BMJ  2003;326 (17 May), doi:10.1136/bmj.326.7398.0

Environmental tobacco smoke does not affect mortality

Environmental tobacco smoke was not associated with mortality from coronary heart disease or lung cancer at any level of exposure in a large study of Californians followed for 40 years. Based on an analysis tracking 35 561 adults who had never smoked and their smoker spouses between the periods 1960 and 1998, Enstrom and Kabat (p 1057) suggest that the effects of environmental tobacco smoke, particularly for coronary heart disease, are considerably smaller than generally believed. In contrast, active cigarette smoking was a strong, dose related risk factor for coronary heart disease, lung cancer, and chronic obstructive pulmonary disease. Despite these findings, Davey Smith (p 1048) says debate about the role of environmental smoke, as well as the risk of being married to a smoker, will continue. Additional research on the link between second hand smoke and disease is needed.

NIKI BOROFSKY


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