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Perspectives in Disease Prevention and Health Promotion 1986 Surgeon General's Report: The Health Consequences of Involuntary Smoking

Inhalation of tobacco smoke during active cigarette smoking remains the largest single preventable cause of death and disability in the United States. The health consequences of cigarette smoking and of the use of other tobacco products have been extensively documented in the 18 previous Surgeon General's reports issued by the Public Health Service. More than 300,000 premature deaths that are directly attributable to tobacco use--particularly cigarette smoking--occur each year in the United States. The magnitude of the disease risk for active smokers, secondary to their high dose exposure to tobacco smoke, suggests that the lower doses of smoke received by involuntary smokers also puts them at risk. The 1986 Surgeon General's Report explores the health consequences incurred by involuntary smokers. It was developed by the Office on Smoking and Health, Center for Health Promotion and Education, Centers for Disease Control (CDC) as part of the U. S. Department of Health and Human Services' responsibility under Public Law 91-222 to report new and current information on smoking and health to the U. S. Congress.

Data in the 1986 report present evidence that the chemical composition of sidestream smoke (smoke emitted into the environment by a smoker between puffs) is qualitatively similar to the mainstream smoke inhaled by the smoker and that both mainstream and sidestream smoke act as carcinogens in bioassay systems (1). Data on the environmental levels of the components of tobacco smoke and on nicotine absorption in nonsmokers suggest that nonsmokers are exposed to levels of environmental tobacco smoke (ETS) that would be expected to generate a lung cancer risk. In addition, epidemiological studies of populations exposed to ETS have documented an increased risk for lung cancer in those nonsmokers with increased exposure. Of the 13 epidemiological studies that were available for review in the scientific literature, 11 reported a positive relationship and six of these observed statistically significant results. It is rare to have such detailed exposure data or human epidemiologic studies on disease occurrence when attempting to evaluate the risk of low-dose exposure to an agent with established toxicity at higher levels of exposure. The relative abundance of data reviewed in the report, their cohesiveness, and their biologic plausibility allow a judgment that involuntary smoking can cause lung cancer in nonsmokers.

The 1986 Surgeon General's Report comes to three major conclusions:

  1. Involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers.

  2. Compared with children of nonsmoking parents, children whose parents smoke have an increased frequency of respiratory symptoms and infections. They also have slightly smaller rates of increase in lung function as the lung matures.

  3. Simple separation of smokers and nonsmokers within the same air space may reduce, but does not eliminate, ETS exposure. The report also reviews policies restricting smoking in public

places and the workplace and states that, in the 1970s, an increasing number of public and private sector institutions began adopting policies to protect individuals from ETS exposure by restricting the circumstances in which smoking is permitted. Local governments have been enacting smoking ordinances at an increasing rate since 1980. Restrictions on smoking at the workplace have resulted from both governmental action and private initiative, and an increase in workplace smoking policies has been a trend of the 1980s. Laws restricting smoking in public places have been implemented with few problems and at little cost to state and local governments. Public opinion polls document strong and growing support for restricting or banning smoking in a wide range of public places.

The Surgeon General, in his preface to the report, states, "Cigarette smoking is an addictive behavior, and the individual smoker must decide whether or not to continue that behavior; however, it is evident from the data presented in this volume that the choice to smoke cannot interfere with the nonsmokers' right to breathe air free of tobacco smoke." Reported by Office on Smoking and Health, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: A review recently published by the National Academy of Sciences states that approximately 20% of the estimated 12,200 lung cancer deaths occurring annually in nonsmokers are attributable to environmental tobacco smoke (2). This estimate falls close to the mid-point of the range published by Repace and Lowery, who state that between 500 and 5,000 lung cancer deaths may occur annually as a result of nonsmokers' exposure to tobacco smoke (3). By comparison, figures published in the Journal of the Air Pollution Control Association estimate that between 1,300 and 1,700 total cases of cancer resulting from other air pollutants in the general environment occur each year in the United States (4). Thus, while the number of lung cancer deaths that may be related to ETS exposure is small compared with those caused by active smoking, the actual number of lung cancer deaths caused annually by involuntary smoking is large. In addition, ETS causes more cases of cancer annually than many other agents in the general environment that are regulated because of their potential to cause disease.


  1. Office on Smoking and Health. The health consequences of involuntary smoking: a report of the Surgeon General. Rockville, Maryland: Public Health Service, 1986.

  2. National Research Council, National Academy of Sciences. Environmental tobacco smoke: measuring exposures and assessing health effects. Washington, DC: National Academy Press, 1986.

  3. Repace JL, Lowrey AH. A quantitative estimate of nonsmokers' lung cancer risk from passive smoking. Environ Int 1985;11:3-22.

  4. Thomson VE, Jones A, Haemisegger E, Steigerwald B. The air toxics problem in the United States: an analysis of cancer risks posed by selected air pollutants. J Air Pollut Control Assoc 1985;35(5):535-40.

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