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Secondhand Smoke

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Call To Action

Smoke-free legislation must be enacted to reduce involuntary exposure to tobacco smoke, especially in children. People should be informed about the risks of secondhand smoke and the potential harms of thirdhand smoke.

Exposure to secondhand smoke can cause many of the same diseases as active smoking. It increases the risks of contracting lung cancer by 30% (small cell lung cancer by 300%) and coronary heart disease by 25%. Exposure to secondhand smoke killed more than 600,000 non-smokers in 2010. Ischemic heart disease, lower respiratory tract infections, asthma, and lung cancer are the most common causes of deaths related to secondhand smoke. Women suffer the greatest number of deaths among non-smoking adults. In 2010, 740 million people were exposed to secondhand smoke in China alone.

Although most health effects of active smoking appear in older ages, many victims of exposure to secondhand smoke are children or even unborn babies. Because these effects occur at early ages, the number of years of healthy life lost due to sickness, disability or early death related to secondhand smoke in children is much higher than in adults. Laboratory tests revealing exposure to smoke suggest that harmful effects of exposure to secondhand smoke in children may even be vastly underestimated.

People can be exposed to secondhand smoke in homes, indoor work and public places, cars, outdoor places, and in multiunit buildings—even if nobody smokes in one’s own apartment but people smoke elsewhere in the building. The health effects of exposure to vapor from e-cigarettes are currently unknown, but several countries have included or are considering the inclusion of e-cigarettes in smoke-free regulations to prevent abatement of smoke free laws by e-cigarette smoking. This inclusion would prevent any potential harm from exposure to e-cigarettes’ vapor.

Nicotine and other tobacco compounds accumulate on various surfaces (such as clothes, furniture, walls, and vehicles) and can stay there several months after smoking has stopped, even after the surfaces have been washed. These residues, or thirdhand smoke, contain several toxic compounds and have shown harmful effects on human cells and animals in laboratory studies, but the nature and magnitude of any health effects in humans need further investigation. Nevertheless, measures to eliminate secondhand smoke, such as banning smoking in public places, houses, and vehicles (see Smoke-free Policies), can also reduce thirdhand smoke

Sources

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60.

Kim CH, Lee YC, Hung RJ, McNallan SR, Cote ML, Lim WY, et al. Exposure to secondhand tobacco smoke and lung cancer by histological type: A pooled analysis of the International Lung Cancer Consortium (ILCCO). International journal of cancer Journal international du cancer. 2014.

Dunbar A, Gotsis W, Frishman W. Second-hand tobacco smoke and cardiovascular disease risk: an epidemiological review. Cardiology in review. 2013;21(2):94-100.

Oberg M, Jaakkola MS, Woodward A, Peruga A, Pruss-Ustun A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377(9760):139-46.

Zhang J, Ou JX, Bai CX. Tobacco smoking in China: prevalence, disease burden, challenges and future strategies. Respirology. 2011;16(8):1165-72.

Jones IA, St Helen G, Meyers MJ, Dempsey DA, Havel C, Jacob P, 3rd, et al. Biomarkers of secondhand smoke exposure in automobiles. Tobacco control. 2014;23(1):51-7.

St Helen G, Bernert JT, Hall DB, Sosnoff CS, Xia Y, Balmes JR, et al. Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in nonsmokers. Environmental health perspectives. 2012;120(7):1010-6.

Sureda X, Fernandez E, Lopez MJ, Nebot M. Secondhand tobacco smoke exposure in open and semi-open settings: a systematic review. Environmental health perspectives. 2013;121(7):766-73.

King BA, Babb SD, Tynan MA, Gerzoff RB. National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2013;15(7):1316-21.

Wilson KM, Torok M, McMillen R, Tanski S, Klein JD, Winickoff JP. Tobacco Smoke Incursions in Multiunit Housing. American journal of public health. 2014;104(8):1445-53.

Matt GE, Fortmann AL, Quintana PJ, Zakarian JM, Romero RA, Chatfield DA, et al. Towards smoke-free rental cars: an evaluation of voluntary smoking restrictions in California. Tobacco control. 2013;22(3):201-7.

Sleiman M, Gundel LA, Pankow JF, Jacob P, 3rd, Singer BC, Destaillats H. Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards. Proceedings of the National Academy of Sciences of the United States of America. 2010;107(15):6576-81.

Thomas JL, Hecht SS, Luo X, Ming X, Ahluwalia JS, Carmella SG. Thirdhand tobacco smoke: a tobacco-specific lung carcinogen on surfaces in smokers’ homes. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2014;16(1):26-32.

Hang B, Sarker AH, Havel C, Saha S, Hazra TK, Schick S, et al. Thirdhand smoke causes DNA damage in human cells. Mutagenesis. 2013;28(4):381-91.

Martins-Green M, Adhami N, Frankos M, Valdez M, Goodwin B, Lyubovitsky J, et al. Cigarette smoke toxins deposited on surfaces: implications for human health. PloS one. 2014;9(1):e86391.

Matt GE, Quintana PJ, Zakarian JM, Fortmann AL, Chatfield DA, Hoh E, et al. When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure. Tobacco control. 2011;20(1):e1.

One of the statements that tobacco companies were required to publish in the United States (newspapers, TV, their websites, and on cigarette packs) after a federal court in 2012 concluded that the companies “deliberately deceived the American public”. “There is no safe level of exposure to secondhand smoke.”

Exposure by Socioeconomic Status

Voluntary smoking ban at home by education level: Guangdong, China, 2010

Families with low socioeconomic status may be more likely to be exposed to secondhand smoke at home.

Harms in Adults

Level of evidence for harms caused by secondhand smoke in adults

Resources

Methods

Sufficient evidence is the term used by the US Surgeon General to indicate that current evidence strongly supports the inference of a causal relationship between smoking and specific health outcomes. Suggestive evidence = similar term used to indicate that current evidence, although indicative, is not yet sufficient to infer a causal relationship.

Sources

IARC Working Group. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol 100E: Personal Habits and Indoor Combustions. Lyon: IARC Press; 2012.

U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 Atlanta, USA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2014.

Pagani LS. Environmental tobacco smoke exposure and brain development: The case of attention deficit/hyperactivity disorder. Neuroscience and biobehavioral reviews. 2013.

Saulyte J, Regueira C, Montes-Martinez A, Khudyakov P, Takkouche B. Active or passive exposure to tobacco smoking and allergic rhinitis, allergic dermatitis, and food allergy in adults and children: a systematic review and meta-analysis. PLoS medicine. 2014;11(3):e1001611.

Jubulis J, Kinikar A, Ithape M, Khandave M, Dixit S, Hotalkar S, et al. Modifiable risk factors associated with tuberculosis disease in children in Pune, India. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2014;18(2):198-204.

du Preez K, Mandalakas AM, Kirchner HL, Grewal HM, Schaaf HS, van Wyk SS, et al. Environmental tobacco smoke exposure increases Mycobacterium tuberculosis infection risk in children. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2011;15(11):1490-6, i.

Based on a survey in 15 low- and middle-income countries in 2008–2011, people are 61% more likely to make their homes smoke- free voluntarily if smoking in workplace and public place is banned.

Harms in Children

Level of evidence for harms caused by secondhand smoke in children

Resources

Methods

Sufficient evidence is the term used by the US Surgeon General to indicate that current evidence strongly supports the inference of a causal relationship between smoking and specific health outcomes. Suggestive evidence = similar term used to indicate that current evidence, although indicative, is not yet sufficient to infer a causal relationship.

Sources

IARC Working Group. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol 100E: Personal Habits and Indoor Combustions. Lyon: IARC Press; 2012.

U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 Atlanta, USA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2014.

Pagani LS. Environmental tobacco smoke exposure and brain development: The case of attention deficit/hyperactivity disorder. Neuroscience and biobehavioral reviews. 2013.

Saulyte J, Regueira C, Montes-Martinez A, Khudyakov P, Takkouche B. Active or passive exposure to tobacco smoking and allergic rhinitis, allergic dermatitis, and food allergy in adults and children: a systematic review and meta-analysis. PLoS medicine. 2014;11(3):e1001611.

Jubulis J, Kinikar A, Ithape M, Khandave M, Dixit S, Hotalkar S, et al. Modifiable risk factors associated with tuberculosis disease in children in Pune, India. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2014;18(2):198-204.

du Preez K, Mandalakas AM, Kirchner HL, Grewal HM, Schaaf HS, van Wyk SS, et al. Environmental tobacco smoke exposure increases Mycobacterium tuberculosis infection risk in children. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2011;15(11):1490-6, i.

In 2007, South Australia became the first Australian state to ban smoking in cars in which children were travelling. “While it is an adult’s right to choose to smoke and expose themselves to all the associated and well-known health risks, this ban aims to protect children who could not otherwise protect themselves.” –Katy Gallagher, Chief Minister of the Australian Capital Territory, 2012

Secondhand smoke prevalence

Secondhand smoke exposure (%): in adults age ≥ 15, Global Adult Tobacco Survey, 2008–2013

Smoking ban in public places have a major effect in reducing exposure to secondhand smoke. For example, Uruguay adopted a comprehensive smoke-free national legislation in 2006. Air nicotine concentrations in public places dropped by 90% in Uruguay from 2002 to 2007.

Resources

Methods

Definition of exposures. Work: among those who work outside of the home who usually work indoors or both indoors and outdoors; restaurants: among those who visited restaurants in the past 30 days; home: somebody smokes in the home at least monthly.

Sources

Blanco-Marquizo A, Goja B, Peruga A, Jones MR, Yuan J, Samet JM, et al. Reduction of secondhand tobacco smoke in public places following national smoke-free legislation in Uruguay. Tobacco control. 2010;19(3):231-4.

Underestimated Exposure

Exposure to secondhand smoke in children brought to a hospital for asthma or breathing problems: Cincinnati, USA, 2010–2011

While only one third of parents reported that their children were exposed to secondhand smoke, laboratory tests confirmed that, in reality, 80% of children brought to a hospital (Cincinnati Children’s Hospital Medical Center) in the United States for asthma or breathing problems were exposed to secondhand smoke. These findings indicate that many respiratory diseases that might not be linked to secondhand smoke based on self-reports may in fact be related to the exposure.

162,200

Each year, secondhand smoking in the United Kingdom causes over 20,000 cases of lower respiratory tract infection, 120,000 cases of middle ear disease, 22,000 new cases of wheeze and asthma, and 200 cases of bacterial meningitis in children alone.

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Smoke-free Policies

Considering the demonstrated health and economic benefits, widespread public support, and low cost of implementation, it is vital that governments act to initiate and fully enforce comprehensive smoke-free legislation.

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