Secondhand Smoke

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). Even though we think of these as the same, they aren't. The sidestream
smoke has higher concentrations of cancer-causing agents (carcinogens) than the mainstream
smoke. And, it contains smaller particles than mainstream smoke, which make their way into the
body's cells more easily.

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
US Environmental Protection Agency (EPA), the US 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
 50,000 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

Whether secondhand smoke increases the risk of breast cancer is an issue that is still being
studied. 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 US 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 US 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 United States 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 US 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 as yet that shows cigarette odors cause cancer in
people. Research does show that particles from secondhand tobacco smoke can settle onto hair,
clothing, and other surfaces and remain there long after the smoke is gone. Some researchers call
this "thirdhand" smoke. Researchers have now proven that these settled-out particles can form
more cancer-causing compounds.

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. The compounds may be
stirred up and inhaled with other house dust, but more may be absorbed through the skin or
accidentally taken in through the mouth. This is why any risk the compounds pose may be larger
for babies and children who play on the floor. No actual cancer risk has been measured, but this
is an active area of 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 US 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.orgh.
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 http://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