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Passive smoking poses significant health hazard
This lack of awareness about the dangers of passive smoking is particularly true in a developing country like Pakistan. Until people understand the dangers of passive smoking, they are not likely to demand clean indoor air regulations or the enforcement of existing nonsmoking regulations By Professor Javaid Khan

Even though private policy and legal restrictions on smoking in public places exist, they are rarely enforced and many people do not take them seriously. Delegates of the 13th World Congress on Tobacco or Health, held in Washington DC recently, agree that one of the fundamental reasons for this indifference is the near universal lack of understanding or appreciation of the health risks of environmental tobacco smoke (ETS) also known as passive or second hand smoking. This lack of awareness about the dangers of passive smoking is particularly true in a developing country like Pakistan.

Electronic and print media in western countries played an important role in educating their public on the dangers of both active and passive smoking. For example California, USA was in a similar situation about 15 years ago when the movement for smoke-free public places was gathering momentum. Today, virtually all work sites and indoor public places in California are smoke-free. Earlier, nonsmokers found smoke objectionable but did not feel empowered to speak out and demand that it be eliminated. Understanding the strong scientific and medical evidence that passive smoking is dangerous, is an important first step in mobilising the nonsmoking majority to support social change in the country.

This lack of understanding on the dangers of ETS has significant implications both for individuals and for public health. Individuals simply may not know why they need to protect themselves, their employees, or their families from tobacco smoke. Until they understand the dangers of passive smoking, people are not likely to demand clean indoor air regulations or the enforcement of existing nonsmoking regulations. The Prohibition of Smoking and Protections of Health of Non Smokers Ordinance was passed in Pakistan in 2002 but no attempt was made by the government to educate the public about the dangers of tobacco smoke, as a result this law remains on papers only.
To educate the public about the health risks of passive smoking, we need to properly convey the concrete scientific evidence proving the severity of its risks.

Research has clearly shown that there are immediate and substantial effects from secondhand smoke. For example, 30 minutes of breathing secondhand smoke makes blood platelets get as activated as in habitual pack-a-day smokers. These activated platelets damage the lining of arteries, which leads to heart disease. If they form a blood clot that lodges in a coronary artery, it may result in heart attacks. If it lodges in the brain, it can cause permanent disability in the form of paralysis/stroke. Facts about ETS In the presence of a smoker, especially in enclosed spaces, a nonsmoker, is forced to breathe 'sidestream' smoke from the burning tip of the smoker's cigarette and 'mainstream' smoke that has been inhaled and then exhaled by the smoker. • Tobacco smoke contains more than 4,000 chemicals in the form of particles and gases. • Many potentially toxic gases are present in higher concentrations in side-stream smoke than in mainstream smoke, and nearly 85 percent of the smoke in a room results from side-stream smoke. • The particulate phase includes tar (itself composed of many chemicals), nicotine, benzene and benzopyrene. The gas phase includes carbon monoxide, ammonia, nitrosamine, formaldehyde, hydrogen cyanide, and acrolein. • Some of these have strong irritant properties and at least 60 of them are known or suspected carcinogens (cancer-causing substances). The United States Environmental Protection Agency has classified environmental tobacco smoke as a 'Class A' (known human) carcinogen along with asbestos, arsenic, benzene and radon gas. Harmful effects of ETS It is important to know that not all ill-effects of passive smoking take a long time to take effect. Many are virtually instant. • Immediate effects of secondhand smoke include cardiovascular problems such as damage to cell walls in the circulatory system, thickening of the blood and arteries, and arteriosclerosis (hardening of the arteries) or heart disease, increasing the chance of heart attack or stroke. • Short-term exposure to tobacco smoke has a measurable effect on the heart in nonsmokers. Just 30 minutes of exposure is enough to reduce blood flow to the heart. • Nonsmokers who are exposed to secondhand smoke in the home have a 25 percent increased risk of heart disease. As is the case with active smoking, much of the cardiovascular effect is due to acute poisoning. • For asthma sufferers, tobacco smoke can cause immediate danger by triggering attacks. The majority of asthma sufferers report symptoms ranging from discomfort to acute attacks from exposure to secondhand smoke, and exposure to smoke can even cause new cases of asthma. • Individuals who are HIV positive may develop full-blown AIDS four times as quickly when regularly exposed to secondhand smoke. • At home, at work, at school, in restaurants, or in theatres, secondhand smoke is a proven health threat to all people, in all countries. All work places should be smoke-free For most adults, the workplace is a greater source of exposure to secondhand smoke than the home. • Secondhand smoke poses a serious health threat in the workplace because it contains toxic chemicals that can poison the heart and blood vessels and cause cancer and respiratory problems. Unfortunately, most workers are not in a position to change their work environment or to leave their jobs to protect their health. In many cases, where smoke-free workplaces are not guaranteed, employees find themselves forced to spend the majority of their waking hours in a health-threatening situation. • People who are routinely exposed to secondhand smoke, such as workers in restaurants, can expect their risk of lung cancer to triple. • Levels of secondhand smoke in restaurants are approximately 1.6 to 2.0 times higher than in office workplaces or other businesses. The epidemiological evidence suggested that there might be a 50 percent increase in lung cancer risk among food service workers that is in part attributable to tobacco smoke exposure in the workplace. What can workers do? Employees can raise awareness of the dangerous health effects of passive smoking in many ways. • Build support for smoke-free policies by providing employers with signs to post and leaflets to distribute that highlight the dangers of passive smoking to all workers. These materials can build support for the adoption of a smoke-free policy or can strengthen support for enforcement of an existing policy. • Recruit union leaders and union workers to distribute brochures on the health effects of passive smoke in the workplace. • Publicise lawsuits and workers' compensation actions for smoke-related illnesses and absenteeism. • Provide brochures for workers subject to specific risks • Survey restaurant workers to see if they are aware of the many harmful effects of passive smoking. By including the short-term and long-term effects of passive smoking in the questions, the survey can educate restaurant employees. Protect your children from ETS The World Health Organisation currently estimates that nearly 700 million, or almost half of the world's children, breathe air polluted by tobacco smoke, particularly at home. In Pakistan, research shows that almost 70 percent of our children get exposed to ETS everyday. Infants and young children subjected to forced passive smoking, experience increased rates of lower respiratory tract infections, such as bronchitis and pneumonia. Other harmful effects of ETS on children includes: • Increased rates of ear infections. • Exacerbated chronic respiratory diseases like asthma. • A four-fold increase in the risk of death from sudden infant death syndrome (SIDS). • Childhood exposure to secondhand smoke may also contribute to heart disease in adulthood adding to behavioural problems. • In nonsmoking pregnant women, exposure to secondhand smoke may impair foetal growth. • A research conducted in UK indicates that in households where both parents smoke, young children have a 72 percent increased risk of respiratory illnesses. The severity of the health impact of ETS exposure on children has led the WHO to call for the right of every child to grow up in an environment free of tobacco smoke. To achieve this goal, greater efforts will be needed to encourage parents to stop smoking.