Air quality,mortality, and economic benefits of a smoke – free workplace law for non‐smoking Ontario bar workers

We estimated the impact of a smoke‐free workplace bylaw on non‐smoking bar workers' health in Ontario, Canada. We measured bar workers' urine cotinine before (n = 99) and after (n = 91) a 2004 smoke‐free workplace bylaw. Using pharmacokinetic and epidemiological models, we estimated workers' fine‐particle (PM_2.5) air pollution exposure and mortality risks from workplace secondhand smoke (SHS). workers' pre‐law geometric mean cotinine was 10.3 ng/ml; post‐law dose declined 70% to 3.10 ng/ml and reported work hours of exposure by 90%. Pre‐law, 97% of workers' doses exceeded the 90th percentile for Canadians of working age. Pre‐law‐estimated 8‐h average workplace PM_2.5 exposure from SHS was 419 μg/m³ or ‘Very Poor’ air quality, while outdoor PM_2.5 levels averaged 7 μg/m³, ‘Very Good’ air quality by Canadian Air Quality Standards. We estimated that the bar workers' annual mortality rate from workplace SHS exposure was 102 deaths per 100 000 persons. This was 2.4 times the occupational disease fatality rate for all Ontario workers. We estimated that half to two‐thirds of the 10 620 Ontario bar workers were non‐smokers. Accordingly, Ontario's smoke‐free law saved an estimated 5–7 non‐smoking bar workers' lives annually, valued at CA $50 million to $68 million (US $49 million to $66 million).     

PCP in the freshwater and marine environment of the European Union.

This study collates monitoring data principally from 1991 to 1996, relating levels of pentachlorophenol (PCP) in the freshwater and marine environments of the European Union (EU) Member States of Belgium, France, Germany, the Netherlands and the UK. In general, PCP levels in the open freshwater and marine environments displayed a downward trend in these countries, and where increased PCP concentrations were observed, these were tentatively linked to specific point discharges. The monitoring data were compared against the relevant predicted no-effect concentration (PNEC) for PCP in a particular environmental medium. On this basis, the study suggests that PCP does not pose a risk to the coastal, estuarine, marine waters or marine sediments of the above countries, and that any risks posed by PCP to the freshwater environment can largely be attributed to sediments contaminated with PCP from historic usage, or due to the continued use of small quantities of sodium pentachlorophenyl laurate in northern France. Further analysis of the data was not possible owing to the lack of systematic reporting by Member States, the lack of information on usage quantities and patterns, and inconsistent environmental surveillance and reporting of environmental data. This is particularly relevant for south-west France, Portugal and north-east Spain, the region which accounts for almost 90% of the EU's consumption of NaPCP. These issues need to be addressed at a pan-European level to better inform the selection of risk management measures and to improve the effectiveness of such measures.     

Effect of Indoor air pollution from biomass and solid fuel combustion on symptoms of preeclampsia/eclampsia in Indian women

Available evidence concerning the association between indoor air pollution (IAP) from biomass and solid fuel combustion and preeclampsia/eclampsia is not available in developing countries. We investigated the association between exposure to IAP from biomass and solid fuel combustion and symptoms of preeclampsia/eclampsia in Indian women by analyzing cross‐sectional data from India's third National Family Health Survey (NFHS‐3, 2005–2006). Self‐reported symptoms of preeclampsia/eclampsia during pregnancy such as convulsions (not from fever), swelling of legs, body or face, excessive fatigue or vision difficulty during daylight, were obtained from 39 657 women aged 15–49 years who had a live birth in the previous 5 years. Effects of exposure to cooking smoke, ascertained by type of fuel used for cooking on preeclampsia/eclampsia risk, were estimated using logistic regression after adjusting for various confounders. Results indicate that women living in households using biomass and solid fuels have two times higher likelihood of reporting preeclampsia/eclampsia symptoms than do those living in households using cleaner fuels (OR = 2.21; 95%: 1.26–3.87; P = 0.006), even after controlling for the effects of a number of potentially confounding factors. This study is the first to empirically estimate the associations of IAP from biomass and solid fuel combustion and reported symptoms suggestive of preeclampsia/eclampsia in a large nationally representative sample of Indian women and we observed increased risk. These findings have important program and policy implications for countries such as India, where large proportions of the population rely on polluting biomass fuels for cooking and space heating. More epidemiological research with detailed exposure assessments and clinical measures of preeclampsia/eclampsia is needed in a developing country setting to validate these findings.     

Chimney stoves modestly improved Indoor Air Quality measurements compared with traditional open fire stoves: results from a small‐scale intervention study in rural Peru

Nearly half of the world's population depends on biomass fuels to meet domestic energy needs, producing high levels of pollutants responsible for substantial morbidity and mortality. We compare carbon monoxide (CO) and particulate matter (PM_2.5) exposures and kitchen concentrations in households with study‐promoted intervention (OPTIMA‐improved stoves and control stoves) in San Marcos Province, Cajamarca Region, Peru. We determined 48‐h indoor air concentration levels of CO and PM_2.5 in 93 kitchen environments and personal exposure, after OPTIMA‐improved stoves had been installed for an average of 7 months. PM_2.5 and CO measurements did not differ significantly between OPTIMA‐improved stoves and control stoves. Although not statistically significant, a post hoc stratification of OPTIMA‐improved stoves by level of performance revealed mean PM_2.5 and CO levels of fully functional OPTIMA‐improved stoves were 28% lower (n = 20, PM_2.5, 136 μg/m³ 95% CI 54–217) and 45% lower (n = 25, CO, 3.2 ppm, 95% CI 1.5–4.9) in the kitchen environment compared with the control stoves (n = 34, PM_2.5, 189 μg/m³, 95% CI 116–261; n = 44, CO, 5.8 ppm, 95% CI 3.3–8.2). Likewise, although not statistically significant, personal exposures for OPTIMA‐improved stoves were 43% and 17% lower for PM_2.5 (n = 23) and CO (n = 25), respectively. Stove maintenance and functionality level are factors worthy of consideration for future evaluations of stove interventions.     

Ambient carbon monoxide and daily mortality in three Chinese cities: the China Air Pollution and Health Effects Study (CAPES)

Ambient carbon monoxide (CO) is an air pollutant primarily generated by traffic. CO has been associated with increased mortality and morbidity in developed countries, but few studies have been conducted in Asian developing countries. In the China Air Pollution and Health Effects Study (CAPES), the short-term associations between ambient CO and daily mortality were examined in three Chinese cities: Shanghai, Anshan and Taiyuan. Poisson regression models incorporating natural spline smoothing functions were used to adjust for long-term and seasonal trend of mortality, as well as other time-varying covariates. Effect estimates were obtained for each city and then for the cities combined. In both individual-city and combined analysis, significant associations of CO with both total non-accidental and cardiovascular mortality were observed. In the combined analysis, a 1 mg/m³ increase of 2-day moving average concentrations of CO corresponded to 2.89% (95%CI: 1.68, 4.11) and 4.17% (95%CI: 2.66, 5.68) increase of total and cardiovascular mortality, respectively. CO was not significantly associated with respiratory mortality. Sensitivity analyses showed that our findings were generally insensitive to alternative model specifications. In conclusion, ambient CO was associated with increased risk of daily mortality in these three cities. Our findings suggest that the role of exposure to CO and other traffic-related air pollutants should be further investigated in China.     

Parental tobacco and indoor secondhand smoking exposure and the risk of offspring under-five mortality in low- and middle-income countries

Children are vulnerable to exposure of secondhand smoking (SHS) which is a major preventable cause of disease and death. This study aimed to investigate the association between parental tobacco use or SHS exposure, respectively, and under-five mortality. Data were obtained from the nationally representative and population-based Demographic and Health Surveys in low- and middle-income countries (LMICs) between 2000 and 2018. Cox proportional hazard regression models with complex survey design were conducted to examine the adjusted associations between parental smoking and SHS exposure and child under-five mortality. In the pooled analysis of parental smoking, 437 322 children were included. Compared with children whose parents are not smoking, those whose father or both parents smoked any form of tobacco had higher risks of mortality (hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 1.03–1.13; HR = 1.18, 95% CI = 1.06–1.32, respectively). In addition, parental using smokeless tobacco, smoking tobacco, and using smokeless tobacco and smoking tobacco simultaneously was significantly associated with child under-five mortality (HR = 1.07, 95% CI = 1.01–1.12; HR = 1.12, 95%CI = 1.04–1.21; and HR = 1.17, 95%CI = 1.06–1.30, respectively). In the pooled analysis of SHS exposure, 605 442 children were included, and weekly and daily SHS exposure were significantly associated with child under-five mortality (HR = 1.11, 95% CI = 1.03–1.20, and HR = 1.10, 95% CI = 1.06–1.15, respectively). The results were robust in most stratification analyses and sensitivity analyses. Parental tobacco use and indoor SHS exposure were associated with increased risk of under-five mortality in LMICs. Comprehensive tobacco control programs should be considered by policymakers in LMICs to promote smoke-free environments for children.     

Assessment and management of risks arising from exposure to cadmium in fertilisers. I

A risk assessment protocol has been developed for use by individual EU Member States with appropriate selection of input data, to assess the risks to humans and the environment arising from exposure to cadmium in fertilisers. The protocol comprises of three modules: (1) the accumulation module, in which the net accumulation of cadmium in soil and soil solution, resulting from the application of fertiliser, is computed over time. The accumulation module allows for a range of inputs from different sources (atmospheric deposition, sludge addition, manure and fertiliser application) as well as for average and extreme rates of fertiliser application. A critical parameter is the solid/liquid partition coefficient, which in turn is a function of soil properties such as pH and is highly variable depending on the algorithm selected as being representative of national conditions. (2) The exposure module, in which the uptake of cadmium from soil into plants and the subsequent intake of cadmium by humans is computed, using exposure parameters characterising both average and extreme exposure scenarios. The protocol focuses on food types known to be sensitive to cadmium uptake (grain, cereals, potatoes, root vegetables and leafy vegetables). Environmental exposure is also characterised. (3) The risk characterisation module, in which Member States may estimate the incidence and severity of the adverse effects likely to occur due to actual or predicted exposure to cadmium. This is undertaken by modelling the Predicted Environmental Concentrations (PECs) in humans and the environment using the accumulation and exposure modules, and then comparing these values against the relevant Predicted No Effect Concentrations (PNECs). A range of environmental PNEC values are reported in the literature; the European Commission recommends that normally the lowest No Observed Adverse Effect Level (NOAEL) should be used in the risk characterisation. For humans, the current WHO Provisional Tolerable Weekly Intake (PTWI) is equivalent to a daily intake of 70 microg Cd day(-1). Particular risk groups can be characterised, namely of: children; smokers; women with low iron stores; consumers of food items with high cadmium content; and extreme consumers of staple food items. At present, with the data available, it is not possible to characterise risk groups in detail, either at EU level or at Member State level. However, most Member States appear to have an average intake of cadmium which is lower than the WHO's PTWI.     

Ozone in urban China: Impact on mortalities and approaches for establishing indoor guideline concentrations

Reducing indoor ozone levels may be an effective strategy to reduce total exposure and associated mortality. Here we estimate (a) premature mortalities attributable to ozone for China's urban population ≥25 years of age; (b) the fraction of total exposure occurring indoors; and (c) mortalities that can be potentially avoided through meeting current and more stringent indoor ozone standards/guidelines based on 1‐hour daily maxima. To estimate ozone‐attributable premature mortalities, we used hourly outdoor ozone concentrations measured at 1497 monitoring stations located in 339 Chinese cities and a published concentration‐response model. We proceeded to estimate province‐specific infiltration factors and co‐occurring hourly indoor ozone concentrations. For the year 2015, we estimated that indoor exposures accounted for 59% (95% confidence interval (CI): 26%‐79%) of the total ozone exposure that resulted in 70800 (95% CI: 35 900‐137 700) premature all‐cause mortalities in urban China. If the current Chinese indoor ozone standards (80 ppbv (160 µg/m³); 56 ppbv (112 µg/m³)) were met, the mean estimates of reduction in mortalities would be indistinguishable from zero. With stricter 1‐hour indoor ozone guidelines, the expected mortality reductions increase exponentially per unit decrease in indoor ozone. The analysis in this paper should help facilitate formulating present and future indoor ozone guidelines.     

Thermal exposure from large scale ethanol fuel pool fires

The growing use of ethanol as fuel for combustion engines has dramatically increased the need for large scale storage of ethanol in tanks. There are new risks related to fires in storage tanks having larger volumes. Very little experimental data exist to support risk assessments regarding emitted radiation and burning rate for large pool fires. Experience from small scale tests show that the exposure to nearby surroundings is less for alcohols than for hydrocarbon fuels like gasoline and these results are often extrapolated to fires of large sizes. This paper describes the results of two pool fires conducted within the frame of the ETANKFIRE project, one with 97% ethanol and 3% gasoline and the other with 85% ethanol and 15% gasoline, both with a surface area of 254 m². The results show, contrary to experience from small scale pool fires, that the exposure to nearby surroundings is much larger for ethanol-rich fuels compared to the calculated radiative heat flux from a pure gasoline fire of same fuel area.     

Household air pollution from wood burning in two reconstructed houses from the Danish Viking Age

During 13 winter weeks, an experimental archeology project was undertaken in two Danish reconstructed Viking Age houses with indoor open fireplaces. Volunteers inhabited the houses under living conditions similar to those of the Viking Age, including cooking and heating by wood fire. Carbon monoxide (CO) and particulate matter (PM_2.5) were measured at varying distances to the fireplace. Near the fireplaces CO (mean) was 16 ppm. PM_2.5 (mean) was 3.40 mg/m³, however, measured in one house only. The CO:PM mass ratio was found to increase from 6.4 to 22 when increasing the distance to the fire. Two persons carried CO sensors. Average personal exposure was 6.9 ppm, and from this, a personal PM_2.5 exposure of 0.41 mg/m³ was estimated. The levels found here were higher than reported from modern studies conducted in dwellings using biomass for cooking and heating. While this may be due to the Viking house design, the volunteer's lack of training in attending a fire maybe also played a role. Even so, when comparing to today's issues arising from the use of open fires, it must be assumed that also during the Viking Age, the exposure to woodsmoke was a contributing factor to health problems.     

Maternal exposure to carbon monoxide and fine particulate matter during pregnancy in an urban Tanzanian cohort

Low birthweight contributes to as many as 60% of all neonatal deaths; exposure during pregnancy to household air pollution has been implicated as a risk factor. Between 2011 and 2013, we measured personal exposures to carbon monoxide (CO) and fine particulate matter (PM_2.5) in 239 pregnant women in Dar es Salaam, Tanzania. CO and PM_2.5 exposures during pregnancy were moderately high (geometric means 2.0 ppm and 40.5 μg/m³); 87% of PM_2.5 measurements exceeded WHO air quality guidelines. Median and high (75th centile) CO exposures were increased for those cooking with charcoal and kerosene versus kerosene alone in quantile regression. High PM_2.5 exposures were increased with charcoal use. Outdoor cooking reduced median PM_2.5 exposures. For PM_2.5, we observed a 0.15 kg reduction in birthweight per interquartile increase in exposure (23.0 μg/m³) in multivariable linear regression; this finding was of borderline statistical significance (95% confidence interval 0.30, 0.00 kg; P = 0.05). PM_2.5 was not significantly associated with birth length or head circumference nor were CO exposures associated with newborn anthropometrics. Our findings contribute to the evidence that exposure to household air pollution, and specifically fine particulate matter, may adversely affect birthweight.     

Establishing a water information system for Europe: constraints from spatial data heterogeneity

Water information systems (WIS) are being developed for countries, international river basins and the European Union (EU), partly as a result of the requirements specified in the EU Water Framework Directive (WFD). The issue of whether and how these information systems should be integrated into the European Commission's water information system for Europe (WISE) is currently an open one. We present a discussion with regard to the challenges facing WISE development, with particular focus on the heterogeneity of spatial base data. In addition, an assessment of this heterogeneity is presented based on Swedish and English WFD reporting data, and on WISE‐relevant small‐scale European base datasets. Results show that WFD reporting data are based on incomparable methods and spatial analysis units, and that small‐scale data are transborder heterogeneous. Interpretation and international comparison of WFD results as well as their combination into a common WISE may therefore be largely constrained by spatial data heterogeneity.     

Smoke Alarm Presence and Performance in U.S. Home Fires

The vast majority of U.S. homes have at least one smoke alarm. For smoke alarms to be effective, they must have a functional power source, be close enough to the smoke to activate, they must be heard, and occupants must take appropriate action. In homes with smoke alarms and fires considered large enough, the alarms operated 83% of the time. Analyses of data from the U.S. Fire Administration’s National Fire Incident Reporting System and the National Fire Protection Association’s fire department survey showed that in 2003 to 2006, no smoke alarms were present in 31% of reported home fires and 40% of home fire deaths. Smoke alarms were present but failed to operate in 9% of the reported fires and 23% of the deaths. Thirty-seven percent of the deaths resulted from the 47% of fires with operating smoke alarms. Circumstances of the fire, the detection equipment, and occupant characteristics must be considered when evaluating smoke alarm performance. Hardwired smoke alarms operated more often than alarms powered by batteries alone. Victims of fatal fires with working smoke alarms were more likely than victims of fires without working smoke alarms to have been in the area of origin when the fire began; fighting the fire; unable to act; or at least 65 years old; and less likely to have been sleeping. Findings from the Consumer Product Safety Commission’s 2004 to 2005 Residential Fire Survey provide background about smoke alarms in the general population and in unreported fires.     

Seasonal variability in environmental tobacco smoke exposure in public housing developments

The risk of tobacco smoking and second‐hand smoke (SHS) exposure combined are the leading contributors to disease burden in high‐income countries. Recent studies and policies are focusing on reducing exposure to SHS in multiunit housing (MUH), especially public housing. We examined seasonal patterns of SHS levels within indoor common areas located on Boston Housing Authority (BHA) properties. We measured weekly integrated and continuous fine particulate matter (PM_2.5) and passive airborne nicotine in six buildings of varying building and occupant characteristics in summer 2012 and winter 2013. The average weekly indoor PM_2.5 concentration across all six developments was 9.2 μg/m³, higher during winter monitoring period (10.3 μg/m³) compared with summer (8.0 μg/m³). Airborne nicotine concentrations ranged from no detection to about 5000 ng/m³ (mean 311 ng/m³). Nicotine levels were significantly higher in the winter compared with summer (620 vs. 85 ng/m³; 95% CI: 72–998). Smoking‐related exposures within Boston public housing vary by season, building types, and resident smoking policy. Our results represent exposure disparities that may contribute to health disparities in low‐income communities and highlight the potential importance of efforts to mitigate SHS exposures during winter when outdoor–indoor exchange rates are low and smokers may tend to stay indoors. Our findings support the use of smoke‐free policy as an effective tool to eliminate SHS exposure and protect non‐smokers, especially residents of MUH.     

Humidifier disinfectant and use characteristics associated with lung injury in Korea

Since around the year 2000, hundreds of people in Korea have developed humidifier disinfectant‐associated lung injury (HDLI). We collected all HD exposure‐related information from the field investigations into the locations in which the 1199 registered patients had used HD. Among the people who registered, 38% (1st round = 214, 2nd = 73, 3rd = 166) were confirmed as HDLI patients. Children aged under eight years old made up the highest proportion of HDLI cases (N = 279, 62%), followed by pregnant women (N = 31, 7%). One hundred thirty‐three (29%) of the confirmed HDLI patients died. Fifty‐seven percent of HDLI patients (N = 259) developed HDLI after <1 year of HD use. The number of HDLI patients who used only the Oxy Saksak HD brand was found to be 176 (39%), followed by the brands Cefu (N = 27, 6%) and Aekyung (N = 22, 5%). HD products containing only polyhexamethylene guanidine phosphate (PHMG‐P) were the most frequently used among HDLI patients (N = 234, 52%), followed by oligo (2‐(2‐ethoxy)ethoxyethyl) guanidinium (PGH) (N = 27, 6%) and a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (N = 26, 6%). The average PHMG‐P inhalation level estimated from the patient group classified as suffering lung injury definitely associated with HD use was 145.1 μg/m³ (N = 91, SD = 395.1 μg/m³), higher than levels estimated from both the probable and possible HDLI patient groups. In conclusion, HD exposure‐related variables, including type of HD brand and estimated inhalation HD level, were associated with the risk of HDLI.     

Building‐related health symptoms and classroom indoor air quality: a survey of school teachers in New York State

Most previous research on indoor environments and health has studied school children or occupants in non‐school settings. This investigation assessed building‐related health symptoms and classroom characteristics via telephone survey of New York State school teachers. Participants were asked about 14 building‐related symptoms and 23 classroom characteristics potentially related to poor indoor air quality (IAQ). Poisson regression analysis was used to assess the relationship between these symptoms and each classroom characteristic, controlling for potential confounders. About 500 teachers completed the survey. The most frequently reported classroom characteristics included open shelving (70.7%), food eaten in class (65.5%), dust (59.1%), and carpeting (46.9%). The most commonly reported symptoms included sinus problems (16.8%), headache (15.0%), allergies/congestion (14.8%), and throat irritation (14.6%). Experiencing one or more symptoms was associated most strongly with reported dust (relative risk (RR) = 3.67; 95% confidence interval (CI): 2.62–5.13), dust reservoirs (RR = 2.13; 95% CI: 1.72–2.65), paint odors (RR = 1.73; 95% CI: 1.40–2.13), mold (RR = 1.71; 95% CI: 1.39–2.11), and moldy odors (RR = 1.65 95% CI: 1.30–2.10). Stronger associations were found with increasing numbers of reported IAQ‐related classroom characteristics. Similar results were found with having any building‐related allergic/respiratory symptom. This research adds to the body of evidence underscoring the importance to occupant health of school IAQ.     

Pre‐natal and post‐natal exposure to pet ownership and lung function in children: The Seven Northeastern Cities Study

To evaluate the association between pre‐natal and post‐natal exposure to pet ownership and lung function in children, a cross‐sectional study named Seven Northeastern Cities (SNEC) study was conducted. In this study, children's lung function including the forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), maximal mid‐expiratory flow (MMEF), and peak expiratory flow (PEF) were measured by spirometers, and pet ownership situations were collected by questionnaire. Analyzed by multiple logistic regression and generalized linear modeling, we found that for all subjects, pet exposure in the first 2 years of life was significantly associated with lung function impairment of FVC<85% predicted (adjusted odds ratio [aOR]=1.28; 95% confidence interval [CI]: 1.01, 1.63). For current pet exposure, the increased odds of lung function impairment ranged from 35% (aOR=1.35; 95%CI: 1.12, 1.62) for FVC<85% predicted to 57% (aOR=1.57; 95%CI: 1.29, 1.93) for FEV₁<85% predicted. The in utero exposure was not related to lung function impairment. Compared with other pets, higher odds were observed among children with dogs. When stratified by gender, girls with current pet exposure were more likely to have lung function impairment than boys. It implies self‐reported exposures to pets were negatively associated with lung function among the children under study.     

Self‐reported health and comfort in ‘modern’ office buildings: first results from the European OFFICAIR study

In the European research project OFFICAIR, a procedure was developed to determine associations between characteristics of European offices and health and comfort of office workers, through a checklist and a self‐administered questionnaire including environmental, physiological, psychological, and social aspects. This procedure was applied in 167 office buildings in eight European countries (Portugal, Spain, Italy, Greece, France, Hungary, the Netherlands, and Finland) during the winter of 2011–2012. About 26 735 survey invitation e‐mails were sent, and 7441 office workers were included in the survey. Among respondents who rated an overall comfort less than 4 (23%), ‘noise (other than from building systems)’, air ‘too dry’, and temperature ‘too variable’ were the main complaints selected. An increase of perceived control over indoor climate was positively associated with the perceived indoor environment quality. Almost one‐third of office workers suffered from dry eyes and headache in the last 4 weeks. Physical building characteristics were associated with occupants’ overall satisfaction (acoustical solutions, mold growth, complaints procedure, cleaning activities) and health (number of occupants, lack of operable windows, presence of carpet and cleaning activities). OFFICAIR project provides a useful database to identify stressors related to indoor environmental quality and office worker's health.     

Risk factors for fatal residential fires

Residential fires are the most important cause of fire-related mortality in the United States. Previous research has concentrated on fatal fires in urban areas; considerably less is known about fatal fires in rural areas.We studied fatal and nonfatal residential fires in predominantly rural areas. Using a casecontrol design, we compared all 151 fatal fires (cases) in single-family dwellings in North Carolina during a 13-month period with a sample of nonfatal fires (controls). Case fires were identified through the medical-examiner system, and control fires that occurred within a few weeks of the case fires were chosen from the records of randomly selected fire departments statewide. For each fire, fire officials were interviewed about the dwelling, the fire, the people involved, and the fire-response system.Although heating incidents were the leading cause of fires, fatal fires were more likely to have been caused by smoking (31% of fatal fires vs. 6% of nonfatal fires). Mobile homes posed a higher risk of death if a fire occurred (odds ratio, 1.7; 95% confidence interval, 1.1 to 2.6), as did the absence of a smoke detector (odds ratio, 3.4; 95% confidence interval, 2.1 to 5.6). Smoke detectors were more protective against death in fires involving young children and when no one present was impaired by alcohol or drugs or had a physical or mental disability. The presence of an alcohol-impaired person was the strongest independent risk factor for death in the case of a fire (odds ratio, 7.5; 95% confidence interval, 4.4 to 12.7).In conclusion, residential fires are most likely to be caused by heating equipment or smoking materials. The risk of death is greatest in fires in mobile homes, in those involving alcoholimpaired persons, and in those in houses without smoke detectors. Reprinted with permission from The New England Journal of Medicine, 1992 Sep 17, 327 (12), pp. 859–863.     

Essay book reviews

MAKING EUROPEAN POLICIES WORK: The implementation of Community legislation in the Member States, eds. (Heinrich Siedentopf and Jacques Ziller. European Institute of Public Administration/SAGE Publications, London, 1988. Vol One: Comparative Synthesis, 288 pp., cloth (£30); Vol Two: National reports, 736 pp., cloth (£45).