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Secondhand Smoke Fact Sheet

June 2007

Secondhand smoke, also known 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

  • Secondhand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of cancer in humans (Group A carcinogen).2
  • 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.3
  • Secondhand smoke causes approximately 3,400 lung cancer deaths and 46,000 heart disease deaths in adult nonsmokers in the United States each year.4
  • Nonsmokers exposed to secondhand smoke at work are at increased risk for adverse health effects.  Levels of ETS 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.5
  • Since 1999, 70 percent of the U.S. workforce worked under a smoke-free policy, ranging from 83.9 percent in Utah to 48.7 percent in Nevada.6   Workplace productivity was increased and absenteeism was decreased among former smokers compared with current smokers.7
  • Fifteen states - Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Maine, Massachusetts, New Jersey, New Mexico, New York, Ohio, Rhode Island, Washington and Vermont - as well as the District of Columbia and Puerto Rico prohibit smoking in almost all public places and workplaces, including restaurants and bars.  Illinois, Maryland, Minnesota, Montana, New Hampshire, Oregon and Utah have passed legislation prohibiting smoking in almost all public places and workplaces, including restaurants and bars, but the laws have not taken full effect yet.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
  • New 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
  • The current Surgeon General’s Report concluded that scientific evidence indicates that there is no risk-free level of exposure to second hand smoke. Short exposures to second hand 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.15

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).

Sources:

1. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.
2. Ibid.
3. The Health Consequences of Involuntary Exposure to Tobacco Smoke: 6 Major Conclusions of the Surgeon General Report. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet6.html: Accessed on 7/7/06
4. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.
5. U.S. Department of Health and Human Services. Report on Carcinogens, Tenth Edition 2002. National Toxicology Program.
6. Shopland, D. Smoke-Free Workplace Coverage. Journal of Occupational and Environmental Medicine. 2001; 43(8): 680-686.
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: 233-238.
8. American Lung Association. State Legislated Actions on Tobacco Issues (SLATI). Available at: http://slati.lungusa.org/StateLegislateAction.asp Accessed on 6/18/07.
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. Vol. 156, 2002: 1094-1100.
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. Vol. 364 No. 9446, 2004
15. The Health Consequences of Involuntary Exposure to Tobacco Smoke: 6 Major Conclusions of the Surgeon General Report. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at:  http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet6.html: Accessed on 7/7/06

*Racial and ethnic minority terminology reflects those terms used by the Centers For Disease Control.

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