Holly, I have looked around the web, and found quite a lot of evidence that second-hand smoking is indeed quite harmful. The thing that strikes me most about your argument that I do not understand, is still what nefarious agency in your version of reality wants to simply control the populace and make us all miserable and take our freedoms away. Most of the studies I have now read were performed by well-respected doctors at major universities, the ones who see first hand the evidence of damage from second-hand smoking, and the studies I have read gather information in different ways from the much-aligned EPA study you have criticized. But I still don't understand why you think this is all about taking your freedoms away (if I understand you correctly).
On one of the web pages I visited, someone made the observation that you can discuss how the information was gathered, and exactly how many lives were lost due to second-hand smoking, but that the most important consideration is that ALL these deaths are preventable. That seems very important to me, and so I think this is an issue where we should maybe agree to disagree. In any event, here are some interesting things I found, some of which is a little repetitious, but which all strike me as significant:
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DANGER: SECOND-HAND
SMOKE
MAY 20, 1997
TRANSCRIPT
New research strongly suggests that second-hand cigarette smoke -- smoke inhaled as a result of
being in the presence of someone else's cigarette -- can cause heart disease. Dr. Ichiro Kawachi
of the Harvard School of Public Health discusses the findings with Charles Krause.
CHARLES KRAUSE: For years scientists published data showing a
direct link between cigarette smoking and heart disease. But does
second-hand cigarette smoke also cause heart disease. New research
published in today's issue of the journal Circulation strongly suggests
that it does. Here to tell us about the link between second-hand
smoke inhaled even by non-smokers and heart attacks is Dr. Ichiro
Kawachi of the Harvard School of Public Health, the lead author of
the new study published today.
Dr. Kawachi, welcome.
DR. ICHIRO KAWACHI, Harvard School
of Public Health: Good evening.
CHARLES KRAUSE: What are the
principal findings of your study?
DR. ICHIRO KAWACHI: We followed a
group of about 32,000 women over a period of 10 years to see
whether passive smoking might increase the risk of heart attack. And
basically we found that women who are regularly exposed in either the
work or the home are at about double the risk for heart attack
compared to those who are not exposed.
CHARLES KRAUSE: How did you find these women, and how did
you monitor them?
DR. ICHIRO KAWACHI: Basically, we took advantage of a
20-year-long ongoing study of women, and about halfway through the
study, we sent out a questionnaire asking them whether they were
exposed to passive smoking in the home and in the workplace, and
then we just sat and waited and saw what happened to them in terms
of their heart attack rates.
CHARLES KRAUSE: Now how do your
findings advance knowledge of the impact of
second-hand smoke?
DR. ICHIRO KAWACHI: Well, there have
been previous studies passing smoking and
heart attack, but there have been two criticisms leveled at studies that
have been done in the past. One is that they haven't asked about
exposure in the workplace, and the second is that most studies have
not adequately managed to take account of the whole range of other
things that might otherwise explain the association. And we were able
to address both of these weaknesses in our study.
CHARLES KRAUSE: For example, what other kinds of things might
affect heart attack?
DR. ICHIRO KAWACHI: Well, aside from exposure to passive
smoking, we asked about their diet, their fat intake, their exercise
levels, family history of heart attack, whether they had high blood
pressure or high cholesterol, their body weight and so on and so forth.
And after taking account of all of these differences and comparing like
woman with like, the only difference being that one group was exposed to passive smoking while the
other was not, we still found that women exposed to passive smoking were at about twice the risk of
heart attack.
CHARLES KRAUSE: Explain for us, if you would, the connection, or the
medical connection between this passive smoke and heart attacks.
DR. ICHIRO KAWACHI: It used to be said when I was in medical school
that if you can understand the effects of tobacco smoke on the
cardiovascular system, you pretty much understand the whole
cardiovascular system because the cocktail of chemicals, about 2,000
chemicals in tobacco smoke, initially does everything to the cardiovascular system. It directly damages
the lining of the lining of the arteries.
It reduces the capacity of the blood to carry oxygen to the tissues. It increases the stickiness of the
blood, and so on and so forth, so we're saying that virtually everything that we know active smoking
does to the circulatory system probably the same thing is happening to the bodies of people who inhale
second-hand smoke.
CHARLES KRAUSE: Does your study--did you have any way of determining how long one would
have to--how much second-hand smoke one would have to be exposed to, to have it be harmful to
you?
DR. ICHIRO KAWACHI: That's actually the one question that I think needs
to be looked at in more refined studies. We weren't able to precisely estimate
just how much of a dose and how long one would have to be exposed to in
order to get into increased--situations of increased risk, such as we observed.
I think it's safe to say that knowing what is in tobacco smoke, any exposure is
likely to constitute some measurable degree of risk. In other words, there are
no known stage thresholds of exposure for most of the chemicals that we know are harmful in tobacco
smoke.
CHARLES KRAUSE: Let me ask you a couple of questions about the methodology. Only women
were involved in your study. Would the impact of second-hand smoke apply to men as well?
DR. ICHIRO KAWACHI: We see no reason why it wouldn't. The risks of heart attack among active
smokers are pretty similar comparing men to women, and there have been previous studies that--of
passive smoking and heart attack that did include men. And although they weren't able to control it for
quite the range of things that we were able to, there's no reason to believe that the risks among men
would be any different.
CHARLES KRAUSE: Now, another question is, as I understand it, the
women involved in your study reported, in effect, on themselves, they
answered questionnaires every so often, is that correct?
DR. ICHIRO KAWACHI: Yes. In fact, they answered the question about
passive smoking at the beginning of the study in 1982, and their exposure
status was self-reported. In other words, we believed them when they said that
they were exposed to second-hand smoke. The thing that should be noted about that particular
designed feature is that both of these things are likely to underestimate the true association between
passive smoking and heart attack because since 1982, when the study began, Americans have been
becoming less and less exposed in general because of rising standards of restrictions of exposure in
workplaces. And that kind of things is, if anything, likely to underestimate the truth of smoking, passive
smoking.
CHARLES KRAUSE: But at the same time, if you only asked them once and if you relied on their
answers, I mean, isn't there the possibility that perhaps they were inaccurate or unreliable in some way
that could affect the outcome of your findings?
DR. ICHIRO KAWACHI: I think most studies in the past which have done very careful measurements
of saliva and urine to see whether people are really exposed when they said they were have found that
people, in fact, vastly underestimate the amount of exposure. In other words, people are much more
exposed to passive smoking than they think they are. And, again, that's a kind of a bias in the
conservative direction. In other words, if you studied people as being not
exposed when, in fact, they are, that's likely to result from the underestimate of
the true association between passive smoking and disease.
CHARLES KRAUSE: Now you were quoted in the New York Times today
as saying that if you extrapolated your findings, that as many as 50,000
Americans every year would have heart attacks because of second-hand smoke. How did you arrive at
that figure?
DR. ICHIRO KAWACHI: Actually, they weren't arrived at by us but by independent researchers
who published those estimates a couple of years ago. The surgeon general has estimated that
approximately 3,000 Americans die each year from passive smoking, causing lung cancer. And these
other researchers, Kyle Steinland and A.J. Wellslyn among them, have estimated that if the association
between passive smoking and heart attack is true, then up to 10 times as many Americans would die
from heart attack. That is about 30,000 Americans each year.
CHARLES KRAUSE: Well, Dr. Kawachi, we'll have to leave it there, but I thank you very much for
joining us. Thank you.
----------------------------------------------------------------------
Second-Hand Smoke Nearly Doubles Risk Of Heart Attack,
Death For Women
DALLAS -- May 21, 1997 -- Constant exposure to second-hand smoke -- in the workplace
or at home -- nearly doubles the risk of having a heart attack, a landmark study of more than
32,000 women suggests. Results of the research appear in yesterday's (May 20) American
Heart Association journal Circulation.
Boston scientists say their 10-year investigation involving female nurses found a higher level of
risk from passive smoking than has been seen before and provides the strongest evidence yet
that exposure to smoke in the workplace is as dangerous as exposure at home.
Healthy, non-smoking nurses who said they were regularly exposed to "passive" smoking by
their co-workers or home companions had a 91 percent higher relative risk of a heart attack or
death, compared to nurses who were not subjected to smoke, the researchers at Brigham and
Women's Hospital and Harvard Medical School report. For nurses who reported only
occasional exposure to smoking in work or home environments, heart disease risk was 58
percent greater.
"Those are larger risks than have been previously reported," says Ichiro Kawachi, M.D., the
study's lead author. He and his co-workers expressed surprise over the magnitude of passive
smoking-related heart disease risks that they found. In one major study published in Circulation
last August, non-smoking spouses of smokers had about 20 percent higher heart disease death
rates than non-smokers living with spouses who did not smoke.
Because heart disease is such a pervasive health problem, Kawachi asserts, the results of the
nurses' study have major public policy implications for the nation.
The Environmental Protection Agency estimates that about 3,000 lung cancer deaths occur each
year in the United States due to passive smoking, Kawachi points out. "Only a few cases of lung
cancer occur among non-smokers," he says.
"So if passive smoking causes heart disease, as our study suggests, then something like 10 to 20
times that number of deaths could occur from heart attack and passive smoking." That would
translate into between 30,000 and 60,000 deaths annually in the United States, he calculates.
"Because heart disease is much more common [than lung cancer], even a small exposure to a
relative risk can give rise to many more cases," he says.
The finding of high risk associated with workplace smoke is a very important one, Kawachi
emphasizes. "It's much harder to reduce smoking exposure at home, which can only be done
through education. But we can always have smoke-free building policies. It's exciting to be able
to show that workplace exposure makes a difference."
The EPA and other agencies have been reluctant to conclude that passive smoking is a cause of
heart attacks, mainly because of a lack of conclusive studies and "lingering concerns that those
studies that have been done have not been controlled adequately for other lifestyle factors that
might explain an increased risk," says Kawachi, assistant professor at the Channing Laboratory
at Brigham and Women's Hospital and the Harvard School of Public Health.
"But our study addressed those issues," he says. During the long follow-up of the Nurses Health
Study participants, the scientists adjusted for "a broad range of risk factors" including high blood
cholesterol and blood pressure, diet, exercise, diabetes and other conditions that could influence
outcome. Although the women exposed to passive smoke did tend to be less healthy than those
who weren't exposed, the adjustments for those potentially confounding factors resulted in only
a "modest" reduction in smoking-related risk levels, the authors report.
When the study began in 1982, the nurses, who were age 36 to 61, gave information via
questionnaires about the extent of their exposure to smoke at work and at home, including the
number of years they had lived with a smoker. Of the 25,959 women who said they were
exposed to passive smoking, 59 percent had occasional exposure at home or work, while 41
percent had regular exposure.
The researchers then carefully monitored the health of the women at two-year intervals. At the
end of the study in 1992, there had been 152 cases of heart disease including 127 non-fatal and
25 fatal heart attacks among the 32,046 participants. Data on the number of cases were
correlated with the information on smoke exposure to calculate levels of relative risk, i.e., the
extra risk conferred by exposure to smoke compared to the heart disease risk experienced by
those who were not so exposed.
The authors acknowledge limitations of their study, including the fact that exposure to passive
smoking was assessed by self-report and only once, at the study's outset. But Kawachi says
that with society's changes in the past decade, including more restrictive smoking rules in offices
and public places, along with smoking cessation efforts, one would have expected to find a
lower, not higher, trend of heart disease risk due to passive smoking. No such "downward drift"
was seen, he says. Thus the study's authors conclude:
"That regular exposure to passive smoking at home or work increases the risk of coronary heart
disease among non-smoking women. The consistency of these findings with the existing totality
of evidence increases the belief that the observed association represents cause and effect."
Other co-authors of the study with Kawachi are: Graham A. Colditz, M.D.; Frank E. Speizer,
M.D.; JoAnn E. Manson, M.D.; Meir J. Stampfer, M.D.; Walter C. Willett, M.D.; and Charles
H. Hennekens, M.D.
Circulation is one of five journals published in Dallas by the American Heart Association.
----------------------------------------------------------------------
STATEMENT BY CALIFORNIA MEDICAL
ASSOCIATION REGARDING NEW BAN ON SMOKING
In Bars
SAN FRANCISCO, Dec. 31 /PRNewswire/ -- With the coming New Year, California once again takes a
bold step forward, becoming the first state to ban smoking in bars. As sponsor of the 1994 legislation
calling for the ban, the California Medical Association strongly supports state implementation of this
controversial but public health-enhancing law.
"California has always been a trend-setter in social policy," said Jack C. Lewin, M.D., CEO and
Executive Vice President of California Medical Association. "With implementation of the toughest
anti-smoking laws in the nation -- and the world for that matter -- our state once again leads the
way. California Medical Association is proud to have played a key role in the passage of this important
legislation. We now look forward to the successful implementation of a complete ban on smoking in
bars."
Thanks to broad public support and a coalition of anti-smoking groups, employees and non-smoking
customers of California bars, taverns and gaming clubs will no longer be exposed to deadly
second-hand smoke. Bar employees are regularly exposed to 20 times as much secondhand smoke as
someone living in a home with a smoker and suffer from more lung and heart disease than those in any
other occupation. The Environmental Protection Agency has classified second-hand smoke as a
Group-A carcinogen and workplace health hazard.
California physicians have worked for decades to educate their patients about the dangers of tobacco
use and to promote anti-tobacco legislation. In recent years, California Medical Association and its
allies in the fight against second-hand smoke have turned back repeated attempts by the tobacco
industry to delay implementation of the smoking ban in bars.
"Successful implementation of this ban will send an important signal to the rest of the nation that the
ground swell of public opposition to smoking cannot be stopped -- no matter how much money the
tobacco industry spends," said Dr. Lewin. "The physician members of California Medical Association call
on every citizen of the state to support the new ban. Your health, that of the person sitting next to
you, and of the person serving you, depend on it."
The California Medical Association represents California physicians from all regions, modes of practice
and medical specialties. With 35, 000 members, CMA is the nation's largest state medical association
and is dedicated to the health of all Californians.
SOURCE California Medical Association
----------------------------------------------------------------------
HOW PASSIVE SMOKING CAUSES HEART DISEASE
by Sean Henahan, Access Excellence
SAN FRANCISCO- Recent studies provide a better understanding of the mechanisms by which second hand
tobacco smoke contributes to the development of heart disease, report researchers from UC San Francisco.
Two noted cardiology researchers, Dr. Stanton Glantz and Dr. William Parmley, have done a considerable amount
of research on the effects of secondhand tobacco smoke on the heart. The two collaborated on a research project
combining their own data with that from other researchers around the world, in an effort to consolidate what is
known about the pathogenic mechanisms of tobacco smoke.
The current data demonstrate that the ill effects of secondhand smoke result from many components of tobacco
smoke. These include carbon monoxide, nicotine, polycyclic aromatic hydrocarbons and others.
The carbon monoxide produced by passive smoking competes with oxygen for binding sites on red blood cells. This
reduces the blood's ability to deliver oxygen to the heart and compromises the heart muscle's ability to use oxygen to
create adenosine triphosphate. The carbon monoxide also increases the amount of lactate in venous blood.
As a result of these effects, people exposed to second hand smoke show a reduced exercise capability. For
example, studies show that people with existing heart disease cannot exercise as hard or as long when exposed to
secondhand smoke. These people are also more likely to develop arrhythmias (irregular heart beats) when exposed
to secondhand smoke. Related studies have shown that people with no signs of heart disease take as long as those
with heart disease to return to their resting heart rate following exercise when exposed to secondhand smoke.
Several studies have shown that children of smoking parents have increased levels of 2,3-diphosphoglycerate. This
enzyme increases the disassociation of oxygen from hemoglobin in red blood cells in an attempt to counterbalance
chronic oxygen deprivation.
Second hand smoke, also called sidestream smoke or environmental tobacco smoke, also increases platelet activity,
accelerates atherosclerotic lesions, and increases tissue damage following ischemia (insufficient oxygen delivery to the
heart or brain) or myocardial infarction (heart attack). Increases in platelet activity are associated with formation of
blood clots and atherosclerosis (hardening of the arteries), both of which are factors predisposing for a heart attack.
There is now a considerable amount of data indicating that second hand smoke has different effects on smokers and
non-smokers, the researchers note. The hearts of chronic smokers make certain adaptations to compensate for the
negative effects of smoking, whereas nonsmokers do not show this 'advantage'.
"The practice-- often advocated by the tobacco industry and its scientific consultants when considering second hand
smoke-- of thinking about cigarette equivalents of simple dose-based extrapolations from smokers to non-smokers
will lead to gross underestimations of the risks of passive smoking to the cardiovascular system... Leaving aside the
philosophical considerations of whether anyone ought to be required to breathe even one cigarette per day under any
circumstances, the environmental tobacco smoke experienceed by many people in their daily lives is enough to
produce substantial adverse effects on the cardiovascular system," note Parmley and Glantz.
The researchers conclude that second hand smoke is the third leading cause of preventable death, after active
smoking and alcohol. They estimate that passive smoking causes as many as 60,000 fatal heart attacks per year and
three times as many non-fatal heart attacks.
Passive smoking should be considered on a par with public health problems such as AIDS and illegal drug use, with
major efforts expended to protect workers, children and the general public, they note, adding that the simplest and
least expensive way to accomplish this is to mandate smoke-free workplaces, schools and public places.
***
For complete details on this study, see Glantz et al., JAMA, , 4/5/95, V.273, No.13, pp.1047-1053.
Transmitted: 95-04-08 11:57:50 EDT
Related information at other Web sites:
Smoking, Tobacco and Cancer at Oncolink
The Franklin Institute's Virtual Heart
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