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Background: Costs of tobacco-related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking. Aim: To estimate the health-related costs of tobacco from both active and passive smoking. Methods: Using local data, we estimated active and passive smoking-attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of US$1.3 million for a life lost. Results: In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was US$532 million for active smoking and US$156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to US$9.4 billion. Conclusion: The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke-free areas in the Asia Pacific Region and elsewhere. ; published_or_final_version

Second-hand smoke, also known as environmental tobacco smoke (ETS), is one of the most harmful indoor pollutants. Exposure to ETS is a worldwide silent cause of mortality and morbidity. Although ETS had been decreased for 20 years, a lot of people who do not smoke still exposed to ETS at home, work, public places, and in vehicles. ETS is a risk factor for many important diseases such as lung cancer, chronic obstructive lung disease, asthma, cardiovascular diseases, upper and lower respiratory tract infections, and sudden infant death. In this article, the harmful effects of ETS and the effects of smoke-free environment regulation on ETS exposure were reviewed.

Objective In 2012, North Dakota enacted a comprehensive statewide law prohibiting smoking in enclosed public places. Disparities in tobacco control exist in rural areas. This study's objective was to determine the extent to which the passage of a comprehensive, statewide, smoke-free law in a predominantly rural state influenced tobacco smoke pollution in rural and nonrural venues. ; 166-175.

Smoke & Mirrors provides an insider's view of the Canadian tobacco war, a hundred-year old conflict that began to escalate in the 1980s. Written by a prominent antismoking advocate, the book explains how Canada emerged as a global leader in the public health crusade to regulate the powerful tobacco industry. Author Rob Cunningham exposes the industry's deception and tactics; and describes in fascinating detail the bitter campaigns to maintain high tobacco taxes, ban tobacco advertising, eliminate tobacco sponsorships, require plain packaging, mandate clear health warnings, and prohibit smoking

Front Cover -- Contents -- List of Illustrations -- Preface -- Acknowledgments -- Abbreviations -- Situating Tobacco Chronologically vis-à-vis Oceania -- Part One The History, Economy, and Ethnography of Tobacco in Oceania -- Chapter 1 Introduction and Historical Background -- Chapter 2 Tobacco as a Comestible -- Chapter 3 Pipe Dreams -- Chapter 4 Tobacco in Indigenous Trade -- Chapter 5 Tobacco as an Object of Exchange between Islanders and Foreigners -- Chapter 6 From Tobacco Trade to Tobacco Production -- Chapter 7 Death, Taxes, and Tobacco Control -- Part Two The Medical Anthropology of Tobacco in Oceania -- Chapter 8 Aotearoa: "Land of the Long White Smoke Cloud": Pacific Smoke Inhalation Case Study Number 1 -- Chapter 9 U.S. Associated Micronesia: Pacific Smoke Inhalation Case Study Number 2 -- Chapter 10 Native Hawaiians: Kanaka Maoli: Pacific Smoke Inhalation Case Study Number 3 -- Chapter 11 Tobaccosis: The Tobacco Syndemic -- Notes -- References Cited -- Index -- Back Cover.

Tobacco kills 5 million people every year - and that number is expected to double by the year 2020. Despite its enormous toll on human health, tobacco has been largely neglected by anthropologists. This book combines an exhaustive search of historical materials on the introduction and spread of tobacco in the Pacific with extensive anthropological accounts of the ways Islanders have incorporated this substance into their lives. The author uses a relatively new concept called a syndemic - the synergistic interaction of two or more afflictions contributing to a greater burden of disease in a population - to focus at once on the health of a community, political and economic structures, and the wider physical and social environment to ultimately provide an in-depth analysis of smoking's negative health impact in Oceania. In this book, the idea of a syndemic is applied to the current health crisis in the Pacific, where the number of deaths from coronary heart disease, cancer, diabetes, and chronic obstructive pulmonary disease (COPD) continues to rise. The case is made that smoking tobacco in the form of industrially manufactured cigarettes is the keystone of the contemporary syndemic in Oceania. The author shows how tobacco consumption (particularly cigarette smoking after World War II) has become the central interstitial element of a syndemic that produces most of the morbidity and mortality Pacific Islanders suffer. This syndemic is made up of a bundle of diseases and conditions, a set of historical circumstances and events, and social and health inequities most easily summed up as "poverty." He calls this the tobacco syndemic and argues that smoking is the crucial behavior - the "glue"--Holding all of these diseases and conditions together. This book offers an examination of the damaging tobacco syndemic in a specific world region, and will be of interest to scholars and students of anthropology, Pacific studies, history, and economic globalization, as well as for public health practitioners and those working in allied health fields. More broadly, the book will appeal to anyone concerned with disease interaction, the social context of disease production, and the full health consequences of the global promotional efforts of Big Tobacco

After an extensive review and analysis of the scientific evidence on the respiratory health effects of passive smoking, the U.S. Environmental Protection Agency concluded that environmental tobacco smoke causes lung cancer in adult nonsmokers and increases the risk of a variety of non‐cancer respiratory disorders, especially in children. This article is a response to claims in Dr. Gio Gori's article "Policy Against Science: The Case of Environmental Tobacco Smoke," appearing in the same issue of this journal, that such conclusions are unwarranted. This response focuses only on the respiratory health effects of environmental tobacco smoke.

The combustion of tobacco indoors results in the emission of a wide range of air contaminants that are associated with a variety of acute and chronic health and comfort effects. Exposures to environmental tobacco smoke (ETS) are assessed for epidemiologic studies and risk assessment and risk management applications. An individual's or population's exposure to ETS can be assessed by direct methods, which employ personal air monitoring and biomarkers, and indirect methods, which utilize various degrees of microenvironmental measurements of spaces, models, and questionnaires in combination with time–activity information. The major issues related to assessing exposures to ETS are summarized and discussed, including the physical–chemical nature of ETS air contaminants, use of proxy air contaminants to represent ETS, use of biomarkers, models for estimating ETS concentrations indoors, and the application of questionnaires.

Background. Two-thirds of complaints received by the Hong Kong Environmental Protection Department in 1988 were related to poor air quality. In July 1990 legislation was implemented to reduce fuel sulphur levels. The objective of this study was to measure the impact of the intervention on respiratory health in primary school children. Methods. In all, 3521 children, mean age 9.51 years (SD = 0.78), from two districts with good and poor air quality respectively before intervention were followed yearly from 1989 to 1991. Children and parents reported the children's respiratory symptoms using self-completed questionnaires. Factor analysis was used to derive independent scores from 12 symptoms. Four groups of related symptoms were identified and binary variables (presence of any symptom in each group) were treated as dependent variables in modelling using generalized estimating equations procedures. Results. In 1989 and 1990 an excess of respiratory symptoms was observed in the polluted compared with unpolluted district. The significant effects (odds ratio [OR], 95% confidence interval [CI], P value) associated with living in the polluted district were: cough and sore throat (OR = 1.22, 95% CI: 1.04-1.43, P < 0.01) and wheezing (OR = 1.35, 95% CI: 1.10-1.66, P < 0.01). After the intervention, in the polluted district only, sulphur dioxide levels fell by up to 80% and sulphate concentrations in respirable particulates by 38%. Between 1989 and 1990-1991 there was a greater decline in the polluted compared with the unpolluted district for reported symptoms of cough or sore throat, phlegm, and wheezing. The risks to respiratory health for children exposed to tobacco smoke in the home were higher than those for air pollution in both 1989 and 1990 and remained unchanged in 1991. Conclusions. Air quality can be improved by fuel controls but an effective intersectoral approach is required if other risks from environmental tobacco smoke are to be avoided. ; published_or_final_version