• Report unequivocal about dangers of secondhand smoke

    November 2006 

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    "Secondhand smoke is killing tens of thousands of Americans every year and banning indoor smoking is the only way to stop it," according to former U.S. Surgeon General Richard Carmona in the most detailed statement ever on the hazards of secondhand smoke.

    Secondhand smoke increases a nonsmoker's risk of developing heart disease by 25 - 30 % and lung cancer by 20 - 30 %.

    This report is not a new study; it is based on hundreds of peer-reviewed studies and major reports since the last Surgeon General's report on secondhand smoke published in 1986. The mounting scientific evidence is indisputable. "Secondhand smoke is not a mere annoyance, but a serious health hazard," Carmona continued.

    Some 126 million nonsmokers, nearly half of all nonsmoking Americans, are exposed to secondhand smoke, and as a result, are at increased risk of death from lung cancer, heart disease and other illnesses. The report warns there is no risk-free level of exposure. The only way to protect nonsmokers from the hazards of breathing in tobacco smoke is to eliminate indoor smoking entirely.

    The report shows that the practice of separating smokers and nonsmokers and of installing ventilation and air-cleaning systems is ineffective in reducing the risks of secondhand smoke. Operation of heating, ventilation and air-conditioning systems actually distributes secondhand smoke throughout a building. While conventional air-cleaning systems can remove the large particles of toxins found in tobacco smoke, they do not remove the smaller particles or the gases found in secondhand smoke.

    Assessing the risks

    What are the risks? Secondhand smoke increases a nonsmoker's risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. In 2005, exposure to secondhand smoke was estimated to kill more than 3,000 adult nonsmokers from lung cancer, approximately 46,000 from coronary heart disease and an estimated 430 newborns from sudden infant death syndrome (SIDS).

    Even a few minutes of exposure to tobacco smoke can be enough to trigger an asthma attack, heighten the chances of blood clotting, damage heart arteries and begin the kind of cell damage that can result in cancer.

    Children are most at risk because their bodies are developing and their tissues are particularly vulnerable to tobacco's poisons, which include formaldehyde, benzene, vinyl chloride, arsenic, ammonia and hydrogen cyanide. Babies whose mothers smoke while pregnant and who are exposed to secondhand smoke after birth are more likely to die from SIDS. Exposed children also suffer more acute respiratory infections, ear problems and severe asthma attacks.

    Although ventilation systems and physical separation of smokers are both ineffective, the report finds that state and local mandates for smoke-free buildings are having enormous positive effects. Levels of cotinine, a biological marker for secondhand smoke exposure, fell by 75 percent in adult nonsmokers in samples taken between 1999 and 2002 when compared to those taken a decade earlier.

    However, more recent data show that cotinine levels in children are more than twice those of adults, and African-Americans have levels that are more than twice as high as Hispanic and non-Hispanic whites. The report states that 22 percent of children under age 18 are exposed to secondhand smoke in their homes, with estimates ranging from 11.7 percent in Utah to 34.2 percent in Kentucky.

    Carmona strongly urges smokers to smoke outside, away from other people, particularly children or sick adults, and avoid smoking in enclosed spaces such as cars. He urged all nonsmokers to avoid exposure to tobacco smoke, whenever possible. Dr. Carmona underscored the fact that any exposure to secondhand smoke carries health risks. The evidence is indisputable.

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  • What the news means for you

    Smoke-free environment only safe haven

    Ellen Hahn, DNS, RN

    This latest report on the hazards of secondhand smoke exposure from the surgeon general reflects what we have learned from an additional 20 years of research evidence. The report cites massive and conclusive scientific evidence of the public health hazard of even casual exposure to secondhand smoke. Importantly, it finds smoke-free laws to be the only way to protect nonsmokers.

    Many of the short-term measures society has taken since the 1986 surgeon general's report, such as the installation of filtration and ventilation systems and the creation of smoking and nonsmoking sections, are a waste of money. They may protect people from the odor of tobacco smoke, but they do not remove the danger posed by the toxins in secondhand smoke.

    “There is no safe level of exposure [to secondhand smoke]” 

    The study is an important wake-up call to anyone who works, lives in or visits factories, stores, homes, restaurants or other public buildings where smoking is permitted. Secondhand smoke is not a nuisance; it is dangerous to people of all ages. It can cause heart disease, cancer and lung disease. There is no safe level of exposure. That's a strong unequivocal statement, and all of us concerned about public health want to be sure everyone understands what that means.

    Breast cancer risk

    The report is strong, but I don't believe it goes quite far enough. Several public health organizations have concluded that secondhand smoke is a cause of breast cancer. A report from the California Environmental Protection Agency (CalEPA), which reviewed data from 15 studies, asserts that breathing secondhand smoke increases premenopausal women's relative risk for breast cancer by 68 percent. The CalEPA report reviewed scientific data from studies of more than 1,000 women who grew up in homes where secondhand smoke was a constant presence and compared their rates of breast cancer to the rates of women who did not live in homes where people smoked.

    The surgeon general report states: "The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke and breast cancer." The surgeon general's report included research through 2004, and the CalEPA report was released in 2005. I am convinced the data is sufficient to show that premenopausal women, in particular, are at special risk from secondhand smoke along with children and individuals with respiratory and heart disease.

    I am particularly concerned about young women because while smoking rates have dropped significantly among other groups, young women continue to smoke at high rates. The tobacco industry often targets women of college age who may become addicted to smoking, or even if they do not smoke, young women make up much of the workforce of the restaurants and bars where smoking is often still allowed.

    Public education key to change

    The research in the surgeon general's report indicates that smoke-free policies are the most economical and effective way to protect people from the dangers of secondhand smoke. Progressive restriction of smoking has also resulted in reduced tobacco use by smokers and shifts in public attitudes about tobacco use from acceptable to unacceptable.

    The Kentucky Tobacco Policy Research Program, which I direct, is actively engaged in informing people, including policymakers, about research related to tobacco use and secondhand smoke exposure. According to a University of Kentucky survey, 34 percent of Kentuckians allow smoking in their homes, which means that more than 1.4 million individuals in the state are exposed to secondhand smoke at home. And, in spite of information about the dangers of secondhand smoke, only 43 percent of Kentuckians perceive it as a serious health hazard.

    What can you do?

    If you smoke, talk to your doctor about ways to quit. If you are a nonsmoker, avoid smokers, particularly in enclosed spaces such as cars or small rooms. Do not allow anyone to smoke in your home or in front of your children. Make sure any daycare facility you use is smoke free. Patronize smoke-free restaurants and bars, whenever possible. Vote for elected officials who support smoke-free legislation to protect all workers and patrons from secondhand smoke.

    Hahn is a professor in the UK colleges of Nursing and Public Health and directs the Kentucky Center for Smoke-free Policy. She also is a faculty associate at the UK Prevention Research Center and a faculty member of the UK Markey Cancer Center.

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