Environmental Tobacco Smoke Health Article

ENVIRONMENTAL TOBACCO SMOKE

According to the United States Environmental Protection Agency (EPA), environmental tobacco smoke (ETS), which is also referred to as secondhand smoke, is a mixture of the smoke emanating from the burning end of a cigarette, pipe, or cigar, and the smoke exhaled from the lungs of smokers. It has also been called passive, or involuntary, smoke. Although different sources may use different terms and varied definitions, the basic focus is on the exposure of a nonsmoker to the high levels of carcinogenic and toxic fumes emitted from burning tobacco.

ETS contains over 4,700 chemicals. Of these chemicals, forty-two are known carcinogenic compounds, including benzene, arsenic, nickel, nicotine, chromium 6, and vinyl chloride. Many of these compounds are added to tobacco in order to enhance burn time, freshness, and nicotine levels.

EXPOSURE TO ETS

A 1996 study conducted by the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) documented that measurable levels of serum cotinine were found in the blood of 88 percent of American nonsmokers. The presence of cotinine, a chemical the body metabolizes from nicotine, shows that a person has been exposed to tobacco smoke in the last two to three days. In other words, nearly nine out of ten nonsmoking Americans are exposed to ETS on a regular basis. Furthermore, it is estimated that 50 to 75 percent of children under five years of age live in homes with at least one adult smoker.

HEALTH EFFECTS

R. J. Reynolds, the manufacturer of Camel, Winston, and other cigarette brands, has stated that they "do not believe that the scientific evidence concerning secondhand smoke establishes it as a risk factor for lung cancer, heart disease, or any other disease in adult nonsmokers" (R. J. Reynolds, "Tobacco Issues"). However, research indicates that exposure to ETS can contribute to serious health consequences and is the third leading cause of preventable death in the United States.

The EPA has classified ETS as a group A carcinogen and estimates that it causes about three thousand lung cancer deaths in U.S. nonsmokers per year. Legal challenges against the validity of this study have been filed, mostly by tobacco interests. However, the EPA stands behind its findings and has received confirmation and support from other health groups conducting similar and expanded studies. For instance, in 1997 a study conducted by the California Environmental Protection Agency linked secondhand smoke not only to lung cancer, but also to heart disease, nasal sinus cancer, and various other life-threatening diseases. Other studies have established a connection between ETS and breast cancer and stroke. Studies of the effects of ETS exposure on children (both prenatal and postnatal) have indicated higher instances of sudden infant death syndrome, low birthweight, problems with neurodevelopment, negative behavior, childhood cancer, cardiovascular disease, and negative respiratory effects such as asthma and reduced lung capacity. The EPA estimates that each year between 200,000 and 1 million asthmatic children have their condition aggravated by exposure to secondhand smoke. Children of adult smokers have been found to have higher instances of ear infections, nosebleeds, colds, and flu.

POLICIES AND LAWS

Tobacco interests concentrate on the issue of "accommodation" in the establishment of ETS policies. Philip Morris, producer of Marlboro, Virginia Slims, and other cigarettes brands, states, "We know that environmental tobacco smoke … can be unpleasant and annoying, and that many people believe that it presents a health risk to nonsmokers. That is why we strongly support— through a variety of actions and programs—options designed to minimize unwarranted ETS, while still providing adults with pleasant and comfortable places to smoke" (Philip Morris USA, "Second Hand Smoke"). The tobacco industry focuses on using ventilation to remove the components of ETS that might "irritate" a nonsmoking patron, while the health community is more concerned with removing the carcinogenic or toxic elements of tobacco smoke altogether.

The bulk of scientific research supports the health communities' claims that ventilation cannot create a safe indoor environment when tobacco smoke is present. Modern ventilation systems may provide a worker or patron with a perception of protection due to an apparent decrease in tobacco-smoke irritants. However, research proves that tobacco smoke does not remain within designated smoking areas, but travels easily through a building's open doorways and ventilation system. Therefore, accommodation policies do not significantly reduce exposure to the toxins that are associated with ETS-related diseases.

Formal policies and laws restricting or banning the use of tobacco in public buildings, schools, workplaces, and places customarily utilized by the public have been enacted at the federal, state, and local levels. Early ETS policies established rules of accommodation, limiting smoking to designated locations within buildings. As information about the inadequacy of accommodation policies grows, however, public and private entities are moving toward a complete ban of tobacco use within buildings and vehicles. The ban of smoking on U.S. airplanes in 1997 was the result of the settlement of a lawsuit brought by 60,000 flight attendants who suffered the ill effects of long-term exposure to tobacco smoke while on duty.

ETS policy should also address tobacco use outside building entrances. Tobacco smoke follows the natural airflow into a building. Open doors and windows can actually attract smoke in a funneling action. Therefore, many public and private facilities are establishing a ten-to twenty-five-foot smoke-free zone around all entrances; around operating window, air conditioning, and heating intake units; and within stairwells. Some entities, such as worksites that handle flammable or hazardous chemicals, health care facilities, and schools and day-care centers, prohibit tobacco use on their entire campus (all property, both inside and outside). In 1999 the State of Arizona passed a law banning both the use and possession of tobacco products on all school K-12 campuses (private, public, and charter). This comprehensive law was in direct response to the state's concern about both the exposure to tobacco smoke and the influence of tobacco use around children.

While children can be protected from ETS exposure by laws prohibiting tobacco use in schools, day-care facilities, restaurants, and other public places, these laws do not protect children from tobacco smoke within their homes or automobiles. Since up to three-fourths of all children live with a smoker, public health professionals work to educate the general public on the importance of establishing smoke-free homes and automobiles for the safety and well-being of their children and nonsmoking family members.