The harmful effects of smoking and second-hand smoke have been well documented in medical literature. A recent report presents the results of the first study to examine the third-hand smoke concept and home smoking bans. More specifically, the study was designed to assess the health beliefs of adults regarding children exposed to third-hand smoke, whether smokers and nonsmokers differed in their beliefs, and whether beliefs about third-hand smoke were associated with household smoking bans. Third-hand smoke is not a new term, and the researchers defined it as "residual tobacco smoke contamination that remains after the cigarette is extinguished."1
Beliefs about harm
A large, nationally representative sample of 1,478 adults 18 years of age and older were surveyed by telephone. The article includes a detailed description of methods. Current smokers represented 18.9% of the respondents and 25.6% of the homes with completed surveys had a resident smoker. Overall, 95.4% of nonsmokers versus 84.1% of smokers agreed that second-hand smoke was harmful to the health of children; 65.2% of nonsmokers versus 43.3% of smokers agreed that third-hand smoke was harmful to children. Strict smoking rules were more prevalent among nonsmokers than smokers (88.4% versus 26.7%, p < 0.001). The belief that third-hand smoke was harmful to the health of children was independently associated with rules prohibiting smoking in the home, although this was not the case with beliefs about harm from second-hand smoke.
What does this mean for us?
Prominent news sources immediately circulated the study's findings with rousing headlines like, Third-hand smoke: Another reason to quit smoking2 and A new cigarette hazard: 'Third-hand smoke.'3 Toxins from tobacco smoke in the form of particulate matter are deposited onto every surface in the home: in dust, on furniture, in carpets, on clothing, and are dispersed into the air over the course of several months. The poisonous gases are known carcinogens and include common substances such as hydrogen cyanide, carbon monoxide, butane, ammonia, and arsenic. How many times have you entered an empty room and smelled the stale remnants of tobacco smoke? Children are especially susceptible to exposure and subsequent harmful effects.
What does this mean for NPs? We all have patients who walk into our offices reeking of tobacco smoke. Efforts to encourage and assist patients to stop smoking are expanding and ongoing. Smoking cessation programs are evidence-based with assessment tools, strategies to help a person quit, pharmaceutical interventions, quit phone lines, support groups, and alternative therapies. Another tactic includes the ever-expanding government bans on smoking in public places. However, the home is predominantly where children and adults are exposed to tobacco smoke.
The Boston team emphasized that healthcare providers should make it a point to ask smokers if there are children in the house, even if the patient states he does not smoke in the house. Smoking in a different room, opening a window, or blowing a fan is not adequate protection for children from the harmful effects of tobacco exposure. Investigating your patients' beliefs about the harmful effects of second-hand and third-hand smoke and encouraging strict smoking restrictions in the home and car are additional strategies to help treat tobacco dependence as you help patients in their efforts to quit and stay quit. This is even more important when there are children in the household.
Jamesetta Newland, RN, PhD, FNP-BC, FAANP, FNAP
Editor-in-Chief, [email protected]
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