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Secondly, in this study we have only included diseases listed in the Surgeon General's Report as causally associated with ETS exposure with the highest level of evidence (Level 1).5 To date, evidence on the causal relationship between ETS exposure and CVD or COPD is inconclusive, although the associations are biologically plausible and evidence is increasing.5 Including CVD and COPD in the AM estimate triples the mortality burden attributable to ETS exposure and would account for more than 2000 deaths per year