The Big Smoke Debate
A London Health Commission Campaign

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Smoking - Frequently Asked Questions

There are around two million people in London who smoke. Many millions more are affected by passive smoking, which can cause many of the same diseases as active smoking, for example lung cancer and heart disease.

Passive smoking affects people of all age groups, across all social classes, from every ethnic group and in all boroughs of London.

Those most at risk are children, pregnant women, people with existing respiratory and cardiac disease and healthy adults in workplaces with unrestricted smoking.

To see answers to some commonly asked questions on passive smoking, select from one of the following questions:

• What is passive smoking?
  
• What does second-hand smoke contain?
  
• Passive smoking in the workplace
  
• What are the effects of passive smoking?
  
• What is the risk to children?
  
• What does the public want?
• What protection is there from passive smoking?

 

What is passive smoking?

• Breathing other people's smoke is called passive, involuntary or secondhand smoking. The nonsmoker breathes "sidestream" smoke from the burning tip of the cigarette and "mainstream" smoke that has been inhaled and then exhaled by the smoker
• Tobacco smoke is a major source of indoor air pollution. It takes more than two and a half hours for the toxins and carcinogens from a single cigarette smoked in a room with the windows open to fall to the acceptable risk level set by the US Environment Protection Agency(1)

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What does second-hand smoke contain?

• What you can see or smell is a small fraction of the emissions from a cigarette - 85% is in the form of invisible, odourless gases, which are not filtered by conventional ventilation systems, but still produce toxins that are harmful to health(2)
• Secondhand smoke contains 60 known or suspected carcinogens, more than 100 chemical poisons, five regulated hazardous air pollutants and 47 regulated hazardous wastes(3)

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Passive smoking in the workplace

• Secondhand smoke is now the only proven human carcinogen that is unregulated in the workplace
• Only half of workers are employed in smokefree workplaces and one in ten people work in places with no restrictions at all(4)

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What are the effects of passive smoking?

• Some of the immediate effects of passive smoking include eye irritation, headache, cough, sore throat, dizziness and nausea. Adults with asthma and other respiratory conditions can experience a significant decline in lung function when exposed, while new cases of asthma may be induced in children whose parents smoke(5)
• Passive smokers suffer an increased risk of a range of smoking-related diseases. Major reviews have concluded that passive smoking is a cause of lung cancer and heart disease in adult nonsmokers(6)
• Secondhand smoke may also cause spontaneous abortion, cervical cancer, have adverse effects on cognition and behaviour and exacerbate cystic fibrosis(7)

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What is the risk to children?

• More than four million people continue to smoke near children(4)
• Clinical evidence suggesting that children are particularly susceptible to the effects of passive smoking has been accumulating since the 1970s
• Passive smoking increases the risk of lower respiratory tract infections such as bronchitis, pneumonia and bronchiolitis in children. One study found that in households where both parents smoke, young children have a 72% increased risk of respiratory illnesses(8)
• Passive smoking causes a reduction in lung function and increased severity in the symptoms of asthma in children, and is a risk factor for new cases of asthma in children
• Infants of parents who smoke are more likely to be admitted to hospital for bronchitis and pneumonia in the first year of life
• It has been estimated that more than 17,000 children under the age of five are admitted to hospital every year because of the effects of passive smoking. That is five children under the age of five every day in London(9)
• Secondhand smoke also causes low birth rate and cot death(7)

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What does the public want?

• Recent surveys of public opinion in London and in Great Britain on smoking in public places including cafes, restaurants, fast food outlets, pubs, shopping centres, railway stations, taxis, hospitals, clinics, theatres, football grounds and colleges reveal widespread support for further restrictions on smoking and for the right to work in smokefree environments
• 78% of the public agree that people should be able to work in a smokefree environment. This includes 76% stating that this should also be true for waiters and waitresses and 61% supporting the right of bar staff to breathe clean air(10)
• 82% of tourists say it should be compulsory for pubs and bars to have smokefree areas and 56% want totally smokefree restaurants. One third of tourists found London smokier than their home town(11)

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What protection is there from passive smoking?

• In 1998, the Government published a White Paper 'Smoking Kills' on tackling smoking which proposed two initiatives on smoking in public places: the Public Places Charter, aimed at the hospitality trade, and the introduction of an Approved Code of Practice (ACoP) on smoking in the workplace
• The Public Places Charter was introduced in 1998, and is a voluntary agreement between the Department of Health and the licensed hospitality industry to 'increase the availability of clean air'
• The ACoP would provide legal guidance to employers on how to comply with their duties under the Health and Safety at Work Act 1974. The ACoP would have a special status under the law. It would not be an offence not to comply with the code, but it code could be introduced as evidence in a prosecution. Compliance with the code would offer some legal protection to employers against claims that they had failed to protect employees from passive smoking. The ACoP is still being considered by the Government
• A 1998 report by the Independent Scientific Committee on Smoking and Health (SCOTH) reviewed the evidence on passive smoking and concluded that: "Smoking in public places should be restricted on the grounds of public health"
• The Chief Medical Officer, Sir Liam Donaldson, highlighted passive smoking as one of five key public health issues in his annual report. He is calling for all employers to introduce smokefree workplaces and for "very serious consideration" to be given to introducing a ban on smoking in public places. He wants both health professionals' and the public's knowledge of the health risks from passive smoking to be improved

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References:

1. Journal of the Air and Waste Management. Ott et al. August 2003, Volume 53, Number 8.
2. National Research Council. Environmental Tobacco Smoke: Measuring exposures and assessing health effects. US National Academy of Sciences, 1986
3. Can ventilation control secondhand smoke in the hospitality industry, 2000. J Repace. www.repace.com
4. Lader D, Meltzer H. Smoking-related behaviour and attitudes, 2002. Office for National Statistics
5. Health Effects of Exposure to Environmental Tobacco Smoke. California Environmental Protection Agency. 1997
6. US Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorder
   Report of the Scientific Committee on Tobacco and Health. The Stationery Office, 1998
   Hackshaw et al. The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ, 1997
   Law et al. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ 1997
   Boffetta et al. Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe . Journal of the National Cancer Institute, 1998
   Health effects of exposure to environmental tobacco smoke, California Environmental Protection Agency. National Cancer Institute, 1999
7. World Health Organisation Consultation on Environmental Tobacco Smoke and Child Health. Consultation Report. 1999
8. Strachan, DP and Cook, DG.  Parental smoking and lower respiratory illness in infancy and early childhood. Thorax 1997
9. Smoking and the Young. Royal College of Physicians, 1992
10. MORI Omnibus, March 2003, for SmokeFree London
11. Conquest, September 2002 for SmokeFree London
12. Callum, The UK Smoking Epidemic. Health Education Authority, 1998
13. ASH Fact Sheet No 3: Why tobacco taxes should be high and continue to increase, February 1999

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