increased protective behaviors suggests that one strategy could be to tap into an odor- based motivation to prevent THS expo- sure. In other words, reinforce the desire to remove the odor as a means to also remove the toxicants. This approach could enhance the performance of THS protective behav- iors among parents. A few limitations need to be acknowledged. First, our findings reflect the perspectives and behaviors of parents in California only. As a state with low smoking rates and high tobacco control eorts, these findings might not be generalizable to other regions of the U.S. where smoking rates are higher and tobacco preven- tion is more challenging. Second, participants were recruited via Facebook. This approach reduces the recruitment of parents who have minimal technology access, are older, and are non-English speaking. Ferrante et al. (2013) called for public health professionals to see protecting chil- dren from THS exposure as a high prior- ity. Almost one decade later, the need to prioritize the protection of children from THS exposure continues. Our results sug- gest that understanding of the harms of THS and the need to prevent exposure to THS has remained relatively low and on par with past research findings (Escoery et al., 2013). The longer THS remains on the outskirts of parental purview, the less prepared parents are to protect their children from exposure to THS. Recommendations from our study can guide the eorts of public health profes- sionals to protect all children from exposure to THS. Corresponding Author: Rachael A. Record, Associate Professor, School of Communica- tion, San Diego State University, 5500 Campa- nile Drive, San Diego, CA 92182. Email: rrecord@sdsu.edu.
TABLE 3 Multivariable Linear Regression Model of Thirdhand Smoke Prevention Behaviors of Parents
β̂
Variable
t
sr 2
p -Value
Demographic of parent Gender
.123 .073 .017 .005 .248 .014
1.32 1.03 0.22 2.03 3.47 0.62
.002 .001 .000 .005 .015 .000
.189 .306 .823 .043 .001 .537
Employed (full- or part-time) Education (graduate degree)
Age
Homeowner
Number of kids in home
Referent group (i.e., all children <13 years) Adolescents (13–17 years)
-.103 -.049
-1.24 -0.52
.002 .000
.217 .604
Combination of ages (≤17 years)
Smoking-related behaviors and perceptions of parent Nonsmoker
.696 .086
4.91 2.34
.031 .007 .005 .003 .003 . 119 .002
.000 .020 .059 .133 .108 .000 .250
Reaction to stale tobacco smoke Recent smoking in home by others Frequency of smelling tobacco smoke
-.102 -.069
-1.89 -1.50
Primary outcomes Knowledge
-.127
-1.61 9.69 1. 15
Attitudes
.660 .051
Efficacy
Note. Combination of ages was defined as at least one child between 13 and 17 years and at least one child <13 years. R 2 = .560; F (15, 346) = 29.37; p < .001. Unstandardized betas reported. Bolded variables have a p -value of <.05. N = 363.
must intentionally include parents with adolescents. We recommend every interac- tion with a healthcare professional includes screening for child exposure to both SHS and THS, education about THS, and guidance to increase parental behaviors to protect their children from exposure to THS. One challenge to this recommendation is that adolescents typically see their healthcare
professionals without a parent present. Rather than a barrier, we suggest that this scenario presents an opportunity for healthcare profes- sionals to screen adolescents for THS exposure and speak directly to adolescents about THS as part of routine tobacco education—and then to share that conversation with the parent. The relationship between a negative response to the smell of stale tobacco and
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March 2024 • Journal of Environmental Health
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