study, only 3 of the 41 papers consid- ETS/IAQ REPORT, ISSUE 51 ered 10 or more of the 21 predetermined variables. The clinical endpoints, usually obtained from parental questionnaire responses, were validated by medical records or physical examination in only slightly more than 50% (21/41) of the relevant epidemiologic studies. Twelve of the 21 predetermined confounders were analyzed in detail. There was wide variation in and a lack of standardization of the criteria used as indices of SES; family and personal health history, and'. age. There was also marked variation among the studies in methods used, if any, to adjust for confound- ing variables. Several of the confounding variables that we looked at appeared to be consistentlyassociated with increased risk of respiratory illness in preschool children, induding familyand'personal health history, young age, male gender„day care use and'season. On the other hand, no consistent association was observed! for SES, artificial'i feeding, gas fuel use and ind'oor pollution, while equivocal! or uncertain data in this regard were obtained for dampness/eold and~ heating/ air-conditioning. While no consistent interactions between various confounders were observed„ the relationship between parental/household smoking and respiratory illness in preschool children appeared to vary inversely related to age. Before epidemiologic associations between parental smoking and respiratory health in preschool children can be concluded to reflect any effects of ETS on the respiratory system of these children, it will be necessary to more thoroughly and'. more consistently consider the role of a number of potential confounding variables, both individually and in combination. It will also be necessary, before reaching such conclusions, to control and/or adjust for these factors where appropriate, as well as to more consistently validate parental quest'-onnaire-base& clinical endpoints." "While a perfectly designed' epidemiologic study pertaining to the effects of parental/household smoking on respiratory illness and disease in~ preschool children may be difficult, if not impossible, to achieve, our analysis of the relevant studies in this area suggests the need for implementation of certain procedures in future studies. There is clearly a need for more consis- tent and comprehensive consideration of potential confounders. The potential confounders addressed should not only be those identified herein as having a strong influence on the respiratory system of preschool'i children but also those that appear to have little effect.

JULY'9; 1993 For example, while a variable such as SES may have little influence on the incidence of respiratory symp- toms and disease in children, it is also possible that the apparent lack of effect observed for SES could reflect the wide variation of criteria and lack of rigor used in its classification. Thus there appears to be a greater need'to standardize as well'as strengthem the criteria used for the identification of potential confounding variables in general'. Furthermore, those potential confounders that have received relatively little attention to date (particularly those that intuitively appear to be important„such as indoor pollution, day care use, animal exposures, nutritional status and maternal smoking during pregnancy) should be considered im future studies. Further analysis should also take intoo consid'eration the potential1 influence of selected combinations of variables as well as their interactions. Finally, in addition to consistent validation of clinical endpoints (which is lacking to date); future studiess should' consider a standardization of experimental design, the questionnaire employed, the method' of gathering information and statistical treatment of the data." OTHER CANCER [28] "Maternal Active and Passive Smoking During Pregnancy and'' t- :. Risk of Childhood Brain Tumor (BT)," G. Filippini, M. Farinotti, G. Lovicu, S. Preston-Martin, and P. Boyle,. Neurology43(4): A331' (680P), 1993 "Experimental evidence supports the hypothesis of an association between childhood BT and in utero exposure to tobacco-specific carcinogens, i.e., nitrosamines." "Parents' smoking during pregnancy and mothers' exposure to smoking by others in the home or at the workplace were examined using data from a case- control study of incidence of childhood BT (912 casess and 321 population controls matched to cases by age, sex, and geographic area) conducted in northern Italy from 1985 to 1988." "Mothers' smoking during pregnancy was associated' with an increased risk (RR = 1.8„95% CI 0.8-3_9). Among nonsmoker mothers, the risk for lighter passive-smoke exposure (2 or less hours per day) and for heavier passive exposure (more than 2 hours per day) was 1.8' (95% CI 0.8-3:8) and 2.4 (95% CI 1.2- 4.7) respectively, suggesting a dose-response gradient." A-5 "The results suggest that maternal active and passive smoking during pregnancy increases the risk for chi]dhood BT. Several studies have found associations of prenatal exposure to passive smoking and childhood cancer. Further study of these associations is warranted, given~ the high prevalence of fetal exposure to cigarette smoke." ETS ExPosuRE AND~ IvfoNITORING [29] "Ninety-Day Inhalation Study in Rats,Using Aged and Diluted Sidestream Smoke from a Reference Cigarette: DNA Adducts and Alveo- lar Macrophage Cytogenetics," C,K. Lee, B.G. Brown, E.A. Reed, C.R.E. Coggins, D.J. Doolittle, and A.W. Hayes, Fundamental and Applied Toxicology 20: 393-401, 1993 "In our previous study, rats were exposed! to ADSS as a surrogate for ETS for 14 consecutive days. No increase in DNA adducts was observed in animals exposed to ambient (0:1 mg/m3) and 10-fold exaggera- tions (1 mg/ml) of ETS. Adducts were increased in lung and heart but only at 10 mg/'m', the I00-fold exaggerated level of the ambient ETS concentration. Cytogenetic analysis in~pulrnonary alveolar macrophagess was completely negative at all''IADSS concentrations." "In the present study, we have significantly extended both the length of the ADSS exposure and the length of the post-exposure recovery period'. Rats were exposed to ADSS at concentrations of 0.1, 1.0, and 100 mg/'mJ for 90 days followed by 90 days of recovery. Two sensitive biological i markers for genotoxiciry, chromosomal aberrations in pulmonary alveolar macrophages (PAM) and DNA adduct formation in, major target and nontarget organs, were analyzed after 28'and 90 days and after the recovery period. The results of the 90-day study confirm the existence of a no-observed-effect-level (NOELYof at least 1.0 mg/m' for DNA add'ua formation and a NOEL of at least 10 mg/ m~ for the induction of chromosomaliabertation in PAMs even in the extended exposure duration of 90 days." "Exposure-related DNA adducts were not observed in any tissue in any of the animals exposed to 0.1 or 1.0 mg TPM/m3. However, increased levels of DNA adducts with diagonal radioactive zones were observed in lung, heart, and larynx DNA of animals exposed to the highest concentration of ADSS (10 mg TPM/m3)'.

A-6 Adduct analyses with varying amounts of DNA from lungs of mid- and high-exposure animals dearly indicate the dose-response for DNA adduct formation1 is nonlinear. The adduct levels were highest after 90 days of exposure and'~were significantly reduced in all target tissues 90days after cessationlof exposure. Chrocnosomal aberrations in alveolar macrophages were not elevated in any group after 28 or 90 1days of exposure." "In the present: study, ADSS was used as a surrogate for ETS and animals were exposed subchronically to three concentrations (0:1, 1.0, and 10'mg total panicu- l'ate matter (TPM)/mJ) of ADSS, representing ambi+- ent, 10-fold, and 100-fold exaggerated concentrations of the particulate matter normally found in indoor environments where smoking,is occurring. When the fact that tobacco smoke accounts for less than 50% of RSP in indoor air is considered, the ADSS concentra- tions in our study in reality represent 2-,20-, and 200,- fold exaggerations of field values. To evaluate the genotoxic effects of exposure, we chose two sensitive and relevant biomarkers of genotoxicity, chromosomal aberrations in pulmonary alveolar macrophages and DNR adducts in major internal organs as measured by the'ZP-postlabeling assay." "The 32P-postlabeling assay has the advantage of high sensitivity as well as not requiring knowledge of the chemical' id'entify of the adducts. Therefore, it is suitable for the study of molecular dosimetry of covalent DNA binding at low concentrations of complex mixtures such as ETS." "The discrete DNA adducts detected in the low- and medium-exposure groups were qualitatively and quantitatively similar to those observed in the sham group. Although the identity of these discrete adduct spots seen in all the tissue samples is unknown, they are also present in the high-exposure group:,..The discrete spots ... increased in their intensity in the high-exposure group, indicating that exposure to ADSS at above 10 mg TPM/m3 accelerated the preexisting DNA lesions in the rat tissues....Statistical' analysis of the...values confirmed that there were more total DNA adducts present in severaliorgans of the high-exposure group compared to those in the sham and low- and medium- exposure groups." . ETS/IAQ REPORT, ISSUE 51 (30] "Environmental Tobacco Smoke Exposure of Young Children as Assessed Using a Passive Diffusion Device for Nicotine," R. Williams, A. Collier, and J. Lewtas, Indoor Environment 2: 989-104,1993 "This paper reports the indoor and personal exposure levels to nicotine for a population of 42 infants and' children under the age of 3 years in 34 homes, using,a light-weight passive diffusion sampler. The children were selected on the basis of age, sex and race in order to studytlie uptake, metabolism and excretion of nicotine and its metabolites (to be reported elsewhere)."' "Indoor airnicotine concentrations in the homes of young clWdren (ages 1-3 years) were monitored for 48 h as part of a study to assess uptake, metabolism and urinary excretion of nicotine and its metabolites, including cotinine. Cotinine has been used as a biological marker for personal exposure to env'uonmental tobaecosmoke (ETS)~ The evaluation of the utility of cotinine as a biomarker of exposure to ETS depends upon an~accurate measure of the nicotine exposure. Personal exposure to nicotine was monitored using a passive diffusion monitor worn by the children. Identical-type stationary monitors were also placed in each home to measure indoor nicotine for comparison to personal monitors. Home and personal monitoring were conducted for a: 48-hour period! proceed- ing admittance of the children into a hospital clinical unit where smoking was prohibited. Personal monitors were also utilized to determine personal exposure to nicotine in the clinical unit. A total of 42 children and 34 homes were successfully monitored for airborne nicotine. Personal exposure ranged up to 47 ug/m3 with ~ an~ arithmetic mean of 6.43 ug/m3., In this population, 68% of the children were exposed to <5.0 ug/m3'nicotine in~the home. Higher exposures (5-25 ug/m3) were observed in 24% of the children. Indoor exposure in the home, measured by the stationary monitors, ranged up to 94 ug/ml with an arithmetic mean of 8.43 ugl'm'. The higher levels of nicotine found with the stationary monitors indicated that ETS exposure in the central family room of each residence was greater than~that observed when mobility (personal monitoring) was a factor. The passive difiFusion monitors were easy to use and, combined with capillary gas chroma- tography with nitrogen-specific detection, allowed for nicotine detection limits as lbw as 0:025 ug/tn':." "Although the sample size in this study may be too small to draw definite condusions on the effect of race and sex

JULY 9, 1993 on exposure to nicotine, the overall study was designed to examine the relationship between race and sex on nicotine and~cotinine metabolism. In this selected population, some differences in personal nicotine exposure by race and sex were observedl Black males and females were exposed to 3.61 and6.85 ug/m' nicotine (arithmetic means), respectively, as compared to white males and females (3.57' and 13.24 ug/m3). The higher mean observed for white females was greatly influenced by the nicotine exposures found in two homes." "The combination of a small, inexpensive personal monitor with a sensitive, specific gas chromatographic analysis allowed for the near, unobtrusive sampling of an extremely young age group (birth~ to 3 years). A sampling success rate of 95% was observed (42 of 44 respondents)....Nicotine was detected in low concen- trations (0.025 ugJm3 clinic, 0.05 ug/m3 home), which wi11 allow for future correlation with cotinine half-life and elimination in urine for these subjects." INDOOR AIR QUALITY [31] "Indoor Air Pollution from Combustion Sources in Developing Countries," G.B. Leslie and V. Haraprasad, Indoor Environment 2: 4-13, 1993 "People living in the affluent nations of Western Europe, North~America and' Japan tend to have a radically different set of priorities regarding indoor air pollution compared to people living,in the developingg countries of Africa, South and Central America and Asia. Affluent nations pay a great deal of attention to the problems of air-conditioned~ buildings, emissions from~building materials, fabrics, furnishings, aerosol sprays, rad'on and environmentali tobacco smoke and try to minimise pollution from vehicular exhausts. In economic terms their biggest problem is upper respira- tory tract disease. It is easy to forget that most of the population of the world has a totally different perspec- tive since they have a totally different set of problems." "In the tropical countries of the developing world most people cannot afford air-conditioning and rely on natural ventilation via open windows and doors. This means that their indoor air is similar to their outdoor air much of the time. In urban areas the outdoor air contaminated by road traffic and from poorly con- trolled industrial pollution provides the indoor air for most of the population." A-7 "In colder climates the urban outdoor air is also often contaminated by the smoke from domestic coal heating. Often the coal is of poor quality and very smoky." "Combustion sources in developing countries range from open fires and cooking stoves to incense burning and tobacco smoking. A wide variety of fuel is burnt in many different ways in such combustion sources. The most common ones are biomass fuels, coal, kerosene and' liquefied petroleum gas. These fuels burnt in poorly ventilated or unventilated situations indoors are the most important sources of air pollution for most of the world's population." "In developing countries,, nearly 30% of urban house- holds and 90% of rural households cook with biomass fuels. Several hundred million people also use biomass fuels for part of the year to warm their homes." "Frequently the fuell is burnt on the earthen floor of an unventilated hut or in an oven with no ventilation system." "This way of burning fuel can be very inefficient, and venting to the exterior may be minimal. Vast quantities of toxic fumes and smoke fill the dwelling, and there is much wastage of scarce fuel resources." "The health consequences of using biomass fuels for cooking and heating have been scarcely studied. Since cooking typically takes 6-8 h of a housewife's time every d'ay, it a major source of exposure to pollutants." "Burning of all primary biomass fuels and many secondary fuels produces a wide range of known~ or suspected animal or human carcinogens." "[M]any cultures burn coal in their homes without any chimney or other ventilation. In some parts of China and' Northern Asia, coal is burned in stoves without chimneys or is burned in a pit in the floor in the centre of the unventilated room. The whole house is often full of smoke throughout the winter months." "Kerosene is burnt in a variety of combustion devices such as pressure stoves, wick stoves and wick lamps.__.When used in wick lamps for illumination indoors, kerosene produces much soot and CO."' "In Korea also, supplementary heating of houses inn winter is often provided by kerosene stoves in unventilated rooms. Thcemissions from kerosene stoves are as harmfiil as those from biomass-burning

A-8 stoves, comprising NO., particulate matter, SO2, CO,, HCHO and carcinogenic hydrocarbons." "Other miscellaneous combustion sources that contribute to indoor air pollution in developing countries include incense burning, tobacco smoking or burning of mosquito-repellent coils and pads. Emis- sions from cooking materials can also be classified as combustion related'. It has been shown that using rapeseed oil for frying is associated with a higher incidence of respiratory disease." "It is necessary to put the problems, real and imagi- nary, of affluent people in developed' countries into perspective. The problems of plenty are relatively trivial compared with the problems of poverty; yet most international conferences on indoor air pollution focus almost exclttsively on the problems of the affluent, working in air-conditioned buildings and living in centrally heated houses. In contrast, in developing countries, where a myriad variety of materials are burnt in many ways, often without ventilation,,the situation is quite different. There are countries where culture and traditions exert a stronger influence on life-style than science and technology and~ situations where people have no other, option but to choose between vehicular exhausts and kitchen emissions. Moreover, it is beyond the means of most people in developing countries to adopt expensive control technologies too keep harmful pollutants at bay." [32) "Airborne Carcinogens," J. Lewtas, Pharmarol ogy & Toxicology72(Suppl. 1): S55-S63, 1993 "Air pollution has been recognized as a cancer risk for many years. More than 2,800 different chemicals have been identified' in the air or emission sources. Only about 10% of these chemicals have been evaluated in bioassays for genetic or carcinogenic effects. Hydrocar- bons, nitrogen-containing organics, and halogenated organics account for nearly60°/u of the airborne chemicals that have been studied in long term animal cancer bioassays or short-term genetic bioassays. The sources that emit the highest number of these poten- tially carcinogenic chemicals are sources involving combustion (e.g., tobacco smoke, automobile exhaust, and coal combustion)L Quantitative estimates of the risk of airborne carcinogens in outdoor air consistently show that polycyclic organic matter (POM) from products of incomplete combustion (PICs)~make [sic] ETS/IAQ REPORT, ISSUE 51 the largest single contribution to human cancer risk. Although the POM emissions from various air pollution sources are chemically similar and induce cancer by a similar genotoxic mechanism, the cancer risk per unit of exposure of these emissions may vary by several l orders of magnitude. Among these combustion sources motor vehicle emissions account for the greatest cancer risk in outdoor air. Environmental tobacco smoke (ETS) and radon are the major sources of cancer risk from indoor exposures. There are, however, many uncertainties in identifying the important airborne carcinogens and quantitating the human cancer risk of air pollution. One important uncertainty is the role of atmospheric transfor- mation products in human cancer." "Environmental tobacco smoke (ETS) from sidestream cigarette smoke, is the largest source of elevated human exposures to carcinogenic particles and gases in indoor environments. I'n addition to the evidence that ETS as a mixture is carcinogenic to humans, ETS contains relatively high concentrations of chemicals for which there is sufficient evidence of carcinogenicity in animals including polynuclear aromatic hydrocarbons, N-nitrosamines, benzene, formaldehyde, and 11,3 butadiene." "Experimental' studies in animals and short-term, bioassays provide much of the evidence that certain indoor and outdoor air pollutants are carcinogenic. Of the nearly 3,000 chemicals identified as air pollutants, only 110% have been studied in experimental bioassays. Many of the chemicals or mixtures that are carcino- genic to humans also induce tumors in animals and are genotoxic in short-term bioassays. There are many more air pollutants that have been shown, to be carci- nogenic in animals for which no adequate human data are available. In some cases human data for the indi- vidual chemicals may never be obtained since humanss are only exposed to mixtures of these chemicals (e.g., PAH). In the absence of such human data, it is advis- able to regard these air pollutants as presenting a carcinogenic risk to humans. There are many more air pollutants that have only been evaluated in short-term bioassays. The prediction of cancer risk based on only positive short term tests is less certain, however in~the absence of other data, it would be advisable to avoid excessive and prolonged exposure to such agents." "Of all the air pollutants studied in humans and experimental systems, the greatest human exposure and

JULY 9, 1993 risk appears to be associated with mixtures of polycy- clic aromatic compounds, particularly those derived from incomplete combustion. The sources of greatest concern in indoor air are tobacco smoke, radon, certain building materials containing asbestos and formalde- hyde, and unventedspace heaters or cooking stoves. The sources of greatest concern in urban areas are usually the area sources such as moror vehicles and residential heating due to the high human exposure resulting from their proximity to population centers. In certain industrial areas, however, coke ovens, alumi- num smelters, iron and steel foundries, chemical plants, power plants and other industrial sources have been shown to emit significant quantities of carcino- genic agents into the air." [33] "Health Effects from Adverse Indoor Air Qual- ityy: An Ewllt>,tive Approach iJsing Toxicologi- cal Principles," M.). Reasor and M.R. Mont- gomery, Indoor Environmenr2: 118-121, 1993 "The present paper presents a scientific approach based on toxicologicaliprinciples for, examining one aspect of the sick building,problem - the role of chemicals in producing undesired health effects. AS in any other scientific question of causation, a dispassion- ate, objective approach should be taken to address the validity of a proposed relationship between chemical exposures and clinical complaints. The approach presented here should be applicable to the problem of evaluating chemical toxicity in indoor environments as well as other circumstances of reported chemical exposure/res ultant inj ury." "While it is true that each~case of potential chemical toxicity may have multiple unique features (such as type of chemicals involved, concentration of chemicals, duration of exposure, susceptibiliry of the individual) certain~ common dements maybe considered. Among these is temporality, do the symptoms appear after the exposure?" "When temporality is appropriate, it is imperative to compare the toxicological properties of the chemical(s) in question with the reported toxicities." "If the chemical(s) have the appropriate toxicological properties, quantitative consideration of the total dose received during the individual's residence in the environment must be carefully evaluated. Was the dose (singly or combined) ~ realistically high enough to produce health effects?"' A-9 "Appreciation and application of this basic tenet of toxicology, the dose-response relationship, are neces- sary when objectively evaluating the potential of chemically mediated adverse health effects." "Finally, the possibility of alternate causes for health problems must be investigated carefully. Individuals are exposed daily to chemicals and pathogenic organisms, may be taking prescription and nonprescription drugs,, may suffer from physiological and psychological stresss or may have preexisting medical problems." "Several chemically mediated toxicities are ap- proached differently from those discussed above. Allergic ('or sensitization) reactions may occur with exposurexo very small quantities of chemicals that would be ineffective in an unsensitized individual." "Adverse responses that are due to genetic determinantss are called idiosyncratic reactions and may occur with exposure to otherwise nontoxic dose of chemicals." "Injury alleged from exposure to chemical mixtures, rather than individual chemicals, is perhaps the most difficult to evaluate and, unfortunately, may be the most commonly encountered in indoor environments....There is no uniformly accepted toxico- logical approach to addressing chemical mixtures." "Once all the toxicological factors have been consid', ered in an individual case involving proposed toxicity resulting from adverse indoor air quality, a decision must be made on the strength of a causal association between the chemical(s) present in the exposure an& the adverse health condition that is claimed to be related. The ramifications of that decision may go welll beyond the individual's health care and may cause a significant financial impact on the business or industry concerned. Therefore, onlywell'-founded, objective reasoning based on sound scientific principles should be used. Importantly, opinions based on exclusion should be avoided." [34] "Airbome Endotoxin and Sick Building Syn- drome," KB. Teeuw, C.M.J.E. Vandenbroucke- Grauls, and J. Verhoef, Pediatric Research 33(4 Part 2): 420A, 1993 "Previous studies on the etiology of Sick Building Syndrome have been contradictory. We correlated physical and chemical factors, number of airborne microorganisms, and concentrations of airborne

A-10 ETS/IAQ REPORT, ISSUE 51' endotoxin with~Sick Building Syndrome symptoms in mechanically-ventilated office buildings with low and high prevalence of these symptoms. A cross-sectional' survey of building-rel4ted symptoms was conducted in 19 Dutch governmental office buildings through a questionnaire mailed'to 2052 office workers. Twelve buildings were mechanically ventilated, seven naturally ventilated buildings were included for comparison, In the same buildings, environmental and biological' measurements were performed. Based on symptom prevalence, mechanically ventilated buildings were grouped as 'healthy' or `sick'..._The concentration of airborne endotoxin was six- to seven,fold higher in the 'sick' buildings group....INo differences in physical characteristics (temperature, humidity, amount of light and noise) were found. Volatile organic compounds and COZ concentrations were higher in naturally ventilated buildings. More positive small air ions were found in 'sick' buildings, but the concentration was within normal ranges." "These findings suggest a role for airborne endotoxin in the causation of Sick Building Syndrome." . 4~$5.q:

290 (Vol'. 1. No. 17) BNA CALIFORNIA-SAFETY & HEALTH REPORT COMPARISON OF AB 13 AND AB 996 COVERAGE AB 13 AB 996* Enclosed workplaces Outrighnban. Partial ban. Exempts workplaces with 15 or fewer full-time employees. Allows smoking in lecture rooms, private offices, and conference rooms iflspecified ventilation standard is met.'• Employee cafeteria Covered by ban. Smoking allowed in area with up to 25 percent of seating if ventilation standard is met. Smoking lounges Not provided for in bill. t+lllows designated smoking Jounges if they meet ventilationn standard. Restaurants Covered by ban. Partial ban. Exemption for those with 50 or fewer seats and for rooms being used for private functions. In larger restaurants, smoking sections with up to 30 percent of service area could be set up if it meets ventilation standard. Shopping ma11s„ Generally covere&by ban. Partial ban. No smoking in many enclbsed indoor facilities open ' other public ~ ucational facilities, retail to the public, including„theaters„ed meeting places service establishments, health spas, libraries, and'museums. Smoking permitted 'in ~ up to 25 percent of concourses and~ seating areas in indoor arenas, concourses of bowling alleys, and! public areas of office buildings, hotel5„motels, and shopping malls. Warehouses, other Covered by ban. Exempted from ban- industrial facilities ~ Hotels, motels Generally covered by ban. Partial ban. Exemption for guest rooms unless designated as Exemption for guest rooms. nonsmoking rooms. Also exemptiomfor meeting and conference ~ rooms while being used for private functions_ Aiiports and ottler Covered by the ban, to the extent i ~ To the extent perrnitted~ by federal law, requires transportation i allbw•ed by federal law. ~ transportation companies such as Amtrak, passenger stage lines„and locally owned facilities i or operated airports to ban smoking in at least 75 percentof their waiting rooms. Smoking banned for people in line buying tickets. To ; extent allowed by federal law„would ban smoking on airplanes,. I Amtrak cars, passenger stagcs, public transit vehicles and vehicles operated by companies receiving state transit assistance. Residenual' Generally not covered'by ban: Exempted except when used as child care or health facility. businesses Other exemptions None. Would exempt from smoking ban gaming clubs, bingo parlors, Iprivate boxes in indoor sports arenas„and indoor areas of arenas being used for animal or automotive events. Allows smoking in company vehicles with consent of everyone inside. - Pre-empdon Would pre-empt all local ordinanccs , Would prohibit local governments from adopting new ordinances ' addressing workplace smoking t stricter than bill. Ordinances in effect by April, 1, 1993, wouldn unless amended to require less be affected~ than total workplace ban. Penalties Enforced by local law Does not say who would enforce smoking restrictions. Fine enforcement agencies, including structure same as in AB 13. health agencies, and potentially Cal/OSHA. Violator subjeco to $100 for first offense, $200 for second within a year,;500 for third and subsequent violations in one year. • AB 996 stresses employers would'retain right to ban smoking altogether if they want to, despite bill's provisions allowing workplace smoking,under some circumstances. '• The applicable standard is Standard 62-1989 of the American Society of Heating, Refrigeration, and Air-Conditioning Engineers. Source: California Legislature A BNA Graphic ISSUE 51 Copyright ® 1993 by The Bureau of National'Affairs.Jnc. 6-21-93 APPENDIX B 1065 3104/93yE0+SL00

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