Oh, Alex, surely you can tell when I'm kidding, can't you? I am really not in favor of mandatory laws forcing addicts to work in bars so that the patrons can continue to smoke. But I had in mind mandatory VOLUNTARY labor, or minimum wage at the most, just so that their society of addicts could be maintained with minimal loss of personal freedoms by the rest of us. My point was that in all fairness, it would be easier to continue to maintain the law against smoking in bars, so that at least a socioeconomically disadvantaged group with few options would not be so likely to die of smoking related diseases.
This flu I have is weird, incidentally. It started like a cold, got much worse, and then just as the respiratory/congestive effects were beginning to wane, has turned into a very upset stomach, not vomiting but an upset/burning kind of sensation. Is that anything like what you have had? I'm quite puzzled.
I think it is important to remind everyone occasionally just how dangerous second hand smoking really is:
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.
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