Psychosocial Changes ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

expressed฀ as฀ a฀ preference฀ for฀ sitting฀ around฀ [96] ,฀ earlier฀ alcohol฀ consumption฀ [252] ,฀ increased฀fat฀intake฀ [252,฀253] ฀or฀an฀accumulation฀of฀these฀unhealthy฀behaviours฀ [254] .฀ The฀smoking฀habits฀of฀the฀children฀also฀correlate฀with฀those฀of฀their฀parents,฀as฀has฀been฀ demonstrated฀in฀several฀studies฀ [255–257] .฀Readers฀are฀referred฀to฀ Chap.฀12 ฀for฀further฀ discussion฀of฀this฀aspect.

9.11 Concluding Remarks

The฀data฀presented฀in฀the฀literature฀permit฀a฀range฀of฀conclusions,฀several฀of฀which฀are฀of฀ major฀importance฀in฀terms฀of฀public฀health฀policy: • ฀ Adult฀ non–smokers฀ exposed฀ to฀ ETS฀ become฀ ill฀ more฀ frequently฀ than฀ non-smokers฀ without฀ETS฀exposure,฀prompting฀the฀conclusion฀that฀smoking฀should฀be฀banned฀in฀the฀ workplace฀and฀in฀public฀buildings. • ฀ Non-smokers฀and฀smokers฀should฀be฀educated฀about฀the฀dangers฀of฀ETS,฀the฀objective฀ being฀to฀reduce฀or฀prevent฀ETS฀in฀their฀own฀homes. • ฀ Any฀study฀of฀the฀medical฀consequences฀of฀smoking฀and฀any฀comparison฀with฀the฀situ- ation฀in฀non-smokers฀must฀always฀consider฀the฀role฀played฀by฀ETS฀because฀this฀factor฀ already฀leads฀to฀health-related฀changes. • ฀ Despite฀ contradictory฀ data,฀ it฀ has฀ now฀ been฀ proved฀ that฀ extensive฀ ETS฀ exposure฀ a฀฀minimum฀of฀20–30฀pack-years฀increases฀the฀risk฀of฀bronchial฀carcinoma฀by฀at฀least฀ 30,฀and฀in฀extreme฀cases฀this฀risk฀may฀be฀increased฀two-฀to฀threefold.฀Ethnic฀differ- ences฀appear฀to฀exist,฀with฀Asian฀populations฀being฀at฀even฀greater฀risk฀than฀those฀in฀ Western฀Europe฀or฀North฀America. • ฀ Female฀ smokers฀ planning฀ to฀ become฀ pregnant฀ or฀ unexpectedly฀ becoming฀ pregnant฀ should฀make฀every฀effort฀to฀stop฀smoking฀either฀before฀pregnancy฀or฀during฀the฀irst฀ weeks฀of฀pregnancy.฀They฀should฀also฀refrain฀from฀smoking฀during฀the฀irst฀years฀after฀ their฀child฀has฀been฀born.฀The฀same฀applies฀for฀fathers฀living฀in฀the฀same฀household. • ฀ The฀mother฀is฀the฀key฀igure฀in฀determining฀a฀healthy฀lifestyle฀for฀the฀family,฀and฀this฀ should฀be฀the฀starting฀point฀increasingly฀for฀health฀education฀programmes฀in฀future. • ฀ Before฀ infants฀ and฀ young฀ children฀ undergo฀ a฀ general฀ anaesthetic,฀ parental฀ smoking฀ status฀should฀always฀be฀ascertained.฀Where฀parents฀are฀smokers,฀the฀risk฀of฀anaesthetic฀ complications฀during฀the฀recovery฀phase฀is฀doubled.฀Urinary฀cotinine฀measurements฀ can฀be฀helpful฀in฀this฀context. • ฀ If฀the฀health฀of฀the฀majority฀is฀not฀to฀be฀further฀endangered฀by฀ETS,฀there฀is฀an฀urgent฀ need฀to฀introduce฀strict฀legislation฀for฀the฀protection฀of฀non-smokers฀Fig.฀ 9.11 . • ฀ The฀general฀population฀should฀also฀be฀kept฀aware฀of฀the฀latest฀findings฀on฀ETS:฀the฀ danger฀ to฀ health฀ must฀ be฀ clearly฀ communicated฀ so฀ that฀ children฀ and฀ adolescents฀ in฀ particular฀are฀protected฀effectively. References ฀ 1.฀Hammond฀SK,฀Sorensen฀G,฀Youngstrom฀R,฀Ockene฀JK฀1995฀Occupational฀exposure฀to฀envi- ronmental฀tobacco฀smoke.฀JAMA฀274:956–960 ฀ 2.฀Manuel฀J฀1999฀Double฀exposure.฀Environmental฀tobacco฀smoke.฀Environ฀Health฀Perspect฀ 107:A196–A201 ฀ 3.฀Lee฀PN฀1986฀Passive฀smoking.฀Br฀J฀Cancer฀54:1019–1021 ฀ 4.฀Lee฀PN,฀Chamberlain฀J,฀Alderson฀MR฀1986฀Relationship฀of฀passive฀smoking฀to฀risk฀of฀lung฀ cancer฀and฀other฀smoking-associated฀diseases.฀Br฀J฀Cancer฀54:97–105 ฀ 5.฀Vutuc฀C฀1984฀Quantitative฀aspects฀of฀passive฀smoking฀and฀lung฀cancer.฀Prev฀Med฀13:698–704 ฀ 6.฀Remmer฀H฀1987฀Passively฀inhaled฀tobacco฀smoke:฀a฀challenge฀to฀toxicology฀and฀preventive฀ medicine.฀Arch฀Toxicol฀61:89–104 ฀ 7.฀Kauppinen฀T,฀Toikkanen฀J,฀Pedersen฀D,฀Young฀R,฀Ahrens฀W,฀Boffetta฀P,฀et฀al฀2000฀Occupational฀ exposure฀to฀carcinogens฀in฀the฀European฀Union.฀Occup฀Environ฀Med฀571:10–18 ฀ 8.฀Drope฀J,฀Chapman฀S฀2001฀Tobacco฀industry฀efforts฀at฀discrediting฀scientiic฀knowledge฀of฀ environmental฀ tobacco฀ smoke:฀ a฀ review฀ of฀ internal฀ industry฀ documents.฀ J฀ Epidemiol฀ Community฀Health฀558:588–594 ฀ 9.฀Nellen฀MA,฀De฀Blij฀BA฀1999฀The฀“success”฀of฀Philip฀Morris’฀campaign฀on฀environmental฀ tobacco฀smoke฀in฀The฀Netherlands.฀Tob฀Control฀8:221–222 10.฀Anonym฀1995฀Second฀hand฀smoke:฀is฀it฀a฀hazard?฀Consume฀Rep฀20:27–33 11.฀Glantz฀SA,฀Parmley฀WW฀1995฀Passive฀smoking฀and฀heart฀disease.฀Mechanisms฀and฀risk.฀ JAMA฀273:1047–1053 12.฀Stamatakis฀KA,฀Brownson฀RC,฀Luke฀DA฀2002฀Risk฀factors฀for฀exposure฀to฀environmental฀ tobacco฀smoke฀among฀ethnically฀diverse฀women฀in฀the฀United฀States.฀J฀Womens฀Health฀Gend฀ Based฀Med฀111:45–51 13.฀Leuchtenberger฀C,฀Leuchtenberger฀R,฀Zbinden฀I฀1974฀Gas฀vapour฀phase฀constituents฀and-SH฀ reactivity฀of฀cigarette฀smoke฀inluence฀lung฀cultures.฀Nature฀247:565–567 14.฀Sonnenfeld฀G,฀Grifith฀RB,฀Hudgens฀RW฀1985฀The฀effect฀of฀smoke฀generation฀and฀manipula- tion฀variables฀on฀the฀cytotoxicity฀of฀mainstream฀and฀sidestream฀cigarette฀smoke฀to฀monolayer฀ cultures฀of฀L-929฀cells.฀Arch฀Toxicol฀58:120–122 15.฀Davis฀RM฀1997฀Passive฀smoking:฀history฀repeats฀itself.฀BMJ฀315:961–962 16.฀Zhong฀L,฀Goldberg฀MS,฀Parent฀ME,฀Hanley฀JA฀2000฀Exposure฀to฀environmental฀tobacco- smoke฀and฀the฀risk฀of฀lung฀cancer:฀a฀meta-analysis.฀Lung฀Cancer฀271:3–18 Fig. 9.11 ฀฀฀Poster฀from฀the฀ German฀Museum฀for฀Public฀ Health฀Deutsches฀Hygiene- Museum฀encouraging฀ smokers฀to฀show฀ consideration฀for฀the฀ non-smoking฀majority฀ source:฀DHM฀1995-641