Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects

TABLE 13–1 Studies of Passive Smoking and Cancers Other Than Lung Cancer with Significantly Increased Risks

Author	Study Design	Size (Cases and Population or Controls)	Tumor Outcome Studied	Odds Ratios^a
Hirayama, 1984	Cohort	34/91,540 28/91,540	Brain Nasal sinus	3.0;6.3;4.3 1.7;2.0;2.6
Miller, 1984	Case-Control	123/537	All sites	1.40
Gillis, 1984	Cohort	Male: 8/827 Female: 43/1917	Sites other than lung	0.5 (M) 1.26 (F)
Sandler et al., 1985a (adulthood exposure)	Case-Control (total) includes smokers	518/518	All sites Breast Cervix Endocrine glands	1.6 1.8 1.8 3.2
Sandler et al., 1985b (lifetime exposure)	Case-control (subset) includes smokers	869/409	All sites Breast Cervix Leukemia and lymphoma	1.4;2.3;2.6 2.0;2.4;3.3 1.6;3.6;3.4 2.5;5.1;6.8
Sandler et al., 1985c (early life exposure)	Case-control (subset) includes smokers	438/470	All sites Cervix Hematopoetic tissue	1.5 1.7 2.4
^aGiven with increasing dose, if available.

the causal relationship is unclear (International Agency for Research on Cancer, 1986). The risk for these cancers to nonsmokers exposed to ETS has been the subject of a few studies.

Hirayama (1984; see Chapter 12 and Table 13–1) examined cancers of the mouth, pharynx, oesophagus, bladder, pancreas, and cervix. The relative risks were not given, but they were reported to be insignificant. However, a relationship between ETS exposure in nonsmokers and nasal sinus cancer was noted, with rate ratios for the aforementioned exposure categories of 1.7, 2.0, and 2.6, respectively (see Table 13–1).

Sandler et al. (1985a; described in more detail below and in Table 13–1) also did not find a significant odds ratio for any of the smoking-related cancers (including lung cancer), except for cervical cancer (p<0.05). The odds ratios given for these cancers included smokers as well as nonsmokers. Therefore, since the odds ratios were not significant for the combined group, they would

Table of Contents

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