Health/Essays/Secondhand Smoke

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Secondhand smoke is defined as cigarette, cigar, or pipe smoke that is inhaled unintentionally by nonsmokers and may be injurious to their health if inhaled regularly over a long period.

Facts about Secondhand Smoke

  • Sidestream (directly into the air from the cigarette instead of through the interior) smoke is said to contain five times as much carbon monoxide as mainstream (through the inside of the cigarette).
  • Exposure to nicotine and secondhand smoke is measured by testing the saliva, urine, or blood for the presence of a chemical called cotinine. Cotinine is a byproduct of nicotine metabolization, and tobacco is the only source of this marker.
  • From 1988–91 to 2001–02, the proportion of nonsmokers with detectable levels of cotinine was halved (from 88% to 43%).
  • Over that same time period, cotinine levels in those who were exposed to secondhand smoke fell by 70%.
  • More than 126 million nonsmoking Americans continue to be exposed to secondhand smoke in homes, vehicles, workplaces, and public places.
  • Most exposure to tobacco smoke occurs in homes and workplaces.
  • Almost 60% of U.S. children aged 3–11 years—or almost 22 million children—are exposed to secondhand smoke.
  • About 25% of children aged 3–11 years live with at least one smoker, compared to only about 7% of nonsmoking adults.
  • The California Environmental Protection Agency estimates that secondhand smoke exposure causes approximately 3,400 lung cancer deaths and 22,700–69,600 heart disease deaths annually among adult nonsmokers in the United States.
  • Each year in the United States, secondhand smoke exposure is responsible for 150,000–300,000 new cases of bronchitis and pneumonia in children aged less than 18 months. This results in 7,500–15,000 hospitalizations, annually.

(Note: a standardization of nomenclature may be in order. There is a confusion of sidestream smoke (SSS)-- directly into the air from the cigarette-- with second-hand smoke (SHS) in the sense of already in and out of the smoker's lungs before it reaches the air. The latter, SHS, is less dangerous than SSS because the smoker's lungs have removed the carbon monoxide and much other toxic $#!!+.)

At Risk Groups



  • Infants and young children are especially susceptible: their lungs are still developing and childhood exposure to secondhand smoke results in decreased lung function. Children who breathe secondhand smoke are more likely to suffer from cough, wheeze, phlegm and breathlessness.
  • In children, exposure to secondhand smoke exacerbates 400,000-1,000,000 cases of asthma in the United States. New evidence suggests that secondhand smoke is a risk factor for induction of new cases of asthma among children and adolescents.
  • The current Surgeon Generals Report states that there is no risk-free level of secondhand smoke exposure. Even brief exposures can be harmful to children.
  • In the U.S., 33 percent of middle school non-smoking children and 30 percent of high school non-smoking children are exposed to secondhand smoke in their own homes. Based on levels of cotinine (a biological marker of secondhand smoke exposure), an estimated 22 million children aged 3-11 and 18 million youth aged 12-19, were exposed to secondhand smoke in the U.S. in 2000.
  • Exposure to secondhand smoke causes 150,000 to 300,000 acute lower respiratory tract infections (pneumonia and bronchitis) annually in children 18 months and younger; these infections result in 7,500 to 15,000 hospitalizations each year.
  • Secondhand smoke exposure causes buildup of fluid in the middle ear, resulting in 790,000 physician office visits. Middle ear infections are the most common cause of childhood operations and of childhood hearing loss.
  • A California EPA study estimates that 46,000 (range is between 22,700 and 69,600) cardiovascular deaths, 3400 lung cancer deaths and 430 sudden infant death syndrome (SIDS) deaths are annually associated with secondhand smoke exposure.

Pregnant Women

  • When a pregnant woman is exposed to secondhand smoke, the nicotine she ingests is passed on to her unborn baby.
  • Women who smoke or are exposed to secondhand smoke during pregnancy have a higher rate of miscarriges and stillbirths, have an increased risk of low birthweight infants, have children born with decreased lung function, and have children with greater risk of sudden infant death syndrome (SIDS).
  • Smoking during pregnancy causes genetic damage in the developing fetus that can be detected at birth, but also that passive - or secondary - exposure causes just as much damage as active smoking, and it is the same kind of damage.


  • Secondhand smoke exposure causes heart disease and lung cancer in nonsmoking adults.
  • Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%.
  • Secondhand smoke exposure causes an estimated 46,000 heart disease deaths and 3,400 lung cancer deaths annually among adult nonsmokers in the United States.
  • Elderly people who live in smoky environments have worse emphysema and bronchitis, than those who live in smoke-free situations.
  • Nonsmoking individuals living with heavy smokers have four times the risk of heart attack compared with those who live in smoke-free environments.

Smoking and Businesses


Smoke-free laws do not harm businesses. A comprehensive examination of smoke-free laws published in 2007 concluded that “the vast majority of scientific evidence indicates that there is no negative economic impact of clean indoor air policies, with many studies finding that there may be some positive effects on local businesses.”1

The creation of smoke-free establishments actually has many positive effects, while those places that allow smoking see negative consequences.


  • There is overwhelming scientific evidence that secondhand tobacco smoke is a direct cause of lung cancer, heart disease and lung and bronchial infections.2
  • Smoke-free laws can help smokers by giving them clear air to help them quit or at least cut back. Workers become healthier, and healthier workers miss less work, are more productive, and have lower health care costs. 3

Direct Costs

  • The American Cancer Society reports that employees who smoke have an average insured payment for health care of $1,145, while nonsmoking employees average $762.26. 4
  • Going smoke-free reduces cleaning and maintenance costs. The Building Owners and Managers Association, a national trade group, reports that indoor smoking increases cleaning costs and states “secondhand smoke does not belong in buildings.” 5
  • The National Fire Protection Association found that in 1998 smoking materials caused 8,700 fires in non-residential structures resulting in a direct property damage of $60.5 million. 6
  • Fire insurance is commonly reduced 25-30% in smoke-free businesses. 7
  • Smoke-free laws add value to establishments. Restaurants in smoke-free cities have a higher market value at resale (an average of 16% higher) than comparable restaurants located in smoke-filled cities. 8
  • In 2004, a Department of Health study found that the New York city's restaurants and bars prospered despite the smoking ban, demonstrating increases in liquor licenses, jobs, and business tax payments. The report stated that tax receipts increased 8.7 percent from April 1, 2003, to January 1, 2004, compared to the same period in 2002–2003. 9

Indirect Costs

  • The American Productivity Audit, a national survey of over 29,000 workers, found that tobacco use was a leading cause of worker lost production time—greater than alcohol abuse or family emergencies. Quitting smoking, or even just cutting back, improves a worker’s productivity. 10
  • Smokers, on average, miss 6.16 days of work per year due to sickness (including smoking related acute and chronic conditions), compared to nonsmokers, who miss 3.86 days of work per year. 11

Here is a list of some notable businesses that have already gone smoke-free:

AT&T - BASF Corporation - Bechtel - BF Goodrich Tire Manufacturing - Boeing - Bristol-Myers Squibb Calgon - Coca-Cola - Dow Chemical Company - Dunkin’ Donuts - Dupont Chemical Company - Eli Lilly and Company - Federal Express - General Mills - Hain Celestial Foods - The Home Depot, Inc. - IBM - Johnson & Johnson - Kennecott Mining - International Truck and Engine Corporation - Lowe’s Companies, Inc. - Marcal Paper Mills, Inc. - MCI Communications - Merck & Company - Nestle - Purina PetCare Company- Nike, Inc. - Proctor & Gamble - Prudential Financial - Scott Paper Company - Sharper Image - Starbucks - Subaru Auto Assembly Plant (Indiana) - Target Corporation - Texas Instruments, Inc. - Tyson Foods - Union Pacific - Verizon - Westin Hotels

Results of Smoke-free policies

  • Many health benefits have resulted from smoke-free policies. The Institute of Medicine released a report in October 2009 that included eleven separate studies. Each found smoking bans led to decreases in heart attacks ranging from six to forty-seven percent.
  • The American Heart Association studied and compared both North American and European communities that implemented smoke-free laws to those that did not. They found that seventeen percent fewer heart attacks occurred in communities with laws compared to communities without smoking bans within just one year of implementing smoke-free policies.
  • Studies show that support for smoke-free policies increases among both smokers and nonsmoker after they are implemented. After New York implemented a statewide smoke-free policy, support rose from 25% to 37% among smokers and from 74% to 86% among nonsmokers within the first two years. 14

See also




1Eriksen, M. and Chaloupka, F., The Economic Impact of Clean Indoor Air Laws, CA: A Cancer Journal For Clinicians, 2007; 57:367-378.

2Campaign for Tobacco-Free Kids. "Smoke-Free Laws Do Not Harm Business at Restaurants and Bars". . Accessed November 10, 2010.

3Centers for Disease Control and Prevention. Save Lives, Save Money: Make Your Business Smoke-Free. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, June 2006. Save Lives, Save Money: Make Your Business Smoke-Free

4"The Cost of Smoking to Business" American Cancer Society. Download at

5Building Owners and Managers Association. Smoking Position Paper. Washington, DC: Building Owners and Managers Association [no date].

6Hall, Jr., J.R., "The U.S. Smoking-Material Fire Problem," National Fire Protection Association, Fire Analysis and Research Division, April 2001.

7"Health Now! and the business community,"

8Taylor, A. E., Johnson, D. C., & Kazemi, H. (1992). Environmental tobacco smoke and cardiovascular disease: A position paper from the council of cardiopulmonary and critical care, American Health Association. Circulation, 86, 699-702.

9New York City Department of Health and Mental Hygiene (2003). Initial effects of New York City smoking ordinance, from

10Stewart, WF, Ricci, JA, Chee, E, Morganstein, D. Lost productivity work time costs from health conditions in the United States: Results from the American Productivity Audit. Journal of Occupational and Environmental Medicine 2003;45(12):1234-1246.

11Halpern, M.T.; Shikiar, R.; Rentz, A.M.; Khan, Z.M., "Impact of smoking status on workplace absenteeism and productivity," Tobacco Control 10(3): 233-238, September 2001.

12Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence (Report Brief). October 2009. Retrieved from [1]

13American Heart Association. Heart attack rates drop after smoking bans, continue downward over time. National Cancer Institute and American Heart Association. 21 September 2009. Retrieved from [2]

14Centers for Disease Control and Prevention. (2011, March 11). Smoke-free policies improve health. Retrieved from