3.25 Air pollution, cigarette smoking and ill health

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3.0 Background

3.1 Tobacco—a leading preventable cause of death and disease

3.2 Cardiovascular diseases

3.3 Lung cancer

3.4 Respiratory diseases

3.5 Other cancers caused by or associated with smoking

3.6 Reproductive health and smoking

3.7 Pregnancy and smoking

3.8 Infant health and smoking

3.9 Increased susceptibility to infection in smokers

3.10 Eye diseases

3.11 Dental diseases

3.12 Gastrointestinal diseases

3.13 Bone density and risk of fractures

3.14 Effects of smoking on the skin

3.15 Smoking and complications in medical treatment

3.16 Smoking and diabetes

3.17 Poorer levels of general health

3.18 Smoking, motor vehicle crashes and other injuries

3.19 Burns and fires caused by tobacco use

3.20 Tobacco poisoning

3.21 Health effects for younger smokers

3.22 Genetic influences on tobacco-caused disease

3.23 Smoking, dementia and cognitive decline

3.24 Lung disease, smoking and occupational exposures

3.25 Air pollution, cigarette smoking and ill health

3.26 Health effects of smoking brands that claim to deliver lower levels of tar, nicotine and carbon monoxide

3.27 Health effects of smoking tobacco in other forms

3.28 Health 'benefits' of smoking?

3.29 Morbidity (ill health) attributable to tobacco-caused disease

3.30 Deaths attributable to tobacco by disease category

3.31 Morbidity and mortality due to tobacco-caused disease and socioeconomic disadvantage

3.32 Health effects of smoking other substances

3.33 Health effects of chewing tobacco, and of other smokeless tobacco products

3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking

3.35 Health benefits of cessation

3.36 The global tobacco pandemic

Acknowledgments

References

3.25.1 Outdoor air pollution

The major contributors to outdoor air pollution in Australia are gases, including carbon monoxide, nitrogen dioxide, ozone and sulphur dioxide, and particles,133 which include lead and other by-products from combustion and industry, as well as natural sources such as dust and pollens. Particles vary in size from those large enough to see (in the form of soot, dust, haze or smoke) down to those only visible through a microscope.134

In high enough concentrations, these pollutants are of major concern to health, especially for those with respiratory illness, cardiovascular disease, the young, the elderly, and pregnant women. Noxious gases cause respiratory symptoms and can exacerbate respiratory illnesses such as bronchitis and asthma.135, 136 People with cardiovascular disease are at higher risk of heart attack or other heart symptoms when exposed to carbon monoxide or nitrogen dioxide.137 Lead causes developmental problems in the unborn child and young children, and other health problems in adulthood.138 Depending on size and chemical composition, particulate matter can cause respiratory symptoms, exacerbate cardiovascular disease, and cause cancer.134

Air quality standards in Australia are generally considered relatively good, and have improved over the past decade, increases in vehicles on the roads and industrial growth having been offset by strategies to control air quality and improved technology.139 However, outdoor air pollution is still a significant cause of sickness and death in Australia. It is estimated that in 2003, about 2000 deaths in Australia were attributable to long-term exposure to urban air pollution, and a further 1000 deaths were caused by short-term exposure through exacerbation of pre-existing illness.6 Most deaths were due to ischaemic heart disease, followed by stroke, lung cancer and chronic obstructive pulmonary disease. In total, urban air pollution caused 2.3% of all deaths in Australia in 2003. Tobacco caused almost five times that amount.6

Tobacco smoke is also a source of environmental particulate matter. A study comparing the output of particulate matter from three single cigarettes burning consecutively over 30 minutes showed that the total delivery of particulate matter was up to 10 times greater than emissions of particulate matter from the exhaust of a modern turbo diesel motor car with the engine left idling for the same amount of time.140 Tobacco smoke is also a major source of indoor carbon monoxide pollution137—see following Section.

3.25.2 Indoor air pollution

With Australians spending up to 90% of their time indoors,141 indoor air quality, whether it be domestic or workplace, is an important health consideration. Sources of indoor pollution in Australia include asbestos products, radon gas, secondhand tobacco smoke, house dust mite allergens, formaldehyde (used in production of pressed wood products such as particleboard, or insulation products), nitrogen dioxide emissions from unflued gas appliances, and pesticides applied under buildings.142 Moulds, dust, animal fur or dander (tiny flakes from fur, skin or feathers), and chemicals arising from paint, glues or other household solvents are also a cause of irritation. 'Off-gassing,' the emission of toxic fumes from furniture, carpets, paints, glues and sealants in newer buildings and houses may remain at high levels for several months.141 Of course, outdoor pollutants may also infiltrate the indoor environment. Exposures to these agents may cause a variety of responses, from mild irritation through to asthma and disease.

Of all these pollutants, the three most significant in Australia are asbestos fibres, radon gas, and secondhand tobacco smoke.142 As already noted, asbestos fibres are a cause of lung cancer and other respiratory disease, and although it is no longer mined and its use in building products has been phased out, asbestos remains present in many structures. Radon gas is also a known human carcinogen that occurs naturally in soil and rocks, collecting in buildings from the soil beneath. Radon levels in Australian buildings are, for the most part, well below internationally recommended indoor levels, and significantly lower than for buildings in the USA and the UK, probably due to different soils, building practices, and the coastal proximity for much housing.142 Secondhand tobacco smoke causes lung cancer, as well as a range of other respiratory symptoms and illnesses among non-smoking adults and children.52 In past decades, exposure to secondhand smoke has been ubiquitous. Restrictions on smoking in the workplace and in many public places have reduced exposure to secondhand smoke for many Australians over the past 20 years, although exposure in recreational facilities and establishments such as hotels and nightclubs has remained high. A significant number of adults and children also remain exposed in the home (see Chapter 4, Section 4.12). For further information on secondhand smoke refer to Chapter 4. Smokefree environments are discussed in Chapter 15.

3.25.3 Sick building syndrome

Over the past 15 to 20 years awareness has risen about 'sick building syndrome,' a term coined to describe the range of symptoms associated most particularly with working in the air-conditioned office environment.142 Symptoms of sick building syndrome include eye, respiratory and skin irritation, headaches and fatigue. Poorly maintained air conditioning systems may also harbour bacteria such as Legionella. It is likely that the cause of sick building syndrome is multifactorial, involving ventilation, airborne particulates from a wide range of sources (including chemicals, micro-organisms and non-organic matter) and other vectors in the indoor environment. Improved ventilation practices and reduction of pollutants are key factors in alleviating sick building syndrome, along with adherence to building and maintenance standards and improved controls over temperature, humidity and lighting.142