Correspondence: Michael Givel, Department of Political Science, The University of Oklahoma, 455 West Lindsey, Room 217, Norman, Oklahoma 73019, USA. E-mail: mgivel@ou.edu

Abstract

This manuscript examines the public policy importance of 1993, United States Department of Health and Human Services actions to require doctors and hospitals to report a new external cause of injury code or E-code for environmental tobacco smoke related to causes of death such as lung cancer and severe heart disease. Methods included a qualitative archival analysis of all previously internal tobacco industry documents, pertinent newspaper and magazine articles, Americans for Nonsmokers' Rights database, and pertinent websites regarding environmental tobacco smoke and E-codes from 1993 to 1998. The E-code has continued to the present because of scientific and administrative recognition that environmental tobacco smoke is conclusively linked to illness and death. The industry argued that the E-code was unnecessary because of costs to business and no conclusive scientific evidence linking environmental tobacco smoke with pulmonary and cardiovascular deaths. This regulatory action based on current scientific evidence and medical decision–making contradicts the industry's claim that no deaths are conclusively associated with environmental tobacco smoke.