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Protection from exiaosure to second-hand tobacco smoke. Policy recommendations. " Evidence on the adverse health effects of expo- Tobacco and Health 18 is that SHS exposure sure to SHS has been accumulating for nearly causes heart disease and increases the risk 50 years. The first studies to appear in the of death from heart disease by about 30%; 1950s and 1960s focused on the effects of SHS recent evidence suggests that the effect could on children and on the impact of smoking by be more than twice as large." the motheron the fetus.5,1'As more and more studies in the ensuing decades have linked Lung cancer. SHS exposure has been linked to SHS exposure to a variety of serious diseases lung cancer in dozens of studies from around the in children and adults, a solid scientific consen- world, beginning with studies in 1981 showing sus has developed on the effects of SHS expo- an increased risk of lung cancer in non-smok- sure. WHO, IARC, the United States Surgeon ing women married to cigarette smokers. 20, 21 General, the United States Environmental The IARC, the United States Surgeon General Protection Agency [EPA). CaVEPA, and numer- and the United States EPA, among numerous ous expert scientific and medical bodies world- other scientific bodies worldwide, have all con- wide have documented the adverse effects of cluded that SHS causes lung cancer in non- SHS on the respiratory and circulatory systems, smokers. 9- 10, 11, 12, 13, 14, 15 its role as a carcinogen in adults, and its impact on children's health and development.',',10, n. Breast cancer. The 2005 CaVEPA report, pre- 12. 13 The IARC review of the relationship pared as part of the process that led SHS to be between SHS exposure and cancer published listed by the state as a "toxic air contaminant," in its 2004 monograph has been followed by indicates that 13 out of 14 studies reviewed, updated comprehensive reviews of the health which contained data on pre- versus post- effects of SHS exposure released by CaVEPA in menopausal status found an elevated risk of 200514 and the United States Surgeon General breast cancer in younger, primarily pre- in 2006.15The chronology of the accumulation menopausal women, leading to an overall esti- of evidence and the summary of conclusions mate that SHS exposure was associated with by the recent Cal/EPA and the United States a nearly 70% increased risk of breast cancer in Surgeon General's reports are found in Appendix this group. The Cal/EPA concluded that SHS 2 and Appendix 3. causes breast cancer in younger, primarily pre- Impact on adults menopausal women based on this observed risk as well as the current state of knowledge Coronary heart disease ICHO/. There is con- . vincing evidence from studies on a wide geo- that the biology of breast cancer and the fact that there are 20 known mammary carcino- graphical and racial range of populations that gens in SHS, which have caused detectable SHS causes both fatal and non-fatal heart dis- genetic damage in women's breasts.14, e The ease. Exposure to SHS causes acute adverse United States Surgeon General's Report found effects on the blood tipids, clotting systems the evidence to be suggestive of a causal rela- (platelets) and arterial wall function within tionship between SHS and breast cancer.15 minutes, and many of these effects are nearly as targe as those seen in active smokers. 14.15, 16 Respiratory symptoms and illnesses. Data indicate that SHS exposure plays a role in the The current consensus from agencies, including development of chronic respiratory symptoms the American Heart Association, 17 the United and produces measurable decreases in put- States Surgeon General, 15 CaVEPAl4and the monaryfunction.l4SHSalso inducesandexacer- United Kingdom Scientific Committee on bates asthma inadults.l4 a e Cal/EPA concluded that evidence for an effect of SHS on breast cancer in postmenopausat women remains inconclusive. i tW