Lawrence Major’s Task Force on Smoking
Report To City Commission
March 31, 2004
Health Impact Summary
Public health officials, including those from the American Cancer Society, the American Medical Association, the American Lung Association, the National Institutes for Health, the American Heart Association, the Environmental Protection Agency, and others—both nationally and internationally, have concluded that exposure to environmental tobacco smoke, also known as secondhand smoke, causes disease, including but not limited to lung cancer, heart disease, bronchitis, asthma, low birth weight babies, and emphysema in non-smoking adults. Moreover, these officials have determined that secondhand smoke exposure of children causes symptoms of coughing and wheezing, and conditions including asthma, respiratory infections, and otitis media. It is associated with increased risk of Sudden Infant Death Syndrome, or SIDS.
Philip Morris USA has publicly acknowledged these above findings.
National Cancer Institute determined in 1999 that secondhand smoke is responsible for the early deaths of up to 65,000 Americans annually. (National Cancer Institute (NCI), "Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency. Smoking and Tobacco Control Monograph 10," Bethesda, MD: National Institutes of Health, National Cancer Institute (NCI), August 1999.)
A significant amount of secondhand smoke exposure occurs in the workplace. Employees who work in smoke-filled businesses suffer a 25-50% higher risk of heart attack and higher rates of death from cardiovascular disease and cancer, as well as increased acute respiratory disease and measurable decrease in lung function. (Pitsavos, C.; Panagiotakos, D.B.; Chrysohoou, C.; Skoumas, J.; Tzioumis, K.; Stefanadis, C.; Toutouzas, P., "Association between exposure to environmental tobacco smoke and the development of acute coronary syndromes: the CARDIO2000 case-control study," Tobacco Control 11(3): 220-225, September 2002.)
What is second hand smoke?[i]
Cigarette smoke is a mix of more than 4,000 known chemical compounds. (National Cancer Institute. Risks Associated with Smoking Cigarettes with Low Machine-Measured Yields of Tar and Nicotine. Smoking and Tobacco Control Monograph No. 13. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub. No. 02-5074, October 2001).
Cigarette smoke is made up of “sidestream” smoke from the burning tip of the cigarette and “mainstream” smoke from the filter or mouth end. Tobacco smoke contains thousands of different chemicals that are released into the air as particles and gases. The particulate phase of cigarette smoke includes nicotine, "tar" (itself composed of many chemicals), benzene and benzo(a)pyrene. The gas phase includes carbon monoxide, ammonia, dimethylnitrosamine, formaldehyde, hydrogen cyanide and acrolein. According to a November 2001 report issued by the National Cancer Institute[ii], there are 69 known or probable carcinogens in cigarette smoke[iii]. The complete list of
What are the health risks associated with exposure to secondhand smoke?
· International Agency for Research on Cancer (June 2002) – According to the IARC, “involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans (Group 1).” [iv] Further, the IARC concluded that there is a “statistically significant and consistent association between lung cancer risk in spouses of smokers and exposure to secondhand tobacco smoke from the spouse who smokes. The excess risk is on the order of 20% for women and 30% for men.”
In addition, the IARC found that “epidemiological studies have demonstrated that exposure to secondhand tobacco smoke is causally associated with coronary heart disease” and they estimated that “involuntary smoking increases the risk of an acute coronary heart disease event by 25-35%.” Further, the IARC noted that, for adults, “the strongest evidence for a causal relation exists for chronic respiratory symptoms.”
· U.S. Environmental Protection Agency (1992) – In its groundbreaking report, the EPA concluded that, for adults, “ETS [environmental tobacco smoke] is a human lung carcinogen, responsible for approximately 3,000 lung cancer deaths annually in U.S. non-smokers” and the report found that secondhand smoke has a statistically significant effect on the respiratory health (e.g., reduced lung function) of non-smoking adults. [v]
· U.S. Surgeon General (1986) – In 1986, the Surgeon General concluded the following regarding exposure to secondhand smoke:
- “Involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers.
- Simple separation of smokers and nonsmokers within the same air space may reduce, but does not eliminate, exposure of nonsmokers to environmental tobacco smoke.”[vi]
· In December 2002, the U.S. Public Health Service's National Toxicology Program issued its 10th Report on Carcinogens, which unambiguously states, based on a thorough review of the available scientific and medical evidence, that:
“Environmental tobacco smoke (ETS) is known to be a human carcinogen based on sufficient evidence of carcinogenicity from studies in humans that indicate a causal relationship between passive exposure to tobacco smoke and human lung cancer (IARC 1986, EPA 1992, CEPA 1997). Studies also support an association of ETS with cancers of the nasal sinus (CEPA 1997). Evidence for an increased cancer risk from ETS stems from studies examining nonsmoking spouses living with individuals who smoke cigarettes, exposures of nonsmokers to ETS in occupational settings, and exposure to parents’ smoking during childhood. Many studies, including recent large population-based case control studies, have demonstrated increased risks of approximately 20% for developing lung cancer following prolonged exposure to ETS, with some studies suggesting higher risks with higher exposures. Exposure to ETS from spousal smoking or exposure in an occupational setting appears most strongly related to increased risk.”[viii]
· A July 2001 study in the Journal of the American Medical Association concluded that exposure to secondhand smoke “substantially reduced” coronary circulation in healthy non-smokers, providing “direct evidence” that exposure to secondhand smoke causes coronary circulatory dysfunction in non-smokers.[ix]
· A December 2001 study published in The Lancet found that exposure to secondhand smoke “increased the likelihood of experiencing [adverse] respiratory symptoms and was associated with increased [adverse] bronchial responsiveness.” Specifically, the study found that exposure to secondhand smoke was “significantly associated” with nighttime chest tightness and breathlessness after physical activity, and that exposure to secondhand smoke in the workplace was significantly associated with all types of respiratory symptoms and current asthma.[x]
· The Public Health Service's National Toxicology Program has listed secondhand smoke as a known carcinogen. (Environmental Health Information Service (EHIS), "Environmental tobacco smoke: first listed in the Ninth Report on Carcinogens," U.S. Department of Health and Human Services (DHHS), Public Health Service, National Toxicology Program, 2000.)
· The Americans With Disabilities Act, which requires that disabled persons have access to public places and workplaces, deems impaired respiratory function to be a disability. (Daynard, R.A., "Environmental tobacco smoke and the Americans with Disabilities Act," Nonsmokers' Voice 15(1): 8-9.)
[i] This section is largely based from a document prepared by Action on Smoking and Health/United Kingdom entitled, Fact Sheet No. 12, What’s In A Cigarette? (August 2001), http://www.ash.org.uk/html/factsheets/html/fact12.html.
[ii] Ibid.
[iii] Ibid.
[iv] International Agency for Research on Cancer, Volume 83: Tobacco Smoke and Involuntary Smoking Summary of Data Reported and Evaluation, June 2002, http://www.iarc.fr/.
[v] U.S. Environmental Protection Agency (EPA), Office of Research and Development & Office of Air and Radiation, Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders, EPA/600/6-90/006F, December 1992, http://www.epa.gov/nceawww1/ets/etsindex.htm.
[vi] The Health Consequences of Involuntary Smoking: A Report of the Surgeon General (1986), U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health, Rockville, MD 20857, http://www.cdc.gov/tobacco/sgr/sgr_1986/SGR1986-PrefaceAndForward.PDF.
[vii] American College of Occupational & Environmental Medicine, Epidemiological Basis for an Occupational and Environmental Policy on Environmental Tobacco Smoke, www.acoem.org/paprguid/papers/etspaper.htm, July 30, 2000.
[viii] National Toxicology Program, Public Health Service, U.S. Department of Health and Human Services (HHS), 10th Report on Carcinogens: Revised December 2002, December 2002, http://ehp.niehs.nih.gov/roc/tenth/profiles/s176toba.pdf.
[ix] Otsuka, Ryo, et al, “Acute Effects of Passive Smoking on the Coronary Circulation in Healthy Young Adults,” Journal of the American Medical Association 286(4), July 25, 2001.
[x] Janson, Christer, et al, “Effect of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey: a cross-sectional study,” The Lancet v.358, December 22/29, 2001.