The Health Consequences of Involuntary Exposure to Tobacco Smoke

A R e p o r t o f t h e S u r g e o n G e n e r a l

you what it means to
e

It hurts you.

It doesn’t take much.

It doesn’t take long.

The 2006 Surgeon General’s report has new information about how 

breathing secondhand smoke hurts your health. You can find more 

information about this report by going to the Surgeon 

General’s website at www.surgeongeneral.gov.

More information is also available by going to the 

Centers for Disease Control and Prevention (CDC) 

website at www.cdc.gov/tobacco.

Secondhand smoke is dangerous.

The Surgeon General of the United States, working with a team 

of leading health experts, studied how breathing secondhand 

tobacco smoke affects you.

This booklet explains what scientists have learned about the 

dangers of secondhand smoke. It also tells you how to protect 

yourself and your family.

What is secondhand smoke?

When a person smokes near you, you breathe secondhand

smoke. Secondhand smoke is the combination of smoke from

the burning end of the cigarette and

the smoke breathed out by

smokers. When you breath

secondhand smoke, it is

like you are smoking.

Whether you are 

young or old, healthy 

or sick, secondhand 

smoke is dangerous.

smokers. When you breathe 

1
What we now know:

■ There is no safe amount of secondhand smoke. Breathing even 

a little secondhand smoke can be dangerous.

■ Breathing secondhand smoke is a known cause of sudden 

infant death syndrome (SIDS). Children are also more likely 

to have lung problems, ear infections, and severe asthma from 

being around smoke.

■ Secondhand smoke causes heart disease and lung cancer.

■ Separate “no smoking” sections DO NOT protect you from 

secondhand smoke. Neither does filtering the air or opening 

a window.

■ Many states and communities have passed laws making 

workplaces, public places,

restaurants, and bars 

smoke-free. But millions 

of children and 

adults still breathe 

secondhand smoke 

in their homes, cars,

workplaces, and in 

public places.

No amount of secondhand 

smoke is safe. 

When you are around a person who is 

smoking, you inhale the same dangerous 

chemicals as he or she does. Breathing 

secondhand smoke can make you sick. Some 

of the diseases that secondhand smoke causes 

can kill you.

Protect yourself: do not breathe secondhand 

smoke. But completely avoiding secondhand 

smoke is very hard to do. Most of us breathe 

it whether we know it or not. You can breathe 

secondhand smoke in restaurants, around the 

doorways of buildings, and at work. When 

someone smokes inside a home, everyone 

inside breathes secondhand smoke. Some 

children even breathe smoke in day care.

There is no safe amount of secondhand 

smoke. Children, pregnant women, older 

people, and people with heart or breathing 

problems should be especially careful. Even 

being around secondhand smoke for a short 

time can hurt your health. Some effects are 

temporary. But others are permanent.

Make your 

environment 

smoke-free. 

WHAT CAN 

YOU DO? 

3

■ Make your home and car 

smoke-free.

■ Visit smoke-free restaurants 

and public places.

■ Ask people not to smoke 

around you and your 

children.

2
Secondhand smoke contains poisons.

The chemicals found in secondhand smoke hurt your health and 

many are known to cause cancer. You breathe in thousands of 

chemicals when you are around someone who is smoking.

WHAT THE SCIENCE SAYS 

How do scientists measure 

exposure to secondhand 

smoke?

Researchers measure

■ how many people are smoking

■ how many cigarettes they 

smoke

■ time spent in the room

■ levels of nicotine in the air,

and

■ levels of nicotine by-products 

in the body 

is toxic

Toxic Metals

Can cause cancer

Can cause death

Can damage the brain and kidneys

Poison Gases

Can cause death

Can affect heart and respiratory functions

Can burn your throat, lungs, and eyes

Can cause unconsciousness

Cancer Causing 

Chemicals

All are extremely toxic

Secondhand smoke 

has more than 4,000 

chemicals.

Many of these 

chemicals are toxic 

and cause cancer.

You breathe in these 

chemicals when you 

are around someone 

who is smoking.

Polonium-210

Radioactive and very toxic

Arsenic

Used in 

pesticides

Butane

Used in lighter 

fluid

Toluene

Found in paint 

thinners

Cadmium

Used in making 

batteries

Carbon Monoxide

Found in car exhaust

Ammonia

Used in 

household 

cleaners

Lead

Once used in 

paint

Vinyl Chloride

Used to make pipes

Chromium

Used to make 

steel

Formaldehyde

Used to embalm dead bodies

Hydrogen Cyanide

Used in

chemical weapons

Benzene

Found in gasoline

4
causes death and sickness in children.

Breathing secondhand 

smoke is a known cause 

of sudden infant death 

syndrome (SIDS).

Children are also more 

likely to have lung 

problems, ear infections,

and severe asthma.

Babies are hurt by secondhand smoke.

Tobacco smoke harms babies before and after they are born.

Unborn babies are hurt when their mothers smoke or if others 

smoke around their mothers. Babies also may breathe secondhand 

smoke after they are born. Because their bodies are developing,

poisons in smoke hurt babies even more than adults. Babies under 

a year old are in the most danger.

Secondhand smoke is a known cause of 

sudden infant death syndrome (SIDS).

The sudden, unexplained, unexpected death of an infant before

age 1 year is known as SIDS. The exact way these deaths happen

is still not known. We suspect it may be caused by changes in the

brain or lungs that affect how a baby breathes. During pregnancy,

many of the compounds in secondhand smoke change the way

a baby’s brain develops. Mothers 

who smoke while pregnant are 

more likely to have their babies die 

of SIDS.

Babies who are around 

secondhand smoke—from their 

mother, their father, or anyone 

else—after they are born, are 

also more likely to die of SIDS 

than children who are not around 

secondhand smoke.

7
9

Secondhand smoke causes low birth weight 

and lung problems in infants.

Babies whose mothers are around 

secondhand smoke are more likely 

to have lower birth weights.

These babies can have more 

health problems because they 

breathe smoke. For example,

they are more likely to have 

infections than babies who 

are not around secondhand 

smoke. Studies show that babies whose 

mothers smoke while pregnant are 

more likely to have lungs that do not 

develop in a normal way. Babies who breathe secondhand smoke 

after birth also have weaker lungs. These problems can continue 

as they grow older and even when they become adults.

WHAT THE SCIENCE SAYS 

The main place young children breathe 

secondhand smoke is in their homes.

Almost 3 million children in the United States under the age of 6 years old breathe 

secondhand smoke at home at least 4 days 

per week.

Older children are in danger, too. Studies show that older children whose 

parents smoke get sick more often. Like 

babies, their lungs grow less than children 

who do not breathe secondhand smoke.

They get more bronchitis and pneumonia.

Wheezing and coughing are also more 

common in children who breathe secondhand 

smoke. Secondhand smoke can trigger an asthma 

attack in a child. Children with asthma 

who are around 

secondhand 

smoke have worse 

asthma attacks 

and have attacks 

more often. More 

than 40 percent 

of children who 

with smokers. A severe asthma attack can put 

a child’s life in danger. go to the emergency room for asthma live Ear infections are painful. Children whos

e

parentssmokearoundthemgetmoreear

infections.Theyalsohavefluidintheirears

moreoftenandhavemoreoperationstoput

ineartubesfordrainage.

WHAT CAN 

PARENTS DO? ■ Do not allow anyone to 

smoke near your child. 

■ Do not smoke or allow others 

to smoke in your home or 

car. Opening a window does 

not protect your children 

from smoke.

■ Use a smoke-free day care 

center.

■ Do not take your child to restaurants or other indoor 

public places that allow 

smoking.

■Teach older kids to stay away 

from secondhand smoke.

Protect your 

children’s health.

89
causes heart disease and lung cancer in adults.

Breathing secondhand 

smoke for even a short 

time can have immediate 

bad effects.

Over time, secondhand 

smoke can cause heart 

disease and lung cancer.

Secondhand smoke hurts adults 

too. 

The longer you are around secondhand 

smoke, the more likely it is to hurt you.

Nonsmokers who breathe smoke at home 

or at work are more likely to become sick 

and die from heart disease and lung cancer.

Studies show that secondhand smoke may 

cause other serious diseases, too.

Secondhand smoke is bad for 

your heart.

Breathing secondhand smoke makes the 

platelets in your blood behave like those 

of a regular smoker. Even a short time in 

a smoky room causes your blood platelets 

to stick together. Secondhand smoke also 

damages the lining of your blood vessels. In 

your heart, these bad changes can cause a 

deadly heart attack.

Secondhand smoke changes how your heart,

blood, and blood vessels work in many ways.

Adults who breathe 5 hours of secondhand 

smoke daily have higher “bad” cholesterol 

that clogs arteries.

More restaurants and bars 

are smoke-free than ever. 

New York City restaurants 

and bars increased business 

by 9 percent after becoming 

smoke-free.

■ Choose restaurants and 

bars that are smokefree. Thank them for 

being smoke-free.

■ Let owners of 

businesses that are not 

smoke-free know that 

smoke bothers you. Tell 

them a “no smoking” 

section is not good 

enough.

WHAT CAN 

YOU DO? 

11

Protect your health.
FOR 

PLACEMENT 

ONLY

Even if you don’t smoke, breathing 

secondhand smoke increases your 

chances of getting lung cancer.

People who have heart disease should be very careful not to go 

where they will be around secondhand smoke.

The bottom line is that breathing secondhand smoke makes it 

more likely that you will get heart disease, have a heart attack,

and die early.

Evenashorttimeinasmokyroom

causesyourblood plateletstostick

together.Secondhandsmokealso

damagestheliningof yourbloodvessels.

Inyourheart,thesebadchangescan

causeadeadlyheartattack.

Secondhand smoke hurts your 

lungs. Secondhand smoke includes many chemicals that are dangerous for your lungs. Secondhand smoke is especially dangerous 

for young children and adults with heart and 

lung disease.

Secondhand smoke causes lung 

cancer. Secondhand tobacco smoke contains the 

same cancer-causing chemicals that smokers 

inhale. Secondhand smoke causes lung cancer 

in adults who don’t smoke. Breathing 

in secondhand smoke at home or work 

increases your chances of getting lung cancer by 20 percent to 30 percent.

13

WHAT CAN 

HEALTH CARE 

EXPERTS DO? ■ Ask patients if they smoke 

and if they are around 

secondhand smoke.

■ Advise patients who smoke 

to stop, and help them quit.

■ Advise patients who smoke 

not to smoke around others.

■ Advise nonsmokers to 

protect themselves by 

avoiding all secondhand 

smoke.

■ Remind parents to 

protect their children from 

secondhand smoke.

■ Discuss the added dangers 

of secondhand smoke 

for adults who have heart 

disease or asthma.

■ Offer special warnings 

to parents when treating 

children with respiratory 

infections, asthma, or ear 

disease.

12
14

WHAT CAN 

EMPLOYERS DO? 

Secondhand smoke is 

harmful for all workers. 

Restaurant and bar workers 

breathe more secondhand 

smoke than other workers 

and have higher rates of lung 

cancer.

■ Make sure your 

employees do not breathe 

secondhand smoke at 

work.

■ Make all indoor places 

smoke-free.

■ Don’t allow smoking near 

doorways and entrances.

■ Offer programs to help 

employees quit smoking.

Protect 

your workers.

Secondhand smoke causes 

other breathing problems.

Secondhand smoke affects how well your 

lungs work, especially if you already have 

asthma or other breathing problems.

Being around smoke makes you more 

congested and cough more.

Secondhand smoke also irritates your 

skin, eyes, nose, and throat. If you have 

allergies or a history of breathing problems,

secondhand smoke can make you even 

sicker.

WARNING

You should especially speak to your doctor 

or healthcare provider about the dangers of 

secondhand smoke if: 

■ You have breathing or heart problems 

■ You are pregnant 

■ You are concerned about your children’s health 

Secondhand smoke may cause

disease in other parts of your body.

We know that smoking causes many forms 

of cancer. Scientists believe even a little 

tobacco smoke is dangerous. Scientists also 

believe secondhand smoke may cause other 

diseases throughout your body. They are 

doing studies on possible links to stroke,

breast cancer, nasal sinus cancer, and chronic 

lung problems in children and adults.

Secondhand 

smoke may 

cause disease 

in other parts 

of your body.

15

No amount of 

secondhand smoke 

is safe.

Here are some unexpected 

ways you may breathe 

secondhand smoke every 

day: 

■ Sitting in the “no 

smoking” section, even 

if it doesn’t smell smoky

■ Riding in a car while 

someone else is 

smoking, even if a 

window is open 

■ Being in a house where 

people are smoking, 

even if you’re in a 

another room

■ Working in any 

restaurant, warehouse, 

or building that allows 

smoking inside, even 

if there is a filter or 

ventilation system

There’s no such 

thing as a 

section

NO

SMOKING
Acknowledgments 

This public document was prepared by the U.S. Department of Health and Human 

Services under the direction of the Office of the Surgeon General to make information in 

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon 

General available to everyone.

Richard H. Carmona, M.D., M.P.H., F.A.C.S., Surgeon General, U.S. Public Health 

Service, Office of the Surgeon General, Office of the Secretary, Washington, D.C.

Kenneth P. Moritsugu, M.D., M.P.H., Deputy Surgeon General, U.S. Public Health 

Service, Office of the Surgeon General, Office of the Secretary, Washington, D.C.

A special thanks to the many people who provided expert advice and suggestions: Dr.

Jonathan Samet, Senior Scientific Editor of the 2006 Surgeon General’s report and 

Professor and Chairman, Department of Epidemiology, Bloomberg School of Public 

Health, Johns Hopkins University; Dr. Karen Near, Senior Science Advisor, Office of 

the Surgeon General, DHHS; Ellen Field, Deputy Assistant Secretary, DHHS; Dr.

Terry Pechacek, Associate Director for Science, Office on Smoking and Health, CDC;

Leslie Norman, Managing Editor of the 2006 Surgeon General’s report, CDC; Dana 

Shelton, Associate Director for Policy, Planning and Coordination, Office on Smoking 

and Health, CDC; Peggy Williams, Writer-Editor, Quantell, Inc.; Gabrielle Robinson,

Writer-Editor, Northrop Grumman; the CDC Health Literacy Workgroup; Dr. P. Lynne 

Stockton, CDC; Victoria Barnard, Teacher, Chamblee High School; Tommy Jones,

Reviewer; and the scientific and communications staff of the Office on Smoking and 

Health, CDC.

Project Leads,Writers, and Editorial Assistance

Sarah Gregory, Health Communications Specialist, CDC

Peter Xiques, Writer, Science Applications International Corporation

Vickie Reddick, Writer, Science Applications International Corporation

Graphic Design

C. Mark Van Hook, Graphic Designer, Science Applications International Corporation

The Surgeon General is the nation’s highest-ranking health officer.

The President appoints the Surgeon General to help promote and 

protect the health of all Americans.

The Surgeon General gives Americans the best scientific information 

available on how to improve their health and reduce their risk of 

illness and injury.

The Health Consequences of Involuntary Exposure to Tobacco Smoke:

A Report of the Surgeon General was prepared by many of the country’s 

leading scientists and public health experts.The full report is more 

than 600 pages long. It took more than 4 years to complete. It is 

written for a scientific audience. However, Surgeon General Richard 

H. Carmona believes the findings are very important to everyone.

About the Surgeon General’s Report

Suggested Citation: U.S. Department of Health and Human Services. The Health Consequences of

Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Secondhand Smoke What It Means 

to You. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,

Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health, 2006.
For more information

For more information on secondhand smoke, talk to your doctor, nurse,

pharmacist, or other healthcare professional.

More information about the Surgeon General’s report is available on the 

Surgeon General’s website at

www.surgeongeneral.gov 

More facts and advice are available from

Centers for Disease Control and Prevention

www.cdc.gov/tobacco

Toll free: 1-800-CDC-INFO (1-800-232-4636)

In English, en Español

24 hours/day, 7 days/week

Text telephone for hearing impaired: 1-888-232-6348

Other helpful information is available at www.smokefree.gov.

To access a telephone quitline serving your area, call 

1-800-QUIT-NOW (1-800-784-8669).

To download copies of this 

booklet or the full Surgeon 

General’s report, The Health 

Consequences of Involuntary 

Exposure to Tobacco Smoke: 

A Report of the Surgeon 

General, go to 

www.cdc.gov/tobacco. 

To order single copies of these 

documents, call toll free 

1-800-CDC-INFO.

It hurts you.

It doesn’t take much.

It doesn’t take long.