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Philip Morris

Legislative Approaches to A Smoke Free Society

Date: 19860000/P
Length: 781 pages
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Barr, G.
Glantz, S.A.
Hanauer, P.
Named Organization
Contra Costa Times
Environment Intl
Journal of Public Health Policy
Los Alamos Monitor
Los Angeles Daily Journal
Los Angeles Downtown News
Los Angeles Herald
Los Angeles Times
Ny State Journal of Medicine
Ny Times
Oakland Tribune
Population + Development Review
Preventive Medicine
Sacramento Bee
San Jose Mercury
Smoking + Health Reporter
Wa Post
Wall Street Journal
Business + Health
Named Person
Goodman, E.
Graff, D.
Greene, R.
Rowan, C.
Scott, A.
Document File
2025684071/2025684856/Americans for Non Smokers
2025684072/2025684855/Americans for Non Smokers
Author (Organization)
American Nonsmokers Rights Foundation
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Legislative Approaehes to a S'moke Free Society Appendix }:, Peter Hanauer Glenn Barr Stanton A. Glantz AMERICAN NONSMOKER:S' RIGHTS FOL?NDs1'T'IONI Berkeley, California
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u C Cbpyriglnt @1I9ss; by American Nonsmokers' Rights Foundation 2054 University Ave., Suite 500, Berkeley,, Cal;fornfia 94704 All rights reserved. No part of'this publication may be reproduced or transmitted' in any form or by any means, electronic or mechanical, including photocopy. recording, or any information storage and retrieval system, without permission in writing from the publisher. ISBN 0-9616473-0-2
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V List of Appendices A. "A Study of'Public Attitudes Toward Cigarette Smoking and the Tobacco Itidkistry in, 1978."' The Roper Organization„ May, 1978;, prepared for the Tobacco ~ Institute B. "Proposition P: Anatomy of' a Nonsmokers' Rights Ordinance," Peter Hanauer. 1New York State Journat of Medicine, July, 1985 C': Charts of'Cali'fornia and national~ nonsmokers' rights laws D: "Bibliography on Involuntary Smoking," compiled by Stanton A. Glantz and Lydia Jensen E. 1986 Letter fiom Siargeon Generali C. Everett Koop to Americans for Nonsrnokers' Rights summarizing the health e$'ects ~ of second-hand smoke F. "Tobacco Smoke and the Nonsmoker" brochure G. Testimony in support of n+onsmokers''rights legislationi before the tJnited'. States Senate Siab• cmmmittee on Civil Serviee, Post Office and~ General Services of the Committee on Govern- mental Affalas,, September 30, 1985 • James L. Repace • Joseph A. Califano, Jr. • Alfred Munzer, M.D. • Stanton A. Glantz, Ph.D. • Bill Ross H. Indoor air pollution studies • Excerpts from "C1ean Your Room!! A Compendium on Indoor Pollution." California Department of Consumer Affairs, February, 1982 • Exeerpts from Indoor Polfutants,,National Academy Press; 1981 I. Letter of support for a nonsmokers' rights ordinance from the Greater Riverside (California) Chambers of Commerce J. Celebrities who have supported nonsmokers' rights 10' ~ 0 ~ co
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vivi1 . Sacramento, 1984 • San,Francisco. 1982 V. Tobacco1 Institute legal opinion on constitutionality of nonsmokers' rights legislation W. "Smoking a the Workplace: Legal' Issues," Timothy J. Lowenburg. American Lung Associa tion; 1983 X. "Addiction Mortality in the United States, 1980: Tobacco; Alcohol, and Other Substances." R.T. Ravenholt,, Population and'Developrnent Review, December, 1984 . Y: "Economic Costs of Smoking: An Analysis of Data for the United States," Dorothy Rice. December 28, 1983 Z: Questions and Answers on Proposed lYonsmokers" Rights Legislation AA. "A Quantitative Estimate of Nonsmokers' Lung Cancer Risk from Passive Smking,"' Repace and Lowrey,, Environment Internataonal; April, 1985 BB. Brochures explaining how smoking pollution contro]' laws work • Oregon • San Jose • San Di+ego : . Fort Coll2ns CC. Sample brochure for businesses explaining, a voluntary workplace smoking program, and in- cluding a survey measuring the success of the program DD: Legal opinion on the right of'an employer to hire only nonsmokers, Tom Downs, September. 11, 1985. EE. Model Smoking, Pollution Control Ordinance FF. Sample smoking pollution control i ordinances • Los i Angeles • San Diego • San Francisco • Sacramento • Palo Alto: • Mountaih, View GG. Legal opinion on validity of clause in workplace smoking ordinance prohibiting ret!aliatib.n by employer against emplioyee for asserting rights under the law, Paul N. Dubrasich, October 18. 1984
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C VOLIIlC I Psapsr.d, for WE 'lOBA'CC0 IZ:STZ'TtJTL lsay 1978, T.k RCPMt G'R'G`,KITA:'i0N Iz_. a-z
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IM r'tODUC';'_O't2 This is the aixth bi'ennial nationa2 opir.ion su-vey we have condti:eted for The Tobacco Institute. Like all its predecessors it deals with public atti- tndies towards tl'u smokirag and health~ issue and attitudes towards both the to2iacco industry and government regulation of'it. Ia the more recent surveys in the series, a secoad focus of'the studies has beem oA the passive smokinq/non-=oke='s rights issues lhis survey updates all sajjor, tren& areas &,nd: breaks significant newgroun3 in the passive smok!ingi/r.on-smoker•s rights area. A complete description of the survey, aethodology, sample size, i.nter- vie+.*ing, dates, etc., as well as copies of the questionnaires used, may be found in the •Metho3ology~' section following: this~ •Itisalysis' section.
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ix HH. Newspaper articles on success of nonsmokers' rights laws • Wall Street Journal, August 15, 1984 • Saeramento Bee, April 3, 1984 • Los Angeles Timies; May 13; 1'985 • Contra Costa Times, November 1'7, 1985 II. Letters~and testimony of enforcement officials and'channber of commerce officials attesting to the success of snnoking, pollution control ordinances • Cupertino • East Lansing, Michigan. • Minnesota • Pasadiena • 'Poway •: San Diegp • San Francisco • San Jose • Santee • West Hollywood (letter from City Councilinember quoting, chamber of commerce offi- cials) JJ. List of officials in California responsible for administering smoking pollution control laws. KK. Sample petition seeking passage of a nonslnokers" rights ~ law LL. Tobacco Institute testimony before the jJnited'~ States Senate Subcommittee on Civil Service. Post Office and' General Services of the Committee on~ Governmental Affairs, September 30. 1985 MM: Sample action letters to grass roots supporters • Pleasant Hill • San Francisco • Los Angeles (postcard) NN. Case study of Los Angeles workplace smoking ordinance, as reported by the Los Angeles press •"T..A. Councilman to Propose Anti-Smoking Ordinance," Los Angeles Times. July 8. 1983 ~ •"L.A.'s Gravy Train," Los Angeles Herald; Feb. 3, 1984 ~ • "City Panel' Studies No-Smoking Proposal,"' Los Angeles Daily Journal: Feb 16': 1984 Q 0 ~
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( vi' K. Data on smoking and fires • Known Causes of Residentiali Fires: National Figures for 1981. California, Fire Incident Reporting System • Known Causes of Residential Fires: California, Figures for 1981. California Fire Incident Reporting System L. "Tobacco Industry Conglomerates," Smoking and Health Reporter. July. 1984 M. Cost of smoking to lbusiness • Testimony of Professor Marvin Kristein before the United States Senate Subcommittee on Civil' Service„ Post Office and General Services of the Committee on Governmental Affairs, September 30, 1985 •"'hTiow Much Can Business Expect to: Profit From Smoking Cessation?" M. Kristein. Preventive Medicine, 1983 •"Wamted: Smoking Policies for the Work Place;" ML Kristein, Business and Health. I+dovember, 1984 • "A Smokefree WorkpIace,"' California Nonsmokers' Rights Foundation, 198'5. N'. Public opinion surveys on smoking restrictions • 1984 Cali'fornia Poll . 1983 National Gallup Polll • 1984 Galdup ;Monthly Report on Eating Out • 1985 Harris Poll • 1984 Michigan Survey • Summary of 1980 Minnesota Poll O. Editorials supporting nonsmokers' rights • Los Angeles Times, February 10~ 1985' • New York Times, April12„ 1980. • New York Times, January 2'1, 1981 • New York Times, February 11, 198G • Oakland Trib'une, September 20„ 1985. • San Jose Mercury; May 20, 1983 • Washington Post, November 22, 1985 P. Columnists supporting nonsmokers' rights • Ellen Goodman. August 6, 1985 (
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n. 8 ob j'.ctivi in otlz opinion ia tu develop aut~ositativ+e ;nd credible eviGlence with - s.spect to the effecu of passive smc4cinq on the nor.-smcker "s heal th. The issue, •s' re sse it, is t#o lznqer' vhat the smoksz does to hi!mstlf, but vhat he dbes ta~ others. I
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x • "Watered Down No-Smoking Law Gets Preliminary OK," Los Angeles Douminurn News. Feb 28, 1984' • "L.A. Council Acts To Limit Srnoking At Pliaces of Work: 10-1 Vote for Measure," Los. Angeles Dazly Journal; Oct. 10, 1984 • "Council Adopts Tough Law on, Smoking on, Job," Los Angeles. Times, Oct. 110. 1984 • "Conflicts Mostly Soived: Few Fired Up OverL.A. Smoking Law," Los Angeles Times, Oct. 11, 1984' • "L.A. Council Acts To Ease. Curbs on Smoking at Work: Victory for Business," Los. Aingeles ! Daily Journal; Oct. 17, 1984 •"Tobacco Firms Act to Snuff Out Smoking, Law:, View Weakening of L.A. Plan as Just a, First! Step,"' Loa Angeles TiTnes,, Oct. 18, 1984' •"No-Smoking Law Opponent Hosting Council at Resort," Los Angeles Times,, Oct. 1'9, 1984 •"I..A. Strengthens Draft Ordinance To Curb Smoking: Penalty for Retaliation,"' Los Angeles Daily Journal,' , Oct. 24, 1984' •"Council Puts Some Muscle Back in L.A. Smoking Law," Los, Angeles Times, Oct 24', 1984 •"L.A. Approves Strict On-Job Smoking Law," Los AngelesTirnes, Oct. 31, 1984 "Bradley to Sip No-Smoking Ordinance, Press Aide Says;" Los Angeles Times, Nov. 1, ' 1984 •"Law's Opposition Doused," Los , Angeles Times, Nov. 9, 1984 •"C1ock Running for No-Smoking Plans," Los Angeles Daily News, Dec. 14, 1984. •"Smoking on Job: No More Ifs, Ands, Butts - It's Law,"' Los Angeles Times, April 14. 1'985 •"A Month: With! S;mokzng Law: Probieffis.Resoived Smoothly," Los Angeles Times, May 13, 1985 00. Sample press releases • Press release announcing a press conference • Press release announcing the support of a nonsmokers' rights ordinance by a prominent physician PP. Transcript of'a debate between a nonsmokers' rights activist and & tobacco industry repre- sentative
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• Don Graffy July 25, 1982. • Bob Greene, December, 1985 • Ann Scott, October 23, 1985' • Carl Roxvany November, 1983 Q. Cartoons on smoking • Abbett, June 8„ 1983 • : Auth, July 25„ 1982 •' Auth, 1982 • Stein, Apri120, 1984 R. Correspondence showing misuse of medical evidence by opponents of nonsmokers' rights leg- islation • Correspondence between Dr. Paul~ &iagnus and Dr. Claude Lenfant • Letter from Dr. Jonathon Rhoads to Mr. Jack Mcdowell and copy pf quote out of context in initiative campaign ballot pamphlet S. Tobacco Institute analyses of health effects of passive smoking and rebuttals thereto • "Cigarette Smoke and the Nonsmoker," The Tobacco Institute, 1984 • "A Rebuttal to the Tdbacco Industry's Paper, 'Cigarette Sffioke! and the Nmnsmoker,'" Ftnster and Burns, Journal of Public Health Policy, September, 1!984 •"Response to'American Lung Association of'Superior; California Document "The Need for Smoking, Control Legislation in Butte County: A Case Statement,' " Center for Environmentall Healith' and Human T1'oxicolmgy • Letter from Robert Hutchings of the Office oni Smoking and Health to Mark Pertschuk. January 24, 1986 T. Tobacco industry polls on smoking restriictions andI related newspaper articles. • Los Angeles, 1984 • Analysis of Los Angeles poll by Californians for Nonsmokers' Rights • Michigan, 1985 : • ?"he Coloradoan, November 13, 1'984 • Los Alamos Monitor, December 15, 1982' U Letters from Califorsua city, attorneys concerning the constitutionality of nonsmokers' rights legislation N • Los AnQeles. 1983' N
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.I .:::-:~.~.:~~-, 22 t3al*ctad qovar^-zont ccntrols (l2;,13) '!'he kiads of drugs a p.raoa. lUr ym'a3,ght talte Tbe kinp of birth control drvi'ces a p.rsoa like you aigfit nse Z'he amcunt a person 1Lkr yoa iight sacke Zhe amouat a p.rsoc if,7ee you a3ght dri;atit The aacont o!I sleep~ a peaoa 1'ike you aight g.t 8mculd _ control 83sould aot _o1 eo^ t tto o .inion _ 29 6b 5 38' 76 6. 13 83 •' 13 83 4 . 2' .95 3' There is certsi3a.Ly' ao overvhelm3:ng sardste here for gaver=nent eoatrols.
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T The only category that decliaes over the four year period' is 'doesn't macter.' One imoker is f'igh!eing back. He has coined t~.>e +rprd •fL=ptaobe • (t"C0ort-ah-T0BE)I and persu.dledns tntest whether this, tan= canbe associated in t.l:e ptia25lic s2nd with an irrational aaiti-=okincp zealot. We asked respondents to choose one of the follow'd~.nq rtat=meots to descri'be whaz they thougkit a fvaaphome i:s. a fumap2aabe is . . .. (Question 31Y A person who doesn't partinilarly like eigarette :moke 7s' X person who :irsds cigarette smoke unpleasant A prss©a who has al medical allergy'to cigasette saoke: a person .rhs thinks cigarette smoke ia bad for people's bealt2a Xpezsoa who has an extr eme feas of' eigaretta s;aoke Doa't )aaw/ao aasawaz 9. 10 40 23 We met,ed'. earli's Nuestion 21) that 58s of' the public t'il.zlcs ssnki.-~, is 'probably' Sazardous to rma-smoke:s' healtb; nndoubt=dly some of tbes are not esrtaia of this a7ad are, tMerefore, emowe3ble.' ftreower, tbeze is amothe= 33% vrbo say that saokiag , doesn't have any real effect on non-smoke_s' health. Based on tae rationale of the ficdieoqs, both groups (the percentage of 'aoveables' along , .r+ t2s t: e group of' disbelievers)' sight be persuaded ta! regard some zealous anti-sanoke_ s as being, perhaps, unbalanced on the subj~ectof cigarette fwaes;, in eff~ect, as 'f=+aptoobes.' A-1!5
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Saai'cer reaetion to restrictioav (Questioa SG ) Mre careful,, sesLsitive: 19'% Mora aarncyed, aqig,ressi've 10 Dat'h (volunt~ersed!) 5 1 lio affect ' 65 Dba" t Jabw/ro sa..~we,r 1. itmen were acre serssitixe. than aost to others' feeLing,s, as were colleqe educated people aasd' tbose vhu, bes.d' professional or aanagerial jobs. lbre men, an& younq people than average said that all the restrictiorss haven't a;ffected theo at a11.. We possd the same qgaestioa to non-smokers', askirrg, whether they t4-wnght smokers r+iouldi be =ore careful or aore unmoyed. The noa-soo3ce_-s expected a stroaqer, reaction from amkers,, aad they th~ught it +rould be more acgqressiv+e.than it_turns out to be. 3bn-smoker expectations of smoker rsacti oas to restrictiostis (!Question 613) Ibre careful, semsitive 21% lbre asuncYed,, aggressive 25 moth (v+o luntetired ) 11. l1o effect 35 DDa't k=ow/m, amsver 8 Indeed, smo3cers have beeom. a great d+aal aore narc:nmfoztatble abo+att other people. seckinq around Qbco.fort.able smokers (Question i9) 1978 19'76' Tte+querstly 13 9. Occasioasally 40 39 N Sa ldom 29 . 34, Q. Jis'ver (volunteered) 17 16 ~ Doa't kncw/rn ansver 1 2' ~ Aoajozity of sooke.s is.eithes frequently or occasionally unrac,iarcible about O. smcki:q in any. The •freqasezstly' eategpry has gone up ala,csst ha, s wh-1e ~ A-13
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•1e ao graat claocs tcr Whe osa.=e. t5e askad 2mw eacasr:rned paop3e were about ciq;arette baotlegg'i.aq'. Coaasra aboot bootl.qqinq (Questioa 34) Oery, cozseun,ed' 12 % Scrae.rhat, eaacs,.-aed'22; 8ot ' too ooacstmed 26 Ibtatalli concs.-sud 35 Doa' L 3=N,/= a:asr++er 4 ~ Zbo-t,t+sirds of the natioa, is sat eoncerned or bas no opinion. Asked if they tbought sakityq, bootlegging a federal c.iae wouU Yaducee baotleqging, apbuaiaca was quite evea,ly, divided and, nocysmetrss^vsemerqed. Lff*ctiveness oi t+ederal Iavs aqai'rsst boo tlegg,iaq (Qulstion 35) lsduee bootlegai'r.g ~ - anea2l.y 15% fiam.,rrhat 28 c3s,iy a lit tIe 26, Ibt at all 24 IDom "t ]mcW/ao aaswes 8
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-1 . XMZI'G7':= OF' THE STVD'Y 7lpprosimate3'y forty percent of'this six:h study of public attitudes tarrard cigarette saoking consists of' new questions rhich have never before been asked for The Tobacoo Institute. !or this reason alone, a+any of the research ., `L hkB II. I".' I?'s'' findings coataiaed in tMSs report are of special interest. The study also coco-- taias a systesstic revi'aw of trend data for questions which have beem asked in the past. Zak'em together, the large body of new matarial and' the eomprehesssive view of changing attitudes over the last ten years highlight results that we con- sider to be of extraordinary iarportance, to t2ne industry. D)ot all of these findings are encouraging. In fact, the ma jor high- lights of this report divide thesaselves into results vhich are sometiaes proris- , img but nostly foreboding as regards the very future of' the tobacco industry. C!b put it another way there are a certain nirmber of •si!Z'ves liaing,s" to thee uany •elouds.") For this reason, we have decided to present the highlights of this report in the form of a balance sheet, measuring the optimistic and pessi- aistic entr'ies., as it were, oa opposite sides o1 the ledger. These balaoce sheet 'eatries' are presented vithout do,-%=entatioa in the interest of conciseness. ZSty are, mowever, •audited"' in the "Detaile3 analysis• that follows. •7L55gZ5" l. the overall saSiency of' the 'eigaretts issue' is low. Coaspared tm crime, drugs, pollution, and a half a dozen otfies itams, smoking is at the bottom of the list of personal ooncerns. 2. There is little aentis+ent for a total b+an on cig,rrette smokimg in public places (but see 13 under •S.iabilities") .. 3. There is overwhelsi'ng approval of placing aotices outside places that restrict cigarette mokitvc. 1. lsore t2sa:e nine out o:f eve-ry t=Americuas bel i eve that smo);iag is hazardous to a saoker's baalth. 2.. A majprity of Jkmeri'cans be:ieves that'it is probabl'y hazardous to be arvszrsd' Qeopl'e .r3'~o smoke evr.z 3 N ~ ~ if they' are not smoking ther.selves. krA 3. Zhere is aajority sent~.ment for separate smoking sect:ons in al: public places we askd3 about. 0 9 A-4
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4 •'7LS5M;• (conti'nued'). 4. Tev people favor job discrimination based on cigarette svckis„q. S. The percentage of'smckerx in the 17 to 24' year oIIid age group is up, and tse amouaat smoked per day per young saoker is also up ftt see f5 ander 'Liabilitiese) . 6. Tbere is broad support for FZ+C regu- lation, of 'public service' adver- tising saon.sored by noc-profi't groups like the Cancer Society an6 Ral'ph Rader. 7. Yhe_•e is less than majority senti- ment in favor of'a gradaated tar cigarette tax. S •LIAB II.IT:'€S" (eont f na ed) 4. There is majority acceptance ' of the idea that the cigarette varning label' should be made stronger an3 more sseti`ic. t. S. The percentage of people vho smoke cigarettes is at the lov- .st level, measzared in the pas t. tan years. 6. A steadily incseasing' majority of Americans believes~ t2ut whe tabacco indust_y knows that the case against eigarettes is true. 7. Favorable attitudes trward the tobacco industry are at their lowest ebb. 8:4 There is widespread support for anti-mokirg education in the schools-and at the very early pears. 9. Tvo-t:fiizds of smokers r.cucd like, to give up smokin5. 10. Nearly half the public thiir_ks that smoking is an addic_on.. 12', ricre people say they would vote for than against a political- caar didate who takes a position, favoring a ban on s*okir.g in pub~- lic places. N
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'!wv aatof three aoa-smo3cp-ss pseties stififer wAr~ ~n:n+g, 1sbels on c3ga.: ettes and even smo3cass are svenly divided oa the subjact. :
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s • 23i°3~.TGK2'I'O2+S 0~~.' T: ,i'i PIND3NG5 ) Shs original Surgeon Geneaal's report, followed by the f'i.r'st. `h,azard' varn- 1 iaq oa cigarette packages, the, v4bsequent 'dasoger• varning on packages, the removal of cigarette advartisirsg from televisioa a;nd the isaclusioa of the danger va_-ning i,a • tiga'rette, advertising were all 'blows• of sorts for the tobacco' industry. They . C were, bowevar, blovs that the cigarette industry c+ould successfully weather because (' they were all directed against the amokes hisiself. whi!le the overvhelrninq ssajority of the public' has been convinced by the anti-smraking forces that smoking is darqerous to tbe sacker's health, this has aot persuadied'very saoy smokers to give up smokittg. C1 Mie anti-smokimg forces' litest' tack, bo+rever--o'n the passive smo0cing issue+--is another ma'tter. What the smoker does to b.d:mself may be his business, but vhat the smoker does to the aon-smoker is quitea different matter. The anti-smokinq C formes~ b3ve~~ aot Yet~ convinced anything l'ikeas'~ sany people that~ smo'3tinq~ haxmsthe Dailth of the non-moker as they have coervinced people that smokinqi harms the health of the smoker. Hut this study shows that they ase well on the vagy to making the same sale about the effects o?' smoking' on the aoa-smoke, as they have already madee vrith rsspect to the effects' on the smoker. pearly six out of tyer. believe t.`sat saok- lbQ is ha.xardous to the nonTsa+oker's healthy up s}narply over the last four years. Ibre than two-thirds of non-smokers belie4e it, nearly hal,' of' all sackers believe it. Shis we see as the most dangerous dev+elopmesst to the viability of the tobacco industry that has yet occsrred. 1h:ile there is little sentiment for an out- riot ban on smokinq in public gatherisog places, there is already majority sentiment for providing separate facilities for smokers and noee-smokers. As the amti-smok:.nq forces succeed in their efforts to convince non-smokess that their bea/t.5 is at N . 0. ~ •take too, the pressure for segregated facilities will change from a ripple to a t;:de~1 as we see it. Zt is, of cou.rse, possible t3iat' once smokers and rmon-smokexs alike ex- perience all' the inconveniences of separate facilities, people will recca+e fed up A-6
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0 17I average rise. Shis is undoubtedly so bscau!se of' the high suppost for •'gpvem-eent is saking about the right sffort' ncnr. One iight speculate that without the public sxo)Cinq~ segregation alts.-aative, har'sher, restrictions ssight be more popular. She crsax of the control eysasstion still' remsins whether or not cigarettes can be con'sidiesed haTSfull to others. U long as smoking is thought of as a possible baza,rd to the smoker h3mself or perhaps srerely annoying to others, the case can be &,zgued for a sccial soiution. sut if smoking is regarded as dangerous to others, Lhen 1!sqal restraints =me into question. Zver simce 1974„vhea ve began a!ski.ng about arguments in favor of laws to prohibit smoki:og, the two most isaportant reasons had to do rit.'~ dangers to others: as a lire hazard in public places and' as a danger to the health of non- smokers. In this study, for the first*time, possible barm to the health of others is' the reason sost often elaosen. JlrTumee~ts in favor of' public aoti-smoki!ng laws (Q.30X) Zhs health of aon-smoJters is harz.d by ot2isr psopl'e smoking in their presence Smokinq;tends to be a firs hazard in public places s,ist-smokers are entitl'ed to br.athe air, lr.e of tobacco smoke some aon-smoksrs are allsrgic to tobacco socks tvess if there is no health hazard to them, aany people are annoyed by •oc.her people smoking in their presence The goveraaent should protect people who d©n't want othez peopl'e to smcke around tDem in public places St viw1Z nc: be a hardship on smokers to stop smoking in public places lion-smoker's are a s1a jori'ty and so their rights ccoe before the rights of' sackers 1978 1976 1974 • 33 25 29 26 28 23 24, 20 -22 2'3' 23 2V 21 21 24' ~ 10, 10 N C!t ~ ~ 9 8 7 N 0 ~ b 7 5 r C` C=; A-l~
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We thank the following for permission to use their copyrigtited material included in~t'his Appendix: "Proposiition P: Anatomy of a Nonsmokers' Rights Ordinance;"' New ~ York State Journal o/'1Vledicinm. Qc 1985: "Tobacco Industry Congiomerates," Smoking and'Health Reporter, cQ 1984; "How Much Can Business Expect to Profit From Smoking Cessation?"' Preventive Medicine, eQ 1983; "Wantedt Smoking, Policies for the Work Place." Business and' HealtJt, ® 1984; 1'984 California Poll, ©c ~ 1984; 1'983 National Gallup Poll. cQ 1983: 1984 Gallup Monthly Report on Eating, O>Ilt„ cQ 1984; "Good Idea Defies Smoke Screen." Los Angeles Tivnes, Q 1985; "Thy Neighbor's Lungs," New York Times, Q 1980; "Smoking Your Wife to Death.' New York Times, cQ 198L "O'h, To Breathe in Nassau County:. " New York Times. © 1986: "Contra Cost& packs it in," Oakland ?~iburse, © 1 1'985; "Clearing the air," San Jose Mercury, cQ 1983: "Secondhand Smoke," The Washington Pvst, Q 1985; "Tobacco Company Crusaders Try Weapon of 'Cotartesy.'- Ellen Goodman, © 1985; "Cigarette makers set greed record,"' Don Gkaff; QQ 1982; "Why Does Anyone In This Nation Still Smoke Cigaret'tes?"' Bob Greene, cQ~ 1985; "Good Neighbor," Ann Scott, ©c 1985: "Frisco votes an antidote to smoking poison," Carl Rowan, © 1983; "Thank you for Smoking" (Cartoon). Auth. © 1982; "Dept of'Health/Dept of Agzicultur" (Cartoon), Auth„©1982; "News Iteffi:' San Francisco~Passes. Toughest Anti-smoking law in U!S." (Cartoon), Abbett, ©c 1983; "Do you mind if'P burn a hole in your shirt:. "' (Cartoon), Stein, © 1984: "A Rebuttal to the Tobacco Industry's Paper, 'Cigarette Smoke and the Nonsmoker,'" Journal of Public Health Policy, Q 1984; "Addiction Mortality in the United States. 1'980:" Population and Develapment'Review, c© 1'984; "A Quantitative Estimate of'Nonsmokers"Lung Cancer Risk from Passive Smoking," Environment lnternationa @ 1985; "Reporter finds tobacco types behind survey; ?7xe Coloradoan, Q ~ 1984; "Tobacco Institute Raising, eyebrows here,"' Los Alamos Monitor. Q 1982. "San Francisco Anti-Smoking, Law & Success," Tla'e Wall Street Journal, Q 1984;, "Smokers Survive Their New Habit,"' The Sacramento Bee, Qc . ~ 1984; "County close to being smoke free," Contra Costa Times. Q 1985. "L.A. Councilman to Propose Anti-Smnking,Ordinance," Los Angeles Timea; ®4983, "L.A.'s Graay Train.' Los Angeles Herald, © 1'984', "City Panel Studies No-Smoking Proposal," Los Angeles Daily Journal. cQ L984. "Watered Down No-Smoking, Law Gets Preliminary OK,"' Loe Angeles Dovnt,oun News, c© 1984. -L. a. Council Acts To Limit Smoking At Places of Work: 10--1 Vote for' Measure," Los A ngeles Daily Journ al: cQ 1984, "CounciliAdopts Tough Law on Smoking on Job." Los Angeles, Times. cQ 1984! "Confiicts Mostly Solved: Few Fired' Up Over L.A. Sm'oking, Law,"' Los Angeles Times, ~¢Q 1984, "L.A. Council Acts To Ease Curbs on Smoking at Work: Victory for Btasiness." Los Angeles Daily Journal. Qc 1984. '"Tooacco Fir--Act. to Snuff Out Smoking Law: View Weakening of L.A. Plan as Just a First Step." Los Angeles Tirnes. Q 1'96-1, "No-Smoking Law Opponent Hosting Council at Resort," Los Angeles Timea, cQ 1984, "L.A. Strengthens Draft Ordinance To Curb Smoking: Penalty for Retaliation," Los Angeles Daily Journal, c© 1984. -Council Puts Some Muscle Back in L.A, Smoking Law," Los Angeles TimeJ, cQ1 1!984, "L.A. Approves Strict On-Job Smoking Law," Los Angeles Times, cQ 1984, "Bradley to Sign No»Sffioking Ordinance, Press Aide Sati-s:" Los Angelea, Time3, cQ 1984, "Law's Opposition Doused." Los Angeles Times, ® 1984. "Clock Running for No-Smoking P1ans,"' Los Angeles Daily Newa, © 1984. "Sffioking on Job: No More Ifs. Ands. Butts - It's Law," Loe Angeles Times, Qc 1'985, "A Month With Smoking Law: Problems Resolved Smoothl.•.' Lon Angeles Times, QQ 1985.
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29 , ' 3e4reg,atiom, Prohibition knd' warmisnc ` Aublic ssntis+ent for prohibiting cigarette smoking in public places has. aofi risen significantly in th. past two years. If anything, 2t has declined some- Mhat. Cu the otiaer landl, there has been an appreciable rise in the n=ber of peoFle tibo favor segregation of public smokers to~separate sections or facilities. We think . the ty+o: tremds are conmected. We think the absence of any rise in sentiieent to out- 1ati smoking is d9:rsctly correlated with the fact that there exists an acceptable oltssnative in segreg,ated' public smoking areas. Shere is apajority approval' for segregating smokers in every one of the pwblic places we tested, and enrery, case represents a rise of sent3aent ove: two ?4:ars ago. (Question 26Y) _ 5mo'kiag~~ should be n_ ermj tted', .. In separate. section5 14nyvhere 1978 1976 1978 •1976' • s s • s Isn traLns, ai.-planes and buses 91 81 7' 16 Ia tbsaters 831 a1 11 15 ia saticq places 73 57' 25 39 at iadoor spor.inq events 73 67 22 28 At public s.etings 67 62 26 33 Ia train, plane, bus stati.orss 62' S4 34 42 In vcrk pl'aces or offices 61 52' 34 42 Ia barber oi beauty sbops 53 43 511 After asking about segregated facilities for pablic s=3ce;s, we asked N ~ ' ~ .::ely :rom a slig*stl'y long,er trfiether people thoughC amoking' should be banned snt~ ~ list that cozatainedl these same placts, as wel'1 as ot.5e:s. ~ ~. C C C A-10
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?ON 1'3 the •zaldc=' rat=yory is down s'ignificantly. Incidkn2ally, people wtio aoke low tar cigazettes are sore uncomfortable about smobcing aroumd other people, w2uiSe more tvgulas cigarette smokers tha:o the average say they are seldom or never samcomfortable.. C oaLis a,ddiedi sensitivity of smokezs-one si'ght almost say 'isferiority ~lez of saoOcess'--i!s demonstrated by their actions when they ase indoors with other pecple and want a cig,arette. We askeA! 'Do you light up a cigarette without really thi,nking about it, oz do you look around and then decide whether it's okay, or do you ask i: others would mincii, or db you just not smoke?' When smo3cing indoors, do yvo.... (Qae,stioa 41) ~ 1976' 1976 1974 Light up 32' 29 36' c" Irao,k a+rouad' and then decide 27 27 29 Ask ot2sers 26 23' 199 ibt mokr 4. S S' Ix dspends 11 13 9 Doa 't ksoow/no azsswes e 2 1 •Ask ottoers' is the only eategoty with a significant iarrease over tMe past fo= years. Blacks, people aged 17 to 20 and'people wbo make less th,an, 57,000 a yearr all l'ight up mcre than tbe average without really thinking about it. womea do so less than the average. , In the same )iciad of situation, what does the non-smoker do? When scmemne is smoking iiodoors, do y,ou.... (Qaest,iasa 62) 1976 ' 1'9'7'6 1974 •' • • Ask aim to stop 5 5 4 Indicate disapp_oval without sayiaq so 10 9 8 N C N, to nove awa Zr 42 39' 41 ~ y y Doesn't matter 33 36' 40 La3oy it It depemds S 7 4 MIL~ (0 00' Don't ksaow/nc answer 4 3 2 A-14 -
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1'6 Zt i& perhaps aotawortlay that, despite steadily incrsasing restrictions irposed by qowermment on ciqaretta emokinq, roughly twice as aany .timericans continue to call for more rathes than less controls--& ratio that bas- changed little over the p+ast tan years. Zbis clamor for stricter goverssmental controls is, of course, part ofa I larger movement involving the public's changing attitudies and expectations with respect to government and is r.at focused! exclusively on 11-~e cigarette iadustrf. As a satter of fact, controls related to cigarettes remain at the bottom of the list we have tested (although ci'garettes have for the first ti'ae drawn even with alcoriolic beserages). S'Me qoverxsnent should take more steps aqsinst (Q.7) 19781 1976 1974 1972 V % a _ i Gr,ime in the streets 82' 67 70 65 Narcotics addiction 76 63' 66 72 Water pollution S& 45 48' SI Erposure to :umes and ds}st on the job 53 36 35 sX' ?ood' additives 33 44 42 37 Xiz pollution 33 42 <Z 47 Use of Mari'juana 69~ 43 47 SO Aresariptioa drugs and sedicines 49i 39 35 36 Autooomile safe--Y 44 34 35 37 Alcoholic beverages _ 34 31 28 25 Cigarette smoking 34~ 29 24' 20 aeinq around people vhc are aaoking 2'S 22 17 7GC Ttse averag,e acceptance of these qoverraer.t controls over twelve selected 2iaz__--3s ~ is 511 and has risen 10 percentage points over the past two years. But the in- Mp in favor of governaent cont_-^ols over ciaarette smakir+g is only halr the crease • 3x ind'icates that question vas not asked in the study, in qtaesticn. ,-
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t: ert5y ra~.'alesdi. To test reaction to such a proposal, we posed tw+o versions of aa question, about x4niform taacss to different halves of' ou: sanple. One-haL' was asktd their opiiuion of' a f sderal tax whieh wouldi raise the price of a pack of cigarettes throughout the nation to the level of tiew Yor3t State,, which is L"ie high- est in the nation. The olhez ha1f' of the sarspl'e was asked' their opinion of a tax arangement rrlaereby the cost of a, pack of cigarettes vculd me rediaced to the level of lbrth Grolin&, the lorrest in the nation. (Question 36) Cost of eicarettes brought. ~ Up to A1ew York Lbwsi to D+'ort1h Carolina To~_l ibn- bbn- Smok:e_-s smokers Total Smobce,s sacke.rs lavor 42 22 51 48 65 38 oppose 42 66 29 34 22 41 Donlt l=w,/no answer 2'6 12' 18 18 13 21 . Jk un.d,for.n cigarette tax to discourage boqtleggin3 is fsvored if the tax is lowered to the level of liorr~.~.2r Carolina. Opinion is divided ov+ez ra:isinq the tax to the level of Diew York. The lotives of smo,kess are aot hard to fatboa. They are opposed' to raisinq csgarette taxes and' in favor of lowering thca--by a:isost the same propor- tiomnc in reverse. Dtyn-smoDcers, on the other hamd, favor rai_- sing cigarette taxes and are of tr+o sSS.rsds about 1owerinq t2xm. Since they youl& pres=ably not pay cigarette taxes, one mrast assnme that their amtives involve t'he conviction that taxes will force smokers to quit. Interestingly, there is a hirst of the same eonwiction on the part of' smokezs wbo are thessselves trying to quit. They seem more disposed toward mi'gher taxes and mare opposed to lower taxes than are smke=s who hsve never tried to qudt--as much as to suggest that they secretly ?aope higher cigarette taxes will help them give up smo `1.izg.. llthaagh An+ericans as a.rhol'e (bat not smokers in partic,:la: ) are disposed to accept the i,dea of unifarm ci'qaretts taxes to discourage bootleggi:x,, there is A-28
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r iobstassces vhicb pradiaces systiptrss li!ke a rasb, nausea, 2readaches, etc.' Tt,en vf asked a31 our rsspor.dents, •llrs you allergic to cigarette sunke or do you just fir.;:! It UnpltasaAt?' aoughly •ti of the mon-smokers in each half of the saaple said tha:t they rere auerqic.. Wett3r or ac+t these smokezs actually have am aSlergy to cigarette saobee is, of ea»se, a sedieas q4*stiom. Dut it seems elear that they truly believe: tbemse lves to have sucm a medical' oonditioa, for the same proport3on of them con- tiiaoe to describ their prflble3 as an allergy rather than mere aaaoyance even after the distinction bas been poiuted cut to t,hem. D6cb larger ra=bers of respoadients said they are 'aasr:oyec' by being near a pezson +r2io is smokiag eigarettes (Questio.n, 1'9). Jllmost no one (2s) finds it `pleasant' to be aear a pnrson who is smokiaq. Sixty percent of'noa-smokers say it is ammyiag, baL of those find it always so. Tn fact, 5% of smokers find' it annclring to be arouni' other smoke=s (92% aren't affected ome way or the 'ot3ier, and only, •4% find': it pleasant)~. But smnkinq is not by aWs+eans tbe aost troubiesome armcyasace (Qaestioa 11)ir anthitag so bad as a drivra: who refuses to dim bis heaClights at night, nQr a ~a~:ent who dcsesn't eon' ol ao a=_ly e3ild' in~ public. For ]1tae:icarss, smoking is sl'iqhtly' acrs annoyi.ag than si. .tL+.mg next to scmeoxie vbm mas an too such perfu:me or shaving lotion, and jus't a little sore anmoyiag than people rrho~ play t.sasis•.or radios an buses. iieves'tmeless, sMo:ce=s: are acutely aware of these aasnoyamces and fea_ s. We wanted to find out if all the iacreasiAg restrictiorss, taxes and prohibitioms on smokiaq have caused smoke=s to be sr:re careful aru!' sensitive about smckinq, or, wtether it has caused thea to be sere asrxoyed and agy'ressive abcut defer,dirnq, the!• rigbt to smoke!. It tvsns oi:t that smckess are in ao d to rebel against an,u- smobcing pressures. ( E A-12
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Sioul'd smokers saoke :mre if there were ao cigarette tax? (Question 52) Yes 10% 3101 s0 Don't kncw,/no answer 10 1 esrtaia numbe.- said they wuld, indeed, saoke more if' there were cigarette tax 0 zelief--althoug2n the vast majori.ty denies t)iat. 8ut note that tt,is question deals with degrees of smoJcing w4ile the previous *ones have had to db~ with absolutes of =mo7cing and' aom-saobcing. It is possible that ciga; ette taxes ase more strongly CmirrelatrtWithclsanges o'f degree in saokingbehaecior tTMsan in absolute chanqesofs itatus Whatever the case, the quOstaan is prov+ocative as an indication of' s=kers, be~s about cigarette taxes and their effect on smo3cing behavior. Mhat does seea clsar, however, is that the series of questions is valuable as an i!ndication oi which seyments of the smrrkinq population are mcst a:fected' by dqarette.tax inereases. As'we have seen, light smokers (who also have a greater desire to quit smok:.n3) say they tirouldi give up smoking more readily, heavy, saokers auch less so. Yct:nger smokers seem nare vulnersble to price coraside:at.ions, while aany nare oldie.: smokers say they wuld contizsue. Blacks se= less able to predict what effect a tax increase might have, but they would probably ter,d to give up smk- Sng more so:tb&n whites. This study al'so eacplored pnblic reacti'on to another kindl of cigarette tax- the graduated tar tax. Or,der this scheme, a hig2ier tax would be~ imposed' on hi'gh tar eigarettes aald' a liowes t= on low tss ei'gaarettes. We asked half' tlie respondents to consider various a:g~aents favoring aM opposing the tax but'asked the entire saaple whethe'r they t2ought it war a, good idea or mt. There was less than majority ses:r.i- sent in f avo: of a graduated'. ta-- cigarette tax, al though there was slir,htly more acceptance of the idea amnq those wbo had' been given a chance to ronsider s+everal arquaoents pro aadl con.. a A-2'6
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.34 (2d+estion 28'1 @a taxicabs stores ,, • Beauty parlors or barber sbsps S+r staur xats Sions outside rrhqre sxk3nq~ 4-s prohibited Should be recvlred Sts6uld not be :erul.-ed bbn- Dbin- 'lbtal Sa+okers s:aoks_-s 'ilotal SboDcers s=kers ~...... ~~ ~_,._. t f t . ~ 1 ~ '7 17 te . 10 11 10 ®8 88 s8 1'0 u . 1a d8 67 i8 10 II 9 90 ft 901 9 101 8 The assent is monolitra,ic. 7nd it sugges:.: a sbort tera tactic that might prove belpful in si'tuatioas vbe,re videspread ::ackiag restrictions are bei.-aq proposed. OQezators of restaurants, cabs and other public places aisd .ehic3es might be per- aitted to establish whatever sxkixq policy the: desi=e: 'Smcki.nq pestzitted',• '?b smokisr3 pes-aitted,• "Separate.facilitiss for smokars,• or 'Separate facilities for mn-smokrss'--aut vith the re3uire,meat that these smok3.:q coaditi.ar.s be posted aut- side the preaises for the eonv+aaiieacr of eustoaers. Our fiadimqs stiaSgost that such a aeasusw would receive widespread support. Wsxting Ubels on potentially hazardous pro+~acts have experienced isscreas- iaq acceptance. To place the cigarette .raraisag in context, we asked respondents to diecidie! whether eight different products should be banned, have varsaiag labels or no warti.nq labels. (Questiou 9) Rhe goweria-eat s*.ould faa the Prodiaet !+eqaire war-...iag la5els aot reTure wi-a=g 1'stels Don• t kssow/ no answer • ~ t t Cigarettes 1.2 82 ' 4 2 lricrvrrave overss 3 79 9 9 ia:r dyes 9 74 8 9 uaoho l 5 73 19 3 s+.cchar in 7 70 14 8 aaroscl caas 27 62 6 5 Tvt sets 1 51, 44 4 automobiles 1' 38 56 5 A-3 5
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00k 3'3 2sasalt-I ~ Znz =c3;:srg in pabSic pLtces trlaere it is profii;ibited (Qnestion 29) 20tal S.oksrs 2an-=oksss 2+.ople dbo t2s,ink thaL smokers have aore of certain, Yir.ds of illnesses 1 People v2r think that any amwumt of' ssokiaq is danqerous 1 Faop e~~ v~ f~lyi~~a:ltly, oftea (ror~~~ than 3timesa 1~esr) 1 People ~o sat cut in restaurants 10 or anre tisies anomth l ?S~'_ bta.rnir Lbzn' t krjo.r/' tac answer 0 % s • 29 65 S 25 78 6'. C:? 37 S8 S'. 40 4 34. 6l S' 4z S~S 4 33 6~l Z'b~.re is a fa,irTy vid+e, assarasen~t of' groups which deviate fs~am the average on the question of fines as purcis2soes~t, aad their smtives .+o~sld seem to ranq~a all the way fz+am self-~:nterzst to paais2asent of smckers for tbe~ own good. Smc>kers, natural.ly ssiouqh~, areacrt infav or o.fjiailsentar~cesorfineslnr, illegal, smoki'ng vls~ilemrr- smo3c~ers atmd pec~ple vbo fly fairly often or dine ovt a great deal, ssay be pres=ed to be tnixsD~s.aq of t3am3:r own ocmfort aban s~os~e of them sndcrse fines for smc~k3:nq than the a~veraqe.oathrotherha~sd,per,~pl~e vi~2bo sayttsat, aasyaesocuitofsmokiiqi isI mha~gesoaxs~~ or that ssnkrss hsve wore of certain ltirdie~ of illnesses axe pres~~ably not tbinkimq j~xst of Lhasaselves vdasn they appro~ve of fiass for ille<pal smokinq, but .~ould a1s+o sees to ~~ve the well-being of the moker at beart,, whether be Zikes it or not,. Indieer~,, cc+~iassioi~ for smokers' is mt a quality that pervades this study. N Q i~at LAers is one ~rars, ~te., ilearly everyone apprAves: of' signs posted outside places N ~ tr}~e:re smcksnq is pror.ibited and this holds true tar' smoktz u~ noa-smokes aLke. ~ ~ ~ r ao A--34
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T The New presss:res fiace our last study tsro years ago, there have been i'hcreasing pressures tor official restrictions on smoki'ng. Mr Secretary Gali_axso's recent wide ranging •florts are by, no 9eans anfique, notaritbstand3ng the fact that they w*^azate .rcar one of the hiqhest ranking officials in government. . '.his latest survey for Tae Tobacco Znstitute suggests that such pres- suras are aeceptable to ai substantial portion of the nation. S4* goe+ex-ment should conduct aati-smokimg c:mpaig;ns (0~24Y) Agrse 47% Disaqzee 43 Don''t kncrir/no aa'swer 30 Shis question is a restiteaent of aaother agree;/disagree question rrhich rre have ose+d in the past: 'Goveraa.ent neney sbovld be spent on aati-smotcimg caaPaiq!ns.' s.+caus+e of' the reference to spending tax dollars, fewer people agree with the old- •r wording of the questi'on; but the 35% who do agree with the statesaent a.re still figtificantly larger than, the 29% who agreed in 1'976. Nevertheless, the highez acceptance ot' aati-smkiag prograas in the qwestion, vrhich his no reference to spending, t:aar dollars suggests that government anti: smoking casnaigau may be vulnerable 'to charges of nnjustifie3 eapease. Sor the past eight years, about half of'the nation has been satisfied vitb governmnt cantrol's over cigarettes. 6cv~~ermest controls on cigarettes (Ip.23), 1'S N' C ~ 197'8' 1976 1974 1977 1'970 ~ ~ ~ Leave things as they are 49~ 46' 52 54 4i8 ~ fbre controls 32' 31 28 27 31 N 0 re.rer controls or gove.rn- stient sbouldt't be invo3v.Z! 14' 17 15 13' 15 a Don' t 1Caow/iso answ+er' S' 7' 4 5 7 A-16
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Latg+.at period without sacsxing. (Quostion 47) . , n - 197'8 ~--- 1976 --- 1974 -- 1972 w- 1'970 -- ., • Caa tr.ek 16 16' 14 15 15 3•2' reeks 110 11 9 9 10 2 i-3 r,."a 9 0 8~ 10 110 3 - 4 aeeks 8' 9 8 & 9 1•3' aonths 1S 24 27 13 1S 3'1- 6 aoaths 20 11 13' 12 16 6- 12 acrnths 14 - 12 13 , 12' 12 .Over, aI year ' 17 18 I'e 18 13 DoW t lnow/no aasver 1 2 • 4 1 8tii.dian dayz .96 ' 51 69' 38 52 Z='idieatally, low tar cigaratte mmokars can quit a lot longer (89 days) than smokers of cigarettes with regular tar, contant (36'days). 8i=ty-onr gercent (Question 44) of fi:ty-sevea millica smnY.e. s(Questian 38) tril us that they tzi.d to quit smokinq an average of' 1.84, times (Question 46). Zbat is sore tham 64,000,000 unsinccesslul attempt.s to quit smoking,. Oee might mot be surprised to fiadi, therefore, t3Lat many smokers consider saaoking an addiction rather than a habit. Actually, aorr non-smokers consider it an.addiction than do smokers and, neither group considers i't the best description. Sabit or addiction (Question 32)' Mc,m- Total Smckers smokers • % 1 Eabit 501 37' 45 Addiction 29 22 33 uitbier 2 4 1! iioth (~rol. ) 17' 15' 18 Dcsn "t knone/ao anssw~er 2 1 3. A-45 I i
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10i Smokino kn9 poittinq : 'ihe percemtagt ot people in our st;adies who say they sa+eke, isi today at tbs lowast level since we began tasting in 29b8.: 37%. (Because of rounding, this liqurs arpears to be the same as our finding in 1976, but ii acL71ality it is nearly 8 oehols percentage point lass.) Of course, not too ssuch should be madk o:' sueh . slight fluctuations because they stiay be sxplained by saig error. Oni the other bar.d''r 7iowsd oves a tan y,ear, pexiod the treod' seems unmista3:ably down. Yhere are, nevertheless more smckers today taari two years agp because of the rise in population. Dsing the latest Census Bureau est!imates tor, the apgrop- riate time periods in question which include the part of the population ia our itudy, the percentage im our studies proj'ect as followsz • 37,63'3,000, sankers in 1978 58,923,000, smokers in 1976' $'9,882,000 smokers in 1974' 51,700,000 smokers in 1972 54,012,000 ssnkers in 1970 Si,038,000 smokers in 1968 By the same token, there are more ncu-s=kers thanever before because of tbe decline ofl the percentaqe who smoke and al'so because of the population i,u- erwse. Xn iaportaat exception to this apparent pattern of decline in smckers is the 17 to 24 year old age group which shows a sarked rise over the past two years in ssmking participation and in the number of cigarettes sme3cbd per day. + S+ome of these estimates are slightly different than those reported'previouslv because they are based on later U.S. Census estim.tes for the periods in ques.ion. gut these stifnor variations do not alter our previous aasalyses. N O N ~ ~ N N (7) A-3'8
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10 Even t.':e ccrvi-_:os has r_s~en ten poir.tr si-:e 1974 _'- a.~ o~:qq ~:..o'l;e-s, .. ... , _ still & n:•r.or:yo uoi'r.ion. But s.ore t:L.ass t•aM cut of r.on-s-ore-s 5el:eve that they are ha,.^.aed by cigarette snok . Snokers .3or.-str,o?a _ r s 1'9'78 19-16 1974 1976~ 1976 ' 19": . ~' ~ +! 1 t +l' Probably is hazardous 40 38 30 69: 61 57 Probably doesm't have any real' effeC' S0 53 64 23'. 32' 37 Don:'t )caow/no~ answer 10 8 7' 8 .:' 6 Thi''s sharp rise in the rno:.uer of people who believe t`ia: v-c_= sao!e::: haras arv health has made a whole new bal'1 game oz:t of the acr.4-sr.nk:.r.; ca=.pa:,.... ~ tso matter hoW' many people believe tLat smoking is ?n;r_ious to the srokers' owa health (more than ai.e out of ten do+--see Question 1'6) , t:-3at, in the -.rie:+ of' =any, is the sao'kers' owa business and t.*.us~ a matter for pe_sor.al rat.':e= than qz1kTes _e::__1 ccnt=ol. &ut or._e s-okiaq' becomes widely t.'iouQ::= of as a p.ubli: .`.eai_~ 'rsacz.=f, then the jtst'i_:ca_ion for legal measi:res aSaixst cica:et_e sales and use has -::ee_ established. Anc:he= ,uestion in this re;==t (Q+sest-on 30 osn, the ":C" :o=) st.ows t_'za: the s`.xornqest arquaera eited 5y' smokers ar.d' rion-=okers aZ,:-.<e in :avcr o: passi:.y laws against r...ok_.^g in public is the _act that "the health of tson-s~k~-s is hazaed by other peo=le saoking i.'Z their presence.'' T.,;1.-ty-twree percent o: :»e pr.b:lic believes that: and t:is is the fist time' that passive s=ici ; has been _':: ent against sr+oD;:r.g iz p~l:e places. 1L-.o`aer 22% say t.'ie s_o-,_st ntimsber one az,_,n as;urie-_ for .a:c:.; public s:ok:aq aleral is that "soz:e r.on-srekers are to tcbacco soke," ..v To tes t whet`e'r this °.-cWen_ c'---.. _c ==z=e _te =cke al'_e_- e=: e- sse.^.t'S sc.^..eth:.:j .:..._e t:':an ]S3I5: aC'S.=YZl:: _. 'de e'X71---: ed tcc^o-h_' of CL:r s_ ="e o: =eswnder._s (f;,-'e==_ors 3_) that "3n a2.le_;_1 is' a ' :v'sl_cc.I re3C._-C^ _.. c_ ___ . A-11
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9 DLTIKIIED 3l2AZYS I'S non*Smokers' Ri4hts '!~e onerwhelming aajority of Anesicans todaybelieves that samking is dwoqerous to their bealth. This sixth in & series of studies of public attitudes tmrrard cigarette asr+okimq oncx again underseores that geaeral conviction, and its 8ocumentation nas been relegated to a later, a3nor position in this report because it oontaims little that is new.. Yhat i~s aewr today is the growiryq oontrov+ezsy ov,er +rhethe=, smokinq is dangerous to aon-smokers' bealt2i. Xnd if it is darogerous, then to what extent is it & personal responsibility to avoid the danger rather than a government responsi- bility to pro2si.bit tbe danger? And if it is serely annoyismg, tlnen to what estent sAould the sajority satisfy its oomfort at the expense of the mimarity? fieanwhile, the vbole eontrvversy takes: p1'act within an atmosphere of in- csasing offic3,al' sanctions and social presssires: against sn+okimg, and this study rill investigate these pherycmera as well. lbst 3mesicaass are «omviaced that it is probably hazardous to their, heal'*.2ih to be around, people vho are smokinr,, even if they are not theaselves =okiloc,. This view has risen by six percentage points since 1976, ttwelve sinor 2964. And the opposite belief' that smoking promably doesn't have amy real, eff ct on the bealth of aon--jmokess is driwn fifteen percentage points since 1974, to a low of 33%. Ys believe it would be diLtficult to ovrsemphasize the importanc+e of this finding, indicatinq, as it does that tMe battle to convince the public of the dangers of passive smoleimg' is in tbe process of' being lost,, it indeed it is not already over. Is smokimg ha2ardous to non- smokess' bealth?' (Q.211) 1978 1!9'716' 1974 s s a C, C c> Probably is hazardious S8 52 46 ?robably, doesn't have any real effect 33'. 40 48 ~ ~ L1oa't krx)+r/nc sasver 9 8 6: ~. ~ a-im
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2025684138 ------- - --------- --
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52 ifhAt do! yon think they a:s 8ciaq about it (Queatsioa 72) • 'P+mtal kezs Sm !'b'a-smokers 1978 1976 1974 1972 1970 1968 _ 24k:nq acme Worts 50 j*'3 45 S0 51 48 418 52 0 m't' d0iDQ sflch of ' awfthi.a9' 39 47 44 37' 36. 35 30 26 01nrkiaq, hard •, 6 7' 8 10 13 Le 1s DOn't kmW,/no :rLSVer • 3 4 .3 4' 4 s A-53
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. /1 dj b-ofprs, hoalth prr.+bl=s ramk fi_st as a raa3on for z,tiaittisg, just as they do wit2s Gmckeza who say they are msking less. •Z1 of sz+oka;!s cite health raasons.. lor quitters, doctors advising aqainst s=+oking is isportant, but not so much as 1t sa.d to, be. Sut bothgovezzament reports on the effects of smokimg on 2ne.alth. W the varni'sygs of friends are increasingly parsuasive. Zov+Qwer, neither sm:okers aor non-saokers believe that increasing re- strictioas, taxes and prohibitions on saoking rri11 be an istportant reason for pec7pl e to, quit ssaoking. ('¢Qestions 51, 64) Increasinq pres~surel~s~s wi~ll' mak~e~~ smokers~ Quit' amtioking 1io't Q171t, saoking Do;A- t' knCV,/ no answeT Smo7rers 9 7 8 12 )ioa-smokers 12 75 . 13 On the o+ther, haasd, smokers rsao thought that increasing restrictions aight cause people to, quit bad theoselves tried to stop more so than the avezage., Si.milarly, smokera eho did not think the restrictions rAuld make people stop smoking, were aore likely not to try to quit themselves.
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r 20 TSais solid approval of trut2l in adv,ertising as regards public ser~~ice 3.sisaq+es suggests that there may be public support for taking legal acti!on, wiL.%i the M and'for deasanding corrective advertising the Aext ti.ze non-profit organi- sations or the~ qovernment~ misrepresentthe facts~~, amout~ smo~king~~ and heal~th., 'Z'aere is only a minority of the public that trould he willing ta cnn- sider a aovel hiring practice iatroduced' by the Pire Caief' of Alexandria, Qirq,ini'a, Qdarfias Fula, v2w rejects job applications from anyone who saokes ciqarettes, pipes or cigars. G"iiet Rml., .iso ended 23, yeazs of ' pipe smok.ing, last Otaly,puttlqe 2ianinto sf factbecause, besaid,he did not want to~ subsidizell dis~ ahility retirsaeints for heart aru3 lung ai.laents. • We asked whether an employer had the right to refuse, to .mploy a number of diflaresat kinds of people. Dbss an smployer have the rignt' to refusetohire someone wlio~.... (¢zsstipn5Y Does Does not Ho. o inion A ` - Saokes cigarettes 22 76 ' 3 Drinkssoaeti.aew 25 71 1 Drives motorcycl'e 9 88 2 Zs ov+er 65 26 6~8 6 Ss a teenager 26' 69 5' 2s an atneiit 15'~ 79 6 Zsahomosexual Zs' blaek 28' 1'S 6p 87' 12 1 Is physically handicxpped' 21 70 7 Zs a woman of childbeari.zq age! 35 82 3 ' This kind' of hiring practice, it r+ould appea:, is not very tol_rahle to most. tV Izericars, ranging from a 2'8A acceptance when apr::ed to, 5oa,cse.xsals on dorr to a ~. 9% accep:arnce vhe::e~ motorcycl'istsart concerned..Sooke_sscore soWewhere in t!:a aiddleof that range. GO ~ ~ A-21 N'
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.. Sar' content of cigarattss tiQssstion SC Lov Reqular E1c regular brand or Don't know/ no amswer • '11oLa1 36 ' 41 24 37 - 24 27' 49. 23 ---- - 25 aad tap 38 39 23 lliale 29 47 . 24' tsmal'e 43 35 23. 31ack 30 43 27' Mlai ts 37 410 23 VCmen sooke more lov tar ci'garettes than they do the reqnlar content brands and older smokers are about evenly divided_as to preference for tar pntent. we seation lov tar cigarette smokers in this sectian because they are potential ca.garette qttitters. More than the a!ve-age, they have read something that torri'ed tbem about smokingi, tlsey, believe it is definitely true that sa+ckers have more of certain kinds of illnesses, that smoking is the ma j;os cause of those ill- nssses assd t2n_t any amosant of' smokir,g is bazardous. And more of them than the averaepe have tried to quit smckinq. Since low tar smokers are an expanding share o'f the aarke=, their greater desire! to quit smoking poses a special probl'em fbrr the eigaretts industry. As in past studies, ve: find that ec-smokers report that they smokec more beav!ily at the' time they quit than the average of current smakers (27.7 cigarettes per day for quitters as coag,ared vith 23*9 per day for esurent smokers). As we havesuggestad bafor,et this, aaybe trme, be.auae: peopleriso quit really veresmQkimc, more h.avily. Ctt the other hand, it is more likely that ex-sankers te'rsd to exagger- ats their past cnns=p2ion vhereas current amckers tend to miniaize it. 2ie ==ber of' ex-ssaokers who report that they have quit s=king within tbe past year is perhaps up semetilaat since two years ago.
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19 We tested the acceptability of aoti-cigarettw education by placing it 1a context witsi other kinds of' prflg:aas at various levels of' instruction. Re- spomdents reti asked to suggest the earliest qxad'e level ae wf,ich vazious subjects '~bould be taught in school--•or don't ycno tMirsk it shoui'd be taught in school at a117•' (Question 10) _Zar_ liest srrade I'evell tariaur.-uctionr concer:Ina S.x Damgers~ of' Dangers Diriver of Religxous in- e+dueati.oea ...__..._ drinking, ~ . trzininGgsro3cing structiM % _ t • i 1 Cradks 1 - 3' 14 17' 1 27 48 Grades 4' - 6 2W 32 1 318~ 11 Grades 7' - 9 31 36 ' 23 25' 4 Grades 10 - 22 12 10 71 6 2 nottaughnt h 3 1 2 28. Dion't k.vow/m answer 5 2 2 2' 6 CS'aarly, there was no objection to aoursesabout the dangers of smokiag.*Aidie. Zrom rei!i'g,ious, instruction and sexeducatioa,, the oaly' apparent opositio:n was to driver trair•L^:g in grades one thzrvugh six. !rt if Americans support aati-ssaokiAg education and anti-smokirrg cam- paigas,, they f.elscrongly thatadNercising, sessages by th+e! goverzxoent aad'hy pisblic interest groups likt the Canear Society or Ralph lsader, ought to be seasured by the same standkrds which~ the lederal Trade Coaasission imposes on G elaims by private ad4ertisvrs. ~ T"iX regulation of all advertisi'ng?, (Q.e) Q N Zas 70V GA 11o 1S ~ s~re Doa't k w/ 15 ~ no no aa r Ira' • 8ad' we asked taal: the respandien_s .rMetlier they would' be wi1liJ:ngi to use , 1 ic educatiorn ftrnds foz anti-cigarette education, we might have found' stststan:ially less support, as was the case vrhe.Z we asked about spar.ding tax dollars for arati- smekinr, caaspaigr.s inrtead' of' ae_ eiy conduc ting such caapaigns (see c==ents above on Question 24!Y) . . 0. A-20
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,13 ,Oa^roroz-forbiddir,q it.*. :"„iiafissdiraqtbat oo= ron-srao9crrs would prefer to avoid ciq;arette smoDciagrather tlaus, taksactioaagainst it,, is inherent, in theidiea of' coa- seni'ent aaAidancam oa. asa p3e ix the Qradcminarit preference for avoidance in QnestS+an 62, wbera we fo=d that aoat amn-=:okers, .xen ltidoors, would 'try to mcv~e praye trca anooYiag ciqarstts socke rather than ma3ce a, acene. On the other harx3, the avoidar.ca, cal be too trQublesome or cause~non-swkers to altu tbeir, babitss v,s.arially. Ye ttsiss4c the results for Q¢aestian 37 above would' have been quite different if we had' asked abotat 'GbTdenrod grflwimg in a Eity gark' or Raather pil.Iaows in a bospital wara.` In such cases, the avoidability factor would have been r,educed'l and t3ie, possibility, of iacaaveaieaceaade qarealeer.Takess in this sease, ttaem,, snti-smokinq sentiment can be viewed as a con- tiautm dependent on convemient avoidance, ramqiaq, all the way from the 86% wto are vi1ling Lol ban amoking in e;levators (vhereavo3idability is almost, nil) tothe11% q rialimq to forbidcigarl iathis question (whereavoirdabilityismta'se•,.or),,Inideedl, the Frinciplc of' Convenient ]lwoi'dance underlies this enti.re e2tiapter awi h+el!ps to eacpla'fn, we be]:ieve,, other aajor developmen!rs,, swch as the empargence of subsuntial opposition to passive smokimq and, of cossrse, the ris,ir,g prefereace for ssgre+gation ofsnoki'ng; rather t~~saaoutrig3at prohibition. 'lbis study b+al found a decided grefer.eace for seq,reqati.ag smokers, but very little approval for drastic esafo;rcement aeaslares, ite asked' respondents what they thooqht the penalty sA©tald be for smokinq where it is prohibited by law. •'i'ldis 11% is probably the bedrock sentiment in favor of banning ciga.-ette s=king nnder _ drc~st~^.crs. Compare it with the 12% ' in f'i!vor cofbanning ciyazettesitsstead of, r'ecT+,¢iLl w~-:uasq, labelsi.n,'Question 9 =6 the 16's.rtso ttiizk alawsl be passed aqaizst the sale of' cigarettes in QEaestion 24. A-33
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/ON . par•aittsd,' •5sparate facilities fpr smckers,• or •Sepasate faciSities for soon-smakers•--buit with the requirement that the smoking coryditions that apply be posted outsidia the preim:ises for tfie eonve2sience and pro- l..ctioa of' mokezs "' aoa-smokazs ali'ke. 3. Za vilev of the vidkspread public belief that pabli'c sez- •ics advertIsing by non-profit organizations s3=eld be subject to the same 7'i+C scrutiny as ocmmnercial advertising, we think it sight be d+esirable to ac+isil'y file an action vrit.b tbe M the next time public sezvice adVertsising sisquotes the facts about smokir,g, and' health, and to further demar,d that tbe !'iC ' require the offesodizsg, or+lanization to run •corrective• advertisiagias Listerine has been required' to do. •, lifbile the peblic widely supports goveznent proywaras to discouraqe cigarette smokisY?,, a sajority opposes spending tax dollars for such a program--vliieh, suggests such pscqrams sight be vsalnerable if people Mese made avaxe ot' theiz rnsts. 0 O C C' S,. Ssvesal questians in this study suggest that vhe,: e there is substantial support for gowerna+erst action against cigarette smok.inc,, there is a disce..~^nibl'e decline of such support when people are made aware of the othrs govrsnment iatrusions that aight follow. '%Mere vrill it all amd?• a,bght be effective in blunting assti-smo Xiaq regulation. f. Anot2irs short rstge tactic is suggested by the questi.on oeocexaiag •fmsaphcbes,•' The fiadings suggest that there is the possi- bSl'ity of dividing those who are relatively unexcitad about the passive ~. 0 smoking issue from the anti-sacking sealots, by poatrayi:nq, these zealots ~ as pecpl'e with an unreasonable fear of cigar ette smcycirg. ~ s s s . . ~ ~ But we would repeat t`sat since the anti-smoks ~*.g, forces have now gone 7 a losr., N way in oonv:.ncirAg, the mon-saoDce.r that his health, too, is at staDce, the muarbzs one A-8
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/k. 21 One other QoS,nt. Uherr th,is qtiaes~aon ras asked in the field (&s with a., mvmbet of other sd'mi!l!ar cases iw this study) the order of the phrases was re- versed tor one-half'of the respondents, beginninq with womer. of childbearing age ~d proceeding~from the bottom to the top of the list. idzen this is done, people sra slightly less likely tors~use =ployment to ssokers--presumably because, sf•er consideriiag a sn;mbe: oS' similar situations, they are better able to see the situation as a kind of'job discrimirnation rather than as a case of saving money on disability payments. 'This question suggests a.short range tactic that may moderate the grovingg acceptance of restrictions on smo3cing. Ytien the restriction is presented first-- assd therefore aut of context-it.finds fairly general acceptance. But when it is suggested after, a series of'other similar restrictions, we think we see evidence ofan attitude that seems to say •Where will ail thisemd?'Ferhapsa snccessfuli pro-smoking campaign would be one which pointed out that restrictions on, smoking aerely open the door to intrusive restrictions about other public activity which some people might find uzutt-active or annoying. the lire Caia: who refuses to e=ploy smoke:s in order to save mcney on disability payments is not very mwcls different from a government which tries to stcp sackinq because it places a bnrden on welfare paymsznts, .etezaas' 2aospfital!s,, Nrdicai'd and' other health programs. Ye asked respondents whether they tlaought. the govezna+e n: has the right to eontrol tihe amount a person smokes and also about E` C_` other activities which iight contribute to the taxpayers' slsare of health costs.
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(Question 27) ~ !hc+usld' :m+oki'rq, be~~. 3+astsed'. lb2. barosoed 19'79 1976 ' • 1978 1976 - S 7 Zn elevators Tm, doetors * or de,rrttist:s ~ waitizg rocros 69 s. 65 u 27 30 Zatetail stores SS' 52 41 44' In ttieatrsx 44 446 47 42 7lt iadoor' spoxtirq events 34 37 57' 49 it p:b1ic meetiaqs 32 34 58 52 Iacity,, state or fsderal builainqs 22 32' 63 62 Sataxis 31 30 64 65. Ia traias, piat4es, buses 26 25 6S Za ea+tiMg places 23 . 22 68 6t Za barlier or beauty shoQs 21 2a 70 65 2a work places or offices 17 17 73 68 In t;aia,, pl'are, b%s ststions 16 16 7'S' 69 2h"e vas V*xy little cha.nqe troa tWo years aqo, and most of ' it sisht be expTained by' saaplisq error alone. Dnt if there was a discernible isaczea:s+e in sesatimeat for smoikiryq, prohibitions, it ax:ld be fo=d' in pl,aces wbere separats facilities are not really a practical solution: placts like elevators, d+octors' waitiaq rooms, taxis or setail stores,. iie tbink the sequences of questions is iimportas4t bese, also. W+e asked about barunit'sg ciqarettRs ~ z:ee had esplmred the question of seqreg,ated s=k:.ng, areas. Bad we asked about ba:sciizq before me_~tiorLir:g, the acceptabl& a2.e=native of segregation, the semtiaent' for ban:xinq taigh't have been substzntially bi.ghe_. taote also that i`' there were a few, iastassces af, iacsease in ban sesstsient, they were re- latsd to ttyose places which had sot been merntioned earlier as ca,r.didates for segre- Saaan.A-31
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1'e At the saae time, the r.asommost often selected in occ,o~ sition to laws against smo0ciriq does not dispute the: contantion of harm t.c others, it mearly aryues that such restrictions eanmt be enforced against 55 mSlliomsmokers,. Rnd the next sost popular arqument is in the same vein: the police would have to Vpsnd too much time aad mpney' tryisag to ersforce such laws. hirtYne_-:anre, the argu- sent with the greatest loss of'support since 1976 claims that the problem has a social solution: fewer people feel ttsat smoDcing in public places is a question of ea4rtesy azd ac>t of l*rgislation. All of wbichAoes not mean that the American public is prepared'to sup- port a law against the sale of' e3igarettes. Cf eight possible goverisaental restric- tions suggested in this survey, outlswing cigarettes had the least support. A law should be passed against the sale of'al'1 cigarettes (Q.24h). 1978~ 1976 19'74' 1972 19'70 7lgree 16 11 12' 13 15 Di'sagree 76 82 82 82 79 L1o'n''t kaaw/r.o answer 8 6 5' 6 6 Qn the other laatad, there was near uaaa,nimous acceptzaacs of the idea ttiat cigasette advertisitsq should contain cigarette warainqs--ia fact, most people favor a stronge:r wrninq, label than the present oa~e. There was substantial support for packaqe labels stowissg, nicotine and tar eontesstr, assd a,Lmost as high a preference for & legal lfsait an tar and' nicotine. A bare aajbrity rculd ban cigarette machis:es to make it aore difficost for minors to pasrchase ciqarettes. Turthes, there apFears to be, substantial suppo.~- for some of the more r e- cent aori-ciqa:rt:e mea ures. One withextensive and long-te:a i'mpl:caticns in- N 0 .olves Sscretaryc Cal'ano's plan for a six-fold i=rease of the tunds that t.ye De- pastment of Hea1Lh, F.ducatiben and Yelfare spends each year on anti-smoJc_nq e.:for =s in ttse:schools. A-1'9
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of estiaation, oonsumption for 17 to 24 ymar alds i's up over the past tz+o yea.s any,- %*ur+s fzom Lwto thrse and a quarter cigwrettes per day. . Viewed over the longer period of tsn years, the rise in smoking and z,ckers s=rsq the 17' to 24 year old group is not so~ drazatic and other patterns seem aore prsdamni.aamt. parceat who smke (Qvestion ;8) 29'78 1976 1974 1 972 1970 1968 Zlotal 37 „ 37 41 39 39 41 hg6 groups 27' - 20 38 35' 40 31 40 34' 2.1 - 24 44' 41 39 45' 42 51 25 - 34' 37' 40 48 46: 43 49 35 - 49 44 44 49 47' 45 47 SCaad'over 3t4 ~ 31 31 29 ~ 31 31 Level of education coll.ge 28 33 37' 34 31 37 High scbool ~ 43 41 43' 43 44 45 Grade sctscol or less 33' 33 39 33 31 Sex 4 xale 39 41 46 43 44' 47 Tamale 35 34' 36 35 34 35 . Ybn-sa+okers in th,i~s study tend to be older, college .dwcatezl, conserva- Live, and live vest of the ltississi;ppi, and ia~ rural aarkets. Dc-smkers, as a subgroup, ar. also coilege .ducatad liviag tirest of' the liississippi, but particu- larly aales, whose ssnoking has drelinesi' steadily over the years while femaSe smcking~ has remaiAe_ relatively constasat. Za this study smckers were asked'' whether they are smoking mere or, less movr ca=pared' to a year ago. A-40
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I !~ackirq lLs A iLta2thProbl-s . . The belief that smokinq is hazardous to health is tiov alaost totally icasptsd by7lmeri'cans. This vi!t+rpoiat prevails by a sargi'n ofl over nine to• oa~e. 47 Moreovsr, asaxly two out of' three people vlya believe ss+okirog is hazardous to health also believe that any aaexnt of smnDciag is darqerous, aot merely beawy smoking. go+r hazardous is aaakirq7 . (Question 16) 1'9'T8 1976 1974 1972 1970 % 1 t ' %I 1 Jlr:y am"nt _ 6l 54 54 48 47 Caly b'e'aroy' smoking 3'l 38 39 42 45 ' Dbt bazardnes 5 4 4 6 S' Doo't hacw/no ansver 4' 4 3 4 3 aaL'• the populiatioa also believes that it sukes a, great deal of diffar- sncK in personal longevity whether or not a person smokes a pack of cigarettes a a,ay. 3ssd this convi!cti'on is in second place smdonq seietted' health hazardt, up a significantly since two years ago, riakes a greit deal of dif f ersncm in longevity (QuestS+on 12) . 2f a person lives wder a lot of tension aasdl stess If' a p+rson smoka& a pack ot' cigarettes aI day' Zt'a persoa regularly sats a lot of food vith high cholesterol 2f a person drinks 3 or 4 bi'ghb lls a di.y, If a person dflesni''t get roqular esercise Zf a persan is 20, pounds ov+erwe3ght 1978 1976 1974 1972 1970 • % s s • 74 76 74 72 ' 69 So 45 44, 42 4,2 43 39 38 34 31 39 37 35 34 29 ~ 34 33 38 38 49 Q ~ ~ 24 24 25 26 23 ~ ~ N ~ ~ A-48'.
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• iriL's the rastsiction:s ars they did with the Vdlstead Act, Scokers vho want to dli'ne, }iorlc or, travel aith~ ncA-su+okers say beea.e fed up with havisr7 to fcreqo s=king. Sba-mckazs vmo wa,nt to dine, vArk or travel with smokers say bec=e fad up with haviacg; to eadure "t2se exta smobca that exists in segregated smokiaq _acilities. Eoth oould' say `!o bell with it a11' and go bac'!c to a smokinq aaiyvt3ere sent3.-aerst. aut if L-Ae aati-se~ekiaq forces are successful in conpiaciar r,oin-smokers that their health is in danger, it's at least as Iikely that the seatit:eat for seSreq,ated' facilities viill be strerxqtbened. arsd if segregated facilities do not aca:asplists the aati-saekirsq forces' desire of a,akinq ser,regated smok:r+q so untessable that smokers rrill qive it up, the next step eov ld' be as out icpht ban. Zf' mn- seokers are by then canwinced that it's tlseir health that is at stake, the present seatimeat for separate facilities emald' beczrme support for a total ban. , The strateqic and' loaq' run antidote to the ;wwsive 'smoki,aq issue is, as ( we see it, dev+elopinq and widely pssblicisi:oq clear-cut, credible, medical erideace ` that passive smoki--q is mt harmtul to the aon-smo6cr.r•s health. tlh.tle that should be the fondamental objective of the tcbacco irsdtast-y in o%tz opiaion, this study suggests that there are soae short teszs tactical approaches that say slow the effor-tw of' the aati-smokizq forces and bay the iadustcy the necessary tiae to dievelop What we sec as the fundamental esidernce needed to reverse& tbe trend. &tt they are tactical and short terza in character. A=a3 these short raiaqe ta;ti'cs are tbe folloWrinq : l. Where outriqht be= an smckimq are proposed and appear li]SsLy, of' passage, the i'mdustry a:ould' propose separate facilities (as the lesser of taro evils) . 2. Wbere I+iltv Jers.y-type leq:slat'•on appears to be a real possibility, the imau:s'try a.iqht gxomcse t.'zat ope:ators of restas:rar.ts, cabs and ot2her public 'iAstitutiosss' be persitted to establish whatever smokinq policy they desire--'Smokirog perait:eG anyti+here,• •:tie saolcrag. A-7
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r 24 ?bese data, we th.inkr s3=uld be ass.alyzed' cautiously. Zn the first placti, the tax rises in question fraaed themselves in the aind of' the respondent as a sudden eont:ast rrithreality and' Aot--as stight well' be the actual' case-as an atti'tude a!volv+td o4er' a fairly Lorg time aad' after suall step-by-step tax increases that ;ccoaVaay geretal price rises on all products diae, to inflation. The question was a.lso posed as an intellaetual hypothesis without any reference to the eaotional sad psycholWical satisfactions usually associated with saok9sn. &nd, quite pr+cabably, these findings reflect a certain amcunt of rejection of the idea of tax l;nceases o: any kind. lbst politieal poll takers rould' be hard pressed to th3rJe of ar.y question inwplvimg taX increases that might elicit a genuinely favorable response. Quite possibly here a certain nuiataes of smoke_-s are expressing d1staste for taz rises pex'se by opting for alternatives-in this case the only aiternati've: givinq, up smok:.ag. itbstever' the escplarution, an addit3ional' insight is suggested by a_-zotber question from this study.' One sdght reasonably arque that, if oost really, does . c.zsrreZatt strongly with giving up eigarettes, then nou-sa+okers might tell us that they would start smokirnp if' cigarette taxes were lifted. eut such is not the ease. tiouLd noa-saokers start szokinq if there were ae tax on cigarettes? (Questiion 57) Zes 2% sb 92 Doa •'t kaoW/ho answer 6 oirtually no mon-smo0cn:s tbought the elimiss.et;on of c_'gr:rette taxes would eacourage tbea to tiks up smo0ciacg. 3actiher piece! of evidence eoncersing, this compl,ex qaestion is suYplied' N by the compasLien to the last question: would smckers sr,ck_ more i: there ve_ e no: © cigarette taAC?' A-25'
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. 1te consider this finding, important, especially in its yaplications for a tobacw industxy postsare. tiherei outr:ight prohibitions of :mokisu}, are being p.-o-, s. posed'., separate facilities might be "gested' as a more popular and s+ore acceptable altsrtaativs. :l Anothez" factor in the equation of cigarette opposi'ti= was tested in Question 37, where we as3ced' about the personal responsibility for avoidance of . atMyior or hazardous sit4ations. We told' respoxadents 'Some people are: allergic to galden.-,od. Do you thirsk sueh, people should take it upon themselves to avoid qolde:arod, or, do you think that a2lor.-ing goldenrod to grow in a field slsould be forbidden by lav?" x similar example tras cited concerning allierg;ie& to~ teather pilZows and then to eiqa_-ett,es. ivoida=e vs. prohibition • (Question 37) Cro idenr od s /ok ?satfiers~ Qiga_ ettes Peop:Ieshomld avoid 85 94 85 Sbould be forbidd'e:n S' 2 Lbm't kacwlno asoswe~~.r 6 4 4 A substantial majority lsels that it is the personal responsibility of allesgy suffererx to avoid irsitating situations. Reversing the order of the questions had littlr elfect_om this se::timent., fts last three questions (Questions 2167, 27' and 37) when taken togetlse: Suggest to us' that there is a fundamesatal principle ussderlyir,g the mechanies of cigarette opposi'tion: Ufhat we eall the Ttiest of Co'nv+e:Lient Avoidance. tjest people. .rt,oasw allsrgSc to feathers a+tedaotbevict.imi.zed; by~ feathe.r pillpvs,theyh,ave only to avoid the problea by selecting ar»ther' pillov, Szcs*:Sarly, few people are forced to pass by golderrad'l qrowitaq xild in a, field; the simplest antidbte for suffsrers is to avoid the vicinity. Zn,ttae question abbmve,. having menr.ionsed Smplyinq iacoove:3's.'nce, we find 05% will:.ng, to avoid cigarette smoke and Q. A-32
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3mokiaq ~~ a+cre~ or ~ lsss thsn, a year~ ago (Qsest:ao 39) riorei Less Same. . . ~, • ~ s s 2972 2!4 14' 7,2 2'974 23 18 68 1976' 12 17 70. 1978 21 17 721 ' ~ A44 17 • 21 21' 12 65 Lo+r' tar smskers 11 _ 21 68 Don "t know/ ao answer . ~ 1 s Otu consistent tindiag, over the years has been that s,ost s=kers cla:a they are sa+ckiag less, aot more, than they,' were a year ago. This, despite the lsct that co:asuimptioa vfthin their respective groups may mot crontira such a per- asptioa. I'ta the case of younger s=kers, however, the opposite is true. They feel th.mselves to be smckisbg murh more and, tsnaloubtedly, they are, s3ssce many of thca •as~ mot too far anray lram their first gradual initiation to sa,okiug. On the other bamd, the 17 to 24 year old'group does.tsot smoke as many cigarettes per day a& do! older, smokers-they coasume anywliere! lsom l~ to almost 3 ciga.rettes less oa the average. ^hus, v!iile tM& 17 to 24 year, old category6as four gercentage points ncre ss+okers than the average, (21 to 24, has se!venpoints more) they d'o, not s=ke so much. By sach o!' three srthods of estimating daily cigarette consuim-ption, low tar smokers cons=e less than the average aus+ber of cigarettes per day and even less than regular brassd' smmkers. . , Zacidenta2ly, youroqer people do not eXpecially sreke low tar ciigaret.es. They much pref er the reqular tar brarsds..
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2025684154 - ------------- -
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to^ Oiveat.5e1'sss, 4u1'1y •6V of oaar sa--z23: used the siord aadd:iction to dlescri,be saokinc,, p1t,Aer aq,re+eiz-q rith that description or roluntaeriaq the opinion that smoking is batli a hha,bilt and, an, addiction. LasgiLa t3ia sGatist.ics vbic2rt dcw-umeat coatinuedl nnsuccessfial sfforts to give up cigarettes, smckers vbo persist are in the lonq run a3aos: as likeiy to lucceed as to fail. Ru cusrsat study indicates th~ odds. Quitting CQUestiaas 38,1 44, SB), Seo3c.rs iever tsied, to quit 15% Stiscll but tailed 22 11oo-snakers " Tried and succe,oded 20 8eqer smked' 43 Of the smaller suYsqsoup of' smokess who evar tri.d' to quit, 47% told us they succeeded while 53% said they lailyd. Uordiar to ss if there bad' been -aay change in the reasons why people give IIp smokiag, ve repeated in this stttdy a question which had beeess used last in 397<~. Siaasuns for quitting • (¢oestion 61) 1978 1974 19722970, s s s . Bea1Llr problesos 37 38 40 39 DbcWrs advisiaq against smckiaq 19 23 19 19 Gavernment reports on the effects of saekitig, en health 17' l+l ~ 1't ?ri'end3 or'rslati.es urging qudtrinq, smokinq 1'b 1'3 12 1'2~ Zbt erpense of smoking 12 13' 1S' 13 Qaildrea obj ectinq' ta, parents saokirrq 5' 6 4 8 3 sa+a k:nq clinic 1 Zz" ne 7oe 3oae 21 20 21' 21 Don't kmotiJm answer 2 3 1 l •' = i'ndicates that question was not asked in the study in question. A-46'
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•38 ftcking aaeong the qeneral' popcnlatioq anid aaong 27 to 24 year oi!ds (Qoestiorss 3'8, 42 ) . ]l1'_ls ee IT- 24 Per+oent• of tatal pocu* ' lation vlzo sao3ce 197$ 1976' G`s,aaqe . 36, 64 40'.8 %' 37.i 37.9 -0.8 +2.7 Wumser of ciqarettyes. smoked per day as •stiasa'ted by D!e t.'y,od l1 197 24.05 C1g3'. 21.16 Qig's. 1976 24.5'9 17.91 C~aqe -O. S4 +3. 25' Method B 197._~. 1976 Chang e 19.93,Cigs. 20.00 ~ -0.07' 28.40 Cigs. 15.821 +2.58 !!lrthfld C ..~.r~ 197'8 19.10 oi'g~a. 17.37 Cigs. 1976, 19.04 151.31 ~ Cb=ga~ 40. 016` +2.06 IIsingltleSargeoa Gsnsril•seethod' oW' cl'assificat:iontMetbod! A): rss3r.fir satsds,ily,eiqa;rettreoasuarptl+on, thesiediian numbar ofeiqzzettesconsumed daily by the populxt3on 17 yeac& old and older is 24.1, dbrrn a half a cigarette from the 24-6e'igarettesperday estlzatadl, in Crurstudy tyo years aro,. But using tvo~ otber, a0z.'c4a of sstimatiorn--methods ve feel greater comfidencre, in (rethocs B ar.d C)-- aons=ption far the vrhole samle appears virtually uwnclbangied',.' But in eva.-j met.hod s Yt have also cansidereC the: possibility that the increased sensisiviry of smokers is sakinq them underreport smokiasq w2ume •ven aore so nov than in past years. ~~ A-39
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24 R:ze graduated tar tax (Question 55) . Good.t,bt a Don't kncw/ idea goodl idea no a=~sver ~Am~oraq respondients who did not consider arq%zments 27 55 1s Jkcdr:g respondents who did '16oasider a y-uments' 32 S3 14' 'You ean't make people stop smok,inq so the next best thing is to make t`sem smoke ciqarrettss with less tar" was chosen as the strongest arg=ent by the forty-three percent of respocsdient,s who selected arquments f avorable to such a, tac. The most frequently selected arqaaeAt by the: sixty-t'^.ree percent who chose argutaersts opposed to the tax was: •Peopie have a right to smoke any cigarette they Vish." iaoke:s tended to dislike the idea of a gradusted tar tax, rangi'ng froa a 60% disapproval among lighfi smokers to a 73!1 rejection, rate among people who smoke lorty or morw cigarettes per day. Zow tar smckexs " non-saokers view t.SR proposal tri!t2a las distaste, alt3r)ough opponents stil'l enjoyed the: edge in eve.-y catetory with the possible exception of those people who feel the goverrmment's role with respect to cigarettes should be to ssspoae more controls. 3notlser tax proposal wh,ieh: has been put forward' rece-tly iznnrolues i..'1t^~. O s - ing a f*deral tax on cigarettes in such a way that the disparity, bbetween the various atate ¢igltrette taxes r+vu2d be equalized and the incentive for cig,arette boo tlegging e Ac,tuments in-faVCr of tax a. You eani't make: people stop smoking so: the next, best thing is to aa.: t2sem saoke cigarettes with less tar, b. It vill discouraqe aunufaeftrers from makirs high tar cigarettes. ~. J1rq%mer•ts aq,aLnst tax C ~. c. People have a right to smoke any ciqar'et te they wi'srh ~ ~ d. Ra,isir.g the tax on eer*aim ciga-rettes von"t change peopTe's . ~ preferesscss, it will jus_ tax some smokers more than o2:ze,s. ~ e. Mooody has yetproved thatts;r is, bad'for you. f. A lower tax on low tas' cigarettes wi31 es:couragr people to =okeoore ofthe= thanl everWore. A-27
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Mre people th..- awer, boliave it is true that ...Aess haw+e aoa* ot , *ca.."aSa illr.zsses' than r,am,-swkars~, aora L"san tarae americans evt of five thirilc =, 3.oksss havi aore iilm+esses (gaestiaa 14Y 1978 1976 1974 197'2 .- 1970~ • • Dstiaitsly true 33~ . 31 31' 30 30 ?rob+ably' true 29 27' 27 26. 26 Pbssibly true 23 24. 27 26 26 mt trtoe! U 23 11 13 13 Dba't kmovr/'ao amsvrer 4 3 3' Oa the other hand, a aajcsri'ty of those who be:~: eve it is definitely, prct'sably os possibly ttue, see cigarette smo7c3:mq a& oae of szaay uases for the fact that ciga- setta ssokrss have aore of those illaesses, mst the aajor cause. ieokirxf as a cause fbr i11ness (O"s o, 15') 1•978 '1976 1974 1972 1970 t - % i • i % A sajor cause 27 23 23 21 24 O" of aany 51 51 55 54 52 11ot a causa 3 4 4' 5 3 Dma't knorr/ao amsver 3 3 - 3 3 3ut onay 3 percent sa+e cigarettes~ as mot a eaiase. Anarieaas; today tbiak (Question 18) that s.oking cigarettes is aore mare- !'tal to health thao drinkiog (swea sooltars think that) or .aybe even smokingi ssa.-ijuana. Zm both categories, belief in the UrA.tuiaess of cigarettes as oougared to! &inkiag amd saaijIuaas smoDcing has risea, ia thle past tWo years:. . On the positivo sidie, it shonld, be 2aotsd that selected oonresrsabanat prrsorsal' velfase (Question 6) are all down except for •erime in the streets•' ar,d `aaraotics addictioa.' Cigarette sa,obciacp ranks low aaosdg such concerns ('6w.h aorsg ttiosr tested) aadl is down significantly. is low cemp'ared! ta: aarrv other prob2ems, sees it as an evil. Thus the salience of the •eicyaret:e issz:e' Q. N 3at once it is fccused oa, n+ea,rly eve..-yoru Cfi[ ~. ~. ~ N W. A-49. W
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A0MI_ ~ •r C Ci'ga.rattss have the highest a:cspt,ance anong, these products for Yarnisag labels and also the highest stppor: for sosae kind of gpvernnent liaitation over the product (94i). ~ Aat the very high acceptance of va_-ning labe ls for all of ' those p_ oducts (even 381% for axatomohil'es, presumably because youmight have an accident in one) ;aadicates that there is little milsage in the arg=ernt 2Tirst it's cigasettes, next ,. it wiIl be warning labels oa vhatsver.• M~e poblic seens satisfied' with .rarnirq labels on whatever. SeAtime--%t. Reversing the order of the p-odascts mentioned had little effect on, this C The relatively high ranking for banrsing, aerosol cans and the low ranking for TV sets are both interestin+g. They svg,3est .that pablic opinion conce.-n:irq the: prohibition of pctentiaLly 2'sazardous products dependls to soae extent on the ava: 1- ability of useful alternatives (as is the case with aesosol cans) " the perceptioa by the public of real dangers involv+ed' (which is uot the case with TV sets).Al- . though there are few saseful' alternatives to cigarettes, ttsere cer-tair.ly is a public awareness of potent.ial danger and this say acxuast for tbe modest seatiment for ma'k'Lmag tbsn illegal. Undoubtedl'y, the high Warnin3 label acceptance has se_-ved to reduce further efforts to outlaw cig,arettes. Ca the subject of cigarette warninq labels, we tested the prnposed neti label for cigarettes (Warrsaissg: Cigarette smoking, is diurerous to health, and may cause dieath fzom cancer, oorosszry heart disease, chronic bronchitis, pul=nary esphysieaa "'otMer diseases) against the present label (W'a_-ning: Zne Surgeon General has dietermined that cigarette smoking is daaaqe_-ous to your healta).the proposed label was a decided favorite, especially with iaon-snoxers. Old vs. proposed' varrsinul labels N Quesr-ion 25)1 ~ old R3-ocaosad Don "t know/ mo answies ~ 'ibt l 34 61 5' ~ ~ a sacck ers 47 47 5' r jV ibn-sa+o3ce= s 26 69 4 ~ A-3 6
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C 51 8ince thwbegira%izq of' these stsdies for The Tobacco Iastitvts, re- ipoadents hav+e been asked what ttsy, think the tobacco i,ndustry itself believes about ,. the case against cigarettes-that they kao+r it's true but won't acsait it, or suspect it's true but don't think it has been prov+en, os don't beUeve it's true. Otnce again the rssults s2aow ar5athesirrrease in the percent arsstire/iag: 'xnov it's t.-ue,• up to . SO from S3's. Go.ly, 8% ansvered' the •don't believe i't's tszae'--dowss five points s'ince 1968',. 3bn-=okez,s eontisme: to be highly criti~cal of tobacco industry motiv!es,, risinq five points in the 'cnor it's true• category, since our last study in~ 1976. Yhat the tobacco industry beliRves about cigarettes (Question 71) Total Smokers 11on-sa+okers 19781976' 1974 , 1972 1970 1968 Tiaor+ it's t=ue 45 62 56 ' 52 SIO' 46' 46 36 iuspect lt's true Don't believe it's true 31 , 12 25 6 27 29 8 9 31 11 33 12 34 12 39 13. Dom't kncv/mo aassre: 1:1 7' 9 10 8' 10 7 11 Other grou!ps that are critical of the tobacco iridustry arntinue to be youmger people between the ages of 17 and 34, sien, people wmo saJre: ove:. $15,000 a ?sar, people rith a college education, or, bolding sanagerial or. Profcssioasal positions" liaally. respon3iants w2ao ans++rs that the tobacco imdust-y •Saaoars it's triae' or 'suspecr.s it's t-ve• are asked what they think the tobacvo i;ndustry iss dbizg aboat~ it-r+orSai'ng hard' tm find' aa, ans,wer, aa]d.mq some, efforts butcould do sore, or' aet, doing saach of' anything about it. Artsress to this question have: s?oovn a oon- tiauous erosiyon, since it was first asked isn. 1968. Cnly 71 of the 2,074 respondents vbo.veree asked' the question in this ss-.ad1y tsim3t the industry is rorkinr; hard to find amwers. Tlsera azt vir^..iaS2y as sany people vhe say the i:ndustsy is s+aJci:q usne tfforts: as say it"s' mt doing sues' o: aart.'sinq about it. ]1mong mn-smakers,. 'mt doing such, of any'•la::ng' is now a plura2.ity. C C A-52'
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^ • Light Mtokars try to qui't aiore frequently t!= acdiazate smokers, and ~ Dodsrats mass smora than h"vy. { ' • IIw lomq ago vas the last time . =M triod-to stop smokinql. (Qu.sti,oa 45) 1-9/ 10-19;/ 20-39/' O+ver ~_ day day 40/day Total _ Lsst' 7roath, ~ 9~ 310 & 9 7 l- 3 aonths 1S' iS 1T 7 2'3 3- 6' soaths ls 12 - 7' 2 9 6' • 32 aaaths 2+1 23 17' 18 20 ~! . Z ys=s 19- 16 22 21 20 ~ 2• lfl ytars 10 17 23' 32 21 pwsr 10 yssrs S 6 13 11 lo Lba't imow/ao answer 2 1 * - l Si=lr-six percent of light ssaksrs tried to qRait sometime in the past yaar, 60% of sod!erats ssickers did, 41% s of propls vho ssnke frca ome to lass th+zmtwo packs a day " ttiod to quit last year amd only 36%of hsavy smokers tried to give up cigarettes in the last tyrelve aoaths. Locked at aa+ather vray, the last time a sediaa light smoker tried' to quitt packiaq' was less than siqht aaaths ago. Fvr saderate smo3cers it was a litrSe ower pia,e seaths ago. !or, a:iakers of f=o. 20 to 39 cigarettes a day, it his been a year •ad msarly five moaths, and tor ssnkers of forty Or' scre cigarettes daily, it has been a sediaa Liss; of one year aad' s3ght aoaths siacsi they tried to quit ssflkinq. ' &W once De tried, the ae."iaa smoker in 1978' vras able to go five aere days tritmaut smnkimq thaa his oountezpast could ttio years ago. . F: A-44 •
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rc-=eekars (Questioa 59) 1978 1976 1974' 1972 1,970 1968 • i % ! • % Yixhia the last yeas 15 13. 14' 13 21 23 Ovar 1' rear# lasa than 2 14 1'3 10 SS }2 10 oftr' 27Saza 71 73 75 73 65 65 Lcm "t know/ao iasrrer 1 1 1 2 1 2 Sh+ese data arv aot sasy to amalyze, caasistiag as they do of shiftiaq aumsers of quitters, relapses and new cohorts of smokers. ?or esa~aple, ruriag, the period be- twoea 1968 and 1976p a total of 107; of the then existing ex-smokess re?ort that th4y quit duriaq the previous two Years, tvea allo.rsMg for the Chanqinq sise of' the populatioa, only .71% af, tbem can be found in this 1'978 study. There aaoe-a..-s to bayi been corss3,derabl'e hac3ulidiar,,. Ye asked' smokers vhether, they wanted to eoeatiane sanrskinq. would •scr, of 1l:ka to• q,iv+r it up or whether they would very saseh 1ike to quit. S.-six perQent of' ®okers would like to quit. !bv sueh mo, you raat to ;:Uit? (Question 43) Yaat to contiaue 31t Sort of like tD quit 32 Qary s~ach like to quit ' 29 LiJc+e to qnit' but can't 5 Ooa't ka,ar,/no answer 3 Smokers dividid thsmselves almost esactly into thirds om the issue, with sookers of 40 cigarettes a day or more vaAtitxy, to eoatinue and to quit in eqnai aubers, saokers of 20' ta+, 39 cigarettes a day •sort of vaatinq to quit' aore, and moderate smokers (10' -19, a day) raritinq mst to quit very such. Light smckers, Iike heavy saokers, Merw ot two s~iZSdis, vatntitaq, to quit and' wanting to continue ia almost equal n=bess. ~. Saokers irantiaq to quit also had read' or beard somethiaq that caused them to wo._ f ~ iore, felt that smkers aze prone to certain illnesses and that any amou*st o? ~ ~ saokinq is hazardous. ~ ~ ~ a-43 . jU ~
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I 0 Elevators; Food markets and supermarkets; (.indbor),Servdce lines; Rest rooms (sometimes "public" onlj); Pharmacies; Buses and!other public transit vehicles and facilities. CAART,V - ENFORCEISNT: ERCEPTIONS: OTHER AREAS AFFECTED HNFORCEMENif: This column, indicates any, special enforcement mechanisms. A' violation, is usually an infraction; this is.true even if' "Infraction" is not specifically shown6 unlessi "misdemeanor" or "none" (inot a violation of law) appears. "Misdemeanor" means any violation is a misdemeanor. Many laws also provide that a, vi'olation ia a public nuisance and allow the city to abate it by the appropriate procedure. "Pub.Nuis." means individuals al'solhave this right. If a particular'of'fice or person!is given enforcement responsibility, that is shown here. "City t'lacager/comp,laint" means any person may initiate aa complaint with the city manager. "Bus.Lic." means compliance is a condition othaving,a business license. Self-certification.of compliance may be requiredc "Bus.Lic.Ren." means it,is required onilicense renewal; "Inspect" means required during otherwise mandated inspection by fire or health department. EXCEPTIONS: "Appl." indicates that an affected,business or facility may apply for a publiic hearing and, upon paying the applicable hearing fees and,making, certain showings which vary from place to p1'ace, may be granted'an exception6 "S3'gr"'indicates that a place may be exempted by posting,.a "smoking permitted" sign. OT}IER AFFEC'IM ARfiAS: Lists other places where smoking is,prohibited. F00'1N0'11F5 T0 CHA'RTS' I' - V + Revised information or new ordinance since~last revdsioniof chart. • Indicates city or county for which: we do not'have complete or most recent information. [1] Smoking prohibited'in all public places and places of employment except in designated smoking areas. Ordinances using,this languagg al'most always contain a list of' specific public places in which a smoking,area may not be designated~ and further restrictions affecting places of employment. [2] County population includes unincorporated:areas onl'y. [3J Year and month.of most recent addition or change. [4'] Exceptionsx Appl. - by application; Sign - by posting a sign. [5] Preference of a majority of'the nonsmokers shall prevail. [6J Workplace minimums are suggested, not required.. [7] If nonsmokers can not be otherwise.accommodated, smoking will be prohibited entirely. [8]! Retail' stores over 1,000 square feet. [9] Violation of the ratailiation, provision is a misdemeanor;,all other violations are infractions. (1i0i] No sections required but policy must be,posted. (I1] Exception can be al'lowed''for, certain places certified as meeting,a specific minimum air, circulation stantard. (121 Smoke free work area must be provided to any employee reques,ting,one im, writing. (13] Smoking is prohibited in all retail,stores, including pharmacies. [14] Smoking prohibited in inner hallh+ays~only,. [15] Private offices may be designated nonsmoking by the occupant. C'-3
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Bibliography on Involuntary Smoking/March, 1986I Baker, R.R. Product formation mechanisms inside a burning cigarette. Prog,. Energy Combustion Sci. 7(2):135-15'3, 1981. Barad, C.B. Smoking on the job: the controversy heats up. Occup. Heal th Saf. . 48 (1)1: 21-241, 1979. Bardana, E.J., Jr. Effect of cigarette smoke on formaldehyde data (letter). J. Occup. Med. 26(6):410-411, 19'84. Barrows, W.R. Smokers', nonsmokers' rights collide in the work envi ron:nent. Occup. Health Saf. 54 ( 2): 31-3'3 , 1985. Basu!, P.K., Pimm, P.E., Shephard, R'.J'., Silverman, F. The effect of cigarette smoke on the human tear film. Can. J. Ophthalmol. 13 (1) : 22-26', 1978. Baumberger, J.P. The amount of smoke produced from, tobacco and i'ts absosptiom, in smoking,as determined by electrical precipitation. J. Pharmacol. Exp. Ther. 21:47-57, 1923. Bausnberger, J.P. The carbon monoxide content of tobacco smoke and its absorption on inhalation. J. Pharmacol. Exp. Thier. 21:23-34', 1923. Baumberger, J.P. The nicotine content of tobacco smoke. J. Pharmacol. Exp. Ther. 21:3I5-46, 1923. Baumgartner, E. Proceedings of the interna ional symposiuaa on medical perspectives on passive smoking; opening address. Prev. Med. 13:558, 1984'. Bavarian, Academy of Occupational and Social Medicine. Passive smoking at work. A survey and analysis from a medical and legal point of view. Munich: Bavarian Academy of Occupational and Social Medicine, 1977. 159 pp,. (German) . Becker, C.G., Dubin, T., Wiedemann, H.P. Hypersensitivity to tobacco antigen. Proc. Natl. Acad. Sci. USA 73(15)r1712-17'16, 1976. Beil, M. Smoking,, chronic airway disease and'lung,cancer. Prax. Pneumol. 29(',7):40'3-412, 1975. Ben Hassine, M.R., Ben Mi1ed', M.T., el Gharbi, T., Bea, Ayed,, N. Passive smoking in asthmatics. Tunis. Med. 62(,3'):251-154, 1984. (French) Benner, J., Keene, C.K., Holt, T.W. Smoke analysis, condensate preparation, and condensate fractionation. In: Proceedingis, 4th Tobacco Health WorkshoplConference. Lexington, Kentucky : Tobacco Health Research Institute, University of Kentucky, 1973. pp. 408- 420. Bennett, J.S. Sic transit non fumare (,ed!itorial). Can. Mied'. D -5
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abbreviations and footnotes have been used extensively. The indicatiow "Yes" in a col'umn,means that smoking,is prohibited or restricted'in the corresponding,place, or that the law contains the corresponding provision. A, blank means that smoking is not regulated,in that place. Abbreviations specific to certainicolumns are explained below. Footnotes appear at the end of this text. CHART II - SUw11ARY,OF MAJOR PROVISIOYS For each city and county with a smoking ordinance, this chart shows whether the law restricts smoking inipri.ate workplaces, in retail stores,,andiin restaurants. This chart is similar to Chart I, but more information is given on the specific restrictions in each place. WORKPLACES RECULATEDs "All" indicates that all private workplaces are required to have a smoking policy. "All 4+" (for example) means that all private employers vithi4 or,more employees are covered. "Ofc." or "Ofc.Wkpl" means that the ordinance covers onIly office workplaces. RETAIL STORES: "Dept." means only department stores are affected. "Ai1Bus" means retail stores and all other'business establishments are affected. RESTAURANTS: Most entries in this coSumn show the minimum percentage of seats required in the nonsmoking,sectibn, and the minimum size of restaurants which are required to have a nonsmoking section. For eiample, "25Z'40,*" means restaurants with 40 or more,seats are required,to have at least 25Z of those seats in a(usual'ly contiguous) nonsmoking section. "NOx" indicates no minimum percentage; often there is a requirement for sufficient,nonsmoking seats to accommodate nonsmokers. If no restaurant size is shown. alll restaurants suat have a nonsmoking section. CHART IIP - SUt44ARY OF WORKPLACE PROVISIONS. This chart lists only those cities and counties with ordinances requiring all or most'employers to have a smoking policy in the workplace. A"Yes° in most col'umns indicates that smoking is prohi'bited in the indicated!area. Other abbreviations: WORKPLACES REGULA'TED: See Chart II above. Cafeteria: An entry in this column indikates the minimum percentage of cafeterias, lunchrooms and (usually) employee lounges required to be nonsmoking. Medicai' Facil.: "Yes" indicates smoking prohibited in medical facilities and' nurses aid stations. Mt¢. Rooms: "Yes" indllcates smoking prohibited in (usually all of)'meeting rooms, conference rooms and auditoriiums. Some ordinances allow for smoking by unanimous consent of'those present. DesiX. OwnArea: "Yes"'indicates that anlempl'oyee,can designate his/her immediate work area as a nonsmoking area6 Nonsmkr Prefnce: "Yes"'indicates that when a dispute arises under the workplace smoking policy, priority must be given to the nonsmokers. Some, ordinances require that,nonsmokers must be satisfied, even if this requires banning,smoking in a work area. Nonretal'n: "Yes" indicates that it is unlawful to dismiss or discriminatee against an employee for requesting,his/her rights under the smoking law. CflART'IV - OTHER PUBLIC PLACES .aF!Fr-C''ED A "Yes" indicates that smoking is prohibited inithe indicated places (abbreviated in column headings)I: Theaters (,sometimes exeepting,the Lobby); Museums, libraries and galleries; Public (i'.e., gavernment)~ meetings; C-2
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BIBLIOGRAPHY ON INVOLUNTARY SMOKING Compiled by Stanton A.~ Glantz and' Lydia Jense~~n. University of California, San Francisco: March, 1'986 Aas, B. Motivating governments to act. In: S'teinfeld, J., Griffiths, Wi., Ball, I+c., Teylor, R.M. (eds.). Smoking,and health II. Health consequences, education, cessation activities, and governmental action. Vol. II. Proceedings of the 3rd'world conference on smoking and'health, New York City, June 2-5, 1975. DHEW Publication No. (NIH) 7'7-1413. pp. 959-963.. Abel, E.L. Smoking and reproductionc an annotated bibliography.. Boca Raton, Florida: CRC Press Inc., 1984. Abelin, T., Winethrich, P. Sample survey of smoking~habits: in the German, Frenoh, and Romansh speaking parts of Switzerland. Soz.. Praventivmed'. 2l1(1)':17=23', 1976. (German) Abelson, P.H. A damaging source of air pollution (editorialY. S'ci~ence 158 ( 38A6Y:1527 , 1967. Adams, J'.D1., LaVoie, E.J., Shigematsu, A., Owens, P., Hoffmann, D., Quinoline and methylquinolines~i'n cig,arette~smoke: coamparative data and the effect of filtration. J. Anal. Toxicol. 7(16),:293-296, November-December 1983. Ad'lkofer, F'., Scherer, G., von Hees, U. Passive smoking ,(,letter). N. Engl. Ji., Med. 31!2(11):719-720, March 14, 1985. Adlkofer, F., Scherer, G'., Heller, W.-D. Hydroxyproli~ne excretion in urine of smokers and passive smokers. Prev. Med. 13:670-679, 1984!. Adlkofer, F., Scherer, G., Wei'mann, H. Small-airways dysfunction in passive smokers (letter),. N. Engl. J. Med. 303(7)r392, 1980. Advisory CounciL on the Environment of Quebec. The use of tobacco in public places and protection of nonsmokers. The Government of Quebec, Publication.No. ISBN 2-550-00193'-I;" May 1979. 28'9 pp. Akh¢neteli, Mi.A. The report of a WHO expert commitee on smoking and its effect on health,. In: Steinfeld, J., Griffiths, Wi., Alarie, Y. Sensory irritation by airborne chemicals. CRC Crit. Rev. Toxicol. 2'( 3 ) : 2'99'-36'3 , 1971.. Alfheim,, I., Ramdahl, T. Contri'butioin oflwood combustion to indoor air pollution as measured by mutaigenicity iin Salmonellal and' polycycl'~ic aro:nati'c hydrocarbon con~centration. Eraviron. Mutagen. 6' ( 2):121, 130, '1984. r J American Academy of~ Pediatrics. Committee,~ on Genet~ics~ and ~i ~. ~ ~ D-1
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0 Bibliography on Involuntary Smoking/March, 1986 Bland, M., Bewley, B.R., Pollard, V., Banks, M.H. Effect of children's and~ pa~rent~~s'~ smok~i~ng,on respirato~ry~syrtptoms~. Ar~ch:. Dis. Child. 53'(2):1O0i-105, 1978'.. Bleda, P.R., Sandman, P.H. In smoke's way: socioemotional reactions to another's smoking. J. Appl. Psychol. 62(4):452-458,. 1977. Blue, J.A. C'igarette asthma and tobacco allergy. Ann. Allergy 2'8(13):110-115, 1970. Biocaneg,ra,~ T.~S'.,, Espinoza, L.R. Raynaudi'~s, ph~en~om~enon~ in passive smokers (letter). N. Engl. Ji. Med. 303(24):1419, 1981. B!ock, F.G., Repace, J.L., and Lowrey, A.H. Nonsmokers and cigarette smoke: a modified perception of risk (letter). Science 215'(,45219),:197, 1982'.- Bogard, H., Shoenfeldi, Y., Pinkhas, J. Passive smoking (editorial). Harefuah C(7):3'45-34'7, 1981. (,Hebrew) Bogen, E. The composition of cigarets and cigaret smoke. JAMA 93(115'):1110-1114, 1929.. Bolin, J.F., Dahms, T.E'., Slavin, R.G. Effects of passive smoking on asthma, (abstract). J1. Allergy C9.in. Immunol. 6'3(3):151-152, 1979. Bonhami, G.H. Fasten your seat belts--no smoking. Br. Columbia Med. J. 1S(14):304-305', 1973. Bonham,, G.S~., Wilson, R.W. Minor error noted in study on child health in smokers' families (,letter). Am. J'. Public Health 72 ( 4 ) : 4!03', 19812. Bonham, G.S., Wilson, R.W. Children's heal'th in families with cigarette smokers. Am. J1. Public Health 71(3):2'90',293, 1981. . Bookman, R. Tobacco sensitivity (letter). Ann. Allergy 46(3):182, 1981. Bos, R.P., Henderson, P.T'. Genotoxic risk of passive smoking. Rev. Environ. Health 4(2):161-178, 1984. Bos, R.P1., Theuws, J.L.G., EBenderson, P.Thi. Excretion of mutagens in human urine after passive smoking,. Cancer Lett. 19(,1Y:85-90,. 1983. Bottoms, S.F., Ruhnert, B.R., Ruhnert, P.M., Reese,, A.Li. Maternal passive smoking and fetal serum thiocyanate levels. Am,. J. Obstet. Gynecol. 144 ( 7 )i:787-7'91', 1982'. Breisacher, PI. Neuropsychological effects of alir pollution. Am. 7 D-7
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Co."JNINITY. Nr. places regulating: Antioch + Berkeley Brea Brentwood! Carlsbad C.rpbnteria + Cathedral City ChulaiVi'sta Clayton Concord' Coronado Cupertino Danville Del Mar El Cajon El Cerrito Escondido + Crand,Terrace Hemet Hercules ++ Huntington Beach Imperial Beach India Irvine La Mesa Lafayette Laguna Beach Livermore Long Beach + Los Altos Los Angeles Los Gatos Martinez + Menlo Park Mili Valley Milpitas Mountain Viiev - Nationail City Nevport'Beach, Oceanside + Orinda Palo Alto Pasadena, Pinoie Pittsburg Poway + Rancho Mirage Richmond Riverside Sacramento San Anselmo San Diego San Francisco San Jose San Luis Oblspo San Marcos San Pablo San Ramon Santa Barbara Santa CLara Santa Monica, Santee Tust3n! Ukiah Vi!sta Walnut Creek Yorba Linda County of Contra Costa County of Marin County of Orange County of'Riversi'de County of Secramento County of San Diego Caunty of,Santa Cruz CHART IV - OTHER PUBLIC PLACES AFFECfED, Thea- Museums Health Public Elevar Food Service Rest Pharma- BusJ ters b,Libr.Fac'Ity, Mtgs» tors' 1Bcts. Lines Rooms cies PubTran 73' 54 73' 67' 71 54 60 58' 45 52' Yes Tes Yes Yes, Yes Yes Yes, Yes~ Yes Yesi Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Tes Yes Yes Yes (1l Yes Yes Yes [1] Yes Yes Yes Yes Yes Yes Yes, Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes (1]'' Yes Tes Tes [I1]' Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yea Yes Yes Yes, Yes Yes Yes Yes Yes Yes Yes Yes Yes (1] Yes Yes Yes (1) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes(13] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Tes [1J Tes Yes Yes (1] Yes Yes Yes Yes Yes Yes Yes Yes Yes -Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes (II] Yes Yes Yes (1]' Yes Yes Yes Yes Yes Yes Yes [1] (1) (1] [1'1 (1] (1] (1) [1') (1] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Tes Yes Yes Yes (1] Yes Yes Yes [1] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes (1]' Yes Yes Yes (1], Yes Yes Yes Yes Yes Yes Yes Y!e.s Yes Yes Yes Tes Yes Yes Yes Yes Yes Yes Yes Yes Yes. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes, Yes Yes Yes Yes Tes Yes Yes 50% Yes Yes' Yes Ies Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Tes Yes Yes Yes Yes Yes Yes Tes Yes 80% ' Yer Yes Yes Yes Yes Yes Yes. Yes Yes Yes Yes Yes Yes Yea Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes, [1] Yes Yes Yes (!1] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Tes (1] Yes Yes Yes (,1] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes [1] Yes Yes Yes (1j Yes Yes Yes Yes Yes [I1] Yes (1)I Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Ies Yea Yes Yes Yes Tea Yes Yes Tes Yes Yes Yes Yes 1/3 Yes Yes Yes Yes Yes Yes [1] Yes Yes Yes [1] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes, Yes Yes Yes Yes (1] Yes Yes Yes [1] Yes Yes Yes Yes Tes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes. Yes Yes Yes Tes. Yes Yes Yes Yes Yes Yesi Yes Yes (1] Yes Yes Yes [11 Tes Yes Yes [ 1'] (1) (1] (1'] (ll [i1l [1] (1'1 [i'1 (1l1 Yes Yes Yes Yes Yes Yes, Yes Yes Yes Yes Yes Yes [I] Yes Yes Yes (1!] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yiesi Yes. Yes Yes Yes Yes Yesi Yes Yes Yes, Yes Yes Yes, Yes Yes Yes, [1] Yes Yes Yes [',ll Yes' Yes Yes. Yes Yes Yes Yes Yes Yes Yes C-7
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CALIFORNIA CITY A'ND COUNTY SMOKIYG OP:DINANCES Americans for'Nonsmokers' Rights 2054 University Avenue, Suite 500 Berkeley, CA'94704 (415) 841-31032 March 1, 1986 SUMMARY This set of charts summarizes the provisions of the significant city and county smoking,ordinances in Californ2a. State law regulates smoking,in supermarkets. health facilities, and public meetings: (Sqx nonsmoking) and'certain, parts of publicly owned buildings. Most localities regulate smoking in theaters. Many communities have enacted far stronger smokinglaws. To be incLuded in this compilation, an ordinance must affect either private workplaces, restaurants, or a substantial numberof significant public places. Among California cities and counties.atleast 74 cities and counties have asignificant nonsmoker protection law. 66 regulate smoking iniprivate workplaces. 62 require nonsmok4.ngsections in restaurants. 54 restrict smoking in retail stores. 44x ofthe population ofCal'i'fornia (11,296I,065 people) lives in a place where a smoking policy is required of private employers. We say "at least" because ordinances are now being enacted at the rate of severalia month. In additionto the jurisdictions counted'above, 6 counties have laws protecting only county, gpvernment employees. They are: Fresno County Lake County IasiAngeles County Monterre7, County, Orange County (also has publicplacesIaw) Yolo County (by resolution) '141E CHARTS I Five chartsare provided. They are: I' Cities and Counties with Ordinances III Summary of Major Provisions III, Workplace Provisimns IV Other Public Places V Enforcement; Exceptions; Other Places A Q!?ICL REFERENCE Chart I is; the "quick reference" for California,smoking ordlLnances. It lists all counties and cities with significant smoking,laws. It,shows population, county,and year and month (when known) of enactment of the most recent ordinance. It also tells whether the lav regulates smokingfor restaurantsy private employers and retail stores. MORE DETAILS Charts IIthrough V contain details of each smoking law. In, order to condense agreat deal of information into a small space, C'-1.
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C CHART I: CALIFORNIA CIT'IES'AND COUNTIES WIITH SMOKING ORDINANCES COMMUNITY COUNTY POPULATION YSvtR/`lONTH PRIVATE RESTAURANTS RETAIL E."IACTED WORKPLACES STORES Nr. places regulating: 74 66 68 56 Anti'och Contra Costa 46,600 1985/11 Yes~ Yes: Yes + BerkeLey Alameda 106.500 1980 Yes~ Yes Yes Brea Orange 32,050 1985/07 Yes Brentwood Contra Costa 5,,150: 1'985/1'1, Yes Yes Yes Carlsbad San Diego 44,550 1'983/06 Yes Yes Yes Carpinteria Santa Barbara 11,400 1985/03 Yes + CathedraliCity' Riverside 16i,050, 1982/12 Chu1a Vista San Diego 90,300 1984 Yes Yes Yes Clayton Contra Costa 4,490 1985/11 Yes Yes Yes Concard' Contra Costa 105,000 1985/11 Yes Yes Yes Coronado San Diego 90,300 1984/08' Yes Yes Yes Cupertino Santa Clara 33,950 198'5/02I Yes Yesi Yes Danvi!11e. Contra Costa 27,600 1985/11 Yes Yes Yes, Del Nlar San Diego. 5,125 1983/06 Yes Yes Yes~ E1,Cajon San Diego 80,1100 1985 Yes Yes Yes El Cerrito, Contra Costa 23,300 1'985i/'lli' Yes Yes Yes Escondido San Diego 75,800 1'983112 Yes Yes Yes +.Grand Terrace San Bernardino 9,875 1'985/11 Yes Yes Yes Hemet Riverside 28,050 1985/05 Yes Yes Yes Hercurles Contra Costa 7,$00' 1985/10 Yes Yes Yes +*~Huatington Beach Orange 179,900 1986/02 Yes Yes Imperial Beach San Diego 24,550 1985/10 Yes Yes Yes Indio Riverside 28',200 1985/11, Yes Yes Yes Irvine, Orange 80,100 1985/10 Yes La' Itlesa San Diego 52,200 1984/02' Yes Yes Yes Lafayette Contra Costa 22,500 1985/10 Yes Yes: Yes Laguna Beach Orange 18,450 1985 Yes: Yes Livermore Alameda 52,100 1985/06 Yes Yes Yes Long, Beach Los Angeles 3811,800 1985/07 Yes Yes + Los Altos Santa Clara 27,400. 1'979 Yes Yes Yes Los Angeles Los Angeles 3',144,800 1984/11 Yes I:os' Gatos Santa Clara' 27„750' 1'980i/06 Yes Yes Yes Martinez Contra Costa 25,300~ 1!985/11 Yes Yes Yes + Menlo Park San Mateo 27,850, 1986/02 Yes Mill Vailey Harin 12,800 1982 Yes Mi'lp,itas Santa Clara 41,850 1985/08 Yes Yes Yes Mountain View SantaiClara 61,600 1984/06 Yes Yes Yes National City San Diego 51,200 1984/05' Yes Yes Yes Newport Beach Orange 66.100 1985/06 Yes Yes Oceanside San Diego 91,800 1983 Yes Yes Yes +-0rinda Contra Costa 15,000 1985/12 Yes~ Yes Yes Palo Alto Santa Clara 56,200 1983/i0, Yes: Yes Pasadena Los Angeles 126,600 1'984 Yes Yes Pinole Contra Costa 14,550 1985/1'11 Yes Yes Yes Pittsburg. Contra Costa 38,600 1'985/11i Yes Yes Yes ~ Poway San Diego 35.950: 1983/03 Yes Yes Yes + Rancho Mirage Riverside 7,575 1986/02 Yes Yes Yes Richmond Contra Costa 76.900' 1985i!09 Yes Yes Yes Riverside Riverside 1!83',400 1985/05: Yes Yes Yes Sacramento Sacramento 875,900 1985 Yes Yes Yes San Anselmo Marin 11,950 1985? San Diego San,Diego 971,600 1982/12' Yes Yes Yes San Francisco San Francisco~ 719;200 1983/11 Yes San Jose Santa C1ara 696,000 1984 Yes Yies, Yes San Luis Obispo S.Luis Obispo 37,150 198'5/1'2' Yes: Yes~ San Marcos San Diego 19,800 1983/03 Yes Yes Yes San Pablo Contra Costa 211,200 1985/10 Yes Yes Yesi San Ramon Contra Costa 23,450 1,985/'111~ Yes Yes Yes: Santa Barbara Santa Barbara 327,200. 1'984 Yes Yes ~J Santa Clara Santa Clara 89„000: 1'985/07 Yes Yes Yes Santa ttlonica Los Angeles 93,1'00: 1'985/04' Yes Santee San Diego 49,500, 1983/02 Yes Yes Yes Tustin Orange 40,800 1985/12 Yes Yes Yes Vf Ukiah Mend'ocino 13',050 1981/07 Yes Yes Yes ~ Vista San,D'ieg!o 43,450 1983/04 Yes Yes Yes VJ Walnut Creek Contra Costa 57,700 1985/11 Yes Yes Yes ~ Yorb'a Linda Orange 36,100 1985/09 Yes Yes Yes ~ County of Contra Costa [2] 139',800 1985/09 Yes Yes Yes County of 5larin (2] 62,500 1981/07 Yes Yes County of Orange (2] 294,900 1985/06 Yes: Yes /!+ Count'y, of Riverside [2] 323.500 1985 Yes Yes Yes. un County oflSacramento [2] 543,,500 1985/02, Yes: Yes Yes County of San Diego [2] 406,1100 1982/12 Yes Yes Yes County of Santa Cruz [2] 121!,300. 1985 Yes, Yes Yes C-4
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Bibliography on Involuntary Smoking/Mar..ch, 19'86 Respiratory effects of household exposures to tobacco smoke and gas cooking. Am. Rev. Respir. Dis. 124(2):143-14'8, 1981. Commission of the European Communities. Report on the EC epidemiological survey on, the relationship between air pollution and respiratory health in primary school children. Blrussels: Commission of the European Communities, Environmental Research .. Programme, December 1983, pp. 215. Consentino, A.M. Environmental tobacco smoke and pulmonary function testing. Eur. J'. Respir. Dis. (Suppl.] 133:88-89, 19'84. Consumer Reports. The murky hazards of secondi-hand smoke. Consumers Reports pp. 81-84, February 1985. Conti, R., Fagioli, F., Pasquini!, R., Savino, A., S'icassellati Sforzoliini, G. Application of' the salmonella mi~crosome test' i,n the evaluation of the mutagenic activity ofl cigarette ssaoker the difference between sidestreamiand mainstream smoke. Ig. Mod. 73 (1) :10-27, 19801. Coodley, A. Effects of passive smoking (lietterY. N. Enlgl. J. Meld. 299 (16 1: 89'T, 19781. Copeland, G.K.E., Stockwell, P.B. Automatic large-scale analysis of cigarette smoke. In: Foreman, J.R., Stockwell, P.B., (eds.) Topics in automatic chemical analysis. Chichester, Eng. : Ellis Horwood, 1979; New York : Halsted Press, 1979. CCormia, F'.E., die Gara, P.F. Vesic'ulobullous diermatitils from tobacco smoke. JAMA 193(5):391-39'2, 1965.. Corn, M. Characteristics of tobacco sidestream smoke and factorss influencing its concentration and distribution in occupied spaces. Scand. Ji. Respir. Dis. SUppl. 91:21-36, 1974. Correa, P'., Pickle, L.W., Fontham, E., Lin, Y., Haienszel, W. Passive smoking and 1'ung cancer. Lancet 2(8350):5'95'-597, 1983. Cousin, Mi., Budwig, J. The smoke-containing atmos'phere or the smoke of others. Rehabilitation (Bonn) 25(11):34-3!6, 1972. (French) Cox, B.D., Whichelow, Mi.J. Carbon monoxide levels in the breath of smokers and' nonsmokers: effect of do:nestic heating sytems. J. Epidemiol. Community Health 3'9:75-78, 1985. Cross, F'.T'. Radioactivity in cigarette smoke issue. Health, Physics 48(1):20'5-208', 1984. Cucu, F. Carbon monoxilde and its implications in atherosclerosi!s ~ O etiopat}trogeny. Med. Interne 16(3):229-242, 1978. C!1 13 ~' N ~. ~ D-13
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0 ' Sr.du'st-v L•save 7be laiaqo of' the tobacco indust.-y c»ntismues to deelirse arad its favor- ability rating is aow at the lowest point re hav+e yet mea.sured. Starting i'n 19+68, !tlisn cigarette sasaafactttrars were aakiaq a'deoidied'ly positive impressioa on t2se pub7:io, t3vr trand' has sloped dowravs,:dl,,, until our last stady, vdaen the bal.anee turned' iy.q;ttive. W+r, in this report, tbe original position in 19b8' is a.Iimost exactly za- Ti~cssd. , Tbe Tcbacco Industry (Question 73) . _ 1978 t 1976' 1974 1972. 1970 19'6e • s savorable 36 43 • 47' 47 • s8 51 Dalavcraale 51 48 45 42 42 37 Don't tnoer,/no answer 23 20 8 22 1m~ 11 tatiarab3lity index 42 dS 47 48 49 51 ''fhe faworability l:ndex is perhaPs a little mors sensitive toehadings of feelirqs *SOd is oosPutad' by giving 'vR.Ty favorable'' a rating of 100, 'moderately favorabl'e• a rating of 66 2/3rds, `tWt very favorable• a saore •af 33 1f3, and 'nc: at all favorab3,e'' a sero. Zhe favorability index among; smnke=s is 54 and among aon-smokers 35. Sbe sub9tatstia2 dzop in favorability between 1978 and 1976 is part of a qeneral' imaqK dlsalisye amoag controaersial' indiastries. Placing the public attitudle tovasd the tobaea industry in ooatext,, we have asked respondents their impression of bow Jatssestsd' a few mrjor ibdsastries are ia the safety and welfare of tbe people mt,c nss tbeir'products or services. A-50
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Bibliography on Involuntary Simoking/Marchi, 1986 19 8 3' . Frisch, A.F., Francis, B.W., Chavis, M.K., Jenkins, R.W., Jr.. Cigarette smoke formation studies. VI-I. The fate of (5-14C)- Methoprene in ci'garette smoke. Bei!tr. Tabakforsch. Int. 11(4):203_ 206, 1982. F'rishman, W.H. Involuntary smoking: Cardiovascular effects of'. smoke on nonsmokets. Cardiovasc. Med. 4(13):28'9-292, 1979. Fulghum, Ji.E., Mitchell, R.Bl. Does my smoking bother you? It doesn't bother me as muchl as it is going to bother you. J. Fla.. Med. Assoc. 60(7'):91, 1973. Fulton, H.B. Jr. A pilot's guide to cabin ai!r quality and fire safety. NY State J. Med. 85(7'):184-38'8,, 1985. Gallup Opinon Index. Smoking in America: publi~c attitudes and behavior. Gallup Opinion Index 1978; 155:1-30, June 1978. Galuski'nova, V. 3, 4-Benzpyrene determination iin the smoky atmosphere of social meeting rooms and restaurants. A contribution to the problem of the noxiousness of so-called passive smoking. Neoplasma 11('5'):465-468I, 1964. Garfinkel, L., Auerbach, 0., Joubert, Li. Involuntary smoking and lung cancer: a case-control study. JNCI' 75'( 3')i:463-4'69, 1985. Garfinkel, L. Passive smoking and cancer--American, experiEnce. Prev. Med'. 13:691'-b]'9, 1984.. Garfinkel, L. Let us not be diverted! from the real problem. MW 123'(,40):1483-1484, 1981. (German). Garfinkel, L. Time trends in lung cancer mortality among, nonsmokers and a note on, passive smoking. JNCI 66(61)1:1061-1066,. 198'1. Garfinkel, L. Cancer mortality in nonsmokers: Prospective study by the American Cancer Society. JNCI 65:1169-117'3, 198,0. Garland, C., Bairrett-Connor, E; Suarez,, L., Criqui, M.H., Wingaird,. DL. Effects of passive smoking on ischemic heart disease mortality of nonsmokers. A prospective study. Am. J!. Epidmiol. 121(5):645- 650, 1985. Garrett, R.J.B., Jackson, M.A. Cigarette smoke and protein synthesis in the lung,. Environ. Resi. 2'1(2):399-406', 1980. GASP. Passive smoking: the facts. Bristol : Avon Area Healtli. Authority Education Service, 19'81. N Gavalov, S.Ml., Demchenko, A.E., Kaznachleeva, L.F., Gorshkova, N.F.R ~ 19 ~ ~ ~ N ~'. 4CO . D-L9
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Bibliography on Involuntary Smoking/March, 1986 Environmental Hazards. The environmental consequences of tobacco, smoking: implications for public policies that affect the health of children. Pediatrics 7'0(',2):314-31'5, 1982. American Conference of Governmental Indiustrial' Hygienists. Threshold'liimit values for chemical substances and physical agents. in the workroom environment. Cincinnati : American Conference of Governmental Industrial Hygienists, 1981. American Conference of Government Indlustrial Hygienists. TLVs(IR)) thresholdil!imit values for chemical substances in workroom air adopted by the Ameriean Conference oflGovernment Industrial Hygienists for 19731. J. Occupi. Medi. 16 (i1) :39-49, 1974. American Society of'Heating, Refrigeration and Ventilation Engineers. Standards for natural and'mechanical ventilation.. ASHRAE Standard 62, New York, NY., 1973. Amindzhanov, S.A., Achilova, A.B., Rybin, I.S. Cigarette smoking and gastric functions (secretion and motility) in duodenal ulcer and some other diseases of the digestive organs. Ter. Arkh. 52(2):36'-3'9, 19'801. (Russian) Anderson, E.W., Andelman, R.J., Strauch,, J.M'., Fortuin,N.Ji., Knel'soni, Ji.H1. Effect of low-level carbon monoxide exposure on, onset and duration of angina pectoris. Ann. Intern. Med. 79'(1):46- 60, 1973. Anderson, G., Dalhamn, T. The risks to health of gass:!ve smoking. Lakartidningen 70, (',3'3):28I33'-2836, 1973'. (Swedish). Andren, A.W., Harri!ss, R.C'. Mercury content of tobaccos. Environ. Lett. 1(4):231-234!, 1971. Andresen, B.D., Ng, K.J., Iams, J.D., Bi!anchi'ne,, J.R. Cotinine in amniotic fluids from passive smokers (letter). Lancet 1(8275'):7911- 792', 1982. Anglenot, L. Chemical composition of tobacco smoke. J. Pharm. Belg. 38'( 31:172-180, 1981- ( French). Anglenot, L. Chemical composition of tobacco smoke. Rev. Med.. Liege 38'(17 )':632-6'40, 1983. ( F'renich ) Arany, S., Makleit, S., Szigeti, K. Analysis of'the physiologically active compounds in cigaret smoke. Dohanyipair (3):100-1013, 1983. (Hungiarian) Aronow, W.S. Effect of' carbon monoxide on cardiovascular disease. Prev. Med. 8( 3):27'1-278, 1979. Aronow, W.S. Effects of passive smoking (letter). N'. Engl. J. Med. 299(1i6'):897, 1978. 2. e C D-2
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Bibliography on Involuntary Smoking/Marchi, 1986 Patrikeeva, I4.Mi. Passive tobacco smoking andi the incidence of bronchopulmonary pathology in children. Pediatriia (1) :32-34, 198'4. (Russian) Germouty, J, Malau'zat, C. The innocent victims of tobacco. Ji. Med. Chir. Pratiques 155(6'-7'):2'93-298, 19'84. (French) Gilder, S.S.B. The passive smoker. Can. Medi. Assoc. J. 109(11):,1084 and 1089, 1973. Gillis, C.R., Hole, D.J., Hawthorne, V.M., Boyle, P. The effect off environmental tobacco smoke in two urban communities in the west of Scotland. Eur.,J. Respir. D'is [Supplj 133:121-126, 1984. Glantz, S.A. What to do because evidence links involuntary (passive) smoking with lung cancer. West. J. Med. 140:636-637, 19'84. Glaatz, S.A. Health effects of ambient tobacco smoke In Indoor Air Quality. Walsh, P.J., Dudney, C.S. (ediltors) Boca Raton, Florida: CRC Press, 1984. Gliner, J.A., Raven, P'.8., Horvath, S.M., Drinkwater, B.L., Sutton, J.C. Man's physiologic response to long-term work during, thermal and pollutant stress. J. App1. Physiol. 3'9(4):628-632, 1975. Godin, G., Wright, G., Shephard, R.J. Urban exposure to carbon monoxide. Arch,. Environ. Health 25(5):305-313, 1'972'.. Gberth, C.R. Economics and court decisions leading to smoke-free workplace. Occup. Health,Saf. 53'(7):2'4, 27, 1984. Gordon, Guyatt H. and Newhouse, Michael T. Are active andi passive smoking harmful? Chest 88:3', September 1965. Gorski, T'. Pressence of polychlorinated dibenzo-P-dioxins CPCDDs) and polychlorinated dibenzofurans (PCDFs) in cigarette ash and pharmaceutical charcoal. Rocz. Panstw. Zakl. Hig. 3'5(13):2'39-241, 1984'. Gortmaker, S'.L,., Walker, D.K., Jacobs, F.H., Ruch-Ross, H. Parental smoking and the risk of childhood asthma. Am. J. Public Health 7'2 ( 6): 57'4-579, 198'2. Gostomzyk, Hi.-G. After all--is passive smoking not dangerous? MMW 1261(42):21-22, 1984. (German) Gostomzyk, H.-G. Sickness as a result of passive smoking?' (letter) MMW 124(4):11, 1982. (,German) Gosto:nzyk, .7.G'., Franck, R. Passive smoking from the medical viewpoint--results of a discussion among experts. Off. 20, c (I r D-20
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:.~..J+.......:._..-._..~r+i::r.~ ~ .~~._r.. ~ _ -. . _ ~ - . . .. ~ CHART III: StiMt`4A'RY OF WORKPLACE PROVISIONS ` ' CO'L"ft3NITY' WORRPLACES Cafe- Rest Eleva-Medical Mtg. Hal1- Desig. Nonsmkr Nonre- REGULA'TED teria Rooms tors Facil. Rooms Ways OvnAreaPreface tal'w Nr. places regulating: 67 42 56 57 40 54 38' 40 43 25 Antioch All 4+ 40% Yes Yes Yes Yes Yes Yes Yes Yes + Berkeley A11 50% Yes Yes Yes Yes Yea Yes Tes Yes Brea Brentwood' All 4+ 40% Yes Yes Tes Yes Yes Yes Yes Yes Carlsbad A'1'1 (1]I Yes Yes Yes Carpinteria A'll (5i' + Cathedral City Ctiwia Vista , A,11 (1] Yes Yes Yes Clayton All 4+ 40% ' Yes Yes Yes Yes Yes Yes Yes Yes Concord All 4+ Coronado All [1'] 4Dw Yes Yes Yes, Yes Yes Yea Yes Yes Yes Yes Yes Cupertino Ofc.Wkpl. 2/3 Yes Yes Yes Yes Yes Yes Yes Danville A11,4+ 40% Yes Yes Yes Yes Yes Yes Yes Yes Dei!Msr All (1j Yes Yes Yes E2'Ca,ion All 5+ 2/3 Yes Yes Yes El Cerrito All 4+ 40R Yes Yes Yes Yes Yes Yes Yes Yes Escondido All (I 1]' Yes Yes Yes + Grand Terrace All [61 50Z Yes Yes Yes Yes Yes Yes Yes C Hemet A,11! (11 Hercules A11'4+ 40Z' Yes, Yes Y!es' Yes Yes Yes Yes Yes +; Huntington Beach All 4+ Yes Yes Imperial Beach A11 (1] Yes Yes Yes Indio A11 (6'] 502 Yes Yes Yes Yes Yes Yes Yes Irvine La Mesai A11 [1] Yes Yes Yes Lafayette All 4+ 40% Yes Yes Yes Yes Yes Yes Yes Yes Laguna Beach Ofc.Srkpl'. 1/2 Yes Tes Yes Yes Yes Yes Yes Livermore All 50% Yes Yes Yes Yes Yes Yes Yes Yes Long Beach All 5+ 1/2 Yes Yes Yes Yes Yes Yes Yes + Los Altos All Los Angeles, AQl' 5+ 2/3' Yes Yes Yes Yes Los Gatos All Martinez A11'4+ 40% ' Yes Yes Yes Yes Yes Yes Yes Yes + Menlo Park Mill Valle7 Milpitas • Aa'1, 75x Yes Tes Yes Yes Yes Yes Yes Mountain View A11' 1/2 Yes Yes Yes Yes Yes Yes Yes National CitY, All [1] Yes Yes Yes Newport Beach Ofc. > 4 Yes Oceanside A11,[1] Yes Yes Yes + Orinda, All 4+ 40% Yes Yes Yes Yes Yes Yes Yes Yes. Palo Alto Ofc.Wkp1. 2/3 Yes Yes Yes Yes Yes Yes Yes Pasadena Ofc.Wkp1. 50% Yes Yes Yes Yes Yes Yes Yes Pinole All 4+ 40S Yes Yes Yes Yes Yes Yes Yes Yes. Pittsburg, A'll, 4+ 40% Yes Yes Yes Yes Yes Yes Yes Yes. Po.ray All' [11 Yes Yes Yes + Rancho Mirage All'[1] Yes Richsond All 4+ 402 ' Yes Tes Tes Yes Yes Yes Yes Yes Riverside A11 [6] 507. Yes Yes Yes Yes Yes Yes Yes Sacramento All [1] 1/2 Yes Yes Yes Yes Yes Yes San, Anselbo San,Diiego All [1!] Tes Yes Tes SaniFrancisco Ofc.Wicpl. [71 (7) (7) [71. [7']I [7l [7'] Yes(7] San ./ose All 2/3 Yes Yes Yes Yes Yes Yes Yes San Luis Obispo All 5+f [7] (7') (7) [7J (7'j [7] [7] Yes[7] San Marcos All [1], Yes Yes Yes San Pablo All 4+ 401. Yes Yes Yes Yes Yes Yes Yes Yes San Ramon, All 4+ 40: Yes Yes Yes Yes Yes Yes Yes Yes Santa Barbara All [7)I [l]I [7]I [ 7]I [7j [7] ('7jl Yes[7jl Santa Clara All 2/3' Yes Yes Yes Yes Yes Yes Santa Monica All 6+ Santee A11, ('1] 2/3' Yes Yes Yes Yes Yes Yes Yes N Tustiln Alli [1] Ukiah A'l'l (1Z] [,1'2] Vista All [1] Yes Yes Yes Vl 'Walnut Creek, All 4+ 4,0% Yes Yes Yes Yes Yes Yes Yes Yes ~ Yorba Linda All 11+ 50% Yes Yes Yes Yes Yes Yes Yes VM , County of ContralCosta All 4+ 40Z Yes Yes Yes Yes Yes Yes Yes Yes W County of Mar,in ' A ~ County of Orange Co.Gov[1i1 County of Riiverside All,[6'J 501. Yes Yes Yes Yea Yes Yes Yes County of Sacramento All (1J, 1/2 Yes Yes Yes Yes Yes Yes W1 A11 (1] County of' San Die Yes Yes Yes Q , , , go County of'Santa C'ruz All 50Z Yes Yes Yes Yes Yes Yes Yes Yes C-6
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Bibliography on -Involuntary Smoking/March, 1986 Doyle, N.C'. Pipe & cigar smoking--is it safe? Am. Lung Assoc. '. Bull. 60 ( 2 ) :12-13, 1974. Dri, E.A., Cheddie, M. Substance abuse and the prenatal employee: A nursing diagnosis perspective. Occup. Health Nurs. 32(9):485- 488, 497, 1984. Dubli~n, W.B. Unwilling s:noking, ('letter)'. Calif. Med. 117(1):7'6- 7'7, 1972. Duncan, D. B. , Greaney, PI. P'. Passive smoking and' uptake of' carbon monoxide in flight attendants (letter). JAMA 251(2'0):2658-26I59, 198'4. Dutau, G., Corberand, J., Leophonte, P., Roichiccioli, P. Respiratory signs linkedi to passive inhalation of tobacco smoke in infants. Poumon Coeur 3'5(2):63-69, 1979. (French) Dutau, G., Corberand, J., Enij'aume, C., Rochiccioli, P. Passive inhalation of tobacco smoke in, preschool children. Clinical andd biological study. Rev. Ft. Mal. Respir. 6:549-553, 1978. Dutau, G., Corberand, J'. Respiratory manifestati'ons in the preschool child caused by the passive inhalation of cigarette smoke. Rev. Med. Toulouse 14:28'3-289, 1978. Dutau, G'., Enjaume, C., Petrus, M., Darcos, P., Demeurisse, P., Rochiccioli, P. Epidemiology of passive smoking of children from 00 to 6 years. Arch. Fr. Pediatr. 38(9f:7'21-72'5, 1981. (French) Ecanow, B., Blake, M'.I. The hazards of particulates in tobacco smoke. N. Engl. J. Med. 2'99(25):1415', 1978. Ekwo, E.E., Weinberger, M.M., Lachenbruch, P.A., Huntley, W.H. Relationship of parental smoking and gas cooking to respiratory disease in, children. Chest 8'4(6):662-668, 1983. EElliott, L.P., Rowe, D.R. Air quality during, public gatherings. J. Air Pollut. Control Assoc. 25(6):635-636, 197'5. Ellis, E.F. Asthma in childhood. J. Allergy C1ini. Immunol. 7'2(5 Pt 2):526-539, 1983. Eng, Wi.G. Survey on eye comfort in aircraft: I. Flight attendants. Aviat. Space Environ. Med. 50(4):401-404', 1979. Enstrom, J.E. Risingilung cancer mortality among nonsmokers. JNCI 62(4):755-760, 1979.. Enstrom, J.E. and Godley, F.H. Caner mortality among a representative sample of nonsmokers in the UnitediStates during, C r 1966-68. JNC'I' 65:117'5-1183, 1980. ~ ~ ~ ~ 16' N ~ ~
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Thr, 3;over Zb Ssx . Tycation is oae of th-e aore rigorcus fo=s of' gRve:rrsnent control a:ad 2ias 1009 been recogatsed' as ao effactive Way to emoawrage sccia1 objectives. And' for. & q,rarirsq' =zmber of Americans, the tax power, is maw being seen as a way to =*- duc+e cigarette amokirq. f laise riqarette tax to cut mm0king, (+QSestion 24g) Total fackers 1bn-sa+okers: 1978' 1976 1978 1976 197'B 1916' ...._ .__.. ~..._, . igzse 32, 33 16 12' SiD 46 Disagree S4 61 78' 83 40 48 D©a"t knov/oo asswer, d 6' 6 S' 10 6 It is perhaps instzvctive that the incrsase of seAtiMesst in favor of taxes to stop rmokiAg i:s fcund' not only among eaon-smnke.r s Dtirt also asor,g smokers, even though their~ aumber,s~ areaot~ la:,ge., 7ndi amecag~ oen-smo kers~ fo=~ the~ f,is~st~~ t,imey there~ isa sajority sesati:®ent in fa~ or of' cigarette tax lnereases to force smokrss to quit. Whether ot aot such taxes accompli'sh their purposes is arguable. Bo: Lhcse is a suggestion that this eould be so. We asked ssaokers if they would con- tistn+s to smoke despite three separate cigarette tax izereases. 9;irsety-thr.e per- Cssat told us they would continue to smnke aftsr a hypot2oetical tax rise of five cents per pack. S;iacty-three percent said tAey would sti12 be smokYrg after a: fifty am't' tax ineraase. Snd fos'ty-,one percent of all smoke:s said' they vosild' remai.n smekers if the tax went up by ons dollar a. pack. i.okers eontiming, to smoke aftaz a.tax increase of.... (Question 53? ?i.e cents: tittv crnts One dall,a: ~ Q e ri Light saooDuezs 92 51 35 ~ lka,dexats smokers 87 53 33 ~ ' ~ 20 - 39 a,day 95 65 42 ~ 40 or siaze 1!04 42 64 QGO !'1 62' 41 A-24
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Bibliography on Involuntary Smoking/March~, 1986 Assoc. J. 115( 91) :836 and 838, 197'6'. Bennett, W. The nicotine fix. RZ Med'. Ji. 66 ( L1) :455-45,8, 1983'. Bense, T., Gastellu, C. Estimation of total volatile bases in tobacco by near infrared (NIR) reflectance of spectrophotometry. Tob. Iint. 185(15):183-1851, 1983. Bentley, H'.R., Berry, E.G.N. The constituents of tobacco smoke: an annotated bibliography. Tobacco Manufacturers' Standing Committee,. Research Papers No. 3, London, England, 1959. Berggreen, S. Parental smoking at home and height of children (letter). Br. Med. J. 283(,6306):1612, 1981. Bergman, A.B., Wiesner, L.A. Relationship of passive cigarette- smoking to sudden infant death syndrome. Pediatrics 58(5):66'5-66'8, 1976. Bergman, H., Axelson, 0. Passive smoking,and'indoor radon daughter concentrations (letter). Lancet 2(',8'362):13'08-L309, 1983. . Berkey, C.S., Ware, J.H., Speizer, F.E., Dockery, D1.W'., Ferris, B.G., Jr. FEV1 growth tate of'preadolescent children and passive smoking (abstract). Am. Rev. Riespir. Dis. 129(4 Pt 2):A14A, 1984. Berkey, G.S., Ware, J.H., Speizer, F.E., Ferris, B.G., Jr. Passive smoking and height growth, of preadolescent children. Int. J. Epidemiol. 13'( 4 ) :4'54-4518, 1i9'84. Berkowitz, S. Smoking and asthmal(',letter). Pediatrics 76(4):6514- 655, 1985. Bernal-Mad'razo, Mi.A., Ham-Carrillo, M.S. Effect of tobacco onithe imaaune system. I. Production of' the cell' migration inhibition factor in the presence of' tobacco extract as an antigen in smokers and non-smokers. Gaic. Med. Mex. 117(10):412-414,, 1'981. (Spanish) Beske, F. Recommendations on governmental social action: governmental programs. In: Steinfeld, J., Griffiths, W., Ball, K., Taylor, R.M. (eds.). Smoking and health, I,I. Health consequences, education, cessation activities, and governmental action. Vol. II. Proceedings of the 3rd world conference on smoking and health, New York City, June 2-5, 19'75. DHEW Publication No. (NIH) 77-1413. pp. 953-957. Binder, R.E., Mitchell, C.A., Hosein, H.R., Bouihuys, A. Importance of the indbor environment i~n air pollution exposure. Arch. Environ. Health 31(16):277-279, 1976. Black, N. The aetiology of glue ear--a case-control study. Int. J. Pediatr. Otorhiinolaryngol. 9( 2')1:121-133, 1985. 6 N O ~ ~ ~. OPh ~ 0 f C
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Bibliography on Involuntary Smoking/March, 1986 Aronow, Wi.S. Effect of passive smoking on angina pectoris. N. Engl. J. Med. 299(',1):21-24, 1978. Aronow, Wi.S. Effect of cigarette smoking and of carbon monoxide on coronary heart disease. Chest 70(4):514-518, 1976. Arono!w, W.S. Effect oflpassive smoking, on the cardiovascular and respiratory systems. In: Steinfeld, J., Griffiths, W., Ball, K., Taylor, R.M. (eds.). Srnoking and health II. Health consequences,, education, cessation activities, and governmental actilon. Vol. I'I. Proceedings ofl the 3rd world conference on smoking and! health, New York City, June 2-5, 1975. DHEW Publication No. (NIH) 77-1413. ppi. 883-89~0. Aronow, W.S. Tobacco and the heart. JAMA 22'9(13):1799-180'0, 1974. Aronow, W'.S. Smoking, carbon monoxide, and coronary heart disease ( ed'itorial f. Ci rculati'on 48'( 6') :1169-1172, 1973. Aronow, W.S., Cassidy, J. Effect of carbon monoxide on maximal treadmill exercise. A study in normal persons. Ann. Intern. Med. 83( 4) :4916-499, 1975. Aronow, W.S., Isbell, Mi.W1. Carbon monoxide effect on exercise induced angina pectoris. Ann. Intern. Med'. 7'9:3'92-395, 1973. Aronow, W.S., Kaplan, Mi.A., Jacob, D. Tobacco: a precipitatingg factor in angina pectoris. Ann. Intern Med. 117:2'69-80, 19'83'. Aronow, W.S., Stemmer, E.A., Isabell, M.W'. Effect of carbon monoxide exposure on intermittent claudication. CircuSation. 4'9 : 415-4'17', 1974. Artho, A., Koch, R. Characterization of the olfactory properties of cigarette smoke components. Ann. Tabac (Section 1-11):3'7-45,. 1973. ( F'rench ) Asano, M. Physiology and hygiene of smoking. 17. In vivo effects of passive smoking (4). Ilts relationship to lung cancer. Kango!gaku Zasshi 4'6(12):1413-1416, 198'2. (Japanese) Asano, M. Physiology and hygiene of'smoking. 16. In vivo effects of passive smoking (3): chronic effects on children. Kango!gaku Ziasshi 4'6(11):1293-1296, 1982. (Japanese) Asano, M. Physiology and hygiene of smoking. 15. In vivo effects of'passive smoking (2): on acute objective effects. Kangiog,aku Zasshi 416(10):1173-1176, 1982. (Japanese) Asano, M. Physiology and hygiene related to smoking,. 14. Physiological effects of passive smoking. (1)1: on acute effects. Kangogaku Zasshi 46(9):1053-1056, 1982. (Japanese), 3 D-3
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Bibliography on Involuntary Sknoking/March,, 1986 Hirayam&, T'. Cancer mortality in nonsmoking women with smoking husbands based on a large-scale cohort study in Japan. Prev. Med. 13:68'0-690, 1984. Hirayamal, T. Passive smoking and lung cancer: consistency of association (letter). Lancet 2(8'364):14'25-142!6, 1983. Hi~rayamal, 'r'. Arguments pro and con on passive smoking hazard. MMIW 12'3 ( 40 ) :14!80-1483, 1981. (G'ermani) HilraYamal, T. Non-smokinig wives of heavy smokers have a higher rilsk of lung cancer (',letter),. Br. Med. J. 283'(,6304):1466, 1961. Hirayama, T. Non-smoking wives of heavy smokers have a higher risk of lung cancer (letter). Br. Med. J. 283I(',6296):916-197, 1981. Hirayaana, T. Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan. Br. Med. J. (Clin. Res.) 282(6259):183-185, 1981. Hirayama, T. Passive smoking and lung cancer (letter). Br. Med. J. 282('6273):1393-13914, 1981. Hirayama, T. Prospective studies on cancer epidemiology basedion census population in Japan. Proc. XI'I'nternational Cancer Congress, October 20-26, 1974. Florence. Hlousek, Z. The effect of passive smoking on the young person with a history of respiratory tract disease. Cas. Lek. Cesk. 122(9'):27'0-27'7, 1983. ((Czech) Hlousek, Z. Passive smoking. Prakt. Lek. 63'(17):623-628,, 198!3. (Czech) Hlousek, Z. Passive smoking and the health status in pre-school age children. Cesk. Pediatr. 35(,11):606-607, 1980. (Czech) Hodges, M.E. Time to give up smokers?' Bi~bra Bull. Sept.:359- 364, 1981. Hoeigg, U.R. Cigarette smoke iniclosedispaces. Envilron. Health Perspect. Experimental Issue no. 2:117-128, 1972. Hoegg, U.R. Cig;arette smoke in closed spaces. Environ. Health, Perspect. Experimental Issue no. 2:117'-128, 1972. Hoegg, U.R. The significance of cigarette smoke i~n confined spaces (master's thesis). C'incinnati, Ohio : University of 0 Cincinnati, Division of Graduate Studies, Dept. of Environmental N' Health,, 1972'. ~ ~. 26' KDk ~ ~ ~. D-2'6. F,
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Bibliography on Involuntary Smoking/March, 1986 J. (Clin. Res.) 282(6273):1393, 1981. Burchfiel, C.M., Howatt, W. F'. , Keller, J.B., Butler, Wi.J., Hig.ginsi, I.T.T., Higgins, M.W. Passive smoking, respiratory symptoms and pulmonary function in the pediatric population of Tecumseh (abstract). Am. Rev. Respir. Dis. 127 (,S1rpp1. 4 Pt 2):1516, 198'3.. Bureau, M.A.,, Monette, J., Pare, C., Lippe, J., Mathieu, J.-L., Blouin, D., Berthiaume, Y., Begin, R., Shapcott, D. Passive smoking and' the fetus: a study of'carbon monoxide in pregnant women and neonates. Union Medi. Can. 10'9(9):134!1-1345, 1980. (French) Burns, D.M. Consequences of smoking--the involuntary smoker. In: Steinfeld, J., Griffiths, W., Ball, K., Taylor, R.M. (eds.). Smoking andihealth II. Health consequences, ediucation, cessation activi~ties, and governmental action. Vol. II. Proceedings of the 3rd world conference on smoking,and health, New York City, June 2- 5, 1975. DHEW Publication No. (NIH) 77-14I13. pp. 45, 51-58'.. Burns, D.M. Scientific evidence on the hazards of involuntary smoking. J'. Breathing, 38:6-7, 1975. Burrows, B., Knudson, R.J., Lebowitz, M.D. The relationship of childhood respiratory illness to adult obstructive airway disease. Am. Rev. Respir. Dis. 11S(5):75'1-760, 1977. Businco, L., Cantani, A. Prevention of atopy - current concepts and'perso'nal experience. Clin. Rev. Allergy 2(2):10'7-123', 19'84: Biutler, N.R. Smoking and pregnancy. In: Steinfeld, J'., Griffiths, W., Ball, K., Taylor, R.M. (eds.). Smoking and health,IZ. Health, consequences, education, cessation activities, and governmental action. Vol. II. Proceedings of' the 3'rd' world conference on smoking and health, New York City, June 2-5, 1975. DHEW Publication No. (NIH) 77-1413. pp. 43-49. Cabo, J., Bravo, L., Fernandez, F., Jimenez, J'., Navarro, C. Stud!y of Spanishitobacco. V. Quantitative determination of pyrolysis products. Ars. Pharm. 2'3(4):493-499, 1982. (Spanish). Cain, W.S., Leaderer, B._P., Isseroff, R.:, Berglund, L.G., Huey, R.J. Lipsitt, E.D., Perlman, D. Ventilation requirements in build'ing,s--I. Control of occupancy odor and tobacco smoke odor. Atmospheric Environ. 17(16'):1183'-1197, 1983. Cameron, P. Children's reactions to second-hand tobacco smoke. J'. Appl. Psychol. 561:171!-17'3, 1972. Cameron, P. Secondi-hand tobacco smoke: children's reactions. Sch. Health 4!2(15):280-28'4, 1972. ~. CCameron, Oselett, P.,, B'., F.ost'ini, Stocker, J.S., Zaks,, J.M., 641olfe, ii.Hi., R., Winton, J. The health of Tighe, Gi.„ smokers'' and! O N ~ ~ 10 ~ 04 C /I- C C C ID-10.
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Bibliography on Involuntary Smoking/March, 1986 nonsmokers' chilidren. J. Allergy 43(6'):336-34'1, 1969. Cameron, P., Robertson, D. Effect of home environment tobacco smoke on family health. J. Appl. Psychol. 57(2):142-147, 1973. Canada. Department of Health and Welfare. Carbon, monoxide yields of cigarettes. Canada, Department of'Health and Welfare News Release, 198'2-11, January 26, 1982. 41 pp. Cano, J.-P., Catalin, J'., Badre, R., Dumas, C., Viala, A., Guillerme, R. Determination of nicotine by chromatography in the g;aseous phase. II. Applications. Ann. Pharm. Fr. 2'8(11):633-640, 1970. (Frernch), Carlens, E. o'bstructive lung disease caused by passive smoking. Lakar'tidningen 7'7 ( 23 ):217'7-2178, 1980'. ( Swed'ish) Castello, D., de Candussio, G., Franchi!, D., Bertocchi, F'. The relationship between, ambient cigarette smoke and respiratory diseases in childreni. First results. Minerva Pediatr. 3'0(19):14'89- 14916, 1978. (,Italian), Castot, A., Efthymiou, M'-Li. Cancers and passive smoking. Slem. Hop. Paris 59(27-28):2028-2'030, 198'3. (French). Catford, J.C., Nutbeam, D. Smoking in hospitals. Lancet 2('8341):94-96, 1983. Cederlof, &., Ciolley, J. Epidemiological investigations on environmental tobacco smoke. Scand. J. Respir. Dis. Suppl. 91:47- 49, 1974. Chan, W.C., Fung, S.C. Lung cancer in non-smokers in Hong Kong. In: Grundmanrn, E., Clemmesen, J., Muir, C.S. (edsi.). Geographical pathology in cancer epidemiology. (Cancer campaign, v. 6) Stuttgart; New York : Gustav Fischer Verlag, 1982. pp. 199-202. Chan Woon Cheung. Data from Hong Kong ( lietter ). MMW 124 ( 4):16,. 1982. ('German). Chappell, S.B., Parker, R.J. Smoking and carbon monoxide levels inn enclosed'places in New Brunswick. Can. J. Public Health, 68(2)1:15'9- 1'61, 1977. Chappell, S. B., Parker, R.J. A study of'carbon monoxide levels in enclosed'public places. New Brunswick Council on Smoking,and! Health, Fredericton, New Brunswick, Canada, June 19'75. 16 pp. Charlton, A. Children's coughs rel'ated to parental smoking. Br. Med. J. ( Cli'n. Res. ]I 228 ('6I43'1) :1647-164'9, 1984. Charpin, D. Passive smoking. Hyg. 42:30i09-3017, 1984. (French) 11 D-11
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Bibliography on Involuntary Smoking/March, 1986' Chen, C.B., Hecht, S.S., Young, R., Ohmori, T'., Hoffmann, D. Comparative carcinogenicity andimetabolism of the tobacco specilfi!c carcinogens, NNN and NNK (Abstract),. Proc. Am. Assoc. Cancer Res. 20:81, 1979. Chojnowski, J.R. The harmfulness of cigarette-smoking. Przegl. Lek. 24(6):527-531, 1968. (',Polish), Chopra, N.M'., Verma, M.M., Zuniga, T.H. On the fate of' maleic hydrazide in t~obacco~ smok~es.~ J Ag,r~ilc.~ Fo~~od~ Chem. 30 (4)~ :!67~2-676 , 1982. Chretien, J'. Inhalation carcinogenesis: an overview. Recent Results Cancer Res. 82:1-10, 1982. - Chyle, P., Chy1e,.M., Korb, J., Papanek, M. Tobacco mosaic virus, polyphenols and the carcinogenicity of the tobacco habit. Cesk. Epide:aiol. Mikrobiol. Imunol. 2'0 ('1)1: 32-42', 1971. ( Czech ). Claoule, C. Smoking habits in the main entrance hall of' a, hospital (,letter),. Br. Med!. J. 283'(6288):4'39-440, 1981. Cohen, J.D. and Bartsch, G.E. A comparis!on-between carboxyhemoglobin and serum thiocyanate as indicators of 'cigarette smoking. Amer. J. Public Health 70:284'-2'8.6, 1980. Cole, P.V. Comparative effects of atmospheric pollution and cigarette smoking on, carboxyhaemog,lobin levels in man. Nature. 2515(5'511):699-701, 1975. C ll i k ' ' o ey, Jl. Pass ve smo ing in children. Nurs. Times 7 1(147 )1:1858- 1859, 1975. Coll'ey, J1.R.T. Respiratory symptoms in children and'parental smoking andiphliegm production. Br. Med. J. 2(59'12):201-204, 1974.. Colley, J.R.T., Doug,las, J.W.B., Reid, D.D. Respiratory disease in young adults: influence of early, childhood lower respiratory tractt illness, social class, air, pollution, and smoking. Br. Med. J. 3 ( 5873 ) :195!-198, 1973. Colley, J.R.T., Holland, W.W., Coxkhill, R.T'. Influence of passive smoking and parental phlegm on pneumonia and bronchitis in early childhood. Lancet 2'(7888'):1031-1034', 1974. Collig;an, M.J. The psychological effects of indoor air pollution. Bull. NY Acad. Med. 57(10+:1014-1026, 1981. Collishaw, N.E., Kirkbride, J, Wigle, D.T. Tobacco smoke in the workplace: an occupational health hazard. Can. Med. Assoc. J. ~ 13'1(10):1199-12'04, 1984. 0 Comstock, G.'r7., Meyer, M'.B., Hielsing, K_J., Tockman, M.S'. NI ~ ~ 12 ~ ~ ~ M.' C C ID-12'.
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Bibliography on Involuntary Smoking/March, 1986 Cuddeback, J.E., Donovan, J.R., Buirgi, W.R. Ambient tobacco smoke measurement. Am. Ind. Hyg. Assoc. J. 3'7:656-657', 1976. Cuddeback, Ji.E., Donovan, J.R., Burg,, W.R. Occupational aspects of passive smoking. Am. Ind. Hyg. Assoc. J. 37(5'):263-267', 1976. Currier, R.W. On tobacco smoke and the nonsmoker. J. Iowa Med. Soc. 681(3) :97, 19781. Czerwiecki, L. Harmful substances in cigarette smoke. Roca. Panstw. Zakl. Hig. 35(13 ):23'3-238', 1964. (Polish) Daff, M.E., Kennaway, E.L. The arsenic content of tobacco and of tobacco smoke. Br. J'. Cancer 4:173-182, 1950'. Dahms, T.E., Biolin, J.F., Slavin, R.G. Passive smoking effects on bronchial asthma. Chest 80(5)1:5'30-5'34, 1981. Dalager, N'., L. Pickle, and T. Mason, et al,. Passive Smoking and lung, cancer. Am. Ji. Public Health 20:482, 19'84. Davies, D.M. The application of threshold'liimit values for carbon monoxide under conditions of'continuous exposure. Ann. Occup. Hyg. 18 (1)': 21-28', 197'5. Davis, G.L., Gantner, G'.E'., Jr. Carboxyhemoglobin in volunteer blood donors. JAMA 230(7):996-997, 1974!. Dawley, H.H., Jr. Protecting hospital patients from passive ssaoking. Psychol. Rep. 46I(,2') :6'78I, 19'801. DeMarini, D.M. Genotoxicity of tobacco smoke and tobacco smokee condensate. Mutat. Res. 114:59-89, 1983. Derbes, V'.J., Engelhardt, H.T'. Urticaria due to inhalantt substances. South. Med. J. 37'(12):72'9-731, 1944. Derouane, A. A comparison betweenismoke concentrations measured indoors and outdoors. Atmos. Environ. 6:209-220, 1972. ((French) Derouane, A., Verduyn, G'. Study of some factors affecting air polliution inside buildings. Trib. Cebedeau 27':482-48'8, 1974. ( F'rench ), Diamond, G.A., Forrester, J'.S. Clinical trials and statistical verdicts: probable grounds for appeal. Ann. Intern. Med'. 9813 ) : 3'85I-394, 1983. Ding, D.J'1. The effect of long-term, passive smoking on pulmonary function. Chung Hua Chieh Ho Ho Hu Hsi Hsi Chi Ping, Tsa Chiih 7(16): 359-362, 383, 1984. '( CMinese ) Dinman, B.D. Pathophysiologic determinants of community air. 14 f D-14
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Bibliography on Involuntary Smoking/March, 198!6 1977. 24 pp. Brunnemann, K.D., Hoffmann, D. N-ni'trosodiethanoSamine in tobacco and mainstreaaa and sidestream smoke. IARC Sci. Pub1. 45:85-92,. 1983. Brunne:nann, K.D., FHoffmann, D. Chemical studies on tobacco smoke. LIX. Analysis of volatile ni'trosaunines in tobacco, smoke and, polluted indoor, environmentsi. I,ARC S'ici. Publ. 19:343-356, 1978. Birunne:aanni, K.D., Hoffmann, D. Chemical studies on tobacco smoke XXXIV. Gas chromatographic determination of ammonia, in cigarette and cigar smoke. J. Chromatogr. Sci. 13'( 4):159-16I3, 1975'. Brunne:aann, K.D., Hoffmann, D. Chemical studies on tobacco smoke.. XXV. The pH of' tobacco smoke. Food Cosmet. Toxicol. 12(1) :115- 124, 1974. - _ B'runnemanni, K.D., Lee, H-C., Hoffmann, D. Chemical studies on tobacco smoke. XLVII. On the quantitative analysis of catechols and' their reduction. Anal. Lett. 9(10):939-955, 1976. B:runnemanni, R.D., Masaryk, J., Rof fmann, D.Ro1e oftoba~cco stems in the formation of N-nitrosamines in tobacco and cigarette mainstream and sidestream smoke. J1. Agric. Food Chem. 31(6):1221- 122'4, 1981. Brunnemann, K.D., Scott, J.C., Haley N.J., FHoffznann, D. Endlogienous formation of N-nitrosoproline upon cigarette smoke inhalation. IARC Sci. Publ. ('5'7):819-828, 198'4. Brunnemann, K.D., Stahnke, GI. , Hoffmann, D. Chemical studiles on tobaccoismoke. LXI. Volatile pyridines: quantitative analiysis in mainstream and sidestream smoke of cigarettes and cigars. Anal.. Lett. All(7):545'-560, 1978. Brunnemann, K.D., Yu, L., Hoffmann, D. Assessment of carcinogenic volatile N-nitrosamines in tobacco and in mainstream and sidestream smoke from cigarettes. Cancer Res. 37('9)i:3218-322I2, 1977'. Brunnemann, K.D., Yu, L., Hoffmann, D. Chemical studies on tobacco smoke. XLIX. Gas chromatographic determination of hydrogen cyanide and cyanogen in tobacco smoke. J. Anal. Toxicol. 1(i1) r3'8- 4'2, 1977.. Buratowski, J'. , Warczynski, A., Piasecki, M. The effect of smallil concentrations of nicotine on the ability of visual adaptation and acuity in non-smokers. Pol. Tyg. Lek. 2'9(25):1077'-1078', 1974. Burch, P.R.J. Lifetime passive smoking and cancer risk. (Letter). Lancet 1(,8433):866, 1985. Burch, P.R.J. Passive smoki'ng and lung cancer (,letter). Br. Med.
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Bibliography on Involuntary Smoking/March, 1986 Behav. Sci. 14(6):837-864', 1971. Bridge, D.P., Corn, M'. Contribution to the assessment of exposure of nonsmokers to air pollution from cigarette and cigar smoke in, occupied spaces. Environ. Res. 5(2):192-209, 1972. Brody, B. Breathing other people's smoke (letter). Br. Med. J. 2(16141):8195, 1978. Bronisz, H., S'zost, T., Li'pska, M., Zawadal, M. Cadmium content in cigarets. Bromatol. Chem. Toksykol. 16(2):121-127', 1983. (Polish) Browne, C.L., Keith, C.H., All!en, R.E. The effect of filter ventilation on the yield'and composition of mainstream and sidestream smokes. Beitr. Tabakforsch. int. 10(2):8'3-90, 1980. Browne, E.V. N-heterocyclic and biologically active compounds inn tobacco smoke. In: Proceedings, 3rd Tobacco Health workshop Conference. Lexington, Kentucky : Tobacco Health,Research. Institute, University of Kentucky, 1971. pp. 158,1!6'6. Brumbaick, C.L. The poliitics of smoking, prevention: a report from the field. J'. Public Health Policy 2'(l):3'6-41, 1981. Brunekreef', B., Boleij, J.S.M. Long-term average suspended particulate concentrations in smokers' homes. Int. Arch. Occup.. Environ. Health,50(3):299-302, 1982. Brunekreef, B., Fischer, P., Remijn, B., van der Lende, R., Schouten, J., Qiuanjer, P. Indoor ai~r pollution and' ilts effect on pulmonary function of adult non-smoking women: III. Passive smoki'ng and pulmonary function. Int. J. Epidemiol. 14(2):2'27-23'0, 19'85. Brunnemann, R.D., Adams, J.D., Ho, D.P.S., Hoffmann, D. The influence of'tobacco smoke on indoor atmospheres. II. Volatile and tobacco specific nitrosamines in main- and sidestream smoke andd their contribution to indloor, pollution. In: Proceedings of tMe 4th joint conference on sensingi of environmental pollutants, New Orleans, Louisiana, 1977. Washington, D.C'.: American Chemical Soci~ety, 1978. pp. 876-8'80. Brunnemann, K.D., Fink, W., Moser, F. Analysis of volatile N- nitrosaaaines in mainstrsaan and sidiestream smoke fromicigarettes by GLC-TEA. Oncology 3!7(4):217-222, 1'980. Brunnemann, K.D., Hecht, S.S., Hoffmann, D. N-nitrosamines: environmental ocurrence, in vivo formation and metabolism. J. Toxicol. Clin. Toxicol. 19(16&7):66l-6&8, 1982-83'. Brunnea:ann, K.D., Hoffmann, D. Volatile N-nitrosamines in tobacco smoke and i~n polluted indoor environments. Presented at the 2ndi Q joint conference sponsored by the Chemical Institute of' Canada, and! jV American Chemical Society, Montreal, Quebec, Canada, May 29-June 2, (f[ . ~ ~ 8 ~ al' N C D-8
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CHART V: E'JFORCFTSE7T; EXCEPTIONS; OTHER PLA'CES~ AFFECTED COMMUftITr, EXCEP- ENF'ORCEMENT TIONS(4] Antioch + Berkel'ey App1'. Brea Appt. Brentwood Carlsbad Appl. Carpinteria +' Cathedral City (!11y Chula:Vista Appl.. Clayton Concord Coronado Appl. Cupertino Danville Del Mar Appl. El Cajon EliCerrito Fscond'idw Appl. + Grand,Terrace Appl. Hemet, Sign, Hercules +* Huntington Beach Imperial Beach Appl. IndioI Appl. Irvine La Mesa Appl. Lafayette Laguna Bieaeh Livermore Appl. Long Beach Appl. + Los Altos Los Angeles Los Gatos Martinez + MenloiPark Mill Valley, (1'1i] Milpitas Mountain View National City Appl. Newport Beach Oceanside Appl. t Orinda, Pal'o Alto Pasadena Ap,pl. Pinole Pittsburg Poway Appl. + Riancho Mirage Appi. R3chmondi Riverside Appi'. Sacramento San Anselmo San Diego Appl. San F'rancisco San Jose. San Lu1s Obispo, San Marcos Appii. San Pablo San Ramon Santa Barbara Santa Clara Santa Monica Santee Appli. Tustin, Appli. Ukiah Appi1. Vi'sta, App~L. Walnut Creek Yorba Linda Appl. County of~Contra,Costa, County of~Marin [11] County oflOrange. County oflRi'verside Appl. County of~Sacramento County oflSan Diego Appl. County of'Santa Cruz Infraction Infraction Infraction/Pub.Nuis. City Mgr/complaint. Infraction, Infraction Infraction. Infraction Infraction City Mgr/complaint Infraction, City Mgr/complaint City'Mgr/complaint Infraction Misdemeanor/Infr. City'Mgr/complaint Infraction Infraction Infraction City Mgr/complaint OTHER AFFECTED A'REAS A11i enclosed areas used by the general public Alli enclosed areas used by the general public A11'enclosed areas used by the general public A11i public places except designated! areas [1!] Laundromats; city facilities A11'public'places except designated'areas! [1i] All enclosed, areas used by the generai' public All encLosed, areas used by, the general' public All public,places except designated,areas;[1] All enclosed'areas used by the general public All public,places except designated areas: (1] All enclosed,areas usediby the general public All public places except designated areas [1J All public places except designated areas [1] All enclosed areas used!by the general public Public buildings Infraction All public places except designated areas [1j'. Infraction Infraction Infraction City Mgr/complaint Infraction All public places except designated areas [I1]I All enclosed areas used by the general public City Mgr./Inspect. Health Dept. Inf'raction Infraction [9J Mlsdemeanor Infraction All,enc7osed areas used by the,general public Infraction Dir.Coem.Devel. Infr./$us:.l.ic.Ren. City Mgr./Inspect. Infraction Infraction Infraction City Mgr/complaint Infraction Infraction City Mgr/complaint Infraction Infraction Infraction City Mgr/complaint Infraction Infraction None specified Infraction Civi1/Dir.Pub.Health Health Officer Admin.Ofc/Pub.Nuis., Infraction Infraction City Mgr/complaint Infr. / Pub.Nuis. City Manager C3vi1/Infraction Infraction Infraction City Mgr/complaint Infraction City }lgr/cpmplair.t Misdemeanor Health,Dept. Infraction Infraction Infraction Director of Health Infraction HealthOfcr/inspect Schoo,ls; child care facilities Encl. public areas;~ child'care facil.; schools. All public places except designated areas [1] All public places except,desi!gnated areas [1] All,enc7osed areas used by the general public All enclosed areas used by the general publ'ic. All enclosed areas used by the general public All public places except desi!gnated areas (1] All public places except desi!gnated areas [,1] All enclosed areas used by the general publiic, A1l,public places except designated areas [1] All public places except designated areas [1] All city buildings; laundromats All public places except designated areas [1] All enclosed areas used by the general publ'ic All enclosed areas used by the general publ!i!c Iaundromats All public places except designated areas (1] [L]; but no area,is required to be all nonsmoKinr All public places: except designated areas [1'] All enclosed areas used by the general public All enclosed areas used by the general public County'buildings except desig. smoking areas All public places except designated: areas (,1!] A11 public pPaces except designated areas (,1!] Enclosed'.public areas c f C-8
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Bibliography on Involuntary Smoking/March, 1986'. Ashley, M.J., Forbes, W.F., Frecker, R.C. Smoking or health in, the '80s? (editorial) Can. Med. Assoc. Ji. 125(10):107'7-1078, 1981. ASHRAE: Standards for ventilation required for minimum acceptable indoor air quality. Standard 62-73R. Atlanta, Ga. : American Society of Heating, Refrigerating and Air-Conditioning Engineers, 1981. Australian Council on Smoking and Health,. List of illnesses and disabilities associated with smoking. Med. J. Aust. (Special. Supplement on Smoking and Health. July 26, 1975'] 2(1):3-4, 1975. ~' Aviado, D.M. Carbon monoxide as an index of environmental tobacco il smoke exposure. Eur. J. Respir. Dis. [Suppl.]I 133':47-60, 1984. Avciado, D.M'. Small-airways dysfunction impassive smok rs (letter),. N. Erngl. J. Med. 303(7):393, 1980. Axelson, 0. Room for a role for radon in lung cancer causation? Med. Hopotheses 13'(1):51-61, 1984. Ayer, H.E., Yeager, D.W. Irritants in cigarette smoke plumes. Am. J. Public Health 7'2(11):1283-1285, 1i9'82 Ayres, S.M., Mueller, H.S., Gregory, J.J., Giannelli, S., Jr.,. Penny, J.L. Systemic and myocardial hemodynamic responses to relatively small concentrations of carboxyhemoglobin (COHB). Arch.. Environ. Health, 18('4!):699-709, 1969. Baldre, R., Guillerm, R., Abran, N., Bourdin, M., Dumas, C. Atmospheric pollution by smoking. Ann. Pharm. F'r. 36(9/10):443- 452, 1978. (French) Bahrmann, E., Paun, D. The scientific basis for tobacco injury by active and'passive cigarette smoking. Dtsch. Gesundheitsw.. 2'9 ( 43 ) :2'017-202'2, 1974'. (,German) Ball, K., Taylor, R.M. ( eds. ). Smoking and'health II . Health consequences, education, cessation activities, and governmental -action. Vol. I'T. Proceedings of' the 3rd world conference on smoking and health, New York City, June 2-5, 1975. DHEW Publication No. (NIH) 77-1413. pp. 891-8!95. Bake, B. Does environmental tobacco smoke affect lung, function? Eur. J. Respir. Dis. [Suppli] 133:85-87, 1984. Baker, R.R. Variation of sidestrea:n gas formation during the smoking cycle. Beitr. Tabakforsch. Int. 1'1(4):181-193, 1982. Baker, R.R. Primary and secondary formation of carbon monoxide during combustion of tobacco. Oxid. Commun. 3(3'4):269-281, 1983. 0 N 0 ~ ~ 4 ~ N. ~ ~ D-4.
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. r /IftN /-I- 2atad iach4strias 'vsry i•stxrestsd• or Incdaratsly iztarsztad• (¢assticn 4) 78 1976' _' 074 197ZI 1970 1968*9 ~ 0 i~uq' 1. 66 s 6+6' . 70: • 39 ~ 63 a 73 A¢tcacbile 65 68 73 67 71 79 fbod 65 69 =* * ZT a t' 2~c Maaiaal 47 55 59 53' a ZT Cil 44 49 42 ~ DC Z7C . Ubestos 32 Zac z~ ~ ~c nc. Stbaeco . 27 28 31' 30 33 36 Licpuar . 25 25 26 25 24 28 S~e drug, iacsustxy ancl' the liqstor industry held tbeis rating of tw, years ago 33 the facs of dieclim,es in e!yery other category. 2a the case of the liquor imdustry, it Us naintiiaed its low rating omnsistantly since 1970 anA is now being c2salleaged' !ar that posixiion by tha: tabacco industsy. Ctber industries schieved' scme sort off peak at the aiddle of the decade but are aar tailing off . As in the past, aoa-aoDcess rate the tobacao industry l'awer thran saokers. ~ Sbey also rats the liquor industsy lower, brrtt tbers is .3rtmally no distinction be- twen smokers and' non-mokars as regards the rema{**ing iadust;ies. satsd industries 'vs_-y intrrested- or Soderately ints.rested' (4uextion 4) Smckers lkan-smcke=s ~_ . .. e , 3n't.omobile 65' 67 D'styq ?ood 64 64 66' 64 Cmemical ~I6 47 oiili 64' 4b 1sbestos 31 31 N' . ~. Sbmacca 37 20 jv Liquor 31 21 . (in * S~C indicates t21at ,cvestioa was not asked ia the study in aaaestion. kthk sr In 1968' the question tiordiaq r,as slightly di-Oferent in that we asked fo: rati.r:,s ~, oa biorr •concsrned!" industsies''vere, rather t.1tara Mv `interesteC' they were. CAI A-51
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Bibliography on Involuntary Smoking/March, 1986 the buildup of carbon monoxide from cigarette smoking in rooms and houses. Am. Soc. Heat. Riefrig. Air Cond. Eng,. J.:49-53, 1974.. Just, J., Borkowska Mi., Maziarka, S. Tobacco smoke contained inn the air of Warsaw coffee rooms. Rocz. Panstw. Zakl. Hig.. 2'3(2):129-135, 1972. (Polish) Kabat, G.C., Wynder, E.L. Lung cancer in nonsmokers. Cancer 53I(',5) :121i4-1221, 1984'. Kalchulis, C.J. Secondhand cigarette smoke as a cause of chronicc carbon monoxide poi'soningi. Postgrad. Med. 701(1!) :77-79, 1!981. Kahn, A.,,Rutledge, R.B., Davis, G.L., Altes, J.A., Gantner, G.E., Thornton, C.A., Wallace, N.D. Carboxyhemogliobin sources in the metropolitan St. Louis population. Arch. Environ. Health 29:127-115, 1974. Kalandidi, A. Lung cancer and passive smoking. Conclusion of Greek study ('thesis). University of Athens, Greece, 19837 Kamstrup, 0., Hugod, C., Larsen, E. Measurements of low concentrations of carbonyl sulfide. Beitr. Tabakforsch. Int. 11(1):33-38, 1981. Karakostov, P. Passive smoking among,pregnant women and its effect on the weight and'growth of the newborn infant. Akush G'inekoli (Sofiia) 24(2'):28!-31, 1983. Kastenbaum, M.A. Consistency of research data, on passive smoking and lung,cancer (letter'),. Lancet 1(8391):1406, 1984. Kasuga, H. Hydroxyproline and passive smoking. Presented at New Etiologies in Lungi Cancer Conference, March 21-23, 1983, Honolulu, Hawaii. Kasuga, H., Hasebe, A., Osaka, F'., Matsuki, H. Respiratory symptoms in school children and the role of passive smoking. Tokai J'. Exp. C1in. Med. 4(2):101-114, 1979. (iJapanese) Kauf'fmanin, F. Small airways dysfunction in nonsmokers (,letter). N. Engl. J. Med. 303'(',7 ): 393, 1980. Kauffmann, F., Tessier, J-F'., Oriol P. Adult passive smoking in the home environment: a risk factor for chronic ai!rflow . limitation. Am. J. Epidemiol. 117(i3):26'9-280, 119,83. Kauffmanni, F., Perdrizet, S. Effect of passive smokingionn respiratory function. Eur. J. Respir. Dis. 62 [Suppl. 113):109- ~' 110, 1981. 0 ~ Kawane, H. Drinking and passive smoking (letterY. Chest ~ ~ 32 ~1 C JI C D-32
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Bibliography on Involuntary Smoking/March, 1986 Jarvis, M.J., Russell, M.A. Measurement and estimation of smoke dosage to non-smokers froaa environmental tobacco smoke. Eur. J. Respir. Dis ['Supp1.] 133:68-75, 19'84. Jarvis, Mi.J., Russell, M.A.H., Feyerabend, C. Absorption of nicotine and carbon monoxide from, passive smoking under natural conditions of exposure. Thorax 38i(,11):829-83i3, 1983. Jarvis, M.J., Tunstall-Ped'oe, H., Feyerabend, C., et ail. Biochemical markers of smoke absorption and sel'f reported exposure to passive smooking. J. Epidemi. Comm. Hlth. 38 ( 4): 3'35- 33'9, December 1984. i Jauvits, R.Li. The rights of nonsmokers in the workplace: recent developments. Labor Law J. 3'4 (13):144-148, 1983. Jenkins, R.A., Guerin, M.R. Analytical chemical methodis for thie detection of environ'mental tobacco smoke constitutents. Eur. J. Riespir. D'is (Suppl) 133:33-46, 1984. Jenkins, R.A., White, S.K., G'ri~est, W.H., Guerin, M.R. Chemical characterization of the smokes of selectediUS commercial cigarettes: tar, nicotine, carbon monoxide, oxides of nitrogen,, hydrogen cyanide, and acrolein (,report)i. ORNL/TM-8749; NTIS 0'rder No. DE83012139', 19181. 44pp. Jenkins, R.W., Jr., Bass, R.T'., Newman, R.H.,, Chavis, M.K. Cigarette smoke formation studies. V. The effects of the cigarette periphery on mainstream smoke formation. Beitr. Tabakforsch. 9(3):126-130, 1977. Jenkins, R.Wi., Jr., Newman, R.H., Lester, G'.F'., Frisch, A.F., Williamson, T.G. Neutron activation analysis in tobacco, anidd cigarette smoke studi'es: the halogens. Beitr. Tabakforsch. Itdt.. 11( 4 ) : 195-202', 19182 . Jenkins', R.W., Jr., Newman, R'.H., Carpenter, R.D., Osdene, T.S. Cigarette smoke formation studies. I,. Distribution and mainstream products from added 14C-dotriacontane-16, 17. Beiltr.. Tabakforsch. 5'('6):295-298, 19701. Jenkins, R.W., Jr., Newman, R.H., Chavis, M.K. Cigarette smoke formation studies. II. Smoke distribution and mai'nstream pyrolytic composition of added 14C-mienthol (U)'. Beitr. Tabakforsch. 5(6):299-301, 1970. Jermi~ni, C., Weber, A., Grandjean, E. Quantitative determination of various' gias phase components of the side-stream smoke of cigarettes in the roomiair as a contribution to the problem of passive-smoking. Int. Arch. Occup. Environ. Health 36(3):169- 181, 1976. (G'erman). Jermini, C., Weber, A. Air pollution through ciigarette 30 smoking. N Q N C!1' ~ ~ ~ N C rn _3if1
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Bibliography on Involuntary Smoking/March, 1986 in the development of chronic middle ear effusions. Clin. Rev.. Allergy 2(4):319-328, 19841. Kraemer, M'.J., Richardsom, M.A., Weiss, N.S., Flirukawa,, C.T'., Shapiro, G.G., Pierson, W.E'., Bierman, C.W. Risk factors for persistent middle-ear effusions. Otitis media, catarrh, cigarette smoke exposure,, and atopy. JAMA 249(8):1022-102'5, 1983'. Kritskii, V.N. Smoking is unhealthy. Med. Sestra 37(2):44-47',. 1978'. (Russian). Krotoszynski, B.K., O'Neill, H.J. Involuntary bioaccumulation off environmental pollutants in nonsmoking heterogeneous human population. J. Environ. Sci. Health A17(6):8'55-8163, 1982. Kuller, L.H1., Radford, E.P. Epidemiological bases for the current ambient carbon monoxide standards. Environ. Health Perspect. 52 :131-139 ( Discussi'on pp. 1'4'1-14i8 ), 1983. Lam, J. Demonstration of 3:4!-benzpyrene, other aroaatic hydrocarbons, and'nitrogen in prodlucts f'ormed by pyrolysis of tobacco extract. Acta Pathol. Microbiol. Scand. 40:369-372, 1957. Laszlo, V. The deleterious effects of'smoking on the sequences of gestation. Magyar Noorvosok Lapja 32'(2'):163-167, 1969. (Hungarian,) Lawther, P.J.' Carbon monoxide. Br. Med. Bull. 31(3'):25,6-260, 1975. Lawther, P.J., Commins, B.T. Cigiarette smokingiand exposure to carbon monoxide. Ann. NY Acad. S'ci. 174(Article 1):1i35-14'7, 1970. Leaderer, B.P., Cain, W.W., Isseroff, R., and Berglund, L.G. Ventilation requirements in buildings - II. Particulate matter andicarbon monoxide from cigarette smoking. Atmos. Environ.. 18:99-106, 1984. Lebowitz, M.D. Influence of passive smoking on pulmonary function: a survey. Prev. Med. 13(6):645-6'5b, 19841. Lebowitz, M.D. The effects of'enwironmental tobacco smoke exposure and gas stoves on daily peak flow rates in asthmatic and non-asthmatic families. Eur. J. Respir. D'is. (Suppl.) 133:90-97, 1984. Lebowitz, M.D. Health effects of indoor pollutants. Annu. Rev. Public Health 4':203!-221, 1983. Lebowitz, M.D. Arnet, D.B., Knudson, R. The effect of passiwe. 35 D-35
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Bibliography on Involuntary Sraoking/March, 19'86 Kjellman, N.-Ii.Mi. Effect of parental smoking on, IgE levels in children (letter). Lancet 1(',8227):993-994, 1981. Klosterkotter, V., Gono, E. On the problem of'passive smoking. ZentralbS. Bakteriol. (Orig B) 162:51-69, 1976. (German) Klus, H., Kuhn, H. Distribution of various tobacco smoke components among mainstream and sidestream smoke (a survey). Beitr. Tabakforsch. Int. 11(5):229-265, 1982. ((German) Knight, A., Breslin, A.B. Passive cigarette smoking and patients with asthma. Med. J. Aust. 142(3):19A-195, 1985. Knoth, A., Bohn, H., Schmidt, F. Passive smoking as a causal factor of bronchial carcinoma in female nonsmokers. Med. Kliin. 78'(,2):66-69, 1983. ('German). Kobayashi, Y., Watanabe, M., et al. Studies on the thermal decomposition of tobacco alkaloids. Part XIV. Products of tobacco alkaloids in cigarette smoke and transfer into main and side stream. Nippon Nogeikagaku Kaishi 3'7('S):2'91-2'95, 1963. (Japanese) Koo, L.C., Ho, J.H.-C'., Lee, N. An analysis of some risk factors for lung cancer, in Hong Kongi. Int. Ji. Cancer 35( 2):149-155', 1985'. Koo, L.C., Ho, J.H.-C'., Saw, D. Is passive smoking,an added risk factor for lung, cancer in Chinese women? J. Exp. Clin. Cancer Pte s. 3( 3): 277-283, 19814. Koo, among L.C., Ho, J.H.-C'., Saw, D. Active and passive smo ing, female lung cancer patients and controls in Hong Kong. J. Exp. Clin. Cancer Res. 4:367-375, 1983. Koplin, A.U. Anti-smoking liegislation: the New Jersey experience. J. Public Health Policy 2(3):247-255, 19'81. Kornegay, H.Pt., Kastenbaum, M.A. Non-smokingiwives of heavy smokers ... risk of lung cancer (,letter). Br. Med. J. 283 ( 62'96 ) : 914, 1981. Kotin, P., Gaul, L.A. Smoking in the workplace: a hazard' ignored. Am. J. Public Health 70(61)1:575-5'76, 1980. Kotin, P., Falk, H.L. The role and'action of environmental agents in the pathogenesis ofllung cancer. II. Cigarette smoke. Cancer 13:250-262', 1960.. Kozlowski, L.T. Smokers, non-smokers, and low-tar smoke (letter). Lancet 1(8218):508', 19,81. Kraemer, M.J., Marshall, S.G., Richardson, M.A. Etiologic factors 34 ~ ~ ~ ~. D-34 C C C
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Bibliography on Involuntary Smoking/March, 1986 Hall, C.B., Hall, W.J'.,, Gala, C.L., MaGill,, F.B., Leddy, J.P. Long-term prospective study in children after repiratory syncytial vilrus infection. J. Pediatr. 105(13)r358-3641, 1984. Hall, W.J., Hall, C.B'.,,, Hyde, R'~.Wi. "'V~isiting~ t~he~ ini~~qui~t~y~ of the. fathers upon the children". Am. J. Dis. Child 12'9(18):88!7-888, 1975. Hammondi, E.C., Selikoff, I.J. Passive smoking,and lung cancer with comments on two new papers. Environ. Res. 24(2):444-452,. 1981. Haneberg,, B.,Tmoranjum, T., Rodahl, K., Gedd'e-Dah1, T.W. Factors preceding the onset of meninigococcal disease, with special emphasis on passive smokingi, stressful events, physical fitness and general symptoms of ill health. NIP'H Ann. 6(2')1:169-73', 1983. Hardee, G'.E'., Stewart, T'., Capomacchia, A.C. Tobacco smoke xenobioti~c compound appearance in mothers" milk after involuntary smoke exposures. I. Nicotine and cotinine. Toxicol. Lett. 151(2- 3):10'9-112, 1983. Harkavy, J. Skin hypersensitiveness to extracts, of tobacco leaf,, tobacco pollen, tobacco seed and to, other allergens in 2'A0 normal smokers. J'. Allergy 6(i1):516-6'1, 1934. Harke, H.-P. The influence of tobacco smoke on indoor atmospheres (,letter). Prev. Med. 4(3):373-374, 1975. Harke, H'.-P. The problem of passive smoking in motor cars. Proc. I'nt. Symp. Recent Adv. Assess. Health Eff. Environ. Pollut. 3:1773-17177, 1975. Harke, H.-P. Air pollution in smoke-filled rooms. Rev. Environ. Health 1(4):305-326', 1974. Harke, H'.-P. The problem of passive smoking. I. The influence of smoking on the CO concentration in office rooms. Int. Arch. Arbeitsmed. 33'(',3')':199-206', 1'974. (German) Harke, H.-P. The problem of passive smoking: particulate matter from tobacco smoke in closed space. Proceedings of the 28th Tobacco Chemists' Research Conference, October 1974. Harke, H'.-P. Contribution to the problem of "passive smoking" (letter). Munch. Med. Wochenschr. 113(18),:71D-7'13, 1971. (German), Harke, H.-P. The problem of'"passive smoking,". Munch. Med. Wochenschr. 112(151):2328-2334', 1970. (German) Harke, H.-P., Baars, A., Frahmi, B., Peters, H., Schultz, Ch. The 23 D ~-23'
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Bibliography on Involuntary smoking/March, 1986I Gesundheitswes. 46(11) :582-587', 1984. (G'erman) Grandjean, E., Weber, A., Fischer, T'. Passive smoking. B'ull. Schwei~z. Akad'. Med'. Wiss. 35(1-3 ):99-109, 19'79'. ('German). Gravella, E. Smoke and'oncogenesis. Minerva Med. 73(36'):2349- 235'6, 1982. (Italian) Great Britain Laboratory of the Government Chemist. Report of the Government Chemist, 1!9791. Londlon : Her Majesty's Stationery Office, 1980. Chapter 51: smoking and health issue. Greenberg, R.A., Etzel, R.A..and Haley, N.Ji. Exposure of thee fetus, neonate, and nursed infant to nicotine and cotiniine from maternal smoking. (better ) Ni. Eng,l. J. Med., 311(101) : 672, 1984 . Greenberg, R.A., Haley, N.J., Etzel, R.A., Loda, F.A. Measuring the exposure of infants to tobacco smoke: nicotine and cotinine in urine and saliva. N. Engl. J. Med. 310(17):1075-1078, 1984. Greene, G.E. Nons:nokers' rights. A public health issule. JAMA 23'9(20):2125-2127, 1978. Gregory, J'. Office air quality, "tight buildings," and job stress--the impaict on women office workers' occupational health. Conference of the American Industrial Hygiene Association,/American Conference of Government Industrial Hygienists, Portland, Oregon, May, 251, 1981. - Grimmer, G. Causal connection questionable (letter). MNtW 124(4):16', 1982. (Germa!n) Grimmer, G., Bohnke, H., Harke, Hi.-P. Passive smoking: intake of polycyclic aromatic hydrocarbons by breathing of cigarette smoke containing air. Int. Arch,. Occup. Environ. Health 40(2):93-99, 1977. '( Ge rmazn ). Grimmer, G., Bohnke, H., Harke, H'.-P. Passive smoking: measuring of concentrations of polycyclic aromatic hydrocarbons in rooms after machine smoking of cigarettes. Int. Arch. Occup. Environ. Health 40(2):83-9'2, 1977. (German)' Grob,, K. Gas chromatography of cigaret smoke. III. Separation ofl the overlapiregion of'gas andiparticulate phase by capillary columns. J. Gas Chromatogr. 3('2):52-56, 1965.. Grob, K. Gas chromatography of cigaret smoke. II. Beitr. Tabakforsch. 9:315-323, 1962. Grob, K. Gas chromatography of cigaret smoke. I. Beitr.. Tabakforsch. 7:285-2'901, 1962. O Grufferman, S., Delzelil, E.S., Maile, M.C., Michialopoulos, G. ~ ~ 21 ~ ~ ID-21
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Bibliography oni Involuntary Smoking,/March, 1986 First, M.W. Environmental tobacco smoke measurement: retrospect and prospect. Eur. J. Respir. Dis. (Suppl) 133:9-16, 1984. First, M.W. Exposure. [Environmental tobacco smoke.] Eur. J. Respir. Disi. [Suppl] 133:13'7-139', 1984. First, M.W. Passive smoking. In: 1975Isymposium nicotine and carbon monoxide, proiceedings-I, University of Kentucky, 1977. pp. 173-175. First, M.W'., Hinds, W.C. Ambient tobacco smoke measurement (',letter). Am. Ind. Hyg. Assoc. J. 37'(11):655-65'6, 1976I. Fischer, T'., Weber, A. Passive smoking, in the work place. Soz. Praventivmed. 2S(6):401-406, 1980. (German) Fischer, T., Weber, A., Grandjean, E. Air pollution, due to tobacco smoke in restaurants. Int. Arch. Occup. Environ. Health 41(4'):267'- 280, 1978. (GermaniT Fletcher, C.M., Dionovani, J.W., bawther, P.J., Waliler, R.E., Ball, R.P. Pipe, and cigair smoking: the report of an expert group appointed by action on smoking and health. Practitioner 2101(1!259 )1:6'45-6'52, 1971. Foliart, D., Benowitz, N.L., Becker, C.E. Passive absorption of nicotine in airline flight attendants (letter). N. Erngl. J. Med. 3081(,18 ) :1105', 1983. Foote, K. D. Children's coughs related to parental smoking (letterY. Br. Med. J. [',Clin Res] 23:2'88(16434):1917, 1984. Fortmann, S'.P., T'. Rogers, and K. Vranizan, et al. Indirect measures of cigarette use: Expired-air carbon monoxide versus plasma thliocyanate. Prev. Med., 13:127-35, 1984. Foster, SI. Stmoke and heat (letter). N. Engl. J. Miedi. 293(l):48, 1975. Frank, R. , Lebowi~tz, M. D. The risk of staying in ( editorial ). Am,. Rev. Respir. Dis. 124(5):521-522, 1981. Fredieriksen, Li.W'., Martin, J'.E. Carbon monoxide and smoking behavior. Addict. Behav. 4(1):21-30, 1979. Freedman, A.P. Small-airways dysfunction in passive smokers (letter). N. Engl. J. Med. 303'(7):393, 1980. Freimanis, A.K. Smoke and heat (letter). Ni. 2'93(1):48, 1975. Ezgl. J. Med'. ~ 0 Friedman, G.D., Petitti, D.Bi., Bawol, R.D. Prevalence and' U1 correlates of passive smoking. Am. J. Public Health 7'3(4):401-405',(7) X ~ 18 r ~ N C - 10.
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Bibliography on Involuntary Smoking/March, 1986 Lenfant, C., Liu, B.M. (Passive) smokers versus (voluntary) smokers (editorial). N'. Engl. J. med. 302(13):742-743, 1980. Letzel, H.W., Johnson, L.C. The extent of passive smoking in the Fedleral Republic of Germany. Prev. Med. 13(6'):717-729, 1984'. Lewis, O.D. Establishing smoke-free environments. In: Ramstrom, L.Ml. (ed.). The smoking,epidemic, a matter of worldwide concern. S'tockholm : Almqvist & Wiksell International, 1979. pp. 255-259. Liard, R., Perdrizet, S., Reinert, P. Wheezy bronchiltis in infants and palrents'' smoking habits (letter). Lancet 1( 8267 ) : 33'4-33'S, 1982. Lindell, S.E. Passive smoking. In: Ramstrom, L.M. (,ed.). The smoking epidemic, a matter of worldwide concern. S'tockholml: Almqvist & Wiksell International, 1979. pp.5'7-59'. Lindesmith, L.A. Clean indoor alir--a fight for rights for health--not unwarranted government intervention. Wis. Mled. J. 78'(',11) :12-13, 1979. Litzinger, E.F., Miatti~na, C.F., Bush, L.P. (,eds.). Formation, analysis, and composition of tobacco smoke. Proceedings of the 36th Tobacco Chemists'' Research Conference, Raleigh, North Carolina,, October 24-27, 1982. Recent Adv. Tobacco, Sci. 8':1-185'. Liu, Y.-Y., Schmeltz, I., Hoffmann, D. Chemical studies on tobacco smoke. Quantitative ana-lysis of'hydrazine in tobacco and cigarette smoke. Anal. Chem. 46(7'):885-889, 1974. Lloyd, D.S'. Connecticut's clean indoor, air act. J'. Public Health Policy 2(2):153!-157, 1981. Loeb, L.A., Ernster, v.Li., Warner, K.E., Abbotts, J., Laszlo, J. Smoking and lung cancer: an overview. Cancer Res. 4!4(112'P't 1):5940-59,58, 1984. Longo, L.D. Some health consequences of maternal smoking: issues without answers. Birth Defects: Original Article Series. 18I(,3A) :13-31, 1982. Longlo, L.D. The biological effects of'carbon monoxide on the pregnant woman, fetus, and newborn infant. Am. J. Obstet. Gynecol. 129(1):69-103, 1977.. Luck, W. , Nau, H. Nocotine and cotinilne concentrations in, serum and urine of infants exposedi via passive smoking or milk from smoking mothers. J. ediatr. 107(5):816'-8'20, 1985. Luck, W'. , Nau, H. EScposure of the fetus, neonate, and' infant to nicotine and cotinine from maternial smoking. 37 nursed N (letter). ~ D-3 7
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Bibliography on Involuntary Smoking/March, 1986 Holsclaw, D.S., Jr., Topham, A.L. The effects of smoking on fetal, neonatal, and childhood development. Pediatr. Ann. 7(3),:105-136, 1978. Holt, P.G., Turner, K.J1. Environmental tobaicco smoke. Effects in humans. 'Respiratory symptoms in the children of smokers: an overvi'ew. Eur. J. Respir. Dis [Suippl. ] 13'3:10'9-20, 1984. Holt, P.G., Turner, K.J. ETS--environmental tobacco smoke, Report from a workshop on ffects andiexposure levels. March 15- 17, 1983, Switzerlandl. Eur. J. Respir. Dils. [Suppl] 133•1-152, ~ 1984. . Holt, P.G., Turner, K.J. Nonsmoking in hospitals, AMA Council on Scientific Affairs. Conn. Med. 4!8(5):2'97'-305, May 1984. Holzer, G., Oro, J., Bertschl, W. Gas chromatographic-mass spectrometric evaluation of exhaled tobacco smoke. J. Chromatogir. 126:771-785, 1976. Horn, D. Smoking and disease-what must be done. WHO C'hroni. 31:355-361, 1977.. Horning, E.C., Horning,, M.G., Carroll, Di.I., Stillwell, R.Ni.,. Dzidic, I. Nicotine in smokers, non-smokers and'room ai'Ir. Life Sci. 13(10):13'31-1346, 1973. Hosein, H.R., Corey, P. Multivariate analysis of nine indoor factors on FEV1 of~ caucasian children (~a~b~~st~ract).~ Am,. Rev. Respir. Dis. 129'(4 Pt 2):A1401, 1984. Hosen, H. Tobacco sensitivity (letter). Ann. Allergy 29111) : 608!-6109 , 1971. House, R. The health effects of involuntary exposure to tobacco smoke. Health Studies Service, ©ntairio Ministry of Labour, June 19851.. Huber, G.L. Small-airways dysfunction in passive smokers (,letter). N. Engl. J. Med. 303(17):3'92'-3'91, 19'80~. Huber, G.L. Smoke and heat (letter). N. Engl. J. Med!. 2'93(1):48-49, 1975. Huber, G'.L. Smoking and nonsmsokers - what is the issue? (leditori~ali) N. Eng,l. J. Med. 292(16):858-859, 1975. Huch, R., Danko, J., Spatling, L., Huch, A. Risks the passive smoker runs (,letter). Lancet 2(8208-8209):1376, 1980. Huglod, C. Passive smoking. Ugeskr. Laeger 143'( 3'4 )• 218'1-2184, 1981. (Danish) Hugod, C. Indoor air pollution with smoke constituients: An 28 i D-28
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Bibliography on Involuntary Smoking/March, 1986 74, 1961. (,French) Morgan, P'.Pi. Time for action on passive smoking. Can. Med. Assoc. J. 1'27( 9):8'10-8!11, 1982. Morgan, W'. J., Taussig, L.M. The chronic bronchitis complex in children. Pediatric Clinics of North America 31(4):851-864, August 1984. Morimoto, K., Miura, K., Kaneko, T.,, Iijima, K., Sata, M'. Koizumi,, A. Humanihealth situation and chromosome alterations: sister chromatid!exchange frequency in lymphocytes from passive smokers andl patients with hereditary diseases. Basic Li~fe S'ci. 29, Pt 8:801-811, 19841. Morozov, V.V. Harm of passive smoking (material for talks')i. Feldsher Akush. 47(2) :57-5&, 198'2. (Russian), Mossman, P.B. A smoking argu¢nent ('letter) . J1. Occup. Med. 25(12):81, 1981. Mozherenkov, V.P, Finkelberg, E.I. Kurenie Tabaka i Organ Ereniia. Smoking and the organ of vision. Vestn. Oftalmol. (2):66-68, 198I4. (Russian) Muir, D. Tobacco smoke inhalation. Scand. J'. Respir. Dis. Suppl. 91:44-46I, 1974. Muramatsu, S., Muramatsu, T., Weber, A. A survey on attitudes towards passive smoking among schoolchildren and students in Switzerland. Soz. Praventivmed. 28(2):82-84, 1983. Muramatsu, M. , Umemura, S~. ,©bcadia, T., Tomita, H. Estimation of' personal exposure to tobacco smoke with a newly developed nicotine personal monitor. Environ. Res. 3'5(1)218-227, 1984. Muramatsu, T., Weber, A., Muramatsu, SI. , Akermann, F. An experimental study on irritation and annoyance due to passive smoking. Int. Arch. Occup. Environ. Health 51(4):305-317, 1983.. Myers, M.G., Fomon, S.J., Koontz, F.P.,, McGui'nness, G'.A.;, Lachienbruch, P.A., Hollingshead, R. Respiratory and gastrointestinal illnesses in breast- and formula-fed infants. Am. J. Dis. Child'. 138(7')1:629-6I32', 1984. Nadkarni, R.A. Some considerations of metal content of' tobacco products. Chem. Ind. (17):693-696, 1974. Nagday N.L., Koontz, M.D. Microenvironmental and total exposures to carbon monoxide for three population subgroups. J. Air Pollut. Control Assoc. 35(2'):134'-137, 1985. Nahum, L.H1. Toxic prodiucts in cigarette s:noke: pleasure or 41 D-41
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CHART II: MAJOR PROVISIONS OF CALIFORNIA' LOCAL StdORZNG ORDINANCES COi POPULATION YEAR/MONTH WORKPLACES ENACTED REGULATED RETAIL RESTi1URA;YTS'. ST1aRES' Nr.,places regulating: 66: 54 62' Antioch 46,600 1985/11 All 4+ A11Bus. 40Z 50+ + Berkeley 1'06y500 1980 All A17Bus. 504' All Brentwood 5,150 1985/111 All 4+ A11Bus. 40% 50+ Carlsbad' 44',550 1983/0fO' All ('.1] Yes NoZ 20ir Carpi'nteria 11,400' 1985/03 All Chula Vista 90,300 1984 All [1] Yes NoZ 20+ Clayton 4,490 1985/11 All 4+ A'lil!Bus. 40'. 50+ Concordi 105,000 . 1'985/'11 All 4+ -A11Bus. 40T 50+, Coronado 90,300 1984/08 A1'1 [1]i Yes No»'20+ Cupertino 33,,950 1985/02 Ofc.Wkpd. Yes 30Z 50+ Damvil'1e 27,600 1985/11 A11 4+ A11Bus,. 40» 504 Del Mar 5,125 1983/06 All (1'] Yes; NoZ 20+ El Ca jpa 80;100 1'985' All , 5+ Yes NoA 20+ El' Cerrito 23,300 1'98511i1 All 4+ A11Bus. 4'02 50+ Escondido 75:,,800 1983/12 A'1'1, (',1 ]' (8] Noz 20+ + Grand Terrace 9,875 1985/11 All [6] Dept. 25% 50+ Hemet 28,050 1985/05 All C17 [i11, No7r 50+ Hercules 7;300 1985/10 All 4+ A'1'1'BUs.40z 50+ ++ Huntington Beach 179,900 1'986/02' A11,4,r 252 50+ Imperial Beach 24,550 1985/10 All (1), Yes No' 20+ Indic 28,,200 1!985/11'. A'11 (16 ] Dept. 50~ 50+ La Mesa 52,200' 1984/02 AS1'(1) Yes Noi 40+ Lafayette 22,500 1985/10 All 4+ A11Bus,. 40Z 50+ Laguna Beach 18;450 1985 Ofc.Wkpl. 25: 40+ Livermore 52,100 1'985/06 A11 A1iliBus. 501. Long Beach 381,800 1'985/07 A'1'1 5+ 25' SO+, + Los Altos 27,400 1'979 All Yes 25Z',50+ Los Angeles 3,,144,800i 1984/11 All 5+ Los Gatos 27,750 1980/06 A1'1, Yes 50S 25+ Martinez 250300 1985/11' All 4+ A11Bus. 40% 50+ Milpitas 41,850 1'985/08 A1l' A'l.118us. 50'» Mountain View 611,600: 1984/06 All A11Bus. 50Z Nat'ionalCity 51;,,200 1984L05 A11, (11 ]I Yes Noz, 40+ Newport Beach 66,1KJ0~ 1985/06 Oft. > 4 25% 50+t Oceanside 91,800 1983 All [1] Yes No7. 20+ • Orinda 1'5,000 1985/12' All 4+ A'i1Bus.40S 50+ Palo-AStw 56,200 1983/'110i Ofc.Wkpl. 1/3 50+ Pasadena 126,600 1984 Of;c.Wkp1'_ 25Z ' 50+~ Pinol~e~ 1f+„550 11985I11~ A'1'1, 4+ A11Bus. 40:~ 50,. Plttsburg, 38,600i 1985/11 A11 4+ A11Bus. 40' 50* Poway 35,950 1983/03' All [1] Yes No : 20+ + Rancho Mirage 7,575 1986/02' All [IlJ Yes Yoa 20+ RicHmond 76,900 1'985/09 A11 4+ A1iliBus. 40x 50+ Riverside 183,400 1'985J05 All (6J Dept. 25Z 50+ Sacraoento 875,900 1985' All (1]', Yes 10% 50+ San Diego 971,600 1982/12 All (1] Yes NoZ'20;. San Francisco 71'9,2001 1983/11 Ofc.Wkpl. San Jose 696,000 1984' A11' Yes 30: 100t San Lub's Obispo 37,150 1985/12 A11 5+ NoZ 50+ San,"larcos 19,800 1983il03 All (1) Yesi Noi 20+ San Pablo 21,200~ 1985/10 All 4+ Ai1Bus. 4'0A'50+~ San Ramon 23,4'50, 1985/11 A17, 4+ A11Bus. 40% ',50+ Santa Barbara 327,200, 1984 All 25: 20+r Santa Clara 89,000 1985/07' a1D Yes 30% 50+ Santa hlonica 93,100 1985/04 All 6+ Santee 49,500 1'983/02 A11.[1] Yes NoZ 20+ Tustin! 40,800 1985/12 All (1], Yes No2 20++ Ukiah 13,050 1981/07 All Yes 502 Vista 43,450~ 1983/04 All (1] Yes No. 20+ Walnut C'reek 57,700 1985/11 All 4+ A11Bus,. 40X 50+ Yorba Linda 36,100 1985Jd9' All 11'+ Yes 1/3 40+ County of Contra Costa 139,800 1985/09 All 4+ A1!liBus. 402 5G1+ County af. R^_versd.de 323,500 11985 ' All (.61 Dept. 25+ 50+ County of' Sacramento543, 500 1985/02.All, (' 1]' Yes 1'OZ~50;r County of'San Diego, 406,100' 1982/12 A11 (7) Yes 44 20+ County of Santa Cruz 1'21 300 1985 A'1!1 Yes No ~I , Populati'nn covered 11,296,065 Percentage of state: 44 '. (3/1/86): C-5
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Bibliography on Involuntary Smoking/March, 1986 Parents" cigarette smoking andichildhood cancer. Med. Hypotheses 12'(l):17-20, September, 1983. 1Grufferman, S., Wang, H.H., DeLong, E.R., Rilmm, S'.Y.S., Delzell, E'.S., Fallettal, J.M. Environmental factors in the etiology of rhabdomyosarcoma in childhood. JNCI 68(1):107-113, 1982. Grundmann, E., Muller, R.-M., Winter, K.D. Non-smoking wives of heavy smokers...risk of lung, cancer (iletter),. Br. Med. Ji. 282(16270):1156, 1981. Guerin, M.R. Detection of sulfur-containing,compounds in the gas phase of cigarette smokes. Anal. Lett. 4(11):7'51-759, 1971. Guillerm, R., Hee, J. Effects of nonoccupational air pollutants upon the tracheobronchial mucosa (except bronchial cancerJ. Bronicho-Pneumologi~e 2'6'(1) : 3-22', 1976. ( F'rench) Gulovali, M.C'.,~ Guniduz~, C. T~r~ac~~e~ e~le~~ment~s~ in Tur~k~~ilsh tob~ac~co~ determined by instrumental neuron activation analysis. J. Radlioanal. Chemi. 78(1):189-198, 1983. (Turkish). Gunby, P. Wives'' ischemic heart disease linked with husbands' smoking (newst. JAMA 2'53 ( 20 ): 2945 , 198'5. Gutenmann, W1.H., Lisk, D.J., Hoffmann, Di., Adams, J.D. Selenium in, particulates and gaseous fractions of smoke from cigarettes prepared from tobacco grown on fly-ash-amended soil. J. Toxicol. Environ. Health 12r2-3):385-393, 1983. ft . Gutenmann, W.H., Bache, C.A., Lisk, D.J., Hoffmann, D., Adams, J.D., Elfving, D.C. Cadmium and nickel in smoke of cigarettes prepared from tobacco cultured on municipal sludige-amendedisoil. J. Toxi~col. Environ. Health 10(3):423-431, 1982. Guyatt,, G.H., Newhouse, M.T. Are active and passive s'mokingi harmful? Determining causation. Chest 88(13):445-4'51, 1985. GGvozdjakova, A., Kucharska, J., Sany, L., et al. Effect of smoking on the cytochrome and oxidase system of the myocardiuan. Bratisl. Lek. Listy 8'3('1):10-15', 1985. (Czech) GNozdjakova, A., Kucharskai, J, Sany, L., et al. The effect of cigarette smoke on cytochrome-oxidaise of the heart muscle. Cor Vasa, 26 (,6 ) : 4!66-4618, 1'984 . Haagien-Smit, A.J., Brunelle, MI.F'., Hara, J. Nitrogen oxide content of smokes from different types of tobac o. A.M.A. Arch. Indust. Health 20:399-400, 1959. Halfpenny, P.F., Starrett, P.S. Control of odor and'irritation due to cigarette smoking aboard aircraft. Am. Soc. Heat Air Cond. Eng. ,7. 3 : 3'39-344, 1961. 22. 0
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Proposition P: anat©my of a nonsmokers' riigbtss ordinance hF:TL'R I IANAI'JCR', t:SQ On Norember 8, 1983, voters in San Francisco passed', "Proposition P;' a referendum on the city's workplacc smoking ordinancc which ha& bccn cnacted by the Board! of Supervisors (uht .~tquivalcnt of a city council) six months earlicr: The vote matkt:d the first' time t'hao the tobacco iitdustry, which has consistently opposed all laws rcgulatin,g public smoking, hud' been defeated in such an election contiest, and it meant that San, Franciscans had approved what was thenithc strongest workplacc smokiitg lsw in the country. The ordinance reyuires that all public and private offcc~ workplaces havc policies on, smoking that seek to accommodate thc nct:ds of smokers and nonsmokcrs. it requires that notice of the policies bc giNCnto employacs and that appropriate signs be posted. The'law is enforccd by the citry's health department, and civil penalties are imposed on employers who fail to establish rcasonable policiies. WINNING OVER BusINESS' LEA4DERS To~understand why the'ordinance reached the ballot in the forrnlof a referendum, it is helofullto review the proctss by which it became law: VlJhen first i'ntroduced before a threie-member committee of the Board of Supervisors, in January i'983, the'ordinantx was stroogly supported by Californians fmr Nonsmokers' Rights (a non-profit orga- niYationdeveloping legislative, legal; and eduealtional ap- proaches tocurtail'smokiieg in ipublic places a~nd the work- site) land by the health cqmmuni'ty ingenerai. It drew vir- tually, no opposition. But by the end of the second hearing,, the sympathetic committee had reservations abouu thee specific language; partly due to a, letter from Robert Beck„ a Bank of Arnerica vice-presidbnt and a, leader in the 3merican Cancer Society. Although he expressed sbrong, support for the concept of the ordinance, Beck was con- cerned that the rigid conditions'of certain provisions would adversely affect businesses. The committee asked for a one-month continuance to see if' the problems eould' be : ironed out. On the day before the ne:tt scheditled hearing, the Chamber of Commerce asked for a meeting with Cal* iforrians for Nonsmokers' Rights to discuss an alternative proposal by the Bank of America. The bank presented the idca xltat became the corners3one of the ordinance and the center oficontroversy: that every'empUoyer be required!to establish, a smoking policy to satisfy the needs of' both smoking and nonsmoking office workers; but if an accom- modation satisfactory to the nons'mokers„whatever their number, could not be made, then smoking would be pro- hibited in that' work area. This proposal would give busi- nesses flexibility inisolving a problernl buvwould giveem- Ployeesa statutory right to a smokc+free environment. In cxchange for acceptiinS', the proposed compromise N r. Hanauer is an editorof law booki and r past-president of the :9oand o('.Di- reetoniof CGlifornians (or Nonsmokers' Riehts. Addi%swtreyponderee to d,y r: Hlanauer, Cal i(orntans for Nonsmokers' R~i 6hts, :*S4 Uni,ersn yA,e. Suiie 500, , 8arkelery. C A.9a7114 . language, the Chamber of Commerce agreed not to;oppose' the ordinance. The precise language was hammered out at one further meeting; attended by Supervisor Wendy Neldcr,. the author.of the ordinance, and representatives of'Calii- fornians for Nonsmokers' Rights; the Chamber of Com- merce, the Small Businessmen's Association, Bank of' America, and two othcr, banks. The ordinance was passed unanimously by uht; supervisors' committec in early May. In two reyuircdivotcs by the full Boardl the mcasure passed by 9 to12 and 10 to 1. It was signed into law by Mayor Dianne Feinstein on June 3. This happened despite intensive lobbying against the law by the'Del!Monte Corporation, a subsidiary of'RJ Rcynolds since 1'979, the localiattorney for the Tobacco instlitutc„and even some members of the na- t,ional Democratic Party who tried to persuade the Mayor to veto the law, In support of themeasure were hundreds of telephone ca11s and letters from San Franciscans. The Mayor later reported that she had recciveti more than 100 letters from people'around the country who urged her, to sign the ordinance so thaetheir local governing,bodies would be encouraged to enact similar legislation. Shortly before the first vote by the full Board, the Chamber of Commerce broke the agreement not, to oppose the ordinance. Since its promised neutral stance had'never been publiciied„thcChamber of Commerce did not appear to have changed its position. On June 1 S, siit people held a press conferencc to announce a campaign for a referendum: to repeal the ordinance. Having eonfrontedl the tobacco industry in Uwo statiewide initiative campaigns in 1'978 and 1980, proponents of the ordinance knew the real signlir, cance of' the announcement and were prepared for what followed. Each tobacco industry campaign, has certain predictable elt:ments, and the Proposition P carnpaigrt fol~ lowed the usual pattern: . The major cigarette companies, thrtatghi their public rela- tions arm„ the Tobacco Institute, hire a campaign manager, whose fursvtask,is toorgrnize a9ncal organizationlof "concerned'; oitizens,"'whicli'then becomes the nominal campaign organisa- tioa. In a ttormal'politial campaign„al group of people forms a steering committee : to act as a policy-making, body, and it,, in, turn, hires a campaign manager, The tobacco industry does ex- actly the opposite, because no grassroots or lor„ally financed or- ganizations opposed to nonsmokers' rights'ttogistation have ever been formed. Moreover, the industryseeks'total controliover pol- icy matters, and the way tolaccomplish that is to hire its own campaign manager. • The tobacco companies contribute to the campaign in di- rect proportion to their rapective market shares. This is a keyy indication thaith'e campaign is actually being run,by the indsu- tryitself-as a single entity-and not by theloeat'organization. • The tobacco companies go to great lcngths to downplay both the extent and nature of their involvement.,They denN that they are doing,any,thing other'uhanimaking financial! contribu- tions to a locaJ campaign organization and'they grossly undtres- timate the amounts of money they are,contributing. They also delay in making the largcst contributions until the end! of the JULY 19N5/NF.W YORK STATE JOURNAL O'F M1EDICINIE 3G9 B-I
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Bibliography on Involuntary Smoking/March, 198!6 problem of passive smoking. The concentration of smoke constituents in the air of large and small rooms as a function of the number of cigarettes smoked and of time. Int. Archiv. Arbeitsmed. 291(4):3I23'-339, 1972. (German). Harke, H.-P., Bleichert, A. On the problem of passive smoking. Int. Arch. Arbei'tsmedi. 29 ( 4): 312'-32'2, 1972. ( German ) Harke, H.-P., Liedl, W., Denker, D. The problem of passive smoking. II. Investigations of Cp level in the automobile after cigarette smoking. Int. Arch. Arbeitsmed. 33(3):207-220, 1i974'. ( German ) Harke, H.-P., Peters, H'. The problem of passive smoking. III. The influence of smoking on the C0 concentration in driving automobiles. Int. Arch. Arbeitsmed. 33(13):221-229, 1974. (German) Harlap, S., Davies, A.M'. Infant admissions to hospital and maternal smoking. Lancet 1(178'57):529-53'2, 1974. Harlap, S., Davies, A.M. Smoking in pregnancy and child development. Br. Med!. J. 2(15919 ):6101, 1974. Harmsen, H., Effenbergier, E. Tobacco smoke in public transportation vehicles, living quarters and work rooms. Arch. Hyg. Bakteriol. 141:383-400, 1957. ('German), Harris, J.E., DuMouchel, W.H. Non-smoking wives of heavy smokers... ri~sk of' lung cancer ( letter) . Br. Medi. J. 283 ( 6296I)1:915, 1981. Harris, J.L., Hayes, L.E. A 2'0 port sidestream collection system. In: Proceedings of the 35th Tobacco Chemists' Research Conference, Winston-Salem, North Carolina, 1981. Hasselbladl, V., Humble, C.G., Graham, M.G., Anderson, H.S. Indoor environmental determinants of lung function in children. Am. Rev. R'espir. Dis. 123(5):479-485, 1981. Hauth, Ji.C., Hauth, J'., Drawbaugh, R.B., Gilstrap, L.C., 3d, Pierson, W.P. Passive smoking and thiocyanate concentrations in pregnant women and newborns. Obstet. Gynecol. 63(4+:5'19-522,. 1984. Hay, D.R. Involuntary ssaoking. NZ Med. J. 86(601):526-52'S, 197'7. Haynes, R.L. Carbon monoxide poisoning from non-tobacco cigarettes. J. Med. Assoc. Ga. 72(8):553-555, 1983. He, Q.-Y. Bei-dlong Xi-yan yu, Fei-ai (Zeng-shu). Passive smoking and lung, cancer (a review). Chinese Journal of Tuberculosis and' 24' f_- C D-24
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Bibliiography on Involuntary Smoki'ng/March, 1986 experimental investigation. Prevent Med 13:582-588', 19'84. Hugod, C., Hawkins, L.H., Astrup, P. Exposure of passive smokers. to tobacco smoke constituents. Int. Arch. Occup. Environ. Health 42'('1) : 21-2'9, 1978. Hugod, C., Hawkins, L.H., Astrupi, P. Passive s:aoking--exposure to the gaseous phase and the particle phase of cigarette smoke. Ugeskr. Laeger 140(44)1:27'07'-2711, 1978. (Dan!ish). Hurshman, L.G. The effects of sidestream cigarette smoke inhalation on work capacity and cardiopulmonary measures among smokers and nonsmokers (dissertation). University of Arkansas, 1976. Diss. Abstr. Int. B 3'7(15):2I14'0-2141, 1976.. Hursh¢nan, L.G'., Brown, B.S., Guyton, R.G. The implications of sidlestream cigarette smoke for cardiovascular health. J. Environ. Health 41(3):145-149,, 1978. Huynh, C.K., VuDuc, T., Debonnevile, C., et al'. Indoor poTluition, by polycyclic aromatic hydrocarbons in tobacco smoke. Sozial' un Praeventivmedizin 29:201'-202, 1984, French. Imrie, B'.Wi. Smoking dangers ( letter ). New Scientist 59'( 862'J':582, 1971.. Iverson, U.T. Smoke and heat ('letter),. N. Engl. J. Med'l. 293(1):47, 1975.. Iwainsky, H'., Winsel, K. Damage factors in tobacco and tobacco smoke. Z. Erkr. Atmungsorgane 1S7(',1):90-102, 1981. (,German) Jackson, D.L., Menges, H. Accidental carbon monoxide poisoning,. JAMA 2 4 3( 8): 77'2-7 7'4 ,, 1980. Jaeger, R.J. Carbon monoxide in houses and vehicles. Bull. NY Acad. Med. 57(10):860-872, 1981. Jaffe, L.S. Sources, characteristics, and'fate of atmospheric carbon monoxide. Ann. NY Acad. Sci. 1!74(Art. 1)1:76'-88', 1970. Jansen, E. Passive smoking,(letter). Tidsskr. Nor. Laegefor. 94 (19/20 ) :128'4-12'85I, 1975. Jarvis, M.J. Serum thiocyanate in passive smoking,('letter). Lancet 1i ( 8421)1:169, January 19, 1985. Jarvis, M.J., Russel, Feyerabend, C., Eiser, J.R., Morgan, M., Gammage, P., Gray, E.M. Passive exposure to tobaccoismoke: saliva cotinine concentrations in a representative population sample of non-smoking school children. Br. Med. J. Clin. Res. England, 291 ( 6500 ):92'7-IS'SN 02617-0623', Octo er S, . 29 ID-29'
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Bibliography on Involuntary Smok~~irng/Marchl, 19~,86' I controlled smoking areas and Health Department attitudes. Hawaii Med. J. 39(1),:7-10,1980. Marwick, C. Effects of 'passive smoking' lead nonsmokers to step, up campaign ('news T. JAMA 2'53 ( 2A ): 29'37-2939', 19851. Mason, R.Ji., Buist,, A.S'.; Fisher, E.B.; Merchant, J.A., Samet, J.M., Welsh, C.H. Cigarette smokingiand health. Am. Rev. Respir. Dis. 132(5):11331-1136, 1985. Matsukura, SI., Hamada, H., Seino, Y., et al. Passive smoking,.. (Letter). N. Engl. J. Med. 312(i11):720-721, 1985. Matsukura, S~., Taminato, T., Kitano, N., Seino, Y., Hamada, Hi., Uchihashi, Mi., Nakajima, H., andiHiralta, Y. Effects of environmental tobacco smoke orn urinary cotinine excretion in nonsmokers: evidence for passive smoking. N. Eng. J. Med., 311(13 ) : 8'28!-8'32, 1984. Matsu¢nura, T., Muramatsui, S. Study of formaldehyde concentratilon in indoor air. PPM 14(L1):2-9, 1983. (Japanese) Matsushita, H., Mori', T., Goto, S. An improved method for measurement of N-nitrosami!nes in sidestream smoke from, cigarets and'its application to Japanese and foreign cigarets. Tai~ki Osen G'akkai shi 18 ( 4): 3'39-3'45', 1983. ( Japanese ). Mau, G., Netter, P. The effects of paternal cigarette smokingion perinatall mortality and the incidence of malformations. Dtschi. Med. Wochenschr. 99, (21):1113-111i8, 1974. McCartney, R.A. Breathing other people's smoke (letter). Br. Med. J. 2 (6138):700, 1978. McCusker, K., Hiller, F.C., Wilson, J.D., et al'. Aerodynamic sizing of tobacco smoke particulate from, commercial cigarettes. Arch Environ Health 38:215-218, 1983. McLean, A.E.M. Blood and urinary nilcotine in non-smokers (letter). Lancet 1(17903):402, 1975. McLeod, K.W., Pinder, J.E'.; Watts,, J.R. Contribution of a nuclear fuel chemilcal separations facility to the plutonium content of aa tobacco crop. Health Phys. 461(6):120'5-1211, 1984. McMichael, W.C. Tobacco Smoke and Energy Conservation. Building Systems Design. Oct/Nov 1973. McMurray, R.G., Hicks,, L.L., Thompsoni, D.L. The effects of passive inhalation of cigarette smoke on exercise performance. Eur. J. Appl. Physiol. 54'(2):1!96-200, 1985. McNall, P.E., Jir. Building ventilation measurements, 39 D-391
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Bibliography on Involuntary Smoking/March, 1986 Soz. Praeventivmed. 20(5):213, 1975. (German) Joffe, J.M. Inf'luence of drug exposure of the father on perinatal outcome. Clin. Perinatol. 6(1):21-3'6, 1979. Johansson, C.R. Tobacco smoke in room ai~r - an experimental investigation on odor perception, and irriltating effects. Build. Serv. Eng. 43:2'54!-262, 197'6'. Johansson, C.R., Ronge, H. Acute irritation effects of tobacco smoke in room air. Nord. Hyg. Tidskr. 416:45-5i0, 1'965'. (SIaedish) Johnson, L.C., Letzel, H.Wi. Measuring passive smoking: Methods, problems, and pierspectives. Prevent. Med. 13:705-716, 1!984'. Johnson, W.R., Hale, R.W., Clough, S.C. Formation of molecular nitrogen by a burning cigaret. Nature (Londbn) 244(5410):51-52, 1973. Johnson, W.R., Hale, R.W., Clough, S.C., Chen, P.H. Chemistry of the conversion of nitrate nitrogen to smoke products. Nature (London), 243(5404)1:22'3-225, 1973. Johnson, W.R., Hale, R.W., Nedlock, J.W. Aliphatic amides in cig;aret smoke. Tob. Sci. 17:73, 1973. Johnsom, W.R., Ha1e, R.W., Nedlock, J.W., Grubbs,, H1.J.,, Powell, D.H. The dlistribution of products between, mainstream and side- stream smoke. Tob. Sci. 17:141-144, 1973. (Pub. in Tobacco 175(21):43-46.) Johnstone, R.A.W., Plimmer, Ji.R. The chemical consti'tuemts of tobacco and tobacco smoke. Chezn. Rev. 59:885-936, 19,59. Jonderko, G'., Kbnca, A., Kwiatek, R., Marcisz, C., Neumann, M. Hypersensitivity to tobacco antigens in smokers and nonsmokers. Allerg. Immunol. (Leipz.) 28(3):187-191, 11982. (German), Jones, J.R., Higgins, I.T.T., Higgins, M.S4., Keller, J.B. Effects of cooking fuels on lung function in nonsmoking women. Arch. Environ. Health, 38(4):2'19-222, 1983. Jones, J.W. Adverse emotional reactions of nonsmokers to secondary cigarette smoke. Environ. Psychol. Nonverbal Behav.. 3(2):125-127, 1978'. Jones, J.W., Bogat, G'.A. Air pollution and human aggression. Psychol. Rep. 43'( 3' Pt 1i ):721-722, 1'978. Jones, R.M., Fag,an, R. Carboxyhemog,lobi!n in nonsmokers. A mathematical model. Arch. Envilrion. Health 30(4')•18'4-189, 1975. Jones, R.M., Faigan, R. Application of mathematical model for 31 D -3I1
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Bibliography on Involuntary Smoking/March, 1986 Ni. Engl. J. Mied. 311(101) :672, 1984!. Luiquette, A.J. Some immediate effects of a smoking environment on children of elementary school age (idoctoral dissertation). Texas A & M University, Graduate College, College Station, Texas, 1'969. Diss. Abstr. Iint. 301(12 Pt 1):5271-A. Luiquette,'A.J., Landiss, C.W'., Merki, D.J. Some immediate effects of a smoking environment on children of elementary school age. J. Sch. Health 4'0(10):533-536, 1970. Luquette, A.J., Merkii, D., Landiss, C'., Giamm, S.S. Some physiological reactions iin children from smoking and non-smoking homes to a smoking environment. AAHPER Southern District Proceedings, 1971. pp. 1!03-104 . Lynch, C.J. Half-liives of selected'tobacco smoke exposure markers. Eur. J. Respir. D'is. (Suppl.J 133:63-67', 1984. MacDonald, E.J. Non-smoking wives of heavy smokers ... lung cancer (letter). Br. Med. J. (Clini Res) 283(162'96):915'-91!6, 1981. MacDonald, E.J. Non-smoking wives of heavy smokers ... lung cancer (letter). Br. Med. J. ('Clini Res) 283(63'D4)1:1465, 1981 Main, D.M., HoganiT.J. Effect of cigarette smoke on formaldehyde data (lietter),. J'. Occup. Med. 26(6):4!11, 1984. Manchester, D.K., Jacoby, E.H. Sensitivity of human pl'acental monooxygenase activity to maternal smoking,. CZin. Pharmacol. Ther. 30(5):687-692, 1981. Manning, D.L., Maskarinec, M.P., Jenkins, R.A., Marshall, A.H. High performance liquid chromatographic determination, of selected gas phase carbonyls in tobaiccoismoke. Ji. Assoc. Off. Anal. Chem. 616(1):8-12, 1983. Mantel, N. Epidemiologic investigaitions: care in conduct, care in analysis, and care in reporting (editorial). J. Cancer Res. Clin. Oncol . 10'5( 2):113'-116, 1983'.. Mantel, N. Non-smoking,wives of heavy smokers ., risk of lung cancer-(letter). Br. Med. J'. (C1in Res) 2!83(6296):914-915, 1981. Markiewicz, K. Passive smoking. Harmfulness of passive inhalation of smoke from cigarettes smoked by others. Pol. Tyg. Lek. 25'(52):2041-2042'. 1970. (Polish,) Martell, E'.A. A1pha-radiation dose at bronchial bifurcations of'f smokers from, indoor exposure to radion progeny. Proc. Nat1. Acad. N Sci. USA 80:128'5-1289, 1!983. Q Marvit, R.C., Rigney, K.B., Yost, F.N. A vood!neighbor policy: ~I ~. 38 ~ ~ ~. N D-38 C
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C f LIE #1: I I I lil~e/ /.l 9rl U~ iM Ttibexo ibr.r/Y oM Corl iMt /rl~aettlr ~ b at tfl ilrtloC tsn.ae. ww. lw.r..oro. rn.-r.w+w~n s... t~~ . Ttu'tonscco liaduslrY 71ed sbout povenrmeat't rote In rnloroinq iPropoation iP. I The toeuto ardastary li.d iemd +rse,i3 sthCad'btt, Pn aerpmud .....w ....w.yv...~w L~~ I ll T funQS CxtO'wOusUY 6td sUOUt ltae'use af Du01it LIEI #5: LIE #61 TtstltottaetO!admy Ibe laooa wrrptan disurai. tw.'n..~m~..x.rrK~...o ..a.....~.ns...a..~..,.a tMtrC 0. PY W~. ~/ .IIf.Vw OiiMw9~w'.wTOW~C~ ~.~•. w...~r ~.Lw~L.~..W.. Trie'tabacoo Industry Ilrea IsDOut emploYet oxqaia• ap nqpts. ''~  Tl+e tmsoeo liatl6s~ Iied at0ort itlfat~ AaaneY's i` f.7ii  a~..~+.+n..nm.aa+., ..r..~ ,....r•...... v.... LI1E #8: Ll E ' LIE. #10: I Ttte tobacca' laeustrY Ned aAaut the eftects of'sea onQ-lliad IIoOaCia!sttlate: TAe tatbow Nrlr.>nYIt1.llseerA tts yelttioas. ...., ..e.~.,,w.~.d.....~ .....d~.b.. ~nart.,u.......o.~w.er~, a+.. t....:........... .. f .~. The tuascto mduoY he'tl sAorA ftlowt wpport. 374 NEW YO'RA STnTI: JIO'UR"Vnd- OF N1FtDIICINE/J'UllY 1985 B-6' ..,.,...~...>o. ~. d ~..._...~.e.. s.lMawrawtn.ero~aslrn~.n wewa~e. /.ww I..'ui7sL~aa.f.~.r Iw r ~..ww~ar~ 1e w...r ae~ U W(hme ~ w w ert .. ProDOStoan P is n eatuety' TaUTH: 'Uq-entors,nq tme: ~Q I.~.~.PdOQ091S0a/~dOESOf11f:7YA!'~s~I0flY~el ' ie ~'.CIIQIpfeE{li4d00{ aQ Rail'~ IqoYMOaleat ~. itiors..om~erw.aeul..aww. aimn~oam~r.e~ S-:.N- . rI ¢1.~~~.Ar ~a~a.. NO..~4'OMYiJVW~Y~7 1~... ~.~~o.. ~....'wnw.. ~...~+.....S.Y A. , THUN: ProtpLlwn P wu lcosf aotlwtq to ttre lupayac' '/'@~ /"~'{~. theposirre iP aoa eat ttroaab s sav 'saf. ,,.rt~fap arra>a~urear ~~ . . . VpViw./ P'&naEeaa emDlrrnes Uaqaunaq nqa13 I If71IM` The Cify AtlereeN.ill raat ' . .1 , P I . . , q• Ae..u...'..n.w..~....w.._.a,.... rn.Gw,ro... ....ae....a~..*..o.-,,.w.v~.~., woe~w.~. ..rr..mw~.waw I Seovid-tuM uaoke Ina qe CeadlYl r THUM: ITfr roAooe YrdrstrY Aad to Ipq, ifsiaefl0wwts f6 ptt Pre~ralbtrP m tM lYia ~. L.,~.....~.....a.~.., _... .rrwN~~®re.+w.w~w~~arw.o tr..l. ~MI.7mawr.pY.ww..s~.~.. w~a~ro~ tw. w.a.a~..~r la NS Om ie y~ ..q...w nq ~r o.v Iw Y. F..ee.~~e.w ee. w. qr.. ~ ..me.0'. Pvwi.ro+aa...a.a»rawrw.~ ~//~]. ~. TAe+t rs,MfM appo~bm to 111 N ~ ii. Plvqaalan IP ....+.r .~0.Y n ~ iY.tw..... ~ ~....frw ~~ w.. ~.................. w ... C
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Bibliography onlInvoluntaxy Smoki'ng/March, 1986 poison ( editorial ). Conn. Med. 32'(,3') :15'4, 156, 19168'. Nat:ional Interagency Counci~l on Smoking and Health. Smokingiand' the Workplace. New York, NY: Business Survey, NI,CSH, 1978'. National Research Council (U.S.). Committee on Indoor. Pollutants. Indoor pollutants. Washington, D.C. : National Academy Press, 1981. National Research Council (U.S.). Committee on Medical and Biologic Effects of Environmental Pollutants. Carbon Monoxide. Washington, D.C'. : National Academy of Sciences, 1977'. Neal, A.D., Wadden, R.A., Rosenberg, S~.Hi. Evaluation of indoor particulate concentrations for an urban hospital. Am. Ind. Hyg. Assoc. J. 39(7):578-58I2, 1978. Neurath, G.B. Chemistry of biologically active components of tobacco and tobacco smoke. Planta Med. 22(3'):26'7-28'0, 1972. (German), Neurath, G.B. N'itrosamine formation from precursors in tobacco, smoke. IARC Sci. Publ. 3:13'4-136, 197'2. Neurath, G., Ehmke, H. Apparatus for the investigation of side- stream smoke. Beitr. Tabakforsch. 2(4):117'-121, 19,64. (Germani) Neurath, G., Dunger, M., Gewe, J: , Luttichl, W., Wi'chern, H. Volatile bases of tobacco smoke. Beitr. Tabakforsch. 3I(,9):5613- 569, 1966. (German) Neurath, G., Ehanke,, H., Horstmann, H. Influence of moisture content of cigarettes on the composition of smoke III. Beitr. Tabakforsch. 2(7):361-369, 1964. (German) Neurath, G'.,, Ehmke, H., Schneemann, Hi. The water content of' main and side stream smoke. Beitr. Tabakforsch. 3(5+:351-357, 1966. (German) Neurath, G., Krull, A., Pirmann, B., Wandrey, K. Volatile bases of tobacco smoke, II. Beitr. Tabakforsch. 3(9):571-5I76, 1966. ('Ge rman), Nichol, F.D. The revolt of a secondhandismokex. Lilfe and Health 79(10):16-17, 27,, 29, 31-3'2, 19614. Noonan, G. Passive smoking i~n enclosed public places. Med. Aust. 2(2):68!-70, 1976. Norman, V. The physical chemistry and fi~ltrati~on of cigarette smoke. Tabak J. Iint. 3':255-256, 1981. Norman, V., Ihrig, A.M., Larson, T'.M., Moss, B.L. The effect of 42 O C:. D-42.
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Bibliography on Involuntary Smoking/March, 1986 h Pershagen, G. Validity of'questionnaire data on smoking and' other exposures, with special reference to environmentall tobacco smoke. Eur. J. Respir. Di~s [SUppl. ], 133:76-80, 1984!. Pershagen, G., Consentino,, A. Discussion [ETS - Environmental tobacco smoke.] EUr. J. Respir. Dis. [Suppl.] 133:1'34-136, 1984. Pierson, W'.E., Covert, D.S., Koenig, J.Q. Air pollutants, bronchial hyperreactivity,, andiexercise. J. Allergy Clin. Immunol. 73(5 Pt 2):717-720, 1984. Pierzcha, W. Mechanism of'the restriction of pulmonary ventilation in workers exposed to mixed air polution. Wiad. Lek. 37 ( 20 ) :1!573!-158'0, 1984 . Pilmm, P.E., Shephardl, R.J., Silverman, F. Physiological effects of acute passive exposure to cigarette smoke. Arch. Environ. Health,33 ( 4 ) :201-213, 1978'. Pipes, D.Mi. Allergy to tobacco smoke. Ann. Allergy 3'(4):277- 282, 1945. Pirkl, F. Proceedings of the international symposium on medical perspectives on passive smokoing; opening address. Prev. Med!. 13':563',564, 1984.. Pittenger, D.J. Passive smoking (letter). N. Eng,l. J. Med'.. 312(11):720, 1985. Polak, E. Cigarette paper. Its role in pollution of dwellings. Passive smoking: the new concept refined'. Brux. Med. 57(8):3I35- 34'0, 1977. (French) Porstendorfer, J., Schraub, A. Concentration andl mean particle size of the main and side stream of' cigarette smoke. Staub- Reinhaltung der Luft (English version) 32(10):3'3-36, 1972'. Portheilne, F. Trifling,experiments (,letter). MMW'124(8):12-13, 1982. (German). Portheine, F. Psychophysical aspects of passive smoking. S'chriftenr. ZentralbS. Arbetismed. Arbeitsschutz Prophyl. (3):5'1- 7'0, 1976. (German) Portheine, F. Avoidable complex environmental evil: "'passive smoking". Erfahrungsheilkunde 21(5'):140-146, 1972. Portheine, F. The so-calledipassive smoking. Rehabilitation (Bonn)' 25(1)i:33!-3'4, 1972. (German) Portheine, F. "Passive smokinig"-nonsmoker protection. Medical Tribune 18:(unpaged), April 30, 19171. (German) 45 D-45
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Bibliography on Involuntary Smoking/March, 1986 smoking on pulmonary function in children. Environ. Iint. 37:151- 155, 1982. Lebowi~tz, M.D., Burrows, B. Respiratory symptoms related to smoking habits of family adults. Chest 69(1):48-510, 1976. Lebowitz, M.D. Airway responses of children to environmental irri~tants (,editorial). Lee, P.N. Passive Smoking,. Food Chem. Toxicol. 20(2):223-22'9, 198'2. Lee, F.N. Passive s:noking,(letter). Lancet 1(8275):791, 1982. Lee, P.N. Non-smoking,wives'of heavy smokers ... risk of lung cancer (letter). Br. Med. Ji. (Clin Res) 283(6304):14165-1466, 1981. Leeder, S.R., Corkhill, R.T'., Irwig, L.M., Holland', W.W., Colley, J.R.T. Influence of family factors on asthma and wheezing during the first five years of 1ife. Br. J. Prev. Soc. Medi. 30(4):213- 218, 1976. Leeder, S.R., Corkfiill, R.T'., Irwig, L.M., Holland, W.W., Colley, J.R.T. Influence of family factors on the incidence of lower respiratory illness during the first year of life. Br. J. P'rev. Soc. Med. 30 ( 4):203-212, 1976. Lefcoe, N.M., Ashley, M.J., Pederson, L.L., Keays, J'.J. The health risks of passive smoking. The growing case for control measures in enclosed environments. Chest 84(1):90-915, 1983. Lefcoe, N.M., Inculet, I.I. Particulates i!n domestic premises. II. Ambient levels and indoor-outdoor relationships. Arch. Envi~ron. Health 30(12):5165-570, 1975. Lefcoe, N.M., I'nculet, I.I. Particulates in domestic premises. I. Ambient levels and central air filtration. Arch. Environ. Health, 22:230-2138, 1971. Lehnert, G. Conclusion: the realm of the speculative (letter). MMW 12'4(4):19-2'0, 1982. (German) Lehnert, G. Sick by passive smoking? MMW 123(',40):1485-1488, 1981. (German) Lehnert, G., Garfinkel, L., Hirayama, T., Schmahl, D. , Uberla, K., Wynder, E.L., Lee, p. Roundtable discuission: symposium: medical pers!pectives on passive smoking. Prev. Med. 13(16):730-7'46, 1984. Lehnert, G., Wynder, E. L. Medical perspectives on passive smoking: foreward to passive inhalation. Prev. Med. 13:557, 1984. 36 r D-36
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Bibliography on Involuntary Smoking/March, 1986 standard for ambient tobacco smoke. Proceedings of the 3rd International Conference on Indoor Air quality and Climate, August 20"24, 1984 S'tockholmi. Repace, J.L., Lowrey, A.H. Modeling exposure of nonsmokers'to ambient tobaccoismoke. Paper presented'at the 76th annual meeting of the Air Pollution Control Association, Atlanta, June 19-24, 1983. Repace, J.L., Lowrey, A.H. Nonsmokers and cigarette smoke: a modified perception of risk (letterf. Science 215(4529):197, 191821. . Repace, J.L., Lowrey, A.H. Tobacco smoke, ventilation, and indoor air quality. ASHRAE Trans. 88(Bt 1)1:8915-914, 1982. Repace, J.L., Lowrey, A.H. Indoor air pollution, tobacco smoke, and public health. Science 2A8(4443):464-472', 19'801. Repace, J.L., Seba, D.B., Lowrey, A.H., andiGregory, T.W. Effect of negative ion generators on ambient tobacco smoke. J. Clini. Ecology 2:90-94, 19831-8'4. Repetto, M., Martinez, D. Benzopyrene from cigarettes and its urinary excretion. Eur. J. Toxicol. Environ. Hyg. 7(4'),:234-23'7, 19'7 4. ( F'r e nc h) Rickert, W.S. "Less hazardiouis" cigarettes: fact or fiction? NY State J. Mied. 83'(13):12'69-1272, 1983. Rickert, W.S., Robinson, J.C., Bray, D.F., Roers,, B., Collishaw, N.E. Characterizatiion of tobacco products: a, comparative study of the tar, nicotine,, and carbon monoxide yields of cigars, manufactured cigarettes, and cigarettes made from fine-cut tobacco. P'rev. Med. 14!(,2'):226-233, 1985. Rickert, W.S., Robinson, J.C., Collishaw, N. Yields of tar, nicotine, and carbon monoxide in the sidestream smoke f'rom 15 brands of Canadian cigarettes'. A:n. J. Public Health 74(3):228- 23'1, 1984. Robinson, B.F. Effects of passive smoking (letter). N. Engl. J. Med. 299(16):8196!-897, 1978. Robinson, S.A., Wolfe, S.M. Smoking: It's adverse effects on airli~ne piot performance. Public Citizen. Report by Health Research Group, Washington, D.C., April 1976. 52'pp. Roemer, R. Restrictions on smoking in the workplace. In: Roemer, R'. Legislative action to combat the world smoking epidemic. Roemer, R'. Geneva : World Health Organization, 1982. Restrictions on smoking, in public places. pp. 60-63. In: 499 D:-4' 9
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BibSiography o Involuntary Smoking/Marchl, 1986 specific U-nitrosainines in the smoke of selected cigarettess fromn the U.S.A., West Germany and France. J. Anal. Toxicol. 4'(',5') :25'5-259, 1980. Rummel, R.M., Crawford, MI., Bruce, P'. The physiological effectss of inhaling exhaledicigarette smoke in relation to attitude off the nonsmoker. J. Sch. Health 45(9):52'4-529, 19751.. Russell, M.A.H., Feyerabend; C. Blood and urinary nicotine inn non-smokers. Lancet 1('7900):179-181, 1975. Russell, M.A.H., Cole, P.V., Brown, E. Absorption by non-smokers of carbon monoxide from room air polluted by tobacco smoke. Lancet 1(,7803 ) : 5'76-5'79, 1973. Russell, M.A.H., Cole, P.V., Brown, E. Passive smoking,: absorption by non-smokers of carbon monoxide from room-air polluted by tobalcco smoke. Postgrad. Med. Ji. 49(57'6),:688-692, 1973. RRussell, M.A.H., Cole, P.V., Brown, E'. Absorption by nonsmokers of carbon monoxide from room air polluted by tobacco smoke. In: Edwards, G., Russell, M.A.H., Hawks, D., MacCafferty, M'i. (eds.). Alcohol depend'ence andismoking,behaviour. London : Saxon House/Lexington Books, 1976. pp. 183-190. Russell, M.A.H., Lebowitz, M.D. Effects on health. Eur. J. Respir. Dis. (Suppl.] 133:14A-142, 198'4. Russell, M.A., West, R.J., Jarvis,, M.J'. Intravenous nicotine simulation of passive smoking to estimate dosage to exposed non- smokers. Br. J. Addict. 80(2):201-2'061, 1985. Rutsch, M. Statistical support lacking (letter). MMW 124'(',4')•1'5, 19'82'. (Germani) ~ Rutsch, M. Non-smoking wives of heavy smokers ., ri'sk of lung, cancer (letter). Br. Med. J. 282(6268):985', 1961. Rylander, R. Environmental tobacco smoke and lung cancer. ~ Eur. J. Respilr~- D'is,. [Supp~~l. ] 133:127-133, 1984. Rylander, R. Workshop perspectives. Eur. J. Respir. Dis. [Suppl] 133:143-145', 19841. Ryland'er, R. The effects of tobacco smoke on nonsmokers. Med'. Hyg. 33(1i136'):2516-257, 1975. (French) Rylander, R. Perspectives on environmental tobacco smoke effects. Scand. J. Respir. Dis. Suppl. 91:79-87, 19'74. Rylander, R. (ed.). Environmentail tobacco smoke effects on the non-smoker. Report from a workshop. Scand. J. Respir. Di's. 51 D-51
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v 2025684230 ----- - - --------------------------------------- Ir.
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Bibliography on Involuntary Smoking/March, 1986'. Cond. Etrg. Trans. 75.93-10'2, 1969. Pachman, J.S'_, Frederiksen, L.W. "Yes I1 do mind"; social skills training,for nonsmokers. Addict. Behav. 4(1):75-81, 1979. Pakozdi, L. The legal protection of non-smokers in,Hungary (statutes, regulations, directions, rules). Scand. J. Respir. Dis. Suppl. 102:147-148, 1978. P'andi~t, V.I., Phadke, K.M. Gaseous composition of ci~garette smoke: effect on human health and air pollution. Indian J. Publi~c Health 17'(1):16-18, 1973. Paris, R. Smoking, restrictions in hospitals (',letter),. Can,. Med. Assoc. J. 115(1):17, 1976. Pascasio, F., Scassellati Sforzolini, G., Savino, A., Conti, R. Tar andinicotine content both i'n inhaled smoke and in smoke dispersed in room-air by various cigarette brands. Ann,. Sanita Pubblica 27(15):971-978', 1966. (Italian) Patrianakos, C., Hoffmann, D. Chemical studies on tobacco smoke LXIV. On the analysis of aromatic amines in cigarette smoke. J. Anal. Toxicol. 3(4):150-154, 1979. Patterson, J.M., Issidorides, C.Hi., Groutas, V.C., Smith, W.T., Jr. Pyrolysis of maleilc hydrazide and N,N-dimethyldodecylamine. Chem. Indi. (London) (',8): 337'-339', 1972. Pedersen, J.T. Passive smoking. Ugeskr. Laeger 14206)':2355- 235'6, 1980. (Danish) Pedreira, F.A. Smoki~ngiand asthma (letter). Pediatrics 76I(4'):655, 1985. Pedreira, F.A., Guanadolo, V.Li., Feroli, E.J., Melta, G.W., Weiss, I.P. Invountary smokiing and incidence of respiratory illness dluring, the first year of life. Pediatrics 7'5(3):594-597, 1985. Pekkanen, T.J.,, Elo, 0., Hanninen, M'.L. Changes in non-smokers' saliva thiocyanate levels after being in a tobacco smoke-filled room. World Smoking and Health 1('1):37'-39, 1'976. Penkala, S.J., de Oliveira, G. The simultaneous analysis off carbon mono~xide and suspended particulate matter produced by cigarette smoking. Environ. Res. 9(2):99-114, 1975. Perdrizet, S., Liard, R., Cooreman, J. Respiratory symptoms in schoolchildren in 7 French survey areas. Arch. Fr. Pediatr. 36(,9):940-948', 1979. (French) Perry, J. Fasten your seat belts. No smoking. B'r. Columbia Med. J. 15(10):304-305, 1973. 44 ( ID-44
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Bibliography on Involuntary Smoking/March, 1986 Roemer, R. Legislative action to combat the world smoking epidemic. Geneva r World Health Organization, 19'82', pp. 51-59. Rogers, K.D., Paradise, J.L., Bluestone, C.D. R'isk factozs for persis-tent middle-ear effusions (letter). JAM1A 251(,'12):1,55!6, 1984. ' Romer, J., Hermann, H1. The significance of tobacco smoking for asthma and rhinitis. Ugeskr. Laeger 145(13):1025-1027, 1983. (D'aniish) Rona, R.J., Chinn, S., Florey, C.D.V'. Exposure to cigarette smoking and children's growth. Int. J. Epidemiol. 14(3):402-409, 1985. Rona, R.J., F'lorey, C. du V., Clarke, G.C., Chinn, S. Parental' smoking, at home and height of childr'en,. Br. Med. J. (Clin. R'es. ) 283'(6303):1363, 1981. Roper Organization. A study of public attitudes toward cigarette smoking and the tobacco industry in 1978. Vol. 1. The Roper Organization Inc., May 1978. Rosano, A.T., Owens, Di.F'. Design procedures to cont.rol cigarette smoke and other ai~r pollutants. Amer. Soc. Heat Refrig. Air Cond. Enig. Trans'. 75:93!-102, 1969. Rosemberg,, J. Jeopardiy to the health of' children diue to smoking habits oflparents. AMB 31(1-2),:-6i, 1985. (Portuguese) Rosemberg, J. Risks to which passive smokers are exposed. Thee right of non-smokers. AMB 3'1'(1-2):7-12, 1985. (Port'ugu.ese) Rosemberg, J. Tobacco use, serious problem in public health. Sao Paulo : ALMED-EDUSP, 19'81. (Portuguese) Rosen, F.L. S'tudies in tobacco allergy. J. Med. Soe. NJ 51(3):109.114, 1954. Rosen, F.L., Levy, A. Bronchial asthma due to allergy to tobacco smoke in am infant. JAMA 14A:62'0-62'1,1950. Rossiter, C.E. Passive smoking (letter). Lancet 1:13516, 198'2. Rozenberg, S. The environment and cardiovascular disease. Arq. Bras. Card'iol. 37(5'):403-407, 1981 Rud'ni'k, J., Hermani, S., Pisiewicz, K., Roszkowska, H. Long-term eff'ects on health of air pollution in children. Z. E'rkr. Atmungsorgane 161(2),:177-191, 1983. N Ruhl, C., Adams, JI.D., Hoffmann, D. Chemical studies on tobacco 0 smoke LXV'I. Comoarative assessment of volaitile and tobacco- 1V ~ Cjji M' 50 Q~ ~ N O ~ C C f C D-50
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Bibliography on Involuntary Smoking/'Mairch, 1986 1( li ) : 2'5-27, 19761. ACKNOWLE'DGEMENTS'. This bibliography was compiled using MEDLINE and CArtCER'Li'NE,. the National Library of Medicine's computerized bibliographies. of' the world's general biomedical and toxicology literature, as well, as standard manual bibliographic techniques. This bibliography could'not have been complietedwithout the patience and understanding of Ted Jensen, husband of Lydia Jensen. The text was preparediusing his computer and a word processing;program under his tutelage. N O 117' ~ 75 ~ ~ ~ ~ ~ ~ D-7 5'
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i to this because the wording was visual only and in relatively sanall type, but they rcfuscJ to do itfor radiu and thereby, lust their largest rudiu buy for the last three wceks of the election. Thi>;nvas the first time that any, rttdioior tclevision .tatiitn in the country had acted to require such a tugl'ine change without having becn urdt:rcrd to do io by the Federal Communications Commission. I'dowever; none uf'the other stations acceded to the request. The third' major component of the campaign, a voter contact mailing prugraim, was where much of the money was spent. VlJhilc free radio andacicvision time was obtained under the Fairness Doctrine, $50;0100 was put into a mailing progr:um. Three hundhed thousand pieces of mail inisevcn versions were tairgeted to particular groups within a larger population of probable voters. The two most important'mailings were one featuring pictures of six celebrities who had dicd'of cancer and sugbestiing that tihcy would all votee for Proposition P if they wcrcaiivc„and one entitled. "Thc. I 13ig Tubact:u Companies Have Licd To You 10 Times." in. which 10 lics of the tobacco industry were docuntcnteJ. As the campaign drew, to a clu.e one humorous and tell- ing incident stood out. A week befurc the election the local public broadcasting station tclecast a program focusing on the campaigns fior two ballot measures-Pruposition P and one aimed at imposing a moratorium on high-rise dcvcl- upmcnt. One of thc aaff people whom the tobacco industry hired fiur its "Nit un P" effort was also the campaign man- agcr of the anti-high-risc proposition. It had bt:cniaKsumcd' that he took the tobacco industry job so he could!deft•aytiho management expenses for the other proposition, which had a very low budgec. Indeed, hrspcnt very little time cam- paigninb against Phupusiuiun P, and it is doubtful the to- bacco industry was getting its money's worth. As the teli- vision show focused on the a.inti+high-ri:+e proposition, it showed this individual sitting behind a battered old'd'esk, in a spartan room, bemoaning how his barcbones campaign The basics of beating the tobacco industry . LSStJES CERTAIN To ARISE Hedt6. The deleterious effects of secondhand tobacco smoke are the raison d'Ltue for any law limiting smoking. Proponents of the law should'have a firm grasp of all the reievant evidence, pary tictilarly the most reliable studies showcing a link' between secondhand smoke and serious diseases, as well as l other studies that may be less conclusive. Even though the health issue is the one in which the proponenta' stand on the mostsoiid ground, the tobacco industry, can confuse voters (as it has even on the issue of smoking's role in lung cancer and heart disease) by claiming that "proof" is lacking and that more "research" is needed.t`3 Costs. The tobacco industry will' claim that any law that restricts smoking will be too expensive both to goverttmentt and private industry. The purported cost factors will include the posting of signs, enforcement; and disruption of businesss operations. The industry will clnimthat the law will force some businesses to close or relocate. Proponents pn safely rely on the experiencrin communities in which such laws have already, been in effect to demonstrate that any costs arc negligible. Enforceatemt. Whether the law is to be enforced by the police or a health authority, the industry will raise the spectre of important criminal or health matters'being ignored Iwhiie smokers arc heing hauled off'to jail. The fact is that the law is intended solely as a recourse in the event' ofl a dispute over, the right to 372 smoke inithe presence of others who may be adversely affieaed. In all places where such laws have beenenactedi they ha'vee proven largely self-enforcing, and, few fines or'citations have been issued.• Govet- P, t regulation. The tobacco industry's argument that nonsmokers' rights legislation represents'government intcusion iinto essetttially private matters has proven to be an effective weapon. The countier argument'must begin with the fact thar the law is a measure to protect publichealth, which isoneofthr most important funetions of govern- ment. Cjrll Gbertia. The tobacco industry maintains that any, infringement on the right to smoke is a violation of' civil liberties. (In the black community ad- vertising by the industry suggests that restrictions on smoking are a first step in bringing back segregationls'To Miami s Jewish community the tobacco industry warned "flon't let it happen here."s) The industry also compares eiean indoor air laws to Prohibition. Such a comparison is not difficult to rebut, for there are numerous governmental restrictions on the useof alcohol to protect public heaith and1 safety that have almost universal l support. Scope of law, No matter how limited' or comprehensive the proposed luw may be, the tobacco ind'ustrry, will oppose all restrictions onsmoking,that may cutinto cigarette sales. The industry will claim either that the law is discriminatory be- cause it applies to some busincsses and not to others or will claim that it is too sweeping and repressive. `GA'' YORK STATE JUt;ttNAL OF ' \ll'IAIt.'1NF; Jl,'1.5° Ivttt Campaign financing. The sudden infusion of enormous funds from the to- bacco industry to defeat clean indoor air laws will become a major issue in the campaign, The industry never enters a campaign halfheartedly and always provides nearly every penny of't'he op- position campaign. The proponents of the law must ezploit'this from the be- ginning of the campaign and must' make the public and press realize that the op. position campaign and the tobacco in+ dustry are one and the same. Many of the local contributors to the opposition campaign are also likely, to have direct financial ties to the sale of tobacco products. Endorsements. Closely connected' wiih the issue of campaign financing is the question of'who supports and who opposes the law, Apart from the to- bacxtrgrowing,and manufacturing states of Connecticu4 Florida, Georgia, Ken- tucky, Mary;land„North Carolina, South Carolina„and Virginia, or New York (where three of the six Unittd States cigaretrte companies are hcad4uartered)6 voters will be interested to learn that the opposition is led by out-of-state interests. Moreover, as such legislation gains in popularity, local public figures are in- creasingly eager to lend! their names too the rampaign. Thc contrast between the quality and quantity of locall support versus that of the outsdde tob:tcco inter- ests is striking; CAIt'tPH7t:N STRATEGY Build a coali'tion. Essential to the passage of clean indoor air measures is B'-4.
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Bibliography on Involuntary Smoking/'March, 1986' fl Stewart, R.Di. The effect of carbon monoxide on humans. Annul. Rev. Pharmacol. 15:409-423, 1975. Stewart, R.Dl. The effects of'low concentrations of carbon monox3de in man. J. Occup. Medl. 18:304-309, 1976. Stewart, R.Di., Baretta, E.D., Platte, L.R., Stewart, E.B., Kalbfleisch, J.H., van Yserloo, B., Rimm, A.A. Carboxyhemoglobin levels in American blood dionors. JAMA 229(',9):1187-1195I, 1974... Stewart, R.Dl. The efffects of low concentrations of carbon monoxidle in man. S'cand. J. Respir. Dis. Suppl. 91:56'-6'2, 197'4. Steyrer, K. Proceedings of',the international symposiumi on medical perspectives on passive smoking,. Prevent. Med. 13:561-562, 1984. Stober, W. Lung dynamics and uptake of smoke consitulents by: nonsmokers - A survey. Prevent. Med. 13:5'89-601,, 1984. Stock, S'.L. Passive smoking and lung cancer (letter). Br. Med. J. 282(6265):733-734, 1981. Stock, S.L. Breathing other people's smoke ('letter). Br. Med. J. 2(6138):69'9-70!0, 1978. Stock, S.L. Passive smoking, and.lung cancer (letter). Lancet 1(~8~27~91:10~~14-1015',~ 19,8~2~. Stock, S.L. Passive smoking.and nicotine (letter). Lancet 2(82541:10144, 1981. Stock, S.L. Risks the passive smoker runs (letter). Lancet. 2(l82031:1082, 1980. Stock, S. The perils of second-hand smoking. New Scie.nti~st, 8811221) :10-13, 1980. Stone, Ji.D., Breidenbach, S.T., Hei!mstra, N.W. Annoyance response of nonsmokers to, cigarette smoke. Percept. Mot. Skills 49(,3'):907-916, 1979. Strasser, A.L. Smoking in the workplace: shoul'd it be p.rohibited'? (editori'lal). Occup. Health Saf. 48(l):9-10, 1979. Strope, G.L., Stempel, D.A. Risk factors associated with the development of chronic lung disease in childrem. Pediatrilc C1inics of North America 31(14 ):757-7'71, August 1984. Sudani, B.J.L., Sterboul, J. Nicotine: an hapten (,letter). Br. J. Dermatol. 104(31:349-350, 1981. Sudlan, B.J.-L. Breathing otlier people's,smoke (letter),. Br. 611 D-61
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Bibliography on Involuntary Smoking/March, 1986 Purcell, Hi. Passive smoki~ng--the evidience confirmed'. Midwif'e, Health Visit. Community Nurse 16(',10):408, 4110, 1'980. Rabkin, M.T. Segregation of smokers at medical meetings. (letter),. N. Engl. J. Med. 292(5):271, Radford, E.P., Jr., Hunt, V.R. Polonium-210: a volatile radioelement imicigiarettes. Science 143(3603):247-249, 1964. Ramaciotti, D., Imhoff, C'., Rey, P., et al. Alveolar CO as ann index of' ambiant C0 in schoolchildren. Rev. Epidemiol. Medl. Soc. Sante Publique 2'4(i1):69-76, 1976. (French) Ramstrom, L.M. Economic losses to the society due to smoking. In: Ramstrom, L.M. (edi.). The smoking epildemic, a matter of worldwide concern. Stockholm : Almqvist & Wiksell International, 1979. pp. 112-116. Randolph, F.L. The regulation of smoking in public p1'aces: predictors of compliance and voluntary enforcement behavior (dissertation). Berkeley : iPniversity ofl California, 1982. 293' pp. Diss. Abstr. Int. 44B('1)':126, 1!983.. Rantakallio, P. A follow-up study up to the age of 14 of children whose mothers smoked during pregnancy. Acta Paediatr. Scand. 7'2(5):]47:753, 1!983'. Rantakallio, P. Relationship of maternal smoking to morbidity and mortality of the childiup to the age of five. Acta Paediatr. Scand. 67('5'):621-631, 1978. Rantakallio, P. The effect of maternal smoking o birth weightt andi the subsequent health of the child. Early Human Dev. 2(4):371-38I2, 1978. Ray, A.M., Rockwell, T.H. An, exploratory study of automobile drivi'ngi performance undier the influence of low levels of carboxyhemoglobin. Ann. N.Y. Acadi. Sci. 17'4:396-408, 1970. Readier, K. Totally unacceptable ( letter ). New Scientist 88(1223):182, 1980. Reed, K. Tobacco smoke is hazardous to non-smokers. J. Dent.. Assoc. S. Afr. 36(6):4'09-411, 1981. Remi~j'ni, B., Fischer, P., Brunekreef, B., Lebret, E., Bioleij, J.S., Noij, D. Indoor air pollution and its effect on pulmonary function of adult non-smoking women: I. Exposure estimates for nitrogen dioxide and, pasisiive smoking. Int. J. Epidemiol. 14 ('2 ) : 2'1'5!-220, 1985. Remmer, H. Is cancer avoidable? Med. Klin. 79(18):4163-467, 484,. 1984. (German) 47
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-3- C) To answer the risk assessment question, Or. Alfred Lowrey, of the Naval Research Laboratory and I used the principles of quantitative risk assessment. After five years of work, and based ini part on our 13'previous sci'entific publica- tions on the health physics of environmental tobacco smoke, we pub1lished!estimates that in the United States, exposure of nonsmokers to indoor air pollution from tobacco combustion products causes a minimum of'about 500, but more 11ilkely 5000 lung cancer deaths per year, with an average loss of life-expectancy of about 1'1 years per vi'ctim.3 To place this into perspective, 5000 lung~cancer deaths per year i s nearlyone-thi rdl of' the annualllung cancer; nartal ity in nonsmokers., There have been no credible scientific attacks on our previous work, although the Tobacco Institute has publicized some failed8 attempts. Insofar as our publltshed! ri sk assessment i s concerned, i n an accompanyi ng edi tori al , the ed'i tor-i'n-chi ef' of the journal stated: "'Diue to the controversial nature of the paper by Repace and, Lowrey, added measures were required to assure adeqpate peer review and'the documentation, of underlying information, including assumptions".1'9 In summary, he concluded that "... Repace andlLowrey make a convincing case for public health hazards of public smoking."19 To explore risk-management options, we assessed the risks associated withi five common types of control measures for tobacco smoke. We found that in the typical! U.S. office workplace, under average condiitions of occupancy and ventilation, the tobacco-smoke-caused lungi cancer risk to the nonsmoking office workers appears to be, depending upon the ventil'ation, 250 to 1000 times the level of' acceptable risk using standard federal guidelines for carcinogens in air or water or food.2• 7 . Q We then explored the risk reduction achievable by various controll options. CA We found that separati on of nonsmokers wi thi n a gi ven space offers only a ~ PON N' ~ ~ G~-3'
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Bibliography on Involuntary Smoking/March:, 1986 Shephard, R.J., Collins, R. Silverman, F'. Responses of exercising subj!ects to alcute "passive" cigarette smoke exposure. Environ. Res. 19(2):279-291, 1979. Shephard, R.J., Ponsford, E., LaBarre, R., Basu, P.K. Effects of. cigarette smoke on the eyes and airway. Int. Arch. Occup. Environ. Health 43(2):13'5-144, 1979. Shephard, R.J. The risks of passive smoking. New.York : Oxford University Press, 1982. Shephard, R.J. Cigarette smoking and reactions to air pollutants. Can. Mied. J. 118:37'9-83', 392, 1978. Shilling, R.S.F., Letai, A.D., Hui~, S.L.,, Beck, G.J., Schoenberg, J.B., Bouhuys,A. Lung function, respiratory disease and smoking in families. Amer. J. Epidemiol. 1D6(4):2'74-28'3, 1977'. Shor, R.E., Shor, M'.B., Williams, D.C. The distinction between the antismoking,and nonsmokers' rights movements. J. Psychol. 106:129-146, 1980. Shor, R.E'., Williams, D.C. Reported physiological and' psychological symptoms of tobacco smoke pollution in nonsmoking and smoking college students. J'. Psychol. 101(iSecond Half):203- 218, 1979. Shor, R.E., Williams, D.C. Small-airways dysfunction in passive smokers (letter). N. Engl. J. Med. 303(7):393, 19801. Simecek, C. Reflection of passive exposure to, smoking in the home on, the prevalence of chronic bronchitis in non-smokers. Czeah. Med. 3'( 4): 3'.08'-310, 19810. Sims, D.G., Downhaaai, M.A.Pi.S., Gardner, P.S., Webb, J.K.G., Weightman, D. Study of 8-year-old children with a history of respiratory syncytial virus bronchiolitis in infancy. Br. Mied. J. 1(61i0A):11-14, 1978. Singer, G.M., Lijinsky, W. Naturally occurring, nitrosatable amines. II. Secondary amines in tobacco and cigarette smoke condensate. J. Agr. Food Chem. 2'4('3):553-555', 1976. Sinzinger, B'., Kefalides, A. Passive smoking severely decreases platelet sensitivity to ant.iaggregatory prostaglandins (letter). Lancet 2( 82'94 )1: 3'92'-393, 1982. Sjolin, K.E. Tobacco Smoking a serrvicel of local pollution. Ugeskr. Laeger 133'(44),:218J'-2188, 1971. (Danish), Slavin, R.G., Hertz, Mi. Indoor air pollution: A study of the 30th annual meeting of the American Academy of Allergy. Paper 58 C C C D-5&
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TESTIMONY OF JAMES' L. REPACE IN THE MATTER OF SENATE' BILL 1440, THE NONSMOKERS' RIGHTS ACT' OF 1985. BEFORE THE U.S. SENATE SUBCOMMITTEE ON CIVIL SERVICE, POST OFFICE AND GENERAL SERVICES, COT4ITTTEE ON GOVERNMENTAL AFFAIRS WASHIINGTO'N„ D.C. September 30, 1985 § MR. CHAIRMAN, AND SENATORS: My name is James L. Repace. As a scientilst whoihas worked for a deca!de on the health physics of environmental tobacco: smoke., and as a policy analyst i n a fedieral regul atory agency, 11 woul d lli ke to share~ wi't you the ri sk assess- ment results and risk management op ions which I have developed in my work. My qualifications are discussed in an appendix to my statement. STATEMENT OF JAMES L. REPACE ON THE HEALTHIIMPACT OF TOBACCO COMBUSTION PRODUCTS 0N NONSMOKERS It has long been known that high levels of outdoor alir pollutioni from! factory chimneys and automobiles could cause acute illness and even death duri ng ai r pol l ution epi sodes a~nd that el evated 1 evel s of outdoor ai r polliuti on were responsible for chironic morbidity and mortality.6 These: serious heal'th effects from air pollution have lied to fede al standards for the regulation of outdoor exposure, lievels, and considerable progress.has been made i'n curtailing outdoor ai r polll uti on. Hbviever, Ameri cans spendl an average of 90% ofi' thei r l i ves ilndoors. Therefore the~ levels of' indoor air pollution assume great importance i n determilni ng total human exposures to many ai r pol l!utants.G.14,,15' Indoor air.pollutilon from tobacco combustion products is not only chemically related to the smoke: factory chimneys andlotfier sources of outdoor air pol- O lution, but generally occurs at far higher level's indoors than does factory smoke ~ and automobile exhaust outdoors 6 Because one-thi'rd of the U adult population: S ~ . . . ~. ~ ~ G-1
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-2- smokes, andl because ventilation rates are primarily diesilgned to conserve energy rather than to~preserve indoor ai'r quality5,6,8,1'4„16 the smoke fromi burningi cigarettes, pipes, and! cigars overwhelms the capability of typical building ventilation systems, inflicting substantial air pollutiion burdens upon nonsmokers -- far in excess of those encountered inismoke-free indoor environments, outdoors, or i'n vehicles on busy commuter hilghways.6,S,15 For more than 20 years, reports of the Surgeon Genera1 -- which now amount to a: stack more than a foot high! -- have, indicted the smoke whichi the smok r inhales (called mainstream smoke) as cause of cancers in many organs of the human body.3'+5 we now, know that the smoke which the nonsmoker inhales (calied side- stream smoke) i's even more carcinogenic than an equal amount of'mai'nstream smoke.3 C7 early„ there i s good reason to bel i eve that nonsmokers are exposed to the ri sk of smoking-reTated diseases from repeated exposure to tobacco combustilon products.3 In a recent official' position paper18 in which it was stated'that environ- mental tobacco smoke appears to be carcinogenic, The Amerilcan Association for Cancer Riesearth stated that gpvernment shouldl"enact and enforce! legislation that restricts smoking i'n public pTaces". In another recent medical journal pap r,17 three offilcials concerned with smoking and health from Canada's Mational Department of Health and'Welfa~re examined the evidence that exposure to tobacco smoke in the workplace Is harmful' to nonsmokers. They concluded that "passive smoking Is an occupational health, hazard to nonsmokers'. This raises two essential questions pertinent to Senate Bi11 1440: First: What are the risks to nonsmokers from breathing envlronmental tobacco smoke in, the workplace? And secondly: What are, the options for management of those risks? G-2
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C campa6gn so as w minimize any adverse publicity, • The tobacco cumpvniesstudiously avoid the subject oflth'e hcalth'ihaaardi uf seeond-handsmoke and attempt to stcer the debate to such ixsucs as gavcrnmcntregulation,and the costs to taxpayers of enacting the lsw. Thcy do this in a manner designcd to convince the votcrs that extremely'harmful consequences will necessarily flow from the law. For exsmple, it is usually predict- cd that smokers will ibe'arrested whila'rupists and robbers go un- detectal. thattpaople will be drivcn out'of business, and that vital x,cial services will be shonchanged!in ordbr, to pay forthe law. • Two important secondary themes are always present to back up thc primary arguments: (1) the Jltw represcntsan attack on civil libcrties and'denics smokers the freadom of choices (2) the industrywill admit there is a problem but claim the proposed lanv is not t hc right solution. Thus thc slogan that appeared at the end of TV advertisements against Proposition, P: "Proposition P is simply not the answen" Thc industry position is that to the ex- tent second-hand smoke might be a minor annoyance to a few particularly sensitive pcopic, "common sense" and, "common eourtcsy"-not Fovcrnmcnt' regulstion-will- suffice: This has the double advantage of sceming to be understanding of'the probltm and at the,samc time depicting,propuncnts of the law as wcillmea'ning but sadly misguided. • When the sub1eatof the effects of second-hand smoke can- not be avoided, such as during live debates and press interviews, the tobacco industry representatives will deny there are any health hazards, often misquoting and quoting out of conte:tt medical authorities in the process. They will claim that,even if some studies show secondlhand Ismoke to be harmful, others do not, and thus the jury is still out. In other words; they impiy;, vir- tual unanimity in the medical community is needed before any laws should be passed that would limit smoking, • The industry uses i'ts economic'and political powerto secure endorsements from both individuals and organizations. • On a general level, the industry7s best weapon is eonfusion.. As any political lanalystwill attest, when voting on ballorissues, a confused, voter will invariably vote "No." Thus, a eommon, thread running through all the industry's campaign advertising and debating is the attempt to confuse the public. All of these factors came into play during the Proposi- tion P campaign. The first public movewas the press con- fercnce tio announce that "Citizens Against Government Intrusion" (later changed to "San Franciscans Against Government Intrusion" doubtless when it was rcalized that the acronyrn for the name would have been CAG'I)'would place a rcferendum onithc ballot to repeal the workplace smoking ordinance. The group announced'thatJim Foster, the founder of one of the city's gay Demoeratic clubs ('San Francisco has the' largest gay community in the United States); would manage the campaign and that, at the group's reqttcst, the tobacco i industry would contribute S4!0,000 to fund thcir petition drive'because of insufficient time to raise funds locally." SLEIGHT O'E HAND None of the people ai'thc news conference had ever tes- tified'against the ordinancc, and cxeept, for Foster;,none of them was hcard!froni again!d'urinig,thc campaign. A few days latcr Foster stated ina newsp:tper intervicw that he had becn recruited for the campaign by, the Tobacco Institute's atuorncy: Another person who lost out on the job later re- vealed that he had been intierviewcd by a vice-president of the Tobacco Instiiute: The S40,000 fagurc„which was re- pcatcd in every interview on the subject'over the next two wccks; was untrue. Theindustry had pledged more than S t00,pfD0; and, in fact, 597,0n0 was spent to put the measure onithc ballot. The tobacco industry, huwever, denied any involvement in the campaign otihcr than as a, financial supporter and at one point stated that subscquent'fu!nding, by the industry would be contingent on a demonstration of local support. The induxt'ry ended up putting Sll,2'50,000 into the campaign; the liacal contributions amounted to $3.300. The moneyspcnt by the "1'Jo on P"'campaign set a new national record for a, locai'ballot measure (surpassing the 51.11 miIDionithe tobacco industry spent in Miami in 11979 to defeat a similar ordinance). To find out firsthand why the tobacco companies were contributing so much money to overturn a local health regulation, Supervisor N+elder field l a press conference early in the campaign to announce tihat she had sent tell:grams to thc presidents of four cigarette companies challenging them toldcbatc her onitht: merits of the law. None replit:d: The petition drive itself was a travesty of the democratic process. Since thclobaccolindustry was not likely to fnd! volunteer signature gatherers, it hired a professional peti- tioning',cornpany.from Los Angelas and paid'petition cir- cu!lators as much as S0.70 per signature. One method'used to collect signatures was for the paidlcirculatots to explain that they were merely trying to put the measure on' the ballot for a public vote-rather than to repeal a law that had' already been enacted. At least two of the paid circulators (who had obtained several thousand signatures between them) were not bona fide registered''voters of'San Francisco, as required by the election laws. lronically, when the de• ceptive practices of the tobacco industry were brought to the attention of the press, they were so confused by the referendum'prtxedure (they could not understand that the tobacco industry put the measure on the ballotinorder to repeal an existing law),,that, they madritappear that the supporters of the ordinance had committed the improper practices. OBJEICiIVEc HOME RULE The campaign organization in favor of'Proposition_ P was formed iniAugust under, the same "San Franciscans for Local Control."'The decision was to make the central issue of the campaign the alttempt by a, large out-of-state special interest group to overturnia local health ordinance. The organization included representatives from Californians for l*lonsmokers"R'ig!hts, the'San Francisco Chapter of the American Cancer Society; the San Francisco Lung AsstD- ciation„the Sicrra Club, and Common Cause, as well as several political activists. The proposition was soon endorsed and supported by'a number of prominent individuals and organizations, including the San Francisco Pblice Officers Association. Early in the campaign, a local attorney appeared on a television debatc with Supervisor Ncldcr and'claimed that imposing restrictions on smoking in the workplace wouldN set a precedent' for denying employment to gays tnni uhq= . grounds that they might, have AIDS. This was pcrccivcdiasN a crass attempt by the tobacco industryta scare the largeN gay community, and several gay leaders denounccd tihcM tactic. The argument was not raiscd aglun; and thc ;ttt0rncyG0i never apreared' agai'n on behalf of the "';`lio on P'' cam-4~, paign. The tobacco industry's efforts settled on the fiullinwinc~A :ullegations tha0 the law con,titutes governmcnt intrusiion~ 370 NEW YORK ST,1Tf? JO'UR'NAIi UU WLIDICI'tiF./JUt.Y IwBt B'-2 cl
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I Bibliography on Involuntary Smoking/March, 1986 Sandl'er, D.P., Wilcox, A.J., Everson, R.B. Cumulative passive. exposure to cigarette smoke andicancer risk (abstract). Am. Ji. Public Health 120:482, 1984. . Sapolsky, H.M. The political obstacles to the control of cigarette smoking in the UnitediStates. J. Health Polit. Policy Law 5(12):2'77-2'90, 1980. Savel, H. Clinical hypersensitivity to cigarette smoke. Arch. Environ. Health 21:146-148,, 1970. Scassellati Sforzolini, G., Saldil, G. Further research on the polycyclic hydrocarbons of cigarette smoke. Comparisons of smoke inhaled and that taken from the ambient atmosphere. Boll. Soc. Ital. Biol. Sper. 37(16):769-771, 19,61. (Ital'ian) Scassellati-Sforzolini, G., Savino, A. Evaluation of a rapid index of' environmental pollution by tobacco smoke and stud'yofl composition of the main-stream and side-stream cigarette smoke. Proc. Int. Symp. Recent Adv. Assess. Health Eff. Environ. Pollut. 3:11749-175'6, 1975. Scassellati-Sforzolini, G., Savino, A. Evaluation of a rapid index of environmental pollution by cigarette smoke, with special reference to the composition of the gaseous phase of the smoke. Riv. Ital. Ig. 28 (1-2):43!-5'5, 1968. Schelenz,, R. , Fischer, E'. On the fate of postassium and cesium- 137 during the machine smoking of cigarettes. Z. Lebensm. Unters. Forsch. 178(2)1:118-119, 1984. (German) S'chenker,, M.B., Samet, J.M'., Speizer, F.E. Rilsk factors for childhoodirespiraltory disease. The effect of host factoxs and home environmental exposures. Am. Rev. Respir. Dis. 128,(6):1038- 1043, 1983. S'chenker, M.B., Samet, J.,, Batterman, S., Speizer, F.E. An epidemiolog,ic study of air pollution effects on childhoodd respiratory disease. Am. Rev. Respix. Dis. 125(4 Part 211:145, 1982. S'chlenker, M.B., Samet, J.,, Speizer, F.E. Biologic and' environmental determinants of childhoodirespiratory disease (abstract). Am. Rev. Respir. Dis. 123(4 Pt 2):13&, 19'81. Schievelbein, H. Are there really important recent findings on passive smoking? Off. Gesundheitswes. 44(7):454-456, 1982. (G'erman)' Schievelbein, H. No proof of health hazard (,letter). MMW 124'('4') :13-15, 1982. (Germam), 53 D-53
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Bibliography on Involuntary Smoking/March, 198'6 3314 ) :249, 197'4. Zussman, B.M. Tobaccol sensitivity (letter). Ann. Allergy 291111) : 6'09-6I1-0, 1971. Zussman, B.M. Tobacco sensitivity in the allergic patient. Ann. Allergy 2'8('8):37'1-377, 1970. Zussman, B.M. Atopic symptoms caused by tobacco hypersensitivity. South. Med. J. 61(11):117'5-1179, 1i968'. -----, Breathing other people''s smoke. Br. Med. J..2(6135I):45'3- 45'4, 1978'.. -----, Warning: smoking may damage your childreni's health (editorial). Br. Med. J. 1(6070):11i79-118!0, 1977. -----, The cowardice continues (editorial). Br. Med. J.. 1(6074):1428-1429, 19717. -----, Segregatedismokers ( editorial ). Br. Med. J. 1(6004): 244,- 2'45, 1976. -----, Smoke-pollutedi food (,editorial ),. Bir. Med. J. 4( 59'93') : 37'0, 1975. --, Symposiu!m, tobacco and alcohol!. Medical and social problems. Bull. Sichweiz. Akad. Med. wiss. 35('1r31:1-2'68, 1979. (German) -----, Tobacco smoke pollution. CAN Bull. 7(2):1-39, 1981. -----, Smoking, may harm some nonsmokers. Chem. Eng. News 53(23'):5',197'5. -----, General references on studies of environmental tobacco smoke (ETS). -----, Eur. J. Respir. Dis. (lSupp1) 133:147 152, 1984. -----, Government Manager: The debate lights up. Smoking and the workplace. National Interagency Council on Smoking and Health, Business Survey. I4ICS'M', New York, N.Y. Gov Manager 138':2,. 1978. -----, Smoking in the car. J. Traffic Med. 1!1.(2):36, 1983. -----, Lifetime passive smoking and cancer risk (letter). -----, Lancet 1 (844'3 ): 144,4 , 1985'.. -----, Lifetime passive smoking and cancer risk (lietter). 73
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Bibliography on Involuntary Smoking/'March, 1986 Suppl. 91':1i-90, 1'974'. Rylander, R. Review of studies on environ:nental' tobacco smoke. Scand. J. Respir. Dis. Suppl. 91:10-20, 1974. Rylander, R., Peterson, Y., Snella, M.-C. ETS--environ¢nentall tobacco smoke. Report from a workshop on effects and'exposure level's. Eur. J. Respir. Dis. [Suppl. ] 133:1-152, 1984. Said, G., Paitois, E., Lellouch, J. Infantile colic and parental smoking. Br. Med. J. [Cliini. Res.] 289(6446):660, 1984. Said, G., Zalokar, J. Incidence of upper respiratory tract disorders in children of smokers. Ann. Otolaryngiol. Chir. Cerviicofac. 95( 3')':23'6-240, 1978. ( French) Said, G., Zalokar, J., hellouich, J., Patois, E. Parental smoking related to adenoidectomy and tonsillectomy in chi,ldren. J. Epiidemiol. Community Health, 32(2):97-101, 1978. Sai~d, G., Zalokar, J., Lellouich, J., Patois, E. Adienoidectomy and'tonsillectomy in children and'parental smoking. Lancet 1(8015):797, 197'7. Saint-Jalm, Y. Qualitative analysis of'the hydroxyl fraction of cigarette smoke. Ann. Tab. Sect. 1. 18:41-48, 1981. (,French). S'akuma, H., Rusama, Mi.,, Munakata, S., Ohsumi, T., Sug,awara, S. The distribution of cigaret smoke components between mainstream and! sidestream smoke. I. Acidic components. Beitr. Tabakforsch. Int. 12(2):63-71, 1983. Sakuma, H., Kusama, M., Yamaguchi, K., et al. The distribution of cigarette smoke compornents between mainstream and sidestream smoke. IIiI. Middle and higher boiling components. Beitr. Tabakforsch. Int. 12(5):2'51-258, 1964. Samfield, M. How important is cigarette sidiestream smoke? Tob. J. Int. 1:45-47, 1985. Sandler, D.P., Everson, R.B., Wilcox, A.J., Browder, J.P. Cancer risk in adulthood' from early life exposure to parents' smoking. Am,. J. Publ. Health 7'5(15) :4!87-492, 1985. Sandler, D.P., Everson, R.B., Wilcox, A.J. Passive smoking in adulthood andicancer risk. Am. J. Epidemiol. 12'1(1):37-48, 1985. Sandler, D.P., Wilcox, A.J'., Everson, R.B. Lifetime passi!ve smoking and'cancer risk (letter). Lancet 1(84'33):867, 1985. Sandler, D.P., Wilcox, A.J., Everson, R.B. C1:mulative effects of lifetime passive smoking on cancer risk. Lancet 1(8424):312 315',. 1985. 52 D-52
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Bibliography on Involuntary Smoking/M'arch, 19186 ;;. &chmeltz, I., Hoffmann, D., Wynder, E.L. The influence of tobacco smoke on indoor atmospheres (letter). P'rev. Med.. 4( 3') : 375-377, 1975'. S'chmeltz, I., Hoffmanni, D., Wynder, E.L. The influence of tobaccoo smoke on indoor atmospheres. 1. An overview. Prev. Mod. 4(1):66-82, 1975. Schmidt, F. Passive smoking and lung cancer, (letter). Lancet 1(8378):684, 1984. Schmidt, F. Passive smoking--only a nuisance or a, real health risk? Oeff. Gesundheitswes. 45(5):2'49-251, 19'83. (,German). Schmidit,, F. Important new findings on passive smoking. Off. Gesundheitswes. 44!(,2'):130-132, 1982. (German) Schmidt, F. Smoking and, passive smoking. Oeff. Dienst 3'5(6):12'2-129, 1982. (German) Schmidt, F. Smoking and passive smoking. Oeff. Dienst 35(5):97- 104, 198'2. (German) Schmidt, F. Health damage from passive smoking. Fortschr. Med. 97(42):1920-1927, 1979. ('German) Schmidt, F. Health damage through forced smoking. Report on the fourth world conference on smoking and health, Stockholm, Sweden, June 18-21, 1979. 22p. Schmidt, F. Passive smoking at work--a critical opinion. Kassenarzt 19(34):3060-3076, 1979. (German,) Schmidt, F. Passive smoking and'cancer. Med. Klin. 74(51/52):1967-1973', 1979. (,German) Schmidt, F. Health risks of passive smoking. World Smokingiand Health 3(1):19-24!, 1978. Schmidt, F'. Current problems of'smoking and passive smoking,. Osterreichische Arztezeitung 31(4):200-203, 1976. (German) Schmidt, F'. Passive smoking as a health halzard. Neue Jurist. Wochenschr. 29(91):358!-3I59, 1976. (German) Schmidt, F. Prohibition of smoking in working areas should bee our goal. MMW 118(341):1043-1046', 1976. ((German) Schmidt, F. Impairment of traffic safety by smoki~ng. Z. Verkehrssicherheit 2D(2)':10'9-122, 1974. (German) N Schmidt, F. Passive smoking of pipes and cigars. Arztl. Praxis 0 2'6(16')':761, 1974. N' ~ ~ 55' ~ ~ ~ D-55
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C Dr. Koop is concerned about the increasing evidence "that environmental tobacco smoke can bring about disease, includ- ing lung cancer, in healthy persons, including infants and children," he advises nonsmokers "to avoid exposure to ciga- rette smoke wherever possible" and particularly, urges that children and infants be protected from involuntary smoking. The number of states that have overcome the well- bankroll'ed efforts of the tobacco lobby and restricted smok- ing in public places has been steadily rising. Twenty-ei~ght states now, limit or ban smoking in health facilities, 17 states restrict smoking in public buildings, 14 in restau- rants, 11 in government work places and eight in private work places. Scores of towns, cities and couritri'es havee enacted such laws even in states which have not yet moved to restrict smoking in enclosed spaces. The self-serving ad- vertisi~ng campaign of the Reynolds Tobacco Company against smoke-free space attests to the impact of such policies in reduced smoking. The issue i's not smokers' rights. The issues are whether we intendito protect non-smokers from involuntarily breathing tobacco smoke, whether we care enough about our fellow human beings who smoke to encourage them to stop killing themselves, and whether we're seri!ous about the billions of dbllars of health care costs smoking causes. Cigarette smoki~ng is slow-motiorn suicide. It is tragic when 0 peaple do it to themselves, but it i's inexcusable to allow ~Cl1' ~. ~ smokers to commit slow-motion murder. . ~. ~ ~ 4 G-12 C F
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other people's cigarette smoke and lung cancer. Just this month, the American Cancer Society study reported that when a woman's husband smokes a pack of cigarettes~a day, he doubles her chances of'getting lung cancer. A study spon- sored by the National Institute of'Environmental Health Sciences found evidence that non-smokers exposed to the smoke of'others have an increased risk not only of lung cancer, but of breast cancer, cervicaL cancer and leukemia as well. Mr. Chairman, there is tremendous fear in this country about AIDS, and it is a!very grave problem. We haven't yet found a c!ure for this terrible disease, but we have no excuse where smoking is concerned. Because we deny people smoke-free space, cigarette smoking is turning cancer into~America's top contagious killer. Tobacco smokee breathed by non-smokers is already killing 5',Oi001 people eachh year, according to Environanental Protection Agency re- searcher James Repace, *far more than the combined deaths from all industrial emissions regulated by the EPA. L,ast year, U.S., Surgeon General Dr. C. Everett Koop wrote that "there is all the medi~cal evidence neces- sary" to protect the non-smoker against "The irritation and potential harm that comes from other people's smoke." Dr. Koop noted that "pollution from tobacco smoke in homes, offices, other works.ites and in, certain, public places can reach levels which exce~ed~contami~,nantle~velspermittedunderenvironmentali and occupational healith, regulations. "' Because 3 G-11
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C r . Surgeon General Koop has called, on Americans to create a smoke-fbee society by theyear 2000. Passing this legislation will send a powerful signal -- through every federal courthouse, every one of Social Security's 1300, field off'ices, every House and Senate hearing room, and. 310,000 post offices -- that the health hazards of second- hand smoke are real' and require protective measures. Itt will ensure a healthier federal workforce and a safer, more pleasant atmosphere for our citIzens who visit federal offices. Mr. Chairman, let me conclude by cong,ratuilating you on your couragie.andiyour commitment to the health and safety of'our people in sponsoring this bill. 6 G-14 N C N ~ ~ ~ N ~. Go f
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Bibliography on Involuntary Smoking/March, 198'6 presented at the American Academy of'Allergy, 3'0th Annual Meeting, San Diego, Calif., February 15-1'9, 1975. 4 pp. Smith, N., Austen, J., Rolles, C.J. Tertiary smoking by the fetus (letter). Lancet 1(8283'):1252, 1982'. Smith, R.G. Disc!ussion, of paper by Dr. Dinman. J. Occup. Med. 10 ( 9 ) : 4516-462, 1968'.. Smoke in occupied spaces: Ventilation requirements. Paper 8'1- 2'2.6' to, be presented at the 74th Annual Meeting of' the Air Pollution Control Association, P'h~iladelp~hia~,~ Pennsylvani~a:,~ J~une 2'2-251, 1981. Sonnenfeldl, G. Effect of'sidestreaan tobacco, smoke components on alpha,/betaii'nterferoniproduction. Oncology 40(1):52-56, 1983.. Spears, A.W. Quantitative determi'nation of phenol in cigarette smoke. Anal. Chem. 35( 3'):32'0-322, 1963. Spears, A.W., Routh, W.E. A combinediapproach to thee quantitative analysis of the volatile coanponents of cigarette smoke, 18th Tobacco Chemists' Research Conference, Raleigh, N.C., 1964. pp. 47-49. Speer, F. Passenger smoking effects on bus drivers (letter). Arch. Envrion. Health 22(4):512, 1971. Speer,F. Tobacco and the nonsmoker. A study of subjective symptoms.,Arch. Environ. Health, l6(3):443-446, 1968. Speizer, F.E., Ferris, B., Jr., Bishop, Y.M.M., Spengler, J'. Respiratory disease rates and pulmonary function in children associatediwith N02 exposure. Am. Rev. Respir. Dis. 12'1(l):3-10, 1980. Speizer, F.E., Thger, I.B. Epidemiology of chronic mucus hypersecretion and obstructive airways disease. Epidemiol. Rev. 1:124-142, 1979. Spengler, J.D., Dockery, D.W., Turner, W.A., Wolfson, J.Mi., Ferris, B.G., Jr. Long-term measurements of respirable sulfates andiparticles inside and outside homes. Atmos. Environi. 1S(1),:23'-30,, 19'81. Spengler, J.D., Sexton, K. Indoor air pollution: a public healthh perspective. Science 22'1(46051):9-17, 1983. Spengler, J.D., Soczek, M.L. Evidence of healthieffects of sidlestream tobacco smoke. ASHRAE Transactions 90(1)1, 1'984.. , Spengler, J.D., Dockery, D.W., Reed, M.P., Tosteson, T., Quinlann, P. Personal exposure to res!pirable particles. Paper 59
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APPENDIX -5'- J.L. REPA'CE: CURRICULUM Y1TAE: For the past six yeam, I been a poJ!icy analyst iin the air pol!icy offi'ce at the U.S. Environmental Protection Agency, Washington, DC. However, my testimony here thi s morni ng wi l l be as a pri'vate ci'ti'zen,, and shoul d not be i nterpreted as representing official U~.S. E~nvironmental Protection Agency pol!ilcy., Prior to: EPA, 11 worked for 1b'years as a, research physicist at the Naval Research Laboratory, at RCA Sarnoff Laboratory, and at two New York hospitals. I earned a Master's degree in physics.from the Polytechnic Institute of Brooklyn. I am a technical advisor to the Nati'onal A'cadiemy of Sciences Committee, on Passive Smoking. I'am a contributor to ani Lnternational Agency For Research on Cancer monograph on Sidestream Srnoke, concerning modeling and measurement of' nonsmokers' exposures., I am executive secretary of the Indoor Air Quality Ciommfittee of the. Air Pml]ution Controll Association. I am a member of' the Interagency Technical Working Committee, on Smoking, Heart, Lung and Blood Diseases. I have been a member of a Natilonal Institute of Health special study committee to review, grant proposals on passi've smoki'ng and lung cancer. I have, testified as an expert witness on the subjiect of'passive smoking at a U.S. House of Representatives hearing on Indoor air pol!lution research. I have been a consultant to both the World'Healthi Organization and the National Acadenpr of Sciences Cbmeittee on Ai rl i ner Cab1 ni Ai r Quality, on the question of' passive smokiing oni passenger ai rcraft. I was a: consultant on, the Involluntary Smoking Chapter of the 1984 Svrgeon. General "s Report on Smoking and Chronic Obstructive Lung Diseases. I served as a consultant to the Federal Trade Commission i'n the area of tobacco, smoke and air, cleaners. Three of my papers are cited in the 1984: Surgeon Generall's Report on, Smoking and' O' Lung Di'sea.se, and' my work is extensi'vely d'i scussed i n two books: "Indoor Ai r UT Quality" by B:. Meyer, Addison Wesley, 1983,, and i'n "I'ndbor A1r Quality" by Walsh, ~~ Dudney, b Copenhaver, CRC Press, 1984. APh N W' G-5
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Bibliography on Involuntary Smoking/March, 1986 Schmidt, F. Tobacco smoke as the most important source of air pollution in enclosed spaces and as a pathogen for passive smokers. Med. Welt 25(44):1824-18'32', 1974!. (German) Schmidt, F., Wiischnath, A. Protection of nonsmokers at the working place. Contribution to the working site regulation and to the reform of'the Industrial Safety Act Adolescents. Zentralbl. Arbeitsmed. 25(5):141-145 concl., 1975. (German) Schmidt, F.,, Wischnath, A. The protection of nonsmokers at the job site -- contributions to the job site regulations and the reform of the child labor law. Zentralbl. Arbeitsmed. Arbeitsschutz 4/'5:129-136, 1975. (German) Schmidt, F. "Active" and "passive" smoking as serious bronchial noxae. MMW 11S(41):177'3-1778,, 1973. (German) Schmidt, F. Health damages andiimpairment of mental efficiency by passive smoking,. Oeffr. Gesundheitswes.. 35(3):150-156, 1973. (,Ge rman) Schmidt, F. Active smoking and~ passive smoki~ngi. Fortschr. Med. 90( 314 ):125I3-12'56, December 7, 1972. (,German) Schmidt, F. Hitherto unpublished legal' violations in, smoking: nonsmokers protection,-,an urgent task of environmentali protection. Z. Allgemeinmed. 48(14):709-713, 1972. (G'erman) Schmidt, F. Concerning the problem, of "passive smoking" (letter).. Munch. Med. Wochenschr. 113'(18):702-705, 1971. (German) Schmidt, F., Wischnathi, A. The protection of nonsmokers at work. Work place regulations andireform of child labor laws. Zentralbl. Arbeitsmed. 25(4):1016-110contdi., 1975. (German) Schneider, S.Z., Primavera, L.H., Tantillo, J. The effect of an anticipated reverse smoking rule on, the perceived distraction, of persons attending organizationa,l meetings. J. Psychol. 1131(First Ha1f):41-45, 1983. Schulte, J.H. Sealed environments in relation to health and disease. Arch. Environ. Health 8'(3):438-452, 1964 Schulte, J.H. Discussion of'paper by Dr. Dinman. J. Occup. Med. 10(9) ' : 46 2'- 46 3, 1968. 8. Schwartz, J. Anti-s'moking, movement--pairt I. P'rogrami gains momentu:n. HealthiSci. J. 5(8):1, &, May 1977. Searle, C.E. Slmoki~ng and FOREST (letter). New Scientist 88 ( 12'31) : 73'4-735,, 1980.. ~ ~. 56 ~ -56 N N O C
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C cancer of the mouth andlesophag!us and has been reLated to kidney cancer and cancer of the cervix. • Up to 90 percent of'the deaths from chronic lung disease • 40 percent of the deaths fr=coro- nary heart disease. The total financial cost of cigarette smokingi is about $65 billion each year -- more than $2'for every pack of cigarettes consumed. The cost in personal anguish, suf- fering and needlessly lost lives is incalculable. As the damage that cigarette smoking does to our health has become clear, the proportion of adult smokers has gone down. In 1965, more than half of the adult men in this country smoked; today it is just over, one-third. The per- centage of women who smoke has also declined, although not nearly as rapidly, from 3'4' to 29 percent. Smoking among, teenagers has dropped dramatically since the late 1970s. Per capita cigarette cpnsumption has been falling steadily since 19'73'. For the first time in two decades total cigarette consumption fell two years in a row in 1982 and 19'83'. These declines have taken place in spite of the tobacco industry's record-breaking levels of advertising which reached more than $2.5 billion in 1983. Now a new wave of evidence is revea1ing,the dan- gers of involuntary, second-hand smoking -- dangers that require a new set of government responses. Studies i'n Japan, Germany, Hong Kong, Greece, Scotland, and the United States point to a, clear relationship between exposure to 2 G-10
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Biblio!graphy on Involuntary Smoking/Mairch, 1986 Schievelbein, H. Sick from passive smoking--no proof of a hazardd to health (letter). MMW 124(8):12', 1982. (German) Sthievelbein, H. Lung cancer iin passive smokers. Munchi. Med. Wochenschr. 123(17)1:668-6'69, 1981. (German) S'chievelbeini, H. Involuntary smoking. Med. Klin. 73 (10 ): 33I3- 340, 1978. (German) Schievelbein, H. On the question, of the influence of tobacco smoke on the morbidity of nonsmokers. Internist (Berlin) 14(15)•236-243, 1973. (German,) Schievelbein, H'., Richter, F. The influence of passive smoking on the cardiovascular system. Prev. Med. 13': 626-644, 1984. Schilling, R.S.F., Bouhys, A. Breathing other people's smoke (letter). Br. Med. J. 2(614,1):895, 1978. Schilling, R.S.F., Letai, A.D., Hui, S.L., Beck, G.J., Schoenberg, J.B., Bouhuys, A. Lung function, respi'ratory disease, and smoking in families. Am. J. Epidemiol. 1016(4):274- 283, 197'7 . Schindl, R. Effect of environmental factors on, pulmonary function. Screening study of flow-volume in children from urban and rural areas. Z. Erkr. Atmungs!organe 16'1(2):199-2'03', 1983. Schmeltz, I. The chemistry of tobacco and tobacco smoke. (Proc. of the symposium on the chemical composition ofl tobacco and . tobacco smoke, September 1971, Washington, D.C'.) New York: Plenum Press, 1972. Schmeltz, I., Hoffmann,, D. Nitrogen-containing compounds in tobacco and tobacco smoke. Chem. Rev. 7'7(3):295-311, 1977. Schmeltz, I., Hoffmann, D. Chemical studies on tobacco smoke,. XXXVIII. The physicochemical nature of cigarette smoke. In: Wynder, E.L., Hoffmann, Di., Gori, G.B. (eds. )1. Modifyingi the rilsk for the smoker. Vol. 1. Proceedings of the 3rd world conference on smoking and health, New York City, June 2-5, 1975. DH'EW Publication No. (NI'H') 76-122'1. pp. 13-34.. Schmeltz, I., Wenger, A., Hoffmann, D., Tso, T.C. Chemical studies on tobacco smoke. 63. On the fate of nicotine during pyrolysis andi in a burning cigarette. J. Agric. Food C'hemi. 27'('3):602-608, 1979. Schmeltz,, I., Wenger, A., Hoffmann, D., Tso, T.C. Chemical studies on tobaccoismoke. 53. Use of radioactive tobaccoo isolates for studying the formation of smoke components. ,7. Agric. Food Chem. 26(i1):2'34-239, 1978. 54.
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{TritteniTestimony of STANTON A. GLANTZ',, PH.D. Associate Professor of' Medicine University of Cali'fornia San Francisco, CA 94143 President Californians for Nonsmokers'' Rights . 2054 University Avenue,, Suite 500 Berkeley, CA 94'704 Submitted to the Subcommittee on Civil Serv ice, Post Office, and General Services Committee on Governmental Affairs Uniltedl States Senate For Hearing,on S.1440 The Non-Smokers Rights Act of 1'9'B'5 September 30, 19'H5 E G-22
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Bibliography on Involuntary Smoking/Maxch, 1986 Lancet 1 (8433'):866-867, 1985. Treatment for alpha 1-antritrypsin deficiency ('editorial). Lancet 2(845'9):8'12'-813, 1985. -----, Passive smoking and lung cancer (letter). Lancett l(8378):6814, 1984. -----, Passive smoking: FOREST, GASP, and facts (editorial). Lancet 11(18271)1:548-5'49, 1982. -----, Passive smoking and angina (editorial). Lancet 2'(,8'086 ) : 413-414 , 1978. -----, Tobacco smoke and the non-smoker (',editorial)I. Lancet 1(',7868 ) :12'01-1202, 1974'. ------- Where there's smoke. MD 17'(3):69-7'1,, 75, 1973. -----, Prohibition of smoking dhiring, courses of continuing medical education. Med. Monatsschr. 29(3):141-142', 1975. -----, Passive smoking (letter) Ni Engi J Med 19'851 Mar 14;312(11):719-21 -----, Contemporary comment. Pennsylvania's Health 30111:9, 1969. -----, Smoke in occupiedispaces: Ventilation requirements. Paper 81-22.6 to be presented at the 74th, Annual Meeting, of the Air Pollution, Control Association, Philadelphia, Pennsylvania, June 22-25, 1981. -----, Statistical error cited in smoking,-cancer study. Tob. Int. 183 (113 ): 73-74, 1981. -----, New method of leaf protection through insect growth regulati'on. Tob. Int. 182(4),:18, 21', February 22, 198 0. -- --, Anti-smokingimomentum threatens cigarette industry. Tob. Reporter 107(1):12, 1980. -----, Smoking affects whole family. West Virginia Med. J. 6 5' (1) : 2 2', 19 6'9 . -----, Smoking and its effects on health. Report of a WHO Expert. Committee. World Health Organization. Technical Report Series, I No. 56'8, 1975. -----, Smoking in the cockpit, and smoking by flight crewmembers before com,merical flight operations. Worldi Smoking and Health 74 f D.-74
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As Secretary, of'HEW, I issued an order requiring that each employee's right to smoke-free space be recog- nized. After a few shakedown weeks:, all employees, smokerss and non-smokers alike, not only lived with~it, they reported that they were much happier than before. I'n April 1984, Malcolm T. Stamper, President of the Boeing Company, estab- Lished a corporate policy to create a smoke-free workplace. As an initial step, Boeing prohibited smoking in common areas throughout the workplace, such as hallways, restrooms,, lobbies, libraries, andicomputer rooms. When Stamper first put this policy in place, he expected resistance from the workers and the union,. Instead he got acceptance and appre- cia ion. Many companies are strictly limiting smoking to designated areas. Workplace no-smoking policies make health andibusiness sense because smokers are sig;nilfi1cantly less producti've and far more accident- and'illness-p.rone. The short-term, costs to business of smoking emplioyees are esti- mated at $3'00 to, $3'50 per year, with long-term effects on productivity, absenteeism and premature death raising this tolabout $1,0100 per year. Mr. Chai~rman, I have one suggestion for your con- silderation, as you continue your deliberations on this legis- lation: Stipulate that when disputes arise from policiess established under the Act, the rights of the non-smoker take precedence. This has been effective in a number of' statee and local statutes. i 5 G-13
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Bibliography on Involuntary Smoking/March, 1986 Praventivmedi. 25(16):32'8-332, 1980. (German). Ware, J.H., Dockery, D.W., Spiro, A., 3d, Speiizer, F'.E., Ferris, B.G., Jr. Passive smoking, gas cooking,, and! respiratory health, of children living in six cities. Am. Rev. Respir. Dis.. 129 ('3 ) : 3616-374, 19841. Warner, R.E. The economics of smoking: dollars and sense. NY State J. Med. 8'3(13):1273-1275, 1983. Watson, W.C. "Bingo brain"'(letter). Can. Ned. Assoc. 126 (11i ) :126'6 , 1982. Weber, A., Jermini, C'. , Grandjean, E. Irritating effects on man of air pollution due to cigarette smoka. Am. J. Public Health 66(7'):672-6I76, 1976. Weber, A. Passive smoking--alhealth hazard?' Dtsch. Ned. Wochenschr. 107'(91:3I23-325, 1982. ('German) Weber, A., Fischer, T., Grandjean, E. Passive smoking in experimental and fileld conditions. Environ. Res. 20(1):205-216, 19791. Weber, A., Fischer, T. Coneentrations of pollutants in the "blowi!ng cloud"' of smokers. Int. Arch. Occup. Environ. Health 53 (11: 47-50, 1'9'83'. (German) Weber, A., Fischer, T. Passive smoking;at work. Int. Arch.. Occup. Environ. Health 47('3):209-2'21, 1980. Weber, A., Fischer, T., Grandjean, E. Passive smoking: irritating,effects of the total smoke and'the gas phase. Int. Arch. Occup. Environ. Health 43(3):183-193, 19'79. Weber, A. Passive smoking,. Schriftenr. Ver. Wasser. Bodien Luft- hyg. 53:17-23, 19'82. (,German) Weber. A., Muramatsu, T., Muramatsu, S. Acute and chronic effects of passive smoking. Soz. Praventivmed. 27(5):262-263, 1'9'82'. (iGerman) Weber, A. Passive smoking, air quality, and protective measures. Soz. Praventivmed. 26(3):182-18'4,, 1981. (German) Weber, A., Acute effects of environmental tobacco smoke. Eur. J. Respir. Dis. [Supp1. ] 133:98'~1i018, 19'84. Weber, A., Fischer, T., Grandjean, E. Passive smoking: irritant effect of the total smoke and the gas phase. Soz. Praventivmedl. 24(4):280-28'1, 1979. (German) Weber, A., Fischer, T., Grandjean, E. Passive smoking under 68 ! n D-68
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; into the private workplace: that'thc 1ltnv isunnrccss:ury and the mattcr of stninking should be worked out privately; and that the lawfosters "anc-man rule" by giving a.ingll• nonsmoker the power tu dictate personal behavior by all llhe other pct+plv in lho office. One of the liirni pirc4s of hlerature by tlhe tobacco industry told citizonx that thcy should be :rngry that tlhey wcrc'being forced to vcttc'in an unnecessary elcctlion, thereby heaping scorn on propuncnts ol' the ordi- nancc for what the tubaccoindustr} itself'hatd engineered. They claimed that thc law' is d'isc,rintinatory because it applies to all private empluyccw but only :(I°i of public employces- in otihcr wurds, city as oppu.ed'tu state and fudcrallcnipliwcc,: Actually,, t'hc City Attorney had deter- mined that the city did not have the tx)wcr tocnfurccthc'lativ in state and' federal officus and, in any evcnt.,allist;ttc cmr ployccs were already protected by a st:uc Iitnv. The most outlandish'allcgatiom c:rntc inimponsc to the growing public awnrenc.s that the "Nlo on P" rtmpaigni wa:s receiving 99,7"l0 of its money from out-of-state tobacco companies. One "Nru on P" rcprerkntativc charged during a dubatic that proponents were gctting 94.''~;% of their money from outside San Franci:u:o, and this absurd claim was continued throughout the campaign. Probabli,v the mos2'important endorsement would be that' of the San Francisco Democratic Central Committee. The Committee had solidly supported the twostatta+idc'inifia- tlixes for nonsmokers' rights in 197'8 and 1'980, and there seemed'to be no reason why, they wouldl not endorse the ordinance, particularly since it, had the backing of the Mayor. But no one reckoned on just how much pressuree would be brought to bear, all the committee endorsed "1Vo on P" by a vote of 15 to 14l Just how much that, endorse- ment meant was brought home the day after the election, whcnthe contact person for the "Yes on P"'campaign in the Mayor's off ce said thao her own!husband Iwas so confused upon receiving the voting recommcndations from the Democratic Central Committee that hc' almost voted against the proposition. Perhaps the saddest moment in the campaign came when The Bav Guardian, a liberal biweckly ncwspapcr, which had been the only ncwspapcr in thestate to support the 197K' statewide initiative and one of the few to support the 19800 initiative, announced itsoppo»ition to Propcflxition P. Neither the publisher nor his support for nonsmokers' rights had cltangcd, but the perceived threat of the loss of cigarette advertising evidently becanne ovcrwhelming. UNDEuSTANUIIVG~ MAtiS 141It•:1rtA Prupuncntsof the ordinance developed three kcy com- poncnts of their campaign. First, Edgar Spi7.ci, a mediaa consultantiand produccrof thousandit qf radiu'and tclcvision commcrcials, volunteered his services. The "1'es on P"television commercial he created featured a, tough-looking cowboy riding a horsc' on a San Francisco street and decrying the fact that the tobacco companics were spending 9970 of the money to overturn the new smoking ordinance. At the end tic repeats the campaign slogan: "Tclllthc to- bacco companies tobuttiuut!i" (The advertising community namcd it the best television commcrcial in Nort'hcrn Cali- forniia for 1'9133'.) The second key clemcn, was to force the ttubacco industry to changc thc'taglines at the end of the "No on P" radio and TV advertisements to say "paid for by the tobacco industry" rather than "paid for by, San Franciscans Against Gov- ernment Intrusion." The Federal Communications Act of' 1934 retquires'broadcast stations to identify the true sponsorr of all politicalladvcrtisementsl fJsingall volunteer attorneys, AUOq(westemlmusic up and undar) . You know, we San Franeisean's aro a proud twnchi We like to idb rtt+inqs our own way. So when soms 4ottcs, like the low tli0iYl9ttDbaeeol eoRpanies from oul of statel qa'up 199.5 % of the doUars to iovertum ourneiw smokinq orQinal . wel1, ttnt just imakes ms mad. It'yuu're as mad as'J am.,why not IPin me in tellinq tMese tobacco companies to ~t7Un OIJ4 Vote Yes on P (music up and iout)) headed by Paul' Loveday, who had led'the twoistatewide initiative campaigns, proponents put together a, 31D+page . memorandum (and more than 100 pages of'supportling documents), which was thcn presented to adl'thrstatidnsl broadcasting "No onP" commercials. W'ithin twod'ay,s of rl of this material„K'RON-TV, the NBC affiliate and tihest'ation with the largcsramount of "No on P"campaiign advcrtising, informed San Franciscans Against Govcrnmcnt Intrusion that if they did! not modify, the ta'glinc, the ad- vcrtlivcmcnts would be taken off the air. KNBR (NBC radio) followed suit. The tobacco industry then chanecd!tht: taglinc for' KRON to rcad; '"paid fior by San Franciscans Against Government' Intrusion, which is funded by com- panies in the tobacco industry."'They reluctantly agreed Jl:liY I1)X5/'!vfw YORK STA'Tf JOtURNTI. O1' NLI)tCIMIi' 371 B -3'.
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Bibliography on Involuntary Smoking/March, 1986 experimental conditions and'in field studies. Soz. Praventivmed'. 23(4):261-262', 1978. (German) Weber, A., Fischer, T., San!cin, E., Grandjiean, E. Air pollution from cigarette smoke: Physiological effects and irritations. Soz. Praeventi'vmed. 21(4):130-1i32, 1976. (French) Weber, A. Annoyance and i'rritation by passive smoking. Prev. Med. 13:618-625, 1984. Weber, A. Air, pollution and burden from cigarette smoking: the . problem of passive smoking. Z. Krankenpfl. 69(4):115-118, 1976. ( Ge rman,) Weber-TSchopp, A., Fischer, T., Gierer, R., Grandij',ean, E. Experimentally induced irritating,effects of acrolein in man,. In'tt. Arch. Occup. Environ. Health 40(',2'):117'-130, 1977. (,German) Wieber-Tschopp, A., Fischer, T., Grandj,ean, E. Irritating effects of formaldehyde in man. Int. Arch. Occup. Environ. Health 39M ': 207-2'18', 1977 . (,Ge rman ). Weber-Tschopp, A., Fischer, T., Grand'j'ean, E. Objective and subjective physiologic and psychologic effects of passive smoking. Int. Arch. Occupi. Environ. Health 37(4)1:277-288', 1976. (German) . Weber-Tschopp, A., Jermini, C., Grandjean, E. Air pollution and irritations due to cigarette smoke. Soz. Praventivmed!. 21(2- 3):101-106, 1976. Weber-Tschiopp, A. Passive smoking--a health risk. Tbbakken Og Vi 4:3-7, 1980. (Norweg,ian) Weir, F.W., Johnson, D.F., Angleni, D.M., Rockwell, T.H.,. Nieu!hard't, J.B., Harshman, D.J., Baliasubramanian, K.N. Thee interactive effects of carbon monoxide and! alcohol on driving . skills. Columbus : Ohio State Univ., 1975. Weir, F.W., Rockwell, T.R.,, Mehta, M.M., Johnson, D.F., Anglen, D.M., Attwood, D.A., Herrin, G.D., Safford, R.R. An investigation of the effects of'carbon monoxide on humans in the driving task. Columbus : Ohio State Univ. Res. Foundation, RF Pro jiects 3'141, 3'332, 1973. Wei~s, W.Li. Clearing the air on office smoke (letter). Bus,. Week Indus. Ed. (12776):4, February 7, 1983. Weis, W.L. Clearing the air on, office smoke (1'etter)1. Bus. Week Indus. Edi. (2776):4, February 7, 1983. Weiss, S.T., Tag!er, I.B., Schenker, M., Speizer, F.E. The health, effects of involuntary smoking. Am. Rev. Respir. Dis. 69 D-69
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Bibliography on Involuntary Smoking/March, 19'86. 128 ( 51:933'-942, 1983. Wei,ss, S.T., Tager, I.B., Speizer, F.E., Rosner, B. Persistent wheeze. Its relation to respiratory illness, cigarette smoking, and level of pulmonary function in a population sample of children. Au. Rev. Respir. Dis. 1'22(5) :697-707, 19'80'. Weiss, S.T., Tager, I.B., Speizer, F.E. Passive smoking. Its relafiionship to respiratory symptoms, pulmonary function and nonspecific bronchial responsiveness (editorial). Chest 84(6):651-652 1983. Weiss, W.L. "No ifs, ands or butts"--why workplace smoking should be banned. Management World!, Sept.:39-4'0, and 44, 1981. Weiss, W'. Smoking: burning a hole in the balance sheet. Personnel Management 13 ( 5): 2'4-2'9, 1981. WWelch, R.M'., Harrison, Y.E., Conney, A.H. Cilgarette smoking: stimulatory effect on metabolism of 3,4-Benzpyrene by enzymes in human placenta. Science 160(3827):5'41-54'2, 1968. Wexler, P. Passive smoking: January 1972 through, September 1980, 1621 citations. Bethesda, Md. : U.S'. Department of Health and Human Service&, Public Health Service, National Institutes of Health, National Library of Medicine, 1980. National Library of Medicine Literature Search No. 80-1. Whidden, P. Clean air charter for airlines (letter). Br. Med. J. 286(6365'):646, 1983. Whidden, P. Scope for legislation on smoking (letter). Lancet 2'( 8296 ) : 498, 19182. White, J.R. Selected pulmonary functions of nonsmokers chronically exposed~ to tobacco smoke (abstract),. Med. Sici. Sports 11(1):8,8(6), 1979. White, J.R., Froeb, H.F. Small-airways dysfunction in passivee smokers ( letter ). N. Engl. J. Med'. 303 (;7') : 393-394, 1980. White, J.Ri., Froeb, H.F. Small-airways dysfunction in nonsmokers chronically exposed to tobaoco smoke. N. EngI. J. Med. 3!021(,13 ) :72'0-723', 19810. White, J.R. Effects of residual tobacco smoke on non-smokers. The International Congress of Physical Activity Sciences, 1976. Wigle, D.T. Publilc health enemy number 1: smoking. Can. Pharm. J'., 117('4'):140-144, 146, April 1984. Wigle, D.T. Forced smoking. Can. J. Public Health 2'32, 198'3. 70 74(4):23'1- f D-70.
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~x- Here is what Surgeon General C. Everett Koop says about involuntary smoking: There is all the medical evidence necessary to support reasonable and sensible protection for the nonsmoker against the irritation and potential harm that comes from other people's smoke. The harmful constituents of mainstream cigarette smoke are found in sidestream smoke, sometimes to a greater atent than in mainstream smoke. Pbllution from tobacco smoke in homes, offices, other uarksites and in certain public places can rrach levels which exceed contaminant levels permitted under environmental and occupational health hn regulations. r- Nonsmokers absorb the constituents of tobacco smoke into their bodies, even though in smaller amounts than is true of those who smoke. - Passive smoking can make the symptoms of asthma and chronic bronchitis worse, and make life miserable for people with allergic conditions. Maternal smoking has a harmful effect on pregnancy, including an increased risk of miscarriage, prematurityt stillbirth, death soon after birth, low birth weight and fetal death. There is increasing evidence to suggest that anoironmental tobacco smoke can bring about disease, - including lung cancer, in healthy adults, children and in/ants. ft is on the basis of these facts that I advise nonsmokers to auoid aposure to cigartite smoke wherever possible, and that, in particuFar, they should protect infants and children from this smoke. Americans for Nonsmokers' Rights and the - - - - American Nonsmokers' Rights Foundation seek to develop a coordinated action-oriented program of legislative, educational and legal activities to permit nonsmokers to avoid involuntary exposure to tobacco smoke in public places and places of employment. Norismoe rs Rights 2054 University Avenue. Suite 500 8erkeky, California 94704 (415)841-3032 VCzV8sRz0z 0 1985 Americans for Nonsmoken' Rights NONSMOKER ;..- .~ . ..: -r ~
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the indoor environment. o The children of smoking parents have an increased prevalence of reported respiratory symptoms,, and have an increased frequency of bronchitis and pneumonia early in life. As you, Mr. Chairman, are aware from legiislation in your own state of Alaska,, many states have exhibited leadershiip to protect the pubI!ic from health risks associiated with passive smoking by enacting 1!egilslatilon which pl!aces limi'tations on smokiing, in public places. A total of 37' states, have such legiislation in pl'ace. Of these, 24, states limit or restrict smoking in forms of' public transportation. Twenty-one states restrict or ban smoking during public meeti'ngs' or restrict smoking to! certain areas within publ,ic bui'ldtngs owned, - operated, or run by the state. Over half of the states--2'b--restrict smoking within certain health care establishments, usually hospiltaTs or clinics. E'1!even states have laws requi'ring, separate seati'ng for nonsmokers in resturaints and 9 states address smoking in places of retail sales. Finally, 10 states have enacted laws specifically addressing smokiing in the workpllace. Hlowever, a review of statewide regullatiion onlly touches the tip of th~e icebergi. Literally hundreds of county and, muinici'ple governments have. G'-19
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l Mr. Chairman and Members of' the Subcommittee, I am Dr. Alfred Munzer a practicing physici'an who specializes in lung di'sease. As a voliunteer with th~e American Lung Association,, I serve on their Board of Dilrectors, and chair their Government Relations Committee. I appear before you today on behalf' of the Coalition on Smoking or Health. T~he C'oaliti'on on Smoking or Hiealth, was formed by the A'mericani Lung Association, the American Heart Association and the American Cancer Society and is backed by many of' this nation's leading private health, education and youth leadership org,anizationis. The Coal!fti'on was created to bring to the attention of legi'slators and other governmental officials smokiing preventi'on and education issues. On behalf of the C'oali'tioni and its member organizati'ons, I waint to, thank you: for the opportunity toi express our views about the merits of the "N'on-Smokers'' Rights Act of 1985"', aind'' commend' you,, Mr. Stevens, for initroducing this legisl!ation. Currently, too little is done to protect the health, safety and comfort of non-smokers who work in, or who v1sit United States government bu i'1 dings . The "'Non-Smokers' RIghts Act of 1985" recogn i zes. this problem and will require responsible government officicals to address it. N O ~ Exposure of noinsmokers, both chil!dren andl adults, to tobacco ~ ~ combustion products is referred to as passive or involuntary. ~ ~ ~ ~ fl G.-16:
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o Several-studies have indicated that from one-half to three-fourths of' nonsmoking adults experience sym- tomiatic effects from ambient tobacco smoke exposu.re i'ncl'udi'ng eye, nose and throat irriltation, headache,, and nausea, withi moire severe effects reported im per- sons with chronic heart or liunig di'sease. Two recent sttudies of lung caincer in nonsmokers showed evidence that passive smokinig more than doubles the nonsmoker's rilsk of lungi cancer. Two epi!demiollogi'cal studies of the indoor environment and marbidity--one of 400 adult nonsmokers who were chronical'ly exposed!to tobacco smoke at work and th~e other of young children raised in households with simokers--fou!nd evidence of pullmoinary impairment from passive smoiking. Miost recently, the 1'984 Surgeon G~eneral's Report oni the Health Consequences of Smoking concluded on the ilssue of passive smokinig: ~ o Cigairette smoke can make a si'ginificaint, measureable N contributioni to the leveT of indoor air pollution at ~ levels of smoking and ventillaitian that are common, in ~ ~ i17 C G-18
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TBSTIMONY' OF JOSEPH A. CALIFAhTiO, JR. BEFORE THE U.S. SENATE SUHCC14MITTES ON CIVIL SERVICE, FOST' OFFICE XNIJ. GENERAL SERVICES September 310, 1985 Mr. Chairman and Members of the Committee: I appreciate your invitationito testify on the Non-Smokers Rights Act ofl 1985. Mr. Chairman, this bill -- by requiring that all Federal agencies restr'ict to limited'l areas any smoking in their buildings -- will help propel us into a second major phase in the nation"s progress towards'a, smoke-free soci'ety. Twenty-one years ago Luther Terry issued'the first Surgeon General's Report on Smoking and Health., That report found cigarettes guilty of murder and mayhem by cancer, heart disease, emphysema!, and chronic bronchitis. The evidence in that first report has grown to;an avalanche of data detailing with grisly precision the toll of cigarette smoking,. It causes at least 3'60',0i00 deaths each year, 170,0!00 from heart disease, 130,0010 from cancer, and'i 60,0100 from chronic lung diseases, including: 9 810 to 815 percent oE al l d'eaths f rom lung cancer ill 40 to 60 percent of bladder cancers among men, and 25 to 3'.5 percent among, women • Up to 84 percent of' cancer of the larynx. Smoking is a major factor in G-9
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In cllosinig I would li'ke to review the results of' a survey the Ameri'can Lung Association conduicted om the issue of non-smoker's rights. The survey, carri!ed out for ALA by the Gallup Organi'zationi„ showedl that 82%' of the nonsmokers and 55% of current smoikers agree that smokers should not smoike around nonsmokers. On the issue of smoking in the workplace, 64% of the nonsmokers andl 63% of the smokers preferred designated smoking areas in the workplace. These results are indicative of the concern of the American public about the health risks of passive smoking. "The Non-Smokers' Rights Act of 198I5I", providlingi for the limitation of smokiing in federal buildings, is a common sense approach designed to reduce exposure to tobacco smoke,, a substance which in our opinion requiires no further study to justify governmental action to protect the non-smoker. M'ore than sufficient evi'dence of its harmfulness exists. We shiould not wait for further before enacting reasonable regulations restricting smoking in public places, includling, the workplace, as a means of protecting publ!ic healith. The Coalition looks forward' to working with you to einact this very important publilc health legisllation. Thank youl.
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DEPARTMENT OF HEALTHi & HUMAN SERVICES Public Health Service Health iResnurces and I Services Administration February 7, 1986 Rockville MD 20857 StantoniA. Glantz, Ph.D. President„ Americans for Nonsmokers' Rights 2054 Uinfiversity A'venue, Suite. 500 Rerkeley, CA 947'OU'. IDear S'Lan s You asked me to summarize for your memberd what we know about the dangers of iinvoluntary, or passive, smoking,to nonsmokers. There is all the medical evidence necessary to support reasonable and sensible protection for the nonsmoker against the irritation and potential harm that comes from other people's smoke~. The harmful constituents of mainstream cigarette smoke are found!in, sidestream smoke,, sometimes to a greater extent than in mainsteram smoke. Pollution from, tobacco smoke in homes, offices, other worksite's and in certain public places can reach levels which exceed contaminant levels permitted under environmental and'occup'ational health,regu'lations. Nonsmokers absorb the constituents of'tobacco smoke into their bodlies, even thougta in smaller amounts than is true of those who smoke. Passive smoking can make the symptoms of asthma and chronic bronchitis worse, and make life miserable for people with allergic conditions. Maternal smoking,ha's a harmful effect on pregnancy, including,an increased risk of miscarriage, prematurity,, stillbirth, death soon after birth, low birth weight and fetal death. There is increasing evidence to suggest that environmental tobacco smoke can bring about disease, including lung cancer, in healthy adults, chi'ldren, and infants. It is on the basi& of these facts that I'advise nonsmokers to avoid exposure to cigarette smoke! wherever'pos'sible„ andithat, in particular, they should protect infants and childl^en from this smoke. Americans for Nonsmokers' Rights is doing outstanding work in not enly, bringing these dangers to the public''s attention, but also i'n helping to pass legislation and creating educational pro'grams that will help us reach the goal of a Slaoke Free Society by the Year 2000. I encourage responsible individuals everywhere to support your good work. Sincerely yours, ~. C. Everett Koop, M.D. Surgeon General E-1
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Bibliography on Involuntary Smoking/March, 19'86' 0'ffice on Smoking and Healthy 1984. DHHS (PHS) 84-50205. p. 3'63-410. Uniited States. Ofice on Smoki'ng and Health. The health consequences of smoking: cancer. A report of the Surgeon General:1982. Rockville, Mdi. : U.S'. Department of Health and' Human Services, Public Health Service, 0'ffice on Smoking and Health, 1982. DHHS (PHS')~ 82-50179. pp. 91, 181-182, 213-214,. 239-254. United States. Office on Smoking and'Health. The health consequences of'smoking: the changing cigarette. A report of'the. Surgeon General. Rockville, Mid. : U.S. Department of Health and Human Services, Public Health Service, Office on Smokinig and Health, 1981. DHHS(PHS) 81-50156. pp. 561, S'8, 204. United States. Office on Smoking and Health. Smoking and health: a report of'the Surgeon General. U.S. Department of Health, Education, and Welfare, Publ'ic Health Service, Office of the Assistant Secretary for Health,, Office on Smoking and Health, 1979. DHEW(PHS) 79-50066. pp. Ii:6-II:24. United States. Public Health Service. The health consequ-ences of smoking. A report of the Surgeon General: 1972. Washington,. D.C. : U.S. Department of' Health, Education, andiWelfare, Public Health Servicel, Health Services and Mental Health,Administration, 1972._ DHEW Publ'ication No. (HSM) 72-7516. pp. 119-135. United State Department of Health and Human Services. The Health Consequences of Smoking,: Cardiovascular Disease. A Report of the Surgeon General (DHHS' ['PHS] 8t-502'04), Rockville, Md. 1983. Urbach, E. Odors (osmyls) as allergenic agents. J. Allergy 13:387-396, 19,42. Vandlenbroucke, J'.P., Verheesen, J'.H., dieBiruin, A., Mauritz, B.J., van der Heidle-Wessel, C., van, der Heide, R.M. Active and passive smoking in married couples: results of 25lyear follow-up. Br. Med. J. (iClin. Res. ] 28i8(6'433):1801-2, June 161, 1984'. Vainio, H., Hietanen, E. Tobacco smoke as an environmental hazard'. Duodecim 9'9(22):1638'-1645', 1983. (FYnnish,) Valentin,, H. Passive smoking: A scientific consideration. Prevent. Med. 13:565-569, 198'4. Valentin, H. Proceedings of the international symposium on medical perspectives on passive smoking. Prevent. Med. 13':559- 560, 1984. Valentin, H., Bost, H.P., Wawra, E. Passive smoking at the workplace--inj'urious to health? 2entralbl. Bakte: i'oli. B 167 ( 5- N 6') :405-434, 1978. (,German,) ~ N VI 65 ~ ~ D-65
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Bibliography on Involuntary Smoking/March, 1986 Portheine, F. A contribution to the problem of "passive smoking" ('letter ),. Munch. Med. Wochenschr. 113'(,18 ):707-709, 1971. ( Ge rman,), Poultoni, J., Rylance, G.W., Taylor, A.W.J., Edwards, C'. Serum thiocyanate levels as indicator of passive smokoing,in children (,letter). Lancet 2'(',8'416):1405-1406, 1984. Preston-Martin, S., Henderson, B.E. N-nitroso compounds and human intracranial tumors'. IAR'C' Sci. Publ.( 57 ):88I7-8914, 198'4 . Preston-Miartin,, S., Yu, M., Benton, B., Henderson, B. N-nitroso compounds andichildhood brain tumors (abstract). Am. J. Epidemiol. 116(3):563, 1982'. Preston-Martin, S., Yu, M., Benton, B., Henderson, B.E. N-nitroso compounds andichildhood brain tumours: a case-control study. Cancer Res. 42(12)1:52'40-5245, 1982. Preussman, R. Occurrence and exposure to N-nitroso compounds and precursors. IARC Sci. Pub1. (57):3-15, 1984. Prevalence in Canada of health conditions aggravated by tobacco smoke. Chronic Dis. Can. 4:9-11, 1983'. Prier, D.G. Detection of free radicals from, the reactions of ozone with olefins and from cigarette smoke by electron spin resonance techniq,ues (dissertation). Baton Rouge, Louisiana : Louisiana State University and Agricultural and Mechanical Col!lege, 1981. 282'pp. Diss. Abstr. Int. 82'-07834. Pryor, W.A. Free radical biology: xenobiotics, cancer, and aging. Ann. NY Acad. Sci. 393:1-22, 1982. Pryor, W.A. Mechanisms and detection of pathology caused by free radicals. Tobacco smoke, nitrogen dioxide and ozone. In:. M'cKinney, J.D. (ed.). Elnvironmental health cheaaistry: the chemistry of envrionmental agents as potential human hazards. Ann Arbor, Michigan : Ann Arbor Science, 1979. pp. 445-466. Pryor, W.A. Smoking at ACS meetings (letter). Chem. Eng. News 53(33):3, 1975. Pryor, W.A., Dooley, M.M'., Chruchl, D.F. Human alpha-l-proteinase inhibitor is inactivated by exposure to sidestream cigarette smoke. Toxicol. Lett. 28(',1):65-70, 19185. Pryor, W.A., Prier, D.G., Church, D.F'. Electron-spin resonance study of mainstream and sidestream cigarette smoke: nature of the free radicals in gas-phase smoke and in ci'garette tar. Envi!ron. Health Perspect. 47:345-355, 19,83. 46 C)1 (-: D~-46
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-7- , SEL'ECTED PRESEMTA'TIONS, J.L. REPACE, 1983 - 1985 "Tobacco Smoke and the Nonsmoker"', lnvited talk, Session on Nonsmokers' Air Environment, 5th World Conference on Smoking & Health, Winnipeg, Canada, 1!3 July, 1983.. Testimony on Passive Smoki'ng, Hearing before the Svbcommittee on Energy Development and'Appllcations and the Subcommittee on Natural Resources, Agriculture Research an& Environment of the Commfittee on Science and Technology, U.S. House of Representatives, Washington, D.C. August 2, 1984. Invitedlparticipant, Internationall Conference on Assessment of'Passive Smoking, sponsored by the International Agency for Research on Cancer, at the American Health Foundation, Va1halla, NY. 8-9 December 1983. "Workplace Passive Smoking"'', Invited talk presented at the, National Safety Management Society Conference, Hotel Sheraton4ashingxon,-Washiington DC, April 23-26, 1984. "Passilve Shioki'ng"', invited talk presented at the 19th A'nnual! Meetin% of the U.S. Publ'ilc Health Service Professional Association, Scottsdale, Arizona, 4-8 June 1984. "A Proposedl'Indoor Air, @Quality Standard for Ambient Tobacco Smoke": paper presented at Third International Conference on Indoor Air Quality and! Indoor Climate, • Stockholm„ Sweden, 20-24 August 1984. "Risks of Passive Smoking" Guest Lecturer at Pierce Foundation Laboratory, Yale Uni'versity, New Haven, CT, 17 December 1984. . Invited Talk oni "Risk Assessment'of Passive Smoking", Interagency Technical Working Committee on Smoking, Heart, Lung,,and!Blood Diseases, National Institutes of I Health, Bethesda, MD, 16 January 1985. Invited Talk on "Risk Assessment of Passive Smoking"', Interagency Task Force on Envi ronmental Lung Cancer, U.S.EPA, Washington, DX. 7 February 1'985.. Panelist, Special Study Section for Review of National Cancer Inst1'tute Grant Appli- cations ('RFA-84!-CA-14) for Passive Snaki ng Research, Arl i ngton VA. 1'S Marchi 1985. Invited Talk on "Cancer Risk fromWorkplace Smoking", Conference on Smokingiand the Workplace, Society for Occupational and Environmental Health, Washingtoni DC, 10 April 1985. Invited participant, Planning, Workshop on Research Programi for Passive Smoking on Aircraft, sponsored by the World Health Organization, Geneva, Switzerland, N Aprili 17-19, 19815. . Invited Talk on ".Risk Assessment of Passive Smoking", University of'California, ~ Berkel ey/Sani Franc1 sco, Program i n Bi o-Engi'neeri ng, Sain Franei sco, CA, 30 Apri'1 19815. ~ Invited Tal k on Model i'ng of Si destream Smoke on Passenger Ai rcraft. Nati onal ~ Academy of Sci'ences Committee on Ai'rliiner Cabin Air Quality. Woods Hole„ Mass. ~ July 25, 1985. ~ OA G-7
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Bibliography on Involuntary Smoking,/March, 19'86 Vutuc, C. Quantitative aspects of passive smoking and lung cancer. Prev. Med. 13':698-704, 1984. Vutuc, C. Lung cancer risk and passive smoking: quantitative aspects. Zentralbl. Bakteriol. Mikrobilol. Hyg. (B) 17'7(i1-2):910- 95, 1983. (German) Waite, C.L. Effects of passive smoking (letter). N. Eng3. J. Med. 299(16):897, 1978'. Wakeham, H. Effects of passive smokingi (letter),. N. Engl. J. Med. 299 (16 ) : 8'96I, 1978. Wakeham, H.R.R. Environmental carbon monoxi~de from, cigarette smoking--a critique. Prev. Med. 6( 4):52'6-5341, 197'7. Wald N' ; Ritchi~e C. Validation of studies on, 1'ungi cancer in non- smokers married' to ssnokers ('letter). Lancet 1(',8'385'):1'067, 11984. Wald, N., Doll, R., Cbpeland, G. Trends in tar, ni'cotine, and carbon monoxide yields of UR cigarettes manufactured since 1934. Br. Med. J. 282(62'66'):763-765', 1981. Wald, i4. J,. , Bo reham; Ji., Bailey, A., Ri tchie, C., Had'dmw, J. E., Knight, G. Urinary cotinine as marker of breathingiother, people's tobacco smoke (,letter). Lancet 1(8137A):230-231, 1984. Walker, D. Histopathology of the nasal cavity in laboratory animals exposed to cigarette smoke and oth~er irritants. In:: Re.znik, G., Stinson, S.F (Edlitors). Nasal Tumors in Animals and. Man. Boca Raton, Fla. : CRC Press, 1983'.. Wa1l M; Brooks J: Holsclaw D ; Reddi~ng G. Health effects of smoking on children. Am Rev Respir Di's 1985INov;13'2(5):113'7-8 Walt, N.J. and Ritchie, C. Validation of'studlies on lung, cancer in nonsmokers married to smokers. Lancet 1:1067, 198:4. Walt, N.J., Boreham, J., Bailey, A., Ritchie, C., Haddow, J.E., FCnight, G. Urinary coti'ni!ne as marker of breathing other people''s tobacco smoke. Lancet, ('837'0), 1: 23i0-1, 1984. WWalsh, D.C. Corporate smoking, policies: a review and ann analysis. J'. Occup. Med. 26(1):17-2'2, 1984 Walters CL. III'.1. a General introdbction. [N-Nitroso compou!nds. ]I. IARC Sici. Publ. 45':2I85-29'4, 1983. Wanner, H.U. Indoor air pollution producedlby man (carbon dioxilde, odors). Schriftenr. Ver. Wasser. Boden Lufthyg. 53:11- 16,, 1982'.. Wanner, H.U. Ai~r quality in residences and places of work. Soz. 67 D-67
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...............y.~..~:.w......._,_...:. smo o t'hly . No city or county that has ever passed an ordilnance has weakened or repealedl it. While it is important that there be strong enforcement provisions in the law to ensure that people take it seriously, Lhere! has never, to, my knowledge,, been the.need to fine anyone. Enforcement has taken, the form of education and negotiation, vith legali sanctions playing a quiet but secondary role to back up the negotiations. Inisum, there are four simple principles that, lead to successful,, trouble-free nonsmokers'' rights legislation: (1) There need to be signs posted in,the nonsmoking areas. (2) There needs to be the capacity for strong enforcement; i!roni'cally,, the presence of sanctions avoids the need for using them. (3) There needs to, be a clear statement that the right to breathe clean air takes precedence over the choice to smoke. The existing,bill meets the first two criteria; to meet the third cri'terfion, I suggest that the followi'ng,language be added at page 3!line 9 after "government buildings": "providedi, however, that in any dispute ari'sing,under such rules and regulations, the needs of'nonsmokers shall ben given precedence;" I have no doubt that passage of the legislation before youivill, qui'ckly, simply and inexpensively clear the ai~r for Federal employees. It will aSso help encourage other public and private employers to follow your lead and produce a safer and healthi'er environment for all of us. Thank you. 6 G-27
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-4!- sl!iight reduction in'risk.5•8 We found that increases in ventilation rates or air cleaning potentially offered much greater reductions in risk, but because such i ncreases requi re respecti vely large amounts of energy and capital, they do not appear to be very cost-effective.2•7 We found that if smokers andi nonsmokers are separated in dilfferent enclosed spaces but not' on different venti',llation systems, as for example in a large building, the background concentrationiof smoke recirculated into the nonsmokers offiices via the venti'llating system would probably be reduced toonly a few times the acceptable risk lieve1,1•2 but this option does not appear to offer the most cost-savings. Separation of smok rs and nonsmokers into different spaces with different ventilatilon systems offers mortprotection than the previous option, but at a potentially higher cost. We found that a ban on smoking in the workplace,appeared to offer the most cost-effective approach of'all.1•2,2m In summary: it appears that the typicaT nonsmoking federal worker in: workplace where smoking is unrestricted faces a large lung cancer risk from , environmentall tobacco smoke. It also appears tfiat there are a variety of' reasonable and cost-effective controll measures which, can provide mitigation of' tfiat ri sk. REFERENCES: 1-15. Listed onipage 6. 16. ASFiRAE Standardl 90-80, Energy Conservati on i'n New Bwi l di ng Oesi'gn, Ameri can Society of Heatiing„ Refrigerating, and Air Conditioning Engineers, Atlantal, 1980. 17. Collishaw NE, Kirkbride J, and Wi'gl'e OT: Tobacco smoke in the workplace: an occupational- health, hazardl. Cain Med Assoc J 1'984;, 131: 11199-12104. 18. Loeb LA, Ernster VL, Warner KE, et al.: Smoking and lung cancer, ain overview. Cancer Res 1984; 44: 5940-5958. 19. Moghissl A: Health risks of passive smoking. Envirom International 1985; , 11:1. 20. Office of'Technology Assessment: Smoking-related deaths and financial costs. 1985. G:-!+.
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Attachments: "San Francisco Anti-Smoking I:av a Success", Wall' Street Journal, August. 15, 1984. Letter from Surgeon General Koop regarding, the health effects of involuntary smoking Letters from eity, county, and state officials regarding ease of enforcement of various ordinances: John Lockvood, Assistant City Manager, San Diego Roger Hedgecock, Mayor, San D!'egp, George Story, Director, Citizens Assistance & Information,, San, Diego James Forde,, Director, Department of Heath Services, San Diego: County Bruce Tsutsi~, Inspector, Department of Publiic Health, San Francisco Rita Hardin,, Director, Neighborhood Preservation, San Jose C. B. Schneider, Chiet, Section of' Environmental Field Services, Minnesota department of'Healtli Letter from Art Pick, Executive Vice President, Greater Riverside Chambers of Commerce, endorsing a proposed! ordinance (vhich passed). ~ Q ~ ~ ~. ~ 7 ~ ( ( G-28
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My name is Stanton A Glantz. I hold a PhD in Engineering and Economics from Stanford University and am nov an Associate Professor of Medicine and Chairman of the Bioengineering Gtadwate Program at the University of Celifornia, San Francisco, vhere I conduct research into the mechanicall function of the heart. I am also President of Californians for Nonsmokers' Rights, an organization that has helped'to pass legislation protecting, nonsmokers from the toxic chemicals in second-hand cigarette smoke in 44' California communities, encompassing approximately 9 million people. Before discussing the specifics of our experience vith legislation in California, I vould like to speak briefliy to two important general issues: the need'for such legislation to protect the public health and'the fact that the only organized opposition to such legislation comes from the tobacco industry. First, there is absolutely no question that, as the National Academy of Sciences concluded in 19811, "involuntary exposure to tobacco smoke has adverse health, effects and ought to be minimized or avoided vhere possible." There are over 600 papers in the medical literature on the effects of involuntary smoking supporting this conclusion. As vith primary smoking, the tobacco industry has tried to diffuse this overwheliming,case by taking advantage of honest differences of opinion in the scientific community on the precise magnitude of the problem, ffsrepresenting the views of'reputable scientists, or hiring,professi'onal quibblers to claim that "the case is not in." After every independent scientific body that addressed the question concluded that involuntary smoking represented a health, hazard, the industry took the creative step of convening its own scientific panels -- in such scientifically impressive places as Geneva and Vienna, -- in an effort to cast an, aura of jU respectability on i'ts position. Contrary to whalt the industry had hoped, 2' G-2'3'. 0 05 ~ ~ N !I
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enacted le!gisllation to protect the public from the health, risks associated passive smoking. The Coalition supports the "N'on-Smokers' Rig;hts Act of 198'5" as a posi'tive step towards addressing the federal role in the prevention of health effects related' to, passive smoking. It is appropriate that the issue of simolkinig in federal bui'.ldings be addressed in the manner providedi. We wouilid make 2 suggestions regarding improvements to this legislation: o The non-smokinig worker and non-smoking vi'sitor dieserve the same health protection in buil4ingsr under the federal government's juridiiction. We woul'd recommend that language speci'fq, that both worker and visitor areas woul1dlbe covered by such regulations developed - under this proposal. o The bill recognizes several jurisd!ictions for thee development of regul'iations for the limitation of smoking in federal builidi.ngs. We would recommend that the 0'ffice of Smoking or Health or a similar office withiin the HIHS also be iinvolved iln the d'evelopment of these regiulations to ensure a consistent approach amoing the speci'fied'l jurisdictions.
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A departmental task force was developed and operated for a period of 901 days. Some of' the duties of that task force may be informative in highlighting areas which need consid'eration in order to successfully implement S 1440. The task force.was directed to: ° plan and coordinate public education activities; ° inform operators,, owners', and "persons-in-charge" reg,arding, their legal obligat;ions and assist them in complying, with: the new no smoking, law, including a distribution of required signs; ° produce guidelines which interpreted' the statute and providied recommendations for implementation of the new law; prepare: guidelines emphasizing education; post smoking and nonsmoking areas; and' present methods of complying with the intent of the law without capital outlay, for, such,projects as reconstruction of'worksites or installation of ventilation equipment; °. N familiarize Department staff with the new law in order Q N to respond to inquiries and to implement provisions of ~ the law in a uniform manner; and ~ N - 8 - G-37
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c INTRODUCTION Mr. Chairman,, I'm Bill Ross, Commissioner of the State of Alaska's Department of Environmental Conservation. I would,like tothank you fort,his opportunity to testify =Senate Bi1L.1440~, the Federal Nonmokers' Rights Act-of 1985. This Senate Bill is very similar to legislation that has become law in Alaska; therefore, I believe my testimony here today has particular relevance when considering its merits. With all smoking legislation, there ~ arethree affected parties to~o be cpnsidered: smokers, nonsmokers, and the owners or operators of facilitie~~s- in whi~ch~ smok~ing~ is to~~ b~e~~ restricted Persons who smoke have made a personal decision that the act of s.moking~ outweighsthe threat: of cancer and other diseases. This is their privilege; and they should be allowed it, as long as their s,mol.ingdoes not infringe on therightsofnansmokers,. Just a s~ smokers have~ the rig~ht~ to ~ smok~~e,~ nonsmokers~~ h~a~ve the~ right to protection from the recognized heaTth hazards of second,-hand smoke~,~ as well as the right to~~ work in a smoke~-free~ ~V. environment. ~ C11 ~ ~ N ~ ~ G-3 0
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Z!. s.mokingi. In enclIosed spaces, s.moke accumulates. The concentrations vary wi'th the number of smokers, wiith the type of smoking, and with the characteristics of the mtcroenviroinment,especial!lyventilation!.Amiong th e constiituents of tobacco smoke that have! been measured, nitrogen, oxidie, carbon monoxide, nicotine and respi.rable partic,les, nitrosamines, and aldiehydes have been shown to, be, significantly el!evatedl indoors as the resuil!t of tobacco smoking. A vari'ety of measures have been utiTized! to quaintify th~e nonsmoker's exposure to tobacco smoke. For example, studies of th~e level's of respirable particles generated by smoking under natural conditions i'n indoor micro- environments showed a ranige of 90-1140 ugLm , diepend!ingi on the smoker density and the effective ventilation. These 1'evels im most instances, if the exposures were repeated, would be a violation of the Natilonal Ambi!ent Air Q!uality Standard for T'otal Suspended Parti'culate; the outdoor equivalent. More than sufficient sci'entif'i'c evidence exiists of the harmfuT effects of smoking on the th~e nion-smoker to 3',usti'fy strong governmental acti'on to protect the non-smoker. Since thee publitation of the Wihtte-F'roeb study, "Small Airways. Dysfunction in Nonsmokers Chronically Exposed to!Tobacco Smoke", the evi'dlence has accumullated: c-li7
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Bibliography on Involuntary Simoking,/March, 1986 Tashkin, D.P., Clark, V.A., Simmons, M., Reems, C'., Coulson~, A.H., Bourque, L.B., Sayre, J.X., Detels, R., Rokaw, S. The UCLA population studies of chronic obstructive, respiratory disease,. VII'. Relationship~between parental smoking and children''s lung function. Am. Rev. Respir. Dis. 198'4 June, 129 (6):891-7. Tate, C.F. The effects of tobacco smoke on the non-smoking cardio-pulmonary public. In: Steinfeld'i, J., Griffiths, W., Ball, K., Taylor, R.M. (eds.). Smoking and health II. Health consequences, education, cessation activities, and governmental action. Vol. II. Proceedings of the third world!conference on smoking and health. New York City, June 2-5, 1975. (DHEW1 Publication No. (NIH) 77-1413) pp. 329-3'35. Taylor, G. Tobacco smoke allergy--does it exist? Scand!. J.. Respi'r. Dis. SuppS. 91:50-55, 1974. Taylor, I.B., Weiss, S.T'., Rosnez, B., Speizer, F'.E'. Effects of parental cigarette smoking on the pulmonary function of children. Am. J. Epi'demiol. 110:15-26, 1979. Teppo, L. Ymparisto ja Syopa. Environment and cancer. Duodecim, 99112'2):37-411, 1981,, Finnish. Terr, A.I. Respiratory symptoms in children whose parents smoke.. West. J. Med. l3'5(l):47-48', 1981. Terry, L.Li. On the subject of non-smoking--you count (editori~al). Am. J. Public Health 64(2):169-170,_197'4. Thiel, H. Inhalation of harmful substances. Verh. Dtsch. Ges. Inn. Med. 88:280-295, 19'82'. (German) Tobaken OchiVi. Passiv Roekning och S:naa Barn. - Nyal Forskningsroen. (Passive smoking and the infant - New research findings. )I Tobaken Och Vi 2'9(13):7-9, 198'4, Swedish. Tobacco Institute. New national survey of smoking and productivity in the workplace. Tobacco Observer 9:6-7, 1984.. Trichopoulos, D., Kallandidi, A., Sparro&, L., MacMahon, B. Lung cancer and passive smoking. Int. J. Cancer 27 (11) :1-4, 1981. Trichopoulos, D. Passive smoking and lung cancer (letter). Lancet 1( 8378 ) :68'4, 19184. Trichopoulos, D., R;alandidi, A., Sparros, L. Lung cancer and passive smoking: conclusion of Greek study (letter). Lancet 2 ( 8355 ) : 67'7-678, 198I3. Triebig, G., Zober, M.A. Indoor air pollution by Smoke constituent& - A survey. Prevent. M6d. 13:570-581, 1984. 63 D-63
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Thus, the 1984 legislation which: finally passed, represented a compromise that went~further than the 1975 law, but did'l not go as far as the original sponsors would'have taken it. Reference! to any ventil!ation, standards or to regulations was deleted, substituting instead the "reasonable accommodation" standard.. Coverage of privately-owned places was eventually li'mited to include: grocery stores, restaurants with a seating capacity of' 50 or more!, schools, pre-schools and day-care centers, health care facilities,, waiting or boarding areas for public transportation, and vehi'cles of public transportation. Coverage was expanded to include State and local government office facilities. C1321PAFRI'S0N OF STATE AND FEDERAL LAW The proposed Senate Bill 1440 would restrict smoking to designated areas~ in all United States' government buildings. Alaska Law includes similar coverage for State buildings. 1. Alaska's law is broader in scope than S 1440 in that it specifically, prohibits~ smoking in are~assuchasschooIs, elevators, taxicabs, convention! halls, courtrooms, jury rooms, grocery stores, and some restaurants, as well as in State buildings. The State law provides that portions off a place or vehicle may be designated as smoking areas, if. "reasonable accoamod'ations" for needs of smokers and - 5 - G-3 4
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nons~mokersare~~ p~rovided,~ whereas S'~ 1~440~ states, that~ smok~ing~~ a~re~~as~~, sha11~ be prow3.de~~d`~ and that the "'r~eas;onable accomtnodations" sha~hl be prescribed as necessary when designa~ting, smoking area~s. Such a distinction appears~ to create a difference in the basic underlying assumption regar~ding~ nonsmoking at named '~ p~Iace&. That i's, the~ Alaska 2aw~~ ass~umes~~ nonsmoking~ is the rule and permits,~ but doesnot~ require, designation of smoking areas using the "reasonable accoramod~ati~ons•, measure. S~~ 1440 dbe& niot~, sperc~ify~ that~ nornsmoking~ is~~, the~ rul~e~~ but rather~ requires d~es~ignat3~on of~ smoltingareas using the~ "reasonable accomodation" measur~e.~ 2. The State~ law requires posting of smoking and'nonsmoking' areas with signsof' prescri'be~d& dimensions in appropriate, areas. S 1440 makes a similar requirement for posting. 3. The State law provides civil fines for violators smoking in nonsmoking areas and for operators o~r"persons-irn-charge" failing to post required signs., Fines range from $10 to $50 . for smoking violations,,, and from $20, to $300 for posting violations. S 1440 provides for a civil fine of from $5,0 to $'5.00fo~rviolatorswho smoke in nonsnokingarea~sofbuild'ings, but it assesses no fine for failure to post signs. This is presumably because GSA or the C.ommittee on
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As a result of' numerous complaints regarding,substanti'al policy inconsistency between State agencies, and! at least one grievance action brought through; an employee union,, a jointt labor-management committee was formed to identify specific problems and to recommend policy and guidelines for the consistent and equitable statewide implementation of'the law. The guidelines emphasize that a cooperative effort be made to provide equitable and reasonable accommodations for smokers, as welli as nonsmokers, wherever possible.: Of'prime consideration is the recommendatioxn that smoking areas be designated, wherever reasonably possible and in accordance with the law. A priority order was established covering situations which cr,at2 the least amount of ambient second-hand smoke to those with the highest acceptable level. Designation of entire areas as "nonsmoking" is the final optioniand i&to be used only when no other arrangement is: or where a!n employee has a medically certified condition which is aggravated by smoke. Upper management is held accountable for implementation and enforcement of guidelines. tti'.' O NI The committee recognized that new difficulties might arise.dule to~~ changes in the work force, or as a result of implementation_of' On «P the proposedipolicy, and therefore provided a neutral method for ~ ~ uniform~ resol!ution of disputes throughout the State. Disputes - 11 - c-4'0
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Rules and Ada~;ng. Neither Alask.ies for failure tc 4. The State la% regulations 1Canseqnaently, . Cbnservation,li recoranended gtreas and the defirh;e Senate Bill dk and regulations. I2'IFLEMENTATION .~' ~I In Alaska, the "Siucias ~ received strong puf,blic ;. awareness about the TASK FORCE Initially, considez)ut the coverage of thethan the law actually "reasonable acco=che worksite. t
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at minimal cost to the State and'affected facilities. However, I believe that the most significant benefit of'the Alaskan law is one which is difficult to quantify. There is a much gareater public awareness of the rights of nonsmokers by smokers. Because of the attention the law has received, smokers are now more conscious that their habits causes discomfort and~aggravation too innocent parties, and' children see fewer examples of a habit they should best avoid. Theair i'n restaurants, grocery stores, and off.ices is undoubtedly of a better quality--a cleaner environment achieved for the most part in an, atmosphere of cooperation, and consideration. C
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, Indoor Po,~utants Committee oni Indpor Pollutants Board on Toxicology andi Environmental Health Hazards Assembly of Life Sciences National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1981 r (
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° develop Department protocol for handling, complaints responding m inquiries and processing, enforcement actions. AGENCY RESPONSE Department Directive Following,dissolution of'the task force, the Department developed' a field directive outlining policy and! procedures regarding implementation and enforcement of law, and addressing educational activities, the provision of information and technical assistance, the distribution of signs, the ha•A1'ng of complaints, and fair and' consistent enforcement. As a part of the field directive, a complaint/request for assistance form was developed'to document activities with regard to the smoking,law. Education Efforts To reduce public confusion about the requirements of the new law, the Department undertook a series of educational efforts, including: press releases, newsletter, and a press conference. In addition,,, the Department sent a letter and copies of the guidelines and statutes to a11 affected facilities. N ~. N. ~ Go ~ N .1 N - G-38
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C courtesy" is a recipe for individual confrontation. Under the current situation, individual nonsmokers are forced to confront indi'vidual' smokers to ask that they smoke elsevhere. Most people are simply not that' aggressive. Furthermore, the ubiquity of cigarette advertising and second handd cigarette smoke in the air, nonsmokers feel very i'solatedland are often afradd to speak up. The presence of a simple "No Smoking" sign dramatically changes this situation. With the sign available, nonsmokers feel comfortable in asking people not to smoke. Let me give yowan example. Several years ago I vas sitting in the Minneapolis airport enjoying the benefimof the Minnesota Clean Indoor Air Act vhich vas passed in 19.87. A man then sat dbwn next mme and began to take out a cigarette. I asked him not to smoke. He initially objected to my intrusi'on, until I pointed out that ve vere in a nonsmoking area:. He then apologized and put the cigarette away. Surprisingly enough, he did not move to the smoking,section. He simply smoked one less.cigarette. That was one less cigarette that a tobacco company soldl. To understand the impact of that simple act consider this: If every smoker in America smokedijust one less cigarette a day due to changing;socialg attitudes or legal restrictions,, there wouldibe 22 billion fewer cigarettes soldieach, year. Given,these stakes, it is not surprising,that the tobacco companies are villling to spend a•fev million dollars initheir unsuccessful attempts to convince Americans that smokers should be~free to pollute the indoor air without restriczi~on. Despite dire predictions of earthquakes iniSan Flranci!sco and ftres~ in N Q Los Angeles, California, every ordinance I'knov of has gone into force ~ ~ 5 ~ ~ ~ G-2'6. ~'
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f 14. Harl,. Hosp 529- 15. 3ave a Hira High Brit 16. Study Hira 17. from of Hirarit. Med. J. Hiea'v . .~ 282: ~ 18. lated to~ LeBc9'76. 19. Smol e on Nat yfr - Indc C 20. Pre: he ottatal 1. Lit+E'. Prof Tobacco: Repa8i0. Smol ~ N.Y. 22. Rep+l Ac'ac 23. nberg', Schuase J.,i-283,, and 197 xa1, 24. "Sm, 25. Pub. .al,. "Sm 26. Ptnb SR and PrC ~ 27. Hea p :f'.fect ~ TaSction ~ of ~ of j~ ~ tJ ~ ~
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The third group in the smoking matrix consists of'the proprietors and employers in buildings where smokers and nonsmokers sharee space.. Uithout a legal framework, proprietors and employers are forced to make difficult decisions regarding the rights of nonsmokers versus the: of smokers. In, addition,, employers have no recourse but to accept the increased, costs associated withh smokers in the work place. These costs are in the form of more frequent absenteeism and higher costs for health insurance, fire insurance, 13fe! insurance, and workers' compensation. A wide body, of research and public opinion has clearly identified uncontrolled smoking as both a nuisance and'.health hazard. It has been suggested that the control of smoking,is.not a proper function of government and that nonsmokers should rely on the willingness of smokers to accommodate.thleir needs. The State of Alaska disiagrees~. No: oneshiould~ ever have to: depend' upon, the~ courtesy of others for the protectiori of their rights. It is they dqty of government to protect individuals from dangers and'' nuisances caused by the actions of others. In Alaska, the most significant areas of'S'tate effort have been in d'eveloping guidelines and ed'ucating, the public. We have net - 2 - G-31
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f The Department of Environmental Conservation's experience inn enforcement of Alaska's own State law leads to some observations which may benefit you in your consideration of S 1440. First, detailed direction on the definition of "reasonable a~ccommodations" for smokers and nonsmokers and effective patterns of'designation of smoking areas would b~e helpful. The authority to, adopt regulations provid'ed'in S 1440 should providie for this. Secondly, if program costs are a consideration,, it may be desirable to amend the size of required signs to conform with a, standard print size. The dimensions currently proposed are the same as those in Alaska's law and these do not result in cost-effective sign reproduction. Another consideration in implementation of th~e law is the provision for sufficient personnel to monitor nonsmoking areas~ and to process complaints. Creation of a labor-management. committee may be helpful in developing policy for the designation of'smoking areas in offices and other work areas. In conclusion,, I wholeheartedly give this senate bill my unqualified endorsement. The Alaskan experience with smoking legislation has shown, that this type of law can be effectively implemented without undue discomfort or expense. Even though the Alaska law is broader in scope than S 1440, it has been well received by the public; it has been effective in the protection: of'rights of nonsmokers and'smokers; and'it has been implemented - 13 - 6-42.
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nonsmoker protection ordinances. We beIi'evedithat,, since the tobaccoo industry had!no real support, informed and organized local consituients could overcome the pressure of lobbyists, lawyers and campaign contributions. '- Th,is strategy has proven successful. As of' this date, every California community that has considered a law protecting nonsmoker sin;the workplace has enacted'it, despi'te vigorous, ve1l-financed opposition from the tobacco industry. The industry's failure to stop us~and other like-minded groups around'. the country has led them to another strategy: they are attempting to shift the fiel&of play back to the ball~ot box where they hope.they cambuy elections vith slick ad!vertising,campaiigns. Fortunately, the Ameri'can public has not been tricked by their efforts. Inladdition to the industry's highly-publicized $1.3'mi'llion effort to get the San Francisco Vorkplace Smoki!ng Ordinance repealed two years ago, their front groups have been rejected!by the voters in Arizona and,Colorado. Thisivillingness oflthe populace to stand up to:the industry attests to the importance and popularity of'protecting nonsmokers from second hand smoke. In fact, our success is not surprising, given that every poll dbne on the subject (including those done for the Tobacco Institute) have shown a majority -- including a majority of'smokers - in favor of legislation to protect nonsmokers. This overvhelming,consensus about the desirability of'protecting nonsmokers is!vhy legislation such as that before you is easy mimpiiment and enforce. It essentially codifies a change in social attitudes that has already occurred. Given this broadlconsensus,, why do we need laws? Why can't we depend on "'commonicourtesy" as the ciagarette companies suggest? Because "common 4 G-25'.
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scientists at both meetings presented evidence that involuntary smoking was harmful~. As a result the tobacco indiustry was reduced to quoting from press releases issued!after the meetings by individuals. In contrast to statements made by the National Academy of Sciences and Surgeon General, these releases vere not subject to any scientific quality control. As a result the only people that seem, to take them seriously are the cigarette companies and their advertising,agencies.. The simple fact is that one need not hold a, PhD and ovn complex scientific equipment to know that second hand tobacco smoke is a serious form of indoor air pollution. Consider a room where people are smoking. Think about what the air looks like, what it smells like, what it tastes like. Consider the fact that your eyes or throat may burn# or that you may develop nausea, or a headache. If you vent outdoors and1the air was that. polluted, you vould be outragedi. And you.vould be right. That is vhy we have passed legislation cleaning up the outdoor air, and' why this bill is necessary to help clean up the air indoors, vhere most Federal workers spend most of their time. Hy, involvement in this issue dates to 1978 when I'vorked with others in, an unsuccessful attempt to pass, by initiative, the California Clean Indoor Air Act vhich wouldihave created nonsmoking sections in the workplace and public places. Before the campaign started, every poll conducted (including those dbne for the Tobacco Institute) shoved the initiative passing by a 3-1 majority. The cigarette companies spent $6,5©0,0IOO on a massive advertising campaign and defeatedithe law. The tobacco industry represented to only organized opposition we faced. The same thing happened again, in 198'a. _ In 1981, we began working at~the state andllocal 1'evel to pass 3 G-24 C
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which~ cannot be resolved at the worksite! may be referred to aa regional subcommittee for discussion and recommendation, and then to the statewide committee for development of' al final recoarmendation, whickh would then be presented tc the appropriate diepartmental commissioner. SALIENT ISSUES Fiscal Impacts. DEC was given a fiscal note for $20,0100 to: implement the law. These monies were used for development, distribution, and printing of the guidelines; educational efforts; and signs.. Costs of enforcing the law have been minimal. Monitoring,is done during the course of regular inspections by departmental sanitarians, or in response to publ!ic complaints. First time violators are warned and are not issued a citation until a second" offense. A record is kept of all warnings. Expenses to buiLding,operators have been minimal or nonexistent. DEC has not required any structural modifications~ orinstalla~tionof smrakel-removing equipment. Some facilities have chosen to makee physical modifications or install equipment but not through any direction from DEC.
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Enforcement. A unique enforcement ticket was developed ('Uniform Citation), since the smoking law contains the only DEC violation which has a bailment associated with a violationi fine. Close coordinationn with the court system was required to develop a procedure consistent with methods used by other agencies to prosecute minor offenses, such as parking violations and some fish and game violations. Basically, after a citation is issued, the violator may mail in the bailment or challenge the matter in, court~. To date, the program has: relied on warnings for enforcement. Four cases involving $10 fines were taken to small claims court before the current procedure was developed. A Statewide procedure was deveLoped for issuance of a Uniform Citation, and, arrangements for processing in district courts were made at each court location:,, accommodating any special circumstances unique to thee area. . L.abor Management Committee oniSmoki~nk in State Buildings Of particula!r, interest to you may be our experience with enforcement of the law in State buildings. This experience should closely parallel the types of problems which may be encountered' at the federal level, and may provide solution.. a potential - 10 - G-39
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7 smoke in any building they entered. Nine years later, with increased medical' evidence concerning the hazards of second-hand smoke, the legislature removed that mandate. The current Alaska law was draftedl to addres& a finding by the Alaska Legislature that second-hand smoke is definitely a health hazard and to~ acknowledge increasing j',udicial recognition, of nonsmokers' rights w work in a smoke-free: environment. The amendtnent& to the State's statute became effective on July 17,, 1984.. The bill as it was initially proposed in 1983'was far broader in scope than the 1975' 1'aw; in that it prohibited smoking in all vehicles and, indoor places open to the public, even those of private oxanership. It also retained'the statutory authority for DEC to develop regulations, specifically mandating use of the! ASHRAE ventilation standards forany designated smoking area&. Review of legislative testimony indicates that the intent of the lav was to recognize: the health issues~~ associated with second-hand smoke, rather than to: pursue active enforcement and require extensive physical modifications to, regulated facilities. Expenses such as these would b~e borne not by smokers, but by the owners and operators of buildings and, businesses. The Alaska Legislature did'not wish to impose this economic burden on those owners and opera.tors. - 4 - G-33
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very little resistance in implementing the law. That is because our law, just as the proposed federal law, stresse_s "reasonable" rules and'arcommodations. ALASKA LAW Pre 19'83 Alaskal enacted its first smoking statutes in, 1975, prohibiting smoking in all public meetings sponsored by any State agency; in public schools, libraries, museums, and swim¢aing pools; in indoor publicly owned or operated'places of entertainment or recreation; in el!evators, and vehicles of public tramsportat=-)n and inn public! area& of hospitals, nursing, homes, and medical andl dental offices. The statute stated that reasonable smoking,areas must be provided. Businesses could elect to post "no~ smoking" signs and were then afforded'.coverage of the law. The 1975 regulations were.promulgated, which made the standards of designated smoking areas more restrictive. Such designation was allowed only if'the affected facility met the American Society of Eeating,, Refrigeration, and Air Conditions Engineers' Standards (ASIHP.AE)1(62-73') for ventilation. N O N ~ One interesting feature of that initial law, is that it mandated ~ the designation of smoking areas in buildings covered by the law. Cb ~ ~ In other words, smokers were almost always assured of a place to ~ ~. 6 C - 3 - G-32
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() I 28. Trihopoulos, D.,,Katandini, A., Sparros, L., McMehov, Bi., "Lung Cancer and Passive Smoking" Int.'J. Cancer 27:1-4, 1981. 291. Wyatt, Paula,, "Tomaccio Smoke: Its Effect on You and Others" unpublished'.thesis, University of California, Santa Cruz, by permission of the author, 1981. V i H-17 I'II.E'. 14'
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was being xac:u»rolilcrcd by the highly financcdcopp,••lsitictn; backed by developers and major cor{klratiun.. A1omcnth Iatcr the same individual u•as IDhutt/graiphcd in the elegunt9y furnirhtal "tiu un F'" ht:adyuartk:rs in front of a sulnhisti- catud cuntruter„which w;ts puttinE out infAlrmtttiion con voter suht?urt by neit:hbuncowuls.. Ih±pite the hugc cxqxnf3iturL. ;ud deceitful tactics ctf the cigarette ctontpaulics, they were braticn in this campaign bew:ausc tlwy cnwrctuntertid a rc.clurccful group cDf non, smukcrx' rights atl'vcoc:ucs who had been through tttc wriing.critwicc before and w•hu iknew what tu cxpCet and 1what had tKa lDr done to win. lu i. hoped that their experience will bc tof hcJto tu people in utllcr communities whu nni¢ht square to(lf against the tubztccto inclitstry in the future. Tile accotm- p;anyinu ;trticlc tln issues tto Ix: faced and campaign stratcgy isclc..igncd ttl provide the basics af!running, a c.tntpaign! The final tally, in thc'clectiiun was iit'J;7-3N tu17KJ;4a'I-a remarkable victc,ry in light uf thc uverwhclming odds. As a broad base of support among , con- stituencics such as health agencies. en- vironmental organizations, and public interest groups. Environmentalists ap- preciate learning or being,remindusd tha't' tobacco smoke is thalargest contributor to indoor air pollution. Getting as many people from different organizations in- volved'as eariyas possible gives them the feeling that they arrpart of tihc'decision making process and gives their organi- zations a stake in the campaign. Gmpaign staff. With the exeeption, of a close-knit community where it is still . possible for local values to prevail against commercial pressures from outsiders, a campaign cannot be run against the to-, bacco industry without' a competent full-time staff. It is important to hire people who are committed to the issue. FYatd-nisinq. Although it is not possible to compete dollar-for-dollar with the tobacco industry for'campaign money,,, there may be no, need to. The tobaaao, industry can be'beaten, even when, it' ouLspends the opposition by 10 to one. On the other hand, a minimum amount of money must be raised'in orderr to run a, creditable campaign. This means mounting a full-scale fund raising effort using both direct mail and per+ son,taperson contact. Campaigrt focus. The most effective issue for proponents of a local' or state nonsmokers' rights law is the invoive- ment and'virtually complete financing of the opposition by the tobacco companies. The proponents"campaign should never focus on the tobacco industry's theme song of costs, enforcement, and govern- ment, intrusion. A campaign that can frDcus the voters' attention on its issues (in a resultL Californians for Nonsmukers'. Rights has suc- cecdrd in lubbying,ot'hcr contmunitics tarcDug,hcout Cali- fornia to pass similar laws„thc most rrcct-t of which is 11 us. nngult:.e, whose ±trict ordinance v.an.ibn(• by Mayor Tum i 1iraJllcycx;tctly, aone year after the vutie, :t l'rutwsiitiun I°. Perhaps with the po..+ibility of a chainL rcactitln in mind, the tobacco industry tricd'one last dcslxtratc r.waaure aftier thc. elcution, On the follwwing5unday the indu.try, ran a full page newspaper advertixement complaining that'the clcl,ee vote was nut sufficient to warrant, imposition of such a controversial law and askingpeuple to urge their Icgixl.•unor.s to amcndl Proposition P. The cigarette cuminanics.huultd have saved their mwney, fur, bby placing the referendum un the ballot they had in,ured; under the terms of the C:ity. Chartcr: that the law could not bc touched for a yc:ur. I3y that timt:, a news story in the anti-rcgulatur} t.UiJlV'.Srrccr JrJUrnaJ'(nugu!;t 15. , 1984) wwould be pronouncing the law a success, this cassc, health and'tobat:co industry money) willl stand' a good chance of winning; a campaign that spends its time answering eharges by the other side will I inevitably lose. Endorsements. It is important to se- cure key local endorsements early. Many subsequent endorsements wiil depend on who has already endorsed the initiative, every radio and'television advertisement must identify the source thatpaid for it. In seeking to defeat clean indoor air measures, the tobacco industry invari- ably organi><es undl:r a mislcading name of an apparent local group (for example, "FAIR. Floridians Against Increase& Regulation"). A challenge can be madee to the use of such a name as the true. Some individuals who may have no sponsor of the advertisements. Even if strongnpinion on the issuemaygivetheir the effort does not succced in forcing a endorsement'to thefinstperson who ap- - change in tagline, it can gcnerate algreat proaches them with a reasonable pre- deal of journalistic scrutiny which will' sentation. Police: sheriffs', and fire- further highlight the issue of tobaxo' fightierrs organizations have been prime early targets of~ the tobacco industry. For the proponents, enlisting the full eom- mitmentof tbelocal medical'assaciation and Ispocifuc physician-spokespersons and other health professionals for hearings, press conferences, and other public ac: tivities is imperative. Regrettably, there are too few physicians with sufficient political and media experieasx: Fairoess time. The tobacco industry will flood the'airwaves.rith advertising. Nevertheless, the law reyttires that all radio and television stations must give each side of a ballot measure fair time (but not equal time) to present'its views. Some stations attempt to fulfill this ob- ligation by giving,the "poor' side of a campaign a chance to present its views on an off-hours public a'ffairs'program, but others will give between one-fourth and one-third of'the advertising time purchased by the tobacco industry. The effort to obtain this time should begin early,,, and' legal advice should be ob- tained' on how to pursue it most effec- ttvely. Radio and tele.i•sion taglines. By laww industry involrvement. ' In.Rstigation of tobacco industry daims. Claims by the tobacco industry concerning the costs of implementing andlenfnrcing the legislation as well as the "evidence of medical experts" should be fully investigated and exposed for whatever fraud is present. For exampie, tobacco industry claims relating to medical evidence often involve either a tnisquote'or a quote out of cotttett. It is important that the press and public be made aware of anysucli fraud'as earlyy and often as possible. REFEatENC'Es 1. A rwb/rraa IJ Qrearoes ad Au.,rrr W eshieqnn, tDC, The Totiweo tmtitute, t 981. 2 Tie Swwkfng Cmunooeays A Irrvpernior. W.atunqon, aC, The Tob.cop tiutituta.,l94i. 3. Tpt f.on Atwr1 ... 1rDlic Seto(uns, Wie- uaa-5akr,u RJ Reynotds Tobacw Co. 1916. a4. KaAn Pt:: The Ntirtncrota Ckan dndoor Air Aot: NYSrareJ,Ned 19tf3i 83:1300-I3o'1, 5. T.te Jr CF. A plnician-lod rrferrndum for cfeaavr air iei Ftonda. .'YY Siare J.1led' 19B3:8J: 1302. 6'. Blum A: CiEaretta smokin}.nd litt prontmwa: editoriuh iare not enouili. Ni)~Srare..J'.Nnl 1983; 83: 1_15:1281. . Jt:I \'' 1'Ix<,tit 11'l }^(lK',1; ST,AfP IUUR'VAi! 01 Mt IDIICINI. B -S t7'T
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-6- SELECTEIDPUBLICATI'ONS, J.L.REPACE 1. "Passive smok4ng has no place in the workplace'. J.L. Repace,, Guest Editorial, CANADIAN MEDICAL ASSOCIATION JOURNAL, 133I: 737-738' (1985). 2. "An Indoor air quality standard for ambient tobacco! smoke based'on carcino- genic risk. J.L., Repace and A.H. Lowrey, NEIV' YORK STATE JOURNAL OF MEDICINE,, 8'5 : 381-383 (19'85) . 3. "A'quantitative estimate of Nonsmokers' Lung Cancer Risk From Passilve Smoking", J.L. Repace and A.H. Lowrey, ENVIRONMENT INTERNATIONAL 11: 3-22'(11985).. 4. "Consistency of research data on passive smoking and 1ung cancer" J.L. Riepace, THE LANCET (ii'): 3 March: 11984, p. 506. 5. "The Problem ofPassive~Smokiing", J. L. Repace, BULLETINIOF THE NEW YORK ACA'DEM'Y' OF MEDICLNE57: 936-946 (1981). 6. "Indoor Air Pollution, Tobacco Smoke, and Public Health", J. L. Repace and A. H. Lowrey, SCIENCE 208: 4I64-474 (1980)1. 1. "Effect of ventilatilon on passive smoking risk in a model workpliace'. Proceedings of an Engineering Foundation Conference on Management of Atmospheres In Tight1y Enclosed, Spa es, Santa Barbara,, Oct. 17-21, 1963, American Society of Henting,, Refrigerating, and Air Condytiioning,Engineers, ASHRAE Special Publliicati on„ 1984. 8. "Tobacco Smoke, Ventil,lation„ and!Indoor Air Quality", J. L. Repace and A. H. Lowrey, ASHRAE TRANSACTIONS 88: Part I,8915-914 (1982). 9. 'The Dosimetry of Passive smoking"', J.L. Repace, Proceedings of The 5th Worldl Conference on Smoking b' Health, Winnipeg, July 10-15, 1'.983. 10. "'Modeling Exposure ofMonsmokers To Ambient Tobacco Smoke", J.L. Repace and A.H. Lowrey, Proceedings of the Tbthi Annual Meeting ofttie Air Pollutilon Control Association,, Atlanta, June 20-24, 1983. 11. "Risks of Passive Smaking', J.L. Repace, in To: Breathe Freely, a book by the Center for Philosophy and, Pub]'ic Policy, University of Rary and, in, press. Pub1ished as al Center Working Paper in 1983. 12. 'Nonsmokers and'.ciigarette smoke: a modified perception of risk", F. G. Bock, reply by J. L. Repace and A. H. Lowrey, SCIENCE 215: 197 (1982). 13. "Effect of'ficegative Ion Generators on Ambient Tobacco Smoke"', J.L. Repace, D.B. Seba, A.H. Lowrey, and T.W. Gregory, J'OURNAL OF CLINICAL ECOLOGY 2: 90-94 (1984)1. 14. "Indoor Air Pollution', J. L. Repace„ ENVIRONMENT INTERNATI'0'NAL 8: 21-36 (1982)1. C 15. °7ota1l Human Exposure to Air Pollution"„ Ji. L. Repace, W. R. Ott, and L. A. Wallace, Proceedings of the 73rdiAnnual Meeting of the Air Pollution Control Association, June 22-27, 1980; Montreal. C tV ~. G-6
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2025684310 N H
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I CLEAN YO'lJ R ROOM ! I A Compendiiam Describing a Wide Variety of Indoor Pollutants and!Their Health Effects, andi,Containing Sage Advice tolBot!h Housetioldiers and! Statespersons in the Matter of Cleaning,Up,, C C AND INCLUDING I A List of Experts Who Know What They're Talking About I AS WELL AS A Consurner Clean-Up Kit REPLETE WITH A Body Chart EDMUND G. BROWN JR. Governor ALICE A. LYTLE, Secretary Sta~te~ and'lConsume~~r'S~erwices ~ Algency RICHARD B. SPOHN, Director Department of Cornsumer Affairs j!V ~. ~ ~ ~ ~~ €nsumer ~ " ~ Fsa?~r.~arv TQ07 ~, a H-2
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FIGURE I ' -f a s 120 100 80 60 20 . . ~........s ~ Q a0 . ~, .__ ` % ~ ~ ~ . ~ .~ . I •. No. Jan Mar Miv Jul Seo tNmr Jan ANSr 1976 1977 1978 Sample represents 80 homes across six cities (approximately 10-15, homes per city),. Ft'eprintedw.ithperrnissionfr:om S~peing,le~retr al. Source: 2aational'Research Council. Indoor Pollutants. Committee on Indoor Pollution. Washington D.C.: National Academy Press, 19:81. p. IV.109. III-.S. 4 a-T
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Celebrities Who Have Supported Nonsmokers' Rights Eddie Albert Ed Asner Lloyd Bridges Carol Burnett Red Buttons Mary Cost& John Forsythe Zsa Zsa Gabor Steve Garvey John Gavin Robert Goulet Buddy Hackett Larry Hagman Charlton.Heston Lena Horne Dennis James Gene Kelly Jack Rlug¢nan Tedl Rnight. Art Linkletter France Nuyen Gregory Peck Tony Randall Kenny Rogers Stan Smith Abigail Van,Buren. Dennis Weaver Cornell Wilde Michael York J-1
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non-smokers, equal to $650,000 in excess wage costs per year (22). Bodxd:found th~aL5'm1$of' non-smokers reported di,fficulty working near & smoker, andl7'$' reported the use of sick leave due to tobacco smoke exposure at work MerleNorman CosmeticsCorportation, saved $33, 0!00~ per year subsequenttoba~nning smoking fo~rits 82'Semployees. It then returned the savings from rediuced' housekeeping, sick leave and increased productivity to the employees in the form of quarte'rly cash bonuses (22)~. L Improvi,ng,ventilation,will help to reduce the hazards of' involuntary smoking,, but the most effective measures must reduce the sources of' tobacco smoke. Specific recommendations for reducing exposure to involuntary smoking are fbundin therecomme~nd'ation section of this report. III.E. 11 C 01 H-14
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2025684312 ' r
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Speer assessed the nature of this irritation byy interviewing 25'A1non-allergenic patients about their reaction to cigarette smoke. 69.2% reported eye irritation, 31.6% headache, 29.2$ nasal symptoms and 25.2% cough (19). Barad surveyed 21,3'66 people and found that non-smokers reported 47.T$ eye irritation, 314.7% nasal discomfort and 30.5$'cough, sore throat or sneezing, when exposed to cigarette smoke (1!9). Weber, et al, and Hagod et. al, both documented that eyes aret most sensitive to the irritants in smoke,, followed by the nose (19). Luguette, et al. exposedl40 children to smoke- contaminated and clean atmospheres. Exposure to smoke was associated'with increase in bothiheart rate and bloodpressure (19),. 4. RECOMMENDATIONS FOR REDUCING' THE HEALTH HAZARDS ASSOCIATED WITH INVOLUNTARY SMOKING Tobacco smoke iniconcentrations commonly, encountered in everyday life can produce measurable physiological changes associated with d'isease in children, healthy adults and adults with pre-e isting disease. Both short-term effects of involuntary smoking (irritants and increased numbers of respiratory infections) and'long term health hazardS (carcinogenic activity and decreased pulmonary function) have been _ identified and documented~. Hazardous components of sidestream smoke, including carbon monoxide, nicotine,, formaldehyde and benzo(a)pyrene, have been identified and quantified. It is clear that tobacco smoke is a majior contributor to both gaseous and particulate indoor air pollution. It is also clear that involuntary smoking constitutes a significant health hazard in our society, particularly in view of' decreased ventilation as energy ef~f iciencyisimproved. Theworld health Organization (wHD)', has concluded that tobacco smoking is a majorr threat to the maintenance ot indoor air quality (2b). Perhaps the most effective means of reducing exposure to involuntary smoking will come f rom tt,e private sector. Data compiled by Dow Chemical Company showed!that smokers used 80% more sick leave than III.E. 10' H-13
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C breathing per unit of body 'weight arr4 (12) because they breathe air in the lower levels which have higher concentrations of particulates (26). Cameron, et al. (11969) found that in 727 Detroit households with children under the age of sixteen the presence of tobacco smoke increased the incidence of acute illness (6). Colley (1974) also found a relationship between parental smoking habits (including cough, arnd, ph~leg~mproduction) and the prevalence of respiratory illness in British children (18). In a later study, Colley, et. al. (1974) found the incidence of pneumonia and bronchitis in the first year of life was highest when both parents smoked, intermediate when one parent smoked and lowest when neither parent srnoked.(91) Harlap and Davies (1974) found similar results in a study of hospital admissions for bronclaitis and pneumonia, among 10, 67'2 inf ants in West Jerusalem (14). Schilling;, et al. (,'1977') failed! to detect any relation- ship between parental smoking and'childrens' symptoms and lung function ('23). Bland, et al. (1978) found that. British secondary school students wgo--se parents smoked wexe more likely to report symptoms of cough andi breathlessness (4). Tager, et. al. (1979) found that parental smoking measurably degraded the children's pulmonary function. Tager also found that children of two smoking parents showed a greater, deterioration of lung function than children of a single smoking parent (,27),. Bonham a!nd, Wilson (1981)i examined illness among 39,7191 children f rom birth to, 16 years of age. . They considered the number of smokers per household and ther number of cigarettes smoked. In families with one smoker, they found 7% more days in which the child's activity was restricted and 1418 more days during which, the child was bedriddien, compared to households with noo smokers. ('The children had predominantly respiratory illnes~ses,. ); Children firomhouseholdswith two smokers showed 29% more restricted activity days. For children in families where 45 or more cigarettes were smoked pez day, restricted activity days were 46% higher than for children in families where no cigarettes were smoked (5')'. In sium, children exposedl to involuntary smoking, are sick more frequently and experience measurable deterioration of lung function. This exposure leads to more days of restricted activity, days in.bed', and III.E. 7 H-10 < t
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1, C hospitalizations. The increase in illness is most lixely due to a combination, of 1) the harmful effects of tobaccoe smoke on cMil~dre,na:nd2!)thefact that smoking parents are sicker than non-smoking parents and more likely to infect their children. Lung cancer is known to have a 20 year lstency peri'od~. Nb long term studies o:n, the re~lationshipof parental smoking analurng ca;nc,erin their children have been completed. It is well documented that maternal smoking is, ass~oc:iatedd with lower birth weight babies, more premature deliveries, more miscarriages, and decreased, total oxygen l!evels ( 25) . The eff ects ot involuntary smoking on the fetus have yet to be examined. 3.B. EFFECTS OF INVOLUNTARY SMpK'INiG ON INDIVIDUALS WITH' PRE-EXISTING DISEASE' Evidence that involuntary smoking can aggravate the condition of people with heart disease, lung disease, and allergies to, other substances is well documented. Ayres, et, al found'decreased arterial and venous oxygen levels(24)_ Inadiditiom, Aranow (1)found' that invol-, untarysmoking increased resting, heart rate, blood pressure, and venous carboxyhemoglobin (carbon monoxide) in patients with angina pectoris (chest pain caused' by inadlequateoxygen~ supply to the heart.) The le:ngtho:f time patients couldi exercise before developing chest pain was reduced by 22% in a ventilated room and by 38% in an unventilated room (1). Aranow found similar results when he studied patients with pre-existing lung disease (2). Aranow et al. also studied patients with coronary artery diisease.~They found that the net effectt of'tobacco smoke to patients with,coronary artery disease wasincreaseds cardiac work for the same card'iac output (24). Concentrations of sidestream tobacco smoke which have little immediate effect on a healthy population can pose a significant immediate health, hazard for people: with pre-existing disease. 3'. C. LONG TEFtM' EFFECTS OF INVOLUNTARY SMOKING ON HEALTHY IND:I'V I DUiALS White and Froeb found a dose-response relationship tjetween degreeofexposuxe tosano,ke and pulmonary N . O 2V G!i ~ (~! ITI . EI. 8' Iip N U-ii ~ CD
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fl monoxide on cardiovascular alation 50(2):340-347,,1974. +er. Effect of carbon :onic obstructive pulmonary tern, and L. L. Johnson. ncascular hemodynamics. Arch. 1 monoxidie effect on intern. Med. 79:392-395, 1 olfactive dies composes de nlof the olfactory s). Annales du Tabac . Mueller . Myocard ial and i. Ann. NLY. Acad. Sci. jory, S. Giannelli, Jr., and modynamic responses to xaxyhemoglobin (CIOKB). Arch. 1, J. R. Dean, and V. secondary school-children.. mntroversy heats up. Occup. ;d' Mk. H. Banks. Effects of )iratory symptoms. Arch. Dis. J. H. Wol'fe, G. Tighe, S. ~ healthlof smokers' and i-341, 1969. )f home environmental tobacco )l. 57:142-147, 1973. )gical investigations on Respir. Dis. (Suppl. )spheric pollution and' levels in man. Nature in children and! parental J. 2:201-20r4, 19741. T: Corkhill. Influence of pneumonia and bronchitis in )74. ider. Mouth absorption of krch. Environ. Health i'der. Retention of cigarette Environ. Health 1'7 : 74i6~748,
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"tightness" in the chest, coughing, and wheezing. The NAAQS level is 5 ppm. Sidiestream, smoke levels nave ueen recorded at 1lesstha~n 1ppm, (,19)1. 4. Acetaldehyde causes irritation and damage (paralysis) to the cilia (hair like pcojections), which liine the upper respiratory tract (29). Respiratory symptoms of coughingiand wheezing may occur. Damage to the cilia results in, a lessening of the body's ability to protect itself agai~nst infectioni, due to an inability to remove particulates and'toxins from the respiratory tract. 2. D. PARTICULATES IN SIDESTREAM SMOKE 1. Nicotine is a poisonous alkaloid used as an insecticide. It constricts blood vessels, increases the likelihood of ventricular arrhythmias, increases blood pressure, increases pulse rate, may cause blood clotti~ng in the.arteries, (thereby increasing risk of artheros- clerotic heart disease) and aggravates respiratory disease. It acts as both a, stimulant and depressant on the nervous systemi(7 )~. 2. Benzoi(a)pyrene and dimethylnitrosamine are known to be carcinogenic to: laboratory animals and to tnumans (29). They are measurable in small amounts in, sidestream smoke. Threshold levels have not been established. 3. Phenols destroy the action of' respiratory tractt cilia. Phenols have also been shown to, potentiate the carcinogenic action of benzo('a)pyrene (29!). 4. Cadmium, lead, arsenic, and fluoride are also potentially tox:ic to humans at relatively low, concentrations and are present in measurable levels in s idestreamismoke . (,'219 ) 3. HEALTH EFFECTS! OF INVOLUNTARY SMO'EING' 3.A. E'FFECTS' OF INVOLUNTARY SMOKING ONI INFANTS AN'D CHILDREN There have been several studies on the effects of parental smoking on thelhealth of their children. The studies show that, children of smoking parents have an increased incidence of upper respiratory infecti~ans, bronchitis, asthma:andl pneumonia, as well as a significant decrease in pulmonary function. It is theorized that children may be more susceptible to air pollutants than adults due to (,1) a greater rate of III.E. 61 HI-9
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function. Th~ey concluded,that chronic exposure to involuntary smoking reduces small airway function of non-smokers to the level of individiuals who smoke 1-10 cigarettes per day (22). A French cooperative group, PAARC, studied 2,812' non-smoking wives and found significantly reduced pulmonary function after 15 years of exposure ('22). Recent studies have linked involuntary smoking with increased risk of developing lung cancer. In a 14 year study in Japan!, Hirayama ('1951) found that non-smoking wives of men who smoked more than 20 cigarettes per day had 2.4 times the risk of dieveloping lung cancer than non-smoking wives of non-smokers (15). Trichopoulos, et al. (198'1) found in Greece that non-smoking wives of inen wTa smoked more than,20 cigarettes per day had 3.4 times the risk of developing lung cancer, than, non-smoking wives of non-smokers ('28). These two studies proYidle independent evidence that long term exposure to involuntary smoking is associated!with an increased'risk of developing lung cancer.. Garfinkel (1981)1 published a study of American women which failed to detect a statistically significant increase in mortality associated with passive smoking (10). Glantz! notes and the British Medical Journal makes the point that the differences between the Japanese~ and Greek studies and the American study may be accounted for by greater mobility andiincreased exposure to smoke outside the home on the part of Azaericam women (113). The tobacco industry has attacked the methods and'£he results reported by Hilrayama an~d Trichopoulos. However, these results have been validated by many expert researchers (17). 3. D. SHpRT' TERM EFFECTS OF INVOLUNTARY SMOKING ON HEALTHY INDIVIDUALS A~ large body of'~ evidence exists which documents that tobacco smo~ke~ can~ produce~ irxita~tion~ of th~e~ e~yes, and throat, nasal congestion and! dtainage (rhinitis ):, nausea, and, headache in both, smokers and non-smokers (,24 ). III.E. 9 H-12 C t
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The National Research Council reports that over 2,000 compounds have been identif ied ini tobacco smoke. Some of the more hazardous compounds and their mechanisms for action ont~he bodyare described, below. A few, definitions are in order here. PPM, or pp m denotes a quantification in parts per millon Threshoidilevel is the concentration of a compound (in ppm): atwhich, it•becomeshazardious to humain, heal'th . NAA,QS level is the NationalAmbie~ntAir QualityStandiard. (in micrograms per cubic meter Lug/m3). It has been established by the Environmental Protection, Agency as the allowable concentration (on a daily basis) of respirable particles in outdoor air. 2. C. GASES AND y1iPORS FOUND IN SIDESTREAM SMOKE 1. Carbon, monoxide has 210 times greater affinity for hemoglobin (the oxygen carrying component ot the blood) than oxygen. The presence of carbon monoxide permanently prevents the binding, transport, and release of oxygen by the hemoglobin of each affected' cell, therebyrediuci.ng oxygienievels in, blood and tissues. The body mu~st, produce new red blood cells to compensate. The lack ofsuffic~ient oxygen can'increa~se stress int~he heart,, impair reflexes, and worsen respiratory symptoms ior those with pre-existingi lung~ disease. Symptoms, of carbon monoxide toxicity in healthy individuals include headache, dizziness, fatigue, and.nausea. The NAAQS level for carbon monoxide is 9 ppm. Carbon monoxide concentrations in rooms and vehicles wherecig~aretteswere being; smoked ranged from 12; ppmto 90~ ,ppm(7) . Z. Formaldehyde,caluses respiratory irritation. It is, detectable at relatively low, levels (,'0.S ppm) by most people. Formaldehyde causes headache, fatigue, eye, nose and throat irritation, coughing, wraeezing, nausea and skin, reactions (19). Laboratory studies have shown that formaldehyde~ has long term carcinogieni~c, mutagenic, and teratogenic properties. The NAAQS level for formaldehyde is 0.5 ppm. 3'. Nitrogen dioxide causes inflamination of the air passages (bronchioles) in,tne lung,. It is known to N destroy cellular and subcel'lular structures and induces Q emphysema in- lataoratory animals. Symptoms may include . ~ L11 ~ ~ III.E. 5 N ~ c f H-8 0I
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2025684314 KNOWN CAUSES OF RESIDENTIAL FIRES CALIFORNIA FIGURES FOR 1981 FIRES pEATH- HEATING COOKING INCENDIARY/SUS SMOKING ELEC. DISTRIB. APPLIANCES CHILD PLAY OTHER EQUIP. EXPOSURE NATURAL OPEN FLAME OTHER HEAT In 1981, In California, there werss 21• InJurles 5,130 Flret 76 Deaths 25,123,000 Dollar loss Source: Californla Fire Incldent Reportlnp System INJURIES DOLLAR LOSS 10 4 I I F1 4 18 4 16 22 ~ 14 18 10 36 16 4 7 ~9 7 3 5 .9 5 2 1 .5 .8 .5 .8 .5 .7 .3 f
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0 E.~ Tb'EACCp'SMO~KE ," Smoke was probably the first "indoor pollutant." Smoke from tobacco poses a majlor health hazard, but also a fundamental issue of individual "choi'ce." It starkly presents a political challenge, to our ability to, protect our health and to, controll our indoor environment. Exposure of non-smokers to ambient (sidlestream)' smo,ke is defined as "involuntary"' or "passive" smoking. Numerous studies have shown involuntarysmoki'ngtobe a si~gnificanthealth, hazard, for several populations incl'udingi infants, children,, pregnant women, elderly people, individuals with cardiovascular disease,, and individuals with impaired pulmonary (respiratory) function, including asthmatics and those with obstructive airway disease. In addition, documentation, is appearing which shows that pro- longed'exposure to sidestream tobacco smoke significantly increases the risk of dilsease in otherwise healthy individuals. Health hazards induced' by involuntary smoking include lung cancer, respiratory infection, anginal (chest pain), decreasedi blood oxygen levels, decreased exercise tolerance, decreased pulmonary function, broncho-constriction and broncho-spasm. Research also shows that tobacco smoke is a major irritant for both smokers and non-smokers, causing symptomswhich include burning eyes, nasal congestion and draina~ge (rhinitis), sore throat, cough, headache and~nauseai. The establishment of separate smoking and no-smoking sections in restaurants, offices, and other public places can be an effective means of'protecting non-smakers. Another alter- native is to require self-extinguishing, cigarettes: this would reduce deaths caused by cigarette-relatedifires and'would. protect bystanders from the fumes of partially-extinguished cigarettes. Adequate ventilation of smoking-areas should be ass!ured',. Research and public information activities are needed to improve public knowledge and awareness.
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377 i.. l I with the decline increasing with number of'cigarettes smoked. This effect was independent of the smoking habits of the children.. Pulmonary infection, early in life has been shown to affect pulmonary function in children and adults adversely, and the decline in flow rates reported by Tager et al. may be secondary to the excess risk of .pneumonia in infants whose parents smoke. They attempted to examine this by retrospectively asking the parents about childhood illness, but did not show an association between parental smoking and childhood infection, in contrast with the results of' Rantakallio and' Harlap. It is not clear whether this represents a true difference in the populations. In a further studly of 5- to 9-yr-old children in the same population, Weiss e al.67 reported that parental cigarette-smoking was linearly rel'ated to the occurrence of persistent wheeze (P - 0.012) and lower degrees of'mean forced midiexpiratory flow, Currentt persistent wheeze occurred in one of 57 children (1.8%)' from households where both parents had never smoked= in 10 of 146 children (6.8i) with one parent currently smoking; and in 20 of'169 children (112!8) with both parents currently smoking. When the analysis was repeated with the exclusion of mothers with wheeze, the results were simi'lar--0, 1.8, and 7'.78 wheeze in children with no smoking parents, one smoking parent, and two smoking parents, respectively. Exclusion of'fathers with wheeze gaNe 0, 6I.7, and 14% wheeze, respectively. In summary, children of'smoking parents have an i'ncreased, incidence of persistent wheeze and may be at excess risk of repiratory infection at least for the first year of life. They may also have reduced pulmonary function as adults. The exact interplay amongithe effects of maternal smoking during pregnancy, involuntary smoking by children, and actual occurrence of infection has not been established. CONCLUSIONS • Tobacco smoke is a major source oflpollution in the indoar environment. • The nonsmoker absorbs measurable amounts of carbon monoxidiee and nicotine and may absorb small amounts of other constituents, owing to involuntary smoking. • The amount of carbon monoxidle absorbed owing to exposure to tobacco smoke in the environment varies from negligible amounts in well-ventilated office buildings to enough to raise carboxyhemoglobin contents by 2-3% in a l- to 2-h exposure. • The carboxyhemoglobin produced by the most severe involuntary smoking exposures likely to occur, in everyday living can reduce thee maximali exercise capacity in normal, healthy adulits, but does not effect submaximal exercise to any measurable degree. • Involuntary smoking has not been shown to prodluce acute change in lung volumes, expiratory flow rates, closing volumes, or the slope of phase III of the single-breath nitrogen washout in normal, healthy adults; but longrterm exposure to cigarette smoke i's related to small-ai'rway dysfunction and an increased! incidence of lung cancer in healthy nonsmoking adiusts. H -25
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J ~1 . KNOWN CAUSES OF RESIDENTIAL FIRES NATIONAL FIGURES FOR 1981 FIRES HEATING COOK INC iNCENDIARY/SUS SMOKING ELEC. DISTRIB. APPLIANCES CHILD PLAY OTHER EQUIP. EXPOSURE' NATURAL OPEN FLAME OTHER H EAT 18 In 1981, In the United States, there were: --- - - - 1,622 Deaths 3,445 Hospitalized Bum In/urls 59,000 Firea 252,191,000 Dollars Lost Caused by Cigarettes In Residential Occu• pencles Atone vZEvs9!31Za% 20 DEATHS 30 0 10 20 , : 30 0 10 20 DOLLAR LOSS 30 0 10 20 30
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51 reimbursement for the cost of the additional air-conditioning needledl to remove tobacco smoke should be explored by governments at all levels. ASBESTOS AND ASBESTIFOAIM FIBERS ii A systematic survey is needed for the evaluation of the distribution, integrity, and concentrations of asbestos in buildings that contain or are thought to contain asbestos ma'terial. However, before this survey can be conducted, there is a need!to: develop; new instruments to record!fi~ber counts continuously, with si'ze determination and possibly asbestiforn-fiber ident'ification, because current sampling andlanalytic techniques: inadequate. Synergistic and interactive toxic effects of asbestos fibers in combinatiom with other air pollutants, particularly organic vapors, should be examined in animal toxicologic! and'mutageni'city studies. Although some asbestiform fibers themselves do not appear, to constitute an immediate health concern~, their role as initiators or promoters in various disease processes should be studied. The incidence.of inesothelioma in humans should be monitored via a registry and.appropriate surveillance methods, to detect cases associated with substantial nonindustrial exposure to asbesti:form fibers. Guidelines should be dieveloped for the control of exposure to airborne asbestos fibers during maintenance, renovation, and reconstruction in bui'ldingGs'that contain, asbestos and asbestos-be'ar'ing shingles, tiles, plaster, etc. COMBUSTICN Indoor combustion produces a number of contaminants. Among the contaminants.that deserve special attention are ni'trogen, dioxide, carbon monoxide, respirable particles, nitrosamines, and! polynuclear aromatilc hydtocarbons. The rates of'their emission from sources of indoor combustion have not been adequately evaluated., The.Committee recommends that contr©lled chamber experiments be condlocted to determine the products and their rates, of emission from various types of combustionlunder various conditions. These experiments should focus pzincipally'on ga&and electric cooking appl!iances~and supplemental heating systems, such as natural-gas, propane, and kerosene~heaters and coal- and wood-burning stoves. Air-venting and air-clieaning systems.should be studied as means of reducing indoor concentrations of contaminants. Indoor concentrations of combustion products have only recently been surveyed. Combustion products are present in many indbor locations, such, as restaurants, cafeterias, homes, hotels, buildings with attached garages, and recreational facili~ties that use gasoline- powered'.equipment. More comprehensive and systematic surveys are needied to identify the range of combustion-product concentratioms encountered indoors and the numbers, of people expasedlto~them. These (I H-24
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:.• Tob aCCo Smoke and the Nonsmoker Tobacco smoking produces serious disease in -- smokers. As biomedical researchers have cemented this link, some have turned their - attention to the question of whether or not tobacco smoke produced by others harms nonsmokers. Research to date supports the following conclusions: Breathing second hand smoke significantly increases the risk of developing cancer. A study by the United States Environmental Protection Agency concluded that passive smoking accounts for up to 5,000 lung cancer deaths annually in nonsmokers. Several independent studies have demonstrated that nonsmoking wives of smoking husbands face 2-3 times the risk of developing lung cancer as nonsmoking wives of nonsmokers. Other studies have revealed that involuntary smoking is associated with a doubling of overall cancer risk, including breast, cervical and endocrine cancers. There is evidence that childhood exposure to cigarette smoke increases the risk of developing cancer as an adult. Breathing second-hand smoke for extended periods causes other diseases in healthy nonsmoker.. Children of smoking parents have more respiratory illnesses and allergic manffestations than similar children of nonsmoking parents. The illnesses appear to be dose-related; that is, when both parents smoke, the children have more respiratory illnesses than if only one parent smokes. Since babies and very young children do not smoke, their increased respiratory illnesses in families where one or more parents smoke clear- ly•results from exposure to second-hand smoke. Teenagers have impaired lung fundion when their parents smoke; this effect is independent of and additive to the effects of any smoking by the teenagers themselves. The pulmonary function of adult nonsmokers who have worked in smoky offices is impaired to the same extent as light smokers. Nonsmokers work- ing in smoke-free offices have better lung function than the light smokers and passive smokers. Breathing second-hand smoke can aggravate the condition of more than 2.5 million Californians with heart or lung disease. Individuals with heart or lung disease generally have reduced reserve capacity available for transporting oxygen from their lungs to their body tissues. The carbon monoxide in second- hand smoke binds tightly to the hemoglobin molecule that normally carries oxygen in the blood, reducing the blood's capacity to carry oxygen. In people with little reserve oxygen- carrying capacity, this reduction in blood's oxygen-carrying capacity makes them more prone to developing symptoms. For example, people with coronary artery disease exposed to second-hand smoke experience angina pectoris, which indicates the heart is not receiving adequate oxygen, after shorter periods of exercise than they do when breathing clean air. Similarly, people with hypoxic chronic lung disease experience shortness of breath after shorter periods of exercise when exposed to second-hand smoke than when breathing clean air. The nicotine in second-hand smoke may also play some role in mediating these effects. Second-hand smoke, like all tobacco smoke, contains more than 4600 toxic chemicals, (including cyanide, arsenic, formaldehyde, - methane, propane, carbon monoxide, acetone, and ammonia). This conclusion follows from chemical analyses of smoke emanating from the end of lighted cigarettes. The concentrations of some of these chemicals are higher in the second-hand smoke than the primary smoke the smoker inhales for two reasons: -, ---- ry p ~y~y - -- - -------- . First, when the smoker inhales, the tobacco -- bums at a higher temperature with more - complete combustion; and, Second, the smoke inhaled by a smoker is filtered by his cigarette. Many of these chemicals are known to be carcinogenic in humans or animals. The precise quantity of these chemicals an involuntary smoker inhales depends on such specifics as where he is located with respect to the smoldering cigarette, the amount of tobacco burned, and the ventilation in the room. Tobacco-related cancer causing chemicals appear in the urine of nonsmokers who are exposed to cigarette smoke. Air pollution above Federal standards can occur in enclosed places because of second-hand smoke, even with normal ventilation. These results follow from analyses of carbon monoxide and particulate concentrations in air samples taken from enclosed public places and_ places of employment. It is important to note that some of the studies found relatively lower or higher tobacco-generated pollution concentrations, depending on the specific location being tested. This result is to be expected because tobacco smoke, like any pollutant, is not uniformly distributed. Nevertheless, cigarette smoking often led to carbon monoxide concentrations above 9 parts - per million (the Federal Ambient Air Quality Standard) and always exceeded the Federal Standard for particulates. Second-hand smoke can cause burning of the eyes and nasal passages, headaches, nausea and discomfort In nonamokers, and can aggra- vate vate the condition of pensons with allergies to other substances These symptoms are created by second-hand smoke inflaming the eyes or naso-bronchial passages or by the carbon monoxide restricting transport of oxygen to the brain and other vital organs. Those people with a history of allergies to other substances are more likely to report the Irritating effects of tobacco smoke. For a list of the more than .S_00 scientific publications used to prepare this summary, send
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7 or deliberate disruption of asbestos-containing surfaces can result in increased fiber concentrations in the indoor environment. There have been a small number of studies in which fiber counts have been documented in association with normal building use. FSctrapol!ation from what we currently undesstand about the exposure-response relationships for asbestos fibers to the very low concentrations reported in indbor spaces, such as school!s, suggests a small health risk under conditions of'normal use. However, deliberate modification of surfaces to remove asbestos from buildings may create a risk of exposure of'occupants and workers. Buildings in wbich asbestos exposure is likely to occur can be identified'. The risk of'exposure from dislodged fibers can be reduced by containment. The occurrence of inesothelloma (a specific form oflcancer believed to result only from the inhalation of asbestos fibers) may provide a very sensitive indicator of'the exposure of'tbe general population. Home~exposure to asbestos due~to aging, cracking,, or physical disruption of insulated pipes or, asbestos-containing ceiling tiles and spackling compounds may be g!reater, than public exposures in schools, which have received the most attention. Homes built before 195A in, northern climates are more likely to have pipes insulated with asbestos plaster., Given the very' common use of'aasbestos ini homes, schools,and other buildings, there is a need for further assessment to identify structures where actual asbestos exposure constitutes substantial risk to humans. The extent of exposure of'tbe general public to asbestos fibers has not been assessed; however, the occurrence of inesothelioma should be carefully monitored in the general population. Manr-made fibers have produced skin irritation, but have not otherwise been demonstrated convincingly as hazardous to health. Epidemiologic and toxicologic investigation of synthetic fibers should continue. On the basis ofl present knowledge, synthetic! fibers in the indoor environment should not cause undue concern. TOBACCO SMOKE Virtually every member of'our society is exposed'to tobacco smoke r 33% of the population smokes, and'the rest are exposed to the smoke released by others. The constituents of tobacco smoke are well documented as hazardous, the prevalence of'population exposures is very high, and there is ani increased incidence of~respiratory tract symptoms and functional, decrements in children residing in homes with smokers, compared with those in homes without smokers. These comsiderations and recent evidence of increased!l'ung-cancez rates among nonsmoking women living with smoking husbands have led us to conclude that indoor, exposure to tobacco smoke has adiverse effects. Coughing, headache, nausea, and irritation of eyes, nose, and! throat are among the reported!symptoms. Although many studies have measured various components of tobacco smoke indoors, total exposure has nott been determdned. Passive exposure to tobacco smoke may constitute an i'mportant exposure to respirable particl'es, such, gaseous compoundsas H-21
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protect and help its cdtiaens deai with a testible epidemic and'to save money at the same time. M-fi'
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C. Repace and Lowrey have stiown that a major portion of indoor RSP comes from tobacco smoke. They have established that concentration of tobacco smoke, is directly proportional to smoker density (# of smokers x # cigarettes smoked)! and inversely proportional to effective ventilation rates. They studied RSP'levels for nonsmokers exposed to involuntary smokingiand found them to be in excess of the NAAQS level by tactors of 1.2, 2.0:and 10.0. Another way to look at the data is to gi~ve equivalents in terms of cigarettes smoked. Repace and.Lowrey found their subjec'ts.involuntarily smoked' the equivalents of' 5, 27' and 50 cigarettes per day (21). - Epidiemiological studies have established "threshold f or harm" levels on which the NAAQS level of 75 ug,/m3 is based (29). Some ot these, levels with respect to certain populations are listed below. THRESHOLD FOR HARM LEVELS OF RSP R5P level Cug,/m3) per 24 hrs. ~, ~, Population ( ~ ~ 100 ug/m3 ~ children / ~ ~ ~ 102 ,ug,/m3 ch ilidren ( ~ (I ~ ~ 100 ,ug,/m3 adults ~ (CQP'D)* ~. ~ 80-1010 pig/m3 elderly ( ~ ~ 1170 Pg,/m3 asthmatics (I I I Eft ect I ~ decreasedllung. ~. function ~ increased! ~I respiratory disease ~I . ~. increasedd chronic (, bronchitis J. increased cardio- ( pulmonary symptoms ~, ; increased broncho- J constr'iction andi 11 broncho-spasm *COPD - chronic obstructive pulmonary disease The following graph from the National Research Council sh©ws the monthl~y mean respirable particle concentraitions resulting from differing smoker density in 8,0 homes across six cities. Respirable particulate concentrations may reach 10Orug/m3 with two-smokers in the home (;which exceedLs the NAA;QE level for outdoor air of 75,ug/m3 over 2'4 hour period). III.E. 3 c t H'-6'
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2. Consideration should be given in establishing such stand'ardis to: a. separate smokers from~non-smokers in the office environment, and b. encourage development of'a self-extinguishing cigarette to decrease unnecessary pollutants and reduce the fire hazards associated with smoldering cigarettes. 3. As part of the state's public education and research programs, provide for: a. information on the dangers of involuntary exposure to tobacco smoke. Priority should be given to certasn~potential high-risk populations,, such as pregnant woanen, infants and children,, the elderly and those with pre-existing respiratory and heart diseases; a b. research,on the~health effects of passive exposure to tobacco smoke. Specifically,, epidemiological studies of the health~effects of indoor pollutants should be designed to include the health~effects of'involuntary, smoking where possible. 4. The hegislature should consider legislation too require health insurance programs,'pre-pai!d health plans and insurance companies to offer lower rates to non-smokers and helpidefray the cost of smoking withdrawal methods for beneficiaries. 5. The: Bureau of' F3ome Furnishings should test all major brands of'cigarettes and proposed' self- extinguishing cigarettes to determine: a. their flammability, and b. their sidestream: smoke emission characteristics. Results should be published in a report which, includes recommended standards for cigarette flamunability and sidestream smoke rediuction. F. Combustion Pollutants 1. The.T'ask Fbrce should request appropriate state agencies to establish ventilation standards ade- q!uate to:vent combustion pollutants from the indoor environment. VI. 13 U-19
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......,....~.,.~.,_.,,.....,...Y...,.~ Chapter III.E TOBACCO SMOKE; A MAJOR SOURCE OF GASEOUS AND PAFtTZCULATE INDOOR AIR POLLUTION 1. SUMMARY Tobacco smoke is a major contributor to indoor air pollution. Exposure of non-smokers to ambient. (sidiestream) smoke is defined as "involuntary" or "passive" smoking. Numerous studies have shown involuntary7 smoking to be a significant health hazard for several populations including infants, ch~ildren, elderly people, individuals with cardiovascular disease, and individuals with impaired pulmonary ('respi~ratory)) function, including asthmatics andi those with obstructive airway disease. In addition, documentation is appearing which, shows that prolongeid exposure to sidestream tobacco smoke significantly increases the risk of disease in otherwise healthy, individuals. Health hazards induced by involuntary smoking include: increased risk of respiratory infection, lung cancer,, decreased blood oxygen levels, decreasedizxercise tolerance, increased episodes of angina in those with heart d'isease, decreased pulmonary function, broncho- constriction, and broncho-spasm. Research also shows that tobacco smoke is a major irritant for both smokers and non-smokers, causing symptoms which include burni'ng eyes, nasal congestion and drainage (rhinitis), sore throat,, cough, headache and, nausea. There follows a discussion of' some of tine hazardous components-of tobacco smoke and'their effects on the body, threshold for harm levels, a review of current literature on health effects of involuntary smoking and suggestions for controlling involuntary inmalation of' tobacco smoke. 2. BACKGRO'UND 2.A. COMPONENTS OF'TOSACCO SMOKE It is estimated that one-third of the adult population; the Ubi~ted States smokes tobacco (19). Virtually everyone is exposed to tobacco smoke in varying degrees depending on the concentratiom of smoke and the effectiveness of ventilation found in ttae indoor envixonment (21):. Tiao types of smoke are discussed inn the literature. Mainstream smoke is defined' as smoke drawn through the tobacco~during inhalation, resulting in higher temperatures, more complete combustion and a greater degree of absorption by the -tobacco, the filter if present, andi the smoker himself. Mainstream smoke~ II'I.E. 1. C C H-4
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( 382 59. Taylor, G. Tobacco smoke allergy--Does it exist? Scand. J. Respilr. Dis. (Suppl. 91):50!-55, 1974. 610. Trichopoulos, D., A. Ealandidi, L. Sparros, and B. MacMahon. Lung ~ cancer and passive smoking. Int. J. Cancer 27:1-4, 1981. 61. U.S. Department of Health, Education, and Welfare, Public Heaith. Service. Smoking and Health. A Report of the Surgeon General. DHEW Publication No. (PHS) 79-50066. Washington, D.C'.: U.S'. Government Printing Office, 1979'. [1'250) pp. 62. U.S. Department of Transportation, Federal Aviation Adm3nistrati'on; ~ and'SD.S. Department of Health, Educati'on, and Welfare, National Institute for 0+ccupationa,l Safety and Health. Report on Health Aspects of Smoking in Transport Aircraft. Washington, D.C.: U.S. Department of Health, Education, and Welfarey National Institute for Occupationali Safety and Health, Division of Technical Services, 1971. 85 pp. ~. . 63'. Waite, C. L. Letter to the editor. N. Engl. J. Med. 299:8I97, 1978. 64. Wakeham, H. R. R. Environmental carbon monoxide from cigarette smoking-A critique. Prev. Med. 6r526-534, 1977. 65. Weber, A., T. Fischer, and E. Grandjean. Passive smoking: Irritating effects of the total smoke and the gas phase. Int. Arch. Occup. Environ. Health 43a183"193, 1979. ! 6 6. . Weber, A., C. Jermini, and E. Grandjean. Irritating effects on man of air pollution due to cigarette smoke. Am. J. Public Health 66:672-676, 1976. 67'. Weiss, S. T:, I. 8. Tager, F. E. Speizer, and B. RQsner. Persistent wheeze. Its relation to respiratory illness, cigarette smoking, and level of pulmonary fdnctioni in a population sample of children. Am. Rev. Respir. Dis. 12'2:697-707,-1980. 68. White, J'. R., and H. F. Froebi Small-airways dysfunction in nonsmokers chronically exposed to tobacco smoke. N. Engl. J. Med. 302:720"723, 1900. 69. Yabroff, I., E. Meyers, V. Fend, N. David', M. Robertson, R. Wright,, and R. Braun. The role of atmospheric carbon monoxide in vehicle accidents. Menlo Park, Cal.: Stanford Research Institute, February 19741. INDOOR AIRBORNE CONTAGION Among the pollutants of'indoor air are biologic aerosols produced by people when they cough, sneeze, sing, spit, blow their noses, or even talk. Discussion of airborne infection i's as old as recorded history, but refined concepts of contagion, expressible in quantitative terms, are surprisingly recent. Less then 50 yr ago. William F. Wells synthesized a coherent theory that has now been tested and amplified.'" Even though the ideas are not yet imbedded in medical thinking and teaching, they pertain to a veryi'~mportant medical and public-health problem. Ai'rborne contagion is the mechanism of transmission of most acute respiratory infections, and these are the ~. i's O greatest of all causes of'morbidity. Primary pulmonary tuberculosis also transmitted in this way. Airborne contagion from person to persi0n N is mostly an indoor phenomenon. ~ ~ ~ ~ W H-30 Q. ~
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l acro,lein and formaldehyde, benzo{alpyrene, andlvazious trace metals. Reduced ventilation increases concentrations of tobacco smoke. As an energy-conserving compromise, smokingl could be restricted: to zones that are well ventilated. Public policy should clearly articulate that involuntary exposure to tobacco smoke has adverse health effects and ought to be minimized or avoided where possible. Under this framework, the prohibition or restriction, of smoking in public buildings, offices, etc., is a control option to be considered!with ventilation and ailr-cleaning,. INDOOR CfJMBUSTI0Ni When fuel combustion occurs indoors--e.g., for heating,, cooking, and power machinery, including automobiles-it gives rise to increased concentrations of gases and particles. Unvented gas cooking is probably responsible for a large portion of nitrogen dioxide exposures in our population. In many homes, chronic exposures to nitrogen dioxide indoors may exceed established natiional ambient-air quality standards. Shorter-term 1-h average concentrations indoors often exceed'the highest hourly concentrations measured!outdoors. The concentrations of nitrogen dioxide and carbon monoxide in residencesi have not been fully documented. However, some studies have shown an, association between gas cooking and the impa3rment of lung function in! children. Gas cooking appliances are also sources of carbon monoxide, carbon dlioxide, formaldehyde,, hydrogen cyanide, sulfate particles, organic particulate matter, and organi'c vapors. The probl'em of' chronic or even peak exposures to combusti'on products indbors will be accentuated with decreased ventilation and the increased!use of portable space-heaters, wood- and coal-burning stoves, and indoor venting of gas dryers.. Carbon monoxide, nitrogen oxides, and particles from automobile exhaust can produce increased concentrations, in office buildi'ngs and public! areas. Concentrations exceeding: 1-h carbon monoxide national ambient-air quality standards (NAAQS) by a factor of'2-4 have beenireported io several ice-skating rinks that usee gasoli'ne-powered ice resurfacing,machinery. Office buildings andi apartment buildings with attached or underground garages can also havee sustained high concentrations of carbon monoxide indoors. Because both carbon monoxide and, nitrogen dioxide are odorless at typical concentrations, the presence of increased and possibly hazardous concentrations may go undetected'6 Although confirmation is necessary, the available evidence suggests that important population exposures to nitrogen dioxide and carbon monoxide can occur indoors and may constitute a, suffici'ent threat to the general public health,to justify remedlial action. Reducing exposure to those gases is.relatively straightforward. Source removal or direct venting,of'combustion sources.should be considered., Efforts to conserve energy present other potential problems indoors. Effective enerqy-conservation measures can result in an overcapac,ity otexisting heating equipment. Operation of'such Hi-22 G l (
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n accounts for approximately 4% of the total smoke prodluced. (Exhaled smoke is included in this 4$) Sidestream smoke is defined as smoke arising,f'rom thee smoldering tobacco and accounts for'ttre majority (96$) of' gases and particulates produced (79) . The National Res'edxch Council Committee on Indoor Pollution, provides an in-depth, analysis of the compos'i- tion, of sidestream and mainstream amoke._ Sidestreamsmoke contains higher concentrations (greater than 2:1 in most cases) of.bot'h gaseous and particulate components (19). , 2'. B'. EXPOSURE LEVELSI OF S'ID'ESTAtEAM SMIOM Federal regulations establishing; standards zor' outdoor air pollution levels have been enacted in response to demonstrable adverse health etfects found when the concentration of respirable suspended , particulates (RSP) exceeds threshold for ttiarm~ l!e'vels.. The Environmental Protection Agency has set the 24 hour outdoor RSP level at 75 micrograms per cubic meter (,pg;/m3 ). This is referredl to as the National Ambient Air Quality' Standard or NAAQS. The maximum level, which cannot be exceeded more than once a year, is 260 -(Wgi/m3). Ftepace and Lowrey sampled a number of restaurants, bars, lodge halls, etc. and tound ipdoor RS'P' levels ranging from 30-5'5 ~ug/m3 in non-smoking areas, to.86-697 ug;/m3 in smoking areas. Outdoor samples taken, at the same time ranged from 24-60, pg/m3.(21) All values where tobacco smoke was present exceed the NAAQS for outdoor air ot 75 yg,/m3, and many exceed the very dangerous level of 260 Ag,/m3'. These data become highly significant when we consider that Americans spend over 90% of their time indoors (20). The potential hazard to health appears to be even greater for indoor pollution tharn for outdoor pollution. Standards for safe indoor levels of RS'P have not been established. The American Society ot Heating, Ftefrigeration, and! Air Conditioning Engineers (ASHRAE) has established minimum ventilation standards for ~ acceptable indoor air qvallilty. However,, these standards are not enforceable by any government agency. As energy conservation has become a major priority in this country, there has Deen a significant decrease in, indoor ventilation rates. Air is recirculated (at lower cost) instead of exchang,ed for outdoor (fresh) air, resulting in a higher concentration of respirable particles and greater exposure to tobacco smoke. III.E. 2 H-5
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3'80, 23. Gliner, J. A., P. B. Raven, S. M. Horvath, B. L. Drinkwatez, and J'. C', Sutton. Man's physiologic response to long-term work during thermal pollutant stress. J. Appl. Physiol. 39.62'8-632, 1975. 24. Harke, H.-P. The problem of' 'passive smoking.' MUnch. Med. Wochenschr. 11Z:23'Z8-2334, 1970. (dn G+erman; English aummary) 25. Harke, H.-P., and A. Bleichert. On the problem of passive smoking. Int. Arch. Arbeitsmed. 29:312-322, 1972. (lin German; Ernglish~ summary) 26. Harlap, S., and A. M4 Davies. Infant admissions to:hospital andd maternal smoking. Lancet 1:529-532, 1974. 27. Hirayama, T. Non-smoking,wives of heavy smokers.have a;higher risk ofllung cancer: A s!tudy from Japan. Br. Med. J'. 2!82A83-185, 1981. 28. Hugodi, C., L. H. &awkins, and P. Astrup. Exposure of passive smokers to tobacco smoke constituents. Int.,Arch. Occup. Environ. Health 4Z:21-29, 1978- 29. Johansson, C. R. Tobacco smoke,imroom air-an experimental investigation of odour perception and irritating effects. Build.. Services Eng. 41:254-262I, 19'76. 30. Johansson, C. R., and 8'. Ronge. Akuta irritationseffekter av tobaksrSk i rumslutt. (Acute irritation effects of tobacco smoke in the room atmosphere). blcrd. Hyg. Tidskr. 4i61:45-50, 1965.. 31. Laties, V. G., andiii'. H. Mtrigan. Behavioral effects of'carbonf monoxide on animals and'man. Ann. Rev. Pharmacol. Toxicol. 19:357-392', 1979. 3Z. Lebowitz, M. D., and B. Burrows. Respiratory symptoms relatedito smoking habits of family adults. Chest 69:48!-50r 1976. 31. beeder, S. R., R. Cbrkhill, L. M. Irwig, W. W. Holland, and J. R. T. Colley. Influence of family factors on the incidence of lower respiratory illness during, the first year, of life. Br. J.. Prevent. Social Med. 30:203-212, 1976. 34. Luquette, A. J., C. W. Landiss, and D: J. Merki. Some immediate effects of a smoking environment on children of elementary school age. J. School Health 40:533-53&, 19'710. 35. National Clearinghouse for Smoking and 8eaith,. Adult Use of Tobacco, 1975. U.S. Department of Health, Education, and Welfare, National Cleariinghouse~for Smoking and'Health, June 1976. 23 pp. 36. National ResearchiCouncil, Committee on Medical and Biologic Effects of Environmental Pollutants. Carbon Mono:cide. Washingtom, D.C.: National Academy of Sciences, 1977. 239 pp. 3'7.,0'Connell, E. J., and'G. B. Logan. Parental smoking,in childhood asthma. Ann. Allergy 32':L42-145, 1974. 38. Pimca, P. E., F. Silverman, and1R. Ji. Shephard. Physiological effects of acute passive~exposure to cigarette smoke. Arch. Environ. Health 33:201-213, 1978. 39. Rantakallio, P. Relationship of maternal smoking to morbidity and mortality of the, child'up to the age of'five. Acta Paediatr. Scandi. 67:621-631, 19718'. 401. Rantakallio, P. The effect of maternal smoking on birth1weight and the subsequent health of the child. Earliy Human Dev. 2:371-382, 1978. H-z8 t
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LI'ST' OF~ WO'RKS CONSULTED~ 1. Azonow, W.S. "Effects of'Passive Smoking on Angina Pectoris," New Engl: J. Med. 29'9:, 21-24, 1978. Azonow, W.S., Ferlinz, J'., Glauser, F., "Effect of' Carbon Monoxide on Exercise Performance in Chronic Obstructive Pulmonary Disease," Am.J.Med'. 63: 904-9108, 1977. 3. ASHRAE STANDARD, "Ventilation for Acceptable Indoor Air Quality," American Society of Heating, Refrigeration and Air Conditioning Engineers, New York, New York, 1980. . Bland, M., Bewlev, R.„ Polland, V., Banks, M.; "Effect of'Children's and Parent's Smoking on Repiratory Symptoms," Arch. Dis. Chi1d. 53: 100-105, 1978. 5. Bonham, G.S. "Children's•Health in Families with Cigarette Smokers," Azn.J.Pub.Healith 71(13) : 290-293, 19S1. 6. Cameron, P., Kostin, J.S., Zaks, J'., Wo1fe, J., Tighe, G'., Oslett,. B., Stocker, R., Winton, J'. "'The Health of Smoker'ss and~ Non-Smoker''s Children" J. Allergy 43: 33'6-341, 1'9'69. 7.' Center for Science inithe Public Interest, The Household Pollutants Guide, Anchor Press/Doubleday, G , New York, #77-76269, 1978. 8. Coliley, J.R.T'., HoSland, W.W.,, Corkhill, R.T., "Influence of Passive Sfioking and Parental Phlegm on Pneumonia andi Bronchitis in Early Childhood" Lancet 2(78'88):1031-1034, 1974.. 9. Colley, J.R.T., "'Respiratory Symptoms in Children and' Parental Slmoking and Phlegm;Production" Brit.Med. J. 2:201-20t, 1974. 10. Diehl, Harold S., Tobacco and Your Health: The Smoking Controversy, McGraw-Hill, Inc. 69-13216, 1969. 11. Garfinkel, H. "'Time Trends in Lung Cancer Mortality Among Noan.-Smokers and a Note on Passive Smoking" JNCI 66:1061- 1066, 1981. 12. Geomet, Inc. The Status of Ind'oor Air Pollution Research 1976. Environmerital Monitoxing, and Support Labbratory,. U:~' Environmental Protection Agency, 197'7. 13. Glantz, Stanton, "Health Effects of Ambient Tobacco Smoke" unpublished, by perm,ission of the author, San Francisco, CA 1981. III.E. 12 H-15
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GVftiQYET USA* Mbntvale,, NJ i Organizaticiwl Profile Liggett & Pyers Tobacco C&pamy Sales in 1'962:$3Tl rtnilltian No. of enployees:1',970 No. of cigarettes sold in US ini 198`?:28 billian! ' Share of US' earieet:4.5i: Nb. of adwlt cmnsurers: 2.5imii1ion The Pinkert,mn Tmbacco CQrpany eg; Red Man ctiewing tobaccoi Allen Products pet foad eg, Alpo, Liv-A-Snaps Internmtianal Distillers 5'Vintners eg, J & 8 Rare Scotch, Grand'Marnier, Baileys Original Irish Crean, Absolut Vodca At1antic Soft Drink CaWy Pepsi Cola bpttli'ngi franchise Pepsi Cola Bottling Carpany of Fresno„ CA Diversified Noduats Cbrporatian ptiysical' fitness equiprnnt Sponsorships and Pfvrnti ons Chilidren's Cancer Classic. Celebrity Golf T+ounnarent, Owrtwn, N.C. Duke Uniiuersity Ballet perfornnnees on tne Publir Broadcasting,Systen (PBS) {'Salies in 1952: $11.3' bill'ion Nm. of erpi oym: 8, 600, Aduerti'sing spending in 1982: $54,000,000 . 91st leading US advertiser (22nd in.megazines, 13th in biTl.boards)' L-4
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50 (} Some of this emission occurs over long periods. Thus, longrterm, effects in humans continuously exposed to formaldehyde at low, concentrations needito be studied. There is a particular need to assess the carcinogenic potential in the concentration, ranges of human exposures, inasmuch,as one study in one strain each of'rats and micee has shown that long-term exposure (lasting 24 mo) caused nasal cancer. Humans have been and are now being exposed to formaldehyde in several' types of occupations and in a variety of structures. Epidemiolocgic investigations are needed to assess the human healthh effects of'formaldiehyde, the magnitude and duration of exposure, and the influence of cigarette-smoking habits and the presence of other contaminants. The mutagenic, embryotoxic, and teratogenic effects must be included in the epidemiologic and animal studies. In humans exposed to formaldehyde, the mechanisms of airway and target cell responses must be evaluated and'characterized as to sensitization and adverse effects in susceptible populationgroups, such as asthmatics and persons with chronic obstructive lung disease. Exposure-effect relations and the mechanisms involved in the biologic effects require further animal toxicologic research. Formaldehyde should be restricted to the extent that household! consumer products and building, products in normal use will not release potentially hazardous or irritating amounts of formaldehyde into indbor air. TOBACCOSMaKE Tobacco smoke has s,hown some evidence of being a major contaminantt in many indoor environments. Involuntary exposure to tobacco smoke should' be assessed to identi'fy locations and populations with high exposure and to determine the factors that contribute to high exposures indoors. Physical and biologic evaluation of'tobacco-smoke constituents should be continued. Tobacco-smoke constituents should be tested for their toxic effects, thei'r ability to act as mutagens or, promoters of carcinogenesis, and their effects in combination with other indoor pollutants. In addi~tion, such properties of tobacco smoke as mass and age, chemical'compositi'on, irritation factors, and odor components should'be examined to learn how, they are affected by ventilation rate, occupancy, extent of smoking, air-cleaning, and other control strategies. The extent to which passive exposure to sidestream tobacco smoke produces respiratory tract symptoms and functional decrements in nonsmokers, especially children, needs further documentation and measurement. Prospective studies of chilldreni in homes with smokerss would be especially desi'rable to determine rates of lung maturation andiillness frequency duringichildhood and adolescence. Information on the potential health effects of exposure of nonsmokers to tobacco smoke,should be widely disseminated. The "energy-cost penalty" of providing adequate ventilation in, indoor environments that permit smokingi should be analyzed in a variety of public buildings. Increasedlciga€ette taxation as a mechanism of H~-23'
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f° 3. The Legislature should! consider legislation too require warnings of potential health effects of formaldehyde pollution on products which emit this pollutant. 4. As part of the State's broader research effort, funding should be pzovidied for research om potential chronic health hazards which, may be associatediwith low-dose formaldehyde exposure. Radon 1. The Task Force should recommend to the Governor and Legislature an appropriate state agency to co- ordinate research, policy development, and public education on radon. 2. This agency should develop alprograzn to: a,, identify areas with highiconcentrations of radon--a radon "map" of the state--with special attention given to areas with high levels off building activity; b. develop met?nods to identify and remedy existing structures subject to high concentrations of radon; c_ research energy-tight structures for better understanding of'increases in radon accumulation in such structures, with recommendations forr prevention through design and equipment or remedial measures in existing structures; d. as part of broader public education efforts, provide information to designers, builders, and consu¢ner&on avoidance or reduction of radon in new and existingistructures; e. formulate measures to reduce exposures to radon which may include standards and/or regulations for (i) levels of indoor concentrations and (ii) radionuclide content in building materials. E. Involuntary Smoke 1. Minimum ventilation and air quality standards should be established for areas in buildings in which tobacco smoking is permitted. Standards for build- ings or parts of buildings used by children, infants, the elderly and those with pre-existingi heart and respiratory disease shoulditake into account the special sensitivity of these populations. H"18' C_.
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378 • Small changes in visual and auditory vigilance have been. demonstrated at carboxyhemoglobin contents capable of being prodhced by involuntary smoking, but no change initests of complex functionhas been dem~onstrated. The interaction o'flfatigue, alcohol, and carbon monoxide exposure on complex functions, such as automobile driving, has not been investigated for CDHb contents capable of'being prodl:ced under normal conditions of involuntary smoking. • Patients with angina pectoris have reduced'exercise tolerance af'terintvol'untarysmoking thatmaybe~a combi'na~tion, of psychologic stress and a reduction in oxygen delivery to the myocardium induced by carbon monoxide. Carbon monoxide clearly reduces the amount.of exercise possible until the onset of angina in, patients with angina pectoris at COHb contents that may be reached as a result of invol'untary' smoking. .• Carbon monoxide has been shown in one study to reduce the amount of exercise that patients with hypoxic chronic obstructive lung disease can perfmrm.until.the onset of'dyspnea.. • l4ost.nonsmokers find it annoying to be exposedlto cigarette smoke. This annoyance is probably due to substances in the gas phase of't'he smoke. • Cigarette-smoke exposure results in eye,.nose, throat, and respiratory irritation. The eyes~are most sensitive, followe&by the nose and!throat. The particulate phase of ci'garette sanoke seems to be predominantly responsible for this irritation. • Persons with al'lerg,ies are more sensit'ive!to the irritant effects of' ciga'rette smoke. However, there is no p'roof of tobacco allergy. • Children.whose parents smoke may be more likely to have respi'ratory symptoms, bronchitis, and pneumonia as infants and may have poorer pulmonary function as advlts, compared withchildten of nonsmoking parents.Thi'~s relationship is not.indiependent of parental symptoms, socioeconomic class, an6the smokingihabits of'the chdl'dren; and it i~s associatedh with the number of cigarettes s:noked' per day, by the parents. REFERENCES 1. Anderson, E. W.,R. J'. Andelman, J'. M-Strauch, NI. J. Fortuin, and'. J. J. Knelson. Effect of low-level carbon monoxide exposure on, onset and duration of'angina.pectori's. A study in ten patients with. ischemic heart disease. Ann. Intern. Med. 79:46-50, 1973.. 2. Anderson, G., and T. Dalhamn. The risks to healthof passive smoking. Lakartidningen 70:2833-283i61, 19'T3'.. 3. Aronow, W. S. Effects o.f passive smoking on angina pectori!s. D]i. Engl. J. l+ied. 299 :21-24 , 19'7'8'.. 4'. Aronow, W. S., and J. Cassidy. Effect of carbon monoxide on maximal treadmtlli exercise. A study in n'or:aall persons. Ann. Intern. Med. 83:496-499, 1975. 5. Aronow, W. S., J'. Cassidy, J. S. Vangrow, Hi. March, J. C. Kern, J. R. Goldsmith, M. Khemka, J. Pagano, and M. Vawter. Effect of . M C C C H-2b
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R.J. REYTDLDS Iti0U5lRIES, INC.•' Winston-Salem, N.C. Organizatianal Profile R. J. Rei Tobacco Cirpany Sa1es ih 19R2:S3.5 bfillion No. of eiployees:14,815 Nof of cigarettes sold in US in 1!: 208. 4' bi l l ian SMare of' U5 market: 3'3.5X No. of adult consu~!ers: 18 million~ R. J! Reynolds Tmbacco International, Inc. wvrldviide cigarette mmnufacturing Oel Monte Corporatiion eg, Oeli Manfie fruits and vegetables, Hawaiian Pinch. Venmont Maid Syrwp, Gxn King, Al Steak Sauce, My-T-Fine Ridding tNeublein Spirits 3 Wine Gotpany eg, Sni rrroff vocka, Bl adc Yel iMet Canadian Mhiskey, Inglenook wines, . L'arKers, Harveys Bristol Crm KetotudUr Friedi (?bicken Corporatian eg, K+ent+xky Fried Chicken, H. Salt Seafood, and Zani ftican Restaurants ftnoil WSA, Inc: exploration and sale of oil and natUral i gas R. J. Reynmlds QeMeloprent Qdrporation packaging Bear Creek Corporatian fruit, garden plants Sponsorships and Pnortmtions Gmel Somreboard (sports sections of over 10() daily newspapersi Qane1 Sca,ncboard (concert schedules in newspapers) Ca!e11 9tiiDays (Brodie Mt.,, MA and I#nter Mt. , NY) Carel' Expeditions (Wilderness actuenture). Winston Team ATerica Series (soccer) Its-1d Gc,p! soccer ctiaipionships a.i{ern RHdGLISGrIes . Ihternatianal Hot Rod ASsociation Iherican tbtorcycle Association (AMA) Irtternatiianai Sports Assoc. Mone Filter FashfimniStw Tour (shmpping centers). Inber-Aierican Festival' of the Arts, Aierto Rico~ Nationai Park Sprvice suarer fttlen and bliues and theatre prograrts. Sal ien Spi ri t Street Scenes (inner ci ty concerts ) R. JL Reynolds ResearzhiFellowship (Rackefeller Universiity) * Sales in 1982: $13.06 biTlion No. of enpl ioyees :117; OG1D 1 Advertising spending in 1'982:. $530 mi'llion, 4th leading US advertiser(1st in neorspapers, 2ndl in rtngazines, 1stin billboards), ** R. J. Reynold& acquired Nabisco Brands, Inic. in, 1!985 L 3
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women). Those who are concerned with fairness In this regard should recalIli that 198'55 marks the year in which female lung cancer mortality rates surpass breast cancer mortality rates. To: use an assumed short run perfiect-market-functioning,economic theory to assert that smokers bear the full costs of, their own behavior, especially im umlic employment, is misleading and,,in1 this context, an example of the misuse of professional competence. Even private eompanies, which are rapidly adopting no-smoking in the workplace programs, do not believe this theory relevant for the private sector. We may turni to srelli-known published data to estimatie the potential shorter-run. (one to three year period) savings likely tolbe enjoyed by the Unitled S'tntes Government from the impiementation of S:1440. These involve only , the areas of prodUctivity, absenteeism, fire losses, accident-based losses, and'passive smoker, eosts. I will use Professor Tollison's figures on government employees.and proportion of smokers. My other cost estimates reflect bare-bones numbers, limited to the costs directly borne by the employer, and'. appropriate for the poorest business. I' prefer underestimaties., Thus, Professor Tollisoa says that there are 356,989 smoking government employees, or approximately one-third of i'ts labor force. Im mid-1985 dollars, based'on my 1983 article, we estimate that the average smoking employee costs his employer i'S50z per year in excess shorter-run costs as compared I to employing & similar non-smoker. If one were to add longer-run (largely health and premature disability and premature death)) costs, which would take three ! to ten years to impact, the totali smoker cost to the employer would be at least =1,1i00 per year per average smoker. Assurning,a 100% succes% in three years, the United States Government would be enjoying an annual savings of almost ;200millionr. Remember, these are understated figurm Even a 50% compliance would ~ save S 100 millions a year. To conclude. S.144i0 recogtoizes the new research and realities regarding, smoking today. It represents a lbudable attempt on, the part of the United States Government to M-5
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381 41. Raven, P. B., B. L. Drinkwater, S. M. Horvath, R. 0. Ruhling, J. A. Gliner, J. C. Sutton, and N. W. Bolduan. Age, smoking habits, heat stress, and their iriteracti've effects with carbon monoxide andd peroxyacetylnitrate on man's aerobic power. Int. J. Biometeorol. 18:222-232', 1974. 42. Repace, J. L., and A. H. Lowzey. Indoor air pollution, tobacco~ smoke, and public health. Science 20'8:464-472, 19,80. 43. Rummel, R. M., M. Crawford, and P. B'ruce. The physiological effects of inhaling exhaled cigarette smoke in relation to attitudie~of thee nonsmcker. J. School Health 45:524-52'9, 1975. 44. Russell, M. A. H., P. V. Cole, and E.. Brown. Absorption by non-smokers of cacbon.monoxiide from room air polluted by tobacco smoke. Lancet 1:576-579, 1973. 45. Russell, M. A. H., and C. Feyerabend. Blood and'urinary nicotine in non-smokers. Lancet 1:179-181, 1975.. 46. Rylander, R., Ed. Environmental Tobacco Smoke Effects on the Nonsmoker. Report from a Workshop. Scandi. J. Respir. Di~s. ($uppl. 91) :1'-90, 1974.. 47. Rylander, R. Perspectives on environmental tobacco smoke effects.. Scand. J. Respdlr. D'is. ('Suppl. 91)':79-8'7, 1974'. 48. Said, G., and J. Zalokar. Incidence of upper respiratory tract disorders in ch,iildrem of smokers. Ann, d'Otorlaryngol. Chi'!r. Cervico-Fac. 95I:236-240, 19'78. 49:. Schilling, R. S. F., A. D. Letai', S. L. Hui, G. J. Beck:, J. B. Schoenberg, and A. Bouhuys. Lung function, respiratory disease, and smoking in families. Amr J. Epidemiol. 10i61:274-283, 1977. 50. Seppanen, A. Smoking in closed space and its effect on carboxyhaemoglobb'n saturation of smoking andinonsmoking subjiects. Ann. C1in. Res. 9:281-283, 1977. • 51. Seppinen, A., and A. J. Liusitalo. Carboxyhaemoglobin saturation i'n, relation to smoking and various occupational conditions. Ann. C1in4 Res. 9:2'61-268, 1977. 52. Shephara, R. J., R. Collins, and F. Silverman. Responses of' exercising subjects to acute "passive" cigarette smoke exposure. Enwiron. Res. 19:279-291, 1979.. 53. Speet, F. Tobacco and the nonsmoker. A study of subjective symptoms. Arch6 Environ. Health 16':443-446, 1968. 54. Srch, Mi. Uber die Bedeutungides Rohlenoxyds beim,2'igarettenrauchen im Perspnenkraftwageninneren. Dtsch. Z. Gesamte Gerichtl. Med. 60(3):80-89, 1967. (in German) 55. Stezli~ng,, T: D., and D. M. Kobayashi. Exposure to: pollutants in enclosedi"living spaces." En!virc,n. Res. 13:1-35, 1977. 56. Szac!kows!ki, D., H.-P. Harke, and'J. Angerer. Body, burden of carbon monoxide from passive smoking in offices. Innere Med. 3':310-313, 1976. 57. Tager, I. B., B. Rosner, P. V. Tishler, F. E. Speizer, and E. H. Kass. Household aggregation of' pulmonary functioniand chronic bronchitils. Am. Rev. Respir. Dis. 114:485-492, 1916. 58. Tager, I. B., S. T. Weiss.,, B. Rosner, and F. E. Speizer. Effect of parental' cigarette smoking on the pulmonary functiora of chi'ldzen. Am. J. Epidemiol. 110:15-26, 197'9'. H-29
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INlERICAW MAMDS, INC- tMew York, NY. Organfizatianali Pnofile Ttie Aeerican Tabacco Ctnpany (New' Yorir, W) Sales in 1982:E1'.2'billion No. of erplioyees: 7,250! No. ofi'cigarettes sold in tiae US in 1S&; 43.6 billion Sfiane of the US oaricet: 7X Nbl of adult oonsuners: 3.9 million Jarrerican Cigar eg, Sai l ~, Flying i Wtchman, Rai'-Tam Jartes B. Bean DistilltingiCampany eg, Jim Bean bauri,ar Sunsiaine Bisqufits eg. Hydrooc, Hafb, Krispy Franklin Insurance Co. Ardrew'Jergens Co. eg, Jergens Lotion SwinglYne, Inc. stapaers. Master locic Co. t Co. eg, Titlest gmlf balls P'inkerton Inc. security and investigative servirEs. " PMduts office prvicts, autt+ repai r, cutliery Wi 1 san Jores Co. micrmcrnputers andloffice supplies Acfe Visible office Qromucts *Sales in 19s2: 36.5 billion Mo. of erployees: 52,(m0 Mvertising spending in 1'982~:57'1.3miTlionTBtti leading US adwertiser ('9th in magatines, 6th in bfillboards) ps end Prwntions luydcy Strikes Agdin - Ameriran Oream Classic (Ibowling) luky Strike dart tarrnwents lLCky Stricke salute to fr Nati anal'. Hoc.key 1'eagwe' Players Sports page, New York Tnmess and Ne+ Yoriu Abst Wamen's page. New York Times. (Cerlton)
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Government. Almost as many Americans are killed annually today due in large part to the rise of the cigarette smoking habit as were killed in all our wars in the 20th Century. The epidemiological evidence on~ the adverse effects of smoking on non- smoking others nearby has led our Surgeon General to suggest that smoking parents may be guilty of child abuse.l Given the weight of evidence and knowledge as to smoking available today, to assert one's right to smoke wherever and whenever one~pleases is virtually eqpi valent to asserting one's right to be a drunken, driirer. Professor Tollison's remarks and analyses are based'on the conceptual mistake of the rights of smokers.plus al one-balf billion dolliar annual' implemenrtintion cost figure which is derivedlfrom fantasy and the standard obstructionist claims of'the Tobacco Institute. The truth is that:.(1) emplbyers have the right to restrict smoking in their workplaces; (2) with a properly devised program (for which we have numbers of examples from, American companies andlstate and local governments), avoidance of confrontation, and good sense, the United States Government in several years will be enjoying a gain in real dollars of hundreds of millions of dollars per year as a result of S.1440. The tobacco industry always emphasizes the difficulties and complexities of impllementatlion by taking, an extreme adversary point of view. The truth, is that the vast majority of smokers want to quit and do not voluntarily wish to harm non-smokers. Since less than one-thirdlof our adult population smokes, more and more smokers ask whether they may smoke !in ifront of you. The law wi12' be largely selfrenforcing, as has been seen at a number of companies. 1 One should not be misliedlby medical research reports which say that the direct causel relationship between passive smoking and cancers and cardiovarcular diseases in N otherwise headlthy persons needs further study. This does not say that passive smoking ~ has no significant adverse health and funetioning i'mpaets onirnost non-smokers. N However, we know that passive smoking reduces breathing capacity, increases the rate of ~ respiratory problems and diseases, reduces produetivity, andlinereases the nicotine content of the blood stream6 ~ ~ •- ~ ~. ~ ~ M-3
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©. I G'reater Riverside Chambers of Commerce Arlington • La Sierra— Riversidc • Woodc.resl • nc Anza Country'• Magnolia Cenler -3'Zifl MamiiSir~c.f. Riiwersulc:; Calilurnid9250l (714)bli3•710(0 May 3', 1985 Patricia Larson, Chairman Riverside Count Board of'Swpervdsors 40'80' Lemon Street, 14th i•1'oor Riverside, CA' -9'2501 Dear Mrs. Larson: The Greater Riverside Chambers of'Commerce, the Lung Association! of Riversidt County and the Califcrnia for NonrSmokers Rights recently went through lengthy process of advocacy and negotiation amdicompromise for the adopti'on, of'a hon,- Smokiing; ordinance that would! materially enhance~ the rights and health of non- smokers. For the first time, to our knowledge, our three org4nizatilons agreed on the basic premise of the ordinance and that it would be mandator for everyy business orga~nizationtohave a reasonable~~ smoking po rc~t each, business, would be allowed to tailor their own policy to benefi't- the non-smoker. Other, amendments were added by City Counciliatthe~reqwestof Attorney Wait Ingall!s. The Greater Riverside Chambers endorsed those'amendments but neither the Lung Association or Cal'.iforni'ai for fionr5mokers Rights did We would hope that the County of Riverside would adopt the exact same ordinance tol encourage unif'orm compliiance by those businesses that have businesses throughout the county. J If the County of Riverside concurs in thiis; approach, the Gireater=Riviersiide Chambers of Commerce would be willing to p te its adoption of other Chambers o~fCortrnerce and ciitiest'hroughiout theeoun~ We believe thatilfthe!CounCy of Riverside adopts the Riverside Ordinance, it couldibecome the leading county in Cali'fornia in protectiingi non-smokers rights. Please schedule this on t.he! May 21st Board of Supervisors agenda. SOicrrelly, / .' ar't P16. Execl,t.ivp Uice Presidlent c: Linda Morton 1 -1
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The following views reflect my many years of work on the economics of'smoking, a topic for which I am internationally recognized as an authority. Please see the appendix attached for copies of my articles. The basic outline of my comments involves three parts: first, a conceptual framework needed for a relevant economic analysis of the policy of' prohibiting smoking in certain public places; second; a criticism of Dr. Tollison's remarks, based on a proper conceptual framework; and third, an estimate of'the probable net savings likely to be enjoyed by the United States Government from a policy of'restraiNrg smoking in Government buildings. The key error in economic analyses of smokinS, usually sponsored by the tobacco incustry involves viewing, smoking merely as a freely ehosen~ eonsumer activity which i many people enjoy, like chew3ng gum or, eating candy bars. Following this error, one may speak of smokers' rights vs. tion-smakers' rights, the utility value of smokimg, the. economic value of the tobacco_industry, etc. A proper conceptual view is to begin with the recognitiion that smoking has been the cause of a major epidemic. Smoking is an addiction which unfortunates acquire at an early impressionable age. Most smokers state that they, wish they, coaild stop. Almost half'of all smokers have quit in the past 20-25 years. Smoking, greatly' increases the risks of serious and eostly consequences fpr the individual later in life. In addition, unlike gum chewing and i candy, bars ~ smoking also involves serious negative,impacts on the health and functioning of nearby nonrsmokerss plus heavy costs to the society. Society has a right and an obligation to restrict the individual's ~right to harm others and to impose available eosts on society by unwise andJor careless behavior. We have laws about littering, pollution, suicide, redcless and dangerous driving, etc. Smoking involves all these aspects and more. The rise of cigarette smoking ih the United States since the first World' War has produced a massive epidemie of illness, suffering, and premature death, involving, many terns of'billions of dollars in annual losses to our, society and to the United Statess r i M'-2
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The premise of the law as to smoking being & form of pollUtiominvolving external diseconomies of substantial size is not at aII faulty. Professor Tollison's comments in this area simply ig!nore the research on the costs to employers of empl oyinQ smokers vs. eqµiiral+ent non-smoiters. More and more businesses are acting, on forbidding smoking in the workplace and the data on their savings is growing. The recent rise of a non-smoking hotel has provided'comparable dollar figures on maintenance and fire los:ses. No one wishes to punish or penalize smoJcers; one simply wishes to restrain the extent to which they harm Innocent others (while, of course, doing great harm to themselves) ~ by restricting a destructive and anti-social activity. This seeks to help smokers. The productivity losses that Profenor Tollfson says will follow from SaNI0 are really, In part, theproductivity'losses'presently being suffered by the United Statet. Government because It employs smokers. Smoking', breaks are probably more frequent andilotger at one's work station and are as non-productive as they would be with limited smoking areas. To these losses, we must add the adverse effects on, non-smokers (two non-+mokers to every smoker) and i the whole, range of 'pollution, cleaning, and fire-risk and accident costs. In fact, the tobacco industry's opposition to 511440 only makes sense if' they fear that restricting smoking locations will reduce cigarette consumption and i encourage smokers to quit. Their very opQosiltioir supports the view tfiat' 5.1440 will leiad i to savings due to reduced smoking. Properly, restidcft smoking in the workplace increa ses p!2ductivity by reducing losses due to smokers. (1'liease see artieles in appendix) No smoking signs cost little;, putting them up takes a few minutes. Getting people to cooperate in helping the United States Government save money is a matter of good supervision and leadership. Restricting smoking in major public places is exactly, where it is most important to emphasize that smoking is not only self-destructive but anti-socfa,l. It does nott discriminate against clerks and receptionists (implying, discriUninat'icn mostQy against M-4
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C 3" MIA'RV1N bt. KRISTElN estimates arrbased on data as to diNerential'.mortality of ctnokersvs nonsmokers reported by the State Mutual I.ife Assurance Company of America and!data in the author's 1977 paper'(20, 48; 57). (Sbe footnoterto Table 2 for details of,the calcula-, tions.) These eompany costs really reflect the extra cost to the business community as a whole. If' a company is experience rated or' self-irsured' (usually a very large company) then its premiums should reflect the high cost due to smoking: and it might~lbok for!ward to directly pocketing those savings by smoking cessatiom Smaller' companies are =enerally' community rated. Their' premiums reflect the extra~costs to its local insurance area in the society as a wholy due to smoking. Unless all such employers an&employees cooperate to reduce smoking. a single small company may not sueceed in reducing its premium costs even if all its own' employees stop smoking and!its medical-care spending declines sigrtifiicantly. 2. Absenttrrsrn The literature on the absenteeism record'of the avenie smoker vs the average taasmoking employee is extensive;,thene are published studies of experience in the United States and'other eonntries,covering rvariety of occupations, ranging from Connectiaut tekphoneoper'ators to members of the'post-World War II Ger- matrArmy (36, 71~ 78. 84). Smokers,have 33 to 45% excess absenteeism as cbm- paredlwith nonsmokers. These figures do eot reflect ease-eotttro0ed studies nor do repeated measurements of 6igh,R2 eonrellstioo!eoef[icients represent causation. In 5et, one may argue that higher rates of absenteeism,and smoking,b!oth relate too and reflect otbcr factors. However, studies of'work site health-promotion pro- jrams, including smoking cessation efforts at a number of ditferent, eompanies, Gnd'substantially reduced absenteeism rates in the shortirun'aftera year or two for participant populations vs bistoricaf and current t3outrols! Based on the 1974 Health Interview Stuvey of'the I+latio.oal Ceaterfor Heahh'Statistics it was,esti- tatated that tbrexcessabsenteeism,associated with smoking in the United States ataountcd! to 81 million lost work days per year,: or about 2 days per smoker (78). Absenteeism among smokers is partieuLrly' concentrated in the 1'f-s4' age group. If, valued at $40: per day, that means that' the average smoker may be costing his or her employer as much as $90 per year in excess absenteeism. To deal with the issue that all : smokers' excess absenteeism may not be dite entirely'to smoking, and!tdat ex-smokets may newer attain tite kvelt,of nonsntok. ers, we ofter, a lower-ran8e absenteeism cost figure of 'S,0' per year per smoker. These calculations do not include the costs of temporary replacements' and I the effects of absenteeism on the: prodtutivity and morale! of co-workers. , •An bwendt study by, tbe aunift sernrice of'Swah'ern NewEnSked DeUlTieiepAone found tha, sMoken','ibseece duelo edds ialone coa an .renSe a('S3o per sowker per re.r norr than nonsmok- ps' abseucs due taooltlj. (i;epotsed at ttte Conetotiow LwS Assowtiow Coofersooe. November 13: tm. Ne.r Haven. Coseecticut.) M-15.
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C 8A'1U5, INC. * Louisville,, KY Orgpni¢ational Pmfile Brarn &Willianson Tiobacco Corp~ Sales in 19M: Sx.2'brillion No. of enplbye-esAS;00© No. of cigarettes sold iniUS in. 1'962:83'.5'billian Share of US r.arket:33! 4X, lib: of Adidt C6nsurers:7.5 millian BATUS Retail' Division (New York, NY) Ginbels, Sal~s Fifth Auenue Kohl s Food Stores, Mmhal l Field and Carpany BATUS Pdper Divi sion i Spmnsorships and Pnvnotions Kowl Jazz Festival, Carregie Halll andiother a,Jtural centers (TVV andlradiio, cartmercials): qoes to cities across ttiie lU5 Koml SuperiVights (jau,rvck and Latin music) Raleigh Lights Rodeo *v'Yort City Opera national tour Jazz' program onNationall Rtil'ic Radio (MPR) 1 National Tour of Phillips Collection of Washington D.C. Royal Acadwry (BriRain) Art Tour *Sales in 19M: $:5' billion; No. of emplioyees: 46,000; 1~lwerti'sing spending in19G2: 5235'5 million; 24th leading US adNertiser (_ Dn~~sQ~ tti ae94zines,, 3rd'~billboards) tlDEW~S York,, NY tDrqanizational Profile Lori 19 iard (Nav Yoric, NY' ) Sales in 1962:51.2 bfil1ion No. of emplioyees::not available. No. of'cigarettes sold in W5 in 19G2:54.8 billiiun 9hare of US oericet:8.$r' No. of adilt consurers:5.million WA' Financial Insuirance Sponsmrshfips and Prarotions Kent G41 den Lights Ladies Gol if Classics (in Connectiiwt, the proceeas go to Gneerwri ch Fbspi tal ) i Kent Sports 8usimess (icolurtn in Walll . Street Jauml each Friiday) Cigarette poster advertising in liaew5 Theatres LoE.ws Theatress eq, cxvneum ana NaranounL (w) Loews Hotels e9n Re9ency. (NY) Sjmd't' (W) L'Enfant Plaza (Wash.D.C.) 8ulova, Watch Cwpany *Sales in 19E2: $4 .7 billion; No. of eip3oyees:29,(JOD; million, (6(Jth largest US advertiser, 11th nei+papers, L-6 Aiiwiertisiing spending in 1!982; $103.3 13th rtagaz i nes, 4th bi l l boards )
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376 MA'RNIiN M. KR75TE1!N and in increased spending on prevention and improved employee productivity will add to the GNP. All other factors remaining the same, an ittcnease in the currenrlevel of national avings, due to a reduction in the costs of 'smoking discussed above plus a decline in premature mortAality; should help to reduce interest rates. This should lead to an, inerease in capital spending; productivity, employment, and a higher rate of growth ini the GNP. While this is not the place to model wch a sequence. it iss ettti'rely possible for the higher levdt of GP1P thereby attained in the next 5 to 10 to. 20'years to tnore than pay fctr„at unchanged taxation and pension deduction rates. the increased funds that wili be needed in the 20- to 30-year future of a, greatly increased retired' poputation. This type of sequence due to successful national smoking cessation is especially important if'we remember that'our population is. in any case, growing very slowly and aging. The demographic effects and! relYted considerations. apart from the financial burdens of maintaining a larger fraction of the ! population in a, nonproductive tttatus. wffl tYquire tttitjor alterations in institutional structures, including our view of compulsory retirement ages which are atresdy beittg,increased. For example. by 2020 wrwile need to keep more older petsotts, especially the highly skilled and experienced technicians and managers, at work in order to keep our economy operating; A simpler shorthand response to those who argue that prolonging lives by re- ducin` the impacts of respiratory cancers and cardiovascular diseases will add to the long-term problems of our society and its economy is that °we should be so fortuttate as to have to face such added Iproblems.- Any, model that says that our society cannot afford to reduce the incidence and prevalence of chronic diseases by pritnary, prevention must bebasically, flawed lasan instrument ~of analy,sis of~ the issues. Acttally, our society cannot afford to allow the "baby boom"' generation (bom 1945-1957) to manifest the chronic disease rates now prevalfnt in the over 65' population (91). CONCLUSION The data reviewed in this article offer an estimate of the annual costs of smoking to tbn average employer. These costs ranged' ffom $936' to 5601 in January 1980 dollars per averaje smoking etapioyee. The sbort-nm costs, i.e., those that appear to be subject to the possibility of change within a 3-year interval, reflect the tsonmedical care, tson -.1ife insurance. and' non-occupational health risk eost cen. ters. These alx the fire and accident costs, the absenteeism, the productivity, and the sbort-run involuntary smoker effects. The short-run costs are estimated to range from SI1169'to S3NI6 per smoker per year. The long-ruacostsn which may take as long as 10 to 15 years to favotnbly impact.,range from Sab7 to S355'per smoker per year4 The data suggests tharall these estimates are understatements of the size of the smoking problem, the lower level of'the range being a deliberate. in some cases arbitrary reduction of already underestimated costs by 5M. Even so. it appears clear that it would be profitable for the typical employer to invest at least $150 per year in a.progtam to encourage employees to quit smoking-at least in the workplace:
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M-48 C c C
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374 MARV'tN Nt. KRiSTEIN proportion of voluntary quitters come from the ranks of those who quitbecause of illness--cfironic and acute-'ntus, the aet benefit in both amount and length off time to observed outcomes of quitting by bealthy, satokersis underestimated in the available data. It is:also true that a number of smokers quit voluntarily every year. Ir these are iacludedia the success rates of smoking programs, the true effectiveness of these programs is being overestimated. A spontaneous quit rate of ' about S-1('% ' is suggested in the literature (77). The Stanford Heart Disease Frevention FRogram reported a 3% quit rate in the control community. However, these quitters over- whelminaly report nonparticipation in organized smoking cessation, especially group, programs. One may further argue thac if companies were to enforce no- smoking rules at thr work site, the number of quitters would consist of the 5-1(1<1 . spontaneous tate plus the 25-S0% Qoup•therapy tAte (41, 69): SUB'STITUTING Ot;aECOST FOR ANOTHER It has been arztted I that a sueaessfull aational satokinQ, cessation effort would significantly increase the number of retired petsons, and thereby intensify the problems of'tbe Social! Security and other retirement systems. These analyses show that in the long tatn, national savings in annual I medi '~caRcare spending on chronic 1ad!at:ute;diseases and in indirect costs wouldlbe more thanioffset, by the rise ia ~the eost of retirement benefits. This view is based on simplified and sutic projection analyses of complex and dynamic issues. L.et us first look closely at the nature of the Gori-Richter argument and its limitations, Second, let us clarify the lack of its application to the discussion of potential business pins from smoking cessation in thia article.. The Gori- Richter article (26) is based on simply askingthe Wharton eeonomet - ric modd~what would happen to the IDiS. ecoaomy if.Ll.S. awrtality, rates for five major eauses of death (major cudiovascular aad renal diseases, tnaliptant aeo- plasms. accidents, diseases of the respiratory system; and diabetes mellitus) weree reduced to the level of the next-to-lowest rates in iadustttialized!countries. These causes of dleath ane aiost important for the population over 50 years of age. 7lherefore, it is the equivalent of "kinr what would happen if the average age of ottr population wereto rise even asore rapidly than it is pnesetttly„if we were to havee particularly Lnne increases in the population over S0„60: 70, and 80 years of age. and at the same time, the labor force were tr.ssticted!to those under 65. Quoting from the Gori-Richterstudy; "'I1te model does not haadle the health care system as a separate sector, and as such it does aot'take account of changes in population, composition; nor does it include the cost of prevention sttategies." Tbe aginzheclrhier population could mean alterations in hospital care demand andi supply and provider prices, and competing health problems at later ages. Adain. quoting from Goriiand Richter. Sue6 dewdopieeats ad oH~tiarepuld sed tAe;seononria,d t!e dsene aarc system ... fsereinioa,woultllai,o.her a v.ruety of taetrns of ecoeannicsWweancek in wxs tAauue 1ro1 psity wAlysad and Nlat the,whactoa emedet--m My otier Aode4-could tI incoa M~-23
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( oven emissions in steel mills. One hundred andififty neopte per year are estimated to die of cancer from xposure to this pollutant. While even completely heatthy adults may be advers ely affected by cigarette smoke, those with preexisting health i ~conditions may experience much more severe reactions to secondhand smoke. Conditions such as asthma, bron- chitis; cardiovasculardisease, nhinitis. colds and allergies are often particulerly hard hit by secondhand smoke. Also, millions of people are sensitive to tobacco smoke. While apparently not technically an allergen; tobacco smoke's irritant qualities resemble those that characterize an allergic response. Concentrations of secondhand smoke that would not affect a healthy person appear to present aniincreased risk t© those with pre-existing heaith conditions. Certain effects of tobacco smoke occur in both healthy and impaired people. Researchers experimentally inves- tigated'the effecTof'side streamsmoke (smoke from the buming end of'the cigarette) on cardiovascular health in both smokers and nonsrraokers. They found that, side stream smoke increased heart rate, blood pressure and oxygen consumption. These responses were more prominent in nonsmokers than insrnokers. Further, these researchers noted a decrease inwork capacity in most groups:. It"s not too surprising thaf passive smoking can have Cuch significant effects. Tobacco smoke contains a. eritable witches' brew of hazardous substances, among which are tar, nicotine, carbon mxide, cadmium, nitrogen dioxide, nitrosamines. benzene. fbrmaldehyde, hydrogen sulfide; and hydtogen cyanide. Side stream smoke contains moreof these compounds than are found in mainstream smoke inhaled by the smoker, M-40 QIWANTIFYN1fG TNE RISKS OF SUOKING' 'A person who srnokes one pack of cigarettes or less aiday would be assuming,risks at the ktwer end of the spectnum. Those 5rnok+ ing more than a pack a day wouktassume risks,as the higher end. Most important, the smoker assumes all these risks at the same time. Soarce. The~.MMnOaniCoxlOdion:SL1e1Ge anQ hMNM ~. 5
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2' c. Some facts abart smokirg.... T1w l+lasardsti of 3mokins Are Not a Mattor of Controwny. There is no longer any disagreement among scientists that smoking tobaccio.,panticulartycigarettes, isextremely hazardous. Every U.S. Surgeon General since 1964 hass emphasized the uniquely dangerousqualities of cigar- ettes. In 1982. Surgeon~General iC: Everett FKoop wrote in his report to the Congress; "Cigarette smoking...is the chief'single avoidable causeof'death in our society and i the most important public health issue of our tiarae": Over 350.000 Americans die each year of smoking-related diseases-lung cancer, heart attacks, emphysema and other diseases. Ci9a.att* snak. ~Can Harm Nonsmokers Too. Involuntary smoking;,the exposure of nonsmokers to others' smoke, is now considered a serious health hazard. Indeed, cigarette smoke is now widely recognized as the most serious indoor air pollutant-a leading cause of exposure to toxic chemicals for most workers : Smoking Is an Addiction Although the percentage of'Americans who smoke declines each ~year: there are still almost 50 million who smoke. The reason ~is that smoking is an addiction-90%% of smokers say they want to quit'and can't. The federall gpvernment's National Institute of Drug Abuse, theV'Vor1d Health Organizatiom andithe AmericanPsychiatric!Assu> ciation all classify smoking as a drug dependency, like alcoholism or heroin addiction. In addition to the physical addiction caused bynicotine, thereis an important behavioral component. Many experts feel that the prin- cipal reason smokersfind it so hard to quitis that smoking is socially acceptable. RESTRICTING OPPORTUNITIES TO SMOKE HELPS SIWOKERS'KICK A DEAl7L'Y HABIT M-37 i Most Americans Are Nonsmokers The U.S. government has determined'that over two-thirds of adult Americans are nonsmokers: Probably as.a resulf of this, the sociafclimate that once tolerated and even encouraged smoking is gone. A Gallup poll in April 1983 found that 82% of nonsmokers and 55% of smokers believed that smokers should refrain ~in the presence of nonsmokers. smokingCostts America 6illions It'has been reliamly estimated'that smoking costs the country over $42 billion per year in health care costs and decreased productiviry due toabsenteeism, sickness; disability and premature death~,property damage, and aa host of related effects.l3usiness and industry bearia large part of this economic burden. The CalMoenia Nonsavok.rs' Riyhts Foundation Can Molp CNRF'is a tax;exempt educational organization whose purpose is to protect people from the harmful'effects of second-hand cigarette!snake andto redbce the ecorkomic burden associated with smoking that nonsmokers must bear. The Foundation has prepared this prospectus in order to illwstrate the advantages of regulating,smoking in the workplace, and prowide sornepractical suggestions on how to do it: For further information call ICNRF at (41'S) 841-3032. Workplace smoking control is an issue whose time has come. CNRF'is glad to ~help you address this extremely importanttopic.
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r 372 MARVIN M. KRlSTElW tstle from S17 to $34 per stnoker per, year. Whik h may be argued that some aspects of excess accident behavior releted to smoking may reflect accident-prone behavioral pxtterns of which smoking is a,syJnptom tatberihan cause, the ability to suceessfuUy stop stnokinginvolives a basic change in behavior. Thus, one may assume that those smokers who quit have improved their life-style so as to peatly reduce their accident proneness (if any). Absenteeism costs due to smoking may be analyzed in a somewhat similar fashion to the discussion on accidents. The evidence is ttronU that the excess absenteeism associated with smoking largely reflects a,=reater frequency andi severity of (non-lifrthreuening) respiratory and digestive diseases. These may be related also to other unhealthful life-style habits, such as excess alcohol con+ sumption, A proUram directedlat smoking cessation probabfy should be part of a total effort at health promotion in order for the UaiAs of each aspect of'a healthful life-style to be fully attained. The evidbnce that absenteeism is one of the first evaluation measures of health promotion to register significant gains (generallb•, within a year or two),is too repetitive in diQerenrcontexts to ignore (3.,5. 12. 41, 60, ES). The cost range, of $40 to SUO, reflecting an excess absenteeism of 1U or 2 days a ryeear, is an underestimate in both time and ivaaue in ithe current economy. The productivity estimate is largely based on the time wasted associated with tumokin; rituals. The extra clean-up cmsts, danta=e to the workplace. ventilation costs, errors, etc., 6Rve been estimated lesswell inithe literature. We have arbi- tsn'ly cttt the S!1i66 underestimate in half to provide a lbwer boundary reflecting a waste estimate of one-balf minute per bour per wodcinr dzy. These .'pure ~.' costs of smoking are real andi extensive as reflected widely in desuiptiwe literature. Unforttutatelyy many of'these pure! saakinU costs have not been scientifically studied or evaluated. Smoking cessation would!reduce these costs to zero. lnvolimtary smoker costs are deriwed by calculatinf oft-fifiA of the short-run oosts of smokers. omitting fire losses. There is neasonably extensive literature indicating that involuntary tanokers sttlfer brssthuts, damage equivalent to that suffered by mild smokers, which is estiatated to be one-fitth of that of smokers of' one pack per day. One may question the productivity bss aspect assigned ~ to nonsmokers in the vicinity of 'aewkerx. In their cases the calculation reflects not the rituals of smoking, but the other produetiirity loss aspects plits the added' effects of the physical and psychological irriutioni which serve to reduce the efficiency of involuntary sQtokers.. h is likely to be a ntuter of from 3 to 10 to 15 years before beahh cano costs are sipri6cantly affected as the chronic disease risk kvd of the ex-snoker moves toward'levels of taon:mokers (21, 7E), ln this reUard. one must. recopsize that the dats on the bealth st,atus of.ex,saakers as a group is adversely alfectedby thrfact that many estimates of numbers of ez:.smoltersinclude pcrsons who quit smoking due to the occurrence of serious Mness: Tbese persons display an iincreaaed risk of'disease and death in the short tun associated with the ilinessex which led to their quitting. This short-run period may last from I to 3 years. This increase in short-run risk of illness and death does not apply to healthy smoken who qvit before being forced to do so by senious alness. The actual company capture proportion of'tbese potential savings in, costs would depend~on the emplnyee participation rates in smokin=,cessation programs. M~-21
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368. wMaVI>v w. ctusTetM fritdina to:the calculations ie VVyader and Stephtan (92). usittS the relatiwe lung eancer risk for light smokers as an index of rdatiwe;enerat risk. one may estimate that the: minimum overall! health status and performance dIsmade to involuntary smokers as equal to one-fifkh of that for smokers ofone pack plus per day. Thus, tLe ! invohtntary, smoker, ir seen i as addina an annuat cosr of S53 to S'105 per, in- voluntary smoking employee to insurance and other costs. The short-run notthealt6, noa+life insurance involuntary smoker eosu range from S27 to SSb. (htly the ! sbort-rtut cost fisures are used hereio, i.e., absenteeismy accident, and productivity impacts, as possible costs to the employ,er: Since these cost figures are expressed in terms of "per smoking employee,"'this paper ibtplicittiy assumes one involuntary smoker for each smoker; this is probably an underestimate by at least: a factor, of 2. S. Orcuporionnl, Henlrlr Occupational health risks are real for workers exposed'to various agents under given work conditions (3, 37: 59: 7E. i2): These risks have been. in part, estab- lished for certain workft conditions by eomparing ;relevant: long- and short,term disease ratesior such workers with the diseaseratesfor otherwise sitnilarpersons tat so oecupied in the general population: In addition, some diseases, such as mesothelionta, appear'to be related to exposure to asbestoi and independent of smoking habits. Also, ehloromethyl ether, eexposure and hutS, cancer incidence (small cell. early ate) appears to be indepeadent of snfokutS: but earliness of cough appears to be smokins-nctatcd even in this exposure. However, thesrsituatioas should not lead to amispl.ced emphasis. For a very large number of! importattt occwpatdoaal health risk exposures, smoking is a very, important factor. Thus (a) smoking may be a vectorfor workplace toxic agents: (b)' a number of chemical a:eMS are made morwbarmful by smoking (e:S:. polymer- Ponse ftver)t (c):cetnain toxic agents in smoke combine with workplace agents so as to increase exposure (e.=.. cyanide, carbon monoxide, acetone; arsenic, lead, aldehydess ketones.,teethyJene chkrride, etc.);(d) wwkitt=,may add significantly to the eltects of occupational exposures such las in tbe case of 'coal dust. cotton dust, beta radiation, eblorine. etc. (E, 32. 14, , S6); (e) smoking may act synergisti+ eally tb, muttiply the inthtence of occupational exposure as in asbestos, rubber. and gold aud tuanium miain- (7E). The lttter provides a=ood example of the nelstiwe importance of'sntolritts in the case of occupational exposure. t7ranium miniag, involves a bedth risk for lung (and other) cancers. That is, aonsmokin= uranium miners 6ave a 7 per 10.000 risk. aneually, of contractin=Jung cancer as compared with a I per 10,000 risk for the nonsmoking-non~uranium atinins populduion, However. smokieg uranium miners have a 42 per U0.000 tisk for, htnS cancer or 6 rimes that for eonsmokie>s miiuers and! over 40 times that for ttonsmokin`-ttonminers (78): The Hammond et ol. study of'dottality ratios from lung cancer for workers exposed to asbestos dust offers another sut7cft example. If the: nwrtality, ratio for aonsmoking.-non+asbestos-exposed persons is set, equal to 1, then the ratio for aottsttwkin=-asbestos-exposed workers is found to be S: For stnoking-non- asbestos-ettposed persons the ratio is 11; for smokin;-asbestos-exposed workers M-17
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fRCFITA'11LITY OF EMPLOYEE' SMOKLNCr CESSATION 363 difference by a(fenerally low) relevant current price has been used. Forexample, fire losses per smoking worker aro estimated by, taking dau.,on nonresidential'fire losses from the "Insurance Infortnation,Institute Fact Book." Atrestimate of the percentage of fi'res due to smoking is applied to this figure„wbich is then divided by an estimate of the number of smoking employees to oboain the estimated cost of $5 per smoking employee. Estimates ofiothertypes of insurance costs (for elcam- ple. We inswarce) ane based on the higher age-adjusted morwlity, rates for smok- ers vs nonsmokers that have been observedi The diffelxnaes between iluurance pre- tniums cbarped. retleciin= suc11 elonalily rue difrerences.,are compared. Productivity-loss estimates rdlect a consideration of a range of estimates from titee ~ and motion testimony to i the U.S. Congress involving a service industry (banking) (bi) to employer comments in the construction industry (R0): the lowest level of estimates is emphasized. While such estimates are not scientifeally ek- gant, we know thatthe smoking rituals take tialeand that them are added cleaning and ventilittion costs. In addition, there are more carefully developed studies of the effects of smoking on the mental and phy,sical capacity of smokers. Again, our estiluates try to reflect the minimal level of such costs. TWE' COST BY COST'CEN1fER! The usual procedure in cost accounting is to classify costs in terms of the adnunismative units. type of activity areas, or dtpanments which pve rise to the costs being studied. These are called cost centers. Since this article seeks to be as fenetalited as possible, the approach followed is classification by type of activity. Tbus, the costs associated with the areas of'insurance costs (major relevant ty,pes). absenteeisnt. productiivity. imvolrintary, tsmoking (effect on ttonsmoking others), and occtlpational i health are studied. The implications of ' the data for company policy are ezplorrd, In addition, examples of cost effectiveness of com- pany programs are discussed. Also, a company experience with work site; no- smoking policies is,neviewed (Illppendix 1) and a caveat oldered (Appendix 2). The evidence suggests that an aggressive antiamoking; policy is a viable company policy thu may be bighlyeost effective. 1. TJu InsuraRce Costa of SnrokragA, company's insurance expenses depend on the coverage it offers its employees. The vast majority of companies offer, health-care insnnance, largely paid for by the company, for employees and their families. Most companies also have fire, worker's compensation, and accident coverage for tbeir employees. There is well-known, reviewed litetature dealing with the excess Mealth•care in- surance costs associated!with smokers. The doUar cost figures used!here are based on the research of Luce and Schweitzer 1978 ' (32). which is, in tum, based on a 1976 study by Boden (11). These calculations rest on the judgments of'medical experts as to the percentages of certain major diseases which are associated with and related to smoking (6, 44, 45): neoplasms and circulatory (cardiovasculxr) system and respiratory systeln, diseases. The percentages emplbyediare, respec- tively: 20, 25„and 40% and some recent Iussearcb indicates that they may, be under- M-12' I
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. witvE.Mmvc MEwaNt' 12, 33a-3t1 (1903) . Hbwv Much Cani Business Expect to Profit from Smoking , Cessation?°,2 I`[AeVIN M. ICtusrtaW' Dt,parwtrnojFeaan.kar. StYNY. SlowrlrvoA: New Yo.k 1/79/.aadAiwnir.e 11r&hR ForeQhNOn. 3I0 Eese I3.d Srrnre. Nrw Ywk: New Yo.4 Wl7 Tbe dMa teviewed in ffiis: efsiele. ebr.w irom vsakwvrn. poWisbed sources. offer an evAmue of tl,e amaul eoatc d sawkieg to t>te averate eepioyer: TGese aosts tanae hom f371bwi601 ia Jaauaey 19W dollars perasrade smoking empoyse. 7De aaalysis is largef> bned oa y,pepue eodemiolopaal'dat. sed.,iu paenl.,tAe eapAsis is on tAe undcr- estimsting d'tlie eoaa to busineu. lt reports •'avnrqei "tsue tor lerfc populations aed. tierefiorR. it ao1 ladfviduWy aredietive: 7U ooA iaasers deab .dt6 ane isswanec. aedual. and iatlers sYCh a aitseaeeism. podued.ity. iavol,anary uaokug; and oceup.taaat healtl, tfsk: leeluded a a Aifewsioa of aa~ioyes~spo.eoeed s.wlciagxwrioa proQams and iee t~eeeifts tfersLraes. INTRODUCTION The Sul=eon General of the UtlitedlStates has stttitad: ••cipretu smoking is the single most important preventable envi7onmeata!!tactoe eontrlbuting to illness, disability. and deatb iin tbe United Staues" (78). In tbe mtlltiw.riate analysir of tbe . taslefor coronary heart disease, bstaed,on Framisl=hm detai cigarettes smoked is a dosrsecondto the number one risk factor (after ap). eboksterol level.,for men.' T6e c.mtnection between smoking and txsp'tratory, cancers--the only aujor t.m of wlcen trepstering an increasing mortality rate in secent years-is well estabhshed (1r*, 7s. 88,92). How much is this well+known heahA problem costin=business and ean some d these costs be reduced in a cost-effective mtulaer? A 1479 survey of 3.Q00 companies by the National Interagency Counc~ll on Smoking and Health repurted tbat less than 1% bad calallsted their costs due to stmokin4. 1 15% had heahh promotiac proRams involving smoking, and one-third wrisbad to develop or expand prograals for employees. Two-thirds of the com- panies had smoking >xstricdons in special '•bWe eollar•.•'areas; threr-qtlarters or awre had oo restrictions on smoking in general ($911 Tnirartick reviews the costs of:mokin=f prialanly dased on data from wdl•ieaown. published sources. in order to aid poGcy, tmakers in develbqft a rational eost-eltectiire policy in thirarea. The analysis is largely based'oaaggreg.te epidantioiopcal data; ireeports "avetaaes." tnue for large populetions; it is tlot individuatly predictive. The numbers are ••b.llpark•• fisllres. not seat, and aisle numbers. The cost centers dealt' with are • To wb- e.peint nasan eeadd be .ddna~: A.eiium li.dti Fowadrioa. 32ID Esn 43rd lteeetl Wm Yoet: NY 10017. aiuqporseA irp.ni by NQiS>< Graat 1J«4JJH9031/13-01 vd'USDHEM GeoaC2RI-7io16isAD toalse Aaeeiea. H..h! Fou.datioa, New Yort. NY. e Msad oo a Wk preq.rud!for tJse Naioetl Wee.p.ey t:eriei w Ssoolii.g swd Hs.hA. January IUiI. idmYmii: sTmFneinb.m lieev diKt'simee tbendoroa.d6eieob tfK..dnd ~ta) Ror,area of ail lyes are: tera.o. oss; forel,o+aweot, a4.: for aipesae ie.oiki.& 0.12, l.rsynoirt,iood pessws,. 0.39 i(7s): a09T-7/3"3 $3,00 C.P1.r1 ~0 ~110 ib AMMS w..: J.c. AJ IFJOU 1 w..YC.~ i. Inr. w.. if=..d. . M-7 >sa
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TROF11rAa1LiTY OF EM[r11OtlSEE SMOKING CESS;ACTtON 359 insurance (medical and other);, absenteeisat, productiwity, involuntary smok= ing, and occupational health ri'sk. We lack meaningful ••case-eontrolled'" eompany comparisons, of experience with smoking employees vs, tvotrsmoking employees vs ex-smokers and the uapact on company costs: Therefore„we must work, from asgregate nationall epidemioloaical' data on illness and other costs associated witfi ismoking and attempt to apportion a realistic share to smoking employees. in general, the emphasis is on andrreszintciing, the costs to business: A sttmmary, of the, various costs of smoking ealculations, performed I in this, tnanner, indicates that the average one-pack-plus-per-day smoker mayy over his or her lifetime, cost his or her employer between S336 and SG01 per year, in January 1980 ddollars, in extra expenses as compared with an otherwise eqpivalent, nonsmoking employee. Adding about 40% would bring the medical-care cost fig- ures up tio ~ January 1983 dollan; adding about 25% wt71 i adjust the other dollar, figures tdmilarly. Preseat;studies suggest that mone than half of these costs anay, at kast' in pan. be recaptured in ~ the medium to short run i by smokinQ uessation, prognams at the workplace. One particularly striking resuh of the analysis which follows is that the annual nonhealth taedicai-care costs may be greater than the bealtlrcare costs. We also deal with the issue of substituting one type of cost for atatherw,t.e.,,the possibility that ~inereasittg pension fund costs may ovetwhelm the gains in terms i of savings on medical care qeendins and higher Qoss national product (GNP) due to lower morbidity and tnottality: Trble 1 suaunarixes the ettrnent totai bealth-ea:eeosts and indirect costs in lost GNP (due to morbidity and premature mortality) of smoking to the society as : a whole. METHODS To attempt a scientifically based answer to the question of how much i employee smokittg is aetually costing the typical Amerkan ~ business and by bow much this cost can be raditced would require studies and data we do 'noc now-and most. likeiy will never--piossess. Thus, it wottld' be necessary to have data rellecting at least a 2(~year follow-up of.at least one case-controUed study eompataetg,a com- pany with several thousand employees that had pursued a smoking cessation effort (perhaps as part of a broader health-protnotion program) with a similar company that has not pursued such a program. One would eoatpare.measures of spendinr on health insurance and other insurance coverates (includittg life, 5ne . and accident)i absenteeism, productivity. occupational heatth. etc., and the costs of the program. Tbereby,, one could estimate over time the sum saved (or not saved) by the company that had reduced the amount of'employee smoking: A 20-year fonow-up would be essential for a full'expression of the range of diseases related to smoking, given the dose-response liierature. as is the requiremenr for several!ttiousand employees for reasonable "effect size" given the incidence rates ofthe diseases involaed and the differentials in rates likely to be found. I+iothing in tlirliterature even approaches such data. There have been aggregatiive and special epidemiological studies and estimates of overall extrr illness rates of smokers vs nonsmokers and ivs ex-smokers, however. ln ~addidon, there is extensiwe literature on the relationship, between chronic diseases and smoking based on population and laboratory epidemiology. Alsu, there are studies,,generaily with serious re- M~-8
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rROf'1TA11LITY'OF ENItLOYEE'fli/OKING~CESSIKTION 369' the ratio is 53 (29). ln terms of risk for'lung cancer„it is more tban twice as risky to tmoke ~ as it is to be a worker exposed to asbestos' dust. lt would be useful if the . public sense of relative risk reflected this fact. Another example concerns the rate of chronic bronchitis among South Afniaan gold miners (70). Smoking =old miners have a' chronic bronchitis rate of S0l ' as oompared with 8% for nonsmoking=old miners and'28% for smoking nonminers in the'general population. Aionsmoking.-non-gold mining persons had rates of chronic bronchitis si=nificantly less than 6%. These data ruse several:important policy issues and questions for'oceupational health policy. First, it may, be possible that a relatively' small expenditure on smoking cessation efforts at the work site, including work site prohibitions along withgliding assistance for quittin=eould greatly reduce the total burden of occupa, tional bealUt.tisk. This is'tnle evenafter the fi.ct of exposure. A 1 o-year folimwv-up of over 2.000 asbestos workera wtio : had quit smoking found a sip 'uficantly lower rate of lun` cancer mortality as compared with those who had continued to smoke (67). As recent cas+es in regard to black' and brown lung ' diseases havs demon- strated, employer financial resprmsibdity for employee it~ury and illness due to well-known oceupationat~risk exposures may grow to a very'iarge sum. Whether or not' legally acknowledged and!included or separated for compensation pur- poses, the smoking component looms preat for many industries and occupational risks. Company tesponsibl7ity to its stockholders alone may require a prudent maAa~ement to vigorously pursue smoking cessation at the work site. Also, fnom the 8naneial I viewpoint of ' certain companies, the potential gains from smoking cessation efforts for the purposes of occupational beahh may be more significant than ~the potential pun from smoking eessation effornsfor health promotion purposes. In particular. these would be especially' companies with oacupationsl risks associated with and1 exactrbated by stnoking. The quantitatiive: emphasis of tbis paper is on!tJte 5nancial rewards associated with reduced ihealth- eare spending and improved emplayee productivity. The potential gains from the occtlpational tiealtli aspect are more : ditlicuh to estimate. However, even apart iirom issues of meeting Occupational Safety and iHealth , Administration require- ments,,ttiey are blely to be magnitudes greater than the medical-eare cost figures for many companies. For atample, on lune :5,1981, The Wall Street Jnvrnal noted tllat a bond rating service, bad' lbwered the ranking of the Johns-Manville debt issues because of its potential outstanding uncertain obligations in regard to as- bestos exposure. In August 1982, J+uhns-Manville 51ed for Chapter 111 bankruptcy to protect the eompany from the efiects :of thousands of potentia) awards, possibly amounting to hundreds of millions of' dbllars: On i Oetober 7, 1981, The New York Times reported that the Supreme Court of North Carolina had apportioned smoking risk and occupational risk in the case off a Burlington Mi11s employee totally disabled by chronic'obstructive lung disease. (COLD). ln any case, the company was ordered to pay S3,000'per year for 6 years to the early disaM'lity+retiredlS4-year-old. 73is'award may have been entinely pre- vented'. if'smnking had been forbidden, at the work site and employees aided to quit (32). 'Ilherefore, even, under a, very restricted occupational bealth liability court decision. a company may be running an annual work site early disability award risk of at least S72;per yeu per smoker (see Table 2, Ref. footnote h);-' "" M;-18
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A' SMOKEFREE WORKPLACE A Message To Employers Irom the Calilonsla Monsnwkers' R19M* Fourndalion: As evidence of the hazards of breathing others' cigarette smoke builds, public tolerance for ,moke-fiiled air decreases. A poll conducted Iby the Roper Organization for the Tobacco Institute in 1978 found that "a majmrityof "anbelieve that it is probably hazardous to beanwnd people who smoke even ifthey are not smoking themselves' : Puqlic attitudes -employee attitudes-in the 1980's are more favorable to non-smoking policies in the workplace then ever before. CNRF has prepared this prospectus tohelp you establish a cleaner healthier environment at work. Detailed inside are the facts you need to make a nonsmoking policy work in your organization. Page 3 The law now protects nonsmokers in numerous situations. Cities and counties across the country are passing workplace nonsmoking ordinances while legal'action of all kinds on behaff'of nonsmokers are finding favor with courts and,administratnre bodies. Page 4 Labor relations may tie improved when employers communicate the message that aa nonsmoking policy is progressive and forward looking-a new employee benefit. Page 4 Health ihazards assoaaied Mrith secondhand smoke ane now knownto be ex3remely serious: Staff of the United States Environmental Protection Agency say that up to one-third of aI11Wng cancer cases in nonsmokers are a result of'involuntary smoking. page 6 Smoking costs business money. Increased costs due to smoking are reflected in higher C 3afth care costs, greater absenteeism and property damage: Since the incidence of'smoking decreases when a non srmoking policy is instituted, the net resultis a saving to business. Pape 7 Nbnsrnokingpoliciescanbetaibn3dtoyournee&a.Threeexamplesarepresentedlhere.You may ahoose one or you may devise your own, and CNRF is willing to help. Page 10 Nonsmokers and smokers may have problems shanng the same workspace. Technical I solutions such as smokeless ashtrays are largely ineffective. Airfittration systems are veryloostly. The, simplest'and most effective measure is to either eliminate or carefully regulate smoking, Page 1y' Developing and implementing a plan of action is nothard. Inside are some practical tips on how to forge your own nonsmoking policy and communicate it effectively to your employees. M~-36
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C 37Q MARVIN M. RR15T'RlN Second, aisens'ble interpretation of OSH;k regulations coapled'witfi,a concern for eost! effectiwernss may Snd that the marginal net present valhe of, aggressiive work site smoking cessation eifons is much greater than that for certain i heroic efforts ati alterins, production sites and technologies. For, example, Selikoff and Lee have said "It would seem that control of cigarette smoking; would, have! a much greater impact oa the incidence of bronchogenic cancer in asbestos workers than fi'rnther reduction of dust levels" (68).'11his suggests that ir may be both in the public interest and in the employer's financial interest to assist employees to stop smoking. Given the above dtta ias to the multiple risk attached to certain, occupational risks plus smokinj, a company which has not made a substantial effort at work sitee smoking cessation might be held notito havc acted responsibly in attempting, to reduce occupationat risk. Eveo elforts to encourage a shift by smokers to lower tar and nicotine cigarettes may be belpfnl (2S: 28, 33. 46, 76. 93). As a eomplicating,factor, however, there has baeai some feeling on the part of certain employees' tepneseucatives that an emphasis on smoking cessation, is a form of "blai the victim"' and!would reduce the incentives for companies to. exeR tull and' appropriate efforts to reduce dan=erous work site exposures: An example of tliis position is tliat of A. Ir/azzocchi, of ti C2iemical: and Atomic Workers Internatioaal Uaion., who views ipdustrial! antismoking campaigns as a diversionary uctic in the area of'reducitg occupational health risks (b1i): He ariues that the workplace should!be adapted to its worker rathertlsan vice versa. If this leads unions and employees' representatives to oppose company efforts to promote smoking i cessation, it is an unfortunate and self-destructive view. ln addition to the issues of cost effectiveness for society and the company; the very health, liives, and well being,of millions of employees are involived, as are theirr own financial i>yterests as citizens and taxpayers (42. 43)1 AU of these interests, given the high multiple risks associated with satoking and certain occupational exposwes. should, rationdly. find eyaployees' Qeatly in favor of efforts to reduce and eliminate smoking ia the : workplace and in society as a wbole. For example; even for lung cancer victims., ex-snakerc have substantially iower dtaths rates than dioicontinuinj smokers (35). The joiniirtterests of'employees and'emplbyers should promote tbeir most effective cooperation in this area: l.eaders of the inter- national Association of'Heat and Frost Insulators and'Asbestos Workers Dave: joined with the Aaserican fancer, Society ilo,a program to belp their members to quit smoking. Table 2'wmmarizes the annual costs of'tmokinr per smoker to~a company by cost center. The sources and techniques employed ane indicated in footnotes for Table 2. The author believes that the high range is an underestimate of true costs and' that the low range of figures is a gross rndere,stinuotr, reflecting the experi., ence of a sample HMO population and based on systematic underestimation due to the limitationa of that studiy. CAPTURING TiWE' BENEFITS OF SMOKING CESSATIOM How much of the cost of smoking can business expect to save and "capture" through smoking cessation and over what period of'tiau^ In order, to answer this question in terms of the cost ranges per "average?" sauokercalculated above: it is N O N t~I 05 CJ ~ M.-i9 ~
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PIIOFITAa1LITY OF EMPLOYEE sMOK7NGXESSATION 371 necessary to first divide these costs into bng-run,and shorter-run cate;ories and look at the evidence reprditlg; tbe Lnpacts of smoking cessation on each cost center. The long-tun impaet eategqries are beahh insurance, life insuranee, and' their portion in the involuntary smoker, costs and occupadonal! health awards. Most, research on these topics indicates that full payotfd in these categories may, involve a lead time of sis much as l10 to 1 S' yws'." Theshort-run payoff cateSories, with, lead times of 11 to 3 years, invotive: abseAteeism, productivity, fire losses, worker's eompensatlolt, and other accident-based losses, and about half of the involuntary-smoker costs. Second, one musurefer to the literature relating smok- inS' cessation and health-promotion activities to improvements in the outcome measures, including health and nonheahh variables; this is, unfiortunately, weakerr tlian, one would prefer. Thvd., employ,er panticipation rates must be estimated. Fourth, the impact of labor'turnover rates has to be ealculated!in order to estimate the proportion of benefits accruing ; to the present employer as compared with society in general or to future employers of the quittinS, smokers. SummariziaQ, based i on Ameriaan! Health Foundation and l other work site (60) experience with screening and interventions to reduce risk factors for chronic diseases, including smoking cessation. one may expect fxiray substantial short-run benefits (3. 3„ 12.,41, aS)., 716ese would be derived: from savings in i the areas of prodwtivity, absenteeism. Are risk..rorker's eompensatioxt. and other accident lossies. The cost figures given above suggest that these potential shorr«nun benr- 5ts may range f>1om 331ti9 to S346 per'year per ex-smoker(S32-d4 in fire, worker's eompeasation. and accidents; $d0+-i0 in absenteeism: and $30- 166 in productiv- ity plus S'27-3b from the involuntary smoker effect)+ Such savings should be visible by the eld of the third year of a prrogram to reduce risk factors. The short-run sawin,Ss may be atv the expense of'iasurersf salvaQers, and suppliers of ttpairs„but db not involve the potential long+run offsets that may follbw long-run declines in chronic disease mortality and morbidity. (Please see OtfsettingCom# plicatibns in the DataL below.) Let us review these data carefully, so that the bases of the calculations are; clear. Sbort-run smoking cessation benefits are related, largely to aoncbronic disease (non-cYncer and non-cardiovascular diseases) and nonbeahh-cost aspects of smokia;. They include the short-ttm health aspects, i.r., respiratory diseases, eoush. effects of carbon monoxide, eye irestation, etc., plus the time devoted'd to smoking ;rituals. ekan-up. and dirty aircost effects. Tbere.is extensive evidence that all these extra costs of smoking are vittuatly elia»nated within a 3-year period' when i a smoker stops. For ettample, extra ttre lossrs due to smoking at the work site hav bee calculated above at r range of'SS- ND per smoker, per year. When :a smoker stops smoking his or eer risk of causiaQ a Sne by smoking is zero. Simi- lirly. worker's eompeosation and! other accident costs have been estimated to "'7bc ts••yw fturo is selaud tomaunss of the fenwl prob.bi6ty o[ all auses nonality for SS: ye.rmW'maks: Bfe ,r"of moeulity for ea-eaokerr dedinss.(tcr about! t0 ysans of auatina io ckse,to the level of the mvet+eeroked ijroup; a mry eves be supenor to the .ever-ssoked poup after 1 S yRam of9uittinS (7tt). 73rt(:k fbr incidenee (aa aaus:vay fual) of conoe.ry Mr+imsease af an ea-semleer n"ve to eoetiauin{ samken drops wyid)y after I to t years ot quittieS. Doll ar+d !ao's IShdinSs iadivte 1hu 3 ysars d aoesmoki~ is reqy~ired ito aip~GcanUy e.duas the Mehl rifks ef seMDkiex (2111. M!-2'0
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lROF11LAKtLtTY'OF EMPLOYEE SMOKING CESSATilOI+ 367 C 3. Prodattisitr In addition to the impact on insurance costs and absenteeirm, there are direct productivity losses due to :ucll' factors as time lost to smoking tituals, extra dean-up costs, extra' damage to equipment, furniture, and fixtures0 extra, inefT- eiency and errors, discussed in the literature as dite to the effects of higher carbon monoxide levels in anokers, eye' irritation, and measured lower attentiveness, lower cognitive and lower exercise eapacity functioning. These costs have been estimated in 19b'9 Congressional testimony andlhave also been updated over time (9, 63, 86). A reasonable anderestimotr of such productiivity losses per year per average smoker for the'average business mould be S16G (in lanuary 198ID'dollrars).tq This is based!on a minimal estimate of a loss of 1 min per'workinQ hour, or 8 ntin per day, for' a 250-ds<y working year, at $40 per day. AB,ain,, to allow for' the possibility that exsmokers may not attain the performance levels of nonsmokers we offer a lower range productivity estimate of'S80 per year per saloker.. 41 Iwvotyntan Smoking Thretieets of smokin=on nearby nonsmokers have been studied. Forexample, the children of smokers have higher rates of respiratory diseases, adjusted for' relevant complicating factors (Z'7. 73. 78)1 The ttonsmokin='wives of smokers have been found to have higher rates of'respiratory cancer than would be expected amon8,nonstuokers (3'L. 74, 7'lL There has been much controversy on the topic ofindtsced eancer in involuntary smokens (2!3. 49; 38)." Therefore, our cost esti- mates emphasize impact on acute illaess and!work capacityrather than on cancer. In addition to the considerable physical and psychological irritation thati nonsmokers sufrer at the hands of smokers, nonsmokers' work performance abil* ity is neduced by the effeets of nearby smoking. White and Froeb ('30. 8'3')~ re:pon that the'damage to breathing capacity as a result of iz+voluntary smoking is equal to that of 1i81tt stnokiAg(i.e., one to ten cigarettes per day)': It is reported that there is a doublittg of tltie rate offunctionally'impairingastbmafor children ages <1-17 with smoking mothers,, statistically significant at the 0.01 level, as eompared' with nonsmoking ewthers' children (27). Also, disability days were 30% higher. even when controlling for the asthma and'brprnlutis: IiFone applies the White and Froeb s t~uce D:1+Ikifoe. Sestian Emoret of the EeerSx !lmnieS and Dtretb4mess OQke ditAe Sute of Itiltttsson has sstiwsted tiw'ehe eatta viesnilatioe twaqtunaeats. bned eaa s~esdatiom d tiu Articaa Society d'HeatutE. TislYiaeratinS. sad AkCon0tionias Eap'eeen (ASH1tAE')1 dw to aaokin{ at itle .roekptacs'~ ouW add ;aboul f;W pa yeat per a.qker to ttie etsee=) eosts af operatin5 :a plant (q: -'Wuh the praem reoommtsdatiosa (of ASHRAEJ. waken'wauW laccanet for 17F', of the Motand fbr'vantilt+tioar e.ef taott{h ttKy'conduste'less ttwt aae-third of the adult populttion i' l13). Ttis 1fSn+r .Moutd be added to the yeoductivity estisute' Si ren in the teat. since tirc latter is simp4 based ao '•time waaed'- and related aspects of sookis>s rituall. "Eetpioyen .rp6 eoasmokiaS!arias at the .+otk sile tsponted ttnt tAey'prarided tw or awre dri). amoki+tt,btxaks, a.etaong ,/3 mio. for.wrkkers is ttuse areas (9), " TAe Japanese study of tAa hrer cancer e:perience of aonaawkiaS ais~es otirawkets is supporaed by a Gseek audy ~(3t.14): The luter'finds a hiaAer tsbytive risk lot lua5 caacer'amosr<ttte twoesmokm5'. .ires atsa+okers in Cnsece. dose-sesponse related to the amouat'of smokby by the busband i similu to the AedinSs for Japan. Passive smoking Gnftk womea bad only a slightly io.rer tisk than activelb saroking l3neek women. A U.S. stttdy'failsd!tohnd this seiatioad6ip (Z3): T!e statistiaJ ralidity of the Jap.nese uudy has also txen queuioned (49). A r.oent umeetins at the NatioaN CNCer l.satutt'on ttiis topi+e ended meonedtsivdy (3i). M-1b
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The California Poll Page three 41237, Sy, a 58% to 391'margin, current smokers agree that smokers should re- frain from smoking in the presence of non-smokers. Former and nonrsmokers say this by even larger margins. Smokers should refrain from smoking in the Current Former lfon- presence,of non-smokers Statewide Smoker Smoker Smoker. t 1 1 t Agree 7< 58 75 79. Disagree 2t 3!9 24 19 No opinion 2 3' 1 2 The sample in, this current California Poll survey was asked' how smoking should be handled in a number of specific public places. Large majorities favor the designation of speciali smoking areas for restaurants, work places, airplanes, and hotels and motels. In the,case of restaurants and work places, few (16t) ' want smoking entirely prohibited. However, for airplanes, a sizeable minority (386) would like all' smoking banned. Ia+ even larger proportion (K6'1) favors a prohibition of smoking on buses and trains. Smoking in specific public places Designate special smoking areas Smoking, should be prohibited' No restriction No on smoking, opinio n Restaurants 77V 16 7 • Work places 70% 16 12 2 Airplanes 59%, 3!8 . 3 ' Hotels andi moteiis 58% ' 7' 33 2 Buses and trains 50% /16' 3 1 • Lera Lhan i orr-tiaif'of one peraant. The percentages shown in the above two tables parailel' findings of a nationali (Gallup) survey taken for the American Lung Association last year. -30- N-4
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K= Em 0 t 0 A ReportCurcl On the 11'a#ioii's Health A Project of the Prevention Research Center N-11 w ...-.~:. . _ . ~?. . ._ . Ld?":175 2Q25l[78"#378
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PHILIP M7RftIS, INC.* New York, NY Qrganiiatianal Profile PtialipiMorris USA (New Yoric,, N:Y.). Sales in i19B2: $4.3 bill ion , No. of ertployees:1•9,900 No. of cigarettes sold in U5 ini 1962:204.4 billion Share of US maricet:32.s% Nb. of adul't oonsurierrs:1B millian Philip Mbrris International' (Ne+v York N.Y.) 1b0'brands of cigarettes in 170 cantries. Miller Brewing CQrpany Miller Highi Life, Miller Life, Lawenbr-aw The Sevet-1up Carpny 7-Up, Diet 7-tlp, Philip Marris Industri'a1 Packaging Mission Viejo Hrne bwildring 0 oa @ther The Philip tbrris Science Syrtposiun (featwring Nbbel' pri ze wni nners immedici me) Career Schmlarship pmgra. s Viocatianai/TiecFhicai Career Szholarship Prograis for high sctrooi dropmts Grants for Lobacco research (Nort?i Carolina State) University of Tennessee, University of KentUcky Marl bomCountry Store (mai ] order i tens wi ith . Nlarlbom logo) Virginia Slims Ginny ,Agger Suit (mafit order) Virginia S'lins Bomk of Days (calendar and appoinbrent book) Free sartple distributions on rtejor city, streets, shappirg centers Philip Mmrris MarketingJCarmunicatibns Cametition "Agricuatwre in the 21st Century" (symposiun)' Spansorships andi Pnamtions COWU Virginia SlimSTennisCircui't, televised OGher tennis prututiams worlid,nide (eg, FNarl boro Aiu5tral ti an Open ) Marlborv: British Grand Prix Auto Race, other races worleWide Marlboro Cup horserace, Belmont Park, NY, tielevised'. Billboards at key caera angles of rtost major league baseball an& fcotball' stadiums. Major advertiser in official tiati onai Faotbal l t.eague publ i cati ans, Major league Baseball and othw sports msgazines. U.S. Olynpic Training Center Mi 11er Hi I Life Citi zen Pt a)er of the llbrrtti and Gare ( fuotbal'1 and i baseball )i Cultural Joffn2y.Ba]1et'Towr IJfaic fram Marlboro, 28-City chatber ntusic tour Marlborm Gouatry M'isic Tcur 'Salute to Marlboro"(etaartber musiic) ItO' radi o, NaN Ymric Art Extiibition, 1982-84!:Ctmpions of p4eri can Sportt (Aeerican Misewn of Natural History, others): 8uffalio Bill and the Wi1d West (Brodclym Mamrn, otfiers)',Grand Central Termrinal (New, York Historical Society); Karxfinsky ('Solamn R. Guggenheim Mrseun, others);Ws CArro11.and Ali¢e (Pierpon' Morgan Library), Oom Pah Pah: The Great lheri cxn i Band (NewYoric Hi stori cal Society); Ederd Hopper (Whit,ney hisem of AhErican Art,,others); The Vatican Col'lections: The PaQacy and Art (Metrvpml'i tan Maeum of Art,©thers ) . Publiic Relations Firm: Ruder & Finn (IFIew York,, NY) ''Sales in 1582` E11.7 billion No. of eiployees: 72,000 Advertising spending in 1982. 5$501.7 million (5th largest advertiser„ 3rd newspapers, Ist nagazines,. 2nd in bi'1'liboards). L-2
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IPRDFITA111.11R' OF'EMTI:OYEE SMOKING CESSATION j$n1 C •D. Weia. W:I.. /f*ro.c prodneti+riry.v.ruigIn.,TAe'C.fkgiuc,Farrww. FaD 1fW: tl. w.a. M.1.. Caa you ~a!locd to bae arokess. PersomfwLAlnawitrcrtw. 1/4y 1111. it. Malil S. Srrrival.wd moetalily coo.tSw.dMsaehenratcnc. ~la. !.' fjidro4ioll l.11(f li'!r0): 83. VVhiu: )i iR.. aad'Frocb. M. F. Saa0lainrari dydYnaeior ~iu aac.akm dtomiaaGy czpoud io 1oD.cco aak'c. NeM• Et#l.' J. Med. J03; 730-7Z] ll91D1. 80. w'dwa. R. W: Ciyeac aqtiK. dia.bitity days a.d Rspiraary ooad'itio.c. !: Orcnp. EI['rd. 15, . M-34 (19,73); 81 Wood. L. "fwcmtat o. Fsd..ud Ce.yay'Savf.St AMOCiacd.ish Ssokiy Cewtioni Ef- tons:" Awa7able trom N.Y. Takpboee Ca.,Idcw York. 66. 1Yyedcr E! 1:. Editori.). New FArl. J. Med. 1!! 6SJ (IM): •7: Myeder: E. L, hlmvNatioa6ip ef amtift ', to other .eriebks, eed preventive .qy.oacde:. in "ltdccarcb oe Shrotins ld.vior" (M.,E. 3wik. 7. W. Calkn. E. R! Griu: T.1,1. Vors- and L. J. Mat. Edt.). pp. f7-!'I. MDA Raswreh Ma.e~ Series No. 17. U.S. DHEW: UiS. Gorl. l•eud.E Od)ae: Warlimoa. D.C.. 1977: M. Wywdet. E. L...ed HoQmaa, D. Tobacco aN Yah6: Ne+rFAt1: J: AIcd. $00. V4+ILl07 (I19"). 119. rVysder. E. L.. aad HoRmw. D. fweki.g sad baML' Fa4omroi'C aed peeventire co..idetauon. Rroi/. SnA+wii. A.t.d.' Urd, 1/7es. !S. 83-f1(19M . 90. Wyedtr. E: il." ad AoQmsa. D. ltietmwd 6MawiF eipeens: ERect a ur. aicodne. ,.nd ! mtEo~ Moeosidc 6Make. JAMAi+/1i 2!b (1l19). 91. Wycdes. E. L..,md Kriacis. M. M. SrOpac vriicd!yweg'hts i. idc. JA/HA 21{,1J0'! (If771. f2. Mysdeq E. L.. a.d Steilvu.. f: Co.pootirt,e*ide.iolbgy dso6mccow*WWaaoecs. C.ncc. Rer. tt.IfOi-d6T2 (1!fTi). 93. Yfy.der. E. L...ed Stellss. S. I.p.es'dlbn wm >nter e3Ercm uw om liat,a.d ).ryez' aaei tiuk: A we eoouol ardy. J. N.d: G.nrff I.rr. i2;171-l77119791. . l+1: Yuut.. P. C.. ..d Dr Gcrv.n. Y. L. LAuearL MI l4arr a bs aaidwa t.ba.ks. Mrd, See.r. 7m8. 23. 7t-Mi (1f73). M-3 p'. f;
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378'. MARVIN w. ERISTEIM tioa in qpitting.This continues to brtrue'eyen though million=lNpersons have quit smoking over the last two dbcad~es and the proportion of thrtotd adult population tLat continues to t(oloke'has been reducedlto about 33%. 1n this context, one should recall the statement of Dr. John H. Knowles, late President of'tbe Rockefeller Foundation 71fe inebvidrul ttas'tlte p,o" l.desd Hse :woral hsspoesibility to M.intain ttim 0.a bealth eyy as.erro.eee:d simp(t It erdem nJa a(bebavior ... t+fe it ae.at to be eqioyed ..,. but the eoW of'i.di.idsal intnpowibility is 'haiM eyre .ow 'leoo.us polubitire: The choice is idividYd t'aPostub7itY ersoeid Gilare. Rapoesibt7'uy asd duty wwt pin some depee of p.ruy we tigfu aaa aneaom. (SS). Given the current crisis in healthicare costs, the society may hawe the right to insist that avoidable antisocial behavior, which i is also: in the individual's own ittterest, is msaresptablt. /RClKNOWCEDGMENTS' The wtlor vis6es to tlret Dr. >ky.e L l..ee s.a the ot1,a aaoaywory i newie+ets ror Use;r eelprui ! eosemeeu and iaaestioee. fREFEiiENCES 11 Aarrkas C~aoer Society. "Career Faets ard Fipvss ^'Me.r Ynrk. 1M. 2. AaKe(uw!Casoer Society. »!lopess'i. Smoking Cssutioa" U. 4. Sch.wrts. Fd.),1.oat,atioml Cenlsn.ee ee Smokiug Qssotion. 197f, 3: AaNeioaa'Ca.aer iociety. .•Aoee.d~. t+laioa.i Cafereaoe o. S.oting o.d'Hr.al(h. New Yort. Noss+bsr 1t-29. 1l11:'.7bbl. No.112-1M-02N3. •: Aaniosu 1.mag Aaxi.tios d Heanepi. Caasity:,"9roking i die Wortpi.oe Coafetence. Oc- t.6en 2!. 191112..' !J Atwrioaw TNsob'o.c and TeleQ.p! Co. "flwpeK,tlahlt Fraawios in t!e Morkplaee" (R. S. lariwnaerr'./.. Ede'.l. lltayfisld.,talo Alto. Gtit:. 11t2. 6: Alkiawa. A. B.. sad Tow.uadl J. L. Ecosomic atpects a[ tedreed is.okiK. Lnrrr 2: 4r.-19x (1I 7: laiC. A.. J!dringer. L. aad YtWkie. S. J. Tee eae.oeie eoet'o( i9eess. lkeal 1975, Mrd. C..r. 16.7SS-7l0 q 19'7t1. L 1cot; W. J.. er.1: La.Icafm dlsr'saployfrat iratvlryudr during 1Y:M:);: Nrr• EwSL J: Nrd. 2!!, 620-4211 4 117t), !: /saett, D.. and Le.y. s. L. Saoit)tg ootiein a.d t.oki.,geestwioa pnepami af' Yrse w*ioyen i 1Mfrehwetts. Awn. J: hei'6c lir.Mk 7Q ,629-i11 (1fW). 10. Dl.e, A. Medids tit. t+ladito. Avewte: Fi.*ltiea ,aeote wad a.oke: JAAIA~ 2It3. 7]9-7/oi11!l01. il. Bodea. L 1J TiM econoaic Lp.et sif dw:o.nanW dinre on he.hh ats dslirery. J. Otcrp. llid: 1a. 461 (~1M: 12. Distrewa. L. A.. and A).aiov: Ni G. A/eeQam ef hahb iisesre i+terventios for 1.blic w.p(oyses.l. Lkc.o. Med,!k $21 (1197). 13. die. W. S.. tsed.:er. !: T.. tawvlt. R~.. ,a.d .J.ey. R. J. ••Olbr Coara( ttaoogh Veaulstioe: Smot<ieg .s. tionseot'ing Ooo.pscy.' P4ese>ued at t!e 74ftb Anurt Hsetiea ofebe AirJoOu- tioa Coattot Attmeistioa. Jo.e 21-2r, 1lt1. !Ililadekpbir. 14. G/(/osi. GAdr Nr.7larer: Jan. 1M. t!. Coeieoe. TZ'. A.. ise.ai, E.. Ste.rartl K.. and Dorv.1. J. !is'tamm boa e.okutt.. NfM1 Eeel: J: a[rd. 301. 3" (1979). Ni: C.neer Lrrrer. Va. s. No~ 2s. p. 3 (Jtme',s; 1f79). llsstoe: va. 17. TA. CAuroae O6rrrve.. Section G.,1larch 25. 1949. N. Cooper. s...ed Rias: D. The eeoaomic ee+a of Meess te+riaiteOJ,Sar. Srr: 1rB. 39: 1Zi1-13b (1976). M-27
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Policlr c Intraduct3ron: This policy is the ~most comprehensive •nd the one nwst likely to be axepted by empkiyees in .ie long term. ft diredly acknowledges that nonsrraoking is the norm, Smoking is prohibited throughout company premises„but employees are allowed to request that smoking areas be set aside; Smokers are also encour, aged to consider making an attempt to quit smoking. ConsotMst.diConnpany Nonsnwkift Policy. The U.S. Surgeon!General has named smokingPublic Healthfnerny # y' in light of its role as the teading~cause of ~ premature death and disability inour country. Research has shown that nonsmokers with chronictieart!or1irng disease canexperience severe distress when exposed to sufficient'concentrations of secondhand smoke. Many allergic individuals and even the majority of'healthy inon- smokers report discomfort when exposed to secondhand smoke.on the job: Furthermore, recent medical studies indicate that long-term exposure tosecondhand smoke may increase nonsmokers' risks ofdevetoping lung cancer. ComsolidatedCompany- is dedicated!to providing a healihy; cornfortable and productive work environment for our employees. This goal can be achieved, however, only through concerted efforts to protect nonsmokers and to help employees adjust to restrictions on smoking. Ctfective stnoking is prohibited througtnout ompany facilities except in designated smoking areas identified by "Srnoking Permittedl" signs: AII Coiasolidated employees, customers and visitors are expected to comply with the smoking regulatipns detailed in this polic}r. Oesignat'forr of "Smoking Prmr/tb0"Ahsas "Smoking Permitted" areas will be designated'only on request. Employees who are interested in having such areas designated should discuss the.matter, with their supervisor. Locations which may be considered for designation as "Smoking Permitted" include outdoor areas. empty rooms, infrequently-used Ihalh,vays , and other areas which are not used by nonsmokers. In addition, up to one-third of the cafetenamay be designated as "smoking permitted" it nonsmokers do not object. Private offices may be~desigrnated "smoking permitted"br"no smoking" bytheoccupant: However; the occupant should refrain ftom smoking in his or heroffice when a nonsmoking employee or visitor is present. Smoking mztst bre prtihibit.d 'U Ehr tolJorvJnQ araas.  Any area in which a fire or safety hazard exists. • Company-owned'vehictes.  Common areas, including eNavators, stairwells, lobbies, waiting rooms, copier rooms, i*ail rooms, auditoriurns, reception areas, customer service areas, employee lounges and restrooms.  Computer, production and manufacturing areas:.  Areas in which smokers iand nonsmokers work together.  Classrooms and conference rooms (A short smoking break may be provided during meetings Iasting longer than one hour, if requested by smokers).  Any area not specifically designated "Smoking Permitted". Enforcem.nt The success of'this policy will depend upon the thoughtfulness, consideration and cooperation of'smokers and nonsmokers. AII employees share in the responsibility for adhering to and enforcing the policy. Conflicts should be broughtito the attention of the appropriate supervisory personnel, and. if necessary, referred to the wice-President for a'final decision. In atl icases the rigM of a rwansmoker to ~ protectNs orher health and comfort mustprevail over an employee's desire to ~smoke : Copies of this policy will be distributed to all employees. Signs displaying the foAowing statement.will be posted at all Ibuilding entrances: "SSrnoking,prohibited except in designated smoking areas". Ashtrays will be placed in all "Smoking permitted" areas and removed from "no smoking" areas. Receptacles for disposal'of smoking, material willlbeprovidediat building entrances. M-44' 9' ( r
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4 LABOR RELATIONS Nonsmoking policies should be viewed as a progressive step by the employer. The great majority ofinonsmokers as well as a majority of smokers will welcome such a ipolicy- if'it'is implemented with a degree of sensitivity, Ermployees', should be included in the development of policies and wherever labor unionssre a factor they should bebrought into the policy-formutating,process. Union support, or at least neutrality: is useful in creating positive employee attitudes. Furthermore, some unions may take the position that the employer has the duty tobargain before making a unilateral decision to initiate a nonsmoking policy. The reasoning,behind such a position is that such ia policy would constitute a change iniconditions of employmentor working conditions. The rnore usual'view is that because a nonsmoking poticywould eliminate anexisting!hazard. an employer may implement it'without bargaining; unless there is specific language in the contract outlining the right to smoke incertain areas or atcertainrtimes. If'the emptoyer, presents the nonsmoking policy to his employees and the union inidsproperdight-as a reason+ able and necessary program to make theworkptace a i healthierenvironment-the potential for conflict is much reducedl Understanding of'the health issue isa key factor in this process. M-3'9 A' HEALTHY IrORKPLAfrh- A' SJMOKEFREE' WORKPLACE Tho R1sks of'saakiny 1 Most Americans have a vague understanding that smoking is hazardous. Few know just'how dangerous smoking really is, 8096of itungcanoer in men is caused by smoking, while lung cancercaused by smoking is fast replacing breasticancer as the number one cancer killer of women. But lung cancer„almost invariably, ffatal, is not the largest cigarette-related cause of death. Over 150,000 Americans die of srnoking-retated heartiattacks each year:. Millions of Americans suffer from the ravages of smoking- caused emphysema: The risks of smoking are quantified in the chart below: The only good news about Smoking,is that most of its effects are reversibte: One very large study found that ten years after quitting the risk of dying among ex-smokers approached'the same riskas amongipeopte who had never smoked. Ouitting, although difficult for some, has immediate results for the ex-smoker: Greatly improved taste and smell are experienced within days or weeks of quitting i Th. Risk: ofi's.aondh.nd smoking, Exposure to others` cigarette smoke is not just unpleasant. It can be asignificanthealth hazard. Tobacco smoke, which iis the principal source of indoor air pollution, contains over 2t>00 compounds (USDHEWII 1979a) many of which are known earcinogens and irritants. Since most people spend tietween 7596 and 90X of a 24-hour day indoor it is evidentithat exposure to tobacco smoke can become a serious hazard. An important 1980 study showed that'nons.moking employees chronically exposed to secondhand smoke in the workplace experienced Ithe same degree of lung damage as light srnokers, Several newer, studies have pointed toward the possibility thatisecondhand smoke increases the risk of lung cancer and other cancers in nonsmoking spouses. A recent Japanese study showss thatinvotuntary smoke exposure at work is at least as serious as exposure at home. Staff of the U.S. Environmental Protection Agency have prepared a report which says that wp toione-thirdof'au lung cancers in nonsmokers are caused by secondhand exposure to tobacco smoke: At the minimum 1500 people per y,ear, die of lung cancer frorn breathing others'.'srnoke: while the maximum is about 5000. This contrasts with the next rnostserious airborneloxic exposure at work: coke
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C, , 'SURYEY OF' ATTITUDES TOWARDS SMO'KINI6' 17+40 B:oadway, New York, N.Y. 10019 (212) 245-8000 Smokers Should Refrain Fromi Smoking intNePresenoeofNonsmokers ('x)~ SUMM!ARY OF RESULTS OiF THE APRIL 1983 SSURVEY BY.THIE GALLUP ORGANIZATION A,gree Smokers 55 Nonsmokers 82' Former Smokers 70 Dis~agree No Opinioni . ,- .391 6' 14, . - 4 22 8 Smoking is Hazardous to the Health of Nonsmokers (X) '' ~ Smokers AMERICAN LUNG ASSOCI~ION ~ iM C7,m;uns S W F,eop,. . A ee 64. Nonsmokers 84 Former Smokers ao ft . Smoking is Harmful to Your HeaM (x) --i Disagree No, Answer 30 61 lli 5: 15 5 Agree Dfisxgr e No Opinion A11~ Respondents ' 92 .5 . 3 Smoking Restcictilon in'SpeciiFic Locations No Restrictions 21 9 13 a- 10 5 42 Designated Smoking 64 63-~ 74 - 65 73 ' 56 Areas . • Prohibit Smoking 11* ' 24 12 26 15 36 No Answer 4 41 1 2 'Smo.--Smokers f Non--Nonsmokers /ab 9/20183 ilork lace; Rest_ aurantsAirtanesHotels riintells. .!' on Smo`. Non Stno. Non • o. on . N~-9 49 2 3 2 . .- Trains/Bus. . Non 20 12 • 6, 60 56' 49 15 30 43'. '5 2' A,q
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INi'ORA6PITION ABOUT THE SURVEY 11'237 SAMPLE DE1'AILS'The survey was taken among a representative cross section of the California adult publi~c. Interviewing was done by telephoneiFebruary 1 through 9, 1984 during the late after- noon and evening,on weekdays and all day on weekends. The sample consisted, of 743! adults, including 194!current smokers, 257 former smokers and 546 non-smokers. QUESTIONS ASKED Do youlnow smokeior not? (If 'no, don't smoke') Did you ever smoke cigarettes, a pipe or cigars? Generally speaking, do you think that smoking is very hazard- ous, not too hazardous or not at all hazardous to a smoker's hea 1'th? Do you think that a smoker's smoke is very hazardous, some- what hazardous, not too~hazardou!s or not at all hazardous to the health of a non-smoker?' When you are in the company afl someone who i's smoking a cigarette, how much does their smoke bother you - does it bother you a great deal, some, only a little or not at all? When youlare inithe company of' someone who i's smoking a cigar, how much does their smoke both you -- does it bother you a great deal. some, only a little or not at aSl?, when you are in the company of'someone,who i's smoking a pipe, how much does their smoke bother you -- does it bother you a great deal, some, only a little or not at all!? Do you agree or'di'sagree with the following statement: Smokers should refrain from smoking in the presence of'non-smokers? Next 11 am going to read you a number of different public places. For each one I'read Ilwould like you to tell me whether you think there should be no restrictions placed on smoking in these pliaces:. a special area set aside for smokers, or whether smoking, shou3d not be allowed at alli in these places. (SEE RELEASE FOR ITEMS'READ.)
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Public Opinion Survey Institute for Social Re earch Methodology (Poll of Michigan residents regarding~law limiting smoking in public). The Institute for Social Research at the University of'Michigan ini Ann Arbor regularly condiucts telephone surveys of~ state residents. In early October,1'g84 the survey consisted of both.new randomly dialed numbers and repeat telephone contacts with, people~ interviewed the previous month. The sampling error on this survey is between 1.5 to 3.0 percent.. The American Heart Association of Ingham County and the American Lung Association ofi Michigarni n:ceiwed information on questions related to! smoking and relevant demographic variables. The data analysis was completed by Harry Perlstadti Ph.D., M.P.H., an associate professor of'sociology at Michigan State University. The data was adjusted (weighted)! forarear of: the state, number ofi telephones and number of adults in the household so that the final results estimate opinioni statie:-wide. People surveyed were first asked: "Would you favor or oppose a state law that limits cigarette smoking toldesignated smoking areas inipublic places such as stores, schools, offices, work places and auditoriums?"' Those who said they would eitherfavor or oppose!such a lawv were then asked: "Would you strongly or not strongly favor or oppcse suchi a law?" These two answers were theni combined into a five point scale ranging from strongly favor to strongly oppose. A tabular summary of the results iare !on the next page. N-1'8'
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The California Polli Page~ tw+o #1237 Overwhelmingly large proportions of former smokers and non-smokers believe that smoking i!s very hazardous to the health of all smokers says this. of a smoker, while half How hazardous is smok!ing, Current Former Non- to the health of' a smoker? Statewade Smoker Smoker Smoker, t 1 % t Very, hazardous 76 S0 86 M Somewhat hazardous 22 46 13 14 Not too,hazardous 2 4 1 1 Not at all hazardous There is also a strong belief that the smoke produced by smokers is hazardous to non-smokers who are nearby. How hazardous is a smoker•s smoke to the health of: a non-saoker? Statrwidb Current Smoker, Former Smoker Non- Smoker t t i t Very hazardou s 44 17 53 54 Somewhat hazardous 411 53 35: 36. Not too hazardousi 10 21 C 6 Not at all hazardous 4 8 5 3 No opinion l 1i 1 1 Substantial majorities of former smokers and those who have never smoked say they, are bothered by the tobacco smoke of,others. Cigar smoke bothers not only former and non-smokers, but more than half of current smokers as we11,, Cigarette and!piipe smoking i's bothersome to a majority of former and non-smokers, but they do not offeiwd most of the current smokers. How much does the smoke of a cigarette smoker bother You? Statewide Current Smoker Former Smoker Non- Smoker I i' t t. A great deal 38 7 431 4'9 Sase 24 13 27' 28 ! Only a little 14 19 16; 112 Not at all 23 60 1,31 10 No opinion 1 li 1 1 How siuch does the smi aciarsmoker botherou? A great leal 58 37 66' 66 Some 19 21 17 19 Only a l'ittle 1:0 13 9 8 Not at all 12 2!9 7 6 Ho opinion 1 - li 1 How much does the smoke of a i e smoker bother you? reat ea1 ]A 25 13 30: 33' , g Some 28 17 2!8 32 N Only, a little 18 12 23' 1'9. Q Not at all 26 58 li8' 15 N No opinion •' - 1 1 ~ ~. • Lasa than ons-lulf of onr pencent.. ~ N-3 ~ ~
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lROflTA[ri.I1fY OF EMPLOYEE SMOICING CESSATION 365 based on total U.S: health-care spendin8 figures and employed the well- establishedipoint in the literature that adultbeavy smokers, especially men, make greateruse of the hr.alth-carrsystetn, especially hospital stays, than do nonsmok- ers. Smokers use at least 30°Ja 1(78) more health care (48). reflecting their increased prevalence rates: ofi chronic and acute conditions and disability, days than do nonsmokers. The results of this calculation produced fi8ures: for national health eare costs of sawkine, which were strikingly similar to those obtained by Luce and Schweitter's 1978 study ~(32): Obviously, the Nealtb-cane expenses of smokers, individually. are concentnted at higher' a8tes; for example the average age for lung cancer is about 60 in the United States (92). This is derived, as one would expect, from the studies of the dose-mponse formulas neiittin8 the relative task of lun8 cancer to the average dat7y tar intake and ditration of smoking (S3, $7, 89). The avera8e age of first heun attack is much bwer and fallina; it is probably about 55. Therefore, only a iraction of health-care costs due to smoking should I be allocated I to : employers. This is conservuiivety estimated at tbree-fourths of the national lfigure, since 87%ofithe medica!' eosts associated with arnokin8 involve circulatory and respiratory dis- etises, which are significant at earlier ages than cancera. The Luice and Scbweitzer article (52) also contains estimates of fire accident costs due to seaknl8, which amount to $10 per smoker per year, includin8 resi- dential 6nes: As , estiinated I herein, nonresidential fire losses are $5 per smoking employee per year (see footnotes to Table 2'for details of the calculations). A S10 fire-loss figure is presented as an upper limit since there is reason to believe that the proportion of nonresidential fires due to smokinQi is =ready underestimated and many of the historically most dlsastrous iadustrial ifires have been caused by smoking (15, 22). The author estimates that other accident costs and the smokers' share of t!)rc annual worker's compensation costs add an additional $17, to 1 $34, per year per working snroker to the insurance cost category. These calculations are based on studies by Naus et o[: (56) and Yusta aad, Da Guevara (78, 94). which 51td' tbat smokens have two times the arcident rate of nonsmokers, due in part to loss of attention, smokin=,hand being occupied. eye ittritation, and cough. These higher accident rates are applied to the total cost of worker's.compensation to obtain the extra cost due to smoking. (See footnotes to Table 2 for detads , of the calcula- tions:) Many companies pay for, life insurance coverage for th* employees and have extensive disability and early retirement provisiOAs. Many employers offer group tetm ~ life insurance as a standard benef t worth at least I year's salary. Such, benefits may add an, additional $20 to $33 per year to the saNokinB, bill l'' These ' Tbe Caf(le.aia GASP INtwtita.r for lawwty 19l0 (1t) 1 repons: Stste Mutual l.ifs Assunnce Coaspaay of,Aatsrica haa {o.vved'peemiuaa per3l.tl(q ol tife insutanee coverqe froeo f3.16 to 5:.67 for aaateoiusa; Ml.ctinS the eompany'1 esperience that. betwees tba 6th aad 1(kh ysan of covcraSe for oersoes a{sd 30 ~to 40. the stnokarfacowtoku 'deatA rario for aA causes vas ~1:3: Also. a rypical 32-year-oid m.le taioker ws ssciamed to havc a lile eapecuncy aveeapaS 40 yean a: eaapared to 19' ycvs far rsoasawiier. M 14 KQ111
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Publlic Opinion Survey I!nst.itute for Social Research A Table Summarizing Results (Michigan nesidents' views on a state law thatJimits cigarette smoking to designated smoking areas In public places) Sttongiy Favor Neutral Oppose Strongly Favor OApose ' All Respondents 68.5% Current Smokers 56:2% Non-Smokers 74.1% Republicans 66A% Democrats 68.0% Independents 69.8% Union Households 73.4% Non-Union 67.6% White 69.0% Black 67.6% Men 63:6% Women 72,5% Detroit 63:2% Metro Suburbs 65:2!% Outstate ! 71.1% Less Than t20:000 72.3% $20 to $35:000 68:0%. Over =35,OOID 64,9% C 14.0% 3.7% 6.3%1 7.5%: 17.6% 3.6% 8.79fo 1 12:996. 12.4% 3.7% 4.7%1 5.1%. 21.7% 3.7% 3.4%1 5:5%, 10.4% 5.3% 8.1%, 82%, 12.6% 2.8% 6.7%8.1% 8.1 % 5.6% 5.4% 7.5% 15.6% 3.2% 6.6% 7.1 % 14.1% 3.5% 6.3% 7.1% 10.0% 5.1 % 5.3% 12.0°/0' 13.9% 3.5% 7.3% 11.3% 14.1%' 3.5% 5.59+0 4.4% 15.4% 3.5% 5.7% 12.3% 12.7% 2.6% 7.2% 12.3%14.2% 4.2% 6.1 % 4.5% 7.6% 5.1% 6.7% 8.3% 17.4% 3.7% 6.8% 3.3% 15.6% 3.0% 6.0% 10.4% 8asedlon a samptrof 750 adults. Results weighted by area of state, number of telephones and number ofi adults in i householdl Sample ©emographicss Men 44.8%, Women 55;3% White 87.4% Blaek 11.0% Other 1l6% Average age 41 Currently Smoking 3'1.0%, N'-19
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G 1984 Gallup Monthly Report on Eating out UPOATE!-8 Vol. VII No. 10 March 16, 1984, SSWEEPING TWE' COUNTRY The Field Institute: in, San Francisco, C A recently contacted AL A about the 1983 G alliup survey' as a basis for a statewide California poll on attitudes about nonsmokers' rights. In late-February,, the findings of their poll, were released an& attitutes in California closely parallel those~ reflected in, the AL A national' survey. The California poll found that 70% of smokers and 90% of nonsmokers believe smoking is hazardous to the health. The: majority of smokers (58'x) and the overwhelming majority of nonsmokers (79%)~ believe smokers should refrain from smoking in the presence of' nonsmokers. In workplaces and restaurants, the ma3orfity of both groups want to see designated smoking and nonsmoking areas. The mayjority also wants such areas in hotels, motels, and airplanes. AA sizable minority (38X) would like all smoking banned' in airplanes. An even larger proportion (46%) favors a ban of smoking on buses and trains. f" . . RtNTAURANITS, TAK'E NOTIICE'!' The Galliup, Monthly Report on Eatingi Oiut, (J'anuary 1984) asked 1,038 adults why they don't eat out mi or p sen. are the top five reasons: ~ . *' Prefer home cooking * Easier and more relaxing to eat at home t Don't like to be ex .osed to smoke * oncern about too much a/cho esterol in foodi * C an't control the ingredients Restaurants, Take Notice! (cont'd) ., A full 30 % agreed' it was "very true"'that they did not eat out more often because they were bothered by smoke. Another 17% said it was "somiewhat true." Lung Associations can, use these statistics to encourage restaurants to voluntarily set up separate sections for nonsmokers and smokers. The statistics can also be useful in testimony before legislatures to restrict smoking in restaurants. . The 1983 G alliup survey conducted for AL A can also provide powerful am m umition. A mong I smokers, 74%, want designated smoking and nonsmoking areas in restaurants and another 12% want smoking banned completely in restaurants. Only 13% of'smoker; think there should be noo restrictions on smoking in restaurants. Among nonsmokers in the Gallup survey, 65% wantedl designated smoking and, nons!mokingi areas ~ in restaurants, while 26%; favoredi a total ban. Only 7x wanted no restrictions. 0 ~17 ~ C?~ ~ ~ ~ t:. N-1i0.
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T SUPF+LV r:Ef•Of:l 1'i%u;E ': - PERLSTAD'l C t,ere strrrnqly in favor, and as i'ndetrr,ndents 70.1 percent were str orroliy in favor. Slupf,ca,-t within each party, hiowever, is apparently diivided, since itror,g E'":epiubli'cans were more stronqly in f e.vor of' suchi l egi s1 ati on than weal: kepatul' i carns (I71. 2 percent to 6'2.7 percent) and weah Democrats were more strongly in favor than strong Democrats (61.9 percent to 71.0 percent). PoS i ti cal ildeo1 ogy may have. some i nf l uence on the above party f'indings. Only 56.7 Nercent of those who said they were po1 i ti ca1 moderates strongliy supoortedl the proposed legisl:.ti'on compared with 6's.8 percent of tho_e wfro said they were political liberals and 71.1 percent of' those who saidl *t'hey were political conservrtives. M,:ny respondcnts refiuscd or did not answer this questi on and percent o+ them strongl y supported restrictions ur, sn.ol:ing in public places. N ~-72.
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c A PLAN OF ACTION 1. Init'ial Planning To oversee the planning Iprocess, it is essentiat that cuae person in upper management be appointed I to take overall responsibility. Time limits should be set for each stage of the process. An advisory committee should be formed made up of managers, and employee or union representatives. This advisory committee should be alknued Ito fiave genuine input into the planning process. 2. Employee Survey Prepare to inform employees of the company's plans to establish a smoking policy. Distribute CNRF's employee survey and instruct supervisors to hold discussions with employees about a workplace nonsmoking pmlicy. 3. Policy Preparation Hold an advisory committee meeting to review employee input and disauss in detail the specific content and'format ofithe srnxoking policy. Prepare a draft of the smoking policy and ciraulatie it to aafirisory committee members for their revie+ec At the second advisory committee meeting review and' finalize the nonsmoking poiicy. 4. C+ommuni+oatin9 the Policy The way in which management communicates its decision to adopta nonsmoking policy is very, important. This shoufd be done in several'ways. A personal'letterfrom top management should be sent toeach!employee along with a copy of the policy. An article ataout the policyshouki be induded in the company or union newsletter Pf there is one. There should Ibeannouncementis atstaff imeetings and a posting of the po1icy on bulletin boards. A notice in payroll envelopes reminding employees about the policy as the effective date approaches would also be helpful. S. Pof iny In+plementation ~ One of'the keys to successful implementation is communicationby2op management to supervisors r„J that the nonsmoking policy has the firm commitment of'management: Consistent enforcement is essential : & Rwiew of Policy Within a reasonable time after imptementation, a meeting of the advisory committee should be planned and held. Necessary revisions shouldibe discussed. An employee survey may be undertaken to determine attitudes about the poiicyc We at Yhe California Nonsrarolcers' Rlghts Foundation fwpe that "A Smoke Free WOrkptaoe" wilp help you prepare and implement a nonsmoking poNcy !n your company,agency, ororgsnization. Hyou have any questions about any sspect of a nonsmoking policy, contact the Foundation. We will be glad to advise you.. 1: fA M-46
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r Public Support ior a State Law~ Restricting Smol:ing in Public Places Preparedi for the Ameri'can Heart Association of' Michigan and the American Lung,Association of Michigan By Harry Perlstadt, frh,.1D., MLF.H. Associate F'rofessor of Sociology,, Michigan State University Efforts to restrict smol:ing in public places through legislation has become a sallient issue in Mi'ch'ig,an. In order to assertain' public opinion on this topi'c, the American Heart Association of' Michigan and the American Lung Association of Michi'gan contracted with the Institute for Social Research Survey Research Center for a telephone survey of 750 Michigan res'idents. The survey was conducted in early October of 1984. The resultss have been analyzed and are weighted for area of the state, number a of telephones and number of adlults in the household. The results indicate that 68.5 percent of Michigan resi'dents stroncoly , favor a state law to 1'imit smoFcing to designat'ed smmokirngl areas in public places such as stores,, schools, offices, work places and auditoriums and that 82.6 percent generally supported such legislation. Thi!s type of legislation even has the support of a majority of current smokers, with 56.2percent strongly 4avoring such legislation a'nd' 73.6 percent generally favoring it. Among, recent ex-smokers, 66.5 percent strong l y f avored , and 8'1 . 1 percent generally favored restrictions an smoking. As expected•„ those who, N-20. ZAZ5684387
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other subgroups tend'to be rather small and undramatic. It is not' possible to say exactly how these responses translate into. actual dav=to-dav behavior-that is, how often and to what extent people are practicing good nutritional habits: At the same time, it is. obviously desirable thatas many people as possible ••try a lot"'to" achieve the stated nutritional goals. Children's Diet and Nutrition Adults who have children in the household watch the children's diett and nutrition more closely than they watch their own. This finding is consistent across both years of the Prevention Index survev: An average of 64% of the child proxies interviewed say they "try a lot" to watch eight aspects of the child's nutrition. This ranges from a high of M who say they try a lot to see that the child gets enough vitamins and minerals, to a low of 43% who sav the% trv a lut to see thao the child avoid§ eating too manv high- cholesterol foods. Children's preven- tive behavior regarding fiber and cholesterol consumption seems to have slackened slightly since 1983. However, each of.the eight figures for children is higher than the corre- sponding figure for adults themselves in.those same house- holds, an average of abour20 points higher. Concemiwith children's nutri- tion does not vary among income groups, just as it did not, vary in the case of adult nutrition. However, itt does vary by age, with adults paying closer attention to the nutri- tion of youngsters than to the nutri- tion of teenagers. When it comes to eating breakfast, moreover, theree are alsosome interesting differ- ences: Lower income children aree less apt to eat breakfast almost every dav than are more afYl uent ehildren: Teenagers are also less apt to dosu:than are younger children. These patterns, also identiilied in last year's surveN% appear to be persistent ones. N-li2 sFCTiow 3:. NONNsMOKING A IND BESTRIC'FE D LSF OF'AL.COHOL ANDDRI''•r•~GS g an+d Nbnsmclong Seventy-two percent of Ameri- can adults sav thev dvnot smoke cigarettes; 28% sav thev do. This is the lowest smoking rate andlthe highest nonsmoking rate ever recorded in aiHarris surve\ designedlto measure this trend of smoking versus nonsmoking: While these figures are not dramatically different, frum the level registered in~ last year's sun•ey,,thev represent a continuing decline of 15 points in smoking over the past, decade. Nonsmoking is a crucial preven- tive step that people can take: Onee hundred and three health experts. interviewed as part of last year 's surver, rated nunstnukini; as the tunuhcv-urte preventive health priwi- itY fiur adults. The groups with.the largest pe.txrntages of nun,mukers include older peuple:,cul lct*e I*raduateh, those in,the hiighcrr incume brac.kets: and those in households whus'<• head
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they do v~a t People of I~/lichiga ~~ say "YES" to limit smoking in public p1'aces Do Michigan residents favor a state iew that limits smoking to designated smoking areas In public places, such as stores, offices, work places and auditoriums? Yes: According ito a telephone survey taken by the Institute for Social Research at the University of Michigan in Ann Arbor, an overwmaiming 82.5% of those surveyed ifavored restrictions on smoking in public places: Of those 82:5%„68:5% ofithem stnongly favored such legislation. Hownr do minorities feel about legislation to limit smoking? Survey data shows that race makes no difference in support for smoking restrictions, with 67.6% of black respondents and 69% ofi white respondents strongly in favor. is there any union support for ciean Indoor air legislation? Yes! 8h.5%iof the survey respondents from union households were in favor of'a state law to limit cigarette smoking to designated smoking areas in public places. In fact. 73.4% of union, member families were stronyly in favor. Does the proposed legislation In the House and! Senate pit smokerss against nonsmokers? No. The survey found that almost three-quart/ers of the smokers responding strongly or generally favored restrictions on smoking in public places. 73.8% of'current smokers support the proposed law. How do the survey results fall along party lines? The bill has across the board bi-partisan support among~voters, the pott'shows: Approximately two- thirds of the respondents who identified themselves as Republicans (B6%). Democrats (68%) or independents (69.8%) were strongly in favort Would l smoking restrictions discriminate against the poor? N No. Those with household incomes under s2o,0010 were more strongly in favor (72.3%) compared to ~j~ those households between $20 and $35.000 (68.8%) and those over $35,000 (64!9%). But if you includi ~ those generally supportive for both theJow and high income group, there is approximately a!8U% support rate. ~, w7 W UD 04 Data from: Study sponsored by the American Heart Asaociation of'Ingham County and theJkmerican Lung Association of Michigan: N-17 I
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C R/SIR'C CATl SYSTEM OJECT: SCR .?IHS8.S'CR QUE~~S~TI CNWA I'R'Q~ L~ I S"~!'~.: rJ9-Cct-:< J 1. 1'6 : • (D MICHIGAN SURV'E 8
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SUf,'.'EY R[F•URT F'f`a:;t- ?' ' F•EF:LSThDT n,ever srtot.ed were most sLnpq,orti ve, wi th 76.0 stron'gl y in+avor and 89.7 qeneralliy favoring this tyNc of' lor),islation. I n general , appiror: i matel y twu-t hn rds, of' al l ma jor groups strong l y f avor 1 egis l at i on desi qnr?d to 1'i'mi t smohi ng to desi gnated areas. For e::ampl e, 72.5 percent of thcr women compared to 6'. 6 percent of the men were strongil y in favor;, 69.0 percen't of' the whi!tes and 67.6 percent of' the bi aeks were strong;l y i n f avor; and 73.4 percent of' union househo3ds compared with 67.6 percent'of, non-union households were stronalv in, favor. Strongest support e:eists outsilde of Detroit (7'1.1 percent of out state residents stronqly favor such legislatilon compared wit'h 63.2 percent of Detroit residents), among the better educated i6f3.7 percent of respondents witl, college degrees compared with a4.5 percent of those wilth less t-lnzin hiuhi school education), and Protestant and Jews (72.6 percent ot Protestants and' 73.3 percentt of Jews surveyed were,strongly in favor compared with 64.9 percent of the CathoS'ics surveyed~). Household income was also examirned. The highest level of support was found among households with annual' -incomes between $10 to s15,0001 (76.0 p'erc'ent strongly in favor) while the lowest level : of' support was found among households with incomes between $35to t50,000 (60.2 percen't strongly in favor). If general support is considered, the Z35 to t50,0U0 grouAp ri'ses to 77.7 percent iln N0 Among residents who identified themsel~ves as kepublicans,~' b6. O percent were, stror,gl y' i n f'avor ; as Dcrmocrats,, 6e. 4 percent VM~ w N-21 (~ ~. favor.
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360 wAttVIW M. <r1tISTEITI Tuf,DLE' 1 To?A1~~ ECpNOWK~.CoiT! Oi SMOa1NG /N'.TMa UNIr[lf ST~ATif !l[a YLAa INJANUARY' I9!<0~ DouAas' (M/uaNs) Dirsat oals' l.dincl tostss' Tow i Nelrolasms $1,433 56.3101 57,763 Cirevlmory' Sa20 slt.2l4 23.3'50 Ziaspiratory 1,430' 12.0'" 164475' Toeai 11.023 j6.i6s s9sas ttr *duh sawker 204.00 6T1.00 811.013 /4t eisaeene sold 0.02 0.016 0.08 !w pac(ss0e sold 0.36 1.19 1.56' • Hased oe I:noe ald ScAmeitter, 1'/arct+ 9. 1Mds21',and aswmOtioe of St milhcn aduh'smoben' a.d 612 bdlioe!eiplettet sold per yar: • H.dieal!eare :speadift o. d"usuesrwhI to smokina: •'Lest praiop'due to embidiry, aad premauns eonaliry, (1liuaamed at'1%). search limitations, of various populations dealin=',witb measurts of productivity. absenteeism. ievoluntaryamolcins, and smoitinj and occupational health (76. 78): This article attempts to mine available dlua to obtain the information soul;ht by starting with aweptive epidemiological data, largely for, the United States as a.vbole. and reduciag it to per eapita dats by dividing by the size of the': relevant poptlllstions: Estimates of the~ excess chronic and acute illnesses asso- ciated with sowicittg, i.e.. qnt;er, drculatony disease. and'respiratory disease; are: taitea'at the lowest range suggested in the literatwe in order to underestimate thee impacts of aal+okint. These percentages of excess ~iWless atx then used to calculate the costs of smoking by' multiplying them by the generally accepted estimated dollar costs of the relevant 171nemes. Old data is inllated by relevant price indices to obtain up4o•date dollar 5=uaes: Obviously. tnia= multiyGed estimates as inputss pt+owides even less aectnste estimates as otuptrt. However. every effort has been made to emphasize tbe ~ lowest ranW of estimates in the sensitivity analysis. Details of tbe atktllatiotts arn provided iu apecial ydereaces to Tabib 2. Tbus, the upper endpoint of the flarl! etafmate, i.e., that the average smoker costs his or her emQloyer about'f1600'per year in various forms, is aa underestimate given the basis from which it is derived. The lower eodpoint. about $340 per average smoker per year. is' an almost arbitrary rednctiott of the apper 5gure by about SW: 71his is a sensitivity analysis where the medical!eare portion is based on data fi~romm an early dnft of a paper on the health care costs of smolCini'renecting threxpenience of a, bealth1 m.iutenance organisation (HMU) ptlpul.tiott (79). When the results were =ener.lized,, they provided an estimate equal to about half, that of the Lucrand Schweitzerfi323 data. The wrorleers' eomperuation: absenteeism, and productivity low estimates are arbit>rary 50% reductions as wdl. rounded to the tyearesr lowest $5 figure. Some of the eost' of smoking estimates are based on statistical associations of the variable concerned and smoking; some are based on laboratnry epidemiology and controlled population studies. lUl who have studied statistics know that cor- relation is not causation, but correlations iupported by elinical, experdmental4 and laboratory data and tested epidsmiolopcal! theory come as close to cause and. M-9
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SMOKING COSTS BUSINESS MO/IIEY' Employers must bear a very large part of the cost of smoking. In 1982, the Surgeon General said that smoking was responsible for up to $13 billion in lost productivity. tJtherexperts insist that'ithe losses due to smoking are much higher-as high as $47 billion per year. Employer costs are incurred lin the following iareas: employee adds between $20 and $33 per year to the annual life insurance bill. Fire insurance costs are also increased because of' smoking. $:5' per smoker peryear, is a conservative estimate of the additional fire insurance costs to 1 businesses having employees who smoke (Kristein,1983) Idsuranee Specific insurance costs attributable to smoking depend i on the type of insurance coverage a company offers its employees. Naturally, the more extensive the coveragee the more cost saving can be expected by restricting smoking at work. Health iinsurance is the most obvious type of insurance which has increased costs associated with smoking. Because it is estimated that 30% of all cancers (0olt and Peto 198t)), 2596 of all icardiovascutardisease (Kristein; Arnold and YM'ynder,1977), and 80% of all deaths from i respiratory disease (U!S. Surgeon General?s Report 1984) are related to smoking, it'is notdifficult to understand'why health insurance costs are increased by smoking. Using the Surgeon General's data (USDHEW,' 1979b)'and' estimating,that smokers use 5096 more health care services than nonsmokers, it is estimated'that business pays an additional $75 to $150 per year in healthh insurance for each smoker on the payroll. Life insurance costs are increased by employee smoking, because of the increased mortality rates between smokers and nonsmokers. Each smoking Absenteeism and i'iekness ssnefits The effectsof smoking upon absenteeism are well documented (tJSDHEVW,1979b). Repeated studies have shown a 33% to 45% higher absenteeism rate among smokers thanrnonsmokers (Knstein. 1983): In 1979 the Surgeon General reported that 81 million work days are lost per year due to smoking; It has been estimated that smokers are absent about two days more per year than nonsmokers: While this represents a staggering cost to society it also can have a large impact on your specific business. R*dNced IProduettiwil+y Smokers'spend some of their work time smoking instead of'working. Researchers vary in their estimates of the work time lost to the smoking ritua{, clean-up costs, and damage to furniture and iequipment, but even the most conservative estimate (Kristein) is that the average smoker costs the average business $166 per year in kut productivity, based on an estimate of aJbss of one minute per hour to smoking. Another researcher(Ulreis,1981) believes thatthe average annual on-the-pb time loss attributableto smoking,is over $1800 per year. In addition to this, Weis estimates the cost' of smoking-related repairs at an annual cost of $1000. Smoking and Occupational Disease Srnoking;and exposure to sorne hazards at work act in a synergistic manner to greatly increase the likelihood that an employee will'devebp an occupational disease. Entitlement to workers' compensation may occur for cases . of lung cancer~ chronic obstructive pulmonary disease. and heart attack when there is a pb-related cause even though thecondition might not have occurred if'the employee had not smoked. Furrthem7ore, corporations may have an obligation under OSHA regulations to control workplace smoking in thepresenceof certainioccupational' hazards such as asbestos. coal dust, andiradiation. Riesearohers have shown that the costs of smoking in the workplace are significant. This confirms what many employers already suspect. Thus in addition to the important health reasons for controlling workplace smoking there is a sound business reason: smoking is an i unrnecess'ary, business expenditure. ~. ~ NI ~ ~ i~. ~ M1i1 0
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•- K~~R"= - ; " I1lOFITAatLITIY OF E'Wri.OYEE SMOKING CESSATION 377 ' APPENDIX 1: EXAMPLE OF A' COMPANY NON+SMO1G1Na PROGRAM Since 1977. Johns- Manvilk Corpotation has pursued irnonsmoking prosram at the work site, beginning at two sites and extended, in, 1M; to all corporate , fiucilitiess While detaikd i evaluation data is not yet available, the company has neason to believe that the program is working and has been basically, ssuccessful in stoppind work': site smoking. So far, a relatively atnall number of employees have . used the smoking eessation clinics, but thr smoking ban is being generally re- spected. Some emplbyees who have violated the worksite no-smoking rules have: been fired: arbitration rulings have generally supported the no:-smoking policy. • The smoking ban was instituted in a facility after smoking employees were pro- vided with an opportunity to attend smokingclinics and after these clinics were completed. The Johns-ManviUe nonsmoking program was announced in a Presidtnt*s bulletin to employees. 1t' began by explainin='the health risks assoeiated' with combined cigarette smoking and asbestos exposure at any level. The policy, had three basic'parts: no smoker would be hired to work in asbestos-usin= activities: tltere'would be no smoking in any asbestos-using area. including workplaee, of-' 6ces, locker rooms, and cafetettiias: tbecompany would help smoking employees to stop by eontractin` with outside specialists ut smoking clinics for employees and their spouses.,Tltie company actually paid!for the clinic'for those who com- pleted the prosratnh altboudh the participant was required to advance 50% of thee cost initially, which was returned to bim, in parts, at various stages of attendance and successful completion of'the clinic. Extensive literature distribution and meetin=s' werr employed to pin the cooperation of: bcal managers, supervisors, union leadersi»p. tiealth and safety committee membas, etaplbyees, and corpo- ration health department personnel. 'Illte company has 14 plants in the United States and Gnada, and employs some a:000 persons. Jofins-Manvilk has had dosens of inquiries from similuiy situated companies regarding this' program. A'PPENDIX' 2: A CAVEAT One must recognize that smokins is a very stubborn habit and i a dilficult ione too tt<o!p. Many smokers do not wis6 to stop smoking even when tbey, uy they do and, even : when they have ahmady suffered serious illnesses associated with smoki~ (2, r0):'a Respitatory'caacers and lun= diseases'1e.=., c41 rooic obstnucti*+e. pulmonary diseasesD are among the few leading causes of death registering rising mortality rates in recent years (S4). This is a serious and' costly national health problem that deserves a serious cooperative eliort, from a11 citizens. One of the Weatest satrces: of', diRcufty in this area arises from i senior management, both employee and etaplbyer. personally stubborn about, their smoking babits. Society needs to impro ve its approaches and techniques of assisting the smoking popula• " As ]toslo.nki ei .l: (MO) tnve poiasd out: (a) Uiine wAdyaa eneioud !th.t up to 209b of rpaup dl+san luaek O.tiems: oadetsd toi*iitt amoting by rieir phytioum: &ed abom !aa tmokina, (bi Of a l+lladdpBiY rnpoeding ! aoap of swokias pvsms d sebool childrRn. 41% esatesrsd iar~t in a naotiaE aswioa ~aYnic: 2% ansaded a pne6minary axsting;' 1.237F acnulty, o.de ru ot the clinic. M-25'
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09-0ct-9k ---------- M I1C HT GAInI! SUA'V!EY 8 We are Unterested in how peopi~e are getting alionq financiallty, ,these days. Would you say that~ ('L307 are better off' or worse off financially than you were a year alSlo? 1. BIETTER OFF' 3. SAME S. wiORSIE OFF 8'. D'ON" T KNOW ci :3m, PW , ? M GI;:, 3 -~ :------------ ----------------- ----------------------------------------- . I NOT'E: S'TAR'TING TIME AND DATE WILL BE S'TAMPEO, WHEN YOU' ENTER RESPOiNSE. 11 1---------------------------------------------------------------------- - Is ~ uM r : V151 CY1 IF V96=«" THEN V96=TME'(1') X V9&=OTEIiOI SK1 IF V15'la1 THEN GOTn Ala ELSE IF V15'1=5 THEN GOTO Ala [!GIQ TO A2 •-- Al!a, Is that 20i4mwaha0'0 better or at14somewhata0O better? 1. MUCX BIETT'ER 2. SOMiE'MHAT 8'ETT'ER 3.. NOT SURE NUIM R> : V3L71 MC T! a? -- Al1a Is that 204Much@00 worse or al04somewhata00 7. MUC'H, WORSE 6. SOMEWHAT WORSE 5. N0T SURE' NU1M 8 > 8 V3'17' worse? N-26
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:'1 T A B' L E 1 3 - 11 Exposure to ambient cigarette smoke af home IIOUttMOtD{'. CN{aftN. sos. +35a' 46II x x Someone smuokes cigarettes 45 40 No one smokes cigarettes 54 51 Not'sure ' - I IT A B L E I 3 Support for regulation of smoking in pubiic places i1r. Do you tfiirnk ttwt taws should prohibit smoking In pubtic pWces: or snoutd!thew nequire separate srmokinq and nnnsmoking'sectionsg or shoukd srnokinq in public ptoces not be reQukrted by ltrw?, ftter Quality Tdvcntv-thrnr prrccuit' uf a1Jul t, rate the qualit' v ufi their luraf Ji-ink- ing water as ..cxcrllrnt." andl anuthrn3lt% juJge it as"prettY guud!" There are fchx su•iling dilier- ences in watcr rauings across subgroups, except that raUings tend tu bv a bit! higher in the MiilA%,.-.,t and outside mrlrapwlit:nratk.r";. This is possible due to the fart tihatt the water suppl~., unlike the air.,has ustnalNt• gone through a purilicatiiun, processbKfurr it reaches the individual. Therefore, in any given area all'scxial classes are Iikcln tuo use the same water supply; cvhile air I mav varv br'thr 1lrcat~ion caf',une's hwrtor'ur work. 2 aa aou .ouM • a. • o..MO w.oia +.me: r. rouu«orn. WWn so0tow on wons ao.nms rMManoOaro .ouVS r.or NoutE~ wwcn No a. waa= aoratn: no. 1i'2S3 355 216' 679 x x x x ~ Should prohibit 20 10 20 26 Require seporote sections' 60 65 59 58 Should not regulate 151 22 18 10 Not sure 4 3 3 4 Exposure to Ambient Cigaretfe Smoke at Home An emerging rnvirunmrntal issue concerns exposure to anrbient cigarette smoke, bcuthiat home and in public places. Fifty-four prrr.ent, of all'horrsrltolds areirx~r of'this problem. but 45% do have xunnr h<tuseholdI membar who smokes. Fiftw-(m percent cJ . all horrsr- l:olds u•uh chii(dren are free uflthe problem of ambiunt, cigarette smoke, but, 49°lc have some member who does currently smuke. Table 13'-2 shows the figures. 29 K-15
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I 8! Roffi'er R hnlrtodaelbet This policy dearfy'delineates where srnoking,is permitted and where prohibited and it also offers guidelines for conflict'nesoflJtiortt Its main draw, back is that'it allows smok'mg in areas wlwe smokers and nonsmokers worlt together. This could lead to ~con- flicts that require management time to resokre: Block Ccmpany, Zinoofctn8 PI Medical evidence clearly showsthatismoking is harmful to the health of'smokers, Smoke from cigarettes, cigars and pipes is also an irritant to many nonsmokers and can exacerbate allergic conditions. In sufficient concentrations secondhand smoke rnay be harmful Itb those with ehronic heart oriungidisease: New research indicates that long- term exposure to secondhand smoke may threatenthe health of nonsmokers as welll In an effort to consider the needs and concerns of smokers and nonsmokers alike and'.to provide a~healthful working environment for every B/ock employee, this company smoking policy will take effect on _ AII'. Block empf©yees, customers and visitors are expected to comply with the smoking regulations detailed in this policy. M-43 Srrroking-Pnohlti/t.d Ahws  Any area in which a fire or safety hazard exists.  Common areas. irxauding efevators, hallways. stairwe8s, lobbies. waiting rooms, copier rooms, mail rooms, auditoriums, reception areas, customer service areas, employee lounges, and restrooms.  Classrooms and conference rooms (a short smoking break may be provided during meetings lasting ilbnger than one houir, if requested by smokers):  Cornputer„production, and manufacturing areas.  All locations not specifically discussed'in the section below entitled "Other Areas". Other Areas ri Private offices may be designated"'Smoking Permitted" or "Nb Smoking" by the occupant. hlowever, the occupantt should refrain fromsmoking in his or'heroffice when a, nonsmoking employee orvisitor is present.  In areas where smokers and'nonsmokers work together, supervisors should take into consideration airflbw, ventilation, existing physical Ibarriers that migtnt be of ihelp, and individual sensitivities of nonsmokers.  Two-thirds of theseating in the cafeteria witl be setaside for nonsmokers.  Employees will refrain from smoking when in company vehicles with nonsmokers. Eh/orewn.nt The success of this policywiltdepend upon thethought- fulness: consideration and cooperation of smokers and nonsmokers. In the event of a conflict, employees are encouraged'to work ouCa compromise among themselves If this effort proves unsuccessfud, the situation should be brought to the attention of the appropriate supervisory . personnel: If necessary, the matter may be referred to the Vice-President for afiina/ decision. If a compromise cannot be reac.hed: the nglat of a non-smdcer to protect his or her health and comfort must prevail over an employee's desire to smoke. Cbpies'of this policy will Ibe distributed to all employees. Signs will be posted to designate all areas where.smoking is prohibited. Employees may use desktop signs to remind others.of their, desire for no smoking. Ashtrays will be removed from all no-smoking iareas and receptacles for disposal of smoking,material provided at entrances to these areas.
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380 MARVIN M. [R/STE1N 4!. Lee. P. N. Ttlssive arohitts. Food Csntet. T4~deol.'D. 22'3-329 (19t21. !0. Leefaut. C.. tM d. Etlilarid. Ne.• F.nrl. J. 4fed. JRi. 7$-743 (1li(1). 31. lsvestth.). H.. ad Ckary. !. Dj The emokiry{ oroblem: A nerteer of the nnearch and theor) in hchavior.l mli modifiauim tsrcMol: lrq. !S, 370-r0E (1W 32. l.uca. 8. L...nd SehWeittst.,S. O: Smoking snd.lt:ohoi ebuse: A aesp.risoe ottheir, eeconomic consequences. New Enrl. J. Aled, 27t. 369-371(1!97H. 53. Mitshiuski. M.. t,nd Stellm.n. S. Impect of eew smoking trsaQs oe .wmen *s occup.twoa!'headh Aer,: Med. 7,' 319-763 (197E). S1,, National Center tor Health Jituistiw. "Vit.) Statistics of tM U.S.. Monaliiy .' Moethl.; .nd tnautl espau: S'S: National lateeapncy Council oe Smohut; aad Hrahh. "Saoking .nd I the waekpl.ee.'• New York. Fell i 196D. 36: ldaos. A.. EAWe.. V.. Hetyc6owa. Yl..ad Viveeetov.c. 0. 9Ybrk „njuries and smokSeg . lnd. Med. Srrs, S!. 1RU-tU (19i66): !7. OsBet, D. L.,Romeder. J. M.d ad l.aace.,J. M! treaume teorWity attributable to smoting and Ysatdous deiakin3 ie Cu.da. Antee. J. Apidenud. 109. 43l!-d6D 119791. 3t. National Csacet hstinne: Conference on lausive Swoking. Sept. 30. 19tII: lethexda: MI . 39. NIOSH. ~Ad+rsne Health Ei[eets d Seok6t{,.ad the Oceapetioa.l Eavvoamcat." Current hsedigew Dul)etis 31. Washington. D.C.. 19'79:. 40. lukinsoa. Rl S..,er d. "1I1.m,peE Health Promotion is tSe wtortpl.oc.' 1rl.yfisUl. Palo Aho:, Cvd.. 1982. E1. iknotvi oosuivipiiption ~by sttbjsct W lenud H. Ellis. d!'fioe of Gacee Co.mtueiosuioa. Nar 1fe.d Cancer lostihne.leslesda. Md.. 197{: 62. Feai J. Tssa. ewokittg. health. l+.wrer u301(»7is) 63. Jb.+eO. D: ><. •'Tbe ERect of s Mnhipk Tretumeae FooRrate ..d Madtte..nee Procedures on . fwehi.E'Caatio.:' awnsoQapbed. Amer. H+nk6 Fautlatioe. Ntr Yak; 1999: 4A: Rorot. E.. aad Manay. J: L. SsokiaE .nd causes of death .moeg U.S. veterans: 16' years of e6servatiom rnAlic Hedth Rep. 95, 218 -22Z (19E0): iK: Roth. A. T. Testitnoey befaee the Honse Co.uaiaee!ae Faaed lsuerstue Caamerce. Apnl! 2D: N69. f6. SciWehter. S. Eetidivism and tsN-ctee d'twolEiaE aW obesity. Ame.. h,rchof. 39+ dS16-sA1 (19'R21. 67: SeWicQ: liJ...ad Haemmad. E. C: Aseestos..d smoking. JrAIKA 2K3~, 4SiL439(1979). A: SdiEaQ.1. J.. twd Lee. D. H.'•Asbettoa a.d Diaau: ' p. 396: Ac.dimic Press. New York.197f1 69. Shqnd. D. Study of SpesdcW ICoty:. Harvard Sehool dTublic HI 1911. 70. 9tia-CY'.osr. G. 1E.. Waden, L, G.. ..d Sichd. Hi S. C>tnooie ~ broaeaitis is t*iaers ead noa- ad.ers: As sOideaioiopcal sur.ey d s es.mt.ityis the pM ati.iK arer i. tbe Traasraeli. 1.it. J.1nd. Med. 24. 1!-12 l19%7). 71. Sthith: D: J: Absenteeism .ad presemeram is isdustry. AerAr. Fnriren. fledtb 211670 i119701. 7'1. Teber.1./.. er d. Effects of p aeeW ~prnae s.okieR as pWmboany Mctioa af cMidree. Amer. J. F.jidemief. 110. 1l-36 d1l791. 73: Tawsued. J. L.. a.d I liesde. T: N. lielewic Mut diue.e mortality eists for snoters .nd i aow4motas. J. EaedeatioL Cowrw+ut. lie.kA J3. 2•3-U7 (1479). 74. TRiouooeubs. D.. Kahudidi. A:. SFrtros.: L.. aad Mac Mahon. S: has ea.em a.d I pessi.re ssakieg.. Mr. J: Clncee 37;,1-4d14611. 7s. Tmett. J.. CaenReld. J.. sad icaeeei. W. A: tanltiv.nine aalysis at the risk o6 cmoevy hean disease in F'rtmti6EA.m. J. CA.owie Dir. 20. s11-SII4(1967). 76. U.S. SuReoa CintaalJ ..The Health Consequences of Yaroting.'. DHHS IFHS)aI 19e1.. 77: , U.S'. SacEeon Geeera): "71te Heeltb Cbesequeaas laf Sarokitg: ' fan 1V . pp. 239. 266. :7l r211E. DH HS .(THS){2-3Q 179. 1942. 78. U S. DHEW. "Sit+okieE wnd Heehh-A Re9mt ~aftbe Sw=eon Geoen)." pp 1. 7-1d: C4aps. 2. 3, S; 7,13t Appendix A. DHEw Tublienion (!HS)74.Sao6l1: 197% 79. Vagt, T: M.. atd3thwxitser, S. O. °Medioai Costsa(iCiprette Saiahiras:" Unpublished paper. 1962. (lased Ion data fiom Oregon HI/ID:) M-29
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c MTCHIGAN SUR'vEY 8 C1':7 aM P4 C= 6 ( Some peon I e don•'t pay much atte'nt i on to piol i!t ica I campa i qns. How about yo'u?' Wouldiyou'say that you have been very much ilnterested4 somewhat Intere'stedl or not much interested In the presidrentiial campaigns so far this year? 1. VERY MUCH INTERE'ST!ED 3'. SbMEWiHAT' INTERESTED 5. NOT MUCH INTERESTED &. DON•T KNOW JH k : V'I,67' -- 891 ---------- And how, interested~ have you been in the U'*S. Senate campa i qn so far this year? l. VERY MUCH INTERESTED: 3. SOM'€'WHiAT INTERESTED 5. NOT' MUCH INTERESTED S. 2DN''T KNOW ~ M. 9 : V1'~69 N -31 rz0 N ~ ~. ~ W W . on
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l1:9-Gc't-34 w'tCFN1 GAN SURVEY 8'. -- A'2 ---------- Now looking aheaid -- do you thi'nk that a year from now, LL307 willi be Q04better offa'D0 financiaJ'1yf or a04:worse! of'fa0'0f or just about the same as now? l. Ii11LL BE BETTER OFF 3o SAME 5. WILL BE WORSE OFF 8. DON'T'KNOW M tr : V152 - a3'---------- C Now turnJng to business conditi'ons in t'he country as a whole mo you think tfiat duriing the next 12 months we'11I have good! t i'mes f'ilnanc i a l 1iy ar bad t i mes or what? l. GOOD TIMES 2. GOOD iiI'TH' QUALIF'ICA'TI0'NS 3. PRO-CON aO2(PF110 T'0 SPEC'I'FY)a00. 4. BAD WITH QUALIFICATIONS 5'. BAD TIMES 8'. DON,' T KNOW M M : V'1S3 - A 4 ---------- Would you say that at the present time business cond'itions are better or worse than they were a year ago? 1. BETTER NOW 3. ABOUT THE SAME' 5. wORSE'NOW, :U1y p> :! V'1S4 N-27 C 1 : 3'G i) :C PA u~- 4
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I .+, I •:-t+ PuUTiOCAL aTUDiFS/ INSTtTUTE FOR' SOCIAL RESEARCH /'THE UNIYEH.odTY' OF MICHIGANI/ ANN ARBUF, MICHiGAN a8t08 August 23, 1985' Prof essor Harry Perlstad t De, ar'tment of Sociology Berkey ilall tlichigan State University East Lansing, MI 48824 Dear Professor Perls'tadt: I am writing'as a fo1!lovup to ou!r recent conversation in which you asked for a description of the methodology used in the Mli'chi'gsn Sur'veys vt:ich we conduct and which included questions on smoking in public places last October. The basic design involves a stratifiedlclus'ter sample of persons 18 and older'resi'ding in, Michigan householde with telephones. Three regions of the state - the exchanges covering the city of'Detroit, the exchanges in remaining suburbs'of the tri~coun'ty area, and'ex'changes in, the rest of, the state - are sampled to achieve equal expected sample sizes and then weighted to reflect their appropriate: propo'rtion of the state's telephoae household population. The purpose of this is to provide for statieticall'y reliable comparisons between groups of individual!s living In these regions. The interviewing is done using Computer Assi'sted Telephone I'nterviewing (CY+TI) procedures. Each respondent is randomly selected from a listing which is made of all adults residing in the household. This listing is made at the start of the interview, an& the selection is peiformed by a computer program which contains the interview schedule and processes this information upon eollection. Only the randomly selected respondent can be intervieved„ and'repe'ated callbacks are made In order to: contact the designated, resp'ondent across the extended intervieving period necessary to conduct surveys'in this f ashion. The October survey was part of a panel study conducted during the fa1i1 election campaign. Of the total o'f 750 interviews conducted N-23
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Professor Harry Perlstadt August 23,,1985 Page2 betveu~ October 1!2 and 29, 401 respondcuts hnd' been contacted previr.usly and 349 involved an inslependhnt random samplL, of approximately half the normali size. The response rate for these 349 interviews was 61 percent, which is in the normal range of 60 to 65'percent which vee obtain for surveys conducted under these conditions. The recontact ratefor' the respondentspreviousliy, interviewed in~ S+eptembervas8'2' percent, uhich, also is in the range of our experience in recontacting respondents under these conditions. I: hope this letter respond's to the quesiions which you raised. If I can be: of any further assistnnce,, please feul free to contact me. Sincerely, ~J1 Michael W. Traugott Senior Study Director N-24 Ci i
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T A B L E 3 - 1, ~ Who restricts their aiicohoi~ tiobacco, and drug wse . OO NOf ..~ 00 MD, c... .110.0lNI[ , .CCOM .M..KN. ., IM x JI&CONX r~W ,oft,, DVxM r t th f h u ti Tbtol 'Iudutfs 1983 1252 % 70 34 92 z c r w o.- as an occ on a pa I siunal. managrr. or proprietor level. U401 Achdh ~~ a; % 72 30 5M 9M 1 autrrrns rlsu idcntiliod in Thrx , r la+t vear's- survxv, secnn to be lxrsi.; s R.g1on lent ones. Table 3-l l shuws who East 321 % 69 23 84 89 tcrads tu be a nunsmuker. Midwest 326 % 72 23 76' 92 A striking finding is the cwnxer- South 373 % 72 39 82 93 gence in srnoking bKhavitur uf men Wesf 233' %' 74 32' 85 86' and women. There has been a dramatAc conver'gence over the past sox Male 619 % 73' 25 77 87 ten ycYars. and'by the time of the ~~ ~~ 634 % 70 34 86 94 the two rates had fiullv 1984 surve y converged. Today, women are statis- Roec tiicalnv indistinguishable fr>Jm men. White 1089 % 72 28 81 9C in terms of their rate oflsmoking Black 110 % 67 38 84 87 versus nonsmoking. NNspornic 72 % 68 31 74 86 AVcahol USie Age 18-29 years 363, % 69 20 70 79 Ttiree in ten.a'dults sav that 30-39 years 283' % 69 23 76 89 they never consume alcoholic bever- 40-49 years 175 % 70i 29 90 95 ages. Another 57% drink moderately 50"64 yean' 238 % 70 36 92 100 or lightli; i.e., they average three or 65 atwf iover 190 % 83 49 93' 99 fewer drinks on days when they do Iducetion drink. Twelve percent ofadults say Not high school they drink more than this on a day graduate 233 % 68 54 80 94 when they consume all:ohol; These Ngh school figures are virtually, unchanged graduate 445 % 69 28 77 92 from last year's stuvey, as shown in some palk" 287' % 70 24 77 88 Table 3-1. Four.year college Of those who do drink, 8 out of' gmduate 286 % 81 17 90 89 110 can, be considered moderate (or ll light) ~drinkers.Thaseadultswho Houmholb i imm $7-5M ,orleas 139 % 66 51 731 8& are most likelly to be nondrinkers vs. S7,W415A00 230 % 67 36 80 90 moderate drinkers can also be seen $15•001-$25:000 1 268 % 69 27 74 89 in rthe Table. SY5,0p1-M000 237 % 72 26 79 91 $35•00'1-$50i000 159 % 71 14' 92 941 $50.00•t and lowrer 112 % 82 15' 87 93'. :at-o..er+e.a Health slaho Exceilent 297' % 801 25 83 93 Very qcrocf or pood 751 % 70 27 80 90 Fair or poor 200 % 66 46 80 92 % suenenmes dr 'Bdsrd un drr70~i , of all adtdt>n0v r ur4; this p.urnnrhur iss rx.r rw.xzwcrli r.num+v urm+'.. s,thKnNfps. "Atudnsate''d•+nkmt; ~ y ;izwrlrN'd/KKGrtj rX(~11rI,dIrrll:fiUnaid(f\"ill'w'!nl'~IYIa"..~H/r l.t'f.ffallft.'.~ I I -'MiN nn4t'd.
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Oi9-Oc t-84 .- A5 -------- M'ICHIGAN SURVEY 8' Looking ahead, whirch would you say i's more likely -- that In the country as a wholie w0 /1 hawe corntinuous good times during the next five years or so, or that we willl have periods o'f widesAreadl unemployment or depressiorl, or what? • 1'----------------------------------------------------------f i' IWER: IF R ANSWERS: IiN COMPARATIVE TERM'S. l.E.,, "®ETT~ERM, I t' "WORSE^. OR „SAMIE", MOBE: N'wouJd that be 804.gooda00 i times or aA4badai00 times?" --------------------------------------------------------- i rPEN ENDiEDc VS55' ------_-_- -- A6 Andihow about a year from now+, do you expect that In the country as a whole busllness condiiti'ons will be betterv or worse than they are at presenit, or Just about' the same? 1. BETTER' A YEAR FROM NOW 3. A80WT' THE SAME' 5. WORSE A YEAR' FROM NOW :NUw1 x'> :' V'156 •-- AZ' ---------- About the b i g th iin gs oeoal!e buy f or t'he i r homes -- such ass furnttures a-Te'.f'rilge'rator, s'tove, teiev'isiionv and things like that. Gener'a1ly swealting, do you t'hink, now is a good or a bad time for peop le to buy major househoild items? I'. GOOD 3. PRO-CON i0Q1P'F110 TO RECORD RESPONSEf'a0i0 5. BAD , 8. DON!•T KNOW i WM M s V157 x+-2rS 0'1 : 3 4 P ~ PAGF 5.
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0 19-:ct-8.4 M;CMI'GAN SURVEY 8 --- a5' ---------- Thero has been some talk recently about a nuclear freezet that i's; a proposal to halt the testingv productiono ai iinstallation of additional nuclear weapons. Have you been paying much attention to the~issue of a nuclear freeze or not?, I . Y'E S 5. NO 41JK N : V164 .-- 06 ---------- Do youi favor or oppose, the United' States agireeJn9 to a "nuclear freeze" with the Soviet Union (that is. putt'ing a stoP to the testingi productiono and instailation of aad j t i ona l nuc 1'ear weapons by trottn s i!des )? 1. FAVOR, 3. ©EIPEND'S (VJLUitiTEERS ) 5. OiPPGSEI 8. ©ON•'T KNOW jJiM 01 : V'165 .-- g7' ------- --- Oo~ you f avor or opoose the Eipua I R i ghts, Amendment - al!so~ knowin as~ t•he~~ E~~RA~ - the, proposed!cons~ti~t~~ut'~i'~ona~ll almen0ment concierni n9 l+omen?' 1. FAVOR 54, CiPPOSE 8'. ©0N'T KNOW JUM ! :' V166
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Vol. 1/No. 4!Juiy; 1984 Smoking and kleaRh Btepqrter Page 11 TOBACCO INDUSTRY CONGLOMERATES- Status Report on i Dbversffi'eation In the Tobacco Industry 1964 representative ~ products. Tobaeao Manufaetunr Tobacco Brands OfMr Ptoduots. (corplomerate owet.rw tMNlete). PHILLIP MORRIS, INCORPORATED Marfbona,, Merit, Benson d Hedges. Ptayeas; Miller Brewing Company (Miller, Lite. Meister Virginia Slims, Padiament! Brau. Lawenbrau: Magnum Malt Lktuor):,The Seven-Up Cornpany'(7-uP. Diet 7,-up. Like Cola), 1Aission lrie)o ReaRy Group R: J. REYNOLDS TOBACCO COMPANY Camei; Winsron. Salem„ Stering, 8r;gh't: Kentucky Fried Chicken. Canada Dry. Delmmnte. (R. J. REYNOLDS INDUSTRIES) Doral, More. Century. Now: Vantage, Chun King oriental (oods, HawaNan Purkti, W1ncliestar. Work Hdse chew, Prlnce Albert. Mortan Frozen Foods. Patio Mexican foods, Carter HbN, Madiera Gold SnatrE-Tum, Milk Mate. A•7 Steak Sauce. Esuoft'ier Sauoes: Grey Poupon, Ortega Mexican bods; My-T•Fine, Brer Rabbit Mclasaas. College kn.,Vermott lilad,' Neublein, Ine. (NRow Cordials. Black Velvet. Cuervo. Don 0 Rum. Itish ~ Mksl, Jose Cueroo. Popov; SrtwrrwM, The Club CodctaiEs, Yukon Jack. Inglenook Wines, Napa Vapey W~ines: FNarveys 9riatd!Creme: Lancer Vin Rose) BROWN i' WII.UAttISON!TOBACCO Kod,' ®&TJay, Bel.+r, Vlceray, Richland ?5's Marshel, Field & Company: laanbel! Depardnent (div. B:A.T. N+dustri.e) Sootes, Saks Fifth Avenue, NCoht's Department'. (9ritleh American Tobaceo) Sloresc Appleton Papers, Yardley: Imasco (Canadi.n aMpiaa: Ynesao) (Imperial Tobacco. Hardee's Restaurants. Peopie'e Orug, Shoppers Drug Marti ®urger Chef. l Embassy Clearxrs) ` LKiGETT GROUP Chesferlisid: L 6 M. Lark. Eve: moat"generio"' Cartsberg Beer.,Atpn Dog Fbodi Diversifled (Llweft !' Myers Tobacco) oigareKes so(d ie (YSyI; Pinkentat Tobacco Products (gym equipment). Chikiren s WohdJ Inc.. (dNr: Gnnd Metropolitan, P.LC:)' Company (Red )Wan, Chew) hKercat>tinental Fbtels Corp., hnsrnational Distillers & Vintners (J 3,® Sootcti. Gitbey's Gin. Bombay Gin. Balley's Original Irish Cream. Grand Mamier. Absohrt'Vodka) LORILLARD Newport, Seon, Kent, Truwnph; Kent Golden (aiv. Loewe Corp.) ~ LipMS,' True. Old 'Go/d: Max; Beech'-nut. Chewotg Tobacco CNA Financial (Continental Casualty Corporation and its insurance and tinaneial af(iliates): Generat Finar" Corporation. Loews Motek, Loews Thwres, Bulova Watch Company. AMERICAN TOBACCO COMPANY Lucky Shitre, Pall Nfal1, Cartron, and Taroyron Franklin Life Insurance Company. Soumt>ynd Lite (div. Ateeriban 8rands, Mc.) r:igaredes; Hafl and HaN, and Bourbon Blend ktsurarxx: Pirokertoes, N1r., Master Lockk antoYanp tobaccos; La Corona, Anronio :y Company,: Swinglinr Office Supplies. James 8: Caopatta,' 1+1or Tani and Grenadiers cigars' Beam DisdNery, Surtahine Biscuits. Wilstx+,Jones Office Fortns: Acme Visibk Office Supplies. ritleiat aed Awshrwt golf products. Andrew Jergens Company U. S. TOBACCO COMPANY Skoat: Skoaf 9andits, Copenhagen, Borkum Chateau Ste. MidteHe wines. Zig Zag cgarette' RiN. Mnphora, Perfecto Garcia papers: Cedar King pernals. Dt: Grabow pipes CULBRO, INC. General Cigar Co. (Garcia iy Vega, White Owl, Snacktime Canparty (Golden Pop. Chesty Potato Robt. Bums, Corina, Wm. Penn, TupaNN'o. Chips. Pepitos, Snack Time). fmpenal Nursenes Tijuana SmaAS, London Dock, Kentucky taub), Helme Tpbacco tYompany'(GoNd 1,?rver, Mail Pouch, SXver Creek, Redwood, Chatanooga Chaw). NOTE: Sources: Company annual'repurts (1982 or 1983) and news re/eases. Based on latest available rnformation, CCopyngM 11'9M NatiDnal. IntNa9enCY ~CCUnCIt on Srtqkrtl9 efll! Health PrapueC by'V1ldlum J. t3a1Ny: MPH L,-11
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f 364' MN'ENJN M. KRIS7EM estimates (7d)' TUesr percentages are applied to the familiar Cooper, and Rice calculations ofithe economic (d~oilar) costs of these diseases (7; 18pand are then adjusted for inflation. The total! figure for the annuai excess-illness cosc (i:e.. direct' excess medica)-eare spending due to: smoking (in January 1960 dollars), would be over 5111 billion. The author has seen, an early draft of a toore' recent attempt at a national estimate4the zedical care cos[ of smokin.g based on the experience of~an Oregon Hh+IO sample of some 2,300 persons.(79) that anives at an upper-range figure of S+t.S'billion in 1960 doliars:"The study covers a nel*tively small sample for only 7 years. ln fact, the short-run quitters have a 26% excess usage as compared with quitters of over 4 years standing. One may use this figure to adjpst;the upper range estimate partially to refiect the smoker/ex-smoker difference which would be found in a longer follow-up (e.g., 20 years, which is the lead time for the relation- ship of respiratory caneers to smoking). This raises the Oregon HNlO estimate to 547 bl7lion: Seven years is barely enouglttime to establish a relevant minimum rate for bean diseases and respiratory diseases for the eoltorc; E2% of whom' were under~ 65. IUSo„ttie ex-stnoker group appeared to consist mostly off persons whoo qvit becausr of tllness, larsely beart disease and respiratory disease. How many of these costs may, be assigned t o the employed! population? How, tmany of'that populatiian's direct costs are borne by coatpany-paid health insur- ance? Dr. Jeffrey Harris has estimated'ahat there were S4!mtlfion smokers over the age of 17'in 1978 (18). Tbust dividing aggregate costs by population. one may say that the average adult stttoker. o+ves his or her lifetime. accounts for S 1A5-20![ of'the annual excess ttledical-care costs as compared with a nonsmoker. The indirect costs of awrbidity'and premature tnortality, i.e:, some 330,00!D premature deaths (78)n, which involve considerable personal losses to the itldividual„ his or her &m1y,and tlle;societyas a,whok: are sepameftom,the direct costs and average' over, two times the dollar cost of direct medicat-eare costs (7,18): They' are excluded from the discussion at this point, since they are picked up in later sections,of ttie paper on abseateeism, etc., aod do aat repnesent direct heatth-care costs to the employer. In the author's 1479 paper (40, be attempted an ~ahtraative type of cost calcuia- ttioia, differing from the l.uce attd Scbweitzer approach to the deta: Rather, it was • 7>ta Anaieas Qresr Soeisty aewaaes drt ss,okiss ia;anoeirsd .~ Jt IF dltie ireidearce aed ! 41% ef tia Maths ans to aaopiaaau (1): Alio. 7096, o['the #atas due to clrpeic obur uctive pulmonar) Auaau .ee r.lar.d'to araki.{ Rs-7p: awdovaaedv ii.rases lCVDI io tse so: to s6year-old ltopalaiioa. aspaoiaily adde.4aati Mut,.aackan ate Ye.vily asaociated with tnroties. Swisucsl atwdiea Yave foaod ewokia5 to bs tYe variable tbat •'taptrini'" up to SO% af'tlre vatiarioe.in CVD simtahWem tiwr(+17). The upper tanse d mrotifWt imp.ct an major'diseafes a'probaI for a.6pras asepiauas. 35% for cardiowtaodir disea.es. 65% for rssyirxay diaeases. e'Vop a.d ScDMeieaa faoad a 294E atars aedicai are ayaEe by •'e6cir.* soatiauibs smokers vs aMaoters ie t!e Ore~ HMO (79). t3is lower ttre aay r.pesena:ecornocted eswn.te of,tee:3p K aaieWe raaatly'poltdI or it may, reflect the stwn'foUowwp period ofoely 7 ytan and the fact iAar tlw ea-smoha Vouo w keavn'ly weiSAtsd .rith petsoas wAo auI tbeir doctors' advloe, a e1lenin5 , tt,e *r.asaae ,d $aious diuase ~. M,-13
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J 9-UIC t- S !4 NICHIGAN S'URVEY' 8 --- C5D-d ---------- ( How much wou l d y'ou say a0!4 a100! f i ts your i mpr ess i on of Lousna: a great deaii somewhate a Iiittlie, or not' at'all?) b. moral c. provides strong lleadershipp d. understands the Orobi ems of' peopl e l iNce you 1. A GREAT DEAL 2. SObEwHAT 3'.. CAN•T' DEC'I'DEI I'VOLUNTEE'R57 4. A LITT'LE 5'. NOT AT ALL 8. DCN •'T' KNOW <NUM kX : V19,6 <',NWM M> : V187 <NUM #> : V168! --- Cb ---------- Suppose the election Nere being he1d today. If Ronald Reagani were the R'.epuiblican candidate for President with Geoirge 8iush M i s V ilce-Pres i dent and Wa l ter Mio.ndaI'e were the Democratic caind,idate for President wiith Geraldine Ferraro his Vice-Presi'dents who would you like to see win? l. REa:vAN-9USH'. 2. MONOALE-F'E'RRA:R0 3. 7THER 7. WOULD NOT' VOTE 8 . D0'V • T KNOW C1:37 c-j pCGr." 1-3 :MUy ;r> : V18'9
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12 REFERE111CES' Alexander vs. Wn.mploynisnt k1suranoe Appea/s Board, . California Cburrt of Appeals, Apri11, 1980 Brooks vs. Trans Work/ Airlines, California Workers' Compensation A'ppeals Board,197b Dotl IR. and Pelo R!: Causes of Cancer: Quantitative Estimates of AvoidsbNs Risks of Cancer /n the United States Today; Oxford University Press, New York, 1981. Fuentes vs. Workrnens Compensation Appeals 9oard; California 1Norkers' Compensation Appeals Board,1976. Gibson vs. Starkist; CalifomiaiUnemploymentInsurance Appeals Board, July 14„1983: Hirayama T: Non-smoking wives of'heavy, smokers have higher risk of tung cancer: A study from Japan, British Afledical Jotrrnai 282: 183-185,1981. Hurshman L.G.. Brown 8'.S: andiGuyton'R!G.: The impli+ cations of sidestream smoke for cardiovascular health; Journal of Environmental Mealth 41(3):145-149;,198h l Kent D.C. and Cenci L.: Smoking and the workplace: Tobacco smoke health hazards to the involuntary smoker, Joutnnalof OixvpationalAMdicfne24 (6); 469-472. J982: Kent D.C., Schram M. and Cenci L:: Smoking and the workplace: A review of'human and operating costs; Personnel Administrator29-33, 83, Augwst 1982. KKristein M.M.: How much can business expect to profit from smoking cessation? Pntw.ntiw AOedicfne 12: 358-381„1983. Kristein M.M., Arnold C.B, and Wynder E.L.: Health economics and preventative care, Science195. 457-462; 1977. Parodi vs. A/erft Systenes Protrctbn Board, #80-7671, Ninth Circuit UnitediStates Courtlof Appeals, October21~ 1982 Pinney J! M.: The largest preventable cause of death inthe United States. Public Health Reports 94 (2)r107-108. 1979: Repace J.L. and Lowrey A.H.: Indoor air pollution, tobacco smoke, and public health. Science 208: 4!64-472.1980. Shimp vs INew Jersey BNl TelepNone Comp.ny, 145 N.J. Super., Superior Court of New Jersey;1976'. Smith vs: Western Efectric Co., Missouri Court of Appeals September 14, 1'982' M-47 United States Department of Health, Education and Welfare,,AdversrHealth Fl/.abt olSmoking and the Qccupational'EmlronrneM; Current Intelligence Bulletin #31. National Instituteof Occupational Safely and Health, DHEW Publication No. (NIqSH);,79-122.1979a: U. S. Department of Health, Education and Welfare. Smoking and Health: A Report o1 the U'S: Surgeon Generai; USDHEIIN Public Health Service ONice fonthe Assistant ~ Secretary for Health, Office on Smoking and Health„DHEW Publication No. (PHS) 79-50066.1979b:. U.S. Department'of Health andiHuman Services. The Health Cbn tequrenar:s ofSntoiring, The Changing, Ctg,-*: atb-A Report ol th. Surgpon Ganeral: USDHHS, Public Health Service, Office on Srnoking,and Health, . 1981. U.S. Department of'Heatth andlHuman SerNices. The Flkalth Conseqwenc.s of Smoking, Chronlc Obabuctire. Lung Disease-A Report of the Surgeon General, USDHHS. Public Health Service, Office on Smoking and Health„1984. Weis W.L.: "Nb its, ands orbutts"-Whyworkpface smoking should be banned; Yinagmsnt World: 39-44, September 1981. White J.R. and Froeb H.F:: Small airways dysfunction in nonsmokers chronically exposed to tobacco smoke, illew England Journal of'Medicine 302: 720-723. 1980. N O N C![ ~ 00 CJ ~ 0~
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4.9-Dc t-fi4 r~.1 : 3,7 : •,. MICHIGAN SURVEY 9 ----- - C 4b -0 (H o« m uch wou.10 you say ;aD4 i)DIC fi ts your impr essi of L ev in: a great dealt sonewhat. a iittle, or n ot a au mor a ) c. provides strong leadership 1. undersfanas tha problems of aeoole like you 1. A GREAT DEAL ?. SOMEWHAT 3. CAN'T DECIDE (VDLUNTEERS')~ 4. A LITTLE 5. NCT AT' ALL 8. DON'T KNOW ,)a *> : Vl'92' <NWM 9> : V'104 j A ie> : Vl!83 - C 5'a ---------- on, t aill?) Nbw about Jack Lousma. Hbw much would you say ^intel 1 i'gent" fits your Ilmamession of' hiT: a great' deal, somewmatt a littieI or not at a I 1? I. 4.r. R E A T D'E A'L 2. SQNEWH,AT ?. CA'I•T DcCIDE: •.., A, LITTLE 5. NOT AT ALL q, DON'T rNtCW : V'185 ( V'C'L' UNT'E'=RS ) C N~35.
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1 THE I'::?E?ENDEt(T ST:1Tii:YIDE SJRbcY OF FU8:1C O?;UCU E'$TAuUSi-wEDi IJ: i'E:i 81 MERVIN 01 FIELD. 234 Nor.t'Street, :aa F!+_n:rs:o 9d1111 t315au:a5163 COPYRIGHT 1984 BY'THE FIELD INSTITUTE. FOR PVBLICATIIDN BY'SSIBSIGtIBERS ONLY. Release 11237 Release date: Wednesday. February 29,. 1984 STRONG SEN4'IMENT'TOiRESTRICT IMPORTANT: Contract for'e:his SHOKZNG IN PUBLIC PLACES. service is subject to revocation if publlication or broadcast takes place before release date or if contents are divulged to persons By Mervin D. Field outside of subscriber,staff prior. Di!rector, The California Poll to reliease tisa. (ISSN 0195-45'201): If former smokers and those who have never smoked had their way, there would'be a range of restrictions put on smokers who want to light up in public places. / Underlying a widespread negative:fee3i'ng about smoking is the belief that'sawking is not only hazardous to the heaSth of smokers but to: non- salokers who are nearby and breathe the fumes. The proportion of adul!ts who smoke has been declining in recent years, while the ranks of ex-smokers have been increasing to the point where they now outnumber current smokers in this state (3St to 26%). Ibn-a.okers account for 391 of the public. With regard to swoki'ng in restaurants, 77% of'the pubsic,prefer that it be limited to spec,ial saloking'areas and 16t opt for outright prohibition. In work places, 70% favor special areas for smokers and 26% think it should be banned. Oh airp,lanes. 5,91 want special' smoking areas, but a.large ainor- ity (3t!t) believes all smoking should be prohibited. A majority (SBt) farors specia,ll smoking areas in hotels and! swte3is, but one in three (33%) opts for no restrictions. On buses and trains, halflthe public (S'Ot) wants special areas for saokers, but an almost equal sized proportion (46%) thinks smoking should be prohibited4 These: findinqs co.e froa a statewide California !o1!1 eurvey conducted' in early February in which a raross section of 743 adults was asked about their current and forsler smoki'ng,habits and how they feel about a number of proposals having to do with,the rights of smokers and non-sslokers in public places. The following table illustrates bow the proportion of current smokers has declined in the past four years with ex-o.okers nov,representing: a larger segment than smokers. Incidence of smoking,among CalifornialaduSsa 1984 1980 t t Current smoker 26 32' Former smoker 35 26 Non-smoker 39, 42 74 CarAwwe !Pett Ns .OnMeA icwlliwarslT , siwce ]f57' es anwyeotwOtntn iwqptdr i wWia . tsewtired MMK eo,wrow :wes . sernce :..lhe pe1r . is swe of 1ee ee.wces ^e..0e0 M. The l.Nd. /qlAute. aww:O1o1A. wcw4y.rtnsn . er~enuetow N.Med i1o 4we f1r0/ e/ OW1.c, oorNOw ewe belta.-w..w ..oc.al ad Ool.l,cal i Yt1R3. hkl(Kr<) Ms1AYtel1{O/Wa1ed.14.MKDWIN!lie'.10•.wqetl oOSllAktlnRUMMlal+e/1 e! yetyl {WRT: (Mldif';S 101he pIDGEea0f0/. (rFet rnuGhc bwnelor;. TAe Itlt•tel[ rete+/M:11s Wyqecl 10e•1iKlMMK, aDreR'wew7a1,.1weEY:. N_,t, e aMYrce6
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0 :7'y-UC 'L- ,54 -- C'C'1d-q ---------- MICHI'GQH SURVEY 9 (Is the State spendin!g too rruchis too i'i tt'le+ or about the right amount on ...) C1:37 p-.. Y4GE' ' 117 Haiti'ng t'he rising crilme rate? ++ainta3ning the publ ic el'ement'ary and high schools? Maintalining the pubJ ic coi leges', and universi'ties? Welfare? 1!. TOQ, MUC'Hll 2. ABOUT RIGHT 3. TClO' L I TTL EINOT ENOUGH 8. Di©k•T KNOW 4UM e : V201 NUM 0 : V203 AUM e : V202 NUM a ; V204 CC 2 ----M~_-. Teaehing,f researc!h, and public servi'ce are the three main functions of col iie-aes and universities. For eachiof thesev pilease tel il me i f you .~ feel it is a very i~npo~rtant. somewhat i!mport'anti somewhat unimoortant. J or very unimportant purpose of' higher education? Let's begin with te2ehinge Would yow say it is a very important, samewhat ilmpor'tantv somewhat unimportant. or very unimportant purpose of higher education? And research? And publli'c servilce? 1. ' VERY I MPORTANT 2. SOMEWHAT I MPOItTANT 3. SOMEWHAT UNIMPORTANT j# . VERY UINIiMIP'OATANT 8. OiON'•T KNOW NUiM p' : V205 NUM 0 : V207 NWM •' : V206 v-L0
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i . 10 G x;~~_N7W I1MWlLEMEJtITATlON ISSUES Eenpi+oy.. Atttitud.s One ofthe most difficult aspects of smoking regulation for employers who do not wish to adopt the third policy, involves the regulation of smoking in work spaces shared by smokers and nonsmokers, Often merely designating a portion of the space as a smoking section is ineffective in protecting nonsmokers from the effects of cigarette s.moke: If'a clear-cut decision mustibe made between the rights of nonsmokers to clean air and the desire of smokers to indutge; it is important to realize that nonsmokers are usually in the maprityand'that public attitudes now favor smoking, regulation. According,to the National Center for Health Statistics only one-third'of adultAmencans are regular cigarette smokers. While this means that there are 51J million smokers; the proportionof the population that smokes iss the lowest in forty years: Over 33 million Americans are fo mer smokers. Given these statistics, it'is not'surprising that smoking,is less acceptable than it used tobe:. Employers who must deal with smoking regulation of shared iwork spaces will find thektask less complicated if they affirm what is already the reality-NOJWSMOKING IS THE NORM. Shoking is allowed only in designated areas. Tiehnioal:oNrtioes The simplest and most effective way to deal with the problem of smoking in shared work spaces is to prohibit it. Smokers can be allowed to smoke in a Separate room set aside for that purpose during a break or lunch hour. However„if it is felt that this type of'nule is inappropnate, you may want to consider other more technical means of protecting your nonsmoking employees:. The following information should!help you deal with the problem of'shared work spaces. Vrntiirrtion i Areas where smoking is allowed should be located directly under or as near as possible to windows or return air ducts: The prevailing air flow should'be toward the areas where smoking is allowed. In some buildings there are differences iniair pressure indifferent'places. Smoking areas in these buildings should be in the lower pressure zones. The degree of air circulation in abuilding is very importanti The number of airchanges per hour and the quantity of ar being !circulatedlhave a direct and Isignificant' effect on the amount of secondhand smoke your employees breathe. Energy, eefficient buildings may present special problems: since they often have a much smaller number of air changes than conventional buitdings. If a!building;s ventilation system transports smoke from one roorndo another via heatmg and cooling dwcts. non. M-45 smokers may be exposed to secondhand smoke even if . they are in rooms that are completelyiseparate from those of smokers. Air Purification Some people have attempted to deal wittfthe problem: of secondhand smoke through the use of air purifiers and' special ashtrays. Unfortunately, these devices have only a very lirnited abilitytm removeparticutate matter fromahe air and cannot remove toxic gases such as carbon monoxide. The most effective; and'most costly, mechanical way to clean the air is a whole-room ainfiltration system. This wouldlconsist of electrostatic precipitators and highi efficiency particulate air (HEPA) filters. Both systems mayy be used together. Electrostatic precipitators contain charged internal plates which electrically trap smoke particles, removing thernfromtheair. Theyrnaybe bought as either portable units or for permanent installation in air, conditioning or forced airheating diicts. The equipment is usually quite large and requires a source of high vottage to charge the collector piates: The collector plates must be cleaned often. HEPA fitters are considered the most effective type of'fiftration system, but they are also the most costly. It is advisable to obtain the iprofessional advice of an industrial Ihygienistior ventilation expert before buying any type of 9arge scale air filtration system. Table top air filters remove some particles from the air and some of them can absorb or mask odors. However, they have very limited capacity and are usually ineffective. Ion generators create electrically charged particles which cleanse the air by attracting smoke. Particles fa11!to the floor or, other surfaces and adhere to the walls. Since the particles are not actually removed, they may becornee airborne again. To remove the particles surfaces must be wiped down often. "Smokeless ashtrays" trap cigarette srnoke and!keep it from drifting out of the immediate area: according to . manufacturers' claims. Another type of ashtraylopens and closes so cigarette butts and ashes can be covered and the odor lessened. These ashtrays are thought to be not very effective in trapping particles or noxious gases.
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09-uct-W4 M'.1'CM'I1GAM SURVEIV 8' - C 7'a -------- -- NioM we'd 1ike~you to telll us about Ronald Reagan"s chances of winninq the presidency In 19:84. As before. we wi11'1 use a scale that runs from CY to 100 where 0 repiresents D04no chiancea'.0C of winning the piresidencyr 50 represents an! 804even chance2i00,9 andl 100 represents o04certai'n v'iCtoryaC'0. A9ailn, you may use any number from Oi to 100. Wha t~ ch~a~nce~~ do~ yo~u; thi nik R~o~na~lid~~ R'eagia~n~ h'as~ o~~f~ w'i nni!ng thie 1934 presidential election? 0-9Q7. ENTER NUiMBER 9!98. D0'N•T 1CA'Ok' J 1+'. NR M' : V! 19I0 - C7b ---------- C And what do yoiu thiink waUter MondaFe•'s chances are of winninqithe 1984 presidentiai -election? 0~-997'. E!NT'ER NiiM!eER 9 m 8. 1`'0N• T K'N OIH P k*p :' V191 - CS ---------- Suo'aose the: eliection for U.S. Senator were being held today. If C'ar1-levrin were the Democratic csndidate and Jack lmusm'3 were! the Repuibllican can'didatev who would you 1ike~to see win? 1. CARL LEVIN 2'. JACK' LO!US'MA 3. OTWER' ®. DON'T KNOW 9. MC'WLD NOT VOTE lUM a'S : V'192 N-3'7 :.1•,7 ?^"(_ P'AG- 14 C
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(Ji9!-0ct-84 - C3a ---------- y1CM+IGAN SURVEY 8 Now 3bout kal'ter Mondale. How much would you say °inteJligent"' fits your impressi'on of h[m: a great deal, somewbate a little, or not at al'I?' 1. A' GR'EAT' DEAL 2'. SOMIE'WHiAT' 3. CAN'T DECIDE (VOLUNTEERS) 4. A L1'TTLE 5'. NOT AT' ALL 8. IDON'T' K'NOIW NUM v> : V'177' •- C 3 b-d' ---------- ( t(ow murh wouil d,you say a04 a00 f i ts your i mpr ess i orn of Mornda)e^: a great deal!. sornewhatW a(ittle, or not at all?) b. moral c. provides strong i'ea,dershilpp do untier s'tands the pro'bl'ems of peopi e 1 i ke you 1i. A GREAT 0'EAL. 2. SOMEaihtAT 3. C'AN,6T DECI'DE' (VOLUNTEERS) 4. A LITTLE 5. NOT AT ALL 8. DON'T KNOW ,lUw r> : V1T8' <'NUMi M!> : V180. NUM' N> : V179 -- C4a ---------- Na'M about Cari' Levin. How much wou ld you say ^iintei'1 iqent'" fits your i'mpres'silon of him: a great deal. somewhat. a little, or not at all? 1. A GREAT DEAL 2. SOMEWHAT 3. CAIN'T DECIDE (VOLUINTEEIR'S). 4. A LITTLE 5. NOT AT ALL 8. DOH'T KNOW NUwi V> : V181 N-34' C'1':37 P, PAG". ~11
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79-Ott-24 . MII'C'HI'GA(V SURVEY 8 - L2 a ---------- ae' C i i ke to know your i maress i ons of Rona l d Rea9an. I am loinig to read a 1 ist of words and mhrases peop4 e use to: describe po1 itical' f~iqu-res. After each one. I wouil'd like you to: te:l1' me how much the word or phrase fits your impressUon of, Ronald Rieagan. The first phrase is "'intelligent.° Hon+ much would you say the word intelligent fits your impression of Ronald Reagan: s;Ireat dlea 1. somewhatp a 1 i tt l e.. or not a a 1 f?' I. A, GREAT DEAL 2. SOMEWHAT 3. C'AN'T DECIDE (V'OLUMT'Ec'RSJ 4. A LITTLE 5. NOT AT ALL p. OG:V"T KNOW Jy N > : V'173 - C 2,b-d ---------- L (How~ much would you say :C4 a'CL" fits yovr impressilon of Rea.-jan: a gr eat diea l. somewhat, a' 1 i tt f e, or not at a l t?) . b. c. •/0 moralpr ov i'daes strong 1 eadersh i p understands the problems of' people like you 1. A GREAT DEAL 2. SD!KEWHAT 3. CAW•'T DECIDE (1VJLUMT€ER5) 4. A L IITTLE-. 5. WOT' AT ALL 9. DJN"T KNCW JM x> : V174 <'NUM ft> : V17~6 Um +:> : V'175 N= 33
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79-0Ct-S4 --- C'9a ---------- MI'CHIGAN SURVEY 8 Now~we'd i,ike you to te1l us about C'ar1 Levin's chances of' winning the U.Si. Senate race in 1984. Usi'ng the same 0-100 scale as beforev what chance do youi thiink Carl Levin has of wi'nning the 1984 U.S* Senate race? 0-997. E'NT'ER NUMBER 998. aiOfV' T KNOW `JM sax : V193 --- CSb ------~~ And what do you think Jack Lousma's chances are of, wi'nning:the 1984 Senate race? 0-997. ENTE!R NUMI3'ER 998. DON' T KNOM N;JM! llfp' : V'194 'SKI IF'V5=2 THEN GOTO CCla-c --- C10 ---------- 0 Now I have a question using a seven-poinit scaie. Some peoptle think tht government should provi'Ce fewer services even In areas suchi as heal'th and educatilon in order to reduce spending. Supposee th3se peopl e are at one endl of, the scai e at poi'nt 1!. 0'.tb er people feel i't-is Important for the government to' continue: the services it now provides* even if It means no reducttion in s,mending. Suippose t'hese, peopiie are at the other endv at point 7. And of course: other peopl!e, have cpinions in between at points 2L3.4.5, and 6. Mhere wouJd you pt'ace yourself on this scale* or haven't you thought muctai about i t? 1-7. ENTER NUMBER 8. OON'T KNOW 0. HA'V EN' T THOUGHT MUCH' VUm iF : V1916' N- 3!8' c1:37 a~ pc~~ 1-
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C ;)9-co.t-34 MICIYIGAN SURVEY 8' -- As ---------- Now turning to busilness' conditions aDwin the state of Mi'.chip;ain-2DO' -- do you think that during the next 12 months we'II have good tines financiallyl or bad timesr or what? I. GOOD TIMES 3'. PPtO-CDnI o102(PF1D TO S'PECTFYI@00 5. 8AD TIMIES 8'. DON'''T KNG"W MuM a> : V15g :K1 I F V6=2 THEN GOTO 88, -- 51 ---------- A mroposed, amendment to the Constitution, would reQuiire Congresi to approve a balanced federalt buoqet each year. Government spendinq would have to be Iimiited to no more thani expected' revenues* unJ eas a thiree-f i ft'hs majority of'Conflress voted to spend'morethan expected revenue. Wouid! you favor or oopose this amendment to the Const i't'ut I on? 1. FA'VL'R. 2I. OIPpOSE 9'. DO'N •T KN@W )" M :' V'162 :V'1 I F V30'3'=""' THEN V303!=TME ( 1) •- 84 ---------- - Do you, th,ink the federal government will raise personal taxes in, the next twelve months.* or do you expect them to stay at their present Ilevei?' 1. YE.is WILL RAIS'E P'ERSDNAL TAXES 3. DEPENDS (VOLUNTEERED) 5. N0. EXPECT THEM TO STAY AT PRESENT LEVELS 8. DiON'T KNOW M N : V163 N-29
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(:9-Ort-84 -- CC7 --- ---- -- MI'CHIGAN SUIR'Wi:Y 8' Have youi heard or read about the Voter''s Choic° oropoS.a1 to revise the Michigan tax structure? 1'. YE'S' 5. NOi 8. OONI1T KNOW * r4'u : V318 .- CC7a ---------- The Voter's Choice Proposal would roll back taxes to thedr 1981 1evels+ and'new taxes could oniiy be passed by a vote of three-fifths of' the state legislature. The supporters of the Voter•'s Choice Proposai say It wilil reduce taxes arndi change the way money i s ra i sed and~ spent by state gover nment. The opponents say i t w i 1!i dr ast i'cali'iiy reduce revenue and e'1 ilmin3tQ many state servilees. Hbw about you' - do you favor or oppose the Voter's Choi'ce Proposal? I'. FAV'OR 5. OPP OS~ 4. 0010T K N 0W . JM' 9 : V319 -- 01 ---------- How at)out the electionithis November? Are you registeredd so that you c3r1i vote in Nf i ch~i g'a'n i n the November el ecti on i f you wint to? 1. Y'E S 3. NIO. NICT INi MICHIGAN 5. N0. NOT AT ALL 8. DON''T KNOW NUM a> : V223. LV1 IF V3,06="" THEN V306=T'NE(1) ~ ~1 0 ... F ~ C'= 1 •- C N-43
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MODEL MOMSMOJICJMG POUCIES' A successful ~norumoking poficy'is'usualty one which has been developedby an employerwhoihas taken the. imeto explain to his or her ernpbyees siome of the reasons'. behind its development and inplertMentation. The heahh reasons show why a non-srtroking policy is!forthe benefit of employees; the legal and lecavornic rsasons demon- strate that a nonsmoking policy is a matter of sound business judgment. In order fora nonsmoking poGcy to be successful, top management must show that Itiis committed to the policy. The policy rnust be specifia-it must designate the areas where smoking is prohibited and where permitted, and it must define enforcement procedures. Also, the posting of appropriate signs is a vital component of a successful policy. Every company will formulate a unique smoking i poiicy, in accordance with its own particular needs: The following three versions of a non+smoking policy may be used as models to stimulate development of your own unique policy, These three policies form the spectrum from ttte'least specific and enforceable to the most.• `Tnsse polic,.s are adapted Ihom reeommsndations of the Amencan LuN Asso=wn. Policy A In3nadualion: This policy may'tie rthe easiest one of the three to initiate since iit leaves aigreat'deal of'discretion to supervisory personnel and does not require'any sweepngi changes in working conditions. Its major disadvantage is that iit provides ambiguous'protection for employees and in the long run is extremely difficult to administer. Because the policy ladcs clarity and precision, it will require frequent intervention by supervisory personnel andimay be inconsistently enfbrcedJ leading to a perception that it is unfair. This policy should ihe considered as a possible beginning, rather than a long-range solution to the problem of smoking in the workpiace. ACME Coerpany,:nwlciM PoRey Smoking poses a serious risk to the health of'both i smokers and nonsmokers. Smoking at work is also an annoyance to many emplby,ees and a cause of lower productivity and increased unnecessary costs. For these reasons. Acme Company has decided to implement a nonsmoking policy whose aim is to eliminate the hazards associated with smoking ifor the,benefit of the company's employees and greateroverall econwrny: Effective , it 3s the policy of Acme Company to respect the preferencesof both'srnokers and nonsmokers in company buildings and facilities. When these preferen- ces conflict, employees and management will endeavor to find a Satisfactorycomprornise. If a comprornise cannot be found, the preference of the nonsmokers should prevaiU On requesi; supervisory personnel will make reasonable efforts to separate smokers from nonsmokers who request a smokefree work area. Smoking will continwe to be pro- hibited in areas where there are safetyor fire hazards and in other places desig nated i by the company. r.--4 2 C
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Support for Regulation of SmoiOng ~ in Public Places Surveys can usefully measure the degree of the public support for policies that would affect the environment. One recent controver- sial issue concerns regulation of smoking in public places. Twenty percent ofladulrc Americans think that laws shouldlprohibit smoking in public places. Sixty percent say, instead, that separate smoking and nonsmoking sections should be required. Fifteen percent believe that smoking in public places should not be subject to regulation (Table 1'3•2). Those who do nor smoke, are twice as likely as those who do smoke to favor outright prohibition of smoking in public places. Nonsmokers who are exposed to ambient cigaretite smoke at home tend to be albit more toleranrof smoke in public places than are adults from households where no one smokes at all. However, sol id' ma jorit iies of' both smokers and I nonsmokers saythey, would support a requirement for separate smoking and nonstnok- ing sections. These findings suggest the political feasibility oCa "separate but equal" strategy for advocates whoare interested in improving the envirvnment in public places.. 30 ;p- ~.~.1~:Y'~'••'fa '~ 4Y.`M.VIV' Procedures for Compu the Preven tion Index The Prevention Index is devel- opedlfrom information collected by . Louis Harris and Associates, Inc. inn two national surveys: 1. Self-reported practice of health-seeki ng, behaviors based on a random sample of' 1,253 members of'the conti- nental United States adult population and 462 adults most familiar with the health of a randomly selected!child in those same households, and. 2. Ratings of the importance of these behaviors wit'h respect to their impact on the overall health of the general adult and!child population, as determined bya sample of 103 representative experts in disease prevention and healthi promotion. Heal'th-seeking behaviors weree chosen using the following criteria: 1. A clear consensus, bothlin the research literature and among representative experts, with respect to a, documented relationship between compliance and the prevention of disease or injtarv;=' 2. The application of each health+seeking bLhavior to the entire adult populatiiun: and 3. A clear abiilit' y on the part of individuals to control their own compliiancc/nuncumpli- ance (therefure, (he exclusion of important environmental detrrminants of healit)n, such as exposure to air pollution or industrial toxins). N-1i6 Compliance with health-seeking, behavior was defined simply: A given respondentl either complied or did not' comply. The characteristics of specific health behaviors deter- mined the definitionlof'compliance/ noncompliance for the behavior. For continuous variables (for example, moderate alcohol consumptioni exercise or frequency of dental examination) compliance was determined by the prevailirog consensus available from the relevant professional literature and from personal communication with various researchers and spokesper- sons forprofrssional organizations. For those health-seeking behav- iors wi't'h no clear consensus on a minimum compliance level (for example, taking steps to control stress or restricting cholesterol I intake), compliance was defined in terms of either always engaging in the behavior (taking steps tiulcontrul stress) or of, trg ing a lot (as in restricting cholesterol intake)~ The specific definition of compliance' noncompliance for each health- seeking behaviur and relevant documentation of thow definitions are presented in the Prevention Index technical report (see box bL60. The overall e.rperd rating for the importance utlracfo separ:uw health- seeking behavior was cumputtid b-, simply deriving the arithmetic mean for the sample of 103 uxpcrts.. The Index is keverl!tu a base ull 100; delined as l0(D per«nt uf'thr ~! adult or child pupulatiiuns uilthr O N Ulnitecl Stateweneaging in allluflthe relevant key health.seckinE btiha~- ~ iurs fiureach pupulatiun. ~ ~ CJ ~ ~. C
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!i9-0;.t-84' --- © 2 ---------- NICMIGAN! SURVfY' 8 'Vow~~ in 1980 ~ you r~~ememter ~~ thatRo~na,ld R'e~~again ran on the R'esaubl ican ti'.cket a~!ainst .limmy Carter on the Ddrrocrati'cc ticket. IDo you remember for sure whether or not you voted' in that ellection? l1I'F VOTED) Which one did you vote for? 0. DiD NOT VOTE 1. VOTED F'CR REAGAN 2. VOTED FOR CAR?iER 3'. V©T'ED VOR AND'ERSDN' 4. VOTED FOR OTHER CANIDIDA'TE' 5'. VOTEiO. NA FOR WHOM 8':. D',C.4I•'T KNOW, CAN• T REHEMBER' <'NWW it> : i224 (CVl IF V5=2 THEN L37="in the Iast'month"l ELSE L37=n" --- C 3 ---------- As you knowv the pol iticia) parties try to talk to as nany people as they, can to flet them out to vote for their candiidate. Has anyone f'r om a po l ilt i ca1 Party ca l1ed you or come ar oundito talk to youi('L37] about the campaiigns thi's year? - 1'. Y'.-: S 5. NO IN1JM I : V225 (SK1 IF V22'S=1 THEN' GOTO D3'a C'1 : 3 Q P- P'A~c 21 UIS C' TS ') ..
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D9-Cct-84. MIIC'NZ'..GAN SURVEY' 8 -- C 11 ---------- Oo you thiink It should be possib)e for a pregnant woman t~o go to a doctor to have ani abort i oni i f she i s marr iled and does not want any mor e ch i Ildr en? 11. 1f'ES s. n,lo 8. DON'T KNDW M s : V197 - CC'1a-c we are faced with many problems in the State of MichiQang none of, wh i ch can be soii ved eas i I'Y or i ne xpens i ve l!y. I'm goi ng to name some of these probiems+ and fom each one I'd like you to tel f me whether you think we're spending too much money on, itv too ('ittl'ee money, or about the right amount. First. is the state spending too much,o too iittler or about the right amount on improvi'n9 and protectinq the environment? Improving and protecting people's heallth? Soiving tfie probl'.ems of the biig cities? 1. T'OJ MUICH' 2'. A'BOtJT' it I GHT 3. TOO LITTLE/NOT ENOUGH &. OON''T KNOW M & :' V198' NUIM e : V200 :M « : V199 :v1 Ilf V3'05="" THIENI V3D5'=TyIE'U) C?'•?7 r~ ( r
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79!-C':.'t-34 MICHIGAN SURV';.Y 8 -- CC3 ---------- On another topi c. dio you know how, many plub i i c f our-year colAe9es and'universitiles there are in Miichigan? (IF YES) Hoiw many Is t'hat?. 01-90. ENTER NUMIe'F'R 98. DON'T KNON, iiK tv : V208 -- CC 4 ---------- Do you think that the ouality of'the educalti'om at each of these oubli'c collleqes and universiities is the same or that same offer a better educati'on than, others? 1'. THE SAME ' AT ALL 2. 8'ETT=R AT SCMIE C )IM e : V209 !K1 I F V209=2 THF.1•: G'OT0 CC4a Z1 ::7 P PE,r,E' 1; 1 [G:, T.." C" -- CC ca ----- ----- Mh3ch ones do you thiin!k offer' a better education? 1l. U"wIVERSITY OF MICHIGANI 9. SAGI'NAW VALLEY STATE C'OLLEGE'. 7.. HICHIGAN STATE UNIVi:RSITY' 10. GRAND VALLEY STATE COLLEGE. 3. WAYkIe STATE UNIVERSITY 11. LAKE S'UPE,RIOR STATE COLLEGE 4. C_NTR'SL MTCHIGAN UNIVERSITY 12. FiERRISI STAT'E' COLLEGE 5. W'ESTERli MI'CHIGdN UINIV€RSI'TY 13'. M ICHI GAN ' TECHNOLOi;I CAL URJl VE? 5'.ITY 6. NOIRTH:RN MICHIGAN UNIVERSITY 14. U OF M - FLINT' 7. GAKLAND WMI'VE'RSI'TY' 15. U OF H- DEARBORN 8'. EASTERN MICHIGAN UNIV'E'RSITY 90, OTHER'(PF10 T'0'SPECIFY) 5------------------------------ ----------------------- ------------- : 1 1!W'E'R: ENT€R' ALL THAT AP'PLY:' ENTER 99' FOR' NO FURTHER M!ENTI1O'NS. 1, :! ----------- -N----- -N -M---------- M M-- -- -- -- t M . , . . - -.l---- --------- ~-- -j r x : V210 HtIM A : V212 tVUMI il : V214. Uw 6 r V211 HuH' 0 : V213 NLIMI q : V215 ~ ;K2 IF V2'11=99 THEN GOTO CC5 Cl1. ;K3 I F V212s99 THEN GIOTO CC'5 ~ iK4 I F V213'=9'9 THEN GOTO CC5 ;'K.ti I F V214=919 THEN GOTO CC5' ~ ~ ~ N-41
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79'-'-'ct-94 +IICH1G'A'ti SW-.VEY' 8 --- E'2 ---------- We haar a~ l ot of' ta 1 k t'nese days about I i ber a l s and c'onserva ti ves. I am going to read a five-point sciale on whilch the pol iltic3l views' that people hold are arranged. Point' I Is very Illberal:; point 2 is somewhat liberali: point 3 is moderate or middle of' the road': ©oint 4 Is somewhat,coins'ervative: and p'oint'5 Is very conse'rvatilve. Where s+ould you place yourse l f on thi's scalel or haven't you t'hought muchiabout i t? 1. VERY LIBERAL 2. SOMEWHAT LIS'ERAL 3. HIOOERATE'. HIO©LE' OF THE R'©A0 v. SJyEwHAT CONSERVATI VE' 5* V'S'aY CONSf.RVAT'IVE q. OIOW'•T KNOW 7. HAVEN'T THOUGHT' AUC,H N'Jr, X : V262 (:SK1 IF V2b2=4 THEN GOTO E2a GSKI IF V262=©' T'M€N GtTJ E12a --- E2a ---------- If you had to ehoosav would you consider yourselif i Ii'beral or conservative? I. L,I'IIER'A'L. 3., Mi0'OEy'AT'E. MIDDLE OF THE a0,yp 5. C0NIS!='RV'ATIV'E 7. RE°US°_S T0' C',f90:SE 3'. 'OO,VI'T N:Nn'W, NJ M' w : V263 N-50 C1 : 3 c''F~G~ ~ GGC TCIs -
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C1!:3e v4 *-G= - 2= M'ICH'JGAN S'URV'EY 8 D6c ---------- Did the co-ncr.ercla!I for Walter Mondate make you more likeiy to supoolrt himi. less li'kely, or dildn't it make any d) ffere.nce? 1. tiOR'E' LIKELY 2'. OID7N''T MAK'E' ANY DIFFERENCE 3.~ LESS LIKELY 8. DDN'T KNON. JiN N' : V'255. SKOi IF v249<>2 AND V250<>2 AND V'251<>2 AND V252<>2' AND V253<>2' THEN' GCTC DF.d -- Dbd ---------- Did the cw+mercia,l for Carl' Levin make you more 1i'kely to suipport himo less likely• or didn't it raalke any diffe~rence? 1. MORE LI'KE'LY' 2. 0I 9iH' T' MAKE ANY' O I F'F zR E'.wCE 3'. LESS LIKFLY 3. DON'T KNOW 1w ~t : V25e :KD IF V249<>4 AVI'i V2.0<>4 AND V251<J4 AND V25204 AND V25'3<>4 THEN GiCTO 06e, .- 06,e e ---------- D'rd the comimercila/! for Jack Lousma make you more Iiltely to support hi'm.-Iess likely, or d'Idn't Ut make any differencz? 1. 11:.It E L I K E'L Y 2. OION•T MAKE ANY DIFFERENCE 3'. LESS LIKELY 8. OOW•T KNOW . V257 KD IF V249<>5 AND V25I0<>5 AND V25I<>5 AND V2S2<>5 AN0 VZ5'3<>5 THEN GC7C E1. N-48
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C9'-CC t-94' MICHi'G'aN SURVEY' 8 E'1 C ---------- (L2?1 a~ uni on member? ( 1F YES) Who wouJC that be? 1. YES, AtES'P'ON'DENT' ONLY 2. YES, RESPmT1DENT AND SOMEONE ELSE 3. YES, OTHER HEHIBERtSI N0T' I'NCLUDING R 4. N0, NO ONE IS A HEIHBER' 8i. OON•'T' KNOH a021 PROBEI@00'. M x> :' V286 '1 IF tV2'81=P0R VZ8'2=1 OR V283'=1 OR' V284=11 THEN L37=1 ELSE L3'7=J 1 IF L37=1 THiEIN L35=N inciuding your job" ELSE L3'5=^" What is the highest grade of: school or year compi e ted? of~ coil l ege you GRADiF.S OF SCHOOL COLLEGE'. 0^Ji 07' 13 01 08 14 02' 09' 1'5 03 10 lb .. 04 1'1 17+: ENTER 17 0 5' 12'. 06 1H r,x> : V2'87 1 I F' V287>12 AND -V287<18 TH!EN GOT'0 E'l lb - E l l a ---------- Did you~ get a high school graduation dl!plloma or pass aa h i gh schoo 1 eQu i'va i ency test? 1. YESI 5. N0. ~ At> : V'288 G1:?9 Pa~ PA SE ;Z to (G'C TO E'1 Zl N-55 1
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:"9!-'~ Z t - ° 4 --- E,?b~-e -------- -- MICHIGAh SU~;VCY 8 ( I' And where woU!'d you pla,ce Conalc: Re3qan on thils Sea[e, or haven't you thought much Lt5out it?. dhere would you pllace Wal'ter Monaiale? wihere would you pllace Cart Levi'n? Where would you pllace Jack Lousma? 1-5'. ENTER NUM3E!R' : 1.. VERY LIBERAL ;, B. D:NI2T KNWW i 2. SOHE'WHIAT L I3'E'RAL ~ 0. HA'VcN'T THOIUGHT MAJC:d i 3. MOOERATE. MIDDLE OF THE ROA'0' l 1 4. SOMEWHAT CONSERVATIVE :. i 5. VERY CONSERV'ATIIVE' ; •iUF! A :' V264 NUf1l 0 : V266 NJM A' : V265' h!J!" N : V267 --- =3 ---------- C wo.+ often dio yoiu watc'h local TV news broadcasts in the evening?' 0'o you do thi's every evening during the week9 t.hr ee or four t i rnes a weelC* once or twi ce a wee!k, or less often than that?' 1. FV_RY EVEI,ING 2. THRE'=_ CR' FO'JR T1'M!ES A Wc!FK 3'. '?NC_ C@ TW'lCE A WIE':K 4. LESS OFTEn 5'. NEVE2 9. 7iC'+v • T' K NIOW' 4'Jr• a : V26R i'SK.O IF VS=Z' TwEht G^70 ;:5 I'SK1 IF V268=5' T'H=N GCTO1 E4 --- E3a ---------- whicM channel do you watch most frequentl'y, for the evening news? 1-47. ENTER NUM!B'ER 9'2. 0'uN''T KNOW qu w a V : V'2'6-3 ::K1 IF v35=3 THEN G^T0 E'3bi GG^. T" ..;? 1 - . , Q=:;' _•- N-51
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( ^I9-Oct-8k MIChQ.GANi SURVEY 8 illb ---------- - Oo you have a col Iz,M degrea? 1. YES 5. N'G a> :' V289 E12 ---------- C1 :39 ?'A P4GS 34 To get a oi'cture of' peopile's financial situation we need to know the genera l ra!rage of' incomes of ai'I people we! interview. Now. thinking about 11321 total income from all sourcesiL351+ di'o FL2?'1 reeeive S'20.C0'0 or more in 1983'? 1. Y'QS 5. N0 M> : V290 I F V29C'J1 TH°N' G'^JTiO 2129 C F 12 © ---------- Was i t E3O,.r,'00 or above? 1. Y"cS 5. N0 X 2 : V'2i91 IIF V2'91>1 THEN GOT'0 E13'. B12c ---------- Was it 535.003 on above? 1 . Y E S'. 5. N 0' y> : V2'97 IF V292>1 THEN G0T'0 E13' N-57
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t^ 09-Cctr84 M 1'C Ha G'aN' SUa:V':'Y 8 -- E4 ---------- Do you read a dta i 1'y newsoaper? 1. YES 5. N~0 NuiM a> : V27'1 SK1 IF V271=5 THEN GOTO E'S -- E42 ---------- 0 Which onet's)~ do you read?' 0'1. ANN ARBOR NEWS 11. LANSING:STATE JOURNAL 02. 3ATTtEI CRE'EK ENGUI'Ri:R/w:NS 12. MONROE NEWS 0.31. 3'A Y' C I T'Y, T I uI F S 13. MT. CLEMENS MACONB DAILY C 0i4., BENTJN HAR8On2 HERALD P'LQM'. 14. MiUSKE.GON C'HRO'NI C'LE 0'S':. 0'ET7OIT' FRrE P7'ESS' 15. P0a*T'IAC OAKLAND PRESS rf a. DIET R D I'T'. NE kS 16. P'ORT' HURON TI MES MER'AL D 07'. FLIMT JOURNAL 17. QOYAL OAK TR I t3UN'E 08. GRAND RAPIDS PRESS' 1E. SAGINAW NEWS Dai. JACKSJra CITIZEN PATRIO'T 19. T'R'AV'E'RSEI CITY iRELOR'D-EAGLE 1'J. KALAMAZ07 GAZETTE 2'0: OTHER ('PF'10' TO S'PEC'IFY) • . .------- -------------------------- -------------------------------- . t RECGRD FIRST THREE' MEkTliOINS: ENTE'R' Ofl FOR N0! FURTHER MENT7'ONS. t' :---------------------------------------------------------------- ~ :NUw a4> : V27? :NUM xa> :' V273 ';K'2 I F V2I73=00 THiEk GOTO E4b •-- F4,b ---------- <NUM! it &> : V274 Hbw often do you, read newspaper stories about state and Iocaf taol i'tics and governnent -- atlmos't every days a fewf times a weeltt a few times a morntri, or less than that? 1. 2'. 3. 4. 8'.. ALNDST EV'ERY' DAY' A FEWl TIMES A WE_.K A F EN T I1MES' A MGNTtHI LESS F'REQIUENTLY t) 0N'' T K N G'H : NUy P> : V275 rli•?: -• N-S3
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C9-CCt-94 yICHQ'GA'N SW2VEY' 9 E 121 ---------- Kas i t S50.0t10 or above? 1., YE S 5. NO w p> : V'Z93 _ E12g ---------- Was i t S10'.0fl0' or above? 1':. Y E'S 5. NO M X> : V2'94 :Ii IF V'294>1! THEN GOTO E13 E 12!`t ---------- was It S'15.OC0 or above? 1'. YES 5. N0 cM x> : V295 E13 ---------- - would yw mind, tei 1 ing me y'ouir' race or ethnic or igi'n? Are you whitev bI'3ck. Hispanic Americanv or some other ethnie or i g iin? 1. WHITEs EXCSPT HISPANIC 2. BI.ACK. EXCEPT tNISPAN.IC 3. HJSiPANIC 4. OTHER I +:! : VZ96. i IF V'296=4 THEN 60T0 E13a N+-58 Cl :39 P,x PAGc' := [G0 TO' E13';' fG'0 TC Fi41 N 0 . N (A
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C7-U: t-_f. MICHi'GIAN SURVEY 8' •-- E3'b ---------- [!n which city, does that news stiiow originate? C,aEN : V?'Tr]~ --- E3c ---------- Oid you watch any of the televised debates bet++een the pre.silaenti'a1 or vice-presidentiaf can~didlates? 1':. Y'E S 5. NO M'J!M N : V320 ( SK1 I F V3'.20!=5 THEN GOTO E4. --- E3d ---------- was there anythiinq In particular you remember fromithe debates that impressed you eithet favorabiy or unfavorably about any of the eanidi!dates? fiHhat was tbat?) (IF NECESSARY - Qid you thi'nk of that favorably or unifavorabiQ?7 1. R'EAaAN - FAVORA3LE' 7. 3U'SIH - FAVORA,3ILE', 2. R'EAGAY - NEUTRAL 8I. t3USFH - NEUTRAL 3. R'EAGAN - UNIFAV'ORABLE a. t3U'SIH - UNFAVORABLE 4. MGN+3ALE - FA'VOIRA3LE I0. FERRARO - FAVOIRA3ILE'. 5. MON'OALE - NEUTRAL, 1'1. FERRARO - NE'JTRAL 9r MQNP>ALE - UNFAV,C'RA'(3LE 12'. FERRARO - UNFAVOR'A9ILE 9:8. DC'V' T K'NICrI .------ ' . ------------- ---------------------------------------------------- :' 1'W:-Rs ENT:R' FIR'ST 9 M°_yT101NS; ENTER' 00 FOR N0 FWRTFIER ME'NTIONS. ~ '-------------------------------- -. . -------------- --------------------- , C''_''2 r P L NJM M :' V321 NUM. R : V323; NUM I : V32'5 NUIM 0 : v='2" Nur+ a : V322 NUM' a : V324 MUM iE t V326 NUM a : V32' [;K2 IF V3122=.10 TH!E'N, GOT'0: E4 [ iK3 1 F V323='r30! THEIN' GOTQ E4 ['SK'4 IF V324=00 THIENiG0T0 E4 ['SK5 1 F V3215='70' THE'N GOTO E4 (lKb IF V326*--d0 THEN GOTO E4 [SK7 I F V3'27=00 THIE'N G0T0 E4 N. O N N-52
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*ROF11MilUTY OF EMPLOYEE SMOKING CESSATION 375 }onae at tRis tioe: Tlwe iaefudr panenrs af aorbid'ay aad!disabili,y, tLe deauu+d f« eaasaeioa.ad admatroa. and tAe nLti.riwportam oLawmdactwieS and serics in4irr tries, to arenuoa but a taw. To study ttnsa sanaerou interactioes is beyo.a the aeooe of our aadysis, wfiicb amply poaas so the ased to eonsider ahe dyaanuc inar9hy, of 4cahh, disease, a.d the .cononry,. The Gorir-Ri+chter, atgtment : arrives at dismal Ma7thusian-like conclusions be- eause, like Maltlius, they teason!in is narrow range, omitting the alterations in key variables forced by events already in process o(development. Thus, the growing populations of countries with s modiera agricultural system have not starved, be- eause of great,improvements inlagnicultutal productivity which werealheady br- pnning in the early 19th eentttry when MnJthus was writing. Similarly, the average age of the U.Sn population is rising from a present age of Z7 to 37 in t6e next feww decades. (average total population, all age =roups, tnortalitytates from cardiovas- wlar diseases DaNe declined by almost 30% since 1968); To deal with such ehanges, we must, ptake significant changes in the structure and financ»ng,of our Social Security and retirement systems to be fait to all. The real' point of the Gori-Richter paper is to etnpltasite the necd& for some honest; bard, long-run thinking about such changes, not to argue that we cannot a!R'ord to reduce: the incidence and prevalence of chronic diaesse. In any ease. the Gori-Ricbter argument does not:apply to our argument about business pins from smoking cessation. We eatphasite short-run gains (l to 3 yeats) as-bein='peater than long-run gains. The short•term =ains have nothing to do with ,t+aducids mortality, from chronic diseases. at any age. These shon•run pins appear to be siprificantly greater than the costs of'impktnenting smoking cessuion etforts. ln tbe lonrer rntt--10!to 2Q years-•smoking cessation may add lat most an additional 350,000 lives per year to our population: Less than 20% of that increase would involve persons over 63 years ofage-(a population gnowing by1.°h au7lion per year): Therefore, smoking cessation, if totailysuccessful, would in ithe bng run increase the over 65 population by an additional' 3% at most. Thus, by itself, smoking cetsation, even in the longer run. ia unlikely to add an intolerable burden to our retirement system: Atkinson and,Townsend (6) calculated, in 1977, the economic impacts of a program.to reduce smoking in Great Britain by 40~7c, back to the levels of 1920: H ls ati.notd'ti+at riiis fal .rodtl h..re.dy fraIind eAects on NatioeN Health tweevwEe, twt warid eesah in imoorwu srimSs is aetaess tune6l sad Wido.:' pnr- sim: q.inst tLsse sarilaSs are ap We esaa eosts of netweaam peesionc sad a beahh t+ubfidty 0mpasws, twt tt is saWastait We tAe o.e.D etkot would he'a neductioa in. Govenmentaapeeditwe teSstser.ihb mi.ene.att in taa rxvsnne: Tld dso be a nvia5 oi a qmrner .Wion,dires 1ry the ead af tbe oesiury and much avoidabk 7leess. In the short and intermediate ttrms (1 to 10 years) most of the lives-we would be proionsing:-especially in work site programs-would be concentrated in thee woriting age popuiation. lt is also essential to recall that smoking is a major risk tact+or, for the rounger age groups according;to the Framingham logistic. Given the level of employment„ the AeI etfecl; would be, a short-run rise in the GTtP'and, natiotusl savinas,, which is currently one of our most needed economic deve!- opments. ln addition, the long-run declinrin medical spendinr on chronic diseases M-24 C, (:
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eQ-01cs-8!4 C1,:3E PM • PEGF 2? MICHIGAN SURVEY 8 -- L3a - --------- C ldih lich party ty waS' thd t? Wh i ch csnid i G15 te were they supp0'T t i ng?' 1. REAGANJ'EUSH (REP'U3LI'CAN PRESIDENTIAL R'ACE) 2. MONIDALEJPE'RRARO' (DEMOCRATIC PRESID'EiNT1AL RACE) 3. LOUSMA ('REPU'9LICA'N SENATE RACE) 4. LEVIN (DEHJCR'ATIC SENATE' RACE) 7'. OTHER CANDIDATES :----------- ---------------------- --------- ----------------- i' S ENTER ALL THAT APP'LY': EfdTER' 0 FOR NO FURTHER' HENTIflN'S .S. il f------------------------------------------ ----------------- :' ,l#O x JM :' : V226 :' V227 NUM It NUM x : V22'8 kUM * : V230 : V22'Q °.'K2 IF V227=0 THEN GO'T0 D4 ;'K3' IF V22'8=0 THiENI GOT'C, 04 ~ ".K4 IF V22Q=0 THENIGOTO 04 .- D4 ---------- rJther than someone f'rom the two major parties, has a'nyone elise swpmortin9 a candidate for offiee called you on come around'to talk to yow [L37]?' 1. YES. 5. N0'O l w # : V'231, ;K1 I'F' V231=5 THE'N G'OT'O D5'
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SYl39Wf1N 3NOHd 33tl'i • 1101'S.NUIN/1 N!!il]jnn i [- N;14oy..2o asa 2aroa."...... ........ ...._~_ __ 4'3111nS'3S OfH H3IHM 'S31v1'S _.. 383M 3b31H'1 tLbl h'I '33'vldA 80 N 3H1 ONV S33'dld '3Il19nd NI 9iNIAOUS JNI13Ia1S3a d0 9hI1V7nI032i S3I1I3 ONV S31r1S 1NTN NI Q3SSdd 9NI39 SMY'1IN'Iu 'dilas 3H u'Q31731338 0N-'13® MON 381 .'SNd3ZNl07 3S3Hlu "Am1Nno3 SIH1 NI 0'NINOwS ON'LOHv'93d Sirt2t37N0:) 1rI70S ONIr S133d33 H1w3H 31H1 d0 uN0'I11IN00332! J0 OtiTyl 1S31Y 1 3H1m Q3'1N'3S3ad3a 'A3,Abn'S N0I1'CI70SSV JNin1 3H1 '11tiH1 ©I'7S 431wi0h!S M'3lland 3H1 ONIHO'V3a SI TJtf3N~j Uo30anS 3H1 A0 3ovSS3N 3H1 aNr NuI1VI3oSSV 9Nnl NvnlHSwY 3H1 sa HOmS SNi0lI1'VZINY560 H17v3H x2i'd1NnlIQA .i'0 30d'SS3N 3H1 A'lbV'3'l]w- 'A3'1NOM'S ''1 S3wrI' ?l1U133rlT(I 9N'I97NOCW V1V OIVS u''3'13'SMIH zl3.AUNS '3ki1 aIN0A3S 09 '9NIN0wS d0 SaaiVZvH HilV3H 3H1 '1M'H'1 aN'V1Sa3ONn MON Sha3Ia1:Vr 'S13!tOIN ON• S'T31GH diNrl NOIiVlSOdSNrsl 3~Il~Snd 'Svldainvl~S3N •3J1a1d:)IdOlM 3H1 NI 9INI)uOWS O4IO8V03d 'SUNONSNON ONd Sm3'NOtiS C:V'3'I'h'3htl 031'30d IOS1r-'S1H9'Ia iSH3X0rJSrlON NO A3Aan5 N01'1rL3ioS'SV 9rrinl 3H1 - - . . 'Sr4Ollv:)ol 40 tl39wnN V NI 'Sr3Hr ''NIXONS 031VNSIS3Q iH3338d AliaoifvH v''a3Hlan.4 ©NIr Sa37+0wSNioN d0 HllV31H 3Hi1 01 'S(fDQIllVZvlH SI OrulNOihS 'AdVlNfi1'tOArJI )INIwt Sa:3A0WS J0 ~SOaIHl-OlMl lVHl 03KoHs 101s7r ''r.0I1d~ZINVSa0 dnlnY9 3H1 A9 NOL1rI3IoS:Sr oNn1 '3H1 N0i in0 1(13lmar3 JA3'nbriS 3H1 ''Sm3)i0W'SNON aNn0d,V dn 1H9I1 1sNaInOF+S S'H3AOHS 33!a9r ------'--------- .-----'---- Sa3AOWS 1N3?l,dn'3 d0 1N33a3d SS hNISI2ld2llnS 1/ (]NM 'SI2l35u0WSt.t71!J j0 '1Ft3a'2i3d 2'9 9NIW'13k+#a3A0 N1-'-(a)31d03d 1'v3IS S'awl'SlIaiH3 3H1 --rIrJI1VI3D'SSd oNrf1 Nd:Olia3Wd 3H1 k9 ~03sr3'13a A3Amn's 3H!1 ~ol !)wl(3bo3ow M'Sa3)+oiwSNIoN do 3oN3'S3ad 3H1 NI 9'NIXOWS Wa8i NI'rm.438 wlnolHS• sa3)+0w 3A3I'13d MON --Sa3AOKSNOrt ©Ur sa3NIU6S w109 '9NI0fil3NI'--SMV3Ia3: 30 AlIaot^oW V 1vH1 431N3win000 S'rH AUdnS 111NOI'lvni !tl373Ii 'V 3xOw'S Il~OA dI H9niw la'3A ONIW AV00l1 SN'Y'3'I2i3W'V s tZ 83i9w31d35 'N0 XaOJI M3N 'WOb3 1SI7a111088 9riIMO1Ti0A A131tI43WwI 'V'Ia3rJ 7d'N0I1diN M3H10 "TlV 01 -~-----------'--.-,-. 1N3S 3Et3M S'3S'731312! 'tl3IM3M1f 9'NINSON 10009 S;iT9V 0'1 3AIS;nl']X3 I''M VIA t2 a3aiw3!1d3S 'W''v kdmS3NI03M 03SV3131a SlM AaniS SS3da Or.'Iy01103 3bN1 £Oit eb V3 03'S'IJrvdl!! Mti'S 133H1S 13,AaVH ££'9 03Si1'7NVHJ r,'vS -40 Ylr d'0,133uICl 3AIln]3X3 I N'llv ~eois £9/02/'60 VA N1liF: S2000 ££'2h'tAd1 S3I £9/02'/bt) 900£92t'1t0IB27 910.1 AN xtioA M3rv 3Ad H1 ~/ m1N3 Aa3S Waa01IrIW a3tJ pvll,al u"It,m i.an1 '1 iTtAt3 l CQ
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SJMOJK/Mri' A1VD TNIE LAW Gbvernrnent'is gett inmg into the workplace more and' more-especially when iit comes to protecting the health of nonsmokers:legislators, judgss, and administrative officials have beenmaking decisions that empkoyers must understand and to which they 1must respond. Local Ordinsness Since 1980 many cities and counties have passed'laws restricting smoking,in the workplace. Mostrequire the employer to establish a nonsmoking poticyof some sort~: While there is usually a significant degree of flexibility, these laws require the needs of nonsmokers for clean air be given priority over the desire of some employees to smoke. Compliance with local ordinances will be much more likely if the employer adopts the attitude that non- smoking is the norm. Smoking is a/loweci, if at a0, only in designated areass: Contact CNRI`to find out whetherthere is a!nonsmoking ordinance inyour community. Lega1 Actions Nonsmokers have successfully used administrative agencies and courts both to enforce the right to clean air ~ at work as well as to recover benefits as a result of b+eing exposed to smoke in the workplace. .Afthough these cases " have until now been fairly uncommon, we can!expect to see rnore and more of'them in the future as the scientific evidence mounts regarding the hazards of involuntary smoking; Indeed, employers who allownonsrrtokersto be 9xposed to cigarette smoke may inthefuture becorne. ~,.iable in ways we cannotinow determine. R.asonabl. tltue to Manditap. Recent cases on both the federal and state levels have held that nonsmokers who are sensitive to cigarette smoke may be considered "handicapped"'for purposes of' nondiscrimination laws. In October of 1984 the California Fair Employment and Housing Commission I ruled in a precedent-setting settlement that an employee was entitled to $27, D01Q'in back pay plus $10.000 in damages for emotional distress because her employer refused too accommodate her need fora smokefree workplaee: The federal Rehabilitation Act of 1973 requires employers to make "reasonable accommodation" fbr handicapped employees, among whom are those who are extretnely sensitive to tobacco smoke. Discrimination suits against employers may be brought directly with the Equal Employment Opportunity Commission of'a state or the federal'govemment or a tawsuit'may be brought directly to the courts: wo./tan' comp.n.at3on t3.n.fits In additionitorthe potential for increased workers'' compensation premiums resulting from the claims of : smokers for other pb-related illnesses and injurues. recent cases indicate that emplayers may be liable for allowing an employee to smoke at work and ithus endanger his own health. In another case, a stewardess was awarded workers' compensation benefits because of an allergic reaction to the smoky air inside an airplane cabin. The EPA''s study showing thatione-third of''all lung cancers in nonsmokers are caused by involuntary smoking could result in workers' compensation death cases being brought by next of kin of nsrnoking employees exposed' to heavy tobacco smoke at work. unanolioyn>wnt.enefits Several icases in California have held that nonsmokers who are verysensitive to cigarette smoke may be consid- ered to have quit'for"good cause" and thus be eligible for unemptoyment benef'rtsidrtheiremployerdid not offer them an equivatent jmb in a smokefree environment (Alexander v. The Cafrfomia U nployment Insurance Appeals Board,1S80. also Gibson v. Starkist, 1983). Emplbv.rs' Duty to Pnsvide a:aft and M.allhhrl M/o.kpli.c. Cases in New Jersey (Shimp v. New Jersey Bell Tele- phone Company,,1976) and Missou0 (Smith v.Westem Electric, 1982) have held that employers have a common law duty to provide a safe workplace, and'that this duty required the employer to protect rioxtsmokers from the hazards of secondhand smoke. Inboth of these cases the plaintiffs demonstrated that secondhand srnoke was a hazard'to all employees exposed to lt and'inboth cases the court ruled that an iinjunction against'the employerwas the proper legal'remedy.Cases of this sort are being litigated in California as well I as other states. wrotrqftl Dischatr+p. Another potential source of liability for the employer is a, suit for wrongful discharge and retaliation by the employer because of'an employee's protest against workplace smoking. One Court of Appeal in California has ruled that an employee cannot be discharged or, discriminated against for complaining in good faith about workplace conditions felt to be unsafe. fk.d.ral Ent+ploy.es Disability and lMtirant+.at fs.n.flits Federal employees may be eligibte for disability benefits or even retirement if they are extremely sensitive to 1 cigarette smoke and Itheir employer, does not provide them with a smokefree environment. The Ninth Circuit Court of Appeals held in thecase of 'Parodi v. Merit System Protection Board (1882)'that suitable employment should be provided if available, and if it is not available or not offered, the employee may be eligible for disability j~ retirement benefits. 0 N ~ ~ ' w M-38 ''I V-j ~ (
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0'9-Oct-Fo4 WI:37 0lk' PAGE . 9 M!IC'HI'GAN SURVEY, 8' Now I e t' s ta l hc about your fee l i'n!gs t ornar ds the candida te s you know somethi ng about. I'11 read the name of, a person and 11 willi ask you to rate that person on a thermometer that runs from 0 degrees to 100 degrees. Ratings between 50, and 100 degrees: mean that you feel favorabJe and' warm toward that person. Ratings between 0 and 50 degrees mean that you dion't feel too favorabie and are cool towards that person. You may use any number from C to 100 to tel l me how favorable or un[avorabile your feei iings are for each, person. If, you recognize the name but don't feel particularly warm or cold toward the, persons you would rate the person at the 50 deg~ree mark. If you don't reco~3nlze~the name, just let me know and we''lI go on to the! next question. Our f i rst person I s al02Rona Idl Reagana00~. How, wouil d you rate him usi'ng this thermometer? 0-10Jl. ENTER NUMBfR 997. OiOESN' T RECCGNI'ZE NAME 998. DON'T KNOW WMtRE T0 RATE: CAN!•T JUOGE 1U M:r N X'2 : V169 :V'I IF V'3'.04=N4' THEN V3Oy=TMF(1) -- C1b-d ---- ------ (Ratiings between 50 degrees and 1010 degrees nean that you feel f'avorabde and warm towardi that person. Ratings between 0 degrees and'l 5') 9e9rees mean that you don't fee4 too favorable and are roo4 toward that' penson. Youimay use any number from 0 to 100 to tel li me how favorable or unfavorabl'e your feel ingsl arel for eachi person. ) Wallter Mon" le (How wouild' you rate him usi'ng thi's tfiermometerl~?' Jack Lousma? Car l! Uev i n? 0-10'0. ENTER NUMBER 997. DOESN'T RECOGN1ZE NAME 998. D'ON'•T KN!0,W' WHEIRE' TO RATE: C'AN'T J'UDG'E WWM Max> : V'170 <NUM 1tIe!> : V172 NuIM MttR> : V171 N-32
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c K I :taI'GAN SUZVEY 9~ --------_- ave yiou ever heard about in'dividuals with hea.rt or 'spiir3toiry prclble:ns r+noi5e ¢oT1diti.Jn was sensitiive to :,e ci;iarett'e smcke of otheris? 1!. YE S' S. NO I F V6=2 THEN GDT9' E1i4 0 = 9 ---------- lie are imterested in you!r present job status. Are you working no.r.v terporari'ly laid offv urnerr.plo'yed+ rctiredv a student. ('housewife), or what? -------------------------- ------------------------- : ENTER ALL THAT APPLY; ENTER A M91" W'HENI NO MORE h!!EINTiIOI(iS : --------------------------------------------------------- 11. WOiR'XING' NOW: ON STRIKE; STCK LEA'V'E 2. TE'MPC'RQRILY'LAI] OFF 3. U"dENI?'LOY'ED OR LOOKING FOR WGRK. 5. RF'TIR'ED OR DISA3LED 6. ST'U2ENTi T. 8. HOUSEKITE OTH_R a02'(PF10 TO RECORD R£SPONSfi)irrJO 9. NO FURTHER MENTIOINS + : V2a1 NUw x : V283' r : Vr82 Nu!" a : V284 I F V30!9="" THEN: V309=TiK!E (1) I F V2i'2=q' TEl_IN G'.L'T''J E10 IF V28?'=9 THEN IF V'281=1 TH~EN: GOTO E9a ELSE GOTO' E10 I F V283=9 THEN IF {V281=1 0?' V28'2=1 ) THI£N' GCTO E9a: ELSE' GOTO E10 IF V28I=1 OR V282=1 OR V283=1i OR V284=1 TH!EN G'OT0 E9a [GO TC E?_. f'9a ---------- tnat i s your m3 i n oCCuoat i ort? . V2'85 C u fj..~: .L N-55
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362: MARVlN M. ICRIST'StN TAII:E 2-•Cotwi+wipd The b.ier'tsrp is baseA' on an annual salary or M0.000: the npOer'ra.Oc e# an annual salir) of 1115.000. (e) Absenteeism cosu are based on the literattm discussed ie the tsport' of the U.S. Surgeon Gtneral: Swtotinr,.nJ Xedrh'. 7aeuary 1g79: Chap. 3471. ?i). The estimate in the Inen+ure is that 81 million workin5 days atx lost per year due to smoking. When diiriabd by d0;tn....: • Workin5' a.mkers. this reduces to 2'ays per aooker'per year. valued at i/0 per day Sivine as the $!o hiyp ran{e. Tbe low range d ts0 is twc only ose-balf the high nrtOr bw also rtefleets the dilferenual laduction d approaiatately one ay per ete-smaker found in certain work site, beahh-promouon et;onsd~, S. 12. 41, i5)~ (fl As indicated in the te:t; erximate of the productivity cost of smokins is bwed on assuming ttrat I min per working btwr, or I tnin a day. are wasted by smokine,rituals.,etc. Actual emplo)Rr estimates are eloser to 30 min Per day (ti01,i1): The iar,tante /fSure lon produniw.ity losses due to amokitK,aerralbiam* ene-balf of the bieh euimate. rounded to the rwreat lower L5. (t)!TRe loss dee to itap.ets an Involuntary smokers is,raku4ted by taking one-68'i+ of the costs assipnd!1o'qakers. emittie5 6nc losses. 73is'is based on the White and Froeb int8ttt5',It3b that i.vahmtuy smokers aay setlfer breatbins eapaeity impairment equal to tbat tor bSltt smoters (onc to tea eipretres per day) atW that the eaear risk d fiebt sawkers is oaefiRb that of uaohen of one !ack 'Nes t+e* day (!Y): We believe that ttrrft relative nncer'risk as an estimate for Oencre1 impairm ttaeat a an tmdbetqim.te. tiaar eaeeer ia a telttivcty nre disease iavolvio5 a IonO-term nla+ionp abip ait6 emokieS. as compared with oardiovasenlr,r ditwus and respiratory diseases on which 1tn ibtpct'ef tmotitt0 is rsrter and ore immediace. Fnrtber.we assiSn,ody the short-term risks to brtinesaes. i.e.., on-Mb. of losses due to rorket s coapeasacioa., abseereeism., and pro. ~etiriy, or iorr,.n0e:S27: Yo rroKc. ssti. 01 21c, 57,2 liswe 1or oce.pationd Yealth is baad on t!e October H tl a. vd by ttte, Supreme Coun d NotY Caroiaa iwa bro~ra Imte ease of 57,000 per ysv for f ysars. x S 1a1.00D to an earty disabitity.retirsd etepbyee. If one etttimaus tbe,otaidenar of COLD or btorn lunr disease to tx ; tom7ar to IuaO cancer ib smoking onnwm tmaers aad asbestos .rorkers. then we are dealin5' with a ootential annual rate of abou! 10 per W000 per year (71). This probably involves an ineu- baios period of'20 years of'esFotro!o. Hovever, for an old company with a lbn5-titne smoking em- Floysrpopulatios, the 0.0D+( latuwal incidence rate aay be etcperienead every'ysar'for the fonesetsble Mtafre. Obe ari0ht. tiermfoe. view, tthe oewpatioeal health cost as a sbort-term cost. but since it ia leahb batied, here it is< dasadud as a ktarterm cost. Bwe .uhiply the Si5:000 award by the Ate dd0 per f0A00i(0!004)we ubtain a ooterroallanmml eost pa smokin5empioyee'ofiY:.,Atcording to Heyden and lRan ('!2). e4mioation o[,twrokin5 a the wrork site would virtually eliminate cotron dIrst,rsleted ttisFiratorry disease. Tbus. is tbis ease. one may assign the entire occupational health ftk award to a.mokia0,ia terms of economic analyris; e+ren tboush the caan viewed!tbis portion as .oenp.rio..l i>A.k: effect as;can be expectedlat this tirue. Forexampk..vecannot state with certainty that absenteeism will declirn if employees stop stnoking. but insofar as absen- teeisnl reflects illnesses (largely acute respinatory, in the short run) related too smoking, absenteeism should decline with a decline in smoking. In facr, thiss outwme has been observed in several tierltlrpromotion, efforts by various types of employers (3. 3. 12. 4'1,., 83).' For cost centers involving matters other than cost of fUness, the approach of applying estimaterof the net eQect of smokingon ~tae cost center, and Ito value the •T1e beNtb-promotion efforts of, various employers rtlerred to ia this contexc include: (a) qtpioyees in the New York , State Department , of ' Education. (b) en iAmeeican Health Foundation RroQam eartied oot.fw employees of the New York City Fasbio.OSrceaf'Skan. Roetwck i Cmn- pary. (c) American Telephone and Telbp.ph Cotapany. (d) Ne.' York,Teiephone Company. (e) Speedall Corporation. NS-11
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C~4-Oct-8!4 PI'.C'HIGAra SURVEY 8 6 I F V245=0 THEN GCTO 06 7 IF V246=0 THEN GOT7,06 D f., ---------- Mave you seen any TV. commerciais L'1373.for any of the candicfa:tes runniing for puitrl'i'c office this year? I. YES 5. N'0 ' M • V248 1' I F V'248!s51 THEN G'CfTO El • D6,a ---------- whose eommerci'al's have you seen?' LPRESI'©ENTIAL RACE3. 1'. RONALD R'EAG~AN (THE REIPUiB'LIICAN). 2. wA~L T'E R. MONDAL E' 3. OTHER PR'ESIDENTIAL CANDIDA'TiE' [SE'NAT'E AtA'CEJ 4. CARL, LEVIN (THE DIEtIOCRAT) 5. JACK LCUSMA (THE R!EPU3LIC'A'N) 3. OTH.RCANDIDaTES tNOT FOR' PRGSID=NT OR SENATOR) 0. NO FURTHER MENT,1CIAS I tr : V249 NUN! f : V2'S1 NWM N :~ V253 I . 6 : V25C7 NUM ~t : V2'5:2 :Z I F V2'50=0 THEN -G0T0 Dhb 3 I F V351=O' Tt1EN G0T0 D6b '4 IF V2'52=0 TtIEN GOTO D6b • D6b ---------- Dild' the commercial forr Ronald Reagan make you more likely to supaort him, less likeiyv or didn't it make any difference? U1i : 3 C P"• PeG" 24 1. MORE LIK'ELY 2. DIONI•T MAKE' ANY DIFFE'R'ENC'E' 3. LESS LIXEiY 8. DON•T KNOW ' ~i. Q. ~ :~ V254 0I F V2S9<'J1''~ ~ ~ AND V25O<71 AND V251C>11 AND V252<>1 AND V2'5'3<>1 THE!N GICTC' C9c. (z N-47
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•79-Wc L-34 5111 C HII G'A'w' SJRVEY 9, a'hat is the rnsme of the communtty you 1 ive in? 1. DETROI'T 2. ©EAR3'CP. N 3. H IGHILAN!0 PARK 4. OTH_R' tPF1Q T0 SPECIFY) .y 4> : V'300 '.0 IF V6=2 THEN GOT'0 E16 F 1,6 ---------- '-low many telephonesv ecuntin5 extension.v do you have i n your home? 1-6,. ENTER E'XACT KUF^:2-E'R 7. MORE THAN 6 a k : V3'29 •.1 1 F V32'9>1 TH'EN GOTO E16a E164 ---------- Oo 311 the telephones have the same number? 1. YES 5. NlJ J V3313 1 IF v330=5 THEkGOT'0 E1bb. E 16 b ----- -- Altogether. how many numbers are there? 2-6. ENTER EXACT NUM9ER 7. MORE THAN 6 ~ : : V331 N-60 C'1 ? 9 P :s PL = ;7' ~ [ ;: T- :? 1 (GC' T-:1 ^ 1'~2
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0'9-Oic t-34 --- E5 ---------- taow I' wioul d!ii'ke to ask a few quest i ons about c i garette smok,inlg. Do you now, smoke cigarettes? 1. YES 5. NO vUM At :' V276 [QV1 IF V'3081=^'^ THEN V3i08=TwE( LL1 LSK1 IF V27'6=5I THEN GOTO E6 --- E6 ---------- Di'd you quit smoking cig,arettes durUng the past year, or was~i''t over a year ago that you quit? 1. flIJRING' THE ' PASTI' YfAR' 2. OVER A YEAR AGO 3I. NEVER STARTED NIJMI 0 : V'277 , --- E7 --------_- wouid you a0wfavora00 or 804oCooseg1OG a, st3te i'aw that 1Anits cigarette smoking: to a04designo.tedgiOD smoking areas in puibi ir places such as st0resi,: sctlools, off icesv work places and auditoriums?' 1. FAV,OR -- 3'r iVE'I'THIER FAVORS' OR' OP'P'OSES 5'. 0 P P'O S E NJM' 9 : V278 UCVI IF V278=1 THEN L36=^f'avor^'ELSE IiF V278=5 THEN L360^oppose^' CS:K1 IF V278=1 OK V'278=5 T'HEN GOTD E7a --- E7a ---------- Wou l~di you str o'ngi y LL36J1 or not st'r ong 1 y tL367? 1. STRONGLY 51w NOT S7'R'0'NGLY iU.y x' :' V2T9 *i ~-S 4 C1:°3 D% P4GF' 1. Iric T^ C- LC-C T7
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Summary of 119W Minnesota Poll In 1980, the Minnesota Tribune conducted a statewide poll of Minnesotans to dietermnne whether they were satisfied'with their C'iean, Indoor Air A'ct, enacted i'n 19715. Following are selections from the results: Do you favor or oppose the Minnesota C1ieani Indoor Air Act?' Favor Oppose Other All Adults 92% 5p 3% Nonsmokers 92% 4% 4% Avg. 9/day 94% 6% 0% Avg. 20/day 9'3% 6% 1% Avg. 4i0;/day 87% 13% 0% Would you like to stop smoking? (For smokers only) Yes Nb Depends: Other Al'1 smakers 67% 21% 10%' 2% Avg. 9[day, 69% 21% 7% 3% Avg. 20/day 71% 19% 9% 1% . Avg. 40/day 55% 31% I4% 0% N-70
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0:9- .r~i."".C t,-. E4 ~. . El ---------- WICN2 'GAN! SURV'"tY 8 a1:! 3 a P'AE,E Next we, have some Cuestions~ about you. Gencra{ Iy s~peakingti do you usually think off yourself as a aQ4R!cDubJii'can2 . a 3-Z4me'rnocratal 9 an a'04i'ndepe'ndenta , or what? . . 5. Vi0 P R E F E It'E N CE7'. OT!i;IER' PARTY' IK' x> : V258 'i IIF V2'58=1 THEhI! L33="Repubf!i'can" ELSE L33'=•1Dem!o.crat" 11 IF V259>7 THEAI' V?61='"" ' 1 I F V3JT="'" THEN V307=T'M'E ( 1' ) I I F V232'=! QR V2518=2 THEN GOTO Ela, 1 I F V253'=31 QR V259!=5 THEN GOTO Elb. L'G C T' E' la , ------ ---- 1. R€PU3L ICAN Z. D'END!CRAT 3 , INDEP ~ENDS' NT would you cai!i yourself aa04stronga EL33]' or a ;34not very strong@ QL33]? 1. ST'RONG 5. N3'T V':'RY S'TRC'!NG 14 y> : V259. 1 IF V?'5°=1 AND V'259=1 THEN V261=1 1, I'.F' V2'58=1 AND V'259=5. TiicN, V 261=2 1 IF'V2'58=2 AND µ'259=1 TH_N V2S1=7 I I'F V25P=2' AND V25S=5 THcru V261=6 1 I'F' V259>5 THEN'. V261=E [iC T- E i b ---------- Do you think of yourself as cioser to the RepubJican Party or to the Demoerati'cParty? 1. CLOSER TO RE'PU'iBILIICAN 3. tVE ITHF_R 5. CLOSER TO D!EMOCRATIC A' ti > : V260 ~ ~ N .C r" 1! t F V260=1 THEN V2b1'=3 1' I F V260=3 THEN V'26I=4 ~ 1' I F V367=5 THEN V'2b1'=5 ' ~ 1 I F V250>5 THEN V2i61=3 ~ ~ ~ N-49 ~
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. - 9-';'¢t- 5 4 M'ICHIGA'V SIUq'VEY g E16C ---------- ~bw+ m~sny numbers are for business use only? ')-6. EtiTEQ' EXA~CT __NUM!S:F. 7. MO:Z,=_ THA!i 6 t : V33'2 GI 31e~4I~ld_~r These are alil the Questions I have. Thank you very much for your time and your help with our research. C-::';S PI,; PA,C 17 3:, f --------------------------------------------------------------------~ 4CTE':! TIN E' AND DATE WILL BE STA,MPED WHEN YOU1 HI'T «ETWqN> S ----------------------------------- --------------------------------- I C 1L!Z -J,> . V.) : I',F V5<>2' THIE'W Gu"',T0 GI RJD ! 1F' V -) 7=""' TH_N V97'=TM!E'( 1) \ V'99=DTE(0]' I L 7'=w1!DCV'96. 1 9 2 l w6u+ MII C( V96.4. 2l. . I F' MID('V96.7. 1)="P"AND L7<72'0 THEN L'7=L7'+7'210 ? L 8!=rIlO('V'?7. 1.,2'1=S0+M110( V97.4. 2l' i IF rIDCV1o7.7.11='P"' AND LB<72!2 THEN L3=L3+7'20 1 y'3'?=L °'-L 7 • 1 i F' W9&<>V9q THEN V'38="'999" . I'F V3P.>67 THEN V38=^999a 0 S' : T' N-61
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C ~; 9-C'Ct-?'4, MIC'FHIGAN SURVEY' a E .33 ---------- Are yoiu American Inlian. Allaskan native, or Asian.or Pacific 1 s lian7er? 1. AM€RI'C'AN INCIAV 2. ALASKAN NATI1VE' 3. ASIAN 0'R ' PACIF'IC I'SLANDEiZ' x :' V'2'97 E14 ---------- !hat is your reli'gious preference - Protestant. Roman: Catholi'c, ewish, or soimettiin9 else? C'1 :3 ; A,,. P'AG= 35 1. P'R7TE S'TANTi 2. RGyAN CATyOL I'C Fa;% 3. JFdISH 5. OT+i,F'R 6. AGy;ST7C, a'TH1EIST 7. PrFUSEO. 13. ^ON'•r KNOWi. NIO PRE=ER'E,N!C= 1 F VZ9a'>5 THEN GCTO =15 E14a ---------- ouly you say' you go to (ch'.wrch/s!yna9'ogu,e)i every week, ITcst every weeks once or twlice a montn., a few times yeart or never?•-' 1. r V'5R Y 1d EEK 2. ALMOST EV'EIRY' WESK 3. OyCE OR T'wI'CE' A MDNTW a. A FE'w T'TMiES A YEAR 5'. N E V'E'R. 7'. ?'E r-US E 7 8. D,lE.N~.T_KIVON, ; . V299 N~-59
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. BuSiNEss AND HEAtM as fin, accidrnts„ ventilation, ckaning, productivity and occupational health risks. One L.os Aageks'eompany'es- timates production losses alone at S67S per smoker per year: Adding longer term costs such as absenteeism. premature mortality and illness would min the total to at Ieast Si,000 per year for eaob atnoker.3It is eurious, given these cost estimrtes, that company policie.cdealing,with smoking largely have besa ia,response to occupational l risk; safety, product eleanliness; customer contact and office appearance, and not to employee health, productivity and health ane costs. For eaample. Campbell Soup's company-wide no smoking policy was started more than' 3q 1 years ago to promote product cleanliness. U covert both production line and office employees to make it an equitable policy for all~ Campbell workers. In reretu years, the eompany expanded'its health promotion program to include subsidies for smoking cessation classes. The history of lohns-Manville Corp. provides a ksson in, the importance of heeding the telatiottship between an occupational' risk and smoking. The surviving Manville Corp, (7iohns-Manville went into bankavptcy in 1993 I!' a consequence of the asbestos nelated! health are claims of its employees) currently forbids smoking in relevant i parts of the work place. The company also lutjes only nonsmokers andd has fired employees who do aot' obey no smoking rules. Given tbe synergistic relationship between amoking, asbestos exposure and lung disease, if Johns Manville originally had followed such a oompany-wide no tanoking, policy, the actual risk of wng disease to etrtployess migltt have been reduced by over 90 percent! Asbestos related lung disease is highly rdated to smoking. Aabestott worliers who smoke have I I times ehe risk as nonsmoking asbestos workers. A company does not have to be in, the asbestos business for its employees who smoke to be au increased risk due to work place exposures. The synergistic effects between smoking and occupational exposures are significant for industries iavolwing, a, wide range of dhemicals, ra- dioactive materials and metals u well. An increasing number of eontpanies: largt and small, are coming to the conclusion i that the costs of a wdl- designed and carefully implemented corporate progrnni an decrease the risks and costs associated with ttnwking.. Three Gannett newspapers in Maine and Boeing ane among the employers that recently instituted no saaking'polieies. Also retlecting employer preferences is that employment agencies report an i increasing demand for nonsmokers. Most companies, nevenheless, have not adopted a policy about smolinc. Sonnc aro reluctant to ittaitttte a smoking policy bec: se they are too dependent on their brsiness rclationships with the tobacco and tobacco related companies and do, not want to aruagonize them. In such cnses, a company does, indeed, need to be cautious about adopting, a no smoking, policy. But this does not free management from its responsibility to respond to the I continuing pressure from nonsmoking employees'. Another situation in which it is di'fficult, - and in, NOVE-NPBE:4, 1984 aotne cases itaposstble - to institute a company policy agaittst smoking is if a significant number of the company's leading executives andlor key snperrisory' employees are committed tanoken. Nothing can be accomplished in, a company tmlbss top management really wants it. The office dynamics aiitigating against instituting ao smoking policies ant: likely to change as younger people rise to poshions of authority. Statistially, them are fewer people, particularly aten, age 30 to a0 who are txaoken in contrast to people age 50 to 160. It also malr• be that as more and nwrt: evidence is developed about, the profitability of no smoking policies, stockholders of public companies with aesistant top management will have the clout to introduce such measures. Objections (werruled! The majority of eompanies that have not implettwented' no anaking, policies are basing their reasoaing in large part an onttlated information aadc basic ignorance of the issues involved. Relatively few of these companies have evsa i thought, aerioualy about it. TAtis. howe+rcr, is likely to change. The published evidence on the strroking, health and work ptaet interaction has greatly expanded in the Last few years along with siinificant changes in public 1 attitudes. Monatnokers. for e:ample, see themselves as a, majority, and morr and more are demanding smoke-ftee environments. Court decisions and state and local! legislation reflect these demands. Recent actions by the tobacco indluuy uself,' in, tnrms of diirenifiatioa and I promoting sales to foreign markets; indicate a basic acceptance of a lost, cause position. Even, the tont: of recent tobacco advertising recognizes that smoking is not for everyone. While these are all positive and uscful steps towards developing a nonsmoking policy, there is also a lag time of' several years before business kadcrs will begin to respond affimutively. Some companies arr aware of the health problems M-32 PAGE 15'
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C Testimony of Harry Perlstadt, Pn.D, M.11.I1., Chairperson M'ic3:igan Coalition on Stroki~ng or Health Before the Michigan House Public Health Ccsimittee Sub-Cazr.iittee on H613. 450V Representative C~ibow an3 t' rs of.the comaittee, I am here to sutzait to you the results of a public opinion survey of Michiyan residents and' to answer any, qquestions you may have about the survey. I' currently am chairperson of the Mir_higan Coalition on Smokiny or Healtth, a group of voluntary health associations, health professicna:l. oryaniz3tioras and& citizen's groups interested in clean indoor air. I a.-n presently employed as an associate professor of sociology at Michigan State Glniversity where I teach and db research in the areas of' medicai sociolcrgy, health care deli'very. In May of' 1984 the Hbuse Public Health Ccmrnittee toehd hearin5: on legislation similar to H.B. 45'H'6,. At that time many of the mem-err organizations of the Michigan Coalition on Smokingi or Health testifiled in favor of the legislation. The feedback we received wasthat the united andl favorable stand of the voluntary health associations and' health professional' organizations was not enough. The House Ccrrmittee uanted to tiear froin, Michigan residents and!learn what they think of the proposed 1'egislation. In.resnonse the American Heart Association of Ingham County andi the American I.ung' Ass'o:.iation of' Michigan decided to participate. in a puhi!ic C N-63'
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)y-;:C:-.4 .r.. . P'.'' 4ICHIGAN SURVEY P, - j1'.?C7 ---------- T'hank you. These are a1 I the qusstions we have for now. r!y of f i ce may wish to get in touch w i th you to ver i fy thi s interview,. We may be call i'ng you aaaiin in about a month to dd a foJlow-up interView. For these reasons. we wouldlli'ke your name and cna i l i nfl add'r ess. EVT'r'R: ( 1) R's NAME ('25 CHARAC'TER'S ) (2) STREET ADDRESS (25 CHARACTERS) (3) CITY' AND,STATE (15 CHARACTERS). (4) STATE COOIc AND 1 I P C''JaE' ( XX 11111 ) P'Ls --------- ------------ ------------------------------------------------t ~VuTc: END TI,MEI AND DATE wILL 8_' STAMPED HHa1! YOU HIT <R'ET'URN> 0 ------------------ ----------- ----------------------- -----------------1 :aE> "KV-'-T> : VU0'9 :' V110 <C I'TiY'> : <S7/ZIP> : V111 V112 1 I'F' V97=n" THEN V9'T=T1iiE('1) \ V9'9'-OTE ('9J ~ 1 L7'=MIO(V96.1.2)*6J+H'IDt'V96.4,2') 11 I F H I'O(V96.7.1 )=^P"' AN0 L7<7201TH=_N L7'='L7+72C+ I1 L S='„I D'( V971r1.2'):-60+M1D( V97.4. 2). o1 IF HI'D'( V'9T.7r 1)="P" AND L8<720 THEN L?!=t8+720 ~ i l V3 3!- L 8'-L 7 ! I F V99<'>V'99 THIF'N'V'3'8="1999" 2' IF V'8>6J THEN' V38="99'9" • C 1 100 ---------- Toi be certain that we can get in touch wiith you in the fulture, woul d you g i ve me the rtane and phone numben of a close friend -or relative who would know how to contact you? ENT'ER: ( ~ 1 ) NAME OF CONTACT' PERSM ('25 CHARACTERS'k (2) PHIOIVE' NUMBER (FORMAT - ('123 ) 123!-12I34) ,HE> : V113' f'-')NE> : V114 v-b2 N O N. ~ ~ N LD
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LIoJLwLJJ l1AiL! JJLf1Lli3t Wanted: Smoking Policies for the Work Place By MARVtNIwd'. ICRrsTEtrJ Nonsmoking, programs are good for corporate health and employees, too. mployers arc taking a two- ponged approach to smoking. They are :beginning to adopt no smoking policies in at least part of the work piate. And they ane offering pnograms - , - . I • '.> ti+- • W ,. .=~ ~ELLI'~TESS `~` REPoRT.: accidtat and labsareteism than the typical nonsnwking,employee. To offset thi: rai increased risk, the tanoking', employee would hire to be clearly, rtrore productive than the aonsarolters. Given this, it is irmtrui analym smoking policies in terms of bow well 1 they reduce health risks. Consider the folloi three exatnpla. A do•nothing policy increases the ttisks: prcsau and future, for a given levet'. of 'reoumL A policy in which sxnoking is controlled in 1 the .wrk place, either by banning uin 91 or, part of the offiae or hiring ady, nnonsmokers, reduces thr risks and is potentially aostttiective for asost' businesses. A third alteraative., providing aids, supports andlor subsidies tw help employee smokers to qMit. perhaps as part of broader hea1M promotion and health eduation i programs; may increase the net, profits and reduce the risks for many bus,nesses'but is' probably ltss oost-ellactiwr than banning smoking. Costs of Ignoring , tbr lswe A number ofdevelopntents have taken place in nxent years that tllustrate why a company policy of' ignoring the issue of smolung , in tbe wort place makes little sense for employers. To begin wuh, there is aa, increasingly aatalkr, minority of adults who smoke. At the satne time: the literuure on damate such as respiratory disease to the involuntary smoker, eis growing, thus supporting the incesasing militancy of'noasntokers aa well as ooun, de- cisions tAat nonsmokers are; entitled to a smoke-frse work envinonment.lsEislition iaGlifocatia, Minnesota. Suffolk Coumy, T+I.Y.. and a frowing, twmber of oommunities around tliie oountry limits smoking in public plaees and pmvidts for smoke-free work places for -titose who ~naquest dtem. The costs ofa do-nothing policy, in terms'of smoking. are huning employers. Recent research shows that, the costs ofsmoking,empioyees'to business arrS30D to $3'50 per average smoker per year at a, minimi These costs includr only shon-term losses that affect employers such often with ash incentives - w aid smoking employees to quit. Therr is some evidence thu. both these types of programs may be profitable for the companies involved, and certainly for society. These steps arr attractive to employers concerned about health ats. particularly if, tthe costs of smoking to business are altulated. They also are attractive to em. playera aoncerned about occupational risks and suits brought by nonsmokers desiring a safe working environment. The business of Dusiness is to make snonelr. F'utaneial ofticers are trained to adoqe r risk-return attitude to making tncney. The.objectiwe is to ataximize return for any given risk and to reduce the tisks associated with any given rtturn, lncreasingiy. companies ate becoming concerned with the potenuia!'aostrof high risk employees. The typical heavy >qmoker consuming aate thin a prck a day is tvnning, a 20 percent lifetime risk of respiratory disease and a 35 to 40 percent lifetime 1 risk of Aeart atnck., stroke and other ardioxaseular problems. iFon persot~ age 30 to 19, State Mutual' Lik Insurance Company of America found smokers have r 1:3 gtenter' ratr of death fnoen al( causes than do nonsmokers.' 7bis analysis is a matter of ' averages. Msny smokers live long and productive lives. Many are gifted; brilliant, hard worlung and rarely illl Nevertheless, the qaestion for the oorporate, planner and policy maker is one of ritk-r+dum. Thrty,picallsmoker is at much higher risk for serious illness,,prantture dath,, Manin M. Krisrein is a prvjessor in the deparr+nerus of economics, and conununiry, and preventive aerdioinr at State IYniyersicy of New Ybr# ar Stony erook'. and ai consultant to rhe AMrnicmn Health fowdarion in New York , Ciry. PAGE 14' M-31
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0 0'9-Oc t-cl'.4. . 043 ---------- MIiCHIGAN SURVEY 8 Ll!1:'38 Pml P'ac° 21 whi'ch candidate were they supporting? ['1N THE' PR'ESIDE!NTIA'L RACEI 1. 2'. 3. RONALD REAGAN ('THEI REPUBLICAN)~ GEORGE BUSH WALTER MONDALE (THE DEHOCRAT'l 4. 5o GERALD:I NIE FERRARO OTH'ER PRESIDENTIAL C'ANDIDATE [IN THE, SE'NATE'RACE] 6. 7. 8. 0. CARL LEVIN ('THE' DEMOCRAT) JACK LOUSMA tTHE REPUBLICAN) OTHER CAND'IDATcS (NOT F'i1R PRES'IDENT OR' SENATOR) N0I FURTHER MENT I OINS: INAP tHl M : V232 NUtl4 #t': : V2'3!4 NUM fl : V236 ' NUIH A : V23e ;M p1 : V2'3 3 NUW 0 : V235 NUM A : V237 NUM x' : V23a' ;K2 IF V233'.=0~ THEN GOTO 05 K3 IF V'234=0! THEN GOTO 0'5 .K'4 IF V2'35=01 THE'N GOTO D'S :K5 IF V'236='0 THEN GOTO 0'5 : K'6 I F V 2'3'7'='0 T'HE N GOT 0 05 :K7 I F V2I38='0 THEN GOTO 0'S Have you recelved' any Iliterature In the mai'1 [L37] asking you to s'u poott a candli date or a'sk3 ng for a co'ntr i but i on to a po l i ti'ca I campa iign? CI F YESJ kh ich cand ildate sent you the m'aterila i s?' [PRESIOENTI1AL RACEJ 1,. RO;yALD RfAGAHI (THE R'EPU9LICAN). 2. GFDRGE' BUSH 3'. WALTER MONOALE (THE DEMOCRAT) 4. GERA'LDIN,E F'ERRARO 5'. OTHER PRESIDENTIAL CANDIDATE [SENATE RACE'] . 6. CARL LEV'I'N (THE DEMDCRAT). 7. JACK LOUSMA (THE REPUBLICAN) 9'. OTHER C'ANDIDATES (NOT FOR PRESIDENT OR SENATOR) 0. N0 FURTHER MENTI!01NS OR NO; HAV'E'N'T RECEIV'ED' M: a : V240 NUK 4! : V2'42 HU'M 9! : V244 NUMI sE :' V2C6 Jri Y : V2'41 NUIM 0'~ : V243 NUIM A' : V245'. NUMI a :' V24'7 ~ K1 IF V240=0 THEN GOTO 06 ~ K2 IF V24'1=]1 TWE'N GOTO 06 ~ K3 IF V24'2'=0 THEN GOTO 06 . ~ K4' IF V243-0 THEN GOTO 0'b ~. K5 IF V'244a'0 THEN GOTO 06. ~ ~ N-46 ~ ~ ~ -- D 5 ------- ---
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V 4a 2025684440 ..
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+Jy-UC C-:f4 MICHIGAN SUAVE'Y 0 C1:?7 ?"• --- C'C"5'------ ---- ro you know iIL any of these pubil ilc col ie9ies or universilties are nati'onally recognized or ranked because of the qumliity of' thei r education? (IF YES) wh ich woui'd thalt be? 1. UNIVERSITY OF HIC'HI!G'AN' 9. SAGINAW VALLEY STATE'CCLLEG'"c 2. NICHIGIA*1 STATE UNIVERSITY 1'0. GRAND VALLEY STATE COLLEGE 3'. w a Y'!3 E S'T A T E UIN I V'E IR'S I T Y 11. LAKE SUPERIOR STATE COLLEGEI 4. CENTRAL MICHIGAN UNIVERSITY 12'.~ F'ER~R~I',S~ STATE CQLL~EGE 5. WES'TER'N' MICHIGAN UNIVERSITY 13. NICHI'GAN TECH NOLOGICAL UNI'VE'2'SITY 6. NORTHERN MICHIGAN UNI1'VER'STTY 14. U OF' H- FLIN T 7. OAKLAND UNIVERSITY Y5. U !DF M! - DEAR BORN 8. EASTERN MICHIGAN UNIVERSITY 90~. OTHER iPF10 TO SPfCIFY), 98'. 70.y•T KNOW IF ANY ARE RANIK'EDJ'Nfl' FURTHER MENTIONS NUr A r V21b MU!M x : V218~ NU:'/ W : V'22'0 WUw ,r : V217' NUw a : V7F9' NiJ'H 19! : V221 ISK1 IF V2'16'=98 THEN GOTO C'Co (SK2 IF V2'17=98 THEN Gu3T0 CC6 {',SK3 I F' V21?=98 THEN GOTO CC'b (SK4 IF V219=98 THEN GOTO CC6 ['SK5 IF V22o=9d TH-2Ni GOTC' CC6 --- C C6 ---------- S!ome peopte think that the state Ie9islature shovld apor'opriate the same amount of money to each publi'c college in, the state fpr each student in attendance. Others think that relatively more money should go to those colleges which offer a better qua.lity education and relat'ively less to those who do not. Do you think that state aporoprations shiould be stanidardi'zed for each cot'i!ege or should there be a differential which reflects the Cuality of education?' 1. A'PPR'J' PRI'ATIION'S SHOULD 8IE STANDARDIZED 2. A'PP2OPR'IATI'ONS SHOULD VARY' MiITH QUALITY OF EDUCATION 3. OTHER (VOLUNTEERED) 8. D0!4•'T KNOW NU M t! : V'2'22 27,42
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r Perlstadt Te:~'tiimony 3' We askaell four yuestionW relutedl to snuking. I heliped dL:il=,c. tnee q}:estionrs in consultation wi th , ttiie Fdoart an& LungAssoci~a ti ons ar.d, the ~ professional staff at ISR. Tiie quesLions :and responses are presented tF--1cw,: E5 P9ow I would like to ask a few questio:Ls about cidorette~ scro'king,. Do you now smoke cigarettes? 31.1% 66. 9~- Respondents who ans,4ered,no were then asked E6 Did you quit smoking cigarettes during the past year or was, it over, a year ago that you qt:it?' 8. DUPtI2d 1 3'i3E PAST YEAR 2. 4'% ~~ OV'iR A YF.AR A'flU 3'1.9b ld::VE2' STARTED 6fi.3a All respondents were Uhen:asked: E7 Would yoa*5evor* or*'c.Dpose*ast,atelawthatli~mits cigarette C=kiny to *designated* smoking are3s in puhlic places such~as stores, schools, offices, work places and'auditoriu¢rs? (The key words favor, oppose and da :gnated were rotated to assure an impartial and, balanced, presentation)~ FaWP 82. 6~ ' NEITFiER FAVJI2S NOR OPPOSES 3. 7 ~ OPPOSE 13. 7`s Respondents who replied either favor or oppose were then asked: E7a N7ou,ld you strongly [favor/opposel or not strongly ['favor/opposeJ .... (This titre the respondent's previous response was inserted ini the wording) STRONGLY Favor 68.5s Oppose 7.5% NOT STRONGLY Favor 14.010 Oppose 6.3s All respondents were then asked: E8 Have you ever heard about individuals with heart or respiratory prohlen; whose condition was sensitive to ttie cigarette 5moke of others? Yt:S 84'.1 % N0 15 . 9 % N-65
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Perlstadt Testimonv ApposYiix A I'•ESPJt4DEP,TS' VIEaS UK•7 A STATE LA1+Tl1M LIM1'P5 CIGAaXi•Pl: St4c3K1NG T0 D?::ST'Qv'aiEJ' SMCKI:JG ARJ1S IN 1'tDi'sL1'C PLtiCL•'S Strongly Favor Fovor NXkra1 Op~~e Stromyly o1-wsp All Responder.ts 68,.5% 14.0'4 3.7% 6.3kb 7.516 Current Smokers 56. 211, 17'. 6 ~ 3. 6-1, 9.71 12'. 9 a t;on-Smoia2rs. 74.1% 1'1'.4"0 3.70 4.7's 5'.1';; Rq~ublilcans 66.03 21.7w' 3.7d 3'.4°6 5.5% 1)--mcrats 68.0% 10A% 563%, B.A 81 A inde.pen3ents 69.8110, 12:6~ 2.$0 6'.7€ 8.1% (,pi!on Households 73.4% 8.1% 5.6% 5.4"b 7.5 1. iaorn-Uni on 67.6~ 15, 6b 3.2ti ti.6t 7.1"s White 69,. 0'0 14 .1`t 3. 5% ' 6, 3?0 7.1% Black 67.6# 10.0% 5.1% 5.16 12.eo Men 63', 6$ 13.9% 3.5% 7,.3% 11.30. Waak:n 72.5% 14I.1% 3I.5$ 5.50 4.4% Detruit 63.2$ 15.4$' 3'.5a 5.7% 12.3% hSetro Suburbs 65.2% 12.7% 2.61 7.2"s 12.3s (?,]tst:Jite . 71.1% 14.24' 4.2e 6.1% 4.5% ' Less Tnar: $20, 0013 72.3% 7.6% 5'.1'% 6.7% 8.3%' $201to S35,000 68. 8% 17.4% 3'.7% 61. 8b 3'.3 0 Over 535,000 64.9% 15.6% 3.0% 6.0% 10.4% on a samplie of 750 adults. Rasults weiy.rte& by area of state, numter of telephones and number of adults in hous:elrol'd. S;art:ple Danographics: Paye 7 Men, 44. 8% Wacren 55.3% 4rhite 87.4% Black 11.0% Average age 41 Currently Wr,mking 31. 0$' Other 1.6% O ~ ~ ~ ~ ~ W ~ N-69 t
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N O N C!1 tT~ ~ C!~ N Q -1
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4i C gious occupations. These te.nd to be people who have more formal educatiun; pay cluser attention to the news media, and might be expected to have learned' more about many subjects, including the subject ufchokytcrul. Effort To Avoid High ~ Cholesterol Foods As discw.kd in, Suctiun2.4'3% of adults say they "try a lot" to avoid high-cholesterol foods. Groups who are particufarlv likely to make this effurt include women and those aged165 rears and older. Thuse with the lowest level of educatiitn are also more likely to try to avoid chules- tcrul', buti they tend to overlap hcavilt with the oldest generatiun: There is no si¢nificant difference between incumc gruups or uccupa- tiunal categorius in the degree of cfUurt they make to avoid1chuics- trrul_ People -,vhu deuribr their currenti health as fair or poor are also more likelv to trc• a lot tuavuid high-chul-c-stet'ol fuucds. Importance to Food Purchasing DecWws Taventy-,.vrnpenrcvmtluf adulits ,av that the chulUtitc.twl content of li-ud is "vrrc important"'tu thrnn tivlien thrv decide whether to buc or catnpcn-ticular tuudl:: Thur.,r particu- larlN liikrl~ to sa% so inclueti thuw over at:v 50 and tlhu..• \% ith the lvast cducation (%%hu also tend to be in tlhc uld.•wtiFrwratiiun). Thc„e in tniir or 1x.~ur hraltll are all:u lil..•Ifi to tnlacc Ra iurk\ on chulrstrnol cuntc,nt whvn th.•\ purcha.w hxucl. Annual Blood Test for Cholesterol, Forty-three percent of adults say they have a bliDodtest for chr,les- tcrol at least once a x•ear. Those who are most Iikelir to have such a test include those over 50 years of age and those with the leasteducatiwn (who tend to overlap with the oldest generat iun)i Those who say their health is only fair or poor are also more Iikely to have an annual blood test: Wkytch%ng Chafesterol as Prevention vs. Treatrnent The pattrrns in Table 12-1 suggest that watching one's choles- terol intake and level is, at the present time, more salient as treat- rurttt than it is as pretvntio-r. This is shuwn by the fact those in~fair or poor health are particularly likeh• tu have a blood test, to take chulrs- trrul content into consideration in choosing food, and to try a IuU to avoid Ihigh-chulirsterol fuods. This same pattern is shuwn amung those who say that' health care sen•ictis shuuld1 give greater emphasis to treatment than toprcvention. The more advantaged segments of sucictv-thu.c with more educa- tiun„highcr incumrs, and more prestigious uccupatiiuns-arc more krtuwluth,;r.uhlr about cholesterol but they currcntlv are no more likeh thanuther pruplc to uevun that knowledge. Motivation is reqtnii-vcd in order to tiranslate knuwlrdgi• into actiiunt and mtotivatiun currentlv srenns to be at a modest level excrpt among lho+c gruttln..cit-•dlabuve. who arc most imntcdiatClVatrisl.. S E C T 1 0 N 13: TMI EN1:1R0-N A- IENT :~.'1~D PREN UNT 110N While most of the preventive factors studied in this survey, are things that indixiduals can, at Ikast potentially, do for themselves, there are other important preventive factors thatlie bevond an ind'ovidu- al's power. Such factors require societal, collective, or governmental action. The survey for the 1985 Prevention Index is the first year in which we measure aspects of this envirortntettt in H•hich people live as it relates to prevention. The survey investigates public jµdgments as to the outcome of cullectiive action or inactiidn: Air Qklali,fy Twenty-fuur percent u1* adults say that the quality of thrir lucal air is "excelllcnt:' and anuthcr 50?~ say the lucallair quality is "prctty good." Those who are most likely to report acceptable air quality include Midwesterners, thux rf.-iirJ- ing outside mrutupuliitan arr.as. and thuse inithc hit*ln~-+t incumu category. Thux who elbscribe their currvtnt health as excellent are alw more likely to rate thuiu- local air quality highly. Thesr pattunos are shown in Table 13• V 28 N-14
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C RKOF)TAf1C1TY'OF EMtLOYEE :MOKING CESSATION 379 1!: Cetaee8 on SekatJtr ASairt: Sa+okiag at+d'hs.hh. JAMA 2i9. 779-7N (1w), 20. Cowen. M. D:, and Hint. D. L. ••Moetatity DiReeeaces between Serokets and Non.seakers° (oompaay doeameot). Swe Mutual Life Assuraeoe Co: d AaKrica. wbroseer.,Mass:. Oct. 2".i 19'19. 21. Doll. A.M wxd ?eto, ). Cipmte swotimawd Ibroaohia) caroiooma. J. Epidrntoi. Cowuare: NrolrM 32, Ilu (147{1. 2t. "Gnat fives d'1N.erica:' P= f!. CeinH+y Dwotitd Cara,. TKautesM. wisc:. 1f'13. . 23. (inRwkeL L. Time treada ia Mag aaeer awoerality aoam aoa-swokers aad a aote on passive smotittf. J, Nal. Cawoe.lwsr. K 1061-1056d1911). 24. , G1aW+r; , R E.. and Dsrnueia. D. A. sehwdoral treaunex of 'sawtieg; Sshsrior. !e ••Mediral ~ Tsys6o(ojy: C.eanilutioas to Deh.vioral Medieiae" (C. K. Prokop and L A.,Deadiey. Edt.):, Awdemir trras. Mew Yock.,13lIJ 25: Gmi; G. S.. end Ly.eh. C: l. Torard less \arardous'ciprettes. JriMA 2+(0: 123S-i289 (19V. 26. Goni. G. D:. owd Rieltsr. D. a. Mtiaueeo.omia al dns.u pe+~satioa aaa ithe U 1S Sriewn. 2c0. 112~-1ItD0 i(197t)• 27. GoRaut'sr. S. L.. e, 01: fteaat awokinS asd irist d ahntlhood whma. A,wer. J: raMic Neo4k 72. 37.-S14 (1lIt2)• 2i: HYmero.d. , E. C.. en d. T.r and aiooti.a eo.esa( of vi`.rette a.wko i. «(atioe co ~ns6 eues. Ewvi.on. ltes. 12. 263- 2741(1976). 2!: Hammond. L C.. Ssii(:oQ'. G 1.. and Seidmaa, H. A.bestos espo.une. aiprene s.roking and dreh,eates. Am. N. r: Ard. Srt. 330, 419-1lD 119D9), 30. Hntnp. T.. ll.asas, D: A.. s•ad:Sollhiti.no.1C. Cf.ical methods (n snol eessatio.. Amer. J: TaMrie: IINbA' f9. 1226 (1!Q!), 31. Hinyama. T.1'Ia.•s.wkias vires af'hs.vy sirokets l..e a hioler tfst ot ires weer A study *om Jaoaa.Iru. Afrd. J. Zt2, 1q-183 (19t1). 32.Heydee. S.. med Pm. T. Espaw+e a easos dns( a.d nesp'natory d'ame: JAlIA Zw1. t797-179! (1910)• 38: llaQmma. D...nd Wyader: E. L. Tiw leuidrsrW ,aiprRm:1)aent aad fbeare. wo.td S+woAYwd lfnahh (American Camer Society). Vol. 2. No: 2'(a977D. 34. l+cohses. M. Smohi"aad IdisrbiNry ia aieets. Larrn 2. 70041910). 35. Joasfo.*Far(y: A.. eri.1 f.wk* 'abaiDeeae and aa.n'cW!haD eaaoer survival. JAItUA' 244. 2173-21791(19N1). 3i. Ktek. 7. D.. l.eliusb: lU.. a.d Rasaoe. L. Ciprette ssokisK aa a tisY Letor for apdemir A (H:N.) i.fluem in young axe. Nr+r. EAl. J.1Y(ed: iW7. iQ12~-1M6(19t2): 37: Kotia. T.. aad!G.u1. L. A. Sasokftm the .roetpi.a: Ai.eard liVt+red. AYses: J: lrblir Xrelrh 70. $73-l7L'(N1110), ]t. IEworles. 7. H.. Is Dwfdas. 79-h04 Trwter i1979I: 7!: Koop, C. E..1ad !l.awo. 7. ThsSeahh ewaaquesoa d sawt*: Caaaer: Osniee d r.epon oG tYe SirI soa Csaerati. h11tc Rr.hA' Rtp: !7. 71i'-32d (190. 440. ICrzb.rkai. L.. Herai... C. P.. ..d Fnqoker, R. C. Mhr eeswehen .rte d.b.t eipestto swkats' afy: FtltaioD snotas.'hot ait. L~ 1. f0l-700 (1!M))• 41. 1Ceisteia: M. M. ,•'How ' Mue6 b Clroaic Diaease CoetiaS the Tyoieal! American Co.prey .''. ~aapapAed. Amer. HealtA FooadYtioa.,lilew• Ynrk. 1900. 42. Y't(uais. MJ M. Asbessoa.aat.rn rd'huK eaeeer, Aiwes. J. lr6lir Ht.hA 711 lrq! 11f1111. 43. lCasaia. M. MJ S&ok'en.,weiety asad tapiruocry, eislls. Amer. J. Aritir XeahA 71. +~W-6'311 (l19it)- 14. Yristsi.. M. MJ. Araoid. C. D.. asd Myeder: E. L. Health .co.omics aetd pteveal tarc. Sri- s ear. 1lS. eS7-r62'(I1997). 43. l(risteia.,M..,a.d Grove. D. Ns.• Fnt1J J. M.d. 2lK. 60b-607 l19M: 46. Ktisteia. M. M: "The Ewaomies!of'the 1!otential af the Safer Ciprette...'TecscauA at the Attan- ~ tie :Ezo.omir Society Coaferceoc, Oct. 11. N'!9, Washinhton. D.C. 17: Kristein. M. M. , Fatty yRan ' of U.S. ciMntte' taokin{', asd bean v.ease and I mrcer .wnaliry t.tes. , J: CArowir Ai.. , ia pMs. ei. 1CAueie, M: M. Eropanic;iswes in pterentioa. lrer. Ml.d i, 232-lr«1!(I(997), M-28 C ' C,
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(~c) 198,2,, Washington Post wxiters, Group reprinted with permission-.,
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r CJ CDnLraCc)SL'aTim'es Papp t'2 A- Sundsy. Juty,25.,1982 (c) 19182, Washington Post Writers Group~, reprinted with permission. Q-2
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Perlstadt Testimony Page 6 1 i I tri-county sinburbs (65.2%) and'' the city of Detroit (63.2b). Fwat when general support is included (14.2%, 1'2.7%' and 15.4% respectively) all three rieqi'ons have at least a 75% overall support rate. Q: Does support vary by gender? A: Fesnales are more strongly in favor (721.5%) than males (63.9U, but if general support is included, over 75% of the males favor the proposed legislation. On the basis of this scientifically conducted' survey by a professi~onall staff of' interviewers, I would argue that substantial anct significant support exists among the residents of Michigan for a clean indoor air act that would limit saoking in public places such as stores, offi!ces, work places and auditoriums. I urge you toireport this bill out of coamittee with a strong favorable recomnandationi and to work for its passage in the Faouse. I am smbrnitting, along with a copy of this statement, a copy of the statisti'cal tables (Appendix A), a, letter frcm the senior study director at the Institute for Social Research, Michael W. Traugott, describing certain aspects of' the metisodblogy (Appendix B) and a copy of the complete cruestiotusaire (A(apendix C). 11 would be happy now or at a, later time, to answer any questions you may have concerning the survey and its results. N'-b'8 1.
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.:as ti~ :oaacco Ins_it,ae c:ai=s? . Did the ::Z'R' see:: tc, publicire- _: :deli'cera:ions - aitervards? Ihav= been toLd .:-& :i'rst -public reference to it came fro= the tobacco indus_ry. Does tre SIii as su.'r. a: --=--:=: -.o:Y;r on•passive snoki!ng, in fact? If so, :wo_:c _=opr of the s:atez`_nt. * Do you have any co :=:ents aba-;c _ r& use of t ir :'IR„ and has the ::Ih aade any co:~n_s zaouc :rez in the pasV. Your help and cooperation on this matter vould' be much appreciated. We have found over the years that the tobacco industry has repeatedly misrepresentedi health bodies and others by zaltazg unsupportable cl'a3'ms by ' misquotes, or by out-of-context or out-of-date quotes. It is our policy to disclose this deception vtr,.rever necessary, so that the public can be correctly infbrmed. To that end. I'vould'also appreciate a:ycommeats about this matter that Imy use publicly when amd' if ' we need to refute the tobacco tindustry on this issue once again. Thank you in advance. Yours siacerely . Dr Paul ?iagtsus Hedical Associate tp the Director bcc Stanton Glantx R-2
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t 4 s Tha f.acnm«rte IS" • TlwradaY, Mareh 1, ttia4 A'7 ! Califomia Polili Majority Would Restrict Smoking By Mervin D. Field Dlrectar.7le Catll.r.lrPail' If'forAner smokers and those who never have smoked had their way, there would be a range of restrictions put on smokers who want to light up ; In publie places. Underlying a widespread I negative feeling about smoking is the belief that !t' is not only hazs ardous to the health of'smokera, but to non+amok- ets who are nearby and'breathrthe fumes. .• • 'Ibe proportion of adults who smoke has been declining in, recent years, whiFe the ranks of ex- smokers have been Increasing,to the point where they now outnumber smokers in this state, 35' percent to 26 percent Non.smokers account for 39'per+cent of the public. With regard to smoking,in restaurants, 77 per- cent of the public prefer that lf be limited to spe- dal smoking areas and 16 percent opt for outright'prohibition: In work places, 70 percent favor special areasm for smokers and 16 percent think it should bee banned. On airplanes, 581 percent, want' special srnoking areas, but a large minority (38'percent) thinks all smoking should be prohibited.. A atajority, (58 pereent) favors special smoktng, areas in hotels and motels, but one,in three (33 percent) : opts for no restrictions. On buses and trains, balf the public (50 percent) wants special areas for sntokers, but an almost equally, large ! group (+lti percent) thinks smoking sbould' be prohibited. Y~CiMr~ ef ianokft Anwsnp Gaiifeewia AdYNa 7fM 1tIf0 curr.m.rtwk« Forrn.r.mok«_ Nor,,.rrak«. 'ilhere is atso a strong ,be3ief that the smoke produced'y by smokers is iharerdoas to not>srnok- ets who are nearby: .. t#ow hassrdbw Is a tmok.r% sr»okr le tha h.alth iM a non*.nwk«'?' C urrant Farm«, Mon- ftat.wrid.fnwk.r tSnak«, snwk.r Very Aaaardoua:...._.......44bG._...1?"N.......53%:.....51% Sortvswnat IRazardow.....4 AN..„...537i'._...35%:.....36•k Not too harardous._.._..,10UG:._.21Y,,.-...6% ...,._a% NW at 4!t Aasardwa. _ 41G_ a'l.__ ._St4. 3y. Noopimon • ...._.1%_1%.___.t%........TlG Now, maoh dowrtha smoke •t a eipar.tl..ewk.r both.r ywR Cwr.ee Former Nten- iNata.dd6aewkarShrok« seak« Aipraat Some ~_. M.13S4:. 28LG Only a Mnle. 14% 19%..~ taS4. 1P% Not at aI1J...._ ~ ~ 23St _ ~ObG....„137i __..1001. Now maeA do.a RAe iarnok.e at a dpw amoh« botlwr rou7 A prpt~dNl'._ .............._.Sa`/......a7S4_...a6M...._.684G Some ___ _ _ 19'J.. 71x. 1TY.. tti54 only a k/tM.. ._._10%.._..t3%:._...A%._.....a% t+/bt lat a1R. ......._tr;y.......297G........7%........a% Now eweti de.a t1,a unek. N aipipa anak« tsethar yoWJ A pnaat daal ......28t/.......t3%.....to'Si.._..a344. S+mnx._..„. _ __ 28%:.....1'T'1.__..28'.y._...32'A' IDNy,rtittk... Z3%__19•/. Not at Z6y..._..Sa% '_....ta'h...„.t5S4 No op.tion __ ......_ t% ........1% 'Lass tnanor++-Aalw of 1ip«o«tt. Overwhelmingly large proportions of former , smokers and nonsmokers think smoking is very haaardoas to the health of a amoker, while half of all smokers say this. 4bw Aasardoua iai.enokNp Uo tA. A.alth or a ainok.r? cwr.nt Former Non. alaHwid r11mok. nemok..enok.r V«y Aazardous............_.76t.G,......SO'/ . ......86 i:.....a5 % Sorns.vdat Aazardoa+s_....22'A...... 46 %.••._ 13'4......1r% Not too Juzardous,.........„.2,/......... 4f,G........ 1%........ 15i Not N ata ha:ardous....... ..... ........ -........... ..........." N-1
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101 Pan iI/SundsY. February 10. 190S B,t Los a"9°iies Tt..s - orang, County edi-tioa ,I r n Cmmen4ary ~ Comty 11 Editoris/s Good Idea I.,fies Smoke Screen people and have no established non-smoking areass The law also will rcqtiire all eamployerr to adopt written smoking policies 'giring employees the right to designatis work areas that would bee off-limits to smoking. The emphaaia of'the new ordinance ia clear in the section that gives non-smokers precedence in disputes over a no-sznokutg policy. We are glkd to aee c[ties such as Ugtnsa Beach move decisively and' override ob}eetiona 1t+omm tobacco interests that attempt to minimize the medicali facts and the hazards to, non-smokers forced to breathe secondhand amoke:. According to tF e American L.tusg Aaen., u many as 34 million Americana are sensitive to tobacco, smoke and studies have shown that non-smokers are indeed espo.ed tm health hazards because of secondhand smoke:. That makes no-smoking ordinances an is;ue of public health that all communities should be addressing. The argument from opponents that such regulations are an unnecessary goverrunent intrusion, into people's rights is nothuog, but a smoke screen: It will take only one more official vote of t1ie. i.agtasa Beach, City Cbuncil to give the city thee strnctest no-smoking law in Orange County. Although final passage appears to be a formality in view of the recent 4-1 vote. we urge enacxment in Lsguna Beach, and the passage of similsr no.amoking regulations elsewhere throughout c)range (County: Laguna Beach isn't the first Orange County community to attempt to control smoking in public places. Westtnirtater, prohibits smoking in city-owned buildings and the county has an ordinance. which willi be reviewed again this week: that designates smoking and non-smoking areas in county-owned buildings and some other public health facilities in the unincorporated!area. What makes Lagµna Beaeh'3 ordinance different is that it ii the first community in the county to attempt to regulate smoking citywide. More cities should tzlte that approach. Under Laguna Beach's prbpois;edl regulations. Rnoking would be banned in public meeting rooces: theaters. auditorituas. service lines, eleva- tors and in restaurants that seat 40 or more Copyright 19 8'S , Los Angeles Times. Reprinted by permissioni. 0-1 1
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I Perlstadt Testimony Page 4 I would now like to: sumaari'ae tne overall findings. with 750 respondents, the statistical margin of error will be approximately 3.0% with a 95% degree of confidence, meaning,that the survey percentages will be within plus or minus 3.0% of the "true value" (see Appendix A: Respondents Views for the complete statistical tables). As I'mentioned'.earlier, the motivation for participating, in apublica op,inion survey was to! answer sor-- questions raised by the HousE Public Health Caamittee after hearings in May, 19e4. I shall present the findinys in qclestion and answer form: Q: How much support exists for a state, law that limits smoking to designated sroking areas in public places, such as stores, offices, work places and auditoriums? A: 68.5% of the respondents strongly favored!limiting smoking to designated scroking areas in public places and an additional 14.0% were generally in favor. This means that an overwheLning,82.5$'of those surveyed favored the type of legislation before this cocrmattee. Q: How do-sinokers feel about this type of legislation7. A: Surprisingly, 56~.21 of the respondents who currently smrske stromgly favor legislation that would restrict their ab,ility, to smoke in public places, and another 17.6% o4'cvrrent smokers were generally in favor. This means that aLcaost three-quarters or 73,81 of current smokers favor such: a law. Q: Do the respondents react to the proposed legislation along partisan or non-pazti~san lines? A: Approximately tsxr-thirds of the respondents who i~dentified themszlves as ?tepublicans~ (66.Q$)', Denocrats (68.0%) or independents (69.8$) were strongly N-66
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Dn YoU MiiqD iF' I SURN a, HoLe iiN YouR 6WRT, SPIa aSHe~ 10 YoUR ceFFee,. coUG.H' o~M YouR FooD, S~feLL 'uP YoUR HaiR aNo cLoTHez5, aMa DoUB.Le YoU . cWaNcE o; GeTtNG caNCER? . I Q-4
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Perlstadt Testiznony Y::g;a 5 in, favor of a state law to limit s,:wkina3 in public places. This, type cf legislation has across the board suppurt amo;:.; pc,telotial voters and uoe:, nTDt appear to be a partisan issue. Qx Do workers favor restrictions on siToki'ny, in public piacz., inciudin y tile work place? A: 73.4Vs ofl responri2nts living in taousv:nolds with a manber of a 1aL;,r union were strocagly in favor and an additional tB.l`a were yE.'neralily in favor for a total of 81.5% in support of limiting smokina3 in public places inclWi,n:~ tile work place. This me3ns that a substantial'and hiyhly signifioznt proportion of workers and their families would support the type of legislation beforee this committee. Qc How do minorities feel about legislation to limit smoking inpuoilic, places? A: The survey found similar levels of support fron both black and white respondents, with 67.6$ of black respondents and 69.0=0 of white resisondznLs: strongly in favor of a state law to limit smoking,. Q: How dbes total! household incocne influence support for the proposcd' legislation? A: Low i'ncome household5 with under $20,000 were more strongly in favor (72.3%) compared, to middle income households with between $2®,6'00 andS35,0041 (68.8%') and high income households~wi'tn over $35,000 (64.9%). Butt if general support is addbd for each incore yroup, (7.6"s, 17.4y, an6 15.C's O respectively) , all three inccme groups have approximately an E0$ support rate. N ~ Q: Does support vary by region in the state? ~ A: Strong support is greatest in the out-state area (71.1%) f©iloc.ec3 by the ~' W' .. ~ N-67
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Perlstadt Testicrony Pa9e 2 I opinion survey of Michigan residents. 1he purcnase.^cl space on the October 1984 Political Survey conducted by tne Insti'tute For Social Research (ISR) at the University of Michigan. Two, other clients purchased'~ space on tnat survey, The Detroit News and The University of M1chi'lyan. Each client independently submitted questions'for the survey whida were reviewed and formatted by the profe_ssional staff at ISR. The staff'then drew the sample, arranged the overall order of the questions and conducted the intzrviews using a camputer assisteai' telephone interviewing (CATP)i syst+an. The sampling d6sign involved a stratified cluster sample of persons 18 and older residiing, in Michigan households witfi telephones in three reyions of the state: the city of Detroit, the tri-county suburbs and the out-state area. Weights we=e assigned to reflect the proportion of the state"s telephone household population. ~The October survey was part of a panel - study condlacted by ISR during, the fall 1984 election, campaign. A total of 750 interviews were conducted between October 12th, and, 29th. Of these, 401, respondents had been previously interviewed in Septur,ber and', 349 were~ initial contacts obtained in an, independent randtxn sample (see Appendix 8'a i.etter to Harry Perlstadt frora Michael! Traugott, Senior Study Director)~. The survey contained questions on the national and state econocny,, a variety of national and state political issues, the presidential and senatorial candidates,, support for public education im Michigan and respondent desnographics. The questions on restricting smoking in public places were included tocards the end of the survey (see page 31 of the 39 page Apperadix C: Michigan Survey 8). The questions on smoking followed a set of three questions on newspaper readership and, how often the resaoccdent read newspaper stories about state and local politics.and government.. *i-64.
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r i . ~a : Tati~onal Heart Foun uw:r~~r~, of Aust: a . P:O. Hm. 2. 11tKicna A.C.1 a' , '{..."!1•^::. 6 November 1985' Dr Claude' Lenfant National Institutes of' Health National Nearv, Lung and Blood Ins'titute Be thesda MARYLAND USA 2b2'05'. Dear Dr Lenfant E:S/CB 152, 1'4S 0 Many thanks for your prompt and detailed reply of 8 October (received today) to my letter of 24 September. Your answers put a wholly different perspective on the situation, confimiag my liongstanding, conviction that the tobaeco industry will' stop at nothing to misrepresent the issues relating to smokiag,. The May 1983' review on passive smookiug and respiratory disease was confined to studies supported by tiMLBI and was not, as the Tobacco Iastitute suggested, a comprehensive review, of all the available li'terature. Moreover, the report prepared by the workshop'chairmen 'does not represent the' opinion of NHI.BI, contrary to what the~ Tobacco Institute has seid. We have foimd that the Australian Tobacco Institute vi'11 take anything andi just about everything out of context to suit its ova purposes,, a problem, I'm sure the NHLBI has in mind when making statements in this area. I find! thi's' quite a challenge when trying to prepare statements for the Foun'dation which are'most explicit and the least amenable to misrepresentation: Thanking you again, Yours sincerely Dr Paul Magnus Medical Associate to, the Director bcc Stanton Clantz ~ Ni'gelL Gray Steve Woodward Panon- NLF.._tlm Th:- k.:r.t Nr..w~raft/cSv N.nianCreMen. VA C. (:\'1 C. niF :.. ~r~...,..-:~:.., Inr.. C~+ran.+n..e~lttr ..C a+net.i:. %ar.rma! Pn'.wrn!"••' er. i' IkMri \.IrrM.J 14R.wM -kmc...rnn C!• i , R-4
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C This doe:wnent is published by The Tobacco Institute in the beiief' that the controversy about sswking and health Must be resolved by sc3entific research and in the belief that full, free and informed~discussion of'the controversy is in the public interest. ~ f Th'lfe Tobawo la.tltote 1M'13trreiet 1Miuthwest WuafagtOa, DC Z"06
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I l 12~r t''I111v)_y ~'sood Neighbor y vy rLun Scott OOO Ih eas+e you don't Jetovr it, tnere?s a new (qaal'lt)) wind blowing itt, Contra Costa. ttursJss to the Amerucaa Cancer Scdery: the Anerir.an Lung Assoefadon and the Ameri• csn 1 Heart ALso cat4on. It's their goal to Set a1l tbe daes in the wttnty topsss aa otdinanm to teTulate smok. ina, It they do. it will be a firs[ in the aadon for a aounty, and a1I its mttnidpalities to be pubL'cfy on, the side of ":aia• aif" tbr aon- staokets: (Guess what side trm on-). So far. the county stspervisors.' Richmond;. San pablo land Herasles have adopted the or- diiLacs and Iafayette; El Cerm and Pinole nave ltad', f,ivotable .votes on lltutxadia6s al- ter pjmkic beuin=s. Tonight Mueuses •wrill bold a putitic beardrs;g on the sattie.topie and iater dates to temember .ri11~ be Nov. 4 in Pimbura; Nov. 6': ia Clayton. Nov. 7 in Daa+ rille and'Nov. 12 in Concord and!San.Raaton If your dty isn't' Ifste4 And out why. The neat tlsing about this prrtirsttar ordi- nance is ~ that it doesn't say "Thank you for not smoking:" It saya, more or kss, "Ihat>3c you for not smoking everyortiere:" I tnaek you, and my lungs do, too. O C'O p-4
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. C The{uldornia Poll,}ias operated continuousl} sutee 1947 as an independent. non-partisan media spon- sored ipublic opinion news service: ThePoll is owned by Field Rescarch Corporation and since 1976 has been operated b,r The Field institil non-profit. non•partisan research groupengaged inconducting studiesof Ipubliropiniononissues of social significance. The Institute receives its financial support from ' academic.,governmental. media and private'sources: , Survey Method fntervie.vs in this survey were:made by telephone. Sample homes are dtawn iniaccordance with a probabi6tv sample design that'giNes all areas o(Ithe state and.all neiFhborhoodl aproperl3• proportion- ate chance to be included. Telephone numbers are randomly generated bti• eomputerin proportion to local prefix allocattomdensity to remove non-hstedl telcphonc biases Up to:four calls are madrweach number at different times toreach one aditlt tneach househuld An adult, respondent is selected for, the interview using an objective procedure to provtde a, balance of age andisex. Accuracy of'the Findings. Several fxuus mil be considered in assessing the accuracy of the findings in this and other Califktrnia Poll repurn One tstheamuunrof'tnler• ance in thc findings duc to the presence of random variations inhercnt in the sampling proicess itself. Anra hcr:•trc a np tnaccuracirs causrd b)^ judgcmcntal factors such as qurstHm wording and sample design. and a t fitrd are t hc cf li.•ctsRtf extcrnal events. Sampling Tibicrance Thc amount ttf sampling tnicrance in these survey findinl;n ean f><e.umauetf quite pa•ctscl; fr,• thcu:ce of x•cllitc%tinf st-rtisucal lurmulas: Thu Caltfornia Poll u.c•l an ad.ancc•d mcthal kntrvnas replicated samphng,•that prut•tdes an empirically determined estimatc of ehc range rif;sn-called sampling error for each item 4tnfhrntatKxt drveh>tted hy tha survey. This methnd wkes ammtmt of the sure of the sample. the dcFrecol vanahtht : tnresponsctocach item:,sample dl ell lclustennF: wrtgfntng). and the effects of variable tmcrvic.ver and codcr performance An estam:uc of the s'amphng,errnrranFc for this survcv is shnM•n in the table hclo.v. The sampling tolerance has been calculated at two statistueal eonlit&•ncc k•t11i. nhtch are eustumarilx used by social scienti.ts-thr y5'.: and the 9Q".'l k•.KI Too usc thr, table. first sekrt the sample svx on ..htchi the percentage in qucmwm is basedl Then note thtl plu.s and mtnux range of sampling tolerance for the dcgrcc of cnnfidence desired and apply this to the prretntaFe ligure. The, resulting "'high" and "low" estimates show the,rangc within which wecanihave; 95 : for LWh)!cuniidrn:e that if the whole popula• tionofi the:statc had bcxn1 surveyed with the same questumnaill the results of such a complrte cov. eragq would fall bctwL•eil two fiLNres obtained f'rom the data~in thetahle The sample tnicrancc figures shown in the table arc avcroFa• figures dcn.•cd fhom the actual cxperi- ence of'a number of recil survecs Tho%. represent maRlmum!tollrunccl fitr the sampll bases sho..•n.. i.e:. for xurll UtndtnEs where the dit,ision of optnHOn isaround SO"•:<i0'r1: Suran•findinE. that; sho..• a more one-sidcdldtsrnhutton of orinion. such as 70":-30.^. or aT:-10"'.. arc usuallp• subl to sliEhtly lower, sampling tolerance than those shown in, the table. Tt N-6 ~~.».. ~~• ~.~. ... ..., :. ........... . .... Plus/minus pereentage range of samplint tok•rance at - Sample Size 9Y'. conladen.e "...ronlidenor t200,....... ,. .. . 30, .............. 4.0 t000 .......... . 3.3 . . . ......... ,41. 3 f300 ............ ..717............. ,,49 600.....,....... 4;2I ............... 56 400 ............ S:Z.............. 6 9 200 ............ 7:5!............... 9 9 So............ . IS!0 .. ....... ... 19 a Other Possible Sources of Error In addition to sampling error, there are other important sources of'potcnttal inaccuracies tn thesr (and in other) poll'findings These sources include the effects of possibly biased or misleading ques. tions. possible s+•stemamc omission of'rclc.arn seg+ ments of ihr population (romthe survel samplcl and the effects of stFnifi;ant e.ents that occur during or after the time the survut tnten•ill are made There is no standard measure of these cflccts: each must be e.•al uatcd j udgmentally , Furthermore. since the influence of'these'factnrson the ultimatr,aecurac, of the sune% findtngs mal he man% times greater than thramount of sampling ernnr: it is important that they also bc carefully wetFhed So that the rradrr..•JI ha.etnformation needed to judge the possiblcimportan:e of tholl effectst ThrCalifornw Poll'prott.kl this bulletin with each relaasel drscri bi nF.thcq t.:stxmrs 1 uscd thc siza'and type of sample usod. and thedate.oftmervietsmR. The Californw Poll has an evccOcnt record for aecuraci v in reflenm} public opinion durmC its 33 year history. The stall ol Thc Cafilnrnw Poll cakes great care to formulate qlxcunns w•htch wc (cnl are objective and 1 unbiaaed and I to carefully supervise the data gathcnnF pha.~% and tnhcr rc.carch oper- ations upon tchtchl the f9r11+ findanps arc, hl Nevenhl"leSs. u1K+rs of this t;anll uther puhlic opinion polling datat shuuld!brconunu.dl, v mindful of 1a11nf ihe factnil tntltx+n.m ins toll"s aecuracv: Sampling error is not the only enterion. andi we caution against citingonl.• the sampling error fiEure trJone as the measure of i a survxl accuracv: since, to do so tends to create an,imyression ofl,aEreater degree of'precision than has in fact been achieved.. Suggested copy for editors to use when.presenting California Poll data inipublicationnr neM•scastSutwesa of~ the kind reported here by The California Poll are suhje,+t to varwhthtn duv to sampling factors and tcn other possible sources of influence on their accull The statowtdl sample results, shown in thtr rrpnn ~ are .ub- ject to a sampling tolarancr of'rlus or minus approximatcli p<•rcentagc pcomc The (ireader) (%•tewer) iGsta•nrr/ .huuld Hl.O be aware. hownver., that thirc are whar pu.+iblr sources of error for which rri:ii+e esnmatcs cannot be calculated For esamplc. different results might have hcvm uhtall trum dlllcr- ent,questinn wordinF:,and undrta-tcll tn the wac thc sampling, and tntcrn i"anF prcxc- dures wcrc carried out cxould ha- r a aFnil t;ant dftrct nrt the findings C.ollhi fxillinl: prall diminish the chances of suc,h c-rnr.l but thrv can ncac he enull ruled out Ia is af.n pu.. siblc. oflcoursef that rventc tkcunnE .mvr the timc the interaiea•s were eonditetcd could hl chan(;ed'the opinions reported here ( (
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C LI iW V,. u. r.r,a policy. Based on national avenges, the company will!have 300 smoking emptrnyees, each 1 costing the employer, $300 a year in extra1 expenses due to their, tsntoking. Ifi they stop4 the employer could save 540.000 a year - all based I on, a one .timr capital investment of SIiDlOCDOi Calculating Costs For managers used to dealing with hard numbers - profit and loss, for acample - it is difficult to think of developing', a company policy based on inferences from estimates. Many of them believe that true proal of the nct gain ofiadopting a company smoking policy is missing because there is no tanoking,gun type of evidence that smoking employees involve a net cost to their employers that can be eliminated through nonsmoking policies. While it is true that such evidenee has twot beenn published widely, a number of' companies have internal studies that are firm enough for them to base policy upon. Based on a 20, to 25 percent awccrss tate for Campbell ` Soup. for example, it has been calculated that its antwaf' rate of return for money invested in smoking cessation programs for employees is between 25 and 50 percent. That means that for every S'1' invested, they will earn 25 cents to 50 cents a year.' Other companies thw have reported that smoking eessation iefforts ars cost-effective include Metropolitan Lire Insurance Co.. Dow Chemical Company.lohnson & Johnson. New York Telephooe Ca. Ford Motor Company, IBMI E.l. DuPont de Nemours li Co. and Cyberteck Cotnputer.6In general, the business community anna afford to wait for the nesults of tong,term controlled trials of this' subject. While the data on the eoats of' smoking, arr estimates and infereaces, they arrbased on dinxt!atcdicai cate spending and toss or gross auional product (GIaP). and on epidemiological Istudies connecting eentaiA illnesses to smoking. These estimates are not guesses but represent aggregate c+ost data, time and motion studies and legal taandards. The estimates based on real dollar ettists invdve dividing by relevant population sizes to arrive at per smoker figures. Obviously, not every smoker actually produces the average cost figure, but for every smoker who is not responsible for this average cost there ttwat be a, smoker producing twice that amtwnt. Using figures inflaued'to approxinntr late 1994 dollars, an estimate of the excess medical taosts to the cowary' of smoking (that is, illnesses that would be insignificant if it were not for the fact that people smoke) is $241 billion per year and the loss in GNP, using, nsinintal, human capital values of' life prematurely, lost and ineotne lost due to these avoidable illnesses, is $36 billion per year.' These figures do not include thr eost of pain and suffering and the multiplier effects on family: friends, employers and society of' prematuro disability and death du: too smoking: I Public Health in the Private Sector Major health gains are expected from, instituting, no smoking policies in the work place. Both employers and I the population at large will benefit. In one sense„ it can be artuedl tlut programs ftx public health gains rally. N()1'EMIII:R 1984 fa11'under the aegis of the gwernmenr. 10 fact, employers might not even enjoy the benefits of successful employee smoking cessation programs because of' labor turnover. An employee who had participated in a smoking cessation program in cnmprny A teay wbsaptattty tttove'to company B. Perhaps' the' alrongest' argument against a nation and in some cases a company adopting no anaking policies is thar the net gains ftom them are t:wre than offset by the costs of an increase in the numbers of older persons due to the reduction in ptetnaturs_ trtortality associated with smoking. "The costs. of 'a do-notlhing policy, in, terms of smoking, are hurting employers. Recent research shows that the'costs of 'smoking employees to business are $300 to $350 peir ' a+rdrage' smoker per year.. . . " It' is itonic: diar the ultimate defettse of' smoking involves accepting the most serious actusations against it: thu' is. it aerves to signiftcantly reduce the survival rate of adults so dur the savings in tstiretnent payments tttay be larger thaa the eost and i G11'IP savings while these persons live. If'the fires of retitt~es are valued' at sero, it is cheaper for the society to let them die at a younger age. If'this txoxtmic logic is putstacd further, it would be even more cost-efrettive for the society (and companies paying for employee retirement) to find a, more perfecr means of killing everyone on his or her 6Sth birthday. without producing the associsted illnesses and productivity losses involved with smoking. A fulkr public discussion of this point as a defense for opposing a nonsmcking, policy in the work place aould. in fact, convince more people that such a policy is the only one tfut is morally acceptabk . i Motei. 1! MiD: Ca.ftql sad B.L. Hirst; "Mortality Differences between Snwkrrs and! Nouumoken,.- (company docvment) State Mutual Lire Assurance Co. of An+erica. Woreester, Nfass., Ckt. 22. 1979. 2. M;M. Kristein; ••How Much Can Business Expeca to Profit from Smoking C'tssstion?" 'rmznri++r AYtdicine, 12:358'-3'81. 1987. 7+ D.P. Rice and!T.A. Hod8sonl "E¢onomic Costs of'Smokintt An i A+wlysis of' Data for the U.S.,•• presented at the Allied I Social Science Assarciation amud meeting. San Francisco. Calif.. Dec. 28. 1983. - - C M.Mi Krittein, "Asbestos Workers and Lung Cancer." Awaniton lorenal'of rrblie Nealth 71:'J+/09. 1981',. 5. Ktistrin. op. cit. 6. R.S. Parkinson n sl, Mvnctin= Mtalrh Pranaion in the Wortplarr (Palb Alto. Calif.: MayfieW Publiahing Co~. 1982). 7. Rice and Hodpon. op., cir. M-34. . ~_;
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pra tl~aYslv Drk!S'1iMz Frattd.1 i.'Josl 1DQLtit A. oCria. PW1Yltef tiK•JotS ARTiII rx !LYli 11ULtat:xcsa, P.El-.A.f 1 rJa'-J #f J OItvILL' bR7t1tIDY.,PslG.il.r1l474892 AIRItUIt A.'1tw;:1~1.i.rWt4Lri I~Y~INA.f' ~'. L.l1. ROlttlttlrUAL, Elteatles f.da.r. p:TUtuUKRlrr7MG VLa.Ttayfdtt.r. AKKHU[Gt3Jt.,ntprtrX..attuy r.~dttarj,A'MlJ[L.GKl.l:MflLLit. A.n.hwtMa.ayt.p F.d.M. ly.TUR MILLOMlS, Ar,.illa.f IL..eyt.g6JctM LOUty i1LYCRaTL7N„Aa.u.l/1./ Mapyt., E/tt..• 1tMi/LIMKE1.,r•dit.riwfPop. LJ.tr.. INp1 IrLWMTHAL, l+~rrty F.Ittrn.l C.,w J:da,n' CnAKiI7RC t:U=rlt1, A...r.a. ,Ldter.. 0 To11 WtCai7t„A..rei.lr Edtt.n AP'R I L 2, 1980 Wednes!day C 1'hy Neighbor's Lungs I The case for restricting smoking ih public rooms is bacco smoke. Perhaps' these dangers alone justify re. gedingstronger. atrictions on public smokttag; It probably risks the. :Until lately the battle between smokers and' non+ health of millionsof espet:i aliyvulnerable people. amqkers has been more emotional than scientific. ' The sensitive smoker has replied, In effect, that at Stnpkers proclaim a'"right"to light up anywhere and' most be causes an eye to itch andla throat to scratch,-- sxy they're harming onlythemseives. Nonsmokers say ' discomfort rather than harm. But that defense may ttie ftunes make them sick andldemand a""right"'to clean air. But neither side could show conclusively that tobAcco smoke is either safe or haxardbus to healthy byst1nders.Lcking hard data, some resorted to,hard language, even fists; an Eastern airliner was actually lorqed to the ground by such a dispute last year.. ,That smoking can harm arnokers is no longer in serfous doubt: The habit has been'implicated In cancer, beaR disease, bronchialiailments and severalldufferent allergies. It may well be the most important public bealth problem in the United States. jirrevennons'ntokers at risk? Some sensitive per- soq, appear to be. Young children raised in smoke-, tilled homes are more apt to develop bronchitis or pnewrtonia earlyin life. Victims of'heartarod'ltutg,dis. .ase or of allergies are apt to sutfer ii exposed to to. now be crumbling. Astudy publishediby The Mew Eng. land Journal of Medicine concludes that'healthy work. ers sufferedilung damage when exposed on the, job to tobacco smoke for 2D years or more. Some of their liiutgs"tiny air tubes and sacs were scarred, and their performance on breathing,tests was impaired. 1t'ork- (ng in~a smoky ennnronment seettaed to have the same adiverseeffeet as smoking one toiten cigaretaes a day. Thatis not yet proofthat'the redi,ce,iliungfunction, In an otherw•ise healthy body is medically impartastt. Most, v8ctitnswere probably tanawareof the impair- ment. But deterioration of the small airways ini the lung does often precede lung,dJsease. It is another rea- ton, on top of,earlier reasons. to prohibit smokiiag,in in- door pubiic piaces unless the smokers can be segre. jated so that'iheycasutot jeopardJzrtheirneigh5ors.
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r g~an pot s AN INDEPENDENT NEWSPAPER A22 FRiDxY:11iD11EatRER 22: 198n Seeondhand Smoke ~' N RECENT YEARS tobacco companies, cae- ~ aerned about the growing movement to restrict~ smoking in public places, have directed an in- ceassatg share d their advertising budget&tb the nonsmoker. The companies propose in ads that the whole controversy be treated as a question of'man- ners rather than, one of: cancer: emphysema and heart disease. If ' we are all just tolerant of our neighbor's right to smoke, the message goes, then smokers might be persuaded to forgp the habit dur- csg, mcpensive meals, small dosed-noomt confer: ences and'tours of firecracker factories. The latest series of advertisements, now appear- ing in full-page spreads across the country. seeks to allav the fears of abstainers-two-thirds of the adult population-who are justifiably concerned that the smoke others generate is harming them. Even the Tobacco Institute's own surveys show i hat a majority favors segregating smokers ini trains, airplanes, theaters, restaurants, work places. offces and the like. And that majority has begun to speak up loud and'. clear. To counter this campaign the tobacco companies question the scientific basis for the fear, as they had for years disputed the surgeon general's findings on the tan- gers to smokers themselves. The complaints of nonsmokers, they imply, are unreasonable. It is, in fact, these lears and phobias [thatj can kad'to dl health," .ne are told, so we should stop malang "a medical problem out d'a aocaal!one." What do the scientists say? Surgeon Gesxral ~ C. Everett Koop presented some persuasive testi- tmony at a r~ecent Senate hearing. In the last three years, he said, 15 pubiishedlstudies ezamined the. }btk between passive atttok'sng and cancer, onlyy three did!not show a statis3ically signifscant posit2vee correlation between the two. While nonsmokers naturally absorb fewer carcinogens than alnokers; there is evidence that those exposed only in the work place--not at all at home-suffer the same impairment of some breathing functions as light smokers. Abstaining: spouses of smokers have had higher rates of' lung, cancer than similar spouses of nonsmokers. The.surgeon general warns that more recent studies indicate that nonsmokers may also be at risk for devebging beart diseasr from second- hand'smoke. hioaamokers.vho.vaat to breathe dean aff are mot fiaicky aanks; intoierattt of the rights d' others, as the tobacco campany ads would iead you to believe. Their o*ctimns are well-founded, as the increasing weight d'acientasc evidence d°sr>mnstrates. Believing industry claims that secondhand smoke is nothing to .worry, about oouid be dangerous to yoia healt;h.. ©-T
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., Cont~aCostalirmes Pape 12 A - Sunday. Ji,ty 25,1982 t7cun 5 Eeat.« Nwas++., JK. w.n.wq . E Jl~,u JWN, ML"4v w.nuyNy 1 ~1N.N. M.I~n A4Hnae: Ah~N~wn P.u~r E'~,kr,u Doa GrafflTobacco lobby Cigarette makers set greed record F OR CALLOUS, CALCULATED greed in market- in 5 percent otdiagnosed cases lead tooral cancer. Also ing, there's no beating the'tobacco industry: E#•er decreased ability to taste and smell, receding gums andl since the iniiial Surgeon 6eneral's report identi+ discolored teeth among other denaal problems: fied smokfng, as a maJior; national health hazard, pro- '"The ads never discuss the health risks or social is- ducers have been: saying it iSn't so and, sues,;' the society notes. "•it'sAheir jobito make chew- misusing the research that supports the Indictment of ing and dipping, appealing." their product to keep smokers' buying. "I1tie ads and the labs aren't the only fronts In the to- 17tey continue to flood the market with low-tar, low• bacco war. It's: also being fought In Congress; which nicotine cigarettesi pushing, these supposedlY safer has passed new price support legislation. It is a cons4d• branda as the answer to the concerned smoker's prob- erable retreat from previous support progra!ms. shilt- lem. The ads would have you believee that low ratings ing, the bulk of the subsidy burdi n from the taxpayc•s• according tu research standards, far from being mea- inigenerai to the growers thentsulre•es. who will be a~• surements uf relative peril, are~virtvally.. equivalent to sessed for a fund to cover losses resulting, from hok% seals of approval. market prices. They have betny nonably successful. The low• branti.~ Even so4 foes of a'"killer crup" were narruwiM1 dr act:ounc for about a third of a cigarette market that i% fuated in an effort to make the new prosram even mun pushing $20 billion a y,ear: n"strictive. The trutih uf'the matter is that there is nu safe cit;,, The leadrrr uf the a!ttack; Scn.'il}iumas~iiagietun. U• rette - or even saifer, if, lower-ruited brands thad ui stu,, is himsrlf, as'muker, which lid to a brirl Senate- smoking more or innading more dcs Uty_ There is al.u fUw,r ezehan'ge uf' last' wordS on the subjc-cE of tobat co1 the carbon monoxide produced by the burning pruces:, and health. nd the still unknown consequences of ingesting the Challenged on his tw"ack-a-d:+y habiu b~' Sen. ~ti'al• ~a chemicais that producers don't publicize - trade se- trr Huddleston, ID-Ky:. Eagdetun described it as a cur.e erets- but add to the tobacco to vumpensatr fur trstk and rued the day of'his addiciion- lost with,the removal'.of'tYtr and nicotine, "Don't blame the little tobaceA farmer fur the wKak- But Ldve the Industry credit. IE< It could produce nut ness you have;" Huddlestonireturn.d. only a tarless but a smokeless cigarette; perfectly safe , lltaybe not. But what about ttire others In' a bik in all respects but In effect' giving the smuking public industry that takes over frnm him" mNlh/hP (-r /fa." mnnnv h,,. ............... ...-. _. .- 1. 1. . P -2
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f UNINERStTY -OF PENNSYLVANIA SCHOOL OF MEDICINE DEPARTMENT OF SURGERY 3400 SPRUCE STREET rHtLADELPliIA. PA. 18111.t JONATHiAM E. RHOADS. M.D.. PRoressoe or suRCCRY October 27,, 1978 2+ir. Jack McDowell Tobacco Industry Campaigu Manager Suite 404 22 &attery Street San Francisco, Cali'fornia 94111 Dea Mr. McDowell:, Youlhave engaged in a reprehensible form of intelle ctual dishonesty and' have thereby perpetrated'a fraud upon the voters of'Califorsia. You have also ssisused'y siy name in1vhat I consider to be a most unfair ma!nner.. In your eampaigailYterature and in your argument against Proposition 5 in the VotKrs" Pamphlet distributed by the Cal!ifornialSecretary of State to every registered voter in California you quote my words out of context in such a way as to make it appear that'I believe that second~-handlsmoke is harmless to . nonsmokers.: The truth i&that medical evi'dence shows:. C 1) Second-hand smoke from the burning ends of cigarettes can cause. respiratory disease in nonsmokers.. 2) Second-hand smoke can worsen the condition of numerous Califor- nians with heart and lung disorders. 3) While there is as yet no epi'demiol'ogical'evidence that second-hand smoke causes cancer in nonsmokers, neither is there proof'to the contrary. I'made the statement which you quoted out of context in response to~a tele- vision moderator's questi'on dealing,with cancer. My words in their proper context only indicate there was no evidence that second-hand smoke causes cancer in nonsmokers. I was not talking about nonmalignant respiratory disease or heart disease.. This important diatinction; has been on public record since 1'977'vhen I learned my words were being quoted out of'context. I n my opinion youishould'rectify your misuse of'ny words by publishing cor- rections satisfactory to me in every daily newspaper in California. JER: i db 0,: R-5
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DEPARTMENT OIF HEALTH & HUMAN SERVIICES October 8, 1985 Dr. Paul Magnus Medical Associate to the Director National Heart Foundation of Australia P.O. Box 2. Woden, A.C.T. 2606 Australl& Dear Dr.,lMagnus: I am responding to your letter of September 24,, 1985 regarding the issue of passive smoking that has been: by the Australian Tobacco Institute. In May 198'3, the D'ivislon of Lung Diseases, National Heart, Lung, and .. Blood Institute, convened a group of experts to examine some of'the epidemiologic data that had been collected over the years by investigators who have! been supported by the Institute. The question rel'ated to possible examination and analysis of the data for impact of passive smoking. The projects that were being discussed had'not been i~mplemented to examine passive smoking per se; the intent of' the workshop was to examine whether or not the Institute could capitalize on exi'sting,data sets•to~gather somee additional information. FollowingI the workshop, some of the part ici pants ~ have worked on further analyses of their data; they will event:uall'y publish their results. The report of the workshop appeared in a summary document;, a copy is enclosed. This report was never published', in the peer reviewed literature.` It does not represent the opinion of.the Nati!onal' Institutes: of Health. It was only`intendedito summarfte the views of the workshop participants. The report was prepared by the workshop chairmen, Dr. Hans Weill and Dr. Sonia Buist and was circulated to, all of the participants. It is my understanding that the workshop participants who have worked together to examine their data sets as per the workshop recpmmendationsi will soon be submitting their analyses for publication. If acceptsd! for pub,licatlon in a peer-reviewed Journal, the Institute may then be in a better position to have a statement to: make about the respiratory effeets of' passive smoking based! on NFIIi,B'i'-sponsored' research. Enclosure Sincerely yours, C' " U,-AAt>,~ Claude Lenfant, M.D. Director N ~ ~ ~. ~ C R'-31 Pubtic Health Service National Institutes of Health ~ National Heart. Luna, and Blbod Institute Bethesda. Marylend 2020'5
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A similar, conclusion was reached'by aI critic of smoking who compl eted one I of the largest, studieseve'r done on i the sub fect. It innrolved' 376 ' families, with $16 children, in three towns.4 ii The conclusion: "Exposure to low levels of seoke Produced by cigarette smokers does not result iin chronic respiratory symptoms or loss of' lung function among children nor among adu,Uts." More recently, data from a continuing study of respiratory disease among more than 1,b'00 Tucson area families indicated that parental smoking had'no significant effect on children's lung function. Researchers also reported no significant relationship between the smoking habits of either parent and.spousal pulmonary function642 W1y 't6e overreaction? Scien+ae is "atiwed" Given that atmospheric tobacco smoke has not been provedito cause disease in nonsmokers, what can account for the overreaction of some nonsmokers to tobacco smoke? Some researchers have suggested that such reactions may have an eoational or psychological basis. The 1979 Surgeon General's report suggested that what response ray occur in healthy nonsmokers exposed to tobacco smoke "may be due to, psychological factors."3 Md the late Dr.iNi'chael Nalberstaw, a physician and medical collaanbst, once suggested that the sy+rptas of' nonsmokers "say oo.e frowi anger rather than the smoke itself."43 A cultural anthropologist who has studied smoking customs in different societies agrees. The emotional reaqtion of soaie nonsmokers may simply reflect frustrations with life in gieneral'l, says Sherwin Feinhandler. As the Harvard Medical School lecturer told a Congressional hearing in 1978, "To some people, the smmker has become a ready target for general frtirstrations, anxiety and di'scontent. "" Nhatever the reasony the overreaction to the considerab3e publicity given studies that purport to show, eenvironmental tobacco smoke is a risk to nonsmokers has resulted in insuffYcient attention to scientists who caution that emotion and fear must not be allowed to obscure scientific facts as they currently exist. Oihe such scientist is the fori.er head of the gmverneent's smoking and health research prograw. Public saoking, Dr. Cio Gbri warns, is so laden with moralistic overtones "it'is not a,Uways easy to separate fact from ewotion."' Too often, he wrote recently, thosee who would advance the nonsmoking point oR'view use "supportive statements frowithe most popular and swccessfallr persuasive ~ force today, namely science." O N UC (ni on, P;~P ~ CD S-8
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Frisco. ~votes.an antiddte to smoking poison s()C'A RATON, Fla:-It is not surprising that San Franciscans, who are out on the cutting edge of many things goodland bad; have declared what is in truth a new civii right. - I refer to the right of'peoplie not to be poisoned by those who use cigarettes and cigars. or smoke a pipe, and defile the only.au that. non•smokers have to breathe: After a IDavid+vs:-Goliath struggle inwbich the tobacco industry pumped' into San Francisco $IS {or every 31 raised by the freedom- from,tDeir-smoke forces, San Francisco voters approved by a narrow margin : Proposition P, which gives non-smok,ers almost total protec- tion in the workplace. I sati hooray! I hopeiervently that~t6ousands.of communit'ies will quickly pass similar legislatiom Pur simply; the San 1 Francisco ordinance requires employers to' make a: rangements thu satisfy noasmoking esnployes; even if that means banntng smoking altogetl3er. ~ . . . ' : The tobacco ptstiers pumped money in behind the argument that all! "San F'rancisratis Agatnst, Government Intrusion" would opt to continue a sort of laissez faire policy. But'a majority of San Francisco voters had come to understand: that the real "intruders," heavily armed' with tobaeco,, are the ones who: push tar and nicotine and eventual bad health into the lungs, beatts„ wombs o(ianocmt non- smokers. I!. 11 did' not onderstand the force of naked greed;'T wouldn+t be- lieve,that! the tobacco industry would spend so much money trying to deny Americans the right not to have to breathe someone else's acrid smoke. C People go to jat7 for lacing the cookies of unwanting and un- 'ting people with L.SD. They, would go to prison for lite if they u. -0 a car upu a house~and stuck a hose from the exhaust insidC kiflmg the occupants witlt carbon~mononide. Studies are sbowing,that ' when a pregnant woman~must ingest day, after day air that arrogzntly . indifferent smokers have turned into foulness, her unborn baby may b'e cnpplbdl ~ Yes. arnrgantly indifferent Tbe hooked ehain.snroker is about the. tudest of' all the kinds and clssses 61 people I see. And the most 1 outrageously uncarin forttie rights and'eomforts of others seems to Qe the three-packs-aay woman. 1 go to elegant dinners at Washington embassies where these bejeweled, sashaNing barbecue pits are barely in~their seats before they pull out a thnee-inch bolder4,a super-long cigarette and a rubN- studded ligAter. Tbea tbry.'prroceed to rum tbe meais of half i the people at their tables: •- Obviously ff ' these women cannot accept the mountain of evi- dence that their cigaretntK end:nger Their bt;+tL, t.`.r:.: iu.::ui;. t;;Eir; lives: they won't believe that their smoke damages. someone who merely, tworks or dines nearby. How many times have diners who are allergac to smoke gone too an excellent and costly restaurant'ttr find that' before they have fur ished the appetiaer, ttiey are thr~oan into an embarrassmg spell of sneezing by smoke from a nearba table*' Given the ruthless greedlo! the tobacco industro and the insensi- tisity and'arrogance of most heavy smokers, tbere is no choice but to have government "intrude"'at every leveL I've long had "smoke cotain; out of my ears" about this business of other peop!e pumying,smoke into my nostrils. tl~roat, eyes: lungs. even though J'detest it. Well. San Franci:ce has said to smokers: "OK. you're a free person. You're free to smoke as long as you ido it on a coffee break, at luncistime. after work• but only, wbenever and whenever you will not force non-smoking workers to become involuntary participants in your tustM1h'abit." This is one time when the nation ought to follow San Franciaco'ss kad. (c) by and permission of News AtttericalSyndicate r•: P-5
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370 JOURNAL OF P'U,BLIC' IiIEALT'II POLICY • SEPTEMBER 1984 In a telcgram (dated~ October 24, 198b) to the supporters of thc initiative, Dr. I:enfaait said, The tobacco companies arc quoting me out of context and niisrcprc-• senting my personal views on the harmful!effectofsecondhand smoke. I personally endorsc ~ Proposition io ~ includang, the five medical find- ings that'secondhand smoking canharm the nonsmokcr especially the millions of people with hcart.andl lung diseases. The industry paper attempts' to downplay cigarette smoke as a signifi- cant source of carbon monoxide in~ the environment. It claims that at+ nnospheric carbom monoxide fronn tobacco smoke rarely exceeds io partss per milli=aaid' is closcr to S parts per million in public places' with normal ventilation, and, that "both f gures are well below the limit of so parts per million recommendedl by health agencies for workers exposed over an eight-hour period: ° It is important to note that the so parts per million is an occupational standard over an eight: liour pcriod, not the recommended air' quality,standard, whichisnine~ parts per million. Thei979S'urgeon Generalrs' report notes that, "Occasionally, under conditions of heavy smoking and poor ventilation, the maxinauln limit for an 8~hour work exposure to carbon monoxide ($o~ parts: per million) may be exceeded. The upper limit for carbon monoxide in ambient air (9 parts per million) may be exceeded even in cascs where ventilation is adequate" (6)'. The industry paper later suggests that carbon monoxide is not a cause of heart disease, citing the fact that members of certain occupations ex- posed, to high Ievels of carboni monoxide on, a regular basis do not have ex-cess rates of cardaovascular disease. However, they fail to note that smokcrs in those occupations have higher rates of cardiovascular disease than their countcrparts' who do not smoke. Thus, whether the carbon monoxid'c conzponcnt of cigarettes is the culprit is a raoorpoint. Cigarette smoke is the issue and, there is no doubt that cigarette smoke can cause cardiovascular disease; thc 1983 report of the Surgeon General concluded that smoking should be considered tlie most important of the known nnodifiabl'c risk factors for coronary hcart disease (7). The industry paper also attempts to; downplay cigarcttc smoke as an important source of particulate matter, noting, that "airbo'nne particulatc rttattcr arises froini many sources besides tobacco smoke." However, ac- cording to the 1981 rcpprt on indoor pollution issued by the National Academy of Sciences, "For inany people, the maiuni or sole exposure to nunicrous gascpus and particulate compound's results from passive expo-
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Gas Phase Constituents oi, Cigarette Smoke Ratio ot Sidestrearn Smoke (SS)to IWiainstreana Smoke (MS) MS sSrMS MS iSrMS Cariyon Dioxide Carbon Monoxide 24b0 mp 1420 mp &1 t5 Nitrogen Qxldes (NOX) Mnmonia !D'pp 173 MetAarat 1.S np i1 Hydtop.n ityaruJd. 430 'Yp 0.25 AcsWene Zt Up - Q8 /AeetbrNVile I= Yp: 3.0. Propane Pnqpene O:S: mp 4.t1 "ine, - 22 pp 10 Metfiylchloride. O.bS mp Zt "icotine 24 pp 13' IWettqItwar+ Xpp i 3.4! iVi.-ylpynltltne ?3 pg Z8' Propi@nttdeNyde •0 Np i Z4'. 01rnelhylnitro:amitr 1045 ytp SZ'. 2Butanone 84250 ' Y0' ?-9 N itrospyrrmUdine 1D,35 +tp ZT' Acelone 1~6p0 yp iCWItcE AbapteC'hn ikunnenynn, 01 at 1972 S-30
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C Page 2 - Mark Pertschuk The Center cites a workshop on possible respiratory effects of involuntary smoke, which was sponsored ln May of 1'983 by the National Heart, Lung, and B'lood' Institute. The workshop reviewed three community-based population studies and concl uded that these studies giive evidence of no, more than a small or negligible effect of' passive smoking on the respiratory system. However, as the Conference noted, none of' the three studies was designed specifically to look at the ef fects of I passive smoking. In one study, a measurable effect was found on the development of pulmonary function in children, whose mothers smoke. It is difficult to take seriously the Center's questioning,of, whether passive smoking is harmful or Irritating,to persons suffering,from chronic bronchitis, asthma, or angina pectoris. We have never known a patient with any one of' these disease conditions who welcomes exposure to cigarette smoke. Finally, the Center discusses whether there is a causal, relationship between lung cancer and passive smoking. A number of studies have been published on this question, as listed in Table 3, showing,positive relationships. .I' hope this information will be usefiul. Robert Hutchings Office on Smoking and Health C Enclosures
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Constituents of Cigarette Smoke.t Ratio of Sidestream Smoke (SS) to Mainstream Smoke (MS) Gas Phase MS SS/MS MS SS/MS Carbon Dioxide Carbo>; Monoxide 20-60 mg 10-20 mg 8.; 2.5 Nitrogen Oxides (NO=) Ammonia - 80 Ag - 73 Methane 1.3 mg 3.1 Hydrogen cyanide 430 µg 0.25 Acetylene 27 µg 0.8 Acetonitrile 120 µg 3•9 Propane Propene o.; mg 4.1 Pyridine 32 µg 10 Methylchloride o.65 mg 2.1 3-Picoline 24 µg 13 Methylfuran 20 Ng 3.4 3-Vinylpyridine 23 pg 28 Propionaldchyde 40 pg 2.4 DimEthylniEtosamine io-6; µg 52 2-Butanone Acetone 80-250 µg ioo-60o µg 2.9 Nitrospyrrolidinc 1o--3S µg 27 Particulate ' Phase MS SS/MS MS SS/MS "Tar" 1-40 mg 1.7 Benzo(a)pyrene 20-40 µg 3-4 3Vater i 4 sng 2.4 Quinoline 1.7 Pg is Toluene 109 µg 3.6 Methylquinolines 0.7 µg si Stigmasterol ;3 µg 0.8 Aniline 36o ng 30 Total Phytosterols 130 Pg 0.8 zrNaphthylamine 2 ng 39 Phenol 2o-i 3o µg 2.6 4 AminobiphEt_tyl 5 ng 31 C-2techol 130-280 µg 0.7 Hydrazine 32 ng 3 Naphthalene 2.8 µg i6 N'-Nitrosonornicotine roo-5oo ng 5 Methylnaphthalene 2.2 ;Ag 28 NNK2 8o-zzo ng io Pyrene 50-200 µg 3.6 Nicotine 1: 2.5 mg 2.7 i Nonftlter cigarette ? NNK = 4-(N-methyl-N-nitrosamino)-s-(3-pyridyl)-t-butanone (tobacco specific carcinogenic nitrosamine) souace: U.S. Depattment of Health, Education, and Welfare: Smoking anAHealch: A Report ofjdu Surgeon Cnenal_ DHEW Publication No. (PHS) 79--Soo6tS. Washington. D.C.: U.S. Government Printing Office, 1979. s4vts9szo%
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ERD71S'TER & BURNS • A REBUTTAL 369 Thcrcforc it is not surprising that thc industry has adbptcd a similar strat- cgy with respcct to involuntary smoking, nanicly, citing cvidcnce selec- tivrly and quoting scic*ntists out of contc.xt. P'rovidrd hcrr arc cxamaplcs of the tobacco indiastry's rcccnt misreprc- scntation of statcmcnts fro~nt the scientific literature in its position paper cntitlcul! "Cigarcttc Snvokc and the NionstnokR:.r." That paper or similar vcrsions havc bccm passed out by industry public rclations representatives to lcgislators in California. The papcr includes many of'the points that Tobacco Institutc represeirtatiwes make rcgarding t'1ac !c&cts of involuntary smoking', in the course of public hcarings and radio and television appear- ainccs. It sccnned, appropriate to have thrsc points discussed ina published papcr that could bc uscd by those who work to promote nonsmoking policies through, legislativc or, other rneans. The indlustry papcr takes to task the results' of a study comducted at, the University of California, San Diego, and published in the New &rigland' . Jnirrn al of Medicinc (3 ) whiich showed'' that nonsmokers exposed to tobacco smoke at work had reduced function, of small airways compared to non- exposed nonsmokers: White and Froeb, the authors of that study, reported that "iflbng-termismall-airways dysfunctionis occurring, the non-smokers who work in a smoky environment have about the same risk of impair- ment as do smokers who do not inhale and smokers who inhale between one and io cigarettes per day." " In an attempt to downplay these findangs, the industry paper quotes from an editorial' written by Dr. Claude Lenfant of the National Heart, Lung,and'Blood' Institute: "The eviidence that pas- sive smoking, in a general atmosphere has health effects reaaains sparse, incoasplete, and' sometinaes unconvmcing." However, reading the entire editorial from which this quote was taken gives the reader a different impression. Dr. Lenfant went on to say: The article!by WJhite and Fro&... brings a new dimension that will' clearly, have considerable impact; they faultlessly demonstrate a re- duction in measures of snzall'~ airways of healthy nonsmokers expose& to cigarette smoke in the workplace ... now, for the first time, we have a quantitative mcasurement of physical change--a fact that may tip the ! scales in favor of the nonsmokr.rs (4). In i98o, whem a statewide initiative to restrict smoking in public places was on the California ballot (Proposition io), thc industry-sponsored carna- pa2gmi to dcfcat the initiative agairn uscd Dr. Lenfant's words selectively. s-is
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~~~ Jv~s ~Isrxur~t P. ANTHONY RIDDER' Y..+..frwt,..rt Pusfiw. ROB'ERT D. 1N6tE YYT ArMdf!111 .walFuewt..r Ed~l.r ROB ELDER RQBERT J. CDCHNuAR JIOHt+f'K, BAKER E.tar Dryw14y E.erws.. Ee,tw W.e.awt;EeNe.. DEAN BARTE£' G'ETa E ~£AL K , YWr,P.e.«4nt~~ -~ Or.ets'~Oprt.tmn. Saks a ~MwretwK~. Editorials Friday. May 20. 1'9g3 Clearing theair C MOKE gipts ~ in your eyes, nose, throat and& lungs when you work next to tobacco addicts. The San Francisco - Board of Supervisors is'trying to clear the air , by reqniring, employers to provide "reason- able" accommodations for noe-srnokers, or ban smoking in the off3ce: Enployess could be : fined $500 a' day for failure ta comply. Tbe ordinance passed its first reading on a 9=Z vote Monday and must past a second time and be -• signed by the mayor before it goes into effect 90 days later. - . The ordinance wouldn't force an employer to create no-szt'noi<ing, areas, or make any "..structural changes;, uniess non-smokers cozn- :: piained. But' it would put the rf ght to inhale clean air above the right to exhale tobacco fumes. T'tie ordinance applies to offices where ~ertoployees work in enciimsed areas; it exempts federal and state off ce building5 and private -homes ~ used' as workplacex.. . If smoking was simply irritating to nor~ sctsokers (77 percent say it is), it wouldn't mes it' regulation any more than popping :gµrn. humming off-key or showing baby pictures. If' secondhand s=nokeaffeeted'the health of only a aandful of ultra,sensitive pnople„it wouldn't, : require a sweeping law to handle the problerm.. In fact, the evidence is mounting,that second- ~., tiand smoke is more than am irritant; it is a Jiealth ba7ard _* When a smoker lights up, two-thirds of the fumes'& go inta ttoe! environment. The "sides, tre,am'• smoke frocr~ the burning end of a cigarette contains much higher concentrations of noxious compounds than the "mainstream" smoke inhaled and exisa9e+d through a filter. Levels of some dangerous subsiancrs are sev- lOB eral1 times higher than tlie' federal limits for inTh~ e's no' clear proof that secondhand smoke increases the risk of'lung cancer, lieart or respiratory disease for healthy adult non, sasokers. However, a 1982' study of' workers who Dad inhaled their colleagues' smoke for many years fflund i changes In the small air- ways of the lungs that could be precursors of e:mphysenaa, chronic bronchitis or other breathing problem.s. In additioni a srnoky environment can aggravate'the symptoms of people with heart and respiratory disease or with allergies, causing headaches, coughing, congestion, shortness of breath, dsest pain, elevated blood pressure and heart rates and irregular heart beats: The effects' can be disabling, or even ldfe tlireatening. to the 5,5 inillion Californians who suffer frmrm heart and lung diseases. The 9th 1Da tSrcuit Court of Appeals recog- nized that a smoky environment can be disa- bling in a 1982 ruling,involving Irene Parodi{ a' Fresnont'records clerk who suffers from asth- matic bronctiitfls: The court ruled that her empioyer, the federal gpvernrnent, must pro• vide her a smoke-free work space or allow her to : collect disability benefits. Non-smokers are', becoming more aggres- sive about'' demanding clean air, and' employ, ers are becoming more' willing, to segregate smokers, but the air hasn't cleared~ in many offices. Regulating secondhand smoke in the workplace is as reasonable as other health and safety regulations. If the San Francisco ordi- nance proves its effectiweness, other citiCs and counties shouid follow suit. JERRY CEPACAS AMWMf X/Mar ~. JOHN HAdME'TT Vr. Plre..denv Lmpl.yre/Cwe.wwny RrWa.m
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ldarsrord Cour:'int Aupust 6, 19'85' page 119, Tobacco Company Crusaders Try Weapon of `Courtesy' Ellfn Goodman Isn't it grand, fellow theater• lovers. At' last, the R.Ji Reynolds company, which has spent sb ~many years writing fiction into its tobac- co ads: has branched out tnto play writing . Its very first attempt ls a charming little vignette on the sub. ject of smoking, and courtesv, printed in the latest series of pua lic-irnage advertising. The script is available to any eager road'. company that would like to blow smoke in the eyes of the audience. But enough of this narration; the play is the thing. TAe curtaln in,the R.J. Reynolds theater opens after a bri+ef' explanation from the playwright ez- plaining his motives. Alas, alack and lackaday„we are told, "these days, the level of'so+cial discourse betr.eea smokers and nonsmokers is approaching that of a t;ag=team wrestling ttutcli:" Thus, we are abontto wtttmm a; scene embodying,a "daring solution: greater coartesy,:" Quiet in ~ tbe ! audi, eace; please: On tbrceoter stage are two main ic4sr- acters. (dne, a male saooker ib about'to light a cigarette in the presence of the other, a female nonsmoker. Here is the ex- cerpted dialogue: He:'°Ercuse me, do you mind if I3'smoke?„ Stie: "I don't mind as long, as you don't let your smoke blow fn my face." Rer"I'11 do my best. Let me know if the smoke bothers yott:" She: "I will andd thanks for asking."' He: 'Z'Banks for be- ing,so anderstattding;"' That's it The curtain, goes down to thunderous: The narrator ccncludes: "Common courtesy. It'f }ustcrazy, enough, It might work." liiow, mindi you, the, dialogue that I have quoted, above isn"t up for a Tony Awu,dl The stakes are much; much higher than that. The tobacco people ! are fighting for air space. The most common scenario of'realilife f.s not necessarily like the one tn Reynolds' road show. The, same encounter re-enacted in a number of Arneri- can the.aters tnay sound more like this: Smoker: "l?acxse me, do you mind if Iismoke?" I+ionsrnoker. "Yes, I do mihd."' The nonsmokers have stopped! believing, that they have to breathe in someone else's bad habits. Smoking, gradually;,ts becoming as socially aceept- able as spittang. We're running the Virginia Slims reel backM1Vard: The tobacco companieS, which do not fear lung cancer, empliysemal or hean disease, are positive- ly terrified of.social pressure: So the lbtesttheatri- cal gambit is to treat the assertive nonsmoker as a rabidJ rude radical. The tobacco people then as* sumc the starring role as the sweet voieeof reason, preaching "coexistence." The nonsmokers are to "understand." Well; forgive me for being rude, but "under- standing!'the smoker sharing your air rights is a bit like giving someone permission to step on your feet, or burn poison-Ivy incense. It's important to keep the characters straight: The smoker is the aggres- sor. Thenotumoker is the defender. But' back to ~ the courtesy charade. One of the great lines in this ad didn't even make the dialogue. It's a stage footnote: "We continue to believe in the power of polite- ness to change the world." Lord knows, so do I: Over the years, I ha9e tried thatcigatettes didn't cause lung cancer. Prettyy please. I have even, ever, so nicely, suggested I that they shou4d'stop selling a product that Is clearly;,ir- refutably,;, lethal. Pretty, pretty, please. 71o be ftank. I don't think It's civil to seil i lung cancer. Nor is it' courte- ous to produce heart dis- ease. It musL surely be Impolite to be responsible for S50;1)00 eiaarette-re- latedldeaths a year in the United' States. • I'd like to read a lit- tle play about people who push cigarettes all day and bow they sleep at night. I wonder If the R.J. Reynolds troupe could whip that one up for me: Maybe If Iasked tliem nicely. After all, we nonsmokers have to, watch our manners these days: I'll say, "Pretty„pretty, pleasre with sugar on top " Ellen Cood>'tcn wnfcs a synrlicoJrd column, from B,oston. (c) 1955, Washington Po t Writers Group, reprintediwitih permission P-1 asking the cigarette companies if they would, stop directiiig their advertising to young people. Please. I have asked them if they would stop pretending C
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. ruNSTER & BltltNiS • A REBUTTAL 371' sure to tobacco snnokc"' and "Snnoking, is the major sourcc of indoor particles . . ." (i). Tlu authors of a paper published in the Auucricart Jorrrrral of Public Hcaltll found that ""Conccntrations of the irritants formaldehyde anud acrol6'n in side stream cigarcttc smol:c lplunncs are up to three orders of unagniteidc above occuraticonal' limits, readily accounting for eye and nasal irritation" (8);. A paper in Scivnn"rcp(Irtl:d that IndlDor tobacco conn- bu5tion cnaits Ilirotinc, poly,cyclic aromatic hy,drocarbons, carbon monax-- idic, acrolcin, N Os, and many other substances (9);, its authors cite earlier work (to) showing that wlicrc two or more heavy smokers resided in a house with low air exchange rates, the 24 hour I*lationall Ambient Air Quality Standard for indoor particle concentrations was violated. Inclnd'cd is a, table from the i979 Surgcion! General's report which lists constituents of cigarette smoke atldi shows their ratio in sidrstrcalm, compared to Imrain- strcanl smoke. This list includes a number of known carcinogcns.. (Scnsitivc scientific measurements arc not rcquircd'to detect the presence of cigarette smoke in the air. It is readily apparent to the human eye and' IlOSc.)' The issue of wlnich component of cigarette smoke is the best ialdiutor of exposure has ~ not been resolved by scientists. The industry has widely quoted a 1975 study that showed that "a nonsmoker would have to spend ioo hours straight in the smokiest bar to "absorb"' the [nicotine) equivalentt of a, single filtcrtip cigarette''' (iii~). However, nicotine tends to settle out of the air fairly quickly and' is not a good indicator of total exposure (iz). Tloc industry paper states that the Surgeon General's report of 1982. '`n4tcd that, the available evidence is not sufficient to conclude that other peoplc's: smoke causes dlsease in nonsmokers." They chose not to cite the Surgeon General's full condusion, i.e.: "Although the currently available evidence is not sufficient to conclude that passive or involuntary smoking causes hung caiiccr ini nonsmokers, the evidence docs! raise concern about a possible serious public health problem!" (S). They also ignored the fore- word to the report by Assistant Secretary for Health, Edward Brandk, M.D., who stated'; While the nature of this association is unresolvcd', it docs raise the con- cern that involuntary smoking may pose a carcinogenic risk to the nonstnokcr. Anyhcaircli risk resulting from involuntary smoke cxpos- sure is a serious public health concern because of thrlarge numbers of nonsmokers in thc population who arc potentially cxposcd. Thcre- fore, for the purposes of preventive nicdicinc, prudcilcc diictatcs tlrat
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2025684493: TABLE 3 ., Sumrriary of studies on passive smoking and cancer Statistically - 11Horf_cer C_ ountry Risk Ratlo. $ig_n_iHcaK- Size Type of Study Cfian (1979) Hong Kong 0.85 223 F Csae control Phillips (1580) USA 2.4F,1.5M F 52,000 F, 17,000 M Prospective Gariinkel (1981) USA 1:Z NO 180,000 F Prospective Hfrayama (1981) Japan 1.6F,Z.9M F,M 90,000 F, 20,000 AM Prospective Trichopoulos (1961) Greece 2.4 F 302 F Case control Coa:rsa (1983) USA 2.0M,2.1F F 188111,155 F Case control Giltis (1903) Seotland 3.3M,1.OF NO 6M,8F Case control Hirsyama (1983) Japan 3.3-3.4 28F Prospective Hirayama (1983) Japan 1.4-1.9 200F Prospective Knoth (1983) Germany 3.0 39F Case control Koo (1983) Hong Kong 120 F Case control KuW (1984) USA 1.4M, 0.9F M 37M,97F Case control Millsr (1984) USA 1.9 F 438 F Can contrw Repaee(1984) USA 1.7 180,000 F Reanalysis Sandier (1985) USA 1.7-4.6 M,F 420M,Is Csse control Ssndler (1985) USA 2A M,F 4661N, F Case control Garfinkel (1985) USA 2.1 F 134 F Case contnol
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Comgoaeats. are . dlluted In air An overall evaluation based!u!pon available seientific data leads to the conclusion that an increased risk [,in lung cancer] for nonsmokers from environmental' tobacco smoke exposure has not been established.s C, Because the workshop, was supported'by a grant from The Tobacc Institute, that report might have met with some skepticism. Appearing almost si~multaneou,sl'y in late 1'9&3, however, was th ~I final report from a workshop sponsored in May by the United' States Pub1i'c Health Servi'ce, specifically the Division of' Lu ~ Diseases of the National Heart, 4ung and'Blood Institute, ino, 8bthesda, Maryl!and'. Participants were 21' investigators from , ~ fields of epidemiology, statistics and adult and pediakric , pulmonary medicine. I I Tfie3~r conclusion: A review oT'the data from the studies Khichihave been 0+ carried out or are in progress which address the ~ effect of passive smoking on the respiratory system suggests that the effect varies from negligible to I quite small. From this review, It was not possible too determine whether there is a specific group which is at i'ncreased risk or what the mechanism of'the effect (if any) may be.6 Some investigators claim reported levels of'various tobacco 3,1 components in the atmosphere -- carbon monoxide, particulate:, i, nicotine -- are hazardous to nonsmokers" health. Otnst' becaus researchers can measure such substances, however, does not me they have any significance to human health,. Cioncantrations of constituents of 'cigarette smoke are:immedia. .~ -dfluted-by: tfie ~surroundingrair.: Andmeas<rranents'of".atinos.pMe_7 : I cigarette smoke taken under-rea~,listic'conditions, indicate thZ; the contribution of tobacco smoke to the air we breathe is fl inimal. One widely stuMied' component of tobacco smoke has been carbon ~ monoxide (CO) . It is well'recognized that the main sources c.. in the environnient are imotor vehicl~es and industrial processe_ - -- not environmental tobacco smoke~. Indoor levels of CO are affected by outside levels and by cooking,and heating, among other factors. Still, environrnental tobacco smoke is frequently blamed for ~ contributing significant aarounts of carbon monoxide to the environment. It is important to re~nber, however, that stuc j~ conducted under realistic conditions indicate that atmospheri from tobacco s=ke!rarely exceeds 10 parts per million (ppm)5 is closer to 5 ppm~in.public places with.normai ventilation,9 IT Both figures are well belb:w the limit of'50 ppm recommended t+• !oph heal!thiagencies for workers exposed'r over an eight-hour perioc. *;~b . hM+~ S~-3
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. T~ ~atio,nal~-nQart Founaarian 01 AL;tra :'a p- A i 7 _^ v:JCB '_5G 2" 5eptenber' 1985 !jr CLaude Len."ant D'ir e zt or ::ationali Institutes of Iiealth 1:ational Heart, Lung, and Blood Institute Biethesda. WYLAaD~ USA 20205'. .r I Dear Dr Lenfant Our Director, Dr Robert Hodge, suggested I vrite._directly to You.for help in clarifying an issue arising,from recent statements by the Australian Tobacco Institute. In July this year, the National Heart Foundation of Australia ran: campaign on the health effects of passive smoking, entitled "So You Th1nk You"re a Nca=.Suoker'. • In response the tobacco imdustry i'n! Australia madie grea t pl'ay of "'three ma jor iateraational workshops' oa passive smoking, during 1983 and 1984 which 'concluded that the health effects of other people's smoke vary from negligible to quite small, that healt hy non-smokers have li'ttle or no physiolbgi'aal response to envjronaaental tobacco smoke, and that lawmakers should not base: their efforts: on, a demonstrated health hazard from 'passlAe smoking'". In particular, the industry hsa referred repeatedly to what it claims i'ss the position of the HI}i. In a letter to the Brisbane Courier-Mai1 published' on 9 August, 1985, David Baconi, the Australian Tobacco Inst!itute' s Ezecutive Officer saLd' 'The US Nat iiomal Institute of Healthr..bas stated quite categorically that possible respiratory effects of environmental tobacco smoke, if aasy, varied from 'negligible to quite . smal'l' •'. It would help the Foundatibn a great deal if youl could clarify, the matter by answering the following questions (please f'oraive me for this tecbni'que, but it helps easure that my understanding is specific and accurate)c- * Is the statement mentioned' the off icial' policy of' the NIH as a * vhole?' I unde In other, vwords, is the Tobacco Institute's.cl'aim true? I RO tand the statemeat was in fact written by the c3airman of' a May 1-31 vorkshop, sponsored by the NHLBI''s Division of Lung, Diseases. Is it in fact the verifi'ed! "conclusion' of the vorkshop as a_vholea Was the document concerned! first ci'rculatedto all the participants for their agreement or submitted to peer review? Has the document been published? C= R_1
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References: 1) Matsukura S. et al. Effects of environmental tobacco ~ smoke on urinary cotinine excretion in nonsmokers: evidence for passive smoking. Ni Engl 3 Med 1994;311:828-832. 2) Feyerabend C. et ai. Nicotine concentrations in urine and saliva of smokers and nonsmokers. Br Med 311934 28'4:1002-10104. 3) Hoffmann, D. et al. Tobacco Sidestream Smoke: Uptake by Nonsmokers. Prev Med ~ 1984;13s 608-61'7. Greenberg, R.A. et al. Measuring, the exposure of infants to tobacco smoke: Nicotine and cotinine in urine and saliva. h1 Eng1 J Med 19$4; 310e1'075-1078. Ohshima, H. et ai. Quantitative estimation of endogenous nitrosation In humans by monitoring N-nitrosoproline excreted in the urine. Can Res. 1981; 41: 3658-3662. 4), The Health Consquences of' Smoking: Chronic Obstructive Lung Disease, (US DHHS Pub (PHS) 303051984:367). 5) The Health Consequences of Smoking: Chronic Obstructive Lung Disease (op. cit. 365). Repace J.L. and Lowrey A.H. Indoor air pollution, tobacco smoke, and public health. Science 1981; 2I08:464-472. 7) Knoth A, et all Passive Smoking as a Causal! Factor oi; Bronchial Carcinoma in Female Nonsmokers. Medizinische 1983; 78(2):66-69. 8) The Health Consequences of Smoking: Chronic Obstructive Lung Disease (op. cit. 386-392): 9) The Health Consequences of~ Smoking; Chronic Obstructive Lung Disease (ap. cit. 1i3'). N O N ~ ~ ~ CD O r S-29
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Foreword: The question of public smoking ugi~fte Smo*ke- and the Nonsmoker 1Als eooklst'foawos on a subdoet that Ras O.eo.o inernasinqly fsoillar to sny - •publle sookiW and the oa.p.iqn to lisit or prohibit s.okinq In publio olaees. The crucial question is .Mtlwsr tMt ssoosure of' non..oksrs to tosaeao s.eke In not..1, evorydsy situations actually creates a health hazard. tN don't think this has 6oon sNown. Ine..e, srnyy soirntists .Ae 0.llisr" s.oklnq is Aar.ful to~s.okars have puWlialy stated tlwm i's not sufficient o.ridbiao to erneluds public s.okirq is har.ful to nsnssokass. Ky, tMxN is so swah 60048" bMsinq 01aood on the sueQoet'' A sLqlwanswr is dlffLoult, but it swrs reasonable to suggest that the failure of the earpaign ai.rd at .akLhq s.okors stop s.oklnq has resultad In a aa.pwwtory effort to srks s.okinqi'aoeUlly. U1moopta0lt.0 i The ea.oaiqn fer outriqAt bans or restrictions on ssokLnp In public Olaws is nyto.oetAy for its lack of'oorsussiMe soisntifio findings. /Ib.er.r, it is eroodinq,diserimLnation and 1'1'11 .i11. 5.okers and' nona.okors, fllonds and n.Lqnbors, are being s.t apainst oad+ other. Soeial friction Mas arisse In o.ey instaness. Yiolonoo and sLL'1'itoney have Ooonikindlsd In sosr cases. Ai+d -• s4st serisusly-- psrsoqsl ftvodoos aru being attsckoS and eroded In a do.oeratib soaiAty. ]*tro Is ns nwd to dsmsnd r+strietiw loqislation - to infringe on frssds• ef choice. Comwe sonso, courtesy and tolsrsneo for the Orofironcss of others arr all that is no.dod to u+aelo ssorers and nowsoolcors wah to .ndoy their pref.rsno.s and to respect those of' others. S eioty is 111-s.r"di.dsn it's ...bors are suba+.ot.d to any kind of ea.osign bas.d on fear or .lsintor.ation. No,yoal Can be Jwstlfii.d sy, Lhe usr of suoh Ocp.ali.nts or contrivances to attain it. EMotionai rlrotorio i's not a substituto for scientific fact. lhe is3soeo ]nstituto Aprili 11MA n
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TABLE 2 Particutate Phase Constituents of Cigeretts Smoke Ratio of Sidestream Smoke (SS)to Mainstream Smoke (fAS)l US i5W Ms ssnres aTar" water 140 mp u mp , 1.7 t. Quleoline Mttnyiqulnotlm 1~ Pp 11 QT{tp 1~! Totuwn. 1oa Vp 6.6' Anilft 360 no sc StiptrWt.ro! 53 p0 0A &MapAt1+y,4WrN Z np 3ia Tctai i Pttytast.rpGt 130 Up o.d' 4AlnnirwobipAenyi 6'np 31 Ptww Cat.cw1 W-11W tp =2BID yp 23, QT Hydratnr N'd+lltroswwsfttir. 22'bp 3 104SOG np i 5 N1tpthaiene 26 NQ 16 NNK• aG220 inp 10 Methylnaphthalerw 22 W U Nieoliey 1-M ' ma 2.7 Pmn.o Qi4200 wC 3S len=ota"nt 2G»a Np U . 4
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A Rebuttal t0 t11e Tobacco Industry's Paper, "Cigarette Smoke andi the Nonsmoker"' VIRGINIA ERNSTER and DAVID BURNS The constituents of tobacco snnoke arc uvell-doeriurntcd as &azardous, the preva- lence of popu lution exposnre is vcry high and there is ari increased incidrnce of respiratory tract, syniptomu airditrnctional drerePnents (decreases) ik cl,ild'ren residg inQ in liornes ivith sinolecrs. Thcsc+ considerations and recent evidcncc of irurcased' hrngt cancer ratcs an:ong noyi-sn:okirig tvoutc7t l'iving tvit'li sinoking husbands have led'us to conclude that indoor e.cposnrc to to6nuo, sinoke has adi,rrse &ects. Public policy should clearly articulate tliat' involiintary exposure to tolracco~sritoke ought to be minitnizrd'or avoidrd ueliere possible. National Rcscarcli Council (i) rGtior+o-z~ ATERIALS prepared by tobacco industry representa- eJ tiwes are diesigned to discredit any links between expo- ~ sure to secondhand smoke and disease. These materials need to bc understood in context, for the tobacco in: _ "-- dustry eontinues to assert that thcre is no evidence cstablishing any adversc health eff+eat of smoking even for individuals who smoke heavily. No scientific group reviewing the medical evidence inAe last i S years has expressedy any doubt that cigarette smoking, causes disease. Only the tobacco industry attempts to make thee issue appear controversial. This has been a long-standing; strategy that was reveale&in an industry document ciitedlin the pederal''Trade Cornniission's report of May 1981 on cigarette advertising. Internal documents from a nzajor U.S: tobacco company describe their public information eiforts as follows: Doubt is our product since it is the best means of:'competing with the 'body of fact' that exists in the mind of'the gcneral public. It is also the mcans of atablisltiing a controversy (2). 368 I S-14
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BusmES&ANU HEALTH CGompany Activities In Smoking Control 3 Fifteen years ago, 78 percent of the population teit dnt managers should' have the right to prohibit stnoking, in their place of business. Now the desire for a smohe- frbe work p,lace is rery much a teality aad extends beyond the traditional boundaries of atanagerttau-labor. aaployRr, employee and white oollar-bloe collar ootteerre;. .. -•: : A review of the liuratureand current sxaau of attoking , control activities suggests that workaite programs have ~ a unique potential to tach those workers who smoke and turdenuilile existing smoking cessation services. As Carok T. Orleans and Robert H. Shipley of Duke University, Medical Center point out in, their tesearrlt. work piace social supports an providb : nonsmoking norms and n.in. forcement to help maintain lasting, changt: : in smoking be - ' hawior: , - Bange' of Approaches Cormpany activities to control uttoking, in the work place range from policies restricting satoking,in designaud aneas, to completely banning smoking at tfie :woeksite. to offering smoking cessation progLVas. Scese an,ployers'pnoo- vide incentives foremployees'who yuit'stnoking that inditde ~ cash and other~ tangible rtwards; as weA as social tein+ fottement through personal recogttition, praiseand company sporuored'conttsts. Smoking casuion suategia may vary deperding on the number of etnployees.,their smoking dehavior, the kind of work performed and the eompaay's involvement in tlle smoking , industry. The Institute on ~Workaite Wellaas of the Washingtoa Business Ghoup on Health, in an ongoing review of'such uruegies, has idetttified several factors contn-buting to suc- oessful smoking cessation programs. One such faetor is that contpany policies are easier to implemenr and less divisive when they ate developed vol- untar6iy. For acample; a study oo employee tatoking', at' Pacific Telesis revealed that 7'out of' 10 (71 percent) of aA enPloyees and over, half'(S1 petceta) of the antokerss would like some type of smoking poliey for ttteirintmed'we, ereated by smoking andlthe eosts of this to their corporate tiudget, but they so far have declined to: develop no smoking policies at the worksite because ~ they view such policies as unenforceable. This, however, is a red hert9ng argument. To : begin with; a policy of no 1 srnolung plus a policy of hiring nonsmokers only comes under a eompany's right: to define the nature of the work place and the appropriate behavior of its employees while at work. This righchas bec* •!n_ held in most legal contexts. For example, the U.S. Equai 3mplbyment Opportunity Commission has held that such a policy does not involve discrimination as long as it is equally' applied! to all employees. Once a company policy is set, most people fiollow. -it: No law; however, is follow,ed perfectly: Think ofispeed limits. A no ismoking policy can neventheless be effective even if'only, 990, percent of employecs follow it. PAG,p lG' work area. About tlirarfotmhs (73 perrent) of all employees would like to have a snaking policy in effect for other arsas at the worksite as well. Six out of 10 (59 percent) would like to iee designated tttttoking and nonsmoking atasi for iastance, in cafeterias and confersttce rooms. . A aeoond tatoass. faotor' is dtat eoatpania that offer ntcentives for stnoking cessatioa realirs the gneatest return on their investment when they provide access to effective smoking stoppage tttediods; that is, those with a proven track record. This is true even when a company's program eonsists primarily of referring smokers to treuments avatil'- able otuside tho , work place. Rodale Press bantxd smokiag in January 1982 for its 350 employees. When a few workers had trouble abiding by the ban, the management encouraged them to enroll in Smok&tders; a'•prirate srtaking txsution program. and Rotlile rdimded the S73'registrationfee as well as paying a SZS bonus to 4toze who stteaessfully quit smoking. . A durd! impmant factor is to precede the offer for cessation treaanent'with eduaticeal campaigns andlor cor- Porate pteswre' or iaoemi'va' to promote quitting. On. Apnl' 1, 1984. dthe Group Health Cooperative of Pltget Sound implitmented its ban on sntokittg,in the work place'for ita'3,OOD employees. This prnhibitiott representss tlie eulhtiaation of rtwo-ycar effort by the,largest Dealth tnaintenattce orpnisatioa in Wathiagton state. Motivated primarly by its mission of wellnas. the smoke-free policy has encouraged most if'at7lt all of its smoking etnployeess tts stttoke kss.and itttanyto t)ttit snroking altogether. Cessation . effiorts of GHC eatplo,yces are supponad by the company duaugfisbe arat'lability of self-help materials and free smok- ing otssation classes. Employees bretking the r les re- peaaedly may erea be fired under tbr new policy,.. At!Ckleatts and Shipley in tlieir mriew fottnd. successful worksite programs hartxss and exploit the ••cltieftberapeutic rssautce - a cohesive sttpport network" with corporate coatiAgenciea rttinforcing', nonsmoking. Srni Fddls,aa, W:shiqgtot. Boid+tess Group on HealtJt The key to appnling to etnployees to comply with ra smoking'pdicies is to introduce policies in a businesslike manner. The point is not to punish or attack smokers.. Employees must understand that the ! no smoking policy involves the riglits of' noesatokers and is ~ designed for the best interests of the company. Introducing a program in such a fasliion is likely to involve little employee opposition or attempts to sabotage it by smoking employees taking an ezcessi vely long time on cigarette breaYs- A arefuily, iintroduced program will cost money. perhaps in the range of $S'to310'per employee for sctting, up the program, arranging employee meetings about the poliey, and promoning it in special newsletters. The om- ployer, however, stands to, get a high rate of return on that investment. For example. suppose a company with 1.000 employees spends 510:000'to introdbce aino smoking NIOYEN'IDER 19'hai M:-33
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T-I b
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30 lMwid 'w Ju1' ADOLTB 6. OL716. AUi.Aer 11i6.1A1S ~ ARIMVR'NAVS IBtA,ZBatOk7lAi0Y+.A.r19'JS~:1P6! oRMII. L 'DRYt008.' Pr6Gr1n 1f61•1D61 AMrBUa OC7$ INI=E1tGF.M. ,Pk61iFAir • A K Itl06QTlAt. fsmnw Edile. QYf10lIR7RD!lIIAG.1lonaruV F.ditor ARTNVRGII9. DVuy 1WaneluM,tduor J/1bM 1L67tT@ftS9A. A.uau+u MananK Edamr /U'X fRAN1IM: Edimrid'J51Es Eduor JI1AC 110sarllfiMLlJwutl Edtmnwl Pw Eduo. ~ IOfM.D.loYlltFr. Ea.e.YP Cene.alYoneter IMD68.L T trvIS.'Sr.YR. OLrw6nar . c~1flCt A rRlHti.Sr.Y.P Atluero.uv J. A.. RlGG&JiL $r: Y.p (Jperaoum flOwARm.DI8H01v: Y.P. B+rayl0.r itelamur . JOlW 1IL03R1)W. V.P Cenae/4. =tJS<J. a0l6, V.P1 8yaau Oh, to Breathe in Nassau County.:. "^Ventpatton in most restaurants'is now so good that smoking doesttlt cause a problem." So said Fted Sampson, president oi the New York State Restaurant Association last year. Too bad he wasn't with us the day we aouldn't taste our stubi, for the cigarettes to the left and right: Or the taigbt' we altipped dessert because the people at the next table were puffing what must have been a pack apiecee over their dernitasses. At times likke ttiat we say "Oh, to be in Nassau County now that the air ls there." 22oat'S because Nassau's stringent newr smoking regulations ro- quirerestauratnts to ptovide noasmokdag srctiaas or to Install highly effective but costly air-cleaning de, v6xs. What Nassau. rez)ttires, however. New York City only hints at. Last June, Mayor Koch asked the city's 14,000 restaurants to reserve 25 perceat' of their seats'for nonsmokers: The Health Department followed up with a letter. Be so ltind. it said, as to fill out the en- closed form u tell us how many seats you're plan - tting to set aside. Fewer than 1,000 even picked up their pens; only 900' were planning, to t>eed the Mayor's modest proposal. Askiisg,restaurants voluntarily to'ereate a non., smolting,secctioa, then, is about as effective as ask-, fng people not to parit on the street. It'S the threat of' a fine, aot the call to honor, tbat works. A bill beforee the City Counciliwould require nonsmoking secticas. ia restauraats seating 80 or, mmm; but without re- quiring fixed proportions or partitioas. Courtesy haviag',failed; it'stime to try clout. 0-4' TFYE NEW YOflT{ TIMES. TUE:
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LOS ANGELES CITY' PUBLIC' SMOK'I'NiG ISSUE PUBLTC' OPINIOW. SURVEY • - SUMMARY OF FINDI'NGS' . . t, . .. . . The foilowi'ng,are highlights of a public opinion survey conducted April 12-16, 1984 by the independent public opinion research firm of Bregman and Associates and its presiden , Gene Bregman, and by Dr. Larry L. Berg, director of the Institute of' Politics and Government of the University of' Southern California. A total of 5'06 registered voters were randiomly selected fromiall 15 L.A. City Council districts in Los Angeles. * Less than one out of five (18t) registerid voters feel the Los Angeles City oumci'1 shoupaSs a law restricting or prohibiting smoking in local businesses. * Four out of five (80%) feel that the Los Angeles City Council shouMeilther not pass a law ('39t) or should simply urge businesses to establish policies based on employer and employee Aeeds (41%). . * Seven out of ten (72i) of, the nonsmokers and almost nine out of tenTM) of' the smokers id'entified in the survey said1 that problems between nonsmokers and smokers during the past three months have been rare or non-existent. * Seven out of ten (70;) feel businesses have already demonstrated, that t-fi-ey can hafildi'e problems in this area on a voluntary basis. * More than 3/4 (79'l') feel the establishment of separate! smoking and nonsmoking areas in restaurants should be left to each individual restaurant owner, base& on the restaurant's size and the needs and d'esires-of its customers. * Seven out of ten (73t) feel that either taxpayer's dollars should'' notFe-used (3813 or feel-authorities should not spend their time enforcing suc lavi5 (35t). 91 beli'eve the police and the courts should'aggressively enforce such a law and 114 feel employees should have •to sue in court to force their employers to: comply. * 2/3 (67i). feel a law regulating smoking in public places would' be unenforceable. 82t feel,civil lawsuits resulting from this law could further clog o!ur already overcrowded courts. : * Seven out of ten (73'1) believe there is already too much ~' government involvement in peogle!s lives and the same 73t' believe ~ government should not, regulate personal' behavior. ~ * Survey sample i'ncluded 651 Democrats and }25% R'epublicans, ~ comparedl to a City of Los Angeles voter regiistratilon of 63% GO Democratic and 271 R'epubli'can. "p . . ~P
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G3prette $II1oke' and the Nonsmoker The Issue isnot new T6e evid+e,nce. Is incoOclusive Among, the more recent charges against smoking is the claim tha exposure to other people's cigarette smoke -- sometimes callea~ "passive" or "involuntary" smoking -- can cause disease in nonsmokers. Efforts to make saaking socially unacceptable -- some try to convince the nonsmaker environmental tobacco smoke i's "harmful" -- rely heavily on certa3n, research reports that purport to lir other people's saMoke with cancer, lung problems and other diseases. Such cliaLms have not, however, withstood scientific scrutiny. Concern among nonsmokers about the possible effects of breathir. other peoplie's tobacco smoke began to emerge following ai 1971' speech by the then Surgeon General, Jesse Steinfeld..Ca,lling : a ban on s:+I in public pl!aces, Steinfeld said that "evidenc, is aacsa,xnlating that the nonsmoker may have untoward effects f: the pollution his smoking neighbor forces upon him."I A year laEer, the 5urgeonI Cenezal's annual report to Congress c seoking andlhealth devoted a chapter to studies claiming to shc exposure to tobacco srac-ke in the air "aay"'have adverse effect: on nonsmokers.2 These pages set off a chain reaction as researchers began weasuring, smoke and smoke components in public places and in laboratory settings and estiuaating amounts to which nonsmokers are eXposed. A body of research a+acumulated during the 197,0s. But, by 1979, the "evidence" was still' so conjectural no objective scientist could have drawn, any har1 aonclusions about sidestreaai smoke and disease. After reviewing, the decade's research in, more than 40, pages, tr 1979 Surgeon C,eneral's report said healthy nonsxookers exposed t cigarette smoke have little or no physiologic response to the smoke, and what reaction may occur is probably psy,chologilcal.3 The 1982 Surgeon General'a report, on cigarette smoking and cancer, noted that the available evidencs is not sufficient to conclude that other people's smoke causes disease in nonsmokers. Itw 1983' two scientific workshop, aieetings on environeeental tobac.: smoke also recognized'that'the scientific evidence was inconclus,ive. Many of the participants at both have published strong anti'-smoking views. The first workshop, which drew medical researchers fromi nine countries to the University of Geneva, heard new data and ~ reviewed existing studies. The Swedish researcher who organizp~ ~ the workshop sumaied up: ~ CA' M1 Gn' ~ ~ W.
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CO test results could not be -- - reproduced Some opponents of tobacco smoke have claimed carboni monoxide causes or contributes to the development of heart disease In ~ nonsmokers. Those who make such claims frequently cite research ~ conducted In the late 1960s by a group of Danish scientists,. I The researchers, studying the effects of CO exposure on rabbits fed a high cholesterol diet, reported carbon monoxide in tobacco smoke ptiayedl a major role ini hardening of the coronary arteries.17 ifiowever, when studies by other researc18rs reported , negligible effects of CO exposure in other animals, the Danish ~ scientists, tried, and failed, to reproduce their earlier test C,' results. They reported in 1978119 and'.again in 198020 and!198'121 I1, that CO did not produce significant changes In the coronary arteries. Studies of humans exposed to high amounts of carbon monoxide in I their work environments also generally fail to support the claiT-) that CO oauses heart disease. workers such as bridge and tunnel workersg and blast furnace workers, known to be exposed to high levels of CO on a, regular basis, have not been, found to have higher rates of cardiovascular disease than the general pwblic 2z: Other researchers al'so have: concluded'.that CO does not contribuRr,,i to the origin oR'heart disease In the nonsmoker. For example, ill a 1981 issue of' the American Heart Journal, a scientist known for ~ his oppositiion to smoking said that exposure to the tobacco smoke~ of'others did not have any liong-termcardiovasaular consequence--. for the nonsmoker.23 Two highly publicized 1981 studies have been! cited frequently to { support the claim that environaenta,l ci'garette! smoke increases I. the risk of lung cancer Ln nonsmokers. A.3apanese study~ by Dr. Takeshi Hlrayaqa?4'. andI orne-by a Credc •team. headed by.mr: .pYaiitrios Tr3chopoi ' both suggested that _nonsioking° wives of '` smokers have a higher risk of'lung canaer than nonsmoking women } married to nonsmokers. 8oth studies have received extensive criticism In the scientific literature since their publ!ication,, In addition, findings from ~ rem nt American Cancer Society study26 contradict the results os °. the 3apani and Greek research. Thus, these claims of increased cancer risk are highly suspect and not proven. Shortly after the Hirayama study appeared' in, the British Medical 3ournal, Westions were raised'by other scientists in the n+edical terature about the design of the study and the validity of O Hirayama's conclusions. A number of highly critical letters In the journal pointed'out inadequacies and~ inconsistencies in the data. U1 M . ~ ~ .~ ~
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! A'PPENDIX : A SLANTED POLL ~ ON SMORINO' LAW During 1984, the Los Angeles.City Council' considered', and eventually enacted, a law to protect nonsmokers from secondhand smoke ira1private workplacesd. Respected polls taken nati'onwide (Gallup poll; Attachment 1) and in California (Field poll; Attachment 2) show a large majority favoring restricting, or banni'ng_smoking in places of employment. Sharply differing views were presented by a pol1 taken . among Los Angeles voters in April 19'84 for the Tobacco Institute:. The poll showed only 18'$ in favor of the proposedg smoking law (Attachment 3). These results were reported in the Los Angeles Daily News on May 28', 1:984 (Attachment 4). The large discrepancy between the Field and'.Gallup polls on the one hand'and the Tobacoo:Institute:poll on the other may be better understood by examinirng, the wording of specific questions (Attachment 5:),. The poll questions have been constructed to slant the responses against the proposed law. The first question makes it easier to be "opposed" by providi'ngtwoneg,ativeresponses~ responses~and favor"., Although,we do not know if'the questions were rotated duri'ng . - ~ polling, all the negativeresponses were in the later positions in the report. Both negative responses contain arguments against the law, both'gentle ('"... should simply urge ... based on ... ~ . T-6
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Why Does Anyone In This Netion Still Smoke Cigerette.s? '' WAS HAYINO e physical exam the olher day, and the ee.mtner - a fellow I had • nerer mel before - was going down hla ' checslGl of queslions. -- ---- -- - --- you fmoke cl`ar.ltesT' ha mid. 1 ald. .'11aa you everY• be eald. "No." ( ald. and be morsd on lo H+e nest • quesllon.- Bul I was ooly htlt Ilstenfnl to ; hlm, I was-thlnklnR how amnelnelf h lhaf antr a11 lhese yean. anyone In the United : Slalea sllll srnokes at all. ~ I hare written angry columns about • smoklnt aed I have rrlllen a11AcaI col- :umrtr about smoking. I have written col- umns gently laying out the er`uments n/,nlnsl smohlng, and I have written columns ucunR orerklll in dncrlbGqmeharwrdr of smoking I have used every rhelorlcal de- vlce I could think of to_ polnt out tbe folly of smoklne. None of tl has mattered In the leesl.--- - - ------ -- ---- ---------- --- Bob Greene tofof number of clprettes smoked is rhlnl. The only Irulh you-can Ilean from all of this b that smo_ke_rs apparently are determined -- - --- -- -- --- ------------ to rmoke. Admllledly, tlU wnimoker, I am pre- cbely Ihe wrong person to eaplaln thb pha• nomenon. 11 b Jusl so battling to me. So lo- day Insieed of arguing against smoking spin. I will approech th6 In a different manner. Today's columofs addressed In Ihe form of questions to those of you who smoke. The quef/lom I ask here are not meant In /esl. They are not meenllo be mrcaullc. I would seriously like your enswers. The ques tlons are ones tha/, to non'mokers, seem tesltlmele; apparently we are wrong. Ilme to llme, pM to twe what the resl of you you thh, but the very corporaflan that sell ere do1n1, ere perplesed. The taste and you your cJprettes tell you the same thing every tlme you purchase apack.-ISO you thlnkIhlf (s fomellrl_n6 they w_enl to do7 Ir the manufacturer of any kind offood prod- Mllllone upon mII11orM ef people continue to smoke, and It should be clear by now that the anllsmok/n1 forces are desllned to 101e. Every time that government s1a11stlcs Indf• cate thepercenlale ofsmokerf tdgnlnl down, another sel ofslatlsllca seerna to Indl• cale the precentage of heavy smoken Is going up. Erery Ilme Ihe sUlBt/n ay that the number ot cigarettes smoked per caplta b fatfln& a sephrete set of sullstlo says the 'f It fun to smokeT You musl thInk It d, et you k!ouldn'1 do II, but those of us who have Inhaled IhaYmoka from e cllarette from phys/cel sensalbn are so foul; It b hard-for as lo understand Ihat you are ttctually Aerflr- fn1 some sense ofpleaeure. Are you? Do you-lhtnk R b an atlraellve faee/ of your personeltlyt Yoe must: but fhese of as who see the grimy butts plied In ashtrays on your de+ks, who smen the roul odor en your breath and on your clolhes• wlro-enler your cars and your homes lobe asuauited by the stench Ilalb left erer from your yean of smoking - we have trouble endentandlng Apparently you aee yourself as doing fome- (htnl pleasant. or at least InoBensive; this puules w. . . Do you think the ctpr_ ette companies put Iho.w IIt11e dlxlalmers on their paktltes end to their ads because Ibey wanl toTil Is clear to theresl of us that overwhefming evidence suggests your smoking habit Is plnllo hurryou, Ifnol kltl you; it woutd be one IhIn1 If we were the only ones te111n1 Caalle+ed Pr+m PW HI Ihey wanl lo nava awayt + ever mkedlheiny when you first pufa eew cigarette Into your . 09 you nof t:are whel others thlnk etalA ymly moulh, do yoa thlnk that somethlnll{ood Is hap• . 6ranted, your aet6lma`e Is more Important Ihan panlns? Nhea the smoke hlts your Ihroaf, 1s R • the precey/lon of you that sa hel-d by olhea. Bul saliffyln+ In any-weyl And H It N. caold you 014, S do lou re.ny think you are alfnIn the days of flne It? 1s sucklnl cigarette smok_e Into year James 6on_ d, wAen people saw a person taking I Ihroat belter, sey,-Ihan sucking In e breath of ~ drel on as ciprette and a.umed he was aophlslt• clean efr?-And If Itls, whyT nttd .M worldly? Gn you possibly not rcenra I will be Iratefetlf I get seme ens.ren te Ihex ~, that people see you amoklnl and a.vume that you questbnat I lhlnk Ihef Ihose of us who doaY smoke : are .lepld and unclean and aelfdeslruNt+e7 Do are genuinely curleuf. Th1a Isn'1 one of Ihose cot- ; you not know that people do not whh to fll eeal lo amnf desltned to plck a nlhL 1 really waol to -; you In reftauranta.buses, alrplantl and wa11/n1 know how you feel about all of Iheme poestlons. '~ rooms7 Does M mean nothing to you that when lyl devote a futere cotumn to fout amwers. a cigarette In your-moulh; •caKqel~wv..e ----- -- ; people see yor with .- 8VVVg9szoz uct put a label on every /ar or hos lelllna you that the contents were-Aotns lo mekeyou slck, would you go ahead and buy that Jar or box? -- Do you have no respect for your faml- lles? It seems to uslhat youdon't. There is a cerlaln devlt-may care recAtessness that some people like to aftect, pul those of us who don'I smoke cannot understand a per- son dragging his er her family Into the plc- lure. Weassume Ibat If you smoke, you'n Ie111nR your famlly that you're not phrtlcu- larly concerned about what's folnt to hap- pen to theminihe f0fure;-we wonder what your spouse and your chlldreh eey, or thlnk, every time they see you light up. Ifeve you See GREENE, Pqe Sy ~:
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Contra Costa packs:it in The Contra Costa County supervisers should be congratulated on their recent deci'- sion to limit smoking in publoc places. And their new orditaance should be taken as a tnodel by other communities that seek to protect the rights of non-smokers., . Actually, the new, ordinance iis a model, in the strictest sense of the word. It Was pro- posed by the locaS' chapters of'ttse Ana+ec+ran Cancer cwi+ot},, the American Heart Atsocia- tion and the American, Lung Associatibn; t~hr+ee national health orgaaisaaoas de; •:e,A too reduciag the damage dome to thepublic healthh by tobacco smoking. The ordinance prohibits smoking in end clbsed public places, requires employers to ensuresrmoke-free workplaces for effipioyees who don't srtsoke„and~orders restaurants that seat SO or more.to devote at least 40 percent of'their seats to non-smoking areas. It Was adopted, oni Monday by the city of Richmond and on Tuesday by Contra Costa, County as a whole. The next step is to try to convince aIG, the other 17, cities in the county to approve the same ordinance bef are Nov. ll.t'~tieannual! GreatArnerican Smakeout. Day. Lf they do. their county will'e become the first in, the L7nited'States to present a united front on behalf' of non-smokers' rights to breathable air. 0'f' course, there is some question as, to whether the presenee of smokers in a con- fined space necessarily renders the air in thatt space unbreathabie. Dr. Stephen Arnold of the American NTeart' Association cbntends that "the effect: on the lungs of a non-srnoker" from secbndhand smoke "can be thee equiva- Ient of smoking' a halt-pack of cigarettes a day." But scientists from the University of' Nia.ssachusetts and Georgetown University, brought to the Bay Area as expert witnesses by the tobacca iDdusuy, contend that re- search on the secondhand smoke issue is still inconclusive. I+fevertheles3, there ii+s no longer any seri~ ous doubt about the deleterious effects of smoking on~the healthloi smokers themselves. In the words of, the new surgeon generairs warniags whichmill begin appearing on ciga- rette pa ck:f the first' of'nert month, it is now a proven fact that' "=oking causes lung can- rer, heart disease (and) ezmpltqsema" and that "smoking,by pregnaatwoaaen may result, in fetal injury, ptemature birth and low birth weight•_"'If there is even the slightest chance that passive smoking exposes non-smokers to these dangers. it would be criminally negli- gent to force thetn to take that chance as the price of venturing into a~ public place. And not even the esperts retained by the tobacco industry contend' that passive smok- ing has been conciusively proven i to be ~ harrn- less. But' even if it had' been; this: would not justify, unrestricted smoking,in public places, particularly enclosed public places. A substantial portion: of the population understandably regards smoking in, their presence as a nuisance. 4nd'the legiumacy of laws limiting or forbidding public nuisances - loud noisemaking, for e=ample, and litter- ing, - has lbng since been established. - No one questions the right of smokers to damage their occn. health if' they so choose. Bt1t they have no~comparable rig52' eitt:er to endanger the health of' others,. or to maike nuisances of thernselves in publSc places. o-s
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DEPARTMENT OF HIEALTH'& HUMAN SERVICES Public Health Service RockvU/e MO 2©815'7 January 24, 1986 Nlark Pertschuk Californians for Nonsmokers' Rights 2054 University Avenue Suite 300 Berkeiey, California 94704 Dear Mark: RSCS1'WS0 f 4~ T~ 1986 It was pleasant to talk with you this morning. We have the deepest respect for what your organization : has done in protection of the nonsrnoker. Sorrae time ago, someone sent us the enclosed statement from the "Center for Environmental Health and Human Toxicology" and asked us for comments. Our comments were very simple: we found nothing,inithe statement to:bring into question the views of'the Public HealthiService. These views, which have been stated by the Surgeon General, are set forth in another enclosure. The workshops in Geneva in 1983 and Vienna In 1984 which were cited in the Center's statement involved'the work of many scientists -- a total of 16 papers were presentedlin Geneva and 16 papers in Vienna on-the signifiicance of human exposure to environmental tobacco smoke (ETS). None dismissed the possibility off health risk, although the conferees differed on the significance of this risk. o At, Geneva, Russell, in his summary paper on the health effects of' ETS, wrote that' although publGshed' data on,ETS and lung cancer cannot be considered conclusive, he believed the attributable risk in exposed nonsmoking wives in some studies is sufficient to indicate a potentially sizeable problem. In the case of chronic changes in lung fiunctiony he wrote that published studies are contradictory but that as these changes may affect, many people, this area deserves further research. He wrote that the evidence of relationship between ETS exposure and lower respiratory disease in children was fairly strong, and that' there are other potentiali risks of ETS exposure which deserve further research. o The papers presented in Vienna also acknowledged the possibility of, risk. Hirayama presented data from Japan which showed a positive linkage between lung cancer andIETS' exposure; Garfinkel reported he could not confirm this with U.S. data,, but, that the possibility of a relationship exists. Several speakers establlishedi the presence of nicotine and nicotine metabolites in nonsmokers exposed to, ETS, including their presence in infanrts. S -26.
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i 0 Another study- another contradiction ' Researchers study InaR function The study wasf'aulted for not recording the cell types of the 'lung cancers found27 and not accounting for either the.level of exposure to cigarette smoke in the surroundi'ng air or to indoor air pol'lution from household heating andlcooking equipment ?8 Problems with the population sample selection$9 and statistical analyses30 also!were noted.. The authors of'the Creek study themselves conceded'the limitations of'their research. Trichopoanlos and colleagues admitted the number of'cases studied was small and noted they presented their data "principally to suggest that further investigation of'this issue should be pressed~"25' The authors offered!li'ttle informatLon about the population from, which thei'r sample was selected. Nor did they i'ndicate they had considered such faetors as diet, family history or occupational exposure in reachd~ng their conclusions. After reviewing problews such as these ini both the Nirayama and the Trichopoulos studies, a scientist from the German Heart Center in Munich concluded that "passive smoking may mean an annoyance for healthy adults, but in all probability it is not connected with damage to health.«31 The American Cancer Society study that reache& conclusions much different froe, those of the 3apanese and!Careek studies casts further doubt on, the research. Author Lawrence Garfinkel, the society's: vice president for epbdemiology and statistics, reported finding noi signi'ficant increase: in lung cancer deathh rates among nonsmoking woeen married to smokers when comparedl with those of nonsmokers with nonsmoking husbands. The population he studied', so.e 160,000 American wives, was larger than the 3apanese and Greek studies coabined.Zd Cartinkel discussed his f'indiings i an interview, coamenting,, "Passive.s.roking way be a political matter but i't is not a main iasue ini terusof healtfl policy."32 In 1980J authors U.es R. White, a pnysiaai education;instructor at the University of California at San Diego, and Herman F. Froeb, a physician, claimed that chronic eacposure to tobacco smoke in the work environwent significantly affected lung function in nonswokers.33 White and Froeb had attempted tol measure swall-airNays function in smokers and nonsmokers enrolled in a physical fitness profile course. They concluded that nonsmokers who: were exposed to tobacco smoke at work for 20 years or more had~ reduced function of their small airways compared to nonswokers who said they were not exposed to tobacco seroke.
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Study design judgtd to be faulty Researchers measured wr~nga eompooent Like CIO, airborne particulate matter arises from many sources besides tobacco smoke. It can include everything from dust,, paper and textile lint to animal dander, pollen and fuellresic A 1980 study invoiving measurement of particulates in public buildings iniwashington, D.C., is cited frequently to sup~portt claim that cigarette smoke may be harmful to nonsmokers. 0 The authors, 3ames Repace and Alfred Lowrey, reported that in buildi'ngs where smoking was permitted levels of'respd~rab,l'e particulat&matter were far greater than in places where smok! was not permitted. Serious qwestions about the study's scientific methodo,logy wer• raised when Repace presented additional'data to a 1982 meeting the:American Society of Heating,, Refrigerating and Air- Conditioning Engineers.ll Questioned from the floor by a consulting engineer, Repace admitted he had, not measured the quantity of outdoor air introduced by ventilating systems»1p ~ Mother critic noted Repace and, Lowrey did not'.easure particulate levels before swoking began, failed to present dat on actual ventilation rates and, most ieportantly, did not determine the specific contribution of tobacco smoke to particiulate leveis.13 Other research does not lend support to claims of adverse healz . effects associated with cigarette ~ smoke components in the environment. Danish scientists exposed'nonsuokingisubjects to atmospheric tobacco smoke. They also measured the levels of smoke eoMponents in.the test roomL Their conclusion: Ho data exi'st to support the contention that ambient tobacco smoke has "a:lasting adyerse health effect,in otherwise healthy . .indiwiduals:"1.4 Use of measurements of CO and!particuliates to estieate environmental smoke lenrels can be questioned,, because both i are produced by many sources. Most researchers consider nicotine a uchimore appropriate-and reliable Lndicator, since it iss produced exclusively by burning tobacco,. Studies using nicotine~as a smoke index help to, confirm that th contribution of tobacco smoke to the atmosphere: mi'nimal. Drs. pill'iaM Hinda and Melvin First, researchers from the Harva School of Public Healthy found only very small' amounts of nicotine in, the atmosphere of crowded'bars, bus and airline terminals, restaurants and student loiunges.15 Researchers in Europe who, used di?f'erent methods to measure the . presence of tobaccoismoke in the atmosphere reported slightly higher nicoti'ne concentrations than Hinds and First.16 But the like Hinds and First, concluded fro+m their measurements that smoking,daes not represent a risk to nonsmokers.
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I ••Evi+dence ... remains sparse" Smoken' children are studied Those who~cite White-Froeb, however, fail to take into account what one of'the government's highest health~offici!als wrote in an editoriali in the same Journal issue. "The evidence that passive sawkingi in a general atmosphere has health, eff+ects,"' wrote Dr. Claude Lenfant of the Matiional Heart, Lung~ and 61ood' Institute, "remains sparse, incomplete and soewetimes unconvincing."34 others criticized the Mhite-Froeb study for usingilung function testing equipment that fails to meet the technical recommen- dations of the Aarerican,Thoracic Society3S'and for using carbon monoxide as aniindex of smoke exposure, as CO isinot unique to tobacco smoke.36 Strong criticism of the White-Froeb work surfaced during a joint annual .eeting of the thoracic society and the American Lung Assoeiation, in 1982. In a session on "seoond}tland smoke," Michael Lebowitz, a Uh.ivers,ity of Arizona epidemiologist who was co-author of the passive smoking chapter in the 1982 Surgeon Ceneral''s report, termed the studly improperly designed from an epide.iologic point of view.37 White a4Froeb, Lebowitz claimed, had unaccountably eliminated 3,OQ0 subjects from thei!r, study population and then declared their results to be significant. The epidewiologist, who has been conducting his own Tucson Study of Obstructive Lung Disease since 1972, concluded the result of'the Mhite-Froeb study cannot be used to demonstrate an effect of environwental seoke onilung function. And in a statement filed in early 1984 with the Los Angeles Coun!cy-public Health Cosuission, Lebowitz took further issue with the white-Froeb work. He wrote: Even with a biased population, poor study design, and incorrect statistical'evaluation, there were no elear-cut, consistent, medically meaningful (or believable) di'fferences between passive, smokers and nonswokers,38 Some studies have reported that respiratory problems in children are related to parental smoking at home. Although they do not pertain directly to the topic of smoking in ublic places, they are frequently cited to heighten health concerns about environwental'tobacxo swoke.. Such studies usually fail to consider other factors that might be related to children's illnesses -- school environnrents, parental economic status, heatingisystems, the use of gas stoves and the illnesses of other family mentiers.39 A five-year study on respiratory ailments in a28'Dutch children found saiokingland nonsmoking parents have about the same proportions of children with respiratory probleias. The researchers concludedr. "The number of cigarettes smoked by the parents has no influence on respiratory symptoms in their childten."40 S 7 C;
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21. Muqod, C. and P., AitruP, "Studies of Coronary .nd Aortic Intisi Morphology in Rabbits ERposod to Cas Phase Constlt- wnts of Tobacco Smo1ce (Hydrogen Cyanldt. Nitric ORlde and CarOonyl Sulphld.)," lmeiv and Arterial Dlissase, edl, RLM. CrosMaloA (Lwodwn: itayn' /Mdlaa~ 907I , qP; si.l2.. Ms.klns, L. andlC. lrqed.,"T6e IefLwnoe of Careon Monoxide on, Intiotil Morplqlioqy In the Rabbl't," S+oki and i Arterial Disease, ed., R. M. Cresehulqn, (London~tsn 11.diZ,1lbT) Pp,. M.66'. 22. 7onss, 3. C. and A. Sinclair, "Arterial Disease A.orgst llisst' Furnace rorkers," A_n , 0~.'~e N 1! (1) r 13-20, 1975. 1975. SiYrers,,R.,F., et al., "Effect of Exposure to Kno.n. Cennntrations'of'Carboe Monoxldet A Stiudy of'TEaffie Drfioers Stationed'at the Nolland Tuwnsl for Thirteen roars:"'u „N 188(a): Sd9'-SM. Fesr+tary, 216 6 1942. 223. Kawwl, t., '1pdate on tM ROle of CiOarstto'Smekinp in Coeen.ry AeROry Dlssase,' Ar Msart 3 101(3)s )1f-32l, MareA 1fli. !%. Mirsyrr, T., NYn-5osltLq1 fiwes N 11sevY S+.kers Nave a Ulylwr Riak of Wrg C.nosrt A StuOy frsta 3apm,' rit 2A2t 1W155. 3anwry'17, 1941. Mieayar. T:, 'pwiwlmmitiwf aM Lu" i Catae.rt Cwistoncy . of Aaseelatian." letter, Lancet IIt N2S- A2i. Dsns.ber 17, 1!b! ~. 2S. Tridropeulos, D., ot ai., 'Luaq CMtoer and Passive idcieq„" 1'~aneoe 27: 1d, tfih: jht , TrIcmPoul'os, 0., ot al, "Lunq Coeeer and Pauive S.okSnp:. Conoiuslbn of Crosk Study,"'lettar, Lancet Us i77-i7e,. Spto.ber 17, 1fl3. 26. Garfinkel, L., 'Tir Tmends In Lung Cancer Msrtalilty Aeoeq: Ibest+okers and a Mste on Ppsilro 3mokinq+- 7 !M Cancer Inst "(6)1 10f1-1Q4i, 1901. 27. Sch.dQ, D., qustod In 'Iarqakrebs aureh P.asivrais.'h.n+. Studio au. 3apan estatlqt wre.eht/ad.r.pnen aus DoutsoAland (Lunq Cancer fro. Passive Ssolclnq° Study fraw 3aPan Confirtis Suspieion/Cartradiietory Opinion fro. iCsrsetY)," ud 1[t, MarcA 10, M'. Translation. 20. Sterlinq, T., '9bn.Siohltp Rives of Heavy S.ekers Ms.r a Higher Risk of LAinq iCa+sc.r," rlt Mid a I: 111SS„ April A, 1fA1. 2!: LoMert, C., `Krank t>u01h Paulrrauotwnt' (,TlL by Passive lsekinq?),• Muntlt .+d lseM 123(40)2 1MS-1AN, 1991. Tranalrtioe. 3n. 1(aodonaUd. E., •Men-swekinQ,Rives of Mosvy Se~oWrs Maw a Mipnr Risk of livrg Canoer," Sr_1t 1Md,y1 2e2: f1S-l1Y„ ifA11'. 31. Sa6lovelWin, N:, 'Lwqe*ar=Snw bel Paulvrauelwr (Laeqi CArolneoa In Passive Srokers)~,' Mineh_d!oodrc 123(17): fib-fil: 1961. Translistiion. 32. Carfinkel, L., lntsrvliw, "N1ont von eiqentUlkd»n Pe+opis. ablenbn (Let'r Concwetrate on the Malm Issue)," Nunet+ sd •seAr i230OI)'n 1+1A3-1rM, 1t61. Translation. Q ~NR vt ~ ~ MP N l
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jo.* Jvwu.iV1%L ur PuIsLJL J!L•ICL'TJ1 Y'UL1iCY • SEPTEMBER 1984 FFinally, the industry paper al'togctlicr omits discussion of frcquent rc- ports of eye, nasal and throat irritation itt nonsznokcrs cxposcd to cigarette smoke and the fact that certaut allergic symptoms appear to be triggcredd by exposure to cigarctxe stnokc (1 7);. Moreover, tlie Accm"beyondhcalth" deserve attention: people have a right to breathe clcan air.. SUMMARY There is no reasonable doubt that cigarette smoking causes cancer, heart disease, lung disease, and complications of pregnancy. Smoking is respon- sible for an estimated 340,000 deaths among Americans each year (6), making it die number one known preverntable cau5e of disease in this country. The question at hand is not whether smoke can cause heart and lung disease and cancer but. rather whether the dose of this agent received by the secondhand or involuntary smoker is large enough to cause disease. A growing body of work suggests that the consequences of this level of exposure may go far beyond the simple eye and throat irritation com- monly experienccd. Im the face of this evidence, the burden of proof shifts to those who~ would expose the nonsmoker to an agent that in higher doses is clrarly deadly. For until it is proven safe, as the Assistant Secretary for Health has said, based on our current leveli of understanding, ". .. prudence dictates tharnonsnnokers avoid exposure to second~-hand tobacco smoke to the extent possible: " REFERENiCESS i. Committee on Indoor Pollutants, Nationali Research Council. Indoor IDbllrrt'- talus. Washington, D.C.: National Acadctny Press, 1981. 2. Mycrs, M: L., C. Iscac, C. Jtnnings, W. Lcnox, E: Minsky, and A. Sacks. Federal Trade Connirission Stn'Riport'oii the Cigarette Advertising Investigation, May' 198r. 3. Whitr„ J. R., and' H. F. Frocb. "Sinall-ainvays dysfianction in nonsmokers chronically cxposcd to tobacco sniokc,'"' Nrcu England Jorrnnal' of Medicine 3022 (1980): 73o-a3. 4. Lcnfant, C:,andl3. M.Liii."(Passivc)' Sinokcrs Versus (Woluntzry) Snlokers,"' Nrit, Eqlnnd Jwr+rual'of ll fadiriatr 302 (198b) : 74a-43!. S. U.S. Public Health Service. Tlic Healtli Cnnsrqr+cuces of SmoLtibg: Cancer. A Rcport, of tJre S,qroij! Ccnrrrrl: Jg82: U.S. Department of Hcalthand'H~unnan
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B'REG1v4AN i AN D ASSOCIATHS' Sur-vey of' Los Angeles City Voters - 506 I'nterviews Margiin of Error: Plus or Minus S; . Question: "Recentl'y, your local city government has been, considering a possible new law that would restri'ct smoking in the workplace. lihich of the following statements comes closest to your opinion about_. restricting smoking where people work? a,. The City Council should pass a law restricting or prohibitiug-smoking iln all local businesses 18i b. The City Council-•shoulid simply urge all local businesses to establish smoking and non-smoking sections, based on the employer's and employees' - needs . , c, The City Council should, not pass a law on this subject because employers and employees should determ4ne a company's C 41; internal policies, not the government 39% : No opimion 2; Question: "if the City Council were to pass a law regulating smoking in the workplace, local police would have to enforce it. Which one of the following statements comes closest to your feelings about this? a. Ii think that the police and' the courts shoul'd' aggressively enforce such a law 91 b. I think employees should have to sue in court to force their employers tp comply 11; c, I don't think the authorities should'be' asked to spend their time enforcing such a law, 35t d. I don't want to spend my tax dollars enforcing such laws ~ 3 8'; . No opinion 7 ; N C I i uesti'on: "I'm going, to read' two statehents with which some (N people agree and other people disagree..Please tell me if' youi strongly agree, somewhat agr e, somewhat GO ~P115SAIwSD . MESTAtEET• SUITf 812 S,AN iFRAINC1SCiO, CA'941,0'4(;415) 6~t QT T-2
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A Statement on the Health ffffects of Passive Smokin¢. I I The Public Health Servike believes that current medical' evidence justifies all. reasonable action to provide the nonsmoker with a smoke-free envuonment. The nonsmoker is entitled to protection from the annoyance, physical irritation, and potential health hazards of passiwe smoking.' . This position~is based on the followimg,evidence: Nonsmokers who are exposed to tobacco smoke in the air absorb nicotine., carbon monoxide andlother constituents of tobacco smbke as do smokers, although, as wouldibe expected, in smaller, amounts. The amounts they absorb are dependent on the extent and length af'exposure and the quality of ventilation. 1Watsukural,. Feyerabend2 and others3 have found levels of' urinary cotinine (a metabolite of nicotine) in nonsmokers who live wlth"smokers higher than those of nonsmokers who do not and In babies whose mothers smoke. Amon the constituents of I ci' arette smoke are substamces which are armacolio gicall active toxic muta eniic carcino enicandianti' enic ABLF.S li AND 2). There is no safe level of exposure for some of these substances, as for example beta naphthydiamine.a Before dilution by air, the constituents of sidestream smoke may exist in i greater concentrations than in smoke which Is inhaled S Exposure of nonsmokers to environmental' smoke can exceed levela permitted in environmental and occu pational health standards. Repace and Lowrey in the United Statesb , and Knoth et al in the Republic of' Gercr.ranyTare among those who have found contaminants from tobacco smoke in homes, offices, other worksites and public places at such levels. Involuntary smokinQ is hixhty annoyinR and physically irritatine to many people, andi can exacerbate the symptoms of asthma and chronic bronchitis and angina pectoris and'. can i make life miserable for people with allergic conditions.g' The physical irritation suffered by non-allergic nonsmokers in the presence of' environmental' tobacco smoke may include eye irritation - the most commonly noted reaction - sore throat, nausea, and hoarseness. The children of smoking parents have an increased prevalence of reported respiratory symiptorns„an increased freguence of bronchitis and penumonia early in life, and rneasurable but, smalui didferences in tests of pulmonary functiion1when compared with children of nonsmoking parents9• There is, final'ly, evidence to suggest that' exposure to tobacco smoke in the air may cause disease in otherwise healthy adiults. In the past six years, 17 studies have been published, 15 of' them showing a relatibnship between: tobacco smoke exposure and cancer (TABLE 3): 5-28,
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needs."') and not so gentle ("... because employers and~employees ! : should determine a company's policies, not the government.") The positive response.contains no argument in-favor. The second question, regarding how such laws are enforced, contains only choices which are opposed to smoking laws. The respondent is asked whether the law should be enforced "aggressively"'by police or by lawsuits against employers, orr whether the authoritiew' time or tax dollars would be s