Tobacco Documents Online

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 D.C: 46, 293 F.2d 1013 (1923), has been superseded by the Federal Rules of Evidence.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based'their conclusion that Bendectin can cause birth~ defects on animal studies, chemical structure analyses and an unpublished"reanalysis" of previously pub- lished epidemiological studies.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