How many deaths are caused by exposure to environmental tobacco smoke?

beach with butts

Mortality caused by smoking is mainly caused by direct consumption, but also by exposure to smoke from the surrounding environment (second-hand smoke or second-hand smoke, which is the one that is inspired by proximity to a person who smokes) and residual or extraneous smoke (the one that remains on surfaces and in the environment in places where the smoke was smoked). According to the World Health Organization (WHO), more than 8 million people worldwide die from tobacco every year. More than 7 million of these deaths are due to direct consumption, and approximately 1.2 million are the result of non-smoker exposure to secondhand smoke. This is a very approximate calculation because not all countries have reliable methods for quantifying smoking and its consequences.

The mortality of smokers is much easier to assess. In Spain, consumption is estimated to have caused around 51,500 deaths in 2020 and there is considerable agreement on this number in different studies. But what about passive smokers? To determine this number, it is necessary, firstly, to know very well the effects of tobacco smoke in the environment and, secondly, to have the tools to adequately quantify the degree of exposure.

A study recently published in the journal Archives of Bronconeumología, the official publication of the Spanish Society of Pulmonology and Thoracic Surgery (Separ), shows the impact of passive smoking on mortality in the Spanish adult population. The main advantage of this work is that it uses nationally representative data on environmental tobacco smoke exposure. The number it shows may seem small: 747 deaths in 2020.

He dies of lung cancer and coronary heart disease

Mónica Pérez Ríos, lead author of the study, Separ member and professor of preventive medicine and public health at the University of Santiago de Compostela, acknowledges that the number of deaths from passive smoking is low compared to deaths from direct consumption. , which is very high. “But when we consider exposure to environmental tobacco smoke, what we have to think is that for many of us it is totally undesirable“. And for countless people, it’s something they can’t help themselves. “For example, waiters are still exposed in their jobs, even though smoking is prohibited in bars,” he argues. It turns out that it is allowed on terraces and the amount of smoke they are forced to breathe daily in these environments is very high.

On the other hand, it has to be taken into account the study only includes the population aged 35 and over and was conducted with very restrictive criteria in the interest of scientific rigor. This means that only those data of which there is a high degree of certainty have been included. Therefore, the number of victims of passive and even third-hand smoke is probably much higher.

Of these 747 deaths, 279 were caused by lung cancer and 468 by coronary heart disease, which represents 1.5% of all deaths from these two groups of diseases. “It would exceed 2,000 per year if we take into account two diseases whose causal link to environmental tobacco smoke exposure is still being investigated.: chronic obstructive pulmonary disease (COPD) and cerebrovascular disease (stroke)”, says the researcher.

Diseases caused by passive smoking

The goal of the Pérez Ríos analysis was to measure mortality from environmental exposure to tobacco smoke, which has not been rigorously studied in the past decade. Other studies have quantified the morbidity of passive smoking, i.e. the diseases it causes.

This was discovered by the International Agency for Research on Cancer (IARC). the presence of 70 carcinogens in the air polluted by tobacco smoke, so he concludes that breathing this air can cause cancer. According to IARC, after burning tobacco, carcinogenic particles are suspended in the air, which, due to their small size, can reach the deep corners of the respiratory system and be very harmful.

In addition to lung cancer, for which there is very strong evidence, there is some evidence that passive smokers are at increased risk of cancers of the larynx, pharynx, sinuses, brain, bladder, rectum, stomach, and breast.

Passive smoking affects the heart and blood vesselsincreasing the risk of myocardial infarction and stroke, among other pathologies. Some studies have also linked it to mental and emotional changes, but their results are still inconclusive.

As for the diseases of the respiratory tract with which it is related, it is worth highlighting asthma, especially in children. It is also associated with an increased risk of ear infections (also higher in children) and an increase in symptoms such as cough, sore throat and chronic respiratory problems.

Residual or extraneous smoke: big unknown

“We didn’t take into account third-hand smoke because we don’t have data on the prevalence of population exposure,” says Pérez Ríos. It is about residual smoke that remains on the surface and can enter the human body; for example through hand and mouth contact. “The study of residual tobacco smoke is very complex,” says the scientist. “But just because there’s no data doesn’t mean it doesn’t have a negative impact; we are in a scenario where we are confident in the information we are providing,” he insists.

A study published in the journal Environmental research in December 2020, scientists from the International University of Catalonia (UIC), the Catalan Oncology Institute (ICO) and the Hospital del Mar Institute of Medical Research (IMIM) provided evidence that the remains that remain in the environment and on interior surfaces due to tobacco smoke are harmful to health. Thanks to this work, it was found out people exposed exclusively to secondhand tobacco smoke in the home may have measurable levels of cotinine in their saliva. Cotinine is a chemical produced by the body after exposure to nicotine. In addition, no differences were found in cotinine levels between people exposed to secondhand smoke and tobacco residue.

The risk of this secondhand smoke may be higher in young children due to specific behaviors such as crawling and mouthing.

beach with butts

Measures to stop smoking

citizen initiative Europe without tobaccowhich has the support of the National Committee on Tobacco Prevention (CNPT) and other public health organizations, proposes the following measures to eradicate environmental exposure to tobacco smoke:

  • Promote Europe’s first tobacco-free generation and end the sale of tobacco and nicotine products to citizens born after 2010.
  • Create a European network of beaches and coastlines free of tobacco and cigarette buttsmaking these spaces healthier and more environmentally sustainable.
  • Create a European network pnational arches free of tobacco and cigarette butts, making them healthier and reducing pollution and fire risk.
  • Expand outdoor spaces without smoke and fumes, especially those visited by minors (parks, swimming pools, sports events and centers, shows, terraces of bars and restaurants).
  • Remove tobacco advertising and its presence in audiovisual productions and on social networks, especially through hidden advertising solutions influencers and product placement.
  • Fund research and development (R&D) projects on tobacco-related diseases to improve their prognosis and make them treatable.

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