In Reply:-In response to Dr. Noel's concerns, the documentation for the fact that 53,000 nonsmokers die each year from ETS exposure is as follows: Glantz S, Parmley WW:“Passive smoking and heart disease: epidemiology, physiology, and biochemistry AHA Circ 1991; 83(1):1-12.

The fact that 6,000 Americans teenagers try their first cigarette each day is documented by, Incidence of initiation of cigarette smoking-United States, 1965-1996. MMWR Morb Mortal Wkly Rep 1998; 47(39):837-40.

The editorial note in this paper states “The findings in this report indicate that, during 1988-1996 among persons aged 12-17 years, the incidence of initiation of first use increased by 30% and of first daily use increased by 50% more than 6000 persons aged <18 years try a cigarette each day, and more than 3000 persons aged <18 years become daily smokers each day.”

If Dr. Noel were in the trenches fighting smoking he would not have to question the fact that smokers tend to underestimate the number of cigarettes smoked per day. The reliability of self-reporting on smoking habits has been evaluated by comparing the reported smoking habits with the concentration of thiocyanate, which is higher in smokers than in nonsmokers and increases with increasing cigarette consumption. See Foss OP: Can we rely on self-reported smoking habits. Tidsskr Nor Laegeforen 1998; 118(14):2165-8.

C. Everett Koop, M.D.

6707 Democracy Boulevard; Bethesda, Maryland 20817

(Accepted for publication October 30, 1998.)