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Harm reduction in nicotine addiction

Harm reduction in nicotine addiction

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Publicado porBK Ainsworth
A report by the Tobacco Advisory Group of the Royal College of Physicians, October 2007
A report by the Tobacco Advisory Group of the Royal College of Physicians, October 2007

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Published by: BK Ainsworth on Jul 24, 2010
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The evidence for harm caused by passive smoking (exposure to environmental
tobacco smoke, involuntary smoking or second-hand smoking) emerged in the
1970s. The smoke breathed in by a non-smoker contains the same range of toxic
substances as that inhaled by active smokers, and typically delivers about 1% of
the quantity of these substances inhaled by active smokers.22

It is, therefore,
plausible that passive smoking causes the same disorders that affect smokers, but
at a lower risk. There is direct evidence from observational studies of adult non-
smokers that passive smoking increases the risk of developing lung cancer,
ischaemic heart disease, chronic obstructive pulmonary disease (COPD) and

6The risk profile of smoked tobacco

113

Fig 6.4Bar chart showing social inequalities in male mortality. Each bar shows the risk
of a man aged 35 years old in 1996 dying from any cause between the age of 35 and
69years. The shaded section indicates how much of this risk is due to smoking. The
shaded part of the bar up to the dashed lines represents the proportion who would
have lived beyond 70 years had they not smoked.

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Risk of dying at ages 35–69 years (%)

50

40

30

20

10

0

Social class

Education

Neighbourhood

Education

income

England and Wales

USA

Canada

Poland

stroke, with percentage increases in risk of 24%, 30%, 25% and 45% respec-
tively.22,23

These represent important increases in risk, particularly in countries
where the smoking prevalence is high such as China, and one in eight non-
smoking men and half of non-smoking women are exposed to passive smoke at
home, and about a quarter are exposed at work.24

There is, therefore, the poten-
tial for a large number of non-smokers, as well as smokers, in China to develop
lung cancer, heart disease and COPD in the future due to passive smoking
exposure, as a consequence of the high prevalence of smoking.
Health concerns about passive smoking tend to focus on lung cancer because
this disease is largely specific to smoking. However, ischaemic heart disease
(IHD) is much more common in non-smokers, so although the effect of passive
smoking on IHD risk is much weaker than on lung cancer, the number of
individuals affected by IHD is much greater. This fact is often overlooked.
In the European Union, there are over six times more IHD deaths than lung
cancer deaths because of passive smoking (Table 6.6).23

Strokes caused by smok-
ing are estimated to account for several thousand premature deaths each year. In
total, an estimated 19,242 non-smokers in the EU die each year from these four
causes by breathing other people’s tobacco smoke – equivalent to one death every
27 minutes

114

Harm reduction in nicotine addiction

Table 6.6. Estimated number of deaths in 2002 among non-smokers due to passive
smoking in 24 EU countries.
#

Exposure at home, adults

Exposure at work

Total (home

Cause of

All work-Hospitality plus

death

24<65

65+

All

places

industry

workplaces)*

Lung cancer

403

629

1,032

521

16

1,553

Ischaemic

1,781

6,977

8,758

1,481

48

10,239

heart disease
Stroke

729

4,954

5,683

596

19

6,279

Chronic

155

815

970

201

6

1,171

obstructive
pulmonary
disease
Total*

3,068

13,375

16,443

2,799

89

19,242

* there is some rounding
# Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary,
Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Slovakia,
Slovenia, Spain, Sweden and UK.
Reproduced from Jamrozik with permission from the European Respiratory Society Journals Ltd.23

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