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The American Cancer Society

Secondhand Smoke: The Surgeon General's Report

by Dr. Len June 27, 2006

Twenty years ago, Surgeon General C. Everett Koop wrote, “The right of smokers to smoke ends where their behavior affects the health and well-being of others.”


Today, the current Surgeon General, Richard Carmona, MD, emphasized that statement and added evidence to the argument that secondhand smoke, or involuntary exposure to tobacco smoke, has severe health consequences. 


His report released this morning and titled “The Health Consequences of Involuntary Exposure to Tobacco Smoke” is thorough and hard hitting, with a clear message.


The evidence cannot be overlooked: secondhand smoke kills, secondhand smoke harms, and secondhand smoke has no safe limit of exposure.


And, according to the Surgeon General, the only effective strategy to reduce the adverse health effects of secondhand smoke is to remove it from our work, home, recreational and hospitality environments.  Anything less than a complete ban simply won’t work.


We have come a long way over the past four decades regarding our knowledge of the harms of cigarette smoking.  There likely aren’t many folks who aren’t aware of the dangers of smoking cigarettes, and for many who do smoke there are many who try repeatedly to quit.


We haven’t been as effective in convincing everyone that second hand smoke is also dangerous to our health, but we have made some progress over the past twenty years since the release of the last Surgeon General’s report which specifically addressed the harms of second hand smoke. 


We still have a long way to go, according to the evidence presented by Dr. Carmona.


Probably the most important messages from the Surgeon General’s report which was released today are what they call the “Major Conclusions.”


Here they are, with some of the points highlighted by me for emphasis:


  • Second hand smoke causes premature death and disease in children and in adults who do not smoke


  • Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma.  Smoking by parents causes respiratory symptoms and slows lung growth in their children.


  • Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.


  • The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.


  • Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.


  • Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke.  Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.


If those are the only points you remember from the extensive scientific review and documentation contained in the report, then you understand enough to realize that this thorough analysis makes the exceptionally strong case for smoke-free environments essentially a no-brainer.


In addition, there are no rational arguments left to oppose smoke-free environments, or to speak against the legislation and regulation required to make them happen in communities across this nation.


Dr. Carmona talked about the fact that many people think that if they have only a little exposure there is no harm.


Not so, he pointed out. 


The Surgeon General was emphatic in his press conference this morning that secondhand smoke is harmful, and the effects are immediate. 


The effects on the cardiovascular system of secondhand smoke on non-smokers can be almost immediate.  If you have coronary artery disease, and you are a non-smoker (perhaps you are a former smoker) and you enter a smoke filled environment, the adverse effects of the second hand smoke in the environment can have an instantaneous effect on your body, your health and maybe even your life if it triggers a heart attack.


The report cites estimates that there about 46,000 excess deaths annually from cardiovascular disease and 3400 excess deaths each year from lung cancer related to secondhand smoke.


I think you will agree that these are not trivial numbers, and each life is a universe of its own, precious to those who know and love the people who die prematurely and unnecessarily (that, in plain English, is what the scientists mean when they say “excess deaths”).


The Surgeon General also takes on the tobacco companies and others who have used tactics that are, shall we say, less than open and honest.


Let me quote some interesting comments from the report:


“The evidence on secondhand smoke and disease risk, given the public health and public policy implications, has been reviewed extensively in the published peer-reviewed literature and in evaluations by a number of expert panels.  In addition, the evidence has been criticized repeatedly by the tobacco industry and its consultants in venues that have included the peer-reviewed literature, public meetings and hearings, and scientific symposia that included symposia sponsored by the industry.  Open criticism in the peer-reviewed literature can strengthen the credibility of scientific evidence by challenging researchers to consider the arguments proposed by critics and to rebut them.


“Industry documents indicate that the tobacco industry has engaged in widespread activities, however, that have gone beyond the bounds of accepted scientific practice.  Through a variety of organized tactics, the industry has attempted to undermine the credibility of the scientific evidence on secondhand smoke.  The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus.”


These are harsh words to be sure, but perhaps the circumstances demand that level of discourse.


We know secondhand smoke is bad.  60% of the citizens of this country have evidence in their bodies of exposure to secondhand smoke.  Our homes are becoming the primary places where this exposure occurs, and 126 million workers are still subject to secondhand smoke in their workplaces.


What more do we need to know? 


What more do our political leaders at the local, state, and national levels need to hear to understand the issue? 


Help me understand what more we can say, what more we can do, what more we can study to prove that smoking is bad not only for the smoker, but for everyone around them (including their spouse, who has a 25% greater chance of getting lung cancer than if they lived with someone who did not smoke)?


Let’s face the facts: even this administration, which is clearly pro-business, has produced a document which says the only way to produce a safe environment is to ban smoking from the building.


No fans, no ventilators, no separate rooms for smokers, no bars where kids can’t eat—NOTHING has been shown to reduce the levels of secondhand smoke to a safe level of zero except getting it out of the building completely.


That, to me, is the key message of the report and it is one that the Surgeon General emphasized clearly in his press conference this morning.


The science is overwhelming, the business case is overwhelming, and the human impact is overwhelming.


I guess I am perhaps a bit angry that it has taken us this long to get to where we are.  At the same time, we shouldn’t ignore the progress that has been made. 


But this stuff is bad, we know it’s bad, and I wonder how much more effort and time will have to expended to convince those that lead, and those that vote, that secondhand smoke is bad for everyone.


I suggest that we take a close look at the overwhelming evidence in the Surgeon General’s report, and make it very clear that the time for excuses is over, and the time for action is now.





Aside from the many tobacco-related activities the American Cancer Society is engaged in, we also have a sister advocacy organization arm called the Cancer Action Network. 


Go to their website for more information, and send a letter to your elected officials about your concerns related to smoking and secondhand smoke in your local community.

Filed Under:

Lung Cancer | Prevention | Tobacco


6/28/2006 3:15:41 AM #

helpless in apartment building

Dear Dr. Lichtenfeld,

I am glad I read your article, although if it would help me remains to be seen.  I am poor, and live in an apartment building.  This year, a couple moved in who smoke.  People began complaining of strong smoke odors seeping into the apartments.  I tend to get bronchitis when exposed to smoke, but so far it hasn't happen yet. But I smell smoke daily, an I feel that my throat is affected by it.

I want to write the new owner, except it is apparent that he does not care about the upkeep of the building, (which is falling apart anyway) and the health of the tenants, he probably cares for the least.  I could threaten to sue him, however, He could evict me, and then where would I be.

I'm trying to be stable enough so that I can go to school in about a year,  but will I be able to escape the effects of involuntary smoking? Only time will tell, yet I really resent feeling helpless, since I quit smoking years ago, only to be forced to involuntary smoke.

What to do?

helpless in Eugene

helpless in apartment building

6/28/2006 11:08:00 AM #

Len Lichtenfeld

Thank you for your comment.

As you might suspect, I don't have a simple answer for your problem. Interestingly, at a meeting of my own homeowner's association last evening, someone recounted a similar problem of cigarette smoke flowing from one apartment to the other.  I suspect this problem is more widespread than people realize.

There is no legislative or regulatory mechanism that I am aware of that addresses people smoking in their own homes. That remains a matter of individual choice.  But when the smoke moves from one unit to another, that may be a different matter.

You may want to check in with your local department of public health to see if they have any advice.  Another option is the question of whether or not, because of the adverse effects the cigarette smoke has on your health, there is in fact a remedy with the landlord.  My question is whether your situation rises to the level of a disability and whether there is a requirement for the landlord to make a special accomodation because of a possible disability.

I am not an attorney, but you may want to consult legal aid to see if they have any advice.

In the meantime, I will pass this on to some other folks to see if they have any suggestions.

Len Lichtenfeld

6/28/2006 11:43:36 AM #

Len Lichtenfeld

I have checked with my sources and they have nothing further to suggest.

You might want to get in touch with your local ACS office and see if they have any suggestions.  Call our National Cancer Information Center at 800 ACS 2345 and they can provide you with the appropriate contact information.

Len Lichtenfeld

6/28/2006 3:40:13 PM #


What about new Surgeon General's health warnings on cigarette packs?

US Surgeon General Richard Carmona wants to inform the public about the dangers of secondhand smoke but strangely shies away from the most obvious, simple, cost-effective and evidence based way to do so: propose new, updated, improved (enlarged and graphic) warnings on cigarette packs.
The warnings set on the side of cigarette packs sold in the US have basically remained unchanged for 20+ years.
This most recent Surgeon's General Report is an opportunity for seriously revisit the issue and decide what appropriate warnings should be like.
The excellent site of Physicians for a smoke-free... Canada provides examples from other countries:
A recent study published in the Tobacco Control Journal clearly shows US consumers are less informed about the risks of smoking than people exposed to more detailed and explicit warnings on cigarette packs:
Questioned about how the Bush adminstration would implement the findings of his report Richard Carmona apparently left this to the President and Congress. Of course that's up to them to pass a new law but he certainly could suggest such a move as could/should the Federal Trade Commission  in charge of protecting America's Consumers and responsible for the actual 20+ years old warnings.

Philippe Boucher
Editor www.glkradio.org
The first podcast about tobacco control issues
Bainbridge Island

PS: for more information the podcasts of
Michael Cummings: http://blogs.globalink.org/item/669
David Hammond: http://blogs.globalink.org/item/657
For the chronology of cigarette pack warnings in the US: www.cdc.gov/.../factsheet_labels.htm


9/8/2009 12:40:13 PM #


Our neighbor on the 1st flr. smokes like a chimney & it rises to our apt. making it very difficult to breath. I have asthma which makes it even worse. We've told the landlord twice. He's mentioned it to him but the guy keeps doing it anyway. We don't have the money to move and this is taking a toll on my health because the landlord isn't really enforcing it the lease. What can we do and what recourse do we have?


10/4/2010 10:50:05 PM #

Charles Beward

Just this: " The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke."  I'll just call that a flat-out lie, but I'll quote the testimony of the anti-tobacco activist Dr. Elizabeth Whelan, President of the American Council on Science and Health and a world-class epidemiologist (Harvard/Yale): "The SG goes even further, with this totally outrageous statement: 'the scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.'  This leaves us with the clear impression that if we merely walk through a smoke-filled room, we have put our health in irreversible jeopardy. ... What is most alarming here is that the top doctor in the land is communicating a message that anything that is harmful at high dose can be lethal at low dose -- when that is simply not true."  In other words, a lie.   And incidentally, Dr. Whelan speaks not only for herself but for her Council of 380 scientists.

Charles Beward

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.