14-1Passive smoking

Passive smoking

Healthcare

workers need to

know about the

effects of both

active and

passive smoking.

14-2Passive smoking

Streams of tobacco fume

Lateral stream or second hand

Main streamSmoker

Third stream

14-3Passive smoking

Tobacco smoke : Gas phaseType of toxicity

Amount in main stream / cig.

Ratio second/main stream

Carbon monoxid Toxic 26,8-61 mg 2,5-14,9

Benzene Carcinogen 400-500 µg 8-10.

Formaldehyde Carcinogen 1 500 µg 50

3-Vinylpyridine Suspected Carcinogen

300-450 µg 24-34

Hydrogen Cyanide Toxic 14-110 g 0, 06-0,4

Hydrazine Suspect Carcinogen

90 ng 3

Azote oxides (NOx) Toxic 500-2 000 µg 3,7-12,8

N-nitrosodimethylamine Suspect Carcinogen

200-1040 ng 20-130

N-nitrosopyrrolidine Suspect Carcinogen

30-390 ng 6-120

14-4Passive smoking

Particular phase

7,20, 72 µgCancerogenCadmium

1,243 ngSuspect CancerogenN-nitrosodiéthanolamine

1-220,2-1,4 µgSuspect Cancerogennor nitrosocotinine

0,5-50,15-1,7 µgSuspect CancerogenN-nitrosonornicotine

8-1115-20 µgCancerogenQuinoléine

2,5-2040-70 ngCancerogenBenzo(a)pyrene

2-440-200 ngCancerogenBenz(a)anthracene

3,1140 ngCancerogen4-Aminobiphenyl

3970 ngCancerogen2-Naphthylamine

18,73 µgCancerogenO-Toluidine

0,67-12,858-290 µgSuspect CancerogenCatechol

1,3-370-250 µgPromotorPhenol

1,3-212,1-46 mgToxicNicotine

1,1-15,714-30 mgCancerogenTars

Ratio second hand/ main stream

Amount in main stream / cig

toxicity

14-5Passive smoking

Discomfort from passive smoking is a reality

• Recent survey (Baromètre santé 2000) showed than 72 % of non-smokers are disturbed by second hand tobacco.

• These results demonstrate the need for non smokers to be totally protected from second hand tobacco.

• NB 53% of smokers also stated that they were disturbed by second hand tobacco. The request for a smoke-free environment is well accept by both non-smokers and smokers alike.

14-6Passive smoking

Discomfort from passive smoking in Europe

0%

10%

20%

30%

40%

50%

60%

70%

80%

BelgiumDenmark

GermanyGreece

SpainFrance

EireItaly

LuxemburgNederland

PortugalUK

Sources: Europe against cancer, 1993 and WHO Europe, 1992.

Disturbance % smokers

14-7Passive smoking

Disturbance from passive smoking report by smokersin response to the question :

«are you disturbed by smoke from others? »

33,2 39,4 45,4 47,558,1 65,3

40,244,2

42,7 40,932,5 25,7

26,616,4 11,9 11,7 9,4 9

0

20

40

60

80

100 %

<1 cig/d 1 - 5cig/d

6 - 10cig/d

11 - 15cig/d

16 - 20cig/d

> 20cig/d

Not at all Yes, little Yes, stronglySource: Baromètre santé 2000, CFES

14-8Passive smoking

Exposure to tobacco smoke

Exposure to tobacco smoke in Europe (%)

86

85

82

63

55

43

84

82

78

56

54

40

0 20 40 60 80 100 %

Restaurants

Friends

Public place

Transports

Working place

At home 1995

1992

Eurobaromètre 1995 (12 european states)

14-9Passive smoking

Recent scientific data demonstrates the risk of second hand smoking for non-smokers.

• Smokers are the main victims of tobacco smoke (500 000 deaths annually in Europe)

• Recent scientific data, mainly published within last 15 years, provides clear evidence than second hand tobacco smoke is the cause of disease in children and adults.

• This evidence calls for responsible action in public places to prevent all exposure to second hand tobacco smoke.

14-10Passive smoking

Second hand tobacco smoke is associate with an increase risk of :

Lower tract respiratory infections in children (+ 72 % if mother smokes),

recurrent otitis media in children (+48 % if both parents smoke),

asthma attack and shyness in children,

intra-uterin growth defects and low birth weight (also occurs in non smoking mothers passively exposed to second hand tobacco),

suddent infant death (two fold increase)

Heart attack (+25 %, it is the main cause of second hand related death)

lung cancer (+ 26 %).

Apart from these well established effects, many other effects are suspected with regard to non malignant diseases and the aggravation of pre-existing conditions or malignous diseases, however new scientific data is needed to confirm these effects.

14-11Passive smoking

Cardiac disease (coronary disease)• Three meta-analysis including more than 25 epidemiologic studies

demonstrates that second hand smoke exposure is associate to an excess of coronary disease (angina and myocardial infarction).

• This effect is established for non-smokers exposed at home or in the working place.

• Biological data explains this excess of risk.

• The risk decreases when exposure stops.

• A dose/response relationship exists.

• The best estimate of this risk excess as compared to non exposed person is 25%.

• Because of the number of people concerned, cardiac risk is the main risk of mortality with regard to second hand tobacco exposure.

14-12Passive smoking

Lung carcinoma

• More than 40 epidemiological surveys included in 3 meta-analysis established that second hand tobacco is associated with an increase in lung carcinoma (25%).

• This effect is demonstrated in non-smokers exposed at home and in the working place.

• A dose/response relationship exists.

• The best estimate of risk as compared to a non exposed person is 26%.

14-13Passive smoking

Lung carcinomaIncreased risk 26%

Heart attacks25%

Disturbance Increase risk80 % for non-smokers 53% for smokers.

Two main risks of passive smoking in adults, in addition to those in pregnancy)

14-14Passive smoking

BronchitisIncreased risk of 72 % for a smoking mother and 29 % if an other family member smokes

Suddent infant death2 fold increased risk

Otitis media

Increased risk of 21%, 38% or 48 % according to whether father, mother or both are smokers

Asthma attack

Increased risk of 14%, 38% or 48% according whether father, mother or both are smokers

The four main risks of passive smoking in children

14-15Passive smoking

Number of workers exposed to respiratory carcinogens in France.

1162464

523971

410499

375461

307025

177949

0 200000 400000 600000 800000 1000000 1200000 1400000

Second hand tobacco smoke. (>75% of working time)

Radon and degradation product

Diesel exhaust fumes

Inorganic acid mists(sulf. ac. )

Formaldehyde

Wood dust

Source : CAREX

14-16Passive smoking

Percentage of people who report that non smokers are protect from second hand tobacco (%)

1993-1994 CFES

1995 CFES 1998 CREDOC

2000 CFES

Workplaces 53,8 56,8 61,9 60,3Transports 53,7 40,1 56,1 45,7Restaurants 36,1 44 40,1 41,2Bars 12,1 17,2 - 13,2Railway and undergrounds

- - 26,9 -

Public places in general 37,2 43,9 - 31,5

School, university 50,8

14-17Passive smoking

Indoor tobacco pollutionCompound Typical value in

clean areaSmoking room Limit value for pollution in

city

CO < 1 ppm 10 ppm 16mg/m3 (14,5 ppm) plan to decrease to 10mg/m3

(8,5 ppm) at /1/2005

Cotinine 0,34 ± 0,007 µg/m3 3,74 ± 0,52 µg/m3

Nicotine < 0,3 g/m3 1-10 g/m3 < limit of detection

Particul mater < 1 m (MMAD)

10-25 g/m3 18-95 g/m3 5000 g/m3 respirable USA

Benzene 3,6 g/m3 7,2 g/m3 10 g/m3 decreasing to 5 g/m3 at 1/1/2010

14-18Passive smoking

Decrease of nicotine in air according to tobacco control regulation

Source : Trout D, J Occup Environ Med 1998; 40:270-6 Hammond SK, JAMA 1995; 274:956-60

8,6

1,30,3

2,3

0,70,2

0

2

4

6

8

10

No policies Non-smoking area Non-smoking casino

nic

oti

ne

in a

ir (

mcg

/m3)

casino

Others workplaces

14-19Passive smoking

Benefit to employees of smoking prohibition in restaurants

Eisner M et coll., JAMA 1998, 280, 1909-1914

Nu

mb

e r o

f b

arm

en w

ith

sy m

pto

ms

Source:

10

20

30

40

Before prohibition After prohibition0

Symptoms in 67 barmen before and after smoking prohibition

DyspneaMorning coughDay coughSputumEyes irritationNose irritation

Throat irritation

,

14-20Passive smoking

Biological monitoring of passive smoking

39621,5 ± 28,77,47 ± 8,25Urinary (ng/ml)

2,49Plasmaic (ng/ml)

150,6 ± 15510–43,65,8 ± 4,35Nicotine Salive (ng/ml)

30Urin. (ng/mg creat.)

3 – 68100–2500,3 – 392Urinary (ng/ml)

15 –7,33undetectableundetectablePlasmatic (ng/ml)

0 – 83,6 – 31,30,4Salive (ng/ml)

Cotinine

RIACGRIACGRIACG

> 5 %2-3 %> 1,7 %HbCO

>10–20 ppm7–11 ppm3 ppm ± 1,5C0

smokerexposedNon-exposedCompound

CG = Gazeous chromatography RIA = radio-immuno-assay