passive smoking

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 2,5-14,9Benzene Carcinogen 400-500 µg 8-10.Formaldehyde Carcinogen 1 500 µg 503-Vinylpyridine Suspected

Carcinogen300-450 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 3,7-12,8N-nitrosodimethylamine Suspect

Carcinogen200-1040 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 / cigtoxicity

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 47,5 58,1 65,3

40,244,2 42,7 40,9

32,5 25,726,6 16,4 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 smokeExposure 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 19951992

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.


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.


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%.


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)


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

Suddent infant death2 fold increased risk

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

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

The four main risks of passive smoking in children


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


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 - 31,5School, university 50,8


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 detectionParticul 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


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 casinonico

tine

in a

ir (m

cg/m

3)

casino

Others workplaces


Benefit to employees of smoking prohibition in restaurants

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

Num

ber o

f ba r

men

with

sym

ptom

s

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

,


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 – 392

Urinary (ng/ml)

15 –7,33undetectableundetectablePlasmatic (ng/ml)

0 – 83,6 – 31,30,4Salive (ng/ml)

CotinineRIACGRIACGRIACG

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

>10–20 ppm7–11 ppm3 ppm ± 1,5C0

smokerexposedNon-exposedCompound

CG = Gazeous chromatography RIA = radio-immuno-assay

passive smoking

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