Third

Hand Smoke: A Lingering Problem

for Children
Hey smokers! You might be doing more damage to children than you
think. Children are being being affected by third hand smoke,
sometimes severely, even when adults smoke outside or when children
arent around. Not first, not second, but yes, third hand smoke!

We all know that smoking is not healthy and that secondhand smoke exposure is also harmful,
but what about third hand smoke?
This relatively new issue is described as the residual nicotine contamination and other
chemicals left behind from tobacco smoke. Tobacco smoke is composed of many types of gases,
chemicals, and harmful matter, including carcinogens and toxic substances, like arsenic, lead
and cyanide.
Have you ever walked into a room, elevator, or gotten into a car and smelled tobacco smoke on
someone? If so, you have been directly affected by third hand smokes deadly toxins. The
nicotine reacts to air (mainly nitrous oxide) and can continue to be carcinogenic long after the
source of exposure has been removed. It cant really be cleaned or aired out, says Nausheen
Hussain, a physician at the Cleveland Clinic.
This sticky, toxic nicotine matter can cling to anything from walls to ceilings. It lingers in rooms
and vehicles, on furniture, clothing, hair, carpets, skin anything with a surface. This residue is
thought to react with common indoor pollutants to create a toxic mix. This mix of third hand

smoke contains cancer-causing substances, posing a potential health hazard to nonsmokers

who are exposed to it, especially children.
I have three children, all out of the house, and youngest finishing college this June, 2014.
When they were growing up, I was aware of the effects of secondhand smoke, which is why I
always went outside to smoke, and never smoked while they were in the car. If I would have
known about third hand smoke, and the residues I was exposing my children to then, I
definitely would have made the effort to quit altogether. I thought I was protecting them by
keeping them away from the smoke, says Sally Van Nuys, local Cleveland mother, artist and
instructor.
According to the American Academy of Pediatrics, only 43.3 percent of smokers believe that
third hand smoke causes any harm to children. The other 56.7 percent are putting all the
children around them at high risk for serious health issues including asthma, decreased lung
growth, respiratory infections and sudden infant death syndrome (SIDS).

Why are children at a greater risk?

A large issue resides in the lack of decision making power a child has, especially in a smokers
home. Children are at the most risk of exposure and contamination because tobacco residue is
not noticeably present and hides on things as small as dust. Colleen Williams, a registered
nurse, says, As a former smoker, and now a registered nurse living with emphysema and
reactive airway disease, I am not surprised to see the passion of the responses. The message is
clear. This is clear. This is not about hating smokers. It is about children and others who choose
not to smoke being forcibly exposed to tobacco toxins.
Emily Lee, M.D., who is the program director for the American Lung Association in Ohio and a
specialist in respiratory illness and prevention, says, There are at risk people for everything,
but children are at risk because they are not the decision-
maker in the home to say no. They depend on the parent to
make the smart decisions for them, so a parent should
recognize early signs of smoke exposure, like coughing or
wheezing, and act immediately. If left unattended, it can
increase the chances of asthma and other respiratory issues.
The developing brain of a child is uniquely susceptible to extremely low levels of toxins, says
Lee. Babies and small children not only crawl, but like to touch everything as well as put fingers
and foreign objects into their mouths exposing them to contaminated surfaces. Children are
more at risk because they spend more time on carpets and lower areas at the same time they

are touching things and putting them in their mouths, says Shazia Choudhry, M.D. Children
also ingest twice the amount of dust that adults do.
If you compare a average 170-pound adult and a 20-pound child, you will find that the child
ingests twice the amount of dust, leaving them susceptible to 20 times the exposure to third
hand smoke contaminants. This is due to the higher respiratory rates of children, which cause
them to inhale particles at a faster rate and absorb chemicals through their skin, as seen in
Figure 1 below.

A study published in 2010 found that third hand smoke causes the formation of many
carcinogens, both indoors and outdoors. The nicotine in tobacco smoke reacts with nitrous acid
(common in indoor air) which then forms very hazardous carcinogens. Nicotine remains on
surfaces for months to even years, says Choudhry, so the carcinogens continue to be created
over time, and are then inhaled, absorbed and ingested by both adults and children. Nicotine
residue cannot be cleaned, so once a surface is exposed (unless its a biological surface like hair
or skin), its going to be tainted for good. Even skin can be permanently soiled and yellowed
from nicotine exposure over time, says Hussain.
To emphasize how long cigarette contamination and residue lingers in high quantities, check
out Figure 2 below. Studies show that when just one cigarette was smoked in a room with a

closed door, it took two hours for particulates in air to return to below federal air quality
standards. This does not mean that contaminants are fully gone, they have just subsided.

A study released March 16, 2014 by Bo Hang, Ph.D., of the Berkeley Lab, found that many of the
more than 4,000 compounds in second hand smoke can linger indoors long after a cigarette is
put out. It goes on to say that these substances can go on to react with indoor pollutants such
as ozone and nitrous acid, creating a brand new carcinogenic compound, NNA, found in third
hand smoke. This compound when mixed with air can damage DNA and stick to it in a way that
could cause cancer, uncontrolled cell growth and the formation of cancerous tumors.

Is Third Hand Smoke Underrated?

Almost every medical professional interviewed for this article agreed that most people are
unaware of the dangers of third hand smoke. Emily Lee believes that is due to its recent
discovery. If more parents were aware of third hand smoke as much as they were familiar with
second hand smoke, I believe they would take the extra steps necessary to protect their
children, says Lee.
I think third hand smoke is very underrated. I see parents bringing their kids into the hospital
all the time with breathing problems, exacerbated asthma and allergies, when the parents had
no idea why. They claim that they never smoked around the child, but failed to understand that
the environment where the child lives and plays is still teeming with carcinogens, says
Nausheen Hussain, M.D.

Whats Next?
If you visit a hospital, go smoke a cigarette, and then try and re-enter any portion that has
children as patients, you can now expect a nurse to tell you to go change your clothes and wash
your hands and face. That is how serious third hand smoke is becoming, as more and more
studies are done about it.
The best way to avoid third hand smoke is not to smoke in your house, car or any enclosed
area. Also, encourage others to refrain from smoking indoors, in your personal space and
especially, around children. Everywhere smoke goes, third hand smoke will follow. While you
can clean your carpets, walls and floors, smoke particles are normally too deep to reach. Third
hand smoke has been detected in homes that have been very thoroughly cleaned, years after
the smokers have moved out. Keep that in mind when looking for a new home!
The only way to protect your children and other nonsmoking families completely from the
effects of thirdhand smoke is to quit completely, says Rabia Jalal, an M.D. who also has a
masters degree in public health.
Parents, teachers, drivers, landlords, business owners and many others need to be aware of the
health risks of exposure to third hand smoke and recognize that eliminating smoking is the only
way to protect ourselves and our children against tobacco smoke contamination.