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Passive Smoking

In Greece’s tobacco culture, passive smoke a serious problem

Nearly two-thirds of Greeks are inhaling someone else’s tobacco smoke on a daily basis, making Greece the worst nation in the European Union in exposing its people to the health risks of passive smoking.

The European Union’s statistical office Eurostat said Wednesday that 64.2 percent of Greeks suffered daily exposure to tobacco smoke indoors. Second in the EU is Croatia with 44.7 percent, followed by Bulgaria with 40.5 percent. At the other end, Sweden best protects its people from secondhand smoke with only 5.9 percent exposed, even better than Finland with 6.3 percent.

In a tally of EU smokers aged 15 and over, Bulgaria tops the rankings with 34.7 percent, ahead of Greece with 32.6 percent. Sweden only has 16.7 percent who smoke, with Britain the second-lowest with 17.2 percent.

1 in every 4 persons aged 15 or over in the European Union is a smoker

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National Cancer Institute – The Economics of Tobacco and Tobacco Control

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Tobacco exposure ups behavioural issues and dropout rates in children

Exposure to tobacco smoke is immensely toxic to the developing brain.

Children exposed to tobacco smoke in early childhood adopt anti-social behaviour, engage in proactive and reactive aggression, and face conduct problems at school, even drop out at age 12, a research has showed. Exposure to tobacco smoke is toxic to the developing brain at a time when it is most vulnerable to environment input, the researchers said. ‘Young children have little control over their exposure to household tobacco smoke, which is considered toxic to the brain at a time when its development is exponential,’ said lead author and Professor Linda Pagani from the University of Montreal in Quebec, Canada. Parents who smoke near their children often inadvertently expose them to second- and third-hand smoke. Abnormal brain development can result from chronic or transient exposure to toxic chemicals and gases in second-hand tobacco smoke. These compounds eventually solidify and create third-hand smoke. In the study, the researchers found compelling evidence that suggests other dangers to developing brain systems that govern behavioural decisions, social and emotional life as well as cognitive functioning.

Anti-social behaviour is characterised by proactive intent to harm others, lack prosocial feelings, and violate social norms. Such behaviours include aggression, criminal offences, theft, refusal to comply with authority, destruction of property and is also associated with academic problems in later childhood. ‘These long-term associations should encourage policy-makers and public health professionals to raise awareness among parents about the developmental risks of second-hand smoke exposure,’ Pagani said. For the study, published in the journal Indoor Air, the team examined 1,035 boys and girls born in 1997 and 1998. Their parents reported whether anyone smoked at home when their children were aged 1.5 to 7.5 years. At age 12, their children self-reported their anti-social behaviour and academic characteristics. (Read: Children exposed to cigarette smoke may develop early heart disease)

Smoking parents linked to severe asthma

A third of children who have potentially fatal asthma attacks are being exposed to tobacco smoke, a new report has found.

Children’s doctors have become “complacent” in the need to advise parents about the hazards of smoke exposure among children with asthma, according to a new audit from the British Thoracic Society (BTS).

The review has prompted a call for health workers to do more to inform parents about the health risks of second-hand smoke to their children.

Experts reviewed data on 5,500 children admitted to 153 hospitals across the UK with severe asthma attacks in November 2015.

They found that 32 per cent had been exposed to environmental tobacco smoke.

The authors point out that passive smoking is “recognised as an important factor in asthma attacks in children that lead to hospitalisation”.

But two in five hospitals failed to record data on this issue, meaning doctors might need to pay greater attention to asking about exposure to tobacco smoke, they said.

The authors conclude: “Paediatricians may have become complacent about the need to record and advise parents about the hazards of smoke exposure in children with wheezing/asthma.”

Dr James Paton, reader in paediatric respiratory medicine at the University of Glasgow, who led the BTS audit, said: “It’s very worrying that a third of children were potentially exposed to tobacco smoke at home, although more data is needed here.

“When discharging children, health professionals should take the opportunity to talk about the issue with their parents or carers – and offer smoking cessation support as appropriate.”

Quebec’s new tobacco laws come into full effect Saturday

Smoking outside, within a 9 metre-radius of a window or door that opens, is now prohibited in Quebec, under the Tobacco Control Act.Formerly known as the Tobacco Act, several amendments were made to the law with the first changes coming into effect one year ago today.According to a government website, the Tobacco Control Act was enacted to protect the public from the dangers of second-hand smoke, to encourage smokers to quit smoking and to prevent youth from taking up smoking to begin with.

Changes to the act targeted several areas, including but not limited to, the use of tobacco in certain places, the promotion and advertising of tobacco products, a framework for electronic cigarettes and increased fines for offences.The last amendments to the law came into effect Saturday.The nine-metre radius rule is also applicable to air intakes connected to an enclosed place where smoking is not allowed. The exception is when the radius extends beyond property limits, meaning that if a door or window leads to a municipal sidewalk the smoke ban doesn’t apply.As of Saturday, it is also illegal for adults to buy tobacco products for minors.Anyone caught contravening the act can be fined anywhere from $250 to $3,000 depending on the offence and whether or not it’s a repeat offence. Prior penalties ranged from $50 to $3,000.For a full list of regulations, fines and offences, you can consult the Quebec government’s online health portal.

AHA: secondhand tobacco smoke ups atherosclerosis risk

In asymptomatic never smokers, the extent of secondhand tobacco smoke (SHTS) exposure is associated with the presence and extent of atherosclerosis, according to a study published online Nov. 13 in JACC: Cardiovascular Imaging. The research was published to coincide with the annual meeting of the American Heart Association, held from Nov. 12 to 16 in New Orleans.

David F. Yankelevitz, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues administered a questionnaire to 268 never smokers, ages 40 to 80 years, assessing risk factors and extent of lifetime SHTS exposure. The participants also underwent low-dose non-gated computed tomographic scans, followed by computed tomographic angiography.

The researchers found that 48 percent of participants had coronary atherosclerosis, and it was more frequent with low-to-moderate and high versus minimal SHTS exposure (48 and 69 versus 25 percent; P < 0.0001). For any atherosclerosis, the adjusted odds ratios were 2.1 (P = 0.05) and 3.5 (P = 0.01) for low-to-moderate and high, respectively, versus minimal SHTS exposure. With increasing SHTS exposure there was an increase in the percentage of major vessels with any plaque or stenosis (P = 0.0013) and in the number with five or more involved segments (P = 0.0001).

“The presence and extent of atherosclerosis were associated with the extent of SHTS exposure even when adjusted for other risk factors, further demonstrating the causal relationship of SHTS exposure and coronary disease,” the authors write.

Several authors disclosed patents relating to the research subject matter.

WHO commends Shanghai’s move to strengthen smoke-free law; urges strict enforcement as way forward

The World Health Organization (WHO) warmly welcomes the strengthening of Shanghai’s existing tobacco control law with respect to smoke-free public places and work places. The Shanghai Regulations on Control of Smoking in Public Places was amended today after months of intense debate and deliberation.

“We are delighted that with the adoption of this new law, Shanghai will be protecting non-smokers from the deadly harms of second-hand smoke. The amended law clearly prohibits smoking in all indoor public places, work places, and public transport as well as in many outdoor public areas. We look forward to Shanghai’s continuous effort to fully implement and enforce the 100% indoor smoking ban without exceptions,” said Dr Bernhard Schwartländer, WHO Representative in China.

The WHO Framework Convention on Tobacco Control (WHO FCTC) – the global tobacco control treaty which China ratified in 2005 – requires all indoor public places and work places to be 100% smoke-free. This is because exposure to second-hand smoke kills – and there is no safe level of exposure. Governments, including in cities like Shanghai, have an obligation to protect non-smokers from toxic, carcinogenic second-hand smoke. Exposure to second-hand smoke causes around 100,000 deaths in China each year.

“When this new law comes into force from March next year, the people of Shanghai will be able to breathe smoke-free indoor air. This is a huge step forward for the health of Shanghai’s more than 20 million residents: deaths caused by involuntary exposure to second-hand smoke are entirely preventable, and from a public health perspective that is simply unacceptable,” Dr Schwartländer said.

WHO notes with concern the clause in the new law which states that the city government may issue specifications regarding indoor smoking rooms under special circumstances.

“We hope that this clause in the law is never invoked. Allowing indoor smoking rooms – in any circumstances – would be in clear contravention of the WHO FCTC. The emphasis should now be on ensuring that the new law is strictly enforced, without any exceptions. Shanghai can count on WHO’s full support in this regard,” Dr Schwartländer said.

“Cities like Beijing, Moscow and others around the world have clearly shown that a comprehensive law that is fully WHO FCTC compliant coupled with rigorous enforcement, public education, and strong political leadership is a sure-win formula for success. 100% smoke-free public places do work. And they are incredibly popular with the public,” said Dr Schwartländer.

As Shanghai plays host to the 9th Global Conference on Health Promotion in just 10 days’ time, all eyes will be on the city and its best practices in promoting public health.

“By fully implementing and enforcing the comprehensive indoor smoking ban without exceptions, Shanghai will once again be able to position itself as a leader in tobacco control and the Healthy City movement in China.” Dr Schwartländer concluded.

About the World Health Organization (WHO):

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

For more information, please contact:
Ms WU Linlin WHO China Office E-mail: Office Tel: +86 10 6532 7191

Secondhand Smoke From Multiple Sources

Secondhand Smoke From Multiple Sources, Thirdhand Smoke and Respiratory Symptoms in Hong Kong Adolescents

Lok Tung Leung, BSc Sai Yin Ho, PhD Man Ping Wang, PhD Tai Hing Lam, MD



Reports on involuntary tobacco smoke exposure in children have focused mostly on secondhand smoke (SHS) from smoking inside the home. We studied the separate and combined prevalence of SHS exposure from multiple sources and thirdhand smoke (THS) and the associations with respiratory symptoms in Hong Kong adolescents.


In 2010–2011, 61 810 Secondary 1 (US Grade 7) to seven students reported their smoking status, respiratory symptoms, and exposure to four sources of tobacco smoke in the past 7 days. Weighted prevalence of exposure was calculated. Associations with respiratory symptoms were analyzed in 50 762 never smokers using logistic regression.


Tobacco smoke exposure at home was 23.2% considering SHS exposure from inside the home, but increased to 33.2% including SHS from neighbors and 36.2% further including THS. Including SHS outside home (55.3%), 63.3% of adolescents were exposed to SHS anywhere or THS at home. In never smokers, SHS from each source and THS at home were linearly associated with respiratory symptoms. Exposure to more sources yielded stronger associations with respiratory symptoms (p for trend<.001).

The adjusted odds ratios (95% CI) were 1.04 (0.97–1.11), 1.12 (1.03–1.22), 1.40 (1.26–1.56) and 1.99 (1.74–2.28) for 1, 2, 3, and 4 sources, respectively.


Although Hong Kong’s smoking prevalence is among the lowest in the developed world, over 60% of its adolescents were involuntarily exposed to tobacco smoke from one or more sources with a linear association with respiratory symptoms in never smokers. More stringent policies are needed to protect adolescents from tobacco smoke.


In a high-density urban setting, involuntary exposure to tobacco smoke in adolescents can be much higher than the smoking prevalence of the general population, especially if SHS exposure from multiple sources and THS are also considered. Such exposures have important health implications as demonstrated by their linear associations with respiratory symptoms. Tobacco control measures effective in reducing smoking prevalence may have little effect in reducing adolescent exposure to tobacco smoke, especially in the private home, in which other public health strategies are urgently needed.

Tobacco use and second-hand smoke exposure in young adolescents aged 12–15 years

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