Secondhand Smoke

[Betsy]

If you're interested in reading about the WHO study, here's a good place to start. There are also links at the bottom of the page where you can read the actual study itself, the WHO press release, etc.

http://www.davehitt.com/facts/who.html

[Hogeye]

Some results from the "Second Hand Smoke" study that may be surprising to some people:

Fact: The study found no statistically significant risk existed for non-smokers who either lived or worked with smokers.

Fact: The only statistically significant number was a decrease in the risk of lung cancer among the children of smokers.

[Savonarola]

Sav, I just saw your post - you are wrong; science does support my assertion (or I wouldn't assert it). If you did your own research instead of just believing what the propaganda artists pass down, you'd know that...

Just to be clear: Are you arguing that secondhand smoke poses no significant health hazard whatsoever?

[Betsy]

We may need to define that, but I'm saying no one's ever died from it.

And I'm sorry if my last post to you seemed rude; after reading it, I realized you could take that in a rude tone and that's not how I meant it.

[Savonarola]

We may need to define that, but I'm saying no one's ever died from it.

By "significant health hazard," I am referring to any factor that has a statistically significant, negative effect on health. Let us even consider only "chronic" conditions such as Barbara's examples of asthma and emphysema, as opposed to examples such as smoke's temporarily giving someone a headache.

Whether anyone has died from secondhand smoke is irrelevant. It's not acceptable for me to purposely transmit a non-lethal disease to you and justify doing so by saying, "Well, it won't kill you!"

ETA: On second thought, it's not completely irrelevant; after all, if someone has indeed died because of secondhand smoke, my point would be affirmed. If it is true that nobody has ever died because of secondhand smoke, there are still other effects to consider.

[Dardedar]

DAR
Highlights from a March '06 American Lung Association fact sheet on 2nd hand smoke:

***
Secondhand Smoke Fact Sheet

March 2006

Secondhand smoke, also know as environmental tobacco smoke, is a mixture of the smoke given off by the burning end of a cigarette, pipe or cigar and the smoke exhaled from the lungs of smokers. It is involuntarily inhaled by nonsmokers, lingers in the air hours after cigarettes have been extinguished and can cause or exacerbate a wide range of adverse health effects, including cancer, respiratory infections, and asthma.1

*
Secondhand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of cancer in humans (Group A carcinogen).2

*
A study found that nonsmokers exposed to environmental smoke were 25 percent more likely to have coronary heart diseases compared to nonsmokers not exposed to smoke.4

*
Nonsmokers exposed to secondhand smoke at work are at increased risk for adverse health effects. Levels of ETS in restaurants and bars were found to be 2 to 5 times higher than in residences with smokers and 2 to 6 times higher than in office workplaces.5

*
Secondhand smoke is especially harmful to young children. Secondhand smoke is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year, and causes 1,900 to 2,700 sudden infant death syndrome (SIDS) deaths in the United States annually.9

*
Secondhand smoke exposure may cause buildup of fluid in the middle ear, resulting in 700,000 to 1.6 million physician office visits per year. Secondhand smoke can also aggravate symptoms in 400,000 to 1,000,000 children with asthma.10

*
In the United States, 21 million, or 35 percent of, children live in homes where residents or visitors smoke in the home on a regular basis.11 Approximately 50-75 percent of children in the United States have detectable levels of cotinine, the breakdown product of nicotine in the blood.12

*
New research indicates that secret research conducted by cigarette company Philip Morris in the 1980s showed that secondhand smoke was highly toxic, yet the company suppressed the finding during the next two decades.13

For more information on secondhand smoke, please review the Tobacco Morbidity and Mortality Trend Report as well as our Lung Disease Data publication in the Data and Statistics section of our website, or call the American Lung Association at 1-800-LUNG-USA (1-800-586-4872).

Sources:

1. California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. September 1997.
2. U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. December 1992.
4. He, J.; Vupputuri, S.; Allen, K.; et al. Passive Smoking and the Risk of Coronary Heart Disease-A Meta-Analysis of Epidemiologic Studies. New England Journal of Medicine 1999; 340: 920-6.
5. U.S. Department of Health and Human Services. Report on Carcinogens, Tenth Edition 2002. National Toxicology Program.
6. Shopland, D. Smoke-Free Workplace Coverage. Journal of Occupational and Environmental Medicine. 2001; 43(8): 680-686.
9. California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. September 1997.
10. Ibid.
11. Schuster, MA, Franke T, Pham CB. Smoking Patterns of Household Members and Visitors in Homes with Children in United States. Archives of Pediatric Adolescent Medicine. Vol. 156, 2002: 1094-1100.
12. U.S. Environmental Protection Agency. America's Children and the Environment: Measures of Contaminants, Body Burdens, and Illnesses. Second Edition. February 2003
13. Diethelm PA, Rielle JC, McKee M. The Whole Truth and Nothing but the Truth? The Research Philip Morris Did Not Want You to See. Lancet. Vol. 364 No. 9446, 2004
***

DAR
Also, I just noticed, the originally mentioned report (US Surgeon General), cited at the beginning of this thread has:

"The report also found that living with a smoker increases a nonsmoker's risk of lung cancer and heart disease by up to 30 percent."

LINK

Hmmm....

D.

Edited by Savonarola on 08072006 1517: Fixed BBCode formatting

[Betsy]

You can take anything derived from the EPA study and throw it out.

If you'll read the study I provided the link to, it will refute what the Surgeon General said handily.

If you just want to believe what the smoke free people put out there, keep repeating it. Eventually it will become true, apparently.

[Savonarola]

You can take anything derived from the EPA study and throw it out.

Betsy, you haven't answered my question: Is it your position that secondhand smoke poses no significant health hazard (as defined above)?

[Savonarola]

If you'll read the study I provided the link to, it will refute what the Surgeon General said handily.

Now that I've had a good chance to review the WHO study and Betsy's link...

Because the Confidence Interval includes 1.0, The Relative Risk of 1.16 number is not statistically significant.

While the statement is technically true, this is like saying "we ignore the 1.44 number because it just so happens that .93 is less than 1.0." This is, naturally, a bit of hand-waving, as the confidence interval is a whopping 0.51. Rather than draw hard conclusions from a study with such a huge confidence interval and consider the case closed, why not try increasing the sample size and coming up with a smaller confidence interval? While a larger sample size does not always decrease the confidence interval, it's worth a try, as smaller confidence intervals better represent the phenomena being studied.

So this study citing a spousal smoking odds ratio of a very similar 1.18, but with a smaller confidence interval (1.01-1.37). If the rationale is that there is no statistical significance when the CI includes 1.0, then we can see that this study shows a statistical significance.
Despite the large intervals for some results of these studies, we see a trend of increased OR with exposure to secondhand smoke. (In the case of spousal smoking, the studies essentially agree: the risk increases by about one-sixth.) In fact, we see statistical significance in all but one of the results from the article I cited, despite the relatively large CIs.

But the really damning part of the WHO study is that it appears to have included "ever" exposure. That is, if I went into a smoking restaurant once and was exposed, then was never exposed again, and never got cancer, I'd count as someone "exposed who didn't get cancer." This is quite obviously not representative of the issue at hand.

Furthermore, the WHO study only looked for lung cancer; that is, citing it to support the assertion that secondhand smoke isn't unhealthy fails for yet another reason: lung cancer is not the only adverse health effect possible.

So the WHO study is questionable for a technical reason, damned for a significant reason, and -- in my opinion -- essentially useless for the main topic of this debate.

It should be noted that the article above was the first article I found that both (1) had a title that made me think it was relevant and also (2) had an abstract that included ORs and CIs. (I made only one previous selection of a title, but even though the results showed an effect, it did not include these statistics.) It was not picked as a source because it supported my point.

From the article cited above:

There was no evidence of confounding by employment in high-risk occupations, education or low vegetable intake. Sensitivity analysis for the effects of misclassification (both positive and negative) indicated that the observed risks are likely to underestimate the true risk. Clear dose-response relationships consistent with a causal association were observed between exposure to secondhand smoke from spousal, workplace and social sources and the development of lung cancer among never smokers.

[Dardedar]

You can take anything derived from the EPA study and throw it out.

DAR
Okay, lets do that.

BETSY
If you'll read the study I provided the link to, it will refute what the Surgeon General said handily.

DAR
How do you know? Do you know what that report, which came out less than a week ago, even says?

BET
If you just want to believe what the smoke free people put out there, keep repeating it.

DAR
I want to believe what is true, and I have no emotional or ego investment in this topic whether there are dangers from second hand smoke or not. Can you say the same?

In fact, it would be a little more interesting if the "smoke free people" were all wet. But I doubt that is the case.

From the Surgeon General's press conference, last Tuesday

LINK

***
Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

Remarks at press conference to launch Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General

Tuesday, June 27, 2006
10:00 a.m.
Washington, D.C.

“The Health Effects of Secondhand Smoke”

Thank you, Rear Admiral Moritsugu for your kind introduction.

I am grateful to be here today and to be able to say unequivocally that the debate is over. The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard that causes premature death and disease in children and nonsmoking adults.

Updating the Evidence

Twenty years ago, the 1986 Surgeon General’s Report on The Health Consequences of Involuntary Smoking concluded that secondhand smoke exposure was a cause of disease in nonsmokers. That Report, which was one of the first major reports to investigate this topic, concluded that secondhand smoke caused lung cancer among nonsmoking adults and several respiratory problems among children.

Since that Report was published, hundreds of peer-reviewed studies and several additional major reports on the health effects of secondhand smoke have been published, and the evidence on these health effects has become even stronger.

The Surgeon General’s Report that we are releasing today, The Health Consequences of Involuntary Exposure to Tobacco Smoke, documents beyond any doubt that secondhand smoke harms people’s health. In the course of the past 20 years, the scientific community has reached consensus on this point.

Main Messages

I would like to draw your attention to several new conclusions that I have reached due to overwhelming scientific evidence.

* Secondhand smoke exposure causes heart disease and lung cancer in adults and sudden infant death syndrome and respiratory problems in children.
* There is NO risk-free level of secondhand smoke exposure, with even brief exposure adversely affecting the cardiovascular and respiratory system.
* Only smoke-free environments effectively protect nonsmokers from secondhand smoke exposure in indoor spaces.
* Finally, the Report concludes that, while great strides have been made in recent years in reducing nonsmoking Americans’ secondhand smoke exposure, millions of Americans continue to be exposed to secondhand smoke in their homes and workplaces.

Secondhand Smoke is Harmful to All People

Allow me to expand on the first major conclusion. Secondhand smoke is a health hazard for all people: it is harmful to both children and adults, and to both women and men. It is harmful to nonsmokers whether they are exposed in their homes, their vehicles, their workplaces, or in enclosed public places. We have found that certain populations are especially susceptible to the health effects of secondhand smoke, including infants and children, pregnant women, older persons, and persons with pre-existing respiratory conditions and heart disease.

It is not surprising that secondhand smoke is so harmful. Nonsmokers who are exposed to secondhand smoke inhale the same toxins and cancer-causing substances as smokers. Secondhand smoke has been found to contain more than 50 carcinogens and at least 250 chemicals that are known to be toxic or carcinogenic. This helps explain why nonsmokers who are exposed to secondhand smoke develop some of the same diseases that smokers do.

Health Effects of Exposure to Secondhand Smoke in Adults

Let’s look first at the health effects that secondhand smoke causes in adults.

Lung Cancer

The Report confirms that secondhand smoke is a known human carcinogen that causes lung cancer in nonsmoking adults. Nonsmokers who are exposed to secondhand smoke, at home or at work, increase their risk of developing lung cancer by 20 percent to 30 percent. Secondhand smoke causes approximately 3,000 lung cancer deaths among U.S. nonsmokers each year.

Heart Disease

The Report released today also concludes that secondhand smoke causes heart disease. Nonsmoking adults who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 to 30 percent. The evidence indicates that even brief secondhand smoke exposures can have immediate adverse effects on the cardiovascular system. This is especially true for persons who already have heart disease, or who are at special risk of heart disease. Secondhand smoke causes tens of thousands of heart disease deaths each year among U.S. nonsmokers.

Health Effects of Secondhand Smoke Exposure in Children

Now let’s turn to the special health risks that secondhand smoke poses to children. Because their bodies are still developing, infants and children are especially vulnerable to the poisons in secondhand smoke.

Respiratory Infections

Secondhand smoke is a cause of respiratory conditions in children—we’ve known that since our study of second hand smoke effects began in 1986. However, after further research and analysis, we have found that the consequences of smoke on a child’s respiratory system are more severe than originally thought. Acute respiratory infections such as bronchitis and pneumonia, respiratory symptoms such as cough, phlegm, wheezing, and breathlessness, more frequent and severe asthma attacks, slowing of lung growth, and ear infections have all been proven to be results of exposure to secondhand smoke in children.

SIDS

In an important new finding, we have determined that secondhand smoke is a cause of sudden infant death syndrome (SIDS). Infants who die from SIDS tend to have higher concentration of nicotine in their lungs and higher levels of cotinine (a biological marker for secondhand smoke exposure) than infants who die from other causes. We have also found that infants who are exposed to secondhand smoke after birth are also at increased risk of dying of SIDS.

In addition, babies of nonsmoking women who are exposed to secondhand smoke during pregnancy are at risk for a small reduction in birth weight. Chemicals in secondhand smoke appear to affect the brain in ways that interfere with its regulation of infants’ breathing.

....

More at the link given above.

[Betsy]

What I like about the WHO study is that first of all, they weren't trying to get those results (like the EPA study and others; they were actually expecting that secondhand smoke would be more dangerous. Second, the methodology is pretty irrefutable, following over 1000 married couples where one smoked and the other didn't over a period of 20 years or so. Therefore, I choose to accept their results far above and beyond the EPA study, which is what the smoke-free people tout as the authority, and the surgeon general, as well.

Only about 20-25% of the US population smokes now, compared to a majority just 30 years ago or so and for decades before that. Our generation was brought up in households with smoking parents, driving in cars with smoking parents, people smoked in offices, at work all day, in the grocery store, EVERYWHERE, and if secondhand smoke were all that dangerous and deadly, common sense would tell you that people would have been dropping like flies back then. We should ALL have asthma if that were the case. They weren't and we don't. Now, the smoke-free people would have us believe that going into a restaurant occasionally where people are smoking on the other side of the room could kill you. It's a bunch of sensationalism.

Furthermore, you have a choice where to go and where to work, and if you don't want to be around secondhand smoke you can avoid it. That was your choice, anyway, before they forced their choice on everyone. I agree there are times when I'd rather not be around smoking and at those times, I avoid it. I agree that there were even restaurants I wouldn't go to because they were too smoky. That was my choice, and if enough people had done that, the market would have forced those restaurants to do something about it.

What they SHOULD do is make any business where smoking is permitted post a sign on the door that warns people that smoking is allowed and it may be dangerous to your health. Also, they could have to give information to employees about the potential hazards of working around secondhand smoke. Then, everyone makes an informed decision about where they want to go or work, and it's fair to business owners who want to allow smoking.

[Savonarola]

Betsy, someone's wires are crossed: I analyzed the WHO study to which you linked in your July 07 post, but that study is not the one you are referring to in your most recent post.

Which study or studies do you think support(s) your point?

Would you please clarify your position regarding "significant health hazards"?

Have you any rebuttal to the study I to which linked?

[Betsy]

OH! I didn't actually read the study in that link; I assumed it was the same one I researched a few years ago when this was the big issue in town. I'll have to check on that now. I did tons of research back then and haven't taken the time to read these studies you all are referring to, so (sigh) I guess I'll have to do that now....or sometime in the very near future, I mean...

[Betsy]

You're right, I was referring to the wrong study - I was doing all that by memory from research done years ago and I'm getting old and forgetful, apparently. Here's a recent article that makes reference to the WHO study and the study I was talking about, which apparently was actually many more than the "over a thousand" people I originally stated...

Killing the passive smoking debate

By Michael Fumento
Jun 29, 2006

“Secondhand smoke debate ‘over.” That’s the message from the Surgeon General’s office, delivered by a sycophantic media. The claim is that the science has now overwhelmingly proved that smoke from others’ cigarettes can kill you. Actually, “debate over” simply means: “If you have your doubts, shut up!”

But you definitely should have doubts over the new Surgeon General’s report, a massive 727-page door stop. Like many massive reports on controversial issues, it’s probably designed that way so nobody (especially reporters on deadline) will want to or have time to read beyond the executive summary. That includes me; if I had that much time I’d reread War and Peace. Twice. But the report admits it contains no new science so we can evaluate it based on research already available.

First consider the 1993 EPA study that began the passive smoking crusade. It declared such smoke a carcinogen based on a combined analysis (meta-analysis) of 11 mostly tiny studies. The media quickly fell into line, with headlines blaring: “Passive Smoking Kills Thousands” and editorials demanding: “Ban Hazardous Smoking; Report Shows It’s a Killer.”

But the EPA’s report had more holes than a spaghetti strainer. Its greatest weakness was the agency’s refusal to use the gold standard in epidemiology, the 95 percent confidence interval. This simply means there are only five chances in 100 that the conclusion came about just by chance, even if the study itself was done correctly.

Curiously, the EPA decided to use a 90 percent level, effectively doubling the likelihood of getting its result by sheer luck of the draw.

Why would it do such a strange thing? You guessed it. Its results weren't significant at the 95 percent level. Essentially, it moved the goal posts back because the football had fallen short. In scientific terminology this is know as “dishonesty.”

Two much larger meta-analyses have appeared since the EPA’s. One was conducted on behalf of the World Health Organization and covered seven countries over seven years. Published in 1998, it actually showed a statistically significant reduced risk for children of smokers, though we can assume that was a fluke. But it also showed no increase for spouses and co-workers of smokers.

The second meta-analysis, published in the British Medical Journal (BMJ) in 2002, likewise found a statistical significance when 48 studies were combined. Looked at separately, though, only seven showed significant excesses of lung cancer. Thus 41 did not.

Meta-analysis, though, suffer from such problems as different studies having been conducted in different ways – the apples and oranges conundrum. What was really needed was one study involving a huge number of participants over a long period of time using the same evaluation.

We got that in the prestigious British Medical Journal in 2003. Research professor James Enstrom of UCLA and professor Geoffrey Kabat of the State University of New York, Stony Brook presented results of a 39-year study of 35,561 Californians, which dwarfed in size everything that came before. It found no “causal relationship between exposure to [passive smoke] and tobacco-related mortality,” adding, however “a small effect” can’t be ruled out.

The reason active tobacco smoking could be such a terrible killer while passive smoke may cause no deaths lies in the dictum "the dose makes the poison." We are constantly bombarded by carcinogens, but in tiny amounts the body usually easily fends them off.

A New England Journal of Medicine study found that even back in 1975 – when having smoke obnoxiously puffed into your face was ubiquitous in restaurants, cocktail lounges, and transportation lounges – the concentration was equal to merely 0.004 cigarettes an hour. That’s not quite the same as smoking two packs a day, is it?

But none of this has the least impact on the various federal, state, and city agencies and organizations like the American Lung Association for a very good reason. They already know they’re scientifically wrong. The purpose of the passive smoking campaign has never been to protect non-smokers, but rather to cow smokers into giving up the habit.

It’s easy to agree with the ultimate goal, but inventing scientific outcomes and shutting down scientific debate as a means is as intolerable as it was when Nazi Germany “proved” the validity of eugenics.

[Betsy]

RE: "significant" health hazards - obviously, the smoke-free people are claiming SHS kills you, which is false. I don't think having an allergic reaction or being irritated is significant - AND if as I proposed, there were warning signs on places that permitted smoking, people affected in those ways could avoid it.

[Betsy]

RE: DAR - I haven't read the Surgeon General's report, you're right. Probably no one has. But it is based on the EPA bogus studies, therefore I'm saying it's bogus. I could be wrong, but I don't think so.

[Betsy]

I also agree that SIDS is a problem, but I believe that's because the mother smoked when pregnant - therefore, the baby was a primary smoker, so to speak - not from SHS breathed after it was born....

Sorry for all the posts, I just don't want to seem like I'm avoiding anything by not answering...

[Savonarola]

But it also showed no increase for spouses and co-workers of smokers.

This is no less a lie than the 90% confidence threshold. The study mentioned did show an increase in risk of 16%, but the difference was not statistically significant. As I explained in a previous post, one "not statistically significant" result doesn't mean that there must be no correlation.

The second meta-analysis, published in the British Medical Journal (BMJ) in 2002, likewise found a statistical significance when 48 studies were combined. Looked at separately, though, only seven showed significant excesses of lung cancer. Thus 41 did not.

Since no link or even title was provided, we can only speculate as to the specifics of the article in question. Here's my educated guess for an explanation of their description: The individual studies had large CIs, allowing the anti-anti-SHSers take this opportunity to make the "no statistical significance" claim. However, when the data were compiled, the CIs went down and the results were statistically significant.
Notice that, if my guess is correct, increasing the amount of data showed a statistical significance. (This is also what resulted when comparing the first study Betsy linked with the study I linked.) Why does the author of this article want to stress looking at the small bits instead of the big picture? This is opposite of logical investigation; more data is desirable. The big picture is what we're after!

Meta-analysis, though, suffer from such problems as different studies having been conducted in different ways – the apples and oranges conundrum. What was really needed was one study involving a huge number of participants over a long period of time using the same evaluation.

Because we are not provided access to the studies this article cites, we can neither confirm nor verify this "conundrum." For example, both the first study Betsy linked and the study I linked concern exposure in the workplace; in fact, the ORs were essentially the same. To say that they must not be comparable merely because they weren't part of the same study is ludicrous.

It found no “causal relationship between exposure to [passive smoke] and tobacco-related mortality,” adding, however “a small effect” can’t be ruled out.

Ah, but we're not debating only mortality, are we? Also, yet again we are given no way to track down the study in question.

obviously, the smoke-free people are claiming SHS kills you, which is false. I don't think having an allergic reaction or being irritated is significant

This does not answer my question, Betsy. Is it your position that secondhand smoke poses no significant health hazard (as defined above)?

AND if as I proposed, there were warning signs on places that permitted smoking, people affected in those ways could avoid it.

Unless your position is that the only effects of secondhand smoke are "those ways" (allergic reactions and irritation), your point is moot. If that is indeed your position, you need to say so, rather than dance around it.

I also agree that SIDS is a problem, but I believe that's because the mother smoked when pregnant - therefore, the baby was a primary smoker, so to speak - not from SHS breathed after it was born....

Do you have any data to support this belief?

Sorry for all the posts, I just don't want to seem like I'm avoiding anything by not answering...

Then perhaps you'll excuse my pointing out these other questions of mine that have gone unanswered:
Which study or studies do you think support(s) your point? (Please provide links where possible, at least, rather than articles citing unnamed studies.)

Have you any rebuttal to the study I to which linked?

[Dardedar]

DAR
Michael Fumento makes a lot of claims but I don't know who he is and you don't provide a source for the article. So I do a little hunting. Before I get around to his claims, a come across a little background on the fellow:

***
http://www.sourcewatch.org/index.php?ti ... el_Fumento

Now I'll go peruse the Surgeon General's report. I guess I will be the first one....

D.

[Dardedar]

Since no link or even title was provided, we can only speculate as to the specifics of the article in question.

DAR
Oh I bet I can find the article, but while looking I got distracted into reading a good half an hour about the antics of this Fumento character. Wow. This Tim Lambert guy, who I have watched carve up rightwing nut bars before goes to town on this guy over and over and over again: HERE. Fumento is a very very questionable source.

I'll investigate this some more later, I have to get a plane ticket for my mum right now, but to start with, my trust meter on believing anything this Fumento guy says is very very low. Be very skeptical. For instance, this guy uses sockpuppets to alter his wikipedia site etc, al a Jason Gastrich.

Can we not find a non-zealot, non controversial type to defend the position that second hand smoke protects the kiddies from cancer?

D.