Intended for healthcare professionals

Rapid response to:


Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98

BMJ 2003; 326 doi: (Published 15 May 2003) Cite this as: BMJ 2003;326:1057

Rapid Response:

Who is Blowing Smoke on Secondhand Smoke?

Dr. Kabat continues to insist that the world is "hyping health risks"
of secondhand smoke, but his outlying view has never been supported by the
science. Secondhand smoke contains in excess of 170 hazardous substances,
including many regulated in the U.S.: 3 regulated outdoor air pollutants
and 33 hazardous air pollutants regulated under the Clean Air Act, 47
pollutants classified as hazardous wastes whose disposal in solid or
liquid form is regulated by the Resource Conservation and Recovery Act, 67
known human or animal carcinogens, and 3 industrial chemicals regulated
under the Occupational Health and Safety Act (Repace, 2007).

Moreover, secondhand smoke is a major source of fine particle
exposure (PM2.5). Long-term exposure to PM2.5 is associated with
increased cardiovascular mortality, various blood markers of
cardiovascular risk, histopathological markers of subclinical chronic
inflammatory lung injury, and subclinical atherosclerosis. Short-term
exposure is associated with cardiovascular mortality and hospital
admissions, stroke mortality and hospital admissions, myocardial
infarction, pulmonary and systemic inflammation and oxidative stress,
altered cardiac autonomic function, and arterial vasoconstriction. The
cardiopulmonary response to PM2.5 on both daily and long-term time scales
appears to be linear across the range of outdoor air PM concentrations as
measured by local monitoring stations (Pope et al., 2001, 2006, 2009).

Concentrations of secondhand smoke PM2.5 indoors exceed PM2.5 from
outdoor air pollution in developed countries by 1 to 3 orders of
magnitude, as dozens of peer-reviewed exposure science publications
confirm (e.g., Repace, 2006). Therefore, to attempt to prevent control of
exposure to secondhand smoke by referring to epidemiological studies with
no measurement of exposure other than a questionnaire concocted by persons
with little or no experience in air pollution exposure assessment would be
the height of imprudence if taken seriously.

James Repace

Pope CA, Dockery DW (2006). Health Effects of Fine Particulate Air
Pollution: Lines that Connect. Journal of the Air & Waste Management
Association 56:709–742.

Pope C.A., Eatough D.J., Gold D.R., Pang Y., Nielsen K.R., Nath P.,
et al. Acute exposure to environmental tobacco smoke and heart rate
variability. Environ Health Perspect 2001: 109: 711-716.

Pope CA 3rd, Burnett RT, Krewski D, Jerrett M, Shi Y, Calle EE, Thun
MJ (2009). Cardiovascular mortality and exposure to airborne fine
particulate matter and cigarette smoke: shape of the exposure-response
relationship. Circulation 120:924-927.

Repace JL (2004). Respirable Particles and Carcinogens in the Air of
Delaware Hospitality Venues Before and After a Smoking Ban. Journal of
Occupational and Environmental Medicine, 46:887-905.

Competing interests:
The author is a secondhand smoke consultant, and has testified in litigation involving injury from secondhand smoke exposure.

Competing interests: No competing interests

22 December 2009
James L. Repace
Visiting Asst. Clinical Prof., Tufts Univ. School of Medicine, Dept. of Public Health
101 Felicia Lane, Bowie, MD, 20720, U.S.A.