When smoke gets in your eyes - passive smoking as a link to health problems for nonsmokers

The next time smoke gets in your eyes don't look at it as just another inconvenience, but as a real threat to your health and the health of others. Unfortunately, being a nonsmoker does not guarantee you freedom from smoking-related diseases and health problems. You must consciously try to avoid the smoke of others at home, at work, and in public places such as restaurants, stores, and shopping malls.

In 1986, then surgeon general Dr. C. Everett Koop stated in the preface of his report, The Health Consequences of lnvoluntary Smoking "The right of smokers to smoke ends where their behavior affects the health and well-being of others; furthermore, it is the smokers' responsibility to ensure that they do not expose nonsmokers to the potential harmful effects of tobacco smoke." Shortly after the release of this report came the National Research Council's publication Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Risks. Since these publications evidence has multiplied pointing to the devastating health effects of passive smoking.

According to the National Research Council, environmental tobacco smoke, or ETS, consists of more than 3,800 compounds, many of which are known to cause cancer.

Sidestream and mainstream. ETS includes both sidestream smoke, which comes from the burning tip of a cigarette, and mainstream smoke, which is exhaled from the smoker. However, most of ETS consists of sidestream smoke.

Sidestream smoke is more hazardous than mainstream smoke because it is a product that burns at a higher temperature and is virtually unfiltered. Compared to mainstream smoke, sidestream smoke contains higher amounts of ammonia, benzene, nicotine, carbon monoxide, and a number of cancer-causing agents.

Exposure to ETS is very common, with most research studies showing that more than 60 percent of people are exposed to at least some level of ETS. Almost one third of people in these studies report being exposed to ETS 10 or more hours per week, and 16 percent report being exposed to ETS more than 40 hours per week.

Passive smoke and disease. The national reports and numerous studies have provided evidence that long-term exposure to passive smoke can cause lung cancer in healthy adults, has a bad effect on children's health, irritates the senses, may cause impairment in lung function, and can increase the risk of cardiovascular disease.

The surgeon general's report concluded that children of parents who smoke have more respiratory infections, more respiratory symptoms, more frequent hospitalizations for bronchitis and pneumonia, and abnormal lung function, compared to children of parents who do not smoke. A number of subsequent studies have indicated that parental smoking may also affect the growth rate of a child's lung.

Younger children appear to be most susceptible to the ill effects of ETS, compared with older children and adults.

Others who can be adversely affected by ETS are persons with preexisting health problems. Research has shown that people who have allergies, such as hay fever and asthma, are more sensitive to the effects of ETS, and that exposure often triggers symptoms earlier and makes them more severe. Some studies have shown that the chest pain of people with known heart disease can be made worse or brought on more often with exposure to ETS.

In healthy adults the immediate effects of ETS are most commonly associated with odor, annoyance, and irritation of the eyes, nose, and throat, with eye irritation most common.

A reduction in lung function has been documented in adults chronically exposed to ETS. These changes in lung function seen in nonsmokers are similar to the changes in lung function seen in most light smokers.

Lung cancer. Of greater concern is evidence that nonsmokers exposed to ETS are at risk of developing lung cancer and other cancers. A number of studies have examined the risk of lung cancer among nonsmoking spouses of smoking spouses. Results showed that the risk is between 1.5 and 2 times greater than among nonsmoking spouses of nonsmokers. Commenting on the recent release of a report from the Environmental Protection Agency (EPA) on the health effects of secondhand smoke, Dr. David Manino of the National Center for Environmental Health in Atlanta, Georgia, said, "It is estimated that 3,000 to 5,000 nonsmokers die from cancer related to ETS exposure every year."

Cardiovascular disease. The chronic effects of ETS in adults have also been shown to be related to the development of cardiovascular disease. One study showed that the nonsmoking wives of smoking husbands were more than 1.5 times more likely to die from coronary heart disease than nonsmoking wives of nonsmoking husbands.

"The evidence that ETS increases risk of death from heart disease is similar to that which existed in 1986 when the U.S. surgeon general concluded that ETS caused lung cancer in healthy nonsmokers," says Dr. Stanton Glanz of the University of California, San Francisco, after reviewing the studies investigating the link between ETS and heart disease. Although the studies to date implicate ETS in increasing the likelihood of developing cardiovascular disease, more information and research are needed to clearly define this relationship.

Effective strategies. Where do we go from here? Following are some effective strategies for ensuring a clean and healthy environment:

* Offer effective methods of smoking cessation for those who smoke.

* Focus on the prevention of smoking, targeting the home, school, and the workplace for those who potentially could become smokers.

* Ban all tobacco product advertising and increase taxation on tobacco products.

* Restrict where tobacco can be smoked by instituting effective workplace antismoking policies.

* Ban smoking in schools and restrict smoking to designated places on college campuses.

Currently 42 states in the U.S. restrict smoking employees and 17 states restrict smoking for public and/or private employees. Numerous states have or are in the process of enacting comprehensive smoking legislation and a multitude of local communities have passed ordinances limiting smoking in public places and in government buildings.

The EPA's recent report on the environmental and health effects of secondhand smoke (see box on p. 9) does not recommend specific policies. However, health advocacy groups see it as an essential step in policy development. "We believe this [EPA report] will motivate state governments, local governments to enact further regulations limiting smoking in public places," says Dr. Alfred Munzer of the Coalition on Smoking and Health, which includes the American Lung Association, the American Heart Association, and the American Cancer Society.

Clearly, as the number of people who smoke continues to decline and the number of nonsmokers increases, an increasing demand for a smoke-free and more healthy environment for all can be expected. Make sure you play your part in creating a healthy environment for yourself, your family, your friends, and for society as a whole. Don't let smoke get in your eyes!

Gregory W. Heath, D.H. Sc. M.P.H., is an epidemiologist in the Division of Surveillance and Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia.

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