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ENVIRONMENTAL TOBACCO SMOKE

Measuring Exposures and Assessing Health Effects

Committee on Passive Smoking

Board on Environmental Studies and Toxicology

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.
1986



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Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects ENVIRONMENTAL TOBACCO SMOKE Measuring Exposures and Assessing Health Effects Committee on Passive Smoking Board on Environmental Studies and Toxicology National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1986

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Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects National Academy Press 2101 Constitution Avenue, NW Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Research Council was established by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and of advising the federal government. The Council operates in accordance with general policies determined by the Academy under the authority of its congressional charter of 1863, which establishes the Academy as a private, nonprofit, self-governing membership corporation. The Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in the conduct of their services to the government, the public, and the scientific and engineering communities. It is administered jointly by both Academies and the Institute of Medicine. The National Academy of Engineering and the Institute of Medicine were established in 1964 and 1970, respectively, under the charter of the National Academy of Sciences. This study was prepared under EPA Contract #68–02–4073 and Department of Health and Human Services, Public Health Services Grant #ASU000001–06-S1. The content of this publication does not necessarily reflect the views or policies of the U.S. Environmental Protection Agency or the Department of Health and Human Services, and an official endorsement should not be inferred. INTERNATIONAL STANDARD BOOK NUMBER 0-309-03730-1 LIBRARY OF CONGRESS CATALOG CARD NUMBER 86–28622 Copyright © 1986 by the National Academy of Sciences No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purposes of official use by the United States Government. Printed in the United States of America

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Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY DONALD HORNIG, Harvard University, Boston, Massachusetts, Chairman ALVIN L.ALM, Thermal Analytical, Inc., Waltham, Massachusetts RICHARD N.L.ANDREWS, University of North Carolina, Chapel Hill, North Carolina WILLIAM E.COOPER, Michigan State University, East Lansing, Michigan JOHN DOULL, University of Kansas Medical Center, Kansas City, Kansas EMMANUEL FARBER, University of Toronto, Toronto, Ontario, Canada BENJAMIN G.FERRIS, Harvard School of Public Health, Boston, Massachusetts PHILIP LANDRIGAN, Mt. Sinai Medical Center, New York, New York RAYMOND C.LOEHR, University of Texas, Austin, Texas ROGER MINEAR, University of Illinois, Urbana, Illinois PHILIP A.PALMER, E.I. DuPont de Nemours & Co., Wilmington, Delaware EMIL PFITZER, Hoffman-La Roche, Inc., Nutley, New Jersey PAUL PORTNEY, Resources for the Future, Washington, D.C. PAUL RISSER, Illinois Natural History Survey, Champaign, Illinois WILLIAM H.RODGERS, University of Washington, Seattle, Washington F.SHERWOOD ROWLAND, University of California, Irvine, California LIANE B.RUSSELL, Oak Ridge National Laboratory, Oak Ridge, Tennessee ELLEN SILBERGELD, Environmental Defense Fund, Washington, D.C. PETER SPENCER, Albert Einstein College of Medicine, Bronx, New York National Research Council Staff DEVRA LEE DAVIS, Acting Director, BEST JACQUELINE PRINCE, Staff Associate

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Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects COMMITTEE ON PASSIVE SMOKING BARBARA S.HULKA, University of North Carolina, Chapel Hill, North Carolina, Chairman OLAV AXELSON, University Hospital, Linkoping, Sweden JOSEPH BRAIN, Harvard School of Public Health, Boston, Massachusetts PATRICIA BUFFLER, University of Texas at Houston, Houston, Texas A.SONIA BUIST, Oregon Health Sciences University, Portland, Oregon DIETRICH HOFFMANN, American Health Foundation, Valhalla, New York BRIAN LEADERER, Yale University, New Haven, Connecticut GENEVIEVE MATANOSKI, Johns Hopkins University, Baltimore, Maryland JAMES ROBINS, Harvard School of Public Health, Boston, Massachusetts JOHN SPENGLER, Harvard School of Public Health, Boston, Massachusetts NICHOLAS WALD, Medical College of St. Bartholomew’s Hospital, London, England National Research Council Staff DEVRA LEE DAVIS, Acting Director, BEST DIANE K.WAGENER, Project Director MARVIN SCHNEIDERMAN, Senior Staff Officer RICHARD E.MORRIS, Editor EDNA W.PAULSON, Information Specialist MARY ELLEN SCHENKENBACH, Staff Assistant JULIETTE L.WALKER, Senior Secretary

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Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects Preface The Office of Air and Radiation of the Environmental Protection Agency and the Office on Smoking and Health of the Department of Health and Human Services asked the National Research Council to evaluate methods for assessing exposure to environmental tobacco smoke and to review the literature on the health consequences from such exposures. The National Research Council responded to this request by appointing 11 scientists to serve on the Committee on Passive Smoking, in the Board on Environmental Studies and Toxicology, under the Commission on Life Sciences. The committee membership represented the disciplines of toxicology, biochemistry, atmospheric science, epidemiology, biostatistics, and pulmonary physiology. The committee’s charge was to review the existing scientific literature and to identify the current state of knowledge with respect to known facts and areas of uncertainty. Many more of the latter were found than the former. To the extent that they could be justified scientifically, conclusions have been stated and recommendations proposed. Many of the recommendations are for future research, rather than for public policy. The latter were for the most part avoided on two grounds: the data were frequently not sufficiently secure and the charge to the committee was primarily for scientific review. The committee conducted a public hearing on scientific studies relevant to its charge on January 29, 1986. Furthermore, it reviewed the published scientific literature and received testimony from professional societies; medical, industry, consumer, and public interest groups; academic scientists; and others involved in the generation and interpretation of scientific evidence on the health

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Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects consequences of exposure to cigarette smoking. Pursuance of these activities was followed by the preparation of individual chapters by committee members and consultants. Thereafter, chapters were discussed, revised, and integrated with each other for the full report. In producing this report, the committee confronted a complex charge under severe time constraints. That it completed its task well and on time is a credit both to its members and the scientific staff of the National Research Council. I would like to express my personal appreciation to every one of the committee members, all of whom donated their time, intellect, and knowledge to the substance of this report. Dr. Diane Wagener of the National Research Council assumed the difficult task of coordinating, translating, and negotiating ideas and insights among committee members, consultants, and reviewers. Drs. Devra Davis and Marvin Schneiderman worked with Dr. Wagener in ensuring the thoughtful and timely completion of this report. While the committee restricted itself to analysis of the scientific data, it was not unmindful of the fact of modern life that smokers and nonsmokers have taken strong positions regarding the right to smoke on the one hand and a rejection of being exposed to other people’s smoke on the other. Persons on each side of the issue may wish to infer information from this report that the committee did not intend. Our strategy has been to synthesize information, present judgments and conclusions wherever possible, and to recognize inadequacies in existing data in order to provide a focus for future research. We have not taken the stance of a public policy board that necessarily has to make decisions on less-than-adequate information. Rather, we have chosen to prepare a scientifically responsible report that will be intelligible to a lay audience and useful to a scientific one. BARBARA S.HULKA, Chairman Committee on Passive Smoking

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Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects Acknowledgments The preparation of this report by the Committee on Passive Smoking would not have been possible without assistance from a large number of people. The committee consulted with a number of experts about various topics. We would like to thank the Office on Smoking and Health, particularly Clarisse Brown, who provided us with the many statistics and data that were requested by various members of the committee. We would also like to thank William Cain and Edward LaVoie for their contributions. Other individuals who gave special assistance in the preparation of the report include Leslie Waters Barger, Kiran Nanchahal, Simon Thompson, Christopher Frost, and Don Blevins. The committee thanks all the peer reviewers of the report. Their constructive remarks contributed to the improvement of presentations of technical information and its readability. We would like to express our thanks to the NRC staff for their work in supporting the committee. We would especially like to thank Edna W.Paulson and the staff of the Toxicology Information Center, who were of great assistance.

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