Based on reviews of the evidence gathered over the previous two decades, active smoking was declared a cause of disease in smokers by landmark reports in the UK (in 1962)1 and the US (in 1964).2 Since then the evidence that inhaling other people’s tobacco smoke can be harmful to health has accumulated.3-7 Early indications that exposure to secondhand smoke was associated with respiratory illness in children were published in the 1970s,3-5 and studies demonstrating adverse effects on the health of adult non-smokers began to emerge in the following decade.6,7
In the second half of the 1980s several major international reports reviewed the scientific evidence about the health effects of secondhand smoke. The International Agency for Research on Cancer,8 Australia’s National Health and Medical Research Council,9 the US Surgeon General,10 the US National Research Council11 and the UK’s Scientific Committee on Tobacco and Health12 issued landmark publications concluding that exposure to secondhand smoke increases the risk of illness and death in non-smokers, from infancy to adulthood. Subsequent reviews published by expert agencies have since strengthened and extended these findings.13-20 Table 4.0.1 is based on an International Agency for Research on Cancer chart summarising the findings and dates of publication of major scientific reports which extensively reviewed evidence on some of the adverse effects of secondhand smoke exposure.
Adverse effects from exposure to secondhand tobacco smoke published in major reports*
SGR: US Surgeon General’s report; EPA: US Environmental Protection Agency; CalEPA: California Environmental Protection Agency; UK: Scientific Committee on Tobacco and Health; WHO: World Health Organization; IARC: International Agency for Research on Cancer
*Table adapted from similar tables in reports by the US Department of Health and Human Services and ASHRAE
† Yes/a = association; Yes/c = causation. Only effects causally associated included
†† Added in 2004
Source: Table 2.1, Chapter 2. Health effects of exposure to secondhand smoke (SHS), International Agency for Research on Cancer. Evaluating the effectiveness of smoke-free policies, IARC handbooks of cancer prevention.19
It is now well established that secondhand smoke causes coronary heart disease and lung cancer in non-smoking adults, and induces and exacerbates a range of mild to severe respiratory effects in infants, children and adults.18, 21 Secondhand smoke is a cause of sudden infant death syndrome and a range of other serious health outcomes in young children.18, 21 There is increasing evidence that secondhand smoke exposure is associated with psychological distress.22
Those at particular risk from the harmful effects of secondhand smoke are the young, who lack control over their environment,21 and the socially disadvantaged, who are more likely to be exposed to secondhand smoke at home and elsewhere.18
There is no level of exposure to secondhand smoke that is free of risk.18 Since Australians spend up to 90% of their time indoors,23 indoor air quality is an important public health issue. Secondhand smoke has been restricted on the grounds of occupational health and safety in entertainment venues including hotels, casinos, restaurants and nightclubs, as well as in vehicles, and many people also restrict smoking in their homes. In some parts of Australia there are now restrictions on smoking in certain outdoor areas as well, such as entrances to public buildings, public transport stops, al fresco dining areas, hospital grounds, universities, sporting and other entertainment venues and beaches. Regulations and policy concerning smokefree environments are discussed in Chapter 15.
The emergence of secondhand smoke as a public health issue has been a major public relations setback for the tobacco industry. Its traditional defence has been that smoking is a rightful expression of individual choice and personal freedom. However, this argument is undermined when considering the broad public health impacts of smoking, including the implications smoking has for occupational health and safety and the right of non-smokers, including children, to breathe smokefree air. Not surprisingly, the industry has fought a bitter rearguard action against publicity concerning the health effects of secondhand smoke. The industry has endeavoured to downplay and obfuscate evidence about health consequences and to influence policies on smoking through a number of means.18, 24-26 This is discussed further in Chapter 10.
Relevant news and research
For recent news items and research on this topic, click here.(Last updated March 2020)
1. Royal College of Physicians. Smoking and health: Report of the royal college of physicians on smoking in relation to cancer of the lung and other diseases., London: Pitman Medical Publishing Co Ltd., 1962.
2. US Surgeon General's Advisory Committee on Smoking and Health, Smoking and health: Report of the advisory committee to the surgeon general of the public health service Rockville, Bethseda, Maryland: United States. Public Health Service. Office of the Surgeon General; 1964. Available from: http://profiles.nlm.nih.gov/NN/B/C/X/B/
3. Colley JR. Respiratory symptoms in children and parental smoking and phlegm production. British Medical Journal, 1974; 2:201–4.
4. Harlap S and Davies A. Infant admissions to hospital and maternal smoking. Lancet, 1974; 1:529–32.
5. Leeder S, Corkhill R, Irwig L, and Holland W. Influence of family factors on the incidence of lower respiratory illness during the first year of life. British Journal of Preventive Social Medicine, 1976; 30:203–12.
6. Trichopoulos D, Kalandidi A, Sparros L, and MacMahon B. Lung cancer and passive smoking. International Journal of Cancer, 1981; 27(1):1–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7251227
7. Hirayama T. Non-smoking wives of heavy smokers have a higher risk of lung cancer: A study from japan. British Medical Journal (Clinical Research Ed.), 1981; 282(6259):183–5. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1503989&blobtype=pdf
8. International Agency for Research on Cancer Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC monographs on the evaluation of carcinogenic risks to humans, Vol. 83.Lyon, France: IARC, 2004. Available from: http://monographs.iarc.fr/ENG/Monographs/PDFs/index.php
9. National Health and Medical Research Council. The health effects of passive smoking: A scientific information paper. Canberra: Australian Government Publishing Service, 1997.
10. US Department of Health and Human Services. The health consequences of involuntary smoking: A report of the surgeon general. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health, 1986. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/previous_sgr.htm
11. Committee on Passive Smoking, Board on Environmental Studies and Toxicology, and National Research Council. Environmental tobacco smoke: Measuring exposures and assessing health effects. Washington DC 1986. Available from: http://www.nap.edu/books/0309037301/html/
12. Scientific Committee on Tobacco and Health. Report of the scientific committee on tobacco and health. London: UK Department of Health, 1998. Available from: http://www.archive.official-documents.co.uk/document/doh/tobacco/contents.htm
13. United States Environment Protection Agency. Respiratory health effects of passive smoking: Lung cancer and other disorders. Washington DC: Office of Health and Assessment, 1992. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1759217
14. Royal College of Physicians, Smoking and the young. London: Royal College of Physicians; 1992. Available from: http://bookshop.rcplondon.ac.uk/index.aspx
15. California Environmental Protection Agency, Health effects of exposure to environmental tobacco smoke. Sacramento: Office on Environmental Health Hazard Assessment, California Environmental Protection Agency; 1997.
16. Scientific Committee on Tobacco and Health. Secondhand smoke: Review of the evidence since 1998: Update of evidence on health effects of secondhand smoke. London: Department of Health 2004. Available from: http://www.advisorybodies.doh.gov.uk/scoth/publications.htm
17. International Agency for Research on Cancer Working Group on the Evaluation of Carcinogenic Risks to Humans. General remarks: Future worldwide health effects of current smoking patterns, in Tobacco smoke and involuntary smoking. Lyon, France: IARC; 2004. p 33–47 Available from: http://monographs.iarc.fr/ENG/Monographs/vol83/index.php
18. US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2006/index.htm
19. International Agency for Research on Cancer. Vol 13. Evaluating the effectiveness of smoke-free policies. Handbooks of Cancer Prevention, Tobacco Control, Lyon, France: International Agency for Research on Cancer, 2009. Available from: http://com.iarc.fr/en/publications/pdfs-online/prev/handbook13/
20. Tobacco Advisory Group. Passive smoking and children. London: Royal College of Physicians, 2010. Available from: http://bookshop.rcplondon.ac.uk/details.aspx?e=305
21. Office of Environmental Health Hazard Assessment and California Air Resources Board. Health effects of exposure to environmental tobacco smoke: Final report, approved at the panel's june 24, 2005 meeting. Sacramento: California Environmental Protection Agency, 2005. Available from: http://www.oehha.ca.gov/air/environmental_tobacco/2005etsfinal.html
22. Zeng YN and Li YM. Secondhand smoke exposure and mental health in adults: A meta-analysis of cross-sectional studies. Soc Psychiatry Psychiatr Epidemiol, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26661619
23. Australian Bureau of Statistics. 1301.0 Australia now. Environment, air pollution. Canberra: ABS, 2004. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/second+level+view?ReadForm&prodno=1301.0&viewtitle=Year Book Australia~2004~Previous~27/02/2004&&tabname=Past Future Issues&prodno=1301.0&issue=2004&num=&view=&
24. Trotter L and Chapman S. 'Conclusions about exposure to ets and health that will be unhelpful to us: How the tobacco industry attempted to delay and discredit the 1997 australian national health and medical research council report on passive smoking. Tobacco Control, 2003; 12(suppl.3):iii102-iii6. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_3/iii102
25. Lopipero P and Bero L. Tobacco interests or the public interest: 20 years of industry strategies to undermine airline smoking restrictions. Tobacco Control, 2006; 15(4):323–32. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/15/4/323
26. Bero LA, Glantz S, and Hong MK. The limits of competing interest disclosures. Tobacco Control, 2005; 14(2):118–26. Available from: http://tc.bmjjournals.com/cgi/content/abstract/14/2/118