TESTIMONY OF CAROL M. BROWNER
April 1, 1998
CAROL M. BROWNER
U.S. ENVIRONMENTAL PROTECTION AGENCY
COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS
UNITED STATES SENATE
April 1, 1998
Good morning, Mr. Chairman and Members of the Committee. I am very pleased to be here today to present testimony on one of the most important issues EPA deals with, the very serious health risk posed by the widespread and completely preventable exposure of our children and other members of the public to secondhand tobacco smoke.
As you know Mr. Chairman, in January 1993, the Environmental Protection Agency (EPA) published a landmark report on the respiratory health risks of passive smoking, entitled Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. This report was issued under the authority of The Radon Gas and Indoor Air Quality Research Act of 1986, which directs EPA to conduct research and disseminate information on all aspects of indoor air quality. The report summarized the findings of the Agency's extensive investigation of the respiratory health risks from exposure to environmental tobacco smoke (ETS). It incorporated comments and recommendations from the public as well as two reviews by EPA's Science Advisory Board (SAB), a panel of independent scientific experts in this field. The Science Advisory Board unanimously endorsed both the conclusions of the report and the methodologies employed. The Department of Health and Human Services (HHS) has endorsed the report and the National Cancer Institute within HHS has printed it as one of their series of scientific monographs.. Based on the total weight of the available scientific evidence, EPA concluded that the widespread exposure to secondhand smoke in the United States presents a serious and substantial public health risk. I'd like to briefly summarize the findings of the report.
One of the most significant conclusions of the report -- and certainly the one that has received the most attention -- is the finding that secondhand smoke is a human lung carcinogen, classified as a "Group A" carcinogen under EPA's carcinogen assessment guidance. This classification is reserved for those compounds or mixtures that have the strongest evidence of a cause-and-effect relationship in humans. In the case of secondhand smoke, unlike any other compound the Agency has ever evaluated, we are able to see a consistent increase in lung cancer risk at actual environmental levels, rather than having to extrapolate downward from very high occupational exposures as we have had to do for such other Group A carcinogens as asbestos and benzene. In attempting to quantify the extent of the lung cancer risk, the report estimated that secondhand smoke may be responsible for approximately 3,000 lung cancer deaths annually in non-smokers in the United States. Of these 3,000, the report estimated that approximately 2,200 are attributable to exposure outside the home.
ETS also has other effects on the respiratory health of adult non-smokers. These include coughing, phlegm production, chest discomfort, and reduced lung function.
The finding that secondhand smoke is capable of causing lung cancer in healthy adults has received the most public attention and is of great concern from a public health standpoint. However, the very serious respiratory effects on young children that are documented in our report are also of great personal concern to me. The report found that young children are particularly sensitive to the effects of secondhand smoke.
Infants and young children who are exposed to secondhand smoke are at increased risk of lower respiratory tract infections such as pneumonia and bronchitis. EPA estimated that each year between 150,000 and 300,000 cases of lower respiratory tract infections are associated with exposure of children to secondhand smoke, resulting in between 7,500 and 15,000 hospitalizations.
Asthmatic children are especially at risk. EPA estimated that exposure to secondhand smoke increases the number of episodes and the severity of symptoms for between 200,000 and one million asthmatic children. In addition, passive smoking may increase the risk of developing asthma for otherwise healthy children.
Children who have been regularly exposed to secondhand smoke are also more likely to have reduced lung function and symptoms of respiratory irritation such as cough, excess phlegm, and wheezing. Passive smoking can lead to a buildup of fluid in the middle ear, the most common cause of hospitalization of children for an operation.
As you are probably aware, immediately following publication of our report in 1993, the tobacco industry filed a lawsuit challenging both our authority to conduct the risk assessment as well as some of the scientific findings of the report. While this lawsuit is still not resolved -- and we fully expect the court to find for the government on every pending procedural and substantive issue -- I think it is particularly telling to note that not one aspect of the report's findings with respect to the serious risks to children was even challenged by the tobacco industry in its lawsuit. In fact, in a full page advertisement in major newspapers across the country, one of the major tobacco companies directly acknowledged that young children should not be exposed to secondhand smoke.
Since publication of our report in early 1993, the evidence that secondhand smoke presents a very serious and completely preventable risk to our Nation's children has grown even stronger. A number of studies have strengthened the evidence associating secondhand smoke exposure to Sudden Infant Death Syndrome and the onset of asthma in young children. There is also evidence suggesting that passive smoking by mothers during pregnancy increases the risk of reduced birth weight in infants.
Because of the health implications of exposure to secondhand smoke documented in our report, EPA recommends a number of actions to prevent involuntary public exposure to secondhand smoke in indoor environments. These recommendations are intended to help parents, decision-makers, and building occupants take steps to protect non-smokers from exposure to secondhand smoke and are outlined in the brochure, What You Can Do About Secondhand Smoke. EPA's primary recommendations are that:
- Residents not smoke in their home or permit others to do so.
- Every organization dealing with children -- schools, day care facilities, and other places where children spend time -- have a smoking policy that effectively protects children from exposure to environmental tobacco smoke.
- In the workplace, EPA recommends that every company have a smoking policy that effectively protects non-smokers from involuntary exposure to tobacco smoke either through complete bans or limiting smoking to rooms that have been specially designed to prevent smoke from escaping to other areas of the building.
- Employer-supported smoking cessation programs should be a part of any smoking policy.
- If smoking is permitted in a restaurant or bar, placement of smoking areas should be determined with some knowledge of the ventilation characteristics of the space, to minimize non-smoker exposure.
As you are no doubt aware, many Federal agencies, State and local governments and private sector organizations began to implement some form of indoor smoking restrictions as a result of the reports issued in 1986 by the U.S. Surgeon General and the National Research Council of the National Academy of Sciences. In the years since publication of the EPA report, however, we have seen a rapid acceleration of measures to protect non-smokers in a variety of settings, including workplaces, restaurants, sports facilities, health and day-care facilities, shopping centers, and a wide range of other public facilities. Hundreds of state and local ordinances have been passed or introduced in virtually every area of the country since 1991. The National Cancer Institute estimates that as of 1993, 46% of all workers reported that their place of employment had a smoke-free workplace policy, while 81.6% indicated that their workplace was covered by some type of formal smoking policy. In contrast, only 3% of workers were covered by such policies in 1986. In August 1997, the President issued an Executive Order directing that employees and visitors at Federal buildings not be exposed to secondhand smoke.
Despite this encouraging trend, there are many places where involuntary exposure to secondhand smoke still occurs and much work remains to be done. Of greatest concern to EPA is the continued exposure of children to secondhand smoke, particularly in the home. A Centers for Disease Control and Prevention (CDC) study of children's exposure to secondhand smoke -- the first such national study -- found that in 1991, 31.2% of children were exposed to cigarette smoke daily in the home. The study found wide regional, income and education differences. For example, 48% of children in homes of low income and education levels were exposed vs. 25% in higher level homes. Regionally, almost 40% of children in the Midwest were exposed to ETS in their homes, vs. 24% of children in California. The study also estimated that children exposed to secondhand smoke daily in the home have 18 million more days of restricted activity, 10 million more days of bed confinement, and miss 7 million more school days than other children. An EPA-funded survey found that approximately 27% of children were exposed to secondhand smoke in the home in 1994, indicating that some progress has been made.
As part of EPA's comprehensive program to address risks associated with indoor air pollution, EPA has established an objective -- consistent with the Department of Health and Human Services Healthy People 2000 goal on the same issue -- of reducing to 15% the number of children regularly exposed to secondhand smoke in the home by the year 2005. While it is our goal over the long term to eliminate our children's exposure to secondhand smoke, we are establishing achievable milestones that will move us closer to our long term goal.
Achieving this objective will be a significant challenge. After years of consistent reductions in the percentage of adults that smoke, the percentage of the population that smokes nationwide has leveled off at about 25% of the adult population. As a result, reducing the number of children exposed to secondhand smoke in the home will require us to continue to strive to find effective ways of reaching and educating those adults who do continue to smoke about the detrimental effects secondhand smoke has on their young children.
Of course, while the home may be where children are most exposed to secondhand smoke, there are many other environments in which children spend time -- such as day care facilities, schools, and restaurants -- that we also cannot ignore.
EPA's strategy is based on development of a broad network of partners and programs designed to help educate parents about the importance of protecting their children's health by keeping their air free of tobacco smoke. EPA coordinates closely with CDC's Office on Smoking and Health on their public information efforts, and we are working with a wide range of State and local government agencies and non-governmental organizations to educate the public about the hazards of secondhand smoke.
EPA is working with the American Academy of Pediatrics (AAP) to develop and promote materials for use by children's health care providers -- and particularly pediatricians -- in delivering health messages to parents about the risks of secondhand smoke to their children. The relationship between the pediatrician and the parent is an extremely rich opportunity for education and motivation on crucial environmental health issues. EPA has begun a pilot program, working with the Pennsylvania Chapter of AAP and the National Resource Center for Health and Safety in Child Care, in an effort to enlist day care centers in the effort to protect children from secondhand smoke during day care, as well as to help reach parents at home with this important message. This program consists of a comprehensive continuing education module for day care operators that includes both education and outreach tools as well as requiring a commitment that the day care operator ensure a smoke free day care environment.
EPA, in collaboration with the Consumer Research Council and the American Medical Association, is also developing a media campaign to develop and distribute public service announcements that will directly reach parents with the message that secondhand smoke is a preventable risk to their children's health and one that they can do something about, even if they don't quit smoking themselves.
EPA is also developing targeted information on secondhand smoke to specific sub-populations where there are significantly higher risks, such as those in households with lower education and income levels.
EPA is also participating in international efforts to address secondhand smoke. In preparation for last year's Denver Summit of the eight major industrialized democracies, I had the honor of hosting a meeting of the Environment Ministers of the Eight that focused on children's environmental health. At that meeting, the Ministers representing the Eight adopted a Declaration on children's environmental health and forwarded it to Denver for consideration by the Leaders at the Summit.
The Environment Ministers called for domestic, bilateral and international efforts to improve the protection of children's health from environmental threats, and specified concrete actions that the Eight will undertake to better protect children from environmental hazards. At the Denver Summit of the Eight, leaders committed their governments to explicitly incorporate children's health issues into environmental risk assessments and standard setting and to work together to strengthen information exchange, provide for microbiologically safe drinking water, and to reduce children's exposure to lead, environmental tobacco smoke, and other air pollutants. While all of the Eight have set standards that protect environmental health generally, recent scientific advances demonstrate that more specific actions must be taken to better address the unique environmental health risks to children. We should explore and investigate potential links between children's health and the environment.
The specific goal regarding ETS is to convene a scientific conference, through the World Health Organization (WHO) or another appropriate scientific organization, to synthesize and share the latest scientific information on risks to infants and children from environmental tobacco smoke and compile information on the most effective educational strategies concerning exposures to children. Planning for this conference is underway with WHO and CDC and we hope to hold it this year.
And the dividend for the rest of society is that by protecting those who are among the most vulnerable in our society -- by ensuring that our kids are safe, by putting them first -- we protect everyone. EPA has a unique role to play in the Federal community in helping to educate the public about the serious health risks of secondhand smoke.
We must continually strive to find the most compelling messages and the most credible sources for those messages, and continue to develop partnerships with all organizations that are concerned with children's health issues. We have only begun to get the message out and much remains to be done.
As society as a whole and the Congress in particular continues to debate the details of tobacco control, I am heartened by the fact that a consensus has emerged around the need to effectively discourage children from developing the smoking habit. Surely, if we can agree that children and teenagers should not smoke, we can also agree that they should also not be exposed to secondhand smoke. We clearly recognize the importance of public health education for preventing teenage smoking and encouraging smoking cessation. This in turn will prevent significant childhood exposure to secondhand smoke.
Thank you for the opportunity to testify before you today. I look forward to working with you, Mr. Chairman, to craft sensible legislation that puts our children's health first. I will be happy to answer any questions that you might have.