account (Meredith, 1975; U.S. Department of Health and Human Services, 1976). This deficit in height and weight appears to persist into infancy and childhood (Goldstein, 1971; Butler and Goldstein, 1973; Dunn et al., 1976; Miller et al., 1976; Rantakallio, 1983).

Current smoking status of the mother also has been associated with decreased attained height (Rona et al., 1981; Berkey et al., 1984), although growth rate was not slower among these children (Berkey et al., 1984). These studies, however, did not differentiate between smoking during pregnancy and subsequent exposures during infancy and preschool years.

Rona and colleagues (1985) reanalyzed data from the National Study of Health and Growth (England) for a sample of 5,903 children aged 5 to 11 years, separating the effects of smoking during pregnancy from those of later smoking. After adjusting the data for social class and other social factors, they found that reduced height was associated with increasing numbers of cigarettes smoked in the home, regardless of whether the mother smoked during pregnancy and regardless of which parent smoked. There remained a small but significant effect on height—a reduction of approximately 0.05 standard deviations of height (approximately 0.3 cm) for each 20 cigarettes consumed daily in the home.

To verify this small change in height, other studies of comparable magnitude are needed. Growth is an especially difficult phenomenon to study. Many factors, such as genetics, nutrition, social class, and ethnicity play important roles, and it is difficult to assign proportionate causality to each factor. Recall bias in the mothers of school-age children regarding their smoking habits during the pregnancy may produce unreliable results, especially in light of the increasing publicity regarding ill effects on the fetus of maternal smoking during pregnancy. Moreover, height and weight ratios and other growth measures are not reliably obtained in standard pediatric surveys.

A number of studies have linked household exposure to ETS with increased rates of chronic ear infections and effusions in children. Chronic ear infections or effusions in young children can lead to hearing loss and consequent speech pathology. Kraemer and colleagues (1983) conducted a hospital-based case-control study of 76 children with persistent middle-ear effusions contrasted with 76

Front Matter (R1-R8)

Contents (R9-R14)

Executive Summary (1-12)

1 Introduction (13-22)

Part I: Physicochemical and Toxicological Studies of Environmental Tobacco Smoke (23-24)

2 The Physicochemical Nature of Sidestream Smoke and Environmental Tobacco Smoke (25-53)

3 In Vivo and In Vitro Assays to Assess the Health Effects of Environmental Tobacco Smoke (54-62)

Part II: Assessing Exosures to Environmental Tobacco Smoke (63-64)

4 Introduction (65-68)

5 Assessubg /Exposures to Environmental Tobacco Smoke in the External Environment (69-100)

6 Assessing Exposures to Enviromental Tobacco Smoke Using Questionnaires (101-119)

7 Exposure-Dose Relationship for Environmental Tobacco Smoke (120-132)

8 Assessing Exposures to Environmental Tobacco Smoke Using Biological Markers (133-160)

Part III: Health Effects Possibly Associated with Exposure to Environmental Tobacco Smoke by Nonsmokers (161-162)

9 Introduction (163-165)

10 Sensory Reactions To and Irritation Effects of Environmental Tobacco Smoke (166-181)

11 Effects of Exposure to Environmental Tobacco Smoke on Lung Function and Respiratory Symptoms (182-222)

12 Exposure to Environmental Tobacco Smoke and Lung Cancer (223-249)

13 Cancers Other than Lung Cancer (250-256)

14 Cardiovascular System (257-268)

15 Other Health Considerations in Children (269-276)

Appendixes (277-278)

Appendix A: Guidelines for Public and Occupational Chemical Exposures to Materials that are Also Found in Environmental Tobacco Smoke (279-283)

Appendix B: Method of Combining Data From Studies of Environmental Tobacco Smoke Exposure and Lung Cancer (284-288)

Appendix C: Adjusments to Epidemiologic Estimates of Excess Lung Cancer in Persons Exposed to Environmental Tobacco Smoke (289-293)

Appendix D: Risk Assessment- Exposure to Environmental Tobacco Smoke and Lung Cancer (294-338)