Health Risks of

Secondhand Smoke
What is secondhand
smoke?
Secondhand smoke (SHS) is also called environmental tobacco smoke (ETS).
Its a mixture of 2 forms of smoke that come from burning tobacco:

Mainstream smoke: The smoke exhaled by a smoker.

Sidestream smoke: Smoke from the lighted end of a cigarette, pipe, or

cigar, or tobacco burning in a hookah. This type of smoke has higher
concentrations of cancer-causing agents (carcinogens) and is more
toxic than mainstream smoke. It also has smaller particles than
mainstream smoke. These smaller particles make their way into the
lungs and the bodys cells more easily.
When non-smokers are exposed to SHS its called involuntary
smoking or passive smoking.Non-smokers who breathe in SHS take in
nicotine and toxic chemicals the same way smokers do. The more SHS you
breathe, the higher the levels of these harmful chemicals in your body.

Why is secondhand
smoke a problem?
Secondhand smoke (SHS) has the same harmful chemicals that smokers
inhale. Theres no safe level of exposure for secondhand smoke (SHS).

Secondhand smoke
causes cancer
Secondhand smoke is known to cause cancer. It has more than 7,000
chemicals, including at least 70 that can cause cancer.

SHS causes lung cancer even in people who have never smoked. Theres
also some evidence suggesting it might be linked in adults to cancers of the:

Larynx (voice box)

Pharynx (throat)

Nasal sinuses

Brain

Bladder

Rectum

Stomach

Breast
Its possibly linked in children to:

Lymphoma

Leukemia

Liver cancer
 Brain tumors

Secondhand smoke
causes other diseases
and death
Secondhand smoke can be harmful in many ways. For instance, it affects the
heart and blood vessels, increasing the risk of heart attack and stroke in non-
smokers. Some studies have linked SHS to mental and emotional changes,
too. For instance, some studies have shown that exposure to SHS is linked to
symptoms of depression. More research is needed to better understand the
link between SHS and mental health.

Secondhand smoke and your

childrens health
Young children are most affected by SHS and least able to avoid it. Most of
their exposure to SHS comes from adults (parents or others) smoking at
home. Studies show that children whose parents smoke:

Get sick more often

Have more lung infections (like bronchitis and pneumonia)

Are more likely to cough, wheeze, and have shortness of breath

Get more ear infections

Secondhand smoke can also trigger asthma attacks, make asthma symptoms
worse, and even cause new cases of asthma in kids who didnt have
symptoms before.
Some of these problems might seem small, but they can add up quickly. Think
of the expenses, doctor visits, medicines, lost school time, and often lost work
time for the parent who must stay home with a sick child. And this doesnt
include the discomforts that the child goes through.

In very young children, SHS also increases the risk for more serious
problems, including sudden infant death syndrome (SIDS).

Where is secondhand
smoke a problem?
You should be especially concerned about exposure to secondhand smoke
(SHS) in these places:

At work
The workplace is a major source of SHS exposure for many adults.

The Occupational Safety and Health Administration (OSHA) and the National
Institute for Occupational Safety and Health (NIOSH), federal agencies
responsible for health and safety in the workplace, recognize there are no
known safe levels of SHS and recommend that exposures be reduced to the
lowest possible levels.

The Surgeon General has said that smoke-free workplace policies are the
only way to prevent SHS exposure at work. Separating smokers from non-
smokers, cleaning the air, and ventilating the building cannot prevent
exposure if people still smoke inside the building. An extra bonus of workplace
smoking restrictions, other than protecting non-smokers, is that they may also
encourage smokers to smoke less, or even quit.
In public places
Everyone can be exposed to SHS in public places where smoking is allowed,
such as some restaurants, shopping centers, public transportation, parks, and
schools. The Surgeon General has suggested people choose smoke-free
restaurants and businesses, and let owners of businesses that are not smoke-
free know that SHS is harmful to your familys health.

Public places where children go are a special area of concern. Make sure that
your childrens daycare centers and schools are smoke-free.

Some businesses might be afraid to ban smoking, but theres no strong

evidence that going smoke-free is bad for business.

At home
Making your home smoke-free may be one of the most important things you
can do for the health of your family. Any family member can develop health
problems related to SHS. Childrens growing bodies are especially sensitive to
the toxins in SHS. And think about it: we spend more time at home than
anywhere else. A smoke-free home protects your family, your guests, and
even your pets.

Multi-unit housing where smoking is allowed is a special concern and a

subject of research. Tobacco smoke can move through air ducts, wall and
floor cracks, elevator shafts, and along crawl spaces to contaminate units on
other floors, even those that are far from the smoke. SHS cannot be controlled
with ventilation, air cleaning, or by separating smokers from non-smokers.

In the car
Americans spend a great deal of time in cars, and if someone smokes there,
the toxins can build up quickly even when the windows are open or the air-
conditioner is on. Again, this can be especially harmful to children.

In response to this fact, many medical expert groups have been working to
encourage people to make their cars, as well as their homes, smoke-free.
Some states and cities even have laws that ban smoking in the car if carrying
passengers under a certain age or weight. And many facilities such as city
buildings, malls, schools, colleges, and hospitals ban smoking on their
grounds, including their parking lots.

There is no safe level of exposure to secondhand

smoke (SHS). Any exposure is harmful.

The only way to fully protect non-smokers from

exposure to SHS indoors is to prohibit all smoking in
that indoor space or building. Separating smokers
from non-smokers, cleaning the air, and ventilating
buildings cannot keep non-smokers from being
exposed to SHS.

What about lingering

smoking odors?
Theres no research in the medical literature as of yet showing that lingering
tobacco smoke odors or residuals from it cause cancer in people. Research
does show that particles from secondhand tobacco smoke can settle in dust
and on surfaces and remain there long after the smoke is gone. Some studies
suggest the particles can last for months. Even though its no longer in the
form of smoke, researchers often call this thirdhand smoke (THS) or residual
tobacco smoke.
Particles that settle out from tobacco smoke have been shown to combine
with gases in the air to form cancer-causing compounds that settle onto
surfaces. For instance, NNK and PAHs (polycyclic aromatic hydrocarbons),
carcinogens that are known to cause lung cancer, have been found in dust
samples taken from the homes of smokers. Research has also shown that
thirdhand smoke can damage human DNA in cell cultures and impact blood
clotting in lab animals.

Though its not yet clear if such smoke residue can cause cancer, any effects
would probably be small compared with direct exposure to SHS. Still, the
compounds may be stirred up and inhaled with other house dust, and may
also be accidentally taken in through the mouth. Because of this, any risk the
compounds pose is probably greater for babies and children who play on the
floor and often put things in their mouths.

No actual cancer risk has been measured at this time, but the health risks of
THS are an active area of research.

What can be done

about secondhand
smoke?
Many US local and state governments, and even federal governments in
some other countries, have decided that protecting the health of employees
and others in public places is of the utmost importance. Many have passed
clean indoor air laws. Although the laws vary from place to place, they are
becoming more common. Detailed information on smoking restrictions in each
state is available from the American Lung Association.
You dont have to wait for the government to act. Even if you smoke, you can
decide to make your home and car smoke-free. This is the safest thing to do
for your children, other family members, pets, and guests.

www.lung.org > Stop Smoking > Smoking Facts

Health Effects of Secondhand

Smoke
Secondhand smoke is a serious health hazard causing more than
41,000 deaths per year. It can cause or make worse a wide range of
damaging health effects in children and adults, including lung
cancer, respiratory infections and asthma.

The American Lung Association has more information available

on laws protecting the public from exposure to secondhand smoke.
Key Facts about Secondhand Smoke
Secondhand smoke causes approximately 7,330 deaths from
lung cancer and 33,950 deaths from heart disease each year. 1
Between 1964 and 2014, 2.5 million people died from exposure
to secondhand smoke, according to a report from the U.S.
Surgeon General. The report also concluded that secondhand
smoke is a definitive cause of stroke.1
There is no risk-free level of exposure to secondhand smoke
and even short-term exposure potentially can increase the risk
of heart attacks.
 Secondhand smoke contains hundreds of chemicals known to
be toxic or carcinogenic, including formaldehyde, benzene,
vinyl chloride, arsenic ammonia and hydrogen cyanide. 2
Secondhand smoke can cause heart attacks; even relatively
brief exposure can trigger a heart attack, according to a report
by the Institute of Medicine.

Secondhand Smoke in the

Workplace
Secondhand smoke costs our economy $5.6 billion per year
due to lost productivity.1
The health of nonsmokers exposed to secondhand smoke at
work is at increased risk. Levels of secondhand smoke in
restaurants and bars were found to be two- to five-times
higher than in residences with smokers, and two- to six-times
higher than in office workplaces.

Being employed in a workplace where smoking is prohibited is

associated with a reduction in the number of cigarettes
smoked per day and an increase in the success rate of
smokers who are attempting to quit.

Casino workers in particular are exposed to hazardous levels of

toxic secondhand smoke at work, including tobacco-specific
carcinogens that increased in their bodies as their work shifts
progressed, according to a report from the National Institute
for Occupational Safety and Health.

Secondhand Smoke and Children

 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. It also causes 430
sudden infant death syndrome (SIDS) deaths in the U.S.
annually.

Secondhand smoke exposure may cause buildup of fluid in the

middle ear, resulting in 790,000 doctor's office visits per year,
as well as more than 202,000 asthma flare-ups among children
each year.7
More than 24 million, or about 37 percent of children in the
U.S. have been exposed to secondhand smoke.

Learn about the American Lung Associations programs to help you

or a loved one quit smoking, and join our advocacy efforts to reduce
tobacco use and exposure to secondhand smoke. Visit Lung.org or
call the Lung HelpLine at 1-800-LUNGUSA (1-800-586-4872).

The Dangers of Secondhand Smoke

Even if you don't smoke, breathing in someone else's smoke can be deadly too. Secondhand
smoke causes about 3,000 deaths from lung cancer and tens of thousands of deaths fromheart
disease to nonsmoking adults in the United States each year.

Millions of children are breathing in secondhand smoke in their ownhomes. Secondhand smoke
can be especially harmful to your children's health because their lungs still are developing. If you
smoke around your children or they are exposed to secondhand smoke in other places, they may
be in more danger than you realize. Children whose parents smoke only outside are still exposed
to the chemicals in secondhand smoke. The best way to eliminate this exposure is to quit.

Read more to learn about the dangers of secondhand smoke and how to create a smoke-
free environment for your children.

What is Secondhand Smoke?

Secondhand smoke (also known as environmental tobacco smoke) is the smoke a smoker
breathes out and that comes from the tip of burning cigarettes, pipes, and cigars. It contains about
4,000 chemicals. Many of these chemicals are dangerous; more than 50 are known to cause
cancer. Anytime children breathe in secondhand smoke they are exposed to these chemicals.

The American Academy Pediatrics (AAP) has conducted research on the effects of
thirdhand smoke and found that it is also harmful. Thirdhand smoke is the smoke left
behindthe harmful toxins that remain in places where people have smoked previously.
Thirdhand smoke can be found in the walls of a bar, upholstery on the seats of a car, or
even a child's hair after a caregiver smokes near the child.

Your Developing Baby and Smoke

If you smoke or are exposed to secondhand smoke when you're pregnant, your baby is exposed
to harmful chemicals too. This may lead to many serious health problems, including:

Miscarriage
Premature birth (born not fully developed)
Lower birth weight than expected (possibly meaning a less healthy baby)
Sudden infant death syndrome (SIDS)
Learning problems and attention-deficit/hyperactivity disorder (ADHD)
The health risks go up the longer the pregnant woman smokes or is exposed to smoke.
Quitting anytime during pregnancy helpsof course, the sooner the better. All pregnant women
should stay away from secondhand smoke and ask smokers not to smoke around them.

Secondhand Smoke and Your Children's Health

Infants have a higher risk of SIDS if they are exposed to secondhand smoke. Children have a
higher risk of serious health problems, or problems may become worse. Children who breathe
secondhand smoke can have more:
 Ear infections
Coughs and colds
Respiratory problems, such as bronchitis and pneumonia
Tooth decay
Children of smokers cough and wheeze more and have a harder time getting over colds. They
miss many more school days too. Secondhand smoke can cause other symptoms including stuffy
nose, headache, sore throat, eye irritation, and hoarseness.

Children with asthma are especially sensitive to secondhand smoke. It may cause more asthma
attacks and the attacks may be more severe, requiring trips to the hospital.

Long-Term Effects of Secondhand Smoke

Children who grow up with parents who smoke are themselves more likely to smoke. Children
and teens who smoke are affected by the same health problems that affect adults. Secondhand
smoke may cause problems for children later in life including:

Poor lung development (meaning that their lungs never grow to their full potential)
Lung cancer
Heart disease
Cataracts (an eye disease)
Secondhand Smoke is Everywhere
Children can be exposed to secondhand smoke in many places. Even if there are no smokers in
your home, your children can still be exposed to secondhand smoke. Places include:

In a car or on a bus
At child care or school
At a babysitter's house
At a friend's or relative's house
In a restaurant
At the mall
At sporting events or concerts
In parks or playgrounds
Creating a Smoke-Free Environment
The following tips may help keep your children from being exposed to secondhand smoke:

Set the example. If you smoke, quit today! If your children see you smoking, they
may want to try it, and they may grow up smoking as well. If there are cigarettes
at home, children are more likely to experiment with smokingthe first step in
becoming addicted.
 Remove your children from places where smoking is allowed, even if no one
is smoking while you are there. Chemicals from smoke can be found on surfaces
in rooms days after the smoking occurred.
Make your home smoke free. Until you can quit, don't smoke inside your home
and don't smoke anywhere near your children, even if you are outside. Don't put
out any ashtrays. Remember, air flows throughout a house, so smoking in even
one room allows smoke to go everywhere.
Make your car smoke free. Until you can quit, don't smoke inside your car.
Opening windows isn't enough to clear the air and can actually blow smoke back
into the faces of passengers in the back seat.
Choose a babysitter who doesn't smoke. Even if the babysitter smokes
outside, your children are exposed. Consider changing babysitters to find a
smoke-free environment for your children.
Encourage tobacco-free child care and schools. Help your children's child
care or school, including outdoor areas and teachers' lounges, become tobacco
free. Get your children involved in the effort to make schools tobacco free!
An Important Choice
If you smoke, one of the most important things you can do for your own health and the health of
your children is to stop smoking. Quitting is the best way to prevent your children from being
exposed to secondhand smoke.

It may be hard to quit. Talk with your doctor or your child's pediatrician if you need help. There
are over-the-counter and prescription medicines that may help you quit. Call 1-800-QUIT-NOW
to be connected to your state quitline- they can refer you to local resources and help you quit.

Parents need to make every effort to keep their children away from smokers and secondhand
smoke. Parents who smoke should quit for their health and the health of their children.