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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 burden of passive smoking in the U.S. The outcomes are the number of attributable myocardial infarctions (MI), coronary heart disease (CHD) events, and CHD deaths. CHD events are MI, cardiac arrest, and new onset of stable or unstable angina. Methods: The estimates used nationally representative surveys of exposure by self-report and serum cotinine in 2000. Estimates were calculated using the CHD Policy Model: a state-transition simulation of the U.S. population over age 35 years. Inputs to the Model include national survey data on the distribution of CHD risk factors, rates of CHD events, and case fatality rates, and 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. Self-report and serum cotinine (≥ 0.05 mg/mL) were used to measure exposure. 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: Annually, 37,000-63,000 MI, 40,000-71,000 CHD events, and 24,000-44,000 CHD deaths are due to passive smoking. 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 (high). Conclusion: Passive smoking remains a major cause of CHD, regardless of the measure of exposure.

Learning Objectives:

• Describe current coronary health burden of exposure to passive smoking in U.S.
• Assess the significance of using different criteria for exposure in estimating current burden of passive smoking.
• Evaluate pros and cons of using different criteria for exposure to passive smoking.

Keywords: Smoking, Environmental Health Hazards

Presenting author's disclosure statement:

Not Answered

Handout (.pdf format, 38.7 kb)