Tobacco.org

What is 'third-hand' smoke?  

"Third-hand" smoke refers to the cigarette byproducts that cling to smokers' hair and clothing as well as to household fabrics, carpets and surfaces -- even after secondhand smoke has cleared. Doctors coined the term to raise awareness about the danger these invisible tobacco toxins pose to small children, who are especially susceptible because they breathe near, crawl on, play on, touch and mouth contaminated surfaces.

The important thing to know is that you can't eliminate smoke exposure in your home by opening a window, using air conditioning or a fan, or allowing smoking in some rooms but not others. If you can smell tobacco smoke -- even if you can't see it -- you're breathing in toxins, including more than 60 known carcinogens. The only way to fully protect your children -- and nonsmoking adults in your family -- is to make your home and car smoke-free. Consider this added bonus: Enforcing these smoke-free zones may help smokers quit and reduce the risk of teens becoming smokers.

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Secondhand Smoke in Pennsylvania Casinos: A Study of Nonsmokers’ Exposure, Dose, and Risk (PDF) 

Mining is described as the most dangerous industry.34 Sixteen Pennsylvania miners died in 15 disasters from 1995 to 2002, a rate of 1.2 deaths per10000 mine workers per year.34 The estimated rate of worker deaths per year from SHS is about 5 times the average annual death rate for Pennsylvania miners in coal mine disasters.

By the workplace standards of the US ½Q22 Occupational Safety and Health Administration ½Q20 (OSHA), which employs a 45-year average time period, casino workers’ risk from SHS-induced lung cancer and heart disease combined is 26 times the level indicating significant risk of material impairment.30

Pennsylvania’s new clean indoor air law permits smoking in 25% to 50% of casino floors. Confining smokers to a smaller area will increase the local smoker density in the smoking area and not protect nonsmoking areas from drifting or recirculated tobacco smoke. . . .

Conclusions

Despite ventilation rates per occupant 50% higher on average than those formerly recommended by ventilation engineers for smoking-permissible casinos, the average RSP concentration measured inside 3 Pennsylvania casinos in which smoking was permitted averaged 6 times that of outdoor levels; PPAH concentrations averaged 4 times outdoor levels, exposing both workers and patrons to harmful levels of air pollution. In the only casino with a separate nonsmoking floor, considerable amounts of RSPs and PPAHs infiltrated the nonsmoking salon. Based on measured RSP levels, SHS odor and irritation thresholds were massively exceeded in smoking areas and considerably exceeded in 1 nonsmoking salon. Using default values, the Active Smoker Model predicted combined RSP observations to within 14%.

Based on cotinine-derived RSP levels, SHS in Pennsylvania casinos produces an estimated excess mortality of approximately 6 deaths per year per 10000 workers at risk, 5 times the rate at which Pennsylvania coal miners have died in mining disasters and 26 times OSHA’s significant risk level. Nonsmoking workers or patrons exposed to casino SHS at the observed level of occupancy for 8 hours would experience ‘‘unhealthy air’’ according to the US Air Quality Index and, at maximum occupancy or exposure duration, ‘‘very unhealthy’’ air. Cotinine- derived PPAHs from SHS increases workers’ 24-hour exposure to PPAHs by an estimated 6-fold over measured outdoor background levels.

Further research is needed to generalize exposures observed in this study to the casino industry as a whole. It is clear, however, that Pennsylvania casino workers and patrons are put at significant excess risk of heart disease and lung cancer from SHS through a failure to include casinos in the state’s smoke-free-workplace law.

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• Secondhand Smoke Threatens Casino Workers’ Health  

New research suggests that casino workers face a higher risk of heart disease and lung cancer because they work in buildings filled with tobacco smoke.

By one scientist’s calculation, six of every 10,000 nonsmoking casino employees in Pennsylvania will die each year because of exposure to secondhand smoke.

The estimate does not rely on the tracking of individual casino workers over time, nor does it compare them to workers who have not had smoke exposure. Still, the findings suggest a significant risk to the health of the workers, said study author James Repace, a Washington D.C.-area consultant who studies the effects of secondhand smoke.

Casino workers “are really the most exposed group in society now,” Repace said. “The only other group that’s exposed so much is bartenders,” but many states have banned smoking in bars and restaurants.

The Flight Attendant Medical Research Institute — which has studied the risk of secondhand smoke to flight attendants when airlines allowed smoking — funded the study. The casino findings appear online and in the August issue of the American Journal of Public Health.

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Puritanism disguised as science 

I'm sitting in the corner of a bar, talking to author Christopher Snowdon and doing something almost unheard of in Britain these days: enjoying a cigarette under cover. Admittedly, it is a pretty open-air kind of 'under cover' in a specially adapted part of the Boisdale restaurant and bar near London's Victoria station; still, the novelty value is not lost on me.

We are here because Snowdon is launching his book this evening, a history of the anti-smoking movement that has been three-and-a-half years in the making. . . .

Tobacco is also popular with soldiers. Soothing, yet stimulating, it is just the ticket for those faced with the possibility of brutal death and horrifying injury. Snowdon quotes the US general John Pershing, who was asked what was the key to winning the First World War. 'I answer tobacco as much as bullets', he said, before urgently cabling Washington: 'We must have thousands of tons of it without delay.' By one reckoning, 95 per cent of the military used tobacco in some form during the First World War. . . .

While Hill and Doll's conclusions have been confirmed time and again, it is the link between 'passive' smoking and ill-health that has driven the debate in recent years. Anti-tobacco campaigns largely failed to make much headway when they simply called for prohibition or for a smoke-free atmosphere. As long as smoking only involved potential harm to the smoker himself, the irritation felt by some non-smokers was never considered enough to justify intervention and the restriction of people's smoking habits.

Then, changing the focus from harm-to-smokers to the alleged dangers of second-hand smoke for everyone proved crucial in building momentum for a variety of smoking bans. Yet, as Snowdon writes, the evidence of second-hand harm has always been flimsy. . . .

Snowdon is once more in demand and dashes off to sign books. I light up again. Funny how pursuing what should be nothing more than a bad habit can seem like a single, raised finger to those who want to restrict our personal freedom and micromanage our lives.

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WINICKOFF: My Turn: Ban Smoking in Public Housing  

Ten years ago, I was the doctor for an 18-year-old with cystic fibrosis whose mother was a heavy smoker. The patient told me how she coughed, wheezed, and choked when she was at home. I became close with her; it seemed she was always in the hospital, and I couldn't help but think it was because she wanted to escape a toxic environment. Three years later, at 21, she died—more than 14 years before a person with cystic fibrosis could be expected to live at that time.

She is not the only young patient of mine to feel the effects of secondhand smoke. More must be done to address this suffering. . . .

change can't come fast enough for children from lower income levels, where rates of exposure to secondhand smoke are especially high—not surprising, given that poor adults smoke at higher rates. Children in densely populated public housing suffer the worst.

That's ironic, since these smoke-filled environments are subsidized by the same government that spends billions of dollars on secondhand-smoke-related disease. . . .

Some people argue that smoke-free regulation weighs against our longstanding cultural values surrounding privacy and protecting the sanctity of our homes. These values are important. But when considering them against the health of a child who has never smoked but is suffering from tobacco exposure in his own building, the choice is clear to me.

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• Solving the Case of How to Quit: Home Invasion  

He and almost a dozen of his support personnel, investigators and deputies, along with other city and county employees, were halfway through their series of tobacco cessation classes.

And they hadn't lost that focused intensity they all brought to the initial session, either. They were still intent on solving this case of how to quit using tobacco.

After the second class, the group received their first prescription for Chantix, a prescription medication used to help people quit smoking. . . .

But just as the effects of smoking are bad on Nugent himself, the effects of his second-hand smoke (also called Environmental Tobacco Smoke or ETS) are dangerous to his family members - and that includes Amber, the Sheriff's bloodhound, if she happens to be around cigarette smoke while with Nugent. . . .

New studies are showing that pets get dosed with poisons from tobacco smoke in two ways: through second-hand smoke and by ingesting the actual smoke particles when they groom themselves, which is being labeled third-hand smoke. . . .

And the licking of things is also a heretofore undetected source of smoke carcinogens for babies, too.

An article in Pediatrics Magazine in the beginning of this year highlighted the risk to pregnant women and babies of third-hand smoke. . . .

An article published in July 2005 in the world-renowned medical journal Lancet indicated that private research conducted by the Philip Morris cigarette company in the 1980s showed that second-hand smoke was highly toxic. Yet the company suppressed the findings during the next two decades.

So the Surgeon General's report was right: there is absolutely no risk-free level of second-hand smoke exposure - to any living thing, especially children, pets and other people living with a smoker.

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• 7 cities join in to kick killer butt 

QINGDAO: After several bans on smoking in public places in most Chinese cities went up in smoke, Shanghai and Luoyang have expressed a desire to educate parents of the dangers of puffing away in front of their kids.

Shanghai and Luoyang are among six cities, including Wuxi (Jiangsu), Changsha (Hubei), Ningbo (Zhejiang) and Tangshan (Hebei), which joined Qingdao in a campaign called "Tobacco Free Cities" launched in the coastal capital of Shandong province yesterday.

The five-year program, funded by the Bill and Melinda Gates Foundation, will provide the cities with funds to implement anti-smoking policies. Most of the seven cities that have joined the campaign already have smoking bans in place, but "hope to tighten controls and raise awareness" about the harmful effects of smoking.

Li Aihong, an official with the Luoyang disease prevention and control center, said her research found that 80 percent of people in her city are "forced to inhale second-hand smoke in their own homes".

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• New research discovers link between smoking and brain damage 

New research which suggests a direct link between smoking and brain damage will be published in the July issue of the Journal of Neurochemistry. Researchers, led by Debapriya Ghosh and Dr Anirban Basu from the Indian National Brain Research Center (NBRC), have found that a compound in tobacco provokes white blood cells in the central nervous system to attack healthy cells, leading to severe neurological damage.

The research centers on a compound known as NNK, which is common in tobacco. NNK is a procarinogen, a chemical substance which becomes carcinogenic when it is altered by the metabolic process of the body.

Unlike alcohol or drug abuse NNK does not appear to harm brain cells directly, however, the research team believe it may cause neuroinflamation, a condition which leads to disorders such as Multiple Sclerosis.

"Considering the extreme economical and disease burden of neuroinflammation related disorders, it is extremely important from a medical, social and economic point of view to discover if NNK in tobacco causes neuroinflammation" said Ghosh. . . .

This shows that NNK provokes an exaggerated response from the brain's immune cells, known as microglia. Microglia cells act as 'destroyers' for the brain by attacking damaged or unhealthy cells. However, when provoked by NNK these cells start to attack healthy brain cells rather than the unhealthy cells they are supposed to attack.

"Our findings prove that tobacco compound NNK can activate microglia significantly which subsequently harms the nerve cells," said Basu. . . .

The study also suggests that second hand smoking may lead to the same neuroinflamation conditions. Concentrations of NNK in tobacco can vary from 20-310 nanograms in cigarettes. However, NNK is also present in the smoke itself, smoke-filled air indoors may contain up to 26 nanograms of NNK. This means that both direct and second-hand smoking can lead to substantial measures of NNK intake.

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GRAY: A ban on lighting up in the car will smoke out bad parents 

This is what makes the reaction to the recent proposal, to ban smoking in cars when children are present, somewhat peculiar. Why would anyone complain about a proposed law to protect their own children?

The person suggesting the legislation is not some fundamentalist, nut job, anti-libertarian, but Professor Terence Stephenson, the extremely eminent head of the Royal College of Paediatrics and Child Health. Part of his job is to improve and maintain the health of children in the UK, and as such his concerns should be addressed with the utmost seriousness.

The response, from smokers of course, has been depressing, as if no-one has learned anything at all in the past 50 years. Simon Clark was one of the first to respond. He's director of the proudly unpleasant Forest, the smokers' lobby group funded by the tobacco industry. Smokers opposing this ban are advertising the fact that they don’t value their children’s health above their addiction . . .

Those who cry "nanny state!" at every piece of new health legislation should reflect on the fact that state intervention is a direct consequence of failing to regulate ourselves. Liberty sometimes means more than just the freedom of personal gratification. It means protecting the rights of the vulnerable.

If Professor Stephenson's advice is taken and law is passed, selfish gits will still smoke in cars with children. Some will get caught. Most will not. But hopefully, just as it's become socially unacceptable to drink and drive, text and drive, or travel without a seatbelt, a new law would make it clear to the transgressors that they are doing something which society at large disapproves of. . . .

The state only needs to nanny when its citizens behave like children.

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• Impact of Environmental Tobacco Smoke and Active Tobacco Smoking on the Development and Outcomes of Asthma and Rhinitis  

Summary: Several deleterious effects have been described in asthma because of smoking: accelerated decline in lung function, more severe symptoms, impairment in quality of life and diminished therapeutic response to steroids. The harmful effect of tobacco smoking is not only on asthma but also on rhinitis playing a role in disease outcomes. Tobacco exposure can influence innate immunity diminishing innate production of antigen-presenting cells cytokines, as well as an impaired response to toll-like receptor ligands. Active smoking is associated with current symptoms of asthma and rhinitis and seems to be a risk factor for developing new asthma in patients with rhinitis. Tobacco smoking has been also found among the factors inducing nasal obstruction and decreased muco-ciliary clearance in nonallergic rhinitis. . . .

The early exposure to ETS, both prenatal and postnatal, increases the risk of IgE sensitization to indoor inhalant and, in particular, food allergens[13••,14] and subsequently may have effects on atopy and airway hyperresponsiveness, with the consequent presence of atopic diseases.[15,16]

More studies are needed to gain insight in the relationship between tobacco smoking, ETS and the immune response and inflammatory lower and upper respiratory illnesses. . . .

All these findings suggest tobacco exposure control should be a tool in the management of asthma.

Conclusion

1. Tobacco smoking provokes a strong immunological imbalance to those exposed. The innate immunity is impaired by tobacco exposure.

2. As a consequence, typical allergic diseases such as rhinitis and asthma could initiate or aggravate preexisting conditions or both. Active smoking is a factor for nasal obstruction in NAR.

3. Tobacco smoking (and probably ETS also) has a detrimental effect on the efficacy of inhaled corticosteroids, leukotriene receptor antagonists and on those patients in programs for controlling asthma in deprived populations.

4. Robust evidence is provided in order to empower both primary and secondary prevention by physicians.

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SCHRAG: Hiding the elephant in smoke 

The Centers for Disease Control and Prevention estimates that secondhand smoke kills as many people in the United States as traffic crashes. So when a city commissioner (or anyone else) stands up in public and says he or she opposes the ban because it cramps bars' style, what's really being said is that the number of people being killed by secondhand smoke isn't too high a price to pay for the freedom to run a business or smoke in a bar.

Except that's not what they actually say. I wonder why.

How do they make this calculation in favor of personal rights? Do they think the CDC is, to abuse a phrase, blowing smoke? If so, you'd think they would have the courage to say so; elaborating on what is flawed about the studies CDC relies upon would give them credibility. To leave this part out, to simply say this is about personal freedoms, is dishonest.

After all, the ban isn't about convenience. It isn't about indulging delicate types who want everything their way. This is about the fact that when people smoke in a crowded room, everyone's health is compromised.

All sorts of people, including commissioners, have spoken out against the ban. If they were stand-up citizens, they'd explain just how they decided the health consequences are outweighed by the loss of freedom.

But don't hold your breath waiting.

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GREELEY: Here’s the point: Make no mistake – smoking is bad for you 

Over 30 years ago, the old Central School in Halifax housed five classrooms of first-, second -, and third-grade students. Different subjects were taught in different classrooms, much like middle and high school. During homeroom one morning, Mrs. Martin told 30 sleepy children something that stands true to this day: "Smoking is bad for you." . . .

Here's the point: Expressed acknowledgment by the proprietor of a business to his employees and customers that smoking will be allowed in the establishment is sufficient information needed for those adults to make the decision as to whether they wish to remain in that establishment. . . .

If people would still walk into the establishment, be they employees or customers, then the problem isn't as big as the government says it is. If fewer people would walk in, then the business would start to fail.

Federal taxes on cigarettes will be raised another 61 cents. Boston is making it illegal to smoke cigars in cigar bars. A restaurant in Halifax spent thousands of dollars to renovate its building to accommodate their patrons who smoke, only to have to move its business to another building after a total smoking ban went into effect.

None of these actions by government allow people who smoke to freely assemble with other people who don't mind when they are smoking.

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STEPHENSON: 'Ban smoking in cars with children' 

We can't smoke in the office or the pub, but we can still smoke in the car when we're travelling with children.

In this week's Scrubbing Up, the new president of the Royal College of Paediatrics and Child Health says this too should be stopped. . . .

Why on earth would you light up in your car whilst your children are sitting quite happily in the back?

On the assumption that you wouldn't pass the packet round and invite the kids to light up, why make them breathe tobacco smoke at all?

You can't inflict this on your colleagues at work any more. Why should we treat our children's health as a lower priority than our employees?

Unfortunately, parents in the UK have smoked around their children for generations.

My parents put me and my brothers and sisters in the back of their car, started their three hour journey and lit up cigarette after cigarette - often with the windows closed. . . .

Let's follow the others who seem to have done it successfully - California, South Australia and Cyprus.

This would be a piece of progressive legislation and we would quickly realise the benefits . . .

Those of us in the medical profession, who see the results of passive smoking first hand, need to be ready to lead and make a convincing case.

Only then can we hope that necessary measures are viewed not as the 'nanny state' but as 'common sense'.

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Asthma and Smoking Could Be Dangerous Combo  

Doctors say smoking and asthma can also be a dangerous combination. “None of your medications will work,” says Dr. Kay Walker, an allergies and asthma physician. “Not only just your simple quick inhaler, but the long term medications which cut down on the inflammation simply cannot be as effective in somebody who is an active smoker.”

Doctor Walker says the chemicals in cigarettes paralyze parts of the lungs that clear out dust and particles. The damage can also prevent inhalers and medicines from helping you during a life-threatening asthma attack. “Because you are continually damaging the lungs, you are continually causing more inflammation, which overwhelms our ability to try and control it.”

Second-hand smoke can also be a problem for asthma sufferers of all ages.

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LETTER: Deutsch: Tobacco bill's consequences 

Hard as it may be to believe, a bill which, as I write, has just been passed by the Senate and is on the way to a President who is eager to sign it, will clearly have effects opposite to those which it is said to have been designed to produce. The bill authorizes the FDA to require that the nicotine content of cigarettes be lowered. Let me explain how this would increase the sales of cigarettes, require smokers to pay more for their habit, and increase the incidence of cancer caused by smoking. . . .

Many studies have shown that nicotine addicts smoke until they have absorbed enough nicotine to satisfy their craving. This means that they will smoke more cigarettes if the cigarettes contain lower concentrations of nicotine. This, in turn, means that they will be subjected to more of the "tars" (the cancer-causing ingredients of the smoke) in their attempt to get their usual dosage of nicotine (the ingredient responsible for heart disease).

Thus they will buy more cigarettes, maintain their exposure to heart disease and increase their chances of developing cancer and thus their overall chance of dying. And for us nonsmokers, the effect will be to increase our exposure to second-hand smoke.

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