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What is secondhand smoke?
Secondhand smoke is also known as environmental tobacco smoke
(ETS) or passive smoke.
It is a mixture of 2 forms of smoke that come from burning tobacco: sidestream smoke
(smoke that comes from the end of a lighted cigarette, pipe, or cigar)
and mainstream smoke
(smoke that is exhaled by a smoker).
When non-smokers are exposed to secondhand smoke it is called involuntary smoking
or passive smoking.
Non-smokers who breathe in secondhand smoke take in nicotine and other
toxic chemicals just like smokers do. The more secondhand smoke you are
exposed to, 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 U.S. Environmental Protection Agency
(EPA), the U.S. National Toxicology Program, and the International
Agency for Research on Cancer (IARC), a branch of the World Health
Organization.
Tobacco smoke contains over 4,000 chemical compounds. More
than 60 of these are known or suspected to cause cancer.
Secondhand smoke causes other kinds of
diseases and deaths
Secondhand smoke can cause harm in many ways. In the United
States alone, each year it is responsible for:
- an estimated 46,000 deaths from heart disease in
non-smokers who live with smokers
- about 3,400 lung cancer deaths in non-smoking adults
- other breathing problems in non-smokers, including
coughing, mucus, chest discomfort, and reduced lung function
- 150,000 to 300,000 lung infections (such as pneumonia and
bronchitis) in children younger than 18 months of age, which result in
7,500 to 15,000 hospitalizations annually
- increases in the number and severity of asthma attacks in
about 200,000 to 1 million children who have asthma
- more than 750,000 middle ear infections in children
Pregnant women exposed to secondhand smoke are also at
increased risk of having low birth- weight babies.
Secondhand smoke may be linked to breast
cancer
An issue that is still being studied is whether secondhand
smoke increases the risk of breast cancer. Both mainstream and
secondhand smoke contain 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.
But a link between secondhand smoke and breast cancer risk in
human studies is still being debated. This is partly because breast
cancer risk has not been shown to be increased in active smokers. One
possible explanation for this is that tobacco smoke may have different
effects on breast cancer risk in smokers and in those who are exposed
to secondhand smoke.
A report from the California Environmental Protection Agency
in 2005 concluded that the evidence regarding secondhand smoke and
breast cancer is "consistent with a causal association" in younger
women. This means that the secondhand smoke acts as if it could be a
cause of breast cancer in these women. The 2006 U.S. Surgeon General's
report, The Health
Consequences of Involuntary Exposure to Tobacco Smoke,
found that there is "suggestive but not sufficient" evidence of a link
at this point. In any case, women should be told that this possible
link to breast cancer is yet another reason to avoid being around
secondhand smoke.
Secondhand smoke kills children and adults
who don't smoke, and makes others sick (Surgeon General's report)
The 2006 U.S. Surgeon General's report reached some important
conclusions:
- Secondhand smoke causes premature death and disease in
children and in adults who do not smoke.
- Children exposed to secondhand smoke are at an increased
risk of sudden infant death syndrome (SIDS), acute respiratory
infections, ear problems, and more severe asthma. Smoking by parents
causes breathing (respiratory) symptoms and slows lung growth in their
children.
- Secondhand smoke immediately affects the heart and blood
circulation in a harmful way. Over a longer time it also causes heart
disease and lung cancer.
- The scientific evidence shows that there is no safe level
of exposure to secondhand smoke.
- Many millions of Americans, both children and adults, are
still exposed to secondhand smoke in their homes and workplaces despite
a great deal of progress in tobacco control.
- The only way to fully protect non-smokers from exposure to
secondhand smoke 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
secondhand smoke.
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 secondhand smoke exposure
for adults. Secondhand smoke meets the standard to be classified as a
potential cancer-causing agent by the Occupational Safety and Health
Administration (OSHA), the federal agency responsible for health and
safety regulations in the workplace. The National Institute for
Occupational Safety and Health (NIOSH), another federal agency, also
recommends that secondhand smoke be considered a possible carcinogen in
the workplace. Because there are no known safe levels, they recommend
that exposures to secondhand smoke be reduced to the lowest possible
levels.
Secondhand smoke in the workplace has been linked to an
increased risk for heart disease and lung cancer among adult
non-smokers. The Surgeon General has said that smoke-free workplace
policies are the only way to do away with secondhand smoke 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
quit.
In public places
Everyone can be exposed to secondhand smoke in public places,
such as restaurants, shopping centers, public transportation, schools,
and daycare centers. Some businesses seem to be afraid to ban smoking,
but there is no proof that going smoke-free is bad for business. Public
places where children go are a special area of concern.
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 secondhand smoke.
Children are especially sensitive to secondhand smoke. Asthma,
lung infections, and ear infections are more common in children who are
around smokers. Some of these problems can be serious and even
life-threatening. Others may seem like small problems, but they add up
quickly: think of the expenses, doctor visits, medicines, lost school
time, and often lost work time for the parent who must take the child
to the doctor. In the United States, 21 million, or 35% of children
live in homes where residents or visitors smoke in the home on a
regular basis. About 50% to 75% of children in the U.S. have detectable
levels of cotinine, the breakdown product of nicotine, in their blood.
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.
In the car
Americans spend a great deal of time in cars, and if someone
smokes there, hazardous levels of smoke can build up quickly. Again,
this can be especially harmful to children. In response to this fact,
the U.S. Environmental Protection Agency has a special program to
encourage people to make their cars, as well as their homes,
smoke-free. And some states have laws that ban smoking in the car if
carrying passengers under the age of 17.
What about smoking odors?
There is no research in the medical literature about the
cancer-causing effects of cigarette odors. Research does show that
secondhand tobacco smoke can get into hair, clothing, and other
surfaces. Some researchers call this "thirdhand" smoke. This refers to
the toxic particles that are left in the air after you can no longer
see the smoke. Over time, they settle on surfaces and can be measured
long after the person is done smoking. Though unknown, the
cancer-causing effects would likely be very small compared with direct
exposure to secondhand smoke, such as living in a house with a smoker.
But this is an active area of tobacco research.
What can be done about secondhand smoke?
Local, state, and federal authorities can enact public
policies to protect people from secondhand smoke and protect children
from tobacco-caused diseases and addiction. Because there are no safe
levels of secondhand smoke, it is important that any such policies be
as strong as possible, and that they do not prevent action at other
levels of government.
Many U.S. 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 in recent years.
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 http://slati.lungusa.org.
To learn how you can become involved in helping to promote
laws to reduce exposure to secondhand smoke, you can visit the American
Cancer Society Cancer Action Network on the Web at www.acscan.org and
see what's happening across the country. The Web site can also take you
to your state's page so you can find out what is going on there. Or you
can call ACS CAN at 1-888-NOW I CAN (1-888-669-4226).
Additional resources
More information from your American Cancer
Society
We have selected some related information that may also be
helpful for you. These materials may be viewed on our Web site or
ordered from our toll-free number.
Other organizations*
Along with the American Cancer Society, other sources of
information and support include:
American Heart
Association & American Stroke Association
American Heart Association
Toll-free number: 1-800-242-8721 (1-800-AHA-USA-1)
Web site: www.americanheart.org
American Stroke Association
Toll-free number: 1-888-478-7653 (1-888-4-STROKE)
Web site: www.strokeassocation.org
Quitting tips and advice can be found at everydaychoices.org or by
calling 1-866-399-6789
American Lung
Association
Telephone: 1-800-586-4872
Web site: www.lungusa.org
Printed quit materials are available, some in Spanish. Also offers the
tobacco cessation program "Freedom from Smoking Online" at www.ffsonline.org
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
Free quit support line: 1-800-784-8669 (1-800-QUIT-NOW)
TTY: 1-800-332-8615
Environmental
Protection Agency (EPA)
Telephone: 202-272-0167
Web site: www.epa.gov
Has advice on how to protect children from secondhand smoke, a
Smoke-free Homes Pledge, and other tobacco-related materials on the
direct Web site, www.epa.gov/smokefree
National Cancer
Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
Web site: www.cancer.gov
Toll-free tobacco line: 1-877-448-7848
Tobacco quit line: 1-800-784-8669 (1-800-QUITNOW)
Direct tobacco Web site: www.smokefree.gov
Quitting information, cessation guide, and counseling is offered, as
well as information on state telephone-based quit programs
*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 1-800-227-2345 or
visit www.cancer.org.
References
American Cancer Society. Cancer
Facts & Figures 2009. Atlanta, Ga. 2009.
American Lung Association. Secondhand Smoke Fact Sheet.
Accessed at: www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35422 on
September 22, 2009.
Betts KS. Secondhand Suspicions: Breast Cancer and Passive
Smoking. Environ Health
Perspect. 2007;115:A136–A143.
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
September 22, 2009.
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-tobacco-smoke-in-the-workplace-lung-cancer.html
on September 22, 2009.
Environmental Protection Agency. Respiratory Health Effects of
Passive Smoking: Lung Cancer and Other Disorders.
Washington, DC: Environmental Protection Agency; 1992. (Report #
EPA/600/6-90/006F) Accessed at:
http://cfpub2.epa.gov/ncea/cfm/recordisplay.cfm?deid=2835 on September
21, 2009.
Mennella JA, Yourshaw LM, Morgan LK. Breastfeeding and
smoking: short-term effects on infant feeding and sleep. Pediatrics.
2007;120:497–502.
Pirkle JL, Flegal KM, Bernert JT, et al. Exposure of the US
population to environmental tobacco smoke: The Third National Health
and Nutrition Examination Survey, 1988 to 1991. JAMA.
1996;275:1233–1240.
Schuster MA, Franke T, Pham CB. Smoking patterns of household
members and visitors in homes with children in the United States. Arch Pediatr Adolesc Med.
2002;156:1094–1100.
U.S. Department of Health and Human Services. 11th Report on Carcinogens.
Public Health Service -- National Toxicology Program. 2005. Accessed
at:
http://ntp.niehs.nih.gov/ntpweb/index.cfm?objectid=035E5806-F735-FE81-FF769DFE5509AF0A
on September 21, 2009.
U.S. Department of Health and Human Services. The Health Consequences of
Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.
Washington, DC: Department of Health and Human Services; 2006. Accessed
at: www.surgeongeneral.gov/library/secondhandsmoke/ on September 21,
2009.
Winickoff JP, Friebely J, Tanski SE, et al. Beliefs about the
health effects of "thirdhand" smoke and home smoking bans. Pediatrics.
2009;123(1):e74–79.
Last Medical Review: 10/01/2009
Last Revised: 10/01/2009
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