~BRt~l11t~~3~"' ~ k~ . . ~?fi~ ~t hA,i r?'S}f!M9+lN?S :-i;y~s n+~ -?•s.tn s w~i, .
Establishing A Workplace Smoking Policy
Consolidated Safety Services, Inc .
Workplace smoking has in recent years been a subject of
controversy. Nearly all major U.S . companies now have policies
regulating smoking in the workplace . A minority have
implemented smoking bans .
Our experience at Consolidated Safety Services, Inc ., has shown
that, in the great majority of cases, the rights and preferences of
smokers and nonsmokers can be accommodated in the workplace .
This kit is intended to provide assistance to managers who believe
it is wise to have a policy, but who also realize total smoking bans
fail to meet the needs of a significant portion of their employees .
In some cases, designated smoking areas or smoking lounges are
the answer. In others, managers have found it sufficient to restrict
smoking to private offices or separate sections of common areas
such as cafeterias . In still others, employers rely on employees to
work out "informal" policies guided by courtesy and cooperation.
The following information contains an overview of some of the
contaminants which may be factors in indoor air quality, guidance
on how to develop a workplace smoking policy, sample policies,
The key to establishing a successful policy is to involve your
employees, get their suggestions and input, and seek their support
as the policy is implemented . Then remain flexible, modifying
your policy as experience shows what works best .
Consolidated Safety Services, Inc ., provides assistance to
employers on a variety of workplace issues, including the
development and implementation of equitable smoking policies .
For assistance in these matters, or any safety and occupational
health issues, contact our headquarters staff at 1-800-888-4612 .
Page 1 April 1992
TABLE OF CONTENTS
Indoor Air Quality : A Broad Problem
Indoor Air Quality
Common Indoor Air Contaminants
SECTION TWO :
Health Allegations about Environmental Tobacco Smoke
"Social Costs of Smoking"
SECTION FOUR :
What Are an Employer's Legal Obligations Regarding
Environmental Tobacco Smoke?
State Legislation Prohibiting Lifestyle Discrimination
SECTION FIVE :
Negotiating a Fair Workplace Smoking Policy
Element 1 : Employee Involvement
Element 2 : Considering the Options
Element 3 : Development of the Policy
Element 4 : Implementing the Policy
Sample Employee Survey To Help Establish
Workplace Smoking Policies
SECTION SIX :
Improving the Air Quality in Company Facilities
SECTION SEVEN : tJ
Sample Smoking Policies ~
Page 2 April 1992
SECTION ONE :
Indoor Air Quality : A Broad Problem
Americans may spend as much as 90 percent of their day indoors .
Complaints from building occupants about indoor air quality (IAQ)
have increased significantly since energy conservation measures
were instituted in the 1970s .
IAQ has become a significant issue for both employers and
employees in the 1990s . Greater awareness among the media and
the general population has escalated interest in IAQ .
One element of IAQ that has received great attention in recent
years is environmental tobacco smoke (ETS) . Whether it's
employee complaints about ETS, occasional tension between
smokers and nonsmokers, the need to abide by state or municipal
smoking regulations, or for other reasons, most large companies
are seeking to establish corporate smoking policies .
While some employers have chosen to deal with the issue of ETS
by instituting a total ban on smoking, others are interested in
seeking an alternative approach that fairly addresses the concerns,
morale and productivity of both smokers and nonsmokers . This kit
has been developed to assist those employers who wish to consider
all aspects of the issue, and offers guidelines for establishing
equitable corporate smoking policies .
Indoor Air Quality
The phrases "indoor air quality" and "environmental tobacco
smoke" are perceived by some to be closely related . Some
employers believe that by adopting a strict smoking policy they
Page 3 April 1992
have assured good IAQ - particularly if they ban smoking in their
facilities . That is usually not the case. In fact, hundreds of
buildings reporting indoor air quality problems have been studied,
and tobacco smoke was considered to be the major cause of those
problems in only about 4 percent of them .
In most offices, the amount of ETS in the air is very low . State-of-
the-art technology used to estimate the amount of ETS to which
nonsmokers are exposed indicates that, on average, it takes about
240 hours in an office where smoking is permitted to be exposed to
the nicotine equivalent of one cigarette .
Yet ETS is often blamed as the sole cause of poor indoor air
quality. That may be because most of us can detect very low levels
of ETS in the air. We can smell it, and we can see it. However,
there are many other common indoor air contaminants, and since
most of these are invisible and odorless, we don't realize that they
are present. Numerous investigations indicate that these other
contaminants are the major causes of more than 90 percent of all
indoor air quality complaints .
Common Indoor Air Contaminants
The indoor environment houses numerous sources that release
contaminants into the air. Besides tobacco smoke, these sources
can include building materials and furnishings as diverse as
deteriorated insulation containing asbestos ; wet or damp carpeting ;
cabinetry or furniture made of certain pressed wood products ;
products for cleaning ; paper dust; adhesives ; perfumes;
combustion by-products ; pest-control products ; biological
organisms; and outside sources such as pollen, radon, pesticides,
and auto emissions .
Common indoor air pollutants and the symptoms commonly
associated with them are described below :
Page 4 April 1992
Biological Contaminants include bacteria, mold and mildew, fungi,,
viruses, dust mites, and pollen . Simple dust contains many of
these organisms, as well as pieces of biological matter such as
insect parts and animal dander . In addition, building occupants
liberate thousands of microorganisms in the course of a day .
Biological contaminants are often associated with wet or water-
damaged areas, especially around air intakes, dehumidifiers and
cooling coils . Symptoms reportedly associated with biological
pollutants include sneezing, watery eyes, coughing, shortness of
breath, dizziness, lethargy, fever and digestive problems .
Carbon Monoxide is a combustion by-product . Sources of carbon
monoxide include automobile exhaust, leaking chimneys and
furnaces, gas stoves and heaters . Carbon monoxide can cause
fatigue in healthy individuals and has been reportedly associated
with chest pain in persons with heart disease . At high
concentrations, it is associated with impaired vision and
coordination, headaches, dizziness, confusion, and nausea . M
Or ang ic Vapors are associated with evaporative products such as
paints, paint strippers, wood preservatives, aerosol sprays, cleaners
and disinfectants, insect repellents and air fresheners . In addition,
copier and photographic chemicals contain high organic solvent
levels. Health effects include eye, nose, and throat irritation,
headaches, loss of coordination and nausea . Long-term exposure
has been associated with damage to the liver, kidneys and central
nervous system .
Radon, a colorless gas, is generated naturally from decaying
uranium and is found virtually everywhere at very low levels .
Sources include earth and rock beneath buildings, well water and
building materials . There are no acute health effects attributed to
radon, but exposure over a period of years has been reported to O
cause an estimated 10 percent of all lung cancer deaths . N
Formaldehyde is an important chemical used widely in industry to
manufacture building materials and numerous household products . CNO
Page 5 April 1992
Sources include plywood, particleboard, fiberboard, urea-
formaldehyde foam insulation, adhesives, carpet, and other
textiles . In addition, carbonless paper contains formaldehyde .
Immediate exposure effects include eye, nose and throat irritation,
wheezing and coughing, fatigue, skin rash, and severe allergic
Pesticides can be used both inside and out'side a facility . Outside
lawn applications can drift or become tracked inside a building .
Acute health effects include irritation to eyes, nose and throat .
Long-term exposure has been associated with damage to the
central nervous system .
Asbestos is a mineral fiber that has been used commonly in a
variety of building construction materials for insulation and as a
fire-retardant. Sources include deteriorating or damaged
insulation, fire-proofing, and acoustical materials . There are no
acute health effects associated with asbestos . However, asbestos M
fibers can accumulate in the lungs and may eventually cause
asbestosis and other diseases of the lung .
Particulates associated with dust, textile fibers, and paper
products are continuously liberated into the air in any occupied
space . These inert materials can cause upper respiratory irritation,
as well as eye, nose and throat irritation. Long-term health effects
are still under investigation, although sinus infection and blockage
have been frequently reported .
Published data have shown that biological organisms rank the
highest in contributing to indoor air pollution . In one scientific
study' conducted in over 400 buildings containing 63 million
square feet of office space, allergic fungi were identified as a major
factor in over 30 percent of the buildings . Allergic or pathogenic
bacteria were a significant factor in nearly 10 percent . In
comparison, environmental tobacco smoke was a major factor in
only 3 percent of the investigations .
Page 6 April 1992
A 1989 survey of workers in 47 district and federal government
buildings in Washington, D .C.z, to assess their attitudes regarding
air quality in their workplaces showed that almost three-quarters
(73.3%) of the respondents indicated air quality at work was a
problem, and nearly all respondents had experienced symptoms
while in the workplace . Eighty-three percent indicated that poor
indoor air quality was the cause of, or a contributing factor to, their
symptoms . It is noteworthy, that most of the buildings in this study
were owned, managed or leased by the U .S . Government. Prior to
the study, in 1986, the U .S. Government had restricted smoking in
all federal office buildings . This study clearly showed that
building occupants complained of health problems and recognized
poor indoor air quality in the absence of environmental tobacco
Many buildings contain sources of gases or particulates and yet do
not have occupants that complain of problems . Frequently, the true
cause of poor indoor air quality is often not the air contaminants
themselves . Rather, it is the inability of ventilation systems to
reduce pollutants to acceptable levels . Poor ventilation and
improperly maintained ventilation systems cause the buildup of not
only the visible constituent ETS but also of all the invisible and
Therefore, before considering a ban on smoking, or even
establishing smoking policies, employers should first examine the
overall indoor air quality in their workplace and try to identify all
the indoor air quality problems which may exist . The result of this
kind of investigation might lead to solutions that address overall
indoor air quality rather than singling out one aspect of the .
problem. Section 5 of this document will assist the employer in
addressing indoor air quality in its entirety.
1 . "Facton Affecting Employee Health & ComfoA, "Healthy Buildings Intemational Magazine, NovJDec .,1990 ~
2. Safe Wa.hpiace Air Corltlion, "(ndoor Air Quality in Fedaal & D .C. Gwemoxat Birildiog.," 1989
Page 7 April 1992
REPRINTED FROM THE JULY 1991 CONSUMERS' RESEARCH
Special Report :
Passive Smoking :
How Great A Hazard?
By Gary L. Huber, MD,
Robert E . Brockie, MD,
and Vijay K . Mahajan,, MD
Reports from medical journals, the popular tions as low as one part in a billion or even~ in a
media, and federal regulatory agencies about trillion~ parts of clean air, some of the highly-
the adverse health effects of passive smoking diluted constit'uents in ETS are irritating to the
have convinced many jurisdictions to ban smok- membranes of the eyes and nose of the non-
ing in public places . What is often missing from smoker . Cigarette smoking is offensive to many
such discussions is the scientific basis for the nonsmokers and some of these highly-diluted
health-related claims . The following article constituents can trigger adverse emotional
examines the scientific data concerning the responses, but do these levels of exposure really
ascertainable risk from inhalation of enuiron- represent a legitimate health hazard?
mental tobacco smoke . One of its authors, Dr .
Gary Huber, spoke at a recent' CR symposium on
"Science and Regulation" (see article on page "Cigarette smoking is offensive
35) :-Ed. to many nonsmokers and some
of these highly-diluted con-
bout 50 million or so Americans are
stituents can trigger adverse
active smokers, consuming well over 500
0 billion tobacco cigarettes each year . The emotional responses, but do
"secondhand" smoke-usually called "environ- these levels of exposure really
mental tobacco smoke," or more simply represent a legitimate health
"ETS"-that is generated! is released into their hazard?"
surroundings„ where it potentially is inhaled
passively and retained by nonsmokers . Or is it?
Literally thousands of ETS-related state- Clear answers to these questions are difficult
ments now have appeared in the lay press or in to find . The generation, interpretation, and use
the scientific literature . Many of these have of scientific and medical information about
been~ published, and accepted as fact, without ETS has been influenced, and probably distort-
adequate critical questioning . Based on the ed, by a "social movement"' to shift the empha-
belief that these publications are accurate, sis on the adverse health effects of smoking in
numerous public policies, regulations ; and laws the active smoker to : an implied health risk for
have been implemented to segregate or restrict the nonsmoker . The focus of this movement,
active smokers, on the assertion that ETS is a initiated by Sir George Godber of the W'orld
health hazard to those who do not smoke . Health Organization 15 years ago, was and is to
What quantity of smoke really is released into emphasize that active cigarette smokers, injure
the environment of the nonsmoker? What is the those : around! them, including their families
chemical and! physical quality, or nature, of and, especially, any infants that might be
ETS remnants in our environment? Is there a exposed involuntarily to ETS . .
health risk to the nonsmoker? In concentra- By fostering the perception that secondhand
smoke is unhealthy for nonsmokers, active
smoking has become an und'esirable and an
Drs . Huber, Brockie, and Mahajan are with ; respect-
ively, the University of Texas Health Science Center, antisocial behavior . The cigarette smoker has
tliePresbyterian Hoospital of Dullas ;, and' St: Vineent "s become ever more segregated and isolated . This
Hospital-Medical College of Ohio ; ETS' social movement has been successful! in
reducing tobacco cigarette consumption, per- health effects of ETS, it must first be appreciat-
haps more than other measures, including ed that not, all tobacco smoke is the same, and
mandatory health warnings, advertising bans thus the risk for exposure to the different kinds
on radio and television, and innumerable other of tobacco smoke must be considered indepen-
efforts instituted by public health and medical dently.l
professional organizations . But,, has the ETS
social: movement been based on scientific truth
and on reproducible data and sound scientific What Is ETS?
principles? The three most important forms of tobacco
At t'imes, not surprisingly,, the ETS social smoke are depicted in Figure 1 . Mainstream
movement and scientific objectivity have been smoke is the tobacco smoke that is drawn
in conflict . To start with, much of the research through the butt' end~ of a cigarette during
on ETS has been shoddy and poorly conceived' . active smoking ; this is the tobacco smoke that
Editoriali board's of scientific journals have the active smoker inhales into his or her lungs .
selectively accepted or excluded contributions The distribution of mainstream smoke is sum-
not always on the basis of inherent scientific marized in Table 1 (page 12) : Sidestream smoke
merit but, in part, because of these social pres- is the tobacco smoke that is released in the sur-
sures and that, in turn, has affected and biased rounding environment of the burning cigarette
the data that are available for further analyses from its smoldering t'ip between active puffs .
by professional organizations and! governmen- Many publications have treated sidestream
tal agencies . In addition, "negative"' studies, smoke and ETS as if they were one : and the
even if valid, usually are . not published, espe- same, but,sidestream smoke and ETS are clear-
cially if they involve tobacco smoke, and thus ly not the same thing. Sidestream smoke and
they do not become part of the whole body of ETS have different physical properties and they
literature ultimately available for analysis .
Negative results on ETS and health can be 1A burning cigarette has been described4s "a miniature chemicalfactory,"'
found in the scientific literature, but only with producing numerous new components from its raw materials . When a
cigarette is smoked, the burning cone has a temperature of about 860 to
great difficulty in that they are mentioned in 900°C during active puffing, and smolders at 500 to 600°C between puffs .
passing as a secondary variable in a "positive" When tobacco burns at these temperatures ; the products ofipyro4yzation are
all'vapors . As the :vapors cool in passage away from the burning cone, they
study reporting some other finding unrelated to condense into minute liquid droplets, initiaVly, about two ten-millionths of a
ETS . meter in siie: Generally ; then, all forms of smoke are mioroaerosols of very
small liquid droplets of parti¢ulate : matter suspended in their surrounding
To evaluate critically any potential adverse vapors or gases . Thus, all smoke has a :"parti¢ulate phase" and a"gas phase :"
Figure 1 : Particulate Phase and Gas Phase of Tobacco Smoke*
0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 00 0 0
000 0 0 0 0 0
0000 0 00 0 0 0 0
000000 00 0 0 0
0000000o00 0 0 0
000000000000000000000 000000000 00 0
Mainstream Smoke Sidestream Smoke Environmental Tobacco Smoke
* Schematio representat(an of the particulate phase and the gas phase of tobacco smoke . Environmentai ltobacco smoke Is not smoke in ithe conventional
sense, but rathef a very limited number of highly-diluted remnants or residual'constituents of mainstream smoke and sidestream smoke .
measurement . In this sense, then, ETS is really
Table 1 : Distribution of not smoke in the conventional sense of itsAefi-
nition, but rather consists of only a : limited
Mainstream Smoke number of "remnants" or residual' constituents .
Total Mainstream Smoke 500* present in highly dilute concentrations,
Wet Total Particulate Matter 22 Because the levels of ETS cannot~, be quanti-
Nicotine 1 .3 fied accurately as su& in the environment,
Water 3.7 some investigators have attempted to measure
"Tar" 17 one or more constituent parts of ETS as, a"sub-
Aerosol Gas Phase stitut'e marker" for ETS' as a whole . The most
Water 478 frequently employed such "marker" has been
Air Components 50 nicotine or its first metabolically stable break-
Carbon Monoxide 350 down product, cotinine. Nicotine was consid-
Carbon Dioxide 50 ered an "ideall marker" because it is more or
Other Components 8 less unique to tobacco, although small amounts
'All data expressed in milligrams for a 500 mg deliver cigarette, as deter- can be found in some tomatoes and in other
mined by FederatTrade Commission criteria. food sources . In the mainstream tobacco smoke
SOURCE: Adapted from Huber,1989 .
that is inhaled by the active smoker, nicotine
starts out almost exclusively in the tiny liquid
have different chemical properties . Environ- droplets of the particulate phase of'the smoke .
mental tobacco smoke is usually defined as a Because the smoke particles of ETS become so
combination of highly diluted sidestream smoke quickly and so highly diluted, however, nicotine
plus a smaller amount of that residual main- very rapidly vaporizes from the liquid suspend-
streamsmoke that is exhaled and not retained ed particulates and enters the surrounding gas .
by the active smoker . What really is ETS?' In In technical terms, the process by which nico-
comparison to mainstream smoke and side- tine leaves the suspended aerosol particle to
stream smoke, ETS is so highly diluted that it enter the surrounding gas phase is called
is not even appropriate to call it smoke, in the "denudatiom"
conventional sense . Indeed, the term "environ- As a vapor or gas, nicotine reacts with or
mental tobacco smoke" is a misnomer . ad'sorbs onto almost everything in the : environ-
Why is ETS a misnomer?' Several reports on ment with which it comes into contact . Thus,
smoking and' health from the Surgeon nicotine :is not a representative or even a good
General's Office, a National Research Council surrogate marker for the particulate phase, or
review of ETS in 1986, t'he more recent even the gas-vapor phase, of ETS . In fact, there
Environmental Protection Agency's risk assess- are no reliable or established markers for ETS .
ment of ETS, and several review articles all The remnant or residual constituents of ETS
have provided a long list of chemical con- each~ have their own chemical and physical
stituents derived from, analyses of mainstream behavior characteristics in the environment
smoke and sidestream smoke,, with the iQn .plica- and none is present ini a concentration in our
tion, that because they are demonstrable in environment that reaches an established
mainstream smoke and sidestream smoke these threshold for toxicity.2
same constituents must, by inference, also be
present in ETS . No one : really knows if they are
present or not . In fact, most are not so presentt Measuring Health Risks
or, if they are, they are present only in very Because the level of exposure to ETS' or the
dilute concentrations that are well below the dose of ETS' retained cannot be quantified,
levet of detection by conventional technologies under every-day, real-life cond[tions, the healthi
available today . effect's following exposure to residual con-
Only 14 of'the 50 biologically active "proba
ble constituents" of ETS listed by the Surgeon 2A threshold limit'value (psually expressed as milligrams of a substance per
General, for instance, actually have been~ mea= cubic meter, of airior as parts of a sutistaDee present~per million parts of res-
pirable clean air) is the recommended concentration of a substance as the
sured or demonstrated at any level'I in ETS . The maximal level that should'.notbe exceeded to prevent occupational disease
others are there essentially by inference, not by th'rough exposure in the workplace . Threshold~ liminvalues have not been
established for our general, every-day environment outside of industrial expo-
actual detection or measurement . Thus, there sure. Threshold limit values are determined by toxicologists, epidemiologists,
are 36 constituents in these lists that are in- and hygienists through their interpretation of literature, and usually, are sanc-
tioned'bythe American Conference of Governmental Ind'ustriallHygienists . No
ferred to be present in ETS„ but their presence constituent of ETS has been measuredlih our every-day envinonmentiat levels
has not been confirmed by actual detection or that exceed the threshold limit'walues permitted in the workplace .
stituents of ETS have been impossible to evalu- pared to "like ." Mainstream smoke and the
ate directly . In broad terms ; two different residual constituents of ETS'represent very dif-ferent exposure conditions
approaches have been employed in an attempt . Whether present in
to assess indirectly the health risks for expo- mainstream smoke or in ETS, particulate phase
sure of the nonsmoker to the environmental and gas phase constituents have very different
remnants of ETS. The first of these involves a biological properties, as well, as different physi-
theoretical concept that is called "linear risk cal and chemical characteristics, and any asso-
extrapolation ." Linear risk extrapolation has ciated health risks are also very different . The
been employed extensively in attempts to deter- concept of linear risk extrapolation for ETS' is
mine the risk for lung cancer in nonsmokers based on a theory that when applied to ETS'
exposed to ETS .3 incorporates unsound assumptions that are not
This concept of linear risk assumes that if valid . There is no way, as yet, to evaluate or
there is a definable health risk for the active compare the levels of exposure in active smok-
smoker, then~ there also must' be a projected ers and nonsmokers exposed to ETS . .
lower health risk for the nonsmoker exposed to The second approach used to evaluate health
ETS . This is represented schematically in risks for nonsmokers exposed to ETS has
Figure 2 : The risk has been presumed to be lin- employed epidemiologic studies . Epidemiology
ear from~ the active smoker to the nonsmoker is a branch of medical science that studies the
exposed to ETS, based proportionately on the distribution of disease in human populations
relative exposure levels and retained doses of and the factors determining that dist'ribution,,
smoke ; it thus requires some measurement of chiefly by the use of statistics . The chief func-
tobacco smoke exposure for both groups . This is
fairly easy to achieve in the active smoker, in 3The concept1s based on a theoretical extrapolation of the risk for lung cancer
part because mainstream smoke has been so in the active smoker to the risk for ; lung cancer in the passive smoker, on thee
basis ofia "representative marker" for both smoke exposures . This "linear risk
well-characterized and it is delivered directly extrapolation" from one to the other is a model that istiased on mathematical I
from the butt-en& of the cigarette into the theory and on several assumptions . The theory assumes thatithe risk applies
to all exposure levels, even ifithey are very low. Some : advocates of the model l
smoker . Su& is obviously not the case, howev- even assume a "one molecule, one hit"' mechanism, where exposures so low
er for the nonsmoker exposed! to ETS . thatRhey cannoUbe detected or measured can stilllcause disease if only a sin-
gle molecule reaches a vulnerable body tissue . The linear risk theory also
Most projections of linear risk for ETS-expo- assumes that1he risk for accumulative exposure remains constant and, thus„
sure have been based on the use of nicotine as a that the exposed individual has no capacity to adaptor develop tolerance
mechanisms for the exposure . Since active smokers readily and rapidty devel-
representative marker of exposure . A few pro- op tolerance through a variety of defense mechanisms, iUseems illogical to
jections have been based on carbon monoxide assume those repeatedly exposed to ETS would not do thesame . The linear
risk model assumes that~ the risk fon exposure to ETS is ind@pendent of any
levels or amounts of respirable suspended par- confounding factors . Finally, for this theory to be valid, it must be assumed
ticulates in the environment, but these thatAhe risk is linear for duration of exposure and that it is linear for concen-
tration ~of exposure : None of these assumptions holds true on scientific testing
approaches are fraught with even greater error . for comparative projections of mainstream smoke to ETS .
Since nicotine initially is in
the particulate phase of the
mainstream smoke inhaled by Figure 2 : Linear Risk Extrapolation*
the active smoker and it is
present primarily as a highly
diluted gasrphase remnant or
residual vapor-phase con-
stituent in the nonsmoker's One Molecule Theory
environment, the concept of a
linear health risk from the
active smoker to the nonsmok-
er is based on rather shaky
That is to say, it is not valid
to estimate a health risk for
exposure : to the particulate r T
phase in the active smoker 2.0 4.0 6.0 8.0 10
and then compare it with, the Relative Enviroemental Exposure Level
health risk for exposures to 'The concept of linear risk extrapolation In this theory ; the health response (expressed as a rela-
the gas phase in the ETS- tive risk) is directiy or linearly reiated to the relative envPronmental exposure level . This theory sug-
gests that there is'no "safe" threshold'below which there is no respunse, and that exposure to as
exposed nonsmoker . Simply little as one molecule of the environmental substance can cause an adverse response .
stated, "like" is not being com-
tion are based on the concept of some measure-
"Of the 30 ETS-lung cancer stud- ment of relative risk . None of the studies actu-
ies, 6 reported a statistically ally has measured exposure to ETS or to any of
significant association . . . and its residual constituents directly. Relative risk
is a relationship of the rate of the development
24 of those studies reported no
of a disease (such as lung cancer) within a
statistically significant effect ." group of individuals exposed to some variable
in the population studied (such as ~ ETS) divided
by the rate of the same disease in those not
tion of epidemiology is the identification of pop- exposed to this variable .
ulations at high risk for a given disease, so tliat Relative risk is most frequently expressed as
the cause may be identified and preventative a "risk ratio," which is a calculated comparison
measures implemented . of the rate of the disease studied in the exposed
Epidemiologic studies are most effective population divided by the rate of that disease in
when they can assess a well-defined risk . some control population not exposed to the
Because ETS-exposure levels cannot be mea- variable studied. The terms "risk ratio" an&
sured or in any other way quantified directly,, "relative risk" are often used synonymously.
even by representative markers, epidemiolo- Thus, the relative risk in all epidemiologic ETS
gists have had to use indirect estimates, or sur- studies on lung cancer is expressed as the rate
rogates, of ETS exposure . For nonsmoking of lung cancer in the ETS-exposed group (indi-
adults, the number of active smokers that are viduals married to a household smoker) divided
present in the household has been used as a : by the rate of lung cancer where there was no
surrogate for ETS exposure . Usually the active ETS exposure (no household smokers) . If thee
smoking household member has been the non- disease rates were exactly the same in these
smoker's spouse . With a few limited exceptions, two groups ; the risk ratio would! be 1 .0 .
disease rates in~ nonsmokers exposed to a There have been 30 epidemiologic studies on
spouse who smokes have been the basis for all spousal smoking and lung cancer published in
epidemiologic assessments . the scientific literature . Twenty-seven of these :
Almost all of these studies have evaluated epidemiological studies were case control stud-
nonsmoking females married to a husband who ies, where the effect of exposure to spousal
smokes . For children„ the surrogate for ETS smoking was evaluated retrospectively on data
exposure has :been the number of parents in the that had already been available for review . The
household! who smoke . Estimates of ETS expo- "cases" in these case-control studies were non-
sure based on spousal or parental surrogates smoking individuals with lung cancer married
have been derived by various questionnaires ; to smokers . The rate of lung cancer in these
no study employs any direct quantification of "cases" was compared, by the derived risk
ETS or of ETS remnant constituents in the ratio, to the rate of lung cancer in "control" or
actual environment' of the nonsmoker . nonsmoking individuals who were married to
Questionnaires of smoking habits are notori- nonsmokers .
ously lilmite& and often inaccurate, in part Three of the studies followed cohort popula-
because of the "social taboo" that smoking has tions of individuals exposed to spousal smoking
become and, in part, for other reasons related prospectively over the course of time . A
to the ETS social movement . Nevertheless, data "cohort" is any designated group of people . A
from questionnaires about smoking behavior in "cohort study" identifies a group of people that
spouses or in parents are the only estimates of will be exposed to a risk and a group that will
ETS exposure available . Rates for three dis- not be exposed to that risk, and then follows
eases in nonsmokers expose& (via surrogates)) these groups over time to compare the rate of
to ETS have been assessed : lung cancer, coro- disease development as a function of exposure
nary heart disease, and respiratory illness in or no exposure .
infants and small children . Only lung cancer The first studies were published in 1982 and
will be discussed in this article . the last studies were published in 1990 . The
studies originate broadly from different parts of
the world and, for the most part, involve evalu-
ETS and Lung Cancer ations of lung cancer in nonsmoking females
What is the state of evidence on ETS and married to a smoking male partner ; eight of the
lung cancer? Almost all of the epidemiologic studies have limited data on nonsmoking males
studies that are available to answer that ques- married to smoking females . Some of the stud-
ies are quite small, listing fewer than 20 sub- the .30 epidemiologic studies on ETS and lung
jects ; others are based on larger populat'ions, cancer, there are 37 different total reported
with four studies reporting between~ 129 and sets of risk ratios for male or female nonsmok-
189 cancer cases . Of the 30 studies, six reported ers . None of the studies reports a strong rela-
a statistically significant association (identified tive risk .
by a positive relative risk ratio in the spousally- Nine of the studies report risk ratios of less
exposed to the non-exposed population) and 24 than 1 .0 . Thus, the results, from all epidemio-
of the studies reported no statistically signifi-
cant effect . The : average esti-
mated relative risk ratio for
each, study and each sex is list- Table 2: Studies of ETS
ed in Table 2, as are the confi~-
dence intervals reported by the
and Lung Cancer in Nonsmokers
authors or, where not reported, Number Relative Confidence
calculated by others in pub- Study Sex of Cases Rlsk* Intervai
lished review artieles .41
Case Control Studies
Some of the .negative studies=
Chan and Fung, 1982 F 34 0 .75 (0.43, 1 .30)
that is, some of the 24 studies
Trichopoulos et ai .,1983 F 38 2 .18** (1 .18, 3.83)
that did not show a statistically Correa et a11,1983 F 14 2 .07 (0.81, 5.26)
significant association between, M 2 1 .97 (0.38, 10.29)
the development of lung, cancer Kabat and Wynder, 1984 F 13 0 .79 (0 .25, 2 .45)
and exposure to spousal smok- M 5 1 .00 (0 .20, 5 .07) .
ing-contained data that sug- Buffler et al ., 1984 F 33 0 .80 (0 .34, 1 .81) .
gested to the aut'hors or to other M 5! 0 .51 (0 .15, 1 .74)
Garfinkel et a1 .,1985 F 92 1 .12 (0 .94, 1 .60)
reviewers a "positive trendl" In
Wu et a1 .,1985 F 29 1 .20 (0 .50, 3 .30)
most of'science,, "trends"' do not Akiba et a1.,1986 F 73 1 .52 (1 .00, 2 .5),
count ; data stand as either sta- M 3' 2.101 (0 .5, 5 .6)'
tistically significant or not sta- Lee et ai .,,1986 F 22 1 .03 (0 .37, 2 .71)
tistically significant', with sig- M 8 1 .31 (0 .38, 4 .59)
nificance determined by specif- Brownson .et a1 .,1987 F 19 1 .68 (0 .39, 2 .97)
ic accepted rules of biostatis- Gao et ai .,1987 F 189' 1 .19 (0:6, 1'.4) .
Humble et al ., 1987 F 14 1 .70 (0 .6, 5 .4)
tics . New rules should not be
Koo et a1 .,1987 F 51 1 .55 (0.87, 3 .09)
"made to fit" an otherwise
Lam et al ., 1987 F 115 1.65** (1 .16, 2,35)
unproved! hypothesis, ju~st Pershagen et al .,1987 F 33 1 .20 (0.70, 2.10)
because the subject is tobacco Geng et al .,,1988 F 34 2 .10 *' (1 :03, 4.53)
and the observed results do not Inoue and Hirayama, 1988 F 18 2.55 (0.91, 7.10)
support the hypothesis investi- Katada et a1 .,1988' F 17 - (NS;p=0 .23)
gated . Lam and Cheng ;,1988 F 37 2 .01** (1 .12, 1 .83)
Shimizu et ai1,1988 F 90 1 .10 W/A
He,, 1990 F 45 0 .74 (0 .32, . 1 .68)
Janerich et a1.,1990 F 129 0.93 (0 .55, 1 .57)
ETS Risk Weak Kabat;1990 M 13 1 .20 (0.54, 2.68)
A relative risk is called' strong F 35 0.90 ` (0 .46, 1 .76)
or it is called weak, depending Kaiandidi et ai:,1990 F 91 2 .11 (1 .09, 4 .08) `
on the degree of association, or Sobue et a1 .,1990 F 64 0.94 (0 .62, 1 .40)
the magnitude of the risk ratio . Svensson, 1990 F 17 1 .20 (0 .40, 2 .90)
A strong, relative risk would be Wu-Wiiliams et at .,1990 F 205 0.7 (0 .6, 0 .9)
reflected by a risk ratio of 5 to
20 or greater . Weak relative F 1 .17 (0.85, 1 .89)
Garfinkel, 1981 88
risks, by conventional defini- (0 .77, 1 .61) '
tion, have risk ratios in the Gillis et al ., 1984 F 6 1 .00 (0 .59, 17 .85)
range of 1 to~ 3' or so . Within M 4 3 .25
Hirayama, 1984b ! F 163 1 .45 (1 .04 2 .02)
4A confidence interval is a range of valVresth'at has 1984a 7 2.28** (1 .19 4 .22)
a specifiedlprobability of including the true value .
(as opposed to the estimated average value) withih `Weak relative risks have risk ratios of between 1 and 3, or so . Any risk ratio below 1 represents a'lieya-
that range . In the data presented in Table 2, the, tive retationship. Note that!none of the studies sdwwa strong relative risk .
confidence intervals are set such that there is a
"' StatisticaHy significant'at the 5a level .
95% probability that1he true value will falJ within
the range of values listed .
Smoke . . . . "No matter how these [risk]
data are analyzed, no one has
reported a strong risk relation-
logic studies consistently reveal only weak lung
cancer risks for nonsmokers exposed to spousal ship for exposure to spousal
smoking, with only six of the studies reaching smoking and lung cancer."
statistical significance ; 24 epidemiologic studies
report no statistically significant effect for ETS
exposure . the American Health Foundation, stated that
Weak relative risks, however, do not exclude when an assessment of relative risk is weak
causal relationships . When the relative risks (that is,, when the odds risk ratios are in the
are weak it is very difficult to determine if the range of 2 to 1 or less) the possibility exists
effect is artifactual or if it is real . Weak associa- that the finding is artificial and a consequencee
tions are close in magnitude to a ; level of risk of problems in the case control! selection or is
that is sometimes called "background noise," due to the presence of confounders (or con-
and at this level of risk there are variables founding variabl'es) and interpretation biases
other thani the one studied that can influence which need to be carefully considered .
the statistical association . Confounding variables must be controlled in
When a series of epidemiologic studies order to obtain an undistorted estimate of the
reveals consistently weak associations that effect of a study factor, such as spousali smok-
sometimes individually reach statistical signifi- ing, oni risk . This is especially true when the
cance and sometimes do not, all of the data can studied risk factor has a weak association .
be pooled into a more comprehensive assess- At least 20 confounding factors have been
ment to enhance : the confidence of the : assess- identified as important to the development of
ment . This is called a " m eta- analysis ." There lung cancer . These include : nutrition and
are specific rules, however, for combining data dietary prevention, exposure to occupational
and not every published study lend's itself to carcinogens, exposure to various air pollution
this kind' of assessment . The National Research contaminants, genetic predisposition and fami-
Council concluded, in 11986, that 13 of the then ly prevalence, circulating beta-carotene levels
available studies met criteria that would permit (as well as vitamin E and vitamin A levels), his-
a combined meta-analysis risk assessment . tory of alcohol consumptions exposure to alpha
When the data from these 13 studies were com- emitting radiation (such as radon daughters),
bined, the net relative risk from all available geographical residence : and country of origin,
studies was represented by a risk ratio of 1 .34 . presence or absence of selenium and other trace
The risk ratios as the result of other adjusted metals, healthy versus unhealthy lifestyles,
meta-analyses available for review vary from, age, gender, housing conditions, race, marital
1 .08 to 1 .42', with generally lower values status, ethnicity, socio-economlc status, diag-
derive& from population studies in the United nostic crit'eria, and perhaps most importantly
States and with somewhat higher levels of risk of all, an enhanced clustering of risk factors .
derived on populations outside of the United Thus, a large number of confounding, variables
States . are important to any consideration of spousal
No matter how the data from all of the epi- smoking and lung, cancer,, and no reported!
demiologicall studies are manipulated, recalcu- study comes anywhere close to controlling, or
lated, "cooked',"' or "massaged," the risk from, even~ mentioning, half of these .
exposure to spousal' smoking and lung cancer
remains weak . It may be 1 .08' or it may be 1 .34
or it may be 1 .4!2, but all of those still represent Is ETS a Health Hazard?
a weak relative risk . No matter how these data Does exposure to the remnants or residuall
are analyzed, no one has reported a strong risk constituents of ETS' represent a legitimate
relationship, for exposure to spousal smoking health hazard to the nonsmoker? In consider-
and lung cancer . Combining all the data from ing spousal smoking, lling cancer, and the con-
all epidemiological studies does not result in an founding factors, Lindal Koo, at the University
enhancement of the relative risk-the risk for of Hong Kong, cautioned that it may not be the
lung cancer with, exposure to spousal smoking, hazards of tobacco smoke that are being evalu-
is weak . at'ed, but a whole range of behaviors~t'hat result
In addressing this problem, Ernst Wynder, of from : having a smoking husband, which may, in
ll Has there been a "misrepresentation of sci-
"Unfortunately, scientific data ence" in the common perception of ETS today?
have not always been utilized Active tobacco smoking and environmental
tobacco smoke are controversial, very emotion-
objectively by governmental
al, and highly politicized subjects . In the quag-
agencies or regulatory bodies mire of ETS forces operative in politics, emo-
that have their own inherent tion, and science, it has been difficult to sort
public health or political out scientific fact from unsound conjecture .
agenda ." Unfortunately, scientific data have not always
been utilized objectively by governmental agen-
cies or regulatory bodies that have their own
turn, increase the risk for certain diseases inherent public health or political agenda . Good
among the wives and children . Indeed', con- science ultimately must rest on established
founding variables are always present and they proven scientific methods, and the full results
are so numerous and so complex that they may generated'. by these scientific methods . When
make it impossible ever to know the true risk these methods are compromised, scientific
for lung cancer in nonsmokers exposed to integrity is lost and society pays the price .
spousal smoking. Interpretations and judgments may vary, as a
Are the studies on the projections of levels of function of an investigator's bias or to expedite
ETS residual constituents in our environment, one or another political, social or emotional
and the studies on the spousal smoking and objective .
lung cancer, a reflection of "bad' science?" Not Richard Lindzen, of the Massachusetts
necessarily, for they are the best science that i& Institute of Technolbgy„ has emphasized that
available today . Sir Bradford Hill of Oxford problems will arise where we will need too
University cautioned years ago that it is impor- depend on scientific judgement, and' by ruining
tant to remember that all science is subject to : our credibility now we leave society with a
being reinterpreted or to being changed and resource of some importance diminished . The
modified by advancing knowledge . As newer implementation of public policies must be base&
technologies are applied to the assessment of on good science, to the degree that it is avail-
environmental tobacco~ smoke, clearer under- able, and not on emotion or on political needs .
standings will evolve . Those who develop such policies must not stray
from, soun& scientific investigations, based only
on accepted scientific methodologies . Such has
Reprints Available not always been the case with environmental
tobacco smoke . ®
How Great A Hazard?
Reprints of this special report are available
for $2 .00' each . Bulk rates : 10-99 copies,
$1 .80 apiece ; 100-499 copies, $1 .75
apiece ; 500 or more, $1 .50 apiece .
Send check to:
800 Maryland Ave., N.E .
Washington, D .C. 20002
ATTN: Reprint Department
Be sure to indicate how many copies of
this reprint you want .
Please allow four to six weeks for delivery .
SECTION TWO :
Health Allegations about ETS
Much of the concern about smoking in the workplace stems from
claims that ETS causes lung cancer and other diseases in
nonsmokers . Before establishing and implementing a policy that
will have a significant impact on the smokers in their workforce,
employers should review and evaluate these claims .
Much of the recent discussion on the relationship between ETS and
nonsmokers' health has been prompted by the media coverage
surrounding the release of two draft documents prepared by the
Environmental Protection Agency (EPA) . Using statistical
methodology, the draft documents estimated that about 3,700
nonsmokers die each year from lung cancer caused by exposure to
ETS . To date, the reports have not been adopted as official agency
policy. The EPA is therefore tasked with redrafting the ETS'
documents in an effort to address some of the issues that were
raised by its own scientific advisory board .
The following article discusses health allegations about ETS from
a perspective that rarely gets media attention . Employers should
consider this information in determining whether to implement a
smoking policy and, if so, what kind of policy to implement .
Page 8 April 1992
Consumer or 'Consumerist'?
There is a difference .
If you're a consumer who d'oesn't feel represented by In every issue, CR offers hard-hitting, reports„ based
much of what passes for "consumerism"'these days . . . on the latest studies and scientific data„concerning sub-
If you don't believe that'~ piling on more government jects such as :
regulations is the answer to your problems . . . • How federal regulations cause airline
If you want accurate, up-to-date information on a wide congestion
range of consumer topics . . . • How farm subsidies raise consumer food prices
Then there is a consumer magazine that's written and • Why auto insurance is so expensive
edited for you . It is, in fact„the,pioneer consumer publiea- • What's causing medical costs to skyrocket'
tionti which has been helping consumers since 1928 . If you would like to see a consumer magazine that
really takes the side of the consumer, favors America's
system of competitive : enterprise, and castsa searchlight
on the forces currently affecting your spending d'ollar,
them you should! be a subscriber to Consumers'Research,
In fact„for new subscribers, we have a special offer : A
one-year subscription for $18 . That's a savings of $12
off the cover price!
And, if you enclose payment with your order, we'll
send you, free, your choice of two of the reprints
listed in the box below.
Simply clip and mail the coupon below with your pay-
ment, and the reprints you want~ . We'll send you the
reprint!s,,and enroll you immediat'ely as a subscriber, and
start you receiving a consumer magazine that's on your
side . And that's a wise decision for any consumer .
If you send payment withl this coupon you can receive two Circulation Department 0
of any of the following reprints„freef Consumers` Research Magazine
800 Maryland Ave., N .E .
• The Cable TV Tangle Washington, D.C . 20002
• Does Everything Cause Cancer?
O The Free Market and the Consumer Please send me the next twelve issues of : CR
magazine for only $18 .
O The Greenhouse Effect : Science Fiction?
O The High Cost of Catastrophic Insurance O Payment enclosed .
O Please bill me.
O NiJclear Energy : How Safe Is It?
El The Real Cause of Airline Delays Name
0 What's Behind the S&L Crisis? Address
El Why Your Phone Bills Keep Going Up
City State Zip
0 I have enclosed payment . Please send
me two of the reprints I have checked .
Please allow up to 6 weeks for processing .
o V sszz tz o z
"Social Costs" of Smoking
There are claims that smoking imposes "social costs" on our nation
and, specifically, on employers . These "costs" are based upon
allegations that smokers are less productive than nonsmokers, that
they have higher absenteeism rates and use health-care programs
more than nonsmokers . This argument has been the basis for the
imposition of excise taxes on tobacco products, higher insurance
premiums for smokers and workplace smoking bans . Employers
have sometimes used this theory as justification for the exclusive
hiring of nonsmokers and the dismissal of employees who smoke
outside the office on their own time .
For a number of'reasons discussed below, the position that there
are "social costs" attributable to smoking should be carefully
examined before using such theories to justify smoking bans or
other discriminatory treatment of smokers .
• The "social cost" concept, if applied to smoking, can
likewise be applied to many types of behavior . It can be
argued that if employers use employment as a means to
regulate employee behavior, then other lifestyle choices
should also be addressed - such as obesity, hazardous leisure
activities and consumption of alcohol (which have been
correlated to higher health care costs) .
• Claims that smokers are less productive than
nonsmokers have not been substantiated ; some surveys
suggest the opposite . In a survey of union representatives
and government and business supervisors by the
independent research firm Response Analysis Corp ., 74
percent said smoking during scheduled work breaks has no
significant effect on job performance . A 1984 survey of
Minnesota bank executives actually found that smokers were
more productive than nonsmokers .
Page 9 April 1992
It is important to carefully examine how "lost productivity"
is defined . For example, if a worker retires at age 55, do the
next 10 years amount to "lost productivity?" If a smoker
skips a coffee break or doubles his work output during an
hour so that he can go to the smoking lounge for a cigarette
break, is that a net loss or gain in productivity ?
• Smokers as a group have not been shown to have higher
absenteeism rates as a result of their smoking than
nonsmokers . A 1989 study by the National Chamber
Foundation reached that conclusion . "The study found that
there was no association between .. . tobacco use and work
loss . The insignificance of the smoking variable was .. .
surprising . Smoking has received widespread public
disapproval in recent years . .. . Notwithstanding this, it had
no statistically significant effect on work loss," according to
Other economists have criticized the theory that smoking
results in absenteeism because it is simplistically used as a
single criterion without correcting for job type, gender, job
satisfaction and-other factors . In fact, the possibility exists
that banning smoking may increase job dissatisfaction
among smoking employees and may therefore increase
absenteeism, rather than decrease it .
• Assertions that smoking leads to increased health
insurance claims have been challenged . Some insurers
charge different premiums for smokers and nonsmokers, but
they have done so "with little supportive actuarial
experience that nonsmokers incur fewer claims," according
to the 1989 Surgeon General's report .
What may seem like a simple solution to the rising costs of
health care - banning smoking, or not hiring smokers to
begin with - may actually be precedent-setting. Since
Page 10 April 1992
married people tend to have higher health-care claims due to
their family coverage, should only single people be hired?
Since overweight people tend to have higher health-care
costs, should only slender people be hired? Alcohol
consumption? Family history of sickle-cell anemia?
Cholesterol levels? At some point, employers will have to
draw the line about delving into the private lives of their
• There is no reliable basis for claiming that smokers place
an above-average demand on Medicare and Medicaid .
Smokers as a group are very much underrepresented in their
use of these programs . According to the Statistical Abstract
of the United States (1987), 45 percent of Medicaid patients
are children ; 15 percent of Medicaid beneficiaries and more
than 90 percent of Medicare beneficiaries are over age 65 -
an age group in which only 16 percent are smokers .
Page 11 April 1992
SECTTON' FOUR :
What are an employer's legal obligations regarding workplace
Two areas where legal issues are often raised in connection with
workplace smoking are employment discrimination and liability .
Employers should consult with their own legal counsel if they have
questions on these, or any, legal issues related to workplace
Some employers have cited the EPA's draft documents on ETS as a
legal mandate that they must ban smoking or restrict it to
separately ventilated lounges . It is important to note the EPA does
not have the authority to regulate indoor air quality . In contrast,
the Occupational Safety and Health Administration (OSHA) can
set workplace limits, and has established thresholds for a variety if
indoor air contaminants . To date, OSHA has not regulated
workplace smoking, but it has issued a "Request information" on
indoor air pollutants, including ETS, and may establish guidelines
sometime in the future. Again, in all cases, employers should
consult their own legal counsel to assess the impact these activities
may have on their workplaces .
Some trends have emerged in employers' liability regarding indoor
air quality. Overviews of current legal trends in this area have
been prepared . If your legal counsel would be interested in
receiving some further information on this area, please indicate
that on the enclosed reply card and return it to C .S .S .
The American Civil Liberties Union, employee organizations, and
even state legislatures have begun debating potential limits on an
employer's ability to dictate an employee's legal off-hours
behavior and lifestyle . Recent news reports about the advances
made in the area of genetic testing are harbingers of the decisions
that lie ahead for employers . How much do employers have the
right to know about their employees' off-hours activities? How
much control should an employer exert over those activities?
Page 12 April 1992
It is also important to check any municipal codes that apply to
company facilities to see what local requirements exist for
smoking policies . Some make no requirements at all, others
require only that some form of a policy exist and be enforced, and
some specify the type of policy that must be in place . Again, legal
counsel should be consulted in this regard .
State Legislation Prohibiting Lifestyle Discrimination
For employers interested in employing only nonsmokers, there are
both personnel considerations and legal limits in some states .
Americans, by and large, don't like to be told what they can and
cannot do in their own homes or on their own time . A 1989 survey
by the National Consumers League found that more than 80
percent of respondents opposed the firing of employees, or denial
of employment to applicants, on the basis of legal off-work
As of May 1992, instances of employment discrimination against
smokers have caused 40 state legislatures to consider legislation on
the issue . To date, 25 have passed legislation protecting smokers
from employment discrimination, most in the last two years .
Following are the states with such legislation :
Arizona New Mexico
Connecticut North Dakota
Kentucky Rhode Island
Louisiana South Carolina
Maine South Dakota
New Hampshire West Virginia
New Jersey Wisconsin
Page 13 April 1992
In Delaware, state government personnel policies prohibit
discrimination against smokers .
Typically, these state laws focus on the right to privacy . They
prohibit employers from discriminating in hiring or terms of
employment based on whether a person smokes off the job. Some
of the laws are more broadly based, prohibiting discrimination
based on any legal off-the job activity.
The protections these laws afford smokers are not consistent from
state to state . Some states provide exemptions for religious
organizations and others that might have a conflict of interest .
There is one consistency, however : These laws do not affect
workplace smoking policies or employee compliance with those
policies. The laws restrict only what employers may demand of
employees during their non-working hours . It is important that
employers contact their legal counsel for an assessment of the
Because state legislation changes quickly, you would be well
advised to check whether your state has recently passed a bill
prohibiting discrimination against smokers .
Page 14 April 1992
t sjt, ;, f+>tr ir :?i;i> > ir
Negotiating a Fair Workplace Smoking Policy
Most individuals prefer accommodation of both smokers and
nonsmokers in the workplace . A recent Gallup survey shows that
69 percent of workers favored "setting aside certain areas" for
smoking . Only 25 percent favored an outright ban of smoking in
the workplace . Employers often overreact to employee requests
for smoking restrictions by believing their only option is to ban
smoking. Instead, a policy that provides designated smoking and
nonsmoking areas will usually address employee concerns .
Obviously, simple solutions to workplace smoking problems are
the best for everyone : rearranging desks, using partitions,
relocating smokers to be near exhaust vents and nonsmokers near
fresh-air intake vents, opening windows, use of portable
"smokeless" ashtrays and air cleaners, etc .
If an employer has determined that a consistent smoking policy
would help alleviate employee problems throughout the workplace,,
there are several key elements that should be considered .
Element 1 : Employee Involvement
Most employees will accept a policy more readily if they play a
role in its development . If employees' opinions have been
considered, management will most likely hear fewer complaints
after the implementation of the policy .
Establishing a team for the development of a policy is often
helpful . Such teams can be made up entirely of management
representatives, but are best structured with members from both
employee and management groups . The team should also
represent smokers, nonsmokers, ex-smokers, and union
representatives where applicable .
Page 15 April 1992
The first task of the team should be to gather information about the
organization's needs and attitudes related to smoking in the
workplace. This information should be gathered from the entire
workforce, and not a select group . Often there is only a minority
of nonsmokers who raise the issue of smoking in the workplace .
Anti-smokers' positions should be equally balanced with those of
smoking employees, as well as nonsmokers who are not totally
opposed to smoking in the workplace .
To gather information on employee needs and attitudes, a survey is
helpful. Written, anonymous surveys are most effective, since
some employees are uneasy about communicating with
management. Surveys can be very brief and straightforward or
very involved .
It is often helpful to conduct a survey of your workforce in relation
to broader issues of indoor air quality, rather than concentrating
solely on smoking . This can not only help you determine .
employee attitudes and preferences on smoking, but may help you
identify other areas of concern as well .
At the end of this section there is a sample survey . It is fairly
comprehensive, and may include more information than you wish
to seek .
If you wish to do a survey focusing directly on smoking rather
than on broader issues, we would direct your attention to questions
25 through 29 . These ask for specific information on smoking .
Whatever approach you take, it is, again, essential to involve
employees in the policy development process, and determine as
objectively as possible their attitudes and preferences .
Note that question 15 on the sample survey can provide the
employer with information regarding general indoor air quality
problems . Should an employer find that employees indicate any
problems with the quality of the workplace environment, Section
Six of this kit will be beneficial .
Page 16 April 1992
The team may also want to enlist the help of the company's
engineering staff or HVAC contractor to help assess the current air-
handling system . Section Six includes a sample checklist of
common HVAC evaluations .
Element 2: Considering the Options
There are several options to be considered when developing a
workplace smoking policy . Often, employers use a combination of
options to accommodate various employee populations and work
areas . The key is to formulate a policy based upon options which
are fair to both smokers and nonsmokers .
• Open Smoking (permission to smoke an,ywhere in an office or
facilit . Some companies will find that an "open policy" is fine for
their operations . To them, common courtesy remains the best way to
resolve issues of smoking in the workplace .
The American Society of Heating, Refrigerating, and Air
Conditioning Engineers (ASHRAE) Standard 62-1989 prescribes
supply rates of acceptable outdoor air required for acceptable
indoor air quality . "These values have been chosen to control C02
and other contaminants with an adequate margin of safety and to
account for health variations among people, varied activity levels,
and a moderate amount of smoking ." A value of 20 cubic
feet per minute has been prescribed for office spaces . This
standard was developed from a consensus of engineers, architects,
chemists, physiologists, product manufacturers and industry
Page 17 April 1992
• Separate Walled Areas for Smokers and Nonsmokers - Careful
selection of the smoking areas with respect to the ventilation
system ideally balances the needs of smokers and nonsmokers .
Smoking can be limited to private offices or workstations, or
designated areas of the facility .
It is important to recognize that toilet or corridor areas designated
as smoking areas may not provide efficient exhaust systems . Also,
problems may arise with the designated smoking areas in a large
building served by many separate air handling units . A
concentration of smokers in an area served by one unit may exceed
the capacity of the unit to dilute the more concentrated smoke,
thereby moving more, not less, ETS to nonsmokers also served by
• Separate . Unwalled Areas for Smoking and Non-smoking -
Separating the workstations of smoking employees is another
option that often works well . This kind of policy has
the advantage of allowing smokers to stay at their workplaces and
continue working as they enjoy a cigarette . It is quite convenient
for nonsmokers, also, because they have easy access to their
fellow employees, but are removed from cigarette smoke .
Large areas such as cafeterias can provide for separate smoking
and nonsmoking pafrons if the smoking area is located closest to
the main ventilation return inlet .
• Separate Smoking Lounges with Separate Ventilation- Some
companies choose to establish smoking lounges . Under this
arrangement, smoking is restricted to areas set aside specifically
for smoking . The obvious advantage to this arrangement is that it
ensures that nonsmokers will not be required to be around smoke .
On the other hand, the success of this kind of policy frequently rests
on the ready availability of the lounges, the aesthetics of the
lounges themselves, and the attitude of the employee population .
If a company has decided to establish a policy that allows smoking
in lounges only, the employer may want to keep some
considerations in mind to enhance the likelihood that the policy
will be supported and accepted by employees .
Page 18 April 1992
Perhaps the most important factor is to make sure smoking
lounges are convenient, accessible and properly ventilated .
Poor selection or design of an area can result in more problems .
It should be recognized that the selection of areas to be
designated as smoking lounges will reflect on management's
attitude toward the smoking employee . Further, if workers have
to walk a great distance and be away from their regular
workplace for too long, productivity may suffer .
Smoking lounges should be sufficient in number, and located
close enough that smokers can leave to enjoy a cigarette and
return to their jobs within a reasonable period of time . It is also
important that nonsmokers not have to walk too far to find a
fellow employee who is in a smoking lounge.
Consideration should also be given to design features that
allow employees to continue working in the lounge if desired.
For example, employees who have phone calls to return might
do so from a smoking lounge equipped with several telephones
while taking their cigarette "break ."
It is also a good idea to furnish the lounge with desks or tables
and chairs, and even computers, so employees can more easily
work. Again, productivity will be higher, and smokers will feel
better about going to the lounge, if they can continue working
Racks of literature on your industry - trade publications and
magazines, for example - might be available to smokers in the
lounge so that they can stay abreast of the latest developments
while smoking a cigarette . Assign one person responsibility for
replacing outdated periodicals . Employers who have offered
periodicals in their lounges have found racks to be helpful - they
keep materials organized and avoid piles of magazines from
being scattered around the room .
Page 19 April 1992
The decor and furnishings of the lounge say a lot to employees
about the way they are perceived by management . If it is
furnished with cracked, broken old furniture, it tells smokers
they are not highly valued in the organization . Tasteful
furnishings and decorations send quite a different message .
Lighting should be equal to that of work areas . This not only
makes it possible for the employees to work in the lounge, it also
makes the lounge more attractive and pleasant for the
Ashtrays should be numerous, sturdy and of a large capacity so
they will not have to be emptied too often, and so they will not
spill. Glass or metal ashtrays are probably the best table-top
choices, or employers may prefer to use free-standing floor
ashtrays . Trash cans in the room should be metal.
Maintenance is also important. Ashtrays should be emptied and
the lounges cleaned daily. Pictures or other wall decorations
should be covered with glass for ease of' cleaning.
The location of the lounge also sends a clear message to your
employees . Rather than consigning them to a dingy, small room
in the basement of the building, try to find a space that is
conveniently located, well-ventilated, and properly sized for the
number of employees who are expected to use it . If possible,
select a room that has an outside wall with a window so that
fans or other ventilation can be added later if necessary.
Developing a smoking lounge need not be excessively expensive
or difficult . Tests have shown that conventional air distribution
with an exhaust fan can be used to properly ventilate a smoking
lounge . (If you are interested in receiving details on smoking
lounge tests, please return the enclosed reply card to C .S .S.)
Ventilation rates in tests conformed to the American Society of
Heating, Refrigerating and Air Conditioning Engineers
(ASHRAE) Standard 62-1989 for a smoking lounge . This
Page 20 April 1992
standard prescribes 60 cubic feet per minute of transfer for each
occupant, all of which is exhausted to the outside of the building .
The arrangement of air distribution tested which resulted in the
greatest acceptance by smokers is conventional overhead air
supply with air diffusers discharging toward the walls, away
from the center of the room . Transfer was brought in through
the ceiling on one side of the room . The exhaust rate exceeds
supply, thus insuring that the room remains at a lower pressure
than the surrounding areas, and not permitting smoke and odors
to infiltrate the surrounding areas . This arrangement lends itself
to economical retrofitting of an existing space into a smoking
Again, if you would be interested in further information on how
to develop a smoking lounge, or additional details on the results
of smoking lounge tests, please return the enclosed reply card to
Keeping the smoking lounge a productive part of the work
environment will aid in employee morale . If nonsmoking
employees perceive that smokers take more breaks than they do,
resentment will follow . If smokers feel guilty over having to
leave their work to go to the smoking lounge, their j ob
satisfaction is likely to suffer . Following these simple, common-
sense guidelines will pay big dividends in terms of employee
support of a decision to provide smoking lounges .
Element 3 : Development of the Policy
After careful review and selection of policy options, the team
should formulate a written policy .
The team may want to talk to other organizations and individuals
that have successfully implemented similar policies . Section
Seven contains sample smoking policies already in force at other
companies . These companies have reported high employee
satisfaction with the policies following implementation . It is
possible that a company could simply adapt one of the sample
Page 21 April 1992
policies which best suits its needs-saving the time of "reinventing
the wheel ." Before instituting any policy, however, it is imperative
that corporate legal counsel be consulted to ensure that the policy
complies with applicable local and state statutes .
Element 4 : Implementing the Policy
The most effective policies are those which are planned and
implemented in an organized manner . Policies should be clearly
announced to the employee populations well before the
implementation date . Give employees at least one month - and
preferably longer - to become familiar with the policy . Publish the
policy in an employee handbook and let future job applicants know
what the company's policy is . Further, top management should
openly support the policy.
After the policy is implemented, keep the employees in the loop -
tell them the percentages who supported the various decisions, and
the procedures followed by the policy development team . When
employees believe they have been part of the solution, they are
more inclined to make it work for them .
It is for this reason that many companies have elected to permit
employees in each work area to decide what policy best meets their
wishes . In such cases, management has acted in an advisory
capacity - making suggestions on workstation configurations,,
scheduling follow-up assessments to be sure the policy suits the
employee group, etc . Once implemented, employees should be
given the opportunity to express their opinions about the policy, on
a regular basis, to determine if changes are necessary .
Page 22 April 1992
1 . What is your job title?
2 . Briefly describe your primary job tasks
What is the location of your workstation in the building
(floor, wing, room number, etc .)?
4 . What type of workstation do you have (check one)
enclosed office with a door
cubicle with full-height partitions
cubicle with mid-height partitions
open office area
industrial processing area
Other (please specify)
Page 23 April 1992
5. How many persons are at your workstation?
one additional person
two or more additional persons
6 . How many hours, on average, do you spend at your
7 . How many years have you been located at this workstation?
8. What time do you arrive at work?
What time do you leave?
9 . Are any of the following located at your workstation?
portable air cleaner or negative-ion generator
Page 24 April 1992
10. How many hours per day, on average, do you use the
other chemicals (please list)
11 . Have there been any of the following changes in your
workstation in the past year?
new office equipment
Page 25 April 1992
12 . Has there been any water damage to your work area over
the past year?
13 . Have you ever noticed any water leaks from the ceiling,
pipes, walls, or floors in your work area?
14 . In the past year, have the conditions in your work area
stayed the same
Page 26 April 1992
15 . Please indicate how often, if at all, you have experienced
each of the following symptoms while working in the
Never Rarely Sometimes Often Always at work
shortness of breath
problems with contact lenses
pain or stiffness in upper back
pain or numbness in shoulder/neck
Page 27 April 1992
16 . When do these problems occur?
afternoon specific day(s) of the week
all day Which days?
no noticeable trend
17 . Do you have any health problems or allergies which might
account for any of the above symptoms?
18. Do the above symptoms appear more frequent or severe
during any season or seasons?
Page 28 April 1992
19. How often do the symptoms listed earlier reduce your
effectiveness on the job?
20 . How often do the symptoms cause you to stay home or leave
21 . If you indicated having experienced any of the symptoms
while at work, have they :
improved over the last year
become worse over the last year
stayed the same over the last year
Page 29 April 1992
22. In the last year, how often have you noticed any of these
types of odors at your workstation?
Never Rarely Sometimes Often Always
musty or damp smells
odors from new carpet
odors from engine exhaust
printing machine fumes
cleaning product odors
odors from glues/adhesives
23 . How often is there a problem with the following at your
Never Rarely Sometimes Often Always
Page 30 April 1992
24. Do any of the problems vary with the seasons?
25 . How many employees in your immediate work area smoke?
more than 50
26 . How many employees in your immediate work area do not
Page 31 April 1992
27 . Which of the following best expresses your thoughts
regarding smoking at work? (check one)
Employees should use common courtesy and
cooperation to decide when and where it is
appropriate to smoke .
Employees in each work area should be free to
decide their own smoking policies.
There should be a company policy that designates
smoking and nonsmoking areas .
Smoking should only be permitted in smoking
Smoking should be completely banned in the
Other (please specify) :
28 . What should the smoking policy be in each of the following
No Workers Company Total
Restric- Decide Should Ban
tions Policy Set Policy
open work areas
Page 32 April 1992
29 . How would you classify your current smoking status?
current cigarette smoker
current pipe or cigar smoker
30. How many times per week do you go outdoors during work
31 . How many times per week do you go outdoors primarily to
get some fresh air?
32. How is the lighting at your workstation?
much too dim
a little too dim
a little too bright
much too bright
Page 33 April 1992
33 . Is there an outside window which can be seen from your
34 . Describe in sets of three words or less, your overall opinion
of the air quality, in your workstation :
35 . OPTIONAL: Your Name
Office Phone Number
Page 34 April 1992
'~ .. : . . .n - .
SECTION SIX :
Improving the Air Quality in Company Facilities
Often, the presence of visible tobacco smoke is an indication of an
overall indoor air quality problem . Experience has shown that
complaints about smoking are indicative of inadequate ventilation .
In addition, many of the symptoms reported to be caused by
tobacco smoke are often still present following the implementation
of smoking bans and other policies . In such cases, the symptomss
may be related to high levels of other air contaminants and poor
Many of the symptoms frequently attributed to "sick building
syndrome" have been shown to be linked to a variety of other, non-
environmental factors as well . Therefore, it is important for
managers to consider all potential causes of employee complaints
rather than assuming indoor air quality is a problem .
Studies conducted by Dr . Alan Hedge of Cornell University have
shown many, of the symptoms frequently attributed to sick building
syndrome are more directly linked to job-related factors such as
stress, the amount of control one has over his or her job, and job
satisfaction rather than to measured contaminants in the air .
In other words, the mere presence of one or more symptoms may
or may not indicate sick building syndrome is the culprit . It is
prudent for managers to consider all potential sources of employee
complaints before deciding on a course of action to address them .
In the event an employee survey, such as that included in Section
Five of this kit, or other complaints alert a company to the N
existence of indoor air quality problems, thorough investigation CO
should be conducted . The key to conducting an investigation is to N
encourage employee involvement, and to identify locations, timesf of day, and types of problems that can be selected for further N
Page 35 April 1992
investigation by in-house engineers and outside consultants . The
sample survey below can serve as a guide in compiling this
If you believe that your workplace could benefit from an analysis
by a professional indoor air consultant, there may be firms in your
area qualified to provide you with assistance . It is advisable to ask
for references prior to contracting with any firm . In addition, local
environmental health agencies may be helpful in identifying
l . The amount of fresh air coming into your HVAC system is
critical. It reduces the build-up of chemicals and bacteria
created by people, equipment and building materials . In
previous years' energy "crunches", some fresh-air intakes
have been closed completely; so that the air in the building
is totally recirculated and could contain high
concentrations of indoor contaminants.
Are fresh-air dampers properly sized and operated to
allow fresh air into the building?
Is your HVAC system cleaned quarterly (or more
often, depending on occupancy) to keep it free of dust,
mold and debris?
The American Society of Heating, Refrigeration, and Air
Conditioning Engineers (ASHRAE) has recently
established an office standard of 20 cubic feet per minute
per person for indoor ventilation rates . (Up from a
previous standard of 5 cfm, which many buildings were
designed for. If you work in such a building, it's likely that
your air exchanges are too low.)
In addition, many state and city building codes specify
exchange rates. Some simply reference the ASHRAE
standard . Check with your city building department for
Page 36 April 1992
minimum requirements in your town, and have your system
Building meets ASHRAE standard of 20 cubic feet per
minute per person.
Building meets local building codes of cubic feet
per minute .
Suggestions from contractor on increasing air flow through
existing system :
3. Some air conditioning systems turn the air-supply fan on and
off by a thermostat similar to home systems . If the fan starts
and stops, there is no outside air ventilation from that system
when the fan is off. (Restaurants often use this type of
Does the fan run continuously or is it cycled?
Can it be modified to run continuously?
Spraying for pests is best done at night or on
weekends, when most employees are not in the
facility . Is the fan set to run following application of
pesticides or cleaning solutions?
4. Placement of the fresh-air intake dampers outside your
building can affect the quality of the air being drawn into
your building . Check to be sure the intake dampers are not
located near :
garages, parking facilities, loading docks or any other
location where auto or diesel exhaust would be present .
Page 37 April 1992
refuse containers or dumpsters .
chemical storage areas.
the exhaust fans from stoves, furnaces or other
Some buildings have uneven air distribution - some areas
are cold, some offices hot and stuffy . To improve this, you
may need to reconfigure interior partitions, or relocate or
install additional ductwork and supply and return air grilles .
To make a simple check of where the air is going, tape strips
of paper or tissue to the grille on the ceiling to make sure the
air is flowing and the direction of the flow .
Is the temperature consistent in each area of the facility?
Do some rooms or areas seem "stuffy" or "stale"?
Are there return-air grilles located in the ceiling or
6 . Many HVAC systems require filters . Check with your
building maintenance office to see that they are changed on
the schedule recommended by the manufacturer of the
system. ASHRAE recommends a minimum filtration
efficiency of 40 percent . Many ventilation experts
recommend a filter efficiency of 60 percent or more .
Are the filters changed or cleaned on schedule?
Do they fit snugly, so no air bypasses the filter?
When was the filter chamber last vacuumed to remove
Are the grease filters on kitchen exhaust fans washed or
Page 38 April 1992
Bacteria, fungi and mildew love damp, dark ventilation systems .
Any moisture sources, such as humidifiers or condensate pans
located under cooling coils should be scrupulously cleaned and
properly drained . Biocide treatment should be used to eliminate
bacteria and slime growth .
When was the last time the system was drained and
Does the system leak fluid anyplace? (Damp or stained
ceiling tiles or carpet areas often indicate a leak or a
condensation problem on an uninsulated duct .)
Are the drip pans of window fan coil units regularly
8. Ventilation ductwork should be checked frequently by a
professional ventilation expert or industrial hygienist with
expertise in examining internal ventilation ductwork . It should
be cleaned of dirt, dust, fungi, microbes and debris . Believe it
or not, even some new systems have been discovered to be
improperly installed - ducts that lead to nowhere, valves
installed incorrectly, etc.
Date of last ductwork cleaning .
Has expert confirmed that system is properly installed
and operating to efficiency guaranteed by manufacturer?
9 . When new equipment, carpeting, furniture, partitions or
other office fixtures are installed, ask the following;
Is the equipment installed to the specifications of the
manufacturer? Does it require special ventilation?
Can the fixtures be "aired out" in an unoccupied area
for a while to let fumes escape from the materials
before they are installed?
Page 39 April 1992
Can the ventilation rate be increased for a while after
the installation of new fixtures or equipment?
10. Low relative humidity in an office can cause many of the
symptoms associated with sick building syndrome -
scratchy throat, itchy eyes, runny or dry nasal passages, etc .
You may want to consider the installation of a humidifier to
the HVAC system, particularly for use through the winter
months when furnaces dry the air.
Relative humidity in the office currently is percent .
Many HVAC experts recommend a level of 20 to 30
percent in winter; 40 to 50 percent in summez
Page 40 April 1992
SECTION SEVEN : SAMPLE SMOKING POLICIES
Sample Smoking Policy #1
To provide guidelines for addressing smoking/no-smoking issues
that arise in the workplace in jurisdictions that have restrictive
smoking laws and regulations .
Applies to all U .S.-based employees .
It is the responsibility of all employees to respect the preferences
of their fellow employees be they smoker or nonsmoker .
Employees are to be encouraged to work out compromises among
themselves when these preferences conflict . When the individual
employee's efforts to work out a solution are unsuccessful, it is the
responsibility of the manager(s) to make reasonable
accommodations to satisfy the preferences of employees .
Managers should seek assistance from their Personnel
Representatives when agreement regarding accommodation cannot
be reached or when extenuating, circumstances (such as a large
capital expenditure) would be required .
When state or local ordinances require a more restrictive practice
than the guidelines contained in this policy, facilities must comply
with the local requirements . When there are no local restrictive
laws affecting the individual facility involved, smoking restrictions
are not required by this policy except to comply with local safety
and fire regulations .
Restricted areas (no-smoking areas)
~ There is to be no smoking in any areas in which a fire or safety
hazard exists . This would include areas where flammable or
hazardous substances are used or stored .
Page 41 April 1992
• The responsibility is left with local management for designating
any other smoking and non-smoking locations (e .g., elevators
or stairwells, etc .)
• There shall be no smoking in areas where any food ingredients
or finished product is being prepared, processed, evaluated or
stored. Employees assigned to these areas will be provided
access to designated smoking areas by local management .
• No-smoking signs shall state "No-Smoking Area" or other
language as appropriate . In New Jersey, the signs shall state
"smoking permitted" and "smoking prohibited ."
The aforementioned policies and procedures may be changed in
whole or in part by the Company at any time without prior notice .
Corporate Safety and Loss Control Manual .
Page 42 April 1992
Sample Smoking Policy #2
The company has developed a policy for all employees in an effort
to reasonably accommodate nonsmokers and those who choose to
Smoking will be permitted in cafeteria smoking areas, designated
office areas, lobbies and restrooms . Effective immediately,
smoking will be prohibited in hallways, elevator lobbies,
refreshment centers, conference rooms (with exceptions made at
the discretion of the meeting leaders) and storage and file areas .
Work Space Guidelines
Extra efforts may be made by the department' manager to ;9
accommodate both smokers and nonsmokers such as:
• Designating office space as "non-smoking" in consultation
with the associate occupying the space .
• Moving individuals who are in open office areas to
accommodate nonsmokers and smokers. However, when
smokers cannot be accommodated in open office areas, the
department manager may designate those areas as non-
• Employees who choose to smoke in their work areas are
requested to order air purifying equipment through the
Engineering Department . This equipment will be paid for by
the employee's department.
Please contact your Human Resources representative if you have any
questions regarding this policy .
Page 43 April 1992
Sample Smoking Policy #3
A mutually comfortable environment for employees is dependent
upon the thoughtfulness and cooperation of both smokers and
The company has a responsibility to provide and maintain a healthy
and clean working environment . It is important to note that the
company is not required to provide a "smoke-free environment" ;
therefore, the company does not attempt to ban smoking entirely .
Rather, we hope to promote an awareness of the concerns of nonsmokers
among those who do smoke and to be responsible to the needs of those
who find close proximity to smoke objectionable .
The following guidelines strive to meet the needs and desires of both
smokers and nonsmokers .
These guidelines will in no way supersede local or state law, or any
existing or future regulations established for fire, health or safety
The following guidelines are intended as examples of actions consistent
with company policy .
• Designation of "no-smoking" areas with appropriate signs .
These areas should include conference rooms, libraries, rest
rooms and health care facilities .
Page 44 April 1992