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SHOOK, HARDY& BACON REPORT ON RECENT ETS AND IAQ DEVELOPMENTS September 24, 1993 N ~ ~ O ~ GT. SHB C

REPORT ON RECENT ETS AND IAQ DEVELOPMENTS. - IN' THIS ISSUE - IN THE UNITED STATES REGULATORY AND LEGISLATIVE ITEMS • Joseph Dear is nominated as assistant secretary in charge of OSHA, p. 1. • Report on a recent EPA indoor air quality committee meeting, p. 2: • Plaintiffs file their brief in opposition to. EPA's motion to dismiss the ETS Risk Assessment litigation, p: 2. ETS-RELATED1ITIGATION AGAINST CIGARETTE MANUFACTURERS • Court of Appeal denies petition for rehear- ing in Broin; CEO depositions being scheduled, p. 5. • Plaintiffs' motion for protective order is denied in Butler, p: 5. SCIENTIFIC/TECHNICAL ITEMS ISSUE 56. • "Heart Disease and'the Environment," p. 7. • "EnvironmentallTobacco Smoke Concentra- tions in No-Smoking and. Smoking Sections of Restaurants," p. 8. • Repace and Lowrey publish study on ETS in the workplace„ p. 9. IN EUROPE & AROUND THE WORLD: REGULATORY AND LEGISLATIVE MATTERS • Tobacco interests challenge cigarette pack warnings M Canada, p. 10. • Health officials plan to introduce antismok- inglegislation in South Korea,, p. 10. ETS-RELATED LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS • ETS/IAQ LrT1GATlON NOT INVOLVING CIGARETTE MANUFACTURERS • • IAQ case in Michigan involves a school's ventilation system, p. 6. • Court cites McKinney in a prisoner smoker's rights case, p; 6. LEGAL ISSL'ES AND DEVELOPMENTS • "Tobacco Strategy Emerges as Legislative Smoke Clears," p. 6. OTHER DEVELOPMENTS/MEDIA COVERAGE. • The Centers for Disease Control launch a SIDS study, p. 6. •"Jailed Pastor Fears Inmates Blame Him for. Butt Ban," p. 12. Decision in1avor~ of defendant in Burswood case in Australia, p: 10. Cameron v: Qantas is dismissed in Australia, p. 1 U. OTHER DEVELOPMENTSIMEDU# COVERAGE • Antismoking group in Australia to publish smoke-free restaurant guide, p. 12. • BASP issues new ETS Booklet in connection~ with the EC's Europe Against Cancer~ Programme, p. 12. 2024702501

- TABLE OF CONTENTS - Issue 56 September 24, 1993 IN THE UNITED STATES REGULATORY'AND LEGISLATIVE MATTERS ULS. O'CCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSI"IA). [i1!] Dear Nominated as Assistant Secretary in Charge of OSH;A ................................................... 1 [2) OSHA Prepares Enforcement Policy for TB Exposure ........................................................--.. 1 U.S. DEPARTMENT OF I!'1FAI_TH'. AND I'IuMAN SERVICES (HHS) [L3] HHS Establishes Goals on Smoke-frce Environments ............................................................. 2 U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) [4] ETS RiskAuessment Liiigation.r Plaintiffs File Brief in Opposition to Motion to Dismiss .............. 2 [5] IAQCommittee Reviews EPA Indoor Air Research Program .................................................. 2 103D CONGRESS [6] Appropriations Measure Moves Into Conference Committee .................................................. 3' STATE AND LOCAL GOVERNMENTS. [7] NCI Publishes List of Loca]ISmoking Regulations ................................................................... 3 [8] ETS-Related State and Local Legisl'aoivc Activities ...................................................................,4' ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [9] Blanchard: Hcaring on Motions,to Transfer Venue and to Strike Held ................................... 4 [10] Broin: Court ofAppeal Denies Petition forRehearing; CEO Depositions Bcing Scheduled ......... 5 [I 1] Butlir: Plaintiffs' Motion for Protective Order Denied ............................................................ 5 [121 Voth: Petition for Writ of Mandamus Denied ......................................................................... 5 ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS WORKPIACE:IAQl~UN7ON' REPRPSEN'rAT1ON', [13] EastJaekson Public School Districr; East Jack'son Education Association v. Knoke, 1993 Mich. App: LEXIS 347 (Couro of Appeals, Michigan) (decided May 26, 1993) ............. 6 PRISONER CA:SE:'. R1GHT TO SMOKE [1i4] Rodriguez v. Pearce, 1993 U.S. App. LEXIS 23385 (U.S, Court of Appealk„ Ninth Circuit) (decided September 10, 1993) ......................................................................... 6 LEGAL ISSUES AND DEVELOPMENTS [I1I5] "Tobacco Strategy Emerges as,Legislative Smoke Clears," J. Matthews, Sacramento Bee, September 14, 1993 ....................................................................................... 6 OTHER DEVELOPMENTS [16) CDC Launches SI Million SIDS Stud'y .................................................................................. 6. [17] Sunroom Sales Increase to Ptovidc Smoking Shelters ............................................................-7 MEDIA COVERAGE [18] "G1ov.ing over the Cigarette Tax," A. Reid, The Boston Globe, September 12, 1993 .................... 7' [191 "The Smoke-Frce Workplace," CNN Managing mirh Lou Dobbs, Scptembcr 11, 1993 ............... 7' SCIENTIFI CITECHhTICAI. ITEMS CARDIOVASCULAR ISSUES [20] "Heart Disease and the Environment," S.A. Glantz„Journal of the American Collegc o,fCardrology 27 (6): 1473-1474„ 1993 [See Appendix A] ............................................. 7 OTHER HEALTH ISSUES [21] "Cigarette Smoke - Radiation Harsrd,."'G.D.,Evans, Ptdiatrics 92(3):,464-465, 1993 [See Appendix A] .................................................................................................... ....... 7 [22] "'Parental Cigarette Smoking and Tonsillectomy in Children," A.E. Hincon4 R.C.D. Herdman; D. Martin.Hirsch, and S.R. Saccd, Clinical Otolaryngology 18: 178-180„ 1993 [See Appendix A] .................................................. 7 z02470z502

Contents Continued, Issue 56 ETS EXPOSURE AND MONITORING [23]I "Validation of ETS Exposure in a Representative Population in Southern Gcrmany;" W.-D. Heller, E. Senncwald~ Ji-G. Gostomzyk, G. Scherer„and F. Ad[kofer, ProceedingJ of/ndoorAir 93 3: 361-365, 1993 [See Appendix A] ................... ................. 8 [24,] "Environmental Tobacco Smoke Concentrations in No•Smoking and Smoking Sections of Restaurants," W.E. Lambert, J.M. Sameo, and J.D. Spangler, American Jburnal'ofPu6lic Healrh 83: 1339-1341, 1993' [Sec Appendix A] ............................. 8'. [25] "Temporal Variability of Benzene Exposures for Residents in Sevcral New Jersey Homes with Attached Garagcs or Tobacco Smoke," K.W. Thomas, E.D. Pellizzari; C.A. Gayton, R.L. Perrirt, R.N. Dictz, R.W. Goodrich, W.C. Nelson, and L.A. Wallace, Jourrtal ofExporure Analysis and Environmental Epudemiolagy 3(1): 49-73', 1993 [See Appendix A] ........................................................................................ 8 INDOOR AIR QUALITY [26] "The Helsinki Office Environment Study: The Type oflVentilation System and the'Sick Building Syndrome,"' J.J.K. Jaakkola; P. Micttinen, P. Tuomaala, and O. Seppanen, Rroceedings oflruloor Air 93 1: 285-290, 1993 [See Appendix A]', ......................,8 [27] "The Impact of Building Management Strategies on Occupant Perception of Indoor Air Quality," E.N. Light, M. Tyson, F.J. Sisson„and'R.D. Gay, Proceedings oflndoorAir 23'6: 563-568, 1993 [See Appendix A]I ............................................ 8 [28] "How Much Does Environmental Tobacco Smoke Contribute to the Building Symptom Ind'ex?'" A. Raynal, P.S. Burge, A. Robertson, M. Jarvis„M. Archibald, and D. Hawkin, Proceedings of/ndoor Air '93 1: 529-534,:1'993 [See Appendix A] .................. 8 SMOKING POLICIES AND RELATED ISSUES [29] "Lower Levels of Cigarette Consumption Found in Smokc-Frce Workplaces in California," T.Jk WoodrufPs B. Rosbrook„J. Picrcc„and SA. Glantz, Archiuts oflnternal Medicine 153: 1485-1493, 1993 [See Appendix A] ................................... 9 STATISTICS AND RISK ASSESSMENT [30] "An Enforccable Indoor Air Quality Standard for Environmental Tobacco Smoke in the Workplace,"' J.L. Repace and'A.H. Lowrty„Ri.ik Analysis 13(4): 463-475, 1i993 ............ 9 [3'1i]I "Publication Bias and Public Policy," L. Bero and D. Rennic, abstract presented at the Second International Congress on Peer Review in Biomedical Publication, American Medical Association, Chicago, Illinois, September 9-11i, 1993 [Sec Appendix A]' .................................................................................................... ................ 9 1 IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS A.USTRALIA. [32] Train Smoking Ban is Extended .............................................................................................. 9, BELGIUhd. [33] Smoking Restrictions Not Being Enforced ...............°............._........-....._.._...........---.......---... 10 CANADA [34] Tobacco Companies Challenge Cigarette Pack Warning Regulations .................................... 10 HONG KONG [351 CouncillEndorses Restaurant Nonsmoking Signs .................................................................. 10 PHILIPPINES [36]1 Smoking Banned in Public Places in Rizal ............................................................................. 10 SOUTH ~ KORFa [37]! Health Authorities to Introduce Smoking Ban Legislation .................................................... 10 UNITED ARABEMIRATES[38] Council Committee Recommends Smoking Bans .....................................................•...•...---• 10, 2024"702iO:3

Contents Continued, Issue 56 ETS-RELATED LITIGATION NOT INVOLVING CIGARETTE MANUFACTURES AUSTRALIA [39] Department of Otcupational Hralth and Safety v. Burswood Rrsorr (Management) Ltd. (Magistrate's Court, Perth) (decided September 17, 1993)',•••-.•-••••-•••••••••••••..-•.-••••--•••••••• 10 [I40] Cameron v. QGntasArruays Limitrd(FederaliCourt, New South Wales) (filed April 7, 1993) ........................................................................................--.......... .......... 1 1 LEGAL ISSUES AND DEVELOPMENTS UNITED KINGDOM [41] Study Focuses Upon Workplace Smoking Policies ...............................•-•••••••..•.•••••-•••••••.••-••. li1 OTHER DEVELOPMENTS AUSTRALIA[42] Cancer Council Survey at Odds with Rcsraurateur Pcrccptions ............................................. 1 1. [43] Antismoking Group to Publish Smoke-Frcc RestauranrList ................... .............................. 12 [44] Smokers Ignore Shopping Center Smoking,Ban .............................................................•-•••.• 12 EURO['EAN'. COMMUNITY[45] BASP Publishes New ETS Booklet .................................................--......................_........_..... 12 UNITED KINGDOM [46] Survcy Addresses Smoking in Pubs ...............................................--....................................... 12 [47]I Nonsmoking Rental Cars,tntroduced' .................................................................................... 12 MEDIA COVERAGE CANADA [48] "Jailed Pastor Fears Inmates Blame Him for Butt Ban," The Vancouver Sun, Septembcr 8„ 1993 ......................... ....................................................... 1 2 HONG KONG [49] "Why Keeping Cool Makes You III," South Ch'ina Morning,Post, September 5, 1993 ................................................... ............................................................. ,13 APPENDIX A .................................................................................................... ............................. Article Summaries.

SEPTEMBER 24, 1993 1 REPORT ON~~ RECENT ETS AND IAQ DEV ELOPMENTS IN THE UIh1ITED STATES REGULATORYA.Ir1'D LEGISLATNE MATTE+RS U.S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA). [1] Dear Nbminated as Assistant Secretary in Charge of OSHA Joseph Dear was nominated on September 7, 1993, ass assistant secretary in charge of OSHA Although his nomination is evidently not expected to face serious opposition, it is u.nknown when he will be confirmed by the Senate and assume his duties. OSHA has been without an administrator since President Clinton took office in January 1993. Dear was former Director of Washington state's Department of Labor and Industries. He has served as a consultant to OSHA since Aprili 1993. Dear currently serves on a committee formed by Labor Secretary Robert Reich, to:analyze proposed OSHA reform legislation andi develop the Clinton administration's position. Meanwhile, the House subcommittee that is conduct- ing hearings on OSHA reform legislation (H.R. 1280)4 will reponedly not invite the Clinton administration to present further testimony on the measure until Dear is confirmed. The subcommittee on Labor Standards, Occupational Health and Safety of the House Education and Labor Committee will apparently resume hearings on September 28„ 1993, with panels representing labor unions and states that conduct their own job safety and health programs. See BNA Daily Labor Rcport; Septem- ber 14, 1993. [2] OSHA Prepares Enforcement Policy for TB Exposure According to a press report, OSHA has circulated an eight-page draft memo that sets forth the agency's enforcement~ policy and procedures for inspecting workplaces for occupational exposure to tuberculosis (TB), A number of labor unions petitioned OSHA in. August 1993' to develop such a policy. See issue 54 of this Report, August 27, 1993. The policy, which is apparently being,issuedg partly in response to the petition,,will reportedly become effective immediately upon receipt of the memo by regional administrators. OSHA will apparently use the general duty clause of the Occupational Safety and Health Act to cite em- ployers who expose their workers to the hazard of TB infectiom The general duty clause requires that em- ployers provide a place of employment that is free from recognized' hazards that may cause death or serious physical harm to workers. OSHA will also rely upon its personal protective equipment regulation~ to cite employers who fail to provide adequate respirator protection to employees in particular circumstances. Dnspections for TB exposure will reportedly be conducted in response to worker complaints or as part of an industrial hygiene inspection~ in places such ass health care facilities, correctional institutions, homeless shelters, long-term care facilities and drug,treatment centers. Among the measures OSHA recommends for hazard abatement are (i) ~ medical screening; (ii) 1 impos- ing,work restrictions on infectious workers; (iii) using respiratory isolation rooms for individuals with sus- pecte&or confirmed TB; and~ (iv) engineering controls, such as local exhaust and ultraviolet lights. Circumstances under which employees must, wear respirators are outlined in, the memo, as are the types of respirators that must be provided. OSHA will also reportedly require employers to use a workplace injury and illness log to record the incidence of active and latent TB among workers in~high-risk settings. See Occupational Safety d' Health Rcponer, September 8, 1993. 2024702505

2 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) [3] HHS Establishes Goals on Smoke-free Environ- ments On September 15, 1993, HHS released its annual report on the nation's health: Health, United States, 12P2: In the report HHS states, "Passive or involun- tary smoking also causes disease, including lung cancer in healthy nonsmokers and respiratory problems in young children and infants." The report provides statistics on~the number of workplaces and ed'ucationall institutions with smoking,restrictions or bans and on the number of states with "clean indoor air" legislation regulating smoking. Also, as part of HHS's °Healthy' People 2000" program, the report contains a series of health objectives, some of which relate to ETS. According to HHS, policies which prohibit or restrict smoking in the workplace have increased from 27 percent of worksites with 50 or, more employees in 1985 to 59 percent in ~ 1992. HHS has established the goal of increasing the number of worksites banning or "severely"'restricting smoking,to 75 percent by the year 20001 Some 17 percenr of schools were "tobacco free" in 1988; and'HHS hopes to increase the number of "to- bacco free" schools to 100 percent in ~ the next seven years. HHS reports that, in 199'1i, 44 states had laws restricting smoking in public places, 35 states had! laws restricting smoking in public workplaces, and 16 states had laws regulating smoking in private and public workplaces. The goal that HHS has established in this regard is for the enactment, in all 501states, of "com- prehensive laws on clean indoor air that prohibit or strictly limit smoking in the workplace and enclosed public places (induding health, care facilities, schools, and public transportation)'." U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) [4] ETS Risk Assessment Litigation: Plaintiffs File Brief in Opposition to Motion to Dismiss In a 50-page brief opposing the motion to dismiss filed by the EPA and its administrator, Carol Browner, plaintiffs refute the procedural arguments in EPA's motion to dismiss. ` An administrative decision so ETS/1AQ REPORT, ISSUE 56 deliberately taken„widi such attendant formality, with such widespread and practical effect upon millions of American farmers and workers, in such lawless disre- gard of statutory and regulatory authority, cannot evade judicial review," the brief states, "To deny review would effectively give EPA powers far beyond those permissible under our system of separation of powers and would perpetuate a patent injustice." The brief was filed on September 20, 1993. EPA's motion to dismiss contends that the court has no jurisdiction over the subject matter of the action and that relief cannot be granted on, plaintiffs' due process claim, In opposition, plaintiffs argue: • EPA's,deeision to designate ETSunder the agency's carcinogen classification scheme is "final agency action" within the meaning of the Administrative Procedure Act and is ripe for judiciallreview; and • The complaint states a viable due process claim that, contrary to EPA's arguments, is not out- weighed by the agency's interest in public health. Plaintiffs' complaint seeks a declaration that EPA's decisioni to designate ETS a Group A carcinogen, together with the risk assessment on which, the decision is based, is unauthorized, arbitrary and capricious, violates procedures required by law, and amounts to a denial of due process. Plaintiffs also seek a permanent injunction, requiring EPA to witlidraw the Group A designation and the underlying risk assessment. Flue- Cured Tobacco Cooperatzve Stabilizntion Corporation, et aL, v. EPA, No. 6:93CV370! (U.S. District Court, Middle District„North Carolina) (filed June 22, 1993). [I5] IAQCommittee Reviews EPA Ind!oor Air Research Program Environmental tobacco smoke was one of the topics discussed at EPA's Indoor Air Quality/Totall Human Exposure Committee meeting on September 8-9, 1993, in North Carolina: The purpose of the meeting was to review the EPA's indoor, air research program. Highlights of the meeting includ'ed the following: • The deputy director, of the Environmental Criteria and Assessment Office characterized the EPA Risk Assessment on ETS as one of the most important public health documents to come out of the federal government. 6 2()24 : ~j2 5 a0

SEPTEMBER 24, 1993 • When the environmental futures project was discussed!, committee members volunteered to take part in the project and began to list "environmental drivers" for IAQ and human exposure issues. Among those "drivers" listed! was ETS, with a notation that tobacco should be banned within twenty years. • Committee members questioned EPA staff about how the agency picks the sources upon whi& to perform testing. According to the staff, the EPA performed a literature search and, of the 22 indoor: air constituents the EPA was able to identify, fiingi4 bacteria and dust mites came out at the top of the list. • Bob Axelrad, director of the EPA's Iind'oor Air Division, distributed the EPA publication "Second- hand Smoke What You Can Do About Secondhand Smoke As Parents, Decisionmakers, and' Building Occupants" during his presentation. He also advised committee members that even where the EPA does not know everything about, a particular indoor air constituent, the agency can tell people to minimize exposures. • During the briefing about energy costs and other economic issues, the committee was told of a BOMA survey which found that most tenants who moved from one location to another listed HVAC problems as their greatest source of dissatisfaction. Also during,this briefing, when the source and accuracy of the EPA's productivity figures were found to be questionable, committee members cautioned the EPA staff to make sure that the figures they use are defensible. Committee members were briefed during the meeting, on various aspects of EPA's indoor air research pro- gram. Presentations were made on the five EPA IAQ research areas, i.e., source characterizations exposure assessment, health effects, risk assessment and! solutions research. Also discussed were a new environmental futures project; the Building Assessment Survey and Evaluation program (BASE), an IAQ survey of office buildings; lead-based paint research; and the efforts of the Indoor Air Division to characterize the relation- ships between energy cost and building IAQ and other economic issues. Prior to the meeting, the committee was charged with reviewing the program's ability to: (i) address the most 3 important scientific questions involving lAQ (ii) provide scientific and technical support to the EPA's program offices and regions; (iii) promote private sector involvement in indoor air research; and (iv) support EPA's leadership ~ role in IAQ research. The IAQTHEC was also charged with; reviewing whether the EPA's Indoor Air Issue Plan projects are commen- surate with these goals and whether the Plan provides adequate intra- and inter,agency cooperation. See Federal Register, August: 31, 1993. During the meeting, the IAQTHEC was asked to add four questions to its charge. They were as follows: (i) whether the Issue Plan format is appropriate; (ii) whether the funding is adequate for the overall IAQ issue; (iii)iwhether funds have been appropriately distributed between the five areas of IAQ research; and (iv) whether the EPA should include the preparation of criteria-like documents for IAQ constituents. Committee members were asked to submit their comments on each of the above eight questions within three weeks following the meeting. The comments will be edited and presented to the EPA's Science Advisory Board executive committee to consider, during itss meeting scheduled for October 26-27, 1993. 103D CONGRESS [6] Appropriations Measure Moves Into Conference Committee The House appropriations bill (H.R. 2403), to which Senator Frank Lautenberg (D-N.J.) successfully append'ed'his PRO-FEDS legislation, was considered briefly on the House floor on September 9; 1993: There was no discussion of the PRO-FEDS amend- ment; the measure was sent~ to the conference commit- tee with instruction on other provisions of the bill, and conferees were appointed. The PRO~FEDS amend, ment would restrict smoking in federal buildings to areaswitLseparate ventilationL STATE AND LOCAL GOVERNMENTS [7] NCI Publishes List of Local Smoking Regula- tions The National Cancer Institute (NCI) has reportedly published a monograph listing the restrictions and bans 2024702"507

4 on smoking in restaurants and workplaces imposed by cities and towns across the nation. The monograph,, entitled Major Local Tobacco Control Ordinances in the United States; apparently covers 505 local ordinances that address smoking in restaurants and 400 ordinances it claims bans smoking in the workplace. See Indoor Pollution News, September 17, 1993. [8] ETS-Related'State and Local Legislative Activities • California On September 7, 1993, Governor Pete Wilson (R) signed into law a bill that prohibits smoking during the hours of operation of a private residence that is licensed'as. a family day care home. The law also prohibits smoking on the premises of any child' d'ay care center. The law goes into eff'ect January 1, 1994. SeeA.B: 615, Reg., Sess. (1993-94) and Sacramento Bee,,September 9, 1'993. Awaiting,the Governor's signature is A.B. 291, a bill that would prohibit smoking in a state-owned or - leased building, within five feet from the main exit or entrance of such a building, or in a state-owned vehicle. SeeA.B. 291, Reg. Sess. (1993-94). • Local Governments in California Huntington Park. The mayor, a councilman, the city attorney and members of the Chamber of Commerce are reportedly forming a committee to draft an ordi~ nance restricting smoking in public workplaces. A news report oni formation of the committee claims the antismoking movemenn has "picked up steam"'since release of the EPA Risk Assessment on ETS. See Los Angeles Tzmes; September 12, 1993. Santa Ana. Tfie City Council unanimously approved an ordinance prohibiting smoking in the 22 buildings owned, leased or used by the city. The ordinance affects 1,400 employees. A county H'ealth Care Agent reportedly said that "a lot of cities are becoming proactive in eliminating the smoke in their workplaces" since the release of the EPA Risk Assessment on ETS. See Los Angeles Times, September 8, 1993. R?estHollywood. The City Councillgave finaliapproval to a measure banning smoking in restaurants, except bars and' outdoor, eating areas. Sce The Los Angeles Times, September 9, 1993. • Local Governments in Louisiana St. Charks Parish. An ordinance under, consideration that would have banned smoking in stores, restaurants ETS/IAQ REPORT, ISSUE 56 and other public places reportedly failed'to meet a state- imposed deadline. The state gave local governments until September, 1, 1'993, to adopt stricter regulations than State of Louisiana, whichiallows businesses to set aside smoking areas for customers. St. Charles pari'shh currently prohibits smoking in some areas of public buildings. See The Times-Picayune, September, 9, 1993: • Local Governments in Maryland Howard County. According to a news report, County Executive Charles Ecker has for the second time vetoed:an antismoking bill that would have prohibited smoking,in nearly all public places except in sPlf-enclosed and! sepa- rately-ventilated bar areas of restaurants. Ecker opposes the exemption and was quoted to say, "I am concerned about the bartenders, waiters and waitresses who:will have to work in those smoking areas." Unless four of the five council members vote to override the veto, it will stand. See Baltimore Morning Sun; September 14, 1993: Talbot County: A petition drive has been initiated in opposition to am antismoking ordinance passed! on August 10, 1993, by the County Council. The ordi- nance prohibits smoking in most public places and common work areas. Bars, bowling alleys, pool halls, private clubs and hotell rooms are exempt. See Baltimore Morning Sun, August 28, 1993. • Local Governments in Texas I'lano. The City Council is reported to~have recently listened to a presentation by city health officials and expressed': its support for stronger smoking restrictions in public places such as restaurants, shopping centers„stores, schools and city buildings. An advisor to the city, Dr. Bill Swicegood~ urged immediate action. Citing the EPA Risk Assessment on ETS, he reportedly said, "The ordinance we have is good, but it's not as visionary as it once was because all our new data ... shows that secondhand smoke causes up to 50;000 deaths a year." See The Dallas Morning News, September 11, 1993. ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [9] Blanchard Hearing on Motions to Transfer Venue and to Strike Held At a:hearing on September 13, 1993, Judge Roy Engelke took under advisement defendants' motions to 2024"70 25(l 8

SEPTEMBER24', 1993' strike and! to transfer venue. As previously reportedi the motions contended, that (i) the Galveston Counry; Texas, venue is improper because plaintiffs' causes of action did not accrue there; (ii) the claims asserted on behalf of the various plaintiffs did not arise out of the same transactions or occurrences; (iii) plaintiffs did not seek leave of court before filing their supplementaliand amended petitions, which added new parties to the case; and (iv) the petitions are improper attempts at forum-shopping. Three of the 14 plaintiffs im this case presently allege injury from exposure to ETS. Raye Blanchard and Tamara Reed, mother and daughter, both claim d'amages for unspecified'"illness and disease" allegedly resulting from exposure to the ETS from cigarettes smoked by Raye's deceased husband, Thomas, and by Raye herself, who claims she smoked "for about ten years." The third ETS plaintiff„Pamela Kastrin Stephens, claims unspecified "lung and respiratory diseases" allegedly caused by exposure to the ETS from~ the cigarettes smoked by her deceased father. The named defendants are purported to be the six major U.S. cigarette manufacturers, The Tobacco Institute, the Council for Tobacco Research, and'a number of wholesalers and retailers. B/anchard, et al., v. R.J.Rrynoa Tobacco Company, et al. (Districn Court, Galveston County, Texas) (filed July 31, 1992)'. [10], Broirr. Court of Appeal Denies Petition for Rehearing; CEO Depositions Being Scheduled, On September 14, 1993, the Third District of the Court of Appeal of Florida denied rehearing and cenification to the Florida Supreme Court on a petition, for writ of certiorari filed after the trial court denied motions to quash deposition notices served on senior executives of six d'efendants. Ini its ruling, the Court also vacated a stay of the deposition notices that it had granted on June 11. The day after the appellate court's ruling, plaintiffs noticed the depositions of executives of Philip Morris, RJ. Reynolds, Lorillard and Liggett. They are presently scheduled'to begin on October 111. The Court of Appeal first denied the petition for writ of ceroiorari' on May 27. At issue in this case are the claims of 28 flight atten- dants allegedly injured by occupational exposure to ETS. In addicions the husband of one of the flight 55 attendants claims loss of consortium. The attendants purport to represent a class of approximately 60,000 other attendants. Injuries alleged by the putative class representatives indude lung cancer~, breast cancer and unspecified respiratory ailments. Plaintiffs further allege that occupational exposure to ETS on board aircraft causes at least 22 diseases and a! reasonable fear of contracting such diseases. The defendants include the six major U.S. cigarette manufacturers (plus related entities), UST, Inc., United States Tobacco Company, Dosal Tobacco Corp:, the Council for Tobacco Research, The Tobacco Institute, and'three trade associations. Broin, et al, v. Philip Morris, et al.(Circuit Court, Dade County, Florida) (filedl October 31, 1991). [11] Butler. Plaintiffs' Motion for Protective Order Denied Oni September 10, 1993, Judge Gibbs denied plain- tiffs' motion for protective order regarding defendants" deposition notice for plaintiff Ava Dean: Butler. Plaintiffs contend that Burl Butler, a barber im Laurel, Mississippi, developed lung cancer~ as a result of his exposure to environmental tobacco smoke. The defen- dants in this case consist of the six major U.S. cigarette manufacturers and several local retailers. Butlrr v. RJ:. Rrynalds Tobacco Company, etal. (Circuit Court, Hinds County, Mississippi) (filed October 21, 1992). [12] T!oth: Petition for Writ of Mandamus Denied On September 8, 1993, the Ninth Circuit Court of Appeals denied per curiam plaintiff s petition~ for writ of mandamus. Plaintiff had asked the court to direct U.S. District Judge Robert Jones to: disqualify himself from~ the case because of bias. The Ninth Circuit's order directs the plaintiff not to file any motions for reconsideration, rehearing, clarif cation, stay of the mandate, or any other submissions in the matter. The panel was composed of Judges Betty Fletcher, Cecil Poole and Diarmuid O'Scannlain. Frank Voth, who is incarcerated im the Oregon State Penitentiary, alleges that his civil rights have been violated as a result of his exposure to environmental tobacco smoke. He also claims that he has "incurred permanent health damage and is at risk of death" as a result of ETS exposure. Defendants in uoth are Forsyth 2024'7(12'509

6 Tobacco Products, R.J. Reynolds and Brown & Williamson. Voth v. Forsyth Tobacco Products, etal (U.S. District Court, Oregon) (filed April 27, 1993) ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS WORKPLACE: IAQIUNION REPRESENTATION [13] East Jackson Public School District, East Jackson Education Association v. Knoke, 1993 Mich. App. LEXIS 347 (Court of Appeals, Michigan) (decided May 26, 1993). A Michigan appellate court has determined that a, labor union met its duty of fair representation in: handling and refusing the claims of a middle school counselor who sought sick leave for symptoms allegedly due to changes in a school's ventilation system. The court also determined that the school district did not breach its contract in failing to pay lost wages and benefits, including sick days, and in failing to provide a transfer to another building. The court: also ruled that the school district had not discriminated against the counselor on the basis of a handicap: The court found that the union had pursued the counselor's claims with due diligence, an& that two medical evaluations in the record supported the schooll district's refusal to provide additional sick leave. The evaluations indicated that the counselor's symptoms were not environmentally induced, The court also found that the counselor was not qualified for a transfer. PRISONER CASE: RIGHT TO SMOKE [14] Rodriguez v. Pearce, 1993 U.S. App. LEXIS 23385 (U'.S. Court of Appeals, Ninth Circuit) (decided September 10, 1993)~ Citing,the U!S. Supreme Court's decision in Helling v. McKinney; 61 U.S.L.W. 4648' Oune 18, 1i993), the Ninth Circuit Court of Appeals has rejected an Oregon state prison inmate's claim, that his constitutional rights of due process and equal protection were violated when he was forbidden from smoking in the disciplinary segregation unit of the prison. The prison policy permitted only death row inmates to smoke there. ETS/IAQ REPORT, ISSUE 56 The court found than there was no authority to support the inmate's daim that the smoking ban impinged his constitutional right to "freedom of choice." The court stated, "even if the smoking bann does impinge on a constitutional right, the ban is reasonabNy related to the legitimate penological' interest of protecting other prisoners from tobacco smoke.... Death row prisoners are not situated similarly to other prisoners, and their impending execution is a reason: to treat them differently." Thus, the court found that the districtr court did not err in granting summary judg- ment in favor of the defendant. LEGAL ISSUES AND DEVELOPMENTS [L5]' "Tobacco Strategy Emerges as Legislative Smoke Clears," J. Matthews, Sacramento Bee, Septem- ber 14, 1993 This article discusses the efforts of antismoking activists and cigarette manufacturers to protect their respective interests. Antismoking lobbyists have reportedly been successful in convincing the governing bodies of a number of cities and'towns to adopt tough restrictions on smoking. The tobacco industry, claims the author, is apparendy focusing its effons upon statewide legislatiom that would impose weaker restric- tions while preempting,local regulations. John Banzhaf, who was interviewed for this article, has reportedly documented tobacco industry lobbying activity in at least nine states, including California. Tom Lauria of the Tobacco Institute is quoted as saying, "Just being objective about it, it makes a lot more sense than anti-smoking activists going from town to town pushing crazy-quili rules that people who want to can easily avoid.... We're fighting prohibitionists." ~ THER DEVELOPMENTS ..r ~ ~ ~ ~ [16] CDC Launches $1 Million SIDS Study The Centers for Disease Control, a division of the U!S. Department of Health and Humam Services, has reportedly launched a study of Sudden Infant Death Syndrome (SIDS) that will attempt to pinpoint risks .r

SEPTEMBER 24, 1993 from ETS, sleeping position and room temperature. The $1 million study will take place in Chicago and is reported to be one of the largest to dealwith environ, mental and social risk factors for SIDS. Chicago is said to have one of the highest rates of SIDS in the nation. See The Baltimore Morning Sun, September, 5, 1993. [17] Sunroom Sales Increase to Provide Smoking Shelters Corporations are reportedly adding glass enclosures to doorways and other~ existing outdoor structures to shelter smokers from the elements. Patio Enclosures of Cleveland, Ohio, purportedly the largest manufacturer of sunrooms and green houses in the United States, says its sales have doubled during the last year. Patio apparently attributes the added'sales to a trend among corporations to give their "hard-core" smokers a place to smoke. See I'ndoor Pollution News, September 17, 1993. MEDIA COVERAGE [18] "Glowing over the Cigarette Tax," A. Reid, The Boston Globe, September 12, 1993 This article outlines the ways in which local commu- nities in Massachusetts are attempting to enforce their smoking restrictions with the money raised through a recentl{y-increased tax on cigarettes. Apparently; budgett cuts in the 19805 caused staffing cutbacks and this resulted in a shortage of enforcement personnell Munici- palities such as Milton, Hingham, Norwelll and Quincy will reportedly be applying for a share of the $7 million raised by the tax increase to hire inspectors and to fund education programs. It is anticipated by some healthh officials that many more communities will adopt: smoking bans and restrictions once the public is educated about the purported health effecta of ETS exposure. [19] "The Smoke-Free Workplace,"' CNN Managing with Lou Dobbs, September 11, 1993 Smoking in the workplace was discussed during a recently-aired segment on a cable news program. The program host referred to the EPA Risk Assessment on~ ETS and observed that employers who are seeking to contain health care liability and costs are creating smoke-free workplaces. 7 Representatives of the Centers for Disease Control and Prevention and The Tobacco Institute,,as well as corporate managers and smoking employees, were interviewe& for their views on, the issue. The experience of a New Jersey business in banning workplace smoking was profiled, with several of its vice presidents noting that employers willI find greater acceptance of smoke-free policies if they try to accommodate the interests of the smokers in the office. SCIENTIFIC/TECHNICAL ITEMS CARDIOVASCULAR ISSUES. [20] "Heart Disease and' the Environment," SA. Glantz, Journal of the American College of Cardiology 21(6): 1473-1474, 1993 [See Appendix A] In this Editorial Comment, Stanton Glantz discusses studies suggesting that air pollution may be related to adult cardiovascular disease. He states that ETS "causes and'aggravates heart disease„" citing the claim made in his earlier paper that 37,000 deaths from heart disease can be attributed to ETS. OTHER HEALTH ISSUES [21] "Cigarette Smoke = Radiation Hazard," G.D.. Evans, Pediatrics 92(3): 464-465, 1993 [See Appendix A] In this Commentary, the author makes the claim that~ cigarette smoke is "substantially radioactive." He suggests that radioactive substances could be deposited in~children exposed to parental smoking, although he provides no~data to support his proposition. [22] "Parental Cigarette Smoking and Tonsillectomy in Children," A.E. Hinton, RC.D. Herdman, D. Martin-Hirsch, and S.R. Saeed, Clinical Otolaryngology 18: 178-180, 1993 [See Appendix A] The authors of this study report that a statistically significant number of children admitted for~ tonsillec- tomy related to recurrent tonsillitis had! parents who smoked, compared to children who were not admitted for tonsillectomy. However, there was no reported relationship between parental smoking and history of 2024702511

8 tonsillitis in the study group, suggesting the influence of some unidentified factor. ETS EXPOSURE AND MONITORING [23] "Validation of ETS Exposure in a Representative Population in Southern Germany," W.-D. Heller, E. Sennewald, J.-G. Gostomzyk,,G. Scherer, and F. Adlkofer, Proceedings ofIndoor Air `93 3: 36I-365, 1993 [See Appendix A]I The authors of this paper report, on misclassification rates in a German populi;tion. They report that 5.0 percent to 7.0 percent of exsmokers and 0.6 percent to 1.1 percent of neversmokers who claimed to be nonsmok- ers at the time of the survey had cotinine levels indicative of current smoking. Also, 17.6 percent and I percent of persons who formerly reported themselves as exsmokers or smokers, respectively, reported themselves as neversmokers at a later interview. [24] "Environmental Tobacco Smoke Concentrations in No-Smoking and Smoking Sections of Restaurants," W.E. Lambert, J.M. Samet, and J.D. Spengler, American Journal of I'ublic Health 83: 1339-1341, 1993 [See Appendix A] The authors of this article, who include Jonathan Samet, report that concentrations of particles and nicotine were 40 percent to 65 percent lower in nonsmoking sections of restaurants than in~smoking sections. The study investigated seven ~ restaurants located in Albuquerque, New Mexico, and reportedly was initiated in response to interest from news report- ers, who were-investigating,tlie local smoking ordi- nance. Samet is one of the members of the Science Advisory Board' committee that reviewed the EPA Risk Assessment on ETS. [R5] "Temporal Variability of Benzene Exposures for Residents in Several New Jersey Homes with Attached Garages or Tobacco Smoke," KW. Thomas, E.D. Pdlizzari, CA. Clayton, R.L. Perritt, R.N. Dietz, R.W. Goodrich„W.C. Nelson, and L.A. Wallace, Journal'ofF_rposure Analysrs and Environmental Epddemiology 3(1): 49-73, 1993 [See Appendix A] This report, part of the EPA's TEAM (Total' Expo- sure Assessment Methodology), studies, discusses data ETS/IAQ REPORT, ISSUE 56 on benzene levels in homes with attached garages and' with smokers. The data suggest that materials (such as paints or gasoline) inigarages were significant benzene sources. The authors also propose that ETS is an important source of benzene. INDOOR AIR QUALITY [26] "The Helsinki Office Environment Study: The Type of Ventilation System and the 'Sick Building Syndrome,'" J.J.K. Jaakkola, P. Miettinen,,P. Tuomaala, and O. Seppanen, Proceedings of Indoor Air '93 11: 285-290, 1993 [See Appendix A] This paper reports on a study comparing self-reported symptoms of sick building syndrome and perceptions of air quality by office workers in buildings with natural'or several types of inechanical ventilation. The authors state that significantly more symptoms were reportedby workers in mechanicallyventilate& build- ings, and also that evaporative humidification was associated with higher1'evels of certain symptoms. [27] "The Impact of Building Management Strate- gies on Occupant Perception of Indoor Air Quality," E.N. Light, M. Tyson, F.J. Sisson, and R.D. Gay, Proceedings of Indoor Air 93 6: 563- 568, 1993 [See Appendix A] Based'on data collected in the Indoor Work Environ- ment Stud'y of Federal office buildings, the authors conclude that occupant dissatisfaction was related to comfort, health and sociali issues. Improvements were reportedly achieved by training HVAC system opera- tors and waiving energy conservation requirements. [28] "How Much Does Environmental Tobacco Smoke Contribute to the Building Symptom P.S. Burge, A. Robertson, M. Raynal Index?" A ~. , . Jarvis, M. Archibald, and D. Hawkin, Proceed- ings of Indoor Azr 931: 529-534, 1993 [See Appendix A] .r.r +A In this report of preliminary results from a study, the authors suggest that building symptom index (BSI, the mean ~number of work-related symptoms typical' of the sick building syrtdiome per occupant) was weakly

SEPTEMBER 24, 1993 correlated with measurements of ETS exposure. Report- edly, BSIi showed stronger conelations with personal smoking status and with perceived ETS exposure. SMOKING POLICIES AND RELATED ISSUES [29] "Lower Levels of Cigarette Consumption Found in Smoke-Free Workplaces in California," T.J. Woodruff, B. Rosbrook, J. Pierce, and S.A. Glantz, Archives of Internal Medicine 153: 1485- 1493, 1993 [See Appendix A] The authors of this study report that workplace smoking policies designed "to protect workers from the toxins in ETS" are associated with a decrease in the number of smokers and in the number of cigarettes consumed. They project that„ if all California work- places prohibited smoking, the result would be a $406 million annuall loss in cigarette sales. See issue 37 of this Report, December 18, 1992, for initial' coverage of this study, f rst presented at an American Heart Association Meeting in November, 1992. STATISTICS AN!D RISK ASSESSMENT [301 "An Enforceable Indoor Air Quality Standard for Environmental Tobacco Smoke in the Workplace," J.L. Repace and A.H. Lowrey, Risk Analysis 13(4): 463-475, 1993 James Repace and Alfred' Lowrey, who have previ- ously published a risk assessment on ETS and' a recent "critique"' of purported tobacco industry positions on ETS, here present a model claiming to extrapolate from ambient nicotine measurements to nonsmoker lung cancer risks purportedly due to ETS exposure. The authors suggest that ambient nicotine levels in workplaces without smoking policies exceed the levell of "acceptable"'or di minimis risk of one death per million persons exposed. They propose that "current workplace exposure to ETS also appears to pose risks exceeding the ... risk level above which carcinogens are strictly regulated by the federal' government." In particular, Repace and Lowrey state that risks of three deaths per 10,000 persons are almost always 9 acted upon by the government, and claim that their methods result in an estimate that is an order of magnitude greater than that level, reportedly two or three deaths per 1,000 nonsmokers. They also claim that the "most heavily exposed" nonsmokers have a risk of 2%, or one death per 1100. Excerpts from this study willappear in issue 57 of this Report. [31] "Publication Bias and Public Policy," L. Bero and D. Rennie, abstract presented at the Second International Congress on Peer Review in Biomedical' Publication, American Medical Association, Chicago, Illinois, September 9-11, 1993 [,See Appendix A] This abstract was presented at a recenr meeting by Lisa Bero, a coauthor with Dr. Stanton Glantz of a recent artide on the tobacco industry response to the EPA Risk Assessment on ETS. See issue 53 of this Report, August 6, 1993. Bero's abstract daims that she is examining whether publication bias (i.e., that studies reporting "negative"'results are less likely to be published) can be illustrated in the literature on ~ ETS,, andl if it could affect the conclusions of reviews like the ETS Risk Assessment. Bero claims that studies reporting "positive" results are more likelyto be published in peer-reviewed journals. Moreover, she states that "negative" studies appear more frequently in industry-sponsored symposia, and that symposia articles are less likely to includ'e a discussion of their methods. (Bero apparently used the presence or absence of a "Methods" section to make a judgment about study quality.) IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AUSTRALIA ~ [32] Train Smoking Ban is Extended Victoria has reportedly extended its smoking,ban on N metropolitan and country trains to interstate trips. ~ Beginning,Scptember 13, 1993, smoking will be ~ banned on the Ivtelb-Sydney Express and The Over-

10 land to Adelaide. See Sydney Morning Herala; Septem- ber 9, 1993: B'ELGI'UM' [33] Smoking Restrictions Not Being Enforced According to a press report, the smoking restrictions in public places which were adopted by Royal Decree in 1987, are not being enforced. Ptrrsuant to the decree, smoking is generally restricted'to those areas of public places where management, at its discretion„has designated smolcing,areas. It has also been reported that the number of smoking seats on~Belgium trains will be reduced from 30 percent to 20 percent. See La Lanterne, September 15, 1993. CANADA ['34] Tobacco Companies Challenge Cigarette Pack Warning Regulations According to a press report, Imperial Tobacco Ltd. and RJR MacDonald Inc. have filed applications with the Canadian Supreme Court seeking to enjpin the application of new government regulations requiring that cigarette packs carry warnings that include the message "Tobacco Smoke Causes Fatal Lung Disease in Non-Smokers." The new law went into effect last month, but tobacco companies were given a year to comply: Further details about the warnings appear in issue 53 of this Report„August 6, 1993. The basis of the legal challenge by two of Canada's major tobacco companies is apparently the constitu- tional validity of the regulations. See USA Today, September 23, 1993. HONG KONG [35]' Council Endorses Restaurant Nonsmoking Signs The Executive Council has reportedly endorsed a proposal that would require restaurant owners to display signs indicating nonsmoking areas. The proposal, which is one of several recommended antismoking measures, must be ratified by the Legisla: tive Council before it becomes law: See South China Morning Post, September 9, 1993.. ETS7IAQ REPORT, ISSUE 56 PHILIPPINES ['36] Smoking Banned in Public Places in Rizal Facing fines and imprisonment for violations of provincial smoking regulations„smokers in Rizal will reportedly be prohibited from smoking in government buildings, public conveyances, private schools, mar- kets, churches, malls and cinemas. See Manila Bulletin, September 4, 1993. SOUTH KOREA [37]I Health Authorities to Introduce Smoking Ban Legislation The Health-Social Aff'airs Ministry is reportedly planning to submit legislation to the National Assembly in the fall to implement a total ban on smoking in all'l public facilities. The recommendation is apparently part of a larger proposal which would include other antismok- ing provisions. The ministry also proposes to use govern- ment profits from cigarette sales for various public health projects. The proposal.s are part of a campaign against smoking that the government has decided'to "spear- head." See Korea Economic Darly„August 17, 1993. UNITED ARAB EMIRATES [38]I Council Committee Recommends Smoking Bans According to a press report, the Gulf Cooperation Council Anti-Smoking Committee recently met im Dubai and recommended, among,other matters, that a smoking ban should be adopted in public places and in the workplace. SeeA'I Khaleej, September 5, 1993. ETS-RELATED LITIGATION NOT INVOLVING CIGARETTE MANUFACTUR'ES. AUSTRALIA [391 Department of Occupational Health and Safety u. Burswood Resort (Management) Ltd. (Magistrate's Court, Perth) (decided September 17, 1993). The Western Australian Health Department has failed in its attempt to prosecute the owner of a casino

SEPTEMBER 24', 1993 for failing to take effective measures to control levels of ETS at its facility. On September 17, 1993, the presid- ing magistrate dismissed the claims against the casino stating, "Whilst: ETS is annoying and of discomfort to non smokers it has not been proved at the required standard, or at all, in this prosecution, that it is a risk to the health of the employees at the Casino." In his ruling,, the magistrate acknowledged that ETS was present at moderate levels in the casino but agreed with the defendant's expert witnesses, who had testified that any irritation which may be caused by exposure to ETS does not constitute a harm to health. In additions the magistrate discussed the U.& EPA Risk Assessment on ETS, which had been introduced by the prosecution over the defendant's objection. He found that the document did not support the prosecution's case, which had alleged! a risk of respiratory illhess andl impairment in adult employees exposed to ETS. Because the ETS risk assessment concludes that there are only "subtle" effects on the respiratory health of nonsmoking adults, the magistrate determinedlthat this was insuffit cient evidence to prove that the risk of harm to health is "probable," as alleged in the complaints. In a media release, TIA reported the magistrate's ruling and characterized! it as a "landmark Court decision." TIA concluded that the decision~ "reinforces our view that the rush to impose smoking bans in the workplace, restau- rants and public places is not based upon conclusive scientific or medicall evidence." [401 Cameron v. QantasAirwaysLimited(F"ederal Court, New South Wales)~ (filed April 7, 1993) The court recently dismissed this action following the failure of plaintiff to replead her case as had been ordered in July. The case involved a woman who daimed her shopping trip to: Bangkok was ruined after she was forced to sit next to a smoker on a Qantas flight. She was seeking, among other things, a declaration that Qantas engaged in unconscionable, misleading or deceptive conduct in permitting smoking in its aircraft. 1I1 LEGAL ISSUES AND DEVELOPMENTS UNITED KINGDOM ['411 Study Focuses Upon Worhlace Smoking Policies A study recently released in the United Kingdomm considers a number of issues involving workplace smoking policies, including the difficulties some employers have encountered in introducing,smoking bans or restrictions. Legal considerations are discussed in the report, and a description is made of the settle- ment reached in the Veronica Blan6 case. That case involved a public employee who claimed she had been inj ured by exposure to ETS in the workplace. A more d'etailed discussion of the case appears in issue 40 of this Reporr, February 5, 1993. One section of the study describes the way in which smoking policies were introduced in 110 organizations in the United Kingdom. Other sections discuss the incentives for employers to introduce or overhaul a smoking policy. The report is based upon a survey conducted by Income Data Services L't& See The Times and Daily Mai4 September 20; 1993. OTHER DEVELOPMENTS AUSTRALIA [42] Cancer Council Survey at Odds with Restaura- teur Perceptions According to the results of a survey published in the Americarr Journal'ofPublic Health„ 90 percent of the customers of eight New South Wales restaurants would prefer the designation of smoke-free areas in restau- rants. Nearly one of every two customers surveyed said they want smoking banned completely from restau- rants. These statistics contrast with the perception of some 373 restaurateurs in the region, who apparently believe that only five percent of their customers would prefer smoke-free dining. The survey was conducted by the New South Wales Cancer Council; See Daily Telrgraph„ September 15, 1993. 2(lZ4'702:51 S

12 [43] Antismoking Group to Publish Smoke-Free Restaurant List According to a press report, Quit For Life, an anti- smoking organization; is contacting every restaurant on~ the Central Coast with questions about smoking policies. The group apparently intends to publish, a list, of smoke- free restaurants on the basis of the results of its survey. See Gosford Central Court Ezpress, September 10, 1993. [44]' Smokers Ignore Shopping Center Smoking Ban During,the six weeks that a smoking ban has been in effect in the eatery area of Casuarina Square, shoppers have reportedly been ignoring the ban. According to the marketing manager for the center, the ban was introduced reluctantly and will not be extended to the entire shopping center. See Northern Territory l'Vews;, September 9, 1993.. EUROPEAN' COMMUNITY' [45]' BASP Publishes New ETS Booklet The Brussels-based antismoking group BASP, in, coordination with the EC Commission's Europe Against Cancer Programme, has published! a new trilingual report on ETS entitled "No Smoke Between Us." The booklet„which is one of the materials produced in support of the EC Commission's "Breath- ing Space" campaign, examines ETS issues and asserts that the purported risks of ETS exposure to nonsmok- ers justifies restricting or banning smoking in public places and workplaces. In English, French and German, the document discusses legislative initiatives being taken worldwide with regard: to ETS and legal cases that have beenn brought by nonsmokers invol1ving ETS. The EPA Risk Assessment on ETS is cited in the booklet as authority for the chapter on the composition of ETS. UNITED KINGDOM [i46] Survey Addresses Smoking in Pubs Some 57 percent of pub owners surveyed reportedly believe that the establishment of nonsmoking areas in ETS/IAQ REPORT, ISSUE 56 pubs will become increasingly important for future business. There has apparently been a rise in the number of pubs offering nonsmoking sections. See Publican, July 26, 1993. Meanwhile, 97 percent of pub goers reportedliy think that smoking should be restricted in pubs, and three quarters of those participating in a pub television quiz company poll said smoking should be banne&alto- gether. Some 1,000 pub customers in England and Wales participated in the survey, which apparently revealed that pub goers also complain about the food, the prices, and the entertainment. See 1'ublican, July 12, 1993: [47]i Nonsmoking Rental Cars Introduced HERTZ is reportedly introducing rental cars that will be designated as nonsmoking vehicles. According to industry figures, only 3 adults in 10 now smoke in Britain. See Evening Standanl, August 112, 1993: MEDIA COVERAGE CANADA [481 "Jailed Pastor Fears Inmates Blame Him for, Butt Ban," The Vancouver Sun, September 8, 1993 A] Waddell„a baptist preacher from the United States, reportedly fears for his life because he says he is being blamed for smoking restrictions introduced last week at a Vancouver jail, and he has filed' a complaint with the BritishiCohtmbia Corrections Branch. Waddell claims that last year he filed a complaint asking that, one of ten tiers in the jail be designated nonsmoking. Waddell'claims that his request was "cwisted around" and that one particular guard has been telling other inmates that Waddell is fully respon, sible for the newly-imposed smoking restrictions. Under the current smoking policy, which took effect September 1, 1993, smoking is limited to designated outdoor areas in the pretrial centre. Seeissue 55 of this Report, September 10, 1993. The government is expected to decide within the next three weeks whether to prohibit smoking in all provincial jails.

SEPTEM BER' 24, 1993 HONG KONG [49] "Why Keeping Cool Makes You Ill," South China Morning Post, September 5, 1993 A researcher at the City Polytechnic of Hong Kong, Dr. Lilian Vrijmoed; has expressed serious concerns about polluted air conditioning systems in Hong Kong. She bases her concerns on her own studies in Hong Kong, as well as on data from studies in Canada and the United States. "The problem,," she says, "is air- conditioners are excellent breeding places for fungi,"' particularly M a sub-tropical country such as Hong Kong, These fungi1 include poisons, allergens, immuno-suppressants and even carcinogens. Common symptoms of fungi in air conditioning systems include runny nose, sore throat, aching body; fever, headache, malaise and! a general feeling of being under the weather. Dr. Vrij',2noed said these problems were particularly notable on Monday mornings, after fungal spores have germinated over the weekend. A spokesman said the government was "looking into the problem" of air conditioner pollutions but because of "limited resources and! staff," studies are only being conducted in government buildings. The government wiR eventually prepare some sort of air,conditioning standard, but the spokesman gave no indication of when this might happen. 13

SEPTEMBER 24„ 1993 APPENDIX A The numbers assigned to the following anicle summaries correspond with the numbers assigned to the synopses of the artides in the text of this Report. CARDD IOVASCULAR ISSUES [20] "Heart Disease and the Environment," S.A. Glantz, Journal of the American College of Cardiology 21(6); 1473-1474, 1993 "Environmental pollution has...been associated~ with adult cardiovascular disease. In a stud'y of a heavy metal Superfund minding site in Gal'ena, Kansas, Neuberger et al. found statistically significant increases in the risk of death from heart disease and stroke (relative risk of 1.2 to 1.3) and morbidity from hypertension, heart disease and' stroke, even after controlling,for such personal risk factors as smoking and weight. It is not clpar~ whether these effects are due to contaminated drinking water or airr pollution caused by dust from mine tailings or, more likely, to a combination of both~ factors." "Air pollution may contribute to heart disease. Carbon disulfide, a compound that can accelerate atherosclerosis and coronary artery disease, has been found in New York City area ambient air and exhaled air from human volunteers.... Zhang et al. showed! that indoor air pollution caused by coal fumes M Shanghai, China increased the incidence of stroke, even after~ all traditional risk factors had been taken into account, and! speculated~ that this result could be due to the sulfur dioxide, total suspended particulates, carbon monoxide or benzo(a)Qyrene produced in burning the coal."' "Finally, there is significant evidence that environ- mental tobacco smoke (ETS) causes and aggravates heart disease. Significantly,,the major disease caused by ETS exposure is heart disease; it accounts for about 37>000 of the estimated 53;000'annual deaths among nonsmokers from ETS exposure. Several of the ele- ments discussed above, i:nclttding polycyclic aromatic hydrocarbons and carbon monoxide, which have been implicated as the biologic link between ETS exposure and heart disease, originate from other pollution sources. The fact that ETS-induced heart disease is such~ a significant problem suggests that heart disease A-1 may be induced or aggravated by other sources of environmental pollution: ETS is, after all, air pollution."' "Although the evidence for a significant environmen- tall component to heart disease is limited (except for ETS) compared with that available for risk factors thart are based on individual behavior,, there is clearly enough evid'encexo raise concern," OTHER HEALTH ISSUES [21] "Cigarette Smoke = Radiation Hazard," G.D. Evans, Pediatrics 92(3): 464-465, 1993 "Recent articles have described the dangers to chil- dren and adults of secondhand cigarette smoke. However, it is not widely known that cigarette smoke is substantially radioactive."' "The average cigarette contains 0.3 pCi of 210Po, which is melted, vaporized, inhaled, and ultimately deposited along the tracheobronchial epithelial linings of smokers." "In D year, a smoker of 1 to ~ 2 packs per day will irradiate portions of his or her bronchial epithelium with about 8 to 9 rem~" "Considering that the average smoker will absorb approximately 80 rem into the lung epithelia] lining in about 10 years, cancer can be anticipated as a promi- nent result of the habit_"' "Despite initial interest, little has been published.on the subject in recent years, and the radioactive risks to children from secondhand smoke remain unknown." "Studies must be undertaken to quantify 210Po deposition in children of smoking parents. Until thens smokers should be informed thatthey spend'their days in radioactive clouds and that they, their families„and friends are at potential risk from those douds of smoke."' "I have observed that many parents who smoke„on~ hearing,of their unexpectedly large exposure to radia- tion from smoking, have found the strength and motivation to quit the habit. I hope that as this information becomes more widely known, fewer children will suffer the i1l effects of secondhand cigarette smoke and that this potential clinically significant exposure to radiation will be eliminated." 2)

A-2 [22], "Parental Cigarette Smoking and Tonsillectomy in Children," A.E. Hinton, R.C.D.. Herdman, D. Martin-Hirsch, and S.R. Saeed, Clinical' Otolaryngology 18: 178-180, 1993 "[T]here is a correlation between~maternal smoking and the frequency of sore throats in children. The influence of passive smoking on the frequency of tonsillitis and the incidence of tonsillectomy has not been previously reported." "Two groups of children were studied. The tonsillec- tomy group were children being admitted for tonsillec- tomy for recurrent tonsillitis....The control group were children being seen at an orthoptic clinic who had no history of previous ENT surgery." "In the tonsillectomy group, 36 out of 60 (60%0)) children had at least one parental smoker compared with 25 out of 60 (42%) ~ in those children fiom the orthoptic clinic." "In the tonsillectomy group, 24 out of 60 (40%) of the parents described the amount of tobacco smoke ini their home as none. For the parents of those children~ from the orthoptic clinic the corresponding number was 36 out of 60 (60%). "In the children admitted for tonsillectomy, the average number of throat infections requiring,antibiotic treatment in the previous 12 months was 3.9, if the parents smoked, and! with non-smoking parents it was 3.3' (not significant). I!n, the children from the orthoptic clinic the average number of attacks of tonsillitis over the previous 12 months was 0.36 in those with a parental smoker and 018 in those witL non-smoking parents (not significant)." "This study presents evidence to support a link between parental smoking and the frequency of both tonsillitis and tonsillectomy in children. We have found that those children admittedifor tonsillectomy are almost twice as likely to have at least one parentalismoker compared with those children in the control group." "Passive smoking may mediate its deleterious effects in at least three possible ways. Firstly, it has been shown that the oropharyngeal' flora is altered in cigarette smokers.... Whether such changes are also associated with passive smoking,is unknown. A secon& mode of action of tobacco smoke is its effect on the ciliate& columnar epithelium of the respiratory tract....The ETSlIAQ REPORT, ISSUE 56 final mechanism by which parental smoking affects the respiratory system of children is not by passive smok- ing, but due to the fact that the parents have an~ increased incidence of respiratory tract infections which may lead to an increase in the number of infections in the children by direct cross-infection." ETS EXPOSURE AND MONITORING [23] "Validation of ETS Exposure in a Representative Population in Southern Germany," W.-D. Heller, E. Sennewald, J.-G. Gostomzyk, G. Scherer, and F. Adlkofer, Proceedings of Indoor Air 93 3: 361-365, 1993 "A recent metaanalysis performed b}!-the US Environ- mental l Protection Agency (EPA) 1 estimated a mean lung cancer risk for ETS exposure of about 1.3. Such an assessment is only valid if misclassification of smokers as neversmokers and possible confounding, factors have been correctly taken into consideratiom As reported in, the literature, the misclassification rate varies from, country to country and from social class to social class. In order to obtain some insight into the situation in Germany, we investigated the prevalence of ~ ETS exposure via a questionnaire and validated these results by determination of serum cotinine, a specific biomarkerfor tobacco smoke uptake,,in a representa tive adult population." "No correlation is found between serum cotinine concentrations and the self-reported ETS exposure. However, this is not the case when subjects with a serum cotinine concentration above 15 ng/mllwhich, is considered'to represent active smoking have been excludedi Under, this condition there is a clear correla- tion between the serum cotinine values and the reported extent of ETS-exposure.... [IT1t can, be seen that the inclusion of misclassified smokers in the nonsmoker group results in a 4 to 5 fold' increase of mean serum cotinine values. Altogether, serum cotinine values provide a valid! parameter for reliable determination of exposure to ETS if misdassifieation isN ,.~ excluded." ~..r "As shown.... 7.0%, 6.9%o and 5.9% of the self-~ reported exsmokers and 0.6%, 1.1% and 0:9°k of self-'p reported neversmokers in [1984L1985, 1987-1988 and~ 1989-1990], respectively, had cotinine serum values ~ above 15 ng/ml. Thus, the rates of misclassification by'yl~ N :Z'

SEPTEMBER 24', 1993 self-reported exsmokers and neversmokers occurring in this population~ between 84/85 and' 89190 remained almost constant.... With respect to self-reported smoking,behaviour in 84/85 as compared to 87/88,. 84.6% of the subjects showed no change during the three year interval, while 17.6% of the exsmokers and 1%o of the smokers in 84/85 reported to be neversmokers three years later. "From this study it can be concluded that two typess of misclassification biassing epidemiological investiga- tions omETS exposure have to be considered in planning and conducting such studies: (a) the present smokers, and (b) the former smokers, who declare themselves as lifelong neversmokers. The first type may constitute a minor source of bias in epidemiological studies, the second type could severely impair the validity of these studies. While the first type of misclassification can easiHy be detected by determining cotinine in body fluids, this is not possible in the second group." [24]I "Environmental Tobacco Smoke Concentrations in No-Smoking and Smoking Sections of Restaurants," W.E. Lambert, J.M. Samet, and J.D. Spengler, American Journal of 1'ublic Healsli 83:' 1339-134 L, 1993 "Although ordinances and policies establishing no- smoking seating areas inside public and commercial buildings are designed to protect indoor air from contamination, there have been few published reportss comparing,levels of environmentall tobacco smoke inn no-smoking and smoking areas. To characterize the effectiveness of a regulation separating smokers from nonsmokers in restaurants, we measured concentra- tions of respirable particles and nicotine simultaneously im the smoking and no-smoking areas of seven restau- rants in Albuquerque„NM. Each of the restaurants wass in compliance with the city ordinance restricting smoking to one third of the total indoor seating, Under the Albuquerque Clean Indoor Air Ordinance, there can be no more than two areas designated for smokers; however, all restaurants participating,in this monitor- ing study had established a single area for smokers." "In the no-smoking areas of restaurants, respirable suspended particle levels ranged from 20.7'to 69.0 ug/ m3, with a median of 27.8 ug/m'. In the smoking areas, respirable suspended particle levels range& from A-3 21.7 to 131.0 ug/m~, with a median of 53.2 ug/m'. In six of the seven restaurants, respirable suspendedd particle levels were lower in the no-smoking areas than in the smoking areas." "Nicotine concentrations ranged from 0.2' to 2.8 ug( m3; with a median of 1.0 ug/m3, in no-smoking areas and from 1.5 to 3'.8 ug/'m3, with a median of 3.2 ug/ m3, in smoking areas. Relative to the smoking,areas, nicotine levels were lower in the no-smoking areas in each of the restaurants." "Considerable variation in respirable suspended particle concentrations was observed among both the no-smoking and smoking sections of the restaurants. In some restaurants, the concentrations of this marker for environmental tobacco smoke wei=e higher in the no- smoking sections than in the smoking sections of other restaurants. For example, the respirable suspended particle concentrations in~the no-smoking sections of restaurants 1 through 3 ranged from 53.9'to 69.0 ugl m3, which was higher than the concentrations observed in the smoking sections of restaurants 4 through 7, which ranged from 21.7 to 53.2 ug/m3. Nicotine levels in these restaurants did not follow the same trend, suggesting that sources of respirable suspended particles other than cigarette smoke may be present in restau- rants 1 through 3. We noted that in two of these three restaurants, flame servers were used to prepare and warm food at tableside." "Our~ measurements of respirable suspended particles and~ nicotine in restaurants indicate that confining tobacco smoking to designated seating sections is an effective way to reduce, although not to eliminate, the exposures of nonsmokers. The pattern of consistently lower levels of respirable suspended particles and nicotine in the no-smoking relative to the smoking areas 'tndicates that the Albuquerque ordinance can be effective in restaurants, regardless of how the individual restaurant management may choose to implement the policy. The greatest protection was affordedl by seating arrangements in which a wall or partition physically segregated smokers from non-smokers: But even for floor plans that basically involved one large room, substantial protection of the air of non-smokers was still observed." "It is important to recognize that the reduction of environmental tobacco smoke concentrations we observed in no-smoking as compared with smoking

A-4 sections, although substantial, was not complete. In fact, concentrations of nicotine were as high in no- smoking,sections of some restaurants as in smoking sections of others. Thus, people who sit in no-smoking sections are still exposed to respirable particles and nicotine vapor generated by smoking and to the other components of environmental tobacco smoke that co- occur with these species. Furthermore, restaurant employees, who spend longer periods of time in restaurants than do the patrons, will still be exposed to environmental tobacco smoke in no-smoking areas. These findings are consistent with the conclusion of the 1986 report of the US surgeomgeneral that 'the simple separation of smokers and nonsmokers may reduce,, but does not eliminate, the exposure of non- smokers to environmental tobacco smoke."' [25]I "TemporaliVariability of Benzene Exposures for Residents in Several New Jersey Homes with, Attached Garages or Tobacco Smoke," K.W. Thomas, E.D. Pellizzari, C.A. Clayton, R.L. Perritt, R.N. Dietz, R.W. Goodrich, W.C: Nelson, and L.A. Wallace, Journal of Exposure Analysis and Environmental Eprdemiology 3(l.i): 49-73; 1993 "Total exposure Assessment Methodology (TEAM)) studies conducted in 700 homes in the United Statess between 1980 and 1985 have provided important information about, the magnitude of human exposure to a number of volatile organic compounds (VOCs). A major finding,of the TEAMstudiesan&other researchi is that the concentrations of a majority of the VOCs found in, indoor air exceed those measured in outdoor air. These elevated indoor levels are clearly the result of emissions from materialk„activities, and/or combustion sources in the home. Significant correlations have been observed between reported! activities and the personal exposure, breath, and indoor, air concentrations of several!chemicals. These have included correlations between concentrations of aromatic compounds (benzene, xylenes,,ethylbenzene)iand the exposure too combustion products from mainstream ~ tobacco smoke, environmental tobacco smoke (ETS)', fuel emissions, and auto exhaust. Wallace has calculated''i risks associ- ated with, exposure to benzene from ETS based on monitoring of 700 persons during previous TEAM studies. He estimated 50 cases of benzene-related leukemia may result in the U.S. population each year ETS/IAQ REPORT, ISSUE 566 from passive smoking. He also estimated that an, ad'ditional 200 cases mayoccur due to personal exposures from other indoor, sources of benzene including surface coatings, consumer products, or emissions associated with attached garages. The extent to which sources other than tobacco smoke load to~ human exposures in indoor environments has not been well described. This is particularly true in residential environments where location, struaural characteristics, and' human activities ean, be highly variable from home to home." "The overall objective of this study was to return to severallof the 355 nortfiern New Jersey homes studied in 198'li to assess principle sources of several VOCs that led to;elevated human exposures_A major, goal of one component of this investigation was to evaluate,, through measurements over multiple time periods at a few homes, the effect of attached! garages, ETS, and outdoor, air sources in, contributing to elevated indoor air levels of benzene with subsequent human exposure. Intensive measurements of benzene concentrations and air flows in several homes with attached garages were made to develop better insight into parameters affect- ing source emissions and indoor concentrations. For comparative purposes, similar measurements were made in several homes with ETS, a more well defined source of benzene in indoor air." "Indoor air and personal levels of benzene were greater than outd'oor levels in one home with both garage and ETS, in two of thexhree other homes with an attached! garage, and'in the three other homes with ETS. Benzene levels were also slightly elevated for two of the three comparative homes with neither ETS or an attached garage. A woodstove was operated: in one comparative home and! may have been a source of benzene. In all homes there was an underlying contri- bution to indoor benzene from the outdoor air."' "The garage was clearly a source of exposure to benzene....No strong relationships were observed between garage benzene levels and vehicles operated in the garage. Gasoline was stored in [two of] the garages.... while paints, cleaning agents, and other consumer products were stored in all four garages. These materials may be sources of benzene that are as important or more important than evaporative emis- sions from vehicles and transiently high benzene production when vehides are moved' into or out of the 20 247 02 521

SEPTEMBER 24, 1993 garage....These data suggest that an attached garage can, under some conditions, introduce as much or more benzene into a home's living areas as other indoor sources, including tobacco smoke. Two possible ways to lower exposure to benzene in homes with attached garages are (1) to remove sources of benzene from the garage or (2) reduce the airflow from the garage into the home's living areas." INDOOR' A1R' QUALITY [26] "The Helsinki Office Environment Study: The Type of Ventilation System and the 'Sick Building Syndrome,'" J.J.K. Jaakkola; P.. Miettinen, P. Tuomaala, and O. Seppanen, Proceedings oflndoorAir '93 1: 285-290; 1993 "We carried out a population-based cross-sectional study in order to assess the HVAC systems in office buildings as determinants of the occurrence of symp- toms of the SBS and perceived air quality in workers. The types of ventilation systems considered were natural ventilation, mechanical exhaust of air, simple mechanical ventilation, air-conditioning,without and with steam or evaporative humidification andl recircula- tion of the air." "The role of simple mechanical ventilation as a determinant of the symptoms and perceived! air quality was assessed by calculating adjusted odds ratios of symptoms in workers in mechanically compared! to naturally ventilated! buildings. The risk of weekly work- related symptoms of interest was greater among the workers in mechanically ventilated buildings for all~ symptoms except headache. The strongest associations were for nasal congestion (OR 1.83, 95%. CI 0.97- 3.48)S pharyngeal' symptoms (2.07, 0.92-4.68) and lethargy (1.67, CI 0.98-2.86). The air was felt to be too warm (1.65, 1.12-2.42)and dry (1.44, 1.05,1.98) significantly more often in mechanically ventilated buildings than in naturally ventilated buildings." "[The] role of air-recirculation was studied by contrasting the occurrence of symptoms and percep- tions in workers of mechanically ventilated! buildings with and without air-recirculation adjusting also for humidification. The adjusted odds ratios of all the symptoms of interest except lethargy were above 1. The risk of nasal congestion was significantly greater among the worker[s] in buildings with air-recirculation. The A-5 occupants of buildings with air-recirculation were more satisfied with their thermal climate and perceived air quality: the relative risk was smaller of perceiving the air both too warm (OR 0.92, 95% CI 0.72-1.17), too cold (0.64, 0.49-0.84) ' as well as of perception of unpleasant odors (0.80„ 0.62-1.03)," "Finnish workers in office buildings with mechanical supply and exhaust of air seern, to have a slightly higher risk of typical work-related symptoms of the SBS than workers in naturally ventilated buildings. This observa- tion is consistent with the results of the studies from England and the Netherlands. Also the use of air recirculation is related to a slightNy increased risk of nasal symptoms in the Finnish building stock.... Evaporative humidification is a determination for both, nasal, pharyngeal andcentral! nervous symp- toms in Finnish office buildings." [27] "The Impact of Building Management Strate- gies on Occupant Perception of Indoor Air Quality," E.N. Light, M. Tyson, F.J. Sisson, and R D. Gay, Proceedings of Indoor Air `93 6: 563- 568, 1993 "The indoor Work Environment (IWE) Study was conducted to identify relatively inexpensive means of improving HVAC operation and'communications with occupants. Four large office buildings were selected for the study. Enhancedl HVAC operationall strategies were implemented in two buildings to improve comfort and ventilation. In addition, complaint response programs were also enhanced in two buildings. Occupant perception~of the building environment was measured by questionnaire at the beginning,and end of the five month study period'to help characterize occupant concerns and to estimate how they were impacted by changes in building management." "Questionnaire results in all four buildings indicated a high rate of occupant dissatisfaction with their work environment." "Continuing observations made over the course of this demonstration project suggest that a variety of factors, some real and some perceived,, contributed to occupant dissatisfaction. These included deficiencies in ventilation, comfort control, lighting and noise, relatively minor problems involving sanitation and! source emissions, unrelated illnesses blamed on IAQ, 20z470z11__zz

A-6 stress, job dissatisfaction, and strained relations be- tween management and occupants." "Despite problems involving the aging and reconfiguration of the three test buildings, each appeared to be capable of providing adequate ventila- tion and temperature control under most conditions. HVAC changes during the IWE study focused on operational strategy and'complaint trouble-shooting. Increased minimum~outside air damper settings and! upgraded controls were found to improve ventilation and pressurization:" "During the course of this study, it became apparent that there were fundamental conflicts between federal energy conservation requirements and IAQ (both in terms of comfort~ and ventilation)." "While each test building already had a mechanism to receive complaints, several! new measures were success- fully demonstrated. These helped to resolve the building problem (where there was one) but also helpe& to improve relations with occupants and their perception of the building environment." "This investigation demonstrated that typical federal office buildings can be made more comfortable and the building environment more acceptable through relatively inexpensive changes in HVAC operation and complaint response procedures. Keys to these changes were improved operator training and exemptions from, energy conservation regulations." [28] "How Much Does Environmental Tobacco Smoke Contribute to the Building Symptom Index?" A. Raynal, P.S. Burge, A. Robertson, M. J'arvis, M. Archibald, and D. Hawkin, Proceed- ings of lndoor Air `931: 529-534, 1993 "As many employers are taking tlie initiative to phase out smoking in~work environments it is useful for those concerned to have information on the extent to which passive (and usually involuntary) exposure to ETS contributes the building symptom index (BSI) in the workplace. The BSI is the mean number of work related symptoms typical' of the sick building syndrome per occupant. If this relationship were to be found to be significant it would be an additional justification for the removal of smoking in the workplace." "The study group [375 employees] were based in an open plan office.... The office was mechanically ventilated by 60 independent roof based air handling E"IiS/1AQ REPORT, ISSUE 56 units which drew in 20% fresL air in each exchange cycle. The air was heated if below a minimum tem- perature but it was not humidified or chilled. The windows of this building could not be opened. The control~group were [26] employees based in the adjacent computer department which had a separate fully air conditioned ventilation system and in which smoking had never been allowed:" "[T]he Buildfng,Symptom Index was significantly higher M the study group compared to the control group. A mean environmental! nicotine level of 4.5 was found in the study area compared to none in the control area; There were no significant differences in the salivary cotinines and exhaled breath carbon monoxide levels between the study and control groups." "There was a significant correlation between the Personal! Symptom Index (PSI, based on correlations with individual data compared to the grouped BSI) and the environmental!nicotine levelk as well as between the latter an& levels of individual sallva cotinines in, non-smokers. A stronger correlation was found between the PSI and perceived exposures to ETS at work and to a lesser extent totall exposure which included exposure outside of work."' "A weakly positive correlation was found' between the Personal Symptom Index and environmental nicotine measurements in non-smokers. Smokers consistently reported fewer symptoms related to the building than non-smokers. However, the environment adjacent to smokers was found to have a significantNy higher environmental nicotine concentration. Smokers perceived less exposure to environmental tobacco smoke at work than did non-smokers but more at leisure and more in total compared to non-smokers."' "It appears that smokers are less likely to experience symptoms which they feel are related to their office environment (or if they do are less likely to report them), and' to perceive less environmental tobacco smoke exposure at work. Non-smokers report more symptoms and a higher exposure to ETS at work." "This study population has a low baseline BSI which is weakly correlated with objective measurements of ETS exposure.... It is planned to follow-up these individuals over two years during which time the level of ETS exposure in the workplace will be reduced and 2024"7~12523

SEPTEMBER 24„ 1993 removed altogether. Analysis of the initial results shows that smoking status and perceived exposure to ETS have a greater influence on the BSI than objectiweNy measured ETS levels."' SMOKING POLICIES AND RELATED ISSUES [29]1 "Lower Levels of Cigarette Consumption Found in Smoke-Free Workplaces in California," T.J. Woodruff, B. Rosbrook, J. Pierce, and S.A. Glantz, Archives of Internal Medicine 153: 1485-1493, 1993 "In this report we examine four different types of workplace smoking policies (smoke-free workplace, work area restrictions, lesser restrictions, and noo restrictions) and investigate how the smoking charac- teristics associated with~ different smoking policies are generalized to the population lpvel in California. The responses from the 1990 California Tobacco Survey are used to examine the public health benef ts, measured by the difference in the number of smokers and the difference in the number of cigarettes smoked per smoker for each of the four types of workplace smoking policies. Other smoking characteristics examined by workplace smoking policy included smokers' views on quitting and the change in smoking status over the last year." "Workplaces with~ more comprehensive controls on smoking had significantly lower regular smoking rates than workplaces with lesser or no: restrictions. Only 13.7% of people in smoke-free workplaces were regular smokers compared with 20.6% in workplaces with no restrictions.... Regular smokers smoked significantly fewer cigarettes per year in workplaces that were smoke-free vs workplaces with no restrictions, Regular smokers employed in smoke-free workplaces consumed 296 packs of cigarettes per year compared with 34.1 packs per year among regular smokers employed where there were no restrictions. These two outcomes associated with smoking controls in the workplace - decrease in the number of regular smokers and decrease in cigarette consumption among continuing smokers - together were associated with a significant reduction in total cigarette consumption." "Our data also indicate that the percentage of smok- ers who were contemplating quitting was greater in workplaces with smoking restrictions than in work- places with no restrictions." A-7 "More comprehensive workplace policies were associated with remaining an occasional smoker rather than progressing to regular smoking." "The type of workplace smoking policy was still significantly associated with being a smoker after adjusting for demographic variables. Workers in workplaces with only work area restrictions were 1. 115 times more likely to be smokers than those who worked in a smoke-free workplace. Workers under lesser restrictions or no restrictions were about 1.3 times more likely to be smokers than those in a smoke- free workplace." "The totalinumber of packs of cigarettes smoked per year in California by people employed indoors was computed for two different scenarios: (1)Ismoke-free workplace for all workplaces and (2) ' no restrictions for all workplaces, and these projections were compared with current consumption.... Under the current situation, regular, smokers under no restrictions smoke a total of 201' million packs of cigarettes per year. If regular smokers under no restrictions were to be in a smoke-free workplace, we assume that only 13.7% of the workers would be regular smokers and that they would smoke a mean of 296 packs of cigarettes per year, which would come to a: total of 116 million packs of cigarettes per year." "If there were no restrictions on smoking at these indoor work sites and if the smoking experience of all indoor workers matched that of workers in our~ survey who experienced no smoking restrictions, we estimate that cigarette consumption for California among people employed indoors would have been 705 million! packs of cigarettes in 1990 and the amount spent on cigarettes in California would have been $963 million compared with $760 million in, estimated actual sales, a 26% difference. Alternatively; if all work sites were smoke-free and the smoking experience of indoor workers matched that reported in our survey for people who worked in a smoke-free workplace, cigarette consumption would have been 411 million packs of cigarettes in 1990 and.the amount spent on cigarettes in California would have been $557 million." "Our data, in combination with those of other longitudinal studies of individual work sites, suggest that smoke-free workplaces are the most effective workplace smoking policies for reducing the percentage of smokers and the number of cigarettes smoked." 2o24'70~ ~24

A-8 "We estimate that the existing workplace smoking policies in California cost the tobacco companies $201 million~per year in lost sales compared with sales if there were no smoking restrictions in workplaces in California: Given that 57.8% of smokers smoke Philip Morris brand'cigarettes in the workplace (41.1%o are Marlboros), this represents a $118 million annual loss to Philip Morris albne. If all'.of the workplaces in California were smoke-free, the tobacco companies would lose an additional $203 million in annual sales, bringing the total loss to $406 million annually compared4ith what would be expected if there were no restrictions in the workplace." [31] "Publication Bias and Public Policy," L. Bero and D. Rennie, abstract presented at Second International Congress on Peer Review in Biomedical Publication; Chicago, Illinois, September 9-11, 1993 "Objective: To examine the tobacco industry's claim that publication bias makes risk assessments of environ- mental tobacco smoke (ETS) invalid.....The tobacco industry has argued, most recently Ma lawsuit against the the [sic] US Environmental Protection Agency (EPA)„that the EPA's risk assessment of ETS, which concluded that ETS is a cause of lung cancer and respiratory disorders, is invalid. The industry claims that the meta-analysis conducted by the EPA was flawed because publication bias against 'negative' studies resulted in exclusion of negative studies from the meta-analysis." "To determine if negative studies on ETS are pub- lished, the numbers of articles that supported ('positive studies') or refuted ('negative studies') the hypothesis that ETS exposure is associated with adverse health effects were assessed. All articles that tested this hy- pothesis were selected from the peer-reviewed medical literature and tobacco industry-sponsored symposia proceedings." "Eighry-two percent (40/49) of the peer-reviewed~ articles were positive, compared with37% (24/65) of symposia articles. [This difference was claimed to be statistically significant.]' Ninety-four percent (46/49) of the peer-reviewed articles contained a;Method's' ETS/IAQ REPORT, ISSUE 56 section{ compared with 43% (28/65) of symposia articles. [Reportedly„a statistically significant difference.]" "These findings raise the policy question of whether negative studies should! automatically be included in meta-analyses. We recommend that the quality of the studies, their sponsorship, and the review process to which~ they have been~ subjectedi be carefully evaluated."

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