Q&A: The Dangers of Secondhand Smoke (web article)

U.S. Surgeon General Richard H. Carmona last week issued a report which concludes that secondhand smoke causes death and disease in children and adults and that there is no risk-free level of exposure to secondhand smoke. In addition, secondhand smoke puts children at an increased risk, specifically for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems and more severe asthma.

Kenna Lowe, with the Bloomberg School’s Office of Communications and Public Affairs, spoke to Jonathan M. Samet, MD, senior scientific editor of the Surgeon General’s report and chair of the Bloomberg School’s Department of Epidemiology, to learn more. This is the fifth Surgeon General’s report Samet has edited in 20 years.

Question: The Health Consequences of Involuntary Exposure to Tobacco Smoke is a 731-page report. What are the key points everyone should know?

Answer: Secondhand smoke is an important issue for public health globally. The key message from the 2006 report is that exposure to secondhand smoke causes death and disease in children and adults. As far as we know, no level of exposure is safe, no matter how brief. However, control of secondhand smoke is possible by eliminating smoking in indoor environments. Nothing short of eliminating smoking all together will fully protect nonsmokers. Air filter systems or moving more air in and out of buildings will not suffice.

There are six major conclusions highlighted in the report.

• Many millions of Americans are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.
• Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke.
• 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.
• Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
• The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
• 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.

Question: How were JHSPH faculty and students involved in the Surgeon General’s report?

Answer: This was an important report that our school had a major hand in developing. I was the senior scientific editor for the 2004 and 2006 reports, but our faculty, staff and students also completed a great deal of work. For this report, the Johns Hopkins contributors were Steve Goodman, [associate professor of oncology, pediatrics, epidemiology and biostatistics], Nora Lee, [epidemiology research program coordinator], Patricia O’Campo, [adjunct professor of population and family health sciences], Nicole Ammerman [epidemiology PhD-candidate], Caroline Fichtenberg [epidemiology PhD-candidate], Charlotte Gerczak [epidemiology research writer], Elizabeth Khaykin [epidemiology PhD-candidate], and Ericka Avila-Tang [epidemiology project coordinator]. Patrick Breysse [professor of environmental health sciences] reviewed parts of the report and Department of Epidemiology support staff were also involved.

With this most recent report, we put together the background evidence for our conclusions in a retrievable, web-based data system. The concept was something I originally developed for the Minnesota Tobacco trial. When we began our work with CDC, we used the same data system as a foundation for the approximately 1,600 articles on secondhand smoke that we examined and included in our analysis. Our thought was that we wanted to allow researchers to go to the data and look at the evidence themselves, organize it and do their own meta-analyses. We also intend that the data could be updated with new evidence in the future.

In the 2004 report, we put in place a uniform approach for classifying the evidence and evaluating it. For this report, my goal was to get the evidence systematically laid out. My job was to recruit authors, go over the chapters, edit and update, respond to reviews and ensure that all was correct. There were authors from all over the world.

Question: What can adults and children do to reduce their exposure to secondhand smoke?

Answer: Educating families about the dangers of secondhand smoke or even implementing family smoking policies can reduce exposure in the home. At work, the majority of adults are covered by a smoking ban. In total, 14 states and more than 250 local jurisdictions have clean indoor air legislation. However, as an example, in Maryland, the health of employees of restaurants with liquor licenses and bars is being overlooked in favor of profits to owners, who are reluctant to be smoke-free. You simply cannot accommodate smokers and nonsmokers in the same area and protect nonsmokers. Restaurant and bar owners will need to voluntarily go smoke-free or local and state governments will need to pass legislation requiring them to do so.

Question: What is the next step?

Answer: The key follow up steps include the dissemination of the Surgeon General’s report and its impact on policy. This report can have an important impact in the U.S. and globally. The whole world is struggling with controlling secondhand smoke. Some countries are already going smoke-free, but there are many where there is limited control. A hope of mine is that publication of this report will support a global movement towards smoke-free environments.

For more information on the Surgeon General’s Report, visit www.surgeongeneral.gov/library/secondhandsmoke/.