Secondhand Smoke

Secondhand smoke has been officially declared a toxic pollutant.
Nations of the world, and states in the USA, going smoke-free
What is secondhand smoke?
Ventilation does not protect people from secondhand smoke.
Virginia -- current state law, 2008 legislative efforts
Restaurants -- Taste the food, or the smoke?
Separate sections do not work -- smoke travels, and does not read signs.
Secondhand smoking is the third leading preventable cause of death.

2008 -- Overview of recent items, see also Newest Entries.
"How Many Deaths Will it Take Before All Indoor Workplaces are NO-SMOKING?"

American Journal Industrial Medicine, Dec. 7, 2007, article by M. Stanbury, D. Chester, E. Hanna, K. Rosenman of Michigan, noting the waitress collapsed at the bar where she worked and was declared dead shortly thereafter. Evaluation of the circumstances of her death and her medical history concluded that her death was from acute asthma due to environmental tobacco smoke at work.
CONCLUSIONS: This is the first reported acute asthma death associated with work-related ETS. Recent studies of asthma among bar and restaurant workers before and after smoking bans support this association. This death dramatizes the need to enact legal protections for workers in the hospitality industry from secondhand smoke.

Fewer acute coronary events (strokes, heart attacks) following establishment of smoking ban.

Circulation, February 2008, "Effect of the Italian Smoking Ban on Population Rates of Acute Coronary Events", published online before print, February 11, 2008. Authors Giulia Cesaroni MSc, Francesco Forastiere MD, PhD*, Nera Agabiti MD, Pasquale Valente MD, Piergiorgio Zuccaro PhD, and Carlo A. Perucci MD. From the Department of Epidemiology (G.C., F.F., N.A., C.A.P.), Local Health Unit ASL RME, and Istituto Superiore di Sanità (P.V., P.Z.), Rome, Italy.

"... We evaluated changes in the frequency of acute coronary events in Rome, Italy, after the introduction of legislation that banned smoking in all indoor public places in January 2005.
Conclusions — We found a statistically significant reduction in acute coronary events in the adult population after the smoking ban. The size of the effect was consistent with the pollution reduction observed in indoor public places and with the known health effects of passive smoking. The results affirm that public interventions that prohibit smoking can have enormous public health implications."

Some conclusions from:
The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, U.S. Department of Health and Human Services June 2006

This confirms and expands the Report issued in 1986.
**Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke.

**Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic (cancer-causing), including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide.

**Secondhand smoke has been designated as a known human carcinogen (cancer-causing agent) by the U.S. Environmental Protection Agency, National Toxicology Program and the International Agency for Research on Cancer (IARC). The National Institute for Occupational Safety and Health has concluded that secondhand smoke is an occupational carcinogen.

**Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.

**Concentrations of many cancer-causing and toxic chemicals are higher in secondhand smoke than in the smoke inhaled by smokers.

**Breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack.

**Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 - 30 percent.

**Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing lung cancer by 20 - 30 percent.

**The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.

**Short exposures to secondhand smoke can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk of a heart attack.

**Secondhand smoke contains many chemicals that can quickly irritate and damage the lining of the airways. Even brief exposure can result in upper airway changes in healthy persons and can lead to more frequent and more asthma attacks in children who already have asthma.

**Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.

**Conventional air cleaning systems can remove large particles, but not the smaller particles or the gases found in secondhand smoke.

**Routine operation of a heating, ventilating, and air conditioning system can distribute secondhand smoke throughout a building.

**The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), the preeminent U.S. body on ventilation issues, has concluded that ventilation technology cannot be relied on to control health risks from secondhand smoke exposure.

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General was prepared by the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). The Report was written by 22 national experts who were selected as primary authors. The Report chapters were reviewed by 40 peer reviewers, and the entire Report was reviewed by 30 independent scientists and by lead scientists within the Centers for Disease Control and Prevention and the Department of Health and Human Services. Throughout the review process, the Report was revised to address reviewers’ comments.

A landmark experiment in healthy young nonsmokers revealed that a mere 30 minute exposure to secondhand smoke causes changes in coronary blood flow, specifically a substantial reduction in the coronary flow velocity reserve, that are indistinguishable from those of habitual smokers.

An April 7, 2006 study, British Medical Journal, revealed that secondhand smoke increases the risk of developing glucose intolerance or diabetes.

Dana Reeve, a non-smoker exposed to secondhand smoke in the nightclubs and other public places where she sang, died recently of lung cancer. Secondhand smoke may well have been a factor in claiming her life. All workplaces should be no-smoking to protect lives.

Heather Crowe, a former waitress in Canada, died in late May from lung cancer from the secondhand smoking on her job. She has appeared in ads for the implementation of Smoke Free Ontario, and hoped to live to celebrate the May 31st beginning of that. In her last commercial, she said, "people shouldn't go to work to die." Her former employer appeared with her in some ads as support.

Additional information on smoking in the workplace under:
Overview, Secondhand smoke Kills, Poisons, Carcinogens,
and also in the general information section.

Secondhand smoke Kills

Cancers, including breast cancer, and other cancers
Cardiovascular, including strokes
Respiratory
Fetus and secondhand smoke

Documentation includes articles from the United Kingdom on number of people dying from secondhand smoke, actions by the British Medical Association, etc.

Some Poisons in secondhand smoke

Some Carcinogens in secondhand smoke

Agencies stating secondhand smoke is carcinogenic
2006 report that secondhand smoke is a toxic air contaminant
Other chemicals in secondhand smoke.

Immediate impacts of secondhand smoke
Impact on female fertility
Children -- Dental Decay caused by secondhand smoke
Further articles on women and tobacco at the INWAT,
International Network of Women against Tobacco, web site.
Cost of secondhand smoke in dollars

Some articles and studies at National Library of Medicine

Secondhand smoke seeping into apartments and condominiums
New Jersey law prohibits smoking in college dormitories

Tobacco industry lost lawsuit challenging scientific report.
Tobacco companies do not show corporate responsibility.
Tobacco industry strategy to undermine research.
Tobacco industry strategy continues.
Tobacco industry used journal to report on secondhand smoke.
Tobacco industry stopped medical use of secondhand smoke exposure diagnostic
code on medical forms.

Some References; many others identified with article when mentioned.

Pets and secondhand smoke:

Articles may be searched at the web site of the American Journal of Epidemiology.
For example, cats have an increased risk of lymphoma from breathing secondhand smoke.

People, as well as plants, are also hurt and killed by secondhand smoke. For this reason, more and more workplaces are going smoke-free. This protects both the nonsmoker and the smoker from the devastating health effects of secondhand smoke.

Tobacco companies have worked to stop the spread of laws and regulations which protect the health of people from secondhand smoke. One recently exposed example is the lobbying to prohibit the use of a medical diagnostic code regarding secondhand smoke exposure.

Smoking is hazardous -- to the smoker, and to those who are forced to breathe the smoke. This smoke is called secondhand smoke (SHS), passive smoke, and environmental tobacco smoke (ETS).

Secondhand smoke has immediate impacts on health, and it can kill through triggering severe asthma attacks, heart attacks, several cancers, and other illnesses. Women who have a smoking spouse have a significantly reduced chance of success with fertility treatments.

Secondhand smoke impacts the brain and can disorient the breather, lowering test scores, affecting reasoning and hand--eye relationships. There is no safe level of exposure to secondhand smoke.

Secondhand smoke around the mother is as harmful to the developing fetus as is maternal smoking.

A study from Shanghai, China, noted an increase in stroke among nonsmoking women whose husbands smoked around them. Prevalence of stroke also increased with increasing duration of husbands' smoking. The authors found that women nonsmokers who lived with husbands who smoked had an elevated prevalence of stroke, and prevalence increased with increasing intensity and duration of husbands' smoking.
The full text, February 2005, is available at the American Journal of Epidemiology. Excerpts from a news article on this study is given later on this page.

A most informative governmental report from Ireland in 2002 on secondhand smoke in the workplace, based on worldwide research, concluded that the weight of evidence for lung cancer, cardiovascular, and respiratory disease, and for adverse effects on reproduction calls for legislative measures to protect employees from exposure to secondhand smoke at work.

A research team at Health Canada found that working in bars and restaurants can triple lung cancer risk. They also observed a dose-response relation between the degree of exposure and lung cancer risk.

In the city of Helena, Montana (USA), the number of heart attacks decreased substantially after the city banned indoor smoking, but then rose quickly to its former level after the law was struck down in court six months later. This event prompted the US Centers of Disease Control and Prevention (CDC) for the first time to warn people at risk of heart disease to avoid all buildings and gathering places that allow indoor smoking.

In Western New York State (USA) air pollution of RSPs (PM2.5) in a sample consisting of seven bars, six bar/restaurants, five restaurants, two bowling alleys, a pool hall, and a bingo hall dropped by 84% after implementation of the Clean Indoor Air Law in 2003.

In New York City (USA), "The city's bar and restaurant industry is thriving and its workers are breathing cleaner, safer air," said a report issued by the Economic Development Corporation and the Departments of Finance, Health & Mental Hygiene and Small Business Services. Mike O'Neal, who served as president of the N.Y. State Restaurant Association for 17 years, supported legislation for a comprehensive smoking ban. "I feel strongly," he said, "that it is pro-business and pro-health to eliminate smoking in all workplaces. We owe our workers a safe, healthy work environment."

In the state of California (USA), the strict smoking bans have led to a substantial decline in smoking prevalence and also in the state's rates of heart disease, lung cancer, and chronic obstructive pulmonary disease (COPD), which have fallen well below the national average.

In New Zealand, the ban on smoking in the workplace, including pubs, has led to a significant decrease in dangerous levels of gases linked to secondhand smoke related deaths. In Excerpts from The New Zealand Herald, December 22, 2004, writer Helen Tunnah noted:

The levels of gases believed to be cancer-causing or linked to second-hand smoking deaths all reduced after the ban.

Greg Guthrie of Panmure said Sky City Casino had improved instantly after the ban.

"It’s much better. In the past it was a case of just having to put up with it [smoke]. In some places it was always very thick."

A pokie machine player who did not want to be named said the air was much fresher.

In Taiwan, a report on smoking in the workplace in Taiwan, Tobacco Control 2005: 14: i 33-i 37, noted that:

Smoking workers lost productivity throughexcessive sick leave, on-the-job injuries, and frequent smokingbreaks. Non-smoking workers also lose productivity through exposureto secondhand smoke. Together these effects incur the equivalentof US$1 billion loss in productivity, accounting for 0.36% oftotal gross domestic product in Taiwan.

Absenteeism and increased use ofmedical services have been reported as consequences of ETS [Environmental tobacco smoke, secondhand smoke, sidestream smoke] exposure. A recent study of Hong Kong police officers found a 27% increasein sick days during a six month period for male officers anda 42% increase for female officers due to ETS exposure.

EXCERPTS from The Ottawa Citizen, April 9, 2006, headlined, Crowe wants to experience smoke-free future, writer Ron Corbett.

Looking frail, tired and at times disoriented, Heather Crowe said at a news conference yesterday she hopes to "be around to see" Smoke-Free Ontario legislation come into effect on May 31.

The former Ottawa waitress, who has never smoked, was diagnosed with lung cancer four years ago and is now in palliative care at the Elisabeth Bruyere Health Centre. Her condition was attributed to second-hand smoke in the restaurants where she worked for 40 years.

After being featured in many media reports, Ms. Crowe became a spokeswoman for various health agencies and went on to be featured in a high-profile television campaign about the perils of second-hand smoke.

This weekend's news conference -- held in the cafeteria of the health centre -- was to unveil another commercial in that campaign. This one features Ms. Crowe and Moe Atallah, owner of the Newport Restaurant, where Ms. Crowe worked for many years.

"Back then, we had no idea what we were doing with second-hand smoke," says Mr. Atallah. "We served ashtrays with the ketchup and the coffee. Everyone did that. I look back and just shake my head."

In the commercial, Mr. Atallah is seen near tears, while calling his former employee "my hero."

Ms. Crowe -- who looks healthier in the commercial, shot just weeks ago, than she does today -- says "people shouldn't go to work to die."

The commercials will air across Ontario over the next two months, in the runup to May 31 -- the implementation of Smoke-Free Ontario. On that date, smoking in public places will be banned across the province, with few exceptions.

"I'm in the last stages of this disease," she says. "It's going to be a grand day for me (when the legislation comes into effect). I hope to celebrate that day. I hope I'm around to have a cup of coffee."

In the rear of the room during the news conference, Ms. Crowe's daughter waited to bring her mother back to her room. She says her mother has good days and bad days, and this was not one of the better days.

"Her memory is starting to go, and she's tired today," said Patricia Crowe.

"She takes cups full of pills just to kill the pain. It's just about constant now. The pain. But she wouldn't have missed this for the world."

GASPer NOTE: Dana Reeve was a nightclub singer, exposed on a daily basis to much secondhand smoke. Many people do not remember the quantities of smoke in the air in earlier years. We still have a long way to go to make it safe to breathe!

Excerpts from Larry King Live, CNN, March 7, 2006:

Larry King, CNN Host: Christopher Reeve's widow, Dana Reeve, lost her brave battle with lung cancer last night less than seven months after her shocking announcement that she was ill and a year and a half after her husband passed away. ...

Joining us from Cleveland is Dr. Derek Raghaven, the Director of the Cleveland Cancer Center. How did she have lung cancer without smoking?

Dr. Raghaven: Well, I think, unfortunately, Larry, I believe she was a passive smoker. You might remember that Dana Reeve was a singer early in her life. And my understanding is that she sang in places where smoking happened a lot.

One of the things that isn't very well known is that, in many ways, passive smoking is much more dangerous than regular smoking, in the sense that, when you inhale a cigarette, it's hot and uncomfortable, and makes you cough. When you're breathing in passive smoke, there isn't the same acute reaction. And so you, in fact, inhale more deeply. So she was exposed to passive smoking, as happens in so many parts of the USA. We just haven't got legislation that's state-of-the-art to protect us.

Excerpts from nbc11.com, March 7, 2006, headlined: Reeve's Death Sheds New Light On Lung Cancer, reporter not named.

WHITE PLAINS, N.Y. -- Dana Reeve, widow of Christopher Reeve, died Monday night as a result of lung cancer. Her case proves lung cancer can also affect non-smokers.

Dr. Larry Einhorn, of Indiana University's School of Medicine, said Dana Reeve, did not fit the typical profile of a lung cancer patient.

Einhorn, a world-renowned oncologist who is best known for treating cyclist Lance Armstrong's cancer a few years ago, told Indianapolis television station WRTV he never treated non-smoking women with lung cancer 30 years ago, but it is becoming more prevalent today.

Einhorn said he has recently treated many women under 50 who are battling the disease, some of them in their 20s. Like Reeve, those women are not and never were smokers.

Einhorn said the cause for the disturbing trend isn't completely clear, but he believes second-hand smoke is a factor.

"The same amount of tobacco exposure is more likely to lead to the changes that cause lung cancer in a woman than the male counterpart who gets the same second-hand exposure. Now, why that is, no one knows," Einhorn said. "It's sometimes too easy to say that this could be due to second-hand smoke. Probably some of the cases are due to second-hand smoke, but I would guess that the majority of them are unknown as to why these young healthy women like Dana Reeve develop this terrible disease and then succumb to lung cancer."

Environmental factors including second-hand smoke are among the most prominent risk factors says the Cleveland Clinic's Dr. Peter Mazzone, "There are a wide variety of chemicals that you can be exposed to, asbestos. And then there are things like radon, radiation exposure from the ground below your home."

States in the USA -- smoke-free restaurant laws, most have far more than restaurants smoke-free:

EXCERPTS from March 27, 2006, The Times in the United Kingdom, headlined, Scotland takes to its first day of no smoke without ire, writers, David Lister and Angus Macleod.

SCOTLAND took a deep breath yesterday and appeared to adapt quickly to becoming the first part of the United Kingdom to take the historic step of introducing a smoking ban in public places.

Individual smokers in pubs voiced their complaints that their days of a puff with their pint were at an end, but the majority decided to make the best of it and comply.

Scottish ministers chose a Sunday for the start of the ban because it was felt that the more restricted licensing hours would reduce the opportunity for flouting it, a tactic that appeared to pay off.

Jack McConnell, the First Minister, conceded yesterday that there would be pockets of resistance but said that the ban was necessary to reduce deaths from cancer, heart disease and strokes. He said: “I think we’ve got to be realistic about this. There are going to be people who will be inconvenienced by the ban. But I also believe Scotland is a law-abiding country.”

Peter Terry, chairman of the British Medical Association in Scotland, said that the day would be remembered as “the time Scotland took a bold and politically courageous step”.

Others said that the ban would encourage them to stop smoking, while bar staff hailed their new working environments. “I’m loving it,” said Kathy Eager, a waitress at a pub in Edinburgh’s Grassmarket area. “I won’t have to go home and scrub the smoke out of my skin.”

If the experience of Ireland, which introduced a ban in 2004, is anything to go by, in virtually all of Scotland’s 5,100 pubs, 1,500 restaurants, 2,400 hotels and 852 nightclubs, the new law will be accepted without fuss and only the occasional incident of “smoke rage”.

EXCERPTS from The Independent, February 15, 2006, United Kingdom, headlined: Smoking will be outlawed in 124,000 pubs and clubs across England from next summer, after MPs voted overwhelmingly to ban lighting up in all enclosed public places; writers Colin Brown and Ben Russell.

In a historic free vote, MPs threw out an "unworkable" compromise ... namely, the commitment to allow smoking to continue in pubs that do not serve food.

Slapping down that compromise, the MPs voted for all pubs to be included in the ban, by 453 votes to 125 a majority of 328.

They then decisively threw out a last-minute proposal to exempt private members' clubs by 384 to 184 a majority of 200 voting again for a complete ban.

Fiona Castle, the widow of the entertainer Roy Castle, lobbied for a total smoking ban a few hours before the MPs took part in six separate votes on the options. She urged them to vote against excluding private members' clubs, telling MPs that her late husband, a non-smoker, had died from a rare form of lung cancer associated with passive smoking in clubs when he was an entertainer.

Her MP, Louise Ellman, the Labour member for Liverpool Riverside, said: "The vote will be a lasting memorial to Roy Castle. His death made Fiona determined to do something about this, and the Roy Castle Cancer Foundation was set up in my constituency as a result."

Professor Alex Markham, chief executive of Cancer Research UK, said: " We're delighted that the smoke-free law will give all workers, including those in pubs and private members' clubs, equal protection from the life-threatening effects of second-hand smoke."

Peter Hollins, director general of the British Heart Foundation, welcomed the vote as "a landmark victory for the public health of this country, which will save the lives of many people across the UK".

Mark Hastings, director of communications at the British Beer and Pub Association, said: "We are pleased that MPs have ensured a level playing field for all, with no exemption for private members' clubs."

Normally, people are not sufficiently aware of their breathing, a largely automatic process, to pay attention to what they breathe or how much they breathe.

For an adult male, for example,

the average daily intake of food is 1.5 kg,
of water is 2.5 kg,
but the amount of air exchanged by the lungs is as high as 15.0 kg.

Neither are people cognizant of the fact that the surface area of the lungs, consisting of millions of tiny air sacs (alveoli) open to the environment, is as large as a tennis court. This large surface area, constituting the interface between the inhaled air and a rich network of fine blood vessels surrounding the alveoli, guarantees an adequate uptake of oxygen to supply every cell in the body as well as the necessary removal of the toxic combustion product, carbon dioxide.

It is estimated that each year an estimated 2.25 million metric tons of gaseous and inhalable particulate matter of secondhand smoke are discharged into our personal air space.

For example, emission estimates in the USA for the year 2002 for three of the major components of secondhand smoke in tons per year are as follows:

Nicotine -- 647 tons per year

Carbon Monoxide -- 30,200 tons per year
Respirable Suspended Particulates (RSPs) -- 5,860 tons per year

Smoking creates a toxic waste dump in the air that lingers long after the smoker has left the room, automobile, etc.

A low-tar filter cigarette may increase health hazards for nonsmokers exposed to its smoke, as more mutagens may be released through the burning end rather than through the filter tip.

The following are among the powerful poisons in secondhand smoke:

Nicotine is a potent poison and is the precursor of the lung carcinogen NNK. Nonsmokers exposed to secondhand smoke carry the lung cancer causing NNK, one of the most potent organ-specific lung carcinogens known, in their bodies. The damage done by carcinogens is permanent and may be cumulative. This is one of the tobacco-specific nitrosamines which arise from nicotine. The Clinical Toxicology of Commercial Products, 5th edition, describes nicotine as "one of the most toxic of all poisons acting with great rapidity."

Carbon Monoxide is highly toxic and disables the oxygen carrying capacity of the hemoglobin in red blood cells, and is associated with heart disease and fetal damage, for example.

Nitrogen oxide is needed for nitrosamine formation.

Ammonia is a respiratory and eye irritant.

Acrolein is a ciliotoxic agent, and it is a respiratory irritant.

Methyl isocyanate is the lung poison known from the Bhopal disaster.

Hydrogen cyanide was used in rat poisons and in Nazi gas chambers.

Phenol was a toilet bowl disinfectant.

Respirable Suspended Particulates constitute the visible smoke which is even less than 5% of the total effluent from a burning cigarette, and carries the bulk of the carcinogens (cancer causing agents) which number approximately 60. The damage done to the body by the carcinogens is permanent.

Air polluted by tobacco smoke contains more than a hundred times the concentrations of endotoxins that are present in average smoke free indoor air. These endotoxins arise from bacteria and can induce serious inflammatory reactions and lead to bronchitis and asthma. A 2006 report from the California Air Resources Board notes that secondhand smoke is a toxic air contaminant. Among other problems produced is the possibility of induction of adult asthma.

Aluminum:
In a March 2006 study reported in The American Journal of Medicine, the authors noted that aluminum in tobacco and cannabis smoke, whether actively (drawn) or passively inhaled, was shown to accumulate significantly in surrogate lung fluids, thus demonstrating its potential biological availability. Active and passive smoking of tobacco or cannabis will increase the body burden of aluminum and thereby contribute to respiratory, neurological and other smoking-related disease.

Secondhand smoke immediately impacts the respiratory system and can trigger asthma attacks which may be severe enough to cause death. Secondhand smoke can also lead to pneumonia, bronchitis, and bronchiolitis.

Secondhand smoke can trigger migraine headaches, earaches, eye and throat irritation, and middle ear infections.

Secondhand smoke can trigger heart attacks and strokes.

An April 7, 2006 study, British Medical Journal, Thomas Houston et al., reveals that secondhand smoke increases the risk of developing glucose intolerance or diabetes. The study followed 5,000 people -- blacks, whites, men, women -- aged 18-30 years, across the USA for 15 years, and found that glucose intolerance was developed by 22% of smokers, 17% of passive smokers, and 12% of people not exposed to smoke.

Secondhand smoke significantly reduces a woman's chance of success in fertility treatments.

EXCERPTS from The Scotsman 26 May 2005, headlined: Passive smoke halves chance of pregnancy, writer Eben Harrell

Doctors have long cautioned that smoking reduces female fertility, but the new research suggests that exposure to smoke, given off by a smouldering cigarette, is just as damaging.

The study, published in the European medical journal Human Reproduction, found that among 225 women seeking fertility treatment, those who lived with a smoker had only the same rate of success in conception as women who smoked.

That rate was half that of "smoke-free" women, said Dr Warren Foster, professor of obstetrics at McMaster University in Ontario, who led the research.

Non-smokers achieved about 48 per cent pregnancy rates per embryo transfer, smokers around 19 per cent and the side-stream smokers 20 per cent.

Nicotine is changed into cotinine in the body. In a study of 4,399 children aged 6 to 16, even the lowest exposure of secondhand smoke, as monitored by the levels of cotinine, a metabolite of nicotine, in blood, urine, saliva, and hair, was found to significantly impair, in a dose related manner, the children's reading, math, and reasoning scores. In other words, in children and teenagers, even low amounts of secondhand smoke can significantly lower test scores by as much as 2-5 or more points and demonstrate a decline in the skills of reading, math, reasoning, and logic. No safe level of exposure to secondhand smoke exists. Quoting from that recent study, the authors stated:

"We estimate that more than 33 million children in the United States are exposed to levels consistent with the adverse effects seen in this study."

"In the United States, 43% of children are exposed to environmental tobacco smoke in their own homes, and 85% of children have detectable levels of cotinine in their blood."
(K.Yolton, et al. Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents. Environmental Health Perspectives 113 (1): 98-103, 2005.)
http://ehp.niehs.nih.gov/members/2004/7210/7210.html

Carcinogens cause damage to the body which is permanent and can lead to cancer. There is no safe level for carcinogens. Approximately 60 carcinogens are present in tobacco smoke.

Secondhand smoke has been definitely linked to several types of cancers including:

Breast Cancer
EXCERPTS from MSNBC News Services, Associated Press, and Reuters, January 27, 2006, headlined, Calif. declares secondhand smoke a pollutant; Decision puts tobacco exposure in same category as diesel exhaust, arsenic; no writer given.

SACRAMENTO - California became the first state to declare secondhand smoke a toxic air pollutant Thursday, citing its link to breast cancer. Experts said the decision may have more impact worldwide than it does in the largely smoke-free state.

The decision by the California Air Resources Board puts environmental tobacco smoke [ETS] in the same category as diesel exhaust, arsenic and benzene.

Scientific studies in recent years have warned about the health impact from second-hand smoke and linked it to a wide array of ailments including heart disease, lung cancer and other respiratory ailments, as well as breast cancer.

“I think there is no question that this puts California way ahead,” said John Froines, chairman of the Air Resources Board’s Scientific Review Panel.

“To actually have the major air pollution agency in the state of California to list ETS (environmental tobacco smoke) as a toxic air contaminant is going to have immense impact, we think, in terms of public education around other states,” he said. “It will clearly lead to regulatory changes within the state.”

The unanimous decision relied on a September report that found a sharply increased risk of breast cancer in young women exposed to secondhand smoke. It also links drifting smoke to premature births, asthma and heart disease, other cancers, and numerous health problems in children.

"If people are serious about breast cancer, they have to deal with secondhand smoke. That's what this is all about," said Dr. Stanton Glantz, director of the Center for Tobacco Control, Research and Education at the University of California, San Francisco. He reviewed the science behind Thursday's decision. "This is a seminal, international document. It's impossible to underestimate what a big deal this is."

The report by scientists at California's Office of Environmental Health Hazard Assessment draws on more than 1,000 other studies of the effects of passive smoke. It blamed secondhand smoke for 4,000 deaths each year in California from lung cancer or heart disease alone.

The most significant new finding is that young women exposed to secondhand smoke increase their risk of developing breast cancer between 68 percent and 120 percent. The disease kills about 40,000 women in the United States each year.

The California report went through an exhaustive review that delayed its release for nearly a year but ensures it is based on sound research, said Dr. John Froines, director of UCLA's Center for Occupational and Environmental Health and head of the scientific review panel.

R.J. Reynolds spokesman David Howard said regardless of the dangers from passive smoke indoors, no research supports regulators' decision to declare it an air pollutant.

A spokeswoman for tobacco giant Philip Morris USA, a unit of Altria Group Inc., declined to comment.

Lung Cancer
EXCERPTS from BBC Cancer Alert for Smoking Parents, January 28, 2005

Children regularly exposed to smoking are three times more likely to contract lung cancer in later life than those in non-smoking homes, research suggests.

The Imperial College researchers tracked the progress of more than 123,000 participants over seven years. They told the British Medical Journal that the link between lung cancer and passive smoking was "significant". Health charity Cancer Research UK said the study raised a "terrifying spectre" for smoking parents.

The researchers tracked 123,479 volunteers - some of whom had never smoked, others had stopped smoking, but all had been exposed to second-hand smoke in their childhoods. Over a seven-year period they found that 97 people developed lung cancer and 20 more had related cancers such as cancer of the larynx. In addition, 14 died from chronic obstructive pulmonary disease.

"Environmental tobacco smoke exposure during childhood showed an association with lung cancer, particularly among those who had never smoked," the researchers said. The team concluded that the study reinforced past research about the cancerous effects of passive smoking. The researchers also found that ex-smokers faced up to twice the risk of respiratory diseases from passive smoke than those who had never smoked. They believe this is because their lungs were already damaged - making them more at risk to the effects of passive smoking.

The British Medical Association (BMA) said the "important study" confirmed that passive smoking kills. "The results show clearly that second-hand smoke causes cancer of the lung, mouth and throat," a BMA spokesman said. Professor Robert West, Cancer Research UK's director of tobacco studies, said society's attitude towards passive smoking "has to change". "As a society we recognise that non-smokers need to be protected from carcinogens when at work but we are not doing enough to protect the most vulnerable non-smokers of all - children," he said.

Amanda Sandford, research manager for Action on Smoking and Health (ASH), called for a smoking ban in all public places. She added: "The best thing parents can do for the health of themselves and their children is to stop smoking."

Breast Cancer

The California EPA report, 2004-2006, conclusively links breast cancer to secondhand smoke. Earlier studies on breast cancer had been inconclusive because of the complexity of variables that needed to be controlled before statistical significance could be achieved, such as menopausal status, age of exposure to secondhand smoke, genetic susceptibility, and the hormone receptor status of the tumor.

EXCERPTS from Reuters Health, March 2, 2005, no writer given, headlined: Smoking Ups Risk of Premenopausal Breast Cancer, based on the International Journal of Cancer, March 10, 2005.

Both active and "passive" smoking (exposure to secondhand smoke) increase the risk of breast cancer in premenopausal but not postmenopausal women, a study of middle-aged Japanese women suggests.

The investigators think that higher levels of estrogens present in the body of premenopausal women may act jointly with external cancer-causing agents, such as tobacco, to fuel the development of breast cancer.

In the study, Dr. Tomoyuki Hanaoka from the National Cancer Center in Tokyo, Japan, and colleagues studied associations between smoking and breast cancer in close to 22,000 women who were between the ages of 40 and 59 years in 1990.

A total of 180 women developed breast cancer by the end of 1999, they report in the International Journal of Cancer this month.

Among all of the women, 5.7 percent were current smokers, 1.7 percent were ex-smokers, and 92.6 percent had never been active smokers. Sixty-nine percent of these "never-active smokers” reported that they had been exposed to sidestream smoke.

Compared with never-active smokers with no exposure to secondhand smoke, ever-smokers who had yet to enter menopause had a greater than 3-fold elevated risk of developing breast cancer. The elevated risk of developing breast cancer among ever-smokers was not observed in postmenopausal women.

Premenopausal but not postmenopausal women who had never smoked but had been exposed to secondhand smoke had a 2.6-fold increased risk of developing breast cancer.

These results, the authors conclude, show that both active and passive smoking increases the risk of breast cancer in premenopausal women. "Both active and passive smoking are promising targets in the prevention of breast cancer," they write.

Nasal Sinus Cancer

Cervical Cancer

A new study reveals that women exposed to secondhand smoke may be at greater risk for cervical cancer. Published in the Obstetrics & Gynecology Journal, 2005, the Johns Hopkins School of Medicine study noted that women who did not smoke but who lived with someone who did smoke were twice as likely to develop cervical tumors as women not exposed to smoke.

There is strong evidence that secondhand smoke is a cause of

nasopharyngeal cancer,
and of brain cancer and lymphomas in children.
(California EPA Report)

A recent study from the Johns Hopkins Bloomberg School of Public Health states that the current EPA Assessment System for Population Exposure Nationwide (ASPEN), which is being used nationally to assess the public health impact of ambient air toxins, underestimates their cancer risk by a factor of as high as three, when compared to directly measuring indoor, outdoor, and personal exposures. (T.J. Buckley, et al. Cancer health risk significantly underestimated by EPA's ambient model estimates. Journal of Environmental Health Perspectives 112: 589-598, 2004.)

Please note: The tobacco industry lost its lawsuit challenging the 1992 U.S. Environmental Protection Agency Report which classified secondhand smoke as a Group A Human Carcinogen.

First, however, Federal Middle District Judge William Osteen in 1998 ruled in favor of the industry. As a private attorney in 1974, Osteen had worked for tobacco growers as a lobbyist.

The EPA appealed his ruling. The Fourth Circuit Court of Appeals not only dismissed Judge Osteen's ruling, but threw out the case against the EPA altogether.

The tobacco companies had the option to appeal to the U.S. Supreme Court, but failed to do so, probably because they knew they would lose with so many credible scientific studies that had reaffirmed that secondhand smoke causes cancer.

The nicotine cartel had succeeded, however, in clouding media reporting and the understanding of the general public who still seemed to think there was doubt about secondhand smoke causing cancer.

There are a variety of web sites which could have hidden ties to the tobacco companies and which continue to cultivate doubt about health hazards with articles sneering at reputable studies and maintaining the "right" of smokers to smoke wherever they please and to blow smoke in other people's airspace.