The smoking gun - passive smoke hazards - includes related articles on cigarette advertising, on exporting cigarettes, and on environmental tobacco smoke - Cover Story

E: The Environmental Magazine, Oct, 1994 by Alice Horrigan

Despite the cigarette dangling from her fingers as she took a smoking break outside a Norwalk, Connecticut clothing shop, Cindy Habighorst is no campaigner for smoker's rights. "It's a sticky habit," she said. "There should be designated areas for smokers, and the workplace should be kept smoke free. There's no smoking inside my store. I think you should pick a place if you choose to smoke, but don't let it affect other people."

Delivery driver Allen Lea from 70 miles away in Hartford, Connecticut doesn't smoke, by he's nonetheless wary of losing his personal freedom. "It's the Gestapo government!" he said, gesticulating wildly. "Don't go telling people what to do. The government can't prove anything about passive smoke--they're full of political crap. My wife is a smoker and I don't have lung cancer so don't even tell me about it!"

Tobacco is the most conspicuous pollutant of our time and also one of our most persistent battlegrounds. Unlike radiation and smog, it has an odor and taste. Smoke curls and settles in people's living rooms, and rises unwanted into innocent nostrils and lungs. Cigarette butts are ubiquitous--lipstick-smeared in ashtrays, swollen in toilet-bowl waters and flattened into the textures of our urban walkways.

U.S. smokers produce 500 billion butts per year. Combined with the pivotal Environment Protection Agency (EPA) risk assessment of second-hand smoke release last year, the immediacy of cigarette smoke has made tobacco--whether it deserves it or not--the nation's highest-profile environmental issue. But is the risk from passive smoke overstated? A hotly contested congressional report says it is.

Tobacco kills an estimated 400,000 active smokers per year. But only recently has it also become an environmental issue--one that ignites complex debates about individual choice, personal space, community, social norms and morality. "It's not just a nuisance, but also a threat to public health," says Representative Henry Waxman (D-CA), torchbearer of anti-smoking legislation.

We now know more about the effects of environmental tobacco smoke (ETS)--the official term for gases and particulates that disperse into the air when a smoker smokes--than any other indoor air pollutant. Also called "passive" or "second-hand" smoke, ETS until a few years ago hardly had a name; today it is well on its way to being abolished or severely curtailed in most public places.

But approximately 26 percent of the adult population (some 46 million people) in the U.S. continues to smoke, which means that every American will likely be exposed to ETS for years to come. For all its importance, though, the ETS debate is far from over.

The ETS Threat: Big or Small?

What we knew about ETS comes mainly from one source: the EPA's official risk assessment, "Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders." Published in January 1993, the assessment is the result of the EPA's examination of existing epidemiologic studies on women exposed to their husbands' tobacco smoke and on children exposed to parents' smoke. The conclusions of the analysis are alarming: that in the U.S., ETS may be responsible for 3,000 cases of lung cancer annually (1,000 of them among former smokers), and may cause from 150,000 to 300,000 lower respiratory-tract infections, such as bronchitis and pneumonia, in babies under 18 months old. ETS may also aggravate symptoms in asthmatic children, and may even cause new cases of asthma--although no proof was found in the studies. Passive smoke is additionally implicated in many thousands of deaths a year.

Partly because ETS consists of the same carcinogenic chemicals found in mainstream smoke (inhaled by the smoker), the report concludes that ETS can itself be classified by the EPA as a "Group A" carcinogen along with arsenic, asbestos, benzene and radon. The report confirms what non-smokers have long suspected: ETS is not just an annoyance, it's a "pollutant." In the words of the risk assessment, ETS poses "a serious and substantial public health impact."

Studies have shown that lung cancer in active smokers is dose related: The longer and more a person smokes, the more likely his or her chance of dying from the disease. Is there a safe threshold for ETS exposure? It's not easy to find an answer. According to John Banzhaf, executive director of Action on Smoking and Health, an antismoking group in Washington, DC, no amount of ETS is safe; cancer can be triggered by a single molecule, a trace amount of "one of the many elements of cigarettes, such as benzene."

But the EPA bio-statistician who headed the ETS risk study, Steve Bayard, disagrees. "My feeling is that's really overstating the case," he said. "Small doses aren't going to kill you." The risks of cancer and other illnesses from ETS are very real, he emphasizes, but relatively speaking, not very high.

Assuming that the EPA assessment is accurate, a nonsmoker's exposure to ETS in social situations, restaurants and other environments over a lifetime increases the chance of lung cancer by one in a thousand. For those with a smoking spouse, the increase is doubled, Even without ETS, a non-smoker still has a four-in-a-thousand chance of getting lung cancer from other causes, such as radon exposure.