By Marc Kaufman
Washington Post Staff Writer
Wednesday, June 28, 2006
Secondhand smoke dramatically increases the risk of heart disease and lung cancer in nonsmokers and can be controlled only by making indoor spaces smoke-free, according to a comprehensive report issued yesterday by U.S. Surgeon General Richard H. Carmona.
"The health effects of secondhand smoke exposure are more pervasive than we previously thought," Carmona said. "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."
According to the report, the government's most detailed statement ever on secondhand smoke, exposure to smoke at home or work increases the nonsmokers' risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. It is especially dangerous for children living with smokers and is known to cause sudden infant death syndrome, respiratory problems, ear infections and asthma attacks in infants and children.
The report -- which was applauded and embraced by public-health and tobacco-control advocates -- found that nearly half of all nonsmoking Americans are still regularly exposed to smoke from others. It concludes that any exposure to secondhand smoke is a risk to nonsmokers, and as a result the only way to protect nonsmokers is to eliminate indoor smoking.
"Restrictions on smoking can control exposures effectively, but technical approaches involving air cleaning or a greater exchange of indoor with outdoor air cannot," the report says. "Consequently, nonsmokers need protection through the restriction of smoking in public places and workplaces and by a voluntary adherence to policies at home," particularly to eliminate exposures of children.
The report represents the strongest statement about smoking and tobacco control to come out during the Bush administration -- which received millions in campaign donations from the tobacco industry.
The administration has been neutral or negative about two major tobacco-control initiatives -- proposals to grant the Food and Drug Administration authority to regulate tobacco, and enacting the World Health Organization global treaty on tobacco. The WHO treaty, for instance, was signed by the administration but has never been sent to the Senate for a ratification vote.
The tobacco industry has been somewhat divided on the dangers of secondhand smoke, with R.J. Reynolds Tobacco Co. saying that the science remains inconclusive and Philip Morris USA generally willing to accept public-health advocates' conclusions. All the companies, however, were accused by the Justice Department of conspiring to undercut the scientific consensus on secondhand smoke, and that charge remains part of the department's lawsuit against them.
A Philip Morris spokeswoman said yesterday that the company is reviewing the report, while R.J. Reynolds spokesman David Howard said that the report "does not change our views about secondhand smoke." He said that the company continues to believe that owners of bars, nightclubs and other places restricted to adults should decide whether to allow smoking.
On its Web site yesterday, the company said: "There are still legitimate scientific questions concerning the reported risks of secondhand smoke."
The report finds that even the most sophisticated ventilation systems cannot eliminate secondhand smoke and that only smoke-free environments are risk-free. Carmona called state and local mandates for smoke-free buildings a major public health success and said they have had enormous positive effects. Levels of cotinine, a biological marker for secondhand-smoke exposure, have fallen by 70 percent in nonsmokers since the late 1980s, he said.
The report does not present new scientific data but is an analysis of the best research on secondhand smoke. It said, for instance, that the Centers for Disease Control and Prevention estimated last year that exposure to secondhand smoke kills more than 3,000 nonsmokers from lung cancer, approximately 46,000 from coronary heart disease, and as many as 430 newborns from sudden infant death syndrome.
"This report once and for all ends any scientific debate about whether exposure to secondhand smoke is a cause of serious diseases like lung cancer and heart disease," said Matthew Myers of the Campaign for Tobacco-Free Kids.
The report, he said, "leads to one inescapable conclusion: Only comprehensive smoke-free workplace laws can protect all workers and the public from the serious, proven health risks of secondhand smoke. . . . Public-health advocates will use this report in every state and every city and every workplace, restaurant and meeting place that doesn't already have a comprehensive smoke-free law."
American Medical Association President-elect Ron Davis added that "this report should be a wake-up call for lawmakers to enact comprehensive clean indoor air laws that prohibit smoking in all indoor public places and workplaces."
The surgeon general directly accused the tobacco industry of trying to minimize the scientific consensus on the dangers of environmental tobacco smoke.
"The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus," the report says.
There are more than 50 cancer-causing chemicals in secondhand smoke, and smokers and nonsmokers in rooms with smokers inhale many of the same toxins. Because the bodies of infants and children are developing, the report says, they are at special risk. Even short exposure to secondhand smoke can lead to immediate cardiovascular problems and long-term health problems and lung disease, the report concludes.
The surgeon general last addressed secondhand smoke in 1986. The Environmental Protection Agency and the California EPA have both addressed the issue since -- concluding that nonsmokers are at risk for secondhand smoke -- but the surgeon general is generally considered the nation's most authoritative source on issues of science and tobacco.