also plays a role. In addition, behavioral studies in adolescent and young adult smokers have revealed an increased propensity for risk-taking, both generally and in the presence of peers, and neuroimaging studies have shown altered frontal neural activation during a risk-taking task as compared with nonsmokers. In 2011, Rubinstein and colleagues used neuroimaging to show decreased brain response to a natural reinforcer (pleasurable food cues) in adolescent light smokers (1–5 cigarettes per day), with their results highlighting the possibility of neural alterations consistent with nicotine dependence and altered brain response to reward even in adolescent low-level smokers. Second-hand smoke Second-hand smoke is a mixture of smoke from the burning end of a cigarette and the smoke exhaled from the lungs of smokers. It is involuntarily inhaled, lingers in the air for hours after cigarettes have been extinguished, and can cause a wide range of adverse health effects, including cancer, respiratory infections, and asthma. Nonsmokers who are exposed to second-hand smoke at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%. Second-hand smoke has been estimated to cause 38,000 deaths per year, of which 3,400 are deaths from lung cancer in nonsmokers. Sudden infant death syndrome, ear infections, respiratory infections, and asthma attacks can occur in children who are exposed to second-hand smoke. Scientific evidence shows that no level of exposure to second-hand smoke is safe. Legislation Smoking restrictions Many governments impose restrictions on smoking tobacco, especially in public areas. The primary justification has been the negative health effects of second-hand smoke. Laws vary by country and locality. Nearly all countries have laws restricting places where people can smoke in public, and over 40 countries have comprehensive smoke-free laws that prohibit smoking in virtually all public venues. Bhutan is currently the only country in the world to completely outlaw the cultivation, harvesting, production, and sale of tobacco and tobacco products under the Tobacco Control Act of Bhutan 2010. However, small allowances for personal possession are permitted as long as the possessors can prove that they have paid import duties. The Pitcairn Islands had previously banned the sale of cigarettes, but it now permits sales from a government-run store. The Pacific island of Niue hopes to become the next country to prohibit the sale of tobacco. Iceland is also proposing banning tobacco sales from shops, making it prescription-only and therefore dispensable only in pharmacies