Secondhand Smoke The Silent Killer
By
Dr . Ashraf El-Adawy Consultant Chest Physcian TB Team Expert - WHO
Tobacco is one of the greatest emerging health disasters in human history
(WHO)
Tobacco use is the leading preventable cause of death in the world
(WHO)
Tobacco may be legal, but that doesn’t mean it’s safe
Smoking is surely the Silent killer of life
Nothing Kills Like Tobacco
Nearly 6 million people die from tobacco use or exposure to secondhand smoke, )1 every 6 seconds( – more than tuberculosis, HIV/AIDS and malaria combined By 2030, the death toll will exceed eight million a year , 80% of those deaths will .occur in developing countries
WHO Report on the Global Tobacco Epidemic, 2011: The MPOWER package. Geneva
Nearly 6 million people die from tobacco use or exposure to secondhand smoke, )1 every 6 seconds( – accounting for 6 per cent of female and 12 per cent of male .deaths worldwide, every year
WHO Report on the Global Tobacco Epidemic, 2011: The MPOWER package. Geneva
In the 20th century, the tobacco epidemic killed 100 million people . worldwide During the 21st century, it could kill .one billion
WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva
The number of smokers in the world, estimated at 1.3 billion, is estimated to rise to 1.7 billion by 2025 if the global prevalence of tobacco use remains unchanged Four-fifths of these current smokers .live in low- or middle- income countries
(WHO World Health Report, 2003)
Tobacco : Deadly in any form or disguise
The Tobacco Tragedy
Smokers are not the only ones sickened and killed by tobacco, Second-hand smoke also has serious and often fatal health consequences
One weapon that kills from both ends
Second-hand tobacco smoke kills .600 000 people each year
WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2009
For every eight smokers who die from smoking, one innocent bystander dies from secondhand smoke
National cancer institute
Secondhand Smoke :Synonyms (Environmental tobacco smoke )ETS• Involuntary smoking• Passive smoking•
WHO
What is ? Second-Hand Smoke
ETS = MS + SS Environmental tobacco smoke )ETS(, :is the combination of Sidestream smoke )85%( : smoke emitted from a burning tobacco product Mainstream smoke )15%( : smoke exhaled from the lungs of smokers American cancer society
ETS = MS + SS
Secondhand smoke is also called Environmental tobacco smoke ( )ETS Exposure to secondhand smoke is called involuntary smoking, or .passive smoking
A Report of the Surgeon General, U.S. 2006
Only 15 per cent of the smoke from a cigarette is inhaled by the smoker - the remaining 85% goes into the surrounding air for everyone to breathe More than 85% of a burning cigarette goes into the room atmosphere where it takes up to 3 hours to disperse
University of Minnesota 2003- Secondhand Smoke Facts
Thirdhand Smoke
Secondhand Smoke stays in the , air for at least three hours It then gradually settles into furniture ,carpeting , toys and .the smoker's hair , clothing Even after the smoke is gone, toxic residue remains on the carpet, walls and on objects, Children may absorb these . toxins
Exposure to secondhand tobacco smoke in the indoor environment
VOCs Direct exposure
SVOCs
H. Destaillats, LBL
Indirect exposure
re-emitted SVOCs and products of chemical reactions
INDOOR SURFACES
Third-Hand Tobacco Smoke What's Left After The Tobacco Smoke Clears
SHS contains at least 250 toxic chemicals Methanol Carbon Monoxide Hydrogen Cyanide Acetone Tar DDT Naphthalene Vinyl Chloride Benzene
Formaldehyde Mercury Lead Arsenic Toluene Cadmium Ammonia Butane Ethanol
There is No risk-free level of exposure to firsthand or secondhand tobacco smoke
Secondhand smoke contains more than 50 cancer-causing chemicals When nonsmokers are exposed to SHS, they inhale many of the same cancer-causing chemicals that smokers inhale Sidestream smoke is more hazardous than mainstream smoke A Report of the Surgeon General, U.S. Department of Health and Human Services 2006
How common is second-hand ?smoke exposure
WHO Report on the Global Tobacco Epidemic, 2009
How common is second-hand ?smoke exposure
an estimated 700 million children worldwide, nearly half of all children in the world are exposed to second-hand tobacco smoke at home
WHO Report on the Global Tobacco Epidemic, 2009
How common is second-hand ?smoke exposure
Each year, approximately 50 million pregnant women worldwide are exposed to secondhand smoke during .their pregnancy
National institute of cancer
Primary Locations for SHS Exposure At Home• The Home is a major source of SHS exposure for children
At work The workplace is a major source of SHS exposure for adults
In Public places• restaurants, bars, other gathering places
In the car• American cancer society
Groups of People at Greater Risk
Pregnancy and Newborns Children and Teens People With Asthma, COPD and Other Respiratory Conditions
Health risks associated with exposure to secondhand smoke
Secondhand smoke is not a mere annoyance .but a serious health hazard
Secondhand smoke causes disease, premature death in nonsmoking . adults and children The U.S. Surgeon General’s 2006 report on
Secondhand Smoke is Deadly
In 2006, the California Environmental Protection Agency’s Air Resources Board designated
SHS a Toxic Air Contaminant )TAC(, an “airborne toxic substance that may cause and/or contribute to death or ”.serious illness
The U.S. Surgeon General’s 2006 report
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Secondhand Smoke is Deadly SHS has been designated as a known human carcinogen by the U.S. Environmental Protection Agency, National Toxicology Program and the International Agency for (.Research on Cancer )IARC
The National Institute for Occupational Safety and Health has concluded that secondhand smoke is an occupational carcinogen A Report of the Surgeon General, U.S. Department of Health and Human Services 2006
In 1992, The U.S. Environmental Protection Agency has officially labelled second -hand smoke as a "class A" carcinogen , a substance known to cause cancer in humans , to which there is NO safe level of exposure
A Report of the Surgeon General, U.S. Department of Health and Human Services 2006
Secondhand Smoke is Deadly
Keep in mind, however, that everyone exposed to secondhand smoke is at risk Breathing Even a Little Secondhand“ �Smoke Can 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 SHS :Short-term effects of second-hand smoke Coughing Headache Eye irritation Sore throat Sneezing and runny nose Feeling sick (Breathing problems )and possibly an asthma attack Irregular heart beats )a particular problem for people with (heart disease
.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
SHS and Cardiovascular Diseases
SHS and Cardiovascular Disease
In 1992 the American Heart Association's Council on Cardiopulmonary and Critical Care concluded that : Environmental tobacco smoke is a major preventable cause of cardiovascular disease and death.
CDC
SHS and Cardiovascular Disease Each year, exposure to secondhand smoke kills 600,000 people: 28 per .cent of them are children Of all adult deaths caused by 8 secondhand smoke, more than 80 .per cent are from CVD
SHS and Cardiovascular Disease
• The Exposure to secondhand smoke worldwide causes an estimated 603,000 deaths each year among non-smokers, including 379,000 deaths from ischaemic heart disease
CDC
SHS and Cardiovascular Disease
Frequent exposure to tobacco smoke, whether in the workplace or home, has been found to nearly double the risk of having a heart attack
The 2006 Surgeon General's Report
SHS and Cardiovascular Disease
Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing CVD by 25 to 30 percent
The 2006 Surgeon General's Report
SHS and Cardiovascular Disease
In April 2004, the CDC issued a warning that all patients with heart disease should avoid exposure to secondhand smoke. because of the risk that even short-term exposure )as .little as 30 minutes( to SHS can trigger heart attacks
The 2006 Surgeon General's Report
SHS and Cardiovascular Disease
There is a causal relationship between smokefree laws,smoking bans and decreases in acute coronary events ranging from 6 to 47 percent
The Institute of Medicine )IOM( report October 15, 2009
SHS and lung cancer
The IARC, the United States Surgeon General and the United States EPA, have all concluded that secondhand smoke causes lung cancer .in nonsmokers
Protection from exposure to second-hand tobacco smoke. Policy recommendations.2007
SHS and lung cancer
Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing lung cancer by 20 to 30 percent
The 2006 Surgeon General's Report
SHS and lung cancer
Most cases of lung cancer are caused by active smoking, but exposure to secondhand smoke is an important cause among nonsmokers Secondhand smoke causes approximately 3,000 lung cancer deaths among U.S. nonsmokers each year
CDC
SHS and lung cancer
As with active smoking, there is a dose-response relationship between SHS exposure and lung cancer —the longer the duration and the higher the level of exposure, the greater the risk of developing lung cancer
CDC
Secondhand smoke at Work
Exposure to secondhand smoke in the workplace is estimated by the International Labor Organization to cause approximately 200,000 deaths .per year worldwide
WHO May 2007
Secondhand smoke at Work Secondhand smoke levels in restaurants are • 150% higher than in a home with at least one smoker Secondhand smoke levels in bars are 450% higher than in a home with at least one smoker American cancer society
•
SHS is an occupational hazard
�Servers have the greatest risk of developing lung cancer and heart disease compared to other . occupations �In an 8-hour shift, a bartender inhales more cancercausing chemicals from SHS than smoking half ( a pack of cigarettes. cigarettes (ACS
American cancer society
Pregnancy & Secondhand Smoke
Pregnancy & Secondhand Smoke
Double risk of Sudden Infant Death Syndrome (. )SIDS or cot death low birth weight .Preterm delivery Intrauterine growth retardation (.Spontaneous abortion )miscarriage Have children born with decreased lung function
Protection from exposure to second-hand tobacco smoke. Policy recommendations. 2007
Secondhand smoke A Health Hazard to Children
!Kids are Especially Susceptible Almost half of the world’s children are regularly“ exposed to ETS , most have No choice in the matter” Home is the predominant location for exposure of children to SHS
WHO
!Kids are Especially Susceptible
Children breath at a faster rate .than adults,inhaling more air Children’s bodies are smaller than adults, and their immune .systems are less developed Often children can’t escape .smoky environments
Secondhand smoke !it’s nothing to kid about
Parents are responsible for 90 percent .of children’s exposure to SHS If you smoke around your children, they can inhale the equivalent of .100 packs of cigarettes by age 5
(U.S. Environmental Protection Agency, 2004)
� Sudden Infant Death Syndrome � Acute respiratory infections � Chronic middle ear infections � Reduced lung function growth � Asthma induction and Exacerbation
.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
In addition to the many health hazards of SHS, Children whose parents smoke are one-and-a half to two times more likely to smoke themselves
WHO Report on the Global Tobacco Epidemic, 2009
Important Facts !There is No safe level of exposure to SHS• The primary source of SHS exposure of children• .. is their parents Children whose parent)s( smoke outside are still .. exposed to SHS The only way to eliminate SHS exposure of children is to eliminate smoking .. by parents
• •
How to Protect Your Kids from ?Secondhand Smoke
�Don’t smoke in your Home and car �Don’t allow others to smoke in your Home �smoke only outdoors �Never smoke around pregnant women, infants, children and teenagers � Post No smoking signs in your home and car
.� Quit for your self and loved ones American cancer society
Remember that opening a window, running a fan or air purifier, will not get rid of second-hand smoke Smoking in a room away from others does not prevent drift or exposure Tobacco smoke travels from its point of generation in a building to all other areas .of the building
American cancer society
Second Hand Smoke even !hurts your pets
American lung association
The most effective method for reducing SHS exposure is to establish smoke free .environments
American Society of Heating, Refrigerating & Air Conditioning Engineers )ASHRAE(, June 2005
smoke-free environment is the only way to fully protect nonsmokers from the dangers of .secondhand smoke
100%
Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure of nonsmokers to SHS
A Report of the Surgeon General, U.S. Department of Health and Human Services 2006
Smoke-free policies decrease exposure to second-hand tobacco smoke by 80–90% .in high-exposure settings
WHO Report on the Global Tobacco Epidemic, 2009
People who work in environments with smoke-free policies are nearly twice as likely to quit smoking ,as those in work sites without such policies and people who continue to smoke decrease their average daily consumption by nearly four cigarettes per day
WHO Report on the Global Tobacco Epidemic, 2009
Comprehensive smoke-free legislation with strong enforcement is the best strategy for reducing exposure to second-hand .tobacco smoke
WHO Report on the Global Tobacco Epidemic, 2009
Most Countries Have Not Implemented Effective Tobacco Control Policies
WHO Report on the Global Tobacco Epidemic, 2008
Only 10% of world covered by effective Tobacco Control Policies
Any country, regardless of income level, can implement smoke-free laws effectively However, only 10% 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
WHO Report on the Global Tobacco Epidemic, 2008
..
Tobacco control, rather than being a luxury that only rich nations can afford, is now a necessity that all countries must . address
WHO Report on the Global Tobacco Epidemic, 2008
important findings from the largest tobacco use monitoring survey ever conducted among adults in Egypt are being launched, 28 January 2010, by WHO Regional Office for the Eastern Mediterranean, Egypt’s Ministry of Health and Central Agency for Public .Mobilization and Statistics
قوانين مكافحة التدخين فى مصر • • • •
قانون رقم 137لسنة 1981م قانون 52لسنة 1981م و وتعديلته بالقانون 85لسنة 2002م قانون رقم 4لسنة 1994م القانون 154لعام2007
قانون رقم 137لسنة 1981م والذي يحظر التدخين في أماكن العمل •
ماده ( )39التدخين أثناء العمل أوفي أماكن العمل اذا كان التدخين ل يترتب عليه خطورة يخصم أول مره يوم ثم يومين ثم ثلثه ثم خمسه أيام. ماده ( )40التدخين أثناء العمل أوفى أماكن العمل. اذا كان التدخين يسبب خطوره على المنشأة أول مرة أنذار بالفصل وثانى مرة يفصل بعد العرض على اللجنه الثلثيه
• • .
قانون 52لسنة 1981م و وتعديلته بالقانون 85لسنة 2002م •
والذي ينص على حظر بيع السجائر ومختلف منتجات التبغ لمن يقل عمره عن ثمانية عشرة عام وكتابة تحذير على كل عبوة من منتجات التبغ أو السجائر ” أحترس التدخين يدمر الصحة ويسبب الوفاة " وبحظر العلن أو الترويج لشراء أو استعمال السجائر ومختلف منتجات التبغ كلية سواء كان ذلك في الصحف أو المجلت أو ما يصدر عنها
قانون رقم 4لسنة 1994م • والذي يحظر التدخين في الماكن المغلقة ووسائل المواصلت وتغريم المدير المسئول عن الماكن المخالفة بغرامة ل تقل عن ألف جنيه ول تزيد على عشرين ألف جنيه ،ومعاقبة المدخن بغرامة بغرامه ل تقل عن عشره جنيهات ولتزيد على خمسين جنيها
• منشور دوري بناء علي تعليمات معالي وزيرالصحة ( )2004يمنع منعا باتا التدخين بالنسبة لجميع الطباء والعاملين والمرضي والزائرين في جميع المنشئات التابعة لوزارة الصحة و السكان واعتبار جميع هذه المنشآت اماكن خاليه من التدخين
القانون 154لعام2007 •
حماية الطفال والنساء بعدم التدخين في الماكن المغلقة مثل المنازل والمكاتب بالضافة للمنشآت الصحية والتعليمية والنوادى الرياضية والجتماعية ومراكز الشباب ،ويلتزم المدير المسئول عن هذه الماكن باتخاذ الجراءات الكفيلة بمنع التدخين فيها ويعاقب عن إخلله بهذا اللتزام بغرامة ل تقل عن ألف جنيه ول تزيد على عشرين ألف جنيه ،كما يعاقب المدخن بغرامة ل تقل عن خمسين جنيها ً ول تزيد على مائة جنيه”.
• حظر أي شعارات جاذبة للتدخين مثل قليلة القطران أو خفيفة أو خفيفة جداً ،يجب أن يثبت على كل عبوة من منتجات التبغ أو السجائر التحذير التي "أحترس التدخين يدمر الصحة ويسبب الوفاة" ويجب أن يشغل هذا التحذير نصف واجهتي العبوة على القل ،ويجوز بقرار من وزير الصحة إضافة تحذيرات أخرى ،أو نشر صور تؤكد أضرار التدخين".
The dangers of secondhand smoke are not imaginary, Governments should protect the rights of individuals to breathe smoke-free air Smoking in public places is not a right ‌ breathing is
The right to clean air, free from tobacco smoke, is a human right
Smoking Shelters
التدخين والدين
السيجارة في قفص التهام
• التدخين هلك للدين } ويحل لهم الطيبات ويحرم عليهم الخبائث { • هلك للصحة } ول تقتلوا أنفسكم إن ا كان بكم رحيما ً { • هلك للمال } إن المبذرين كانوا إخوان الشياطين { • قال ابن باز – رحمه ا " : -والدخان ل يجوز شربه ،ول بيعه ، ول التجارة فيه كالخمر ،والواجب على من كان يشربه أو يتجر فيه البدار بالتوبة والنابة إلى ا سبحانه وتعالى ،والندم على ما مضى ،والعزم على أن ل يعود في ذلك " .
رأى المسيحية وبخاصة المذهب الرثوذكسى فى التدخين والخمور والمخدرات
• •
البنبا موسى السقف العام ترى المسيحية فى التدخين والخمور والمخدرات ،بصفة عامة ،أبنها بنوع من قتل البنسان لبنفسه بطريقة بطيئة أو متوسطة أو سريعة ترى المسيحية أن صلوات متعاطى هذه الفات ل تصير مقبولة ما لم يبنوى صاحبها التوبة الكاملة عبنها ،وأن يجاهد فعلً فى هذا السبيل ،بقوة الرادة، واللجوء إلى الشبع الديبنى ،والتخلى عبنها فع ً ل ،إلى أن يبنقطع عبنها تمامًا.
Several studies estimate that 10% of total tobacco-related economic costs are attributable to SHS exposure
Tobacco control is not expensive
The cure for this devastating epidemic is dependent Not on medicines or vaccines, but on the concerted .actions of government and civil society Full enforcement of smoke-free laws is critical to ... establishing their credibility
WHO Report on the Global Tobacco Epidemic, 2008
Passive smoking kills people and being passive about it will also kill
Enviromental protection Agency EPA
Secondhand Smoke is a real and Preventable Health Risk
Enviromental protection agency EPA
Key Components of an Effective Change A little bit of knowledge • A little bit of effort •