Control of secondhand smoke exposure
- Jonathan M Samet, MD, MS
Jonathan M Samet, MD, MS
- Professor and Flora L. Thornton Chair, Department of Preventive Medicine
- Keck School of Medicine, University of Southern California
- Marianna Sockrider, MD, DrPH
Marianna Sockrider, MD, DrPH
- Associate Professor of Pediatric Pulmonology
- Baylor College of Medicine
- Section Editors
- George B Mallory, MD
George B Mallory, MD
- Section Editor — Pediatric Pulmonology
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
Exposure to secondhand smoke (SHS) takes place in many different microenvironments (ie, distinct places where time is spent). The contributions of various microenvironments to personal SHS exposures depend upon the amount of time spent in each setting, and on the concentrations of SHS in those environments. The contributions of different microenvironments also depend upon age, sex, and other sociodemographic factors that determine time-activity patterns. For children, the home is a dominant locus of exposure, whereas for adults the workplace and social environments may be significant loci, depending on coverage by clean indoor air regulations and laws.
The concentration of SHS in a particular indoor environment depends upon the intensity of smoking (the strength of the source), the rate of exchange of air in the space with outdoor air or other "clean" air, and the presence and effectiveness of any air cleaning devices. For public and commercial buildings, ventilation requirements are set by code, generally following the standards published by the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE). The ventilation standard assumes that adequate indoor air quality cannot be achieved if smoking is allowed, even with additional ventilation, a view reaffirmed in a position statement by ASHRAE . Air cleaning also is not sufficient if smoking is allowed. Elimination of smoking in an environment appears to be the only effective means of preventing SHS exposure in that location [2-4].
Strategies to prevent SHS exposure and the role of the healthcare provider are reviewed here. The adverse health effects of SHS and related issues are discussed separately:
- Samet JM, Bohanon HR, Jr., Coultas DB, Houston TP, Persily AK, Schoen LJ, Spengler J, Callaway CA, ASHRAE's Environmental Tobacco Smoke Position Document Committee. ASHRAE position document on environmental tobacco smoke. Atlanta, GA. American Society of Heating Refrigeration and Air Conditioning, 2005.
- Institute of Medicine. Chapter 7: Exposure to environmental tobacco smoke. In: Clearing the Air: Asthma and Indoor Air Exposures, National Academy Press, Washington, DC 2000. p.263.
- US Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National C, 2006.
- World Health Organization. Protection From Exposure to Second-hand Tobacco Smoke, WHO Press, Geneva 2007.
- Davis RM. Exposure to environmental tobacco smoke: identifying and protecting those at risk. JAMA 1998; 280:1947.
- Pirkle JL, Bernert JT, Caudill SP, et al. Trends in the exposure of nonsmokers in the U.S. population to secondhand smoke: 1988-2002. Environ Health Perspect 2006; 114:853.
- Stranges S, Bonner MR, Fucci F, et al. Lifetime cumulative exposure to secondhand smoke and risk of myocardial infarction in never smokers: results from the Western New York health study, 1995-2001. Arch Intern Med 2006; 166:1961.
- Centers for Disease Control and Prevention (CDC). Vital signs: nonsmokers' exposure to secondhand smoke --- United States, 1999-2008. MMWR Morb Mortal Wkly Rep 2010; 59:1141.
- Task Force on Community Preventive Services. Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med 2001; 20:10.
- Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Available at: www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf (Accessed on September 30, 2011).
- Winickoff JP, Hillis VJ, Palfrey JS, et al. A smoking cessation intervention for parents of children who are hospitalized for respiratory illness: the stop tobacco outreach program. Pediatrics 2003; 111:140.
- Winickoff JP, Buckley VJ, Palfrey JS, et al. Intervention with parental smokers in an outpatient pediatric clinic using counseling and nicotine replacement. Pediatrics 2003; 112:1127.
- Stotts AL, Green C, Northrup TF, et al. Feasibility and efficacy of an intervention to reduce secondhand smoke exposure among infants discharged from a neonatal intensive care unit. J Perinatol 2013; 33:811.
- Association of Reproductive Health Professionals. Current issues in smoking and reproductive health. 1996; ARHP Clinical Proceedings. Available at: www.arhp.org/healthcareproviders/onlinepublications/clinicalproceedings.cfm (Accessed on October 16, 2007).
- Mullen PD, Quinn VP, Ershoff DH. Maintenance of nonsmoking postpartum by women who stopped smoking during pregnancy. Am J Public Health 1990; 80:992.
- Mullen PD, Richardson MA, Quinn VP, Ershoff DH. Postpartum return to smoking: who is at risk and when. Am J Health Promot 1997; 11:323.
- Emmons KM, Hammond SK, Fava JL, et al. A randomized trial to reduce passive smoke exposure in low-income households with young children. Pediatrics 2001; 108:18.
- Farber HJ, Groner J, Walley S, et al. Protecting Children From Tobacco, Nicotine, and Tobacco Smoke. Pediatrics 2015; 136:e1439.
- Tobacco- Free Environments. Academy of Pediatrics. www2.aap.org/richmondcenter/pdfs/IssueBrief_Tobacco-freeEnvironments.pdf (Accessed on December 15, 2015).
- Farber HJ, Walley SC, Groner JA, et al. Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke. Pediatrics 2015; 136:1008.
- Frankowski BL, Weaver SO, Secker-Walker RH. Advising parents to stop smoking: pediatricians' and parents' attitudes. Pediatrics 1993; 91:296.
- Hopper JA, Craig KA. Environmental tobacco smoke exposure among urban children. Pediatrics 2000; 106:E47.
- Epps RP, Manley MW. A physicians's guide to preventing tobacco use during childhood and adolescence. Pediatrics 1991; 88:140.
- Sims TH, Committee on Substance Abuse. From the American Academy of Pediatrics: Technical report--Tobacco as a substance of abuse. Pediatrics 2009; 124:e1045.
- Klein JD. Incorporating effective smoking prevention and cessation counseling into practice. Pediatr Ann 1995; 24:646.
- A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. JAMA 2000; 283:3244.
- Marano C, Schober SE, Brody DJ, Zhang C. Secondhand tobacco smoke exposure among children and adolescents: United States, 2003-2006. Pediatrics 2009; 124:1299.
- Johansson A, Hermansson G, Ludvigsson J. How should parents protect their children from environmental tobacco-smoke exposure in the home? Pediatrics 2004; 113:e291.
- Blackburn C, Spencer N, Bonas S, et al. Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey. BMJ 2003; 327:257.
- Spencer N, Blackburn C, Bonas S, et al. Parent reported home smoking bans and toddler (18-30 month) smoke exposure: a cross-sectional survey. Arch Dis Child 2005; 90:670.
- King BA, Patel R, Babb SD. Prevalence of smokefree home rules--United States, 1992-1993 and 2010-2011. MMWR Morb Mortal Wkly Rep 2014; 63:765.
- Centers for Disease Control, Secondhand Smoke. Vital Signs, February 2015. Available at: http://www.cdc.gov/vitalsigns/tobacco/ (Accessed on February 09, 2015).
- Homa DM, Neff LJ, King BA, et al. Vital signs: disparities in nonsmokers' exposure to secondhand smoke--United States, 1999-2012. MMWR Morb Mortal Wkly Rep 2015; 64:103.
- Rees VW, Keske RR, Blaine K, et al. Factors influencing adoption of and adherence to indoor smoking bans among health disparity communities. Am J Public Health 2014; 104:1928.
- Wahlgren DR, Hovell MF, Meltzer SB, et al. Reduction of environmental tobacco smoke exposure in asthmatic children. A 2-year follow-up. Chest 1997; 111:81.
- Greenberg RA, Strecher VJ, Bauman KE, et al. Evaluation of a home-based intervention program to reduce infant passive smoking and lower respiratory illness. J Behav Med 1994; 17:273.
- Wall MA, Severson HH, Andrews JA, et al. Pediatric office-based smoking intervention: impact on maternal smoking and relapse. Pediatrics 1995; 96:622.
- Keintz MK, Fleisher L, Rimer BK. Reaching mothers of preschool-aged children with a targeted quit smoking intervention. J Community Health 1994; 19:25.
- McIntosh NA, Clark NM, Howatt WF. Reducing tobacco smoke in the environment of the child with asthma: a cotinine-assisted, minimal-contact intervention. J Asthma 1994; 31:453.
- Irvine L, Crombie IK, Clark RA, et al. Advising parents of asthmatic children on passive smoking: randomised controlled trial. BMJ 1999; 318:1456.
- Hovell MF, Zakarian JM, Matt GE, et al. Effect of counselling mothers on their children's exposure to environmental tobacco smoke: randomised controlled trial. BMJ 2000; 321:337.
- Hovell MF, Meltzer SB, Zakarian JM, et al. Reduction of environmental tobacco smoke exposure among asthmatic children: a controlled trial. Chest 1994; 106:440.
- Hovell MF, Meltzer SB, Wahlgren DR, et al. Asthma management and environmental tobacco smoke exposure reduction in Latino children: a controlled trial. Pediatrics 2002; 110:946.
- Groner JA, Ahijevych K, Grossman LK, Rich LN. The impact of a brief intervention on maternal smoking behavior. Pediatrics 2000; 105:267.
- Woodward A, Owen N, Grgurinovich N, et al. Trial of an intervention to reduce passive smoking in infancy. Pediatr Pulmonol 1987; 3:173.
- Eriksen W, Sørum K, Bruusgaard D. Is there an increased lability in parents' smoking behaviour after a childbirth? Scand J Prim Health Care 1996; 14:86.
- Chilmonczyk BA, Palomaki GE, Knight GJ, et al. An unsuccessful cotinine-assisted intervention strategy to reduce environmental tobacco smoke exposure during infancy. Am J Dis Child 1992; 146:357.
- Severson HH, Andrews JA, Lichtenstein E, et al. Reducing maternal smoking and relapse: long-term evaluation of a pediatric intervention. Prev Med 1997; 26:120.
- Farber HJ, Nelson KE, Groner JA, et al. Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke. Pediatrics 2015; 136:998.
- Winickoff JP, Friebely J, Tanski SE, et al. Beliefs about the health effects of "thirdhand" smoke and home smoking bans. Pediatrics 2009; 123:e74.
- Benowitz NL, Hukkanen J, Jacob P. Nicotine chemistry, metabolism, kinetics and biomarkers. In: Nicotine Psychopharmacology, Handbook of Experimental Pharmacology, Henningfield JE (Ed), Springer-Verlag, Berlin 2009. Vol 192, p.29.
- Sleiman M, Gundel LA, Pankow JF, et al. Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards. Proc Natl Acad Sci U S A 2010; 107:6576.
- Samet JM, Chanson D, Wipfli H. The Challenges of Limiting Exposure to THS in Vulnerable Populations. Curr Environ Health Rep 2015; 2:215.
- Schober W, Szendrei K, Matzen W, et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. Int J Hyg Environ Health 2014; 217:628.
- Czogala J, Goniewicz ML, Fidelus B, et al. Secondhand exposure to vapors from electronic cigarettes. Nicotine Tob Res 2014; 16:655.
- Durmowicz EL. The impact of electronic cigarettes on the paediatric population. Tob Control 2014; 23 Suppl 2:ii41.
- Pell JP, Haw S, Cobbe S, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med 2008; 359:482.
- Cesaroni G, Forastiere F, Agabiti N, et al. Effect of the Italian smoking ban on population rates of acute coronary events. Circulation 2008; 117:1183.
- Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence, The National Academies Press, Washington, DC 2010.
- Marchese ME, Shamo F, Miller CE, et al. Racial Disparities in Asthma Hospitalizations Following Implementation of the Smoke-Free Air Law, Michigan, 2002-2012. Prev Chronic Dis 2015; 12:E201.
- Been JV, Nurmatov UB, Cox B, et al. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. Lancet 2014; 383:1549.
- Kabir Z, Daly S, Clarke V, et al. Smoking ban and small-for-gestational age births in Ireland. PLoS One 2013; 8:e57441.
- Cheng KW, Glantz SA, Lightwood JM. Association between smokefree laws and voluntary smokefree-home rules. Am J Prev Med 2011; 41:566.
- Lee JT, Glantz SA, Millett C. Effect of smoke-free legislation on adult smoking behaviour in England in the 18 months following implementation. PLoS One 2011; 6:e20933.
- Hammond SK. Exposure of U.S. workers to environmental tobacco smoke. Environ Health Perspect 1999; 107 Suppl 2:329.
- American Nonsmokers Rights' Foundation. 100% Smokefree ordinance list. Available at: www.no-smoke.org/goingsmokefree.php (Accessed on January 08, 2010).
- Healthy People 2020 Objectives. Available at: http://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use/objectives (Accessed on November 15, 2015).
- US Department of Health and Human Services (USDHHS). The health consequences of involuntary smoking: A report of the Surgeon General. DHHS Publication No. (CDC) 87-8398, 1986.
- Lambert WE, Samet JM, Spengler JD. Environmental tobacco smoke concentrations in no-smoking and smoking sections of restaurants. Am J Public Health 1993; 83:1339.
- Rees VW, Connolly GN. Measuring air quality to protect children from secondhand smoke in cars. Am J Prev Med 2006; 31:363.
- STRATEGIES TO PREVENT SECONDHAND SMOKE EXPOSURE
- Recommendations of the Task Force on Community Preventive Services
- Air cleaners
- THE ROLE OF THE HEALTH CARE PROVIDER
- Support for smoking cessation
- THE HOME ENVIRONMENT
- Effect of smoking bans
- Third-hand smoke exposure
- Electronic cigarette secondhand vapor exposure
- PUBLIC SMOKING BANS
- Public places and transportation environments
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS