The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006
The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006
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29th report. Documents the serious and deadly health effects of involuntary exposure to tobacco smoke. Secondhand smoke, also known as environmental tobacco smoke, is a mixture of the smoke given off by the burning end of tobacco products (sidestream smoke) and the mainstream smoke exhaled by smokers. People are exposed to secondhand smoke at home, in the workplace, and in other public places such as bars, restaurants, and recreation venues. It is harmful and hazardous to the health of the general public and particularly dangerous to children. It increases the risk of serious respiratory problems in children, such as a greater number and severity of asthma attacks and lower respiratory tract infections, and increases the risk for middle ear infections. It is also a known human carcinogen (cancer-causing agent). Inhaling secondhand smoke causes lung cancer and coronary heart disease in healthy, nonsmoking adults. 




Table of Contents

Table of Contents:

Chapter 1. Introduction, Summary, and Conclusions 1

Introduction 3

Definitions and Terminology 9

Evidence Evaluation 10

Major Conclusions 11

Chapter Conclusions 12

Methodologic Issues 17

Tobacco Industry Activities 23

References 24

Chapter 2. Toxicology of Secondhand Smoke 27

Introduction 29

Evidence of Carcinogenic Effects from Secondhand Smoke Exposure 30

Mechanisms of Respiratory Tract Injury and Disease Caused by Secondhand Smoke Exposure 46

Mechanisms of Secondhand Smoke Exposure and Heart Disease 52

Evidence Synthesis 64

Conclusions 65

Overall Implications 66

References 67

Chapter 3. Assessment of Exposure to Secondhand Smoke 83

Introduction 85

Building Designs and Operations 86

Atmospheric Markers of Secondhand Smoke 93

Exposure Models 96

Biomarkers of Exposure to Secondhand Smoke 100

Conclusions 115

References 116

Chapter 4. Prevalence of Exposure to Secondhand Smoke 127

Introduction 129

Methods 129

Metrics of Secondhand Smoke Exposure 130

Estimates of Exposure 132

Conclusions 158

Overall Implications 158

References 159

Chapter 5. Reproductive and Developmental Effects from Exposure to Secondhand Smoke 165

Introduction 167

Conclusions of Previous Surgeon General’s Reports and Other Relevant Reports 167

Literature Search Methods 167

Critical Exposure Periods for Reproductive and Developmental Effects 169

Fertility 171

Pregnancy (Spontaneous Abortion and Perinatal Death) 176

Infant Deaths 179

Sudden Infant Death Syndrome 180

Preterm Delivery 194

Low Birth Weight 198

Congenital Malformations 205

Cognitive, Behavioral, and Physical Development 210

Childhood Cancer 221

Conclusions 242

Overall Implications 244

References 245

Chapter 6. Respiratory Effects in Children from Exposure to Secondhand Smoke 257

Introduction 261

Mechanisms of Health Effects from Secondhand Tobacco Smoke 262

Methods Used to Review the Evidence 266

Lower Respiratory Illnesses in Infancy and Early Childhood 267

Middle Ear Disease and Adenotonsillectomy 292

Respiratory Symptoms and Prevalent Asthma in School-Age Children 310

Childhood Asthma Onset 355

Atopy 375

Lung Growth and Pulmonary Function 385

Conclusions 400

Overall Implications 401

References 402

Chapter 7. Cancer Among Adults from Exposure to Secondhand Smoke 421

Introduction 423

Lung Cancer 423

Other Cancer Sites 446

Conclusions 484

Overall Implications 484

Appendix 7.1. Details of Recent Lung Cancer Studies 485

References 498

Chapter 8. Cardiovascular Diseases from Exposure to Secondhand Smoke 507

Introduction 509

Coronary Heart Disease 509

Stroke 527

Subclinical Vascular Disease 529

Evidence Synthesis 531

Conclusions 532

Overall Implications 532

References 533

Chapter 9. Respiratory Effects in Adults from Exposure to Secondhand Smoke 537

Introduction 539

Biologic Basis 542

Odor and Irritation 545

Respiratory Symptoms 547

Lung Function 553

Respiratory Diseases 555

Conclusions 562

Overall Implications 563

References 564

Chapter 10. Control of Secondhand Smoke Exposure 569

Introduction 571

Historical Perspective 571

Attitudes and Beliefs About Secondhand Smoke 588

Policy Approaches 598

Technical Approaches 635

Conclusions 649

Overall Implications 649

References 651

A Vision for the Future 667

Appendix 671

List of Abbreviations 675

List of Tables and Figures 679

Index 685


Target audience are policymakers, businesses and organizations that can eliminate smoking areas and create smoke-free zones, medical experts and researchers and members of the general public who wish to know about second-hand smoke and its negative effects on human health.

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Health and Human Services Dept., Public Health Service, Office of the Surgeon General
Key Phrases:
  • Report of the Surgeon General
  • Medical Research
  • Tobacco
  • Smoking
  • Cigarettes
  • Substance Abuse
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