In 2003, over 11,000 people in the UK are estimated to have died as a result of
passive smoking.* Although regarded for many years as little more than a
nuisance, exposure to ambient tobacco smoke released directly by burning
tobacco and indirectly by exhalation of smoke by smokers (also variously
referred to as environmental tobacco smoke, second-hand smoke, or tobacco
smoke pollution) is now a recognised cause of significant short- and long-term
harm to others. Many of those adverse health effects were summarised,
particularly in relation to adult exposure, in an earlier Royal College of
Physicians report.†
Increasing awareness of these health risks has led the UK and several other
countries to introduce legislation restricting or prohibiting smoking in enclosed
public places. This legislation has typically been justified by the legal and moral
obligation to ensure safe working environments and, in the UK, to prevent the
600 or so deaths previously estimated to be caused each year by passive smoking
at work.* However, these are the minority of deaths caused by passive smoking,
the bulk of which (an estimated 10,700 deaths in adults in 2003)* arise from
exposure to tobacco smoke in the home.
Passive smoking in the home is also a major hazard to the health of the
millions of children in the UK who live with smokers, and the extent of this
health problem has not, to date, been accurately quantified. In this report, we
therefore use established literature and additional analysis to estimate the
prevalence, determinants and trends in passive smoking exposure, present new
systematic reviews and meta-analyses of the magnitude of the effects of passive
smoking on the main recognised health consequences in children, and estimate
the numbers of cases of illness and death arising from these effects. We also
quantify the effect of exposure to smoking behaviour on the risk of children
starting to smoke, and estimate the number of children who do take up smoking
as a consequence. We then consider the financial cost of the disease burden for
the NHS and wider society arising from all of these exposures. The report also
explores ethical issues relating to passive smoking and children, and public
opinion on measures to prevent passive smoking, concluding with policy options
that would reduce exposure of children to this significant health hazard and
negative behavioural model.
Governments, and societies, have a duty to ensure that children grow up in a
safe environment, and are protected from explicit or implicit encouragement to
take up hazardous behaviours such as smoking. This report provides some of the
background and policy measures necessary to ensure that that duty is discharged.
I am personally very grateful to John Britton and the other members of the
RCP’s Tobacco Advisory Group, and the many contributors to this report who
have continued the excellent tradition of the RCP in this important area.
