Passive smoking and smoke-free environments

A person who smokes a cigarette inhales no more than a quarter of the smoke themselves. The rest is released into the environment. The people present become passive smokers. Passive smoking is dangerous. A person who inhales other people's tobacco smoke is exposed to the same types of health risks as the smoker himself, although usually at a lower level. This means, for example, that passive smoking can also contribute to respiratory problems, cardiovascular disease and cancer.

Tobacco smoke can be just as harmful to your health outdoors as it is indoors – it all depends on the concentration of dangerous particles and the length of time you are exposed.

In 2005, Sweden introduced smoke-free restaurants, with the exception of the establishment of special smoking rooms. In December 2018, a new tobacco law was passed that extends the smoking ban to certain outdoor public places: including outdoor restaurants, entrances to smoke-free premises, outdoor public transport areas, and fenced areas for sports and play.

Since the introduction of smoke-free restaurants, smoking and passive smoking have decreased significantly. However, many people are still exposed to passive smoking. In the Swedish National Institute of Public Health's public health survey Health on Equal Terms in 2005, 21 percent of adult Swedes said that they were used to being exposed to other people's tobacco smoke. In 2014, the figure was 15 percent. This is progress, but at the same time it is far from the tobacco convention's goal that everyone should be protected from passive smoking.

Children are particularly sensitive to the harm of tobacco smoke in their environment. According to the National Board of Health and Welfare's statistics on the smoking habits of parents of infants, in 2017, eleven percent of children aged eight months lived with someone who smoked in the home.

New smoke-free laws have been shown to have a rapid positive impact on public health. There is strong evidence of this in many countries where such laws have been introduced:

The fastest effects are for cardiovascular diseases. For example, after one year of the new law, hospital admissions due to heart attacks had decreased by an average of 17 percent in Italy, Ireland, France, Canada, Scotland, England and Argentina.

Hospitalisations for asthma are also decreasing. In Scotland, childhood asthma had decreased by 13 percent a year after a smoking ban in restaurants was introduced.

Read more examples of tobacco prevention work in other countries in International Outlook.

Although Sweden ratified the FCTC in 2005, it does not live up to its guidelines in a number of areas. Regarding Article 8 on passive smoking, Sweden has come a long way, and Tobacco Facts welcomes the new Tobacco Act that was adopted at the end of 2018, which will likely lead to an improvement in the statistics on people exposed to passive smoking. Tobacco Facts believes that Sweden still has to do this:

1. The smoking ban must be implemented without exception. This means, for example, abolishing the possibility of having smoking rooms and smoking booths in workplaces, restaurants and public premises. The smoking ban must cover all workplaces, for example homes where others have their workplace, such as home care, cleaning and home healthcare.
2. Awareness of the serious risks of passive smoking must be increased and improved, as too many people are unaware of them. This helps people support and comply with smoke-free laws.
3. The supervision work to ensure that the laws that prescribe smoke-free environments are followed should be made more efficient.
4. The penalty must be made more noticeable for those responsible for premises that are supposed to be smoke-free who violate the smoking ban.

A person who smokes a cigarette inhales no more than a quarter of the smoke themselves. The rest is released into the environment. The people who are there and may have never smoked or quit smoking themselves become passive smokers. They are affected by the nicotine and all the other chemicals that the burning cigarette produces. Repeated passive smoking over a longer period exposes those affected to the same type of health risks as the smoker, although the increase in risk is lower.

There is a useful biological measure of passive smoking. It is called cotinine and is a breakdown product of nicotine. Cotinine can be detected in the body for up to a week after a non-smoker was last exposed to tobacco smoke.

• When a cigarette burns, it releases approximately 7,000 chemical substances. Around 50 of them are carcinogenic or suspected of causing cancer. A couple of them are completely banned in Swedish work environments by the Swedish Occupational Safety and Health Administration – except when they are produced by cigarette smokers. The substances are called betanaphthylamine and 4-aminodiphenyl.

The smoke that escapes into the environment is called sidestream smoke. It contains more particles than the so-called mainstream smoke that the smoker inhales. The amount of particles and nicotine per unit volume is twice as large as that inhaled by the smoker. This is because the cigarette burns less well between puffs. This causes the temperature to drop and combustion to decrease. When the smoker inhales smoke, the draft increases, the temperature rises and combustion becomes more efficient. In addition, the smoke passes through a filter.

The passive smoker still ingests fewer chemicals than the smoker, thanks to the fact that the smoke has time to be diluted before it reaches the lungs.

Involuntary smokers can quickly notice that their eyes and airways are irritated by cigarette smoke. This is the body's way of warning. Asthmatics often have difficulty breathing. Over the past 10-15 years, a number of research reports have shown that passive smoking causes even more serious health effects.

• According to several reports, the risk of lung cancer increases by about 30 percent for non-smokers who live with a smoker for a long time. Recently, an increased risk of cardiovascular disease has also been observed. According to the Environmental Health Report 2001 from the National Board of Health and Welfare, passive smoking causes just over 1,000 heart attacks in Sweden each year. At least 500 of those affected die. Later estimates cited by the National Institute of Public Health (2010) suggest that the number of deaths has decreased to about 200 per year. The reason is, among other things, the introduction of smoke-free restaurants and smoking-free workplaces.

Children with smoking parents are often harmed. The strongest connection – especially with the mother’s smoking – is found in children under two years of age. Asthma and ear infections are more common in children who are forced to live with tobacco smoke. The development of children’s lung function can also be inhibited. Swedish studies show that many asthmatic children have significant amounts of cotinine in their bodies. The fact that children ingest more nicotine and other toxins in smoke than adults may be due to the fact that they move more and breathe faster.

The connection was discovered in 1950
The first time passive smoking was linked to asthma in children was in the USA in 1950. A doctor treated an asthmatic child for a long time without success. Suddenly the asthma disappeared. Later on it returned just as suddenly. When the doctor questioned the mother, it turned out that she was a heavy smoker, but that she had tried to quit for a while. It was during the cessation period that the child escaped the disease. It is now known that 20-30 percent of childhood asthma is caused by passive smoking.

In the early 1980s, several studies were published on the risks of passive smoking. Japanese researcher Takesi Hirayama had examined the number of deaths from lung cancer among non-smoking women married to smokers and compared the results from a similar study among non-smoking couples. That study showed that the risk of dying from lung cancer was 40 percent higher among women married to smoking men.

The tobacco industry spent huge sums of money to counter Hirayama in advertisements around the world. In the long term, the campaign had the effect of encouraging more researchers to investigate the links between passive smoking and lung cancer – and other diseases as well.

In 1986, two important reports on these connections were published. One came from the Surgeon General of the United States (the deputy secretary of health and official spokesman for health issues) and the other from an expert committee within the World Health Organization that investigated the risks of passive smoking. Both concluded that passive smoking can cause lung cancer and that children of smokers have more respiratory problems and diseases than children of non-smokers.

In the same class as asbestos
In 1993, tobacco smoke was classified by the US federal environmental agency, EPA, as a category A carcinogen, i.e. in the same group as asbestos, for example. The results of some 30 epidemiological studies are considered to support the EPA's classification.

4,000 passive smokers are estimated to die of lung cancer in the US each year, while 37,000 die of cardiovascular disease. In Sweden, up to 60 lung cancer cases a year are estimated to be due to passive smoking. An Australian study shows how blood vessels are negatively affected by passive smoke. The study included 78 healthy non-smoking men aged 15 to 30 and showed that the elasticity of the arteries had decreased in those who had been exposed to passive smoke regularly for more than three years. The arteries of the non-smokers were able to dilate by eight percent compared to 3,2 percent in the most exposed passive smokers.

The reduced elasticity is cited as an early sign of vascular disease. The New England Journal of Medicine reported on the study in April 1996.

In August 1999, the specialist journal Tobacco Control, published by the British Medical Journal, published a report on a study based on research in New Zealand, which showed that the risk of stroke increases in passive smokers by 88 percent among men and 66 percent among women. For smokers themselves, the risk increases fourfold. The difference in risk between smokers and non-smokers becomes most apparent when smokers are compared with non-smokers who are not exposed to passive smoke. The study indicates that the risk of damage to blood vessels is greater than the risk of cancer from passive smoking.