What are the other health effects of exposure to secondhand smoke?

Secondhand smoke is associated with disease and premature death in nonsmoking adults and children.3,7 Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It increases the risk of heart disease by about 25 to 30%.In the United States, secondhand smoke is estimated to cause nearly 34,000 heart disease deaths each year.10 Exposure to secondhand smoke also increases the risk of stroke by 20 to 30%.10

Secondhand smoke exposure during pregnancy has been found to cause reduced fertility, pregnancy complications, and poor birth outcomes, including impaired lung development, low birth weight, and preterm delivery.11

Children exposed to secondhand smoke are at increased risk of sudden infant death syndrome, ear infections, colds, pneumonia, bronchitis, and more severe asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless.3,7,10

There is no safe level of exposure to secondhand smoke. Even low levels of secondhand smoke can be harmful.

How can you protect yourself and your family from secondhand smoke?

The only way to fully protect nonsmokers from secondhand smoke is to eliminate smoking in indoor workplaces and public places and by creating smokefree policies for personal spaces, including multiunit residential housing. Opening windows, using fans and ventilation systems, and restricting smoking to certain rooms in the home or to certain times of the day does not eliminate exposure to secondhand smoke.3,4

Steps you can take to protect yourself and your family include:

  • not allowing smoking in your home
  • not allowing anyone to smoke in your car, even with the windows down
  • making sure the places where your children are cared for are tobacco free
  • teaching children to avoid secondhand smoke
  • seeking out restaurants, bars, and other places that are smokefree (if your state still allows smoking in public areas)
  • protecting your family from secondhand smoke and being a good role model by not smoking or using any other type of tobacco product. For help to quit see smokefree.gov or call 1-877-44U-QUIT.

Do electronic cigarettes emit secondhand smoke?

Electronic cigarettes (also called e-cigarettes, vape pens, vapes, and pod mods) are battery-powered devices designed to heat a liquid, which typically contains nicotine, into an aerosol for inhalation by a user. Following inhalation, the user exhales the aerosol.12

The use of electronic cigarettes results in exposure to secondhand aerosols (rather than secondhand smoke). Secondhand aerosols contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents. More information about these devices is available on CDC’s Electronic Cigarettes page.

What is being done to reduce nonsmokers’ exposure to secondhand smoke?

On the federal level, several policies restricting smoking in public places have been implemented. Federal law prohibits smoking on airline flights, interstate buses, and most trains. Smoking is also prohibited in most federal buildings by Executive Order 13058 of 1997. The Pro-Children Act of 1994 prohibits smoking in facilities that routinely provide federally funded services to children. The Department of Housing and Urban Development published a final rule in December 2016, which was fully implemented in July 2018, that prohibits the use of cigarettes, cigars, pipes, and hookah (waterpipes) in public housing authorities, including all living units, indoor common areas, and administrative offices, as well as outdoor areas within 25 feet of buildings.

Many state and local governments have enacted laws that prohibit smoking in workplaces and public places, including restaurants, bars, schools, hospitals, airports, bus terminals, parks, and beaches. These smokefree policies have substantially decreased exposure to secondhand smoke in many U.S. workplaces.13 More than half of all states have implemented comprehensive smokefree laws that prohibit smoking in indoor areas of workplaces, restaurants, and bars, and some states and communities also have enacted laws regulating smoking in multi-unit housing and cars.14 The American Nonsmokers’ Rights Foundation provides a list of state and local smokefree air policies.

To highlight the health risks from secondhand smoke, the National Cancer Institute requires that meetings and conferences organized or primarily sponsored by NCI be held in a state, county, city, or town that has adopted a comprehensive smokefree policy, unless specific circumstances justify an exception to this policy. 

Healthy People 2020, a comprehensive nationwide health promotion and disease prevention framework established by the U.S. Department of Health and Human Services (HHS), includes several objectives addressing the goal of reducing illness, disability, and death caused by tobacco use and secondhand smoke exposure. For 2020, the Healthy People goal is to reduce the proportion of nonsmokers exposed to secondhand smoke by 10%. To assist with achieving this goal, Healthy People 2020 includes ideas for community interventions, such as encouraging the introduction of smokefree policies in all workplaces and other public gathering places, such as public parks, sporting arenas, and beaches.

Because of these policies and other actions, the percentage of nonsmokers who are exposed to secondhand smoke declined from 52.5% during 1999–2000 to 25.3% during 2011–2014.15 Exposure to secondhand smoke declined among all population subgroups, but disparities still exist. During 2011–2014, 38% of children ages 3–11 years, 50% of non-Hispanic blacks, 48% of people living below the poverty level, and 39% of people living in rental housing were exposed to secondhand smoke.15

Selected References

1. National Toxicology Program. Tobacco-Related Exposures. In: Report on Carcinogens. Fourteenth Edition. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program, 2016.

2. International Agency for Research on Cancer. Tobacco smoking, Second-hand tobacco smoke, and Smokeless tobacco. In: Personal Habits and Indoor Combustions: A Review of Human Carcinogens.IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 100E. Lyon, France: International Agency for Research on Cancer; 2012. p. 43-318.

3. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

4. National Cancer Institute. Cancer Trends Progress Report. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health; 2018.

5. U.S. Food and Drug Administration. Harmful and Potentially Harmful Constituents in Tobacco Products and Tobacco Smoke: Established List. Silver Spring, MD: U.S. Department of Health and Human Services, Food and Drug Administration, Center for Tobacco Products; 2012.

6. Rodgman A, Perfetti TA. Tobacco and/or tobacco smoke components used as tobacco ingredients. In: The Chemical Components of Tobacco and Tobacco Smoke. Boca Raton, FL: CRC Press; 2009. p. 1259.

7. U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

8. National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke. Smoking and Tobacco Control Monograph 10. NIH Pub. No. 99-4645. Bethesda, MD: U.S. Department of Health and Human Services, National Cancer Institute; 1999.

9. U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Washington, DC: U.S. Environmental Protection Agency, Office of Health and Environmental Assessment, Office of Research and Development; 1992.

10. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

11. National Cancer Institute. A Socioecological Approach to Addressing Tobacco-Related Health Disparities. National Cancer Institute Tobacco Control Monograph 22. NIH Pub. No. 17-CA-8035A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2017.

12. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016.

13. National Institute for Occupational Safety and Health. Promoting Health and Preventing Disease and Injury Through Workplace Tobacco Policies. Current Intelligence Bulletin. DHHS (NIOSH) Publication No. 2015-113. U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2015.

14. Tynan MA, Holmes CB, Promoff G, et al. State and local comprehensive smoke-free laws for worksites, restaurants, and bars – United States, 2015. MMWR Morbidity and Mortality Weekly Report 2016; 65(24):623-626. [PubMed Abstract]

15. Tsai J, Homa DM, Gentzke AS, et al. Exposure to secondhand smoke among nonsmokers — United States, 1988–2014. MMWR Morbidity and Mortality Weekly Report 2018;67:1342–1346. DOI: http://dx.doi.org/10.15585/mmwr.mm6748a3

Source: National Cancer Institute.