Health Impact

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General June 27, 2006

This twenty-ninth report of the Surgeon General documents the serious and deadly health effects of involuntary exposure to tobacco smoke. Secondhand smoke is a major cause of disease, including lung cancer and coronary heart disease, in healthy nonsmokers.

In 2005, it was estimated that exposure to secondhand smoke kills more than 3,000 adult nonsmokers from lung cancer, approximately 46,000 from coronary heart dis- ease, and an estimated 430 newborns from sudden infant death syndrome. In addition, secondhand smoke causes other respiratory problems in nonsmokers such as coughing, phlegm, and reduced lung function. According to the CDC’s National Health Interview Survey in 2000, more than 80 percent of the respondents aged 18 years or older believe that secondhand smoke is harmful and nonsmokers should be protected in their workplaces.

Components of chemical compounds in secondhand smoke, including nicotine, car- bon monoxide, and tobacco-specific carcinogens, can be detected in body fluids of exposed nonsmokers. These exposures can be controlled. In 2005, CDC released the Third National Report on Human Exposure to Environmental Chemicals, which found that the median cotinine level (a metabolite of nicotine) in nonsmokers had decreased across the life stages: by 68 percent in children, 69 percent in adolescents, and 75 percent in adults, when samples collected between 1999 and 2002 were compared with samples collected a decade earlier. These dramatic declines are further evidence that smoking restrictions in public places and workplaces are helping to ensure a healthier life for all people in the United States.

However, too many people continue to be exposed, especially children. The recent data indicate that median cotinine levels in children are more than twice those of adults, and non-Hispanic blacks have levels that are more than twice as high as those of Mexican Americans and non-Hispanic whites. These disparities need to be better understood and addressed.

Research reviewed in this report indicates that smoke-free policies are the most economic and effective approach for providing protection from exposure to secondhand smoke. But do they provide the greatest health impact. Separating smokers and nonsmokers in the same airspace is not effective, nor is air cleaning or a greater exchange of indoor with outdoor air. Additionally, having separately ventilated areas for smoking may not offer a satisfactory solution to reducing workplace exposures. Policies prohibiting smoking in the workplace have multiple benefits. Besides reducing exposure of nonsmokers to secondhand smoke, these policies reduce tobacco use by smokers and change public attitudes about tobacco use from acceptable to unacceptable.

Research indicates that the progressive restriction of smoking in the United States to protect nonsmokers has had the additional health impact of reducing active smoking. In November 2005, CDC’s Tobacco-Free Campus policy took full effect in all facilities owned by CDC in the Atlanta area. As the Director of the nation’s leading health promotion and disease prevention agency, I am proud to support this effort. With this commitment, CDC continues to protect the health and safety of all of its employees and serves as a role model for workplaces everywhere.

Children and Secondhand Smoke Exposure-Excerpts from The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2007

The Health Consequences of Involuntary Exposure to Tobacco Smoke provided a progress report on the remarkable reduction in involuntary exposure to secondhand smoke that has been achieved over the last 20 years. It also noted the gaps and disparities that remain in this regard. This excerpt highlights the serious health risks that secondhand smoke expo sure poses to our children and the need to extend the same protections to them that many U.S. adults already enjoy.

Children are more heavily exposed to secondhand smoke than adults. Almost 60 percent of U.S. children aged 3-11 years, or almost 22 million children, are exposed to secondhand smoke. A Healthy People 2010 objective calls for reducing the proportion of children aged 6 years and younger who are regularly exposed to secondhand smoke in the home from 20 percent in 1998 to 6 percent by 2010. According to the 2005 National Health Interview Survey, this proportion may already be as low as 8 percent, suggesting that, with sustained and expanded efforts, we may be able to achieve this target.

However, too many children continue to be exposed. Children who are exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, lower respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth. The California Environmental Protection Agency recently estimated that 430 infants die from sudden infant death syndrome in the United States every year as a result of secondhand smoke exposure. The same agency also estimated that secondhand smoke exposure is responsible for 202,300 asthma episodes and 790,000 doctor appointments for U.S. children with ear infections annually. Children whose parents smoke and who grow up in homes where smoking is allowed are also more likely to become smokers themselves.

The home is the major setting where children are exposed. Children who live in homes where smoking is allowed have higher levels of cotinine, a biological marker for secondhand smoke exposure, than children who live in homes where smoking is not allowed. One of the strongest predictors of children’s cotinine levels is the number of cigarettes smoked daily in the home. Almost one in four children aged 3 to 11 years lives in a household with at least one smoker, compared to only about one in fourteen nonsmoking adults. Children are also exposed to secondhand smoke in vehicles.

Low-income children and African American children are disproportionately exposed to secondhand smoke. In fact, cotinine levels suggest that African American children are among the most heavily exposed of any population group. These disparities need to be better understood and addressed.

This excerpt moves forward the mission of CDC to promote and protect Americans’ health. I applaud those who have had a part in focusing our national attention on accelerating our progress in reducing the burden of disease that smoking and secondhand smoke exposure continue to impose on our nation.

Preventing Tobacco Use Among Youth and Young Adults A Report of the Surgeon General, 2012

Preventing Tobacco Use Among Youth and Young Adults

A Report of the Surgeon General, 2012

Preventing smoking and smokeless tobacco use among young people is critical to ending the epi- demic of tobacco use. Since the first Surgeon General’s report on youth in 1994, the basis for concern about smoking during adolescence and young adulthood has expanded beyond the immediate health consequences for the young smoker to a deeper understanding of the implications for health across the life span from early use of tobacco. Cigarette smoking remains the leading cause of preventable death in the United States, accounting for approximately 443,000 deaths, or about 1 of every 5 deaths, in the United States each year.

Since 1994, there have been many legal and scientific developments that have curtailed some- what the tobacco companies’ ability to market to young people. The 1998 Master Settlement Agree- ment eliminated most cigarette billboard and transit advertising, print advertising directed to underage youth, and limited brand sponsorship. In addition, the Master Settlement Agreement resulted in the release of internal tobacco industry documents that have been analyzed by scientists. Furthermore, during this time, the prices of cigarettes and smokeless tobacco products also increased. These signifi- cant developments, among others, resulted in a sharp decrease in tobacco use among adults and youth. However, this progress has stalled in recent years.

More than 80% of adult smokers begin smoking by 18 years of age with 99% of first use by 26 years of age. In addition, adolescent smokeless tobacco users are more likely than nonusers to become adult cigarette smokers. Adolescents and young adults are uniquely susceptible to social and environmental influences to use tobacco, and tobacco companies spend billions of dollars on cigarette and smoke- less tobacco marketing. The findings in this report provide evidence that coordinated, high-impact interventions including mass media campaigns, price increases, and community-level changes protect- ing people from secondhand smoke and norms are effective in reducing the initiation and prevalence of smoking among youth. However, many of these comprehensive tobacco control programs remain underfunded. Now more than ever, it is imperative that we continue investing in tobacco prevention and control. An increase in spending on sustained comprehensive tobacco control programs will result in reductions in youth and adult smoking rates and, ultimately, in health care costs.

Reducing tobacco use is a winnable battle. We have the science and, with additional effort and support for evidence-based, cost-effective strategies that we can implement now, we will improve on our nation’s health and our children’s future.

An easy-to-read guide with practical information and steps every American can take to join the fight against youth tobacco use:

An easy-to-read guide with practical information and steps every American can take to join the fight against youth tobacco use:Preventing Tobacco Use Among Youth and Young Adults: We Can Make the Next Generation Tobacco Free

Public Service Announcement: Making Our Next Generation Tobacco Free

A Report of the Surgeon General: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, 2010 The Report

A Report of the Surgeon General: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, 2010

The Report

In 1964, the first Surgeon General’s report on the effects of smoking on health was released. In the nearly 50 years since, extensive data from thousands of studies have consistently substantiated the devastating effects of smoking on the lives of millions of Americans. Yet today in the United States, tobacco use remains the single largest preventable cause of death and disease for both men and women. Now, this 2010 report of the Surgeon General explains beyond a shadow of a doubt how tobacco smoke causes disease, validates earlier findings, and expands and strengthens the science base. Armed with this irrefutable data, the time has come to mount a full-scale assault on the tobacco epidemic.

More than 1,000 people are killed every day by cigarettes, and one-half of all long-term smokers are killed by smoking-related diseases. A large proportion of these deaths are from early heart attacks, chronic lung diseases, and cancers. For every person who dies from tobacco use, another 20 Americans continue to suffer with at least one serious tobacco-related illness. But the harmful effects of smok- ing do not end with the smoker. Every year, thousands of nonsmokers die from heart disease and lung cancer, and hundreds of thousands of children suffer from respiratory infections because of exposure to secondhand smoke. There is no risk-free level of exposure to tobacco smoke, and there is no safe tobacco product.

This new Surgeon General’s report describes in detail the ways tobacco smoke damages every organ in the body and causes disease and death. We must build on our successes and more effectively educate people about the health risks of tobacco use, prevent youth from ever using tobacco products, expand access to proven cessation treatments and services, and reduce exposure to secondhand smoke. Putting laws and other restrictions in place, including making tobacco products progressively less affordable, will ultimately lead to our goal of a healthier America by reducing the devastating effects of smoking.

The Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and other federal agencies are diligently working toward this goal by implementing and sup- porting policies and regulations that strengthen our resolve to end the tobacco epidemic. CDC has incorporated the World Health Organization’s MPOWER approach into its actions at the local, state, and national levels. MPOWER consists of six key interventions proven to reduce tobacco use that can prevent millions of deaths. CDC, along with federal, state, and local partners, is committed to monitor- ing the tobacco epidemic and prevention policies; protecting people from secondhand smoke where they live, work, and play; offering quit assistance to current smokers; warning about the dangers of tobacco; enforcing comprehensive restrictions on tobacco advertising, promotion, and sponsorship; and raising taxes and prices on tobacco products.

In 2009, the Family Smoking Prevention and Tobacco Control Act was enacted, giving FDA explicit regulatory authority over tobacco products to protect and promote the health of the American public. Among other things, this historic legislation gave the agency the authority to require compa- nies to reveal all of the ingredients in tobacco products—including the amount of nicotine—and to prohibit the sale of tobacco products labeled as “light,” “mild,” or “low.” Further, with this new regula- tory mandate, FDA will regulate tobacco advertising and require manufacturers to use more effective warning labels, as well as restrict the access of young people to their products. FDA will also assess and regulate modified risk products, taking into account the impact their availability and marketing has on initiation and cessation of tobacco use.

Reducing the tremendous toll of disease, disability, and death caused by tobacco use in the United States is an urgent need and a shared responsibility. All public health agencies need to partner together to develop common strategies to combat the dangers of smoking and tobacco use and defeat this epidemic for good.

This 2010 Surgeon General’s report represents another important step in the developing recogni- tion, both in this nation and around the world, that tobacco use is devastating to public health. Past investments in research and in comprehensive tobacco control programs—combined with the findings presented by this new report—provide the foundation, evidence, and impetus to increase the urgency of our actions to end the epidemic of tobacco use.

Surgeon General’s Report

The Surgeon General of the United States, working with a team of leading experts on smoking and health, released a new report in 2004.

The 2004 Surgeon General’s report has new information about how smoking harms your health. A new database of more than 1,600 articles cited in this report is available on the Internet. By going to the CDC Web site at www.cdc.gov/tobacco you can search many of the studies cited in this report. Topics include cancer, cardiovascular diseases, respiratory diseases, reproductive effects, and other harmful health effects.

After reviewing scientiﬁc evidence, researchers reached these important conclusions:

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Tobacco-Free Oklahoma Campaign Week

This year’s Tobacco-Free Oklahoma Week, which officially began Monday, is broadening its focus to include not only public awareness campaigns on the health effects of smoking, but also on the financial costs to smokers and non-smokers.

You can read more about the campaign here.

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