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Electronic Letters to:

Original articles:
Ruth Bonita, John Duncan, Thomas Truelsen, Rodney T Jackson, and Robert Beaglehole
Passive smoking as well as active smoking increases the risk of acute stroke
Tob Control 1999; 8: 156-160 [Abstract] [Full text] [PDF]
*eLetters: Submit a response to this article

Electronic letters published:

[Read eLetter] Punish all smokers that won''t stop with a new law.
Carlos   (18 August 1999)
[Read eLetter] Nomenclature re passive smoking
Simon Chapman   (19 August 1999)
[Read eLetter] Re: Nomenclature re passive smoking
Ron Davis   (19 August 1999)
[Read eLetter] Re: Re: Nomenclature re passive smoking
Simon Chapman   (19 August 1999)
[Read eLetter] Re: Re: Nomenclature re passive smoking
Tac Tacelosky   (19 August 1999)
[Read eLetter] Re: Re: Re: Nomenclature re passive smoking
D Gordon Draves   (20 August 1999)
[Read eLetter] Re: Nomenclature re passive smoking
Eric Lindblom   (20 August 1999)
[Read eLetter] Re: Nomenclature re passive smoking
John Slade   (20 August 1999)
[Read eLetter] Re: Re: Re: Nomenclature re passive smoking
Phil Wilbur   (20 August 1999)
[Read eLetter] Re: Re: Nomenclature re passive smoking
Allyn Taylor   (21 August 1999)
[Read eLetter] Re: Re: Re: Nomenclature re passive smoking
Phillip Whidden   (25 August 1999)
[Read eLetter] Second hand tobacco smoke/ETS, a definition.
Albert Benson   (9 September 1999)

Punish all smokers that won''t stop with a new law. 18 August 1999
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Carlos,
Technician at a radiostation
_ n.a. _

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Re: Punish all smokers that won''t stop with a new law.

cold{at}copacabana.com Carlos

I work at a radiostation in Amsterdam - The Netherlands, in the on-air studio directing the show, doing editing and mixing and so on. I have to work together with 1 other in the same room. This is usually a smoker.

I will simply get fired if I would even ask my co-workers to stop smoking. You have to get this through to the LAW a.s.a.p. maybe then I stand a chance...

I sure as hell have felt these consequences many-a-time already. I get head-aches etc. I tend to be very hateful towards life, and have become very pessimistic all because of those stupid smokers.

Nomenclature re passive smoking 19 August 1999
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Simon Chapman,
Editor
Tobacco Control

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Re: Nomenclature re passive smoking

simonc{at}pub.health.usyd.edu.au Simon Chapman

Tobacco Control's editors have never developed a formal policy about which nomenclature we should adopt as the preferred way of writing about passive smoking. This present article, which has attracted huge international media attention, is a good example. Its title contains the term "passive smoking" and its text frequently uses ETS (environmental tobacco smoke). Our technical editor has recently requested clarification from me on how she might standardise references to this issue.

We first sought the opinion of the former editor Ron Davis who wrote:

"Passive smoking and secondhand smoke were probably the first terms that came into common usage. Their advantage is that the public probably understands those terms much better than other terms that followed, such as environmental tobacco smoke (ETS).

A problem with "passive smoking" is that it implies that nonsmokers are passive -- at a time when we want to see nonsmokers become more assertive about their rights to breathe clean air. There is some evidence that nonsmokers are indeed becoming more assertive about getting smoke- free air (although other evidence indicates that many nonsmokers will continue to suffer in silence when exposed to secondhand smoke).

The US Surgeon General's 1996 report on "The health consequences of involuntary smoking" used "involuntary smoking" instead of "passive smoking" because the former "denotes that for many nonsmokers, exposure to ETS is the result of an unavoidable consequence of being in proximity to smokers" (page vii). Despite the good rationale for using "involuntary smoking," that expression never caught on.

I'm not sure exactly when the term ETS was introduced. It was given some prominence when it was used in the title of the National Research Council's report "Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects," which was published by National Academy Press in the same year (1986) as the Surgeon General's report on involuntary smoking. ETS is probably the term most favored by the tobacco industry because it is neutral, lacking the emotive impact of words like "passive" and "involuntary." Also, ETS doesn't imply anything about exposure or absorption (as opposed to "passive smoking"), which is probably another reason why the industry likes it.

ETS is also a useful term for scientists as a descriptor for the combination of sidestream smoke and exhaled mainstream smoke. ETS also works better for researchers because it sounds more scientific than the corresponding term "secondhand smoke," which is a poorly defined lay expression.

The bottom line is that we have a mishmash of terms, with varying degrees of emotive impact, scientific precision, and clarity to the public. An expression that is useful in one of those domains is likely to be problematic in another. One might consider developing a standardized terminology through some consensus process involving tobacco control researchers and advocates. However, the problems caused by these myriad terms are not as important as the problems caused by, for example, the different definitions used for smoking status.

So working on standards for "ETS terms" might not be worth the trouble."

***** I personally believe that it is important that we preserve the ability of authors to use both "passive smoking" and "ETS". When needing to denote the act of inhaling secondhand and sidestream smoke, a term is needed (as in: "Passive smoking has been shown to exacerbate asthma in children"). Equally, when needing to talk about the combination of secondhand (exhaled) smoke and sidestream smoke, ETS would seem to be peerless. I am aware of the view that because the tobacco industry prefers "ETS" we should not use it. Frankly, given the florid documentation of the industry's fear and loathing of anything to do with this subject in their internal documents, this is a bit like arguing about whether "liar" or "cheat" is a worse insult: to me, it's rather too precious a concern.

Can I invite all those interested in this debate to contribute to this discussion through this e-letters facility? Personally, I'm also interested to learn of the first recorded use of the term "passive smoking". I have seen some references to it in tobacco industry documents dating from the early 1970s, but would be interested to learn of its genesis.

Re: Nomenclature re passive smoking 19 August 1999
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Ron Davis,
Physician
Henry Ford Health System

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Re: Re: Nomenclature re passive smoking

rdavis1{at}hfhs.org Ron Davis

Simon:

In your note, you appear to use "secondhand smoke" to refer to exhaled smoke. However, it seems as if many people use secondhand smoke synonymously with ETS, and that's how I use it. People talk about nonsmokers' exposure to secondhand smoke, but nonsmokers' exposure is typically to ETS, which is made up of exhaled smoke PLUS sidestream smoke. It would be difficult for someone to be exposed to pure exhaled smoke -- unless you go back in history to the old Chesterfield advertisement (c. 1928) in which the woman tells her man to "blow some my way." Our different usage of "secondhand smoke" is a good example of the ambiguity of these terms.

Ron

Re: Re: Nomenclature re passive smoking 19 August 1999
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Simon Chapman,
Editor

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Re: Re: Re: Nomenclature re passive smoking

simonc{at}pub.health.usyd.edu.au Simon Chapman

Ron: "secondhand" implies to me "used". So it seems to apply more to the exhaled component of the total ETS mix than it does to the sidestream component. Before the sidestream component is inhaled by those exposd, it has yet to be "used" in this anthropocentric perspective on the subject.

Re: Re: Nomenclature re passive smoking 19 August 1999
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Tac Tacelosky
Smokescreen/Tobacco Documents Online

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Re: Re: Re: Nomenclature re passive smoking

tac{at}smokescreen.org Tac Tacelosky

If Tobacco Control is looking for input as to what name to use, I urge "Secondhand Smoke". ETS is a great term for those that don't like to type, but it's a very neutral term. People hate secondhand smoke, they don't care much about ETS.

Passive Smoking and Involuntary Smoking are good terms, but I don't think they'll catch on.

Congrats to Tobacco Control for a great launch into Cyberspace!

Tac

Re: Re: Re: Nomenclature re passive smoking 20 August 1999
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D Gordon Draves,
President of GASP
GASP--Georgians Against Smoking Pollution

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nonsmoke4ga{at}earthlink.net D Gordon Draves

I would prefer if we could move away from using ETS--Environmental Tobacco Smoke, because it was either developed by the tobacco companies or was gleefully adopted by them. The term ETS is benign while the actual product is extremely dangerous. Some suggestions for substitutes would be TSP--tobacco smoke pollution, TSP--tobacco smoke poisons, TST--tobacco smoke toxins, TTS--toxic tobacco smoke. However, all except the first one could be applied to the tobacco smoke inhaled by the smoker or given off from the burning end.

Passive smoking is sometimes too true for far too many nonsmokers are passive about ETS. But they might get more involved if a better, more demonstrable description was developed. Most people have no understanding of what is in tobacco smoke, for we have not been able to afford effective public announcements nationwide, or worldwide.

I like the term secondhand smoke because it has negative connotations. Most people don't like secondhand things, and as Simon stated, it denotes that the smoke has been used by others, and it is coming out of them possibly with microbes. Maybe we need to show that to people more--a TV spot with a smoker exhaling a big cloud of smoke, and a person scrunching up her nose, thinking, "this has been inside someone else, gag." Or "would you eat after that person, then why do you want to breathe after him?" However, I generally lump sidestream smoke with exhaled smoke. Even though it hasn't been used by the smoker, it is still not my smoke, so it is secondhand to me.

Here again, sidestream smoke sounds so innocent, while it is the worst smoke for us--containing several times the poisons that inhaled smoke yields per given amount. I have seen smokers "being courteous" by not puffing much on the cigarette, but allowing the cigarette to burn, and thus making worse pollution for me to breathe.

Some people have expressed a dislike for our classification. They would like not to be called -smoker. Whether we are called nonsmokers, passive smokers, involuntary smokers, forced smokers--we are still called smokers. WHY? We don't smoke, and smoking should not be considered the norm. How about using--tobacco user and non-user? Or maybe we could call them polluters?

Involuntary smokers or forced smokers are more descriptive of the situations many of us have found ourselves in. We inhale the fumes, not because we want to, but because we must breathe or pass out. We are forced to partake of the poisons in the air, so we can live. But to some of the most sensitive people, that can mean severe breathing problems, even death.

So we need terms suitable for scientific journals that will note the toxic nature of tobacco smoke--whether inhaled, exhaled, or sidestream. Terms that will be understood by the public as meaning this smoke is bad for you. It contains poisons including carcinogens which can make cancer in your body. I have used TSP--tobacco smoke pollution for several years rather than ETS, but generally I have to spell it out. Just the two words, tobacco smoke is sufficient for me to know how bad it is for smokers and non-users. But today, we need something catchy, strong and descriptive of the bad nature of tobacco smoke. ETS just doesn't cut it.

Re: Nomenclature re passive smoking 20 August 1999
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Eric Lindblom,
policy analyst
Campaign for Tobacco-Free Kids

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Re: Re: Nomenclature re passive smoking

elindblom{at}tobaccofreekids.org Eric Lindblom

"Secondhand smoke" seems like the most unappetizing name for smoke inhaled by nonsmokers, and using the most unappetizing name possible should probably be the goal for those working to prevent and reduce smoking. [For the same reasons "spit tobacco" is a wonderful replacement for "smokeless tobacco."]

While "involuntary smoking" has the right idea, refering to "involuntary smoke" sounds a bit odd.

Re: Nomenclature re passive smoking 20 August 1999
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John Slade,
Physician
School of Public Health of NJ

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Re: Re: Nomenclature re passive smoking

jdslade{at}ix.netcom.com John Slade

As described, there are problems with both the term "passive smoking" and "ETS", but on balance I think ETS has advantages.

To be difficult, I'd propose a different term altogether, Tobacco Smoke Pollution. The problem is, basically, one of pollution, and its most useful comparisons are to other pollution problems. Persons exposed to tobacco smoke pollution can have their exposures described using the same syntax as exposure to other airborne pollutants. An advantage of this approach is that it places the arcane world of tobacco smoke in the mainstream of pollution and environmental concerns and breaks down the artificial barriers of the specialized jargon we in tobacco control so often saddle ourselves with.

Re: Re: Re: Nomenclature re passive smoking 20 August 1999
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Phil Wilbur
Pacific Institute for Research and Evaluation

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wilbur{at}pire.org Phil Wilbur

I applaud the effort to create consensus on how we should describe this stuff. To me, it's a strategic question: Which term is most likely to encourage support for clean indoor air regulations and most likely to generate negative feelings toward the manufacturers? Although my bet would be on "involuntary smoking", I don't have the evidence to back that up. But surely that evidence must exist somewhere! Was the question ever raised, for example, during focus group tests for the Massachusetts or California media campaigns? I would love to see the existing research on this one! And by the way, I don't agree with Tac's assertion that involuntary smoking is no good because it won't catch on; if WE all agree on the terminology, it WILL catch on. Widespread use of the term "Spit tobacco" is a perfect example.

Re: Re: Nomenclature re passive smoking 21 August 1999
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Allyn Taylor,
attorney
Tobacco Free Initiative, WHO, Geneva

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Re: Re: Re: Nomenclature re passive smoking

tayloral{at}aol.com Allyn Taylor

I agree with John Slade that ETS is not a satisfactory term and that a new term, incorporating the idea of pollution, should be utilized. I prefer to describe it as "environmental tobacco pollution."

Incorporating the term "pollution" appropriately reflects that so called second hand smoke is more than just a mere nuisance as the tobacco industry claims. "Environmental tobacco pollution" adequately reflects the reality that tobacco smoke has real and dangerous health consequences and significant "clean-up" costs like other forms of pollution such as toxic waste.

As an international lawyer, I also prefer the term "environmental tobacco pollution" because I believe that it broadens the message and the appeal of our movement to those outside of tobacco control, particularly organizations (national and international), academics and activists in the environmental realm. Nationally and internationally the environmental movement is a powerful force and potentially a tremendous ally. Utilizing the term "environmental tobacco pollution" may function to educate the environmental community about how closely aligned our interests truly are and, thereby, mobilize broader interest in tobacco control.

Allyn Taylor WHO/TFI

Re: Re: Re: Nomenclature re passive smoking 25 August 1999
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Phillip Whidden,
Lecturer
Founder, Assoc for Nonsmokers'' Rights, UK

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Re: Re: Re: Re: Nomenclature re passive smoking

pwhidden{at}newbold.ac.uk Phillip Whidden

I wonder if we are being a bit too condescending to the general public in this discussion about what to call passive smoking. I agree that this proliferation of terms is probably somewhat confusing. All of the terms currently in use by scientists and laypeople have their drawbacks. However, my experience in conversation with the wo/man in the street is that we are all fairly good at decoding our imprecise language.

For instance, several times I have heard people, even activists in the tobacco-control movement, call passive smoking "secondary smoking." A few times I have also seen this "incorrect" use of the term in letters to the editor of newspapers. Now in the scientific literature this term means smoking a tobacco product other than the one a smoker usually smokes. For instance, a person who usually smokes cigarettes, but very occasionally smokes a pipe or a cigar, is said to be engaging in secondary smoking when indulging in that pipe or cigar instead of smoking a cigarette. But when ordinary people use the term to mean "secondhand smoking" I suspect that everyone (or practically everyone) decodes "secondary smoking" correctly. (There is of course the wider issue of imprecise language being read and spoken by people whose native language is not English and who are still at a stage of comprehension that is not sophisticated enough to have to deal comfortably with several ambiguous terms all supposedly "meaning" the same thing.)

One point not already raised by previous correspondents is that even highly educated writers, such as scientists, sometimes make the mistake of using the phrase "exposure to passive smoking." Presumably what they are trying to say is something like, "exposure to another person's or other people's tobacco smoke in the air." Of course, I concede that, again, most of us manage to decode correctly the incorrect expression, "exposure to passive smoking."

It is true that the term "passive smoking" may cause some people subliminally to become passive about having to put up with tobacco smoke in their air. On the other hand, it is probably just as true to say that those who are not passive about this forced exposure to a poisonous pollution are angered by the term "passive" and thus are motivated to become active in their opposition to so many people being passive about it. Incidentally, I know of no scientific evidence about how the term "passive smoking" affects people, their attitudes or their actions.

The term "involuntary smoking" seems unnecessarily clumsy. Besides, for those who believe that active smoking is addictive, those addicted to it could be said to be doing "involuntary smoking."

Forgive me, but I just can't imagine normal people talking about "Environmental Tobacco Smoke" or "ETS" at parties, on picnics and in pubs, nevermind whether or not it is the pet term of the tobacco industry. I can't recall any person outside the tobacco-control movement using the term anywhere, not even in the more formal forum of letters to the editor of newpapers and magazines. Do we really want to create yet another unnecessary a gap between the terms being used by the scientific community and those outside it?

When I use the term "secondhand smoke" I have always assumed that everyone knew I meant the tobacco smoke in the air that surrounds me, smoke created firsthand by someone other than me lighting up a cigarette, pipe or cigar. It doesn't matter to me one whit whether those listening to me know that only a small fraction of that is exhaled smoke and that most of it is sidestream smoke. The point is that I am being exposed to other people's dirty, sticky and poisonous pollution and I am certain that when I'm on a TV or radio programme everyone knows that that is what I am unhappy about.

As much as some may regret it, passive smokers are smokers. They are doing a type of smoking which is causing many of the sorts of disease outcomes linked to active smoking. Indeed there are some disease outcomes now associated with passive smoking that are not linked to active smoking, such as tooth problems in children and Legg Perthes disease. To avoid the obvious fact that passive smoking is a type of smoking and has unsurprising smoking-related disease outcomes is to undermine the power of the message we want to get across. If you are a passive smoker and don't like being called a smoker, you shouldn't object to being called a smoker; you should object to being forced to be a smoker. Since well over 90% of the population in the U.S.A. are either active smokers or passive smokers, we have to face the fact that smoking is the norm in America and presumably in all Westernized, industrial nations. Once we accept that fact, angrily, we will be better motivated to take effective action.

Incidentally, I suspect that some disease outcomes from "passive smoking" are not at all from inhaling smoke. For example, various eye problems resulting from exposure to smoke are probably due to the surface of the eye being exposed directly to the pollution and not to the eye receiving irritant ingredients of the smoke delivered to it via the bloodstream. The link between second-hand smoking and cervical cancer may be due to sticky tobacco smoke adhering to the fingers of the smoking sexual partners and being applied directly to the female sexual organs during digital stimulation as in foreplay. I also hypothesize that certain rare skin disorders apparently brought on by exposure to tobacco smoke in the air may be reactions of the skin to the smoke adhering to the skin and then being absorbed directly into it. (See, for instance, the various publications in the scientific literature by B. J. L. Sudan on the disease suffered by him and the immediate members of his family when exposed to tobacco-smoke pollution.) If these instances of exposure other than through inhalation are considered important, then perhaps a term such as "tobacco-smoke pollution" (please note the hyphenated, grammatically correct form of that phrase)would be better than any term involving the word "smoking." The problem with Allyn Taylor's suggested "environmental tobacco pollution" is that what we are discussing is the pollution of the environment by smoke, not by tobacco. It is of course true that tobacco products pollute the environment (as in dropped cigarette butts being left in their billions as litter practically everywhere and specifically in places where toddlers pick them up and ingest them and also lit butts being discarded and causing major forest fires) but this is a matter distinct from what we are trying to discuss when coming up with a term for exposure to tobacco-smoke pollution.

On balance, I think I agree with John Slade that we are probably going to be wisest if we choose "tobacco-smoke pollution" as our term. However, because of the various reasons already put forward in favour of "secondhand smoking," I would be very pleased with it as well.

Second hand tobacco smoke/ETS, a definition. 9 September 1999
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Albert Benson,
Television Engineer

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Re: Second hand tobacco smoke/ETS, a definition.

ajbenson{at}home.com Albert Benson

I believe we have come a long way when we are at the point that we are trying to define just what this toxic pollution really is. When I first started writing, about 15 years ago, I saw the need to define tobacco smoke polluted air which had been air conditioned and filtered but which still contained the gaseous elements which are in tobacco smoke in copious amounts. When the air is not entirely smokefree, filtering it through an air conditioning system will not make it safe for us who are hyper-sensitive to second hand tobacco smoke, hence the need for nomenclature which would essentially describe air with the smoke smell filtered out, but which still contains the gaseous elements. These are exceedingly dangerous to us as a component of ETS. This kind of air has a characteristic stuffy odor, which can cause me illness that can require weeks or months to recover to the previous state of well being which I had previously enjoyed.

I believe it is not enough to just use ETS since it is too brief. People new to this problem may not get the picture. I use 'second hand tobacco smoke/ETS' as the defining description since it describes second hand tobacco smoke pollution as a factor added to ETS, but which might require a dialogue about ETS since it is a seperate complex problem.

I think it is necessary that we spell it out for them, what 'second hand tobacco smoke/ETS' actually is. I also believe that since this has been used for so many years, we should not change it because it does work. Some legislators pretend to ignore this but they know what we are talking about. It is more important to keep talking about it until they do the right thing. They need to know that we are knowledgeable and have the resources to back us up.

Sincerely, Albert Benson


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