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November 2006

• The 2006 U.S. Surgeon General's Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke concluded that there is "no risk-free level of exposure to secondhand smoke." The report states that "secondhand smoke contains many chemicals that can quickly irritate and damage the lining of the airways. Even brief exposure can result in upper airway changes in healthy persons and can lead to more frequent and more asthma attacks in children who already have asthma."¹
  
  
• SHS is the third leading cause of preventable death in this country, killing 53,000 nonsmokers in the U.S. each year. For every eight smokers the tobacco industry kills, it takes one nonsmoker with them.^2,3
  
  
• The United States Centers for Disease Control and Prevention has determined that the risk of acute myocardial infarction and coronary heart disease associated with exposure to tobacco smoke is non-linear at low doses, increasing rapidly with relatively small doses such as those received from secondhand smoke (SHS) or actively smoking one or two cigarettes a day, and has warned that all patients at increased risk of coronary heart disease or with known coronary artery disease should avoid all indoor environments that permit smoking.⁴
  
  
• Just thirty minutes of exposure to secondhand smoke can cause heart damage similar to that of habitual smokers. Nonsmokers' heart arteries showed a reduced ability to dilate, diminishing the ability of the heart to get life-giving blood. In addition, the same half hour of secondhand smoke exposure activates blood platelets, which can initiate the process of atherosclerosis (blockage of the heart's arteries) that leads to heart attacks. These effects explain other research showing that nonsmokers regularly exposed to SHS suffer death or morbidity rates 30% higher than those of unexposed nonsmokers.^5,6
  
  
• The California Air Resources Board has determined that secondhand smoke is a toxic air contaminant (TAC) -- an air pollutant which may cause or contribute to an increase in deaths or in serious illness, or which may pose a present or potential hazard to human health. Other TACs include diesel exhaust and benzene.⁷
  
  
• Secondhand smoke is as damaging to a fetus as if the mother were inhaling the smoke directly from a cigarette.⁸
  
  
• Long-term exposure to secondhand smoke increases the risk of developing breast cancer in younger, primarily premenopausal, women.⁹
  
  
• A study of hospital admissions for acute myocardial infarction in Helena, Montana before, during, and after a local law eliminating smoking in workplaces and public places was in effect, has determined that laws to enforce smokefree workplaces and public places may be associated with a reduction in morbidity from heart disease.¹⁰
  
  
• A June 2004 study published in the British Medical Journal reaffirmed that there are virtually no health disparities between active and passive smoking. The risks of heart disease associated with secondhand smoke are twice what were previously thought and are virtually indistinguishable from those associated with active smoking.¹¹
  
  
• There is a link between secondhand smoke to an increased risk of stroke. Regular exposure to secondhand smoke, such as in restaurants, heightens one's chance of stroke by 50 percent.¹²
  
  
• The 1999 National Cancer Institute Monograph 10, based on the 1997 Cal-EPA (Environmental Protection Agency) review of population-based studies, confirmed that SHS is fatal and has numerous non-fatal health effects. SHS chemicals include irritants and systemic toxicants, mutagens, and carcinogens, and reproductive and developmental toxicants. More than 50 compounds in tobacco smoke are known carcinogens. SHS exposure causes lung and nasal sinus cancer, heart disease, and Sudden Infant Death Syndrome. Serious impacts of SHS on children include asthma induction and exacerbation, bronchitis and pneumonia, middle ear infection, chronic respiratory symptoms, and low birth weight.^13,14
  
  
• SHS is a major source of PM [particulate matter] pollution - a risk factor for pulmonary disease, asthma, and lung cancer - and that three cigarettes smouldering in a room emits up to 10-fold more PM pollution than an ecodiesel engine. The study concluded that high levels of PM exposure from SHS may account for frequent episodes of short term respiratory damage in nonsmokers.¹⁵
  
  
• Secondhand smoke exposure during childhood has been associated with an increased risk of spinal pain, such as neck pain and back pain in adult life. Researchers suggest this may be due to the negative effects of smoke exposure during childhood on the developing spine.¹⁶
  
  
• Secondhand smoke exposure impairs a child's ability to learn. It is neurotoxic even at extremely low levels. More than 21.9 million children are estimated to be at risk of reading deficits because of secondhand smoke. Higher levels of exposure to secondhand smoke are also associated with greater deficits in math and visuospatial reasoning.¹⁷
  
  
• The excess risk of coronary heart disease (CHD) associated with passive smoking is 50-60%, twice what was previously thought by researchers, and the risks of CHD for passive smoking are virtually indistinguishable from active smoking. A study published in the July 2004 edition of the British Medical Journal found higher risks of CHD because, rather than using marriage to a smoker or working in a smoky environment as their measure of exposure, the study's authors used plasma cotinine (metabolized nicotine), a direct biochemical measure of total SHS) exposure. By doing so, they captured SHS's entire exposure effect.¹⁸
  
  
• The 1986 Report of the Surgeon General; the 1986 National Research Council report, Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects; and the 1992 U.S. Environmental Protection Agency report, Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders, established that SHS exposure causes lung cancer.^19,20
  
  
• The 2002 Environmental Health Information Service's 10th Report on Carcinogens classifies SHS as a Group A (Human) Carcinogen - a substance known to cause cancer in humans. There is no safe level of exposure for Group A toxins. In addition, the 2002 World Health Organization International Agency's (IARC) Monograph on Tobacco Smoking, Both Active and Passive concluded that nonsmokers are exposed to the same carcinogens as active smokers.^21,22
  
  
• In 1991, data showed that nearly 90 percent of the U.S. population had measurable levels of serum cotinine in their blood. In 2002, the Centers for Disease Control and Prevention's National Report on Human Exposure to Environmental Chemicals found more than a 75 percent decrease in median cotinine levels for nonsmokers in the U.S. since 1991- an indication that smoke-free environments significantly reduce exposure to SHS.^23,24

May be reprinted with appropriate attribution to the American Nonsmokers' Rights Foundation, © 2006.

REFERENCES

1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
2. Glantz, S.A. & Parmley, W., "Passive Smoking and Heart Disease: Epidemiology, Physiology, and Biochemistry," Circulation, 1991; 83(1): 1-12.
3. Taylor, A., Johnson, D. & Kazemi, H., "Environmental Tobacco Smoke and Cardiovascular Disease," Circulation, 1992; 86: 699-702.
4. Pechacek, Terry F.; Babb, Stephen, "Commentary: How acute and reversible are the cardiovascular risks of secondhand smoke?" British Medical Journal 328: 980-983, April 24, 2004.
5. Otsuka, R., et al. "Acute Effects of Passive Smoking on the Coronary Circulation in Healthy Young Adults," Journal of the American Medical Association, 286: 436-441, 2001. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11466122&dopt=Abstract. Downloaded on November 25, 2003
6. Burghuber, O., et al. "Platelet sensitivity to prostacyclin in smokers and non-smokers," Chest, 90: 34-38, 1986.
7. Appendix II Findings of the Scientific Review Panel: Findings of the Scientific Review Panel on Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant as adopted at the Panel's June 24, 2005 Meeting," California Air Resources Board (ARB), September 12, 2005.
8. Grant, S.G., "Qualitatively and quantitatively similar effects of active and passive maternal tobacco smoke exposure on in utero mutagenesis at the HPRT locus," BMC Pediatrics, 2005, 5:20. Available at http://www.biomedcentral.com/content/pdf/1471-2431-5-20.pdf. Accessed on September 7, 2005.
9. [n.a.], "Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant," California Environmental Protection Agency, Air Resources Board, Office of Environmental Health Hazard Assessment, June 2005. Available at http://www.arb.ca.gov/toxics/ets/dreport/dreport.htm. Accessed on June 3, 2005.
10. Sargent, Richard P.; Shepard, Robert M.; Glantz, Stanton A., "Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study," British Medical Journal, 328: 977-980, April 24, 2004.
11. Whincup, P. et al., "Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement," British American Journal, June 2004. Available at http://bmj.bmjjournals.com/cgi/content/abstract/bmj.38146.427188.55v1.
12. Zhang, X. et al., "Association of Passive Smoking by Husbands with Prevalence of Stroke among Chinese Women Nonsmokers," American Journal of Epidemiology, 2005; 161(3): 213-218.
13. National Cancer Institute, "Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency." Smoking and Tobacco Control Monograph 10, 1999. Available at: http://cancercontrol.cancer.gov/tcrb/monographs/10/. Downloaded on November 25, 2003.
14. California Environmental Protection Agency, "Health Effects of Exposure to Environmental Tobacco Smoke," 1997.
15. Invernizzi, G.; Ruprecht, A.; Mazza, R.; Rossetti, E.; Sasco, A.; Nardini, S.; Boffi, R., "Particulate matter from tobacco versus diesel car exhaust: an educational perspective," Tobacco Control. 13(3): 219-221, September 2004. Available at http://www.tobaccocontrol.com/cgi/content/abstract/13/3/219?etoc.
16. Eriksen W., "Do people who were passive smokers during childhood have increased risk of long-term work disability?" European Journal of Public Health, September 2004; 14(3): 296-300. Available at http://bmj.bmjjournals.com/cgi/content/full/329/7460/250. Downloaded on August 2, 2004.
17. Yolton, K. et al., "Exposure to Environmental Tobacco Smoke and Cognitive abilities of U.S. Children and Adolescents," Environmental Health Perspectives, 113(1): 98-103. Available at http://ehp.niehs.nih.gov/members/2004/7210/7210.pdf.
18. Whincup, P.H.; Gilg, J.A.; Emberson, J.R.; Jarvis, M.J.; Feyerabend, C.; Bryant, M.W.; Cook, D.C. "Passive smoking risk of coronary heart disease and stroke prospective study with cotinine measurement." British Medical Journal, doi: 10.1136/bmj.38146.427188.55 (published 30 June 2004). Available at http://bmj.bmjjournals.com/cgi/content/abstract/bmj.38146.427188.55v1. Downloaded on July 16, 2004.
    National Center for Chronic Disease Prevention and Health Promotion, "1986 Surgeon General Report:
19. The Health Consequences of Involuntary Smoking," 1986. Available at: http://www.cdc.gov/tobacco/sgr/sgr_1986/index.htm. Downloaded on November 25, 2003.
20. U.S. Environmental Protection Agency, "Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders," 1992. Extended version available at: http://cfpub.epa.gov/ncea/cfm/ets/etsindex.cfm. Summary available at: http://www.epa.gov/iaq/pubs/etsfs.html. Downloaded on November 25, 2003.
21. Report on Carcinogens, Tenth Edition; U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program, December 2002. Available at: http://ehp.niehs.nih.gov/roc/toc10.html. Downloaded on November 25, 2003.
22. International Agency for Research on Cancer Monograph's Program, "Monograph on Tobacco Smoking, both Active and Passive," World Health Organization, June 2002. Available at: http://www.iarc.fr/pageroot/PRELEASES/pr141a.html. Downloaded on November 25, 2003.
23. Centers for Disease Control and Prevention; Department of Health and Human Services, "Second National Report on Human Exposure to Environmental Chemicals," National Center for Environmental Health (NCEH Pub. No. 02-0716) January 2003.
24. Centers for Disease Control; Department of Health and Human Services, "Facts about Secondhand Smoke," Updated: September 2003.