Thanks. It was number 70 on the list presented to me. Most likely to do with my university proxy gaining additional access.
I skimmed it and it’s pretty much over my head, with an abundance of jargon and references that I can’t access. It looks like one needs some measure of medical knowledge to truly understand (or be able to ask legitimate questions about) the contents. One day when I’m not under deadlines…
Okay, so the challenge is to attack the validity of the 1.33 risk factor posed by involuntary smoking, eh? I think there was another specific risk factor cited…yes, Mtgman [post=7543627]cited[/post] a number:
What does HR stand for, by the way? Since I don’t know, my wording will be understandably awkward.
So we have two factual claims in this thread so far regarding the risk of involuntary smoking:
1.33 HR for coronary disease
1.32 HR for breast cancer in active smokers (Same number or less for ETS, one would assume.)
I find these numbers interesting. Why? Because apparently the National Cancer Institute’s guidelines – and seemingly the field of epidemiology in general – maintain that “risk factors less than 2 are considered small…Such increases may be due to chance, statistical bias, or effects of confounding factors that are sometimes not evident.”
So, why should we pay any mind at all to rates of 1.33 when 2 is the pay-attention threshold?
Now, I’m a smoker, and most of the science is beyond me, but I would just love to see a solid refutation of this cite, whose credibility I am incapable of assessing.
Particularly the paragraph from which I took the “less than 2” quote, where it states that drinking whole milk poses far more risk of lung cancer than secondhand smoke. (I also drink whole milk, so if you could debunk that, it’d be just super.)
Finally, the scale for assessing risk for active smokers is measured in pack-years, meaning that until you smoke 7,300 cigarettes – 20 every day for a year – you don’t even register on the scale. How many trips through smokey doorways does it take to accumulate the equivalent of 7,300 full cigarettes, do you think?
Yes, you should.
Bear in mind that the cited study on cardiovascular disease risk, for example, is just one example of the large body of research that has been accumulating for decades on the dangers of secondhand smoke (SHS) exposure. One could question a single study showing the cited level of increased risk - but prevailing views in science are based on repeated demonstrations of evidence. Looking at the section of the Surgeon General’s report on cardiovascular disease risk from SHS, I count 22 separate published studies, demonstrating varying but consistently elevated levels of risk in nonsmokers exposed to SHS. The statistical analysis incorporated in these studies was among the factors reviewed by the Surgeon General, who looked into possible sources of bias and confounding factors in all of this work and examined previous reviews on the subject - before concluding that SHS does increase the risk of cardiovascular disease by 25-30%.
The National Cancer Institute, by the way, does not doubt that SHS is a danger to public health for numerous reasons.
So, nothing to refute the “less than 2 is small” guideline, nor anything to refute any of the claims in the Cato article? Okay then.
I admit that I’m a little lost here. For example, given Polycarp’s disclaimers, I can’t see where the controversy is. He would ban smokers from restaurants, bars, workplaces and even doorways: I would think that it would be difficult to show medical harms from secondhand smoke from the resulting (very small) exposures.
The dose makes the poison. Take a look at #4 in your list. They divide their sample into 3 groups with low, medium and high secondhand smoke exposure. Only the top tertile has significant health outcomes as a result. And (looking at #3) it’s clear that secondhand smoke exposures have declined significantly over the past 20 years.
More generally (following TVeblin, I’d like to see a comparison of the harms of secondhand smoke with other risks. Ah heck, I’ll do it now.
Secondhand smoke … 3000 Deaths per year (From memory)
From the Statistical Abstract, 2003:
Motor vehicle accidents … 43,354
Accidental discharge of firearms … 25 billion, just kidding: 776
Accidental drowning … 3482
Pneumonia … 63548
Meningitis … 758
Homicide … 16,765
Diabetes … 71,252
So to this viewer, secondhand smoke doesn’t seem like either a tiny nor particularly large risk. I wouldn’t dismiss it, but I’m not calling for additional curbs either. Indeed, I could imagine arguments for rollback.
They’re already banned from quite a few of those, even the doorways. For the doorways, though, they congregate right there anyway.
I haven’t seen this particular study, so I don’t know what time course was involved or what they consider “significant health outcomes”. Again, in making his conclusions about the dangers of secondhand smoke, rather than cherry-picking one or two reports, the Surgeon General examined many studies (22 alone in the area of cardiovascular risk) in deciding that a “safe” dose of secondhand smoke has not been established.
Not sure what your point is here. Now that “only” 43% of Americans are exposed to secondhand smoke, we’re supposed to think the problem is solved?
Wrong - it’s close to 50,000 deaths per year according to the Surgeon General. Stacks up pretty well with your other cited causes of death.
Many disagree.
If you’re dismissing my explanation, you need to provide a cite for this alleged “less than 2X risk is nothing to worry about” statement by the National Cancer Institute (which, as noted, is convinced that secondhand smoke poses a serious risk). It is not generally accepted by physicians and researchers that any risk factor is to be dismissed if it doesn’t double the chance of one’s getting sick or dying. One can find many examples of published research in which relative risks of less than 2X are found to be statistically significant.
Interestingly, this Wikipedia article in discussing the subject of relative risk notes that "a blanket requirement that RR>2, taking no account of base rates or sample size, is a fairly crude solution to the problem (of assessing significant risk), and one that appears unduly favorable to opponents of regulation (bolding added*). For this reason, most statisticians continue to use the standard hypothesis testing framework, though with more caution than would be indicated by a standard textbook account.
The article further states that “In medicine, small effect sizes (reflected by small relative risk values) are usually considered clinically relevant (if there is great confidence in them) and are frequently used to guide treatment decisions. A relative risk of 1.10 may seem very small, but over a large number of patients will make a noticeable difference. Whether a given treatment is considered a worthy endeavour is dependent on the risks, benefits and costs.”
So, much as I stated earlier, if there is great confidence in a result (i.e., in the consistent finding over many studies that secondhand smoke poses significant health risks), it is not considered mandatory or desirable by public health experts and researchers that a 2X risk be documented as a prerequisite for action.
*the Wikipedia article also specifically notes that the 2X standard is being promoted by opponents of anti-passive smoking regulation. You can decide if you want a lawyer and a mathematician working under the auspices of the Cato Institute to make decisions relative to your health. I’d sooner trust the Surgeon General and the many cancer and public health experts who agree on the dangers of secondhand smoke.
I suspect that the authors of the Cato Institute article
Clarification - the line “For this reason, most statisticians continue to use the standard hypothesis testing framework, though with more caution than would be indicated by a standard textbook account.” is from the Wikipedia article.
And you can delete the superfluous last line of my previous post.
I have some nits I could pick with Jack, but I’d like to correct the record.
Jackmannii is correct: here’s the quote from the Surgeon General’s Executive Summary, page i
It would appear that secondhand smoke remains a serious public health problem.
I assume from the quoted cite that sudden infant death syndrome can be caused by exposure to second-hand smoke. Is that the case?
Regards,
Shodan
No one knows what causes it. There is a very strong correlation between smoking near an infant and SIDS, however.
There also appears to be a correlation between tobacco industry funding and lack of integrity in the study of SIDS and secondhand smoke.
The cite seemed to be stating fairly clearly that SIDS was caused by second hand smoking.
Which leads to the question as to how that estimate came about, and how reliable both the assertion about SIDS and the rest of the quote might be.
Jackmannii, you probably know the statistics better than I. Could you comment?
Regards,
Shodan
I don’t know where the figure 430 comes from or how it was derived.
Here’s the section of the Surgeon General’s report that deals with evidence supporting the conclusion that secondhand smoke exposure is a major preventable risk factor for SIDS. It might answer your question about reliability of the data, or raise other points for discussion.
If we want to get technical about it, driving my car poisons the air you breathe too. For that matter, when you smell someone’s fart, it’s actually little particles of their shit entering your body. We’re still allowed to drive and fart.
Hmm.
If I understand correctly, exposure to SHS is correlated with an increased risk of SIDS. But the estimate seems to take it for granted that correlation is causality.
Interesting.
Regards,
Shodan
The attitude towards smokers in the US has always baffled me. When I’m in Korea no one will give you a dirty look or probably even notice if you’re smoking a cigarette. For whatever reason American non-smokers have developed this victim mentality towards smoking and have this belief that they’re ‘better’ than smokers. Apparently they don’t have any bad habits.
For non-smokers in the US: Go anywhere else in the world (except the UK maybe) and observe the local attitude towards smoking. Maybe then you’ll start to realize that smokers aren’t always being inconsiderate, but you’re being over-sensitive. Or prone to petty knee-jerk reactions.
It’s an easy bandwagon to jump on so everyone get on board! Let’s find and burn the witch!
One of the first principles involved in correlating an activity or exposure with health risk is to control for simultaneous unrelated risk factors. Are you suggesting this was not done in the numerous studies cited by the SG? In what cases do you find the methodology faulty?
By the way, I think you’re confusing statements about the need for further research to clarify the SIDS-smoking association with doubt that such an association exists.
Is Korea like China, in that you could probably spit up a major organ onto the sidewalk without anyone giving you a second look?
Maybe you’d be happier living in Korea full-time. 
The first part seems quite reasonable. Smoking is a detriment to our health. Regarding the second part, overall no claims can be made person to person, but yes, I do believe that not smoking is better than smoking.
I’m not doubting the association. I am saying something fairly obvious, that correlation != causation, which is a point made on the SDMB a dozen times a week.
I’m no epidemiologist, but ISTM that mothers who smoke after their children are born tend to be those who smoked before as well, and fathers too. Is it not possible that it is not the exposure to SHS that correlates with SIDS, but the prenatal smoking by the mother? Or even (possibly) that those who are careless enough about their health (and the health of their children) to smoke are going to also be careless enough to lay their children on their bellies to sleep. Or tend to be further down the socio-economic ladder. Or tend to be black. Or a half-dozen other factors that I can’t think of.
You know as well as I do that dosage makes (or does not make) a poison. And it would seem fairly clear that one would have to breathe a heck of a lot of second hand smoke before approaching the levels of exposure involved in actually having a cigarette in your mouth. No one doubts that actually smoking is bad for you. Or even that “there is no safe level of exposure to cigarette smoke”. But how unsafe is unsafe, and at what level of exposure?
Regards,
Shodan