NEHA March 2024 Journal of Environmental Health

The purpose of our study was to examine these perceptions related to THS exposure among a sample of parents in California. More specifically, our study examined the relationships among THS-related knowledge, attitudes, eœcacy, and protective behaviors; demographic characteristics; household composition; and parental smoking-related behaviors and perceptions. These aims were explored through the following hypotheses. First, building on the observation by Rob- inson and Kirkcaldy (2009) that parents are more apt to prevent tobacco exposure for younger children, it was anticipated that parents with younger children would have higher THS-related knowledge, attitudes, eœcacy, and protective behaviors than would parents with adolescents. Second, based on the literature that demonstrates the broad ways that knowledge, attitudes, and eœcacy impact THS-related perceptions, it was antic- ipated that THS-related knowledge, attitudes, and eœcacy would be significantly related to THS protective behaviors.

cross-sectional survey. Of these participants, 363 identified as parents. Participants were incentivized with a chance of winning one of five $150 Amazon gift cards. The study was reviewed and approved by the institutional review board at San Diego State University.

substantial evidence documenting harms to human health of that exposure, research shows that parental awareness of the pres- ence and dangers of THS is generally low. Several research studies have found that the majority of participants are unaware of the term (Díez-Izquierdo et al., 2018; Esco„ery et al., 2013). While many people recognize the unpleasant odor of stale tobacco smoke or stained walls in the home of someone who smokes, most people do not connect these sensory experiences with the term thirdhand smoke or the exposure to a mixture of car- cinogens and other reproductive toxicants. Even in studies showing a high level of awareness of the term, knowledge and atti- tudes regarding the hazards of THS exposure and importance of prevention show room for improvement. For instance, a survey of more than 1,400 U.S. adults found that only 65.2% of nonsmokers and 43.3% of smokers believed that THS could harm children (Winicko„ et al., 2009). Even more concerning, Roberts et al. (2017) found that these numbers were much lower when participants were asked if THS neg- atively a„ected specific conditions (as opposed to health generally). Not surprisingly, research has also found that the more parents smoke, the less likely they are to believe that THS expo- sure is harmful (Drehmer et al., 2012). There is a growing body of research explor- ing parental behavior to prevent THS expo- sure. Several studies have shown that parental belief in the harms of THS exposure for chil- dren is positively associated with the presence and enforcement of in-home smoking bans; as such, parents who believe THS exposure to be less harmful are the less likely to have an in-home smoking ban (Baheiraei et al., 2018; Drehmer et al., 2014; Winicko„ et al., 2009). Although in-home smoking bans are not guar- anteed to protect a child from THS, especially if the parent smokes, in-home smoking bans are an important protective behavior that reduces a child’s THS exposure (Mahabee-Gittens et al., 2019; Northrup, Matt, et al., 2016). Existing research studies have demon- strated a) deficiencies in parental knowledge of what THS is; b) nonurgent attitudes regard- ing the degree of harm associated with THS exposure; c) insuœcient eœcacy on the abil- ity to prevent THS exposure; and d) modestly e„ective behaviors, such as in-home smoking bans and active tobacco-related education, can prevent THS exposure in children.


Children in the Home To determine how many children a partici- pant had and each child’s age group, partici- pants were asked, “How many children under the age of 13 live in your home?” and “How many children between the ages of 13 and 17 live in your home?” Numeric response options ranged from 1 to 19 ( m = 2.08, SD = 1.75). These responses were used in two ways. For group comparisons, each item was dummy coded for yes/no, creating three cat- egories of child age in the household: all chil- dren under the age of 13 only; all children between the ages of 13 and 17 only; and a combination of child ages under 18 (where at least one child is between 13 and 17 years and at least one child is less than 13 years). For regression analysis, the first two items were summed to represent the number of children, regardless of age, living in the home. Smoking-Related Behaviors and Perceptions Parental smoking-related behaviors and per- ceptions were assessed with five items. First, participant smoking status was assessed with two items: “Have you ever smoked a ciga- rette, even a pu„?” and “Have you smoked at least 100 cigarettes in your entire life?” If yes to both, participants were asked to respond to the question, “Do you now smoke ciga- rettes?” Response options were as follows: not at all, some days, or every day. Participants were categorized as nonsmok- ing if they selected no to either of the first two questions or not at all to the third. Sec- ond, reaction to tobacco smoke was assessed to determine how participants generally felt about the most noticeable aspect of THS— the smell. On a 5-point Likert-type scale from strongly disagree to strongly agree, par- ticipants responded to the statement, “Stale cigarette smoke makes me feel ill.” Third, participants reported recent smoking in their home by others by responding to the ques- tion, “In the past month, about how often has someone smoked a cigarette inside of your


Procedures Data were collected using an anonymous online survey as part of a larger, 7-month social media intervention designed to increase and improve knowledge of what THS is, atti- tudes about the degree of harm associated with THS exposure, eœcacy on the ability to prevent THS exposure, and protective behav- iors to reduce exposure (Record et al., 2023). Adults of low-to-middle socioeconomic sta- tus who have children; travel; have pets; or have computer search histories related to cars, apartments, or real estate were recruited through Facebook’s advertising program to identify adults from California households most likely to be exposed to THS (e.g., own a pre-owned vehicle, live in multiunit housing, own a house) or households with individu- als most vulnerable to THS exposure (e.g., a home with children living there). These characteristics in our search produced an estimated sampling frame of 24 million users. Recruitment ran from October 2019 to November 2019. Excluding participants who did not provide an email address for follow-up ( n = 612) and duplicates ( n = 56) resulted in 1,087 unique participants who were included in the larger intervention and completed a


March 2024 • Journal of Environmental Health

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