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la: r.N t.rrr+a+ yak~k V KCWuMl111p hctWt'tli 1wo MdKD or Ifaf .uK fTnIt c1rOSYTt and ntl 01 C:htOnK (KfNKhllt3, aKhit1711c •pn Ancarc and urolt amc+nE IJctont pon•snwlcn (atundardiw7 tot aFr and . tot is{oust tmokant. rAtllw tbc Irurrurc wat 6ntnlnt ot srdadt raaurY sr-1r Mak'Irwlu3 le.rsJr rar.wti ,ftatt cwdwwel ti)W,arr ./ .dri/lrlrl Ca.n C.rurrJi R Casn C.•urnlt R Caut C .+rrds R C/rnw/r IrwwrM'lit Cornbinal u4ct' Scott 0-I I 27 1 7 73 1 1 10Z 1 Scorc 2-4 2 55 013 4 61 I05 6 116 100 S,corc 5- 12 1 IS 110 1 21 1 .03 2 36 I10 Sl+ousc unolal man cip rn .hok ol marnalrs No a 93 I 4 99 I 12 I{2 1 Yes 1 -60 0.3+ 13 229 1 .22 ta 269 0.13 LrAo~u lwan dvuv ComDbncd InJci' Scorc0- 1 15 21 1 2) 75 1 38 102 1 5cort 2-4 12 55 01) 9 11 059 21 116 0.52 Storc 5- 12 3 IS 04) A 21 Olll 7 36 0.61 S(+Ouu smnlcd man np tn . hnk o( mamaFc Nu 26 93 1 22 19 1 4E 1t : I Yts 15 40 1 .24 55 229 093 70 269 1 .03 S+rol r Comb"ncd rnSca• Scott 4 1 5 27 I 19 75 1 24 102 1 Scott 2-4 10 15 f0 LI 096 20 116 091 fcorc 5-12 ~ IS 177 7 21 2 W 11 36 2.11 Spourt smoled man op In .Ac.h od marru~c No It 93 I ' 19 19 1 31 1t2 1 Yes 1 40 0u 19 229 092 55 269 090 'Oared on wm o/ 0- not al all, 1 . 4nk, 2- avsratc, )o a tot for at Aomc, at .or1, aunnt trartt, Iurnis kxsurc onc eapretlc would be 1I hours as tsEards panicuhlc mattct and SO hours as rctards nicotine . S+milarly, larvis et .1. (1965) havc Mown that the incrcasc in sahvary cotlninc in rctation so passive smoke cxfwsurc is kis than I'.4 of that in relation to activc amokc caf+osurc E :trapokatint hncarly from the t0-fold tclalwr rssk of king nncrr in lclalion to scllvc unoklnf would thcreforc predlct a cclative risk in rNation to rassive smoking kn than 1 .1, while a quadratrc catrapotation, as tujlccted by Doll and Pcio (1979) would predict a lower risk aill . The contllct bctwrcn Ihc dou and the claimed raponse ia panicularly dear for the tasults ot Hirsyama (I"l) who found a aimitar efiact on lunj txncer ror passive anoking as fbr active smoking ot S ciprttla a day . 5ccond, all the audia wffer from weak caposure data, most studia only obuinin3 infortnation on the tpowe's smoking habits and aonc obtaining obIoctivc data by measurement of ambicrlt Ilcveb of tnwkc oonstituents in thc air of the 6otrse or http://legacy.library.ucsf.edu/tid/wyk81f00/pdf workplacr anG/or of concentrations of constituents in body rluids . Third, ao Nudrcs adcquately uke into account the possibility that misclassification of activc smokers as non•txnokers may 6avs oonsiuently biascd relative mk estimates ",ard Activl : amokcn havc a lugh rslative nisk of king ancrr and apouscs' smoking kabits are positively Oorretate•d fecausc of this, t1 can 6e shown tbat if a tclalively tmall prof+ortion of arnoken reny amokinE, this resuhs in an aploreal c"tion in risk of IunE pnar in 'aon•smokcri tnarricd lo amoken compared to ' .on•atwkm' nsarriad to aan-smokcrs, even when .o rsar sffon of pasaive smoking caists A dcmonuration that this aouroc or Was is of rcal Imporuncc can be found in the study of Garfinkel tt .! . (1985) Used on ttrlvalidated smoking data takcn from hospilal taoles, a rolative risk of lun3 nncxr in relation so Musb .nd's smoking at (some of 1 .06 was pkulated, with t'eiativc risks of at kast 13 aecn irs rclation to each :='-I _. . .. . . .~.,.~ ... .,~ . -....
t k http://legacy.library.ucsf.edu/tid/wyk81f00/pdf kvcl or husband's oEarcttc smoking and in setation to huaharsd's ctFar and pipe smoktnt When addittonal sourvs of information on atnoking habtts were used . the overall rnlattvc risk was rc,duced to a marpnilly ugnif"nt 1-31 with an ekvatec3 risk onl) n:a1t) dtsrcrniblc in rcl:tion to fteavy cilare{sc smoktnE by thc husband Evcn itctt, it is sxwubk that the ckvauon in risk was t .ol evsdcnt when smoktng data were obtained from the subject or her spouse directly, but was only evidcnt when thc data werc obtatned from the dauShtrr or son or another informant, ir from those pcoplc who were icst Mkcll to have known the full amoktnF htstor) The (owcr rrtattvc risk may still have arisen wholl) or fsarsl) as a bas rt:suliinj from misctauiftcatton of smokrng habtts Founh, many of the studies are otxn to tp,xifsc eriticisms For elamptc . thc aonclus on of Gi11ts et •1 (1981) that male IunF cancer d~caths in aantmokers rose from 4 per 10 .000 in those not exposrd to pass vc smoke to 13 per 10,000 in those who wcrti esposcd was based on a toul of only b(!) deaths and was not tutisticali) silnificant . Also the claim by Knoth .r ./ (1983) of a tetationship between passive smoktnr and lung cancer in s>ton• unokint women was based simply oet the obscrvauon that the proportion of fcmak atontmokin= lung cancer patients ltvinE toFelher with a smoker escooded the proponion o( mak amoke :n as rcT+oned in the prcvtous microeensus . ignoring inrrr a4o lhc fact that in man) familics womcn I .ve with more than just their husbands In the preunt uudy no tiFnificant relationshir of passivc smoking to lung canccr incrdcnct in lifelonj t+on•smokcn was seen, either in the arsalyses based on the information collected in hospital or in sstbsequent inquiry of the "usn ot both It must be pointed out, Ao .ever, that the number of lung cancer pattcnu who had ncver smoked was rather small so that, though our findings are coasisacnt with p .uivc smoking hsvinE no effcet am lunS cancer risk at all, they do wot eadudc the poss;bility of a small incrcase in risk, tlsou=h the upper 955, sonfidena limit of 1 .50 for the awimate of 040 (Table IV) in relation to the .pousc smoking during the whole of thc marriage is nsot tonsistent with some of the brFer incraaw claimed by Hiraysma (19i1, 19N) Tric)wfroukoc tr d . (t9E1, 119113) and Correa rr al (I9d3) . Thoujh the numbcr of lunI catscer patients who lud rtevcr smoked a vrull, varying arowsd )4-50 dcpendint on the analysis, this ntxrsbcr ic aot vsry different from that reported in a stm+ber ar other ttudies, e .E the fsndmfs of Corrta er atl . (19t3) .rere based on only 30, while thou of Triclsopoulos tt d. (1911) . even when apdated (Triclsoyoulot t/ a) .. I"1) srrc haed on only 77 . The difl1ruhy of obcaininj an adequate sample aix ie ..deriirsed .. .~.,.w. .s- , .,. ~.~ ------`-- .- rASSIVE SMOKING AND SMOKtNCrRtilJ17U) DIIUSLS N3 when onc oowdcn that in our study the 44 acver arnoktng lung cancer paticnts who comrleted pauix smoking questionnairss in hospital were estracted from a tota( of 792 lung cancer patients It would srood a very Mrgc research efiori to irscroasr pracision aubsuntially, and even then onc would havc to take care that thc masnttudc of any biasa did aot csaeod the malnitudc of the effcct one was looktnr for . The two srulor prosfroctive ctudia which Rave so far reportod findtnFs on lussive amokin ; (Htrsyama, 1%1, t'iarfinkel, 19b1)' wero "t actually daiEncd to investiEatc this issue and, as a result, could only usc srousc's smoking as an tndct of eat+osure Out study, on the other hand, thouSh .ot abk to monitor eaposure objrcttvely, as would luve been prsferabk, was able to look at pauivs tmoktnj in a wider context, by asking about the extent of uposurs at home, at work, during travel arsd at kisun Although thc answers to tt•.ese questions were wbjoctivc, and could have eshibitad aome bias, their inclusion ptrFups allows `reater oonfidenoe in the oostclusions . It was interestint that, of the 59 patients for whom sqwusc's titarrttc smoking habits were obtained from both the sf+auu and the ptients, there were 9(IS!k) (satients for whom thcrc was dtsafr¢ement as to whether Ihc spouse had been a tanoker at torrse time during thc marrsafc . It acems rs:asonabk to suppose that some of thtse wert in fact svnokess and may have brrn erroneously dauificd as aon•unoken kad onl) one tourac of information been tr,cd It was also noteworthy that there was quite a strong corTClatton in our audy between actrvc and passive tmoktnF As illustrated in Tabk Vt, turrent smokers were considerably more kikely to be eat,oscd to yuive amoke cnpasure at home (from aourm other than their own ciE+rettes) thnn were t.ever or ea-smokers As sw,cd above, this corrcl.tion,' coupkd with some tnisclassification of smokers as st,on•unoken, tmay spursously intLte the estimate of risk related to passive smoking It is important to carry out fonher studies fo obtain more atxurate information on rtlublltty of statements about smoking habits benusc of this pocsibiltty of bus . Littk other evidence is availybk ebneensinf the rs:lationshif+ brtusen passive smoking sad risk of the other ta,okin=•assocsated dtseases in (adult) bon-mnoken and much of this is open to criticism (n kis original paper . Hiraysmn (19E1) presented tttativc risks of doth for various diseases for Ron• tMrwkinE women aacardinj to the Isusband's rwnokinj Isabur based on a total of 5b deaths, a dight positive trend tor emfshysema and asthma tras twt ttignificant, wfiik, based ou a total of 406 •caths, uo indiation of a uend at i,n was aern for i.chaernic lrean disrase ta a Osttt paper, (xsad on
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