The Environmental Consequences of Tobacco Smoking: Implications for Public Policies That Affect the Health of Children

Abstract

The human health consequences of cigarette smoking have been more thoroughly studied than those of any other environment exposure. According to the 1979 publication, Smoking and Health: A Report of the Surgeon General,1 and the 1982 Surgeon General's Report on the Health Consequences of Smoking,2 specific mortality ratios are directly proportional to the years of cigarette smoking, and they are higher for those who initiated smoking at younger ages. Smoking contributes to mortality from lung cancer, cardiovascular disease, and non-neoplastic bronchopulmonary disease; and it increases the risk of cancer from exposure to other carcinogens, such as asbestos. Birth weight and fetal growth may also be adversely affected by smoking during pregnancy. Despite their efforts to educate young patients about the dangers of smoking, it is alarming to pediatricians that the incidence of daily smoking among high school seniors is still 20%.2 Although the direct effects of cigarette smoking on the smoker are generally accepted, and less attention has been paid to the environmental hazard created by smokers for the nonsmoker, these effects also are addressed in the Surgeon General's report. Tobacco and tobacco smoke act as antigens and sensitize T lymphocytes. The lighted cigarette generates approximately 4,000 compounds, including gases and particulate phases. Cigarette smoking in enclosed areas can produce concentrations of carbon monoxide well above the ambient air quality standard, even when ventilation is otherwise adequate. In comparison with children of nonsmokers, children of parents who smoke have more bronchitis and pneumonia and reduced pulmonary function. Nonsmokers who are chronially exposed to tobacco smoke have reduced function of small airways comparable to that found in light smokers.