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二手烟

二手烟每年导致近90万人死亡,而全球有四分之一的人仍暴露于二手烟中。有些人群,如不吸烟的女性和社会经济地位低的群体,经常面临更高的暴露风险,进而承担更重的烟草使用负担。

In 2016, an estimated one-fifth of males and one-third of females globally were exposed to secondhand smoke. Although secondhand smoke usually come from cigarettes, smoking other tobacco products (such as waterpipe) is common in some populations and can substantially contribute to secondhand smoke exposure.

Exposure to secondhand smoke is associated with numerous adverse health effects, even among children and unborn babies, and causes substantial mortality and morbidity globally. In 2016 alone, for example, it caused an estimated 884,000 deaths. The years of life lost due to ill-health, disability, or early death because of secondhand smoke was 6.4 million years for lower respiratory infections, 2.5 million for chronic obstructive pulmonary disease, and more than 200,000 for middle ear infection.

Exposure to secondhand smoke is common in many countries, notably in Asia. In Indonesia and Pakistan, for example, more than 80% of people are exposed to secondhand smoke in restaurants.

Variations in smoke-free laws and enforcement of these laws greatly affects levels of exposure. Due to these variations, prevalence of exposure to secondhand smoke in bars and restaurants is relatively low in several European Union member states (<10%) but is far higher in some others (e.g., nearly 80% in Greece in 2017). After implementation of comprehensive laws in Turkey in 2009, exposure prevalence in workplaces and restaurants dropped substantially— from 37% and 56% respectively in 2008 to 16% and 13% in 2012.

Prevalence of secondhand smoke exposure in many countries with a low Human Development Index (e.g., in sub-Saharan Africa) is low simply due to relatively low smoking prevalence. However, even those countries must implement or enforce existing comprehensive smoke-free laws to protect their populations. With current trends, many of them are likely to see a substantial increase in smoking, and consequently, secondhand smoke prevalence.

Within countries, some groups demonstrate higher exposure levels and related burden, such as those of lower socioeconomic groups and non-smoking women. For example, secondhand smoke causes more deaths in women than in men globally (573,000 vs. 311,000 in 2016) and more lung cancer deaths among women than men in China (40,000 vs. 12,000 in 2013). Returning to the example of Turkey, the decline in prevalence of exposure at home (from 56% to 38%) was smaller than the decline in public places, reinforcing the importance of focusing on exposure inside the home. In many population, homes are the main place of exposure to secondhand smoke for women and children.


二手烟接触率

在一些国家,二手烟暴露是一种常见现象。

2011-2015 年,全球成人烟草调查,年龄 ≥15 岁的人群在家、室内工作场所和餐馆的二手烟暴露率 (%)。

欧洲酒吧中的二手烟

2017年,在28 个欧洲国家,年龄 ≥15 岁的人口,在酒吧中二手烟的暴露率。

欧洲餐馆中二手烟的暴露率

2017年,在28 个欧洲国家,年龄 ≥15 岁的人口,在餐馆中二手烟的暴露率。

按社会经济状况划分的暴露情况

在较低的社会经济群体中,接触二手烟更为普遍。此外,其他非卷烟的烟草制品可能对某些人群的二手烟暴露负主要责任。

2011-2012 年 ,按父亲教育程度划分,6-18 岁的伊朗儿童卷烟和水烟产生的二手烟暴露率 (%)。

青少年吸烟率

2007-2014 年,按世卫组织地域划分,年龄 13-15 岁的青少年在家外接触二手烟的百分比和数量 。

栏内的数字代表暴露于二手烟的青少年的数量(百万)。全球很多青少年都暴露在二手烟环境中。

References

GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1345-1422.

European Commission. Smoke-free environments. Available at: https://ec.europa.eu/health/tobacco/smoke-free_environments_en. Last Accessed September 13, 2017.

Global Adult Tobacco Survey. Comparison fact sheet. Turkey 2008 & 2012. Available at: http://www.who.int/tobacco/surveillance/survey/gats/gats_turkey_2008v2012_comparison_fact_sheet.pdf. Last Accessed: September 13, 2017.

Global Adult Tobacco Survey.

Islami et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013. Annals of Oncology. 2017. doi:10.1093/annonc/mdx342. Published online 4 July 2017

Kelishadi et al. Exposure to Hookah and Cigarette Smoke in Children and Adolescents According to Their Socio-Economic Status: The CASPIAN-IV Study. Iran J Pediatr. 2016 Jun 12;26(4):e3036. PMID: 27781078 [This is a nationwide survey.]

Lim et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224-2260.

Special Eurobarometer 458: Attitudes of Europeans towards tobacco and electronic cigarettes.

Yang et al. Association of Husband Smoking With Wife's Hypertension Status in Over 5 Million Chinese Females Aged 20 to 49 Years. J Am Heart Assoc. 2017 Mar 20;6(3). pii: e004924. PMID: 28320748

U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 Atlanta, USA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2014

U.S. National Cancer Institute and World Health Organization. The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016.

WHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies. Geneva, Switzerland: World Health Organization. [GTCR 2017]

Wipfli H, Avila-Tang E, Navas-Acien A, Kim S, Onicescu G, Yuan J, Breysse P, Samet JM; Famri Homes Study Investigators. Secondhand smoke exposure among women and children: evidence from 31 countries. Am J Public Health. 2008 Apr;98(4):672-9. PMID: 18309121.