Monday, September 27, 2004

Secondhand smoke: Issue under gray cloud

By Matt Leingang
Enquirer staff writer

With her boss' approval, Becca Wenzel works exclusively in the nonsmoking section at Price Hill Chili.

But the 23-year-old waitress can't escape secondhand smoke. It's in her face every time Wenzel passes through the smoking section on her way to the kitchen.

Robyn Harrison (left) and Becca Wenzel are servers at Price Hill Chili. They don't smoke and would like a smoking ban in restaurants and bars.
(Enquirer photo/MICHAEL E. KEATING)
The smoky air she breathes contains more than 4,000 hazardous chemicals, including benzene, lead and arsenic, research says. At least 60 of those chemicals can cause cancer.

Wenzel favors a smoking ban, currently being studied in Cincinnati, that would give her the protection already afforded to many Americans.

About 76 percent of white-collar workers in the United States are covered by smoke-free laws or workplace policies that ban smoking, but just 43 percent of the 6.6 million food preparation and service workers have that protection, according to the Journal of Occupational and Environmental Medicine.

"The hearts and lungs of people who work in bars and restaurants are no less valuable," said Lisa Owendoff, director of communications for the American Cancer Society in Cincinnati.

While no one is forcing bartenders or waiters to work where they do, "exposure to toxic smoke shouldn't be a condition of employment," Owendoff argues.

Nationwide, more than 1,700 cities, including Toledo and Lexington, and 10 states have some form of clean indoor-air legislation, according to the American Nonsmokers' Rights Foundation in Berkeley, Calif.

In Cincinnati, the debate is heating up. The city Health Department has put together a 30-member panel to study a workplace smoking ban and to prepare a report to City Council in November.

Vice Mayor Alicia Reece has supported a ban, but other council members are reserving judgment because of fears from some bar and restaurant owners that it will hurt business.

There's no guarantee that council will even vote on the issue.

But advocates, who include the cancer society, the American Lung Association and various health officials, have succeeded in getting the city to study the issue. No other municipality in the area has agreed to do that.

Across the river, advocates in Northern Kentucky are polling residents to gauge support for restricting workplace smoking in Boone, Kenton, Campbell and Grant counties. Results will be presented to government officials.

Advocates say the science is on their side. It is, but not without a minor degree of controversy.

The collective opinion of the U.S. Environmental Protection Agency, the Centers for Disease Control and Prevention and the World Health Organization is that secondhand smoke is a real danger.

Short-term effects of secondhand smoke include coughing, sore throat, eye irritations and breathing problems, especially for asthmatics.

In addition, the CDC estimates that long-term exposure to secondhand smoke causes 3,000 Americans to die of lung cancer each year, along with 35,000 to 62,000 deaths from coronary heart disease.

Dr. Joe Hackworth, a Cincinnati cardiologist, said he advises patients with heart disease to avoid places where secondhand smoke lingers.

A 30-minute exposure is enough to constrict coronary blood and prompt a heart attack, according to some medical research.

But this is where the science can get tricky.

While their numbers are small, some medical researchers argue that the link between secondhand smoke and disease is not that strong.

Hard to prove

Proving a link between secondhand smoke and cancer has always been technically difficult.

For ethical and legal reasons, researchers can't put one group of people inside a room and subject them to endless amounts of smoke for months, leaving another group unexposed, in order to see who gets more cancer.

Instead, for the past 30 years researchers have relied on studies that compare the health of non-smokers with spouses who smoke and spouses who don't smoke.

When cancer rates are significantly higher in these nonsmokers, it is considered unlikely it was just chance.

In 2002, the International Agency for Research on Cancer, part of the World Health Organization, examined all of the 58 major studies looking at smoking and cancer and quantified the risk.

Taken as a whole, the studies suggest nonsmokers who are exposed to secondhand smoke are 20 percent to 30 percent more likely to develop lung cancer, the agency said. From there, health agencies like the CDC are able to derive their annual death estimates.

That's not good enough for Ken Schwab, a 34-year-old bartender at Garfield Suites Hotel in downtown Cincinnati.

Schwab, who smokes, said he opposes a smoking ban, in part because he believes the decision to allow smoking should be left to individual business owners. But he's also unconvinced that his smoking poses any significant threat to customers.

A dissenting study

Schwab and other critics got some ammunition in 2003 when James Enstrom, a researcher at the UCLA School of Public Health, outraged many in the medical community when he claimed that the danger of secondhand smoke is greatly overstated.

Enstrom's study of smokers and nonsmokers in California, which appeared in the prestigious British Journal of Medicine, found that exposure to secondhand smoke had no significant effect on death rates from lung cancer or heart disease. The rates were similar for those with spouses who smoked and those with nonsmoking spouses, the study said.

chart Anti-smoking activists, including top officials at the American Cancer Society, attacked Enstrom, calling his study "critically flawed" because of the way he juggled data sets from the 1950s and 1980s, and for accepting money from the tobacco industry to complete the study.

Enstrom fired back, accusing the Cancer Society and other health agencies of attempting to suppress divergent results. Enstrom said his study had been subjected to rigorous peer review and denied tobacco industry influence.

"The attacks on me were disingenuous," Enstrom said.

Enstrom said his study is "just one in the body of evidence out there."

"I didn't say that all other studies were invalid," he added. "Studies in other countries have shown a much stronger link to disease. Mine didn't."

Terry Pechacek, associate director of science at the CDC's Office on Smoking and Health, concedes that "we don't know everything" about how secondhand smoke causes disease.

"But we know enough to make sound public policies," Pechacek said.

"Removing secondhand smoke from the workplace is just like taking toxins out of drinking water or food. The idea that we would leave on the marketplace a crop sprayed with a known carcinogen is unconscionable. We need to be thinking of analogies like that."

Indications of danger

Which is worse - a smoky bar or a city street filled with diesel truck fumes?

Answer: Smoky bars and casinos have up to 50 times more cancer-causing particles in the air than highways and city streets clogged with diesel trucks at rush hour, according to a study released last week by the Journal of Occupational and Environmental Medicine.

It's the latest in a line of intriguing health studies involving secondhand smoke.

The study also showed that ventilation systems, sometimes touted by tavern, restaurant and casino groups as an alternative to smoking bans, cannot exchange air fast enough to keep up with the smoke.

In recent years, bars and restaurants have also spent thousands of dollars on air filtration systems to clear the haze for patrons.

But that doesn't clean the air, experts say.

Filters may trap air particles and remove some toxic gases found in secondhand smoke, but not all of them, said Frank Dill, a chemist at the University of Cincinnati and a member of the city's advisory panel.

"Different companies make a variety of claims about their filters, but I have seen very little objective analysis of their efficacy," Dill said. "Filtration might decrease the amount of exposure to secondhand smoke, but no exposure to secondhand smoke should be deemed 'safe.' "

Other studies of note:

• A 1998 study of 53 bartenders in San Francisco found that before California's statewide smoking ban, 75 percent of them suffered from lung ailments. After the law, symptoms for 60 percent disappeared. Lung tests showed bartenders had 4 percent better lung capacity just four weeks after the smoking ban.

• Researchers in Helena, Mont., found that the number of heart attack victims admitted to a regional hospital dropped by nearly 60 percent during the first six months that a smoke-free ordinance was in effect in the area in 2002.

Heart attack admissions decreased from 40 (the average number occurring during the same months in the previous four years) to 24. The study's authors attribute much of the sharp decline to a near-elimination of the rapid and harmful effects of secondhand smoke.

But the study raised eyebrows from epidemiologists and statisticians who said the small sample size is a limitation that undermines the argument. Statistically speaking, the ban on smoking may have had little effect.



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