Secondhand Smoke Basics

Secondhand smoke has a variety of names, including environmental tobacco smoke (ETS), passive smoking, and involuntary smoking. By definition, secondhand smoke is "sidestream smoke" (smoke from the burning end of a lit cigarette) or "mainstream smoke" (smoke that is exhaled from the lungs of a smoker).

When doctors refer to secondhand smoke, they are mostly describing sidestream, or ambient, smoke. Put another way, when a smoker lights up a cigarette, roughly 80 percent of the smoke burns off into the room and only 20 percent is inhaled. Sidestream smoke, then, is more dangerous than mainstream smoke.

While both types of smoke share most of the same compounds -- including more than 200 substances known to be harmful -- sidestream smoke has much higher concentrations of ammonia and chemical carcinogens such as benzene (an additive formerly found in gasoline before it was deemed to be too dangerous). A primary reason for this is that when a smoker inhales, he or she is drawing oxygen through the lit end of the cigarette, thereby nearly doubling the heat at which the smoke is produced. This increase in temperature results in the formulation of smaller, less harmful compounds.

Secondhand smoke is not solely derived from cigarettes; pipes and cigars produce many of the same harmful substances. In fact, a cigar produces much more sidestream smoke than a cigarette because of its larger size. Recent studies have shown that even hookahs carry a significant secondhand smoke risk.

The Contents of Secondhand Smoke

Most people who have been around a burning cigarette will tell you that the smell of the smoke is unpleasant. In addition to smelling bad, it can irritate your eyes and throat. However, the same can be said of just about any type of smoke, so there are other factors that make secondhand tobacco smoke so dangerous. Chief among them are the contents of secondhand tobacco smoke.

It is nearly impossible to come up with an exact accounting of what is in secondhand smoke because there are so many varieties of and ways to smoke. The main influences on the contents of secondhand smoke are:

There are, however, some common substances that most tobacco products produce. More than 4,000 chemicals have been identified in secondhand smoke, and the number goes up with each new study. According to the National Cancer Institute, more than 50 carcinogens have been found in secondhand smoke, including formaldehyde.

In addition, secondhand smoke contains many substances that interfere with normal cell development and function, such as nicotine and carbon monoxide. Secondhand smoke also has many insoluble particles, such as tar, that the body cannot use and simply build up over time.

A study from the August 2004 British Medical Journal reported that a cigarette releases 10 times the amount of air pollution as a diesel engine. In 1993, the Environmental Protection Agency categorized secondhand smoke in Group A -- the most severe form of carcinogen -- along with arsenic, mustard gas, and asbestos.

Naturally, there are a number of serious health problems associated with secondhand smoke. In the next section, we will look at these conditions, which range from heart disease to various types of cancer.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The big question is: How exactly does secondhand smoke affect your body? In this section, we will detail the various health problems that can be caused by secondhand smoke -- from heart disease and cancer to asthma and sudden infant death syndrome (SIDS).

Heart Disease

Heart disease is the leading cause of death among Americans. While it can be brought on by many factors, such as diet and lack of exercise, secondhand smoke also can be part of the equation. According to the American Lung Association, passive smoking is responsible for anywhere from 35,000 to 62,000 cardiovascular-related deaths each year. In addition, nonsmokers who are exposed to secondhand smoke are 25 percent more likely to have coronary heart diseases than nonsmokers who are not exposed to secondhand smoke.

Exposure to smoke thickens the blood by increasing the production of red blood cells. This, in turn, increases the likelihood of clotting and strokes. Essentially, any activity that limits the amount of oxygen entering the bloodstream forces the heart to work harder to circulate the oxygen it does have. Furthermore, increased blood platelet activity can damage the walls of the arteries, thereby raising blood pressure and adding even more stress to the heart.

Cancer

Cancer is the second-most common cause of death among people under the age of 85. Secondhand smoke has been linked to several types of cancer, including:

Lung cancer. According the National Cancer Institute, there are approximately 3,000 lung cancer deaths a year of nonsmokers exposed to secondhand smoke. Actually, secondhand smoke is the third-leading cause of lung cancer, behind active smoking and radon gas. Lung cancer kills more women every year than breast cancer, and it is the leading cause of premature death among men.

Nasal sinus cancer. Similar to lung cancer in that it is a respiratory illness, nasal sinus cancer is thought to be caused by the formaldehyde found in secondhand smoke. Though nasal sinus cancer is much less common than lung cancer, it can be a devastating disease because the areas affected, such as the nose, are so visible.

There has been no conclusive evidence to link secondhand smoke to other types of cancer, such as breast or bladder cancer. However, many of the substances believed to cause these types of cancer are found in secondhand smoke. As more studies arise citing sidestream smoke as a factor in other forms of cancer, it seems likely that conclusive evidence will arrive.

Asthma and Other Respiratory Illnesses

Let's face it: If you are a nonsmoker with asthma who lives with a smoker, you are courting frequent asthma attacks. Any attempts to asthma-proof your home are virtually worthless if you are constantly exposed to secondhand smoke. Cigarette smoke is a known asthma trigger.

In a broader sense, secondhand smoke is linked to just about any condition that involves breathing. From pneumonia and sinusitis to coughs and post-nasal drip, exposure to secondhand smoke can irritate and aggravate your throat and lungs. Even the ears are not safe because of their close ties to the sinuses. The Eustachian tube that connects the nose to the middle ear can easily become infected from exposure to secondhand smoke.

Sudden Infant Death Syndrome

Pregnant mothers exposed to secondhand smoke run a higher risk of having a baby with a low birth weight, but the dangers don't end there. Involuntary smoking has also been shown to cause SIDS. According to the American Cancer Society, as many as 35 percent of all SIDS deaths could be due to secondhand smoke.

The effects of secondhand smoke are causes for grave concern. Fortunately, there are steps you can take to protect yourself. In the next section, we will tell you how much secondhand smoke is too much and how to minimize the risks.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

On June 27, 2006, U.S. Surgeon General Richard H. Carmona released an exhaustive scientific report concluding that there is no risk-free level of exposure to secondhand smoke. In other words, even the slightest exposure to secondhand smoke increases the odds of being stricken by the health problems we outlined in the previous section.

Does this mean that when you're at a friend's house and someone lights a cigarette, you should immediately dive through a window? No -- that constitutes a larger health hazard -- but the statistics are much more dire than was originally thought.

The Surgeons General's Report on Secondhand Smoke

"The health effects of secondhand smoke exposure are more pervasive than we previously thought," Carmona said in his report. "The scientific evidence is now indisputable: Secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults." This is a bold claim, but the evidence backs up Carmona.

To measure the impact of secondhand smoke, researchers generally test for a substance called cotinine. Cotinine is the compound that is produced when the body metabolizes nicotine.

Because nicotine is found almost exclusively in cigarette smoke, testing the body for cotinine levels is an accurate and dependable method for gauging a subject's exposure to secondhand smoke. Armed with this information, the report draws some shocking conclusions:

It doesn't take much. While more research is needed to know the exact atomic weight of cigarette smoke that translates into a significant health problem, the studies show that even minimal exposure results in a rise in cotinine levels. The Surgeon General concluded that any exposure results in a measurable degree of risk.

Smoking or nonsmoking? The report also proved that the conventional measures public spaces have taken to protect their nonsmoking patrons against secondhand smoke are inadequate. Tests revealed that designated smoking areas, or even air filters, are not enough to prevent a marked rise in cotinine levels. The report recommends that the only way to be safe is to dine in a completely smoke-free environment.

Children are especially vulnerable. Because they are still developing physically and tend to have higher breathing rates -- and, in turn, higher quantities of smoke entering their bodies -- children are especially at risk around secondhand smoke. According to the Environmental protections agency, secondhand smoke will:

Protecting Yourself and Your Family

Obviously, the best thing to do is to avoid secondhand smoke at all costs. If you're a smoker, stop. If you are unable to quit smoking, at least refrain from lighting up in your house and around your family. Naturally, your child's daycare or school should also be a smoke-free environment. Here are some other steps you can take:

In an apartment. If you live next to someone who smokes and are worried about the health risks, try speaking to him or her and working out a peaceful solution. If your apartment building has a nonsmoking policy, ask that your landlord enforce it rigidly. If your building is not smoke-free, you could point out to your landlord that a nonsmoking building has lower insurance and maintenance costs.

At work. Most businesses have policies that protect nonsmokers from secondhand smoke. If your company does not have such a policy, you can work with management and labor organizations to create one.

You also can encourage your coworkers to take advantage of the many smoking-cessation programs that most companies sponsor. Finally, if there is an outdoor smoking area, it should not be adjacent to any of the exits or high-traffic areas.

While traveling. Fortunately, the government has taken care of most of this one for you. Smoking is not allowed on commercial airplanes in the United States and on flights leaving the U.S. for foreign destinations. Smoking is also prohibited on all interstate bus travel and is limited to a designated car on all trains.

However, when staying in a hotel, it is important to secure a nonsmoking room due to the amount of time that harmful cigarette-smoke chemicals can linger in the furniture. In addition, you should be aware that antismoking laws are different in each country.

Of course, the best way to avoid secondhand smoke is to live in a completely smoke-free environment. Sounds like a pipe dream, right? Well, some communities have enacted laws in an effort to realize this ideal. In our final section, we will explore the growing support for antismoking laws and the health benefits reaped by these smoking bans.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

In 1995, California passed a law banning smoking in public places such as bars and restaurants. Because it was the first law of its kind, California lawmakers gave the state's dining and drinking establishments an exemption of three years before the ban would be enforced. On January 1, 1998, when the law went into effect, nobody paid much attention -- patrons continued to smoke inside, and officials did not do much about it.

Then, slowly, signs were posted, fines were handed out to both the establishment owners and patrons, and smokers moved outdoors. Soon, more towns and counties began banning smoking in restaurants, bars, and other social areas.

In 2002 Delaware became the second state to pass a comprehensive antismoking law, and it was quickly followed by the cities of New York and Boston. Antismoking laws are becoming increasingly popular; it appears to be only a matter of time before they are the norm, not the exception.

Still, smoking bans remain highly controversial because some restaurant and bar owners claim the laws significantly affect their financial bottom lines. But before we delve into that debate, let's look at the health benefits of smoking bans.

The Health Benefits of Smoking Bans

Soon after New York passed its antismoking legislation, the Centers for Disease Control and Prevention made a scientific study of the air quality in 20 of the city's hospitality venues to see if the ban had had a positive effect on air quality. Not surprisingly, they found that it had.

Using a standard measure called respirable suspended particles, or RSPs, the researchers found that the levels of harmful compounds in the air dropped by 84 percent. But this finding wasn't startling -- obviously, if people stop smoking, there will be fewer pollutants in the air. So the real question is: How does this translate into a healthier population?

A 2003 study from the University of California, San Francisco found that the number of heart attack victims admitted to a local hospital dropped nearly 60 percent during the first six months after a smoke-free ordinance was passed in the area. Another study focused on bar workers in the San Francisco area. The data showed roughly the same drop-off in reported respiratory problems and in nose, eye, and throat irritation. Furthermore, there was a four percent increase in lung capacity among bar workers tested after just four weeks of the antismoking policy.

In 2004, Ireland became one of the few countries to pass a nationwide ban on smoking in public places. Naturally, then, Ireland became a veritable Petri dish for researchers who wanted to study the effects of antismoking laws. The following year, British Medical Journal published a comprehensive study documenting the health changes in Ireland due to the lack of secondhand smoke. The researchers found that the number of nonsmoking bar workers with respiratory problems dropped 17 percent and that their cotinine levels dropped 80 percent.

Although it shouldn't come as a surprise, smoking bans clearly have had major health benefits wherever the laws have been enacted. No research, however, has demonstrated that antismoking laws have encouraged smokers to quit or even light up less frequently.

The Economic Effects of Smoking Bans

This is a highly politicized issue. There are numerous studies stating that sales in the impacted establishments plummet after smoking laws are passed; other studies, however, claim that sales remain stable or even increase. It is not as easy to quantify restaurant and bar sales as it is to measure chemical compounds in the air. Therefore, it is difficult to know which side is right.

After El Paso, Texas, passed a nonsmoking ordinance in 2002, the Texas Department of Health and the Centers for Disease Control and Prevention analyzed sales-tax and beverage-tax data from the year of the ban and the 12 years prior. The report states that there was no statistically significant change in revenue after the smoking ban took place.

Naturally, many bar and restaurant owners make the opposite claim. The Pioneer Press in St. Paul, Minn., reported that one local tavern suffered a drop in revenue of almost $10,000 in the year after St. Paul's smoking ban went into effect. Meanwhile, the famous brewer Guinness claims its sales have fallen six percent since Ireland's antismoking laws were passed.

Although it may be impossible to know the whole truth regarding the economic impact of smoking bans, the health benefits are indisputable. And while some protest that the bans should not be used to persecute smokers, others counter that governments have a responsibility to protect the health of the nonsmoking population.

The recent report from the Surgeon General may not have been "breaking news." However, sometimes it takes the words of a prominent public figure to help us see the unpleasant reality that is wafting through the air all around us.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.