Tobacco and Public Health - TCSC Indonesia

evidence have proved to be effective tools for translating the findings on smoking, both
active and passive, and disease into policy.
The issue of passive smoking and health has a briefer history. Some of the first
epidemiological studies on second-hand smoke or environmental tobacco smoke
(ETS) and health were reported in the late 1960s (Cameron 1967; Colley and Holland
1967; Cameron et al. 1969). Prior to that point, there had been scattered case reports,
the Nazi government had campaigned against smoking in public, and one German
physician, Fritz Lickint, used the term ‘passive smoking’ in his 1939 book on smoking
(Proctor 1995). In the 1960s, the initial investigations focused on parental smoking and
lower respiratory illnesses in infants; studies of lung function and respiratory symptoms
in children soon followed (US Department of Health and Human Services 1986;
Samet and Wang 2000). The 1971 report of the U.S. Surgeon General raised concern
about possible adverse effects of passive smoking (US Department of Health Education
and Welfare 1971).
The first major studies on passive smoking and lung cancer in nonsmokers were
reported in 1981, a cohort study in Japan and a case–control study in Athens (Hirayama
1981a, b;Trichopoulos et al. 1981), and by 1986 the evidence supported the conclusion
that passive smoking was a cause of lung cancer in non-smokers, a conclusion reached
by the International Agency for Research on Cancer (IARC), the U.S. Surgeon General,
and the U.S. National Research Council (IARC 1986; US Department of Health and
Human Services 1986). The evidence on child health and passive smoking was also
reviewed in 1986 by the U.S. Surgeon General and the U.S. National Research Council
(Table 17.1). A now-substantial body of evidence has continued to identify new
diseases and other adverse effects of passive smoking, including increased risk for
coronary heart disease (Table 17.1) (California Environmental Protection Agency
1997; Scientific Committee on Tobacco and Health & HSMO 1998; WHO 1999; Samet
and Wang 2000).
In Australia and New Zealand, the United Kingdom, some countries of Scandinavia,
and the United States, for example, the evidence of harm to nonsmokers from breathing
secondhand smoke has led to the implementation of national and local policies
and regulation to restrict smoking in public places and workplaces (National Cancer
Institute 1999; Corrao et al. 2000). In the state of California in the U.S., all workplaces,
including bars and restaurants, are now smokefree. Smoking is no longer permitted on
international airplane flights. There are abundant successful examples of using the
scientific evidence on passive smoking as the foundation for effective public policies
for reducing exposure.
Toxicology of tobacco smoke
JONATHAN M. SAMET 289
Tobacco smoke is generated by the burning of a complex organic material, tobacco,
along with the various additives and paper, at a high temperature, reaching about