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Secondhand smoke kills one person for every 52 smokers

Secondhand smoke kills one person for every 52 smokers, study says. That’s a million people worldwide each year

(CNN)It took a mere 52 smokers to kill one person via secondhand smoke in 2016, according to a new analysis of worldwide statistics on the impact of smoking.

Considering there are an estimated billion smokers in the world, that means a million people die each year simply by inhaling the smoke around them, according to the study published Tuesday in the journal JAMA Network Open.

“There’s a sense of secondhand smoke being benign, or not as damaging as the actual smoking is,” said study co-author Dr. Jagat Narula, associate dean of global affairs at the Icahn School of Medicine at Mount Sinai in New York City.

“But it’s truly deadly,” Narula added.

“This study confirms what other research has shown: That nonsmokers are at risk from secondhand smoke and that no one should be exposed to it,” said Dr. Albert Rizzo, chief medical officer for the American Lung Association, who was not involved in the study.

“While it may be called ‘secondhand,’ the health effects of those exposed are truly firsthand,” Rizzo said.

Role of smokers

Secondhand smoke is defined as the mixture of the smoke breathed out by the smoker combined with the smoldering end of a cigarette, cigar or pipe. According to the United States National Library of Medicine, secondhand smoke contains more than 7,000 chemicals, 70 of which are known to cause cancer and hundreds more are toxic.

Even a low dose of secondhand smoke can contribute to sudden infant death and cause ear infections and asthma attacks in children while causing cancer and heart disease in adults.

“In 2006 the US Surgeon General declared there was no safe level of exposure to secondhand smoke,” Rizzo said.

While the harmful effects of secondhand smoke have been known for years, no one knew the full impact on deaths on a global basis, Narula said.

“We wanted to calculate how many smokers are needed to kill one innocent nonsmoker,” he said.

The Mount Sinai researchers worked in tandem with colleagues at the Amsterdam Medical Center, Amsterdam UMC, to analyze a number of datasets from the World Health Organization, the Global Burden of Disease Reports, International Mortality and Smoking Statistics and others.

They looked at the number of active smokers and secondhand smoke victims over a 26-year period from 1990 to 2016.

They developed a “secondhand smoke index” and applied it to North America; South Asia; Middle East and North Africa; East Asia and Pacific; Europe and Central Asia; Sub-Saharan Africa; Latin America and the Caribbean.

Globally, in 1990 it took only 31 smokers to kill one person; in 2016 that number rose to 52 smokers, the study found — an improvement due to smoking bans in restaurants, business and the like in some countries.

North America had the most favorable secondhand smoke index: around 86 smokers for each death. The Middle East and Southeast Asia had least favorable numbers due to few protective measures — around 43 smokers to one death.

More protections needed, study says

Despite the advances in some countries, the absolute number of people who smoked between 1990 and 2016 has been on the rise, the study says. That’s mostly due to the increase in smoking in China and India and other low-to-middle income countries, a trend which is expected to continue.

“This study demonstrates the devastating effect of secondhand smoke,” Narula said. By putting the blame for deaths directly at the feet of smokers, he added, this study will hopefully “influence public opinion against secondhand smoke exposure” and encourage governments to pass and enforce “stringent” anti-tobacco controls.

While developing countries need to step up their game, there is still much to be done in the US and other developed countries, said lead author Dr. Leonard Hofstra, a professor of cardiology at Amsterdam UMC.

“There is a lot to gain when it comes to strengthening policies to protect nonsmokers, especially children,” he said. “For example, it should not be allowed for parents to smoke inside their cars with them.”

Twenty-two states in the US have “not yet passed comprehensive laws protecting their citizens — and the Lung Association calls on them to do so,” Rizzo said, adding that the public can also make use of online tools provided by the American Lung Association “to end their addiction.”

CNN reached out to various tobacco companies for their response but did not hear back before our publication deadline.

It’s not safe to sit near smokers

Sitting near smokers in the cinema exposes you to up to ten cigarettes’ worth of smoke, a study suggests.

Researchers found that smokers can carry hazardous compounds from cigarette smoke on their clothes and skin — third-hand smoke — that is then released.

The study, carried out at Yale University, raises questions about whether regulations creating non-smoking areas do enough to minimise the risks of second and third-hand smoke.

Researchers tracked thousands of compounds in a cinema screening room over a week. They found that the volatile organic compounds found in tobacco smoke rose dramatically when audiences arrived for a film. Despite the screening room being a well-ventilated non-smoking area, the amounts were the equivalent of smoking between one and ten cigarettes in an hour.

This is the first study to demonstrate real-world third-hand smoke emissions in an indoor non-smoking environment. Years of research have shown that no level of exposure to cigarettes is safe. Public health initiatives focused on reducing second-hand exposure by banning smoking in public places, but the latest research, published in Science Advances, shows that even with no cigarette present, people are at risk of inhaling evaporated gases or dust that settles on surfaces after smoking.

Drew Gentner, associate professor of chemical and environmental engineering at Yale, said: “People are substantial carriers of third-hand smoke contaminants to other environments. The idea that someone is protected because they’re not directly exposed to second-hand smoke is not the case.”

Secondhand Smoke Exposure and Subsequent Academic Performance Among U.S. Youth


Previous research shows the associations between secondhand smoke exposure and health consequences among youth, but less is known about its effect on academic performance. This study examines a dose–response relationship between secondhand smoke exposure and subsequent academic performance among U.S. youth.


Data were from a nationally representative sample of youth non–tobacco users (aged 12–16 years) in Wave 2 (2014–2015) who completed Wave 3 (2015–2016) of the Population Assessment of Tobacco and Health Study ( n=9,020). Past-7-day number of hours exposed to secondhand smoke at Wave 2 and academic performance at Wave 3 (1=Mostly As to 9=Mostly Fs) were assessed. Weighted multivariable linear regression models were used to examine the association between hours of self-reported secondhand smoke exposure at Wave 2 and academic performance at Wave 3 (1=Mostly Fs, 9=Mostly As), adjusting for covariates including sociodemographics, prior academic performance, internalizing and externalizing problems, and substance use problems. Analyses were conducted in 2019.


More than 30% of U.S. youth non–tobacco users were exposed to secondhand smoke in the past 7 days. Compared with unexposed youth at Wave 2, those who were exposed for 1–9 hours had poorer academic performance at Wave 3 (adjusted regression coefficient= −0.11, 95% CI= −0.18, −0.04), and those who were exposed for ≥10 hours at Wave 2 had even poorer academic performance (adjusted regression coefficient = −0.31, 95% CI= −0.45, −0.18).


A dose–response relationship was observed between secondhand smoke exposure and academic performance among U.S. youth. Reducing youth secondhand smoke exposure may promote academic performance and subsequent educational attainment.

Tobacco smoke exposure reduction strategies – do they work?



Many children experience tobacco smoke exposure (TSE) and parents may take preventive measures to reduce TSE. The study goal is to assess if these strategies are associated with lower cotinine values, an objective biological measure of TSE.


Families admitted to Children’s Hospital Colorado from 2014-2018 who screened positive for TSE were invited to participate in a tobacco smoking cessation/reduction program. Caregivers were consented and asked about demographics, beliefs around smoking, and strategies to reduce TSE. Child urine samples were collected, tested for cotinine levels, and analyzed using geometric means. Bi-variable comparisons and multivariable linear regression were completed using SAS v9.4.


213 children (81.4%) are included in this analysis. The median ages of children and parents were 4 and 32 years. 57% of children were male, 36% were Hispanic, and 55% were white. 56% of parents had at least some college education and 69% had an annual income less than $50K. The median daily cigarettes smoked per day was 10. 88% reported using at least one type of protective measure to prevent TSE and 90% believed they protect other household members from TSE. None of the strategies had a significant relationship with lower cotinine levels on bi-variable or multivariable analyses.


Parental strategies to decrease TSE did not result in lower cotinine levels. Many measures are not evidence-based and do not protect children. Parent’s clothing and homes may create a reservoir for nicotine. Education should focus on exposure elimination and cessation rather than protective measures.

Parental Tobacco Counseling in the Well-Child Visit—A Method With Enhanced Effectiveness but Nowhere to Go

Exposure to tobacco is the leading preventable cause of disease and death in the United States and as such was noted in the recent US Surgeon General’s report, “The Health Consequences of Smoking: 50 Years of Progress”: “The epidemic of smoking-caused disease in the 20th century ranks among the greatest public health catastrophes of the century, while the decline of smoking consequent to tobacco control is surely one of public health’s greatest successes.”1(p33) As the documented consequences of passive tobacco exposure make clear, these observations are as relevant for the pediatric population of this country as they are for adults.

Parental tobacco use and child death

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How Much Are You ‘Smoking’ by Breathing Urban Air?

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Measures against secondhand smoke insufficient

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Smoke-Free Car Legislation and Student Exposure to Smoking

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Onam to see tobacco smoke-free zones bloom in the capital city

Ahead of the frenetic festival and wedding season, florists in the city have decided to make their shops tobacco smoke-free. The decision, taken by the Trivandrum Florists Association, seeks to protect the environs of its 600 member families and the health and well-being of thousands of customers.

Passing the resolution – in line with the Indian tobacco control law COTPA’s prohibition of smoking in public places – at its annual Onam gathering on Wednesday, the association also decided to set up statutory warning boards in member shops.

Association President M Vairavan Pillai presided over the function. General Secretary C Sasidharan Nair, Treasurer Haridas, Vice Presidents C Sukumaran Nair, K Radhakrishnan and S Ambika and Joint Secretaries S Sreekumaran Nair, T Suresh Kumar, T Manikantan and J Reena were also present.