bmj.com Abstracts: Enstrom and Kabat 326 (7398): 1057

¹ School of Public Health, University of California, Los Angeles, CA 90095-1772, USA, ² Department of Preventive Medicine, State University of New York, Stony Brook, NY 11794-8036, USA

Correspondence to: J E Enstrom jenstrom@ucla.edu

Objective To measure the relation between environmental tobacco smoke, as estimated by smoking in spouses, and long term mortalityfrom tobacco related disease.

Design Prospective cohort study covering 39 years.

Setting Adult population of California, United States.

Participants 118 094 adults enrolled in late 1959 in the American Cancer Society cancer prevention study (CPS I), who were followeduntil 1998. Particular focus is on the 35 561 never smokerswho had a spouse in the study with known smoking habits.

Main outcome measures Relative risks and 95% confidence intervals for deaths from coronary heart disease, lung cancer, and chronicobstructive pulmonary disease related to smoking in spousesand active cigarette smoking.

Results For participants followed from 1960 until 1998 the age adjusted relative risk (95% confidence interval) for never smokersmarried to ever smokers compared with never smokers marriedto never smokers was 0.94 (0.85 to 1.05) for coronary heartdisease, 0.75 (0.42 to 1.35) for lung cancer, and 1.27 (0.78to 2.08) for chronic obstructive pulmonary disease among 9619men, and 1.01 (0.94 to 1.08), 0.99 (0.72 to 1.37), and 1.13(0.80 to 1.58), respectively, among 25 942 women. No significantassociations were found for current or former exposure to environmentaltobacco smoke before or after adjusting for seven confoundersand before or after excluding participants with pre-existingdisease. No significant associations were found during theshorter follow up periods of 1960-5, 1966-72, 1973-85, and 1973-98.

Conclusions The results do not support a causal relation between environmental tobacco smoke and tobacco related mortality, althoughthey do not rule out a small effect. The association betweenexposure to environmental tobacco smoke and coronary heartdisease and lung cancer may be considerably weaker than generallybelieved.

This article has been cited by other articles:

G. Davey Smith
Effect of passive smoking on health
BMJ, May 15, 2003; 326(7398): 1048 - 1049.
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Need for clarification on competing interest: Martin McKee; bmj.com, 15 May 2003 [Full text]
Flawed study from the outset: Jayant S Vaidya; bmj.com, 15 May 2003 [Full text]
Risks for passive smoking are likely to be underestimated.: Trevor LP Watts; bmj.com, 16 May 2003 [Full text]
Re: Second-hand smokescreens: Brian David Porter, et al.; bmj.com, 16 May 2003 [Full text]
Irresponsible journalism: Dominic C Horne; bmj.com, 16 May 2003 [Full text]
Agreeing the limits of conflict of interest: richard horton; bmj.com, 16 May 2003 [Full text]
Editorial responsibility to publish sound science: Trish A Fraser; bmj.com, 16 May 2003 [Full text]
BMA Turns Tabloid: Dale Jackaman; bmj.com, 16 May 2003 [Full text]
Evidence Based Medicine?: Stephen Novick; bmj.com, 16 May 2003 [Full text]
The letter BMJ failed to write: Pascal A. Diethelm; bmj.com, 16 May 2003 [Full text]
Unproven health impact of environmental smoke: A study with low statistical power: Parthasarathy K S; bmj.com, 16 May 2003 [Full text]
ETS - Interpretation of the wider evidence: Julia A Critchley; bmj.com, 16 May 2003 [Full text]
Seondhand Smoke Study is Seriously Flawed: Marty Eckrem; bmj.com, 16 May 2003 [Full text]
Lies, Damned Lies and Statistics: Richard EK Russell; bmj.com, 16 May 2003 [Full text]
Timing of publication: Jephat Chifamba; bmj.com, 16 May 2003 [Full text]
Irresponsible public health message: Sabina Fatima Hussain; bmj.com, 16 May 2003 [Full text]
California-smoky offices, windows open at home most of the year ....: HS Roberts; bmj.com, 16 May 2003 [Full text]
Give them enough rope: Daniel F. Hass; bmj.com, 17 May 2003 [Full text]
Re: Irresponsible journalism: Ellen C G Grant; bmj.com, 17 May 2003 [Full text]
what does this add?: Paul M Jones; bmj.com, 17 May 2003 [Full text]
Swimming with sharks: Paul S McDonald; bmj.com, 17 May 2003 [Full text]
Biggest impact on developing countries: Judith M Mackay; bmj.com, 17 May 2003 [Full text]
some thoughts: martin heilweil, PhD; bmj.com, 17 May 2003 [Full text]
Study Objective Flawed--Fatally: Stephen J. Jay; bmj.com, 17 May 2003 [Full text]
Re: Agreeing the limits of conflict of interest: Clive D Bates; bmj.com, 17 May 2003 [Full text]
Re: Need for clarification on competing interest: Geoffrey C Kabat; bmj.com, 17 May 2003 [Full text]
Nothing new from the antismoking front: Wiel M Maessen; bmj.com, 17 May 2003 [Full text]
Reply to Bates: Tony Delamothe; bmj.com, 17 May 2003 [Full text]
From hero to pariah in one easy jump: Richard Smith; bmj.com, 17 May 2003 [Full text]
Children are not exposed to parental smoke??!!: Andrew J Fall; bmj.com, 17 May 2003 [Full text]
What in the world were you thinking?: Sera Kirk; bmj.com, 17 May 2003 [Full text]
Re: Nothing new from the antismoking front: David F. Copeland; bmj.com, 17 May 2003 [Full text]
FINALLY !! Truth Comes Out of the Closet.: Stephen Hartwell; bmj.com, 17 May 2003 [Full text]
Funding by EPA,, CDC, WHO equally "tainted": Natalie P.R. Sirkin; bmj.com, 17 May 2003 [Full text]
When conflict of interest becomes unacceptable: Deborah Arnott; bmj.com, 18 May 2003 [Full text]
Did non-smokers REALLY avoid: Simon Chapman; bmj.com, 18 May 2003 [Full text]
Re: Re: Nothing new from the antismoking front: Wiel M Maessen; bmj.com, 18 May 2003 [Full text]
Whither epidemiologic reporting?: Gio B. Gori; bmj.com, 18 May 2003 [Full text]
Consistency - science for sale?: John R. Polito; bmj.com, 18 May 2003 [Full text]
Tobacco Toxicity: Ken B. Jones; bmj.com, 18 May 2003 [Full text]
BMJ-comic or respectable journal?: Raj Thakkar; bmj.com, 18 May 2003 [Full text]
WHAT THE HELL HAVE THESE PEOPLE BEEN SMOKIN'?: Errol E. POVAH; bmj.com, 18 May 2003 [Full text]
4 Questions, 2 comments: tOM Trottier, et al.; bmj.com, 18 May 2003 [Full text]
Another "competing interest" of James Enstrom: Robert S. Broughton; bmj.com, 18 May 2003 [Full text]
RESPONSE TO PAPER ON PASSIVE SMOKING: Christopher W IDE; bmj.com, 18 May 2003 [Full text]
Science as PR: Gene Borio; bmj.com, 18 May 2003 [Full text]
A "passive smoke" observation: Robert I. Rudolph, M.D., FACP; bmj.com, 18 May 2003 [Full text]
Remember "Frank Statement to Smokers"?: Joanne L. Addison; bmj.com, 18 May 2003 [Full text]
Bully for the BMJ: Bryce C. Peterson, M.D.; bmj.com, 18 May 2003 [Full text]
Six Key Issues: Ronald M. Davis; bmj.com, 19 May 2003 [Full text]
The bottom line: Andrew S Furber; bmj.com, 19 May 2003 [Full text]
What killer? Let’s call things with their name.: Gian L. Turci; bmj.com, 19 May 2003 [Full text]
environmental tobacco smoke paper requires further benefits from critical appraisal: Rosemary Fox, et al.; bmj.com, 19 May 2003 [Full text]
BMJ, Impact Factor and Irresponsible Journalism: A 'nasty' nexus?: Zubair Kabir; bmj.com, 19 May 2003 [Full text]
Adequacy of age-adjustment?: Eugene Milne; bmj.com, 19 May 2003 [Full text]
Response to Simon Chapman: Michael J Thun; bmj.com, 19 May 2003 [Full text]
Why The Double Standard?: Dave Hitt; bmj.com, 19 May 2003 [Full text]
Pots calling kettles black: GH Hall; bmj.com, 19 May 2003 [Full text]
SARS causes no harm: Jonathan P. Krueger; bmj.com, 19 May 2003 [Full text]
Reply to ASH - please be more careful in future: James A Delphi; bmj.com, 19 May 2003 [Full text]
Inverse effect can be explained: Wiel Maessen; bmj.com, 19 May 2003 [Full text]
Freedom: Crystal L Pherson; bmj.com, 19 May 2003 [Full text]
More details on competing interests: Martin McKee, et al.; bmj.com, 20 May 2003 [Full text]
A very interesting coincidence: ELIF DAGLI; bmj.com, 20 May 2003 [Full text]
Confirmation: Secondhand smoke does cause respiratory disease: Anthony J Hedley, et al.; bmj.com, 20 May 2003 [Full text]
Tobacco cartel wants to create a "controversy": Joseph Cherner; bmj.com, 20 May 2003 [Full text]
Re: Adequacy of age-adjustment - a hypothesis: Eugene Milne; bmj.com, 20 May 2003 [Full text]
An American Cancer Society Perspective: Michael J. Thun; bmj.com, 20 May 2003 [Full text]
Defining a set of difficult issues: richard horton; bmj.com, 20 May 2003 [Full text]
Read peer review comments: Kamran Abbasi; bmj.com, 20 May 2003 [Full text]
The Correlation of Smoking and Deep Breathing: Bernard X. Bovasso, et al.; bmj.com, 20 May 2003 [Full text]
Reviewers' comments: Martin McKee; bmj.com, 20 May 2003 [Full text]
Apology Requested: William T Godshall; bmj.com, 20 May 2003 [Full text]
Jumping out of a 3rd storey window "may not kill" either...: Peter J Flegg; bmj.com, 21 May 2003 [Full text]
Re: Read peer review comments: Kamran Abbasi; bmj.com, 21 May 2003 [Full text]
Re: Defining a set of difficult issues: Zubair Kabir; bmj.com, 21 May 2003 [Full text]
Old habits new diseases?: Teresa Ramos; bmj.com, 21 May 2003 [Full text]
Re: Science as PR....Bravo, Gene!: Errol E. POVAH; bmj.com, 21 May 2003 [Full text]
Re: Inverse effect can be explained: Adam Jacobs; bmj.com, 21 May 2003 [Full text]
Why am I dying from lung cancer caused by second-hand smoke?: Heather S. Crowe; bmj.com, 21 May 2003 [Full text]
It's not always easy: James W Austin; bmj.com, 21 May 2003 [Full text]
Flawed Study on Passive Smoking: Michael J. Martin; bmj.com, 21 May 2003 [Full text]
PUT YOUR LUNGS WHERE YOUR MOUTH IS: Emanuel Goldman; bmj.com, 21 May 2003 [Full text]
Re: Why The Double Standard?: M. L. Herrin; bmj.com, 21 May 2003 [Full text]
"Serious misclassification of exposure": Pascal A. Diethelm; bmj.com, 22 May 2003 [Full text]
Judging Research: freda lee nason; bmj.com, 22 May 2003 [Full text]
Re: Six Key Issues: Emma L Dickinson; bmj.com, 22 May 2003 [Full text]
Lost Credibility: Christopher Lovelidge, et al.; bmj.com, 22 May 2003 [Full text]
Response to McKee and Diethelm: Geoffrey C Kabat; bmj.com, 22 May 2003 [Full text]
The 'overwhelming evidence' for the links between ETS and lung cancer and heart disease: Wiel M Maessen; bmj.com, 22 May 2003 [Full text]
Re: Why am I dying from lung cancer caused by second-hand smoke?: Wiel Maessen; bmj.com, 22 May 2003 [Full text]
Re: Judging Research: Nigel R Winterbottom; bmj.com, 22 May 2003 [Full text]
Re: Re: Inverse effect can be explained: Wiel M Maessen; bmj.com, 23 May 2003 [Full text]
What are the tobacco manufacturers saying?: Andrew S Furber; bmj.com, 23 May 2003 [Full text]
Response to James Austin: Simon Chapman; bmj.com, 23 May 2003 [Full text]
Smoke: Cancer ingredients or not: George F Sedlacek; bmj.com, 23 May 2003 [Full text]
The Confounding Urban Factor: David W. Kuneman; bmj.com, 23 May 2003 [Full text]
Misleading the public about secondhand smoke ... Again: Lisa A Bero, et al.; bmj.com, 23 May 2003 [Full text]
Re: Response to McKee and Diethelm: Malcolm X. McGarrity; bmj.com, 23 May 2003 [Full text]
Response to Simon Chapman: James W Austin; bmj.com, 24 May 2003 [Full text]
Re: Misleading the public about secondhand smoke ... Again: B.J. Allen; bmj.com, 24 May 2003 [Full text]
Wrong conclusion: William Carey; bmj.com, 25 May 2003 [Full text]
Re: Misleading the public about secondhand smoke ... Again: Wiel M Maessen; bmj.com, 25 May 2003 [Full text]
Do any of the "non-smokers" smoke?: John H. Glaser; bmj.com, 25 May 2003 [Full text]
Research Bias and Science: Michael J. McFadden; bmj.com, 25 May 2003 [Full text]

Related editorials in BMJ:

Effect of passive smoking on health.: George Davey Smith
BMJ 2003 326: 1048-1049. [Full text]