(Redirected from Second-hand smoke):''See also
tobacco smoking and
Health effects of tobacco smoking''
:''"Second Hand Smoke" redirects here. For the
Sublime album, see '
Second-hand Smoke (album)'''
Tobacco smoke used to fill the air of
Irish pubs before the
smoking ban came into effect on March 29, 2004
'Passive smoking' (also known as 'secondhand smoking', 'involuntary smoking', 'exposure to environmental tobacco smoke', or 'ETS exposure') occurs when smoke from one person's burning
tobacco product (or the smoke exhaled by the smoker) is inhaled by others. Current scientific evidence shows that exposure to secondhand tobacco smoke causes death, disease and disability.
[1][2][3][4]
Passive smoking is one of the key issues leading to
smoking bans in workplaces and indoor public places, including
restaurants, bars and night clubs.
Long-term effects
Research has generated scientific evidence that secondhand smoke (i.e. in case of cigarette, a mixture of smoke released from the smoldering end of the cigarette and smoke exhaled by the smoker) causes the same problems as direct smoking, including
heart disease,
[5] cardiovascular disease,
lung cancer, and
lung ailments such as
COPD,
bronchitis and
asthma.
[6] Specifically,
meta-analyses have shown lifelong non-smokers with partners who smoke in the home have a 20–30% greater risk of lung cancer, and those exposed to cigarette smoke in the workplace have an increased risk of 16–19%.
[7]
A wide array of negative effects are attributed, in whole or in part, to frequent, long term exposure to second hand smoke.
[8][9][10] Some of these effects include:
★
Cancer:
★
★ General: overall increased risk;
[11] reviewing the evidence accumulated on a worldwide basis, the International Agency for Research on Cancer concluded in 2002 that "Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans (Group 1)."
[12]
★
★
Lung cancer: the effect of passive smoking on lung cancer has been extensively studied. Studies from the USA (1986,
[13][14] 1992,
[15] 1997,
[16] 2001,
[17] 2003
[18]), the UK (1998
[19][20]), and Australia (1997
[21]), as well as pooled international cohorts (2004
[22]) have consistently shown a significant increase in
relative risk among those exposed to passive smoke.
★
★ There is conflicting information regarding increased risk of
breast cancer[23][24]
★
★ Passive smoking does not appear to be associated with
pancreatic cancer[25]
★
Ear, nose, and throat: risk of ear infections
[26]
★
Circulatory system: risk of
heart disease[27]
★
Lung problems:
★
★ Risk of
asthma[28][29]
★
Pregnancy:
★
★ Risk of
premature birth[30]
★ General:
★
★ Worsening of asthma, allergies, and other conditions
[31]
★
Risk to children[32]
★
★ Risk of
sudden infant death syndrome (SIDS)
[33]
★
★ Risk of developing
asthma[34][35]
★
★ Risk of lung infections
[36][37][38][39]
★
★ More severe illness with
bronchiolitis, and worse outcome
[40]
★
★ Increased risk of developing
tuberculosis if exposed to a carrier
[41]
★
★ Risk of allergies
★
★ Risk of
Crohn's disease[42]
★
★ Risk of learning difficulties, although this may only be in children exposed before birth.
[43] Animal models suggest a role for nicotine and
carbon monoxide in neurocognitive problems
★ Overall increased risk of death in both adults, where it is estimated to kill 53,000 nonsmokers per year, making it the 3
rd leading cause of
preventable death in the U.S.
[44] and in children
[45]
Short-term effects
Persons with
asthma can experience attacks brought on by passive smoking
[46] whether they are adults or children,
[47][48][49] supporting calls for a
smoking ban.
[50]
Tobacco smoke is an
irritant, and allergy sufferers can experience stuffy or runny noses, watery or burning eyes, sneezing, coughing, wheezing, a feeling of suffocation, and other typical allergy symptoms within minutes of exposure. Some people with no known allergies and without asthma may cough in smoke-filled rooms, get
headaches, feel
nauseated, feel sleepy, and experience other ill effects, when they would not normally exhibit these symptoms without the presence of smoke.
Many former smokers, and those who are trying to quit prefer to not be around smoke as it can cause them to have cravings. Some people simply do not like the odor, which clings to hair, skin, teeth, fingernails, clothing, furniture, and rugs.
Many of these short-term effects terminate after the exposure ends. Repeated exposure, however, is believed to cause more serious long-term effects.
Epidemiological studies of passive smoking
Epidemiological studies show that non-smokers exposed to secondhand smoke are at risk for many of the health problems associated with direct smoking.
In 1992, the ''
Journal of the American Medical Association'' published a review of the available evidence regarding the relationship between secondhand smoke and heart disease, and estimated that passive smoking was responsible for 35,000 to 40,000 deaths per year in the
United States in the early 1980s.
[51] Some studies find that non-smokers living with smokers have about a 25% increase in risk of death from heart attack, are more likely to suffer a stroke, and can sometimes contract genital cancer.
Some research, such as the Helena Study,
[52] suggests that risks to nonsmokers may be even greater than this estimate. The Helena Study reported that exposure to secondhand smoke increases the risk of heart disease among non-smokers by as much as 60%.
[53] Parental smoking can affect children and babies, and is associated with low birth weight, sudden infant death syndrome (SIDS), bronchitis and pneumonia, and
middle ear infections.
[54]
In 2002, a group of 29 experts from 12 countries convened by the Monographs Programme of 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 secondhand 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.[55][56]
Additionally, studies assessing passive smoking without looking at the partners of smokers have found that high overall exposure to passive smoking is associated with greater risks than partner smoking and is widespread in non-smokers.
[57]
The National Asthma Council of Australia cites studies showing that:
Environmental tobacco smoke (ETS) is probably the most important indoor pollutant, especially around young children:
[58]
★ 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 passive smoking has been estimated to cause between 3,000
[59] and 5,000 premature deaths per year, with the larger figure cited by Prime minister
Dominique de Villepin during his announcement of a nationwide smoking ban: "That makes more than 13 deaths a day. It is an unacceptable reality in our country in terms of public health."
[60]
Studies of passive smoking in animals
Experimental studies in which animals are exposed to tobacco smoke have produced results supporting the
carcinogenicity of passive smoking. The International Agency for Research on Cancer expert group concluded that:
There is ''limited evidence'' in experimental animals for the carcinogenicity of mixtures of mainstream and sidestream tobacco smoke.
There is ''sufficient evidence'' in experimental animals for the carcinogenicity of sidestream smoke condensates.[61]
Secondhand smoke is generally recognized as a risk factor for cancer in pets.
[62] A study conducted by the
Tufts University School of Veterinary Medicine and the
University of Massachusetts 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.
[63] 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.
[64]
In 1990, a tobacco-industry researcher in
Germany proposed a study of the effects on animals of lifetime exposure to secondhand smoke. The proposed study was blocked by
Philip Morris,
[65] as described in an internal company report:
PM [Philip Morris] recently succeeded in blocking Adlkofer's plan to conduct lifetime animal inhalation study of sidestream smoke. ( . . .an INBIFO study has shown that in 90-day inhalation test, no non-reversible changes has [sic] been detected. In a lifetime study, the results were almost certain to be less favorable. Based on the analysis, the other members of the German industry agreed that the proposed study should not proceed.)[66]
Risk level of passive smoking
The
International Agency for Research on Cancer of the
World Health Organization concluded in 2002 that:
There is ''sufficient'' evidence that involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) causes lung cancer in humans.
Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is ''carcinogenic to humans (Group 1)''.[61]
Most experts believe that moderate, occasional exposure to secondhand smoke presents a small but measurable cancer risk to nonsmokers. The risk is considered more significant if non-smokers work in an environment where cigarette smoke is prevalent.
[68]
In May 2006, the United States
Centers for Disease Control issued its first new study on secondhand smoke in 20 years.
Surgeon General Richard Carmona summarized:
The health effects of secondhand smoke exposure are more pervasive than we previously thought. The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults.
The study estimated that living or working in a place where smoking is permitted increases the non-smokers' risk of developing heart disease by 25–30% and lung cancer by 20–30%. The report also found that passive smoke causes
sudden infant death syndrome (SIDS), respiratory problems, ear infections, and
asthma attacks in children.
[69]
Scientific basis for bans
A study issued in 2002 by the International Agency for Research on Cancer of the
World Health Organization concluded that nonsmokers are exposed to the same carcinogens as active smokers.
[70] Sidestream smoke contains more than 4000 chemicals, including 69 known carcinogens such as formaldehyde, lead, arsenic, benzene, and radioactive polonium 210,
[71] and 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.
[72]
Environmental tobacco smoke and particulate matter emission
Environmental tobacco smoke (ETS) was shown to be a much higher source of pollution than an idling
ecodiesel engine in regard to
particulate matter (PM) emission. In an experiment conducted by the Tobacco Control Unit of the National Cancer Institute, three cigarettes were left
smouldering, one after the other, in a 60 m³ garage with a limited air exchange. The cigarettes produced PM indoor pollution exceeding outdoor limits, as well as PM concentrations up to 10-fold that of the idling engine.
[73]
Criticism of the scientific majority view
The link between passive smoking and health risk has been the subject of some dissent, notably publicised by
Steven Milloy and his
Advancement of Sound Science Center (TASSC). Criticism has focused on critiques of confidence intervals, the position of the World Health Organization, a decision of the
United States District Court in 1998 (the Osteen decision) and on cohort studies by James Enstrom and Geoffrey Kabat. Regarding this criticism, much of which has been funded by the tobacco industry, a U.S. District Court reported in ''United States of America v. Philip Morris et al.'' that "...the scientific community had reached a consensus on ETS as a cause of disease by 1986... most significantly, Defendants themselves had determined by the 1970s that ETS was harmful to nonsmokers."
[74]
Critique of confidence intervals
Some criticism has focused on debate over proper
confidence intervals in passive smoking studies. These critics focus on the statistical significance of passive smoke findings at the p=.05 confidence interval.
Gio Batta Gori, a full-time tobacco-industry consultant
[75] writing in the
libertarian Cato Institute's journal ''Regulation'', claims 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."
[76]
This is contrary to the scientific consensus, which asserts that the evidence assembled in these studies, when taken as a whole rather than individually, demonstrates a clear link between passive smoking and health risks. The tobacco industry's approach to epidemiology, involving efforts to discredit individual studies rather than addressing the evidence as a whole, was described 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." The campaign also included attempts to characterize relative risks of 2 or less as highly questionable and not amenable to investigation by epidemiologic methods.[77]
These efforts were largely abandoned by the tobacco industry when it became clear that no independent epidemiological organization would agree to the standards proposed by Philip Morris et al.
[78]
World Health Organization Report 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."
[79]
In March of 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''
[80] and ''
The Economist'',
[81] among other sources,
[82][83][84] claimed that the WHO withheld from publication 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 entitled: "Passive Smoking Does Cause Lung Cancer; Do Not Let Them Fool You." The press release denied the allegations, saying 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.
[85]
The study was published in the ''Journal of the National Cancer Institute'' in October of the same year. 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.[86]
It was later discovered 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 findings which would harm their business interests.
[87][88] It was also reported, in the ''
American Journal of Public Health'', that Philip Morris had launched a public relations campaign to "shape the standards of scientific proof to make it impossible to 'prove' that secondhand smoke... is dangerous."
[78]
The Osteen decision
In 1993, the
United States Environmental Protection Agency (EPA) issued a report estimating that 3,000 lung cancer related deaths in the
U.S. were caused by passive smoking annually.
,
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.
United States District Court Judge William Osteen of the
Middle District of North Carolina vacated this study in
1998, finding that the EPA had:
1) Publicly committed to a conclusion before research had begun
2) Violated procedural requirements
3) Adjusted scientific norms to validate their conclusions
4) Engaged in a scheme to influence public opinion
5) Disregarded information and made findings based on selected information
6) Not disseminated significant information
7) Deviated from its own Risk Assessment Guidelines
8) Failed to disclose important findings and reasoning, and
9) Left significant questions unanswered.
[90]
The EPA appealed Judge Osteen's decision to the
United States Court of Appeals for the Fourth Circuit. The EPA made five arguments on appeal:
1) The District Court incorrectly held that the Report was final agency action under the
Administrative Procedures Act (APA),
2) The plaintiffs did not have proper standing to challenge the EPA report
3) The EPA had followed certain protocols
4) Any violation of protocols were not grounds for vacating the Report, and
5) The District Court exceeded its scope of judicial review.
In
2002, the Fourth Circuit reversed the decision below solely on the procedural ground that "the Report is not a reviewable agency action under the APA."
[91]
Enstrom and Kabat
Two studies by Enstrom and Kabat suggest that previous studies may have overestimated the effect of environmental tobacco smoke (ETS) on both lung cancer and heart disease.
The first, a
cohort study spanning 39 years, appeared in the
May 17 2003 issue of the ''
British Medical Journal'' (BMJ). Focusing on over 35,500 never-smokers, the study concluded that "The results do not support a causal relation between environmental tobacco smoke and tobacco-related mortality, although they do not rule out a small effect. The association between exposure to environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed."
[92]
This study was the subject of considerable debate. BMJ Editor Richard Smith defended the publication, explaining that the study was "a useful contribution to an important debate... We must be interested in whether passive smoking kills, and the question has not been definitively answered." Smith also "found it disturbing that so many people and organisations referred to the flaws in the study without specifying what they were."
[93]
Enstrom and Kabat's second contribution was a 2006
meta-analysis, published in ''Inhalation Technology'', which came to similar conclusions.
[94]
The BMJ study was criticised by the
American Cancer Society, which describes the study as "misinformation" on the grounds that both the original cohort and Enstrom and Kabat's follow-ups were inappropriate for reliably determining ETS exposure and smoking history and that Enstrom and Kabat had failed to disclose funding from the tobacco industry.
[95] Other criticisms were made on methodological grounds.
[96][97][98]
Role of tobacco industry funding
Supporters of the scientific consensus have argued that much criticism is funded by the tobacco industry.
[95] The influence of tobacco-industry funding on studies of passive smoking was investigated in a literature review by Barnes & Bero, who found that the only factor associated with concluding that passive smoking is not harmful was whether an author was affiliated with the tobacco industry.
[100] 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.[101]
Presentation of dissent in legal cases
In the 2004-2005 case of ''United States of America v. Philip Morris et al.'', heard by the
United States District Court for the District of Columbia, the tobacco industry called only one
expert witness to dispute what the Court described as "the overwhelming weight of scientific authority finding that secondhand smoke is a health risk to both adults and children."
This witness, Edwin Bradley, stated his belief that the existing evidence did not demonstrate a link between passive smoking and lung cancer or heart disease. His testimony was rejected by the Court, which found it "not credible" for, among other reasons, focusing primarily on the
statistical significance of individual studies of passive smoking. The Court found that:
No scientific or medical authority shares Dr. Bradley's view. Statistical significance is not one of the Surgeon General’s criteria for causality. As described below, it is a statistician's term of art, a tool to evaluate the possibility of chance in a particular study... Moreover, Dr. Bradley admits that he stands alone in adopting and applying his test.
Current state of controversy
Currently, there is widespread scientific agreement that passive smoking is harmful, with little to no scientific dissent.
The link between passive smoking and lung cancer is widely accepted; while there is general agreement regarding the existence of a link between passive smoking and heart disease, as reported by the WHO and Surgeon General, the magnitude of the increased risk remains debated by a minority of epidemiologists.
[102] For example, John Bailar of the
National Academy of Sciences questioned the proportionality of the passive smoking risk, stating, "Regular smoking only increases the risk of cardiovascular disease by 75%, so how could second-hand smoke, which is much more dilute, have an effect one-third that size?" One explanation put forward is that secondhand 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.
For other scientists, on the other hand, the risk of passive smoking, in particular the risk of developing coronary heart diseases, may have been substantially underestimated.
[103]
The health benefit to non-smokers of smoking bans has also been disputed by a small number of epidemiologists, who call for a prospective trial to more accurately determine the benefit. These epidemiologists advocate indoor smoking bans, but express a concern that widespread outdoor smoking bans,as implemented by some towns in the U.S., may be unsupported by the evidence available thus far.
Tobacco industry response
The passive smoking issue poses a serious economic threat to the tobacco industry. It has broadened the definition of smoking beyond a personal habit to something with a social impact, it has been the cause of successful litigation against employers by workers with a history of exposure to smoke, and it has resulted in various types of smoking restrictions. In a confidential 1978 report, the tobacco industry described increasing public concerns about passive smoking as "the most dangerous development to the viability of the tobacco industry that has yet occurred."
[104] 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."
Accordingly, the tobacco industry have developed several strategies to minimise its impact on their business:
★
Libertarian: the industry has sought to position the passive smoking debate as essentially concerned with civil liberties and smokers'
rights rather than with health.
★ Funding bias in research; in all reviews of the effects of passive smoking on health published between 1980 and 1995, the only factor associated with concluding that passive smoking is not harmful was whether an author was affiliated with the tobacco industry.
[105]
★ Delaying and discrediting legitimate research: Australia
[106]
★ 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 [3]. Ong & Glantz (2001) cite an internal Phillip Morris memo giving evidence of this as company policy
[107]
★ Creation of outlets for favorable 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".
[108]
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."
[109] 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."
Position of major tobacco companies
'
Altadis' (site accessed on November 19, 2006)
Non-smokers who breathe air containing ambient smoke are often referred to as
passive smokers and many studies have been conducted to assess their risks. Some
studies on exposure to ambient smoke conclude that it represents a risk for health.
'
British American Tobacco' (site accessed on July 27, 2007)
'The World Health Organisation, the United States Surgeon General and other public health bodies have concluded that exposure to environmental tobacco smoke (ETS), sometimes called ‘second-hand smoke’, is a cause of various serious diseases, including lung cancer, heart disease and respiratory illnesses in children.'
They conclude that there is no known safe level of ETS exposure and hence advise that public health policy would be best served by bans on public smoking.
'Our view of the science'
The risks associated with ETS have been measured in epidemiological studies. These mainly use questionnaires to compare the incidence of diseases such as lung cancer in non-smoking women whose husbands were smokers, with non-smoking women whose husbands were non-smokers.
For lung cancer, the major studies report that relative risk associated with prolonged non-smoker exposure to ETS is 1.3. A relative risk of 1 means no risk, and prolonged active smoking is typically associated with a relative risk of lung cancer of the order of 20 or higher.
For heart disease, the major studies also report a relative risk for ETS exposure of around 1.3. The relative risk for active smoking and heart disease is typically of the order of 3 to 5.
Many epidemiologists say that relative risks below 2 are weak associations and are more difficult to quantify than stronger associations. Perhaps because the relative risks reported in individual studies tend to be below 2, many studies do not reach statistical significance.
Studies of respiratory illnesses in children whose parents smoke, and research into whether ETS exposure exacerbates symptoms for people with conditions such as asthma, suggest that ETS can increase risks of respiratory illnesses in children and can affect people with pre-existing conditions such as asthma.
'Our approach to regulation'
We support regulation that accommodates the interests of both non-smokers and smokers and limits non-smokers’ involuntary exposure to ETS.
We favour restrictions on smoking in enclosed public places and we accept that there needs to be regulation.
We support practical initiatives such as the creation of smoke-free areas, combined with adequate provision for smokers.
'
Imperial Tobacco Group plc' (site accessed on November 19, 2006)
Imperial Tobacco recognises that other people’s tobacco smoke can be unpleasant or annoying, and can raise concerns leading to calls to ban smoking . However, it is our view that the scientific evidence, taken as a whole, is insufficient to establish that other people’s tobacco smoke is a cause of any disease.
The statistical population studies (epidemiology) which have led to claims that other people’s tobacco smoke is a risk to health are subject to some methodological flaws. Most individual studies show no statistical effects. When study results are combined (a process called ‘meta analysis’), at most they indicate a very small increase in relative risk.
'
JT International (Japan Tobacco)' (site accessed on November 19, 2006)
We agree that ETS can be annoying to non-smokers and that in poorly ventilated areas ETS can cause substantial irritation of the eyes, nose and throat. We therefore ask all smokers to be aware of and show consideration for people with whom they come into contact. However, we do not believe that the claim that ETS is a cause of lung cancer, heart disease and chronic pulmonary diseases in non-smokers has been convincingly demonstrated or that a reliable causal link between ETS exposure and chronic diseases has been established.
'
Philip Morris USA' (site accessed on November 19, 2006)
Public health officials have concluded that secondhand smoke from cigarettes causes disease, including lung cancer and heart disease, in non-smoking adults, as well as causes conditions in children such as asthma, respiratory infections, cough, wheeze, otitis media (middle ear infection) and Sudden Infant Death Syndrome. In addition, public health officials have concluded that secondhand smoke can exacerbate adult asthma and cause eye, throat and nasal irritation.
Philip Morris USA believes that the public should be guided by the conclusions of public health officials regarding the health effects of secondhand smoke in deciding whether to be in places where secondhand smoke is present, or if they are smokers, when and where to smoke around others. Particular care should be exercised where children are concerned, and adults should avoid smoking around them.
We also believe that the conclusions of public health officials concerning environmental tobacco smoke are sufficient to warrant measures that regulate smoking in public places. We also believe that where smoking is permitted, the government should require the posting of warning notices that communicate public health officials' conclusions that secondhand smoke causes disease in non-smokers.
'
R.J. Reynolds Tobacco Company' (site accessed on November 19, 2006)
RJRT believes that individuals should rely on the conclusions of the U.S. Surgeon General, the Centers for Disease Control and other public health and medical officials when making decisions regarding smoking.
Smoking bans
:''See also:
Smoking bans,
List of smoking bans''
As a consequence of the health risks associated with passive smoking, a general
ban on smoking in all establishments serving food and drink, including
restaurants,
cafés, and
nightclubs, was introduced in
Norway on
1 June 2004, and in
Sweden on
1 June 2005, the
United Kingdom on
1 July 2007, and
many parts of the United States have similar legislation in place.
These initial bans have grown in scope, with countries (such as
Ireland, the
UK,
Australia), jurisdictions (like
New York State,
Washington State,
Ohio, and
Arkansas in the U.S.) now prohibiting smoking in public buildings as well as private businesses such as restaurants and clubs. Many office buildings contain specially ventilated smoking areas; some are required by
law to provide them.
The state of Hawaii recently passed a bill making it illegal to smoke in any public place or within 20 feet of an entrance or ventilation shaft intake of a building.
Some regions and local governments have banned smoking in all workplaces, in taxicabs, and in ventilated smoking rooms or enclosed smoking shelters such as those found in front of hospitals.
Even in countries traditionally seen as nations of smokers, opinion polls have shown support for bans, with 70% of those in France supporting a ban.
In the first 18 months after the town of
Pueblo,
Colorado enacted a smoking ban in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighboring towns without smoking bans showed no change. Raymond Gibbons, M.D.,
American Heart Association president said, "The decline in the number of heart attack hospitalizations within the first year and a half after the non-smoking ban that was observed in this study is most likely due to a decrease in the effect of secondhand smoke as a triggering factor for heart attacks."
[110]
References
1. WHO Framework Convention on Tobacco Control; First international treaty on public health, adopted by 192 countries and signed by 168. Its Article 8.1 states "Parties recognize that scientific evidence has unequivocally established that exposure to tobacco causes death, disease and disability."
2. U.S. Department of Health and Human Services. "The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General", 2006; One of the major conclusions of the Surgeon General Report is: "Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke."
3. California Environmental Protection Agency: Air Resources Board, "Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant" (June 24, 2005); on January 26, 2006, the Air Resources Board, following a lengthy review and public outreach process, determined ETS to be a Toxic Air Contaminant (TAC).
4. WHO International Agency for Research on Cancer "Tobacco Smoke and Involuntary Smoking" IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83, 2002; the evaluation of the Monograph is: "There is sufficient evidence that involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) causes lung cancer in humans. [...] Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans (Group 1)."
5. "An individual male never-smoker living with a current or former smoker is estimated to have an approximately 9.6% chance of dying of ischemic heart disease by the age of 74 years, compared with a 7.4% chance for a male never-smoker living with a nonsmoker. The corresponding lifetime risks for women are 6.1% and 4.9%." Passive smoking and the risk of heart disease, ''The Journal of the American Medical Association'', Vol. 267 No. 1, January 1, 1992
6. European Code Against Cancer and scientific justification: third version (2003)., Boyle P, Autier P, Bartelink H ''et al.'', , , Ann Oncol., 2003
7. Tobacco smoking and cancer: a brief review of recent epidemiological evidence., Sasco AJ, Secretan MB, Straif K., , , Lung Cancer, 2004
8. Passive smoking and lung cancer: a cumulative meta-analysis., Taylor R et al, , , Aust N Z J Public Health, 2001
9. Passive smoking and the risk of coronary heart disease—a meta-analysis of epidemiologic studies., He J et al, , , N Engl J Med, 1999
10. Effects of passive smoking in the Multiple Risk Factor Intervention Trial., Svendsen KH, Kuller LH, Martin MJ, Ockene JK., , , Am J Epidemiol, 1987
11. U.S. Surgeon General's report on Secondhand Smoke (Chapter 2; pages 30–46)
12. WHO International Agency for Research on Cancer "Tobacco Smoke and Involuntary Smoking" IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83, 2002
13. US Department of Health and Human Services., The health consequences of involuntary smoking: report of the Surgeon General (DHHS Pub No (PHS) 87–8398), DHHS, Washington, DC (1986). PMID 3097495
14. National Research Council. Environmental tobacco smoke: measuring exposures and assessing health effects, NRC, Washington, DC (1986).
15. US Environmental Protection Agency.
16. California Environmental Protection Agency., Health effects of exposure to environmental tobacco smoke, California EPA, Sacramento (1997). PMID 9583639
17. Centers for Disease Control and Prevention (CDC). State-specific prevalence of current cigarette smoking among adults, and policies and attitudes about secondhand smoke—United States, 2000. MMWR Morb Mortal Wkly Rep. 2001 Dec 14;50(49):1101–6. id=PMID 11794619
18. Alberg AJ, Samet JM. Epidemiology of lung cancer. Chest. 2003 Jan;123(1 Suppl):21S-49S. PMID 12527563
19. Report of the Scientific Committee on Tobacco and Health to the Chief Medical Officer, Part II
20. Hackshaw AK. Lung cancer and passive smoking. Stat Methods Med Res. 1998 Jun;7(2):119-36. PMID 9654638
21. National Health and Medical Research Council. The health effects of passive smoking, Australian Government Publishing Service, Canberra (1997).
22. Secondhand smoke exposure in adulthood and risk of lung cancer among never smokers: a pooled analysis of two large studies, Brennan P, Buffler P, Reynolds P, Wu A, Wichmann H, Agudo A, Pershagen G, Jöckel K, Benhamou S, Greenberg R, Merletti F, Winck C, Fontham E, Kreuzer M, Darby S, Forastiere F, Simonato L, Boffetta P, , , Int. J. Cancer, 2004
23. Johnson KC. Re: more data regarding the effects of passive smoking on breast cancer risk among younger women. Int J Cancer. 2007 Jun 1;120(11):2519–20. PMID 17304510
24. Roddam AW, Pirie K, Pike MC, Chilvers C, Crossley B, Hermon C, McPherson K, Peto J, Vessey M, Beral V. Active and passive smoking and the risk of breast cancer in women aged 36–45 years: a population based case-control study in the UK. Br J Cancer. 2007 Jun 19. PMID 17579618
25. Hassan MM, Abbruzzese JL, Bondy ML, Wolff RA, Vauthey JN, Pisters PW, Evans DB, Khan R, Lenzi R, Jiao L, Li D. Passive smoking and the use of noncigarette tobacco products in association with risk for pancreatic cancer: A case-control study. Cancer. 2007 Jun 15;109(12):2547–56. PMID 17492688
26. Diseases of the Ear, Nose and Throat, , P.D., Bull, Blackwell Science, , ISBN 0-86542-634-1
27. U.S. Surgeon General's Report on Secondhand Smoke (Chapter 8)
28. U.S. Surgeon General's Report on Secondhand Smoke (Chapter 9; pages 555 - 558)
29. U.S. Surgeon General's Report on Secondhand Smoke
30. Fantuzzi G, Aggazzotti G, Righi E, Facchinetti F, Bertucci E, Kanitz S, Barbone F, Sansebastiano G, Battaglia MA, Leoni V, Fabiani L, Triassi M, Sciacca S. Preterm delivery and exposure to active and passive smoking during pregnancy: a case-control study from Italy. Paediatr Perinat Epidemiol. 2007 May;21(3):194–200. PMID 17439527
31. The effect of passive smoking on respiratory health in children and adults., Janson C, , , Int J Tuberc Lung Dis, 2004
32. Parents warned not to smoke at home
33. The U.S. Surgeon General's Report on Secondhand Smoke (Chapter 5; pages 180–194)
34. U.S. Surgeon General's Report on Secondhand Smoke (Chapter 6; pages 311–319)
35. KL Vork ''et al'', Developing Asthma in Childhood from Exposure to Second-hand Tobacco Smoke – Insights from a Meta-Regression, ''Environmental Health Perspectives,'' Published online June 24, doi:2007,0.1289/ehp.10155, Accessed July 3rd, 2007.
36. Spencer N, Coe C. Parent reported longstanding health problems in early childhood: a cohort study. Arch Dis Child. 2003 Jul;88(7):570-3. PMID 12818898
37. de Jongste JC, Shields MD. Cough . 2: Chronic cough in children. Thorax. 2003 Nov;58(11):998–1003. PMID 14586058
38. Dybing E, Sanner T. Passive smoking, sudden infant death syndrome (SIDS) and childhood infections. Hum Exp Toxicol. 1999 Apr;18(4):202-5. PMID 10333302
39. DiFranza JR, Aligne CA, Weitzman M. Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics. 2004 Apr;113(4 Suppl):1007–15. PMID 15060193
40. Chatzimichael ''et al''. The role of breastfeeding and passive smoking on the development of severe bronchiolitis in infants. Minerva Pediatr. 2007 Jun;59(3):199–206. PMID 17519864
41. den Boon S, Verver S, Marais BJ, Enarson DA, Lombard CJ, Bateman ED, Irusen E, Jithoo A, Gie RP, Borgdorff MW, Beyers N. Association between passive smoking and infection with Mycobacterium tuberculosis in children. Pediatrics. 2007 Apr;119(4):734-9. PMID 17403844
42. Mahid SS, Minor KS, Stromberg AJ, Galandiuk S. Active and passive smoking in childhood is related to the development of inflammatory bowel disease. Inflamm Bowel Dis. 2007 Apr;13(4):431-8. PMID 17206676
43. Richards GA, Terblanche AP, Theron AJ, Opperman L, Crowther G, Myer MS, Steenkamp KJ, Smith FC, Dowdeswell R, van der Merwe CA, Stevens K, Anderson R. Health effects of passive smoking in adolescent children. S Afr Med J. 1996 Feb;86(2):143-7. PMID 8619139
44. Glantz, S.A. & Parmley, W., "Passive Smoking and Heart Disease: Epidemiology, Physiology, and Biochemistry", Circulation, 1991; 83(1): 1–12. [1] and Taylor, A., Johnson, D. & Kazemi, H., "Environmental Tobacco Smoke and Cardiovascular Disease", Circulation, 1992; 86: 699–702 [2]
45. U.S. Surgeon General's Report on Secondhand Smoke (Chapter 6; pages 376–380)
46. The effect of passive smoking on asthma symptoms, atopy, and airway hyperresponsiveness in schoolchildren., Jang AS et al, , , J Korean Med Sci., 2004
47. The adult incidence of asthma and respiratory symptoms by passive smoking in uterus or in childhood., Skorge TD, Eagan TM, Eide GE, Gulsvik A, Bakke PS., , , Am J Respir Crit Care Med., 2005
48. Effects of passive smoking and breastfeeding on childhood bronchial asthma., Wafula EM, Limbe MS, Onyango FE, Nduati R., , , East Afr Med J, 1999
49. Epidemiology of passive smoke: a prospective study in 589 children., Cantani A, Micera M., , , Eur Rev Med Pharmacol Sci., 2005
50. Directly measured second hand smoke exposure and asthma health outcomes., Eisner MD, Klein J, Hammond SK, ''et al.'', , , Thorax, 2005
51. Review of epidemiological evidence by the Journal of the American Association
52. The Helena Study ''(Abstract)''
53. Whincup PH, Gilg JA, Emberson JR, Jarvis MJ, Feyerabend C, Bryant A, Walker M, Cook DG. Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement. BMJ. 2004 Jul 24;329(7459):200-5. PMID 15229131
54. Fact sheet published by the Victorian government (Australia)
55. Monographs Programme report on SHS
56. International Agency for Research on Cancer (IARC) - Summaries & Evaluations
57. Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement., Whincup PH et al., , , BMJ, 2004
58. Health effects of indoor air pollution
59. Passive smoking, Wirth et al., , , Rev Pneumol Clin., 2005
60. France to ban smoking in public
61. International Agency for Research on Cancer (IARC) - Involuntary Smoking
62. Secondhand Smoke Causes Cancer in Pets, by Andrea Thompson. Posted at LiveScience on August 31 2007; accessed August 31 2007.
63. p53 expression and environmental tobacco smoke exposure in feline oral squamous cell carcinoma., Snyder LA, Bertone ER, Jakowski RM, Dooner MS, Jennings-Ritchie J, Moore AS., , , Vet Pathol, 2004
64. Passive smoking and canine lung cancer risk., Reif JS, Dunn K, Ogilvie GK, Harris CK., , , Am J Epidemiol., 1992
65. Tobacco industry efforts at discrediting scientific knowledge of environmental tobacco smoke: a review of internal industry documents, Drope J, Chapman S, , , Journal of epidemiology and community health, 2001
66. Smoking and health research activities in Europe, from the Philip Morris document archive. Accessed August 10 2007.
67. International Agency for Research on Cancer (IARC) - Involuntary Smoking
68. Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe
69. Study: Secondhand Smoke Effects Pervasive
70. Disparity in Protecting Food Service Staff from Secondhand Smoke Shows Need for Comprehensive Smoke-Free Policies, Say Groups
71. WHO International Agency for Research on Cancer "Tobacco Smoke and Involuntary Smoking" IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83, 2002; the overall evaluation of the Monograph is: "Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans (Group 1)."
72. Philip Morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke., Schick S, Glantz S., , , Tob Control., 2005
73. Particulate matter from tobacco versus diesel car exhaust: an educational perspective., Invernizzi G, Ruprecht A, ''et al.'', , , 15333875, 2004
74. United States of America v. Philip Morris et al., Final Opinion of Judge Gladys Kessler, United States District Court for the District of Columbia. Accessed July 29 2007.
75. ETS / IAQ SCIENTIFIC CONSULTANTS, from the Legacy Tobacco Documents Archive. Accessed July 19 2007.
76. www.cato.org/pubs/regulation/regv30n1/v30n1-5.pdf
77. Turning science into junk: the tobacco industry and passive smoking, Samet JM, Burke TA, , , American journal of public health, 2001
78. Constructing "Sound Science" and "Good Epidemiology": Tobacco, Lawyers, and Public Relations Firms, Ong EK, Glantz SA, , , American Journal of Public Health, 2001
79. Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe, Boffetta P, Agudo A, Ahrens W, ''et al'', , , J. Natl. Cancer Inst., 1998
80. Passive Smoking Doesn't Cause Cancer —Official
81. Smokescreens - The World Health Organization is showing signs of allowing politics to get in the way of truth. The Economist March 14th, 1998
82. Le Grand C. Anti-smokers blown away by study. Australian 1998, March 10.
83. WHO Rejects smoking link with lung cancer. Zimbabwe Independent 1998, Oct 23.
84. No Link Between Passive Smoking and Lung Cancer. The Times 1998, March 9.
85. Passive Smoking Does Cause Lung Cancer, Do Not Let Them Fool You
86. Passive Smoking and Lung Cancer Risk: What is the Story Now?
87. Tobacco industry efforts subverting IARC’s second hand smoke study
88. Tobacco Companies Strategies to Undermine Tobacco Control Activities at the World Health Organization
89. Constructing "Sound Science" and "Good Epidemiology": Tobacco, Lawyers, and Public Relations Firms, Ong EK, Glantz SA, , , American Journal of Public Health, 2001
90. The Osteen Decision
91. Flue-Cured Tobacco Cooperative vs. EPA
92. Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98
93. Passive Smoking: Comment From the Editor
94. Environmental tobacco smoke and coronary heart disease mortality in the United States-a meta-analysis and critique, published in Inhalation Technology
95. Tobacco industry publishes disinformation
96. Passive smoking: study was flawed from outset, Vaidya JS, , , BMJ, 2003
97. Passive smoking: wider evidence needs to be interpreted, Critchley J, , , BMJ, 2003
98. Passive smoking: tobacco industry publishes disinformation., Thun MJ, , , BMJ, 2003
99. Tobacco industry publishes disinformation
100. Why Review Articles on the Health Effects of Passive Smoking Reach Different Conclusions
101. As quoted in the ''Washington Post'': U.S. Details Dangers of Secondhand Smoking, by Marc Kaufman. Published June 28 2006; accessed July 25 2007.
102. Passive Smoking: Out from the Haze, by Kris Novak. ''Nature'' 2007 Jun 28;447(7148):1049-51. PMID 17597735.
103. Passive smoking danger was underestimated, by Gaia Vince ''New Scientist'' 2004 June 30
104. A STUDY OF PUBLIC ATTITUDES TOWARD CIGARETTE SMOKING AND THE TOBACCO INDUSTRY IN 1978, produced for the Tobacco Institute and released under the terms of the Tobacco Master Settlement Agreement.
105. Why review articles on the health effects of passive smoking reach different conclusions, Barnes DE, Bero LA, , , JAMA, 1998
106. "Conclusions about exposure to ETS and health that will be unhelpful to us": how the tobacco industry attempted to delay and discredit the 1997 Australian National Health and Medical Research Council report on passive smoking., Trotter L, Chapman S, , , Tob Control, 2003
107. "Constructing "Sound Science" and "Good Epidemiology": Tobacco, Lawyers, and Public Relations Firmsg., Ong, E. & Glantz, S., , , American Journal of Public Health, 2001
108. Environmental tobacco smoke research published in the journal Indoor and Built Environment and associations with the tobacco industry, Garne D, Watson M, Chapman S, Byrne F, , , Lancet, 2005
109. Executive Summary of the U.S. Surgeon General's Report, 2006.
110. Reduction in the Incidence of Acute Myocardial Infarction Associated with a Citywide Smoking Ordinance
External links
Scientific bodies
★
Health Effects of Exposure to Environmental Tobacco Smoke, from the U.S.
National Cancer Institute
★ . From the 11th Report on Carcinogens of the U.S.
National Institutes of Health
★
The Health Consequences of Involuntary Exposure to Tobacco Smoke, from the
United States Surgeon General
★
Tobacco Smoke and Involuntary Smoking, a monograph of the
World Health Organization and
International Agency for Research on Cancer
★
Secondhand Smoke Fact Sheet from the U.S.
Centers for Disease Control and Prevention
Tobacco industry-related
★ : Report of the Committee of Experts on Tobacco Industry Documents from the
World Health Organization
★
The Legacy Tobacco Documents Library from the
University of California, San Francisco
★
Philip Morris USA Document Archive, made public as a result of the
Tobacco Master Settlement Agreement
Other links
★
How dangerous is passive smoking? Article from
BUPA, a healthcare organisation.
★
Website of tobacco.org; news and analysis supporting tobacco control
العربية
中国
Français
Deutsch
Ελληνική
हिन्दी
Italiano
日本語
Português
Русский
Español
