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Passive smoking

Passive smoking. Healthcare workers need to know about the effects of both active and passive smoking. Streams of tobacco fume. Third stream. Lateral stream or second hand. Main stream Smoker. Tobacco smoke : Gas phase. Amount in main stream / cig. Ratio second hand/ main stream.

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Passive smoking

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  1. Passive smoking Healthcare workers need to know about the effects of both active and passive smoking.

  2. Streams of tobacco fume Third stream Lateral stream or second hand Main stream Smoker

  3. Tobacco smoke : Gas phase

  4. Amount in main stream / cig • Ratio second hand/ main stream toxicity Particular phase • Tars • Cancerogen • 14-30 mg • 1,1-15,7 • Nicotine • Toxic • 2,1-46 mg • 1,3-21 • Phenol • Promotor • 70-250 µg • 1,3-3 • Catechol • Suspect Cancerogen • 58-290 µg • 0,67-12,8 • O-Toluidine • Cancerogen • 3 µg • 18,7 • 2-Naphthylamine • Cancerogen • 70 ng • 39 • 4-Aminobiphenyl • Cancerogen • 140 ng • 3,1 • Benz(a)anthracene • Cancerogen • 40-200 ng • 2-4 • Benzo(a)pyrene • Cancerogen • 40-70 ng • 2,5-20 • Quinoléine • Cancerogen • 15-20 µg • 8-11 • N-nitrosonornicotine • Suspect Cancerogen • 0,15-1,7 µg • 0,5-5 • nor nitrosocotinine • Suspect Cancerogen • 0,2-1,4 µg • 1-22 • N-nitrosodiéthanolamine • Suspect Cancerogen • 43 ng • 1,2 • Cadmium • Cancerogen • 0, 72 µg • 7,2

  5. Discomfort from passive smoking is a reality • Recent survey (Baromètre santé 2000) showed than 72 % of non-smokers are disturbed by second hand tobacco. • These results demonstrate the need for non smokers to be totally protected from second hand tobacco. • NB 53% of smokers also stated that they were disturbed by second hand tobacco. The request for a smoke-free environment is well accept by both non-smokers and smokers alike.

  6. Discomfort from passive smoking in Europe Sources: Europe against cancer, 1993 and WHO Europe, 1992. % smokers Disturbance 80% 70% 60% 50% 40% 30% 20% 10% 0% Eire Germany Spain Portugal Belgium Luxemburg Denmark Italy Greece Nederland UK France

  7. Disturbance from passive smoking report by smokersinresponse to the question : «are you disturbed by smoke from others? » 100 % 9 9,4 11,7 11,9 16,4 26,6 80 25,7 32,5 40,9 42,7 44,2 60 40,2 40 65,3 58,1 47,5 45,4 20 39,4 33,2 0 11 - 15 <1 cig/d 1 - 5 6 - 10 16 - 20 > 20 cig/d cig/d cig/d cig/d cig/d Not at all Yes, little Yes, strongly Source: Baromètre santé 2000, CFES

  8. Exposure to tobacco smoke in Europe (%) 63 82 85 86 Exposure to tobacco smoke 40 At home 1995 43 1992 54 Working place 55 56 Transports 78 Public place 82 Friends 84 Restaurants 0 20 40 60 80 100 % Eurobaromètre 1995 (12 european states)

  9. Recent scientific data demonstrates the risk of second hand smoking for non-smokers. • Smokers are the main victims of tobacco smoke (500 000 deaths annually in Europe) • Recent scientific data, mainly published within last 15 years, provides clear evidence than second hand tobacco smoke is the cause of disease in children and adults. • This evidence calls for responsible action in public places to prevent all exposure to second hand tobacco smoke.

  10. Second hand tobacco smoke is associate with an increase risk of : • Lower tract respiratory infections in children (+ 72 % if mother smokes), •  recurrent otitis media in children (+48 % if both parents smoke), •  asthma attack and shyness in children, •  intra-uterin growth defects and low birth weight (also occurs in non smoking mothers passively exposed to second hand tobacco), • suddent infant death (two fold increase) •  Heart attack (+25 %, it is the main cause of second hand related death) •  lung cancer (+ 26 %). Apart from these well established effects, many other effects are suspected with regard to non malignant diseases and the aggravation of pre-existing conditions or malignous diseases, however new scientific data is needed to confirm these effects.

  11. Cardiac disease (coronary disease) • Three meta-analysis including more than 25 epidemiologic studies demonstrates that second hand smoke exposure is associate to an excess of coronary disease (angina and myocardial infarction). • This effect is established for non-smokers exposed at home or in the working place. • Biological data explains this excess of risk. • The risk decreases when exposure stops. • A dose/response relationship exists. • The best estimate of this risk excess as compared to non exposed person is 25%. • Because of the number of people concerned, cardiac risk is the main risk of mortality with regard to second hand tobacco exposure.

  12. Lung carcinoma • More than 40 epidemiological surveys included in 3 meta-analysis established that second hand tobacco is associated with an increase in lung carcinoma (25%). • This effect is demonstrated in non-smokers exposed at home and in the working place. • A dose/response relationship exists. • The best estimate of risk as compared to a non exposed person is 26%.

  13. Two main risks of passive smoking in adults, in addition to those in pregnancy) Heart attacks 25% Lung carcinoma Increased risk 26% Disturbance Increase risk 80 % for non-smokers 53% for smokers.

  14. The four main risks of passive smoking in children Otitis media Increased risk of21%, 38% or 48 % according to whether father, mother or both are smokers Suddent infant death 2 fold increased risk Asthma attack Increased risk of14%, 38% or 48% according whether father, mother or both are smokers Bronchitis Increased risk of 72 % for a smoking mother and 29 % if an other family member smokes

  15. Number of workers exposed to respiratory carcinogens in France. Wood dust 177949 Formaldehyde 307025 Inorganic acid mists (sulf. ac. ) 375461 410499 Diesel exhaust fumes Radon and degradation product 523971 Second hand tobacco smoke. (>75% of working time) 1162464 0 200000 400000 600000 800000 1000000 1200000 1400000 Source : CAREX

  16. Percentage of people who report that non smokers are protect from second hand tobacco (%)

  17. Indoor tobacco pollution

  18. Decrease of nicotine in air according to tobacco control regulation 10 8,6 casino 8 Others workplaces 6 4 2,3 nicotine in air (mcg/m3) 1,3 2 0,7 0,3 0,2 0 No policies Non-smoking area Non-smoking casino • Source : Trout D, J Occup Environ Med 1998; 40:270-6 Hammond SK, JAMA 1995; 274:956-60

  19. Benefit to employees of smoking prohibition in restaurants 40 Symptoms in 67 barmen before and after smoking prohibition • , Dyspnea 30 Morning cough Day cough Sputum 20 Eyes irritation Number of barmen with symptoms Nose irritation Throat irritation 10 0 Before prohibition After prohibition Eisner M et coll., JAMA 1998, 280, 1909-1914 Source:

  20. Biological monitoring of passive smoking • exposed • Non-exposed • Compound • smoker • C0 • >10–20 ppm • 7–11 ppm • 3 ppm ± 1,5 • HbCO • 2-3 % • > 5 % • > 1,7 % • CG • RIA • CG • RIA • CG • RIA • Cotinine • 0,4 • 3,6 – 31,3 • 0 – 8 • Salive (ng/ml) • 1 • undetectable • undetectable • 5 –7,33 • Plasmatic (ng/ml) • Urinary (ng/ml) • 0–250 • 3 – 6810 • 0,3 – 392 • Urin. (ng/mg creat.) • 30 • 150,6 ± 155 • 5,8 ± 4,35 • 10–43,6 • Nicotine • Salive (ng/ml) • 2,49 • Plasmaic (ng/ml) • Urinary (ng/ml) • 21,5 ± 28,7 • 7,47 ± 8,25 • 396 CG = Gazeous chromatography RIA = radio-immuno-assay

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