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| {{Redirect|Second hand smoke|the ] album|Second-hand Smoke}} | |||
| ] before a ] came into effect on March 29, 2004]] | |||
| '''Passive smoking''' is the inhalation |
'''Passive smoking''' is the inhalation, usually involuntary, of ] from tobacco products by non-smokers or persons other than the intended 'active' smoker<ref>http://dictionary.cambridge.org/dictionary/british/passive-smoking</ref><ref>http://lungcancer.about.com/od/glossary/g/passivesmoking.htm</ref><ref>http://www.merriam-webster.com/medical/passive%20smoking</ref><ref>http://medical-dictionary.thefreedictionary.com/passive+smoking</ref>. It occurs when tobacco smoke permeates any environment, causing its inhalation by people within that environment. Exposure to second-hand tobacco smoke through passive smoking ] disease, disability, and death.<ref name="framework-treaty">{{cite web |url = http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf |title = WHO Framework Convention on Tobacco Control |publisher = ] |quote = Parties recognize that scientific evidence has unequivocally established that exposure to tobacco causes death, disease and disability |date = 2005-02-27 |accessdate = 2009-01-12 |format = PDF}}</ref><ref name="sg-report">{{cite web |url = http://www.surgeongeneral.gov/library/secondhandsmoke |title = The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General |publisher = ] |date = 2006-06-27 |accessdate = 2009-01-12 |quote = Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke}}</ref><ref name="calepa2005">{{cite web |url = http://repositories.cdlib.org/context/tc/article/1194/type/pdf/viewcontent/ |title = Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant |date = 2005-06-24 |accessdate = 2009-01-12 |publisher = ]}}</ref><ref name=IARC2004>{{harvnb|IARC|2004}} </ref> The health hazards of passive smoking, which are a matter of ].<ref name=Samet008>{{cite journal |author=Samet JM |title=Secondhand smoke: facts and lies |journal=Salud Publica Mex |volume=50 |issue=5 |pages=428–34 |year=2008 |pmid=18852940 |doi= 10.1590/S0036-36342008000500016|url=http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0036-36342008000500016&lng=en&nrm=iso&tlng=en}}</ref><ref name=Circ07 />, have been a major motivation for ] in workplaces and indoor public places. | ||
| ===Alternative terms=== | |||
| Concerns around second-hand smoke have played a central role in the debate over the harms and regulation of tobacco products. Since the early 1970s, the ] has viewed public concern over second-hand smoke as a serious threat to its business interests.<ref name="smoke-screen">{{cite web |url = http://dev.ersnet.org/uploads/Document/ab/WEB_CHEMIN_1092_1166196139.pdf |title = Lifting the smokescreen: Tobacco industry strategy to defeat smoke free policies and legislation |publisher = European Respiratory Society and Institut National du Cancer |author = Diethelm P, McKee M |quote = The industry quickly realised that, if it wanted to continue to prosper, it became vital that research did not demonstrate that tobacco smoke was a dangerous community air pollutant. This requirement has been the central pillar of its passive smoking policy from the early 1970s to the present day |date = February 2006 |accessdate = 2009-01-17}}</ref> Harm to bystanders was perceived as a motivator for stricter regulation of tobacco products. Despite the industry's awareness of the harms of second-hand smoke as early as the 1980s, the tobacco industry coordinated a scientific controversy with the aim of forestalling regulation of their products.<ref name="kessler"/>{{rp|1242}}<ref name=Circ07>{{cite journal|last=Tong|first=EK|coauthors=Glantz, SA|title=Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease|journal=Circulation|date=2007 Oct 16|volume=116|issue=16|pages=1845–54|pmid=17938301|doi=10.1161/CIRCULATIONAHA.107.715888}}</ref> | |||
| ''Passive smoking'' is used widely in news media and in older scientific research papers and may therefore be regarded as a ] for exposure to ]. More recent scientific literature and regulatory material tends to refer directly to ], and the two terms are effectively employed as synonyms, although etymologically passive smoking is the act or behaviour of exposure to a contaminant, and second-hand smoke the hazardous substance. A minority of scientific papers, and some material generated by representatives of the tobacco industry, refer to environmental tobacco smoke or 'ETS' rather than either passive smoking or second-hand smoke. | |||
| ===Consequences=== | |||
| {{TOC limit|3}} | |||
| {{Main|Second-hand smoke}} | |||
| == Effects == | |||
| The evidence of health hazards arising from passive smoking and exposure to second-hand smoke have played a central role in the debate over the regulation of tobacco products and smoking. Since the early 1970s, the ] has viewed the passive smoking issue as a major threat to its business interests.<ref name="smoke-screen">{{cite web |url = http://dev.ersnet.org/uploads/Document/ab/WEB_CHEMIN_1092_1166196139.pdf |title = Lifting the smokescreen: Tobacco industry strategy to defeat smoke free policies and legislation |publisher = European Respiratory Society and Institut National du Cancer |author = Diethelm P, McKee M |quote = The industry quickly realised that, if it wanted to continue to prosper, it became vital that research did not demonstrate that tobacco smoke was a dangerous community air pollutant. This requirement has been the central pillar of its passive smoking policy from the early 1970s to the present day |date = February 2006 |accessdate = 2009-01-17}}</ref> Harm to bystanders was perceived as a motivator for stricter regulation of tobacco products. Despite the industry's awareness of the harms of second-hand smoke as early as the 1980s, the tobacco industry coordinated a scientific controversy with the aim of forestalling regulation of their products.<ref name=Circ07>{{cite journal|last=Tong|first=EK|coauthors=Glantz, SA|title=Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease|journal=Circulation|date=2007 Oct 16|volume=116|issue=16|pages=1845–54|pmid=17938301|doi=10.1161/CIRCULATIONAHA.107.715888}}</ref> Nevertheless, as evidence of the hazards of second-hand smoke exposure through passive smoking has accumulated, so has the use of ] (or 'smoking bans') proliferated. | |||
| Second-hand smoke causes many of the same diseases as direct smoking, including ]s, ], and ]s.<ref name="sg-report"/><ref name="calepa2005"/><ref name=IARC2004/> These diseases include: | |||
| * ]: | |||
| ** General: overall increased risk;<ref>{{harvnb|Surgeon General|2006|pp=30–46}}</ref> reviewing the evidence accumulated on a worldwide basis, the ] concluded in 2004 that "Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans."<ref name=IARC2004/> | |||
| ** ]: the effect of passive smoking on lung cancer has been extensively studied. A series of studies from the USA from 1986–2003,<ref>{{cite journal |author= |title=1986 Surgeon General's report: the health consequences of involuntary smoking |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=35 |issue=50 |pages=769–70 |year=1986 |pmid=3097495 |author1= Centers for Disease Control (CDC) |ref= harv }}</ref><ref>National Research Council. Environmental tobacco smoke: measuring exposures and assessing health effects, NRC, Washington, DC (1986).</ref><ref name="EPA report">US Environmental Protection Agency. {{PDF|1=}}</ref><ref>{{cite journal |author= |title=Health effects of exposure to environmental tobacco smoke. California Environmental Protection Agency |journal=Tob Control |volume=6 |issue=4 |pages=346–53 |year=1997 |pmid=9583639 |doi=10.1136/tc.6.4.346 |pmc=1759599 |ref= harv}}</ref> the UK in 1998,<ref>{{cite web |title=Report of the Scientific Committee on Tobacco and Health to the Chief Medical Officer, Part II |url=http://www.archive.official-documents.co.uk/document/doh/tobacco/part-2.htm |accessdate=2006-07-26}}</ref><ref>{{cite journal |author=Hackshaw AK |title=Lung cancer and passive smoking |journal=Stat Methods Med Res |volume=7 |issue=2 |pages=119–36 |year=1998 |pmid=9654638|doi=10.1191/096228098675091404 }}</ref> Australia in 1997<ref>National Health and Medical Research Council. The health effects of passive smoking, Australian Government Publishing Service, Canberra (1997).</ref> and internationally in 2004<ref>{{cite journal |author=Brennan P, Buffler P, Reynolds P, Wu A, Wichmann H, Agudo A, Pershagen G, Jöckel K, Benhamou S, Greenberg R, Merletti F, Winck C, Fontham E, Kreuzer M, Darby S, Forastiere F, Simonato L, Boffetta P |title=Secondhand smoke exposure in adulthood and risk of lung cancer among never smokers: a pooled analysis of two large studies |journal=Int. J. Cancer |volume=109 |issue=1 |pages=125–31 |year=2004 |pmid=14735478 |doi=10.1002/ijc.11682 }}</ref> have consistently shown a significant increase in ] among those exposed to passive smoke.<ref>{{cite journal |author=Alberg AJ, Samet JM |title=Epidemiology of lung cancer |journal=Chest |volume=123 |issue=1 Suppl |pages=21S–49S |year=2003 |pmid=12527563|doi=10.1378/chest.123.1_suppl.21S }}</ref> | |||
| ** ]: The ] concluded in 2005 that passive smoking increases the risk of breast cancer in younger, primarily premenopausal women by 70%<ref name="calepa2005" /> and the US ] has concluded that the evidence is "suggestive," but still insufficient to assert such a causal relationship.<ref name="sg-report"/> In contrast, the ] concluded in 2004 that there was "no support for a causal relation between involuntary exposure to tobacco smoke and breast cancer in never-smokers."<ref name=IARC2004/> | |||
| ** ] (RCC): A recent study shows an increased RCC risk among never smokers with combined home/work exposure to passive smoking.<ref>{{cite journal |author=Theis RP, Dolwick Grieb SM, Burr D, Siddiqui T, Asal NR |title=Smoking, environmental tobacco smoke, and risk of renal cell cancer: a population-based case-control study |journal=BMC Cancer |volume=8 |pages=387 |year=2008 |pmid=19108730 |pmc=2633310 |doi=10.1186/1471-2407-8-387 }}</ref> | |||
| ** Passive smoking does not appear to be associated with ].<ref>{{cite journal |author=Hassan MM, Abbruzzese JL, Bondy ML, ''et al.'' |title=Passive Smoking and the Use of Noncigarette Tobacco Products in Association With Risk for Pancreatic Cancer: A Case-Control Study |journal=Cancer |volume=109 |issue=12 |pages=2547–56 |year=2007 |pmid=17492688 |pmc=2215306 |doi=10.1002/cncr.22724 }}</ref> | |||
| ** ]: The risk in children increases significantly with higher amount of passive smoking, even if the mother doesn't smoke,<ref>{{cite journal |author=Filippini G, Farinotti M, Lovicu G, Maisonneuve P, Boyle P |title=Mothers' active and passive smoking during pregnancy and risk of brain tumours in children |journal=Int. J. Cancer |volume=57 |issue=6 |pages=769–74 |year=1994 |month=June |pmid=8206670 |doi=10.1002/ijc.2910570602 }}</ref> thus not restricting risk to ] during pregnancy. | |||
| * ]: risk of ear infections.<ref>{{cite book |last=Bull |first=P.D. |title=Diseases of the Ear, Nose and Throat |publisher=Blackwell Science |year=1996 |isbn=0-86542-634-1 }}</ref> | |||
| ** Second-hand smoke exposure is associated with hearing loss in non-smoking adults.<ref>{{cite journal |author=Fabry DA, Davila EP, Arheart KL, ''et al.'' |title=Secondhand Smoke Exposure and the Risk of Hearing Loss |journal=Tob Control |volume= 20|issue= 1|pages= 82–5|year=2010 |month=November |pmid=21081307 |doi=10.1136/tc.2010.035832 |pmc=3071573 }}</ref> | |||
| * ]: risk of ],<ref>{{harvnb|Surgeon General|2006|loc=Ch. 8}}</ref> reduced heart rate variability, higher heart rate.<ref>{{cite journal |author=Dietrich DF, Schwartz J, Schindler C, ''et al.'' |title=Effects of passive smoking on heart rate variability, heart rate and blood pressure: an observational study |journal=Int J Epidemiol |volume=36 |issue=4 |pages=834–40 |year=2007 |pmid=17440032 |doi=10.1093/ije/dym031 }}</ref> | |||
| **Epidemiological studies have shown that both active and passive cigarette smoking increase the risk of atherosclerosis.<ref>{{cite journal |author=Zou N, Hong J, Dai QY |title=Passive cigarette smoking induces inflammatory injury in human arterial walls |journal=Chin. Med. J. |volume=122 |issue=4 |pages=444–8 |year=2009 |month=February |pmid=19302752 }}</ref> | |||
| * ]: | |||
| ** Risk of ].<ref>{{harvnb|Surgeon General|2006|pp=555–8}}</ref> | |||
| * ] and ]: Exposure to secondhand smoke may increase the risk of cognitive impairment and dementia in adults 50 and over.<ref>{{cite journal |author=Llewellyn DJ, Lang IA, Langa KM, Naughton F, Matthews FE |title=Exposure to secondhand smoke and cognitive impairment in non-smokers: national cross sectional study with cotinine measurement |journal=BMJ |volume=338 |pages=b462 |year=2009 |pmid=19213767 |pmc=2643443 |doi=10.1136/bmj.b462 }}</ref> | |||
| * During ]: | |||
| ** ]<ref name="calepa2005"/><sup>, part B, ch. 3</sup>.<ref>{{harvnb|Surgeon General|2006|pp=198–205}}</ref> | |||
| ** ]<ref name="calepa2005"/><sup>, part B, ch. 3</sup> (Note that evidence of the causal link is only described as "suggestive" by the US Surgeon General in his 2006 report.<ref>{{harvnb|Surgeon General|2006|pp=194–7}}</ref>) | |||
| ** Recent studies comparing women exposed to Environmental Tobacco Smoke and non-exposed women, demonstrate that women exposed while pregnant have higher risks of delivering a child with congenital abnormalities, longer lengths, smaller head circumferences, and low birth weight.<ref>{{cite journal |author=Salmasi G, Grady R, Jones J, McDonald SD |title=Environmental tobacco smoke exposure and perinatal outcomes: a systematic review and meta-analyses |journal=Acta Obstet Gynecol Scand |volume=89 |issue=4 |pages=423–41 |year=2010 |pmid=20085532 |doi=10.3109/00016340903505748 }}</ref> | |||
| * General: | |||
| ** Worsening of asthma, allergies, and other conditions.<ref>{{cite journal |author=Janson C |title=The effect of passive smoking on respiratory health in children and adults |journal=Int J Tuberc Lung Dis |volume=8 |issue=5 |pages=510–6 |year=2004 |pmid=15137524 }}</ref> | |||
| * Skin Disorder | |||
| ** Childhood exposure to Environmental Tobacco Smoke is associated with an increased risk of the development of adult-onset Atopic dermatitis.<ref>{{cite journal |author=Lee CH, Chuang HY, Hong CH, ''et al.'' |title=Lifetime exposure to cigarette smoking and the development of adult-onset atopic dermatitis |journal=Br J Dermatol |volume= 164|issue= 3|pages= 483–9|year=2010 |month=November |pmid=21054333 |doi=10.1111/j.1365-2133.2010.10116.x |pmc=3062947}}</ref> | |||
| * Overall increased risk of death in both adults, where it is estimated to kill 53,000 nonsmokers per year, making it the 3rd leading cause of ] in the U.S.<ref>{{cite journal |author=Glantz SA, Parmley WW |title=Passive smoking and heart disease. Epidemiology, physiology, and biochemistry |journal=Circulation |volume=83 |issue=1 |pages=1–12 |year=1991 |pmid=1984876 |url=http://circ.ahajournals.org/cgi/content/abstract/83/1/1?ijkey=4a5be6d1e9e3a9b7d6b3b9ab29a0f748d8b955ed&keytype2=tf_ipsecsha }}</ref><ref>{{cite journal |author=Taylor AE, Johnson DC, Kazemi H |title=Environmental tobacco smoke and cardiovascular disease. A position paper from the Council on Cardiopulmonary and Critical Care, American Heart Association |journal=Circulation |volume=86 |issue=2 |pages=699–702 |year=1992 |pmid=1638735 |url=http://circ.ahajournals.org/cgi/content/abstract/86/2/699 }}</ref> and in children.<ref>{{harvnb|Surgeon General|2006|pp=376–380}}</ref> Another research financed by the Swedish National Board of Health and Welfare and Bloomberg Philanthropies found that passive smoking causes about 603,000 death a year, which represents 1% of the world's death.<ref>. // The Washington Post, 26.11.2010</ref> | |||
| ===Risk to children=== | |||
| * ] (SIDS).<ref>{{cite journal |author=McMartin KI, Platt MS, Hackman R, Klein J, Smialek JE, Vigorito R, Koren G |title=Lung tissue concentrations of nicotine in sudden infant death syndrome (SIDS) |journal=] |volume=140 |issue=2 |pages=205–9 |year=2002 |pmid=11865272 |doi=10.1067/mpd.2002.121937 }}</ref><ref>{{cite journal |author=Milerad J, Vege A, Opdal SH, Rognum TO |title=Objective measurements of nicotine exposure in victims of sudden infant death syndrome and in other unexpected child deaths |journal=J. Pediatr. |volume=133 |issue=2 |pages=232–3 |year=1999 |pmid=9709711 |doi=10.1016/S0022-3476(98)70225-2}}</ref> In his 2006 report, the US Surgeon General concludes: "The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and sudden infant death syndrome."<ref>{{harvnb|Surgeon General|2006|p=194}}</ref> Secondhand smoking has been estimated to be associated with 430 SIDS deaths in the United States annually.<ref name=ala> August 2006.</ref> | |||
| * ]<ref>{{harvnb|Surgeon General|2006|pp=311–9}}</ref><ref>{{cite journal |author=Vork KL, Broadwin RL, Blaisdell RJ |title=Developing Asthma in Childhood from Exposure to Secondhand Tobacco Smoke: Insights from a Meta-Regression |journal=] |volume=115 |issue=10 |pages=1394–400 |year=2007 |pmid=17938726 |pmc=2022647 |doi=10.1289/ehp.10155 }}</ref> | |||
| * Lung infections,<ref>{{cite journal |author=Spencer N, Coe C |title=Parent reported longstanding health problems in early childhood: a cohort study |journal=] |volume=88 |issue=7 |pages=570–3 |year=2003 |pmid=12818898 |pmc=1763148 |doi=10.1136/adc.88.7.570 }}</ref><ref>{{cite journal |author=de Jongste JC, Shields MD |title=Cough • 2: Chronic cough in children |journal=Thorax |volume=58 |issue=11 |pages=998–1003 |year=2003 |pmid=14586058 |pmc=1746521 |doi=10.1136/thorax.58.11.998 }}</ref><ref>{{cite journal |author=Dybing E, Sanner T |title=Passive smoking, sudden infant death syndrome (SIDS) and childhood infections |journal=Hum Exp Toxicol |volume=18 |issue=4 |pages=202–5 |year=1999 |pmid=10333302|doi=10.1191/096032799678839914 }}</ref><ref name="Difranza 2004">{{cite journal |author=DiFranza JR, Aligne CA, Weitzman M |title=Prenatal and postnatal environmental tobacco smoke exposure and children's health |journal=] |volume=113 |issue=4 Suppl |pages=1007–15 |year=2004 |pmid=15060193 |doi=10.1542/peds.113.4.S1.1007 |url=http://pediatrics.aappublications.org/cgi/content/full/113/4/S1/1007 |doi_brokendate=2010-06-20}}</ref> also including more severe illness with ]<ref name=Chatzimichael/> and ],<ref name="CDC2007">. Centers for Disease Control and Prevention. July 2007.</ref> and worse outcome,<ref name=Chatzimichael>{{cite journal |author=Chatzimichael A, Tsalkidis A, Cassimos D, ''et al.'' |title=The role of breastfeeding and passive smoking on the development of severe bronchiolitis in infants |journal=Minerva Pediatr. |volume=59 |issue=3 |pages=199–206 |year=2007 |pmid=17519864 }}</ref> as well as increased risk of developing ] if exposed to a carrier<ref>{{cite journal |author=den Boon S, Verver S, Marais BJ, ''et al.'' |title=Association between passive smoking and infection with ''Mycobacterium tuberculosis'' in children |journal=Pediatrics |volume=119 |issue=4 |pages=734–9 |year=2007 |pmid=17403844 |doi=10.1542/peds.2006-1796 }}</ref> In the United States, it is estimated that second hand smoke has been associated with between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year.<ref name=ala/> | |||
| * Impaired respiratory function and slowed lung growth<ref name="CDC2007"/> | |||
| * Allergies | |||
| * ].<ref>{{cite journal |author=Mahid SS, Minor KS, Stromberg AJ, Galandiuk S |title=Active and passive smoking in childhood is related to the development of inflammatory bowel disease |journal=Inflamm. Bowel Dis. |volume=13 |issue=4 |pages=431–8 |year=2007 |pmid=17206676 |doi=10.1002/ibd.20070 }}</ref> | |||
| * Learning difficulties, developmental delays, and neurobehavioral effects.<ref>{{cite journal |author=Richards GA, Terblanche AP, Theron AJ, ''et al.'' |title=Health effects of passive smoking in adolescent children |journal=S. Afr. Med. J. |volume=86 |issue=2 |pages=143–7 |year=1996 |pmid=8619139 }}</ref><ref>, The Collaborative on Health and the Environment’s Learning and Developmental Disabilities Initiative, November 7, 2007</ref> Animal models suggest a role for nicotine and ] in neurocognitive problems.<ref name="Difranza 2004"/> | |||
| * An increase in ] (as well as related salivary ]) has been associated with passive smoking in children.<ref name="pmid18672230">{{cite journal |author=Avşar A, Darka O, Topaloğlu B, Bek Y |title=Association of passive smoking with caries and related salivary biomarkers in young children |journal=Arch. Oral Biol. |volume=53 |issue=10 |pages=969–74 |year=2008 |month=October |pmid=18672230 |doi=10.1016/j.archoralbio.2008.05.007 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-9969(08)00143-X }}</ref> | |||
| * Increased risk of middle ear infections.<ref>{{harvnb|Surgeon General|2006|pp=293–309}}</ref><ref>{{cite journal |author=Jacoby PA, Coates HL, Arumugaswamy A, ''et. al'' |title=The effect of passive smoking on the risk of otitis media in Aboriginal and non-Aboriginal children in the Kalgoorlie–Boulder region of Western Australia |volume=188 |issue=10 |pages=599–603 |year=2008 |url=http://www.mja.com.au/public/issues/188_10_190508/jac10619_fm.pdf |journal=Med J Aust |pmid=18484936 }}</ref> | |||
| == Evidence == | |||
| ] studies show that non-smokers exposed to second-hand smoke are at risk for many of the health problems associated with direct smoking. | |||
| In 1992, the '']'' published a review of available evidence on the relationship between second-hand smoke and heart disease, and estimated that second-hand smoke exposure was responsible for 35,000 to 40,000 deaths per year in the ] in the early 1980s.<ref name="steenland">{{cite journal |author=Steenland K |title=Passive smoking and the risk of heart disease |journal=JAMA |volume=267 |issue=1 |pages=94–9 |year=1992 |month=January |pmid=1727204 |doi= 10.1001/jama.267.1.94|url=http://jama.ama-assn.org/cgi/content/abstract/267/1/94 }}</ref> The ] of heart disease due to ETS was 2.2%, while the ] was 23%. | |||
| Research using more exact measures of second-hand smoke exposure suggests that risks to non-smokers may be even greater than this estimate. A British study reported that exposure to second-hand smoke increases the risk of heart disease among non-smokers by as much as 60%, similar to light smoking.<ref name="pmid15229131">{{cite journal |author=Whincup PH, Gilg JA, Emberson JR, ''et al.'' |title=Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement |journal=BMJ |volume=329 |issue=7459 |pages=200–5 |year=2004 |pmid=15229131 |doi=10.1136/bmj.38146.427188.55 |pmc=487731 }}</ref> Evidence also shows that inhaled sidestream smoke, the main component of second-hand smoke, is about four times more toxic than mainstream smoke. This fact has been known to the tobacco industry since the 1980s, though it kept its findings secret.<ref name="diethem2005">{{cite journal |author=Diethelm PA, Rielle JC, McKee M |title=The whole truth and nothing but the truth? The research that Philip Morris did not want you to see |journal=Lancet |volume=366 |issue=9479 |pages=86–92 |year=2005 |pmid=15993237 |doi=10.1016/S0140-6736(05)66474-4 }}</ref><ref name="glantz2005">{{cite journal |author=Schick S, Glantz S |title=Philip Morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke |journal=Tobacco control |volume=14 |issue=6 |pages=396–404 |year=2005 |pmid=16319363 |doi=10.1136/tc.2005.011288 |pmc=1748121 }}</ref><ref name="schick2006">{{cite journal |author=Schick S, Glantz SA |title=Sidestream cigarette smoke toxicity increases with aging and exposure duration |journal=Tobacco control |volume=15 |issue=6 |pages=424–9 |year=2006 |pmid=17130369 |doi=10.1136/tc.2006.016162 |pmc=2563675 }}</ref><ref name="schick2007">{{cite journal |author=Schick SF, Glantz S |title=Concentrations of the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone in sidestream cigarette smoke increase after release into indoor air: results from unpublished tobacco industry research |journal=Cancer Epidemiol. Biomarkers Prev. |volume=16 |issue=8 |pages=1547–53 |year=2007 |pmid=17684127 |doi=10.1158/1055-9965.EPI-07-0210 }}</ref> Some scientists believe that the risk of passive smoking, in particular the risk of developing coronary heart diseases, may have been substantially underestimated.<ref>{{cite web |url=http://www.newscientist.com/article.ns?id=dn6091 |title=Passive smoking danger was underestimated |author=Gaia Vince |publisher=New Scientist |date=2004-06-30|accessdate=2007-07-24 }}</ref> | |||
| A minority of epidemiologists have found it hard to understand how second-hand smoke, which is more diluted than actively inhaled smoke, could have an effect that is such a large fraction of the added risk of coronary heart disease among active smokers.<ref name="nature">{{cite journal |author=Novak K |title=Passive smoking: out from the haze |journal=Nature |volume=447 |issue=7148 |pages=1049–51 |year=2007 |pmid=17597735 |doi=10.1038/4471049a }}</ref><ref>{{cite journal |author=Bailar J |title=Passive Smoking, Coronary Heart Disease, and Meta-Analysis (Editorial) |journal=The New England Journal of Medicine |volume=340 |issue=12 |year=1999 |pmid=10089192 |pages=958–9 |doi=10.1056/NEJM199903253401211}}</ref> One proposed explanation is that second-hand smoke is not simply a diluted version of "mainstream" smoke, but has a different composition with more toxic substances per gram of total particulate matter.<ref name="nature"/> Passive smoking appears to be capable of precipitating the acute manifestations of cardio-vascular diseases (atherothrombosis) and may also have a negative impact on the outcome of patients who suffer acute coronary syndromes.<ref>{{cite journal |author=Raupach T, Schäfer K, Konstantinides S and Andreas S|title=Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm|journal=European Heart Journal|volume=27|pages=386–392|year=2006|doi=10.1093/eurheartj/ehi601 |pmid=16230308 |issue=4 }}</ref> | |||
| In 2004, the ] (IARC) of the ] (WHO) reviewed all significant published evidence related to tobacco smoking and cancer. It concluded: | |||
| {{quote|These meta-analyses show that there is a statistically significant and consistent association between lung cancer risk in spouses of smokers and exposure to second-hand tobacco smoke from the spouse who smokes. The excess risk is of the order of 20% for women and 30% for men and remains after controlling for some potential sources of bias and confounding.<ref name=IARC2004/>}} | |||
| Subsequent meta-analyses have confirmed these findings,<ref name="pmid17690135">{{cite journal |author=Taylor R, Najafi F, Dobson A |title=Meta-analysis of studies of passive smoking and lung cancer: effects of study type and continent |journal=Int J Epidemiol |volume=36 |issue=5 |pages=1048–59 |year=2007 |month=October |pmid=17690135 |doi=10.1093/ije/dym158 |url=http://ije.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17690135 }}</ref><ref name="pmid17267733">{{cite journal |author=Stayner L, Bena J, Sasco AJ, ''et al.'' |title=Lung Cancer Risk and Workplace Exposure to Environmental Tobacco Smoke |journal=Am J Public Health |volume=97 |issue=3 |pages=545–51 |year=2007 |pmid=17267733 |doi=10.2105/AJPH.2004.061275 |pmc=1805004 }}</ref> and additional studies have found that high overall exposure to passive smoke even among people with non-smoking partners is associated with greater risks than partner smoking and is widespread in non-smokers.<ref name="pmid15229131"/> | |||
| The National Asthma Council of Australia cites studies showing that second-hand smoke is probably the most important indoor pollutant, especially around young children:<ref>{{cite web |title=Health effects of indoor air pollution |url=http://www.nationalasthma.org.au/html/management/infopapers/health_professionals/4005.asp |accessdate=2006-07-26 }}</ref> | |||
| * Smoking by either parent, particularly by the mother, increases the risk of asthma in children. | |||
| * The outlook for early childhood asthma is less favourable in smoking households. | |||
| * Children with asthma who are exposed to smoking in the home generally have more severe disease. | |||
| * Many adults with asthma identify ETS as a trigger for their symptoms. | |||
| * Doctor-diagnosed asthma is more common among non-smoking adults exposed to ETS than those not exposed. Among people with asthma, higher ETS exposure is associated with a greater risk of severe attacks. | |||
| In ], exposure to second-hand smoke has been estimated to cause between 3,000<ref>{{cite journal |author=Wirth N, Abou-Hamdan K, Spinosa A, Bohadana A, Martinet Y |title= |language=French |journal=Rev Pneumol Clin |volume=61 |issue=1 Pt 1 |pages=7–15 |year=2005 |month=February |pmid=15772574 |url=http://www.masson.fr/masson/MDOI-RPC-03-2005-61-1-0761-8417-101019-200513087}}</ref> and 5,000 premature deaths per year, with the larger figure cited by Prime minister ] during his announcement of a nationwide smoke-free law: "That makes more than 13 deaths a day. It is an unacceptable reality in our country in terms of public health."<ref name="France to ban smoking">{{cite news |title=France to ban smoking in public |url=http://news.bbc.co.uk/1/hi/world/europe/6032125.stm |accessdate=2006-10-09 |publisher = ] |date = 2006-10-08}}</ref> | |||
| There is good observational evidence that smoke-free legislation reduces the number of hospital admissions for heart disease.<ref>{{cite journal |date=8 June 2010 |doi=10.1136/bmj.c2161 |journal=BMJ |volume=340 |pages=c2161 |title=Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction |author=Sims M, Maxwell R, Bauld L, Gilmore A |pmid=20530563 |pmc=2882555 }}</ref> In 2009 two studies in the United States confirmed the effectiveness of public smoking bans in preventing heart attacks. The first study, carried out at the University of California, San Francisco and funded by the National Cancer Institute, found a 15 percent decline in heart-attack hospitalisations in the first year after smoke-free legislation was passed, and 36 percent after three years.<ref>{{cite journal |author=Lightwood JM, Glantz SA |title=Declines in Acute Myocardial Infarction following Smokefree Laws and Individual Risk Attributable to Secondhand Smoke |journal=Circulation |volume=120 |issue=14 |pages=1373–9 |year=2009 |month=October |pmid=19770392 |pmc=2967202 |doi=10.1161/CIRCULATIONAHA.109.870691 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=19770392 }}</ref> The second study, carried out at the University of Kansas School of Medicine, showed similar results.<ref>{{cite journal |author=Meyers DG, Neuberger JS |title=Cardiovascular effect of bans on smoking in public places |journal=Am. J. Cardiol. |volume=102 |issue=10 |pages=1421–4 |year=2008 |month=November |pmid=18993167 |doi=10.1016/j.amjcard.2008.06.065 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(08)01239-3 }}</ref> Overall, women, non-smokers, and people under age 60 had the most heart attack risk reduction. Many of those benefiting were hospitality and entertainment industry workers.<ref>{{cite news |last = Tamkins |first = Theresa |title = Big drop in heart attacks after smoking bans, studies say |publisher = CNNhealth.com |date = September 22, 2009 |url = http://www.cnn.com/2009/HEALTH/09/22/moh.healthmag.smoking.heart/ |accessdate = 2009-09-23}}</ref> | |||
| === Risk level === | |||
| <span class="wikiEditor-tab"></span> | |||
| The ] of the ] concluded in 2004 that there was sufficient evidence that second-hand smoke caused cancer in humans.<ref name=IARC2004/> | |||
| <span class="wikiEditor-tab"></span> | |||
| Most experts conclude that moderate, occasional exposure to second-hand smoke presents a modest but measurable cancer risk to nonsmokers. The overall risk depends on the effective dose received over time. The risk level is higher if non-smokers spend many hours in an environment where cigarette smoke is widespread, such as a business where many employees or patrons are smoking throughout the day, or a residential care facility where residents smoke freely.<ref name="environmental1440">{{cite journal |author=Boffetta P, Agudo A, Ahrens W, ''et al.'' |title=Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe |journal=J. Natl. Cancer Inst. |volume=90 |issue=19 |pages=1440–50 |year=1998 |pmid=9776409|doi=10.1093/jnci/90.19.1440 }}</ref> | |||
| <span class="wikiEditor-tab"></span> | |||
| The ], in his 2006 report, estimated that living or working in a place where smoking is permitted increases the non-smokers' risk of developing heart disease by 25–30% and lung cancer by 20–30%. | |||
| ===Biomarkers=== | |||
| ] | |||
| Environmental tobacco smoke can be evaluated either by directly measuring tobacco smoke pollutants found in the air or by using biomarkers, an indirect measure of exposure. ] monitored through breath, ], ], ], and proteins are the most specific biological markers of tobacco smoke exposure.<ref name=Metz05>{{cite journal |author=Metz-Favre C, Donnay C, de Blay F |title= |language=French |journal=Rev Mal Respir |volume=22 |issue=1 Pt 1 |pages=81–92 |year=2005 |month=February |pmid=15968761 }}</ref><ref>{{cite journal |author=McClure JB |title=Are biomarkers useful treatment aids for promoting health behavior change? An empirical review |journal=Am J Prev Med |volume=22 |issue=3 |pages=200–7 |year=2002 |month=April |pmid=11897465 |doi=10.1016/S0749-3797(01)00425-1 }}</ref> Biochemical tests are a much more reliable biomarker of second-hand smoke exposure than surveys. Certain groups of people are reluctant to disclose their smoking status and exposure to tobacco smoke, especially pregnant women and parents of young children. This is due to their smoking being socially unacceptable. Also, it may be difficult for individuals to recall their exposure to tobacco smoke.<ref>{{cite journal |author=Klesges RC, Debon M, Ray JW |title=Are self-reports of smoking rate biased? Evidence from the Second National Health and Nutrition Examination Survey |journal=J Clin Epidemiol |volume=48 |issue=10 |pages=1225–33 |year=1995 |month=October |pmid=7561984 |doi=10.1016/0895-4356(95)00020-5 }}</ref> | |||
| A 2007 study in the Addictive Behaviors Journal found a positive correlation between second-hand tobacco smoke exposure and concentrations of nicotine and/or biomarkers of nicotine in the body. Significant biological levels of nicotine from second-hand smoke exposure were equivalent to nicotine levels from active smoking and levels that are associated with behaviour changes due to nicotine consumption.<ref>{{cite journal |author=Okoli CT, Kelly T, Hahn EJ |title=Secondhand smoke and nicotine exposure: a brief review |journal=Addict Behav |volume=32 |issue=10 |pages=1977–88 |year=2007 |month=October |pmid=17270359 |doi=10.1016/j.addbeh.2006.12.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0306-4603(07)00002-0}}</ref> | |||
| ====Cotinine==== | |||
| ], the metabolite of nicotine, is a biomarker of second-hand smoke exposure. Typically, cotinine is measured in the blood, saliva, and urine. Hair analysis has recently become a new, noninvasive measurement technique. Cotinine accumulates in hair during hair growth, which results in a measure of long-term, cumulative exposure to tobacco smoke.<ref name=Florescu09>{{cite journal |author=Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G |title=Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicology |journal=Ther Drug Monit |volume=31 |issue=1 |pages=14–30 |year=2009 |month=February |pmid=19125149 |doi=10.1097/FTD.0b013e3181957a3b |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0163-4356&volume=31&issue=1&spage=14}}</ref> Urinary cotinine levels have been a reliable biomarker of tobacco exposure and have been used as a reference in many epidemiological studies. However, cotinine levels found in the urine only reflect exposure over the preceding 48 hours. Cotinine levels of the skin, such as the hair and nails, reflect tobacco exposure over the previous three months and are a more reliable biomarker.<ref name=Metz05/> | |||
| ====Carbon Monoxide (CO)==== | |||
| ] is also a reliable biomarker of second-hand smoke exposure as well as tobacco use. With high sensitivity and specificity, it not only provides an accurate measure, but the test is also non-invasive, highly reproducible, and low in cost. Breath CO monitoring measures the concentration of CO in an exhalation in ], and this can be directly correlated to the blood CO concentration (]).<ref>{{cite journal |author=Irving JM, Clark EC, Crombie IK, Smith WC |title=Evaluation of a portable measure of expired-air carbon monoxide |journal=Prev Med |volume=17 |issue=1 |pages=109–15 |year=1988 |month=January |pmid=3362796 |doi=10.1016/0091-7435(88)90076-X }}</ref> Breath CO monitors can also be used by emergency services to identify patients who are suspected of having CO poisoning. | |||
| == Pathophysiology == | |||
| A 2004 study by the ] of the ] concluded that non-smokers are exposed to the same carcinogens as active smokers. ] contains more than 4,000 chemicals, including 69 known carcinogens. Of special concern are ], tobacco-specific N-], and ], such as ], all known to be highly carcinogenic. Mainstream smoke, sidestream smoke, and second-hand smoke contain largely the same components, however the concentration varies depending on type of smoke.<ref name=IARC2004/> Several well-established ]s have been shown by the tobacco companies' own research to be present at higher concentrations in sidestream smoke than in mainstream smoke.<ref>{{cite journal |author=Schick S, Glantz S. |title=Philip Morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke |journal=Tob Control. |volume=14 |issue=6 |pages=396–404 |year=2005 |pmid=16319363 |pmc=1748121 |doi=10.1136/tc.2005.011288 }}</ref> | |||
| Second-hand smoke has been shown to produce more particulate-matter (PM) pollution than an idling low-emission ]. In an experiment conducted by the Italian National Cancer Institute, three cigarettes were left ]ing, one after the other, in a 60 m³ garage with a limited air exchange. The cigarettes produced PM pollution exceeding outdoor limits, as well as PM concentrations up to 10-fold that of the idling engine.<ref>{{cite journal |author=Invernizzi G, Ruprecht A, Mazza R, ''et al.'' |title=Particulate matter from tobacco versus diesel car exhaust: an educational perspective |journal=Tob Control |volume=13 |issue=3 |pages=219–21 |year=2004 |pmid=15333875 |pmc=1747905 |doi=10.1136/tc.2003.005975 }}</ref> | |||
| Tobacco smoke exposure has immediate and substantial effects on blood and blood vessels in a way that increases the risk of a heart attack, particularly in people already at risk.<ref>{{cite journal |author=Barnoya J, Glantz SA |title=Cardiovascular effects of secondhand smoke: nearly as large as smoking |journal=Circulation |volume=111 |issue=20 |pages=2684–98 |year=2005 |pmid=15911719 |doi=10.1161/CIRCULATIONAHA.104.492215 }}</ref> Exposure to tobacco smoke for 30 minutes significantly reduces coronary flow velocity reserve in healthy nonsmokers.<ref name="pmid11466122">{{cite journal |author=Otsuka R, Watanabe H, Hirata K, ''et al.'' |title=Acute effects of passive smoking on the coronary circulation in healthy young adults |journal=JAMA |volume=286 |issue=4 |pages=436–41 |year=2001 |pmid=11466122|doi=10.1001/jama.286.4.436 }}</ref> | |||
| Pulmonary emphysema can be induced in rats through acute exposure to sidestream tobacco smoke (30 cigarettes per day) over a period of 45 days.<ref></ref> Degranulation of ]s contributing to lung damage has also been observed.<ref></ref> | |||
| The term "]" was recently coined to identify the residual tobacco smoke contamination that remains after the cigarette is extinguished and second-hand smoke has cleared from the air.<ref>{{cite journal |author=Matt GE, Quintana PJ, Hovell MF, ''et al.'' |title=Households contaminated by environmental tobacco smoke: sources of infant exposures |journal=Tob Control |volume=13 |issue=1 |pages=29–37 |year=2004 |month=March |pmid=14985592 |pmc=1747815 |doi= 10.1136/tc.2003.003889|url=http://tc.bmjjournals.com/cgi/pmidlookup?view=long&pmid=14985592 }}</ref><ref>{{cite journal |author=Winickoff JP, Friebely J, Tanski SE, ''et al.'' |title=Beliefs about the health effects of "thirdhand" smoke and home smoking bans |journal=Pediatrics |volume=123 |issue=1 |pages=e74–9 |year=2009 |month=January |pmid=19117850 |doi=10.1542/peds.2008-2184 }}</ref><ref>{{cite news |url = http://www.nytimes.com/2009/01/03/health/research/03smoke.html |work = ] |title = A New Cigarette Hazard: ‘Third-Hand Smoke’ |first = Roni Caryn |last = Rabin |date = 2009-01-02 |accessdate = 2009-01-12}}</ref> Preliminary research suggests that by-products of third-hand smoke may pose a health risk,<ref>{{cite journal|author=Sleiman M, Gundel LA, Pankow JF, ''et al.''|title=Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards|journal=Proc. Natl. Acad. Sci. U.S.A. |year=2010|month=February|doi=10.1073/pnas.0912820107|url=http://www.pnas.org/content/early/2010/02/04/0912820107.full.pdf|pmid=20142504|volume=107|issue=15|pages=6576–81|pmc=2872399}}</ref> | |||
| though the magnitude of risk, if any, remains unknown. In October 2011, it was reported that Christus St. Frances Cabrini Hospital in ] would seek to eliminate third-hand smoke beginning in July 2012, and that employees whose clothing smelled of smoke would not be allowed to work. This prohibition was enacted because third-hand smoke poses a special danger for the developing brains of infants and small children.<ref>, Fox News, October 3, 2011</ref> | |||
| In 2008, there were more than 161,000 deaths attributed to lung cancer in the United States. Of these deaths, an estimated 10% to 15% were caused by factors other than first-hand smoking; equivalent to 16,000 to 24,000 deaths annually. Slightly more than half of the lung cancer deaths caused by factors other than first-hand smoking were found in nonsmokers. Lung cancer in non-smokers may well be considered one of the most common cancer mortalities in the United States. Clinical epidemiology of lung cancer has linked the primary factors closely tied to lung cancer in non-smokers as exposure to second-hand tobacco smoke, carcinogens including radon, and other indoor air pollutants.<ref>{{cite journal |author=Samet JM, Avila-Tang E, Boffetta P, ''et al.'' |title=LUNG CANCER IN NEVER SMOKERS: CLINICAL EPIDEMIOLOGY AND ENVIRONMENTAL RISK FACTORS |journal=Clin. Cancer Res. |volume=15 |issue=18 |pages=5626–45 |year=2009 |month=September |pmid=19755391 |doi=10.1158/1078-0432.CCR-09-0376 |url=http://clincancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=19755391 |pmc=3170525}}</ref> | |||
| == Opinion of public health authorities == | |||
| There is widespread ] that exposure to second-hand smoke is harmful.<ref name="kessler">{{harvnb|Kessler|2006}}</ref> The link between passive smoking and health risks is accepted by every major medical and scientific organisation, including: | |||
| * The ]<ref name=IARC2004/>: The governments of 168 nations have signed and currently 174 have ] the ], which states that "Parties recognize that scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability."<ref name="framework-treaty"/> | |||
| * The U.S. ]<ref>{{cite web |url = http://ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s176toba.pdf |title = Environmental Tobacco Smoke |work = 11th Report on Carcinogens |publisher = U.S. ] |accessdate = 2007-08-27}}</ref> | |||
| * The ]<ref>{{cite web |url =http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm |title = Secondhand Smoke Fact Sheet |publisher = U.S. ] }}</ref> | |||
| * The ]<ref name="sg-report"/> | |||
| * The U.S. ]<ref>{{cite web |url = http://cancercontrol.cancer.gov/tcrb/monographs/10/index.html |title = Health Effects of Exposure to Environmental Tobacco Smoke |publisher = U.S. ] |accessdate = 2007-08-22}}</ref> | |||
| * The ]<ref>{{cite web |url = http://www.epa.gov/smokefree/healtheffects.html |title = Health Effects of Exposure to Secondhand Smoke |publisher = ] |accessdate = 2007-09-24}}</ref> | |||
| * The ]<ref name="calepa2005"/> | |||
| * The ],<ref>{{cite web |url = http://www.americanheart.org/presenter.jhtml?identifier=3039906 |title = The Truth about Secondhand Smoke |publisher = ] |accessdate = 2007-08-27}}</ref> ],<ref>{{cite web |url = http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35422 |title = Secondhand Smoke Fact Sheet |publisher = ] |accessdate = 2007-09-24 |archiveurl = http://web.archive.org/web/20070918063752/http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35422 <!-- Bot retrieved archive --> |archivedate = 2007-09-18}}</ref> and ]<ref>{{cite web |url = http://www.cancer.org/docroot/PED/content/PED_10_2X_Secondhand_Smoke-Clean_Indoor_Air.asp |title = Secondhand Smoke |publisher = ] |accessdate = 2007-08-27}}</ref> | |||
| * The ]<ref>{{cite press release |url = http://www.ama-assn.org/ama/pub/category/16496.html |title = AMA: Surgeon General's secondhand smoke report a wake-up call to lawmakers |publisher = ] |accessdate = 2007-08-27}}</ref> | |||
| * The ]<ref>{{cite web |url = http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b107/4/794 |title = Tobacco's Toll: Implications for the Pediatrician |publisher = ] |accessdate = 2007-10-02}}</ref> | |||
| * The Australian ]<ref name="nphp">{{cite web |url = http://www.nphp.gov.au/publications/legislation/smoke_passive.pdf |title = National Response to Passive Smoking in Enclosed Public Places and Workplaces |publisher = Australian National Public Health Partnership |date = November 2000 |accessdate = 2007-09-11}}</ref> | |||
| * The ] Scientific Committee on Tobacco and Health<ref>Two relevant reports have been published by the Scientific Committee: | |||
| * A concluded that passive smoking was a cause of lung cancer, heart disease, and other health problems. | |||
| * A , reviewing new evidence published since the 1998 report, found that recent research had confirmed the initially reported link between passive smoking and health risks.</ref> | |||
| == Public opinion == | |||
| Recent major surveys conducted by the U.S. ] and ] have found widespread public awareness that second-hand smoke is harmful. In both 1992 and 2000 surveys, more than 80% of respondents agreed with the statement that second-hand smoke was harmful. A 2001 study found that 95% of adults agreed that second-hand smoke was harmful to children, and 96% considered tobacco-industry claims that second-hand smoke was not harmful to be untruthful.<ref>{{harvnb|Surgeon General|2006|p=588 Ch. 10}}</ref> | |||
| A 2007 ] found that 56% of respondents felt that second-hand smoke was "very harmful", a number that has held relatively steady since 1997. Another 29% believe that second-hand smoke is "somewhat harmful"; 10% answered "not too harmful", while 5% said "not at all harmful". | |||
| == Controversy over harm == | |||
| As part of its attempt to prevent or delay tighter regulation of smoking, the tobacco industry funded a number of scientific studies and, where the results cast doubt on the risks associated with second-hand smoke, sought wide publicity for those results. The industry also funded libertarian and conservative think tanks, such as the ] in the United States and the ] in Australia which criticised both scientific research on passive smoking and policy proposals to restrict smoking.<ref>"". Accessed 8 April 2011.</ref><ref>Nahan, Mike. ''The Australian'', 10 April 2000, "The IPA sings its own song".</ref> ''New Scientist'' and the ''European Journal of Public Health'' have identified these industry-wide coordinated activities as one of the earliest expressions of ]. Further, they state that the disinformation spread by the tobacco industry has created a ''tobacco denialism'' movement, sharing many characteristics of other forms of ], such as ].<ref>{{Cite journal | journal=New Scientist|author=Shermer M, MacKenzier D, Littlemore R, Giles J, Fitzpatrick M | last1=Shermer|first1=Michael | last2=MacKenzie|first2=Debora | last3=Littlemore|first3=Richard | last4=Giles|first4=Jim | last5=Fitzpatrick|first5=Michael | date=15 May 2010 | pages=36–45 | title=State of Denial, a Special Report | url=http://www.newscientist.com/special/living-in-denial | accessdate=16 August 2010 }}</ref><ref>{{cite journal | author = Diethelm, PA and McKee, M | year = 2009 | title = Denialism: what is it and how should scientists respond? | journal = European Journal of Public Health | volume = 19 | issue = 1 | pages = 2–4 | url = http://eurpub.oxfordjournals.org/cgi/content/extract/19/1/2 |laysummary=http://denyingaids.blogspot.com/2009/05/denialism-what-is-it-and-how-should.html | ref = harv| doi = 10.1093/eurpub/ckn139 | pmid = 19158101}}</ref> | |||
| ===Industry-funded studies and critiques=== | |||
| ====Enstrom and Kabat==== | |||
| A 2003 study by Enstrom and Kabat, published in the '']'', argued that the harms of passive smoking had been overstated.<ref>{{cite journal |author=Enstrom JE, Kabat GC |title=Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98 |journal=BMJ |volume=326 |issue=7398 |page=1057 |year=2003 |pmid=12750205 |doi=10.1136/bmj.326.7398.1057 |pmc=155687 }}</ref> Their analysis reported no statistically significant relationship between passive smoking and lung cancer, though the accompanying editorial noted that "they may overemphasise the negative nature of their findings."<ref>{{cite journal |author=Davey Smith G |title=Effect of passive smoking on health: More information is available, but the controversy still persists |journal=BMJ |volume=326 |issue=7398 |pages=1048–9 |year=2003 |pmid=12750182 |doi=10.1136/bmj.326.7398.1048 |pmc=1125974 }}</ref> This paper was widely promoted by the tobacco industry as evidence that the harms of passive smoking were unproven.<ref>{{harvnb|Kessler|2006|p=1383}}</ref><ref name="tong2007">{{cite journal |author=Tong EK, Glantz SA |title=Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease |journal=Circulation |volume=116 |issue=16 |pages=1845–54 |year=2007 |pmid=17938301 |doi=10.1161/CIRCULATIONAHA.107.715888 }}</ref> The ] (ACS), whose database Enstrom and Kabat used to compile their data, criticized the paper as "neither reliable nor independent", stating that scientists at the ACS had repeatedly pointed out serious flaws in Enstrom and Kabat's methodology prior to publication.<ref name="acsresponse">{{cite press release |url = http://www.no-smoke.org/pdf/BMJrelease.pdf |title = American Cancer Society Condemns Tobacco Industry Study for Inaccurate Use of Data |publisher = ] |date = 2003-05-13 |accessdate = 2007-08-29}}</ref> Notably, the study had failed to identify a comparison group of "unexposed" persons.<ref>{{cite journal |url=http://www.bmj.com/content/327/7418/E237 |author=Thun MJC |title=More misleading science from the tobacco industry |journal=BMJ |volume=327 |page=E237–8 |year=2003 |doi=10.1136/bmjusa.03070002 |doi_brokendate=2010-06-20 |issue=7418}}</ref> | |||
| Enstrom's ties to the tobacco industry also drew scrutiny; in a 1997 letter to ], Enstrom requested a "substantial research commitment... in order for me to effectively compete against the large mountain of epidemiologic data and opinions that already exist regarding the health effects of ETS and active smoking."<ref>{{cite web |url = http://legacy.library.ucsf.edu/tid/dfk37d00 |title = Proposed Research on the relationship of Low Levels of Active Smoking to Mortality: Letter from James Enstrom to Philip Morris Scientific Affairs office |date = 1997-01-01 |accessdate = 2007-08-29}}</ref> In a ], the Enstrom and Kabat paper was cited by the US District Court as "a prime example of how nine tobacco companies engaged in criminal racketeering and fraud to hide the dangers of tobacco smoke."<ref name="nature-2007-review">{{cite journal |author=Dalton R |title=Passive-smoking study faces review |journal=Nature |volume=446 |issue=7133 |pages=242 |year=2007 |month=March |pmid=17361147 |doi=10.1038/446242a |url=http://www.nature.com/nature/journal/v446/n7133/full/446242a.html }}</ref> The Court found that the study had been funded and managed by the Center for Indoor Air Research,<ref>{{harvnb|Kessler|2006|p=1380}}</ref> a tobacco industry ] tasked with "offsetting" damaging studies on passive smoking, as well as by Phillip Morris<ref name="ong-glantz-2000"/> who stated that Enstrom's work was "clearly litigation-oriented."<ref>{{harvnb|Kessler|2006|pp=1380–3}}</ref> Enstrom has defended the accuracy of his study against what he terms "illegitimate criticism by those who have attempted to suppress and discredit it."<ref>{{cite journal |author=Enstrom JE |title=Defending legitimate epidemiologic research: combating Lysenko pseudoscience |journal=Epidemiol Perspect Innov|volume=4 |issue=1 |page=11 |year=2007 |pmid=17927827 |doi=10.1186/1742-5573-4-11 |pmc=2164936 }}</ref> | |||
| ====Gori==== | |||
| ], a tobacco industry spokesman and consultant<ref>{{harvnb|Kessler|2006|p=162}}</ref><ref>, United States Factual Memorandum Pursuant to Order No. 470, Section V, United States District Court for the District of Columbia. p. 44</ref><ref>, from the Legacy Tobacco Documents Archive. Retrieved July 19, 2007.</ref> and an expert on risk utility and scientific research, wrote in the ] ]'s journal ''Regulation'' that "...of the 75 published studies of ETS and lung cancer, some 70 percent did not report statistically significant differences of risk and are moot. Roughly 17 percent claim an increased risk and 13 percent imply a reduction of risk."<ref>{{cite journal |author=Gori, Gio Batta |title=Stoking the Rigged Terror of Secondhand Smoke |journal=Regulation |volume=30 |issue=1 |pages=14–7 |date=Spring 2007 |url=http://www.cato.org/pubs/regulation/regv30n1/v30n1-5.pdf }}</ref> | |||
| ====Milloy==== | |||
| ], the "]" commentator for ] and a former ] consultant,<ref>, by Paul D. Thacker. Published in '']'' on January 26, 2006. Retrieved August 22, 2007.</ref><ref>, listing Milloy as a paid consultant. Retrieved August 22, 2007.</ref> claimed that "...of the 37 studies , only 7 – less than 19 percent – reported statistically significant increases in lung cancer incidence."<ref>, by ]. Retrieved August 22, 2007.</ref> | |||
| Another component of criticism cited by Milloy focused on ] and epidemiological practices in studies of passive smoking. Milloy, who has a masters degree from the Johns Hopkins School of Hygiene and Public Health, argued that studies yielding relative risks of less than 2 were meaningless ]. This approach to epidemiological analysis was criticized in the '']'': | |||
| {{quote|A major component of the industry attack was the mounting of a campaign to establish a "bar" for "sound science" that could not be fully met by most individual investigations, leaving studies that did not meet the criteria to be dismissed as "junk science."<ref>{{cite journal |author=Samet JM, Burke TA |title=Turning Science Into Junk: The Tobacco Industry and Passive Smoking |journal=Am J Public Health |volume=91 |issue=11 |pages=1742–4 |year=2001 |pmid=11684591 |doi=10.2105/AJPH.91.11.1742 |pmc=1446866 }}</ref>}} | |||
| The tobacco industry and affiliated scientists also put forward a set of "Good Epidemiology Practices" which would have the practical effect of obscuring the link between secondhand smoke and lung cancer; the privately-stated goal of these standards was to "impede adverse legislation".<ref>, from the Philip Morris document archive. Retrieved October 3, 2007. Also cited in {{cite journal |author=Ong EK, Glantz SA |title=Constructing "Sound Science" and "Good Epidemiology": Tobacco, Lawyers, and Public Relations Firms |journal=Am J Public Health |volume=91 |issue=11 |pages=1749–57 |year=2001 |pmid=11684593 |doi=10.2105/AJPH.91.11.1749 |pmc=1446868 }}</ref> However, this effort was largely abandoned when it became clear that no independent epidemiological organization would agree to the standards proposed by Philip Morris et al.<ref name="pmid11684593">{{cite journal |author=Ong EK, Glantz SA |title=Constructing "Sound Science" and "Good Epidemiology": Tobacco, Lawyers, and Public Relations Firms |journal=Am J Public Health |volume=91 |issue=11 |pages=1749–57 |year=2001 |pmid=11684593 |doi=10.2105/AJPH.91.11.1749 |pmc=1446868 }}</ref> | |||
| ==== World Health Organization controversy ==== | |||
| A 1998 report by the ] (IARC) on environmental tobacco smoke (ETS) found "weak evidence of a dose-response relationship between risk of lung cancer and exposure to spousal and workplace ETS."<ref name="environmental1440"/> | |||
| In March 1998, before the study was published, reports appeared in the media alleging that the IARC and the ] (WHO) were suppressing information. The reports, appearing in the British '']''<ref>{{cite web |title=Passive Smoking Doesn't Cause Cancer —Official |url=http://tobaccodocuments.org/pm/2063594041-4042.html}}</ref> and '']'',<ref>{{cite web |title=Smokescreens – The World Health Organization is showing signs of allowing politics to get in the way of truth. The Economist March 14th, 1998 |url=http://ltdlimages.library.ucsf.edu/imagesv/v/d/m/vdm97d00/Svdm97d00.pdf|format=PDF}}</ref> among other sources,<ref>Le Grand C. Anti-smokers blown away by study. Australian 1998, March 10.</ref><ref>WHO Rejects smoking link with lung cancer. Zimbabwe Independent 1998, Oct 23.</ref><ref>No Link Between Passive Smoking and Lung Cancer. ] 1998, March 9.</ref> alleged that the WHO withheld from publication of its own report that supposedly failed to prove an association between passive smoking and a number of other diseases (lung cancer in particular). | |||
| In response, the WHO issued a press release stating that the results of the study had been "completely misrepresented" in the popular press and were in fact very much in line with similar studies demonstrating the harms of passive smoking.<ref>{{cite web |title=Passive Smoking Does Cause Lung Cancer, Do Not Let Them Fool You |url=http://www.who.int/inf-pr-1998/en/pr98-29.html}}</ref> The study was published in the ''Journal of the National Cancer Institute'' in October of the same year. An accompanying editorial summarized: | |||
| {{quote|When all the evidence, including the important new data reported in this issue of the Journal, is assessed, the inescapable scientific conclusion is that ETS is a low-level lung carcinogen.<ref>{{cite journal |author=Blot WJ, McLaughlin JK |title=Passive smoking and lung cancer risk: what is the story now? |journal=J. Natl. Cancer Inst. |volume=90 |issue=19 |pages=1416–7 |year=1998 |pmid=9776401|doi=10.1093/jnci/90.19.1416 }}</ref>}} | |||
| With the release of formerly classified tobacco industry documents through the ], it was found that the controversy over the WHO's alleged suppression of data had been engineered by ], ], and other tobacco companies in an effort to discredit scientific findings which would harm their business interests.<ref name="ong-glantz-2000">{{cite journal |author=Ong EK, Glantz SA |title=Tobacco industry efforts subverting International Agency for Research on Cancer's second-hand smoke study |journal=Lancet |volume=355 |issue=9211 |pages=1253–9 |year=2000 |pmid=10770318 |doi=10.1016/S0140-6736(00)02098-5 }}</ref> A WHO inquiry, conducted after the release of the tobacco-industry documents, found that this controversy was generated by the tobacco industry as part of its larger campaign to cut the WHO's budget, distort the results of scientific studies on passive smoking, and discredit the WHO as an institution. This campaign was carried out using a network of ostensibly independent ] and international and scientific experts with hidden financial ties to the industry.<ref>{{cite web |title=Tobacco Companies Strategies to Undermine Tobacco Control Activities at the World Health Organization |url=http://www.who.int/tobacco/media/en/who_inquiry.pdf|format=PDF|accessdate=2008-12-30}}</ref> | |||
| ==== EPA lawsuit ==== | |||
| In 1993, the ] (EPA) issued a report estimating that 3,000 lung cancer related deaths in the ] were caused by passive smoking annually.<ref name="EPA report"/> | |||
| ], ], and groups representing growers, distributors and marketers of tobacco took legal action, claiming that the EPA had manipulated this study and ignored accepted scientific and statistical practices. | |||
| The ] ruled in favor of the tobacco industry in 1998, finding that the EPA had failed to follow proper scientific and epidemiologic practices and had "cherry picked" evidence to support conclusions which they had committed to in advance.<ref>{{cite web |title=The Osteen Decision |url=http://www.tobacco.org/Documents/980717osteen.html}}</ref> The court stated in part, “EPA publicly committed to a conclusion before research had begun…adjusted established procedure and scientific norms to validate the Agency's public conclusion... In conducting the ETS Risk Assessment, disregarded information and made findings on selective information; did not disseminate significant epidemiologic information; deviated from its Risk Assessment Guidelines; failed to disclose important findings and reasoning…" | |||
| In 2002, the EPA successfully appealed this decision to the ]. The EPA's appeal was upheld on the preliminary grounds that their report had no regulatory weight, and the earlier finding was vacated.<ref>{{cite web |title=Flue-Cured Tobacco Cooperative vs. EPA |url=http://pacer.ca4.uscourts.gov/opinion.pdf/982407.P.pdf|format=PDF|accessdate=2008-12-30}}</ref> | |||
| In 1998, the U.S. Department of Health and Human Services, through the publication by its National Toxicology Program of the 9th Report on Carcinogens, listed environmental tobacco smoke among the known carcinogens, observing of the EPA assessment that "The individual studies were carefully summarized and evaluated."<ref>{{cite book |contribution=Final Report on Carcinogens – Background Document for Environmental Tobacco Smoke |title=Meeting of the NTP Board of Scientific Counselors – Report on Carcinogens Subcommittee |editor=U.S. Department of Health and Human Services, National Toxicology Program |location=Research Triangle Park, North Carolina |date=December 2–3, 1998 |url=http://ntp.niehs.nih.gov/files/EnvironmentalTS.pdf |page=24 |format=PDF |ref=harv |postscript=<!--None--> }}</ref> | |||
| ==== Tobacco-industry funding of research ==== | |||
| The tobacco industry's role in funding scientific research on second-hand smoke has been controversial.<ref>{{cite journal |author=Thun MJ |title=Passive smoking: Tobacco industry publishes disinformation |journal=BMJ |volume=327 |issue=7413 |pages=502–3; author reply 504–5 |year=2003 |pmid=12946979 |doi=10.1136/bmj.327.7413.502-c |pmc=188400 }}</ref> A review of published studies found that tobacco-industry affiliation was strongly correlated with findings exonerating second-hand smoke; researchers affiliated with the tobacco industry were 88 times more likely than independent researchers to conclude that second-hand was not harmful.<ref name="pmid9605902">{{cite journal |author=Barnes DE, Bero LA |title=Why review articles on the health effects of passive smoking reach different conclusions |journal=JAMA |volume=279 |issue=19 |pages=1566–70 |year=1998 |pmid=9605902|doi=10.1001/jama.279.19.1566 }}</ref> In a specific example which came to light with the release of tobacco-industry documents, Philip Morris executives successfully encouraged an author to revise his industry-funded review article to downplay the role of second-hand smoke in ].<ref>{{cite journal |author=Tong EK, England L, Glantz SA |title=Changing conclusions on secondhand smoke in a sudden infant death syndrome review funded by the tobacco industry |journal=Pediatrics |volume=115 |issue=3 |pages=e356–66 |year=2005 |pmid=15741361 |doi=10.1542/peds.2004-1922 }}</ref> The 2006 U.S. Surgeon General's report criticized the tobacco industry's role in the scientific debate: | |||
| {{quote|The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus.<ref>{{cite web |title = The Health Consequences of Involuntary Exposure to Tobacco Smoke |publisher = ] |work = Executive Summary |year = 2006 |accessdate =2009-01-28 |url = http://www.surgeongeneral.gov/library/secondhandsmoke/report/executivesummary.pdf |format = PDF |page=21}}</ref>}} | |||
| This strategy was outlined at an international meeting of tobacco companies in 1988, at which Philip Morris proposed to set up a team of scientists, organized by company lawyers, to "carry out work on ETS to keep the controversy alive."<ref name="whitecoat">{{cite web |url = http://tobaccodocuments.org/landman/2063791182-1187.html |title = Minutes of a meeting of Philip Morris with British tobacco companies to discuss tobacco-industry strategy on passive smoking |accessdate = 2007-08-27}}</ref> All scientific research was subject to oversight and "filtering" by tobacco-industry lawyers: | |||
| {{quote | |||
| |Philip Morris then expect the group of scientists to operate within the confines of decisions taken by PM scientists to determine the general direction of research, which apparently would then be 'filtered' by lawyers to eliminate areas of sensitivity.<ref name="whitecoat"/> | |||
| }} | |||
| Philip Morris reported that it was putting "...vast amounts of funding into these projects... in attempting to coordinate and pay so many scientists on an international basis to keep the ETS controversy alive."<ref name="whitecoat"/> | |||
| === Tobacco industry response=== | |||
| Measures to tackle second-hand smoke pose a serious economic threat to the tobacco industry, having broadened the definition of smoking beyond a personal habit to something with a social impact. In a confidential 1978 report, the tobacco industry described increasing public concerns about second-hand smoke as "the most dangerous development to the viability of the tobacco industry that has yet occurred."<ref>, produced for the Tobacco Institute and released under the terms of the ].</ref> In ''United States of America v. Philip Morris et al.'', the District Court for the District of Columbia found that the tobacco industry "... recognized from the mid-1970s forward that the health effects of passive smoking posed a profound threat to industry viability and cigarette profits," and that the industry responded with "efforts to undermine and discredit the scientific consensus that ETS causes disease."<ref name="kessler"/> | |||
| Accordingly, the tobacco industry have developed several strategies to minimise the impact on their business: | |||
| * The industry has sought to position the second-hand smoke debate as essentially concerned with civil liberties and smokers' ] rather than with health, by funding groups such as ].<ref name="voice-smoker">{{cite journal |author=Smith EA, Malone RE |title='We will speak as the smoker': the tobacco industry's smokers' rights groups |journal=Eur J Public Health |volume=17 |issue=3 |pages=306–13 |year=2007 |month=June |pmid=17065174 |doi=10.1093/eurpub/ckl244 |url=http://eurpub.oxfordjournals.org/cgi/content/full/17/3/306 |pmc=2794244 }}</ref> | |||
| * Funding bias in research;<ref name="smoke-screen"/> in all reviews of the effects of second-hand smoke on health published between 1980 and 1995, the only factor associated with concluding that second-hand smoke is not harmful was whether an author was affiliated with the tobacco industry.<ref name="pmid9605902"/> However, not all studies that failed to find evidence of harm were by industry-affiliated authors. | |||
| * Delaying and discrediting legitimate research (see<ref name="smoke-screen"/> for an example of how the industry attempted to discredit Hirayama's landmark study, and<ref>{{cite journal |author=Trotter L, Chapman S |title="Conclusions about exposure to ETS and health that will be unhelpful to us"*: How the tobacco industry attempted to delay and discredit the 1997 Australian National Health and Medical Research Council report on passive smoking |journal=Tob Control |volume=12 |issue=Suppl 3:iii |pages=102–6 |year=2003 |pmid=14645955 |doi=10.1136/tc.12.suppl_3.iii102 |pmc=1766130 }}</ref> for an example of how it attempted to delay and discredit a major Australian report on passive smoking) | |||
| * Promoting "good epidemiology" and attacking so-called ] (a term popularised by industry lobbyist ]): attacking the methodology behind research showing health risks as flawed and attempting to promote ] . Ong & Glantz (2001) cite an internal Phillip Morris memo giving evidence of this as company policy<ref name="pmid11684593"/> | |||
| * Creation of outlets for favourable research. In 1989, the tobacco industry established the International Society of the Built Environment, which published the ] journal ''Indoor and Built Environment''. This journal did not require conflict-of-interest disclosures from its authors. With documents made available through the ], it was found that the executive board of the society and the editorial board of the journal were dominated by paid tobacco-industry consultants. The journal published a large amount of material on passive smoking, much of which was "industry-positive".<ref>{{cite journal |author=Garne D, Watson M, Chapman S, Byrne F |title=Environmental tobacco smoke research published in the journal Indoor and Built Environment and associations with the tobacco industry |journal=Lancet |volume=365 |issue=9461 |pages=804–9 |year=2005 |pmid=15733724 |doi=10.1016/S0140-6736(05)17990-2 }}</ref> | |||
| Citing the tobacco industry's production of biased research and efforts to undermine scientific findings, the 2006 U.S. Surgeon General's report concluded that the industry had "attempted to sustain controversy even as the scientific community reached consensus... industry documents indicate that the tobacco industry has engaged in widespread activities... that have gone beyond the bounds of accepted scientific practice."<ref name="sg-exec-summary"/> The U.S. District Court, in ''U.S.A. v. Philip Morris et al.'', found that "...despite their internal acknowledgment of the hazards of secondhand smoke, Defendants have fraudulently denied that ETS causes disease."<ref>{{harvnb|Kessler|2006|p=1523}}</ref> | |||
| ==== Position of major tobacco companies ==== | |||
| The positions of major tobacco companies on the issue of second-hand smoke is somewhat varied. In general, tobacco companies have continued to focus on questioning the methodology of studies showing that second-hand smoke is harmful. Some (such as ] and ]) acknowledge the medical consensus that second-hand smoke carries health risks, while others continue to assert that the evidence is inconclusive. ] describes second-hand smoke as "annoying" and "unpleasant", but denies any associated health risks. Several tobacco companies advocate the creation of smoke-free areas within public buildings as an alternative to comprehensive ].<ref>The most current positions of major tobacco companies on the issue of passive smoking can be found on their websites. As of 13 January 2009, the following websites contain tobacco-industry positions on the topic: | |||
| * ]: | |||
| * ]: | |||
| * ]: and | |||
| * ]: </ref> | |||
| === US racketeering lawsuit against tobacco companies === | |||
| On September 22, 1999, the ] filed a ] lawsuit against Philip Morris and other major cigarette manufacturers.<ref> U.S. Department of Justice</ref> Almost 7 years later, on August 17, 2006 U.S. District Court Judge Gladys Kessler found that the Government had proven its case and that the tobacco company defendants had violated the ].<ref name="kessler" /> In particular, Judge Kessler found that PM and other tobacco companies had: | |||
| * conspired to minimize, distort and confuse the public about the health hazards of smoking; | |||
| * publicly denied, while internally acknowledging, that second-hand tobacco smoke is harmful to nonsmokers, and | |||
| * destroyed documents relevant to litigation. | |||
| The ruling found that tobacco companies undertook joint efforts to undermine and discredit the scientific consensus that second-hand smoke causes disease, notably by controlling research findings via paid consultants. The ruling also concluded that tobacco companies continue today to fraudulently deny the health effects of ETS exposure.<ref name="kessler" /> | |||
| On May 22, 2009, a three-judge panel of the Washington, D.C. U.S. Court of Appeals unanimously upheld the lower court's 2006 ruling.<ref name="rico-appeal">, U.S. Court of Appeals for the District of Columbia Circuit, 22 May 2009</ref><ref> Bloomberg news, 22 May 2009</ref><ref> Reuters, 22 May 2009</ref> | |||
| == Smoke-free laws == | |||
| {{See also|Smoking ban|List of smoking bans|Smoking bans in private vehicles}} | |||
| As a consequence of the health risks associated with second-hand smoke, ] in indoor public places, including ]s, ]s, and ]s have been introduced in a number of jurisdictions, at national or local level, as well as some outdoor open areas. ] was the first country in the world to institute an comprehensive national smoke-free law on smoking in all indoor workplaces on 29 March 2004. Since then, many others have followed suit. The countries which have ratified the ] (FCTC) have a legal obligation to implement ''effective'' legislation "for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places." (Article 8 of the FCTC<ref name="framework-treaty" />) The parties to the FCTC have further adopted ''Guidelines on the Protection from Exposure to Second-hand Smoke'' which state that "effective measures to provide protection from exposure to tobacco smoke ... require the total elimination of smoking and tobacco smoke in a particular space or environment in order to create a 100% smoke-free environment."<ref name="fctc-guidelines">{{cite web |title = Guidelines on the Protection from Exposure to Secondhand Smoke |work = ] |publisher = ] |year = 2007 |accessdate =2009-01-29 |url = http://www.who.int/fctc/cop/art%208%20guidelines_english.pdf |format = PDF}}</ref> | |||
| Opinion polls have shown considerable support for smoke-free laws. In June 2007, a survey of 15 countries found 80% approval for smoke-free laws.<ref></ref> A survey in France, reputedly a nation of smokers, showed 70% support.<ref name="France to ban smoking"/> | |||
| === Effects === | |||
| In the first 18 months after the town of ], ] enacted a smoke-free law in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighbouring towns without smoke-free laws showed no change, and the decline in heart attacks in Pueblo was attributed to the resulting reduction in second-hand smoke exposure.<ref>{{cite journal |title=Reduced hospitalizations for acute myocardial infarction after implementation of a smoke-free ordinance—City of Pueblo, Colorado, 2002–2006 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=57 |issue=51 |pages=1373–7 |year=2009 |month=January |pmid=19116606 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5751a1.htm |author1= Centers for Disease Control and Prevention (CDC) }}</ref> | |||
| In April, 2010 the '']'' published a study evaluating the effects of a 10-year, three-stage smoke-free regulatory programme in ]. The study found that during the implementation of a restaurant smoke-free ordinance, hospital admissions for cardiovascular conditions declined by 39%, and admissions for respiratory conditions declined by 33%. No significant reductions in hospital admissions occurred in other cities which did not have smoke-free ordinances. The authors concluded that the study justified further efforts to reduce public exposure to tobacco smoke. In May 2006, Ontario instituted a comprehensive province-wide smoke-free law which extended the restrictions to all cities and municipalities in Ontario.<ref>{{cite journal |author=Naiman A, Glazier RH, Moineddin R |title=Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions |journal=CMAJ |year=2010 |month=April |pmid=20385737 |doi=10.1503/cmaj.091130 |url=http://www.cmaj.ca/cgi/content/abstract/cmaj.091130v1 |volume=182 |issue=8 |pages=761–7 |pmc=2871198 }}</ref> However, not all researchers agree that this was a causal relationship, and a 2009 study of many smoke-free ordinances in the United States disagreed with these conclusions.<ref>{{cite journal |author=Shetty, Kanaka D.,'' et al.'' |title=Changes in U.S. Hospitalization and Mortality Rates Following Smoking Bans |journal=NBER |year=2009 |month=April |url=http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1359506}}</ref> | |||
| In 2001, a systematic review for the Guide to Community Preventative Services acknowledged strong evidence of the effectiveness of smoke-free policies and restrictions in reducing expose to second-hand smoke. A follow up to this review, identified the evidence on which the effectiveness of smoking bans reduced the prevalence of tobacco use. Articles published until 2005, were examined to further support this evidence. The examined studies provided sufficient evidence that smoke-free policies reduce tobacco use among workers when implemented in worksites or by communities.<ref>{{cite journal | author = Hopkins DP, Razi S, Leeks KD, Priya Kalra G, Chattopadhyay SK, Soler RE | year = 2010 | title = Smokefree policies to reduce tobacco use. A systematic review | journal = Am J Prev Med | volume = 38 | issue = 2 Suppl | pages = S275–89 | doi = 10.1016/j.amepre.2009.10.029 | pmid = 20117612}}</ref> | |||
| While a number of studies funded by the tobacco industry have claimed a negative economic impact from smoke-free laws, no independently funded research has shown any such impact. A 2003 review reported that independently funded, methodologically sound research consistently found either no economic impact or a positive impact from smoke-free laws.<ref>{{cite journal |author=Scollo M, Lal A, Hyland A, Glantz S. |title=Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry |journal=Tobacco Control |year=2003 |month=Mar |pmid=12612356 |pmc=1759095 |volume=12 |issue=1 |pages=13–20 |doi=10.1136/tc.12.1.13}}</ref> | |||
| Air nicotine levels were measured in Guatemalan bars and restaurants before and after an implemented smoke-free law in 2009. Nicotine concentrations significantly decreased in both the bars and restaurants measured. Also, the employees support for a smoke-free workplace substantially increased in the post-implementation survey compared to pre-implementation survey. The result of this smoke-free law provides a considerably more healthy work environment for the staff.<ref>{{cite journal |author=Barnoya J, Arvizu M, Jones MR, Hernandez JC, Breysse PN, Navas-Acien A |title=Secondhand smoke exposure in bars and restaurants in Guatemala City: before and after smoking ban evaluation |journal=Cancer Causes Control |volume=22 |issue=1 |pages=151–6 |year=2010 |month=November |pmid=21046446 |doi=10.1007/s10552-010-9673-8 }}</ref> | |||
| === Public opinion === | |||
| Recent surveys taken by the Society for Research on Nicotine and Tobacco demonstrates supportive attitudes of the public, towards smoke-free policies in outdoor areas. A vast majority of the public supports restricting smoking in various outdoor settings. The respondents reasons for supporting the polices were for varying reasons such as, litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.<ref>{{cite journal |author=Thomson G, Wilson N, Edwards R |title=At the frontier of tobacco control: a brief review of public attitudes toward smoke-free outdoor places |journal=Nicotine Tob. Res. |volume=11 |issue=6 |pages=584–90 |year=2009 |month=June |pmid=19359392 |doi=10.1093/ntr/ntp046 |url=http://ntr.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=19359392}}</ref> | |||
| === Alternative forms === | |||
| Alternatives to smoke-free laws have also been proposed as a means of ], particularly in bars and restaurants. For example, critics of smoke-free laws cite studies suggesting ventilation as a means of reducing tobacco smoke pollutants and improving air quality.<ref>{{cite web |work = Building Sustainable Design |url = http://www.bsjonline.co.uk/story.asp?storyType=85§ioncode=95&storyCode=3047478 |title = No ifs or butts |date = March 2005 |accessdate =2009-01-28 |first = Andrew |last = Geens |coauthors = Max Graham}}</ref> Ventilation has also been heavily promoted by the tobacco industry as an alternative to outright bans, via a network of ostensibly independent experts with often undisclosed ties to the industry.<ref>{{cite journal |author=Drope J, Bialous SA, Glantz SA |title=Tobacco industry efforts to present ventilation as an alternative to smoke-free environments in North America |journal=Tob Control |volume=13 |issue=Suppl 1 |pages=i41–7 |year=2004 |month=March |pmid=14985616 |pmc=1766145 |doi= 10.1136/tc.2003.004101|url=http://tc.bmjjournals.com/cgi/pmidlookup?view=long&pmid=14985616 |quote = The industry developed a network of ventilation 'experts' to promote its position that smoke-free environments were not necessary, often without disclosing the financial relationship between these experts and the industry. }}</ref> However, not all critics have connections to the industry. | |||
| The ] (ASHRAE) officially concluded in 2005 that while completely isolated smoking rooms do eliminate the risk to nearby non-smoking areas, smoking bans are the only means of completely eliminating health risks associated with indoor exposure. They further concluded that no system of dilution or cleaning was effective at eliminating risk.<ref name="ASHRAE">{{cite web |url = http://www.ashrae.org/content/ASHRAE/ASHRAE/ArticleAltFormat/20058211239_347.pdf |format = PDF |publisher = ] |date = June 30, 2005 |accessdate =2009-01-28 |title = Environmental Tobacco Smoke: Position Document}}</ref> The ] and the ] have reached similar conclusions.<ref name="sg-exec-summary">{{cite web |title = The Health Consequences of Involuntary Exposure to Tobacco Smoke |publisher = ] |work = Executive Summary |year = 2006 |accessdate =2009-01-28 |url = http://www.surgeongeneral.gov/library/secondhandsmoke/report/executivesummary.pdf |format = PDF}}</ref><ref name="ecjrc">{{cite web |publisher = ] ] |title = Institute for Health and Consumer Protection Activity Report 2003 |year = 2003 |url = http://ihcp.jrc.ec.europa.eu/docs/IHCP_annual_report/ihcp03.pdf |format = PDF |accessdate =2009-01-28}} {{Dead link|date=October 2010|bot=H3llBot}}</ref> The implementation guidelines for the ] states that engineering approaches, such as ventilation, are ineffective and do not protect against second-hand smoke exposure.<ref name="fctc-guidelines" /> However, this does ''not'' necessarily mean that such measures are useless in reducing harm, only that they fall short of the goal of reducing exposure completely to zero. | |||
| Others have suggested a system of ], similar to the ] pollution permits systems used by the ] in recent decades to curb other types of pollution.<ref>{{cite news |title = Let Bars Buy, Sell Smoking Permits |url = http://www.madison.com/archives/read.php?ref=/madison.com/html/archive_files/wsj/2005/09/25/0509240280.php |first = Robert |last = Haveman |coauthors = John Mullahy |work = ] |date = September 25, 2005 |accessdate =2009-01-28 |page = B2}}</ref> This would guarantee that a portion of bars/restaurants in a jurisdiction will be smoke free, while leaving the decision to the market. | |||
| ==In animals== | |||
| {{main|Animals and tobacco smoke}} | |||
| Multiple studies have been conducted to determine the carcinogenicity of environmental tobacco smoke to animals. These studies typically fall under the categories of simulated environmental tobacco smoke, administering condensates of ], or observational studies of cancer among pets. | |||
| To simulate environmental tobacco smoke, scientists expose animals to sidestream smoke, that which emanates from the cigarette's burning cone and through its paper, or a combination of mainstream and sidestream smoke.<ref name=IARC2004/> The IARC monographs conclude that mice with prolonged exposure to simulated environmental tobacco smoke, that is 6hrs a day, 5 days a week, for five months with a subsequent 4 month interval before dissection, will have significantly higher incidence and multiplicity of lung tumors than with control groups. | |||
| The IARC monographs concluded that sidestream smoke condensates had a significantly higher carcinogenic effect on mice than did mainstream smoke condensates.<ref name=IARC2004/> | |||
| ===Observational studies=== | |||
| Second-hand smoke is popularly recognised as a risk factor for cancer in pets.<ref>{{cite web |url = http://www.livescience.com/animals/070831_pets_smoking.html |title = Secondhand Smoke Causes Cancer in Pets |first = Andrea |last = Thompson |publisher = LiveScience |date = 2007-08-31 |accessdate = 2007-08-31}}</ref> A study conducted by the ] and the ] linked the occurrence of feline oral cancer to exposure to environmental tobacco smoke through an overexpression of the ] gene.<ref>{{cite journal |author=Snyder LA, Bertone ER, Jakowski RM, Dooner MS, Jennings-Ritchie J, Moore AS. |title=p53 expression and environmental tobacco smoke exposure in feline oral squamous cell carcinoma |journal=Vet Pathol |volume=41 |issue=3 |pages=209–14 |year=2004 |pmid=15133168 |doi=10.1354/vp.41-3-209 }}</ref> Another study conducted at the same universities concluded that cats living with a smoker were more likely to get ]; the risk increased with the duration of exposure to secondhand smoke and the number of smokers in the household.<ref>{{cite journal |author= Bertone ER, Snyder LA, Moore AS. |title= Environmental Tobacco Smoke and Risk of Malignant Lymphoma in Pet Cats |journal=American Journal of Epidemiology |volume=156 |issue=3 |pages=268–273 |year=2002 |pmid=12142262 |doi= 10.1093/aje/kwf044 |ref= harv}}</ref> A study by ] researchers, looking at cases of canine lung cancer, was generally inconclusive, though the authors reported a weak relation for lung cancer in dogs exposed to environmental tobacco smoke. The number of smokers within the home, the number of packs smoked in the home per day, and the amount of time that the dog spent within the home had no effect on the dog's risk for lung cancer.<ref>{{cite journal |author=Reif JS, Dunn K, Ogilvie GK, Harris CK. |title=Passive smoking and canine lung cancer risk |journal=Am J Epidemiol. |volume=135 |issue=3 |pages=234–9 |year=1992 |pmid=1546698 }}</ref> | |||
| ====Animal nicotine poisoning==== | |||
| Animals like dogs, cats, squirrels, and other small animals are affected by not only second-hand smoke inhalation, but also ]. {{Citation needed|date=April 2011}} Domestic pets, especially dogs, usually fall ill when owners leave nicotine products like cigarette butts, chewing tobacco, or nicotine gum within reach of the animal.{{Citation needed|date=April 2011}} Littered cigarette butts from smokers are a problem for small animals that mistake them for food if they find them on sidewalks or trashcans.<ref>{{cite journal |author=Novotny TE, Hardin SN, Hovda LR, Novotny DJ, McLean MK, Khan S |title=Tobacco and cigarette butt consumption in humans and animals |journal=Tobacco Control |volume=20 Suppl 1 |issue= Suppl_1|pages=i17–20 |year=2011 |month=May |pmid=21504918 |pmc=3088460 |doi=10.1136/tc.2011.043489 |url=http://tobaccocontrol.bmj.com/cgi/pmidlookup?view=long&pmid=21504918}}</ref> ]s are the remains of a cigarette after smoking which contain the ] which is meant to contain tar, particles, and toxins from the cigarette such as ammonia, arsenic, benzene, turpentine and other ]. {{Citation needed|date=April 2011}} | |||
| == See also == | == See also == | ||
| * ] | |||
| * ] | * ] | ||
| * ] | |||
| * ] | * ] | ||
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| {{reflist|colwidth=30em}} | {{reflist|colwidth=30em}} | ||
| == External links == | |||
| ;Scientific bodies | |||
| {{refbegin}} | |||
| * , from the U.S. ] | |||
| * {{PDFlink||219 KB}}. From the 11th Report on Carcinogens of the U.S. ] | |||
| *{{cite journal |author1=U.S. Dept. of Health and Human Services |author2=Centers for Disease Control and Prevention |author3=Coordinating Center for Health Promotion |author4=National Center for Chronic Disease Prevention and Health Promotion |author5=Office on Smoking and Health |url=http://www.surgeongeneral.gov/library/secondhandsmoke |title=The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General |publisher=] |date=2006-06-27 |location=Atlanta, Ga. |id=O2NLM: WA 754 H4325 2006|ref=CITEREFSurgeon_General2006 |quote=Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke}} | |||
| *{{cite book |author1=] |author2=] |title=Tobacco Smoke and Involuntary Smoking |publisher=IARC Working Group on the Evaluation of Carcinogenic Risks to Humans | |||
| |location=Lyon, France |year=2004 |isbn=92-832-1283-5 |url=http://monographs.iarc.fr/ENG/Monographs/vol83/volume83.pdf |volume=83 |series=IARC monographs on the evaluation of carcinogenic risks to humans |format=PDF |ref=CITEREFIARC2004}} | |||
| * from the U.S. ] | |||
| * , from the ] | |||
| {{refend}} | |||
| ;Tobacco industry | |||
| {{refbegin}} | |||
| * {{PDFlink||1.55 MB}}: Report of the Committee of Experts on Tobacco Industry Documents from the ] | |||
| * and from the ] | |||
| * , made public as a result of the ] | |||
| {{refend}} | |||
| ;Other links | |||
| {{refbegin}} | |||
| * , by WHO Framework Convention on Tobacco Control | |||
| * | |||
| * , in ] | |||
| *{{cite web |url=http://www.tobacco.neu.edu/litigation/cases/DOJ/20060817KESSLEROPINIONAMENDED.pdf |title=United States of America v. Philip Morris ''et al.'': Final Opinion of Judge Gladys Kessler |publisher=] |last=Kessler |first=Gladys |date=August 17, 2006 |format=PDF |ref=CITEREFKessler2006}} | |||
| * | |||
| {{refend}} | |||
| {{Cigarettes}} | |||
| {{DEFAULTSORT:Passive Smoking}} | {{DEFAULTSORT:Passive Smoking}} | ||
| ] | |||
| ] | ] | ||
| ] | ] | ||
Revision as of 10:13, 30 March 2012
Passive smoking is the inhalation, usually involuntary, of second-hand smoke from tobacco products by non-smokers or persons other than the intended 'active' smoker. It occurs when tobacco smoke permeates any environment, causing its inhalation by people within that environment. Exposure to second-hand tobacco smoke through passive smoking causes disease, disability, and death. The health hazards of passive smoking, which are a matter of scientific consensus., have been a major motivation for smoke-free laws in workplaces and indoor public places.
Alternative terms
Passive smoking is used widely in news media and in older scientific research papers and may therefore be regarded as a common name for exposure to second-hand smoke. More recent scientific literature and regulatory material tends to refer directly to second-hand smoke, and the two terms are effectively employed as synonyms, although etymologically passive smoking is the act or behaviour of exposure to a contaminant, and second-hand smoke the hazardous substance. A minority of scientific papers, and some material generated by representatives of the tobacco industry, refer to environmental tobacco smoke or 'ETS' rather than either passive smoking or second-hand smoke.
Consequences
Main article: Second-hand smokeThe evidence of health hazards arising from passive smoking and exposure to second-hand smoke have played a central role in the debate over the regulation of tobacco products and smoking. Since the early 1970s, the tobacco industry has viewed the passive smoking issue as a major threat to its business interests. Harm to bystanders was perceived as a motivator for stricter regulation of tobacco products. Despite the industry's awareness of the harms of second-hand smoke as early as the 1980s, the tobacco industry coordinated a scientific controversy with the aim of forestalling regulation of their products. Nevertheless, as evidence of the hazards of second-hand smoke exposure through passive smoking has accumulated, so has the use of smoke-free laws (or 'smoking bans') proliferated.
See also
References
- http://dictionary.cambridge.org/dictionary/british/passive-smoking
- http://lungcancer.about.com/od/glossary/g/passivesmoking.htm
- http://www.merriam-webster.com/medical/passive%20smoking
- http://medical-dictionary.thefreedictionary.com/passive+smoking
- "WHO Framework Convention on Tobacco Control" (PDF). World Health Organization. 2005-02-27. Retrieved 2009-01-12.
Parties recognize that scientific evidence has unequivocally established that exposure to tobacco causes death, disease and disability
- "The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General". Surgeon General of the United States. 2006-06-27. Retrieved 2009-01-12.
Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke
- "Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant". California Environmental Protection Agency. 2005-06-24. Retrieved 2009-01-12.
- IARC 2004 harvnb error: no target: CITEREFIARC2004 (help) "There is sufficient evidence that involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) causes lung cancer in humans"
- Samet JM (2008). "Secondhand smoke: facts and lies". Salud Publica Mex. 50 (5): 428–34. doi:10.1590/S0036-36342008000500016. PMID 18852940.
- ^ Tong, EK (2007 Oct 16). "Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease". Circulation. 116 (16): 1845–54. doi:10.1161/CIRCULATIONAHA.107.715888. PMID 17938301.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - Diethelm P, McKee M (February 2006). "Lifting the smokescreen: Tobacco industry strategy to defeat smoke free policies and legislation" (PDF). European Respiratory Society and Institut National du Cancer. Retrieved 2009-01-17.
The industry quickly realised that, if it wanted to continue to prosper, it became vital that research did not demonstrate that tobacco smoke was a dangerous community air pollutant. This requirement has been the central pillar of its passive smoking policy from the early 1970s to the present day