Secondhand Smoke Exposure

Report on smoking trends and tobacco smoke exposure

Secondhand tobacco smoke

Over 58 million Americans are still exposed to SHS. 

According to the 2014 Surgeon General’s Report, “The Health Consequences of Smoking – 50 Years of Progress,” exposure to SHS causes more than 41,000 deaths from lung cancer and heart disease among non-smoking adults and 400 deaths from sudden infant death syndrome every year.

What is secondhand tobacco smoke

Cigarette smoke is a complex aerosol consisting of thousands of chemicals [1]Tong EK, England L, Glantz SA. Changing conclusions on secondhand smoke in a sudden infant death syndrome review funded by the tobacco industry. Pediatrics. 2005;115(3):e356-66. It consists of gases and volatile compounds in which particulate matter (PM) is suspended. The gas-phase consists of air, carbon dioxide, carbon monoxide, nicotine, formaldehyde, acrolein, benzene, and many other dangerous chemicals. The particulate phase, “tar,” consists of thousands of additional chemicals, including alkaloids, larger PAHs, tobacco-specific nitrosamines, polonium-210, nickel, cadmium, arsenic, and lead. Some compounds, such as cresols and PAHs, are partitioned between vapor and particulate phases [2]Ibid, Changing conclusions on secondhand smoke in a sudden infant death syndrome review funded by the tobacco industry. Pediatrics. 2005;115(3):e356-66.

About 85% of SHS is composed of sidestream smoke emerging from the burning tip of the cigarette, and the remainder is exhaled in mainstream smoke (the smoke inhaled by a smoker when puffing on a cigarette) [3]Kritz H, Schmid P, Sinzinger H. Passive smoking and cardiovascular risk. Arch Intern Med. 1995;155(18):1942-8.. Mainstream smoke is generated at higher temperatures in the presence of oxygen and is drawn through the tobacco column. These conditions favor the formation of smaller particulates in sidestream smoke (0.01 to 0.1 μm (micrometer) in diameter) than in mainstream smoke (0.1 to 1 μm), which makes them more easily inhaled. Most compounds from cigarettes are emitted in sidestream smoke in much higher amounts than in mainstream smoke [4]Indoor Pollutants. Washington (DC)1981, [5]IARC Monographs programme on the evaluation of the carcinogenic risk of chemicals to humans. Preamble. IARC Monogr Eval Carcinog Risk Chem Hum. 1986;39:13-32.

SHS causes premature death and illness in those it doesn’t kill and is estimated to cause about 600,000 premature deaths per year worldwide, 31% occurring among children, and 64% among women. There is no risk-free level of SHS exposure; even brief exposure can be harmful to health [6]A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You. 2010, [7]Al-Delaimy W, Fraser T, Woodward A. Nicotine in hair of bar and restaurant workers. N Z Med J. 2001;114(1127):80-3, [8]National Toxicology Program. Report on Carcinogens, Fourteenth Edition. In: U.S. Department of Health and Human Services PHS, editor. NC: U.S. Department of Health and Human Services, Public Health … Continue reading.

Secondhand smoke and disease:

  • Heart disease

For nonsmokers, breathing SHS has immediate harmful effects on the heart and blood vessels [9]Warren GW, Alberg AJ, Kraft AS, Cummings KM. The 2014 Surgeon General’s report: “The health consequences of smoking–50 years of progress”: a paradigm shift in cancer care. … Continue reading.

It is estimated that SHS caused nearly 34,000 heart disease deaths each year during 2005–2009 among adult nonsmokers in the United States.

  • Lung cancer.

SHS exposure caused more than 7,300 lung cancer deaths each year from 2005–2009 among adult nonsmokers in the United States [10]The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Reports of the Surgeon General. Atlanta (GA)2014, [11]Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999–2008. MMWR Morb Mortal Wkly Rep. Atlanta, GA: Centers for Disease Control and Prevention; 2010. p. 1141-6.

  • Stroke
  • Flight attendants with previous exposure to passive or SHS have displayed preclinical signs of accelerated vascular aging [12]Wei J, Shufelt C, Oestreicher Stock E, Mills C, Dhawan S, Jacob R, et al. Vascular Aging Is Accelerated in Flight Attendants With Occupational Secondhand Smoke Exposure. J Occup Environ Med. … Continue reading.
  • The same Flight Attendant population experience increased rates of respiratory illnesses compared to a population sample. The frequency of symptoms of nasal congestion, throat, or eye irritation is associated with occupational SHS exposure in the pre-smoking ban era.[13]Beatty AL, Haight TJ, Redberg RF. Associations between respiratory illnesses and secondhand smoke exposure in flight attendants: A cross-sectional analysis of the Flight Attendant Medical Research … Continue reading:
  • Diseases caused by tobacco smoke appear higher in states with higher smoking rates and fewer public smoking restrictions.

COPD in Smokers and Non-Smokers based on state smoking prevalence

Percentage of U.S. adults with chronic obstructive pulmonary
disease (COPD), overall and by current or previous smoking status

[14]Anne G. Wheaton PYL, MD1; Janet B. Croft, PhD1; Brenna VanFrank, MD2;Thomas L. Croxton, PhD, MD3; Antonello Punturieri, MD, PhD3; Lisa Postow, PhD3; Kurt J. Greenlund, PhD1. Percentage of U.S. adults … Continue reading.

An analysis of state-specific behavioral risk data from 2017, indicates that overall among U.S. adults, 6.2% reported having been told by a health care professional that they had COPD. The prevalence of COPD was 15.2% among current cigarette smokers, 7.6% among former smokers, and 2.8% among adults who had never smoked. A higher prevalence of COPD was observed in southeastern and Appalachian states, regardless of the smoking status of respondents. Whereas the strong positive correlation between state prevalence of COPD and state prevalence of current smoking was expected among current and former smokers, a similar relationship among adults who never had smoked suggests SHS exposure as a potential risk factor for COPD. One study conclusion is that continued promotion of smoke-free environments might reduce COPD among both those who smoke and those who do not.[15]Anne G. Wheaton PYL, MD1; Janet B. Croft, PhD1; Brenna VanFrank, MD2; Thomas L. Croxton, PhD, MD3; Antonello Punturieri, MD, PhD3; Lisa Postow, PhD3; Kurt J. Greenlund, PhD1. Percentage of U.S. … Continue reading.

COPD in Smokers and Non-Smokers

References

References
1 Tong EK, England L, Glantz SA. Changing conclusions on secondhand smoke in a sudden infant death syndrome review funded by the tobacco industry. Pediatrics. 2005;115(3):e356-66
2 Ibid, Changing conclusions on secondhand smoke in a sudden infant death syndrome review funded by the tobacco industry. Pediatrics. 2005;115(3):e356-66
3 Kritz H, Schmid P, Sinzinger H. Passive smoking and cardiovascular risk. Arch Intern Med. 1995;155(18):1942-8.
4 Indoor Pollutants. Washington (DC)1981
5 IARC Monographs programme on the evaluation of the carcinogenic risk of chemicals to humans. Preamble. IARC Monogr Eval Carcinog Risk Chem Hum. 1986;39:13-32
6 A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You. 2010
7 Al-Delaimy W, Fraser T, Woodward A. Nicotine in hair of bar and restaurant workers. N Z Med J. 2001;114(1127):80-3
8 National Toxicology Program. Report on Carcinogens, Fourteenth Edition. In: U.S. Department of Health and Human Services PHS, editor. NC: U.S. Department of Health and Human Services, Public Health Service; 2016
9 Warren GW, Alberg AJ, Kraft AS, Cummings KM. The 2014 Surgeon General’s report: “The health consequences of smoking–50 years of progress”: a paradigm shift in cancer care. Cancer. 2014;120(13):1914-6
10 The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Reports of the Surgeon General. Atlanta (GA)2014
11 Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999–2008. MMWR Morb Mortal Wkly Rep. Atlanta, GA: Centers for Disease Control and Prevention; 2010. p. 1141-6
12 Wei J, Shufelt C, Oestreicher Stock E, Mills C, Dhawan S, Jacob R, et al. Vascular Aging Is Accelerated in Flight Attendants With Occupational Secondhand Smoke Exposure. J Occup Environ Med. 2019;61(3):197-202
13 Beatty AL, Haight TJ, Redberg RF. Associations between respiratory illnesses and secondhand smoke exposure in flight attendants: A cross-sectional analysis of the Flight Attendant Medical Research Institute Survey. Environ Health. 2011;10
14 Anne G. Wheaton PYL, MD1; Janet B. Croft, PhD1; Brenna VanFrank, MD2;
Thomas L. Croxton, PhD, MD3; Antonello Punturieri, MD, PhD3; Lisa Postow, PhD3; Kurt J. Greenlund, PhD1. Percentage of U.S. adults with chronic obstructive pulmonary disease (COPD), overall and by current or previous smoking status — Behavioral Risk Factor Surveillance System, 2017 MMWR Morb Mortal Wkly Rep 2019. 2017;68:533–8
15 Anne G. Wheaton PYL, MD1; Janet B. Croft, PhD1; Brenna VanFrank, MD2; Thomas L. Croxton, PhD, MD3; Antonello Punturieri, MD, PhD3; Lisa Postow, PhD3; Kurt J. Greenlund, PhD1. Percentage of U.S. adults with chronic obstructive pulmonary disease (COPD), overall and by current or previous smoking status — Behavioral Risk Factor Surveillance System, 2017 MMWR Morb Mortal Wkly Rep 2019. 2017;68:533–8