Secondhand Smoke & Asthma

Secondhand SmokeSecondhand Smoke
& Asthma& Asthma

ByBy
Dr . Ashraf El-AdawyDr . Ashraf El-Adawy
Consultant Chest PhyscianConsultant Chest Physcian
TEAM EXPERT – WHOTEAM EXPERT – WHO
Mansoura -EgyptMansoura -Egypt

Tobacco is one of the greatestTobacco is one of the greatest
emerging health disasters inemerging health disasters in
human historyhuman history
)WHO(

Tobacco use is the leadingTobacco use is the leading
preventable cause of death inpreventable cause of death in
the worldthe world
)WHO(

Nothing Kills Like TobaccoNothing Kills Like Tobacco

Smoking is surelySmoking is surely
the Silent killerthe Silent killer
of lifeof life

This year, tobacco will kill more than fiveThis year, tobacco will kill more than five
million people )1 every 6 seconds( –million people )1 every 6 seconds( –
more than tuberculosis, HIV/AIDS andmore than tuberculosis, HIV/AIDS and
malaria combinedmalaria combined
By 2030, the death toll will exceed eightBy 2030, the death toll will exceed eight
million a year , 80% of those deaths willmillion a year , 80% of those deaths will
occur in developing countriesoccur in developing countries..
WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva

The number of smokers in the world, estimated atThe number of smokers in the world, estimated at
1.3 billion, is estimated to rise to 1.7 billion by1.3 billion, is estimated to rise to 1.7 billion by
2025 if the global prevalence of tobacco use2025 if the global prevalence of tobacco use
remains unchangedremains unchanged
Four-fifths of these current smokersFour-fifths of these current smokers
live in low- or middle- income countrieslive in low- or middle- income countries..
)WHO World Health Report, 2003(

Smokers are not the only ones sickened andSmokers are not the only ones sickened and
killed by tobacco, Second-hand smoke alsokilled by tobacco, Second-hand smoke also
has serious and often fatal healthhas serious and often fatal health
consequencesconsequences
The Tobacco TragedyThe Tobacco Tragedy

One weapon that kills from both endsOne weapon that kills from both ends

Second-hand tobacco smoke killsSecond-hand tobacco smoke kills
600 000 people each year600 000 people each year..
WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2009

For every eight smokers who die fromFor every eight smokers who die from smoking,smoking,
one innocent bystander dies from secondhand smokeone innocent bystander dies from secondhand smoke
National cancer institute

Secondhand SmokeSecondhand Smoke
Synonyms:
••Environmental tobacco smoke )ETSEnvironmental tobacco smoke )ETS((
••Involuntary smokingInvoluntary smoking
••Passive smokingPassive smoking
WHO

What is Second Hand SmokeWhat is Second Hand Smoke??
The topic of passive or involuntary smokingThe topic of passive or involuntary smoking
was first addressed in the 1972 U.S.was first addressed in the 1972 U.S.
Surgeon General’s ReportSurgeon General’s Report
Now referred to as “secondhand smoke” orNow referred to as “secondhand smoke” or
“Environmental tobacco smoke“Environmental tobacco smoke.”.”
The term “secondhand” smoke betterThe term “secondhand” smoke better
captures the involuntary nature ofcaptures the involuntary nature of
the exposurethe exposure
A Report of the Surgeon General, U.S. 2006

ETS =ETS = MSMS ++ SSSS
Environmental tobacco smoke )ETS(,Environmental tobacco smoke )ETS(,
is the combination ofis the combination of::
Sidestream smokeSidestream smoke )85%()85%( :: smoke emittedsmoke emitted
from a burning tobacco productfrom a burning tobacco product
Mainstream smokeMainstream smoke )15%()15%( :: smoke exhaledsmoke exhaled
from the lungs of smokersfrom the lungs of smokers
What isWhat is
Second-Hand SmokeSecond-Hand Smoke??
American cancer society

Only 15 per cent of the smoke from a cigaretteOnly 15 per cent of the smoke from a cigarette
is inhaled by the smoker - the remaining 85%is inhaled by the smoker - the remaining 85%
goes into the surrounding air for everyonegoes into the surrounding air for everyone
to breatheto breathe
More than 85% of a burning cigarette goes intoMore than 85% of a burning cigarette goes into
the room atmosphere where it takesthe room atmosphere where it takes
up to 3 hours to disperseup to 3 hours to disperse
University of Minnesota 2003- Secondhand Smoke Facts

Secondhand Smoke stays in theSecondhand Smoke stays in the
air for at least three hoursair for at least three hours,,
It then gradually settles intoIt then gradually settles into
clothing, furniture andclothing, furniture and
carpetingcarpeting..
Even after the smoke is gone,Even after the smoke is gone,
toxic residue remains on thetoxic residue remains on the
carpet, walls and on objects,carpet, walls and on objects,
Children may absorb theseChildren may absorb these
toxinstoxins..
Thirdhand SmokeThirdhand Smoke

VOCs
INDOOR SURFACESINDOOR SURFACES
Exposure to secondhand tobacco smoke
in the indoor environment
Direct exposureDirect exposure
IndirectIndirect
exposureexposure
SVOCs
re-emitted SVOCs
and products of
chemical reactions
H. Destaillats, LBL

Methanol
Carbon Monoxide
Hydrogen Cyanide
Acetone
Tar
DDT
Naphthalene
Vinyl Chloride
Benzene
There is No risk-free level of exposure to firsthand
or secondhand tobacco smoke
SHS contains at least 250 toxic chemicalsSHS contains at least 250 toxic chemicals
Formaldehyde
Mercury
Lead
Arsenic
Toluene
Cadmium
Ammonia
Butane
Ethanol

Secondhand smoke contains more thanSecondhand smoke contains more than
50 cancer-causing chemicals50 cancer-causing chemicals
When nonsmokers are exposed to SHS,When nonsmokers are exposed to SHS,
they inhale many of the same cancer-causingthey inhale many of the same cancer-causing
chemicals that smokers inhalechemicals that smokers inhale
Sidestream smoke is more hazardous thanSidestream smoke is more hazardous than
mainstream smokemainstream smoke
A Report of the Surgeon General, U.S. Department of Health and Human Services 2006

How common is second-handHow common is second-hand
smoke exposuresmoke exposure??
WHO Report on the Global Tobacco Epidemic, 2009

an estimated 700 millionan estimated 700 million
children worldwide,children worldwide,
nearly half of all childrennearly half of all children
in the worldin the world are exposedare exposed
to second-hand tobaccoto second-hand tobacco
smoke at homesmoke at home

Each year, approximately 50 million pregnantEach year, approximately 50 million pregnant
women worldwide are exposed towomen worldwide are exposed to
secondhand smoke duringsecondhand smoke during
their pregnancytheir pregnancy..
National institute of cancer

Primary Locations for SHS ExposurePrimary Locations for SHS Exposure
••HomeHome
Smokers expose non-smoking family members
••Public VenuesPublic Venues
Workplaces, restaurants, bars, other gathering
places
••VehiclesVehicles
Automobiles

Groups of People at Greater RiskGroups of People at Greater Risk
Pregnancy and NewbornsPregnancy and Newborns
Children and TeensChildren and Teens
People With Asthma, COPD and OtherPeople With Asthma, COPD and Other
Respiratory ConditionsRespiratory Conditions

Health risks associated with exposureHealth risks associated with exposure
to secondhand smoketo secondhand smoke
Secondhand smoke is not a mere annoyanceSecondhand smoke is not a mere annoyance
but a serious health hazardbut a serious health hazard..
Secondhand smoke causes disease,Secondhand smoke causes disease,
premature death in nonsmokingpremature death in nonsmoking
adults and childrenadults and children..
The U.S. Surgeon General’s 2006The U.S. Surgeon General’s 2006 report onreport on

–In 2006, the California Environmental Protection
Agency’s Air Resources Board designated
SHS a Toxic Air Contaminant (TAC), anSHS a Toxic Air Contaminant (TAC), an
“airborne toxic substance that may“airborne toxic substance that may
cause and/or contribute to death orcause and/or contribute to death or
serious illnessserious illness”.”.
Secondhand Smoke is DeadlySecondhand Smoke is Deadly
The U.S. Surgeon General’s 2006The U.S. Surgeon General’s 2006 reportreport

SHS has been designated as a known human carcinogenSHS has been designated as a known human carcinogen
by the U.S. Environmental Protection Agency, Nationalby the U.S. Environmental Protection Agency, National
Toxicology Program and the International Agency forToxicology Program and the International Agency for
Research on Cancer (IARCResearch on Cancer (IARC).).
The National Institute for Occupational Safety and HealthThe National Institute for Occupational Safety and Health
has concluded that secondhand smoke is anhas concluded that secondhand smoke is an
occupational carcinogenoccupational carcinogen

In 1992, The U.S. Environmental Protection AgencyIn 1992, The U.S. Environmental Protection Agency
has officially labelled second -hand smoke as ahas officially labelled second -hand smoke as a
"class A" carcinogen"class A" carcinogen , a substance known to, a substance known to
cause cancer in humans , to which there iscause cancer in humans , to which there is
NO safe level of exposureNO safe level of exposure

Keep in mind, however, that everyone exposedKeep in mind, however, that everyone exposed
to secondhand smoke is at riskto secondhand smoke is at risk
““Breathing Even a Little Secondhand SmokeBreathing Even a Little Secondhand Smoke
Can Be DeadlyCan Be Deadly””
The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General.
Atlanta, GA: U.S. Department of Health and Human Services, 2006.

Health Consequences of SHSHealth Consequences of SHS
Short-term effects of second-hand smokeShort-term effects of second-hand smoke::
CoughingCoughing
HeadacheHeadache
Eye irritationEye irritation
Sore throatSore throat
Sneezing and runny noseSneezing and runny nose
Feeling sickFeeling sick
Breathing problems (and possibly an asthma attackBreathing problems (and possibly an asthma attack))
Irregular heart beats (a particular problem for people withIrregular heart beats (a particular problem for people with
heart diseaseheart disease))

Lung cancer
Risk increased by 20 -30%
Coronary heart disease
Risk increased by 25 -30%
Discomfort
80 % for non smokers,
53% for smokers.
The 2 Main Risks of SHSThe 2 Main Risks of SHS
in Adultsin Adults

SHS and Cardiovascular DiseasesSHS and Cardiovascular Diseases

Nonsmokers exposed to secondhand smokeNonsmokers exposed to secondhand smoke
at home or work increase their risk ofat home or work increase their risk of
developing heart disease bydeveloping heart disease by
25 to 30 percent25 to 30 percent
SHS and Cardiovascular DiseaseSHS and Cardiovascular Disease
The 2006 Surgeon General's Report

because of the risk that even short-term exposure (asbecause of the risk that even short-term exposure (as
little as 30 minutes) to SHS can trigger heart attackslittle as 30 minutes) to SHS can trigger heart attacks..
SHS and Cardiovascular DiseaseSHS and Cardiovascular Disease
In April 2004, the CDC issued a warning
that all patients with heart disease should
avoid exposure to secondhand smoke..

Nonsmokers exposed to secondhand smokeNonsmokers exposed to secondhand smoke
at home or work increase their risk ofat home or work increase their risk of
developing lung cancer bydeveloping lung cancer by
20 to 30 percent20 to 30 percent
SHS and lung cancerSHS and lung cancer

WHO May 2007
Exposure to secondhand smokeExposure to secondhand smoke
in the workplace is estimatedin the workplace is estimated
by the International Laborby the International Labor
Organization to causeOrganization to cause
approximately 200,000 deathsapproximately 200,000 deaths
per year worldwideper year worldwide..
Secondhand smoke at WorkSecondhand smoke at Work

Secondhand smoke at WorkSecondhand smoke at Work
••Secondhand smoke levels in restaurants areSecondhand smoke levels in restaurants are
150% higher than in a home with at least150% higher than in a home with at least
one smokerone smoker
••Secondhand smoke levels in bars are 450%Secondhand smoke levels in bars are 450%
higher than in a home with at least onehigher than in a home with at least one
smokersmoker
American cancer society

Pregnancy & Secondhand SmokePregnancy & Secondhand Smoke

Pregnancy & Secondhand SmokePregnancy & Secondhand Smoke
Double risk of Sudden Infant Death SyndromeDouble risk of Sudden Infant Death Syndrome
(SIDS or cot death(SIDS or cot death(.(.
low birth weightlow birth weight
preterm deliverypreterm delivery..
intrauterine growth retardationintrauterine growth retardation
spontaneous abortion (miscarriagespontaneous abortion (miscarriage(.(.
Have children born with decreasedHave children born with decreased
lung functionlung function
Protection from exposure to second-hand tobacco smoke. Policy recommendations. 2007

Secondhand smokeSecondhand smoke
A Health Hazard to ChildrenA Health Hazard to Children

““Almost half of the world’s children are regularlyAlmost half of the world’s children are regularly
exposed to ETSexposed to ETS ,, Most have No choice in the matterMost have No choice in the matter””
Home is the predominant location for exposure ofHome is the predominant location for exposure of
children to SHSchildren to SHS
WHO
Kids are Especially SusceptibleKids are Especially Susceptible!!

Kids are Especially SusceptibleKids are Especially Susceptible!!
Children breath at a faster rateChildren breath at a faster rate
than adults,inhaling more airthan adults,inhaling more air..
Children’s bodies are smaller thanChildren’s bodies are smaller than
adults, and their immuneadults, and their immune
systems are less developedsystems are less developed..
Often children can’t escapeOften children can’t escape
smoky environmentssmoky environments..

􀂋􀂋 Sudden Infant Death SyndromeSudden Infant Death Syndrome
􀂋􀂋 Acute respiratory infectionsAcute respiratory infections
􀂋􀂋 Chronic middle ear infectionsChronic middle ear infections
􀂋􀂋 Reduced lung function growthReduced lung function growth
􀂋􀂋 Asthma induction andAsthma induction and
ExacerbationExacerbation

In addition to the many health hazards of SHS,In addition to the many health hazards of SHS,
Children whose parents smoke are one-and-aChildren whose parents smoke are one-and-a
half to two times more likely to smokehalf to two times more likely to smoke
themselvesthemselves

Sudden infant death
Risk x 2
Otitis media risk increased 21-
38-48 % when the father, the
mother or both are smokers..
The 4 Main Risks of SHSThe 4 Main Risks of SHS
in childrenin children
Bronchitis risk increased by 72% if
the mother is a smoker and 29% if
another family member is a smoker.
Asthma attacks
Risk increased by 14,38 and
48% when the father, the
mother or both are smokers.

Secondhand Smoke and AsthmaSecondhand Smoke and Asthma
Persons who already have asthma or other respiratory conditionsPersons who already have asthma or other respiratory conditions
are at especially high risk for being affected by secondhandare at especially high risk for being affected by secondhand
smokesmoke
Brief exposure to secondhand smoke can trigger an asthma attackBrief exposure to secondhand smoke can trigger an asthma attack
in children with asthmain children with asthma
Asthma attacks are perhaps the most well-known health effectAsthma attacks are perhaps the most well-known health effect
of secondhand smoke exposure among childrenof secondhand smoke exposure among children
Sadly, children are powerless to protect themselvesSadly, children are powerless to protect themselves
from the dangers of secondhand smokefrom the dangers of secondhand smoke

Asthma is the most common chronic childhood diseaseAsthma is the most common chronic childhood disease
SHS is one of the leading triggers for an asthma attack ,especiallySHS is one of the leading triggers for an asthma attack ,especially
in childrenin children
SHS exposure causes children who already have asthma toSHS exposure causes children who already have asthma to
experience more frequent and severe attacksexperience more frequent and severe attacks
SHS is probably the most important indoor pollutant, especiallySHS is probably the most important indoor pollutant, especially
around young childrenaround young children
The National Asthma Council of Australia

Secondhand smoke exposure increases the frequencySecondhand smoke exposure increases the frequency
of episodes and the severity of symptoms inof episodes and the severity of symptoms in
asthmatic childrenasthmatic children..
According to the EPA, children's exposure to SHS isAccording to the EPA, children's exposure to SHS is
responsible for increases in the number and severityresponsible for increases in the number and severity
of asthma attacks in 200,000 to 1 million childrenof asthma attacks in 200,000 to 1 million children
with asthmawith asthma

Children who are exposed to second hand smoke are at higherChildren who are exposed to second hand smoke are at higher
risk for severe and life-threatening asthma attacks and poorlyrisk for severe and life-threatening asthma attacks and poorly
controlled asthmacontrolled asthma
Exposure to SHS in the home increases emergency room visitsExposure to SHS in the home increases emergency room visits
and medication use by asthmatic childrenand medication use by asthmatic children..
Reducing ETS exposure is associated with both fewer visits to theReducing ETS exposure is associated with both fewer visits to the
emergency room and fewer hospitalizations related to asthmaemergency room and fewer hospitalizations related to asthma

AAAAI: Fetal Tobacco ExposureAAAAI: Fetal Tobacco Exposure
Promotes AsthmaPromotes Asthma
Maternal smoking during pregnancy was associated with theMaternal smoking during pregnancy was associated with the
development of asthma during childhood than postnataldevelopment of asthma during childhood than postnatal
SHS or breastfeeding by smoking momsSHS or breastfeeding by smoking moms
Children of different ethnicities with exposure in utero to tobaccoChildren of different ethnicities with exposure in utero to tobacco
smoking were at nearly six times as likely to develop persistentsmoking were at nearly six times as likely to develop persistent
asthma than children whose moms didn't smoke duringasthma than children whose moms didn't smoke during
pregnancypregnancy,,
There was also a clear correlation between the numberThere was also a clear correlation between the number
of cigarettes smoked and the risk of developing asthmaof cigarettes smoked and the risk of developing asthma
AAAAI March 01, 2010

Relative to children of never-smokers, children whose mothersRelative to children of never-smokers, children whose mothers
smoked throughout the pregnancy have an elevated risk ofsmoked throughout the pregnancy have an elevated risk of
asthma in the first five years of life.asthma in the first five years of life.
Children whose mothers quit smoking prior to the pregnancyChildren whose mothers quit smoking prior to the pregnancy
show no increased riskshow no increased risk..
The connection between prenatal smoke exposure andThe connection between prenatal smoke exposure and
asthma appears to be mediated via the developmentasthma appears to be mediated via the development
of bronchial hyper-responsivenessof bronchial hyper-responsiveness
American Nonsmokers' Rights Foundation September 2009

Studies have shown that exposure to secondhandStudies have shown that exposure to secondhand
smoke can lead to the development of new casessmoke can lead to the development of new cases
of asthma in in preschool aged children whoof asthma in in preschool aged children who
were not born with itwere not born with it....
Second hand smoke increases the risk ofSecond hand smoke increases the risk of
early onset asthmaearly onset asthma
New England Journal of Medicin18 March 2009

Smoking by either parent, particularly by the mother,Smoking by either parent, particularly by the mother,
increases the risk of asthma in childrenincreases the risk of asthma in children
Children aged five years and under have significantChildren aged five years and under have significant
increases in the likelihood of developing asthmaincreases in the likelihood of developing asthma
if the mother smokes ten or more cigarettesif the mother smokes ten or more cigarettes
per dayper day
Action on Smoking and Health

Secondhand smoke exposure is associated with increasedSecondhand smoke exposure is associated with increased
respiratory-related school absenteeism among children,respiratory-related school absenteeism among children,
especially those with asthmaespecially those with asthma..
Children with asthma who live in homes where one parent smokesChildren with asthma who live in homes where one parent smokes
are twice as likely, than children with asthma whose parents doare twice as likely, than children with asthma whose parents do
not smoke, to take time off school due to a respiratory illness.not smoke, to take time off school due to a respiratory illness.
If both the parents smoke, then the asthmatic children is fourIf both the parents smoke, then the asthmatic children is four
times as likely to be absent from schooltimes as likely to be absent from school
Studies show that even if a child does not suffer from asthma, butStudies show that even if a child does not suffer from asthma, but
both their parents smoke, they will have a 40% higher chanceboth their parents smoke, they will have a 40% higher chance
of being absent from school due to a breathing illnessof being absent from school due to a breathing illness

Babies whose mothers smoke while pregnant or whoBabies whose mothers smoke while pregnant or who
are exposed to secondhand smoke after birth haveare exposed to secondhand smoke after birth have
weaker lungs than unexposed babies, whichweaker lungs than unexposed babies, which
increases the risk for many health problemsincreases the risk for many health problems
Secondhand smoke exposure causes respiratorySecondhand smoke exposure causes respiratory
symptoms in children and slows their lung growthsymptoms in children and slows their lung growth

The U.S. Environmental Protection Agency (EPA) has reportedThe U.S. Environmental Protection Agency (EPA) has reported
that secondhand smoke exposure increases the risk of lowerthat secondhand smoke exposure increases the risk of lower
respiratory tract infections such as bronchitis and pneumonia.respiratory tract infections such as bronchitis and pneumonia.
The EPA estimates that between 150,000 and 300,000 annualThe EPA estimates that between 150,000 and 300,000 annual
cases of lower respiratory tract infections in infants and youngcases of lower respiratory tract infections in infants and young
children up to 18 months of age are attributable to secondhandchildren up to 18 months of age are attributable to secondhand
smoke exposure.smoke exposure.
Of these cases, between 7,500 and 15,000 result inOf these cases, between 7,500 and 15,000 result in
hospitalizationhospitalization..

ETS exposure in childrenETS exposure in children
Nationwide, secondhand smoke exposure increases the numberNationwide, secondhand smoke exposure increases the number
of episodes and the severity of asthma in children who alreadyof episodes and the severity of asthma in children who already
have the diseasehave the disease
source: American Lung Association
Children exposed to secondhand smoke in utero and in the homeChildren exposed to secondhand smoke in utero and in the home
are more likely to develop asthmaare more likely to develop asthma....
Source: American Lung Association
Exposure to the smoke of as few as 10 cigarettes per day raisesExposure to the smoke of as few as 10 cigarettes per day raises
a child’s chances of getting asthma even if that child hasa child’s chances of getting asthma even if that child has
never had any symptomsnever had any symptoms
Source: Centers for Disease Control
•.

Repercussions on Adult HealthRepercussions on Adult Health
Not only does in utero and childhood secondhandNot only does in utero and childhood secondhand
smoke exposure cause decreased lung functionsmoke exposure cause decreased lung function
and asthma in children, but such exposure isand asthma in children, but such exposure is
also responsible for poor lung function andalso responsible for poor lung function and
respiratory disease in adultsrespiratory disease in adults..
American Nonsmokers' Rights Foundation September 2009

ETS exposure in adultsETS exposure in adults
Recent studies of adults without an asthma diagnosisRecent studies of adults without an asthma diagnosis
have found an association between SHS exposurehave found an association between SHS exposure
and the risk of developing asthma.and the risk of developing asthma.
Source: Environmental Protection AgencySource: Environmental Protection Agency
In adults with established asthma, recent studiesIn adults with established asthma, recent studies
showed exposure to SHS resulted in an increaseshowed exposure to SHS resulted in an increase
in asthma severity and more frequent asthmain asthma severity and more frequent asthma
exacerbationsexacerbations..
Source: Centers for Disease ControlSource: Centers for Disease Control
,
•.

Exposure to SHS exacerbates preexistingExposure to SHS exacerbates preexisting
asthma ( acute asthma exacerbations )asthma ( acute asthma exacerbations )
and causes new-onset asthma amongand causes new-onset asthma among
children as well as adultschildren as well as adults

Secondhand Smoke ControlSecondhand Smoke Control
The most effective method for reducing SHSThe most effective method for reducing SHS
exposure is to establish smoke freeexposure is to establish smoke free
environmentsenvironments..

100%100%smoke-free environment is the only way tosmoke-free environment is the only way to
fully protect nonsmokers from the dangers offully protect nonsmokers from the dangers of
secondhand smokesecondhand smoke..
Separating smokers from nonsmokers, cleaning theSeparating smokers from nonsmokers, cleaning the
air, and ventilating buildings cannot eliminateair, and ventilating buildings cannot eliminate
exposure of nonsmokers to SHSexposure of nonsmokers to SHS

Smoke-free policies decrease exposure toSmoke-free policies decrease exposure to
second-hand tobacco smoke by 80–90%second-hand tobacco smoke by 80–90%
in high-exposure settingsin high-exposure settings.
WHO Report on the Global Tobacco Epidemic,
2009

Comprehensive smoke-free legislation withComprehensive smoke-free legislation with
strong enforcement is the best strategystrong enforcement is the best strategy
for reducing exposure to second-handfor reducing exposure to second-hand
tobacco smoketobacco smoke.

Most Countries Have Not ImplementedMost Countries Have Not Implemented
Effective Tobacco Control PoliciesEffective Tobacco Control Policies

Only 5% of world covered by effectiveOnly 5% of world covered by effective
Tobacco Control PoliciesTobacco Control Policies

Any country, regardless of income level, can
implement smoke-free laws effectively However,
only 5% of the global population is protected by
comprehensive smoke-free legislation
..In most countries, smoke-free laws cover only
some indoor spaces, are weakly written or are
poorly enforced

Tobacco control, rather than being a luxuryTobacco control, rather than being a luxury
that only rich nations can afford, is nowthat only rich nations can afford, is now
a necessity that all countries musta necessity that all countries must
addressaddress..

Passive smoking killsPassive smoking kills
people and being passivepeople and being passive
about it will also killabout it will also kill
Enviromental protection Agency EPA

Secondhand Smoke & Asthma

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