Tobacco Prevention and Control Branch

Secondhand Smoke

• Secondhand Smoke
• Changing Environments
• Current Policy
• Local Community Authority
• Smoke-free Places

The NC Tobacco Prevention and Control Branch works to eliminate North Carolinians’ exposure to secondhand smoke (SHS). SHS has been linked with health problems such as heart disease, heart attack, stroke, lung disease, lung cancer and some other cancers. Childhood exposure to SHS can lead to upper respiratory infections, decreased lung capacity, ear infections, and even behavioral problems and learning difficulties. Pregnant women exposed to SHS have increased risk of delivering prematurely or having an infant die of SIDS.

Exposure to secondhand smoke is a preventable cause of significant illness and death. According to the Task Force on Community Preventive Services, which reviews published studies on preventive health, policies to ban smoking indoors reduce exposure to secondhand smoke, reduce the number of cigarettes smoked each day, and increase the number of people who quit smoking.

According to the Task Force on Community Preventive Services, which reviewed published studies on secondhand smoke policy, smoking bans and restrictions are effective in reducing exposure to secondhand smoke.

According to the Task Force’s Guide to Community Preventive Services, smoking bans prohibit smoking from indoor areas of public places and workplaces. Studies showed an average reduction in exposure to components of secondhand smoke of 72 percent.

What Is Secondhand Smoke?

CDC: Secondhand Smoke Facts

Health Hazards

The American Society of Heating and Air-Conditioning Engineers (ASHAE)published an updated position paper on Environmental Tobacco Smoke in July, 2020.

Secondhand Smoke and Smoking During Pregnancy Expose Infants and Young Children to Lead

Smoking and Lead Exposure in NC Children 2019 (From Duke University’s Environmental Law and Policy Clinic) (PDF, 5.6 MB)

The Surgeon General’s Report on Involuntary Exposure to Tobacco Smoke (2006)

Note: In 2014 another Surgeon General's Report added stroke to the health problems known to be caused by SHS. Get more facts about SHS.

The US Surgeon General released a report in 2006 called The Health Consequences of Involuntary Exposure to Tobacco Smoke which explains all the known health risks of SHS and states, “there is no known safe level of exposure to SHS.”

• Full Report

Major Conclusions of the Surgeon General's Report

1. Secondhand smoke causes premature death and disease in children and in adults who do not smoke.
2. Exposed children have increased risk for:
   • Sudden infant death syndrome (SIDS)
   • Acute respiratory infections
   • Ear problems
   • More severe asthma
3. Parents’ smoking impacts their children by
   • Causing respiratory symptoms
   • Slowing lung growth
4. Exposing adults to secondhand smoke causes
   • immediate adverse effects on the cardiovascular system
   • coronary heart disease
   • lung cancer
5. The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
6. Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.
7. Eliminating indoor smoking fully protects nonsmokers from exposure to secondhand smoke.
8. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure to secondhand smoke.

Additional Information

2009 Institute of Medicine Report

• Read the Free, Online Version of the Report

The Institute of Medicine released a report in October, 2009, Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. This report provides a comprehensive review of the science on the relationship between secondhand smoke exposure and heart attack.  The report was requested by CDC, but the review was conducted independently by the Institute of Medicine.

Major Conclusions of the Institute of Medicine's Report

• The evidence is consistent with a causal relationship between secondhand smoke exposure and acute coronary events, including acute myocardial infarctions.
• It is biologically plausible for a relatively brief exposure to secondhand smoke to precipitate an acute coronary event.
• There is a causal relationship between smoke-free laws and decreases in acute coronary events.

Other Resources

• SmokeFree NC: NC’s Smoke-Free Restaurants and Bars Law - Secondhand Smoke