Tobacco Documents Online

FOREST. the Freedom Organisacion for the Right to Enjoy Smoking Tobacco, claims there is no evidence that'bassive" smoking-breathing other people's smoke-is harmful. But the evidence is growing Sherridan Stock -. Smoke from any source consists of ix a scientist and a - minute particles suspended in a smoker -" mixture of gases that usually _ . include volatile organic substances and water vapour. A single cigarette produces about five million million particles, each measur]ng about 02 ym amoss. They are droplets of tar, and consist of numerous chemicals; altogether there are about 3000 different . chemirzls in cigarette smoke. Some of these chemicals, including nicotine, are present in the unburnt tobacco, but most are formed during combustion: Table 1 lists some of the more toxic ones and shows thetr biological importance, r Smoking a cigarette produces two main kinds of smoke; mainstream smoke, which is what the smoker draws into his mouth (and usually on into his lungs); and sidestream smoke, which issues into the atmosphere when the cigarette is held smouldering (or "idling"). From the passive smoker's point of view, it is side-stream smoke rather than exhaled mainstream smoke that is the more important. First, a cigarette produces about twice as much ~ side-stream smoke as mainstream smoke. (Side-stream • smoke may be less conspicuous though, since it is produced over a far IonSer period-about 10 minutes per cigarette compared s.ith only 20-30 seconds for mainstream smoke.) 5ecandly, many of the chemicals in tobacco smoke are presenr in hiKhcr <vncentratiuns in sideatream smoke, often con,iderably so. Md thirdly, side-stream smoke is "unfiltered", both by the cigarette filter, and more importantly, by the smoker himself. whose body retains substanttal amounts of the constituents of the smoke that he inhales. ' - FOREST maintains there is no evidence that passive smoking is harmful to healthy peopie-althougn the c3se s seems to be conceded for that large segment of the popula- tion suiiering from allergies or lung or heart disease. This assertion is in error; there is evidence. It is also misleading, for it implies that the relevant data have been sought, evaluated. and found to be negative. In fact the data are sparse, and it is this sparsity that is being taken as proof that health hazards do not exist. Doubtless the same rash elaim was repeated ad nauseam in connection with many uther environmental pollutants before their hazards were appreciated (as in the case of smoking itself). . It seems at least possible, if not probable, that passive smoking of sidastream smoke, often heavy, and repeated over a lifetime, could give rise to the same alarming spectrum of disease suSered by the smoker himself. The incidence and severity would be expected to be much fess among "passve smokers" though; their exposure will obviously be less intense due to the dilution in ambient aftr (and of cnurse the "active" smoker also breathes diluted side-stream smoke). One complicating factor is that low- level exposure to a toxin can sometimes be more toxic than exposure to a higher level of the same toxio-pos- sfhly berause the higher dose kills target cells instead of setting pernicious metabolic events in train-and it is believed that this might occur with certain of the chemicals in tobacco smoke. . -Studies to establish whether passive smoking could reuse any of the diseases associated with active smoking would need to be as prolonged and comples as those required to demonstrate such disease in smokers. How- ever, only a handful of such studies has been attempted, and the results of these are not in the least reassuring. There have also been many shnrt-term studies, and studies measuring atmospheric or bodily pollution, though of course the latter can provide only suggestive evidence of harmful effects. Some of these are now summarised. .ei 0

l New S<ientist 2 Oclohcv 1930 Report nn Smoking and 'This risk of bronchitis and pneumonia in the _ Hcalth covcludes ". .' it is very young is appreciably increased if either parent possible to .. demonstrate ehanpes in smokes, These illnesses be life-threatenin psychmnomr _ , g --Tunctlan at levels of curbon . at this acagen ...' . jnonovide found in passive smnking conditions . smukers. The reason is not In active smokers, uarbosyhaemoglobin levels are fre- clear, but Dr Miller proposes - quently in the a10 per cent range, and in very heavy that long[crm passive smok- -smokers may even approach 20 per cent. At these levels ing alone could account for -:mental function-including the abi]ity tu drive-clearly the finding. deteriorates. Drivers who smoke may thus create risks for 13, Tobacco smoke removes others. ., . . - d . . negative ions from the atmo- dn Los Angeles,avhere pollution is a special problem, sphere, which is already ~ research has shown that atmospheric levels of carbon grossly depleted of its ~ monoxide above about A ppm are assnciated with an natural cemplement by ; increase in the overall mortality rate. To what degree, if urban pollution and various ? any, these elevated levels of carbon monoxide me respon- other factors associated with I sible for the excess mortality is not clear; but an adverse modern. mammade environ- effect eHect on very ill patients, part.irularly those with lung or ments. Negative ions henefit J heart disease, would not be unexpectcd. the human body in many i 10. Passive smoking begins in the womb, and there is little ways, and are necessary for ' daubt that smoking during pregnancy can damage the full mental and physical y unborn child. The main effects seems to be to retard intra- health. In recognition of this effect of tobacco smuke, some uterine growth and development (probably by reducing company executives have installed negative ion generators the blood supply to the uterus), with the result (as shown in their offices and cnnference rooms. - by Professor N. A Butler of the Bristol Royal Hospital for 19- Immunological studies conducted by Professor Carl Sick Children, and H. Goldstein) that the babies are borrt Becker and colleagues at Cornell Medical Center, New smaller and go into childhood with reduced height and York Hospital, have shown that both active and passive with some educational retardation. -- snoking can probzbly sensitise a person to a glycoprotein Further. in women who smoke there is anfncrease in the found in tobacco smoke. The signincance of this is not stillbirth and neunatal death rate. In fact it has been clear, but Professor Becker suggests that continued calculated that maternal smoking results each year in the exposure tu tobacco glycoproteln could damage the arteries death of 1500 babies in Britain and 4600 in the United of a sensitised subject, and accelerate the development of States. Professor R- Saeye of Pennsylvania State Oniver- atherosclerosis_ Further, tobacco g!ycoprotein contains a sity College of biediune has demonstrated that much of flavonoid, rutin, which act!vates the blood clotting system. the In¢ease in the rxte of stillbirths and neonatal deaths and this might therefore complement the above effect to associated wilh maternal smoking probably results from produce arterial thrombosis. Becker also speculates that placental disorders, and that the incidence of these dis- persons sensitised to tobacco glycnprotein mayy as a result. . orders increzses with the number of years that cigarettes become allergic to a wide variety of other allergens that have been smoked. This finding suggests that established contain slmilar glycoproteins. . smokers who give up smoking during pregnancy-highly 15. According to the World Health Organisation, "Health desirable though this may be-might still run the risk of is not only ttie absence of disease and infirmity, but also losing their babies through their previous cigaretie con- the presence of full psychological, mental, and sonal well- ,Sumption. " I - . 1 be+nK'. On the basls of this admittedly broad but none the ~-11. Several studies have demonstrated that children whose less sensible definition, smoking must damage the health of . parents smoke, suffer more Inwer respiratory tract disease millions ot people wno do not smoke. (This concept proved .~ (eough, whceze. bronchitis, pneumonia) than children to be a significant factor in getting the Howard County ..; whose parents do net smoke, The same also appears to be Clean Air Act of 1977 enacted, which requires resraurants, ::Yrue for upper respiratory tract disease (colds, influenza, shops, offices and many other public places in Howard ' Dhaqrs4i[is. [onsillitisl, and this has recently been enn- County, Maryland, to provide separate areas for people firmed by a'study from the Institut Natinnal de la Sante who do not smoke.) :-..`. ,;._.'' - ` et de la Recherche \tedicale;.which demonstrated that In addition to all this, which I believe will eventually children of smokid¢ parents are about twice as likely to be seen as only the tip of the iceberg, smoking affects norr .. have their tonsils and/or adenoids removed than children smokers in many other ways-too numerous to discuss "whose parents do not smoke. However, other factors be- . here. The main reason for smoking is vndoubtedly to sides pas,i.e smokln¢ mav play a part-for evample, if obtain the effects of the psychuactive dru:, nicotine; people ` smoking induces respvatnry disease in the parent, the have no inclination to smuke materials that do not contain ~ parent could then infect the child. Yet, even when only such drugs. It is a most terrible indictment of modern man parents withuut symptoms are cunsidered,and other cnn- and his life.style that so many people depend upon a drug founding factors are mntrolled, the risk of bronctuHs and to the exlent that they are prepared to sacrifice their . pneumoma in the very young is appreciablv increased if health and their lives in order to obtain it, and in the either parent smokes: convincing evidence of an effect of pivicess are blinded to the mental and physical harm that passice smoklne. I'h.ese ilhu-stes con be life-threatcninG at they inflict upon those who have to live alongside them, this agc. Furthermore, lower respiratory tract illness in Perhzps I ran end with a nuotation from Dr H. Slahle:, the voune appears to give rise to impaired lung function direclorgeneral of the World Health Organisation, takcn and hest riise,ese in later childhood and in adulthood, even from his address to the Fourth World Conference an Smok o ^ tn those whn du not take up smoking, ing and Health, June 1979~ "Indi- , 12. In a remarkable new study conducted in Erie County, vidoa7s and governments are com- tf h'e Pennsylvania. Dr G. H. Mill n ' er at Edinboro State Coll e^e in t lth t h ca i a w 1 ki is whose husbands are long-standing cigarette smokers, die, do, it affects the health and the ~~~~ l~ M. on average, four y'ears earlier than women married to nom quality of life of everyone. .,." 0 =1.=^~ g . . esmo g i Pennsylvania, has tlemonsGa[ed that non-smoking w'omcn something that unly indisidunls can

. New Scienust 2 Oetober 1980 - 1. About 75 per cent of nomsmokers find it . cigarette smoke for two Niroti < ndocF«alksferds Tmm'm(moral oyens!) hours and then undertook I pbenol Irrnnu.na onnr mademte excrcise They (L yromoters experienced pain much GmeemDhme souner than when they had Niveuminer, Hydnclne. Vinyl chloride, Grcinogent nut been expused_ Patients ursthan< wi[h thronic bronr.nitis or I py,iLine. AtAeEyEer (Pormahkhyde, Ttaim or irtlnnu empnysema would presum- Aceraldenrdcqcrolein/,Hydrogen ably be affected simll.vly; ryan,de,uiuogeno,adn,Ammem., certairdv they ran espe:, earboo mono.me ence nonnus respuatory diss • The indunion of n appears < aior n.qa: tress in smoky atnmspheres, In'eiation and promotion~A mnar inmamr ie a rnbna c ma ior e mat brass and .me nrfIDn5t2nceS aeour rne in en [,aee, tEet b ron. v a r. mr1 ral inie a dor. reactions cnuid perneps be I m r a Tan^o Oro enaer.ioo r^ne'rcmat^onsme IifPthreatemng Co e: I . n < Irtnle en a or~ a e 4. 'Cobacco smoke rontains I prn e tn. . ~ , ~le o .e to mq yoro.~y:mp a als~~.ta >nd naboom j n u m e r o Y 5 nrnnOy'enic I~a ^ . v me~ a; rnoge am ia oaEl' ot bnnmmg e tn* I (eaneer-pruduanq/ m A c ~open ~r s~6v ~uame rG• ce aot a noge sub~ mo-emapo ,.. cn.~a.uaaone. acuon nru e1l stances,itduding 1000 or so . tobacco smoke may prr ,Itisashockingthing,blowingsmokeoutofourmouths tnasmnkyr0omsnhaleas dispase irritated eyes to much benzpyrene in one both bacterial and viral into other people's mouths, eyes and noses- and having hour as they would by f n f e c t i o n s. Contac[dens the same thing done to us.' - Scmuel Johmon smoking four clgarettes, and wearerssurferparticulardis- according to the Britsrt comfort. Other symptoms include headache (32 per cent), Ffedical Journol (1976, Vo] 2, p'te31 benzpyrene from this . nausea 19 percenUr dizziness or lightheadedness (6 per source is responsible for about two cases of lung car.cer eent).loss of inemory, difiieulty in concentration, depressive per year per 100 000 nonsmokers who receive regular and personatitychan¢es.doublevisian,andevenblacisoutsy fairly teavy exposure to tobacco smoke. However, this 2. Peopiee with allergic disease (about 10 per cent of the calculation takes no account of tl:e other substances in population), particularly hay fever and asthma suHerers, tobacco smokn associated with cancer, which could have are even more likely to suffer symptoms when exposed an additive or even synergistic eHect. Most cancer to tobacco smoke. Speer's study has shown that of those resezrcisets now subscribe to the linear theory of carcino- non smoking allergic patients adected, 73 per cent com- genesis rather than the threshold theory-that is, there is plain of eye Im[anon, 67 per cent of nasal symptoms no "safe" level of a carcinogen. (sneezine, dripping. stuthnessi, 46 per cent of headache, Nitroszmines are also well represented in tobacco 46 per cent of coughing. 23 per cent of wheezine, 23 per smoke; these are extremely powerful, orgxmspecific . cent of sore throat. 16 per cent of hoarseness. 15 per cent carcinogens in animals, and much indirect evider.ce sug. of nausea, and 5 per cent of dizziness. Other people's gests that the same is true in man. In fact r.itrosan:ines , tobzcrn smoke is one of the most serious problems asth- and various other organ-specific carcinogens in tobacco matic pati•tt•s have to faee in daily life. It can precipitate smoke may contribute to smokers' higher rates of cancer a Eull-hlown attack in same of the opper digestive and .., panents, and it has been Table I Somebiologicallyimportantcons[ituentsai aeas,respiratorp tracti, the pan- eas, acd the lower uriaary shnwn to induce or aqgra~ eigarette smoke - vate symptoms in more than tract. Ritrosamines can be 50 per cent of a>thmatte Sab.wnca Pmaerry p r e s e n[ in sidestream - children. (When the expo- '>^n'nataeepn^ae smoke in quantities fifty . sure is from parental smnk- Poi rromrzlc Eydronrbons Cancer initlaeon, times those present in main- promoten. ing the children often show ranor -stream smokc; and a non- -improvement if therr ~ .... ! °ollo''or smokerinasmokyroomcan , parents stop smokinq in ' Dibenarridinee. Dibenxonrbssole, and Cancer inichren inhale in one hour nitro- their presence.) ' amerav.-armes , samines equivalent to fnhal- ' 7- Patients with chronic rynbytindoles MesAylorbssoles, - Councinogens ing the mainstream smoke . heart or lung disease are ears:noh . from up to 35 fttertipped - especialfy vnlnerabie..In nne . Nisroe,m;ner, pwonmmato, wnenir, ---GronoaI nr dgarettes, study, patients with angina Nirk.lmmpounm,Gdmiummmpounm . . Incidentally, people who pectoris were efsposed to wromnic aminea -Bladder carcmoaem live in Utah but are not annoying to be fn the presence of a cigarette smaier. while at least 50 per cent of non- ..mokers say they suder detinite ill effects from passive emokiny. (About 55 per cent of British adu!ts are nurtsn:okers.) In one studv Or F. Speer nt the Children's Mercy Hospital. Kansas City, showed that of those healthy (nonUllereic) non-smoker,s a6ected. 69 per cent complain of eye irritation, 29 per cent of nasal symptoms (itc]ting, sneceinql. 25 per ren[ of cev.hinc, 6 per cent of sore throat. 4 per cent of hoarseness, and 4 per eent complain of .vheezine. The main eye sym_otnms are stinging, itchmg, and watering, and constant exposcre to . potycyclic aromatic hydrocarbons. which are probably the most important. Of thcsc hydro- carbons the most studied, but not necessarily the most intportantt is benzpyrene; a single cigarette generates about 130 ng and more than 100 ng of this enters the atmosphere directlv in side-stream smoke. Pipe tobacco liberates considerably more benzpyrene than the same amount of cigarette tobacco, protr ably mainiy because tobacco burns at lower temperatures in pipes. Although tobacco xsmoking pmduces far less benxpyrese than ~ coal tires or the ubiquitous garden bonfire, the ;difierence is that benzpyrene from tobacco ~smoi:ing is often released into confi:ted spaces. Indeed, non-smokers

I U li~~WlS~W3 iJr'~3*•I9S1?u~1~3G9 r I.,,y?c ~, ::Mah~,w s~s > ..rts:ava ~~~~~ dm? JA ~I as y~~ p»wu~~ ~ i.~ in:RuwnunoCeinmsw G°L'°Ln-vveeL. I Frornthe Illustrated London \ews: July 1900,ubove; ; and Seplembe. 1892 (right)-fears were that tFx chotera 1 ePHem,c in fiamourg would spread to England . 'Nicotine is a co-mrcinogen; a substance that augments the action of carcinogens, of which there is no shortage in the environment of -' yIdtiliditil .,. -,nusrase socees .. ~ , LY C pELIC10o5 . IMPORT.aIi t "•- . - ~- s t~ a~ - DR, TASSINARL ~ Mormons have u lower incidence of lung cancer than the general population of the US (the Mormans, who of course generally are nonsmokers, have an even lower inadence). It seems possible that reduced passive smoking could at least partially account for this finding. 5. As already indicated, the partJcles in cigarette smoke are mnute-indeed. they are in the colloidal sire-range, and by virtue of their large surface area have tremendous . adsorptive propeY•ies. Surface-active agents, which are abundant in the respiratory system, are readily adsorhed. They interact with the colloidal particles in cigarette smoke to form a cantple<, which accumulats with contlnued exposure. These complexes may irritate the lung lining- and may even lead to emphysema or possibly cance- whether formed in the lungs of a smoker, or anyone who GDEN' O ROSE OTTO DE CIGARETTES, PURE VIRGI.~'IA. . FIRST QUALITY. .. PURE RIOE PAPE9, ARE U~RIdALLE9. tion Atmospherique et Affections Respiratofrs Chroniques, in which the passive smoking of wives of smoking hus bands was examined. A further study faund reduced pulmonary function in children whose paren•s smoked. g. About threequarters of the nicotine released by a filter-tipped cigarette is Rberated into the atmosphere in side-stream smoke, and Drs M. A, H. Russell of the Institute of Psychiatry and C. Feyerabend have shown that most urban non-smokers have nicvtine in their body fluids for most of their lives. (Passive smoking is virtually unavoidable in towns.) Nicvtine is an alkaloid with a wide spectrum of biological activity and is more acutely toxic than either arsenic or cyanide. However, the latest /1979) US Surgeon Genr.ral's Report on Smoking and Health cron- siders that nicotine in the environment is of coacern inhales cigarette smoke. - because in smokers it is believed to accelerate athero- 6. Non-smokers who work in smoky offices have Cursch- sclerotic disease. Of more concern perhaps, is the recent-- mann's spirals in their sputum, whereas those who are not finding by Or F. G. Bock at Roswell Park Memorial Insti- - exposed to passive smoking do not. (Curxhmann's spiraLs tute, Buffalo, New York. that nicotine is a coMarcinogen-y ,. ~ are casts of jellitied mutvs which form within the small a substance that augments the action of carcinogens, of :- bronchi and bronrhioles of patients with chronic bronchial which there is no shortage in the environment of indu.s- •. - disorders.) This provids some evidence that passive trlalised societies. smuking can impair the action of the miaoscopic "hairs" 9. A cigarette generates up to about 70 mg of carban~~ ~ (cr7ia) that line the airways of the lungs, whose normal monoxide, some 50 mg of which is released in side-stream function is to remove inhaled dust partides and bacteria smoke; the concentration compares with that in vehide by propelling them, trapped in a blanket of muaus, up into exhaust. In smoky rooms, like pubs and conference rooms, the throat where the mucus is (imvluntarily) swallowed ._ thecarbonmonoxidclevelisusuallyabout10-15ppmbutmay In fact cigarette smoke contains mare than ten chenticals which poison the atLOn of respiratory cilia, and thus encourage mucus to stagnate in the lungs of the smoker. This state renders the smoker more liable to infection, ond further• is believed to facilitate the development of lung cancer by causing the retention of inhaled carcinogens. 7. In on important new study involving over 2000 subjects, Drs ], R. R'hite and H. F, Froeb at the University of California, San Diego, found that non-smokerz who had worked alongside smokers for many years had significantly poorer lung function than non-smokers without such exposure. In view of the particular tests employed, the tindrn¢s suegmc disease of tae "small" ainvays, which are broncni and bronchiules of less than two millimetres diameter-a condition which mzy be related to the deve!opment of chronic bronchitis. Disturbingly, but not really surprisingly, the aRUal valus obtained (15 to 20 per cent lower than normal) wese comparable to those found in aaive smokers smoking up to 10 ciRare;tes a day. Simiiar resulls have now been reported from a large French study conducted by the Couperative Group, Pollu- be much higher, particularly if the air is recirculated with- ' uu[ being adequately cleansed, and in confined spaces such as vehicles, where peaks of up to 95 ppm have been recorded in the vicinity of a person smoking a single cfgareae. (The level in the home of a non-smoker is about 2 ppm, white that of the outdoor air in London measured ' 6 m above pavement level and 10 m from the edge of amzjor roadway averages about 3•5 ppm.) Protracted esposure to such elevated levels can increase the rnneen- tratian of carboxyhaemoglobin in the blood-and only modest elevations will impair psychumolor function Ithe ability to perceive and react to stimuli like light and sound). Such impatrment could be important in people driving cars, or nperaling machines. However, researchers do not agree abnut the m mum carboxyhaemoglobin level required to impair funeHOm some have tound impair- ment at a level as low as 2 per cent f which passive smokers could achieye~, while others believc that 5 per cent is more realistic (which wnuld not be reached through pas- sive smnking). On the basis of the prescnt data the US Surgeon General's C o~L~_Z+e REp•MY