Environmental Tobacco

Smoke
Environmental Tobacco Smoke

 Environmental tobacco smoke (ETS) refers to exposure to

tobacco smoke – not from your smoking, but from being
exposed to someone else's cigarette, cigar, or pipe smoke.
 It can also be described as the material in indoor air that
originates from tobacco smoke. Breathing in ETS is known
as passive smoking, second-hand smoke, or involuntary
smoking.
 It is composed of sidestream smoke (SS) and mainstream
smoke (MS)
Environmental Tobacco Smoke

Sidestream Smoke (SS) Mainstream Smoke (MS)

 The smoke that enters the air  The smoke that is inhaled and
directly from the burning end then exhaled from the smoker's
of a cigarette, cigar, or pipe. lungs.
 Since some chemicals are
favoured by this incomplete
burning, undiluted sidestream
smoke contains higher
concentrations of several
chemicals than the mainstream
smoke inhaled by the smoker.
Environmental Tobacco Smoke
Environmental Tobacco Smoke
General Composition of Tobacco Smoke

 It consists of solid particles and gases. More than 7,000 different

chemicals have been identified in tobacco smoke. The number of
these chemicals that are known to cause cancer in animals, humans,
or both are reported to be about 70.
 The solid particles make up about 10 percent of tobacco smoke and
include "tar" and nicotine.
 The gases or vapours make up about 90 percent of tobacco smoke.
The major gas present is carbon monoxide. 
Secondhand Smoke

 Secondhand smoke is a mixture of the smoke that comes from the

burning end of a cigarette.
 Specifically the mixture of Mainstream Smoke and Sidestream Smoke
Third-hand Smoke

 Third hand smoke is cigarette smoke particles that become re-

suspended in air after being on the furniture or clothes.
 For example, when smoking indoors, smoke particles can become
adsorbed into indoor surfaces such as clothes, curtains, carpets or
cushions and remain on these surfaces even after the room has been
ventilated.
Third-hand Smoke

 This finding implies that cigarette smoke that becomes adsorbed onto
the clothing of smokers (third hand smoke) pose a similar risk to
second hand smoke.
Types of Tobacco Products

 Smokeless tobacco: Smokeless tobacco is a type of tobacco that is

not burned. It includes chewing tobacco, oral tobacco, spit or spitting
tobacco, dip, chew, snus, dissolvable tobacco, and snuff. 
 Cigars: These include premium cigars, little filtered cigars (LFCs), and
cigarillos. LFCs resemble cigarettes, but both LFCs and cigarillos may
have added flavors to increase appeal to youth and young adults. Most
cigars are composed primarily of a single type of tobacco (air-cured
and fermented), and have a tobacco leaf wrapper.
 Pipes: In pipe smoking, the tobacco is placed in a bowl that is
connected to a stem with a mouthpiece at the other end. The smoke
is usually not inhaled. Pipe smoking causes lung cancer and increases
the risk of cancers of the mouth, throat, larynx, and esophagus  
Types of Tobacco Products

 Hookah or waterpipe (other names include argileh, ghelyoon, hubble

bubble, shisha, boory, goza, and narghile): A hookah is a device used
to smoke tobacco (often heavily flavored) by passing the smoke
through a partially filled water bowl before being inhaled by the
smoker.
EFFECTS OF
E.T.S.

REPORTED BY: KLYDE JASPER JOSE

ON THE
ENVIRONMENT
Growing and • Tobacco growing and curing (the drying of the
tobacco leaf) are both direct causes of deforestation,

curing because forests are cleared for tobacco plantations

and wood is burned to cure tobacco. Deforestation is
a cause of climate change, soil erosion, reduced soil
fertility and disrupted water cycles.
• A previous investigation into the production,
promotion and use of tobacco in developing
countries estimated that for every 300 cigarettes
produced (about 1.5 cartons), one tree is used just to
cure the tobacco leaf.
Manufacturing
and production
Manufacturing • Shredding and assembling tobacco, which uses energy
and metals for the machines

and production • Preparing and treating tobacco, which uses thousands

of chemicals and chemical additives
• Producing rolling paper, which generates waste and
more deforestation
Distribution and • more energy is used to fuel trucks, ships and planes
to transport tobacco products from production

Transportation plants to retailers. Transporting a finished pack of

cigarettes to its point of sale often involves trucks
that use diesel gas, a known carcinogen.
• The indiscriminate use of plastic sachets/pouches
has become a new environmental concern in a
number of countries where smokeless forms of
tobacco such as gutkha, pan masala etc. are
packaged and sold. The environmental, human and
ecological damage of plastic waste materials,
especially to marine biology, is well documented
 • The impact of tobacco cultivation on forests since the
mid-1970s is a significant cause for concern
DEFORESTATION • Tobacco farming has become the main cause of
deforestation in countries
AND • Tobacco causes soil erosion because it is usually
planted as a single or monocrop, leaving the topsoil
poorly protected from wind and water. Desertification
LAND LOSS from tobacco cultivation has been observed in
numerous countries, including Jordan, India, Cuba,
Brazil
• Indirect effects of tobacco production include
greenhouse gas emissions related to deforestation and
the change to agricultural land use
 • The smoke generated from burning tobacco,
called secondhand smoke or environmental
tobacco smoke, contains more than 7,000 toxic
chemicals that pollute both indoor and outdoor
environments and can be toxic even after the
Consumption tobacco product is put out.
• The end of tobacco’s life cycle is tobacco product
and waste, which includes cigarette butts, the 
most littered item on earth. With 75 percent of
Post-consumption smokers reporting that they dispose cigarettes
on the ground or out of a car, an estimated 1.69
billion pounds of cigarette butts wind up as toxic
trash each year.
 • The toxic chemicals from littered cigarette butts
leach into the environment and end up scattered
along green spaces, sidewalks, roadsides,
beaches and waterways. The toxic exposure can
contaminate water and poison fish, as well as
Consumption animals that eat cigarette butts.
• Thirdhand smoke, which can affect air quality
and and become more toxic over time, is the residue
from secondhand smoke that gathers in dust
Post-consumption and on objects and surfaces in indoor
environments. These objects can end up in
landfills and waste, becoming a further pollution
risk to the environment.
ON HEALTH
Tobacco Smoke • With the exception of the filter, the entire cigarette is
fuel for the production of tobacco smoke

Composition and • With a nearly 1 billion smokers in 2012 consuming an

estimated 6.25 trillion cigarettes worldwide, tobacco
Emissions smoke from cigarettes globally release significant
amounts of toxicants and pollutants directly into the
environment.
Lung cancer
Cervical
Cancer
Bladder
Cancer
Esophagus
Cancer
Liver Cancer
Stomach
Cancer
Brain Cancer
 Other – Nasal-Sinus
– Aerodigestive Tract
Cancers – Renal Pelvis or Ureter Cancer
– Pancreatic
– Rectum
– Larynx (voice box)
– Pharynx (throat)
– Ovarian
– Colorectal
– Acute Myeloid Leukemia
– Ureteral
 OTHER • Heart Disease
– Some studies have found an association between ETS

DISEASES exposure and an increase of heart disease among

persons who never smoked. Among non-smokers

IN ADULTS exposed to ETS, there is an estimated 20 to 30% increase

• Stroke
• Cirrhosis (Liver Damage)
Irritant • Many of the substances in cigarette smoke are
very irritating to the following:
Effects – eyes
– Throat, and
– respiratory mucous membranes.

• A high proportion of non-smokers report:

– eye irritation (the most prevalent in passive smoking)
– headache
– nasal discomfort
– cough
– sore throat
– sneezing when exposed to cigarette smoke
Effects on • Non-cancer respiratory Illnesses
• At least 150 epidemiological studies on ETS and non-cancer

Children respiratory health effects in children have been published in

the last 25 years
• ETS affects the developing respiratory system and causes an
increased risk of the following health effects:
– lower respiratory tract infections (e.g. bronchitis, bronchiolitis
and pneumonia) in infants and young children;
– chronic middle-ear effusion in young children;
– increased frequency and severity of asthma attacks in
asthmatic children;
– irritation of the upper respiratory tract; and
– reduced lung function.

“Acute respiratory illnesses are one of the leading causes of

morbidity and mortality during infancy and childhood”
Effects on • Decreased birth weight
• Sudden infant death syndrome (SIDS)
Children – Sudden infant death syndrome (SIDS) is the sudden,
unexpected and inexplicable death, usually during sleep,
of infants aged 1 month to 1 year. In developed countries,
this is the most common cause of post-neonatal death.
Sources • Brownson, R. C., Eriksen, M. P., Davis, R. M., & Warner,
K. E. (1997). ENVIRONMENTAL TOBACCO SMOKE :
Health Effects and Policies to Reduce Exposure ∗.
• Ets, S., Ets, W., & Also, S. (2000). Chapter 8.1
Environmental tobacco smoke, 1–23.
• Pugmire, J., Sweeting, H., & Moore, L. (2017).
Environmental tobacco smoke exposure among infants
, children and young people : now is no time to relax,
102(2), 117–118.
• The American Cancer Society. (2015, November 13).
Health Risks of Secondhand Smoke. Retrieved from
American Cancer Society:
https://www.cancer.org/cancer/cancer-causes/tobacco-
and-cancer/secondhand-smoke.html
STANDARDS -ENVIRONMENTAL
TOBACCO SMOKE
To be presented by:

Manuel, Ysabelle L.
ASHRAE Position Document on Environmental
Tobacco Smoke

1. Considerations Related to HVAC

System Design and Operation
Approved by ASHRAE
1.1. Design and Operation Board of Directors
Approaches (October 22, 2010)

Expires June 29, 2019

2. ASHRAE Standard 62: tobacco
industry’s influence over national
ventilation standards
Design and Operation Approaches

▪ banning smoking indoors

▪ allowing smoking only in isolated rooms
▪ allowing smoking in separate but not isolated spaces
▪ totally mixing occupancy of smokers and nonsmokers.
ASHRAE Standard 62: tobacco industry’s influence
over national ventilation standards

▪ The tobacco industry has been involved in the development of

ventilation standards for over 20 years
▪ he tobacco industry determined that allowing smoking in
ventilation standards for indoor air quality was a high priority and
dedicated significant human and financial resources to ensure that
its interests were represented.
ASHRAE STANDARD 62

▪ Standard 62-1981: ventilation requirements and energy costs as an

incentive for smoke-free buildings
▪ Standard 62-1989: the “accommodation” standard assumed
“moderate” amounts of smoking
▪ ASHRAE Standard 62-1989R: source control to provide acceptable
indoor air quality
▪ ASHRAE Standard 62-1999: despite tobacco industry opposition,
assumes non-smoking indoors
▪ …..
LAWS ON
PRODUCTION/US
AGE
Environment Tobacco Smoke
REPUBLIC ACT NO. 9211
 Also known as “Tobacco Regulation Act of 2003”

 “AN ACT REGULATING THE PACKAGING, USE, SALE

DISTRIBUTION AND ADVERTISEMENTS OF TOBACCO

PRODUCTS AND FOR OTHER PURPOSES.”

 Approved: June 23, 2003

PURPOSES
 Promote a healthful environment;
 Inform the public of the health risks associated with cigarette smoking and tobacco use;
 Regulate and subsequently ban all tobacco advertisements and sponsorships;
 Regulate the labeling of tobacco products;
 Protect the youth from being initiated to cigarette smoking and tobacco use by prohibiting the
sale of tobacco products to minors;
 Assist and encourage Filipino tobacco farmers to cultivate alternative agricultural crops to
prevent economic dislocation; and
 Create an Inter-Agency Committee on Tobacco (IAC-Tobacco) to oversee the implementation
of the provision of this Act.
HEALTHFUL ENVIRONMENT
 Smoking is prohibited in enumerated indoor public places and workplaces such as:
 government facilities,
 healthcare and educational institutions,
 facilities frequented by minors while,
 in other public places and workplaces, including bars and nightclubs, designated smoking areas are
allowed.
 Smoking is prohibited in public land transport, aircraft, and public transport terminals.
 There should be at least one sign posted for smoking and non-smoking areas.
AGE RESTRICTION
 For any retailer or tobacco products to sell or distribute tobacco products to any minor;

 For any person to purchase cigarettes or tobacco products from a minor;

 For a minor to sell or buy cigarettes or any tobacco products; and

 For a minor to smoke cigarettes or any other tobacco products.

PROMOTIONS AND
ADVERTISING
 Anyone who sells cigarettes within the 100 m perimeter
from any establishment for advancement, public
establishments and parks and all those who are being used
particularly by minors will be penalized.
 Also, the law mandates cigarette brands to put warning at
least 50% of the front packaging:
 "GOVERNMENT WARNING: Cigarettes are Addictive";
 "GOVERNMENT WARNING: Tobacco Can Harm your
Children"; or
 "GOVERNMENT WARNING: Smoking Kills."
REPUBLIC ACT NO. 10643
 Also known as “The Graphic Health Warnings Law”

 “AN ACT TO EFFECTIVELY INSTILL HEALTH

CONSIOUSNESS THROUGH GRAPHIC HEALTH WARNINGS

ON TOBACCO PRODUCTS.”

 Approved: July 15, 2014

PURPOSES
 to have Graphic Health Warnings that effectively warn of the devastating effects of tobacco
use and exposure to second hand smoke;

 to remove misleading or deceptive numbers or descriptors like "low tar", "light", "ultra lights"
or "mild" which convey or tend to convey that a product or variant is healthier, less harmful or
safer; and

 to further promote the right to health and information of the people.

GRAPHIC HEALTH WARNINGS
(GHWS)
 The GHWs shall have two components: a photographic picture warning and an accompanying
textual warning that is related to the picture.
REFERENCES
 https://www.tobaccocontrollaws.org/legislation/country/philippines/summary
 https://www.who.int/fctc/reporting/Philippines_annex3_packaging_and_advertising2003.pdf
 https://www.lawphil.net/statutes/repacts/ra2014/ra_10643_2014.html
 Measurement
Procedures
&
Control Protocols

ME192-3/B1

AGUILAN, REX TEODORO C.

Measurement Procedures

https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3644554/
Measurement Procedures

https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3644554/
Measurement Procedures
WHERE IS NICOTINE FOUND?
• cigarettes
• cigars
• e-cigarettes (vaping)
• liquid nicotine
• nicotine gum
• nicotine patches
• nicotine lozenges
• chewing tobacco
• pipe tobacco
• snuff
• some insecticides
• tobacco plants

https://www.medicalnewstoday.com/articles/3
19627.php
Measurement Procedures

https://www.medicalnewstoday.com/articles/3
19627.php
 Control & Protocols

• Laws of Smoking
• WHO Framework Convention on Tobacco Control
• PH Smoking Ban
 Laws on Smoking
1. Smoking in a car 
2. Smoking in a public area
3. You can be fined
4. You can't smoke in partially enclosed public areas
5. You can't smoke on premises used for commercial childcare activities
6. No advertising
7. Not for sale to under 18s
8. Sweets and toys that look like tobacco products are banned
9. No more than 25% of a public place can be designated as a smoking area
10. Stricter Laws to come

https://www.health24.com/Medical/Stop-
smoking/About-stop-smoking/10-smoking-
laws-you-must-know-20120721
WHO Framework Convention on
Tobacco Control

• Reduction of demand
for tobacco
• Reduction of supply
for tobacco
• Protection of the
environment
• Livelihood for tobacco
workers
PH Smoking Ban

President Rodrigo Duterte on May 16 signed

Executive Order 26 which bars smoking in
public spaces nationwide.
The signing of the EO fulfills Duterte’s
campaign promise to replicate nationwide a
similar policy he implemented in Davao City,
where he served as mayor for 20 years.

https://news.abs-
cbn.com/focus/05/18/17/understanding-
dutertes-smoking-ban
 S IN E N V I RO N M E N TA L
TREND
TOBAC C O SM O K E
TRENDS
• MATERNAL SMOKING HAVE BEEN LINKED TO PRETERM BIRTH
• HYPOTHESIZED THAT EXPOSURE TO ENVIRONMENTAL TOBACCO SMOKE OR SECOND HAND SMOKING IS
ALSO RELATED

• AFTER IMPLEMENTATION OF SMOKING BANS, THERE IS SIGNIFICANT DECREASE IN PRETERM BIRTH

RATES

• NOTE: PRETERM BIRTH – PREMATURE BIRTH

TRENDS
TRENDS
• CIGARETTE RELATED DISEASES
• CANCER
• CARDIOVASCULAR
• CHRONIC PULMONARY DISEASES
• MORBIDITY WILL INCREASE THREEFOLD IN THE NEXT 20 YEARS
• TOBACCO IS RESPONSIBLE FOR 24% OF ALL MALE DEATHS AND 7% FOR FEMALE IN A COUNTRY
TRENDS

• ETS IS THE MAIN SOURCE OF CHRONIC PULMONARY DISEASES

• ETS IS A RISK FACTOR IN DEVELOPMENT OF LUNG CANCER
• CHILDREN EXPOSED TO ETS TENDS TO HAVE DETERIORATION IN LUNG FUNCTIONS
• ELIMINATION OF THIS ABUSE IS STILL A MEDICAL NECESSITY
REFERENCES
• SAHA, S., BHALLA, D., WHAYNE JR, T., & GAIROLA, C. (2007). CIGARETTE SMOKE AND ADVERSE HEALTH
EFFECTS:. CIGARETTE SMOKE AND ADVERSE HEALTH EFFECTS:, 1-7.

• ELKIN, E., & O'NEIL, M. (2017). TRENDS IN ENVIRONMENTAL TOBACCO SMOKE (ETS) EXPOSURE AND
PRETERM BIRTH: USE OF SMOKING BANS AND DIRECT ETS EXPOSURE ASSESSMENTS IN STUDY DESIGNS.
CHEM RES TOXICOL, 3-8.