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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
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1
Introduction

Environmental tobacco smoke (ETS) occurs in homes, at workplaces, and in public places. The acute irritating and noxious effects of involuntary exposure to ETS, or “passive smoking,” are well established. Based in part on these irritating properties of ETS, a recent report of the NRC recommended a ban on smoking in the small enclosed spaces of airliner cabins (National Research Council, 1986). More than 20 states and numerous local governments have enacted legislation and policies restricting smoking (1985 information obtained from the Office on Smoking and Health, personal communications). Such public information campaigns and other actions have convinced a large portion of the population that active cigarette smoking is dangerous to health. To many, this also implies that exposure to ETS can affect health. This report, in part, evaluates whether the latter beliefs are warranted. It also makes recommendations for future exposure monitoring and epidemiologic research.

The issues are complex. In some cases the conclusions are uncertain, because much of the scientific data necessary to shed light on these concerns does not exist. This report addresses the following major issues pertaining to ETS:

  • The nature of the smoke. What constitutes ETS? What are the chemicals in ETS and what are the dilutions therein? There are two physical phases of smoke: particulate phase and vapor phase. What chemicals are in each phase? Are any of these chemicals carcinogenic or toxic, as determined in bioassays?

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
  • Factors affecting exposure and the assessment of exposure. To what extent is the nonsmoker exposed to harmful chemicals that can be measured in ETS? How can we measure exposure to ETS? Can ambient monitoring be used in epidemiological studies? How reliable is questionnaire information? What constitutes the dose a person may receive? Are there objective measures of dose received, such as tobacco-smoke-specific biological markers? What choices and reasons for choice are there among the markers?

  • Effects of exposure. What are the health effects, if any, consequent to exposure to ETS? Are these health effects related to discomfort or irritant effects only, or more serious disease? Are the potential health effects reversible when exposure ceases? What are the data from human studies? Do interactions with other environmental agents at workplaces or in homes need to be considered? Are there biologically plausible explanations for the various effects ascribed to ETS exposure?

The report considers sensitive populations such as children, pregnant women, older persons, and those with persisting respiratory illnesses. It does not consider the established effects on the fetus carried by a pregnant, smoking woman because this is not an instance in which a nonsmoking individual breathes ETS generated by other people. However, a pregnant, nonsmoking woman might be affected by exposure to ETS, as may her fetus.

The health effects considered include respiratory symptoms and lung function, and other respiratory ailments (especially in children), such as asthma and allergic responses, cancer at various sites, and cardiovascular disease, among others. Some attention is paid to irritation, annoyance, and associated responses.

DEFINITIONS

Environmental tobacco smoke (ETS) originates from the smoldering end of the tobacco product in between puffs, known as sidestream smoke (SS), and from the smoker’s exhaled smoke. [The smoke that the smoker inhales is known as mainstream smoke (MS).] Other contributors to ETS include minor amounts of smoke that escape during the puff-drawing from the burning cone and some vapor-phase components that diffuse through the cigarette paper into the environment. These various components are released into the environment and are diluted by ambient air. They

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

may also aggregate with pollutants already in the environment and thereby change character. The composition of this complex mixture, known as ETS, has different physicochemical characteristics than the MS.

There are various terms in the literature that refer to the inhalation of ETS by nonsmokers, e.g., “passive smoking,” “involuntary smoking,” and “breathing other people’s smoke.” We will refer to the inhalation of ETS by using the terms “passive smoking” and “exposure to ETS by nonsmokers” interchangeably.

TRENDS IN CIGARETTE USAGE

Exposure of nonsmokers to ETS is a function of several variables, one of which is the number of active smokers with whom the nonsmoker comes into contact throughout some period of time. The percent of the population who smoke steadily increased over the first two-thirds of this century but has declined more recently. In 1980, 32% of the adult population considered themselves to be cigarette smokers (U.S. Department of Commerce, 1984). This percentage, now roughly equal for men and for women, reflects a reduction of almost one-third in men since the publication of the first Surgeon General’s Report on Smoking and Health in 1964 (U.S. Public Health Service, 1964). Figure 1–1 shows the trends in cigarette usage between 1955 and 1985 for males and females. Table 1–1 gives cigarette consumption since 1900. Table 1–2 illustrates an overall increase in cigar and pipe smoking, followed by a decline during the past decade. The actual probability of exposure to ETS is complex, affected by ventilation rates, size of houses, restrictions on where tobacco products may be smoked, and changes in the cigarette itself. The consequence of Figure 1–1 is that the general probability of being exposed to some ETS for the nonsmoker has increased until quite recently.

The magnitude of exposure to ETS will depend upon the number of cigarettes and/or cigars and pipes smoked in a given environment, as well as other factors such as ventilation. Light smokers are more likely to stop smoking than heavy smokers, which might explain why over the past 30 years the number of cigarettes per smoker and the total consumption (Figure 1–2) have not declined as rapidly as the percentage of people who smoke (see also cigar and loose tobacco consumption in Table 1–2). From a peak consumption in the early 1960s, there has been a decline of

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

FIGURE 1–1 Percentage of current smokers in the United States. Adult population, by sex, 1955–1983. From Shopland and Brown (1985).

20% in the per capita (U.S.) consumption of cigarettes (Shopland and Brown, 1985). These data, however, are averaged over the total U.S. population, including smokers and nonsmokers. Among persons who consider themselves smokers, the cigarette consumption per adult smoker actually has increased from 27.3 to 30.0 cigarettes per day. Table 1–3 demonstrates that, for both sexes, the percent of smokers who are heavy smokers has steadily increased over the past 30 years. Therefore, the consumption per active smoker indicates that the nonsmoker who has close contact with a smoker may be exposed to greater amounts of smoke in 1985 than in 1955, although the total number of hours a nonsmoker is exposed to ETS would have declined.

Counteracting this trend of increased exposure has been the trend of reduction in amount of tobacco used to fill each cigarette. Physical changes of the leaf due to modern methods of processing, the use of filter tips (United States, >90% of all cigarettes since

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

TABLE 1–1 U.S. Cigarette Consumption, 1900 to 1985a

Year

Total Billions

Number Per Capita, 18 Years and Older

Year

Total Billions

Number Per Capita, 18 Years and Older

Year

Total Billions

Number Per Capita, 18 Years and Older

1900

2.5

54

1930

119.3

1,485

1960

484.4

4,171

1901

2.5

53

1931

114.0

1,399

1961

502.5

4,266

1902

2.8

60

1932

102.8

1,245

1962

508.4

4,265

1903

3.1

64

1933

111.6

1,334

1963

523.9

4,345

1904

3.3

66

1934

125.7

1,483

1964

511.3

4,195

1905

3.6

70

1935

134.4

1,564

1965

528.8

4,259

1906

4.5

86

1936

152.7

1,754

1966

541.3

4,287

1907

5.3

99

1937

162.8

1,847

1967

549.3

4,280

1908

5.7

105

1938

163.4

1,830

1968

545.6

4,186

1909

7.0

125

1939

172.1

1,900

1969

528.9

3,993

1910

8.6

151

1940

181.9

1,976

1970

536.5

3,985

1911

10.1

173

1941

208.9

2,236

1971

555.1

4,037

1912

13.2

223

1942

245.0

2,585

1972

566.8

4,043

1913

15.8

260

1943

284.3

2,956

1973

589.7

4,148

1914

16.5

267

1944

296.3

3,039

1974

599.0

4,141

1915

17.9

285

1945

340.6

3,449

1975

607.2

4,123

1916

25.2

395

1946

344.3

3,446

1976

613.5

4,092

1917

35.7

551

1947

345.4

3,416

1977

617.0

4,051

1918

45.6

697

1948

358.9

3,505

1978

616.0

3,967

1919

48.0

727

1949

360.9

3,480

1979

621.5

3,861

1920

44.6

665

1950

369.8

3,522

1980

631.5

3,851

1921

50.7

742

1951

397.1

3,744

1981

640.0

3,840

1922

53.4

770

1952

416.0

3,886

1982

634.0

3,753

1923

64.4

911

1953

408.2

3,778

1983

600.0

3,502

1924

71.0

982

1954

387.0

3,546

1984

600.4b

3,461b

1925

79.8

1,085

1955

396.4

3,597

1985

595.0c

3,384c

1926

89.1

1,191

1956

406.5

3,650

 

1927

97.5

1,279

1957

422.5

3,755

1928

106.0

1,366

1958

448.9

3,953

1929

118.6

1,504

1959

467.5

4,073

aIncludes overseas forces, 1917–1919 and 1940 to date. Commodity Economics Division, Economic Research Service, USDA.

bSubject to revision.

cEstimated.

SOURCE: U.S. Department of Agriculture, 1985.

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

FIGURE 1–2 Total cigarette consumption (domestic sales), 1955–1985.

1978; Griese, 1984), and variations in the composition of tobacco blends for cigarettes (Norman, 1982) have made this reduction possible.

In 1956, the U.S. average tar and nicotine yields were 38.4 mg and 2.69 mg, respectively. Since then, tar and nicotine yields have steadily decreased to 13.2 mg tar and 0.95 mg nicotine in 1980 (The Tobacco Institute, 1981). However, tar and nicotine yields in the SS of cigarettes have not significantly changed except

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

TABLE 1–2 U.S. Consumption of Cigars and Tobacco for Pipes and Hand-rolled Cigarettes

Year

Cigars, millions

Tobacco, Mn. lba

Year

Cigars, millions

Tobacco, Mn. lba

Year

Cigars, millions

1920

8,609

1950

5,608

104.3

1980

5,386

1921

7,435

1951

5,778

97.4

1981

5,231

1922

7,527

1952

6,037

92.9

1982

4,901

1923

7,505

1953

6,107

84.3

1983

4,884

1924

7,189

1954

6,024

81.2

 

1925

6,949

1955

6,078

77.8

1926

7,008

1956

6,039

70.0

1927

7,008

1957

6,194

68.9

1928

6,874

1958

6,586

74.4

1929

6,972

1959

7,377

71.9

1930

6,272

1960

7,434

72.2

1931

5,656

1961

7,083

72.7

1932

4,724

1962

7,103

69.8

1933

4,553

1963

7,434

69.7

1934

4,818

1964

9,899

81.7

1935

4,943

1965

8,949

69.8

1936

5,362

1966

8,610

68.6

1937

5,516

1967

8,403

66.4

1938

5,294

1968

8,331

69.6

1939

5,469

1969

8,579

68.3

1940

5,491

1970

8,881

74.0

1941

5,933

1971

8,830

69.5

1942

6,339

1972

11,125

66.8

1943

5,350

1973

11,126

59.5

1944

4,878

1974

9,339

 

1945

5,027

1975

8,663

1946

5,929

1976

7,492

1947

5,706

1977

6,792

1948

5,860

1978

6,231

1949

5,625

1979

5,706

aTobacco for pipes and hand-rolled cigarettes, not available prior to 1950.

SOURCES: Lee, 1975; Tobacco Reporter, 1984.

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

TABLE 1–3 Number of Cigarettes Smoked per Day, as a Percentage of Current Smokers, by Sex

 

Less Than 15

15–24

25 or More

Males

 

1965

30.1

45.7

24.1

1976

24.9

44.4

30.7

1980

24.2

41.7

34.2

1983

23.5

42.9

33.6

Females

 

1965

46.2

40.8

13.0

1976

37.6

43.4

19.0

1980

34.7

42.0

23.0

1983

33.8

45.6

20.6

SOURCE: Shopland and Brown, 1985.

in the case of cigarettes designed for ultralow yields of tar and nicotine. Certain other components, in particular volatile, toxic components, are released into SS in significantly greater amounts than into MS. Furthermore, ETS contains significantly smaller particles than MS, and nicotine, and perhaps other smoke constituents, is volatilized to a greater extent in SS than in MS. This means that the gas-phase composition of SS differs substantially from that of MS.

The health implications to nonsmokers of exposure to ETS may not be a simple extrapolation from the studies of active smokers. The complexities of such extrapolations will be discussed.

Children represent a large population of nonsmokers who may be exposed to environmental smoke. Several cohort studies of children are reviewed in Chapter 11. Although there is some variation among these studies, they indicate, mainly through questionnaires, that between 50 and 65 percent of the children have been exposed to tobacco smoke in the home during the past 20 years. Health implications of this exposure for the developing child will be discussed.

ORGANIZATION

This report begins with a discussion of the components of ETS (Chapter 2) and what in vivo and in vitro studies have determined about ETS (Chapter 3). Various methods of exposure assessment

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

are considered in Chapters 4 through 8, including physical effects, questionnaires, and biological markers. Chapters 9 through 15 review epidemiologic studies of possible health effects of these exposures. The health consequences examined range from irritation and allergic reactions to cancer and cardiovascular disease. Only studies that assess exposures under experimental conditions or in the home are included. ETS potentially interacts with constituents of the ambient air. This makes the evaluation of possible health effects due to workplace exposure complex and specific to each situation because of the varying nature of contaminants. Each chapter concludes with a summary of what is currently known, the strength of that knowledge, and what additional information would further clarify the relationship of ETS and possible health effects. Some recommendations for additional research are also given.

REFERENCES

Griese, V.N. Market growth of reduced tar cigarettes. Recent Adv. Tob. Sci. 10:4–14, 1984.


Lee, P.N., Ed. Tobacco Consumption in Various Countries, pp. 82–84. London, England: Tobacco Research Council, 1975.


National Research Council, Committee on Airliner Cabin Air Quality. Airliner Cabin Environment: Air Quality and Safety. Washington, D.C.: National Academy Press, 1986. 303 pp.

Norman, V. Changes in smoke chemistry of modern day cigarettes. Recent Adv. Tob. Sci. 8:141–177, 1982.


Shopland, D.R., and C.Brown. Changes in cigarette smoking prevalence in the U.S.: 1955–1983. Ann. Behav. Med. 7:5–8, 1985.


The Tobacco Institute. U.S. tar/nicotine levels dropping. The Tob. Observ. 6:1, 1981.

Tobacco Reporter. Cigars in the U.S.: Is the upturn real? Tob. Rep. 111:43–46, 1984.


U.S. Department of Agriculture. Tobacco: Outlook and Situation Report. DOA Publ. No. TS-129. Washington, D.C.: U.S. Government Printing Office, 1985.

U.S. Department of Commerce. Statistical Abstract of the United States: 1985. Washington, D.C.: U.S. Department of Commerce, Bureau of the Census, 1984. 119 pp.

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

I
PHYSICOCHEMICAL AND TOXICOLOGICAL STUDIES OF ENVIRONMENTAL TOBACCO SMOKE

Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×

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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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Suggested Citation:"INTRODUCTION." National Research Council. 1986. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/943.
×
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This comprehensive book examines the recent research investigating the characteristics and composition of different types of environmental tobacco smoke (ETS) and discusses possible health effects of ETS. The volume presents an overview of methods used to determine exposures to environmental smoke and reviews both chronic and acute health effects. Many recommendations are made for areas of further research, including the differences between smokers and nonsmokers in absorbing, metabolizing, and excreting the components of ETS, and the possible effects of ETS exposure during childhood and fetal life.

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