Environmental tobacco smoke: health policy and focus on Italian legislation.

Worldwide tobacco smoking kills nearly 6 million people each year, including more than 600,000 non-smokers who die from smoke exposure. Environmental tobacco smoke (ETS, also called secondhand smoke, involuntary smoke, or passive smoke) is the combination of sidestream smoke, the smoke given off by a burning tobacco product and mainstream smoke, the smoke exhaled by smokers. People may be exposed to ETS in homes, cars, workplaces, and public places, such as bars, restaurants, and recreational settings. In addition, there is another type of smoke which until now has not been recognized: the so-called thirdhand smoke, that comes from the reaction of mainstream smoke and environmental nitrous acid (HNO2) making carcinogenic tobacco-specific nitrosamines (TSNAs). The effects of ETS on human health are well-known, passive smoking is harmful to those who breathe the toxins and it is a serious problem for public health. The smoking ban in Italy had reduced ETS pollution, as in the United States and in other countries all over the world. However, the implementation of comprehensive legislation on smoking policy will necessitate other tobacco control measures for its successful fulfillment: increased media awareness, telephone smoking cessation helplines and smoking cessation support services could be an opportunity to ensure awareness, comprehension and support to those who want to quit smoking. The effectiveness of legislative efforts will also depend on successful enforcement of smoking bans and compliance with the legislation. This review summarizes the evidences about the effect of ETS and provides an overview of smoke-free laws and policies.