This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Kyle Steenland, PhD

JAMA. 1992;267(1):94-99.

Abstract
Objective.
—This paper reviews the evidence that exposure to environmental tobacco smoke (ETS) increases the risk of heart disease death among persons who have never smoked (never-smokers). The annual number of heart disease deaths in the United States attributable to ETS is estimated, as is the individual risk of heart disease death for exposed never-smokers.

Data Sources.
—Nine epidemiologic studies and numerous experimental studies are available to evaluate the association of ETS and heart disease.

Data Synthesis.
—The relative risk for never-smokers living with current or former smokers, compared with never-smokers living with nonsmokers, has ranged from 0.9 to 3.0 in nine studies. Seven studies were positive, one was positive for women but not men, and one was negative. Several studies have shown a dose-response relationship and have controlled for other risk factors. Evidence from experimental studies suggests that ETS can damage the cardiovascular system, via both short-term and long-term mechanisms. Assuming that the observed heart disease risk for those exposed to ETS is not an artifact of misclassification or confounding, approximately 35000 to 40000 deaths from ischemic heart disease among never-smokers and long-term former smokers are estimated to have occurred annually in the United States as a result of ETS exposure in the early 1980s. An individual male never-smoker living with a current or former smoker is estimated to have an approximately 9.6% chance of dying of ischemic heart disease by the age of 74 years, compared with a 7.4% chance for a male never-smoker living with a nonsmoker. The corresponding lifetime risks for women are 6.1% and 4.9%.

Conclusions.
—The public health burden due to ETS exposure is likely to be much greater for heart disease than for lung cancer, which has been the focus of most debate to date. Individual lifetime excess risks of heart disease death due to ETS of one to three per 100 can be compared with much lower excess risks of one death per 100 000, which are often used in determining environmental limits for other toxins. Exposure to ETS is not currently regulated at the federal level, except for domestic air traffic.

(JAMA. 1992;267:94-99)

Author Affiliations
From the National Institute for Occupational Safety and Health, Cincinnati, Ohio.

Footnotes
Reprint requests to the National Institute for Occupational Safety and Health, Mailstop R13, 4676 Columbia Pkwy, Cincinnati, OH 45226 (Dr Steenland).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

American Cancer Society Perspectives on Environmental Factors and Cancer
Fontham et al.
CA Cancer J Clin 2009;59:343-351.
ABSTRACT | FULL TEXT  

Mortality and morbidity from coronary heart disease attributable to passive smoking
Heidrich et al.
Eur Heart J 2007;28:2498-2502.
ABSTRACT | FULL TEXT  

Overexpression of lysosomal Acid lipase and other proteins in atherosclerosis.
Zschenker et al.
J Biochem 2006;140:23-38.
ABSTRACT | FULL TEXT  

Population level policy options for increasing the prevalence of smokefree homes.
Thomson et al.
J. Epidemiol. Community Health 2006;60:298-304.
ABSTRACT | FULL TEXT  

Risks for Heart Disease and Lung Cancer from Passive Smoking by Workers in the Catering Industry
Hedley et al.
Toxicol Sci 2006;90:539-548.
ABSTRACT | FULL TEXT  

Psychosocial work conditions, unemployment, and leisure-time physical activity: A population-based study
Mohammad Ali and Lindstrom
Scand J Public Health 2006;34:209-216.
ABSTRACT  

Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm
Raupach et al.
Eur Heart J 2006;27:386-392.
ABSTRACT | FULL TEXT  

Role of Smoking in Global and Regional Cardiovascular Mortality
Ezzati et al.
Circulation 2005;112:489-497.
ABSTRACT | FULL TEXT  

Cardiovascular Effects of Secondhand Smoke: Nearly as Large as Smoking
Barnoya and Glantz
Circulation 2005;111:2684-2698.
ABSTRACT | FULL TEXT  

Prenatal Environmental Tobacco Smoke Exposure Promotes Adult Atherogenesis and Mitochondrial Damage in Apolipoprotein E-/- Mice Fed a Chow Diet
Yang et al.
Circulation 2004;110:3715-3720.
ABSTRACT | FULL TEXT  

Tobacco Industry Efforts to Defeat the Occupational Safety and Health Administration Indoor Air Quality Rule
Bryan-Jones and Bero
AJPH 2003;93:585-592.
ABSTRACT | FULL TEXT  

Social capital and leisure time physical activity: a population based multilevel analysis in Malmo, Sweden
Lindstrom et al.
J. Epidemiol. Community Health 2003;57:23-28.
ABSTRACT | FULL TEXT  

Science in regulatory policy making: case studies in the development of workplace smoking restrictions
Bero et al.
Tobacco Control 2001;10:329-336.
ABSTRACT | FULL TEXT  

Passive smoking in the home: plasma cotinine concentrations in non-smokers with smoking partners
Jarvis et al.
Tobacco Control 2001;10:368-374.
ABSTRACT | FULL TEXT  

The Smoke You Don't See: Uncovering Tobacco Industry Scientific Strategies Aimed Against Environmental Tobacco Smoke Policies
Muggli et al.
AJPH 2001;91:1419-1423.
ABSTRACT | FULL TEXT  

Policy makers' perspectives on tobacco control advocates' roles in regulation development
Montini and Bero
Tobacco Control 2001;10:218-224.
ABSTRACT | FULL TEXT  

Acute Effects of Passive Smoking on the Coronary Circulation in Healthy Young Adults
Otsuka et al.
JAMA 2001;286:436-441.
ABSTRACT | FULL TEXT  

Print media coverage of research on passive smoking
Kennedy and Bero
Tobacco Control 1999;8:254-260.
ABSTRACT | FULL TEXT  

Effects of L-Arginine on Atherogenesis and Endothelial Dysfunction due to Secondhand Smoke
Hutchison et al.
Hypertension 1999;34:44-50.
ABSTRACT | FULL TEXT  

Passive Smoking and the Risk of Coronary Heart Disease -- A Meta-Analysis of Epidemiologic Studies
He et al.
NEJM 1999;340:920-926.
ABSTRACT | FULL TEXT  

Publicans and passive smoking: a survey of publicans' views on tobacco smoke in their workplaces
Davies
Health Education Journal 1999;58:271-279.
ABSTRACT  

Passive Smoking and Coronary Heart Disease • Response
Gori and Kawachi
Circulation 1998;97 :1871-1873.
FULL TEXT  

Coronary events and exposure to environmental tobacco smoke: a case-control study from Australia and New Zealand
McElduff et al.
Tobacco Control 1998;7:41-46.
ABSTRACT | FULL TEXT  

Cigarette Smoking and Progression of Atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Study
Howard et al.
JAMA 1998;279:119-124.
ABSTRACT | FULL TEXT  

Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence
Law et al.
BMJ 1997;315:973-980.
ABSTRACT | FULL TEXT  

Chronic Dietary L-Arginine Prevents Endothelial Dysfunction Secondary to Environmental Tobacco Smoke in Normocholesterolemic Rabbits
Hutchison et al.
Hypertension 1997;29:1186-1191.
ABSTRACT | FULL TEXT  

Effect of Environmental Tobacco Smoke on LDL Accumulation in the Artery Wall
Roberts et al.
Circulation 1996;94:2248-2253.
ABSTRACT | FULL TEXT  

Industry-Funded Research and Conflict of Interest: An Analysis of Research Sponsored by the Tobacco Industry through the Center for Indoor Air Research
Barnes and Bero
Journal of Health Politics, Policy and Law 1996;21:515-542.
ABSTRACT  

State-of-the-Art Review : Sex and Cardiovascular Risk Factors
Prisco et al.
CLIN APPL THROMB HEMOST 1996;2:94-102.
 

Passive Smoking and Impaired Endothelium-Dependent Arterial Dilatation in Healthy Young Adults
Celermajer et al.
NEJM 1996;334:150-155.
ABSTRACT | FULL TEXT  

Atherosclerosis and Risk Factor Modification: Does It Really Make a Difference?
Corson et al.
PERSPECT VASC SURG ENDOVASC THER 1996;9:75-94.
 

Occupational Exposure to Environmental Tobacco Smoke
Hammond et al.
JAMA 1995;274:956-960.
ABSTRACT  

Passive Smoking and Heart Disease: Mechanisms and Risk
Glantz and Parmley
JAMA 1995;273:1047-1053.
ABSTRACT  

Patient-Directed, Nonprescription Approaches to Cardiovascular Disease
Simon
Arch Intern Med 1994;154:2283-2296.
ABSTRACT  

Environmental Tobacco Smoke: Health Effects and Prevention Policies
Council on Scientific Affairs, American Medical As
Arch Fam Med 1994;3:865-871.
ABSTRACT  

Publication Bias and Public Health Policy on Environmental Tobacco Smoke
Bero et al.
JAMA 1994;272:133-136.
ABSTRACT  

Priorities for Research in the Field of Indoor Air Pollution
Roe
Indoor and Built Environment 1994;3:191-199.
ABSTRACT  

The Human Costs of Tobacco Use- First of Two Parts
Bartecchi et al.
NEJM 1994;330:907-912.
FULL TEXT  

Sponsored Symposia on Environmental Tobacco Smoke
Bero et al.
JAMA 1994;271:612-617.
ABSTRACT  

Passive smoking at work as a risk factor for coronary heart disease in Chinese women who have never smoked
He et al.
BMJ 1994;308:380-384.
ABSTRACT | FULL TEXT  

Indoor Air Quality and Respiratory Disease
Weetman
Indoor and Built Environment 1994;3:5-12.
 

Smoke and Letters
Rennie
JAMA 1993;270:1742-1743.
ABSTRACT  

Lower Levels of Cigarette Consumption Found in Smoke-Free Workplaces in California
Woodruff et al.
Arch Intern Med 1993;153:1485-1493.
ABSTRACT  

Cigarette Smoking, Nicotine Addiction, and Its Pharmacologic Treatment
Lee and D'Alonzo
Arch Intern Med 1993;153:34-48.
ABSTRACT  

Environmental Tobacco Smoke and Heart Disease
Aviado
JAMA 1992;267:3284-3285.
ABSTRACT