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LITERATURE REVIEW Background on Smoking and Secondhand Smoke Secondhand smoke, also known as environmental tobacco smoke (ETS), is a complex chemical mixture emitted by a lit tobacco product or exhaled by a smoker. Secondhand smoke contains thousands of chemicals, including mare than 50 known cancer-causing agents and 200 known poisons. In 1992 the U.S. Environmental Protection Agency published a majar assessment of the respiratory health risks of exposure to secondhand smoke." Secondhand smoke is a human lung carcinogen, responsible for approximately 3,000 lung cancer deaths annually among U.S. nonsmokers.'g Secondhand smoke has been classified as a Group A carcinogen under EPA's carcinogen assessment guidelines (other carcinogens on this list are asbestos and radon). This classification is reserved for those compounds or mixtures that have been shown to cause cancer in humans, based on studies in human populations.18 Numerous authorities have determined that secondhand smoke is harmful to human health. These authorities include the U.S. Environmental Protection Agency, the World Health Organization, the American Medical Association, the American Lung Association, the American Cancer Association, the U.S. National Institute of Occupational Safety and Health, the National Academy of Sciences, the U.S. Occupational Safety and Health Administration, and the Office of the U.S. Surgeon General. Health Effects of Secondhand Smoke on Adults and Children There is no safe level of exposure to secondhand ama�€c. ' Scientific and medical literature has confirmed that exposure to secondhand smoke causes many illnesses in nonsmokers including: • cancer (lung, nasal sinus, and possibly ��}��r�� � heart �i�17" • asthma,2z and • low birth w'�i�h1.'' Infants and children are particularly vulnerable to secondhand smoke, which causes: • respiratory tract infections (chest colds, sinusitis, bronchitis, and Fn�urreuni��'� • asthma (including mare frequent exacerbations and mare severe �}'rnpt�m��"" • middle ear infections (often necessitating surgery to insert ear tubes) `'�" • decreased lung function (coughing, wheezing, increased mucus pr�du�ti�n�'a • and possibly adult cancers (leukemia, Iyrr�Frv�m��_' Secondhand smoke is also linked to sudden infant death syndrome (independent of birth weight and gestational a�c� "�` Health Effects of Secondhand Smoke on Employees and Customers A review of research on restaurant employees found that secondhand smoke is a significant occupational health hazard for food-service workers.' Hospitality employees working in settings with no restrictions on customer smoking are exposed to secondhand smoke on a regular basis at