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It is estimated that passive smoking kills 53,000 nonsmokers per year, making it the 3<sup>rd</sup> leading cause of [[preventable death]] in the U.S.<ref>Glantz, S.A. & Parmley, W., "Passive Smoking and Heart Disease: Epidemiology, Physiology, and Biochemistry", Circulation, 1991; 83(1): 1-12. [http://circ.ahajournals.org/cgi/content/abstract/83/1/1?ijkey=4a5be6d1e9e3a9b7d6b3b9ab29a0f748d8b955ed&keytype2=tf_ipsecsha] and Taylor, A., Johnson, D. & Kazemi, H., "Environmental Tobacco Smoke and Cardiovascular Disease", Circulation, 1992; 86: 699-702 [http://circ.ahajournals.org/cgi/content/abstract/86/2/699]. </ref>
It is estimated that passive smoking kills 53,000 nonsmokers per year, making it the 3<sup>rd</sup> leading cause of [[preventable death]] in the U.S.<ref>Glantz, S.A. & Parmley, W., "Passive Smoking and Heart Disease: Epidemiology, Physiology, and Biochemistry", Circulation, 1991; 83(1): 1-12. [http://circ.ahajournals.org/cgi/content/abstract/83/1/1?ijkey=4a5be6d1e9e3a9b7d6b3b9ab29a0f748d8b955ed&keytype2=tf_ipsecsha] and Taylor, A., Johnson, D. & Kazemi, H., "Environmental Tobacco Smoke and Cardiovascular Disease", Circulation, 1992; 86: 699-702 [http://circ.ahajournals.org/cgi/content/abstract/86/2/699]. </ref>

Correction: Reference 14, Boffetta et al, is claimed as evidence
that passive smoking (PS) causes lung cancer. It is not.
The results of Boffetta et al show that spousal and workplace PS
have no significant effect on lung cancer rates but childhood
exposure significantly reduces lung cancer rate by 22%, the reverse
of what this article claims. See: http://jnci.oxfordjournals.org/
cgi/content/abstract/90/ 19/1440?maxtoshow=&HITS=10&hits=10&RESULT
FORMAT=&fulltext=boffetta& searchid=1&FIRSTINDEX=10&resourcetype=HWCIT
This confirms a similar observation by Brownson et al (1992):
http://members.iinet.com.au/~ray/b.html

J.R.Johnstone ray@iinet.com.au
http://members.iinet.com.au/~ray/


==Short-term effects==
==Short-term effects==

Revision as of 16:07, 28 April 2007

See also tobacco smoking and Health effects of tobacco smoking
"Second Hand Smoke" redirects here. For the Sublime album, see Second-hand Smoke (album)
Tobacco smoke used to fill the air of Irish pubs before the smoking ban came into effect on March 29, 2004

Passive smoking (also known as secondhand smoking, involuntary smoking, exposure to environmental tobacco smoke, or ETS exposure) occurs when the smoke from one person's burning tobacco product (or the smoker's exhalation) is inhaled by others. Current scientific evidence shows that passive exposure to tobacco smoke causes death, disease and disability.[1][2][3][4]

Passive smoking is one of the key issues leading to smoking bans in workplaces and indoor public places, including restaurants.

Long-term effects

Research has generated scientific evidence that secondhand smoke (i.e. in case of cigarette, a mixture of smoke released from the smoldering end of the cigarette and smoke exhaled by the smoker) causes the same problems as direct smoking, including heart disease,[5] cardiovascular disease, lung cancer, and lung ailments such as COPD, bronchitis and asthma.[6] Specifically, meta-analyses have shown lifelong non-smokers with partners who smoke in the home have a 20-30% greater risk of lung cancer, and those exposed to cigarette smoke in the workplace have an increased risk of 16-19%.[7]

A wide array of negative effects are attributed, in whole or in part, to frequent, long term exposure to second hand smoke. Some of the symptoms which have been or are frequently attributed to second hand smoke include:

  • Increased risk of lung cancer
    • The effect of passive smoking on lung cancer has been extensively studied. Studies from the USA (1986,[8][9] 1992,[10] 1997,[11] 2001,[12] 2003[13]), Europe (1998[14]), the UK (1998[15][16]), and Australia (1997[17]) have consistently shown a significant increase in relative risk among those exposed to passive smoke.
  • Increased risk of cancer[18]
    • Reviewing the evidence accumulated on a worldwide basis, the International Agency for Research on Cancer concluded in 2002 that "Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans (Group 1)."[19]
  • Increased risk of heart disease[20]
  • Increased risk of miscarriage and birth defects[21]
  • Increased risk of sudden infant death syndrome (SIDS)[22]
  • Increased risk of developing asthma, both for children[23] and adults[24][25]
  • Increased risk of lung infections[26][27][28][29]
  • Increased risk of ear infections[30]
  • Increased risk of allergies and death of children[31]
  • Worsening of asthma, allergies, and other conditions[32]
  • Increased risk of learning difficulties,[33] although this may only be in children exposed before birth.[34] Animal models suggest a role for nicotine and carbon monoxide in neurocognitive problems[29]

Although the nature of passive smoking makes study design problematic, meta-analyses from around the world suggest that dangers of passive smoking are significant.[35][36][37]

It is estimated that passive smoking kills 53,000 nonsmokers per year, making it the 3rd leading cause of preventable death in the U.S.[38]

Correction: Reference 14, Boffetta et al, is claimed as evidence 

that passive smoking (PS) causes lung cancer. It is not.
The results of Boffetta et al show that spousal and workplace PS
have no significant effect on lung cancer rates but childhood
exposure significantly reduces lung cancer rate by 22%, the reverse
of what this article claims. See: http://jnci.oxfordjournals.org/

cgi/content/abstract/90/ 19/1440?maxtoshow=&HITS=10&hits=10&RESULT FORMAT=&fulltext=boffetta& searchid=1&FIRSTINDEX=10&resourcetype=HWCIT 

This confirms a similar observation by Brownson et al (1992):
http://members.iinet.com.au/~ray/b.html

J.R.Johnstone ray@iinet.com.au 

http://members.iinet.com.au/~ray/

Short-term effects

Persons with asthma can experience attacks brought on by passive smoking[39] whether they are adults or children,[40][41][42] supporting calls for a smoking ban.[43]

Tobacco smoke is an irritant, and allergy sufferers can experience stuffy or runny noses, watery or burning eyes, sneezing, coughing, wheezing, a feeling of suffocation, and other typical allergy symptoms within minutes of exposure. Some people with no known allergies and without asthma may cough in smoke-filled rooms, get headaches, feel nauseated, feel sleepy, and experience other ill effects, when they would not normally exhibit these symptoms without the presence of smoke.[citation needed]

Many former smokers, and those who are trying to quit prefer to not be around smoke as it can cause them to have cravings. Some people simply do not like the odor, which clings to hair, clothing, furniture, and rugs.

Many of these short-term effects terminate after the exposure ends. Repeated exposure, however, is believed to cause more serious long-term effects.

Epidemiological studies of passive smoking

Epidemiological studies show that non-smokers exposed to secondhand smoke are at risk for many of the health problems associated with direct smoking.

In 1992, the Journal of the American Medical Association published a review of the evidence available from epidemiological and other studies regarding the relationship between secondhand smoke and heart disease and estimated that passive smoking was responsible for 35,000 to 40,000 deaths per year in the United States in the early 1980s.[44] Some studies make the claim that non-smokers living with smokers have about a 25 per cent increase in risk of death from heart attack, are more likely to suffer a stroke, and can sometimes contract genital cancer. Some research, such as the Helena Study, suggests that risks to nonsmokers may be even greater than this estimate. The Helena Study claims that exposure to secondhand smoke increases the risk of heart disease among non-smokers by as much as 60 percent.[45] Parents who smoke appear to be a risk factor for children and babies and are associated with low birth weight babies, sudden infant death syndrome (SIDS), bronchitis and pneumonia, and middle ear infections.[46]

In 2002, a group of 29 experts from 12 countries convened by the Monographs Programme of the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) reviewed all significant published evidence related to tobacco smoking and cancer. It concluded:

These meta-analyses show that there is a statistically significant and consistent association between lung cancer risk in spouses of smokers and exposure to secondhand tobacco smoke from the spouse who smokes. The excess risk is of the order of 20% for women and 30% for men and remains after controlling for some potential sources of bias and confounding.[47]

Additionally, studies assessing passive smoking without looking at the partners of smokers have found that high overall exposure to passive smoking is associated with greater risks than partner smoking and is widespread in non-smokers.[48]

The National Asthma Council of Australia[49] cites studies showing that: Environmental tobacco smoke (ETS) is probably the most important indoor pollutant, especially around young children:

  • Smoking by either parent, particularly by the mother, increases the risk of asthma in children.14,15,<LE III-2>
  • The outlook for early childhood asthma is less favourable in smoking households.15,<LE III-2>
  • Children with asthma who are exposed to smoking in the home generally have more severe disease.16,<LE III-1>
  • Many adults with asthma identify ETS as a trigger for their symptoms.17,<LE III-1>
  • Doctor-diagnosed asthma is more common among non-smoking adults exposed to ETS than those not exposed. Among people with asthma, higher ETS exposure is associated with a greater risk of severe attacks.18,<LE III-2>

In France passive smoking has been shown to cause between 3000[50] and 5000 premature deaths per year, with the larger figure cited by Prime minister Dominique de Villepin during his announcement of a nationwide smoking ban: "That makes more than 13 deaths a day. It is an unacceptable reality in our country in terms of public health."[51]

Studies of passive smoking in animals

Experimental studies in which animals are exposed to tobacco smoke have produced results supporting the view that exposure to secondhand or 'environmental' tobacco smoke is carcinogenic. The International Agency for Research on Cancer expert group concluded that:

There is limited evidence in experimental animals for the carcinogenicity of mixtures of mainstream and sidestream tobacco smoke.
There is sufficient evidence in experimental animals for the carcinogenicity of sidestream smoke condensates.[52]

A study conducted by the Tufts' School of Veterinary Medicine and the University of Massachusetts concluded that a cat living with a smoker is two times more likely to get feline lymphoma than one that is not. After five years living with a smoker, that rate increases to three times as likely. And, when there are two smokers in the home, the chances of getting feline lymphoma increases to four times as likely.[53]

A study by Colorado State University found that a dog that has exposure to a smoker in the home is 1.6 times more likely to develop lung cancer than a dog that is not exposed to a smoker. The study also found that skull shape had an effect on the estimated risk of lung cancer in dogs.[54]

Risk level of passive smoking

The International Agency for Research on Cancer concluded in 2002 that:

There is sufficient evidence that involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) causes lung cancer in humans.
Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans (Group 1).[55]

Most experts believe that moderate, occasional exposure to secondhand smoke presents a small, but measurable cancer risk to nonsmokers. The risk is considered more significant if non-smokers work in an environment where cigarette smoke is prevalent, although few studies bear this out.[56]

In May 2006, the United States government's Center for Disease Control issued its first new study on secondhand smoke in 20 years. Surgeon General Richard Carmona summarized, "The health effects of secondhand smoke exposure are more pervasive than we previously thought. The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults." The study estimated that living or working in a place where smoking is permitted increases the non-smokers' risk of developing heart disease by 25-30% and lung cancer by 20-30%. The study finds that passive smoke also causes sudden infant death syndrome (SIDS), respiratory problems, ear infections, and asthma attacks in children.[57]

Scientific basis for bans

A study issued in 2002 by the International Agency for Research on Cancer of the World Health Organization concluded that nonsmokers are exposed to the same carcinogens as active smokers.[58] Sidestream smoke contains more than 4000 chemicals, including 69 known carcinogens such as formaldehyde, lead, arsenic, benzene, and radioactive polonium 210,[59] and several well-established carcinogens have been shown by the tobacco companies' own research to be present at higher concentrations in sidestream smoke than in mainstream smoke.[60]

Environmental Tobacco Smoke and Particulate Matter Emission

Environmental tobacco smoke (ETS) was shown to be a much higher source of pollution than an ecodiesel engine in regard to particulate matter (PM) emission. Three cigarettes smouldering in a room of 60m³ with a limited air exchange, a setting commonly encountered in everyday life, were able to produce PM concentrations up to 10-fold that of the engine’s emissions, and up to 15-fold PM10 and PM2.5 outdoor limits, in agreement with previous data on ETS pollution observed in the hospitality industry.[61]

The Osteen decision

In 1993, the US Environmental Protection Agency (EPA) issued a report.[10] estimating that 3,000 lung cancer related deaths in the U.S. were caused by passive smoking every year. The Congressional Research Service issued a report that generally endorsed the findings of the study, while noting that 'a few researchers have challenged the classification of ETS as a known carcinogen'.[62] Among those testifying in favour of the tobacco industry at the inquiry was Congressman Thomas J Bliley, who was criticized for having received donations from tobacco companies (more than $22,900 from tobacco companies in 1993–1994,[63] and more than $53,000 from them in 1995–1996).[64]

Philip Morris, R.J. Reynolds and groups representing growers, distributors and marketers took legal action, claiming that the EPA manipulated scientific studies and ignored accepted scientific and statistical practices. In 1998 United States District Court Judge William Osteen vacated this study, finding in support of the claim that the EPA had manipulated results and violated scientific norms.

Osteen had worked as a lobbyist for the tobacco industry prior to becoming a judge. However, he had previously delivered a ruling contrary to the interests of tobacco companies: in 1997 he had refused to strike down a FDA rule restricting young people's access to tobacco products.[65]

Osteen's decision was overturned by the United States Court of Appeals for the Fourth Circuit in 2002 on the technical grounds that the report was not a reviewable agency action under the Administrative Procedure Act, and the EPA classification of tobacco was ultimately left intact.

Enstrom and Kabat

Two studies by Enstrom and Kabat[66][67] conclude that the previous studies may have overestimated the effect of Environmental Tobacco Smoke (ETS) on both lung cancer and heart diseases.

These studies have been criticised by the American Cancer Society, which describes the study as "misinformation", on the grounds that both the original cohort and Enstrom and Kabat's follow-ups, were inappropriate for reliably determining ETS exposure, smoking history, etc. Furthermore, Enstrom and Kabat are funded by the tobacco industry.[68]

Enstrom and Kabat have rejected this criticism, claiming that the American Cancer Society funded most of the first study, but pulled their funding at the last minute, forcing the researchers to look elsewhere to find funding. Further, they say were only able to find funding from a foundation funded by the tobacco companies. In response, ACS vice-president Michael Thun[69] asserts that Enstrom had been funded by the tobacco industry since 1997 without informing the ACS, and that Enstrom had communicated with Philip Morris about the potential value of the CPS-I follow-up as early as 1990.[70]

The study also attracted criticism for a number of methodological flaws:

  • It did not account for participants' considerable ETS exposure before California implemented a smoking ban in the late 1990s[71]
  • The analysis did not account for losses to follow-up, nor misclassification
  • The lower than usual relative risks for active smoking and coronary heart disease could have obscured the effect of ETS[72]
  • The participant group they used was designed to assess the effect of active smoking, not ETS[73]

Allan Hackshaw, deputy director of the cancer trials center at UCL, concluded "Enstrom and Kabat's conclusions are not supported by the weak evidence they offer, and, although the accompanying editorial alluded to 'debate' and 'controversy,' we judge the issue to be resolved scientifically, even though the 'debate' is cynically continued by the tobacco industry."

In addition, Enstrom and Kabat's work confirmed some harmful effects of secondhand smoke, in particular that it increased the risk of Chronic Obstructive Pulmonary Disease (COPD).[74]

The link between tobacco industry funding and the results of studies on the nature of passive smoking was investigated in a literature review by Barnes & Bero, who found that the only factor affecting the conclusions of epidemiological studies of passive smoking was whether the authors had received funding from the tobacco industry or not.[75] ASH published an analysis of the studies that concluded that the studies cannot be trusted, as there appears to be a direct conflict of interest. Alongside other faults, this analysis also criticizes the BMJ for failing to inform readers who funded the studies.[76]

Tobacco industry response

The passive smoking issue poses a serious economic threat to the tobacco industry. It has broadened the definition of smoking beyond a personal habit to something with a social impact, it has been the cause of successful litigation against employers by workers with a history of exposure to smoke, and it has resulted in various types of smoking restrictions. Accordingly, the tobacco industry have developed several strategies to minimise its impact on their business:

  • Libertarian: the industry has sought to position the passive smoking debate as essentially concerned with civil liberties and smokers' rights rather than with health.
  • Funding bias in research; in all reviews of the effects of passive smoking on health published between 1980 and 1995, the only factor associated with concluding that passive smoking is not harmful was whether an author was affiliated with the tobacco industry[77]
  • Delaying and discrediting legitimate research: Australia[78]
  • Promoting "good epidemiology" and attacking so-called junk science (a term popularised by industry lobbyist Steven Milloy): attacking the methodology behind research showing health risks as flawed and attempting to promote sound science [3]. Ong & Glantz (2001) cite an internal Phillip Morris memo giving evidence of this as company policy[79]

Position of major tobacco companies

Altadis (site accessed on November 19, 2006)

Non-smokers who breathe air containing ambient smoke are often referred to as passive smokers and many studies have been conducted to assess their risks. Some studies on exposure to ambient smoke conclude that it represents a risk for health.

British American Tobacco (site accessed on November 19, 2006)

The World Health Organisation and various other public health bodies have reported that exposure to environmental tobacco smoke (ETS), sometimes called 'passive smoking', is a cause of various diseases. The risks they report are far lower than those associated with active smoking, but are said to be large enough to make public smoking an important public health issue.
Our view of the science is that ETS exposure is associated with various short term health impacts, such as exacerbating symptoms in asthmatics and respiratory illnesses in children. The science on ETS and chronic diseases, such as lung cancer and heart disease, is in our view not definitive and at most suggests that if there is a risk from ETS exposure, it is too small to measure with any certainty.

Imperial Tobacco Group plc (site accessed on November 19, 2006)

Imperial Tobacco recognises that other people’s tobacco smoke can be unpleasant or annoying, and can raise concerns leading to calls to ban smoking . However, it is our view that the scientific evidence, taken as a whole, is insufficient to establish that other people’s tobacco smoke is a cause of any disease.
The statistical population studies (epidemiology) which have led to claims that other people’s tobacco smoke is a risk to health are subject to some methodological flaws. Most individual studies show no statistical effects. When study results are combined (a process called ‘meta analysis’), at most they indicate a very small increase in relative risk.

JT International (Japan Tobacco) (site accessed on November 19, 2006)

We agree that ETS can be annoying to non-smokers and that in poorly ventilated areas ETS can cause substantial irritation of the eyes, nose and throat. We therefore ask all smokers to be aware of and show consideration for people with whom they come into contact. However, we do not believe that the claim that ETS is a cause of lung cancer, heart disease and chronic pulmonary diseases in non-smokers has been convincingly demonstrated or that a reliable causal link between ETS exposure and chronic diseases has been established.

Philip Morris USA (site accessed on November 19, 2006)

Public health officials have concluded that secondhand smoke from cigarettes causes disease, including lung cancer and heart disease, in non-smoking adults, as well as causes conditions in children such as asthma, respiratory infections, cough, wheeze, otitis media (middle ear infection) and Sudden Infant Death Syndrome. In addition, public health officials have concluded that secondhand smoke can exacerbate adult asthma and cause eye, throat and nasal irritation.
Philip Morris USA believes that the public should be guided by the conclusions of public health officials regarding the health effects of secondhand smoke in deciding whether to be in places where secondhand smoke is present, or if they are smokers, when and where to smoke around others. Particular care should be exercised where children are concerned, and adults should avoid smoking around them.
We also believe that the conclusions of public health officials concerning environmental tobacco smoke are sufficient to warrant measures that regulate smoking in public places. We also believe that where smoking is permitted, the government should require the posting of warning notices that communicate public health officials' conclusions that secondhand smoke causes disease in non-smokers.

R.J. Reynolds Tobacco Company (site accessed on November 19, 2006)

RJRT believes that individuals should rely on the conclusions of the U.S. Surgeon General, the Centers for Disease Control and other public health and medical officials when making decisions regarding smoking.

Smoking bans

See also: Smoking bans, List of smoking bans

As a consequence of the health risks associated with passive smoking, a general ban on smoking in all establishments serving food and drink, including restaurants, cafés, and nightclubs, was introduced in Norway on June 1, 2004, and in Sweden on June 1, 2005, and many parts of America, including the states of Florida, Delaware, California, Ohio and New York, have similar legislation in place.

These initial bans have grown in scope, with countries (such as Ireland and Scotland), jurisdictions (like New York State, Washington State, Ohio, and Arkansas in the US) now prohibiting smoking in public buildings as well as private businesses such as restaurants and clubs. Many office buildings contain specially ventilated smoking areas; some are required by law to provide them.

The state of Hawaii recently passed a bill making it illegal to smoke in any public place or within 20 feet of an entrance or ventilation shaft intake of a building.

Some regions and local governments have banned smoking in all workplaces, in taxicabs, and in ventilated smoking rooms or enclosed smoking shelters such as those found in front of hospitals.

Even in countries traditionally seen as nations of smokers, opinion polls have shown support for bans, with 70% of those in France supporting a ban.[51]

In the first 18 months after the town of Pueblo, Colorado enacted a smoking ban in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighboring towns without smoking bans showed no change. Raymond Gibbons, M.D., American Heart Association president said, "The decline in the number of heart attack hospitalizations within the first year and a half after the non-smoking ban that was observed in this study is most likely due to a decrease in the effect of secondhand smoke as a triggering factor for heart attacks."[80]

Notes

  1. ^ WHO Framework Convention on Tobacco Control; First international treaty on public health, adopted by 192 countries and signed by 168. Its Article 8.1 states "Parties recognize that scientific evidence has unequivocally established that exposure to tobacco causes death, disease and disability."
  2. ^ U.S. Department of Health and Human Services. "The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General", 2006; One of the major conclusions of the Surgeon General Report is: "Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke."
  3. ^ California Environmental Protection Agency: Air Resources Board, "Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant" (June 24, 2005); on January 26, 2006, the Air Resources Board, following a lengthy review and public outreach process, determined ETS to be a Toxic Air Contaminant (TAC).
  4. ^ WHO International Agency for Research on Cancer "Tobacco Smoke and Involuntary Smoking" IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83, 2002; the evaluation of the Monograph is: "There is sufficient evidence that involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) causes lung cancer in humans. [...] Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans (Group 1)."
  5. ^ "An individual male never-smoker living with a current or former smoker is estimated to have an approximately 9.6% chance of dying of ischemic heart disease by the age of 74 years, compared with a 7.4% chance for a male never-smoker living with a nonsmoker. The corresponding lifetime risks for women are 6.1% and 4.9%." Passive smoking and the risk of heart disease, The Journal of the American Medical Association, Vol. 267 No. 1, January 1, 1992
  6. ^ Boyle P, Autier P, Bartelink H; et al. (2003). "European Code Against Cancer and scientific justification: third version (2003)". Ann Oncol. 14 (7). PMID 12853336. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  7. ^ Sasco AJ, Secretan MB, Straif K. (2004). "Tobacco smoking and cancer: a brief review of recent epidemiological evidence". Lung Cancer. 45 (Suppl 2): S3-9. PMID 15552776.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ US Department of Health and Human Services., The health consequences of involuntary smoking: report of the Surgeon General (DHHS Pub No (PHS) 87–8398), DHHS, Washington, DC (1986). PMID 3097495
  9. ^ National Research Council. Environmental tobacco smoke: measuring exposures and assessing health effects, NRC, Washington, DC (1986).
  10. ^ a b US Environmental Protection Agency. Template:PDF
  11. ^ California Environmental Protection Agency., Health effects of exposure to environmental tobacco smoke, California EPA, Sacramento (1997). PMID 9583639
  12. ^ Centers for Disease Control and Prevention (CDC). State-specific prevalence of current cigarette smoking among adults, and policies and attitudes about secondhand smoke—United States, 2000. MMWR Morb Mortal Wkly Rep. 2001 Dec 14;50(49):1101-6. id=PMID 11794619
  13. ^ Alberg AJ, Samet JM. Epidemiology of lung cancer. Chest. 2003 Jan;123(1 Suppl):21S-49S. PMID 12527563
  14. ^ In: P Boffetta, A Agudo and W Ahrens et al., Editors, Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe, J Natl Cancer Inst 90 (1998), pp. 1440–1450.
  15. ^ "Report of the Scientific Committee on Tobacco and Health to the Chief Medical Officer, Part II". Retrieved 2006-07-26.
  16. ^ Hackshaw AK. Lung cancer and passive smoking. Stat Methods Med Res. 1998 Jun;7(2):119-36. PMID 9654638
  17. ^ National Health and Medical Research Council. The health effects of passive smoking, Australian Government Publishing Service, Canberra (1997).
  18. ^ U.S. Surgeon General's report on Secondhand Smoke (Chapter 2; pages 30 - 46)
  19. ^ WHO International Agency for Research on Cancer "Tobacco Smoke and Involuntary Smoking" IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83, 2002
  20. ^ U.S. Surgeon General's Report on Secondhand Smoke (Chapter 8)
  21. ^ U.S. Surgeon General's Report on Secondhand Smoke (Chapter 5; pages 176 - 179)
  22. ^ The U.S. Surgeon General's Report on Secondhand Smoke (Chapter 5; pages 180-194)
  23. ^ U.S. Surgeon General's Report on Secondhand Smoke (Chapter 6; pages 311 - 319)
  24. ^ U.S. Surgeon General's Report on Secondhand Smoke (Chapter 9; pages 555 - 558)
  25. ^ U.S. Surgeon General's Report on Secondhand Smoke
  26. ^ Spencer N, Coe C. Parent reported longstanding health problems in early childhood: a cohort study. Arch Dis Child. 2003 Jul;88(7):570-3. PMID 12818898
  27. ^ de Jongste JC, Shields MD. Cough . 2: Chronic cough in children. Thorax. 2003 Nov;58(11):998-1003. PMID 14586058
  28. ^ Dybing E, Sanner T. Passive smoking, sudden infant death syndrome (SIDS) and childhood infections. Hum Exp Toxicol. 1999 Apr;18(4):202-5. PMID 10333302
  29. ^ a b DiFranza JR, Aligne CA, Weitzman M. Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics. 2004 Apr;113(4 Suppl):1007-15. PMID 15060193
  30. ^ Bull, P.D. (1996). Diseases of the Ear, Nose and Throat. Blackwell Science. ISBN 0-86542-634-1.
  31. ^ U.S. Surgeon General's Report on Secondhand Smoke (Chapter 6; pages 376 - 380)
  32. ^ Janson C (2004). "The effect of passive smoking on respiratory health in children and adults". Int J Tuberc Lung Dis. 8 (5): 510–6. PMID 15137524.
  33. ^ Richards GA, Terblanche AP, Theron AJ, Opperman L, Crowther G, Myer MS, Steenkamp KJ, Smith FC, Dowdeswell R, van der Merwe CA, Stevens K, Anderson R. Health effects of passive smoking in adolescent children. S Afr Med J. 1996 Feb;86(2):143-7. PMID 8619139
  34. ^ Richards GA, Terblanche AP, Theron AJ, Opperman L, Crowther G, Myer MS, Steenkamp KJ, Smith FC, Dowdeswell R, van der Merwe CA, Stevens K, Anderson R. Health effects of passive smoking in adolescent children. S Afr Med J. 1996 Feb;86(2):143-7. PMID 8619139
  35. ^ Taylor R; et al. (2001). "Passive smoking and lung cancer: a cumulative meta-analysis". Aust N Z J Public Health. 25 (3): 203–11. PMID 11494987. {{cite journal}}: Explicit use of et al. in: |author= (help)
  36. ^ He J; et al. (1999). "Passive smoking and the risk of coronary heart disease—a meta-analysis of epidemiologic studies". N Engl J Med. 340: 920–6. PMID 10089185. {{cite journal}}: Explicit use of et al. in: |author= (help)
  37. ^ Svendsen KH, Kuller LH, Martin MJ, Ockene JK. (1987). "Effects of passive smoking in the Multiple Risk Factor Intervention Trial". Am J Epidemiol. 126: 783–95. PMID 3661526.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  38. ^ Glantz, S.A. & Parmley, W., "Passive Smoking and Heart Disease: Epidemiology, Physiology, and Biochemistry", Circulation, 1991; 83(1): 1-12. [1] and Taylor, A., Johnson, D. & Kazemi, H., "Environmental Tobacco Smoke and Cardiovascular Disease", Circulation, 1992; 86: 699-702 [2].
  39. ^ Jang AS; et al. (2004). "The effect of passive smoking on asthma symptoms, atopy,and airway hyperresponsiveness in schoolchildren". J Korean Med Sci. 19 (2): 214–7. PMID 15082893. {{cite journal}}: Explicit use of et al. in: |author= (help)
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