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Sidestream smoke is smoke which goes into the air directly from a burning cigarette, cigar, or smoking pipe. Sidestream smoke is the main component (around 85%) of second-hand smoke (SHS), also known as Environmental Tobacco Smoke (ETS) or passive smoking. The relative quantity of chemical constituents of sidestream smoke are different from those of directly inhaled ("mainstream") smoke, although their chemical composition is similar. "This evidence is sufficient to conclude that involuntary smoking is a cause of lung cancer in never-smokers." Sidestream smoke has been classified as a Class A carcinogen by the U.S. Environmental Protection Agency.
Evidence has shown that sidestream smoke may be more harmful, per gram, than mainstream smoke. However, sidesmoke is inhaled in far lesser amounts than mainstream smoke in people who smoke tobacco.
The relative risk of cardiovascular disease is 1.2–1.3 with exposure to sidestream smoke due to the cyanide present in the smoke. There is also evidence that sidestream smoke causes negative effects in children, both behaviorally and cognitively. One study found that higher levels of cotinine in children were correlated with a decreased ability to perform in reading and math.
Factors such as age, gender and different occupations put a person at risk for bladder cancer - smoking is the only other known risk. 4-aminobiphenyl (4-ABP) is an integral component in tobacco smoke, as well as a risk factor for bladder cancer. Sidestream smoke puts individuals at an increased risk of bladder cancer because the 4-ABP concentrations are over ten times that of mainstream smoke."Health consequences of tobacco use among women." Women and Smoking. Centers for Disease Control and Prevention. Pg. 1-8.
The US Environmental Protection Agency estimates sidestream smoke causes approximately 3,000 lung cancer deaths and 62,000 deaths from heart disease in non-smokers every year in the United States.
Social effects
A non-smoker who is inhaling sidestream or second-hand smoke has a 30% greater risk of getting lung cancer at some point in their lives.American Cancer Society (2025). 9780944235690, American Cancer Society/Health Promotions. ISBN 9780944235690 Exposure to second hand or sidestream smoke has been associated with people who have not smoked before.
Children
A child's exposure to contaminants in the air can have detrimental health effects including heightened risk of respiratory tract infections, increased likelihood of childhood asthma, behavioural problems and reduced neurocognitive abilities. Exposure to mainstream and sidestream smoke in childhood poses an increased risk of coughing, wheezing, and mucus production. Studies on rats have shown that those who were exposed to sidestream smoke while in utero and following the period directly after, had differences in airway sensitivity in comparison to those that had been exposed to sidestream smoke only while in utero or only following the period after."Health consequences of tobacco use among women." Women and Smoking. Centers for Disease Control and Prevention. Pg 74-75.
Test tubes
A reduction in glutathione levels was observed following exposure to sidestream smoke in vitro. Glutathione is an antioxidant which resides in the lung after development. Exposure to sidestream smoke for as little as twenty minutes can lead to an increase in contaminant particles within human small airway epithelial cells (SAEC). Cells exposed to sidestream smoke experienced oxidative stress, which further allowed for DNA damage as well as cell transformation and an uncontrolled cell proliferation. Such DNA and uncontrolled cell division resulting from exposure to sidestream smoke may result in cancerous tumours.
Toxicological experiments
During the 1980s the Philip Morris Tobacco Company carried out research on sidestream smoke at the Institut für Biologische Forschung, although this was not voluntarily published. This study found that sidestream smoke is nearly four times more toxic than mainstream smoke per metric gramme. They also found that sidestream condensate was nearly three times more toxic than mainstream smoke as well as 2–6 times more tumourigenic per gram than mainstream condensate when applied to the skin of a mouse; results also showed that sidestream smoke hinders an animal's ability to reach a weight that is considered normal. The research team concluded that the only way to protect oneself from sidestream smoke was to be in smoke-free public places and workspaces.
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