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Clearing the Air

The Impact of EPA's Landmark Health Assessment on "Passive Smoking"

burning cigarette

A recent segment on the daytime talk show "Ellen" featured a comical look back at old advertisements. One example to flash across the television revealed a confident looking doctor leaning back in his chair with a freshly lit cigarette in his hand. The studio audience roared with laughter as the host read aloud the screaming headline below the image: "According to a Recent Nationwide Survey: More Doctors Smoke Camels than Any Other Cigarette."

A quick internet search of vintage smoking ads reveals a host of such claims. In addition to smiling babies, Ronald Reagan, and Santa Claus, science and statistics were common themes enlisted to help consumers choose one brand of smokes over another.

Of course, it wasn't until real science began to investigate the health effects of smoking that the smartest choice—not to smoke at all—was revealed.

This year marks the 20th anniversary of a landmark EPA health assessment, Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders, that put much of that science into perspective. The assessment concluded that tobacco smoke not only presented risks to the health of smokers but also to those around them: "Based on the weight of available scientific evidence, the U.S. Environmental Protection Agency (EPA) has concluded that widespread exposure to environmental tobacco smoke (ETS) in the United States presents a serious and substantial public health impact."

The science behind the assessment provided the basis and support to health officials and others as they moved to protect people from tobacco smoke in public places. The impacts have been far-reaching, leading to healthier air, particularly indoors, for millions of people.

"EPA's study was a major catalyst for taking action to protect everyone, especially kids, from tobacco smoke. The impact has been healthier kids, healthier parents, healthier workers, and an awareness that the science is clear: if you smoke around kids and other non-smokers, you threaten and endanger their health," says Matthew L. Myers, President of the Campaign for Tobacco Free Kids.

To develop the health assessment, EPA critically reviewed a wealth of existing data from previous studies exploring the potential health effects of what is called "environmental tobacco smoke," or the secondhand smoke that nonsmokers were exposed to by sharing space with those who smoked.

The bulk of that work began to come to light in 1986, when the National Research Council (NRC) and the Surgeon General of the U.S. Public Health Service released independent studies on the health effects of exposure to secondhand smoke. Both reports concluded that exposure to secondhand smoke can cause lung cancer in adult nonsmokers and can lead to increased frequency of respiratory problems, including infections and reduced lung function.

The reports sparked interest by EPA officials, including those looking at studies to better understand questions about air pollution, particularly indoors. Because people spend some 90 percent of their time indoors, exposure to air pollutants inside buildings is significantly higher than it is outdoors. Agency scientists and engineers work to advance the understanding of indoor air quality and to find ways to reduce people's exposure to air pollutants in offices, homes, schools, and other places where people work and play. EPA decided to conduct its own health assessment on secondhand smoke largely because of broad concerns about indoor air quality.

A wealth of additional studies by different independent organizations followed the release of the reports by NRC and the Surgeon General, more than doubling the size of the database EPA researchers were able to consider when they conducted their own health assessment. For that work, Agency scientists critically reviewed the existing database on the respiratory health effects of passive smoking (e.g. inhaling secondhand smoke) to develop a hazard assessment and make quantitative estimates of the public health impacts for lung cancer and various other respiratory diseases.

EPA researchers based their conclusions on an analysis of all the available data at the time, including more than 30 human epidemiological studies looking specifically at passive smoking as well as information on active or direct smoking. In addition, they considered animal data, biological measurements of human uptake of tobacco smoke components, and other available data.

In the end, the assessment concluded that secondhand smoke is a human carcinogen, responsible for 3,000 lung cancer deaths annually in the U.S. The assessment also concluded that infants and young children were especially sensitive to secondhand smoke exposure. Secondhand smoke exposure to infants and young children led to increased risk of respiratory infections such as bronchitis and pneumonia, lower lung function, and additional episodes and increased severity of symptoms in children with asthma.

The EPA study provided the science needed for Agency officials and others across the nation to conclude that secondhand smoke is a preventable health risk.

Even after 20 years, the impact of this work can be seen, and felt, every time a child or an adult is protected from secondhand tobacco smoke. Thousands of lives have been saved, millions of children are healthier, and people across the country, and even in other countries, enjoy smoke-free workplaces and homes.

"The impact of EPA's landmark study can't be underestimated. It provided the science that sparked a revolution in how people view the hazards of secondhand smoke, which has led to smoke-free policies across this country and around the world. Millions of people are protected and ultimately millions of lives will be saved," says Albert A. Rizzo MD, Chair of the American Lung Association Board of Directors.

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