Introduction

During the 1970s, as the scientific evidence of the dangers of environmental tobacco smoke (ETS) was beginning to accumulate, a grassroots movement for nonsmokers' rights emerged (1). When it became evident that tobacco smoke can harm nonsmokers who inhale it passively, the public became less tolerant of smoking in public places and the workplace, and restrictions on smoking began to be implemented, by both government and private businesses. Although the mainstream health establishment was slow to appreciate the significance of the passive smoking issue, the tobacco industry was quick to recognize the need to counter this emerging shift in social attitudes toward smoking, particularly smoking in the workplace, and mobilized its public relations and political resources to deal with the potential threat. It used scientists, who were funded through the Council for Tobacco Research (CTR) special projects and special accounts (see chapter 8), to oppose restrictions on smoking in public places and workplaces, and it organized to fight ballot measures for clean indoor air in California and elsewhere.

The smoke that cigarette smokers draw into their lungs is "mainstream" smoke, while the smoke that comes off the burning tip of a cigarette is "sidestream" smoke. Sidestream smoke actually contains higher

concentrations of many toxic chemicals than mainstream smoke (2), because sidestream smoke is not filtered and because cigarettes burn at a lower temperature when they are smoldering, leading to a less complete, dirtier combustion. The air pollution resulting from sidestream and extracted mainstream smoke is called secondhand smoke or environmental tobacco smoke, and people who breathe this smoke are known as passive smokers or involuntary smokers. Research conducted in the 1970s showed that children exposed to ETS have higher rates of respiratory diseases (2). In 1981 several published studies showed that nonsmoking women married to smokers have a higher risk of dying from lung cancer than nonsmoking women married to nonsmokers (3–5). This work was widely reported in the press, and provided the first strong evidence that passive smoking causes fatal diseases such as lung cancer. Research on ETS rapidly accumulated during the 1980s, and in 1986 major consensus reports by the National Academy of Sciences' National Research Council (6) and the Surgeon General (7) confirmed the evidence that ETS endangers children and causes lung cancer in adults. In 1992 the Environmental Protection Agency listed environmental tobacco smoke as a Class A (known human) carcinogen and a major source of respiratory problems in children (2). Subsequent studies have shown that exposure to ETS also increases the risk of heart disease (8–11).

In 1978 the Roper Organization conducted a confidential study for the Tobacco Institute on the attitudes of the public toward smoking (12). This report, which was obtained by the Federal Trade Commission and subsequently made public, stated:

The original Surgeon General's report, followed by the first "hazard" warning on cigarette packages, the subsequent "danger" warning on cigarette packages, the removal of cigarette advertising from television and the inclusion of the danger warning in cigarette advertising, were all "blows" of sorts for the tobacco industry. They were, however, blows that the cigarette industry could successfully weather because they were all directed against the smoker himself.

The anti-smoking forces' latest tack, however—on the passive smoking issue—is another matter. What the smoker does to himself may be his business, but what the smoker does to the non-smoker is quite a different matter. ... six out of ten believe that smoking is hazardous to the nonsmoker's health, up sharply over the last four years. More than two-thirds of non-smokers believe it; nearly half of all smokers believe it.

This we see as the most dangerous development yet to the viability of the tobacco industry that has yet occurred [emphasis added]. (p. 6)

The Roper report recommended that the industry engage in research to discredit the evidence that passive smoking is dangerous to nonsmokers.

The strategic and long run antidote to the passive smoking issue is, as we see it, developing and widely publicizing clear-cut, credible, medical evidence that passive smoking is not harmful to the non-smoker's health [emphasis added]. (p. 7)

The documents indicate that the tobacco industry followed this advice.