Passive smoking - who is at risk of passive smoking and secondhand smoke.

passive smoking
Considering the number of years people have been smoking, whether it's cigarettes, pipes or cigars, it is only recently that we have discovered the extent of the damage that smoking can cause to our health.

Smoking, especially heavy smoking can be the cause of a number of serious diseases, many of which we are aware of, such as lung cancer and heart disease and others of which we have been less informed about, for example atherosclerosis or osteoporosis.

Likewise, we have been even more in the dark about the effects that other people's smoking has on our health, or passive smoking, as it is otherwise known.
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It is only in the last twenty years or so that conclusive evidence proving that the inhalation of other people's smoke may also be a major health hazard has come to light and can no longer be ignored.

Research carried out in the US during the early 1990's estimated that exposure to tobacco smoke or passive smoking was the third leading preventable cause of death. Only active smoking and alcohol abuse preceded it.

In the US, it has been estimated by the EPA (Enviromental Protection Agency) that 3,000 non-smokers die each year from lung cancer, as a result of breathing in other people's tobacco smoke. 800 of those deaths are caused from exposure to secondhand smoke in the home, whilst a staggering 2,200 from exposure in the workplace or in public places.

Non-smokers who are exposed to breathing in tobacco smoke at home have a 25% higher risk of developing lung cancer or heart disease. If this is added to exposure in the workplace and public places, the risk goes up to as high as 60%.

Many children are affected by passive smoking in the home. In the UK almost half of all children are exposed to secondhand smoke indoors, as either one or both parents smoke in front of them. Doctors say that more than 17,000 children a year, who are under the age of 5 years old, are admitted into hospital due to the harmful effects of passive smoking. If parents did not smoke at home, these illnesses and admissions into hospital could have been avoided.

Due to these recent warnings about passive smoking, a number of Governments are implementing or proposing to implement a complete ban on smoking in all indoor public places and in all workplaces, in order to protect the health of non smokers and smokers and to promote and smoke-free and healthy environment for all.

What is passive smoking?

Passive smoking is also known as secondhand or involuntary smoking. It is basically the breathing in and exposure to other people's cigarette smoke, which is also known as secondhand smoke or Environmental tobacco smoke.

Environmental tobacco smoke is one of the biggest sources of indoor air pollution. As well as making your home or your workplace smell bad, it also, more importantly can lead to lung cancer and heart disease in smokers and in non-smokers.

Scientists have ranked indoor air pollution as one of the top five major environmental health risks that affect us today. This statistic is quite worrying as most people spend as much as 90% of their time indoors.

Babies and children are especially at risk and their health, as a child and even as an adult in years to come, is jeopardised if they are exposed to passive smoking at home.

Environmental tobacco smoke (ETS) is a product of two of the three types of tobacco smoke produced when a person smokes a cigarette.

The first type of smoke that makes up ETS is exhaled mainstream smoke. Exhaled mainstream smoke is the smoke that is first of all inhaled by the smoker upon taking a puff of a cigarette and then breathed out into the air from his lungs.

The second type of smoke that makes up ETS is called sidestream smoke. Sidestream smoke is the smoke that drifts upwards and into the air from the tip of a burning cigarette.

Finally, the third type of smoke that is produced on smoking a cigarette, but which does not make up ETS is mainstream smoke. This is the smoke that is inhaled by the smoker himself, through the cigarette and which stays inside the body.

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Mainstream smoke and exhaled mainstream smoke are not the same, as they differ chemically. After inhaling cigarette smoke into the lungs, some of the smoke stays in the body, along with some of the chemical substances, whilst the rest is exhaled together with the remaining chemical substances. The exhaled smoke undergoes several chemical changes upon coming into contact with enzymes from the tissues of the human body before being released into the air. Mainstream smoke is the smoke that stays inside the smoker's body and is not breathed out into the air.

Although the health risks that a passive smoker may occur are considerably less than those of an active smoker, secondhand smoke still contains many of the chemicals and carcinogenic compounds that are also breathed in by the active smoker. Nevertheless the active smoker chooses to smoke himself, whilst the passive smoker is forced to do so against his will.

What does tobacco smoke consist of?

The combustion of tobacco produces a type of smoke that contains more than 4000 substances and chemicals, which are made up of particles and gases that can be inhaled and absorbed into the body.

Many of these chemicals are extremely dangerous, not only for the smoker but also for those people nearby.

The International Cancer Investigation Agency has identified over 50 carcinogenic substances in tobacco smoke. 11 of the substances are proven to cause cancer in humans, 7 probably cause cancer in humans and 49 of the substances cause cancer in animals but have not yet been proven to in humans.

Other substances found in environmental tobacco smoke are certainly poisonous and most definitely none are beneficial to a person's health.

The U.S. Environmental Protection Agency (EPA) has classified environmental tobacco smoke as a Group A carcinogen. This means that there is more than enough evidence to prove that tobacco smoke, whether it is inhaled by the smoker or the non-smoker, can cause cancer in humans.

Mainstream and sidestream smoke both contain a huge number of toxic, poisonous and carcinogenic substances.

Surprisingly, sidestream smoke (smoke that escapes the end of a burning cigarette) contains much higher concentrations of many of the chemical compounds.

What's more is that the particles that make up sidestream smoke are much smaller than those of mainstream smoke. This means that these smaller particles that float in the air, will be inhaled much deeper into the lungs and will be able to reach the furthest and deepest corners within a person's respiratory system and therefore causing much more damage.

For example, cadmium, a known lung cancer causing substance, is found in concentrations that are six times higher in the smoke that is inhaled by passive smokers as opposed to the smoke that is inhaled directly by the smoker through the cigarette.

Even so, although 85% of the smoke that is present in a smoke-filled room is made up of sidestream smoke, passive smokers still have a lesser risk of suffering the effects of the harmful substances contained in tobacco smoke.

Three of the main components of environmental tobacco smoke are:
  • Nicotine - an addictive drug as powerful as cocaine or heroin. It alters the brain as well as a person's behaviour and mood. It is also used in insecticides.
  • Tar - a cancer causing substance that damages the lungs.
  • Carbon monoxide - a gas that replaces some of the oxygen in the body that is needed for the lungs to function properly. Carbon monoxide is a poisonous gas, which is also found in car exhaust fumes.
Some of the carcinogenic substances found in tobacco smoke are:
  • Tar - used to tarmac roads.
  • Arsenic - very potent deadly poison.
  • Cadmium and nickel - used in batteries.
  • Vinyl chloride - used to make vinyl products. Short-term exposure causes dizziness, headaches and tiredness. Long-term exposure can lead to cancer and liver damage.
  • Creosote - a component of tar. If inhaled it can cause irritation of the respiratory tract.
  • Formaldehyde - a preservative substance used in forensic labs. It causes cancer in humans and in animals.
  • Polonium 210 - a radioactive substance that requires special handling techniques when studied in labs. It can cause cancer of the liver and bladder, stomach ulcers, leukaemia amongst other diseases.
Other irritant toxins that are found in cigarette smoke are:
  • Ammonia - a pungent colourless gas used in many cleaning products such as window or glass cleaner.
  • Acetone - the main component of nail varnish remover.
  • Acrolein - an extremely toxic substance used to manufacture acrylic acid. It is considered a possible human carcinogen and it irritates the lungs and is the cause of emphysema.
  • Hydrogen cyanide - deadly toxic poison used to kill rats. If breathed in in small doses, it can cause headaches, dizziness and weakness.
  • Carbon monoxide - a deadly gas if inhaled in enclosed spaces. Faulty and leaking gas heaters, boilers, stoves and tobacco smoke all produce this gas.
  • Toluene - used to manufacture paint, paint thinners, nail varnish and adhesives. Low - moderate levels can provoke tiredness, weakness, loss of appetite and memory loss.
Although it is smokers who are mainly at risk from suffering the side effects of smoking, in reality, anyone who is regularly exposed to tobacco smoke is at risk of developing any smoking related disease.

For non-smokers who choose not to smoke, whatever their reason, it is unfair that they are not protected from secondhand smoke and the threat of developing a potentially life threatening illness from somebody else's habit.

Many adults die as a direct result of smoking each year and in fact smoking is the biggest cause of preventable death in the worlds.

Although relatively few people die from passive smoking, even still, hundreds and possibly thousands of people a year die unnecessarily from inhaling the tobacco smoke of those people around them.

No one in the world would willingly inhale or ingest such a concoction of harmful gases, chemicals and substances into their body. However, on smoking a cigarette or from inhaling the smoke from someone else's cigarette, that's exactly what you are doing.

What are the risks of breathing in secondhand smoke?

Obviously, with the amount of chemicals, toxins and harmful substances that are contained in tobacco smoke, there are going to be adverse effects on your health if you breathe it in, whether you are a smoker or not.

With passive smoking, non-smokers are forced to breathe in secondhand smoke, which is made up of the smoke that escapes the end of the burning cigarette and the smoke that is exhaled out of the smoker's lungs.

Both of these types of smoke contain just as many toxins, chemicals and carcinogenic substances as the smoke from the cigarette that the smoker inhales. This means that anyone breathing in secondhand smoke is exposed to the harmful effects of these substances, as is the smoker himself (see section on what does tobacco smoke consist of).

In fact, when a person smokes a cigarette, they only inhale 15% of the tobacco smoke themselves, as the rest escapes into the air for anyone around to breathe in. Studies show that if a non-smoker spends over two hours in a smoky room, during that time, they will have inhaled the equivalent of 4 cigarettes.

Some of the chemicals that are found in secondhand smoke, which include a number of carcinogens, are benzene, benzopyrene, formaldehyde, ammonia and hydrogen cyanide. It has also been found that secondhand smoke contains twice as much nicotine and tar and five times the amount of carbon monoxide than the mainstream smoke that is inhaled by the smoker. This means that passive smokers could be more at risk than smokers if exposed for long periods of time.

Sidestream smoke, which is the smoke that drifts from the top of the burning cigarette, may often contain higher levels of some of these chemicals, due to the fact that this smoke is produced at a cooler temperature and therefore the tobacco does not combust fully.

When a person smokes a cigarette, the hot smoke in the room rises, as hot air does. However, tobacco smoke tends to cool rapidly, which immediately stops its ascent upwards. The smoke is denser than air, which therefore causes it to descend to a level where smokers and non-smokers can do nothing but breathe in this smoky cloud.

If you breathe in tobacco smoke, you are damaging your body and your health. For every 8 smokers that die from a smoke-related illness, 1 non-smoker also dies with them.

For those who are not exposed every day to hours of breathing in other's smoke, the risk to your health is somewhat less, although if you suffer from asthma, inhaling secondhand smoke that has wafted over from a smokers table in a restaurant, for example, could trigger an attack.

Incidentally, and more worryingly, 10 -20 minutes exposure to secondhand smoke can increase the heart rate, constrict blood vessels and increase blood pressure. It can also restrict the flow of oxygen to the heart. All of these symptoms are associated with heart disease or a stroke.

Pregnant women should definitely not smoke themselves but even breathing in other people's tobacco smoke can have severe repercussions on her unborn baby, its health and its weight. (see section on smoking and pregnancy)

Non-smokers who are married to a smoker or who work in an environment where smoking is permitted suffer up to 60% higher risks of developing cancer or heart disease. Likewise children who are subjected to passive smoking in the home will more than likely suffer breathing difficulties, coughs, ear infections, or pneumonia, amongst other illnesses, and therefore have to take more time off school. Passive smoking has also been linked to poor results at school and severe behaviour disorders (see section on smoking and pregnancy).

Passive smoking in the short term can irritate the eyes, nose and throat and result in a headache, cough, chest pain, dizziness or feelings of sickness.

For people with asthma, the effects of passive smoking are more severe, as their lung function can be negatively affected and they may occur serious respiratory problems and wheezing. Asthmatic children will obviously be more at risk from exposure to passive smoking as their lungs are still developing. The EPA has estimated that between 200,000 and 1,000,000 children have seen their condition deteriorate due to the exposure to tobacco smoke. For more information see section on passive smoking and children.

In the long-term, adult passive smokers are at risk of the following:
  • 20% - 30% increased risk of developing lung cancer. Environmental tobacco smoke has been classified as a Class A carcinogen and may also cause cancer of the bladder, cervix, throat and breast cancer.
  • 25% increased risk of heart disease. Conclusive evidence exists and proves that non-smokers who live with smokers have higher risks of coronary heart disease than those who live in a smoke-free home. A report from the US Surgeon General in 1999 stated that secondhand smoke has been linked to up to 62,000 deaths from ischemic heart disease per year.
  • A significantly higher risk of frequently suffering chronic respiratory disorders, as the tobacco smoke may irritate the tissues of the respiratory tract. In 1979 the US Surgeon General reported that as a result of breathing in secondhand smoke adults and children were found to experience several adverse respiratory symptoms.
  • Narrowing of the carotid arteries, which are responsible for carrying blood to the brain.
  • Suffering from blood clots, due to the fact that tobacco smoke makes the blood denser and more likely to clot.
  • HDL cholesterol, which is the good cholesterol that protects the blood, is reduced.
  • The development of atherosclerosis or hardening and narrowing of the arteries. This process can start after 30 minutes exposure to environmental tobacco smoke.
  • Suffering a stroke.
  • Developing nose and sinus cancer.
  • An increased risk of cardiovascular disease, as blood vessels are damaged thus preventing any form of exercise to take place and cholesterol levels to rise.

Passive smoking and children

Unfortunately it is not just adults who are at risk to the adverse effects of passive smoking. Children and newborn babies are particularly at risk too.

Young children and toddlers are especially sensitive to the effects of secondhand smoke, due to the fact that their bodies are still growing and developing and they breathe faster then adults and therefore may inhale more smoke.

Research has shown that children, who grow up in a smoky household, where one or both parents smoke, have twice the amount of respiratory and lung disorders, and in some cases they even have to be hospitalised.

In fact, when a person smokes a cigarette, they only inhale 15% of the tobacco smoke themselves, as the rest escapes into the air for anyone around to breathe in. Studies show that if a non-smoker spends over two hours in a smoky room, during that time, they will have inhaled the equivalent of 4 cigarettes.

Some of the chemicals that are found in secondhand smoke, which include a number of carcinogens, are benzene, benzopyrene, formaldehyde, ammonia and hydrogen cyanide.

It has also been found that secondhand smoke contains twice as much nicotine and tar and five times the amount of carbon monoxide than the mainstream smoke that is inhaled by the smoker. This means that passive smokers could be more at risk than smokers if exposed for long periods of time.

These children are usually absent from school more often than children who grow up in a smoke-free home and some studies have even suggested that children who are exposed to passive smoking are more likely to have behavioural problems and that they may not develop mentally as quickly as other children.

More recent studies have shown that exposure to passive smoking affects a child's behaviour and their learning abilities. Children from smoking homes scored lower in maths, reading, logic and reasoning tests and showed a more difficult and conflictive attitude towards their teachers and peers.

Asthma is a severe breathing disorder that is caused by the lungs not working to their full potential. When a person suffers an asthma attack they can experience shortness of breath, coughing, pressure or tightness in their chest, or wheezing and in children these symptoms can be much worse. Children with asthma also suffer more frequent attacks if they are exposed to tobacco smoke in the home.

Children with asthma who live in homes where one parent smokes are twice as likely, than children with asthma whose parents do not smoke, to take time off school due to a respiratory illness. If both the parents smoke, then the asthmatic children are four times as likely to be absent from school.

Studies show that even if a child does not suffer from asthma, but both their parents smoke, they will have a 40% higher chance of being absent from school due to a breathing illness.

Even breathing in very small amounts of tobacco smoke could set off a severe attack in children with asthma and these attacks would be worse than those suffered by children with asthma who are not exposed to tobacco smoke. Studies have shown that exposure to secondhand smoke can lead to the development of asthma in children who were not born with it.

Children who are exposed to secondhand smoke at home:
  • are twice as likely to suffer from bronchitis, pneumonia or bronchiolitis. In the US, secondhand smoke has been linked to up to 300,000 cases of bronchitis and pneumonia in small children each year.
  • will have less developed lungs that have a reduced ability to function well.
  • will suffer severe asthma attacks if they are already asthmatic and more of them.
  • have a higher risk of developing asthma if they were not born with it.
  • are more likely to be hospitalised before they reach their 2nd birthday.
  • will suffer from more colds, coughs and sore throats.
  • are more likely to suffer ear infections, fluid in the ears, chronic middle ear disease or "glue ear", which could lead to some loss of hearing. Many children will need to have the fluid from their ears surgically drained as a result of passive smoking.
  • could suffer from possible cardiovascular disorders.
  • will have a higher risk of developing cancer as an adult.
  • will suffer from some loss of smell.
  • are more likely to have been born with a low birth weight. Low birth weight babies are less healthy in general and can experience negative health problems all the way through to adulthood. Low birth weight as a baby has been linked to suffering a stroke as an adult, high blood pressure, coronary heart disease and diabetes.
  • are more likely to die of cot death. If a mother smokes, the risk of the baby suffering a cot death is twice as high.
  • are at risk of developing meningitis.
  • will be absent from school more often due to various illnesses caused from breathing in the tobacco smoke.
  • will take longer to recover from the above illnesses.

How to protect yourself and your children from secondhand smoke.

If you are a smoker and unable to give up smoking at the moment and you have children or a non-smoking partner, the following steps will protect them from the harmful effects of passive smoking in your home:
  • Smoke outside at all times. Even if you limit smoking to one room, the smoke will spread tot eh rest of the house and the poisonous tiny particles and gases can easily be inhaled.
  • Ask your visitors to smoke outside.
  • Do not smoke in the car during a journey - either smoke beforehand or after and if embarking on a long car journey, smoke when you stop the car for a break. Even if you wind the windows down in the car, the wind may cause the harmful tobacco smoke to be blown back into the car into the faces of those occupying the back seat.
  • Educate everyone, especially spouses and children on the dangers of breathing in secondhand smoke.
When you are out and about:
  • Use the non-smoking areas in bars and restaurants or frequent places where there is a total ban on smoking.
  • Sit away from smoking areas in airports, train stations etc.
  • Try to spend as much time as possible outdoors, if the weather permits.
  • Take children to places where smoking is not allowed and where parents won't be tempted to smoke.

Secondhand smoke at work

Exposure to environmental tobacco smoke at work also poses a risk to our health. People who are at particular risk are those working in bars, restaurants, clubs and pubs where staff are subjected to breathing in up to hundreds of other people's cigarettes over a period of about 8 hours a day or possibly more.

It has been estimated that in the UK 1 employee a week that works in the hospitality trade dies prematurely from passive smoking and that overall 617 people die prematurely each year from exposure to passive smoking in the workplace.

At the moment over 50% of non-smoking employees in the UK are still exposed to tobacco smoke in the workplace.

Depending on where you work, the health risks could actually be higher than at home. A number of factors determine how high the actual risk is. These factors include how large the working area is, how many people are smoking in it, how many hours you spend exposed to environmental tobacco smoke and how much ventilation there is.

Studies have shown that workers in particularly smoky atmospheres, could see their risk of developing lung cancer double or even triple, depending on the amount of exposure.

A study carried out in Australia showed that non-smoking bar workers, who worked in a bar where smoking was permitted, had four times the amount of carbon monoxide in their body after only four hours of work, than non-smoking employees who worked in smoke-free bars.

Several states in the US have already applied a no-smoking ban in all public places and workplaces and in particular California implemented this ban on January 1st 1998. Before the ban came into force, 53 bar workers were interviewed about their health and then several months after January 1st 1998, they were interviewed again. 78% of the bar workers said that their symptoms of eye, nose and throat irritation had completely disappeared, whilst 58% of them had no complaints at all about their health after the ban had been implemented. Even the bar staff who did actually smoke themselves said that they felt healthier as they no longer had to breathe in other people's smoke for a number of hours whilst they were working.

It is really in the employers favour financially if smoking is not permitted in the workplace. It has been calculated that each employee that smokes, costs his employer between $2000 and $6000 a year in extra fire insurance, cleaning costs, health insurance and absenteeism.

Many Governments and Environmental Agencies recommend that smoking should be banned in all workplaces and that it is the responsibility of each employer to ensure the health and safety of each of his employees.

As smoking is a health risk, the needs of non-smoking employees should come first.

Some workers are already at risk by being exposed to cancer causing substances at work. Secondhand smoke should be restricted to certain separate ventilated areas or even better to an outside location, so as not to increase further major health risks.

Public opinion polls carried out recently have shown that there is overwhelming support for the implementation of a no smoking ban in the workplace, with 80% of people in favour of a completely smoke-free environment at work.

This public demand and support is probably due to an increased awareness of the health risks of passive smoking, although many people are still not fully aware of the total impact that passive smoking has on one's health.

Secondhand smoke in public places

People's awareness of passive smoking and their attitudes towards smoking have changed immensely over the recent years. More and more people now support a ban on smoking in public places and are beginning to demand to their Government that something be done in order to protect their health when they are out socialising or at work.

Nowadays people are more understanding if they are asked not to smoke in certain public places and once they have got used to the smoking restrictions, not being able to smoke ceases to be a problem and people are actually glad to be able to enjoy a healthy environment minus the smoke.
Employees are usually the most grateful, as their health is no longer at risk. Besides, non-smokers are now able to enjoy a meal or a drink without sitting in a smelly cloud of smoke that can irritate their eyes and throat, ex-smokers are not tempted to pick up their old habit and smokers are encouraged to smoke less.

Another positive effect is that young people, who are often targeted by tobacco advertising campaigns, see that not smoking is becoming popular and the norm and they are less likely to take up the habit themselves.

With complete bans in public places more people are protected against the harmful effects of passive smoking.

Quite a number of countries and states around the world have imposed a no-smoking ban in all or the majority of workplaces and public places in their countries. In Europe, Ireland was the first country to implement a total ban on smoking in all public places and workplaces, even in the several thousands of pubs.

Other European countries have banned smoking in most workplaces, although smoking is still permitted in certain pubs, bars and discotheques, where larger areas for no-smokers have been provided or separate ventilated rooms have been added. Similar regulations regarding smoking have been put in motion in other countries all over the world such as USA, Canada, Australia and New Zealand and some of the toughest no-smoking laws exist in California, San Francisco and more recently New York.


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