The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, U.S. Department of Health and Human Services

6 Major Conclusions of the Surgeon General Report

Smoking is the single greatest avoidable cause of disease and death. In this report, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, the Surgeon General has concluded that:

1. Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.

Supporting Evidence

• Levels of a chemical called cotinine, a biomarker of secondhand smoke exposure, fell by 70 percent from 1988-91 to 2001-02. In national surveys, however, 43 percent of U.S. nonsmokers still have detectable levels of cotinine.
• Almost 60 percent of U.S. children aged 3-11 years�or almost 22 million children�are exposed to secondhand smoke.
• Approximately 30 percent of indoor workers in the United States are not covered by smoke-free workplace policies.
2. Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke.

Supporting Evidence

• Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic (cancer-causing), including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide.
• Secondhand smoke has been designated as a known human carcinogen (cancer-causing agent) by the U.S. Environmental Protection Agency, National Toxicology Program and the International Agency for Research on Cancer (IARC). The National Institute for Occupational Safety and Health has concluded that secondhand smoke is an occupational carcinogen.
3. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.

Supporting Evidence

• Children who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances and poisons as smokers. Because their bodies are developing, infants and young children are especially vulnerable to the poisons in secondhand smoke.
• Both babies whose mothers smoke while pregnant and babies who are exposed to secondhand smoke after birth are more likely to die from sudden infant death syndrome (SIDS) than babies who are not exposed to cigarette smoke.
• Babies whose mothers smoke while pregnant or who are exposed to secondhand smoke after birth have weaker lungs than unexposed babies, which increases the risk for many health problems.
• Among infants and children, secondhand smoke cause bronchitis and pneumonia, and increases the risk of ear infections.
• Secondhand smoke exposure can cause children who already have asthma to experience more frequent and severe attacks.
4. Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.

Supporting Evidence

• Concentrations of many cancer-causing and toxic chemicals are higher in secondhand smoke than in the smoke inhaled by smokers.
• Breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack.
• Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 - 30 percent.
• Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing lung cancer by 20 - 30 percent.
5. The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.

Supporting Evidence

• Short exposures to secondhand smoke can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk of a heart attack.
• Secondhand smoke contains many chemicals that can quickly irritate and damage the lining of the airways. Even brief exposure can result in upper airway changes in healthy persons and can lead to more frequent and more asthma attacks in children who already have asthma.
6. Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.

Supporting Evidence

• Conventional air cleaning systems can remove large particles, but not the smaller particles or the gases found in secondhand smoke.
• Routine operation of a heating, ventilating, and air conditioning system can distribute secondhand smoke throughout a building.
• The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), the preeminent U.S. body on ventilation issues, has concluded that ventilation technology cannot be relied on to control health risks from secondhand smoke exposure.

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General was prepared by the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). The Report was written by 22 national experts who were selected as primary authors. The Report chapters were reviewed by 40 peer reviewers, and the entire Report was reviewed by 30 independent scientists and by lead scientists within the Centers for Disease Control and Prevention and the Department of Health and Human Services. Throughout the review process, the Report was revised to address reviewers� comments.

Citation
U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

For more information, please refer to the Resources page. Additional highlight sheets are also available at www.cdc.gov/tobacco.

Last revised: January 4, 2007

Esto mismo puede consultarse en la página del United States Department of Health & Human Services.

Harvard Researchers Find Nicotine Content has Increased 11%

Harvard School of Public Health, Jan. 18, 2007

The discovery of an 11% increase in nicotine content confirms recent statements by the US District Court for the District of Columbia that manufacturers have the ability to manipulate addictive additives.

Boston, MA--A reanalysis of nicotine yield from major brand name cigarettes sold in Massachusetts from 1997 to 2005 has confirmed that manufacturers have steadily increased the levels of this agent in cigarettes. This independent analysis, based on data submitted to the Massachusetts Department of Public Health (MDPH) by the manufacturers, found that increases in smoke nicotine yield per cigarette averaged 1.6 percent each year, or about 11 percent over a seven-year period (1998-2005). Nicotine is the primary addictive agent in cigarettes.

The full report "Trends in Smoke Nicotine Yield and Relationship to Design Characteristics Among Popular U.S. Cigarette Brands" is available here: http://www.hsph.harvard.edu/nicotine/trends.pdf

In addition to confirming the magnitude of the increase, first reported in August, 2006 by MDPH, researchers from the Harvard School of Public Health (HSPH) extended the analysis to:

1) ascertain how manufacturers accomplished the increase -- not only by intensifying the concentration of nicotine in the tobacco but also by modifying several design features of cigarettes to increase the number of puffs per cigarette. The end result is a product that is potentially more addictive.

2) examine all market categories -- finding that smoke nicotine yields were increased in the cigarettes of each of the four major manufacturers and across all the major cigarette market categories (e.g. mentholated, non-mentholated, full-flavor, light, ultralight).

The analysis was performed by a research team from the Tobacco Control Research Program at HSPH led by program director Gregory Connolly, professor of the practice of public health, and Howard Koh, associate dean for public health practice at HSPH and a former commissioner of public health for the Commonwealth of Massachusetts (1997-2003). The other co-investigators were HSPH researchers Hillel R. Alpert and Geoffrey Ferris Wayne.

"Cigarettes are finely-tuned drug delivery devices, designed to perpetuate a tobacco pandemic," said former Commissioner Koh. "Yet precise information about these products remains shrouded in secrecy, hidden from the public. Policy actions today requiring the tobacco industry to disclose critical information about nicotine and product design could protect the next generation from the tragedy of addiction."

Said Connolly: "Our findings call into serious question whether the tobacco industry has changed at all in its pursuit of addicting smokers since signing the Master Settlement Agreement of 1998 with the State Attorneys General. Our analysis shows that the companies have been subtly increasing the drug nicotine year by year in their cigarettes, without any warning to consumers, since the settlement. Scrutiny by the Attorneys General is imperative. Proposed federal legislation has been filed by Senator Edward Kennedy (D-Ma.) that would address this abuse and bring the tobacco industry under the rules that regulate other manufacturers of drugs."

Beginning in 1997, Massachusetts regulations have required an annual report to be filed with the MDPH by all manufacturers of cigarettes sold in Massachusetts. The reported data include machine-based measures of nicotine yield as well as measures of cigarette design related to nicotine delivery.

The Tobacco Research Program at HSPH obtained from the MDPH a complete set of brand-specific data from 1997 to 2005 and analyzed trends in smoke nicotine yield.

The discovery of an 11 percent increase in nicotine content, said Connolly, confirms recent statements by the US District Court for the District of Columbia that manufacturers have the ability to manipulate addictive additives, and, he said, "it underscores the need for continued surveillance of nicotine delivery in products created by an unregulated industry."

In an opinion in US vs. Philip Morris USA et. al. Judge Gladys Kessler wrote that tobacco companies "can and do control the level of nicotine delivered in order to create and sustain addiction" and further, that the "goal to ensure that their products deliver sufficient nicotine to create and sustain addiction influences their selection and combination of design parameters."

Cigarette smoking causes an estimated 438,000 premature deaths (or about 1 of every 5 deaths) annually in the U.S., and approximately 900,000 persons become addicted to smoking each year.

In conclusion, according to the HSPH researchers, the extended analysis of MDPH data has demonstrated its potential to reveal undisclosed hazards to human health. They suggest that MDPH amend its unique reporting requirements to include more information about cigarette and smokeless tobacco product design features that affect nicotine delivery - as well as testing of a sample of brands for the actual delivery of nicotine to the body.

Work on the report was supported by funds from The American Legacy Foundation and the National Cancer Institute.

For more information contact: Robin Herman rherman@hsph.harvard.edu (617) 432-4752

Tomado de Clark County Tobacco Prevention and Cessation Coalition. Usted puede hallar el reporte original de la Harvard School of Public Health en esta liga:

http://www.hsph.harvard.edu/nicotine/trends.pdf