Activity

Activity Description

The Centers for Disease Control and Prevention request that the IOM convene an expert committee to assess the state of the science on the postulated causal relationship between secondhand smoke exposure and acute coronary events.  Specifically the committee will review available scientific and evaluation literature on secondhand smoke exposure (including short-term exposure) and acute coronary events and produce a  report characterizing the state of the science on the topic, with emphasis on the evidence for causality and knowledge gaps that future research should address.

In conducting its work the committee should address the following questions:

1. What is the current scientific consensus on the relationship between exposure to secondhand smoke and cardiovascular disease?  What is the pathophysiology?  What is the strength of the relationship?
2. Is there sufficient evidence to support the plausibility of a causal relation between secondhand smoke exposure and acute coronary events such as acute myocardial infarction and unstable angina?  If yes, what is the pathophysiology?  And what is the strength of the relationship?
3. Is it biologically plausible that a relatively brief (under 1 hour) secondhand smoke exposure incident could precipitate an acute coronary event?   If yes, what is known or suspected about how this risk may vary based upon absence or presence (and extent) of preexisting coronary artery disease? 
4. What is the strength of the evidence for a causal relationship between indoor smoking bans and decreased risk of acute myocardial infarction?
5. What is a reasonable latency period between a decrease in secondhand smoke exposure and a decrease in risk of an acute myocardial infarction for an individual?  What is a reasonable latency period between a decrease in population secondhand smoke exposure and a measurable decrease in acute myocardial infarction rates for a population
6. What are the strengths and weaknesses of published population-based studies on the risk of acute myocardial infarction following the institution of comprehensive indoor smoking bans. In light of published studies' strengths and weaknesses, how much confidence is warranted in reported effect size estimates?
7. What factors would be expected to influence the effect size?  For example, population age distribution, baseline level of secondhand smoke protection among nonsmokers, and level of secondhand smoke protection provided by the smoke-free law.
8. What are the most critical research gaps that should be addressed improve our understanding of the impact of indoor air policies on acute coronary events?  What studies should be performed to address these gaps?