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SHOOK, I-IARDY&BACoN REPORT ON RECENIT'ETS AND IAQ DEVELOPMENTS August 6, 1993 tV ... ~ N A ~ ~ ~ SHB ~

REPORT ON RECENT ETS AND IAQ DEVELOPMENTS - IN THIS ISSUE - ;AF IN THE UNITED STATES REGULATORY AND LEGISLhTIVE IVIATTERS • Congressional activity on PRO-FEDS, Traficant and IAQAct of 1993 bills, p. 1. • Capitol Architect willldesignate house smoking site, p. 2. • ASH files another petition for emergency OSHA standard on ETS, p. 3. • Los Angeles smoking ban in restaurants takes effect after petition drive dismissed; drive organizers sue, p. 4. ETS-RELATED LITIGATION!AGAINST CIGARETTE IVIANUFACTURERS. • Latest activity in Butler and' Dunn, p. 5 ETS/IAQ LITIGATIONI NOT INVOLVING CIGARETTE MANUFACTURERS. • Frank Voth loses bid to sue prison officials, p. 6: • Two child custody decisions, Montufar and Shumaker, p. 6. LEGAL ISSUES AND DEVELOPMENTS. "The Call for State Legislation on Environ- mental Tobacco Smoke in State Prisons," p. 8~. • "Dangerous Products and Injured Bystand- ers," p. 8. SCIENTIFIC/TECHNICAL ITEMS LUNG CANCER' • "Exposure to Environmental Tobacco Smoke and Female Lung Cancer in Guaugzhou, China," p: 9.. ISSUE 53 • "Involuntary Smoking in the Restaurant Workplace," p. 10. INDOOR AIR QUALITY •"Big Air Quality Complainers - Are Their Off ce Environments Different from Workers with No Complaints?"' p. 11. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS • Australian Health and Police ministers approve new cigarette package warning on ETS, p: 11. • Canadian government gives final'approval on cigarette package warning on ETS,, p. 12.. • Dutch parliament refuses to enforce smok- ing,ban, p. 12. ETS/IAQ Litigation~ Not Involving Cigarette Manufacturers. • Burswood trial begins in Perth,,Australia,. p. 12. OTHER' DEVELOPMENTS/MEDIA COVERAGE OTHER DEVELOPMENTS/MEDIA COVERAGE • Hong Kong Council on Smoking and Health launches new antismoking cam- ~ ~ ~ • Smokers' rights group plans march on Washington, p. 8. • Popeyes chicken franchisee bans smoking, paign, p. 113. • United Kingdom pub rescinds smoking ban,, p. 13. ~ ~ p. 8. t1: • CNN broadcast discusses discrimination for ofI the-job activities, p..9. ~ ~

- TABLE OF CONTENTS - Issue 53 August 6, 1993 Q IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS 103D CONGRESS [1] SenateAttachcs PRO-FEDS Bill'toAppropriations Bill ...........................................................1 [2] Traficant Bill Faces Challenges ....... ......................................................................................... ........................,1 [3] IAQAcoof 1993 is Approved in Senate Committee ................................................................I [4] House Subcommittee Holds Hearing,Held on Airplane lAQ ..................................................2 [5] Risk Assessment is Subject of Congressional Hearing ................... ............................................ 2 [6] Architect to Designate Smoking Area in Rayburn Building .....................................................2 U.S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA)', [7] ASH Files New Petition For Emergency Temporary Standard on ETS .................................... 3 [8] ASH v. OSHA:,ASH! Responds to OSHA's Motion to Govern Further Proceedings ................3 [9] House Holds Hearing on OSHA Reform Legislation ..............................................................3 U.S: ENVIRONMENTAL PROTECTION AGENCY (EPA) [10] Occupational Physicians Endorse EPA Pamphlet on ETS ........................................................4 U.S. ARMED FORCES ~ [11] Navy Considers Smoking Bans ................................................................................................4 STATEAND LOCAL GOVERNMENTS [12] ETS-Relatcd State and: Local'L.egislation ..................................................................................4 ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [13] Butler.• Discovery Continues .................................................................................................... ,5 [14] Dunn: Defendants' Responses to the Complaint Due .............................................................. 5 ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS PRISON EXPOSURE CASES [15] Jensen v. Gunter, 1992 U.S. Dist. LEXIS 21603 (U.S. District Court, Nebraska): (decided June 11, 1992) .................................................................................................... ......6 RE,SIDENTIAL EXPOSURE - CHILD CUSTODY [16] Montufar v.,Navror(Superior Court, Camden, New Jersey) (decided July 22, 11993) ...............6 [17] Shumaker v. Andrews, 1992 Del. Ch. LEXIS 316 (Family Court, New Castle„Delaware) (decided December 3, 1992) .......................................................................................°........... 6 WORKPLACE: WORKERS'COMPENSATION CLAIM~ [18] Employer: Eisner Levy Pollack etc., 1993 WL 265224 (New York Workers' Compensation Board)' (decidcd'Junc 19, 1993) .......................................................................7 WORKI'LACE:.HANDICAP DISCRIMINATION;. BATTERY,.EMOTIONAL D'ISTRESS [19] Richardson v. Hennly, First Federal Savings and Loan Association v. Richardion,. A93A0680 & A93A0807 (Court of Appeals, Georgia) (decided July 15, 1993) ' .......................7 CIVIL RIGHTSVI~OLATIONS [201 Brown v. Costello, 1993 U.S_ Dist. LEXIS 10104 (U.S. District Court,. Northern District, New York) (decided July 15, 1993) ...........•...----.••••-••--•-------------••••••••-•.•-----7 CRIMINAL BATTERY [21i] I Smoker Charged with Battery after Disagreement with Hotel Clerk ........................................ 8' LEGAL ISSUES AND DEVELOPMENTS [22] 1 [23]1 "The Call for State Legislation on Environmental Tobacco Smoke in State Prisons," L.M. Galbraith-Wilson, 13 Hamline Journal ofPublic Law and Poliry:335 (1992)! ................... 8 "Dangerous Products and Injured Bystanders," R.F. Cochran+ Jr.,,Kentucky Law fournal, 81r 687-725 (1992-93) .................................................................................................... .............. 8 OTHER DEVELOPMENTS [24] Smokers' Rights Group Plans:March on Washingcon ..................... ......................................... [25] Health Service Releases Job Injury Survey ................................................................................8 [26] Fast Food Franchisee Adopts Smoking Ban .............................................................................8 [27] Smoking Bans Extend to Apartment Buildings ...............................................................•••••.•••9 [28] Mall Manager to ImplemennSmoking Bans atAll'Properties ........................................••••-••••••9 [29] A New Indoor Air Diagnostic Too]: Mold-Sniffing Dogs .............................................•.•••••••.•9

Contents Continued, Issue 53 MEDIA COVERAGE [30] "Second-Hand Scienee„"'Editorial, National Review; July 19, 1993 ......................................... 9 [31] CNN Broadcast Explores Discrimination for Ofl=the-Job Activities ........................................9 SCIENTIFIC/TECHNICAI'. ITEMS LUNG CANCER [32] "Exposure to Environmental Tobacco Smoke and Female Lung Cancer in Guangzhoui China," Y:X. Du„Q.,Cha, Y.Z. Chen, and J.M. Wu, Proceedings oflndoorAir'93 1: 511-516::1993' [See Appendix A] .......................................................................................... 9 [33] "Involuntary Smoking in the Restaurant Workplace: A Review of Employee Exposure and HealchEffeets," M. Siegel,Journalofth'eAmericanMedualAssociation - 270(4)t 490-493, 1993 [SeeR:ppendixA] ................................................................................10 RESPIRATORY DISEASES AND COND3TIONS-CHILDREN' [34] "Race and Gender Differences in Respiratorydllness Prevalence and Their Relhtionship to Environmental Exposures in Children 7 to 14 Years oFAgc," D.R. Gold, A. Romitzky, A.II Damokoshj J.H. Ware, F.E. Speizer, B.G. Ferris, and'D.W: Dockery,. American Review ofRespiratoryDisease 148: 10-18, 11993 [See Appendix A] ............................... 10 ETS EXPOSUREAND MONITORING [35] "Hair Analysis as a Marker for Fetal Exposure to Maternal Smoking," J. Klein, D. Chitayat, and G. Koren, New England Journal ofMedicine 328(1): 66-67, 1993. [See Appendix A] .................................................................................................... ................ 10 [36] "Determination ofAirbome Cadmium in Environmental Tobacco Smoke by Instrumental! Neutron Activation Analysis with a Compton Suppression System," S. Landsberger, S. Larson, and D. Wu, A'nalyticalChemistry65: 1506-1509; 1993 [See Appendix A] ................. 110[371 "Estimated'Reduction in Exposure to Environmental Tobacco Smoke Through Removing Smoking in the Workplace," A. Raynal„P.S.:Burgc, A. Robertson, M. Jarvis, M. Archibald, and D. Hawkina Proceedings oflndoorAir'93 1: 639-643, 1993 [See Appendix A] .................... 10 INDOOR AIR QUALITY [38] "Effectiveness of Ventilation and Ocher Controls in Reducing Exposure to ETS in Office Buildings," S.B. Hayward, K.-S. Liu„L. Alevantis„K. Shah;,S. Loiselle,F.J. Offermann, Y.-L. Chang; and L. Webber, Proceedings ofYndoorAir'93 5: 509-514 [See Appendix A] ........... 10: [391 '°Legionnaires' Discase: The Infective Dose Paradox," S;J. O'Brien and R.S. BhopaL The Lancet342: 5-6, 1993 [See Appendix A] ..........................................................................• 11 [40] "Big Air Quality Complainers -Are Their~Office Environments Different from Workers with No Complaints?" R.M. Tamblyn, R.I. Menzia, F. Ntines, J. Leduc, J. Paszcor, and R.T. Tamblyn, Proceedings oflndoor Air'93 1: 133-138, ,1993' [See Appendix A] I ...................... 1 it [41i], "Sensitization to Domestic Mites in a Cold Temperate Region,"' M. Wickman, S.L. Nord'vall, G. Pershagen, Jl Korsgaard, andlN. Johansens American Review of Respiratory Disease 148: 58-62, 1993'[See Appendix A] ............................................................. III STATISTICS AND RISKASSESSMENT [42] 1 "Tobacco Industry Response to a Risk Assessment of Environmental Tobacco Smoke," L.A. Bero and S.A. Glantz, Tobacco Control2: 103-1 13, 1993 [See Appendix A] ...................... Ill IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AUSTRALIA ........... 1 i 1 [43] Ministers Meet and'Approve New Cigarette Package Warnings .................................. [44] Health Minister Wants Phase-in of Smoking,Bans ................................................................ 1l1 CANADA [I45] New Package Warnings to Indude ETS Health Effects Claims ............................................. 12 [46] Critics Say Restaurant Smoking Ban Will Threaten Jobs ....................................................... 12' NET1iER1wNDs [I47] Parliameno Refuses to Enforce Smoking,Bans ........................................................................12 TAIWAI+1 [481 PrisomSmoking,Ban Repealed ...............................................................................................,12

Contents Continued, Issue 53 ETS/L1Q LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS AUSTRAL.IA [49] Departmrnt ofOccupational Health andSafrty v. Burrwood ReJorr (ttifianagement) Ltd. (Magistrate's Court, Perth) (filed December 1992) .................................. 12 [50] Mother Ordered not to Smoke in Front of Children ............................................................. 13 LEGAL ISSUES AND DEVELOPMENTS AUSTRA[SA [51] Asthma Foundation Director Calls for Smoking Prohibitions ................................................ 13' OTHER DEVELOPMENTS CANADA [52j National Arts Centre Bans Smoking ...................................................................................... 13 HONG KONG [53] New Antismoking Campaign Launched ................................................................................13 UNITED KINGDOM [54] Smoking Ban Rescinded Afrer Business Slump ...................................................................... . 13 WORLD AIRLINE NgWS~ [55] Canada .................................................................................................... ..............................13 MEDIA COVERAGE AUSTRALIA . [5G] "When~the Censors Become Dictators," D. Hampson, Sunday Heralr[-Sum August 1, 1993 .............................................................. ........................................................ 14 APPENDIX A .................................................................................................... .................................Article Summaries

AUGUST 6, 1993 1 REPORT ON RECENT ETS AND IAQ DEVELO!PMENTS IN THE UN!ITED STATES REGULATORY AND LEGISLATIVE: IvfATTERS 103D CONGRESS [1] Senate Attaches PRO-FEDS Bill to Appropria- tions Bill On August 3, 1993, the Senate voted to add Senator Frank Lautenberg's (D-N.J.) "PRO-FEDS" (S. 262)) legislation as an amendment to the Treasury, Post Office andl Generali Government Appropriations Billi (H.R. 2403): The Senate has not yet voted on H.R. 2403 and was not expected to do so prior to adjourn, ing for its recess scheduled to begin August 6. The Congress is expected to reconvene on, September 9. The PRO-FEDS amendment, which is virtually- identical to the original bill, would restrict smoking to separately ventilated areas in, all federal buildings. The only provisions that, differ in the amendment are the addition of an exemption, for VA hospitals and the deletion of a section establishing an Environmental, Tobacco Smoke Advisory Office at EPA. For further details of the "PRO-FEDS" bill, see issue 40 of this Report, February 5; 1993. In 1992, Senator Lautenberg,was able to add! his PRO-KIDS legislation to the Labor-HHS-Education Appropriations billl The amendment was later dropped! during House and Senate negotiations. See issue 32 of this Report, October 9, 1992. [2] Traficant Bill Faces Challenges Several committees have reportedly asked that the bill introdueedi by Representative James Traficant (D- Ohio)~to ban smoking in federal buildings (H.R 881) be referred to them before it reaches the House floor. The measure was approved by the House Public Works Committee on June 17, 1993. See issue 50 of this Report, June 25, 1993. According to press reports,. Traficant recognizes that opponents of the bill are eager to land it in a hostile committee. Committees that have already expressed an interest in considering the bill indude Government Operations and Science, Space and Technology. See Congressional'Qunrterly! Weekly Report, July 17, 1993. Traficant has introduced extensions to the remarks section for the bill in the Congressional Record. Citing the EPA Risk Assessment on ETS in his remarks, he urged Congress to approve H.R 881 this year and' stated that officials from the Department of Labor testified during subcommittee hearings that the Federal Government has paid hundreds of thousands of dollars in workers'compensationdaims to nonsmoking employees who daimed they were disabled due to ETS exposure. See Congressional Record, ' E-1856 (Jluly 26, 1993). [3]I IAQAct of 1993 is Approved in Senate Committee The Indoor Air Quality Act of 1993 (S. 656); intro- duced by Senator George Mitchell (D-Me.) in March, was approved on July 30, 1993, by the Senate Environ- ment and Public Works Committee. The bill has not been assigned to any other committee; presumably, it will now go to the full Senate. For a discussion of the provi- sions of the bill as originally introd'uced, see issue 44 of this. Report, Apri12„ 1993. The bill that was approved contained an amendment introduced by Senators Mitchell, John Chaffee (R-RI.) and Joseph Lieberman (D-Conn.). The amendment would; among other matters, (i) darify the listing of indoor air contaminants and extend the time for listing from 240 days to 18' months after enactment; (ii) allow an additional six months for development of the first set of health advisories; (iii) require that any health ~ advisory be based on scientific information that has undergone peer review; (iv) delete the requirement for a new office of indoor air quality at EPA; and (v) delete the provision for the Council on Indoor Air Quality to report to Congress on the progress of indoor air quality programs. Although the bill does not provide any direct~ author- ity for EPA to regulate indoor air~ quality issues, it does

2 give the agency the authority to coordinate the develop- ment of a national' strategy for combating sick building syndrome and relatedi health complaints. Representative Joseph P. Kennedy II (D-Mass.) introduced companion House legislation in May 1993 (H.R. 1930). The House bill was referred to three House committees: Energy and Commerce; Science, Space and Technology; and Educa- tion and Labor. As of this writing, no hearings had been sclieduledi on H.R. 1930. See BNA Daily Labor Repom August 2, 1993. [4] I House Subcommittee Holds Hearing Held on Airplane IAQ On July 30; 1993, a House subcommittee conducted a hearing to consider whether reductions in fresh air supplies aboard! commerciallairliners are causing health problems„including,the spread of infectious diseases such as tuberculosis. A Uhited Airlines flight attendant who testified at the hearing said she has become more aware of air quality complaints since the 1990 bamon smoking on most domestic flights. She suggested that air quality complaints prior to the ban were disguised by the smoke. Federal'Aviation Officials and a representative of the Centers for Disease Control and Prevention testified that there is no evidence that air travel puts a person at a higher risk of contracting infectious diseases. According to Representative Tim Valentine ('D N.C.), the subcommittee chair, this investigation wass prompted by a report in The New York Times which said that airlines, to save money, are circulating less fresh air into the cabins of many airplanes. Newer aircraft~ reportedly provide half fresh air and half recirculated air that is freshened every six or sevenn minutes. Aircraft built before the mid-80's providedl cabins with 100 percent fresh air that was circulated every three minutes. Flight attendants and passengers reportedly testified during the hearing that they have suffered such prob- lems as nausea, dizziness, headaches and other ailments from breathing,the d'ry, pressurized, recirculated air in air cabins. Contaminants of concern to federal' investi- gators include high concentrations of ozone, carbon dioxide and microbiological aerosols and viruses. The hearing was before the House Subcommittee on Technology, Environment and Aviation. See The New York Times, July 26, 1993; Newsday, July 30, 1993. ETS/IAQ REPORT, ISSUE 53 [5] Risk Assessment is Subject of Congressional Hearing On July 28, 1993, a subcommittee of the House Science, Space and Technology Committee conducted a hearing on the role of risk assessment in the regula- tory process. Testifying at the hearing were representa- tives of public interest groups, including the Carnegie Commission on Science, Technology and Govern- ment, the Institute for Evaluating Health Risk and the Center for Media and Public Affairs. One of the witnesses referred to the EPA Risk Assessment on ETS and criticized the report for focusing too much on the accuracy of the number of estimated cancer cases. According to this witness, the major public health concern of the report should be the size of the population of infants and children allegedly at risk of respiratory disease. A witness for the Center for Media and Public Affairs noted that his organization recently analyzed scientific opinion vs: media coverage of environmental cancer risks and reported that some 59 percent of scientists believe the media accurately portrays the alleged cancer risk of tobacco and ETS, while 36 percent said that the media understates the purported risks. A witness for the Carnegie Commission discussed its recently released'report entitled "Risk and the Environ- ment: Improving Regulatory Decision Making,° in which the usefulness of risk analysis in setting a regulatory agenda was acknowledged. The report, however, called for the recognition of limitations on risk analysis im a democratic society. E. Donald' Elliott, a former EPA employee who was speaking for the Carnegie Commission„was critical of the current practice of communicating risk estimates as a worst case scenario and recommended that risk ranges be publicized instead to improve the legitimacy of risk assessments. [6] Architect to Designate Smoking Area in Rayburn Building According to a press report, the Architect of the Capitol is expected to designate a test site for smoking in the Rayburn Building, following the ban imposed om the House side of the Capitol by the Speaker in May 1993. See issue 47 of this Report,, May 14, 1993.. The House Building Commission reportedly decided i

AUGUST 6,1993 to analyze the demand for smoking sections by estab- lishing the Rayburn test site before spending money to construct separately-ventilated smoking sections in other House buildings. A reporter has evidently been told that staffers, since the ban took effect, have discovered numerous hiding places throughout the buildings where they can~smoke undetected. See Roll Calr; July 19, 1993. U.S. OCCUPATIONAL SAFETY AND HEALTH ADIvIINISTRATION (OSHA) . [7] ASH Files New Petition For Emergency Tempo- rary Standard on ETS On July 12, 1993, ASH filed a petition with OSHA demanding that the agency issue an emergency tempo- rary standard prohibiting smoking in all indoor workplaces. ASH points out in its petition that it last petitioned for an emergency temporary standard on ETS in 1987, and alleges that there is considerably more evidence now, including the EPA Risk Assess- menr on ETS, that ETS poses a "serious risk of cancer, heart disease, various respiratory illnesses and! other grave dangers to employees." ASH purports to link ETS exposure to lung cancer, cervicalI cancer, tumors of the brain, nasal sinus, breast, endocrine glands, and hematopoietic tissues, leukemia; lymphoma, and heart disease. The petition alleges that ETS causes 53,000 deaths eachiyear, making it the third major cause of all U.S. deaths. ASH acknowl- edges that many state and local governments andl private employers have banned smoking in the work- place, but argues "this piecemeal haphazard approach is totally unsatisfactory."' The petition also contains allegations that ventilation will not remove ETS from the workplace and that a total workplace smoking ban will be cost effective in the long run given purported savings from "health care cost containment, fire loss prevention, reduced legal costs and' even decreases inJanitorial costs." Attach- ments to the petition include the EPA report on ETS, a statement to ASH by then-candidate Bill Clintons ASH petitions to OSHA dated February 26, 1992, March 10, 1992, and July 31, 1992, and statements by former Secretary of Labor Lynn Martin and former EPA Administrator William Reilly. 3 [8]' ASH v. OSHA: ASH Responds to OSHA's Motion to Govern Further Proceedings On July 29, 1993, ASH filed a response in opposition to OSHA's request that the court continue to hold the case in abeyance. Characterizing OSHA's assertions that the Secretary of Labor has not determined whether or how to regulate ETS'in the workplace as "an insult to this Court," ASH demands that the court intervene to force OSHA to commence rulemaking on ETS. ASH observes that OSHA's request is actually a request for an indefinite stay and states in this regard that OSHAA has failed to discuss the factors set forth in General Rule 7(h) of the D.C. Circuit Court. ASH continues to cite the EPA risk assessment on ETS to support~ its claims about health risks to workers, and updates its allegations with references to the recent Congressional testimony of Administrator Carol Browner in defense of the EPA risk assessment, the Supreme Court decision in Helling v. McKinnry, 61 U.S.L.W. 4648 (U.S. 6/18/93), and a study appearing in the Journall of the American Medical Association regarding,the risk of lung cancer for waiters and bartenders exposed to ETS. ASH v: Department of f Labor, No. 92-1661 (U.S. Court of Appeals, D.C.. Circuit) (filed~ December 22, 1992.) > JAMA Study, item 33. [9] House Holds Hearing on OSHA Reform Legislation On July 29, 1993, the H'ouse Committee on Educa- tion and Labor: held a hearing on H.R. 1280, the Comprehensive Occupational Safety an& Health ReformAct. Those testifying included Thomas Donahue, secretary-treasure.r of the AFL-CIO, who reportedly told lawmakers that Congress should protect worker healtL and safety witL the same level of com- mitment that it devotes to preservation~of the environ- ment. Donahue urged the committee to approve the labor-backed OSHA reform legislation. Representatives of major employer associations, such as the National Association of Manufacturers (NAM), the Associated Builders and Contractors and the American Iron and Steel Institute, reportedly maintained their opposition ~ to the legislation as drafted, claiming it is too prescriptive to apply to diverse workplaces.

4 According to a former OSHA official who testified on behalf of NAM, the deficiencies in the reform legislation indude (i) provisions for standard setting which set time frames, mandate certain standards and allow OSHA to regulate chemical risks to a higher degree of worker protection; (ii) hazard abatement provisions whicL require immediate abatement of the most serious hazards; and (iii) criminalisanctions which subject CEOs and front-line supervisors to penalties absent any intent to injure. The July 29 hearing was the fourth of six that the committee plans to hold. See BNA Daily Labor Report, July 30, 1993. U.S. ENVIRONMENTAL PROTECTION AGENCY (ET?A) ~ [10] Occupational Physicians Endorse EPA Pamphlet on ETS The American College of Occupational and Environ- mental'Medicine (ACOEM), an organization of some 6,500 occupational and environmental' physicians, has reportedly endorsed the EPA's latest publication, What You Can D'o About Secondhand Smoke. ACOEM has apparently been~ urging federal agencies to regulate smoking im the workplace since the EPA released its Risk Assessment on ETS in January 1993. Specifically, ACOEM has reportedly asked OSHA to regulate ETS separately from other indoor air issues. See PR Newswire, July 23, 1993. U.S. ARMED FORCES. [I11] Navy Considers Smoking Bans The Navy's Surgeon General reportedly stated that creating a smoke-free Navy will take more than just ordering sailors to quit smoking. Speaking at a July 29, 1993, news conference, Vice Admiral Donald Hagen indicated that commanders have the authority to impose smoking bans on their ships. He acknowledged that total bans could create a black market for tobacco and may violate individual rights. Studies apparently indicate that some 42 percent of sailors smoke when the troops are at sea. According to Hagen, sm,oking, bans coupled with cessation programs and nicotine patches might reduce the number of smokers in the Navy. See The Arizona Republic, Jul{y 30, 1993. ETS/IAQ REPORT, ISSUE 53 STATE AND LOCAL GOVERNMENTS [12] ETS-Related State and Local Legislation •Los Angeles, California Opponents of a Los Angeles ordinance banning smoking im restaurants gathered enough signatures to force a citywide referendum and prevent the measure from taking effect as scheduled on July 26, 1993, but election officials later dismissed the petition drive after reviewing the validity of a random sample of signa- tures, and the measure took effect August 2. The next day, a coalition of restaurants and smokers reportedly sued the City Clerk, charging she improperly invali- dated the petitions. The ban,,which applies to some 7,000 ~ restaurants, was adopted June 23 by the City Council and signed by then-Mayor Tom~ Bradley. It exempts bars, nightclubs and outside dining areas only. Proponents of the measure support it by citing the EPA Risk Assessment on ETS and other reports. Opponents of the ordinance say it will cause tourists and local patrons to dine in nearby cities with more lenient smoking laws. About 96,000 signatures opposing the ban - almost twice the number needed to force a referendum - were presented to the city on July 24. The petitions were dismissed on August 2; and the ban took effect immediately. Election officials reported that they randomly sampled 4',878'signatures. Of that total, the number of valid signatures was placed at 2,082. A total of 2,624 valid signatures was needed to require a review of all signatures. But an attorney for the Hospitality Coalition, a group of restaurants and hotels, claims that nearly 1,200 signatures were wrongly invalidated, according,to aa newswire report. "We never dreamed the clerk would do something like this," the attorney was quoted as saying. "Our position is that people cannot have their signatures summarily dismissed because of errorss committed by the guy carrying the clipboard."' The battle over the ordinance has attracted national attention. This summary is based on reports from the LosAngelxs Times, National Public Radio, United Press Internationa4 The Associated Press, The Washington Post, CNNand CBS.' The reports are dated between July 21 and August 3, 1993.

AUGUST 6, 1993 In its coverage of the ordinance, the Los Angeles Times reported! that of the 56 cities and'counties across the nation that have banned smoking in restaurants, 49: of them are in California: •ather Local Governments in California San Francisco Supervisor Angela Alioto has made a proposal! to ban smoking in all workplaces, including restaurants, and at Candlestick Park. There has not been any published report of council!activity on the proposal~ since it was announced on July 19, 1993. See The San Francisco Chronicle, July 20, 1993. Meanwhile, a number of communities near Los Angeles have joined that~ city in banning smoking in restaurants and other public places. Long Beach The Long Beach City Council gave final approval'on July 28, 1993, to an ordinance banning smoking in restaurants and requiring that two-thirds of the seating in~ bars and outdoor eating areas be reserved for nonsmokers. It also makes cafeterias, bowling alleys, bingo parlors, hair salons, hotel lobbies and other public places smoke free. See LosAngeles Times, July 29; 1993. Pasadena. On July 27, by a vote of 4-2, the Pasadena City Council approved an ordinance banning smoking in restaurants. The law could go into effect as early as mid-September. Bars attached to restaurants will have a year to phase in the ban. The two councilmenwho voted against the measure have accused their colleagues of violating,the state's open-meetings law in approving the ordinance, but apparently no~formal'.challenge has been made. Press reports indicated that the release of the EPA Risk Assessment on ETS aid'ed~the passage of the law. See Los Angeles Times, July 28 and 29, 1993. Thousand Oaks and Calabasas. The Thousand Oaks City Councilihas directed''staff to draft a law that would prohibit smoking in~the workplace and other public places, and the Calabasas City Council has told its staff to prepare an ordinance banning smoking inside restaurants. The directives reportedly have been prompted by no- smoking ordinances in neighboring communities. See Los Angeles Times, July 29 and 30, 11993. •Florida The Department of Health, and Rehabilitative Servicess has reportedly proposed regulations under Florida's Clean Indoor Air Act of 1985 that would restrict smoking in shopping malls to those areas of restaurants 5 that have been designated for smoking and' have been licensed by the state. Department officials are soliciting input from those who may be opposed to such restric- tions. Comments will be received until the end of August 1993, and will be addtessed in~ public hearings scheduled by the state. See United Press Internationar;. July 29; 1993. •Local Governments in Hawaii On July 26, 1993, Honolulu Mayor Frank Fasi vetoed a bill that reportedly "would have prohibited smoking in almost all public areas in privately-ownedd commer- cial and residentiall buildings." Fasi said the measure was too restrictive and couldn't be enforced. According to one report, the City Council can vote to override the mayor's veto when it next meets, on August 11. See The Associated'Press, July 27, 1993. •Local Governments in Texas A group called Smoke-Free Dallas is preparing to present a draft ordinance to the city's Environmental Health Advisory Commission that would require restaurants, malls, hotels and workplaces to either ban! smoking or restrict~ it to separately ventilated smoking lounges. The group says it plans to present its proposal in the fall. See Dallas Morning News, July 28, 1993. ETS-RELATED LITIGATION AGAIriISTCI'GARETTE MANUFACTURERS [13] Butler. Discovery Continues On Jkily 30, 1993, plaintiffs filed a motion for protec- tive order to prevent defendants from deposing plain- tiffAva Dean~ Butler. Defendants deposed four broth, ers of plaintiff Burl Butler in late July and early August: Dan~ Buder, Pete Butler, Bill Butler, and Oscar Butler.. Plaintiffi contend that Burl Butler, a Laurel, Mississippi, barber, developed lung cancer as a result of his exposure to: environmental tobacco smoke. His wife, Ava Dean Butler, claims loss of consortium. The defendants in this case consist of the six major U.S. cigarette manufacturers and several local retailers. Butler v. RJ. Reynolds Tobacco Company, et aL (Circuit Court, Hinds County, Missis- sippi) (filed October 21, 1992). [14] Dunn: Defendants' Responses to the Complaint Due Defendants are scheduled to respond to plaintiff's' complaint on Thursday, August 12, 1993.

6 Plaintiffs in this case contend that Mildred Wiley was a nonsmoker who died of lung cancer on June 24, 1991, as a result of her exposure to environmental tobacco smoke at her place of employment (a Veteran's Administration hospital) 1 for the last seventeen years of her life. Her husband, Philip Wiley, is also asserting a loss of consortium claim. Defendants in the case are each of the six major U! S. cigarette manufacturers, parent companies of three of the manufacturers, The Tobacco Institute, and'the Council for Tobacco Research, Dunn v. RJR Nabisco Holdings Corporation, et al' (Superior Court, Delaware County, Indiana) ~ (filed May 28, 1993). ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS PRISON EXPOSURE CASES Voth v. Maass, 1993 U.S. DistL LEXIS 9894 (U.S. District Court, Oregon) (decided'. July 2, 1993). Frank E. Voth, who has filed an action against several cigarette manufacturers, see issue 52 of this Report, July 23, 1993, has lost his bid to sue prison officials under the Eighth Amendment for, among other matters, assigning him to dormitory housing where smoking is permitted. In denying numerous motions filed by Voth and in granting the defendants' motion for summary judgment, the court observed that Voth did state a section 1983 claim in~relation to his allegations about ETS exposure, but disall'owed the claim because Voth had been transferred to a: nonsmoking dormitory. [15] Jensen v. Gunter, 1992 U.S. Dist. LEXIS 21603 (U'.S. District Court, Nebraska) ' (decided June 11, 1992) A U.S: Magistrate Judge has determined that Eighth Amendment rights were violated,, in minor part, by prison practices involving double eeiling,of smokers with nonsmokers that led to tensions which created an increased risk of violence. The case was a class action filed by all of the inmates housed or to be housed in the four main housing units of the Nebraska State Penitentiary. The court ordered the defendants to develop a policy which would better classify prisoners ETS/IAQ REPORT, ISSUE 53 who were to be double celled to prevent violence and protect inmates who receive threats. RESIDENTIAL E3CPOSURE - CHILD CUSTODY' [16) Montufar v. Navrot (Superior Court, Camden,. New Jersey) (decided July 22, 1993)! An order has reportedly been entered in family court whereby the mother of a l0~year-old boy has agreed to stop all smoking in her home and automobile so that the boy will not be exposed'to ETS. The boy's father requested such an order in a motion filed in June 1993. See issue 51 of this Report, July 9, 1993. The father had alleged that the mother and her new hus- band were chain smokers and were endangering the health of the boy. According to the agreement, the maternal grandparents must also avoid smoking in the child's presence. The father's attorney has reportedly said that this order may be the first of its kind in the area and that the decision represents "a trend that is now irreversible." See The Philudelph'ia lnquirer, July 23, 1993. According to a press report, studies about the pur- ported health effects of ETS exposure provided the impetus behind the father's motion. He apparently filed the motion after his son suffered two respiratory infections earlier this year. See South Jersey Courier Post, July 23, 1993. [17] Shumaker v. Andrews, 1992' Del. Ch. LEXIS. 316 (Family Court, New Castl'e, Delaware)' (decided December 3, 1992). A family court judge has entered an~order which givess primary physical custody of a two-yearrold boy to his mother and orders her to insist that the child's mater- nal grandmother "refrain from smoking in the same room with Joseph,,so that the threat of secondary smoke is lessened." There is no discussion of the issue in the opinion, and there is no indication what prompted this particular order. The only health issue that was discussed at length involved the mother's allegations that the child returns from visits with his father with diaper rash and diarrhea.

AUGUST 6, 1993 WORKPLACE: WORKERS' COMPENSATION CLAIM [118] Employer.' Eisner Levy Aollack etc., 1993 WL 265224 (New York Workers' Compensation Board) (decided Jttne 19, 1993) The Workers' Compensation Board has upheld the claim of a paralegal'lwho alleged that poor air quality on the job caused her to sustain chronic mucous membrane irritation and chronic neuro-behavioral symptoms consistent with "tight building synd'rome." The Board, after reviewing the evidence presenteddetermined'that the claimant had sustained a work-related accident and was entiiled to compensation. According to the Board, the workplace had undergone reconstruction which included modification of the ventilation system, and the claimant worked in a cubicle with no windows and poor air quality. Her doctor advised her to seek fresh air at work. Surveys of ventilation~conditions at the workplace suggested poor air circulation and a temperature control problemL WORKPLACE: HANDICAP DISCRIMINATION, BATTERY, EMOTIONAL DISTRESS [19] Richardson v. Hennly, First Federal Savings and Loan Association v. Richardson,, A93A0680 & A9'3A0807 (Court of Appeals, Georgia), (decided July 15, 1993) The Georgia Court of Appeals has determined that a bank employee may try the merits of her complaints against a co-worker and her former employer alleging harm from exposure to her co-worker's pipe smoke. Employee Bonnie Richardson's complaint against her former employer alleges violation of the Georgia Equal Employment of the Handicapped Code, battery and intentionaliinfliction of emotional harm; her complaint against co-worker J.R Hennly, J'r.,, contains claims of battery, intentional' infliction of emotional distress and interference with contractual relations. Richardson alleged~ that Hennly's pipe smoke caused her to suffer nausea, stomach pain, loss of appetite, loss of weight, headaches and anxiety. According to the court, she was hospitalized twice because of her adverse reactions and was terminated from her position after the second hospitalization due to excessive absenteeism. Richardson 7 claimed'that Hennly was aware of her adverse reactions to his pipe smoke, that he smoked near her to annoy her and that he made teasing or offensive remarks regarding his smoking. In affirming in part and reverser ing in part the trial court's determinations regarding the defendants' motions for summary judgment, the appellate court (i) rejected a claim that the Workers' Compensation Act provided Richardson with her exclusive remedy; (ii) determined that pipe smoke can constitute an offensive "touching" for purposes of a battery claim; and (iii) agreed with the trial court that proof of difficulty in working and retaining employment at a particular job couldzneet the statutory definition of a"handicapped individuai."'The court's decision will send! the cases back to Lowndes Superior Court for further proceedings. According to a press report, when Hennly switched to smoking cigarettes in the fall of 1990 for a brief period' of time, Richardson's symptoms subsided until Hennly resumed smoking his pipe. See Fulton County Daily Report,, July 21, 1993. CIVIL RIGHTS vIOLATIONS [20] Brown v. Costello, 1993 U.S. Dist. LEXIS 10104 (U.S. District Court, Northern District, New York) ~(decid!ed July 15, 1993). The U.S. District Court has dismissed, in part, a pro se complaint involving a claim for damages for expo- sure to ETS filed against several attorneys and various lbcal and state officials and governing bodies. The complaint alleged, among other matters, that one of the plaintiffs, who ~ had been incarcerated on~ a con- tempt of court charge, was forced'to inhale cigarette smoke in violation of New York Public Health Law g 139-n and that such inhalation~ of ETS constituted denial of due process, trespass and battery. Finding that the complaint was devoid of any factual allegations against the attorney defendants who had filed a motion for judgment on the pleadings, the court dismissed the complaint as to these defendants and refused the plaintiffs'' untimely request to amend. The claims against the other defendants are still pending.

8' CRIMINAL BATTERY [21] Smoker Charged with Battery after Disagree- ment with Hotel Clerk According to a press report, a 24-year-old woman was charged with battery after allegedly pushing a hotel clerk who was attempting to enforce a no-smoking policy. Marjorie Kain of Aurora, Illinois, was appar- ently arrested on July 117, 1993, and released on her own recognizance. A hearing was reportedly scheduled on the charge for August 5, 1993, in Kane County Circuit Court. See Chicago Tribune, July 20,,1993. LEGAL ISSUES AI*ID DEVELOPMENTS [22] "The Call for State Legislation on Environmen- tal' Tobacco Smoke in State Prisons," L.M. GalbraitlR-Wilson, 13 Hamline fournal of Public Law and I'olicy 335 (1992). The article examines the issue of ETS exposure in prisons and concludes that, in spite of the fact that some 70 percent of prison inmates smoke, smoking should be banned to protect prisoners' eighth ~ amend- ment rights against cruePand unusual punishment. The author cites a draft vers'ton of the EPA Risk Assessment on ETS to support her claims that ETS poses a health risk to nonsmokers. She also di'scusses several of the prisoner ETS cases that have been decided by the federal: courts in recent years. [23] "Dangerous Products and Injured Bystanders," R.F. Cochran, Jr., Kentucky Law Journa4 81: 687-725 (1992-93)This:article, written by a Pepperdine University School of Law Professor, suggests that the manufactur- ers of inherently dangerous products that are not used by a majority of the populationi such as cigarettes, should be liable to bystanders for the injuries caused by those products. The basis for this suggestion is that bystanders are subjected to "unreciprocated risks" by the manufacturers of goods they have not purchased or used, and compensating them forr their injuries would spread the costs of such injury to the consumers who help to create the risk Citing the EPA Risk Assessment on ETS, the author claims that the evidence is clear that ETS causes lung ETS/IAQ: REPORT, ISSUE 53 cancer in bystanders and states, "It may be that tobacco manufacturers (through liability) and consumers (through higher prices) should be responsible for the risks that they cause others." The author believes that a bystander liability theory is especially apt in ETS cases because bystanders will be unable to bring suit against the users of the products that cause their injury under a negligence or abnormally dangerous activity theory because they have typically been "subjected to a lifetime of second'-hand'smoke by many smokers." OTHER DEVELOPMENTS [24] Smokers' Rights Group Plans March on Washington The Individual Rights Association, a smokers' rights advocacy group, reportedly held a: news conference on July 30, 1993, in Washington, D.C., to announce plans for a "march on Washington." Evidently, the march is being organized as part of the group's agenda to change what the group perceives as the present course of discrimination against smokers. See The Reuter Washington Report, July 30, 1993. [25] Health Service Releases Job Injury Survey According to a press report, the U.S. Public Health Service released'the results of a! survey on July 27, 1993, showing, among other matters, that the percent- age of workers who smoke has decreased by 191 percent in the last decade. Two out of five individuals surveyed reportedly said that smoking is permitted M their workplace, regardless of complaints by nonsmokers, and 551 percent said smoking is not permitted ini their workplaces. See PR'Newswire, July 27, 1993. [26] Fast Food Franchisee Adopts Smoking Ban A Popeyes Famous Fried Chicken & Biscuits franchi- see has reportedly banned smoking in all of its 20 restaurants in tlie Washington, D.C. area. The new policy was apparently introduced early in July 1993, after the franchisee determined that very few people smoke during their meals. The parent company has indicated that it will track the experiment to see if the policy should be expanded to other markets. According to a representative of the parent company, Popeyes

AUGUST 6, 1993 restaurants provide quick service and most customers do not linger afterr their meals. See Nation 's Restaurant News, July 5, 1993. [27] I Smoking Bans Extend to Apartment Buildings According to a press report, Signature Management Inc. of Baltimore, Maryland, has decided to implement smoking bans in all public areas of the apartment build- ings it manages. Published reports out of Washington, D.C., about the purported health hazards of ETS expo- sure, and not tenant complaints, apparently motivated the action; Smoking in individual apartments will 'i not be affeeted. See The BaltzmoreSun, July 117; 1993. [28] Mall Manager to Implement Smoking Bans at All Properties JMB Retail Properties, which manages 60 shopping malls across the country, will reportedly ban smoking at all of its facilities by the end of 1993. Although individuall stores will be permitted to set their own policies, and smoking will apparently be permitted in some restaurants, the ban will include food courts and hallways. The decision to ban smoking was reportedly based on the EPA Risk Assessment on ETS. According to a spokesperson for the International Council of Shopping Centers, the number of smoke-free malls has climbed from a mere handful to more than 100 within the last six months. SeeMiamr HeraU July 21, 1993. [29] A New Indoor Air Diagnostic Tool: Mold- Sniffing Dogs According to a paper presented at a recent scientific meeting, dogs can apparently be trained to "sniff out" hidden bacterial and fungal contamination in build- ings. SwedisL researchers reported at Indoor Air '93, a major conference held in Helsinki, Finlands that a trained dog located contamination hidden in insulation behind other building materials. MEDIA COVERAGE [30] "Second-Hand Science," Editorial, National Review, j!uly 19, 1993 This editorial criticizes the EPA and its methodologies, particularly with regard to the Risk Assessment on ETS. 9 The article quotes Representative John Dingell (D-Mich.) who once said of the EPA, "It cooks the books with great vigor." The author is skeptical; that elevating the EPA to Cabinet level status and requiring that each EPA regula- tion be supported by the best scientific data will I"clhange the way the EPA does business." In discussing the ETS risk assessment, the author applauds the tobacco industry's challenge of the EPA, writing "tobacco growers and cigarette companies are serving,thepublic interest in taking the EPA to court for its misuse of science in declaring environmental tobacco smoke (ETS) ' a`Class A carcinogen' its most deadly category." Characterizing the lowering,of confidence intervals and the agency°s use of meta- analysis as "scandalously manipulative standards," the author concludes, "We are on the side of the fighters where science supports thems however politically incorrect they may be." [31] CNN Broadcast Explores Discrimination for Off-the-job Activities On~July 25, 1993, CNN Weekend broadcast a report on cable television that discussed issues related to discrimination for off-the-job activities such as smok- ing, drinking, or participating,in high risk sports and hobbies. According to a representative of the American~ Civil Liberties Union who appeared during the broad- cast„28 states now have laws prohibiting suchZscrimi- nation. Apparently, a number of corporations are currently monitoring the smoking habits of their employees by administering urine tests and by encour- aging other employees to inform company personnel if theysee a co-worker smoking off the job. See CNN Inside Business, July 25, 1993. SCIENTIFIC/TECHNICAL ITEMS LUNG CANCER [32]I "Exposure to Environmental Tobacco Smoke and Female Lung Cancer in Guangzhou, China," Y.X. Du, Q Cha, Y.Z. Chen, and J.M. Wu, Proceedings of Indoor Air '93 1: 511-516, 1993 [See Appendix A] Based on several epidemiological analyses of data collected in Guangzhou, China, the authors report that

10 "[4]u results of these studies demonstratedthat exposure to ETS had no association with~female lung cancer." From their case-control study of 75 women and 128 controls, the authors report an overall risk estimate of 1.19 (95% CI 0.66-2.16) for husband ever having smoked. This risk estimate is not statistically significant. [33] "Involuntary Smoking in the Restaurant Work- place: A Review of Employee Exposure and Health Effects," M. Siegel, Journal of the American Medical Association 270(4): 490-493, 1993 [See Appendix A] The author of this paper reviews publishedindoor air quality data for bars and restaurants, in comparison with offices and residences, and epidemiologic studies of lung cancer risk in food service workers. He claims that ETS levels are substantially elevated'. in restaurants, and that ETS exposures could account for some of the elevated lung cancer risk reported for food service workers. The author concludes that, smoking should be prohibited in restaurants and bars "to protect these workers." RESPIRATORY DISEASES AND CONDITIONS - CHILDREN [34] "Race and Gender Differences in Respiratory Illness Prevalence and Their Relationship to Environmental Exposures in Children 7 to 14 Years of Age," D.R Gold, A. Rotnitzky, A.I. Damokosh, J.H. Ware, F.E Speizer,,B.G. Ferris, and D.W. Dockery, American Review ofRespira- tory Disease 148: 10-18, 1993 [See Appendix A] This study, part of the Harvard Six Cities Study, reports that maternal smoking was associated with elevated risks of wheeze and other respiratory symp- toms in the children studied. The authors note, however, that racial differences in: symptom prevalence could be related to socioeconomic differences. ETS EXPOSURE AND PvfONITORING [35] "Hair Analysis as a Marker for Fetal Exposure to Maternal Smoking," J. Klein, D. Chitayat, and ETS/IAQ REPORT, ISSUE 53 G: Koren, New EnglandJournal ofMedicine 328(1): 66-67, 199'3 [See Appendix A] The authors of this letter to the editor report that they have measured higher cotinine levels in the hair, of women and infants reportedly exposed to ETS than in women and infants reportedly not exposed. [36] "Determination of Airborne Cadmium in Environmental Tobacco Smoke by Instrumental' Neutron Activation Analysis with a Compton Suppression System," S. Landsberger, S. Larson, and D. Wu, Anralytical Chemistry 65: 1506- 1509, 1993 [See Appendix A] This study details a new methodology for measuring cadmium, purportedly from ETS, in indoor air. The authors call ETS a "significant source"'of cadmiums and claim that cadmium levels in places where smok- ing is allowed may be 30 times higher than in~ non- smoking,areas. [37] "Estimated Reduction in Exposure to Environ- mental Tobacco Smoke Through Removing Smoking in the Workplace," A. Raynal, P.S. Burge, A. Robertson, M. jlarvis, M. Archibald, and D. Hawkin, Proceedings of Zndoor Air `931: 639-643, 1993 [See Appendix A] The authors of this study compare questionnaire responses concerning perceived ETS exposures andl salivary cotinine levels in 1,200 ofl-ice workers. They report a positive correlation between perceived expo- sure and salivary cotinine, and'suggest that 85% of nonsmokers would "have a substantial reduction in ETS exposure" if smoking were to be banned in the workplace studied. INDOOR AIR QUALITY N r-, ... [38] "Effectiveness of Ventilation and Other Con- ~ trols in Reducing Exposure to ETS in Office Buildings," S.B. Hayward, K-S. Liu, L. ~ Alevantis, K. Shah, S. Loiselle, F.jl. Offermann ~ , ~ Y.-L Chang, and L Webber, Proceedings of Indoor Air `93 5: 509-514 [See Appendix A] M+ ~ This study, conducted in California, evaluates exhaust ventilation, physical barriers, and other

AUGUST 6, 1993 methods "for protecting non-smokers from" ETS. The authors report that ETS concentrations varied according to the engineering controls used'. ['39] "Legionnaires' Disease: The Infective Dose Paradox," S.J. O'Brien and R.S. Bhopal, The Lancet 342: 5-6, 1993 [See Appendix A] The authors of this commentary brieflyreview data on Legionellu, the bacterium responsible for the form of pneumonia called Legionnaires' disease. They call for further investigations into the infective hazard of Legionella. [401 "Big Air Quality Complainers - Are Their Office Environments Different from Workers with No Complaints?" R.M. Tamblyn, R.I. Menzies, F. Nunes, J. Leduc, J. Pasztor, and R.T. Tamblyn, Proceedings oflndoorAir '93 1: 133-138, 1993 [See Appendix A] This study investigates the possible role of method- ological problems in the lack of reported associations between worker perceptions and actual measurements of IAQ The authors conclude that significant environmen- tal differences existed between the offices of "complain- ers" and persons who did not complain, and that worker susceptibility, work conditions, and office environment may act multiplicatively to increase complaints and reported symptoms. [4'1] "Sensitization to Domestic Mites in a Cold Temperate Region," M. Wickman, S.L. Nordvall,. G: Pershagen, jl. Korsgaard, and N. Johansen, American Review of Respiratory Disease 148: 58- 62, 1993 [See Appendix A] This Swedish study reports that house dust mites doo occur in a cold; temperate, region. Moreover, mite infestation~appears to be related to "tight and damp housing characteristics." Presence of mites in the home is reportedly related to allergic sensitization and to the occurrence of rhinitis in the children tested, I li STATISTICS AND RISK ASSESSMENT' [42] "Tobacco Industry Response to a Risk Assess- ment of Environmental Tobacco Smoke," L.A. Bero and S.A. Glantz, Tobacco Control2: 103- 113, 1993 [See Appendix A] I The authors of this paper daim to have evaluated the quality of the scientific data presented in the industry- sponsored comments submitted to the public docket on the 1990 draft of the EPA Risk Assessment on ETS. They claim that the tobacco industry selectively cited only literature supporting its positiom Stanton Glantz is a noted antismoking activist. A presentation based on~ this material was given at the November 1992 American Public Health Association Annual Meeting. See issue 38 of this Report, January 7, 1993. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AUSTRALIA [43] Ministers Meet and Approve New Cigarette Package Warnings On July 7, 1993, Australia's health and police ministers reportedly agreed to require tough new warnings on cigarette packages. The warnings willl evidently be rotated and will include the statement "Your smoking can harm others." As of April 1994, cigarette manufacturers will be required to print the warnings on at least 25 percent of the front of each cigarette pack. The top third of the back of the pack will require additional health information. See The National'DrugStrategy; July 7, 1993. [44] Health Minister Wants Phase-in of Smoking Bans Minister for Health, Wayne Berry, reportedly said, in response to a submission of the Australian~ Hotels Association, that smoking bans in Australian Capitol Territory (ACT) public places would be phasedd in gradually. The Minister apparently expects to receive a

12 report from the ACT Occupational Health & Safety Councill on ETS in the near future and will have something to say on the issue before the end of the year. See Canberra Times, August 11, 1993. CANADA [45] New Package Warnings to Include ETS Health Effects Claims The federal government has reportedly given final approval to new cigarette package health warnings which will include the message "Tobacco smoke causes fatal'lung disease in non-smokers." The warnings must be printed in two languages and4ill'appear in black and white letters on 25 percent of the front and back of all tobacco packages. The new warnings will apparently not go into effect until July 1994., See Canada Newswire, July 22; 1993; The Gazette, July 23, 1993; and CentralNewsAgenry, July 24, 1993. [46] Critics Say Restaurant Smoking Ban Will Threaten Jobs. Scarborough's plan to ban smoking in all public places, which must be approved by the province before it becomes law, has reportedly been criticized by representatives from Canadian and Ontario restaurant associations. Unless such a ban is imposed province- wide, the critics say, business proprietors will see their business go across city borders. Some 9,200 restaurant jobs are claimed to be at risk. Members of the restau- rant associations are reportedly collecting the signatures of patrons who are opposed to the ban and will: fight the bylaw when it goes before the council and if it reaches the province. Restaurant owners who now permit smoking in their establishments say that patrons have not raise& any complaints about current smoking policies. See The Toronto Star, July 22, 1993. NETHERLANDS [47] Parliament Refuses to Enforce Smoking Bans According to a press reports the Second Chamber of the Dutch parliament is ignoring the requests of an anti-smoking group, Clean Air Now, that parliament more strictly enforce the country's public smoking ban. The ban, which includes parliament buildings, is ETS/IAQ REPORT,, ISSUE 53 apparently being violated, but those infringing the ban are not being punishedL The director of the health care service is quoted' as saying, "It's an internal thing. We don't want to start a witch hunt." See De Telegraaf, June 22, 1993. TA1WAl•r' [48]I Prison Smoking Ban Repealed On July 8, 1993, the ROC Legislature voted to permit prison inmates over the age of 18 to smoke at designated times and in designated areas. The decision apparently ends a smoking ban that has been enforced in~ Taiwan penall institutions for more than four decades. Cigarettes and lighters will~ under the new policy, be under the control of jail guards to prevent illegal smoking or arson. See The Free China Journa4 July 23, 1993. ETSIIAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS AUSTRALIA [49] Department of Occupational Health and Safety v. Burswood Resort (Management) Ltd (Magistrate's Court, Perth) (filed December 1992) Trial began before a Magistrate in~the Perth Court of Petty Sessions on August 2„ 1993. The case is a criminal prosecution under the Occupational' Health, Safety and Welfare Regulat;ions, in which Burswood Resort Casino has been charged! with failing to ensure that effective measures were taken to control the level of ETS so that the health or safety of its employees was not at risk The casino is Western Australia's largest tourism employer with some 2,600 full and part-time staff. A conviction will' carry a maximum~ fine of $50,000. A related prosecution was instituted for the alleged wrongful discharge of a casino employee who aided the Department of Occupational Health and Safety investigation. This prosecution resulted in an acquittal for the casino. Thus far, witnesses for the prosecution have testified regarding the indoor air monitoring that took place at

AUGUST 6, 1993 the casino on June 28, and July 11, 1992. It is antici- pated that trial will take two weeks. The prosecution has dropped its eye irritation allegation and concluded the presentation of its case with the testimony of two respiratory physicians. One used the EPA Risk Assess- ment on ETS in support of his testimony and it was admitted into evidence. [50]i Mother Ordered not to Smoke in Front of Children On July26, 1993, a Family Court Judge inAdelaide, reportedly ordered the mother of asthmatic childreni not to smoke in their presence. The order was rendered in response to an application made by her former husband earlier in July 1993. According to a family lawyer in Melbourne, the order will clear the way for similar or even more outrageous demands in child custody cases. See Sydney Morning Heralct; Australian I11'awarra Mercury, Courier Mail , J,nly 27, 1993; Daily Telegraph Mrrror; July 28; 1993. LEGAL ISSUES AND DEVELOPMENTS AUSTRALIA [51] Asthma Foundation Director Calls for Smoking Prohibitions Tim Shackleton, the executive director of the West Australian Asthma Foundation, has reportedlyralled for health authorities to consider making,it illegal for parents to smoke near their asthmatic childrenL A year-long study was apparentlycondueted by the foundation which revealed that one in five families with asthma sufferers has a parent who smokes. Shackleton's recommendation was evidently based upon his frustration with the study's findings. See WestAustralian, July 28, 1993. OTHER DEVELOPIv1ENTS. CANAD:PI. [52] National' Arts Centre Bans Smoking It has been reported that, as of August, 1, 1993, the National Arts Centre in Ottawa will ban smoking anywhere in the building. Smoking had previously been permitted in the lobby, box office and foyer 13 outside the building s cafe. According to a spokesper- son, for the centre, a survey of performing arts centers across North America revealed that 14' of 25 already ban smoking and the remainder are considering doing so. See The Ottawa Citi,zen, July 7, 1993. HONG KONG [53] New Antismoking Campaign Launched The Hong Kong Council on Smoking and Health (COSH) has reportedly launched a number of new initiatives designed to increase the availability of non, smoking accommodations in hotels and restaurants. The results of a survey on attitudes about smoking in public places conducted in February 1993, were formally released on the eve of a new television campaign which depicts all the customers leaving a restaurant when a smoker lights a cigarette. For further information about the results of the survey, see issue 47 of this Report, May 14, 1993: COSH will also reportedly be meeting with representatives of a hotel association to encourage members to set aside more rooms for nonsmokers. See South Chirut Morning PoA July 30, 11993. UNITED KINGDOM [54] Smoking Ban Rescinded After Business Slump Pub manager Mike Wilson has reportedly rescinded the ban on smoking he adopted at the Smugglers bar in Sund'erland, Tyne and Wear. The ban was apparently introduced after nonsmoking customers complained about other people's cigarette smoke. After a loss of 30 percent of his business during a three-month period, Wilson decided to end the ban. Promotions such as discounted drinks and meals and karaoke nights could'not attract customers, but most former customers returned to the pub within a week of the end of the ban. See Press Association Newsfile, July 25, 1993. WORLD AIRLINE NEWS [55] Canada According to a press report, passengers traveling to international destinations will be able to smoke on Canadian airlines following the postponement of a smoking ban that was scheduled' to take effect on July 1,

14! 1993. The Department of Transport, apparently at the request of Canadian Airlines International (CAI), delayed' implementing the new poliry until July 1, 1994. EEvidently, CAI was able to convince the govern- ment that it would suffer "an immediate and negative impact" in flights to Japan, as other international carriers have not adopted smoking,bans. See The Buffalo News, July 18, 1993. MEDIA COVERAGE AUSTRALIA [56] "When the Censors Become Dictators," D. Hampson, Sunday Herald-Sun, August 1, 1993 This article criticizes those who think they know what is best for everyone else, and! specifically targets the anti',smoking lobby. Stephen Woodward, executive director of ASH, is singled out for endorsing the concept of mothers who smoke during pregnancy being sued by their offspring and a proposal from doctors not to operate on patients who smoke. The author makes the totalitarian nature of such discrimi- nation clear by changing the concept to read that doctors will no longer operate on heroin addicts, AIDS victims, drunks, bad drivers, etc. ETS/IAQ REPORT, ISSUE 53 ( 1k

AUGUST 6, 1993 APPENDIX A The numbers assigned to the following article summaries correspond with the numbers assigned to the synopses of the articles in the text of this Report. LUNG CANCER [32] "Exposure to Environmental Tobacco Smoke and Female Lung Cancer in Guangzhou, China," YX Du, Q Cha, Y.Z Chen, and J.M. Wu, Proceed:ngs oflndoorAir 931: 511-516, 1993 "Cigarette smoking is widely accepted as a major risk for human lung cancer. However, the relationship between ETS exposure and female lung cancer is being debated. Since 1980 to 1988, there have been 5,546 cases of deaths from lung cancer in Guangzhou, and 811 cases of them were never smokers. In this group, 552 cases were from ETS exposure [sic]. I6order to ascertain the relationship between ETS exposure and lung cancer, some epidemiological analyses have been performed as follows: (1) Comparisons of medical histories between ETS and Non-ETS exposure of never smokers. (2) Conditional logistic regression analyses of never smokers. (3) A case control study of female never smokers. (4) ETS exposure and cell type of lung cancer. All results of these studies demonstrated that exposure to ETS had no association with female lung cancer." "[R]esults [of one analysis] suggest that fresh veg- etables act as a protective factor against lung cancer, whereas contact with toxic substances increases the risk of lung cancer. It is worth noting that in females, indoor air pollution and situation of kitchen [sic] are risk factors for lung cancer. However, the [sic] respira- tory disease, ETS exposure, living conditions, and familial history of cancer, exerted'no effect whatsoever on female lung cancer.... In the case of males, besides cigarette smoking, the major risk factors were related to occupational exposure." "The OR of ETS exposure is between 0.61-1.62, showing that spousal smoking, measured either by daily cigarette consumption, or the duration of smok- ing, is not a risk factor for female lung cancer." "The results indicated that no differences in cell types were observed between the exposed and non-exposed groups in both males and femal'es. In other words, A-i exposure to ETS is not to be [sic] etiologically linked to an increase in epidermoid carcinoma of [sic] lung cancer." "Our studies showed that exposure to ETS had no associated [sic] with lung cancer, but it does not mean that ETS had no harmful [sic] to human health." [33] "Involuntary Smoking in the Restaurant Work- place: A Review of Employee Exposure and Health Effects," M. Siegel, Journal oftfieAmerican lkledical Associatian 270(4): 490-493, 1993 "This review assesses the potential health hazard of ETS exposure for bar and' restaurant employees. There are two questions considered. First,-what is the relative exposure to ETS for bar and restaurant employees compared! with employees of other businesses and with individuals who live in a home with a smoker? Second, d'oes ETS exposure in bars and restaurants produce an elevated'lung cancer risk among these workers? To answer the first question, published indoor air quality data for bars, restaurants, offhces, and residences were reviewed. To answer the second questiony the epidemiologicstudies of lung,cancer risk in food- service workers were reviewed."' "The mean restaurant ETS constituent concentra- tions are between 1.6 and' 2.0 times higher than those in the office workplaces studied, and 1.5 times higher than levels in homes with at least one smoker present. Mean concentrations of ETS constituents in~bars are 3.9 to 6.1 times higher than in the office workplaces,, and 4.4 to 4.5 times higher than in the residences." "Six studies have examined lung cancer risk in food- service workers, controlling for active smoking and other potential! confounding variables. One of these was a historical cohort study that examined occupa- tional! lung cancer mortality. Five were case-control studies that included incident lung cancer cases." "Taken together, these studies suggest that there is an excess lung cancer risk of approximateHy 50% (range 10% to 90%) among food-service workers compared with the general population, controlling for active smoking. In the two studies that examined bartenders and other food-service workers separately, this excess lung cancer risk was found for both groups of workers. Thus, it appears that there is an elevated lung cancer risk in both bar and restaurant workers that persists after controlling for active smoking."

A-2 "This excess risk could well be due to the increased ETS exposure of food-service workers. However, there are several alternative explanations that must be considered." "First, residual confounding by smoking might explain the elevation in lung cancer risk for food-service workers. There are several reasons to believe that this is not the case."' "Second, confounding by a variable known to be associated with both lung cancer and food-service employment might explain the observed association. The most important considerations are age, sex, race, socioeconomic status, and diet." "Third, publication bias might explain why the six published studies reported am increased lung cancer risk in food-service workers.... [Ilt is not plausible that studies finding no association between lung cancer and food-service emplbyment have been differentially rejected or not submitted for publication." "Finally, the observed increase in lung cancer risk among,food-service workers might be due to a carcino- genic exposure other than ETS. The most important consideration is exposure to cooking,fumes....It is quite possible that the increased lung cancer risk among cooks is due to confounding by active smoking." "An elevation in lung cancer risk attributable to ETS exposure in the restaurant workplace is plausible. Since domestic ETS exposure is associated'with a relative risk for lung cancer of l'1.3 and this review estimated that typical restaurant ETS exposure is at least 1.5 times higher than domestic exposure, an excess lung cancer risk over 30% in restaurant workers, compared with unexposed nonsmokers in domestic settings, would be expected," "Public health~ efforts to regulate smoking in bars and restaurants can no longer focus only on protecting the patron. Food-service workers must be afforded the same public health protectiom as other workers. To protect these workers from the hazards of ETS; smoking should be prohibited in bars and restaurants." ETS/IAQREPORT, ISSUE 53'. RFSPIRt\TORY' DISEASES AND CONDITIONS - CHILDREN [34]I "Race and Gender Differences in Respiratory Illness Prevalence and Their Relationship to Environmental Exposures in Children 7 to 14 Years of Age," D.R. Gold, A. Rotnitzky, A.I. Damokosh, J.H. Ware, F:E. Speizer, B.G. Ferris, and D.W. Dockery, American Review of Respira- tory Disease 148: 10-18, 1993 "In examining the relationships between race and respiratory illness, the effects of gender on respiratory illness rates must be taken into account._In infancy, males have higher rates of lower respiratory illness and wheeze than females. This study examines whether the increased prevalence of respiratory illness in males persists into the school-age period and whether gender differences are similar for both black and white children." "Hay fever was more strongly associated'with mater- nal smoking for black children than for white children. Maternal smoking was associated with higher asthma rates for boys than for girls. The associations with maternal'smoking did not vary with the age of the child." "The relative odds of any wheeze were 1.16 for: children of mothers who were former smokers versus children of mothers who never smoked. Children of mothers who smoked > 30 cigarettes per day had 1.35 times the odds of persistent wheeze, 11.62 times the odds of any wheeze, 1.51 times the odds of chronic cough, 1.2'9 times the odds of chronic phlegm, and 1.37 times the odds of chest illness as children of mothers who did not smoke. For most illnesses, there wass in increase in risk with the amount of maternalismoking when smoking was examined as a continuous variable."' "This study demonstrated a greater prevalence of chronic respiratory illnesses in boys than in girls in this cohort of 7- to li4-yr-old! white and black children." "In each of the four cities, black children reported more asthma than white children. In three of four cities, black children also reported more persistent wheeze." "This racial disparity in wheeze and'asthma preva- lence may relate to prenatal or early childhood expo- sures associated with socioeconomic disadvantage that were unmeasured in this study: Parentalleducation is

AUGUST 6, 1993 an imperfect surrogate for exposures related to socio- economic disadvantage." "The racial differences in respiratory illness prevalences were most prominent in the illnesses most strongly associated with allergy and atopy. Increased exposure to allergens, such as house dust mite or cockroach dust, or increased predisposition to allergy may have played some part in the evolution of these racial differences." "No racial differences were found in the relationships between respiratory illness prevalence and many of the indices of environmental exposure and body habitus there were measured in this study." "Black children 10 to 14 yr of age reported taking up smoking less frequently and smoked~ fewer cigarettes than white children. Mothers of black children, if they smoked, reported smoking fewer cigarettes than mothers of white children."' "The associations between maternal smoking and respiratory illness were comparable in magnitude to the effects of personal smoking and persisted into the early teenage years....Maternal and personal smoking may not be the explanation for racial differences in the _ prevalence of childhood respiratory disease." ETS EXPOSURE AND IVIONITORING [35]I "Hair Analysis as a Marker for Fetal Exposure to Maternal Smoking," J. Klein, D. Chitayat,,and G. Koren, New Erigland fournal of Medicine 328(1); 66-67; 1993 "We describe the distribution characteristics of nicotine and its metabolite cotinine in maternal'and fetal hair." "We studied 110 smoking and 11 nonsmoking mothers (mean ages, 19 and 20 years,, respectively) i in two hospitals in Toronto. From one to three days after delivery, hair samples were obtained' from the mothers and their babies by cutting five to seven shafts of hair.... The nicotine and cotinine content of the extracts was measured." "In the nonsmoking mothers, the hair concentrations of nicotine and cotinine (0.9 ± 0.8' and 0.3 ± 0.5 ng per milligram, respectively) weresignifrcantNy lower than those in the smokers. Similarly, the concentra- A-3 tions of nicotine and cotinine (0.7 ± 0.7 and 0.3 ± 0.2 ng per milligram) in the hair of the infants of the nonsmokers were significantly lower than those in the infants of the smokers. Four nonsmoking mothers were passively exposed to their spouses' cigarette smoking at home. Their mean hair concentration of nicotine (0.9 ± 0.9 ng per milligram) did not differ from that of the other seven nonsmoking,mothers (0:9 ± 0.9 ng per milligram), but their hair cotinine concentrations (0.6 ± 0.7 ng per milligram) were significantly higher. The trend was similar in their infants: the infants of women exposed passively had more cotinine in their hair than the infants of mothers not exposed (0.3'±0.2 vs. 0:1 ±0.1 ng per milligram); but there were no differences in hair nicotine concentrations." "The positive correlation between maternal exposure to nicotine and cotinine and'the accumulation of these compounds in fetal hair suggests that measurements of hair may provide a better estimate of long-term systemic exposure to the toxic constituents of cigarettes and may thereby yield a better prediction of fetal risk." [36] "Determination of Airborne Cadmium in Environmental Tobacco Smoke by Instrumental Neutron Activation Analysis with a Compton Suppression System," S.. Landsberger, S. Larson, and D. Wu, Analytical Chemistry 65: 1506- 1509, 1993 "Concentrations of cadmium, a toxic trace element,, were measured in the indoor air of several public places where environmental tobacco smoke was present. Particulate-phase cadmium concentrations were determined by analyzing air filter samples.... Results show that where environmental tobacco smoke is present, cadmium concentrations are significantly higher than background and that about 80% of the cadmium found in indoor airborne particulate matter is associated with particles with aerodynamic diameters less than 1.8 um. In one instance, airborne cadmium concentrations in a music club were found to be 38 ngL m3, which is at least 30 times higher than background." "To evaluate possible health risks due to intake of heavy metals present from ETS, it is important to develop methods to accurately measure the concentra- tion of these metals in indoor air."' "Cadmium is one heavy metal that may be present at high enough concentrations in tobacco to potentially

A-4 cause health risks to nonsmokers over long exposure times....Our measurements show cadmium~ to be present in an unburned cigarette at an approximate concentration of 11 ppm. When a cigarette is smoked, cadmium is released into the environment in ETS and also retained in the cigarette ash." "[w]e found that approximately 80% of the cadmium in tobacco goes to the tobacco smoke, indicating that cadmium will be found! in ETS." "Particulate cadmium concentrations in indoor air of some public places where smoking is allowed can be 30 times higher than in a no-smoking area. More than 70% of cadmium in environmental tobacco smoke is found in fine airborne particles (diameters <1.8'um),. which is of toxicological significant since the fine particles have the deepest penetration into the human~lung. ETS can be a significant source of cadmi= in indoor air, and cadmium may prove to be a good tracer for ETS."' [37] "Estimated Reduction in Exposure to Environ- mental Tobacco Smoke Through Removing Smoking in the Workplace," A. Raynal, P.S.. Burge, A. Robertson, M. Jarvis, M. Archibald, and D. Hawkin, Proceedings of Indoor Air `931: 639-643, 1993 "A stratified ['systematic] sample was taken in a cross- sectional study of 1,200 office workers to assess where their predominant exposure to environmental tobaccoo smoke (ETS)' occurred."' "As manyoffce workers are exposed to environmen- tal tobacco smoke in alternative locations such as their own homes andlsocial, venues it is of interest to attempt to quantify the amount of exposure to ETS that is likely to take place for non smokers in each location." "Some 15 (5%) employees reported! no ETS exposure at any source; a total of 244 (85%) reported some exposure at work and 1'102 (35%)' reported that the workplace was their sole source of ETS exposure." "The 123 persons who reported only one source of ETS exposure had a mean salivary cotinine ... which was [significantly] greater than those who reported no ETS exposure. The 150 employees who reported more than one source of exposure had a mean salivary cotinine ...again significantly higher than those who only reported a single source of exposure."' ETS/IAQ REPORT, ISSUE 53 "The data shows [sic] that questioning non-smoking office workers in this population about ETS exposure in terms of numbers of venues and quantity of expo- sure gave reliable results when validated with salivary cotinines [sic]." "If smoking were banned from this workplace 85% of non-smokers could expect a substantial reduction~ in overall'exposure to ETS; 35% of non-smokers could be expected to have their salivary cotinine levels reduced to that of the group who reported no exposure, which is nearly half of their current levels; another 49% could expect to have, on average, a reduction of 0.46 ngJml in their salivary cotinine levels:" "Salivary cotinine is used as a marker of environmen, tal tobacco smoke exposure andl it is assumed that there would be a similar reduction in exposure to other components of environmental tobacco smoke whichh contribute to an excess of cancers, heart disease and respiratory diseases in passively exposed non-smokers." INDOOR AIR' QUALITY [38] "Effectiveness of Ventilation and Other Controls in Reducing Exposure to ETS in Office Build- ings," S.B. Hayward, K-S. Liu, L. Alevantis, K Shah, S. Loiselle, F.J. Offermann, Y.-L. Chang, and'~ L. Webber, Proceedings of Indoor Air '93 5: 509-514 "A study was conducted in government-owned buildings in California to evaluate the effectiveness of various control measures such as exhaust ventilation and physical barriers for protecting non.smokers from environmental tobacco smoke (ETS) generated by smoking in designated areas in the building." "This study's objective was to evaluate the effective- ness of several methods of protecting occupants iin a non-smoking area from ETS produced in~a designated smoking area located in the same building. These methods included 1)~situating,non-smoking working, and/or eating areas adjacent to smoking areas, without a physical barrier and served by the same ventilationn system, 2) separating smoking and non-smoking areas by walls, and 3) providing smoking areas, either with or without walls, with exhaust-only ventilation....The amount of ETS present in both smoking and non- smoking areas was determined by measurements of

C AUGUST 6, 1993 total nicotine and fluorescent particulate matter (FPM), sometimes referred to as tarry respirable particles. The movement of air form the smoking to non-smoking areas was traced using an inert gas (SFG) released in the smoking area(s). We report results of these measurements in three buildings studied." "Building 1 had a 19 mz glass-enclosed smoking room (within a: break room) i with a 370 1 lls exhaust fan to the outside, and with the HVAC return blocked off. Non-smoking,areas sampled includ'ed~ two in the break room, and''one in an:adjoining office.... Building 2 allowedi smoking ini a 109 m2 portion of the lunch- room with non-smoking areas separated from the smoking areas by partitions 1.2 m high. The lunch- room air was exhausted by a 1490l/s fan to the patio, and by two kitchen range hoods. Non-smoking areas were sampled behind and on top of curved partitions, and in the off ce.... Building 3 contained a smoking room with no:exhaust fan situated in a basement served' by only one return. Two non-smoking sample loca- tions were in nearby offices, and one was in the hall.°° "The mechanism for controlling exposure (for a given number of cigarettes smoked) in non,smoking areas can be viewed in two stages. The first is the dilution and/or removal of ETS components in the smoking area itself ...The effectiveness of this stage of control is related to the normalized exposure in the smoking area. These values are substantially higher for alli three contaminants' in Buildings I and 3 than for Building 2." "The second mechanism is related to the movement of pollutants from the smoking area to the non- smoking area, which is determined by the extent of mixing and convective flows between the smoking and non-smoking areas, including recirculation by the HVAC system. This is related! to the existence of physical barriers, to the pressure relationships govern- ing air movement in the building, and to the extent of recirculation." "The effect of the exhaust fan in Building 1 is most obvious at the second stage." "The results of this study suggest that an understand~ ing of the airflows in a building is useful for under- standing exposures to ETS in non-smoking areas adjacent to smoking rooms or areas. A tracer gas (SF.)) can be used to understand these flows, and has the advantage of much higher detectability than nicotine A-5 or FPM.... Using similar techniques as those in this study, normalized exposures to SF6or other inert tracer gases can be used to evaluate the effectiveness of measures to control exposures to any pollutants emitted from localized sources in a building, including those which are impossible to eliminate from the buiiding by a simple ban."' INDOOR AIiR' QUALITY [39] "Legionnaires' Disease: The Infective Dose Paradox," S.J. O'Brien and R.S. Bhopal, The Lancet 342: 5-6, 1993 "The species of Legionella bacteria that cause legion- naires' disease are widely distributed in aquatic habits. Infection via inhalation of aerosols containing bacteria is the main, though contested, mode of [transmission]. Most outbreaks have been associatediwith aerosols from evaporative cooling systems and complex hot water systems." "There are several gaps in our understanding,of the transmission of legionnaires' disease. One area of uncertainty is the size of the infective dose of the organism required to produce disease in human beings. Animal experiments suggest that a high dose is re- quiredi and! the fact that there is no person-to-person spread supports this view. However, low concentrations of legionellae seem to be emitted fo-om water systems, and! epidemiological evidence indicates that infection can occur at some distance from the source of aerosol." "Environmental concentration of legionellae might have been underestimated because of technical ob- stacles to derection."' "Extrapolation from experimental data from one study on the infective dose in animals provided an estimate of 1141 million organisms required to produce disease in human beings." "Certain human beings,, including those who are immunocompromised, may be unusually susceptible. Overall, the animal evidence conflicts with the envi- ronmental and epidemiological! observations." "One possibility is that the infective hazard of aerosols containing legionellae depends on the survival and stability of the bacterium, which in turn depend on several factors related to the bacterium itself (meta-

A-6 bolic activity, effects of passage, and virulence of the strain) and its relation with other micro-organisms, notably blue-green algae and amoebae.... Perhaps non- clinical legionellosis follows exposure to small numbers of bacteria alone, the clinical form occurring as a result of exposure either to a large dose of bacteria or to legionellae packaged in amoebae. Solving,the infective dose paradox might lead to new strategies for elimina- tion of this preventable pneumonia." [40J "Big Air Quality Complainers - Are Their Office Environments Different from Workers with No Complaints.>" R.M. Tamblyn, R.I. Menzies, F. Nunes, J., Leduc, J. Pasztor, and R.T. Tamblyn, Proceedings of Indoor Air '93 1: 133-138, 1993 "Numerous complaintsabout air quality among workers in mechanically ventil'ated office buildings has created an interest in id'entifying the possible causes of these complaints, and interventions to remedy the problem. There is systematic evidence that complaints about the office environment are associated with work- related! illness and sickness absence. What is surprising is that no association has been demonstrated between the worker's perception of the air quality in their work environment and actual measurements of these envi- ronmental conditions. It was our hypothesis that the absence of association~ may be due to a number of methodological problems: inadequate sampling of the prevailing conditions in the workplace, and statisticall methods used to summarize these conditions. The purpose of this study was to evaluate this possibility." "A cross-sectional observational study design was used....A convenience sample of 10 mechanically ventilated buildings were selected for study."' "A self-administered, standardized questionnaire was used to collect data on the worker's perceptions of the usual air quality in their office environment. Workers rated three aspects of indoor air quality: temperature,, humidity and air circulation....Workers with~ major air quality complaints were defined as those who rated all three aspects (temperature, humidity, and air circula- tion) on the extreme categories of the scale. The comparison group; workers with no air quality com- plaints, were defined as workers who rated all three aspects as being ideal or close to ideal." ETS/IAQREPORT, ISSUE 53. "The same questionnaire was also used to collect information on socio-demographic characteristics (age, gender), health status ('atopic history, smoking status, medication use, contact lens use), work characteristics (job type, computer use, tobacco smoke exposure, jobb control, job stress), and experience with cardinal symptoms of sick building syndrome at work (head- ache, nasal irritation/stuffiness, dry/sore throat, cough, fatigue, poor concentration, eye irritation)." "Four environmental conditions were measured: temperature, relative humidity, C02, and air velocity. Measurements were taken twice a day, in the morning and afternoon, at 8-1'0 worksites per study floor." "Among these workers, 9.3% had major complaints about the usual indoor air quality in~ their offices and 18!8%o had no complaints. Workers with major air quality complaints experiencedl the same mean tem- perature and daily range of temperature at their worksite as workers with no complaints. However in repeated samples we found that they were exposed to greater variability in temperature. There were larger deviations in temperature from seasonally adjusted optimal temperature values (above and below) in the offices of workers with major complaints than those with no complaints. Relative humidity was signifi- cantlylower in the offices of major complainers, and when humidity deviated from the optimal seasonal range„values for major complainers were significantly lower than those with no complaints. Air velocity wass also significantly lower in the offices spaces of workers with major complaints.... Using the ASHRAE formula for converting CO2 to cubic feet per person (cfmpp)~of ventilation, both groups of workers received ventilation well above the minimum standard of 201cfmpp; and the workers with major complaints received, on average, better ventilation (a higher proportion of outdoor air) than non-complainers." "A greater proportion of workers with major air quality complaints experienced frequent and numerous work-related symptoms (12%0) relative to non com- plainers (0!4%0), and'a much smaller proportion reported that, they had none of the cardinallsymptoms of sick building syndrome (4% versus 21%). Major air quality complainers were also more likely to be female, have an atopic history, smoke, and be employed in management or clerical positions. A greater proportion of major air quality complainers were exposed to (

AUGUST 6, 1'993 smoke at their worksite, reported less control over their work, and worked longer hours per day at a computer.... [IW]e found that mean humidity at the worksite, sex, atopic history, and job control were the four factors which were significantly associated w'ith the odds of being a major air quality complainer." "By using repeated measurements of the workers office environment to provide a more precise estimate of office conditions, we demonstrated that significant differences did exist, particularly in temperature and humidity. Workers with major air quality complaints experienced lower relative humidity, more variable office temperatures, and slightly lower air velocity than workers with no complaints. As estimated by C02, workers with major air quality complaints also received a greater proportion~ of outdoor air. On the basis of the strong association between C02' and relative humidity, and the time of year when the samples were taken, we believe these results were attributable to the exposure to lower humidity as the proportion of outdoor air delivered to the worksite increasedl" "We found that there were significant linear associa- tions between workers' ratings and temperature, humidity, air velocity; and C02 at the worksite.... There are four practical implications suggested by these findings. A single measurement of a worker's office environment is too imprecise to draw any conclusions about the usual conditions in their office space. Secondly measurements of indoor air quality need to be summarized to reflect not only the average value, but al.so the variability in conditions.... Thirdly, workers' perceptions that there is an~ indoor air quality problem in their office space i's probably a valid indicator of sub optimal conditions.... Finally, inadequate humidification of outdoor air in the winter months in colder climates may lead to more frequent air qualiry complaints, even when average humidity is withM norms for the season- ally adjusted comfort range. A balance needs to be struck between inadequate dilution of indoor contami, nants by increasing ventilation, and maintenance of adequate indoor humidity." "We identified that sex, atopic history, job control, and office humidity were the most important factors for increasing the odds of air quality complaints. These findings suggest that worker susceptibility, coupled with work conditions, and office environment act in a A-7 multiplicative way to increase the odds of air quality complaints and work-related symptoms. [41] "Sensitization to Domestic Mites in a Cold Temperate Region," M. Wickman, S.L Nhrdval'l, G. Pershagen, J. Korsgaard, and N. Jlohansen, American Review of Rcspiratory Disease 148: 58-62, 1993 "Factors favoring sensitization to house dust mites (HDM) were studied in a cold, temperate dimate in northern Sweden. Sixty-five children previously found to react positively to a skin prick test (SPT) to HDM were included." "In a further analysis the homes of the 65 children were divided'into mite-infested (_ 1 mite per 0.1 g mattress or floor dust) and non-mite-infested homes. More tight and damp housing characteristics were suggested in the mite-infested homes. Dust from beds located on the basement or ground level harbored significantly more mites than did mattress dust from upper floors (OR, 3.9; CI, 1.2 to 12.9)." "No relationship was found between~bronchial asthma or eczema and exposure or sensitization to Dtrmatopliagoides [a common genus of dust mite]. However, of the 10 children who were exposed to Dermatopliagoides in floor dust, all suffered from allergic rhinitis compared with 38 of 54 children who did not. This was also consistent when comparing the occurrence of mites in mattress dust and the occur- rence of rhinitis (OR', 4.9; CI, 0.7 to 31.1)! Funher„a relationship was found between allergic rhinitis and sustained mite sensitization." "In~this first systematic study of HDM allergy in a cold', temperate, and partly subarctic region, we have shown that infestation of domestic mites does occur and' is a risk factor for sensitization to H'DM....It is conceivable that modern building techniques in combination with energy saving measures have created an indoor `greenhouse effect' with elevated humidity and high replication of mites even where the dimate is cold." "In a previous ease-controllstudy ofHDM-sensitized, other atopic, and'healthy children, we reported an association between sensitization to HDM and energy- saving measures and damp housing characteristics. In this study, 'low air exchange' characteristics, i..e., additional thermali insulation of mineral wool, win-

A.-8' dow-stripping, and condensation on window panes were slightly more prevalent in homes in which mites were found than in homes without, thus supporting the data of our previous study. In the present study,,no control group was induded, which probably explains the less pronounced associations between residential characteristics and HDM-sensitization." STATISTICS AND RISK ASSESSMENT [42]' "Tobacco Industry Response to a Risk Assess- ment of Environmental Tobacco Smoke," L.A. Bero and S.A. Glantz, Tobacco Control2r 103- 113, 1993 ETS/IAQ REPORT, ISSUE 53 "We determined whether or not the author of a comment was affiliated with the tobacco industry [TIA]. An affiliation as defined in this study means that: the reviewer had a financial or other interest in the tobacco industry. An affiliation does not mean that the reviewer was biased or supported the position~of the tobacco industry that ETS is not harmful to health....A reviewer was categorised as being affiliated if he or she, 1)' disclosed in the written comment that he or she was a paid consultant to the tobacco industry,. 2) received grant funding from the tobacco industry, 3) appeared at least twice at tobacco industry-sponsored symposia, 4) ~ testified as an expert witness in support of the tobacco industry during legal proceedings, or 5) was on the Board of Direetors of a tobacco company or "The only stud'y to evaluate the quality of scientific data presented by the tobacco industry in response to a the Tobacco Institute. Sources used'to determine tobacco industry affiliations were 1) the submissions themselves, 2) government report on ETS was conducted' by the New ieulum vttae accomhe submissions, 3) Zealand Department of Health. Its analysis of the New curr pan~g t Zealand Tobacco Institute's submission in response to proceedings of tobacco industry-sponsored symposia, and 4) transcripts from legal proceedings." the New Zealand Department of Health's report on ETS found that the Tobacco Institute submitted' an "The tobacco industry's specif c approach in response incomplete, selective and distorted'analysis of the to the EPA risk assessment was to criticize the draft's scientific data. SpecifiealNy, the New Zealand Depart- methodology by selectively citing the scientific litera- ment of Health concluded that the submission: ture that supported its positions rather than citing,alll reviewed less than 40% of the refereed~ scientific the relevant literature. The TIA reviewers often cited literature published'since the US Surgeon General's unrefereed literature, such as symposia, editorials, and report on ETS; cited mainly unrefereed research for letters-to-the-editor,,and they cited this material as post-1986 studies; ignored~scientists' defence of their though it were peer reviewed. The large number of work, presenting criticisms of the work as if they had critical comments on the draft risk assessment sug- not been~ answered; ignored! most articles on child gestedl on the surface that it was seriously flawed and health and ETS; accorded small studies as much merit that the evidence regarding the health effects of ETS'S as large studies;, and denied~ the validity of pooling remains controversial. However, the majority of the results of existing studies (meta-analysis) ~ to obtain critical comments were submitted by reviewers affili- sufficient numbers for analysis." ated with the tobacco industry. The pattern of argu- "This study examines all submissions received by the ment and citation displayed in the TIA submissions EPA during its public comment period to determine if was similar to that used by the Tobacco Institute of submissions from the US tobacco industry presented~ a New Zealand in its rebuttal to the New Zealandl pattern of argument and citation similar to that Department of Health report on ETS. The comments f TIA d' d h presented by the New Zealand Tobacco Institute. We rom revtewers an atauons use to support t em ~ tested the hypothesis that~ comments which opposed were in sharp contrast to the comments provided by the conclusions of the draft risk assessment were no the SAB, ad group of independent experts who also j~ more likely to be submitted by individuals affiliated reviewed the draft. The SAB' pointed out areas in which ~ with the tobacco industry than others. We also corn the risk assessment could be improved, but its criticisms O nanYl rhr editncislsev'iew nnlirirs fnr thr ritar;nne sn tended to be more balanced than the TIA reviewers." ~

AUGUST 6~,,11993 studies that should have been included or exduded in the risk assessment, the TIA reviewers attempted to show that the analysis was unbalanced. However, they often cited unsupported opinion, such as letters-to-the- editor, editorials, or discussions at meeting proceed- ings, as evidence that ETS is not harmful. TIA review- ers sometimes misrepresented the findings of individual studies.... The TIA reviewers misrepresented' literature describing how methods of ETS exposure measure- ment can be incrementally improved by using it to suggest that currently available measures of ETS are invalid and should not be used at alll" "TIA reviewers attempted to create an unattainable 'standard of scientific proof by failing to accept epidemiological models of causality and rejection of the null hypothesis. This tactic is identical to one that the industry has used for decades in contending that there is a continuing scientific'controversy''as to whether or not active smoking harms smokers." "A frequent criticism of the draft risk assessment was that it ignored the literature on potential confounding factors that can contribute to lung cancer or respiratory problems in children. Although most of the literature cited to support the argument on~ confounders was peer reviewed, the papers cited did not usually include ETS exposure as a variable and, therefore, were not directly relevant to the EPA analysis.... We found that the draft risk assessment cited the available literature that assessed the effects of both ETS and confounders." "The analysis of the scientific literature used to support specific arguments of the TIA reviewers reveals that the reviewers based their comments on non-peer- reviewed literature to a greater degree than~did the EI'A risk assessment'....The citation of non~peer-reviewed literature by reviewers affiliated with the tobacco industry suggests that the industry was attempting to refute the scientific evidence published in peer- reviewed publications with resear& or opinion of inferior quality. In addition, the non peer-reviewed material cited by the critical reviewers was not ac- knowledged as such and criticisms included' in letters- to-the-editor were cited without citing investigators' responses to the letters." "The tobacco industry appears to be producing publications which can be used to support its conten- tion that ETS is not harmful to health, including A-9 pseudo- or quasi~scientific booklets, pamphlets, editorials, and letters-to-the editor refuting the harmful effects of ETS. In addition, four of the symposia cited in the critical comments explicitly stated that they were sponsored, at least in part, by the tobacco industry. This material was heavily cited by TIA reviewers." "The tobacco industry has used the comments as part of its public relations campaign to refute the dangers of ETS. The tobacco industry prepared excerpts of criticisms of the risk assessment and released them at a press conference in 1990. These excerpts have been circulated to local legislators where smoking restric- tions were being,considered M California. In addition, letters>to-the-editor and editorials in local newspapers where smoking restrictions were being considered have cited the TIA reviewers comments as if they repre- sented the EPA's position: One letter stated that, according to EPA Docket No. 600,6-90-006A, 'over 50 scientists speak out against the overblown health issue of ETS'. None of this press material acknowl- edges that the majority of the comments came from sources affiliated to the tobacco industry, or that these statements did not represent EPA policy." "By responding to the tobacco industry criticisms, as well! as to the criticisms of other reviewers and the SAB, the EPA scientific staff produced a stronger document. However, the invoNvement of the tobacco industry in the critical comments and the literature cited to support the commentsdEtracted from the scientific value of their criticism. The price to thepublic has been that the sheer volume of industry documents requiring consideration probably slowed down release of the final report and, perhaps, reduced the resources that EPA devoted to other work. Tobacco industry activities might also have drawn public attention to the report and thereby increased public interest in and awareness of the dangers of ETS." "As the regulation~of ETS exposure continues to be an~ issue, the tobacco industry can be expected to persist in using the tactics outlined in this paper at the local, national, and international levell to refute the independent scientific findings regarding,the health efI'ects of ETS. Policymakers concerned with limiting the effects of ETS exposure should be informed about these tactics in order to evaluate fairly the conclusions of scientific consensus documents on ETS."

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