15_970_Sikorska-Jaroszynska.indd


Annals of Agricultural and Environmental Medicine 2012, Vol 19, No 3, 547-550

www.aaem.plREVIEW ARTICLE 

Passive smoking as an environmental health 
risk factor
Małgorzata H. J. Sikorska-Jaroszyńska1, Maria Mielnik-Błaszczak1, Dorota Krawczyk1,  
Alicja Nasiłowska-Barud2, Jerzy Błaszczak3
1 Chair and Department of Paedodontics, Medical University, Lublin, Poland 
2 Department of Clinical Psychology, Medical University, Lublin, Poland 
3 Department of Dental Prostetics, Medical University, Lublin, Poland

Sikorska-Jaroszyńska MHJ, Mielnik-Błaszczak M, Krawczyk D, Nasiłowska-Barud A, Błaszczak J. Passive smoking as an environmental health 
risk factor. Ann Agric Environ Med. 2012; 19(3): 547-550.

Abstract
Initially, tobacco was considered as a decorative plant and only later began to be treated as a herb with special therapeutic 
properties. With time, it was found that tobacco had strong insecticidal and addictive properties. There also occurred reports 
about the negative influence of tobacco on human health. The World Health Organization (WHO) classifies smoking as a 
chronic, progressive disease which is also ‘contagious’. It is also considered to be a neurobiotic addiction. Nicotine addiction 
does not cause changes in the behaviour or functioning of a smoker; however, it adversely affects his or her general health 
status and the health status of people within their environment. Passive smoking (so-called ETS – Environmental Tobacco 
Smoke), which means accompanying smokers negatively influences the health of passive smokers. Environmental tobacco 
smoke, on the one hand, is the result of spontaneous cigarette burning and, on the other hand, the result of the side-stream 
of cigarette smoke, as well as the smoke exhaled by active smokers. Health personnel should clearly and convincingly present 
the data concerning the adverse results of smoking, as well as the dangers of exposure to environmental tobacco smoke, 
thereby making their patients aware that breaking their addiction will not only be beneficial for their own health, but will 
also protect non-smokers in their environment from the adverse effects of exposure to environmental tobacco smoke.

Key words
Passive smoking, Environmental Tobacco Smoke, Second Hand Smoking

IntroductIon And objectIve

Tobacco appeared 6,000 BC and from the very beginning 
it accompanied humanity like ‘tea and food’. Tobacco is a 
crop known to the ancient civilizations of Central and South 
America, as well as the Middle East and China. The plant 
was treated by the ancestors of modern Indians not only 
as God’s gift, but also as ‘holy smoke’ that gave people the 
possibility of reconciliation and eternal peace. It reached 
Europe as late as the 15th century, and the first person who 
brought the tobacco seeds to Spain in October 1492 was a 
participant of the second trip by Christopher Columbus, a 
monk called Romano Paro. Tobacco seeds reached Poland 
almost 100 years later, in 1590 [1, 2, 3, 4].

It should be stressed that initially tobacco was considered 
as a decorative plant and only later began to be treated as a 
herb with special therapeutic properties. In 1571, Nicolas 
Manardes wrote a dissertation concerning the incredible 
properties of tobacco, which allowed for the treatment of 
many diseases. In his work, he stated that tobacco can be used 
in the treatment of 36 diseases, including mental illnesses, 
fever, headache, frost bite, ulcers, wounds, oedemas, and 
toothache, as well as dermatological and venereal diseases 
and poisoning. Over the centuries, the way of tobacco usage 
changed. In the beginning, it was chewed, drunk in the 
form of brew, eaten, and sniffed as snuff. It was used as 

eye drops, enema, analgesic, antiseptic, anti-inflammatory, 
diuretic medicine, and an antitoxin. Later on, there occurred 
cigarettes, cigars and pipes. Nowadays, tobacco is a plant that 
is most frequently used for smoking after being previously 
dried and fermented [1, 3, 4].

With time, it was found that tobacco has strong insecticidal 
and addictive properties. There also occurred reports about 
the negative influence of tobacco on human health [1, 5].

At the beginning of the 17th century in England, the first 
attempt to reduce tobacco consumption was undertaken by 
imposing tax on tobacco. In the middle of the 18th century in 
Germany, Frederick the Great issued an edict against tobacco 
smoking. Actually, the entire 18th century was the period in 
which many countries, including Russia and the Vatican 
State, introduced a ban on tobacco smoking. However, 
it should be stressed that these prohibitions were rather 
connected with the requirements of faith and morality, and 
not due to concern about the negative influence of tobacco 
on human health. Despite the discovery of the harmful 
properties of the plant, it became more and more popular. 
Wars and epidemics facilitated further popularization of 
tobacco smoking. During World War II, in the United States, 
it was even decided that tobacco plantations should become 
areas of special protection. In the 1940s and 1950s, there 
appeared reports that cigarette smoking may be involved in 
the development of lung cancer, and that the tar included 
in cigarettes adversely affected human health and could 
participate in the occurrence and development of neoplasms. 
However, it was in the 1960s when more evidence for the 
adverse influence of tobacco on human health was found 
and presented [1, 3, 4, 5].

Address for correspondence: Małgorzata H. J. Sikorska-Jaroszyńska, Wieniawska 10/4, 
20-071 Lublin, Poland.
E-mail: MHJSJ@interia.pl

Received: 28 February 2012; accepted: 17 August 2012



Annals of Agricultural and Environmental Medicine 2012, Vol 19, No 3

Małgorzata H. J. Sikorska-Jaroszyńska, Maria Mielnik-Błaszczak, Dorota Krawczyk, Alicja Nasiłowska-Barud, Jerzy Błaszczak. …

State of knowledge. Nowadays, smoking is considered to 
be one of the unhealthiest of human behaviours and the most 
hazardous of addictions. The World Health Organization 
classifies smoking as a chronic, progressive disease which 
is also ‘contagious’. It is also considered to be a neurobiotic 
addiction. According to the definition issued by the WHO, a 
smoker is somebody who smokes at least one cigarette a day 
for at least 6 months [6]. The number of cigarettes smoked 
within one’s lifetime and exposure to cigarette smoke is 
determined using a ‘pack/year’ index. One ‘pack/year’ equals 
10 cigarettes a day for the period of one year [7]. In Poland, 
cigarette consumption is 3,650 cigarettes a person a year, and 
the average number of smoked cigarettes is about 20 a day 
[8, 9]. According to the WHO data, more than 4.9 million 
people die every year due to diseases resulting from cigarette 
smoking and using tobacco based products, as well as passive 
smoking [10, 11]. 

Nicotine addiction does not cause changes in the behaviour 
or functioning of a smoker; however, it adversely affects his 
or her general health status and the health status of people 
within their environment. Passive smoking (so called ETS – 
Environmental Tobacco Smoke), which means accompanying 
smokers negatively influences the health of passive smokers. 
Environmental tobacco smoke, on the one hand, is the result 
of spontaneous cigarette burning, and on the other hand, 
the result of side-stream of cigarette smoke, as well as the 
smoke exhaled by active smokers. It should also be noted that 
smokers who are in the company of active smokers are also 
considered to be passive smokers. It can be said that in case 
of these people the negative results of smoking are cumulated 
[12]. Oberg et al. observed that, worldwide, 40% of children, 
33% of male non-smokers, and 35% of female non-smokers 
were exposed to second-hand smoke in 2004 [13]. At the same 
time, according to the WHO, it is not possible to declare any 
level of exposure to the environmental tobacco smoke to be 
safe. In places where smoking is forbidden, the concentration 
of nicotine in the air is lower than in places where people are 
allowed to smoke. However, even in places where smoking 
is forbidden, the level of nicotine in the air never equals 0. 
Recently, apart from second hand smoking, another term, 
third-hand smoking, is being used to describe a situation 
in which non-smokers move into apartments previously 
occupied by smokers, or buy a car from a smoker [14].

Smoking, as well as exposure to environmental tobacco 
smoke, in pregnancy adversely affects the development of 
the foetus. Children are exposed to ETS in utero through 
the umbilical cord bond. It should be stressed that the 
placenta does not constitute a barrier against tobacco smoke. 
Study results show that the ETS can be a factor in such 
complications as premature birth, lower birth weight (33-335g 
depending on the author), more frequent birth (by about 22%) 
of children with birth weight below 2,500 g, occurrence of 
birth defects, and smaller head circumference. The influence 
of environmental tobacco smoke probably contributes to 
foetuses being too small for their gestational age; however, the 
ETS was not found to contribute to the delay of intrauterine 
development. It has been confirmed that children born to 
mothers exposed to environmental tobacco smoke attain 
lower APGAR scale results. It has also been established that 
women infants exposed to second-hand tobacco smoking 
during pregnancy had their BMI index at the age of 2 and 3 
years higher than their contemporaries, whose mothers were 
not passive smokers. At the same time, on the basis of many 

years of observation of children exposed to environmental 
tobacco smoke in utero, it was found that passive smoking 
affected the functioning of the immunological system, 
probably by adversely influencing neurodevelopment; the 
occurrence of respiratory system diseases is also significantly 
higher after birth. It is supposed that the ETS affecting the 
foetus may facilitate the incidence of allergic disorders. 
However, it should be stressed that, to date, the results of 
epidemiological studies have not equivocally confirmed 
whether a mother’s active smoking during pregnancy causes 
allergy in her child [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25].

Exposure to environmental tobacco smoke, both in 
foetal life and after birth, contributes to the occurrence of 
diseases of the lower and higher airways, asthma, wheeze, 
lung lesions detectable in computer tomography, as well as 
lung function impairment [26, 27, 28, 29, 30, 31, 32]. In the 
case of passive smokers, the risk of the occurrence of chronic 
obstructive pulmonary disease is significantly higher. By 
2020, this disease is probably going to be the top third cause 
of mortality [17, 33].

Recently, it has been suggested that the ETS contributes to 
the occurrence diabetes mellitus type 2 [34], multiple sclerosis 
[35], increases the possibility of the occurrence of pain in the 
abdominal cavity, joints, back and head [36]. In daughters 
of smoking mothers who smoked during pregnancy, or who 
were exposed to the ETS, the first period occurs later [37]. 
The results of other studies showed that there is a small-to-
modest association between in utero exposure to tobacco 
smoke and reduced fertility [38].

Passive smoking increases the risk of occurrence of 
cardiovascular diseases. The ETS contributes to endothelial 
function impairment and increases the oxidative stress 
[39]. As demonstrated, significant exposure to the ETS is 
associated with the presence of an increased level of C – 
reactive protein (CRP) which, in turn, explain the relationship 
between second- hand smoking (SHS) and death due to 
cardiovascular reasons [13, 40].

There are also reports that exposure to environmental 
tobacco smoke influences the development of hard and soft 
oral tissues. Passive smoking contributes to alteration of 
the composition of the oral bacterial flora. The number of 
Streptococcus mutans and lactobacilli increases [41, 42]. It 
was found that in case of in utero exposure, as well as after 
birth, there was increased risk of early caries and deciduous 
teeth decay. It is worth noting that smoking by the father 
is less harmful than that by the mother [43, 44]. It was also 
demonstrated that smoking by household members, as well 
as second-hand exposure outside one’s house, may contribute 
to the development of permanent teeth caries in adolescents 
[42, 45, 46, 47]. In the case of smokers, there is an increased 
risk of tooth loss, while it decreases in people who give up 
smoking. However, it is not clear whether the ETS affects 
tooth loss in non-smokers and, according to Arora et al., this 
requires further studies and confirmation [48].

Animal studies revealed the occurrence of cytoplasm and 
acinar cells nuclei involution, inflammatory infiltration, type 
I collagen accumulation in the stroma, and the increase of 
interacinar space filled with extracellular matrix which, in 
effect, leads to salivary glands function disorder [49]. It has 
also been observed that in passive smokers, the level of sIgA 
is decreased, amylase activity is increased, and the level of 
sialic acid in the whole stimulated saliva is also increased [50]. 
The results of other, 10-months-long studies, of children aged 

548



Annals of Agricultural and Environmental Medicine 2012, Vol 19, No 3

Małgorzata H. J. Sikorska-Jaroszyńska, Maria Mielnik-Błaszczak, Dorota Krawczyk, Alicja Nasiłowska-Barud, Jerzy Błaszczak. …

3.5-5 years exposed to the ETS, showed that the levels of IgA 
and IgG in saliva were increased [51]. In other studies, it was 
observed that passive smoking contributes to the decrease 
of salivary pH, the rate of the secretion of saliva and its 
buffering abilities [50]. In case of children exposed to the 
ETS, the level of cotinine is increased and accompanied by 
lowered CAL (Clinical Attachment Level) [52]. In the case 
of passive smokers, the inflammatory response from the 
periodontal tissues is increased, and the risk of progression 
of periodontal diseases is also higher [53]. It was also 
found that environmental tobacco smoke impairs the final 
differentiation of keratinocytes [54], and contributes to 
increased gingival pigmentation, evaluated on the basis of the 
gingival pigmental index and digital oral photographs [55].

As already stated, cigarette smoking contributes to the 
occurrence of neoplasms. Reports have also appeared that 
the ETS is directly associated with lung cancer [56], and 
may contribute to higher risk of breast cancer in younger, 
primarily premenopausal women [57], as well as to the 
occurrence of pancreatic cancer [58]. However, it should 
be stressed that studies performed recently did not confirm 
the influence of passive smoking on the general risk of 
incidence of neoplasms, with pancreatic cancer being the 
only exception [59].

In the 1980s and 1990s, due to the results of experimental, 
clinical and epidemiological studies revealing the harmfulness 
of tobacco, there appeared new laws limiting smoking in 
public places, especially at work. The Framework Convention 
on Tobacco Control (FCTC) is the first international treaty 
concerning public health. It was issued after four years of 
negotiations among the WHO members. It was signed in 
2004 by 192 countries, and its provisions were officially 
introduced in February 2005. The provisions of FCTC mainly 
concern the tobacco industry, the necessity for the labeling 
of tobacco products packaging, introduction of new taxes 
on tobacco products, and illegal trade and protection from 
exposure to tobacco smoke In 2005, the Oral Health Network 
of Tobacco Use Prevention and Cessation was established 
[60]. In 2008, a work group was formed in the European 
Parliament aimed at the introduction of a complete ban on 
the tobacco trade in the European Union by 2025. Guidelines 
included in the Healthy People 2010 Programme are meant 
to limit cigarette smoking. According to these guidelines, 
cigarette smoking frequency should drop to 12%. According 
to current Polish law, persons below 18 years of age are not 
allowed to purchase cigarettes. It should be stressed that 
cigarette vending machines and sales of single cigarettes are 
also illegal. It is also forbidden to advertise cigarettes on TV, 
radio, in the press, cinema, and on billboards. There is also a 
complete ban on smoking in hospitals, schools, universities, 
institutions, offices, theatres and cinemas, and a partial ban 
in restaurants and bars. There are warnings about the health 
hazards of smoking printed on cigarette packets. As a result 
of this campaign, a decrease of the incidence of lung cancer 
has been observed in young and middle-aged people [11, 61].

Nowadays, 12 types of smokers are distinguished, 
including ‘childish smokers’. These are people smoking ‘in 
hiding’, in whom smoking evokes a sense of security due to 
memories from childhood. Smoking reminds them of one 
or both parents smoking at home and helps them come to 
grips with the passage of time. It can also be stated that such 
people feel well and safe in an environment with a relatively 
high concentration of cigarette smoke. Parents who smoke 

and live in a house with high concentration level of cigarette 
smoke often make children start smoking at a very early age, 
thereby adopting negative, unhealthy behaviour. Despite 
the constant flow of information about the harmfulness of 
smoking from the mass media (newspapers, radio, television, 
the internet), doctors and dentists still have a very important 
role to play in anti-nicotine campaigns, convincing people 
about the negative influence of tobacco smoke on the state of 
their health. In the course of control visits, health personnel 
should clearly and convincingly present the data concerning 
the adverse results of smoking, as well as the dangers of 
exposure to environmental tobacco smoke [1, 11, 61, 62], 
thus, make their patients aware that breaking their addiction 
will not only be beneficial for their own health, but will also 
protect non-smokers in their environment from the adverse 
effects of exposure to environmental tobacco smoke.

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