Abstract
Secondhand smoke contains many chemicals, including substances that can stimulate the development of cardiovascular diseases. Regular exposure to cigarette smoke put people at risk of developing various diseases including cardiovascular dysfunction. This is true even to non-smokers, due to the thousands of toxic chemicals found in tobacco smoke. Inhalation of these substances may lead to serious and life-threatening health concerns. Consequently, those who are exposed to secondhand smoke have a higher possibility of developing lung, nasal and other forms of cancer and heart diseases. The toxic substances upset the normal functioning of the heart and blood vessels which leads to increased risk of heart attack and stroke. The dangers associated with secondhand smoke should encourage people to be concerned about exposure to this toxic substance. It is to be noted that even a minimal level of exposure, when they add up can lead to distressing results.
\Second Hand Smoking
I. Introduction
Secondhand smoke is the exposure and inhalation of environmental tobacco smoke. Tobacco smoke can come from the smoke puffed out by the smoker and the smoke that comes directly from the end of a burning end of a cigar or tobacco pipe. Otherwise known as passive smoking, exposure to secondhand smoke is an inevitable consequence when one is in a smoke-filled surroundings. Consequently, non-smokers who inhale secondhand smoke take in the same harmful chemicals such as nicotine in the same way as the smokers do. Passive smoking is associated with the increased rate of morbidity due to smoke-related diseases, and people who are exposed to it are at risks of developing adverse health consequences such as cardiovascular problems.
A. History of the Study of Secondhand Smoking
During the 20th century, the effects of cigarette smoking to health and the toxic contents of tobacco smoke became one among the central focus of researchers after the identification of the first indications of the lung cancer epidemic. In the 1950s, a substantial experiments and research were done, resulting in the conclusion that active smoking was a cause of lung cancer by the 1960s (World, 2016). After the alarming findings in the 1960s, further epidemiological research was conducted, this time to address the harmful effects of cigarette smoke in the home, especially on the health of children. Another report in Japan sometime in 1981 suggested a noted increase in lung cancer risk among nonsmoking women who were married to cigarette smokers (World, 2016). These generated a series of additional epidemiological research on lung cancer and further studies on the effect of secondhand cigarette smoke exposure.
B. Literature Review
The negative impacts of smoking not only affect the direct smoker, but also the person that inhales the smoke secondhand. A number of researches have linked various diseases with smoke from the direct smoker. A research conducted on the cardiovascular effects of secondhand smoke reported that the effects are closely as huge as smoking. It concluded that the secondhand smoke elevates the chances of developing coronary heart disease by an estimate of thirty percent. A study by Barnoya & Glantz (2005) suggest that there is a relatively high risk of heart diseases and conditions associated with second hand smoke as compared the normal expectations.
Additional publication on the relationship between secondhand smoke and cardiovascular conditions indicated an increased sensitivity of the cardiovascular system to the poisonous substances found in second hand smoke. Barnoya & Glantz observed various health problems associated with second hand smoke; endothelial dysfunction, weakening of the heart muscle, problems in the arteries and increased aggregation of platelets (2005).
Research conducted to investigate the pathophysiology of cigarette smoking and cardiovascular disease indicated the contribution of smoking to increased mortality and morbidity (Ambrose & Barua, 2004). All the stages of atherosclerosis are affected by both passive and active smoking. Passive and active smoking generate cigarette smoke that negatively impacts all the stages of atherosclerosis ranging from endothelial impairment to critical clinical problems. According to Ambrose & Barua, people who are exposed to either passive or active cigarette smoke are at an elevated risk of developing cardiovascular disease and conditions (2004). A large number of studies indicate that there are over 4,000 poisonous chemicals contained in cigarette smoke. Carbon monoxide is one of the numerous poisonous chemicals in cigarette smoke. The presence of this gas is attributed to numerous causes of cardiovascular dysfunction. Even though the linear dose impact of smoke to cardiovascular risk has not yet been established, the connection between passive smoking and elevated risk of cardiovascular disease has been evidently confirmed.
Additional research indicates that cigarette smoking, either in a passive or active form, present negative impacts on respiratory system as well as cardiovascular systems. The effects of cigarette smoking not only affect the direct smoker, but also those exposed to the second hand smoke. Exposure to second hand cigarette smoke is responsible for annual death and hospitalization of close to 22,000. Out of the number hospitalized, between 150, 000 to 300,000 are cases of pneumonia and bronchitis. Also, between 8000 and 26,000 cases were reported to be asthmas only.
According to numerous researches, exposure to second hand cigarette smoke has crucial negative impacts on health. Apart from alcohol abuse and active smoking, passive smoking or second hand smoke is the leading the third leading cause of premature deaths and poor health. The major impacts of exposure to secondhand smoke include coronary heart conditions and diseases as well as cancer (Flouris et al, 2004). While active smoking results in specific cancer, second hand smoking imposes some level of increased risk.
Various studies have indicated a relationship between increased risk of developing cervical cancer and exposure to second hand cigarette smoke. Women who are exposed to second hand cigarette smoke report an estimate of 40 percent increased risk of developing cervical cancer. Most of these women are exposed to secondhand smoke through living with active smokers. Other reviews and researches report a 75 percent increased risk of developing cervical cancer in women exposed to second hand cigarette smoke (Flouris et al, 2004).
II. Physical and Biochemical properties of Cigarette Smoke
Cigarette smoke contains physical and biochemical properties that largely contribute to the development of diseases. It was found that cigarette smoke contains thousands of harmful substances, but only a few of them were studied in isolation. Many of the components of cigarette smoke are known to cause cardiovascular problems such as polycyclic aromatic hydrocarbons that are identified to trigger atherosclerosis. A research published in the International Journal of Environmental Research and Public Health claimed that the complex and dynamic tobacco smoke contains reactive mixtures of about 5,000 chemicals (Talhout et al, 2011). Exposure to any of these components are said to increase the risk of developing respiratory and cardiovascular diseases.
A. Carcinogens
Carcinogens are agents that were observed to cause alterations of the genetic components, leading to the growth of cancer cells. A substance is considered as a carcinogen after scientific research establishes human and animal exposure with it will trigger the growth of cancer cells. Consequently, cigarette smoke is laden with numerous substances that are identified as animal and human carcinogens. When the International Agency for Research on Cancer (IARC) enumerated 36 chemicals that are proven to trigger cancer cell growth in humans, it was established that 10 out of the 36 substances were found in cigarette smoke, in addition, other “mutagenic chemicals that are in the “probably carcinogenic” or “possibly carcinogenic” categories” (Fowles & Bates, 2000).
B. Gases
The cigarette smoke is also laden with many chemicals in gaseous phase. The commonly emitted gas from cigarette smoke is the carbon monoxide which is released in high concentrations. Carbon monoxide is considered to have a high level of toxicity because it can produce Carboxyhaemoglobin which is a form of stable chemical complex with hemoglobin (Fowles & Bates, 2000). The Carboxyhaemoglobin takes away the oxygen-carrying hemoglobin that circulates in the blood and other body tissues, thus the inhalation of carbon dioxide decreases the capacity of hemoglobin to transport oxygen in the body. It was found that a minimum of 2% Carboxyhaemoglobin concentrations in the circulatory system has been linked to chest pain in people who are suffering from cardiovascular disease; thus this leads to cardiac ischemia and reduced blood flow to the heart (Fowles & Bates, 2000). Moreover, hydrogen cyanide, which is an extremely toxic gas that can be compared to the gas that was used in the gas chambers of the Nazis in the Second World War were are also found in cigarette smoke.
C. Tobacco-specific Nitrosamines
Another form of carcinogen is the tobacco-specific nitrosamines that come from nicotine and alkaloids found in cigarette smoke. Two of these nicotine-based nitrosamines are the NNK and NNN, which are found by the International Agency for Research on Cancer to have a strong carcinogenic to both laboratory animals and humans (Stepanov, 2006). These carcinogens are known to induce the development of tumors, for instance, a mixture of NNK and NNN triggers the growth of lung cancer. It was found that there are sufficient NNK and NNN quantities in tobacco smoke, and they pose similar effect to long term smokers, in a similar pattern with the total amount needed to produce cancer in laboratory animals. The inclusion of high levels of carcinogens such as nitrosamines poses a great risk, both to tobacco smokers and non-smokers who were regularly exposed to tobacco smoke. An alarming finding is that the “levels of tobacco-specific nitrosamines in tobacco are thousands of times higher than the amounts of other nitrosamines in consumer products that are regulated by government authorities (Hect & Hoffman, 1988).
The tobacco-specific nitrosamines are contributory factors that play a role in cancer growth, especially in people who practice snuff-dipping. While epidemiologic research revealed that snuff-dipping causes oral cancer, the NNK and NNN are two of the most prevalent carcinogens in snuff, based on the results of their application on the rat oral cavity (Hect & Hoffman, 1988). Further, the tobacco-specific nitrosamines are also suspected to be involved in the development of tobacco-related cancers in other organs such as the esophagus, pancreas and the respiratory tract. There is a high level of nitrosamines found in cigarette smoke, and it was advised that government regulations should be implemented to regulate the production and selection of tobacco lines that have a lower level of tobacco-specific nitrosamines
III. Secondhand Smoke and Cardiovascular Impairment
Continuous exposure to cigarette smoke intensifies the free radical imbalances that lead to potential mechanisms that initiate cardiovascular impairment. Oxidative stress due to free radicals can lead to arterial diseases, and these free radicals are produced from the gas or the tar phase of cigarette smoke. The effects of increased oxidative stress may result to many cardiovascular dysfunction. Studies indicated that exposure to secondhand smoke plays a role in increasing the risk of developing coronary heart disease by 30 percent, accounting for about 35,000 annual deaths in the United States alone (Barnoya & Glantz, 2005). There are additional evidences suggesting that existence of increased risks despite minimal exposure, such as those taken from cellular and animal experiments indicating the plausible effects of secondhand smoke to the development of cardiovascular dysfunction. While the exact element of cigarette smoke and its effect in the development of cardiovascular diseases is yet unknown, the fact that cigarette smoke causes the inflammation, thrombosis and oxidation of low-density cholesterol (Ambrose & Barua, 2004) is something to be concerned about.
A. Cigarette Smoke and Atherosclerosis
Exposure to cigarette smoke subjects an individual to experience different clinical atherosclerotic syndromes. It was found that secondhand smoke plays a role in activating blood platelets, which in turn increases the likelihood of developing thrombosis and damage to the arterial lining. The process eventually leads to atherosclerosis, the symptoms of which include stable angina, acute coronary syndromes, sudden death, and stroke (Ambrose & Barua, 2004). The study conducted by Ambrose & Barua (2004), suggested that there is a possible increase of aortic and peripheral atherosclerosis due to the inhalation of secondhand smoke, which can result in the obstruction of the arteries and abdominal aortic aneurysms.
There are different clinical imaging techniques that have been used to determine the plausible link between cigarette smoke and atherosclerosis. In earlier studies, it was established that years of pack smoking have a direct relationship with the severity of atherosclerosis. The Canadian Coronary Atherosclerosis Intervention trial revealed that cigarette smoking was an independent predictor of new coronary lesion formation (Ambrose & Barua, 2004). Moreover, it was found that passive smoke lowers the level of high density lipoprotein (HDL), which is a well-behaved cholesterol known to prevent atherosclerosis (Barnoya & Glantz, 2005). A low level of HDL is linked to a higher risk of developing heart dysfunction.
B. Cigarette Smoke and Thrombosis
Active and passive cigarette smoking is linked to a greater risk of developing acute myocardial infarction. Researchers found that people who cease to smoke have a lower risk of “over a one-to three-year period with an exponential decline approaching the risk in ex-smokers within five years of cessation” (Barnoya & Glantz, 2005). Another recent study showed a direct decrease in thrombotic symptoms with smoking cessation (Ambrose & Barua, 2004). Secondhand smoke can trigger the instability of atherosclerotic plaque, a factor that prompts thrombotic events. Further, it was also found that a certain level of nicotine concentrations in passive smokers alters the normal functioning of human arteries. Research showed that intravascular thrombosis are the predominant cause of acute cardiovascular events (Ambrose & Barua, 2004).
IV. Intervention to Control Secondhand Smoke
The World Health Organization (WHO), has been working towards the reduction of tobacco use worldwide. First, the organization sponsored the consultations of the WHO Framework Convention on Tobacco Control (WHO FCTC), in a treaty that set the policies and guidelines that aim to reduce the use and supply of tobacco through evidence-based interventions (World, 2011). The implementation of WHO guidelines is based on the observation that tobacco control is the best and cost effective option among other forms of intervention.
A. The Best Buys
The best buys in tobacco use intervention includes the ways to lessen the consumption of cigarettes and the prevention of noncommunicable diseases. These include the increase in taxes, which is considered to be “by far the best buys in tobacco control because they can significantly reduce tobacco use through lower initiation and increased cessation” (World, 2011). The increase excise taxes on tobacco is an added burden smokers, thereby reducing the prevalence of smoking. The well-timed information dissemination of the risks of smoking to one’s well being is another effective way to control the use of tobacco. These can be implemented with the help of mass media campaigns and prominent health warnings on tobacco packages. It was found that comprehensive bans on tobacco advertising, promotion and sponsorship decrease tobacco use by up to 6.3%, though narrow-based advertising bans have minimal or no effect (World, 2011). These measures, in addition to restrictive rules on smoking in public places and wide-ranging sanctions on advertising, promotion and sponsorship of tobacco products lead to the decrease the social acceptance cigarette smoking.
B. Good Buy
The cost-effective treatment of tobacco dependence is considered as a good buy intervention. This form of intervention requires that treatment should be accessible by the public. There are key approaches that are needed for the successful implementation of these measures: a) First, there is a need for countries to cooperate for the success of tobacco control programs, b) second, the intended programs should be designed in a way that they cover multiple levels of interventions, c) third, is the grant of the capacity of the implementing bodies to employ the programs, and d) the presence of wide-ranging surveillance and monitoring on the consumption of tobacco (World, 2011).
IV. Conclusion
There are many dangers of exposure to cigarette smoke even for people who are not direct smokers. Many studies since the middle of the 20th century indicated that the inhalation of cigarette smoke increased the risk of cardiovascular disease. This shows that secondhand smoke is a contributory factor in increasing the prevalence of diseases and even death. While many organizations such as the World Health Organization have implemented programs to reduce the dangers associated with direct and indirect smoking, there is yet a long way to go before the dangers of smoking will be reduced considerably.
People can help prevent the development of smoke-related diseases. For example, an individual can help in the dissemination of the health consequences of smoking in the family and community. Moreover, smokers can opt to quit smoking for better personal and family health. While smoking is addictive, there ways to help them quit such as counselling, drug treatment or the gradual reduction of cigarette consumption.
References
Ambrose, J., & Barua, R. (2004). The pathophysiology of cigarette smoking and cardiovascular disease. Journal of the American College of Cardiology, 43(10), 1731-1737. doi:10.1016/j.jacc.2003.12.047
Barnoya, J., & Stanton, S. (2005). Cardiovascular effects of secondhand smoke: Nearly as large as smoking. Circulation Journals, 1111, 2684-2698. doi:10.1161/CIRCULATIONAHA.104.492215
Fowles, J., Bates, M., & Noiton, D. (2000). The chemical constituents in cigarettes and cigarette smoke: Priorities for harm reduction. Retrieved from New Zealand Ministry of Health website: http://www.moh.govt.nz/moh.nsf/pagescm/1003/$File/chemicalconstituentscigarettespriorities.pdf
Hect, S., & Hoffman, D. (1988). Tobacco-specific nitrosamines, an important group of carcinogen in tobacco and tobacco smoke.Carcinogenesis, 9(6), 875-84.
Stepanov, I., Jensen, J., Hatsukami, D., & Hecht, S. (2006). Tobacco-specific nitrosamines in new tobacco products. Nicotine & Tobacco Research, 8(2), 309-313.
Talhout, R., Shulz, T., Florek, E., Van Benthem, J., Wester, P., & Opperhuizen, A. (2011). Hazardous compounds in tobacco smoke.International Journal of Environmental Research and Public Health,8, 613-628.
World Health Organization. (2011). Reducing risks and preventing disease: Population-wide interventions. In Global status report on noncommunicable disease 2010.
References
World Health Organization. (2016). Health effects of exposure to secondhand smoke (SHS). In Evaluating the effectiveness of smoke-free policies. IARC Publications.
