Remarks as prepared; not a transcript.

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

Remarks at press conference to launch Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General

Tuesday, June 27, 2006
10:00 a.m.
Washington, D.C.

“The Health Effects of Secondhand Smoke”

Thank you, Rear Admiral Moritsugu for your kind introduction.

I am grateful to be here today and to be able to say unequivocally that the debate is over. The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard that causes premature death and disease in children and nonsmoking adults.

Updating the Evidence

Twenty years ago, the 1986 Surgeon General’s Report on The Health Consequences of Involuntary Smoking concluded that secondhand smoke exposure was a cause of disease in nonsmokers. That Report, which was one of the first major reports to investigate this topic, concluded that secondhand smoke caused lung cancer among nonsmoking adults and several respiratory problems among children.

Since that Report was published, hundreds of peer-reviewed studies and several additional major reports on the health effects of secondhand smoke have been published, and the evidence on these health effects has become even stronger.

The Surgeon General’s Report that we are releasing today, The Health Consequences of Involuntary Exposure to Tobacco Smoke, documents beyond any doubt that secondhand smoke harms people’s health. In the course of the past 20 years, the scientific community has reached consensus on this point.

Main Messages

I would like to draw your attention to several new conclusions that I have reached due to overwhelming scientific evidence.

• Secondhand smoke exposure causes heart disease and lung cancer in adults and sudden infant death syndrome and respiratory problems in children.
• There is NO risk-free level of secondhand smoke exposure, with even brief exposure adversely affecting the cardiovascular and respiratory system.
• Only smoke-free environments effectively protect nonsmokers from secondhand smoke exposure in indoor spaces.
• Finally, the Report concludes that, while great strides have been made in recent years in reducing nonsmoking Americans’ secondhand smoke exposure, millions of Americans continue to be exposed to secondhand smoke in their homes and workplaces.

Secondhand Smoke is Harmful to All People

Allow me to expand on the first major conclusion. Secondhand smoke is a health hazard for all people: it is harmful to both children and adults, and to both women and men. It is harmful to nonsmokers whether they are exposed in their homes, their vehicles, their workplaces, or in enclosedpublic places. We have found that certain populations are especially susceptible to the health effects of secondhand smoke, including infants and children, pregnant women, older persons, and persons with pre-existing respiratory conditions and heart disease.

It is not surprising that secondhand smoke is so harmful. Nonsmokers who are exposed to secondhand smoke inhale the same toxins and cancer-causing substances as smokers. Secondhand smoke has been found to contain more than 50 carcinogens and at least 250 chemicals that are known to be toxic or carcinogenic. This helps explain why nonsmokers who are exposed to secondhand smoke develop some of the same diseases that smokers do.

Health Effects of Exposure to Secondhand Smoke in Adults

Let’s look first at the health effects that secondhand smoke causes in adults.

Lung Cancer

The Report confirms that secondhand smoke is a known human carcinogen that causes lung cancer in nonsmoking adults. Nonsmokers who are exposed to secondhand smoke, at home or at work, increase their risk of developing lung cancer by 20 percent to 30 percent. Secondhand smoke causes approximately 3,000 lung cancer deaths among U.S. nonsmokers each year.

Heart Disease

The Report released today also concludes that secondhand smoke causes heart disease. Nonsmoking adults who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 to 30 percent. The evidence indicates that even brief secondhand smoke exposures can have immediate adverse effects on the cardiovascular system. This is especially true for persons who already have heart disease, or who are at special risk of heart disease. Secondhand smoke causes tens of thousands of heart disease deaths each year among U.S. nonsmokers.

Health Effects of Secondhand Smoke Exposure in Children

Now let’s turn to the special health risks that secondhand smoke poses to children. Because their bodies are still developing, infants and children are especially vulnerable to the poisons in secondhand smoke.

Respiratory Infections

Secondhand smoke is a cause of respiratory conditions in children-we’ve known that since our study of second hand smoke effects began in 1986. However, after further research and analysis, we have found that the consequences of smoke on a child’s respiratory system are more severe than originally thought. Acute respiratory infections such as bronchitis and pneumonia, respiratory symptoms such as cough, phlegm, wheezing, and breathlessness, more frequent and severe asthma attacks, slowing of lung growth, and ear infections have all been proven to be results of exposure to secondhand smoke in children.

SIDS

In an important new finding, we have determined that secondhand smoke is a cause of sudden infant death syndrome (SIDS). Infants who die from SIDS tend to have higher concentration of nicotine in their lungs and higher levels of cotinine (a biological marker for secondhand smoke exposure) than infants who die from other causes. We have also found that infants who are exposed to secondhand smoke after birth are also at increased risk of dying of SIDS.

In addition, babies of nonsmoking women who are exposed to secondhand smoke during pregnancy are at risk for a small reduction in birth weight. Chemicals in secondhand smoke appear to affect the brain in ways that interfere with its regulation of infants’ breathing.

There is No Risk-Free Level of Exposure to Secondhand Smoke

We know that secondhand smoke harms people’s health, but many people assume that exposure to secondhand smoke in small doses does not do any significant damage to one’s health. However, science has proven that there is NO risk-free level of exposure to secondhand smoke. Let me say that again: there is no safe level of exposure to secondhand smoke.

Breathing secondhand smoke for even a short time can damage cells and set the cancer process in motion. Brief exposure can have immediate harmful effects on blood and blood vessels, potentially increasing the risk of a heart attack. Secondhand smoke exposure can quickly irritate the lungs, or trigger an asthma attack. For some people, these rapid effects can be life-threatening. People who already have heart disease or respiratory conditions are at especially high risk.

Establishing Smoke-free Environments is the Only Proven Way to Prevent Exposure

The good news is that, unlike some public health hazards, secondhand smoke exposure is preventable. A proven method exists for protecting nonsmokers from the health risks associated with secondhand smoke exposure: avoiding places where secondhand smoke is present.

An important new conclusion of this Report is that smoke-free environments are the ONLY approach that effectively protects nonsmokers from the dangers of secondhand smoke. The 1986 Surgeon General’s Report concluded that the simple separation of smokers and nonsmokers within the same air space may reduce, but does not eliminate, secondhand smoke exposure among nonsmokers. The current Report expands on that finding by concluding that even sophisticated ventilation approaches cannot completely remove secondhand smoke from an indoor space. Because there is no risk-free level of secondhand smoke exposure, anything less cannot ensure that nonsmokers are fully protected from the dangers of exposure to secondhand smoke.

Yet, Many Americans Remain at Risk

The good news is that we are making progress. Secondhand smoke exposure among U.S. nonsmokers has declined since the publication of the 1986 Surgeon General’s Report. Levels of cotinine, the biomarker of secondhand smoke exposure, fell by 70 percent from 1988-91 to 2001-02. The proportion of nonsmokers with detectable cotinine levels has been halved from 88 percent to 43 percent.

However, while we have made great strides over the years to reduce smoking in America, the success story is not complete. More than 126 million nonsmoking Americans, including both children and adults, are still exposed to secondhand smoke in their homes and workplaces.

Given the extensive evidence on the serious health risks posed by secondhand smoke exposure that is reviewed in the Report we are releasing today, the involuntary nature of this exposure, and the availability of a proven method for eliminating these risks, we cannot be satisfied until all Americans are aware of the health hazards caused by secondhand smoke on their families and loved ones.

Companion Piece

As many of you are aware, I have made it my goal as US Surgeon General to increase the overall health literacy of my fellow Americans. Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

More than 90 million Americans cannot adequately understand basic health information. People of all ages, races, incomes, and education levels are challenged by low health literacy.

By making health information easier to understand, we allow people to actively take steps to increase their health and wellness and to actually prevent disease as a result of healthy choices.

Because of this, all communications issued by the Office of the Surgeon General for the general public are now tested to be sure that they are on a reading level where people can understand and use the information. In addition to this report, I am also releasing a magazine-style, full-color “Consumer Guide or People’s Piece” with the science presented in a way that every American can understand and apply to their individual circumstances.