By Alice Goodman

It’s a familiar scene to most Americans. The leggy blonde draws slowly on the lit cigarette before giving a come-hither look to whatever leading man sits across from her. Unfortunately, we now know the smoke that wafted across the room can do as much damage to his heart as she can.

Smoking, once synonymous with glamour and rebellion, now finds itself attached to words like addictive and deadly, and not only for those who actually inhale, but also for those in close proximity—the so-called passive smoker.
According to the American Society of Clinical Oncology (ASCO), secondhand smoke is the third leading cause of preventable death in the United States after alcohol use and active smoking. The U.S. Environmental Protection Agency says passive smoking causes 3,000 lung cancer deaths a year in nonsmokers.

In 1964, the U.S. Surgeon General’s report established that smoking was the major cause of lung cancer, which claims more lives each year than any other type of cancer. Within one year of that report, Congress passed legislation requiring health-risk warning labels on cigarette packages and banned cigarette advertising on television.

More recently has come the news that not only are smokers at greater risk of lung cancer and other health problems, but people who are exposed to secondhand smoke also have a greater risk of lung cancer, heart disease, respiratory ailments, and other health hazards. Over the past decade, overwhelming evidence has shown that exposure to secondhand smoke is a growing public health issue.

What is Secondhand Smoke?

The term “secondhand smoke” refers to a mixture of smoke given off by the burning end of a cigarette, pipe, or cigar, and the smoke exhaled from the lungs of smokers. This noxious combination contains at least 40 substances that are known carcinogens, many of which are strong irritants. Secondhand smoke is also known by other names, including environmental tobacco smoke, involuntary smoking, or passive smoking.

At greatest risk from secondhand smoke are children, the innocent bystanders in homes and other locations where smoking is allowed. According to Danny McGoldrick, director of research for the Campaign for Tobacco-Free Kids (www.tobaccofreekids.org), aside from causing respiratory illnesses, compromised lung function, buildup of fluid in the ears, and exacerbations of asthma, passive smoking can cause asthma in children who don’t already have the disease.

“Secondhand smoke causes illnesses in children,” says McGoldrick. “There is no doubt. It’s estimated that it causes over half a million physician visits for asthma and over a million for coughs. And a kid who isn’t well can have the condition exacerbated from secondhand smoke. The Environmental Protection Agency estimates that 150,000 to 300,000 children under the age of 18 months get bronchitis or pneumonia each year from breathing secondhand smoke.”

McGoldrick says the campaign focuses on a number of areas to reduce secondhand smoke, including encouraging smoking cessation, increasing taxes on cigarettes, and legislating for smoke-free environments.

“One of the best ways to keep kids from smoking is to keep adults from smoking, and we are discovering that smoke-free laws related to secondhand smoke get people to stop smoking, so not only do the secondhand smoke laws protect those who don’t want to be around it, they encourage those who do smoke to cut down or quit.”

More Confirmation

As more studies are conducted, the list of illnesses related to secondhand smoke grows. Recent evidence from the International Agency for Research on Cancer, an agency of the World Health Organization, suggests that persons exposed to secondhand smoke may be more likely to develop other types of cancer in addition to lung cancer, including cancers of the stomach, liver, cervix, kidney, and myeloid leukemia.

“Many studies provide strong evidence for the harmfulness of secondhand smoke,” says Paul A. Bunn, Jr., MD, president, ASCO, and director, University of Colorado Cancer Center, Denver.

The strongest association is between secondhand smoke and cardiovascular disease, including increased risk of heart attack, Dr. Bunn explains. There is also sufficient evidence that secondhand smoke damages the lungs.

“The risk of lung cancer is increased in those exposed to secondhand smoke, but the risk of cardiovascular disease is even higher,” says Dr. Bunn. “And exposure to secondhand smoke is particularly bad for people who have already had one smoking-related cancer and are at risk of another.”

To combat the rise in lung cancer cases and related fatalities, Dr. Bunn favors anti-smoking initiatives being considered by a number of cities and states to create smoke-free workplaces and restaurants.

The American Society of Clinical Oncology also released a report in May 2003 advocating tobacco control. The report states that secondhand smoke causes an estimated 53,000 deaths a year.

“Eliminating exposure to secondhand smoke will have the immediate benefit of reducing tobacco consumption, encouraging people to quit, and presenting more positive role modeling for children,” the report says.

“I know that smokers have rights, but do any of us have the right to give other people a disease?” Dr. Bunn asks.

State Initiatives

Lung cancer survivors, such as George Barbarosh, are among those most vulnerable to the dangers of secondhand smoke.

“Growing up, I considered secondhand smoke as part of the natural environment,” says the 62-year-old retired psychologist. “My father smoked cigars during the week and cigarettes on the weekend, so he wouldn’t get addicted to cigars. My older brother and my mother each smoked at least a pack of cigarettes a day. As a child, I didn’t have much reaction to cigarette smoke.”

But as an adult who has experienced two bouts of primary lung cancer, Barbarosh’s feelings have radically changed.

Aside from the increased risk of cancer, heart disease, and other health conditions, Barbarosh has a physical reaction to secondhand smoke. It makes his chest feel tight and compromises his ability to breathe. Barbarosh and his wife, Judi, a breast cancer survivor, both make every effort to avoid contact with secondhand smoke.

The couple divide their time between Key West, Florida, and Alamo, California—two places that, until last summer, reflected very different attitudes related to smoking and exposure to secondhand smoke. But on July 1, 2003, Florida’s Amendment 6 took effect, ending smoking in many public venues. Delaware, New York, Utah, South Dakota, Connecticut, and Maine have also passed statewide prohibitions on smoking in the workplace and/or restaurants and bars.

Barbarosh spends the other half of the year in California, the state with the best record for successful anti-smoking initiatives. California laws have created smoke-free restaurants and workplaces in an effort to spare citizens the harmful health-related effects of secondhand smoke.

“In California, we have spent well over $1 billion since 1988, and our efforts have resulted in the most dramatic declines in the consumption of cigarettes in the country,” says Dileep G. Bal, MD, chief of California’s Tobacco Control Section. “We took on the tobacco industry head on 14 years ago. At the same time, we initiated a campaign against secondhand smoke; and we have de-normalized smoking in the state of California better than any other state.”

A major step toward reducing exposure to secondhand smoke was achieved by the California Smoke-Free Workplace Law passed in 1995. Since then, there has been an exponential increase in the percentage of adults reporting smoke-free workplaces.

“One effect of this law is that changing access to smoking at the worksite has sensitized people who smoke to the dangers of smoking, so they also stop smoking at home,” says Dr. Bal. This extends protection to children and families of smokers.

A survey published in a recent issue of Tobacco Control found that by 2000, compliance with the California law had reached 99% in bars and restaurants.

Taxing Question

The 2003 legislative sessions found many states fighting record deficits, and many legislators cut tobacco control spending and increased tobacco taxes. As of July 2003, all 50 states have cigarette taxes. Virginia’s tax is the lowest at 2.5 cents and New York City comes in as the highest at $3 a pack when city and state taxes are combined.

In addition, more than 1,600 municipalities have adopted local laws that restrict smoking in some or all public locations, such as workplaces, restaurants, and bars, reaching an estimated 281 million Americans, according to statistics compiled by the American Nonsmokers’ Rights Foundation (www.no-smoke.org).

Additionally, the Centers for Disease Control recommends that states spend $5-$10 per person on tobacco control, yet 16 states spend less than $1 per person, says the nation’s 2003 annual report on cancer published in the Journal of the National Cancer Institute.

McGoldrick says increasing taxes is one of the best ways to reduce smoking among the most vulnerable populations: children, pregnant women, and lower income communities.

“We know that every [tax] increase of 10 percent reduces smoking by 7 percent,” he says.

Secondhand smoke is currently being studied with a report due from the U.S. Surgeon General in early 2005. No one doubts the results will confirm what is already known—secondhand smoke kills.