Table 2.1bLevel of certainty of causality reported in the 2004 and 2006 Surgeon General’s reports

SufficientSuggestiveUndetermined or inadequately studied
Chronic respiratory diseases (USDHHS 2004)
Maternal smoking in pregnancy
 Reduced lung function in infantsX
 Lower respiratory tract illnesses in infantsX
 Impaired lung function in childhoodX
Active smoking
 Lung growth in childhood and adolescenceX
 Onset of decline in lung functionX
 Respiratory symptomsX
 Asthma-type symptomsX
 Physician-diagnosed asthmaX
 Poor prognosis among asthmaticsX
Fertility, pregnancy, and pregnancy outcomes and other effects on offspring (USDHHS 2004)
Active smoking
 Relation to sperm qualityX
 Reduced fertility among womenX
Pregnancy and pregnancy outcomes
 Ectopic pregnancyX
 Spontaneous abortionX
 Premature rupture of the membranes, placenta previa, and placental abruptionX
 Reduced risk for preeclampsiaX
 Preterm delivery and shortened gestationX
 Fetal growth restriction and low birth weightX
Congenital malformations, infant mortality, and child physical and cognitive development
 Congenital malformations in generalX
 Oral cleftsX
 Sudden infant death syndrome and maternal smoking during and after pregnancyX
 Physical growth and neurocognitive development of childrenX
Maternal and paternal secondhand exposure (USDHHS 2006)
Fertility and fecundability
 MaternalX
 PaternalX
Spontaneous abortionX
Neonatal mortalityX
Sudden infant death syndromeX
Preterm deliveryX
Small reduction in birth weightX
Congenital malformationsX
Cognitive functioning among childrenX
Behavioral problems among childrenX
Children’s height/growthX
Cancer
 Prenatal and postnatal exposure to secondhand smoke and childhood cancerX
 Maternal exposure to secondhand smoke during pregnancy and childhood cancerX
 Exposure to secondhand smoke during infancy and childhood cancerX
 Prenatal and postnatal exposure to secondhand smoke and childhood leukemiasX
 Prenatal and postnatal exposure to secondhand smoke and childhood lymphomasX
 Prenatal and postnatal exposure to secondhand smoke and childhood brain tumorsX
 Prenatal and postnatal exposure to secondhand smoke and other childhood cancer typesX
Respiratory effects
 Lower respiratory illnesses in infants and childrenX
 Cough, phlegm, wheeze, and breathlessness among children of school ageX
 Ever having asthma among children of school ageX
 Onset of wheeze illnesses in early childhoodX
 Onset of childhood asthmaX
 Persistent adverse effects on lung function across childhoodX
 Lower level of lung function during childhoodX

From: 2, The Health Consequences of Tobacco Use Among Young People

Cover of Preventing Tobacco Use Among Youth and Young Adults
Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health.

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