Muhammad Mughees Zafar  ( King Edward Medical College, Lahore. )
Abdul Mueed Zafar  ( Aga Khan University, Karachi. )

Madam, Passive smoking is an enormous health problem all over the world causing a number of neoplastic, cardiovascular and respiratory diseases in the exposed individuals. Its adverse effects on children and foetus are also well-documented. Passive smoke is a mixture of carcinogens, irritants and toxins with no minimum safe level of exposure; 100% smoke free environment is the only way to prevent its hazards. Recognizing the scope of this problem, WHO has set 'smoke free environments' as the theme for 2007 World No Tobacco Day.¹
There is a dearth of literature explicating the extent of this problem in the local scenario. A study done in Karachi found only 22% of participants to be aware of the term 'passive smoking'.² Another study has demonstrated that about 88% of passengers commuting in air-conditioned coaches were being exposed to passive smoke.³It is commendable that legislation against passive smoking has been developed in Pakistan.¹ However literature indicates that, even in areas with comprehensive laws against passive smoking, a large proportion of non-smokers would consent to passive smoking out of 'common courtesy' whereas only a disturbing 5.5% would actively defy it.⁴ This suggests that if non-smokers do not actively proscribe passive smoking, mere legislation may not be effective.
Passive smoking inside homes is an area which may not be covered by legislation. Majority of smokers are adult males, with the children and women in the household being exposed passively.^1,2 An estimated one-half of world's children are exposed to passive smoke; mainly in their homes.¹ A preference to avoid passive smoking and a better awareness of its ill-effects among the household members have been implicated in the development of smoke free homes.⁵ This underlines the importance of this proportion of passive smokers, especially females, as key players to curtail the problem at hand. They should be encouraged to actively confront this assault on their health and the wellbeing of their family.

In our opinion, an attitude of active confrontation against passive smoking is pivotal to curb this problem in both public and private places. Collaborative efforts to develop such an attitude should be made by all stakeholders of the healthcare system. Educating and empowering non-smokers to actively exercise their 'right to smoke free environment' is the need of the hour. Tolerating passive smoking is not courtesy; it is criminal negligence.

 Muhammad Mughees Zafar¹, Abdul Mueed Zafar²
  King Edward Medical College¹, Lahore.
  Aga Khan University², Karachi.

1.  World Health Organization. Tobacco Free Initiative [Online] [cited 2007 Nov 8] Available from: URL: http://www.emro.who.int/TFI/tfi.htm 
2.  Nisar N, Qadri MH, Fatima K, Perveen S. A community based study about knowledge and practices regarding tobacco consumption and passive smoking in Gadap Town, Karachi. J Pak Med Assoc. 2007; 57:186-8.
3.  Mal R, Rizvi N, Rathi S. Prevalence of smokers among air-conditioned coaches, Pakistan. J Pak Med Assoc 2001; 51:405-6.
4.  Germain D, Wakefield M, Durkin S. Non-smokers' responses when smokers light up: A population-based study. Prev Med 2007; 45: 21-5.
5.  Gilpin EA, White MM, Farkas AJ, Pierce JP. Home smoking restrictions: which smokers have them and how they are associated with smoking behavior. Nicotine Tob Res 1999; 1:153-62.