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Passive smoking and cardiorespiratory health in a general population in the west of Scotland
David J Hole, Charles R Gillis, Carol Chopra, Victor M Hawthorne

Objective-To assess the risk of cardiorespiratory symptoms and mortality in non-smokers who were passively exposed to environmental smoke. Design-Prospective study of cohort from general population first screened between 1972and 1976 and followed up for an average of 11-5 years, with linkage of data from participants in the same household. Setting-Renfrew and Paisley, adjacent burghs in urban west Scotland. Subjects-15 399 Men and women (80% of all those aged 45-64 resident in Renfrew or Paisley) comprised the original cohort; 7997 attended for multiphasic screening with a cohabitee. Passive smoking and control groupswere defined on the basis of a lifelong non-smoking index case and whether the cohabitee had ever smoked or never smoked. Main outcome measure-Cardiorespiratory signs and symptoms and mortality. Results -Each of the cardiorespiratory symptoms examined produced relative risks >1-0 (though none were significant) for passive smokers compared with controls. Adjusted forced expiratory volume in onesecond was significantly lower in passive smokers than controls. All cause mortality was higher in passive smokers than controls (rate ratio 1-27 (95% confidence interval 0-95 to 1-70)), as were all causes of death related to smoking (rate ratio 1-30 (0-91 to 1-85)) and mortality from lung cancer (rate ratio 2-41 (0.45 to 12.83)) and ischaemic heart disease (rate ratio 2-01 (1-21 to 3.35)). Whenpassive smokers were divided into high and low exposure groups on the basis of the amount smoked by their cohabitees those highly exposed had higher rates of symptoms and death. Conclusion-Exposure to environmental tobacco smoke cannot be regarded as a safe involuntary habit.
West of Scotland Cancer Surveillance Unit, Ruchill Hospital, Glasgow G20 9NB David J Hole, MsC,

of lungcancer; it overcomes many of these criticisms. The survey prospectively studied a general population aged 45-64 years, and the collected data allowed participants from the same household to be identified. The measure of exposure to environmental tobacco was obtained directly from cohabitees and did not rely on self reporting. Data on prevalences of symptoms of respiratory and cardiovascular disease,forced expiratory volume in one second, mortality, and incidence of cancer are all available for this population. The findings reported here update an earlier report; it adds 567 further deaths to the previous findings" and extends the range of baseline measurements to include forced expiratory volume in one second. Confounding variables such as social class, blood pressure, cholesterolconcentration, body mass index, and social class have been allowed for in calculating relative risks for passive smokers.

Charles R Gillis, MD, director

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States Carol Chopra, research
student Victor M Hawthorne, MD, professor

Correspondence and requests for reprints to: Mr Hole.

Introduction Though evidence has accumulated about the risk to health of involuntary, or passive, exposure to environmental tobacco smoke, further information is required from cohort studies to confirm these observations. Deleterious effects on the respiratory system of infants and children have been observed' 2 as have chronic effects on lung function in adults,34 but these findings havebeen criticised on methodological grounds.! An overview of 10 case-control and three cohort studies estimated a relative risk of 1 35 for lung cancer in people passively exposed compared with non-exposed controls.6 Three studies have reported increased (though not significant) risks ofischaemic heart disease in non-smokers with partners who smoke.78 Problems in interpreting these findings...
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