Passive Smoking

(Date of publication: 20th December 2004)

Passive smoking – not dangerous? Just ask the estimated 17,000 children admitted to hospital in the UK every year as a result of illnesses caused by it. So, before lighting up at this year’s festive bash, spare a thought for those around you. The controversial question of the danger of passive smoking has already led to bans in places as diverse as Ireland, New York and California; the government’s White Paper on health suggests that England, Scotland and Wales may well follow suit and forbid smoking in public places by 2008. British addicts desperate to know the worst can find an executive summary here.

Estimated figures for the annual UK death toll from passive smoking vary between 1,000 and 4,500 for otherwise healthy people. Among those over 65, the total figure could be as high as 16,900 – but 9,700 of these are from strokes, where medical evidence regarding contributory factors is weakest. According to one recently published study, passive smoking in the workplace alone kills three people a day.

Like ‘active’ smoking, ‘secondhand’ smoke is carcinogenic and frequent or prolonged exposure also substantially increases the risk of ischaemic heart disease, stroke and other respiratory and circulatory disorders. Research by the American Heart Association indicates that the risk of heart attack is 91% higher in women who are regularly exposed to others’ tobacco smoke. In addition, women whose partners smoke are three times more likely to have a stroke and 2.3 times more likely to suffer an ischaemic stroke, and living with a smoker increases the risk of lung cancer by 30%.

Why is passive smoking so harmful? Fumes from a lit cigarette contain more than 4,000 chemicals, including tar, carbon monoxide, ammonia, dimethylnitrosamine, formaldehyde and acrolein. Smoke also contains hydrogen cyanide, not a substance noted for its health-giving effect! Many of these compounds have marked irritant properties and over 60 are either established or suspected carcinogens. Some of the unpleasant effects on the lungs can be examined here. Also, many toxic substances are more concentrated in sidestream smoke (fumes from the end of a lit cigarette) than mainstream smoke (that which has already been inhaled and exhaled by a smoker) and nearly 85% of the smoke in a room is the former.

Most people are familiar with the immediate effects of environmental exposure - eye irritation, headache, cough, sore throat, dizziness and nausea. The physiological response to passive smoking unsurprisingly resembles that of the active smoker. The rate of mucus and white blood cell production can multiply up to 7-fold, and mucosal permeability to allergens increases. Exposure for as little as 30 minutes can reduce coronary blood flow, while aortic elasticity can also be seriously affected, impairing left ventricular performance. Asthmatics can experience a significant decline in lung function and tobacco smoke triggers attacks in more than 80% of sufferers.

Infants and young children, whose airways are smaller and immune systems less developed, are particularly sensitive to environmental tobacco smoke. A study by the Environmental Protection Agency of America (EPA) found that exposure to tobacco fumes increases the number of respiratory tract infections like bronchitis and pneumonia by an estimated 150,000 to 300,000 cases annually. It may even contribute to the development of asthma in children; the Australian government concluded that children with a smoking parent were 1.4 times more likely to develop the condition than the children of non-smokers.

Evidence suggests that passive smoking during childhood also has a detrimental effect on IQ. Measuring the levels of cotinine, a nicotine by-product, in the bloodstream of over 4,000 American children, researchers discovered that less than one nanogram (a level produced by a parent smoking less than a pack a day) reduced IQ scores by 2 points. Those whose mothers smoked 10 or more cigarettes a day were, by the age of 10, between three and five months behind in reading, mathematics and general ability when compared to the offspring of non-smokers. Their physical development was also affected; they were an average of 1.0 centimetre shorter, even allowing for associated social and biological factors.

Maternal exposure to smoke during pregnancy can also affect the unborn foetus – passive smoking via the maternal bloodstream. As well as increasing the risk of respiratory disorders after birth, it can raise the likelihood of miscarriage and cot death. Children whose mothers smoked while pregnant are also more susceptible to psychological disturbances, such as attention-deficit hyperactivity disorder or ADHD.

Controversy erupted last year after the British Medical Journal published one study claiming the health risks of passive smoking had been greatly exaggerated, and it is available online here. However, as the BUPA overview at points out, funding was derived indirectly from the tobacco industry and the research methods employed were highly questionable.

This can only be a brief overview of a very extensive subject. Those wishing to explore passive smoking in (exhaustive!) detail could do worse than scrutinise the impressively comprehensive list of studies here.

Finally, it’s not just your major organs and vital bodily functions that are at risk from passive smoking. It can even rot your teeth and indirectly compromise your relationship with your partner!

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A Tour around Passive Smoking

A Tour around Passive Smoking