NEHA March 2024 Journal of Environmental Health


ecacy, and protective behaviors (with atti- tudes not supported). We used multivariable linear regres- sion modeling to explore factors that best explained parent behavior to prevent THS exposure. The model significantly accounted for 55% of parent THS-related behavior ( R 2 = .560, F (15, 346) = 29.37, p < .001), with atti- tudes ( β̂ = .660, sr 2 = .119, p < .001), smoking status ( β̂ = .696, sr 2 = .031, p < .001), reaction to the smell of tobacco smoke ( β̂ = .086, sr 2 = .007, p < .05), home ownership ( β̂ = .248, sr 2 = .015, p < .001), and age ( β̂ = .005, sr 2 = .005, p < .05) emerging as the strongest predictors. Table 3 displays included variables with their unstandardized coecients and semipartial correlations squared. Discussion and Conclusion The purpose of our study was to examine the relationships among parental THS- related knowledge, attitudes, ecacy, and protective behaviors; demographic char- acteristics; household composition; and smoking-related behaviors and perceptions in a sample of California parents. Parents in households where all children were younger (i.e., <13 years) had more THS-related knowledge, attitudes, ecacy, and protective behaviors than did parents in households that included children who were older (i.e., between 13–17 years), whether or not these households also included younger chil- dren. These results suggest that the age of children in the home is more influential on THS-related knowledge, attitudes, ecacy, and protective behaviors of parents than the number of children in the home. Further, younger children who live in households with older siblings are less likely to be pro- tected from exposure than their peers who live in households without older siblings. In addition to the age of children in the household, parental behaviors to protect their children from exposure to THS were associ- ated with parental educational attainment, age, and home ownership status. Parents who endorsed THS-protective behaviors had more education, were older, and owned their own homes. In addition, they were more likely to be nonsmokers, report a negative reaction to the odor of tobacco smoke, and hold a nega- tive attitude toward THS. The results of our study are consistent with past research (Robinson & Kirkcaldy, 2009)

TABLE 2 Association of Child Age on Thirdhand Smoke Perceptions of Parents

β̂ (t)

sr 2


R 2

F +

Parents with children who are:


.025 4.69 **


-.153 (-1.77)

.009 .025

Combination of ages

-.280 (-3.05)**


.022 3.96*


-.145 (-1.42)

.006 .022

Combination of ages

-.303 (-2.81)**


.034 6.35 **


-.304 (-2.68)** -.406 (-3.37)***

.019 .031

Combination of ages


.018 3.25*


-.257 (-2.21)* -.271 (-2.20)*

.013 .013

Combination of ages

Note . Referent group was parents with all children <13 years. Adolescents were defined as all children between 13 and 17 years, with no child <13 years. Combination of ages was defined as having at least one child between 13 and 17 years and at least one child <13 years. * p < .05; ** p < .01; *** p < .001; + df = 2, 360; N = 363.

and have implications for clinical practice. Past research suggests that pediatric health- care professionals are an important source of support and influence for parents, and best practice calls for routine screening for tobacco exposure and education about pre- vention (Drehmer et al., 2012).The results of our study suggest that routine screening by healthcare professionals for tobacco exposure and education should be expanded to include THS, especially for young children who have older siblings (i.e., 13–17 years). Of note, parents of young children with older siblings report THS knowledge deficits and fewer protective behaviors than parents of young children without older siblings. This di›erence points to a need for increased education with this particular group of par- ents. Parents of older children (i.e., only ado- lescents) are also in need of increased educa- tion, as they also report knowledge deficits and few preventive behaviors compared with parents of young children. Every visit with a healthcare professional presents an opportu- nity to share educational materials focused on the risks of exposure to SHS and THS for young children, the harms of tobacco expo- sure for developing teens (Merianos et al.,

2020), and the benefits of protective behav- iors such as in-home smoking bans. Furthermore, our study results suggest that healthcare professionals should be aware that some parents are less likely to protect their children from exposure to THS, regard- less of their children’s ages. Younger parents and those who do not own their own homes were less likely to protect their children from exposure to THS. Similarly, parents who smoke tobacco and parents who do not react negatively to the smell of tobacco smoke or hold negative attitudes toward THS were less likely to protect their children from exposure, regardless of the children’s age. It is noteworthy that not all parents of young children report protecting their children from THS exposure; experienced parents (i.e., those with older children) with young children in the house were less likely to report protecting their children. This finding suggests that par- ents of adolescents are most in need of screen- ing and education, to protect not only the adolescents but also younger siblings, which points to the importance of understanding the family constellation of young children. Thus, any strategy to protect children— regardless of age—from exposure to THS


Volume 86 • Number 7

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