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APHA Scientific Session and Event Listing

James Lightwood, PhD¹, Pamela Coxson, PhD², Kirsten Bibbins-Domingo, MD², Lawrence Williams, MSc³, and Lee Goldman, MD, MPH². (1) Clinical Pharmacy, University of California, San Francisco, 3333 California St., Suite 420, San Francisco, CA 94118, 415-514-0939, lightwoodj@pharmacy.ucsf.edu, (2) Medicine, University of California, San Francisco, 3333 California St., San Francisco, CA 94118, (3) Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115

Objective: Our goal was to estimate the current and future benefits of the reduction in exposure to passive smoking that occurred between 1990 and 2000 in the U.S. The outcomes are the reduction in myocardial infarctions (MI) and coronary heart disease (CHD) deaths for the years 2005-2030 attributable to reductions in passive smoking. Methods: The estimates used nationally representative surveys of exposure by self-report and serum cotinine in 1990 and 2000. Estimates were calculated using the CHD Policy Model: a state-transition simulation of the U.S. population, age 35 years and over. Inputs to the Model include national survey data on the distribution of CHD risk factors, rates of CHD events and case fatality rates; estimated risk factors based on Framingham and other epidemiological and interventional studies. The Model uses estimates that the risk due to average daily passive smoking in exposed individuals is equivalent to one cigarette/day, which produces about 1/3 the excess CHD risk of smoking one pack/day. The Model is calibrated to reproduce, in its baseline year of 2000, all key outcomes in the U.S. to within 1% as well as the results of relevant clinical trials. Results: The annual reductions are 14,000-32,000 (MI) and 9,000-22,000 (CHD death). The cumulative reductions are 352,000-832,000 (MI) and 237,000-579,000 (CHD death). The range of the estimates depends on which measure of exposure best reflects the threshold for clinically significant exposure: self-report (low) or serum cotinine ≥ 0.05 ng/mL (high). Conclusions: Reduction in passive smoking has produced substantial coronary health benefits.

Learning Objectives:

• Describe the current and future coronary health benefits of the reduction in passive smoking in US that occurred between 1990 and 2000.
• Assess the importance of exposure measurement in estimating the coronary health burden of passive smoking.
• Understand the advantages and disadvantages of using self-report and serum cotinine level to estimate the health burden of passive smoking.

Keywords: Smoking, Environmental Health Hazards

Presenting author's disclosure statement:

Not Answered

Handout (.pdf format, 42.4 kb)