Protecting the world from secondhand tobacco smoke exposure: where do we stand and where do we go from here?
BACKGROUND
Article 8 of the Framework Convention on Tobacco Control mandates all signatory countries to "protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places." Even though there has been great progress in the implementation of Article 8, still most of the world population remains exposed to secondhand smoke (SHS). In this article, we sought to summarize the research that supports Article 8, where do we stand, and current research gaps and future directions.


CONCLUSIONS
Secondhand smoke is an established cause of heart disease and several types of cancer. Additional research is needed to reach final conclusions for diseases where evidence is only suggestive of causality. The only solution to SHS exposure in public places is banning smoking indoors. Research on the gaming industry and nightclubs, particularly in developing countries, needs to be disseminated to support their inclusion in smoke-free laws. Aside from indoor bans, additional research is needed for outdoor and multiunit housing bans and in support of measures that protect children and other vulnerable populations. The impact of smoke-free laws on other health outcomes, besides heart disease and respiratory outcomes, is another area where further research is needed. Thirdhand smoke assessment and health effects are also likely to be a topic of further research. As new tobacco products emerge, evaluating SHS exposure and effects will be vital.


CONCLUSIONS
Furthering research in support of Article 8 can contribute to reach the final goal of protecting everyone from SHS exposure.
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA. barnoyaj@wudosis.wustl.edu
Joaquin
J
Barnoya
Ana
A
Navas-Acien
D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D003906:Developing Countries; D033161:Government Regulation; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D007391:International Cooperation; D011633:Public Facilities; D012106:Research; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence; D012907:Smoking / Q000009:adverse effects / Q000331:legislation & jurisprudence; D000074606:Smoking Prevention; D019460:Tobacco Industry / Q000331:legislation & jurisprudence; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D017132:Workplace / Q000331:legislation & jurisprudence*
D014028:Tobacco Smoke Pollution