Passiv chekish - Passive smoking

"Ikkinchi qo'l tutun" bu erga yo'naltiradi. Sublime albomi uchun qarang Ikkinchi qo'l tutun.

Tamaki tutuni an Irlandiyalik pab oldin chekishni taqiqlash 2004 yil 29 martda kuchga kirdi

Passiv chekish deb nomlangan tutunning nafas olishidir chekish (SHS), yoki atrof-muhit tamaki tutuni (ETS), mo'ljallangan "faol" chekuvchidan boshqa shaxslar tomonidan. Bu tamaki tutuni atrof muhitga kirib, shu atrofdagi odamlar tomonidan uning nafas olishiga sabab bo'lganda paydo bo'ladi. Tamaki tamaki tutuniga ta'sir qilish sabablari kasallik, nogironlik va o'lim.[1][2] Tamaki tutunning sog'liq uchun xavfliligi masalasidir ilmiy konsensus.[3][4][5] Ushbu xatarlar asosiy turtki bo'ldi tutunsiz qonunlar ish joylarida va yopiq jamoat joylarida, shu jumladan restoranlar, panjaralar va tungi klublar, shuningdek, ba'zi ochiq jamoat joylari.[6]

Tamaki mahsulotlarining zarari va tartibga solinishi to'g'risida bahslarda chekuvchi tutun atrofidagi xavotirlar asosiy rol o'ynadi. 1970-yillarning boshidan beri tamaki sanoati jamoat tamaki chekishidan xavotirni uning biznes manfaatlariga jiddiy tahdid sifatida ko'rib chiqdi.[7] Yaqin atrofdagi odamlarga zarar etkazish tamaki mahsulotlarini qat'iy tartibga solish uchun turtki sifatida qabul qilingan. 80-yillarning o'zidayoq chekuvchi sigaretaning zarari to'g'risida soha xabardor bo'lishiga qaramay, tamaki sanoati o'z mahsulotlarini tartibga solishni to'xtatish maqsadida ilmiy bahslarni muvofiqlashtirdi.[3]:1242[5]

Effektlar

Tamaki tutun kabi ko'plab kasalliklarni keltirib chiqaradi to'g'ridan-to'g'ri chekish, shu jumladan yurak-qon tomir kasalliklari, o'pka saratoni va nafas olish yo'llari kasalliklari.[1][2][8] Ushbu kasalliklarga quyidagilar kiradi:

  • Saraton:
    • Umumiy: umumiy o'sish xavfi;[9] butun dunyo bo'ylab to'plangan dalillarni ko'rib chiqish, Xalqaro saraton tadqiqotlari agentligi 2004 yilda "Majburiy bo'lmagan chekish (tamaki yoki" ekologik "tamaki tutuniga ta'sir qilish) odamlar uchun kanserogen hisoblanadi" degan xulosaga keldi.[2]
    • O'pka saratoni: passiv chekish o'pka saratoni uchun xavf omilidir.[10][11] Qo'shma Shtatlarda passiv tutun yiliga chekuvchilar orasida o'pka saratonidan 7000 dan ortiq o'limga olib keladi.[12]
    • Ko'krak bezi saratoni: The Kaliforniya atrof-muhitni muhofaza qilish agentligi 2005 yilda passiv chekish yosh, birinchi navbatda menopozdan oldin ayollarda ko'krak bezi saratoni xavfini 70% ga oshiradi degan xulosaga keldi.[8] va AQSh Bosh jarroh dalillar "taxminiy" degan xulosaga keldi, ammo baribir bunday sababiy munosabatlarni tasdiqlash uchun etarli emas.[1] Aksincha, Xalqaro saraton tadqiqotlari agentligi 2004 yilda "hech qachon chekmaydiganlarda tamaki tutuni va ko'krak bezi saratoniga beixtiyor ta'sir qilish o'rtasidagi sababiy munosabatni qo'llab-quvvatlamaydi" degan xulosaga keldi.[2] 2015 yilda o'tkazilgan meta-tahlillar shuni ko'rsatdiki, passiv chekishni ko'krak bezi saratoni xavfini o'rtacha darajada oshirganligi "bir necha yil avvalgiga qaraganda ancha muhim" bo'lgan.[13]
    • Pankreatik saraton: 2012 yilgi meta-tahlil passiv chekishni me'da osti bezi saratoni xavfini oshirishi bilan bog'liqligini isbotlamadi.[14]
    • Serviks saratoni: 2015 yildagi muntazam tekshiruvlarga umumiy nuqtai nazardan, chekilgan tutunga ta'sir qilish bachadon bo'yni saratoni xavfini oshirdi.[15]
    • Quviq saratoni: 2016 yildagi tizimli tekshiruv va meta-tahlil shuni ko'rsatdiki, tutunni tashqi tomondan iste'mol qilish siydik pufagi saratoni xavfini sezilarli darajada oshirishi bilan bog'liq.[16]
  • Qon aylanish tizimi: xavf yurak kasalligi,[17][18] yurak urish tezligi o'zgaruvchanligini pasayishi.[19]
    • Epidemiologik tadqiqotlar shuni ko'rsatdiki, faol va passiv sigareta chekish ateroskleroz xavfini oshiradi.[20]
    • Passiv chekish qon tomir xavfi bilan kuchli bog'liq va bu xavf past darajadagi ta'sir qilishda nomutanosib ravishda yuqori bo'ladi.[21]
  • O'pka bilan bog'liq muammolar:
    • Xavf Astma.[22]
    • Xavf surunkali obstruktiv o'pka kasalligi (KOAH)[23]
    • 2015 yilgi sharhga ko'ra passiv chekish xavfini oshirishi mumkin sil kasalligi yuqtirish va kasallikning rivojlanishini tezlashtirish, ammo dalillar zaif bo'lib qolmoqda.[24]
    • Chekish bilan tutun ta'sir qilish o'rtasidagi bog'liqlik bo'yicha tadqiqotlarning aksariyati sinusit ikkalasi o'rtasida muhim birlashma topdilar.[25]
  • Kognitiv buzilish va dementia: Tamaki tutunga ta'sir qilish 50 va undan katta yoshdagi odamlarda kognitiv buzilish va demans xavfini oshirishi mumkin.[26] Tamaki tutunga duchor bo'lgan bolalar, ochiq bo'lmagan bolalar bilan taqqoslaganda, so'z boyligi va fikr yuritish qobiliyatini pasaytiradi, shuningdek, umumiy bilim va intellektual nuqsonlarga ega.[27]
  • Ruhiy salomatlik: Tamaki tutunga ta'sir qilish depressiv alomatlar xavfi ortishi bilan bog'liq.[28]
  • Davomida homiladorlik:
    • Tug'ilishning past vazni[8], B qismi, ch. 3.[29]
    • Erta tug'ilish[8], B qismi, ch. 3[30] (Shuni e'tiborga olingki, nedensel aloqaning dalillari AQSh bosh jarrohi 2006 yilgi hisobotida faqat "taklif" sifatida tavsiflanadi.[31]) Chekishni cheklovchi qonunlar erta tug'ilishni kamaytiradi.[32]
    • Tug'ilish va tug'ma nuqsonlar bolalarda[33]
    • Yaqinda o'tkazilgan atrof-muhit tamaki tutuniga duchor bo'lgan ayollarni va ochiq bo'lmagan ayollarni taqqoslash bo'yicha o'tkazilgan tadqiqotlar shuni ko'rsatadiki, homilador bo'lgan ayollarda tug'ma anomaliyalar, uzunroq uzunliklar, bosh atrofi kichikroq va vazni past bo'lgan bolani tug'ish xavfi yuqori.[34]
  • Umumiy:
    • Astma, allergiya va boshqa holatlarning yomonlashishi.[35] 2014 yilgi tizimli tahlil va meta-tahlil passiv chekishni bolalar va o'spirinlar orasida allergik kasalliklar xavfi biroz oshganligi bilan bog'liqligini aniqladi; assotsiatsiyaning dalillari kattalar uchun kuchsizroq edi.[36]
    • 2-toifa diabet.[37][38][39] Passiv chekish va diabet o'rtasidagi bog'liqlik nedenselmi yoki yo'qmi noma'lum bo'lib qolmoqda.[40]
  • Tashish xavfi Neisseria meningitidis yoki Streptokokk pnevmoniyasi.[15]
  • Mumkin bo'lgan xavf periodontit.[41]
  • Ikkala kattalarda ham o'lim xavfi oshib bormoqda, bu erda yiliga 53,000 sigaret chekuvchilarni o'ldirishi taxmin qilinmoqda, bu esa uni etakchi uchinchi sababga aylantiradi oldini olish mumkin bo'lgan o'lim AQShda,[42][43] va bolalarda.[44] Butunjahon sog'liqni saqlash tashkiloti passiv chekish yiliga 600 mingga yaqin odamning o'limiga va kasallikning global yukining taxminan 1 foiziga sabab bo'lishini ta'kidlamoqda.[45] 2017 yilga kelib passiv chekish yiliga 900 mingga yaqin odamning o'limiga sabab bo'ladi, bu chekish oqibatida o'limning 1/8 qismiga to'g'ri keladi.[46]
  • Teri holatlari: 2016 yilgi muntazam tekshiruv va meta-tahlil passiv chekishni yuqori darajaga bog'liqligini aniqladi atopik dermatit.[47]

Bolalar uchun xavf

  • To'satdan chaqaloq o'lim sindromi (SIDS).[48] 2006 yilgi hisobotida AQSh general jarrohi shunday xulosaga keldi: "Ikkinchi tutunga ta'sir qilish va go'dakning to'satdan o'lishi sindromi o'rtasidagi sababiy bog'liqlikni aniqlash uchun dalillar etarli".[49] Ikkilamchi chekish har yili Qo'shma Shtatlarda 430 SIDS o'limi bilan bog'liq deb taxmin qilinmoqda.[50]
  • Astma.[51][52][53] Tamaki tutuniga ta'sir qilish, shuningdek, astma bilan kasallangan bolalar orasida astmaning kuchayishi sababli kasalxonaga yotqizilish xavfi deyarli ikki baravar ko'paygan.[54]
  • O'pka infektsiyalari,[55][56][57] bilan, shuningdek, og'irroq kasallik bronxiolit[58] va bronxit,[59] va yomonroq natija,[58] shuningdek, tashuvchiga ta'sir qilsa, sil kasalligini rivojlanish xavfi ortadi.[60] Qo'shma Shtatlarda, ikkinchi darajali tutun chaqaloqlar va 18 oygacha bo'lgan bolalarda pastki nafas yo'llarining 150,000 dan 300,000 gacha infektsiyalari bilan bog'liq bo'lib, natijada har yili 7500 dan 15000 gacha kasalxonaga yotqiziladi.[50]
  • Nafas olish funktsiyasi buzilgan va o'pka o'sishi sekinlashgan[59]
  • Allergiya[61]
  • Onaning passiv chekishi sindromli bo'lmagan xavfni oshiradi orofakal yoriqlar ularning farzandlari orasida 50% ga.[62]
  • Prenatal va bolalik davridagi passiv tutunga ta'sir qilish xavfini oshirmaydi yallig'lanishli ichak kasalligi.[63]
  • O'qishdagi qiyinchiliklar, rivojlanishning sustligi, ijro funktsiyasi muammolar,[64] va neyroxavioral ta'sir.[65][66] Hayvonlarning modellari nikotin va uchun rolni taklif qiladi uglerod oksidi neyrokognitiv muammolarda.[57]
  • Ortishi tish chirishi (shuningdek, tegishli tuprik biomarkerlar ) bolalarda passiv chekish bilan bog'liq bo'lgan.[67]
  • Xavfining oshishi o'rta quloq infektsiyalari.[57][68][69]
  • Invaziv meningokokk kasalligi.[15][70]
  • Homiladorlik paytida onaning tutun bilan tutunni yuqtirish xavfi ortishi bilan bog'liq asab naychasining nuqsonlari.[71]
  • Homila tushishi: 2014 yilgi meta-tahlil natijalariga ko'ra onaning tutunidan tutun tushishi tushish xavfini 11 foizga oshirgan.[72]
  • Anesteziya asoratlar va ba'zi bir salbiy jarrohlik natijalar.[73]
  • Uyqu buzilishi bilan nafas olish: Ko'pgina tadkikotlar bolalarda passiv chekish va uyquni buzilishi bilan nafas olish o'rtasida muhim bog'liqlikni aniqladilar, ammo ushbu assotsiatsiyani sabab bo'lganligini aniqlash uchun qo'shimcha tadqiqotlar o'tkazish kerak.[74]
  • Bolalarning yurak-qon tomir tizimiga salbiy ta'sir.[75]

Dalillar

2010 yilda AQShda yoshi, irqi va qashshoqlik darajasi bo'yicha chekuvchi tutunga ta'sir qilish

Epidemiologik tadkikotlar shuni ko'rsatadiki, chekuvchi chekuvchilar chekadiganlar chekish to'g'ridan-to'g'ri chekish bilan bog'liq ko'plab sog'liq muammolari uchun xavf ostida.

1992 yilda qayta ko'rib chiqilgan ma'lumotlarga ko'ra, yiliga 35-40 ming kishining o'limiga ikkinchi darajali tutun ta'sir qiladi Qo'shma Shtatlar 1980-yillarning boshlarida.[76] The xavfning mutlaq o'sishi ETS tufayli yurak xastaligi 2,2% ni tashkil etdi tegishli xavf foizlari 23% ni tashkil etdi. 1997 yildagi meta-tahlillar shuni ko'rsatdiki, tutunning ikkinchi darajali ta'siri yurak xastaligi xavfini to'rtdan biriga oshirgan[77] va 1999 yildagi ikkita meta-tahlil shu kabi xulosalarga keldi.[78][79]

Dalillar shuni ko'rsatadiki, ikkinchi darajali tutunning asosiy tarkibiy qismi bo'lgan nafas olish yo'lidagi tutun asosiy tutunga qaraganda to'rt baravar ko'proq zaharli hisoblanadi. Bu fakt tamaki sanoatiga 1980 yildan beri ma'lum bo'lgan, garchi u o'z xulosalarini sir tutgan bo'lsa ham.[80][81][82][83] Ba'zi olimlar passiv chekish xavfi, xususan rivojlanish xavfi mavjud deb hisoblashadi yurak tomirlari kasalliklari, sezilarli darajada baholanmagan bo'lishi mumkin.[84]

1997 yilda tutunni tutun bilan o'pka saratoni o'rtasidagi o'zaro bog'liqlik bo'yicha meta-tahlil natijasida bunday ta'sir o'pka saratoniga sabab bo'lgan degan xulosaga keldi. Xavfning o'sishi chekuvchi bilan birga yashaydigan chekmaydiganlar orasida 24% ni tashkil etgan.[85] 2000 yilda Kopas va Shi ushbu meta-tahlilga kiritilgan tadqiqotlarda nashrga moyillikning aniq dalillari mavjudligini xabar berishdi. Bundan tashqari, ular nashr etilgan noaniqliklarni tuzatgandan so'ng va barcha tadqiqotlarning 40% nashr etilmagan deb taxmin qilgandan so'ng, ushbu xavf 24% dan 15% gacha kamaygan degan xulosaga kelishdi.[86] Ushbu xulosa, barcha tadqiqotlarning 40% nashr etilmagan degan taxmin "haddan tashqari" degan fikrga asoslanib e'tiroz bildirildi.[2]:1269 2006 yilda Takagi va boshq. nashr etilgan nashrlarning xolisligini hisobga olgan holda ushbu meta-tahlil ma'lumotlarini qayta tahlil qildi va ikkinchi darajali tutunga duchor bo'lganlar orasida o'pka saratonining nisbiy xavfi 1,19 ga teng, deb taxmin qildi.[87] 2000 yilgi meta-tahlil natijasida a nisbiy xavf Sigareta chekadigan erkaklar orasida o'pka saratoni uchun 1,48, ishda unga duchor bo'lganlar uchun nisbatan 1,16 xavf.[88] Boshqa bir meta-tahlil keyingi yili er chekadigan sigareta bilan turmush o'rtog'i bo'lgan ayollarda o'pka saratoni xavfi yuqori bo'lganligini tasdiqladi. Xotin-qizlar tomonidan chekilgan tutunga duchor bo'lgan ayollar uchun o'pka saratonining nisbiy xavfi 1,29 ni aniqladi.[89] 2014 yilgi meta-tahlilda "chekilgan tutunga ta'sir qilish va o'pka saratoni xavfi o'rtasidagi bog'liqlik yaxshi yo'lga qo'yilganligi" ta'kidlangan.[90]

Epidemiologlarning ozchilik qismi faol nafas olayotgan tutundan ko'ra ko'proq suyultirilgan ikkinchi darajali tutunning qanday ta'sir qilishi mumkinligini tushunishga qiynalishdi, bu faol chekuvchilar orasida yurak tomirlari kasalligi xavfining katta qismini tashkil etadi.[91][92] Tavsiya etilgan tushuntirishlardan biri shundan iboratki, ikkinchi darajali tutun - bu oddiy "tutun" tutunining suyultirilgan versiyasi emas, balki umumiy zarracha moddasining grammiga ko'proq toksik moddalar bo'lgan boshqa tarkibga ega.[91] Passiv chekish yurak-qon tomir kasalliklarining (aterotromboz) o'tkir namoyon bo'lishini tezlashtirishi mumkin, shuningdek o'tkir koronar sindrom bilan og'rigan bemorlarning natijalariga salbiy ta'sir ko'rsatishi mumkin.[93]

2004 yilda, Xalqaro saraton tadqiqotlari agentligi Ning (IARC) ning Jahon Sog'liqni saqlash tashkiloti (JSST) tamaki chekish va saraton bilan bog'liq barcha muhim e'lon qilingan dalillarni ko'rib chiqdi. Xulosa:

Ushbu meta-tahlillar shuni ko'rsatadiki, chekuvchilarning turmush o'rtog'ida o'pka saratoni xavfi bilan chekuvchi turmush o'rtog'ining ikkinchi qo'l tamaki tutuniga ta'sir qilish o'rtasida statistik jihatdan muhim va izchil bog'liqlik mavjud. Haddan tashqari xavf ayollar uchun 20% va erkaklar uchun 30% darajasida bo'lib, ba'zi potentsial tarafkashlik va aralashuv manbalarini tekshirgandan so'ng saqlanib qoladi.[2]

Keyingi meta-tahlillar ushbu topilmalarni tasdiqladi.[94][95]

Avstraliyaning Milliy Nafas Kengashi, chekilgan tutun, ayniqsa, yosh bolalar atrofidagi binolarni ifloslantiruvchi eng muhim omil ekanligini ko'rsatadigan tadqiqotlarga asoslanib:[96]

  • Har qanday ota-onadan, ayniqsa onadan chekish, bolalarda astma xavfini oshiradi.
  • Sigaret chekadigan uy xo'jaliklarida erta yoshdagi astma istiqbollari unchalik qulay emas.
  • Uyda chekishga chalingan astma bilan kasallangan bolalar odatda og'irroq kasallikka ega.
  • Astma bilan og'rigan ko'plab kattalar ETSni ularning alomatlarini qo'zg'atuvchi omil deb bilishadi.
  • Vrach tashxisi qo'yilgan astma ETSga chalingan sigaret chekmaydigan kattalar orasida tez-tez uchraydi. Nafasga chalingan odamlar orasida yuqori ETS ta'sir qilish og'ir hujumlarning katta xavfiga bog'liq.

Yilda Frantsiya, ikkinchi darajali tutunga ta'sir qilish 3000 gacha bo'lganligi taxmin qilinmoqda[97] va yiliga 5000 bevaqt o'lim, bu esa bosh vazir tomonidan keltirilgan katta ko'rsatkich bilan Dominik de Villepin u butun mamlakat bo'ylab tutunsiz qonunni e'lon qilish paytida: "Bu kuniga 13 dan ortiq o'limni keltirib chiqaradi. Bu bizning mamlakatimizda aholi salomatligi nuqtai nazaridan qabul qilinishi mumkin bo'lmagan haqiqatdir."[98]

Tutunsiz qonunchilik yurak xastaligi bilan kasalxonaga yotqizish sonini kamaytirayotgani to'g'risida yaxshi kuzatuv dalillari mavjud.[99][100]

Ta'sir qilish darajasi va xavf darajasi

The Xalqaro saraton tadqiqotlari agentligi ning Jahon Sog'liqni saqlash tashkiloti 2004 yilda chekilgan tutun odamlarda saraton kasalligini keltirib chiqarganligi to'g'risida etarli dalillar mavjud degan xulosaga keldi.[2] Tutun tartibga solinmagan muhitda ishlaydiganlar yuqori xavf ostida.[101][102] Ayniqsa, ta'sir qilish xavfi ostida bo'lgan ishchilarga montajni ta'mirlash va texnik xizmat ko'rsatish, qurish va qazib olish va tashish bilan shug'ullanadiganlar kiradi.[103]

Ko'p tadqiqotlar chekuvchi bilan turmush qurgan chekuvchilarni tadqiq qilishdan olingan. The AQShning umumiy jarrohi, 2006 yilgi hisobotida chekishga ruxsat berilgan joyda yashash yoki ishlash chekuvchilarning yurak xastaligi rivojlanish xavfini 25-30% ga va o'pka saratonini 20-30% ga oshirishini taxmin qilgan.[104]. Ba'zi qarama-qarshi tadqiqotlar ko'rib chiqiladi Omadsiz ish tashlash: xususiy sog'liqni saqlash va chekish fani, huquqi va siyosati [105].

Xuddi shunday, atrof-muhit tamaki tutuniga duchor bo'lgan bolalar ham turli xil salbiy ta'sirlarga ega ekanliklari ko'rsatilgan[106][107][108] va keyinchalik hayotda chekuvchiga aylanish xavfi yuqori.[109] The JSSV atrof-muhit tamaki tutuniga ta'sirini kamaytirishni bolaning sog'lom rivojlanishini rag'batlantirish bo'yicha harakatlarning asosiy elementi sifatida aniqladi.[110]

AQSh Kasalliklarni nazorat qilish va oldini olish markazlari sarumni o'lchash orqali atrof-muhit tamaki tutuniga ta'sir qilish darajasi va tendentsiyalarini nazorat qiladi kotinin milliy sog'liqda so'rovnomalar.[111] The tarqalishi AQSh chekmaydiganlar orasida chekuvchi tutunga ta'sir qilish 1988 yildagi 87,5% dan 2014 yilda 25,2% gacha kamaydi. Ammo, deyarli yarmi qora tanlilar va kambag'allar 2014 yilda fosh qilindi.

Atrof-muhit tamaki tutunini kamaytirish bo'yicha tadbirlar

Tizimli ko'rib chiqishda chekishni nazorat qilish dasturlari va ularning bolalardagi tutun ta'siriga ta'siri solishtirildi. Ko'rib chiqishda jamoatchilikka asoslangan, kasal bolalar va sog'lom bolalar sharoitlari va eng keng tarqalgan aralashuv turlari klinik tashriflar paytida maslahat yoki qisqacha maslahat ajratilgan. Ko'rib chiqishda biron bir aralashuv uchun yuqori natijalar topilmadi va mualliflar kattalar tomonidan olingan dalillar bolalarga yaxshi ta'sir qilmasligi mumkinligidan ogohlantirmoqda.[112]

Biomarkerlar

Ekshalatsiyalangan nafas namunasining uglerod oksidi kontsentratsiyasini (ppm bilan) ko'rsatadigan nafas olish CO monitorini quyida ko'rsatilgan karboksihemoglobinning tegishli foizli konsentratsiyasi.

Atrofdagi tamaki tutuni to'g'ridan-to'g'ri havoda topilgan tamaki tutunini ifloslantiruvchi moddalarni o'lchash yoki ta'sirlanishning bilvosita o'lchovi bo'lgan biomarkerlar yordamida baholanishi mumkin. Uglerod oksidi nafas bilan kuzatiladi, nikotin, kotinin, tiosiyanatlar va oqsillar tamaki tutuniga ta'sir qilishning eng o'ziga xos biologik belgilaridir.[113][114] Biyokimyasal testlar, tutunga ta'sir qilishning tadqiqotlarga qaraganda ancha ishonchli biomarkeridir. Odamlarning ayrim guruhlari chekish holatini va tamaki tutuniga ta'sir qilishni, ayniqsa homilador ayollar va yosh bolalarning ota-onalarini oshkor qilishni istamaydilar. Bu ularning chekishi ijtimoiy jihatdan nomaqbul ekanligi bilan bog'liq. Shuningdek, odamlarga tamaki tutuniga duchor bo'lganligini eslash qiyin bo'lishi mumkin.[115]

2007 yilda o'tkazilgan tadqiqot Qo'shadi xulq-atvori Jurnal jabrdiyda tamaki tutuniga ta'sir qilish va organizmdagi nikotin va / yoki nikotinning biomarkerlari kontsentratsiyasi o'rtasida ijobiy bog'liqlikni aniqladi. Boshqa tomondan tutun ta'sirida nikotinning muhim biologik darajasi faol chekishdagi nikotin darajasiga va nikotin iste'moli tufayli xatti-harakatlarning o'zgarishi bilan bog'liq darajaga teng edi.[116]

Kotinin

Kotinin, nikotin metabolitlari, tutun ta'sirida biomarker hisoblanadi. Odatda kotinin qon, tupurik va siydikda o'lchanadi. Sochni tahlil qilish yaqinda yangi, invaziv bo'lmagan o'lchov texnikasiga aylandi. Kotinin soch o'sishi paytida sochlarda to'planib qoladi, natijada tamaki tutuniga uzoq muddatli, kümülatif ta'sir ko'rsatiladi.[117] Siydikdagi kotinin darajasi tamaki ta'sirining ishonchli biomarkeri bo'lgan va ko'plab epidemiologik tadqiqotlarda mos yozuvlar sifatida ishlatilgan.[112] Shu bilan birga, siydikda topilgan kotinin miqdori ta'sirni faqat oldingi 48 soat ichida aks ettiradi. Soch va tirnoq kabi terining kotinin darajasi oldingi uch oyda tamaki ta'sirini aks ettiradi va yanada ishonchli biomarker hisoblanadi.[113]

Uglerod oksidi (CO)

Uglerod oksidi nafas olish yo'li bilan kuzatiladi shuningdek, chekishni chekish va tamaki iste'mol qilishning ishonchli biomarkeri. Yuqori sezuvchanlik va o'ziga xoslik bilan u nafaqat aniq o'lchovni ta'minlaydi, balki sinov ham invaziv emas, juda takrorlanadigan va arzon narxga ega. Nafas olish CO-ning monitoringi ekshalatsiyadagi CO kontsentratsiyasini o'lchaydi millionga qismlar va bu qonning CO konsentratsiyasi bilan bevosita bog'liq bo'lishi mumkin (karboksigemoglobin ).[118] Nafas olish CO monitorlari shoshilinch xizmat tomonidan CO zaharlanishiga shubha qilingan bemorlarni aniqlash uchun ham ishlatilishi mumkin.

Patofiziologiya

2004 yilgi tadqiqot Xalqaro saraton tadqiqotlari agentligi ning Jahon Sog'liqni saqlash tashkiloti chekmaydiganlar faol chekuvchilar bilan bir xil kanserogen moddalarga duchor bo'lishadi degan xulosaga kelishdi. Ikkinchi oqim tutuni tarkibida 4000 dan ortiq kimyoviy moddalar, shu jumladan 69 taniqli kanserogen moddalar mavjud. Alohida tashvish tug'diradi ko'p yadroli aromatik uglevodorodlar, tamakiga xos N-nitrosaminlar va aromatik aminlar, kabi 4-aminobifenil, barchasi yuqori darajada kanserogen ekanligi ma'lum. Asosiy tutun, chekka tutun va ikkinchi darajali tutun asosan bir xil tarkibiy qismlarni o'z ichiga oladi, ammo tutun turiga qarab konsentratsiyasi o'zgaradi.[2] Bir nechta yaxshi tashkil etilgan kanserogenlar tamaki kompaniyalari tomonidan olib borilgan izlanishlar, asosiy tutunga qaraganda chekka tutun tarkibida yuqori konsentratsiyalarda ekanligini ko'rsatdi.[119]

Sekondand tutuni bo'sh emissiyaga qaraganda ko'proq zarrachalar (PM) ifloslanishini keltirib chiqarishi isbotlangan dizel dvigatel. Italiya milliy saraton instituti tomonidan o'tkazilgan eksperimentda uchta sigaret qoldi tutun, bir-birining ortidan, cheklangan havo almashinuvi bo'lgan 60 m³ garajda. Sigaretalar tashqi muhit chegaralaridan yuqori PM ifloslanishini va bo'sh turgan dvigatelning 10 baravarigacha bo'lgan konsentratsiyasini keltirib chiqardi.[120]

Tamaki tamaki tutuniga ta'sir qilish qon va qon tomirlariga darhol ta'sir qiladi va shu bilan yurak xuruji xavfini oshiradi, ayniqsa xavf ostida bo'lgan odamlarda.[121] Tamaki tutuniga 30 daqiqa ta'sir qilish sog'lom chekmaydiganlarda koronar oqim tezligining zaxirasini sezilarli darajada kamaytiradi.[122] Ikkilamchi tutun buzilishi bilan ham bog'liq vazodilatatsiya kattalar chekmaydiganlar orasida.[123] Tamaki tutun ta'siriga ham ta'sir qiladi trombotsit funktsiyasi, qon tomirlari endoteliy, va ish joyida tez-tez uchraydigan darajalarda miyokard mashqlar tolerantligi.[124]

O'pka amfizemasi kalamushlarda 45 kun davomida yonboshdagi tamaki tutuniga (kuniga 30 ta sigareta) ta'sir qilish orqali chaqirilishi mumkin.[125] Degranulyatsiya mast hujayralari o'pkaning shikastlanishiga hissa qo'shishi ham kuzatilgan.[126]

Atama "uchinchi qo'l tutun "yaqinda tamaki tutuni o'chirilgandan va qolgan tutun havodan tozalanganidan keyin qolgan qoldiq tamaki tutunining ifloslanishini aniqlash uchun ishlab chiqilgan.[127][128][129] Dastlabki tadqiqotlar shuni ko'rsatadiki, uchinchi qo'l tutunning yon mahsulotlari sog'liq uchun xavf tug'dirishi mumkin,[130]xavf darajasi, agar mavjud bo'lsa, noma'lum bo'lib qolmoqda. 2011 yil oktyabr oyida Kristus-Sent-Frensis Kabrini nomidagi kasalxonada joylashganligi haqida xabar berilgan edi Iskandariya, Luiziana 2012 yil iyulidan boshlab uchinchi qo'l tutunni yo'q qilishga intiladi va kiyimlari tutun hidi bo'lgan xodimlarning ishlashiga yo'l qo'yilmaydi. Ushbu taqiq, uchinchi qo'l tutun chaqaloqlar va kichik bolalarning rivojlanayotgan miyasi uchun alohida xavf tug'dirgani sababli qabul qilingan.[131]

2008 yilda Qo'shma Shtatlarda o'pka saratoniga sabab bo'lgan 161 mingdan ortiq o'lim qayd etildi. Ushbu o'limlarning taxminiy 10% dan 15% gacha birinchi chekishdan boshqa omillar sabab bo'lgan; har yili 16000 dan 24000 gacha o'limga teng. Sigaret chekmaydiganlarda o'pka saratoniga chalingan o'limning yarmidan ko'prog'ini birinchi chekishdan boshqa omillar sabab bo'lgan. Chekmaydigan odamlarda o'pka saratoni Qo'shma Shtatlardagi eng keng tarqalgan saraton o'limlaridan biri hisoblanadi. O'pka saratonining klinik epidemiologiyasi chekuvchi odamlarda o'pka saratoni bilan chambarchas bog'liq bo'lgan birlamchi omillarni o'zga tamaki tutuni, radon, shu jumladan kanserogen moddalar va boshqa uy ichidagi havoni ifloslantiruvchi moddalar ta'siriga bog'laydi.[132]

Sog'liqni saqlash organlarining fikri

U erda keng tarqalgan ilmiy konsensus ikkinchi darajali tutunga ta'sir qilish zararli.[3] Passiv chekish va sog'liq uchun xavf o'rtasidagi bog'liqlikni har qanday yirik tibbiy va ilmiy tashkilot qabul qiladi, shu jumladan:

Jamoatchilik fikri

AQSh tomonidan o'tkazilgan so'nggi yirik tadqiqotlar Milliy saraton instituti va Kasalliklarni nazorat qilish markazlari chekish zararli ekanligi haqida keng jamoatchilik xabardorligini topdilar. 1992 va 2000 yillarda o'tkazilgan so'rovlarda respondentlarning 80% dan ortig'i chekish zararli ekanligi haqidagi bayonotga qo'shilishdi. 2001 yilda o'tkazilgan bir tadqiqot shuni ko'rsatdiki, kattalarning 95 foizi chekish bolalarga zararli ekanligiga qo'shilishgan va 96 foizi tamaki ishlab chiqaruvchilarning ikkinchi darajali chekish zararli emasligini da'vo qilishgan.[144]

2007 yil Gallup so'rovi respondentlarning 56 foizi chekish "juda zararli", deb hisoblashgan, bu raqam 1997 yildan beri nisbatan barqaror bo'lib kelgan. Boshqa 29% esa chekish "biroz zararli", deb hisoblashadi; 10% "juda zararli emas", 5% "zararli emas" deb javob bergan.[145]

Zarar haqida tortishuv

Chekishni qattiqroq tartibga solishni oldini olish yoki uni kechiktirishga urinish doirasida tamaki sanoati bir qator ilmiy tadqiqotlarni moliyalashtirdi va natijalar chekish bilan bog'liq bo'lgan xavf-xatarlarga shubha tug'dirgan holda, ushbu natijalar uchun keng reklama qilindi. Sanoat, shuningdek, libertarian va konservativ tahlil markazlarini, masalan Kato instituti Qo'shma Shtatlarda va Jamiyat bilan aloqalar instituti passiv chekish bo'yicha ilmiy tadqiqotlarni va chekishni cheklash bo'yicha siyosiy takliflarni tanqid qilgan Avstraliyada.[146][147] Yangi olim va Evropa sog'liqni saqlash jurnali ushbu soha miqyosidagi muvofiqlashtirilgan faoliyatni eng dastlabki ifodalaridan biri sifatida aniqladilar korporativ inkor etish. Bundan tashqari, ular tamaki sanoati tomonidan tarqatilgan dezinformatsiya a tamaki rad etish harakati, boshqa shakllarining ko'plab xususiyatlarini baham ko'rish inkor etish, kabi OIV-OITSni rad etish.[148][149]

Sanoat tomonidan moliyalashtirilgan tadqiqotlar va tanqidlar

Enstrom va Kabat

2003 yilgi tadqiqot Jeyms Enstrom va Jefri Kabat, nashr etilgan British Medical Journal, passiv chekishning zarari oshirib yuborilganligini ta'kidladi.[150] Ularning tahlillari passiv chekish va o'pka saratoni, yurak tomirlari kasalligi (CHD) yoki surunkali obstruktiv o'pka kasalligi ammo, ilova qilingan tahririyatda "ular o'zlarining topilmalarining salbiy xususiyatlarini ta'kidlashlari mumkin" deb ta'kidlashgan.[151] Ushbu maqola tamaki sanoati tomonidan passiv chekishning zarari isbotlanmaganligining isboti sifatida keng targ'ib qilindi.[152][153] The Amerika saraton kasalligi jamiyati Ma'lumotlar bazasi Enstrom va Kabat o'z ma'lumotlarini yig'ishda foydalangan (ACS) ushbu maqolani "ishonchli ham emas, mustaqil ham emas" deb tanqid qilib, ACS olimlari nashrdan oldin Enstrom va Kabat uslubiyatidagi jiddiy kamchiliklarni bir necha bor ta'kidlaganligini ta'kidladilar.[154] Ta'kidlash joizki, tadqiqotda "ta'sirlanmagan" odamlarning taqqoslash guruhi aniqlanmadi.[155]

Enstromning tamaki sanoati bilan aloqalari ham diqqatni tortdi; ga 1997 yilgi xatda Filipp Morris, Enstrom "katta miqdordagi epidemiologik ma'lumotlar va ETSning sog'lig'iga ta'siri va faol chekish to'g'risida allaqachon mavjud bo'lgan fikrlarga qarshi samarali kurashishim uchun ..." tadqiqotni talab qildi.[156] A Tamaki ishlab chiqaradigan kompaniyalarga qarshi AQSh reketlari bo'yicha sud jarayoni, Enstrom va Kabat gazetalari AQSh okrug sudi tomonidan "tamaki kompaniyalari tamaki tutunining xavfini yashirish uchun jinoiy reket va firibgarlik bilan shug'ullanganligining eng yaxshi namunasi" sifatida keltirilgan.[157] Sud, tadqiqot tomonidan moliyalashtirilgan va boshqarilganligini aniqladi Yopiq havo tadqiqot markazi,[158] tamaki sanoati oldingi guruh passiv chekishga oid zararli tadqiqotlarni "ofset" qilish vazifasi, shuningdek, Filipp Morris tomonidan Enstromning ishi "aniq sud jarayonlariga yo'naltirilgan" deb ta'kidlagan.[159] 2005 yilgi qog'oz Tamaki nazorati "Enstrom" va "Kabat BMJ" qog'ozlaridagi ma'lumotlarning oshkor etilishi, garchi jurnal talablariga javob beradigan bo'lsa-da, "mualliflarning tamaki sanoati bilan aloqalarining to'liq hajmini ochib bermaydi", deb ta'kidladi.[160]

2006 yilda Enstrom va Kabat tomonidan nashr etilgan meta-tahlil Passiv chekish va yurak tomirlari kasalligi bilan bog'liq tadqiqotlar, unda passiv chekish va yurak kasalliklari o'limi o'rtasidagi juda zaif bog'liqlik haqida xabar berilgan.[161] Ular ikkinchi darajali tutunga ta'sir qilish CHDdan o'lish xavfini atigi 5 foizga oshirgan degan xulosaga kelishdi, garchi ushbu tahlil sanoat tomonidan moliyalashtirilgan ikkita ekspluatatsiya keng tarqalgan noto'g'ri tasnifidan aziyat chekkan tadqiqotlarni o'z ichiga olganligi uchun tanqid qilingan.[5]

Gori

Gio Batta Gori, tamaki sanoatining vakili va maslahatchisi[162][163][164] va yozishicha, xavf-xatarlardan foydalanish va ilmiy tadqiqotlar bo'yicha mutaxassis ozodlik Kato instituti jurnal Tartibga solish bu "... chop etilgan 75 ETS va o'pka saratoni tadqiqotlarining 70 foizga yaqini xavfning statistik jihatdan ahamiyatli farqlari haqida xabar bermagan va ahamiyatsiz. 17 foizga yaqini xavfni talab qilmoqda va 13 foizi xavfni kamaytirishni nazarda tutadi."[165]

Milloy

Stiven Milloy, "keraksiz ilm "uchun sharhlovchi Fox News va avvalgi Filipp Morris maslahatchi,[166][167] "passiv chekish bo'yicha o'tkazilgan" 19 ta tadqiqotning "atigi 8 dan ortig'i 42 foizdan ko'proq - yurak xastaligi bilan kasallanish statistik jihatdan sezilarli darajada oshgani haqida xabar berdi.”[168]

Milloy keltirgan tanqidning yana bir tarkibiy qismiga e'tibor qaratildi nisbiy xavf va passiv chekishni o'rganishdagi epidemiologik amaliyot. Jons Xopkins nomidagi gigiena va jamoat salomatligi maktabida magistr darajasiga ega bo'lgan Milloy nisbiy xavf tug'diradigan tadqiqotlar 2 dan kam ma'nosiz axlat fanidir, deb ta'kidladi. Epidemiologik tahlilga ushbu yondashuv tanqid qilindi Amerika sog'liqni saqlash jurnali:

Sanoat xurujining asosiy tarkibiy qismi bu ko'pgina individual tekshiruvlar natijasida to'liq javob bera olmaydigan "tovushli fan" uchun "bar" tashkil etish kampaniyasining kuchayishi bo'lib, mezonlarga javob bermaydigan tadqiqotlar "axlat fanlari" . "[169]

Tamaki sanoati va unga aloqador olimlar, shuningdek, chekilgan tutun va o'pka saratoni o'rtasidagi aloqani yashirishga amaliy ta'sir ko'rsatadigan "Yaxshi epidemiologiya amaliyotlari" to'plamini taklif qildilar; ushbu standartlarning xususiy bayon qilingan maqsadi "salbiy qonunchilikka to'sqinlik qilish" edi.[170] Biroq, biron bir mustaqil epidemiologiya tashkiloti Filipp Morris va boshqalar tomonidan taklif qilingan standartlarga rozi bo'lmasligi aniq bo'lganida, bu harakatlar asosan tark etildi.[171]

Levois va Layard

1995 yilda Levuis va Layard ikkala tamaki sanoatining maslahatchilari jurnalda ikkita tahlilni nashr etishdi Normativ toksikologiya va farmakologiya chekish va yurak xastaligi bilan turmush o'rtog'i ta'sir qilish o'rtasidagi bog'liqlik haqida. Ushbu ikkala hujjatda ham chekish va yurak xastaligi o'rtasida hech qanday bog'liqlik yo'qligi haqida xabar berilgan.[172][173] Ushbu tahlillar chekuvchilarni hozirgi va sobiq chekuvchilarni farqlay olmaganligi uchun tanqid qilindi, garchi avvalgi chekuvchilar, hozirgi sigaretlardan farqli o'laroq, yurak xastaligi xavfini sezilarli darajada oshirmasalar ham.[5][174]

Jahon sog'liqni saqlash tashkiloti bahslari

Tomonidan 1998 yilda o'tkazilgan tadqiqot Xalqaro saraton tadqiqotlari agentligi (IARC) atrof-muhit tamaki tutuniga (ETS) "a ning zaif dalillarini topdi doza va javob munosabatlari o'pka saratoni xavfi bilan turmush o'rtog'i va ish joyidagi ETSga ta'sir qilish o'rtasida. "[175]

1998 yil mart oyida, tadqiqot nashr etilishidan oldin, ommaviy axborot vositalarida IARC va Jahon Sog'liqni saqlash tashkiloti (JSST) ma'lumotni bostirmoqda. Britaniyada paydo bo'lgan hisobotlar Sunday Telegraph[176] va Iqtisodchi,[177] boshqa manbalar qatorida,[178][179][180] JSST go'yoki passiv chekish va boshqa bir qator kasalliklar (xususan o'pka saratoni) o'rtasidagi bog'liqlikni isbotlay olmaganligi to'g'risida o'z hisobotini nashr etishdan saqlagan deb da'vo qildi.

Bunga javoban JSST press-relizni e'lon qildi va natijada tadqiqot natijalari ommabop matbuotda "to'liq noto'g'ri" berilganligi va aslida passiv chekishning zararli ekanligini ko'rsatadigan shunga o'xshash tadqiqotlar bilan juda mos kelganligi haqida xabar berdi.[181] Tadqiqot nashr etilgan Milliy saraton instituti jurnali o'sha yilning oktyabr oyida va mualliflar "bolalarning ETSga chalinganligi va o'pka saratoni xavfi o'rtasida bog'liqlik yo'qligini" aniqladilar, ammo "o'pka saratoni xavfi va turmush o'rtog'i va ish joyidagi ETS ta'sirining dozasi-javob munosabatlarining zaif dalillarini topdilar. "[175] Ilova qilingan tahririyat sarhisob qilingan:

Jurnalning ushbu sonida keltirilgan barcha muhim dalillar, shu jumladan muhim yangi ma'lumotlar baholanganda, muqarrar ilmiy xulosa shuki, ETS o'pkaning past darajadagi kanserogenidir.[182]

Ilgari tamaki sanoati hujjatlari chiqarilishi bilan Tamaki bo'yicha asosiy kelishuv shartnomasi, topildi (Elisa Ong tomonidan va Stanton Glantz ) JSST ma'lumotlarini bostirish to'g'risidagi bahs-munozaralar ishlab chiqilganligi Filipp Morris, British American Tobacco va boshqa tamaki kompaniyalari o'zlarining biznes manfaatlariga zarar etkazadigan ilmiy topilmalarni obro'sizlantirish maqsadida.[183] Jahon sog'liqni saqlash tashkilotining tamaki sanoati hujjatlari e'lon qilingandan so'ng o'tkazilgan so'rovi shuni ko'rsatdiki, bu qarama-qarshilik tamaki sanoati tomonidan JSST byudjetini qisqartirish, passiv chekish bo'yicha ilmiy tadqiqotlar natijalarini buzish va obro'sizlantirish kampaniyasi doirasida yuzaga kelgan. JSST muassasa sifatida. Ushbu aksiya go'yoki mustaqil tarmoq yordamida amalga oshirildi oldingi tashkilotlar va sanoat bilan yashirin moliyaviy aloqalari bo'lgan xalqaro va ilmiy mutaxassislar.[184]

EPA sud jarayoni

1993 yilda Qo'shma Shtatlar atrof-muhitni muhofaza qilish agentligi (EPA) 3000 o'pka saratoni bilan bog'liq o'limlar haqida hisobot chiqardi Qo'shma Shtatlar har yili passiv chekish oqibatida kelib chiqqan.[185]

Filipp Morris, R.J. Reynolds tamaki kompaniyasi va tamaki ishlab chiqaruvchilari, tarqatuvchilari va sotuvchilari vakili bo'lgan guruhlar EPA ushbu tadqiqotni manipulyatsiya qilgan va qabul qilingan ilmiy va statistik amaliyotlarni e'tiborsiz qoldirgan deb da'vo qilib, qonuniy choralar ko'rdilar.

The Shimoliy Karolinaning O'rta okrugi uchun Amerika Qo'shma Shtatlari tuman sudi 1998 yilda tamaki sanoati foydasiga qaror qildi, EPA tegishli ilmiy va epidemiologiya amaliyotlariga rioya qilmaganligi va ular oldindan qabul qilgan xulosalarini tasdiqlovchi "gilos yig'ib olgan" dalillarni topdi.[186] Sud qisman shunday dedi: "EPA tadqiqot boshlangunga qadar ommaviy ravishda xulosa qilishga majbur bo'ldi ... Agentlikning jamoat xulosasini tasdiqlash uchun belgilangan tartib va ​​ilmiy me'yorlar o'rnatildi ... ETS xavfini baholashni o'tkazishda, e'tiborga olinmagan ma'lumotlar va selektiv ma'lumotlarga oid xulosalar; muhim epidemiologik ma'lumotlarni tarqatmaslik; Xatarlarni baholash bo'yicha ko'rsatmalardan chetga chiqish; muhim topilmalar va mulohazalarni oshkor qilmaslik ... "

2002 yilda EPA ushbu qarorga murojaat qildi To'rtinchi davra bo'yicha AQSh apellyatsiya sudi. EPAning apellyatsiya shikoyati dastlabki hisobotda ularning hisobotida me'yoriy vazn yo'qligi sababli qondirildi va oldingi topilma bo'shatildi.[187]

1998 yilda AQSh Sog'liqni saqlash va aholiga xizmat ko'rsatish vazirligi o'zlarining milliy toksikologiya dasturi tomonidan kanserogenlar to'g'risidagi 9-hisobotni e'lon qilish orqali atrof-muhit tamaki tutunini ma'lum kanserogenlar qatoriga kiritdi va EPA bahosiga rioya qilgan holda "individual tadqiqotlar diqqat bilan umumlashtirildi va baholandi. "[188]

Tamaki sanoati tadqiqotlarini moliyalashtirish

Tamaki sanoatining zararli tutunga qarshi ilmiy tadqiqotlarni moliyalashtirishdagi o'rni munozarali bo'lib kelgan.[189] Nashr etilgan tadqiqotlarni qayta ko'rib chiqishda, tamaki sanoatiga mansubligi chekuvchi tutunni oqlaydigan xulosalar bilan juda bog'liq bo'lganligi aniqlandi; tamaki sanoatiga aloqador tadqiqotchilar mustaqil tadqiqotchilardan 88 marta ko'proq chekish zararli emas degan xulosaga kelishgan.[190] Tamaki sanoati hujjatlari chiqarilishi bilan paydo bo'lgan ma'lum bir misolda Filipp Morris rahbarlari muallifni chekishni chekishdagi rolini kamaytirish uchun sanoat tomonidan moliyalashtirilgan obzor maqolasini qayta ko'rib chiqishga undashdi. to'satdan chaqaloq o'lim sindromi.[191] 2006 yilgi AQSh umumiy jarrohining ma'ruzasida tamaki sanoatining ilmiy munozaralardagi o'rni tanqid qilindi:

Sanoat xolisona deb topilgan tadqiqotlarni moliyalashtirdi yoki amalga oshirdi, olimlarni tadqiqot nashrlarini tanqid qilgan, tahririyatlarga maktublar yuborishda qo'llab-quvvatladi, asosiy tadqiqotlar natijalarini buzishga urinib ko'rdi, jurnal bilan ilmiy jamiyat yaratishda yordam berdi va harakat qildi. ilmiy jamoatchilik hamjihatlikka erishgan taqdirda ham tortishuvlarni davom ettirish.[192]

Ushbu strategiya 1988 yilda tamaki ishlab chiqaradigan kompaniyalarning xalqaro yig'ilishida bayon qilingan bo'lib, unda Filipp Morris "munozaralarni saqlab qolish uchun ETS bo'yicha ish olib borish" uchun kompaniya yuristlari tomonidan tashkil etilgan olimlar guruhini tuzishni taklif qildi.[193] Barcha ilmiy tadqiqotlar tamaki sanoati huquqshunoslari tomonidan nazorat va "filtrlash" dan o'tkazildi:

Philip Morris then expect the group of scientists to operate within the confines of decisions taken by PM scientists to determine the general direction of research, which apparently would then be 'filtered' by lawyers to eliminate areas of sensitivity.[193]

Philip Morris reported that it was putting "...vast amounts of funding into these projects... in attempting to coordinate and pay so many scientists on an international basis to keep the ETS controversy alive."[193]

Tobacco industry response

Measures to tackle secondhand smoke pose a serious economic threat to the tobacco industry, having broadened the definition of smoking beyond a personal habit to something with a social impact. In a confidential 1978 report, the tobacco industry described increasing public concerns about secondhand smoke as "the most dangerous development to the viability of the tobacco industry that has yet occurred."[194] Yilda United States of America v. Philip Morris et al., the District Court for the District of Columbia found that the tobacco industry "... recognized from the mid-1970s forward that the health effects of passive smoking posed a profound threat to industry viability and cigarette profits," and that the industry responded with "efforts to undermine and discredit the scientific consensus that ETS causes disease."[3]

Accordingly, the tobacco industry have developed several strategies to minimise the impact on their business:

  • The industry has sought to position the secondhand smoke debate as essentially concerned with civil liberties and smokers' rights rather than with health, by funding groups such as O'RMAN.[195]
  • Moliyalashtirish tarafkashligi in research;[7] in all reviews of the effects of secondhand smoke on health published between 1980 and 1995, the only factor associated with concluding that secondhand smoke is not harmful was whether an author was affiliated with the tobacco industry.[190] However, not all studies that failed to find evidence of harm were by industry-affiliated authors.
  • Delaying and discrediting legitimate research (see[7] for an example of how the industry attempted to discredit Takeshi Hirayama 's landmark study, and[196] for an example of how it attempted to delay and discredit a major Australian report on passive smoking)
  • Promoting "good epidemiology" and attacking so-called junk science (a term popularised by industry lobbyist Stiven Milloy ): attacking the methodology behind research showing health risks as flawed and attempting to promote sound science. Ong & Glantz (2001) cite an internal Phillip Morris memo giving evidence of this as company policy.[171]
  • Creation of outlets for favourable research. In 1989, the tobacco industry established the International Society of the Built Environment, which published the ekspertlar tomonidan ko'rib chiqilgan jurnal Ichki va ichki muhit. This journal did not require conflict-of-interest disclosures from its authors. With documents made available through the Master Settlement, it was found that the executive board of the society and the editorial board of the journal were dominated by paid tobacco-industry consultants. The journal published a large amount of material on passive smoking, much of which was "industry-positive".[197]

Citing the tobacco industry's production of biased research and efforts to undermine scientific findings, the 2006 U.S. Surgeon General's report concluded that the industry had "attempted to sustain controversy even as the scientific community reached consensus... industry documents indicate that the tobacco industry has engaged in widespread activities... that have gone beyond the bounds of accepted scientific practice."[198] The U.S. District Court, in U.S.A. v. Philip Morris et al., found that "...despite their internal acknowledgment of the hazards of secondhand smoke, Defendants have fraudulently denied that ETS causes disease."[199]

Position of major tobacco companies

The positions of major tobacco companies on the issue of secondhand smoke is somewhat varied. In general, tobacco companies have continued to focus on questioning the methodology of studies showing that secondhand smoke is harmful. Ba'zilar (masalan British American Tobacco va Filipp Morris ) acknowledge the medical consensus that secondhand smoke carries health risks, while others continue to assert that the evidence is inconclusive. Several tobacco companies advocate the creation of smoke-free areas within public buildings as an alternative to comprehensive smoke-free laws.[200]

Tamaki ishlab chiqaradigan kompaniyalarga qarshi AQSh reketlari bo'yicha sud jarayoni

On September 22, 1999, the AQSh Adliya vazirligi a reketchilik lawsuit against Philip Morris and other major cigarette manufacturers.[201] Almost 7 years later, on August 17, 2006 U.S. District Court Judge Gladys Kessler found that the Government had proven its case and that the tobacco company defendants had violated the Racketeer Influenced Corrupt Organizations Act (RICO).[3] In particular, Judge Kessler found that PM and other tobacco companies had:

  • conspired to minimize, distort and confuse the public about the health hazards of smoking;
  • publicly denied, while internally acknowledging, that secondhand tobacco smoke is harmful to nonsmokers, and
  • destroyed documents relevant to litigation.

The ruling found that tobacco companies undertook joint efforts to undermine and discredit the scientific consensus that secondhand smoke causes disease, notably by controlling research findings via paid consultants. The ruling also concluded that tobacco companies were fraudulently continuing to deny the health effects of ETS exposure.[3]

On May 22, 2009, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit unanimously upheld the lower court's 2006 ruling.[202][203][204]

Smoke-free laws

Shuningdek qarang: Chekishni taqiqlash, Chekish taqiqlari ro'yxati va Xususiy transport vositalarida chekishni taqiqlash

As a consequence of the health risks associated with secondhand smoke, smoke-free regulations in indoor public places, including restoranlar, kafelar va tungi klublar have been introduced in a number of jurisdictions, at national or local level, as well as some outdoor open areas.[205] Irlandiya was the first country in the world to institute a comprehensive national smoke-free law on smoking in all indoor workplaces on 29 March 2004. Since then, many others have followed suit. The countries which have ratified the Jahon sog'liqni saqlash tashkilotining Tamaki nazorati to'g'risidagi Asosiy Konvensiyasi (FCTC) have a legal obligation to implement samarali legislation "for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places." (Article 8 of the FCTC[206]) The parties to the FCTC have further adopted Guidelines on the Protection from Exposure to secondhand Smoke which state that "effective measures to provide protection from exposure to tobacco smoke ... require the total elimination of smoking and tobacco smoke in a particular space or environment in order to create a 100% smoke-free environment."[207]

Opinion polls have shown considerable support for smoke-free laws. In June 2007, a survey of 15 countries found 80% approval for smoke-free laws.[208] A survey in France, reputedly a nation of smokers, showed 70% support.[98]

Effektlar

Smoking bans by governments result in decreased harm from second hand smoke, including less admissions for acute coronary syndrome.[209] In the first 18 months after the town of Pueblo, Kolorado enacted a smoke-free law in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighbouring towns without smoke-free laws showed no change, and the decline in heart attacks in Pueblo was attributed to the resulting reduction in secondhand smoke exposure.[210] A 2004 smoking ban instituted in Massachusets shtati workplaces decreased workers' secondhand smoke exposure from 8% of workers in 2003 to 5.4% of workers in 2010.[103] A 2016 review also found that bans and policy changes in specific locations such as hospitals or universities can lead to reduced smoking rates. In prison settings bans might lead to reduced mortality and to lower exposure to passive smoking.[211]

In 2001, a systematic review for the Guide to Community Preventive Services acknowledged strong evidence of the effectiveness of smoke-free policies and restrictions in reducing expose to secondhand smoke. A follow up to this review, identified the evidence on which the effectiveness of smoking bans reduced the prevalence of tobacco use. Articles published until 2005, were examined to further support this evidence. The examined studies provided sufficient evidence that smoke-free policies reduce tobacco use among workers when implemented in worksites or by communities.[212]

While a number of studies funded by the tobacco industry have claimed a negative economic impact from smoke-free laws, no independently funded research has shown any such impact. A 2003 review reported that independently funded, methodologically sound research consistently found either no economic impact or a positive impact from smoke-free laws.[213]

Air nicotine levels were measured in Guatemalan bars and restaurants before and after an implemented smoke-free law in 2009. Nicotine concentrations significantly decreased in both the bars and restaurants measured. Also, the employees support for a smoke-free workplace substantially increased in the post-implementation survey compared to pre-implementation survey. The result of this smoke-free law provides a considerably more healthy work environment for the staff.[214]

Jamoatchilik fikri

Recent surveys taken by the Society for Research on Nicotine and Tobacco demonstrates supportive attitudes of the public, towards smoke-free policies in outdoor areas. A vast majority of the public supports restricting smoking in various outdoor settings. The respondents reasons for supporting the policies were for varying reasons such as, litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.[215]

Muqobil shakllar

Alternatives to smoke-free laws have also been proposed as a means of zararni kamaytirish, particularly in bars and restaurants. For example, critics of smoke-free laws cite studies suggesting ventilation as a means of reducing tobacco smoke pollutants and improving air quality.[216] Ventilation has also been heavily promoted by the tobacco industry as an alternative to outright bans, via a network of ostensibly independent experts with often undisclosed ties to the industry.[217] However, not all critics have connections to the industry.

The Amerika isitish, sovutish va konditsioner muhandislari jamiyati (ASHRAE) officially concluded in 2005 that while completely isolated smoking rooms do eliminate the risk to nearby non-smoking areas, smoking bans are the only means of completely eliminating health risks associated with indoor exposure. They further concluded that no system of dilution or cleaning was effective at eliminating risk.[218] The AQShning umumiy jarrohi va Evropa komissiyasining qo'shma tadqiqot markazi have reached similar conclusions.[198][219] The implementation guidelines for the Jahon sog'liqni saqlash tashkilotining Tamaki nazorati to'g'risidagi Asosiy Konvensiyasi states that engineering approaches, such as ventilation, are ineffective and do not protect against secondhand smoke exposure.[207] Biroq, bu shunday emas necessarily mean that such measures are useless in reducing harm, only that they fall short of the goal of reducing exposure completely to zero.

Others have suggested a system of tradable smoking pollution permits, ga o'xshash savdo-sotiq pollution permits systems used by the Atrof muhitni muhofaza qilish agentligi in recent decades to curb other types of pollution.[220] This would guarantee that a portion of bars/restaurants in a jurisdiction will be smoke-free, while leaving the decision to the market.

Hayvonlarda

Asosiy maqola: Animals and tobacco smoke

Multiple studies have been conducted to determine the carcinogenicity of environmental tobacco smoke to animals. These studies typically fall under the categories of simulated environmental tobacco smoke, administering condensates of chekka tutun, or observational studies of cancer among pets.

To simulate environmental tobacco smoke, scientists expose animals to sidestream smoke, that which emanates from the cigarette's burning cone and through its paper, or a combination of mainstream and sidestream smoke.[2] The IARC monographs conclude that mice with prolonged exposure to simulated environmental tobacco smoke, that is 6hrs a day, 5 days a week, for five months with a subsequent 4 month interval before dissection, will have significantly higher incidence and multiplicity of lung tumors than with control groups.

The IARC monographs concluded that sidestream smoke condensates had a significantly higher carcinogenic effect on mice than did mainstream smoke condensates.[2]

Kuzatuv tadqiqotlari

Secondhand smoke is popularly recognised as a risk factor for cancer in pets.[221] Tomonidan olib borilgan tadqiqot Tufts universiteti veterinariya tibbiyoti maktabi va Massachusets universiteti Amherst linked the occurrence of feline oral cancer to exposure to environmental tobacco smoke through an haddan tashqari ifoda ning p53 gen.[222] Another study conducted at the same universities concluded that cats living with a smoker were more likely to get feline lymphoma; the risk increased with the duration of exposure to secondhand smoke and the number of smokers in the household.[223] Tomonidan o'rganish Kolorado shtati universiteti researchers, looking at cases of canine lung cancer, was generally inconclusive, though the authors reported a weak relation for lung cancer in dogs exposed to environmental tobacco smoke. The number of smokers within the home, the number of packs smoked in the home per day, and the amount of time that the dog spent within the home had no effect on the dog's risk for lung cancer.[224]

Terminologiya

As of 2003, "secondhand smoke" was the term most used to refer to other people's smoke in the English-language media.[225] Other terms used include "environmental tobacco smoke", while "involuntary smoking" and "passive smoking" are used to refer to exposure to secondhand smoke.[226] The term "environmental tobacco smoke" can be traced back to a 1974 industry-sponsored meeting held in Bermuda, while the term "passive smoking" was first used in the title of a scientific paper in 1970.[225] The Amerika Qo'shma Shtatlarining umumiy jarrohi prefers to use the phrase "secondhand smoke" rather than "environmental tobacco smoke", stating that "The descriptor "secondhand" captures the involuntary nature of the exposure, while "environmental" does not."[1]:9 Most researchers consider the term "passive smoking" to be synonymous with "secondhand smoke".[227] In contrast, a 2011 commentary in Atrof muhitni muhofaza qilish istiqbollari argued that research into "thirdhand smoke" renders it inappropriate to refer to passive smoking with the term "secondhand smoke", which the authors stated constitutes a pars pro toto.[227]

Shuningdek qarang

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Tashqi havolalar

Ilmiy organlar
Tamaki sanoati
Boshqa havolalar