TheHealthConsequencesofSecondhandSmoke (InvoluntaryExposuretoTobaccoSmoke)

WhatIsSecondhandSmoke?

Secondhandsmokeiscomposedofsidestreamsmoke(thesmokereleasedfromtheburningendofacigarette) andexhaledmainstreamsmoke(thesmokeexhaledbythesmoker). Whilesecondhandsmokehasbeenreferredtoasenvironmentaltobaccosmoke(ETS)inthepast,theterm secondhandsmokebettercapturestheinvoluntarynatureoftheexposure. The2006SurgeonGeneralsreportusestheterminvoluntaryinthetitlebecausemostnonsmokersdonot wanttobreathetobaccosmoke.Theterminvoluntarywasalsousedinthetitleofthe1986SurgeonGenerals reportonsecondhandsmoke. Cigarettesmokecontainsmorethan4,000chemicalcompounds. o Secondhandsmokecontainsmanyofthesamechemicalsthatarepresentinthesmokeinhaledby smokers. o Becausesidestreamsmokeisgeneratedatlowertemperaturesandunderdifferentconditionsthan mainstreamsmoke,itcontainshigherconcentrationsofmanyofthetoxinsfoundincigarettesmoke. TheNationalToxicologyProgramestimatesthatatleast250chemicalsinsecondhandsmokeareknowntobe toxicorcarcinogenic. Secondhandsmokehasbeendesignatedasaknownhumancarcinogen(cancercausingagent)bytheU.S. EnvironmentalProtectionAgency,theNationalToxicologyProgram,andtheInternationalAgencyforResearch onCancer,andanoccupationalcarcinogenbytheNationalInstituteforOccupationalSafetyandHealth. o Secondhandsmokecontainsmorethan50cancercausingchemicals. o Whennonsmokersareexposedtosecondhandsmoke,theyinhalemanyofthesamecancercausing chemicalsthatsmokersinhale.

TheSurgeonGeneralhasconcludedthat:

Thereisnoriskfreelevelofexposuretosecondhandsmoke:evensmallamountsofsecondhandsmoke exposurecanbeharmfultopeopleshealth. ManymillionsofAmericanscontinuetobeexposedtosecondhandsmoke. Asmokefreeenvironmentistheonlywaytofullyprotectnonsmokersfromthedangersofsecondhandsmoke. Separatingsmokersfromnonsmokers,cleaningtheair,andventilatingbuildingscannoteliminateexposureof nonsmokerstosecondhandsmoke.

6MajorConclusionsoftheSurgeonGeneralReport

Smokingisthesinglegreatestavoidablecauseofdiseaseanddeath.Inthisreport,TheHealthConsequences ofInvoluntaryExposuretoTobaccoSmoke:AReportoftheSurgeonGeneral,theSurgeonGeneralhas concludedthat: 1. ManymillionsofAmericans,bothchildrenandadults,arestillexposedtosecondhandsmokeintheir homesandworkplacesdespitesubstantialprogressintobaccocontrol. SupportingEvidence

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Levelsofachemicalcalledcotinine,abiomarkerofsecondhandsmokeexposure,fellby70percentfrom 198891to200102.Innationalsurveys,however,43percentofU.S.nonsmokersstillhavedetectable levelsofcotinine.

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Almost60percentofU.S.childrenaged311yearsoralmost22millionchildrenareexposedto secondhandsmoke. Approximately30percentofindoorworkersintheUnitedStatesarenotcoveredbysmokefree workplacepolicies.

2. Secondhandsmokeexposurecausesdiseaseandprematuredeathinchildrenandadultswhodonot smoke. SupportingEvidence

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Secondhandsmokecontainshundredsofchemicalsknowntobetoxicorcarcinogenic(cancercausing), includingformaldehyde,benzene,vinylchloride,arsenic,ammonia,andhydrogencyanide. Secondhandsmokehasbeendesignatedasaknownhumancarcinogen(cancercausingagent)bythe U.S.EnvironmentalProtectionAgency,NationalToxicologyProgramandtheInternationalAgencyfor ResearchonCancer(IARC).TheNationalInstituteforOccupationalSafetyandHealthhasconcludedthat secondhandsmokeisanoccupationalcarcinogen.

3. Childrenexposedtosecondhandsmokeareatanincreasedriskforsuddeninfantdeathsyndrome (SIDS),acuterespiratoryinfections,earproblems,andmoresevereasthma.Smokingbyparents causesrespiratorysymptomsandslowslunggrowthintheirchildren. SupportingEvidence

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Childrenwhoareexposedtosecondhandsmokeareinhalingmanyofthesamecancercausing substancesandpoisonsassmokers.Becausetheirbodiesaredeveloping,infantsandyoungchildrenare especiallyvulnerabletothepoisonsinsecondhandsmoke. Bothbabieswhosemotherssmokewhilepregnantandbabieswhoareexposedtosecondhandsmoke afterbirtharemorelikelytodiefromsuddeninfantdeathsyndrome(SIDS)thanbabieswhoarenot exposedtocigarettesmoke. Babieswhosemotherssmokewhilepregnantorwhoareexposedtosecondhandsmokeafterbirthhave weakerlungsthanunexposedbabies,whichincreasestheriskformanyhealthproblems. Amonginfantsandchildren,secondhandsmokecausebronchitisandpneumonia,andincreasestherisk ofearinfections. Secondhandsmokeexposurecancausechildrenwhoalreadyhaveasthmatoexperiencemorefrequent andsevereattacks.

4. Exposureofadultstosecondhandsmokehasimmediateadverseeffectsonthecardiovascular systemandcausescoronaryheartdiseaseandlungcancer. SupportingEvidence

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Concentrationsofmanycancercausingandtoxicchemicalsarehigherinsecondhandsmokethaninthe smokeinhaledbysmokers. Breathingsecondhandsmokeforevenashorttimecanhaveimmediateadverseeffectsonthe cardiovascularsystemandinterfereswiththenormalfunctioningoftheheart,blood,andvascular systemsinwaysthatincreasetheriskofaheartattack.

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Nonsmokerswhoareexposedtosecondhandsmokeathomeoratworkincreasetheirriskof developingheartdiseaseby2530percent. Nonsmokerswhoareexposedtosecondhandsmokeathomeoratworkincreasetheirriskof developinglungcancerby2030percent.

5. Thescientificevidenceindicatesthatthereisnoriskfreelevelofexposuretosecondhandsmoke. SupportingEvidence
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Shortexposurestosecondhandsmokecancausebloodplateletstobecomestickier,damagethelining ofbloodvessels,decreasecoronaryflowvelocityreserves,andreduceheartratevariability,potentially increasingtheriskofaheartattack. Secondhandsmokecontainsmanychemicalsthatcanquicklyirritateanddamagetheliningofthe airways.Evenbriefexposurecanresultinupperairwaychangesinhealthypersonsandcanleadtomore frequentandmoreasthmaattacksinchildrenwhoalreadyhaveasthma.

6. Eliminatingsmokinginindoorspacesfullyprotectsnonsmokersfromexposuretosecondhand smoke.Separatingsmokersfromnonsmokers,cleaningtheair,andventilatingbuildingscannot eliminateexposuresofnonsmokerstosecondhandsmoke. SupportingEvidence

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Conventionalaircleaningsystemscanremovelargeparticles,butnotthesmallerparticlesorthegases foundinsecondhandsmoke. Routineoperationofaheating,ventilating,andairconditioningsystemcandistributesecondhand smokethroughoutabuilding. TheAmericanSocietyofHeating,RefrigeratingandAirConditioningEngineers(ASHRAE),the preeminentU.S.bodyonventilationissues,hasconcludedthatventilationtechnologycannotberelied ontocontrolhealthrisksfromsecondhandsmokeexposure.

SecondhandSmokeIsToxicandPoisonous

The National Toxicology Program estimates that at least 250 chemicals in secondhand smoke are known to be toxic or carcinogenic (cancer causing). Secondhand smoke contains a number of poisonous gases and chemicals, including hydrogen cyanide (used in chemical weapons), carbon monoxide (found in car exhaust), butane (used in lighter fluid), ammonia (used in household cleaners), and toluene (found in paint thinners). Some of the toxic metals contained in secondhand smoke include arsenic (used in pesticides), lead (formerly found in paint), chromium (used to make steel), and cadmium (used to make batteries). There are more than 50 cancer-causing chemicals in secondhand smoke that fall into different chemical classes, including:
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Polynucleararomatichydrocarbons(PAHs)(suchasBenzo[a]pyrene) NNitrosamines(suchastobaccospecificnitrosamines) Aromaticamines(suchas4aminobiphenyl) Aldehydes(suchasformaldehyde) Miscellaneousorganicchemicals(suchasbenzeneandvinylchloride)and Inorganiccompounds(suchasthosecontainingmetalslikearsenic,beryllium,cadmium,lead,nickeland radioactivepolonium210).

Eleven compounds in tobacco smoke (2-naphthylamine, 4-aminobiphenyl, benzene, vinyl chloride, ethylene oxide, arsenic, beryllium, nickel compounds, chromium, cadmium and polonium-210) have been identified by the International Agency for Research on Cancer as Group 1 (known human carcinogen) carcinogens. Secondhand smoke has been designated as a known human carcinogen (cancer-causing agent) by the U.S. Environmental Protection Agency, National Toxicology Program and the International Agency for Research on Cancer (IARC). The National Institute for Occupational Safety and Health has concluded that secondhand smoke is an occupational carcinogen. Secondhand smoke is composed of sidestream smoke (the smoke released from the burning end of a cigarette) and exhaled mainstream smoke (the smoke exhaled by the smoker). Because sidestream smoke is generated at lower temperatures and under different conditions than mainstream smoke, it contains higher concentrations of many of the toxins found in inhaled cigarette smoke.

ThereisNoRiskFreeLevelofExposuretoSecondhandSmoke TheU.S.SurgeonGeneralhasconcludedthatbreathingevenalittlesecondhandsmokeposesarisktoyour health.

Scientificevidenceindicatesthatthereisnoriskfreelevelofexposuretosecondhandsmoke.Breathingevena littlesecondhandsmokecanbeharmfultoyourhealth.

Secondhandsmokecauseslungcancer.

Secondhandsmokeisaknownhumancarcinogenandcontainsmorethan50chemicalsthatcancausecancer. Concentrationsofmanycancercausingandtoxicchemicalsarepotentiallyhigherinsecondhandsmokethanin thesmokeinhaledbysmokers.

Secondhandsmokecausesheartdisease.

Breathingsecondhandsmokeforevenashorttimecanhaveimmediateadverseeffectsonthecardiovascular system,interferingwiththenormalfunctioningoftheheart,blood,andvascularsystemsinwaysthatincrease theriskofheartattack. Evenashorttimeinasmokyroomcancauseyourbloodplateletstobecomestickier,damagetheliningofblood vessels,decreasecoronaryflowvelocityreserves,andreduceheartratevariability. Personswhoalreadyhaveheartdiseaseareatespeciallyhighriskofsufferingadverseaffectsfrombreathing secondhandsmoke,andshouldtakespecialprecautionstoavoidevenbriefexposure.

Secondhandsmokecausesacuterespiratoryeffects.

Secondhandsmokecontainsmanychemicalsthatcanquicklyirritateanddamagetheliningoftheairways. Evenbriefexposurecantriggerrespiratorysymptoms,includingcough,phlegm,wheezing,andbreathlessness. Briefexposuretosecondhandsmokecantriggeranasthmaattackinchildrenwithasthma. Personswhoalreadyhaveasthmaorotherrespiratoryconditionsareatespeciallyhighriskforbeingaffectedby secondhandsmoke,andshouldtakespecialprecautionstoavoidsecondhandsmokeexposure.

Secondhandsmokecancausesuddeninfantdeathsyndromeandotherhealthconsequencesininfantsand children.

SmokingbywomenduringpregnancyhasbeenknownforsometimetocauseSIDS. InfantswhoareexposedtosecondhandsmokeafterbirtharealsoatgreaterriskofSIDS.

Childrenexposedtosecondhandsmokearealsoatanincreasedriskforacuterespiratoryinfections,ear problems,andmoresevereasthma.Smokingbyparentscausesrespiratorysymptomsandslowslunggrowthin theirchildren.

Separatingsmokersfromnonsmokers,cleaningtheair,andventilatingbuildingscannoteliminate secondhandsmokeexposure.

TheAmericanSocietyofHeating,RefrigeratingandAirConditioningEngineers(ASHRAE),thepreeminentU.S. standardsettingbodyonventilationissues,hasconcludedthatventilationtechnologycannotbereliedonto completelycontrolhealthrisksfromsecondhandsmokeexposure. Conventionalaircleaningsystemscanremovelargeparticles,butnotthesmallerparticlesorthegasesfoundin secondhandsmoke. Operationofaheating,ventilating,andairconditioningsystemcandistributesecondhandsmokethroughouta building.

ChildrenareHurtbySecondhandSmoke

Secondhandsmokecontainsmorethan250chemicalsknowntobetoxicorcarcinogenic(cancercausing), includingformaldehyde,benzene,vinylchloride,arsenic,ammonia,andhydrogencyanide.Childrenwhoare exposedtosecondhandsmokeareinhalingmanyofthesamecancercausingsubstancesandpoisonsas smokers.

HealthEffectsofSecondhandSmokeinChildren

Becausetheirbodiesaredeveloping,infantsandyoungchildrenareespeciallyvulnerabletothepoisonsin secondhandsmoke. Bothbabieswhosemotherssmokewhilepregnantandbabieswhoareexposedtosecondhandsmokeafter birtharemorelikelytodiefromsuddeninfantdeathsyndrome(SIDS)thanbabieswhoarenotexposedto cigarettesmoke. Motherswhoareexposedtosecondhandsmokewhilepregnantaremorelikelytohavelowerbirthweight babies,whichmakesbabiesweakerandincreasestheriskformanyhealthproblems. Babieswhosemotherssmokewhilepregnantorwhoareexposedtosecondhandsmokeafterbirthhaveweaker lungsthanotherbabies,whichincreasestheriskformanyhealthproblems. Secondhandsmokeexposurecausesacutelowerrespiratoryinfectionssuchasbronchitisandpneumoniain infantsandyoungchildren. Secondhandsmokeexposurecauseschildrenwhoalreadyhaveasthmatoexperiencemorefrequentandsevere attacks. Secondhandsmokeexposurecausesrespiratorysymptoms,includingcough,phlegm,wheeze,and breathlessness,amongschoolagedchildren. Childrenexposedtosecondhandsmokeareatincreasedriskforearinfectionsandaremorelikelytoneedan operationtoinserteartubesfordrainage.

ExposuretoSecondhandSmokeAmongChildren

TheSurgeonGeneralhasconcludedthatthereisnoriskfreelevelofsecondhandsmokeexposure.Evenbrief exposurescanbeharmful. Onaverage,childrenareexposedtomoresecondhandsmokethannonsmokingadults. Basedonlevelsofcotinine(abiologicalmarkerofsecondhandsmokeexposure),anestimated22million childrenaged311yearsand18millionyouthaged1219years,wereexposedtosecondhandsmokeinthe UnitedStatesin2000. Childrenaged311yearsandyouthaged1219yearsaresignificantlymorelikelythanadultstoliveina householdwithatleastonesmoker.

Childrenaged311yearshavecotininelevelsmorethantwiceashighasnonsmokingadults. Childrenwholiveinhomeswheresmokingisallowedhavehighercotininelevelsthanchildrenwholivein homeswheresmokingisnotallowed.

HowtoProtectYourselfandYourLovedOnesfromSecondhandSmoke

TheSurgeonGeneralhasconcludedthatthereisnoriskfreelevelofexposuretosecondhandsmoke.Breathing evenalittlesecondhandsmokecanbeharmful. TheSurgeonGeneralhasconcludedthattheonlywaytofullyprotectyourselfandyourlovedonesfromthe dangersofsecondhandsmokeisthrough100%smokefreeenvironments. Openingawindow,sittinginaseparatearea,orusingventilation,airconditioning,orafancannoteliminate secondhandsmokeexposure. Youcanprotectyourselfandyourlovedonesby: o Makingyourhomeandcarsmokefree. o Askingpeoplenottosmokearoundyouandyourchildren. o Makingsurethatyourchildrensdaycarecenterorschoolissmokefree. o Choosingrestaurantsandotherbusinessesthataresmokefree.Thankingbusinessesforbeingsmoke free.Lettingownersofbusinessesthatarenotsmokefreeknowthatsecondhandsmokeisharmfulto yourfamilyshealth. o Teachingchildrentostayawayfromsecondhandsmoke. o Avoidingsecondhandsmokeexposureespeciallyifyouoryourchildrenhaverespiratoryconditions,if youhaveheartdisease,orifyouarepregnant. o Talkingtoyourdoctororhealthcareprovidermoreaboutthedangersofsecondhandsmoke. Ifyouareasmoker,thesinglebestwaytoprotectyourfamilyfromsecondhandsmokeistoquitsmoking.Inthe meantime,youcanprotectyourfamilybymakingyourhomeandvehiclessmokefreeandonlysmokingoutside. Asmokefreehomerulecanalsohelpyouquitsmoking. o Jointhenationaltrend.TaketheSmokefreeHomePledgebycallingthetollfreeSmokefreeHome PledgeHotlineat1866SMOKEFREE(18667665337)orvisitingwww.epa.gov/smokefree. o Toaccessatelephonequitlineservingyourarea,call1800QUITNOW(18007848669)orvisit www.smokefree.gov.

TheHealthConsequencesofInvoluntaryExposuretoTobaccoSmoke:AReportoftheSurgeonGeneralwas preparedbytheOfficeonSmokingandHealth,NationalCenterforChronicDiseasePreventionandHealth Promotion,CentersforDiseaseControlandPrevention(CDC).TheReportwaswrittenby22nationalexperts whowereselectedasprimaryauthors.TheReportchapterswerereviewedby40peerreviewers,andthe entireReportwasreviewedby30independentscientistsandbyleadscientistswithintheCentersforDisease ControlandPreventionandtheDepartmentofHealthandHumanServices.Throughoutthereviewprocess, theReportwasrevisedtoaddressreviewerscomments. Citation U.S.DepartmentofHealthandHumanServices.TheHealthConsequencesofInvoluntaryExposuretoTobacco Smoke:AReportoftheSurgeonGeneral.U.S.DepartmentofHealthandHumanServices,CentersforDisease ControlandPrevention,NationalCenterforChronicDiseasePreventionandHealthPromotion,Officeon SmokingandHealth,2006.

UniversityofMiamiBeSmokeFreeSmokingCessationProgram www.miami.edu/besmokefree|3052437606