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.

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.

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.