Loading...
HomeMy WebLinkAboutCOM 0746.073 2000-2002 tIOANews.coam - ~ -~V. Purging the Political Correctness Within Tuesday, October 16, 2002 _ Iva By !Wendy McElroy cou?,!r . pJ~ra. Paws Political correctness is not just an ideology; it is ars attitude. And although the ideology may be dying out, it can live on in the attitudes many of as have absorbed from our culture a- a culture that has been ravaged and dominated by it for decades. We need to exorcise its spirit. As an ideology, political correctness says that some ideas, attitudes and peaceft€1 behavior are unacceptable and should be legally discouraged. Acceptable ones should be encouraged by law. 'T'hus discrimination against "minorities," such as women (who are actually a majority), is prohibited in both the public and private sector. Discrimination in favor of minorities is mandated through the de facto quotas imposed by policies like affirmative action. But political correctness is also an attitude. The politically correct arrogantly expropriate "the truth" and deny the posse` lily,of honest d' x neut. To them it is a given: anyone who dissents does so because of ill motives e.g. economic greed, patnarchal power4ist, racism. To the PC, society L,;- a battleground on which classes of people representing good and evil conflict: black versus white, female versus male, Western culture versus the "emerging nations." The coin of the realm is collective victimhood, not individual responsibility. T demand a civil society that respects the individual and acknowledges the existence of honest disagreement between human beings of good will. But getting there means rooting out not only the ideology of political correctness but also the attitudes many of us have adopted almost by osmosis from our culture. The attitudes include: Gender bashing. "Men versus women" permeates every corner of society. (Indeed, so many PC laws now favor women at the expense of men that there has come to be truth to the analysis.) A gender conflict mentality has set in. Women say hateful things about amen lender the guise of T, things they would ne er ; . say about other classes of people, Rke Jews or Hispanics. For their part, men t~ aslz all Svc,mcfi because to woman treated them badly. The merits of individual women and men are entirely ignored. But individ women and amen constitute our families, friends and neighbors. The antidote to gender bashing is to get personal, Whenever you hear a remark that slanders all men women, replace the noun with the none of someone you love. Do they deserve to be the brunt of hat speech? Don't let your husband or child be slandered. ,49 Psychobgizing disagreements. This involves ignoring the content of what is said and analyzing, insteg, ' psychology of the speaker. For example, a roan opposes affirmative action and is immediately laded racist or "misogynist. A woman questions the wisdom of working while her children are young and accused of trying to shove women back to '50s. The PC camp has made this approach into a staple of social (SUd TTTLD L KEITH i4 i~ AJ%News.com discourse. The remedy: When you hear an argument, refuse to psychologize the speaker. Show respect for ideas and ask yourself whether there is anything -.my statement, however minor with which you agree. Or construct a counter argument. Don't turn the intellectual realm into a research project in aberrant psychotherapy. Making the per-soriA political. "The personal is political": This slogan has come to mean that politics is determined by our personal lives which, in turn, determines the lives of others. Thus, the IBC argue for laws to ensure that individuals make the "correct" personal choices so that the "correct" political consequences can sculpt society. Your choice to be a heterosexual, a stay-at-home mom or to dissent on af'irinative action becomes my business. This leads to the PC attitude that everything a neighbor (or a stranger) does is your business and the appropriate target of legal control. The solution: Mind your own business. Respect the private lives and choices of others. Celebr ti - vietimhood. An automatic hush of respect falls over a discussion whenever someone declares herself to be a victim. I know. I was :severely beaten, by a boyfriend and my a- if announced makes me an incontrovertible expert on domestic violence. Only it doesdi. Being on the wrong end of a hurled fast doesrA it ke me an expert on anything except how much it hurts. I know no more about domestic violence and arguably less than the woman who chose to walk out at the first signs of physical abuse. Society's canonization of suffering is unhealthy and bizarre. The cure: Show compassion for victims but not deference. Zero tole nee. On some social issues, a declaration of "war" may make sense. But, with most social problems, human beings with human frailties are involved. Declaring war only makes every member of society ' into a combatant, with no prisoners 1 ken. How about reconsidering concepts like negotiation, forgiveness, compassion, and empathy? flow abort making the law a last resort rather than a first option? Sweeping up the debris of political correctness means demolishing the laws, the institutions and the tax- funded bureaucracies that are its structure. But it also means eliminating the vicious attitudes of intolerance and anger that are its spirit. Wendy McElroy is the editor of s and a research fellow for The Independent Institute in Oakland, Calif. She is the author and editor of many books and articles, including the new boob, Liberty for Women: Freedom and Feminism in the 21st Century (Ivan R. Dee/Independent Institute, 2002). She lives mth her husband in Canada. Arjvesbse or, FOX News S Ci i L4- C. -.;U- } For POXNem.c®m comments writa to For POX t'Jeft Chanrx~ comrnerds a to OAwo6awl Press. All 6" regd. Copyfi r. 0 2002 Starxiard & !hr's This matmal may not be puVisfiwe9, broadcaet tauten, or redistdbiAed. POX Nee Net wo(k, t.t_C 2002.,Ni dgh reserved. All marW data delayed 20 minertes. f _ _ imoketree 1 ransportatton unronotogy ~ a as m Join AN I Donate to the MR.s oundation l i're- subscription Merchandise °aas AP ou.t. s I Links ?dome Smokefree Transportation Chronology ~r August 21, 2002 1964 The U.S. Surgeon Genera<''s Deport identifies smoking as a cause of increased mortality and as a contributing factor in a host of diseases. 1971 United Airlines becomes the first carrier to offer separate smoking and nonsmoking sections. #.t> 1973 The Civil Aeronautics Board (CAS) requires separate smoking and nonsmoking sections on airplanes. 1976 Regulations are passed to restrict smoking on trains to separate cars; and dining cars are made smokefree. 1986 Publication of The Airliner Cabin Environment: Air Quality and Safety, National Academy of Sciences (NAS). The NAS recommends "a ban on smoking on all domestic commercial flights..." A grassroots campaign to eliminate smoking in airplanes is initiated with the publication of a front page story in the Fall, 1986 issue of ANR UPDATE. Titled "Where There's Smoke, There's Fire: Banning Smoking on Airplanes," the article stated: "ANR feels it is essential that the federal government quickly implement the proposed ban..." 1967 Februarys - The U.S. Department of Transportation rejects the recommendation of the NAS to make domestic commercial flights smokefree. Secretary Elizabeth Dole states that no new regulations are necessary because the market will accommodate demand. Julys - By a vote of 193 to 193, the U.S. House of Representatives passes the Durbin Amendment to make domestic flights of two hours or less smokefree. ANR's swift national grassroots campaign plays a critical role in securing the passage. ` 1968 A federal law making all domestic flights of two hours or less smokefree is passed. The law is designed to sunset in two years. Northwest Airlines makes all its domestic flights smokefree, and a California law banning smoking on all in-state flights takes effect. ;moketree Transportation Lnronoiogy r arc ` vi 1989 September- The House approves language extending the two- hour ban beyond two years. The battle shifts to the Senate, where Senator Lautenberg will fight to make longer flights smoke-free. October 21- Representative Durbin publishes an acknowledgment piece in the Congressional Record. ANN is thanked as "particularly active!' November 8 - The Senate gives final approval to a bare on smoking on all domestic, and domestic overseas flights, of six hours or less. November 18 - The House and Senate Conference Committee adopt a "compromise" that makes domestic flights of six hours or less smokefree. 1990 Federal law making domestic airline flights of six hours or less srnokefree takes effect on April 23rd. Interstate buses also become smokefree. 1993 Amtrak makes most of its trains smokefree. 1995 Delta Airlines goes smokefree worldwide on January 1st, Other U.S. airlines follow. 2000 President Clinton signs legislation making all flights to and from the U.S. smokefree. Secondhand bnoke Srnoketree Advocacy ) AJ,po!ts c n- .=_ien I Tobacco's Tricks I 'riot Documents I Ventilation ~ Fi c:c .Or1 I YGuth 0 2001, Americans for Nonsmol*rs' RicgMs, American Nonsmdws! dig s Foundatiorv Some images are 0 2001 www.arttoday.com Designed and maintained by Diane Jones. r oneI History Ul Lue VV UK Uti 3111V&C1s i arc i vi A brief history of the War o Smokers What began as an honest concern for the public health has, over the ensuing four decades, become a Holy Crusade, an ideological war against one-quarter of the American public funded with public money. These activities raise i ortant question:, concerning the ;propriety and legality of tax-funded politics--the use of tax revenues by special interest group to promote one side of a political issue. Such misappropriation of tax dollars has long been recognized inappropriate. Doing so essentially forces taxpayers to contribute to political causes with which they disagree--a fundamental o ense against individual liberty (and constitutional principles). And it degrades democracy, for it is an attempt by government to manipulate and manufacture the will of the people. In 1964 the Surgeon General's report on smoking and lung cancer was published, followed one year later by the Federal Cigarette Labeling and Advertising Act which required the Surgeon General's warning be printed on each pack of cigarettes. Twenty years later, in 1984, the Cornprehensivc Tobacco Education Act (Public Law 98-474) was passed. This Act created the taxpayer-funded Interagency Committee on Smoking and Health, a, partnership between the federal government and the biggest of the non-profits, including the American Cancer Society, the American Medical Association, and later, the Robert Wood Johnson Foundation. Their stated purpose was to coordinate public and private tobacco research nand education programs. This partnership laid the foundation for the non-governmental organizations' involvement in policy making and gave them the power of another branch of government. These elected and therefore essentially o tent ,gro€nps are still the basis for the War on Smokers and they're more powerful than ever ...probably more powerful than governnye itself In 1985 legislation sponsored by Congressman Henry Waxman (D-Calif.) was passed (over a presidential veto) that gave Congress explicit controls over science f mdiing by the National Institutes of Health (which includes the NCI). Waxn 's bill had the support of a large number of speciahzed private health organizations, including the American Cancer Society and the American Lung Association. On December 12, 1989, the National Cancer Institute, an arm of the federal government's taxpayer funded National Institutes of Health wrote that using activists to reduce public tolerance of smoking was the "state of the science" and the way to go. Later that year, in a booklet entitled "Tips for Kids," the CDC commented that smokers were, in fact, "second-class citizens" and would eventually be treated as such. A side effect of these strategies was to contaminate the pool of jurors who would sit on future lawsuits against the tobacco industry. Also in 1989, C. Everett Koop as Surgeon General of the United States changed the definition of "addiction" to include smoking, thereby also including things such as TV watching, video games, chocolate, sex, etc. In October of 1991.% the federally funded American Stop Smoking Intervention Study (Project ASSIST) was begun and by 1993, the American Cancer Society (ACS) had prepared its Action flan, which included raising cigarette taxes, the banning of tobacco advertising, workplace smoking bans, and more. In 1992, the CDC (which housed the ICSH) began hosting meetings of public and private attorneys, many of whom were heavy contributors to President Clinton's campaigns, who wanted to sue the tobacco industry. These meetings were held behind closed doors, not available to the public or the media. In 1993, the EPA Report on Secondhand Smoke was published, giving the anti-tobacco crusaders a very big stick with which to beat the industry. In 1994, after Hillary Clinton's disastrous National Health Plan, the President was searching for a cause ak onet nnstory or the war on 6moxers 1 ar,v G V1 J Americans could get behind. Presidential advisor Dick Morris urged Clinton to take on "kids smoking" as a cause. (Although Clinton was at first reluctant, a'poll' paid for by Dickie Scruggs changed his mind.) Scruggs, a Pascagoula, Mississipppi, attorney, had a novel idea: away to sue the tobacco companies that had never been done. He took his idea to his old college roommate, Mississippi Attorney General Mike Moore. Trent Lott, Senate Majority Leader and Scruggs' brother-in-law i€troduced Dickie to Presidential advisor and right hand n, Dick Morris. Morris, who helped Scruggs pick the "right" jury for his lawsuit, Scruggs and Moore began the first tobacco lawsuit which would set the stage for all others to follow. When the industry realized it couldn't win a lawsuit if it was no longer allowed to use the only true defense it had--smokers knew what they were doing and chose to do it anyway--they entered `settlement' talks. During these talks, Hugh Rodham~ Hillary's brother, was brought into one of the law firms who stood to gain the billions in fees, even though he had no plaintiffs bar experience. Also in 1934, and drawing on the earlier ACS Action Plan, guidelines for a tobacco control program were published in the NE Journal of Medicine Avhich included increased federal taxes on tobacco products, comprehensive restrictions on smoking in the work-place and in public, bans on advertising and sponsorship by tobacco companies, government : upport for conversion of tobacco crops to other crops, financial support for tobacco counteradvertising, support for personal-injury litigation against the tobacco industry, etc., most of which guidelines are now in place. In May of 1994, Stanton Glantz received more than 4000 internal documents that had been stolen from Brown & Williamson and its parent company, EAT Industries, by paralegal Merrell Williams, Jr.who called himself "Mr. Butts." Possession of these damaging documents made Glantz a hot property worth a lot of money in grants and funding. The anti-tobacco crusaders soon realized that simply telling people their health was at risk was not getting the result they wanted, so they decided to expand the problem--they used the EPA's faulty report to make secondhand smoke a public policy issue. C. Everett Loop, David Kessler, Richard Daynard, Jaynes Repace, Stanton Glantz, and other activists enlisted several politicians, notably Henry Waxman of California, to help "prove" that tobacco company executives lied in testimony before Congress about the addictiveness of nicotine. Using modified criteria to call smoking addictive created a new 'social` definition, without which the tobacco company executives could not be said to have lied and the anti-tobacco agenda: would not be nearly as strong. By adding the pedorative label "addiction" to the unapproved habit of smoking, anti-tobacco forces justify intervention-for the addict's own good, of course. If an addict doesn't understand what he's doing or can't keep himself from doing it, that addict is a victim so others can intercede on his behalf With or without his permission. They can take his money and use it against hire, for his own good, and society at large approves. In July 1995 the Journal of the Americana Medical Association ran five long articles by Glantz and his co- workers, including Richard Daynard, on the pirated B&W memos, later to be published by Glantz as The Cigarette Papers. In 199$, commissioned by a Congressional cadre of anti-tobacco legislators in response to the tobacco settlement., ex-FDA czar David Kessler and former Surgeon General C. Everett Loop hand-picked representatives from twenty-three organizations to constitute an ;expert tobacco control panel. Among the representatives are some of the most zealous anti-tobacco activists in the U.S. including John Banzhaf, Executive Director of ASH; Michael Pertschuk, Co-Director of the Advocacy Institute; John Seffffiin, American Cancer Society; Dudley H..afner, American Heart Association; John Garrison, American Lung Association; Julia Carol, Americans for Nonsmokers' Rights; William Novelk National Center for Tobacco- Free Kids; Matt Myers, Center for Tobacco-Free Kids; Jesse W. Brown, The Onyx Group; JeNesbit, Science and Public Policy Institute; Thomas Houston, Robert Wood Johnson Foundation, Smokeless States % oneI nistory or ine war on 6moKers ra~,G J ul J Prog.;Judy Sopenski, STAT; Richard Daynard, Tobacco Products Liability Project. They met three times and provided to President Clinton and Congress a 60-page document that is one of the most chilling displays of disregard for American tenets in existence today. Defining the choice to smoke as a "chronic disease" and declaring "no value" to the use of cigarettes, the panel proposed an ®rwellian "blueprint" for "control" of the problem on a global basis. The commission recommended the ' 'sate implementation of what clearly mast be seen as totalitarian means, backed fully by the power of police state enforcement, to achieve an almost classically totalitarian goal, a kind of mandated behaviorism Or, to use their own words, "the goal is to change the behavior of smokers." Everywhere in the world. Not only does every single organization represented on the panel (and every individual representative) stand to benefit financially from the proposals in the Advisory Committee on Tobacco Policy and Public Health Report, this blueprint gives the anti tobacco advocacy groups far more power than they should ever have, including the "freedom and resources to monitor and oversee government enforcement of legislation and regulation...freedo n from political "censorship" or constraints, including the freedom to advocate the enactment of tobacco control policies, ...and to challenge the failure of government entities to carry out the law." To enforce the proposed regulations and bans and to administer all the funding, new federal and private agencies would be created and certain existing federal agencies would be given additional funding and additional regulatory powers. The "'blueprint" is, in fact, the quintessence of federal Nannyism with its focus on growth of the regulatory apparatus. What is even more disturbing is its stated airs to extend its regulatory programs throughout the world and use U.S. funding and influence to do so. An interesting aside: According to a study published in July, 1999 in JAMA, the tobacco industry took in $80 million. On those same sales, the federal government took in $222 million and the states took in $293 million. So just who is in the 'tobacco business'? . ug~. ? vi v Iurrunary Summary 4. tt ~ a 3~ t 'Elke dag nieuvvs over de waanzin van de anti-rroken gekte... De blinde woede... Het geld... De belangen.... De ven Floofdnmenu EXECUTIVE SUMMARY Over Forces... Thema's In February 1987, the U.S. Department of Transportation received recommendations from the Nation Posters Academy of Sciences related to airliner cabin air quality. In response to their recommendation that srnokir Artikelen be banned on all commercial domestic flights, the Department indicated its intention to conduct a study Analyses Quantify pollutant levels in airliner cabins and to assess the associated health risks. The study w. Media conducted during the period when smoking was banned on scheduled commercial flights having duration Wegen of two hours or less, pursuant to Public Law 100-202.* This report presents methodological aspects at Links results of that study. Forces NL Forum Discussies _ Commentaren M Steun Forces Archief Horror Stories The study addressed the broader topic of airliner cabin air quality rather than the single issue environmental tobacco smoke (ETS). The purpose of this work was to develop information to be used f determining health risks from exposures to ETS for nonsmoking airliner occupants as well as risks fro Navigatie other pollutants of concern for all airliner occupants. To meet this primary objective, secondary objectiv4 were established to (1) identify air contaminants and other parameters requiring measurement, (2) We Hoofdpagina appropriate instrumentation, (3) develop measurement protocols for collection of data that a Zoekpagina representative of in-flight conditions, (4) develop a statistical sampling frame that enables representation Inhoudsopgave commercial flights departing from major U.S. airports, (5) collect data on flights chosen for monitoring, ( Wist U...? analyze data. to characterize concentration patterns in different types of aircraft under different condition All Time Favorites (7) identify health effects of the chosen contaminants and select populations of interest for developing a ri; assessment framework, (8) apply the framework for risk assessment, and (9) develop and evaluate optior for mitigation of contaminants as required. Internationaal pollutants were selected for monitoring that had known or suspected sources in the aircraft and could I monitored or sampled in airtiner cabins with small, unobtrusive instrumentation. The monitoring packal Forces Psychiatry configured for the study consisted of instruments and sensors for measurement of time-varyk concentrations of contaminants in addition to samplers for collection of time-integrated samples. It ah Canada included a data acquisition system for recording outputs from the continuous monitors. The instrument w. Manitoba (email) packaged in a single, compact carry-on bag typical of that carried by airline passengers. Electromagnel Italy compatibility tests of all monitoring devices were performed by the Federal Aviation Administration (FAA) New Zealand ensure that they did not interfere with aircraft navigation or communication systems. UK (email) The ETS contaminants monitored during the study were nicotine, respirable suspended particles (RSP), at Russia carbon monoxide (CO). Nicotine was measured through collection of time-integrated samples and CO w. measured with portable continuous monitors; RSP was measured both by integrated and continuos VS afdelingen methods. The other pollutants' that were monitored were ozone and microbial aerosols. In addition, carbc dioxide (CO2) was monitored. C02 and ozone were measured with time-integrated samples whereas shoe term samples were collected for microbial aerosols (bacteria and fungi) near the end of each flight, prior California, descent. Connecticut Temperature, relative humidity, and cabin air pressure were monitored continuously with portable sensor Delaware these measurements were used to further characterize the cabin environment and to provide appropria Duluth, correction factors for the flow rates of pumps used for sampling. Air exchange rates were measured ush Georgia constant release and integrated sampling of perfluoro- carbon tracers. All aspects of the measureme Indiana protocol were pre-tested on four commercial flights that were monitored over a three-day period in Mar( Maine 1989. Massachusetts Monitoring was to be performed by each technician at an assigned seat. Based on pretest monitoring at Minnesota variety of locations, the following four locations were chosen for monitoring on smoking flights: (1) coat Rochester smoking section; (2) boundary region of the no-smoking section within three nonsmoking rows near tl USA coach smoking section; (3) middle of the no-smoking section; and (4) remote no-smoking section (i.e., . Virginia far as possible. from coach smoking, usually near the first-class smoking and nonsmoking section; Because less substantial variations were expected on nonsmoking flights, two locations (middle and rear Affiliates the plane) were chosen for those flights. ETS contaminants were monitored at all seat locations and oth pollutants were monitored at half of the locations. The instrument package was typically placed on tl technician's lap or lap tray to obtain measurements of contaminants most representative of passeng Smokers' Club summary ~ age vi u NYC C.L.A.S.H. The target sample size for the study was 60 to 120 smoking flights on jet aircraft, including son Smoking-Paradise . international flights. A smaller set of 20 to 40 nonsmoking flights was targeted to provide a baseline f MA Citizens for comparison. The target sample size for nonsmoking flights was smaller because flight-to-flight variations Freedom ETS contaminant levels were expected to be lower than for smoking flights. Real Texas Freedom A total of 70 airports that collectively accounted for 90 Ontario Smoking y percent of U.S. enplanements during 1987 was usr I as the sampling frame for selection of flights to be monitored. Airports of departure were selected for stua flights to provide proportional representation of airports associated with all smoking and nonsmoking fligh he Evidence scheduled for departure during January 1989, based on computer data files supplied by DOT. The specii revive flights to be monitored were chosen by randomly chaining together the selected airports of departur subject to constraints relating to the smoking/nonsmoking status of flights. For a typical chain of flights, to wft ym thinic you knm technicians monitored six smoking flights and then split into two teams to monitor five nonsmoking flight abaA toba= may surprise In total 92 flights were monitored between April and June 1989; 23 nonsmoking flights and 69 smokir YOU flights which included eight international flights were monitored. r„rc Con-5 6, -f The monitored smoking flights proved to be representative with respect to airlines, types of aircraft, flig A ,bev. rlq durations, and times of day for departures. A wide range of smoking rates was observed, ranging from : little as one cigarette per hour to as much as one cigarette per minute. Comparative analyses indicated th soma- Nederland smoking rates based on technician observations agreed very well with rates based on collected cigaret E-Mail: butts. An average of 20 cigarettes per hour, or 68 cigarettes per flight, was smoked by passengers in tl lWorn,force-nLoro, coach smoking section on smoking flights that were monitored. i`-- 1144 C)l 11141 i_, ETS contaminants occur in both the gaseous and particulate phases; measurements were made for bo phases. Levels of ETS contaminants that were measured on smoking and nonsmoking flights a summarized is Exhibit 1. Eased on both Gravimetric and optical measurements, RSP concentrations we highest in the smoking section, averaging near 175 micrograms per cubic meter (ug/m3) compared to background level of 35 to 40 qg/rn3 on nonsmoking flights. Differences across the no-smoking sections the aircraft for smoking flights, and differences between these no-smoking sections and nonsmoking flight were less pronounced. The optical measurement method indicated some migration of ETS contaminan into the no-smoking sections on smoking flights in terms of one-minute peak RSP concentrations. EXHIBIT 1. /AVERAGE CONCENTRATIONS OF ETS CONTAMINANTS ON SMOKING ANC NONSMOKING FLIGHTS Smoking Flights' Nonsmoking flights Smoking No-smoking Section Section Boundary Middle lRo mote Rear Middle Roues Rows wsRows Rows Parameter Particles -PhaseMeasurements Average RSP', ug/m3 175.8 53.6 30.7 35.0 34.8 40.0 Peak RSP+ (1 minute), 883.4 211.8 68.7 69.6 Ng/m3 Gas-Phase. Measurements Average Nicotine, ug/m3 13.43 0.26 0.04 0.05 0.00 0.08 Percent Nicotine Samples 4.3 154.4 82.6 66.7 100.0 78.3 Below Minimum Detection Average CO, ppm' 1.4 0.6 0.7 0.8 0.6 0.5 wmrnary r za~c vi o vaan vv k. nunato/, MNm v.a Observed effects of tobacco smoking, based on gas-phase measurements, were more discernible f nicotine than for CO. Beyond the marked increase in nicotine in the smoking section, the boundary region the no-smoking section was most affected. Differences between nicotine levels for the remaining n smoking locations and levels on nonsmoking flights were within the range of measurement uncertainty, b nicotine levels were more often above detection limits in the no-smoking locations of smoking flights thi on nonsmoking flights. The only discernible effect for CO was in the smoking section itself. CO levels we generally highest before aircraft were airborne, both for smoking and nonsmoking flights, due to intrusion ground-level emissions. Measured RSP levels in the boundary region were strongly related to observed smoking rates (i.e., high levels when smoking rates were 'ppm: parts per million higher) and to the distance from the coach srnokir section (i.e., higher levels at shorter distances). Measured levels of nicotine and CO in the boundary regic did not correlate with smoking rates or distance from the smoking section, but measured levels of all El contaminants in the smoking section were strongly related to smoking rates. EXHIBIT 2. AVERAGE CONCENTRATIONS OF SELECTED POLLUTANTS ON SMOKING Smoking Flights Nonsmoking Flights Parameter Smoking Rows Middle Rows Average C02, ppm* 1562 1568 1756 Percent C02 Samples 87.0 88.1 87.0 z 1,000 ppm Average Ozone, ppm 0.01 0.01 0.02 Percent Ozone Samples OA 0.0 0.0 ' > 0.1 ppm Average Bacteria', CFU/m3 162.7 131.2 131.1 Average Fungi, CFU/m3 5.9 5.0 9.0 W *ppm: parts per million 'CFU/m3: colony-forming units per cubic meter Relatively high C02 levels were measured, averaging over 1,500 parts per million (ppm) across c monitored flights (Exhibit 2). Measured C02 concentrations exceeded 1,000 ppm, the American Society Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) level associated with satisfaction comfort (odor) criteria, on 87 percent of the monitored flights. Depending on assumed C02 exhalation rate measured levels were as much as twice those predicted by a cabin air quality model. Even if the measure levels were to be lowered by half, however, C02 concentrations would still exceed 1,000 ppm on 24 perce of the study flights. Monitored ozone levels were relatively low, averaging an order of magnitude below the FAA three-ho standard of 0.10 ppm and never exceeding this level. Bacteria levels were higher than fungi levels ai somewhat higher in smoking than nonsmoking sections, but the measured bacteria and fungi levels in cases were low, relative to those that have been measured in other indoor environments. Some difficulties were encountered in measuring air exchange rates, particularly for aircraft witho recirculation, due to (1) the limited number of tracer sources and samplers that could be deployed within ti constraints of remaining unobtrusive and (2) the lower extent of lateral air movement within the airlin cabin. Based on measurement results for aircraft with recirculation, there were some indications that r exchange rates were higher on smoking than nonsmoking flights, but the number of measurements was tc limited to allow firm conclusions. Relative humidity levels measured during the study were quite low, below 25 percent for about 90 percent the monitored > tur~uaa.g-y I as%, °P V X U Humidity levels were louver on smoking flights (average of 15.5 percent) than on nonsmoking High (average of 21.5 percent). Temperatures averaged near 24 C (75 F) for both smoking and nonsmokii flights. RISK ASSESSMENT Estimates of lifetime lung cancer risk for nonsmoking cabin crew members (flight attendants) at nonsmoking passengers were developed by combining date on measured RSP concentrations wi assumptions concerning relative amounts of time spent in different sections of the cabin, respiratory rata for each group, and models expressing dose-response relationships for cancer. Two dose-response mode were used, one with risk linearly related to dose (phenomenological model) and one based on ti multistage theory of carcinogenesis, which takes into account the age at which exposure begins (multistai model). Resultant estimates of lifetime lung cancer risk (i.e., premature deaths per 100,000 persons at ris for nonsmokers exposed to ETS are summarized in Exhibit 3 for crewmembers, business passenge (frequent flyers), and casual passengers. The estimated risks were highest for cabin crew members; it w, assumed that cabin crew members sustain higher exposures due to larger amounts of time flying, high respiratory rates and more tirne spent in the smoking section of aircraft cabins. Estimates from the tv dose-response models were quite consistent except in the case of business passengers; for this group, tl assumption that frequent flying begins at a later age resulted in lower estimates with the multistage model EXHIBIT 3. EST IM1A_` i:T-) LIFETIME DISKS OF PRF"",r-, t LJRE LUNG CANCER DEATH- ASCRIBABLE TO ETS ON SMOKING FLIGHTS PER 100,000 NONSMOKING CABIN OCCUPANTS Cancer Risk per 100,000 Cabin Occupants Type of Flight/ Model Cabin Crew Business Casual Member Passenger Passenger' Domestic Flights Phenomenological Mode! 12.06 0.83 0.11 V Multistage Model 14.86 0.27 0.08 International Fights Phenomenological Model 13.46 0.61 0.08 Multistage Model 16.59 0.20 0.06 'Assumed to fly 960 hours per year for 20 years, starting at age 25. 'Assumed to fly 480 hours per year for 30 years, starting at age 35. 'Assumed to fly 48 hours per year for 40 years, starting at age 25. Applying the risk estimates in Exhibit 3 to the entire U.S. cabin crew population results in an estimated O., premature lung cancer deaths per year for domestic flights (that is, approximately 4 premature deaths cs be expected every 20 years) and 0.16 premature deaths per year for international flights. Correspondi? estimates for the U.S. flying population are 0.24 premature lung cancer deaths per year for domestic fligh and 0.18 premature deaths per year for international flights. Acute upper respiratory and ocular irritation effects of ETS exposure were estimated using C concentrations as a proxy for ETS levels. Measured 30-minute peak CO concentrations were compared with empirical data provided by hum, chamber studies on the numbers of individuals experiencing irritation by various levels of CO as an El surrogate. Based on this comparison, it was estimated that on one-third of smoking flights about one in eight person; - smokers and nonsmokers - seated in the smoking section would experience irritation due to El exposure. A similar type of analysis, using nicotine as a surrogate for eye and nose irritant effects of ET indicated that on about one-third of smoking flights ETS levels in the smoking section would be sufficient high to evoke a marked sensory response in the eye and nose of an airliner cabin occupant. )UJILUI UY tngG V Ul O substantially increase the risks of respiratory and other irritant effects from acute exposure to ETS durii the brief periods when smoking would be allowed. Increasing ventilation rates could lower FTS exposures by as much as 33 percent, but associated fu penalties would result in costs estimated to be greater than the benefits. Improved filter efficiency w, estimated to provide only a marginal reduction (about 5 percent) in ETS exposures. Exposure management was considered to be the only viable option for reducing exposures of cab crewmembers and passengers to cosmic radiation. In the case of cabin crewmembers, this strategy wou involve careful scheduling of personnel to avoid persistent exposure to higher cosmic radiation leve generally associated with high-altitude flights and flight paths toward extreme northern or southern latitude For removal of C02, sorption on solid adsorbent beds whose absorbent capacity for C02 can 1 regenerated by heating was considered to be a method with potential benefits for aircraft with recirculatio Cost or reliability data were not available for comparison with costs of additional ventilation, which cou also be used to bring C02 levels closer to the guidelines specified by ASHRAE.in other c:onfinr environments (e.g., residential, office, public access buildings) and ambient outdoor environments began shed light on previously unstudied phenomena, such as bieaerosols, and began to illustrate previous unrecognized chemical complexity. Continuing studies of exposure to ETS, for example, cast some dou on the utility of the much earlier FAA/i HS study because more effective marker constituents had be identified, and, of at least equal importance, improved rneasurc;rient capabilities allowed more preci: monitoring of a eider range of field environments. In that light, it carne as no surprise that a series of Congressional hearings held in 1983 and 19€ concluded the` the available data on the airliner cabin environment were contradictory and that prese standards and practices could be questioned. As a result of the hearings, Congress, through Public Law 9 466, directed the Secretary of Transportation to commission an independent study by the National Acaden of Sciences to examine the adequacy of industry practices and FAA rules and regulations as they affect ti health and safety aspects of the airliner cabin environment aboard civil commercial aircraft. This mandate served as a major collection point to review previous work directed specifically to tl environmental quality aboard aircraft and to examine other pollutants and sources that, based on emergir concerns from ether fields, could be responsible for health problems in the long or short run. The Academy was directed to recommend remedies for problen discovered and to outline safety precautions to protect passengers from smoke and fumes produced by i flight fires. To maintain the independence of the study, FAA did not participate or take any actions that could affe findings, conclusions, or recommendations of the study. At the request of the Academy, however, FA provided data and rendered assistance to the committee established in the National Research Cound Commission on Life Sciences that was assembled to conduct the study. In the course of the study, tl Committee on Airliner Cabin Air Quality reviewed the available technical literature including characteristic of various models of modern aircraft. The Committee also held a series of technical meetings and briefing with experts in relevant fields and made a number of site visits to evaluate specific issues. The Committee's report (NRC 1986a), issued in August of 1985, identified several potential sources environmental quality problems on aircraft including tobacco smoke, ozone, cosmic radiation, humidity, at microbial aerosols. The Committee noted, however, that available empirical evidence was of insufficie quality and quantity for a scientific evaluation. Unique aspects of the airliner cabin environment preclude drawing valid conclusions on the basis of data from other environments. Consequently, recommendatioi from the study focused largely on defining areas of data collection necessary to more fully understai potential exposures. The Committee recommended that smoking be banned on all commercial flights to lessen irritation at discomfort and to reduce potential health hazards associated with ETS by bringing that aspect of cabin , quality into line with established standards for other closed environments. The smoking ban was also cite as a means to eliminate the possibility of fires caused by cigarettes. There has been a growing concern that exposure to ETS may be associated with adverse health at comfort effects among nonsmokers. This concern is further enhanced by the growing interest in indoor quality, the recognition that ETS is a major indoor contaminant source, and the fact that a large number people are exposed to ETS. The health and comfort effects of involuntary smoking have been extensive reviewed by the Committee on Passive Smoking of the National Research Council (NRC 1986b) and by tl U.S. Surgeon General (DHHS 1985). Both reviews concluded that exposure of nonsmokers results in: Acute irritation of the eyes, nose, and throat along with perception of odor. Upper airway problems in children including increased prevalence of respiratory symptoms (cough, sputu production, wheezing), decreased lung function, increased lower respiratory illness, and increased rates chronic ear infections increased risk of lung cancer. The reviews also noted other outcomes related to the growth and health children, including lower birth weight. After completing a review of the Academy report on the airliner cabin environment, DOT assembled a repo to summarize its responses (DOT 1987) to accompany submittal of the Academy report to Congress ummaty - - - - - EXHIBIT 4. ESTIMATED LIFETIME RISKS OF PREMATURE CANCER DEATH ASCRIBABL TO IN-FLIGHT COSMIC RADIATION EXPOSURE PER 100,000 FLYING CABIN OCCUPANTS Caner Risk per 100,000 Cabin Occupants Cabin Crew Members Passengers Type of Flight/Path Flying 960 Flours Flying 480 hours Per Year Per Year Domestic Flights East-West (<~2 hours) 299 to 714 149 to 357 f East-West (>3 hours) 988 to 1,026 494 to 513 North-South (<_2 hours) 90 to 526 45 to 263 North-South (>3 hours) 830 415 International Flights' Long, circumpolar (13 512 256 hours) Medium, non-circumpolar F (7 - 9 hours) W Fo 484 TI 94 to 242 Short, non-circumpolar (<_3 hours) 220 to 291 110 to 146 *Assuming 20 years of flying. 'Assuming 10 years of flying. Cosmic radiation levels were not monitored because an assessment performed at the outset of the stut indicated that extensive existing data provided a sufficient basis for risk assessment. Caner risk estimate dependent primarily on flight altitude and latitude, were developed for a number of different flight pail using dose-response data developed by the United Nations Scientific Committee on the Effects of Atom Radiation. As indicated in Exhibit 4, the highest risks are associated with longer domestic and internation flights, primarily due to higher altitudes. Because the risks scale linearly with dose, the estimates for cab crewmembers assumed to fly 960 hours per year are double those of passengers assumed to fly 480 hou per year (Exhibit 4). MITIGATION Mitigation options were not explored for ozone or biological aerosols because of the low levels that we measured in this study. For ETS, procedural options such as restriction of smoking and technologic options such as increased ventilation were assessed. Of these options, a total ban on smoking w: estimated to provide the greatest benefit at least cost. Estimated benefits were based on reduced lun cancer mortality risks. Costs for procedural options associated with smokers' inconvenience and diseomfo or displacement of smokers to other modes of transportation, could not be estimated due to da limitations. Relative to the case of unrestricted smoking, the two-hour ban in effect during the past two years wou reduce risks ascribable to ETS exposure on domestic flights by about 45 percent. A four-hour ban wou reduce risks by about 86 percent, and a six-hour ban would reduce risks by approximately 98 percent. different type of strategy to curtail smoking, such as allowing smoking during a 10-minute period every tv hours, could reduce average exposures to ETS by as much as 70 percent. However, such a strategy cou ?EUiuxKUy ragc o Ui o stratospheric ozone into the flight cabin, but also cited the need for additional data to establish complian with FAA standards. Issues surrounding potential exposures to cosmic radiation (particularly at hic altitudes) were also raised. REFERENCES U.S. Department of Health and Human Services. 1986. The Health Consequences of Involuntary Smokin4 Report of the Surgeon General. Rockville, MD. U.S. Department of Transportation. 1987. Report to Congress: Airline Cabin Air ®uati~t Prepared Punsua to Public Law 98-466 by the U .S . Department of Transportation, Washington, DC. Federal Aviation Administration Public Health Service. 1971. Health Aspects of Smoking in Trans ~c Aircraft. U.S. Federal Aviation Administration and U. S. National Institute for Occupational Safety ar Health. Available from the National 'technical Information Service (Report No. AD736097). Federal Aviation Administration. 1980. Results of FAA Cabin Ozone Monitoring Program in Commerci Aircraft in 1978 and 1979. Report No. FAA-EE-80-10 , Office of Energy and Environment, U S . Feder Aviation Administration, Washington, DC. Federal Aviation Administration. 1985. Air Carrier Operation Pollution. Consolidated Reprint, U.S. Fede; Aviation Administration, Washington, DC. Federal Aviation Administration. 1989. Draft Advisory Circular on Radiation Exposure of Air Carrier CrE Members.U.S. Federal Aviation Administration, Washington, DC. Mattson, M.E., et al. 1989. "Passive Smoking on Commercial Airlines." J. Am. Med. Assoc., Vol. 261, No. pp. 867-872. National Research Council. 1986a. The Airliner Cabin Environment. National Academy Press, Washingto DC. National Research Council. 1986b. Environmental Tobacco Smoke: Measuring Exposures and Assessif Health Effects. National Academy Press. Washington, Oldaker, G.B., and F.C. Conrad. 1987. "Estimation of Effects Environmental Tobacco Smoke on Air (Quality Within Passenger Cabins of Commercial Aircraft." Enviro Sd. Technol., Vol. 21, No. 10, pp. 994-999. ~Zend clezepaaina nadir een vriena Contact: Forces Nederland, De pro-rakers organisatie van Nederland en Belgic info 00 forces-nl.ora DOT English 1 Summary I Chapter 2 I hr 9 3 t C apts 10 1 Chapter 61 Chapter 71 Chapter 81 u.uutuu y February 1987. DOT accepted in full or in part most of the recommendations made in the Academy repo While recognizing that exposure to ETS could be viewed as a problem by some crewmembers at passengers, DOT suggested that further study was needed to better define health effects, conc entratior and possible technical solutions before proposing a definitive response to a smoking ban on all commerci aircraft. In December of 1987, Public Law 100-202 was enacted, prohibiting smoking by passengers on all scheduled commercial flight of two hours or shorter duration. This limited smoking ban is effective for months beginning April 23, 1988. At the same time, DOT also received Congressional approval to condu a study to resolve technical questions that must be answered before continuing or broadening tl prohibitions contained in PL 100-202. REVIEW OF AVAILABLE DATA The information incorporated into the Committee on Airliner Cabin Air Quality report constitutes comprehensive survey of the published literature to about 1985 (NRC 1986x). This section briel summarizes the results of relevant studies identified by the Committee together with research results th have been published since that time. Environmental tobacco smoke is a complex mixture of gas- and particulate-phase contaminants. More IN 3,800 compounds have been identified in ETS. Field monitoring studies, however, seek to quantitate relatively small number of marker constituents. The aircraft environment has not been systematical investigated for ETS contaminant levels. Early studies conducted by FAA and PHS (1971) measured cab levels of CO, hydrocarbon vapors, TSP, and PAH on twenty Military Airlift Command flights and fourtea domestic flights over an 18-month period. Environmental sampling revealed very low levels of sag contaminant measured, well below occupational and environmental air quality standards, and the: contaminants were not judged to represent a hazard to non-smoking passengers. Analysis of subeecsi, questionnaires, however, also revealed that a significant proportion of nonsmoking passengers we bothered by tobacco smoke, leading to regulations to segregate smoking passengers. Other ETS studies of the airliner cabin environment identified by the committee utilized measures of C and RSP. Anecdotal measurements carried out by Committee members during the Academy study inciudi very limited measurements of N02, RSP, and C02 using portable instruments on commercial flight Although suggesting the possible range of concentrations of ETS-based contaminants, none of these earli data provide definitive results. More recent sampling studies aboard commercial airliners have been published by Oldaker and Conn (1987) and by Mattson et al. (1989). Oldaker and Conrad measured vapor-phase nicotine in no srnokir and smoking sections of three types of commercial aircraft (Boeing 727-200, 737-200 and 737-300). Fort nine measurements were conducted in no-smoking sections, out of which 40 measurements we conducted in the boundary region (i.e., two rows in no-smoking sections adjacent to smoking sections). Additionally, 26 measurements were conducted in smoking sections. Average nicotine concentratioi (+®standard deviations) were 22.4 t 28.4 Ug/m3 in smoking sections, 10.6 9.7 Ug/m3 in the bounda region of no-smoking sections, and 3.3 ± 3.6 Ug1m3 in the remainder of the no-smoking sections. They d not find any significant correlation between nicotine concentrations and the number of smokers; howevc smoking rates were not measured but assumed to be 2 cigarettes per hour per passenger seated in tl smoking section. Data on nicotine exposures, cotinine (a major metaoblite of nicotine) excretion levels, and acute sympton from a subsequent study of passive smoking on commercial airliner flights showed that a total separation smoking and nonsmoking sections was not achieved (Mattson et al. 1989). The study was conducted with subjects on tour flights lasting approximately 4 hours each. Two of the four flights were on aircraft with 1( percent outside air ventilation (Boeing 727) and the other two were on aircraft with 50 percent recirculatk (Boeing 767). The observed nicotine levels were similar to those measured in the Oldnker and Conn study: 13.6 23.0 ug/m3 in the boundary region of no-smoking sections and 16.5 +m 7.1 ug/m3 smoking sections. Aircraft with no recirculation had significantly lower nicotine concentrations than tho: with recirculation. Urinary cotinine levels were related to nicotine exposure for the subjects those with ti highest nicotine exposures had the highest levels of cotinine excretion. Eye and nose symptoms indicati, of acute symptoms were related to nicotine and cotinine levels. Although these studies have been useful in suggesting ranges of concentrations of ETS tracers encounters in the general airliner cabin environment, the samples were not randomly selected and the nurnber observations was generally small, precluding any generalization of the results. Similarly, determinh factors (e.g., ventilation systems, eating patterns) of ETS concentrations for the general airliner cab environment have not been systematically investigated. Although ETS is of obvious importance in the context of PL 100-202, additional pollutants and facto identified by the Committee warrant attention. Essentially no published measurement data exist with rega to ventilation rates (i.e., fresh-air dilution rates in the passenger breathing zone), carbon dioxide levels, microbial aerosols. As cited in the Academy report (NRC 1986x), some data exist to confirm expectations low relative humidity. Similarly, the committee identified fairly abundant data to confirm intrusions .;tempter 1u ra~c i ~1 Chapter 1 IElke dag nieuws over de waanzin van de anti-roken gekte... De blinde woede... Het geld... De belangen.... De ven Hoofdmenu 10. CONCLUSIONS AND Over Forces... Thema's RECOMMENDATIONS Posters Artikelen Analyses Media 10.1 CONCLUSIONS Vliegen Links Forces NL Forum 10. 1. 1 Measurement Methods and Results Discussies Commentaren The flights that were randomly chosen for monitoring in this study proved to be representative of the Archie teun f Forces population of flights departing from major U.S. airports. Distributions of the monitored flights by S airline and type of aircraft were very similar to those for all scheduled commercial jet aircraft flights. Horror Stories Levels of particle-phase ETS contaminants monitored during the study were substantially higher in smoking sections of the aircraft than in nonsmoking areas. Respirable suspended particle (RSP) Navigatie concentrations in the coach smoking section averaged about 175 ug/m3. The average RSP concentration in the no-smoking section near coach smoking (i.e., boundary region) was near 55 Hoofdpagina ug/m3, and RSP concentrations averaged about 35 ug/m3 in other no-smoking areas and on Zoekpagina nonsmoking flights. These averages are based on combined results from two measurement Inhoudsopgave methods optical and Gravimetric. One-minute peak RSP concentrations measured with optical Wist U...? sensors were more than ten times higher in the smoking section, and three times higher in the All Time Favorites boundary region, than in the no-smoking areas on smoking flights. Measured RSP levels in the boundary region were most strongly correlated with observed smoking rates in the coach smoking section (i.e., higher levels when smoking rates were higher) and distance from the coach smoking internationaal section (i.e., higher levels at shorter distances). Levels of gas phase ETS contaminants that were monitored were also highest in smoking sections. Forces Psychiatry Nicotine concentrations averaged near 13.5 ug/m3 in the coach smoking section, near 0.25 ug/m3 in the boundary region within the no-smoking section, and near or below 0.05 ug/m3 in other no- Canada smoking areas and on nonsmoking flights. CO concentrations averaged near 1.4 ppm in the coach Manitoba (email) smoking section, near 0.7 ppm in no-smoking areas of smoking flights, and 0.6 ppm on Italy nonsmoking flights. New Zealand Levels of these ETS tracers in the boundary region were not strongly correlated with observed UK (email) smoking rates or distance from the coach smoking section. Russia Two separate techniques for estimating smoking rates on each monitored flight provided consistent results. Estimates based on technician observations of the number of lighted cigarettes during a VS afdelingen one-minute interval every 15 minutes agreed well with estimates based on cigarette butts collected by technicians at the end of most smoking flights. An average of 20 cigarettes per hour, or 68 California cigarettes per flight, was smoked by passengers in the coach smoking section on smoking flights Connecticut that were monitored; an average of 13.7 percent of passengers were assigned to the coach Delaware smoking section. Duluth Carbon dioxide (CO2) levels on flights monitored during this study were frequently above the level Geor is recommended by ASHRAE (1,000 ppm) to satisfy comfort (odor) criteria. CO2 concentrations on Indiana the monitored flights averaged above 1,500 ppm and exceeded 3,000 ppm on several occasions. Maine Measured concentrations were 1,000 ppm or greater on 87 percent of the monitored flights, and the Massachusetts C02 levels were most strongly related to the number of passengers in the airliner cabin; on the Minnesota average, 70 percent of the seats were occupied on the flights monitored in the study. Depending on assumed C02 exhalation rates, measured levels were as much as twice those predicted by a cabin Rochester air quality model. Even if the measured levels were to be lowered by half, however, C02 USA concentrations would still exceed 1,000 ppm on 24 percent of the study flights. Virginia Relative humidity levels on monitored flights were quite low, averaging near 15 percent on smoking r~ flights and near 20 percent on nonsmoking flights. Humidity levels were below 25 percent, outside I the range indicated by ASHRAE for provision of adequate thermal comfort, on about 90 percent of napter t u 1 C%%, „1,, all monitored flights. Temperatures in the cabins of monitored aircraft averaged near 24 oC (75 oF) Smokers' Club for both smoking and nonsmoking flights and were within ASHRAE's comfort range. NYC C.L.A.S.H. Average levels of other pollutants (ozone, bacteria, and fungi) were relatively low on virtually all Smoking Paradise monitored flights. Measured levels of ozone did not exceed the FAA 3-hour standard of 0.1 ppm or MA Citizens for the current EPA standard of 0.12 ppm on any of the monitored flights. The highest ozone level Freedom measured was 0.08 ppm, and the average measured level was between 0.01 and 0.02 ppm. Real Texas Freedom Measured bacteria levels were somewhat higher in the smoking than no-smoking sections of Ontario Smoking monitored smoking flights, and the average level in the no-smoking section on these flights was nearly identical to that on nonsmoking flights. Measured fungi levels were somewhat higher on nonsmoking flights than smoking flights, but the bacteria and fungi levels in all cases were low, K relative to those that have been measured in other environments. he Evidence rchive The method used in the study to measure air exchange rates was generally adequate for aircraft What you think you know with recirculation but was inadequate for other types of aircraft. The measurement method, about tobacco may surprise involving release and sampling of perfluorocarbon tracers, was less effective on aircraft without you recirculation because of the limited extent of lateral air movement on such aircraft. This limitation could have been overcome by increasing the number of tracer release and sampling locations, but Forces comfit&_van such a strategy was deliberately avoided in this study in order to remain unobtrusive to passengers :,anteietinr and flight attendants during monitoring. The strategy of monitoring at multiple seat locations provided important insights regarding spatial Forces Nederland variations in cabin air quality, particularly for ETS contaminants. This strategy provided some E-mail: indications that the boundary region in the no-smoking section was affected by coach smoking, in info~Jtorces-ni.ore addition to the distinct effects in the smoking section itself, and that spatial variations were relatively minor for C02 and other pollutants (ozone, bacteria, and fungi) that were monitored. The strategy of continuous monitoring where practical, combined with integrated sampling, also provided some important insights concerning cabin air quality. Continuous monitoring results provided the strongest indication of an effect of smoking in the no-smoking boundary region. 10. 1.2 Risk Assessment The risks faced by cabin crew members and passengers depend on such factors as frequency of flying, number of years flown, specific routes flown, and, in the case of ETS exposures, seat locations and prevailing smoking rates. The study conclusions pertaining to cancer risks are based on specific scenarios relating to number of hours per year in flight, number of years flown, and, in the case of ETS exposures, proportion of time spent in the smoking section, boundary region near smoking, and other no-smoking areas. Detailed descriptions of the scenarios and calculations underlying the risk estimates given herein are provided in Section 7.0 for ETS and in Section 8.0 for cosmic radiation. Estimates for cabin crew members relating to ETS exposure pertain only to flight attendants and do not include the cockpit crew. ETS Estimated lifetime lung cancer risks ascribable to ETS exposure for nonsmoking cabin crew members frying 960 hours per year on smoking flights for 20 years range from 12 to 15 premature cancer deaths per 100,000 nonsmoking cabin crew members for domestic flights and from 13 to 17 premature cancer deaths per 100,000 for international flights. The range of estimates was derived from two different cancer risk models (a phenomenological model and a multistage model) that assume different durations of exposure.) Applying these risk estimates to the entire U.S. cabin crew population results in an estimated 0.18 premature lung cancer deaths per year for domestic flights (that is, approximately 4 premature deaths can be expected every 20 years) and 0.16 premature deaths per year for international flights. Estimated Lifetime lung cancer risks due to ETS exposure for nonsmoking passengers flying 480 hours per year on smoking f0igghts for 30 years range from 0.3 to 0.8 premature cancer deaths per 100, 000 nonsmoking passengers for domestic flights and from 0.2 to 0.6 premature cancer deaths per 100,000 for international flights. The range of estimates was derived from the two cancer risk models mentioned above, and the relatively broad range is due to differences in assumed durations of exposure and the sensitivity of the multistage model to assumptions concerning the age at which exposure begins. Estimated lifetime lung cancer risks due to ETS exposure for nonsmoking passengers flying 48 hours hours per year on smoking flights for 40 years are approximately 0.1 premature cancer deaths per 100,000 for both domestic and international fights. Applying these risk estimates to the U.S. flying population results in an estimated 0.24 premature lung cancer deaths per year for domestic flights (that is, approximately 10 premature deaths can be expected every 40 years) and 0.12 premature deaths per year for international flights. in terms of acute effects based on CO concentrations as a proxy for ETS levels, it is estimated that on one-third of smoking flights about 1 in 8 persons seated in the smoking section would experience .Yapter iv irritation due to ETS exposure. Further, it is estimated that on about one-third of domestic smoking flights, ETS levels in the smoking section (based on nicotine concentrations as a proxy ) would be sufficiently high to evoke a marked sensory response in the eye and nose of an airliner cabin occupant. Differential effects of ETS and its constituents on such sensitive populations as asthmatics, children, and persons with ischaemic heart disease or other cardiovascular disease could not be estimated. Cosmic Radiation Estimated lifetime cancer risks due to cosmic radiation exposure for cabin crew members flying 960 hours per year range from 90 to 1,026 premature deaths per 100,000 individuals flying for 20 years on domestic flight: and from 220 to 512 premature deaths per 100,000 individuals flying for 10 years on international flights. The estimates, which pertain to cockpit crew members as well as cabin crew members, are lowest for relatively short north-south domestic flights and higher for coast-to-coast flights involving higher altitudes. The highest estimates are for relatively long, circumpolar international flights which also occur at high altitudes. Estimated lifetime cancer risks due to cosmic radiation exposure for passengers flying 480 hours per year range from 45 to 513 premature deaths per 100, 000 individuals flying for 20 years on domestic flights and from 110 to 256 premature deaths per 100,000 individuals flying for 10 years on international flights. Like the above estimates for cabin crew, the range is governed largely by flight altitudes and latitudes. Another concern is the effect of cosmic radiation on a fetus, particularly during the first trimester. Other Pollutants The levels of bacteria and fungi measured in the airliner cabin air in this study were found to be below the levels generally thought to pose risk of illness. Because quantitative dose-response information on the health risks of biological aerosols was not available, the evaluation of the concentration data was performed by placing the prevalence of individual genera that were identified in rank order, and comparing the prevalence to biological aerosols in other indoor environments. The levels and genera measured in the cabin environment were similar to or lower than those commonly encountered in indoor environments characterized as "normal." It was unnecessary to perform a risk assessment for ozone because measured levels on all monitored flights were well below the current FAA and EPA standards. 10.1.3 Mitigation Among the methods evaluated for reducing risks due to ETS, a total ban on airliner cabin smoking would eliminate ETS exposure in airliner cabins and yield the greatest benefit to fight attendants and nonsmoking passengers. A total ban on smoking on domestic flights is estimated to result in an annual benefit of approximately 3 million to cabin crew and passengers, based on reduced mortality risks. In conducting this benefit/cost analysis, reduction in mortality and associated economic benefits were considered but benefits relating to reduced morbidity were not. Possible costs related to smokers' inconvenience and discomfort or to displacement of smokers to other modes of transportation were not considered due to limited data. Beyond the two-hour ban that reduces ETS exposures on domestic fights by approximately 45 percent, more restrictive bans could be implemented to reduce exposures by as much as 98 percent. Restricting smoking to flights of a 6-hour or greater duration would reduce ETS exposures by approximately 98 percent. and a restriction for flights of 4 hours or longer would reduce exposures by about 86 percent. A different type of strategy to curtail smoking, such as allowing smoking for a 10-minute period every two hours, could reduce average exposures to ETS by as much as 70 percent. Such a strategy, however, could substantially increase the risks of health effects from acute exposure during the brief periods when smoking would be allowed. Two other mitigation measures increased ventilation and improved filter efficiency - would reduce ETS exposures by lesser amounts, ranging from 5 to 33 percent. Annual costs of increased ventilation ( 6 to 50 million), which could reduce ETS exposures by as much as 33 percent, are substantially higher than the benefits ( 0.7 to 1.0 million) that could be calculated within the constraints of this study. Costs related to improved filter efficiency were not available, but improved efficiency would provide only a marginal reduction (5 percent) in ETS exposures. Exposure management is the only viable option for reducing cabin crew member and passenger exposures to cosmic radiation. In the case of crew members, this strategy would involve careful scheduling of personnel to avoid persistent exposure to higher cosmic radiation levels generally associated with high-altitude flights and flight paths toward extreme northern or southern latitudes. On aircraft with recirculation, C02 could be removed by sorption on solid adsorbent beds whose adsorbent capacity for C02 can be regenerated by heating. Increased ventilation could also bring 11211JLGl 1 V I arp, -r vt ? C02 levels closer to the guidelines speoftd by ASHRAE. Cost or reliability data for a sorption system were not available for comparison with costs of additional ventilation. In view of the low levels observed for ozone and biological aerosols, mitigation strategies were not assessed for these pollutants. 10.2 RECOMMENDATIONS 10.2.1 Actions for Improving Cabin Air Quality Considerations should be given to a total ban on smoking on all flights departing from or arriving at U.S. airports as a means of eliminating the ETS risks currently faced by nonsmoking passengers and nonsmoking cabin crew members. The estimated benefits of such a strategy exceed the costs, based on currently available data. In considering this ban, consideration will need to be given to smokers inconvenience and discomfort, possible economic consequences of displacement of smokers to alternative transportation modes, and other potential consequences such as smoker withdrawal symptoms. Possible alternatives include limiting smoking to longer-duration flights or restricting the time periods when smoking is allowed on flights. In the latter case, further study would be needed of the potential health effects from acute exposure that could occur during the limited periods when smoking would be allowed. Airlines should implement exposure management strategies to reduce risks faced by cabin crew members, particularly those related to cosmic radiation. Such strategies would include careful scheduling of personnel, especially those at highest risk, to avoid persistent higher exposures associated with flight paths at extreme northern/southern latitudes and higher altitudes. Sorption should be considered as a means of reducing C02 levels in airliner cabins. The feasibility of implementing this approach needs to be further explored, along with potential costs, benefits, and practical considerations. Such an approach, or increased ventilation, could also reduce levels of other potentially hazardous chemicals, such as volatile organic compounds that were not measured during this study. No actions need to be taken to reduce currently prevailing levels of ozone or biological aerosols. The types of preventive strategies that are currently in place for ozone, which may be partly responsible for the relatively low levels measured during this study, should be continued. 10.2.2 Information Needs Due to constraints of unannounced and unobtrusive monitoring required to meet study objectives, this study could not take full advantage of the currently available state-of-the-art instrumentation for pollutant monitoring. Based on observations and conclusions from this study, the following areas of further study are recommended: Additional measurements of C02 should be performed in commercial airliner cabins. Such measurements need to be conducted with continuous monitoring devices on different types of aircraft and at different levels of passenger occupancy. A study of bight attendants' exposures with personal monitors should be conducted if a total ban on smoking is not enacted. Due to study limitations, flight attendants' exposures could not be estimated directly. A personal monitoring study of flight attendants would improve estimates of exposures by accounting for the different breathing height from that of passengers and time spent in areas such as galleys, which were not monitored during this study. Further measurements of prevailing air exchange rates on aircraft should be performed. Due to the need to remain unobtrusive during this study, it was not possible to widely deploy sources and samplers to obtain more reliable measurements. Improved estimates will provide a stronger basis for cabin air quality modeling which is crucial to assessment of mitigation strategies related to ventilation. Further information on special populations and short-term health effects would support improved risk assessments. The information required includes (1) the flying frequency of children and sensitive individuals such as asthmatics, (2) dose-response functions relating various types of short-term health effects (e.g., eye/nose/throat irritation) to levels of various ETS tracers, and (3) quantitative measures of ETS effects on the cardiovascular system of individuals with pre-existing cardiovascular disease. . uapter i u J V l J Contact: Zeesd clez"agina Haas Enn yr r!d !Forces Me- erland, De pro-rokers organisatie van Nededand en BeBgie ?nf!;~Vorc -nl.®ra DOT English 1 SuMmary I Chapter 2 Charter I 36Chaa t r 51 Chapter 61 Chapter 71 Chapter 81 PREFACE This assessment of the respiratory health effects associated with passive smoking has been prepared by the Human Health Assessment Group, Office of Health and Environmental Assessment, Office of Research and Development, which is responsible for the report's scientific accuracy and conclusions. The assessment was prepared at the request of the Indoor Air Division, Office of Atmospheric and Indoor Air Programs, Office of Air and Radiation, which defined the assessment's scope and provided funding. The report has been developed under the authority of Title IV of Superfund (The Radon Gas and Indoor Air Quality Research Act of 1986) to provide information and guidance on the potential hazards of indoor air pollutants. Two drafts of this report were made available for public review and continents, the first in June 1990 (reviewed by the Agency's Science Advisory Board [SAB] in December 1990) and a significantly revised draft in May 1992 (reviewed by the SAB in July 1992). This report reflects the comments received from those reviews. A comprehensive search of the scientific literature for this report is complete through September 1991. In addition, pertinent studies published through July 1992 have been included in the analysis in response to recommendations made by reviewers. Due to both resource and time constraints, the scope of this report has been limited to an analysis of respiratory effects, primarily lung cancer in nonsmoking adults and noncancer respiratory illnesses in children, with emphasis on the epidemiologic data. Further, because two thorough reviews on passive smoking were completed in 1986 (by the U.S. Surgeon General and the National Research Council), this document provides a summary of those reports with a more comprehensive analysis of the literature appearing subsequent to those reports and an integration of the results. Xvi AUTHORS, CONTRIBUTORS, AND REVIEWERS This document was prepared by the Office of Health and Environmental Assessment (OHEA) within the Office of Research and Development, with major contract funding provided by the Indoor Air Division within the Office of Air and Radiation's Office of Atmospheric and Indoor Air Programs. Steven P. Bayard' was the OHEA project manager with overall responsibility for the contents of this report and its conclusions. Other OHEA staff members responsible for the scientific content of sections of this document are Jennifer Jinot' and Apama M. Koppikar.' Jennifer Jinot and Steven Bayard were the scientific editors. AUTHORS Major portions of this revised report were prepared by ICF Incorporated, Fairfax, Virginia, under EPA Contract No. 68-00-0102. While OHEA staff provided technical editing and incorporated reviewers' comments into each chapter in an attempt to develop a comprehensive and consistent document, the following people were the primary authors: Chapter l: Steven P. Bayard Chapter 2: Jennifer Jinot Chapter 3: Brian P. Leaderer' Chapter 4: Jennifer Jinot Chapters 5/6: Kenneth G. Brown' Chapter 7: Fernando D. Martinez' Chapter 8: Fernando D. Martinez and Steven P. Bayard Appendix A: Kenneth G. Brown, Neal R. Simonsen,' and A. Judson Wells' Appendix B: A. Judson Wells Appendix C: Kenneth G. Brown Appendix D: Kenneth G. Brown and Neal R. Simonsen 'Human Health Assessment Group, Office of Health and Environmental Assessment, U.S. EPA, Washington, DC 20460. 'J.B. Pierce Foundation Laboratory, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520. Subcontractor to ICF, Inc. 'Kenneth G. Brown, Inc., P.O. Box 16608, Chapel Hill, NC 27516. Subcontractor to ICF, Inc. 'Division of Respiratory Sciences, University of Arizona Medical Center, Tucson, AZ 85724. Subcontractor to ICF, Inc. xvii CONTRIBUTORS I Numerous persons have provided helpful discussions or responded to requests for preprints, data, and other material relevant to this report. The authors are grateful to W.J. Blot, N. Britten, R.C. Brownson, P.A. Buffler, T.L. Butler, D.B. Coultas, K.M. Cummings, J. Fleiss, E.T.H. Fontham, Y.T. Gao, L. Garfinkel, S. Glantz, N.J. Haley, T. Hirayama, D.J. Hole, C. Humble, G.C. Kabat, J.C. Kleinman, G.J. Knight, L.C. Koo, M. Layard, M.D. Lebowitz, P.N. Lee, P. Macaskill, G.E. Palomaki, J.P. Pierce, J. Repace, H. Shimizu, W.F. Stewart, D. Trichopoulos, R.W. Wilson, and A. Wu-Williams. REVIEWERS This final report was preceded by two earlier drafts: an External Review Draft (EPA/600/6-90/006A) published in May 1990, and an SAB Review Draft (EPA/600/6-90/006B) published in May 1992. The External Review Draft was released for public review and comment on June 25, 1990, and was subsequently reviewed by the EPA Science Advisory Board (SAB) on December 4 and 5, 1990. The SAB Review Draft incorporated many of the public comments and especially the valuable advice presented in the SAB's April 19, 1991, report to the Agency. In addition, many reviewers both within and outside the Agency provided assistance at various internal review stages. The second Review Draft also was reviewed by the SAB on July 21 and 22, 1992, which provided its report to the Agency on November 20, 1992. The authors wish to thank all those who sought to improve the quality of this report with their comments and are particularly grateful to the SAB for its advice. The following members of the SAB°s Indoor Air Quality and Total Human Exposure Committee (IAQTHEC) participated in the reviews of the two Review Drafts. Chairman Dr. Morton Lippmann, Professor, Institute of Environmental Medicine, New York University Medical Center, Tuxedo, NY 10987 Vice Chairman Dr. Jan A.J. Stolwijk, Professor, School of Medicine, Department of Epidemiology and Public Health, Yale University, 60 College Street, New Haven, CT 06510 Members of the IAQTHEC Dr. Joan Daisey, Senior Scientist, Indoor Environment Program, Lawrence Berkeley Laboratory, One Cyclotron Road, Berkeley, CA 94720 xvln Dr. Timothy Larson, Environmental Science and Engineering Program, Department of Civil Engineering, University of Washington, Seattle, WA 98195 (1992 review only) Dr. Victor G. Laties, Professor of Toxicology, Environmental Health Science Center, Box EHSC, University of Rochester School of Medicine, Rochester, NY 14642 Dr. Paul Lioz, Department of Environmental and Community Medicine, Robert Wood Johnson School of Medicine, Piscataway, NJ 08854 (1992 review only) Dr. Jonathan M. Samet, Professor of Medicine, Department of Medicine, University of New Mexico School of Medicine, and New Mexico Tumor Registry, 900 Camino De Salud, NE, Albuquerque, NM 87131 Dr. Jerome J. Wesolowski, Chief, Air and Industrial Hygiene Laboratory, California Department of Health, Berkeley, CA 94704 Dr. James E. Woods, Jr., Professor of Building Construction, College of Architecture and Urban Studies, 117 Burress Hall, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061-0156 Consultants to the IAQTHEEC Dr. Neal L. Benowitz, Professor of Medicine, Chief, Division of Clinical Pharmacology and Experimental Therapeutics, University of California-San Francisco, Building 30, Fifth Floor, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110 Dr. William J. Blot, National Cancer Institute, 9000 Rockville Pike, Bethesda, MD 20892 (Federal Liaison to the Committee) Dr. David Burns, Associate Professor of Medicine, Department of Medicine, University of California, San Diego Medical Center, 225 Dickenson Street, San Diego, CA 92103-1990 Dr. Delbert Eatough, Professor of Chemistry, Brigham Young University, Provo, UT 84602 Dr. S. Katharine Hammond, Associate Professor, Environmental Health Sciences Program, Department of Family and Community Medicine, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 06155 Dr. Geoffrey Kabat, Senior Epidemiologist, American Health Foundation, 320 East 43rd Street, New York, NY 10017 Dr. Michael D. Lebowitz, Professor of Internal Medicine, University of Arizona College of Medicine, Division of Respiratory Sciences, Tucson, AZ 85724 Dr. Howard Rockette, Professor of Biostatistics, School of Public health, 318 Parran Hall, University of Pittsburgh, Pittsburgh, PA 15261 xix _ Dr. Scott T. Weiss, Channing Laboratory, Harvard University School of Medicine, Boston, MA 02115 Acknowledgments The authors would like to acknowledge the contributions of several people who have made this report and the previous two drafts possible. Foremost is Robert Axelrad, Chief of the Indoor Air Division, Office of Air and Radiation, who provided the foresight, funding, and perseverance that made this effort possible. We also would like to thank the following people: • Individuals from the Office of Health and Environmental Assessment's Technical Information Staff who were responsible for the overall quality, coordination, organization, printing, and distribution of these reports: Linda Bailey-Becht, Terri Konoza, Marie Pfaff, Michele Ranere, and Judy Theisen. Also, Karen Sandidge from the Human Health Assessment Group for the typing support that she provided. • Staff from R.O.W. Sciences, Inc., under the direction of Kay Marshall, who were responsible for editing, word processing, and proofreading the final report. • Robert Flaak, Assistant Staff Director of the SAB, whose efforts and professionalism in organizing and coordinating the two SAB reviews led to an improved and more useful product. xx 1. SUMMARY AND CONCLUSIONS 1.1. MAJOR CONCLUSIONS Eased on the weight of the available scientific evidence, the U.S. Environmental Protection Agency (EPA) has concluded that the widespread exposure to environmental tobacco smoke (ETS) in the United States presents a serious and substantial public health impact. In adults: a ETS is a human lung carcinogen, responsible for approximately 3,000 lung cancer deaths annually in U.S. nonsmokers. In children: * ETS exposure is causally associated with an increased risk of lower respiratory tract infections (LRIs) such as bronchitis and pneumonia. This report estimates that 150,000 to 300,000 cases annually in infants and young children up to 18 months of age are attributable to ETS. * ETS exposure is causally associated with increased prevalence of fluid in the middle ear, symptoms of upper respiratory tract irritation, and a small but significant reduction in lung function. * ETS exposure is causally associated with additional episodes and increased severity of symptoms in children with asthma. This report estimates that 200,000 to 1,000,000 asthmatic children have their condition worsened by exposure to ETS. * ETS exposure is a risk factor for new cases of asthma in children who have not previously displayed symptoms. 1-1 . 1.2. BACKGROUND Tobacco smoking has long been recognized (e.g., U. S. Department of Health, Education, and Welfare [U. S. DHEW], 1964) as a major cause of mortality and morbidity, responsible for an estimated 434,000 deaths per year in the United States (Centers for Disease Control [CDC], 1991 a). Tobacco use is known to cause cancer at various sites, in particular the lung (U.S. Dcpartment of Health and Human Services [U.S. DHHS], 1982; International Agency for Research on Cancer [IARC], 1986). Smoking can also cause respiratory diseases (U.S. DHHS, 1984, 1989) and is a major risk factor for heart disease (U.S. DHHS, 1983). In recent years, there has been concern that nonsmokers may also be at risk for some of these health effects as a result of their exposure ("passive smoking") to the tobacco smoke that occurs in various environments occupied by smokers. Although this ETS is dilute compared with the mainstream smoke (MS) inhaled by active smokers, it is chemically similar, containing many of the same carcinogenic and toxic agents. In 1986, the National Research Council (NRC) and the Surgeon General of the U.S. Public Health Service independently assessed the health effects of exposure to ETS (NRC, 1986; U. S. DHHS, 1986). Both of the 1986 reports conclude that ETS can cause lung cancer in adult nonsmokers and that children of parents who smoke have increased frequency of respiratory symptoms and acute lower respiratory tract infections, as well as evidence of reduced lung function. More recent epidemiologic studies of the potential associations between ETS and lung cancer in nonsmoking adults and between ETS and noncancer respiratory effects more than double the size of the database available for analysis from that of the 1986 reports. This EPA report critically reviews the current database on the respiratory health effects of passive smoking; these data are utilized to develop a hazard identification for ETS and to make quantitative estimates of the public health impacts of ETS for lung cancer and various other respiratory diseases. The weight-of-evidence analysis for the hmg cancer hazard identification is developed in accordance with U.S. EPA's Guidelines for Carcinogen Risk Assessment (U.S. EPA, 1986a) and established principles for evaluating epidemiologic studies. The analysis considers animal bioassays and genotoxicity studies, as well as biological measurements of human uptake of tobacco smoke components and epidemiologic data on active and passive smoking. The availability of abundant and consistent human data, especially human data at actual environmental levels of exposure to the specific agent (mixture) of concern, allows a hazard identification to be made with a high degree of certainty. The conclusive evidence of the dose-related lung carcinogenicity of MS in active smokers (Chapter 4), coupled with information on the chemical similarities of MS and ETS and evidence of ETS uptake in nonsmokers (Chapter 3), is sufficient by itself to establish ETS as a known human lung carcinogen, or "Group A" carcinogen under U.S. EPA's carcinogen classification system. In addition, this document concludes that the overall results of 30 epidemiologic studies on lung cancer and passive smoking (Chapter 5), using spousal smoking as a surrogate of ETS exposure for female never-smokers, similarly justify a Group A classification. The weight-of-evidence analyses for the nommncer respiratory effects are based primarily on a review of epidemiologic studies (Chapter 7). Most of the endpoints examined are respiratory disorders in children, where 1-2 parental smoking is used as a surrogate of ETS exposure. For the noncancer respiratory effects in nonsmoking adults, most studies used spousal smoking as an exposure surrogate. A causal association was concluded to exist for a number of respiratory disorders where there was sufficient consistent evidence for a biologically plausible association with ETS that could not be explained by bias, confounding, or chance. The fact that the database consists of human evidence from actual environmental exposure levels gives a high degree of confidence in this conclusion. Where there was suggestive but inconclusive evidence of causality, as was the case for asthma induction in children, ETS was concluded to be a risk factor for that endpoint. Where data were inconsistent or inadequate for evaluation of an association, as for acute upper respiratory tract infections and acute middle ear infections in children, no conclusions were drawn. This report also has attempted to provide estimates of the extent of the public health impact, where appropriate, in terms of numbers of ETS-attributable cases in nonsmoking subpopulations. Unlike for qualitative hazard identification assessments, where information from many sources adds to the confidence in a weight-of- evidence conclusion, for quantitative risk assessments, the usefulness of studies usually depends on how closely the study population resembles nonsmoking segments of the general population. For lung cancer estimates among U.S. nonsmokers, the substantial epidemiology database of ETS and lung cancer among U. S. female never-smokers was considered to provide the most appropriate information. From these U.S. epidemiology studies, a pooled relative risk estimate was calculated and used in the derivation of the population risk estimates. The large number of studies available, the generally consistent results, and the condition of actual environmental levels of exposure increase the confidence in these estimates. Even under these circumstances, however, uncertainties remain, such as in the use of questionnaires and current biomarker measurements to estimate past exposure, assumptions of exposure-response linearity, and extrapolation to male never-smokers and to ex-smokers. Still, given the strength of the evidence for the lung carcinogenicity of tobacco smoke and the extensive human database from actual environmental exposure levels, fewer assumptions are necessary than is usual in EPA quantitative risk assessments, and confidence in these estimates is rated medium to high. Population estimates of ETS health impacts are also made for certain noncancer respiratory endpoints in children, specifically lower respiratory tract infections (i.e., pneumonia, bronchitis, and bronchiolitis) and episodes and severity of attacks of asthma. Estimates of ETS-attributable cases of LRI in infants and young children are thought to have a high degree of confidence because of the consistent study findings and the appropriateness of parental smoking as a surrogate measure of exposure in very young children. Estimates of the number of asthmatic children whose condition is aggravated by exposure to ETS are less certain than those for LRIs because of different measures of outcome in various studies and because of increased extraparental exposure to ETS in older children. Estimates of the number of new cases of asthma in previously asymptomatic children also have less confidence because at this time the weight of evidence for asthma induction, while suggestive of a causal association, is not conclusive. 1-3 Most of the ETS population impact estimates are presented in terms of ranges, which are thought to reflect reasonable assumptions about the estimates of parameters and variables required for the extrapolation models. The validity of the ranges is also dependent on the appropriateness of the extrapolation models themselves. While this report focuses only on the respiratory health effects of passive smoking, there also may be other health effects of concern. Recent analyses of more than a dozen epidemiology and toxicology studies (e.g., Steenland, 1992; National Institute for Occupational Safety and Health [NIOSM, 1991) suggest that ETS exposure may be a risk factor for cardiovascular disease. In addition, a few studies in the literature link ETS exposure to cancers of other sites; at this time, that database appears inadequate for any conclusion. This report does not develop an analysis of either the nonrespiratory cancer or the heart disease data and takes no position on whether ETS is a risk factor for these diseases. If it is, the total public health impact from ETS will be greater than that discussed here. 1.3. PRIMARY FINDINGS A. Lung Cancer in Nonsmoking Adults 1. Passive smoking is causally associated with lung cancer in adults, and ETS, by the total weight of evidence, belongs in the category of compounds classified by EPA as Group A (known human) carcinogens. 2. Approximately 3,000 lung cancer deaths per year among nonsmokers (never-smokers and former smokers) of both sexes are estimated to be attributable to ETS in the United States. While there are statistical and modeling uncertainties in this estimate, and the true number may be higher or lower, the assumptions used in this analysis would tend to underestimate the actual population risk. The overall confidence in this estimate is medium to high. B. Noncancer Respiratory Diseases and Disorders 1. Exposure of children to ETS from parental smoking is causally associated with: a. increased prevalence of respiratory symptoms of irritation (cough, sputum, and wheeze), b. increased prevalence of middle ear effusion (a sign of middle ear disease), and c. a small but statistically significant reduction in lung function as tested by objective measures of lung capacity. 2. ETS exposure of young children and particularly infants from parental (and especially mother's) smoking is causally associated with an increased risk of LRIs (pneumonia, bronchitis, and bronchiolitis). This report estimates that exposure to ETS contributes 150,000 to 300,000 LRIs annually in infants and children less than 18 months of age, resulting in 7,500 to 15,000 hospitalizations. The confidence in the estimates of LRIs is high. Increased risks for LRIs continue, but are lower in magnitude, for children until about age 3; however, no estimates are derived for children over 18 months. 1-4 3. a. Exposure to ETS is causally associated with additional episodes and increased severity of asthma in children who already have the disease. This report estimates that ETS exposure exacerbates symptoms in approximately 20% of this country's 2 million to 5 million asthmatic children and is a major aggravating factor in approximately 10%. b. In addition, the epidemioiogic evidence is suggestive but not conclusive that ETS exposure increases the number of new cases of asthma in children who have not previously exhibited symptoms. Based on this evidence and the known ETS effects on both the immune system and lungs (e.g., atopy and airway hyperresponsiveness), this report concludes that ETS is a risk factor for the induction of asthma in previously asymptomatic children. Data suggest that relatively high levels of exposure are required to induce new cases of asthma in childrcn. This report calculates that previously asymptomatic children exposed to ETS from mothers who smoke at least 10 cigarettes per day will exhibit an estimated 8,000 to 26,000 new cases of asthma annually. The confidence in this range is medium and is dependent on the conclusion that ETS is a risk factor for asthma induction. 4. Passive smoking has subtle but significant effects on the respiratory health of nonsmoking adults, including coughing, phlegm production, chest discomfort, and reduced lung function. This report also has reviewed data on the relationship of maternal smoking and sudden infant death syndrome (SIDS), which is thought to involve some unknown respiratory pathogenesis. The report concludes that while there is strong evidence ftt infants whose mothers smoke are at an increased risk of dying from SIDS, available studies do not allow us to differentiate whether and to what extent this increase is related to in utero versus postnatal exposure to tobacco smoke products. Consequently, this report is unable to assert whether or not ETS exposure by itself is a risk factor for SIDS independent of smoking during pregnancy. Regarding an association of parental smoking with either upper respiratory tract infections (colds and sore throats) or acute middle ear infections in children, this report finds the evidence inconclusive. 1.3.1. ETS and Lung Cancer 1.3.1.1. Hazard daendficadon The Surgeon General (U.S. DHHS, 1989) estimated that smoking was responsible for more than one of every six deaths in the United States and that it accounted for about 90% of the lung cancer deaths in males and about 80% in females in 1985. Smokers, however, are not the only ones exposed to tobacco smoke. The sidestream smoke (SS) emitted from a smoldering cigarette between puffs (the main component of ETS) has been documented to contain virtually all of the same carcinogenic compounds (known and suspected human and animal carcinogens) that have been identified in the mainstream smoke (MS) inhaled by smokers (Chapter 3). Exposure concentrations of these carcinogens to passive smokers are variable but much lower than for active smokers. An excess cancer risk from passive smoking, however, is biologically plausible. 1-5 Based on the firmly established causal association of lung cancer with active smoking with a dose-response relationship down to low doses (Chapter 4), passive smoking is considered likely to affect the lung similarly. The widespread presence of ETS in both home and workplace and its absorption by nonsmokers in the general population have been well documented by air sampling and by body measurement of biomarkers such as nicotine and cotinine (Chapter 3). This raises the question of whether any direct evidence exists for the relationship between ETS exposure and lung cancer in the general population and what its implications may be for public health. This report addresses that question by reviewing and analyzing the evidence from 30 epidemiologic studies of effects from normally occurring environmental levels of ETS (Chapter 5). Because there is widespread exposure and it is difficult to construct a truly unexposed subgroup of the general population, these studies attempt to compare individuals with higher ETS exposure to those with lower exposures. Typically, female never-smokers who are married to a smoker are compared with female never-smokers who are married to a nonsmoker. Some studies also consider ETS exposure of other subjects (i.e., male never-smokers and long-tern former smokers of either sex) and from other sources (e.g., workplace and home exposure during childhood), but these studies are fewer and represent fewer cases, and they are generally excluded from the analysis presented here. Use of the female never-smoker studies provides the largest, most homogeneous database for analysis to determine whether an ETS effect on lung cancer is present. This report assumes that the results for female never-smokers are generalizable to all nonsmokers. Given that ETS exposures are at actual environmental levels and that the comparison groups are both exposed to appreciable background (i.e., nonspousal) ETS, any excess risk for lung cancer from exposure to spousal smoke would be expected to be small. Furthermore, the risk of lung cancer is relatively low in nonsmokers, and most studies have a small sample size, resulting in a very low statistical power (probability of detecting a real effect if it exists). Besides small sample size and low incremental exposures, other problems inherent in several of the studies may also limit their ability to detect a possible effect. Therefore, this report examines the data in several different ways. After downward adjustment of the relative risks for smoker misclassification bias, the studies are individually assessed for strength of association, both for the overall data and for the highest exposure group when exposure-level data are available, and for exposure-response trend. Then the study results are pooled by country using statistical techniques for combining data, including both positive and nonpositive results, to increase the ability to determine whether or not there is an association between ETS and lung cancer. Finally, in addition to the previous statistical analyses that weight the studies only by size, regardless of design and conduct, the studies are qualitatively evaluated for potential confounding, bias, and likely utility to provide information about any lung carcinogenicity of ETS. Based on these qualitative considerations, the studies are categorized into one of four tiers and then statistically analyzed successively by tier. Results from all of the analyses described above strongly support a causal association between lung cancer ETS exposure. The overall proportion (9/30) of individual studies found to show an association between lung cancer and spousal ETS exposure at all levels combined is unlikely to occur by chance (p < 10-4). When the analysis focuses on higher levels of spousal exposure, every one of the 17 studies with exposure-level data shows increased risk in the 1-6 highest exposure group; 9 of these are significant at the p < 0.05 level, despite most having low power, another result highly unlikely to occur by chance (p < W). Similarly, the proportion (10/14; p < 10.E showing a statistically significant exposure-response trend is highly supportive of a causal association. Combined results by country showed statistically significant associations for Greece (2 studies), Hong Kong (4 studies), Japan (5 studies), and the United States (11 studies), and in that order of strength of relative risk. Pooled results of the four Western European studies (three countries) actually showed a slightly stronger association than that of the United States, but it was not statistically significant, probably due to the smaller sample size. The combined results of the Chinese studies do not show an association between ETS and lung cancer; however, two of the four Chinese studies were designed mainly to determine the lung cancer effects of high levels of other indoor air pollutants indigo nous to those areas, which would obscure a smaller ETS effect. These two Chinese studies do, however, provide very strong evidence on the lung carcinogenicity of these other indoor air pollutants, which contain many of the same components as ETS. When results are combined only for the other two Chinese studies, they demonstrate a statistically significant association for ETS and lung cancer. The heterogeneity of observed relative risk estimates among countries could result from several factors. For example, the observed differences may reflect true differences in lung cancer rates for never-smokers, in ETS exposure levels from nonspousal sources, or in related lifestyle characteristics in different countries. For the time period in which ETS exposure was of interest for these studies, spousal smoking is considered to be a better surrogate for ETS exposure in more "traditional" societies, such as Japan and Greece, than in the United States. In the United States, other sources of ETS exposure (e.g., work and public places) are generally higher, which obscures the effects of spousal smoking and may explain the lower relative risks observed in the United States. Nevertheless, despite observed differences between countries, all showed evidence of increased risk. Based on these analyses and following the U.S. EPA's Guidelines for Carcinogen RiskAssessamcent (U.S. EPA, 1986a), EPA concludes that environmental tobacco smoke is a Group A (lrnown human) carcinogen. This conclusion is based on a total weight of evidence, principally: • Biological plausibility. ETS is taken up by the lungs, and components are distributed throughout the body. The presence of the same carcinogens in ETS and MS, along with the established causal relationship between lung cancer and active smoking with the dose-response relationships exhibited down to low doses, establishes the plausibility that ETS is also a lung carcinogen. • Supporting evidence from animal bioassays and genotoxicity experiments. The carcinogenicity of tobacco smoke has been demonstrated in lifetime inhalation studies in the hamster, intrapulmonary implantations in the rat, and skin painting in the mouse. There are no lifetime animal inhalation steadies of ETS; however, the carcinogenicity of SS condensates has been shown in intrapulmonary implantations and skin painting experiments. Positive results of genotoxicity testing for both MS and ETS provide corroborative evidence for their carcinogenic potential. 1-7 • Consistency of response. All 4 of the cohort studies and 20 of the 26 case-control studies observed a higher risk of lung cancer among the female never-smokers classified as ever exposed to any level of spousal ETS. Furthermore, every one of the 17 studies with response categorized by exposure level demonstrated increased risk for the highest exposure group. When assessment was restricted to the 19 studies judged to be of higher utility based on study design, execution, and analysis (Appendix A), 17 observed higher risks, and 6 of these increases were statistically significant, despite most having low statistical power. Evaluation of the total study evidence from several perspectives leads to the conclusion that the observed association between ETS exposure and increased lung cancer occurrence is not attributable to chance. • Broad-based evidence. These 30 studies provide data from 8 different countries, employ a wide variety of study designs and protocols, and are conducted by many different research teams. Results from all countries, with the possible exception of two areas of China where high levels of other indoor air lung carcinogens were present, show small to modest increases in lung cancer associated with spousal ETS exposure. No alternative explanatory variables for the observed association between ETS and lung cancer have been indicated that would be broadly applicable across studies. • Upward trend in exposure-response. Both the largest of the cohort studies-the Japanese study of Mrayama with 200 lung cancer cases-and the largest of the case-control studies-the U.S. study by Fontham and associates (1991) with 420 lung cancer cases and two sets of controls--demonstrate a strong exposure--related statistical association between passive smoking and lung cancer. This upward trend is well supported by the preponderance of epidemiology studies. Of the 14 studies that provide sufficient data for a trend test by exposure level, 10 were statistically significant despite most having low statistical power. • Detectable association at environmental exposure levels. Within the population of married women who are lifelong nonsmokers, the excess lung cancer risk from exposure to their smoking husbands' ETS is large enough to be observed, even for all levels of their spousal exposure combined. Carcinogenic responses are usually detectable only in high-exposure circumstances, such as occupational settings, or in experimental animals receiving very high doses. In addition, effects are harder to observe when there is substantial background exposure in the comparison groups, as is the case here. • Effects remain after adjustment for potential upward bias. Current and ex-smokers may be misreported as never-smokers, thus inflating the apparent cancer risk for ETS exposure. The evidence remains statistically significant and conclusive, however, after adjustments for smoker misclassification. For the United States, the summary estimate of relative risk from nine case-control plus two cohort studies is 1.19 (90% confidence interval [C.I.] =1.04, 1.35; p < 0.05) after adjustment for smoker misclassification. For Greece, 2.00 (1.42, 2.83), Hong Kong, 1.61 (1.25, 2.06), and Japan, 1.44 (1.13, 1-8 1.85), the estimated relative risks are higher than those of the United States and more highly significant after adjusting for the potential bias. • Strong associations for highest exposure groups. Examining the groups with the highest exposure levels increases the ability to detect an effect, if it exists. Nine of the sixteen studies worldwide for which there are sufficient exposure-level data are statistically significant for the highest exposure group, despite most having low statistical power. 'The overall pooled estimate of 1.81 for the highest exposure groups is highly statistically significant (90% C.I. =1.60, 2.05; p < 10-6). For the United States, the overall pooled estimate of 1.38 (seven studies, corrected for smoker misclassification bias) is also highly statistically significant (90% C.I. = 1. 13, 1.70; p = 0.005). • Confounding cannot explain the association. The broad-based evidence for an association found by independent investigators across several countries, as well as the positive exposure-response trends observed in most of the studies that analyzed for them, make any single confounder highly us likely as an explanation for the results. In addition, this report examined potential confounding factors (history of lung disease, home heat sources, diet, occupation) and concluded that none of these factors could account for the ob: erved association between lung cancer and ETS. 1.3.1.2. Esdvwdon of'Popula&n Risk The individual risk of lung cancer from exposure to ETS does not have to be very large to translate into a significant health hazard to the U.S. population because of the large number of smokers and the widespread presence of ETS. Current smokers comprise approximately 26% of the U.S. adult population and consume more than one-half trillion cigarettes annually (1.5 packs per day, on average), causing nearly universal exposure to at least some ETS. As a biomarker of tobacco smoke uptake, cotinine, a metabolite of the tobacco-specific compound nicotine, is detectable in the blood, saliva, and urine of persons recently exposed to tobacco smoke. Cotinine has typically been detected in 5011/o to 75% of reported nonsmokers tested (5(% equates to 63 million U.S. nonsmokers age 18 or older). The best estimate of approximately 3,000 lung cancer deaths per year in U.S. nonsmokers age 35 and over attributable to ETS (Chapter 6) is based on data pooled from all 11 U.S. epidemiologic studies of never-smoking women married to smoking spouses. Use of U.S. studies should increase the confidence in these estimates. Some mathematical modeling is required to adjust for expected bias from misclassification of smoking status and to account for ETS exposure from sources other than spousal smoking. The overall relative risk estimate of 1.19 for the United States, already adjusted for smoker miscla,mfication bias, becomes 1.59 after adjusting for background ETS sources (1.34 for nonspousal exposures only). Assumptions are also needed to relate responses in female never- smokers to those in male never-". and ex-smokers of both sexes, and to estimate the proportion of the nonsmoking population exposed to various levels of ETS. Overall, however, the assumptions necessary for estimating risk add far less uncertainty than other EPA quantitative assessments. This is because the extrapolation for 1-9 ETS is based on a large database of human studies, all at levels actually expected to be encountered by much of the U.S. population. The components of the 3,000 lung cancer deaths figure include approximately 1,500 female never-smokers, 500 male never smokers, and 1,000 former smokers of both sexes. More females are estimated to be affected because there are more female than male nonsmokers. These component estimates have varying degrees of confidence; the estimate of 1,500 deaths for female never-smokers has the highest confidence because of the extensive database. The estimate of 500 for male never-smokers is less certain because it is based on the female never-smoker response and is thought to be low because males are generally subject to higher background ETS exposures than females. Adjustment for this higher background exposure would lead to higher risk estimates. The estimate of 1,000 lung cancer deaths for former smokers of both sexes is considered to have the lowest confidence, and the assumptions used are thought to make this estimate low as well. Workplace ETS levels are generally comparable with home ETS levels, and studies using body cotinine measures as biomarkers demonstrate that nonspousal exposures to ETS are often greater than exposure from spousal smoking. Thus, this report presents an alternative breakdown of the estimated 3,000 ETS-attributable hung cancer deaths between spousal and nonspousal exposures. By extension of the results from spousal smoking studies, coupled with biological measurements of exposure, more lung cancer deaths are estimated to be attributable to ETS from combined nonspousal exposures-2,200 of both sexes--than from spousal exposure--800 of both sexes. This spouse- versus-other-sources partitioning depends on current exposure estimates that may or may not be applicable to the exposure period of interest. Thus, this breakdown contains this element of uncertainty in addition to those discussed above with respect to the previous breakdown. An alternative analysis, based on the large Fondram et al. (1991) study, which is the only study that provides biomarker estimates of both relative risk and ETS exposure, yields population risk point estimates of 2,700 and 3,600. These population risk estimates are highly consistent with the estimate of 3,000 based on the combined U.S. studies. While there is statistical variance around all of the parameters used in the quantitative assessment, the two largest areas of uncertainty are probably associated with the relative risk estimate for spousal ETS exposure and the parameter estimate for the background ETS exposure adjustment. A sensitivity analysis that independently varies these two estimates yields population risk estimates as low as 400 and as high as 7,000. These extremes, however, are considered unlikely; the more probable range is narrower, and the generally conservative assumptions employed suggest that the actual population risk number may be greater than 3,000. Overall, considering the multitude, consistency, and quality of all these studies, the weight-of-evidence conclusion that ETS is a known human lung carcinogen, and the limited amount of extrapolation necessary, the confidence in the estimate of approximately 3,000 lung cancer deaths is medium to high. 1-10 1.3.2. ETS and Noncarwer Respiratory Disorders Exposure to ETS from parental smoking has been previously linked with increased respiratory disorders in children, particularly in infants. Several studies have confirmed the exposure and uptake of ETS in children by assaying saliva, serum, or urine for cotinine. These cotinine concentrations were highly correlated with smoking (especially by the mother) in the child's presence. Nine to twelve million American children under 5 years of age, or one-half to two-thirds of all children in this age group, may be exposed to cigarette smoke in the home (American Academy of ;pediatrics, 1956; Overpeck and Moss, 1991). With regard to the noncan tier respiratory effects of passive smoking, this reportfocuses on epidemiologic evidence appearing since the two major reports of 1986 (NRC and U.S. L'HHS) that bears on the potential association of parental amoir-mg s.ith detrimental respiratory eff its in their cWWren. These effects ii ~-?u& symptoms of respiratory irritation (cough;, sputuxi, production, or .wheeze); acute diseases of the lower respiratory tract (pne unonia, bronchitis, and bronchiolitis); acw:: middle ear infections and indications of chronic middle war infections (predominantly middle ear effusion); reduced lung function (from forced expiratory vol ie and flow-rate measurements); incidence and prevalence of asthma and exacerbation of symptoms in asthmatics; and acute upper respiratory tract infections (colds and sore throats). The more than 50 recently published studies reviewed here essentially corroborate the previous conclusions of the 1956 reports of the NRC and Surgeon General regarding respiratory symptoms, respiratory illnesses, and pulmonary function, and they strengthen support for those conclusions by the additional weight of evidence (Chapter 7). For example, new data on middle ear effusion strengthen previous evidence to warrant the stronger conclusion in this report of a causal association with parented smoking. Furthermore, recent studies establish associations between parental smoking and increased incidence of childhood asthma. Additional research also supports the hypotheses that in utero exposure to mother's smoke and postnatal exposure to ETS alter lung function and structure, increase bronchial responsiveness, and enhance the process of allergic sensitization, changes that are known to predispose children to early respiratory illness. Early respiratory illness can lead to long-term pulmonary effects (reduced lung function and increased risk of chronic obstnmctive lung disease). This report also summarizes the evidence for an association between parental smoking and SIBS, which was not addressed in the 1956 reports of the NRC or Surgeon General. SIDS is the most common cause of death in infants ages I month to I year. Th. cause (or causes) of SIBS is unknown; however, it is widely believed that some form of respiratory pathogenesis is generally involved. The current evidence strongly suggests that infants whose mothers smoke are at an increased risk of dying of SIDS, independent of other known risk factors for SIDS, including low birthweight and low gestational age, which are specifically associated with active smoking during pregnancy. However, available studies do not allow this report to conclude whether that increased risk is related to in utero versus postnatal exposure to tobacco smoke products, or to both. The 1956 reports of the NRC and Surgeon General conclude that both the prevalence of respiratory symptoms of irritation and the incidence of lower respiratory tract infections are higher in children of smoking 1-11 parents. In the 18 studies of respiratory symptoms subsequent to the 2 reports, increased symptoms (cough, phlegm production, and wheezing) were observed in a range of ages from birth to midteens, particularly in infants and preschool children. In addition to the studies on symptoms of respiratory irritation, 10 new studies have addressed the topic of parental smoking and acute lower respiratory tract illness in children, and 9 have reported statistically significant associations. The cumulative evidence is conclusive that parental smoking, especially the mother's, causes an increased incidence of respiratory illnesses from birth up to the first 18 months to 3 years of life, particularly for bronchitis, bronchiolitis, and pneazmonia. Overall, the evidence confirms and strengthens the previous conclusions of the NRC and Surgeon General. Recent studies also solidify the evidence for the conclusion of a causal association between parental smoking and increased middle ear effusion in young children. Middle ear e%i sion is the most common reason for hospitalization of young children for an operation. At the time of the Surgeon General's report on passive smoking (U. S. DHHS, 1986), data were sufficient to conclude only that maternal smoldng may influence the severity of asthma in children. The recent studies reviewed here strengthen and confirm these exacerbation effects. The new evidence is also conclusive that ETS exposure increases the number of episodes of asthma in children who already have the disease. In addition, the evidence is suggestive that ETS exposure increases the number of new cases of asthma in children who have not previously exhibited symptoms, although the results are statistically significant only with children whose mothers smoke 10 or more cigarettes per day. While the evidence for new cases of asthma itself is not conclusive of a causal association, the consistently strong association of ETS both with increased frequency and severity of the asthmatic symptoms and with the established ETS effects on the immune system and airway hyperresponsiveness lead to the conclusion that ETS is a risk factor for induction of asthma in previously asymptomatic children. Regarding the effects of passive smoking on lung function in children, the 1986 NRC and Surgeon General reports both conclude that children of parents who smoke have small decreases in tests of pulmonary output function of both the larger and smaller air passages when compared with the children of nonsmokers. As noted in the NRC report, if ETS exposure is the cause of the observed decrease in lung function, the effect could be due to the direct action of agents in ETS or an indirect consequence of increased occurrence of acute respiratory illness related to ETS. Results from eight studies on ETS and lung function in children that have appeared since those reports add some additional confirmatory evidence suggesting a causal rather than an indirect relationship. For the population as a whole, the reductions are small relative to the interindividual variability of each lung function parameter. However, groups of particularly susceptible or heavily exposed children have shown larger decrements. The studies reviewed suggest that a continuum of exposures to tobacco products starting in fetal life may contribute to the decrements in lung function found in older children. Exposure to tobacco smoke products inhaled by the mother during pregnancy may contribute significantly to these changes, but there is strong evidence indicating that postnatal exposure to ETS is an important part of the causal pathway. 1-12 With respect to lung function effects in adults exposed to ETS; the 1986 NRC and Surgeon General reports found the data at that time inconclusive, due to high interindividual variability and the existence of a large number of other risk factors, but compatible with subtle deficits in lung fimetion. Recent studies confirm the association of passive smoking with small reductions in lung function. Furthermore, new evidence also has emerged suggesting a subtle association between expose m to ETS and 'increased respiratory symptoms in adults. Some evidence suggests that the incidence of acute upper respiratory tract illnesses and acute middle ear infections may be more common in children exposed to ETS. However, several studies failed to fund any effect. In addition, the possible role of confounding factors, the lack of studies showing clear dose-response relationships, and the absence of a plausible biological mechanism prelude more definitive conclusions. in reviewing the available evidence indicating an association (or lack thereof) bet-,veer. ETS exposure and the different noncancer respiratory disoxders analyzed in this report, the possible role of several potential confounding, factors was considered. These incl- de other indoor air pollutants; socioeconomic status; effect of parents.' symptoms; and characteristics of the exposed child, such as low birthweight or active smoking. No single or combined confounding factors can explain ft observed respiratory effects of passive smoking in children:. For diseases for which ETS has bean either causally associated (LRIs) or indicated as a risk factor (asthma cases in previously asyrnptomatic children), estimates of population-attributable risk can be calculated. A population risk assessment (Chapter 8) provides a probable range of estimates that 8,000 to 26,000 cases of childhood asthma per year are attributable to ETS exposure from mothers who smoke 10 or more cigarettes per day. The confidence in this range of estimates is medium and is dependent on the suggestive evidence of the database. While the data show an effect only for children of these heavily smoking mothers, additional cases due to lesser ET'S exposure also are a possibility. If the effect of this lesser exposure is considered, the range of estimates of new cases presented above increases to 13, to 60,000. Furermorc, this report estimates that the additional public health impact ofETS on asthmatic children includes more then 203,000 children whose symptoms are significantly aggravated and as many w 1,000,000 children who are affected to some degree. This report estimates that ETS exposure contributes 150,000 to 300,000 cases annually of flower respiratory tract illness in infants and children younger than 18 months of age and that 7,500 to 15,000 of these will require hospitalization. The strong evidence linking ETS exposure to increased incidence of bronchitis, bronehiolitis, and pneumonia in young children gives these estimates a high degree of confidence. There is also evidence suggesting a smaller ETS effect on children bet*cveen the ages of 18 months and 3 years, but no additional estimates have been computed for this age group. Whether or not these illnesses result in death has not been addressed here. In the United States, more than 5,000 infants die of SIDS annually. It is the major cause of death in infants between the ages of 1 month and 1 year, and the linkage with maternal smoking is well established. The Surgeon General and the World Health Organization estimate that more than 700 U. S. infant deaft per year from SIDS are attributable to maternal smoking (CDC, 1991a, 1992b). However, this report concludes that at present there is not 1-13 4;nough direct evidence supporting the contribution of ETS exposure to declare it a risk factor or to estimate its population impact on SH)S. 1-14 131CC:~ J - 11 V 11Jr 1V l fl? - N t? V L' 1C a1V1tjn.n1.c L U!v V k-tuV l.r iC I-U a1La r 1`v1V1 zAr v a U 1CIG.. r a~~ t 1 > BACK TO FORCES MAIN PAGE < FORWS - EVICkH "o by too - Back tn:. Provir~ the lies of-the anti-tobacco carte! The Evidence LUNG CANCER RISKS FROM PARTICULATE TOBACCO SMOKE EXPOSURE A. Arundel, T. ,Sterling, and J. Weinkaam FacWty of Applied Sciences, School of Computing Science, Simon Fraser University, Ba> malt', B.C. V5A 1S6 Canada Environmental International, Vol 13, pp. 409-426, 1987. This study is exposing interesting discrepancies on deaths "caused" by Environmental Tobacco Smoke (ETS). The alarmistic results about mortality "caused" by ETS are estimated from methods based on the average lung cancer risk observed in epidemiological studies of exposure to ETS. Different methods based on empirical data extrapolation can be used. Empirical data implies more use of direct measurement, and less computer-generated estimates based on epidemiological data charts which as we well know by now can be very easily affected by unintentional or intentional bias. Therefore, the observations of this older study highlight certain constants that don't change with time, or political winds. EXCERPT FROM ABSTRACT "The average particulate environmental tobacco smoke (ETS) exposure of never and current smokers and the average lung cancer mortality rate for current smokers is estimated from, empirical data, These estimates are used in a linear dowtmard extrapolation of the lung cancer risk/milligram of particulate ETS exposure for current smokers to calculate the average lung cancer risk for never smokers and the number of never smoker lung cancer deaths (LCD) in the U. S. in 1980 from exposure to particulate ETS. " "The estimated average daily inhaled particulate ETS exposure for never smokers is 0.62 milligrams/day for men, and 0,28 mnilligrams/day for women. The average never smoker is estimated to retain 11 % of the inhaled exposure, for a daily retained exposure of 0.07 milligrams for men and 0.03 milligrams for women. " "Other estimates are: a daily retained exposure for current smokers of 310 milligrams for men and 249 milligrams for women, a smoking-attributable lung cancer risk for current smokers in 1980 of 284 LCD1100, 000 men and 121 LCD/100,000 women, and an annual retained exposure hang cancer risk for never-smokers of 0.64 LCD1100, 000 men and 0.015 LDC1100, 0€10 women. " "These risks and exposures estimate 12 lung cancer deaths among never smokers for exposure 'UKUhs - 1 lih h V W_tr-0 h - 1Vh v r.K ~1V1V1LCK 1.Uf4u t t~ivt Ott n an-0 rnvlvi ILZ%.r v.~viwa i to particulate ETS: 8 among the 11, 960, 000 male never smokers and 4 among the 28,850, 000 female never smokers in the U.S " The study continues on describing the methodology used, the direct ny-wurements for mainstream and sidestream smoke, as duel' as the mathematical equations used for the calculations. Direct measurement of emissions is a true representative of pollution values thus exposure to risk outperforming any interpolation and. extrapolation of statistical data. Mathematical calculation cart then be performed on solid data, as opposed to assumptions and biased surveys. If there are 8 lung cancer deaths among 11,960,000 males, it means that the odds for a male non-smoker to die of lung cancer from ETS exposure are 1 in 1.5 millions If there are 4 lung cancer death among 28,850,000 females, it means that the odds for a female non-smoker to die of lung cancer from ET'S exposure are I in over 7.2 millions. It is our understanding that the odds of being struck by lightening are the classic I in a Million. So, this is yet another demonstration of the gratuitous fear tactics that the antismoking industry uses to justify the acquisition of power and tax funds. In light of the latest computer-generated factual distortions of the latest California. EPA "study" that the Bill Clintons of this world use to justify subjugation of dissenting population to political agendas, this empirical "old" data should give us quite a lot to think about. And the White House and FDA should consider legislation on lightening rods. > BACK TO FORCES MAIN PAGE < I '(.)KI;tJ~ - l t~C ~YA'J "t3Al;ltliKV u1vU ~ 1 J t~1v1J v t race r~ts~ a.~a ~ ~ e, > BACK TO FORCES MAIN PAGE < AJRCES - Evide by topic Back to: Provinn the lies of the anti-tobacco carte!: The. Evidence OTHER AND FRAUDS FROM "°RESPIRI TORY HEALTH EFFECTS OF PASSIVE SMOKING: LUNG CANCER AAA OTHER DISORDERS, Or EPA.1600164901006 , December 1992, PAGE 6-22; aka "The EPA resort on secondhand smoke" TABLE 6-3. Ferrule and rule hung cancer mortality estimates by attributable ETS sources for the United States, 1985, using 11 U.S. studies (never-smokers and former smokers who have quit 5+ years)1 [column (1) "number at risk" excluded for space and given in the text] --------------------L U N G-------------- CANCER MORTALITY Smokin Exposed to (2) (3) (4) status Sex Spousal ETS Background Spousal Total Total ETS by sex i ETS ETS ETS & smoking status NS F No 410 410 1500 (NS, F) NS F Yes 620 470 1090 NS M No 320 320 500 (NS, M) PATS M Yes 100 80 180 FS F No 60 60 430 (FS, F) FS F Yes 210 160 370 FS M No 280 280 630 (FS, ) FS M Yes 200 150 350 Total 2,200 860 3,060 3,060 (71.9) (28.1) 1 Percentage of f total EIS- adribulable lung cancer deaths (3,060) in parentheses. 2 AS = never-smokers; FS =former sneers who have quit 5+ years ago. "Background' exposure is defined as, "the incremental increase in risk above the baseline in all never-smokers from exposwe to non-spousal sources of ETS, pp. 6-10, 6-12. "Spousal" I exposure is defined as "the additional incremental risk [above background] in never-smokers exposed to spousal smoking," p 6-12. ;r~4 Matn - 1992 E.P. A. Report By the Numbers Yes Let's Look at Those Inhalation Anthrax Victims I P, A, R I E - ru" ' " ()r R T BE' Y T H E N The EPA stated "ETS is a human lung carcinogen responsible for approximately 3,000 lung cancer deaths annually in the U.S. nonsmokers." The relative risk that they use is 1.19 The report was published in 1992. Most of the work was done in 1991, and the latest figures that they would have had to work from were from 1990. Checking the figures: Smoking status rates (from NHSDA, 1990) Male Fertile Current smokers 28.4% 22.8% Former smokers 30.3% 19.5% Never smokers 41.3% 57.7% Population (from U.S. Census, 1990) 94,755,000 102,292,000 Calculate numbers Current smokers 26,910,420 23,322,576 Former smokers 28,710,765 19,946,940 Never smokers 39,133,815 59,022,484 Lung cancer deaths (Age 35, 1990, from CDC) 91,685 52,064 Relative risks for lung cancer (From CDC SAMMEC 11) Current Smokers 22.4 11.9 Former Smokers 9.4 4.7 4-FA Matti rake L vi v Never Smokers 1.0 1.0 The fundamental equation for calculating lung cancer deaths from risks is: NumDeaths = EaseRate * NueverSmokers + EaseRate * RelativeRisk(Former) * NumFormerSmokers + EaseRate * RelativeRisk(Current) ' NumCurrentSmokers We have everything for the above equation except the base rate. Manipulating the equation algebraically results in: EaseRate = NumDeaths / (NumNeverSmokers + RelativeRisk(Former) * NumFormerSmokers + RelativeRisk(Current) * NumCu rentSmokers) Filling in the figures and calculating results in: Ease hate 0.000100553 0.000120991 We can now calculate the expected number of lung cancer deaths by gender and smoking status Malc Female Current smokers 60,613 33,580 Former smokers 27,137 11,343 Never smokers 3,935 7,141 In the EPA's claim, does "non-smoker" mean "never-smoker" or "never-smoker AND former smoker". First, we can calculate the "new" lung cancer death base rate by the equation: EPAEaseRate = (Lung Cancer Deaths - 3000) / Total population. If "non-smoker" means "never-smoker", then that rate becomes: EPAEaseRate = ((3,935+7,141)-3000) / (39,133,815+59,022,484) = 8,076 / 98,156,299 = 0.00008227694 Since: Lung Cancer Deaths = EPAEaseRatte * Unexposed Population + EPAEaseRate * Relative Risk * (Total Population - Unexposed Population) we can manipulate the equation to give us the Unexposed Population: Unexposed population = (Lung Cancer Deaths - EPAEaseRate * Relative Risk Total Population)/ :rA main 1 QgG J V1 V r (EPABaseRate - EPABaseRate * Relative Risk) for "non-smoker" meaning "never smoker", the unexposed population can be calculated to be: Unexposed Population = ((3,935 + 7,141) - 0.000082276794 * 1.19 98,156,299)/ (0.000082276794 - 0.000082276794 * 1.19) = (11,076 - 9610.44) / -0.000015632 = -93,753,838 Unfortunately for the EPA, a negative figure for the unexposed population is not physically possible. Therefore, "non-smoker" does NOT mean "never-smoker" alone. It can only mean, therefore, "never-smoker" + "former-smoker". Doing the same calculations again, using "never-smoker" + "former-smoker" as "non-smoker" results in: EPABaseRate = ((27,137 + 11,343 + 3,935 + 7,141) - 3000) / (28,710,765 + 19,946,940 + 39,133,815 + 59,022,484) = 46,556 / 146,814,004 0.0003171087 Unexposed population = ((27,137 + 11,343 + 3,935 + 7,141) - 0.0003171087* 1.19 * 146,814,004)/ (0.0003171087 - 0.0003171087 * 1.19) (49,556 - 55,401.64)/ (-0.000060250) -5845.64 / -0.000060250 = 97,023,071 meaning, of course, that 97,023,071 / 146,814,004 = 66.1% of the non-smoking population is unexposed, leaving 33.9% of the non-smoking population (or 49,790,933) exposed to ETS sufficiently to produce "measurable" results. But now that we have the proportion exposed, we can calculate the base rates for each of those groups (never-smokers and forgoer-smokers) by way of the formula: Base Rate = Lung Cancer Deaths / (Unexposed population + Relative Risk * Exposed population) For never-smokers, this works out to be: Base Rate = (3,935 + 7,141) / (66.1 % * (39,133,815 + 59,022,484) + 1.19 * 33.9% * (39,133,815 + 59,022,484)) = 11,076 / 0.661 * 98,156,299 * 0.40341 * 98,156,299) = 11,076 / 98,156,299 * (0.661 + 0.40341) = 11,076 / (98,156,299 * 1.06441) = 11,076 / 104,478,546.21859 :PA Math rage,+ of o 0.00010601219 The expected number of lung cancer deaths for never-smokers, in an "ideal" world (assuming that the model used is correct), where no never-smoker was exposed to ETS, would be: 0.00010601219 * 98,156,299 =10,406 However, in that group, there were 11,076 lung cancer deaths, so we can assume (if the model is correct) that 11,076 - 10,406 = 670 lung cancer deaths of never-smokers due to the exposure to ETS annually. The number of lung cancer deaths of former-smokers due to SHS would therefore be 3000 - 670 = 2,330. But hold on just one minute, here. The relative risk ratios used by SAN MEC II were derived from studies which accounted for ALL the lung cancer deaths in each of the three groupings - never-smoker, former-smoker and current-smoker. Therefore, those 2,330 "additional" deaths of former smokers have already been co'mted. So, what the EPA is really saying is that each year, 2,330 ex-smokers die of lung cancer, then are miraculously resurrected, only to die *again* from lung cancer. The numbers have been reduced to the extent that basic algebra is all that is required to understand them. We welcome any critique pohiting out where, mathematically, this has gone wrong. But what the EPA is really sa3 ing is that each year, 2,330 ex-smokers die of lung cancer, then are miraculously resurrected, only to die *again* from ling cancer. Hell„ Christianity is based on the resurrection of ONE man, 2000 years ago, yet here we have 2,330 resurrecting each and every year. YES, - Excerpted from the NY Post, Sunday, November 11, 2001: _ ueja.com: Indepenaent assessment TOXIC TOXICOLOGY PLACING SCIENTIFIC CREDIBILITY AT RISK Review procedures and listing criteria used in the preparation of the DMHS Report on Carcinogens (RoC) September 15, 1999 Washington, D.C. Littlewood & Fennell Independent Public & health Policy Research Austin, TX Michael R. Fox, PH.D. Chemist Richland, WA Independent assessment and remarks .Littlewood & Fennell is an independent public and health policy research groin, with no ties whatsoever to industry or any government agency. 1 awn here today on any own time and at any own expense to address the clear possibility that the National Toxicology Program has actively undermined the process by which risk assessments should be conducted. NTP overlooked a substantial body of evidence showing uncertainty, vagueness, and lack of statistical support of what is and is not carcinogenic. In addition, NTP conducted its assessments in a manner reminiscent of a rubber stamp proceeding, which favored politics over science. I have included a history of our involvement with the NTP carcinogen listing process as an addendum to this paper. Briefly, we became interested in the topic of environmental tobacco smoke (or ETS) during an ongoing study of increasing rates of asthma in the U. S. Because a review of the literature indicates a negative I correlation between ETS and asthma, and because ETS is physically and chemically quite different from mainstream tobacco smoke, we were curious about NTP's decision to list ETS as a carcinogen. We requested background materials from them in order to review this listing process. It was during this review that we unearthed a number of gross scientific improprieties in both procedure and conduct by a nutter of federal agencies. NTP is simply the latest chapter in the same sad story. Since the topic of today's meeting is NTP's review process and procedure for listing substances as human carcinogens, I will limit most of my discussion to these matters. There are three areas I believe are critical to the process of listing human carcinogens, none of which are addressed by NTP: One: Inclusion of a reasonably expected real-life exposure to toxic or carcinogenic substances. Exaggerated estimates of risk can themselves be toxic; inasmuch as these exaggerated estimates of risk create confusion, misunderstanding, anxiety and, inevitably, utter disdain by the general public. We call this phenomenon Toxic Toxicology for, in the end, it does far more harm than good. Tiro: Assessment of scientific research and comments based on substance, merit and quality irrespective of source -a industry, academia or government. I contend that if you are unable to determine what is sound science without knowing the antecedents of the researcher then you are not competent to assess risk. Three: Animal studies must be put in perspective. Rats and mice are not little people. Nothing could make this more clear than Dr. Robert A. Weinberg's very recent success at finally inducing malignant transformation in human cells. As Gilbert L. Ross, M.D., Medical Director ofthe American Council on Science and Health, noted a letter to the New York Tithes this past August: Scientists induced such cancerous changes in rodents 15 years ago. The fact that it took so many years to accomplish this feat in humans illustrates how _)e a.com: independent assessment V, u differently carcinogens affect rodents than humans. Rodents are far more susceptible to cancer induction than humans. Merely because chemicals produce tumors in rodents sloes not mean that humans will be harmed. Real-life exposure levels. Each substance proposed for listing as a human carcinogen must be subjected to a careful and unbiassed process of assessment for real-life exposures. The compilers of reports from the National Academy of Sciences, the US Surgeon General, and the Environmental Protection Agency have simply inferred the presence of ETS components by proxy, based on the composition of the highly diffuse sidestream smoke from which ETS derives. Still, even CDC concludes, ETS contains higher amounts of some of the components of cigarette smoke in general only when it is obtained in its undiluted form under laboratory conditions (CDC/DHSS 1989). 1 would propose that only those chemicals preset, in significant amounts - pc&iaps 10% of the miaximum tolerated dose in rodents be considered. Independent laboratories could then conduct personal air monitoring for these chemicals tinder realistic conditions, rather than in laboratory conditions designed to exaggerate exposure risk. CDC notes that ETS is diluted in the air before it is inhaled and thus is less concentrated than ISIS (mainstream smoke). Further, on the basis of urinary cote concentrations, the NRC [19861 concluded that non- smokers exposed to ETS absorb t1w equivalent of 0.1 to 1.0 cigarettes a day. On the basis of 1985 data, NIOSTI estimates that each cigarette smoker in. the US smokes an average of about 21 cigarettes a day. Flood and urine samples analyzed for vapor phase nicotine indicate that nonsmokers exposed to ETS absorb about 1% of the tobacco combustion products absorbed by active smokers [NRC 1986: DMIS 19861. If these urine and blood samples were accurate, that would indicate that, at most. ETS would account for only 0.021 cigarette ovrer exposure to 21 cigarettes on average. In his RoC subcommittee testimom., last December, Dr. Philips reported that, based on actual personal monitoring, average ETS exposure; is as little as five to six.cigarettes per year. I would tend to think these figures more accurate than our extrapolations from NIOSH data, In the case of environmental tobacco smoke, such simple and rigorous personal air monitoring would have eliminated any possibility of listing; ETS as a carcinogen. Most ETS components are far below the sensitivity of current analytical capabilities. Of those chemicals present in ETS, only a very few can even be classified as toxins or carcinogens. Some basic physics, a bit of chemistry and a series of rather simple mathematical calculations reveal that exposure to LETS is hardly a dangerous event. Indeed, the cancer risk of ETS to a non-smoker appears to be roughly equal to the risk of becoming addicted to heroin from eating poppy seed bagels. Calculating the non-existent risks of ETS We have taken the substances for which measurements have actually been obtained - very few, of course, because it is difficult to even find these chemicals in diffise and diluted ETS. We posit a I €10m3 sealed and unventilated enclosure. For those of us who and metrically challenged, that is a room approximately 20-feet square with a 9-font ceiling cleanance. Taking the figures for ETS yields per cigarette directly from EPA, we calculated the number of cigarettes that would be required to reach the lowest published threshold for each of these substances. The results are actually quite amusing. In fact, it is difficult to imagine a situation where these threshold omits could be realized. Our chart (see Table 1) illustrates each of these substances, but let me report some notable examples. For veja.corn: tncaepenaent assessmenr ra8c j vi a Benzofa]pyrene, about which we heard so much last year, 222,000 cigarettes would be required to reach the lowest published danger threshold. For Acetone, 118,000 cigarettes would be required. At the lower end of the scale - in the case of Acetaldehyde or Hydrazine, more than 14,000 smokers would need to light up simultaneously in our little room reach a threshold limit. Toluene would require 50,000 packs of smoldering cigarettes - given 20 cigarettes per pack. For Hydroquinone only 1,250 cigarettes are required. Perhaps we could post a notice limiting this 20-foot square room to 300 rather tightly packed people smoking no more than 62 packs per hour? Of course, the moment we introduce real world factors to the room - a door, an open window or two, or a healthy level of mechanical air exchange - achieving these levels becomes even more implausible. It becomes increasingly clear to us that ETS, as well as other spurious indoor substances such as asbestos and radon, are political rather than scientific scapegoats for poorly ventilated, hermetically sealed, energy- efficient buildings; with endlessly re-circulated nd poorly filtered-air. Table 1 CALCULATED NUMBER OF CIGARETTES REQUIRE, D TO REACH A THRESHOLD LIMIT FROM ETS IN A SEALER, UNVENTILATED 100m3 ENCLOSURE AT STP ETS CAS Molecular ETS Output Threshold Thresho Cigarettes # Component Number Weight (mg/eigarette)(z) Limit (ppm) Limit Required 1 3 107.15 0.003 8.7 290,000 2-Totuidine isomers) (3) 14,255 (AcetaldelaS,de 75-07-0 .05 1.26 111 E180(4) (Acetic acid 64-19-7 1160.00 111.5 ~ (10 25 1,666 iAeetaae 67-64-158 11 500 1 1187 115,700 .05 7143-2 78.11 0.24 1 13.1(5) 11290 3enzene LJ 11 :3 l~l~enzo(al ~ ~ ® nzo JO 32-8 [252.30 110.00009 0.02 222,000 Pyrene 12.40 0.0007 0.002 0.01 1,430 Cadmium 9440-43- 11- .1 --1 11 11 J1 TCatechol 120-80-9 110.11 0.14 15 22 ,700 jl Dimet ylamin 14-40-3 145.08 0.1336 40 (7) 9.2 259555 FE-ormic id 6-4181146.0 2 0.525 15 (8) 9.4 1,790 Hydra~.ine 370 -0I-2 32.1;55 110.00009 0.01 0.013 114,444 Jjj Hy nouc - --2-- -9 110 11 0.16 0:4 2 111,250 IlMetbylamine 74-89-5 31.0 101 5 13 I1 0 111,170 Veth lebioridc 74-873 50.49 0.88 50 11103.0 Nickel 0440-02- ] - - 58.71 EO.O5 110.4 1 1140,000 )eja.com: Independent assessment page 4 of 8 Phenol 1Og-95-2 94.11 - 0.25 ~ 19 7,6 ' Polo niua 2~0 210 0.4pCi na 3pCi/1iter (10) P50,000 t9~ ]Pyridine 110-86-1 70.01 10.39 5 16 4,00 T'oluene~ lO1i-$S- 92.13 j0 35 _ 56 375 K,000,000 These calculations are not complex. They assume a 100m3 enclosed and unventilated space at Standard Temperature and Pressure. STP assturnes 24.45 = molar volume of air in liters at ST? conditions (25oC. and 760 torr). Conversion equations are as follow: (TLV in ppm)(gram mol wt of substance) (TLV in mg/rxa3)(24:45) TLV in mg/m3 = TLV in pprn 24.45 gram mol wt of substance Assessment of scientific research and comments based on substance, merit and quality irrespective of source - - industry, academia or government. The tobacco industry's interest in the basic science and epidemiology of ETS may be a vested interest, but their research should be judged on its own merits not suppressed or ignored because thee results are politically inconvenient. When scrutiny of research both during peer review and post-publication is objective and scientific it is valuable. NTP's thinly veiled hostility toward presenters minding no convincing evidence of ETS carcinogenicity is imacceptable. We found the presentations last December of varying quality, but were generally impressed with their factual and substantive nature. As we prepared our comments earlier this year on the 9th RoC subcomm'ittee's decision regarding ETS, we dug into the original risk assessment proceedings of the EPA. It became abundantly clear that the so-called independent scientific bodies were not independent at all. the integrity of research sponsored by governmental or other private organizations is rarely questioned. Ignoring the possibility that the granting agencies may have specific agendas for the research they sponsor, there are substantial pressures on scientists to publish and a well-known bias against publication of negative data. (Letter, 7AIa+M 1998; 280:1141) Rather, these groups - Scientific Advisory Boards were pressured by a wide variety of political and procedural forces to cast their weight (quite reluctantly in several cases) on the side of ETS as a carcinogen. After reviewing the NTP materials forwarded to us, as well as what source documents we could acquire during the response period, we conclude that government and institutional bias far exceeds industry bias in the issue of ETS. Biological gradient (exposure or dose-response consistently exhibited over the range of the studies) is a critical factor in establishing cause and effect. There is no clear pattern of dose/response in the majority of epidemiological studies tracking ETS and lung cancer where quantity of exposure is measured. We had determined that only 16.6% of the papers used in the EPA report included the odds ratios necessary to conduct a trend analysis. There was no correlation between dose increase and odds or risk increase across ' the range of studies. Of the 24 trend tests reported by the EPA, only 11, or 41.6% showed any cN dence of upward trend - thus 58.4% of the tests for trend were non-monotonic. Time after time we encountered actual human measurements of ETS exposure. For example: Urine cotinine _ .Jeja.LOM: IMUPCI1UMIL C6~3~JJi1aC.ali "Sv -i measurements between ETS exposed and non exposed women, which showed no difference. Or, in the matter of DNA adducts, personal air monitoring of carcinogenic polycyclic aromatic hydrocarbons (PAM showed no significant difference in DNA adduct levels between non-smokers and smokers for RSPs of <2.5 microns after controlling for exposure to ETS via urine cotinine. More recently we found that ETS- subjects had levels of carbon monoxide (CO) in expired similar to that of the non-ETS nonsmokers, and significantly lowed than the smokers (p<= 0.05), their actual exposure (>=4 hr/day) to ETS may not have been sufficient enough to have the adverse effect. While CO is not a carcinogen, it is an absolute bell cow for indoor air quality. The fact that NTP`s RoC subcommittee overlooked so much information is disturbing. It suggests extreme bias. We strongly urge that NTP's supervisory agency insist that future subcornmittees employ the services of independent specialists, untainted by bureaucratic pressure, past or potential grant seeking or advocacy/activist status. Animal studies must be part iii perspective. All substances are toxic in quantity. Many therapeutic medications are acutely toxic, but beneficial when used at a therapeutic level. Mater, oxygen, and table salt are toxic in large enough doses. The mere presence of a substance does not imply toxicity. The National Research Council and the USEPA have both recommended improvements in the risk assessment process that involve incorporating consideration of dose to the target tissue, mechanism of action, and biologically based dose-response models, including a possible threshold of dose below which effects will not occur. Testing for carcinogenicity at near-toxic doses in rodents does not provide enough information to predict the excess number of human cancers that might occur at low-dose exposures. Testing at the maximum tolerated dose (MTD) frequently can cause chronic cell killing and consequent cell replacement (a risk factor for cancer that can be limited to high doses), and ignoring this effect in risk assessment greatly exaggerates the risks. ...rodent bioassays provide little information about mechanisms of carcinogenesis and low-dose risk. ( Gold LS et al) Animal studies cited during the 9th RoC process (Witschi et al, various) used injectable concentrates of carcinogens, intense concentrations, of tobacco smoke and skin application of tobacco smoke condensate. Not only do these studies bear no relation to inhalation of ETS; they also use concentrations that are so high that nearly any substance in these concentrations could be expected to cause deleterious effects. In addition, Volume II of the NTP materials included animal study results (heavily relied upon according to the transcript) using concentrations of tobacco smoke that far exceed any exposure that humans could reasonably be expected to experience. Even theca, despite the intense concentrations of condensates Exposure to tobacco smoke had no effect on pulmonary tumor incidence or tumor multiplicity. Vol. H (p 47). Animal studies can be useful in identifying gross cause and effect relationships between substances and animal cancers. They should play only a minor role in the assessment of carcinogenicity in humans. The close makes the poison A basic tenet in toxicology is the dose makes the poison. Cooking food generates thousands of chemicals. There are over 1,000 chemicals reported in a cup of coffee - 19 of them are rodent carcinogens, but this does not mean. that coffee is dangerous. At some level, every chemical becomes toxic, but there are levels below which no adverse health effects are observed. )e)a.com: independent assessment rag o v Ul a In addition, cancer is largely a disease of aging. Carcinogenic effects on a short-lived species such as rodents can hardly be expected to offer realistic estimates for effects a long-Paved species such as human. High dose animal cancer testing; and exaggerated risk assessment cannot be considered measures of true risks. Data on high doses in rodents simply cannot be extrapolated to low doses in humaw without information on the precise mechanism ofmutagenesis or carcinogenesis. Indeed, the carcinogenic mechanisms of tobacco smoking are not well understood. What is more, cancers once associated with smoking are being quietly removed from the official lists. Stomach cancer - which is likely caused by undetected H. pylori, is one example; cervical cancer - in which fresh evidence suggests that human papillornavirus (I. V) may b~ the sole cause should soon meet the saw fate. How many hundreds of millions of dollars are being wasted on senseless, useless - and quite possibly harmful dame ETTS research? How anucl ; time and talent is being diverted from used research into chronic infectiom from bacteria-and viruses that are major causes of cancer worldwide? Hour many more absurd risk alerts v,i l it take before the public: hmghs scienti4-i out of a position of trust altogether? Even the best of epidemiological studies conclude only a very slight and easily confounded risk for lifetime exposure to ETS. Clearly NTP is not able to distinguish a caner risk for the occasional exposures most of us experience during our daily activities. And Just as clearly NTP must incorporate truly scientific standards and procedures before its reports deserve to be given even marginal credence. A history of our involvement Earlier this year, we undertook a. re-hew of the National Toxicology Program's 9th Report on Carcinogens regarding Environmental Tobacco Smoke (ETS). Our interest in ETS is an outgrowth of an ongoing project involving increased asthma rates in the U.S. What we have found is an negative correlation - smoking rates and exposure to ETS havee markedly decreased while the incidence of asthma has dramatically increased. Unconvincing background materiels. We were somewhat surprised at the background materials we received from NTP. With the exception of one study, (Eofetta et al., which showed a tiny and easily confounded 1.14 RR for lung cancer and ETS and no consistent dose-response trend) there was nothing new. The two volumes we received consisted almost exclusively of the same inadequate and tortured data used by the USEPA and CaIEPA to reach the conclusion that a lifetime of exposure to ETS confers only a statistically marginal correlation with increased risk of lung cancer. As you know, such tiny expressions of risk. are easily confounded by myriad variables. The single animal study presented, the words of its own authors (Witschi et al), may not serve as a valid model to assess carcinogenicity in human. RoC meeting transept After expressing our disappointment with these background materials, we received a verbatim transcript of the RoC subcommittee's discussion on ETS's possible listing as a human carcinogen. This was a most illuminating document. It included several informative and sound presentations from outside researchers who had made direct air measurements of ETS exposure, analyzed a variety of animal studies and assessed the raw data from several significant studies upon. which the USEPA bald its decision on ETS. This complete transcript is markedly different from the publicly posted, abridged version of the meeting available at the NTP website which completely conceals any of the twisted reasoning and political maneuvering that actually took place and ignores nearly every salient point made by the outside presenters. I will be happy to provide a -in3a.com. tndepenatent assessment 1 "r"- / Vl copy of the entire transcript to anyone who is interested in the contorted and illogical process by which the subcommittee reached its questionable conclusions. Unwarranted bias luring the actual meeting, subcommittee members routinely ignored convincing, well-documented presentations by outside sources - making it abundantly clear that current or past associations with industry rendered these presentations null. Several of these same subcommittee members then proceeded to base their final vote on a rather bizarre suggestion by a self avowed anti-smoker activist (Repace) who proposed that a hypothetically pure control group be used to assess exposures. This is an appalling suggestion to those of us who understand quite clearly that case and control groups should be as alike as possible except for specific exposure to the substance being studied. One subcommittee member went so far as to say that she was comforted by this suggestion since it enabled her to vote on ETS as a carcinogen despite the fact that relative risks in this for ETS were (from her perspective) quite low. Another sub-committee member stated that he hoped when we get to diesel we will get the same generous interpretation of epidemiology enjoyed by the ETS-as-carcinogen faction. This is science? No. It is politics. And it is insupportable, unacceptable - and, quite possibly, legally actionable. Bias and a priori conclusions are not sound science in our public comments, we raised several substantive issues and found serious faults not only in the data used to reach a decision, but also with the decision making process itself. I would be pleased to provide copies of this document as well. We concluded that: It is the result of our careful review of the NTP process regarding ETS that brings me here today - at my own time and expense. Dr. Michael R. Fox, a nationally recognized and highly respected chemist, generously assisted me in establishing and verifying real-fife exposure levels for various components of ETS. I sincerely wish he were able to join us today to express his own concerns about NTP°s risk assessment process. Inadequate ventilation, not ETS, is the danger We find continuing evidence that energy-efficient building techniques and increasingly limited ventilation - not ETS - adversely iuence asthma and other upper respiratory problems - especially in children. There is an old maxim in the engineering world: The solution to pollution is dilution. Yet building ventilation rates continue to decrease replaced by inadequate filtering and re-filtering systems and exposing and re-exposing us via re-circulated, undiluted air to contaminants strongly associated with asthma and allergies: bacteria, fungi, viruses, algae, amoebae, dust mite and cockroach feces, pollen, etc. Since ventilation rate recommendations for buildings accommodating snookers are high enough to promote dilution of all indoor air contamhmts, we have been quite careful in our assessment of risks presented by ETS. Our conclusions may be politically incorrect, but they are scientifically sound: ETS poses little if any risk to non-smokers, Indeed, it is entirely possible that buildings ventilated to a level to comfortably accommodate smokers would promote higher indoor air quality overall. Technology, not toxic toxicology, is the solution Father than desperately attempting to sustain the myth that ETS is some mysteriously lethal substance, we urge an honest, open-minded loop at real risk factors and real solutions for respiratory health. Rather than accepting the incremental lowering of ventilation rates for indoor air, we would insist that energy efficiency take a bank seat to respiratory health. L)cj&com.: inaepenaem assessment rugc U V1 o If buildings were designed to accommodate smokers, air quality would inevitably improve for us all, since fresh air exchanges would be increased and biocon is such as bacteria, fungi, viruses, algae, amoebae, dust mite and cockroach feces, porn, would be diluted. Potential toxins from building materials, office chemicals, cleansers, cooping, etc. could be exhausted rather than inadequately filtered and re-eirculated. NTPs Investment in Toxic Toxicology The National Toxicology Program has become a willing and enthusiastic participant in the disturbing trend toward Toxic Toxicology. In doing so, it undermines scientific credibility and contributes to the increasing skepticism and disdain with which the public views science in general and health wan ings in particular. NTP does so by implying that even the tiniest exposure to toxic or carcinogenic substances somehow constitutes a life threateningrisk. This is patently absurd - contravening a basic tenet of toxicoloogy: the dose makes the poison. Animal cancer tests and. worst-case risk assessment should not be considered true risks. And regulatory policy aimed at reducing minute exposures to rodent carcinogens confuses and -amrcessarily alarms the public about what factors are truly important for preventing cancers. Data torturing of epidemiological studies concerns the many responsible scientists and public health researchers who work honestly, openly and willingly in the service of sound science. We are seem an enormous diversion of funds and talent from truly important health risks - and the real possibility that anxiety raised by false health scares is in itself a risk factor. Thus the term Toxic Toxicology. It is obvious that by straining at greats, exaggerating risks and supporting researchers who are willing to do the same, the National Toxicology Program perpetuates its own existence. There is certainly nothing new about this type of metastasmng bureauer y and empire building. What is new, is the public's increasing tendency to ignore this sound-bite science. timing labels have become subjects of comics and late-night Wk show hosts. Editorial cartoons poke fun at the Health Scare of the Day. Yet irresponsible risk assessment continues to be a growth industry. It is time to call a halt. The financial and social costs of biassed risk assessment are receiving increased scrutiny at both the Federal and State level. The ?pen Science Freedom of I orrnation Act - making data om Federally funded studies available for independent review - is a good start. It should be followed immediately by GAO investigation of the shoddy standards and political pressures that have undermined the integrity of our nations with research pro . http.//ehis.niehs.pih goy/roc/toc9.html Ninth Report of Carcinogens _ 51'5 - A Summary of the aClentliC Llte'atUre ragc 1 V1 J P 5 V k f9' 3 0 J$° 1 Tr a A O... SM_ A SUMMARY OF THE SCIENTIFIC LITERATURE The scientific evidence, taken as a whole, does not demonstrate that other people's smoke - known as "environmental tobacco smoke" or "ETS" - is a cause of disease in non-smokers. ETS can be, of course, an annoyance - to smokers as well as non-smokers - especially if there is inadequate ventilation. This has increasingly prompted calls for smoking bans or severe restrictions. Solutions that address the rights of one group at the expense of another cause hostility and resentment. Policies based on accommodating smokers and non-smokers alike will have more support and lead to greater harmony in workplaces, hotels, restaurants and other places where people gather. In a number of countries, discrimination against smokers has increased substantially during the past several years. Much of this discrimination results from claims by anti- smoking activists, and some public health officials and scientists, that ETS causes disease in non-smokers. I Articles appearing in the popular press over the past fifteen years would convey the impression that there is little doubt about the purported; health implications of exposure to ETS. Studies that can be construed, generally without critical analysis, to indict ETS tend to be covered extensively in the press, whereas studies that suggest a lack of an association between ETS and non-smoker health problems are generally ignored. Smelling smoke is not the same thing as smoking a cigarette. ETS is not the same in chemical or physical properties as the mainstream tobacco smoke to which active smokers are exposed. Active smokers and ETS exposed non-smokers also differ, not only in their level of exposure, but in their route and manner of exposure. Consequently, conclusions concerning possible health effects of ETS should be based on studies of actual ET'S exposure, not on studies of smoking. Scientists have recently measured exposures to ETS in eight European and four Pacific cities for more than 2,500 non-smoking volunteers using personal monitoring over 24 hour periods. To give a perspective on the actual levels of exposure of non- smokers to E'T'S, they calculated the annualised median ETS exposure expressed as cigarette equivalents (CE) for non-smoking subjects working with smokers. The CEs ranged from 0.2 in Sydney, 1.4 in Prague to 4.3 in Barcelona. ;'1 The most publicised health claim about ETS is that it causes lung cancer in non- 'TS - A Summary of the 6ceentatc Literature raga z. V& smokers. In total, more than 40 epidemiological (statistical) steadies of ETS and lung cancer have now been published. Most of these steadies compare lung cancer rates in non-smoking spouses married to smokers, to lung cancer rates in non-smoking spouses of non-smokers. Any difference in lung cancer risk in the group of non- smokers married to smokers generally has been considered by the authors of these steadies to be a result of their exposure to ETS, although rather authors have challenged this assumption. Of the published studies, about i reported no overall statistically significant association between marriage to a smoker and development of lung cancer. More important than the lack of statistical significance is the fact that the vast majority of these studies, and all of the large, well-conducted studies, reported either a very weak apparent association or even a negative association between ETS exposure and lung cancer. These results, therefore, could have easily resulted from "systematic biases" present in virtually all epidemiological steadies. Although fewer studies have peen published that focus on exposure to ETS in the workplace, rather than in the horno, about 80% of these studies as well have reported no overall statisticalt^y significant association between this exposure and lung cancer. And, as noted above, virtually all report very weak associations. A 1992 report by the Environmental Protection Agency (EPA) examined the epidemiological data and produced a risk assessment for the United States. For reasons that are difficult to explain, the EPA: firstly, did not take account of the results of two relevant epidemiological studies, one of which was then the largest ever conducted on the subject and which had received funding from the National Cancer Institute in the USA, and: secondly, altered their standards for statistical significance, lowering the 95% significance level to 90%, doubling the likelihood of finding an increase in the risk as a result of chance. The methods used by the EPA in reviewing studies of ETS have been called into question by the S Congressional Research Service (CRS),; a non-partisan official body. it queried the EPA's departure from the conventional standard for statistical significance saying: "it is unusual to return to a study after the fact, looser the required significance level, and declare its results to be supportive rather than unsupportive of the effect ones theory suggests should be present The CRS concluded that the CPA's finding on hang cancer was "uncertain" and this point has been reiterated in its latest report (1995), which re-examined all of the data. Because of the inevitable lack of precision in epidemiological studies, these results cannot be interpreted as being meaningful. particular. importance is the fact that factors known to be associated with hang cancer and erasure to ETS received woefully inadequate attention, and no monitoring of ETSexposure was attempted. Attempts to estimate numbers of deaths claimed to be attributed to ETS on the basis of the existing evidence have been criticised. For example, the EPA included an estimate of annual U.S. lung, cancer deaths claimed to be attributed to ETS in its 1992 risk assessment, despite being cautioned by its own Science Advisory Board that the calculation was based on flawed studies. In sum, the scientific evidence does not support the claim that ETS ceases lung cancer in none-smokers. Recently, a US district court vacated that portion of the EPA risk assessment dealing with TS exposure and lung cancer'. Although the judge's decision was based primarily on the EPA's failure to include all interested parties in the conduct of the risk assessment, these procedural grounds alone would not have been sufficient to vacate had the judge not been able to demonstrate issues with the risk assessment :l.s - A Summary of Me Nciemiic -LITeraiure Nevertheless, it would be prudent to suggest that adults should limit smoking around very young children, if for no other reason than that they are unable to communicate possible discomfort. i Although some non-smokers find smoky atmospheres uncomfortable, it is wrong to confuse annoyance with health effects. In recent studies of adult asthmatics, short term ETS exposure did: not result in airway obstruction or changes in bronchial responsiveness. Even long-term exposure to very high levels of IaTS failed to elicit an attack in about 8 of adult asthmatics. For some people; moreover, the very sight and smell of tobacco smoke are a cue for coughing. It is worth noting that respiratory problems among children, notably asthma, are becoming more prevalent in developing countries even as fmoldn rates among adults decline. When researchers have looked at the effect:- of :E TS in experimental rooms on asthmatic adults and children, the results reported have been inconsistent. Lastly, it is extremely important to note that there is no convincing evidence that ETS exposure can cause asthma, in previously non-asthmatic persons. Almost all national authorities in the UK, US, the Netherlands, Norway, Australia and Canada in their reviews have not concluded that ET'S exposure causes heart disease. However, several scientific articles have recently appeared that suggest that there I may be an association between E'TS exposure and heart disease. Not only are such claims, once again, based on speak reported associations, but they have excluded published results from three large studies, including one reporting on over 19,E cardiovascular deaths, that show no increased risk of heart disease whatsoever. Many of the studies fail to consider possible confounding factors, such as diet and lifestyle, believed to differ between smoking and non-smoking households, which in themselves may explain the ciaimed effects. For example, it has been reported that non-smokers living with smokers have a diet higher in fat: and lower in fresh fruits and vegetables, which is a risk factor for hurt disease. Over 300 different risk factors have been reported for heart disease. In seem, the studies that have addressed S and heart disease are, at most, inconclusive. As a whole, the epidemiology does not demonstrate that exposure to ETS increases the risk of heart disease in son-smokers. 1. Pews vAre coverage of Judge ®steen's Decision regarding the ETS Risk Assessment concerning the railing of the US District Court for the Middle District of North Carolina in the EPA lawsuit, July 1998. 2. Boffetta P et at Multicenter Case-Control Study of Exposure to Environmental Tobacco Smoke and Lung Cancel- in Europe JNC1 90 1440-1450 1998. 3. News wire coverage of the Multicenter Case-Control Study in France, Germany, Greece, Italy, Portugal, Spain and United Kingdom. I S 1~ - A ~Wmmary oI ine 3uivinnt; JALU LULU i ug., -Y vl ~ itself. To cite a single example from the decision: "EPA Is study selection criteria is disturbing First, there is evidence that the EPA 'cherey picked' its data Second, EPA's excluding nearly half of the available studies directly conflicts with EPA's purported purpose for analysing the epidemiological studies and conflicts moth EPA's Risk Assessment Guidelines. " More recently, the International Agency for Research on Cancer (IARC) has published the findings of it's large European multi-centre case-control study of ETS exposure and lung cancer z, 3. This has been one of the largest.and best conducted of all the epidemiological studies on the subject to date. It reported an extremely weak, not statistically significant, association between spousal or workplace ETS exposure and lung cancer. No association was reported between exposure to ETS during- childhood or in social situations and lung cancer in non-smokers. Furthermore, there is clear evidence from the data reported by 1ARC that much, if not all, of the association reported could be explained by systematic biases in the data collected. The possible impact of ETS on respiratory disease, other than lung cancer, in adults has been considered even by the US Surgeon General and by the US National Academy of Sciences to remain an open question. The few studies that have been published on this issue do not demonstrate that ETS is a cause of respiratory disease in adult non-smokers. No claim regarding ETS is as capable of provoking strong feelings as the charge that parents who smoke may harm the health of their children. While, the issue of parental smoking is laden with emotion - the scientific evidence is difficult to interpret. Although an association with respiratory illness has been reported in pre-school children, no consistent association has been found in older children. Arguably the pre-school association could be due to many other factors that may be statistically associated with both ETS exposure and respiratory illness. These factors could include household overcrowding, attendance at day-care centres (leading to cross- infection), damp and mouldy housing, the quality of parental care, poor diet and even bottle feeding. As noted above, the association weakens with age and is not consistently found among older children, which adds to the uncertainty of its meaning. Because of the exceptional difficulties in taking confounding factors into account, such studies cannot support an inference of causality. As the EPA acknowledged, studies have been unable to distinguish possible effects of maternal smoking in pregnancy and post-natal ETS exposure on the incidence of cot death. Numerous factors which may increase the risk of cot death have been identified. These include not being immunised, being bottle-fed, sleeping in a warms room or on a soft mattress, recent illness, and sleeping in the prone position. Thus the epidemiological data can be extremely misleading. Considered in their entirety, the data do not support an inference of causality. Attempts to attribute a number of cot deaths to ETS exposure are, therefore, no more than speculation. A THE EPA ETS FRAUD THE WORLD HAS BEEN CHESTED Y T( ANTI- TOBACCO CARTEL THE A Mere is the whole US Federal Court decision. This decision makes liars of all those "professionals" who have exposed themselves by stating that ETS hurts children and adults. It severely questions the integrity of our institutions, and those ministries and department of health who have promoted smoking leans, and manipulated time public opinion into the perception that "emoker^s are killers". It accuses politicians, health activists, certain doctors, and whoever else has engaged In the persecution of smokers of being corrupted. The anti-smoking cartel has been officially stamped with the truth. But this will not deter It from proceeding with its agenda of repression and deceit. In fact, the cartel has already announced that this decision will not alter its agenda. When exposed for what it is, the cartel show no modesty, but it even accelerates the suppression of liberties and its criminal promotion of deceit for as tong as it is not stopped by the force of those who are the oppressed. THE TEXT THE DECISION T U FEDERAL COURT _T . T CONCLUSIONS THE EPA "'EPA publicly committed to a conclusion before research has begun; excluded industry by violating the [Radon) Act's procedural requirements; adjusted established procedure and scientific norms to validate the agencies public conclusion, and aggressively used the Act's authority to disseminate findings to establish a de facto regulatory scheme intended to restrict Plaintiffs products and to influence public opinion"' "The Court is faced YAth the ugly possibility that EPA adopted a methodology for each chapter, without explanation, based o the outcome sought in that chapter" "The Court is disturbed that EPA and Kenneth Brown [one of the EPA report's authors] buttress the bioplausibility theory with epidemiological studies. EPA's theory must be independently plausible5' JUDGE 0STEENS ORDER Judge Osteen granted aintifrs (the tobacco industry's) motion for partial summary judgement, ordering that Chapter 1 to Chapter 6 and appendices in the A"s 'Respiratory Health c o Passive Smoking., Lung Cancer and Other Disorders-, " (December 1992), vacated. According to Black's Law, Fourth Edition, the terns " vacated°' means: To annul to set aside to cancel or rescind; to render an act voids as, vacate an entry or words or a judgement. In layman's terms, Chapters 1 to 6 and appendices to that 1992 EPA MkI. secondhand smoke report no _ Ion -exist. `h sf °e, the follo g conclusions, as taken verbatim from Chip er 1, page 1, of the report, do not 4 nd must be_ sMgardeda ex! THE US THE EPA STATED: FEDERAL ("1.1 Major Conclusions:") COURT LED: 713ased on the weight of the available scientific evidence, the U.S, Environmental Protection Agency (EPA) has concluded that the VACATED widespread exposure to environmental tobacco smoke (E TS) presents a serious and substantial public health impact." in acfu : 'S Is a human lung carcinogen responsible for approximately 3,000 lung cancer deaths annually in the U.S. VACATED nons€noksrs.~ Cents courtesy of Abw an K%ono > BACK TO FORCES MAIN PAGE < _ Judge ste ' using on the Tobacco Industry's EPA Lawsuit: Summary and Practical Implications Background On July 17, 1993, U.S. District Judge William Csteen (Middle District of North Carolina) issued a summary judgment in the tobacco industry's 1993 challenge to the EPA's report, entitled "Respiratory Health Effects of Massive Smoking: Lung Cancer and Other Disorder." 1. The Court vacated (Invalidated) every part of the 1993 EFTA ETS (Environmental Tobacco Smoke) Risk Assessment dealing with lung cancer (Chapters 1-6 and the Appendices). 2. The Court granted the industry's motion to move forward on a supplemental pleading claiming the EPA has had improper influence on various organizations that have the power to regulate or influence regulations concerning cigarette smoking. The Court's ruling highlighted numerous errors in the scientific process, as well as procedural failings. The Court noted (p. 91): 1. "EPA's conduct of the TS Risk Assessment frustrated the clear Congressional policy underlying the Radon Research Act [the statute EPA cited as authority for its Risk Assessment]." 2. "I=PA also failed the Act's procedural requirements." i Chapters 7-3 of the Disk Assessment, which deal with effects other than lung cancer, were not challenged by the industry primarily because these chapters did not form the basis for the regulatory efforts to bare smoking that have taken place throughout the country as a result of the EPA's incorrect and now invalid classification of secondhand smoke as a known human carcinogen. Court Findings A Federal Court has ruled that the EPA wrongly classified secondhand smoke as a Croup A (known human) carcinogen. Contrary to statements by the EPA Administrator, the Court's ruling was not merely procedural. Among other things, the Court found (pp. 39-90) that EPA: "publicly committed to a conclusion before research had begun" "adjusted established procedure and scientific norms to validate the Agency's public conclusion" "aggressively utilized the Act's authority to disseminate findings to establish a de facto regulatory scheme intended to restrict Plaintiffs products and to influence public opinion" "disregarded information and made findings on selective information" "failed to disclose important findings and reasoning" i . left significant questions without answers" • "did not disseminate significant epidemiologic information" "excluded industry by violating the [Radon] Acts procedural requirements" • "deviated from its Risk Assessment Guidelines" The Court noted as "particularly relevant" the fact that the EPA's own internal risk assessment experts had told the agency that the Risk Assessment did not support a Group A classification (p.64): "EPA's Disk Criteria Office, a group of EPA risk assessment experts, concluded that EPA failed to reasonably explain how all relevant data on ET S, evaluated according to EPA Risk Assessment Guidelines' causality criteria, can support a Groin A classification." The Court concluded that: "EPA produced limited evidence, Chem claimed the viteight of the Agency's r. search evidence demonstrated TS causes cancer." Butt Line It may be politically correct to attack secondhand smoke, but it is not scientifically correct nor, in the Court's opinion, legally correct. The Court's ruling clearly confirms that: EPA deliberately misted the Americana public about the science concerning secondhand smoke. EPA was guilty of major scientific and procedural errors in preparing its Risk Assessment. * EPA cherrypicked information, changed the standards of scientific inquiry and tortured the data to reach a predetermined conclusion. : EPA abused its power and authority in an effort to force regulation on secondhand smoke when the scientific basis for the EPA's claims simply did not exist. 7/23/98 rccal 111caos 1. While it is unlikely that there will be a rush to overturn smoking bans and restrictions currently in place, this ruling raises serious questions about whether there is a legitimate basis for severe and overly restrictive smoking regulations. 2. Any legislative body currently considering smoking regulations cannot rely on EPA's now invalid claim that secondhand smoke is a known human carcinogen. 3. This ruling should create a new environment to foster the development of practical and reasonable solutions that accommodate the preferences of smokers and nonsmokers alike. 7/23/98 Economic Iact of Smoking Bans I Anchorage, Alaska.- "Village Inn waitresses said tips are down significantly, from $100 a day to $30." Anchorage Daily News, January 11, 2001 "There's always a table free now at Son of Fiver City Billiards. Business is down 70 percent, and the reaper of dead dreams is chalking his cue. The small corner pool hall at Fireweed Lane and Denali Street is failing fast because of the city's new smoking ban. Guess what, says owner Dent Andersson, pool players like to smoke. So his customers are drifting off to the one billiards parlor in town that has a smoking exemption. Or maybe they're racking balls in someone's basement. Who knows?" Anchorage Daily News, April 18, 2001 "So Hot Shots is taking down the no-smoking signs and setting out the ashtrays. Starting Saturday, it's declaring itself a private, members-only billiards club where smokers will be welcome. °I'hey play pool. They smoke. The two seem to go together,' said owner Jim Foss. His efforts to lure nonsmokers with family deals, a new menu, guys' nights, girls' nights and other discounts haven't made up for the smokers he lost when the city smoking ban took effect Dec. 31. He estimated business is down by one-third." Anchorage Daily News, May 31, 2001 J Mesq, Arizoncr "[Patricia] Payne is one of the customers who stuck by [Bob] Jobin when he adhered to the ban for four months. Jobin says he lost $75,000 and came close to closing the restaurant he had owned since 1953. He says smokers abandoned his place to go to restaurants in adjacent cities where smoking was allowed. The nonsmoking customers followed their friends. Loyalists such as Payne had to take their iced tea or coffee outside, where they could legally light up. At first, Jobin tried to get around the ordinance by saying the ?Marquee was a private club, issuing membership cards for 10 cents a year. But the city didn't go for it and fined him $370. He gave in after he says he was threatened with a $2,500 fine and six months in jail. "Because Jobin was able to prove he lost more than 15 percent of his business during those smokeless months, he received the hardship exemption. The smokers were allowed to return, and a sign on the front door now greets them, announcing in 3-inch-high block letters: This is a smoking establishment, and does not provide a nonsmoking area.' The sign also forbids people younger than 18 to enter without an adult. `I believe in freedom, right and choice, and that's what I was fighting for,' Jobin says." Washington Post, February 19, 2001 0 Tucson, Artzonce "Jeff Short, owner of Chad's Steakhouse, said some of his regulars switched to bars and restaurants in the Catalina foothills after the no-smoking ordinance went into effect. He said he had two cancellations of Christmas banquets because of the smoking restriction. `As far as my lounge, it's killed it,' he said of the ban. 'T own this place, and I should be able to run it the way I want to. ' Tucson Citizen, January 12, 2000 ~I ca ,fora : "According to the California Licensed Beverage Association, business has dropped as much as 85 percent at many California bars since the prohibition took effect." 'The Daily News of Los Angeles, January 30, 1998. Excerpt reprinted in PR Newswire, February 26, 1998 Anahein4 Ca4fornbw "`I do not smoke; however, I have tended bar for several years and have already seen a dramatic decrease in business since the ban went into effect. if businesses are forced to close, expect unemployment benefits and welfare rates to rise. My advice is: If you can't stared the smoke, stay the hell out of the bar.'" Stacy Kersten, Anaheim. Tfae Orate Coaz= Re er, Januazy 9, 1998 Antelope Valley., CaRfornim -Lawson [Claudia Lawson of Claudia's Bar and Grill] said business at her Palmdale Boulevard bar has dropped 35 percent since the law tools effect." The Daft Nof I&s AYaal elea, January 30, 1998. Excerpt reprinted in PR iVe e, February 26, 1998 ] Burbank, l o .ft "Proprietor Many Georges said lie doesn't knom, hour much longer he can keep doors opera at his Middle Beast Connection restaurant and nightclub Burbank. George said receipts have &-oil ed 50 percent at the Burbank Boulc and night stop." The Pgfl f l1e oY I -s _eles, j .nary 30, 1998. Excerpt reprinted in PR L.Te,,.°a~'irf-, February 26, 1998 C o i4' Sue Cole, a bartender at Jan's Lounge Citrus Heights, does not smoke, but she opposes the Ian% `Our business is dropping, and. I'm a little bit afraid I'm going to be out of a job,' she said." The Sacramento Vie, January 28, 1998. Excerpt reprinted in PR NgM s®dsre, February 26, 1998 7 Davt&~ l for° : "In the city of Davis, which in 1993 became one of the first cities in the nation to enact a barn, operators saw clear signs of lost business. Scott Rea, general; manager of the paragon. bar and restaurant, explains, 'it threw e off about 200 o, and there was some f bung.' Restaur at Pusine , February 1, 1998. Excerpt reprinted in FR Newswire, February 26, 1998 3 Huntington Beach, for k: "'I'm a bar owner Huntington Beach, and I'm hurting. My daily totals used to be $x€500. Yesterday, it was $135. On Tuesday, it was $137. Saturday night I had $81 receipts. I've already lost three employees. Once the franchise tax board loses my tax income, they'll change their minds. A lot of people won't come in if they can't smoke and drink. If they step outside, they could be cited for drinking in public or for loitenng, and my insurance won't cover my liability outside the bar. It looks like my other business will be paying my mortgage on this one for a. while.' Janelle Sims, owner of The Filling Post, Huntington Beach. "I'm a bartender. I used to take home $50 a might in tips. Now I'm leaving with $18. I'm a single moan. I don`t smoke, and I don't care if you do. Bartenders make $5.25 an hour. Most of your income lake three-quarters comes from tips. There are four people the bar right now; we used to have 20 or 30. If this is meant to protect us, we don't need it.' Shelly Pettijohn, Huntington Beach.- The QKa~np oUa ,Iter, January 9, 1998 mom CalVornta: "This law makes me very nervous. Ninety percent of our customers that drink also smoke. 'T`his is more of a rights issue than a smoking issue.' (quote from Donna McClung, co-owner of Dan's Place in Moss Beach, where McClung estimated business is down about 30 percent.' Half Moore Review, January -28, 1998. Excerpt reprinted in PR N , February 26, 1998 -3- mean Beach, California: "`My sales were off 34 percent last year, my worst year in 15," said Mark Gorski, who owns Bullfrogs in Ocean Beach. ...Gorski said he was forced to close i early on many nights last year, only to see many of his former customers at a nearby tavern that had a large, open patio. Gorski said his sales rebounded only after Bullfrogs also added a patio." Copley News Service, November 6, 1999 3 ore County, California: "The smokers support any business that allows smoking,' said Anne Marie Neiss, owner of Aloha Family Billiards in Buena Park. She said her business has plunged 65 percent in the two years she hasn't allowed smoking." Orange Coun Register, September 5, 2001 J hole, f alifornice -'It's running people out of here,' said. [Terry] Schaner, a bartender for 13 years at the Antlers. `It's probably cost me about $150, $200 a week in tips,' he said about half of his income." The saes, February 2, 1998. Excerpt reprinted in PR Newswire, February 26, 1998 a San Diego, California: "`Although I [Mark Gorski] cannot speak for restaurant-only sales under California's smoke-free program, I can assure The Post's readers that `stand-alone' bar sales throughout California have been decimated. On average, sales at the local bars, taverns and pubs have dropped nearly 30 percent since the enactment of the ban. I have talked to literally thousands of owners and employees who have sales and income losses as high as 95 percent. Thousands of employees have had their hours cut, and hundreds have lost their jobs because of the loss of the smoking customers who form a majority of their customer base. (Last year, my establishment suffered its worst performance in 15 years). As for the `huge influx of non-smoking customers' who were supposed to flock to our establishments after the ban well, it never happened. We are attempting to regain our smoking clientele by introducing a bill that would allow bars and taverns, not restaurants, to permit smoking in designated areas wherein the latest air filtration systems are in use." The Washington Post, July 20, 1999 "Srnoke-free California Pubs Still Waiting for `Hordes"by Mark Gorski, owner, Bullfrogs; President, Food & Beverage Association of San Diego, California: "As usual, the anti-tobacco folks continue to paint a rosy picture in California with regard to the total smoking ban in bars and restaurants. "Cries of `it hasn't hurt business' can be heard emanating from every orifice. Unfortunately, the truth is that the smoking ban, at least when it comes to bars and pubs, has been a total disaster for both employees and owners. Sales losses average 25-40 percent in those taverns enforcing the ban. Employees complain of dramatically lower tips while also having their hours cut because of the huge loss of business. Don't let anyone tell you that 'hordes of non- smokers will flock to your bars' after you go smoke free. It's been three years now here in California and we're still waiting, that is those of us who haven't gone bankrupt." Edmonton Journal, December 23, 2000 "For small, corner bars, business has been drastically reduced because of the new law, the owners claim....The bartender at Fee's Sports Tavern in Escondido shoots you a look when you mention the new law. 'Tips have fallen off big tine,' she said, `even though the bar has put in an outside patio for smokers.' -4- ] San pmncisco, Cag/orniz "Patricia Breslin, Executive Director of the Golden Gate Restaurant Association San Francisco, said a surrey of the group's 500 members revealed an average of a 20 percent drop in business." The Atlanta Constitution, May 5, 1999 ] stantor4 cagfornfiv -[Richard] Oliverio (bookkeeper for a nonprofit group called the Kingsmen) has complained to the City Council about the smoking laws, saying revenue from bingo has decreased because patrons now travel to Native American bingo games where smoking is allowed. Oliverio said the lost business could force him to renege or, a promise to donate $1,000 per week to Stanton charities..." The Times, May 9, 2000 , Cali, for fe "The law sucks!' says chain.-smoking Tustin City Councilman Mike Doyle, owner of the. Revere House restaurant and bar. ...He estimates the number of bar patrons to have dropped by 25 percent. He closes earlier, so his employees have fewer hours and estimate their tips have dropped by 25 to 40 percent." The Or a Couar Register, January 29, 1998. Excerpt reprinted in PR Newswire, February 26, 1998 J Woodland Hills, California; "`I'd love to see the lam= repealed it might faring my business back,' said Craig Holman, owner of Pickwick Pub in Woodland bills, where business reportedly has dropped about 40 percent since the ban took effect January 1 [19981." Terre Pail News oaf Lis Angeles, January 30, 1998. Excerpt reprinted in PR New wwrsre, February 26, 1998 ®n e, Colorado: "The reason why these complaints sound so similar is that people are sick and tired of these restrictive laws,' Pan) Jensen (owner of Jan's Kitchen restaurant) said. Jensen has complied with the law since the election. She threatened to fire employees if they smoked in the building. The new law has `run off about 80 percent of her business, Jensen said. Many regular customers were smokers, but she was unable to snake the costly smoking section upgrades, she said." Grand Juxrction _Daily News, May 19, 2001 :1 Superior, Co: "A no-smoking ordinance is forcing the Bleachers Sports Grille to shut dowry for good on Saturday, the bar's owner said. `From day one, its been an uphill struggle,' owner Rob Schmidt said. I picked the wrong town to do business in.' Associates) Press, June 27, 2001 Z) Wayne, Ind : "`I have lost 45 percent of business,' said Steve Skallarou, owner of King Gyros Restaurant. `I am working for these people, and they are giving me nothing. I am paying taxes for my equipment. What are they giving to me? Ninety-five percent of my customers smoke. They are not coming.' Associated Press, May 30, 1999 -5- PC aayne, Indiana (continued): "`Some restaurant owners say Fort Wayne's smoking ban targeting eateries has hurt business by discouraging smokers from dining out. Revenues from Allen County's food-and-beverage tax shrunk last year for the first time since 1991, and some blame the smoking ban. 'Our business is down, you can actually see it,' said Dud Hall of the Mall's restaurant chain. `We don't have the weekend crowds like we used to. People don't come from out of town to have dinner like they did.' The 1999 ordinance bans all smoking in restaurants unless it is done inside a specially designated, enclosed area. Last year, the food and beverage tax - which collects a penny on each $1 spent on meals and drinks in Allen County - brought in about $4.14 million, down $45,979 from 1999. ...John Livengood of the Restaurant and Hospitality Association of Indiana said the tax revenue decline in Allen County might indicate more severe damage to business because restaurant sales have increased statewide." Associated Press, April 22, 2001 :1 Ames, Iowa; "Owner Lowish Bederazack, an Ames businessman [owner of Cafe Lowish] for 24 years, said in an affidavit filed Monday that he was losing more than $2,200 a month as a consequence of the [smoking ban] ordinance." Ames Tribune, October 16, 2001 Cora t Iowa City, lows; "Mondo's Tomato Pie in Coralville and Mondo's in Iowa City broke from a tiro-year stint of being smoke-free because he was losing business after smoking customers started going elsewhere, owner Jim Mondanaro said. This punches a hole in claims by smoking-ban supporters who say that restaurants that don't allow smoking do not lose money,' Mondanaro said Friday. I will not concur to that anymore,' he said. 'Ihere is a loss. There's no doubt about it. Iowa C~ Press-Citizen, July 14, 2001 :1 TopekeG Kwwas: "The restaurant operators asked how the ordinance would be enforced. They said they feared the ordinance would hurt their business. One cited an Outback Steakhouse in Fort Wayne, Ind., that lost $60,000 a month after a similar ordinance was adopted." The Topeka Capital-Journal, December 20, 2000 ZI Maine: "The Maine Restaurant Association, which tried in vain to persuade the Legislature not to enact Maine's [smoking] ban, maintains its predictions were correct. Dick Grotton, the group's executive vice president, said that while restaurant revenues show an increase, they would have been higher if the ban had not taken effect. In essence, smokers have moved to venues that stilt allow smoking,' said Grotton. The properties that had a fairly significant bar business have lost it.' Maine's law does not outlaw smoking in clubs or taverns. Three Maine restaurants were fined after trying to get around the law by claiming to be smoking clubs. Two of those restaurants have closed, but Grotton said a number of restaurants have changed hands with the enactment of the ban." Associated Press, September 18, 2000 U. Biddeford, Maine: "It was bleak for Amanda Mae's Cafe after patrons were required to snuff out their smokes: regular customers disappeared, business plummeted 40 percent and tips dried up for waitresses who needed them to feed their families." Associated Press, November 27, 1999 -6- 1 Agaumm, Ih . "Like many restaurants with bars, Alexander's still makes a large share of its money selling food. And since the ordinance went into effect Feb. 15, business at Alexander's has declined by 30 percent to 40 percent, Grasso estimated. That's why he believes the decision over whether to allow smoking in restaurants should be left up to individual restaurant owners." Union-News grad Suraday Ftepubhcan, July 6, 2000 3 Amherst Massachusetts: "However, bar owners say their business has been severely hurt because patrons who want to smoke are now going to bars in toes where there isn't a ban. Several bar owners at first resisted telling patrons not to smoke and refused to pay fines for non-compliance. The town has been seeking to recover those fines in court." Pioneer Valle News and Information, October 6, 1999 , lau: 'Try telling Peter Feeney that Barnstable's smoking ban hasn't cost the Windjammer Lo-singe any business. `Anybody who says it doesn't hurt business is crazy,' said Feeney, who has owned the 97-seat restaurant and bar on Cape Cod for 27 years. People have been laid off, Deno operators. It absolutely hurts business.' At the Windjammer, sales fell $2€10,000 since Barnstable, prohibited restaurant smoking in April, Feeney said. He had expected to bring in $1.6 million this year; instead, the smoking ban has reduced the restaurant's income to $1.2 million, he said. Establishments such as VFW posts that only serve drinks and Keno games are hurt even more, he said." The Associated Press, March 27, 2001 3, Bon, Massachusetft. "`Our business went down the tubes. I think we lost about 40 percent of our customers, and many of those were smokers,' said Charles Thompson, a chef at Nanina's, an Italian restaurant in the city's Dorchester neighborhood. The restaurant originally went smoke-free, but after a dap in revenues, it made renovations and built partitions. StilE, word hasn't gotten around that smokers are once again welcome in the 32- year-old establishment. 'It's hard to get the word out when you're a small restaurant owner,' Thompson said. `Our smoking customers are probably sitting somewhere, drinking coffee and having a cigarette, just like they dad here for 32 years without interruption. I'm afraid they°ve said good-bye to us.' The Associated Press, January 11, 1999 "Foodservice operators opposed to smoking restrictions received more ammunition to bolster their stance in the forge of a new report concluding that Boston restaurateurs could lose about $40 million in sales annually because of the city's 11-month-old prohibition on puffing.... Although several studies have yielded conflicting results regarding the effects of smoking bans on restaurant sales, the Boston study distinguishes itself from some by looking at businesses both before and after the city's ban went into effect,' McGovern said. David Sollars, associate professor of marketing at Auburn university, and Jerry Ingram, a professor of marketing at the university, interviewed a total of 1,200 patrons and 600 restaurant owners and managers during a three-month period before and after the ban's implementation. -7- Boston, Massachusetts (continued): "The report said 48.1 percent of the surveyed smokers indicated they would spend less time in. Boston restaurants because of the ban. It also said that they would travel to surrounding towns where no bans are in effect: skip desserts, coffee and after-dinner drinks; or frequent stand-alone bars and lounges where smoking still is permitted. In addition, the report found that alcohol sales had fallen by about 14 percent and restaurant sales had. recorded a 5-percent drop since the ban was implemented. Meanwhile, employee tips had declined 15 percent, wages and salaries paid out to employees were down about 6 percent and 142 people had lost their jobs." Nation's Restaurant News, August 23, 1999 Bourne, Massachusetts: "Karen Hayes used to tend bar in Wareham, at a place called the Raven, until the town imposed a smoking ban. Then, she says, the bar's clientele dropped by about 50 percent. Today, Hayes works at the Port Q'Call, a Buzzards Bay bar near the Wareham line that even patrons say has a reputation for being a tough biker bar. But it's also a place, she says, where people know they can have a couple of drinks after work, play some pool, and relax with a. smoke." Cane Cod Times, May 17, 2001 Brookli , Massachusetts: "Brookline has lost a dozen restaurants and taverns since it banned smoking in 1993, Potter said, including the 1280 and the entire Matt Garrett's chain." The Associated Press, March 27, 2001 :1 Hingham, Massachusetts: "`We're going to go out of business. That's it,' Tom Harrington, the owner of MacArthur's on Route 53 in Hingham, said. We fought this thing hard. It's not a happy situation' The Patriot Ledger (Quincy, MA), December 14, 1998 3 ® Bluffs, Massachusetts: "`I've lost probably $200 to $300 a day. The whole after-work crowd,' said Janet Ding-Stead, owner of the Ritz Cafe." Boston Globe, June 3, 2002 :1 Plymouth, Massachusetts: "Dorsey Carey considers the evening of Sept. 1 the `Saturday night massacre'. Carey manages Handlebar Harry's bar/restaurant in Cordage Park. It's tucked at the back of a mostly deserted retail complex, but locals have made it a destination. While other Cordage businesses vanished over the last decade, Handlebar Harry's kept the lights shining brightly. Until now. Sept. 1 was the first day of a town ban on smoking in bars and restaurants. The only exemptions are private clubs and outdoor patios at bars and eateries. The measure passed town meeting in May by a 49-44 margin. 'On Saturday night, we had a band, two bartenders, two waitresses, a doorman, a floor man, and we grossed $33,' Carey said. We got massacred, absolutely massacred, and it will get worse. For one thing, we're right on the Kingston line, so smokers will just go to bars there. I spent all last week saying good-bye to customers it's taken us 10 years to build up."' The Boston Globe, September 9, 2001 "Longtime employees are job hunting, less than two weeks after Plymouth's smoking ban went into effect. Whey need to make some money from tips they're not getting here,' [Louise] Houston [owner of Handlebar Harry's] said." Old C®lo y Memorial, Septembei° 13, 2001 -8. P tI, Massachusetts (continued); "Marsha Wilson told Town Meeting representatives that after supporting herself for 10 years as a waitress at Handlebar Harry's, she can no longer pay her mortgage. Proponents of the barn mean well, she said, 'But they don't live with this every day like I do.' She makes $2.63 an hour and needs tips to survive. Since the ban, customers leave after dinner. Despite nightly entertainment, Wilson said, `the room is empty. The Boston Globe. October 28, 2001 Sakw4 s . "[Thomas] Barrett (a Salem lawyer representing the Salem Food and Beverage Association) said ome of his clients, most of whom are longtime Salem business owners, have ea erienced as much as a 41 percent drop in revenue since the ban went into effect six weeps ago." The Boston Globe, May 13, 2001 "This latest attempt to loosen the smoking ban comes after a few businesses met with the mayor to try to offer proof that they are being hurt. `I'm down about $1,000 a week,' said Jennifer Reardon, owner of In A Pig's E+ye. Until recently, she had been one of the so-called moderate business people who had been hoping the increased food business would mare up for liquor losses. Reardon said she began to change her mind when she saw the impact it was having on her bartenders. Her bar manager has 'taken a 30 percent pay cut,' she said. On a recent Wednesday night, he got only $60 in tips instead of the usual $100, she said." Salem Evenin Dews, June 12, 2001 Southborougk Massachusetts: "Waitresses and bartenders said they're worried about losing their jobs and medical benefits if the restaurants close. Susan. Johnson, a waitress at White's Corner, said she usually makes about $100 in tips on Monday nights. Two nights ago, she said, she brought home $35. 'You say you have to be concerned about public health, but what about the public health of people who can't pay their bills or afford to take care of their kids?' Johnson asked the board." Metrowest Daily News, September 26, 2001 a Massachusetts. "'In the months since the regulations were put into effect in February, the board 'received little or no complaints,' Hoffman said, regarding violations of the regulations. But local restaurants tell another story. `We've had many complaints from customers,' said Matt Wallace, who works at Barbers Crossing on Route 12 and is the son of owners John and Patricia 'Wallace. Smoking has been restricted at Barbers Crossing to a downstairs bar instead of one of the three main upstairs dining rooms and the upstairs bar. 'A lot of people came m and were upset when they found out they couldn't smoke inside. Some people would actually leave,' said Kristen Mills, who has worked as a waitress at Barbers Crossing for several years. 'It's definitely killed the business,' agreed fellow waitress Francine Johnson." The Landmark (Holden, VIA), August 24, 2000 Massachusetts: "At least one business owner, however, has had trouble dealing with the [restaurant smoking] ban and claims that business has taken a nosedive in the month of :September. Bob McAree, owner of J. J. Grimsby & Co. on Lynn Fells Parkway, says i the smoking ban is the cause of his restaurant's recent loss of business. 'It's made quite an impact,' McAree said. It's been considerable. It's taken. a toll on our after dinner lounge business.-' Stoneham Independent, October 21, 1998 . . -9- Warehaff4 hus ; "Among those who addressed selectmen were residents who said their rights were being violated, leaders of fraternal organizations who said their fund- raising efforts were being hamstrung and restaurant owners who said their businesses were being crippled. We're begging for your help,' said Cheryl Lindsey, owner of Lindsey's restaurant. We never knew the devastating impact this would have.' She and other business owners told selectmen that in the seven weeks since the ban was imposed, they've seen their business drop off anywhere from 25 to 40 percent. They believe that their customers are patronizing establishments in the surrounding towns of Bourne, Plymouth and Marion, where they are allowed to light up. The drop in revenue has business owners fearful of the future, board members were told. `I can see the loop in their eyes and I can hear it when they're talking, they're scared,' said John Salerno of Marc Anthony's restaurant. "But those in attendance said the fallout from the smoking ban was much more far-reaching than the bottom line. The business owners told the board that the downturn inhibits their ability to beep people employed and to continue to offer decent benefits to those who are working for them. Also, the falloff in business paeans they'll have fewer, if any resources, available to contribute to the community through donations for fund-raisers and contributions to civic projects. And representatives from the Elks club told the board that the ban has meant a sharp decline in the number of people attending their weekly bingo nights, the proceeds of which are used to finance, among other things, scholarships for local students." Standard-Times, December 6, 2000 "Joseph Sauro, owner of the Gateway Tavern on Marion Road, is thankful that the Board ®f Health is willing to revisit the smoking ban issue and hopeful that he and other restaurant owners can describe for the panel the negative impact the ban has had on their businesses. We're hoping to get across how bad things really are here. Everything I've worked so hard for over the past two years is crumbling, laterally crumbling, because of the smoking ban:,' Mr. Sauro said. "Mr. Sauro noted that since October, when the regulation prohibiting smoking went into effect, his gross sales have been down about 25 percent over the same period last year. "The drop-off in businesses has forced hies to lay off two Deno operators. The Deno machine has been moved to the bar, where the bartender now has time to man it because the tavern has fewer customers, lair. Sauro said. Additionally, he's laid off two dishwashers and a waitress." Standard-Times, December 18, 2000 "A number of them told Board of Health members the downturn had forced them to lay off personnel and some said they'd seen anywhere from a 25 to 40 percent drop in the business since the ban went into effect. A number of those business owners offered to open their boobs to the board to back up their claims. `Please, Can you help us? We're begging you,' and `Can you do something for ChristmasT were some of their pleas to the board." Standard-Times, December 25, 2000 -10- th Maws Aso 'The new Board of Health regulation banning smoking in public places is killing their businesses, restaurant owners told the Town Council Monday night. Business is down 50 percent since the ban gent into effect March 5, they said. Tricia Mutter, owner of Kelly's Landing in North Weymouth, held up a newspaper ad by a Quincy bar welcoming Weymouth smokers. %~Te have lost thousands of dollars,' butter said. 'The economic impact on small business is huge. We are also facing a loss in value of our businesses and our liquor licenses. Who would want to buy a bar in Weymouth now?' Sara Lin, owner of Panda Palace in South Weymouth, described how the business she fought to build for 10 years is nov,, crumbling.. `I have struggled and straggled and through hard work and determination, I have built my business to be somewhat successful. Ninety percent of my regular customers, if not more, are smokers. These people came in five to six times a weep; staying for hours at a t rae. In d° e past two weeks, I have seen my regulars only once or twice, and then only for an hoar or so. They have informed me they are looking for a ne-,$j place to go,' Lin said. Lin's customers do not have a long way to go to find somewhere friendly to smokers. Abington and Rockland are within a few minutes' drive of the panda Palace. Lin reported that since the ban took effect, revenues for the eat in/take out business for her Chinese restaurant were down 20 percent, even after a `huge' mail-out advertising campaign. Bar revenues decreased by 50 percent. Lottery/Keno was down 50 percent. Video games revenue was down 50 percent. `Usually I take in about $150 every two weeks on video games. This time, I made only $75. Entertainment costs the same, between $200 and $400 per night, with or without customers,' Lin said. Lin expressed concern for her staff, now that her customers have left. Not only have I lost a tremendous amount of business, but my employees are also losing money. The regulars are the people who tip the waiters and bartenders so they can make a decent living. Hopefufly, they will not quit,' Lin said." Townordine.com, March 20, 2002 "My tips, which support my three children, have diminished to less than 50 percent of what they were a month ago. I work at a restaurant in Weymouth five days a weep and am concerned about the future of all the restaurants in the town.. Shall I go to Rockland, Abington or Quincy to loop for another job? Please tell me. For the past two weeks I've seen my regular customers come in, but only once or twice a week, and stay for maybe one drink, or leave quickly after dinner or lunch.. I don't have the groups of construction workers or tradesmen who would stop in for a quick lunch, or after a hard day, for a beer. The office workers who would come in for lunch must go to other towns now, as many of them would enjoy a cigarette after their meal. With all of this, where are the non-smoking residents who said they would support the local restaurants and be happy to have a smoke-free environment?" By Wendy Allegra, Weymouth The Patriot Le , April 2, 2002 -11- Minnesota: "A month after Cloquet's ban went into effect, one of the city's newest restaurants, Grandma's, said its bar business was down by a third. ale have direct evidence of losing laterally hundreds of customers (tourists and locals) in the past two weeks due to the fact that our guests are unable to smoke and eat in our bar area,' wrote Tim. Mattson, regional manager of the Duluth-based restaurant chain, in a letter to Cloquet Mayor Bruce Ahlgren. In nearby Duluth, a smoking ban has been in place since Jan. 1, and restaurant owners say the financial pain is real. Judy Thomas, owner of Duluth's 21st Delight restaurant, said she stopped paying some of her bills just to stay in business after the ban took effect. Even with a hardship exemption to the ban [approved for a number of restaurants after their sales declined], Thomas said she hasn't given herself a paycheck since May unless she filled in for an absent waitress, cook, or dishwasher. `January was the first time I was behind on my bills,' said Thomas, who bought the 21 st Delight five years ago. In August, Thomas wrote the Duluth City, Council urging a repe.- of the smoking ban. The future of my business depends on it,' Thomas said in her letter." Star Tribune, November 19, 2001 J lutk Minnesota: "Things were back to normal Tuesday after the Duluth City Council exempted the tiny cafe Pim's Hamburgers] from the smoking ban. `Nobody was coaxing in here,' said (customer John] Maniekee, who's retired. 'I come here every day, this is the way it's supposed to be.' Business is nearly back to normal, owner Dennis Christensen said. `It's noticeably better,' he said as a few customers puffed: away. 'I was worried that people wouldn't comeback, but they did.' Tuesday's receipts were up about 15 percent front Monday, when the ban was still in effect, he said. News Tribune, February 15, 2001 "The Duluth Grill is closing on March 19 largely because it can't be profitable under the city's new restaurant smoking ban, its owner said Tuesday. Kay Biga, whose family bought the restaurant in 1985, cited the city's smoking ban and other reasons for closing the Lincoln Park (West End) business. But the smoking ban is `the largest reason,' Riga said. `It's put us in a position where we can't operate profitably.' Biga said sales at the restaurant were down about 15 percent in February, compared with the same month last year." News Tribune, March 7, 2001 "Of more than 40 restaurants contacted by the News Tribune, all but four reported decreased sales since the smoking ban kicked in. The restaurants that received exemptions reported sales losses of at least 15 percent." News Tribune, April 9, 2001 "`Of course it would help,' said Mary Jurek, general manager of Mr. D's Bar and Grill in West Duluth. e are in the process of building a wall and installing a ventilation system right now.' Mr. D's laid off 15 people after the ban took effect, and plans to rehire some of those workers when the $15,000 renovation is complete, Jurek said. [Councilor Herb] Bergson and Councilor Neill Atkins, who also supports the plan, said the smoking ban has devastated matey businesses. Several restaurant and bar owners, mostly in the western part of the city where there is little tourism traffic, reported sales declines of more than 15 percent, and some closed their kitchens to comply with the ban.... Bergson and Atkins said business at trendy and national chain eateries in Duluth has fared well in the past year, masking steep declines at smaller restaurants and bars." News Tda une, March 15, 2002 -12- 1 Minnesotec "flick Erickson, operations manager for Perkins Restaurant in Faribault, said his business experimented for eight months with a no-smoking time on Sundays between 6 a.m. -id S p.m. `business did drop,' Erickson said. `People wasted a smoking section. Once we dropped the no-smoking time, our Sunday business came back up." Faribault Paily Mews, August 23, 2000 1 Las $ New Mexico. 'Gloria Roberts, general manager of the bowling alley, Sun Danes, said banning smoking would hurt, business.... `I lost eight teams of bowlers because of those nonsmoking tunes,' Roberts said. We were never aisle to replace those teams, and I've still got empty lanes there.' Associated Press, February 7, 2001 1 &Ie County, Now York- "`Restaurants without liquor licenses have suffered the worst damage,' said (Dennis) Diraolo, who operates Ilio DiPaolo's Restaurant and Lounge in Blasdell. The county law still alloys smoking in bars. `Since the no smoking law has gone into effect, our business has decreased: dramatically,' said James Geiger, owner of two Country Yatchen restaurants in Amherst." Buffalo t ews, August 30, 2000 New York Swtv- "Scott iexler, executive director of the Empire State Restaurant and Tavern Association, a trade group, said in an interview that his group sponsored a study in 1996 that showed jobs at cite restaurants declining 4 percent. He said that since his group's study examined statistics for the months just before and after the law took effect, it could isolate more fairly the `cataclysmic' influence of the smoking ban on business. ivir. Wexler said Dais group's study showed retail jobs going up 2 percent at the same time that restaurant jobs dropped 4 percent, suggesting that something beyond general economic trends was at work, he said.- "Dan Tubridy, who owns Pier 92, a restaurant in Rockaway Beach, (queens, said in an interview that he lost customers unmediately. They said that if they couldn't cat at my place they were going to Nassau County, pure and simple,' he said. `And you know what happens? They don't come hack." Me Ng York des, January 12, 1999 uge , t gon; 'Blaming a tailspin in video poker revenue, Parrs closed his Track Town Pizza sports bar on West 11th Avenue about two weeks ago, putting six employees out of work. Many customers thought the city's smoking ban already was effect, he said, and they went elsewhere, outside city limits. `After they passed the smoking ban, our video income just took a dive, and At kept going down and downs and down,' Parrs said. That's what happened to us. It virtually put us out of business at that location." Me Register-Guam, May 18, 2001 -13- Eugene, Oregon (continued): 'Eugene bar patrons are skipping town for Springfield rather than abiding by the Eugene City Council's indoor smoking ban. Or so say Eugene bar owners, who swear the proof is in their books. Saying their food, drink and video poker revenues have dropped substantially - from 20 to 50 percent, for some - about a dozen Eugene bar owners and employees asked the council Monday to reconsider the ban. `It has been. devastating to us,' said Old Pad tavern owner Cheryl .McCabe, who said she lost $65,000 in the first six months after the ban took effect. A couple of owners said their revenue losses have forced them to lay off employees. Several employees told the council that they've lost tips and hours because of the ban.... `I'm hoping they'll show some fairness and revisit it,' said Patricia McCall, who owns The Cooler in Eugene. "My overall business is dowry 53 percent.' Employees said their jobs have gotten more stressful and their tips meager since the ban took effect. Old Fad server Cynthia Adeniji said that in addition to worrying about `over serving' customers, she now has to be sure they don't smoke in the bathroom or take their drinks outside when they smoke. Servers rely on their tips, which are plummeting, she said. `I'm a single mother trying to make ends meet.' University of Oregon senior Taunya DeBoer, another server, said she's pushed her work week from three to four days, and had to supplement her income with student loans. She said her earnings have dropped by a third since the ban. `I don't know of any employee who's in favor of it,' she said." The Register-Guard, April 9, 2002 1 Rog, U : "Jac1d Belden, who owns and has operated the Silverado Cafe in Roy since 1959, said the legislation [Utah Clear Air Act] almost forced her out of business. Three months after the law took effect my business had fallen off 56 percent. This is how my family survives. I had to either declare bankruptcy or get creative,' Belden said. [The Silverado Cafe; became a private club.] She said she knew of 397 other `any and pa' businesses like hers that shut down that year." Standard Exasgainer, July 3, 2001 Pond du Lac, Wisconsin: "Paul Cunningham, the restaurant's [Schreiner's] owner, said he, and not the Fond du Lac Common Council, should decide what's best for his restaurant. `I know for sure that we have lost customers,' Cunningham said. `I don't know that I've gained customers. No one said, 'I'an here regularly because of this smoking ban.' Some customers have told me they walked up to the door with other customers who see the sign and turn around and leave." Milwaukee Journal Sentinel, October 21, 1999 a Kitchener, Onto, Canada: "regional councillors got an earful last night from bar and restaurant owners and their staff who say business has gone down the tubes since a ban on smoking came into effect Jan. 1. This is a disaster,' said Arnold Attwooll, owner of three bars in Kitchener-Waterloo. `I had a profitable business. I expect to lose $5,000 to $8,000 in the month of January,' he said. Attwood and other owners said bookings are being cancelled, parties are being transferred to private clubs and business is migrating to Guelph, Paris and Puslinch. ...Brandie Lee flay, a waitress at the Grand River Hotel in Cambridge, told councillors her full-time job was cut back to 25 hours a week Jan. 8 because of declining business." The Toronto Star, January 27, 2000 -14- ",After listening to scores of presentations, the [Ottawa] City Council in April passed the toughest smoking loan in Canada and one that rivals California's law, considered the strictest on the continent. Opponents say the effect was immediate. `beer and cigarettes seen to go together,' says Scott Philip, an Ottawa pub owner. Instead of two or three beers, now people have one and leave.' y business is clown, and the scary thing is this is gust the warning period,' says Jill Scott, one of those suing the city. Mere are businesses that have stropped 85, 90 percent.' St. Petersbur des, September 2, 2001 i Wei th, g Does anyone know, or even care, how this has affected the employees of restaurants and bars in ley outh? On a Saturday night the bar I work at had a decent crowd (mostly smokers), and I made out great in tiles. With the no-smoking ban being enforced. I am lucky I make a third of what I was before. I am a 25-year-old, newly wed homeowner who relies on this second ,fob. Unfortunately, if things don't change, I am gobig to have to leave the glace where I have worked for several years, where I have made friends that will last a lifetime, and I may even say a fun place to work. To me this is sad. Copyright 2002 The Patriot Ledger, Transmitted Wednesday, June 05, 2002 Smoldng Bans Lead to boss of Restaurant Revenues and Jobs i A small reduction in customer base or decrease in business caused by a smoking ban may result in lost revenues, jobs, and ultimately can lead to a business failure. Smoking bans are economically unwise and fiscally unsound. They create unnecessary and burdensome laws that hurt the business climate and tax base. Smoking bans that have been enacted in Massachusetts provide an excellent example of the potential economic impact that could be suffered by hospitality establishments. In December, 1998, Dr. David Solars and Dr. Jerry Ingram conducted a study on the economic impact of the restaurant and restaurant-bar smoking ban in Boston that took affect on September 30, 1998. The study found that the smoking ban would have a dramatic economic impact on establishments within the city of Boston. These effects include: • $40.3 million nct decrease per year in final demand for Boston restaurant services, a decline of 7.9 percent; • $2 million decrease in final demand for stand alone bar services per year; • $61.5 million decrease in final demand in the city of Boston's overall economy per year; • $8.9 million decline in earnings per year; and • Net employment reduction of 655 workers. (Dr. David Solars and Dr. Jerry Ingram, "Economic Impact of the Restaurant Smoking Ban in the City of Boston, Massachusetts," Southeast Research, December, 1998.) Two months after the smoking ban was enacted in Boston: • Liquor sales in restaurant bars had dropped 13.6 percent; • gages and salaries of restaurant bar employees dropped by 6.2 percent; • Restaurant bar s decreased employment by an average of 3 persons. (Dr David Sours and Dr. Jerry Ingram, "Economic Impact of the Restaurant Smoking Ban in the City of Boston, Massachusetts," Southeast Research, December, 1998.) Businesses in other Massachusetts towns have suffered the same fate. The Massachusetts Restaurant Association, in November 1996, released a study on the impact of local smoking restrictions on restaurant jobs. Smoking restrictions enacted in 23 Massachusetts cities and towns during the period of 1993 to 1995 were analyzed. The study found that the communities with "severe" or 100% smoking bans lost on average 21 % of their local restaurant job base. A few examples are: • Brookline, with a complete smoking ban, suffered a 22% decline in restaurant jobs; • Wakefield, with a complete smoking ban, suffered a 57% decline in restaurant jobs; and • Falmouth, which prohibited smoking in 70% of restaurant seating up to April 1995, suffered a 9% decline in restaurant jobs under the 70% ban. This is not just the case in Massachusetts, For instance, stringent restaurant and stringent restaurant-bar smoking bans typically trigger double-digit job losses in the regulated businesses in other geographic locations as well. • California-total .Fmoking ban in all restaurants & Bars, 49% decline; • California-stringent smoking restrictions in restaurant-bars, 31 % decline; and • New York City-stringent restaurant smoking regulations, 7.4 % decline. (William Lilley ,end Laurence DeFranco, "The Impact of Restaurant-Bar Smoking Regulations on Jobs," Incontext Inc., 1998) Recently, Montgomery County, Maryland, adopted a complete restaurant and bar smoking bars that will go into affect in three years. The county shares borders the District of Columbia which has a much more owner and ca umer friendly smoking law than the adopted Montgomery County ordinance. The restaurant industry is facing dire consequences from this government imposed ban. • "County Restaurant owners predict local sales could drop about 25 percent as smokers leave for neighboring communities where smoking is permitted.," (Washington Post, 2/22/99) In 1996, Howard County, Maryland, adjacent to Montgomery County, l a aped smoking in most restaurants with eery few exceptions. The results have been disastrous for many restaurant owners. • "Claude Anderson, corporate operations manager for Clyde's Restaurant Group, said revenue at the Columbia, Maryland (Howard County) restaurant dropped from $6.4 million in 1996 to $5.8 million last year. He said the location has reduced its staff by 10 percent." "Its l n. a disaster." "When we went smoke free, people told us there was a big market out there for those who wanted that. Unfortunately, we haven't seen it." (Washington Post, 2/22/99) Carrollton, Texas legislated a solution after a smoking ban -had been in affect for three years. In 1995, Carrollton adopted a restaurant smoking ban which lead to a decline in the restaurant industry within the city limiu. Three years later, in December, 1998, the Carrollton City Council amended the ordinance to accommodate sneakers and non-smokers alike by allowing smoking in 30 percent of a restaurant's seatng area. • "City leaders have softened the restrictions in hopes of luring new restaurants and keeping patrons satisfied." tDallas Morning News, 12/10/98) • "Council member Fr Drown said the change already appears to be helping the city attract new business.. Developers have shown an interest in building; a restaurant with a smoking area at interstate 35E and Franford road." (Dallas Morning News, 12/10/98) • Mayor Milburn Gravley said, "now they (residents) can get what they want in Carrollton without having to drive across city limits." Recent consumer surveys support the right of an owner or manager, not the government, to determine the smoking policies of their hospitality establishments. In December 1'998, the Oregon Restaurant Association released a statewide consumer and owner poll regarding hospitality establishments. The findings included: • 53% of the consumers polled believed it was the right of the owner or manager to determine smoking policies within their own establishments, while only 28% believed it was the government's right to set smoking policies; and • 77% of owners who articipate a ban would lead to a decline in business said they would have to layoff workers. In October, 1998, the Wisconsin Restaurant Association released a consumer and owner poll that showed similar results. These results included: • 61% of businesses with no smoking restrictions would lose a dramatic amount of business according to owners; Many small businesses would be forced to layoff workers because of the decline in revenue; and • Owners of mid-scale restaurants and small bowling centers anticipate losing up to 201% of their business if a smoking ban were to be enacted. Given the potential economic harm to businesses and the preferences of today's consumers and owners, accommodation is the sensible solution. KPMG' Peat MarwickLLP AME CAN BEI GE INS'7CT°T'U 1prd Mg _ AIVfER cm BEw.RAGE Immun TABLE OF CONTENTS RESEARCH KMHODOLOGY ....<....a....,.,............. 1 DEMLED FINDINGS ........................................................»....»......................«............................1 SOON L MO`Y VATd NA[ $~A~ SD ,..........,..a..< 2 Qwsdox I.- Are ym the endii&xwls owner or a~stat 2 Qxn*n2. pacb of dx following bat yamr axaaA&aeM...».».»...........»....».».».....»..........»...... 2 Q as as 3: Do you sccora :oche smakers waPh an osatdoor wreaking saataon?...........».....»».»..»»..»..........» 3 Qsesikx 4: yv inawd or dftTeased sargv the bon on smoking m bars wmt isato effe; on jaraapy 1, 1998?»,,,.< ........».......................»......3 QwWn S: Appr&Wmwz~ by what pawa have your w1a 3...,..» ..............».».......».».»»..............4 Quadox 6: Hkw yox wwtkd an incraase or da-mar ors nursaber of y awomers since the b t into offat oralomwy 1, i998 ....................».,,,....<,,,,<..,»...»».....,»»» f Qwuim 6 e s tihvhad v; tw a to Qwdw 4; wixther the m*oncdwu notate an ' mcmw or damw in b s saw thebwra ors smoiiag ara barn mat in o pct os 1mu y 1,1998b .»».»...<»,»»<»»»»» 6 Quatka 7. A 7 by t at the ramherof ymr antemm t 7 Qxm*x S. Haw y rao or dwmw in dx number ofwerkend cowman saw bra onjoney 1,1998 ..................».»...»»»„<..»».....»».».»».».....,».»,<»,.<.»,...»<..,»<» »,,,».<»<» 8 Qaafim 8 an niadox to (Nadw ;4; w1kdar the nVwdm& wd an humw or loess on Mukins in barn went into elect offfiaway 1,199~ Qaaataosa 8 so oho cmz tabdowf by araMi4ment tjfw. 9 Quadn P.- App by+ p moo' aommm t.....10 QwWox 1®:11 awwr the a "}rag or "No" YeVmm Hag ~e swag burs isa bars bd C® OM TABULATIONS AmERic N BEw-RAGE INsT rr T3'E l . esea reh Method of o y is market researcb study was conducted on behalf of the American Beverage Institute throughout the state of California. Questions were meticulously designed in order to achieve the precise project obj , American Beverage Instituters main objective is to determine the effects of the state-wide smoking bast on business operations. All questions were pre-toted to verify reliability. The wording, sequencing and effectiveness of the gr tions were carefully assessed, Some refinements were made, as needed, to ensure the validit ° and reikbi ity of the results, The questions were there presented to KPG Teat Marwick, LLp for final review and approval. Telephone interviews were then conducted between March 3A 1998 , Mar 61 1998 by our team of ha-hoses survey profession, Furthermore, specialists closely monitored -progress iatterview& Survey responses were dully coded, entered, and tabulated. At this staff the tabulated data were analyzed and a va l to reveal characteristics and apphcations relevant to American Beverage teas objectives. The report was then designed using phs and charts to € u ate ' and emphasize &gnif findings in understandable format. A total of 300 individuals were randomly selected from a list of 7,216 esublishments provided by the Alcohol Bevw4e Control and m6xkd this study. Uxese itad€ duala induded owners of establishments w where effected by the jmuwf 1, 1998 state-wide smoke ban. Of th 300 owners, 11 contuse &Ubs patrons make within their establish , Separate ubdmons wen run for these ihdividuds to allow the results to be compared atsd conu m very the r dts of owneo that enforce the smoking b Business o: were selected at rxxtom from a list provided by the Alcohol Bemw Control. Based on an industry rd r cdcalation. limiting the entire popul on co the 7,215 provided, the approximate mm*n of error is 5.5484%. many wter and important responses emerged throughout the srady, the results of which are sununanzed hawn. The ffolloving am the survey molts, Ah+ImcC N BEVERAGE INs7T`ruTE Conclusions • A total of 300 alcoholic beverage serving operations were surveyed, The sample was selected at random from a list of 7,216 beverage license holders provided by the Alcohol Beverage Control. The sample brews down by property type as follows: Ivne of Estes lislarnent P" =10 of Resnondents Bar Connected to 57.3% Restaurant/Hotel Stand-alone Bar/'Tavern 35.7% Nightclub 7.0% • Of the 300 beverage operations .surveyed, 3.7% of the establishments did not actively enforce the ban while an additional 22.6% indicated that customers simply ignored the ban. Overall, this implies that smoking stall occurs in appro < ely one out of every four establishments. • The survey results indicate that the majority of establishments (59.3%) experienced a decrease in busine since the ban went into effect on January 1, 1998, while 30.3% experienced no effm, 3.7% refused to answer or did not know and only 6.7% experienced an increase in business. The 178 establishments that experienced a decry in business averaged a 26.2% decrease in sales, with over a third of the establishments (35.4%) experiencing a decline of over 30%. In contrast, the 20 establis is that experienced an increase in business averaged only a 7.8% increase in sa , with the majority (60.0%) experiencing less than 10% increase. of the establishments that experienced a decrease in business, 89.3% experienced a decrease in weekday customer traffic and 81.5% experienced a decrease in weekend customer traffic. contrast, 60% of the establishments that experienced an increase in business experienced no effect to average weekday customer traffic, while 70% experienced an increase weekend customer traffic. . AMERICAN BEVERAGE INSMUM • Separating the respondents by establishment type indicates that bars attached to restaurants/hotels € y have been less adversely affected than stan"one establishments and. nightclubs since the ban went into effect on January 1, 1998. According to the survey, only 44.5% of the connected establishments reported a decrease in busing, as opposed to 51.3% of the stand-atones acid 66.7% of the nightclubs. In term of average customer traffic, only 47.4% of connected establishments indicated a deer a in weekday counts, while only 37.4% indicated a decrease in weekend counts. The lamest percentage of connected establishments reported no effect to either weekday (47.4%) or weekend (4x,1 ) counts. In direct contrast, 79.6% of stand-alones and 61.9% of nightclubs indicated decreases in weeltday customer traffic, while 75.0% of stand atones and 57.1% of nightclubs indicated a decrease in wend customer traffic. • The smoking ban appears to have had the following negative impacts on the respondent's o 'onss • 503% of the respondents indicated an increase in customer complaints/fights; • 65.0% indicated a loss of rvAw customew, • 59.0% indicated a loss of taps/ 'ties for the bar and/or serving staff ICON IC IMPACT OF THE RESTAURANT SMOKING BAN I THE CITE' ASTON, MASSACHUSETTS SPONSORED BY: THE INTERNATIONAL SOCIETY OF RESTAURANT ASSOCIATION EXECUTIVES FUNDED BY: THE ACCOMMODATION PROGRAM, COURTESY OF OPTIONS, PHILIP MORRIS USA PREPAID BY: DR. DAVID SOLLARS, PH.D? DR. JERRY INORAM, PH.D?? MAY 5, 1999 Assistant Dean, School of Business, and Associate Professor of Economics, Auburn University Montgomery, Montgomery, Alabama. "Professor of Marketing, Auburn University Montgomery, Montgomery, Alabama. All opinions in this steady are those of the authors and not Auburn University Montgomery ECONOMIC PACT OF THE RESTAURANT A I THE CITE O BOSTON, MASSACHUSETTS SPONSORED BY: THE INTERNATIONAL SOCIETY OF RESTAURANT ASSOCIATION EXECUTIVES FUNDED BY: THE ACCOMMODATION PROGRAM, COURTESY OF OPTIONS, PHILIP MORRIS USA PREPAID BY: DR. DAVID SOLLARS, PH.D` DR. JERRY INGRAM, PH.D** MAY 5, 1999 ' Assistant Dean, School of Business, and Associate Professor of Economics, Aubum University Montgomery, Montgomery, Alabama. Professor of Marketing, Auburn University Montgomery, Montgomery, Alabama. All opinions in this study are those of the authors and not Auburn University Montgomery 1. Executive Summary A. Economic Impact * On September 30`x, 1998 a restaurant smoking ban became effective in the City of Boston, Massachusetts. Results from survey data suggest that the net decrease in final demand for Boston restaurant services will be $40.3 million dollars per year, a decline of approximately 7.9 percent. Stand-Alone bars appear to be complementary to restaurants and restaurant-type bars. The survey data suggest a net decrease in final demand of almost $2 million per year for Stand- Alone bar facilities. If bar areas of restaurants want to accommodate smoking under the new law, alterations to the physical layout of such facilities will have to be made. Our survey data indicate that restaurants will spend slightly over $1 million to accommodate smoking in accordance with the law. ® Using the RIMS II' model for Suffolk county, MA, we estimate the combined net effect of the smoking ban lam= change to be a decrease in the final demand of $61.5 million for the city of Boston, a decline in earnings of $8.9 million, and a net reduction in employment of 655. B. Patrons Sure y 2 ® Awareness of Smoking Ban Two months after the smoking ban started, approximately 95 percent of the Boston area patrons were aware of the new law. The total awareness gradually increased over the three month survey period. Facility Usage among Boston Area Patrons Slightly over two-thirds of the Boston area respondents patronize both city restaurants and restaurant type bars. One third patronize only restaurants. * Change in Patronage of Boston Restaurants Due to the Smoking Baas Two months after the smoking ban went into effect, the annualized lost restaurant sales from full-service restaurants in Roston is estimated to be over $40 million. The decrease in Refers to Regional Input-Output modeling system developed by the U.S. Bureau of Economic Analysis. 2 Survey Administration - Patrons of Boston restaurants were surveyed by telephone utilizing a questionnaire of approximately 7 minutes in length on September 29`h, October 160' and November 19", 1998. 3 F~W#h 13 r' OEM J Sun-sentinelecon-i 1111: WT ' NEWHS Horne Nevvs Sports Entertainment CLassiified Business Weather Shopping Ske seams INSIDE OPINION L Cartoonist. Chan Lowe Sheriff limiting smokers' right e~ columnists CHANNELS N Barbara AiJCOIn CLASSIFIED wobum, mass. Careers, Ho..mes, stud Dece„-~' Es D Apartments, Cars, ~ ; Personals a*.e Apparently, the rights and freedoms contained NEWS South .Florida, in the U.S. Constitution and the Sill of Rights a F. s ory to a I\latic:,. V,!crld, CUba: only apply to people who don't smoke. cola n,-Fls duc. ticn, 0b:;," Prin<er f nrhy ve Eon The anti-smoker terrorists, in this case the , c e; Palm Beach County Sheriff's Department ("Palm Beach Sheriff's Office says it will hire r" - only nonsmokers," Dec. 25), can blithely 1 v E . ca sI control, manipulate and eliminate any 87 r s;r police detain ~v SPORTS fnore, ;ash uit, nts Dolphins, Marlins, Heat, segment of the population they so choose, c-~ Pop-- srtthere roust be r acr Panthers, Fusion, High without fear of objection or reprisal. no war in God's name school, Col!egp, Outdoor 0 13-' l-n ntin; foils ;:;nd your nE 89aSIeiESS There are federal laws against discrimination robs Y tryr anlits znd vehicle nav Stocks & s folios, in hiring and employment practices except b=ra fs pme,cash Calculators in Palm Beach County. SHOPPING shopping-Guide; Who have the aid off in their zeal to deprive citizens of gainful Tfftmentsx Shop local merchants they p Advertisers employment, whose only "crime" is that they have chosen to engage TRAVEL in the legal activity of smoking, even on their own time In their own THE EDGE homes? Multimedia games and graphics. Their outrageous decision to force smoking employees to stand in ENTERTAJN.ME'NT the middle of the street and down the block ("50 feet away from Dining, Movies, Festivals, buildings") is all right with these anti-smoker zealots. Would they go Music, TV, Stage, along with limiting their own consumption of junk food to standing Attractions, Contests 50 feet away from buildings? HEALTH FEATURES; LIFEsTYLE Instead of refusing to hire anyone from a minority population such Food, Horne & Garden, as smokers, perhaps Palm Beach County should refuse to faire or rind a local area` Books keep in their employ anyone who is 10 pounds or more overweight, City COFa MUNM calendar, Lost work, sick time, prescriptions and hospitalizations for fat people 113usiness EpTTORZP...- KETTERS cost millions of dollars more a year for taxpayers in the United Enter a business Chan Lowe. .c.aMoons States than smokers ever could. name (optional): OTHER "SERVICES Maps, s, ewsp,aper Archives, <tiwsp Does Undersheriff Ken Eggleston weigh more than 10 pounds over X ~ customer garvice, News his ideal weight, I wonder? by email Need more optio What about people who consume alcohol? Are they or will they be Try an advanced hired by Palm Beach County? Why? search. The shame at this holiday season in particular (that the article was printed on Christmas Day, with the Sun-Sentinel's editor probably hoping no one would read it) is that there are thousands of our young men overseas protecting the USA. Little do they know that the terrorists they're fighting live in balm Beach County. _ xticle from the Bangor Lally News r a~~ 1 ~l REGISTERED f ~ f~ !Dan r 1>, q 21000SIGN-ON C I Last updated: Friday, December 28, 2001 LETTERS ARTICLES * The--casefor.laptops Stop blaming smokers * Carter for single payer Letters to the Editor I have seen many advertisements against tobacco from the Partners for a Letters to the Editor Tobacco Free Maine and groups like the coalition that is under affordable Letters health care in Maine. We all kno v smoking isn't the best habit to have, s i n c r., i ch u d but neither is being obese. A new study states that being obese is far - - more dangerous to one's health then smoking. Yet, smokers are still in it r the back of the bus. Or rather, we aren't even allowed on the bus. The anti-smoking groups in Maine are being paid big bucks to beat on us, yet the governor can't balance the budget without increasing cigarette taxes. And if Maine became tobacco free, it would put groups like Partners for a Tobacco Free Maine out of business. The tobacco settlement money being fed into the state is being paid for by the smokers. What many do not realm is that this money is paying for the sick smoker, should there be any. So, when our health officials say that smokers are costing more insurance in Maine, they are lying. It's just another ploy to continue the fight against the smoker, and continue feeding at the honey pot of big money. Big tobacco sold us out. And Maine has sold us out. A lot of people tell me, "I hate smoking. A family member died from a heart attack or lung cancer." But I say, "Was your family member obese? Did that person exercise? What kind of lifestyle did the person lead?" ,People are too quick to blame smoking, and it's too easy to blame the smoker. The anti-smokers want it their way or no way. What happened to the freedom of choice in America? How did Maine turn into a bunch of Taliban? Darlene Brennan News Business I-Sports Announcements Style I Columnists Viewpoints Obituaries Search Classifieds about us faq contact us subscribe advertise with us advertise onl.in... cop _ ght,policy ©2001 Bangor Daily News. All rights reserved. rticle from the Bangor Daily News ragu vi isangar Da n~'REGISTERED N~ES; -XX ~~200QSIGWON 80NUSt :-.X.--- i:: 4 W~A Last updated: Friday, December 28, 2001 l itt ERS ARTICLES » The, case for la.pto.ps Stop blamin smokers » 0- rter for sin .le :-aver » I.etter s to the Editor I have seer mazy advertisements against tobacco from the Partners for a N i,etcers tc the Editor Tobacco Free Mainc and groups 1c. the coaDEtion tbat is under affordable c, health care ir. lainc _ 'We all know smoking isn't Ehc best habit to have, » o s r ; q r-; I c h a u r but neither is being obese. Lei new study states that bring obese is far more dang.~rovq to one's health then smoking. Yet, smokers are still in the back of the bus. Or rather, we aren't even allowed on the bus. 'snit The anti-smoking groups in Maine are being paid big bucks to beat on us, yet the governor can't balance thr; budget without increasing cigarette taxes. And if Maine became tobacco free, it wood put groups kc Partners for a Tobacco Free Maine out of business. The tobacco settlement money being fed into the state is being paid for by the smokers. What many do not realL is that this money is paying for the sick smoker, should there be any. So, when our health d ials say that smokers are costing more insurance in Maine, they are lying. It's just another play to continue the fight against the smoker, and continue feeding at the honey pot of big money. Big tobacco sold us out. And Maine has sold us out. A lot of people tell me, "SI hate smoking. A family member died from a heart attack or lung cancer." But I say, "Was your family giber obese? Did that person exercise? What kind of lifestyle did the person leadT' People are too wick to blame smoking, and it's too easy to blame the smoker. The anti-smokers want it their way or no way. -What happened to the freedom of choice in America? How did Maine turn into a bunch of Taliban? Darlene Brennan News I Ru a ne4s [Sports I Armouncements I St le I Columnists I Viewpoints I Obituaries I Search ( Classifieds about us fa.q con act us s.ubscne„ agvertise with us I advertisa onl . I copyright pQIicY c@2001 Bangor Daily News. All fights reserved. Emil Massachusetts Restaurant Association 95-A Tuc lte Road, Westborough, lam. 01581-2850 TEL (508) 3(x6.4144 a 1-800.852.3442 (MA Only WATS) • FAX (508) 356-4614 EXECUTIVE SUMMARY 1-his study co 'oned by t carat Association analyzes what happened to noes jobs in chase c "ties that enacted restaurant srnold ag bans. Mae studly concludes that a stmt restaurwd smoking barns is adopted, them dgnifteant nnmft of local restaurant labs wiff be lost. Thk analysis loolmd, at the eff= on restunnt jobs in 23 cities and totem Massachusetts which enacted t smoking baw " g the peaoad 1993 through 1995. Me ' "pal - of this study is that a smoking saict ban 1, In almost all communities, mmfi In t& km of loci ==ant jobs. In the. instance of 23 Mwmhuw= yes =4 tow=, those comramitim adopting ct, bans lost avemp 21 percent of job b, This zwdy Is designed to and local o resuarat=g. and sash as well as Charnbazz of Commww, Bow of Health, a Tmvet and °I' B us v** edw Iavd u6 woric in and/Or govern, a efty or town considering the adoption of a smoking remumat ban. From the of communities with restaurant ' resWc&w and bm.the=y=- 0 1 ption of a" " ban will tt ;ob loss y &bo shows that the less f smoking the law, tbo ban has on local resuamritjobs. De ° ' n of Severe. Tae study defines as "severe" bans those which include most or all of the mowing rotas; • smoiring is bumed in 100 pement of 's public space; wrAdng as banned in 100 of 60 a ss blic space wmept, fora speeMy • constructed and f Y &;-;:ed arem6 with cot~p y sup t is off of c space in the resta t tangh which tpawns can enter and t~ . only Voluntarily; this'"sep ite" ~ space spetfi ly includes the res 6s"_ • no vadance or exn procedure; an ex y arduous vmia= procedure which does not include fimincial hardship grounds. 3e ° ' n of Restaura?W This study spedfically excludes fist-food restaurants of any variety . The midy dames as remurants otdy those with the following c °stics, • iWoUc beverages a served; • fot g a n; nts are available for at food and beverages seined'. • prepared menus shown to pate. -Mom- V1il L"J - 1i3C rrA~ ygtSl i\LT1iVV1VL r.10 A'%IN J V 111Li1\ Vr%,C VLJ i sag. 6 v. s It explicitly assumes that "the excess risk of lung cancer from ETS exposure is proportional to ETS exposure," p. 6-12, right down to zero, as extrapolated from the exposed/unexposed ratio of screening cotinine levels. in other words, the 'traditional' exposed versus unexposed spouse odds ratio has become the spouse versus background odds ratio; THE "BASEL E" FROM WHICH THE "BACKGROUND" ETS DEATHS ARE CALCULATED IS A HYPOTHETICAL "ZERO ETS" I.,EV'EE. So, the unexposed spouses are not taken as the traditional 1.0 'no risk' reference; they are also considered to have a risk according to typical cotinine levels. These "background" deaths are not derived from the epide n- logic data regarding social or occupational exposure, but in this way. This is doubly sclenti,Bally disreputable. It is known that cancers are not produced in anh,nals i proportion to dose, from high levels to low, no matter how small the dose At low levels, genetic damage is repaired much nwre efficiently. It is also known that coti ne levels are dispropaa ana€teA, too h1gk to accurately reflect e osure to pmdcles The ,QA's pose behind tb pseudarwlence to inflate the supposed rrnnaber° of death& Thgjl aunt to jusigfy harassment acrd persecution of r wkers by making ETS appear to be a public health danger. In addition, they arbitrarily lowered the standard of' statistical significance used in the eWosedlunexposed risk ratio, front the scientifically accepted 95% level down to as more lenient 90% They have also violated a cardinal rule of epidemiology that exposures of greater magnitude must be adequately controlle~.$ for before any conclusions may be drawn about the exposure in question. Since the alleged ETS risk is very small and a multitude of other factors, including diet, lung disease, and even pct birds, have been found to be greater, and no study has even considered them all, they have no right to conclude that ETS is the culprit. Notice that 1060 of the supposed 3060 ETS deaths are actually ez-srnoker^s. The anti- smokers have gotten away -vidth inflating their figures with ex-smokers ever since the days of C Everett Koop, despite the fact that the average lung cancer case among ex-smokers of over 7 years, not just 5, someone who smoked nearly 1 1/2 packs for nearly 30 years. Yet the EPA attributes propor- tionately as many ETS deaths among ex-smokers as among never-smokers, 1060/ 23.7 million and 2000145.36 million respectively, and they expect us to believe that these ex-smokers were felled by a whiff of secondhand smoke! Notice above aIi that there are only 550 supposed deaths among never- smoking spouses of smokers, which a deceived public thinks the fuss is all about. See what patsies the media are, to hide these facts and tell us that "secondhand smoke kills 3000 non-smokers a year!" Courtesy of Carol Thokipsen 0$123193 Smokers' Rights Actin Group Smoker' Rights Action Group P.O. Box 259575 Madison, 153725-9575 Phone; 645-249-4568 > BACK TO FORCES MAIN PAGE < Mamchusetts Restaurant Association 95-A `li ke Road, 'estb®ro a l 131 1.7x50 TEL (508) 366-4144 • 1-800.852.3042 ( Only 'DA'I`S) • R (508) 3"-4614 EXECUTIVE SUMMARY 7bb smdy cunuussa by the Musachusm m-ant ' Association to ream t jobs in Mamchusm c ' ' enacted restaurant 7he sudy concludes t a arki rrmwmw s o g ban adopted, then gnt ant : numbers Of loo rest"rent jobs wtw be lost This y a the d1m on remmantjobs in 23 cities and owns in Massacbusew smoking baw i g the Wdod 1993 Hugh 1995. 7be ' "p , firding of this study is t a ban val, In alai all communities, mwk In t of lmd =satbL In ° of 23 Massachusm d tbm a adopting lost on- lv=p 21 P=ent Of 4 y is dedped to $ usefid to Manchu= state and it offlcklj~ l umm M as well as of Towism B - 11 wat in and/or pvem acity or town ct ° , the adoption `t rwmmt mobag ban. t le ~f laz t r ~ ys a "bau b t the`al~ tl l t local De ' n of Serem The study deftes as " " bars those which include most or aH of the faf . g ramictions: • anddag is bared in 100 powam of is public spate spam a specinHy =Wdng is bmmed In 100 of is blrc vendhd • tlti A c` tt~ stom` t a=ns can em:r and pm tf 1 l this "separate spaCC Spec Wes t s • vwiame or exemption • an cx y arduous vuimce ywcedure which does not include fi=chd Wdship Wounds- Dq n of R . rals s y sp y excludes fast-fa ur is of any varLny. Mw study defiries as r u mly d sc with the following c ' tics: • alcoholic bevemon are saved-, • fonyW. tin ts available- for all food and beverages served;- prepared thus asp shown pamons. s€t- BL.UEPRIN T FOR SUCCESS ~ i COUNTDOWN ~ 2 0 0 0 ~ TEN YEARS TO A t - ~ TOBACCO-FREE ~ AMERICA TSOCIElys AMERICAN ME Aff ~vn„icon LUNG CAN Ass t The Civistmas ocivtion ASSOCIATION COUNTDOWN 2000 BLUEPRINT Contents Drafting Committee i Preface Introduction A 'targeted Populations. Youth, MinorWes, Women - - - y and the educationally Disadvantaged. Tobacco accise Taxes: Raising the Cost of Tobacco 10 Restrictions on Smoking in Public Places i Sources of Additional information 22 ec4derence September 11. 1990 C COUNTDOWN 2000 - BLUEPRINT - raffang Corm ttee Charles A. LeMate, M.D., Chair President, University of Texas M.D. Anderson Cancer Center, Houston, Texas TARGETED POPULATIONS: YOUTH, MINORITIES, WOMEN AND THE EDUCATIONALLY DISADVANTAGED Reed V. Tuckson, M.D., Subcommittee Chair Volunteer, American Lung Association Senior Vice President for Programs, March of Dimas, White Plains, New York Former Commissioner, District of Columbia Public Health Commission, Washington, DD Scott D. Bailin, J.D., Vice President, Public Affairs and Legislative Counsel American Heart Association, Washington, DC Richard Hamburg, National Affiliate Legislative Coordinator, American Heart Association, Washington, DD -Stever Largent, Communications- Director, American Heart Association, Utah Affiliate, Salt Lake City, Utah Joe Patterson, Director of Public Education, Division Services, Government Relations and Special Projects, American Cancer Society, Atlanta, Georgia TOBACCO RISE TAXES: RAISING THE COST DP TOBACCO Mary Sandberg, Subcommittee Chair Assistant Director of Public Issues, American Cancer Society, California Division, Los Angeles, California Carl Sooberg, Executive Director, American Lung Association of Virginia, Richmond, Virginia Harry Holmes, Ph.D., Director of Governmental Relations, University of Texas, M.D. Anderson Cancer Center, Houston, Texas John H. Madigan, Jr., Assistant Vice President, Public Affairs, American Cancer Society, Washington, DC . RESTRICTIONS ON SMOKING IN PUBLIC PLACES _ Hon. Alexander "Petem rannis, Subcommittee Chiir -Now York-State Assem New York, New York _ Fran Du Melle, Director, Office of Government Relations, American Lung Association, Washington, DC Russell Hinz, Manager, Health Care Policy, American Lung Association/American Thoracic S ety, ice of Government Pel 'rte; Washington, John Pinney, Corporate Health Policies Group, Washington, ®C Former Executive Directcr, Institute for the Study Smoking Behavior and Policy, Harvard University, Cambridge, Massachusetts Dorothy Stake, Volunteer, Member, National Public Issues Committee, American Cancer Society, Lennox, South Dakota ADVOCACY Patricia M. Hudgins, PhD., Subcommittee Chair Volunteer, American Heart Association Krksville College of Osteopathic Medicine, K 'ile, Missouri Angels T. Mickel, Director, Tobacco-Free America Legislate Clearinghouse, I Washington, DC Michael Pertschuk, Co-Director, '°1°he Advocacy Institute, Washington, DC u COUNTDOWN 2000 BLUEPRINT FOR SUCCESS Preface in recent decades, the U.S. tobacco murers have sperm umold billions doftm to protect and expand the sales of their addictive and deadly products, These uncons ' e peddlers of destruction pose an enormous and weU nanced challenge to voluntary agencle& And yeL In the lac nearly overwhelming odds, the t-Ide of public opinion has been turned by scientific facts and by a strong coalition of tobacco-control forces who are as creative as the tobacco marketers. and even more energetic. Having led the way in this battle during the past decade at the national level as the Coalition on Smoking Or Health, the American Cancer Society, American Heart Association and American Lung Association united as 'T'obacco Free America (MA), now bring important additlonal resources to a growing trend evidenced in states and localities across the nation. Our course of action for the IMs will be set at Countdown 2000, a landmark conference in Washington. CC, on September 9-11. 1M. Countdown 2000, sponsored by Tobacco-Free America and Its member organizations, will develop the strategy and enhance the skills needed by state and local voluntary leaders in their pursuit of a tobacco- free America by the year 2000. Essential to the achievement of this goal is the release of this Blueprint for Succ . The document is an action plan for achieving consistent nationwide policy in states and localities It provides guidelines to address the following three major tobacco issues: 1) marketing targeted at special populations, 2) tobacco excise tastes and 3) restrictions on smoking in public places. This draft will eventually form the basis for _achieving the goals we share for the year 2000. Following a summaries of recommendations for the three primary issues. Targeted Populations The tobacco Industry has long targeted youth, women, minorities and the educationally disadvantaged through massive advertising and publicity campaigns needed to replace the thousands of consumers each year ers die from mokln or decide to kick ftk hablL The rsfport of this subcommittee clearly kienti es the tactic used by tobacco c spaaaies to UMW po tlon groups with sophisticated market research and advertising. The subcommittee makes a number of recommendations to curb, these efforts. Included are severe limitations on salmi and access u sdu for children In grades K-1Z, tc er prornation for youth and aminorffles and the weation of smte offices on tobacco and hea*L The sub es also pro es a moMcatlon In t4 Public e Act of t to allow states to taks miors effective action In =Wng cigarette advardsing- Existing constitutional auftwity ally a ban on ffxxa promotional a e& This ee argues that states and local entities must aregu to wtw the tobacco industry has failed to do on Its own.' Tobacco Excise Taxes The subcommittee on tobacco excise taxes reviews well-known shies and data anaWng taxes as deterrents to l gg particdarly for young Americans who never have used tabacco. nting that most revenue genemted by Increased tobacco excise taxes is needed by the as for g rw m the s irinee recommends that a portion be devoted to health goals such as prevention, education, media campaigns and smoking cessation. A primary focus of any excise tax In should be to apply that increase to all tobacco products. The subcommittee also mcommends Mat the Tobacco-Free America Legislative aearinghouse serve as a key resource center to help states k=me thalrJobacco excise taxe& Restrit ons on Smoking In Public Places The su ee on smoldng In public places has developed a Wong set for =*dJdathg and strengthening state low smokhg-controf effor€sm To achieve the Countdown 2WO gOW& the teespecifies the following minimum ards: be prohbW In dM day care centers. on school property. In all public and private work pliciM In retall St in health care ities and on any form of public transportation. Most odw Indoor emu q= to the public would be smoke-free under these proposals. Restaurants would provide smoke-fte space bas ed IV on the ratio of nonsmokers to smokers. Any ate-level pr tion provision must be opposed bemuse k would preclude potentially stronger aL-don In localities. Finally. the su ee opposes es -pnviding civil d" protection for smokers. The Challenge Ours is not an easy task We have a greet deal more to do to assure that our nation enters the next century free from the deadly scourge of tobacco. More ttw 50 million Anwicans continue to smoke. Many young people ® seduced by the allure tobacco advwdsing and promotion at vulnerable points In their lives - take up the addicting habit every day. To help people stop smoking - and keep countless others from starting - state and local advocacy efforts of the ACS. AIWA and Alit must be strengthened. While we have reason to celebrate our numerous victories, we cannot rest. Our strength lies not orgy In our resolve to preserve and promote public health, but also in our natural.-resources.' the miilk)m of dedicated volunteers who lend their time, talents and services to our effort Our objective In releasing this blueprint for Success is to provide a focal point for public policy action over the next ten years and beyond. Our plan requires; a full commitment to tobacco-control advocacy from each organiWon and at all levels. Material and human resources dedicated to this effort must be Increased. and the commitment of both volunteers and professional staff further encouraged. . supported and rewarded. most importantly, the Journey ahead will take commitment. resources and brain power. This erence will be it catalyst for action in that quest. CUdes A. larstre, A7 v on the ratio of nonsmokers to smokers. Any state-level preemption provision must be opposed use It would preduds potentially stranger action In localities. Finally, the s e opposes muies -p ing tights pnxection for smokers. The Challenge 8t b not an easy task We have a greet deal more to do to assure the ow natim wam the n century free from, the deadly scourge of tobacco.. More there 50 million Amedcans continue to smoke. Many young maple - seduced by the allure tobacco a&ienWW and purr s points their Dyes - take up the addl lhg habit every day. To helpa stop king - r keep countless others from smrting ® state and local advocacy effo of the ACS, AHA and ALA must be strengthened. While have reason to celebrate our numerous victories, we cane rest. Our strength ties not ordy in our resolve to preserve and promote public health, but also In our "natural resources,' the millions of dedicated volunteers who lend their time, talents and series to our effort. Our objective in releasing this Blueprint for Success is to provide a focal point for public policy action over the ten years and beyond. Orin plan requires;s full commitment to tobacco-oorad advocacy from each organization and at all levels. Material and human resoumes dedicarted to this effort must be increased, and the commitment of both volunteers and professional staff further encouraged, . supported and rewarded. most importantly, the Journey ahead l take commitment, resoumw and b er. This ~wrderence will be a catalyst for action In that west. Chades A. l alstre, M.D. V barrier in our bade for public health, it is in no way impenetrable. The strength of our organizations lies not only In our commitment to the preservation and promdw of pc lc health, but also the dyer 5 million persons who volunteer their services. Currently, one may question whether our grassroots are not merely , an artificial roster of volunteers who may or may not respond to a call for awn. We are rr t eff we have a core group of dedicated advocates who will act on a rnornenes notice. In the wake of major tobacco of victorles, such as passage of the New York State Clean Indoor AIr Act and the overMWmIng approval by California voters of proposition 99, the ballot Initiative dud li=sased the state ckprette excise tax by 25 cents, there have also been setbacks. For kwtance, Colorado, Kenftcky, Oregon, Tennessee and Virginia enacted anal-discrimination protections for smokers by prohibiting employers from establishing as a condition of employment that employees and prospective employees must be nonsmokers; thus, putting smokers into a *protected' class. In addklon, several motes have adopted restrictions on smoking In public places that prevent localities from enacting further restrictions. These regressions. when viewed from a global perspective, signify a negative trend for the tobacco-control movement that began In the late 1980s. in spite of the great progress made during the balk of that decade. Our ability to organize, energize and mobilize our vast base of dedicated volunteers; to affect public policy will determine our degree of success In the 199os. Our objective in setting into motion this national 'plan of action' Is for states and localities to use public policy to the fullest extent over the next ten years, and beyond, to achieve a tobacco-free society. This plan may be illusory without total commitment to tobacco-control advocacy from each organization, at all levels. To be su=essM In our campaign, the ACS. AHA and ALA must adopt tobacco-control advocacy as a major organizational priority and act accordingly. Public policy can have an enormous Impact on our efforts to eradicate the diseases upon which our organWaiom whom founded We must transcend turf battles. Institutional rivaines. bureaucratic resistances and Intraa Institutional inertia In the common pursuit of the overriding public goal. The movemeM needs both professional advocacy resources and dedicated. wined, empowered volurstftm To a ish these goals. we need mutual commitment and support at the locA state and nationgl leis; a coordinated strategic plan; Interactive communications networks; and advocacy training and skills budding. To provide the necessary support and assistance to achieve the objectives In the Blueprint for vii Success. two rnanagement goals must be adopted to reaffirm commitment to is wig' advocacy for nth and to cont]nWng and riling the TFA LegislaM Clearinghouse for the res a ACS, AMA and ALA field organizations. GOAL 1: Acceptance and affinnation that public policy advocacy is absolutely s l to slflll the mission of heal promotion end disease pre on through tole co l regulation stated by the American: Cancer Society, AmerWan Heart oAssociation and American Umg lion. • National, state and low boards should adopt tobacco-control advocacy as a priority. This aeon requires the education of volu eer boards as:'to Me tobacco-cowol advocacy a y to achieve the overall mission of out respective organ tlens. Staff and resources of Bernal. Mate and local agencies must be dedicated to the political education, recrultmem bon ene e-building and kwitutlonal recognition their volunteer members whoa to tobacco-control policies at each level of gove€ mem Tobacco-control advocacy committem must be organized. or strengt . at all levels to reflect a clear priority within the. organizations. • Staff positions of experienced government relations/public affairs professionals must be created at the stye level. • ate and local coalitions must be organized or strengthened with the following: I ® added human and fsnan l resources; ® aggressive outreach to new and potential alliances. We must reach out to, and enlist In our quest other sectors that have a vested !merest in tobacco regulations,-such as; Consumer grour's Health professionals' groin Emdr r;W groups Smokers for tobacco-control M Old-w Americans inoffty groups igious Unlikaiy Was omewe gMAX der profession assoclatlom Educational groups Political parties tt community organizations Sports organtations e AM local vesents CeWbrkla Y Groups Arts and cultural organizations Non-tobacco related businesses Insurance companies Unions ela and strati plarming and corrow ns capability. Viii GOAL *2: The Tobacco-Free America Legislative Clearinghouse- will continue to provide Its services to the field to assist in the achievement of the goals that are essential to objets of the Countd wn-2000-Biueprint f u ss. • Develop a national, uniform, m d, kitemetive ucommunkadons and distftWon network in conjunction with the A 9 ARA, a national govern relations/public Wffaft Vices and r system dezign Is Consisters with the gods articulated to the Bluepdnt fcr Success. • provide strategic planning counseling support services that Includes a team of GVerts in toba strategies, similar to a SWAT teaffL who are available to travel to states and localities that require mediate strategic support to kill or pass a measure. • Provide tanning for staff and volunteers In tobacco-control advocacy skills, lobbying t ues, media relations and Mon rnanagemenL • Develop resource materials, including policy research and guidebooks. Compile case studies that probe detailed aunts of rnajor tobacco-control campaigns - successes and (allures and lessons learned from those campaigns that may he applied elsewhere; efficacy studies of existing !arms. ix Targeted Populations: Youth, Minorities, Women. and the Educationally Disadvantaged GCS It is a primary goal of Tobacco-Foe America to decrease or deter consumption of tobacco products by groups of Individuals; eted by the tobacco Industry. RATIO : Tobacco use by youth. min ies, women and the educationally disa6/antaged continues at higher rates than other segments of the population. The tobacco Industry has long targeted youth, minorities, women and the educationally disadvantaged with advartisng campaign& The Industry spends massive affxmn of money to sponsor comnxmity and sporting events traditionally attended by these target groups. And. the industry places Its tobacco advertisements In locations that will maximize exposure to these specific groups. In fact, the media has featured many examples of such targeted °p py' and promotidn. In April 1990. the Washington Post reported that RJR Nabisco contributed $30 million for 'Inriovattva .education programs* to schools across the country, Including $1.2 million to two schools In Washington, DC. At around the same time, Philip Morris contributed $1 m8flon to District of Columbia public schools. An Arlington, Virginia woman wrote the following to the Post: The companies are desperate to develop new clients, since so many of their old ones have either quit or died young. This Is only the latest In a series of calculated efforts to lure youngsters to smoke through careful public Image building. Added a District of Columbia man. That's a great ethics lesson the District [of Columbia] has presented to the young men and women in the ration's capital city take the money and run, regardless of the source or the strings a leached. [If] Philip Morris really wanted to promote good Firth for the kids of Washington, It should have removed every sign and symbol of smoking and any mention of Its name - from its contribution and the programs that that contribution would fund. Reed V. T r% M.D., former Commissioner of Public Health for the District of Columbia asks, Where do the cigarette companies go to farad these new recruits for the death march to the land of profit and greed` To get not only to the children, but also the other va ni ble and oppressed segments of our court They go to the people of color, to women and to the poor- The tobacco Industry is subjugating people color through disease. In the spring of 19M. a. black minister. the Rev. Calvin C. Butts, pastor of the Abyssinian Baptist Church In New York City, became so upset with cigarette advertisements In nearby neighborhoods that he whitewashed billboards containing liquor and cigarette advertisements .targeted at blacks. Said Reverend Butts, 'The prevalence of alcohol and cigarette advertisements In-America's inner cities 1 manifests the elastic nithlessness d.these companies' greed and proclivity to explok the poor and disenfranchised people.' Fa Figures Much of t canes for Industry targeting Is tied to the Increased rata of tobacco-re4ited mortality and morbidity in certain segments of the popLWon. For example. black men experience a 20 percent higher mortality rate fmm h disease and 58 percent higher incidence of lung cancer than white men. Mack women have a 50 percent higher mortality rate from heart disease than white worsen. OveraA Wicks are 1.32 times more likely to die from maligna neoplasms, lnciuding lung cancer. They a 1.34 tunes more likely to die from diseases of the heart. Inexorably tied to these statistics is tobacco prevalence dates Prevalence differs when factored for race, sex and level of education. According to the National Health Interview Surveys, 28.5 percent of 'whites as opposed to 34 percent of blacks continued to smoke in 1987. Other dies show that Hispanic raven smoke at even h°sg-her rates, as nigh as 40 percent. Although smaller percentages of worsen than men smoke (26.8 percent vs. 31.7 percent), the overall decline has been foams times greater for mates over a year pedod. By addcational WWI, tobacco use Is almost double for those with no more than a nigh school education when compared with college graduates. For blue collar and white collar workers. the prevalence disparity Is 39.7 percent to 27.5 percent, respectively. Further, according to the Final Report of the 1989 Tobacco Use in erica Contemn= - There Wso afar to be: spcific alga mne brand sr s ng patterns wftWn tllir o y populations. Of those who smoke. 47 percent of Mexican-Aimerlmn mere amoke dboro and 20 percent Winston; 30 :percent of Mexican-American smoke Marlboro, 20. percent Mori and 16 pernt Sale, Use al cigarettes is very common among blacks. with 76 percent reporting that they smoke tee. Such purchasing eats are a testa, tarVe part, of condnued tobacco Industry targeting of these grow - Early In 199D. R.J. Reynolds Introduced a new product, called Uptown, clearly targeted to blacks. Said Secretary of Health a~ d Human Services Louis W. Sullivan. OX a lints when our people desperately need the message of health promotion Uptown's message Is mors d ass, more suffering and more death.' 2 - - -The test-rnarketing of Uptown in Philadelphia was stopped only-after a public uproar was led by a coalition of more than 40 groups and given greater credence by Sullivan's comment& While - addressing a press conference In February 1990, Sufound llivan said It Is frightening to realize that studies have that the younger the age at which one begins to smoke, the mom likely that a person will become a tong4erm smoker and develop srnok ted disease& In fact, 90 percent of smokers begin a e addiction as children or adolescents. Advertisers I shun the temptation of this taWad money, stalned by addiction. disease and dead. Finally I call upon amokwa and potwgial smokers ® including yob people, 'o no i "es and blue-collar workers - to erase good jWgement and personal responsibility. The l e you may not only be-yon own b4A also the life someone y love or maybe don't even know. who rnig3tt passim breathe the deadly tobacco f e& - 'tobacco Promotion In February i9 W. R.J. Reynolds caused an uproar when the public learned that a new brand, Dakota, would be test marketed to young, poorly educated white worsen described by the cigarette manufacturer as avirfle females.' The preferred Dakota smoker was described by R.J. Reynolds as 'a -woman with no education beyond high school, whose favorite television roles are 'Roseanne' and evening soap opera 'bitches' and whose chief aspiration is to get married In her early 20s and spend her free time %vkh her boyfriend doing whatever he is doing.- The Women VS. Smoking NetworK a coalition of women's groups based In Washington. DC. noted the parallels between Dakota and Uptown. According to a director of the group, Anne Marie O'Keefe. "When you target for marketing you target for death." Tobacco ustry product manipulation has included promotional efforts such as the marketing _.,of -fated_~smokeless cis in 1988.--.Jhe<,ciWene..was-adverfted as providing 2T-he Cleaner Smoke.' Under intense public pressure, led by the Coalition on Smoking OR hleatth and other pro-bmith groups, the product was-puffed off the market In late 1918. The Coalition had previously petitioned the Food and Drug Administration to gate <low-W cigarettes, Including Premier, In an attempt to expose their use as a drug delivery system. The Coalition argued the tobacco companies' advertising was tantarnourd to a health claim. Tobacco companies frequently sponsor sporting events. Including bo%~Iing. skiing, speedboat racing, truck and tractor puffs, fishing, tennis (Virginia Slims circuit). stock car racing (Winston Cup). soccer (hJ°J.ariboro Cup) and horse racing (Marlboro Stakes). Although tobacco advertising is prohibited 3 on television. the strategic placement of tobacco product ads In baseball stadiums, hockey rinks And other sporting venues Is quite visible when American families (and their children) watch TV. in early 19W. USA Today-reported that tobacco company spon d sports and CUWW events amounted to $150 million In 1 , with about 7 pent spent on sporm Dr. Alan 81of Doctoms Ought to Cam, are cutspoken of the tole InCILWY and ks advertising and promotional egies. states, "You watch an awo race and you going see cam tracks with cigarette logos. You watch tennis and you ses the logos In the background. Truth is good, but Juxtaposition is better.' States Joe Cherner, president of Smoke-Free Educational Services In New York City, I have found that the average sba"rade girl actually thinks women tennis players smoke= Jennifer priatl plays Virginia Slims (tournaments) at 13 [years of age]. That means she is not old enough to smoke but she is old enough to be a walking billboard for a cigarette company.' A recent Winston adverusernent included a *900' number to call for sports scores. The brand was advertised as Your ticket to the best in sports.' 7uckson says, The tobacco industry seeks to gain 'innocence by association' through. sponsorship of events° They attempt to make cigarette brand names synonymus with community aver like the Ebony Fashion Fair, the Kool Jam Festivals and Salsa Festivals In the Latino community.0 Helen Munoz, of the National Coalition of Hispanic Health and Human Services Crganttations, sheds further light on the subject Perhaps most disturbing of all.' she says, se study of 4th and 5th graders In Los Angeles revealed that Hispanic boys -and girls-are more likely to say they used cigarettes (than their non-Hispanic counterparts) and that Hispanic boys were six tunes as likely as fir nor- ic white counterparts to be smokers.' Using such practices, the tobacco industry regularly violates Its own 'voluntary adyenWW and sampling fie.' The code prohibits advertisements and sampling practices a Jed at persons under the age of 21. For example, the industry also has resorted to 'cis whereby cigarette smokers can send in cou to redeem "prizee ranging from additional packages of cigarettes to compact dLqc& A recent glveaway promised a free pack of Alpina cigarettes. The only protection against m1nors participating was a disclaimer on the advertisement that eby accepting this offer you certify that you are a a _ _ smoker 21 years of age or older.' R.J. Reynolds sponsored a Willionaire Cash Quiz me' whereby contestam wem.urged to submit ten or mom correctly answered game tickets In order to win S2. The nxxo ppacks the snore money you could win. The Industry also targets the economically disadvantaged and the young through the marketing of generic products.. This sector of the market has risen dramatically In recent years and riow holds a substantial market share. The tobacco industry also targets these groups with promotional giveaways of items such as hats, T-shirts and sporting equipment. These Items are often disputed at areas of high concentrations of youth, such as sporting events, rock concerts and public beaches. Access & 01stribution Most cigarette vending machines remain unsupervised, Inviting purchase by youth. Free samples are distributed on street corners and at athletic and music events well-attended by those under 1S years of age. By raid-1990, 45 states had minimum-age lays for the purchase of cigarettes. Yet, enforcement of these laws Is a serious problem. Most current licensing laws do not address the Issue of enforcing the minimum age for purchasing tobacco products. Officer Bruce R. Talbot of the Woodridge (IL) Police Department, testifying before Congress In April 1990, described a new law passed in his hometown. die said he had - received complaints from teachers. parents and even the students themselves that Woodridge merchants are selling cigarettes to minors.. On one occasion. a gym teacher observed a 13-year-old female student purchase a pack of Marlboros from a MoN gasoline stations just two blocks from the school. Woodridge-has reduce tobacco sales to minors from 83 percent to zero. But without this legislation our local efforts may have been for naught because the merchants: whose stores ;border Woodridge continue to sell cigarettes to 13-year-old children 94 percent of the time. Philanthropy In INS. the tobacco Industry contributed millions of dollars to the National Archives to help promote the anniversary of the BM of Rights. This action placed the Philip Morris name on millions television sets for the first time since tobacco advertising was banned on television nearly 20 years ago. The Coalition on Smoking OR Health called the campaign - 5 _ a corporate image advertising blitz that was cleverly deskjned to wrap the tobacco company and, by Impli torn, ifs rr rket ng practice In t American fag and the f - ten amendments to the United States institution- The ed bM Aglts carnpaign Is not abort freedom or god corporate cal hlp. It is Wended to Avow the cigarette company's goal of continuing to meet €n, women and btu r workers.... Tuckson points out that Philip !Morris gave $2.4 rnrM!on-to Me kx=1 chapters of 180 black, his panic and women's groups In 1987. Says Tuckson, .The United Negro Sege Puri nxxived $267,000 from R.J. Reynolds, $120,000 from PhRip Morris and X2.000 from Bryn and Ilarnson. So they are telling the 18-year-olds going to college, We gave you all the money for your education, so you owe us access to your market= Countdown 2000 Legislative & Regulatory Objectives A001 t tad igtribkgi, c9 Tobacgo Er cts .Although the tobacco industry has developed Its own .Code of Cigarette Sampling Practlces.' which detalls certain standards to be observed to avoid distributing cigarette samples to under-age children. reports of random spot-checking of sampling and distribution points prove that such resbi;ctlons are not being observed. Trials observing minors attempting to purchase cigarettes in BostM l rage, MO. Allentown, PA, Decatur. IL Brookline. AAA, Worcester. MA, New Brunswick, NJ and many other cities found that minors were able to purchase tobacco products more than 70 percent of the time. Countdown 2000 Cblective: Achieve a bars on cigarette and tobacco product vending machines. As Interim objectives, the fallowing measures are acre ble public polLy. • a ban on unsupervised vending machines and/or • a barn on m e vending machine& ° Any state law enacted to limit mess to tobacco product vending machInes must also dearly recognize that ft mere posting of signs is ineffective in deterring access by minors to tobacco products sold via vending machines. Additional Countdown 2000 objectives Include the fail • estabfth, as the standard, a minimum purchase age for tobacco products 1S yem of age; • adequate and meaningful penalties should be set for both er and . mkxm. • faire the tensing of risers comparable to the flcenses hued for the se4s of al is beverages. The use of the licensing gee could be applied toward the cas" of enforcernem public education activity, . 6 _ _ ban the distribution of free or discounted samples; and • prohibk via the mail system, access to tobacco products. - CriticaLto-any law1hat adequately addre she.problems of access to and d utlon of iobacco products to young people Is the enforcement of such laws and regulatiorm attention must be paid to • p n of ade4ixiie resources to state and local agencies charged with enforcement responsibilities, • authority to conduct random monitoring of r ns on access and cliZibutlon of tobacco produ to minors, and • - -establ nt of mechanisms to facilitate the reporting of citizen or other complaints to a designated office or department concerning violation of laws that restrla or pmhlbk the sale and/or distribution of tobacco products to minors. Inspection responsibUltles should be dearly delegated to such designated offices. Advertising To curb advertising abuses by the tobacco industry. TFA recommends as a CourAdown 2000 objective, enactment of state and local bans on advertising to the fullest extent permitted by the U.S. Constitution and not In violation of federal preemption law (Public Health Cigarette Act of 199). Countdown 2000 Objective: As allowed by the U.S. Constitution and federal law, ban the advertising of tobacco products within each state. Specific objectives could be • a barn on all billboard advertising and advertising on other public visual displays (scoreboards: --..-a-ban.on advertising-within state supported::mass -transit systems: and • a ban on all advertising in 101M = media. There is considerable case law distinguishing the power of the federal gcve under the Commerce Clause of the U.S. Constitution from the powers of the states over intrastate commerce. There Is even a Suprenw Court decision upholding a sttate°s right to regulate bill advertising. However, the federal preemption clause applies to adve that addresses the a p ;between smoking and health= Therefore` bans on billboard dve mast be ' of all advertising. hdwM Promotion There is growing dependence by the tobacco industry on promotional activity to secure new smokers. This is especially true for youth, minorities, women and the educationally disadvantaged. 7 Countdown 2000' Objective: Bari tobacco product promotion to the fullest nUrd permitted by the U.S. Constitutions including but not limited. to product manipulation, spo po pricing, give- away* JL&: flash tats atQ), upons and product plaicanwrit. den added objective could be - • funds ralsed thigh tobacco product excise taxes shouid be eanmrked to support aftematlve sponsorship community-related ac"es. het< ti ~~l id tdtigns Much can be done through grassroots efforts to decrease or deter the consumption of tobacco products by youth. In the arm of ed 'on and empowerment, TFA recommends that moots consider the following additional activity: advocates • network with the non-health based institutions (religious groups. youth clubs. socW organizations and community groups) to foster education, and to ensure promotion of self- esteem; • seep mandatory comprehensive sohool education prof m (K-12) that include tobacco education, emphasizing Wat tobacco is an addictive gateway drug and that the tobacco industry deliberately advertises and promotes cigarettes In ways that lure yob Into becoming addicted to their products; and • promote and encourage funding for counter-advertising and counter-promotion alrned at youth. For minorities, TFA has the following additional goals: • increase the cultural and language relevancy of educational messages, and • increase state funding for €rainority health programs to support program to prevent tobacco use and to address tobacco use cessation. As a final action, TFA recommends support of applicable sections at federal legislation that VMWd provide grants to states for activities that will prevent the Initial use of tobacco products by minors, encourage the dory the use of tobacco products through prohlb1tions on the salt of tobacco prods to nvnors, Improve the erf ent existing provisions. • • prohibk the sale oftobacco products In vending machines unless the presence of minors is not allowed on the premises where the machine Is located, • promote and enforce a minimum age of at let IS for the purctme tobacco produce, enhance the ab ity of state health departments to it rd comprehensive planning and intervention a s for €i-tobacco use, and • provide education and training to teachers and health care professionals. a _ Conclusion As meted in the Final Report of Vie Tobacco Use in America COaffence, held in Houston In January 1!39 ies have Whown a relationship between media dependence on tobacco rtlsing revenue and coverage smoking a health topics. Tobacco sponsorsNp of orgar&ations and events appear to discourage those organizations from speaking out and editing their constituents above smoking and hem ci tw advertisft and lore also seem to affect ard/orpromote are atrnosphere In which tobacco Is legitimate, even wholesome, and cert aly acceptable.' We are dealing with an industry whose voluntary code states that 'c! a not suggest that smking is essential to social prominence, distinction, success or smajal ' State and local public policy makers must work within their constitutional and federal legisiatlve constraints to regulate what the tobacco industry has obviously failed to do on its own. 9 . . . . . . . . . . _ Tobacco Excise Taxes: Raising the Cost of Tobacco CCAU To Incmase. at a substantial rate, the existing: state and local all tobacco produce to deter a nsumptior4 especially long young maple RAMO NAl t. Sbcty merit curry smokers by age, 14, 90 perms age 19. Rwwrch Indicates that teenagers are more price-responsive and USG 19W Uft= ' the price Increasm Tobacco was one of the first goods faxed In North America, LnItialiy by the British and then by the my lndependerd Republic in the early 1790s. The early fax on snuff was eliminated In 1804 and revived briefly as a wartime measure In 1814. Various federal tobacco taxes were Imposed In 1864. including a tax on cigarettes. as part of a package of taxes to finance the CM War. In one form or another. federal excise taxes on tobacco have remained a part of the tax system. The tax on tobacco was a particularly important source of revenue to the federal government prior to enactment of the Income tax In 1913. The federal tax on cigarettes over the 120-year period from 1964-1983 tended to fluctuate with the revenue requirements of the government, corresponding to alternating periods of war and peace. The federal tax on cigarettes, introduced during the Civil War. was raised briefly during the Spanish American war. and again during World Wars I and SL During the Korean War. the federal excise tax was Increased from seven to eight cents per pack. It remained at this level for more than three decades, and was then temporarily doubled to Ifs cents a pack as part of the Tax Equity and lFiscal Responsibility Act of 1982. After several temporary extensions. Congress made the 16-cent rate perrnanent In 19M. A federal excise tax on smokeless tobacco was levied by the Omnibus Bridget Reconciliation Act of 1985. In 1987, federal tobacco taxes grossed $4.8 billion, with more than 98 percent of revenues provided by the tax on cigarettes. But cigarette excise taxes have contributed a declining share of total federal revenue since World War H. Moreover, the federal excise tax has deciiried In real temu since 1964, despite rising concern about the adverse health effete of smoking that followed release of the 1954 Surgeon General's Report and adoption of specific federal toba r l policies. One reason for the decline was the lack of legislated Increases In the tax rate. inflation also eroded the real excise tans because these taxes tend to be unit rather than ad valorem takes. A unit tax Is a constant nominal rate per unit of a well-defined product. whereas the ad valorem taxis a constant traction of either wholesale or retail price. Current federal taxes on cigarettes, 10 cigarette paper and tubes. smokeless and smoking tobacco, and small cigars, as well as most ate and local taxes on cJ es, are unit taxes. Federal taxes on large cigars and most state taxes rion- cigame -tobacco products are ad-valorem a maces fall relative to the price of cigar es when cigarette are not changed by at least as much as the rate of general bRation or t rate of kmsase In cigarette prices. Price Elasticity & Demand for Tobacco Produce -One of the first p'inciples learned In Economics 101 is the law of downward sloping dernand, 1 Is, the don-and for a product declines as the price increases. Many studies have shown that this rwory holds for tobacco products, especially cigarettes. Several steadies have been conducted to measure the reliability of teenage elasticity. The General Accounting Office (GAO). In a June 1969 steady, concluded that teenage smokers do respond substantially to changes in cigarette prices. The GAO report indicates that the range of estimates for teenage elasticity (ages 12-17) vary from -0.76 to -1.2. Thus, a 10 percent increase In cigarette prices will result in a decrease in teenage smoking from 7.6 percent to 12 percent. In 1966 the National Institute on Drug Abuse indicated that 16 percent of high school seniors (aged 17 and 18) smoked. U you determine that you want to cis this rate In half. or 9 percent a 10 percent tax Increase should accomplish your goal since such an Increase will cut consumption anywhere from 7.6 percent to 12 percent. Should you determine that you want to el' a smoking by high school seniors, according to the elasticity model. an increase of 20 percent or more would be necessary. Health Impact of Tobacco Excise Taxes: Look at the Debate Kenneth Warner. RLD., contends In his article. 'Health and Economic Implications of a Tobacco-Free S that the arguments of both the tobacco industry and tobaCCO-Contral activists are fundamentally flawed, or miss the pckv- Warner believes that the economic I npact of a tobacco-free society would be modest and of far less cores -.than the pl' , a significantly enriched -quality and quantity of Iffe.- The Warner article. which appeared in the Jouma/ of the Amedcan Med cal Associatlon In October 1967, clearly states that the use of cigarettes causes more premature deaths-than AIDS, use of 11 heroin, cocaine and alcohol, fare. •autornobile accidents, homicides and suicides combine& ent -d =o4ree society by the year would 2000 efirnimw 1 .Wo prematum d spamd a tobacco-reWed death cad add 15 years to Warner frrles that aftwkV the causes d death In the country will reduce the burdens on health care facMes and s medical specialties to odw d e arm. He Is concerned that the tobacco Industry cries that the demise d the tobacco Industry will ruin the U.S. economy, while tobacco-control activists falsely suggest a muftl-blillon doW fiscal dividend. loth are wrong, according to warmer. whIs some in the voluntani heath agencies concerned with tobacco might argue with wamees e on of the debate, we must not lose sight of our goal, which Is to kxnmw the excise tax on tobacco products to deter consumption of these deadly products. H the additlonal revenues are -spent by our poles leaders is their decision. Although we may be asked to comment on the use of those funds. our Interest is the public's health. Policy Considerations Public policy considerations entrenched in this debate include the following: How much do you raise the tobacco excise tax at the state and local level? How does the federal tole excise affect state a local taxes? What are the berms of switching from ai specific unit tax to an ad valorem tom? Do we support efforts to earnnark or dedicate a portion of the increase In tobacco taxes for education programs or related ?wealth care casts? Mew do you counter bootlegging/smuggling arguments? ---How do you accomplish wising the tobacco excise twC- legislative processor through Initiative and referendum? Countdown 2000 legislative & Regulatory Objective T® g gise Taxes Selecting the appropriate level for a state tobacco excise tax pIlments the legislawe activity suggested in the previous section. Targeted Populations: YoutK Minorities. Women and the Educationally Disadvantaged, by adding a further tool to the penal available to deter young people and other targeted populations from taking up the addictive habit d tobacco uses- _ _ C 12 _ State officials continue to be concerned that an increase in tobacco excise taxes at than federal level wouid adversely affect their oven revenues. Studies shover that this. has not tappened. p rrly because some states Increased their excise tastes at the same time as the federal goverrunent. Countdown 2000 Objective: Achieve an Increase In the state and/or laical tobacco excise tax sufficient to deter tobacco use by young people. There are a variety of strategy options available to determine the appropriate leis of kxnk-ise for a state or local tobacco excise tax, including: • Strategy Option 1: Level of Taxation Wlth the exception of Hawaii, all federal. state and local tobacco excise taxes are specific unit takes, that is a speck set amount per pack of cigarettes. This formula Is used because of Its administrative simplicity. Yet the negative effect is that real revenue tends to decline with Ir3flation. Unit excise taxes must be raised periodically If rail revenues and the Impact on consumption are to be maintained. An option for consideration Is replacing the unit excise tax with an equivalent yield ad valo a tai:, which is a constant fraction of either retail or wholesale price. Another option Is to index the unit tax to changes in either the general price level or to a price index for cigarettes and other tobacco products. A final option is to consider use of the teenage elasticity figures (-0.76 to •1.2) to compute the tact Increase for your state or locality. Other Issues to consider when determining the level of taxation include the tax level in neighboring states or localities. date of last increase and tax level on other tobacco products If only a cigarette tax increase is under consideration. Strategy Option 2: Earmarking An excise tax increase may be justgfiied based on the fact that a higher cost for the product may be a deterrent to a practice=-tobacco use-that has an undesirable health consequence. Thus, new revenues may be earmarked to various public need Including the costs of health care, public and/or school education, or counter- advertising and promotion measures. f Strategy Option 3: Bootlegging and Smuggling The possibilities of bootlegging and smuggling are often used as objections to raising tobacco excuse taxes. Officials are concerned about losing revenues to neighboring states or localities. Such problems can be resolved by raising the level of taxation to meet or surpass the rate In surrounding areas. 0 Strategy Option 4: The Legislative Process vs. An Initiative or Referendum State excise taxes can be legislated by governmental jurisdictions or by citizen petition. The lobbying efforts of tobacco companies frequently make It difficult to increase state 131 excise taxes on tobacco products by the state legislature. In these clrcur-Lances, the _ In Native process has preen to be an effective vehicle for mange In those testes t allow Initiatives or referendum Undertaidng the InIflative/referendum process requires an abundance of resources, both human and financial. To be successful proponents need a strategic i c l/rued. plan to deal with MIS high stabs process and the well-landed"tobacco Industry. Only 25 states allow lnfiiatives and referendums. The table on the following page provides information on each state's requirements, Strategy Option 5s Exemption Clauses In many smtes, tobacco products are exempt from state or local sales tic. Consider the removal of any exemption clauses. If your state tms such language in Its taxation code. conclusion From a public heafth policy perspective. a primary focus of the excise tax Increase on ail tobacco products is the deterrence of smoking. Since the tax increase also will generate substantW income, Mch state will need to establish guidelines on how to use that revenue. Support for new tobacco excise taxes can be expected from various Interest groups with sometimes differing perspectives on government funding priorities. Consouendy, ft Is Important to bring together early in the campaign process those whose perspectives should be recorded to assure a. successful outcome. As states begin to Implement the Countdown 2000 Blueprint for Success, the Tobacco-Free America Legislative Clearinghouse will play an extremely important role. It is essential that the Clearinghouse be considered the primary resource canter in any coordinated effort to secure new excise taxes on tobacco products. 14 FLEMONS Tzbk 5.29 STATE a . G PERMSSON TO CMCUIATE A P ON i-164P -~j - lea 03 ~ j7w AOMPM fry Aw*~7 moo in IMAM m T iT ss ST M T 3 T AG v N AG AG M COMM • t T AG St M AG ,4G Y N Y t M A~ C Y *waft . tea........... . m9wa Y. sr N AG AG T Y Y~ Vie Y &mwo 7 samms? Y 1 Y Lomm Me . . 3 T Y r ss st r r r 8® ss YY AG AG Y T r ~S s M AG AG T N 9 T ji EV ss p T AG AG T M _ Y ss SP N N T T gam "OLIG t Y ss ss SS V.00 CAROM ? T. T ss SP ~Y a 3 Y gel aggs T T Y~ 21 SF T Arp Y N T Y T ss st N 35 Y Ong . r ss t sa ss ss T , . 3;Vi¢ imad y T t Y N pml~m T ss Ussom Yom Twms . ~ Y t t ~ ~ T AG ~ Y N T v v a a T s aftow s tae Or 418 Iftbb ,MUM N Tau fts m& vwm or $W S s ~e ~e f"m N~ f of dw *mmw Awl ea• smy bg tsY ~ ~Y$ B REF si B oe.. s a awaymaw a" Rom gG G Ig *a s m at test ~ tit ads s8 A > a~B 41 8a ffi ass s I&AM V vBfl &Va eta sfmumJ3 ftovpml 4A+awmgw 1. Im ban ~ t ~s FNS ~ sttmm dew w of ow. aH $fffi> PC" m- t . t~3 P4iet adr 8 s $as a6 r8s 48 AQ Lq*kmw ~ &rt H 9~ E a~€ aawOS Sod w The Council of State Gov eats 273 15 Restrictions on Smoking in Public Places GOAL* To protect public health, exposure to environmental tobacco smoke should be eliminated. I TI®NALI-, Establishment of public indoor smoking wig prof public hWM by offecWft reducing voluntary ensure to environmental tobacco sr ka: ing to the U.S. Surgeon General, as many as 5,000 nonsmokers die each year of dlssease3 caused by inhaling smoke released Into the air by tobacco produces Environmental tobacco smoke (ETS) is second only to asbestos In causing more deaths than all other combined, known airborne pollutants While much is known about the adverse health consequences of tobacco use by smokers, recent reports also show a clear health danger to nonsmokers. As a result, public policy debate by low, state and federal lawmakers has focused on protecting nonsmokers from IaTTS. According to the 1990 Tobacco Free America Legislative Clearinghouse report, State Legislated Actions can Tobacco Issues. '45 states and the District of Columbia restrict smoking In some manner in public places.' These laws, coupled with those at the local level. range from simple (banning smoking on school buses while they operate) to comprehensive (restricting smoking In most public places, including restaurants and all work places). While there has been a dramatic proliferation of smoking control laves over the past three years, the policy debates that have erupted in local and state legislative chambers havt proved that thA tobacco Industry has raised the stakes by abandoning the political strategy of opposing all smoking control laves to pushing for laves that preempt local action and classify smokers as 'a protected class, Across. the .country, the tobacco-industry-is -working to consolidate its poorer In the statehouse. - State legislatures provide a forum more conducive to working through political procem fnoiuding campaign contributions, wall-placed and w ed hIg paid lobbyists and legislaWs maneuvers controlled by Institutionalized pour brokers. The tobacco lndusuy Is In a d ge contrd mods on smoking control laws and would prefer to use the sate political system where cftens have low zoom to lawmaker' to l ies where public opinion generates policy change mom raptly. To effectively coumer this strategy, public health advocates need to work for public Moor smoking control laves that adhere to the highest public health standards a standards that meet the daunting health risk posed by tobacco use and exposure to others' tobacco use. To meet this challenge, it is vital that public health advocates establish firm public policy 16 positions that define basic goals and establish the parameters for negotiation strategies. While the political climate in a given legislative body may not be conducive to achieving all of the goals articulated In this blueprint for ~cuccem, it Is crucial for yoking ;advocates to secure resutdons an snv*Ing In child cre facIlUes, educational best' and the work place. These are absolutes. Other provisions In public indoor smoking-control lags may be used as points of negotiation. leverage to ensure Inclusion of the priority affecting children and occupational protection. Countdown 2000 Legislative Regulatory Objectives Hesttictlons on _Erriokinc in Public places Restrictions on smoking In public places remain a keystone in the overall challenge to achieve a Yobacco-free society. To accomplish the public health goals inherent In this arena, TF A recommends that a series of provisions be adopted to provide uniform protections for the nonsmoker. Priority emphasis should be placed on achieving restrictions that provide protection for children and the adult workforce. Protection of children is not only a public health Imperative but Is essential to set a healthful example that could prevent children from becoming addicted to tobacco later In life. The latter requires restrictions on the use of tobacco products by teachers and other school personnel while on school property. The work place is targeted for priority action because working adults spend a slgnificant portion of their waking hours--fight or more hours per day, fire days per week-at work. Daily exposure to tobacco smoke poses an unnecessary health risk and therefore, elimination of tobacco smoke exposure becomes another critical public health goal that should lead to increased productivity, decreased employee health problems and a safer work environment. Countdown 2000 Objective: Enact a comprehensive Clean indoor Alr statute to ensure elimination of exposure to environmental tobacco smoke. Comprehensive statutes should Include the following provisions: A prohibition on smoking in all child care facilities, including any portion of a facility whose purpose Is the care and/or pre-school education of children. 17 _ position that define basic goals and establish the parameters for negotiation strategies. e the political climate in a given legislative body may not be conducive to achieving aft of the Qoals articulated In V* Blueprint &r S~cen. It Is = for smoking-contral - - advocates to secure resvictions an smoldng In child care faclities. educational Irwitutions and the work place. Them a ute& Other p ' ns In public indoor srnoking-control law may be umed as points of tiort, leverage to ensure Inclusion of the priority affecting children and occupadonal protection,. Countdown 2000 Legislative Regulatory Objectives BgstriZJgns on mokla in Publig Places Restriction on smoking In public places remain a keystone in the overall cha°lenge to achieve a tobacco-free society. To accomplish the public health goats inherent In this arena, TFA recommends that a series of provision be adopted to provide uniform protections for the nonsmoker. Priority emphasis should be placed on achieving restrictions that provide protection for children and the adult: workforce. Protection of children is not only a public health Imperative but is essential to set a healthful e=mple that could prevent children from becoming addicted to tobacco later In life. The latter requires nntrictlons on the use of tobacco products by teachers and other school personnel while on school property. The work place Is targeted for priority action bemuse working adults spend a significant portion of their waking hours-eight or more hours per day. five days per week-at work. Daly exposure to tobacco smoke poses an unnecessary health risk and therefore. elimination o$ tobacco smoke exposure becomes another critical public health goal that should lead to increased pr u , decreased employee health problem and a safer work environment. Countdown 2000 Objective: Enact a comprehensive Clean indoor Air statute to ensure elimination of exposure to e n ental tobacco smoke. Comprehensive statutes shd Include the following prohibition on smoking fn all child facilities, Including any • portion of a lacier whose purpose is the care and/or pre-school education of children, 17 consumption including, but not limited to, restaurants, cafeterias, coffee shops. diners, _ ch shops and short-order cafes. A bar is defined as any indoor area open to ft publIc and devoted to the sale and service. of alcohol beverages for on-promises consumption of such beverages. Service of food is considered Incidental V the food service generates lass than 40 percent of total gross sales. Any bar that generates 40 percent or more of total amual gross sales from the sale of food for on-premises consumption should be considerod a food service establishment. A prohibition can smoking In Indoor areas open to the public Including auditorium. elevators, gymnaslums, enclosed indoor areas containing a swimming pool. public buildings (any building owned or operated by the state or any county, city, town, village or other political subdivision, public improvement. or special district. public authority. commission, agency or public benefit corporation, or any other separate corporate Instrumentality or unit of state or local government), theaters, museums, libraries, indoor common areas. waiting rooms, banks, rest room and waiting areas in public transportation terminals. • Any comprehensive Clean Indoor Air statute must root contain any pmemptive clause: that are Intended to remove power and authority to regulate the Indoor environment from a unit of local government. Preemption clauses have been attached to laws restricting smoking In public places In six states. A new form of preemption was recently passed in Virginia (1M) that was disguised as a *local option.' Local option permits localities to enact ordinances that further restrict smoking In public places; however, the low legislation must conform to a emoder bill laid out in the state law. Because the state law dictates to localities what language they use, this local option clause serves as a disincentive for localities to take actlom Preemption clauses may serve to weaken stronger pre-existing local laws. preclude stronger local laws from being passed In the future and runt contrary to the usual legislative procedure of setting minimum standards that to governing bodies may exceed. • Any comprehensive Cleary Indoor Air statute must rot contain provisions that provide clvii rights protection for smokers against employment discrimination. ° 19 consumption Including, but not limited to, restaurants. cafeterias, coffee shops, dinem sandwich shops and der cafes. A bar is defined as any Indoor area open to the public and devoted to the sale and service of alcohol beverages for on-premises ption of such beverage& Service of food Is considered incidental I the food service generates low than 40 percent of total gross sales. Any bar that generates 40 percent or more of total annual r saes from the sale of food for on-premises consumption should be considered a food service inert. prohibition an smoking in Indoor areas open to the public including audko , elevators, slunw% enclosed indoor -areas containing a swimming pool. public buildings (any binding owned or operated by IN state or any county. city, town, village or other political subdivision, public improvement, or special district, public authority. commission, agency or public berief t corporation, or any other separate corporate Instrumentality or unit of state or local government), theaters, museums, libraries. indoor common areas, waiting room, nks, rest moms and waiting areas. in public transportation terminals. Any comprehensive Clean Indoor Air statute mu n t contain any preemptive causes that are Intended to remove :power and authority to regulate the Indoor environmertt from a unit of local govemment. Preemption clauses have been attached to laves restricting smoking in public places In six states. A new form of preemption was recently passed in Virginia (I M) that was disguised as a local optfomo Local option permits localities to enact ordinances that further resuia ng In public places; however, the Local legislation must cordorm to a "modeF bill laid out In the state law. Bemuse the ate law die tes to :tie what language they use, tit local option clause serves a disincentive fmr localities to take action. Preemption clauses sway serve to weaken stronger pre-existing local laws, preclude stronger kxcal laws from being passed the future and run convary to the usual legislative procedure of setting minirritim standards that local governing bodies y exceed. Any cornprehensi Clean indoor Air statute mLjst net contain provisions tMt provide mil € hts protection for smokers against employment discrimination, 19 . in fact, the overwhelming popularity of smoking-control policies has less government and business alike to provide ennanced protection for their workers and patrons. The provisions articulated In this Blueprint for Success are not designed to pit smokers against nonsmokers. They are not Intended to force people to stop smoking. If laws are astablLshad based on the public health p es advanced In this document they will prevent the Involuntuy exposure to an Indoor environmental tox!rL Many state and local governments already have established sound smoking-control !Many cdwrs have taken t , although Inadequate, steps to address the health Vveat posed by Irs exposure to environmental tobacco smoke. The Tobacco-Free America Legislative Clearinghouse serves as the primary national source for information on tobacco-control initiatives for the voluntary public health community, state and local government officials and the media. This is a valuable resource that tobacco-control advocates are urged to utilize. 21 In fact, the overwhelming popularity of smoking-control policies has led government and business dike to provide ennanced protection for their workers and patrons. The provisions articulated In this Blueprint for Success are not design to pit smokers against kern, They are not Intended to force people to stop smoking. If laws are established based on the public health p es advanced In this document they will prevent the hwoluntary exposure to an Roar environmental toxin. Many sWe and local governments already have established soured smoki rod # s. Many cdwm have taken to gh inadequate, steps to address the he,h throw posed by Involurgary exposure to environmental tobacco smoke. The Tobacco-Free Americas Legislative Clearinghouse serves as the primary national ;scarce for information on tobacco-control ini-tiatives for the voluntary public health community. s=e and local government officials and the media. This is a valuable resource that tobacco-control advocates are urged to utifte. 21 Restrictions on Stroking in Public Places Advocacy InstitLee and Public Citimen. The Advocates Guide to Preemption: Preserving State and Loc! PnXection for Public Health Safety. Washington, DC. 1M. Goamer. Donald, Pair Treatment for the New Minority. 19W. Sylvester, Kathleen. 'The Tobacco Industry Wlli Walk a Mile to Stop an Antl-Sas oking Law.' Governing. May 1990. Tobacco-Free America Legislative Clearinghouse. Anti-discrimination Protection for Smokers. Washington. DC. 1994. Tobacco-Free America Legislative Clearinghouse. Guidelines for State Legislative P urea. Washington, DC. 1994. Tobacco-Free America Legislative Clearinghouse. lPreernptiom Restrictions on Smoking In Panic Planes. Washington, DC. 1994. Tobacco-Free America Legislative Clearinghouse. State Laws Restricting Smoking on School Property. Washington, DC. 1989. 'tobacco-Free America Legislative Clearinghouse. State Legislated Actions on Tobacco Issues. Washington, DC. 1994. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Smoking: A Report of the Surgeon General, Washington, DC. 1988. 23 AYSTERIA ABOUT SECONDARY SMOKE--TIMELINE Yage 1 of 3 HYPE AND HYSTERIA ABOUT SECONDARY SMOKE MORE THAN 50,000 PEOPLE DIE EACH YEAR FROM HEART DISEASE DUE TO SECONDHAND SMOKE FALSE At the Seventh World Conference on Tobacco and Health held in Perth, Australia in 1990, anti-smoker crusader Stanton Glantz gave the keynote address in which he said, among. other things. "The main thing the science has done on the issue of ETS, in addition to help people like tae pay mortgages, is it has legitimized the concerns that people have that they don't like cigarette smoke. And that is a strong emotional force that needs to be harnessed and used. IsWe're on a roll, and the bastards are on the run. And I urge you to keep chasing theta." But the public was not terribly incensed about the alleged "3000" deaths each year blamed on secondary smoke. So to create a problem of epidemic proportions that could be used in the war on smokers, and using several disparate epidemiological "studies," Stanton Glantz performed a meta-analysis which was published in the journal Circulation in 1991, and republished in JAMA in 1995. (Of the 12 studies on fatal myocardial events used by Glantz in this review, 8 showed NO statistically significant risk for ets exposure in non- smokers; of the 11 studies covering non-fatal myocardial events, 10 failed to show a significant link.) Relying heavily on questionable research about a tiny increase in arterial deposits, Glantz came to the conclusion that if a non-smoker exposed to secondary stroke had 20% increase in arterial deposits, then 20% of the 1,000,000 heart disease deaths each year must be attributed to secondary smoke. Disregarding the concept of "threshold," he wrote a massive paper on it and his conclusions have been used since to claim more than 50,000 deaths due to secondary smoke each year. Realizing the flimsy basis for such a claim, no agency of the U.S. government--including the EPA and the CDC--has officially endorsed Glantz's misrepresentation of the facts. However, even with this most blatant misuse of science, the American Heart Association still uses Glantz"s biased figure of 50,000 deaths a year as does the anti-smoker cartel of NG0s, pharmaceutical companies, once-respected charities, and paid professional anti-smoking activists. MORE THAN 3,000 PEOPLE EACH YEAR DIE OF LUNG CANCER DUE TO SECONDHAND SMOKE FALSE In 1992, the EPA report "Respiratory Health Effects of Passive Smoking," based on a meta analysis of I I separate studies, uses 3,000 deaths per year attributable to environmental tobacco smoke. Federal judge William Osteen, the very same judge who had earlier ruled that the FDA should control tobacco, overturned the EPA's fraudulent report. He said that the EPA "'publicly committed to a conclusion before research had begun... disregarded information and made findings on selective information; did not disseminate significant epidemiologic information; deviated from its own Risk Assessment Guidelines; failed to disclose important findings and reasoning; left significant questions without answers... produced limited evidence, then claimed the weight of the Agency's research evidence demonstrated ETS causes cancer." In short, the report was faked. In 1995 the Congressional Research Service (a 741 person, $62 million per year think tank that works exclusively for Congress) rejects EPA and 3 other studies as not statistically significant and tainted by poor research and analysis. After 20 months and several million dollars, the CRS stated: "It is verb passible that no deaths have been caused by environmental tobacco smoke. " It found no basis for a proposed OSHA smoking ban in federal workplaces. In 1998, the World Health Organization study on environmental tobacco smoke, purportedly the largest such ever undertaken, comprising 20 years in 38 centers in 21 countries was denounced by anti-smoking activists i 1 J 1G1<LLi tLDllV 1 .7i.< VLVLt9i~ 1 J1Vl%J111:--111V1G1111VZ raga Y. Ul J because it minimized the allegedly detrimental effects of environmental tobacco stroke. It actually showed no statistically significant increase (1.16) in lung cancer in non-smokers who had lived and worked with smokers for 40-50 years. € HO didn't relea the study at all until it was leaked to a newspaper, and when they did release the study, it was accompanied by a press release whose headline screamed; "Passive Smoke Does Cause Cancer, Do Not Let Them,. Pool You," which was published verbatim by the popular press here and abroad. Apparently not one of the journalists took the trouble to read the actual study. ASTHMA IN CHILDREN IS CAUSED BY SECONDHAND SMOKE FALSE Dr. Fernando Martinez, director of respiratory sciences at the University of Arizona and co-author of Chapter 8 of the 1993 EPA Report on environmental tobacco stroke, the chapter that dealt with asthr. and other respiratory diseases, is among those specialists who believe that unproved hygi-,nc and overuse of antibiotics are at the heart of the problem. "L e most people," he says, "I assumed tobacco stroke and pollution were the problem this was thc. politica~fy correct x y to thirst;.. But these factors tu.-mcd out not to play a major role." In 1970, 44.1 % of all hales in the US stroked, 33.9% of females smoked. Tha" year the number of hospital discharges for astrhm in the under 15 age group was 33,040 (5.8%). In 1980, 37.6/0 of males smoked, 29.3% of fem- les stroked. The number of under 15 hospital discharges for asthma was 124,000 (24.2%). In 1990, 28.4%, 22.8% females stroked. The number of under 15 hospital discharges was 169,000 (30.8'/0). So while stroking decreased to nearly half the stroking rates of 1970, the number of children with asthma attacks severe enough for hospitalization skyrocketed six titres from 5% to 30%. While other respiratory illnesses do not show such a monotronic curve, they too are on the increase as smoking decreases. According to the CDC, adult and childhood asthma cases have increased from approximately 6.7 trillion in 1980 when people stroked virtually everywhere to 17.3 trillion in 1998 when smokers seldom even stroke in their own homes. Blaming secondary smoke for asthma is nothing more than an emotion-laden gimmick in the war on smokers. SIDS IS CAUSED BY SECONDHAND SMOKE FALSE No one knows what causes SIDS. Ask any pediatrician. SMOKING BANS ARE GOOD FOR BUSINESS When the hospitality industry in California claimed that business was down due to the harsh smoking restrictions, and that claim began to effect other areas of the country in which ANR (Americans for Nonsmokers Bights, founded by Stanton Glantz) was attempting to enact similar laws, Glantz produced a "study" that showed business was up. Dr. Michael K. Evans, a respected. economist, accused Glantz of misrepresenting data in a study that was apparently designed to mislead elected officials. A Sacramento court issued a restraining order against Glantz for destroying documents in the ab:)ve case and required him to show why he should not be held in contempt of court. It also charged him with unauthorized use of University of California resources for political lobbying, electioneering and private political activities, and of using his time on the University payroll to do so. 11 J 1 LtUA "V U 1 J ,%-VINVAM I 31VIU %rI__ 111VMIAIVla r agv j vi j Until recently, Glantz's "study" was the only one ever done and anti tobacco crusaders conveniently ignored the questions brought up by Dr. Evans. Early in 2001 another study was completed, a study that cost no taxpayer dollars, a study performed by a noes-smoker, a study that took into account all the things that Glantz's "study" didn't, and it came to a very different conclusion. With the growth rate of Califorl since the smoking bans were enacted, it would be expected that there would be 1036 MORE dine-in restaurants than there are. The anti-smoker crusades set out to change society and they have indeed done so, to the detriment of society. r 8 National Vital Statistics Report, Vol. 49, No. 11, October 12, 2001~~~ Table C. Deaths and percent of total deaths for the 10 leading causes of death: United States, 1999 and 1999 Percent of Rank' Cause of death and year Deaths total deaths 19992 All causes 2,391,399 100.0 1 Diseases of hea.^ . (100-809,111,113,120-151) 725,192 30.3 2 Malignant neoplasms (C00-C97) 549,838 23.0 3 Cerebrovascular diseases (160469) 167,366 7.0 4 Chronic lower respiratory diseases (J40-f47) 124,181 5.2 5 Accidents (unintentional injuries) (V01-X59,Y85-Y86) 97,860 4.1 6 Diabetes mellitus (E10-E14) 68,399 2.9 7 Influenza and pneumonia (J10,118) 63,730 2.7 8 Alzheimer's disease (G30) 44,536 1.9 9 Nephritis, nephrotic syndrome and nephrosis (N00-N07,N17-N19,N25-N27) 35,525 1.5 10 Septicemia (A40-A41) 30,680 1.3 All other causes (Residual) 484,092 20.2 19983 All causes . . . . . . . . . . . . . . . . . . . . 2,337,256 100.0 1 Diseases of heart (390-398,402,404-429) 724,859 31.0 2 Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues (140-208) 541,532 23.2 3 Cerebrovascular diseases (430-438) 158,448 6.8 4 Chronic obstructive pulmonary diseases and allied conditions (490-496) 112,584 4.8 5 Accidents and adverse effects (E800-E949) 97,835 4.2 6 Pneumonia and influenza (480-487) 91,871 3.9 7 Diabetes mellitus (250) 64,751 2.8 8 Suicide (E950-E959) 30,575 9 Nephritis, nephrotic syndrome arF! nephrosis (580-589) 26,182 .3 1.1 10 Chronic liver disease and cinhosia (571) 25,192 1.1 All other causes • (Residuall 463,427 19.8 Category not applicabs. 'Rank bated on number of deaths. 'Causes of death for 1999 based on the Tenth Revision, lntaTational Classification of D'~~Pases, 1992, see TecfnkA notes. 3Causm of death for 1998 based an the Ninth Revision, Intenahbnal Class9ication of Dvwases, 197., see Technical notes. NOTE: See Technical notes for information on the comparatiifitj between data dassirvtd by ICD-9 and ICD-10 i "Table D. [Heaths for the 10 leading causes of death: United States, 1999 and comparability-Modified 1999 Rank' Cause of death (Based on the Nint Revision, 1^temationalC/assiffca8on of Diseases, 1975) and year Deaths 1998 All causes 2,337,256 1 Diseases of heart (390-398,402,404-429) 724,859 2 ;+dalignant neoplasm, includinp neoplasms • •asms ~ of lymphatic and hematopoietic tissues (140-208) 541,532 3 Cerebrovascuiar diseases (430-438) 158,448 4 Chronic obstructive pulmonary diseases and allied conditions (490-496) 112,584 5 Accidents and adverse effects, .........................................(E800-E949) 97,835 6 Pneumonia and influenza (480-487) 91,871 7 Diabetes mellitus (250) 64,751 8 Suicide .......................................................(E950-E959) 30,575 9 Nephrite, nephrotic syndrome and nephrosis (580-589) 26,182 10 Chronic liver disease and cirrhosis (571) 25,192 All other causes (Residual) 463,427 1998 comparability modified2 All causes 2,337,256 1 Diseases of heart . (390-398,402,404-429) 714,566 2 Malignant neoplasms, including neoplasms of lymphatic and hematopoistic tissues (140-208) 545,130 3 Cerebrovascular diseases (430-438) 167,765 4 Chronic obstructive pulmonary dseases and allied conditions (490-496' 117,966 5 Accidents and adverse effects .........................................(E800-E949) 100,819 6 Diabetes mefitus (250) 65,282 7 Pneumonia and influenza (480-487) 64,144 8 Alzheimer's disease (331.0) 35,306 9 Nephritis, nephrotic syndrome and nephrosis (580-589) 32,256 10 Suicide (E%O0 E959) 30,458 All other causes (Residual) 463,564 Category not applicable. 'Rank based at number of dea+hs. 2Modified counts: for causes of death calculated by multiplying fi? 1998 count by cause-specific comparability ratios; see Technical notes. I . GF,CES - Researchers - W. Hamilton - American Uancer ~ioclety aamits "smKe m ftu ro c 1 vi ~ American Cancer 4j WANDA Society r Return to Admits Researcher's' HAMILTON "'Mistake" in # Return to age Date of original release: 8/10/98 "Secondhand Smoke Kills more Americans each year than cocaine, crack, heroin, homicide, suicide, car accidents, fires and AIDS," the headline of a halfage ad in the March °X0,1998, flans Herald screamed in, big, bold letters. Below was a listing for the number of deaths in each category. The only figure in boldface was: "Secondhand Smoke - 53,000.'* As someone who has closely followed the scientific claims surrounding the smoking issue, I wasn°t particularly surprised to see the 53,000 figure. Though no U.S. government agency publishes or endorses it, this number paps up regularly in anti-tobacco ads whenever and wherever the push is on for a smoking ban. And, indeed, the purpose of the Herald ad was to campaign for removal of the preemption clause in the Florida Clean Indoor Air Act, thus enabling city and county commissions to enact local smoking bans. Predictably, the American Cancer Society, the American Heart Association and the American Lung Association were the ad's sponsors. What surprised me was the citation for the 53,000 figure: "U.S. Environmental Protection Agency, ETS Compendium, :986 data." I knew the "official" EPA number was 3,000, not 53,000, and according to such independent analysts as the Congressional Research Service, even the EPA estimate of 3,000 deaths appeared to be too high, given the available scientific data. Determined to get to the bottom of the puzzling citation, 1 phoned the 800 number provided in the ad. It connected me to a voice-mail recording at the American Cancer Society (ACS). I left my name, phone number and a brief inquiry about the EPA citation. I also e-mailed David Lawrence, publisher of the Miami Herald. Lawrence responded that he would share my concern with the vice president of advertising, as he did each time I sent him an update. Several days later, Marcia Nenno of the ACS contacted me. She seemed discomfited by my questions about the citation. First, she said the 53,000 figure was actually from the 1986 EPA risk assessment. When, she claimed that it was from the EPA report. Finally, she said the source was a Surgeon General`s report. Based on my familiarity with those reports, I replied that it was from none of those sources. She insisted there was documentation and asked if 1 would like her to send it to me. "Yes, indeed," I responded. A packet from the ACS arrived more than a week later. The explanation in the enclosed letter was vague at best: "Upon researching this we found that such a Compendium was produced in 1986, thus the statement that the data was 1986 is correct. However, the data was not published until 1988. Enclosed is the 1988 publication that was the basis of the EPA Compendium data. 'Are Estimate of Adult Mortality in the United States from Passive Smoking' by Judson Wells." The Wells article had been published in 1988 all right, but in the journal Environment ORCES - Researchers - W. Hamilton - American Cancer Society Actmits "mistaKe- in tact rage z of z Intemational, not by the EPA, and the photocopy I was sent bore Wells! name, fare number and the date March 18, 1995, at the top of each page. So much for the convention of actually having a document in hand before citing it as a source. Nothing in the packet pertained to the United States Environmental Protection Agency or the "Compendium." followed asp with a letter to the ACS and copied the Herald and the Tampa Tribune, which had also run the ad. My k-. r Pointed out that the ACS had not substantiated their claim that the EPA was the source s:X the 53,000 lure and that the organization could well be guilty of false and nail€ Ing asvena sig. In a terse reply, Jeanne lambert, director of communications for the ACS, wrote: "As an earlier letter to you indicated, the source of 'secondhand smoke kills 53,€300 Americans each year' as the EPA was correct; however, it was not published in 1986,." 1 fired off another letter to the ACS. In em nce it said that since the ACS had, been unable to praxluc°;~,,: even a V<ngle % of do umer- tion thti~- the EPA. published or e.ndorsirml the i;: R { i < 3 53,W00 re3. 3tfa trT ?f.je i:pp±,"^ kxrv'. J l:. t'# paY,fs I 3 r: :..zI;.; ,i. `:te_5 ht. zG4.s i13 ;~e.:~~^.' 3.r''# aY~'^SG and i sWe$ ±e g y5 5`ffie4 t} ; , Several,mmeks later, the P^,CS's final response arrived. "T he American Cancer Society vMll no longer a the Environmental Protection Agency as the source for the slatisfic because we too have been unable to.acq€ ire the documentation to support this citation." At last, the unambiguous, nva ished truth - the ACS had lied In their ad. However, the later wend en to say: "Any future references to'secondh d smoke kills 53,000 Americans each year' will be attributed to an article written by Stanley (sic) Glantz, Ph.D., and William Parrnley, MD, called Passive Smoking and Heart Disease, Mechanics and Fisk published most recently in The Journal of the American Medical Association, April 5, 1995...." So the ACS and their ant.-smoking allies will continue to use the 53,0€30 figure in their smoking bar; campaigns, but at least from now on there; can be no doubt about its source: an article by Stanton Glantz, notorious anti-tobacco activist and a founder of Americans for Nonsmokers' Rights. The same Stanton Glantz whose inflated mortality figures on secondhand smoke were Selected by the EPA as toss flimsy for inclusion in Its awn controversial report. The same Stanton Glantz that one of his own - Mike Pertschuk of the Advocacy Institute accused of "ugly, propagandistic distortion." As for the press, the result was what we have come to expect. Even though both the Miami Herald and the Tampa Tribune publishers and ad directors were copied with ali correspondence about the ACS ad, to date neither paper has printed a retraction. Even the smoking gun of an outright admission that the citation in the ad was false has left the media barons unmoved. Was the exercise worth it`P You bet it was. The anti-smoking zealots believe they can get away with saying or coo€rag anything if the subject is smoking. This proves they can't if we remain vigilant. . luxuLJ - Kesearcners - M. rersice - Jcience x ou won, 1xCctu ut Uc~ lJdlty i~cws~a~r~ia i arp, i V t Science You Won't Read in tV~ ~ MARTHAI Return to the Daily Researchers' Return to PERSK eiW/Spaf' s Date of original release: 6/9/98 Until the U.S. Environmental Protection Agency (EPA) released its 1993 report classifying environmental tobacco smoke (also known as ETS or secondhand smoke) as a known human carcinogen, the anti-smoking forces in this country were losing their war for Prohibition. Americans, no matter whn their smoking status or personal preferences, generally agreed that it was not their role - or the role of the government to save a smoker from him or herself. As long as individuals are aware of the possible risks of a product, let them make their own choices, was the consensus. Then came the secondhand smoke scare, and the battlefield dramatically changed. Despite serious questions raised by scientists and researchers regarding the EPA's claims, the anti- smoking movement has successfully used the report to promote their Prohibitionist goals. The media, in turn, haslet anti-smokers' claims go largely unchallenged, and politicians, eager to jump on any politically correct bandwagon, have joined in the campaign. Now hardly a week goes by without a story being reported somewhere about the "dangers" of secondhand smoke. These claims have led to smoking bans in public places nationwide, the most extreme example being the recent smoking ban in bars and restaurants across California. Efforts by business owners in California and elsewhere to convince politicians that they should be free to make their own decisions regarding smoking policies just as customers are free to choose not to patronize establishments that allow smoking have largely been ignored. Even separate sections in restaurants and bars do not appease the prohibitionists, who claim workers in these places are facing health risks from secondhand smoke. Their claims, however, are not grounded in fact. Of the approximately 25 published studies that deal with ETS in the workplace and lung cancer or heart disease risk, only one study [Pontham et al. 1994, "Environmental Tobacco Smoke and Lung Cancer in Nonsmoking Women," Journal of the American Medical: Association, June 8, 1994] reports an overall statistically significant increased risk. Even then, the increased risk reported in the study was so small that, according to standards put forth by the National Cancer Institute, it could be due simply to chance, statistical bias or effects of unknown confounding factors. Virtually all studies reach the same conclusion: They find no statistically significant increased risk for non-smokers who are exposed to secondhand smoke in the workplace. A few examples, with direct quotes from the studies, are listed below. This is what you won't read in your local newspaper: "7n general, there was no elevated lung cancer risk associated with passive smoke exposure in the workplace...."- Brownson et. al., 1992 "Passive Smoking and Lung Cancer in Nonsmoking Wornen" - American Journal of Public Health, November 1992, Vol. 82, No. 11 an odds ratio of 0.91... indicating no evidence of an adverse effect of environmental tobacco smoke in the workplace."- Jariench et al., 1990 "Lung Cancer and Exposure to Tobacco Smoke in the Household" - New England Journal of Medicine, Sept. 6, 1990 40XULJ i - Keseareriers - M. FerSKe- - 6mence r ou wont xeao m the vauy ivewspapers Science You won MARTHA. Return to the Daily $ ~ Date of original #f se I release: 6/9/ Until the U.S. Environmental Protection Agency (EPA) released its 1993 report classifying environmental tobacco smoke (also as ETS or secondhand smoke) fis a known human carcinogen, ft art -v oking fens in this country %s re losi the r v, r for Prohlfbi-tion. A.rnerica no matter w their sm&,Ing states e° per ri..:: pre erende s, genera'llg aar~ed than it m,! tl'Rir - or the role of the cover: me it to wave a z33' : from him, or herself. A €?:sag -:Es are aware of the Possible riv ; rz c:: pr'odu.. , them make their or-o , cN,.ki; eb, was t'ns consensus. Then came the secondhand smoke re, and the battlefield drama€ically changed. Despite serious questions raised scntrsts and researchers regardrQ the TA's alai, fhe anti smoking r.ovement has. _successfully € sed the report t promote their Prohibitionist goals. The media, in turn, h 1s an-fi-smoker' claims g€? lady unchailenged, and poflticlanf , ear to jump on any poli ically corm bandwagon, hme joined in theoampaign. Now hardly a ~ k goes by without, a story being reported somewhere about the "carers" of secondhand smoke. These d r have led to smoking bans in public daces nationwide, the most extreme example being the recent smoking ban in bars and restaurants across California. 1 Efforts by business owners in California and elsewhere to convince politicians that they should be free to make their own decisions regarding smoking policies -just. as customers are free to choose not to patronize establishments that allow smoking - have largely been ignored. Even sap to tior3s in restaurants and bars do not appease the prohibitionists, who claim workers in these plus are € rQ health risks from secondhand smoke. Their claims, however, are not grounded in fact. Of the approximately 25 published studies that deal with ET S in the workplace and lung canes or heart disease risk, only one stu&j [Fontha et al, 1994, ' ironntental Tobacco Smoke .and Lung Cancer in Nonsmoking, Pillow;," Journal of the Amencan Medical Association, June 8, 19941 reports an overal : statisticaily 5iignifi x €rx:;>reas l nsk. Even then, the increased risk reported in the studj was so small that, accord;M, to standards p forth byt the National Canes Institute, it could due simply to chance, statistical bias or effects of unknown confounding factors. Virtually all studies reach the sane conclusion. They find no statistically significant increased risk for non-smokers who are exposed to secondhand smoke in the workplace. A few examples, with direct quotes from the studies, are listed below. This is what you won't read in your local newspaper: "in general, there was no elevated lung cancer risk associated with passive smoke exposure in the workplace...."- Brownson et. al., 1992 "Passive Smoking and Lung Cancer in /Nonsmoking Women" - American Journal of Public Health, November 1992, Vol. 82, No. 11 an odds ratio of 0.91... indicating no evidence of an adverse effect of environmental tobacco smoke in the workplace."- Janerich et al., 1990 "Lung Cancer and Exposure to Tobacco Smoke in the Household" - New England Journal of Medicine, Sept. 6, 1990 Environmental Tobacco Smokc Proceedings of the International Symposium at McGill University 1989 Donald J. Ecobichon .McGill university Joseph I. Wu New York Medical t:ollcgc Editors and Organizers of the Symposium 110lIiw Lexi on Books D.C. Neath anal C:ompar*wLesikzte m. Massachusetts''Tiimmto 6 Envimnmental Tobacco Smoke and Cancer: The pidemiol is Evidence Maxwell W. yard, Pb.D Layard Associates, Mountain View, California 1. Introduction to this paper, 1 review the epiderniologic evidence for the efft:ct of exposure to environmental tobacco smoke ("ETS") can cancer incidence in human pop- ulations. Most of ehc available data rclarc to lung cancer, but a few studies have investipted the incidencc of cancer of all, sites, or of particular sites other than the lung. A question of obvious importance is whether the collec- tive epiderniologic data adequately satisfy the accepted criteria for the use of epiderniologic evidcnce in supporting a causal inference. My conclusion is that the currently available data do not support such a judgment. U. The RtAe of Epidetttiologic Evidence in Drawing CaUW Inferences In assessing whether epidemiologic evidence reflects a casual association be- rwecn an exposure and a health effect, it is first necessary to consider whether the data demonstrate a statistically significant association, that is, an associ- ation which is unlikely to be due to chance. If a statistically significant asso- ciation has been demonstrated, it is then necessary to assess the validity and weight of the evidence in light of criteria which refer to the epiderniologic studies themselves. The most important of these criteria are: a, strength of association; b. consistency of results; c. demonstration of dose-reaponse relationship; d. freedom from biases; and e. control of confoundinz factors. However, even after these criteria have been concidered, epiderniologic evidence must bbe corroborated by other types of evidence before it is appro- 100 • EnWroeanoi8af Tobacco Smoke priate to drams a causal inference. 'ire biologic plausibUiry of an observed as"atioo between Ppl+rsga.~ and health effect roust be considered. Consld- erations of biologic plausibility involve such matters as knowledp of diwase mechanisms, eoher ce with known facts about the rural history of the dis se in qucstior, and toxicologic experiments with animals which avoid problems of confounding and bia$ typically seers in epiderniologic studies. 111. Fpiderniologic Studies of Lung Cancer Reports of 23 epidemiologic studies have been pubIL;hed concerning ETS and the incidence of lung cancer in hurnans. Twenty of these were retrospective case-control stuc4irs and three were prospective cohort steadies. These studies arc listed in Fable 6-1. In nearly all cases, spousal smoking has been used as the index of the exposure of nonsmokers to ETS. Of the 23 cpide niologic studies of lung cancer and ET'S rcftsrred to a boyc, five reported statistically significant associations between P'TS and lung cancer at the 5% level of significance. 'The othet It studies reported wla 'vc rinks which were not signific2ndy elevated, with 95% confidence in- tervals encompassing I.O. In addition to nr reported assmiatrons in the individual studies, the Na- tion2l Research Council (`NRC' ; Committee on Passive Smoking calculated a statistically significant association using a statistical technique known as "meta-analysis." This technique is sometimes employed to combine the re- sults of individual ep:derniologic studies, in order to give a quantitative summarization of data relating to a particular area of investiga6rin. The NRC conduc:tod a rneta-analysis of the results of 13 of the 23 studies listed in Table 6-1 (NRC: 1986). This calculation produced a combined relative risk of 1.34, which, though crnall, was statistically significant. `1°hsre are several reasons why combining the results of these studies is of douHul validity. A fundanwntal consideration in conducting a steers-analysis is whether the published literature is representative of all studies of s partic- ular:question. A "publication bias" would result if studies reporting s positive swocieriort werr murc likely to be published than negative studica, and it is powlic that :such a bias exists in the literature on ETS and lung cancer (Van- dcnbmuke 19881. Meta-analysis should not be used urals&s it can reasonably be €*ncluded that the results of the various studies provide comparable cstr- mates of a m.,mmon quantitative endpoint, in this c, the rclacivc risk of lung cancer among nonrarnokcrs exposed to ETS. Such a conclusion requires that ghc studies be reasonably comparable with respect to exposure indices, dcmagrraphic and social chmractcristia of the study populations, and disease die obis, among other factors. In fact, the studies of and lung cancer display substantial diversity in these and other areas. As well as being com- M and Cancer • 101 Table 6-1 Stlsdies of ETS and Lung Cancer its Nesessteaokm Number of Gases in Exposed Radative 95% confidence Srardy Sex Group USA Interval vm80-C®osPrvd 9Y9r6d1e9 I Chan and Funs. 1982 F 34 0.75 (0.43, 1.30) Ttichopoinoa el al.. 19R3 F 38 1,13' 11.16. 3.931 Gwtcca er gd., 1983 F 14 2.07 S.26) M 2 1,97 (0.38, 10.29) Kabatt and Wynder, 1911-d F 13 0.79 (0.25, 2.43) Al 5 1.00 (0.20, S.07i buffler et at., 1944 V 13 0.84) (034, 1.89) M 5 0.51 (0.14, 1.80) Gsr4mkel st_1„ 1985 F 92 1.12 (0.74, 1.70) Wu er af., 1985 F' 29 1.20 (0.$0, 3.30) Akiba of at.. I9x6 F 73 1.52 (0.18, 2.64) M 3 2.10 (0,51, 839) Lee es al., I Y96 F 22 1.03 (0.41, 2,56) M s 1.71 (0.30, 4.S4) Brewnsun er al., 1987 F 19' 1.6E (0.39, 2.97) Can ef al., 1987 F 189 1.19 10,82, 1.73) Humble ers!,1987 F 14 1.711 (0.45, 4.85) Kum at al.. 11987 e S 1 1.s5 (0.9(1, 2,61) Lam er al., 1997 F 1 1 S 1.65' i 1.16, 2.35) I'etehspen ei al.. 1987 F 33 1.20 10.70, 2.10) Ucng el al., 1981! F 34 2.16' (1.09, 4.30) Inoue and Miraysms, l' 1x 2.53 (0.74, 8.76) 19KA Katads ei al, 1968 F 17 - INS; p - 0.231 Lam and t;hcng, 19AK F 37 2.01' (1.09, 3,71) Shimizu er sR!., tv#8 F to, 1.10 n/a Crrknrt trrrdies Carfinkel, 1951 F 88 1.17 (0.93, 1.47) (0.20, 4.9') Gillis rr at., 1984 F 6 1.00 (0.59, 17.15) M 4 3.25 Hirsysms, 1084b F 161 1.41' (1,02, 2.08) 1981, N. 7 2.200 (1.04, 5.01) Total number of cases, including unexposed. '5tati5tic3lly significant at the 5% Itse . parable, each steady should be methodologically stxand 2nd free frolta poten- tial biases and confounding factors which could distort the result. Aa I point Out in this paper, those conditions arc not islet for the studies in question. The small positive associations secn in enese studies, to the extent that they are not simply due to chance, may in face he the resale of bias and confound- ing. If so, a 13 na•analysis would serve only to:provide spurious reinforcement of the invalid results of the individual studies. I 102 - Environmearal `tobacco Spnoke Although a formal meta-analysis sestets hisppropriate, a substantial ma- jority of the 23 studies rspvrted relative risks greater than 1. But even if one assumes that the studies, taken collectively, reRect a statistically significant association between ETS exposure and lung cancer incidence among non- smokers, it is stall necessary to e'xasnifte the validity of the udies which dem- onstrate this association before the data can be prestutned to support a :.aural inferanxe_ in the remainder of this section 1 consider various aspects of this question, beginning with a discussion of the five criteria listed in section II. A. 'Weight and Validity of Lung Cancer Studres 1, sat mph of As"ation. Even if an association between exposure and out- come is s.atistiealiy significant, the weaker it is (that it, the smaller the rela- tive risk W the less confic9ence we can have in its validity. A weak association is more likely than a strong association to be an artefact produced by bias or confounding factors. Of the 23 studies, four reported relative risks of 1.0 or less for either :Hales or females or for both sexes (that is, no increase or a decrease in risk), 13 reported relative risks between 1.0 and 2.0 for either resales or females or for both sexes, and 8 reported relative risks above 2.0 for either males or females or for both sexes. Although there is no precise definition of a "weak" association, relative risks of Ims than 2.0 are generally considered to be weak. By this standard, 22 of the 30 sex-specific studies displayed in Table 6-1 represent nonexistent or weak associations.'t'he cpidemiologisr Jerome Cornfield thought that any relative risk under 3.0 might be considered weak (Wyndcr 1997). lay this standard: all but one of the observed associations between ETS and lung cancer are weak. The one exception was based on only four mate lung cancer cases in the exposed group and is not statistically significant; in the same study the relative risk for females was 1.0. 2. Consistency of Resttlts. The studies also lack consistency. Relative risks vary widely between the studies; several reported risks are below 1.0. The differences between inciansistent associations observed in these studies arc undoubtedly produced partly by chance variations. But it is also likely that they are partly due to the differential effects of biases and confounding factors. Some steadies display inconsistency with respect to the cell type of lung cancer for which risk elevation with 1rTS exposure was observed. Lam cr at. (1957) reported a significant relative risk of 2.12 for adenbcarcinoma. But for all other cell types the relative risk was 123 and was noc significant. On the other hand, Pershagers et, al. (19871, reported a significant relative risk of 3.3 for squarnous or small cell cancer but for vrher cancer types (predomi- nandy adenocarcinoma) the relative risk was O.S. ETS and Cancer • 103 3. Dowflixspoaw Relationship. A doss-rceponsc:relationship means th,.t as the extent of exposure and hence the amount of the doss increa'ca, •u too does the incidence of she oa rcome. In assessing the exismnce of a dole- iresponse relationship, the non-exposed subjects are nn: considered; Alone of the 23 studies discussed above dernonstrate s stAristically segnlifcanr dow- responte relationship. 'ne ,Japanese cohnrt atudy of Miraysma reported an inconsistent dow-mponse relation0up when the:suhjects were stratified-by the wife's age at the time of entry into the study (Mirayarna 1984b), as shown In Figure 6--1. Also, lrr the large American Cancer Society cohort Garfinkel 1981), women w)-ise husband smoked ZO or more cigarettes pcr day had a lower relvisc risk (1.10) than those whose husbands smoked 1-19 cigairucs per d.sy (1.27). Lack of a dose-response relationship is an internal inc:onsis- rency in a study which increases the likelihood that an observed association is due to the meets of biax or confounding, rather than to an effect of exposure. Some studies have examined more than one exposure measure without finding a dose response. For example, Kris et al. (1987) performed a spousal Wine Cancer Mortalify 9 e's En" Age 40-40 Z (n-91) 1 70-79 (mad) 0 t ®t as 30+ Husband's Smoking Habit (cigarettes/day) IM 1.34 1.6! Fig4rc 6--1. Hirayaria Japanese Cohort Study: Lung Cancer in Non- Smoldug Married Worricw 104 • F.xviroermentif Tobacco Smoke stroking analysis by number C4 c;8marrms per daffy smoked by husband, and calculated relative risks of 2.37, 1.30, and 1Z2 kr 1-10, t 1--3.0 and 20+ cigarettes per day respectively-a negative dose-response relationship. Several other exposure ?treasures, such as total gears exposed, were analyzed, but none of them showed a positive dose-tnponse relatiotis: alp.. Other authors have reported a significant overall increasing trend in rtsk with.a treasure of ETS exposure, including non-exposed subjects. As noted agbove, such an anal yaia of itself should not be construed as a finding of a air-response relation- ship, fsera et al. (1YVel reported a significant trend in task with husband's daily cigarcitc consumption. But no dose-response relationship was found when attention was restricted to th_ exposed subjects. ('f'oe relative tasks re- ported in this analysis were artificially inflared because smoking-level infor- mation was missing for as larger proportion of controls than cases, a point that the authors did not mention.) 4, Biases. The result; cif epiderniologic studies can be distorted by various types of bias, including interviewer bias, respondent bias, selection bias, and bias arising frown misclassification of exposure status and disease diaagnosiL Biases can give rise to apparent associations that, on further investigation, turn out to be spurious. Case-control studies are susceptible to selective recall bias. due tp the propensity of cases report exposure samara Completely than the amrm4s. None of the studies of ETS and lung cancer used objective ETS ' exposure measures such as levels of nicotine or cutinine in body fluids or atmospheric measurements of tobacco smoke in the home or workplace. Bias can i4o arise w•i:en exposure inform2don is obtained from relatives of cases. In the C:ari;nkcl et al. (1995) study, an odds ratio of 1.0 resulted from ex- posure information from the cams themselves. Rut when the information was obtained from husbands the odds ratio was 0.92, and when the information was obtained irorn cons or daughtem the odds ratio was 3.19. Onc bia. that hits: been consistently cited in connection with atudics of ETS and lung cancer is under aborting of active smoking by professed "non- smokers." (See, for example, Lee 1987 and 1988.) Such misclassification would result in .,vin-catimaation of relative risk, since the smoking habits of spouses, ac well as smoking and lung cancer incidence, are positively corre- lated. On the basis of studies of the frequency of misclassification, Lec con- cludcd that this awur x of bias saauld explain most or all of the observed excess lung canccr risk. 5. Confounding Fatctvn. Positive confounding can also dnnrribute to an ob- served aassociaanon in an epidetniologic shady. A number of steadies have sug- gested associations berwam lung cancer ,and factors such as occupation, nu- trition and alcohol consumption. To the extent dear such facevrs are F.TS and Cancer • 105 eoerelated with E'TS furs, they could alga give rise to a spurious assod- ation betwean ETS and lung sxr t. Fever of the studies of ETS and lung can- ccr have bwn able to control for potential confounding factors. An example of ail potential confounding, was men in a study of dietary beta-carotene intake in a group of nonsmokers for whom ETS exposure in- formation Dues collected (Sidney et sal. 1999). Subjects who reported no ETS exposeare in the harm were found to have a higher mean carotene intake than those who reported E3°S expoarare. Since epidemiologic evidence sugBcstr an inverse relationship between dietary intake or blood levels of beta-carotene and lung cancer, beta-car ne status ia, likely, to be a confounding factor in studies of ETS mid lung cancer. Another example of potential confounding ie provided by s study by Koo et al. (1999) of Chinese couples in bong Kong, These investigators found that wives of nonsmoking husbands had "heailthicr" lifestyles than wives of stroking husbands. They concluded that caution is needed when, interpreting data on EI-5: "It may not be the hazards of tobacco stroke that are being evaluated, but a whole range of behaviors that result from having a smoking husband, which may in rum Increase the risk for certain diseases among their wives and children." Recent reports by Rylander et al. (1999) and lKoo (1999) have suggested that ingcstcd substances, including components of the diet, are risk factors for lung cancer and potential confounders for studies of ETS and lung cancer. Ktw stated that data on Chinese women in Hong Kong suggest that con- sumption of vegetables, treats and fish that are smoked, salted, cared or pick- led increased risk of lung cancer relative to fresh versions of these foods, and that the former diet was more frequent among women with smoking hus- bands relative to women with nonsmoking husbands. B. Mcibodological Issues Confidence in the results of an epidemiologic study requires that the study should be methodologically sound. Many if not all of the 23 studies of ETS and lung cancer are open to criticism for flaws in their design and execution. For example she Creek study of Trichopolous et al. (1983) was subject to a possible selection bias because controls were selected from a different hospital than these from which the cases were obtained. Moreover, the controls were selected by a mangle physician who was aware of the purpose of the study. The same physician interviewed both cases and controls, so interviewer bias cannot be excluded. Only 65% of the cases were pathologically confirmed, and alveolar careinorna and adenocarcinonta cases were excluded from the case group, raising the possibility of another selection hiaq. 1U6 • Eravrabo~~aa! ~s~bmaaaa Sore®ks Another study that hu received consi&mble critical comment is the Jap- ancze cohort study of Hiraystna 119114a,b;, Potential problerv which have been cited include bias in the wieedow of the study .sample, misclassification of lung cancer diagnosis, ` ifisation of the non-smoking status of wives and of M exposure, hiftte to contrail fbrpotrgntial con otapdecs, and inap- propriate statistical analy-tis of the data, Annt~ z problem in assessing the quality of the study is the inadequate reporting of the study -design, conduct and resulit. In particular, Hirayame's pubhthed reports fail w describe fully the wav in which the sturdy cohort era.; ;slatted, and gave no information about the numbers of rd;roa_ excluded from the cohort on health grounds or the criteria for such m-elusions. More seriously, no explicit information has been reported on the number of subjects last to follow-tap. My analysis of the published data indicates that some 100% of the cohort was lost to follow-up, and comparisons with Japanese national mortality statistics strongly saw est that dealt rates among thrase lost were at mst twice as high as death rates among t tc successfully traced (Layard and Viren 1989). A mortality differential of this magnitude rain the possibility than selection biases exist ir, the data which could invalidate an Observed relationship be- tween exposure to ETS and cancer mortality. Comparisons with vantge national mortality statistics reveal serious internal inconsistencies it the reported cohort mortality expericnoe which cas: fu4'er doubt an t ht validity of 1'firays ma's results. In particular, re- ported lung cancer mortality among nonsmoking married worsen in the ' cohort war. 29% less than that projected ran the basis of national statistics. For all other women in the cohort, however, tcported lung cancer mortality was only .I% le" than projected. Also, reported lung cancer mortality among nonsmoking married women aged 60-69 years at entry into the study was 49'Yo ie*3 than pmjcctcd, while for nonsmoking married women aged 40_59 at entry, reported lung cancer mortality was 16 less than pro- jected. T'he inconsistent pattern of lung cancer relative risks seen when the Hi- rayams data are analywe by wifet entry age (Hirayatma 1984b), which is illustrated in Figurc 6-1, urd3 er detracts from the validity of the study con- elusions. These relative rasps exhibit a very strong, and highly significant, downward trtnd with wifOs entry age, and there is no elevation of risk at all for worncn aged 60 years or More at entry. This anomalous pattern is even more surprising because the entry age groups had considerable overlap in terms of Attained age during the 16-year course of the study, In my view, the serious ex &I and internal inconsistencies in the re- ported maults a ! the Hirayatna study require investigation and explanation before this study can properly be used in assming a possible relationship between M and lung cattier. E TS wssd Coneer • 107 C. Dosimetric Considerations The combined lung cancer relative risk of 1.34 derived in the 1926 NRC tepon from the mm-analysis of 13 epidctniologic studies is much higher than would be expwted from comparisons of biological markers of smoke exposure between E1S-exp®sed persons and active smokers. T1w NRC reset stated that an analysis of urinary levels of eotinine (a metabolite of nicotine) in a group of ETS-exposed persons suggested chat ETS exposure was rasughly equivalent to smoking 0.1 to 0.2 cigarettes per day. '[h c excess lung cancer risk calculated from the combined epidemiologic steadies is about 10 tunes greater than the excess risk that might be calculated from smoking 0.1 to 0.2 cigarettes per day under a linear dose-response assumption (Lec 1988 and 1989). Arguing that particulate matter is more relevant than nicotine to lung cancer risk, Lee estimated that the inhaled dose of particulates is about one thousand tithes smaller for E'T`S-exposed persons than for smokers, and hence that the excess lung cancer risk derived from the epidemiologie studies is about 100 tithes grcater than that suggested by studies of smokers. The effects of ETS exposure and cigarette smoking cannot be precisely compared on the basis of biological markers, since ETS and mainstream smoke are qualita- tively different substances (NRC 1986). Nonetheless, this huge discrepancy casts serious doubt on the validity of the observed association between ETS and lung cancer. As noted above, Lee concluded that a more likely explana- don for the observed associarion was misclassification of smokers and ex- unokers as nonsmokers. IV. Epidemiologic Studies of ETS and Cancer Other than Lung In contrast to the many studies dealing with RTS and lung cancer, only nine studies have been reported concerning FTS and cancer other than of the lung. Some of the results of these studies are summarized in Table 6-2. As in the case of the lung cancer studies, most of the studies used spousal wreaking as the ETS exposure index. These nine studies provide insufficient data to eval- uate the effect of ETS on cancer other than of the htng. The reported asso- ciations are weak and inconsistent, and are subject to the potential effects of biases and uncontrolled confounding factors noted above in connection with the lung cancer steadies. The individual studies are briefly discussed below. Gallas et al. (1986). In this small Scottish cohort study, there were a total of 43 non-lung cancer deaths among nonsmoking women, and eight strong nonsmoking men. This study is flawed by a 20% non-response rate, and by IOU • drrevirwtrraetetd€~ Tobacco So aka Table f-2 Studies n-f E'TS and Cancer in Nonsmoker MWMe rr Cases in F,aosed Strdy Conner ,Sire Sex Grosrp RelatisT Risk Gillis et a:.. 1994 All sites F 33 1.26 szcept lung M 2 0.50 Mirayarnga 1984s .All sites F 870 1.11 rcpt lung F 23 1.99 Nasal sinus F 31 315' M111cr, I ss4 All sites F 34 0.97 Sandier et 4. 1995 All cites Moth its 2.00" !?ndocrlne 50th 32' 4.40' Ce"in F 46' 7..10• Breast F 13' 2.00 K*bas N at., 1986 bledder F 24 1.21 M 15 %1.77 Rcynaldc es at.. 19K7 All sites F I50> 1.66" Burch ce s!.. 1981 Bladder r 10 0.75 1HOme exposed) 39 0.93 (Work sxpoood) M 37 0.94 (l loo w exposed) 25 0.97 (Work exposed) Sandlr.r er a!., 1989 All arcs F 290 1.00 ' M 31 IXI Slarrery et at.. 1999 (:ervtz F 91, 1.14 (<I hr/day) 1.57 (1-3 hr/day) 3.43 • (3 a hr/day) 'All cases, including uncxtsoscd. `All cescs, includint, srnvking a otmn and unexposed. 'Based on a proportional hazards regression analysis which included smoking women. 'Statixtical s significant at the 5% level. "Statiseimlly srsnificant at the 1% level. the exclusion (71 some eligible subjects from the analysis for apparently un- known reasons. 1•iirayarsta ;14S4t1). The reported relative risk of 1.11 in women for cancer other than lung in the Hirayattla cohort study is a very weak association. Confounding and nlisclallsif Cation of smokers as nonsmokers cannot be ex. cluded as explanatory factors. 14irayarnat results are not controbled for po- tentially confounding life-style and smorconornic risk Ta rs. Hirayama reported Significant agsociatinns in women between brain and F:73 and Cancer , t09 nasal sinus cancers and spousal smoking. abe result for nasal sinus cancer is not significant when wornen with ex-smoker husbands are included.) These findings have not been replicated in other studies, so they must be considered inconclusive. The rwult for brain cancer lacks plausibility. because brain can- ccr has not been shown to be associated with smoking. Hirayama considered mortality in women for at least 18 different cancer types other than lung, so a question of statistical multiple comparisons arises. When 18 statistical tests are performed, there is a substantial chance that one or more of the 18 will be significant even if there is no association berwcen exposure and disease. Miller (1984). In this Pennsylvania case-control study of nonsmoking mar- ried women, 123 cancer deaths (cast,) owere compared with 414 non-cancer deaths (controls) with respect to husband's smoking status. '1'hr age-adjusteJ odds ratio was 0.97. Given the substantial number of cases, the power of this study to detect a modest elevation in risk would be reasonably high. Sandier ct al. (1985). In this case-control study, cancer cases aged 1S to 59 years were identified from a hospital based registry in North Carolina. Matched friend controls owcre obtained for 60% of the cases, and matched p opulatiuc controls for the remaining 40%. For 1 yZ nonsmoking female cases (including at most two lung cancers) the crude odds ratio for cancer of all sites was 2.0. No dose response was found for all-bite cancer using as the exposure index either number of years married to a smoker or the number of cigarettes srnuked per day by the spouse. Risk was significantly elevated for endocrine cancers (all nonsmokers, odds ratio - 4.4), and for cervical cancer (nonsmoking yeomen, odds ration - 2.1). The odds ratio of 2.0 for breast cancer in nonsmoking women was not quite significant. The Sandler et al. study has been criticized because it failtd to control for known risk factors for specific cancers. A notable example is cervical cancer, with which sexual activity, as indicated by the number of sex partners for example. hs srmngly related. Since SCXUal activity i$ also correlated with smoking habin, it is powerful confounder for cervical cancer. This is dem- onstrated in the Slattery et al. study discussed below. Other grounds for skep. ticism about the Sandler et al. results are the unusually high relative risks reported for all-site cancer, and high risks reported for sites which are not generally considered to be smoking related. Kabat at al. (1486). In this hospital-based case-control study of bladder can. cer, analyses of both spousal smoking and self-reported ETS exposure found no significant aicaociation between bladder cancer and ETS. The authors stated that their study suggests ETS exposure is not an important factor in bladder canwerr in nonsmokers. 110 - ESt4mmmexul Ta c® Smoke Reynolds et al. (1987). In this California cohort study- there were 147 cancer eases diasnosed among 2.385 married women. including an unstated manber of lung cancers. A Cox proportional harards regression analysis, using both smoking and nonsmoking women, gave a cancer relative risk of 1.7 for non- smoking women with smoking husbands when compared with nonsmoking couples. !f only the wife smoked, the relative risk was 2.0, snd if both spouses smoked it was I.S. Tl%t implausible implication that cancel risk any lower for couples with two smnkers relative to couples with one smoker raises doulbts about the validity of the statistical model used. No association dues found between cancer incidence and apoubal smoking among the husbands, which is a major inconsistency in the study results. Moreover the relative risk of 1.7 reported for women is inconsistent with other studica, particularly with the large i-12$4reaie.'. l0!%nrv VU AV. Burch ct al. (1989). This population-based.casc-control study of bladder can- crr was zonducted in rwo Canadian provinces from 1979 to 1952. Of 826 cases, 105 were nonsmoking women and t12 were nonsmoking men. In an age-adjtF;.~aed logistic regression analysis, no association was found between bladder cancer and self-reported exposure.of nonsmokers to ETS at home or at work. This result was not affected by Ajustrnent for several medical and occupational risk factors for bladder cancer. Sane ct al. (19149). in this cohort study, 28,000 white adult smokers and ' 19,000 never smokers in Washington County, Maryland, were followed from 1963 to 1975. Mortality from all causes and certain specific causes in not:- smokers was evaluated with reference to smoking habits of anthers in the household. For death from cancer of 211 sites, the relative risks of ETS expo- sure, ad;usted for age, housing quality, education and marital status, were 1.01 and 1.00 for men and women respectively. This study had rcrasonabic power to detect an elevation of risk, with 11 S cancer deaths among naen and 501 among women. Slattery et al. (1989;. This population-bnscd case-control study o, cervical cancer was inducted in the Salt Lake City, Utah, area. Of the caycs idcnti- fied, 266 (65%' were included in the study, and of the conrrols seiected, 490 (76%) al rmd to be interviewed. This low participation rate is a ~veakness of the study. The authors reported a relative risk of 3.4 for cervical caned in non- smokers with respect to self-reported ETS exposure of 3 or more hours per day. This relative risk was the same as that reported fo- current cigarette smokers. In both cases, the relative risks were adjusted for age, church atten- dance, education and number of sexual partners (but not, surprisingly, for membership in the Mormon religion). In the ease of current smokers, the unadjusted relative risk was 10.1. which illustrates the potentially profound FT's ,:nd Cancer • 111 citcct of confounding variables (the unadjusted relative risk was not reported for nonsmokers). An editorial eommeut il.ayde 1°89) pointed out that the most important catase of cervical cancer it thought to:be a sexually tranamit- ted infectious agent. Since measures oc sexual activity, such as number of sex parmers, are unlikely to reflect completely ogvstiarc to the causal agent, the editorial noted that the reported relative risk probably overestimates eve- true risk from ETS exposure. The authors themselves noted that misclassification of sex history could result in inflated risk estimates for ET5 exposure. The associatinn of cerN,cal cancer with FM exposure reported by Slattery et al. has nut been fauna in wher studies, except for Sandler et al. (1985). In particular, Hirayama (1984,,) found no .issociaeion of cervical cancer with sp00341 smoking among m nsmoking women. V. Conclusion The weak and inconsigtcnt associations seen in the epidemiulogic studies of ETS and lung canLCT, the fa .t that bias and confounding cannot be ruled out, and questions abour the reliability of the reported results, all indicate that these data do not support a judgment of a causal relationship between ex• pcssure to HTS and lung cancer. The validity of the observed associations between ETS and lung, cascr, ie also brought into question by considerations of dosirnetry. The data on cancers other +an lung cancer suffer from the saute defi- ciencies as those noted in ncc lung cancer studies, and are sparser, weaker, and less consistent than chc lung cancer data. Findings of associations with cancer of sires that are not associated evith smoking cast doubt on the validity of all of the ETS-cancer epidemiology, including the lung cancer studies, VI, Recommendations for Future Research Reooltirion of the open questions concerning the possible effects of ETS ex- posure on cancer incidence will require further epidemiclogie studie: which avoid as far as possible the pitfalls and problems seen in the c-urrently avail- able data. One irnpurtaw requirement is the n•measuren-icrit of biological rnark- crs such as urinary cotinine to validate ETS exposure information. Recogniz- ing the need for such data, the IAKC has aponsored an international collaborative study of urinary cotinine levels in nonsmoking married women (Preston-Martin et al. 1987). There are several reasons for the importance of obiccrive exposure rriea- ,uremerits, including measurements of biological markers and direct trmea- curemcnt of environmental concentrations of smoke constituents. Subjective assessments of ETS exposure by the subject or others arc inaccurate and un- 111 ExpioemovnmW T&Wom Smake reliable, as are surrogate measures such as spousal smokin& Measurement of biological markers should kelp reduce bias arising from rnisdassification of amokers m nonsmokers. Also, biological imirker data would hells e1mcldate total ex urc to ETS from all sources: ;homer workplace, transportation, etc. Finally, biolg6cal marker datawould help ablith the presmcc nr absence of a dosedeesponsc relation lip and, if present. help quar:;af, it. Apart from collecting irfortaiataun on biological markers.. attempts must be made to determine hems the present and. past stroking status of declared nonsrnol rrs----fns Pxann;L, by cross-vtiWating nformarion from several sources; the subject, i'e126ves and friends, medical records, etc. Also, as much information as possible should be obtained from various sources on the in- tensity and daily duration of subjects' exposure to ETS at horns: and else- wkere, as well as on the duration in years of such exposure. In view of the weak observed associations between ETS exposure and cancer incidc°rice seen in the epiderniologic studies, it is obviously necessary in future studies to collect information on, and take into account, all known risk factors and potential ccanfoundem for the cancer; under investigation. Koo (198V; and others have sugrstatd that dietary factors are important con- founders. Friedman et A. 0923) found that l?'Y'S exl;K sure is correlated with maniuana use, alcohol consumption and occupational hazards, all of which are possiblz risk factors for lung and other cancers. To shed light on the contradictory results which have been ruportcd con- cerning El S and lung canctr of different cell typen, future lung cancer studim should encure that complete histological information i7 obtained and taken into account in rratictical arsalyees. Another important nasal for research is. in the area of dosimetrie mea- surements of srroke cornporicnts for both amokers and ETS-exposed persons. Such data are likely to be valuable in confirming or refuting the results of apidemiologic invcntigations. A promising avenue of research was described by McAugliey ct al. (1989), who used a ratliolraccr to measure tar intake front mainstresni smoke in smokers and to estimate, for exposure to side- stream irmokr, particulate deposition In the tracheo-bronchial region of non- smokers' pings. References Alibi, S., 14. ICiw, and WJ. 51ce (1986). Passive sneaking and lung cancer anion8 Japanese women. Cancar Research 46:4804-4807 Brownwri. K.C. J.S. Reif. T.J. Keefe, S.w. Fcrguson, and J.A. Prir.l (1987). Risk factors for adeniocarcinotra of the lung. Am.). Apida"s,iof. 12St25_34. 1luffler, IRA., L.W. Pickle, T .J. Mason, and C. C:« ntant (1984). `l Re cause, of cancer in Texas. In: Lmngl (arcer: Ciuses and Prevention (Eds. Mizell and C:orrca). Vcriag-Chcrosc International, New York. F. and Cancer • 113 Burch, J.D., T.E. Robin, G.R, Howe, H.A. Risch, G.B. Bill, R. Staele, and A.B. Miller (1989), Risk of bladder cancers by source and type of tobacco exposure: a case- control study. ins. J. Cancer 44:62.2428. Chan, W.C. and S.C. Fung (1982). Lung cancer in non-smokers in bong Fong. In: Cancer Campaign, Vol, 6. Cancer Epidemiology (Ed. Grundrnann). Gustav Fisher Verlag, Stuttgart Correa, P., L.W. Pickle, E. Pontham, Y. Lies, and 'W. Hwsscl (1793). Passive smoking and lung cancer. Lancer 2:393-397. Gao, Y.T., W.I. War, W. Z1 crtg, A.G. Ershow, C.W. Hsu, L.1. Levin, R. Zhang, and J.r. Fraurneni (1949). Lung cancer among C hincn women. Mr. J. Cancer 40:604-609. Garfinkel, L. (1941). Tirnc trends in lung caan"r mortality amaig nonsmokere and a note on passive smoking. J. Maid. Cantor bass, 66;1061-1066. Garfinkel, L.. 0. Auerbach, and L Juubcrt (1985). Involuntary amnkinS and lung cancer: A case-contra! study. J. Nail. Cancer lnsi. 73:463-469. Gong, G.Y., Z.H. Wang, A.Y. Zisang, and C.L. Wu (1988). In: Smoking and Health 1957 (Eds. Aoki et al.). Excerpta Medici, Ammrdam. Gillis, C.R., D.J. Hole, V.M. Hawthorne, and P. Pk;ry)c (1984). The effect of environ. mental tobacco smoke in two urban comintinitics in:thc west of Scotland. Fur. J. Respir. Dis. 65 (Suppl.):121-126. Kirayama, T. (19841). Canccr mortality in nonsmoking women with smoking hus- bands based on a large-scale cohort study in Japan. Prevent. Aged. 13:680-190. Hirayama, T. (1994b). Lung cancer m Japan: liffccts of nutrition and passive smok- ing. In: Laing C'4ncer: (;ayses and Pretentton (Eds. Mizell and Correa). Vcriag- Own-tie International, New York. Humble, C.G., J.M. Samot, and D.R. PAt6sk (1987). Marriage to a smoker and lung cancer riwk. Am. J. Publ, Healrfs 77:59b-dr02. Inoue, R. and T. Hirayama 0998). Pawive smoking and lung cancer in women. 1n; Smoking and Health 1987 (Eds. Aoki art al.) EXCCrPta !Modica, Arnsterdarn. Kabat, G.C., and E.L. Wyndcr 11984). Lung cancer in nonsmokers. Cdaeor S30214- 1221. Kabat, G.C., G.S. Dicck, and E.L. Wyndcr (1986). Bladder canCttr in nonsmokers. Cancer .57:.162-367, Kam&, H., K. Miksm:, M. Konishi, Y. Koyama, and N. Narita (1988?. Effect of passive smoking in lung cancer development in women in the Nara region. Can No Rinsbo 34:21-27. Koo, L.C. 0989), Environmental tobacco smoke and lung cancer: Is it the smoke or the diet.? In: llrrsenr and future of Indoor Air Quality (Eds. Bieva et al.) Execrpta Medica, Amsrcniatn. Koo, L.C., J.M-C. Ho, D. Saw, and C. No (1987). Measurements of passive smoking and cvrinaates of lung cancer risk among nonsmaking Chinese females. Int. J. (:.steer 39t 162-169. Koo, L.C., J.H.-C, 14o, and R. Rylander (1988;. Late-history curmlatca of environ- mental tubacoo smoke: A study of nonsmoking Hong Kong Chinese wiyea with smoking versus nonsmoking husbands. Soc. Sci. M.od. 26:751-760. Lam, T.H., I.T.M. Kung, C.M. Vbng, et al. (1997). Smoking, gaassivo smoking and histological types in lung cancer in Hong Kong Chinese women. Brit. J. C,aareer 36:763--678. 114 • Envirorrmtartal Tobaa:eo Smoke Lassa, T.H., mid K.K. Chem (1958). Passive stroking is a risk factor in never smoking women in Hong Kong. In- S- Nsokbw and Health 9987 (Eds. Aoki at al.). Exl to Medics, Arsanel!darn. layard, M. W., and I.R. Viren (1959). Assessing. the validity of a Japanese cohort study. In; Present and Aftm of Indoor Air Quakry-(Eds. Rieva er al.). Excerpts Medica, Amewdsm. 1_ayde, P.M. (1959). Smoking and cervical cancer: Cause or coincidence? J. 4m. bred. Assoc. 261:12631-1633. L,at, P.N. (1957). Luang cancer and passive & mki% Toxieot. Letters 35:137®162. Lee, P.N. An alternative =planation for tae lncmascd risk of hang cancer in nonsmokers r arricd to smokers. 1n: Indoor stir and Amblem Atr Quattey (Eds. Merry and Kirk). Selper Lid., London, Lee, P.N. (1989). Passive smoking and lUngLeanceri fact or fiction? In; Present and Future of Indoor Air Quatiity (Eds. Bieva et 4). Excerpts Modica, Amsterdam. Lee, P.N., J. Charnbtelsin, &nd M.R. Alderson (1986). Relationship of passive sanok- in8 to 6&k of Lung cancer and other smoking-associated diseases.. Br; J. C"ceF U!97_16S. McAughey. J.J.. J.N. Pritchard., and A, 914rV r1000, Rcianve lung cancer risk from exposure to rtaatnstream and siidestream smoke particulates. 1r:: Present rand Fu- taart o! !~ilnn. a!- Oualiry (Eds. Eteva3 et al.). Excerpts Medics, Amsterdam. Miller, G.H. (1994). Cancer, passive stroking and nontmployed and employed wives. Weitz]. Med. 140.6-12435. ivai", 14a n=srcl Council (1956). Envirorrarrental Tobacco Smoke. 1Vleassiring Ex- posures.,and :Assessing Health Effects. National Academy Press, Washington, D. C. Pershagen, G., Z. tirubcc, and C. Svensson (1987). Passive smoking and lung cancer in Se cd4h women. Arr. J, !pidemiol. 123:1724. ftsron-Martin, S., b. nude:, and R. Saraeci (1987;. Ppidemiologic studies of passive smoking, in: ?as4iVC SwtokM,g (Eds. O'Neill ez al.). )ARC Scientific Publications No. 81, IARC, 1.1ron. Rsynolde, P., G.A. Kaplan, and R.D, Colson A987). Passive smokin6 end cancer in- cidence: larospective evidence from the Alameda Counry ®tudy (Abarract). Ilse. J. Epi6dBmial. 126:767. Rylander, R., H.-J. Haussmann, and F.J. Fewet (19119). Lung cancer ride by oral ex- posure. Ir : Present and Furstrs of Indoor Air Quality (Eds. Bieva er al.). Excerpts Medica, Amsterdam. Sandler, D.P., G. J. Comstock, K.J. )eking, and D.L. Shore (195911. Deaths from all cau5cs m non-smokers who lived with satmokets. Am, J. Fubl. Health 79:163- 16° Sandler, D.P, R.D. Everson, and A.J. Wilcox (193) 1. P3ssivc smoking in adulthood an., artc~ risk. Am. J. Rpi riol. 121:37--4 S. Shimizu, H., M. Morishim, K. miluno, es al, (108K. A can consrs$4 study of lung uu:et M nonsmoking women. Tohokta J. tax;,. A1e1. 134:389-397. Sicincr, S., 5.). Cain, and G.D. Friedman (1989). Dteranry Intake of carotene in non- rmukcra with and w;thcwt paaaive smo;.ing ac hoarse. Area. J. Inpiademial. 129,1305-1 303. Slattery, M.L., L.M. Robison, K.L. Schuman, T.Y. F.en,t, T.M. Abbott, J.R. Overall, M sped Coacer • 115 and J.W. Gardner %19F9). Cigarem smoking and exposure to passive mmokc arc risk factors for ca vics i an=. J. Am. Med. Assoc. 261:1593-15913. Trichopolous, D., A Kah ndldi, and L. Sparms (1913). Lung canter and paes;v* smcsklrt : Concl =siov)f Greek =d/ meet 2:677-471. Vandenbrouke, J.P. ;i 98S) Pawivt wnokinS and lung cancer: a publication bits? Br. Mad. J. 296:391-392 IN, A.H , D.E. H- ndRrsot , M.C. Pike, and M.C. Yu (1985). Smoking and other risk f®crors fvr lmnz. cmncer sg, women, J. Nadi. CAncer Inst. 74:747-751. $iTPder, E.L. (l9$ Workahop on ,suidefincs to the epidemiefty of weak associ:- ~:aasa. Pea era:. a~~d 16:139-141. Herald Sun home page the edit or Letter to :::i:C?':':i w.v ! •::F:ivii{i: is:iiSiiiii:T::i'"::; r{'r:ri:..r•'{iii::•ii:•iiii'~ :•iiii:C: n,{....... {liiv 'ii:i::iiiJiiii'. Editorial contact Advertising contact ......i Newspapers Search He d Sub Help back ~ G;47k-V4 ~r Feedback Surgery ban on smokers By TANYA TAYLOR, medical reporter XX. 08feb01 DOCTORS are refusing smokers 4~ potentially life-saving surgery until they quit their habit. ate' ~~Y r Physicians and surgeons at Melbourne's top hospitals told the Y Herald Sun they are denying smokers elective treatment such :as lung and heart transplants, lung Associate protessor Greg Snell: 'There~s not enough he, reduction surgery, artery by-passes dollars to go around." and coronary artery grafts. Picture: Jay Town Alfred Hospital respiratory physician Associate Professor Greg Snell said reasc for the ban were medical and moral. I "There's not enough health dollars to go around," he said. "It is within our mandate to ration services and smoking is one way to define patient population. "It is common practice to not do elective surgery, and certainly some lung operations, on people who smoke." Austin and Repatriation Medical Centre senior respiratory physician Associate Professor Lou Irving said it was left to each doctor how to deal with smokers. "Why should taxpayers pay for it? It is consuming resources for someone whc contributing to their own demise. "We'd be better off putting the money into the prevention and treatment of tobacco addiction." Prof. Irving said he knew of many vascular and cardiac surgeons who would refuse treatment based on a patient's smoking status. "My policy is to very strongly discourage smoking and to encourage them to q because smoking will reduce the effectiveness of the treatment," he said. "I would not give treatment if I felt ongoing smoking would make the risk of t procedure too greats" _ Alfred Hospital patient Steve Marwick admitted yesterday that not even multil injures from a car accident could stop his craving. "I know the people at the hospital are right but it's a pretty hard thing to give up," he said after sneaking out to smoke. Prof. Irving said strong scientific evidence had shown snookers risked complications such as lung infections during operations requiring anaesthesia Austin policy meant smokers were strictly denied long-term supplemental oxygen to improve blood oxygen levels because it was too dangerous. Prof. Irving said it disappointed him when patients refused to help themselves avoid~nq tobacco-related diseases. The Alfred's criteria on eligibility for lung transplants require a patient to havE been smoke-free at least six months. It says candidates must have been free of all substance addiction including alcohol, tobacco and narcotics for six months. Prof. Snell said many other specialist treatment units, including heart and vascular, had more informal criteria. Austin director of vascular surgery Andrew Roberts said research had proved smoking was risky in many types of surgery. He said studies had shown the long-terns results of bypass reconstructive surgery in smokers was deplorable. Unless someone risked losing a limb to gangrene or ulcers, he would refuse to perform the operation. "Most vascular surgeons will not operate because they know the operation is likely to fail." Royal Australasian College of Surgeons president Bruce Barraclough agreed some surgery was futile for smokers. "Lung reduction surgery, for example, where the problem has been caused by smoking, well, there's not much point doing something that is life-threateninc the patient continues to smoke," he said. Director of the Murdoch Childrens Research Institute ethics program Julian Savulescu said singling out smokers was inconsistent. Many illnesses could al: be blamed on a patient's lifestyle, such as obesity and heart disease. "In principle, the idea of making people responsible for their illness by paying the consequences Hof their actions is attractive to some," he said. "But in pracl it will ultimately lead to selective discrimination." He said smokers theoretically paid for extra health care costs through tobaccc taxes. back 11 iV l W U - NewsLetter Z5 ragc i vi < Previou- Home Contact W Next > 1 Newsletter 28 Antisrn®kers Caught While Deleting Unfavourable Evidence in Passive Stroking Studies Conflict of interest and the corruption of science in the anti-smoker industry were on parade in Australia last week when it was revealed that a report on environmental tobacco smoke was fiddled - and that an anti-smoker lobbyist involved in the preparation of the report may have influenced its outcome. An Australian news agency caught that country's main medical advisory group doctoring a report in order to cook up a case for smoking bans. Seems that the Australian Associated Press got hold of documents which indicated that the report-writers, working under the august National Health and Medical Research Council, had deleted data which clearly did not support the report`s recommendations for smoking bans in a whole host of publicly accessible places (Sydney, Australia AP, 04/20/97). The news agency even obtained a copy of a "smoking gun" letter, in which one member of the report's working group, a Sydney University public health professor named Simon Chapman, complained that the data collected by the group didn't support the recommendations. In a letter to colleagues working on the project, Chapman reportedly wrote: "Journalists looking at that table (or being directed to it by the industry) will be hard pressed to write anything other than 'Official: passive smoking cleared - no lung cancer."' "Much of your report recommends tightening restrictions on passive smoking surely with your calculations being so low, these recommendations are way over the top?" By the time the draft report came out, the table Chapman was referring to had been deleted. The Associated Press also notes that the report was suppressed by a federal court, which ruled that the National Health and Medical Research Council had not discharged its duty to conduct public consultation and had not given genuine consideration to submissions. How does this sort of thing happen? Good old-fashioned conflict-of-interest seems to be the most likely explanation? 0T W U - NewsLetter :Zb r a~~ a vi Your, r. t;napman is ~ neao or an anti-smoKing i t group, according to the press report. One would think ti? I5,,:, declare :iMtlvism would rule him out from p loipating in what we can cr?ly amore ns intended to an objective and unbiased report. Yet Mr, Chapman was permitted td sit on a body the purpose of which was to review the state of scientific eviderne as it related to environmental tobacco smoke and illness and make recommendations for publ policy, All sorts of questions arise. Why was someone with a clear and obvious vested interim in the outcome of the report atiovied to be part of its preparation in the first place? Is Mr. Chapman id for his position as head of the lobby group? How much is he paid and by whom? It doesn't take a rocket scieritist to conclude that if you are a prominent lobbyist and you grant to remain in the position, you need to demonstrate thed. you can be effective in getting things done that support your agenda. Put plainly, the Australian r~port on environmental tobacco smoke seem=s to have been a caw of letting the fox into the henhouse. The rights of smokers and public confidence in the scientific community - v re the casualties in this case. THE AUSTRALIAN FEDERAL COUR : JUSTICE FINN'S DECISION ON ETS The total silence of major North Arnert ri ilia on virtually any information that could be used against the (political enda of the international anti-tobacco cartel is truly astonishing. We are almost ashamed t admit that even ? at FORCES did not know about a major decision by the Australian Federal Court on the corrupted science about' TS. That decision predates the decision by the US Federal Court, for it was issued on December 20, ISM. To the best of our knowledge, this information has gone totally unreported by the media. The Australian Nationas Health & Medical Research Council was taken to task by the tobacco industry for deliberately suppoe ing scientific evidence. Justice Finn's findings were eloquent: " It is clear that the I H&MRC has fallen well short of meeting . the obligation to have regard to submissions mcelved . to take them into account of to give positive consideration to their contents as a fundamental element in ft decision waking. " " The community is not to be excluded from that participation simply because, for whatever reason, the NH&MRC does not wish to give, consideration to some part of the contents of submissions. it had unilaterally excluded from consideration material, which it previously had determined to be relevant virtue of the Terrns of Reference it had approved. " " What was objectionable in what the Working Party did was to adopt this exclusionary discriminator, thout bringing to the nice of the public that this was what they were going to do. They misled the public. " Justice Finn made subsequerA orders that t recommendations contained in the draft report on the estimated costs to the community of passive smoking, and for the elintnation of environmental tobacco smoke in public places be taken out, as those recommendations could not inferred from the evidence contained:'in the report. In fact, working party member Simon Chapman, an associate professor at the Department of Public Health and Community Medicine at Sydney University and member of ASH (Vttat is a member of a fanatical icy group doing working in a National Health $ Medical Research Council project?) and h gang were caught While deleting information that mild have exonerated passive smoke from association with disease. V 1 YY V 1VGWS1'GLL01 Ga: 1V ? va a Justice Finn basically reached the same conclusion of Judge ®steen in the more notorious US case of tobacco industry vs. EPA: THE EVIDENCE IS CORRUPT. In the face of overwhelming; evidence atotA the corruption of science and the lack of evidence on the "dangers" of ET S, the international anti tobacco cartel trims to intimidation of the scientists who do not play along, libet, suppnession of information, white accelerating the pace of repression. In the meantime the WHO, international arm of the cartel, paid by the pharmaceWic al industry to push smoking cessation devices, and already a moppet of the US administration, endorses the frauds on ETS as part of its political agenda against smokers an agenda that € M itself based on computer-generated epidemics that simply do not exist. In fact, the WHO endorses the VERY STUDY THAT WAS THE OBJECT OF THE AUSTRALIAN LAWSUIT, h i total disrespect for the courts of the countries that are footing part of its immense. expenditures When the findings of those courts go against its political agenda. And a final wa rd........ Shouldn't this have rung alarm bells to the fact that the passive smoking propaganda was a lie? Why the need to delete evidence?? Grow a brain and think for yourself. So even in Australia 4 years ago Official: passive smoking cleared-no lung caner. Yet the antis to this day are still being allom ;to use this phony evidence against the smoker, thus alloMng governments to extort money and repeat there lies. The Australian Federal Court: Justice Finn's Decision on ETS. Conclusion: They misled the public. In other words, they bloody lied. You continually take information from these lying bastards and print it with impunity, while destroying an industry because they lied. Are the world governments also lying, Hitler started this anti-smoking crap in the )'s so govern is have known for at least that long of the health risks. Why are n' t they being sued for billionsM. ?M? This court judgement can be gotten in full from the URL For god sake, I am not asking you bastards to believe me, just the evidence from Judges and the zealots themselves. Joy Faulkner «revious Horne Contact Us Next >