INDEX Environmental Tobacco Smoke is abbreviated as ETS throughout this index. ABSORPTION biological markers for ETS, 200— 206 biological markers of smoke absorp- tion in smokers and nonsmokers, 181 ETS vs. active smoking, compari- son, 215-216 nicotine, tobacco smoke exposure determination, 203-205 ACROLEIN measurement under realistic condi- tions (table), 148 ADOLESCENTS regulations in schools to prevent smoking initiation, 282 AEROSOLS mainstream smoke, particle size measurement during laboratory smoking, 182-183, 186 monodisperse vs. polydisperse, af- fect on respiratory tract deposi- tion, 181-182 regional deposition in respiratory tract, smoke particle size as fac- tor, 189, 191-192 sidestream smoke, mass median di- ameter effect on deposition in respiratory tract, 187 AGE FACTORS respiratory effects of involuntary smoking in infants and children, 42-44 AIR POLLUTION (See also ENVIRONMENTAL TO- BACCO SMOKE) hospital smoking policies, assess- ment of effect, 311 ALDEHYDES irritant in ETS, 229 AMMONIA irritant in ETS, 229 AROMATIC AMINES sidestream smoke levels higher than in mainstream smoke, 14 AROMATIC HYDROCARBONS measurement under realistic condi- tions (table), 149-150 ASTHMA (See also RESPIRATORY TRACT DISEASES) children, maternal smoking as risk factor, 55-58 pulmonary function in adult asth- matics exposed to cigarette smoke, 63, 65 ATTITUDES public attitudes and social norms, cigarette consumption relation- ship, 321 public knowledge and attitudes about smoking, assessment by surveys, 307 public toward smoking, conclusions of 1986 report, 324 review of impact of smoking re- strictions, 319-320 smokers on cessation or reduction, restrictions and social norms as factors, 305 BEHAVIOR, HUMAN (See also SMOKING CHARACTER- ISTICS; SMOKING HABIT) anticipated changes by smokers to workplace regulations, 312 assessment of impact of smoking policies on smokers, 307 335 INDEX BEHAVIOR, HUMAN—Contd. bans on smoking, effect on behav- ior of smokers, 16 direct and indirect effects of smok- ing policies, 304 hospital employees, smoking behav- ior before and after policy im- plementation, 315 hospital patients and employees, current evidence of smoking pol- icies, 308-309 nonsmoking as normative behavior, reinforcement with smoking poli- cies, 304 reduction or cessation of smoking, indirect effect of smoking poli- cies, 304-305 research recommendations, effect of smoking restrictions, 322 review of impact of smoking re- strictions, 320-321 smoking policy impact, evaluation, 306 BIOASSAY chemical assays for human expo- sure to cigarette tar components, 206, 217 cotinine levels as measure of nic- otine absorption, 205-206 nicotine in blood for exposure de- termination, feasibility, 205 BIRTH WEIGHT maternal smoking as risk factor, 6 BLOOD cotinine level as marker for ETS exposure in nonsmokers, 36 cotinine levels as measure of nic- otine absorption in nonsmokers, 205-206 cotinine levels in ETS-exposed non- smokers vs. active smokers (ta- ble), 211-214 nicotine and cotinine levels to quantify ETS exposure, 208 nicotine levels in ETS-exposed non- smokers vs. active smokers (ta- ble), 209-210 nicotine levels in nonsmokers vs. smokers, 216 white blood cell counts in smokers vs. nonsmokers, 244 336 BRAIN CANCER (See also CANCER } ETS exposure as risk factor, 102, 104 BREAST CANCER (See also CANCER ) spousal smoking as risk factor, 102 BRONCHITIS (See also RESPIRATORY TRACT DISEASES) children, involuntary smoking rela- tionship, longitudinal studies, 38, 42 children of smokers, conclusions about risk, 106 infants and children, parental smoking as risk factor, 10 CANCER (See also BRAIN CANCER; BREAST CANCER; CERVICAL CANCER; LUNG CANCER; RES- PIRATORY TRACT CANCER) carcinogenesis, initiators and pro- moters in tobacco smoke, 28 carcinogens in ETS as risk factors, 135 children, parental smoking as risk factor for cancers other than lung cancer, 102-105 ETS exposure risk, 102-104 involuntary smoking relationship requires further investigation, 14 smoking as major risk factor, 6 CARBON MONOXIDE acute toxicity in animals as factor in smoke carcinogenicity testing, 247 biological marker for ETS absorp- tion, 201-202 ETS exposure measurement, lack of specificity as limitation, 202 involuntary smoking exposure may be more constant than active smoking, 202 lung deposition kinetics as factor in temporal variation in concen- tration, 201-202 measurement under realistic condi- tions (table), 151-154 sidestream smoke vs. mainstream smoke, 129 INDEX CARBON MONOXIDE—Contd. workplace level, contribution of to- bacco smoke, 232 CARBOXYHEMOGLOBIN LEVELS biological marker for carbon mon- oxide exposure, 202 CARCINOGENESIS initiators and promoters of cancer in tobacco smoke, 28 tumor induction in animal tissues with cigarette smoke condensate, 249-250 CARCINOGENS environmental vs. mainstream smoke, 134-135, 137 ETS vs. mainstream smoke in in- door environments (table), 136 human and animal, definition, 135, 137 mainstream and sidestream smoke, 23-24 sidestream and ETS, 251-252 CARDIOVASCULAR DISEASES ETS exposure as factor not estab- lished, 10-11 involuntary smoking as risk factor, conclusions, 107-108 involuntary smoking relationship requires further investigation, 14 nonsmokers, prospective and case- control studies, 105-106 CASE-CONTROL STUDIES (See also EPIDEMIOLOGICAL STUDIES) cardiovascular disease risk, 105-106 lung cancer risk, 97-98 lung cancer risk in exposed non- smokers, Hong Kong study, 80- 81 lung cancer risk in spouses of smokers, Louisiana study, 79-80 lung cancer risk in wives of smok- ers, Greek study, 78-79 lung cancer risk relationship, Four Hospitals study, 84-86 lung cancer risk relationship, Ger- man study, 90 lung cancer risk relationship, Japa- nese study, 88-89 lung cancer risk relationship, Swedish study, 89-90 CASE-CONTROL STUDIES lung cancer risk relationship, Unit- ed Kingdom study, 86-88 respiratory disease risk in children, 43-44 CELLS inflammatory cell number and function in smokers, inferences for involuntary smokers, 244-245 inflammatory, experimental models of cigarette smoke inhalation, 245-246 inflammatory, need to determine effect of ETS exposure, 252 CELLS, EPITHELIAL chronic ETS exposure, inferred risk in nonsmokers, 240-241 ETS exposure effect, research need- ed, 252 hyperplasia, loss of cilia, nuclear atypia, smoking habit relation- ship, 239-240 CERVICAL CANCER (See also CANCER) spousal smoking as risk factor, 102 CESSATION OF SMOKING public attitudes and smoking poli- cies as indirect influences, 304— 305 research recommendations on effect of smoking restrictions, 322 workplace programs as part of smoking control, 297 workplace programs, survey data, 294 workplace smokers motivation and success, smoking policies as fac- tor, 313-315 CESSATION OF SMOKING, METHODS workplace program, smoking policy implementation effect on partici- pation, 314-315 CHEMICAL ANALYSIS sidestream vs. mainstream smoke, 127 CHILDREN asthma, maternal smoking as risk factor, 55-58 brain tumors, maternal smoking as factor, 104 337 INDEX CHILDREN—Contd. bronchitis, involuntary smoking re- lationship, longitudinal studies, 38, 42 cancer risk other than lung cancer, parental smoking as risk factor, 102-105 cough, phlegm, and wheezing, pa- rental smoking as risk factor, 44, 47-49 ETS exposure, determinants, 12 ETS exposure, reported irritation, 239 health risks of ETS exposure, con- clusions, 107 health risks of involuntary smok- ing, summary and conclusions of 1986 report, 12-13 leukemia, maternal smoking during pregnancy as factor, 103 lung cancer risk, parental smoking as factor, 90-91 lung function, information needed on relationship with ETS expo- sure, 32 lung function, involuntary smoking risk relationship (table), 50-52 lung function, maternal smoking relationship, 49, 53-54 lung function, parental smoking as factor, 13, 107 middle ear effusions and diseases, parental smoking risk relation- ship, 58-59 respiratory diseases, involuntary smoking relationship (table), 39- 41 respiratory diseases, parental smok- ing as risk factor, 10, 13, 43-44 respiratory function tests, maternal smoking as factor, 53 respiratory symptoms in children of smokers, 13 respiratory symptoms, relationship with involuntary smoke exposure (table), 4546 respiratory system effects of invol- untary smoking, 37-59 saliva cotinine concentrations, in- fluence of parental smoking, 207-208 338 CIGARETTE EQUIVALENTS calculation of individual constitu- ents needed to determine disease risk, 199-200 involuntary smoking toxicity esti- mation, mathematical modeling, 198-200 CIGARETTE SMOKE (See also ENVIRONMENTAL TO- BACCO SMOKE; MAINSTREAM SMOKE; SIDESTREAM SMOKE; SMOKE STREAMS; TOBACCO SMOKE) aerosol, suspension of particles in a gaseous or vapor medium, 181 animal models of carcinogenicity, 247-249 carcinogenicity, condensate bioassay as alternative to smoke expo- sure, 249-250 carcinogenicity demonstrated in an- imal models, 252 carcinogenicity testing in animals, nicotine and carbon monoxide toxicity as factor, 247 ETS in public places, major source, 128 inflammatory cell function, experi- mental models of inhalation ef- fect, 245-246 particulate mass deposited in respi- ratory tract, 193, 198 particulate phase constituents, side- stream to mainstream ratio (ta- ble), 130-131 regional deposition in respiratory tract, particle size as factor, 189, 191-192 total suspended particulates gener- ated under laboratory conditions (table), 197 toxic and carcinogenic agents in in- door environments (table), 136 unfiltered cigarette, comparison of mainstream and sidestream smoke (table), 128 vapor phase constituents, side- stream to mainstream ratio (ta- ble), 130-131 CIGARETTES nonfiltered, vapor and particulate phase smoke components (table), 130-131 INDEX COMBUSTION TEMPERATURE mainstream and sidestream smoke, effect on composition, 24 sidestream vs. mainstream smoke generation, effect on component levels, 128-129 COTININE biological marker for ETS absorp- tion, 35-36, 200 blood levels in nicotine-injected vs. smoke-exposed nonsmokers, 215- 216 body fluid level as marker for smoke exposure in nonsmokers, 8 body fluid levels in nonsmokers as measure of nicotine absorption, 205 body fluid levels in nonsmokers to establish lung cancer risk, 95 body fluid levels increase with re- ported ETS exposure, 15, 217 ETS exposure marker of choice in epidemiological studies, 217 ETS exposure marker under real- life conditions, 207 ETS exposure quantification, 208, 215 nicotine absorption estimation, 205- 206 plasma, urine, saliva concentra- tions, correlation, 205 plasma, urine, saliva levels in ETS- exposed nonsmokers vs. active smokers, 211-214 urinary levels in ETS-exposed vs. nonexposed men, 207 COUGH (See also RESPIRATORY SYMP- TOMS) children of parents who smoke, re- lationship, 44, 47-49 EARS middle ear effusions in children of smokers, 58-59, 107 EMPHYSEMA (See also RESPIRATORY TRACT DISEASES) nonsmokers vs. smokers, 246 ENVIRONMENTAL TOBACCO SMOKE (See also CIGARETTE SMOKE; IN- VOLUNTARY SMOKING; MAINSTREAM SMOKE; SIDE- STREAM SMOKE; TOBACCO SMOKE) absorption of constituents by non- smokers under experimental! and natural exposure, 206-207 active smoking dose-response rela- tionships provide insight into risks, 26-28 acute exposure, irritation effects, 229-239 acute physiological response, exper- imental studies, 233-239 air dilution effect on particle size and distribution, 134 airways hyperresponsiveness and other factors in response, 28 annoying and irritating effects of exposure, field and experimental studies, 231-239 assessment techniques needed of recent and remote exposure, 14 atmospheric markers of exposure, 33 atmospheric vs. biological markers of absorption, 201 bioassays needed to determine gen- otoxicity, 252 biochemical markers of exposure during experimental and natural conditions, 206-207 biological markers for absorption, 200-206 biological markers for estimating exposure, 141 brain cancer risk relationship, 102, 104 cancers other than lung cancer, risk relationship, 102-104 carbon monoxide as biological marker of exposure, 201-202 carcinogen levels vs. mainstream smoke, 134-135, 137 carcinogenicity, 10 carcinogenicity, in vivo and in vi- tro experimental determination, 247-251 339 INDEX ENVIRONMENTAL TOBACCO SMOKE—Contd. cardiovascular disease risk, prospec- tive and case-control studies, 105-106 chemical analysis shows spectrum of carcinogens, 251-252 chemical composition, comparison with mainstream smoke, 135, 137 chemical composition, complexity as factor in exposure determina- tion, 147 chronic exposure, inferred risk for respiratory epithelial changes, 240-241 cigarettes as major source in public places, 128 concentration determination, venti- lation and other factors, 146- 147, 164-165 concentration measurement, 193 concentrations in public transporta- tion as factor in smoking restric- tions, 278 constituents from mainstream and sidestream smoke, 7-8 contribution to indoor air pollution, conclusions, 169 cotinine as biological marker of ab- sorption, 35-36 cotinine as exposure marker of choice in epidemiological studies, 217 cumulative, duration, and intensity of exposure influences effects, 33 determinants of exposure, 11-12 disease risk estimation, value of bi- ological markers of absorption, 200-201 dose, product of mass in inhaled air and deposition fraction, 193 exposure estimation, mathematical model using “cigarette equiva- lents”, 198-200 exposure expressed as ciga- rettes/day, variations in esti- mates, 25-26 exposure, extrapolation of active smoking data, 23-28 eye irritation in exposed children, 239 eye, nose, throat, respiratory sys- tem irritation, conclusions, 252 340 ENVIRONMENTAL TOBACCO SMOKE—Contd. genotoxic potential, use of short- term in vitro assays, 250-251 health effects, 21-106 health effects, methodological prob- lems in assessment, 21-22 health effects of exposure, summa- ry, 13-14 health risk determination, assess- ment of exposure critical, 32 health risks of exposure, conclu- sions, 7, 107-108 human exposure, factors in estima- tion, 139, 141-142 “individual solution” approach to workplace smoking implies no hazard, 298 inflammatory cell functions in smokers, inferences for exposed nonsmokers, 244-245 irritant components, whole side- stream smoke vs. gas phase only, 236-238 irritant effect on allergic persons, 239 irritant effects of exposure in non- smokers in restaurants and of- fices, 232 laboratory, toxicological, human ex- posure, and epidemiological in- vestigations of hazards, 22-23 lung cancer risk, epidemiological and case-control evidence, 97-98 lung cancer risk in exposed non- smokers, Hong Kong case—con- trol study, 80-81 lung cancer risk in spouses of smokers, Louisiana case-control study, 79-80 lung cancer risk in spouses of smokers, Scottish study, 77-78 lung cancer risk in wives of smok- ers, Greek case-control study, 78-79 lung cancer risk, need for more ac- curate estimates of exposure, 102 lung cancer risk relationship, Four Hospitals case-control study, 84— 86 lung cancer risk relationship, Ger- man case-control study, 90 lung cancer risk relationship in nonsmokers, 8-10 INDEX ENVIRONMENTAL TOBACCO ENVIRONMENTAL TOBACCO SMOKE—Contd. lung cancer risk relationship, Japa- nese case-control study, 88-89 lung cancer risk relationship, Los Angeles County study, 83 lung cancer risk relationship, pre- liminary findings of U.S. study, 82 lung cancer risk relationship, sum- mary and conclusions, 96-102 lung cancer risk relationship, Swedish case-control study, 89- 90 lung cancer risk relationship, Unit- ed Kingdom case-control study, 86-88 lung disease risk in nonsmokers as extrapolation of risk in smokers, 30-31 lung effects, inferences from avail- able data, 246-247 lung function effects in nonsmok- ers, 60, 62 lung function in children, more in- formation needed on relation- ship, 32 major irritants, concentrations in mainstream and sidestream smoke (table), 230 mass deposition in respiratory tract estimation, 193, 198 mathematical models of lung can- cer risk in nonsmokers, 93-96 measureable exposure in general population of developed coun- tries, 216 misclassification of smoking status and exposure as factor in deter- mining risk, 66-67, 72-73 monitoring methods to estimate ex- posure, 164-167 nasal vs. mouth inhalation, effect on particle deposition, 189 nicotine and cotinine in body fluids increase with increasing expo- sure, 15 nicotine and cotinine to quantify exposure, 208, 215 nicotine as biological marker of ex- posure, 202-205 nicotine as tracer, need for proper validation in personal monitor- ing, 168 SMOKE—Contd. nicotine levels in nonsmokers may underestimate exposure to other components, 216 organic gases and aromatic com- pounds as indicators of exposure, nonspecificity, 168-169 particle size as factor in dispersion, 169 particle size distribution and breathing pattern effect on dose, 25 particle size facilitates rapid distri- bution, 14 particles, number and size distribu- tion, 137, 139 particulates, aldehydes, phenol, am- monia, and other irritants, 229 personal monitors to measure con- centrations preferable to area monitoring, 166 physiochemical nature, distribution, and estimation of human expo- sure, 125-169 plasma and urine nicotine levels in nonsmokers vs. intravenous nic- otine injection, 215 plasma, urine, saliva cotinine in exposed nonsmokers vs. active smokers (table), 211-214 plasma, urine, saliva nicotine in exposed nonsmokers vs. active smokers (table), 209-210 proximity to smoke source as expo- sure factor, 141 questionnaires for estimating expo- sure, uses and limitations, 34-35 radioactivity, 134 reduction of exposure as primary goal of smoking regulation in public places, 304 respirable suspended particulates in exposed vs. nonexposed nonsmok- ers, 169 respiratory disease risk relationship in infants, children, adults, 10 respiratory infections in infants, risk relationship, 31 respiratory symptoms in nonsmok- ers, possible relationship, 31 school smoking regulations tradi- tionally not to reduce exposure, 282 341 INDEX ENVIRONMENTAL TOBACCO SMOKE—Contd. sidestream smoke as major contrib- utor, 186 statistical significance testing of health risks, 36-37 summary and conclusions of 1986 report, 12-13 temporal and spatial distribution of smokers in exposure determina- tion, 145-146 thiocyanates as biological marker of exposure, 202-203 time-activity patterns as determi- nant of exposure, 142-145 time period most important deter- minant of personal exposure, 167 total suspended particulates in in- door working and living areas (table), 194-196 toxic and carcinogenic agents in- doors from nonfilter cigarettes (table), 136 toxicity, acute irritant effects, and carcinogenicity, 15 urinary cotinine levels in exposed vs. nonexposed men, 207 vapor phase, retention by involun- tary smokers, 126-127 workplace exposure, evidence of health hazards as factor in smoking regulations, 286 workplace, lung cancer risk in non- smokers, 91-92 ENZYME ACTIVITY lungs of smokers, alveolar macro- phages influence on protease-an- tiprotease balance, 242-243 polymorphonuclear elastase in lungs of smokers, 243 respiratory system of smoke-ex- posed animals, 245-246 ENZYMES elastase, 243 EPIDEMIOLOGICAL STUDIES (See also CASE-CONTROL STUD- TES) confounding variables, 36 lung cancer risk in spouses of smokers, 98, 101 methodological considerations, 32- 37 342 EPIDEMIOLOGICAL STUDIES—Contd. questionnaires for estimating ETS exposure, uses and limitations, 34-35 ETS See ENVIRONMENTAL TO- BACCO SMOKE EX-SMOKERS (See also NONSMOKERS) misclassification of status and ETS exposure as factors in determin- ing risks, 66-67, 72-73 EYES annoying and irritating effects of ETS exposure, 231-239 irritation from ETS exposure, 11 irritation in ETS-exposed children, 239 nonsmokers, irritant effect of invol- untary smoking in restaurants and offices, 232 nonsmokers, sidestream smoke as irritant in laboratory, ventilation as factor, 234-235 smoke concentration vs. exposure duration as factors in irritation, 235 tear film in ETS-exposed nonsmok- ers, experimental study, 234 FETUS maternal smoking, effect of expo- sure to tobacco smoke constitu- ents, 31-32 GAS PHASE, CIGARETTE SMOKE activity in in vitro assays, 251 irritation in nonsmokers vs. whole sidestream smoke, 236-238 HOSPITALS (See also PUBLIC PLACES) air quality, effect of smoking poli- cies, 311 cessation of smoking programs, ef- fect, 314-315 employee attitudes and approval of smoking policies, 311-312, 315 lung cancer case-control study in four hospitals, 84-86 smoking policies, positively worded signs and enforcement factors in compliance, 310 smoking policies, review of current evidence on impact, 308-309 INDEX HOSPITALS—Contd. State legislation restricting smok- ing, 269 IMMUNE SYSTEM cigarette smoking effects, 244 INFANTS respiratory diseases, parental smok- ing as risk factor, 10 respiratory system effects of invol- untary smoking, 38-59 time-location patterns, 144 tracheobronchial smoke particle de- position, mathematica! model prediction, 192 INVOLUNTARY SMOKING (See also ENVIRONMENTAL TO- BACCO SMOKE; NONSMOK- ERS) absorption vs. active smoking, 215- 216 absorption of constituents under experimental and natural expo- sure, 206-207 adult asthmatics, lung function ef- fects, 63, 65 allergic persons, irritant effect, 239 assessment of nonsmoker’s expo- sure, 307 atmospheric vs. biological markers of ETS absorption in disease risk estimation, 200-201 bronchoconstriction and asthma in children of parents who smoke, 55-58 bronchoconstriction in normal adult nonsmokers, 63 cancers other than lung cancer, risk relationship, 102-104 carbon monoxide as biological marker of ETS exposure, 201- 202 cardiovascular disease risk, prospec- tive and case-control studies, 105-106 children, brain cancer risk, 104 children, lung function effects (ta- ble), 50-52 children, nonuniform deposition of particles in respiratory disease risk, 192 children, parental smoking as fac- tor in saliva cotinine concentra- tions, 207-208 INVOLUNTARY SMOKING—Contd. children, reported eye irritation, 239 children, respiratory disease rela- tionship (table), 39-41 children, respiratory symptoms re- lationship (table), 45-46 children, respiratory symptoms risk, 44, 47-49 children, risk of cancer other than lung cancer, 102-104 cotinine in body fluids as measure of nicotine absorption, 205 cotinine level in saliva, blood, and urine as ETS exposure marker, 36 cumulative, duration, and intensity influences health risks, 33 disease risk estimation, value of bi- ological markers of ETS absorp- tion, 200-201 ETS vapor phase components, re- tention, 126-127 exposure to sidestream and main- stream smoke components, 8 eye and nasal irritation, smoke concentration vs. duration as factors, 235 health effects and public attitudes as factors in smoking restric- tions, 265 health hazards, increasing evidence as factor in regulation, 282, 286 health risks, 6-7, 107-108 infants and children, bronchitis and pneumonia risk, 38, 42-44 infants and children, respiratory system effects, 38-59 inflammatory cell numbers and functions in smokers, inferences, 944-245 irritant effects in nonsmokers in restaurants and offices, 232 irritation from gas phase vs. whole sidestream smoke, 236-238 lung cancer dose-response relation- ship, problems in exposure deter- mination, 92-93 lung cancer in spouses of smokers, prospective and case-control studies (table), 71 lung cancer in wives of smokers, Japanese prospective study, 73- 76 343 INDEX INVOLUNTARY SMOKING—Contd. lung cancer relationship, relative risk, 72 lung cancer risk, American Cancer Society Cohort Study, 76-77 lung cancer risk assessment, impor- tance of definition of exposure, 92 lung cancer risk, bias in case—con- trol studies (table), 98 lung cancer risk, epidemiological evidence, 97-98 lung cancer risk, evidence from case-control studies, 97 lung cancer risk factor in children, 90-91 lung cancer risk factor in non- smokers, 13 lung cancer risk in nonsmokers, Hong Kong case-control studies, 80-81 lung cancer risk in spouses of smokers, Louisiana case-control study, 79-80 lung cancer risk in spouses of smokers, Scottish study, 77-78 lung cancer risk in wives of smok- ers, Greek case-control study, 78-79 lung cancer risk relationship, case— control studies (table), 68-70 lung cancer risk relationship, Los Angeles County study, 83 lung cancer risk relationship, pre- liminary findings of U.S. study, 82 lung cancer risk relationship, pro- spective studies (table), 67 lung cancer risk relationship, sum- mary and conclusions, 96-102 lung cancer risk relationship, the Four Hospitals case-control study, 84-86 lung cancer risk relationship, the German case-control study, 90 lung cancer risk relationship, the Japanese case-control study, 88- 89 lung cancer risk relationship, the Swedish case-control study, 89- 90 lung cancer risk relationship, the United Kingdom case-control study, 86-88 344 INVOLUNTARY SMOKING—Contd. lung cancer risk, study power of case-control studies (table), 99- 100 lung disease risk, extrapolation from risk in smokers, 30-31 lung function effects in adult non- smokers, 60, 62 lung function effects in adults (ta- ble), 61 lung function effects in healthy adults (table), 64 mathematical models of lung can- cer risk, 93-96 middie ear effusions and diseases in children, risk relationship, 58-59 misclassification of smoking status and exposure as factors in deter- mining risk, 66-67, 72-73 nicotine and cotinine levels as ex- posure markers under real-life conditions, 207 nicotine and cotinine to quantify ETS exposure, 208, 215 organization of the 1986 Report, 5 personal monitoring to measure ex- posure, 33-34 personal monitors to measure ETS concentrations, 164-167 public and workplace smoking re- strictions, conclusions of 1986 re- port, 324 public awareness of health hazards as factor in changing attitudes, 320 quantitative and qualitative differ- ences in exposure from active smoking, 23-24 questionnaires for estimating expo- sure, uses and limitations, 34-35 research recommendations, 321-323 respirable suspended particulate levels as marker of smoke expo- sure, 8 respiratory system effects in chil- dren, case-control studies, 43-44 respiratory system effects in chil- dren, cross-sectional studies, 43 respiratory system effects in in- fants and children, longitudinal studies, 38, 42-43 State legislation in 1970s aimed at protecting nonsmokers, 267 INDEX INVOLUNTARY SMOKING—Contd. summary and conclusions of 1986 report, 12-13 thiocyanate levels not specific for exposure, 203 toxicity, mathematical model for estimating using “cigarette equivalents”, 198-200 urinary nicotine and expired car- bon monoxide in nonsmokers fol- lowing exposure, 207 workplace, lung cancer risk rela- tionship, 91-92 workplaces, current status of smok- ing regulations, 285-303 IRRITATION (See also RESPIRATORY SYMP- TOMS) acute effects of ETS exposure, 229- 239 allergic persons, ETS exposure ef- fect, 239 annoying and irritating effects of ETS, 231-239 children exposed to ETS, 239 ETS exposure effects, conclusions, 252 nonsmokers, experimental studies of ETS exposure effects, 233-239 LABORATORY SMOKING chemical analysis of sidestream smoke in special chambers, 127- 129, 132 mainstream and sidestream compo- sition data collection, 125 mainstream smoke particle size dis- tribution (table), 184-185 particle size of mainstream smoke aerosol, measurement, 182-183, 186 sidestream smoke particle size dis- tribution (table), 186 LEGISLATION (See also SMOKING REGULA- TIONS) average restrictiveness of State laws, 1960-1985 (figure), 276 comprehensiveness index of State laws, 327-328 current State smoking regulations, variations, 268-270 early restrictions as moral crusade and fire protection, 266-267 LEGISLATION—Contd. emphasis shift and increase in State legislation during the 1970s, 267 Federal, State, and local to restrict smoking, 266-278 impact on smoking behavior, as- sessment, 306-307 local, California’s nonsmokers’ rights movement as factor, 277 Minnesota, landmark Ciean Indoor Air Act of 1975, model for other States, 267 nonsmoking sections in restaurants mandated by State laws, 280 rate of new State legislation con- tinues into 1980s, 268 regional variation in State laws against smoking (table), 277 restrictions and bans on smoking, 16 review of impact on smoking be- havior, 320-321 smoking regulations, conclusions of 1986 report, 324 social norms and public attitudes as factors in passage, 321 State and local laws and Federal regulation in health care facili- ties, 284-285 State and local laws on public smoking, influence on private sector, 295 State and local smoking control statutes, implementation evalu- ation, 316-318 State, increase in comprehensive- ness of smoking regulations since 1970, 275 State laws regulating smoking in public places and workplaces (ta- ble), 271-274 State laws restricting smoking, 1970-1985 (table), 269 States with no regulations against smoking, 268 student smoking, legal incentive for regulation by schools, 282 tobacco-producing States have less restrictive laws on smoking, 275-276 workplace smoking, early contro- versy, 286 345 INDEX LEGISLATION—Contd. workplace smoking, private sector, State and local laws, 285 workplace smokin; regulation, vari- ations in State laws, 270, 275 LEUKEMIA children of women who smoked during pregnancy, risk relation- ship, 103-104 LEUKOCYTES polymorphonuclear, lung disease risk relationship in smokers, 243-244 LUNG CANCER (See also CANCER) animals exposed to cigarette smoke, 248-249 confounding variables in studies of ETS risk in nonsmokers, 36 ETS as risk factor in nonsmokers, 8-10 ETS exposure as risk in nonsmok- ers, Hong Kong case-control studies, 80-81 ETS risk relationship, need for more accurate estimates of expo- sure, 102 involuntary smokers, study power of case-control studies (table), 99-100 involuntary smoking as factor, American Cancer Society Cohort Study, 76-77 involuntary smoking as factor, Los Angeles County study, 83 involuntary smoking as factor, pre- liminary findings of U-S. study, 82 involuntary smoking as factor, rela- tive risk, 72 involuntary smoking as factor, the Four Hospitals case-control study, 84-86 involuntary smoking as factor, the German case-control study, 90 involuntary smoking as factor, the Japanese case-control study, 88- 89 involuntary smoking as factor, the Swedish case-control study, 89- 90 346 LUNG CANCER—Contd. involuntary smoking as factor, the United Kingdom case-control study, 86-88 involuntary smoking as risk factor, bias in case-control studies (ta- ble), 98 involuntary smoking as risk factor, case-control studies (table), 68- 70 involuntary smoking as risk factor, prospective studies (table), 67 involuntary smoking as risk factor, summary and conclusions, 96- 102, 107 involuntary smoking dose-response relationship, problems in expo- sure determination, 92-93 mathematical models of ETS expo- sure risk in nonsmokers, 93-96 methodological issues in assessing involuntary smoking risk, 66-67, 72-73 mortality in nonsmoking wives of smokers, 27 nonsmokers, case-control study evi- dence of ETS exposure as risk factor, 97 nonsmokers, epidemiological evi- dence of ETS exposure as risk factor, 97-98 nonsmokers, involuntary smoking as risk factor, 13, 66-101 nonsmokers, projection of ETS risk from relationship with smoking in smokers, 26-27 nonsmoking spouses of smokers, Louisiana case-control study, 79- 80 nonsmoking spouses of smokers, po- tential bias in Japanese study, 74-75 nonsmoking spouses of smokers, Scottish study, 77-78 nonsmoking wives of smokers, Jap- anese prospective study, 73-76 nonuniform carcinogenic particle deposition as possible risk factor, 192 parental smoking as risk factor, 90-91 sample size of concern in studies of nonsmokers, 22 smoking as major risk factor, 6 INDEX LUNG CANCER—Contd. spousal smoking as risk factor, pro- spective and case-control studies (table), 71 women married to smokers, Greek case-control study, 78-79 LUNG DISEASES (See also RESPIRATORY TRACT DISEASES) active smokers, extrapolation of risk in involuntary smokers, 30 bronchiolitis, early pathologic le- sions in smokers, 241 LUNG FUNCTION adult asthmatic nonsmokers ex- posed to cigarette smoke, 63, 65 adults exposed to involuntary smoking (table), 61 asymptomatic adults, long-term workplace exposure as risk fac- tor, 60 children and adolescents who start to smoke, 28 children and adults, conclusions about ETS exposure risk, 107 children, information needed on re- lationship with ETS exposure, 32 children, involuntary smoking risk relationship (table), 50-52 children, maternal smoking rela- tionship, 49, 53-54 healthy nonsmokers exposed to cig- arette smoke (table), 64 nonsmokers, ETS as factor in de- cline, 10 nonsmokers, extrapolation of ETS risk from risks in smokers, 27 LUNGS (See also RESPIRATORY SYSTEM) carbon monoxide deposition kinetics as factor in variations in concen- tration, 201-202 children of parents who smoke, possible long-term effects, 44 cigarette smoking effect, implica- tions for chronic ETS exposure, 239 cigarette smoking effects, summary, 246-247 inflammatory cell function, experi- mental models of cigarette smoke inhalation, 245-246 LUNGS—Contd. inflammatory cells, cigarette smok- ing effect, 241-246 inflammatory lesions in smokers vs. nonsmokers, 245 parenchyma alterations in smokers, 246 parenchyma destruction by poly- morphonuclear elastase in smok- ers, 243 regional deposition of mainstream smoke particles in smokers, 189, 191 respirable particle deposition, non- uniformity, 191-192 sidestream smoke particle deposi- tion, mass median diameter as factor, 187 MAINSTREAM SMOKE (See also CIGARETTE SMOKE; SIDESTREAM SMOKE; SMOKE STREAMS; TOBACCO SMOKE) condensates, in vitro assays of mu- tagenic activity, 250-251 definition, 7 electrical charge as factor in parti- cle deposition, 187 particle size distribution studies, 140 particle size distribution (table), 184-185 regional deposition in respiratory tract of smokers, 189, 191 respiratory system deposition vs. sidestream smoke (table), 190 MATERNAL SMOKING (See also PARENTAL SMOKING) asthmatic children, risk relation- ship, 55-58 brain tumors in children, risk rela- tionship, 104 cancer other than lung cancer in children, risk relationship, 103- 104 health risks for fetus and neonate, 6 leukemia in children of women who smoked during pregnancy, 103 jung function in children, risk rela- tionship, 49, 53-54 lung function in children, risk rela- tionship (table), 50-52 347 INDEX MATERNAL SMOKING—Contd. respiratory illness in children, case-control studies of risk, 43- 44 respiratory illness in children, cross-sectional studies of risk, 43 respiratory illness in infants and children, 38, 42-43 MATHEMATICAL MODELS airways deposition of sidestream smoke suggested, 217 humidity effect on particle size and deposition, 187-188 lung cancer risk of ETS exposure, "93-96 particle deposition patterns, effect of cigarette tar content, 191 regional deposition of polydisperse aerosols, 189 respirable suspended particulate constituent of ETS for exposure prediction, 165 respiratory tract deposition of side- stream smoke particles, 186-187 tracheobronchial smoke particle de- position prediction, age as factor, 192 MINNESOTA landmark Clean Indoor Air Act, model for other States, 267 public approval of 1975 Clean In- door Air Act, 318-319 MORTALITY cancers other than lung cancer, standard ratios for wives of smokers, 102 lung cancer, establishing risk in nonsmokers, 95-97 lung cancer in ETS exposed non- smokers, American Cancer Soci- ety Cohort Study, 76-77 lung cancer in nonsmoking wives of smokers, 27 lung cancer in spouses of smokers, Scottish study, 77-78 lung cancer in wives of smokers, Japanese prospective study, 73- 76 maternal smoking as risk factor for infant mortality, 6 348 MOTIVATION cessation of smoking, public atti- tudes and restrictions as rein- forcement, 305 worker safety not health as factor in early smoking regulations, 287 workplace smoking policies, effect on smoking cessation attempts, 313-314 workplace smoking regulation, 295- 296 NICOTINE (See also TOBACCO SMOKE CON- STITUENTS) absorption in nonsmokers to assess lung cancer risk, 9 absorption in populations suggests ETS exposure is common, 15 acute toxicity in animals as factor in smoke carcinogenicity testing, 247 atmospheric levels as marker of ETS exposure, 33 biological fluid levels, promising tracer of ETS exposure, 165-166 blood levels, metabolism, and excre- tion rate to determikne intake, 203-204 body fluid levels as marker of smoke exposure in nonsmokers, 8 body fluid levels increase with re- ported ETS exposure, 15, 217 body fluid levels specificity for to- bacco or tobacco smoke expo- sure, 204 ETS as source in general environ- ment, 14, 169 ETS exposure determination, speci- ficity, 147 ETS exposure quantification, 208, 215 ETS tracer, need for proper valida- tion, 168 measurement under realistic condi- tions (table), 155-156 personal air monitoring for intake determination, 216 plasma and urine levels from in- travenous infusion vs. ETS expo- sure in nonsmokers, 215 INDEX NICOTINE—Contd. plasma, urine, saliva levels in non- smokers vs. active smokers, 209- 210, 216 suspended particulate levels as measurement of ETS exposure, 193 tobacco smoke exposure determina- tion, absorption, distribution, me- tabolism, 203-205 vapor phase of sidestream vs. mainstream smoke, 127 NITROGEN OXIDES carcinogenic potential of oxides of nitrogen in sidestream smoke, 129 irritant in ETS, 229 measurement under realistic condi- tions (table), 157 nitrogen dioxide in sidestream smoke, carcinogenic potential, 129 NITROSAMINE CONTENT N-nitrosamines in sidestream vs. mainstream smoke, 129 NITROSAMINES ETS as only source of some N-ni- trosamine compounds in general environment, 169 ETS exposure determination, speci- ficity, 147 measurement under realistic condi- tions (table), 158 sidestream smoke levels higher than in mainstream smoke, 14 NONSMOKERS absorption of smoke constituents under experimental and natural exposure, 206-207 blood cotinine levels, nicotine injec- tion vs. smoke exposure, 215-216 California nonsmokers’ rights move- ment as factor in local smoking regulation, 277 cardiovascular disease, prospective and case-control studies of ETS risk, 105-106 chronic ETS exposure, inferred risk for respiratory epithelium, 240- 241 cotinine elimination half-life vs. smokers, 205-206 NONSMOKERS—Contd. emphysema risk vs. smokers, genet- ic predisposition as factor, 246 ETS as lung cancer risk factor, problems in exposure determina- tion, 92-93 ETS-exposed, plasma, urine, saliva cotinine vs. active smokers (ta- ble), 211-214 ETS-exposed, plasma, urine, saliva nicotine vs. active smokers (ta- ble), 209-210 ETS exposure, experimental studies of irritant effects, 233-239 ETS exposure, relationships with active smoking provide insight into risks, 26-28 ETS exposure toxicity, mathemati- cal model using “cigarette equiv- alents”, 198-200 ETS exposure, wide variations, 14 health risks of ETS exposure, con- clusions, 107-108 health risks of involuntary smok- ing, summary and conclusions, 12-13 irritant effects of involuntary smoking in restaurants and of- fices, 232 irritation from sidestream smoke vs. gas phase sidestream smoke, 236-238 irritation from smoke exposure, concentration vs. duration as factors, 235 lung cancer, establishing risk of ETS exposure, 95 lung cancer, ETS exposure as fac- tor, Four Hospitals case-control study, 84-86 lung cancer, ETS exposure as fac- tor, German case-control study, 90 lung cancer, ETS exposure as fac- tor, Hong Kong case-control study, 80-81 lung cancer, ETS exposure as fac- tor, Japanese case-control study, 88-89 lung cancer, ETS exposure as fac- tor, Los Angeles County study, 83 349 INDEX NONSMOKERS—Contd. lung cancer, ETS exposure as fac- tor, preliminary findings of US. study, 82 lung cancer, ETS exposure as fac- tor, Swedish case-control study, 89-90 lung cancer, ETS exposure as fac- tor, United Kingdom case—con- trol study, 86-88 lung cancer in spouses of smokers, prospective and case-control studies (table), 71 lung cancer, involuntary smoking as risk factor, 13 lung cancer risk from ETS expo- sure, 8-10 lung cancer risk from ETS as pro- jection of relationship of smok- ing in smokers, 26-27 lung cancer risk in spouses of smokers, Japanese prospective study, 73-76 lung cancer risk in spouses of smokers, Louisiana case-control study, 79-80 lung cancer risk in spouses of smokers, Scottish study, 77-78 lung cancer risk of ETS exposure, American Cancer Society Cohort Study, 76-77 lung cancer risk of involuntary smoking, case-control studies (ta- ble), 68-70 lung cancer risk of involuntary smoking, more accurate data needed, 102 Jung function in healthy adults ex- posed to cigarette smoke (table), 64 mathematical models of lung can- cer risk with ETS exposure, 93- 96 misclassification of status and ETS exposure as factors in determin- ing risk, 66-67, 72-73 nicotine and cotinine to quantify ETS exposure, 208, 215 odor perception and irritation, in- fluence of room temperature and humidity, 234 plasma and urine nicotine levels, intravenous vs. ETS exposure ef- fect, 215 350 NONSMOKERS—Contd. plasma, saliva, and urine nicotine and cotinine levels vs. active smokers, 216 preferential hiring, most restrictive smoking policy, 301-302 private, local, governmental actions for protection from smoke expo- sure, 265 respirable suspended particulates in ETS-exposed vs. nonexposed, 169 review of impact of smoking re- strictions on attitudes, 320 separation from smokers for risk reduction, effectiveness, 11-12 State antismoking legislation in 1970s aimed at protection, 267 temporal and spatial distribution of smokers in ETS exposure deter- mination, 145-146 urinary cotinine levels in ETS-ex- posed vs. nonexposed men, 207 urinary nicotine and expired car- bon monoxide, effects of smoke exposure, 207 workplace bans for maximum pro- tection, momentum growing among large employers, 301 workplace demands for clean air as motivation for smoking regula- tions, 296 workplace smoking as eye irritant, 233 workplace smoking as lung cancer risk factor, 91-92 NOSE annoying and irritating effects of ETS exposure, 231, 235 ETS particle deposition, effect of nasal inhalation, 189 smoke concentration vs. exposure duration as factors in irritation, 235 PARENTAL SMOKING (See also MATERNAL SMOKING) cancers other than lung cancer in children, risk relationship, 102- 105 cough, phlegm, and wheezing in children, 44, 47-49 lung cancer risk relationship, 90-91 lung function in children, relation- ship (table), 50-52 INDEX PARENTAL SMOKING—Contd. lung function in children, risk rela- tionship, 53-54 middle ear effusions and diseases in children, risk relationship, 58-59 respiratory illness in infants and children, 38, 42-44 respiratory symptoms in children, 13 respiratory symptoms in children, relationship (table), 45~46 respiratory system effects in chil- dren, 38-59 saliva cotinine concentrations in children, effect, 207-208 Passive Smoking See INVOLUN- TARY SMOKING PHYSICAL ACTIVITY ETS deposition increase with in- creasing activity, 187 PREGNANCY fetal exposure to tobacco smoke constituents, possible effects, 31- 32 leukemia risk in children of smok- ers, 103 PUBLIC PLACES (See also HOSPITALS; WORK- PLACE) current status of smoking regula- tions mix of public and private actions, 265-266 employee attitudes before smoking policy implementation, 311 health care facilities, public sup- port of smoking restrictions, 284 health care facilities, smoking regu- lations, 283-285 hotels and motels, smoking regula- tions, 281-282 impact of public and workplace policies restricting smoking, 303- 321 interstate transportation, smoking regulated at Federal level, 278 legislation restricting smoking, evaluation of impact, 316-318 local smoking regulations, 277-278 public transportation, smoking reg- ulations, 278-279 PUBLIC PLACES—Contd. research recommendations on ef- fects of smoking regulations, 321 restaurants, opposition, acceptance, and implementation of smoking restrictions, 280 restaurants, smoking regulations, 279-281 retail stores, smoking regulations, 279 schools, smoking regulations, 282- 283 smoking regulation, State laws (ta- ble), 271-274 smoking regulations, conclusions of 1986 report, 324 smoking regulations, factors in ac- ceptability, 266 smoking regulations in specific public places, 278-285 smoking regulations, public approv- al, national and regional polls, 318-319 smoking restrictions, variations in current State legislation, 268- 270 State laws regulating smoking, comprehensiveness index, 327- 328 State legislation to restrict smok- ing, increase during the 1970s, 267 States restrict smoking in transpor- tation, hospitals, elevators, and others, 269 total suspended particulates (table), 194-195 PULMONARY ALVEOLAR MAC- ROPHAGES lung injury relationship in smok- ers, 241-243, 245 protease-antiprotease balance in lungs of smokers, influence, 242—243 respiratory bronchioles of smoke-ex- posed animals, 245-246 PYRIDINES sidestream vs. mainstream smoke levels, 129 RADIATION decay products of radon in tobacco smoke, 132, 134 ETS radioactivity, 134 351 INDEX REDUCTION OF SMOKING (See also CESSATION OF SMOK- ING) public attitudes and smoking poli- cies as indirect influences, 304~ 305 RESIDENCES total suspended particulates (table), 195-196 RESPIRABLE SUSPENDED PAR- TICULATES enclosed places, ETS role, 169 ETS-exposed and nonexposed sam- ples, percentage distribution, 167 hospital before and after adopting restrictive smoking policy, 311 irritants in ETS, 229 marker for ETS exposure, 33-34 personal monitors to measure ETS exposure, 166-168 residental levels as function of number of smokers (table), 164 respiratory disease risk in children of smokers, 192 : tracheobronchial deposition in in- fants vs. adults, prediction, 192 RESPIRATORY FUNCTION TESTS children, involuntary smoking as risk factor, 53-54 nonsmokers exposed to involuntary smoking, 62-63 predicted levels, relationship with number of cigarettes smoked, 29 RESPIRATORY SYMPTOMS (See also COUGH; IRRITATION; NOSE) annoying and irritating effect of ETS exposure, 231-232, 238-239 children and adolescents who start to smoke, 27 children and adults, ETS exposure as factor, conclusions, 107 ‘children, parental smoking as fac- tor, 13 children, relationship with inyolun- tary smoke exposure (table), 45- 46 cough, phlegm, and wheezing in - adults, ETS exposure as risk not established, 60 352 RESPIRATORY SYMPTOMS—Contd. cough, phlegm, wheezing in chil- dren, parental smoking as factor, 44, 47-49 involuntary smokers, 31 RESPIRATORY SYSTEM (See also LUNGS) animals, carcinogenicity of cigarette smoke, 247-248 breathing pattern and particle size distribution effect on ETS dose, 25 breathing patterns as factor in sidestream smoke deposition, 187 bronchoconstriction in children, pa- rental smoking as risk factor, 55-58 bronchoconstriction in normal adults exposed to involuntary smoking, 63 cigarette smoking effects, implica- tions for involuntary smoking risks, 239-241 deposition and absorption of tobac- co smoke constituents, 181-216 deposition of mainstream and side- stream smoke, 25 . enzyme activity in smoke-exposed animals, 245 : epithelial cells, dose-response effect of cigarette smoking, 239 ETS deposition, 193-216 ETS dose, product of mass in in- haled air and deposition frac- tion, 193 hyperplasia and metaplasia in tra- chea and bronchi of smoke-ex- posed animals, 248 involuntary smoking effects, 37-65 mass deposition of ETS, estimation, 193 nasal vs. mouth inhalation of ETS, effect on particle deposition, 189 nose, throat, and airway irritation from smoke exposure, 11 particle size of cigarette smoke as _ factor in deposition, 182 puffing and inhalation patterns as factor in particle deposition, 183 regional deposition of smoke parti- cles, 189, 191 sidestream and mainstream smoke deposition (table), 190 INDEX RESPIRATORY SYSTEM—Contd. sidestream smoke particle deposi- tion, 186-189 smoke particle size as factor in re- gional deposition, 189, 191-192 RESPIRATORY TRACT CANCER animals exposed to cigarette smoke, 248 RESPIRATORY TRACT DISEASES acute illness in children, parental smoking as risk factor, 38, 42-44 asthma in children, maternal smoking as risk factor, 55-58 children, case-control studies of pa- ternal smoking as risk factor, 43-44 children, nonuniform deposition of smoke particles as risk factor, 192 children, parental smoking as fac- tor, 13 - children, parental smoking as risk factor, 38-59 early childhood, involuntary smok- ing relationship (table), 39-41 involuntary smoking as risk factor, 10 nonsmoking adults and children, involuntary smoking as factor, 37-66 pneumonia in children of smokers, conclusions about risk, 107 population characteristics as factor in ETS risk, 28 smoking as major risk factor, 6 RESPIRATORY TRACT INFEC- TIONS children of smokers, conclusions about risk, 107 infants, ETS exposure as risk fac- tor, 31 SALIVA cotinine level as marker for ETS exposure in nonsmokers, 36 cotinine levels in ETS-exposed non- smokers vs. active smokers (ta- ble), 211-214 nicotine and cotinine levels to quantify ETS exposure, 208, 215 nicotine levels as sidestream smoke exposure indicator, 204-205 SALIVA—Contd. nicotine levels in ETS-exposed non- smokers vs. active smokers (ta- ble), 209-210 nicotine levels in nonsmokers vs. smokers, 216 SIDESTREAM SMOKE (See also CIGARETTE SMOKE, MAINSTREAM SMOKE; SMOKE STREAMS; TOBACCO SMOKE) bioassays needed to determine gen- otoxicity, 252 carbon monoxide and carbon diox- ide levels vs. mainstream smoke, 129 carcinogen levels vs. mainstream smoke, 24 carcinogenic potential, effect of lev- els of oxides of nitrogen, 129 carcinogenicity vs. mainstream smoke in animal models, 252 chemical analysis, 127-129, 132 chemical composition as factor in estimating exposure using “ciga- rette equivalents”, 199 component levels, combustion tem- perature effect vs. mainstream smoke, 128-129 constituent formation vs. main- stream smoke, 7-8 definition, 7 experimental and mathematical models show deposition in air- ways, 217 formaldehyde and acrolein concen- trations above occupational lim- its, 230 formation and physiochemical na- ture, 127 inhalation effects in laboratory ani- mals not reported, toxicity fac- tor, 249 irritation in nonsmokers vs. gas phase sidestream smoke vs. acro- lein, 236-237 irritation of nonsmokers in labora- tory, ventilation as factor, 234- 235 laboratory collection devices, 125~ 126 major source of ETS, 125 353 INDEX SIDESTREAM SMOKE—Contd. mass median diameter, effect on deposition in respiratory tract, 187 mathematical models of particle de- position in respiratory tract, 186-187 nicotine in vapor phase vs. main- stream smoke, 127 particle distribution in respiratory tract, 186-189 particle size distribution studies (ta- ble), 138 particle size distribution (table), 186 particles, number and size distribu- tion, 137, 139 particulate matter vs. mainstream smoke, 129, 132 particulate phase as major determi- nant of irritation in nonsmokers, 237-238 physiochemical nature and spec- trum of carcinogens, summary, 251-252 regional deposition in respiratory tract, particle size as factor, 189, 191-192 respiratory system deposition vs. mainstream smoke (table), 190 saliva nicotine levels as indicator of exposure, 204-205 toxic and carcinogenic agents, 21 toxic and carcinogenic compounds, 14 toxic and carcinogenic compounds vs. mainstream smoke, conclu- sions, 169 tumor induction by condensate on mouse skin vs. mainstream smoke condensate, 250 vapor and particulate phase con- stituents, sidestream to main- stream ratio (table), 130-131 SMOKE INHALATION, ANIMAL carcinogenicity testing, 247-250 laryngeal leukoplakias in hamsters, 248-249 lung and respiratory cancers in mice and rats, 248 lung inflammatory cell function, experimental models, 245-246 354 SMOKE STREAMS (See also CIGARETTE SMOKE; MAINSTREAM SMOKE; SIDE- STREAM SMOKE; TOBACCO SMOKE) combustion temperature effect on components of sidestream vs. mainstream smoke, 128-129 mainstream and sidestream smoke, comparison, 23-25 mainstream smoke vs. ETS, chemi- cal composition, 135, 137 mainstream vs. sidestream smoke from unfiltered cigarette, com- parison (table), 128 particulate matter in mainstream and sidestream smoke, 129, 132 sidestream and mainstream smoke inhalation by smokers and invol- untary smokers, 126-127 toxic and carcinogenic agents in in- door mainstream vs. ETS (table), 136 vapor and particulate phase con- stituents, sidestream to main- stream ratio (table), 130-131 SMOKING immune system effects, 244 public knowledge and attitudes, policy impact assessment by sur- veys, 307 public places and workplaces, State regulations (table), 271-274 regulatory approaches of State and local governments, 278 SMOKING CHARACTERISTICS compensatory smoking by workers following smoking policy imple- mentation, 312-313 machine smoking simulation, incon- sistency with current patterns, 126-127 puffing and inhalation effect on particle deposition, vs. machine smoking, 183 SMOKING CONTROL PROGRAMS evaluation, methodological consider- ations, study design as factor, 306-308 guides on how to adopt and imple- ment regulatory policies, 302 INDEX SMOKING CONTROL PROGRAMS—Contd. ‘individual solution” approach to control workplace smoking, 298 separating smokers and nonsmok- ers, improving workplace ventila- tion, 299 workplace cessation of smoking programs as part of control poli- cies, 297 workplace restrictions on where smoking is allowed, variations, 299-300 SMOKING HABIT consumption decline, effect of pub- lic attitudes and social norms, 321 population group differences in ETS exposure determination, 145-146 research recommendations on effect of smoking restrictions, 322 smoking restrictions with most im- pact on behavior, research need- ed, 323 SMOKING MACHINES (See also LABORATORY SMOK- ING) human smoking simulation incon- sistent with current patterns, 126-127 standard conditions for machine smoking cigarettes, 125 SMOKING REGULATIONS (See also LEGISLATION) assessment of effect on air quality, 307 average restrictiveness of State laws, 1960-1985 (figure), 276 case-control studies of impact on human behavior, evaluation, 306 current State legislation, variations, 268-270 designated smoking or no-smoking areas to control workplace smok- ing, 299-300 employer-mandated policies in the private sector, opposition, 296- 297 enforcement costs, experience con- tradicts tobacco industry esti- mates, 316 SMOKING REGULATIONS—Contd. geographic variability of State laws on smoking in public places (fig- ure), 270 health care facilities, 283-285 health care facilities, public sup- port, 284 health care facilities, variations in policies, 284-285 hospitals, awareness and compli- ance, 309-310 hospitals, effect on air quality, 311 hospitals, employee approval of pol- icies, 312 hospitals, positively worded signs and enforcement factors in com- pliance, 310 hospitals, review of current evi- dence of impact, 308-309 hotels and motels, private initiative in response to perceived demand, 281-282 hotels and motels, public support, 281-282 impact on air quality, behavior, at- titudes, 303-321 implementation, 309-310 implementation, assessment of im- pact, 307-308 implementation of workplace poli- cies, 302-303 implementation, smokers’ support as factor, 303-304 legislation to restrict smoking in public places, 266-276 local legislative restrictions, 277- 278 local restrictions, California’s non- smokers’ rights movement as factor, 277 nonsmoker’s exposure to second- hand smoke, assessment of im- pact, 306 policy components that impact on smoking behavior, research need- ed, 323 preferential hiring of nonsmokers as most restrictive policy, 301- 302 public and private organizations, employees’ attitudes, 311-312 public and workplace, conclusions of 1986 report, 324 355 INDEX SMOKING REGULATIONS—Contd. public and workplace control poli- cies, indirect effects, 304-305 public and workplace restrictions, review of impact, 303-321 public approval, national and re- gional polls, 318-319 public awareness, compliance, and enforcement of violations in im- plementation, 303 public places and workplaces, Fed- eral, State, and local action, 15- 16 public places and workplaces, State laws (table), 271-274 public places, current status mix of public and private actions, 265- 266 public places, factors in acceptabili- ty, 266 public places, role of public atti- tudes and social norms, 321 public support, 16 public transportation, 278-279 regional variation in State laws against smoking (table), 277 research must consider policy char- acteristics, institution, and popu- lation, 321-323 research recommendations, 321-323 restaurants, 279-281 restaurants, opposition, acceptance, and implementation, 280 retail stores, 279 review of impact on attitudes and social norms, 319-320 schools, difficulties in enforcement, 283 schools, double standard of teacher smoking vs. student restrictions, 283 schools, traditionally not to reduce sidestream smoke exposure, 282 social phenomenon, impact infor- mation lacking, need for re- search, 323 specific public places, 278-285 State and local governments, re- strictions, 12 State and local statutes, implemen- tation evaluation, 316-318 State laws, comprehensiveness in- dex, 327-328 356 SMOKING REGULATIONS—Contd. State laws restricting smoking, 1970-1985 (table), 269 State legislation, emphasis shift and increase during the 1970s, 267 State legislation in 1970s aimed at protecting nonsmokers, 267 State legislation, increase in comprehensiveness, 275 States with no smoking legislation, 268 tobacco-producing States, fewer enacted and less restrictive, 275- 276 worker safety as motivation for early policies, 287 workplace ban, complexity of assur- ing compliance, 301-302 workplace bans, usually preceded by progressively stricter regula- tions, 300-301 workplace, barriers to adopting pol- icies, 296-297 workplace, categories of policies, 298 workplace compliance with local or- dinances, type of business as fac- tor, 317 workplace, current evidence of im- pact, 308-309 workplace, current status, 285-303 workplace, early controversy in the private sector, 286 workplace, economic considerations apparently not a factor, 296 workplace, effect on smoking cessa- tion motivation and success, 313-315 workplace, employee attitudes be- fore policy implementation, 311 workplace, impact on absenteeism, health care costs, productivity, turnover, 315-316 workplace, impact on health care and maintenance costs, 305 workplace, influence of nonsmok- ers' demand for clean air, 286 workplace, nature, scope, and prev- alence in the 1980s, 294-295 workplace, policy implementation effect on smokers’ behavior, 312- 313 INDEX SMOKING REGULATIONS—Contd. workplace, prevalence, 286-287, 294-295 workplace, public vs. private sector, 270 workplace, worker health, State legislation, nonsmokers’ demands as factors, 295-296 workplace, workforce size, industry type, geographic location as fac- tors, 295 workplaces, survey data 1977-1986 (table), 288—293 SMOKING STATUS (See also SMOKING HABIT) misclassification as factor in deter- mining ETS risk, 98, 101 misclassification as factor in deter- mining health risks of involun- tary smoking, 66-67, 72-73 SMOKING SURVEYS workplaces, 287, 294-295 STATISTICS significance testing of ETS risks, 36-37 TARS, CIGARETTE carcinogenicity testing in animals, 247-248 chemical assay for human exposure to components, research goal, 217 tumor induction on mouse skin, sidestream vs. mainstream con- densates, 250 TARS, TOBACCO particulates measured under realis- tic conditions (table), 159-162 sidestream smoke particle size dis- tribution studies (table), 138 THIOCYANATES sources, metabolism, elimination, half-life, 202-203 TOBACCO SMOKE (See also CIGARETTE SMOKE; MAINSTREAM SMOKE; SIDE- STREAM SMOKE; SMOKE STREAMS) absorption during active smoking vs. involuntary smoking, 215-216 TOBACCO SMOKE—Contd. biological markers of smoke absorp- tion in smokers and nonsmokers, 181 machine vs. human smoking, non- comparability of chemical and physiochemical data, 135 mainstream vs. environmental, characteristics, 6 nicotine in vapor phase, sidestream vs. mainstream, 127 odor perception and irritation, in- fluence of room temperature and humidity, 234 particle size distribution of main- stream smoke (table), 184-185 particle size distribution of side- stream smoke (table), 186 quantitatively determined com- pounds in sidestream and main- stream smoke, 128 radioactivity, 132, 134 residuals, measured under realistic conditions (table), 163 vapor phase, retention by smokers vs. involuntary smokers, 126-127 workplace air pollution, contribu- tion (table), 233 TOBACCO SMOKE CONSTITU- ENTS (See also COTININE; NICOTINE) absorption in nonsmokers under experimental and natural expo- sures, 206-207 chemical assay for human exposure to tar components, research goal, 217 deposition and absorption, 181-216 deposition fraction of individual components needed to determine disease risk, 200 ETS and mainstream differences as factor in exposure of nonsmokers vs. smokers, 201 ETS exposure quantification, 208, 215 irritants also produced by other sources, 229-230 irritants in ETS, 229 nicotine, absorption, distribution, metabolism, and body fluid lev- els, 203-205 357 INDEX TOBACCO SMOKE CONSTITU- ENTS—Contd. particle deposition in lung areas, nonuniformity, cancer risk rela- tionship, 192 trapping devices to analyze individ- ual components, 126 TOBACCO SMOKE PARTICU- LATES carcinogenicity testing in animals, 247-248 indoor concentrations by cigarette smoking under laboratory condi- tions (table), 197 irritation in nonsmokers vs. gas phase of sidestream smoke, 237- 238 potential toxicity estimation using “cigarette equivalents”, deficien- cies, 199 total suspended particulates in in- door working and living environ- ments (table), 194-196 URINE cotinine level as marker for ETS exposure in nonsmokers, 36 cotinine levels in ETS-exposed non- smokers vs. active smokers (ta- ble), 211-214 cotinine levels in ETS-exposed vs. nonexposed men, 207 mutagenic activity not good mea- sure of tar absorption, 206 nicotine and cotinine levels to quantify ETS exposure, 208, 215 nicotine excretion, individual me- tabolism as factor in smokers and nonsmokers, 203-205 nicotine levels in ETS-exposed non- smokers vs. active smokers (ta- ble), 209-210 nicotine levels in nonsmokers vs. smokers, 216 VENTILATION ETS components elimination, major factor, 146-147, 164-165 ETS, determinant of exposure, 11 ETS, effect on levels, 229 ETS, factor in estimating human exposure, 139, 141-142 involuntary smoking exposure, fac- tor, 67 restaurants, inadequate control of ETS levels, 279 358 VENTILATION—Contd. sidestream smoke in laboratory, ef- fect on perceived irritation in nonsmokers, 234-235 WOMEN cancers other than lung cancer in nonsmokers married to smokers, 102 lung cancer in wives of smokers, Greek case-control study, 78-79 lung cancer, involuntary smoking as factor, German case-control study, 90 lung cancer risk in wives of smok- ers, Japanese prospective study, 73-76 lung cancer risk with ETS expo- sure, Hong Kong case-control studies, 80-81 WORKPLACE (See also PUBLIC PLACES) barriers to adopting smoking poli- cies, 296-297 carbon monoxide, nitrogen, and particulate matter levels due to tobacco smoke, 232 categories of smoking policies, 298 compliance with local smoking or- dinances, type of business as fac- tor, 317 health care and maintenance cost reduction as benefit of smoking policy, 305 hospitals, employee approval of smoking policies, 312 involuntary smoking, irritant ef- fects, 232 irritants, tobacco smoke and other sources, 229-230 preferential hiring of nonsmokers as most restrictive smoking poli- cy, 301-302 research recommendations on effect of smoking regulations, 321 safety as motivation for early regu- lations against smoking, 287 smoking policies, survey data 1977- 1986 (table), 288—293 smoking restrictions, conclusions of 1986 report, 324 State laws regulating smoking, comprehensiveness index, 327- 328 INDEX WORKPLACE—Contd. surveys of smoking policies, 287, 294-295 tobacco smoke contribution to air pollution (table), 233 total suspended particulates (table), 194-195 WORKPLACE SMOKING (See also ENVIRONMENTAL TO- BACCO SMOKE; INVOLUN- TARY SMOKING) bans, usually preceded by progres- sively stricter regulations, 300- 301 business type as factor in compli- ance with local smoking ordi- nances, 317 cessation programs as part of pri- vate sector smoking control, 297 control by restricting where smok- ing is allowed, variations, 299- 300 ETS exposure determination, factor, 142 eye irritation reported in nonsmok- ers, 233 government offices, smoking regula- tion increasing, 285 guides on how to adopt and imple- ment smoking policies, 302 hospitals, awareness and compli- ance of employees, 309-310 hospitals, review of current evi- . dence on impact of smoking reg- ulations, 308-309 impact of public and workplace re- strictions, 303-321 WORKPLACE SMOKING—Contd. “individual solution” approach to regulation, 298 legislated restriction, early contro- versy, 286 lung cancer risk factor in non- smokers, 91-92 lung function effects of exposure in nonsmokers, 60 motivation for regulation, 295-296 nature, scope, and prevalence of regulation in the 1980s, 294-295 policy implementation effect on smokers, 312-313 private sector regulation, legislation and public support as factors, 295 private sector, State and local leg- islation, 285 regulation, impact on absenteeism, health care costs, productivity, turnover, 315-316 regulations, current status, 285-303 regulations supported by smokers and nonsmokers, 285 regulations, workforce size, geo- graphic location, type of indus- try as factors, 295 restrictions, 16 restrictions, voluntary vs. govern- mental, 12 schools, restrictions to reduce facul- ty/staff exposure to ETS, 282 State regulation, public vs. private sector, 270 State regulations (table), 271-274 urinary cotinine levels as marker of exposure in nonsmokers, 207 359