Boston, MA – Secondhand tobacco smoke (SHS) can have harmful effects on children. Some of the adverse health outcomes include a greater likelihood of ear infections, lower respiratory infections, sudden infant death syndrome and severity of asthma symptoms. It is estimated that 35% to 45% of children are regularly exposed to SHS from adults using tobacco in homes and cars. To date, there has been little research on SHS in cars.

In the first study to measure SHS in cars in real driving conditions, Harvard School of Public Health (HSPH) researchers have shown that smoking in cars can produce unsafe levels of SHS. Even with the driver’s window slightly open, mean respirable suspended particles (RSP) concentrations hit levels rated “hazardous” by the U.S. Environmental Protection Agency (EPA). In the study, concentrations of 272 µg/m3 were measured, with a peak level of 505 µg/m3. In comparison, the EPA’s air quality index rates concentrations of more than 40 µg/m3 as “unhealthy for sensitive groups,” such as children and the elderly, and more than 250 µg/m3 as “hazardous” for the general population. The results showed that smoking a single cigarette for just five minutes could produce potentially harmful RSP levels. Given the levels the researchers observed, SHS in cars poses a potentially serious threat to children’s health.

The authors hope that their findings will encourage renewed efforts to promote smoke-free environments for children both in cars and homes. The study will be published in the November 2006 issue of the American Journal of Preventive Medicine and is available online now at http://www.ajpm-online.net/webfiles/images/journals/amepre/1751.pdf.

SHS is associated with adverse effects in adults as well, including cancers, cardiovascular disease and reproductive and respiratory problems. However, SHS may have more harmful effects on children because their immune systems are less mature and, due to smaller airways and greater demand for oxygen, they may be more vulnerable to respiratory diseases.

The researchers, Vaughan Rees, research associate, and Gregory Connolly, professor of the practice of public health, both in HSPH’s Division of Public Health Practice, recruited volunteers to smoke while driving vehicles in Boston city traffic. In 45 driving trials, which averaged about an hour, SHS measurements were taken using devices that could detect and measure respirable suspended particles (RSPs) of less than 2.5 microns in diameter and carbon monoxide (CO), a poisonous gas. RSPs, which are found in tobacco smoke, are small enough to be inhaled and can transport carcinogens and other toxic substances deep into the lungs. Respiratory illnesses like bronchitis, emphysema, and asthma are linked to exposure to RSPs. The measurement devices were positioned in an empty child restrainer seat at simulated head level. Measurements were obtained under two different ventilation conditions: all car windows rolled down, then with just the driver’s side window cracked about two inches.

“The smoke particle levels we measured are alarming and are above the threshold for what’s considered unhealthy for sensitive groups — people like children and the elderly,” said lead study author Rees. “Adults who smoke while driving their children may be harming them more than they realize.”

Driving under closed-windows conditions generated the highest RSP and CO levels. But the levels of contaminants during open-windows conditions, though significantly less than when the windows were closed, were still unsafe. “There is an argument that even exposure for very short periods of time, perhaps even 10 seconds, can precipitate asthmatic episodes in children,” Rees said. He added that ventilation won’t likely overcome secondhand smoke pollution that sticks to surfaces.

“Toxic particles from secondhand smoke can settle on furniture or on floors, and we are assuming that will also occur in cars on child-restraint seats. Children tend to touch things with their hands, and put their hands in their mouths. So children can also be exposed to contaminants in that way,” Rees said.

Arkansas and Louisiana have recently banned smoking in cars with young children as passengers. Similar legislation has also been introduced, but not passed, in California, Georgia, Michigan, New Jersey, New York, Pennsylvania and Vermont. Although concerns have been raised about government intrusion on personal privacy, supporters of smoking bans note that SHS is dangerous to children’s health and that the use of safety devices such as seat belts and infant car seats are already widely legislated.

“We know from previous research that smoking indoors can produce dangerous levels of toxic contaminants,” said Reese. “This research has shown that smoking in cars, even with the windows open, can produce smoke pollution that compares with smoky bars or restaurants. Unlike adults, children cannot advocate for smoke-free spaces and are sometimes physically restrained in very smoky cars. We think that policymakers and health advocates should pay close attention to these findings in order to promote smoke-free domestic environments for children.”

The authors acknowledge the support of the Flight Attendant Medical Research Institute, which provided funding under a Distinguished Professorship awarded to Gregory Connolly.

For further information, contact:
Todd Datz
617.432.3952
tdatz@hsph.harvard.edu

Of all the compelling reasons to quit smoking, this one should make pet lovers sit up and take notice: there's ample scientific evidence to suggest that secondhand cigarette smoke can cause cancer in companion animals.

And your furry friends don't just inhale smoke; the smoke particles are also trapped in their fur and ingested when they groom themselves with their tongues. A study published in the American Journal of Epidemiology found that dogs in smoking households had a 60 percent greater risk of lung cancer; a different study published in the same journal showed that long-nosed dogs, such as collies or greyhounds, were twice as likely to develop nasal cancer if they lived with smokers.

And in yet another study, vets from Tufts University found that cats whose owners smoked were three times as likely to develop lymphoma, the most common feline cancer.

So - short of kicking the habit - Garnant and her husband take three of the cats to the vet at least twice a year for checkups; the fourth, Barney, goes every three months.

Secondhand smoke is a mixture of the smoke given off by the burning end of a cigarette, pipe or cigar and the smoke exhaled from the lungs of smokers. Secondhand smoke contains more than 250 chemicals known to be toxic or cancer causing, including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide.1

Infants and young children are especially susceptible: their lungs are still developing and childhood exposure to secondhand smoke results in decreased lung function.2 Children who breathe secondhand smoke are more likely to suffer from cough, wheeze, phlegm and breathlessness.3

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.4

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.5

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.6 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 2000.7

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.8

Secondhand smoke exposure causes buildup of fluid in the middle ear, resulting in 790,000 physician office visits.9 Middle ear infections are the most common cause of childhood operations and of childhood hearing loss.10

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.11

Babies whose mothers smoke while pregnant or who are exposed to secondhand smoke after birth have weaker lungs than other babies, which increases the risk of many other health problems.12

Sources:

The Health Consequences of Involuntary Exposure to Tobacco Smoke: Children are Hurt by Secondhand Smoke. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet2.html. Accessed on January 16, 2008.
Ibid.
Ibid.
California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. June 2005.
The Health Consequences of Involuntary Exposure to Tobacco Smoke: Children are Hurt by Secondhand Smoke. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet2.html. Accessed on January 16, 2008.
Centers for Disease Control and Prevention, Youth Tobacco Surveillance, U.S., 2002. MMWR, 55(SS03), May 2006.
The Health Consequences of Involuntary Exposure to Tobacco Smoke: Children are Hurt by Secondhand Smoke. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet2.html. Accessed on January 16, 2008.
California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. June 2005.
Ibid.
Ibid.
Ibid.
The Health Consequences of Involuntary Exposure to Tobacco Smoke: Children are Hurt by Secondhand Smoke. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet2.html. Accessed on January 16, 2008.

ScienceDaily (May 5, 2008) — Exposure to secondhand smoke even for a brief period is injurious to health, a new study by researchers at the University of California, San Francisco has found.

According to the study, a 30-minute exposure to the level of secondhand smoke that one might normally inhale in an average bar setting was enough to result in blood vessel injury in young and otherwise healthy lifelong nonsmokers. Compounding the injury to the blood vessels themselves, the exposure to smoke impedes the function of the body's natural repair mechanisms that are activated in the face of the blood vessels' injury, the researchers report. Many of these effects persisted 24 hours later.

Study findings are reported in the online edition of the "Journal of the American College of Cardiology," and will appear in the Journal's May 6 print issue.

The results showed that brief exposure to real-world levels of passive smoke have strong and persistent consequences on the body's vascular system, the researchers conclude.

For the study, subjects were exposed to carefully controlled levels of secondhand smoke in a research setting. The smoke was equivalent to being in a bar where smoking is allowed--as it still is for 51 percent of the US population and in other countries, such as Germany--for 30 minutes. As a control, the same subjects were exposed to clean air on a different day.

In both settings, the researchers evaluated the subjects' blood vessel health through ultrasound to measure blood flow and analysis of blood samples. In the exposure environment, this was done before exposure to establish baseline measures, immediately after exposure, and then 1 hour, 2.5 hours, and 24 hours after exposure. The study involved 10 young adult subjects between the ages of 29 and 31.

The study is the first of its kind to link injury to blood vessels with the decreased efficacy of the body's own repair mechanism, namely the endothelial progenitor cells (EPCs). EPCs are circulating stem cells in the blood that play a key role in the repair mechanism of injured blood vessels.

The researchers examined three effects of secondhand smoke exposure:

the effect of smoke on the mechanical function of blood vessels whether they could detect particles in the blood that are known to be increased in the blood due to blood vessel injury
whether there was any effect on the stem cells (EPCs) that comprise the body's blood vessel repair mechanisms

"We wanted to study whether even a brief 30 minutes of exposure to second hand smoke in otherwise healthy subjects would result in blood vessel injury and how the body's own repair mechanisms--the EPCs--would be affected by such an exposure," says Yerem Yeghiazarians, MD, director of the Translational Cardiac Stem Cell Program at UCSF.

The secondhand smoke's effect on all measures was profound, he says. "Even brief secondhand smoke exposure not only resulted in blood vessel injury, but it also interfered with the body's ability to repair itself by making the EPCs dysfunctional. It is quite amazing that only 30 minutes of exposure could cause such demonstrable effects." The study also showed that the deleterious effects of the exposure remain in the body for at least 24 hours, much longer than previously thought.

Study results showed that smoke exposure made EPCs less functional. "So it's a double hit: not only does a person develop blood vessel injury, but the cells that are supposed to help repair this damage are themselves also dysfunctional, compounding the injury," he says.

The public health implications of the study findings are significant, according to Yeghiazarians. "Our study helps explain why there is about a 20 percent drop in hospital admissions for heart attacks when cities and states pass laws mandating smokefree workplaces, restaurants and bars."

The study suggests that there is no safe level of exposure to secondhand smoke.

The study was supported by awards from the Flight Attendant Medical Research Institute, the American Heart Association, the Wayne and Gladys Valley Foundation, and the UCSF Cardiac Stem Cell Foundation. In addition to Yeghiazarians, other lead investigators on the study are Christian Heiss, MD, and Nicolas Amabile, MD, who contributed to the work as fellows in the Division of Cardiology, Department of Medicine, at UCSF.

Other investigators in the study are Andrew C. Lee, MD; Wendy May Real, BS; Suzaynn F. Schick, PhD; David Lao, MD; Maelene L. Wong, BS; Sarah Jahn, MB; Franca S. Angeli, MD; Petros Minasi, BA; Matthew L. Springer, PhD; Stanton Glantz, PhD, FACC; William Grossman, MD, FACC; and John Balmes, MD, FACC; all of the Department of Medicine at UCSF. S. Katharine Hammond, PhD, of the Division of Environmental Health Sciences, School of Public Health, UC Berkeley, also contributed to the study.
Adapted from materials provided by University of California - San Francisco.

Q: What one easy step can a community take to instantly improve its health and economic well-being?

A: Go 100% smokefree indoors of course!

Advocates and policymakers are curious to gauge and prove to nay-sayers how smokefee laws benefit a community. Science demonstrates that brief exposure(30minutes) to secondhand smoke can cause an individual to go into cardiac arrest, whether they actively smoke or not. Because of secondhand smoke's unique and immediate effects on the heart, scientists can determine how much a smokefree law improves heart health.

A number of communities, states, and nations are quantifying heart health improvements just one year after the smoke clears. The results are clear: Smokefree Laws reduce heart attacks, which results in increased health cost savings. Let the facts speak for themselves!

Helena, MT: 40% decrease in heart attacks (2004)
Bowling Green, OH: 39% decrease in heart attacks after one year and 47% decrease in heart attacks three years after the smokefree law went into effect (2007)
Pueblo, CO: 27% decrease in heart attacks (2006)
NY: 8% decrease in heart attacks (3,813 people), $56 million increase in direct health cost savings (2007)
Scotland: 17% decrease in heat attacks (2007)
Ireland: 14% decrease in heart attacks (32,000 people) (2007)

Remember, the U.S. Centers for Disease Control and Prevention warns: If you are at risk of heart disease (e.g., there is a history of heat disease in your family), avoid exposure to secondhand smoke due to its immediate effect on the heart.

Volume 26, Number 4 Winter 2007 Newsletter

Americans for Nonsmokers' Rights American Nonsmokers' Rights Foundation ©2008

As the body of scientific evidence becomes larger and more precise, it is now possible to prove that smoke-free policies not only work to protect nonsmokers from the death and disease caused by exposure to secondhand smoke, but also have an immediate effect on the public's health . On a larger scale, a study has confirmed that restaurants and bars located in smoke- free cities have 82% less indoor air pollution than restaurants and bars in cities that do not have smoke-free protection. Because of the mountain of evidence from these peer-reviewed, scientific studies, the Centers for Disease Control recently issued a warning for anyone at risk for heart disease to avoid smoke-filled indoor environments completely.

Secondhand smoke kills. Knowing the science behind it, as well as how smoke-free policies protect the public from secondhand smoke will help cement this in the minds of the public.

(Article taken from AMERICANS for NONSMOKERS’ RIGHTS
web-page (www.no-smoke.org) Getting the Facts – Secondhand
Smoke on 08-29-07)