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January, 2006:

California Identifies Secondhand Smoke As A “Toxic Air Contaminant”

Jerry Martin, Gennet Paauwe – the California Environmental Protection Agency | January 26, 2006

SACRAMENTO — Today the California Air Resources Board (ARB) identified environmental tobacco smoke (ETS), or secondhand smoke, as a Toxic Air Contaminant (TAC). ETS is now formally identified as an airborne toxic substance that may cause and / or contribute to death or serious illness. ARB’s action to list ETS as a TAC was based on a comprehensive report on exposure and health effects of ETS.

This new report reaffirms many of the adverse health effects associated with ETS, especially in children who live in homes where smoking occurs,” said ARB Chairman, Dr. Robert Sawyer. “It also raises new concerns about its effects on women. All this strongly supported the need for the Air Board to identify ETS as a serious health threat.”

Secondhand smoke is a complex mixture of compounds produced by burning of tobacco products. ETS is also a source of other toxic air contaminants such as benzene, 1,3 butadiene, and arsenic. In California each year, tobacco smoke is responsible for the release into the environment of 40 tons of nicotine, 365 tons of respirable particulate matter, and 1900 tons of carbon monoxide.

As required by State law, the ARB evaluated exposures to ETS, while the Office of Environmental Health Hazard Assessment (OEHHA) assessed the health effects from these exposures. The OEHHA evaluation clearly established links between exposure to ETS and a number of adverse health effects, including some specific to children and infants. These include premature births, low birth-weight babies and Sudden Infant Death Syndrome (SIDS). Other effects of ETS on children include the induction and exacerbation of asthma, and infections of the middle-ear and respiratory system.

The OEHHA evaluation also found links between ETS exposure and increased incidences of breast cancer in non-smoking, pre-menopausal women. ETS had already been linked to adult incidences of lung and nasal sinus cancer, heart disease, eye and nasal irritation, and asthma.

The ARB’s action rightfully puts second-hand tobacco smoke in the same category as the most toxic automotive and industrial air pollutants,” OEHHA Director Joan Denton said. “Californians, especially parents, would not willingly fill their homes with motor vehicle exhaust, and they should feel the same way about tobacco smoke.”

Now that ETS is identified as a toxic air contaminant, the ARB must evaluate the need for action to reduce exposures. In this risk management step, ARB conducts an analysis that includes a review of measures already in place, available options and the costs for reducing the health risks from ETS exposure. The analysis is conducted using an open public process.

More information is available on ARB’s ETS website, click here.

The Air Resources Board is a department of the California Environmental Protection Agency. ARB’s mission is to promote and protect public health, welfare, and ecological resources through effective reduction of air pollutants while recognizing and considering effects on the economy. The ARB oversees all air pollution control efforts in California to attain and maintain health based air quality standards.

Passive Smoking Risks in Catering Industry

Published by Oxford University Press on behalf of the Society of Toxicology on the 20th of January 2006: 

Risks for Heart Disease and Lung Cancer from Passive Smoking by Workers in the Catering Industry

Workers in the catering industry are at greater risk of exposure to secondhand smoke (SHS) when smoke free workplace policies are not in force. We determined the exposure of catering workers to SHS in Hong Kong and their risk of mortality from heart disease and lung cancer. Non-smoking catering workers were provided with screening at their workplaces and at a central clinic. Participants reported workplace, home and leisure time exposure to SHS. Urinary cotinine was estimated by enzyme immunoassay. Catering facilities were classified into three types: non-smoking, partially restricted smoking (with non-smoking areas) and unrestricted smoking. Mean urinary cotinine levels ranged from 3.3 ng/ml in a control group of 16 university staff, through 6.4 ng/ml (non smoking), 6.1 ng/ml (partially restricted) and 15.9 ng/ml (unrestricted smoking) in 104 workers who had no out of work exposures. Workers in non-smoking facilities had exposures to other smoking staff. We modeled workers’ mortality risks using average cotinine levels, estimates of workplace respirable particulates, risk data for cancer and heart disease from cohort studies, and national (US) and regional (Hong Kong) mortality for heart disease and lung cancer. We estimated that deaths in the Hong Kong catering workforce of 200,000 occur at the rate of 150 per year for a forty year working life time exposure to SHS. When compared with the current outdoor air quality standards for particulates in Hong Kong, 71% of workers exceeded the 24 hour and 98% exceeded the annual air quality objectives due to workplace SHS exposures.

Cost of tobacco-related diseases


Cost of tobacco-related diseases, including passive smoking, in Hong Kong

S M McGhee1, L M Ho1, H M Lapsley2, J Chau1, W L Cheung1, S Y Ho1, M Pow1, T H Lam1, A J Hedley1

1 Department of Community Medicine, University of Hong Kong, Hong Kong SAR, China
2 Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Brisbane, Queensland, Australia

Correspondence to:

Professor Anthony J Hedley
Department of Community Medicine, University of Hong Kong, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China; Background: Costs of tobacco-related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking.

Aim: To estimate the health-related costs of tobacco from both active and passive smoking.

Methods: Using local data, we estimated active and passive smoking-attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of US$1.3 million for a life lost.

Results: In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was US$532 million for active smoking and US$156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to US$9.4 billion.

Conclusion: The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke-free areas in the Asia Pacific Region and elsewhere.


Abbreviations: COPD, chronic obstructive pulmonary disease; IHD, ischaemic heart disease; LIMOR, University of Hong Kong Lifestyle and Mortality Study; OR, odds ratio; PAF, population attributable fraction; SAF, smoking-attributable fraction