GOVERNMENT STUDIES OF HEALTH EFFECTS OF ENVIRONMENTAL TOBACCO SMOKE
The following is from the June 27, 2006 Surgeon General's press release: U.S. Surgeon General Richard H. Carmona today issued a comprehensive scientific report which concludes that there is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. The finding is of major public health concern due to the fact that nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke. The report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, finds that even brief secondhand smoke exposure can cause immediate harm. The report says the only way to protect nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors. "The report is a crucial warning sign to nonsmokers and smokers alike," HHS Secretary Michael Leavitt said. "Smoking can sicken and kill, and even people who do not smoke can be harmed by smoke from those who do." Secondhand smoke exposure can cause heart disease and lung cancer in nonsmoking adults and is a known cause of sudden infant death syndrome (SIDS), respiratory problems, ear infections, and asthma attacks in infants and children, the report finds. "The health effects of secondhand smoke exposure are more pervasive than we previously thought," said Surgeon General Carmona, vice admiral of the U.S. Public Health Service. "The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults." Secondhand smoke contains more than 50 cancer-causing chemicals, and is itself a known human carcinogen. Nonsmokers who are exposed to secondhand smoke inhale many of the same toxins as smokers. Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer, the report says. In addition, the report notes that because the bodies of infants and children are still developing, they are especially vulnerable to the poisons in secondhand smoke. "The good news is that, unlike some public health hazards, secondhand smoke exposure is easily prevented," Surgeon General Carmona said. "Smoke-free indoor environments are proven, simple approaches that prevent exposure and harm." The report finds that even the most sophisticated ventilation systems cannot completely eliminate secondhand smoke exposure and that only smoke-free environments afford full protection. ... He emphasized, however, that sustained efforts are required protect the more than 126 million Americans who continue to be regularly exposed to secondhand smoke in the home, at work, and in enclosed public spaces. To help communicate the report findings as widely as possible, the Surgeon General unveiled an easy-to-read guide with practical information on the dangers of secondhand smoke and steps people can take to protect themselves. Copies of The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General and related materials are available on the Surgeon General's Web site by clicking here. To access the press release, click above. To access a summary of the 6 major conclusions of the Surgeon General's report, click here. To access a glossy brochure based on the report (this is in pdf format and is a large megabite document), click here.
On January 26, 2006, the California Air Resources Board (ARB) identified environmental tobacco smoke (ETS), or second-hand smoke, as a Toxic Air Contaminant (TAC). ETS is now formally identified as an airborne toxic substance that may cause and/or contribute to death or serious illness. ARB's action to list ETS as a TAC was based on a comprehensive report on exposure and health effects of ETS. "This new report reaffirms many of the adverse health effects associated with ETS, especially in children who live in homes where smoking occurs," said ARB Chairman, Dr. Robert Sawyer. "It also raises new concerns about its effects on women. All this strongly supported the need for the Air Board to identify ETS as a serious health threat." Second-hand smoke is a complex mixture of compounds produced by burning of tobacco products. ETS is also a source of other toxic air contaminants such as benzene, 1,3 butadiene, and arsenic. In California each year, tobacco smoke is responsible for the release into the environment of 40 tons of nicotine, 365 tons of respirable particulate matter, and 1900 tons of carbon monoxide. As required by State law, the ARB evaluated exposures to ETS, while the Office of Environmental Health Hazard Assessment (OEHHA) assessed the health effects from these exposures. The OEHHA evaluation clearly established links between exposure to ETS and a number of adverse health effects, including some specific to children and infants. These include premature births, low birth-weight babies, and Sudden Infant Death Syndrome (SIDS). Other effects of ETS on children include the induction and exacerbation of asthma, and infections of the middle-ear and respiratory system. The OEHHA evaluation also found links between ETS exposure and increased incidences of breast cancer in non-smoking, pre-menopausal women. ETS had already been linked to adult incidences of lung and nasal sinus cancer, heart disease, eye and nasal irritation, and asthma. "The ARB's action rightfully puts second-hand tobacco smoke in the same category as the most toxic automotive and industrial air pollutants," OEHHA Director Joan Denton said. "Californians, especially parents, would not willingly fill their homes with motor vehicle exhaust, and they should feel the same way about tobacco smoke." Now that ETS is identified as a toxic air contaminant, the ARB must evaluate the need for action to reduce exposures. To access the press release announcing this report, click above. To access more on the report, go to the Environmental Tobacco Smoke section of the Air Resources Board web site by clicking here.
A scientific working group of 29 experts from 12 countries convened by the Monographs Programme of the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO), Lyon, France, has reviewed all significant published evidence related to tobacco smoking and cancer, both active and involuntary. Its conclusions, released in June, 2002, unsurprisingly confirmed the cancer-causing effects of active smoking, which an earlier working group had considered back in 1986. However, it now concluded its evaluation of the carcinogenic risks associated with involuntary smoking, and IARC now classifies second-hand smoke as carcinogenic to humans. This report is very significant because it places a prestigious international organization officially on record as finding secondhand smoke to be a carcinogen, i.e., a substance which causes cancer in humans. To access the report on both smoking and involuntary smoking, which was published by IARC in July, 2004, click here. To access the portion of the IARC report on "Involuntary Smoking," click above.
The U.S. Department of Health and Human Services through its Public Health Service, National Toxicology Program on December 11, 2002 issued its 10th Report on Carcinogens. The report includes a list of all 228 known carcinogens -- cancer-causing agents. The 10th Report added 15 carcinogens which had not previously been listed. Included among the list of carcinogens is "Tobacco Related Exposures" which includes Environmental Tobacco Smoke, Tobacco Smoking, and Smokeless Tobacco. The report states that each of these tobacco related exposures are carcinogenic. To access the full report, click above and scroll down to "Tobacco Related Exposures." To directly access the section on "Tobacco Related Exposures," in pdf format, click here. For additional information on the 10th Report, including a Factsheet, click here.
The ninth official federal government report, issued on May 15, 2000, listed the 218 substances known to cause cancer. This report, for the first time, specifically listed ETS as a "known human carcinogen," based on evidence that indicates there is a causal relationship between passive exposure to tobacco smoke and lung cancer. This report succinctly provides information about the composition and properties of ETS, as well as information about levels of exposure to ETS in various settings. To access the press release announcing this report, with specific mention of the addition of ETS to the listing of carcinogens, click here. It appears that the 9th Report is no longer accessible, but instead you are directed by the NIEHS web site to the 10th Report which is described in the above paragraph and may be accessed by clicking above.
The National Report on Human Exposure to Environmental Chemicals provides an ongoing assessment of the U.S. population's exposure to environmental chemicals using biomonitoring. Biomonitoring is the assessment of human exposure to chemicals by measuring the chemicals or their metabolites in human specimens such as blood or urine. The first National Report on Human Exposure to Environmental Chemicals was issued in March 2001, and presented exposure data for 27 chemicals from NHANES 1999, including Environmental Tobacco Smoke. The Second Report, released in January 2003, presents biomonitoring exposure data for 116 environmental chemicals (including the 27 in the first Report) for the noninstitutionalized, civilian U.S. population over the 2-year period 1999-2000. The Second Report also presents exposure data for the U.S. population divided into age, gender, and race/ethnicity groups. To access the full Second Report, click above. To access information, in pdf format, on Tobacco Smoke: Cotinine from the Second Report, click here.
This site includes the final report adopted in September, 1997 titled Health Effects of Exposure to ETS. This report, by the California Environmental Protection Agency, is one of the most comprehensive reports yet compiled and identifies the many health dangers of ETS. The site also contains the draft updates to the 1997 report; the draft was issued in 2003, revised and re-issued in October, 2004. To access each of these important documents, plus more, click above.
The U.S. Environmental Protection Agency (EPA) in 1992 published this landmark assessment of the respiratory health risks of passive smoking (Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders; EPA/600/6-90/006F). The report concluded that exposure to environmental tobacco smoke (ETS) -- commonly known as secondhand smoke -- is responsible for approximately 3,000 lung cancer deaths each year in nonsmoking adults and impairs the respiratory health of hundreds of thousands of children. This Fact Sheet, prepared by the EPA, summarizes the findings of this landmark report; click above for the Fact Sheet. [Note: This EPA report was the subject of an intensive legal challenge by the tobacco industry, but, in a December 11, 2002 decision, the U.S. Court of Appeals for the 4th Circuit unanimously upheld the validity of the EPA report. The decision may be accessed by clicking here. The tobacco companies who had challenged the validity of the EPA report decided not to appeal this decision. Therefore, the findings of the EPA report stand and are subject to no further legal challenge.] To access the full 1992 EPA report, click here.
NIOSH -- the National Institute for Occupational Safety & Health -- has determined that environmental tobacco smoke (ETS) is "potentially carcinogenic to occupationally exposed workers," and that "workers should not be involuntarily exposed to tobacco smoke." NIOSH recommends that "the best method for controlling worker exposure to ETS is to eliminate tobacco use from the workplace and to implement a smoking cessation program." NIOSH has a variety of reports and materials which can be accessed from its home page by doing a search for "environmental tobacco smoke." The NIOSH home page can be accessed by clicking above. To obtain the NIOSH Carcinogen List, which includes Environmental Tobacco Smoke, click here. To access the most recent NIOSH Current Intelligence Bulletin 54: Environmental Tobacco Smoke in the Workplace (Lung Cancer and Other Health Effects) which was published in 1991 (NIOSH Publication Number 91-108), and which contains information on the carcinogenic effects of environmental tobacco smoke and the possible association between ETS exposure and an increased risk of heart disease, click here.
SCIENTIFIC STUDIES, REPORTS & FACT SHEETS ON THE HEALTH EFFECTS OF SECONDHAND SMOKE
On June 30, 2004, a landmark study published in the British Medical Journal found that exposure to secondhand smoke is even more dangerous than previously thought and increases the risk of heart disease among non-smokers by as much as 60 percent. This study provides the most compelling evidence yet that secondhand smoke causes heart disease. It is the first study to show a direct physical link between secondhand smoke exposure and an increased risk of heart disease. The study, conducted over 20 years by researchers at St. George's Hospital Medical School in London, is particularly important because it measured exposure to secondhand smoke from all sources -- including in bars, restaurants, and other workplaces, as well as in the home -- based on blood levels of a nicotine byproduct called cotinine. They found that high blood cotinine levels were associated with a 50 to 60 percent higher risk of coronary heart disease. Previous studies had estimated increased risk at 25 to 30 percent. The study is one of the few that has sought to account for all sources of exposure to secondhand smoke, not just home exposure. To access the full study, click above.
On May 20, 2004 the Campaign for Tobacco-Free Kids released results of a study comparing indoor air quality in bars and restaurants of three cities with smoke-free laws (New York City, Buffalo and Los Angeles) and four cities without smoke-free laws (Washington, DC, Philadelphia, Baltimore and Hoboken, NJ). The study found that air pollution levels were 82 percent lower on average in venues required by law to be smoke-free. According to the researchers at the Roswell Park Cancer Institute in Buffalo, this study is the largest of its type ever conducted to measure the impact of smoke-free laws on the indoor air quality of restaurants and bars. It provides powerful evidence that smoke-free laws protect workers and patrons from the harmful air pollutants in secondhand smoke and shows why every community and every state should enact such laws covering all indoor workplaces and public places. The 33-page study can be accessed by clicking above.
On April 5, 2004, a new study was posted on the British Medical Journal (BMJ) web site to report that the implementation of a comprehensive local clean indoor air ordinance in Helena, Montana, may have resulted in a rapid reduction in heart attacks. The study, which will be published in the April 24 print BMJ, found hospital admissions for acute myocardial infarction (AMI) declined by about 40% during the 6 months the ordinance was in effect and rebounded after the ordinance was suspended. A commentary on the study, provided by Dr. Terry Pechacek, Associate Director of Science in CDC's Office on Smoking and Health (OSH), and co-author Stephen Babb, a CDC health education specialist, also to be published in the April 24 issue, discusses the biological plausibility of these types of findings. The commentary is available on the BMJ web site by clicking above. To access the Helena study, see note directly below.
The following is from an ANR press release: A new study posted April 5, 2004 on the British Medical Journal website shows that the health benefits of a comprehensive smokefree workplace law may be much more immediate than previously thought, resulting in a decline of 40% in the number of heart attacks. The study, authored by Richard P. Sargent, MD, Robert M. Shepard, MD, and Stanton A. Glantz, PhD, looked at the number of hospital admissions in Helena, Montana for acute myocardial infarctions (AMI) during a sixth month period; compared those numbers to the same time period in the previous four years, and looked at figures for the surrounding area not affected by the smokefree law. The doctors found a 40% drop in admissions for heart attacks from people living or working in Helena -- where a smokefree ordinance was in effect -- and no change for people living further away. According to Dr. Glantz, "This is not the first study to find a link between long term exposure to secondhand smoke and heart attacks. There is a mountain of evidence that this connection exists. It is, however, the first study to show the rapid community level benefits of a smokefree policy. This study shows that a comprehensive indoor smoke-free law reduces heart attacks immediately." One year after Dr. Sargent presented the Helena Heart Study findings at the Annual Scientific Sessions of the American College of Cardiology in Chicago in April, 2003, the British Medical Journal, one of the most prominent peer-reviewed medical journals in the world, is publishing the dramatic results. The journal article points out that even 30 minutes of exposure to secondhand smoke increases blood platelet "stickiness," which can lead to blood clots. In addition, arteries narrow after exposure to secondhand smoke, so smaller clots cause more damage, and there is an increase in heart rhythm problems associated with heart attacks. According to Cynthia Hallett, Executive Director of Americans for Nonsmokers' Rights (ANR), "The bottom line is simple. Secondhand smoke kills. This study validates that there are important and immediate community-level health benefits to smoke-free workplace policies. All nonsmokers deserve to breathe smoke-free air in enclosed workplaces and public places." To access the full study, in pdf format, click above. For the full ANR press release, click here.
The study of the above title was published in the April 5, 2004 issue of the British Medical Journal. The study examined the association between secondhand smoke and mortality. The authors found that adults who had never smoked and who lived with smokers had about 15% higher mortality than never smokers living in a smoke-free household. This is another very important study of the effects of secondhand smoke. Click above to access the full study, in pdf format.
The December 21, 2001 issue of Lancet contains one of the largest studies of passive smoking. The study found that secondhand smoke increases the risk of asthma and other respiratory problems in non-smokers and is widespread in many countries, particularly in the workplace. The study analyzed data on nearly 8,000 people in the United States, 16 European countries, Australia and New Zealand. The study showed the proportion of people who regard themselves as exposed to passive smoking varied from a high of 53 percent in Spain to less than three percent in Sweden. Dr. Christer Janson said his colleagues analyzed information on nearly 8,000 men and women questioned about their exposure to secondhand smoke and given a physical examination to determine its impact on their health. In 12 of the 36 centers included in the study more than half of those questioned reported being exposed to secondhand smoke. The prevalence of passive smoking was directly related to the level of smoking in each country. They found passive smoking had a strong effect on asthma and respiratory symptoms such as breathlessness, chest tightness and lung function in adults. "It (passive smoking) has been described in many other publications in children but it hasn't been studied to that extent in adults," said Janson. Regulations and the prevalence of smoking were the biggest factors determining the number of people exposed to secondhand smoke. Italy, Spain and other southern and central European countries, which have a higher prevalence of smokers, have more passive smokers while Scandinavian nations, Australia, New Zealand and the United States had the least. "We found a positive association between passive smoking in the workplace and current asthma," the researchers said. "Decreasing involuntary exposure to tobacco smoke in the community, especially in workplaces, is likely to improve respiratory health." Click above to access the full text of the study. You will need to be a registered user or an activated subscriber to The Lancet . Becoming a registered user of most major online journals allows free access to past issues six or twelve months old and older.
This presentation by Clifford Douglas, Esq., legal consultant to the Smoke-Free Environments Law Project, was given on November 9, 2000 at the Michigan Tobacco-Free Institute. The presentation examined the ways in which the tobacco industry has utilized the addictive nature of nicotine to hook smokers on this deadly product and keep them hooked. The presentation provides, in a highly interesting manner, a historical look at what the tobacco industry knew about nicotine and how they tried to keep most of this secret; the result has been that 9 out of 10 lung cancer deaths are due to the use of this addictive product.
On May 15, 2001 the Hong Kong Council on Smoking & Health (COSH) released the results of a very significant study which examined the effects of secondhand smoke exposure among food service workers in Hong Kong. The study -- which involved interviews and urine samples to detect cotonine, a marker for secondhand smoke -- estimated that secondhand smoke kills about 150 food service workers annually in Hong Kong. The study found that food service workers had 5 1/2 times more cotonine in their urine than a control group of nonsmokers working in smoke-free settings. Two articles have been released by COSH based on this study, as follows: one article is by James Repace, titled Preliminary Analysis of Dose, Exposure, and Risk for 104 Hong Kong Catering Workers Exposed to Second Hand Smoke at Work Only, which may be accessed here; and an article by Hedley, McGhee, Repace, et al titled Second-hand Smoke Exposures and Passive Smoking in Non-Smoking Catering Workers in Hong Kong: the Combined Risks for Heart Disease and Cancer, which may be accessed here. Click above for a Hong Kong news article on the study. Click here for Hong Kong Council on Smoking & Health site which also has the texts of the articles and related information.
This is a link to the ASH-Great Britain site which provides information and additional links to a treasure trove of information on the ingredients and additives in cigarettes, and the composition and constituents in tobacco smoke. This site provides a simple explanation of the nature and composition of secondhand smoke, as well as links to many of the scientific reports and analyses of secondhand smoke. The site is a very valuable, one-stop resource.
This July 30, 2000 position statement and supporting analysis of the American College of Occupational & Environmental Medicine (ACOEM) sets forth the compelling evidence that secondhand smoke is a serious danger in the workplace. The ACOEM states that "implementation of policies to prevent workplace ETS can be highly effective, entailing low costs and yielding primary and secondary benefits to employers and employees. ACOEM strongly supports an increase in the scope and effectiveness of policies and efforts that protect against exposure to ETS in the workplace and elsewhere ..., including public spaces such as bars, casinos, restaurants, schools, daycare centers, and public transportation."
This August 9, 2000 study in the Journal of the American Medical Association (JAMA) titled "Environmental Tobacco Smoke Exposure Among Police Officers in Hong Kong" provides strong new evidence of the dangers of secondhand smoke to workers on their job. The study surveyed almost 4,500 male and over 700 female police officers in Hong Kong who were never smokers; it found that 80% were exposed to secondhand smoke in the workplace, and that significant associations existed between this exposure and respiratory problems in both men and women. The study states that the findings demonstrate a clear need for bans on smoking in the workplace. Click above to access the full text of the study. You will need to be a registered user or an activated subscriber to JAMA. Becoming a registered user of most major online journals allows free access to past issues six or twelve months old and older.
This detailed report by noted secondhand smoke expert James Repace examines the question of whether traditional mechanical ventilation systems or new displacement ventilation can reduce secondhand smoke levels to the point that they are safe for workers or patrons in hospitality venues. He concludes that they cannot, and that the only viable control measure continues to be total smoking bans. (This 56 page report is in pdf format.)
This excellent analysis by Repace, Kawachi & Glantz is called a Fact Sheet, but is much more than that. It provides a concise, but highly authoritative review of the health issues associated with secondhand smoke, including the hazards posed by exposure to secondhand smoke, the ingredients in ETS, as well as information on smoke-free restaurant laws and the impact of these laws on the economic viability of restaurants
This is a comprehensive 1999 review, by Samet & Wang, of findings on the respiratory and other health effects of ETS. The article reviews many reports issued in recent years which examined ETS in relation to cardiovascular diseases, asthma and ear disease in children, and sudden infant death syndrome; it includes an extensive list of references on ETS.
This highly regarded article by Hackshaw, Law & Wald in the October 18, 1997 issue of the British Medical Journal analyzed 37 published epidemiological studies of the risk of lung cancer in non-smokers who did and did not live with a smoker. The risk estimate was compared with that the risk in smokers using 7 studies. The analysis concluded that there is compelling evidence that exposure to ETS is a cause of lung cancer.
This October 18, 1997 article by Law, Morris & Wald in the British Medical Journal analyzed 19 published studies of ischaemic heart disease and concluded that there is no satisfactory alternative interpretation of the evidence reviewed than that environmental exposure to tobacco smoke causes an increase in risk of ischaemic heart disease of the order of 25%. In proportionate terms this is of similar magnitude to the effects of exposure to environmental tobacco smoke on lung cancer, but the number of excess deaths from heart disease will be far greater because heart disease is so much more common than lung cancer in non-smokers. The effect of ETS is not trivial. It is a serious environmental hazard, and one that is easily avoided. The evidence on ischaemic heart disease warrants further action in preventing smoking in public buildings and enclosed working environments. The hazard in the home requires greater public education so that smokers recognize the risk to which they expose members of their family. It is also important that clinicians advise that families of patients with known coronary artery disease do not smoke in their presence.
This paper from the National Clearinghouse on Tobacco and Health in Canada provides a concise overview of the health effects of ETS.
This editorial by Dr. Ronald Davis was published in the December 9, 1998 issue of the Journal of the American Medical Association. The editorial reviews the current research on ETS and examines which workers are at great risk from secondhand smoke and remedies that are available. You will need to be a registered user or an activated subscriber to JAMA. Becoming a registered user of most major online journals allows free access to past issues six or twelve months old and older.
This article by Eisner, et al in the December 9, 1988 issue of the Journal of the American Medical Association studied the respiratory health of bartenders before and after the prohibition of smoking in all bars and taverns in California. This seminal study found that the establishment of smoke-free bars and taverns was associated with a rapid improvement in the respiratory health of the bartenders.
This Canadian National Clearinghouse on Tobacco and Health site provides links to a variety of Fact Sheets on ETS, including ones on: ETS and Your Heart; ETS at Work; ETS and Your Lungs; ETS and Public Places; etc.
This Americans for Nonsmokers' Rights site provides a brief synopsis of the scientific reports on the dangers of ETS, and a listing of tobacco industry attacks on scientific reports concerning ETS.
Smoke-Free Environments Law Project
The Center for Social Gerontology
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Ann Arbor, MI 48103