Monograph 4 Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders

  1. Behavioral Research Program
  2. Tobacco Control Research Branch (TCRB)
  3. Tobacco Control Monograph Series
  4. Monograph 4
Monograph 4 Cover

Exposure to environmental tobacco smoke (also called secondhand smoke) presents a substantial public health problem, as it is responsible for lung cancer and other respiratory disorders in adults and various illnesses in children, including upper and lower respiratory tract infections and asthma. Monograph 4 attempts to estimate the extent of environmental tobacco smoke’s impact on public health.

Suggested Citation

National Cancer Institute. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Tobacco Control Monograph No. 4. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. NIH Pub. No. 93-3605, August 1993.

View Individual Chapters

Chapters and key topics covered within each chapter are listed below. Chapters generally include an introductory section, details on methodology, a chapter summary, research needs, and a reference list.

  • Forward
  • Preface
  • Chapter 1. Summary and Conclusions
    • Major Conclusions
    • Background
    • Primary Findings
  • Chapter 2. Introduction
    • Findings of Previous Reviews
    • Development of EPA Report
  • Chapter 3. Estimation of Environmental Tobacco Smoke Exposure
    • Physical and Chemical Properties
    • Assessing ETS Exposure
  • Chapter 4. Hazard Identification I: Lung Cancer in Active Smokers, Long-Term Animal Bioassays, and Genotoxicity Studies
    • Lung Cancer in Active Smokers
    • Lifetime Animal Studies
    • Genotoxicity
  • Chapter 5. Hazard Identification II: Interpretation of Epidemiologic Studies on Environmental Tobacco Smoke and Lung Cancer
    • Relative Risks Used in Statistical Inference
    • Statistical Inference
    • Study Results on Factors that May Affect Lung Cancer Risk
    • Analysis by Tier and Country
    • Conclusions for Hazard Identification
  • Chapter 6. Population Risk of Lung Cancer from Passive Smoking
    • Prior Approaches to Estimation of Population Risk
    • This Report’s Estimates of Lung Cancer Mortality Attributable to ETS in the United States
  • Chapter 7. Passive Smoking and Respiratory Disorders Other Than Cancer
    • Biological Mechanisms
    • Effect of Passive Smoking on Acute Respiratory Illnesses in Children
    • Passive Smoking and Acute and Chronic Middle Ear Diseases
    • Effect of Passive Smoking on Cough, Phlegm, and Wheezing
    • Effect of Passive Smoking on Asthma
    • ETS Exposure and Sudden Infant Death Syndrome
    • Passive Smoking and Lung Function in Children
    • Passive Smoking and Respiratory Symptoms and Lung Function in Adults
  • Chapter 8. Assessment of Increased Risk for Respiratory Illnesses in Children from Environmental Tobacco Smoke
    • Possible Role of Confounding
    • Misclassification of Exposed and Unexposed Subjects
    • Adjustment of Background Exposure
    • Assessment of Risk
  • Appendix A. Reviews and Tier Assignments for Epidemiologic Studies of ETS and Lung Cancer
  • Appendix B. Method for Correcting Relative Risk for Smoker Misclassification
  • Appendix C. Lung Cancer Mortality Rates Attributable to Spousal ETS in Individual Epidemiologic Studies
  • Appendix D. Statistical Formulae
Last Updated
September 24, 2020