Report Lists Effects of Smoke on Californians

Secondhand smoke may be implicated in 120 cases of sudden infant death annually in California, as well as contributing to increased asthma, cancer and heart disease, says a massive new report issued Monday by the state Environmental Protection Agency.

The report does not include original research, but instead is a survey of scientific studies on the topic of so-called environmental tobacco smoke. The eight-volume document apparently is the most extensive survey of the ill effects of secondhand smoke ever produced by a government agency in this country.

Although secondhand smoke has been linked to cancer, heart disease and respiratory ailments, the new report cites studies that have found evidence that other people’s smoke is linked to spontaneous abortion and cervical and breast cancer.

The report notes that exposure to secondhand smoke is lower in California than in other states because of state laws prohibiting smoking in most indoor workplaces, and because the smoking rate is lower in California than in most other states.

Still, the report says secondhand smoke is “an important source of exposure to toxic air contaminants indoors” in California.

“Despite an increasing number of restrictions on smoking and increased awareness of health impacts,” the report says in its opening, “exposures in the home, especially of infants and children, continue to be a public health concern.”

The Office of Environmental Health Hazard Assessment, the scientific arm of the state EPA, made the report available on the Internet (https://www.calepa. cahwnet.gov/oehha). After giving the public 60 days to comment on the document, the agency will make revisions and turn the report over to the state Department of Health Services, which would impose any regulations.

“I would hope that it will have significant impact in terms of providing [state regulators] with information,” said Richard Becker, head of the health hazard assessment office.

The report, six years in the making, was commissioned by the state Air Resources Board as part of its effort to identify and reduce air pollutants. State law does not give the air board authority to regulate indoor pollutants.

One of the more immediate uses of the document could be to aid the California Division of Occupational Safety and Health as it writes rules on smoking in bars, hotels and casinos, the only buildings where public smoking is still permitted in California.

It also could have impact outside California.

“It will provide additional support for the regulations proposed by [the federal government] and other states [considering smoking bans] that don’t have the depth of scientific resources of California,” said Dr. David Burns, professor of medicine at UC San Diego, and a tobacco expert. “This is a current review of the state of the science and as such is extremely valuable.”

Secondhand smoke was the focus of major reports in 1986 by the U.S. surgeon general and in 1992 by the federal Environmental Protection Agency. Both of those reports affected the smoking debate, resulting in increased regulation.

In the years since those documents were released, knowledge has expanded significantly about the ill effects on nonsmokers of other people’s smoke.

“The state of California has therefore undertaken a broad review of [secondhand smoke], covering the major health [problems] potentially associated with [secondhand smoke] exposure: perinatal and postnatal manifestations of developmental toxicity, adverse impacts on male and female reproduction, respiratory disease, cancer, and cardiovascular disease,” the report says.

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The report describes secondhand smoke, also called environmental tobacco smoke, as a “complex mixture formed from the escaping smoke of a tobacco product, and smoke exhaled by the smoker.”

To date, the report says, more than 50 compounds in tobacco smoke have been identified as carcinogens, and six have been linked to birth defects or are reproductive toxicants.

Perhaps the report’s most significant aspects deal with the impact on infants and children. The report describes, for example, studies that document childhood ailments ranging from increased middle ear infections to sudden infant death syndrome.

“Numerous studies have demonstrated an increased risk of sudden infant death syndrome, or SIDS, in infants of mothers who smoke,” the report says, citing a dozen studies that investigate possible connections between tobacco smoke and sudden infant death.

“Until recently,” the document continues, “it has not been possible to separate the effects of postnatal [secondhand smoke] exposure from those of prenatal exposure to maternal active smoking. Recent epidemiological studies now have demonstrated that postnatal [secondhand smoke] exposure is an independent risk factor for SIDS.”

The report comes up with the number of sudden infant deaths in California by using a complex formula, taking into account the number of such deaths nationwide, the number in California, and a study that estimates that 17.3% of children under age 5 in this state are exposed to tobacco smoke in their homes.

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The report finds that as many as 30%, or 120, of the 398 sudden infant death cases in 1995 “may be attributed to [environmental tobacco smoke] exposure.”

In most cases, the report bases California numbers on studies showing the national estimates of secondhand smoke-related disease, and figuring that California, which has 12% of the nation’s population, also has 12% of secondhand smoke-related diseases.

The report says secondhand smoke causes asthma in as many as 3,120 children in California each year, and worsens asthma in 48,000 to 120,000 children in this state.

In California adults, other people’s smoke reportedly results in 360 lung cancer deaths a year and as many as 7,440 deaths from heart disease a year.

The report says more research is needed on the impact of secondhand smoke on birth defects, changes in female fertility and the male reproductive system, rare childhood cancers, and cancers of the bladder, breast, stomach and brain.

One reason the report was six years in the making is that the tobacco industry challenged various studies examined by the state. For the most part, however, anti-smoking leaders say they believe the document is solid.

“It’s amazing and ground breaking,” Robin Hobart, co-director of Americans for Nonsmokers Rights, said of the report.

But pro-smokers were quick to criticize the document.

“In my view, the risks for most of these studies--even if you thought the studies were good, and we don’t believe they are--are too low to be meaningful,” said Gary Auxier of the National Smokers Alliance in Virginia.