Chronic involuntary exposure to environmental tobacco smoke (ETS, also "secondhand smoke"...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ENVIRONMENTAL-SECONDHAND-SMOKE-LUNG-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-NSCLC`
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-NSCLC-2025`

Red Flag Origin

Definition	Chronic involuntary exposure to environmental tobacco smoke (ETS, also "secondhand smoke" or "passive smoking") with household or workplace exposure duration ≥10 years. ETS is an IARC Group 1 carcinogen (Monograph 83, 2004; reaffirmed multiple times) and a US Surgeon General-confirmed cause of lung cancer in non-smokers (2006 + 2014 reports). Meta-analyses (Hackshaw 1997; Stayner 2007): adult non-smoker household ETS exposure raises lung-cancer risk by ~20-25% (RR ~1.20-1.25); workplace ETS exposure similar magnitude. Childhood / in-utero ETS exposure has additional long-term lung- cancer + childhood-asthma signals. Mechanisms: sidestream smoke contains many of the same carcinogens (PAHs, nitrosamines, aromatic amines, benzene, heavy metals) as mainstream smoke; combustion- particle inhalation drives oxidative + inflammatory injury; KRAS/EGFR mutation enrichment in passive-smoke-exposed...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "household_ets_exposure_ge_10y",
      "value": true
    },
    {
      "finding": "workplace_ets_exposure_ge_10y",
      "value": true
    },
    {
      "finding": "spouse_active_smoker",
      "value": true
    },
    {
      "finding": "in_utero_or_childhood_ets_exposure",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for chronic ETS exposure (household / workplace ≥10y). IARC Group 1 + US Surgeon General-confirmed cause of lung cancer in non-smokers. risk_category=occupational is closest enum match — schema lacks an explicit 'environmental' enum. Distinct from active-smoking RF. Engine routes to PreventionPlan recommending exposure elimination (cohabitant smoking cessation / workplace smoke-free policy enforcement / personal mitigation) + USPSTF screening eligibility check + symptom-triggered evaluation. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-ENVIRONMENTAL-SECONDHAND-SMOKE-LUNG-PREVENTION-ELIMINATION - IND-ENVIRONMENTAL-SECONDHAND-SMOKE-LUNG-PREVENTION-ELIMINATION
IND-ENVIRONMENTAL-SECONDHAND-SMOKE-LUNG-PREVENTION-OBSERVATION - IND-ENVIRONMENTAL-SECONDHAND-SMOKE-LUNG-PREVENTION-OBSERVATION