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Resource:  National Cancer Institute

1.  
   • arsenic (a heavy metal toxin)
   • benzene (a chemical found in gasoline)
   • beryllium (a toxic metal)
   • cadmium (a metal used in batteries)
   • chromium (a metallic element)
   • ethylene oxide (a chemical used to sterilize medical devices)
   • nickel (a metallic element)
   • polonium–210 (a chemical element that gives off radiation)
   • vinyl chloride (a toxic substance used in plastics manufacture)
2. What is secondhand smoke?
3. How is secondhand smoke exposure measured?
4. Does secondhand smoke contain harmful chemicals?
5. Does exposure to secondhand smoke cause cancer?
6. What are the other health effects of exposure to secondhand smoke?
7. What is a safe level of secondhand smoke?
8. What is being done to reduce nonsmokers’ exposure to secondhand smoke?

Secondhand smoke (also called environmental tobacco smoke) is the combination of sidestream smoke (the smoke given off by the burning end of a tobacco product) and mainstream smoke (the smoke exhaled by the smoker) (1, 2, 3, 4). Exposure to secondhand smoke is also called involuntary smoking or passive smoking. People are exposed to secondhand smoke in homes, cars, the workplace, and public places such as bars, restaurants, and other recreation settings. In the United States, the source of most secondhand smoke is from cigarettes, followed by pipes, cigars, and other tobacco products (4).

 Secondhand smoke is measured by testing indoor air for nicotine or other smoke constituents. Exposure to secondhand smoke can be tested by measuring the levels of cotinine (a nicotine by-product in the body) in the nonsmoker’s blood, saliva, or urine (1). Nicotine, cotinine, carbon monoxide, and other evidence of secondhand smoke exposure have been found in the body fluids of nonsmokers exposed to secondhand smoke.

Yes. Of the more than 4,000 chemicals that have been identified in secondhand tobacco smoke, at least 250 are known to be harmful, and 50 of these are known to cause cancer. These chemicals include (1):

Many factors affect which chemicals are found in secondhand smoke, including the type of tobacco, the chemicals added to the tobacco, the way the product is smoked, and the paper in which the tobacco is wrapped (1, 3, 4).

 

Yes. The U.S. Environmental Protection Agency (EPA), the U.S. National Toxicology Program (NTP), the U.S. Surgeon General, and the International Agency for Research on Cancer (IARC) have classified secondhand smoke as a known human carcinogen (cancer-causing agent) (1, 3, 5).

Inhaling secondhand smoke causes lung cancer in nonsmoking adults (4). Approximately 3,000 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke (2). The Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30 percent (4).

Some research suggests that secondhand smoke may increase the risk of breast cancer, nasal sinus cavity cancer, and nasopharyngeal cancer in adults, and leukemia, lymphoma, and brain tumors in children (4). Additional research is needed to learn whether a link exists between secondhand smoke exposure and these cancers.

Secondhand smoke causes disease and premature death in nonsmoking adults and children (4). Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It may increase the risk of heart disease by an estimated 25 to 30 percent (4). In the United States, secondhand smoke is thought to cause about 46,000 heart disease deaths each year (6). There may also be a link between exposure to secondhand smoke and the risk of stroke and hardening of the arteries; however, additional research is needed to confirm this link.

Children exposed to secondhand smoke are at an increased risk of sudden infant death syndrome (SIDS), ear infections, colds, pneumonia, bronchitis, and more severe asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless (4).

There is no safe level of exposure to secondhand smoke. Studies have shown that even low levels of secondhand smoke exposure can be harmful. The only way to fully protect nonsmokers from secondhand smoke exposure is to completely eliminate smoking in indoor spaces. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot completely eliminate secondhand smoke exposure (4).

Many state and local governments have passed laws prohibiting smoking in public facilities such as schools, hospitals, airports, and bus terminals. Increasingly, state and local governments are also requiring private workplaces, including restaurants and bars, to be smoke free. To highlight the significant risk from secondhand smoke exposure, the National Cancer Institute, a component of the National Institutes of Health, holds meetings and conferences in states, counties, cities, or towns that are smoke free, unless certain circumstances justify an exception to this policy.

More information about state-level tobacco regulations is available through the Centers for Disease Control and Prevention (CDC) State Tobacco Activities Tracking and Evaluation (STATE) System Web site. The STATE System is a database containing up-to-date and historical state-level data on tobacco use prevention and control. This resource is available at http://apps.nccd.cdc.gov/statesystem/ on the Internet.

On the national level, several laws restricting smoking in public places have been passed. Federal law bans smoking on domestic airline flights, nearly all flights between the United States and foreign destinations, interstate buses, and most trains. Smoking is also banned in most Federally owned buildings. The Pro-Children Act of 1994 prohibits smoking in facilities that routinely provide Federally funded services to children.

The U.S. Department of Health and Human Services (DHHS) Healthy People 2010, a comprehensive, nationwide health promotion and disease prevention agenda, includes the goal of reducing the proportion of nonsmokers exposed to secondhand smoke from 65 percent to 45 percent by 2010 (7). More information about this program is available on the Healthy People 2010 Web site at http://www.healthypeople.gov/ on the Internet.

Internationally, several nations, including France, Ireland, New Zealand, Norway, and Uruguay, require all workplaces, including bars and restaurants, to be smoke free.

Selected References

1. National Toxicology Program. Report on Carcinogens. Eleventh Edition. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program, 2005. 
2. National Cancer Institute. Cancer Progress Report 2003. Public Health Service, National Institutes of Health, U.S. Department of Health and Human Services, 2004. 
3. International Agency for Research on Cancer. Tobacco Smoke and Involuntary Smoking. Lyon, France: 2002. 
4. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. 
5. U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking (Also Known as Exposure to Secondhand Smoke or Environmental Tobacco Smoke–ETS). U.S. Environmental Protection Agency, 1992. 
6. California Environmental Protection Agency, Office of Environmental Health Hazard Assessment. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant: Part B Health Effects, 2005. 
7. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, 2000. 

Related NCI materials and Web pages:

• National Cancer Institute Fact Sheet 10.16, Questions and Answers About Cigar Smoking and Cancer
  (http://www.cancer.gov/cancertopics/factsheet/Tobacco/cigars)
• National Cancer Institute Fact Sheet 10.19, Quitting Smoking: Why To Quit and How To Get Help
  (http://www.cancer.gov/cancertopics/factsheet/Tobacco/cessation)
• Smoking and Tobacco Control Monograph 10: Health Effects of Exposure to Environmental Tobacco Smoke
  (http://cancercontrol.cancer.gov/tcrb/monographs/10/index.html)
• NCI’s Smoking and Cancer Home Page
  (http://www.cancer.gov/cancertopics/smoking)

For more help, contact:

NCI’s Cancer Information Service
Telephone (toll-free): 1–800–4–CANCER (1–800–422–6237)
TTY (toll-free): 1–800–332–8615
LiveHelp^® online chat: https://cissecure.nci.nih.gov/livehelp/welcome.asp

Reference:

National Cancer Institute (2009). Secondhand smoke questions and answers.  Retrieved November 2, 2009 from http://www.cancer.gov/cancertopics/factsheet/Tobacco/ETS

Secondhand Smoke Facts – American Lung Association   
Resource:  American Lung Association

 
Secondhand smoke, also know as environmental tobacco smoke (ETS), is a mixture of the smoke given off by the burning end of a cigarette, pipe or cigar and the smoke exhaled from the lungs of smokers. It is involuntarily inhaled by nonsmokers, lingers in the air hours after cigarettes have been extinguished and can cause or exacerbate a wide range of adverse health effects, including cancer, respiratory infections, and asthma.1

•The current Surgeon General’s Report concluded that 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 heart attack.2

•Secondhand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of cancer in humans (Group A carcinogen).3

•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, including formaldehyde, benzene, vinyl chloride, arsenic ammonia and hydrogen cyanide.4

•Secondhand smoke causes almost 50,000 deaths in adult nonsmokers in the United States each year, including approximately 3,400 from lung cancer and 22,700-69,600 from heart disease.5

•Nonsmokers exposed to secondhand smoke at work are at increased risk for adverse health effects. Levels of secondhand smoke in restaurants and bars were found to be 2 to 5 times higher than in residences with smokers and 2 to 6 times higher than in office workplaces.6

•Workplace productivity was increased and absenteeism was decreased among former smokers compared with current smokers.7

•Twenty-three states – Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, Washington, Utah, and Vermont – as well as the District of Columbia and Puerto Rico have passed laws prohibiting smoking in almost all public places and workplaces, including restaurants and bars.8

•Secondhand smoke is especially harmful to young children. Secondhand smoke is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year, and causes 430 sudden infant death syndrome (SIDS) deaths in the United States annually.9

•Secondhand smoke exposure may cause buildup of fluid in the middle ear, resulting in 790,000 physician office visits per year.10 Secondhand smoke can also aggravate symptoms in 400,000 to 1,000,000 children with asthma.11

•In the United States, 21 million, or 35 percent of, children live in homes where residents or visitors smoke in the home on a regular basis.12 Approximately 50-75 percent of children in the United States have detectable levels of cotinine, the breakdown product of nicotine in the blood.13

•Research indicates that private research conducted by cigarette company Philip Morris in the 1980s showed that secondhand smoke was highly toxic, yet the company suppressed the finding during the next two decades.14
For more information on secondhand smoke, please review the Tobacco Morbidity and Mortality Trend Report as well as our Lung Disease Data publication in the Data and Statistics section of our website at www.lungusa.org, or call the American Lung Association at 1-800-LUNG-USA (1-800-586-4872).

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Sources:

1. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.
2. Centers for Disease Control and Prevention. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006. 6 Major Conclusions of the Surgeon General Report. Available at the Surgeon General’s website. Accessed on January 8, 2009.
3. Ibid.
4. Ibid.
5. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.
6. U.S. Department of Health and Human Services. Report on Carcinogens, Tenth Edition 2002. National Toxicology Program.
7. Halpern, M.T.; Shikiar, R.; Rentz, A.M.; Khan, Z.M. Impact of Smoking Status on Workplace Absenteeism and Productivity. Tobacco Control 2001; 10:233-8.
8. American Lung Association. State Legislated Actions on Tobacco Issues (SLATI). December 11, 2008. Available at http://slati.lungusa.org/StateLegislateAction.asp Accessed on January 8, 2009.
9. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.
10. Ibid.
11. Ibid.
12. Schuster, MA, Franke T, Pham CB. Smoking Patterns of Household Members and Visitors in Homes with Children in United States. Archives of Pediatric Adolescent Medicine. November 2002; 156(11):1094-100.
13. U.S. Environmental Protection Agency. America’s Children and the Environment: Measures of Contaminants, Body Burdens, and Illnesses. Second Edition. February 2003
14. Diethelm PA, Rielle JC, McKee M. The Whole Truth and Nothing but the Truth? The Research Philip Morris Did Not Want You to See. Lancet. July 2005; 364(9446):86-92.