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Monday, November 11, 2019

History of tobacco

From Wikipedia, the free encyclopedia
 
Tobacco has a long history from its usages in the early Americas. It increased in popularity with the arrival of Spain to America, which introduced tobacco to the Europeans by whom it was heavily traded. Following the industrial revolution, cigarettes were becoming popularized in the New World as well as Europe, which fostered yet another unparalleled increase in growth. This remained so until scientific studies in mid 20th century demonstrated the negative health effects of tobacco smoking including lung and throat cancer.

Early history

Tobacco was first discovered by the native people of Mesoamerica and South America and later introduced to Europe and the rest of the world.

Tobacco had already long been used in the Americas by the time European settlers arrived and took the practice to Europe, where it became popular. Eastern North American tribes have historically carried tobacco in pouches as a readily accepted trade item, as well as smoking it in pipe ceremonies, whether for sacred ceremonies or those to seal a treaty or agreement. Tobacco is considered a gift from the Creator, and tobacco smoke is seen as carrying one's thoughts and prayers to the spirits.

In addition to its use in spiritual ceremonies, tobacco is also used in ethnobotany for medical treatment of physical conditions. As a pain killer it has been used for earache and toothache and occasionally as a poultice. Some indigenous peoples in California have used tobacco as one ingredient in smoking mixtures for treating colds; usually it is mixed with the leaves of the small desert sage, Salvia dorrii, or the root of Indian balsam or cough root, Leptotaenia multifida (the addition of which was thought to be particularly good for asthma and tuberculosis). In addition to its traditional medicinal uses, tobacco was also used as a form of currency between Native Americans and Colonists from the 1620s on.

Religious use of tobacco is still common among many indigenous peoples, particularly in the Americas. Among the Cree and Ojibwe of Canada and the north-central United States, it is offered to the Creator, with prayers, and is used in sweat lodges, pipe ceremonies, and is presented as a gift. A gift of tobacco is traditional when asking an Ojibwe elder a question of a spiritual nature.

European usage

The earliest image of a man smoking a pipe, from Tabaco by Anthony Chute.
 
Of the four plants of the Americas that spread to the rest of the world in the Columbian Exchange—potato, maize, tomato, and tobacco—the last is the only one used in every country. Greek and Roman accounts exist of smoking hemp seeds, and a Spanish poem c. 1276 mentions the energetic effects of lavender smoke, but tobacco was completely unfamiliar to Europeans before the discovery of the New World. Las Casas vividly described how the first scouts sent by Columbus into the interior of Cuba found
men with half-burned wood in their hands and certain herbs to take their smokes, which are some dry herbs put in a certain leaf, also dry, like those the boys make on the day of the Passover of the Holy Ghost; and having lighted one part of it, by the other they suck, absorb, or receive that smoke inside with the breath, by which they become benumbed and almost drunk, and so it is said they do not feel fatigue. These, muskets as we will call them, they call tabacos. I knew Spaniards on this island of Española who were accustomed to take it, and being reprimanded for it, by telling them it was a vice, they replied they were unable to cease using it. I do not know what relish or benefit they found in it.
Following the arrival of Europeans, tobacco became one of the primary products fueling colonization, and also became a driving factor in the incorporation of African slave labor. The Spanish introduced tobacco to Europeans in about 1528, and by 1533, Diego Columbus mentioned a tobacco merchant of Lisbon in his will, showing how quickly the traffic had sprung up. Jean Nicot, French ambassador in Lisbon, sent samples to Paris in 1559. The French, Spanish, and Portuguese initially referred to the plant as the "sacred herb" because of its valuable medicinal properties.

Nicot sent leaves and seeds to Francis II and his mother Catherine of Medici, with instructions to use tobacco as snuff. The king's recurring headaches (perhaps sinus trouble) were reportedly "marvellously cured" by snuff (Francis II nevertheless died at seventeen years of age on December 5, 1560, after a reign lasting less than two years). French cultivation of herbe de la Reine (the queen's herb) began in 1560. By 1570 botanists referred to tobacco as Nicotiana, although André Thevet claimed that he, not Nicot, had introduced tobacco to France; historians believe that this is unlikely to be true, but Thevet was the first Frenchman to write about it.

Swiss doctor Conrad Gesner in 1563 reported that chewing or smoking a tobacco leaf "has a wonderful power of producing a kind of peaceful drunkenness". In 1571, Spanish doctor Nicolas Monardes wrote a book about the history of medicinal plants of the new world. In this he claimed that tobacco could cure 36 health problems, and reported that the plant was first brought to Spain for its flowers, but "Now we use it to a greater extent for the sake of its virtues than for its beauty".

Sir Walter Raleigh introduced "Virginia tobacco into England. "Raleigh's First Pipe in England", included in Frederick William Fairholt's Tobacco, its history and associations.
 
John Hawkins was the first to bring tobacco seeds to England. William Harrison's English Chronology mentions tobacco smoking in the country as of 1573, before Sir Walter Raleigh brought the first "Virginia" tobacco to Europe from the Roanoke Colony, referring to it as tobah as early as 1578. In 1595 Anthony Chute published Tabaco, which repeated earlier arguments about the benefits of the plant and emphasised the health-giving properties of pipe-smoking.

The importation of tobacco into England was not without resistance and controversy. Stuart King James I wrote a famous polemic titled A Counterblaste to Tobacco in 1604, in which the king denounced tobacco use as "[a] custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomelesse." That year, an English statute was enacted that placed a heavy protective tariff on tobacco imports. The duty rose from 2p per pound to 6s 10p, an increase of 4,000%, but English demand remained strong despite the high price; Barnabee Rych reported that 7,000 stores in London sold tobacco and calculated that at least 319,375 pounds sterling were spent on tobacco annually. Because the Virginia and Bermuda colonies' economies were affected by the high duty, James in 1624 instead created a royal monopoly. No tobacco could be imported except from Virginia, and a royal license that cost 15 pounds per year was required to sell it. To help the colonies Charles II banned tobacco cultivation in England, but allowed herb gardens because doctors said it had medicinal purposes.

Tobacco was introduced elsewhere in continental Europe more easily. Iberia exported "ropes" of dry leaves in baskets to the Netherlands and southern Germany; for a while tobacco was in Spanish called canaster after the word for basket, canastro, and influenced the German Knaster. In Italy, Prospero Santacroce in 1561 and Nicolo Torbabuoni in 1570 introduced it to gardens after seeing the plant on diplomatic missions. Cardinal Crescenzio introduced smoking to the country in about 1610 after learning about it in England. The Roman Catholic Church did not condemn tobacco as James I did, but Pope Urban VIII threatened excommunication to anyone smoking in a church.

In Russia, tobacco use was banned in 1634 except for foreigners in Moscow. Peter the Great—who in England had learned of smoking and the royal monopoly—became the monarch in 1689, however. Revoking all bans, he licensed an English company to import 1.5 million pounds of tobacco per year, the monarchy receiving 28,000 pounds sterling annually.

Asia

The Japanese were introduced to tobacco by Portuguese sailors from 1542.

Tobacco first arrived in the Ottoman Empire in the late 16th century, where it attracted the attention of doctors and became a commonly prescribed medicine for many ailments. Although tobacco was initially prescribed as medicine, further study led to claims that smoking caused dizziness, fatigue, dulling of the senses, and a foul taste/odour in the mouth.

A tobacco plantation in Queensland, in 1933.
 
Sultan Murad IV banned smoking in the Ottoman Empire in 1633. When the ban was lifted by his successor, Ibrahim the Mad, it was instead taxed. In 1682, Damascene jurist Abd al-Ghani al-Nabulsi declared: "Tobacco has now become extremely famous in all the countries of Islam ... People of all kinds have used it and devoted themselves to it ... I have even seen young children of about five years applying themselves to it." In 1750, a Damascene townsmen observed "a number of women greater than the men, sitting along the bank of the Barada River. They were eating and drinking, and drinking coffee and smoking tobacco just as the men were doing."

Australia

Although Nicotiana suaveolens is native to Australia, tobacco smoking first reached that continent shores when it was introduced to northern-dwelling Indigenous communities by visiting Indonesian fishermen in the early 18th century. British patterns of tobacco use were transported to Australia along with the new settlers in 1788; and in the years following colonisation, British smoking behaviour was rapidly adopted by Indigenous people as well. By the early 19th century tobacco was an essential commodity routinely issued to servants, prisoners and ticket-of-leave men (conditionally released convicts) as an inducement to work, or conversely, withheld as a means of punishment.

United States

Economic history in the American colonies

In the Eastern United States, gold and silver were scarce, which made it harder for colonists to trade with Native Americans. The cultivation of tobacco in the Chesapeake area was essential to solving this problem. Without silver and gold to trade to the Chesapeake tribes, colonists traded tobacco for essential natural resources. This started in the 1620s. Tobacco was also used as a currency in the colonies, used for paying fines, taxes, and even marriage licenses.

The increasing demand for tobacco in Europe fueled the slave trade. In the colonies land was at a premium because tobacco required lots of land to cultivate. This created a problem for the institutionalized practice of indentured servitude. Indentured servants were promised land of various amounts in their contracts. This land became harder to part with due to tobacco.

The uncultivated Virginia soil was reportedly too rich for traditional European crops, especially cereals like barley. Tobacco "broke down the fields and made food crops more productive" by depleting the soil of nutrients.

With the profitability of the land rapidly increasing, it was no longer was economically viable to bring in indentured servants because they were promised physical benefits at the end of their tenure. What the plantation owners wanted was workers who could legally not be paid and would be able to work long hours in the hot sun. Their conclusion was to turn to another institutionalized practice: slavery. The demand and profitability of tobacco led to the shift in the colonies to a slave-based labor force. Tobacco is a labor-intensive crop, requiring lots of work for its cultivation, harvest, and curing. These tasks were carried out during the colonial period by slaves.

Tobacco's impact on early American history

The cultivation of tobacco in America led to many changes. During the 1700s tobacco was a very lucrative crop due to its high demand in Europe. The climate of the Chesapeake area in America lent itself very nicely to the cultivation of tobacco. The high European demand for tobacco led to a rise in the value of tobacco. The rise of value of tobacco accelerated the economic growth in America. The cultivation of tobacco as a cash crop in America marks the shift from a subsistence economy to an agrarian economy. Tobacco’s desirability and value led to it being used as a currency in colonies. Tobacco was also backed by the gold standard which meant that there was an established conversion rate from tobacco to gold.

The increasing role of tobacco as a cash crop led to a shift in the labor force that would shape American life and politics up through the Civil war. In order to keep up with demand tobacco plantation owners had to abandon the traditional practice of indentured servitude in the Americas. In order to pursue maximum profits, the plantation owners turned to slavery to supply them with the cheap, fungible labor that they needed to keep up with increasing production.

Early cultivation of tobacco

In the first few years of tobacco cultivation in the colonies, the plants were simply covered with hay and left in the field to cure or "sweat." This method was abandoned after 1618, when regulations prohibited the use of valuable potential animal food for such purposes. It was also abandoned because a better method of curing tobacco had been developed. In this new method the wilted leaves were hung on lines or sticks, at first outside on fence rails. Tobacco barns for housing the crop were in use by the 1620s.

During the curing period, which lasted about four to six weeks, the color of the tobacco changed from a greenish yellow to a light tan. Mold was an immense danger during this time. Once again, a planter relied on his experience to know when the tobacco was ready to be removed from the sticks on which it hung, a process known as "striking."

At last, when the tobacco was ready, and preferably during a period of damp weather, workers struck the tobacco and laid the leaves on the floor of the tobacco barn to sweat for somewhere between a week or two. Logs could be used to press the tobacco and increase its temperature, but with that there came a danger. The heat might become too intense and mold spoil the crop.

After sweating, the next step was sorting. Ideally, all the tobacco should be in a condition described by cropmasters as "in case". This meant that the tobacco had absorbed just the right amount of moisture; it could be stretched like leather, and was glossy and moist. If tobacco were too damp, it would rot in transit; if too dry, it would crumble and be unsalable.

In the early years at Jamestown the settlers paid little heed to quality control, this attitude soon changed due to both the market and to regulations. Over time, the settlers began to separate the tobacco into sections of equal quality. The leaves were then tied together in Hands, bunches of five to fourteen. The Hands were returned to platforms to sweat. When they were once again "in case", the inspection of the crop could take place and the final processing for export begin.

Early on, the preparation of tobacco for shipping was very simple. The tobacco leaves were twisted and rolled, then spun into rope, which was wound into balls weighing as much as a hundred pounds ( 45 kilograms ). These balls were protected in canvas or barrels, which would then be shipped to Britain. Although the export of bulk tobacco was not outlawed until 1730, a large barrel called a "hogshead" soon became the favored container throughout the colonial period. Even though its capacity varied slightly, governed by the regulations of the day, the average weight of the tobacco stored in a hogshead barrel was about a thousand pounds ( 450 kilograms ).

These barrels were transported in a variety of ways to the ships on which they would be carried to England. At first, captains of merchant vessels simply traveled from one plantation dock to the next, loading up with barrels of tobacco as they moved along the river. Other ways included employing northern smugglers to ferry tobacco to England.

Plantations in the American South

This 1670 painting shows enslaved Africans working in the tobacco sheds of a colonial tobacco plantation.
 
In 1609, English colonist John Rolfe arrived at Jamestown, Virginia, and became the first settler to successfully raise tobacco (commonly referred to at that time as "brown gold") for commercial use. Tobacco was used as currency by the Virginia settlers for years, and Rolfe was able to make his fortune in farming it for export at Varina Farms Plantation.

When he left for England with his wife Pocahontas, a daughter of Chief Powhatan, he had become wealthy. Returning to Jamestown, following Pocahontas' death in England, Rolfe continued in his efforts to improve the quality of commercial tobacco, and, by 1620, 40,000 pounds (18,000 kg) of tobacco were shipped to England. By the time John Rolfe died in 1622, Jamestown was thriving as a producer of tobacco, and its population had topped 4,000. Tobacco led to the importation of the colony's first black slaves in 1619.

Throughout the 17th and 18th centuries, tobacco continued to be the cash crop of the Virginia Colony, as well as The Carolinas. Large tobacco warehouses filled the areas near the wharves of new, thriving towns such as Dumfries on the Potomac, Richmond and Manchester at the Fall Line (head of navigation) on the James, and Petersburg on the Appomattox.

There were also tobacco plantations in Tennessee, like Wessyngton in Cedar Hill, Tennessee.

Modern history

A historian of the American South in the late 1860s reported on typical usage in the region where it was grown:
The chewing of tobacco was well-nigh universal. This habit had been widespread among the agricultural population of America both North and South before the war. Soldiers had found the quid a solace in the field and continued to revolve it in their mouths upon returning to their homes. Out of doors where his life was principally led the chewer spat upon his lands without offence to other men, and his homes and public buildings were supplied with spittoons. Brown and yellow parabolas were projected to right and left toward these receivers, but very often without the careful aim which made for clean living. Even the pews of fashionable churches were likely to contain these familiar conveniences. The large numbers of Southern men, and these were of the better class (officers in the Confederate army and planters, worth $20,000 or more, and barred from general amnesty) who presented themselves for the pardon of President Johnson, while they sat awaiting his pleasure in the ante-room at the White House, covered its floor with pools and rivulets of their spittle. An observant traveller in the South in 1865 said that in his belief seven-tenths of all persons above the age of twelve years, both male and female, used tobacco in some form. Women could be seen at the doors of their cabins in their bare feet, in their dirty one-piece cotton garments, their chairs tipped back, smoking pipes made of corn cobs into which were fitted reed stems or goose quills. Boys of eight or nine years of age and half-grown girls smoked. Women and girls "dipped" in their houses, on their porches, in the public parlors of hotels and in the streets.
Until 1883, tobacco excise tax accounted for one third of internal revenue collected by the United States government. Internal Revenue Service data for 1879-80 show total tobacco tax receipts of $38.9 million, out of total receipts of $116.8 million. Following the American Civil War, the tobacco industry struggled as it attempted to adapt. Not only did the labor force change from slavery to sharecropping, but a change in demand also occurred. As in Europe, there was a desire for not only snuff, pipes and cigars, but cigarettes as well. 

With a change in demand and a change in labor force, James Bonsack, an avid craftsman, in 1881 created a machine that revolutionized cigarette production. The machine chopped the tobacco, then dropped a certain amount of the tobacco into a long tube of paper, which the machine would then roll and push out the end where it would be sliced by the machine into individual cigarettes. This machine operated at thirteen times the speed of a human cigarette roller.

This caused an enormous growth in the tobacco industry that lasted well into the 20th century, until the scientific revelations discovering health consequences of smoking and tobacco companies' usage of chemical additives was revealed. 

In the United States, The Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) became law in 2009. It gave the Food and Drug Administration (FDA) the authority to regulate the manufacture, distribution, and marketing of tobacco products to protect public health.

Health concerns

A lengthy study conducted in order to establish the strong association necessary for legislative action.
 
Nazi Germany saw the first modern anti-smoking campaign, the National Socialist government condemning tobacco use, funding research against it, levying increasing sin taxes on it, and in 1941 banning tobacco in various public places as a health hazard. 

In the UK and the USA, an increase in lung cancer rates was being picked up by the 1930s, but the cause for this increase remained debated and unclear.

A true breakthrough came in 1948, when the British physiologist Richard Doll published the first major studies that proved that smoking could cause serious health damage. In 1950, he published research in the British Medical Journal that showed a close link between smoking and lung cancer. Four years later, in 1954 the British Doctors Study, a study of some 40 thousand doctors over 20 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related. The British Doctors Study lasted till 2001, with result published every ten years and final results published in 2004 by Doll and Richard Peto. Much early research was also done by Dr. Ochsner. Reader's Digest magazine for many years published frequent anti-smoking articles. 

In 1964 the United States Surgeon General's Report on Smoking and Health likewise began suggesting the relationship between smoking and cancer, which confirmed its suggestions 20 years later in the 1980s.

Partial controls and regulatory measures eventually followed in much of the developed world, including partial advertising bans, minimum age of sale requirements, and basic health warnings on tobacco packaging. However, smoking prevalence and associated ill health continued to rise in the developed world in the first three decades following Richard Doll's discovery, with governments sometimes reluctant to curtail a habit seen as popular as a result - and increasingly organised disinformation efforts by the tobacco industry and their proxies (covered in more detail below). Realisation dawned gradually that the health effects of smoking and tobacco use were susceptible only to a multi-pronged policy response which combined positive health messages with medical assistance to cease tobacco use and effective marketing restrictions, as initially indicated in a 1962 overview by the British Royal College of Physicians and the 1964 report of the U.S. Surgeon General

In the 1950s tobacco companies engaged in a cigarette advertising war surrounding the tar content in cigarettes that came to be known as the tar derby. The companies repositioned their brands to emphasize low tar content, filter technology and nicotine levels. The period ended in 1959 after the Federal Trade Commission (FTC) Chairman and several cigarette company presidents agreed to discontinue usage of tar or nicotine levels in advertisements.

In order to reduce the potential burden of disease, the World Health Organization(WHO) successfully rallied 168 countries to sign the Framework Convention on Tobacco Control in 2003. The Convention is designed to push for effective legislation and its enforcement in all countries to reduce the harmful effects of tobacco.

In science

The tobacco smoke enema was the principal medical method to resuscitate victims of drowning in the 18th century.

As a lucrative crop, tobacco has been the subject of a great deal of biological and genetic research. The economic impact of Tobacco Mosaic disease was the impetus that led to the isolation of Tobacco mosaic virus, the first virus to be identified; the fortunate coincidence that it is one of the simplest viruses and can self-assemble from purified nucleic acid and protein led, in turn, to the rapid advancement of the field of virology. The 1946 Nobel Prize in Chemistry was shared by Wendell Meredith Stanley for his 1935 work crystallizing the virus and showing that it remains active.

Passive smoking

From Wikipedia, the free encyclopedia

Tobacco smoke in an Irish pub before a smoking ban came into effect on March 29, 2004
 
Passive smoking is the inhalation of smoke, called secondhand smoke (SHS), or environmental tobacco smoke (ETS), by persons other than the intended "active" smoker. It occurs when tobacco smoke enters an environment, causing its inhalation by people within that environment. Exposure to secondhand tobacco smoke causes disease, disability, and death. The health risks of secondhand smoke are a matter of scientific consensus. These risks have been a major motivation for smoke-free laws in workplaces and indoor public places, including restaurants, bars and night clubs, as well as some open public spaces.

Concerns around secondhand smoke have played a central role in the debate over the harms and regulation of tobacco products. Since the early 1970s, the tobacco industry has viewed public concern over secondhand smoke as a serious threat to its business interests. Harm to bystanders was perceived as a motivator for stricter regulation of tobacco products. Despite the industry's awareness of the harms of secondhand smoke as early as the 1980s, the tobacco industry coordinated a scientific controversy with the purpose of stopping regulation of their products.

Effects

secondhand smoke causes many of the same diseases as direct smoking, including cardiovascular diseases, lung cancer, and respiratory diseases. These diseases include:
  • Cancer:
    • General: overall increased risk; reviewing the evidence accumulated on a worldwide basis, the International Agency for Research on Cancer concluded in 2004 that "Involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) is carcinogenic to humans."
    • Lung cancer: passive smoking is a risk factor for lung cancer. In the United States passive smoke is estimated to cause more than 7,000 deaths from lung cancer a year among non-smokers.
    • Breast cancer: The California Environmental Protection Agency concluded in 2005 that passive smoking increases the risk of breast cancer in younger, primarily premenopausal females by 70% and the US Surgeon General has concluded that the evidence is "suggestive," but still insufficient to assert such a causal relationship. In contrast, the International Agency for Research on Cancer concluded in 2004 that there was "no support for a causal relation between involuntary exposure to tobacco smoke and breast cancer in never-smokers." A 2015 meta-analysis found that the evidence that passive smoking moderately increased the risk of breast cancer had become "more substantial than a few years ago."
    • Pancreatic cancer: A 2012 meta-analysis found no evidence that passive smoking was associated with an increased risk of pancreatic cancer.
    • Cervical cancer: A 2015 overview of systematic reviews found that exposure to secondhand smoke increased the risk of cervical cancer.
    • Bladder cancer: A 2016 systematic review and meta-analysis found that secondhand smoke exposure was associated with a significant increase in the risk of bladder cancer.
  • Circulatory system: risk of heart disease, reduced heart rate variability.
    • Epidemiological studies have shown that both active and passive cigarette smoking increase the risk of atherosclerosis.
    • Passive smoking is strongly associated with an increased risk of stroke, and this increased risk is disproportionately high at low levels of exposure.
  • Lung problems:
    • Risk of asthma.
    • Risk of chronic obstructive pulmonary disease (COPD)
    • According to a 2015 review, passive smoking may increase the risk of tuberculosis infection and accelerate the progression of the disease, but the evidence remains weak.
    • The majority of studies on the association between secondhand smoke exposure and sinusitis have found a significant association between the two.
  • Cognitive impairment and dementia: Exposure to secondhand smoke may increase the risk of cognitive impairment and dementia in adults 50 and over. Children exposed to secondhand smoke show reduced vocabulary and reasoning skills when compared with non-exposed children as well as more general cognitive and intellectual deficits.
  • Mental health: Exposure to secondhand smoke is associated with an increased risk of depressive symptoms.
  • During pregnancy:
    • Low birth weight
    • Premature birth (Note that evidence of the causal link is described only as "suggestive" by the US Surgeon General in his 2006 report.) Laws limiting smoking decrease premature births.
    • Stillbirth and congenital malformations in children
    • Recent studies comparing females exposed to Environmental Tobacco Smoke and non-exposed females, demonstrate that females exposed while pregnant have higher risks of delivering a child with congenital abnormalities, longer lengths, smaller head circumferences, and low birth weight.
  • General:
    • Worsening of asthma, allergies, and other conditions. A 2014 systematic review and meta-analysis found that passive smoking was associated with a slightly increased risk of allergic diseases among children and adolescents; the evidence for an association was weaker for adults.
    • Type 2 diabetes. It remains unclear whether the association between passive smoking and diabetes is causal.
  • Risk of carrying Neisseria meningitidis or Streptococcus pneumoniae.
  • A possible increased risk of periodontitis.
  • Overall increased risk of death in both adults, where it is estimated to kill 53,000 nonsmokers per year, making it the 3rd leading cause of preventable death in the U.S, and in children. The World Health Organization states that passive smoking causes about 600,000 deaths a year, and about 1% of the global burden of disease. As of 2017, passive smoking causes about 900,000 deaths a year, which is about 1/8 of all deaths caused by smoking.
  • Skin conditions: A 2016 systematic review and meta-analysis found that passive smoking was associated with a higher rate of atopic dermatitis.

Risk to children

  • Sudden infant death syndrome (SIDS). In his 2006 report, the US Surgeon General concludes: "The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and sudden infant death syndrome." Secondhand smoking has been estimated to be associated with 430 SIDS deaths in the United States annually.
  • Asthma. Secondhand smoke exposure is also associated with an almost doubled risk of hospitalization for asthma exacerbation among children with asthma.
  • Lung infections, also including more severe illness with bronchiolitis and bronchitis, and worse outcome, as well as increased risk of developing tuberculosis if exposed to a carrier. In the United States, it is estimated that secondhand smoke has been associated with between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year.
  • Impaired respiratory function and slowed lung growth
  • Allergies
  • Maternal passive smoking increases the risk of non-syndromic orofacial clefts by 50% among their children.
  • Prenatal and childhood passive smoke exposure does not appear to increase the risk of inflammatory bowel disease.
  • Learning difficulties, developmental delays, executive function problems, and neurobehavioral effects. Animal models suggest a role for nicotine and carbon monoxide in neurocognitive problems.
  • An increase in tooth decay (as well as related salivary biomarkers) has been associated with passive smoking in children.
  • Increased risk of middle ear infections.
  • Invasive meningococcal disease.
  • Maternal exposure to secondhand smoke exposure during pregnancy is associated with an increased risk of neural tube defects.
  • Miscarriage: a 2014 meta-analysis found that maternal secondhand smoke exposure increased the risk of miscarriage by 11%.
  • Anesthesia complications and some negative surgical outcomes.
  • Sleep disordered breathing: Most studies have found a significant association between passive smoking and sleep disordered breathing in children, but further studies are needed to determine whether this association is causal.
  • Adverse effects on the cardiovascular system of children.

Evidence

Exposure to secondhand smoke by age, race, and poverty level in the US.
 
Epidemiological studies show that non-smokers exposed to secondhand smoke are at risk for many of the health problems associated with direct smoking. Most of the research has come from studies of nonsmokers who are married to a smoker. Those conclusions are also backed up by further studies of workplace exposure to smoke.

In 1992, a review estimated that secondhand smoke exposure was responsible for 35,000 to 40,000 deaths per year in the United States in the early 1980s. The absolute risk increase of heart disease due to ETS was 2.2%, while the attributable risk percent was 23%. A 1997 meta-analysis found that secondhand smoke exposure increased the risk of heart disease by a quarter, and two 1999 meta-analyses reached similar conclusions.

Evidence shows that inhaled sidestream smoke, the main component of secondhand smoke, is about four times more toxic than mainstream smoke. This fact has been known to the tobacco industry since the 1980s, though it kept its findings secret. Some scientists believe that the risk of passive smoking, in particular the risk of developing coronary heart diseases, may have been substantially underestimated.

In 1997, a meta-analysis on the relationship between secondhand smoke exposure and lung cancer concluded that such exposure caused lung cancer. The increase in risk was estimated to be 24% among non-smokers who lived with a smoker. In 2000, Copas and Shi reported that there was clear evidence of publication bias in the studies included in this meta-analysis. They further concluded that after correcting for publication bias, and assuming that 40% of all studies are unpublished, this increased risk decreased from 24% to 15%. This conclusion has been challenged on the basis that the assumption that 40% of all studies are unpublished was "extreme". In 2006, Takagi et al. reanalyzed the data from this meta-analysis to account for publication bias and estimated that the relative risk of lung cancer among those exposed to secondhand smoke was 1.19, slightly lower than the original estimate. A 2000 meta-analysis found a relative risk of 1.48 for lung cancer among men exposed to secondhand smoke, and a relative risk of 1.16 among those exposed to it at work. Another meta-analysis confirmed the finding of an increased risk of lung cancer among women with spousal exposure to secondhand smoke the following year. It found a relative risk of lung cancer of 1.29 for women exposed to secondhand smoke from their spouses. A 2014 meta-analysis noted that "the association between exposure to secondhand smoke and lung cancer risk is well established."

A minority of epidemiologists have found it hard to understand how secondhand smoke, which is more diluted than actively inhaled smoke, could have an effect that is such a large fraction of the added risk of coronary heart disease among active smokers. One proposed explanation is that secondhand smoke is not simply a diluted version of "mainstream" smoke, but has a different composition with more toxic substances per gram of total particulate matter. Passive smoking appears to be capable of precipitating the acute manifestations of cardio-vascular diseases (atherothrombosis) and may also have a negative impact on the outcome of patients who suffer acute coronary syndromes.

In 2004, the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) reviewed all significant published evidence related to tobacco smoking and cancer. It concluded:
These meta-analyses show that there is a statistically significant and consistent association between lung cancer risk in spouses of smokers and exposure to second-hand tobacco smoke from the spouse who smokes. The excess risk is of the order of 20% for women and 30% for men and remains after controlling for some potential sources of bias and confounding.
Subsequent meta-analyses have confirmed these findings.

The National Asthma Council of Australia cites studies showing that secondhand smoke is probably the most important indoor pollutant, especially around young children:
  • Smoking by either parent, particularly by the mother, increases the risk of asthma in children.
  • The outlook for early childhood asthma is less favourable in smoking households.
  • Children with asthma who are exposed to smoking in the home generally have more severe disease.
  • Many adults with asthma identify ETS as a trigger for their symptoms.
  • Doctor-diagnosed asthma is more common among non-smoking adults exposed to ETS than those not exposed. Among people with asthma, higher ETS exposure is associated with a greater risk of severe attacks.
In France, exposure to secondhand smoke has been estimated to cause between 3,000 and 5,000 premature deaths per year, with the larger figure cited by Prime Minister Dominique de Villepin during his announcement of a nationwide smoke-free law: "That makes more than 13 deaths a day. It is an unacceptable reality in our country in terms of public health."

There is good observational evidence that smoke-free legislation reduces the number of hospital admissions for heart disease.

Risk level

The International Agency for Research on Cancer of the World Health Organization concluded in 2004 that there was sufficient evidence that secondhand smoke caused cancer in humans. Those who work in environments where smoke is not regulated are at higher risk. Workers particularly at risk of exposure include those in installation repair and maintenance, construction and extraction, and transportation.

The US Surgeon General, in his 2006 report, estimated that living or working in a place where smoking is permitted increases the non-smokers' risk of developing heart disease by 25–30% and lung cancer by 20–30%. In the U.S., smokers that have not quit successfully have a risk of lung cancer about 20 times higher than that of never smokers.

Biomarkers

Breath CO monitor displaying carbon monoxide concentration of an exhaled breath sample (in ppm) with corresponding percent concentration of carboxyhemoglobin displayed below.
 
Environmental tobacco smoke can be evaluated either by directly measuring tobacco smoke pollutants found in the air or by using biomarkers, an indirect measure of exposure. Carbon monoxide monitored through breath, nicotine, cotinine, thiocyanates, and proteins are the most specific biological markers of tobacco smoke exposure. Biochemical tests are a much more reliable biomarker of secondhand smoke exposure than surveys. Certain groups of people are reluctant to disclose their smoking status and exposure to tobacco smoke, especially pregnant women and parents of young children. This is due to their smoking being socially unacceptable. Also, it may be difficult for individuals to recall their exposure to tobacco smoke.

A 2007 study in the Addictive Behaviors journal found a positive correlation between secondhand tobacco smoke exposure and concentrations of nicotine and/or biomarkers of nicotine in the body. Significant biological levels of nicotine from secondhand smoke exposure were equivalent to nicotine levels from active smoking and levels that are associated with behaviour changes due to nicotine consumption.

Cotinine

Cotinine, the metabolite of nicotine, is a biomarker of secondhand smoke exposure. Typically, cotinine is measured in the blood, saliva, and urine. Hair analysis has recently become a new, noninvasive measurement technique. Cotinine accumulates in hair during hair growth, which results in a measure of long-term, cumulative exposure to tobacco smoke. Urinary cotinine levels have been a reliable biomarker of tobacco exposure and have been used as a reference in many epidemiological studies. However, cotinine levels found in the urine reflect exposure only over the preceding 48 hours. Cotinine levels of the skin, such as the hair and nails, reflect tobacco exposure over the previous three months and are a more reliable biomarker.

Carbon monoxide (CO)

Carbon monoxide monitored via breath is also a reliable biomarker of secondhand smoke exposure as well as tobacco use. With high sensitivity and specificity, it not only provides an accurate measure, but the test is also non-invasive, highly reproducible, and low in cost. Breath CO monitoring measures the concentration of CO in an exhalation in parts per million, and this can be directly correlated to the blood CO concentration (carboxyhemoglobin). Breath CO monitors can also be used by emergency services to identify patients who are suspected of having CO poisoning.

Pathophysiology

A 2004 study by the International Agency for Research on Cancer of the World Health Organization concluded that non-smokers are exposed to the same carcinogens as active smokers. Sidestream smoke contains more than 4,000 chemicals, including 69 known carcinogens. Of special concern are polynuclear aromatic hydrocarbons, tobacco-specific N-nitrosamines, and aromatic amines, such as 4-aminobiphenyl, all known to be highly carcinogenic. Mainstream smoke, sidestream smoke, and secondhand smoke contain largely the same components, however the concentration varies depending on type of smoke. Several well-established carcinogens have been shown by the tobacco companies' own research to be present at higher concentrations in sidestream smoke than in mainstream smoke.

secondhand smoke has been shown to produce more particulate-matter (PM) pollution than an idling low-emission diesel engine. In an experiment conducted by the Italian National Cancer Institute, three cigarettes were left smoldering, one after the other, in a 60 m³ garage with a limited air exchange. The cigarettes produced PM pollution exceeding outdoor limits, as well as PM concentrations up to 10-fold that of the idling engine.

secondhand tobacco smoke exposure has immediate and substantial effects on blood and blood vessels in a way that increases the risk of a heart attack, particularly in people already at risk. Exposure to tobacco smoke for 30 minutes significantly reduces coronary flow velocity reserve in healthy nonsmokers. secondhand smoke is also associated with impaired vasodilation among adult nonsmokers. secondhand smoke exposure also affects platelet function, vascular endothelium, and myocardial exercise tolerance at levels commonly found in the workplace.

Pulmonary emphysema can be induced in rats through acute exposure to sidestream tobacco smoke (30 cigarettes per day) over a period of 45 days. Degranulation of mast cells contributing to lung damage has also been observed.

The term "third-hand smoke" was recently coined to identify the residual tobacco smoke contamination that remains after the cigarette is extinguished and secondhand smoke has cleared from the air. Preliminary research suggests that by-products of third-hand smoke may pose a health risk, though the magnitude of risk, if any, remains unknown. In October 2011, it was reported that Christus St. Frances Cabrini Hospital in Alexandria, Louisiana would seek to eliminate third-hand smoke beginning in July 2012, and that employees whose clothing smelled of smoke would not be allowed to work. This prohibition was enacted because third-hand smoke poses a special danger for the developing brains of infants and small children.

In 2008, there were more than 161,000 deaths attributed to lung cancer in the United States. Of these deaths, an estimated 10% to 15% were caused by factors other than first-hand smoking; equivalent to 16,000 to 24,000 deaths annually. Slightly more than half of the lung cancer deaths caused by factors other than first-hand smoking were found in nonsmokers. Lung cancer in non-smokers may well be considered one of the most common cancer mortalities in the United States. Clinical epidemiology of lung cancer has linked the primary factors closely tied to lung cancer in non-smokers as exposure to secondhand tobacco smoke, carcinogens including radon, and other indoor air pollutants.

Opinion of public health authorities

There is widespread scientific consensus that exposure to secondhand smoke is harmful.[3] The link between passive smoking and health risks is accepted by every major medical and scientific organisation, including:

Public opinion

Recent major surveys conducted by the U.S. National Cancer Institute and Centers for Disease Control have found widespread public awareness that secondhand smoke is harmful. In both 1992 and 2000 surveys, more than 80% of respondents agreed with the statement that secondhand smoke was harmful. A 2001 study found that 95% of adults agreed that secondhand smoke was harmful to children, and 96% considered tobacco-industry claims that secondhand smoke was not harmful to be untruthful.

A 2007 Gallup poll found that 56% of respondents felt that secondhand smoke was "very harmful", a number that has held relatively steady since 1997. Another 29% believe that secondhand smoke is "somewhat harmful"; 10% answered "not too harmful", while 5% said "not at all harmful".

Controversy over harm

As part of its attempt to prevent or delay tighter regulation of smoking, the tobacco industry funded a number of scientific studies and, where the results cast doubt on the risks associated with secondhand smoke, sought wide publicity for those results. The industry also funded libertarian and conservative think tanks, such as the Cato Institute in the United States and the Institute of Public Affairs in Australia which criticised both scientific research on passive smoking and policy proposals to restrict smoking. New Scientist and the European Journal of Public Health have identified these industry-wide coordinated activities as one of the earliest expressions of corporate denialism. Further, they state that the disinformation spread by the tobacco industry has created a tobacco denialism movement, sharing many characteristics of other forms of denialism, such as HIV-AIDS denialism.

Industry-funded studies and critiques

Enstrom and Kabat

A 2003 study by James Enstrom and Geoffrey Kabat, published in the British Medical Journal, argued that the harms of passive smoking had been overstated. Their analysis reported no statistically significant relationship between passive smoking and lung cancer, coronary heart disease (CHD), or chronic obstructive pulmonary disease, though the accompanying editorial noted that "they may overemphasise the negative nature of their findings." This paper was widely promoted by the tobacco industry as evidence that the harms of passive smoking were unproven. The American Cancer Society (ACS), whose database Enstrom and Kabat used to compile their data, criticized the paper as "neither reliable nor independent", stating that scientists at the ACS had repeatedly pointed out serious flaws in Enstrom and Kabat's methodology prior to publication. Notably, the study had failed to identify a comparison group of "unexposed" persons.

Enstrom's ties to the tobacco industry also drew scrutiny; in a 1997 letter to Philip Morris, Enstrom requested a "substantial research commitment... in order for me to effectively compete against the large mountain of epidemiologic data and opinions that already exist regarding the health effects of ETS and active smoking." In a US racketeering lawsuit against tobacco companies, the Enstrom and Kabat paper was cited by the US District Court as "a prime example of how nine tobacco companies engaged in criminal racketeering and fraud to hide the dangers of tobacco smoke." The Court found that the study had been funded and managed by the Center for Indoor Air Research, a tobacco industry front group tasked with "offsetting" damaging studies on passive smoking, as well as by Philip Morris who stated that Enstrom's work was "clearly litigation-oriented." A 2005 paper in Tobacco Control argued that the disclosure section in the Enstrom and Kabat BMJ paper, although it met the journal's requirements, "does not reveal the full extent of the relationship the authors had with the tobacco industry."

In 2006, Enstrom and Kabat published a meta-analysis of studies regarding passive smoking and coronary heart disease in which they reported a very weak association between passive smoking and heart disease mortality. They concluded that exposure to secondhand smoke increased the risk of death from CHD by only 5%, although this analysis has been criticized for including two previous industry-funded studies that suffered from widespread exposure misclassification.

Gori

Gio Batta Gori, a tobacco industry spokesman and consultant and an expert on risk utility and scientific research, wrote in the libertarian Cato Institute's magazine Regulation that "...of the 75 published studies of ETS and lung cancer, some 70% did not report statistically significant differences of risk and are moot. Roughly 17% claim an increased risk and 13% imply a reduction of risk."

Milloy

Steven Milloy, the "junk science" commentator for Fox News and a former Philip Morris consultant, claimed that "of the 19 studies" on passive smoking "only 8— slightly more than 42%— reported statistically significant increases in heart disease incidence.."

Another component of criticism cited by Milloy focused on relative risk and epidemiological practices in studies of passive smoking. Milloy, who has a master's degree from the Johns Hopkins School of Hygiene and Public Health, argued that studies yielding relative risks of less than 2 were meaningless junk science. This approach to epidemiological analysis was criticized in the American Journal of Public Health:
A major component of the industry attack was the mounting of a campaign to establish a "bar" for "sound science" that could not be fully met by most individual investigations, leaving studies that did not meet the criteria to be dismissed as "junk science."
The tobacco industry and affiliated scientists also put forward a set of "Good Epidemiology Practices" which would have the practical effect of obscuring the link between secondhand smoke and lung cancer; the privately stated goal of these standards was to "impede adverse legislation". However, this effort was largely abandoned when it became clear that no independent epidemiological organization would agree to the standards proposed by Philip Morris et al.

Levois and Layard

In 1995, Levois and Layard, both tobacco industry consultants, published two analyses in the journal Regulatory Toxicology and Pharmacology regarding the association between spousal exposure to secondhand smoke and heart disease. Both of these papers reported no association between secondhand smoke and heart disease. These analyses have been criticized for failing to distinguish between current and former smokers, despite the fact that former smokers, unlike current ones, are not at a significantly increased risk of heart disease.

World Health Organization controversy

A 1998 study by the International Agency for Research on Cancer (IARC) on environmental tobacco smoke (ETS) found "weak evidence of a dose–response relationship between risk of lung cancer and exposure to spousal and workplace ETS."

In March 1998, before the study was published, reports appeared in the media alleging that the IARC and the World Health Organization (WHO) were suppressing information. The reports, appearing in the British Sunday Telegraph and The Economist, among other sources, alleged that the WHO withheld from publication of its own report that supposedly failed to prove an association between passive smoking and a number of other diseases (lung cancer in particular). 

In response, the WHO issued a press release stating that the results of the study had been "completely misrepresented" in the popular press and were in fact very much in line with similar studies demonstrating the harms of passive smoking. The study was published in the Journal of the National Cancer Institute in October of the same year, and concluded the authors found "no association between childhood exposure to ETS and lung cancer risk" but "did find weak evidence of a dose–response relationship between risk of lung cancer and exposure to spousal and workplace ETS." An accompanying editorial summarized:
When all the evidence, including the important new data reported in this issue of the Journal, is assessed, the inescapable scientific conclusion is that ETS is a low-level lung carcinogen.
With the release of formerly classified tobacco industry documents through the Tobacco Master Settlement Agreement, it was found (by Elisa Ong and Stanton Glantz) that the controversy over the WHO's alleged suppression of data had been engineered by Philip Morris, British American Tobacco, and other tobacco companies in an effort to discredit scientific findings which would harm their business interests. A WHO inquiry, conducted after the release of the tobacco-industry documents, found that this controversy was generated by the tobacco industry as part of its larger campaign to cut the WHO's budget, distort the results of scientific studies on passive smoking, and discredit the WHO as an institution. This campaign was carried out using a network of ostensibly independent front organizations and international and scientific experts with hidden financial ties to the industry.

EPA lawsuit

In 1993, the United States Environmental Protection Agency (EPA) issued a report estimating that 3,000 lung cancer related deaths in the United States were caused by passive smoking annually.

Philip Morris, R.J. Reynolds Tobacco Company, and groups representing growers, distributors and marketers of tobacco took legal action, claiming that the EPA had manipulated this study and ignored accepted scientific and statistical practices.

The United States District Court for the Middle District of North Carolina ruled in favor of the tobacco industry in 1998, finding that the EPA had failed to follow proper scientific and epidemiologic practices and had "cherry picked" evidence to support conclusions which they had committed to in advance. The court stated in part, "EPA publicly committed to a conclusion before research had begun…adjusted established procedure and scientific norms to validate the Agency's public conclusion... In conducting the ETS Risk Assessment, disregarded information and made findings on selective information; did not disseminate significant epidemiologic information; deviated from its Risk Assessment Guidelines; failed to disclose important findings and reasoning…"
In 2002, the EPA successfully appealed this decision to the United States Court of Appeals for the Fourth Circuit. The EPA's appeal was upheld on the preliminary grounds that their report had no regulatory weight, and the earlier finding was vacated.

In 1998, the U.S. Department of Health and Human Services, through the publication by its National Toxicology Program of the 9th Report on Carcinogens, listed environmental tobacco smoke among the known carcinogens, observing of the EPA assessment that "The individual studies were carefully summarized and evaluated."

Tobacco-industry funding of research

The tobacco industry's role in funding scientific research on secondhand smoke has been controversial. A review of published studies found that tobacco-industry affiliation was strongly correlated with findings exonerating secondhand smoke; researchers affiliated with the tobacco industry were 88 times more likely than independent researchers to conclude that secondhand smoke was not harmful. In a specific example which came to light with the release of tobacco-industry documents, Philip Morris executives successfully encouraged an author to revise his industry-funded review article to downplay the role of secondhand smoke in sudden infant death syndrome. The 2006 U.S. Surgeon General's report criticized the tobacco industry's role in the scientific debate:
The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus.
This strategy was outlined at an international meeting of tobacco companies in 1988, at which Philip Morris proposed to set up a team of scientists, organized by company lawyers, to "carry out work on ETS to keep the controversy alive." All scientific research was subject to oversight and "filtering" by tobacco-industry lawyers:
Philip Morris then expect the group of scientists to operate within the confines of decisions taken by PM scientists to determine the general direction of research, which apparently would then be 'filtered' by lawyers to eliminate areas of sensitivity.
Philip Morris reported that it was putting "...vast amounts of funding into these projects... in attempting to coordinate and pay so many scientists on an international basis to keep the ETS controversy alive."

Tobacco industry response

Measures to tackle secondhand smoke pose a serious economic threat to the tobacco industry, having broadened the definition of smoking beyond a personal habit to something with a social impact. In a confidential 1978 report, the tobacco industry described increasing public concerns about secondhand smoke as "the most dangerous development to the viability of the tobacco industry that has yet occurred." In United States of America v. Philip Morris et al., the District Court for the District of Columbia found that the tobacco industry "... recognized from the mid-1970s forward that the health effects of passive smoking posed a profound threat to industry viability and cigarette profits," and that the industry responded with "efforts to undermine and discredit the scientific consensus that ETS causes disease."

Accordingly, the tobacco industry have developed several strategies to minimise the impact on their business:
  • The industry has sought to position the secondhand smoke debate as essentially concerned with civil liberties and smokers' rights rather than with health, by funding groups such as FOREST.
  • Funding bias in research; in all reviews of the effects of secondhand smoke on health published between 1980 and 1995, the only factor associated with concluding that secondhand smoke is not harmful was whether an author was affiliated with the tobacco industry. However, not all studies that failed to find evidence of harm were by industry-affiliated authors.
  • Delaying and discrediting legitimate research (see for an example of how the industry attempted to discredit Takeshi Hirayama's landmark study, and for an example of how it attempted to delay and discredit a major Australian report on passive smoking)
  • Promoting "good epidemiology" and attacking so-called junk science (a term popularised by industry lobbyist Steven Milloy): attacking the methodology behind research showing health risks as flawed and attempting to promote sound science. Ong & Glantz (2001) cite an internal Phillip Morris memo giving evidence of this as company policy.
  • Creation of outlets for favourable research. In 1989, the tobacco industry established the International Society of the Built Environment, which published the peer-reviewed journal Indoor and Built Environment. This journal did not require conflict-of-interest disclosures from its authors. With documents made available through the Master Settlement, it was found that the executive board of the society and the editorial board of the journal were dominated by paid tobacco-industry consultants. The journal published a large amount of material on passive smoking, much of which was "industry-positive".
Citing the tobacco industry's production of biased research and efforts to undermine scientific findings, the 2006 U.S. Surgeon General's report concluded that the industry had "attempted to sustain controversy even as the scientific community reached consensus... industry documents indicate that the tobacco industry has engaged in widespread activities... that have gone beyond the bounds of accepted scientific practice." The U.S. District Court, in U.S.A. v. Philip Morris et al., found that "...despite their internal acknowledgment of the hazards of secondhand smoke, Defendants have fraudulently denied that ETS causes disease."

Position of major tobacco companies

The positions of major tobacco companies on the issue of secondhand smoke is somewhat varied. In general, tobacco companies have continued to focus on questioning the methodology of studies showing that secondhand smoke is harmful. Some (such as British American Tobacco and Philip Morris) acknowledge the medical consensus that secondhand smoke carries health risks, while others continue to assert that the evidence is inconclusive. Several tobacco companies advocate the creation of smoke-free areas within public buildings as an alternative to comprehensive smoke-free laws.

US racketeering lawsuit against tobacco companies

On September 22, 1999, the U.S. Department of Justice filed a racketeering lawsuit against Philip Morris and other major cigarette manufacturers. Almost 7 years later, on August 17, 2006 U.S. District Court Judge Gladys Kessler found that the Government had proven its case and that the tobacco company defendants had violated the Racketeer Influenced Corrupt Organizations Act (RICO). In particular, Judge Kessler found that PM and other tobacco companies had:
  • conspired to minimize, distort and confuse the public about the health hazards of smoking;
  • publicly denied, while internally acknowledging, that secondhand tobacco smoke is harmful to nonsmokers, and
  • destroyed documents relevant to litigation.
The ruling found that tobacco companies undertook joint efforts to undermine and discredit the scientific consensus that secondhand smoke causes disease, notably by controlling research findings via paid consultants. The ruling also concluded that tobacco companies were fraudulently continuing to deny the health effects of ETS exposure.

On May 22, 2009, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit unanimously upheld the lower court's 2006 ruling.

Smoke-free laws

As a consequence of the health risks associated with secondhand smoke, smoke-free regulations in indoor public places, including restaurants, cafés, and nightclubs have been introduced in a number of jurisdictions, at national or local level, as well as some outdoor open areas. Ireland was the first country in the world to institute a comprehensive national smoke-free law on smoking in all indoor workplaces on 29 March 2004. Since then, many others have followed suit. The countries which have ratified the WHO Framework Convention on Tobacco Control (FCTC) have a legal obligation to implement effective legislation "for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places." (Article 8 of the FCTC) The parties to the FCTC have further adopted Guidelines on the Protection from Exposure to secondhand Smoke which state that "effective measures to provide protection from exposure to tobacco smoke ... require the total elimination of smoking and tobacco smoke in a particular space or environment in order to create a 100% smoke-free environment."

Opinion polls have shown considerable support for smoke-free laws. In June 2007, a survey of 15 countries found 80% approval for smoke-free laws. A survey in France, reputedly a nation of smokers, showed 70% support.

Effects

Smoking bans by governments result in decreased harm from second hand smoke including decrease cardiovascular disease. In the first 18 months after the town of Pueblo, Colorado enacted a smoke-free law in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighbouring towns without smoke-free laws showed no change, and the decline in heart attacks in Pueblo was attributed to the resulting reduction in secondhand smoke exposure. A 2004 smoking ban instituted in Massachusetts workplaces decreased workers' secondhand smoke exposure from 8% of workers in 2003 to 5.4% of workers in 2010. A 2016 review also found benefits of decrease exposure to smoke from specific location policies.

In 2001, a systematic review for the Guide to Community Preventative Services acknowledged strong evidence of the effectiveness of smoke-free policies and restrictions in reducing expose to secondhand smoke. A follow up to this review, identified the evidence on which the effectiveness of smoking bans reduced the prevalence of tobacco use. Articles published until 2005, were examined to further support this evidence. The examined studies provided sufficient evidence that smoke-free policies reduce tobacco use among workers when implemented in worksites or by communities.

While a number of studies funded by the tobacco industry have claimed a negative economic impact from smoke-free laws, no independently funded research has shown any such impact. A 2003 review reported that independently funded, methodologically sound research consistently found either no economic impact or a positive impact from smoke-free laws.

Air nicotine levels were measured in Guatemalan bars and restaurants before and after an implemented smoke-free law in 2009. Nicotine concentrations significantly decreased in both the bars and restaurants measured. Also, the employees support for a smoke-free workplace substantially increased in the post-implementation survey compared to pre-implementation survey. The result of this smoke-free law provides a considerably more healthy work environment for the staff.

Public opinion

Recent surveys taken by the Society for Research on Nicotine and Tobacco demonstrates supportive attitudes of the public, towards smoke-free policies in outdoor areas. A vast majority of the public supports restricting smoking in various outdoor settings. The respondents reasons for supporting the policies were for varying reasons such as, litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.

Alternative forms

Alternatives to smoke-free laws have also been proposed as a means of harm reduction, particularly in bars and restaurants. For example, critics of smoke-free laws cite studies suggesting ventilation as a means of reducing tobacco smoke pollutants and improving air quality. Ventilation has also been heavily promoted by the tobacco industry as an alternative to outright bans, via a network of ostensibly independent experts with often undisclosed ties to the industry. However, not all critics have connections to the industry. 

The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) officially concluded in 2005 that while completely isolated smoking rooms do eliminate the risk to nearby non-smoking areas, smoking bans are the only means of completely eliminating health risks associated with indoor exposure. They further concluded that no system of dilution or cleaning was effective at eliminating risk. The U.S. Surgeon General and the European Commission Joint Research Centre have reached similar conclusions. The implementation guidelines for the WHO Framework Convention on Tobacco Control states that engineering approaches, such as ventilation, are ineffective and do not protect against secondhand smoke exposure. However, this does not necessarily mean that such measures are useless in reducing harm, only that they fall short of the goal of reducing exposure completely to zero. 

Others have suggested a system of tradable smoking pollution permits, similar to the cap-and-trade pollution permits systems used by the Environmental Protection Agency in recent decades to curb other types of pollution. This would guarantee that a portion of bars/restaurants in a jurisdiction will be smoke-free, while leaving the decision to the market.

In animals

Multiple studies have been conducted to determine the carcinogenicity of environmental tobacco smoke to animals. These studies typically fall under the categories of simulated environmental tobacco smoke, administering condensates of sidestream smoke, or observational studies of cancer among pets.

To simulate environmental tobacco smoke, scientists expose animals to sidestream smoke, that which emanates from the cigarette's burning cone and through its paper, or a combination of mainstream and sidestream smoke. The IARC monographs conclude that mice with prolonged exposure to simulated environmental tobacco smoke, that is 6hrs a day, 5 days a week, for five months with a subsequent 4 month interval before dissection, will have significantly higher incidence and multiplicity of lung tumors than with control groups. 

The IARC monographs concluded that sidestream smoke condensates had a significantly higher carcinogenic effect on mice than did mainstream smoke condensates.

Observational studies

Secondhand smoke is popularly recognised as a risk factor for cancer in pets. A study conducted by the Tufts University School of Veterinary Medicine and the University of Massachusetts Amherst linked the occurrence of feline oral cancer to exposure to environmental tobacco smoke through an overexpression of the p53 gene. Another study conducted at the same universities concluded that cats living with a smoker were more likely to get feline lymphoma; the risk increased with the duration of exposure to secondhand smoke and the number of smokers in the household. A study by Colorado State University researchers, looking at cases of canine lung cancer, was generally inconclusive, though the authors reported a weak relation for lung cancer in dogs exposed to environmental tobacco smoke. The number of smokers within the home, the number of packs smoked in the home per day, and the amount of time that the dog spent within the home had no effect on the dog's risk for lung cancer.

Terminology

As of 2003, "secondhand smoke" was the term most used to refer to other people's smoke in the English-language media. Other terms used include "environmental tobacco smoke", while "involuntary smoking" and "passive smoking" are used to refer to exposure to secondhand smoke. The term "environmental tobacco smoke" can be traced back to a 1974 industry-sponsored meeting held in Bermuda, while the term "passive smoking" was first used in the title of a scientific paper in 1970. The Surgeon General of the United States prefers to use the phrase "secondhand smoke" rather than "environmental tobacco smoke", stating that "The descriptor "secondhand" captures the involuntary nature of the exposure, while "environmental" does not." Most researchers consider the term "passive smoking" to be synonymous with "secondhand smoke". In contrast, a 2011 commentary in Environmental Health Perspectives argued that research into "thirdhand smoke" renders it inappropriate to refer to passive smoking with the term "secondhand smoke", which the authors stated constitutes a pars pro toto.

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