A ir p o llu t io n p o se s h e a lth p r o b le m s t h r o u g h o u t th e w o r ld . F i r s t w e -p ro v id e a g e n eral o v e r v ie w o f the h e a lth h a z a rd s a s s o c ia te d w ith air p o ll u t io n , e m p h a s iz in g the ty p es o f m ed ica l d is o rd e r s th a t a ir b o r n e s u b s t a n c e s c a n g e n e ra te . A i r p o l l u t i o n is m o s t o fte n a s s o c ia te d w it h fa c t o r ie s and w ith o u t d o o r air.

. B u t , as d iscu ssed n e x t,.th e . g reatest s o u r c e o f h a r m f u l air p o l l u t i o n is cig a rd tte s m o k in g . M o r e o v e r , as w e t h e n s h o w , the h e a lth h az ard s f r o m p o llu t e d air in sid e o u r h o m e s are o f t e n w o r s e than that fr o m o u t d o o r air, even in an in d u stria l city't > (t. '

A. Air Pollution and Health

Air pollution mainly damages the lungs and airways, although injury to other organs can happen as well. In this section, we describe the m ajor effects o f the m ost com m on pollut ants in the air we breathe. Accidental release of airborne chemicals, such as ch lo rin e and a m m o n ia , also cause problems, but because these accidents are rare, they are not included in this chapter but left to the appropriate en try headings in Part II. In d oo r air pollutants can be o f even greater concern than outdoor pollutants, in part because a large proportion ! o f our time is spent indoors. In d o o r pollution is especially significant in the hom es of srrld k -, ers and where radon concentrations are high, i This is discussed more in Section C o f t h is 1 , chapter (In d o or A ir Pollution). 1 W e have divided the health effects o f ; air pollution into four groups: short-term or acu te respiratory effects, long-term or chronic respiratory effects, lung cancer, and | nonrespiratory effects. Damage is said to be ! acute if it happens suddenly and id relatively short-lived, a few minutes to a few days. A n j asthmatic attack, for example,' is ah acute ef- ; feet. C h ro n ic effects persist over; extended. ! periods o f time, generally years. Perm anent > respiratory loss from a decreased r it e o f luhg ! growth in children and obstructive pulm o- > nary disease (discussed later) are examples o f j chronic effects. '

Acute Respiratory Effects

F o u r acute respiratory effects of air pollution are well established: (1) asthmatic attacks, (2) hyperreactive airways, (3) respiratory in fections, and (4) reversible changes in lung functions. A sthm a is a condition affecting about 10 million Americans, in which the air ways suddenly narrow , obstructing the flow o f air .through the lungs. T h e narrowing is caused by spasn.o o f the small muscles that x encircle the airways and by the release o f thick, excessive m ucus that plugs them. An' attack can be triggered b y an allergic reaction to i foreign substance (either breathed or swalidwed) and by a variety o f other stimuli, sucfi ki respiratory infections, exercise, cold a i r l a n d emotional stress. A ir pollution can bring on asthmatic attacks. In Los Angeles, attiibks have been associated with ozone and p a rticu la te pollution, and in areas surround ing power plants and smelters, s u lfu r dioxide aildfjSulfate particulates cause reactions. It is not know n whether air pollution can actually cijis e Asthma or whether it only triggers asth m a t ic attacks. '.A n o th e r 20 million Americans have what are Jjcalled hyperreactive airways, which are airways that constrict much more readily than average in response to foreign matter. U n lik e arthina, so m e; constriction o f the airways is a ;ridrmal defense mechanism to prevent in haling noxious substances. In persons with
l-

pollution has also been linked to C O P D in duced in bo th children and healthy adults irecerij; studies, o f M o rm o n s, a group with a when exposed to elevated pollutant Toricrivery-'jow rate o f sm oking. Th e longer and trations, but this returns to norm al when ex greater the exposTire to outdoor levels o f sulfUHBilbcide and sulfate particulates, the more posure ceases. W h eth er such change# iridic'ate pfeviibht Srid severe the disease sym ptom s. that lo n g-term damage ii? Being done not Siiidijl firi laboratory animals have shown k n o w n at the present time.'' -I ! -.< 1 thalH'Jhg-tefrri Exposure to nitrogen dioxide I , , t' : , V ' destruction o f alveoli walls, Chronic Respiratory Effects. , , S lM ilil1( 8 fempiiysema. ' 1 , ' : ! ,'C ' . * > " *'I' Mljj i ' \ ' T h e two main chronic effects o f lo n g-tim U T / T'BuIgii'fbw ith is also affected by air polluxpo sur to ir p o ll ta n j aside Frh llirg tioB;TTHA!lUrig^ typically grow until the age cancer, are th ro n ic obstru ctiv e pMlrrioh'dry v' : Bfy|(|jfj, tjiln slbw ly decline in' their ability disease (C O P D ) and changs in th dviop- ' fo? ildidf air with age. Slowed rates o f lung m ent and aging o f the lungs'. C O P D - is ict-.';': j ^rpM li HaVe Been observed in children ages ally a group o f diseases that share!the orti- : 6 tHrplighi 12 in relation to certain indoor air m on sym p to m s o f breathlessness. Because a pdilUtarifs- T h e c h a n g e s are greatest in homes clear-cu-'r-diagnosis is o ft h ! impossible tiritil after death, the conditioris are lumped t o witli'smokers. A smaller adult lung size means less reserve against the inevitable shrinkage of / i! ;: ; i

hyperreactive airways, however, the airways respond to levels that do not bother m ost people. T h e sym ptom s are similar to asthma: shortness o f breath, coughing, and wheezing. Sulfur dioxide, particulates, ozone, and n i tr o g e n oxides are know n to stimulate airway reactivity. T h e incidence o f respiratory infections, particularly in children, is increased by air pollution. U p p e r respiratory infections, such as colds, influenza, and Sore throats, are as sociated with sulfates, sulfur dioxide, and particulates in outdoor ait. N itrogen dioxide released indoors by gas cooking stoves is as sociated with m ore frequent colds in children under the age o f 10 compared with children who live in hom es equipped with electric ranges. A nim al studies show chat co n cen tra tions o f o z on e and nitrogen dioxide typical o f peak pollution episodes low er the resis tance to bacterial infections, such as pn eu monia and acute bronchitis. A ir pollutants boch disable the clearance mechanisms that rem ove viruses and bacteria from the respir atory tract and incapacitate the cells that fight the infections. S h o rt-te rm , reversible changes in lung function are also caused by air pollutants. F o r example, th maximum am ount ofi air that can. be inhaled c f exhaled iii one second is re

1 gether. T h e group includes chronic b ro n chitis) em p h y sem a, and sm all a irw ay disease. - Chronic bronchitis involves the persistent secretion of excessive amounts of mucus into the airways; its leading symptom is a lasting, I phlegmatic cough. Em physem a is a destructio h 'b f the walls of the air sacs (alveoli) and \ is indicated by breathlessness without cough. j Srnilf Airway disease involves inflammation and harrowing o f the smallest airways (b r o n chioles) and is the earliest sigh of smokingi induced C O P D . These diseases can appear separately or together. People with C O P D have weakened lungs. T h eir long-term survi val is.influenced strongly by how susceptible they are to respiratory infections such as in fluenza and pneum onia.' About 10 million pe'ople irl the U nited States are afflicted with

copb.
Th e main causes o f C O P D are sm oking; occupational exposures to such substances as coal and co tto n dusts, high concentrations o f sulfiir dioxide, and particulates^ and genetic factors. Air pollution plays a role in several ways.! Som e evidence suggests that a history o f respiratory infections during childhood m ay 'io rltfib u te to pulm onary disease in old age, and as previously mentioned, air p o l lution- increases childhood infections. Air

48

ALL ABOUTTOXI CS

the lungs with old age and against the onSct o f obstructive pulmonary disease, which o c curs more com m only at older ages.
|

Nonresplratory Effects
Air pollutants affect organs in the body ocher than the iungs. O n ce inhaled, pollutants can be absorbed into the bloodstream and can reach all areas of the body (see Chapter 4, Section A). Airborne lead has caused nervous disorders in children, including learning dis abilities (decreases in IQ s ) and hyperactivity! kidney' damage leading to high blood pres sure in both children and aduits; and .outright poisoning. Lead levels have dropped dramat ically in the last 15 years as leaded gasoline has been phased out, but deposits on the ground from years past are a lingering source - of exposure. B en zen e is a cause of leukemia in rubber and chemical workers and is present in the air from refinery operations and gasoline co m bustion. Because the concentrations of ben zene in the air are low, it is difficult to know ! iwhat effect it has on the general population, i s k estimates . for the Los Angeles basin suggest that benzene in outdoor air causes 100 cancer cases per year there. Various other organic solvents are associated with nervous system disorders in workers, but again, co n centrations are so lo w that it is difficult to as. ciribe any particular cases to such exposures. , j : C a r b o n m o n o x id e may play a part in the

Lung Cancer
C ancer of the lung is the leading fatal cancer among both men and w om en , responsible for over one-fourth o f all cancer deaths. S m o k ing is the m ajor cause o f lung cancer. A ir p o l lution causes some fraction of lung cancers, but exactly how much is in dispute. Som e ex perts contend that air pollution causes only a few percent o f all cases, while others ar gue that its 2 0 % o r m ore. It is clear that carcinogenic com pounds are present in in door air and polluted ! outdoor urban air. Chem ical analyses o f air show the presence o f cancer-causing by-products o f burning such as benzo-[<a]-pyrenes and dioxin s, fi bers such as asbestos, and metals such as a r senic and cad m iu n i. T o xico lo gical studies show that extracts o f polluted air can pro duce lung tumors in mice, rats, and hamsters and can cause injury to the genetic material D N A . Studies in human populations have found increased caner rates arouhd sm elt ers and factories, in cities compared to ru ral areas, and with duration o f exposure to

, development o f ischemic heart disease, in pollution. ! . which the heart muscle does not get enough T h e m ajo r question has been to what ex ' dxvgen over long periods and its tissues tent these materials alone have caused cah. siowly die.' Similarly, the added strain on the cer compared with tobacco smoke.' T o b a c co heart, and lungs caused by a lack o f oxygen smoke interacts synergisticlly with o ther car during peak carbon m onoxide episodes (for cinogens, including radon, asbestos, arsenic, ' and alcohol, to increase the. underlying can . example, when smoking cigarettes or when A fu tk in'rush hour traffic) m iy trigger heart cer risk o f either material. Tp w ho are nonsmokers at death may hvesmokd. eat attacks. While evidence of carbon monoxide lier in life, and many people w ho hav hever ^ ijia y jn g a widespread role in heart disease is f Abt conclusive at the m oment, m ost experts smoked are exposed passively to tobco smoke either on th jo b or at borne. These and other problem s blur the role o f air pollut ants in producing lung cancerS. Nevertheless, the E P A estimates that betweert 5 0 0 0 and 20 ,000 cases o f lun cancer per' y ear 're caused by ra d o n , with m ost caises occurring among S m o k e rs .; . ) !v 1
- it i ' -, ; \ \ \

tKink it is plausible.

!| .y
' '-Air pollutants cause many.health problems, hanging from the triggering o f asthmatic at tacks to the' slow degeneration of the lungs, x #4'-:>V . ;%
. -A-

r :

,y
'

TOXICS IN AIR

"x

49

from cancer to brain disorders. With the n o ta ble exception o f lead, air quality hasjnot im proved significantly in the last ten years, and in som e instances it has gotten worse! T h e widespread health effects of many pollutants, such as lead, asbestos, and radon, have been generally recognized only within the last ten years, and new products and substances are co nstantly being introduced. Air quality must remain a top priority, both at home and i:n the political arena, if the quality o f life is not to suffer.

; ting rather than to fewer people taking up the ; habit. N early half o f all living adults who e v e r y r io k e d have quit. But the most recent ; inform ation about smoking among teenage : boys shows that primary prevention (never smoking) is beginning to play a part in reducing-the sm ok in g rate. A m o n g blacks, blue-collar workers, and less educated people the smoking rate is higher than in the population as a whole. Level o f education is more closely related to sm oking than any o ther factor. The higher the level o f education, the less likely someone is to be a smoker. S n ick in g begins primarily during childh ood' and adolescence. O n e-fou rth o f high school seniors w ho have ever smoked had their first cigarette by sixth grade, one-half : by eighth grade. F o r those who begin sm ok: ing before age 20, the younger they begin, the ; more-likely they are. to continue and the more I likely; they .are to smqlce heavily. These facts ; indicate the imjbortancir o f starting sm oking ' education campaigns at the earliest possible ; ages. ;
ft

B. S m oking and Health

Cigarette sm ok in g is the single most prevent able m a jo r cause o f death in our society. M ore than one in every six deaths in the U n ited States can be attributed to mokirig, over 3 9 0 ,0 0 0 deaths anniially. At every age, p ro p o rtio n a te ly m ore sm o k ers die each year than do nonsm okers. T o b a c c o contributes to 3 0 % o f all cancer deaths yearly, including 8 5 % o f all lung cancer deaths. Smokers o v er all have a 7 0 % greater c o ro n a ry heart disease death rate the leading cause o f death c o m pared to n on sm o k ers. A n additional 10 m il lion A m erican s suffer inctedsed rates o f vari ous debilitating diseases carised by smoking, including bron chitis, em p h y sem a , And a th e r o sclerosis. Inhaling other p e o p le s sm oke, t>r passive sm o k in g, is now'firriplicated kb dis ease (particularly lung caftber) arhong nonsm okers.

Diseases C aused By Sm oking

- i - ''I1 -: . , Lu ng T an ce r is the disease most often iden tified jfwith sm oking. In 1985, smoking ac counted for 8 7 % o f all lung cancer deaths. Atnorig w o m en , lung cancer recently overfo o kiB rit cancer as the leading fatal cancer, direct result oF the increase in female sm o k 'Itk ' 1 1' ' ing over' th past three decades. IC j i & b d iseases k now n to be caused by sm o k in g . include co ro nary heart disease, stroky arid peripheral vascular disease (as miriyjjbaies o f cardiovascular disease as lung cancei| afe caiisd by smoking); cancers of th l ry fN , m o u th ,and esophagus; chron ic o bstru ctiv e p u lrh oh a ry disease (C O P D ); fetal growfftVretafdation; and low birth weight babisi-CSgartte sm oking is now considered to b e ('jijfbable use o f unsuccessful pregnahdy| Increased infant m ortality, and peptic ulcer .disease; to be a contributing factor in can cer! Of the bladder, pancreas, and kidney; ' I I. ' > 1 ,V I;

Who Smokes and Who Doesnt: Trends in Smoking Habits

T h e fractio n o f A m erican adults who sm oked in 198 7 was 2 9 % , down f i o n i 4 0 6 / o In 1965. M en sm o k ers still o u t n u m b e r womeii s m o k ers, but the differential has been shrinking, and am ong high scho o l s e n io rs , m ore girls sm o k e than do boys. T h e g reatest increase in sm o k in g has been a m o n g w o m e n aged 20 ter 34. T h e progress made in re d u cin g the s m o k ing rate has been largely dtie t o smokers quit-

50

ALI. ABOUT TOXICS

and to be associated with cancer of the sto m ach. Tobacco smoke also interacts with vari ous workplace substances and with alcohol to increase the risk o f cancer. There are over 4000 compounds present in tobacco smoke, many of which have been proven to be toxic or to cause cancer and m u tations. A total of 43 carcin og en s have been identified, including several n itro sam in es, benzo[tf]pyrene, cadium , nickel, and zinc. C a r b o n m on o xid e, n itro g e n oxides, and particulate m a t te r are some of the other toxic substances present.

u,

C. Indoor Air Pollution

In the mid-1970s, a few scientific reports began to appear indicating that air pollution might be more hazardous in the kitchens of iaverage U.S. homes than outdoors near a Los Angeles freeway. Since then, with the completion of many air pollution studies in ihomes, the problem of indoor air pollution, las it is called, is becoming clear.

; Indoor Air Pollution Sources

iT here are five types o f pollution sources in the home. These are summarized in the simIplified diagram shown in Figure 3. Th e first -to be recognized was burning fuel indoors for cooking and space heating. Natural gas, the m ost com m only used indoor fuel in the United States, mainly produces n itro g en " '(dioxide and c a rb o n m o n o x id e along with (harmless combustion products. If wood is ; burned in a fireplace or for cooking (as is the case in much of the world), then in addition _ j t o these two pollutants, p a rticu la te m a t t e r and a host o f potentially hazardous h yd ro c a r b o n s are produced. These hydrocarbons 1 include the group o f benzo[tf]pyrenes that : 'are known to be potent carcinogens. Burning coal or oil produces all o f these pollutants |jjliis sulfur dioxide. Because most oil-heated fi homes in the United States use a low-sulfur : ri:|rade o f oil and few houses use coal, sul' fur dioxide is generally not a m ajo r problem here. How ever, in many other countries such as China, coal is widely used in the hom e and ' .the spectrum o f pollutants it produces poses \;k serious health threat. In developing nations y where poorly vented stoves and fireplaces are ' coinm on, indoor pollution from fuel burning Is believed to be a m ajor health hazard.

Passive Smoking and Involuntary Exposure

Breathing the sm oky air produced when other people smoke tobacco is called passive smoking. Practically all o f th substances in haled by smokers are present in the smoke drifting off the end o f a burning cigarfette or exhaled by the person smoking. Although concentrations o f toxics are low er becaus o f the dilution in the surrounding air, health: ef fects from this sm oke are now established. Th e E P A has recently classified passive smke as a class A carcinogn (see C hapter 3, Section B). Lung cancer in healthy nonsm bkers is .the most serious outcom e and has been dem on strated in families o f s m o k e rs.;A n incrs^ in' respiratory infections and sym ptom s among children of smokers, increased syfnptomS of allergies, chronic lng conditions! and chest pains have all been reported, as well as head aches, nausea, and irritation o f the eyes dnd nose.

Involuntary exposure to substances in to bacco smoke occurS to the developing em bryos o f pregnant w om en whoj smoke n<^ to the infants o f w om en w ho brest-fed'ind.; 'Ur*". A secofid source o f indoor air pollution resmoke. M any o f th substanbes are able] to. /, suits from synthetic, and some natural, matellals Used for carpeting, foam insulation, wall cross the placenta and reach th fetus; other overingS, and furniture. G lue used in some substances appear in breast milk. Sbtne o f He consequences o f these exposures include still . plyw ood; for example, gives off fo rm a ld e birth, miscarriage, premature birth, lo w bifth weight babies, and retarded development! hyde. Latex carpet is a source o f phenylcy; clohene. Asbestos, u-sed as a building mateN ff!; . a.

T O X IC S IN AIR

51

from other toxics such as those just discussed rial because of its heat-resistant properties, if you smoke or live with a smoker. can shed asbestos fibers into the indoor air if the material is not properly sealed. In offices, some copy machines and com puter printers Reduction of Indoor Air Pollution arc a source of toxic organic substances such T h e indoor air pollution from all five sources as toluene. Indeed, the air in many modern can be reduced by increasing the ventilation office buildings is particularly polluted be irf-the home. U nfortunately, this strategy can cause o f the com bination o f Office equip bfe costly, for in cold weather increased ven ment, synthetic carpets, and po o r ventilatiort. tilation means either a chillier home or higher The phrase sick building syndrqm e has been hbating bills. Also, the higher heating bills coined to describe homes and w ork places are a symptom o f a host o f other environwhere headaches and eye irrittion are co m hiental problems such as greenhouslng warm mon as a result o f poor indoor air quality. In ing, acid rain (see C hapter 11, Sections A and industry, there re O ccu pation al S afety a n d C ). Indeed, much o f the earliest interest in in H ea lth A dm inistration (OS-HA) regulations to protect workers against the more blatant door air pollution stemmed from concern that examples o f indoor air pollution generated in plugging the leaks in houses to save energy would seal in gaseous pollutants as well as manufacturing. In principle, O S H A has the authority to protect office. ..workers against wUrm air. sick building syndrome, but the complex na 1 Fortunately, there are other and better ture o f the pollution in sick buildings and the wTyS to reduce in d o or air pollution levels ambiguous nature Ojf it health effects has re than to have excessive air infiltration and con sulted in very little regulatory action to date. sequent energy waste. C ooking stoves can be A third source cjf indoor air pollution is Vented with an exhaust fan, which increases toxic gases leaking1 upward into the living ventilation right at the source of pollution where its needed most. Alternatively, electric area o f a home from the soil beneath the house. This is the m ost serious o f the sources StpVes can be used, although this means in the U nited States, for this is the way the higher outdoor pollution levels if the elec radioactive gas rad o n enters. Recent evidence tricity is produced by burning fossil fuel, suggests that toxic gases can prbably enter iijdbbr pollution from space^ heating can be houses located hear chemical waste dumps jfeiU ce d , i f : not com pletely eliminated, by this way as well, although the ixtent o f th ' -tiding properly designed, efficient furnaces or threat is not really kilown. ' | w k o d stoveS. Pollution from synthetic matcitiais can be reduced by avoiding their use M any com m ercial'produ cts such.aS furjtke home, provided they can be recogniture polishes, glus cleaning agents, cos metics, deodorizers, pesticides, andi. solvents used in the hom e contribute to the toxicitj^ of indoor air. (See the C ross-Refettices at the beginning o f the b o o k for Spdifi tb X r ics associated with tfiese varioui ptodcts.|) Moreover, dry-cleaned clothes brought into the home are a source o f tetrachloroetkyl-ene. These consum er products are the foUrth source o f indoor air pollution. ! j T h e fifth sourp is to b acco smoking. N o t only is it a serious indoor air pollutant in its own right, but as was discussed in Section B of this chapter, you increase the risk o f illness rilzed, or by airing any suspiciously smelling 1 jf l w ' items stick as plastic tableclothes Until the ;.niell oes away. N e w pieces of furniture, j ^p'lkrcicularly Sofas and easy chairs stuffed with .TdlrtV'are often a m uch greater source of in ' door air pollution than used furniture is. The fe iso n is that by the time a'foam-stuffed cush> ioh is several years old, it will have emitted . dihch o f its formaldehyde. Reduction o f in-ddor air pollution can thus be added to the ifilh y other reasons for recycling and pro longing the jife o f consumer items (see C hap ter 16, Section D ). Finally, sealants ban be

iif
.

T /S

'
-f

TOXICS,IN AIR

"fs

53

'

used to coat some building materials to pre tilated homes, the results suggest that these vent release o f substances such as fo rm al house' plants may be useful as well as o rn a dehyde or asbestos, and Indoor radon levels mental; can be redue'ed by a variety o f ways discussed ' B u t even after all the strategies just de under ra d o n m Part II. scribed have been tried, the problem of in R ecen t studies by the National A ero n a u d oor air pollution will still remain in certain tics and Space A dm inistration (N A S A ) in situations. Som e houses contain construction dicate that there may be another way to at materials that are big sources o f pollution least partially reduce indoor pollution levels. such ai asbestos which cannot be removed N A S A scientists have shown that co m m o n except at enorm ous cost. O th er houses may house plants absorb into their leaves cer be located sufficiently near toxic waste dumps tain polluting gases such as formaldehyde, so chat mo solution short o f cleaning up the b e n z e n e , and carbon m onoxide (N ew Y ork dump is possible. T im es, Ju ly 26, 1988). It appears from these ! People concerned that they may have a studies that som e plants are better able to do seriousriridoor air pollution problem in their this than others. Philodendrons are particu homC.dr w o rk place should call the appro larly effective at removing these gases. O th e r priate, hotline n um ber listed under the headplants show ing this ability are spider plants ! ing N ational H otlines (at the back o f the (for rem oving carbon m onoxide), aloe veras bo o k ) to obtain information on the serious (fo r form aldehyde), and gerbera daisies and ness o f their sittiacion. If persistent head ch ry san them u m s (for benzene). W hile the aches, y irritation, or general malaise seem' tests were carried out under conditions re fo b associated with time spent indoors at sem bling airtight spacecrafts rather than venh o m b 'r w o r k , such concern is warranted.

F urther Reading
AmdUR, M a r y O . 1986. Air Pollutants. Ih (Sasatett and Doulls Toxicology: The Basic Science o f Poisons. Edited by Klaass^n, Curtis D.> Amdur, Mary O., and Doull, John. 3d edition. New York: Macmillan. t y, i Y y E r i k s e n , M. P., LeMaISTRE, C .'A , and Hewei.L, G. R. 1988. Health Hazards of Passive Smoking. Annual view 'of Publia, flth 9:47-70. M c G i n n i s , J . M . , S h O P L A N D , Dy hd|BkWN, C. 1 9 8 7 . Tobacco and Health: Trends in Smoking arid SmokeleYTobccoCohsurnpt Consumption in the United States. Annual Revikv of~Public-'Hedlih-8 :44 National Research Council. 1985. Epiderhiok gy _ and Air Pollution. National Academy of Sciences^ Washington, D .C . i NdtiohaliAcdmy Press. N e r o , A. V. 1988. Controlling Indoor Airfollutibn. Scientific American 258(5):42-48. TURIEL, I. 1985. Indoor Air Quality cnd'Humari H ealth, Stanford, CA: Stanford Uni versity Prs. ? ;j ' ; ; .; h 'I U.S. Department of Health,and Hmn^ertcesj. 1989.' The Surgeon Generals 1989 Report omReducing tHd..Health'','Gbn^tjeHcs:.of Smoking: 2-5 Years of Progress. M M W R Supplement. M orbidity nd MVtliy. W eekly Report, volume 38, number S-2. T ip ! il;

Q. I

C ^ _

8 1(p Ov't (*

o*

54

Al l. AOUTTOXICS