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14-1 Passive smoking Healthcare workers need to know about the effects of both active and passive smoking.

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Presentation on theme: "14-1 Passive smoking Healthcare workers need to know about the effects of both active and passive smoking."— Presentation transcript:

1 14-1 Passive smoking Healthcare workers need to know about the effects of both active and passive smoking.

2 14-2 Passive smoking Streams of tobacco fume Lateral stream or second hand Main stream Smoker Third stream

3 14-3 Passive smoking Tobacco smoke : Gas phase Type of toxicity Amount in main stream / cig. Ratio second/main stream Carbon monoxidToxic26,8-61 mg2,5-14,9 BenzeneCarcinogen µg8-10. FormaldehydeCarcinogen1 500 µg50 3-VinylpyridineSuspected Carcinogen µg24-34 Hydrogen CyanideToxic g0, 06-0,4 HydrazineSuspect Carcinogen 90 ng3 Azote oxides (NOx)Toxic µg3,7-12,8 N-nitrosodimethylamineSuspect Carcinogen ng N-nitrosopyrrolidineSuspect Carcinogen ng6-120

4 14-4 Passive smoking Particular phase 7,20, 72 µgCancerogenCadmium 1,243 ngSuspect CancerogenN-nitrosodiéthanolamine 1-220,2-1,4 µgSuspect Cancerogennor nitrosocotinine 0,5-50,15-1,7 µgSuspect CancerogenN-nitrosonornicotine µgCancerogenQuinoléine 2, ngCancerogenBenzo(a)pyrene ngCancerogenBenz(a)anthracene 3,1140 ngCancerogen4-Aminobiphenyl 3970 ngCancerogen2-Naphthylamine 18,73 µgCancerogenO-Toluidine 0,67-12, µgSuspect CancerogenCatechol 1, µgPromotorPhenol 1,3-212,1-46 mgToxicNicotine 1,1-15, mgCancerogenTars Ratio second hand/ main stream Amount in main stream / cig toxicity

5 14-5 Passive smoking Discomfort from passive smoking is a reality Recent survey (Baromètre santé 2000) showed than 72 % of non-smokers are disturbed by second hand tobacco. These results demonstrate the need for non smokers to be totally protected from second hand tobacco. NB 53% of smokers also stated that they were disturbed by second hand tobacco. The request for a smoke-free environment is well accept by both non-smokers and smokers alike.

6 14-6 Passive smoking Discomfort from passive smoking in Europe 0% 10% 20% 30% 40% 50% 60% 70% 80% Belgium Denmark Germany Greece Spain France Eire Italy Luxemburg Nederland Portugal UK Sources: Europe against cancer, 1993 and WHO Europe, Disturbance % smokers

7 14-7 Passive smoking Disturbance from passive smoking report by smokers in response to the question : « are you disturbed by smoke from others? » 33,2 39,4 45,4 47,5 58,1 65,3 40,2 44,2 42,7 40,9 32,5 25,7 26,6 16,4 11,9 11,7 9, % <1 cig/d cig/d cig/d cig/d cig/d > 20 cig/d Not at allYes, little Yes, strongly Source: Baromètre santé 2000, CFES

8 14-8 Passive smoking Exposure to tobacco smoke % Restaurants Friends Public place Transports Working place At home Eurobaromètre 1995 (12 european states)

9 14-9 Passive smoking Recent scientific data demonstrates the risk of second hand smoking for non-smokers. Smokers are the main victims of tobacco smoke ( deaths annually in Europe) Recent scientific data, mainly published within last 15 years, provides clear evidence than second hand tobacco smoke is the cause of disease in children and adults. This evidence calls for responsible action in public places to prevent all exposure to second hand tobacco smoke.

10 14-10 Passive smoking Second hand tobacco smoke is associate with an increase risk of :  Lower tract respiratory infections in children (+ 72 % if mother smokes),  recurrent otitis media in children (+48 % if both parents smoke),  asthma attack and shyness in children,  intra-uterin growth defects and low birth weight (also occurs in non smoking mothers passively exposed to second hand tobacco),  suddent infant death (two fold increase)  Heart attack (+25 %, it is the main cause of second hand related death)  lung cancer (+ 26 %). Apart from these well established effects, many other effects are suspected with regard to non malignant diseases and the aggravation of pre-existing conditions or malignous diseases, however new scientific data is needed to confirm these effects.

11 14-11 Passive smoking Cardiac disease (coronary disease) Three meta-analysis including more than 25 epidemiologic studies demonstrates that second hand smoke exposure is associate to an excess of coronary disease (angina and myocardial infarction). This effect is established for non-smokers exposed at home or in the working place. Biological data explains this excess of risk. The risk decreases when exposure stops. A dose/response relationship exists. The best estimate of this risk excess as compared to non exposed person is 25%. Because of the number of people concerned, cardiac risk is the main risk of mortality with regard to second hand tobacco exposure.

12 14-12 Passive smoking Lung carcinoma More than 40 epidemiological surveys included in 3 meta-analysis established that second hand tobacco is associated with an increase in lung carcinoma (25%). This effect is demonstrated in non-smokers exposed at home and in the working place. A dose/response relationship exists. The best estimate of risk as compared to a non exposed person is 26%.

13 14-13 Passive smoking Lung carcinoma Increased risk 26% Heart attacks 25% Disturbance Increase risk 80 % for non-smokers 53% for smokers. Two main risks of passive smoking in adults, in addition to those in pregnancy)

14 14-14 Passive smoking Bronchitis Increased risk of 72 % for a smoking mother and 29 % if an other family member smokes Suddent infant death 2 fold increased risk Otitis media Increased risk of 21%, 38% or 48 % according to whether father, mother or both are smokers Asthma attack Increased risk of 14%, 38% or 48% according whether father, mother or both are smokers The four main risks of passive smoking in children

15 14-15 Passive smoking Number of workers exposed to respiratory carcinogens in France Second hand tobacco smoke. (>75% of working time) Radon and degradation product Diesel exhaust fumes Inorganic acid mists (sulf. ac. ) Formaldehyde Wood dust Source : CAREX

16 14-16 Passive smoking Percentage of people who report that non smokers are protect from second hand tobacco (%) CFES 1995 CFES1998 CREDOC 2000 CFES Workplaces 53,856,861,960,3 Transports 53,740,156,145,7 Restaurants 36,14440,141,2 Bars 12,117,2-13,2 Railway and undergrounds --26,9- Public places in general 37,243,9-31,5 School, university 50,8

17 14-17 Passive smoking Indoor tobacco pollution CompoundTypical value in clean area Smoking roomLimit value for pollution in city CO< 1 ppm10 ppm16mg/m 3 (14,5 ppm) plan to decrease to 10mg/m 3 (8,5 ppm) at /1/2005 Cotinine0,34 ± 0,007 µg/m 3 3,74 ± 0,52 µg/m 3 Nicotine < 0,3  g/m  g/m 3 < limit of detection Particul mater < 1 m  (MMAD)  g/m  g/m  g/m 3 respirable USA Benzene 3,6  g/m 3 7,2  g/m 3 10  g/m 3 decreasing to 5  g/m3 at 1/1/2010

18 14-18 Passive smoking Decrease of nicotine in air according to tobacco control regulation Source : Trout D, J Occup Environ Med 1998; 40:270-6 Hammond SK, JAMA 1995; 274: ,6 1,3 0,3 2,3 0,7 0, No policiesNon-smoking areaNon-smoking casino nicotine in air (mcg/m3) casino Others workplaces

19 14-19 Passive smoking Benefit to employees of smoking prohibition in restaurants Eisner M et coll., JAMA 1998, 280, Number of barmen with symptoms Source: Before prohibitionAfter prohibition 0 Symptoms in 67 barmen before and after smoking prohibition Dyspnea Morning cough Day cough Sputum Eyes irritation Nose irritation Throat irritation,

20 14-20 Passive smoking Biological monitoring of passive smoking ,5 ± 28,7 7,47 ± 8,25 Urinary (ng/ml) 2,49 Plasmaic (ng/ml) 150,6 ± –43,65,8 ± 4,35 Nicotine Salive (ng/ml) 30 Urin. (ng/mg creat.) 3 – –250 0,3 – 392 Urinary (ng/ml) 1 5 –7,33 undetectable Plasmatic (ng/ml) 0 – 83,6 – 31,30,4 Salive (ng/ml) Cotinine RIACGRIA CG RIA CG > 5 %2-3 % > 1,7 % HbCO >10–20 ppm 7–11 ppm 3 ppm ± 1,5 C0 smoker exposed Non-exposed Compound CG = Gazeous chromatography RIA = radio-immuno-assay


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