Health Effects of Involuntary Smoking: Impact on Tobacco Use, Smoking Cessation, and Public Policies

In 1964, the subject of involuntary tobacco smoke inhalation was not addressed in the first report by the Surgeon General on the health consequences of tobacco smoking. In the reports that were to follow, the first discussion of involuntary smoking did not appear until the fifth report, released in 1971. Some 15 years later, substantial literature had been published on this subject and the 1986 report by the Surgeon General focused almost exclusively on this subject. The Surgeon General's silver anniversary edition, released in 1989, incorporated additional discussions on this topic, including a review of national, state, and local legislative policies. Probably no aspect of tobacco use has generated more controversy or had a greater impact on smoking practices by Americans; in addition, probably no other aspect of the tobacco and health issue has had more shoddy research and less reproducible results published. The purpose of this contribution is to review some of the more important data that are available; more than a thousand reports on this subject now appear in the literature and a comprehensive or complete review of all publications is beyond the intent and scope of this endeavor. We have tried to review in some detail the most frequently cited publications, including a summary of relevant supporting studies and specific criticisms. Unfortunately, the most frequently cited publications are not always the scientifically best investigations. It also is within the intent of this contribution, at least in some degree, to assess the impact of public policies pertaining to involuntary smoking on tobacco consumption in the United States, as well as on the development of successful smoking cessation strategies. The potentially harmful effects of tobacco smoke on the nonsmoker have become an ever progressively more important topic of debate. Until 1979, no more than about 300 articles had appeared in the literature on the health effects of tobacco smoke on the nonsmoker. At that time, in the United States, an estimated 54 million men and women smoked 615 billion cigarettes. A much larger number of nonsmokers most likely were exposed passively to the smoke resulting from this active and extensive cigarette consumption. Today, there are an estimated 50 million Americans still smoking only a somewhat slightly lesser number of cigarettes. Considering the very large number of persons still exposed to environmental tobacco smoke, detection of even a small percentage of nonsmokers experiencing the harmful effects of tobacco smoke from others would have important public health consequences. Because of the public health concerns for this matter, a fervent controversy has developed both in the scientific and in the lay press. The issue also has gained a tremendous momentum with the general public, because differing claims are made by those who smoke and by those who do not want to be exposed involuntarily to the smoke of others. It is common to see now on an almost daily basis well-publicized reports, as well as wellpublicized distortions, in the national news media, including newspapers, magazines, and television, dealing with passive smoking. A number of these reports quote on a regular basis highly placed public health officials who have major influence on the national policies related to tobacco smoking. However, unlike the direct health effects of tobacco smoking on the voluntary consumer, only sparse, and not nearly as solid, scientific data are available on the health effects of passive smoke inhalation. Far too frequently, reports receiving widespread