TESTIMONY OF CAROL M. BROWNER U.S. ENVIRONMENTAL PROTECTION AGENCY BEFORE THE SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT U.S. HOUSE OF REPRESENTATIVES FEBRUARY 7, 1994 Good morning, Mr. Chairman and Members of the Subcommittee. I am pleased to be here to testify on the Environmental Protection Agency's (EPA) activities related to environmental tobacco smoke (ETS), to comment on H.R. 3434, the Smoke-Free Environment Act of 1993, and to relate to you some of our preliminary conclusions concerning the economic impacts of H.R. 3434, which you requested, Mr. Chairman. As you know, in January 1993, the Environmental Protection Agency (EPA) published an assessment of the respiratory health risks of passive smoking, entitled Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. This report was issued under the authority of The Radon Gas and Indoor Air Quality Research Act of 1986, which directs EPA to conduct research and disseminate information on all aspects of indoor air quality. The report summarizes the findings of the Agency's extensive investigation of the respiratory health risks from exposure to environmental tobacco smoke. It incorporates comments and recommendations from the public as well as two reviews by EPA's Science Advisory Board (SAB), a panel of independent scientific experts in this field. The Science Advisory Board unanimously endorsed both the conclusions of the report and the methodologies employed. The Department of Health and Human Services (HHS) has endorsed the report and the National Cancer Institute within HHS has printed it as one of its series of scientific monographs. Based on the total weight of the available scientific evidence, EPA concluded that the widespread exposure to secondhand smoke in the United States presents a serious and substantial public health risk. I'd like to briefly summarize the findings of the report. Findings of the EPA Risk Assessment Perhaps the most significant conclusion of the report is the finding that secondhand smoke is a human lung carcinogen, classified as a "Group A" carcinogen under EPA's carcinogen assessment scheme. This classification is reserved for those compounds or mixtures that have the strongest evidence of a cause-and-effect relationship in humans. In the case of secondhand smoke, unlike any other compound the Agency has ever evaluated, we are able to see a consistent increase in lung cancer risk at actual environmental levels, rather than having to extrapolate downward from very high occupational exposures as we have had to do for such other Group A carcinogens as asbestos and benzene. In attempting to quantify the extent of the lung cancer risk, the report estimates that secondhand smoke is responsible for approximately 3,000 lung cancer deaths annually in non-smokers in the United States. Of these 3,000, the report estimates that approximately 2,200 are attributable to exposure outside the home. ETS also has subtle but significant other effects on the respiratory health of adult nonsmokers. These include coughing, phlegm production, chest discomfort, and reduced lung function. Although the finding that secondhand smoke is capable of causing lung cancer in healthy adults has received the most public attention, I am personally even more concerned about the very serious respiratory effects on young children who have been found to be particularly - sensitive to the effects of secondhand smoke -- that are documented in our report. Infants and young children whose parents smoke are at increased risk of lower respiratory tract infections such as pneumonia and bronchitis. EPA estimates that passive smoking is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age annually, resulting in between 7,500 and 15,000 hospitalizations each year. Children who have been exposed to secondhand smoke are also more likely to have reduced lung function and symptoms of respiratory irritation such as cough, excess phlegm, and wheezing. Passive smoking can lead to a buildup of fluid in the middle ear, the most common cause of hospitalization of children for an operation. Asthmatic children are especially at risk. EPA estimates that exposure to secondhand smoke increases the number of episodes and the severity of symptoms for between 200,000 and one million asthmatic children. In addition, passive smoking is a risk factor for the thousands of non-asthmatic children who develop the condition each year. Policy Recommendations EPA firmly believes that the scientific evidence is sufficient to warrant actions to protect non-smokers from involuntary exposure to secondhand smoke. Because of the health implications of exposure to secondhand smoke documented in our report, EPA recommended actions to prevent involuntary public exposure to indoor secondhand smoke, which I outlined before this Subcommittee on July 21, 1993. The recommendations are intended to help parents, decisionmakers, and building occupants take steps to protect non smokers from exposure to secondhand smoke and are outlined in the brochure, What You Can Do About Secondhand Smoke. EPA's primary recommendations are that: • Residents not smoke in their home or permit others to do so. • Every organization dealing with children -- schools, day care facilities, and other places where children spend time -- have a smoking policy that effectively protects children from exposure to environmental tobacco smoke. • In the workplace, EPA recommends that every company have a smoking policy that effectively protects non-smokers from involuntary exposure to tobacco smoke either through complete bans or limiting smoking to rooms that have been specially designed to prevent smoke from escaping to other areas of the building. policy. • Employer-supported smoking cessation programs should be a part of any smoking • If smoking is permitted in a restaurant or bar, placement of smoking areas should be determined with some knowledge of the ventilation characteristics of the space, to minimize non smoker exposure. EPA is working closely with public and private sector partners to educate the public about secondhand smoke and actions that can protect non-smokers from the health risks associated with ETS. In cooperation with the American Lung Association, EPA is targeting information on secondhand smoke specifically to lower socio-economic class parents. EPA coordinates closely with the Office on Smoking and Health on their public information efforts, and we are working with a wide range of State and local government agencies to educate the public about the hazards of secondhand smoke. As you are no doubt aware, many Federal agencies, State and local governments and private sector organizations began to implement some form of smoking restrictions indoors as a result of the landmark reports issued in 1986 by the U.S. Surgeon General and the National Research Council of the National Academy of Sciences. In the year since publication of the EPA report, however, we have seen a rapid acceleration of measures to protect non-smokers in a variety of settings, including workplaces, restaurants, sporting facilities, health and day-care facilities, shopping centers, and a wide range of other public facilities. Hundreds of local ordinances have been passed or introduced in virtually every area of the country since 1991 and it is estimated that about 30% of employees are subject to restrictive smoking policies, of which about 20% are covered by a smoking ban. Despite this encouraging trend, there are many places where involuntary exposure to secondhand smoke still occurs. Many businesses are concerned about being left at a competitive disadvantage if they go smoke-free, or if their communities enact restrictive smoking ordinances and neighboring jurisdictions do not. While recent studies of the effects of local ordinances on revenues and the experiences of many businesses indicate that smoking restrictions do not reduce sales or revenues for businesses that choose to adopt them in fact, many report increases in business from non-smokers -- businesses frequently receive misinformation claiming that smoking restrictions will hurt their business. Administration Views on H.R. 3434 The Smoke-Free Environment Act of 1993, H.R. 3434, would prohibit the smoking of tobacco products within any building regularly entered by ten or more persons at least one day per week, including State, local and Federal buildings. The bill would allow for the |