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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,

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

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

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

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