Citizens for Clean Air and Clean Lungs

The Facts about Second-Hand Smoke
The following is a brief review of the health risks associated with second-hand cigarette smoke.

Second-hand smoke is the third leading preventable cause of death in the U.S., killing over 50,000 nonsmokers every year [1].

Second-hand smoke causes lung cancer, other types of cancer, and heart disease in nonsmokers [2].

Children are especially likely to become sick from second-hand smoke. Exposure to second-hand smoke can cause children to develop asthma, bronchitis, pneumonia, other respiratory infections, and ear infections. An estimated 40%-60% of all early childhood cases of asthma, bronchitis, and wheezing are attributable to exposure to second-hand smoke. Exposure to second-hand smoke also increases the risk that infants will die of Sudden Infant Death Syndrome (SIDS). Finally, children who are exposed to second-hand smoke are more likely to develop leukemia during childhood and to develop lung cancer and heart disease later in life [3].

Food service workers appear to be 50% more likely than the general population to develop lung cancer, largely because many of them are exposed to second-hand smoke on the job. (Siegel, M., Involuntary Smoking in the Restaurant Workplace: A Review of Employee Exposure and Health Effects, JAMA 1993; 270:490-493. A recent national survey of American workers found that food service workers are more likely to be exposed to second-hand smoke on the job than any other occupational group. The survey also found that teen workers were more likely to be exposed to second-hand smoke on the job than any other employee age group [4].

Besides causing disease, second-hand smoke also exacerbates a number of pre-existing health conditions, including some allergies, asthma, bronchitis, other respiratory ailments, and heart disease. In some cases, exposure to second-hand smoke can trigger severe, even life-threatening reactions in individuals who suffer from these conditions [5].

People whose pre-existing medical conditions make them especially sensitive to second-hand smoke are effectively barred from working in or patronizing enclosed public places where smoking is allowed -- or do so only at considerable risk to their health. To give some idea of the numbers affected, the American Lung Association estimates that as of 1997, 89,400 New Mexico residents had chronic bronchitis, 59,277 had adult asthma, and 34,363 had pediatric asthma [6].

Cigarette smoke contains over 4,700 chemicals, over 200 poisons, and over 50 human carcinogens. The poisons in cigarette smoke include carbon monoxide, hydrogen cyanide, and methyl isocyanate. The carcinogens in cigarette smoke include benzo[a]pyrene and NNK, which cause lung cancer; nitrosamines, which cause cancer of the lung, respiratory system, and other organs; aromatic amines, which cause bladder and breast cancer; formaldehyde, which causes nasal cancer; and benzene, which causes leukemia. The carcinogen NNK has been found in nonsmokers who have been exposed to second-hand smoke [7].

Second-hand smoke is the single most important source of indoor air pollution [8].

There are only two ways to eliminate the health risks posed by exposure to second-hand smoke in enclosed public places:

  1. make the entire building smokefree, or
  2. restrict smoking to a separately enclosed, separately ventilated room that is vented directly to the outside and which nonsmokers are not required to enter.

The health hazard is not removed by establishing a nonsmoking section or installing a more powerful ventilation system [9].

Many workplaces and businesses that recognize their obligation to protect the health of their employees and patrons have voluntarily adopted smokefree policies. In other cases, communities have mandated that workplaces and businesses implement policies that provide effective protection against second-hand smoke.


[1] Glantz, S. et al., Passive Smoking and Heart Disease: Epidemiology, Physiology and Biochemistry, Circulation 1991; 83:1-12.

[2] Glantz, S. et al., Passive Smoking and Heart Disease: Epidemiology, Physiology and Biochemistry, Circulation 1991; 83:1-12; G. Howard et al., Cigarette Smoking and Progression of Atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Study, JAMA 1998; 279:119-124.

[3] U.S. Environmental Protection Agency, Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders, 1992; DiFranza, J. and Lew, R.A., Morbidity and Mortality in Children Associated with the Use of Tobacco Products by Other People, Pediatrics 1996; 97:560-568; Aligne, C.A. and Stoddard, J.J., Tobacco and Children: An Economic Evaluation of the Medical Effects of Parental Smoking, Archives of Pediatric and Adolescent Medicine 1997; 151:648-653.

[4] Gerlach, K.K., et al., Workplace Smoking Policies in the United States: Results from a National Survey of More than 100,000 Workers, Tobacco Control 1997; 6:199-206.

[5] S.A. Glantz and W.W. Parmley, Passive Smoke and Heart Disease: Mechanisms and Risk, JAMA 1995; 273:1047-1053; M.D. Eisner et al., Environmental Tobacco Smoke and Adult Asthma: The Impact of Changing Exposure Status on Health Outcomes, American Journal of Respiratory and Critical Care Medicine 1998; 158:170-175.

[6] American Lung Association, Estimated Prevalence and Incidence of Lung Disease, 1997.

[7] D. Hoffman and I. Hoffman, The Changing Cigarette, 1950-1995, Journal of Toxicology and Environmental Health 1997; 50:307-364; U.S. Department of Health and Human Services, Surgeon General's Report, 1989, Reducing the Health Consequences of Smoking: 25 Years of Progress, p. 21.

[8] K.H. Ginzel, Hazards Smokers Impose, New Jersey Medicine 1990; 87:311-317.

[9] National Institute for Occupational Safety and Health, Environmental Tobacco Smoke in the Workplace: Lung Cancer and Other Health Effects, NIOSH Current Intelligence Bulletin, June 1991, No. 54, p. 13; Environmental Protection Agency, Indoor Air Facts: Environmental Tobacco Smoke, June 1989; U.S. Department of Health and Human Services, Surgeon General's Report, 1986, The Health Consequences of the Involuntary Smoking; J.L. Repace, Risk Management of Passive Smoking at Work and at Home, St. Louis University Public Law Review 1994; XIII 2:763-785; J.L. Repace and A.H. Lowrey, An Indoor Air Quality Standard for Ambient Tobacco Smoke Based on Carcinogenic Risk, New York State Journal of Medicine 1985; 85:381-383.

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