Tobacco Documents Online

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'