Çevresel tütün dumanı (ÇTD), sigara içen kişi tarafından ortama verilen ve sigaranın yanmakta olan ucundan çıkan dumandan oluşur. Dünya Sağlık Örgütü, dünya çocuklarının yarısının sigara dumanına maruz kaldığı bildirilmektedir. Ülkemizde gerçekleştirilmiş olan çalışmalar ise daha yüksek bir maruziyet düzeyine işaret etmektedir. ÇTD maruziyetinden etkin bir korunma sağlamanın tek yolu % 100 dumansız ortamlardır. Etkin bir ÇTD kontrolü ancak yasal düzenlemeler aracılığıyla güvence altına alınabilir. Bebekler ve çocuklar açısından en önemli maruziyet alanı evdir. Ailelerin evlerini %100 dumansız ortamlara dönüştürebilmeleri için toplumu eğitimi ve klinik müdahaleler gibi bileşenleri kapsayan toplum tabanlı çalışmalar yürütülmelidir.
Environmental tobacco smoke (ETS) is the combination of smoke exhaled by the smoker and smoke emitted from the burning end of a cigarette. The World Health Organization has estimated that the health of almost half of the world's children is threatened by exposure to ETS. The studies in Turkey indicates an higher level of exposure. 100% smoke-free environments is the only effective strategy to reduce exposure to tobacco smoke. An effective ETS control can be achieved only by comprehensive legislation. For infants and children, the home is often the most important site for ETS exposure. Community based programs including public education and clinical interventions are needed to support to families in providing 100% smoke-free homes.
1. World Health Organization. Tobacco Free Initiative. Protection from exposure to second-hand tobacco smoke. Policy recommendations. Ulaşım tarihi: 12.01.2008, http://www.who.int/tobacco/en/
2. Okoli CTC, Kelly T, Hahn EJ. Secondhand smoke and nicotine exposure: a brief review. Addict Behav 2007; 32: 1977-88.
3. Thomson G, Wilson N, Howden-Chapman PJ. Population level policy options for increasing the prevalence of smokefree homes. Epidemiol Community Health 2006; 60; 298-304.
4. US Environmental Protection Agency. Smoke-free Homes and Cars Program. Ulaşım tarihi: 20.04.2008, http://www.epa.gov/smokefree/healtheffects.html
5. World Health Organization Regional Office for Europe. Environmental Tobacco Smoke Air Quality Guidelines – 2nd ed. Copenhagen, Denmark: WHO; 2000. Ulaşım tarihi:12.01.2008,http://www.euro.who.int/document/aiq/ 8_1ets.pdf
6. Schick S, Glantz S. Philip Morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke. Tob Control. 2005; 14 (6): 396-404.
7. Kalinic N, Skender L, Karacic V et al. Passive exposure to tobacco smoke: Hair nicotine levels in preschool children. Bull Environ Contam Toxicol 2003; 71(1): 1−5.
8. Al-Delaimy W, Fraser T, Woodward A. Nicotine in hair of bar and restaurant workers. N Z Med J 2001; 114: 80−3.
9. Dimich-Ward H, Gee H, Brauer M et al. Analysis of nicotine and cotinine in the hair of hospitality workers exposed to environmental tobacco smoke. J Occup Environ Med 1997; 39: 946−8.
10. Halterman JS, Fagnano M, Conn KM et al.. Barriers to reducing ETS in the homes of inner-city children with asthma. J Asthma 2007; 44 (2): 83-8.
11. Navas-Acien A et al. Secondhand Tobacco Smoke in Public places in Latin America, 2002-2003. JAMA 2004; 291: 2741-5.
12. Centers for Disease Control and Prevention. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA. 2006. Ulaşım tarihi: 12.01.2008,
13. Ashley MJ, Ferrence R. Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies. Tob Control 1998; 7: 61-5.
14. World Health Organisation. Tobacco free initiative consultation report: international consultation on environmental tobacco smoke (ETS) and child health. Geneva, Switzerland: WHO; 1999.
15. Physicians for a Smoke-Free Canada. Highlight sheet No.1. Smoking in Canadian homes: Are children at risk? 1999. Ulaşım tarihi: 12.01.2008. [http://www.smokefree.ca/eng_home/news_press_jun99.htm].
16. Jarvis M, Goddard E, Higgins V et al. Children’s exposure to passive smoking in England since the 1980s: Cotinine evidence from population surveys. BMJ 2002; 321: 343-5.
17. Halterman JS, Fagnano M, Conn KM, Szilagyi PG. Do parents of urban children with persistent asthma ban smoking in their homes and cars? Ambul Pediatr 2006; 6: 115-9.
18. McMillen RC, Winickoff JP, Klein JD et al. US adult attitudes and practices regarding smoking restrictions and child exposure to environmental tobacco smoke: changes in the social climate from 2000-2001. Pediatrics 2003; 112: e55-e60.
19. Berg CJ, Cox S, Nazir N et al. Correlates of home smoking restrictions among rural smokers. Nicotine Tob Res 2006; 8 (3): 353-60.
20. The GTSS Collaborative Group. A cross country comparison of exposure to secondhand smoke among youth. Tobacco Global Youth tobacco Survey. Tob Control 2006; 15 (Suppl III): ii4-ii9
21. Ekerbicer HC, Celik M, Guler E et al. Evaluating environmental tobacco smoke exposure in a group of Turkish primary school students and developing intervention methods for prevention. BMC Public Health 2007; 7: 202.
22. Boyacı H, Etiler N, Duman C et al. Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures. Pediatr Int 2006; 48: 382–9.
23. California Environmental Protection Agency. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant, SRP Approved Version. Executive Summary. Apendix III, 24 june 2005. Ulaşım tarihi, 12.01.2008,
24. Sasco AJ, Secretan MB, Straif K Tobacco smoking and cancer: a brief review of recent epidemiological evidence. Lung Cancer 2004; 45 (Suppl 2): S3-9.
25. Lesmes GR, Donofrio KH. Passive smoking: The medical and economic issues. Am J Med 1992; 93(1A): 38-42.
26. Action on Smoking and Health. Passive smoking: A summary of the evidence ASH UK. 2004. Ulaşım tarihi, 17.07.2008, http://www.ash.org.uk.
27. Rees VC, Connolly GN. Measuring air quaility to protect children from secondhand smoke in cars. Am J Prev Med 2006; 31: 363-8.
28. Willer S, Skarping G, Dalene M. et al. Urinary cotinine in children and adults during and after semiexperimental exposure to environmental tobacco smoke. Arch Environ Health 1995; 50: 130-8.
29. Stoddard JJ, Miller T. Impact of parental smoking on the prevalence of wheezing respiratory illness in children. Am J Epidemiol 1995; 141(2): 96-102.
30. Corbo GM, Agabiti N, Forastiere F et al. Lung function in children and adolescents with occasional exposure to environmental tobacco smoke. Am J Respir Crit Care Med 1996; 154(3): 695-700.
31. Gergen PJ, Fowler JA, Maurer KR et al. The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: third national health and nutrition examination survey, 1998 to 1994. Pediatrics 1998; 101(2): E8.
32. DiFranza JR, Lew RA. Morbidity and mortality in children associated with the use of tobacco products by other people. Pediatrics 1996; 97: 560-8.
33. Skorge TD, Eagan TM, Eide GE et al. The adult incidence of asthma and respiratorty symptoms by passive smoking in uterus or in childhood. Am J Respir Critical Care Med 2005; 172: 61-6.
34. Gürkan F, Kıral A, Dağlı E et al. The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis. Eur J Epidemiol 2000; 16: 465-8.
35. Adair-Bischoff CE, Sauve RS. Environmental tobacco smoke, parental atopy and childhood asthma. Environ Health Perspect 2001; 109: 579-82.
36. United States Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Washington, DC: Environmental Protection Agency; 1992. Ulaşım tarihi, 12.01.2008. http://www.epa.gov/ncea/ets/pdfs/acknowl.pdf
37. Weitzman M, Byrd R, Aligne A et al. The effects of tobacco exposure on children’s behavioral and cognitive functioning: implications for clinical and public health policy and future research. Neurotoxicol and Teratol 2001; 24: 397-406.
38. Batstra L, Hadders-Algra M, Neeleman J. Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in childhood: prospective evidence from a Dutch birth cohort. Early Hum Dev 2003; 75(1–2): 21–33.
39. Wagner J et al. Environmental tobacco smoke leakage from smoking rooms. J Occup Environ Hyg 2004; 1 (29): 110-118.
40. Pion M, Givel MS. Airport smoking rooms dosn’t work. Tob Control 2004; 13: i37.
41. Johansson AK, Hermansson G, Ludvigsson J. How should parents protect their children from environmental tobacco-smoke exposure in the home? Pediatrics 2004; 113(4): 291-5.
42. Pizacani B, Martin D, Stark M et al. Household smoking bans: which households have them and do they work? Prev Med 2003; (36): 99–107.
43. Robinson J, Kirkcaldy AJ. Disadvantaged mothers, young children and smoking in the home: Mothers’ use of space within their homes. Health & Place 2007;13(4):894-903.
44. Bakoula CG, Kafritsa YJ, Kavadias GD et al. Factors modifying exposure to environmental tobacco smoke in children (Athens, Greece). Cancer Causes Control 1997; 8: 73– 6.
45. Wakefield M, Banham D, Martin J et al. Restrictions on Smoking at Home and Urinary Cotinine Levels Among Children with Asthma. Am J Prev Med 2000; 19(3):188–192
46. Blackburn C. Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey. BMJ 2003; 327: 257.
47. Semple S, Creely KS, Naji A et al. Secondhand smoke levels in Scottish pubs: the effect of the smoke-free legislation. Tob Control 2007; 16: 127-32.
48. Pickett M, Schober SE, Brody DJ et al. Smoke-free laws and secondhand smoke exposure in US non-smoking adults, 1999-2002. Tob Control 2006; 15: 302-304.
49. Allwright S, Paul G, Greiner B et al. Legislation for smoke-free workplaces and health of bar workers in Ireland: before and after study. BMJ 2005; 331: 1117.
50. Ellingsen DG, Fladseth G, Daae HL et al. Airborne exposure and biological monitoring of bar and restaurant workers before and after the introduction of a smoking ban. J Environ Monit 2006; 8 (3): 362-8.
51. Eagan T, Hetland J, Aaro LE. Decline in respiratory symptoms in service workers five months after a public smoking ban. Tob Control 2006; 15: 242-6.
52. CDC. Morbidity and Mortality Weekly Report. 2004; 53 (44):1038-1041.
53. Akhtar PC, Currie D, Currie CE et al. Changes in child exposure to environmental tobacco smoke (CHEST) study after implementation of smoke-free legislation in Scotland: national cross sectional survey. BMJ 2005; 335: 545.
54. Heironismus J. Impact of workplace restrictions on consumption and incidence. Tobacco Documents Online. Ulaşım tarihi, 17.07.2008, http://tobaccodocuments.org/landman/2023914280-4284.html.
55. Proctor RN. Commentary: Schairer and Schöniger’s forgotten tobacco epidemiology and the Nazi quest for racial purity. Int J Epidemiol 2001; 30; 31-34.
56. American Nonsmokers’ Right Foundation. How many smokefree laws? Ulaşım tarihi, 17.07.2008, http://www.no-smoke.org/pdf/mediaordlist.pdf
57. Wikipedia, the free encylopedia. Smoking ban. Ulaşım tarihi, 01.08.2008, http://en.wikipedia.org/wiki/Smoking_ban
58. TBMM: Tütün Mamullerinin Zararlarının Önlenmesine Dair Kanunda Değişiklik Yapılması Hakkında Kanun. Ulaşım tarihi, 17.07.2008, http://www.tbmm.gov.tr/kanunlar/k5727.html
59. Fitzpatrick L. Can Asia Kick the Habit? Time. February 28, 2005. Ulaşım tarihi, 01.08.2008, http://www.time.com/time/magazine/article/0,9171,1032 420-2,00.html
60. Hiilamo H. Tobacco industry strategy to undermine tobacco control in Finland. Tob Control 2003; 12: 414– 23.
61. Carter SM, Chapman S. Smoking, disease, and obdurate denial: the Australian tobacco industry in the 1980s. Tob Control 2003; 12 (suppl III): iii23-iii30.
62. British American Tobacco Türkiye. Ulaşım tarihi, 01.08.2008, http://www.bat.com.tr/OneWeb/sites/BAT_6N6FYR.nsf/v wPagesWebLive/C125713A004170F680256BF4000331 93?opendocument&DTC=&SID=
63. Enstrom JE, Kabat GC. Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98. BMJ 2003; 17: 326 (7398): 1057.
64. Bakırcı N. Sigara tröstlerinin Yeni oyunu; “Pasif içicilik Öldürmüyor!”. Sted 2003; 12 (5): 172-3.
65. Encyclopedia of Public Health. Precede-Proceed Model. Wachsberger K, editor. Ulaışm tarihi, 17.07.2008. http://www.enotes.com/public-health-encyclopedia/precede-proceed-model
66. Robinson J, Kirkcaldy AJ. You think that I’m smoking and they’re not’: Why mothers still smoke in the home. Soc Sci Med 2007; 65: 641-52.