Slow Progress in Controlling Second-Hand Smoking

Passive smoking is defined as involuntary exposure to environmental tobacco smoke (ETS) by non-smokers at home, at work or in public places in general. Data from population surveys indicate a drop in tobacco use in Spain in men and women (39.2% among men and 24.7% among women in 2001 vs 31.6% and 21.5%, respectively, in the Spanish National Health Survey [NHS] of 2006). 1 Smoking has changed from being behavior considered socially acceptable to one that causes a public health problem not only for smokers, but also for the innocent bystander who becomes a passive smoker. In many cases, active smoking is the only cardiovascular risk factor found in patients with myocardial infarction under 45 years, and affects 76%-91% of this population. 2 It is also clear, and demonstrated by a case-control study, that quitting smoking reduces coronary mortality and continuing to smoke after a first infarction increases the risk of suffering a new coronary event that is 3 times greater than that among those who quit smoking. When the patient succeeds in quitting smoking after following a secondary prevention program, risk becomes equal to that of non-smokers before the first infarction. 3 These data have strengthened secondary prevention programs which are currently one of the main pillars of clinical cardiology. 4 Achieving less exposure to ETS in coronary patients who formerly smoked would fulfill 2 aims: first, abstinence would be maintained by there being more environments that were free from smoke and its temptation; and second, the impact on the cardiovascular system due to such involuntary exposure would be reduced. According to the International Agency for Research on Cancer (IARC) from the World Health Organization (WHO) and the United States Environmental Protection Agency, tobacco smoke is a class A carcinogen, which