"The debate is over. The science is clear: Secondhand smoke is not a mere annoyance, but a serious health hazard," said U.S. Surgeon General Richard Carmona.
More than 126 million nonsmoking Americans are regularly exposed to smokers' fumes — what Carmona termed "involuntary smoking" — and tens of thousands die each year as a result, concludes the 670-page study. It cites "overwhelming scientific evidence" that secondhand smoke causes heart disease, lung cancer and a list of other illnesses.
The report calls for completely smoke-free buildings and public places, saying that separate smoking sections and ventilation systems don't fully protect nonsmokers. Seventeen states and more than 400 towns, cities and counties have passed strong no-smoking laws.
But public smoking bans don't reach inside private homes, where just over one in five children breathes their parents' smoke — and youngsters' still developing bodies are especially vulnerable. Secondhand smoke puts children at risk of sudden infant death syndrome, or SIDS, as well as bronchitis, pneumonia, worsening asthma attacks, poor lung growth and ear infections, the report found.
Carmona implored parents who can't kick the habit to smoke outdoors, never in a house or car with a child. Opening a window to let the smoke out won't protect them.
"Stay away from smokers," he urged everyone else.
Even a few minutes around drifting smoke is enough to spark an asthma attack, make blood more prone to clot, damage heart arteries and begin the kind of cell damage that over time can lead to cancer, he said.
Repeatedly questioned about how the Bush administration would implement his findings, Carmona would only pledge to publicize the report in hopes of encouraging anti-smoking advocacy. Passing anti-smoking laws is up to Congress and state and local governments, he said.
"My job is to make sure we keep a light on this thing," he said.
Still, public health advocates said the report should accelerate an already growing movement toward more smoke-free workplaces.
"This could be the most influential surgeon general's report in 15 years," said Matthew Myers of the Campaign for Tobacco-Free Kids. "The message to governments is: The only way to protect your citizens is comprehensive smoke-free laws."
The report won't surprise doctors. It isn't a new study but a compilation of the best research on secondhand smoke done since the last surgeon general's report on the topic in 1986, which declared secondhand smoke a cause of lung cancer that kills 3,000 nonsmokers a year.
Since then, scientists have proved that even more illnesses are triggered or worsened by secondhand smoke. Topping that list: More than 35,000 nonsmokers a year die from heart disease caused by secondhand smoke.
Regular exposure to someone else's smoke increases the risk of a nonsmoker getting heart disease or lung cancer by up to 30 percent, Carmona found.
Some tobacco companies acknowledge the risks. But R.J. Reynolds Tobacco Co., which has fought some of the smoking bans, challenges the new report's call for complete smoke-free zones and insists the danger is overblown.
"Bottom line, we believe adults should be able to patronize establishments that permit smoking if they choose to do so," said RJR spokesman David Howard.
And a key argument of some business owners' legal challenges to smoking bans is that smoking customers will go elsewhere, cutting their profits.
But the surgeon general's report concludes that's not true. It cites a list of studies that found no negative economic impact from city and state smoking bans — including evidence that New York City restaurants and bars increased business by almost 9 percent after going smoke-free.
To help make the point, Carmona's office videotaped mayors of smoke-free cities and executives of smoke-free companies, including the founder of the Applebee's restaurant chain, saying business got better when the haze cleared.
In addition to the scientific report, Carmona issued advice for consumers and employers Tuesday:
Choose smoke-free restaurants and other businesses, and thank them for going smoke-free.
Don't let anyone smoke near your child. Don't take your child to restaurants or other indoor places that allow smoking.
Smokers should never smoke around a sick relative.
Employers should make all indoor workspace smoke-free and not allow smoking near entrances, to protect the health of both customers and workers, and offer programs to help employees kick the habit.
Among other findings: