Surgeon general's dire new warning on secondhand smoke

WASHINGTON — Secondhand smoke dramatically increases the risk of heart disease and lung cancer in nonsmokers and can be controlled only by making indoor spaces smoke-free, according to a comprehensive report issued Tuesday by U.S. Surgeon General Richard Carmona.

"The health effects of secondhand-smoke exposure are more pervasive than we previously thought," Carmona said. "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."

According to the report, the government's most detailed statement ever on secondhand smoke, exposure to smoke at home or work increases the nonsmokers' risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. It is especially dangerous for children living with smokers and is known to cause sudden infant death syndrome, respiratory problems, ear infections and asthma attacks in infants and children.

The report found that nearly half of all nonsmoking Americans are still regularly exposed to smoke from others. It concludes that any exposure to secondhand smoke is a risk to nonsmokers, and as a result the only way to protect nonsmokers is to eliminate indoor smoking.

"Restrictions on smoking can control exposures effectively, but technical approaches involving air cleaning or a greater exchange of indoor with outdoor air cannot," the report says. "Consequently, nonsmokers need protection through the restriction of smoking in public places and workplaces and by a voluntary adherence to policies at home, particularly to eliminate exposures of children."

In Washington state, voters by a 2-to-1 ratio last fall banned smoking in all restaurants, bars, nontribal casinos, bowling alleys, skating rinks, reception areas and workplaces. The law, which took effect Dec. 8, also prohibits smoking within 25 feet of the doorways of those businesses.

Before the statewide vote, the Washington Restaurant Association reported that 80 percent of its members were smoke-free establishments, compared with 45 percent six years ago. The group represents more than 4,500 restaurants, bars and other businesses.

The tobacco industry has been somewhat divided on the dangers of secondhand smoke, with R.J. Reynolds Tobacco Co. saying the science remains inconclusive and Philip Morris USA generally willing to accept public-health advocates' conclusions. All the companies, however, were accused by the Justice Department of conspiring to undercut the scientific consensus on secondhand smoke, and that charge remains part of the department's lawsuit against them.

A Philip Morris spokeswoman said Tuesday that the company was reviewing the report, while R.J. Reynolds spokesman David Howard said the report "does not change our views about secondhand smoke." He said the company continued to believe that owners of bars, nightclubs and other places restricted to adults should decide whether to allow smoking.

The report finds that even the most sophisticated ventilation systems cannot eliminate secondhand smoke and that only smoke-free environments are risk-free. Carmona called state and local mandates for smoke-free buildings a major public-health success that has had enormous positive effects. Levels of cotinine, a biological marker for secondhand smoke exposure, have fallen by 70 percent in nonsmokers since the late 1980s, he said.

The report does not present new scientific data, but rather is a compilation of research that has been conducted over the past two decades.

Nonetheless, experts hope it will galvanize public sentiment in much the same way that the 1964 Surgeon General's report on smoking and health did, accelerating the momentum toward an extension of smoke-free laws to cover the estimated 126 million nonsmokers who are now unprotected.

"This report once and for all ends any scientific debate about whether exposure to secondhand smoke is a cause of serious diseases like lung cancer and heart disease," said Matthew Myers of the Campaign for Tobacco-Free Kids.

The report, he said, "leads to one inescapable conclusion: Only comprehensive smoke-free workplace laws can protect all workers and the public from the serious, proven health risks of secondhand smoke."

American Medical Association President-elect Ron Davis added, "This report should be a wake-up call for lawmakers to enact comprehensive clean indoor air laws that prohibit smoking in all indoor public places and workplaces."

A key argument of some business owners' legal challenges to smoking bans is that customers who smoke will go elsewhere, cutting their profits.

But the surgeon general's report concludes that's not true. It cites a list of studies that found no negative economic impact from city and state smoking bans — including evidence that New York restaurants and bars increased business by almost 9 percent after going smoke-free.

More than 50 cancer-causing chemicals can be found in secondhand smoke, and smokers and nonsmokers in rooms with smokers inhale many of the same toxins. Because the bodies of infants and children are still developing, the report says, they are at special risk from secondhand smoke. Even short exposure to secondhand smoke can lead to immediate cardiovascular problems and to long-term heath problems, the report concludes.

The surgeon general last addressed secondhand smoke in 1986. The Environmental Protection Agency and the California EPA have both addressed the issue since then — concluding that nonsmokers are at risk for secondhand smoke — but the surgeon general generally is considered the nation's most authoritative source on issues of science and tobacco.

Material from The Associated Press, Los Angeles Times and Seattle Times staff is included in this report.