Smoking Doesn’t Just Harm Yourself

The risks of smoking are often described from the perspective of the user: “It’s bad for you.” What does not get as much attention is what one smoking does to others. It’s far easier than many people realize to suffer from smoke-related medical issues without ever having smoked, all due to the poor choices of others. The CDC estimates a death toll to the tune of 2.5 million as a result of health complications related to secondhand smoke exposure. That’s 2.5 million people who made a safe choice by not smoking yet still ended up suffering from lung cancer, productive health effects, asthma attacks, and all of the other adverse effects of smoking (many of which are or will be highlighted in other For Future Lungs NY articles). 

The argument is this: Nobody wants to intentionally harm their loved ones (that is a contradiction after all). Even when it comes to strangers, nobody wants to be the villain. Many people likely smoke without entertaining the thought that they might be harming anyone else. But the reality is, the smoke that you inhale by using a cigarette can be just as easily inhaled by others around you. Smoke doesn’t discriminate. That brings about all the effects of actual smoking, or possibly even more if the individual has preexisting medical conditions.

The Research

This is not simply an argument of logic; countless studies back up the intuition that was previously presented. A report by the CDC in 2006 notes that the same cancer-causing compounds in tobacco smoke are naturally present in secondhand smoke as well. Building on that, researchers from all over the world find associations with lung cancer through cohort and epidemiologic studies in regions such as the US, Scotland, and China (Garfinkel 1981, Hole et al. 1989, Zhong et al. 1999). 

More recently, Flor et al. (2024) find associations of secondhand smoke exposure with all nine health conditions they studied – Ischemic heart disease, for example, is estimated at an 8% increased risk, and stroke carries a 5% increased risk, at conservative estimates. At first glance, some might be tempted to write off an increase of 5% or 8%. The issue is that we are dealing with potentially catastrophic conditions where 5% could mean the difference between life and death (or debilitating malignancies). And it must be emphasized that these estimates were noted as conservative, meaning likely an underestimate rather than an overestimate. The CDC, via a report of the Surgeon General in 2014, estimated the increased risk of stroke at 20-30% instead of just 5%. 

The Surgeon General’s report also identifies several other severe consequences of secondhand smoke, such as a direct association with sudden infant death syndrome (SIDS), which has a rather self-explanatory name – in the worst case scenario, smoke can cause deaths in infants. Even removing the extreme cases, secondhand smoke has been connected to exacerbation of asthma in children, while also opening the door to other respiratory and ear infections. Even beyond the respiratory system, there have been associations drawn with damage to the lining of blood vessels, which lead to increased risk of heart attack, or, as in Flor et al. (2024), ischemic heart disease. The gist is simple, one person’s smoking can ruin the lives of many. It can ruin lives immediately, or it can ruin them many years down the line. Either way, it can endanger the lives of others just as much as it can endanger the smoker’s own life.

What About Vaping?

Given the declining rates of smoking and increasing rates of vaping, it is also worth discussing secondhand exposure to vaping. Unfortunately, the effects here are considerably less studied than smoking, but it must be emphasized that lack of research does not equal lack of harmful effects. Islam et al. (2022), for example, performed a cohort study of adolescents and young adults over 5 years (i.e., annual surveys about smoking and vaping habits). They found a 3.9% increase in exposure to secondhand nicotine vapors over the course of their study, which were associated with a prevalence of symptoms of wheezing, bronchitis, and shortness of breath in the population. In particular, bronchitic symptoms and shortness of breath were shown to have a moderately strong association (“odds ratio” of 1.40 and 1.53 respectively at a 95% confidence interval) to secondhand vape inhalation, especially in participants who had never smoked or vaped in the past. To put that in plain English, there was a 40% higher incidence of bronchitic symptoms and a 53% higher incidence of shortness of breath in individuals exposed to secondhand nicotine vaping compared to those who were not, enough to make the suggestion that vaping causes the same kind of harm to one’s surroundings that smoking has been identified to cause.

There is also an intuitive argument to be had, which is also noted in studies such as Czogala et al. (2014). Similar to traditional smoking, vaping requires the individual to exhale some of the vapors they have just taken in. These vapors can then be inhaled by others even if they don’t vape themselves, which in turn can expose potentially vulnerable populations (e.g., children, individuals with respiratory conditions, women undergoing a pregnancy) to nicotine (Czogala et al, 2014) and compounds that are toxic to lung health, such as oxidant metals and volatile aldehydes as noted in Islam et al. (2022). Just as smoke doesn’t discriminate, the vapors from electronic cigarettes also don’t care whose lungs they enter.

What It All Means…

Cutting down on smoking or vaping is not an easy challenge for many, but considering the impacts on others can be a helpful tool and incentive for those trying to quit. Whether it’s your own child, a friend, a relative, or a stranger on the street with their own family to care about, smoking puts someone at risk. It doesn’t matter how brief the exposure is; the CDC maintains that even a secondhand whiff can cause “immediate harm” in the worst of cases. Even for those that don’t smoke or vape, it is still important to understand the risks of secondhand smoke, especially if you live in a more urban area or if you have loved ones who smoke. Catching a whiff may be unavoidable at times, but it is still possible to minimize risk by promptly avoiding areas where smoke or vapors from nicotine vapes are concentrated (i.e., don’t stand directly next to strangers that are smoking). Protecting lung health is a community-level effort just as much as it is a personal one. By understanding the costs of smoking to bystanders, we can paint a better picture of the tremendous harm that smoking does to the population at large. Written by: Derek Wang

Edited by: Albert Deluxe Citations Czogala J, Goniewicz ML, et al. Secondhand exposure to vapors from electronic cigarettes. 

Nicotine Tob Res. 2014 Jun;16(6):655-62. doi: 10.1093/ntr/ntt203. Epub 2013 Dec 11.  PMID: 24336346; PMCID: PMC4565991.

Flor LS, Anderson JA, et al. Health effects associated with exposure to secondhand smoke: a  Burden of Proof study. Nat Med. 2024 Jan;30(1):149-167. doi:  10.1038/s41591-023-02743-4. Epub 2024 Jan 9. PMID: 38195750; PMCID:  PMC10803272.

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