REGULATION OF SMOKING IN THE WORKPLACE
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Collection:
Document Number (FOIA) /ESDN (CREST):
CIA-RDP88G01332R000300250001-1
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RIPPUB
Original Classification:
K
Document Page Count:
69
Document Creation Date:
December 27, 2016
Document Release Date:
November 14, 2011
Sequence Number:
1
Case Number:
Publication Date:
July 14, 1986
Content Type:
MEMO
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STAT
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EXECUTIVE SECRETARIAT
ROUTING SLIP
ACTION
INFO
DATE
INITIAL
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DCI
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DDCI
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EXDIR
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D/ICS
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DDI
DA
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DDO
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DDS&T
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Chm/NIC
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GC
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IG
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Compt
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D/OLL
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D/PAO
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D/PERS
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VC/NIC
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Remarks
To 6: Please have response prepared for
EXDIR Signature.
STAT
x rve ecre ary
2 Jul 86
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TRANSMITTAL SLIP July 28 , 1986 I
TO: Mr. William J. Casey, DCI
RgBt8o.
REMARKS:
.UILDING
Qs
Attached please find for your
review a memorandum recently
presented primarily by FBIS
employees to Agency safety and
health officials. It addresses
an issue that transcends the
jurisdiction of any individual
office or group of offices.
STAT
Donnelly, DDA & CIA
ROOMM N0. BUILDING an ea t,
7D21+ Hqs
Attached please find for your
review a memorandum recently
subscribed primarily by 2BIS
employees. It addresses an issue
that transcends the jurisdiction
of any individual office or group
of offices.
STAT
FORM NO,
1 FEB 56 .
STAT
STAT
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/A R
July 14, 1986
STAT
Environmental Health and Preventive Medicine Officer
Office of Medical Services
From: Individual Agency Personnel
Subject: Regulation of Smoking in the Workplace
Enclosures: (15)
1. Testimony of Surgeon General C. Everett Koop on H.R.4488, H.R.4546, June
12, 1986.
2. Testimony of Lawrence Garfinkle before National Academy of Sciences (NAS),
January 29, 1986.
3. Testimony of John F. Banzhaf III before NAS, January 29, 1986.
4. Testimony of John C. Topping, Jr., before NAS, January 29, 1986.
5. Editorial from AMERICAN REVIEW OF RESPIRATORY DISEASE (1986) by Scott T.
Weiss.
6. Editorial from AMERICAN REVIEW OF RESPIRATORY DISEASE (1986) by Robert
J. Mason.
7. Testimony of Peter Hanauer on H.R.4488, H.R.4546, June 12, 1986.
8. Testimony of Stanton A. Glantz on S.1440, September 30, 1985.
9. American Lung Association news release on Gallup poll, December 5, 1985.
10. U.S. Merit Systems Protection Board notice (April 29, 1986) and news
release (May 13, 1986).
11. General Services Administration news release and proposed rule, May 22,
1986.
12, 13, 14, 15. Senate bills S.1440 (July 16, 1985), 5.1937 (December 12,
1985), House bills H.R.4488 (March 21, 1986), H.R.4546 (April 9, 1986).
STAT Pursuant tol ~ which identifies each employee's "right to comment
on safety and health standards the Agency follows or proposes," the
undersigned, for the most part from FBIS, in the interest of achieving and
maintaining a wholesome work environment with its obvious implications for
morale and productivity, respectfully draw your attention to the health threat
and discomfort caused by the virtually unrestricted use of tobacco products in
Agency worksoace in weneral and at of FBIS in particular. In accordance
STAT with we bring these hazards to your attention
and we look for a timely review and resolution of the problem. We address our
appeal to you because of your professional qualifications and because as
Environmental Health and Preventive Medicine Officer you are the logical party
to advise the Agency Safety and Health Committee and Agency policymakers on
this matter so that a uniform clean air policy can be established throughout
the Agency.
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In our judgment, the workforce has been left unprotected from ambient tobacco
smoke, an increasingly recognized threat to everyone and a source of
irritation and suffering for many. This situation exists at a time when
American society as a whole has come to recognize secondhand, or passive,
smoking as a serious hazard.
Given the current state of our knowledge on the magnitude of the threat
represented by such smoke and our own personal experiences at various
worksites, it is clear that the remedies prescribed in the present regulation
on smoking in A enc occupied buildings and facilities under the heading
STAT "Logistics" - which is nearly identical to current GSA rules, are
inadequate.
The legal basis for remedying this problem is a sound one, considering Agency
recognition of each employee's "right to work in an environment free of safety
STAT and health hazards" We are further encouraged by a July 22,
1983 Office of General Counsel memorandum of law which notes that our Agency
is free to adopt what it considers to be an appropriate safety and health
policy.
This freedom to act is especially necessary at a time when many concerned
persons are looking with hope to the proposed new GSA regulation on smoking in
the workplace, which, while a promising development in the general trend
toward protecting employee health, would fall short of providing adequate
protection. It would allow smoking in "private offices," a concept which,
when discussing the movement of tobacco smoke, simply does not exist since
smoke flows from private offices into anterooms occupied by secretaries and/or
into the increasingly common bay-type work areas, effectively undercutting
efforts to keep the air clean in nonsmoking workspace. This predicament is
exacerbated by the transportation of smoke, with its unfilterable gases, by
air conditioning systems from the sites of origin to all parts of the
building, by seepage under and around closed doors separating distinct work
areas, by movement between floors through wiring passageways, and between
rooms on the same floor via common dead-air space above false ceilings. John
C. Topping, Jr., EPA Staff Director of the Office of Air and Radiation,
testifying before a National Academy of Sciences Committee on January 29,
1986, discussed the problem in the following terms:
"Efforts to protect the lives of nonsmokers will necessarily
involve severe restrictions or bans on workplace smoking,
especially in enclosed environments .... Significantly protective
standards against involuntary inhalation of dangerous quantities of
tobacco smoke are not likely often to be met by sequestration and
ventilation in most buildings. If we are to achieve tobacco smoke
risk levels for nonsmokers no higher than those we tolerate for
industrial carcinogens, air exchange rates akin to those found in
wind tunnels would often be required."
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For FBIS, with its anticipated move to new quarters that will feature even
more bay-type workspaces into which numerous private offices will open, the
potential for increased suffering should be clear. Moreover, to allow smoking
in private offices, while enforcing, say, the proposed GSA ban in general work
areas, would bring with it unsavory class distinctions, whereby a relative few
would enjoy a license to smoke, heedless of the impact on others.
For the above reasons we urge the Agency to move from its current regulation
on smoking--which is based on a model generally regarded as among the weakest
in the nation--to one clearly oriented toward providing the healthiest
workplace possible for employees, both nonsmokers and smokers.
* * *
We specifically propose that smoking be restricted to externally vented,
separately air conditioned smoking rooms, for the convenience of those who
wish to smoke indoors and for the protection of those who do not smoke by
choice and do not wish to smoke passively. Use of these rooms would be
required only when an employee chose to smoke; no one would use the rooms as a
permanent office. While some remodeling costs would be incurred, a high
material price is already being paid under the current policy that allows
smoking, viz. diminished productivity and increased insurance and sick leave
costs.
Among the most important benefits that would derive from restricting smoking
as here suggested are:
* the comfort of most employees and a more healthful setting for
absolutely all employees, especially those for whom exposure to
even small amounts of smoke causes pulmonary and other airway
complications, dizziness, headaches and nausea;
* elimination of situations where equal employment career
opportunities are passed up or lost because, in practice, an
unspoken requirement of a given job is that it be performed in an
atmosphere permeated by tobacco smoke;
* help for current smokers enrolled in smoking cessation programs,
which, judging from Agency notices, are seen as worthy of
promotion;
* enhancement of the health benefits derived from any fitness
facility on the premises;
* reduced health, life, fire, and accident insurance costs for both
employees and the government, plus a cut in the price of health and
life insurance costs for retirees;
* avoidance of the organizational and logistical problems inherent
in the creation of separate smoking and nonsmoking offices, an idea
suggested by some parties.
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We view the smoking room proposal as the only viable solution for dealing with
the problem at hand short of a complete ban. Necessarily strict, it is
clearly in step with a growing tide of proposals, programs, and expert
judgments in favor of dealing firmly with the problems arising from smoke in
the workplace, including:
* A series of warnings from the nation's surgeons general,
including those of C. Everett Koop, on the health dangers of
tobacco smoke and the need of everyone for a smoke-free environment
in which to work and live, most recently in testimony of June 12,
1986 before a subcommittee of the House of Representatives. Koop
there noted how one of many studies on the dangers of passive
smoking identified ambient tobacco smoke as responsible for "more
cancer deaths annually than any other agent currently regulated by
the Environmental Protection Agency." Elsewhere in the same
testimony he cited a study that showed nonsmoking adults exposed to
cigarette smoke in the workplace suffering "a decrease in small
airways function equivalent to that decrease observed in light
smokers."
* Regulatory actions taken by corporations, municipalities, states,
and government agencies, including organizations presently having
total bans on smoking in the workplace, such as the U.S. Merit
Systems Protection Board, New England Telephone, Pacific Northwest
Bell, Union Mutual Life Insurance Co.; and others restricting it in
the workplace but preparing to implement total bans on work
premises and/or resolving conflicts in ways consistent with
recognition of nonsmokers' prior right to clean air: Boeing
Aircraft Company and Chesapeake and Potomac Telephone Co., for
example.
* Legislation before the House of Representatives and Senate
(S.1440, S.1937, H.R.4488, and H.R.4546) recognizing secondhand
smoke as a significant health hazard, acknowledging the
individual's right to work in an environment free of smoke, and, in
several instances, allowing government agencies to establish rules
stricter than those proposed in the bills themselves.
* The proposed regulation of the General Services Administration,
already noted above, which includes language that both sanctions
rules stricter than those contained in its own draft and allows for
expenditures necessary for achievement of the regulation's end
(this is especially significant because the current GSA regulation
prohibits "costly alteration" of office space). The new
regulation, according to GSA Administrator Terence C. Golden, is
part of a program aimed at "total wellness" of government workers.
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* A Gallup poll conducted for the American Lung Association in
July 1985, which found that 80 percent of current smokers, 92
percent of nonsmokers, and 89 percent of former smokers believe
that employers should either ban workplace smoking completely or
restrict it to designated smoking areas.
* A recent U.S. Public Health Service survey, which showed that 78
percent of those polled believe employers have a right to prohibit
smoking at work.
* A January 21, 1986 FBIS Near East Asia Division memorandum
reporting personnel desires for "a vented smoking room with
worktables or desks, unless smoking is banned altogether."
* A June 6, 1986 memorandum issued by the FBIS Quality of Life
Subcommittee, Building Group, which recognized ambient tobacco
smoke as "a major concern to a large number of employees" in FBIS.
We believe that the foregoing discussion and the supporting documents that
follow provide essential guidance for a necessary review of the Agency Safety
and Health Program treatment of smoking in the workplace, a review based on
the belief that everyone possesses the fundamental right to clean air, a right
that exists prior to and takes precedence over any individual's right to
smoke. Furthermore, some of us stand ready to collaborate in planning the
implementation of the needed reforms.
cc: DCI; OGC; IGO; DDA; DDST; DFBIS; editor, MEDICAL NEWSLETTER
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STAT
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STATEMENT OF
C. EVERETT KOOP, M.D.
SURGEON GENERAL
PUBLIC HEALTH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
BEFORE THE
SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT
COMMITTEE ON ENERGY AND COMMERCE
U.S. HOUSE OF REPRESENTATIVES
JUNE 12, 1986
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Mr. Chairman, Members of the Committee:
I am pleased to appear before you today to discuss the public health aspects of
efforts to restrict smoking in Federal buildings.
At the outset, let me note that we defer to the General Services Administration
(GSA) in the formulation of public buildings' policy. As you know, the GSA has
recently promulgated proposed guidelines similar to those contained in the two bills
before your Committee (H.R. 4488 and H.R. 4546). My Office and the Office on
Smoking and Health have met on numerous occasions with the Administrator of the
General Services Administration and various staff to discuss features of the
currently proposed regulations to ensure that nonsmokers' rights are protected to
the extent possible.
My expertise is in the field of public health and I would like to express my views
about the public health aspects of these measures.
For the past 15 years, the Public Health Service has supported the reduction of
nonsmokers' exposure to ambient tobacco smoke. For example, a component within
the Public Health Service, the Indian Health Service, as part of its emphasis on
disease prevention and health promotion, has recently adopted a policy that all
Indian Health Service facilities should be smoke-free environments. Nonsmokers,
as you are probably aware, make up more than two-thirds of our adult population.
Increasingly, this majority has become more and more vocal concerning their right
to breath air that is free of pollutants emitted from burning tobacco. As this
majority finds existing administrative procedures for settling workplace grievances
unsatisfactory, they are turning to the courts for relief.
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I believe such procedures for protection of nonsmokers rights to be adequately
justified in the scientific literature. I would like to briefly summarize the Public
Health Service's current understanding of the scientific evidence which we feel
justifies restrictions on smoking.
The health effects of cigarette smoking have been known or suspected for over 50
years. It was not until the 1950s, however, that a number of well designed
epidemiological studies conclusively demonstrated an association between
cigarette smoking and lung cancer as well as other cancers. The scientific base
linking smoking to various chronic diseases is now overwhelming, totalling more
than 50,000 studies. This evidence led scientists to suspect that tobacco smoke
emitted into the air of enclosed indoor environments may also have an effect on
health. In the 1970s, investigators began to turn their attention to the possible
health effects of passive smoking. The early research designs looked primarily at
artificial environments and centered on measuring chemical constituents such as
carbon monoxide, tars, benzopyrene, nicotire and other substances found in
tobacco smoke. In many studies the environments were strictly controlled
laboratory exposures.
We know today that cigarette smoke contains over 4,000 known constituents, some
five dozen of which are known carcinogens, tumor promoters or initiators. Many of
these constituents are found in side-stream smoke in greater concentrations than in
mainstream smoke. Some of these are illustrated in Table 1.
Tar, the fraction of tobacco smoke that is usually associated with the carcinogenic
process, is 70 percent higher in side-stream than in mainstream smoke. Carbon
monoxide is 2.5 times greater; ammonia 73 times; benzopyrene 3.4 times; and
nicotine 2.7 times greater in side-stream than in mainstream smoke.
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Side-stream smoke is released into the ambient air, resulting in dilution.
Nonsmoker (and smoker) exposure is dependent upon the amount of smoke
generated, the volume of ambient air, and the type and amount of ventilation of
the occupied space.
While absorption of smoke constituents by nonsmokers in smoked filled spaces has
not been completely characterized, a recent Japanese report by Matsukura,
Taminato and associates using urinary cotinine levels as a marker for exposure,
found that some heavily exposed nonsmokers actually absorbed the equivalent of
one to two cigarettes per day (Figure 1).
Contaminants from tobacco smoke are found everywhere, in homes, offices,
worksites, and other places where people are permitted to smoke. Sometimes
levels of these constituents are higher than are allowed in National Ambient Air
Quality Standards (NAAQS). Repace and Lowrey, in their 1980 study, found
excessive levels of particulate matter from tobacco smoke in every one of the 19
environments where smoking was taking place. Short-term concentrations
exceeded levels of National Ambient Air Quality Standards by factors ranging from
1.2 to 10 and more (Figure 2).
Differences in the carcinogenicity of side-stream and mainstream smoke may also
exist. Wynder and Hoffmann found side-stream smoke condensate to be more
tumorigenic per unit weight in mouse skin assays than mainstream smoke
condensate.
The rationale and concern for the possible health effects of passive smoking are
well founded in the epidemiological literature on active smoking which has
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consistently noted a strong dose-response effect. Data from the major prospective
studies have documented a greater than four-fold excess risk of lung cancer for
those smokers consuming nine or fewer cigarettes daily. As the level of daily
smoking increases so does the lung cancer'death rate. Figure 3, extracted from the
American Cancer Society study of more than 1 million men and women followed
prospectively for 12 years, illustrates the dose-response effect for four levels of
daily cigarette consumption. A dose-response effect has also been observed by the
length of time one has smoked, an earlier age of initiation, depth of inhalation, and
other variables. In short, the greater the overall exposure to tobacco smoke, the
greater the health risk.
One study conducted among nonsmoking adults exposed to ambient tobacco smoke
noted a decrease in small airways function equivalent to that decrease observed in
light smokers. This study population consisted of nonsmoking adults who did not
live with smokers but were exposed to cigarette smoke at the workplace.
Nonsmokers who are exposed to tobacco smoke in the air absorb nicotine, carbon
monoxide, and other constituents, as do smokers, although, as would be expected,
in smaller amounts. The amounts they absorb are dependent on the extent and
length of exposure and the quality of ventilation.
In the 1982 Surgeon General's Report on the Health Consequences of Smoking and
Cancer, three epidemiological studies were cited that dealt with passive smoking
and cancer. The findings of these studies, one each in Japan, the United States,
and Greece, indicated that nonsmoking wives of smoking husbands experienced
higher lung cancer rates than nonsmoking wives of nonsmoking husbands. In the
studies from Japan and Greece the differences were statistically significant, while
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the differences in the United States study were not. In the past four years,
however, many additional studies have been published (Table 2). Of the 15 studies
to date which have examined the link between passive smoking and lung cancer,
only three have not shown a positive correlation and several report statistically
significant results.
The case control study by Garfinkel et a! is particularly important to note, as the
investigators designed the study to take into consideration many of the problems
found in other studies. These investigators examined 1,175 women with lung cancer
from four hospitals between 1971 and 1981. Eight hundred and ninety eight of
these women (76 percent) were identified as smokers according to hospital records.
Of the 283 remaining women 36 or 12.7 percent were proved histologically to have
other than lung cancer and another 113 or 40 percent were found to be smokers
upon re-interview. These cases were excluded from the study. In all, 134 cases of
lung cancer were available for analysis, and these were compared to 402 cases of
colon-rectum cancer which served as controls. All were nonsmoking women. Two
findings are significant. Women whose husbands smoked 40 or more cigarettes per
day had a two-fold risk of developing lung cancer (1.99) and women whose husbands
smoked 40 or more cigarettes per day in the home had a slightly greater than two-
fold (2.11) risk of lung cancer. The strength of this study, however, is that the
authors were able to eliminate those women from the study pool who were
originally misclassified as nonsmokers and all lung cancers were histologically
confirmed. A logistic regression analysis showed a significant positive trend of
increasing risk with increasing exposure to husbands smoking at home, controlled
for age, hospital, socioeconomic class, and year of diagnosis.
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Two additional studies, soon to be published, are purported to also -show a strong
positive correlation between passive smoke exposure and an increased risk for lung
cancer. More recently, studies have also indicated that nonsmokers may be at risk
for developing coronary heart disease as a result of exposure to ambient tobacco
smoke.
In an attempt to provide a public health estimate of the number of lung cancer
deaths that might be attributed to passive smoke exposure each year, Repace and
Lowery constructed an exposure model which provided that between 500 and 5,000
lung cancers among nonsmokers may result. Even if the lower figure is accepted,
exposure to ambient tobacco smoke would represent more cancer deaths annually
than any other agent currently regulated by the Environmental Protection Agency.
Finally, two major reviews on environmental tobacco smoke's effect on nonsmokers
were published this past month. One by the Office of Technology Assessment and
the other by the International Agency for Research on Cancer (IARC) in Lyon,
France. The Office of Technology Assessment Staff Report concluded "The
epidemiologic evidence from a number of studies is generally consistent with the
biologically plausible hypothesis that passive exposure to tobacco smoke can cause
lung cancer." The Office of Technology Assessment Report observed that
published studies to date, while not free of flaws in methodology and design,
particularly in their measurement of exposure to tobacco smoke, do not invalidate
the studies, and that the data are sufficient to warrant serious concern because of
the number of people in the population who are currently exposed to such
contaminated environments. The International Agency for Research on Cancer
(IARC) of the World Health Organization concluded that "passive smoking gives
rise to some risk of cancer." IARC supported this conclusion on the basis of the
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characteristics of side-stream and mainstream tobacco smoke, absorption of these
substances by nonsmokers, and the nature of the dose-response relationship
consistently observed for active smoking and lung cancer. As with the OTA report,
IARC appropriately based its conclusion on the basis of the biological plausibility
Surveys conducted by the Department of Health and Human Services, the American
Cancer Society, and even the Tobacco Institute show that the majority of people,
smokers as well as nonsmokers, favor reasonable restrictions on smoking in public
places including the workplace. In fact, these surveys indicate strong public
sentiment favoring the restriction of public smoking. In the survey conducted by
the Tobacco Institute, the majority approved of segregating smokers in every one
of the public places tested, including trains, airplanes, buses, theaters, eating
establishments, and in workplaces and offices.
Last year the Gallup Poll and the American Lung Association in their biennial
survey of attitudes toward public smoking found that 75 percent of all adults,
including 62 percent of smokers, agreed that smokers should refrain from smoking
in the presence of nonsmokers and 79 percent agreed that companies should have a
policy on smoking at work. The percent of adults expressing agreement with these
two statements increased since 1983 when the survey was first conducted.
More than 40 states have enacted legislation that controls, restricts, or prohibits
smoking in public places. Many of the laws address select circumstances such as
elevators while many others have enacted "Comprehensive Clean Indoor Air Acts."
This legislation has not been enacted for reasons of fire or safety, per se, but to
protect the rights of the nonsmoker to breathe clean air.
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In a recent review conducted by the Office on Smoking and Health of all state
legislation enacted through 1985, 17 states were identified which have enacted
legislation relating to smoking in offices and other workplace settings. (Figure 4).
Many address smoking among Government employees or in Government offices.
However, 12 also address non-Government settings. California, for example,
requires that state departments employing more than 50 workers adopt a written
policy providing nonsmokers a smoke-free environment in meetings and at
individual work stations. The statutes of Connecticut and New Jersey mandate
that employers of more than 50 workers establish and post written rules regarding
smoking and nonsmoking within their facilities. Several states impose restrictions
on smoking in workplaces not usually frequented by the general public. Minnesota,
Nebraska, and Utah have directed their state health. departments to establish rules
to prohibit or restrict smoking in factories, warehouses and similar places of work.
The legislation, as proposed in the Senate and now the House of Representatives,
parallels actions taken by several large corporations, including the Boeing Company
of Seattle, Aetna Life and Casualty Company, Texas Instruments and others that
have instituted measures whereby smoking is either banned or restricted to
designated areas in the workplace.
Mr. Chairman, in summary, I personally believe that sufficient evidence exists to
indicate that nonsmoker exposure to ambient tobacco smoke is hazardous to their
health, that such exposure can cause lung cancer and probably other diseases, and
that we should not delay public health measures to reduce or eliminate exposure to
an agent proven to represent a substantial health threat.
Mr. Chairman, this concludes my statement. I will be happy to respond to
questions.
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ASH SPECIAL REPORT
National Academy Of Science Hearings On Passive Smoking
Action on Smoking and Health joined scientists, health professionals, and others in testifying before the Na-
tional Academy of Sciences (NAS) on the health effects of ambient or passive tobacco smoke. The NAS, an
organization chartered by Congress in 1863 to give federal agencies independent scientific advice on technical
issues, was asked by the Environmental Protection Agency to study and report on two issues: how can indirect
exposure to tobacco smoke be measured, and what are its effects on health? As part of this process, the NAS's
Committee on Passive Smoking heard testimony on Wednesday, January 29,1986, from approximately twenty
witnesses, almost half of them associated with the tobacco industry
Generally, the testimony and views of government officials, representatives of major health organizations, and
independent scientists agreed that there is more than enough scientific and medical evidence to warrant action.
On the other hand, the opinion of the tobacco industry and the members of a so-called "Indoor Air Pollution
Advisory Group"-individuals whose research is funded by the tobacco industry-is that the evidence is weak
and the studies flawed, and that the ill effects many people feel when exposed to tobacco smoke could easily be
caused by other things.
Because of the importance of this issue and of the proceedings before the National Academy of Sciences,
ASH presents this Special Report, which contains excerpts from the testimony before the Committee and from
some of the materials referred to.
NOTES
1. Materials printed in smaller type are from the actual documents cited. Omissions and footnotes are generally NOT
indicated.
2. Materials in larger type are comments or additions by ASH, and should not be attributed to the authors.
3. Items in brackets are footnotes from the original document if the notation "fn." appears; otherwise, they are
comments or additions by ASH.
4. ASH regrets that it cannot respond to requests for individual copies of the documents. Requests should be sent to
the individual authors or the NAS, 2100 C St. NW, Washington, DC, 20006.
Statement of the Coalition on Smoking OR Health
by Lawrence Garfinkle, Vice Presi-
dent for Epidemiology and Statistics,
and Director of Cancer Prevention for
the American Cancer Society
This Statement is of particular impor-
tance for two major reasons. The first
is that not only is Mr. Garfinkle a very
prominent researcher in the area, but
also he speaks here on behalf of the
three major national health organi-
zations. The second is that the
tobacco industry has quoted Mr. Gar-
finkle-he says misquoted-in a
number of their ads about passive
smoking (see discussion following
the Statement).
I am Lawrence Garfinkle, Vice President for
Epidemiology and Statistics and Director of
Cancer Prevention for the American Cancer
Society. I am speaking on behalf of the Coalition
on Smoking OR Health, whose member organi-
zations the American Heart Association, the
American Cancer Society, and the American
Lung Association founded the Coalition in
March 1982 to bring smoking prevention and
education issues to the attention of legislators
and other government officials. I have published
two studies on involuntary smoking and lung
cancer, one a prospective study and one a case
control study, the latter appearing in the Journal
of the National Cancer Institute in September,
1985. I am pleased to have this opportunity to
present the views of the Coalition and myself
about involuntary smoking.
Evidence continues to accumulate on the
harmful effects of environmental tobacco
smoke. Many people, allergic and non-allergic,
complain of the acute effects of exposure to
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tobacco smoke. In one study of non-allergic per- v'
sons exposed to environmental tobacco smoke,
nearly 70% said they suffer from eye irritation,
30% indicated they experience nasal discom-
fort, 30% get headaches and 25% develop a
cough. Of those individuals who say they are al-
lergic to tobacco smoke, the percentages
complaining of various symptoms are even
higher.
The relationship of involuntary smoking and
cancer has generated the most interest and sci-
entific inquiry. Studies in both Japan and
Greece revealed that women nonsmokers
married to smokers have higher risks of lung
cancer. In the Japanese study, nonsmoking
wives of heavy smokers had an 80 percent high-
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a1 11plr v1 auyun n 1y luny cancer, wnae the ureeK
study showed nonsmoking wives of heavy
smokers had a risk of developing lung cancer
three times that of nonsmoking wives married
to nonsmokers.
In a case-control study by the American Can-
cer Society of 134 lung cancer cases and 402
controls, wnicn used four different methods to
measure exposure to tobacco smoke, invol-
untary smoking increased the risk of lung can-
cer from 13 percent to 31 percent. This overall
risk was comparable to that shown by an earlier
American Cancer Society prospective study,
although the earlier study did not show a rela-
tionship between an increased risk of lung can-
cer in the nonsmoking wife and the number of
cigarettes smoked per day by her husband. The
latest ACS study did show a dose response
relationship based on the number of cigarettes
smoked by the husband. The risk of lung cancer
doubled in nonsmoking women whose hus-
bands smoked 20 or more cigarettes a day at
home.
Several investigators have shown that certain
chemical constituents in sidestream smoke
(including "tar" and nicotine) are found in much
greater concentrations than in mainstream
smoke. A number of studies have also demon-
strated that involuntary smokers have higher
levels of cotinine in blood plasma, urine or saliva
than nonexposed nonsmokers. Cotinine is a
metabolite of nicotine and is considered an
accurate measure of exposure to tobacco
smoke.
The evidence linking involuntary smoking
and lung cancer is growing. At least two addi-
tional case-control studies, each with large
numbers of nonsmoking lung cancer cases, are
in press. Both new studies show essentially the
same dose response relationship between risk
of lung cancer and exposure to tobacco smoke
as described above. Several other large multi-
center studies are now underway as well.
In addition, involuntary smoking may also
exacerbate symptomatic coronary heart
disease. At a recent American Heart Associa-
tion meeting, report was made of increased risk
of death from coronary heart disease due to in-
voluntary smoking. This paper is now being pre-
pared for publication. Although this report is
preliminary and additional studies are required
to confirm the finding, this could be an even
more serious public health problem than lung
cancer, as many more deaths would be involved.
After the first studies linking active smoking
and lung cancer in the early 1950s, such as the
Hammond-Horn study in 1954, it took six years
before the American Cancer Society issued its
first policy statement on the dangers of cigar-
ette smoking, and even then ACS limited its
concerns to teenage smoking. Many said at that
time that more proof was needed before the
relationship between active smoking and lung
cancer could said to be proved. Speculation
about confounding factors such as personality
and genetic background impeded those urging
initiatives to stem the growing tide of American
smokers. Not until the 1964 Surgeon General's
report (ten years after the Hammond-Horn
study) did education initiatives about the
dangers of smoking take hold and begin to have
an effect on the nation's smokers.
The Coalition believes that the evidence ac-
ASH Review
AnriI 1QAA
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consequences of involuntary smoking is
sufficient to recommend that action be taken to
protect the health of nonsmokers in the work.
"Involuntary smoking may also
exacerbate symptomatic coronary
heart disease ..this could be an even
more serious health problem than
lung cancer, as many more deaths
would be involved."
place and in public places. Although more
research is needed to determine the details of
the relationships between nonsmokers' expo-
sure to tobacco smoke and lung cancer and
coronary heart disease, the question of whether
the involuntary smoker faces a health risk has
been answered. The risks posed by involuntary
smoking may be much smaller than those
posed by active smoking, but the potential num-
ber of affected individuals is much, much
greater. We should take our lesson from the
events of the 1950s and 60s. The time to act is
now.
The R.J. Reynolds Tobacco Com-
pany, in national ads designed to
reassure nonsmokers about passive
smoking, has quoted Mr. Garfinkle of
the American Cancer Society as
saying that passive smoking had
"very little, if any" effect on lung
cancer rates among nonsmokers, and
that "passive smoking may be a
political matter, but it is not a main is
sue in terms of health policy." Mr
Garfinkle has publicly labeled the
latter use of his work "scandalous
and hypocritical" because it was
taken out of context from its origina
source, and further distorted it
meaning for purposes of the adver
tisement.
The most recent study Mr
Garfinkle mentioned-Garfinkle
Auerbach, and Joubert, "Involuntary
Smoking and Lung Cancer. A Case.
Control Study," J. Nati. Cancer Inst
75(3):463-469, Sept. 1985-found that
the chances of developing lung
cancer for women whose husbands
smoked were 30 percent higher than
for wives of nonsmokers even after
correcting for the fact that wives of
smokers are more likely to be
smokers or exsmokers. When the
husband smoked more than a pack a
day at home, the woman's risk was
over 100 percent higher. The study
concluded:
This indicates that lung cancer is very
uncommon among women who don't
smoke. Their risk is very small. But
we've found that living with a smoker
and breathing smoky air heightens the
chance that a nonsmoker will develop
lung cancer, and that the risk increases
the more the smoker smokes per day.
On The Effects Of Passive (Or Involuntary) Smoking By
Nonsmokers
by John F. Banzhaf III, Executive
Director and Chief Counsel, Action on
Smoking and Health (ASH)
Because Action on Smoking and
Health is primarily a legal action rather
than a scientific organization, and be-
cause the major scientific studies in
the area had already been fully
discussed before the NAS committee,
ASH decided to use its limited time to
emphasize several common-sense
points in its testimony.
My name is John Banzhaf, and in addition to
my position as Professor of Law at the National
Law Center of the George Washington University,
I am Executive Director and Chief Counsel of
Action on Smoking and Health (ASH). ASH is a
non-profit tax exempt scientific and educational
organization headquartered in Washington, D.C.
It is the only national organization concerned
solely with the problems of smoking.
ASH is generally credited with initiating the
nonsmokers' rights movement by first
successfully petitioning for no-smoking sections
on airlines, helping to pass the first two state-
wide nonsmokers' rights laws in Arizona and
South Dakota, and by developing the "THANK
YOU FOR NOT SMOKING" sign. Since the very
beginning, ASH, which serves as the legal-action
arm of the antismoking community, has been in-
volved directly or indirectly in most of the judicial,
regulatory, and legislative proceedings related to
the problems of protecting nonsmokers from the
adverse effects of ambient tobacco smoke. It is
SMOKING AND HEALTH REVIEW. ; Action on Smoking and Health. 2013 H St.. N.W.. Washington. DC 20006. Action on Smokina and Health a nalln~al r.. tax
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testify. nonsmokers, and in some situations have even the evidence normally required to take action
Although I have a scientific degree from M.I.T., ordered compensation. with regard to other suspected public health
two U.S. Patents, and have published almost a Surely the fact that many people with various problems (eg., industrial exposure, outdoor air
dozen technical papers, and although in the susceptibilities suffer severe health problems pollution), and to the strength of the evidence
course of my work I have become generally from exposure to ambient tobacco smoke is not concerning well-known public health problems
familiar with the scientific and medical evidence open to question, and no further detailed as to which action has long since been taken
related to the effects of passive smoking, my studies are necessary. While attempting to (eg., lead in gasoline, food additivei
testimony is primarily that of a layman and not a better quantity the number of such people and I can testify from personal experience that a
scientist. For these reasons I would like to very the nature and severity of their reactions might great deal of confusion has occurred with
briefly address, not the methodologies of per. be useful, it. is far from necessary for purposes regard to discussions of debated about whether
forming or evaluating the individual studies, but of establishing this simple fact. ambient tobacco smoke is a cause of lung
rather the form the ultimate findings should take Equally clear is the fact that many-perhaps cancer. Since your report is designed at least in
to most fairly and effectively fulfill your mandate a majority-of nonsmokers with no particular part to provide information to the lay public-
of making not only a comprehensive but also a susceptibilities suffer real physical irritation including regulators, legislators, and other
clear and understandable report to the public on upon exposure to tobacco smoke in typical officials-it is respectfully suggested that it
this important issue. ` social situations. The most common must take into account the most popular forms
In summary, ASH has four major recommend- manifestations, in order of decreasing of confusion or misunderstanding and directly
ations: frequency, are eye irritation, nasal symptoms, address them.
I. That your report forcefully and without equivo? headache, cough, wheezing, sore throat, The first problem is that many people believe
cation document those shortterm health hazards hoarseness, and dizziness. Once again this fact that a scientific proposition such as causation
and physical Inflations caused by ambient tobec- is so well known that it is hardly open to any is either "proven" or "not proven"; i.e., that there
co smoke as to which there is no serious doubt, serious doubt or in need of further studies. is some certain and easily determined quantum
and clearly distinguish time from the long-term Indeed, it is so well known that a major brand of or standard of evidence that must be met in
consequences as to which some may have eyedrops actually advertises its product for order to prove the proposition, and that at any
doubt. relief from the "red eyes" caused by exposure to lower level the proposition is not proven. In
In seeking to determine whether various sub- cigarette smoke. short, they do not realize, as scientists do, that
stances-such as lead from gasoline, workplace In any body or randomly selected group of propositions such as causation only tend to be
chemicals, food additives and residues, and con- nonsmokers there are many who can testify established, and that while increased levels of
taminants in drinking water-cause adverse from their own experience of the physical evidence produce higher and higher levels of
health consequences, it is often necessary to do irritations they have suffered from exposure to certainty, there is no magic or preordained level
many large-scale carefully controlled studies; in various levels of tobacco smoke (e.g., a recent at which certainty is achieved.
part because the adverse effects may be masked survey at the U.S. Agency for International De- Closely related is the failure of many people
by the effects of other substances to which there velopment showed that 63 percent experienced to realize that with regard to most suspected
is also exposure; and in part because the effects irritation from smoking in their workplace). In public health problems, action must be taken
take so long to manifest themselves. Fortunately, such situations detailed scientific studies are long before one can say that causation has been
with regard to many of the problems caused by unnecessary: the nonsmoker experiences established to a standard of "reasonable med-
ambient tobacco smoke, the effects are so physical manifestations of irritation every time ical certainty" (a standard familiar from civil
immediate, so serious, and so overwhelming that he or she is exposed to sufficient concentration actions) or "beyond a reasonable doubt" (a
no such studies are necessary. In short, the of tobacco smoke; the irritations cease after standard familiar from criminal proceedings). In-
power of tobacco smoke to cause immediate leaving the smoky situation, and the irritations deed to require this very high and incredibly
physical reactions in commonly encountered sit- are of the type known to be caused by some of difficult-to-obtain level of evidence before taking
uations among such a large body of people is by the specific chemical irritants identified in any action, particularly with regard to a
itself conclusive evidence of at least some of the tobacco smoke. Once again further studies may substance to which millions are exposed, and
health hazards it poses. be helpful, but they are hardly necessary to which is suspected of causing very serious
For example, it has long been known by document the physical irritations many healthy consequences only manifested after many
allergists and by many other physicians that nonsmokers suffer. years of exposure, would doom tens of
there are many conditions that make people very Nor can it be doubted that what each of these thousands of people to death.
susceptible to the concentrations of tobacco two groups experience are health problems. By the same token, it is inappropriate to
smoke they encounter in their daily lives. These They are in many ways the same manifestations initiate various regulatory measures based upon
conditions include chronic sinusitis, asthma, hay suffered by people with colds, flu, and other nothing more than a hunch or suspicion. It is for
fever, various allergies, chronic bronchitis, common health problems that interfere with a this reason that public health professionals to-
emphysema, and other lung conditions, as well person's ability to work, and in many cases even gether with legislators and regulators have
3s lesser-known conditions. The National Health cause absence from work. The relevarrt federal developed a variety of criteria- standards of
survey ending June 1967 estimated that over 30 agencies, and a U.S. District Court, have deter- proof-to determine with regard to various
'pillion Americans suffer from these diseases. mined that persons with a particular suscepti- types of problems when it is appropriate to take
Virtually every allergist and many other doc- bility to smoke are "handicapped persons." action. Common examples include foods and
:ors know patients with these and other drugs, various components of outdoor air
:onditions who suffer serious and often debili- pollution, workplace exposure to various sub-
:ating health problems upon exposure to smoke "the power of tobacco smoke to stances, and contaminants in drinking water.
n workplace and social situations. Such situa- cause immediate physical reactions To make whatever assessment you may
:ions have been well documented in the medical in commonly encountered situations make of the weight and strength of the evidence
iterature for at least the past 15 to 20 years. among such a large body of people is linking ambient tobacco smoke to long-term
4sthmatics who suffered an attack and were health problems such as lung cancer meaning-
orced to seek medical help from drifting by itself conclusive evidence of at ful to governmental officials as well as the lay
obacco even while seated in the no-smoking least some of the health hazards it public, ASH would suggest that your report
,ection of airplanes, and people whose reaction poses." include two simple and brief sections. One
o smoke was so severe that they had to be section would simply state the criteria, in terms
aken from an airplane in an ambulance, have of the types and conclusiveness of proof, that
peen the subject of testimony at the C.A.B. are generally required in similar or related sit-
.ourts, administrative agencies have, after Il. That, in evaluating the strength of the uations to trigger regulatory action; e.g., by the
tearing all of the evidence, ordered restrictions evidence linking ambient tobacco smoke to Delaney Amendment, the uniform cancer
to smoking in the workplace because of the long-term health problems such as lung cancer, policy, OSHA's criteria, and the various EPA cri-
SMOKING AND HEALTH REVIEW. Action on Smoking and Health. 2013 H St.. N.W.. Washington. DC 20006. Action on Smoking and Health. a national nonprofit tax- ASH Review
exempt organization concerned with the problems of smoking and the rights of nonsmokers, is entirely supported by tax-deductible contributions. Regular contributors April 1986
receive the Smokinn Ann k . din Oa-.- D-,en ...,.n,.,... ,., .. .. o_..._... ___ -. --- I...- -
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,
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able layman can evaluate the significance of the
weight of the evidence relating to ambient
tobacco smoke.
Second, it is respectfully suggested that in
order to provide some basis of comparison, the
weight of the evidence linking ambient tobacco
smoke to lung cancer should be compared to
the weight of the evidence relating to other well-
known issues. For example, since we have
taken several very stringent measures to
severely restrict lead in gasoline because of its
alleged adverse health consequences when in-
haled by children, it is reasonable to ask
whether the evidence supporting that action is
substantially stronger, substantially weaker, or
of the same order of magnitude as that related
to ambient smoke and lung cancer. Other exam-
ples that came readily to mind include saccharin
and cyclamates, various contaminants in drink-
ing water, the various components of outdoor
air pollution, and substances whose exposure is
regulated by OSHA.
Obviously it would not be necessary to com-
pare ambient smoke evidence with that related
to all of the above situations or substances, nor
to provide a detailed quantitative discussion of
the evidence in these other areas. However, it
should not be difficult for persons skilled in
these areas to provide a few simple
comparisons with other well-known substances
likewise subject to regulation. It is respectfully
suggested that only in this way will the report be
truly meaningful in view of the growing public
controversies Involving this issue. It should be
noted that making such comparisons is purely a
scientific assessment, and does not necessarily
imply that any particular regulatory action with
regard to smoking or the other substances is
proper, necessary, or appropriate.
"Surely the fact that many people
with various susceptibilities suffer
severe health problems from expo.
sure to ambient tobacco smoke is not
open to question, and no further de-
tailed studies are necessary."
Ill. That the report include a discussion of the
serious adverse effects on nonsmokers of
efforts to heat, cool, and ventilate buildings in
which smoking is permitted-including
dramatically increased costs and the problems
caused by recirculation-drawing upon the
work done by ASHRAE
In reporting on the exposure of nonsmokers
to ambient tobacco smoke, it would seen only
appropriate to examine, draw upon, and report
to the extent that it is found to be sound, the
work done by the American Society of Heating,
Refrigerating, and Air-Conditioning Engineers
(ASHRAE) in developing their standards for ven-
tilation. After all, ASHRAE, like the NAS, is an
impartial professional body that developed
these standards and the underlying
methodology based upon its very considerable
ASH Review
April 1986
Page 8
ate. if a,r vvettt, it urns zo Hen important are asserted to be the conclusions of differen
that the' public know about this, and its ramifi- bodies and the positions of various scientists
cations.
Basically, what ASHRAE set out to do was to
determine how often the air in a room must be
exchanged in order to maintain minimum ac-
ceptable levels of air quality. What they deter-
mined is that with regard to most indoor areas,
the number of air exchanges per hour (or the
amount of.ventilation in cubic feet per minute)
must generally be three to five times greater if
smoking is permitted. Implicit in these stand-
ards is the well-known scientific fact that the
gases in cigarette smoke,(or indeed in any other
contaminant) cannot be filtered out of the air,
that the particulates in cigarette smoke can be
filtered out only to a limited extent; and that
much of the air exhausted from a room with
conventional ventilation systems is simply recir-
culated - thus returning most of the cigarette
smoke contaminants to the indoor area.
These studies are important for government
officials and others seeking to assess the im-
pact of ambient tobacco smoke. They indicate
that it costs far more to maintain an acceptable
level of air quality if smoking is permitted than if
it is not, or if it is permitted only in separately
ventilated areas. They also indicate that, partic-
ularly for persons with conditions making them
specially sensitive to tobacco smoke, prohibit-
ing smoking in their immediate area may not
eliminate the problems. A report noting these
facts will also help to put nonsmokers on notice
that if they suffer from various ill effects in the
work environment, they should not rule out
tobacco smoke as the culprit simply because no
smoking occurs in their immediate vicinity.
IV. That your report specifically address, evahr
ate, and report on the alleged reports, quota-
tions, and other materials cited by the Tobacco
Institute and the R.J. Reynolds Company in ads
as evidence proving that ambient tobacco
smoke does not create health hazards for non-
smokers.
Over the past several years large advertise-
ments sponsored by either the Tobacco
Institute or the R.J. Reynolds Tobacco Com-
pany have appeared in newspapers and maga-
zines across the country. They address the
question of whether ambient tobacco smoke
causes health problems for nonsmokers, and
Action on Smoking and Health respectfull
suggests that it is not only appropriate but act
ually necessary for your report to specificall'
address the purported authorities cited by thest
two companies in your final report. We believt
that this is necessary for at least two reasons
The first is that the cigarette manufacturers an(
their major spokesperson, the Tobacco
Institute, have frequently maintained tha-
evidence tending to support their side of issue:
related to smoking is unfairly and Improperly
ignored by various bodies that have reviewec
the evidence. Indeed, they seem to maintair
that the weight of evidence on the issue of
ambient tobacco smoke is on their side, anc
that conclusions to the contrary can be reachec
only if the authorities they cite are Ignored.
Thus, to avoid any controversy of this type with
regard to your own report, it would seem useful
to at least briefly discuss each of the authorities
they have cited, and explain both the weight you
attach to them and their impact, if any, on your
conclusions.
A second reason why ASH believes that you
should at least briefly address these assertions
is that they appear to have confused and
perhaps even misled many readers. Many
people have reportedly seen the ads and no
doubt concluded from looking only at the one-
sided and self-serving statements therein that
there is a significant body of scientific thought
to the effect that there are no health problems
related to ambient tobacco smoke. Any conclu-
sions to the contrary are likely not to be believed
by such readers, unless they specifically ad-
dress and do not duck the evidence cited by the
cigarette manufacturers.
It must be emphasized that ASH does not
suggest in any way that your report review the
specific ads, nor attempt to determine whether
they are in some sense unfair or misleading as
some have charged. Rather, what we suggest is
that your report specifically address the docu-
ments cited by the industry, as you presumably
will for-other reports and studies, and assess
the weight, if any, that should properly be given
to them based upon well-established scientific
criteria
Passive Smoking and the Innocent Victim:
A Dilemma for Policy Makers
by John C. Topping, Jr., Staff Director,
Office of Air and Radiation, U.S. Envi-
ronmental Protection Agency
This paper, by a government official
with extensive experience related to
air pollution, summarizes most of the
major evidence in this area, and rec-
ommends elimination of all smoking
in the workplace as a necessary step
to adequately protect nonsmokers.
Until recently involuntary exposure to ciga-
rette smoke has been treated more as a matter
of social etiquette than of public health. The
nonsmokers' rights movement has been
portrayed by tobacco interests as an
assemblage of finicky busybodies intent on
imposing their values on smokers. In the past
year the passive smoking issue has taken on
new dimensions as evidence has mounted that
involuntary exposure to tobacco smoke may be
one of the leading environmental sources of
death.
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of groups such as Mothers Against Drunk
Driving, we have become more conscious of the
slaughter on our highways caused by alcohol
abuse and have taken concrete steps to curb
this abuse. Efforts to curb drunk driving have
undoubtedly saved lives of persons in each of
these categories, sparing the lives of potential
drunk drivers, their willing or unwilling passen-
gers. and innocents who would have had the
misfortune to come across these drivers on the
highway.
"Involuntary exposure to tobacco
smoke may be one of the leading
environmental sources of death."
Our experience in dealing with drunk driving
is instructive as we approach a source of death
of equal or greater magnitude, passive smoking.
Last year Repace and Lowrey projected an
annual U.S. lung cancer death rate among
nonsmokers from involuntary exposure to to-
bacco smoke of about five thousand. These
projections have gained acceptance in the
public health community as indicated by an edi-
torial in the current issue of the American
Review of Respiratory Disease by Scott T.
Weiss, M.D., Associate Professor of Medicine at
Harvard Medical School. Repace and Lowrey's
lung cancer risk projections appear consistent
with the findings of a number of epidemiolog.
ical studies indicating elevated lung cancer risk
from exposure to sidestream tobacco smoke.
This five thousand annual projection for lung
cancer deaths alone from sidestream tobacco
smoke exceeds most current total annual
cancer estimates for general population
exposure outside the workplace from all
industrial carcinogens combined. Yet, while
these estimates of lung cancer risk from
involuntary exposure to tobacco appear to be
the most firmly supported of the passive
smoking risk projections, they may represent
only the tip of the iceberg of the health damage
from such exposure. [fn: Peter Fong, Physics
Department, Emory University, has projected
that passive smoking exposure of nonsmokers
is responsible for between 10,000 and 50,000
deaths annually. Fong, "The Hazard of Cigarette
Smoke to Nonsmokers," J. Biol. Phys., Vol. 10,
1982.]
If we are to minimize cancer risks from invol-
untary exposure to tobacco smoke, further
research by health scientists on the specific
mechanisms elevating such cancer risk would
be desirable. Yet from the viewpoint of
policymakers and citizens alike the present
evidence, fragmentary though it is, seems suf-
ficient to warrant strong steps to cut down
involuntary exposure to cigarette smoke.
Although the greater accessibility of data on
family smoking habits and childhood or spousal
health provides us considerably greater
understanding of passive smoking in the home,
there is evidence that tobacco smoke
concentration and health risks may be greater in
the workplace. James L Repace, one of the
pioneers with A.H. Lowrey in research on
passive smoking, summarizes the findings the
two have made in a series of studies:
cigarettes, pipes, and cigars indoors was not only
chemically related to the smoke from factory
chimneys, but routinely occurred at far higher levels
indoors than did factory smoke or automobile
exhaust outdoors. [Our] controlled experiments and
field studies showed that in buildings where tobacco
is smoked, substantial air pollution burdens were
inflicted upon nonsmokers, far in excess of those
encountered in smoke-free indoor environments,
outdoors, or in vehicles on busy commuter highways.
Daily exposure to ambient tobacco smoke, (we]
found, could cause air pollution levels corresponding
to violation of the annual National Ambient Air
Quality Standard for Total, Suspended Particles for
exposed office workers, at typical building
occupancies and ventilation rates, and amounted to
the single most important source of exposure of the
population to this harmful kind of air pollution.
Tobacco particulate consists overwhelmingly
of respirable small particles. Recognizing that
particles of 10 microns or less are readily
inhaled into the lungs where they cause
respiratory difficulty, EPA has proposed
adoption of a health standard keyed to particles
of 10 microns or less.
"(Five thousand nonsmoker deaths
a year from passive smoking] may
represent only the tip of the iceberg
of the health damage from such
exposure."
Some health studies have indicated that
passive smoking exposure of adults may signifi-
cantly increase risks of heart attack. Garland at
a/ found in a prospective study of 695 Southern
California married women who had never
smoked that over a 10 year period nonsmoking
wives of current or former cigarette smokers
had a higher total and age-adjusted death rate
from ischemic heart disease than women
whose husbands never smoked. This is not par-
ticularly surprising as we know sidestream to-
bacco smoke includes substantial quantities of
carbon monoxide. EPA recently reaffirmed a Na-
tional Ambient Air Quality Standard of 9 parts
per million, 8 hour average, of carbon monoxide
not to be exceeded more than once a year. A sig-
nificant factor in this reaffirmation was evidence
that exercising angina patients exposed to ele-
vated levels of carbon monoxide showed more
rapid onset of angina pain. In one study, Pimm
at al (1978) exposed nonsmoking adults to
tobacco smoke in an exposure chamber and
realized relatively constant levels of carbon
monoxide of about 24 parts per million above
the ambient level, concentrations three times
EPA's 8 hour average carbon monoxide stand-
ard for ambient air. Such levels are probably
often reached when smoking occurs in en-
closed environments with little ventilation such
as many taverns, restaurants, banquet halls,
closed cars or taxicabs. Within a few minutes
elevated carbon monoxide levels in the air
which is breathed will be reflected in increased
levels of blood carboxyhemoglobin. As blood
capacity to carry oxygen is diminished, thus in-
creasing risk of heart attack or stroke. Approxi-
mately 8.7 million individuals are known to
suffer from angina and related cardiovascular
disease. These individuals can be presumed to
be at special risk from both mainstream and
sidestream tobacco smoke.
About 3 percent of the population, many
acute asthmatics, bronchitics or atopics, are
allergic to tobacco smoke. Such hypersensitive
individuals report frequent nose and throat irri-
tation, wheezing, coughing, nausea and some-
times persistent headaches following exposure
to tobacco smoke. A much larger portion of the
nonsmoking population appears to experience
some form of annoyance or distress at
involuntary exposure to tobacco smoke. This is
especially true of those who have never
smoked, about 44 percent of the total U.S. pop-
ulation. In 1979, nearly eighty percent of those
who indicated to interviewers that they had
never smoked, reported that it was "annoying to
be near a person who is smoking cigarettes".
Despite the deep aversion which many non-
smokers have long had at being forced to inhale
others' tobacco smoke, until recently they have
been on the defensive. A social onus has
existed on the nonsmoker who replies
negatively to the sometimes proffered plea, "Do
you mind if I light up?" Tobacco smoking has
moved over three generations from an almost
exclusively male ritual focused around pipes
and cigars and found generally at salons, prize
fights and smoking parlors to a socially per-
vasive cigarette-based addiction Involving all
classes and both sexes.
Surgeon General C. Everett Koop has artic-
ulated what is a laudable goal, "a smoke free
society by the year 2000. Such a policy, fully
inplemented; would save the lives of thousands
of nonsmokers annually. Yet for each non-
smoker's life spared, it is virtually certain that
the lives of several smokers will be saved.
"the present evidence, fragment-
ary though it is, seems sufficient to
warrant strong steps to cut down
involuntary exposure to cigarette
smoke."
Efforts to protect the lives of nonsmokers will
necessarily involve severe restrictions or bans
on workplace smoking, especially in enclosed
environments. These restrictions will them-
selves result in some curtailment of tobacco
consumption. Moreover, the willpower smokers
develop to refrain from smoking when they
would imperil others may help them to kick the
habit. A high percentage of smokers would like
to do precisely that, but because of nicotine or
other tobacco-related dependency have not
been successful.
Significantly protective standards against in-
voluntary inhalation of dangerous quantities of
tobacco smoke are not likely often to be met by
sequestration and ventilation in most buildings.
If we are to achieve tobacco smoke risk levels
for nonsmokers no higher than those we toler-
ate for industrial carcinogens, air exchange
SMOKING AND HEALTH REVIEW. Action on Smoking and Health. 2013 H St.. N.W.. Washington. DC 20006. Action on Smoking and Health. a national nonprofit tax- ASH Review
exempt organization concerned with the problems of smoking and the rights of nonsmokers, is entirely supported by tax-deductible contributions. Regular contributors April 1986
-el. a the q-k nrl N.-1 Gc O., o... , _ ............... ...,.-..
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rtes akin to those found in wind tunnels wnulrf __ _
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Alfred H. Lowrey, "An indoor air quality stand-
ard for ambient tobacco smoke based on carcin-
ogenic risk," New York State Journal of Medi-
cine, Vol. 85, July 1985. The authors calculate
that ventilation to achieve an acceptable risk
from passive smoking would require $28,000 per
smoker, exclusive of fan operating costs.
Repace and Lowrey, 382.]
For economic and technical reasons such
ventilation would not be feasible. Passive
smoking in the home is not and should not be
susceptible to government regulation. Family
members share a concern for each other which
should cause them to adopt more considerate
behavior once they have facts on the health
risks of passive smoking. Following on the
recent, salutary expansion of the health warning
on cigarette packages should be added
warnings on the risks to nonsmokers of
involuntary exposure to tobacco smoke.
Elimination of unwanted tobacco pollution in
the workplace and informing the public of the
health risks attendant to passive smoking will
strike at some powerful economic interests.
While the stakes for the public health are enor-
mous in this battle, it would be Pollyannaish to
assume easy sledding. If the public is to act in-
telligently to address this problem, the health
science community must speak out clearly. This
workshop is an auspicious beginning.
1SH Review
lpril 1986
'age 10
Author Ref-
erence
Trichopoulos and 7,8
associates (1981)
Garfinkle and 9
coworkers (1985)
Hirayarna, (1981) 10,11,12
by Scott T. Weiss, M.D., Assoc. Prof.,
Harvard Medical School
This editorial from the American Re-
view of Respiratory Disease (1986;
133:1-3), referred to by John Topping
of the EPA, is important because it
summarizes and evaluates the major
studies linking ambient tobacco
smoke to lung cancer in nonsmokers.
Although Dr. Weiss,finds that the
available evidence does not meet the
very strict scientific standards of
causality-in large part because of
the almost impossible problem of
accurately measuring exposure and
dosage-he nevertheless cites many
reasons for believing the association
exists, indicates that most of the
studies to date support the
association, and concludes that 5000
lung cancer deaths a year from
passive smoking is the most "plau-
sible estimate from the current data."
Below are excerpts from this edito-
rial, including the important foot-
notes, and a table summarizing the
major articles but omitting his com-
ments on them. -
Repace and Lowrey (1) have recently estimated
that approximately 4,700 nonsmoking
Americans die each year from lung cancer as a
result of involuntary tobacco smoke exposure.
The purpose of this editorial is to comment on
the association between passive smoking and
"There is no disagreement about
the biological plausibility of an asso-
ciation between passive smoking and
lung cancer."
lung cancer and the biological and mathemat-
ical assumptions underlying Repace and
Lowrey's assessment of risk.
There is no disagreement about the biologi-
cal plausibility of an association between
passive smoking and lung cancer. Active smok-
ing is unequivocally and causally associated
with this disorder. Even at the lowest levels,
active smoking is associated with an increase in
STUDIES OF PASSIVE SMOKING AND LUNG CANCER
Study Design Country Results Response
Case-Control Greece + association in nonsmoking yes
females; statistically significant
Case-control U.S. + association in nonsmoking yes
females; statistically significant
Cohort Japan + association in nonsmoking yes
males and females; statistically
significant
Cohort U.S. + association in females; not no
statistically significant
Gillis and 14 Cohort Scotland + association in males but not in no
associates (1984) females; statistical significance
tested for
Correa and 15 Case-control U.S. + association in both males and yes, females
coworkers (1983) females; statistically significant only
Kabat and 16 Case-control U.S. + association in males but not in no
Wynder (1984) females; statistically significant
for males only
Sandier and 17,18 Case-control U.S. + association in both males and not tested
associates (1985) females; statistically significant
for females only
Chan and 19 Case-control Hong Kong No association for females; no no
coworkers (1979) statistical significance
Knoth and 20 Cases Germany + association when compared to not tested
associates (1983) German population; no statisti-
cal significance tested for
Koo and 21 Case-control Hong Kong No association for females; no no
coworkers (1983) statistical significance
SMOKING AND HEALTH REVIEW. - Action on Smoking and Health. 2013 H St., N.W., Washington, DC 20006. Action on Smoking and Health, a national nonprofit tax-
exempt organization concerned with the problems of smoking and the rights of nonsmokers. is entirely supported by tax-deductible contributions. Regular contributors
receive the Smoking and Health Review. Printed portions of the Review may be reprinted with credit to ASH
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...y ........... ___..._ ~_ ,~...._..y. ,,. .y ...................nore
threshold exists. In addition, sidestream smoke
has the same carcinogens and cocarcinogens
as mainstream smoke, most at significantly in-
creased concentrations. Thus, although the
quantitative smoke is less than that of the active
smoker, the qualitative exposure to carcinogens
may be the same or greater, and it remains un-
known how active and passive smoking differ in
terms of actual carcinogens delivered to the
respiratory tract. The finding of mutagens in the
urine of passive smokers is consistent with the
carcinogenic potential of sidestream smoke.
"The finding of mutagens in the
urine of passive smoking is consistent
with the carcinogenic potential of
sidestream smoke."
Equally indisputable is the ubiquitous nature
of this exposure to passive smoke. Although
only 30 percent of adult Americans are active
smokers, biochemical indices of exposure,
such as urinary cotinine, suggest that the vast
majority of nonsmoking adults have at least
some exposure, that this exposure is greater
than that reported by questionnaire, and that it
varies with the number of smokers in the home
and/or workplace. Approximately 70 percent of
children in the United States live in homes with
at least one smoking adult. Despite the
increasing information in the field, the episodic
nature of exposure, and the imperfect means of
measuring this exposure indicate that further
research is required to define more clearly who
is being exposed and how exposure is best as-
sessed for an individual.
Biological plausibility and the ubiquitous na-
ture of the exposure aside, the scientific studies
examining the association between passive
smoking and lung cancer (summarized in table)
have definite flaws. The bulk of the studies
show a positive association (1.18,20). Compared
to active smoking, the association is relatively
weak, varying from a 30 to 340 percent increase
in risk (odds ratios of 1.3 to 3.4 for exposed
relative to nonexposed). Given the nature of the
exposure, one would expect the increase in risk
to be relatively low. Conventional measures of
statistical significance for the association are
present in half of the studies (7-12,17,18). This is
not surprising, given that the increase in risk is
small. Several studies (14, 15, 17, 18), all showing
a positive association, have too few cases to
have adequate statistical power to achieve
statistical significance for all comparisons. A
dose response relationship is not uniformly
present (7.12, 15). These varying results reflect
both the small number of cases and imprecise
measurement of exposure. Finally, only one
study has documented a reduction in cancer
incidence with a reduction in exposure (10.12).
Based on the above summary, the existing
data on passive smoking and lung cancer do not
meet the strict criteria for causality of this as-
sociation. However, the nature of the scientific
problem is such that achieving these strict crite-
ria may be exceedingly difficult, if not impos-
sible.
deaths, roughly 15 percent of which (16,275)
were in nonsmokers. Repace and Lowrey (1)
estimate that 4,666 deaths/yr, 5 percent of all
annual lung cancer deaths and 30 percent of
nonsmoker annual lung cancer deaths, are due
to passive smoking. They derived this estimate
by comparing age-standardized differences in
lung cancer mortality rates between Seventh
Day Adventists who never smoked, and
demographically comparable nonsmoking, non-
Seventh Day Adventists. The investigators
make many simplifying assumptions, namely,
that the entire lung cancer death rate difference
is due to passive smoking, that the Seventh Day
Adventists are all not exposed and non-Seventh
Day Adventists are exposed, that there are no
differences between men and women, and that
there are no other differences between the 2
groups. Even though these assumptions are
overly simplistic, the resulting figure, 7.4 lung
cancer deaths per 100,000 person-years, is
remarkably close to the estimate from the best
available study, that of Hirayama (6.8 lung
cancer deaths per 100,000 person-yearst(10.12).
An alternative and less satisfactory approach,
in my view, is the use of a probabilistic model
that is less biologically plausible and based on
far greater assumptions about the amount of ex-
posure per-person per-day. This model yielded a
roughly tenfold lower estimate, 0.87 lung cancer
deaths per 100,000 person-years. Slight
changes in the amount of exposure per-person
per-day yields a similar estimate to that given in
the previous analysis. As pointed out by the
"Repave and Lowrey's figures re-
main the best current estimates of
lung cancer deaths from passive
smoking."
authors, even this lower figure is tenfold greater
than many currently regulated carcinogens(1).
Despite the simplifying assumptions of the
risk estimates and the flaws in the epidemio-
logic data from which they are derived, Repace
and Lowrey's figures remain the best current
estimates of lung cancer deaths from passive
smoking. Current epidemiologic data are suffi-
ciently imprecise to be able to accurately distin-
guish between the estimate of 500 or 5,000
plausible estimate from the current data Future
epidemiologic studies will allow revision of
these estimates but are unlikely to dispute the
basic nature of the association.
References
1. Repace JL, Lowrey AH. A quantitative esti-
mate of nonsmokers' lung cancer risk from pas-
sive smoking. Environment International 1985;
1:3-22.
7. Trichopoulos D, Kelandidl A, Spanos L, Mac-
Mahon B. Lung cancer and passive smoking. Int
J Cancer 1981; 27:1-4.
8. Trichopoulos D, Kelandidl A, Spanos L Lung
cancer and passive smoking, conclusion of
Greek study. Lancet 1983; 2.677.8.
9. Garfinkle L, Auerback 0, Joubert L Involun-
tary smoking and lung cancer a case-control
study. J Natl Cancer Inst 1985; 75:463-9.
10. Hirayama T. Nonsmoking wives of heavy
smokers have a higher risk of lung cancer a
study from Japan. Br Med J 1981; 282:183-5.
11. Hirayema T. Passive smoking and lung can-
cer. Br Med J 1981; 282:1393.4.
12. Hirayama T. Passive smoking and lung can-
cer consistency of association. Lancet 1983;
21456.
13. Garfinkle L Time trends in lung cancer mor-
tality among nonsmokers and a note on passive
smoking. J Nail Cancer Inst 1981; 66:1061-6.
14. Gillis CR, Hale DJ, Hawthorne VM, Boyle P.
The effect of environmental tobacco smoke in
two urban communities in the West of Scotland.
Eur J Respir Dis 1984; 65(Suppl. No. 133):121.6.
15. Correa P, Pickle LW, Forham E, Lin Y, Haen-
szel W. Passive smoking and lung cancer. Lan-
cet 1983;2595.7.
16. Kabat GC, Wynder EL Lung cancer in non-
smokers. Cancer 1984; 53:1214.21.
17. Sandler OP, Everson RB, Wilcox AJ. Passive
smoking in adulthood and cancer risk. Am J
Epidemiol 1985; 121:37-48.
18. Sandler DP, Wilcox AJ, Everson RB. Cumu-
lative effects of lifetime passive smoking on
cancer risk. Lancet 1985; 1:312-4.
19. Chan WC, Colboume MJ, Fung SC, Ho HC.
Bronchial cancer in Hong Kong 1976.1977. Br J
Cancer 1979; 39:182.92.
20. Knoth A, Bohn W, Schmidt F. Passive smok-
ing as a causal factor for bronchial carcinoma in
female nonsmokers. Mad Klin 1983; 78:66-9.
21. Koo LC, Ho HC, Saw D. Active and passive
smoking among female lung cancer patients
and contacts in Hong Kong. J Exp Clin Cancer
Res 1983; 4:367-75.
Should Chest Physicians Be Passive On Smoking?
by Robert J. Mason, Dept. of Medi-
cine, National Jewish Center for
Immunology and Respiratory
Medicine, Denver, Colorado
concludes that there is more than
enough information for all people-
especially including chest physicians
-to act.
This companion piece, also from the
American Review of Respiratory Dis-
ease [1986; 133:4], likewise reviews
the available medical literature and
The current focus of public concern is on pas-
sive, or secondhand, smoking. The adverse
effects that have been reported include in-
creased respiratory infections in infants of
smoking mothers, increased lung cancer in non-
SMOKING AND HEALTH REVIEW. ; Action on Smoking and Health, 2013 H St.. N.W., Washington, DC 20006. Action on Smoking and Health, a national nonprofit tax- ASH Review
exempt organization concerned with the problems of smoking and the rights of nonsmokers, is entirely supported by tax-deductible contributions. Regular contributors April 1986
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smoking women whose husbands smoke, and
respiratory irritation among asthmatics and
Dthers who are sensitive to cigarette smoke.
Side-stream smoke, the smoke inhaled by non-
smokers, is known to contain carcinogens, and
metabolites of the smoke can be measured in
the urine of nonsmokers, Hence, it is extremely
ikely that side-stream smoke poses a risk of
ung cancer in nonsmokers. The major question
Is the magnitude of the risk. Garfinkle and assn
iates reported a large case control study of
ung cancer among lifetime nonsmoking w -
"The current data are sufficient for
me to conclude that passive smoking
carries a significant risk to the public
and should be curtailed."
men whose spouses smoke cigarettes. The
smoking histories of both spouses and the his-
tologic diagnosis of lung cancer were independ-
ently verified. There was an increased risk of
lung cancer among nonsmoking spouses
whose husbands smoked more than 20 ciga.
rettes per day at home. There have been two pre-
vious large epidemiologic studies from Greece
and Japan, which found a similar effect,
"To my knowledge, there is no
proven threshold for exposure to
cigarette smoke that carries no
adverse health effect."
although there have been methodologic reser-
vations about these studies. Garfinkle and
associates discuss both the positive and the
negative data that are currently available. The
current data are sufficient for me to conclude
that passive smoking carries a significant risk to
the public and should be curtailed. To my
knowledge, there is no proven threshold for ex-
posure to cigarette smoke that carries no ad-
verse effect. We must take a position against
allowing smoking in public places such as
schools, restaurants, airports, government
buildings, and hospitals. We must educate
smokers about the effect of smoking on their
health as well as on the health of others.
"We must take a position against
allowing smoking in public places
such as schools, restaurants,
airports, government buildings, and
hospitals."
We have enough information to limit smoking
in public places for health reasons. I hope all
chest physicians will review existing data and
discuss cigarette smoking with their col-
leagues, their patients, their students, and the
public. Make an active, not a passive, decision
on your involvement in freeing society of ciga?
rettes. Most chest physicians have been too
quiet for the good of society.
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Written Testimony of
President
Americans for Nonsmokers' Rights
2054 University Avenue, Suite 500
Berkeley, CA 94704
Submitted to the
Subco mtittee on Health and the Environment
Comi t tee on Energy and Coerce
United States House of Representatives
For Hearing on
H.R. 4488 'Nonsmokers' Protection Act of 1986' and
H.R. 4546 'Nonsmokers' Rights Act of 1986'
June 12, 1986
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Mr. Chairman and members of the Committee. My name is Peter Hanauer. I
hold a law degree from Columbia University and I have been editing law books
for more than twenty years. I have been involved in the nonsmokers4 rights
movement for twelve years and I am currently president of Americans for
Nonsmokers' Rights. I want to thank you for the opportunity to testify in
support' of the nonsmokers' rights bills you are now considering.
During the last five years, Americans for Nonsmokers' Rights has helped
to pass more than 100 laws at the state and local level in California to
protect the right of nonsmokers to breathe clean air in public places and in
places of employment. Approximately 50% of Californians now live in a city
or county which regulates smoking in the workplace. State law also requires
that all state agencies have a policy to protect the rights of nonsmoking
employees.
Although California may have received the most attention on this issue,
largely because of four ballot measures between 1978 and 1983, it is by no
means the only place where nonsmokers' rights laws have been passed. In
fact, in 1975--even before my nonsmokers rights' organization was formed--
the state of Minnesota passed a comprehensive measure regulating smoking in
all public places and workplaces. Currently, at least thirty-seven states
regulate smoking to some extent in public places, and at least ten states
regulate smoking in the workplace.
Thus, the bills before you will not thrust the federal government into
new territory. To the contrary, these bills will merely bring the federal
government in line with numerous state and local governments. The time has
come for Congress to act to protect the health and comfort of the hundreds
of thousands of federal employees as well as the millions of people who do
business in or visit federally owned and operated buildings.
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The legislation before you will be opposed by the tobacco industry,
which for the last ten years has waged a cynical and reprehensible campaign
throughout the country to prevent the enactment of such public health
measures. They have spent and are continuing to spend tens of millions of
dollars in elections and lobbying efforts. Yet in virtually every place
that a nonsmokers' rights law is proposed it is being passed by near-
unanimous votes. The reason is simple: the laws are overwhelmingly popular
among both nonsmokers and smokers. In fact, the only opposition to these
laws comes from the tobacco industry, which, as is evident from the public
opinion polls, does not even represent the consumers of its product.
Recent surveys by three of the nation's most respected polling
organizations demonstrate how much the public wants these laws. A 1983
Gallup Poll showed that 83% of the public believes that smoking should
either be prohibited altogether or restricted in the workplace. Only 12%
opposed any restrictions. A 1984 California Field Poll showed 83% in favor
of workplace smoking restrictions and-only 13% opposed. In 1985, a Lou
Harris Poll, focusing on public places generally, found 80% in favor of
smoking restrictions and only 15% opposed.
But probably the most important poll of all was conducted in Minnesota
by the Minneapolis Star and Tribune in 1980, five years after the Minnesota
Clean Indoor Air Act was passed. It showed 92% in favor of the law and a
more 5% opposed. Interestingly, a slightly higher percentage of smokers who
smoked a pack of cigarettes or less per day supported the law than did
nonsmokers. Actually, it is not surprising that most smokers favor smoking
restrictions. There are three good reasons: 1) it helps them to quit
smoking; 2) it reassures them they can smoke in designated smoking areas
without being asked by others to stop; and 3) it affords them the means to
avoid other people's smoke!
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The overwhelming consensus about the desireability of smoking
restrictions not only shows why the proposed legislation will be popular,
but also why it will be easy to implement and enforce. It will essentially
codify a change in social attitudes that has already occurred.
Once it is determined where smoking should and should not be permitted
in a given facility, there are only three basic ingredients to a successful
1) The posting of signs clearly indicating the nonsmoking and smoking
areas;
2) A clear statement that the right of nonsmokers to breathe clean air
takes precedence over the desire to smoke; and
3) A reasonable enforcement mechanism.
Once the signs are posted (and, in places of employment, employees are
informed of the regulations), these laws become essentially self-enforcing.
In short, most people obey the signs just as most drivers obey stop signs,
even though they know there is little likelihood of being given a ticket.
Of course, the tobacco industry argues that these laws are
unnecessary--that 'common courtesy' is sufficient. While that is a nice
phrase, it is a totally impractical solution. That is so not because
smokers lack courtesy, but rather because there is no basis for the exercise
of courtesy without the establishment of ground rules as to where smoking is
or is not permitted. To use the stop sign analogy again, most drivers are
courteous and law-abiding, but if there were no stop signs, drivers would
not know where they should stop. The 'common courtesy' solution puts the
burden on nonsmokers to continually ask others--often total strangers--to
refrain from smoking. It is quite simply a recipe for confrontation between
nonsmokers and smokers--the very thing the tobacco industry professes a
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desire to avoid. Every mid-level manager in the Federal government should
be supporting these bills as the best way to avoid the Solomon-like
decisions they must try to make now when a confrontation between a nonsmoker
and a smoker arises.
The universal experience with existing nonsmokers' rights legislation
is that the costs of implementation and enforcement have been minimal. The
one-time cost of posting signs is greatly overshadowed by long-term savings
that will be realized in various areas such as increased productivity on the
part of nonsmoking employees, reduced health care and insurance costs,
reduced smoke and fire damage, and reduced maintenance expenses.
Since these laws have been self-enforcing, the associated costs have
been negligible, with no need for added personnel. The San Francisco
workplace ordinance provides an interesting illustration. When it was first
proposed, it contained an appropriation to cover the cost of two additional
health inspectors. But the mayor, who strongly supported the law, insisted
that the appropriation be deleted and-that the Health Department report back
six months after the ordinance went into effect as to the impact of the law
on its personnel needs. The Health Department found it could easily respond
to all complaints with no additional personnel.
Despite the dire predictions of the tobacco industry--disruption of the
economy, fistfights among employees, a decrease in tourism, and an exodus of
small businesses--every nonsmokers' rights law in the country has been
implemented and enforced without significant problems. To my knowledge, no
such law has ever been weakened or repealed; however, many have been
strengthened. The attached materials representing the views of numerous
enforcement officials is ample testimony to the fact these laws work well.
When considering the arguments of the tobacco industry, I ask that you
note the glaring inconsistency between the fact that the industry opposes
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these laws so vigorously, and their contention that they are unenforceable.
If no one obeyed the laws the industry would not have to worry about them.
But it is precisely because they work so well that the industry works so
hard to defeat them.
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Written Testimony of
STANTON A. GI.ANTZ, PH.D.
Associate Professor of Medicine
University of California
San Francisco, CA 94143
President
Californians for Nonsmokers' Rights
2054 University Avenue, Suite 500
Berkeley, CA 94704
Submitted to the
Subcommittee on Civil Service, Post Office, and General Services
Committee on Governmental Affairs
United States Senate
For Hearing on 5.1440
The Non-Smokers Rights Act of 1985
September 30, 1985
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My name is Stanton A Glantz. I hold a PhD in Engineering and Economics
from Stanford University and am nov an Associate Professor of Medicine and
Chairman of the Bioengineering Graduate Program at the University of
California, San Francisco, where I conduct research into the mechanical
function of the heart. I an also President of Californians for Nonsmokers'
Rights, an organization that has helped to pass legislation protecting
nonsmokers from the toxic chemicals in second-hand cigarette smoke in 44
California communities, encompassing approximately 9 million people.
Before discussing the specifics of our experience with legislation in
California, I would like to speak briefly to two important general issues:
the need for-such legislation to protect the public health and the fact that
the only organized opposition to such legislation comes from the tobacco
industry.
First, there is absolutely no question that, as the National Academy of
Sciences concluded in 1981, "involuntary exposure to tobacco smoke has
adverse health effects and ought to be minimized or avoided vhere possible."
There are over 600 papers in the medical literature on the effects of
involuntary smoking supporting this conclusion.
As vith primary smoking, the tobacco industry has tried to diffuse this
overwhelming case by taking advantage of honest differences of opinion in
the scientific community on the precise magnitude of the problem,
misrepresenting the views of reputable scientists, or hiring professional
quibblers to claim that "the case is not in." After every independent
scientific body that addressed the question concluded that involuntary
smoking represented a health hazard, the industry took the creative step of
convening its own scientific panels -- in such scientifically impressive
places as Geneva and Vienna -- in an effort to cast an aura of
respectability on its position. Contrary to what the industry had hoped,
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scientists at both meetings presented evidence that involuntary smoking was
harmful. As a result the tobacco industry was reduced to quoting from press
releases issued after the meetings by individuals. In contrast to
statements made by the National Academy of Sciences and Surgeon General,
these releases were not subject to any scientific quality control. As a
result the only people that seem to take them seriously are the cigarette
companies and their advertising agencies.
The simple fact is that one need not hold a PhD and own complex
scientific equipment to know that second hand tobacco smoke is a serious
form of indoor air pollution. Consider a room vhere people are smoking.
Think about what the air looks like, what it smells like, what it tastes
like. Consider the fact that your eyes or throat may burn, or that you may
develop nausea, or a headache. If you vent outdoors and the air was that
polluted, you would be outraged. And you would be right.
That is why we have passed legislation cleaning up the outdoor air, and
why this bill is necessary to help clean up the air indoors, vhere most
Federal workers spend most of their time.
My involvement in this issue dates to 1978 when I worked with others in
an unsuccessful attempt to pass, by initiative, the California Clean Indoor
Air Act which would have created nonsmoking sections in the workplace and
public places. Before the campaign started, every poll conducted (including
those done for the Tobacco Institute) shoved the initiative passing by a 3-1
majority. The cigarette companies spent $6,500,000 on a massive advertising
campaign and defeated the law. The tobacco industry represented to only
organized opposition we faced.
The same thing happened again in 1980.
In 1981, we began working at the state and local level to pass
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nonsmoker protection ordinances. We believed that, since the tobacco
industry had no real support, informed and organized local consitutents
could overcome the pressure of lobbyists, lawyers and campaign
contributions.
This strategy has proven successful. As of this date, every California
community that has considered a law protecting nonsmoker sin the workplace
has enacted it, despite vigorous, veil-financed opposition from the tobacco
industry.
The industry's failure to stop us and other like-minded groups around
the countryhas led them to another strategy: they are attempting to shift
the field of play back to the ballot box where they hope they can buy
elections with slick advertising campaigns. Fortunately, the American
public has not been tricked by their efforts. In addition to the industry's
highly-publicized $1.3 million effort to get the San Francisco Workplace
Smoking Ordinance repealed tvo years ago, their front groups have been
rejected by the voters in Arizona and Colorado. This willingness of the
populace to stand up to the industry attests to the importance and
popularity of protecting nonsmokers from second hand smoke.
In fact, our success is not surprising, given that every poll done on
the subject (including those done for the Tobacco Institute) have shown a
majority -- including a majority of smokers -- in favor of legislation to
protect nonsmokers.
This overwhelming consensus about the desirability of protecting
nonsmokers is why legislation such as that before you is easy to impliment
and enforce. It essentially codifies a change in social attitudes that has
already occurred.
Given this broad consensus, why do we need laws? Why can't we depend on
"common courtesy" as the ciagarette companies suggest? Because "common
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courtesy" is a recipe for individual confrontation. Under the current
situation, individual nonsmokers are forced to confront individual smokers
to ask that they smoke elsewhere. Most people are simply not that
aggressive.
Furthermore, the ubiquity of cigarette advertising and second hand
cigarette smoke in the air, nonsmokers feel very isolated and are often
afraid to speak up. The presence of a simple "No Smoking" sign dramatically
changes this situation. With the sign available, nonsmokers feel
comfortable in asking people not to smoke.
Let me give you an example. Several years ago I was sitting in the
Minneapolis airport enjoying the benefits of the Minnesota Clean Indoor Air
Act which was passed in 1987. A man then sat down next to me and began to
take out a cigarette. I asked him not to smoke. He initially objected to
my intrusion, until I pointed out that we were in a nonsmoking area. He
then apologized and put the cigarette away. Surprisingly enough, he did not
move to the smoking section. He simply smoked one less cigarette.
That was one less cigarette that-a tobacco company sold. To understand
the impact of that simple act consider this: If every smoker in America
smoked just one less cigarette a day due to changing social attitudes or
legal restrictions, there would be 22 billion fever cigarettes sold each
year.
Given these stakes, it is not surprising that the tobacco companies
are willing to spend a few million dollars in their unsuccessful attempts tc
convince Americans that smokers should be free to pollute the indoor air
without restriction.
Despite dire predictions of earthquakes in San Francisco and fires in
Los Angeles, California, every ordinance I know of has gone into force
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smoothly.
No city or county that has ever passed an ordinance has weakened or
repealed it.
Vhile it is important that there be strong enforcement provisions in
the law to ensure that people take it seriously, there has never, to my
knowledge, been the need to fine anyone. Enforcement has taken the form of
education and negotiation, with legal sanctions playing a quiet but
secondary role to back up the negotiations.
In sum, there are four simple principles that lead to successful,
trouble-free nonsmokers' rights legislation:
(1) There need to be signs posted in the nonsmoking areas.
(2) There needs to be the capacity for strong enforcement; ironically,
the presence of sanctions avoids the need for using them.
(3) There needs to be a clear statement that the right to breathe clean
air takes precedence over the choice to smoke.
The existing bill meets the first two criteria; to meet the third
criterion, I suggest that the following language be added at page 3 line 9
after "government buildings": "provided, however, that in any dispute
arising under such rules and regulations, the needs of nonsmokers shall be
given precedence;"
I have no doubt that passage of the legislation before you will
quickly, simply and inexpensively clear the air for Federal employees. It
will also help encourage other public and private employers to follow your
lead and produce a safer and healthier environment for all of us.
Thank you.
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Attachments:
"San Francisco Anti-Smoking Law a Success", Vall Street Journal, August
15, 1984
Letter from Surgeon General Koop regarding the health effects of
involuntary smoking
Letters from city, county, and state officials regarding ease of
enforcement of various ordinances:
John Lockwood, Assistant City Manager, San Diego
Roger Bedgecock, Mayor, San Diego
George Story, Director, Citizens Assistance & Information, San
Diego
James Ford*, Director, Department of Heath Services, San Diego
County
Bruce Tsutsi, Inspector, Department of Public Health, San Francisco
Rita Hardin, Director, Neighborhood Preservation, San Jose
C. B. Schneider, Chief, Section of Environmental Field Services,
Minnesota department of Health
Letter from Art Pick, Executive Vice President, Greater Riverside
Chambers of Commerce, endorsing a proposed ordinance (which passed)
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NEWS from
AMERICAN LUNG ASSOCIATION
The omsunas Seal Pecos e
1740 Broadway, New York. N. Y. 10019 (212) 315-8700
EMBARGOED FOR RELEASE:
6:30 P.m. (EST) THURSDAY, DEC.5, 1985
CONTACT: Michele Kling
Dec. 3-4 (212) 315-8836
Dec. 6-7 (305) 634-7711
OR
Elaine Chapnick
(212) 315-8740
AMERICANS WANT SMOKE-FREE AIR AT WORK
COLORADO SPRINGS, COLO., December 5, -1985--For the first time, there is
documentation that the vast majority of Americans want smoking regulations at the
workplace. Eighty-seven percent of Americans--smokers and nonsmokers--now
believe companies should either ban smoking totally at work or restrict it to
designated areas, according to a new national survey released today by the
American Lung Association--the Christmas Seal People'.
The same survey also showed that fully 75 percent of Americans believe that
smokers should not light up in the presence of nonsmokers. This figure is up 6
percentage points from the 69 percent recorded in the Lung Association's original
1983 survey of attitudes toward smoking. And 94 percent of Americans now believe
smoking is hazardous to health, as compared with 92 percent in 1983.
Despite tobacco industry claims that there is no need for smoking
regulations at the workplace, the survey, which was conducted by the Gallup
Organization for the Lung Association, found that 80 percent of current smokers,
92 percent of nonsmokers, and 89 percent of former smokers feel companies should
have policies designating smoking and nonsmoking areas in the workplace or
totally banning smoking at work.
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Americans Want Smoke-Free Air at Work--2
"More and more companies around the U.S. are instituting smoking
restrictions at the office in response to the needs and wishes of the employees,"
said ALA Managing Director James A. Swomley. This survey documents what
American business has been demonstrating--that Americans now understand the
health hazards of smoking go beyond the-active smoker to the involuntary smoker.'
Swomley said the Lung Association's survey reflects 'I new assertiveness
among American employees who can't be fooled by the cigarette industry's claim
that smoking is merely an issue of courtesy and not a health issue.'
'But,' Swomley said, 'this attitude is not new to those of us in public
health education. Our survey shows that 62 percent of America's current smokers
agree that they should not smoke in the presence of nonsmokers. This represents
an increase of 7 percentage points in just two years.
'We are dealing with a serious health issue here,* Swoml ey added. 'When
both smokers and nonsmokers alike agree that the air should be free of smoke,
they're worried about their health and health of those around thew.'
Swomley said the time has come to address the addictive nature of tobacco.
The U.S. Public Health Service has called smoking 'the most widespread example
of drug dependence in this country,' he noted. U.S. Surgeon General C. Everett
Koop, M.D., earlier this week said, 'Seventy-eight percent of the nation's 53
million smokers wish they could quit but can't...because they're addicted.'
The Lung Association survey, carried out through personal interview with a
national sample of adults over age 18, asked 1,540 men and women their opinions
about smoking. Other data from this survey showed:
? Among those who said companies should have separate areas for smoking and
nonsmoking, 76 percent are current smokers and 80 percent are former
smokers.
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Americans Want Smoke-Free Air at Work--3
? 62 percent of the respondents felt smokers should refrain from smoking in
a public place.
? 32 percent felt there should be a total ban on cigarette advertising.
? Another 36 percent believed there should be curbs on some types of
advertising.
The American Lung Association, dubbed in 1981 by the Tobacco Institute as
its 'No. 1 adversary,' is the oldest nationwide voluntary health agency in the
U.S. and was one of the first health organizations to assume major public
education activities on behalf of nonsmokers' rights and the health effects of
involuntary smoking.
EDITOR'S NOTE: SEE ATTACHED STATISTICS AND ILLUSTRATIONS.
12/85
/dsp
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Merit
Systems
Protection
Board
NOTICE
No: 86-46
Date: April 29, 1986
BUILDINGS AND SPACE MANAGEMENT (1510)
BAN ON SMOKING AT MSPB
Smokers slowly burn it; non-smokers, some of them, slowly
burn because of it. Not only people but machines as well,
most notably our omnipresent H-P computers, are affected
adversely by the smoke and ash associated with cigarettes
and the like. As our offices become increasingly smaller,
the problem of smoking looms ever larger. The conclusion is
inescapable that the efficiency of the Board's operations is
compromised by the contaminants associated with smoking.
It's time to clear the air.
Effective May 15, 1986, the Board will join the growing
ranks of public and private sector offices that prohibit
smoking, in the regions and in headquarters; in private
offices as well as open space; in meeting ro1nis, hearing
rooms, rest rooms, and corridors. All of us--" and all our
visitors, too.
In an effort to assist employees in the transition to a
smoke-free environment, for the next ninety days a
reasonable number of short breaks will be permitted away
from the premises for those unable to cope otherwise.
Stairwells or, at headquarters, for example, the terrace
canteen and cafeteria, may be considered away from the
premises.
Our commitment to a smoke-free environment is now the policy
of the Board. I realize that this will cause, at least
temporarily, some inconvenience to some of you. However,
J Given our statutory obligations to complete the
bargaining process with the Association, this directive is
not presently effective as to bargaining unit personnel.
Members of the unit are urged, however, as a matter of
courtesy to their fellow employees, to limit smoking,
voluntarily and without fear of penalty, to their private
offices or an appropriately ventilated area away from the H?
equipment.
Distribution: LL E,71,0,:' S Initiated' b-,,: BC
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your support is greatly appreciated. The MSPB Recreation
Association is looking into ways of providing assistance to
those who desire to break the habit. Watch for future
announcements.
Failure to abide by the Board's "No Smoking" policy will be
dealt with in the same manner as any other violation of an
administrative directive or rule.
Maria L. Johnson
Acting Chairman
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-NEWS RELEASE
U.S. MERIT SYSTEMS i-,myrEuriON BOARD
Public Information and Median Services Division
Washington. 0C. 20-119
(2I)1) ( : 7 I ;
Contact: Paul Trayers May 13, 1986
(202) 653-7175 Immediate Release
MSPB BANS SMOKING
In a recent notice sent to its employees, the U.S. Merit
Systems Protection Board announced that, as of the 15th of
May, it will ban smoking throughout the agency. The notice,
signed by Acting Board Chairman Maria L. Johnson, cited
increasingly smaller office space and adverse effects to
both employees and computer equipment as grounds for the
ban. Stating, "It's time to clear the air," the notice
said:
Effective May 15, 1986, the Board will join
the growing ranks of public and private sector
offices that prohibit smoking, in the regions
and in headquarters; in private offices as
well as open space; in meeting rooms, hearing
rooms, rest rooms, and corridors.
Timed in conjunction with a health and fitness drive at the
Board commemorating rLitional Physical Fitness and Sports
Month, the announcement went on to say that there will be a
ninety-day grace period during which "a reasonable number of
short breaks will be permitted away from the premises, for
[smokers) unable to cope otherwise."
In addition, an earlier notice on the health and fitness
program announced:
...the (Board's] Recreation Association will
offer the American Cancer Society FRESHSTART
program, designed to help smokers stop
smoking. The program consists of four one-
hour, small group sessions. This program is
offered without charge and administrative
leave will be authorized for those who
participate.
"Our commitment to a smoke-free environment," stated Acting
Chairman Johnson, "is now the policy of the Board."
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News Release
r 7
Contact: Joseph V. Slye 202/566-0705
GSA's Golden Previews New Smoking- Rules For Federal Puildings
SEATTLE, Wash. (May 22) - The head of the U.S. General Services Admin-
istration (GSA) announced here today proposed regulations that would ban govern-
ment employees and the public from smoking -- except at designated smoking areas
-- in the 6,800 buildings nationwide managed by GSA.
Administrator Terence C. Golden previewed the stringent new regulations in
keynote remarks at the opening of a two-day Regional Conference on Public Employ-
ee Fitness and Health sponsored by the President's Council on Physical Fitness
and Sports. The theme for his address was the "total wellness" of government
workers.
Golden said the new regulations, which were scheduled for publication today
in the Federal Register for a 60-day comment period, probably will not take
effect until this fall. The smoking ban will include general office space,
lobbies, corridors, conference rooms, classrooms, libraries, elevators and rest
rooms. Designated smoking areas will be established at cafeterias and vending
facilities. Nothing in the regulations precludes an agency from setting more
stringent guidelines.
He told the physical fitness program managers that his smoking ban regu-
lation is one of several initiatives designed to promote the "total wellness" of
federal employees, including:
? Safety improvements in the workplace, including the removal
asbestos, tra z o--. _=-_4 other ?~~_ ~o. titer a
-MOPS,--
U.S. General Services Administration, Washington, DC 20405 (202) 506-1231
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productivity;
? Strengthened physical security in public areas and at the
workplace for government workers in federal buildings;
o Clearing the way for federal agencies to establish and
sponsor physical fitness facilities for government workers;
o r1Iaking it possible for day care,centers to be established
at GSA managed buildings for sponsors to help meet the
needs of working parents.
Golden said "the official regulations I have proposed for federal buildings
are a positive step toward the 'total wellness' of federal employees. Hand-in-
hand with other initiatives to improve the quality of the federal workplace, the
federal workforce can be healthier, happier and more efficient."
He said his main concern is for the health of the federal worker, adding
"smoking has begun to infringe on the health interests of nonsmokers in the
workplace. No longer is it the right of the individual to smoke without regard
for the health concerns of those who work in the same area."
Citing cigarette smoking as the cause of some 340,000 premature deaths an-
ually, Golden said in 1984 the direct medical costs from smoking-related disease
and death totalled $23,300,000,000 with indirect costs from smoke-related ill-
nesses set at 19,300,000,000.
# # #
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(:1 l:l'" L (, < 1:V l CL - 1,1)"1 t:I S i:AT] ON
1'l'RI.I C PM] [A)l NGS SEPV] CE
(41 C F R raft 101-20)
S `:UF: I t:G :: ;t1 [.A7 I Ot:S
C; CY: Ccencia] Services Administration.
ACTION,: ri opposed rule.
X. APY: This regulation provides for revised smoking
regulations in buildings controlled by GSA. It has become
necessary to regulate smoking in certain areas of Federal
buildings because smoke in a confined area may be irritating and
annoying to non-.-::.okc!rs. In addition, the-Office of the Suz(joon
General has indicated that current scientific evidence suggests
that exposure to ambient tobacco smoke can be hazardous to non-
s:no):ers and may create a potential hazard to those suffering from
heart and respiratory diseases or allergies. GSA also r(?coyni?res
the rights of individuals to smoke in such buildings provided
such action does not cause discomfort or unreasonable annoyance
to non-smokers or infringe upon their rights. The intent of this
xC?yu]ation is to provide
a reasonably smoke-free environment for
tljc)s.e uc'r}:ina and visiting GSA-controlled bui ldinas.
Cc;::ncnts rust be r c?ce i vtd on or before: (60 rays from the
c't:te of F,ui,l ic.it ion in tl,( Fr?(:cral Register).
~
1,[):)F-:ESS: 1:r it ton c ~,~r^c nts should be sent to the General Servi
Ad-- ini~-~t rt icn (1), 1:i:)gtcon, I)C 70405,
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t'OR FU1 I1I:R I NI-OI;-;ATI Ot: CONTACT: Mr. James A. Marsden, Acting
D i r e c t o r , F,,c-i 1 i tl. Management Division, (202-566-1563)
S111'PLf:!',i:NTARY INI'UI 9ATJON: The General Services Administration
has detezmi ned that this rule is not a major rule for the
purposes of E. O. 12291 of February 17, 1981, because it is not
1 i;.ely to result in an annual effect on the economy of $100
million or more; a major increase in costs. to consumers or
others; or significant adverse effects. Therefore, a Regulatory,
In.-pact Analysis has not been prepared. GSA has based all
Administrative ciecisions underlying this rule on adequate
information concerning the need for, and the consequence of, this
rule; has determined that the potential benefits to society from
this rule outweigh the potential costs and has maximized the net
benefits; and has chosen the alternative approach involving the
least net cost to society.
GSA Pr opposes to amend Part 101-20 as follows:
PART 1 01 -20-- MANAC:FMENT OF BUILDINGS AND GROUNDS
1. The authority citation for Part 101-20 continues to read as
follows:
ALTTI10RI TY: S.ec. 205 (c) , 63 Stat . 390; 40 U.S.C. 486 (c)
1 01 1:111 I.n] NG OPERATI Or-IS, MAINTENANCE, PROTECT] ON,
A!;D A L I t:1:.,Ti (~t;S
2. 101-20.109-10 is revised to read as fo] lows:
101-:0.109--10 ion of smoking.
F~,cul pit ions :.I ,?,ii, r o] ] i nc
.l..nc in GSA-controlled buildings
and facilit ,It? !.(?t f(IIth below.
Agencies are enceuraced to
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de'.?t!lop )J,ii; ion.il (au)de]ine, for internal use and for action
w h e n v i o l i o n s of these regulations occur. Nothing in these
:e:uIati( )5
rocludes an agency from establishing more stringent
1 1 0 s , . For purposes of these regul 3t ions, general office
space is .fined as space occupied by personnel performing their
daily work functions; this includes, but is not limited to: ADP
arc3s, m.-il rooms, file rooms, duplicating areas, court and jury
roe:ms, office space, etc.
(a) Smoking is prohibited in the following areas, except as
dt?signatod pursuant to paragraph (b) (1) below.
(1) Genera] office space.
(2) Auditoriums, classrooms, and conference rooms.
(3) Elevators. "No-smoking" signs shall be posted in
elevators, .adequate receptacles shall be placed outside the
entrances.
(4) Corridors, lobbies and restrooms.
(5) Mcdi;al care facilities such as medical clinics and health
units.
(5) 1_ihi i~'s.
(7) :ii-cas. Each agency shall post and enforce "no
577.:''.in,)" in -)ny location under its jurisdiction which
involves i liquids, flammable gases, or flammable
Vat) cxs, or in .311 other locations where there is a collection of
re.-ci Iv i