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Clear the Air of Secondhand Smoke

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by Susan Blumenthal, M.D, M.P.A. and Emily Gaukler*

In a leadership move this month, Marriott International declared that all of its hotels worldwide would be smoke-free by September 2006. This important policy change heralds an increasing trend in the spread of smoke-free establishments. Why now? Because there's a killer at loose in our communities linked to 1 out of 5 deaths in the United States. Is this killer on the FBI's Most Wanted List? No. Why not? Because the killer is tobacco. Smoking is the largest preventable cause of death in the United States, taking an enormous personal and societal toll on the Nation as well as costing $75 billion dollars in direct medical costs each year. The first Surgeon General's Report on Smoking and Health published in 1964 contained important scientific evidence documenting tobacco's health damaging effects. The report provided the foundation for lifesaving public health interventions that have resulted in a 50% decrease in smoking rates in the United States over the past 40 years. Now, similarly, a new Surgeon General's Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke issued in June provides powerful scientific evidence of the scope and impact of the dangers of secondhand smoke. Each year there are 46,000 premature deaths due to heart disease, 3000 from cancer and 430 from sudden infant death syndrome all linked to secondhand smoke. In spite of this evidence, today, nearly half of all nonsmoking Americans are still regularly exposed to these toxic fumes, including millions of children. Approximately 60% of children aged 3-11 years old are exposed to secondhand smoke and roughly 30% of indoor workers in the United States are not protected by smoke-free workplace policies. The Surgeon General's Report underscores that there is no risk-free level of secondhand smoke; the only protection is to ensure all indoor areas are smoke-free. Ventilators, open windows and other methods of cleaning indoor air cannot eliminate all secondhand smoke or people's exposure to it.

Findings from the Report reveal that the health damaging effects and dangers of secondhand smoke are substantially more prevalent and serious than previously thought, especially among children. It provides indisputable scientific evidence that secondhand smoke is responsible for tens of thousands of premature deaths each year in the United States alone. Nonsmokers exposed to secondhand smoke increase their risk of heart disease by 25-30% and lung cancer by 20-30%. Even a brief exposure can have immediate harmful effects on a person's blood vessels, potentially increasing the risk of a heart attack. We now know that secondhand smoke emitted from the burning end of a cigarette has an even higher concentration of carcinogenic compounds than what is inhaled directly by a smoker. By breathing these fumes, a person inhales a substance containing more than 4000 chemicals, at least 250 of which are known to be toxic or carcinogenic. Among these are hydrogen cyanide (used in chemical weapons), carbon monoxide (as in car exhaust), ammonia, arsenic and lead. Inhaling secondhand smoke, even briefly, causes blood platelets to become 'sticky,' which can damage blood vessels and increase the risk of a heart attack. The Report is a warning to smokers and non-smokers alike that smoking can sicken and kill. Even those who don't smoke can be harmed by smoke from those who do.

The Report underscored that secondhand smoke's effects on children is significantly more severe and harmful than previously estimated. Children's developing bodies are particularly susceptible to the toxins in secondhand smoke. Among children, inhaled secondhand smoke causes serious respiratory problems, increases the risk of infections, weakens and slows lung growth and function, and is linked to a higher incidence of sudden infant death syndrome. Each year secondhand smoke contributes to 150,000 - 300,000 cases of bronchitis and pneumonia in children less than 18 months old as well as 7,500 - 15,000 hospitalizations. Over 40% of children admitted to emergency rooms for asthma are regularly exposed to smoking at home. This exposure can trigger an asthma attack, threatening the life of a child. Despite these deleterious effects, children remain more exposed to secondhand smoke than do nonsmoking adults with nearly 60% of children aged 3-11 breathing in these toxic fumes. Approximately 25% of children in this age group live with at least one smoker, as compared to only 7% of nonsmoking adults. Pregnant women should be especially careful of their exposure to secondhand smoke. Babies born to mothers who smoked or were exposed to secondhand smoke have a lower birth weight and poorer lung function than children who did not have this exposure. Both of these factors significantly increase the risk for health problems later on in life. These babies are also more likely to die from sudden infant death syndrome. These findings underscore that parents, communities and policymakers must strengthen efforts to establish smoke-free environments to ensure a healthier future for children.

While most children are exposed at home, the workplace remains the most vulnerable location for nonsmoking adults to breathe in secondhand smoke. Nearly 30% of indoor workers in America are not protected by smoke-free policies. Despite the serious health hazards and premature deaths attributed to secondhand smoke, only 14 states have laws requiring private workplaces to be smoke-free. Among the food service industry, a major economic sector in the United States, only 28% of waiters and waitresses and 13% of bartenders are covered by protective policies. Smoke-free policies must be developed to ensure that those who choose not to smoke do not become unwary victims of its toxic health effects. Over the past several years, tougher smoke-free policies have emerged as well as a greater demand for smoke-free establishments. The scientific evidence shows that smoke-free laws protect health without harming business. To illustrate this, despite initial concerns raised by business owners over New York City's smoke-free business legislation, the city's bars and restaurants actually increased their trade by 9% after becoming smoke-free. This movement must expand and extend to the more than 126 million Americans who still lack protection at home, at work and in public places.

Eleanor Roosevelt once said, "I never see what has been done. I only see what remains to be done." Yes, a great deal of progress has been made in reducing smoking from 50% of the U.S. population in 1964 to 21% of all adults today, as well as in reducing secondhand smoke in public places. But much more needs to be done to ensure everyone's right to breathe clean air. Fortunately, the solution is simple -- eliminate smoking. What is needed to eradicate this public health hazard is a combination of personal responsibility and smoke-free public policies. There are simple measures that everyone can take to establish and support a smoke-free environment. Make your home and car smoke-free. Ask those around you not to smoke. Support, thank and frequent businesses that are smoke-free: they are promoting the health of their employees, customers and saving on health care costs as well. Educate children about the dangers of secondhand smoke and ensure that schools and day care centers are smoke-free. Take special caution in avoiding secondhand smoke if you have respiratory problems, heart disease or are pregnant. Talk to your doctor if you have any questions about the hazards of secondhand smoke and spread the word to others.

If you are a smoker, protect the health of others by limiting your smoking to the outdoors. To protect your health, do everything you can to stop smoking. If you need assistance, there are support groups, behavioral interventions and medications that can help. You can find a telephone quitline in your area by calling 1-800-QUIT-NOW (1-800-784-8669) or visit www.epa.gov/smokefree.

Advocate for public health policies in your community including city, state and federal legislation to ensure smoke-free environments in the United States. Fourteen states in our country and the District of Columbia have already put in place full smoking bans inside restaurants and bars. But consider this: by 2015, 70% of tobacco related deaths will be in the developing world. This means that tobacco prevention and control efforts must be global in scope. Full smoking bans inside restaurants and bars have been adopted in seven countries (Bhutan, Iceland, Ireland, Lithuania, New Zealand, Norway and Uruguay), nine Canadian provinces and territories, seven Australian states and territories as well as Scotland, Guernsey, Bermuda and Puerto Rico. In the United Kingdom, a bill has been adopted by the House of Commons and is awaiting final approval. Smoke-free laws are being developed in many other countries worldwide. But globally this is just a beginning. Much more remains to be done, especially in the developing world.

The scientific and public health knowledge presented in the recent Surgeon General's Report provides a call to action to protect the health of the nearly 50% of Americans who still regularly breathe in the toxic fumes of secondhand smoke. No one should have to suffer the health damaging effects of someone else's smoking in their home, school or workplace. The good news is that unlike some other public health problems, the dangers of secondhand smoke can be easily prevented. So let's all work together to clear the air of tobacco smoke and take an important step towards a healthier future for our country and our world.

To learn more about the dangers of secondhand smoke and tobacco prevention strategies, visit www.surgeongeneral.gov/library/secondhandsmoke and http://www.cdc.gov/tobacco/.

*Emily Gaukler, a recent graduate of Brown University, serves as Research Assistant to Rear Admiral Blumenthal at the Center for the Study of the Presidency in Washington D.C.