Elsevier

Clinics in Chest Medicine

Volume 28, Issue 3, September 2007, Pages 559-573
Clinics in Chest Medicine

Environmental Tobacco Smoke: Respiratory and Other Health Effects

https://doi.org/10.1016/j.ccm.2007.06.006Get rights and content

Involuntary exposure to environmental tobacco smoke (ETS) is a serious and entirely preventable public health hazard. It has become clear that ETS adversely affects the health of all who breathe its toxins. Independent of active smoking, ETS exposure is a modifiable risk factor for chronic obstructive pulmonary disease. The expanding body of research presented in this article provides evidence that the damaging consequences of ETS reach far beyond the lungs. Having been determined the third leading cause of preventable death in this country, this is a problem that must be addressed aggressively.

Section snippets

Definitions

The term, ETS, has been defined as the sum of sidestream smoke (SS) released from the burning tip of a cigarette and mainstream smoke (MS), which is exhaled by smokers. Each type of smoke is comprised of a particulate and a vapor phase. The physical and chemical characteristics of ETS are dynamic and differ significantly between MS and fresh SS. MS contributes 15% of total ETS whereas SS, a product of incomplete combustion, constitutes 85% [5]. Particles present in SS have one tenth the

Composition of environmental tobacco smoke

More than 4000 compounds have been identified in tobacco smoke and of these, at least 60 are known or suspected carcinogens [7], [8]. These chemicals comprise approximately 95% of MS weight. This complex mixture of chemical substances also has unique proinflammatory and cytotoxic effects [9]. Inorganic compounds, such as nickel, chromium, cadmium, arsenic, and hydrazine, are related to lung cancer whereas ammonia, nitrogen dioxide, sulfur dioxide, hydrogen cyanide, and acrolein are among the

Assessing exposure to environmental tobacco smoke

Overall, the extent of adverse health effects resulting from ETS exposure is related to two major factors: the duration and intensity of exposure and individual susceptibility, believed to be genetically controlled [13].

The determination of an individual's exposure to ETS is a complex task, given the multiple vari-ables involved. The number of cigarettes smoked by people in an environment, the length of time over which smoking occurs, the ventilation properties of a building, and the absorptive

Exposure prevalence

Several studies have estimated the prevalence of ETS exposure [13], [16]. Reported prevalence rates of exposure vary between 30% and 80% [17] for adults, with many studies showing the workplace as a major source of exposure. Increased regulation on smoking in the workplace and in most public places in recent years has made the home the leading unregulated source of ETS. This has significant potential impact on preschool-aged children who spend proportionately more time in the home [16]. One

Health problems and environmental tobacco smoke exposure

The increased risk for a wide range of adverse health effects associated with ETS is well established from experimental animal data and human studies in children and adults. The multitude of health risks linked to ETS is shown in Box 1. The following sections review the literature on these health effects in more detail.

Children's health, fertility, and environmental tobacco smoke

Almost 60% of United States children aged 3 to 11 years—or almost 22 million children—are exposed to ETS [1]. The reproductive health effects of cigarette smoke exposure for women are far reaching [23]. Children's exposure to ETS during fetal development and during childhood likely is the most pervasive and hazardous of children's environmental exposures [24]. The first report detailing the adverse effects of ETS on children's health was published in 1967 [25]. Several comprehensive reviews

Environmental tobacco smoke and adult health

Evaluating ETS exposure in adults is more complex than in children. Adults are exposed to ETS in multiple venues other than the home, including the workplace and many other public arenas. Because active smoking is a well-established cause of chronic respiratory disease and lung function decline, more information regarding the relationship of ETS with these health effects has been sought over the past several decades. As discussed in the section that follows, a causal relationship between acute

Reducing exposure to environmental tobacco smoke

As a result of the wide body of research presented in this article, ETS now is considered a serious public health hazard. The demonstration that ETS can augment allergic airway responses makes it a public health issue of extreme importance. Workers in the 5 Bs have the highest occupational levels of exposure to ETS and many children remain in situations at home or in cars with adults who smoke. Intervention studies on domestic ETS exposure have focused primarily on children and on achieving

Summary

In general, people have been less well informed of the risks of ETS than the risks of active smoking. ETS exposure, however, has been determined to be the third leading cause of preventable death in this country, resulting in more than 50,000 deaths each year [93].

As discussed in this review, ETS can lead to a broad spectrum of adverse health consequences affecting the respiratory tract, the cardiovascular and central nervous systems, systemic metabolic and immunologic functions, and fetal

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