PASSIVE SMOKING

assive smoking is the inhalation of smoke, called secondhand smoke (SHS).It

occurs when tobacco smoke permeates any environment, causing its inhalation by

people within that environment

Passive smoking has played a central role in the debate over the harms and regulation of tobacco products. Since the early 1970s, the tobacco industry has viewed public concern over second hand smoking as when a person smokes a cigarette; three different types of tobacco smoke are produced:  Mainstream smoke - the smoke breathed in through the burning cigarette by the smoker.  Exhaled mainstream smoke - the smoke breathed out by the smoker from their lungs. These two types of smoke can contain different chemicals, because some of the compounds in the tobacco smoke stay in the smoker's body or are changed during inhalation.  Side stream smoke - the smoke which drifts from the end of a lit cigarette a serious threat to its business interests.

Second-hand tobacco smoke consists of a gas phase and a particulate phase. Almost 85 per cent of second-hand smoke is in the form of invisible, odourless gases. The particulate phase includes tar, nicotine, benzene and benzopyrene. The gas phase includes carbon monoxide, ammonia, dimethyl nitrosamine, formaldehyde, hydrogen cyanide and acrolein. Smokeless tobacco are the cheapest, least taxed and most commonly used tobacco products in India. They are highly addictive and high in carcinogens. They cause a broad spectrum of diseases; yet awareness about their ill-effects is low. Smokeless tobacco is used in almost one-third of households in rural areas whereas almost one-sixth of households in urban areas. All Smokeless tobacco contain nicotine, a potent addictive substance. Chewing allows nicotine, which is a drug you can become addicted to, to be absorbed into the bloodstream through the tissues in your mouth. They also contain carcinogenic tobacco-specific nitrosamines , albeit at differing levels .Smokeless tobacco is carcinogenic to humans and the pancreas has been identified as a main target organ. It can cause localized oral lesions, oral cancer and fatal myocardial infarction etc.

Smokeless Tobacco may refer to Dipping tobacco (a type of tobacco that is placed between the lower or upper lip and gums), Chewing Tobacco (a type of tobacco that is chewed), Snuff (a type of tobacco that is inhaled or "snuffed" through the nose), Snus (a Swedish product similar to dipping tobacco), Creamy snuff (a fluid tobacco mixture marketed as a dental hygiene aid, albeit used for recreation).

Known health effects of passive smoking There is substantial evidence that passive smoking causes: Adults Lung cancer Stroke Coronary heart disease Reduced foetal growth (low birth-weight baby) Asthma attacks in those already affected Premature birth Onset of symptoms of heart disease Worsening of symptoms of bronchitis Children Cot death Middle-ear disease (ear infections) Respiratory infections Development of asthma in those previously unaffected Asthma attacks in those already affected Other proven health effects of passive smoking Shortness of breath Nausea Airway irritation Headache Coughing Eye irritation Exposure to second-hand smoke can be measured in a number of ways: y y The air concentration of constituents of second-hand smoke can be measured directly. Surveys and questionnaires can be used to gather data on time and frequency of exposure and for example: the number of cigarettes smoked in a household. Personal monitors can assess exposure to nicotine or smoke particles. Constituents or metabolites of tobacco smoke can be detected in hair, blood, saliva or urine samples. Biomarkers such as nicotine and its breakdown product cotinine, as well as markers of DNA and protein damage, can be used as indicators of the amount of second-hand smoke absorbed by a person.

y y

TOBACCO AND WOMEN The prevalence of smoking among women is low in most states of India due to social unacceptability. But many women in the rural areas consume tobacco in smokeless forms. The major threads faced by women are the secondhand smoking. WHO reports 200 million female smokers in the world and half of them will die within the next two decades. In India 2.4% women smoke and 12 % chew tobacco.

Use of tobacco by the mother during pregnancy may lead to still birth or a low birth weight baby who is at higher risk of many health problems. In women smokers, heart attacks occur about 16- 19 years earlier than in women who are non smokers. Women smokers / tobacco users are less fertile and may become sterile. Using tobacco during pregnancy may result premature birth and spontaneous abortion. Both active and passive smoking was associated with delayed conception y y y y Maternal use of smokeless tobacco decreases birth weight and gestational age Infants of users have a greater risk of having low birth weight (< 2500 g) and being delivered preterm ( < 37 weeks of gestation), independent of confounders. Maternal smokeless tobacco use is associated with high risks or early preterm delivery, independent of confounders. Maternal use of smokeless tobacco use should receive specific attention as a part of routine prenatal care.

Biomarkers Evidence of exposure to tobacco smoke in both active and passive smokers can be found by measuring biological markers of tobacco smoke components or their metabolites (by products) in body fluids. The most commonly used, and most sensitive markers are nicotine and its metabolite, cotinine. Neither nicotine nor cotinine is usually present in body fluids unless a person has been exposed to tobacco smoke. Levels of these markers can also be used to measure the intensity of exposure. The risks associated with passive smoking have also been estimated by comparing levels of biological markers present in the body fluids of active smokers with those of non-smokers. Because nicotine stays in the body for a shorter time, nicotine concentrations in body fluids measure more recent exposures. Cotinine stays in the blood or plasma significantly longer, and so its presence provides information about more chronic (longer term) exposure to tobacco smoke in both active and passive smokers. Environmental tobacco smoke can be evaluated either by directly measuring tobacco smoke pollutants found in the air or by using biomarkers, an indirect measure of exposure. Carbon monoxide monitored through breath, nicotine, cotinine, thiocyanates, and proteins are the most specific biological markers of tobacco smoke exposure. Chemical tests are a much more reliable biomarker of environmental tobacco smoke than surveys.

Cotinine Cotinine, the metabolite of nicotine, is a biomarker of environmental tobacco smoke exposure. Typically, cotinine is measured in the blood, saliva, and urine. Hair analysis has recently become a new, non-invasive measurement technique. Cotinine accumulates in hair during hair growth, which results in a measure of long-term, cumulative exposure to tobacco smoke. Urinary cotinine levels have been a reliable biomarker of tobacco exposure and have been used as a reference in many epidemiological studies. However, cotinine levels found in the urine only reflect exposure over the preceding 48 hours. Cotinine levels of the skin, such as the hair and nails, reflect tobacco exposure over the previous three months and are a more reliable biomarkers. Carbon Monoxide (CO) Carbon monoxide monitored via breath is also a reliable biomarker of environmental tobacco smoke exposure as well as tobacco use. With high sensitivity and specificity, it not only provides an accurate measure, but the test is also non-invasive, highly reproducible, and low in cost. Breath CO monitoring measures the concentration of CO in an exhalation in parts per million, and this can be directly correlated to the blood CO concentration (carboxy haemoglobin).Breath CO monitors can also be used by emergency services to identify patients who are suspected of having CO poisoning. REFERENCES 1. Smokeless Tobacco: Harm reduction debatable.CA Cancer J Clin. 2007 Dec 14 2. Dobe M, Sinha DN, Rahman Smokeless tobacco use and its implications in WHO South East Asia Region. Indian J Public Health. 2006 Apr-Jun;50(2):70-5. 3. Prakash C Gupta, Sreevidya S. Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India 2004. BMJ, doi:10.1136/bmj.38113.687882.EB. 4. Gupta D, Aggarwal AN, Jindal SK 2002. Pulmonary effects of passive smoking: the Indian experience. Tobacco Induced Diseases Vol. 1, No. 2: 129 136 5. National Research Council (1986) Environmental tobacco smoke: measuring exposures and assessing health effects. National Academic Press: Washington. 6. Mishra DP and Nguyen RH (1999) Environmental tobacco smoke and low birth weight: a hazard in the workplace? Environmental Health Perspectives 107: 89790. 7. Jindal, S. K. et al., Thorax, 1982, 37, 343347. 8. Liu, B. Q. et al., Br. Med. J., 1998, 317, 14111422.

9. Gupta PC, Subramoney S. Smokeless tobacco use and risk of stillbirth. A cohort study in Mumbai, India.Epidemiology. 2006;17:4751. 10. National Health & Medical Research Council. The health effects of passive smoking: A scientific information paper. Canberra: Australian Government Publishing Service, 1997. 11. P.R. Murti, P.C. Gupta, R.B. Bhonsle, D.K. Daftary, F.S. Mehta,and J.J. Pindborg.Effects on Oral Mucosa 12. Agrawal P, Chansoriya M, Kaul KK. Effect of tobacco chewing by mothers on placental morphology. Indian Pediatr. 1983; 20: 5615. 13. World Health Organization, Regional Office for South-East Asia Region Health Situation in the South-East Asia Region, 1998-2000. New Delhi, 2002. 14. Mira B. Aghi. Women, Children and Tobacco. Paper presented at the WHO International Conference on Global Tobacco Control Law, New Delhi, India, January 2000 15. Prakesh C. Gupta & Hemali C. Mehta: Cohort study of all-cause mortality among tobacco users in Mumbai, India; Bulletin of WHO, 2000, 78(7) 877-883). 16. Deshmukh JS, Motghare DD, Zodpey SP, Wadhva SK. Low birth weight and associated maternal factors in an urban area. Indian Pediatr. 1998 Jan;35(1):336. 17. Borland R, Yong H-H, Siahpush M, et al. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control. 2006;15(suppl_3):3441. 18. Prakash C Gupta and S Sreevidya, Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India. April 1, 2004.