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SHOOK, HARDY& BACON REPORT ON RECENT ETS AND IAQ DEVELOPMENTS December 3, 199'3~ SHB

REPORT ON RECENT 5TS AND lAQ DEVELOPMENTS - IN THIS ISSUE- IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS • Representative Lautenberg introduces another ETS bill, p. 1. • Representative Waxman introduces labelling legislation that would' includ'e an ETS warning, p. 1. • Newly confirmed assistant OSHA director discusses the agency, p. 2. ETS-RELATED LITIGA'TIONAGAINST CIGARETTE MANUFA'CTURERS • Report on deposition activities involving plaintiffs and senior company executives in Broin, p. 5. • Argument still scheduled on defendants' motion for summary judgment in~ Butler, p. 5: ETS/1:AQ Litigation Not Involving Cigarette Manufacturers • New York Court of Appeal5 grants review of ETS workers' compensation case, p. 5. • Maryland prisoner told he may pursue Eighth Amendment claim for ETS exposure, P: 6- OTHER DEVELOI?MENTS/MEDIA COVERAGE • A grant is awarded in New York to aid antismoking efforts, p. 7. • Hotel survey indicates lAQ is important to business travelers, p. 7. •"The Outcasts of the '90s: Smokers in the Workplace," p. 8.. SCIENTIFIC/TECHNICAL ITEMS ISSUE 61 Page 8: JNCI publishes new study that strongly links dietary factors to lung cancer risk, "Saturated Fat Intake and Lung Cancer Risk Among Nonsmoking Women in Missouri." An editorial on~the study also appears in the journal. •"Effects of Man•Made Mineral Fibers in Settled Dust on~Sick Building Syndrome in Air-Conditioned Off ces," p, 11. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS • ETS legislation is introduced in Canada, p. 11. • Czech physicians draw up charter on ETS exposure to children, p. 12. • Physicians in Germany call on Bundestag to pass antismoking law, p: 12. ETS-RELATED LITIGATION INVOLVING CIGARETTE MANUFACTURERS • Decision in TIA' v. Woodward p. 13'. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS, • Report on Blackwood workplace exposure case in Australia, p. 13. OTHER' DEVELOPMENTSIMEDIA COVERAGE • Nonsmoking guide to restaurants is pub- lished in France, p. 13. • Researchers in the United Kingd'om are looking for "sick buildings," p. 14. • "Board on the Carper,"' p. 14. • "Travel: Smokers Run Out of Flight Time," p. 14.

- TABLE OF CONTENTS - Issue 61 December 3, 1993 IN, THE UNITED STATI FS REGULATORY AND LEGISLATIVE MATTERS 103D CONGRESS [I] Lautenbcrg Proposes Adding ETS Regulatory Authority to Toxic Substances Control Act ...... l [2] ETS Health Warning Proposed for Cigarette Pack Labding .......................................••••••-••-.•• 1 [31 Traficanr Bill Placed on Senate Legislative Calendar ...............................................•••••••..--•••.•• 1 [4]' EPA Cabinet Status Bill Cleared for Debate ...........................................••-••••-•---•••••••-.•••••-.•.--. 1 U.S. OCCUPATIONAL SAFETYAND. HEALTH ADMINISTRATION (OSHAY [5]1 Reich Introduces Dear to OSHA Employees ar"Town Hall" Meeting.................................... CENTERSFOR. DISEASE CONTROL ANDPREVENTION. (CDC) [I61'Hospital Survey Shows Inadequate Ventilation to ControliSpread'of TB ................................ 2 . U.S... ENVIRONMENTAL PROTECTION.AGENCY(EPA) [7] Committee Meets to Discuss EPA Indoor Air Research Program ............................................ 2 [8] ETS Reference Made During,EPA Press Conference ............................. ........................... ...•••• 3 [9] EPA Develops 1AQ Monitoring Equipment for Large Buildings, ............................................. 3 NIOSH (10) NIOSH Publishes RFI Seeking IAQ Research on Workplace Chemicals Transported into Homes ........................................................................................ 3, STATE AND. LOCAL. GOVERNMENTS [11i]1 Florida PTA to Seek School IiAQEvaluation Bi11I ........................................................--•••••••---3'. [12]1 Privacy Legislation ............................ ....................................................................................... ' [1311 ETS-Rclated State and Loca1 Legislation ................................................................................. 4 ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS [I4] Bluitt: Motion to Amend Complaint Filed .....................................--..••••--••---.--.••••••••--.•••••••-•.. 5 [15] Broin: Depositions of Senior Executives Continue; Defendants Begin Depositions of P]aintiffi .............................................•....••••••••--•••-••••••••-••• • 5 [16] Butler: Argument Scheduled on Defendants' Motion for Summary )udgmcnt ........................ 5 ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS. WORKPLACE: WORKERS' COMPENSATION [17] fohanncsrn v.,New York City Dept. ofHousing Prrsrrvation and Development (Court of Appeals, New York) (review granted Ocrober 12, 1993) .......................................... 5 WORKPLACE: COLLECTI'VE.BARGAINING [!18] Matter ofNLRB and NLRB ProfissronalAis n and Wa.rhington Local, NLRB Union, 1993 WL 456696 (Federal Service Impasses Panel) (decided November 5, 1993) ...................................................................................................6 PRISONER CASE [19] fohnson v. Laham, etal., 1993 U.S. App. LEXIS 29528 (U.S. Court ofAppeals, Fourth Circuit) (decided October 28; 1993) ........................................................................... 6 LEGAL ISSUES AND DEVELOPMENTS [201 "Smoky Custody Battles," Ellen Goodman;, The Boston Globe, November 21, 1993 ................ 6 OTHER DEVELOPMENTS N [21i]; CaliforniaTradc Union Officials Ask for Free Smoking Cessation Classes .............................. 6 ~ ~ [22] New York Antismoking Coalition Receives Grant ..........................................•-.••...•••••••••••-••••• 7 [23] Polling Research Supports Accommodation in Malls ............................................................... 7 [241 State Disrributes Information About ETS to Smokers ............................................................. 7 [251 IAQ Claimed';to be Critical to Hoteliand Motel Customers .................................................... 7 [26] Cleveland Man Develops "Talking SmokeBusrer" .................................••-••••••••••••••••••-•••-••••-•.• 7 ~ [27] Smoking Ban Causcs Business Backlash .................................................................................. 7 ~Wr WJ.

Contents Continued, Issue 61 MEDIA COVERAGE [28) "The Outcasts of the '90s: Smokers In the Workplacc,° LosAngelns Times;,November 19, 1993.................................................................................... .................... 8 [29] "Noseworthy Progress for a Sick Sense," Chicago Tribunr„November 111, 1993'.........-.••.••..••.. 8 SCIENTIFIC/TECHNICAL ITEMS UPCOMING SCIENTIFIC MEETINGS [30) Indoor Environment '94, IAQ Publications and Other Sponsors, Washington, DiC., March 22-24, 1994 .................................................................................. 8 LUNG CANCER [31) "Saturated Far Intake and'Lung Cancer Risk Among Nonsmoking Womcni imMissouri,."' MLC:R. Alavanja, C.C: Brown, C. Swanson, and R.C. Brownson, fourna!'ofthrNarional Canerr7nrtitr.tt85(23): 1906-1916, 1993 [See Appendix A] ............... 8 [32] Editorial Regarding,"Saturated Fat Intake and Lung Cancer Risk Among,Nonsmoking Women in Missouri,."'Iv[.C.R. Alavanja, C.C. Brown, C. Swanson, and R'.C. Brownson, fournal'ofthr National Citnctr Institute 85(23): 1906-11916, 1993 ........................................... 9 [33) Letters to the Editor Regarding "The Hazards of Passive - and Active - Smoking," P. Boyle, New England fournal ofMeditinz328(28): 1'708-1709; 1993 ................................... 9' OTHER CANCER [34] "Epid'emiologyof lntracraniallIvleningioma," W.T. Longstreth, L.K. Dennis, V.M. McGuire, M.T. Drangsholt, and T.D. Koepsell, Cancnr72(3): 639-648, 1993 [See Appendix A] .................................................................................................... ..... 10. OTHER HEALTH ISSUES [35)i "Exposure to Environmental Tobacco Smoke as a Risk Facton for Recurrent Acute Otitis Media in Children under the Age of Five Years," R'. Stenstrom, P.A.M. Bernard, and H. Bcn-Simhon, lnternationalfournalofPediatric ......................................... 10 Ororhinolaryngology 27: 127-136, 1993 [See Appendix A] ............ ETS EXPOSURE AND MONITORING [36] "Questionnaire Assessments of Recent Exposure to Environmental Tobacco Smoke in Relation to Salivary Cotinine„° R'.J. Dclfino„P: Ernst, M.S. J'aakkola„ S. Solbmon, and M.R. Becklake, European Resprratory fournal'6: 1104-1 108, 1993 [See Appendix A] I .................................................................................................... ..... 10 [37] Letters to the Editor Regarding "The Nicotine Content of Common Vegetables," E.F. Domino, E.,Hornbach, and T. Dcmana, NrwEnglandJournalof Medicine 329(6): 437, 1993 .................................................................................................. 10 [38] "Questionnaire Data as Predictors of Utinary Cotinine Levels Among Nonsmoking Adolescents," F. Forastiere, N. Agabiti, V. Dcll'Orco, R. Pistelli, G.M. Corbo,. G. Brancato, R. Paci6ci; P. Zuccaro, and C.A. Pcrucci; Archives of EnvironmentalHralrh'48(4): 230-234; 1993 [See Appendix A] ............................................. 11 [39] "Environmental Tobacco Smoke: Mulricomponent Analysis and Room-to-Room Distribution in Homes,"'G. Lofroth, Tobacco Control2: 222-225, 1993 [See Appendix A] .................................................................................................... .............. 11, INDOOR AIR QUALITY [40] "Effccts of Man-Made Mineral Fibers in Settled Dust on Sick Building Syndrome in Air-Conditioned Of$ces," A. Hedge„W.A. Erickson, and G. Rubin, Proceedings oflndoorAsr'93 1: 291-296, 1993 [See Appendix A],.......................................... 11' SMOKING POLIiCIES AND RELATED I!SSUES [411 "'Pilbt Study on thc Effects ofa Workplace Smoking Ban oniIndices of Smoking,. Cigarette Craving, Stress and Other Health Behaviours." M. Gomel, B. Oldenburg; J. Lemon. N: Owen„and F. VUcstbrook, Psychology and Health 8; 223-229, 1993 [See Appendix A] ........................................................................... 1 1 [42] "The Effects of Smoking Bans on Extended Care (Jnits at State Psychiatric Hospitals," J.J. Parks and D.D. Devine, HoipitalarudCommurrity Psychiatry 44(9): 885•886, 1993 [See Appendix A] ................................................................................ lil

Contents Continued, Issue 61 IN' EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS CANADA [431 Proposed Smoking Prohibitions Introduced by Health Minister ........................................... 1 1 CZECH. REPUBLIC [44] Charter of Child'ren's,Rights Established ..................................••.•••..-•.••-.•••••••••••.•••.-•••••.. ...•.. 12 G ERMPiNY [45) Bund'esaag Called on to Pass Antismoking Law ........................................................••..•-..-...• 12 MALAYSt + [46) New Smoking Law in Malaysia ............................................................................................. 12 UNITED KINGDOM '' [471 Measures to Scrap I-Iealkh and Safety Laws to be Debared'in Parliament ..............................A2 ETS-RELATED LITIGATION INVOLVING THE CIGARETTE INDUSTRY AUSTRALU+ [48] TIA v. Strphrn Woodward (Supremc Court, Equity Division, New South Walcs)', (decided December 3, 1993) ................................................................................................. 13 ETS/IAQLITIGATIONINOT INVOLVING CIGARETTE MANUFACTURERS AUSTRAI.IA. [49]I Blackwood v. Hornefwrsr (Workers'.'Compensation Court, Western Australia) (filing date unknown) .................................................................................................... ........ 13 OTHER DEVELOPMENTS CANADA [501 Children Allowed to Restrict Parents' Smoking in Southern Ontario Town .......................... 13 FRANCE [51] French Guide Names 735 Smoke-Free Restaurants ............................................. .............. .... 13 [52] First Prosecution for Violating,Public Smoking Law ............................................................. 13 HONG KONG [53) SBS Research is Recommended ............................................................................................. 14 NORWAY [54] New Antismoking Campaign is Announced in Norway ........................•-••••••.••.•--••••••••••---... A4 UNITED KINGDOM ..................................................... li [55] Sick Buildings Sought for Inclusion in Study ..................• MEDIA COVERAGE CANADA. (56) "Boar&on the Carpets" The Ottawa Cirizrn, November 25, 1993 ......................................... 1'4. WoRLDAI~RLfNE NEWS [57] "Travel: Smokers Run Out of Flight Timc," The Daily Tilrgraph. Nbvember 27, 1993 ........ 14' APPENDIX A .................................................................................................... ................................ Article Summarics APPENDIX B .................................................................................................... ...........,Upcoming Scientific Meetings

DECEMBER 3, 1993 REPORT ON RECENT ETS AND IAQ DEVELOPMENTS IN THE UNITED STATES REGUL..ATORYAND LEGISLATIVEIvIATTERS 103D CONGRESS [1] Lautenberg Proposes Adding ETS Regulatory Authority to Toxic Substances Control Act On November 18, 1993, Senator Frank Lautenberg (D-N.J.) introduced the Senate's version of the "Smoke-Free Environment Act of 1993" (S. 1680). The bill, which would amend the Toxic Substances Control Act and~ give regulatory authority over ETS in public buildings to the EPA, is similar to the legislation introduced by Representative H'enry Waxman (D-Cal.) on Nbvember 3, 1993 (H'.R. 3434). Details about Waxman's bill appear in~ issue 59 of this Report, November 5, 1993. Lautenberg's measure, like Waxman's, would restrict smoking in all public facilities to areas that are separately ventilated. Where separatelyventilated'areas do not exist, smoking wouldl be prohibited indoors and within the immediate vicinity of the entrance to the facility. Unlike the House bill, Lautenberg's proposal would permit public facilityowners to petition for a waiver from~ compliance. The waiver provision states, "If the [EPA] Administrator determines that the public facility is subject to unusual and extenuating circumstances that prevent the compliance, the Administrator may grant the waiver and instead require that the faciliry protect nonsmokers to the maximum extent practicable." In introducing the measure, Lautenberg relied on the EPA Risk Assessment on ETS. In this regard, he stated,. "an EPA report released on January 7, 1993, undeni- ably confirmed what public health officials have reported for several years, smoking kills those who smoke and those who breathe secondhand smoke.... This EPA report was twice reviewed by an EPA Science Advisory Board and was approved unanimously by the scientists on this panel." Lautenberg also quoted'~ from the ETS brochure released by the EPA in July 1993, and made a reference to the U.S. Supreme Court decision in I-Ielling v. McKinney. [2] ETS Health Warning Proposed for Cigarette Pack Labeling Before the House recessed on November 22, 1993, Representative Henry Waxman (D-Call)iintroduced a bill that would, among other matters, replace the current warnings on cigarette packages with nine bigger labels that would'include the warning "Smoke From These Cigarettes Can Cause Cancer in Non-Smokers." The bill (H.R. 3614), entitled "Promotion of Tobacco Products, Restriction," has four cosponsors and was referred to the House Committee on Energy and Commerce. Surgeon General Joycelyn Elders has reportedly endorsed the legislation. See Reuters, November 23, 1'993. [3] Traficant BiII Placed on Senate Legislative Calendar 1 Following its passage in the House, the "Ban on Smoking in Federal Buildings Act" (H.R 881), introduced by Representative James Traficant (D- Ohio), was read twice in the Senate. The second reading occurred on November 22, 1:993, two days before the Senate recessed for the year. At the time of the second reading, Senator Dirk Kempthorne (R- Idaho) objected to further consideration of the mea- sure, and it was placed on the Senate Legislative Calendar under the rules. Further details about the bill„ which would restrict smoking in all Federal buildings, appear in issue 60 of this Report, November 19, 1993. [4]I EPA Cabinet Status Bill Cleared for Debate 11 14 ~ ~ N Although the EPA cabinet status bill (H.R. 3425) was ~ cleared for limite& debate on the House floor by m resolution of the Committee on Rules, the merits of N~ the measure were not considered before the House ~ recessed on November 22, 1993. Further information about the bill appears in issue 60 of this Report, ~d'" November 19, 1993.

Representatives John Mica (R-Fla.)~and Newt Gingrich (R-Ga.)iboth objected to the limitations on debate. Gingrich recommended that the leadership pull' the bill and return in January 1994 with a debate rule to which all the members could agree. He supported his request bynoting,that (i) the bill will cost taxpayers $1.2 billion, (ii), the ranking member of the Commit• tee on Government Operations who worked on the bill was not present due to incapacity, and (iii) the debate rule effectively eliminated from the bill amendments on "unfunded mandates" and risk assessment. Mica also objected to the absence of a risk assessment provision in the measure. U.S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) Reich Introduces Dear to OSHA Employees at "Town Hall" Meeting Labor Secretary Robert Reich introduced Assistant Labor Secretary in charge of OSHA, Joseph Dear, to OSHA staff on November 19, 1993, during a"town. hall" meeting. Both men addressed the 200 OSHA staff members who attended the meeting. According to a press report, Reich observed that the Clinton admin- istration is committed'to "strict and responsible" enforcement of job safety laws, and he lauded OSHA for "leading the way" in efforts to streamline operations under Vice President Al Gore's reinventing govern- me1it program. Dear's remarks apparently focused upon his three- point program, which includes more effective targeting of enforcement effons, a streamlined standard-setting process, and education and training: Neither Dear nor Rei& indicated what position the Clinton administra- tion would be taking on measures to reform the Occupational Safety and Health Act. Dear is report- edly committed to OSHA reform, and he stated' that in~ the near future a memo on the issue will be sent to the president, after which Reich will announce the administration's position. Dear also stated that OSHA was placing regulations to combat the workplace spread of tuberculosis on a "fast-track approach." Alchough he did not explain what this meant, he did say he will set a deadline and challenge staff to expeditiously come up with proposal. He reportedly cautioned, however, that OSHA's efforts r,.3ank.4 rr.i•Uni, i33ur- 0 1 in this regard will be dependent on the Centers for Disease Control and Prevention finalizing new guide- lines to prevent TB transmission among health care workers. See BNA Daily Rrport for Executives, Novem ber 23, 1993. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) [6] Hospital Survey Shows Inadequate Ventilation to Control Spread of TB According to a recent survey, almost one-third of hospitals polled reportedly do not have adequate ventilation in rooms for patients with infectious tuberculosis. This, according,to CDC and the Ameri- can Hospital Associationwho reportedly conducted a survey of over 1,000 hospitals concerning the incidence of tuberculosis (TB) and practices related to preventing the spread of the disease. The survey, which will apparently be released' in early 1994, showed that nearly 30 percent of the 758 responding facilities reported having no rooms meeting the CDC ventila- tion criteria for the isolation of patients with TB. The CDC recommends that TB isolation and treatment rooms have at least six air changes per hour, direct outside exhaust, and negative pressure ventilation. The number of TB isolation rooms meeting this standard per hospital ranged from zero to more than 60, with the median being six. See Occupational Safety d Health Reporter, November 24, 1993. U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) ( [f7] Committee Meets to Discuss EPA Indoor Air Research Program The indoor air quality committee of the EPA Science Advisory Board (SAB)'met in Washington, D.C., on December 2-3,1993. The agenda for the meeting was to indude further discussion of the SAB's Environmental Futures Project and consideration of revisions to the ~ committee's draft working paper on EPA's Indoor Air ~ Rcsearch Program. See FiArral Regirter, November 22, 1993. In 1990-91 and again in 1992, this committee reviewed the drafts of the EPA Risk Assessment on ETS. At the time of the reviews, the committee was 1: ` ~ ~

DECEMBER 3, 1993 chaired by Dr. Morton Lippmann. At the decision of EPA Administrator Carol Browner, Lippmann recently was replaced as chair by Joan Daisey of the Lawrence Berkeley laboratory's indoor environment program. The draft working paper on EPA's an Indoor~ Air Research Program was reportedly prepared and released by EPA's Office of Research and Development (ORD). The program is apparently a five-year plan that is designed to refine the agency's environmental research programs, integrate research activities, set priorities for funding and describe the research program to EPA's program office. ORD's plan reportedly includes 1AQ studies of large buildings, the development of building investigation protocols and the evaluation of strategies for source management, ventilation and air cleaning to determine the most cost-effective options for achieving healthful indoor air. According to a press repon, the research on source management and air cleaning may affect future versions of ASH'RAE Ventilation Standard 62-1989, which could be amended with consideration being given to these issues. See Indoor Air Review, November 1993. [8]I ETS Reference Made During EPA Press Conference On November 22, 1993, the EPA conducted a press conference at which Administrator Carol Browner introduced the Assistant Administrators for the EPA's offices. Mary Nichols, Assistant Administrator of the Office of Air and' Radlation, discussed ETS to the extent that the ageney had learned' through its "ed'uca- tional information~campaigns on environmental tobacco smoke ... of ways in which the agency can work with the private sector and with affected commu- nities to make major improvements in the amount of risk that people are being exposed to." Immediately following these remarks was a statement by Nichols that "[t]he goal here, I think, is to provide strong standards and good, well-crafted regulationss that will provide maximum flexibility for those who want to innovate, and we're looking forward to working with them." See Federal News Seruice, Novem- ber 22, 1993. [9] EPA Devel'ops 1AQ Monitoring Equipment for La.rge Buildings The EPA is developing equipment that will' be capable of monitoring IAQ within single zones of large buildings. The equipment, developed in conjunction 3 with the agency's Florida Radon Research Program, will apparently be capable of gathering data on tem, perature, pressure, relative humidity, radon, and other unspecified IAQ factors. Information will reportedly be stored as 30-minute averages for up to 20 days and can~ be retrieved by d'ownloading on a portable computer or over telephone lines. According to a press report, each unit willi be the size of a suitcase. See IndoorAir Review, November 1993. NIOSH [10] NIOSH Publishes RF1 Seekiing IAQ Research on Workplace Chemicals Transported into Homes On November 15, 1993, NIOSH published' a request for existing information regarding the contamination, of workers' homes by hazardous chemicals and sub- stances transported into homes from the workplace on, equipment, clothing or the worker's person. Among the items of information sought is "indoor air quality research, that pertains to the fate of chemicals trans- ported from a workplace into the home environment." STATE AND LOcal. GbVERNMENTS [ 11 ] Florida PTA to Seek School IAQ Eval'uation Bill Representatives of the Florida Parents and Teachers Association reportedly agreed during their annual' convention in St. Petersburg to seek legislation thart would require school buildings to undergo 1AQ evaluations and to adopt measures to improve poor IAQ. The recommendation was apparently part of aa larger platform focusing on children's health. See St. Petersburg Times, November 21, 1993. Several Florida elementary and second'ary schools have reported 1AQ problems due to molds, fungi and other things in the past year. [12]1 Privacy Legislation •Wash.ington According to a press report, groups such as the Ameri- can Civil Liberties Union, and the National Abortion Rights Action League have united in the State of Washington to lobby for the passage of privacy legisla- tion; that would prohibit employers from discriminat-

4 ing against workers who engage in lawful activities outside the workplace. The coalition has not yet been successful. Although~the legislature passed such a measure in 1992, Governor Booth Gardner (D) vetoed it. Gardner reportedly explained his decision by stating that the bill, which he dubbed smokers rights legisla- tion, "would have done little to promote healthier lifestyles." A similar measure never made it out of committee in 1993 due to a political controversy unrelated to the bill Some employers in Washington, apparently do not hire smokers, among them, Schweitzer Engineering Labora- tories, Alaska Airlines and the Ada County Sheriff's Department. According to a press report, Schweitzer claims it is saving money on its health insurance benefits by hiring only nonsmokers, but the savings are achieved due to claim rates. See Lewiston Morning Tribune, November 21, 1993. [13] ETS-Related State and Local Legislation •Local! Governments in California San Fernando. Contrary to a trend' arnong California cities of prohibiting restaurant smoking, the San Fernando City Council is considering a voluntary resolution that would allow restaurants to keep their smoking sections as long as the restaurants permit smoking,in less than~ half of the establishment and display signs informing customers. "We came up with a solution that protects both sides," a councilman was quoted as saying. "I think that it's a step to empower the public to make that choice itself, If a restaurant sees its business go down because of the smoking, it will change. It's better for people to vote with their dollar than to have a bureaucracy decide it." See LosAngelcs Times, November 18, 1993. San Juan Capistrano. On November 16, 1993, the City Council voted unanimously to consider an ordinance that would prohibit indoor smoking in restaurants. Before becoming law, the proposal requires a second reading and vote, which may occur in December. See LosAngeles Times, November 18, 1993. Shasta. Four restaurant owners reportedly have been charged with violating a four-month-old'smoking restriction ordinance because "they were seen providing their customers with ashtrays." City officials contend that such behavior violates a section of the ordinance requiring business owners to make a reasonable effort ETS/IAQ REPORT, ISSUE 61 to keep their customers from lighting up. See Sacra- mento Bee, November 25, 1993. •Local Government in Georgia The Richmond County Board of Health reportedly has proposed that indoor smoking be prohibited in restaurants throughout the county. A three-member committee was assigned to draft a proposed ordi- nance. See The Atlanta Journal and Constitution, November 20, 1993. •Local' Government in Massachusetts Brook'line Smoking will be prohibited in restaurants (including private function rooms), bars, taxis, workplaces and "all hotel rooms" under a law passed at a Brookline town meeting on November 16, 1993. The prohibitions are scheduled to be phased in over the next two years: During the meeting, some supporters of the measure relied on the EPA Risk Assessment on ETS. According to one newspaper, the law represents "the broadest smoking ban in the state." See The Boston Globe, November 18, 1993. •Nlcw Jersey On November 22; 1993, a bill was introduced in the New Jersey Senate that would limit smoking in the state's shopping malls to smoking lounges that are either "enclosed by walls" or separately ventilated (S. 2194). For malls without smoking lounges, the measure would result in a smoking ban. Mall manag- ers would have discretion to permit smoking in designated' areas of restaurants, food courts and tobacco businesses. A statement attached to the billl cites the EPA Risk Assessment on ETS and notes that, since the risk assessment was released, "shopping malls in New Jersey and around the country have been banning smoking om their premises." •Il,ocal Government in Ohio Cincinnati. The Health Department reportedly is considering a recommendation to tlie city that ir prohibit smoking in workplaces, restaurants, bars and bowling alleys. A propose&health regulation may be submitted in February 1994. A newspaper article suggests that the health department began working on tougher smoking regulations as a result of the EPA Risk Assessment on ETS. See The Plain Dealer, November 22, 1993.. N ....

DECEMBER 3, 1993 ETS-RELATEDLITDGATIONAGAINSTCIGARETTE 1v1ANUFACTURERS [14] Bluitt. Motion to Amend Complaint Filed' On November 17, 1993, in response to ('i) defendants motion to dismiss for failure to plead fraud with particu- larity and (ii) defendants' motion~for a more definite statement, plaintiffs filed a motion for leave to amend their complaint in an unspecified manner. The court has not ruled on defendants' or plaintiffi' motions. Plaintiffs in~this action allege Willie Ruth Bluitt was a nonsmoker who diedof lung cancer as a result of her exposure to environmental tobacco smoke. Defendants in the action are the six major Ui.S& cigarette manufacturers. Bluitt v. RJ Reynolds Tobacco Co., et al.' (U.S. District Court, Eastern District„Texas) (filed August 30, 1993)! [15] Broirn Depositions of Senior Executives Continue; Defendants Begin Depositions of Plaintiffs Plaintiffs deposed four representatives of The Tobacco Institute - Samuel Chilcote, Walker Merryman; Brennan Dawson and Thomas Lauria - on November 18-19, 1993. Plaintiffs also deposed Dr. James Glenn, President of the Council''for Tobacco Research,,on November 29. Additional l depositions of senior executives have been noticed for December and January. Preston Robert Tisch, co-CEO of Loews Corpora- tion, was to be deposed' on December 9, but a motion to quash the notice to d'epose him was granted on November 24. Defendants began deposing the plaintiffs on Decem- ber 1 with the deposition of Patricia Crittenden; her deposition continued on December 2. Plaintiff Valerie Gibson was to have been deposed on November 30 and December 1, but the deposition was postponed. On November 23, plaintiffs filed a motion to add R.J. Reynolds Tobacco Co: and R.J. Reynolds Tobacco International as defendants in the action. A hearing on the motion, and on the motion to dismiss filed by the Reynolds entities named in the complaints in the case, is scheduled for December 117. At issue in this case are the claims of 28 flight atten- dants allegedly injured' by occupational exposure to ETS. In addition, the husband of one flight attendant claims loss of consortium. The 2$ attendants purport 5 to represent a class of approximately 60,000 other attendants. Plaintiffs' class action allegations have been dismissed by the trialicourt-, plaintiffs' appeal of that dismissal is pending in the Florida Court of Appeal. Injuries alleged by the putative class representatives include 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 are purported to be 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, etaZ (Circuit Court, Dade County, Florida) (filed October 31, 199'1)'. [I16] Butler: Argument Scheduled on Defendants' Motion for Summary judgment A hearing,on defendants' motion for partial summary judgment is still scheduled for December 13, 1993. Defendants seek summary judgment on all of plaintiffs' claims except design defect. Plaintiffs contend that Burl Butler, a barber from Iaurel! Mississippis developed lung cancer as a result of his exposure to environmental tobacco smoke. The defendants in this case consist of the six major U.S. cigarette manufacturers and several local retailers. Butler v. RJ Rrynolds Tobacco Company, et aL' (Circuit Court, Hinds County, Mississippi) ~ (filed October 21, 1992). ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS WORKPLACE: WORKERS' COMPENSATION [I17] ,J'ohannesen v. New York City Dept. ofHousing Preservation and Development (Court of Ap- peals, New York) (revicw granted October 12, 1993) The Court of Appeals has reportedly agreed to review the decision of the Workers' Compensation Board to award benefits to a claimant who alleged that work- place exposure to ETS caused disabling asthma. The

6 claim had originally been~ decided against the claimant in 1989. Subsequent review resulted in a determination by an administrative law judge that the claimant had suffered a compensable occupational disease. The Workers' Compensation Board rescinded that decision, finding instead that the daimant had sustained' an accidental injury as a result of repeated exposure to ETS. See New York Law Journal'' November 19, 1993. WORKPLACE: COLLECTIVE BARGAINING [18] Matter of NLRB and NLRB I''rofessiottal Ass n and Washington Loca4 NLRB Union, 1993 WL 456696 (Federal Service Impasses Panel) (decided November 5, 1993) A Federal Service Impasses Panel has decided to order the National Labor Relations Board (NLRB) to adopt the more restrictive smoking policy sought by the unions representing,NLRB attorneys and clerical workers. The parties had reached a negotiationss impasse and submitted their dispute to the panel for resolution. The NLRB suggested that smokers be permitted to smoke in smoking lounges with "state of the art" ventilation systems. The unions wished to establish a smoke-free workplace, with smoking permitted only in outdoor areas and in a garage-level designated'smoking area. The panel, in endorsing the union positions, also ordered the NLRB to establish smoking cessation courses for smoking employees. PRISONER CASE [19J Johnson v. Laham, et aL, 1993 U.S. App. LEXIS 29528 (U.S. Court of Appeals, Fourth Circuit) (decided October 28, 1993). The Fourth Circuit Court of Appeals has determined that a Maryland state prison inmate may pursue his Eighth Amendment claim of cruel and unusual punishment due to ETS exposure. The district court had dismissed inmate Steven Johnson's daims, but the Court of Appeals reversed on the basis of Helling v. McKinney, 1113 S. Ct. 2475 (1993). Under the Su- preme Court ruling, Johnson will be entitled to injunctive relief only if he can prove that prison officials were deliberately indifferent to his exposure in failing to enforce the state's inmate smoking policy, and that he is entitled to the specific remedy of an ETSLIAQ REPORT, ISSUE 61 injunction. He must also prove (i) that he is being exposed to unreasonably high levels of ETS, (ii) that the exposure subjects him to unreasonable risk with respect to his future health, and (iii)'that today's society will not tolerate his exposure. LEGAL ISSUES AND DEVELOPMENTS [201 "Smoky Custody Battles," Ellen Goodman, The Boston Globe, November 21, 1993 This opinion piece by columnist Ellen Goodman is critical of the recent trend in child custody cases of parents seeking to base custody decisions on smoking. Goodman prefaces her remarks by noting that she does not like to be exposed to ETS and suffered for years while located at work between two cigar smokers. Nevertheless, Goodman questions whether "the cigarette is another weapon of warring parents. It's fair to ask whether smoking,should be the trump card in everyday wrangles over the kids." Goodman refers to the EPA Risk Assessment on ETS, and suggests that if smoking is harmful to children who are involved in custody disputes, then it should also be harmful to all children. She wonders where children should be placed if they are removed frorn~ every home with a smoker in it. Goodman also ob- serves that if health care is a pivotal issue in custody battles, then lead paint, radon, nutritional balance, guns, seat belt habits and wealth should also be criteria to consider. She concludes by stating, "In divorce,, should the smoker lose the kids to the nonsmoker? Not even~ I want to see that warning on the cigarette pack." OTHER DEVELOPMENTS [21] California Trade Union Officials Ask for Free Smoking Cessation Classes According to a press report, California trade union officials, seeking to promote good IAQ and occupa- tional health, safety and' welfare for working families, believe that employers should offer free work-site smoking cessation classes as a health benefit. State labor councils have reportedly produced guidelines and' brochures which recommend ways in which manage-

) DECEMBER 3, 1993 ment and labor can bargain over workplace smoking, policies and other related issues. See BNA Occupational' Safeo; d Health Daily, November 24, 1993. [22]', New York Antismoking Coalition Receives Grant A five-year grant providing $35,000 each year to aid in antismoking programs has been awarded to the Niagara County Coalition on Smoking or Health. The grant will reportedly be used to promote and encourage smoke-free environments, to control tobacco advertise- ments and promotion of tobacco products, to limit access to tobacco of children, and to support tobacco price increases. The grant, awarded by the American Stop Smoking Intervention Study for Cancer Preven- tion, represents a joint effort by the National Cancer Institute and the American Cancer Society. See The Buffalo News, November 24, 1993. [23] Polling Research Supports Accommodation in Malls Ninety percent of those responding to a recent survey of 2,000 adults reportedly did not cite cigarette smoke as one of the biggest problems in shopping malls. In fact, 28 percent of respondents claimed they would spend less time in malls which prohibit smoking. The survey was conducted by Roper Starch Worldwide, Inc., for The Accommodation Program, which is sponsored by Philip Morris U.S.A. The Accommoda- tion Program assists businesses in enhancing accommo- dations and offers free resources to develop separate areas, enhance ventilation systems and train employees. According to a newswire report, Roper research has also shown that smokers tend' to spend an average of 10 percent more than nonsmokers per mall visia The survey indicates that high prices, crowd's and parking concerned consumers two to four times as much as ETS in malls. See PR Newswire, November 26, 1993. [24] State Distributes Information About ETS to Smokers The Massachusetts Tobacco Control Program and the American Cancer Society have reportedly launched a toll-free "Smoker's Quitline" which will give callers access to information about cessation programs, counselling options and the purported hazards of ETS. 7 The program is part of a number of initiatives funded by a 25 cent-per-pack tax on cigarettes, and apparently made its debut on November 18, 1993, as part of the "Great American Smokeout." See PR Newswire, November 11, 1993. More information about the Massachusetts Tobacco Control Program appears at issue 58 of this Report, October 22, 1993. [25] IAQ Claimed to be Critical to Hotel and Motel Customers According to a survey by Omni Hotel, 27,500 members of the company's Select Guests business travelers said "they considered a room free from: stale, cigarette air as the most imponant, hotel amenity.°' Omnii reserves 20 percent of its rooms for nonsmokers. More than 86 percent of hotels and motels that belong to the National Hotel & MotellAssociation now provide smoke-free rooms, according to the associa- tion. See IndoorAir Review, November 1993. [26] Cleveland Man Develops "Talking SmokeBuster" A former computer programmer in Cleveland, Ohio„ has reportedly developed a device he calls a"talking, SmokeBuster." The device is intendedto~be placed in~ such places as restrooms, elevators and other designated nonsmoking areas. Then, when it detects a lit cigarette, it will voice an antismoking message proscribed by its owner. "It can be as polite or obnoxious as you want," according to Michael Kaufmans developer of the device, who was interviewed for media reports. Kaufman says the device is very sensitive and can detect even a puff or two of smoke. In response, a spokesman interviewed itom the United Smokers Association, "There are already enough harassments that smokers have to endure. It's disappointing that people keep capitalizing on smoke-bashing." See Sofrline Informa- tion, September 5, 1993. [27] Smoking Ban Causes Business Backlash Accord'ing to a press report, the Bakers Square Restau- rant in the Twin Cities has lost some business as a result of implementing a nonsmoking policy during the last month. The Illinois-b.sed chain, however, is apparently determined to continue the policy in Minnesota, and

8 local~ restaurant managers consider the test ban to be permanent. See Star Tribune, November 9, 1993. MEDIA COVERAGE [28] "The Outcasts of the '90s: Smokers In the V(/ork- place," Los Angeles Ti»us, November 19, 1993 This article discusses the increase in smoking restric- tions in the workplace and other public places since the January 1993 release of the EPA Risk Assessment on ETS. Citing The Tobacco Institute, the article states that legislatures in 46 states have passed laws restricting, smoking, and that all 50 states have locat laws govern- ing smoking. In California alone, 250 cities have anti- smoking ordinances. Beginning next year, prisoners in California will not be allowed to smoke in their cells. The article also discusses the bill! introduced by Representative Henry Waxman (D-Cal.) to limit smoking inside all public buildings to separately ventilated rooms (H.R 3434)s as well as the November 1993 report by 16 states attorneys general urging that smoking be prohibited in all fast-food restaurants. [29]I "Noseworthy Progress for a Sick Sense," Chicago Tri6une, November 11, 1993 This article discusses complaints of sensitivity to various odors, including perfume and tobacco smoke. The articlt focuses on Dr. Alan Hirsch, Director of the Smell and Taste Treatment and Research Center in Chicago, who daims that his caseload has increased with new attention to such odors and claims of °mul- tiple chemical sensitivity." The article notes that perfume wearers are increas- ingly being segregated in some public places. For example, the article says, several restaurants in Chicago "discreetly sniff their patrons" and segregate the "overscented" from the rest of the diners. Also, within the past year, San Francisco and Oakland have adopted policies excluding heavy perfume wearers from govern- ment meetings. The artide also discusses Charlie Trotter, who bans smoking and uses fragrance-free flowers in his restau- rant. But Jimmy Rohr, a restaurant owner and claimed "multiple chemical sensitivity" sufferer, told the ETS/IAQ REPORT, ISSUE 61 newspaper he decided to lift his ban on smoking and perfumes in January because he was losing $140,000 a year in business due to the bans. SCIENTIFIC/TECHNICAL ITEMS UPCOMING SCIENTIFIC MEETINGS [30] Indoor Environment '94, IAQ Publications and Other Sponsors, Washington, D.C., March 22- 24, 1994 This upcoming conference was described in Indoor Air Review as providing "information ~ on the latest developments in legislation, policy strategies and government programs; building management; evalua- tion and abatement; safety and health; and litigation and liability:" According to the article, last year's conference had more than 100 speakers and 1,000 attendees. It was co-sponsored by the American Industrial Hygiene Association, the National Institute of Building Sciences, the Environmental Information Association4 and the Consumer Federation of America. LUNG CANCER [31] "Saturated Fat Intake and Lung Cancer Risk Among Nonsmoking Women in Missouri," M.C.R. Alavanja, C.C. Brown, C. Swanson, and RC. Brownson, Journal of tlie National Cancer Irutitute 85(23)s 190fr1916,1993 [See Append'nt A] In this paper, the authors report on the possible effects of a"broad range of dietary faaors"'for lung cancer risk in their study population. They report a strongly elevated, statistically significant relative risk for the highest level of saturated fat consumption, a"protective" effect for bean and pea consumption, and an elevated risk associated with consumption of citrus fruit and juice. [Saturated fats are those fats that are solid at room temperature, e.g., meat fat, butter, lard, etc.] The magnitude of the reporte& risk estimate for high saturated fat intake - an approximate six-fold increase when compared to the group reporting the lowest intake - is substantially higher than risks reported in

DECEMBER 3,1993 other studies on dietary factors. The authors attribute this to the use of only nonsmoking women in the study, and to the large percentage of adenocarcinoma cases in their sample. In comparison to the point estimate of 6.14 for the highest level of saturated fat intake in the Alavanja, et al., study, the overall'point estimates reported~in the approximately 35 available studies on spousal smoking range from approximately 0.7 to 2.5. The Brownsons et al., (1992) spousal smoking study, based on the same data set, claims that "dietary beta carotene" and "dietary fat" were considered among a number of potential confounders in the ETS analyses, but appar- ently only age„active smoking, and previous lung disease were adjusted in calculating risk estimates for ETS. Moreover, it is not~ clear how "dietary far,"'as used by Brownson, et al''., corresponds to "saturated fat," as used by Alavanja, et al. None of the other spousal smoking studies evidently ind'uded an adjustment for dietary fat intake. [32] I Editorial Regarding "Saturated' Fat I!ntake and Lung Cancer Risk Among Nonsmoking Women in Missouri," M.C.R. Alavanja, C.C. Brown,,C. Swanson, and R.C. Brownson, Journal of the National Cancer InstituteS 5(23): 1906-1916,. 1993 An editorial by Laurence N. Kolonel of the Cancer Research Center of Hawaii was published in the same issue of the Journal'of the National Cancer Institute as the Alavanja, et al., studyon dietary fat intake and lung cancer risk. Kolonel has also published research concern- ing diet and cancer. The editorial appears at Journal of the National Cancer Institute 85(23): 188Cr 1887: In Kolonel's opinion, there is a "biological rationale" for fat as a lung cancer risk factor. He lists several potential mechanisms by which fat could have a carcinogenic effect: alteration of the immune response, effects on carcinogen activation or detoxification,, inhibition of cellular communication, influence on the endocrine system, effects on hormone production, and enhancement of tumor cell proliferation. With regard to the Alavanja, :t al., study, Kolonel comments that the authors "give no information as to 9 whether [their]I models were appropriate." He suggests that their study does not resolve the issue of which dietary components may be related to increased risk. Finally, Kolonel addresses the public health impor- tance of the reported findings; he says that the addition of lung cancer to the list of health endpoints attributed to a high-fat diet is not needed to strengthen argu- ments for reducing fat intake. Moreover, Kolonel concludes: "[D]bes the identification of secondary risk factors for lung cancer play into the hands of the tobacco industry, which grasps at these straws in its relentless efforts to diminish the significance of ciga- rette smoking as the overwhelming worldwide cause of lung cancer?" [L33] Letters to the Editor Regarding "The Hazards of Passive - and Active - Smoking," P. Boyle, New England Journal of Medicine 328 (28): 1708-1709, 1993 The New England Journal ofMedicine recently pub- lished two letters concerning an editorial previously published in the journaL in which the EPA Risk Assess- ment on ETS was discussed. The current letters are by Chris Coggins and the author of the original editorial, Peter Boyle. The letters appear at New England'Journal of Medicine329(21); 1580, 158i„1993. In his letter, Coggins, of the RJ. Reynolds Tobacco Company, proposes that there were "a number of erroneous statements" in Boyle's editorial. For instance, he suggests that Boyle implied that research had suggested a link between parental smoking and childhood brain tumor. The majority of Coggins' letter focuses on the ETS risk assessment. He states that the EPA'S ETS risk estimate would not have been statistically significant if a 95 percent confidence interval had been used, notes that none of the eleven U.S. studies used by the EPA was statistically significant at the 95 percent level, and states that adding two recent studies "for some reason excluded by the EPA" would also result in a statistically nonsignifi- cant risk estimate. Coggins also criticizes the EPA's daim that risk increased with increasing,exposure, suggests that EPA "disregarded its own guidelines," and discusses the Agency's failure to account for chance, bias, and~con- founding as possible explanations of the claimed'associa- tion. Finally, Coggins also notes that ETS is not a "quantitative variant" of mainstream smoke. He con-

10 dudes: "Boyle's comparisons and unsupportable conclu- sion do not withstand even minimal scientific scrutiny." In his reply, Boyle opines that "Coggins raises several points that could have been resolved by a more carefuli reading of my editorial." He suggests that the editorial was subjected to "detailed dissection," and that the "tobacco industry's objections" raised in Coggins' article "are mainly irrelevant to the points" he raised in the editorial. Boyle then suggests that Coggins' letter exhibits "implicit acceptance of many of the points concerning tobacco-related cancer" made in the original editorial, and further claims that the Coggins' letter represents "implicit acceptance of the hazards of smoking by tobacco manufacturers." Boyle describes Coggins' reply as providing "no facts, only bluster" in response to Boyle's position that strict tobacco-control measures are justified. OTHER CANCER [34]I "Epidemiology of Intracranial Meningioma," VfJ.T. Longstreth, L.K Dennis, V.M. McGuire, M.T: Drangsholt, and T.D. Koepsell, Cancer 72(3): 639-648, 1993 [See Appendix A] Meningioma is a cancer of the meninges, the mem- branes that cover the brain and spinal cord. The authors review possible risk factors for this cancer, and mention that a 1992 Australinn~epidemiologic study reported an inueased'risk associated with "passive smoking." OTHER HEALTH ISSUES [35] "Exposure to Environmental Tobacco Smoke as a Risk Factor for Recurrent Acute Otitis Media in Children under the Age of Five Years," R. Stenstrom, P.A.M. Bernard, and H. Ben- Simhon, International Journal of Pediatric 4torhinolarymgology 27: 127-136, 1993 [See Appendix A] These Canadian researchers examined 85 children with recurrent acute otitis media (RAOM); and compared their reported ETS exposure to that of 85 controls. The authors report that ETS exposure was ETS/IAQ REPORT, ISSUE 61 statistically significantly associated with an increased risk of RAOM. ETS EXPOSURE AND MONITORING [36] I"Questionnaire Assessments of Recent Exposure to Environmental Tobacco Smoke in Relation to Salivary Cotinine," R.J. Delfino, P. Ernst, M.S. Jaakkola, S. Solomon,, and M.R. Becklake, European RespiratoryJournal6: 1104-1108, 1993 [See Appendix A] Based on comparisons of questionnaire responses and salivary cotinine measurements from 258 nonsmokers, the authors report poor agreement between recent exposure, using cotinine as a surrogate, and self- reported exposure, as assessed' by questionnaire. They suggest that further work is needed to improve the assessment of recent ETS exposure. [37] Letters to the Editor Regarding "The Nicotine Content of Common Vegetables," E.F: Domino, E. Hornbach, and T. Demana, New England Journal ofMedicine 329(6): 437, 1993 The New England Journal ofMedicine recently pub- lished two letters concerning the Domino, et al., letter, which suggested that consumption of certain vegetables could affect low levels of nicotine measured in the body fluids of nonsmokers. See issue 54 of this Report, August 27, 1993. This Report erroneously identified the original letter as having been published in ~ The Lancet. The current letters, by Jack E: Henning6eld' and' Edward F. Domino, appear at New England Journal ofMedicine 329(21): 1581-1582, 1993. Henningfield's letter claims that Domino and colleagues'' inferences were flawed due to a "500-fold error in the calculations used to determine the veg- etable equivalent of toxicologically meaningful expo- sure to tobacco smoke." He suggests that, to produce an exposure equivalent to one-half cigarette per day, a person would have to consume more than 100 kilo- grams (220 pounds) of tomatoes in one day. Henningfield also suggests that "ingesting nicotine is not equivalent to inhaling it," as nicotine is poorly absorbed from the stomach, and 70 percent is metabo- lizcd by the liver before entering the blood.

DECEMBER 3, 1993 In his reply, Domino agrees with Henningfield's assertion that "the amount of nicotine in certain vegetables is obviously too small to produce any pharmacologic or toxicologic effects." He states his position that "[u]rinary cotinine levels would surely be measurable in persons eating less than 100 kg of tomatoes a day." Domino concludes with the following statement: "I stand behind' our letter and say loud and' clear - let us do more research." [38] "Questionnaire Data as Predictors of Urinary Cotinine Levels Among Nonsmoking Adoles- cents," F.. Forastiere, N. Agabiti, V. Dell'Orco, R. Pistelli, G.M. Corbo, G. Brancato, R. Pacifici, P., Zuccaro, and C.A. Perucci; Archives ofEnvironmental Health 48(4): 230-234, 1993 [See Appendix A] Urinary cotinine measurements and questionnaire responses were compared in a sample of 542 Italian adolescents. The authors report that maternal smoking was the best predictor of cotinine level, and that house size and crowding, and subject's perception of a smoky environment could also be predictive. [39]' "Environmental' Tobacco Smoke: Multicompo- nent Analysis and Room-to-Room Distribution in Homes," G. Lofroth, To6acco Conrrol2: 222- 225, 1993 [See Appendix A] Based on measurements of nicotine, particles and other ETS constituents in one townhouse and one apartment, the author concludes that nonsmokers in homes where smoking occurs will be exposed to ETS regardless of their location relative to the location of the smoker. INDOOR AIR QUALITY [40] "Effects of Man-Made Mineral Fibers in Settled Dust on Sick Building Syndrome in Air-Condi- tioned Off'tces," A. Hedge, WA. Erickson, and G. Rubin, Proceedings of Indoor Arr '93 1: 2'9'1- 2'96, 1993 [See Appendix A] The authors of this study report on their analysis of nicotine, particulates, formaldehyde, settled dust, and man-made mineral fibers (MMMF) in nine air- conditioned buildings, with respect to reported symptoms of sick building syndrome. Reportedly, 11 smoking policy, which rangedfrom a ban to smoking areas that were separately ventilated, separately filtered, or not separately treated, was not associated with building sickness score or indoor environmental conditions. MMMF count in settled'dust was the only factor correlated with sick building,complaints. SMOKING POLICIES AND RELATED ISSUES [41] "P'ilot Study on the Effects of a Workplace Smoking Ban on Indices of Smoking, Cigarette Craving, Stress and Other Health Behaviours," M. Gomel, B. Oldenburg, J. Lemon, N'. Owen„ and F. Westbrook, Psychology and Health 8: 22'3-229, 1993 [See Appendix A] This study reports on measurements of effects of a workplace smoking ban at amAustralian ambulance center. The authors report a decrease in the number of cigarettes smoked per day following the ban, as well as an. increase in reported stress. [42] "The Effects of Smoking Bans on Extended Care Units at State Psychiatric Hospitals," J.JI. Parks and D.D. Devine, Hospztal and Community Psycliiatry44(9'): 885-886, 1993 [See Appendix A] Citing a "serious health~ risk posed by" ETS, the authors of this study examine the perceived resulEs of smoking bans in a number of psychiatric hospitals. They conclude that such bans are "feasible, safe, and beneficial to the milieu." IN EUROPE & AROUND THE WORLD REGULATORYAND LEGISLPITIVE MATTERS CANADA [43] Proposed Smoking Prohibitions Introduced by Heal'th Minister On November 22, 1993, Ontario Health Minister Ruth Grier announced' the introduction of legislation

12 which would, among other matters, prohibit smoking in designated public places andall health care facilities, with the exception of residential facilities such as nursing homes. The "Tobacco ControllAct," which is a part of a Tobacco Strategy launched in January 1992,, was apparently subject to public consultation. The Ministry of Health reportedly received 240 written submissions and 34 oral presentations regarding its discussion paper on the proposed tobacco legislation. The President of the Canadian Tobacco Manufactur- ers' Council (CTMC), which was one of the groups submitting comments to the Ministry, reportedly issued a statement upon the introduction of the Tobacco Control Act. The statement refers journalists to its March 1993 submission, which does not address the ETS issue. The statement also observes that new or modified provisions in the bill will be studied by the CTMC. See Canada NewsWtre, November 22 & 23, 1993; The Toronto Star, November 24, 1993: CZECH REPUBLIC. [44] I Charter of Children's Rights Established The Czech Republic's Charter of Children's Right to Protection Against the Harmful Effects of Smoking was established at a recent workshop of experts that was organized by The Czech Sociery of Physicians. The Charter urges pregnant women, parents, teachers and! doctors to give up smoking because "children have the right to live in a society inwhich non-smoking is a normal way of living," Jiri Kozak, head of the H'eallth Ministry's Advi'sory Council' for Prevention of Smoking, claims that every third day, one nonsmoker in the Czech Republic dies as a result of ETS exposure. Set CTKNational News Wire,,November 16,1993. GERMANY [45] Bundestag Called on to Pass Antismoking Law At their annual meeting in Frankfurt, the Doctor's Working Group on Smoking and Health called on the Bundestag to pass a law "for the protection of non- smokers." The working group announced that it had joined forces with the German Non Smokers' Initiative, and' that together, they would present draft legislation to the parliament at the end of December 1993. E7~S/iAQ ftEPUK'Y, ISSI'1;.~~61 The group's proposal reportedly calls for smoking restrictions at state-sponsored events and in all places of employment, all public sector institutions, all forms of public transportation, and all restaurants. The drak also provides for specific areas where smoking is allowed and' establishes minimum size and ventilation levels for such areas. The proposal calls for violations to be treated as misdemeanors and to be subject to fines of as much as $6,000. In addition nonsmokers would have the right to make damage claims. While the initiative is reportedly supported by two Bundestag deputies, there is also apparently much opposition to such legislation. Sce Week ln Germany, October 29, 1993. MALAYSIA [46] New Smoking Law in Malaysia A new law recently approved'by the Malaysia Parlia- ment states that smokers who light up in designated nonsmoking areas or on public transport face jail sentences of up to two years and fines of up to $2;640. The law takes effect on May 15, 1994; it reportedly prohibits smoking in all public places. It also bans all forms of cigarette advertising and promotions with the exception of in-house magazines. See The Ottawa Citizen, November 23, 1993; Xinhua General News Service, November 22, 1993, UNITED KINGDOM [47]I Measures to Scrap Health and Safety Laws to be Debated in Parliament According to a Department of Trade and Industry document apparently leaked to the press, the govern- ment plans to introduce legislation that would reform current workplace health and safety laws by removing most employer obligations. Among the proposals being considered'as part of the reform legislation is a provi- sion that would require the minimum in building ventilation or smoke-free zones already prescribed by EC directives. The measures, which are apparently intended to minimize costs to commerce and industry, have provoked opposition by Labour and the unions. See Independent on Sunday, November 14, 1993.

DECEMBER 3, 1993 ETS-RELATED LITIGATION INVOLVING THE CIGARETTE INDUSTRY AUSTRALIA [48] TL4 v. Stephen Woodward (Supreme Court, Equity Division, New South Wales) (decided'. December 3, 1993)' On December 3, 1993, the New South Wales Supreme Court ruled in favor of defendant Stephen Woodward on the issue of whether statements allegedly made by him were made in trade or commerce. The court did not address the question of whether the statements were misleading,or deceptive. TIA issuedla press release following the ruling saying it is "disappointed that Australia's leading,anti-smoking spokesperson is not bound by the law to make accurate statements on such an important public issue the same way that the Tobacco Industry is bound." The action was brought by TIA on the basis of misleading statements allegedly made by Woodward about the judgment of the full federal court in AFCO v. TI'A'~and the EPA Risk Assessment on ETS. Trial was held September 6-7, 1993; further details regard- ing the trial' appear in issue 55 of this Report, Septem- ber 10, 1993.. ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS AUSTRALIA [49] Blackwood v. Homeswest (Workers' Compensa- tion Court, Western Australia) (filing date unknown) A State Housing Commission employee has filed a workers' compensation claim alleging that he had a mild' heart attack in July 1992 that was caused by workplace exposure to ETS. The claimant, Allan Samuel Blackwood, claims exposure from 1968 through 1988. A pre-trial conference will be held on December 16, 1993, before a workers' compensation tribunal. A hearing on the merits is not expected for another six or more months following the conference. 13 OTHER DEVELOPMENTS CANADA [50] Children Allowed'~ to Restrict Parents' Smoking in Southern Ontario Town Under a pilot project by the Waterloo regional health unit, 70 pre-teen children have signed formal contracts with their parents that restrict parental smoking. Contract rules range from designated smoking roomss in the home to a total indoor ban. After six weeks, approximately 88 percent of the families were report- edly honoring their contracts. See The Reuter Library. Report;, November 17, 1993. FRANCE [51] French Guide Names 735 Smoke-Free Restaurants Now on the newsstands in France is the country's first nonsmokers' guide to restaurants and hotels. The guide lists 735 smoke-restricting establishments. The Guidr to Non-Smoking Hotels and Restaurants was publishedby the National Committee Against Smoking,approxi.mateHy one year after the effective date of nationwide smoking restrictions. Only a handful of the establishments in the guide are entireNy smokeftee; most offer designated smoking areas. The guide also contains information on the relationship between food and tobacco, and research on the claimed effects of ETS exposure. See Associated Presc Woddttream, November 26, 1993. [52] I First Prosecution for Violating Public Smoking Law A smoker, who was reportedly smoking in the non- smoking section of a cafe, became the first person to be prosecuted for smoking in public. According to a press report, the smoker ignored another customer's request that he not smoke. The other customer apparently poured a pitcher of water over the smoker's head, and the smoker threw the empty pitcher back, missing the customer and' allegedly hitting a five-year old child. The smoker was fined for smoking in public and for injuring the child. See The Guardian; November 13, 1993.

14 HONG KONG [53]I SBS Research is Recommended'At a mid-November conference in Hong Kong, specialists urged more research into the "ill-defined area" of sick building syndrome (SBS). They suggested that measures to "protect" workers from SBS may be a waste of time due to a lack of information about the syndrome and its possible causes. Professor Anthony Hedley, head of the Department of Community Medicine at the Hong Kong Univer- sity, was quoted as saying that "symptoms of the sick building syndrome could! be found' in everyone if you were looking for them;'," that "the cause of the syn- drome is not known and the methods available to investigate it are profoundly inadequate;" and that "glib assertions that the health risk can be avoided by the installation of so-called modern ventilation systems are patently untrue." See South China lllornrng Post, November 16, 1993. NORWAY [54]I New Antismoking Campaign is Announced in Norway According to a press report, one of the goals of a new, nationwide antismoking plan is to make all facilities that serve youth smoke free by 1998. The new plan, known as "A Tobacco-Free Norway Year 2000," replaces the previous "Smoke-Free Norway Year 2000" campaign. The new plan does include age limits for buying tobacco, an~ increase in the tobacco tax, and new warnings for tobacco and snuff boxes. See Aftenposten; November 16, 1993.. UNITED KINGDOM~ [55] Sick Buildings Sought for Indusion in Study The authors of a $685,000 research project are seeking "sick buildings" for inclusion in a two-and-a- half year study of the design and operation of hcalthy buildings. The study is being,funded by the Depart- ment of Trade and' Industry and the Science and Engineering Research Council. ETS/IAQ REPORT, ISSUE 61 The head of the project, Professor Patrick O'Sullivan of University College London, suggests that, instead of referring to a building as sick, it is more accurate to say that parts of a building tend to concentrate indoor air constituents. "This is particularly the case where air conditioning systems draw in air that is already pol- luted, as in many city centres," he is quoted as saying. See The Independenk November 14, 1993.. MEDIA COVERAGE CANADA ['S6] "Board on the Carpet," The Ottawa Citizen, November 25, 1993 This article discusses the potential indoor air quality problems that carpets may create in schools. The discussion centers around the Carleton Board of Education, which is building a new middle school in Barrhaven for September 1994. The author of this article urges readers to express their concerns regarding carpets to the Board so that they willlopt to install smooth flooring. The Barrhaven community has apparently welcomed'persons, including children, with~ "Environmental Sensitivity" into their school system. "The health and ability to learn of children with environmental sensitivity is severely compromised by current levels of indoor air pollution Mour schools," the author claims. "Provision of a carpet-free environ, ment in the new middle school in Barrhaven would'& eliminate a major source of indoor air pollution while simultaneously resulting,in significant cost savings to the taxpayer and the Board." WORLD AIRLINE NEWS [57]' "Travel: Smokers Run Out of Flight Time," The Daily Tekgraph, November 27, 1993 This article discusses the increasing number of airline smoking bans, asserting that "since October 1992, when the International Civil Aviation Organisation (ICAO) recommended a ban on smoking on all international flights within four years, scarcely a month has gone by without an airline announcing new

DECEMBER 3, 1993. restrictions." Last May, the International Agency on Tobacco and Health reported that 18 airlines were entirely smoke free and that another 32 had made provision for some nonsmoking flights. Passengers have, on occasion, won the right to smoke on airlines that were attempting to introduce bans. The Scandinavian airline, SAS, was forced to allow smoking seats after only two months of a trial ban on European flights. Even nonsmokers had apparently complained about the ban. The Dutch airline, KLK after a three- month trial ban~on~shon flights, found that passengers preferred to retain smoking seats. 15 ~

DECEMBER 3, 1993 APPENDIX A The numbers assigned to the following article summaries correspond with the numbers assigned to the synopses of the articles in the text of this Report. LUNG CANCER (31J "Saturated Fat Intake and Lung Cancer Risk Among Nonsmoking Women in Missouri," M.C.R. Alavanja, C.C. Brown, C. Swanson, and R.C. Brownson, Journal of the National Cancer Institute 85(23): 1906-1916, 1993 "Approximately 9%-20% of lung cancer cases in women occur in nonsmokers. Because of the large number of ]ung cancers unrelated to active smoking in women, with about 4000 incident cases in the United States in 1990, the etiology of these cases needs further study. The limited number of nonsmoking womenn with lung cancer in most studies has, however, mini- mized the opportunity to assess the etiologic role of dietary and other factors among nonsmokers. In the present study, we examined the effect of a broad range of dietary factors on lung cancer risk in a large, population-based, case-control study of women who were either lifetime nonsmokers or former smokerss who had quit at least 15 years ago." "A telephone-administered questionnaire was used to determine and/'or verify eligibility with regard to age, gender, race, and smoking status. In a second interview at the participant's home, a widely used food' frequency questionnaire was filled out, and logistic regression was subsequently used to analyze the responses. We obtained dietary information on 429 case subjects who had a diagnosis of lung cancer reported'to the Missou6 Cancer Registry between June 1, 1986, and June 1, 1991, and 1021 control subjects. If a case subject had died or was too ill'to be interviewed, next-of-kin familiar with the woman's diet were interviewed instea& Of the 429 women with lung,cancer, 211 (49%) had lung adenocarcinoma." "Lifetime nonsmokers consisted of those women who had not smoked more than 100 cigarettes or used any other tobacco products for more than 6 months in their lifetime. Former smokers were defined as women who ceased using all tobacco products 15 or more years prior to interview; the median period of smoking A-1 cessation in our study was 2'4' years. Questionnaires given to participants in this study were designed to assess lifetime passive smoking, previous active smok- ing, diet, and previous lung disease." "In addition to the registry-reported diagnosis of lung cancer, tissue slides were reviewed for histologic verification for 333 (77%) of the cases." "The effect of previous smoking is seen in this study of current nonsmokers, since the proportion of former smokers was approximately twice as large among case subjects (32%) as control subjects (117%) ~ (P<.0001)'. Next-of-kin interviews were used for 58% of the case subjects and only 2%'0 of the controhsubjects (P<.0001') because many case subjects had either died or were too ill for an in-person interview. A larger proportion of case subjects (42%) than control subjects (35%) had a history of previous lung disease (P =.04)." "Along with age, we included previous smoking habits, prior, lung disease, and type of interview (i.e., in person or next of kin) in all subsequent logistic regres- sion analyses of dietary factors. Passive smoking did not affect risk estimates in this study and, therefore, was not used in any regression analysis of dietary factors. Interview status, because of its relationship to both case-control status and measured nutrient intake,, was a potentially confounding factor that needed to be adjusted for in the analysis." "Because the statistically significant measures of dietary fat intake, daily consumption of total fat, saturated fat, and oleic acid; weekNy servings of red meat; percent calories from total fat; and percent of calories from saturated fat are all closely related to one another, we examined each measure's contribution to risk while adjusting for the other measures. The univariately significant effects of total fat, oleic acid, red meat, percent of calories from fat, and percent of calories from saturated fat disappeared when daily intake of saturated fat was included in the regression model, while the effect of saturated' fat remained highly significant no matter which other fat measure was induded....Therefore, our subsequent regression analyses included only the daily consumption of saturated fat as the measure of dietary fat intake." "The independent effects of daily intake of saturated fat,,weekly servings of beans and peas, and weekly servings of citrus fruit and juice remained statistieally

A-2 significant, while those of weekly servings of fish and chicken, noncitrus fruit, dairy products, and percent calories from carbohydrates became nonsignificant." "Table 6 presents the results of our final multivariate regression model, which includes the three significant diet factors along with~ the adjustment variables: age, smoking history, previous lung disease, interview type, and total caloric intake. Daily intake of saturated fat was strongly associated~ with increasing lung cancer risk (trend, P=.0001); Compared with those in the lowest quintile, the increase in risk was statistically significant for the two highest quintiles, surpassing sixfoU for the top quintile of saturated fat intake. Weekly servings of beans and peas were signif cantly protective (trend; P= .02), with the two highest quintiles showing approxi- mately half the risk of the lowest quintile. A significant (P =.004) trend of increasing risk with increasing, weekly consumption of citrus fruit and juice was also observed, with the top quintile showing a twofoU increase in risk compared with the lowest quintile." "Table 7 presents the results of the final regression model for lung adenocarcinoma as well as other tumors (i.e., squamous cell# small cell; and other, mixed, or~ unknown cell types). The association of saturated fat intake with increased risk of lung adenocarcinoma had greater statistical significance than the association~with increased risk of lung cancer of other cell types (trend, P =.0001 versus P = .07). There was an L1-fold increase in RR of adenocarcinoma from~the lowest to highest intake quintiles." "In~ this study, the leading contributors of dietary saturated fat were hamburgers, cheeseburgers, and meat loaf (derived from one line item in the questionnaire) followed by weekly consumption of cheeses and~ cheese spreads, hot dogs, ice cream, and sausages." "In.our study of nonsmoking women, the effect of saturated fat intake was most pronounced for lung adenocarcinoma, with an 11-fold elevation in risk in the highest versus lowest quintiles of saturated fat consump- tion. Cholesterol and total fat consumption, which seemed to be relatively weak risk factors for lung cancers in other published studies, did not appear to have an effect independent of saturated fat in our study. The risk of lung,cancer associated with saturated fat was greater than expected on the basis of results from earlier studies. However, our analysis differs in three important ways: the use of quintiles of intake rather than the ETS/IAQ REPORT„ISSUE 61 more commonly used quartiles; the focus on adenocarcinomas, which are less often observed in~ smokers; and the concentration on nonsmokers, so that diet effects are not overwhelmed by the d'ominant riskk factor (i.e., smoking) and are thus easier to detect." "Proposing a biologic mechanism for the observed association between dietary fat and lung cancer would be speculative at this time in light of the inconsistent pattern of risk observed in the epidemiologic literature. Experimental data supporting a link between dietary fat and lung cancer, however, does exist. Dietary fat appears to act primarily as a promotor of tumorigenesis in experimental animals but may also affect initiation of tumors." "Fruit: andlor vegetable consumption has been found to be inversely associated with lung cancer risk in a number of previous studies, but only noncitrus fruits were found to be protective in our univariate analysis.... The protective effect of noncitrus fruits disappeared when simultaneously considered with the other dietary components found to have an effect onn lung cancer risk in this study. We have no clear explanation~ for this finding,or for the surprising, increase in lung cancer risk associated with dietary intake of citrus fruit and juice, but one might speculate that citrus fruit consumption was increased to relieve symptoms of lung disease in the months or years preceding lung cancer diagnosis.... Since most cancers in our study were adenocarcinomas,, it may be that the protective effect: of fruits and vegetables is limited to cancers that are more closely related to smoking." "Major strengths of our investigation include the evaluation of incident cases of lung cancer in a population-based setting, the relatively large number of nonsmoking women available for study, and pathology review of most cases. A potential1 weakness is thclarge number of proxy respondents for diet information and the imbalance between the numbers of proxy interviews for case subjects (58%) and control subjects (2%). We used two analytic approaches to 'adjust' for this factorc including interview types in the regression equation and using only the self•reporting subjects (179 case subjects and 1002 controlisubjects). Because the two analyses produced similar results, we believe that using an interview type indicator variable in the regression model provides adequate protection against any bias from including next-of-kin food frequency reports."

DECEMBER 3, 1993' "A second potential weakness is the possibility of recall bias associated with most case-control studies.... While we cannot rule out the possibility of bias, it seems unlikely that recall bias alone could fully explain the pronounced direct association of saturated fat and lung cancer risk in this study. A third poten- tial weakness could result from measuring 'usual' diet via a one-time administration of a food frequency questionnaire....Finally, with numerous food groups and nutrients being examined, we cannot rule ouc the possibility that our results could be due to chance alone.... [W]e do realize that high correlations are no guarantee against occasional spurious 'significant' results when large numbers of comparisons are made, so we recommend careful interpretation." "In summary, our study finds a strong, increasing trend in lung cancer risk associated with increased saturate& fat consumption among nonsmoking womem This effect was most pronounced for adenocarcinomas. We believe the large number of adenocarcinoma cases in this study helps make it possible to observe this striking association, which may have been masked in earlier studies. A smaller protective effect was also observed with bean and pea consumption. While our results support the public health admonition to reduce fat and''saturated fat consumption, additional etiologic studies are needed before we can fully understand the nature of this association." -OTHER CANCER [34] I "Epidemiology of Intracranial Meningioma," W.T. Longstreth, L.K. Dennis, V.M. McGuire,. M.T. Drangsholt, and! Ti.D. Koepsell, Cancer 72(3): 639-648, 1993 "Intracranial meningiomas arise from the meninges and typically have benign histologic findings. They constitute approximately 20% of all intracranial tumors. Their incidence increases with age, and they affect women more commonly than men. The annual incidence per 100,000 people ranges from two to seven for women and from one to five for men. Since the first study was published in 1970, only eight major epidemiologic studies have been done that attempted to identify risk factors for meningioma." A-3 "Although the results have not been consistent across all studies, those with the strongest designs and~the most subjects suggest that ionizing radiation is an important factor. Other less-studied but hypothesized risk factors include head trauma and gender. In the following section, these and~ other~ risk factors will I be discussed." "The strongest epidemiologic evidence linking ionizing radiation and meningioma comes from the studies of radiation therapy in childhood for tinea capitis (ring- worm of the scalp)." "In other series, most patients with meningiomas never had radiation therapy for tinea capitis. What are other common sources of radiation exposure to the head in the range of 1-2 Gy? Dental radiographs are one potential! source." "Cigarette smoking has not been found to affect risk. It is interesting that the Australian case-control study found an elevated risk with passive smoking, more so in women than in men." "Overall, these studies support the contention that ionizing radiation is a risk factorfor meningioma. Less certam is the role of head trauma, and the role of endogenous and exogenous estrogens and progestins hass not been studied.... Identification of etiologic risk factors, especially those that could be modified, such as radiation exposure, would allow for the possibility of preventing this disease." OTHER HEALTH IssuEs [35] "Exposure to Environmental Tobacco Smoke as a Risk Factor for Recurrent Acute Otitis Media in Children under the Age of Five Years," R. Stenstrom, P.A.M. Bernard, and H. Ben-Simhon; International' foxrnal of Pediatric Otorhinolaryngology 27: 127-136, 1993 "Exposure to environmental tobacco smoke (ETS) has remained a controversial risk factor for otitis media in children. This study evaluates the association between: exposure to ETS and recurrent acute otiitis media (RAOM)~in 85 caqes and 85 age and gender matched controls under the age of 5 years.... Cases were defined as having four or more physician documented AOM

A-4 episodes in the preceding 12' months and contruls were otitis free in the prior 12 months. Exposure status wass assessed~via parental questionnaire." "Exposure to ETS was categorized (presentLabsent)) on the basis of any caregiver (mother, father or regular babysitter) i smoking in the household (more than 5 cigarettes per week for at least 4 weeks) in the 112 months preceding the interview (therefore, the latency of the effect of exposure to ETS was presumed to be quite short)." "Exposure to ETS was categorized (low or high) on, the basis of the total number of cigarettes consumed by all caregivers/family members (1-15 cigarettes/day = low exposure; > 15/day = high exposure)." "In order to evaluate the association between ETS and RAOM while controlling for other exposures, a modeliwas developed.... The resulting OR for ETS was 2.68 (95% CI = 1.27-5.65)." "The results of this study support the hypothesis that exposure to ETS is associated with RAOM in children under the age of five. These data do not offer definitive proof of a causal relationship, but this supposition is certainly tenable given these results. Specif cal ly the odds ratio for RAOM and exposure to ETS remained significantly elevated even when other exposures were adjusted for. The association between ETS and RAOM was relatively independent of other risk factors mea- sured in this study (SES, daycare attendance, prematu- rity, breastfeeding, etc.). This observation reduces the likelihood that exposure to ETS is simply a risk marker for other risk factors, such as SES. Also, a striking, exposure-response relationship was evident when exposure to ETS was categorized (absent, low and high). The population etiologic fraction for exposure to ETS and RAOM suggests that up to 34% of cases of RAOM may be due to this exposure.° "The mechanism by which exposure to ETS may precipitate AOM is unclear at this time.... ETS may affect eustachian tube function by acting as an irritant to the lining of the eustachian tube. This may be accomplished by the antigenic substances found in ETS which have been shown (on animals) to produce increased (lower) respiratory mucosa permeability and d'assic inflammatory reaction." ETS/IAQ REPORT, ISSUE 61 TTS FxPOSURE AND MONITORING [36] "Questionnaire Assessments of Recent Exposure to Environmental! Tobacco Smoke in Relation to Salivary Cotinine," R.J. Delfino, P. Ernst, M.S. Jaakkola, S. Solomon, and M.R Becldahe, Euro- pean Respiratory Journal6: 1104-1108, 1993 "The objective of the present study was to determine whether the ability of various questionnaire-derive& estimates of ETS exposure to predicr salivary cotinine, in both men and women, could be enhanced by considering detailed exposure information from the previous 3 days, and estimating a cumulative index which,takes into account the half-life of cotinine." "The questionnaire. .. induded! questions regarding personal smoking history, exposure to ETS over the period 1981'-1988, and of direct concern to the present analysis, questions detailing the previous 3 days of ETS exposure." "For each of the prior 3 days (today, yesterday and the day before yesterday) i and each potential place of exposure (work, home, vehicle, social setting and other) subjects were questions ont 1) type of tobacco smoke exposure (cigarette, pipe and' cigar smoke) S 2) number of smokers within a 110 ft radius of the subject (intensity), set at a maximum value of five; and 3) duration of exposure in number of hours. Although the type of tobacco smoke was ascertained, they were treated', equivalently, due to the rarity of pipe/cigar exposure in this population. Source identity (spouse, friend, etc.)~ for exposure was not ascertained." "[TJhere was considerable overlap in the number of exposed and unexposed subjects within each of six intervals of cotinine concentration. There was, how ever, on average a greater concentration of cotinine among exposed subjects, evident for both men and women."' "In a model containing cumulative exposure for each separate place of exposure, significant relationships to...cotinine were found for work exposure and in social exposures, whereas exposures at home, in vehicles, or at other places were not significant. This was expected since the great majority of reported exposures occurred at work and in: social settings." "Self-reported levels of exposure to environmental tobacco smoke were not strongly related to the level of

DECEMBER 3, 1993 salivary cotinine, with none of the regression models explaining more than 16% of the variability im..cotinine levels. Thus, little difference was found' between standard'~ approaches and present attempts to enhance the ability of questionnaire-derived estimates of ETS exposure to predict salivary cotinine, which induded: 1) adjustment of previous days' exposure for the half life of cotinine; and 2) the use of cumulative exposure, the summed product of exposure intensity multiplied by duration....In the present study, most of the exposures (and their strength of relation to cotinine levels) occurred M the office and social settings, where ETS levels were probably d'etermined by the amount of smoking,throughout those sections of a building connected by ventilation systems or large open spaces. Therefore, the actual level of tobacco smoking may not have been as apparent to subjects as in the home, thus explaining the considerable overlap in cotinine concen- trations in those reporting exposure with those report- ing no exposure." "Part of the low level of concordance between questionnaire-based' estimates of ETS exposure and salivary cotinine is due to inaccuracy in the measure- ment of cotinine." "In addition to place of exposure, other determinants of exposure to ETS found in the present study were the level of aversion~to ETS, age, and the time of year. An increased level of cotinine for the two lower versus two higher levels of aversion was only apparent in men. Higher levels of cotinine were found in the two younger versus the two older age categories." "The modelling approaches in the present study should be re-examined in different settings, to confirm or reject the lack of improvement in the ability of a detailed~ questionnaire-derived model to predict cotinine. Our findings do suggest, however, that the cumulative exposure estimate was related more signifi- candy to cotinine than were intensity or d'uration as exposure covariables." "In the present study, the weak relationship between questionnaire responses and salivary cotinine pertains to recent, not chronic ETS exposures, and thus to studies of the acute health effects of recent exposure.... [F]rom the present study and other similar investigations, it appears that questionnaire assessments of recent ETS exposure are inaccurate, given the low A-5 levels of concordance with cotinine despite the use of conceptually better exposure estimates. Further efforts appear necessary to improve the assessment of recent ETS exposure, with investigations aimed at verifying the success of such efforts." [38) "Questionnaire Data as Predictors of Urinary Cotinine Levels Among Nonsmoking Adoles- cents," F. Forastierc, N. Agabiti, V. De[I'Orco, R. Pistelli,,G.M. Corbo, G. Brancato, R. Pacifici, P. Zuccaro, and CA. Perucci, Archives of Environmental Health48(4): 230-234, I993 "The purpose of the present study was to examine the strength of association between urinary cotinine and questionnaire data among adolescents. The leading predictor factors were determined''.with the aim of developing a proxy of the objective indicator, at least in this age group." "Overall, the single variablt that best predicted the outcome was maternal smoking, according to both~ the mother's and the subject's reports. Noteworthy is the inverse relationship to house size and, consequently,, the positive association with house crowding. Nb statistically significant association was found for sex, age, presence of other smokers at home, father'ss education, or exposure to smoking outside the home." "We found thar the best predictors of urinary cotinine arnong adolescents were maternal smoking, house crowding, and passive smoking as reported by the subject. The important role of mother's smoking for subjects accords with other reports. Father's smoking is better subsumed under the subject's view of smokiness at home in the preceding 3[days]." "Our results...show a high impact on cotinine levell of house crowding, an indicator of the space available. There is a strong synergism between maternal smoking and' house crowding; it underlines the need for closer consideration of this variable in future studies of passive smoking at home." "However, as a limitation that should be recognized, we may have misclassified subjects with a high passive smoking exposure simply because their urine was too diluted. For example, it should not be concluded that father's smoking,isof little significance for this age group because an independent effect may be present but it may be more difficult to be detected." ,

A-6 "We did not observe any contribution from indica- tors of exposure outside the home, and no difference between boys and girls was indicated. It might be suggested that the activity pattern outside the familial setting is not relevant where exposure to cigarette smoke is concerned; however, a more sensitive cotinine measure might have detected such effects." "In conclusion, we found that passive smoking at home,,especially in the presence of a smoking mother„ explains urinary levels of cotinine among adolescents, as has been shown previously among infants an& children. Two questions about maternal smoking and house crowding, together with the subject's perception of a smoky environment, might be useful predictors of a high passive smoking exposure, which could be usedl for community studies."' [39J "Environmental Tobacco Smoke: Multicompo- nent Analysis and Room-to-Room Distribution in Homes," G. Lofroth, Tobacco Control2: 222-225, 1993 "The present study was undertaken in order to study how tobacco smoke is dispersed in real homes having low ventilation rates that typieally prevaill in temperate and cold climate zones in order to conserve energy. The study included the measurement of concentrations of nicotine, isoprene, and particles (which together comprise a reasonable distribution of component types present in ETS), as well as the mutagenic activity of the particulate matter." "The homes investigated'were one 3-bedroom apartment and one 3-storey/3-bedroom townhouse....Smoking,did not occur on a routine basis in either of the homes." "Smoking was performed in the living rooms with a frequency of 1 cigarette every 30 min in the apartment and 1 cigarette every 20 min in the townhouse." "The ventilation rates were found to be about 0.5 air changes per hour (ACH) " "The outdoor concentrations of particles measured before and after the indoor studies were always <50 ug/ m'....Thus, the high indoor concentrations were almost entirely due to the smoki'ng:" "The concentrations of nicotine decreased' drastically with the distance from the living room, where the ti J/.li'1llxL!•11K1 „1,SJUt 01 smoking took place, to other rooms in the homes. This is in contrast to the other pollutants, which were at about the same concentrations in all rooms of the apartment and which only decreased by about 50% in the most remote room of the townhouse." "The efficient dispersion of ETS to all rooms in the homes, as shown by the analysis of particles and iso- prene, implies that occupants cannot escape exposure to ETS if smoking occurs within the home." "The present study, in real environments, confirms that nicotine disappears faster from indoor home air tham other components, implying that the exposure to nicotine relative to other ETS components may be dependent on the distance between the smoker and'the passive smoker." "The major message from this study is that smoking in the home will expose non-smoking occupants to tobacco smoke throughout the home, with potential health consequences. Parents and other child guardians should be enlightened about this fact." INDOOR AIR QUALI7Y [40] "Effects of Man-Made Mineral Fibers in Settled Dust on Sick Building Syndrome in Air-Conditioned Offices," A. Hedge, W.A. Erickson, and G. Rubin, Proceedings of Indoor Air `]31: 291-29G,,1993 "A survey of sick building syndrome complaints in nine buildings was conducted. Airborne pollutants and ambient conditions were not correlated with sick building syndrome complaints. There was a significant correlation between man-made mineral fiber counts in settled dust and sick building syndrome complaints." "Nine air-conditioned buildings with either variable air or constant air volume ventilation systems were studied. In three buildings smoking was prohibited; in two buildings smoking was restricted ... to a separately ventilated cafeteria; in one building smoking was restricted to a room with additional local air filtration; and in three buildings smoking was restricted to specific rooms with no additional air treatment."

DECEMBER 3, 1993 "A self-report questionnaire was used which gathered information on worker perceptions of ambient condi- tions, occupational factors, work-related SBS symp- toms, occupationali and personal information. The frequency of occurrence of 15 work-related sick building symptoms during the previous month was assessed (dry eyes, irritated eyes, sore throat, dry skin, hoarseness, congested nose, runny nose, menta[fatigue, irritability, headache, wheeze, nausea, dizziness, skin irritation, lethargy)." "The number of work-related'symptoms per person was counted and the average number of symptoms per worker for each building, termed the building sickness score (BSS) was calculated. Because the buildings operated different smoking,policies the effect of this on the BSS was tested. There was no effect of smoking policy on the BSS or on any of the indoor environment conditions, ind'ud- ing,the number of fibers or fiber density." "There were no significant correlations between ind'oor pollutants, temperature„humidity or lightning [sic] and the [BSS] for the 9 buildings surveyed, apart from a significanro correlation for the density of MMMF in the initial settled dust.... There was, however, no significant rel'ationship between either the airborne MMMF or the settlhd!MMMF counts and the BSS, which suggests that complaints may be linked to the total'amount of MMMF deposited'on surfaces and not the rate of settling or amount of suspended fibrous material in office air~." "A significant rel'ationship between MMMF in settled' office dust initially sampled and! reports of SBS symp- toms among workers was found. No other indoor air quality or ambient measure correlated with SBS complaints. This effect was mainly driven by results for one building where settled fibrous material was the most abundant, which suggest[s] that MMMF is not the sole cause of SBS symptoms, but that there may be a threshold effect of MMMF in settled dust on SBS symptoms.... [O]ur results suggest that SBS symptoms should be influ- enced by the office cleaning regime." A-7 SMOKING POLICIES AND RELATED ISSUES [41) "Pilot Study on the Effects of a Workplace Smoking Ban on Indices of Smoking, Cigarette Craving, Stress and Other Health Behaviours," M. Gomel, B. Oldenburg, J. Lemon, N. Owen, and F. Westbrook, Fsychology and Health 8: 223-229, 1993 "This paper reports on the results of a pilot study conducted to examine the short term effects of a workplace smoking,ban on self-reported smoking behaviour, CO, plasma cotinine levels and a number of the appetitive behaviours." "On the tst August 1989, a smoking ban was intro- duced into all offices and ambulance stations of the New South Wales Ambulance Service. The ban was not preceded by any smoking restrictions." "A survey of the staff in the Sydney Coordination Centre of the New South Wales Ambulance Service was conducted to identify current smokers. Allismokers were approached to participate in the study. Because of the demanding and intense nature of the work in, the Coordination Centre, little opportuniry is available for staff to leave the work environment during working hours, making the Centre an ideal setting to examine the effects of periods of enforced abstinence from smoking." "The final sample size for the pilot studywas 24 (15 males; and9 females):...[iIlhe average number of cigarettes smoked per day was 26.3, with a range of 10 to 43." "Mean self-reported total daily smoking was signifi- cantly lower at the one week follow-ups compared to baseline; and there was little change in mean repotted smoking between the one and six week follow-ups. The mean level of cotinine, which: is an objective measure of total smoking consumption, showed a strong downward trend between baseline and one week, but drifted' back up to baseline levels, by six weeks, con- trary to the self reported smoking data." "There were no significant changes in snack eating between baseline and one week, between one and six weeks and baseline and six weeks." "The total number of cigarettes smoked on a working day and the number of cigarettes smoked during working hours declined immediately after the ban was introduced." . lti'

DECEMBER 3, 1993 B-1 APPENDIX B vPCOMI'NG SCIENTIFIC MEETINGS • December 5-8, 1993 Annual Meeting, Society for Risk Analysis, Savan- nahs Georgia [Issue 60, Item 351 • December 9, 1993 Liability, Compliance, Insurance and Indoor Air Quality, MidAtlantic Environmental Hygiene Resource Center, Philadelphia; Pennsylvania [Issue 60, Item 36] • December 10, 1993 One Day Overview of Indoor Air Quality, MidAtlantic Environmental Hygiene Resource Center, Philadelphia, Pennsylvania [Issue 60;, Item 37] • December 15, 1993 Indoor Air Quality: An Overview for People Who Need to Know, AIHH'M, San~Antonio, Texas [IIssue 57, Item 35] Same program to be held' March 4, 1994, Orlando, Florida; April 13, 1994, Minneapolis, Minnesota; May 5, 1994, Chicago, Illinois; June 17, 1994, Oklahoma City, Oklahoma; July 14, 1994, Anchorage, Alaska • December 16-17, 1993 The Nanional! Environmental Tobacco Smoke Conference: Public Battles, Private Choices, IAQ Publications,;Washington, D.C. [''I'ssue 55, Item 34;. Issue 60, Item 34'] i • March 28-3'1, 1994 Eleventh ORNL Life Sciences Symposium, Indoor Air and Human Health Revisited (Bringing Se- lected Advances in Medical Science to the Indoor Air Quality Community), Knoxville, Tennessee [Issue 58, Item 43] • May 5-7, 1994 Second Annual IAQ Conference and Exposition, NC IAQ, Tampa, Florida [Issue 49, Item 35] • May 22; 1994' Indoor Air Quality Symposium, American Indus- trial Hygiene Conference and Exposition, Anaheim, California [Issue 57, Ikem 34]' • October 10-14, 1994 9th World Conference on Tobacco and Health, Paris, France [Issue 60, Item 38] • October 18-20, 1994 Indoor Air Quality M Asia, Beijing, China [Issue 54, ItemA2] • October 30-November 2, 1994 IAQ'94: Engineering Indoor Environments, ASHRAE and other sponsors, St. Louis, Missouri' [Issue 58', Item 42] • March 22-24, 1994 Indoor Environment '94, IAQ Publications and other sponsors, Washington, D.C. [In This Issue]

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