Perspectives in Disease Prevention and Health Promotion
1986 Surgeon General's Report: The Health Consequences of
Involuntary Smoking
Inhalation of tobacco smoke during active cigarette smoking
remains the largest single preventable cause of death and
disability
in the United States. The health consequences of cigarette smoking
and of the use of other tobacco products have been extensively
documented in the 18 previous Surgeon General's reports issued by
the
Public Health Service. More than 300,000 premature deaths that are
directly attributable to tobacco use--particularly cigarette
smoking--occur each year in the United States. The magnitude of
the
disease risk for active smokers, secondary to their high dose
exposure
to tobacco smoke, suggests that the lower doses of smoke received
by
involuntary smokers also puts them at risk. The 1986 Surgeon
General's Report explores the health consequences incurred by
involuntary smokers. It was developed by the Office on Smoking and
Health, Center for Health Promotion and Education, Centers for
Disease
Control (CDC) as part of the U. S. Department of Health and Human
Services' responsibility under Public Law 91-222 to report new and
current information on smoking and health to the U. S. Congress.
Data in the 1986 report present evidence that the chemical
composition of sidestream smoke (smoke emitted into the environment
by
a smoker between puffs) is qualitatively similar to the mainstream
smoke inhaled by the smoker and that both mainstream and sidestream
smoke act as carcinogens in bioassay systems (1). Data on the
environmental levels of the components of tobacco smoke and on
nicotine absorption in nonsmokers suggest that nonsmokers are
exposed
to levels of environmental tobacco smoke (ETS) that would be
expected
to generate a lung cancer risk. In addition, epidemiological
studies
of populations exposed to ETS have documented an increased risk for
lung cancer in those nonsmokers with increased exposure. Of the 13
epidemiological studies that were available for review in the
scientific literature, 11 reported a positive relationship and six
of
these observed statistically significant results. It is rare to
have
such detailed exposure data or human epidemiologic studies on
disease
occurrence when attempting to evaluate the risk of low-dose
exposure
to an agent with established toxicity at higher levels of exposure.
The relative abundance of data reviewed in the report, their
cohesiveness, and their biologic plausibility allow a judgment that
involuntary smoking can cause lung cancer in nonsmokers.
The 1986 Surgeon General's Report comes to three major
conclusions:
Involuntary smoking is a cause of disease, including lung
cancer, in healthy nonsmokers.
Compared with children of nonsmoking parents, children
whose
parents smoke have an increased frequency of respiratory
symptoms and infections. They also have slightly smaller
rates of increase in lung function as the lung matures.
Simple separation of smokers and nonsmokers within the
same
air space may reduce, but does not eliminate, ETS
exposure.
The report also reviews policies restricting smoking in public
places and the workplace and states that, in the 1970s, an
increasing
number of public and private sector institutions began adopting
policies to protect individuals from ETS exposure by restricting
the
circumstances in which smoking is permitted. Local governments
have
been enacting smoking ordinances at an increasing rate since 1980.
Restrictions on smoking at the workplace have resulted from both
governmental action and private initiative, and an increase in
workplace smoking policies has been a trend of the 1980s. Laws
restricting smoking in public places have been implemented with few
problems and at little cost to state and local governments. Public
opinion polls document strong and growing support for restricting
or
banning smoking in a wide range of public places.
The Surgeon General, in his preface to the report, states,
"Cigarette smoking is an addictive behavior, and the individual
smoker
must decide whether or not to continue that behavior; however, it
is
evident from the data presented in this volume that the choice to
smoke cannot interfere with the nonsmokers' right to breathe air
free
of tobacco smoke."
Reported by Office on Smoking and Health, Center for Health
Promotion
and Education, CDC.
Editorial Note
Editorial Note: A review recently published by the National Academy
of
Sciences states that approximately 20% of the estimated 12,200 lung
cancer deaths occurring annually in nonsmokers are attributable to
environmental tobacco smoke (2). This estimate falls close to the
mid-point of the range published by Repace and Lowery, who state
that
between 500 and 5,000 lung cancer deaths may occur annually as a
result of nonsmokers' exposure to tobacco smoke (3). By
comparison,
figures published in the Journal of the Air Pollution Control
Association estimate that between 1,300 and 1,700 total cases of
cancer resulting from other air pollutants in the general
environment
occur each year in the United States (4). Thus, while the number
of
lung cancer deaths that may be related to ETS exposure is small
compared with those caused by active smoking, the actual number of
lung cancer deaths caused annually by involuntary smoking is large.
In addition, ETS causes more cases of cancer annually than many
other
agents in the general environment that are regulated because of
their
potential to cause disease.
References
Office on Smoking and Health. The health consequences of
involuntary smoking: a report of the Surgeon General.
Rockville,
Maryland: Public Health Service, 1986.
National Research Council, National Academy of Sciences.
Environmental tobacco smoke: measuring exposures and assessing
health effects. Washington, DC: National Academy Press, 1986.
Repace JL, Lowrey AH. A quantitative estimate of nonsmokers'
lung
cancer risk from passive smoking. Environ Int 1985;11:3-22.
Thomson VE, Jones A, Haemisegger E, Steigerwald B. The air
toxics
problem in the United States: an analysis of cancer risks
posed
by selected air pollutants. J Air Pollut Control Assoc
1985;35(5):535-40.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
