Third-hand smoke

Humans can be exposed to THS through inhalation, skin contact, or ingestion. Many common surfaces can accumulate THS compounds, including furnishings, walls, flooring, and clothes. THS is thought to potentially cause more harm to infants and young children because younger children are more likely to put their hands in their mouths or be cuddled up to a smoker with toxins on their skin and clothes. Infants also crawl on the floor and eat from their hands without washing them first, ingesting the toxins into their still-developing systems.{{cite journal |doi=10.1289/ehp.1103500 |pmid=21628107 |pmc=3230406 |title=Thirdhand Tobacco Smoke: Emerging Evidence and Arguments for a Multidisciplinary Research Agenda |journal=Environmental Health Perspectives |volume=119 |issue=9 |pages=1218–26 |year=2011 |last1=Matt |first1=Georg E |last2=Quintana |first2=Penelope J. E |last3=Destaillats |first3=Hugo |last4=Gundel |first4=Lara A |last5=Sleiman |first5=Mohamad |last6=Singer |first6=Brett C |last7=Jacob |first7=Peyton |last8=Benowitz |first8=Neal |last9=Winickoff |first9=Jonathan P |last10=Rehan |first10=Virender |last11=Talbot |first11=Prue |last12=Schick |first12=Suzaynn |last13=Samet |first13=Jonathan |last14=Wang |first14=Yinsheng |last15=Hang |first15=Bo |last16=Martins-Green |first16=Manuela |last17=Pankow |first17=James F |last18=Hovell |first18=Melbourne F }}

According to a study conducted by Northrup, 22% of infants and children are exposed to SHS/THS in their homes each year, comprising a major proportion of the 126 million nonsmokers exposed to harmful tobacco products annually.{{cite journal |doi=10.1177/003335491613100206 |pmid=26957657 |pmc=4765971 |title=Thirdhand Smoke: State of the Science and a Call for Policy Expansion |journal=Public Health Reports |volume=131 |issue=2 |pages=233–8 |year=2016 |last1=Northrup |first1=Thomas F |last2=Jacob |first2=Peyton |last3=Benowitz |first3=Neal L |last4=Hoh |first4=Eunha |last5=Quintana |first5=Penelope J.E |last6=Hovell |first6=Melbourne F |last7=Matt |first7=Georg E |last8=Stotts |first8=Angela L }}

Though research is limited, many harmful health effects have been linked to THS exposure. THS has the potential to impair wound healing by altering the body’s natural anti-inflammatory response, remodel respiratory structure due to increased collagen deposits in airways, and cause permanent damage to DNA. Other health effects include asthma, increased cough morbidity, and other respiratory conditions.{{cite journal |doi=10.1042/CS20160236 |pmid=27129193 |title=Tobacco toxins deposited on surfaces (third-hand smoke) impair wound healing |journal=Clinical Science |volume=130 |issue=14 |pages=1269–84 |year=2016 |last1=Dhall |first1=S |last2=Alamat |first2=R |last3=Castro |first3=A |last4=Sarker |first4=A. H |last5=Mao |first5=J.-H |last6=Chan |first6=A |last7=Hang |first7=B |last8=Martins-Green |first8=M |url=http://www.escholarship.org/uc/item/4dn9x2s9 }} If pregnant mothers are exposed to THS, it can slow fetal lung development in the third trimester. In children, THS exposure has also been linked to sudden infant death syndrome (SIDS) as a potential cause factor,{{Cite journal|last1=Rosen|first1=Laura J.|last2=Noach|first2=Michal Ben|last3=Winickoff|first3=Jonathan P.|last4=Hovell|first4=Mel F.|date=2012-01-01|title=Parental Smoking Cessation to Protect Young Children: A Systematic Review and Meta-analysis|url=https://pediatrics.aappublications.org/content/129/1/141|journal=Pediatrics|language=en|volume=129|issue=1|pages=141–152|doi=10.1542/peds.2010-3209|issn=0031-4005|pmid=22201152|s2cid=7600779|via=AAP News & Journals Gateway|doi-access=free}} and has also been linked to cognitive and memory deficits in growing children.{{cite journal |doi=10.4081/monaldi.2013.108 |pmid=23741945 |title=Third-hand smoke exposure and health hazards in children |journal=Monaldi Archives for Chest Disease |volume=79 |issue=1 |pages=38–43 |year=2015 |last1=Ferrante |first1=G |last2=Simoni |first2=M |last3=Cibella |first3=F |last4=Ferrara |first4=F |last5=Liotta |first5=G |last6=Malizia |first6=V |last7=Corsello |first7=G |last8=Viegi |first8=G |last9=La Grutta |first9=S |url=https://iris.unipa.it/bitstream/10447/97131/2/Ferrante_Monaldi%202013_Thirdhand%20smoke.pdf }} Whether or not these largely theoretical relationships are causal in humans at realistic exposure levels remains to be seen.{{Cite web |date=2021-04-12 |title=What are the effects of secondhand and thirdhand tobacco smoke? |publisher=National Institute on Drug Abuse (NIDA) |url=https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/what-are-effects-secondhand-thirdhand-tobacco-smoke |access-date=2024-01-25 |language=en}}

Third-hand smoke has also been tested in various cell assays. THS exposure by cells has been shown to lead to the observation of DNA strand breaks, inhibition of proliferation, and cell death. Acrolein has shown to be a particularly potent third-hand smoke gas.{{cite journal |last1=Bahl |first1=V. |last2=Weng |first2=N.J.-H. |last3=Schick |first3=S.F. |last4=Sleiman |first4=M. |last5=Whitehead |first5=J. |last6=Ibarra |first6=A. |last7=Talbot |first7=P. |year= 2016 |title= Cytotoxicity of Thirdhand Smoke and Identification of Acrolein as a Volatile Thirdhand Smoke Chemical That Inhibits Cell Proliferation |journal= Toxicological Sciences |volume=150 |issue=1 |pages= 234–246 |doi= 10.1093/toxsci/kfv327 |pmid=26719373 |doi-access=free }}

A study led by Ashley Merianos, a tobacco researcher at the University of Cincinnati, revealed that in homes where children live, surfaces were contaminated with nicotine and the tobacco-specific carcinogen NNK. This was observed even in homes with voluntary indoor smoking bans, highlighting the persistent nature of THS pollutants. The study revealed higher levels of NNK and nicotine in lower-income households and homes that do not ban indoor smoking.{{Cite web |last=Koenig |first=Angela |title=Thirdhand smoke study teaches reveals more about the risks |url=https://medicalxpress.com/news/2024-01-thirdhand-reveals.html |access-date=2024-01-25 |website=medicalxpress.com |language=en}}

Third-hand smoke and its components have been detected in various indoor environments. The possibility of nitrosamine formation on vehicular surfaces was identified via the spraying of "high but reasonable" levels of nitrous acid (about 4–12 times the levels typically found in homes) onto cellulose substrates and wiping surfaces in a vehicle that had experienced heavy smoking. Similar results were found when cellulose substrates were kept (without wiping) in the vehicle for three days when smoking occurred. Additionally, the persistence of various third-hand smoke components was quantified on wool, cotton, and polyester fibers with THS the most persistent on wool and least persistent on polyester. Washing clothing without detergent was found to remove some THS, though a substantial amount remained after standard laundering.

Because of the growing resolving power and improved detection limits of analytical instruments, studies have demonstrated the transport of THS into other spaces via various media. For instance, third-hand smoke signatures have been detected in particles, which can effectively transport such compounds between indoor and outdoor air.{{cite journal |last1= DeCarlo |first1= P.F. |last2= Avery |first2= A.M. |last3 = Waring |first3 = M.S. |year= 2018 |title= Thirdhand smoke uptake to aerosol particles in the indoor environment |journal= Science Advances|volume= 4 |issue= 5 |pages= eaap8368 |doi= 10.1126/sciadv.aap8368 |pmid= 29750194 |pmc= 5942907 |bibcode= 2018SciA....4.8368D }}{{cite journal |last1= Collins |first1= D.B. |last2=Wang |first2=C. |last3 =Abbatt |first3 =J.P.D. |year= 2018 |title= Selective uptake of third-hand tobacco smoke components to inorganic and organic aerosol particles |url= https://pubs.acs.org/doi/abs/10.1021/acs.est.8b03880 |journal= Environmental Science & Technology |volume= 52 |issue= 22 |pages= 13195–13201 |doi= 10.1021/acs.est.8b03880 |pmid= 30347142 |bibcode= 2018EnST...5213195C |s2cid= 53037953 |access-date= December 28, 2021}} Additionally, both gas-phase and aerosol-phase compounds linked to third-hand smoke were detected and quantified in a non-smoking movie theater, possibly via moviegoers' clothes and breath.{{cite journal |last1=Sheu |first1=R. |last2=Stonner |first2=C. |last3=Ditto |first3=J.C. |last4=Klupfel |first4=T. |last5=Williams |first5=Jonathan |last6=Gentner |first6=D.R. |year= 2020 |title= Human transport of thirdhand tobacco smoke: A prominent source of hazardous air pollutants into indoor nonsmoking environments |journal= Science Advances |volume=6 |issue=10 |pages=eaay4109 |doi= 10.1126/sciadv.aay4109 |pmid=32181345 |pmc=7056301 |bibcode=2020SciA....6.4109S }}

Environmental tobacco smoke can oxidize with environmental nitrous acid to create carcinogenic (cancer-causing) tobacco-specific nitrosamines (TSNAs).{{cite journal |doi=10.1073/pnas.0912820107 |pmid=20142504 |pmc=2872399 |title=Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards |journal=Proceedings of the National Academy of Sciences |volume=107 |issue=15 |pages=6576–81 |year=2010 |last1=Sleiman |first1=M |last2=Gundel |first2=L. A |last3=Pankow |first3=J. F |last4=Jacob |first4=P |last5=Singer |first5=B. C |last6=Destaillats |first6=H |bibcode=2010PNAS..107.6576S |doi-access=free }} One TSNA, called 4-(methylnitrosamino)-1-(3-pyridinyl)-1-butanone (also known as nicotine-derived nitrosamine ketone, or NNK), is a potent lung-specific carcinogen ubiquitous in tobacco smoke and smokers' homes, and has been detected on clothing fibers, dust, and in the air.{{cite journal |doi=10.1063/1.4939941 |pmid=26909119 |pmc=4752521 |title=Detection of third-hand smoke on clothing fibers with a surface acoustic wave gas sensor |journal=Biomicrofluidics |volume=10 |issue=1 |pages=011907 |year=2016 |last1=Cheng |first1=Chi-Yung |last2=Huang |first2=Shih-Shen |last3=Yang |first3=Chia-Min |last4=Tang |first4=Kea-Tiong |last5=Yao |first5=Da-Jeng }}{{cite journal |last1= Matt |first1= G.E. |last2=Quintana |first2=P.J.E. |last3 =Zakarian |first3 =J.M. |last4=Fortmann |first4=A.L. |last5=Chatfield |first5=D.A. |last6=Hoh |first6=E. |last7=Uribe |first7=A.M. |last8=Hovell |first8=M.F. |year= 2010 |title= When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure |url= https://tobaccocontrol.bmj.com/content/20/1/e1 |journal= BMJ Tobacco Control|volume= 20 |issue= 1 |pages= e1 |doi= 10.1136/tc.2010.037382 |pmid= 21037269 |pmc= 3666918 |access-date= December 28, 2021}} Nitrosamines, along with other tobacco smoke chemicals that are deposited on surfaces or compounds that formed as a result of surface-phase reactions, can be a major source of toxicity, especially for infants. Infants can be particularly adversely affected given their frequent proximity to household surfaces and their propensity to ingest third-hand smoke residue from surfaces and dust.

It is important to acknowledge the biomarkers of third-hand smoke because they indicate the severity and presence of disease. In a recent study involving mice, THS biomarkers were discovered after four weeks of initial exposure at equivalent levels to those found in the homes of people who smoke. Researchers used a system that mimicked exposure to humans and sought out biomarkers found in serum, liver, and brain tissues in the mice. The mice were then exposed to THS at varying months and as early as one month, they began to show signs of increased circulating inflammatory cytokines, tumor necrosis factor, granulocyte macrophage colony stimulating factor, and an increase in the stress hormone epinephrine.{{cite journal |doi=10.1042/CS20171053 |pmid=28912356 |title=Biomarkers of disease can be detected in mice as early as 4 weeks after initiation of exposure to third-hand smoke levels equivalent to those found in homes of smokers |journal=Clinical Science |volume=131 |issue=19 |pages=2409–2426 |year=2017 |last1=Adhami |first1=Neema |last2=Chen |first2=Yuxin |last3=Martins-Green |first3=Manuela |s2cid=9167990 |doi-access=free }} Damage from THS exposure continued after two, four, and six months. Such damages included oxidative stress and molecular damage. Some of the mice also became hyperglycemic and hyperinsulinimic, which could mean that insulin resistance could be a consequence of long-term exposure. This study implies that increased exposure time to THS can have dramatic effects. Additional studies with human subjects are still needed to fully understand the implications of THS.

Third-hand smoke is a relatively newly postulated concept, and public awareness of it is lower than that of second-hand smoke. A 2013 study with six focus groups in metro and rural Georgia (USA) asked participants whether they had heard of THS, most of the participants had not heard about it and did not know what third-hand smoke was.{{cite journal |doi=10.1093/her/cyt056 |pmid=23669213 |pmc=3772331 |title=Third-hand smoke as a potential intervention message for promoting smoke-free homes in low-income communities |journal=Health Education Research |volume=28 |issue=5 |pages=923–30 |year=2013 |last1=Escoffery |first1=C |last2=Bundy |first2=L |last3=Carvalho |first3=M |last4=Yembra |first4=D |last5=Haardorfer |first5=R |last6=Berg |first6=C |last7=Kegler |first7=M. C }} Research on THS is growing, but it does not compare to the 40 years of research on the effects of second-hand smoke. Yet, it is estimated that 5%-60% of second-hand smoke-related harm may be attributable to third-hand smoke exposure. THS poses such a risk because its exposure can linger much longer than second-hand smoke. Third-hand smoke-contaminated surfaces like carpet, walls, and car interiors are also especially hard to clean, whereas second-hand smoke can be removed with ventilation.

Smoking rates in the United States have fallen considerably from 42.4% in 1965 to 17.8% in 2016. However, the downward trend is slowing, and it is estimated that 23% to 42% of adults in America with low education or living in poverty still smoke. This exposes millions of nonsmokers, many of whom are children.

THS awareness campaigns are growing and primarily focus on the health risks for young children. A 2014 study published in Pediatrics demonstrated that parents are more likely to attempt to quit smoking if they become convinced that third-hand smoke is harmful to children and are more likely to have smoke-free home and car policies if they are aware of the dangers of third-hand smoke. It was recommended for parents to safeguard their children by ensuring they have a smoke-free zone. One such way recommended for smokers to protect family, friends, and others is by smoking outside and showering and changing clothes before coming into contact with others.{{cite journal |doi=10.1542/peds.2013-3392 |pmid=24590745 |pmc=3966506 |title=Thirdhand Smoke Beliefs of Parents |journal=Pediatrics |volume=133 |issue=4 |pages=e850–6 |year=2014 |last1=Drehmer |first1=J. E |last2=Ossip |first2=D. J |last3=Nabi-Burza |first3=E |last4=Rigotti |first4=N. A |last5=Hipple |first5=B |last6=Woo |first6=H |last7=Chang |first7=Y |last8=Winickoff |first8=J. P }} However, research has shown that parents who are heavy smokers (> 10 cigarettes per day) are less likely to believe that third-hand smoke is harmful to children.{{cite journal |doi=10.1016/j.amepre.2012.07.020 |pmid=23079177 |pmc=3486922 |title=Pediatrician Interventions and Thirdhand Smoke Beliefs of Parents |journal=American Journal of Preventive Medicine |volume=43 |issue=5 |pages=533–6 |year=2012 |last1=Drehmer |first1=Jeremy E |last2=Ossip |first2=Deborah J |last3=Rigotti |first3=Nancy A |last4=Nabi-Burza |first4=Emara |last5=Woo |first5=Heide |last6=Wasserman |first6=Richard C |last7=Chang |first7=Yuchiao |last8=Winickoff |first8=Jonathan P }} Third-hand smoke is one of the issues promoting indoor smoking bans, especially supported by performers such as musicians, who are forced to bring third-hand smoke contamination into their homes through contaminated instruments and cases.

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