This Issue

Making smoking history

Health experts warn against second-hand and now third-hand smoke

It’s better to never start
than stop

Q & A

Lung Cancer
A Deadly Transformation

Healthy Lungs
Smoker’s Lungs

The major purpose of the lungs is the exchange of gas. We breathe in oxygen from the air and breathe out carbon dioxide, a waste product. Oxygen is essential to the body; it provides the fuel our cells and organs require to function. The average adult takes 15 to 20 breaths a minute.

According to the U.S. Surgeon General, even occasional smoking causes immediate damage to the lungs. Inhaling a small amount of tobacco smoke can damage a person’s DNA, which can lead to cancer. Tobacco also destroys the tiny air sacs of the lungs, which results in emphysema.
While healthy lung tissue is pink in color, lungs with emphysema or cancer are black.

Take a deep breath

Lung Cancer
A Deadly Transformation

Signs and symptoms

Risk factors

Need help to kick the habit?


• Persistent cough

• Blood-streaked sputum

• Constant chest pain

• Repeated bouts of pneumonia or bronchitis

• Shortness of breath, wheezing
or hoarseness

• Fatigue

• Loss of weight or appetite for no known cause

  • Smoking
    Smoking is responsible for almost 90 percent of all cases of lung cancer.

  • Second-hand smoke
    The U.S. Surgeon General has concluded that there is no risk-free level of exposure to second-hand smoke.

  • Industrial and environmental exposure
    Exposure to certain substances, such as radon, a colorless gas often found in the home, asbestos and arsenic, may increase the risk, especially in smokers.

  • Personal or family history
    A person who has had lung cancer or has a parent or sibling with lung cancer may be at increased risk.

  • Radiation to the chest
    Radiation to the chest to treat other cancers may increase the incidence of lung cancer, especially in those who smoke.

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.

Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
Remember to call ahead to confirm
time and date
of screenings.

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Need help to kick the habit?

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Organization Method Availability Contact Information
Smokers’ Helpline
Telephone M-Th 9am–7pm
F 9am – 5pm
800 – 784-8669 Interactive website 24 hours 800-879-8678
QuitWorks Interactive website 24 hours
National Cancer Institute      
Smoking Quitline Telephone M-F 8am–8pm 877-44U-QUIT
LiveHelp Online Chat Instant messaging M-F 8am–11pm
Internet Interactive website M-F 8am–11pm
Boston Tobacco Prevention and Control Program Educational material M-F 9am–5pm 617-534-4718

Anatomy of nicotine addiction
Source Mayo Clinic

November 15, 2012 is the

Great American Smokeout

Health experts warn against second-hand and now third-hand smoke

Meena Carr (right) and Westlyn Bruno are members of a committee that was successful in making Washington-Beech, a public housing development in Roslindale, smoke-free. (Ernesto Arroyo Photo)
It took a while before 70-year-old Meena Carr figured out that her scratchy throat and persistent cough was attributable to her husband’s second-hand smoke. “You have a problem, but you live with it so long, you’re not aware of it,” she explained.

But it was the plight of her grandson who had asthma that triggered Carr to take action. “You wouldn’t understand until your child wakes you up in the middle of the night saying ‘I can’t breathe,’ ” she said.

The family never attributed his multiple visits to the emergency room to exposure to tobacco — especially since no one in the household smoked at the time.

But the neighbors did. That’s when Carr said she realized that closing the front door does not provide a protective barrier from another person’s smoke.

Carr, a non-smoker, did not sit idly by. She and a small group of residents decided that the new Washington-Beech Housing Development under construction in Roslindale would be smoke-free.

They solicited the assistance of the Committee for Boston Public Housing (CBPH) whose mission is to “improve the quality of life for Boston’s public housing residents.” The CBPH did a survey and discovered that buildings that had a higher rate of kids with asthma also had a higher number of smokers.

That was not unusual. According to a report cited by the Boston Public Health Commission, more than 23 percent of residents in Boston public housing had asthma compared to 15 percent of residents in non-public housing.

Armed with that information, the group began a campaign to educate the residents of the perils of smoking — not only for the smoker, but for innocent bystanders. Especially children.

Renee D. Boynton-Jarrett, M.D.
Boston Medical Center
The message was often directed to parents who tried to protect their children by smoking outside of their presence. “You have a baby and you smoke at work,” she explained. “When you come in from work and hold your baby close to you, your baby inhales the fumes. You’re the one who is causing the problem.”

The residents listened and responded. When a grant was given to build the new Washington Beech, more than 80 percent of the residents — even the smokers — agreed to make the complex a no-smoking residence.

That is also the goal of the Boston Public Health Commission. They are launching the Boston Smoke-Free Homes campaign and are asking property owners to register their apartments and rental homes as smoke-free ( Boston Mayor Thomas M. Menino took this pledge one step further and has made all developments in the Boston Housing Authority (BHA) smoke-free in 2012.

It is well known that second-hand smoke — the combination of the burning end of a tobacco product and the smoke breathed out by smokers — can cause heart disease and lung cancer in non-smokers. According to the Centers for Disease Control and Prevention (CDC), second-hand smoke causes roughly 46,000 premature deaths each year in this country from heart disease and another 3,400 from lung cancer.

There are many perks to going smoke-free. Cost is one. A report from the Boston Tobacco Prevention and Control Program indicated that apartment turnover costs can be two to seven times greater for a unit in which the resident smoked. Insurance rates are less and the risk of fire is reduced. Furthermore, in a city like Boston, where 85 percent of the residents are non-smokers, a smoke-free apartment or home is a prime attraction.

But it’s the health concerns that are primarily driving this resolution. The 2008 Behavioral Risk Factor Surveillance System, a survey sponsored by the CDC, determined that a higher percentage of public housing residents in Boston had asthma, high blood pressure and diabetes than the general population. Moreover, 25 percent smoked compared to 13 percent of non-public housing residents.

Unfortunately, smoke doesn’t have boundaries. Second-hand smoke seeps under doors and through shared ventilation systems. That is the finding of Dr. Jonathan P. Winicoff, a pediatrician at Massachusetts General Hospital.

He and his co-researchers measured cotinine, a chemical byproduct of nicotine exposure, in the blood of 5,000 children across the country that lived in apartments or attached homes. They found that 73 percent of the children tested positive for the chemical, the highest level being found in children who lived in large multi-unit buildings.

For your kids’ sake

Source: Centers for Disease Control and Prevention
The kicker is that none of these children lived with someone who smoked. Winickoff suggests that smoke may seep through walls or air ducts exposing children who live in neighboring units.

Dr. Renee D. Boynton-Jarrett, a pediatrician at Boston Medical Center, explained that her major concern is the health of the child, but that is so intertwined with the health of the caregiver, that she winds up more often with two, rather than one patient. Particularly when it comes to smoking.

“Children of smokers are more likely to smoke,” she explained. “They get a level of comfort around smoking. They adopt the same behavior [as their parents] and they initiate smoking early.”

Infants and toddlers pose a different kind of problem. They don’t smoke, but they are not exempt from its hazards if they live in a house of smokers.

In children it causes severe asthma attacks, respiratory and ear infections and sudden infant death syndrome.

“Parents are aware of the impact of smoke on children,” Boynton-Jarrett said. “Some might feel guilt about their habit.”

So essential is a smoke-free environment to the health of children that the hospital has introduced into the medical record a tool to screen for smoking around children. The purpose is to determine all environments the child might inhabit that could expose him or her to second-hand smoke that a parent might overlook. Often it is places you would least expect it — day care, for example or the grandmother’s house.

But even refraining from smoking around a child may not provide full protection. Winickoff is credited with coining the term “third-hand smoke” — a toxic combination of gases and particles that lingers long after smoking.

According to a recent report in Environmental Health Perspectives, third-hand smoke consists of residual pollutants from tobacco smoke that remain in dust and on surfaces. According to Winickoff, you don’t have to see the smoke, as you do in second-hand smoke. If you smell it, it’s there.

Not a game

Source: Boston Public Health Commission

The issue of third-hand smoke is a fairly new concept, but preliminary studies have shown that house dust in smokers’ homes and even the dashboards of cars were contaminated with nicotine.

More disturbing was that dust and surfaces of homes were contaminated even when smokers tried to limit exposure to smoke by turning on fans or opening windows. It was found that the remnants of smoking cling to pillows, carpets and upholstery. It even clings to toys. And that is the concern of Boynton-Jarrett. Infants and toddlers put things in their mouths.

Even smoking outdoors is not a solution — smoke clings to clothes, hair and skin. Boynton-Jarrett offers suggestions. “Wear a coat when you smoke outside to protect your clothing from the pollutants,” she said. “Wash your hands before you touch your kids.”

But one piece of advice prevails. “Try quitting,” she said.