Forensic Analysis of Lung Cancer from Secondhand Smoke Exposure of a Motel Worker
Article Sidebar
Downloads
Submit your own article
Register as an author to reserve your spot in the next issue of the Medical Research Archives.
Author RegistrationJoin the Society
The European Society of Medicine is more than a professional association. We are a community. Our members work in countries across the globe, yet are united by a common goal: to promote health and health equity, around the world.
Join Europe’s leading medical society and discover the many advantages of membership, including free article publication.
MembershipMain Article Content
Abstract
Background: In July 2018, Ms. PJM, a 50-year-old lifelong nonsmoker, was diagnosed with primary Stage IV lung adenocarcinoma with secondary metastasis to the brain, after being hospitalized for a fall in the motel where she worked, in Los Angeles, California. She had been employed as a maid cleaning rooms in this motel for 20 years, where she was exposed to secondhand and thirdhand tobacco smoke daily. Her death certificate, dated June 2021, declared metastatic lung cancer to be the cause of her death at age 53. Occupational disability and death claims filed by her attorney were contested by her employer.
Aims: To conduct a forensic analysis using mathematical modeling to quantify Ms. PJM’s toxic secondhand and thirdhand smoke exposures, in order to estimate her risk of lung cancer from exposure to tobacco combustion products and other potential carcinogenic agents to which she might have been exposed.
Methods: A quantitative analysis employing assessment of Hazard, Exposure, Dose, Dose-Response, and Risk plus a Discussion of Uncertainty. It is routinely used by U.S. federal regulatory agencies, including the Occupational Safety and Health Administration (OSHA), and the Environmental Protection Agency (EPA).
Results: Ms. PJM’s modeled exposure to fine particulate matter from secondhand smoke ranged from the Hazardous to Significant Harm Levels of the EPA Air Quality Index for fine particles (PM2.5). Her modeled dose of serum cotinine ranged from the 90th to beyond the 95th percentile of nonsmokers’ dose, measured in a statistical sample of the U.S. nonsmoking population. Her estimated risk exceeds OSHA’s Significant Risk of Material Impairment of Health Level by a factor of three. She is estimated to have been exposed to the thirdhand smoke of at least 1.4 million cigarettes outgassing from room surfaces during her 20 years of labor. As for potential confounders, there were no known carcinogens in any of the cleaning agents she used; there is no evidence that she was exposed to asbestos, and she resided in a low-radon area of Los Angeles.
Conclusions: As a result of her occupational exposure to secondhand and thirdhand smoke, Ms. PJM lost an estimated 33 years of life expectancy. The State of California has been remiss in failing to extend its workplace smoking ban to hotels and motels, leaving their workstaff at grave risk of the manifold diseases of passive smoking.
Article Details
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
2. Repace JL. Respirable Particles and Carcinogens in the Air of Delaware Hospitality Venues Before and After a Smoking Ban. Journal of Occupational and Environmental Medicine, 46:887-905 (2004).
3. Repace JL. Human Exposure to Secondhand Smoke. Chapter 9, In: Human Exposure Analysis, W Ott, L Wallace, and A Steinemann (Eds.), CRC Press (2006).
4. Repace JL, and Lowrey AH. Tobacco Smoke, Ventilation, and Indoor Air Quality. ASHRAE TRANSACTIONS 88: Part I,895 (l982).
5. Repace JL. Is the Dose-Response curve between Tobacco Smoke Exposure and Lung Cancer Linear from Active to Passive Smoking? Environment International 18: 427-429 (1992).
6. Repace, JL, and Lowrey, AH (1985a). A quantitative estimate of nonsmokers' lung cancer risk from passive smoking. Environment International 11: 3-22.
7. Repace JL, and Lowrey AH. An enforceable indoor air quality standard for environmental tobacco smoke in the workplace." Risk Analysis, 13:463-475 (1993).
8. Repace JL, Jinot J, Bayard S, Emmons K, and Hammond SK. Air nicotine and saliva cotinine as indicators of passive smoking exposure and risk. Risk Analysis 18: 71-83 (1998).
9. Repace JL, Hyde JN, Brugge D. Air Pollution in Boston Bars Before and After a Smoking Ban. BMC Public Health 2006, 6:266 (27 Oct 2006). Open Acess, on-line journal:
10. Repace JL, Jiang RT, Cheng K-C, Acevedo-Bolton V, Klepeis NE, Ott WR, and
Hildemann LM. Fine Particle and Secondhand Smoke Air Pollution Exposures and Risks Inside 66 US Casinos. Environmental Research 111 (2011) 473–484.
11. Repace J, Zhang B, Bondy SJ, Benowitz N, Ferrence F. Air Quality, Mortality, and
Economic Benefits of a Smoke-Free Workplace Law for Non-Smoking Ontario Bar
Workers. Indoor Air 2013; 23: 93–104.
12. Repace JL, Al-Delaimy WK, Bernert JT. Correlating Atmospheric and Biological
Markers in Studies of Secondhand Tobacco Smoke Exposure and Dose in Children and
Adults. JOEM 48: 181-194 (2006).
13. Repace JL. Secondhand Smoke in Pennsylvania Casinos: A Study of Nonsmokers’
Exposure, Dose, and Risk. American Journal of Public Health 99: 1478–1485 (2009).
14. Repace J, Zhang B, Bondy SJ, Benowitz N, Ferrence F. Air Quality, Mortality, and
Economic Benefits of a Smoke-Free Workplace Law for Non-Smoking Ontario Bar
Workers. Indoor Air 2013; 23: 93–104.
15. EPA Technical Assistance Document for Reporting of Daily Air Quality – the Air Quality Index (AQI). EPA 454/B-18-007, September 2018.
https://nepis.epa.gov/exe/zypdf.cgi/p100w5ug.pdf?dockey=p100w5ug.pdf
16. Air Now. Action Days.
https://airnow.gov/index.cfm?action=airnow.actiondays.
17. Matt GE, Matt GE, Quintana PJE, Zakarian JM et al. Tobacco Control 2011 20: e1, doi: 10.1136/tc.2010.037382.
18. Matt GE, Quintana PJE, Fortmann AL, et al. Thirdhand smoke and exposure in California hotels: non-smoking rooms fail to protect non-smoking hotel guests from tobacco smoke exposure. Tobacco Control 2014;23:264–272.
19. Tobacco Smoke. Proposition 65 Warnings, Office of Environmental Health Hazard Assessment, OEHHA.
https://www.p65warnings.ca.gov/sites/default/files/downloads/factsheets/tobacco_smoke_fact_sheet.pdf
20. Mulcahy M, Evans DS, Hammond SK, Repace JL and Byrne M. Secondhand smoke
exposure and risk following the Irish smoking ban: an assessment of salivary cotinine
concentrations in hotel workers and air nicotine levels in bars. Tobacco Control 14: 384-
388 (2005).
21. U.S. Centers for Disease Control & Prevention. Fourth National Report on Human Exposure to Environmental Chemicals Updated Tables, January 2019, Volume One (2019).
22. Pirkle JL, Flegal KM, Bernert JT, Brody DJ, Etzel RA, Maurer KR. Exposure of the population to environmental tobacco smoke: the third national health and nutrition examination survey, 1988 to 1991. JAMA 275: 1233- 1240 (1996).
23. Thun MJ, Henley SJ, Burns D, Jemal A, Shanks TG, Calle EE. Lung cancer death rates in lifelong nonsmokers. J Natl Cancer Inst. 2006 May 17;98(10):691-9. doi: 10.1093/jnci/djj187. PMID: 16705123.
24. Niosh Current Intelligence Bulletin #54. Environmental Tobacco Smoke in the Workplace, Lung Cancer and Other Health Effects. U.S. Department of Health and Human Services, National Institute for Occupational Safety and Health, Cincinnati, OH June 1991.
25. National Toxicology Program. 9th Report on Carcinogens 2000. U.S. Dept. of Health & Human Services, National Institute of Evironmental Health Sciences, Research Triangle Park, NC.
26. California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke, Final Report 1997.
27. U.S. Dept. of Labor, Occupational Safety & Health Administration. 29 CFR Parts 1910, 1915, 1926, and 1928 Indoor air quality, proposed rule Fed Reg 59 # 65, Tues April 5, 1994, 15968-16039.
28. U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. EPA/600/6-90/006F.
29. Repace JL, and Lowrey AH. Risk Assessment Methodologies in passive smoking-induced lung cancer. RISK ANALYSIS, 10: 27-37, (1990).
30. American Cancer Society (2015). Cancer Facts & Figures for Hispanics/Latinos, 2015-2017; American Cancer Society. ACS cancer-facts-and-figures-for-hispanics-and-latinos-2018-2020.
31. National Cancer Institute. Smoking and Tobacco Control Monograph No. 8: Changes in Cigarette-Related Disease and their Implications for Prevention and Control. (1996).
32. Arias A, Xu J. United States Life Tables, 2018. National Vital Statistics Reports 99: 12, Nov. 17, 2020
33. Vida S. et al. Environmental Health 2014, 13:55 Brain tumours and cigarette smoking: analysis of the INTERPHONE Canada case–control study.
34. Dacunto PJ, Cheng K-C, Acevedo-Bolton V, Jiang R-T, Klepeis NE, Repace JL, Ott
WR, Hildemann LM. Identifying and quantifying secondhand smoke in source and
receptor rooms: logistic regression and chemical mass balance approaches. Indoor Air
2013, Apr 30. doi: 10.1111/ina.12049.
35. American Cancer Society. California CANCER SCREENING AND RISK FACTOR PREVALENCE, 2018.
36. ASHRAE Position Document on Environmental Tobacco Smoke. American Society of Heating Refrigeration and Ventilating Engineers (2013).
37. Cal/OSHA Consultation Service, AB-13 FACT SHEET - CALIFORNIA
WORKPLACE SMOKING RESTRICTIONS (1997).
38. CalEPA, 2006. California Environmental Protection Agency, Air Resources Board Office of Environmental Health Hazard Assessment, State of California. Proposed Identification of, Environmental Tobacco Smoke as a Toxic Air Contaminant As Approved by the Scientific Review Panel, on June 24, 2005.
39. Cancer in Los Angeles Trends by Race/Ethnicity 1976-2012 County. Liu et al. Los Angeles Cancer Surveillance Program USC/Norris Comprehensive Cancer Center The Keck School of Medicine of the University of Southern California.
40. Los Angeles County. Lung and Bronchus Cancer Incidence Rate by Race/Ethnicity
County: Los Angeles.
41. MMWR. Age-adjusted Death Rates from Lung Cancer by Race/Ethnicity. National Vital Statistics System, United States, 2001-2013. https://www.cdc.gov/mmwr/volumes/67/wr/mm6730a8.htm.
42. Msds fabuloso all purpose cleaner liquid lavender. Colgate Palmolive Co.
43. MSDS Kaboom Shower Tub & Tile Cleaner. Orange Glo International.
44. Zitting A, Husgafvel-Pursiainen K, Rantanen J. Environmental tobacco smoke—a major preventable cause of impaired health at work. Scandinavian Journal of Work,
Environment, & Health (Vol. 28, supplement 2, 2002).
45. Weiss, ST. Passive Smoking, what is the risk? Am Revs Resp Dis 133:1-3, 1986.
46. Ott WR, Wallace LA, and Steinemann A. Human Exposure Analysis, (Eds.), CRC Press (2006).
47. Repace JL. Indoor concentrations of environmental tobacco smoke: field surveys. Ch. 10, IARC Scientific Publications no. 81, Environmental Carcinogens--Selected Methods of Analysis--Volume 9 Passive Smoking; I.K. O'Neill, K.D. Brunnemann, B. Dodet & D. Hoffman, International Agency for Research on Cancer, World, Health Organization, United Nations Environment Programme, Lyon, France, (1987).
48. Travers MJ, KM Cummings, A Hyland, J Repace, S Babb, T Pechacek, PhD, R Caraballo. Indoor Air Quality in Hospitality Venues Before and After Implementation of a Clean Indoor Air Law — Western New York, 2003. MMWR Vol. 53 / No. 44 1038-104, November 12, 2004.
49. Repace JL. Is the Dose-Response Curve between tobacco smoke exposure and lung cancer linear from active to passive smoking? Environment International 18: 427-429 (1992).
50. Ott WR. Mathematical models for predicting indoor air quality from smoking activity. Environmental Health Perspectives 107, suppl 2, 375-381 (1999).
51. National Research Council (1986). Environmental tobacco smoke -- measuring exposures and assessing health effects. National Academy Press, Washington, DC.
52. Thun MJ, Henley SJ, Burns D, Jemal A, Shanks TG, Calle EE. Lung cancer death rates in lifelong nonsmokers. J Natl Cancer Inst. 2006 May 17;98(10):691-9. doi: 10.1093/jnci/djj187. PMID: 16705123.
53. Churchill, January 2005. California Geological Survey Radon Potential Zone Map for Southern Los Angeles County, California.
54. Jacob P 3rd, Benowitz NL, Destaillats H, Gundel L, Hang B, Martins-Green M, Matt GE, Quintana PJ, Samet JM, Schick SF, Talbot P, Aquilina NJ, Hovell MF, Mao JH, Whitehead TP. Thirdhand Smoke: New Evidence, Challenges, and Future Directions. Chem Res Toxicol. 2017 Jan 17;30(1):270-294.
doi: 10.1021/acs.chemrestox.6b00343. Epub 2016 Dec 21. PMID: 28001376; PMCID: PMC5501723. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501723/.
55. Weigel EA, Matt GE. When Hotel Guests Complain About Tobacco, Electronic Cigarettes, and Cannabis: Lessons for Implementing Smoking Bans. Tob Use Insights. 2022 Sep 5;15:1179173X221124900.
doi: 10.1177/1179173X221124900. PMID: 36090650; PMCID: PMC9449509.
56. Kolb, S., Brückner, U., Nowak, D. et al. Quantification of ETS exposure in hospitality workers who have never smoked. Environ Health 9, 49 (2010).
https://doi.org/10.1186/1476-069X-9-49.
57. Sheu R, Stönner C, Ditto JC, Klüpfel T, Williams J, Gentner DR. Human transport of thirdhand tobacco smoke: A prominent source of hazardous air pollutants into indoor nonsmoking environments. Sci Adv. 2020 Mar 4;6(10):eaay4109.
doi: 10.1126/sciadv.aay4109. PMID: 32181345; PMCID: PMC7056301.