Prime Time Replay:
Ichiro Kawachi, M.D., Ph.D.
on the health dangers
of passive smoking and
psychosocial factors linked to heart disease
MsgId: *breakthrough(2)
Date: Wed Sep 24 20:51:56 EDT 1997
From: moderator At: 152.163.195.101
Hi, this is your moderator, Madeleine Lebwohl, and tonight I'll be speaking with Ichiro Kawachi, M.D., Ph.D., associate professor of health and social behavior at the Harvard School of Public Health. Tonight I'll be conducting an in-studio interview with Dr. Kawachi. Welcome to Breakthough Medicine.
MsgId: *breakthrough(4)
Date: Wed Sep 24 20:56:34 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: Good evening.
MsgId: *breakthrough(5)
Date: Wed Sep 24 20:57:30 EDT 1997
From: moderator At: 152.163.195.101
The dangers of inhaling second hand smoke are still found everywhere. Just how likely are we to get sick from it?
MsgId: *breakthrough(6)
Date: Wed Sep 24 20:59:56 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: According to our study, women who are regularly exposed to passive smoking are at about twice the risk of getting a heart attack, compared to someone who isn't exposed. And obviously the danger is quite a bit less than if someone actively smoked. Nonetheless, its been estimated that passive smoking counts for about 60,000 cases of heart attack each year.
MsgId: *breakthrough(7)
Date: Wed Sep 24 21:00:22 EDT 1997
From: moderator At: 152.163.195.101
Are men similarly affected?
MsgId: *breakthrough(8)
Date: Wed Sep 24 21:01:29 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: We studied women only, but I see no reason why the same findings would not apply to men. In other words, everything we know about tobacco smoke suggests that, the facts are not different by sex.
MsgId: *breakthrough(9)
Date: Wed Sep 24 21:01:59 EDT 1997
From: moderator At: 152.163.195.101
Was there a reason that you only studied women?
MsgId: *breakthrough(10)
Date: Wed Sep 24 21:03:42 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: No, it was only a coincidence. We happened to take advantage of an ongoing study of women and heart attack which happened to ask about passive smoking. There have been other studies of heart attack in men, too.
MsgId: *breakthrough(11)
Date: Wed Sep 24 21:04:52 EDT 1997
From: moderator At: 152.163.195.101
Given the huge numbers of people affected by second hand smoke, why did it take so long to notice that smoker's companions were getting sick?
MsgId: *breakthrough(12)
Date: Wed Sep 24 21:07:23 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: It had been suspected for some time that passive smoking might have damaging health affects, but it always takes time to prove statistically that this is true, that this is the case. To give an example, it took about thirty years of studies to show conclusively that active smoking is the cause of lung cancer.
MsgId: *breakthrough(13)
Date: Wed Sep 24 21:08:34 EDT 1997
From: moderator At: 152.163.195.101
Does it matter how close you are to the smoker? If you enter a room filled with smoke, or a room that was recently filled with smoke, and still has the smell, can you be affected?
MsgId: *breakthrough(14)
Date: Wed Sep 24 21:11:37 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: It's safe to assume that if you can smell it you're being exposed. There is no safe threshhold of exposure. And even if you can smell stale smoke, where someone's been smoking, you are really being exposed to nicotine vapor, and other compounds that are coming off the surface of the room. In effect, you can regard that room as a miniature toxic waste dump.
MsgId: *breakthrough(15)
Date: Wed Sep 24 21:13:25 EDT 1997
From: moderator At: 152.163.195.101
Is there a time factor, when the chemicals begin to lose their toxic nature? Or a concentration level when you begin to be affected? And one other thing-does it matter how many cigarettes had been lit?
MsgId: *breakthrough(16)
Date: Wed Sep 24 21:15:05 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: It depends on the intensity of smoking. The greater the number of smokers and the greater the number of cigarettes that are consumed, the greater will be the exposure. We can show a dose response effect between intensity of exposure and risk of heart attack. Again the safe rule of thumb is that if you can smell it you're being exposed.
MsgId: *breakthrough(17)
Date: Wed Sep 24 21:15:47 EDT 1997
From: moderator At: 152.163.195.101
So going to a club full of smoke becomes a dangerous experience?
MsgId: *breakthrough(18)
Date: Wed Sep 24 21:17:05 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: Certainly if you work there. It's been shown statistically that non-smoking restaurant workers and bar tenders have a statistically higher risk of lung cancer, presumably as a result of passive smoking exposure.
MsgId: *breakthrough(19)
Date: Wed Sep 24 21:17:52 EDT 1997
From: moderator At: 152.163.195.101
Is there anything you can do to clean out your lungs after you've spent an evening in a smoke filled room?
MsgId: *breakthrough(20)
Date: Wed Sep 24 21:18:23 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: No. The best cure is prevention.
MsgId: *breakthrough(21)
Date: Wed Sep 24 21:21:47 EDT 1997
From: moderator At: 152.163.195.101
Does that mean leaving rooms when there's a lot of smoke?
MsgId: *breakthrough(22)
Date: Wed Sep 24 21:22:47 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: The most effective thing to do is to set aside smoke-free areas. And of course many restaurants are either doing that or going entirely smoke free.
MsgId: *breakthrough(23)
Date: Wed Sep 24 21:24:54 EDT 1997
From: moderator At: 152.163.195.101
Smoke may be something that, with difficulty, we can occasionally avoid, but a stressful lifestyle is harder to change. Your research on stress and heart disease explores this connection. What is the worst stressor you found?
MsgId: *breakthrough(25)
Date: Wed Sep 24 21:27:00 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: There are some aspects of stress that we can manage. To give a couple of examples from my own research. Things like shift work. We've shown that people who do shift work have about a 60% increased risk of heart attack. There are many things that both employers and employees can do to minimize the amount of shift work.Another example is anger and heart attack. We've found that people who experience chronic anger have about 2 to 3 times the risk of heart attack. Now, anger is a manageable emotion. In other words, you can get treated for it.
MsgId: *breakthrough(28)
Date: Wed Sep 24 21:30:22 EDT 1997
From: moderator At: 152.163.195.101
How can you minimize the harmful affects of shiftwork?
MsgId: *breakthrough(29)
Date: Wed Sep 24 21:32:07 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: The most health damaging type of shift work is the one where the worker keeps switching from day work to night work, and often that type of work pattern is just a matter of convenience, people trying to earn more money, or deal with child care issues. But I think its one of these things that needn't happen.
MsgId: *breakthrough(30)
Date: Wed Sep 24 21:32:38 EDT 1997
From: moderator At: 152.163.195.101
What are the worst social forces that you found?
MsgId: *breakthrough(31)
Date: Wed Sep 24 21:33:58 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: Clearly, poverty, and even larger social forces such as income inequality appear to influence rates of heart attack. But those require intervention at a different level. Namely, we're talking social policy rather than what individuals themselves can do.
MsgId: *breakthrough(32)
Date: Wed Sep 24 21:35:34 EDT 1997
From: moderator At: 152.163.195.101
How have people who were in your studies reacted to your findings.
MsgId: *breakthrough(33)
Date: Wed Sep 24 21:38:36 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: Knowledge is a powerful incentive for action. Women in our study, for instance, have been quitting smoking at about twice the national rate, and I'm sure that's in part due to the many reports that have come out on the hazards of smoking, from the study.
MsgId: *breakthrough(35)
Date: Wed Sep 24 21:39:32 EDT 1997
From: moderator At: 152.163.195.101
Have people changed their behavior after being in your other studies?
MsgId: *breakthrough(36)
Date: Wed Sep 24 21:40:42 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: It's difficult to tell. But every time I publish a study on something like anger and heart attack I get inundated with calls from people with anger problems. And they all want to know what they can do to manage their problem.
MsgId: *breakthrough(37)
Date: Wed Sep 24 21:41:22 EDT 1997
From: moderator At: 152.163.195.101
What kind of advice can you give them?
MsgId: *breakthrough(38)
Date: Wed Sep 24 21:42:00 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: I refer them to good self-help books or send them back to their personal physicians.
MsgId: *breakthrough(39)
Date: Wed Sep 24 21:45:51 EDT 1997
From: moderator At: 152.163.195.101
In all your studies, lifespan is being affected by risk factors. Yet the lifespan in American is supposedly increasing. How do you account for this?
MsgId: *breakthrough(40)
Date: Wed Sep 24 21:47:26 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: That's where poverty comes into it. In other words , life expectancy and heart attack rates have vastly improved for the rich and the well-off. But for the poor, who are, by the way, more often exposed to things like passive smoking, the heart attack rates have hardly budged. So when we talk about public health successes, it can be a little misleading to just talk about what's happening to the average rates.
MsgId: *breakthrough(41)
Date: Wed Sep 24 21:48:18 EDT 1997
From: moderator At: 152.163.195.101
So when we see an increase in lifespan, it's a complex number--not a number for everyone.
MsgId: *breakthrough(42)
Date: Wed Sep 24 21:51:02 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: It's an average number. And it doesn't reflect the experience of all Americans. You have to beware of averages. Life expectancy is greatly improved for Americans who have succeeded in quitting smoking and eating a healthy diet. The same is not true for the more disadvantaged groups.
MsgId: *breakthrough(43)
Date: Wed Sep 24 21:51:57 EDT 1997
From: moderator At: 152.163.195.101
Does income necessarily have to be linked to living a healthy lifestyle?
MsgId: *breakthrough(44)
Date: Wed Sep 24 21:53:00 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: It seems that people with higher incomes smoke less, eat a better diet, exercise more, they have less stress and consequently they seem to do better in almost every measure of health.
MsgId: *breakthrough(45)
Date: Wed Sep 24 21:54:35 EDT 1997
From: moderator At: 152.163.195.101
Do you see each study giving people answers for how they can help themselves?
MsgId: *breakthrough(47)
Date: Wed Sep 24 21:55:27 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: Yes, that's we're providing, information on how people can help themselves to prevent illness.
MsgId: *breakthrough(48)
Date: Wed Sep 24 21:56:34 EDT 1997
From: moderator At: 152.163.195.101
Have you had any surprises in the findings from your studies -- things you didn't expect to find?
MsgId: *breakthrough(49)
Date: Wed Sep 24 21:59:02 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: Each study has provided surprises. We were impressed by the sheer magnitude of risk associated with passive smoking. In our studies of emotional stress, we've been impressed with a different range of negative emotions that are linked to heart attack. We find not only that anger is a risk factor for heart disease, but also anxiety and depression. It's very surprising to us for the range of things that seem to predict heart attack.
MsgId: *breakthrough(51)
Date: Wed Sep 24 22:00:07 EDT 1997
From: moderator At: 152.163.195.101
Does it matter how angry and how anxious you are -- what was the threshhold you found for damage?
MsgId: *breakthrough(52)
Date: Wed Sep 24 22:02:47 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: We used a questionnaire to measure levels of things like anger and anxiety. Clearly the biggest risk is among people who have very high intensity of negative emotions. So when you're very angry, such as to the point of smashing objects, you're being violent and so on, people who are "angry all the time." And in the case of anxiety, people who have levels of incapacitating anxiety. These were the biggest risk. Nonetheless, the risk extends even into what we might call normal levels of such emotions. In other words, having less of these emotions is better.Most risk factors have that kind of relation to disease. For instance, very severe blood pressure is worse than moderately raised blood pressure, but the best thing of all is to have the lowest blood pressure that you can sustain.
MsgId: *breakthrough(57)
Date: Wed Sep 24 22:06:57 EDT 1997
From: moderator At: 152.163.195.101
In your current study you're looking at the ways people recover after an illness. Can we expect to improve to our health from this study also?
MsgId: *breakthrough(58)
Date: Wed Sep 24 22:08:52 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: I think so. It's important for public health scientists to study ways in which to prevent the onset of illness, but we mustn't forget that we need to understand ways in which we can improve the quality of life and recovery of people who already have disease. One of the things we're studying is how can we improve recovery among patients with heart attack, breast cancer and prostate cancer.Obviously medical care is important in assisting people's recovery, but we're also interested in the role of stress and social support. We're particularly interested to see whether these might affect the rate of recovery after a major illness.
MsgId: *breakthrough(60)
Date: Wed Sep 24 22:11:28 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi, thank you so much for joining me tonight. Good luck with your new study--it sounds like information we all can use.
MsgId: *breakthrough(62)
Date: Wed Sep 24 22:13:22 EDT 1997
From: moderator At: 152.163.195.101
Dr. Kawachi: Thank you. It's been a pleasure.
MsgId: *breakthrough(63)
Date: Wed Sep 24 22:17:49 EDT 1997
From: moderator At: 152.163.195.101
Please join me next week when I speak with Joel Schwartz, Ph.D., who will discuss the health effects of air pollutants.
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