Identifies upward trend in cigar use as potential serious public health problem.

In response to rapidly accumulating evidence that environmental tobacco smoke (ETS) exposure causes disease beyond lung cancer & respiratory effects in children, the Calif. Environmental Protection Agency undertook a comprehensive assessment of the total range of health effects correlated with exposure to ETS. Chapters: impact of ETS on the health of Californians; exposure measurement & prevalence; developmental toxicity I: perinatal manifestations; developmental toxicity II: postnatal manifestations; reproductive effects; respiratory health effects; carcinogenic effects; & cardiovascular effects. Dozens of tables & figures.

This eighty-ninth volume of the IARC Monographs is the third and last of a series on tobacco-related agents. Volume 83 reported on the carcinogenicity of tobacco smoke and involuntary smoking (second-hand smoke or environmental tobacco smoke) (IARC 2004a). Volume 85 summarized the evidence on the carcinogenic risk of chewing betel quid with and without tobacco (IARC 2004b). That volume explored the variety of products chewed in South Asia and other parts of the word that contain areca nut in combination with other ingredients, often including tobacco. In this eighty-ninth volume, the carcinogenic risks associated with the use of smokeless tobacco, including chewing tobacco and snuff, are considered in a first monograph. The second monograph reviews some tobacco-specific nitrosamines. These agents were evaluated earlier in Volume 37 of the Monographs (IARC 1985) and information gathered since that time has been summarized and evaluated.

This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.