Tobacco and Public Health - TCSC Indonesia

708
IMPACT OF SMOKE-FREE BANS AND RESTRICTIONS
Health effects of ETS
Information about the damaging effects of ETS began to appear in the 1970s for children
(e.g. Colley 1974) and for adults in the early 1980s (Hirayama 1981). In the mid-1980s
a number of governmental reports and reviews, of which the US Surgeon-General’s
report was the most influential (U.S. Department of Health and Human Services 1986)
had confirmed findings of the harmful effects of ETS for non-smokers. Subsequent
reviews have confirmed and extended these conclusions (e.g. United States
Environment Protection Agency 1992; California Environment Protection Agency
1997; Tobacco Free Initiative 1999).
The more serious adult conditions linked to passive smoking include chronic respiratory
symptoms, lung cancer, cardiovascular disease (CHD), and disorders of the nose
and sinus (Benninger 1999; Wiebel 1997). Infants, children, and those with chronic
conditions such as respiratory disorders are more susceptible to harm from ETS exposure
than adults (Davis 1998). Adverse effects of passive smoking on children, include
a causal role in respiratory diseases such as bronchitis, pneumonia, asthma (as well as
triggering bouts), and reduced lung function, plus increases in middle ear infections
and SIDS. ETS has also been causally linked to lower birth weight. There is also evidence
of harmed neural development in utero (Samet 1999).
Immediate reactions to ETS include sore eyes, itching, sneezing, coughs, and wheezing.
The financial cost of treating coughs, phlegm, and wheeze in children exposed to ETS
is estimated to be 14% higher in homes with one smoker and 25% higher in homes
with two smokers compared to children not exposed to ETS (Peters et al. 1998).
Voluminous evidence now attest to the adverse health effects of ETS on non-smokers,
with both long term and immediate health effects constituting a clear threat to public
health. Further, it is likely that passive smoking adds to the risks of active smoking in
smokers. However, the nature of the dose–response relationship is less well documented.
Studies showing adverse effects of ETS exposure have used crude exposure measures,
such as spouse smoking and rarely have there been more than two categories of exposure
(e.g. for children’s exposure: neither, one, or both parents smoking). Extrapolating
from the active smoking literature where dose–response effects are clearly present and
detectable at low exposures, plus the reality that ETS exposures are almost always lower
than active smoking exposures, it is reasonable to assume that there is no safe level of
exposure. For many conditions, chronic exposure seems to be critical; however, there are
conditions, which can be triggered or exacerbated by acute exposure such as asthma
attacks and problems for those with major respiratory problems like cystic fibrosis. That
said, from what we know the bulk of the serious harm comes from prolonged (chronic)
exposure, so this should be the focus of public policy and public education.
The magnitude of the adverse health consequences caused by passive smoking while
comparable to other environmental toxins are small compared with those associated with
active smoking. The strong societal responses to reduce passive smoking summarized