Date reviewed: 2/14/2000 Environmental Tobacco SmokeEnvironmental tobacco smoke (ETS), also called "secondhand smoke," is the combination of two forms of smoke from burning tobacco products:
When a cigarette is smoked, about half of the smoke generated is sidestream smoke, which contains essentially the same compounds as those identified in the mainstream smoke inhaled by the smoker. Some of the chemicals in ETS include substances that irritate the lining of the lung and other tissues, carcinogens (cancer-causing compounds), mutagens (substances that promote genetic changes in the cell), and developmental toxicants (substances that interfere with normal cell development). Tobacco smoke is known to contain at least 60 carcinogens, including formaldehyde and benzo[a]pyrene, and six developmental toxicants, including nicotine and carbon monoxide. Nonsmokers who are exposed to ETS absorb nicotine and other compounds just as smokers do. As the exposure to ETS increases, the levels of these harmful substances in the body increase as well. Although the smoke to which a nonsmoker is exposed is less concentrated than that inhaled by smokers, research has demonstrated significant health risks associated with ETS. Health Effects Associated With ETS ExposureIn 1986, two landmark reports were published on the association between ETS exposure and the adverse health effects in nonsmokers: one by the U.S. Surgeon General and the other by the Expert Committee on Passive Smoking, National Academy of Sciences' National Research Council (NAS/NRC). Both of these reports concluded that:
In 1992, the U.S. Environmental Protection Agency (EPA) confirmed the above findings in its study on the respiratory health effects of ETS. In addition, the EPA classified ETS as a Group A carcinogen—a category reserved only for the most dangerous cancer-causing agents in humans. The EPA report, a compilation of 30 epidemiological studies that focused on the health risks of nonsmokers with smoking spouses, concluded that there is a strong association between ETS exposure and lung cancer. Scientists estimate that ETS is responsible for approximately 3,000 lung cancer deaths per year among nonsmokers in the United States. Recent studies and the EPA's report point to a 20–percent increased risk of lung cancer in nonsmokers due to ETS. In response to evidence that ETS causes diseases beyond lung cancer and respiratory problems in children, the California Environmental Protection Agency (Cal/EPA) conducted a comprehensive assessment of the range of health effects connected with ETS exposure. In 1999, the National Cancer Institute (NCI) published the Cal/EPA's results as part of its Smoking and Tobacco Control monograph series in Health Effects of Exposure to Environmental Tobacco Smoke. The following table outlines the health effects that were found to have a significant association with ETS exposure. Table 1: Health Effects Associated With ETS Exposure
Other health effects that were found to be possibly associated with ETS were as follows:
However, further research is needed to confirm the link between the above health risks and ETS. Carcinogenic Effects of ETSMore than 3,000 chemicals are present in tobacco smoke, including at least 60 known carcinogens such as nitrosamines and polycyclic aromatic hydrocarbons. Some of these compounds become carcinogenic only after they are activated by specific enzymes (proteins that control chemical reactions) found in many tissues in the body. These activated compounds can then become part of deoxyribonucleic acid (DNA) molecules and possibly interfere with the normal growth of cells. Tobacco also contains nicotine, a chemical that causes physical addiction to smoking and makes it difficult for people to stop smoking. Although much of the research into the carcinogenicity of ETS has focused on lung cancer, ETS has also been linked with other cancers, including those in the nasal sinus cavity, cervix, breast, and bladder. The role of ETS in the development of nasal sinus cancer has been investigated in three recent studies; all three showed a significant positive association between ETS exposure and the development of nasal sinus cancer in nonsmoking adults. Several studies that focused on ETS as a risk factor for cervical cancer have shown a possible association between ETS and cancer of the cervix, although no specific conclusions could be made. Similarly, studies of the relationship between ETS exposure and breast cancer suggested an association between the two, but the evidence was weak. Although active smoking has been identified as a cause of bladder cancer, the results of studies focusing on ETS and bladder cancer have not been conclusive. More research is needed into the impact of ETS on nonsmokers' risk for cancers of the cervix, breast, and bladder. Public Policies Restricting SmokingStudies dating from the early 1970s have consistently shown that children and infants exposed to ETS in the home have significantly elevated rates of respiratory symptoms and respiratory tract infections. These findings prompted recommendations that ETS be eliminated from the environment of small children. In adults, ETS can worsen existing pulmonary symptoms for people with asthma and chronic bronchitis, as well as for people with allergic conditions. Even individuals who are not allergic can suffer eye irritation, sore throat, nausea, and hoarseness. Contact lens wearers can find tobacco smoke very irritating. Following the release of the 1986 reports by the Surgeon General and the NAS, many new laws, regulations, and ordinances were enacted that severely restrict or ban public smoking. With the release of new studies such as the 1999 NCI monograph, many more such laws can be expected:
The 1999 NCI monograph Health Effects of Exposure to Environmental Tobacco Smoke can be ordered from the Cancer Information Service (see below). U.S. residents can order the monograph online at https://http://www.cancer.gov/publications on the Internet. (The monograph can also be viewed and downloaded from this Web site.) Additional information on the health effects of tobacco is available from the CDC's Tobacco Information and Prevention Source at http://www.cdc.gov/tobacco on the Internet. This program collects and distributes reports and news about tobacco, lists services available for people trying to quit using tobacco products, and produces publications about tobacco and the dangers of its use. Sources of National Cancer Institute Information
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