Tobacco and Public Health - TCSC Indonesia

portable piezobalance to sample aerosols in restaurants, bars, and other locations. In
the places sampled, respirable particulate levels ranged up to 700 µg/m 3 , and the levels
varied with the intensity of smoking. Similar data have been reported for the office
environment (National Research Council 1986; US Department of Health and Human
Services 1986; National Cancer Institute 1999; Jenkins et al. 2000). Recent studies
indicate low concentrations in many workplace settings, reflecting declining smoking
prevalence in recent years and changing practices of smoking in the workplace. Using
passive nicotine samplers, Hammond (1999) showed that worksite smoking policies
can sharply reduce ETS exposure.
Transportation environments may also be polluted by cigarette smoking.
Contamination of air in trains, buses, automobiles, airplanes, and submarines has been
documented (National Research Council 1986; US Department of Health and Human
Services 1986). A National Research Council report (National Research Council 1986)
on air quality in airliners summarized studies for tobacco smoke pollutants in commercial
aircraft. In one study, during a single flight, the NO 2 concentration varied with
the number of passengers with a lighted cigarette. In another study, respirable particles
in the smoking section were measured at concentrations five or more times higher
than in the nonsmoking section. Peaks as high as 1000 µg/m 3 were measured in the
smoking section. Mattson et al. (1989) used personal exposure monitors to assess
nicotine exposures of passengers and flight attendants. All persons were exposed to
nicotine, even if seated in the nonsmoking portion of the cabin. Exposures were
much greater in the smoking than in the nonsmoking section and were also greater in
aircraft with recirculated air. Fortunately, with the banning of tobacco smoking on all
domestic flights in 1987 and on all flights into and out of the United States in 1999, the
issue has for the most part been resolved, as reflected in the National Research
Council’s 2002 updated report (National Research Council 2002).
Health effects of passive smoking
JONATHAN M. SAMET 297
Overview
Evidence on the health risks of passive smoking comes from epidemiologic studies,
which have directly assessed the associations of measures of secondhand smoke exposure
with disease outcomes. Judgments about the causality of associations between
secondhand smoke exposure and health outcomes are based not only on this epidemiologic
evidence, but also on the extensive evidence derived from epidemiologic and
toxicologic investigation on the health consequences of active smoking. To date, the
evidence has supported causal conclusions on a range of acute and chronic adverse
effects in children and adults (Table 17.1). This paper provides an overview of the now
extensive data on adverse health effects of passive smoking on women and children,
drawing on various synthesis reports and other reviews (Samet and Wang 2000). The
evidence is reviewed separately for adults and children.