Abstract
Smoking is generally regarded as one of the most injurious activities to human health. While there is consensus among medical experts and theoreticians that first hand smoke is harmful to the smoker’s health, there is still debate and too much back and forth among medical researchers as to whether second hand smoke is harmful to those people close to the smoker. This research proposal shall lay the foundation for an incisive and well-informed research paper on the facts behind second hand smoke and its effects on health.
Introduction
White (2010) defines second hand smoke as “environmental tobacco smoke that is inhaled involuntary or passively by someone who is not smoking”. The crux of the issue of second hand smoke is that smoking in public brings about exposure of innocent persons to the smoke which is harmful to their health. Proponents for the total ban on smoking in public argue that there is no justifiable cause for other people to suffer adverse health effects due to the acts of others.
While there is a general agreement that smoking in public is a nuisance to others, there is debate on whether inhalation of smoke actually brings about adverse health effects on the innocent non-smoking bystander. However, several pieces of legislation have already been passed banning public smoking. In addition, many organizations have a ‘no smoking’ policy which is aimed at protecting workers from the harmful effects of tobacco smoke. This debate has been a ripe topic for biostatisticians who aim at establishing the truth behind second hand smoke and its purported effects on human health.
Purpose Statement
While there have been many theories and research papers written on the topic of second hand smoke, new aspects keep coming up and they require a comprehensive report to capture the entire debate. The proposed research attempts to introduce these new aspects of the debate to a much more detailed report on the topic. The paper also studies the effects of second hand smoke and purposes to contribute to the field of biostatistics by incorporating the latest research findings in a manner that is illustrative and conclusive to an issue that has simply refused to go away. This paper is thus inspired by the need for such a report.
Hypothesis
Second hand smoke is responsible for over 300,000 respiratory complications in children below six years. It is also responsible for about 3,000 annual deaths of non smokers who contract lung cancer and other health conditions based on their close proximity to regular smokers. This is because of the toxic and carcinogenic impurities in tobacco that have been proven to increase the chances of contracting over 17 types of cancer especially the type that attacks the respiratory system such as lung and throat cancer (Carrey et al., 1999).
In addition, second hand smoke causes health complications in unborn children such as susceptibility to heart disease and middle ear problems. It may also cause the death of the fetus. Second hand smoke has also been linked to higher incidences of bronchitis, pneumonia, asthma, hypertension, stroke, ear, nose and throat (ENT) infections and many other health complications.
Conceptual Framework
The 1950’s and 60’s saw an increase in public awareness that there were some dangerous health attributes that were caused by smoking (White, 2010). However, tobacco companies came out fighting the notion that their products were unsafe and even funded researchers to pronounce tobacco as a harmless product. All these tactics were meant to introduce doubt in people’s minds as they continued to rake in millions of dollars in profits.
However, with time, it was finally settled that there were certain adverse health effects that came with smoking. Nevertheless, these adverse effects were attributed to the smoker himself/herself and initial research concentrated on the effects of first hand smoke. The effects of this ‘first hand smoke’ were well researched and documented and in fact several people were able to use them to claim compensation from tobacco companies in civil suits for contracting ailments related to smoking.
The debate on second hand smoke began much later and continues to date. While tobacco companies could admit some form of liability for the smoker, being a direct consumer of their products, they were against the idea that they could be liable for a horde of non-smokers too who were affected by inhaling second hand smoke. Health researchers were already looking on the effects of second hand smoke on the respiratory tract and on other body parts. A lot of evidence has been presented that shows that second hand smoke just like first hand smoke can cause lung cancer and heart disease. It was also found to have an effect on children by increasing their likelihood to contract pneumonia and bronchitis (He et al., 1999).
Out of the 33 studies conducted on people exposed to second hand smoke, 26 have confirmed the connection between such exposures to lung cancer. The study confirmed fears about the dangerous effects of second hand smoke by finding that people inhaling it were up to 150 percent times more likely to contract lung cancer. These revelations have led to formation of many antismoking organizations pushing for a total universal ban on smoking in public places. Still tobacco companies are disputing the findings of these studies stating that they are exaggerated and are a result of non-smokers trying to get smokers to quit smoking which they term as an infringement of their liberties.
While it is true that most non-smokers perceive smoking as a disgusting habit, the threat of health complications is too serious to ignore. Judging from the fact that about 11 percent of the population is composed of regular smokers, this threat is very real and must be addressed (White, 2010). Second hand smoke is now ranked as the third cause of lung cancer in non-smokers (American Lung Association, 2007). It has also been established that mothers living with a smoking spouse are likely to develop complications that may affect children way before their birth. Pregnant mothers pass the harmful components in cigarettes on the developing fetus which causes them to weigh less upon birth and to have stunted growth.
Other effects that have recently been discovered include blood clots and damaged arterial linings which cause an increased chance for cardiac arrests, stroke and hypertension. These findings that keep streaming in have led tobacco companies to join the fray of researchers. Most of the studies commissioned by these companies are trying to show that the evidence being presented against second hand smoke is not conclusive and is more or less speculative. Their findings are now being fed to the public through medical journals and sympathetic scientists who are trying to introduce doubt as to the negative effects of second hand smoke.
Surprisingly, only 4 percent of the research funded and/or commissioned by these tobacco firms shows that second hand smoke is completely safe (White, 2010). Even with the use of different study techniques and different research approaches by various researchers, most of the studies published are confirming the same thing- that second hand smoke is indeed a health hazard. This has meant that governments and non-governmental organizations have had to embark on awareness campaigns on the dangerous effects of second hand smoke and also to put a cap on public smoking. Debate still rages on but upon analysis of both human and laboratory evidence the negative effects of second hand smoke can no longer be ignored.
Proposed Analysis
The analysis of the research problem shall be twofold. First I shall look at the proponent view on the effects of second hand smoke and then I shall look at the opposing view.
The Proponent View
This view reflects the opinions of people that believe that second hand smoke does have some serious health ramifications. These people view cigarette smoking as a major health concern that should be curtailed. Their arguments are grounded on the fact that when one smokes, certain known poisons, toxins and carcinogens such as formaldehyde, carbon monoxide and benzene are released into the air and are then inhaled by other people close to the smoker.
This means that when a cigar, pipe or cigarette is lit, smoke is released into the air via two sources. The first type is that which is released by the smoker upon puffing which analysts refer to as ‘mainstream’ smoke. This kind of smoke is directly inhaled by those close to the smoker. The other type which is considered more dangerous is the so called ‘side stream’ smoke which is released directly into the air upon the burning of tobacco.
Side stream smoke is considered as the more serious type of second hand smoke since it is argued that the non smoker inhales it directly without the benefit of a filter which the smoker enjoys. Passive smoking or second hand smoking is therefore the inhalation of these two types of smoke and He et al (1999) state that this is a major cause of various respiratory ailments. Second hand smoke has also been rated by the Environmental Protection Agency (EPA, 2002) as a ‘Group A carcinogen’ which confirms its toxicity and high likelihood to cause cancer.
It further estimates that this kind of smoke is responsible for 3,000 annual lung cancer deaths reported among nonsmokers. The EPA further attributes the rising cases of asthma in America to environmental tobacco smoke (ETS). These cases have now hit one million with 26,000 new cases being reported among children every year.
Proponents also link second hand smoke to low birth weight in newborns, respiratory tract diseases, ear infections, fatal heart disease and Sudden Infant Death Syndrome (SIDS). They further rank it as the third cause of preventable deaths worldwide due to the number of fatalities caused by cancer, breathing disorders and heart complications all which are associated with ETS.
ETS has been linked with certain instantaneous health ailments such as irritation of the ENT system, dizziness, nausea, breathing problems, coughing and congested chest. The effects are worse in children below six since their lungs are still developing and thus they breathe more than adults. This is why the EPA (2002) attributes the 150,000 to 300,000 cases of pneumonia and bronchitis reported among children less than 18 months in the US annually to exposure to second hand smoke.
The same EPA report finds that children suffering from asthma run a greater risk of succumbing to the condition by inhaling ETS and it also finds that this smoke may bring about asthma in non-asthmatic children while worsening the symptoms of asthma in patients e.g. increasing the recurrence of fits. At the same time, ETS has been claimed to increase fluid build up in the ear and also raising susceptibility to ear complications. Based on a World Health Organization report dated September 1999, between 33 to 50 percent of SIDS cases reported could be linked to exposure to cigarette smoke during pregnancy.
The proponents’ case has received a major boost from the National Toxicology Program (NTP), a scientific review body that reports to Congress, by listing second hand smoke as a known carcinogen in its report in the year 2000. In that report the NTP stated that it could confidently attribute the rising cases in nasal sinus cancer and heart disease among Americans to second hand smoke released into the environment.
It quoted three studies which conclusively confirmed that 35,000 to 62,000 of the fatalities arising from heart disease were caused by inhaling second hand smoke. The reason for this was cited as the extra stress that this smoke places on the patient’s heart reducing his/her capacity to take in and absorb oxygen. One of the three studies also showed that frequent ETS exposure increased the risk of coronary heart disease by over 91% and 58% for infrequent exposure. This is in addition to the other related complications such as emphysema and chronic bronchitis.
A 2009 study looking into occupational ailments found that smoking at work was responsible for a majority of cases of lung diseases in nonsmoking employees. A similar report on asthma published by the Connecticut Department of Health established that there was an increase in asthma cases with about 7.3% of the Connecticut adult population and at least 1 out of every 11 children of school going age suffering from it (White, 2010). While these two studies did not directly attribute the rise in cases to ETS, they listed it among the possible causes.
The issue of children getting sick from second hand smoke-related complications has increased proponents’ tone against smoking. In fact, over half of the studies that have been done on second hand smoke have concentrated on the effect of ETS on children’s health. Almost all of these studies have concluded that second hand smoke is causing a horde of illnesses among children such as pneumonia, bronchitis, asthma, wheezing, lung cancer, ear infections and respiratory complications. In fact, it is now a settled fact that exposure to second hand smoke accounts for about 40% to 60% of all childhood cases of wheezing, bronchitis and asthma. A new study has also linked second hand smoke to a predisposition towards leukemia and other types of cancer when inhaled at tender ages (White, 2010).
Second hand smoke has also been blamed for worsening the health of persons with pre-existing conditions such as heart disease, allergies, asthma, hypertension, bronchitis and other related respiratory infections. These individuals’ lives are threatened when exposed to ETS and they are normally advised to avoid working or staying in places where smoking is allowed. The American Lung Association (2007) reported that there were increased cases of chronic bronchitis, pediatric asthma and adult asthma in New Mexico which could be associated to increased exposure to ETS.
The most extreme views expressed by the proponents of a ban on public smoking state that smoking as a whole should be made illegal and that tobacco companies should be shut down since they are in the business of selling poisonous substances. They use the evidence from scientific analysts who find that cigarette smoke has about 4,700 chemicals of which 200 are known poisons and 50 are listed human carcinogens (EPA, 2007).
Toxins such as hydrogen cyanide, methyl isocyanate and carbon monoxide are deadly poisons that may even cause death yet they are released upon lighting a cigarette. Carcinogens such as NNK and benzopyrene have been found in tobacco smoke yet they cause lung cancer. Other forms of cancer such as throat, bladder, nasal and lung cancer have been blamed on other suspected carcinogens present in tobacco smoke such as formaldehyde, nitrosamines and aromatic amines. Benzene is also known to induce leukemia.
All these poisons are deadly to man yet proponents fail to understand why cigarettes cannot be completely banned for health reasons just like narcotics. The fact that carcinogens like NNK are now being detected in nonsmokers is being cited as a reasonable ground to ban smoking. However, the moderate view is that what needs to be banned is smoking in public places and also smoking zones to be established. This is the view that most governments around the world have adopted. However, this view attempts to legitimize injury to the smoker himself/herself yet the state has a duty to protect the health of all its citizens even against the threat they pose against themselves in the same way that suicide is prohibited.
Other moderate proponents have argued that proper ventilation can help in reducing the effects of second hand smoke. Since smoking is the lead cause of indoor pollution, smokers should ensure that the smoke is not inhaled by others. Many organizations have also established their workplaces as smoke free zones as a policy to protect the health of their employees. This is a good way to go since they owe a duty of care to their employees. While ventilation and smoking zones have been cited as good ideas, there are those who feel that smoke released goes into the air and since these toxins and carcinogens cannot be absorbed, they remain in the air thus poisoning it in whole areas.
The Opponent’s View
As earlier stated, tobacco companies do not agree that their products are as harmful as they are portrayed to be. Therefore several studies have been commissioned by these studies seeking to bring an end to the speculation that cigarette smoking can be dangerous to another party other than the smoker, these studies have worked on the assumption that human beings are capable of deciding whether or not their health is a concern. The studies on smoking have now taken the civil liberties approach and now human beings are being considered as being capable of deciding whether or not their health is important to them or not.
A 2008 study commissioned by several of the tobacco companies attempted to show that human health is affected by too many chemicals in the air that are a result of many types of pollution which are not necessarily caused by the release of tobacco smoke into the air. About 4 percent of all the studies commissioned by the tobacco companies have shown that release of second hand smoke into the air is not in any way unhealthy (White, 2010). These studies argue that once cigarette smoke is released into the air, they dissipate just like all the other gases or elements released into the air and thus there is no way that this smoke could be responsible for all the ailments that it is claimed to cause. They therefore find that most of these studies on the dangers of ETS are just sensational to say the least.
However, the opponent view is limited by the fact that very few of its studies have been accepted or taken seriously by the medical world. In fact, cigarette manufacturers have had to label their products in a manner showing that they do pose a risk to human health. It is now a common practice around the world for labels like “SMOKING KILLS” and “CIGARETTE SMOKE IS HARMFUL TO YOUR HEALTH” written in huge letters in the cigarette packet. This has made the case for tobacco companies to be quite limited to technical arguments. It has also been quite hard to prove why they accept that first hand smoke is dangerous to the body yet second hand smoke is not.
Restatement of thesis
As seen from the studies above, a good majority have shown that second hand smoke is quite harmful to health. Reputable health organizations such as WHO and various state departments of health have supported the finding that second hand smoke is quite dangerous. Legislation passed to ban public smoking has generally been supported (though smokers are a minority) since it has not only saved the public from innumerable diseases but also it has helped them escape the nuisance of inhaling tobacco smoke as they go about their daily activities. Second hand smoke is thus a major health risk that should be eradicated by placing stricter measures on smoking.
Conclusion
This research proposal has attempted to articulate all the angles that the proposed paper will tackle. It has generally summarized the topic of second hand smoke and its dangerous health effects and also given due attention to the opposing view. All in all, the research paper shall look deeper into the actual studies themselves and the reaction they received from the public as well as scholars and scientists in the medical world.
This research paper shall be a major contribution to the medical world as it shall take a biostatistical approach to lay the issue of second hand smoke and its harmful effects to rest. The paper is also quite helpful in assisting the public to get a comprehensive view of the issue of second hand smoke. This shall assist them to protect themselves better and to make smokers become more responsible for their actions.
References
American Lung Association. (2007). Children Secondhand Smoke Fact Sheet. Web.
Carrey, I. M, Cook, D. G., and Strachan, D.P. (1999). The effects of environmental tobacco smoke exposure on lung function in a longitudinal study of British adults. Epidemiology, 12, pp. 22-55
He, J., Vupputuri, S., and Allen, K. (1999). Passive smoking and the risk of coronary heart disease: a meta-analysis of epidemiological studies. English Journal of Medicine, 32, pp.133- 199
Environmental Protection Agency (EPA) (2002). Asthma Triggers – Secondhand Smoke. Web.
Environmental Protection Agency (EPA) (2007). Health Effects of Exposure to Second Hand Smoke. Web.
White, T. (2010). Children and Second Hand Smoke. Web.