Warning: Overstating the Case Against Secondhand Smoke is Unnecessary and Harmful to Public Health Policy

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In a full page ad in the New York Times this week, the Coalition for a Smoke-Free New York called on the New York City Council to pass legislation requiring that all workplaces, including small restaurants, restaurant bars and stand-alone bars and nightclubs become l00% smokefree. New York City already has expansive smoke-free laws, but still allows smoking in bars and in eateries that seat under 30.

The call for a smoke-free environment in public places citywide is commendable. Cigarette smoking is annoying and can cause acute health problems, but the headlines of this ad are alarmist: SECOND HAND SMOKE..CAUSES LUNG CANCER, HEART DISEASE, ASTHMA AND RESPIRATORY DISEASE. NOBODY SHOULD HAVE TO BREATHE IT TO HOLD A JOB.

The headlines go on to claim, "The #1 Killer in the American Workplace is..Secondhand Smoke."

What we have here is a good cause smoke-free living threatened by hyperbole about the likely effects of ETS .

The Coalition for a Smoke-Free City states in this ad that workers are the focus of their concern in this case particularly bartenders who perform their tasks in smoky environments. The Coalition does have some facts going for it: secondhand or "environmental tobacco smoke" (ETS) is a complex mixture of over 4,000 chemicals in the form of both gases and particulates, produced by burning materials (tobacco and additives ) of a cigarette. Among the toxicants in ETS are nitrogen oxides, ammonia, formaldehyde, carbon monoxide, methyl isocyante, nicotine and more.

There is an extensive literature on the health effects of ETS and substantial scientific agreement that ETS causes irritation and respiratory problems, particularly in children. Indeed, the findings that ETS causes or aggravates respiratory illness is undisputed, scientifically. Children exposed to ETS are at greatly increased risk for lower respiratory tract infections, middle-ear disease ,and worsening of asthma symptoms. In adults, ETS has been shown to aggravate symptoms of pre-existing health conditions such as asthma--and has been shown to have subtle but significant effects on nonsmoking adults' respiratory health, contributing to such symptoms as increased cough, phlegm production, postnasal drip, chest discomfort and reduced lung function.

But the main message from this ad is that workers (such as bartenders) exposed to secondhand smoke are at significant risk of lung cancer and heart disease.

The evidence linking ETS with chronic disease is much more speculative than that linking it to acute diseases like ear infections and respiratory effects. There are some studies have noted that ETS is a only a weak risk factor for development of lung cancer and heart disease in nonsmokers after regular, long term exposure. But, simply put, the role of ETS in the development of chronic diseases like cancer and heart disease is uncertain and controversial. To state that occupational exposure of bartenders is the "#1 killer in the American workplace" is without scientific basis.

What is to be gained by overstating the case against secondhand smoke? The Coalition for Smoke-Free New York would have been on firm scientific ground if it simply stated that ETS caused irritation of the eyes, nose and respiratory tract and aggravated preexisting asthma. Surely that is enough of a reason to justify the protection of all workers. By exaggerating, the Coalition only serves to give ammunition to those who are both generally skeptical of public health "meddling," and to those who maintain that health advocates, motivated by "the end justifies the means" philosophy, frequently play quick and dirty with the facts in an attempt to justify the interventions they want . When they see an ad like the one the Coalition ran this week, these critics of public health may rush to defend existing smoking policies in restaurants and bars.

Public health policy is best advanced by policies that stick closely to the scientific facts while recognizing that the best way to lose a legitimate argument is to overstate and exaggerate it.