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Indoor air quality is a matter of growing concern to public health because of the recognition that concentrations for most air pollutants are typically two to five times higher indoors than outdoors.  Time and activity studies also show that people spend between 70% to 90% of their time indoors.  These two factors, longer exposure times and higher pollutant concentrations, suggest that indoor exposure are the dominant source of human exposure to air pollutants.


Each year about 36 million kilograms of tobacco is burnt in South Africa during the act of smoking, making tobacco smoke is one of the commonest source of indoor air pollution in this country.  In fact, tobacco smoke is so common in urban environments that most non-smokers can scarcely avoid breathing air polluted with other people’s tobacco smoke.  It is estimated that about 90% of urban nonsmokers have nicotine in their blood.


This paper will examine the health effects of exposure to passive smoke or environmental tobacco smoke (ETS), the public health response to the threat and the role of environmental health officers in protecting public health.  Before dealing with the health hazards let us briefly examine the nature of tobacco smoke.


The Composition of Tobacco Smoke


Physically, tobacco smoke is a mixture of gases, liquid droplets and solid particles dispersed in air.  Chemically it is a cocktail of 4000 compounds, including 200 known poisons and 43 cancer causing agents.


90% of smoke is composed of a few gases which include carbon monoxide, cyanide and nitrogen oxides.  Carbon replaces oxygen in the blood and may cause heart disease.  Cyanide and the oxides of nitrogen damage the linings of the airways and contribute to the development of chronic bronchitis.


The remaining 10% of smoke is made up of dust particles, the best known of which are tar and nicotine.  Nicotine is, of course, the addictive component of tobacco and it is the tars, which cause cancer.


The chemicals found in an environment in which a cigarette, cigar or pipe has been smoked come from two main sources – mainstream and sidestream smoke.  Mainstream smoke is the aerosol drawn through the cigarette and inhaled by the smoker.  The smoke that comes from the burning cigarette between puffs is called sidestream smoke.  The term applied to the combination of diluted sidestream and exhaled mainstream smoke. In an area where smoking has taken place in environmental tobacco smoke (ETS).


Chemically sidestream and mainstream smoke are very similar.  However, there are some difference between the two.  Some substances are found in greater concentrations in undiluted sidestream smoke that in mainstream smoke, including nicotine (3 times as much), carbon monoxide (X 2.5), ammonia (X 73) and the carcinogens benzo-a-pyrene (X 3.4) and nitrosamines (X 100) 3.


It must be remembered though that whereas the smoker is exposed to undiluted mainstream smoke, the sidestream smoke, to which the involuntary smoker is exposed, is diluted to a variable extent depending on distance from the smoking source and the amount of ventilation.


What is the fate of tobacco smoke in and indoor environment?


The gases in smoke remain in the air until fresh air pushes them away.  On the other hand, droplets and particles are small enough to remain floating in the air for a long period, but they then gradually settle down and stick to walls, clothing, hair and any other available surfaces.  As a consequence, even after a room has been well ventilated unless surfaces are wiped down, then smoke particles will be desorbed from these surfaces and re-enter the atmosphere.


After the partial smoking of a single cigarette in a laboratory, trace amounts of nicotine could still be detected in the atmosphere six months later.




Over six hundred studies have now linked environmental tobacco smoke with both chronic and acute ill health in non-smokers.  The most immediately obvious effects of passive smoking is the annoyance and irritation it causes, these effects include irritation of the eyes, headache, cough, hoarseness of the voice and asthma attacks.


Twelve international Expert Committees which have reviewed the scientific literature have concluded that passive smoking increase the risk of lung cancer, heart disease, strokes and respiratory disease in non-smokers.  These experts international committees include the US Surgeon General, International Agency for Research in Cancer (IARC), the California Environmental Protection Agency and the Australian  National Health and Medical Research Council.


The most recent such review was by the UK Department of Health’s Scientific Committee on Tobacco Health.  This Committee found that:


(a)                Exposure to environmental tobacco smoke is a cause of lung cancer and, in those with long-term exposure, the increase risk is in the order of 20-30%.

(b)               Exposure to environmental tobacco smoke is a cause of ischaemic heart disease and, if current published estimates of magnituded of relative risk are validated, such exposure represents a substantial public health hazard. 

(c)                Smoking in the presence of infants and children  is a serious respiratory illness and asthmatic attacks.

(d)                 Sudden infant death syndrome, the main cause of  post-neonatal death in the first year of life, is associated with exposure to environmental tobacco smoke.  The association is judged to be one of cause and effect.




All major health authorities, including the WHO, have responded to this public health threat by strongly recommending public policies that protect nonsmokers from the harmful effects of passive smoking.


The number of states in which smoking in public places is controlled by legislation rose from 47 in 1986 to 90 in 1991.  Countries or communities which have enacted ordinances to make public places and workplaces smoke free include Argentina, Australia, Brazil, Canada, France, Ireland, New Zealand, Singapore, the Scandinavian countries and the USA.


In addition to legislation, court decisions are contributing to making public places and workplaces smoke-free.  In Australia, Sweden, the UK and the US nonsmokers have successfully sued their employers for compensation for harm of their health caused by smoking at work.




South Africa is the latest country to join this worldwide movement towards ensuring that a small minority do not pollute the air the majority have to breathe.  In 1998 the Tobacco Products Control Amendment Act was passed which banned smoking in all public places unless specifically exempted by the Minister of Health.  A notice specifying those areas in which smoking will be allowed and under which conditions is currently being finalized by the Department of Health.


The principle behind this policy is to guarantee non-smokers the right to clean air but where possible to take account of the needs of smokers by allowing them to smoke where their smoke cannot harm others.  Just as people are allowed to drink alcohol but are not allowed to drink and drive, so the new policy allows people to smoke but not in places where they can harm others.


It must also be recommended that smoke free allows equal access to facilities and services for everyone, smokers and non-smokers alike.  The restriction applies to the cigarette not the smoker.


A summary of the notice regulating smoking in public places is given below.


1.                  Smoking is prohibited in all public places except for the following :

§         Retail tobacco stores;

§         Designated smoking areas in workplaces, restaurants, bars, shebeens, taverns, nightclubs and casinos.  and hotels, trains and passenger ships.


2.                  In designated smoking areas the following conditions must be met:

§         The smoking area must be physically separated from the rest of the public area;

§         The air from the smoking area must not be re-circulated to nonsmoking areas;

§         The smoking and nonsmoking areas must be clearly signposted;

§         Employees must be consulted before a smoking areas is designated;

§         Smoking in common work areas like offices, storerooms, meeting rooms, corridors, etc, is prohibited;

§         The size of the smoking area cannot exceed 25% of the total area of the public place.


3.                  Employees have a legal right to be protected from smoking at work.


4.                  Passenger trains and ships must be 90% non-smoking.


5.                  Restaurants with more than 35 seats may designate a maximum of 25 percent of the seating for smoking.


6.                  Smokers can be fined up to R200.00 for smoking in a non-smoking area.


7.                  Public places can be made totally smoke-free if the owner or occupier so decides.




People often express concerns about the enforceability and economic consequences of such laws.  International experience shows that a non-smoking environment is rapidly becoming the social norm in many countries.  The majority of people in South Africa express a desire and support for smoke-free common environments.  A 1998 survey by Market Research Africa found that 90% of nonsmokers and 70% of smokers supported a ban on smoking in public places.


International experience shows that legislation to restrict smoking in public places has generally been implemented without difficulty.  Even the most comprehensive legislation, such as that of Belgium and \New York City banning smoking in virtually all indoor public places, has met little resistance from the public.


In addition to health benefits many countries have also found economic benefits from making workplaces smoke-free.  These include:


i)                    Reduce risk of legal action by sick employees’

ii)                   Reducing cleaning costs – fewer ashtrays to empty and less frequent cleaning of curtains, upholstery, etc. to which smoke sticks’

iii)                 Reduce maintenance costs – discarded smoking materials cause 7% of all fires in South Africa, as well as burning holes in carpets, etc.

iv)                 Reduce air circulation and ventilation costs’

v)                  Reduce absenteeism – smokers have higher rates of absenteeism,

vi)                 Reduce accident rate – smokers have twice the accident rate of nonsmokers.



A major concern in the hospitality industry is that they will lose business.  Research from the US, UK and Canada indicates that restaurant sales are maintained or improved following the implementation of smoke-free bylaws.


In 1999, the Alberta Tobacco Control Centre compiled a list of all available literature on the economic effects of smoke-free ordinances on the restaurant and bar businesses.  Every study conducted independently  of the tobacco industry found that smoke-free ordinances:


i)                    do nor adversely affect, and may increase, tourist business;

ii)                   do not adversely affect restaurant or bar sales, according to sales tax data from 22 American cities;

iii)                 Attract more business (any money) than they drive away do not have a negative effect on other local businesses.




Although there is widespread public support for restriction on smoking in public places, environmental health officers will have a crucial role in making the legislation work.  The critical period will be the first six months or year, this is the period  during which the public will have to be informed of their rights and to create a positive “can do” attitude on the part of owners of public places.


Environmental professionals responsibilities will include:

§         Explain the regulations to the public,

§         Advice employers, restaurants owners on the legal position,

§         Monitor the implementation of the policy and recommend adjustments where necessary,

§         Acting on public complaints about non-compliance by employers, etc.


The Department of Health is planning a media campaign in support of regulations and arrange in-house seminars to explain issues and respond to questions on the implementation on the Act.


Finally may I remind you that South Africa has already successfully introduced restrictions on smoking in some public places.  Cinemas, theatres and museums  were the first to go smoke and all domestic and international flights on South African Airways are smoke-free.  When SAA went smoke-free many people  predicted an increase in air plane crashes because of smoking in toilets.  Nothing of these things happened.  They did not happen because the majority of the public support the law and public support is the first step in successful implementation.


Thank you for your attention.

























Pollutant                               Outdoor Air (Average)                       Indoor Air (Ranges)

                                                EPA             Allegheny                        Smoke-free           Smoking

Inhalable Particles                Standard                     County                              10-30ug/m³            50-1370ug/m³

Nitrogen Dioxide                  50ppb          26 ppb                               1-2ppb                    24-362 ppb

Sulfur Dioxide                       30ppb           16 ppb                              3-13ppb                  13-75ppb

Benzene                                 NA                4.9ppb                              1-4ppb                    10-160ppb

Benzo(a)Pyrene                    NA                 6.1ng/m³                          NA                          3-144ng/m³

Carbon Monoxide                9ppm(max)   6.7 ppm                            1-3 ppm                  4-42ppm




ug/m³    -           micrograms per cubic meter

ppb      -           parts per billion

 ppm    -           parts per million

max      -           maximum

NA      -           Not available or not applicable


Sources of Data


US EPA:   1992 Respiratory Health Effects of Smoking

1986 US Surgeon General’s Report

1991 Allegheny County Health Department Bureau of Air Pollution.






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