Updated 20 March 2008
Special thanks to Dr. K. Heinz Ginzel and Anne Morrow Donley for help on this update.

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

In this Fact Sheet on secondhand smoke the following topics are considered:

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.

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
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.

April 2006:  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.

January 2006 -- A unanimous decision by the California Air Resources Board listed secondhand smoke as a toxic air contaminant, January, 2006.  The most significant new finding is that young women exposed to secondhand smoke increase their risk of developing breast cancer between 68% and 120%.   Breast cancer kills about 40,000 women in the United States each year.

New findings in the Cal-EPA report, Part B, include:
-- a causal link between secondhand smoke exposure and pre-term delivery;
-- asthma induction in adults;
-- breast cancer in younger, primarily premenopausal women; and
-- altered vascular properties.
Part A of the report contains the first ever outdoor monitoring of secondhand smoke exposure near designated smoking areas in California.

The report has gone through an extensive, four-year scientific review process, including public comment and independent peer review.

EXCERPTS from Reuters, August 17, 2005
The effects of secondhand smoke in the United States cost nearly $10 billion every year ....

The Society of Actuaries said that the direct costs of secondhand smoke exposure are $4.98 billion, including expenses related to the treatment of heart disease, chronic pulmonary disease, lung cancer, asthma and other sicknesses.

The study also detailed indirect costs of $4.68 billion, stemming from lost wages, reduced services and costs associated with disabilities.

The group measured the costs by examining more than 200 studies that have been published since 1964 on the effects of environmental tobacco smoke.

There may be many things that people will accept secondhand -- but smoke is NOT one of them. 
Tobacco Smoke is so dangerous, it can even kill secondhand.  It is the third preventable cause of death, after smoking and alcohol use.

Tobacco companies do not allow smoking around tobacco seedlings -- because it kills them
-- tobacco mosaic virus.
Tomato plants are also susceptible to this. 

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 through excessive sick leave, on-the-job injuries, and frequent smoking breaks.  Non-smoking workers also lose productivity through exposure to secondhand smoke. Together these effects incur the equivalent of US$1 billion loss in productivity, accounting for 0.36% of total gross domestic product in Taiwan.

Absenteeism and increased use of medical 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% increase in sick days during a six month period for male officers and a 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."

Several nations recognize the lethal health dangers of tobacco smoke
and prohibit smoking in most workplaces, including restaurants, pubs, clubs, and bars.  For a weekly update of the nations and a summary of their laws and regulations, please see the ASH of Scotland web site, and click on "Briefing on smoke-free legislation around the world."  Also, see

Nations either 100% no-smoking, or with few exceptions smoke-free including restaurants and bars:

Bhutan, Demark, England, France, Iceland, Ireland, Norhern Ireland, Hong Kong, Israel, Italy, Lithuania, Malta, New Zealand, Norway, Portugal, Scotland, Slovenia, South Africa, Sweden, Tasmania, Uganda, Uruguay, Wales

Parts of: Australia, Germany

Under consideration:  Czech Republic, Turkey

Canada -- Provinces and Territories that are smoke-free:

Alberta, British Columbia, Manitoba, New Brunswick, North West Territories, Nova Scotia, Nunavut, Ontario; Quebec considering this.

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

Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Louisiana, Maine, Maryland (Feb.1 all workplaces), Massachusetts, Montana , Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Washington

Additionally:  Washington, D.C.; Guam, Puerto Rico

The University of Guam is smoke-free and tobacco-free as of August 1, 2006.
Smoking was already prohibited inside University buildings, and now this will include all University grounds, including parking lots, courtyards, atriums, Dean's Circle, and off-campus facilities.  Smoking cessation programs will be offered to people associated with the University.

In a media release, Dr. Helen Whippy, Senior Vice President of Academic Affairs and Student Services, noted:  "Guam has, per capita, the highest adult smoking rates in the nation, higher than tobacco producing states.  With the establishment of the Cancer Research Center at the University of Guam and its focus on cancer disparity issues among Pacific Islanders, research on smoking cessation, and the fact that 60 per cent of all Guam cancer deaths are tobacco related, the University must take a stand for the health and wellness of our students and employees."

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."

Secondhand smoke results primarily from sidestream smoke and partly from exhaled mainstream smoke.   Sidestream smoke is the smoke emitted by the burning end of the cigarette, cigar, pipe, etc. between puffs.  Mainstream smoke is the smoke the smoker inhales. 

There is no safe level of exposure to
secondhand smoke.

Secondhand smoke is the single most important source of harmful indoor air pollution.  It has been officially declared a toxic pollutant by the California Environmental Protection Agency after reviewing the numerous scientific studies.
There is no safe level of exposure to tobacco smoke.

The simple separation of smokers and nonsmokers within the same air space is not sufficient to protect nonsmokers.

Smoke cannot read signs, and it does not stay in the "smoking" section.
Picture a swimming pool filled with water -- now, which part is not chlorinated?  Would you put up signs saying "Chlorinated Area" and "Unchlorinated Area"?

If people are swimming at one side of the swimming pool, and a child is urinating at the other side of the swimming pool, would you put up signs saying, "Swimming Area" and "Peeing Area"?

So it is with smoke in the air.

The US Environmental Protection Agency has concluded that "Research indicates that total removal of tobacco smoke through ventilation is both technically and economically impractical."

Ventilation is not the answer to protecting people from
secondhand smoke.

The British Medical Association has declared that:
Research in America found that there was 50 times more air pollution in a smoky bar than in New York's Holland tunnel at rush hour, and studies have found that ventilation in bars does not reduce the risk to the health of customers or staff.

The tobacco industry has proposed that ventilation is the solution to the problem of passive smoke, however, scientific evidence proves that conventional ventilation and air-cleaning systems do not provide effective protection against the health hazards of second hand smoke.

Ventilation systems use a filtration method to re-circulate air. However, while this method can clear the smoky atmosphere, the toxins present in the gas of second hand smoke remains.

Particulate matter and toxic gases of secondhand smoke remain suspended in the air of a room, a car, and/or attached to walls, furnishings, and materials in the room, long after smoking has ceased.  This can trigger health problems for people who enter that room, car, etc.

The abstract on a Fact Sheet on Secondhand Smoke, available at http://www.repace.com states:
Breathing secondhand-smoke causes morbidity and mortality from cancer, heart disease, and respiratory disease, as well as acute sensory irritation.  It causes the premature death of hundreds of thousands of nonsmokers worldwide.  Smoke-free buildings are the only remedy.  Secondhand smoke cannot be controlled by ventilation, air cleaning, or spatial separation of smokers from nonsmokers.

Secondhand smoke contains more than 4,000 chemicals and approximately 60 carcinogens (cancer causing agents).  See also the web page on smoke chemicals.
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 NNKNonsmokers 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.


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.

Among the carcinogens (cancer causing agents) in secondhand smoke are
Benzo [a] pyrene  -- implicated in lung cancer

Nitrosamines -- cancer of lung, respiratory system, and other organs

Aromatic amines -- cancer of the bladder, cancer of the breast

Benzene -- leukemia

Formaldehyde -- nasal cancer; used in embalming fluid

Polonium-210 -- radioactive -- yes, radioactive!

National Toxicology Program, Report on Carcinogens

IMMEDIATE impacts of secondhand smoke on health
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.

econdhand 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.

econdhand 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.)

Secondhand smoke KILLS
Cardiovascular Disease
Respiratory Disease
Perinatal death, miscarriage, low birth weight, Sudden Infant Death Syndrome (SIDS)

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.

econdhand smoke Kills, continued:
Cardiovascular Diseases
One out of every six deaths from cardiovascular disease is caused by smoking, the leading preventable risk factor.  Secondhand smoking is the third leading preventable cause of death.  Smoke-free workplaces would significantly reduce heart disease.

A 2006 California Air Resources Board report found that secondhand smoke altered vascular properties, and labeled secondhand smoke a toxic air contaminant.

EXCERPTS from American Academy of Family Physicians, Journal, November 15, 2004, titled, Impact of Secondhand Smoke on Inflammation, author Karl Miller, M.D., reviewing:  Panagiotakos, DB, et al.  Effect of exposure to secondhand smoke on markers of inflammation: the ATTICA studyAmerican Journal of Medicine, February 1, 2004;116:145-50.

Next to active smoking and alcohol abuse, secondhand smoke is the third leading cause of poor health and premature death in the developing world. There are multiple mechanisms by which secondhand smoke has a negative effect on coronary risk factors. Inflammation markers have been shown to be related to the development of atherosclerotic disease. Panagiotakos and colleagues evaluated the effect of secondhand smoke on inflammatory markers related to cardiovascular disease in persons without any clinical evidence of cardiovascular or atherosclerotic disease.

When compared with persons who were not currently exposed to secondhand smoke, those with regular exposure had significantly higher white blood cell counts and C-reactive protein levels. In addition, the regularly exposed group had significantly higher homocysteine, fibrinogen, and oxidized LDL cholesterol levels compared with those who had no exposure. After adjusting for age, sex, physical activity, body mass index, and food consumption, persons with regular exposure to secondhand smoke had significantly higher levels of all of the inflammatory markers.

The authors conclude that exposure to secondhand smoke leads to inflammation and oxidation. This finding suggests that the impact of secondhand smoke on inflammation may be another pathophysiologic mechanism for the development of atherosclerosis. They add that more effort should be made to reduce involuntary exposure to secondhand smoke.

Coronary Heart Disease (CHD) is causally associated with secondhand smoke exposure. 

The latest estimate of the annual death toll from secondhand smoke-related CHD in the USA ranges from 22,700 to 69,600.  Underlying conditions such as diabetes, hypertension, or vascular disease worsen the risk.

Stroke -- Secondhand smoke can contribute to stroke due to atherosclerosis of the carotid artery and the large arteries of the brain as well as the degeneration of intracerebral arteries.

A recent 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 is available at the American Journal of Epidemiology.

EXCERPTS from Reuters, February 24, 2005, quoted at the National Library of Medicine web site, no writer noted, headlined, Wives of Smokers Run Risk of Stroke

"Growing evidence suggests that exposure to environmental tobacco smoke may have deleterious cardiovascular effects," Dr. Xiao Ou Shu, of Vanderbilt University, Nashville, Tennessee, and colleagues write in the [February, 2005] American Journal of Epidemiology. "Few studies have investigated environmental tobacco smoke exposure in relation to stroke."

The researchers looked into husbands' smoking status and the prevalence of stroke among Chinese women non-smokers in Shanghai. The team notes that two thirds of men, but few women, in the region smoke.

Included in the analysis were 60,377 women between the ages of 40 and 70 years.

The survey showed that 32,287 women (54 percent) were living with a husband who was a current smoker. A total of 5108 (9 percent) were living with a husband who was a former smoker. Overall, 526 cases of stroke were reported.

Analysis showed that women living with a current smoker had a 47 percent higher risk of stroke compared to women married to a never-smoker. The risk was not significantly higher among women married to a former smoker.

"The odds of stroke increased with increasing number of cigarettes the husbands smoked per day," Shu and colleagues write. Compared with women whose husbands had never smoked, those whose husbands were current smokers had a 28 percent to 62 percent increased risk of having a stroke, depending on how much the husband smoked.

The odds of stroke also increased with increasing duration of husbands' smoking, according to the team.

The mechanisms by which secondhand smoke affects the heart and blood vessels comprise
arterial wall thickening,
lesion formation,
decrease in aortic distensibility and reactivity, and
endothelial dysfunction which has emerged as a major factor in CHD.

Secondhand smoke induced endothelial dysfunction, that is, a functional impairment of the linings of blood vessels, may finally explain why secondhand smoke can cause much greater damage to the cardiovascular system than one would have expected simply by comparing the quantities of cigarette smoke to which active and passive smokers are exposed. 

A recent landmark experiment (JAMA 2001) 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.  These changes are caused by nicotine which inhibits the self-regulatory widening of the coronary blood vessels (vasodilatation) in response to nitric oxide, an endogenous agent released by endothelial cells.  Since this effect of nicotine reaches its maximum already in the small amounts present in secondhand smoke, the difference between passive and active smoking as to their effects on blood vessels is greatly narrowed.  By the same token, smoking of only 1 to 3 cigarettes per day can cause heart disease by this mechanism.

Other factors contributing to heart disease and stroke are the adverse effect of
secondhand smoke on blood lipids:  increase in "bad" cholesterol, LDL, decrease in "good" cholesterol, HDL, as well as platelet activation and elevated fibrinogen levels, all of which are associated with endothelial damage and plaque formation leading to atherosclerosis that, in turn, predisposes to coronary heart disease and stroke.

Secondhand smoke Kills, continued:
Respiratory Disease
Asthma in children and in adults can be induced and exacerbated by exposure to secondhand smoke.
A 2006 report from the California Air Resources Board notes that adult asthma can be induced from secondhand smoke, which it has labeled a toxic air contaminant.
Secondhand smoke aggravates episodes and severity of asthma attacks.
Secondhand smoke causes more than 8,000 new cases of asthma in children each year.
As children grow, secondhand smoke significantly reduces their lung capacity and exercise tolerance.

The fetus and secondhand smoke -- Children and secondhand smoke
A 2006 report from the California Air Resources Board notes a causal link between secondhand smoke exposure and pre-term delivery.

Secondhand smoke can damage a developing fetus, and it can be as dangerous as primary exposure from maternal smoking.
  This is reported in a 2005 study from the University of Pittsburgh Graduate School of Public Health and published in the online journal BMC Pediatrics.  Stephen G. Grant, Ph.D. reports that both active maternal smoking and secondary maternal exposure result in similarly increased rates of genetic mutation that are basically indistinguishable.

"This analysis shows not only that smoking during pregnancy causes genetic damage in the developing fetus that can be detected at birth, but also that passive -- or secondary -- exposure causes just as much damage as active smoking, and it is the same kind of damage. ... These kinds of mutations are likely to have lifelong repercussions for the exposed fetus, affecting survival, birth weight and susceptibility to disease, including cancer."

Secondhand smoke from either parent hurts the fetus. 
The fetus is hurt by smoke from the pregnant mother who smokes, and the secondhand smoke breathed by the mother.

Secondhand smoke from either parent hurts infants and children.

Pregnant women who smoke, or who are around secondhand smoke, may find serious consequences for the fetus and later for the infant, such as:
perinatal death
low birth weight, a predictor of frequent illness in the first year of life
sudden infant death syndrome (SIDS)
childhood leukemia
cancer of the brain or lungs later in life
conduct disorder
emotional as well as intellectual deficits which have been traced past age 20

This damage can be manifested in impaired lung development, decreased lung function, sudden infant death syndrome (SIDS), acute and chronic respiratory illnesses (including otitis media), and the induction and exacerbation of asthma.

Secondhand smoke exposure in pregnancy is responsible for a reduction in birth weight which is associated with respiratory problems and perinatal mortality.

The danger of SIDS, the most common cause of death in the first year of life, greatly increases for infants whose parents smoke near them.

Nicotine, which impacts the brain during critical stages of its intrauterine development in experimental animals, is a likely cause for the deficits in learning and memory, and the emotional and behavioral problems seen in childhood and later in life.

Prenatal nicotine also primes the adolescent brain for addiction.

Carcinogens reaching the fetus via the placental circulation can cause cancer later in life.

Experimental findings in mice suggest that prenatal secondhand smoke exposure may also promote development of adult cardiovascular disease.

Secondhand smoke increases the incidence of middle ear effusion in children.

Heart disease risks go up as secondhand smoke lowers kids' "good" cholesterol [HDL] and increases the "bad" cholesterol [LDL].

Children suffer great physical and psychological distress from secondhand smoke exposure.

Secondhand smoke causes Dental Decay
Association of Pediatric Dental Caries With Passive Smoking
Conclusions:  There is an association between secondhand smoke and risk of caries among children. Reduction of passive smoking is important not only for the prevention of many medical problems, but also for the promotion of children's dental health.
JAMA, Journal of the American Medical Association.  2003;289:1258-1264
Vol. 289 No. 10, March 12, 2003; C. Andrew Aligne, MD, MPH; Mark E. Moss, DDS, PhD; Peggy Auinger, MS; Michael Weitzman, MD

History:  The British Medical Association (BMA) called for smoke-free workplaces and smoke-free enclosed public places.  Noting on their web site:
"The politicians in Ireland, Norway, and New York have decided to put the health of their citizens first by banning smoking in enclosed public places.  Surely we have a right to ask the same from our Governments?"

Related items:

Jamrozik, Konrad (School of Population Health, University of Queensland, Australia); The British Medical Journal, March 1, 2005, Estimate of deaths attributable to passive smoking among UK adults: database analysis, BMJ, doi:10.1136/bmj.38370.496632.8F.

Objective To estimate deaths from passive smoking in employees of the hospitality industry as well as in the general workforce and general population of the United Kingdom.

Design Calculation, using the formula for population attributable proportion, of deaths likely to have been caused by passive smoking at home and at work in the UK according to occupation. Sensitivity analyses to examine impact of varying assumptions regarding prevalence and risks of exposure.

Setting National UK databases of causes of death, employment, structure of households, and prevalences of active and passive smoking.

Main outcome measures Estimates of deaths due to passive smoking according to age group (<65 or 65) and site of exposure (domestic or workplace).

Results Across the United Kingdom as a whole, passive smoking at work is likely to be responsible for the deaths of more than two employed people per working day (617 deaths per year), including 54 deaths in the hospitality industry each year. Each year passive smoking at home might account for another 2700 deaths in persons aged 20-64 years and 8000 deaths among people aged 65.

Conclusion Exposure at work might contribute up to one fifth of all deaths from passive smoking in the general population aged 20-64 years, and up to half of such deaths among employees of the hospitality industry. Adoption of smoke free policies in all workplaces and reductions in the general prevalence of active smoking would lead to substantial reductions in these avoidable deaths.

EXCERPTS from the BBC, March 2, 2005, article taken from the above mentioned British Medical Journal study; BBC article headlined: Passive smoking killing thousands.

Passive smoking kills more than 11,000 a year in the UK -- much higher than previously thought, a study shows. The British Medical Journal study also gives a figure for people dying from second-hand smoke in the workplace - 600 a year - for the first time.

Leading doctors said the findings proved a complete ban on smoking in public places was needed.

But smoking lobby group Forest said there was still little hard evidence of the effect of passive smoking.

November's Public Health White Paper proposed a ban on smoking in public places with the exception of pubs which do not serve food.

At the time much of the medical establishment criticised the proposals for not going far enough.

But doctors have thrown their support behind Liverpool's bid to introduce a complete ban in all workplaces, which is due before the House of Lords later this month.

Researchers at University of Queensland in Australia compiled the report from UK databases of causes of death, employment, structure of households and levels of active smoking and exposure to passive smoking.

They found 2,700 deaths among people aged 20 to 64 could be attributed to second-hand smoke and 8,000 in 65-year-olds and over.

A further 617 deaths were caused by workplace passive smoking, including 54 in the hospitality industry.

Report author Konrad Jamrozik said: "It is clear that adoption of smoke free policies in all workplaces in the UK might prevent several hundred premature deaths each year."

Previous studies have put the figure much lower. The British Medical Association estimated it was 1,000 a year three years ago but said the latest study was a much more comprehensive guide to the problem.

BMA chairman James Johnson said: "As doctors we see first-hand how second-hand smoke kills.

"I don't know how John Reid [the home secretary] can continue to serve the public half-measures on health. We need a total ban and we need it now."

And Royal College of Nursing president Sylvia Denton said a complete ban would "save lives".

Below are EXCERPTS from the press release from the British Medical Association (BMA), November 9, 2004, calling on the English Health Secretary, John Reid, to set a date to ban workplace smoking in the United Kingdom.

In a stark BMA report, The Human Cost of Tobacco, published today (9 November 2004), doctors chronicle individual stories behind the statistics to show how second-hand smoke destroys lives and health.

Every year [in England] at least 1000 people die from the effects of passive smoking. The BMA believes the biggest single step governments can take to improve the health of the public is to take action at national level to stop smoking in enclosed workplaces.

In his foreword to the report, BMA Chairman, Mr. James Johnson, offers the Health Secretary, John Reid, the same advice as smokers get:
There is no doubt that giving up smoking can be extremely difficult – like any addiction kicking the habit is no easy task. When smokers decide to quit they are often advised to set a date, bin the fags and then just do it. Support from a doctor or health professional during this time can be invaluable. I am going to give the same advice to John Reid.

In the forthcoming White Paper for England, he should set a date for banning smoking in all enclosed public places, this will give the bars and restaurants time to bin their ash-trays and then these workplaces will just have to abide by the law. John Reid already has the support of the medical profession.

The report charts around 70 cases throughout the United Kingdom of doctors’ experiences of dealing with patients who have been exposed to second-hand smoke. For example:

Lung Cancer
“I have had three confirmed cases of inoperable primary lung cancer in life-long non-smokers in the last two years. The biopsies showed the type of lung cancer only seen in smokers, and all three worked in public places where they were heavily exposed to secondary cigarette smoke. All three died within weeks of diagnosis.”

Respiratory Disease
"I have recently seen a thirty-four year old landlady with severe bronchial irritation and a history of recurrent wheezy chest infections caused by her work environment in a smoky pub. She now needs regular inhaled drugs including steroids to control her symptoms. She herself has never smoked.”

“I saw a young boy on a number of occasions suffering from severe asthma attacks. His mother said she could not think of anything that brought on the attack, but the young boy said 'I always get sick after seeing granddad'. Apparently his grandfather owns a small and usually smoke filled restaurant.”

“In my current post in obstetrics I see numerous cases of low-birth weight babies and difficult pregnancies exacerbated by passive smoking."

The BMA has been calling for legislation to ban smoking in enclosed public places since 1986.

Several agencies classify secondhand smoke as a human carcinogen including:
The International Agency for Research on Cancer (IARC) classified tobacco smoke as a human carcinogen -- a global recognition
The World Health Organization -- another global recognition
The Surgeon General's Report on the Health Consequences of Involuntary Smoking, United States Department of Health and Human Services (USDHHS), 1986
The National Academy of Sciences, USA
The National Cancer Institute, USA
The National Institute for Occupational Safety and Health (NIOSH), USA
The National Research Council of the National Academy of Sciences, Report on Environmental Tobacco Smoke, 1986, USA
U.S. Environmental Protection Agency, 1992 Report, endorsed and reprinted by the National Cancer Institute, USDHHS, as Smoking and Tobacco Control Monograph 4, 1993.
California EPA, 1997, endorsed and reprinted by the National Cancer Institute, USDHHS, as Smoking and Tobacco Control Monograph 10, 1999, USA
California EPA Update
The U.S. Public Health Service

The Smoke-Free Environments Law Project in Michigan addresses the problems of secondhand smoke seeping from one apartment or condominium into another one. This presents problems for immediate and long range health, as well as the hazard of fire, and also the fact that if smoke can seep into your apartment, so can other toxic fumes.

Here is an excerpt from and a link to the 
Smoke-Free Environments Law Project:
"As the serious health effects of environmental tobacco smoke (ETS), or secondhand smoke, have become better understood, the seepage of ETS into apartments and condominiums has emerged as a growing area of controversy for tenants and building owners alike.  Clearly, virtually all tenants find secondhand smoke which enters their residence from their neighbors to be an annoyance and a discomfort, but for some persons it is also a cause of serious illness or the precipitant of significant health problems.  For landlords or condominium associations, the issue of ETS seepage creates unwanted concerns and tensions, but also potential legal and liability problems, as evidenced by the increasing number of lawsuits resulting from these situations."

EXCERPTS from The Star-Ledger, New Jersey USA, August 23, 2005, headlined,
N.J. dorms become smoke-free, a U.S. first; Codey signs law that applies to both public and private colleges; writer, Paula Saha

Calling it the nation's toughest law on college smoking, acting Gov. Richard Codey signed legislation yesterday that prohibits smoking in dormitories at both public and private New Jersey colleges.

"Today we are creating a safer, healthier college campus," Codey said before signing the bill at Drew University's Madison campus.

Two states, Connecticut and Wisconsin, have banned dorm smoking at public colleges, said Karen Blumenfield of New Jersey GASP, an anti-smoking organization. But local and national anti- smoking organizations said no state had ever banned smoking in dorms at both public and private institutions.

Drew University was the site of a Feb. 14 dormitory fire attributed to discarded cigarette ash on the floor of a room. More than 140 students were evacuated. No one was injured.

Sen. Barbara Buono (D-Middlesex), one of the bill's sponsors, said that incident gave the measure added momentum in the Legislature.

Enforcement of the ban will be primarily the responsibility of the colleges and universities, Codey said yesterday. But the law also allows individuals to bring complaints to the state or local board of health, which can impose fines of up to $200 for repeated violations.

More important, Willmore said, the law establishes a new social norm for students.

"This is establishing an environment in college campuses that discourages students from starting to smoke and encourages those who smoke to start to quit," he said. "It's an important legal step and an important cultural step, as well."

Some New Jersey schools, including Princeton, Seton Hall and Fairleigh Dickinson universities and Ramapo College, have already adopted their own dorm smoking bans, according to New Jersey GASP.

Drew University adopted a smoke-free dorm policy earlier this summer and sent letters to all its students. Spokesman Thomas Harris said yesterday the school is still working out enforcement, but he thought much of it would be educational or informational at first, and could ultimately result in fines for the smoker.

Several Drew students on campus yesterday endorsed both the school policy and the state law. Stephani Kim, 19, said she felt the ban would make her living conditions safer.

"You're living in a hall with up to 40 students," she said. "If there are people who don't want (to be around smoking), you're being disrespectful to them. ... I think smoking outside is more acceptable."

Stacy Serra, 20, started smoking at 17 but said she favors the ban and does not believe smoking in a dorm room is a privacy issue. "If they don't let you light candles in rooms, why should they let you smoke?"

The tobacco industry is the only industry which when confronted with the illness, death, and devastation it causes to people and the environment, refuses to stop manufacturing and marketing the product. 
Instead, as greedy drug pushers, they continue to promote their products and refuse to accept responsibility for their actions, blaming the user, not the manufacturer, blaming the addict, not the ones who made the product addictive. 

They post so-called information on their web sites stating that the products they make have been deemed by others to be harmful.  Since they continue to manufacture and advertise their products, this is apparently a legal ploy to try to say that they have sufficiently warned every consumer, so that no one can then sue them for any illness or death resulting from the use of their products.  This is immoral, obscene, and shows a total lack of compassion for both their consumers -- the smokers -- and those bystanders, including children and adults, who are forced to breathe the tobacco smoke.

This is not an industry that exhibits corporate responsibility.

Furthermore, as evidenced by the items given below on this page, they have in the past and continue to this day to try to intimidate scientists and to discredit peer reviewed studies.

Press release from the International Agency for Research on Cancer (IARC)
January 14, 2005
IARC Press Releases http://www.iarc.fr, 2005

Tobacco industry undermining the basis of trust in Science

Bitton and colleagues publish in the current issue of Lancet further revelations about Tobacco Industry subterfuge employed to discredit scientific research, including work conducted at the International Agency for Research on Cancer (IARC), and to target specific scientists.

"The use of consultants, who fail to declare their associations with the tobacco industry, to publish purchased critiques of scientific research appears to remain one of the key strategic approaches of the Tobacco Industry" said Dr Peter Boyle, Director of the IARC. "Strategically coordinated attacks by hired guns, hiding behind undisclosed paid associations with industry, on the personal research of independent scientists by such means is at best unethical and at worst cowardly."

Mutations in p53 tumour suppressor gene have been reported in 60% of lung tumours. Work published from 1996 onwards, based to a large extent on IARC's p53 Database (http://www-p53.iarc.fr/index.html), demonstrated patterned mutagenic effect of benzo[a]pyrene, a carcinogen present in tobacco smoke. "The tobacco industry tried to tamper with this evidence because of the implications in the recognition of tobacco smoke as the cause of individual cases of lung cancer. Their strategy of infiltrating the scientific community to undermine the normal process of peer review and publication is distressing for the scientists whose work is targeted. It is also damaging for outstanding journals and academic institutions whose record with respect to tobacco research might appear to be blurred by the actions of a few individuals who maintained undisclosed tobacco industry ties."

"Such activity was supposed to be a thing of the past following the U.S. Master Settlement in the late 1990s, but obviously this is not the case" noted Dr Boyle. "The Tobacco companies claim that they are now working with the public health community to support a single, consistent public health message on the role played by cigarette smoking in the development of disease in smokers."

"If the Tobacco Industry is genuine in their recently proclaimed desire to work with the Public Health community then they cannot expect any cooperation if they continue to be involved in this and other similar activities. This Industry needs to demonstrate true corporate social responsibility. Until then, the public health community can have no confidence in the actions of the Tobacco Industry, and academic institutions should refuse any involvement with them, no matter how loudly the industry claims that they will not interfere in the research."

Nicolas Gaudin, Ph.D.
Chief, IARC Communications Group
International Agency for Research on Cancer
World Health Organization

Tobacco Industry Strategy to Undermine Research

Excerpted from EurekAlert, November 1, 2001 http://www.eurekalert.org/pub_releases/2001-11/uoc--idr110101.php

ID: 77768   Contact: Wallace Ravven, wravven@pubaff.ucsf.edu, 415-476-2557, University of California - San Francisco

Philip Morris tobacco company launched a hidden campaign in the 1990s to change the standards of scientific proof needed to demonstrate that secondhand smoke was dangerous, according to an analysis of internal tobacco industry documents by researchers at the University of California, San Francisco (UCSF). The "sound science" standards they promoted through a variety of industry groups would have made proving the hazards of secondhand smoke virtually impossible, according to the study.

The tobacco industry strategy involved a seemingly noble calling for "sound science", while rejecting so-called "junk science" on secondhand smoke that actually threatened the industry's business interests.

Working through lawyers and public relations firms, Philip Morris sought to organize other industries to participate in the "sound science" movement, masking its own involvement. It also hired public relations and marketing firms to help form The Advancement for Sound Science Coalition (TASSC), developed to look like a grassroots organization of scientists and policymakers. Phillip Morris hoped TASSC would seem like an independent body rejecting evidence that secondhand smoke caused significant lung cancer and heart disease risk, according to the analysis of the documents.

In Europe, where secondhand smoke restrictions had not yet been put in place, Philip Morris promoted a set of standards originally proposed by the Chemical Manufacturers Association called "Good Epidemiology Practices." By modifying the proposal and developing new opportunities to introduce it, Philip Morris sought to establish an arbitrary threshold for identifying health risk from secondhand smoke - a threshold higher than what scientists had found for secondhand smoke.

The proposal would have revoked conclusions that an environmental toxin such as secondhand smoke was a public health problem. This effort was particularly focused on undermining a large European epidemiologic study of passive smoking and lung cancer being conducted by the International Agency for Research on Cancer at the time, the researchers found.

The analysis appears in the November issue of The American Journal of Public Health.

First author is Elisa K. Ong, MD, a medical resident at Santa Clara Valley Medical Center who conducted the research while a medical student working in the Institute for Health Policy Studies at UCSF.  Her co-author is Stanton Glantz, PhD, a core faculty member of the Institute and a professor of medicine at UCSF.

Between 1994 and 2000, seemingly independent seminars involving other industries and issues on the so-called "Good Epidemiology Practices" (GEP) were conducted in the United States, United Kingdom, European Union and China, yet in all cases Philip Morris was connected to these events, the documents show.

Essentially, Philip Morris appropriated the "sound science" concept to shape the standards of epidemiology and to prevent increased smoking restrictions, the authors state.

"Phillip Morris has gone beyond 'creating doubt' and 'controversy' about the scientific evidence, to attempting to change the scientific standards of proof," they write.

The approach, the report states, ignores the fact that a comprehensive assessment of risk involves considering all the evidence related to a toxin, not just the epidemiology.

"While every practicing scientist agrees that scientific work should be rigorously done, the scientific, public health and regulatory community need to be more aware that the 'sound science' and 'GEP' movement is not simply an indigenous effort from within the profession, but also reflects sophisticated public relations campaigns controlled by industry executives and lawyers to manipulate the scientific standards of proof for the corporate interests of their clients," the authors conclude.

The research was supported by the National Cancer Institute and the Richard and Rhoda Goldman Fund.

The full text of the article is available online at the American Journal of Public Health web site http://www.ajph.org/cgi/content/abstract/91/11/1749

Two editorials commenting on the significance of this work are also in the journal: http://www.ajph.org/cgi/content/abstract/91/11/1742


"Tobacco Industry associations with
ETS [Environmental Tobacco Smoke] research published in the journal Indoor and Built Environment"
Lancet 2005; 365: 804-09 Volume 365, Number 9461 26 February 2005
David Garne, Megan Watson, Simon Chapman, Fiona Byrne
School of Public Health, University of Sydney, NSW 2006, Australia (D Garne MIPH [Hons], M Watson MIPH [Hons], Prof S Chapman PhD, F Byrne BAppSc)

In the late 1980s, the international tobacco industry assisted in the establishment of the International Society of the Built Environment, which published the journal Indoor and Built Environment. Using evidence from tobacco industry documents, we examine the industry associations of the Society's executive, the journal's editor and board, and the extent to which the journal publishes papers on environmental tobacco smoke that would be deemed favourable by the tobacco industry. The society's executive has been dominated by paid consultants to the tobacco industry: all six members in 1992 and seven of eight members in 2002 had financial associations through industry lawyers. 67% of the editorial board in 1992 and 66% in 2002 had histories of financial associations with the tobacco industry. 61% (40/66) of papers related to environmental tobacco smoke published in Indoor and Built Environment in the study period reached conclusions that could be judged to be industry-positive.  Of these, 90% (36/40) had at least one author with a history of association with the tobacco industry. The executive of the International Society of the Built Environment and the editorial board of Indoor and Built Environment are in large part consisted of people with histories of consultancies to the tobacco industry. On the basis of the evidence presented in this paper, there is a serious concern the tobacco industry may have been unduly influential on the content of the journal.

Article regarding this study:
EXCERPTS from HealthDay Reporter, February 24, 2005, writer Ed Edelson, headlined:  How Big Tobacco Tells Its Side of the Story

"The journal would seem to be a place where industry-funded scientists can get their work published," said Simon Chapman, a professor of public health at the University of Sydney. "Published work can then be publicized by the tobacco industry's formidable PR machine."

Chapman is lead author of a paper in this week's issue of The Lancet that uses internal tobacco industry documents made available by the Master Settlement Agreement between tobacco companies and American states to describe the establishment of the International Society of the Built Environment, which publishes its own journal, Indoor and Built Environment.

The Master Settlement Agreement, reached in 1998, required tobacco companies to pay the states $206 billion, to finance a $1.5 billion anti-smoking campaign and to disband trade groups that dispute scientific evidence about the health damage caused by smoking.

However, the settlement papers also describe a meeting in March 1987, at which tobacco industry personnel from the United States, United Kingdom, Japan and Germany considered how to "improve the industry's position" on secondhand smoking and concluded that "more industry-sponsored research [was] needed" and that an industry-sponsored journal might be needed to get such research printed.

Two months later, tobacco giant Philip Morris USA proposed a program, one part of which was to "establish a genuine scientific journal on indoor air quality."

That journal first appeared in May 1991, and is still being published by the Switzerland-based International Society of the Built Environment.

"The society's executive has been dominated by paid consultants to the tobacco industry; all six members in 1992 and seven of eight members in 2002 had histories of financial associations with the tobacco industry," Chapman and his colleagues reported.

As for content, "61% of papers related to environmental tobacco smoke published in Indoor and Built Environment in the study period reached conclusions that could be judged to be industry-positive," the report said. "Of these, 90% had at least one author with a history of association with the tobacco industry."

"The Lancet study demonstrates that the tobacco industry lawyers organized what can only be described as an international conspiracy to systematically undermine the scientific consensus linking secondhand smoke to serious disease," said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids.

Establishment of the journal was part of a larger campaign "to sow seeds of doubt in the minds of the public" about the damage done by secondhand smoke, Myers said.

Just last month, a report in The Lancet by the Center for Tobacco Control, Research and Education at the University of California, San Francisco, described how several papers questioning the genetic damage done by secondhand smoke were published in the journal Mutagenesis. The researchers who wrote the papers and the editor-in-chief of the journal had undisclosed ties to the tobacco industry, that report said.

"In the United States, the industry has claimed that it has changed," Myers said. "The new study demonstrates that the tobacco industry continues to engage in the same wrongful deception around the world."

A spokesperson for Philip Morris did not respond to a request for comment.

Philip Morris blocked a 1994 medical diagnostic code for secondhand smoke exposure, and as of 2004 it still remained an invalid entry on a common medical form.  Tobacco industry documents reveal that Philip Morris budgeted more than $2 million for this.  It is reported in the July/August 2005 issue of Health Affairs
The Power of Paperwork --  How Philip Morris Neutralized the Medical Code for Secondhand Smoke; authored by Daniel M. Cook, Elisa K. Tong, Stanton A. Glantz, and Lisa A. Bero.  This subject was part of a resolution in the 2006 Philip Morris shareholders' meeting.

Some of the REFERENCES used in preparing this Fact Sheet are given on the References page.

[Virginia GASP]   Updated 11 March 2008