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CEMTEA FO'ii ER1Vt13ICr11A£MTAL HEALTH! ^wo Hu,aAH ToxicoLocY su.TC 205 11oti • l0TM Snsti: M.W. w"W+oroK D.C. 20007 002) S.13-Se'S!s i hcooe " roi Aowsoor Gwoup RESPONSE TO JWERICAN UONG ASSOICIATION OF SUPERIGR, CALIfORM1IA WK *THE' UEED fOR' SMOKING .CO;NTROL LEGISLATION IM BUTTE C~OAM: A CASE STATEMM• This is !a rsponsi to the docv.ent eThe N..d for Sroktng Controli Log 1 sl atlon 1 n i Butte 1 Countys A Cas. Statea.nt, `whi+ch oas prepared bIr tho /wo.rlcan Lung, Association, of' Sup.riorr Calffornia. Our response addresses the, stateernts In tha docussnt conc.rning a aaus. and' rffect relationship betr+..n. .xposur. ~ to omriron..ntal tobacco saak., (ETS) and Nalth dls.turbaiicss. . Sc.l.ntlf9cally valid coaclssR=s1 conc.rning causaA r.lataonshdps oan be arrived at only by .valuating, all of the, relevant scientific data, considering each study within the context of the str.ni and wdcaass+as of Its aicpert- wntal desiQns execution and' resul'ts. Norei rather than a ao.pretrsastvi survey, and critical analysis of the lit.rature, this document selectively cites only, tthose studies tihicA, support 1ts conclusion that E'TS exposure .ay represent a health hazard. @ver'tho past three years. several lndepsndlMit scientific groups have been convened to reviev the, scientific evidence conc.nnibg the health sf'facts of ETS. Workshops In Geneva In 1983'. (1) and yienna 1n 198+t (2)'# attended by scientists actively Involved in research 1in this arsa. reported that the scientific data which had been collected' failed to support a conclu- slon that exposure to ETS represents a hazard to health. TAe Workshop In Vienna was sponsored by the WHO and Ibt.rnational Green Cross, aemng others. A workshop h.ld in the United States and sponsored bli the National Institutes of Health focus+sdi on evidence related to the .ff.cts of' exposure to ETS on. lung function tn chtl'dr+sn and' adults. Agains the consensus of the workshop pairt1- clpants was that the available data did not support i conclusion that exposure to ET'S r.presented a hazard to respiratory health GJ. . Ifa reprepent an lnterdisciplinary group of acada.ic sclenttsts, Tb. Indoor-Air Pollutlon Advisory 6ronp. who were asked by tAe Tobaaaa Institute to review critically at'1' of' the available scientific data and provide tos Insti- tute with an Independent opinion on the relationship betreen rcposure, to ETS and chronic health disturbances. Our ao.clssaons are ta agre...nt with those of ths other groups rhich have gone through a st.illa!r e.vliwr proc.ss. r8en we looked at studies 1n the literatur. adidressiag possible h.a1tL effocts of envtrann.ntal tobacco s.ok.s a. most s~ 1fleant probler ~ri fo.wd ~ras =#at they g.n.rallly.laekrd' appropriately valid.tid~.xposur. estisrtas .r-dosy- ssasurr s+.nts. In the absence of' adeqwte dosage, lnfoest.xiiae tt 1s difficult to, r.ach scientifically reliable conclusions r.g.rding cmse~ a+.d of'feet hlistion- ~7 ships. In addition to the prodli.m associat.d' with rocsseattng emposurra, onr O group was lepressed by serious f7ars !s Nstga and' rthodology associated with CA s -22

C `-- a11 of' the studies Investigating the Malth sff.cts of emrlroewntal tobacco C saoke - those purportfng:1 to shor an eff.ct and those showing no ef~fect. The, M.rlcan Lung Association dbcuwent, in citing literature to support tts concluslon that eocposure to ETS'may present an lincreas.d risk to 1Adlvid- uals with chronic tlung or cardiovascular disease* may result In small airway dysfunction, and may increase the risk of' lung cancer In nonsaokerso fatls, to ~ acknorledge the potential flaws tn aany of thr studil.s, the existence of G studies rith confliicting, resultsr and thw socistence of lieglti.ete sclnntf f iic disagreesnt over the health effscts assocldtrd with exposure to ETS. For eacaaple, the American Lung Association document states that exposure to1ETS may present an lncreaseC risk for IndiViduals with asth.a and chronlc~ bron- chitisp or vho are atlergic to: ssoke. Fkrther. when on; looks at thei scien- t1filc 11t.rature addressing this area, the: data are contradictory and taade- ~ quate. Dah.s dt ,1, (4) reported that t.n asthmatics .xposed to tobacco smok. In an environeentai cha.ber developed a d.cr.ase 1n; respiratory fllar, rats. Interestingly,, even rhere, these, ph)rsiiologtc changes were detectablls# po c11n1ca1 sympta.s of asthma occurred. Norevere as the authors themselves acknowledger e•btlonal and psycbog.nic factors could not be eocc'Iudeddw to certaindefiiciencles 1a the eocperirntal design of'thls study. In addition, the! Dahms study fs also wakened by the sthod~ of s.lecttion of the test subjl.cts~ andi the absencee of appropriate .nvtlran..ntal'l controls - all of which makes 1t fepossible to conclud; that exposure to ETS 1s the cause of the physiclogic changes observed. Three other studies. sot cited In the American Lung Association docua.nti were not able to, de.onstrate that ETS exacerbates asthma, ('S-7'). Furthersorer the available data do not support the existence of an allergy to tobacco s.oke1 or Its constituents (8'). Even asiony subJ.cts who claimed to: be smoke sensitive, studies kave, b.en unable to docussnt an, allergic response to tobacco smoke (9, 104. Mith regard to individuals with cardiovascular diisorders, the A..rican Lung Association docusisnt cltes a study done by Aronow published in 1978. Aronow concluded' tAat eocposure to ETS decreased the duration of exercise which could be tolerated befiore precipitation of'an angina attack. This study has a number of problems 1ncLuding! unresolved ihconsistencles with other publlished! data froa the -same researcher, use of a subjective endpolnt for onset of anglnar poor controls and Inappropriate statiistlcal methodology. Further, recent studies have fa1'1'ed to; conftira,these findings Y'11). Thus 1t 1a lapos- sible to conclude that exposure to ETS has an adverse effect on Individuals . with angtina. • . _ S'1a11ar1'y, the two studies which were cited to support the conclusion that exposure to ETS leads to 1mpaAred lung function in AeaTthy iwdltvidualis (12.13) have serious msthodbloglc problems andJor tnternal lnconsist.nc/i.s which, greatly, ltrit the validIty and~slgnificance of the data reported. •Further.oe." other studies exaolning this qpestion fait to find any changes 1!n lung function as a result to~ exposure to ET5' ('11,1'2), A workshop sponsored by the /iationai- Institutes of Health In 1'983' considered theser -as wel l as otiher relevant p stu d'i es on the respl ratory ef f.cts of enosure to ETSP and concluded that any jU ef ferts of' env t ron..nt.al t'abacco, smoke on the redpR ratory system were. •negl 1- ( f~l gilble to qutte small (3').•' Q9

C~ . . ~,,. .. C ' flnallyo th. Jlo.rscaa Lang Assoclatloni doca.rnt c1t.s thrre studies which reported an 1hcr.as.d Mdsc of' lung cancer a.onp nons.olc.rs s+ar~ri.d to spous.s who srok.. /1ga1n, a careful r.vlew of' these studies reveals significant weaknesses In design and is+ChodoloUy. Aeot'h!.r study also pu611sh.d in 1981 which .xaain.d th.~ldinttcal question In a study population of appracli.atNZy 175.001D /lw.r,lloan vo..n cas not cited. This study t'14J fatied to find a relationship O.W,..n .xposure to ETS and lung cancer. As n.coQnlz+.di In th.~ Narrican Lung Association docwnti tho, eurrsntly ava111ab1.i .v4d.ne. iia not sufficient to cooc"1ude thatpassiv.s.ok~lng eausrslunp eanesr iw nonsaoia.rs. In conc'{usiion. If one vc.ry, carefully loolcs at all of the relevant studies reported In thw scientific 1ltaratdre and carefully applltlss the prtnalol.s of critical sclentlflc analysis to thss studiiss on+e can conclude thst.Rwlronr swntal tobacco s.oicr.Kposure is a significant health itazara only by wry, s.l.cttv.ly, iinterpreting t'he data, Ignoring serious flaws In studies and~ ipnoring contradictory data. In other words* the concluston of'oar group# as wall as that of' others who bave co.pr.hwsstiv.iy .+raluat.d' th• 11t.ratur., iis that the currently avat1aQl, data do not support a conclusion that sposuro to .nv f rorm.ntal tobacco s.ok. represents a h.al th Aarard'. Sorall L. Sch+rarts, Ph.QL . Professor of Pharaacolo9Y 6rorg.torn Unlv.rsity School of M.dticln.. CAat nm.n Nancy a~. 6altrr. Ph.D. Associate Rss.arcA Professor D.parEasnt of Biology Georgetown Un1.w.rsit r1c.-chalin.an PIi11'1p Mltorsch, M.D. C71ntieat Professor of, Medicine Tb. George Washington Univ.rs!'ty Sclwol of' M.dlcin. M..b.r I I S-24

R.f.ri . 1. Ry1andsr. Rr iod.). ETS-Envirom.ata1' Tobaoco S.ok.s Report of a Workshop on Effects and Exposur.lL.v.l's. Fu*_e-„ eU%,#v011. 6S.' wpptl. 133. 190+4. 2. Proc.rdlngs, of the International Slaposiiu.: on Medical PMespsctivs on Passihr. S.akiin5. Pres- bed= 13r SS7-746. 1984. 3. Public Hea1th Srrvlc.. Report of' a Morkshop oni Rrspiratory Effocts of Ibwoiluntarlr S.okr Exposuros EPRids.3oloSic Studios. U.S. Dept. of lMalth and tlimn Sarvic.sr poc.. 19'd3. • .4. Dahss;, T.E.. Bo'1 in. J'.F., Siovin, R.G.. Passive S.okinS: Effects on Bronchial Astlwr thit a0:5, M2. • - S. Sh.phardr R.J.. Coll'insr R.., SKlvari F.. Passive Ex~ of A'sthwatib Sub,~!acts to Cip~arsLt. Sboki. Fmt~. ~-~• 20s 392, . - 6. Iag. A.3. Broslino A.B.X.. The Effect of Passive Cipar.tt. Ssiokiitg on, Asthoatic Pationts. 13r S43. 1983. 7. Pim. P.E., Sh.phard, R.a., S11won.an. F.. Physlolog1ca1 Effrcts of Acut.l Passi'vr Exposure to Cigarot!t. Smcko, In Abtiwtiics. EaL-i 316r W, 1977.. • - a. U.S. Public Health Sorvics., Smoking and lMi A R.port of tha Surp.on, G.n.ral, cAapt.r 11P p.31. 19796 9. McDouQa11 J.C.. G1a+ch. 6.a.. Tobacco Allergy-Fact or Fancy? i..~Sl. Cl in. T.~nnt _ S7s 237. 197iQ. 10, Lehr.r. S.B.. tMlson. M.R., Karr. R.M. Salvaqglo. 2.E.* ISE Antibody Respons" of' Saok.rs. Nonsaokars and! S.okrSensttlve Persons to Tobac+co. Lsaf, aand Smoke Antip.ns. Am_ oa,r_ ta:se_js_ 121t 1680 1930. - . V 11. Schtwelb.ln. H., Richt.r. F.. Thi . Inf1iwnce of Passive S.oitirg, on 'th. Cardlovasculiair System. P'ey_ W- 13s 626. 1984., 12. Shf1l111'nig,- R.S,. Letail. D.D., Hiut. S.L.. 8eck. G.J., Schornb.rD;r J.B., Biouhuys. A.. Lung functlon, r.spi'ratory disease and smokioQ iA families. . J. Fa 1, dant~ 106: 274. 1977. 13. Coastock. G.If., M.lr.r. M.D.. H.lisiag, K.a'., Torkaan. M1S.. Respiratory .ff.:ts of' housohoid .xposur.s to tobaxo s.oke an0 gss cookinS. d1;. Ray- kesse_ @!ts_ =4i" 143r- 196Q. 14. Garftnkal. L. Tisie trends tin lung~ cancer ssartality as,onp, aoomokers and a note an passilve smtti'np, = 66s _ 1051!. 19Si. . 4