Review of Related Literature Secondhand smoke is the combination of smoke from the burning end of a cigarette and the

smoke breathed out by smokers. Secondhand smoke contains more than 7000 chemicals. Hundreds are toxic and about 70 can cause cancer. There is no risk-free level of exposure to secondhand smoke. Secondhand smoke causes numerous health problems in infants and children, including severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome (SIDS). Some of the health conditions caused by secondhand smoke in adults include heart disease and lung cancer. Secondhand Smoke Causes Heart Disease Exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and can cause coronary heart disease. Secondhand smoke causes an estimated 46,000 premature deaths from heart disease each year in the United States among nonsmokers. Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 30%. Breathing secondhand smoke can have immediate adverse effects on your blood and blood vessels, increasing the risk of having a heart attack. Breathing secondhand smoke interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of having a heart attack. Even brief secondhand smoke exposure can damage the lining of blood vessels and cause your blood platelets to become stickier. These changes can cause a deadly heart attack. People who already have heart disease are at especially high risk of suffering adverse effects from breathing secondhand smoke and should take special precautions to avoid even brief exposures. Secondhand Causes Lung Cancer Secondhand smoke causes lung cancer in adults who themselves have never smoked. Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing lung cancer by 2030%. Secondhand smoke causes an estimated 3,400 lung cancer deaths among U.S. nonsmokers each year. Nonsmokers who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances and poisons as smokers. Secondhand smoke contains about 70 cancer-causing chemicals. Even brief secondhand smoke exposure can damage cells in ways that set the cancer process in motion. As with active smoking, the longer the duration and the higher the level of exposure to secondhand smoke, the greater the risk of developing lung cancer. Secondhand Smoke Causes SIDS SIDS is the sudden, unexplained, unexpected death of an infant in the first year of life. SIDS is the leading cause of death in otherwise healthy infants. Secondhand smoke increases the risk for SIDS. Smoking by women during pregnancy increases

the risk for SIDS. Infants who are exposed to secondhand smoke after birth are also at greater risk for SIDS. Chemicals in secondhand smoke appear to affect the brain in ways that interfere with its regulation of infants' breathing. Infants who die from SIDS have higher concentrations of nicotine in their lungs and higher levels of cotinine (a biological marker for secondhand smoke exposure) than infants who die from other causes. Secondhand Smoke and Children Secondhand smoke can cause serious health problems in children. Studies show that older children whose parents smoke get sick more often. Their lungs grow less than children who do not breathe secondhand smoke, and they get more bronchitis and pneumonia. Wheezing and coughing are more common in children who breathe secondhand smoke. Secondhand smoke can trigger an asthma attack in a child. Children with asthma who are around secondhand smoke have more severe and frequent asthma attacks. A severe asthma attack can put a child's life in danger. Children whose parents smoke around them get more ear infections. They also have fluid in their ears more often and have more operations to put in ear tubes for drainage.

Each day in the United States, approximately 4,000 adolescents aged 12-17 try their first cigarette.1 Each year cigarette smoking accounts for approximately 1 of every 5 deaths, or about 438,000 people. Cigarette smoking results in 5.5 million years of potential life lost in the United States annually.2 Although the percentage of high school students who smoke has declined in recent years, rates remain high: 19% of high school students report current cigarette use (smoked cigarettes on at least 1 day during the 30 days before the survey).3 Forty-six percent of high school students have ever tried cigarette smoking, even one or two puffs.3 Eleven percent of high school students have smoked a whole cigarette before age 13.3 Nearly 9% of high school students (15% of male and 2% of female students) used smokeless tobacco (e.g., chewing tobacco, snuff, or dip), on at least 1 day during the 30 days before the survey.3 Adolescents who use smokeless tobacco are more likely than nonusers to become cigarette smokers.4 Fourteen percent of high school students smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey.3 Prevalence of Current Cigarette Use Among High School Students, 20093
Racial/Ethnic Group Male 10.7% 19.4% 22.3% Female 8.4% 16.7% 22.8% Overall 9.5% 18.0% 22.5%

Black (Non-Hispanic) Hispanic White (Non-Hispanic)

Health Effects of Tobacco Use by Young People y Cigarette smoking by young people leads to immediate and serious health problems including respiratory and nonrespiratory effects, addiction to nicotine, and the associated risk of other drug use.4,5 Smoking at an early age increases the risk of lung cancer. For most smoking-related cancers, the risk rises as the individual continues to smoke.4,5 Cigarette smoking causes heart disease, stroke, chronic lung disease, and cancers of the lung, mouth, pharynx, esophagus, and bladder.4,5 Use of smokeless tobacco causes cancers of the mouth, pharynx and esophagus; gum recession; and an increased risk for heart disease and stroke.4,5 Smoking cigars increases the risk of oral, laryngeal, esophageal, and lung cancers.5,6

Nicotine Addiction Among Young People

The younger people begin smoking cigarettes, the more likely they are to become strongly addicted to nicotine. Young people who try to quit suffer the same nicotine withdrawal symptoms as adults who try to quit.4 Several studies have found nicotine to be addictive in ways similar to heroin, cocaine, and alcohol. Of all addictive behaviors, cigarette smoking is the one most likely to become established during adolescence.4 Among high school students who are current smokers, 51% have tried to quit smoking cigarettes during the 12 months before the survey.3

Tobacco Sales and Promoting to Youth y All states have laws making it illegal to sell cigarettes to anyone under the age of 18, yet 14% of students under the age of 18 who currently smoke cigarettes reported they usually obtained their own cigarettes by buying them in a store or gas station during the 30 days before the survey.3 Cigarette companies spent more than $15.2 billion in 2003 to promote their products.7 Children and teenagers constitute the majority of all new smokers, and the industrys advertising and promotion campaigns often have special appeal to these young people.8 Eighty-three percent of young smokers (aged 12-17) choose the three most heavily advertised brands.9

Health Effects of Secondhand Smoke in Youth y An estimated 1011 million youth aged 1218 live in a household with at least one smoker, and over 6 million are exposed to secondhand smoke daily.10 Those most affected by secondhand smoke are children. Because their bodies are still developing, exposure to the poisons in secondhand smoke puts children in danger of severe respiratory diseases and may hinder the growth of their lungs.5,11 Secondhand smoke exposure during childhood and adolescence may contribute to new cases of asthma or worsen existing asthma.5,11 There is no risk-free level of secondhand smoke exposure. Even brief exposure can be dangerous.