10!

TABLE 4. — Effects of carbon monoxide on psychomotor junctions — Continued

 

 

co COHb
Test or level level
Reference Measurement ppm (Percent) Effect
Fodor, G.G., Attentiveness to 50x 5 hrs. 2-5 Decreased
Winneke, G. auditory stimuli
a9)
Flicker fusion $0 x 5 hrs. 2-5 No change
Speed of motor performance $0 x 5 hrs. 2-5 No change
Perception of complex $0 x 5 hrs. 2-5 Improved
visual patterns
Schulte, J.H. Cognitive function 100 5 Decreased
(43)
Reaction time 20 No change
Bender, W., et al. Threshold for temporal 100 7.25 Raised
(6) resolution of visual stimuli
Manual dexterity 100 7.25 Decreased
Learning meaningless syllables 100 7.25 Decreased
Retention of 10 syllables 100 7.25 No change
for 1 hr
Groll-Knapp, E., et al. Attentiveness to auditory 50 Deterioration at
(22) stimuli 100 50 ppm, worse at
100 ppm, worst
150 at 150 ppm
Wright, G., et al. Reaction time 6.3 Prolonged
50
(90) Glare recovery 6.3 Prolonged
Careful driving habits 6.3 Failure to improve

with practice

 
Two government sponsored studies have attempted to evaluate
the degree of minor irritation due to cigarette smoke experienced by
bus and plane passengers. The U.S. Department of Transportation
(44) studied the environment on two ventilated buses — one with
simulated unrestricted smoking and another with simulated smoking
limited to the rear 20 percent of the seats. In one bus, lighted
cigarettes were placed at every other seat (23 cigarettes) to simulate a
bus filled with smokers. In the other bus, cigarettes were placed only
in the rear 20 percent of the bus (five cigarettes) to simulate a bus
where smoking was limited to the rear 20 percent of the seats. When
smoking was limited, the CO level at the driver’s seat was only 18
ppm (ambient air 13 ppm) compared to the level of 33 ppm
(ambient air 7 ppm) measured in the unrestricted smoking situation.
Four of the six subjects seated in the bus reported eye irritation
during the unrestricted smoking simulation. None of the six subjects
reported any eye irritation in the restricted smoking situation (not
even those seated in the rear 20 percent of the bus).

Several Federal agencies (48) cooperated to survey the symp-
toms experienced by travelers on both military and commercial
aircraft. They distributed a questionnaire to passengers on 20
military and 8 commercial flights; 57 percent of the passengers on
the military flights and 45 percent of the passengers on the
commercial flights were smokers. The planes were well ventilated
and CO levels were always below 5 ppm with low levels of other
pollutants as well. In spite of the low level of measurable pollution,
over 60 percent of the nonsmoking passengers and 15 to 22 percent
of the smokers reported being annoyed by the other passengers’
smoking. Seventy-three percent of the nonsmoking passengers on the
commercial flights and 62 percent of the nonsmoking passengers on
the military flights suggested that some remedial action be taken; 84
percent of those suggesting remedial action felt that segregating the
smokers from nonsmokers would be a satisfactory solution. These
feelings were even more prevalent among those nonsmokers who had
a history of respiratory disease.

Children have been found to have a higher incidence of
respiratory infections than adults and are thought to be more
sensitive to the effects of air pollution due to their greater minute
ventilation per body weight than adults. Several researchers have
investigated the effects of parental smoking on the health of
children. Cameron, et al. conducted two telephone surveys of Detroit
families to determine the relationship between children’s respiratory
illness and parental smoking habits. In the first survey (9) they found

a statistically significant relationship between the prevalence of

102
children’s respiratory infection and parental smoking habits only
when all children under 16 were considered (not when only those
under 9 or under 5 were considered). In a larger survey of the same
city (10) they found a relationship between parental smoking and
prevalence of respiratory illness in the 10- to 16-year age group and
in the birth to 5-year age group. Neither study controlled for
smoking by the children which might be a factor in the 10- to
16-year age group or for socioeconomic status which has an effect on
both smoking habits and illness. However, the data were consistent
with a higher prevalence of respiratory disease in families where there
are smokers than in nonsmoking families.

Colley (/2) also found a relationship between parental smoking
habits and the prevalence of respiratory illness in the children. He
found an even stronger relationship between parental cough and
phlegm production and respiratory infections in children. He
postulates this latter relationship to result from the greater infec-
tivity of these parents due to their cough and phlegm production.
The relationship between parental cigarette smoking and respiratory
infection in their children would then occur because cigarette
smoking caused the parents to cough and produce phlegm and would
not be indicative of a direct effect of cigarette smoke-filled air on the
children.

Harlap and Davies (29) studied infant admissions to Hadassah
Hospital in West Jerusalem and found a relationship between
admissions for bronchitis and pneumonia in the first year of life and
maternal smoking habits during pregnancy. Data on maternal
smoking habits after the birth of the child were not obtained, but it
can be assumed that most of the mothers who smoked during
pregnancy continued to smoke during the first year of the infant’s
life. A relationship between infant admission and maternal smoking
habits was demonstrable only between the sixth and ninth months of
infant life and was more pronounced during the winter months
(when the effect of cigarette smoke on the indoor environment
would be greatest). Mothers who smoke during pregnancy are known
to have infants with a lower average birth weight than the infants of
nonsmoking mothers. The relationship between maternal smoking
and their infants’ admission to the hospital found in this study was
greater for low birth weight infants, but was also found for normal
birth weight infants (Table 5) (29). Harlap and Davies (29)
demonstrated a dose-response relationship for maternal smoking and
infant admission for bronchitis and pneumonia; however, they also
found a relationship between maternal smoking and infant admis-
sions for poisoning and injuries. This may indicate a bias in the study

103
701

TABLE 5.- Admission rates (per 100 infants) by diagnosis, birth weight, and maternal smoking

 

 

 

 

Birth weight (g) Total

Diagnosis <2,999 3,000 - 3,499 3,500+ (including unknown)
s NS S NS S NS Ss NS

(297) (2,326) (415) (4,098) (264) (3,195) (986) (9,686)

Bronchitis and

pneumonia 19.2 12.3 9.6 8.2 12.1 9.0 13.1 9.5
All other 22.6 19.9 14.5 14.6 15.2 13.3 16.9 15.5
Total 41.8 32.2 24.1 22.8 27.3 22.3 30.0 24.9

 

NOTE. — S=Smokers; NS=Nonsmokers.
Source: Harlap, S., Davies, A.M. (29).
due to relationships which may exist between smoking and factors
such as parental neglect or socioeconomic class. In addition, hospital
admission rates may not be an accurate index of infant morbidity.

Colley, et al. (73) studied the incidence of pneumonia and
bronchitis in 2,205 children over the first 5 years of life in relation to
the smoking habits of both parents. They found that a relationship
between parental smoking habits and respiratory infection in
children occurred only during the first years of life (Table 6). They
also showed a relationship between parental cough and phlegm
production and infant infection (Table 6) which was found to be
independent of the effect of parental smoking habits. The relation-
ship between parental smoking and infant infection was greater when
both parents smoked and increased with increasing number of
cigarettes smoked per day. The relationship persisted after social
class and birth weight had been controlled for.

Thus, respiratory infections during the first year of life are
closely related to smoking habits independent of parental symptoms,
social class, and birth weight. Because of the dose-response relation-
ship between parental smoking and infant respiratory infection
established by Colley, et al. (/3), it is reasonable to suspect that
cigarette smoke in the atmosphere of the home may be the cause of
these infections; however, other factors such as parental neglect may
also play a role.

The above studies examined the effects of involuntary smoking
on relatively healthy people. A substantial proportion of the U.S.
population suffers from chronic cardiovascular and pulmonary
diseases, however, and they represent the segment of the population
most seriously jeopardized by conditions found in involuntary
smoking situations. In Chapter 1 of this report (Cardiovascular
Diseases) evidence was presented which showed that levels of CO
sometimes experienced in smoke-filled environments (50 ppm) are
capable of significantly decreasing the exercise tolerance of persons
with angina pectoris and intermittent claudication. In addition, these
levels of CO have been shown to decrease cardiac contractility and to
raise left ventricular end-diastolic pressure (an indication of heart
failure) in persons with cardiovascular disease.

Persons with chronic bronchitis and emphysema have consider-
able excess mortality under conditions of severe air pollution. In
smoke-filled environments levels of CO and several other pollutants
may be as high or higher than occur during air pollution emergencies.
The effects of short-term exposure of persons with chronic obstruc-

105
901

TABLE 6. — Pneumonia and bronchitis in the first 5 years of life by parents’ smoking habit and morning phlegm

 

Year of

Annual incidence of pneumonia and bronchitis per 100 children

(Absolute numbers in parentheses)

 

Both ex-smokers
of one ex-smoker

 

 

Followup Both nonsmokers One smoker Both smokers or smoking habit All
changed
N O/B N O/B N O/B N O/B N O/B
1 1.6 10.3 10.4 14.8 15.3 23.0 8.2 13.2 10.1 16.7
(343) (29) (424) (128) (339) (139) (546) (129) (1,652) (425)
2 8.1 8.3 71 15.5 8.7 9.2 6.5 10.7 74 11.3
(322) (36) (365) (129) (286) (152) (599) (159) (1,572) (476)
3 6.9 8.1 10.5 9.4 79 11.0 8.2 11.6 8.4 10.6
(305) (37) (353) (107) (242) (154) (661) (173) (1,561) (471)
4 8.0 11.1 7.5 10.8 716 11.6 8.2 9.1 7.9 10.3
(287) (36) (306) (102) (236) (121) (695) (187) (1,524) (446)
5 6.7 14.7 5.6 9.4 3.9 10.6 6.4 7.3 5.9 9.1
(285) (34) (267) (107) (208) (132) (737) (219) (1,497) (492)

 

 

 

 

 

 

 

 

 

 

 

NOTE. — N=neither with winter morning phlegm. O/B=one or both with winter morning phlegm.

Source: Colley, J.R.T., et al. (13).

 
tive bronchopulmonary disease (COPD) to these conditions have not
been evaluated. Persons with COPD are also possibly at increased risk
to CO exposure because of their low alveolar Po2. Due to the
reduced amount of oxygen available to compete with the CO for
~ hemoglobin binding sites, these persons might experience a carboxy-
hemoglobin to oxyhemoglobin ratio higher than those in healthy
subjects under the same conditions of CO exposure. The retention of
CO may also be prolonged due to both this increased binding of CO
to hemoglobin under low alveolar Po, and decreased ventilatory
capacity to excrete CO.

In summary, the effects of cigarette smoke on healthy
nonsmokers consists mainly of minor eye and _ throat irritation.
However, people with certain heart and lung diseases (angina
pectoris, COPD, allergic asthma) may suffer exacerbations of their
symptoms as a result of exposure to tobacco smoke-filled environ-
ments. These effects are dependent on the degree of individual
exposure to cigarette smoke which is determined by proximity to the
source of the tobacco smoke, the type and amount of tobacco
product smoked, conditions of room size and ventilation as well as
the amount of time the individual spends in the smoke-filled
environment, and his physiologic condition at the time of exposure.

107
SUMMARY

1. Tobacco smoke can be a significant source of atmospheric
pollution in enclosed areas. Occasionally under conditions of heavy
smoking and poor ventilation, the maximum limit for an 8-hour
work exposure to carbon monoxide (50 ppm) may be exceeded. The
upper limit for CO in ambient air (9 ppm) may be exceeded even in
cases where ventilation is adequate. For an individual located close to
a cigarette that is being smoked by someone else, the pollution
exposure may be greater than would be expected from atmospheric
measurements.

2. Carbon monoxide, at levels occasionally found in cigarette
smoke-filled environments, has been shown to produce slight
deterioration in some tests of psychomotor performance, especially
attentiveness and cognitive function. It is unclear whether these
levels impair complex psychomotor activities such as driving a car.
The effects produced by CO may become important when added to
factors such as fatigue and alcohol which are known to have an effect
on the ability to operate a motor vehicle.

3. Unrestricted smoking on buses and planes is reported to be
annoying to the majority of nonsmoking passengers, even under
conditions of adequate ventilation.

4. Children of parents who smoke are more likely to have
bronchitis and pneumonia during the first year of life, and this is
probably at least partly due to their being exposed to cigarette
smoke in the atmosphere.

5. Levels of carbon monoxide commonly found in cigarette

smoke-filled environments have been shown to decrease the exercise
tolerance of patients with angina pectoris. ,

108
10

11

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