~-.~JiVIi~ s«M .

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http://legacy.library.ucsf.edu/tid/dsk94c00/pdf 

ASSESSMENT OF THE ASSOCIATION 

EETNEEN PASSIVE SMOKING AND 

LUNG CANCER 

YARELA• LUIS R . 

OE4REE DATE : 1987 . 

~-.~JiVIi~ s«M .

LEGZSSOSz 


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, , Dissertation 

U Information Service 

tM~sily A/xrd,Yns trnmnalqnal 

A BWI a taren In/ormaUUn Cnmpany 

300 N. Zeeb Roan . Am AnW. MCnigan 48106 

880PS2t-0688 OR 71y761-470a 

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7N190iOH da SIItlC[N.tYJ bmnrna +t]i 

Saaa 711 @N tS1mI6S ia'itd11 aNY Sl[m166 iMm 

•erntvnc 7H yIU ta"MMH 39y NI :HIIOS 3qI8Std UL 

3IfsiOCi AD STaldA/tlDSlt3d IiLiM 900D ',7a7 h'MAD '.JM HIMPMD 

. 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ •Yl 41 aanbld 

'17 aorA3maaV rapm nTrsy) 

3qf56Mi d0 SInNOfnIT41 •tmu+ra tCH 

3m 'X77 07V :SIN:iQiadm 3LC1W!/15 am •57K1QcdS3Ud735 

'SLbf9(5 TN tlM t(nQCn7YH 3L1 NI •.llII1C16 36I4Y6 PL 

319;4tpp .ia 611Y3A/HS)Bd 1Q.IM 'AA1 a71 iQNrJ ' I NI ii'JNl6D 

L6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

.fa nlt aa57d 

'3N15D;JG dD SIItla_Am ]Kit33IIa 11Q3 3700 77I aNY !^..3dIS 

0:xnlsnt x~wmo+>~airrnr ar. '= 'rms/atumma 

'Sd..'? .'BfiS TN iiPi 'SM QrMCeN 7111Lq 931ad5 31i1. A9 MaS 

m.L7m TJ ja Ki®17N N17tf SOOa 7P7 L'i7MlJ 'JLTI NI 3.R"D 

68 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 


.L7 ocr+cn aralct~a u~a 

sn~ ~t an artr. wv s rr~ 

'cLT+mS 71Y Nad am /$'u'MM'.!.'M'O 39iMS miL A17 a:f1108 

Sd' iJ3tlb1:1 dD K!®dtN Nl.in 900a ''1 6a"7• N17 7lltl ta 3NWD 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .i7 aN am6Ta 

'3XISU11Ca 30 "^ 7"•++a*a tlCi 

Slm 'jp7 aNV tSK91p•S t(qiyQ3 aNY SICOI65 IWM 

'SL .~t815 ?% W{ '3M aSrMUhi'31IYIC 3SladS 9 :1. AH tT.a1O6 

S,iiL7U1OL' dl K3MIV N7.iM 9000 'JOl iC{iA9 SN(R NI 3.7tY1D 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .01 a1 ambld 

.Tnw .nv JD Sa 'Pp OUN ry ..rnrix .:a Wl 

30;1D Da7 ON t&IIi1Q1l)LSitl =tl77tl1iG R7Y '9:Kia

FYqu.-e . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. i0 : 

CGANGE IIi FDFx CAlK.F7t 'J.7C LaD9 MTRI 7FR.SON/YPARS Q' IX.LSLFE 

TD PASSIVC 4ClD?G IY'RM tCfi'^CW: FGW R[L S/gh:'P' . 

SFIi'-R:aPCTDEllS, N8 SNRXAT`_' aESPOfaIN1' : NSl ILG CO06 

EIX! O1TTi'OM G1'IIXRL°5 OF ti6fS[8E 

IAnuits urtrs Aesup.ian 21 . 

Pigice No 1B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

aW= IN L'RJG G1lG71 LW DClJS Ml'1N PLR~'LN/YFMS OP mompL 

?0 P.-SSIVE 9dd!@I'i -N TAE 1CUg]GTD : fOR ALL SUd.'TIRS, 

NLV1R SPOIORS, AND FtFFER 4flF7RS : AND ILO mD5 

FL1P O sI'E'.7V1f CIi1".WtffS OP IX7C5fLlE 

( 1L•sults uo drs Asu puon 2) . 

Pigure Fb 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

O00>E 

70 PASSIVE 5}YXING 1N 1fE R77SppIDP Fqt .VL SUBIFrfS, 

PQOIE5 AND NPIFSt AND Fa D

NA 'Ilir . 

1 BF?.7~)!ID . 

t]OW3fA QE 

LI:fF)lH1M RVI1L1 

7n 19%2, the Report to the tMitd States Caqte ., on the iMalrhh 

Conwepxraas ot moleing fcr de first tiee gave sericus mroidrratioa 

to the !ssue of the e!fectJ of amiSrn .ental tahsxn smke an the nm- 

sideer (I) . Rtrt others besides senbrs tluselves orutd expsience 

deCimHtd hwalth effects doe to tah .cvo seoke Ird 6aan in the miu.is 

of nay for at least a deude. W.tetrieiAM in particalar seened to 

have im :m+ified this atcamp.tt.an, by repsring that cigaette 

sokinq rmmg pregnant woeen as associated with preman¢ity 12) and 

vith I.a/ hi . .•tlr.eiget (I) . Ather rep.xta attriauced a sole arrey, or 

adverse effeccs of aatemal smk4q m the foeuy . raeqinq frra 

Lticsire1 rxt-neral develacaent 11 .5) to rxqcmital arltornatiau f6) . 

Ieier studies acecAel to the effects of tohecco oaiocrwnts 

releatsM vKO the tTVirrivent at larqe . Fur inrJece, studies in tG2 

Lr1;ed states t7,5), flqlani t91, Israel Il0) and otMs cont_iee !1 .) 

sha .et ho . .hi1Grmn of wokinq parents had himri Lxiimx ^_f 


.t 

/ respirat3_/ infecuuns, as aell as hiqh.G hoeuital adAisaian cates . 

Ie6ocatary imeetimticro sho.ed that expan:ae to setenal snoking 

.xaduoed a defective develop,eat of pilawty faTCtim in childrm, as 

m..eQvd by toroed expiratacy wl .ne in one secvd 112) . Finally, 

reports of cltildheod tuecrs associated vitti puentai mnkinq appenrtd 

ia the aediOl literature . attha.3h often vnth eontradic-.ary results 

I1J-17) . 

:Tnt there Kse aeriooa twlth effects aa the adiLLt passive 

seker - soeh effects as thase exxrieioed by the swMeis thmeelua, 

i .e. luiq mnc.r -- .n net cons:detad possihle as cecaKiy as a 

decade ago . This on be gathered fxrs the follo+inq paragraphs 

pi6lished in 1975 s 

'ln smn.ry, the effects of ci9aretta sdw m Maltty 

wn-mdmrs cwist eaialy of dror eye aqd tlanat 

irritaLòf . 6oia!oer . people with oertaln heart anl 

lvg diseases (wgine Pee[oris, COPU . alleagie 

astte.) ry suffer eoorzhacitn ot tlrir s"Pcois as a 

result of aspanun to tnnceo .dra-filled 

.mito.ena . .r (lp . • . 

• With respece to lung eancri there is no evidenoe to 

l+diuta %hetber or rot this leuel of apos¢e has an 

effect an the risk of developing lmq raiqer . xo,ever, 

tacau.e of the lw dosqe and trief apcsure, it .oold 

see . unlikely tJnt rlere wold be a siqnificanc 

i+rtw~ e in the risk of dr .elaQinq lung canee: • i191 .

_ t- 

tt is an establisMd fact that the overnll caaoer tist for nor 

Makers is lnrer than tAe emwer risk ot the general population 120- 

221 . Cainsrd to smkers, noa-srokece' risk fer cancei is alnut 50s 

la+r t2C1 . ler oereain sius -in particular the respi-atory tract- 

the datferscea are evea aece drWeric . A recent atudy, icietheless, 

hes suqgested ttrt 4eq m,noer an

2 

fYIDWlOfAGIC =1f5 . 

-5- 

Conttouersul reP .u'ts on len9 m+cer tsWs snony narsokers 

have rot been dixvaa9in9 enou9h to dississ cne nyPothesis that 

passive sedting - also tnmed lnwlunruy ssYdrq or sea :dery 

Wdkinq - i,t ausally related to luq M-r' LI Jamxry of 1981, 

the British Medal Jounal pblished the first pqr .laticn stvdy 

. 8izayum repor*ed :1"r 

sPet3ficelly addn+si'9 tlus iawe (25) 

fi-dings of a 14 year old prospctiae stF .dY %Auch I"°olaed a follwrW 

for 91,560 soa-smaking malcTSed Japatese %acmm• rkro hwIlred aad se`^ccy 

four msss of Unq canar• had develocad in this 9ra¢o for Mhic4 the 

tw6asdl aWCinq history had been colle•tM itdePdrlently . aoften 

earr_ed to hsavy saduKS 11r20 oiq .retvs/deyl s0owed a hi9lws risk 

for lunq eancer thae +ms+ serrld en nar-s .okats IstaMatdired risk 

ratio . 2 .081 . RirtieIDOre, a statisrically siqalfiaust doee-tespo:ue 

relat_w .shiP was fosrl : the relative ruk for ni.es of +-s-+ ca or 

smkers of 1-19 ciqarettes/day .as 1 .6 : the relative risk for heavy 

2 

srokers 1>•201 s.. 2 .08 (NUReI-extension X test ') .299 ; P, tuo tails 

- .00091 . 7fie tred rass also otwtved .hen h•s^wd

-I- 

letrn that in a sulsricle of 23 cases, 17 were aderocarcinonss . Since 

sdurq has peen posralaoN to be aasoclated with specific histologic 

typt, this infa+*Mt :^^ ~,1d seen avaal . 

Ompite the draWecks nrntiax6 aEO", thrze are •xrtain features 

alplt lilreymM-s study that CiKf it 1ad:fJ" afld plCtobly very difficult 

to reulicate . 'A(e prospective design inwlvifq a large popolatioa in 

aore uwo on e 9eo9rapwc region is certainly a n asset . Also 

advantageats is tln fact that the smdY ans mrried out in a 

tradltfoul society Mrs'e sioting hsbita of wum are low * 

tlus 

d(m: . .L...iry th e pro6 .bilitias of inclodin9 ertauaaly classified 

arnen Nn developed uncer of the ltoq as a awnsequenon of their ewn 

sakinq . A lso , ss( soch a setting sairrLqes my last longer . Aames are 

rerta'snly sah ~rllec . atd soclalixinq for roirn woally tdxs p~ace 

ir, the cmp.oy of theL halw :ds . All of the abwe s:qgests 

Trnti-ìo(tlon of the Inn6srds' a .oki(q Aabita esy ffr3eed be a 

aeasae of aspcam to secvidhsrd smola . 

Ilin in 1961, hidup0olos at. al . plb lished the prelLMnery 

resolts of a stWy do,dactad in Gteeee (27) , using a nse control 

drsi9n. Ln ey assaebl.d a qra4 of 40 nm-sACking - dinpne+d with 

:Ully cancer in three lalys AtM.M 11WQifUls . lfe pGtietlts w~:e 

I 

intwnu.ed rmaedirq their Meta'ds' IDoicl+q habits aM yere ce :pnred 

r,t1N the ha bm6s~ saoking h .bits of 149 nomrdciiq trospi'al 

ca:trols . 

The 

car.trols aere ortbcpedic petients who did not differ 

si9nifimntly frv. the cssn with regard to aqe . eduratioo , 

dcratiao 

of exr ;i .+?e, oxvlatien or resicWky . ^_te odds ratio for w:en Vftraed 


that 

9ood 

to ex-sdoees w 1 .8; it w 2 .4 if they rwe m .rtaeA to curr,r.t 

enkers of 1-20 cigarettes/day ; and 3 .4 if arrried to cv[rent smmrSs 

of more than 20 ciqatettes/day . T7d .s doee-rrspuua txp :c w fowd to 

he statiatimlly si9nifiont (Chi-sq for linear trmd . 6 .45, p(2 

tails) < .02 .) . M :en espoe:¢e to hushuda' santilq over the murse . of 

the awrriage .as assessed a sLeilar trad .es cEe.zved . Fstireted 

odds ration .era 2 .5 for tlnw expoffied to 100 - 299 •ho-usar• 

ri9arett+s a(d 3 .0 for ttnae nsposed to 300 tlosanS or mre 

cigarettes ( ai-∎q for linesr trvd - 6 .56 . p (2 tail) c .02) .• 

Tis linear t :aM ~ idenriol in both grcop of oses : thoaa with 

eitological mnfiye•tion of tmor a :d *]nse with clinical diagemis 

o+niy . 

A later rapaR of ilidepaden' atody in 1983 aeided nearly as 

mmy taaes" and 5o6 anse oanrols, m w st'ry nmJacts (28) . ine 

results were •,^•••••••ially the saae : odds ratio of 2 .4 for dves of 

eeokers of less than 20 cig .rattes/dsy . .nd e31S ratio of 3 .4 for 

worrcn ms .-riad to smdeecs of acre tfien 20 ciqsrattes per day 1Ch1-sy 

far linear trend • 6 .7, p 12 tall) . .01) . 

'me Gree¢ atLdy . altlnulh rot enclrelY ooiparable tm that of 

llliayala . !)b. ." similar rfadlta . It also s11lres lpn: Cf t11N adVantaqla 

of the latter, n .rtly' tlsse oonoernlnq fasily atrmaora and fanily 

soeiel lif .' toqMhe- with their IaplicKions on the aswaent of 

eqxnore . as amaroratad apws . Differr.t aetlpdolaqical pfo6lerm . 

h-er . ou9ht to He oaniderad . For lrotanos . Ue study qtoq, is 

saell and tIC de9ax of p.vuloqieal OWim .tioe poor IonlY 651 had 

a citoioq .ol or ur,aloqiml diagncsis) . 'ms stody sonjcccs (nrn

)a 

yrotiag ypmn vit 

.h long cenczrl [epr~t aGOUt 78% of all the fanale 

!mg mrwsr uses diagrneed in Che pesticipetvq MaPrtais 

. ns is 

sentianed in a subsequeut . sectim o` utis cAspter isee : Oiscoloqic 

:yoe ao! 4slq Carcer) tM1e Propor"-ioo af noo-sookvm patients in other 

series of luy cancar cases has 6een "subli'aherl at ahout 10% for 

~ . The esassisely high ProPortlm relnxtrs' by T-'icbPo 41 Psck+ of ciqarectu per year (aa . 

3 .11 . p < .05) . 

Iepoerent drawsrke rai be found in the study by ltlayu Cortea 

et . al . . Its uin dissdvantage is the fact that the asehei of 

psrtrnpents is so sawll that any of the possible strRWqt .he of the 

study -- wch as the 1005 histoloqic emfixe.tim of dSagroai.-, - 

fail to aaFelnate for tlLL+ wMess . 

A mcre recant epideeioloqic stody m the llaq caneerpassive 

smdcinq ralatianship . .s carried aR by eerfiNrol . AoerAsN and 

Joubert (30) . Their qrolp of cases w wprisad of e11 farele non- 

arokuq lonq canosr patients diag'osed in three hospitals in Nev 

Jersey and en Auspital ln OAio. he~w~ dt.gooswd with aolm rwnoer 

se.wed as controls . _Tree metrols were sateMd to each case m t he 

basis of age 1-5 ys.rsl and hospital of di.grosis . Patioloqy slides 

for both ceses and xntrols .ere revre.ed Clindly in order to caMiim 

the diagtbeis . me tnmdred and thirty four lug rancer cases a rd 402 

mntrols .ere tlm uxert:e.ed regarding tee ssokinq habits of their 

t+wbaed+ . CUrre'rc saokinq Aanits, nuRher of cigarettes sad .ed at 

hrne, and mnoer of rea_-s cse As6a:ds esd ruked .ere assessed .

-11- 

SinilarlY . .a .en wre quest:aêd ahwt me mm°er of Murs a day tneY 

Md oeen exmmed to the siroke of otlrrs in the past 5 and 25 years . 

it wss foud that wwm . sarried to ssokars of 40 or sore 

c_garet[es per day ned an cdds ratio of 1 .99 1951 Qa :1 .13-3 .501 as 

crnpsrel to ttcse nrrried to narsd:ea . If half that asoimt of 

ei4arettes .es smoked a= 1xme, the adis ratio was estiarted to be 2 .1! 

1951C.:1 .13-1 .951 . 5ladlarly, an increased risk wm foond for chme 

„rnm netried to sen %s:c lad san :ed for 20-29 years (OR - 2 .21 . tut, 

mamerraSly . sot for t1c .e ssesid to ndasra of snre than 30 yesrs . 

fb incsea .ie of risk vas foud to be dependent ae the :sster of 

e:pcauTe-•Iqors 1n th last five md 25 years . 

tsiny logistic rnqresstan teciniquss, a scdel w fitted to tie 

stody data . The arasal incloded tesss for possibie m+fouders and, 

ser.ral m: timroos tim variables repcesentL :g 

espon:re. M lnaeese in 

roos risk with inceastrg espaeore ess foord for the nuMer of cigarettes 

srioloed by the Isnbsnd at hmr . 71LLs tzad .as statistiully 

signi!iavn at ths 0 .05 leuel . 

7Te study by GarfiNul et. al . attepted to tadcle sase of t-he 

aethcdololical pmol" ptesent in t 

.4e forsez ttodies as passive 

s :mlci0y, ;fie authors .rre socce-tsfal in pottinq tagethez a sirnble 

5co,p of cases Nro •r-te emfiraed neuer-s:mcers asd .t:ose diaqnesis 

wes nistolo3ically eesfircwd . Yheir assessrcnt af espoaute .as net 

1lmito:l to the ab:e derived fras the sus6n .'+ds' moki .-:u but ineluded 

_'at . .e~perunc~d at the 

.otbite and a_hei areas. !b.er:ul 

s :atistacnl tec`nid:+rf (logistic reqressioe) .ere used to ane! ;ze che 

9e'n, ord~v+g results cû'-armt 


.ria t~e f :ni .iins of c~e tw :.:xr 

-12- 

mejQ rcudies on this tcpic . It seme, t.he[efore, that the onay 

aspr of the sndy rhat ooold have affected the resolrs is tnat ~hics 

is acst diffialt to esaluste : tte reliahili-y of the data oollected 

thras7h the iMerv~ . fven efo:rp7 tle ilR.erviwwia .nse n¢:asedly 

blins in relard to tla i:ypetleai, of the study and the casrJantaol 

stetos of the paRScipsta . the psrtidpeKe tlrmelves varo anre of 

ehsr awf oonditioa . In Nis altuatiu: tte posaihiiity of 

o`TnePorci+9 by the mses mt be porne in mird . Ildaitionally 

lntentieaa of surrogate respes :dents msy Ie" affeRed the reliability 

of the informstlos about the esaaeure variable . In fact, lAeoel (31) 

has slo .el that Carfinlat'a eeMyrtaa of tLS addm ratios vary 

muiderably aocolding to the type of s.apvdsrt. Bs foud that ih 

odis ratio . for lug canmr ra 3 .51 19ls Q. : 0 .Ba-15 .281 in qr 

nsHrnw !n'hidh the sesP+de:na sere elttAr a dayMer oc a aon of 

the stidy subjecv . In the w :bgotq in Mddh tle lsobnd providsd 

inforaetiom on the elpwn¢e he foud that the odds ratio w 0 .17 

195sM : 0 .56-1 .06 . 1W finally, in tas wbgto:p of cases wte repecead 

a6wrt thel.r o.e espeau[e, the cdds ratio . .s estiaated to be 0 .e1 (95% 

Q. : 0.5e-1 .301 . 

At tM ssie t=se that this teport 4as beiml p.epsred, twu 

additiwl epidesioloqic studies olaiauq tne existen,, of a .odente 

effer of passi•'e smd .Lq m lueq essoer riab rese published . The 

first of the.e .as also eond.Red in Jap.n 132/ . It is a oex- oont.ml 

stuty, hut, as Yas tiue of its prede¢lor, it r :eMes use of a cefiRt 

i .zit.ally defined for .roCyr pocp:ae (rh study of the effecr.s of 

atcmic radiation in 4i_-oaai . :~ atd %~Yasaici sun•ivoa•s) in ont' r_o

-17- 

oorein its stedy subJecs . '1he cd~ort, c°'4r-'°d cf a6out 1101000 

xnplew yielded 525 cases of lun9 ceacer becween 1971 and 1980 . 

patholslic diagnosis vere drne in 37% of [hese 

. Castrols yere 

selr_ced fran :iie same ortqrt asang wenibet's 

.+'n had not develop lunq 

canoer . 1ye centzols 

.+!re Ldividually s+tched to the mses wuh 

regard to year of birth I+- 2 yrsl, resideiee, sec, vital status, aM 

,metrer or not Lh 

.ry had fielooqed to tlu ranrt sutBroup Uat unY.x.a+t 

. Inforn+tion m+s obtained for 428 cases 

biennial mriial eumisations 

ard 957 contaols . No .emer, oety 19 sale cases aM 94 f®ale cases 

occurred amg roa-ymMe_s . fwpiy the non-smokiny msles the adds 

ratio associated with hwin9 a apane `fi° woked `°s 1 .0 1901 CL~ 0 .5 

- 5 .61 . For females the corraspadiM figure às 1 .5 /90t Q.= 1 .0 - 

2 .51 . In a3lition, teieles slsa.. .1 an increase in, riak of lmig canoer 

with the ilCressing nalrr of cigarettes by the Mubud 

; the 

odZ+ ratio ceing 9remter than 2 .0 for the highest espomce care9o[y . 

1fie test of linear tra'sy, hawser, rs not s•a" 

:imcally si9nitiont 

at the 0 .03 level 

. Likawise, another nwwts of hu+huids' mdcin9 -' 

the rnnber of years the husband ~clod - . .s rot statistically 

siqnifiwnt . rLrlly, their rswlte sha.d that nan-aoking wmn Mn 

had peen eqn .ed to tle 1snLSSk' nckln9 in the lsst 10 years OsE a 

lo.er risk Wit e 1 .3, 90a G.t 0 .9 - 2 .ai than those aaen aRceed 

within the last 10 yesn IOB - 1 .6, 904 Q.x 1 .0 - 3 .21 . 

9aR of the ahoue estLutes are cwistenr in their nwgnitude 

•if net in their statistical siqnititancel ritFh the results of the 

!sst Japlrese stody, as wl : as Mit .h the ct=et stu8ies M lassive 

xm . ;ny . :!a .ene_, this suWequnt sntoy equelly shares in sae of cY.e 


-1,- 

setlndoloqic plvblem that cast doubts ower-their results . one w=h 

pruolem is the pxr rate of histologic omfi

-15- 

signifiauft 

. 1NL~tiunally, 90\ osdidare liRits are reoarted instead 

of the earon.i 959 a. . 

. klthw9h fsdn e nettqdologic or 

statistical Pnint of 4feN there is lOthin9 wror) with this alproath . 

it raiVA Cmtern Shst rese~-'d~Ers 

. i9 o[dQ to detrct ud re[+rct 

'siqeifiamt' efters . sey take the risk of aoo¢CL .9 a qrester mle 

of caanc4 in their !Ldinqs then tnat whtdi is oanleotionally deened 

apeaqruts . 

1fx sxrd arat recently published article is based on the poolzd 

data fran three case-cmtrol studi.es ()]! . .A lnety nLie histologically 

omfiz .ed lung tarcar rasea nd 736 oonttols omprisd the study 

ytuy . These vrre all the participants in smdies ewrzisd out in 

;ncsiara . 7"a

-17- 

wrm meraxd cc nm-s*rJCe .-s . '1=e rate ~ only 101 iug :rr òr tMee 

sarried to a $m*er of eure than 20 cioa :ecte pes day . :a~ 

oadoudinq variables `wre taken into acodmt laqe, rac¢, edumtim, 

reyidence and ry,ysbands• oxtqmt .ion), the eaRSS risk vas 371 and e1, 

rewectively . Noix of tlrx findings .ere atatistically significant . 

lk~ . the resolts have to be interpreted with great cautior. because 

the rt¢y w never desiqned to ebenin infon :~on an lmaive smKuq . 

PqrtBecaore, rhaceuer sedrinq intomnttan res aaailablc carespaded 

o :ly to the exposure at tfine of earollsent into the sttdy . 

Li6st and wynder 1311 assessed e:@aaite to seoxHa_'y s:mke in a 

suMet of :v :,kirA patients included in a large sody of tabscm- 

related cancers . Oot af 2S sade rases six reportd esposure to ocher 

pecple's aol:e at hone . as mpseed to 5 oit of 25 oarczoln . lYqrmn 

e( ttssse eases nWSted eRasufe at work verss 1l of the aurcrolsS this last ditfezence wws barely statisrlcally siynificsait . Aasq tne 

feale g.aq (m'S3) abaR the saee Ittapurtion of eeses and cmtrols 

were e :preed to oHrt pecple's >odee at hal ad wctc : omsequertli 

the association with lunq Cancer w nac .seatiaeially siqnificant . 

Sandler, et . a1 . reportad tlr, results of a casreantzol study 

ia•nl-rLq Sle r~r pa'ierKs (all sites, eaotpt basal-cell rancxr of 

the slcin) and SIB controls . in three separate publiatiars the au.hers 

assessed t .he association l:etwee~ tt:ese crrxrs aid : 1) emcsure in 

clutdnaod and adult life to the ssokinq of all !coselwld nedtrs ut:o 

smked (351, 3/ early lift fte to parental sadci .•i9 (36l, aM 

31 e:qasure in adaldnod as a resolt of spnuse's saok:ag 1371 . in the 

: :at of t.tiese --'e odi• ratio for t .Sae e,-csed to one s-nvr 


-LS- 

in the houxhold ees fomd to Ce 1 .5. If e:¢oswd to the moke of tuo 

indivi.luals, the oQls ratio inaewted to 2 .3 . and to 2 .6 if ex;ioeed to 

the snoke p[od:nad by three s:mkers . Tfiis tred was statisticalll• 

significant (p < 0.01) . Ba..ecar . it Mould be noted ttut an in¢ease 

in [isk walan uEsetv.d for active avokers .to pad been espoaed to 

the svdce of otts!rs in the Aasetold . 

11e overall unosr risk for all swdy subjects (passi.e . as rell 

as active, smokets) Ws reported to be elevated in both of two 

circwetaz,oes : .i+ei expoaure to setvNary sadmd had ocvrref dorinq 

d:ildamd miy IOnal .61 . and ,Aen the emilmMifte took place in adult 

life eslu.iuely (OIal .51 . for an individual espased in both pericds 

of life, the odds ratio exceadad tvo 10R-7 .7) . 

• Ibr the seoond repo

-le_ 

race, sex .-ed,mt3on, or oocluetim between cases and cc,rtiols . Mr;.i 

sue-speclfic cancer risk was asscsed, the authors found that exprnad 

individuals ILbse married to snokers) were at hiqher risk for cancer 

of the Faeasst laa1 .81, of the finele genital organs Iaftil .e), and of 

t11r_ efdocine systm IaN-3 .2) . Buad on a wnll nnher of caece 

In- :21 it w faad that passive sdkers shaed 1 .9 tiaes the risk for 

lunq cancar than these nor espoeed to seemx1herd sso:e . :Tis finding 

did net raech sutastial siqaifiona . 

There are mainly three grobleiatic features in Safdler'a 

cubliwtims that deserve eane atterrticn . The first relates to the ry 

in Ndch the results have bern preseitad . In aany instances the risk 

!or oncer associated with passive .mki1q is presented for the Mnle 

study qeoup . cceprising nm-seokers as well as asoixrs . AItlnugh the 

lat•.ier graup carr be tauidered passive mokxrs of their rnm se=Ndary 

smki - as well u of the sadot that othem promce - their 

inclusion seens inappfepfate, siire the ovatwhele'uq effects due to 

direct ssokinq wald tend to distort the effett due eaclmively to 

pesaiw amadrq . Saas tables, hwnner, do aeke the distinct .ion 

between the two gcoRa, and those ere the ones that are emst 

infometive . Secadly . eonfowdinq variables that aey explain the 

o0setved associationa were not taken into aemunt . Soae of these 

+a:iahies nce exmeure to alcohol, .to ooagational hafards, to dtuqs, 

and to sexual and reprcduttive behavior variables . thirdly and 

lastly, the fact cnst an asocucien .as tound between passive svoking 

and cance-s net previously deserihe7 as tohacm-relaud fhreast . 


syrem : raises srne suspicim . This fiidinq :ay be a 

- :o- 

crnsaryenc! of the inability to cmtrol for 2mfo,mdrls, aa mectiQatd 

am e . 

In additim to the epidmloloyic stdies, lahocatnry 

irnctiqetions, aloq with clivLLwl and patholoqical observatirns, 

have suppcrtad the hypcttesis that lunq cancer and prssiaa ssokL~q 

indeed eay be asaoeiated . The smt relevant literature in thne arens 

is disc.used in the follorsg paragreEtis . 

4 1l.FfJPNSONy INVGYCIfJrfIDNS 

mth obaervatimal nd eapesisantal lalrxatory studies iuve 

praduoed valuable infornetton on the biologio .l plausibility of the 

health effects of pssive sadcEnq . The amat isportsnt findings ere 

related to the identifiatfon of orcSnegenic substanees in sider .rea, 

smke and the ability of sae sideefie® saoke componefts to enter the 

oiqanisw of the passive sw,er f3W5/ . Cigarette a,dce omtaLts ower 

ane t)outand substances 116/ . Many of thea . including o¢cinoqelL+, 

are present in evan higher mioentrations in sidestzeam mn*e than 

mawtream snoke . fbr instmce, Diacthylnitraamine, a petent 

carciaoqen in aNaa :s, is 5, twros nore ooncartrated in sidestrsam 

meke 1a7-181 Bfweienn, et . al . /191 have estimsted that a nan- 

smoke : Mw apaLLi ene hour in a smky coon oay L4ule nitzosamurs in 

(Tuantities equivalent to snuking amut 15 cigarettes . aenzola)pirme, 

another knan carcinogen in srm asd uu .mals, is present 3 .4 tiaes aa 

,r.,;t^, i. ;idcstc~ sneke . F1rthermore, ene ci ;arette nay relmse up

-21- 

to 100 nq'of tmt substence lato the air 1461 . 

91t ho 

.w mrll mq,•' to these subetnnK¢s doel the reqular mr 

smokiry perfa : really erpesierm? This has beP+. arsy difficcvlt tn 

qrwn•Sfy . 'O+e oooartSations of tmacm oouponr+rzs in t.he emuanat 

tepet.is oe rnveran faccees 

. The aeumt of tobaao camaxd, the 

valune of aebieot air, the size of the :oom iArre swkin7 takes place . 

aM the type and aeamt of veiLlatien in an rnclosed space are soie 

of the aerl variables that affect sodce intake . Dr prWinity Of the 

passive sariter to the swtoe of sabks aed his/her pattam of 

iMalarian ery alan affect attu .l e«pes.ue 4491 . siailarly . the 

amkiig patterv of the individuls Mn do tire smkinl need to be 

oon"dared 

. lyr i••••••••••, the vatiatios in poff frequeoc,v . putff 

duatton and puff volwe an knwn to affer borh tre dmmiwl 

oompaaitian of sidestraem 4oke and its bioloqiwl activity (S0-sa) . 

Even the srtoker "s health statos sam to affect the wwy in 

.Mich 

sidestesa ssake is ptoLOed (55) . In faet, it is the sidest:eam 

senke that has bsw sydl[led by tta above ard uttrs factors t .hat 

oanrtitote t.1n ree! .MQonns to the pessive asdcer . Sane autlars 

prefer to refer to this as emiromatthl tobscoo sdoe raUer Uwl 

s :jestleam smke . 

Desoite these diftlcoltin 

. sae stuCies have attenxed to 

quentify actual ecgosure by mesrain9 tohaRo aetabolites in had!v 

produ«s . 5er,p 

:byacianate ard mtinine are found in the blood, 

ur~, ' senm and saliva of the passive seoker (4S . 56-60) . Ntl+oqh 

iiycriarote msy molt ![an otl+er sourre - i .e . leafy veqetables - 


_2=_ 

caunsne is a specific aerker far eeposure to tmecnv mwke nnd 

therefore its preseoce in the nomaQOkeis is ta .er- as evidrnte of 

pi+sive imela•ion . In one esq,eriment a researcher ves also able to 

identify nKegenic wlsunoes in the orine Of aocje~zs eiposed to 

swke in a prxaly ventSlatai rooA (60/ . 

6tudies aieed at deterasininq the apecifie de(asition of 

envi . ... .. .. . .~ snehe ceqponmU in the lurq tissues are very sr.anty . 

In tlr.my . the biotogiosl feetaes of the aurtary aM pAysyoioqy of 

the huaen reapiratay systm . ud the physiml and tlamiol 

cMracreristio Of slEestsese yoke, nqgest th+t sarL deposition 

takes place . The este0t of it . hv+eaer, has bxn a ratter of debete . 

oi_ferent aotlsas hsve remeted high levels of mdre bronrhial 

depositicn ranging Ira 116 (61-62) to 606 (63) . 

ConvrrselYr peli .ce aM Lorty (66) think that pt passiw 

sûYers an espnsad to a m4dw1 asant of asoke . peth.ps m .~. than 

the qoivalerc Of aee ciqarette per day . It has been us)qested that 

a" en erpccure oonveys a negliqi6le risk /651 . Mith respect to 

aLLs, it slwld be sord tlrt tq treYnld level Of asposice fer the 

develouent Of lisg runoer has Eeen established . Therefon, any le~el 

of .xPoaire - incloSfeq the low leval attsirs.d by psasi.e snyLiip - 

slnuld be oostiderd pota+txally able to elicit a qreirvlenic 

rest.rrse . 

Another s.ties Of studies have been aired to dete .t the .f•.eccs 

of pessive seqkyq in the respiratyy •uKtioo of pusive sekers . 

'M1is la particularlY relevant since saae aotlrns tbink -h .t an

~•'^('4« ..:ez 

iaosi.:,d ;espira-, .arj 

_21_ 

fwcim is in itself a risk fact..-r for linq 

caK.er (66-69) . In ftant: . Faoff:ren 1681 ot . al . oonoared sPi-'o'etric 

nesaceeents oet 

.reen tw types of nai-wokers, eKrosed and nm-eqosed 

to secadary >neke . M11ey found that mth aen and .caen nerziG' to 

ymsers of r 10 g of tota .m a day hd a siqnificantly lort foroed 

mid-expitatory `ld rate {FL" 25-7SI then t .hoee auried to ron- 

mc.e.'s . In additiot, wnen in the expmed q :oi4 ats*a~i a decrease in 

forced ex?iratary volwie in one secmd f?£J 1) . The stud9 ffi-=fui :y 

cmt-rolled for cmafomditrl variables surn as aqe, sotial class, 

eduatiam, family size and air pollutian . 

Wtite aRl frotl> f69) eeadueted a sady in %hidt the effects of 

payive sradc'vtq in tlfa wrkPlaoe were asaessel . It aas fouM that the 

deczeasm in ferce0 mid-expiratory and end exPiravay IFFY 25-7i and 

!L

S Ap'IIMAL M FIIIIOri5 . 

-25- 

7estirq the hypethesia that passi.e smking ani lunl cancer are 

related by amens of animl -quriaenra lnrnolves sismilar difficylties 

asei'ad to the stsdy of the oreinqmie effects of dir!et saokinq . 

44e search for a suitable ahiael .odel has taken smfy yee .-s . nd rhlle 

researc-s are able ta reFrodiea msny of the respirarory s}stea 

tumn . ro oae .wld claimed to hew frsssf an ideal .edel . 

N~, eaan vittiam interdinq to do so, away of the w .periments 

aised at snslLq the effects of direct ssdcinF aey inleed have heea 

test,sl the effects pmdmed by pnsise ssoking . Various spedes of 

la6oratoty anla.ls laice. rfta . syriah hrestersl have been 

esperimennlly expesed to .rcJorfilled emirauEnu (72-75) am such 

stody (72) now ovnidereA a classic in the field, has slwm that 

ratbits ex7iosed to eavirvepKal avoke sry develop ttachecbrmdhial 

eptChelial aetaplasia ard dyspla.L . This study, along with the 

otters rhich follo.ed it, 

.ere interpreted rlth auch rautim since they did act quite s/aallared the phe~am/m they were iateMei to 

stody (i .e . the effects of direct ssokinql . Different but equally 

iapcrvnt oeests should be taken into crosideretim N,en these 

studies are used to drar cmclutions ah= expmore to psssi•.re 

udcnq . For Lntwrre, ee cannot be sure thet erirsore to asoke in a 

closed e!swber actually sLe.latas passive mo" . mr tFat Cs 

amta .ry ard physiolaqy of tm respiratory tract of the ex@erLne ::dl 

aeumsls wWd :espord to sacvdazry s+*e = the saae .e- as hwnn's . 

fbre re :ently . nFoistitat-t eaAirnv.t that ?roduces ani traos 


i 

- 26- 

sidestrean smse has been de .¢loped to sLnilate ex;msuje to Mnle 

ymke or to its qu phase only (76) . Such devices inclode emposore 

rsaaoers for roiemts, cell cultures or isolated perfused lmgs, as 

.ell as mechanissro to senipulate aeda roluae, dilutim . ad oriMs 

variables to be stodied . 'lhese denioes are rcmt yet part of the 

staaderd aqulaeat af speaaliaad laboretories, but it is likely ttxt 

their inttado¢im vi11 prodze a reslth of lcorledge regarding Cx 

effec-s of udescteen sdre . 

testly, saay studies have presented evidewe of Ce cerdmgenic 

precerties of toha¢o ampomenra .Mn admi^ :s'•M throxJh ra,res 

otlxc c~an the respirstory t .-act- lYny artieles m the effects of 

suhwtaxvu in7eetiens ef tdacm ospments 176-'l7I . along with 

artic!es m the effects of rubbinq ud sklh painting with te4c+m 

ctepourNs 1761 . aqree that there !s little rmsrn to doubt the 

careinolenie pxoper•1es of toosma sede . 

6 S4AQDG NID HISIFdAGIC TYPE aF 11R& Qlll9t 

An oheer'atien that has created a qreat deal of intexset aemg 

r.+ ..n++e .s crnterns differenees fomd hetreen knq rsuioer ases in 

snokers a,d lmg caneer rases in nonsmkers . These differeaces 

pecrain aa :nly to tw factors . sea and histologic type . lfae relevant 

li_eretore in this sobjeR is discussed in the folla .Lq paragraphs . 

Mong ra,en wtl1 lurg tanoar there is a higher perrareye of 

la.sucMrs than ananq sale eases . ln upper tw York State - as

-27prelimWry 

infaeetivm for this study yes bein7 M1ier .'sl - w fwod 

t'xt nawmocvig ~ conPrised 9 .01 of ai1 feaale ases, .beress 

tntymkuiy anf repre+ented only 2 .0% of ell eale caves• Osing dats 

published by [SeNzr9 ee• a1 . f7B1 . I estisated suiilar figures . In 

their series of cases . 10 .71 of t!a wrcn .are nonsrroMers verw 3 .0% 

of the ec.r: . Ymn data prwided by F .ot and y+derr /311 tle estiseted 

cnnesondin7 figures an 14 .96 and 1 .90 . Finally, GsrfiNcel et . al . 

raporred that 12s of the fswle luq raeoer cases saeened for 

psrttcipstim in their st.dy (301 .ere ien-sdters . 

I_ has been wggestad - sinc< ferer wmee than men ssoke - 

Wt a larger ptoportion of females an left sueeptible to the effccts 

of otisr urcino9ms ilndldiM seouelu^d smlie( than to direct 

cigarette sm*e . 7bese c,teelnegens .wld be respaoible for the 

'exQas' mrrber of no>asaikinl fessla caxs . The effects ef these 

carcieo9ens in een so+ld be sasYd by the ouenAelaing effect of 

direct ciqarette mdce . 

Histologic type has also beei reeegnisad to be associated ua--4 

sndcieq habits . Tr roaae of this asociatirn, }w~r, reaaim 

controversial . As early " 1957, Doll et . al . f791 had pte{esed a 

'dose-respaee' relationship by sM.ir.q an assoei.ation flecween the 

aeasrc of toEaoco mosed aM the deaelcl7*nrt of e ;ademoiP.• lary_ oell 

ad sall cell otreLrma . f!ther listnloqie types uere faad to be 

either or.:elated. or only sliqhtly relatd, to snohLw_ A feu yenrs 

:ater . !cre.yoetq wblished similar ehsetvations f8m . He foed an 

as»ratir. Y_-.em viokinW ard eprdenmid, lae" c^l : aed smll -e_ : 


-2e- 

ra.-cimsee, similarly he rejected an assa :attoss be!wers, smRanq and 

bot.h adanrarcimss and Lrurhioslvectar ca[ :i .nie . 

Ils then os. w arthoc Irs fully agreed .dth any other, 

• preaentiog reaults tlet are ofun frarJdy contradictory . weiss . et . 

al . (611 in a prospxtlw sudy of 6 .163 sen, added .~+MTinae to 

the list of histologic types related to mok : .q. Yesner (62) 

cmfixmd the asseciation beoem aol~i.~q ard mnll cell ortltneu, 

hut snt with other oell types . lroerb.ch fourl aok:ng habits te be 

equally distribuasd in all eell types, tturefcre deryiog any 

aseociation beywen histology and tc6amo amoh. 183) 4inmnt cvclodes 

thet adenwarcimr and bmsbioilvaolar carcLoss ate irnenely 

related to ndcin9 itll . Atd . acte teoatly, be lnleoedett atudies 

have eepn•eed that a11 c.ll types. including ~ . are 

related to agsrette .okleq 1051 . ' 

•1Ae difficulties in interpreting the results of theee sndies are 

many . 7b in fartia+lar, ticrelar . deserue to be mrntioed . First, 

there is the ptobimattc drrecteristie of the study 9rThey 

m,prise such hetereqews - and selected - populations thrt 

pasible saeple bias is difficult to ignore . Seasdly, the 

LxerveR.ion of so meny, petholoqists in the rwit..inq of the slides 

brings to mind the liYelihcod of Imreliability, of diaqnxe . . It 

slnuld also be added that the studies mer an ••*end-+ period, the 

oud fifties to 1984 . ourinq this period the ability to assign laq 

cancer raxs to soeelfic histologic types has clwqed . as on Ce 

assens.d by tx :.e.-erosing nuMer of casc diagnosed as

In 

wdiffereneiatai êl1 typn . 

A msa c ;e.•rc assacia[_on ' s fou:d bero,eer: hl.stn!oqic :ype and 

gpX . MG6t studie9 a9tCe thet epideifrcld rfl'^llYllla is TJCe frequOR lf1 

ma!es tlw+ finela 

. 7fie pivporcim of male raxs classified as 

epideeroid earci+nies nn9as Ue*.ween 381 qu1 64" wr fe :mles, the 

val :xs are 6etweeA 21% end. 551 . 1Ye ottrt notabie dSfel~- occ.as 

an,,4 ademurc~mies : this taor is e=h so:e mnm : evrrwl .aien tlw, 

nm . ap to 52% of a11 1 :m9 earner casa in faftles have bem repa'tc1 

to `slong to these qraip, M~ 331 is the highest aavo9 aen to be 

pces,ced in recent studia . 

17w differenm in tmeki+sl eabits Cet .een seA and .omen aulgeses 

dre such iubits s .y 6e raspotnlDls for the diffeZms.a in histoloqic 

types avq the .esu . Oefortontaly . this has net been pmperly 

assesasd in any at•* . Nast reperts deal with the sex-hinnlegic 

type, or the s+okilK''l3tolegie type .a.otiariam. 2ne thier+ey 

interacrlon, xx-sdcUq-histoloqie type, reawins to be studied . 


. aGPIfR W4D 

In Anrii of 1982 the Ner York State ptpattmeot of Health 

initiated a latqe stidy nf the tpldaefolary ot luq oen'i . t!w York 

SGt., with appmximstely 10 .000 oses of Wnq caneri reprsted every 

}rar to its tumr registry, ptovided an e>mellerc setting for a stufy 

of this natore . The pmject wes intaided to be emprelx•naive, that 

is . to intiode both snokinq and nat-smdcLq long caneer cases . Stsdy 

of the q[oup of sndcing cases wes limttad to the clinidl ard 

patAolo9inl cfur .c.e.istics of lunq canner, .heress the asses>fne :t of 

espnsure to passive sndciig ad other relevsnt em .im.rntal variables 

w:re the mein study variables in the non-s:rqking The ruay 

design also d1iaC for a population based mse,rtdrd emtrol groop 

(this gM'P wil l be descihed Iater in full dereil l . Lt is only clese 

~ lattel qn .xps - sm-aiokinq cases and their wtteapordvnt 

Mtdrd ceetrols - that will be used to assess the effect of 

eW:sure to paesive srokinq on t,rye risks of lJry caKer . 1Te 

-30

RG4N;dJlGQ1C app[oa-" '1Sld CC J'JS eld is Che C11eKO'QR rbtCMYI c3•le 

crnt_ol study. _ 

It aay be pertinent to eentian tlnt the ariqiral desiqn of the 

st 

:dy specified that, in oper to disQra aoce precisely the effects 

of passire snoi :iat oa the risk of dew:aping lv:q renaes . all caaes 

u:cluded .wld be never snokers . 1w tMn9s were clear early on . 

9wevet 

: firscf that aale cases eere rarely never >nokers (cnly 2 . 0% 

of cAose initially saeend for iLclosim in the scudy rel .nrted to 

have aever sanred) . ard se .vd, that a sofftcimt mwler of these 

r&ses mWd for pes .ibly be asseblad in a reaxarohle per?ad of tiue 

so as to satisfy the ee:ple aite req:creRnrs . M1tmreCore, the 

elegibility eriteria for r .ses uas ncrraisd to lwlude thft Nn had 

stcppet saddrg at lent 10 yaars befote dia :gnsia . It "d ttbn be 

clear tlxt rRrn Ve refer ln this tepctt to tJr qrwp of aoa-su(wg 

ease.s . we are refereinq not only to never ssokers but also N forner 

slmkers 

. 'Ihe iupliostials of the deWicn to incWde forner sokers 

in the study 9ivuB are discussed in the later sectio : of this C+apter 

that deals with serhods of anelysis, as 

1 a61E.'PIV6 . 


.el l as in 0oprer rour . 

itx sayi nLL-7 ose of this stv?,i w tc e>mixe rle relationship 

xr .ees xssive ankinq and llnq ce'mr in non-vmokers . oxn9 a ose- 

cx :r_rol approsch . Taa w tal! by alely=iag c'ata tallr_t~d in 439 

cnes cf lvq t•aqrr aod 439 metUW "healthy population ~ls . 

The specific questioa addressed in tLe analysis .ere: 

11 Is there a risk for luq ~ a .sQiared vith tlss apSnes' 

ssolNirg hshiXl 

2( Is r .Yle a risk for luag osnaer aaaeciatad with mmmk.~ng 

haaits of se :6ars of the Iwse:nld lirclusaw of spaael? 

• 71 Is aKpcaute to passtve mkiay in the wirlpl .oa asea.Hated 

with a htgher risk of lug cmOerp 

11 Is passive amking in saefal stLatLtitu auactaty with 

e hlqMer risk of Ivag carnaf ~• 

. 5) In the awrc thet *ha aawRr to tln .m q(aet(trts is afllrertive, 

d°°G the asappiatlca pgaLt after mRtollLq tor oeafpadiay 

'nriables7 

61 f5n a doae-reapenaa Eabeel psdw alnkiiq and lmrl er,orr 

be sMm in thts dan7 

. 71 An tlen diffefenx in risk for aiao ad .~7 

!1 Me there diff~ in risk for ae .er saqMrs ayd 

for fmier snokars7 

91 Is Lhere a higrer risk assoeiatdd Hrl+ a apecifie llnq 

tanaer histeloqit type?

2 SnARLS sl :e. 

_„_ 

It ~ estiaated that a sample sire of 45o cases 1215 males and 

225 femlesl . tegeteMx with 450 ocntrols, wuld be eeou .ury to d7tect 

• relarive risk of the order r4ertsd by e1"'Os• 125) and 

'lYiMOpraailous, et. a1 . 127/ . prelimisary :nfacmtien ellectcd in the 

study area snv.ed that apureodrtately 1,200 femile lung ca,»tr ~ 

aere diagrux.d in the study area every year . and tti: 9 .09 .exe mMrng 

never aroke_y, 'llsW, it ys estlaeted ttiat lallorini fur a 15% 

refuaal retel the 225 fnele eases coold be assenbled ln a 

:erial of 

a6wt IO noathe . rouyhly the tve available to collect the data for 

d :a study . SLMV oNy 2 .01 of aen .ere never sokers, garhe_-ing the 

ye~p IILLd,er of alate cases MWld have takefl rrlGh eY'xe tlae thM the 

available period alloyed . As iediwted a6~, it w suurlh a 

realstation that praped the de 

:isim to include cases that had 

sttigxd sidcing at least 10 years osek . 

1Le final saiple site fell slightly sheet of Ghe pxopeaed nuo~xc . 

tt vas caprised of the 439 taaes aed their 439 eetcned aentrols, for 

,AU;.h info[netioo ..s teipleoa . NRrq all eligible caxs thf respotie 

zte .es aose to 801 . SAccae.un9 an addltiaixl 4 .0% fa : 

drJ :icians* refusal to let their patients parti_ipate, the total 

rearanse rate o'n be estimted to he 759 . 


) Im11TON OP STR SPDY . 

_3t_ 

A check of the data acnnilatd by the tLV Ynrk State Tapr 

pegistry nloed t .4t abwK 800 of des of lug am.i ecwr aea,g 

residents of the el¢R Stantitd Metrcpolitan St .tistlnl Aress of 

lletate New York. 71fis loeale eoa4zisea 23 coaRies . with 

ap,wn.i .aely 125 diaqrastic ad/er trrnn

in 

-35- 

sussed by .the hveQtta!-oased r®ortu .q ays :es . Specal emphasis .as 

pat cy the field staf : an the tivelinns of the reporti.iq, lt+ce it 

.es necessary for tir_ p.ulmes of the study to aMain personnl 

iatervrn~ vi h the mxa before they died or 6eane too 111 to 

perticapate. The :~mn tiae elapsed 6etreer dia9nosis ani repnrtitg 

.as .3Geeted to be 45 days, with an additiorxl 102 days transpired 

before the e.xducttn4 of the interview . 

Rhe reqrcinq of a case .as follosed by the securing of the 

soksa9 histery statea in the pstiexs' Inepirnl medical rtmr.ls . a11 

wn reuo[ted as nevet sooke.7 . forvlr seokets or of uNawn smokinq 

stetm 

.ere oontacted by telaFMM and theix s .oking history 

coifiad . ohly those cmfitsed oever aekars, or ex-smdaexs for at 

:esse 10 yesn. .wte oansidead for itrcluslan in the study . Atl the 

eleqthility ctitezia for cases are listd i .ld. 

S fLOGG1811d1Y QtT1fRfA kall fA45 . 

1/ The patiwit aut be a resfdent of the 21 cuwit.y study 

area IS 46R of Vpstite Nnr York) . 

2) '17+e Patient had to be beo mm 20 ard 90 years of age . 

ll 7he patient had to be a never fsdoet lMrkM < . 100 

cigarettes in a lifetlael or an ax-spo'i (amted :dyvrdwl or a pnysician's muenat 

was not gnncc;l .

6 SF3fLTtaN OF WNmDIS- 

-3%- 

Lry order to pmvide a mme :isoa qrwP. each case ias 

irdiv/doally aerrhd to a PW+lacian aatrol 

. The aa+rce for soch 

coarzols ws fne State DeAarw'X of !btQ uMicles fiies . This 

source was cmidered apPopriate sinR it Pon"ided ~e of the 

rdoCnetion neoesary to perfara the aeecltLxl . Additiarully. thi s 

eethed .es re9asdad as :ess txw-comsumting and lore ecormirwl than 

otl+es Possible aeNni+ for the selecting of mncxols 

. such as random 

di~,t dialvq. For each aue. six potan:ial cosrsols .ere selected w 

c1e hasis ct age, an 

. and castty of rasidrsoa. Upoa a teled" 

lnterview, the tixst Pocartial control V .» was to+md also to mtc.h the 

case an tlr. bnsis of ssokvsl status - and Mn . in edtitiom, agreei 

to psit.icipate fully -was included in the study . In su,nery, the 

eligibility criteria for cartzols w as follous . 

11 The control had to be of the ssn+ aga l . - S yearsl as 

the cortesEa .vdin4 case . 

71 The control had to be of tJn ssm ses as the case . 

11 'Ihe control had to te a residmt of Me saae 

nmty as the mntrcl . 

Ii T.r . control dad to have the sare aaoking l+is :ory as the 

©se. That is, both had to oe eitle.r never smkers or 

ex-wo4ers for it lnast 1o yiars . 


-38- 

An ad3itioeal artdiing variable was aaaidemf at the tiae of 

caducung the int.eview. it mcerns the aetter of +.hether t2e 

questiomaire was reslanded to by the case hiseelf/Msself or, on the 

other had by a*nrmgete fesPudent . The awtrlhing on type of 

vu:emer is better explaLal in the sectim of oRA CCLl2fia : etiieh 

apOSVs next on in this Qupcer. 

On the aa .rage, two Pctercial oo'xzols had to be ulled until me 

aetd+ed the mse an mddnq history and was rilling to partitipate in 

the stUAV . 

7 pNfq WyIffi'1W . 

Qae the eleqidility of eases and controls was determird . the 

Field sr .aff artanged a face to face intesvier vhleh took ap~tely 

one hoor to wnduct in the patiaR's hrnr . All rfaaatirn Was 

collected using a pre-oeded Gucstiosvaira, The queationnsire was Pre- 

tested for a 3 amth-period using patients diagnosed Pnnr to the 

study lariod . The sectiov of the qoestiornsire that coarutn the 

iteas used for analysis in the prerGit study are found in 11pPeMis A, 

AS wuld be siraecced, aoet of that questioro are orncerned with the 

measu,eer.nt of exeosore to pusive arcikinq ; but iKorsPtian an social . 

,Avo4rePhic and medical variables 'es also souqht . Both cases and 

mntrols were iirervie .ed exactly in the saae fsshiui, and eu.ept for 

cne ite :n in the questiuwlue reterring to the _ inical asoeets of

$~: ;,4a,=< 

_39- 

che arzre :r mafical cmditaa+ . they tcth av~red the sm.z nuimer and 

cype of Wesuons . 

tt,n the fie1L staff fwd that a mse had died or had be`'ane toa 

ill to pnrticipa2, he/she You1d ast to oaduct the inte :view r :fh a 

noa ot kin . [s-eferaSly _t' : the s^rane- but children and other 

relatives Nec'e also oonsidered apecppriate surmgace respo .imts . When 

a surrogate respordent had to be used for a tase . a surrogate 

renadent w also uxd for the crncml . tbr instanCS . :a,m the 

spooe of a case .as Mterviewed in lieo of the ase . we would seek to 

:r,cewiey the spouse of the persen aelecred as a ea :t_-ol,ol, err~ : if the 

latter .as available ad willing to be imervie.ed. In this respect 

.e should thn note chac cases am mnrols rera srtched 1n addition 

to SIX . 1Ge . 9rilIIt IRSrI)lC ad A6IDklL'CM on the TRE CF' 

ltffl7NIF11 conducted . 

0 elsmluar lesvra+ . 

M Udepa :da,t reviev of the patbology af.ednrns initially 

ezasinr] to aake the df.agnosis of l:mn eanzr s.sed uiportanc for :w 

reasons . First, to mske sea thst all âses weie ccnfirned priau'Y 

lung uncer cases . and semd . •a provide a unifans criterla of 

diagnns . '[be pceotdl•re fx wd : reviev w as follera . 

'.he ftel] steff .aIld Cx.ca .t rne pac.ieicgy depacaacac uf the 


- .o- 

dieqrosusi hospirsls and ,.wld requ .sc the slides or tissue blodcs for 

the Patient in questiam . In all but five patav" socn reqest was 

sirasseaful . lfie *R-^ . . +..a. aould tlen be seat to a iLthologist at 

mmoriel Sloane Yetteritq Cancer Gs .ter in Ne.. York City, ao wuld 

revid Usa, blindly with rooard to endtSnq hiarory, the initial 

tuepital diagnosis, asd other risk factnrs . 'L1e reeiev pachologist 

assigned each case a hisruloqieal diagnr.is aaôedinq to tne kbrld 

Neaith frganiatiof Intetnatienal Ptisroloqiml Classifiescion of 

'.lswra (B6) . lhe review dia.gnsis .rs tlen espared to the initial 

hospital diaspnais- if tlcê yas dis+7caeKnt betv .een in:.cla1 acd 

cevaer diegnosis4 a seeord pstholoqist frim the saae lestitntim uould 

revlew the slidea artd assign the fiaal diaq :neis. E1a: trrough a 

detailed bistologiml classifiostlon w provided by the patLologists, 

for the purpxes of thrse stuy re hm uied a tarese elessifiewtion 

that divides our cases into the following histologic typss : f.pidernoW 

or squsnous tall a«ciflCff%, 9oa11 cell utciaaa . AdHmrclnars, 

Large cell cereLw,r. a:tl Others . 

9 DTOMt vMtlABfyS . 

:he aaie hy~is of the stndy .as cmrmed with the effects 

of passive sndcirq on luq c.noer risk . In order to assess the 

aaqnitude of such an a+sncattcn . .,e needed to have bath accuaate 

seasur'anents of sspowr.e to the suspected risk factor and accurate 

:roas.:rment of h disease status . Hov the latter w aCiewd nas

-a :- 

yee; e- .planed in the previous section dealing with hiv^-0loqic zeviev . 

ln r}us serSan it will be explained hou the expmre to r.he risk 

f .crjr was decemtined . 

9 .1 SR7U"P 9OILFC NA91TS . 

.t.as 59 to 73 in the :psstia ;:ai: _ IJppedis A) Lqo.red about 

w ~-g hao:ts of op to fwr spwses P.r study subject. 'met 

infornwuT .as used to aeare the follodnq eeesur~ents of 

asposore : 11MaOe_ oC e:wrettca asokid .~ b. rhe s(s . The 

mmber reported by the respendert rs take.i directly frvn the 

yuesCianaLre Lf Jw eue vsKecl 1ed hee; ar.:led only arce . or ii 

only me of his/lera spniwfs/ had sunk.d : If mre trin one s .rriage 

to a snoker wes reporrad . .Ae e+¢c~son w asefnered to be tfe nwsn 

naoer of ciprettes/day ssskad by as srrry spxaes as repocced 

Issinai 41 . 21Nnter ef Years tl±e s°ase smred . This fi9ire •w•, 

. tiken directly fras the rS»rtad mn6er of ye+o w fizst spuue 

Woked .ii.le inerriwd and livinq ta)erMz with the study .ubjeR .ws•n 

ap?licanle - tAat ss . in the ms, of sore cMn on sarriaqe to a 

anoker - the maeer of years ssoled by sulsewnt saodues rs s:nply 

added to che first figure. )17ota? nurter of cigarettes smked !Lrf•e 

ecane drinn ma .:iad life . 7tis variable .as calculated hy 

TAl :yplinq the mmte! ef cigarettes ssoY~d per day by 365 to ntu:n an 

estiswte of the +aoer of eigarettes seck .d in a lvr ; t .hen, 

nllitiPl,;InQ tlNt !i9Ufe Dy the n'1'r!t of vMrb the sDOWe W repQ!ed 

tG YYVe Sok ed in J! C1nrae of rlr .' :MCrN§t . WMJI af.re a1M CI* 

:pn.ue . .es :elar.as s+ sadcer, the ror.l arrried-life nuroer of 


_42_ 

cigerettes fa w3; .ould be adld into a single smasuremmt of 

ex,7os:a'e . 

9 .2 0Q'06tAE 1D PASSIVE Sflal

9 .1 PASi1VC SIqN1PG IN PcFAW4'tAa. 

The infe:eetion eolleeted thm~yh t~l! itee6 aGrked wyth an 

asterisk ir. paues 168 aId l09 of 7 ;Qeidix A'es the basis o^ `mich to 

estlsete eq.more irn the ruHiplaoe . This variable was created in 

nactly ire ssme nwmer as hanehold esEemue . 9nt is. the mnEer ef 

years tl,e atudy suoj+sc wrked in a lwrttcvlar place ys nultiplied 

by the eoi6er of sool-ers rie «orked in the same roon or arus. 2his 

was dme for the 12 anet recent jobs ud added ov.-c to ahtain a single 

rms:rmer:c of exposure . ?fie uMts of expcs,¢e . .as rell as hometnld 

vpnare, are eqaeseed in person/yeezsi aM their inte[laetation 

shwld also be similar : a smi~j• of epowue tot esch stdy subjee_ 

to svakers in the %orlplaee ouer oerrtln period of tLse . 

9 .4 PASSIVE 9T71QNG IN 90CD1L CllaGIbT11NCs=, . 

Page No 173 in pppendi x A ahors the i tmr asked durinq th e 

interview in order to estimete ewposuce to secmdary sroke in social 

ctrasrtwKns . 

'Riee itmnt .ete iirceMed tc ml3eet iafarnetieo m J 

aspec.s of aynsum The ilLSC is the type of social acivitin .fiich 

are cmdncive to ex?Owre to psssivt smdLleg : secmdly, the frefi.rny 

vi`,.h rhieh fldi activities were carried ow' : alY1 tP1:Lly , t he stages 

in life (10 year ir.tervslsl in 

%hic h such ael vi 

ties were carrie d out 

• •Rie infernetion cahueyed by these 

n_1 _hat par-.icvlar f„eqoency . 

-_!e asoees o : +JGASYe •.e4 slrTeri^2 3 in a s ingle :idex 

chat uoee 


e 

-„- 

fmn :ero to a rtvximan value of 96 . ',ftta indes is cbtainml by adiinq 

the infornetiun ooded in item+ 166-Z00M lbr further details cn the 

eestion of the iidot of eqmure the reed'r aet refer to the 

AppmdiX. 'CYreo bo[h the list of the att_`vities Lfcloded md the ,ay 

in Mudi the infomation w entered is self-eWlanetcry . 

10 tvmfIA1Ly CRaqRIDQ1G VANIAgt}.;., 

Lupectim of the data sloed that .ases and coritznls uere 

diflerent vith ieqerd to vuiables `hitlh vere trelieved to affeci timg 

canos risk . It w dedded thet thM~e should 6e cauiMsed in the 

analysis as pn[wnlal Cmfouders. It .wre arre . M~ar, that the 

infonetian availa6le +.s rct of umforn quality aaass veriables . 

`neress infot21stian M sociodeMmraphie variablea was iiloely to be 

highly reliable . the infomatioe pertalni.q to drsycol and/or 

ott.uretional esposures - ail ebtaired on a s .lf-repoctad Esats -~as 

rot deemd so. 7tw . re nrried eot the adjtreme~t fa oonfoondirty 

var iables ln tro steps. 1he first, NLLd h ve call 'psctial' 

ad7osrnawt . ierluled oely those variaCles for whieh ,+e hsd •hud• 

intotrtntim . Such variables were RPLI(;tON ICathplio ~a Oflrr) . 

[KI7ME. N1RPW. s1a1CS Isingle verw ot'ri) . . !rd 42Bf7t ot' CIOVV.PItS 

sf10J/u9Y aeorq the fornrt smkers . In the secvM step tw 

veriables .eze added in order to orry oot a'full' dj,naeaot . 

otlrr 

'Ifine 

ver :abiea .en : en os,¢e to any of h C4HICJ,IS (never versLLS ever 

eqrasurel liated in itans t02-218 in paqe 176 of Appe,dix A , ard 

~ n to •R.`L . rt'SI OR RKIATILli CN l1E J®' Isee page 169 io

-a5- 

tnad :x A) . In adflitim to PJese . otMr relevaat varia6les ~re 

cvuidered for inclosim, hot a closer ammimum . of ttie := 

distribution ar .vs) cases and mrr`sols slwed no simuficant 

diffelemcss. '.Tnse variaoles Kle : F]Wl1Rtl.'LV Dff= dR FJIli1LL .)î: 

tilFS 1aQf 8Ug5, T/C7G6 t7R 1U18M : 17UO6LN6 TO A rAS MOLQIf; 

pAt .ro AT LLy£: rxMRE TO MEOS2E !1EP.TEFS : and M O6I7R . . 10 A 06V. 

dp Wpp $Stllri (paqes 169 and 

171 of AlpvidiII A) . 

Ye believe trst au best djnnted vtL:etes ~e those cbtained 

by rhe in-'-u+im of t 

.he first qraQ of variables, since they are based 

m the sret reliable inforsetam . In Me Mct chaprer, therefore, W 

mly preseet Lir. additia : to t2r eude e+*lizatma1 the results of the 

socalled 'Part'•lv ad7ustnant . 

11 AtalI15I5 

1Le e`nior of sutLstir,l amlysis terJniques rss primsrily 

determire.d by the design of the stssly . 1hs latter called for the use 

of terlniquea capable of aacou :ting for the srtOWsl, as .ell as for 

tec`.niy+:es capable of dealing .ntb canolex situations in wuch 

cv .araaces - in additian to the eq :osure verlables -- cnuld be taken 

ssultaneauly into ca+sideratim . 

3efore eVlaining amv f741y hae these technryves .ete eceLied . 

Lt is Rr .ineet to rmtim that sinpler tetlmiq~e '.ere a'so _veG to 

._r mpl :re :re :haracteristi6 of the data wlleaed. C:u.variace 


-a6- 

swtistics aed/or sisgle frequencies .ere nhea :n. . : for al~t all of 

the variables for .R:ich ae had inforsettm . Such erplorarion of the 

data also iacluded -- ..hen eproppriete - the ose of etem and leaf 

or 6mo-ptot diegraee to m .e the nature of the distribirtim of 

the varia6les, in both cases and co :trols . Il :e crapernhility of these 

two qcapa also needed to be established and several sta~,ntiol tests 

.ere perforsed to such an erd . In the ee.e of the variables that had 

been used to perfcrm the art"'~ : ,4 IAiF. S7[ . 3pfTflC IQMIIIy . 

P6IDQ1M AMD TYPE OF INitRVIDi/, wa Imm+ of moca that no 

diffarersES ~e to be fosd . 9 :c there w no eertainty that cases 

and cTtmis .eold he equal in otlrz rv-Apeers. 5ociodmoaraprtic 

variv' les aoch as nw8er of ~s of snc=l attendsnam, kuaze, ethLLc 

gnKp . oweRry of origie. rncEer of times s.rrid. and othe-^s . .wre 

m:ns :ed osinq either paired t-tests fconti, ... . .s variaDlnl or ohi- 

sqi:ere tests Ifttlser's test for dlcnttsaoum vsria6les or chi-equsre 

for mteqcriml variables with sare than tuo lnalal . In the sene 

faelum thone varf .bles that r_te viewd as potential cconfowd'Ys .ere 

campsred first before deciding ylether or not to inclode thes as 

cv+fouders in tLe final ansly .is. IM : apptioble, th mmerisom of 

t.he petert .iaily m :faMieq v.riables +u done by treacinq the 

variables as horh ®teqorifal Ifor efolnole . yee/no euoaure to gas 

ccdu .?I and oas:irsoiu Ifor emmle . euo6sr of yesrs of empo,ure to 

gas .cdanvl . 'Rxu . the decision to include a variable as cmfovicer 

vas followed by the decisioe m .Aether to include it as a categorical 

or as a emK.inunus vnriable . tagartic regrenioo ss used to 

deternw:e if then w ev .denm to aswne linearity oa the effect of 

the ?oc.ncial xnfousfer . It my be useful to advance enw that we

U 

-47- 

of tLe pereatially eonfoudinq cmtsrwus variables (with the 

excepcion of inrae) sts..ed udiotioa of linearity . Therefore they 

wece inclad only as categoriol variables . 

11 .1 1DGiSllc .."FS• ESS:ON LCN lN141FD ONa-C4+lmL 57iNg5 . 

Iblfoxd et . al .. 187) have poblished a vethod to amlyre peirwise 

setrtwd stulies besed on the linesr logistic aulel destzibcd by 

cornfield et. al . (88) . As pointed aot by the aothnes . this method 

shws several features that p∎.ke it the 6est available cloice to 

analys data sets sudl as the prase:t me. Fitst, it allows os to 

obtain the estisate of efle.z tor me or acro e:qnsure variables while 

darntrollirq lQ variables not eaesiderd in the eatrfiifg . Semd . it 

tan ptovide estia .tes of the effect associated with different levels 

of oro or eo:e dtegorinl etpoeure variables, as well as the 

estieates of effeet for the levels (ooe uLLt cha'ye) of one cr eore 

cvr.Lsnos ex?ason variables . Nd third, it allows us easily to 

obtain estLiwtes usociwtad wdth the ditferent levels of the ewtching 

variables . 

In this adaotatioe of the loqirtic eodel the reqressor variables 

are represenud by the case-cs+trol differenexs of the valoe for dr. 

eR»sure lar cmloudinq) variables, the intercept is not :ncluded . 

ud ri :e respane is always pcsiti" IWt is, for each value o! the 

:e ;resss varu6le the:e is always :w case and one art .~l) . '1!x 

:ewltirq etltuietes are the naximsn caditic.el likelitmd .r..irtetes 


of the pirmetrrs . 

In the rsesent analysis I u+d the proqra for lagistic 

re9ression available in CLW (99) . 7he analysis of eadl of the 

e,pm :ae variables proteeded very such in the aeee .ey. 7he 

follovuq . ttefefore . is a geeral deseiptim of the stapa tollowed 

to assess the effeet o! eaoA ot tllese e¢o .oe variables oa the risk 

of lt+g masr . 

11 .2 F76[StBE AS ^J1S430RL ."111 VM1AB[.IS . 

All infomatioe cn eeposure ..s mllecoed in wch a way as to 

al!or the ereatim of variables that .r>,1d reflect nd+ expoa :re in a 

ca:cfiuda srale. Me considered it usefol, horeeer, to look first at 

the effect of the espoeure veriatrles as ordinal Cataqories . fbr that 

catter all variables wse traneEoread into new ategoriwl variabin . 

U+e cx-off points fer the nteqorin Were chaen by following 

oarvention (e .g. p.cks of cigarettes/day) or by :aferrinq to Mnt 

ocher authors have used in their stw1~ !e .q . SYiclnloolous 

cateqCeisaticn of eWoeore to cigarettes in a lifetLee) . Once the 

categories had been created and the infornetiom mmewrited in tabMa, 

the analysis preceeded in this .ey : 

1) :Te eofel that assuies ro associatia: 6etYeea risk Eaetat ard 

disa+c .as fx_.td to the data . '~is is also referred to as the 

nadel with fa psraseters or the wodel of total synaetry .

-ar 

21 The Io9issSc aodel that considers expomae as an ordinal 

cateqorical variable w fitced to the data. These aodels 

provided esc.imetc of tife effect of each of the Lewis of 

eQImICe Yslnq Lero C1pMLê as the [e!ere11C^8 rJtH]oC( . 

31 In order to test for a lLr.ar trer.4 in the levels of the 

catcqory, a third eodsl as fitted . This inclVded as the 

reqressx veriabie the oasrca~tml difère.oes cf the mid-points 

of the atavo

M 

ostegoraes . 

-51- 

At tus point it xas Also oanidere.i peânent to look at 

estineres for spaafie stratn of the studY FWulation 

. 

Peviaus 

srydin have sqgested that the effe¢ of psssive aukitg ney vary 

pet.een the acxs, or by type of interview or acosd£rvl to imu kiaq 

R; stor) . 

The ewtched design wald nat allo+ :zs to obtain estizetee 

for the zrin effects of such variables Iby desiqn .Aoee effects heve 

been set to be zerol . but eseintes for eacA of their leuels could 

provide useful ]nfornet:on oe the relatianhiP beneen the risk factor 

and the sady disease. Also, previoux -reseazch wrk has suq'lesrcd 

that passive saokinq soy daewmane the type of histoloqic twor 

.dereloceC by the pstiena . ltrreforew re wntd to see if the 

mqnitode or dizectioe of the effect varied aocudinq to the 

histnlagic type --mmside:-A . 

folla .s . 

Lf xrmwty, tie sOeA takel at tnis .raqe of tLe anslysis uere q 

1) A logistic eodel w fitted for each of the e>qxrsute 

variables . Tfine nodels p.wided escisntess of effect for the 

noosere in question, takLq into aQVm all 439 psira available 

for analysis . 

2) 5 loqiseac model uss f1etM for eaU of t .he ezcosue variables 

ard tleit interacclm with the nciahle TYPE af IICtP.V[fl+. l~ 

ttese sodels es•..tsetes for effects wcre aMaind for Sf7.F- 

P15FQOfMfS and for SRIPACATE Pf57ONOfMfS . 


3) A lapistie moiel .as fitted for exh of the 

emesure variables 

a.d thear i .» ... .e :oa vac : the vzzriable 4-ORZtL IQS.qtY. fY® 

these sodels senaraee est'ua ;rs .ere vlny ne d for 

t2VFA 3t/67B 

and Fvp{R sqlRpS . 

41 A Ioqistic raWel w fitted for . ech 

o f th e p___ variables 

and Ltiz i n2eraeeiama vith the variabl e 

umvided eatiewtes for F}f1A16 Md 17A= . 

g7c. T.eae mQ3els 

51 A laqietic arfel .as fitted for e .ch of the exposu¢e veriablas 

ard tAeir lntsssctions . .ith the varzable lR811II=e 1-!PC . 

FY?zrate effects WRre obtwlned for FpmfAlpID A!O 2Vyl . (la 

CMBqflNA aed 11DII{701AGTm At0 f71HERS . 

6) 'hsts of the siqnifian :.e of the effeRS of all of the ivNe 

PU'a"eterS Kra obralned . as weil as tests of the siqnifiau,,, uf 

the iotsscc;oas . 4he lattei are atIuivalait to testinq the null 

hYPotheis tnst the effect doea eot vary aa=yiry to the leuels 

of the st-Zatifyinq varf.zDle . 

)1 wre eaplex epdels iaelud'vg the eqOaure variable in 

questian aid tio . t.Rree aM four u.o-yy interactions .ere 

fitted . 

91 Models with L~le +r~ vanaqla attl all the hASible 

m~binatiau of Mrer .aY ieterectiqys .ete fittod .

-5]- 

91 Ftdels obtained in 8 ald 9 .rre oapnred to each oc•wr as nell 

as to rYe avMlest aodels obtained :n 1 rhWwgh S . 

10) fie • .ar_ables seleeted u poteeriai cmfounYss Wre 

included in r/w eodels cbtailnd in I uuough S . 

avkP2f]l I1Nf£ 

11) A aingle eodel tlrt cmtu»ed the three mutuslly acluaive R!S[cfP3 

epan¢e vaciahlee Ilnuaehold . wftleca ard sccial esposurel and thhe co+taaxkrs 

.*s titted to the dete . 

12) A aadei wes fitted to the daG that caaK .ined only the tw 

variables with signifiaet effects eed the m+fouders . 


This c`xpter is divided into three sect,icus . 1M tint is 

devoted to the desctiption af the study aaple !n terne of snHO- 

dmcgrapsic cl+atacteristio . in additinn. it dwzis tt : distriMnioo 

of the variables used to aatch oses to oorRtols and prneets the 

distrihution of casea regerdiey histologic diaqncaes . lhe sewd 

section easiivea the distribution of osstain variables not tskm into 

amount by the aistChiag ptaoen - variables wfLLdh . by their nature, 

n .y be cornidered as potential mnfoeders of the asaociatiee Eet+een 

pessi•.e saoking and lueq cancer (for exanple . pipe end cigar asukLngl . 

7hM! third aAd last aettloT la slbd(Yided into four auhsectSGtts . eadf 

ane reporting the aaseseaar, of the aseociation bet .Ken luq uooer 

aM a different neuurenent of e~aaure to pessivs wokiyr, . 

-54

1 DFSQII8f1rN OF THE 51UDy 'aM8[° AN) 

DISfM1IB/f10N OP 4EE l4.1C'_ItNO OkRIF&E+• 

The results peesented here are tweo on the stanstiul analysis 

prrforned on data petraiwn0 to 439 ose-ooDtn+l pai .n . Table No l 

preseMs thc sost relevant dcmaqtaPAtc checacte_-istio of the swdy 

suy7ects . By design li .e- eetthinql . the sez dat_-ieutitn Was set to 

6e aQproxiewtel•! euen . 1sts, there are 218 (49 .7%) feiwle case- 

cuntrol pairs and 221 (50 .31) pairs Of slos . in the saa aenner . 

.9e, whid+ .as eatmed aithin a .- five yec age rmqe . caused the 

nean age faz the uses 167 .05 years) to be very close to tfie sean age 

for tvrcrols (68 .13 years) . As is .ell knwn, scac lung cancer 

paieats aepLLre tL+ dLwsa later in life . This is likely to be a 

reflection either of a lonq latency paiod or Of tty requiremeot Of a 

peo ;onled esQesure to etioloyic factors necessary for the dewloFmmt 

of the eisesse) . ltaeouer, 776 Of wr a+e antrol-pairs remcted 

theselves 60 years or older at the tfne ot dingmsis . By the time 

the interviev vs -n"Ktr', an additional 3 .0 \ wre reryrted to 

fall into Vat cateqnry . 'tne latter lneeax .a. obvioosly due to the 

tLne elapsed Eetween the discharge disgnosis, tne obtaining of cotnent 

!ivn Lhe attrnditq Ghysician . tlle CVntactitq of the petient IWIr or 

he:sc_f s,d . finally, the er_anqement ard tsxductfng of the inserv :N . 

Siroe s.cv~%at snonq 1un7 calwer cases is k .v.e: _ohe poor, and sir.ce 

ouraw::q t!e infornetion d.recily fra the patient before death vss 

cros .°.ered ccicial for the qoality of ve data sotr5ht, ve sied to 

'aoncsas asd inrrr'liev as sbr_ as poss :ble . 

.ts a c~rsr,~-te . the sea+ o'xner of days t^d : tran

-57- 

crn_~ls . ltat pntienu r-*er.ed tlameelaa as !uv:ng been horn in the TAefS tb. I 

;pilred States (B86) . In adllttim to this awntry, 22 other 

NII[.VANf QLW)LTrR:4ff6 OF TlO: ST>Dy PCFt7ATIQ1 

cantri.es . smtly ILtvpenn . were sentioned as ?lace of birth . None of Si7C 

-5,- 

CASFS OOttf%ys 

tM differvms in the distrihution of ethnic grvo2 or national origin F991[L'^ 49 .7% 49 .7% 

lwIES $0.36 50 .3 

wne stacisticel :y signifrcer.t . 

qEa 

eQ•7f1 1[E 67 .05 68 .13 

I~ cties tl,, cv,tzols reeorted ever to havmq been mm~ried IN YPARS 

;87t ~rsus 9211 . Simi3arly . at tbe tiae of the inrt.rviev, fewer %upalc 

BISIORY • 

~ 160t) wie repcrted to be errned tron mr~ols . Mile these 

6EV6A 91Z a7L S 45 .06 45 .06 

ditfereaQs se sratvc:cally si.gnifiaunr (Qhiyyuare - 11 .46 . 1 dfl tuv4R Srplydt5 55 .1m 55 .06 

.he nu.bec of ti®s being wnrried or the eesn r.uK>•r of yevus duration 

1yP3 OF INIfliPIt71 • 

of aerriage .ere eot . Siqniflcant ditfeeerwxs of reliqion .ere offered 

b! the presenx of roro utholio (5AI amng tR cases t!+en aernq the 

ccntrols (62 .0 t), and by soze Prateetinn uaq the mntTol . (786) 

StLxRf'.,NJtDfYlS 

SJRR XTTE B6PQ€QAS 

611PtIC fitQlP 

67 .06 

33 .0% 

67 .06 

32 .31 

Han ascnq L1e ea+en (I28) (Qd-s*an - 17 .67 . 4 df) . Ilr» uts 

NW-W /I'"E 

t6= 

2.76 

86 .6\ 

3 .66 

85 .66 

foud to be si9nifianty hfqher for the o .es t]rn for the m-tcol . . 

lftis lLdfrq suggests Urc aer.7Wq on canty of residence does mt 

senn effective to omxml for ~e status . Bwrtver, arochr 

variable . .hic+ is qenerally oonaidered to be an iLdimtx of 

xcioe:c statA , i .e . mn4ier of years of seiraol artendann , did 

IDUOKTIW 

MFJW MAefX OF Y%i0S 

OF 9CMf. 

A^RMHIF 

PV Lm OE BIBI11 

not stow any significant differences for cases and acntmis . '.à ~ BFISOt@7 

Lt1Mf9 SW85 

dfl m 

11 . 4 12 .7 

non .r of ysara of xtwol ar_ers'anee tor caxs .es 11 .It vears ard, CA1fc4IC 54 .06 32 .4t 

Olln OR lQiE 46 .01 57 .6% 

;;.r cmtroar !2 .7 y'are . 

8I54OILTIC TYPE 

89 .7i 

10 .3% 

fPIDQeOID 50 .6t - 

'Ca distrib.nson of listolalic diaq'mes resulting fran the study TOEIJOGI .7[.:`{!01 25 .1% - 

1AKE My 10 .31 - 

reviev irdicares Wt Cie se;orlty of taees in ~ study ~e 9uW. Ct7 .1. 7 . :1 - 

7 ~ 6 .a1 

adenocariwos 1222 =ise .t . 50 .6!) : e;ider_vic ca•ciroro ccnataW.ed 

~~bc=h,.~g variables 


86 .86 

13 .2%

-i9- 

aooot nne uu .uter cf the pacients 1110 caaes . 25 .11 . ; large ard small were sxtdied with controls .dn .+ere forner zoken . This ploeechire, 

cell acc.unted for e5 110 .Ja1 and 34 (/ .7f1 cases . rinally . 28 fnwever, did not neosarily ensure that the par .ic4larities of the 

patients .ae classified as 'nt7er' histologic types . I .e went to svcking habits of the forner smokers -- such ae intazity and 

gnohasize that this catego :iaatien of cases accarding to histologic duration of cigarette aoukirq - .,ere eoriparable asmg cases and 

d:acpmes is based an tne diagrnees provided by our sndy review, 

('xoept for the five cases in Mich the patLology slidn eoold not be 

obru+Kdl . 11" distriAorinn is very sieolat 70 the me derived fran 

the initial hospital dumnses . The ooerall a4ceen-st hets .een the 

latter aM our study teview wae 94 .04# with a Fappa value of 0 .564 . 

2 OLSet.'OVffON Q FGfRftUILY COt4

.6l_ . 

&M 99 coetrolsl . 7tre incenulty of this habit às also similar for 

esse and controls (4 .6 ci9ars/daY (or cases snd 3 .4 cigars /day for 

controlsl . as w the overall length of use 120 .5 years tor ca .xs and 

16 .26 yeers for de cv+erolsf• Cases and omtxols wre aln siatlar 

in pscportim, iiKerity . and doration of pips smking . ¢tqthy three 

casn arrl 90 emttols . .ars ever pip smk¢s . The

- 63- 

,b 2 presen the t e.tiaat. ., eun dars .rrtr, o adds t,:iea and 

amfidmce lf .its for ..ch of tAess ospriscm . 'tlu ai9Mst rists- 

op.a. .7 torrspad to o6da rstios ot 2 .66 (for axposar to s[rasm 

s,,.d nq or .ore tz an ao agoaayf a+d 1 .23 tfor QxVOSUVR oeR..pmalav 

to 41 to 60 cLq.rettr/dsy) . 14e aar+spmdin4 4mntidaea limits. 

hpuaer, lodieW 6hat tlrss .nlus ate not siqnificrRly diffeart 

fro the mil .alm . iftiqi .ctdly . tltee af the aatia•tas in the 

table siqgaet a detaease in risk for 10011 tanac for tlsaa erpsad to 

1-20 dgaiettr/dry /CW .76971 . to i1-sp Mgaraetu/dsy IG6r.9G6J1 . 

and to 60 to s0 eiq~L/Asy (a1P- .6196) . 1.11awiss . tMa . •s•ima•'• 

aua aot afftastinlly diffetent ftaa the eell wtos. u slwt in the 

same trDle- 

a plot of tlr fiw tog adds eerrapadt+q to enc cate9ory is 

wodi in fiqure No l(est9aus rpns .ntad by dtands at eidpolnt of 

eaugary oalar) . rar of the points l.q9sat a patlHle 14wr 

retatiauhip . In ertl.r to tast tat 1Lrstity In th e o.t.qcria . tJr 

~.r.xnuol dUferwroaa oC the a W-poidt s of eadh ataqery wrrt 

sntered as the r.qr.aws vari.Etea In the toqistie eaMl . ' iM 

. .eJ..ts cetay.d for the +tap6 of the sitt.d line P. .t+.ae• .oo1oli , 

wId t•st• .2271 1 ys not stattstiaslly differeit lrt. ssn . thanfare 

omcl .u1!nq t•at tlrt. 1s no widrwm to sUppnrt a 1L~wu rwpaw for 

the osqarin . 

2 

tern aap.r.d to a aodsl of toral tyvstry (G • 10 .29 . 11 df I 

- that is , to a aodel with ro psrARetersM rlrt aswaes no (W fe_re~ces 

in t>grnuaa for uass aM oontralt - neither t :+t toaal for ssFcau.-e 

2 - 

as r.teqoriea (G - S .JN, 6 df1 . ror !!r nndel for 13nsar tran: (G • 


2 

10 .24, 10 dt ) . seaea to provue a better fit to the data 1 c . G• 

2 

4 .99, 5 df, aMaG • .G5, 1 df. respectively) . /lla.q the s .n lJtr s . 

a loqistic sdd that oapares zeto eipsoa " to any exposure 1•> I 

ci9/d+ryl aha .d ndtlrr aty sigqifican t affeet no< any apprap3ate fit 

2 

to the dara, aAen anpacd to the stltl with m Rramtters ( 4 G' 

2 .72, 2 dfl . 

'Ae analysis of the effect of maE .r of cigatettes/ day 8dnd by 

the sprue alw Lc1udM ter.tin9 the .xposiae as aa•••••+ n ••• tbr' 

thet pcpo.e a liir .r logistic sodsl .ns fitt.d to the data. 7he 

asds ntio as.ad,.td vit11the spars n dc(nq I padc of eigstaicW 

day . .s 1 .011 n.we xo . 3 . Its rJ6 mnfid ente li .dt, (n .6s6 -1 .1e) 

includn the null valua .d Mn.fate pevr}des ec eoidnas at a 

signifiont aesoclatitn with the tl.aly dlssew. It my be pertinent 

to menticn at this point N .t .M.n logistic enyr(sion ts applitl to 

ri. analytis ot od,ae,wa data, the e .tl,.te of effect a,t.urd for 

a parrlalar unit of axpnqure om 4 osad to olculat e the .ati .te 

as.ociated with other In+sls of aqcos.. [or iestawe, by .uttyptinq 

the e.tsa∎t e for 1 pae of eiy .e.et ..n+,y 10.0109981 by 2, 3 or 4 , .. 

wuld obrain the astUrtee of sffect as .oelat,ed with th. spw.e 

>,adrn the respective nu+bw of parxa /day. Ia ctie . .. e fashion . 

a:ltiPlyi ng Jie staMa .-d error of 1 6+dfPo.y by the quanticia cited 

atoae will yield the variation raoeiated ritA tAe'stissta at that 

level of Wposors . :t aeould be evideec by the yy in .WcA ch.e. 

utieetm sre olxalned that AiqMr .qmwrtes will alwys be associated 

with larger estlestas (as Mll as with qreatar variation) so that the 

.alsttcl ai9•.:fieante of the estiraites does rot vr/ accocdi q tn

lerel of e;¢rosura. 7n the praeeet enee . the estivntes fot 2 . J . and 4 

Tsd;s Cqatetoea/day wold all be rot signifiontly differa ;t [rm the 

null velue ; thair emfIdetumi intetvala rould facloda a .ri a a9ise . 

ligon tb I slnrf the 1ur that reFsuanes the retatianship 6etuea ; 

a;q orze Ici9aret!u/day in the X axis) ad risk of diaee.e (loq odie 

in t5o Y axis), ace Xdfn9 to the loqiaria eodel fitted to the data 

(oontlnudu lim) . Aqaln, the al.vR eKirely flat LMe auggeats a 

tarA of doae ie.po;w r.latimdup. 'On tro oMer It4rw rqz.aant tw 

su5geap of 9r study popolatim . 7he l.rye da.h lin annpmds to 

aekqfTTES 

NAT 

.Hf reapadw.t . . .d the uell dash line to aurragata re+pm8een, . 21- 40 - .TKM 

6nN of eFeae lime Yould ar to auyge .t .ffRa due m ewnwaa that 

are not only greater tlrn the effeR fet the 9it.q as a anle. 6ut 11-66 

also thK ao .a in opposite Aix+eclau fms oee anoUer . ilawuer, 

1-i6 

-ss 

TMIf 1h 2 

tNRMT[7 

.00606nTqdMp9ss CAlIppQ tlnm 

iq1 f]WO6UIIE to flTf GT[BRUfS6a0W[TTfy yfp p,ty 

, .Y10I(fp 6T TI( Xqff[(3) . 

f3TIfNTE SWUYIp (q m 

MTq 

%iLC 951 LY1 

-2361 .i566 .7H7 .6l19 107f7 

-966.7 -6666 1 .349? 

.20t1 . .3390 1. 2313 . 6336 2.3930 

nritibr is aiSnifiyRly dlff.n6t fraa the 1Lr that nprerenta all 61 -0 -.l6E4 .e7s1 .l196 .o75S z3322 

wo)MS, nor are they 6iynifionrly differa2 fr® ans a ;other . 

Lllaerise, the e.tL.tr that de .dbe these li ;rs am rot 

6ignifiwrtly dltfer.R flm the emll valoa . 

The lorr patt of Table lb l(li6n 1-91 aM liqie ;e Ib 2 . 3 . ard 

} . oreaent fer the 6t~dy pepulstia+ .atLww a/d fitted IL~' 

r.sµtt.ivaly . acvxdirg to 61[71QLS N1SR7RY . SOf and NESIQUJG:C 

olxtrJEIS . The aignifioaiw t..an ad ooifidera linls ir, the table 

etow no ei9n:fiomt effect of spaw Acly saokL;q .men eremined 

•eper.tely for rwu amk .rs and fara.r adara 

;re'r ;eea A:rtoloqie types . ualec ad famlesf ud epidernoid ard admee . M~r' t]r_ 

tests of interaction of the w¢~ var iable with 9C1¢ :G IQS[CRY , 


ea . . 

1 .050 1 .1590 .2917 r.70'!0 

a

. 

ia 

t 

a.•• w.r 

~ + / • • r 

R. .~' . .' 4 . .4 . . .!~ . . 4 4 


-qy 

P r r 

I . . .4... .4 

• 

I 

SC.LL6, 

61911 fl6t' 6iS6' OY60' 0ibo'- 'naaf6v 

TO] 1TK 

t0lrr 6LSS ' LRt'1 YLfI' LS//• bplbi0idi 

i{i'tl tiii 6M1 o6Ct' IYKO' LiNM 

6COL1 116L' S{t6' 60DI' oC2Q• S1P/Yif 

L96T/ tL9Y' lLSO'I OWI' 9SSO' 

i?R'1 69W 6U6' ZOIt' YISO'' 

Stl17a1K 

1/fWJ 

itl1:OL6 

IHnb 

• 

SIIA04CS31 

Zwo't LwS IISYL' f~St' Zorb'- liveass 

f6ff't YSZ6' 2511'1 1ri66 uot' 

st/nuoess 

l13S 

suwc 

01Y1'1 SS9P' tt161 9L6L0' %60t0' ttn 

0111M 1O6M3 

'CXI 146 ro1 fS6 S00) OM./iHtS 71ripK7 dUNU 

7bOlSIt13WODOL ~ WI]l7~S 7S(OdS 

0177YK9d)0 C 7YIlMIMLl10 V 1ql SL411XN7G{lQJOMI 

~SOIlY6S00i~S71YMISS)QilStYVMMI 

fqtIlOVl 

-G3

{ )} 


• 

f IaRE Nn 2 

CtNNCt IN IUND GNCER LDD ODDS WIIN NUIEER Q CIIMPEITES 

PER Du1Y YtOKED SY iK SPDUSE . FDR Il L SUEJECI S', 

NEYER Sr1dcENS' WD FCREtER SnOKERS' ; 

AM L00OD05 FOR Diff ERENE GIEDDRIES DF E%PU~''UREY 

' - - - --- .----- - - - - - - - 

• 

~ 

as 

ctvwr •anv n .a.F 

Y cartl ~ . ..RaìtN.a/ 

LIM • Hr~ MaG! 

LAIiF-OAM LIM - s01Y[A GYIF1a OINOOY' YItrf01M OF Gl[Mi GLL W"lO 

f IDURE N2 3 

-- 

- - - - - - 

-"----••- 

OWXE IN LI11/OCWELR LW DUDS WITN NNIEER Df CIWtETTES 

PER DAY SHCRED EY INE SPd15[, fpi ALL Si.EJECTY• 

FEMKES',AND hL4EY ; 

MD LDDUDUS FGIE DIFFERCNI UIEDOINES DF E]IPDSURE' 

-- _ ----- _ ___ - __ - ______ - 

• ~ r . r r Sr 

el(,ry,~T Y~EY[0 n ~R~Q 

aMll-MM LIM . I[YLL4 

UYLTWM LIM . YN!• 

•1/OA - Y/O-N1Ml CF UT[OdR NLL a/JRCt•/ 

Ir 

m 

e


. 

t ,t 

1 , 

, t 

1, ,1 

I 

• i 4 1 

. . . .... 

. 

f s 

I 

. 

( 2505521361 

-„- 

iMIE /14 4 

AOJUf RD ESTIMi1TEl. mLS M1106. 

NC OdiID(KY IIMIiSrp1/1 arRNE1RVL G pt1OM TO 

SodISE 99UG166 20 CIOaETSE3/Mi . 

0R" E7I11MR JfA/6" 0007 96s lQ 952 04 

ENIi01 M710 

ALL -.0152 .00 .1I .90y .6369 1 . 1591 

as)Ecn 

41f .01]! .G9l7 I .0/7, .!9[2 1 .'J198 . 

Wspom,: 

•,7669 :lSES. .,6M6 .5601 1 . 0977 

~p -.06M .1271 .9A9 .7279 1 .19e I 

.0247 .1101 1 .02501 A261 0 .2718 

rOMlL7 -90P7 .1/0r .901 . .flq 1 .1703 

plun aa. .,tn. 1s'. . s,]! l3 .or 

~~ - .0! 1] .1337 .9719 .N71 1 .S21S 

awu au 

aA/or.. - .0,9t .Ilel M : :wt 

a onms

. .fY~+rYji ;~ 

sec . u+o NtSIt4aGiC DtP[ZriS75 are not si9nifiunt 

. 1.•dinttoq th.t the 

estia.us for the - 

.o siub9raSM in asrfi of the rtrstifyinq variabla 

ere not siqnifi.xntly diffstent t :on or snot.hAsr. 

Able w 4 ptesants sst.isetn for ALL 611910Cf5 and for eadh 

level of the variables M6 DP IItIEAV1W 

. 9C!mC HL4m[b• 57c a .d 

lII51OtDG2C DLCWGIS ohtaind with the la ;L+tie :agression safel that 

iirluda omfavding variables 

. A coporison of these values uith 

ttae preènted in 7tible No 3 show aa aesnuqtol differvrcv . ~he 

tests of siqnifiacs MppoR the Ra+*M OosolosLSt of no 

siqnifirm associatien bst..an sxpoacre W etody disease . 'Dwn is 

also no evidenos of diffeawcr in tin lines zearemsntiiq the 

different sucqrrWS for rhit 

.i tlr affct of esposuce is being 

ewluatsd . 

3 .1 .2 N[lBFR aF yEVK Q' SPOM go= • 

M11n assssmm"t of yesrs of emposoCe to spuuse srokin9 as an 

ordinal eattgorial vsriable diM nnt slnn avSdrss of 4 sigmifit .nt 

sssodatioe with the susly diseaM (hble M 5) Al1 of the sic 

ertisrtn are aceonpuSed bqr test results that are mt statistically 

si9nificent 

. +s w+11 as by omfidprce 1Lits tlrt includs tir nd! 

vsloe . A plot nf the stiaato in yipes 14 . 3(dL.aM in .Id-point 

of otsrprias/ did rot suqqest s stron9 dss-rVOPmse relatiadMp 

pNer . 1fie ayuaioe of ncQ relatlanshlp %+s oanfinmd L .y ∎ nan- 

yylnifiaK test for the tr9msx amriabia ceposse+'1•+n a linoer 

trad for the acelfries (estmrte• - .00t93 . wid• - .a552! . 


_7,_ 

1M nuber of "srs of spo,w -!dn4 vs asrssa6 as a 

micincus van.ble 17sbla NW .61 it rsa fouM that 10 years of .pane 

sok109 W+s aa.ociatsd vith an adis rstio of 0 .99 (9S6 CLs 0 .912 - 

1 .074) . 0paa¢e to n sudh u S0 9yrs of apmne sm°kinl, rai9lay 

the highest eepusure obawa in teese aaa, aaua deesse the odle 

rstio to 0 .95 ( 951 6t .6200 - 1 .16001t 6ut aqaio, mia is not 

sr+ist+clly diffeteR tfiun the risk foc the nvwsesal . Also to 

7a61a tb 6 and in li9ures lao . 6-! . the sstfsetm snd fitt.d lines 

for the different levels of the motchiig variables aM the nn 

histologic types are lsaxnced . 'ss sisaq. the poiat estWtr for aWh 

of thse subgecips flumuce. IsoMeuts positiw aM eeqstiw values . 

Mhidh in ro case piess~c avidsnos of being significantly ditfennt 

frm tha udl valus . LUrMse• the asW .vs are eot slgdfiontly 

different betyeen tewis of the wriaEles St7I . 9p@1G MSlv[f ao0 

N1bT71a'IC DUQiM . as svLLwted by the lnterao[!al with the 

eTosors variable . Aa.wr. the Intseactinn tsn+rs~ the latTar rsl 

tYPS or 1N1tAVid w fosd to be sfqnifiea+t IIS .IA t.eo+ 2 .13 ).1 .96, 

p< .051 . so99sstie9 that the tlfJmstp fcr warvqsts relpmdsnts is 

differ.nt !tam that far rlf-raspaWnts . tbwetlrfas . as satlon.A 

ahor. . nsither on be aasidund to be si9fdfiont . 

the inelmfen of oenfasstLq wrfaplq in the Icgistie sndel 

ga+ezstd thr ertivistn preeenced in lebls lb 7 . An inspeetioe of 

these fiqures, for all ao6jects and by levels of the stratifyvg 

vsri .blee . wqcecs the oa"tlosiom mMytl by the imsdjusted 

astis.tr tirt th.em is ro a. .ectation with the sw9f diaeoe . 

JLLt.haqh this bssie tonrlosion is net c! .n0ed, it fhiuld te netal tMt

9f90•/ i6S9' 09%' Srm' 09V• r~ou~ov 

2ful't sStc' Olro'1 ~qp• 

tloro• 

•IIf,ma 

pKpp,= 

bowl Im MII• OWT COL^. ' • fi1YN 

LKr1 tLOP a00'1 0190 OTAO fiMB4 

i921'/ K0/',. iio0'1 09f0' tYOC.' ~p~ 

mulw 

%~~1 MSY' 0196' ff90' 9ff0'- %1~ 

kOn~l 

YS007 :PYC• FC9i' rStO' f'L11'- 

fu/079dCil 

LYIwnY 

W91'1 LfL6' ' WCO'1 0190' 92f0' ~~ 

IUS 

KL0•1 tili' po{(, 

7]11t% Dl i% 

t1ro• 0010,- 

SUl'qK 

TM, 

alw 

fD07 Otl~N1S 31YUItS7 dpOg 

SW7AOl J0611JOyC7ppAL 

Ot 3tlflDd'13 q bI1N3N3Wlo Y tlOf S11NI1 3al0iflU ary 

swtw coao'cuvwllst a3umaMn 

9A131W1 


WI'L aWr , K09 , C9i9 LSOf• •Of 

tf9L'1 @OYY' fWt' tY9Z• 9Z6i'- OC•1 . 

Ort9'1 A09' 9tCL9 991L' 140L' Or-If 

St~ZI 4S:fS' 9419' R91T 9f0¢'• pi•IL 

fYZI'1 OWr' 00, 969i' 6COC- OZ-11 

Llll'l Lf09' #O6' L9Li' Ot60'' Ol' 1 

YXI f96 

D11% 

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'(f)A'UdC 311 CI OIy0L1C 

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99113l9Yt 

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ai3 

+~7,. .- .... .. . . 

asi 


F HM1RE Eb 5 

flKMII IHLUiUEWNXR 106QMlS WIfH NUH6ER OI YEMS 

TNE SPpJSC St1fXE0, FqRlIL SUSJECTS•, 

SELF VE5PONf1ENTS •, ND SIIRRCOVF RE :PdLEH17^ ; 

N/E1LOOOOOBFqIOtiFERENfG1E0UUE5trt EXPpSURE- 

!/ s ' i 

11LIi1 w RA/a 11vlt[ 111oM111 

a 

' MtI~ LM • 1LL afJRH 

WtL~ LIK • ~1t[ EWGOIM 

U4-04M LIM - BO.! /VO®112 

OIUO(A • YIPNIMI v G1tL0lI IYHR 0 C1if00111 4LL YJFM 

r 

M 

n 

R 

T

LOi 

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FIOUAE Na 7 

ClW16E IN IUND CAIKER L00 ODDS WI1H NLRt6FR OF YEMS 

IEE SPOUSE SMOKED .FOR N.L SU6 .XC13•, 

FEESKES• .iWD IMLES• ; 

NfD LOD ODDS FOR OIFFERENI CATEOCRIES OF E%PDSURE• 

N• f a 

Malr / VIL/A !am nOaO 

• fbAtNJM LNg • 1LL U1Aw 

Y4LL4W Lfll • IdYll 

INO~AM L1M • WtU 

f1NO0 • YICAbiY 7 fAttOm GLL WRTO 

FIDURE Na S 

CHWO[ IN LUHD CMICtR L00 ODDS WITM M1n6ER OF YEMS 

TME $OCUSE 51'10¢ED, FORIIL SUBJECtS•, 

EPIOFAHC/O/3HN.L CLLL •, AND NfENCY'.NCINMV0INEA•; 

HISTOLCOICIYDES 

AiDL00ODDS FUI OlFFEAENT CA3EOORItS OF E7G0'L1RE• 

a a 

- - - - - - - - - - - - - - - -------------"'--- 

_ .~ f. a 

∎•NOR t ClYr wOtI t•O" 

~ mMtYYy LUNE . NL SYM 

wiua .a LEr • Lslm .osa ro .uu ma 

LHQ~ Lu! •~ IWY a,0 t1+Ef L4LD 

OIM6O0 • N1pf6NR w tlifiplf L1LL MRC IP 

a

xw>:1 Jc 6Ras siY UT solmimpT> .1 . A4 Ass'• +vw= 0 : IoT'awpT aT 02 

1N01P iIM im YiaCG770 a(/. -a(Qvpp TO'aCbl'a0 Y A Twwi~ 

lWTi ssn aacdt ap !q PrMms pqautbp le aa4vi0 Trmy s+1L 

' lsa . .i 

fE x sNp S9E xAsP/ssaa.r6p OL/ slTi LrTaaw raiVsi4 10 nnw «P 

.~ satiunbT2 000'OSL lano 00 PI aq Pi~ .Esp aad saiw++bTa io 

„ad T 7o aeloa e 0a srwlC SE &TmV pTaaw 7asFW ••aOUr+M a0l 

'ssaowatSts Twomm iiwsrtla7 ia7 uT a0u tp sasarw Y6TV •tlfiuryaas 

..wR anp pwoiys.w aq as0s iT 'a .nsroy 'ywba sTP To ssywa 

•va asiaaaa A- styc ' WO>smR )0 sP•3pffy w-P io asPao stE+ w 

saQSw a7 ao qm6Ti bmitow w{T, '&msc& . Io Wammwam T .4as 

sT" • owT 0n pIppe sm yaw aC9 ssan6H wp •aaoll Ow unp 

.apu sw .aaYl 31 'u0F7rnT9s4>•+ 3o s>

-„- 

.eron . The estimsces of the effects fo.r tne 5 osteqor_n asseseed are 

presented in Table Nn 8 . 1M fiat feur esefa.ras . mcealpsdirg to 

esposures of W to s00 .000 cigaretus, shw a r.g.ti.a sign, 

.q9eetin9 that the effects eey be as+r .rary to the hFpethnited . 

Vie.ed smttxlcally, Mw .er, elwe valuas are eot si9nifie .ncly 

d:fferent fran the reall wloe, as deedutxated by the m .fidenee 

iMa .vals alse prewiW fe ?aUle tb e. ".M fifth rr..finece, 

ex-eswdinq to m expowre of rore tirn 400 .000 cigerettes IOR = 

1 .0e61, fugyute a snll risk abov" the rid for the nm-expoeed . But 

aoaia, Cnis fi9urs does mt r..eR sratlsuol signifiearoe f95f 

CLt .6532 - 1 .6762) . The plot that presmts tha eatie .tes ef effeci 

for the fiee ate9oriee in a logaritlWC sraie (rl9ure tb 9 1 ngqests 

tlrt a test of linear tsad shwld b perforntl. TW p .vmfftsr 

representing this linear tred rs foud not to be signlt :rant . 

Ctaperfug the lo9istie ardai fcr espeswae as categuries a'd tie ondel 

for wtegezies as a linear vari+ble, with the mill eedel of no 

paraeeters (1 .e . total apmetry soldl, prwidd furtlrz evidence of 

no nw++ion between eoesce ud sndy disena. Mefther m.e d-vd 

2 

itself to fit the data better then the m111 .cAal (A C e 1 .95, 5 df . 

2 

and 4G - .0061, 1 dt, respectiaelyl . 

F]rposure, assestl es a eontimnos variable theaqh a logistic 

reqression eed.l, yieldeC ae esticete of effect equfvalent to sn oQis 

ratio cf 1 .0175 for eqnaue to 700 .000 riq6ratw dsing uarriad life 

( :bhle 40 .91 . This eeclmste ..s frnad not to be sfqnSficwt, ud. u 

avEaiued in a previms ssetian, iidlutes thtt ry estln .re for 

h :9her or lwer esTwaarp b .rd on the eres loqietic andel will be 


f6A18ER0 

CIBWEETES 

f-t00Aae 

- 64- 

• TMLL/46 

f7f1fMT(S, O66 MT106AIC 9St 03IHOpBT LIFIIf3 

Fdl f10'06tMf TOF/YE C1TEfqRIF30F TOTµ IMMER Oi faOVKETFS 

8/7DRf06r TNE Jf C/!((d) OURIW FNRRIED LIFC 

ESTIWITE IfNOWO 

ERROR 

00p5 

MFq 

%1la a6illa 

- .t02f .1896 .6163 .6670 L16J6 

-200.000 -.1 j77 .2185 .6711 .5678 1 .3372 

-MAN -2130 2E56 .6062 .60f1 128I0 

.a0.a60 -.0762 .3087 .9247 .5060 1 .6935 

~'~ • .MS]S 2901 1 .6M .6672 1.6762

~ ik A p p 

~.~. .~ .1. . ._ . . . . .~__~_ ._ . .~ . . . . . . . ._~ 

∎ ~1 


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COK'1 90CY' lSSO'1 122i' 9CS0' kqylpp 

IYO•'1 C916' N[{'/ 9001' IfLI' tlM/ 

ODCI GlLP .IL6'I Wo/• 10i6' CiAtO, ~ 

OOt•Z I K1Y tdN I 16Y0 f6C0 

YLrt'{ . Y6LL• 6911' L916'- 

6N7 0Y5 I 

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IZIC'1 2101't KY0' W60' Jl)C 

CL1Y'WIC 

£0i1'1 z[LF 9L1o't L9t0• StlO, rn 

0 Ilw w /dl 

TX1 Y% Ul LSd S= Ur1aMf1S LvWILS3 dfqMB 

'C1UIN6q0l'AbOL D WIll0181CIDdC 

Oi 7l,ISbCt3 !0 T7Lt3ClJla V 7D! SUUn 3CH301lM CN/ 

•0Ilro SOOD'CLLYHI :C7 OJ1CtllOMY1 

6+oN?lYq

a IFJ 

a 

a 

L a 

• 

• 

4 

0 4 

~ 

41 

41N 

FIOIME N0. 10 

Q41NOE IN l6Yq CWCER LCO FAOS WITN NUnLER CF CIOWEi i[S 

StICKED 6Y TNE SPOUSE DURIND PWIRIED IIFE, FOR ALL SUBJECTS•, 

NCYER StICRERS',Nq fCRMCR Stll.RERS• ; 

AID LDD ODDS FOR DIFFERCNF C4IEOCRIES If ExPOSUiE' 

----------------- 

4 .71 

'rr~--- 

-` ----- ` -- 

• - 

a lo . >!rR ~ 6011111111 mILn 

.j 

aaH 

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0 

• I 

awi I 

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MYldlat tM • IIVP O~ 

tMQblM tfla llp® 

OWYai • III}NIMI R ulf~ taLl YSTO 

FIDURE !4 11 

C/MNDE IN LUND%dICCR lOD DDDS WIfN NUt46CR CF CRNRETTES 

S17p(ED 6Y FNE SPOUSE OlMINO iW(RIED LIFE, FOR ALL SUd„[CiS', 

FEIINES•,N1D rU1ES• ; 

NO LDD C005 FOR DIFFERENI GEEDDRIES Lf [XPOSURE' 

r,I 

i 

/ ~ . 

SONr « 6111111111 

raO w CtaMtYtls 

~ tOn1YYA L7NE - ILL OIaAM 

MYlti11M LI/! • IfMM9 

t4i0[YY/ LII/ - WM 

*IYYA - MIFRIYf W CLTLODR WL. f!


. 

T 

r i~ + r 

~.• .. .. 

. 

. 

0 

_9o- . 

2505521370 

tA6L[ w l0 

/~AIUSTEO t~11MI1tt7 . 000.7 M7t03. 

AfOlbilOERf LIMITS iRl ADIA[AFMfUI pF pNf,W 70 

s7aA[ 970tl1e OI :00 .000 aOWrR:3 

6AOIIV ESTIMATE SrAWMO 000.•. 95l1a 9ssWl 

[NAOR IIAr10 

ALL 

SUAJIC73 

.0126 .0604 1.0129 .6662 1 .1666 

7[li I .0666 . .0641 1 .0926 .9170 1 .3019 

RfoWiOIIS 

9m06"~ 

R'00lNq 

OEM 

slCKee 

rarm 

9rtOp6e 

- .1697 .155/ :6272 .{Oq7 1 .1224 

- .0212 .1226 .9790 .769f 12I50 

.0D62 .2460 1 .03" .6926 1 .6793 

1EM4t! LOl1 .104 1A067 dpj t7JS7 

wlllf .0216 Z11p IAQR AGy7 IffiM 

mw"W - .1R6 .1T39 .a7Tt s931 1./0/a 

stuL m>. 

"DVIOCA . - .0626 .2566 .9206 :5790 1 .46]6 

A Otltlp

_9t . 

.qually ~ si9Nfiuot• Atso in Tahle Bo . 9 estimetes for the levels 

of the stratifytn9 variiCies 'fkPF OF 1NfElvfaf . 9O1@lG NI`1CAy. SFX 

and NISID11'Gi : DIH?14SI5 do nnt shw significant effects # aM in .11 

taseS the estlntp y .ra mt fasp to be significmely dltfennt 

rithln lewls of the ss va=iabl. . Inydditim to this e.cA of the 

oodels that irclUded the intarettlan Est.we.i the stratifying variables 

and 1r wVouure variable did not ptwids better fit to the dsta ttun 

the sodels for all soEjecta . or tMn the sodel of total rysnetry . M 

illmtsation of the lines fitted for all wbj.ets . alanq vith the 

levels of the stntifyinq v.rlables . is dame in ngutes 9 ttoi9h 12 . 

Finlly, the total t.>Ih~z of ciqu.tts s.nsed Oain9 sa_zi.d 

life ms orssed in the peawin of eantnudinq variabl" . Table 1b 

10 stw the estisrtu oEtainsl aed tM1eir mnfidsioe lisdts . In m 

ase did the pnsmce of ontaristr in the sadLL lsRoue the fit to 

the data cc omeil any st9olfiaM .ffact of the sspana. vsriable o0 

lotg o.noez risks . 

3.2 P765IV6 9CPHC IN 4fc 1Gf~,D 

Cases anA oa¢cols 

.are qiretinnrl ebwn: the ncaeet of 

a oken viEl vha they siesed their 12 woet -eoes: resaderes . 

tcyemer with the duntiT of .edi orhuDiTatim . The nu*er of 

sroken in eam hcuselold, multiplitl by the .srber of ye.a lived in 

aech purltalar lameeold, and suimed oe.r the 12 rnidtrras . 

estisetes -he nurCer of person/yean of eFamea to passive aKlkt :q . 


I 

i 

-92- 

InspecUOn of the eav data .ho.nd that foc soie of the 12 

residcqes - perricularly those aeexapadynq to e .rly xms in 

life - the infornrtien on the mcirc of smoeea in the e"Unld . .s 

missinq . The data u.s analymf in -~o ..ys . each mkiyg a different 

assunption ahont t.he.e swinq aal.us . IMer the first asn .ption .. 

axwned that one smket had liwd in the Inu .etrolds for .ALdi 

infae.tim w .LLS.ing if, that is. thes. .s .videmn that the sprly 

sobject had lived in ptevicos or funae tsideas vlth at l .ast one 

other snoker . 0ifer aswaptian ese6er ero it . .s assuud that tlrte 

w no espaare li .. . . no .noeets in the tws .lnld/ for those 

residewes in rlLLae infotatim w sd»Lq . pyulta fra an.lninq 

the data urdet the two es .wpt(ons atm pratimlly idertiosl . 

tiwauet . 6oth seta of t+nln vill w tx'a ..nt.d w .llov the nrder to 

twke his/her om mrlusiau tagudUg the Nrdlf+y of Winfng values . 

39 .1 . PL9E .75 trtClA I1.91IPyiDN 1 . 

The resolts of analytleq Inueeold eqnnus u a ot .qorinl variable 

are sho.n in Tme tb. tt . Dzapt for tle ptyia. corerpadlnq to 

26-SD pereen/lvrs of apence taRe .91Sa . 9S9 Q.i .SS10 - 1 .S20t1, all 

point oas ratins svpest an ircteased risk of luq tanoer assoei .t.d 

with hcwenold esiaure to Passlue sTakioq. ftoun ~ only the highest 

esp,pce - onieh alao R'achws the IdqOut Miesra of .dfett -- 

s1e+ .vidsnoa of statlstial siynifitsnoa /Drt far egoar to a17S 

Pn'sal/ye .rse 2 .tS (9S1 dS 1 .09 - 7 .12)) . 8ti1l, the plot of the 

eight estiman pteseiu .d in Pique tb 13 suygescs thet , li+nir endel 

snv be adnywte to b .¢ibe G1e s:r.ien~h{p oet. .c.n c5e rae>qal .a of

eQon¢e and the risk of diaease . In the usual ®nmr, a variable 

reflecti•'i lirearity in the levels of the categories (the oue•contzal 

differanca of the eidpcintf of the wteqoria/ ..s ancered in the 

reqmsion rodel . The resultinq aodel stwed oo be sigLLfioecly 

2 

dlfferer,t froa the eWel ntA eo par . .erera IpG • 9 .01, 1 df) . In 

additiae, the estimate reprsmtijq t!r slc0e for the fitra7 line ra 

foud m be eiqnilioetly different fcne sao lestLUt~ .B0W485, 

ruld• 2 .95 / . 4n omparisrn of the wedet for the oteguriea with the 

aodel for the 'liaeer' e•ta9orie did ncr provide eviden :e of 

2 

de0.raae frm linearity laG• 5.87, 7 dtl . A higher ocder model 

with a a wMio term rs fitted to the data blt it vas tomd ,nt to 

be si9nifice nt. 

:fie eodet fittad to the data m . .sue the effeet of o¢osore ae 

a oaK4uws variable yteldtl estlmet.s that suppart the aaistace of 

an asso:iatioe betre.n e>pewrte and stody disease . R1r odde ratio 

associated with 150 prmal/l9ars af e3pmee t .a 1 .856 . with lar.r 

(1 .218) nd ulper (2 .830) 951 omfidna limits .ell abore the nill 

.alue Ibee'lbblelb 121. ' 

Osim the s.,e ecdel w ran estimate the odde ratio aesoniated 

wirh a very high epcase et 290 parson/yars o .arylnq bet.aen 1 .389 

aiH 5 .66, as indinced by Nr peitt eetlmaas ceefidon ce limits . 

Te effeet of !auehold smkiiq acxading to'fYPE OP I :VfHMFw 

d~ea nat 31nv di :hrences in •:1 effect for self-respaKimcs vers:r 

sur.cgate reepoMents ('YaCia Ni 131 . N.rarer . Men 9MaQ.vG iQ54IItY is 


-9.- 

rn+siderd, the affecs fcr ,rwr .mlars is not eiqLLficant . +Mr.es 

the effect for fm.r s~olars ia . This filtlL.q is all the ecn* 

parlin9 because botb estie.tes are elroae identical in value erd 

heanx the test of 4^teuiT suggdts that they are nnr 

significantly differ .m fine eaeh other . ar effect for e.eh of the 

tw saae is also estieated to he very close to ene a,otlrr. in this 

ca.e, ho+e.iesa mrh are significant nd not differea frca eeU otlrr . 

A higher effect of hanalold ppive wdcin8 . .e foud as .oefated 

with epidemid aM .ell eetl hirtoloqie typa (ahx :e3) t.vn for 

edenacareinar aM other aell typs IOR-1 .621 . lkaeover, the effect 

for eplderaoid type is siynificane 1951 Q .: 1 .39-5 .76) . Mrraas tie 

effect for admoareinmr is ect (ri6 Q,r .435 - ] .{l1. Fi9um tb 

13 - 16 illwtrata the lines for the reqs+seion endela for rrh of LM 

sotq[ap de .eibed ahoue . 

The .odel that u.esees the effect of hauwhold e>qoaae in the 

prewrn.a of oa[omdinq variables yields rwlts that are diffecent 

ffaa the resulta of the rodel withent sarh variables (ifble tb 131 . 

'l1The estimate of effert for the Nole qrap is sllqrhly lowr lal • 

1 .S561, but eo clrrqe is o6 ..rid in its statistical siqni.fican. (9St 

Q . • 1 .0006 - 2 .42) . The aetlmat.s for slcroy.te r.apa,dw+rs, Mlf- 

resaonde,te, former sndrers, e.les . fem.las, and epidernoid hlstoloqic 

type - foraerly significant - do Bave oonfidwp intervals lin the 

Presao of eovariataal that include the eoll nlue, aM polnt 

estiaates M,ich suggest lener effec~s then the wdlosrcd eariaetee . 

Ihr point estiwte for adeieurrlhrns IpM .B7) . althwqh still lour

111M6 al Mq9C'I UpOrm An hlma" 

GBYD 9 

► LO ►2 ►SCC 2YIV1 oou SC6rr ~pllOn 

7N1 tTnB 

1SSL'S KYCI YLAZ 929C' S6C0'I Ipp ►Ipel 

900CC CD[0'1 IMfI 0f6T 6tlr 571M 1 

Mh'Y M101 LmI OLIC' 6Ctf S)iMAI 

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L6CYC C9Y6' 909'I 961C' 99019' 

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Y62YZ YLITI C9SY1 ISlZO 9619'0 TM 

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9LIYL R60'l ~29Y9 L Lii ► ' 09Yfi'1 {,1 1 

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-96- 1 -66

0 


-97- 

-98- 

• 

2505521374


FNRRUNn Is 

GMFqE IN LLRq CNfER L00 dD03 WITH PER701UTEARS OF E%POR/RE 

TO PtiSSIYE SF70[INO IN TNE NOUSfNOLO•, FOR ALL Sl16RCF3•, 

FEM6LES•,ND MI1ES- ; 

ANG LOOODDS FOI DIFFLRENI CATEOCRIES Of ERPOSIIRE• 

s s r n Ir Ls Ir sY. 

PYlql 1tY!{ V Oldw[ 

lRafNb udr mf .ItPttm 1 . Sw lal br Add1. 

. FpRMRIM LIM • ALL WfLM 

M44af1 LIM • /L11t= 

lMf4~ llO • 11 .kU 

a .mas - .m+oln v uasaN uu Naano 

nDwt rd ls 

p WqE IN lUq CNXIR LOD ODDS WI IN PERSON/YFARS 0F E1/POSl1RE 

TO PASSIYE YIORINO IN TNE NWSEIQD•, Fp1 ML SIIOJECIY, 

EPIOER/1010/SW1Ll CELLN, MQAOENOGWCINOMUOTI[R• ; 

NISTttC01CTYPES 

AFD LOD 000! FOR DIFFERENT CATEOtlNES DF EXP64RIE• 

u. La 

Puei xw . mos~ 

lRaulb iMr reumPHon 1 . S .e tal Rr df1Nb . 

• Lri/T1KaAll LIM • YL WM 

.uu~ LIM - o1ao.atn we .uu uLL 

IMa4.M LIM •/OplIC4Cr~ tlV CMp CLl! 

uros • .u+aln s uFCmn uu sane

-ICl- 

TMLE W IS 

-102- 

ttun the e.cimets for epideamid type ICR-2 .)21, t .kes on a haderline 

significant vnlue . 

Ap.SqTEDtSIIfM7EJ .D006MT106. ' 3 .2 .2 .7fS1R.75 @aFR A59t!@2TCR 2. 

A/O CNA;KX LIMtTSiOC A pfEEAEHNt OT f1VOIFE OF , 

750 tLRS01V7FMlS3MOK1N017/ T/t /WSLMDID• , 

GtpF ESTUNITF 57AeMpD 010% 95: lf1 95: La 

EQRON OATIO 

Nl .M22 .a'25S I6561 1.0006 2.1200 

5116BCiS 

St1f 

45PVC0119 

.323E ,2764 1 .3824 .A011 2.3766 

1Xn4eArt .6726 .3937 ' 1 .9593 .9056 42591 

sl7vcraen5 

NEM 

4TeA5 

fau 

1 smam 

.3753 .309b 1 .4354 .7936 2 .6665 

.51 S7 .3266 1 .6746 .6631 3,1764 

Rwip !Q79 ]256 IY71 .710 2AYt6 

nWS .El6 ]0Y0 139" ' A671 2l106 

9rwl taL 

W*" 

.M26 5M 2.3230 .67" 6.1996 

ADDIMA• 62!6 .3166 1 .6676 1 .0000 3 .4666 

i 9oOK 

anwurovsrr esrnAfai 1 . 5o iwi br eeen4 


Table Iao 14 pre.'nta the results cf ansly-.inq handnld 

e:qnsora as a ategor:wl varl .Ele Nwl AwuetplA eWoaue w 

ulalsted under assuipdcn 2 . dcept fs tlr first tw .stimet'". 

all suggeat an t . . .on .. . .d risk for looq olner .mq G'r e:@o.d . Thu 

plot of the estisrtrs (Fig W 17 1 alsu ssso to soqqst tlrt tlb riak 

increases vith InQassinq empenur . MLLla nons of e!r aatic.ue is 

si9nifiant Isen oon[ideuoe 14db in the tabla, the lilrse treld is 

2 

f A G - 7 .014 . 1 df, goiiq f=ew the sod.l with no p.ra.etan to the 

nodel with the regressor reper .mrLg a linear trvd for tir 

cateqariesl . 41su . in oonprlson vlth she .rtla.tas oMained onder 

asseQUm 1, the pca.eet sstl.atas only differ te tte nor 

si9nifioules of the estirts for tLe hlqhest asponra . Yrn 

analyzed as a aonHnces variable 1labla tb 15 t!r ertlnrp of effett 

(Op- 1 .73 for 150 peraoNyears of efpekse) is sliqht2y lo ..r~thkn rh 

ef:eR obtained mder aseu%tim L (Un -1 .656) . Ik.e+er, tlsrir 

cmfidenes intervals overlap to a muiderWle de9ree 195% R : 1 .216 - 

2 .81 and 1 .137 - 2 .640 . nnpeCively/ . Slgnifiont effects .ere fooM 

for only two cf rhe s.*rouR an.lynedr for.er nmiaa (OR - 1 .770 . 

951 Q.: 1 .000! -] .1321 a:d .pidesnoid l.istoloqic type /OP - 2 .565, 

95% Q. : 301 - S .IT71 . Lcloslan of cwrtoadirq vsriahles in the sud .l 

17'eCle tlc 16 ) results ia ron-siqaicant affacts for tEa .e aM ti. 

er.'rr sobqisp . at %el : as for the qtap that co:SrSsee all suGj .r„a

q/.W JM uw s 2 uo116u+m .ne wnvy. 

CtW107 

ssaz ts9r rcu'I sur wsr •„.Vtw , 

Qscrs 9oorl sYsss wss' 96.r 

lID TM6 

NYI'C m66' WCt o/6C KCt C7NY 

COWT q16' 9CYil tolC YDLC' C711N7f 

91CIT 9000'I WdL'1 016r LILS' 

9251'C I7A6' Y9C9'1 Z61C' 9m, 

cmouc 

IOVp~ 

Sul ot6 

MAN 

C1Mi)nSY 

OIY6T SY06' /9CC'I YSLS' 9S£g' uYurs 

6tLL2 62f6' 2649'1 ZL9Z CyOa- 

ulooaas~l 

d17C 

wrnc 

9LL9i Itft'1 !ltCL'1 9YIr Z6y rn 

Ollw EOtltl7 

TYI i96 711 fS6 5907 OLMXVtt 31Yt111S3 dflOUB 

o010N7ClIDI )11 41 Cat117qIJC CINJUNOCtlId OCI 

7D i1ffIS0At7 D M1N7N77110 Y tl0! S11NIl ZF1301lm01fV 

'salw som'ru.uutl munmwl 

sl •11171sY1 


pnw loi uwl INS 'L Iq1101AO° +w~ clPoa6 

6Y90'9 6,906- 9YK'i 61,110' ILs6' .yll 

c976[ o66S OC[Ct Clsti [60L Scl•1s1 

14CCY 619L' CLiit . Os' 161% OCI-9t/ 

CYC6'I 1619' ACOt't u6r 0101- al-lol 

06RZ SLfL' CLLrI 601, 14YL' 00t-CL 

9C91Z 01LY' CKC'1 Car I' CCL' CL-Is 

19CL'I 90YV LOLC 0/K' YOCr- 04-9Z 

Lft9'/ 9if9' LC06' 699T Y960'- R-1 

1JI1 ss6 ln 156 

0111011 

som 

1pNM7 

ONSdIS 31Y1J1:S3 SC.UN05nld 

pQ10N7c101/7N1N1 

ONI DHS !p 5711pB31q 1/DI7 017MI15L4)C1 tl01 

Ctlllil 1a1701YOJ ICL OI1YSOllYtl SW0'C71KIIlC7 

YI aM 31CV1


- 1os- 

2505521378


-tot- 

- 1 oe- 

2505521379 

a 

e 

. 

I

sna.m~m • n"(bj~ .vy u{ amcbCa 30 aUNccawW 

'2~ Lml 

PuM olft2on wp uT 6uFps na 9am.aLU wroaq m}7oposso Oa m3 

amopW nMP awrym) t!9i 'IRtan7l~wdsw •1P I'160' ~ 0 V pw 'JP 

L 

6•CB'L ~ 9 0) Lolarloon. ou )O ioPv+ llM +P UELP nR i47 Os 713 

L 

"aa .q a raqAmd 'sal=Eaip .y>, a07 pwa 2wvil .yL~ owry 

1OPM 04+ aau • .LqeTaaiD1 20fino lwqWO Ot sw s.am .odo Lacr,assr 

2M fi 1aP= wp ayliiI ' ( 6CK•- .isa plwf 'LK000'- "W faca) 

t9/s6nW .4i a07 pl.ai n .O/i 9 LOryoqsLa alq .)atn ay7 a03 

1m3A +a )O oacT7N6n v= an Aq t+ wm F3= ~ WTWw jo adwsqv 

iA 'aninon.lu .ncd.a-ww ou 6uTS.a66M , Wia •wanaov sj 

•m6{3 aqi vT -lyqlairFp 2FUA 1 It cN '6i,a) pnWta an wa.mpca 

~n tm M '/ o 19n a•R UR ea.a{I e= PT3= j 03 sum[m awl 

mmvT+N6Tt 6IIpTUFira9 9S +~0~4 )O auil • (991'1 •9Bi'1 'LBT'1) 

Wia TFy Ntp aWWWi7sa +tpp0 w H99'D N bT " soliu sqn 

~i 6v{6u.z sa=in l~P WTWiqO spWrysO a.)a )O IolUaJcu3 

p14rPM sa.oxLls w7s caqxawp 

a .ys wTVw aKt UT a.Ylwp sroTn .ad an u) punl(b+ wsq 9 .q npm 

Vax IO UOp.a.ad=lv) .IQ, 'WWH3Md Lu)q .y ary i+WO Ll ai ai9Rt 

U4 U'oy . .ae Lsrr.drs am alrs.)w slp a0> >(Iaola) /.ao6.= Ipw 

v?4+~ PoP+1=OF saOT .n wQ, 'wnuomw 3u .l~l ylwa7np Oi 6uTpmxe 

praaaa arai . .aelml>al e43 UT 6uqas; In sapc4Tlp wuRl 

'3Mm11RY 3tL !II '.IJDIOiB OL 3N190iDC7 C'C 

-911- 


'I68'i - K6' ;2) tSf 'SI'1 - tn) 

I 

qMW A14v1 .S '21qWwne .i.n q)wy* 

GtliuO * 

499Z'f D096' L99L'I 491f' 1699' 'raprui 

lID T1v16 

99CL'9 iZIQ' 0691't 9Q61•' 9691' bplpCjp 

11999 t9[F t9N1 101C tia' sm 

KLCL 6ril' IfKI Pit' LIIC i1mW1 

YK92 m ' t9LC1 160f' 9Ylf' 

Lbl6Z 9YIG' iUS'l 99tf' K96' 

YDit'f KOi' O£CI 906f' DISS' 

Stli>d.li 

lam/ 

suaaa 

ly,il 

f1N17OaCL 

7L.misa6 

fIM1WA11 

L9LL2 CILL' 9LLC'I f9it' Y/K' IVt 

OY9[L rif6" R9V1 Z9LL' ZTLf' 

L173PWK 

nr 

Ot1VM If1MM7 

S]fl =S6 U'. iS6 sm DINONL9 71Millf3 dqtlB 

• av!3S11w 71L Ix aM~Ln+sC9+3U1acu3~ Dst 

D 3tlfRD~O O M1N31f3L•i0"1111141111113J1/3DIl4J ON 

'SOIIYtl 9 W 7'93LVWI lC3 G319f NDr 

91 DN3lW1 

-60T

Y9rOl Y096' Lf00"1 fLZO' Lf00' 

>~1104 

lID 7ma 

9SI0'1 rL96' ilK' KIO' 9900'- ~papppt 

S9C0'/ IL96' 9061 90t0' aO6' L111M 

r/Crl LW • tN6' L16Y atc- ti1M/1/ 

0910'1 1£L6' £S66' 9010' LWO'- 

L9L0'I 9K9' 19i6' 6m, 6L£40'- 

6r1'1 i00L' IS6P NLI' 9011'- 

taQUB 

Ip,qpl 

SOCIA 

MAN 

OU7uoJCi1 

109011" 

tul0aalsL 

f660"1 9m, 6£10't OLIO' Yf10' IllC 

L17791i 

9r10'1 01•L6' 0010" 0900'- TTf 

OI1M/ tl00C3 

mn t% A1 1% 900] ONON9tf 31YIdI1S'3 dd61 

INId7UlM 3N11110IIX1tS t1Mldltl:y3e 021 

A 7tlODR130-MOtl1U10 V 101 s11un 3DOOIftfl a/1 

'9011Y6 900i'p1liNllt3 0314/YtiNY1 

01 V131W1 


ts9v1 0££9' 0£!6' IrIZ' L1S0-- ul 

OL9G1 L691' 9911' 9LIY Lt9L- 4t - tst 

LKL'I 396C . L90C wa' LO£- OCI-9it 

M,6PZ 690' fEp'1 9YSY L1CI' CI-101 

OC9£ ;1 LAr L9Ls' LOw' If89'- 001-9L 

LL£IZ LLf9' 0961'1 £90£' 9f91' 4 .Is 

LOK'i a2t' 6291'1 £1£r 40L1' 04-9L 

6111171 LLhB' £llt' 900r 160L'- Q-1 

til f% II1 t% 

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9o1ro3 

O1MalV1S 31VWIIS3 ftl1/NOS63d 

.~S31 3X1lRtl0 1lRtl0.M 3p1 N1 

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C11F11139130UIN t%OM90Ilq1 fOW' :3 :VWIlf3 

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I

Lij 

1. L7y 

111 

FNIURE ! 21 

DIMIOE IN LUND V111ELR Lb0 ODDS WItX PCR70NITEA45 K E%POSIIRE 

10 P/SSIYE Sf10KIH01N !HE WORP PUCE, Eq7 ALL SUtlJEC/S*, 

AND LOOOODS EOR DIE E~Nt CAEEOORIES K E YPOSVRE• 

----------- 

.. ----- - 

~L ryww.ww~ . . .~.. ..~w . . . ..t. .. .. . . ..n.... .. . .~••w .. ...L . ....... .~ ...... .. .~ 

Lii 

Ls 

{ni 


L 

/ 7/ a /1 30 ti 1! 174 i >a Im 

PiWOI 1n! 1 OlY9Nt 

v CORMrlljlll, LIM - ML ll/C" 

wiLbAp LIM • ~It nlL~ 

~-6W LIM . IIW ft~lP 

n .0on - aaroun r c.~ uu .auese 

PtQyB No . 22 

CFNNOE IN LI1N0 CN/QR L00 CDOS WITH PE RSCIUYEAR3 K E%POSIIRE 

10 PASSIYE Sttq(INO IN TI[ WptKPLI[£, Fqi I1L SUBJfC15•, 

NEYERSYICUCRS*,NA FCRHERSi10%ERS• ; 

AIA LOO ODDS Fpl DIFPERENI GTEOORIES K E%POSt1RE4 

-------------------------- 

J i • 1~ i~ f~1 1! 19~ i a s~ 

POYI "/I! / 0IMW 

~ 0111MYr LIM - Ml YalQIo 

iI MLLb/il LIM< - ~4 fOms 

LA10~1M LIM - fYYO ~ 

nwso - nuP4alwT s aRLar ou sJCCte

aYa 

a wl 

ifF 

aa .~ 


L 

Ytal+6 Nv . 21 

DYIAEINLUHOGNCE0 .LE160DDSW1111 PERSON/YEARSCf FKPOSU0.E 

TO PASLVE NK,KIND IN THE WCAKPIICE, f0R rLL Slfi1ECTSY . 

FEMKES •, AND MLES• ; 

MO LOD ODOS Fp! Olf f ERENT GiE00N1ES Of EKPOSl1RE• 

. . . 1/ t/ Ii 7r 1Y{ i. a 291 

rvm ers r c.a~w 

• mIrYlKelu tNs - Y.L .urn 

•ulL-Gw LIM - IWLQ 

LJAft~ LIM . WIIi 

tlllqa . 111trfO1M i 41fCfRf Wl Y16>0 

nDUREPb 24 

C7N/M3E 1N LUd G1EICER L00 DODS W/TH PERSDN/YFMS OF EKPGStRE 

10 PtiSSIYE SMOKIND IN THE WORKPLMC f01t ALL SIIEJECTS•, 

EPIDERNOID/371ILL CELL• MID MENOCARCI11D14VO1HER• ; 

HISTOl001C TYPES 

AND LODODDS fOR DIFFERENT GTEODRIES ff EIIPOSIAL• 

w..... .q, . 

. . a w Ea Ys 1. u. aRf a s 

raa w.w a pvEtA 

. 

LOR1M01 LIM . .Yt R~lt. 

~1dM Ll/f • 411a910 Yp yLLt tlLL 

~-dM LIM . ILr)~tiDU YO OIM,, Ist{ 

.1NOq . 111PfoNR Ot tatfOO .Y LYl YJqYP

-117- 

iMLENe 19 

NNWED EAN10E3.0006M1f08 . 

ANOOONf10CN1I LIMITS f0A A OIffEqLNfY1t Oi E1fPo511AE ('l 

150 PEA :AiNfffA0.S MINB IN TNt WON¢PIILL 

IefRUfF STANONID 0005 

Bfqp 1 LAAOR PATIO 

951 L4 

95t Ud . 

ALL - .0101 .0106 .9900 .9797 1 .0107 

Y.6Et1S 

ffli 

)41s'1st .EMf 

rt?~0'9[MIS 

~k 

fn~OB 

f am 

lva71S 

.0105 .0170 1 .0)06 .9775 1 .04/6 

~.1M7 .1395 .8657 .6N8 1 .1263 

-A900 .06716 .9159 .6017 1 .0175 

- .0081 .0104 .9919 .9719 1,0124 

f0Vlf8 -ABet A801 M3 J008 1 .120 

fWFS - .009a 4105 .9f06 .970I 1 .0113 

UVINSI'OD -„1 t 89 .0m .9M7 .9Q0 1 .0285 

OW :411. 

ANICU . - .011 S 0120 .9886 .9656 1 .0121 

1.071Eae 


varsahle eui5oitn .he fiM :nqs desaiEed for t.hv categorical enca;ue 

variable . 7tie od'u ratio uaaciatd with an erpos¢e of 150 

1:ceoNyears w 0 .994 . vich loYSr /0 .971/ aM uppmr f1 .0111 95% 

ccn!idnioe limita that include the null veivc 1'fa0le No . 181 . 

ltreouer: omednntien ef . G'r .aNlwtu for the dtffexw)t aukqtcups 

defkKd by the levels of the stratifying variablu furrlar supPort the 

tark af evide+re for an asaooistlonflo~ patt of Table db le .M 

Pfqutea Ns I1.191 : Likevise, ••s--z = of the effart of espaure 

olttai)rd from soisls that Lcluie the oaKwMiny variabin du not 

providr erati.r+âlly siqnil'iomt esti .ap.s (7able No 19) . 

3 .4 E7ffC5UlE 10 PASSIVL 9UKfSIO IN 

SOCLIL CIDClS9C1lC8 . 

IYqht eategn•is mrzerfeMLg to d/tferant lwets of eeqroars 

to pwive snokin9 in aaeS .al setti+ga . .re capnd to aero e~wl¢e 

thrau9A the fitting of a logistic .odsl . ' 9xh a eodel previded a 

1 

better fit to the dan tlrn the eodet with nn Pen .eters t . 0 • 

26 .41, 8 df) . Tlr aatlwtas for the tw Iawt eMc.uns mrtenpad 

to odds ratios of 1 .836 and 1 .06/ t9aible No. 20) . 'i!e aqgestion of 

ilcreawl Ilsk for luq cwlar for thse oataqeryY ef arposure, 

hm.wr . is not supltorttl by the wide oontidenee ll .its ehat incltde 

tir nuil wlue. 7M six tawinlwg ueirLS of .Ef.rt - all non 

siqnifioent -- do taFw erptiw aelurr Wy alw .ses to Sidir~te a 

sttag linrr tred in that diteefiqn . tiqute No . 25 sfiurs':+r peints 

suggestive of such linear tred . A tert prtovided the neeessary 

sutistieal evidecs tescLrote •- .0276) . tald- - 4 .380) . Ll

-119- 

suns,ry, by =ittinq a loqlstie ro8r1 to tne data that incWdn 

eVosure as a cateqo:inl variable, we foud uo thieqs3 first . that 

tas resu 1tUy eotlel fits the Anta lecosr Wn a mMel with ro 

perrietats ( .uen tlias g h aer11 peiasetaar in the firol: mdd is mt 

siqnifiemtly diffetent fron rerol . and ssmd . tLat Mwt oetpedes 

are e.de to raI re.ent i+azwlnq Oa .es of agrsrtr . Mty sler a line.r 

tra,a o ppo,ite to that nypuetieai=ea . e.tiac u , a are :.ase in rialc nm 

i.K2% ∎.>n5 e PPO. Mre . 

^_Y analysis of the ildes of seeial e+@anaw to passice srakfng 

as a aoncin+ae variabiw doea not cAUqe the pitnas (4able No . 21) . 

Dposv¢e to 20 units of the itdex of social eqiostre is a2aipemiied 

by an odds ratio of 0 .699 1991 Cmfideioe ILdtsz 0 .5202 - .76901 . 

]he estlsetss Tar the different levels of the stratifying variables 

are all close to the value dtad abeua. with omtidmce limits equslly 

exelusiw of the null valo.. 0Kh of theae are shwn irn ti+e lwer 

pR of 11b1e No 21, nd Cr 1Las reprasentlnq the linesr trands 

aPl,ear In fxyur. . 2s ;ntwle 26 . 

Eurcneo 00 e, the imlosim of aonfasuny vart .blee in w andels 

fitted nave .e.y little lapact on tlr valt.s of tn, Polnt escia .tes 

( Tanle w . 22 ) . m. »a ilarlty of aajustee ana wwwa.d : .eim.re ie 

also ratlectid in ouerlappinq eonfitlente L>OCvals . Ln t*o Lutvvas, 

Iwver , tM 1^'*oS--+t^° of oonfaudi4y wirlables hsd the affeet of 

yletAinq mn-afgiEflom wstiseas . for aese9ate respuideme the 

cmfideice limits a .-o ad the o3L ratio (0 .951 ) inelude the null valoe 

10 .6424 - 1 .i261 . in Lhs swiw wy as do the owtfa4aitr_ ll amits for the 


-t2o- 

TMIE th 20 

emrutta.cewluTro6r/o %s colrmfra EmlTs 

f00 Ey>'0511RE 10 EIOHl EkTE00RtE5Of iM1S9/YE SrkX1/6 

IN 30CU11 y17LLttWaS 

~ ESIfN1E t+~ OS 

fDRATIO 

952 lG %~ 

1'le .6067 .6636 L6360 .33l1 9.9916 

11-20 .0617 ,66M 1 .0677 .t964 5.74169 

2t-36 -.1034 .607 .901! .t706 4.76N 

31-0 .,I94 .l63t .6p96 .1144 3.2606 

41-50 -s363 .es3s 30019 .107f s .I7n 

91-fa -xo6 sll" 6ofe .1112 33ow 

61-T6 - 1.aa 9sTl beo atu 13402 

70 . -1 .6700 I . 4SSO .1541 .0089 26693


f9Y1' 9UY 0119' OoRI' 9Z6~-- 

aouos 

R~. t1R[ 

0626' 616Y Y169' 9tilt' W9C- I ~totllpm• 

L066' INLG 66iL' WCt' i6tt• tT1V4 

ilit' 6Y91: 1ZI>: KYI' GW- St7NH1f 

00¢6' 6ZSS' 0/0L' OZ>•1' OISf'- 

19L1' OLIi' 969C' 1641' iZ94'- 

ommc 

laapj 

901E1i 

gnil/ 

. :1looas111 

ZrYG BOYV 6" SY61' 9tiCi'- 2LVSOes 

illi' [66r' 4m, Oiil' 6196'- 

CSYL' ZOZ±' 0665' 0901' iLK'- 

{Og~aas7/ 

NC 

Wave 

l,ry 

011Vtl Ki1119 

SYI ;S6 tIIRSS 9000 OL1qNlf 3lV4IL57 dlDw 

I OMIy[L/C 3LKLVJ'M7pCO1 ;IrIp6d10 tl 7ClfJ/l )4 hIS10Yl OZ 

l03MfR9df3 T WI :NIIfliJlO V!plS11N11 DN70IM OMf 

; 'OOI1Vtl900q'[Iri.itlfJ • 

IZ aM 31YV1 

N


. 

/ 

. • r e ! r a 

i r• ~ 1 f! a a r? r a~ 

I 

I 

2505521387 

r


-t2s- 

• 

a 

y 

.a 

~ 

~ 

j°ll 

~~~~ ~ 3 

1~ . 

~~Yd 

-t26- 

U6LL pa 22 

NOCOi~ ~LOIIM~ITSf1 AW altp10006[M1uVL~aFL919A[Oi 

20lMITSIIITIEIIOpIOFplp9p[7070CLLLP• 4L81p01! 

BRDA ESTIMATE STA/OtqO OOps %I td 952 OS 

[FPOI MTIO 

ALL -A6l/ .1107 .{264 .fO.H .7769 

SLILFrn 

SCif 

W90cm 

- .4616 .I3Gb .6176 .41763 .T979 

204"GAn -.0439 2034 .96i I .6424 1 .4259 

q[ssaoorn 

Wm 

glam 

rum" 

l+aaas 

-.6310 .1626 .6669 .4216 .6y6m 

-.1141 .1612 .660V• .4914 .I690 

rowa •aeo . .nhl aoa 311,111 .la . 

IM12f -]900 •Np6 .7416 mM .0!!0 

~~ -.3020 .2i16 .7393 .a603 1 .1676 

vWl Ok4 

^DOMA . - .3%3 .1445 ;726 .5070 .6926 

a mtas

-+n- 

esc:mert òr m*~Zuxoid licnlo9tc t)p.. dues tON ~ .7337 . 95% 

cmfiden

-129- 

ip,+eyer. he nnp!.e[ nature of Or Plcblw. iltlp with LY 

i 

.per!eecinn of present rewarch toolso have Preci .afN tne 

NublialsMnt of definite ttoclwions 

. As it is alaoat always ris! 

ose in epidemologic resesrch* it is the infc .setion fxout zwv k 

different studies that will pirwl& the evidecw neoessery eit[rr to 

rejeR er to sccept the esisteaae of the aeaaciatiou 

. The Presrnt 

,xudy ys car:ied out ra :attBer assess the reln.iWhiP bec-m 

passive smkitg arcl lug onR . as well as to ptovide aaf.ers to sarr. 

Of the seNndolegical Pmbleer ancamtend by other authxo . In this 

cMpter I will present a diac+rsian of the 9eoerel asPecv of the 

study that say have had an sffeet an our trmib, such as s'uPle size, 

omposltien of our sasly pepulation li.e . inclWion of both sexes, 

irclWion of foroer ssdelts. at:.l apPrerch to data aolle~tion. 

cinice Of statistivl taGniaues . ecd so an. M :s will be fellm.ed 

by a axr specific dlmasion of the results of each of wr expo .u.re 

wriables . faasing an the wsy in whlch tSwe results eaRoRre~ with 

others Praviwsly reported . 

7fis pevcit sddy is to deta t4t lar9sst awr mMceed m this 

suSjset . '9e aRliestiae of this fact refleRS an the ie0rcved 

statistical po~ of omr study eare otlrr studir with regard to tlei .- 

a6llity to detect diftaranas in risk 6et+wn the exposrd and the 

wieseoaed . 1twn the eatiwte of et4c : is aSpected to be rrxlerste or 

sss.l . as 1in hsen the osse as suqgutad by Previaus e9idlaioloqic ald 

laboratory studiesi coosideration of saqla sise takes on speriai 

isporeane. Our ast:mstion at sepla sira reqiured to Jetect an ef :e^ 

of the order repor-ed ` .rrlependintly by '.lirrpo+ ard 'Cidn{uulou 


-i3o- 

:esulted in a figure of I50 casc-catrol pairs. gira+ that a exrdhed 

design .ould be used . We .ere able co aseembla 439 pairs that net the 

eligibility criteria fully. A saeplc of this aiae peavides a a clase 

to 951 pro6sbility of oorrectly rejec-1ng the tmll hypoUesis Ipwer 

ala.lat.ivn hssed an an odda ratio of 2.01 p.uPOrt{on of exposed 

crntmis to spewe Wmkiog, P. of 0 .25; and siguitiranQ level, -[, of 

It has been sq9utM that the estSesrtes faud by 8lrayaaw, ad 

Tridcpaulaus are tee high, in light of what is Imoel a6w.z smNe 

uQUke by rm-*ukers (the uptake has been estiatad to be aluivalwrt 

to the amokitg of 0 .1 to 1.0, oiqarette Psr day (451) . It fo? laa that 

the use of suoti estiswtp tould ousrestS"ta the pxr of acy givan 

sanple sin. An odds ratio of 1.3 is hliavad to raflacz son 

acauately the risk aswciated with the lewl of wpenue attained by 

Passiw smdcicg 1651 . Mle rs ur the latter asriaste to calculate 

the statistiol Porr of our sWPla ais, the resulting figure is 

er111 higher than the cvnrntion.l3y aaaeptad Ws. tueilreMre, yrn 

in : tlrse ealculatiqu .w ohuge the value of the Ptaportion of the 

eposaS epKtuls from 0 .25 to 0.50 Itlr peoportion of aqwsad cmtrols 

actually ebsarw0 in our studyl . aur sratisttpl Poyr Lnaesses a6eve 

90s . 

The difficulty In gathering a large enwqh nuter of cases for 

study derives tran the fact that nnnt l .ng oaoar asea occur aeang 

sackwrs . tlron thoialh the latter are proosnly expcaad to large aonu.¢s 

Of emiravrcmal toeecto sedce as a cvuaqueev.r of both their O~.n 

aimking and '7air assoclaucn with r_'*_- srtokcs, t,ey are avurted

-131- 

for a study of the effects of passive ssokinq. since tAeir o.e habits 

wold tend to eeek any effect due to ervirvneatal sadoe . w 

rexgnited that the ideal erwp to be .todiad w a gzoup of ne~ 

ssoiaexs . It Oeraee avideerc . Fv.ever, that tne pcpulation we rere 

werkin9 with waLLd not yield anaqh navar sndtiaq cases in any 

Qraccial period of tim . Instead of red,.zinq oar seeQle eize at the 

4Werae of statistial paer. it ras dacided to include ex-mmlaers in 

the study . 'IDe a+jor prespectiva studies f90-911 have shoyn that the 

tisk of lurl cenaer aonq foner su.en can daQense. after 15 to 20 

years, to a point sMra it eaerbles the risk of the never .edoen . 

a the awrqe thaa-rohsrs Litludad fn oir aaiple had qoit le 

yesre prior to thafr lnrticipKion in w sdary . 

. ur em ayre,nonetlrless, 

that .or raaidial effea of past sndcinq habits ai9ht 

still slnw in atr data ud this oonfovd the etfrr- doa to pusive 

we cmk threa sapa to enan that oot coselusions veuld nnt be 

affeeud by the inclwian of fateer sanMrs . These ane 1) the design 

of H+e snudy esraklishd tlrt asas and costols should be setdasf on 

tha basis of . .okinq history. 21 sepsnte eatLrtes of effect vera 

obtained for asckers a.d fomes ackars, aM 31 We aonttol7.ed in tlro 

anslysis for a variable that represented the ne6er of cigarettes the 

ex-yndeers used to ada p's day . Oor CeaWts prM".ded evidence that 

the Lnel•~sion of Lomer ssWaers was not i'rppsafdau . In no asa did 

w f :nd differTCes in t.4e estinates of effect beaeen n.ver and 

fotser mokefs Msich .efe aptistically slqniL'.car.l . lbvere'rless . a 

:esidul .e!!!^ dus to past Y(awing haolts yas tou4 . ?bcrcr aTrJfeis 


of I ps* of cigarrsew)day rtnrd a statistiolly significant odds 

ratio of 1 .30 . It shcold be anFhssised th .t thie effect w.s 

cantrolled for in the analysis lea asalained in nudrr 3 . ahaa/ and 

therefore is nar to 4 viasd u resporuible for amy effect foad Lor 

passive aakin9 

1rnt twsiecLas hsw raR[ic4d their sbHis en passive s a kinq 

aeluaiwly to w4so. 'Rhis is again related to the fact t1Ht it is 

enier to find non-.uking lvq viwr tases aeoy •tmen than mansl 

sea . In this Cnin it is iaiplisd to a certain e¢at tlrt results on 

tlen be estrapolatad to swn. That i ., lt is aseiasf that own are as 

susce ptihle to emiva imental nuka aO wuen, althaqh this is nnt as 

easily obetved in a ar/e popolatlin Eeeauaa nsn acquite lung csnwr 

ss a mnw,7oe M of their own WdHng . IKIe this prepositicn aeias 

sense, ee felt that it de.etv.d to be eusluatd . The findinq ot an 

association in srles awid struqthen the evidence of the c.rcinoqaMc 

effect of envitomsnc .l sncke. Pa stiNy includes also the largest 

Series of n .le nm-m okiig lunq tannr osea 126 .SS of these are 

never ~alata .nd 71 .3% an fonrr asnkers/ . 

Oor cases •ere drmn fto∎ all di.qnostic ad tmsaes,t facilities 

opentinq in the study area . ftrther aierJn for cases .qza perforred 

at the t+w yerk State 'Mor 8egistry . bsNpt for a fw cases dq ney 

iave left the ares in order to 9a•. erdial ora in other reqioin. w 

are centident of fuving detected .11 inddent mses ocarrin9 during 

t!e study period . Oot rescnw rate of 161 ean be oarjideral 9ca1 fer 

m+t es+umtion .l sWdarls . t+e do net have deu/ . :ed in'or»dciae on

-133- 

the r.Mrac~risrio of tne in0ivWnels .rtw refumd to parti='pate . but 

it is the luPreessicn of the field rt'swrch ausisear .eS that the reasans 

for refusal rere erre of a sedleal neore - i .e . Cie oase ws taa 

i11 ro Parric 

.pete - aathsr then eesodated with aey Pu'ticvlar 

sxiodemqrmnrc cha=ae'2riseica . 

Corect clessitiwtim of tb stedy aubjeots atxozdi^4 to their 

snkiag Aisemy is encial in sntliu m Pa+siw .roki+y. Inclmion 

of os.zant lalars .wEd epaiowly i'ievase the ci+k for the study 

dseaee . wen a,ckiny status of the rapated ^-axes ..a aeoertairod 

as paet ot dexeminin9 alegibillty for ParticiFatien in our study, 

aelv r8ase repoat.et in clr .dical raesda as formr smkers, rover 

adrrrs at of aYec .n snakle9 sntus nere oontactad by teleptea+e to 

!=ther ca,lirs ttar .mkinq hfstoties . In addition to this . the 

resesrEh assistant vaild at the tler of the int .rvlar further quesrioe 

G+iesa aobjects in this raqaA 

. Vr nad to emfia the smkLq 

hlsrnry sruted in eslinl remrda is 6at illost :ar+d by Cwrtinksl's 

fLdinqs (301 . In that study close to 40% of rhe wron with U.g 

cantar elassified as narsmlaa (or mkU9 atatw rot stated) an the 

la ;spiul noorde, had peen snirrs at a .ae tLer. In our study no 

a:-aept .as aade to confira the aoklno history of tlc.e reported as 

sokars . or even to establish tsn'act with thus. !t seero tese 

likaly . haraer, wt a foner or a neuer .roker wuld reporr 

tdaAhverself as a rorzent sokar . rhu aeaPlnl incluaioo into the 

ec av . 

lta clcoe swtiny of oir eues and cartrols regaidi+g ehei .- 


i 

-13t+ 

udkug luararief stroqiy fn'imres that misclassiftcat :m wes nct a 

Lilxly av .nt . Pravious fadin have beea µestlard ia this regard . 

aie ralatiw:y high lael rnwr eomality aee .q mramokLy .a.n ae 

wpnd to mockitg .a.e in tllraynr's sbcy t251 . a+ .+11 as the 

hiqh rintility for other G*attvr+lated diraw . hve nq9esud that 

sos w#inq ymen say Irw reparted T1rMlvet to ralonq to the nvr 

emckirp qso.p . This would not be eurpriaing in a traditla+al society 

suoh as Sapeo. The aoesaqsaas of euot. Wiaclassifiestinn vnuld be to 

ouetMCiate the sffat dir to pWivs aecking . 

Sfn Oreek stvdt (]7) on al .n Lr crit/eird on the saee qtoaxla . 

120 cla1L that arta tha 731 140 odt of !11 of lag osnoer ouea ..re 

diagnosed aecrg nor W akbg WOOrl is incasisant with the propecttee 

reporred in the liteature . It is mnfdurd that only atoK 10% a[ 

all lag rarcer in woi m onuts in narma da_-a , (tee aa[rapuding 

tiqure for e .n is 2 .0l1/ . It is tfrtrfor" litely that this study 

wntoaded the afGte of puetw sdNnq with elr effect An to direct 

ci9srette .nkiig . at leat to a ontaLn degree . 

8efors oa study. only tiarfiNUl aM caak.rs (30) Atl carried 

out an indepe .t .nt review of the histologic diagnoses of vaes . In 

snst other retorss the auC'ors wd relied oe the dischergs dta9no .aa 

reoorded in the patient's ndicsl nooeds . The deyree to .hith rlow 

diaqrous wwre hased oe woskrtim of pathology epecisms is wrid . 

In Tridrpcuicuf' stvdy only 351 Ird an histnloqic diaqrrsie (271 . 

'11e casespondinq tiqen for nkiba's stuily . is S71 (321 . Pelayo Csree 

relnrt. 9'71 (29) . Oorh Nirayaw 1 work aM 6arf itdn6l "a f irst study

osinq the w'erian 5near 

-13s- 

.e,mety data rwlied sxelusively oc deaLY 

osrtifioto 121-231 . The isportarca of histolnqic die? :«ses is that 

it provides the soet amtt.ta smsurenmt of disease status . 

Inclusim of other onocs can Wes the rssults either a+y frtm or 

tw[ds tle null value , de{andfoq on saerliec or :at they are related 

to sycur) . T .e latter ts tBe eost likely s[tu.ti.en since inclusion of 

orher arars .culd tnd to be ssndas. As .dditlonsl adven

-137- 

diffetenteet eusclassificat_an in o.r st:dy, we ,wld cveet to f>td 

bias elG'Mt aMy froA Or tdYids the plLl ValOe . If . oIl the other 

hand . av :u:fferrntial elsclassifiration atfecred onr resolts, the blss 

m,ild omly he an attarr.ation of the .stisatn of .effectf far sC : 

m:t.inwsly awsord variables as the aras asaessed in this atvdy, 

the segtitode of this bias wonid depe :d an the ragnivde of the 

correlatian beosn tne tn:e values for etpo .ure aM the valms of 

e%PCPre as MWred . 

We did not obtain infcmacian On c ertaio variahles km .n to 

affaat aa:aw :re . tMStilatim. eisa of coms , pea:imity to the amlmr 

a::d other to:ditlons onder M:ieh suklnq taku Plaoe influere the 

aocoal doea reeeiwd by the pssiw srolor . Ne atlknwlabge the 

diffiwlty in obreirtng d .ta in t.41s raqard, eqacially if irQonation 

a6ort a lifetise is tewt souqht . Ma also beleived that askinq for 

s :d : ezcee .iw derail in a :, mestiornlre might peeaent our aoqoisitia+ 

of aar basic irSCCeetlae. Ly distracting the intetvie~ froe 

eseentials . Bw t .hese facters say haw influe:ad nur results can not 

finally be datw omfned . 

Al I o :r omtrols eaee ftm the files of ttr l1n York State 

oepareaent of ltwcx velLLclu. M h" .deta to support that they an 

caq:eraEle to the msn in tM ooat relew:t ctrraeteriatica . 'Mece 

is, h~ . ons potee:tial soorea af pecblv . tt+ereas .e an 

CWMia . M. definitioo . thst atl oa.tsols rere lio.n.d drivara, ye do 

not kro+ the raxs' staws ,.ithtaqord w dri•Mq . If driving statu+ 

ls sa:e .tior related to the tisk of 11319 oinoer either directly or . m,ch 

.more lue7y, u,C_rly . aor results might haw been soClece to ~ias . 


I 

Na+ewr . !f any poss/ble differences tn drivlrp .eatoa reflect «:ly 

differences in aoeioeco :o.te status .our oo:2rol1Ls1 in the analysis 

by IHm4E slnuld have taken eaa of the paobls . 

Of all the eun¢as aiml to aeaus eqoeore to passive aiWnq . 

•me .m .uis,ee: of the apnue achirg hebits has he.n the mst 

frequently used . Thia sy .caastt.at least {aftialiy, for tne faez 

that Lhis if also t3r a.. .ure .oet otb .: rapccr.d to slew a positive 

aaaociatue with luq oncar risk . Iuanq the dUferent wya in MLLCh 

spouse smekinq has ber: quantifid, the ms6er of eiqacettr amaroed 

p.r day alpa .rs eott often in tlr literature . Nabr of pads a year 

xoFed . total nue6er ot ciqatKtss ad:d in a ilfatim, nsEer of 

years snddnq, aod mabr of tiqatsttr smlml at haee havw also bm 

used n a ptosy for esprs:¢e to passive .nkLg . In the prw :t study 

we haw eho.en Mr.e different saars.nrs of eq+oson: 11 :snhr of 

eiqarettea saaksd a day by tM al+o:w . 21 :snEar of yaan the srou.e 

snoiced. aM 71 total tumber of aiqaettes edud M :ils wmrriad ad 

livinq toqetlrr . we pelidvs tiras tlrc.a s.esuraasnts ao :prise 

inforn .tim an the t.o snst Utnrtant dlsansio:u of axOmon, 

intensity a:d dration. Mditiwly they also prwlde reaolts easily 

oaeperabte to those in otMr statiu . 

vreviaus studtu have shoun that nae-rid :Lq ..ar: ar-id to 

st.ti:ers of 20 or sm cigarettes a day nAlbit a risk of dewlopinq 

t•.ng cancer that is aq0eteda+taty double the riak of tlose satritl to 

mn-smtrers 125 .17 .301 . The btlsates obtaind in those Kodias hne 

bew: :eported to be significant, and .ti.: m:sidezed along virh t!x

-1/9- 

e.eimn:es for achPr levela u[ a4aw[e, t~ also mm foiad to siw a 

doee-respmse re ;atlo1uhia. %akiC+ further svppozn the mte for a 

ar .5a1 relatians,hip . fbr a so.e.iat ccsparable level of exposure .e 

.tre unable to detwct aay significant in¢esse in lmq orcer risk . 

Occ point estimte of effar- fQ those individuals married to wakers 

of 21-40 ciqarettesJday .na an adds rat .'o of 0 .906 (959 ¢ : 

.609- 

1 .35) . ~ exposure uss malyred as a atsgrical var~-ahle . For 

ntqtur levels of exposure .e fourd risks ahnue the aoll valoe . aut 

aa. .• ttese fiidiags were aot statiatiolly signifia,t . '_M analysis 

of exposure data as a apRi : .cus variable w mnsistant with the 

ahoee -m .ultss inleed the effect twrl fQ a differential of exposure 

of 20 e[9arerves per day rs hstely abave t1r iuil value (OR • 1 .01I), 

with c+anfidenee limits that include sueh a fiqure- !mr tMre w aay 

evlderaae of a liroar trend . 

9hiL report is ent tin anly a,r that has bssn unsble to onnfism a 

statistically signiffont as.nefatLon htsn nu~er of cigarettes 

.ukad by the spase od lnq anoer risks . Akie., at . a1 .(32) 

reported an adds ratio of 1 .31 (909 O., 0.M-3 .171 far LSare .,paseA 

to spsoe mekleq aS 20-40 ciqeratees/day (reported as 140-279 

ciqarattes/umk) . fbr a s.fnllar leral of eaposure, hlaqer at . al . 

(331 found an adds ratio of : .3 (95% CLs 0 .8-2.7) . 8rse latter 

estisatae . alrlooqA not signifiwnt, are within the r+b'qe of the 

suspeetd mbqniCAe of effact . A closer fi9ure to as re .ulta, 

haever . w reported by Garfinlml in his aeslysia of the 7aerinn 

Canoer Sndety Stuly daa 124) . far eiFa.ure to epouse seaking of 

20 or :rore ctgattres.Iday he fmad an o00s ratio of 1 .10 . Sisilarly 

his results aeje aot uqnifiwM . 

5V£GZS909Z 


-1uo- 

Oor results regarding tt~ .uvariable emuct be aommted for by 

the fi,alusiae of faoer senkarn sina aay effect due to this 

eirametnr.e wuid aC_ in th opgasite .tire+ . . . ., . that is, would 

inflate the risk attriLutabla to ama.uce. Nor asn it be esplained Dy 

the use of snsopte lnter.ie.e either, sime eo siep+ifiant 

diffetaKa.s ware faund Eet.e.n tle rtLetes fow the latter aM the 

eatiwtas for s.lf-resputls¢a . 'Ru eHsct aaold ntt haw he.n diluted 

by the irclusSon of mmles . siroe they sees to ahher a siadlar ruponw 

to that of w.n . Finally . m .qaal dirtrfla>`. .bon In ews aid ceattreta 

ragenSi,g om!ounlkg variablas ennt 6a raspayiDle far the 

fiediags . as *q)est.d by the airor dfnqe the estimstes mdecgo M>n 

those veriabla ara ineloded in the airlyefs . 

11a did aat find an effect depn0.¢ ae the d urar.tm of exposure 

to passiva smki:g a s sass¢ed by the an6es of ysan the sppse 

smalord rlSle .uri.0 ud livin9 mqetMr . i wo other studies Ird 

evaluated the effect attriEutable to this srbuie of aposors . 

Oalager at. al . (33) tepoctad ern slyelffaat ferrsw in risk d ue to 

s{uee simtdnq of 1-20 years (al - 1 .73, 9S1 Q.: .52-S .s2) . 21-30 

years Ipt - 1 .7l . 951 CW .60-5 .101, ud 930 yaaf ( 08 • 1 .24, 951 

0. : ./2-3 .531 . T1rae figures did nat slnr avidrr.y of a linrr trand . 

AkiLS . at . al . 132) reported od+ , rstioe of 2 .1 1991 C1s 1 .0 - 4 .31 

for tim .e a arrid to sndzrs of 1-19 ya.rs, of 1 .5 1909 as 0 .8 - 2 .71 

for those e,ptns0 during 20-39 years . ad an odds ratio of 1 .3 1901 

0.: 0 .7 - 2 .51 for thcse eaposed to 40 or aore years . Strtse em 

s(9nificaot effetn did ,nt shw evlds,ee of a Unat trend . 

6arfi+Gce :, at, al incorporated a different meenue of dtsetian of

erposore. ".1ey eatiaated rhe ar :ect associated with elqowre doe to 

hs6utl's ankSlq in the last 5 rd tee last 25 years . 'Cmse remoace 

of eapcwee . .um analysed fnt dilferent age gro,Rs . hisrnlo9ic types . 

type of respudu2, and socioecamic statw . Only om of 30 

eacfaetes oetalned alowd statistical signitirarae fat - 2 .38 for 

modera of the lower Mddle class esposed to spaee sndcilq in 

last 5 yaeral . 

itae svaloat .ioe of our third seawusaee of spas.e sselcing - 

toul :aa6er of rigesattea sadasd datieg sssried life . - dos not 

aoppnrt an aasorSatioe with lug wrces risk . fie estLete asscciated 

with a dif tarantial of aayowaa of 200 .000 dgaretres wes found to ta 

1 .018 (959 Ca o.8T/ - 1 .tet . ;'~!~+T+~~~as at . at . 127) used the 

a.e eessresnt to asars psair . .wkinq . 1Trir analyeis, laa.ever, 

rewlttd in sstJmtr that are relatively high (a thtee-totd lnaed+e 

in risk for eapxa¢e to 700 .000 - 400,000 ci9arettee) . and .+hidh also 

show evidenoe of a linear traM. Their finditqe persisted after 

owntrollirq for soee iapoetant wriabls . in our atody the Lxlusion 

of oonfomdLig variables did ont ptofooa any dreqea . that .aLLd 

reverse oia camcl•saiee of a em algeifinnt as.xlatlo+ . 

in the paraqraphs abvn .w have vallad attention to t.1e fact that 

factors ralatsd to the design of the stuuy, or ra t!r pceaeur of 

anfcrdinq variablu . mold eo3 explaln the diffetencee betueen oor 

rerllts and those ahorin4 a positiue associatioe with scvcse smking . 

Other ciranatanoa . hweaer . way Mve afir_rad oor results . Sonr of 

thse ate prese2e:1 as follon . 


tra 

-1e2- 

t7ltim of the Lirst tra apadesioloqic studies an passive entlling 

raised the mr:zn that the resolts carried aK in tw foraLgn 

rnan:ries (i .e. Japan and itesos) adght iut apply to tlw U .S . 

pquiationl t]pasure to spaaa adtin9, it .u st .gqestad, wold mt 

be as good a pmay aeesote for overall aponce to sacloe in this 

cvuntrp as it .oold be in rlwr ann t:aditicnal sodeeia . In 

tMse sociatic ynw smokinq - it is beleived - nnt only 

oarelates Ye11 with overall eaponAta. but ateoally oomprisesa large 

ptnpxtioe of it . a rsre . t aady in the U.S . soqqests a different 

pieture for this m .ntry . FrisB.n at. al . 1921 have foud that 

determtntn7 an Lriividosb e.prors an the Csais of the spasa a.okinq 

habits aay lead to qroas errors . For Lrtann . they r.ported that 471 

of +amn and 3% of arn aarritl to aanlwrs npart.ad aem hoas of 

eapeeure at hons. Omversely . 40 .Sa of wmen ard a9 .n of sen sarried 

to nwraaokars reportad sae espesura to the avoke or otlrr penam . 

'Itie deqcee in Wch a aiwilar pmobla a.y alply to eur d .fa, ar the 

ysy in which (if pr..eeU it ary have affected oor easr aM eo,trols 

differeetly . ourpt be ascertained thto.qh the available infonatfon. 

'lfius, soch a po.sibility r.ains a potential wrte of aiar . 

Different llfe oaidittons le the U.S . ssy al .n wMs the use of 

sP2.r+e snWn9 a Ed peoay for diqaMUS to passive swakLg . tor 

instweCe, the a.erqe Japanase has is much wllar than th hnerion 

hone . 7b i(dlatas ot laue siae oad ty the U1td tations 

ill .nrretes this 03) : 1) The avetsge size, eeprasencad by the sesn 

ndmr of parsons par hoanalcld, is 3 .2 in Japan . Mereas in the U .S . 

is 2 .2 . an! 21 1x peeeercags of Inudnq untts vic, on, roos only ia

5s in .Tapae eM 1 .6% in this cantry . As watioed in arother seetian 

of vLLs rapert, soon siaa, tagethar with a cloaely nl .ted wriable 

- i .e . proxi.tty to the asdoer - qreatly influenoe the sponae 

dose actually rteeiaad by the {assira .mdmr. 

It might .ell be arqi .d that. sinoe sose reoelK nmerion stod/s 

hsve supported the finii.njs of Xiraysa and'thridwpculaos . objactioes 

suoh as tiuse ratsed ahoue Irae alraady heen discwnad . It .hould be 

eepfsi:ed, loeuer. - tfrt only the stuty Ey Urfinkel et. d . has 

slao siqnifimnt fiMilqs in the oarcexi of rasasreh vithoot sr jnr 

aaHndoloqiosl problas . nn additimsl study Illlayo tcrzea, at . a1) 

prsent.L qustionehle rwlts, pvtimlarly dua ta the nrll maiu 

of wbjettts stulied . flrcehrsQe the ot recent peper poblisled 1n 

thts cavdry ws unable to vcwr .ry statistically sigetficant 

a .sccf.tScn /0a1.q.r . at . at .) . . . 

20 effect due to spwr .mdcinq in our sady sobjecrs may be ao 

aaLL1 as to be ade6aeuble Wer the pssot mditions of stcdy . 

SLeh sffect, haiever, might M11 Wm~a detacreble if espeson ftae 

differant sourees uere to amouLte . 'lhe fact tht s fowd an affect 

d.e to asFas:re in the lousenold - which lnclodes the spousa's 

seakin7- atmqly soqgMte this {wsibility. Sudler'a fLdi .-us 

furt.Mr support it 1771 . Be found an lfxzes in risk with the 

increasinq nuber of hwWnld rembers do amked, lncludinq the 

spouse . Lwition, toqnilrr with theae resolts . rculd ses t] suqqeat 

tlrt chs enst sWropiua ray to evaluate the effect of pesaive sdneg 


-1a4- 

wold be tLmiqh L'se o .se of a c-ualative itder of esponure . Altfouqh 

in thsy this is driraels . the si4soas of ©llectSng the 

intomtire smy p.v.crlbe it . Fecple's pe:eep[ton of Hr amam that 

goes an aremd t3r sy sary frm pr cirvst .nee to anether . 

Nwreaa paople wy 6e able to prtwide mre or less dstailtl ant 

eocraate infors.tian oe the smoldnr, ef the spouae nr otlrr amtaa of 

the fsily, they eiqht not be s pa.els. Nun it oo.r to the sarhinq 

of others or to the amkinq that oaxra in pubac pfaoe .. c~hy~ynq 

such infornation 1n a single iids osold rwlt in the aixi'g of 

"goN" quality lhformtion with sca . "hed• quality tnfoneeian, thus 

d'n~ tfr prut.dtlitis of finding qod eatls .mn of the 

effect . 

Ia+tly, an esplanstion for or negative fiMiiqs stiy oe 

attributable to the fact tlat .ukinq by the spouse is an asizn¢e 

that is inucmu oed late in life and .ay not be prelolqed drs)h to 

pram = an effaR in and of itself . 9o b eqowrte, hdbwr, muld 

l+ac®a inpoetnR in t!n praae~c. of a prevlous .aposor, hisrory (i .e . 

P.cenril mucking ) a' . as e w lalnrl a6d w , in conjisction with tqnin¢e 

fro other sarces . 

ua foud an inaease m risk fo< tonq cancer for tlese .3pesad to 

the serJoe of others at hom . 11e odds ratio abndattl with ISO 

peneNyears of c4oeure Ms sifnwted to be 1 .86 (ril dl 1 .22 - 

2 .6I/ . only a few previeus sncis have included a arsurvaurm of 

expowre at lwnu as a .isk factor to be Mluated. in socA snriia. 

ho.erar . CSS ftanmrenrr_ of eq>oa¢e has S..n ndimntvy, u>u.lly

-ts- 

.upreseed as a diooCoey (Ye+ .^•n wGIC1111rel . we believe our 

eesau==sant to be aore wWlete given that it cenpr.aas a prury for 

the Lntenaity of the a~osuta (n .eher of sokeia in the Aoud:old) . as 

wll u for its d :uatSon (auesr of yaars of colrbi*nt .ion .rith 

>edssrs) . It on also be raqardsd as a auptaMiuive aeeaue . at~te 

it irclodes all Lo,saAold sbaw for the subjacts' ruidmroe histor! : 

(tM latter ekpudLq for the rost pstt of slnir tl+lt 10091 . '!ha 

wllertion of suT sasniva infometion, twea.r, w oot .attwt its 

proClm . ws evida :od by the owxxaoca of sae nissing vadrs . '.e 

have eq+lained the rkys in whid : ra aR'COd"Id suc+ lc+bles Ity 

lopotation of aissin9 saluu wder tw diffarant aswptio:u) aod feet 

mnftdmt ttet our e.sults have not been 0•"6t-^'"11y affected by it . . 

'IIw follw" are tle rwlts ftv oUrr studies assesrrg the 

role af e:@wura to pssive s.0kieg at hoas . 

Grfinkel ai . ai (30) alauifitl the o¢owre to s:dw at Aone 

ataOtQlrg to Aw ts'Hlt 1Y the asponlte . 1Nt tlwse axpnad at Ilose in 

the lut five yeats (yp[ne apas ; asl an odds ratio w fovd for 

lmg tancer of 1 .22 495% Qa 0 .92 - 1 .621 . M .vaA 1~ astJarte was 

rapertad for expoeun In the lut 25 yesn ((Xt - t .15 . 9S1 Ct. t 0 .69- 

1 .19) . M1tree results vcf ::ot ststifCitally siqnificar- . as a1w.s: by 

the etetiMn.a iatarvals . A stre sef.ierd aeaacene:t of e"ora et 

io,r .ae also assesad by Garfirvmt . but it rs limited to spnne 

®nki:q . A sig:ufiomt tlnear assooiation ss :omd fw e:pcnure m 

the speLLSe smokinq at hw (no aaaxiation r .e foaN for the sneiti-q 

that occvre ourside the Aeae) . 8atdler at . al . (37 / rapertad ar. 

eleVated risk for tkaM a1QaneE at kaef . 'f!e oddf rYtioe alsotla_ed 


-le6• 

rith 1 . 2 . aM 3 or aQe tdcinq hwsd :old ar:bers y .n 1 .3 . 2 .3 and 

] .a . tspatt.iveiy. nrn tlw :qh oalf the last fiq.ae .as in itself 

stati. .i.+tly, sigJtiont . the tlren figuree toghether follw a 

statiktieally si9ntfieant li:rer ttend . Rahet rd MyMer (34 ) foond 

no aseociation 6en+en eMOMte at Aune (yr/ro e .pasural and risk for 

luq aaoer . IIrtr estieattl, ho~. are based on a study that 

included only 25 laq cower prieras . 

In additica to the oweralI effeet doe to hoiudold esFVaae fnad 

in o:o: data . there ts one other finding that das .c ves tpecial 

consu.ksetioa . 79 :e affeet ' of psufw woklnq in the hvauhold %s 

fourf to be siyetfionUy larser for apid.vuL!/s a il esll histologic 

type t1 .n for adsnoett ina m/eeler odls histologic type luad}rer) 

odda twtfos af 2 .07 aad 1 .42, tdpactiv.ly) . Cmtiollinq for 

tanfoirdLg variables rwltad In utlrtr , that altLough tnt 

siqdfioant , yra nwntLalaes oeirietra witl : the aho+a findings 

(adjust.d (M - 2 .12 , aM 1 .li . t.spu.tiwly) . As ekplaimd•in the 

paragraphs abnu. , only a fer studies hsvu classified their caeu in 

regstd to :Wto)oqie dlagnesis . pd ewn tewar have SneloOad a 1arq. 

aaoqb nurtar of ' wes of eatA histologic type as to 6e able to 

vasdna speeifit assadations . ttr rotSon that pessi+n rakdrg sry 

be more strongly asocaa-nd riN epldunold tt .ora , therefor.. mas 

∎.inly fran studias on ~n e effeces of direct amkieg . Alriouqh soaw 

of these stuCies t :ave Cete!riend that all lutoloqit types are ralatad 

to snokinq (aee CU xar 1 : •Sn>kSeq rN 8istalaqie iypa of 4keq 

:anoer") , ecst of t.'ae s!•on to a.pw that the strongest relatlanship 

is obsarm d 'Q epa!er,:o.d ur) mail tell tunar l . Te suqqesti.n that -

auch fiMUys hold as Yall for pssuve madtLq pxovinn np0ort to J* 

hypotn ..is that ens.-ito.e,t,l make acn in a sle,ilar .ay to 

w,.me.o smaka and tk.t K---s-- that tk only di :ferences between 

the tw types of etpesores are quantitative . 7h0 one otler study that 

fomd a statistically signifimrc hiyhe risk for ipidrrvn!d type .a . 

that of Cacfinrel's et. a1 . 130) . '(fry ra0ortad an odds rstio of 5 .0 

1951 Qu 1 .43 - 20 .101 assoriated with th6 kWa'd's srukitg at hose . 

Juietler study reported simiSar resoltv alt]au9h non significsnt . 

O.la9.r at . al .(33) reForteS an adiustsd odds ratio of 2 .66 (95% C : 

0.91-9 .101 for .pidereoid/snWl wll ateitaa•s . and an eidb ratio of 

1 .02 (95% C : .33-3 .161 for adcuwrrinos . 

'fis lapcrtana of psasive seoking in rlr teusdmld ant be put 

l= perspective with r.gad to the aoa.rt of 4XIasore nemo .ery to 

olsyrvs an effect of the sspnitude dnQihtl. We have pces.nted the 

utl.rtes of effects aaeclY.erJ with an exposure of 150 pmaJyeers . 

This is cqnivalant to Nvinq lived over a period of 30 years with fiw 

sokers, or with appearlestaly 4 ss7/ors for 37 years . it should 6e 

eaphasila0 that sodl 1M1 of exposure !s rather high and my be 

uroanon in the general p:qutatlon . In our study qtaQ. for iesrance . 

only 7.54 of the wsn and 4 .3% of the otRmLt attafntd that or 

hiqher levels of a¢oaira. lnlssd, la+er levels of exposure are . .ch 

sort caman . For example, Z56 of the oeses sid 20 .5i of the tvntrols 

eeporttl eAoau

-149- 

ef the family eey be closely o0trelatd with the dc7e received by the 

pessi•x m0is, the cort alati0n betwe.n Oo- .arYSrs' swking and the 

d0ee se0eive6 by the passive sakar msy not be as close . 

1b other stvdy Befon Oars h.d LnOludtl the aseeymmt of 

a,posute to pas.siw amking in social eitusvas>s . We lak, 

tlssef0ae . any point of catereca by .hith to campare a0r mumpecterwlts 

. We f0oad a deet+sse Ln risk fce U.e9 Orka with i0onesed 

eiQ~onue to an iMnc astad to rK1e0t sodal pmLw tMng .lOn ~ 

0 .639 . 95% C1. : O .S20 - 0 .765i . OLven all the follovieq - 11 the 

Prevaaa reporu that have sham an asscdatf0n hewa0 espow¢e to 

pesaLea >mhiiq ard Wtq enar . 21 aor ao e+sults that sopmrt soeh 

telattOnslnp tat l.est for oee of the opOwaa v.riablesl . 31 the 

aGdiss that have ufablishtl the assoeiatl0e heerarn actiw addnq 

aM the diaseue . .nd 6) the latOtstay dsta that hu cumfissed the 

or-iroq/r1ic propettLN ef teCrm ssOks - tIr pOSSlbtlity of a 

Ourtradir.acy effect of pessive aoklnq a6 lug cano .r risks ssrns 

oMOOMid . 

In ssRhi+g for ae sxplanstim of this rwlt . ye eat easider 

tw possihilittesa Il that the association fasd tefletts a trw 

reiatlor-ship , 

sid 21 the 

the teaulu aoa p[oMet of data artifacts . A 

third pasiDili'y . t/!@ tola Of c.hmee . hu larqely heen dismunted 

thmi9h the appliation of tests for Miich the statistiCal 

siq0lficsn0e has been set at O :OS Ii ... CesultU su0h u the mn 

owtvad mey have Oce.aed as a cauequeroe of tlrrce mly .In S oot of 

l00 'ttials•1 . 


-ISU- 

If we assne first that the relattauYifp fowd betkeen social 

eaEaeore t0 passive smkirq las m5axUrad1 nd lusq mxar is trae- we 

well miqht ronder .ent oo01d have Oso.ed tng cencer patlgnta to have 

heen e,Waed to less soclal Passive aekitsl than .ere the •heslthy 

emmols. My response alow tlnse litr rould be eerely spewlative : 

hut the toilov4nq is ar that hes o.=arnd to Os . aqpae thst the 

msn have ic:leed developed the disease as aconseTaence Of espOSUxa 

to p .sive aaekinq . AOmtdln9 to nuc rasultso the 'ca0bal' espon¢e 

.wld be ttr. One drrivad f_=m ssddnel Ln the hosdnld : that Ls, fmm 

the cnly esmaura for rhieh ww foud signifitstnt results . It oould 

ttrn be a.-gt~ that the aponae Mueh a0cata in the hae eamot be 

avoided lor . wmt be easily awldsdl , whn+as amposura in soeial 

t4resstanoes is sontlsinq w .r Mioh the Ldlv16a1 has a certain 

d.qrss of ontrol . If tho .. W o ar s to develop img canm deuelop 

early respiratory syaprau las is avi9uttl by the fact that lunq 

oncer is otter. ptw0eede6 by a poor easpiaMey fvKtiOn (6711 . they 

mey dnoea tn avoid am@onae to s®kR in soelal dmsnsunoes . lut 

fLM it harder to do so at Ma. ihOs . empOaaY in ttis iswtlold 

w0uld aaneinue to petmit the dissa.e-gariati0n pmcass to be 

aqflettl, rhile at the sasis t!s epos" fras other so0mes .oold be 

dSsinWhed. SimLiarly . it Oculd be psOpead thet . in additio0 to 

pessive ssoldn9 in the haralnld . tMn is an aa yet widsntifid risk 

factoc raqanai5le far a OOnaidsrable peocotti0n of the 

ases. 

inCessLg esposOre to n ich a risk factor a+orl the c .ass . heweVes . 

~,'d alse MVe to be asaodaW with a dsaessinq axp a0n to seclal 

passtw siNCLg . In this Ysy the tswrsa association OOsaN .d hetwe .n 

social fwssxe aoktnq aM lunq caneer wuld be nst, tslt by nu menu

vmld be 00113241 . 

/l acroid possihility rs !rw to:ridarad is that aor results 

te+podiog socal urpaw" an artifaenul . Nut is mst liloely 

rar.pndble tor this is the ose Of se eS..~~ ~~~i ~~i{e Lr3mt of atpowuas .ct 

pcevicusly vslidated rhtoqh petpstAodoleqic atudiar . Sone 

fwtats %ftich ay eew atfe=ted w yuaity of tae iofo®etioe 

collaud tAroqh w ch modwiies as follcr. [int of .11 . the 

prsiod of tias conar.d by t!r qunrlaarlR ltems is v .ry lealtlry . 

LlititLq good infooetiod oq d .y-m-tYy ew.ets in the Pbt seqoins a 

omsldsrahls effort of rear.llasion. /erN^lArly 

for the first yeats 

of life . a o~stdacable raaoilsetiae of th qraR's or ttr faaily's 

eoCial life, M1i~% LLf th Oill v9l{eie of tl( os tre to flWirono RKJl 

Man fa , is rill/ired. 

S.mrdly. rh intanstion o lt rs oollenad d!d rtet wks any 

attapt to r..nse intrialty Of 409awas. aor did it ssublirt the 

relative laportatnl Of eapowas dorLq ar activity as eplr3sed to 

anodar . fiere is a tr1 qusat.ioo . fur itutrns. if visitinq fdends 

ar relativo Mn secke mAeys tM s+ME dr,e .e Of .XponeMP as wold be 

inasred by qoinq to Eers aM nsuunnt. . 7>tus, exyomta for all 

activities .as riigeud equally . 

ihi.-dly , the .pecifS.c sodrl acLtvitias apecifitl to the 

imarvit.ee in oeder to elicit a nspe»e - tlrt is . t.hane 

repras..RStlve activities feon m be cvdsive to e)q osur. - yera 

\l.ty lieCÀd (fRe 1iQFiC'IZif n. :Yge 1711 . fbr INCV f ;alAy sub ]eCCS L'10 


,xpcavre might originate fron vety differant sarts of smial 

cim.xe'uanoes thnr: tLose explidtly qoesciond . The faaure 

spe=fically to rentim tlnse activities wy cmxivebly have 

pivduoea so"e ""'' ~ a , 

ktacth , 

the ose of dic differatt onits of tim to eeaaore 

frequac7l of eapow.ro .ey alsc have oanitued the tespadm .t.s . lbe 

less fregoeit aqioartes iud to ee reportsd lceadi19 to the nmber Of 

tises a uurch ttn es{awrs oct=a d. Mrrsss the eost ftequent 

eq~res had to be r~ ted on a par/wk 6uL . 

Finally oxVrenensim of tIM infotwtlan being nqeestad sy have 

• Ifeef jpLj-ed by the ceples IIetICe of the qlMtiols. FJCd ilquiry 

deffitlGd reslMN/ UlliGlf s16tlltaeeClsly sy/1C11etiAd illfo[/wt1C1` OIf 

three diffeceot .spects of npoeun /typs of saeial actlvity, age Of 

aqowre, rd frechercy of empes :rel . 8uch qoutlms . Plaond ahmst 

at the erd of a on hoau iMatvi.r . ry havu Eew+ aroil+red Witlnut the 

=,muentretion ntasssry to ptwlde altoqaNMr adequate taepansn . 

W Osw• not emticn in the above list the ur of turragete 

raq :(dr2s as a po.siDle sourc+ af data artifacts .'Cn re.son is Wt 

r do net have any evidenar to support that tlr estiartas ^^••'- e ' for 

self-respudents ars .ey diffarent fros eM . of sorcaqste aespwde

lsperfact:au of the . :a:a colletc:cn taola alone, haaver, ney 

noe be aufficient to uPlain o,:r rasults . It is the .ny in Nuch ncn 

laper?ections affectwd the respmse of zavs via-a-vis tx res{mse of 

cartxola tna: any ptc.ride addil~1 m"xieratanditq . .gr : .i . .e can 

anly spern:ac- on this satter . Our --es'a17s sUqqot thnt the ceaes 

owy )~ wrlerepcrted their aioorue to eaeLl pWiva sadcinq- 9uh 

a p[ralea is otten sentiae .d in relac-an to r.Hies in .Lich the 

surycsed e4.wure fs ao=ially us.4sitatlew as is tho aae vitti drug 

or alaohol use . in the present i .'v-snte, Nuewr, there is no anh 

stiamti :aticn attaiwl to espoeote . Lt is, attet all, the wdcM of 

orliers . aM mt the patient'a wn risk fnetor that is being 

lsplieatd . xeuer,hless, patielta for vhateiar reason my have felt 

the need to m"vnimize tMi . Cyoaore to anything that potanttally they 

mi5ht have been able to avold . IfNorepo[tinq of eVisu:e by cantmis 

asy aiso . in tlroory . have piod~x.ed the results aheerved . In practice, 

tw.ever, there is no cviollicg raason to baleiva that cantrols '.oold 

benefit frvs such bdsrviour . As a maeqoenre .e Aeve disownted 

o.ereportiry as a poesiDility) . 

'CrcowlrrK this doneent re have presented a sumery of Cie 

inforaetion cvr-mtty available cn the relationship bet+een lur, 

crKer ud passive simking . Li ,he !sst part re !uva revi-wd tx 

nepr epidenieloCic stvoies en the wo7er.t, as Mell ee aoae rele1nnt 

laeoratcry data . Sne a .jcr pos•1on of this dac~ane+t, haaver. nts 

yeen devoted to t1e dee. ..-ptfon of tne setbdology and the results o! 

this . laryest epidemioleqle ruM' so :ar _^.cdr,rd to rr.,ins the 


afotenentrmd assoclatian . Both the streqW aid waak :nasaas of . the 

study heve oeen ftdivred= Wt Mwq tlwe are pur into a balance, .e 

helelw to Laua gathsrd ar ot the 6 .K dau aeta to ju* the 

estmse of the T¢pY.ad ralatiauhip. 

Ye .err aeble to mnfism an ~.-'~ atio^ with the aat cvmnnly 

used ea .wao of apoaure fspouse wdtin7) . bnt e+ did find an affect 

doe to eqoeare to pasive swcict-4 in the Iwsetnad . 'tlnaa retolts. 

altFnvgh only in paetJal agce+smnt wdth tlw of otl .r sddias, are 

vamsiatent rith the .xistaa of a s•all to sedersta etfect af puaive 

eeokLng on lun7 neoer risks . 14 did eet tJd an effact ive to 

eq3on" to a ssaivs aaycLq in the wtlPlaa .. We fasd. lo.ver . a 

dsaeuad risk in lunq unoer with :n'^°e' nq aa@oeure to passive 

aackinq in social drnnreanas . FeesiEle reesma for suCt findLps 

Mve been dfaaused aeoue . 

Out fLslLgs au7yast tAat the prwims atudiae .ry have 

orecestLsted the elfect attributable to passive asoMrq. 9Lvh a 

ponat6i11ty tias 6 an pcqsie7 by tMr Mc oatand that a typiol 

aysaora to passive tddny is tely eqoivalurc to arekLq actively 

les than oea cigarette per day IMieA in itself amveys risks that 

are lowr than the tw-fold incswe peo{rned for pwfve ssekLq) . 

Itrtlydaloqlc prable e that say !we ld to sor h over.eeL.tion of the 

effect have tsnn poifrcwl oot in Crpoar 1, as aell as in this thsptee . 

As Is .aIl lmowa to epidmuoloqiscs, the rwlts of ane ac+Wy -- 

or even a few stodies-- are seldm suffinarc to ans .er all questlou

-1i5- 

te :atd_-g tlfe -vla~toM1SVg b9t!en a pnn. ae t3k factor e.ri a 

disease . We belelw•e tne present sRct/ :vs anCibuted to a 5etter 

mderscrnding of t.he lun9 caneer risk i+rvoltai !n Ue ea?oeore to 

passive smoWn9 . Neuertheless . we think we are sti11 far fran 

Icnrirg al1 tte details neoeasart to eetaolish a final judg,e• :t . 

tut=e studies vil ; be necewry- to tvte tMt steP . 


BIBLIG7UPiK 

1) The health - 5t smoking . A rq:nt at the SutSsun 

General : 1972 . O .S .p7psranst of Nealth. Etlur.atxm ard 1:elfate . 

lublxc Beulth Service . PP 121-135 . 

21 Elnrieon, M .J . . A prelialKry tcmrt on ciqarette esdclm arrl 

the 'sutlence of prwmturity . Me:_ean .~ of f_bnirtac3 and 

Gy ::taniogy ;1957 :73 . 807 . 

31 to.e, C. A . . LSfactv of oaBMr's saokieq habits ee bi-rh 

us/.9ht of ttftir children . @i 't~ Medical wrnel ; 1959 : 2 . 673 . 

4) Nut-ition PerJawa . Sm7Li+q. Pregn.ncy, aM Devetop+e;t of the 

offsoring. Nn.ritia ; Pevie•x . ]lt5) :143-145 . Nay 1973 . 

5) Rw, R . J. . Plaeq. C .V ., Ciatlae, G .C. . C91tm. S . Pe-^sr.tal 

smok=q at ho:e aM height of d :ildten. British Metml Jaa :al, 

1981 ; 283 : 1363. 0 

6) Chsq . C .S . . Myriantham :rles, N .C. . Pactots affectfn9 risk 

of crqenital nalfacrtiom . I Analysis of tptdem:iolo9ie faciaa 

in oon9rniC.a1 malfatations . Bepcat txon the cv1laS;xative 

Feruaral Project . birth ltetects : Oriqinl article se :ies . 11 

(l0) : 1-19, 21-22, 1 75. '- 

1) Caeetvn . P . at . a1 . . The health of sndrera' aM nms.d:era' 

children. Journel of A .•leeov, 43(6) : 336-341, Jmo 1969 . 

8 ; eunhse, G.S . . wilson . R. N. Childcm5"a Arlth in tawiltes 

vith ciqerexe sxketa . Anerion Ja:rnal e! PLLhlic _iealN . 1981 . 

71 : 290-293 . 

91 Cu11r! . J . . Reapintory syapfms in child :en aM mrent.t 

s:rokln9 and pnlx.o pnodtKtion. Briish Pedical Joornsl, 

2 : 291-204 . apnl 27, 1974 . 

101 Narlap . S . . Cavies . A .M . . Infant dsissiaen to hosPitsl aM 

ewtettul Mdti :q . 7Te Lanrnt 117857) : 529-532 . Mstth 30, 1974 . 

-156

-1c7- 

ll/ Hcran . 1 : .J . . 

:fle eK-~zS of snolea~ cari:A Prqq~.e/ . 

fealyti' Medi

341 Ba'ant . C . C . . Wnder . S. L. . 4vy ca.oer in nan~i¢rs . 

Canvs . !h.rch 1 . 1984 . Vol 53 ; 1214-122! . 

35) Sa .Yllet, D .P . . Wikae . A.J ., LVerem, R .B . . Llnulaire 

effeccs of lifetime pasv;ve Bmoking on onqr risk . preliminary 

:mmuuaation. 7M t~, tYhvary 9 . 1985, 312-314 . 

30 Svdle¢, D .P ., El+reon, R .B ., Mil®[ . A .J., Bro.dec, J .p . 

Gacez risk in adulthlod frta early life eqOSUre m pnrenra' 

ae*i+.) . Ra._ion Jao:nal of PuMic Heclth. Mey 1985, tb1 65, No 

5, 487-492 . 

37) Smdlet, D .P., Evereon, R .e. . Wiloa, A .J ., Passive yioking 

in adulthcod and mnoer risk . Aaeriean Jounal of fLidmiolocv . 

bbl 121, eb . 1, 1985 . 37-48 . 

381 U .S . Departmne of Health ud eu.n SarvLOef: •D :e health 

or+ks~s of ma/ :vq a reporc of the Cenrral 

. DBtS Pub . Ne . (PBS)82-50179 . fiah:aa/W; . D.C . . Cuvt 

Princ"vq Dffiee, 1982 . . , 

39) Botqq . U.R . CLq.retti surke in closed apewe . 8hvlrmmnral 

Health Persoective . 2, 117-128 (1972) . 

40/ Boe R ., K. al ., --locration of autagene in taarn urine after 

Pavine sadci+9. G ;nar Letera . 19 /19B3) 85-9D . 

41) Moffoem . et . e1 . 'lohecm efdeette® a;eke ; (PtaAe by non• 

ssohess . P-euwitiae Madicira. 13. 608i17 (1984) . 

421 BLrL. . W .C. Aed Pi.-at . M.V. Conoeftretlmr of nicotine ard 

tohacca snoke ln p ;blic placea . New pp1aM Jeunel of ha~Lcse . 

292, 844-845, 1975 . 

431 lA .pd C ., itaMdns, L .B ., Aetny, P. 87qnaot.a of Matve 

Bedrere to ootecco secke oontntvelrca . L:t ArJ: Ocup tSlivn 

Mea_ lth . 42s 21-19, 1978 . 

44) Ttiebiq r,., 2obar, M .A. Ldo:; ai! pollution Ce = olre 

mutitumts . A wcvey . P-eeent.ve Medlci.x . L3 : 570-581, (198a) . 


-160- 

45) Jarvis . n .J . . Setua thitcyenate in oesaive saoiiaq . :he 

Lanoet . Jar .av-y 19, 1985. p 169 (letter) . 

461 fliitonal . Brewtlssng other pacple"e suloe . Britfsh MeAml 

Journal . No 6135, p 453, Aug 12, 1985 . 

47) neeting repoet . fYqht Interna- tlonel IIM[itq an M-•titzaeo 

oaFnmd: . Jciare .oe . Sioloqia.l effects and relevenR to haen 

enxrr. Cancer Pesoarrn. 44 . 1301-1304 . Match, 1994 . 

487 U.S . Oemrtma .t of Beelt.h and Munen SerrriQe . Public Bealth 

Swloe . The heelth oasa~ ;e;tae of ®ddllq . A repx2 of the 

8 ; .-gem f+meral . 1982 . DBBS Whlioatim No (PIL4) 82-50179 . 

49) Bnsnmem+ R .D ., eoffaam . 0. aeeial BtWfee on taheeco 

salke . LII. Analyeia of wlatile nztztwamulea in tomam emke and 

pclluted indoor annmeenu . Int Waler . C.A . . (;

-161- 

551 Ardernm . W . e . . 3[iGlr.' . C . . dM l.vc-_tt . J . .nwtt:taticn of 

sndcu,9 in pe::e:Rs v:tn s.:oci:q relared c'4ae . Q:eet. 

WI 76 !31 . 415, 1976 . (Aosc.-xc21 . 

561 Mets :luua . S ., 4aauastA . T., NotikasU . K ., et . al . CfecrS 

of errvims.rrtal rahseco snxe or ,:ruary octinu :e emxetiorn ia 

mrv :oken . 6videnoe for Fase :ve ssedn9 . N?w rMlard Ja:xnal of 

Me,iicine, Sept 27, 1984 . 828-832 . 

S7) 6wld . N .J . . Bo [ehea. J . . Friley . A., et . al . Urinery cotinine 

as meraz of txest~niny otlri people's toh.cm mcko . 4fie %enoet . 

Ja:uary 28, 1984 . 230-231 . 

S81 Meld . N . . Kitc.hie . C . Valtdatim of stodi" of lung canaer in 

aatyxdrets serried to saekess . 7he farcec . !ny 12 . 1984 . 1067 . 

591 Shiyeru . N. . T®dneto . T . . Kitarto. N ., et . ai . Plfecv of 

envirvoencal toEa® 6no1x m urinary eetinine euretim in noM 

s>okacs . Nev pg1aM Jamml of etedi 'ene . Sept 27 . 1984 . 828-832 . 

60) Jarvis M. . 'MSrall-Padce . B. . Peynaberd, c. . tlsey . C. . 

Salleojee . Y. B :ec':emiwl eerkers of soole ahearptien and selfrepnrted 

expos,ue to csasive saYNnq. Joiaml of Wdeniolo79 aM 

dmmcitv Health . 1961, 18 : 335-339 . 

611 Mtllaz, P.C. . M- Cimkar . K .T., leaeder. M .K ., Mglaoe, J .D ., 

Booe . R .C. Dq.osition of sidesrawe smke in LM !s®n 

apiratory tract . Amec Rev N Dis . 125, 406-408 . 1382 . 

62) Killer. P.C ., et. al . Deposition of sidestresw cigarette 

smice in the hm6n respiratny tract . Pceventive Medicine . 13 : 

602-607, 19di . 

63) Mitd.ell . R .I . Cart.col!ed aea*usent of eaolar particles 

reter2wa ia the teapiratory tsact . .r Ja Nev RsSp DLs . 85 . 526- 

$33 (196.) . 

64) Bepr.w . J .L. . W-rey . B.N . Iad7or air pollution' toLecoo 

sceke, and a :olic 1+ualN . Sncl . 208 : 464-472, 1960 . 

65)tea.c . C . Drnt :tative aslncce of paastve aokieq aM lon9 

ceno•.r . Pre~ntive Medicine . l3+ 698-704, 1984 . 


-162- 

661 Lynd. . N .T ., et . al . Genetic aM simkir9 a:aaciats oncers . 

A study of 485 families . ('anccr . April 15, 1986 . 

67) Davies . A.L. BrorKlnrmic carcifoea ia Chronic rletrucrlve 

pulmnary dises.x• . Joi¢nn1 of the lnrstoan Mediml Association . 

1976, 235 : 621-622 . 

68) Ksuftaenn . P ., Tesster, J-P . . urinl . P . Adult pelsive sCOking 

in the hone emaxvve,x : A risk factor for c9rvic a:r!lw 

liaotation . Ane-iran Jaa7u1 of Eaidenuolow . 901 117, No 3 . 

269-280 . 1983 . 

69) NLLte . J .R. . Froeb, B .P . Sra11-aL~ . .ys dysfuec[ion in nmsnabr.rs 

chronic.lly esR:eed to tn0aem sol : . ttv t5gland Jau-el 

of Maticine . 302 (131 : 720-72J, Msrd: ]7. 1900 . 

701 Chef Yue, fa Men-ltise . 'me effects af Paseive aaokirq en 

rhildren's pulamary fsmction in Slwrlai . leenon Jamal of 

P.wlic Nee1Lh . May 86, Lbl 76 . No 5. 

71) My :drr L.L., Ocodloen . M.T . 9nokSnq and Im:g tincrr : So.e 

ut¢wlved iasw . lbademoloeic Ne.ners . Wl 5 . 177-207 . 1983 . 

72) Fbllaed . 8 .8 . . Pnrlamki . &J., Bocker, L. 'D :e effects of 

eiqarette saoke aa the respiratnry systes of the raMit. A final 

re{prt . Ca:rri . l6(5) :612-615, Mty 1963 . 

731 Saffietti . U . E+~erlaenul respiratory tnct urcinagemia . 

e9s in ltmerimsral lnror eard : . 11 : 302-333, 1969 . 

741 Mrnder . C .L., fnfhsun . D. 1eAaceo ad oo6ecco sneke . Sndtes in 

experinmtal rarcinme:esis . New York AcadeAic Press, 1976, 

730 lp . 

751 shuhik . P . 'Ne use of the syrfar. 9olden he:wter in daaLLc 

t=Cty testing . In, Nmiuqoer, F 1@Sitor) . ess in 

f5merin.rcel'llnor P.esear.Yh PeWlory of the syrian hanstar . 

Vol 16, Bseel, 5 . Kac~ . 

761 4tiiffith. N .B . . ard IYncod: . R . BLa!taoaous saiearzesesiddtreae 

s+o :e e:mos :ae systeir . I . Dfiti ;m2nC and Procedaes . 

7tzuc%io.yv, 34 : 123-138, 1985 .

-163 

77) Orns . L . . Var, Dooren . B .L. . 9nsak . A .I . . Neleor : . N ., SCmitt 

P .L . t+e cuciu~city for aane akin ard the arrnetic 

hyd~acroon cmtent of eigarettr9roke osdettsates . .7o,mx1 of 

C.Y Nariaxl Cancer laotilute . 21(31 ; 557-:61 . Sept, 1958 . 

78) Creenbeeq . R .S., et . .1 . . Inddmce of l:ag uurrr by oell 

t9Re: APaWlatim-Caand stody in ta•w 8aapehire ana Vemqnt . 

Joutnal of th Na:ional Canoer In!r-itvre . W1 71, .b 3 . Nerch . 

1984 . 

79) Doll . R ., at . al ., The siqnificsnae of cell type in re.arlam 

to the aetiolegy of lleg cuvr . Sr . J . Cancer ., 1957 ; 11 :u-48 . 

80) Rny6riq, L. . Risteloqlal luy oraar cypes . A 

aupwlogical a :d binlo9iml oarela:am . Aera PsL+el . 

Niacbiol . 6 :d. 5pp1 . 157 : 1-92. 1962. 

81) Neias . N.A. . Rosa :siaig . N. . tleiw, N . A. . Risk of luy 

car:cer acm :di:y to hi+toleqie type a :d cigarette doeaqe . 

Jomsl of tne laerian Nedicsl Aaeociation . 1972, Vo1 

2a : '99 70T- 

. 

821 Yesner. R. . .7elfewl, N . 11. . ald Pelnseain, A. R . . A 

reappraisal of hiscaced»ltary of tvs3 wber aM wmlatioc of 

cell type with anteoedcR ciqaret9e ssub . JYrr . R,!V . Res . Di+ . 

Wl 107 : 790-797, 1973 . 

831 AuerSac.h, 0 ., Gsrfinkal . L. . Parks, V. R ., Niatoloqie type 

at Imq onrer in nlation to aericinq habits, year of diegnoais 

ud sites of ne'astam es . CTest . 1975e 67 : 382 - 387 . 

84) R .G., et . al . .'Rie chvqinq histapstSnloqy of lun9 

mloer . A reVia of 1682 a+d . Canoer . 39 (4) e 1647 - 1655 . 

1977 . 

65/ Stayner, L., uid Ikg.an, D . . eroking . oee{ation ald 

~isecpacholug~ of luq wnoera A ase-control atody with the use 

of the 4hud Netimsl C~ SLrveys . Joor;lal of the N!ticnal 

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