BOX 8-1

Specific Questions to the Committee

The Centers for Disease Control and Prevention requested that the IOM convene an expert committee to assess the state of the science on the relationship between secondhand smoke exposure and acute coronary events. Specifically, the committee was to review available scientific literature on secondhand smoke exposure (including short-term exposure) and acute coronary events, and produce a report characterizing the state of the science on the topic, with emphasis on the evidence for causality and knowledge gaps that future research should address.

In conducting its work the committee was to address the following questions:

  1. What is the current scientific consensus on the relationship between exposure to secondhand smoke and cardiovascular disease? What is the pathophysiology? What is the strength of the relationship?

  2. Is there sufficient evidence to support the plausibility of a causal relation between secondhand smoke exposure and acute coronary events such as acute myocardial infarction and unstable angina? If yes, what is the pathophysiology? And what is the strength of the relationship?

  3. Is it biologically plausible that a relatively brief (e.g., under 1 hour) secondhand smoke exposure incident could precipitate an acute

tegrate all sources of exposure and inhalation rates, but cannot identify the place where secondhand-smoke exposure occurred and, because of a short half-life they reflect only recent exposures. Airborne measures of exposure can demonstrate the contribution of different sources or venues of exposure and can be used to measure changes in secondhand-smoke concentrations at individual venues, but they do not reflect the true dose. Airborne concentration of nicotine is a specific tracer for secondhand smoke. Particulate matter (PM) can also be used as an indicator of secondhand-smoke exposure, but because there are other sources of PM it is a less specific tracer than nicotine. The concentration of cotinine in serum, saliva, or urine is a specific indicator of integrated exposure to secondhand smoke.

Although in most of the smoking-ban studies the magnitude, frequency, and duration of exposures that occurred before a ban are not known, monitoring studies demonstrate that exposure to secondhand smoke is dramatically reduced in places that are covered by bans. Airborne nicotine



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