Second-hand smoke (SHS) : Hidden Danger as there is no safe level of exposure to secondhand smoke.

Second-hand smoke (SHS)

• Introduction

Second-hand smoke is a mixture of the smoke from the burning tip of a cigarette and the smoke exhaled by a smoker. When second-hand smoke contaminates the air, especially in enclosed spaces, it is inhaled by everyone, exposing both smokers and non-smokers to its harmful effects. It causes lung cancer in non-smokers and increases the risk of coronary heart disease. Second-hand smoke (SHS), which is also called environmental tobacco smoke (ETS), involuntary smoke, and passive smoke, is the combination of “side stream” smoke given off by a burning tobacco product and “mainstream” smoke exhaled by a smoker. Second-hand smoke (SHS)from cigarettes is a known human toxin and carcinogen. SHS is a complex mixture of more than 4,000 compounds and is also referred to as involuntary smoking, tobacco smoke pollution, and passive smoking. Worldwide, 40% of children, 33% of male non-smokers, and 35% of female non-smokers were exposed to second-hand smoke in 2004.

The Global Youth Tobacco Survey (GYTS) in India, coordinated by the Centres for Disease Control, found moderate exposure to second-hand smoke among school students aged 13-15 years. For example, in 2009 one in five students surveyed reported they were exposed to second-hand smoke in their home and more than one-third of the students were exposed to smoke outside of the home. Almost six million people die from tobacco use each year. Of these total deaths, just over 600,000 are attributable to second-hand smoke exposure to non-smokers and more than five million to direct tobacco use (both smoking and smokeless tobacco).

• The harms of second-hand smoke

There is no safe level of exposure to second-hand smoke, and even brief exposure can cause harm. Severe or fatal diseases, including heart disease, respiratory disease, and cancer can result from exposure to second-hand smoke – and non-smokers living with smokers are at greater risk of such diseases, and premature death. Children and infants are particularly susceptible and at increased risk for respiratory disease, middle-ear disease, and sudden infant death syndrome. Pregnant women exposed to second-hand smoke are more likely to experience stillbirths, and their fetuses are more likely to have congenital malformations and lower birth weights. The only way to adequately protect both smokers and non-smokers from second-hand smoke is to fully eliminate indoor smoking. For example, an analysis based on data from Brazil suggested that, over a period of 16 years, up to 15 000 infant deaths may have been averted by the implementation of comprehensive smoke-free laws.

Second Hand Smoking and venerable population like female, child, adolescents, youth and senior citizen.

Secondhand smoking can have a profound impact on vulnerable populations, including females, children, adolescents, youth, and senior citizens. Here's how secondhand smoke affects each of these groups: 

Females: Women exposed to secondhand smoke may face increased risks of respiratory issues, cardiovascular diseases, and certain cancers. Pregnant women exposed to secondhand smoke are at a higher risk of complications such as preterm birth, low birth weight, and developmental problems in their children. 

Children: Secondhand smoke poses severe health risks to children. They are more susceptible to respiratory infections, asthma, ear infections, and sudden infant death syndrome (SIDS). Secondhand smoke exposure can hinder their lung development, impair cognitive function, and lead to long-term health issues.

Adolescents and Youth: Secondhand smoke exposure can influence adolescents and youth to initiate smoking. They may face a higher risk of developing smoking-related behaviors, addiction, and long-term health consequences such as respiratory diseases, cardiovascular problems, and certain cancers.

Senior Citizens: Older adults, particularly those with pre-existing health conditions, are more vulnerable to the negative effects of secondhand smoke. Secondhand smoke can exacerbate respiratory conditions such as COPD, asthma, and increase the risk of heart disease and stroke. It can also compromise their immune system, making them more susceptible to infections.

Protecting these vulnerable populations from secondhand smoke is crucial. Implementing smoke-free policies in public spaces, homes, and vehicles can help reduce their exposure. Additionally, promoting smoking cessation programs, raising awareness about the dangers of secondhand smoke, and providing support for quitting smoking can contribute to better health outcomes for females, children, adolescents, youth, and senior citizens. Creating smoke-free environments is essential for safeguarding their health and improving their overall well-being.

Laws and regulations to restrict smoking in public places vary across different countries and jurisdictions. Here is an overview of smoking restrictions in public places in India and globally:

• India:

Cigarettes and Other Tobacco Products Act (COTPA): Implemented in 2003, COTPA is an important law in India that regulates tobacco consumption and restricts smoking in public places. It prohibits smoking in public places, including workplaces, educational institutions, hotels, restaurants, and parks. It also mandates the display of health warnings on tobacco products and bans the sale of tobacco products to minors.

Smoking Prohibition in Public Places Rules: Under these rules, designated smoking areas may be provided in hotels with more than 30 rooms, restaurants with a seating capacity of 30 or more, and airports. However, these areas must be physically separated and have proper ventilation.

• Global:

Smoke-Free Policies: Many countries have implemented comprehensive smoke-free policies that prohibit smoking in indoor public places, including restaurants, bars, shopping centers, airports, public transportation, and workplaces. Some countries have also extended these restrictions to outdoor areas like parks and sports stadiums.

Framework Convention on Tobacco Control (FCTC): The World Health Organization's FCTC is an international treaty aimed at reducing tobacco consumption and exposure to secondhand smoke. It has been ratified by numerous countries worldwide and encourages the implementation of comprehensive smoke-free legislation.
Graphic Health Warnings: Many countries require graphic health warnings on cigarette packages to educate consumers about the harmful effects of smoking and discourage tobacco use.

It's important to note that specific smoking restrictions may vary from country to country, and even within different regions of a country. The extent and enforcement of these laws depend on local regulations and policies. It is advisable to consult the specific laws and regulations in your own country or region for the most accurate and up-to-date information on smoking restrictions in public places.

Prevention: Non-smokers need to be protected from secondhand smoke exposure within the home, at school and in the workplace. Women and children often do not have the power to negotiate smoke-free spaces, even within their own homes. Some workers are obliged to spend most of their work time in a health-threatening environment. 
There is no safe level of exposure to secondhand smoke.

• Non-smokers, including women and children, have a right to breathe tobacco-free clean air.

• Ventilation or designated smoking-rooms do not offer effective protection.

• All indoor workplaces, public transport, schools and health services should be smoke free. 

• People need to be better informed of the hazards of second-hand smoke to themselves, fetuses, children and other family members. 

References

1. Study of Secondhand Smoke Levels Pre and Post Implementation of the Comprehensive Smoking Ban in Mumbai Aditi Deshpande, Priyanka Kudtarkar, Dhanashri Dhaware, Rohini Chowgule.
2. Determinants of exposure to second-hand smoke at home and outside the home among students aged 11-17 years: Results from the Mumbai Student Tobacco Survey 2010. Raute LJ, Pednekar MS, Mistry R1, Gupta PC, Pimple SA2, Shastri SS 
3. Fact sheet. Global Youth Tobacco Survey (GYTS), India, 2009. Available from: http://www.who.int/fctc/reporting/Annexoneindia.pdf. [Last accessed on 2012 Jul 16]. 
4. World Health Organization (WHO). Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva: World Health Organization, 2009. 
5. The Prohibition of Smoking in Public Places, 2008. The Gazette of India, Ministry of Health and Family Welfare; Notification G.S.R. 417 (E) No. 304

This article is dedicated to my Teachers, Seniors, and Well-Wishers on the occasion of "Guru Purnima".

Regards and Thanks,

Dr. (Prof)Rajendra T. Nanavare

Chest Physician GTB hospital Sewri Mumbai,

Editorial Manager for Indian Journal of Tuberculosis,

Faculty of chest and tropical medicine in College of

Physicians and Surgeons CPS Parel Mumbai.