Second-hand tobacco smoke is the smoke emitted from the burning end of a cigarette (also known as ‘side-stream smoke’) or from other tobacco products, in combination with the ‘mainstream smoke’ exhaled by the smoker. Second-hand smoke (SHS) is variously called involuntary smoking, passive smoking and environmental tobacco smoke.
The International Agency for Research on Cancer has declared SHS as carcinogenic.124 Article 8 of the Framework Convention on Tobacco Control (FCTC) focuses on “protection from exposure to tobacco smoke” and signatories to the FCTC have agreed to recognise that “scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability.” Signatories agreed to adopt effective legislation in order to provide protection from second-hand smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.
In 2002, before the introduction of smoke-free policies, second-hand smoking at work appeared to account for over 7,000 deaths across the EU every year. Second-hand smoking at home appeared to account for 72,000 deaths per year. Since the introduction of smoke-free policies, a Cochrane review by Callinan et al. has found consistent evidence of reduced exposure to SHS in workplaces, restaurants, pubs and in public places. Callinan et al. also found consistent evidence of a reduction in cardiac events as well as some improvement in other health indicators after the introduction of smoke-free legislation. In Scotland, following the introduction of smoke-free legislation covering all enclosed places, hospital admissions for acute coronary syndrome decreased by 17%, compared with only a 4% decrease in England (where the legislation was not in place at the time).
Although 67% of the decrease involved non-smokers, fewer admissions among smokers also contributed to the overall reduction. A study in northern Italy (Piedmont region) reported the number of admissions for acute myocardial infarction (AMI) decreased significantly after the introduction of the smoke-free legislation: from 922 cases in February-June 2004 to 832 cases in February-June 2005 (sex- and age-adjusted rate ratio, 0.89; 95% Confidence Interval (CI) 0.81-0.98 in those aged under 60 years). The authors postulated the effects on AMI admissions might be due to the reduction of passive smoking.
In Italy, after the smoke-free legislation there was a statistically significant reduction in acute coronary events in the adult population, suggesting that public interventions that prohibit smoking can have enormous public health implications.
