s passive smoking harmful?

Yes. Breathing in someone elses cigarette smoke (passive smoking or secondhand smoking) can increase your risk of cancer and other health problems. It is also particularly harmful for children.

Smoke stays in the air

When someone smokes a cigarette, the smoke from the burning tip is released into the air. So is the smoke they breathe out. Smoke can stay in the air for up to two and a half hours even with a window open. It may still be there even if you cant see it or smell it. This also applies in small enclosed places, such as cars. Smoke may still be present in large amounts even after the person has stopped smoking.

Risks of passive smoking

Passive smoking can damage your body because secondhand smoke contains more than 4,000 chemicals, many of which are irritants and toxins, and some of which are known to cause cancer. Passive smoking from all forms of tobacco is harmful, including:

cigarettes cigars pipe tobacco hand-rolling tobacco

Frequent exposure to other peoples smoke can increase your risk of lung cancer, even if youre a non-smoker. Passive smoking also increases your risk of coronary heart disease. Coronary heart disease can cause a heart attack, angina (chest pain) and heart failure. It aslo increases your risk of stroke.

Children and passive smoking

Breathing in secondhand smoke is particularly harmful for children. Children who breathe in secondhand smoke have an increased risk of:

cot death (sudden infant death syndrome or SIDS) this is twice as likely in babies whose mothers smoke developing asthma smoking can also trigger asthma attacks in children who already have the condition serious respiratory (breathing) conditions such as bronchitis and pneumonia younger children are also much more likely to be admitted to hospital for a serious respiratory infection meningitis

coughs and colds middle ear disease, such as otitis media (a middle ear infection), which can cause hearing loss

Children who grow up with a parent or family member who smokes are three times as likely to start smoking themselves. If youre a parent who smokes, it will be hard to explain to your children why they shouldnt start smoking. Try to lead by example and quit. As well as improving your health and theirs, your children may be less likely to start smoking later in life. See below for where to get support.

Smoking and the law

In July 2007, smoking in public places, such as bars, restaurants and workplaces, was made illegal to protect non-smokers from the health risks associated with passive smoking.

Stopping smoking
Read more about treatment and support to quit smoking, as well as advice about self-help when youre preparing to stop. Your GP can also give you advice about quitting smoking and NHS stop smoking support services through Go Smokefree. Read the answers to more questions about stopping smoking.

Further information:

What are the health risks of smoking? Where can I get help with quitting smoking? Stop smoking help Download our quit smoking widget Go Smokefree QUIT: I want to quit

Passive smoking means breathing in other peoples tobacco smoke. Exhaled smoke is called exhaled mainstream smoke. The smoke drifting from a lit cigarette is called sidestream smoke. The combination of mainstream and sidestream smoke is called second-hand smoke (SHS) or environmental tobacco smoke (ETS). Second-hand smoke is a common indoor pollutant in the home, making passive smoking a

serious health risk for both those who smoke and those who do not. Children are particularly at risk of serious health effects from second-hand smoke. In Victoria, it is illegal to smoke in cars carrying children who are under 18 years of age.

Irritant effects of passive smoking

Tobacco smoke inside a room tends to hang in mid-air rather than disperse. Hot smoke rises, but tobacco smoke cools rapidly, which stops its upward climb. Since the smoke is heavier than the air, the smoke starts to descend. A person who smokes heavily indoors causes a permanent low-lying smoke cloud that other householders have no choice but to breathe. Tobacco smoke contains around 7,000 chemicals, made up of particles and gases, over 50 of which are known to cause cancer. Second-hand smoke has been confirmed as a cause of lung cancer in humans by several leading health authorities. Compounds such as ammonia, sulphur and formaldehyde irritate the eyes, nose, throat and lungs. These compounds are especially harmful to people with respiratory conditions such as bronchitis or asthma. Exposure to second-hand smoke can either trigger or worsen symptoms.

Health risks of passive smoking pregnant women and unborn babies

Australian data indicates that about 12 per cent of women smoke during pregnancy. Both smoking and passive smoking can seriously affect the developing fetus. Health risks for mothers who smoke during pregnancy include:

Increased risk of miscarriage and stillbirth Increased risk of premature birth and low birth weight Increased risk of sudden unexpected death in infants (SUDI), which includes sudden infant death syndrome (SIDS) and fatal sleep accidents Increased risk of complications during birth.

A non-smoking pregnant woman is more likely to give birth to a baby with a slightly lower birth weight if she is exposed to second-hand smoke in the home for example, if her partner smokes.

Health risks of passive smoking children

Children are especially vulnerable to the damaging effects of second-hand smoke. Some of the many health risks include:

Passive smoking is a cause of sudden unexpected death in infants (SUDI), which includes sudden infant death syndrome (SIDS) and fatal sleep accidents. A child who lives in a smoking household for the first 18 months of their life has an increased risk of developing a range of respiratory illnesses including bronchitis, bronchiolitis and pneumonia. They are also more prone to getting colds, coughs and glue ear (middle ear infections). Their lungs show a reduced ability to function and slower growth. A child exposed to second-hand smoke in the home is more likely to develop asthma symptoms, have more asthma attacks and use asthma medications more often and for a longer period. School-aged children of people who smoke are more likely to have symptoms such as cough, phlegm, wheeze and breathlessness. Children of people who smoke have an increased risk of meningococcal disease, which can sometimes cause death or disability.

Health risks of passive smoking partners who have never smoked

People who have never smoked who live with people who do smoke are at increased risk of a range of tobacco-related diseases and other health risks, including:

Passive smoking increases the risk of heart disease. There is consistent evidence that people who do not smoke, who live in a smoky household, have higher risks of coronary heart disease than those who do not. Passive smoking makes the blood more sticky and likely to clot, thereby leading to increased risk of various health conditions, including heart attack and stroke. There is evidence that passive smoking can cause levels of antioxidant vitamins in the blood to reduce. Just 30 minutes of exposure to second-hand smoke can affect how your blood vessels regulate blood flow, to a similar degree to that seen in people who smoke. Long-term exposure to passive smoking may lead to the development of atherosclerosis (narrowing of the arteries). People who do not smoke who suffer long-term exposure to second-hand smoke have a 20 to 30 per cent higher risk of developing lung cancer. There is increasing evidence that passive smoking can increase the risk of stroke, nasal sinus cancer, throat cancer, breast cancer, long- and short-term respiratory symptoms, loss of lung function, and chronic obstructive pulmonary disease among people who do not smoke. It is estimated that in Australia, in the financial year 200405, 113 adults and 28 infants died from diseases caused by second-hand smoke in the home.

Passive smoking a good reason to quit

The risks of active smoking are well known. If a person who smokes cant give up for their own health, then the health of their family or other members of their household could be a stronger motivation. There is a wealth of assistance for people who wish to stop smoking. See your doctor for further information and advice, or ring the Quitline on 13 7848.

Reducing the risk of passive smoking

If a person who smokes is unwilling or unable to stop immediately, there are various ways to help protect the health of the people with whom they live. Suggestions include:

Make your home smoke-free. Limiting your smoking to one or two rooms is not an effective measure tobacco smoke can easily drift through the rest of the house. Make sure that visitors to your house smoke their cigarettes outdoors. Make your car smoke-free. The other occupants will still be exposed to tobacco smoke even if the windows are open. In Victoria, it is illegal to smoke in cars carrying children who are under 18 years of age. Dont allow smoking in any enclosed space where people who do not smoke spend time for example, in the garage, shed, cubby house, boat or caravan. Try to avoid taking children to outdoor areas where people are smoking and you cant easily move away, such as a caf courtyard. Make sure that all people who look after your children provide a smoke-free environment.

Where to get help

Your doctor Your pharmacist Quitline Tel. 13 7848

Things to remember

In Victoria, it is illegal to smoke in cars carrying children who are under 18 years of age, and in enclosed workplaces. If a person who smokes cant give up for their own health, perhaps the health of their partner or children, or other members of their household, will be a stronger motivation. Passive smoking increases the risk of respiratory illnesses in children, including asthma, bronchitis and pneumonia. People who have never smoked who live with people who do smoke are at increased risk of a range of tobacco-related diseases including lung cancer, heart disease and stroke.

Effects
Second-hand smoke causes many of the same diseases as direct smoking, including cardiovascular diseases, lung cancer, and respiratory diseases.[2][3][8] These diseases include:

Cancer: General: overall increased risk;[9] reviewing the evidence accumulated on a worldwide basis, the International Agency for Research on Cancer concluded in 2004 that "Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans."[3] o Lung cancer: the effect of passive smoking on lung cancer has been extensively studied. A series of studies from the USA from 19862003,[10][11][12][13] the UK in 1998,[14][15] Australia in 1997[16] and internationally in 2004[17] have consistently shown a significant increase in relative risk among those exposed to passive smoke.[18] o Breast cancer: The California Environmental Protection Agency concluded in 2005 that passive smoking increases the risk of breast cancer in younger, primarily premenopausal women by 70%[8] and the US Surgeon General has concluded that the evidence is "suggestive," but still insufficient to assert such a causal relationship.[2] In contrast, the International Agency for Research on Cancer concluded in 2004 that there was "no support for a causal relation between involuntary exposure to tobacco smoke and breast cancer in never-smokers."[3] o Renal cell carcinoma (RCC): A recent study shows an increased RCC risk among never smokers with combined home/work exposure to passive smoking.[19] [20] o Passive smoking does not appear to be associated with pancreatic cancer. o Brain tumor: The risk in children increases significantly with higher amount of passive smoking, even if the mother doesn't smoke,[21] thus not restricting risk to prenatal exposure during pregnancy. Ear, nose, and throat: risk of ear infections.[22] [23] o Second-hand smoke exposure is associated with hearing loss in non-smoking adults. [24] [25] Circulatory system: risk of heart disease, reduced heart rate variability, higher heart rate. o Epidemiological studies have shown that both active and passive cigarette smoking increase the risk of atherosclerosis.[26] Lung problems: [27] o Risk of asthma. Cognitive impairment and dementia: Exposure to secondhand smoke may increase the risk of cognitive impairment and dementia in adults 50 and over.[28] During pregnancy: [8], part B, ch. 3 [29] o Low birth weight . [8], part B, ch. 3 o Premature birth (Note that evidence of the causal link is only described as "suggestive" by the US Surgeon General in his 2006 report.[30]) [31] o Damage to children's carotid arteries at birth and at age 5 o Recent studies comparing women exposed to Environmental Tobacco Smoke and nonexposed women, demonstrate that women exposed while pregnant have higher risks of delivering a child with congenital abnormalities, longer lengths, smaller head circumferences, and low birth weight.[32] General: [33] o Worsening of asthma, allergies, and other conditions.
o

Skin Disorder o Childhood exposure to Environmental Tobacco Smoke is associated with an increased risk of the development of adult-onset Atopic dermatitis.[34] Overall increased risk of death in both adults, where it is estimated to kill 53,000 nonsmokers per year, making it the 3rd leading cause of preventable death in the U.S.[35][36] and in children.[37] Another research financed by the Swedish National Board of Health and Welfare and Bloomberg Philanthropies found that passive smoking causes about 603,000 death a year, which represents 1% of the world's death.[38]

Risk to children

Sudden infant death syndrome (SIDS).[39][40] In his 2006 report, the US Surgeon General concludes: "The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and sudden infant death syndrome."[41] Secondhand smoking has been estimated to be associated with 430 SIDS deaths in the United States annually.[42] Asthma[43][44] Lung infections,[45][46][47][48] also including more severe illness with bronchiolitis[49] and bronchitis,[50] and worse outcome,[49] as well as increased risk of developing tuberculosis if exposed to a carrier[51] In the United States, it is estimated that second hand smoke has been associated with between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year.[42] Impaired respiratory function and slowed lung growth[50] Allergies Crohn's disease.[52] Learning difficulties, developmental delays, and neurobehavioral effects.[53][54] Animal models suggest a role for nicotine and carbon monoxide in neurocognitive problems.[48] An increase in tooth decay (as well as related salivary biomarkers) has been associated with passive smoking in children.[55] Increased risk of middle ear infections.[56][57]

Evidence

Exposure to secondhand smoke by age, race, and poverty level in the US.

Epidemiological studies show that non-smokers exposed to second-hand smoke are at risk for many of the health problems associated with direct smoking. Most of the research has come from studies of nonsmokers who are married to a smoker. Those conclusions are also backed up by further studies of workplace exposure to smoke.[58] In 1992, the Journal of the American Medical Association published a review of available evidence on the relationship between second-hand smoke and heart disease, and estimated that second-hand smoke exposure was responsible for 35,000 to 40,000 deaths per year in the United States in the early 1980s.[59] The absolute risk increase of heart disease due to ETS was 2.2%, while the attributable risk percent was 23%. Research using more exact measures of second-hand smoke exposure suggests that risks to nonsmokers may be even greater than this estimate. A British study reported that exposure to second-hand smoke increases the risk of heart disease among non-smokers by as much as 60%, similar to light smoking.[60] Evidence also shows that inhaled sidestream smoke, the main component of second-hand smoke, is about four times more toxic than mainstream smoke. This fact has been known to the tobacco industry since the 1980s, though it kept its findings secret.[61][62][63][64] Some scientists believe that the risk of passive smoking, in particular the risk of developing coronary heart diseases, may have been substantially underestimated.[65] A minority of epidemiologists have found it hard to understand how second-hand smoke, which is more diluted than actively inhaled smoke, could have an effect that is such a large fraction of the added risk of coronary heart disease among active smokers.[66][67] One proposed explanation is that second-hand smoke is not simply a diluted version of "mainstream" smoke, but has a different composition with more toxic substances per gram of total particulate matter.[66] Passive smoking appears to be capable of precipitating the acute manifestations of cardio-vascular diseases (atherothrombosis) and may also have a negative impact on the outcome of patients who suffer acute coronary syndromes.[68] In 2004, the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) reviewed all significant published evidence related to tobacco smoking and cancer. It concluded: These meta-analyses show that there is a statistically significant and consistent association between lung cancer risk in spouses of smokers and exposure to second-hand tobacco smoke from the spouse who smokes. The excess risk is of the order of 20% for women and 30% for men and remains after controlling for some potential sources of bias and confounding.[3] Subsequent meta-analyses have confirmed these findings,[69][70] and additional studies have found that high overall exposure to passive smoke even among people with non-smoking partners is associated with greater risks than partner smoking and is widespread in nonsmokers.[60]

The National Asthma Council of Australia cites studies showing that second-hand smoke is probably the most important indoor pollutant, especially around young children:[71]

Smoking by either parent, particularly by the mother, increases the risk of asthma in children. The outlook for early childhood asthma is less favourable in smoking households. Children with asthma who are exposed to smoking in the home generally have more severe disease. Many adults with asthma identify ETS as a trigger for their symptoms. Doctor-diagnosed asthma is more common among non-smoking adults exposed to ETS than those not exposed. Among people with asthma, higher ETS exposure is associated with a greater risk of severe attacks.

In France, exposure to second-hand smoke has been estimated to cause between 3,000[72] and 5,000 premature deaths per year, with the larger figure cited by Prime minister Dominique de Villepin during his announcement of a nationwide smoke-free law: "That makes more than 13 deaths a day. It is an unacceptable reality in our country in terms of public health."[73] There is good observational evidence that smoke-free legislation reduces the number of hospital admissions for heart disease.[74] In 2009 two studies in the United States confirmed the effectiveness of public smoking bans in preventing heart attacks. The first study, carried out at the University of California, San Francisco and funded by the National Cancer Institute, found a 15 percent decline in heart-attack hospitalisations in the first year after smoke-free legislation was passed, and 36 percent after three years.[75] The second study, carried out at the University of Kansas School of Medicine, showed similar results.[76] Overall, women, non-smokers, and people under age 60 had the most heart attack risk reduction. Many of those benefiting were hospitality and entertainment industry workers.[77]

Risk level
The International Agency for Research on Cancer of the World Health Organization concluded in 2004 that there was sufficient evidence that second-hand smoke caused cancer in humans.[3] Most experts conclude that moderate, occasional exposure to second-hand smoke presents a modest but measurable cancer risk to nonsmokers. The overall risk depends on the effective dose received over time. The risk level is higher if non-smokers spend many hours in an environment where cigarette smoke is widespread, such as a business where many employees or patrons are smoking throughout the day, or a residential care facility where residents smoke freely.[78] The US Surgeon General, in his 2006 report, estimated that living or working in a place where smoking is permitted increases the non-smokers' risk of developing heart disease by 2530% and lung cancer by 2030%.

Biomarkers

Breath CO monitor displaying carbon monoxide concentration of an exhaled breath sample (in ppm) with corresponding percent concentration of carboxyhemoglobin displayed below.

Environmental tobacco smoke can be evaluated either by directly measuring tobacco smoke pollutants found in the air or by using biomarkers, an indirect measure of exposure. Carbon monoxide monitored through breath, nicotine, cotinine, thiocyanates, and proteins are the most specific biological markers of tobacco smoke exposure.[79][80] Biochemical tests are a much more reliable biomarker of second-hand smoke exposure than surveys. Certain groups of people are reluctant to disclose their smoking status and exposure to tobacco smoke, especially pregnant women and parents of young children. This is due to their smoking being socially unacceptable. Also, it may be difficult for individuals to recall their exposure to tobacco smoke.[81] A 2007 study in the Addictive Behaviors Journal found a positive correlation between secondhand tobacco smoke exposure and concentrations of nicotine and/or biomarkers of nicotine in the body. Significant biological levels of nicotine from second-hand smoke exposure were equivalent to nicotine levels from active smoking and levels that are associated with behaviour changes due to nicotine consumption.[82]
Cotinine

Cotinine, the metabolite of nicotine, is a biomarker of second-hand smoke exposure. Typically, cotinine is measured in the blood, saliva, and urine. Hair analysis has recently become a new, noninvasive measurement technique. Cotinine accumulates in hair during hair growth, which results in a measure of long-term, cumulative exposure to tobacco smoke.[83] Urinary cotinine levels have been a reliable biomarker of tobacco exposure and have been used as a reference in

many epidemiological studies. However, cotinine levels found in the urine only reflect exposure over the preceding 48 hours. Cotinine levels of the skin, such as the hair and nails, reflect tobacco exposure over the previous three months and are a more reliable biomarker.[79]
Carbon monoxide (CO)

Carbon monoxide monitored via breath is also a reliable biomarker of second-hand smoke exposure as well as tobacco use. With high sensitivity and specificity, it not only provides an accurate measure, but the test is also non-invasive, highly reproducible, and low in cost. Breath CO monitoring measures the concentration of CO in an exhalation in parts per million, and this can be directly correlated to the blood CO concentration (carboxyhemoglobin).[84] Breath CO monitors can also be used by emergency services to identify patients who are suspected of having CO poisoning.

Pathophysiology
A 2004 study by the International Agency for Research on Cancer of the World Health Organization concluded that non-smokers are exposed to the same carcinogens as active smokers. Sidestream smoke contains more than 4,000 chemicals, including 69 known carcinogens. Of special concern are polynuclear aromatic hydrocarbons, tobacco-specific Nnitrosamines, and aromatic amines, such as 4-aminobiphenyl, all known to be highly carcinogenic. Mainstream smoke, sidestream smoke, and second-hand smoke contain largely the same components, however the concentration varies depending on type of smoke.[3] Several well-established carcinogens have been shown by the tobacco companies' own research to be present at higher concentrations in sidestream smoke than in mainstream smoke.[85] Second-hand smoke has been shown to produce more particulate-matter (PM) pollution than an idling low-emission diesel engine. In an experiment conducted by the Italian National Cancer Institute, three cigarettes were left smoldering, one after the other, in a 60 m garage with a limited air exchange. The cigarettes produced PM pollution exceeding outdoor limits, as well as PM concentrations up to 10-fold that of the idling engine.[86] Tobacco smoke exposure has immediate and substantial effects on blood and blood vessels in a way that increases the risk of a heart attack, particularly in people already at risk.[87] Exposure to tobacco smoke for 30 minutes significantly reduces coronary flow velocity reserve in healthy nonsmokers.[88] Pulmonary emphysema can be induced in rats through acute exposure to sidestream tobacco smoke (30 cigarettes per day) over a period of 45 days.[89] Degranulation of mast cells contributing to lung damage has also been observed.[90] The term "third-hand smoke" was recently coined to identify the residual tobacco smoke contamination that remains after the cigarette is extinguished and second-hand smoke has cleared from the air.[91][92][93] Preliminary research suggests that by-products of third-hand smoke may pose a health risk,[94] though the magnitude of risk, if any, remains unknown. In October 2011, it was reported that Christus St. Frances Cabrini Hospital in Alexandria, Louisiana would seek to

eliminate third-hand smoke beginning in July 2012, and that employees whose clothing smelled of smoke would not be allowed to work. This prohibition was enacted because third-hand smoke poses a special danger for the developing brains of infants and small children.[95] In 2008, there were more than 161,000 deaths attributed to lung cancer in the United States. Of these deaths, an estimated 10% to 15% were caused by factors other than first-hand smoking; equivalent to 16,000 to 24,000 deaths annually. Slightly more than half of the lung cancer deaths caused by factors other than first-hand smoking were found in nonsmokers. Lung cancer in nonsmokers may well be considered one of the most common cancer mortalities in the United States. Clinical epidemiology of lung cancer has linked the primary factors closely tied to lung cancer in non-smokers as exposure to second-hand tobacco smoke, carcinogens including radon, and other indoor air pollutants.[96]

Opinion of public health authorities

There is widespread scientific consensus that exposure to second-hand smoke is harmful.[4] The link between passive smoking and health risks is accepted by every major medical and scientific organisation, including:

The World Health Organization:[3] The governments of 168 nations have signed and currently 174 have ratified the World Health Organization Framework Convention on Tobacco Control, which states that "Parties recognize that scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability."[1] The U.S. National Institutes of Health[97] The Centers for Disease Control[98] The United States Surgeon General[2] The U.S. National Cancer Institute[99] The United States Environmental Protection Agency[100] The California Environmental Protection Agency[8] The American Heart Association,[101] American Lung Association,[102] and American Cancer Society[103] The American Medical Association[104] The American Academy of Pediatrics[105] The Australian National Health and Medical Research Council[106] The United Kingdom Scientific Committee on Tobacco and Health[107]

Public opinion
Recent major surveys conducted by the U.S. National Cancer Institute and Centers for Disease Control have found widespread public awareness that second-hand smoke is harmful. In both 1992 and 2000 surveys, more than 80% of respondents agreed with the statement that secondhand smoke was harmful. A 2001 study found that 95% of adults agreed that second-hand smoke was harmful to children, and 96% considered tobacco-industry claims that second-hand smoke was not harmful to be untruthful.[108]

A 2007 Gallup poll found that 56% of respondents felt that second-hand smoke was "very harmful", a number that has held relatively steady since 1997. Another 29% believe that secondhand smoke is "somewhat harmful"; 10% answered "not too harmful", while 5% said "not at all harmful".[citation needed]

Controversy over harm

As part of its attempt to prevent or delay tighter regulation of smoking, the tobacco industry funded a number of scientific studies and, where the results cast doubt on the risks associated with second-hand smoke, sought wide publicity for those results. The industry also funded libertarian and conservative think tanks, such as the Cato Institute in the United States and the Institute of Public Affairs in Australia which criticised both scientific research on passive smoking and policy proposals to restrict smoking.[109][110] New Scientist and the European Journal of Public Health have identified these industry-wide coordinated activities as one of the earliest expressions of corporate denialism. Further, they state that the disinformation spread by the tobacco industry has created a tobacco denialism movement, sharing many characteristics of other forms of denialism, such as HIV-AIDS denialism.[111][112]

Industry-funded studies and critiques

Enstrom and Kabat

A 2003 study by Enstrom and Kabat, published in the British Medical Journal, argued that the harms of passive smoking had been overstated.[113] Their analysis reported no statistically significant relationship between passive smoking and lung cancer, though the accompanying editorial noted that "they may overemphasise the negative nature of their findings."[114] This paper was widely promoted by the tobacco industry as evidence that the harms of passive smoking were unproven.[115][116] The American Cancer Society (ACS), whose database Enstrom and Kabat used to compile their data, criticized the paper as "neither reliable nor independent", stating that scientists at the ACS had repeatedly pointed out serious flaws in Enstrom and Kabat's methodology prior to publication.[117] Notably, the study had failed to identify a comparison group of "unexposed" persons.[118] Enstrom's ties to the tobacco industry also drew scrutiny; in a 1997 letter to Philip Morris, Enstrom requested a "substantial research commitment... in order for me to effectively compete against the large mountain of epidemiologic data and opinions that already exist regarding the health effects of ETS and active smoking."[119] In a US racketeering lawsuit against tobacco companies, the Enstrom and Kabat paper was cited by the US District Court as "a prime example of how nine tobacco companies engaged in criminal racketeering and fraud to hide the dangers of tobacco smoke."[120] The Court found that the study had been funded and managed by the Center for Indoor Air Research,[121] a tobacco industry front group tasked with "offsetting" damaging studies on passive smoking, as well as by Phillip Morris[122] who stated that Enstrom's work was "clearly litigation-oriented."[123] Enstrom has defended the accuracy of his study against what he terms "illegitimate criticism by those who have attempted to suppress and discredit it."[124]

Gori

Gio Batta Gori, a tobacco industry spokesman and consultant[125][126][127] and an expert on risk utility and scientific research, wrote in the libertarian Cato Institute's journal Regulation that "...of the 75 published studies of ETS and lung cancer, some 70 percent did not report statistically significant differences of risk and are moot. Roughly 17 percent claim an increased risk and 13 percent imply a reduction of risk."[128]
Milloy

Steven Milloy, the "junk science" commentator for Fox News and a former Philip Morris consultant,[129][130] claimed that "of the 19 studies" on passive smoking "only 8 slightly more than 42 percent reported statistically significant increases in heart disease incidence.."[131] Another component of criticism cited by Milloy focused on relative risk and epidemiological practices in studies of passive smoking. Milloy, who has a masters degree from the Johns Hopkins School of Hygiene and Public Health, argued that studies yielding relative risks of less than 2 were meaningless junk science. This approach to epidemiological analysis was criticized in the American Journal of Public Health: A major component of the industry attack was the mounting of a campaign to establish a "bar" for "sound science" that could not be fully met by most individual investigations, leaving studies that did not meet the criteria to be dismissed as "junk science."[132] The tobacco industry and affiliated scientists also put forward a set of "Good Epidemiology Practices" which would have the practical effect of obscuring the link between secondhand smoke and lung cancer; the privately stated goal of these standards was to "impede adverse legislation".[133] However, this effort was largely abandoned when it became clear that no independent epidemiological organization would agree to the standards proposed by Philip Morris et al.[134]
World Health Organization controversy

A 1998 report by the International Agency for Research on Cancer (IARC) on environmental tobacco smoke (ETS) found "weak evidence of a dose-response relationship between risk of lung cancer and exposure to spousal and workplace ETS."[78] In March 1998, before the study was published, reports appeared in the media alleging that the IARC and the World Health Organization (WHO) were suppressing information. The reports, appearing in the British Sunday Telegraph[135] and The Economist,[136] among other sources,[137][138][139] alleged that the WHO withheld from publication of its own report that supposedly failed to prove an association between passive smoking and a number of other diseases (lung cancer in particular). In response, the WHO issued a press release stating that the results of the study had been "completely misrepresented" in the popular press and were in fact very much in line with similar

studies demonstrating the harms of passive smoking.[140] The study was published in the Journal of the National Cancer Institute in October of the same year, and concluded the authors found "no association between childhood exposure to ETS and lung cancer risk" but "did find weak evidence of a doseresponse relationship between risk of lung cancer and exposure to spousal and workplace ETS."[78] An accompanying editorial summarized: When all the evidence, including the important new data reported in this issue of the Journal, is assessed, the inescapable scientific conclusion is that ETS is a low-level lung carcinogen.[141] With the release of formerly classified tobacco industry documents through the Tobacco Master Settlement Agreement, it was found[by whom?] that the controversy over the WHO's alleged suppression of data had been engineered by Philip Morris, British American Tobacco, and other tobacco companies in an effort to discredit scientific findings which would harm their business interests.[122] A WHO inquiry, conducted after the release of the tobacco-industry documents, found that this controversy was generated by the tobacco industry as part of its larger campaign to cut the WHO's budget, distort the results of scientific studies on passive smoking, and discredit the WHO as an institution. This campaign was carried out using a network of ostensibly independent front organizations and international and scientific experts with hidden financial ties to the industry.[142]
EPA lawsuit

In 1993, the United States Environmental Protection Agency (EPA) issued a report estimating that 3,000 lung cancer related deaths in the United States were caused by passive smoking annually.[12] Philip Morris, R.J. Reynolds Tobacco Company, and groups representing growers, distributors and marketers of tobacco took legal action, claiming that the EPA had manipulated this study and ignored accepted scientific and statistical practices. The United States District Court for the Middle District of North Carolina ruled in favor of the tobacco industry in 1998, finding that the EPA had failed to follow proper scientific and epidemiologic practices and had "cherry picked" evidence to support conclusions which they had committed to in advance.[143] The court stated in part, "EPA publicly committed to a conclusion before research had begunadjusted established procedure and scientific norms to validate the Agency's public conclusion... In conducting the ETS Risk Assessment, disregarded information and made findings on selective information; did not disseminate significant epidemiologic information; deviated from its Risk Assessment Guidelines; failed to disclose important findings and reasoning" In 2002, the EPA successfully appealed this decision to the United States Court of Appeals for the Fourth Circuit. The EPA's appeal was upheld on the preliminary grounds that their report had no regulatory weight, and the earlier finding was vacated.[144] In 1998, the U.S. Department of Health and Human Services, through the publication by its National Toxicology Program of the 9th Report on Carcinogens, listed environmental tobacco

smoke among the known carcinogens, observing of the EPA assessment that "The individual studies were carefully summarized and evaluated."[145]
Tobacco-industry funding of research

The tobacco industry's role in funding scientific research on second-hand smoke has been controversial.[146] A review of published studies found that tobacco-industry affiliation was strongly correlated with findings exonerating second-hand smoke; researchers affiliated with the tobacco industry were 88 times more likely than independent researchers to conclude that second-hand was not harmful.[147] In a specific example which came to light with the release of tobacco-industry documents, Philip Morris executives successfully encouraged an author to revise his industry-funded review article to downplay the role of second-hand smoke in sudden infant death syndrome.[148] The 2006 U.S. Surgeon General's report criticized the tobacco industry's role in the scientific debate: The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus.[149] This strategy was outlined at an international meeting of tobacco companies in 1988, at which Philip Morris proposed to set up a team of scientists, organized by company lawyers, to "carry out work on ETS to keep the controversy alive."[150] All scientific research was subject to oversight and "filtering" by tobacco-industry lawyers: Philip Morris then expect the group of scientists to operate within the confines of decisions taken by PM scientists to determine the general direction of research, which apparently would then be 'filtered' by lawyers to eliminate areas of sensitivity.[150] Philip Morris reported that it was putting "...vast amounts of funding into these projects... in attempting to coordinate and pay so many scientists on an international basis to keep the ETS controversy alive."[150]

Tobacco industry response

Measures to tackle second-hand smoke pose a serious economic threat to the tobacco industry, having broadened the definition of smoking beyond a personal habit to something with a social impact. In a confidential 1978 report, the tobacco industry described increasing public concerns about second-hand smoke as "the most dangerous development to the viability of the tobacco industry that has yet occurred."[151] In United States of America v. Philip Morris et al., the District Court for the District of Columbia found that the tobacco industry "... recognized from the mid-1970s forward that the health effects of passive smoking posed a profound threat to industry viability and cigarette profits," and that the industry responded with "efforts to undermine and discredit the scientific consensus that ETS causes disease."[4]

Accordingly, the tobacco industry have developed several strategies to minimise the impact on their business:

The industry has sought to position the second-hand smoke debate as essentially concerned with civil liberties and smokers' rights rather than with health, by funding groups such as FOREST.[152] Funding bias in research;[7] in all reviews of the effects of second-hand smoke on health published between 1980 and 1995, the only factor associated with concluding that second-hand smoke is not harmful was whether an author was affiliated with the tobacco industry.[147] However, not all studies that failed to find evidence of harm were by industry-affiliated authors. Delaying and discrediting legitimate research (see[7] for an example of how the industry attempted to discredit Hirayama's landmark study, and[153] for an example of how it attempted to delay and discredit a major Australian report on passive smoking) Promoting "good epidemiology" and attacking so-called junk science (a term popularised by industry lobbyist Steven Milloy): attacking the methodology behind research showing health risks as flawed and attempting to promote sound science [4]. Ong & Glantz (2001) cite an internal Phillip Morris memo giving evidence of this as company policy[134] Creation of outlets for favourable research. In 1989, the tobacco industry established the International Society of the Built Environment, which published the peer-reviewed journal Indoor and Built Environment. This journal did not require conflict-of-interest disclosures from its authors. With documents made available through the Master Settlement, it was found that the executive board of the society and the editorial board of the journal were dominated by paid tobacco-industry consultants. The journal published a large amount of material on passive smoking, much of which was "industry-positive".[154]

Citing the tobacco industry's production of biased research and efforts to undermine scientific findings, the 2006 U.S. Surgeon General's report concluded that the industry had "attempted to sustain controversy even as the scientific community reached consensus... industry documents indicate that the tobacco industry has engaged in widespread activities... that have gone beyond the bounds of accepted scientific practice."[155] The U.S. District Court, in U.S.A. v. Philip Morris et al., found that "...despite their internal acknowledgment of the hazards of secondhand smoke, Defendants have fraudulently denied that ETS causes disease."[156]
Position of major tobacco companies

The positions of major tobacco companies on the issue of second-hand smoke is somewhat varied. In general, tobacco companies have continued to focus on questioning the methodology of studies showing that second-hand smoke is harmful. Some (such as British American Tobacco and Philip Morris) acknowledge the medical consensus that second-hand smoke carries health risks, while others continue to assert that the evidence is inconclusive. Imperial Tobacco describes second-hand smoke as "annoying" and "unpleasant", but denies any associated health risks. Several tobacco companies advocate the creation of smoke-free areas within public buildings as an alternative to comprehensive smoke-free laws.[157]

US racketeering lawsuit against tobacco companies

On September 22, 1999, the U.S. Department of Justice filed a racketeering lawsuit against Philip Morris and other major cigarette manufacturers.[158] Almost 7 years later, on August 17, 2006 U.S. District Court Judge Gladys Kessler found that the Government had proven its case and that the tobacco company defendants had violated the Racketeer Influenced Corrupt Organizations Act (RICO).[4] In particular, Judge Kessler found that PM and other tobacco companies had:

conspired to minimize, distort and confuse the public about the health hazards of smoking; publicly denied, while internally acknowledging, that second-hand tobacco smoke is harmful to nonsmokers, and destroyed documents relevant to litigation.

The ruling found that tobacco companies undertook joint efforts to undermine and discredit the scientific consensus that second-hand smoke causes disease, notably by controlling research findings via paid consultants. The ruling also concluded that tobacco companies continue today to fraudulently deny the health effects of ETS exposure.[4] On May 22, 2009, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit unanimously upheld the lower court's 2006 ruling.[159][160][161]

Smoke-free laws
See also: Smoking ban, List of smoking bans, and Smoking bans in private vehicles

As a consequence of the health risks associated with second-hand smoke, smoke-free regulations in indoor public places, including restaurants, cafs, and nightclubs have been introduced in a number of jurisdictions, at national or local level, as well as some outdoor open areas. 1 Ireland was the first country in the world to institute an comprehensive national smoke-free law on smoking in all indoor workplaces on 29 March 2004. Since then, many others have followed suit. The countries which have ratified the WHO Framework Convention on Tobacco Control (FCTC) have a legal obligation to implement effective legislation "for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places." (Article 8 of the FCTC[1]) The parties to the FCTC have further adopted Guidelines on the Protection from Exposure to Second-hand Smoke which state that "effective measures to provide protection from exposure to tobacco smoke ... require the total elimination of smoking and tobacco smoke in a particular space or environment in order to create a 100% smoke-free environment."[162] Opinion polls have shown considerable support for smoke-free laws. In June 2007, a survey of 15 countries found 80% approval for smoke-free laws.[163] A survey in France, reputedly a nation of smokers, showed 70% support.[73]

Effects
In the first 18 months after the town of Pueblo, Colorado enacted a smoke-free law in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighbouring towns without

smoke-free laws showed no change, and the decline in heart attacks in Pueblo was attributed to the resulting reduction in second-hand smoke exposure.[164] In April, 2010 the Canadian Medical Association Journal published a study evaluating the effects of a 10-year, three-stage smoke-free regulatory programme in Toronto. The study found that during the implementation of a restaurant smoke-free ordinance, hospital admissions for cardiovascular conditions declined by 39%, and admissions for respiratory conditions declined by 33%. No significant reductions in hospital admissions occurred in other cities which did not have smoke-free ordinances. The authors concluded that the study justified further efforts to reduce public exposure to tobacco smoke. In May 2006, Ontario instituted a comprehensive province-wide smoke-free law which extended the restrictions to all cities and municipalities in Ontario.[165] However, not all researchers agree that this was a causal relationship, and a 2009 study of many smoke-free ordinances in the United States disagreed with these conclusions.[166] In 2001, a systematic review for the Guide to Community Preventative Services acknowledged strong evidence of the effectiveness of smoke-free policies and restrictions in reducing expose to second-hand smoke. A follow up to this review, identified the evidence on which the effectiveness of smoking bans reduced the prevalence of tobacco use. Articles published until 2005, were examined to further support this evidence. The examined studies provided sufficient evidence that smoke-free policies reduce tobacco use among workers when implemented in worksites or by communities.[167] While a number of studies funded by the tobacco industry have claimed a negative economic impact from smoke-free laws, no independently funded research has shown any such impact. A 2003 review reported that independently funded, methodologically sound research consistently found either no economic impact or a positive impact from smoke-free laws.[168] Air nicotine levels were measured in Guatemalan bars and restaurants before and after an implemented smoke-free law in 2009. Nicotine concentrations significantly decreased in both the bars and restaurants measured. Also, the employees support for a smoke-free workplace substantially increased in the post-implementation survey compared to pre-implementation survey. The result of this smoke-free law provides a considerably more healthy work environment for the staff.[169]

Public opinion
Recent surveys taken by the Society for Research on Nicotine and Tobacco demonstrates supportive attitudes of the public, towards smoke-free policies in outdoor areas. A vast majority of the public supports restricting smoking in various outdoor settings. The respondents reasons for supporting the polices were for varying reasons such as, litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.[170]

Alternative forms

Alternatives to smoke-free laws have also been proposed as a means of harm reduction, particularly in bars and restaurants. For example, critics of smoke-free laws cite studies suggesting ventilation as a means of reducing tobacco smoke pollutants and improving air quality.[171] Ventilation has also been heavily promoted by the tobacco industry as an alternative to outright bans, via a network of ostensibly independent experts with often undisclosed ties to the industry.[172] However, not all critics have connections to the industry. The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) officially concluded in 2005 that while completely isolated smoking rooms do eliminate the risk to nearby non-smoking areas, smoking bans are the only means of completely eliminating health risks associated with indoor exposure. They further concluded that no system of dilution or cleaning was effective at eliminating risk.[173] The U.S. Surgeon General and the European Commission Joint Research Centre have reached similar conclusions.[155][174] The implementation guidelines for the WHO Framework Convention on Tobacco Control states that engineering approaches, such as ventilation, are ineffective and do not protect against secondhand smoke exposure.[162] However, this does not necessarily mean that such measures are useless in reducing harm, only that they fall short of the goal of reducing exposure completely to zero. Others have suggested a system of tradable smoking pollution permits, similar to the cap-andtrade pollution permits systems used by the Environmental Protection Agency in recent decades to curb other types of pollution.[175] This would guarantee that a portion of bars/restaurants in a jurisdiction will be smoke free, while leaving the decision to the market.

In animals
Main article: Animals and tobacco smoke

Multiple studies have been conducted to determine the carcinogenicity of environmental tobacco smoke to animals. These studies typically fall under the categories of simulated environmental tobacco smoke, administering condensates of sidestream smoke, or observational studies of cancer among pets. To simulate environmental tobacco smoke, scientists expose animals to sidestream smoke, that which emanates from the cigarette's burning cone and through its paper, or a combination of mainstream and sidestream smoke.[3] The IARC monographs conclude that mice with prolonged exposure to simulated environmental tobacco smoke, that is 6hrs a day, 5 days a week, for five months with a subsequent 4 month interval before dissection, will have significantly higher incidence and multiplicity of lung tumors than with control groups. The IARC monographs concluded that sidestream smoke condensates had a significantly higher carcinogenic effect on mice than did mainstream smoke condensates.[3]

Observational studies

Second-hand smoke is popularly recognised as a risk factor for cancer in pets.[176] A study conducted by the Tufts University School of Veterinary Medicine and the University of Massachusetts Amherst linked the occurrence of feline oral cancer to exposure to environmental tobacco smoke through an overexpression of the p53 gene.[177] Another study conducted at the same universities concluded that cats living with a smoker were more likely to get feline lymphoma; the risk increased with the duration of exposure to secondhand smoke and the number of smokers in the household.[178] A study by Colorado State University researchers, looking at cases of canine lung cancer, was generally inconclusive, though the authors reported a weak relation for lung cancer in dogs exposed to environmental tobacco smoke. The number of smokers within the home, the number of packs smoked in the home per day, and the amount of time that the dog spent within the home had no effect on the dog's risk for lung cancer.[179]
Animal nicotine poisoning

Animals like dogs, cats, squirrels, and other small animals are affected by not only second-hand smoke inhalation, but also nicotine poisoning.[citation needed] Domestic pets, especially dogs, usually fall ill when owners leave nicotine products like cigarette butts, chewing tobacco, or nicotine gum within reach of the animal.[citation needed] Littered cigarette butts from smokers are a problem for small animals that mistake them for food if they find them on sidewalks or trashcans.[180] Cigarette butts are the remains of a cigarette after smoking which contain the filter which is meant to contain tar, particles, and toxins from the cigarette such as ammonia, arsenic, benzene, turpentine and other toxins.[citation needed]

See also

Health effects of tobacco Third-hand smoke Tradable smoking pollution permits Tobacco Control Philip Morris v. Uruguay

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117. Jump up ^ "American Cancer Society Condemns Tobacco Industry Study for Inaccurate Use of Data" (Press release). American Cancer Society. 2003-05-13. Retrieved 2007-08-29. 118. Jump up ^ Thun MJC (2003). "More misleading science from the tobacco industry". BMJ 327 (7418): E2378. doi:10.1136/bmjusa.03070002 (inactive 2010-06-20). 119. Jump up ^ "Proposed Research on the relationship of Low Levels of Active Smoking to Mortality: Letter from James Enstrom to Philip Morris Scientific Affairs office". 1997-01-01. Retrieved 2007-08-29. 120. Jump up ^ Dalton R (March 2007). "Passive-smoking study faces review". Nature 446 (7133): 242. doi:10.1038/446242a. PMID 17361147. 121. Jump up ^ Kessler 2006, p. 1380 122. ^ Jump up to: a b Ong EK, Glantz SA (2000). "Tobacco industry efforts subverting International Agency for Research on Cancer's second-hand smoke study". Lancet 355 (9211): 12539. doi:10.1016/S0140-6736(00)02098-5. PMID 10770318. 123. Jump up ^ Kessler 2006, pp. 13803 124. Jump up ^ Enstrom JE (2007). "Defending legitimate epidemiologic research: combating Lysenko pseudoscience". Epidemiol Perspect Innov 4 (1): 11. doi:10.1186/1742-5573-4-11. PMC 2164936. PMID 17927827. 125. Jump up ^ Kessler 2006, p. 162 126. Jump up ^ United States of America v. Philip Morris et al., United States Factual Memorandum Pursuant to Order No. 470, Section V, United States District Court for the District of Columbia. p. 44 127. Jump up ^ ETS / IAQ SCIENTIFIC CONSULTANTS, from the Legacy Tobacco Documents Archive. Retrieved July 19, 2007. 128. Jump up ^ Gori, Gio Batta (Spring 2007). "Stoking the Rigged Terror of Secondhand Smoke". Regulation 30 (1): 147. 129. Jump up ^ Smoked Out: Pundit for Hire, by Paul D. Thacker. Published in The New Republic on January 26, 2006. Retrieved August 22, 2007. 130. Jump up ^ Philip Morris budget for "Strategy and Social Responsibility", listing Milloy as a paid consultant. Retrieved August 22, 2007. 131. Jump up ^ "Secondhand Joking", by Steven Milloy. Retrieved May 31, 2013. 132. Jump up ^ Samet JM, Burke TA (2001). "Turning Science Into Junk: The Tobacco Industry and Passive Smoking". Am J Public Health 91 (11): 17424. doi:10.2105/AJPH.91.11.1742. PMC 1446866. PMID 11684591. 133. Jump up ^ Scientific Communications Through the Media, from the Philip Morris document archive. Retrieved October 3, 2007. Also cited in Ong EK, Glantz SA (2001). "Constructing "Sound Science" and "Good Epidemiology": Tobacco, Lawyers, and Public Relations Firms". Am J Public Health 91 (11): 174957. doi:10.2105/AJPH.91.11.1749. PMC 1446868. PMID 11684593. 134. ^ Jump up to: a b Ong EK, Glantz SA (2001). "Constructing "Sound Science" and "Good Epidemiology": Tobacco, Lawyers, and Public Relations Firms". Am J Public Health 91 (11): 1749 57. doi:10.2105/AJPH.91.11.1749. PMC 1446868. PMID 11684593. 135. Jump up ^ "Passive Smoking Doesn't Cause Cancer Official". 136. Jump up ^ "Smokescreens The World Health Organization is showing signs of allowing politics to get in the way of truth. The Economist March 14th, 1998" (PDF). 137. Jump up ^ Le Grand C. Anti-smokers blown away by study. Australian 1998, March 10. 138. Jump up ^ WHO Rejects smoking link with lung cancer. Zimbabwe Independent 1998, Oct 23.

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Secondhand Smoke What is secondhand smoke?

Secondhand smoke (SHS) is also known as environmental tobacco smoke (ETS). SHS is a mixture of 2 forms of smoke that come from burning tobacco: Sidestream smoke smoke from the lighted end of a cigarette, pipe, or cigar Mainstream smoke the smoke exhaled by a smoker

Even though we think of these as the same, they arent. Sidestream smoke has higher concentrations of cancer causing agents (carcinogens) than mainstream smoke. And, it has smaller particles than mainstream smoke, which make their way into the lungs and the bodys cells more easily. When non-smokers are exposed to SHS it is called involuntary smoking or passive smoking. Non-smokers who breathe in SHS take in nicotine and toxic chemicals by the same route smokers do. The more SHS you breathe, the higher the level of these harmful chemicals in your body.

Why is secondhand smoke a problem?

Secondhand smoke causes cancer
Secondhand smoke is classified as a known human carcinogen (cancer -causing agent) by the US Environmental Protection Agency (EPA), the US National Toxicology Program, and the International Agency for Research on Cancer (IARC), a branch of the World Health Organization. Tobacco smoke contains more than 7,000 chemical compounds. More than 250 of these chemicals are known to be harmful, and at least 69 are known to cause cancer.

SHS has been linked to lung cancer. There is also some evidence suggesting it may be linked with childhood leukemia and cancers of the larynx (voice box), pharynx (throat), brain, bladder, rectum, stomach, and breast. IARC reported in 2009 that parents who smoked before and during pregnancy were more likely to have a child with hepatoblastoma. This rare cancer is thought to start while the child is still in the uterus. Compared with non-smoking parents, the risk was about twice as high if only one parent smoked, but nearly 5 times higher when both parents smoked.

Secondhand smoke and breast cancer

Whether SHS increases the risk of breast cancer is an issue thats still being studied. Both mainstream and SHS have about 20 chemicals that, in high concentrations, cause breast cancer in rodents. And we know that in humans, chemicals from tobacco smoke reach breast tissue and are found in breast milk. One reason the link between SHS and breast cancer risk in human studies is uncertain is because breast cancer risk has not been shown to be increased in active smokers. One possible explanation for this is that tobacco smoke might have different effects on breast cancer risk in smokers and in those who are exposed to SHS. A report from the California Environmental Protection Agency in 2005 concluded that the evidence regarding SHS and breast cancer is consistent with a causal association in younger women. This means the SHS acts as if it could be a cause of breast cancer in these women. The 2006 US Surgeon Generals report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, sums it up by saying that there is suggestive but not sufficient evidence of a link. Research is still being done, but women should be told that this possible link to breast cancer is yet another reason to avoid being around SHS.

Secondhand smoke causes other kinds of diseases and death

Secondhand smoke can cause harm in many ways. Each year in the United States alone, it is responsible for: An estimated 46,000 deaths from heart disease in people who are current non-smokers About 3,400 lung cancer deaths in non-smoking adults Worse asthma and asthma-related problems in up to 1 million asthmatic children Between 150,000 and 300,000 lower respiratory tract infections (lung and bronchus) in children under 18 months of age, with 7,500 to 15,000 hospitalizations each year Children exposed to secondhand smoke are much more likely to be put into intensive care when they have the flu, they are in the hospital longer, and are more likely to need breathing tubes than kids who arent exposed to SHS In the United States, the costs of extra medical care, illness, and death caused by SHS are over $10 billion per year

Surgeon Generals reports: Findings on smoking, secondhand smoke, and health

Since 1964, 34 separate US Surgeon Generals reports have been written to mak e the public aware of the health issues linked to tobacco and SHS. The ongoing research used in these reports still supports the fact that tobacco and SHS are linked to serious health problems that could be prevented. The reports have highlighted many important findings on SHS, such as: SHS kills children and adults who dont smoke. SHS causes disease in children and in adults who dont smoke.

Exposure to SHS while pregnant increases the chance that a woman will have a spontaneous abortion, stillborn birth, low birth-weight baby, and other pregnancy and delivery problems. Babies and children exposed to SHS are at an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections, ear infections, and more severe and frequent asthma attacks. Smoking by parents can cause wheezing, coughing, bronchitis, and pneumonia, and slow lung growth in their children. SHS immediately affects the heart, blood vessels, and blood circulation in a harmful way. Over time it can cause heart disease, strokes, and heart attacks. SHS causes lung cancer in people who have never smoked. Even brief exposure can damage cells in ways that set the cancer process in motion. Chemicals in tobacco smoke damage sperm which might reduce fertility and harm fetal development. SHS is known to damage sperm in animals, but more studies are needed to find out its effects in humans. There is no safe level of exposure to SHS. Any exposure is harmful. Many millions of Americans, both children and adults, are still exposed to SHS in their homes and workplaces despite a great deal of progress in tobacco control. On average, children are exposed to more SHS than non-smoking adults. The only way to fully protect non-smokers from exposure to SHS indoors is to prevent all smoking in that indoor space or building. Separating smokers from non-smokers, cleaning the air, and ventilating buildings cannot keep non-smokers from being exposed to SHS.

Where is secondhand smoke a problem?

You should be especially concerned about exposure to secondhand smoke in these 4 places:

At work
The workplace is a major source of SHS exposure for many adults. Occupational Safety and Health Administration (OSHA), the federal agency responsible for health and safety in the workplace, is concerned about SHS as a possible carcinogen at work. The National Institute for Occupational Safety and Health (NIOSH) and OSHA recognize there are no known safe levels of SHS, and recommend that exposures be reduced to the lowest possible levels. SHS in the workplace has been linked to an increased risk for heart disease and lung cancer among adult nonsmokers. The Surgeon General has said that smoke-free workplace policies are the only way to do away with SHS exposure at work. Separating smokers from non-smokers, cleaning the air, and ventilating the building cannot prevent exposure if people still smoke inside the building. An extra bonus other than protecting non-smokers is that workplace smoking restrictions may also encourage smokers to smoke less, or even quit.

In public places
Everyone can be exposed to SHS in public places, such as restaurants, shopping centers, public transportation, schools, and daycare centers. The Surgeon General has suggested people choose restaurants and other businesses that are smoke-free, and let owners of businesses that are not smoke-free know that SHS is harmful to your familys health. Some businesses seem to be afraid to ban smoking, but theres no proof that going smoke -free is bad for business. Public places where children go are a special area of concern. Make sure that your childrens day care center or school is smoke-free.

At home

Making your home smoke-free may be one of the most important things you can do for the health of your family. Any family member can develop health problems related to SHS. Childrens growing bodies are especially sensitive to the poisons in SHS. Asthma, l ung infections, and ear infections are more common in children who are around smokers. Some of these problems can be serious and even lifethreatening. Others may seem like small problems, but they add up quickly the expenses, time for doctor visits, medicines, lost school time, and often lost work time for the parent who must stay home with a sick child. Think about it: we spend more time at home than anywhere else. A smoke-free home protects your family, your guests, and even your pets. Multi-unit housing where smoking is allowed is a special concern and a subject of research. Tobacco smoke can move through air ducts, wall and floor cracks, elevator shafts, and along crawl spaces to contaminate apartments on other floors, even those that are far from the smoke. SHS cannot be controlled with ventilation, air cleaning, or by separating smokers from non-smokers.

In the car
Americans spend a great deal of time in cars, and if someone smokes there, the poisons can build up quickly. Again, this can be especially harmful to children. In response to this fact, the US Environmental Protection Agency has been working to encourage people to make their cars, as well as their homes, smoke-free. Some states and cities even have laws that ban smoking in the car if carrying passengers under a certain age or weight. And many facilities such as city buildings, malls, schools, colleges, and hospitals ban smoking on their grounds, including their parking lots.

What about smoking odors?

There is no research in the medical literature as yet that shows cigarette odors cause cancer in people. Research does show that particles from secondhand tobacco smoke can settle into dust and onto surfaces and remain there long after the smoke is gone some studies suggest the particles can last for months. Researchers call this thirdhand smoke or residual tobacco smoke. Studies have shown that the particles that settle out from tobacco smoke can form more cancer-causing compounds. Though unknown, the cancer-causing effects would likely be small compared with direct exposure to SHS. The compounds may be stirred up and inhaled with other house dust, but may also be absorbed through the skin or accidentally taken in through the mouth. This is why any risk the compounds pose may be larger for babies and children who play on the floor and often put things in their mouths. No actual cancer risk has been measured, but the health risks of thirdhand smoke are an active area of research.

What can be done about secondhand smoke?

Local, state, and federal authorities can enact public policies to protect people from SHS and protect children from tobacco-caused diseases and addiction. Because there are no safe levels of SHS, its important that any such policies be as strong as possible, and that they do not prevent action at other levels of government. Many US local and state governments, and even federal governments in some other countries, have decided that protecting the health of employees and others in public places is of the utmost importance. Many have passed clean indoor air laws. Although the laws vary from place to place, they are becoming more common. Detailed information on smoking restrictions in each state is available from the American Lung Association at www.lungusa2.org/slati/.

To learn more
More from your American Cancer Society
Here is more information you might find helpful. You also can order free copies of our documents from our toll-free number, 1-800-227-2345, or read them on our Web site, www.cancer.org. Questions About Smoking, Tobacco, and Health (also in Spanish) Smoking in the Workplace Guide to Quitting Smoking (also in Spanish)

Other organizations*
Along with the American Cancer Society, other sources of information and support include: Environmental Protection Agency (EPA) Telephone: 202-272-0167 Toll-free number for smoke-free info: 1-866-766-5337 (1-866-SMOKE-FREE) Web site: www.epa.gov Has advice on how to protect children from SHS, a Smoke-free Homes Pledge, and other tobacco-related materials on the direct Web site, www.epa.gov/smokefree. Also has specific information on dealing with SHS in apartment buildings at http://iaq.supportportal.com/link/portal/23002/23007/Article/21526/What-can-I-do-about-secondhandsmoke-coming-from-my-neighbor-s-apartment American Lung Association Telephone: 1-800-586-4872 Web site: www.lungusa.org Printed quit materials are available, some in Spanish; also has details on state-specific tobacco/smoking control laws and policies at www.lungusa2.org/slati/. Centers for Disease Control and Prevention Office on Smoking and Health Toll-free number: 1-800-232-4636 (1-800-CDC-INFO) Web site: www.cdc.gov/tobacco Offers answers to tobacco-related health questions, a lot of information on tobacco and smoking, and tools and resources for taking action against SHS National Cancer Institute Toll-free number: 1-800-422-6237 (1-800-4-CANCER) Web site: www.cancer.gov Direct tobacco Web site: www.smokefree.gov Quitting information is offered, as well as information on smoking by state and information about SHS *Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1800-227-2345 or visit www.cancer.org.

References
American Cancer Society. Cancer Facts & Figures 2012. Atlanta, Ga. 2012. American Cancer Society. Cancer Facts & Figures 2013. Atlanta, Ga. 2013. Betts KS. Secondhand Suspicions: Breast Cancer and Passive Smoking. Environ Health Perspect. 2007;115:A136A143. Borland R, Yong H-H, Siahpush M, et al. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control. 2006;15(suppl 3):34-41. California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. June 2005. Accessed at www.oehha.ca.gov/air/environmental_tobacco/pdf/app3partb2005.pdf on October 11, 2012. Centers for Disease Control and Prevention, National Institute of Occupational Safety and Health. Current Intelligence Bulletin 54: Environmental Tobacco Smoke in the Workplace Lung Cancer and Other Health Effects. 1991. (Publication No. 91-108) Accessed at www.nasdonline.org/document/1194/d001030/environmental-tobaccosmoke-in-the-workplace-lung-cancer.html on October 11, 2012. Dreyfuss JH. Thirdhand smoke identified as potent, enduring carcinogen. CA Cancer J Clin. 2010;60(4):203-204. Matt GE, Quintana PJ, Destaillats H, et al. Thirdhand tobacco smoke: emerging evidence and arguments for a multidisciplinary research agenda. Environ Health Perspect. 2011;119(9):1218-1226.

Secondhand smoke occurs as the result of inhalation of pollutants in the air from cigarette smoke and other tobacco products. According to the American Lung Association, secondhand smoke contains over 4,000 toxic chemicals, of which 40 are known carcinogens (cancer-causing). While many people may be able to limit their exposure to secondhand smoke while in the comfort of their own homes, people who travel, especially to places that are not "smoke-free", are at particular risk for possible exposure. After returning from a Guide Event in Las Vegas, Nevada, where guests of the casinos and hotels are still allowed to smoke freely, many Guides, including myself, expressed concern about exposure to secondhand smoke, in spite of staying in non-smoking rooms. Secondhand smoke being insidious in nature, seems to creep into other rooms through less-than-perfect, hotel ventilation systems. Although I did not experience any severe consequences from the weekend exposure, people who suffer from COPD or other chronic illnesses may not have been so lucky. With this in mind, I asked a few of my fellow Guides how they go about protecting themselves from the dangers of secondhand smoke while traveling. Here are some of their suggestions:

1. Always Ask for a Non-Smoking Room or Cabin

When I lived overseas, I quickly learned that smoking flights still exist in some areas of the world. I've been on planes where I couldn't see the other end of the cabin due to the smoke. There are non-smoking flights and cabins available, but only if you know to ask for them. They assume you don't mind the smoking if you don't clearly state otherwise. Jennifer Heisler, RN, Guide to Surgery

2. Try an Emergency Escape Mask

For people with asthma or COPD or other potentially life-threatening conditions, carrying something like this for emergencies while traveling might not be crazy: The Breath of Life Emergency Escape Mask Nancy Lapid, Guide to Celiac Disease

3. Pamper Yourself
o o o o o o

Take vitamin C. It may have something that counteracts the effects of smoking in the lungs. Drink Green tea - same as above. Drink lots and lots of water the entire time you are on your trip. Surround yourself by nature with fresh air both before and after the event. Do some form of deep breathing. Try an essential oil spritz in the room/environment that you are staying in.

Anne Asher, Guide to Back and Neck Pain

4. Note a Sensitivity to Smoke on Your Reservation

For ships and hotels that don't specify smoking vs. non-smoking rooms note a sensitivity to smoke on your reservation and request special cleaning. Call down and request it again if your room smells smoky on check-in. Cleaning staffs have extremely high powered ozone-based machines that can remove the leftover smoke in under an hour....you may want to arrange to be out of the room while its being cleaned though, as the machines are loud and can give off their own odor. Also, Febreeze does wonders for taking away the smell of smoke. I have no idea if it removes the toxins, but it definitely cuts the smell! Lisa Fritscher, Guide to Phobias

5. Speak-Out for the Underdog

Speak up for anyone with allergies, asthma, COPD or other chronic illnesses. Last week on a flight to San Francisco, the flight attendants asked that nobody open or eat anything containing nuts due to a passenger having a severe nut allergy. I didn't hear any squawks suggesting anybody was offended. It would seem secondhand smoke could be just as life-threatening, and perhaps smokers, or restaurant owners/taxi drivers/etc. would respect that? Have your kids join in. My children tend to make interesting comments around smokers. Loud comments like "mommy, that man really stinks" usually cause smokers to move away. Lynne Eldridge, MD, Guide to Lung Cancer

6. Choose a Non-Smoking Hotel

To avoid the issue of secondhand smoke all together, look for a hotel that is nonsmoking. When I did a search for non-smoking rooms in hotels, a few links came up to entirely smoke-free hotels, which is probably the best option. Barbara Poncelet, Guide to Teen Health Thanks to some great suggestions from some of your favorite Guides at About.com, secondhand smoke may be less of an issue on your next trip out of town. In conclusion, here are some of my own, personal suggestions on how to protect yourself from secondhand smoke:

Ask for a large fan -- this will help to circulate stale, smoky air in your hotel room. Hang your clothes in a garment bag and remove items only as you wear them -- this way, the items that you don't wear don't get exposed to secondhand smoke. Join in the fight against secondhand smoke -- if you are staying in a hotel that allows smoking, make it known to hotel management that secondhand smoke is dangerous and that you are offended by their smoking policy.

http://copd.about.com/od/livingwithcopd/a/secdhandsmlke2.htm

Facts About How Secondhand Smoke Affects Children's Health

Babies whose mothers smoke during pregnancy often weigh less at birth than those born to non-smoking mothers. Low birth weight is a leading cause of infant death. Babies whose mothers smoke during pregnancy are at increased risk for developmental issues, such as learning disabilities and cerebral palsy.

Babies who are exposed to secondhand smoke after birth have twice the risk for SIDS (sudden infant death syndrome) as babies who aren't exposed. Babies whose mothers smoked before and after birth carry three to four times the risk for SIDS. The EPA estimates that between 200,000 and 1,000,000 kids with asthma have their condition worsened by secondhand smoke. Passive smoking may also be responsible for thousands of new cases of asthma every year. Among children under 18 months of age in the United States, secondhand smoke is associated with 150,000 to 300,000 cases of lower respiratory tract infections, like bronchitis or pneumonia each year. Children in smoking households experience more middle ear infections. Inhaled cigarette smoke irritates the eustachian tube, and the subsequent swelling leads to infections, which are the most common cause of hearing loss in children. The lungs of children who regularly breathe in secondhand smoke develop more slowly. Research has uncovered evidence that suggests secondhand smoke may be related to childhood leukemia, lymphoma and brain tumors. However, to date, that evidence is insufficient to link these childhood cancers with secondhand smoke definitively.

Facts about Children's Exposure to Secondhand Smoke

On average, children have more exposure to secondhand smoke than non-smoking adults. Cotinine levels in children between 3 and 11 years old are more than double that of nonsmoking adults. An alarming 90% of the exposure kids get to secondhand smoke comes from their parents. Over half of American children breathe in secondhand smoke in cars, homes and public places where smoking is allowed.

With upwards of 70 carcinogenic and 250 poisonous known chemical components, it is clear that air laden with secondhand smoke is toxic and unsafe for anyone, especially our kids. It is up to us to provide them with healthy air to breathe. If you smoke, please make sure that you do all that you can to protect others from the secondhand smoke you create. Better yet, use the resources below to help you get started with smoking cessation.

Your Quit Smoking Toolbox After the Last Cigarette Smoking Cessation Support Forum

It is never too late to stop smoking, and the work it takes to achieve is minor when compared to the benefits you'll enjoy once you do.
Sources:

U.S. Dept. of Health and Human Services. Surgeon General Reports. The Health Consequences of Involuntary Exposure to Tobacco Smoke. Health Effects of Secondhand Smoke in Children. http://www.surgeongeneral.gov/library/reports/secondhandsmoke/factsheet2.html. Accessed July 2012.

Centers for Disease Control and Prevention. 2010 Surgeon General's Report: How Tobacco Smoke Causes Disease. http://www.cdc.gov/tobacco/data_statistics/sgr/2010/consumer_booklet/pdfs/consumer.pdf. Accessed July 2012.

United States Environmental Protection Agency. Health Effects of Exposure to Secondhand Smoke. http://www.epa.gov/smokefree/healtheffects.html. Accessed July 2012.

American Cancer Society. Secondhand Smoke. http://www.cancer.org/Cancer/CancerCauses/TobaccoCancer/secondhand-smoke. Accessed July 2012.

There is a fallacy that people who smoke himself will not be affected by second-hand smoking. However it is not the case. Hong Kong University had just published a research result on the journal Pediatrics, stating that passive smoking not only influence the health of non-smoker, but also smokers. Researchers from the universitys school of public health said the study was the first to show that exposure to second-hand smoke was associated with increased risk of persistent respiratory symptoms among adolescent smokers. The research targets were teenagers who smoked. Smoking is a kind of social life among teenagers, while we can see groups of youths gathering together in the playground and parks at night and smoke together. All the gathered teenagers become second-hand smokers, as they are all exposed to their peers smoke. Not even teenagers are affected. There is a voice in the society that we should exclude the smoking ban on the restaurants with all the waiters smoke. But the research stated that even smokers themselves cannot resist the impact of second-hand smoke. This exclusion is meaningless as it will still put the waiters and customers in risk. Here are some of the research results:

Current smokers who were exposed to second-hand smoke at home for five to seven days a week were 77 per cent more likely to suffer from respiratory symptoms than those who were not exposed If teenagers often encountered passive smoking, the risk of suffering from persistent respiratory symptoms increased 12 per cent and 25.9 per cent respectively for non-smokers and current smokers.

Can you see how second-hand smoke ruined our lives? Therefore the smoking ban in town is good for our quality of life. From the information of Secretary for Food and Health Dr York Chow Yat-ngok, smokers in Hong Kong are decreasing. However, data shown that there is only slightly decline in youth and female smokers. So please support the action which encouraging the youth and female smokers to give up smoking hobby. Source: Oct 21, 2009 SCMP , by Ng Yuk-hang Passive smoking leads to heart failure If you have chronic heart failure, being around a smoker may be bad for your physical and mental well-being, a new study suggests. Researchers found that of 205 non-smokers with heart failure, those who regularly breathed in secondhand smoke reported more problems in their day-to-day functioning -- physical and emotional. The findings, reported in the Archives of Internal Medicine, do not prove that other people's smoke was to blame. But they add to the large body of evidence tying secondhand smoke to heart disease, researchers say. A number of studies have found that non-smokers who regularly breathe in other people's tobacco smoke have an increased risk of developing heart disease. This latest study suggests that secondhand smoke may also affect a heart failure patient's quality of life, according to the researchers, led by Dr. Kirsten E. Fleischmann of the University of California, San Francisco. "In my opinion, patients with heart failure should definitely avoid secondhand smoke exposure -both to minimize the risk of cardiac events such as heart attacks and because of the effects on health-related quality of life that we documented," Fleischmann told Reuters Health in an email. Heart failure is a chronic condition in which the heart can no longer pump blood efficiently enough to meet the body's needs, which leads to symptoms like fatigue, breathlessness and swelling in the limbs. People can develop heart failure due to a condition that damages the heart muscle, like a heart attack or poorly controlled high blood pressure. It's possible, according to Fleischmann's team, that secondhand smoke could worsen the situation by impairing blood-vessel function, or increasing inflammation in the blood vessels. The findings are based on questionnaires and tests from 205 heart failure patients at the researchers' medical center. One questionnaire focused on "health-related quality of life," which asked about everyday physical and emotional well-being. Overall, one-quarter of the patients said they were exposed to secondhand smoke at least one hour out of every week. And they scored lower on measures of emotional well-being, and physical and emotional "role" -- meaning they had more physical limitations and emotional problems keeping them from their usual daily routines.

- See more at: http://www.newspakistan.pk/2011/11/30/Passive-smoking-leads-to-heartfailure/#sthash.lMY8pOOs.dpuf 3 June 2012| last updated at 09:27AM

7.6m exposed to tobacco smoke

By PUNITHA KUMAR | punithak@nst.com.my Read more: 7.6m exposed to tobacco smoke - General - New Straits Times http://www.nst.com.my/nation/general/7-6m-exposed-to-tobacco-smoke-1.93840#ixzz1432x0fkl

JUST AS DANGEROUS: Four in 10 Malaysians are passive smokers at home

SUBANG JAYA: FOUR in 10 Malaysian adults, or 7.6 million people, are exposed to tobacco smoke and considered passive smokers at home, according to the Global Adult Tobacco Survey (GATS) 2011. Health Ministry director-general Datuk Seri Dr Hasan Abdul Rahman said the health effects on a passive smoker were just as dangerous as a smoker. "The health effects of second-hand smoking (SHS) includes coronary heart diseases, lung and breast cancers, stroke and nasal iritation among adults. "Among children, it has been scientifically-proven to cause Sudden Infant Death Syndrome, impaired lung functions and ear diseases," he said when he launched the 15th National Institute of Health Scientific Meeting 2012 yesterday. The three-day meeting, themed "Harnessing Research for Better Health", will include symposiums and poster presentations from 600 participants. Dr Hasan said Malaysians generally believed wrongly that non-smokers did not face health risk, but research and findings had proven otherwise. "To avoid this from worsening, I urge smokers to consider the people around them, especially parents who smoke at home." According to GATS 2011, every four in 10 adults who worked indoors, and seven in 10 adults who went to restaurants, were exposed to tobacco smoke. World Health Organisation programme officer for Brunei, Malaysia and Singapore, Dr Soo Chun Paul, said even third-hand smoke could cause harm to infants and young children. "Third-hand smoke involves gases and particles that lingers on long after second-hand smoke has cleared the room."

He said it was more prone among children, as they were more likely to crawl on the floor and ate with their hands without washing them first. In Kuala Lumpur, Health Minister Datuk Seri Liow Tiong Lai said enforcement would be stepped up to cut the supply of contraband cigarettes in the market. The ministry was working with the Immigration department, Customs and other agencies to curb the sale of contraband and illicit cigarettes, he added. "We have raised the price of cigarette and it is proven to have reduced the percentage of smokers." Liow said the sale of cigarettes manufactured illegally would slow down the ministry's effort to reduce the number of smokers. This was a concern of the ministry as these cigarettes were more harmful to smokers, he added. "The amount of nicotine and tar content cannot be controlled in these cigarettes."

Read more: 7.6m exposed to tobacco smoke - General - New Straits Times http://www.nst.com.my/nation/general/7-6m-exposed-to-tobacco-smoke1.93840#ixzz14335uFHe
http://www.nst.com.my/nation/general/7-6m-exposed-to-tobacco-smoke-1.93840

Health Effects: Children

In children, secondhand smoke causes the following:3

Ear infections More frequent and severe asthma attacks Respiratory symptoms (e.g., coughing, sneezing, shortness of breath) Respiratory infections (i.e., bronchitis, pneumonia) A greater risk for sudden infant death syndrome (SIDS)

In children aged 18 months or younger, secondhand smoke exposure is responsible for4

An estimated 150,000300,000 new cases of bronchitis and pneumonia annually Approximately 7,50015,000 hospitalizations annually in the United States

Health Effects: Adults

In adults who have never smoked, secondhand smoke can cause heart disease and/or lung cancer.3
Heart Disease

For nonsmokers, breathing secondhand smoke has immediate harmful effects on the cardiovascular system that can increase the risk for heart attack. People who already have heart disease are at especially high risk.3,5 Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 2530%.3 Secondhand smoke exposure causes an estimated 46,000 heart disease deaths annually among adult nonsmokers in the United States.6

Lung Cancer

Nonsmokers who are exposed to secondhand smoke at home or work increase their lung cancer risk by 2030%.3 Secondhand smoke exposure causes an estimated 3,400 lung cancer deaths annually among adult nonsmokers in the United States.6

There is no risk-free level of contact with secondhand smoke; even brief exposure can be harmful to health.3

Estimates of Secondhand Smoke Exposure

When a nonsmoker breathes in secondhand smoke, the body begins to metabolize or break down the nicotine that was in the smoke. During this process, a nicotine byproduct called cotinine is created. Exposure to nicotine and secondhand smoke can be measured by testing saliva, urine, or blood for the presence of cotinine.3

Secondhand Smoke Exposure Has Decreased in Recent Years

Measurements of cotinine have shown how exposure to secondhand smoke has steadily decreased in the United States over time.3,7 o During 19881991, approximately 87.9% of nonsmokers had measurable levels of cotinine. o During 19992000, approximately 52.5% of nonsmokers had measurable levels of cotinine. o During 20072008, approximately 40.1% of nonsmokers had measurable levels of cotinine.

The decrease in exposure to secondhand smoke over the last 20 years is due to the growing number of laws that ban smoking in workplaces and public places, the increase in the number of households with smoke-free home rules, and the decreases in adult and youth smoking rates.8,9

Many in the United States continue to be exposed to secondhand smoke7

An estimated 88 million nonsmokers in the United States were exposed to secondhand smoke in 20072008. Children are at particular risk for exposure to secondhand smoke: 53.6% of young children (aged 311 years) were exposed to secondhand smoke in 20072008. While only 5.4% of adult nonsmokers in the United States lived with someone who smoked inside their home, 18.2% of children (aged 311 years) lived with someone who smoked inside their home in 20072008.

Disparities in Secondhand Smoke Exposure

Racial and Ethnic Groups

Although declines in cotinine levels have occurred in all racial and ethnic groups, cotinine levels have consistently been found to be higher in non-Hispanic black Americans than in non-Hispanic white Americans and Mexican Americans.7,8,9 In 20072008: o 55.9% of non-Hispanic blacks were exposed to secondhand smoke. o 40.1% of non-Hispanic whites were exposed to secondhand smoke. o 28.5% of Mexican Americans were exposed to secondhand smoke.

Low Income

Secondhand smoke exposure tends to be high for persons with low incomes: 60.5% of persons living below the poverty level in the United States were exposed to secondhand smoke in 2007 2008.7

Occupational Disparities

Occupational disparities in secondhand smoke exposure decreased over the past two decades, but substantial differences in exposure among workers remain. African-American male workers, construction workers, and blue collar workers and service workers are among some of the groups who continue to experience particularly high levels of secondhand smoke exposure relative to other workers.10

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/

Med J Malaysia. 2005 Aug;60(3):305-10.

Maternal passive smoking and its effect on maternal, neonatal and placental parameters.
Ramesh KN, Vidyadaran MK, Goh YM, Nasaruddin AA, Jammal AB, Zainab S.

Source
Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor.

Abstract
A study was undertaken to 1) determine the effects of tobacco smoke exposure on maternal and neonatal weight and body mass index (BMI) and placental weight, volume and surface area and 2) establish any correlations between the placental surface area, volume and weight with maternal and neonatal body weight and BMI in mothers exposed to cigarette smoke. A total of 154 full-term placentae, 65 from mothers exposed to tobacco smoke and 89 from non-exposed mothers were collected from Kuala Lumpur Maternity Hospital. The placental surface area was determined using a stereological grid, the volume by Scherle's method and the weight by using an electronic weighing machine. In general there were no differences in maternal, placental and neonatal parameters between the exposed and non-exposed groups. However, there were significant correlations between placental weight with maternal weight and maternal BMI in both exposed (r = 0.315; p = 0.013) and (r = 0.265; p = 0.038), and non-exposed (r = 0.224; p = 0.035) and (r = 0.241; p = 0.023) mothers. It was also found that the maternal weight on admission correlated significantly with placental weight in both Malay (r = 0.405; p = 0.020) and Indian (r = 0.553; p = 0.050) passive smokers. Correcting the placental parameters for the maternal weight had no effect on the results. PMID: 16379184 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/16379184