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Robert J. Roscoe, MS; Kyle Steenland, PhD
National Institute for Occupational Safety and Health Cincinnati, Ohio

JAMA. 1989;262(24):3404.

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In Reply.—

We appreciate the comments of Dr Ravenholt and Dr Kuller. In response to Dr Ravenholt's first point, we are reasonably sure that all our nonsmoking miners were indeed nonsmokers. We defined nonsmokers as persons who never reported smoking one or more cigarettes per day (or any pipes or cigars) for any length of time, as reported on smoking surveys conducted from an initial physical examination in the 1950s and updated through 1969. We reviewed all survey data to ensure that only nonsmokers were included in the study. Survey data were collected without knowledge of the health outcome and the review process was the same for the entire cohort. While it is possible that some of the 14 lung cancer decedents took up smoking after 1969, when they were in their 40s, this is quite unlikely, based on the known behavior of men who have never smoked. Dr Ravenholt's . . . [Full Text PDF of this Article]

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