The Alliance of Boulder County
on Tobacco and Health

National Cancer Institute

November 22, 1999

Environmental Tobacco Smoke Linked to Lung Cancer and Other Health Effects

The National Cancer Institute (NCI) announced today the availability of the most comprehensive report on the health risks of secondhand smoke ever conducted. The monograph, "Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency," links secondhand smoke, also called environmental tobacco smoke (ETS), not only with lung cancer, but with heart disease, sudden infant death syndrome (SIDS), nasal sinus cancer, and a host of other diseases in both adults and children.

In a preface to the 430-page report, U.S. Surgeon General and Assistant Secretary for Health, David Satcher, M.D., Ph.D., said that the public health burden caused by ETS "more than justifies public policies creating smokefree workplaces and public areas."

After reviewing the monograph, Carol Browner, administrator for the U.S. Environmental Protection Agency, said that "Today's report confirms what most Americans already know - cigarettes not only pose grave health risks to the smoker, they also threaten the health of anyone who is even near a lighted cigarette, especially children."

Previous reports issued by the U.S. Surgeon General in 1986 and the U.S. Environmental Protection Agency in 1992 concluded ETS caused lung cancer, but that too few studies were available to assess its relationship to heart disease. In contrast, the new report compiled by the California Environmental Protection Agency (Cal/EPA) includes 18 epidemiological studies linking ETS to coronary heart disease.

"The weight of the scientific evidence is now more than sufficient to conclude that the relationship between environmental tobacco smoke and heart disease is real," according to Satcher.

Adding to the impact of the Surgeon General's comments, Donald Shopland, coordinator of NCI's Smoking and Tobacco Control Program, notes that the Cal/EPA report estimates that each year in the United States between 35,000 and 62,000 coronary heart disease deaths occur due to ETS exposure. "ETS exposures are related to much more than heart disease. When the thousands of ETS-related lung cancers and other diseases are considered, ETS clearly is a major cause of death in the United States," said Shopland.

Because of the new findings, Satcher said, "I call on everyone committed to public health to join me in a renewed effort to complete the creation of a smokefree society."

Environmental tobacco smoke is a complex mixture formed during burning from lighted cigarettes, pipes, and cigars. Thousands of chemicals are found in the ETS mixture including hydrogen cyanide, carbon monoxide, and dozens of compounds that are known carcinogens, tumor promoters, or tumor initiators. Many of these chemicals have been identified as hazardous and are regulated by various federal or state agencies.

Perhaps some of the most troubling findings in the new report are those related to increased morbidity and mortality in children due to their ETS exposure. The Cal/EPA report documents that secondhand smoke is now associated with SIDS, middle ear infections, asthma, bronchitis, and pneumonia.

Numerous studies clearly demonstrated an increased risk of SIDS in infants of mothers who smoke during pregnancy. Some epidemiologic studies now have determined that postnatal ETS exposure may be an independent risk factor for SIDS.

"The report confirms the U.S. Environmental Protection Agency's position that secondhand smoke poses major health risks, and we again call on all parents to protect their children from exposure to secondhand cigarette smoke whenever possible," said Browner.

Since the findings were first assembled, evidence that ETS causes disease has continued to accumulate. One study showed that just six weeks after a new California law required smokefree bars that eliminated ETS exposure, respiratory symptoms in bartenders improved significantly. The rapid resolution of the effects of ETS exposure after the law went into effect both demonstrates that ETS causes respiratory problems and illustrates that simple control measures can protect nonsmokers.

Acting on behalf of the U.S. Public Health Service, the NCI and the Centers for Disease Control and Prevention, in coordination with Cal/EPA, will disseminate the monograph as widely as possible. This monograph is the 10th in a continuing series of NCI monographs dealing with smoking and health issues. Additional smoking and health monographs will be issued in 2000.

Except for the addition of the Surgeon General's preface, the monograph contains only minor editorial changes from the initial Cal/EPA report. The initial report was conceived and developed under the editorial direction of Lauren Zeise, Ph.D., chief of the Reproductive and Cancer Hazard Assessment Section at Cal/EPA, Oakland, Calif., and Amy Dunn, M.P.H., research scientist at Cal/EPA.

A copy of the monograph is available by calling NCI's Cancer Information Service at 1-800-4-CANCER. The report is available, along with some of the earlier monographs, on NCI's Web site at The Center for Disease Control and Prevention is making copies of the monograph available to each state health department.

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