One of the major challenges to public smoking, which has also spurred anti-smoking legislation in many countries in recent years, has centered around secondhand smoke (SHS) — smoke arising from the end of a burning cigarette (sidestream smoke), combined with that being exhaled from the person smoking the cigarette (mainstream smoke) — that harms non-smokers.

India, for example, in compliance with the World Health Organization (WHO) Framework Convention on Tobacco Control, bans smoking in many public spaces — in healthcare, educational and government institutions, on public transport, and in auditoriums, stadiums, railway stations, bus stops and stands. In establishments such as airports, hotels or restaurants, a designated smoking area is established for smokers, so they don’t inflict secondhand smoke on non-smokers.

According to the Global Adult Tobacco Survey, however, Indian workplaces are not free of tobacco smoke yet — 30.2% Indian adults are exposed to secondhand smoke at their workplaces. In addition, 48.8% of Indian households are rife with tobacco smoke, with a greater prevalence in rural India. While India’s anti-smoking laws for the public good have been in response to a growing body of research that highlights the harms of passive smoking, their lax implementation signals the dangers of passive smoking have not been driven home yet.

According to the Cleveland Clinic, cigarette smoke contains 4,000 chemical compounds, 250 of which are toxic, and 50 of which are cancer-causing toxins. These linger in the air for four hours after a person has smoked in an area. Five minutes of exposure to these toxins in the air “stiffens the aorta as much as smoking a cigarette”; 20-30 minutes of exposure “causes excess blood clotting, as well as increases the buildup of fat deposits in blood vessels, increasing the risk of heart attack and stroke”; two hours of exposure “increases the chance of irregular heart beat (arrhythmia) and can trigger a fatal cardiac event or heart attack.”

Long-term passive smoking habits — cohabitating with a habitual smoker, for example — can cause lung cancer and other lung diseases such as emphysema, asthma and chronic bronchitis, according to the Cleveland Clinic — the risk of developing these through passive smoking increases by 20% to 30% by living with a smoker. Other ailments caused by secondhand smoke include heart disease, sinus, and respiratory infections. According to the American Cancer Society (ACS), passive smoking has also been linked to signs of depression in those routinely exposed to secondhand smoke.

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Young children, especially, are vulnerable to the physically detrimental health consequences of secondhand smoke, the ACS reports. “Most of their exposure to SHS comes from adults (parents or others) smoking at home,” which results in them getting sick more often, experiencing frequent lung infections, and being more prone to coughs and ear infections. Passive smoking can also cause asthma attacks and make asthma worse in children, according to the ACS.

“Some of these problems might seem small, but they can add up quickly. Think of the expenses, doctor visits, medicines, lost school time, and often lost work time for the parent who must stay home with a sick child. And this doesn’t include the discomforts that the child goes through,” according to the ACS.

Secondhand smoke can also increase risks of Sudden Infant Death Syndrome (SIDS) — an unexpected death of an infant in their first year of life, according to the Centres for Disease Control and Prevention (CDC). Not only are infants exposed to secondhand smoke at greater risk for SIDS, their brain activity and subsequent breathing levels are also affected by passive smoking.

In order to protect non-smokers from secondhand smoke, the CDC recommends not to smoke in or near home, inside cars, or in public areas. As for how to protect smokers, well, that’s a whole different ballgame — one the Indian government seems to be losing.