Quantifying Risk to Flight Attendants from Secondhand Smoke Exposure in Airline Cabins Using Pharmacokinetic Modeling: A Case Report
Main Article Content
Abstract
Background: Several studies of the health problems incurred by flight attendants flying during the smoking years concluded that they suffered elevated rates of chronic bronchitis, heart disease, skin cancer, breast cancer, melanoma, reproductive cancers, middle ear infections, hearing loss, asthma, pneumonia, chronic obstructive pulmonary disease, various pulmonary function abnormalities, plus depression and anxiety.
Aims: Systematic review of secondhand smoke risks to flight attendants, exemplified using a specific case involving a deceased flight attendant who suffered from a multiplicity of tobacco-smoke-related diseases, including asthma, breast cancer, carotid artery stenosis, cataracts, cervical cancer, chronic obstructive pulmonary disease, coronary artery disease, laryngeal cancer, pneumonia and chronic myeloid leukemia. The decedent died in 2014 at age 68, losing an estimated 18.5 years of life expectancy.
Methods: Pharmacokinetic modeling was used for the first time to estimate the risk from secondhand smoke for flight attendants on typical passenger aircraft flown by the decedent during an 18 year period ending in 1988.
Results: Based on in-flight cotinine dosimetry measured in an Air Canada study, typical flight attendants would have inhaled a dose-equivalent of fine particle air pollution exceeding the “Air Pollution Emergency” levels of the U.S. Environmental Protection Agency’s Air Quality Index. The secondhand smoke cotinine dose for typical flight attendants in aircraft cabins is estimated to have been 6-fold that of the average US worker and 14-fold that of the average person. Thus, ventilation systems massively failed to control secondhand smoke air pollution in aircraft cabins, and led to extreme exposures. The decedent’s estimated lifetime cancer risk from secondhand smoke was 18 times U.S. OSHA’s Significant Risk of Material Impairment of Health level of 1 per 1000 per working lifetime.
Conclusions: In-flight exposure to toxic and carcinogenic tobacco smoke in smoky passenger cabins was the major risk factor leading to the decedent’s multiple smoking-related diseases, and her premature death. This has implications for the extant and future health of the cohort of surviving flight attendants exposed to secondhand smoke on aircraft during the 20th Century Era.
Article Details
How to Cite
REPACE, James.
Quantifying Risk to Flight Attendants from Secondhand Smoke Exposure in Airline Cabins Using Pharmacokinetic Modeling: A Case Report.
Medical Research Archives, [S.l.], v. 11, n. 7.2, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4157>. Date accessed: 23 nov. 2024.
doi: https://doi.org/10.18103/mra.v11i7.2.4157.
Section
Case Reports
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Repace J. Flying the smoky skies: secondhand smoke exposure of flight attendants. Tob Control. 2004 Mar;13 Suppl 1(Suppl 1):i8-19. doi: 10.1136/tc.2003.003111. PMID: 14985612; PMCID: PMC1766146.
2. Arjomandi M, Haight T, Redberg R, Gold WM. Pulmonary function abnormalities in never-smoking flight attendants exposed to secondhand tobacco smoke in the aircraft cabin. J Occup Environ Med. 2009 Jun;51(6):639-46. doi: 10.1097/JOM.0b013e3181a7f048. PMID: 19448573; PMCID: PMC2722845.
3. Beatty AL, Haight T, Redberg RF. Associations between respiratory illnesses and secondhand smoke exposure in flight attendants: a cross-sectional analysis of the Flight Attendant Medical Research Institute Survey. Environmental Health 10: 81- (2011) doi:10.1186/1476-069X-10-81.
4. McNeely, E., Gale, S., Tager, I. et al. The self-reported health of U.S. flight attendants compared to the general population. Environmental Health 13, 13 (2014).
5. McNeely, E., Mordukhovich, I., Staffa, S. et al. Cancer prevalence among flight attendants compared to the general population. Environ Health17, 49 (2018). https://doi.org/10.1186/s12940-018-0396-8.
6. McNeely E, Mordukhovich I, Staffa S, Tideman S, Coull B (2019) Legacy health effects among never smokers exposed to occupational secondhand smoke. PLoS ONE 14(4): e0215445.
7. Ebbert JO, Croghan IT, Schroeder DR, Murawski J, Hurt RD. Association between respiratory tract diseases and secondhand smoke exposure among never smoking flight attendants: a cross-sectional survey. Environmental Health 2007 Sep 26;6:28.
doi: 10.1186/1476-069X-6-28. PMID: 17897468; PMCID: PMC2064907.
8. Oberstar Hearing on Legislation to limit or ban smoking on commercial airliners, Washington DC. Subcommittee on Aviation, Committee on Public Works and Transportation, U.S. House of Representatives, Washington DC, 22 June 1989.
9. Repace JL. Enemy No. 1 – Waging The War On Secondhand Smoke. Repace Associates, Inc. (2019). Amazon Books: https://www.amazon.com/-/e/B07Y289SVT?ref_=pe_1724030_132998070. Accessed 12 June 2023.
10. Americans for Nonsmokers’ Rights & ANR Foundation. Flight Attendant Cheney Speaks about Smoking on Airplanes. (2015) https://www.youtube.com/watch?v=WLPweqhk5ic. Accessed 12 June 2023.
11. Idris S, Baqays A, Isaac A, Chau JKM, Calhoun KH, Seikaly H. The effect of second hand smoke in patients with squamous cell carcinoma of the head and neck. J Otolaryngol Head Neck Surg. 2019 Jul 23;48(1):33. doi: 10.1186/s40463-019-0357-4. PMID: 31337433; PMCID: PMC6652014.
12. Zhang ZF, Morgenstern H, Spitz MR, Tashkin DP, Yu GP, Hsu TC, Schantz SP. Environmental tobacco smoking, mutagen sensitivity, and head and neck squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev. 2000 Oct;9(10):1043-9. PMID: 11045786.
13. Repace JL. Exposure to Secondhand Smoke. Chapter 9, In: Exposure Analysis, W Ott, A Steinemann, and L Wallace, Eds. CRC Press (2007).
14. Johnson KC, Glantz SA. Evidence secondhand smoke causes breast cancer in 2005 stronger than for lung cancer in 1986. Prev Med. 2008 Jun;46(6):492-6. Doi: 10.1016/j.ypmed.2007.11.016. Epub 2007 Dec 4. PMID: 18182169; PMCID: PMC2737483.
15. Miller MD, Marty MA, Broadwin R, Johnson KC, Salmon AG, Winder B, Steinmaus C; California Environmental Protection Agency. The association between exposure to environmental tobacco smoke and breast cancer: a review by the California Environmental Protection Agency. Prev Med. 2007 Feb;44(2):93-106. doi: 10.1016/j.ypmed.2006.08.015. Epub 2006 Oct 5. PMID: 17027075.
16. American Lung Association (2023). Overall Tobacco Trends, Trends in Cigarette Smoking Rates. https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/overall-tobacco-trends. Accessed 12 June 2023.
17. Repace JL, and Lowrey AH. Indoor Air Pollution, Tobacco Smoke, and Public Health. SCIENCE 208: 464-474 (l980).
18. Mattson ME, Boyd G, Byar D, Brown C, Callahan JF, Corle D, Cullen JW, Greenblatt J, Haley NJ, Hammond SK, Lewtas J, Reeeves W. Passive Smoking on Commercial Airline Flights. JAMA 261: 867-872 (1989).
19. NHANES (1989-1991). Third National Report on Human Exposure to Environmental Chemicals July 2005 . Tobacco Smoke, Table 2, Cotinine. Centers For Disease Control.
20. Repace JL, and Lowrey AH. Tobacco Smoke, Ventilation, and Indoor Air Quality. ASHRAE TRANSACTIONS 88: Part I, 895-914 (l982).
21. ASHRAE Standard 62-1973. ASHRAE Standard 62-73 for Natural and Mechanical Ventilation (American Society of Heating, Refrigerating, and Air Conditioning Engineers,
New York, 1973).
22. National Research Council. 1986. The Airliner Cabin Environment: Air Quality and Safety. Washington, DC: The National Academies Press.
23. Nagda NL, Koontz MD, Konheim AG, Hammond SK. Measurement of cabin air quality aboard commercial airliners, Atmospheric Environment. Part A. General Topics, Volume 26, Issue 12, 1992, 2203-2210, ISSN 0960-1686.
24. Nagda NL, Fortmann RC, Koontz MD, Baker SR, Ginevan ME. Airliner Cabin Environment: Contaminant Measurements, Health Risks, and Mitigation Options. December 1989 Final Report, US Department of Transportation, Washington, DC.
25. U.S. EPA (1999) Guidance on SIP Elements Required Under Sections 110(a)Q) for the 2006 24-Hour Fine Particle (PM2.5) National Ambient Air Quality Standards (NAAQS).
26. Repace JL. Chapter 7. Tobacco Smoke Pollution, in: Nicotine Addiction Principles and Management, Edited by C. Tracy Orleans and John Slade, Oxford University Press, Published: 11 November 1993, 456 Pages | 23 illus. ISBN: 9780195064414.
27. Liu R, Dix-Cooper L, Hammond SK. Modeling flight attendants' exposure to secondhand smoke in commercial aircraft: historical trends from 1955 to 1989. J Occup Environ Hyg. 2015;12(3):145-55. doi: 10.1080/15459624.2014.957830. PMID: 25587876.
28. National Toxicology Program 2021. Report on Carcinogens, Fifteenth Edition. Research Triangle Park, NC: U.S. Department of Health and Human Services, Public Health Service.
29. U.S. Surgeon General. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. PMID: 24455788.
30. California Environmental Protection Agency, Air Resources Board, Exposure Assessment Office of Environmental Health Hazard Assessment - Part A – Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. - Part B – Health Effects June 2005.
31. U.S. EPA. Respiratory Health Effects Of Passive Smoking: Lung Cancer and Other Disorders EPA/600/6-90/006F December 1992
32. Repace J, Al-Delaimy WK, Bernert JT. Correlating atmospheric and biological markers in studies of secondhand tobacco smoke exposure and dose in children and adults. J Occup Environ Med. 2006 Feb;48(2):181-94. doi: 10.1097/01.jom.0000184883.72902.d4. Erratum in: J Occup Environ Med. 2006 May;48(5):529. PMID: 16474267.
33. Eisner MD, Balmes J, Yelin EH, Katz PP, Hammond SK, Benowitz N, Blanc PD. Directly measured secondhand smoke exposure and COPD health outcomes. BMC Pulm Med. 2006 Jun 6;6:12. doi: 10.1186/1471-2466-6-12. PMID: 16756671; PMCID: PMC1524811.
34. Repace JL, and Lowrey AH. A quantitative estimate of nonsmokers’ lung cancer risk from passive smoking. Environment International 11: 3-22 (1985).
35. Arias A, Xu J. United States Life Tables, 2018. National Vital Statistics Reports 99: 12, Nov. 17, 2020.
36. Batty GD, Kivimaki M, Gray L, Smith GD, Marmot MG, Shipley MJ. Cigarette smoking and site-specific cancer mortality: testing uncertain associations using extended follow-up of the original Whitehall study. Ann Oncol. 2008 May;19(5):996-1002. doi: 10.1093/annonc/mdm578. Epub 2008 Jan 22. PMID: 18212091.
37. Brown LM, Gibson R, Blair A, Burmeister LF, Schuman LM, Cantor KP, Fraumeni JF Jr. Smoking and risk of leukemia. Am J Epidemiol. 1992 Apr 1;135(7):763-8. doi: 10.1093/oxfordjournals.aje.a116362. PMID: 1595675.
38. Healthline (2023). History of COPD. https://www.healthline.com/health/copd/copd-history. Accessed 12 June 2023.
39. IARC Monograph 100F (2018). Benzene. https://monographs.iarc.who.int/wp-content/uploads/2018/06/mono100F-24.pdf. Accessed 12 June 2023.
40. Jones ME, Schoemaker MJ, Wright LB, Ashworth A, Swerdlow AJ. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Res. 2017 Nov 22;19(1):118. doi: 10.1186/s13058-017-0908-4. PMID: 29162146; PMCID: PMC5698948.
41. Kasim K, Levallois P, Abdous B, Auger P, Johnson KC; Canadian Cancer Registries Epidemiology Research Group. Environmental tobacco smoke and risk of adult leukemia. Epidemiology. 2005 Sep;16(5):672-80. doi: 10.1097/01.ede.0000173039.79207.80. PMID: 16135944.
42. Li B, Wang L, Lu M-S, Mo X-F, Lin F-Y, Ho SC, et al. (2015) Passive Smoking and Breast Cancer Risk among Non-Smoking Women: A Case-Control Study in China. PLoS ONE 10(4): e0125894. doi:10.1371/journal.pone.0125894.
43. Macacu A, Autier P, Boniol M, Boyle P. Active and passive smoking and risk of breast cancer: a meta-analysis. Breast Cancer Res Treat. 2015 Nov;154(2):213-24. doi: 10.1007/s10549-015-3628-4. Epub 2015 Nov 6. PMID: 26546245.
44. Musselman JR, Blair CK, Cerhan JR, Nguyen P, Hirsch B, Ross JA. Risk of adult acute and chronic myeloid leukemia with cigarette smoking and cessation. Cancer Epidemiol. 2013 Aug;37(4):410-6. doi: 10.1016/j.canep.2013.03.012. Epub 2013 May 2. PMID: 23643192; PMCID: PMC3819424.
45. Roura E, Castellsagué X, Pawlita M, Travier N, Waterboer T, Margall N, Bosch FX, de Sanjosé S, Dillner J, Gram IT, Tjønneland A, Munk C, Pala V, Palli D, Khaw KT, Barnabas RV, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Fagherazzi G, Kaaks R, Lukanova A, Steffen A, Trichopoulou A, Trichopoulos D, Klinaki E, Tumino R, Sacerdote C, Panico S, Bueno-de-Mesquita HB, Peeters PH, Lund E, Weiderpass E, Redondo ML, Sánchez MJ, Tormo MJ, Barricarte A, Larrañaga N, Ekström J, Hortlund M, Lindquist D, Wareham N, Travis RC, Rinaldi S, Tommasino M, Franceschi S, Riboli E. Smoking as a major risk factor for cervical cancer and pre-cancer: results from the EPIC cohort. Int J Cancer. 2014 Jul 15;135(2):453-66. doi: 10.1002/ijc.28666. Epub 2014 Jan 6. PMID: 24338632.
46. Su B, Qin W, Xue F, Wei X, Guan Q, Jiang W, Wang S, Xu M, Yu S. The relation of passive smoking with cervical cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Nov;97(46):e13061. doi: 10.1097/MD.0000000000013061. PMID: 30431576; PMCID: PMC6257541.
47. Wells AJ. Deaths in the United States from passive smoking; ten-year update, Environment International, 5, #4, 1999, 515-519, ISSN 0160-4120.
48. Batty GD, Kivimaki M, Gray L, Smith GD, Marmot MG, Shipley MJ. Cigarette smoking and site-specific cancer mortality: testing uncertain associations using extended follow-up of the original Whitehall study. Ann Oncol. 2008 May;19(5):996-1002. doi: 10.1093/annonc/mdm578. Epub 2008 Jan 22. PMID: 18212091.
49. Brown LM, Gibson R, Blair A, Burmeister LF, Schuman LM, Cantor KP, Fraumeni JF Jr. Smoking and risk of leukemia. Am J Epidemiol. 1992 Apr 1;135(7):763-8. doi: 10.1093/oxfordjournals.aje.a116362. PMID: 1595675.
50. Ji R, Pan Y, Yan H, Zhang R, Liu G, Wang P, Wang Y, Li H, Zhao X, Wang Y; Chinese Intracranial Atherosclerosis (CICAS) Study investigators. Current smoking is associated with extracranial carotid atherosclerotic stenosis but not with intracranial large artery disease. BMC Neurol. 2017 Jun 26;17(1):120. doi: 10.1186/s12883-017-0873-7. PMID: 28651523; PMCID: PMC5485653.
51. Jones ME, Schoemaker MJ, Wright LB, Ashworth A, Swerdlow AJ. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Res. 2017 Nov 22;19(1):118. doi: 10.1186/s13058-017-0908-4. PMID: 29162146; PMCID: PMC5698948.
52. Korsbæk N, Landt EM, Dahl M. Second-Hand Smoke Exposure Associated with Risk of Respiratory Symptoms, Asthma, and COPD in 20,421 Adults from the General Population. J Asthma Allergy. 2021 Oct 28;14:1277-1284. doi: 10.2147/JAA.S328748. PMID: 34737580; PMCID: PMC8560177.
53. Macacu A, Autier P, Boniol M, Boyle P. Active and passive smoking and risk of breast cancer: a meta-analysis. Breast Cancer Res Treat. 2015 Nov;154(2):213-24. doi: 10.1007/s10549-015-3628-4. Epub 2015 Nov 6. PMID: 26546245.
54. Musselman JR, Blair CK, Cerhan JR, Nguyen P, Hirsch B, Ross JA. Risk of adult acute and chronic myeloid leukemia with cigarette smoking and cessation. Cancer Epidemiol. 2013 Aug;37(4):410-6. doi: 10.1016/j.canep.2013.03.012. Epub 2013 May 2. PMID: 23643192; PMCID: PMC3819424.
55. Ye J, He J, Wang C, Wu H, Shi X, Zhang H, Xie J, Lee SY. Smoking and risk of age-related cataract: a meta-analysis. Invest Ophthalmol Vis Sci. 2012 Jun 22;53(7):3885-95. doi: 10.1167/iovs.12-9820. PMID: 22599585.
56. Aerocorner.com. McDonnell Douglas DC-9-30, McDonnell Douglas’ answer to the Boeing 737. https://aerocorner.com/aircraft/mcdonnell-douglas-dc-9-30/#aircraft-specifications. Accessed 12 June 2023.
57. Li B, Wang L, Lu M-S, Mo X-F, Lin F-Y, Ho SC, et al. (2015) Passive Smoking and Breast Cancer Risk among Non-Smoking Women: A Case-Control Study in China. PLoS ONE 10(4): e0125894. doi:10.1371/journal.pone.0125894.
58. Leukemia Research Foundation. Chronic myelomonocytic leukemia. https://leukemiarf.org/leukemia/chronic-myelomonocytic-leukemia/. Accessed 12 June 2023.
59. ATSDR Toxzine – Agency for Toxic Substances and Disease Registry: Benzene. https://www.atsdr.cdc.gov/sites/toxzine/docs/benzene_toxzine.pdf. Accessed 12 June 2023.
60. Pan J, Barbeau EM, Levenstein C, Balbach ED. Smoke-free airlines and the role of organized labor: a case study. Am J Public Health, 95(3):398-404 (2005) doi: 10.2105/AJPH.2004.040592. PMID: 15727966; PMCID: PMC1449191.
61. Broin v. Philip Morris Companies, Inc., 641 So.2d 888 (Fla. App. 3 Dist., 1994) https://www.tobaccocontrollaws.org/litigation/decisions/broin-v-philip-morris-companies-inc#:~:text=Broin%20v.-,Philip%20Morris%20Companies%2C%20Inc,cigarettes%20of%20passengers%20during%20flights. Accessed June 12, 2023.
62. Estate of Kathleen Sprowl-Cheney, Plaintiff, vs. Philip Morris USA, Inc. et al., Defendants
·Case No. 00-21850 CA 23, Florida, USA..
63. IN THE CIRCUIT COURT FOR THE COUNTY OF LOUISA, THOMAS ALEXANDER GARRETT, JR., Plaintiff, v. CL19000417-00 FLANNA SHERIDAN (f/k/a GARRETT), Defendant. Virginia, USA.
64. Brandon W. Melton v. Brandy Jean Melton Sevier County Circuit Court Case No. DR 2010-35-2. Arkansas, USA.
65. Casino Workers. Januszewski et al., v. Horseshoe Hammond, USDC, NDIN, Hammond Div., 2:00CV352JM. Indiana, USA.
2. Arjomandi M, Haight T, Redberg R, Gold WM. Pulmonary function abnormalities in never-smoking flight attendants exposed to secondhand tobacco smoke in the aircraft cabin. J Occup Environ Med. 2009 Jun;51(6):639-46. doi: 10.1097/JOM.0b013e3181a7f048. PMID: 19448573; PMCID: PMC2722845.
3. Beatty AL, Haight T, Redberg RF. Associations between respiratory illnesses and secondhand smoke exposure in flight attendants: a cross-sectional analysis of the Flight Attendant Medical Research Institute Survey. Environmental Health 10: 81- (2011) doi:10.1186/1476-069X-10-81.
4. McNeely, E., Gale, S., Tager, I. et al. The self-reported health of U.S. flight attendants compared to the general population. Environmental Health 13, 13 (2014).
5. McNeely, E., Mordukhovich, I., Staffa, S. et al. Cancer prevalence among flight attendants compared to the general population. Environ Health17, 49 (2018). https://doi.org/10.1186/s12940-018-0396-8.
6. McNeely E, Mordukhovich I, Staffa S, Tideman S, Coull B (2019) Legacy health effects among never smokers exposed to occupational secondhand smoke. PLoS ONE 14(4): e0215445.
7. Ebbert JO, Croghan IT, Schroeder DR, Murawski J, Hurt RD. Association between respiratory tract diseases and secondhand smoke exposure among never smoking flight attendants: a cross-sectional survey. Environmental Health 2007 Sep 26;6:28.
doi: 10.1186/1476-069X-6-28. PMID: 17897468; PMCID: PMC2064907.
8. Oberstar Hearing on Legislation to limit or ban smoking on commercial airliners, Washington DC. Subcommittee on Aviation, Committee on Public Works and Transportation, U.S. House of Representatives, Washington DC, 22 June 1989.
9. Repace JL. Enemy No. 1 – Waging The War On Secondhand Smoke. Repace Associates, Inc. (2019). Amazon Books: https://www.amazon.com/-/e/B07Y289SVT?ref_=pe_1724030_132998070. Accessed 12 June 2023.
10. Americans for Nonsmokers’ Rights & ANR Foundation. Flight Attendant Cheney Speaks about Smoking on Airplanes. (2015) https://www.youtube.com/watch?v=WLPweqhk5ic. Accessed 12 June 2023.
11. Idris S, Baqays A, Isaac A, Chau JKM, Calhoun KH, Seikaly H. The effect of second hand smoke in patients with squamous cell carcinoma of the head and neck. J Otolaryngol Head Neck Surg. 2019 Jul 23;48(1):33. doi: 10.1186/s40463-019-0357-4. PMID: 31337433; PMCID: PMC6652014.
12. Zhang ZF, Morgenstern H, Spitz MR, Tashkin DP, Yu GP, Hsu TC, Schantz SP. Environmental tobacco smoking, mutagen sensitivity, and head and neck squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev. 2000 Oct;9(10):1043-9. PMID: 11045786.
13. Repace JL. Exposure to Secondhand Smoke. Chapter 9, In: Exposure Analysis, W Ott, A Steinemann, and L Wallace, Eds. CRC Press (2007).
14. Johnson KC, Glantz SA. Evidence secondhand smoke causes breast cancer in 2005 stronger than for lung cancer in 1986. Prev Med. 2008 Jun;46(6):492-6. Doi: 10.1016/j.ypmed.2007.11.016. Epub 2007 Dec 4. PMID: 18182169; PMCID: PMC2737483.
15. Miller MD, Marty MA, Broadwin R, Johnson KC, Salmon AG, Winder B, Steinmaus C; California Environmental Protection Agency. The association between exposure to environmental tobacco smoke and breast cancer: a review by the California Environmental Protection Agency. Prev Med. 2007 Feb;44(2):93-106. doi: 10.1016/j.ypmed.2006.08.015. Epub 2006 Oct 5. PMID: 17027075.
16. American Lung Association (2023). Overall Tobacco Trends, Trends in Cigarette Smoking Rates. https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/overall-tobacco-trends. Accessed 12 June 2023.
17. Repace JL, and Lowrey AH. Indoor Air Pollution, Tobacco Smoke, and Public Health. SCIENCE 208: 464-474 (l980).
18. Mattson ME, Boyd G, Byar D, Brown C, Callahan JF, Corle D, Cullen JW, Greenblatt J, Haley NJ, Hammond SK, Lewtas J, Reeeves W. Passive Smoking on Commercial Airline Flights. JAMA 261: 867-872 (1989).
19. NHANES (1989-1991). Third National Report on Human Exposure to Environmental Chemicals July 2005 . Tobacco Smoke, Table 2, Cotinine. Centers For Disease Control.
20. Repace JL, and Lowrey AH. Tobacco Smoke, Ventilation, and Indoor Air Quality. ASHRAE TRANSACTIONS 88: Part I, 895-914 (l982).
21. ASHRAE Standard 62-1973. ASHRAE Standard 62-73 for Natural and Mechanical Ventilation (American Society of Heating, Refrigerating, and Air Conditioning Engineers,
New York, 1973).
22. National Research Council. 1986. The Airliner Cabin Environment: Air Quality and Safety. Washington, DC: The National Academies Press.
23. Nagda NL, Koontz MD, Konheim AG, Hammond SK. Measurement of cabin air quality aboard commercial airliners, Atmospheric Environment. Part A. General Topics, Volume 26, Issue 12, 1992, 2203-2210, ISSN 0960-1686.
24. Nagda NL, Fortmann RC, Koontz MD, Baker SR, Ginevan ME. Airliner Cabin Environment: Contaminant Measurements, Health Risks, and Mitigation Options. December 1989 Final Report, US Department of Transportation, Washington, DC.
25. U.S. EPA (1999) Guidance on SIP Elements Required Under Sections 110(a)Q) for the 2006 24-Hour Fine Particle (PM2.5) National Ambient Air Quality Standards (NAAQS).
26. Repace JL. Chapter 7. Tobacco Smoke Pollution, in: Nicotine Addiction Principles and Management, Edited by C. Tracy Orleans and John Slade, Oxford University Press, Published: 11 November 1993, 456 Pages | 23 illus. ISBN: 9780195064414.
27. Liu R, Dix-Cooper L, Hammond SK. Modeling flight attendants' exposure to secondhand smoke in commercial aircraft: historical trends from 1955 to 1989. J Occup Environ Hyg. 2015;12(3):145-55. doi: 10.1080/15459624.2014.957830. PMID: 25587876.
28. National Toxicology Program 2021. Report on Carcinogens, Fifteenth Edition. Research Triangle Park, NC: U.S. Department of Health and Human Services, Public Health Service.
29. U.S. Surgeon General. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. PMID: 24455788.
30. California Environmental Protection Agency, Air Resources Board, Exposure Assessment Office of Environmental Health Hazard Assessment - Part A – Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. - Part B – Health Effects June 2005.
31. U.S. EPA. Respiratory Health Effects Of Passive Smoking: Lung Cancer and Other Disorders EPA/600/6-90/006F December 1992
32. Repace J, Al-Delaimy WK, Bernert JT. Correlating atmospheric and biological markers in studies of secondhand tobacco smoke exposure and dose in children and adults. J Occup Environ Med. 2006 Feb;48(2):181-94. doi: 10.1097/01.jom.0000184883.72902.d4. Erratum in: J Occup Environ Med. 2006 May;48(5):529. PMID: 16474267.
33. Eisner MD, Balmes J, Yelin EH, Katz PP, Hammond SK, Benowitz N, Blanc PD. Directly measured secondhand smoke exposure and COPD health outcomes. BMC Pulm Med. 2006 Jun 6;6:12. doi: 10.1186/1471-2466-6-12. PMID: 16756671; PMCID: PMC1524811.
34. Repace JL, and Lowrey AH. A quantitative estimate of nonsmokers’ lung cancer risk from passive smoking. Environment International 11: 3-22 (1985).
35. Arias A, Xu J. United States Life Tables, 2018. National Vital Statistics Reports 99: 12, Nov. 17, 2020.
36. Batty GD, Kivimaki M, Gray L, Smith GD, Marmot MG, Shipley MJ. Cigarette smoking and site-specific cancer mortality: testing uncertain associations using extended follow-up of the original Whitehall study. Ann Oncol. 2008 May;19(5):996-1002. doi: 10.1093/annonc/mdm578. Epub 2008 Jan 22. PMID: 18212091.
37. Brown LM, Gibson R, Blair A, Burmeister LF, Schuman LM, Cantor KP, Fraumeni JF Jr. Smoking and risk of leukemia. Am J Epidemiol. 1992 Apr 1;135(7):763-8. doi: 10.1093/oxfordjournals.aje.a116362. PMID: 1595675.
38. Healthline (2023). History of COPD. https://www.healthline.com/health/copd/copd-history. Accessed 12 June 2023.
39. IARC Monograph 100F (2018). Benzene. https://monographs.iarc.who.int/wp-content/uploads/2018/06/mono100F-24.pdf. Accessed 12 June 2023.
40. Jones ME, Schoemaker MJ, Wright LB, Ashworth A, Swerdlow AJ. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Res. 2017 Nov 22;19(1):118. doi: 10.1186/s13058-017-0908-4. PMID: 29162146; PMCID: PMC5698948.
41. Kasim K, Levallois P, Abdous B, Auger P, Johnson KC; Canadian Cancer Registries Epidemiology Research Group. Environmental tobacco smoke and risk of adult leukemia. Epidemiology. 2005 Sep;16(5):672-80. doi: 10.1097/01.ede.0000173039.79207.80. PMID: 16135944.
42. Li B, Wang L, Lu M-S, Mo X-F, Lin F-Y, Ho SC, et al. (2015) Passive Smoking and Breast Cancer Risk among Non-Smoking Women: A Case-Control Study in China. PLoS ONE 10(4): e0125894. doi:10.1371/journal.pone.0125894.
43. Macacu A, Autier P, Boniol M, Boyle P. Active and passive smoking and risk of breast cancer: a meta-analysis. Breast Cancer Res Treat. 2015 Nov;154(2):213-24. doi: 10.1007/s10549-015-3628-4. Epub 2015 Nov 6. PMID: 26546245.
44. Musselman JR, Blair CK, Cerhan JR, Nguyen P, Hirsch B, Ross JA. Risk of adult acute and chronic myeloid leukemia with cigarette smoking and cessation. Cancer Epidemiol. 2013 Aug;37(4):410-6. doi: 10.1016/j.canep.2013.03.012. Epub 2013 May 2. PMID: 23643192; PMCID: PMC3819424.
45. Roura E, Castellsagué X, Pawlita M, Travier N, Waterboer T, Margall N, Bosch FX, de Sanjosé S, Dillner J, Gram IT, Tjønneland A, Munk C, Pala V, Palli D, Khaw KT, Barnabas RV, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Fagherazzi G, Kaaks R, Lukanova A, Steffen A, Trichopoulou A, Trichopoulos D, Klinaki E, Tumino R, Sacerdote C, Panico S, Bueno-de-Mesquita HB, Peeters PH, Lund E, Weiderpass E, Redondo ML, Sánchez MJ, Tormo MJ, Barricarte A, Larrañaga N, Ekström J, Hortlund M, Lindquist D, Wareham N, Travis RC, Rinaldi S, Tommasino M, Franceschi S, Riboli E. Smoking as a major risk factor for cervical cancer and pre-cancer: results from the EPIC cohort. Int J Cancer. 2014 Jul 15;135(2):453-66. doi: 10.1002/ijc.28666. Epub 2014 Jan 6. PMID: 24338632.
46. Su B, Qin W, Xue F, Wei X, Guan Q, Jiang W, Wang S, Xu M, Yu S. The relation of passive smoking with cervical cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Nov;97(46):e13061. doi: 10.1097/MD.0000000000013061. PMID: 30431576; PMCID: PMC6257541.
47. Wells AJ. Deaths in the United States from passive smoking; ten-year update, Environment International, 5, #4, 1999, 515-519, ISSN 0160-4120.
48. Batty GD, Kivimaki M, Gray L, Smith GD, Marmot MG, Shipley MJ. Cigarette smoking and site-specific cancer mortality: testing uncertain associations using extended follow-up of the original Whitehall study. Ann Oncol. 2008 May;19(5):996-1002. doi: 10.1093/annonc/mdm578. Epub 2008 Jan 22. PMID: 18212091.
49. Brown LM, Gibson R, Blair A, Burmeister LF, Schuman LM, Cantor KP, Fraumeni JF Jr. Smoking and risk of leukemia. Am J Epidemiol. 1992 Apr 1;135(7):763-8. doi: 10.1093/oxfordjournals.aje.a116362. PMID: 1595675.
50. Ji R, Pan Y, Yan H, Zhang R, Liu G, Wang P, Wang Y, Li H, Zhao X, Wang Y; Chinese Intracranial Atherosclerosis (CICAS) Study investigators. Current smoking is associated with extracranial carotid atherosclerotic stenosis but not with intracranial large artery disease. BMC Neurol. 2017 Jun 26;17(1):120. doi: 10.1186/s12883-017-0873-7. PMID: 28651523; PMCID: PMC5485653.
51. Jones ME, Schoemaker MJ, Wright LB, Ashworth A, Swerdlow AJ. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Res. 2017 Nov 22;19(1):118. doi: 10.1186/s13058-017-0908-4. PMID: 29162146; PMCID: PMC5698948.
52. Korsbæk N, Landt EM, Dahl M. Second-Hand Smoke Exposure Associated with Risk of Respiratory Symptoms, Asthma, and COPD in 20,421 Adults from the General Population. J Asthma Allergy. 2021 Oct 28;14:1277-1284. doi: 10.2147/JAA.S328748. PMID: 34737580; PMCID: PMC8560177.
53. Macacu A, Autier P, Boniol M, Boyle P. Active and passive smoking and risk of breast cancer: a meta-analysis. Breast Cancer Res Treat. 2015 Nov;154(2):213-24. doi: 10.1007/s10549-015-3628-4. Epub 2015 Nov 6. PMID: 26546245.
54. Musselman JR, Blair CK, Cerhan JR, Nguyen P, Hirsch B, Ross JA. Risk of adult acute and chronic myeloid leukemia with cigarette smoking and cessation. Cancer Epidemiol. 2013 Aug;37(4):410-6. doi: 10.1016/j.canep.2013.03.012. Epub 2013 May 2. PMID: 23643192; PMCID: PMC3819424.
55. Ye J, He J, Wang C, Wu H, Shi X, Zhang H, Xie J, Lee SY. Smoking and risk of age-related cataract: a meta-analysis. Invest Ophthalmol Vis Sci. 2012 Jun 22;53(7):3885-95. doi: 10.1167/iovs.12-9820. PMID: 22599585.
56. Aerocorner.com. McDonnell Douglas DC-9-30, McDonnell Douglas’ answer to the Boeing 737. https://aerocorner.com/aircraft/mcdonnell-douglas-dc-9-30/#aircraft-specifications. Accessed 12 June 2023.
57. Li B, Wang L, Lu M-S, Mo X-F, Lin F-Y, Ho SC, et al. (2015) Passive Smoking and Breast Cancer Risk among Non-Smoking Women: A Case-Control Study in China. PLoS ONE 10(4): e0125894. doi:10.1371/journal.pone.0125894.
58. Leukemia Research Foundation. Chronic myelomonocytic leukemia. https://leukemiarf.org/leukemia/chronic-myelomonocytic-leukemia/. Accessed 12 June 2023.
59. ATSDR Toxzine – Agency for Toxic Substances and Disease Registry: Benzene. https://www.atsdr.cdc.gov/sites/toxzine/docs/benzene_toxzine.pdf. Accessed 12 June 2023.
60. Pan J, Barbeau EM, Levenstein C, Balbach ED. Smoke-free airlines and the role of organized labor: a case study. Am J Public Health, 95(3):398-404 (2005) doi: 10.2105/AJPH.2004.040592. PMID: 15727966; PMCID: PMC1449191.
61. Broin v. Philip Morris Companies, Inc., 641 So.2d 888 (Fla. App. 3 Dist., 1994) https://www.tobaccocontrollaws.org/litigation/decisions/broin-v-philip-morris-companies-inc#:~:text=Broin%20v.-,Philip%20Morris%20Companies%2C%20Inc,cigarettes%20of%20passengers%20during%20flights. Accessed June 12, 2023.
62. Estate of Kathleen Sprowl-Cheney, Plaintiff, vs. Philip Morris USA, Inc. et al., Defendants
·Case No. 00-21850 CA 23, Florida, USA..
63. IN THE CIRCUIT COURT FOR THE COUNTY OF LOUISA, THOMAS ALEXANDER GARRETT, JR., Plaintiff, v. CL19000417-00 FLANNA SHERIDAN (f/k/a GARRETT), Defendant. Virginia, USA.
64. Brandon W. Melton v. Brandy Jean Melton Sevier County Circuit Court Case No. DR 2010-35-2. Arkansas, USA.
65. Casino Workers. Januszewski et al., v. Horseshoe Hammond, USDC, NDIN, Hammond Div., 2:00CV352JM. Indiana, USA.