The Smoking Gun Warning! The Surgeon General has determined that passive smoke is hazardous to your health!

Despite the cigarette dangling from her fingers as she took a smoking break outside a Norwalk, Connecticut clothing shop, Cindy Habighorst is no campaigner for smoker’s rights. “It’s a sticky habit,” she said. “There should be designated areas for smokers, and the workplace should be kept smoke free. There’s no smoking inside my store. I think you should pick a place if you choose to smoke, but don’t let it affect other people.”

second-hand smoke
Credit: Lea Aharonovitch, FlickrCC

Delivery driver Allen Lea from 70 miles away in Hartford, Connecticut doesn’t smoke, by he’s nonetheless wary of losing his personal freedom. “It’s the Gestapo government!” he said, gesticulating wildly. “Don’t go telling people what to do. The government can’t prove anything about passive smoke–they’re full of political crap. My wife is a smoker and I don’t have lung cancer so don’t even tell me about it!”

Tobacco is the most conspicuous pollutant of our time and also one of our most persistent battlegrounds. Unlike radiation and smog, it has an odor and taste. Smoke curls and settles in people’s living rooms, and rises unwanted into innocent nostrils and lungs. Cigarette butts are ubiquitous–lipstick-smeared in ashtrays, swollen in toilet-bowl waters and flattened into the textures of our urban walkways.

U.S. smokers produce 500 billion butts per year. Combined with the pivotal Environment Protection Agency (EPA) risk assessment of second-hand smoke release last year, the immediacy of cigarette smoke has made tobacco–whether it deserves it or not–the nation’s highest-profile environmental issue. But is the risk from passive smoke overstated? A hotly contested congressional report says it is.

Tobacco kills an estimated 400,000 active smokers per year. But only recently has it also become an environmental issue–one that ignites complex debates about individual choice, personal space, community, social norms and morality. “It’s not just a nuisance, but also a threat to public health,” says Representative Henry Waxman (D-CA), torchbearer of anti-smoking legislation.

We now know more about the effects of environmental tobacco smoke (ETS)–the official term for gases and particulates that disperse into the air when a smoker smokes–than any other indoor air pollutant. Also called “passive” or “second-hand” smoke, ETS until a few years ago hardly had a name; today it is well on its way to being abolished or severely curtailed in most public places.

But approximately 26 percent of the adult population (some 46 million people) in the U.S. continues to smoke, which means that every American will likely be exposed to ETS for years to come. For all its importance, though, the ETS debate is far from over.

The ETS Threat: Big or Small? 

What we knew about ETS comes mainly from one source: the EPA’s official risk assessment, “Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders.” Published in January 1993, the assessment is the result of the EPA’s examination of existing epidemiologic studies on women exposed to their husbands’ tobacco smoke and on children exposed to parents’ smoke. The conclusions of the analysis are alarming: that in the U.S., ETS may be responsible for 3,000 cases of lung cancer annually (1,000 of them among former smokers), and may cause from 150,000 to 300,000 lower respiratory-tract infections, such as bronchitis and pneumonia, in babies under 18 months old. ETS may also aggravate symptoms in asthmatic children, and may even cause new cases of asthma–although no proof was found in the studies. Passive smoke is additionally implicated in many thousands of deaths a year.

Partly because ETS consists of the same carcinogenic chemicals found in mainstream smoke (inhaled by the smoker), the report concludes that ETS can itself be classified by the EPA as a “Group A” carcinogen along with arsenic, asbestos, benzene and radon. The report confirms what non-smokers have long suspected: ETS is not just an annoyance, it’s a “pollutant.” In the words of the risk assessment, ETS poses “a serious and substantial public health impact.”

Studies have shown that lung cancer in active smokers is dose related: The longer and more a person smokes, the more likely his or her chance of dying from the disease. Is there a safe threshold for ETS exposure? It’s not easy to find an answer. According to John Banzhaf, executive director of Action on Smoking and Health, an antismoking group in Washington, DC, no amount of ETS is safe; cancer can be triggered by a single molecule, a trace amount of “one of the many elements of cigarettes, such as benzene.”

But the EPA bio-statistician who headed the ETS risk study, Steve Bayard, disagrees. “My feeling is that’s really overstating the case,” he said. “Small doses aren’t going to kill you.” The risks of cancer and other illnesses from ETS are very real, he emphasizes, but relatively speaking, not very high.

Assuming that the EPA assessment is accurate, a nonsmoker’s exposure to ETS in social situations, restaurants and other environments over a lifetime increases the chance of lung cancer by one in a thousand. For those with a smoking spouse, the increase is doubled, Even without ETS, a non-smoker still has a four-in-a-thousand chance of getting lung cancer from other causes, such as radon exposure.

Even these risk levels, however, have been called into question by independent observers. No one is surprised (or pays much attention) when the tobacco companies and other pro-smoking groups criticize the EPA’s risk assessment as “creative epidemiology” full of statistical confidence tricks. But in an April report, the Congressional Research Service (CRS)–a non-partisan arm of the Library of Congress–joined these groups in suggesting that the EPA assessment may have gone too far in finding a causal relationship between ETS and cancer, rather than a less-certain “association” between the two. Titled “Cigarette Taxes to Fund Health Care Reform: An Economic Analysis,” the CRS report examines whether the proposed 75-cent excise tax on cigarettes to help fund President Clinton’s health plan is sound public policy. CRS looked at the EPA report–and roundly criticized it.

“If you read the newspapers,” says Jane Gravelle, CRS senior specialist in economic policy and principal author of the report, “your conclusion about passive smoke would be that it’s a very certain and very significant risk.” But, she said, “My understanding after doing this research is quite different from my understanding as just an observer.”

The CRS report, whose second author is public-finance specialist Dennis Zimmerman, points out that the EPA assessment is based on “a group of 30 studies of which six found a statistically significant (but small) effect, 24 found no statistically significant effect, and six of the 24 found a passive smoking effect opposite to the expected relationship.” To standardize these diverse studies, the EPA “adjusted (weighted) the estimate of passive-smoking effect in each study.” This de-emphasized studies that found less significant effects for passive smoking and emphasized those that found more significant effects, says the report.

Gravelle and Zimmerman also note that the EPA changed the standard for statistical significance used in the original studies. They write: “…it is unusual to return to a study after the fact, lower the required significance level, and declare its results to be supportive rather than unsupportive of the effect one’s theory suggests should be present.”

Surprisingly, the CRS report has received very little media attention. “I think criticizing the popular wisdom on ETS is a very unpopular thing to do right now,” says Gravelle. “But all we’re saying is it’s not certain that there is an effect from passive smoke.”

EPA report author Steve Bayard says that the agency “flatly rejects the CRS complaints and stands by its report.” Gravelle and Zimmerman, he said, “don’t have the expertise to really do an adequate criticism.” The EPA assessment went through four years of development and review–including guidance on how to analyze the ETS studies from a panel of 18 scientific experts, Bayard said. Even the tobacco industry was given a chance to contribute to the process.

Bayard also defends the changes the EPA team made to the statistical-significance standards as “a practice that is not unusual in meta-analysis; we had to choose our own standard to be consistent.” The dispute leaves average folks who don’t know the difference between one-tailed and two-tailed statistical tests two choices: to have faith or not have faith in the EPA’s risk projections.

The EPA, in a 17-page statement, calls the CRS report “inaccurate and biased … The CRS review apparently lends more credibility to the propaganda of the tobacco industry and its paid consultants … than to the conclusions of well-documented, peer-reviewed reports…”

The CRS position took a further hit in June when the results of a study of ETS and lung cancer in non-smoking women was published in the prestigious Journal of the American Medical Association. The study found that, “Tobacco use by spouse(s) was associated with a 30 percent excess risk of lung cancer: all types of primary lung carcinoma, pulmonary adenocarcinoma and other primary carcinomas of the lung.” The risk factor rose dramatically when the exposure was long-term. A woman who’d been exposed to her husband’s two-pack-a-day smoking for 40 years was found to have an 80 percent excess risk of lung cancer.

At the AMA press conference announcing the study, the appropriately named Dr. Randolph Smoak, Jr., an AMA board member, demanded “federal protection for non-smokers–who comprise the vast majority of this nation–from the cancerous and potentially deadly effects of passively inhaled tobacco smoke.”

Some would say that active smoking’s well-established dangers are enough evidence that ETS is hazardous. “We know there are 44 chemicals in ETS which have been proven in other studies to cause cancer,” points out Banzhaf, “so we have no reason to assume that these substances are not going to be carcinogenic.”

But a lot of public policy issues and moral positioning pivot directly on the EPA’s particular assessment of risk. The decision about how much to tax smokers–the majority of whom are lower income–will be based in part on the assessment.

Accepted knowledge about the dangers of ETS also has serious implications for interpersonal relationships. With any reasonable doubt about the safety of children, adults now can eliminate ETS from their children’s living space. But what about past exposure? What is the acceptable level of guilt for a parent whose passive-smoking child, now grown up, contracts lung cancer? The social costs of an inaccurate risk assessment can be high.

CRS’ Gravelle claims that, even if the EPA is right, ETS represents “a very small risk–smaller than radon and car accidents and all the other ways you’re likely to die.” The EPA’s Baynard–who himself smokes the occasional cigar–doesn’t disagree: “It doesn’t seem like a whole bunch of risk to me.” But, Bayard adds, “Do you want to take that risk?” Looking at the tightening noose of federal, state and local laws against ETS, it would appear that few people do.

The War Against ETS 

When the EPA announced its landmark risk assessment last year, smokers became social outcasts and legal public smoking became an endangered practice. Partially because of new vulnerability to lawsuits brought by non-smokers, businesses that had shunned anti-smoking legislation for fear that it would cut into profits now support it. McDonald’s and Taco Bell banned smoking at company-owned restaurants in March of this year, and the National Council of Chain Restaurants–which also includes Burger King, Wendys and Taco Bell–endorsed federal legislation to prohibit smoking in all public places. Marriot Hotels banned smoking in July.

The city of Los Angeles passed an ordinance last year banning all smoking in restaurants, and Juan Corona, manager of a McDonald’s there, is happy about it. “The no-smoking policy has not reduced business; on the contrary, it has increased it,” he said. At a Dallas Wendy’s with both smoking and no-smoking sections, manager Kimberly Polk isn’t worried about going totally smoke-free. “I think people are becoming accustomed to not smoking in public,” she said.

The Smoke-Free Environment Act, sponsored by Rep. Waxman, proposes to either ban smoking completely or restrict it to separate, ventilated rooms everywhere except residential buildings.

The Occupational Safety and Health Administration (OSHA), meanwhile, has been concentrating on ETS in the workplace. Labor Secretary Robert B. Reich announced in March that, in writing rules for the Indoor Air Act of 1993, it wants to stub out all cigarettes in both private- and public-sector workplaces. Also in March, the Defense Department declared all its workplaces smokeless zones, affecting 3.6 million civilian and military employees. Many federal agencies, including the U.S. Postal Service, have extended the no-smoking rule to their entire grounds,

Dozens of municipalities and states have taken their own initiatives. Forty-six states and the District of Columbia have laws regulating smoking in public places, and many of them restrict smoking in private workplaces. According to Action on Smoking and Health, 85 percent of companies now have restrictions in their buildings and one third completely prohibit smoking.

Smokers now huddle at the entrances of their office buildings as non-smokers protest having to pass through a cloud of smoke to get inside. A new product for the outsiders–the enclosed “smoking shelter”–is on the market.

Concerned about the effects of non-smoking ordinances and smoking’s bad image on cigarette sales, the tobacco industry is fighting back–sometimes with covert tactics.

Philip Morris, for instance, is one backer of an initiative recently launched for California’s November ballot. The initiative calls for a “single, tough, uniform statewide law” to regulate smoking in public areas and workplaces. But critics say it’s an underhanded attempt to replace the approximately 270 existing local ordinances in California with a weaker state law. Many people have signed petitions withoutreading the fine print and recognizing the tobacco-industry sponsorship.

ALA alleges that the Tobacco Institute-the public relations and lobbying arm of the tobacco industry, formed in 1958–is using state chambers of commerce to distribute several versions of a booklet called “Workplace Smoking: A Guide for Employers,” without disclosing that the publication was financed by the tobacco industry. The Institute is also wooing labor unions with an information kit titled “Workplace Smoking Issues.” Philip Morris has also joined five other organizations, including R.J. Reynolds Tobacco Company, to challenge the EPA’s classification of ETS as a Group A carcinogen.

Diane Maple of the American Lung Association denounces the tobacco company tactics. “The industry is still trying to say that the science on tobacco smoke is not good. Everyday, a new study comes out showing that it’s dangerous, and the tobacco industry denies it. Their denials are self-preservation.”

ETS and Active Smoking 

As ETS and its opponents take the limelight, the social deviance of active smoking is reaching an all-time high. The smoker is seen as both a burden and a menace to society. The tobacco company is increasingly vilified. “It reminds me of vicious dogs surrounding an animal and trying to kill it,” says North Carolina tobacco auctioneer Roy Talley.

ETS, an environmental issue, has become heavily intertwined with active smoking, a personal health issue, and the battle against other people’s smoke is fueling the war on cigarettes.

In President Clinton’s health plan, smoking tops the list of behaviors Americans must change–before violence, excessive drinking, illicit drug use and teen pregnancy. Clinton has proposed a 75-cent per-pack cigarette tax; a House subcommittee voted for an even bigger one, $1.49 a pack, in March.

The Food and Drug Administration (FDA) is considering treating tobacco as an addictive drug. In February it charged tobacco companies with intentionally adding nicotine to cigarettes in order to hook smokers. (R.J. Reynolds responded with a full-page ad denying the charge, “We Do Not |Spike’ Our Cigarettes With Nicotine,” it said, under a photo of Chairman James Johnston puffing away.

In dramatic House subcommittee hearings on the nicotine charges in April, tobacco-company chief executive officers (CEOS) were questioned about everything from their advertising practices to whether they would want their own children to smoke. “It entails clear health risks,” one CEO was driven to admit about active smoking. It was a rare statement from a tobacco company.

Meanwhile, 26 lawyers have filed a class-action suit in New Orleans against the tobacco industry on behalf of three smokers, one of whom has died from cancer. The suit accuses cigarette companies of intentionally suppressing evidence that nicotine is addictive.

Protests against cigarette-company advertising–particularly ads aimed at youth and minorities–are also heating up. R.J. Reynolds’ cartoon-based “Joe Camel” campaign is increasingly under fire for its appeal to children (see sidebar), though the Federal Trade Commission has decided against banning the ads. R.J. Reynolds spokesperson Peggy Carter defends the company’s sense of responsibility. “If we thought Joe Camel got kids to smoke, we’d stop the ads right away,” she said. “Children recognize the Joe Camel character, but at that age they are so anti-smoking it doesn’t change their feelings or behavior.”

In March, the Vermont House of Representatives voted in favor of a bill banning advertising of tobacco products that feature cartoon characters. In April, a Boston-based consumer group, INFACT, announced a campaign to exert pressure on retailers to remove the ads from their stores.

There is also a movement to divest in tobacco company stock. The American Medical Association divested in 1981 and universities such as Harvard and Johns Hopkins are also taking action. State legislators have introduced several divestment bills.

Getting Rid of the Canaries 

Some believe that the intense focus on ETS is at the expense of other issues, such as occupational safety hazards. “It’s a lot easier to raise funds by whipping up hysteria about tobacco than it is to say you’re going to improve occupational health and safety laws,” says Ray Scannell, director of research and special projects for the Bakery, Confectionery and Tobacco Workers International Union, an affiliate of the AFI-CIO representing many U.S. tobacco manufacturing workers.

ALA, meanwhile, suggests that union positions on smoke-free policies in the workplace are heavily influenced by the tobacco industry. It adds that smoking has a “synergistic effect when combined with industrial agents such as asbestos, coal dust, cotton dust, radiation and various organic chemicals.”

Scannell, who says he doesn’t want smokers to become scapegoats, notes that coal miners used to take canaries with them underground. The birds are extremely sensitive to changes in levels of oxygen, methane and carbon monoxide. “If the canaries fell dead, the miners would hightail it out of there,” Scannell said.

Smokers were the “canaries” at a sheet-rock company in the late 80s, insists Scannell. They were getting respiratory illnesses from working with rock-mineral dust, and instead of dealing with the dust problem, the company forced smokers to either quit or be fired. “They were getting rid of the canaries,” says Scannell.

While smoking and its passive effects may have taken the fall for some other environmental problems, evidence of their danger continues to mount. Battles will continue to be fought, but the tobacco lobby seems to be losing the war. The hardy souls standing outside in all weathers to get their nicotine fix shouldn’t expect to come in out of the cold anytime soon.

Helpful Resources: 

American Cancer Society, 1599 Clifton Road, NE, Atlanta, GA 30329/ 800)4-CANCER. Coalition on Smoking and Health, 1150 Connecticut Avenue NW, Suite 820, Washington, DC 20036/(202)452-1184.

WHAT EXACTLY IS ETS? 

ETS is smoke from two sources: the end of a burning cigarette and the exhalation of a person smoking. Although it is diluted into the air, ETS is chemically similar to the concentrated gases and particulates a smoker inhales. It is a complex mixture of organic and inorganic compounds released by combustion of both tobacco leaves and additives.

As early as the 1930s, some 120 components were identified in tobacco smoke. By 1959, that number had grown to 450 and today it exceeds 4,000. According to the ALA, burning cigarettes contain over 200 poisons, 43 of which are carcinogenic.

The chemicals include benzene and 2-naphthylamine, known human carcinogens, cadmium and n-nitrosodiethanolamine, which is associated with cancer in humans, and polonium-210, an element that emits alpha radiation. Residues of agricultural chemicals and pesticides are found in some tobaccos but are not heavily monitored in the U.S.

According to Doug Richardson, acting deputy director of the Tobacco and Peanuts Division of the U.S. Department of Agriculture (USDA), the USDA sponsors tests for only 16 pesticides on flucured tobacco, a main type used in cigarettes.

The tests are conducted only for pesticides that are not approved or use in farming (DDT, for instance) only certain tobaccos are tested, and the tobacco farmers’ own cooperative marketing association oversees the testing.

The public is even less informed about compounds the tobacco companies blend into tobacco. Additives, which vary by cigarette brand, have long been protected as trade secrets by the U.S. government. But in April–after searing interrogations of tobacco company executives at Rep. Waxman’s subcommittee hearings on nicotine–the leading companies decided to release a list of 599 chemical additives.

The curious list includes food items such as chocolate, wine and coconut oil. It also includes an insecticide-methoprene–sprayed onto tobacco leaves to fight beetles, as well as ammonia and ethyl furoate, which may be linked to liver damage in animals. Some debate has erupted over whether the chemicals have been approved for use in or on food, but as an FDA official pointed out, such approval hardly suggests they are safe to smoke.


UNSMOKEY JOE’S
Smoke Never Gets in Your Eyes at the Camel Cafe 

R.J. Reynolds invites customers into the cartoon world of “Joe’s Place,” a club where everyone smokes Camels and nobody gets sick or even has to breathe in smoke.

It’s a colorful nightspot with elegant sconce lighting, purple carpeting and a large spiral staircase descending from the mezzanine. It’s homey and working-class (complete with pool table), sophisticated (“The Hard Pack” blues band features sax and harmonica, acoustic guitar and drums) and rugged (lots of cowboy boots).

The camel people have four finger and active lifestyles. None of the camel women are fat and all of the camel men have good muscle tone. But Joe’s Place exits in some weird alternative universe. Although about a third of the camel people are smoking (including the guitarist and drummer), the ashtrays are all empty and–miraculously–there’s no smoke in the air.

R.J. Reynolds Media Relations Manager Peggy Carter says the camel’s smokeless tobacco can be attributed to…an artist’s whim. It’s a creative illustration,” she said, with the same zealotry demonstrated by the tobacco lobbyist in Christopher Buckley’s novel Thank You For Smoking. “I don’t believe it to be a deliberate effort to keep it out of the advertising.”

Asked why cigarette ads using photos rarely show either, Carter said, with true esprit de corps, “The cameras may not be sensitive enough to film the smoke.”


EXPORTING DEATH
Social Outcasts at Home, U.S. Cigarette Companies Maker Their Fortunes Abroad

In Hong Kong last year, passersby on the fashionable Nathan Road were surprise to see attractive, well-dressed young women handing out packs of cigarettes. American cigarettes. Camels. It was just another part of R.J. Reynold’s aggressive attempt to market its wares abroad, where profits are high and anti-smoking awareness is low. Reynolds makes 20 percent of its profits on the international market; Philip Morris, its biggest competitor, makes 30 percent. Both companies reported that international tobacco income rose sharply in 1993 over 1992.

With anti-smoking fever spreading through the U.S., Japan and Western Europe, the tobacco giants are looking at Eastern. Europe, Asia and Latin America as highly promising new markets. The Poles, for instance, are the heaviest smokers in the world, with Polish smokers (42 percent of the population) puffing on an average of 3,620 cigarettes a year (compares to 2,670 in the U.S.), according to the World Health Organization (WHO). R.J. Reynolds recently built a $33 million plant to produce Camels, Winstons and Salems in suburban Warsaw, and Philip Morris want to buy an existing plant in Cracow. The U.S. tobacco companies also have operations in Hungary and the Czech Republic.

Reynolds and Philip Morris together sell 10 billion cigarettes per year in the formers Soviet Union. This $100 million slice of the pie may seem large, but because it represents only a fortieth of the total market there’s considerable room for expansion. Reynolds International President Anthony Butterworth calls the former Soviet Union “a huge, raw opportunity for us.”

The American butt peddlers are not always welcome. Both China and Hong Kong now ban TV advertising for cigarettes, and new anti-smoking groups in Asia are trying to stop the spread of smoking to women and teenagers. But the activists must fights billboard campaigns and the growing sense that American cigarettes, in their shiny, colorful packs, are status symbols.


WHAT EXACTLY IS ETS?

ETS is smoke from two source: the end of a burning cigarette and the exhalation of a person smoking. Although it is diluted in to the air, ETS is chemically similar to the concentrated gases and particulates a smoker inhales. It is a complex mixture of organic and inorganic compounds released by combustion of both tobacco leaves and additives.

As early as the 1930s, some 120 components were identified in tobacco smoke. By 1959, that number had growth to 450 and today it exceeds 4,000. According to the ALA, burning cigarettes contain over 200 poisons, 43 of which are carcinogenic.

The chemicals include benzene and 2-naphthylamine, known human carcinogens, cadmium and n-nitrosodiethanolamine, which is associated with cancer in humans, and polonium-210, an element that emits alpha radiation. Residues of agricultural chemicals and pesticides are found in some tobacco but are not heavily monitored in the U.S.

According to Doug Richardson, acting deputy director of the Tobacco and Peanuts Division of the U.S. Department of Agriculture (USDA), the USDA sponsors tests for only 16 pesticides on flucured tobacco, a main type used in cigarettes.

The tests are conducted only for pesticides that are not approved for use in farming, (DDT, for instance), only certain tobaccos are tested, and the tobacco farmers’ own cooperative marketing association oversees the testing.

The public is even less informed about compounds the tobacco companies blend into tobacco. Additives, which vary by cigarette brand, have long been protected as trade secrets by the U.S. government. But in April–after searing interrogations of tobacco company executives at Rep. Waxman’s subcommittee hearing an nicotine–the leading companies decided to release a list of 599 chemical additives.

The curious list includes food items such as chocolate, wine and coconut oil. It also includes an insecticide–methoprene–sprayed onto tobacco leaves to fight beetles, as well as ammonia and ethyl furoate, which may be linked to liver damage in animals. Some debate has erupted over whether the chemicals have been approved for use in or on food, but s an FDA official pointed out, such approval hardly suggests they are safe to smoke.