NEHA March 2024 Journal of Environmental Health


Open Access

Parental Knowledge, Attitudes, Efficacy, and Protective Behaviors About Thirdhand Smoke and Children Ages 0–17

Rachael A. Record, PhD School of Communication, San Diego State University Georg E. Matt, PhD Department of Psychology, San Diego State University Lydia H. Greiner, DrPH Department of Psychology, San Diego State University Heather Wipfli, PhD Keck School of Medicine, University of Southern California

with adults, children engage in more hand-to- mouth behaviors (Xue et al., 2007) and ingest greater amounts of dust (Roberts et al., 2009). Their rapid respiratory rate and large sur- face area relative to body mass make inhala- tion and absorption, respectively, more likely (World Health Organization, 2008). Lastly, their immature immune systems increase their vulnerability. A study assessing child exposure to THS found that almost all of the children (98%) had nicotine on their hands, regardless of parental smoking status or smoking bans at home (Matt et al., 2022). Young children are not only at the greatest risk of exposure to THS pollutants but also likely to have adverse health e˜ects from expo- sure (Ferrante et al., 2013; Mahabee-Gittens et al., 2018; Sleiman et al., 2010; Tan et al., 2016). One examination of tobacco smoke exposure by Merianos et al. (2021) found that children with greater exposure to both secondhand (SHS) and THS had increased emergency department visits. Other studies have found that exposure to THS exacerbates asthma, directly damages DNA, induces oxida- tive stress, slows wound healing, and changes the function of reproductive cells (Hang et al., 2013, 2017; Jacob et al., 2017; Martins-Green et al., 2014). Similarly, in two separate studies, Kelley et al. (2021) and Northrup et al. (2021) found that children living in THS-polluted homes had changes in their microbiomes com- pared with children living in homes that were not polluted by THS. Parental Knowledge, Attitudes, and Protective Behaviors Despite the recognition that children are at increased risk of THS exposure and the

Abstract Our study examined parental knowledge, attitudes, ecacy, and protective behaviors about thirdhand smoke and the toxic mixture of chemicals left in indoor environments after smoking stops. This study also explored the associations with household characteristics. Participants ( N = 363) were parents in California who had at least one child <18 years. Parents were recruited via Facebook and completed a cross-sectional survey. Data were analyzed using multiple linear regression. Parents with children 0–12 years had significantly higher knowledge ( sr 2 = .025, p < .05), attitudes ( sr 2 = .022, p < .01), ecacy ( sr 2 = .031, p < .001), and protective behaviors ( sr 2 = .013, p < .05) than did parents with children 0–17 years. In addition, statistical modeling significantly accounted for thirdhand smoke-related parent behaviors ( R 2 = .548, p < .001), with the strongest independent associations being attitudes, smoking status, reaction to the smell of tobacco smoke, home ownership, and age. Overall, families with adolescents are in need of education to protect all children from exposure to thirdhand smoke. Keywords: thirdhand smoke, child health, prevention, tobacco control, environmental risks

Introduction Decades of indoor smoking have left a legacy of persistent tobacco pollutants, known as thirdhand smoke (THS), in indoor environ- ments (Jacob et al., 2017; Matt et al., 2011). THS is a mixture of toxic particles and gases created from the smoke of cigarettes and cigars (Matt et al., 2011) that contains more than 25 chemicals known to cause cancer or reproductive harm (California O ce of Environmental Health Hazard Assessment, 2023). THS sticks to surfaces, accumulates in dust, and becomes embedded in everything from carpets and furniture to toys and pillows

(Matt et al., 2004, 2008; Singer et al., 2002). Moreover, THS persists in indoor environ- ments for years after the smoking stops (Matt et al., 2020, 2021), and thus humans can be exposed unintentionally to the chemicals in THS through skin absorption, inhalation, and ingestion (Matt et al., 2011). Young children are at the greatest risk of exposure to THS (Jacob et al., 2017; Northrup, Jacob, et al., 2016). Young children not only spend more time indoors than adults but also are lower to the ground and likely to crawl into small spaces where dust accumulates, increas- ing the likelihood of THS exposure. Compared


Volume 86 • Number 7

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