What is secondhand smoke?

Secondhand smoke is the smoke from the burning tip of a cigarette, the contaminants that diffuse through the cigarette paper and the smoke exhaled by the person smoking. Other references to the act of people inhaling smoke produced by another individual includes passive smoking, involuntary smoking, exposure to environmental tobacco smoke (ETS) and tobacco smoke pollution.

What’s in secondhand smoke?

Smoke from the burning end of a cigarette contains more than 4,000 chemicals and at least 60 carcinogens (substances known to cause cancer in humans). The smoker, and anyone else nearby, inhales these chemicals. (Environmental Protection Agency, Indoor Air Facts, No. 5, 1989.) The following is a list of chemicals found in secondhand smoke, together with their common uses. 



Ammonia, Benzene, Arsenic, Nickel, Lead, Polonium-210, Carbon Monoxide, Formaldehyde, Hydrogen Cyanide, StyreneHydrazine, Beryllium, Chromium (only hexavalent), Cadmium, Acetaldhehyde, Ethyl carbamate, Ethylene oxide, Propylene oxide, Methyleugenol, Benzo(b)fluoranthene, Vinyl chloride, 1,3-Butadeine, Benzo(j)fluoranthene, Benzo(k)fluoranthene, Benzo(a)pyrene, Dibenz(a,h)anthracene, Dibenzo(a,l)pyrene, Dibenzo(a,e)pyrene, Indeno(1,2,3-cd)pyrene, 5-Methylchrysene, N-Nitrosodimethylamine,N-Nitrosoethylmethylamine Nitrosodiethylamine, N-Nitrosodi-n-propylamine, N-Nitroso-di-n-butylamine, N-Nitrosopyrrolidine, N-Nitrosopiperidine and thousands more.

How does secondhand smoke affect your health?

Healthy nonsmokers who inhale secondhand smoke suffer many of the same diseases as regular smokers. In 1986, the U.S. Surgeon General’s Report concluded “involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers.” Heart disease deaths and other cancers have also been causally associated with secondhand smoke exposure. 



Secondhand smoke causes a wide variety of adverse health effects in children including bronchitis and pneumonia, development and exacerbation of asthma, middle ear infections and “glue ear,” which is the most common cause of deafness in children. 



In women who don’t smoke, exposure to secondhand smoke during pregnancy reduces fetal growth. In infants, the postnatal exposure to secondhand smoke greatly increases the risk of sudden infant death syndrome (SIDS). 



Tobacco smoke also causes immediate effects such as eye and nasal irritation, headache, sore throat, dizziness, nausea, cough and respiratory problems.

What is the extent of the problem of secondhand smoke?

There are 53,000 annual deaths in the United States attributed to secondhand smoke. Of those 53,000 deaths, 37,000 are attributed to heart disease, 12,000 are attributed to various forms of cancer and 3,700 are attributed to lung cancer specifically.
(National Cancer Institute, “Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency” Smoking and Tobacco Control Monograph 10)

Secondhand smoke is the third leading cause of preventable death in the United States. For every eight smokers the tobacco industry kills, it takes one nonsmoker with them.
Glantz, S.A. & Parmley, W., “Passive Smoking and Heart Disease: Epidemiology, Physiology, and Biochemistry,” Circulation, 1991; 83(1):1-12; and, Taylor, A., Johnson, D, & Kazemi, H., “Environmental Tobacco Smoke and Cardiovascular Disease,” Circulation, 1992; 86:699-702

Just twenty minutes of exposure to secondhand smoke causes a nonsmoker’s blood platelets to become sticky, which reduces the ability of the heart to pump, and puts a nonsmoker at an elevated risk of a heart attack.
Glantz S, Parmley W. “Even a little secondhand smoke is dangerous,” JAMA 286:462-463, 2001)

Nonsmoking workers routinely exposed to significant secondhand smoke triple their risk for lung cancer.
International Journal of Cancer, July 2001.

Smoke-filled rooms can have up to six times the air pollution of a busy highway.
Centers for Disease Control, It’s Time to Stop Being a Passive Victim, 1993

The restaurant industry employs 11.7 million people, or 9 percent of the working population, and is the nation’s largest employer other than the government. Latinos/Hispanics comprise 18 percent of the restaurant workforce and are the single largest ethnic group in this occupational sector.
National Restaurant Association, 2003 Restaurant Industry Forecast: Industry at A Glance, 2003. http://www.restaurant.org/research/ind_glance.cfm

Despite low smoking rates and often not allowing smoking at home, Latino/Hispanic males (58.8 percent) and Latina/Hispanic females (69.9 percent) are less likely than white males (63.5 percent) and white females (74.1 percent), to be covered by workplace smoking laws.
Shopland, Donald R. Using Science to Further Public Health: The 30 Year Battle to Protect Nonsmokers from Environmental Tobacco Smoke. PowerPoint Presentation

African Americans (40.7 percent) are more likely than the national average (27.3 percent) to work in the service industry or as laborers, where they are least likely to be protected from secondhand smoke. African Americans (21.7 percent) are less likely than the national average (30.1 percent) to work in professional occupations, which are most likely to have smokefree workplace laws.
U.S. Census Bureau, Current Population Survey, March 2000. Table 11. Major Occupation Group of the Employed Civilian Population 16 Years and Over by Sex, and Race and Hispanic Origin: March 2000

Are well-ventilated nonsmoking sections the answer?

In 1986, the Surgeon General of the United States reported, “Nonsmoking sections do not eliminate nonsmokers’ exposure to secondhand smoke; the smoke knows no boundaries.”
The Health Consequences of Involuntary Smoking: A Report of the U.S. Surgeon General, 1986

Science has yet to determine a safe level of exposure to secondhand smoke. In 2000, a panel of ventilation experts assembled by the Occupational Safety and Health Administration and the American Conference of Governmental Industrial Hygenists concluded that ventilation cannot eliminate all exposure to secondhand smoke; therefore, ventilation is not a viable solution to the health risks of secondhand smoke.
Repace, J. “Can Ventilation Control Secondhand Smoke in the Hospitality Industry? An analysis of the document “Proceedings of the Workshop on Ventilation Engineering Controls for Environmental Tobacco Smoke in the Hospitality Industry” sponsored by the Federal Occupational Safety and Health Administration and the American Conference of Governmental Industrial Hygienists prepared for the California Department of Health Services, 2000

The tobacco industry wants business owners to believe that installing a new (and expensive) ventilation system in their business will protect patrons and employees from the dangers of secondhand smoke.

Despite tobacco industry claims, experts agree that the only way to truly protect people from the dangers of secondhand smoke is by providing smokefree environments. In fact, the national standard for indoor air ventilation is based on a totally smokefree environment.
American National Standards Institute, 2000.

So why would the tobacco industry want businesses to believe that installing an improved ventilation system for a smoking area is adequate protection against the cancer-causing chemicals in secondhand smoke?

When people cannot smoke in work and public places, Big Tobacco loses a lot money. And they know it. In a 1993 internal document, Phillip Morris estimated that smoking restrictions in work and public places would decrease the company’s profits by $40 million in that year alone.

The tobacco industry is concerned enough with their bottom line to start spinning tales about the safety of ventilation systems. The threat to the bottom line causes tobacco giants, like Philip Morris, to try to get rid of the national standard calling for totally smokefree environments, (Philip Morris and R.J. Reynolds appealed the national standard with the American National Standards Institute multiple times. ANSI voted to deny the appeals, upholding the ruling as a national standard) and to pay consultants to tour the country pitching their own ventilation system to restaurant owners and managers. They say there are new and emerging technologies that make it unnecessary to create smokefree environments. However, the fine print of their own literature states otherwise.
“Options, Philip Morris USA [the company’s own ventilation system] does not purport to address health effects attributed to environmental tobacco smoke.” Philip Morris web site at http://www.pmoptions.com/und/und.asp.

The scientific evidence is clear: Ventilation technology does not serve as an alternative to eliminating exposure to secondhand smoke as the best strategy to protect the health of Omaha citizens.

What do national organizations say about ventilation technology?

“From the industrial hygiene perspective, general ventilation as delivered by heating, ventilation and air condition (HVAC) systems is not an acceptable engineering control measure for controlling occupational exposures to [environmental tobacco smoke].”
U.S. Occupational Safety and Health Administration

“The most direct and effective method of eliminating [environmental tobacco smoke] from the work place is to prohibit smoking in the work place.”
National Institute of Occupational Safety and Health

Are smoking restrictions hard to enforce?

Most of the general public, including smokers support smokefree spaces. Smokefree policies in workspaces and public places work effectively when people are aware of them. The public should know in advance that smokefree policies are being implemented, and they should know the health reasons for smokefree policies.

Enforcement of clean indoor air laws is generally done on a complaint basis, without the need for active law enforcement. Prior to implementation, public education about the health effects of secondhand smoke and the need for a clean indoor air law can help build support for the law and increase compliance.
Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs-August 1999. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, August 1999

Do smoking restrictions hurt businesses?

All reputable studies have shown that clean indoor air laws either have no negative impact, rather sometimes a positive impact on the economic health of businesses within the hospitality industry.
“Review of the Quality of Studies on Economic Effects of Smokefree Policies on the Hospitality Industry,” Scollo, Lal, Hyland, Glantz, Tobacco Control, 2003 12:13-20

In fact, employers who go smokefree save money by increasing productivity, lowering maintenance and cleaning costs and lowering insurance coverage.

The tobacco industry has spent years trying to convince communities that 100 percent smokefree policies will hurt local businesses because they know that more smokefree places result in smokers quitting. According to Philip Morris, “[T]otal prohibition of smoking in the workplace strongly affects industry volume. Smokers facing these restrictions consume 11-15 percent less than average and quit at a rate that is 85 percent higher than average… Milder workplace restrictions, such as smoking only in designated areas have much less impact on quitting rates and very little effect on consumption.”
Internal Memorandum from Philip Morris, Bates Nos. 2023914280/4284

The truth is that most smokers accept smokefree policies. And surveys show that most do not stop patronizing smokefree places. In fact, 67 percent of Omaha residents say they would be more likely to go to a restaurant if it was entirely smokefree, and 64 percent say they would favor a law that would prohibit smoking in the workspace and public places.
“Attitudes toward smoking in public places and secondhand smoke among residents in the Omaha Metropolitan Area”, The Gallup Organization, April 2003.

Why aren’t all workspaces and public places smokefree?

Simply put, the tobacco industry is rich and influential. The tobacco industry spends millions of dollars to fund misinformation campaigns on secondhand smoke.

Scientists and consultants have been hired to not only confuse the public about the validity of scientific data, but to also create doubt in the researchers who produce the data and even in the science itself. In addition to attacking legitimate studies, false research projects that downplay the seriousness of secondhand smoke are funded and promoted.

Tobacco lobbyists and lawyers deflect government regulation of secondhand smoke, aided by huge tobacco industry contributions to political campaigns. When money and misinformation do not work, the industry promotes false solutions to control secondhand smoke.

Although evidence shows that ventilation is not an effective solution to the problem of secondhand smoke, the industry continues to push for this option, even forming indoor air consulting “front groups” who downplay the risks of secondhand smoke.

A campaign to promote “courtesy of choice” as an alternative to banning smoking in public places has been launched worldwide. This implies that the serious problem of secondhand smoke can be solved merely by smokers asking for permission before they light up, or by having separate smoking and nonsmoking sections. Secondhand smoke is thus portrayed as a mere annoyance for nonsmokers, rather than as a serious health issue. The industry also funds smokers rights’ movements to create so-called independent opposition to smoking bans. People concerned about secondhand smoke are then branded as zealots.

Another argument manufactured by the tobacco industry is that policy makers at the federal, state or local level should not be allowed to implement policies that limit exposure to secondhand smoke. “It’s a personal choice,” they say. But the government’s role in protecting public health in work and public places is clear. It regulates the food we eat and the safety in our workspaces. Their role in deciding this important issue is clear.

Fortunately, tobacco industry opposition to clean air is being defeated. According to the ANR Foundation’s Local Tobacco Control Ordinance Database©, communities across the country, from Barrow, Alaska to Boston, Massachusetts, and from Helena, Montana to El Paso, Texas have passed local clean indoor air laws protecting workers and the public from the dangers of secondhand smoke. As of July 2008, 748 U.S. cities and towns enjoy strong smokefree indoor air laws, and more than 2,800 communities have a clean indoor air law.

The bottom line is this is a public health issue, and everyone has the right to breathe smokefree air at work and in public places.