Abstract

Objective: Third-hand smoke is a serious threat to health. This study aimed to guide the fight against tobacco by determining parents’ awareness about third-hand smoke and smoking behaviors.

Methods: 244 volunteer parents with children under the age of 18, who applied to the outpatient clinics of a hospital in Ankara between 16.7.2022 and 15.9.2022, were included in the descriptive, analytical study. A 28-question data collection form, including questions on sociodemographic characteristics and smoking behaviors, the Fagerström nicotine dependence test, and the awareness scale about third-hand smoke, was applied face-to-face to the participants. Data were analyzed with IBM SPSS 22.0. p<0.05 was considered statistically significant.

Findings: Participants were between the ages of 18-65, 30.33% were fathers, 69.67% were mothers, 52.05% smoked (50% of them were with their children), 9.45% did not smoke at home, and 88.93% had never heard of third-hand smoke. The total score of the awareness scale about third-hand smoke was found to be high in those aged 31-45 (55%), those who quit smoking, those who had previously heard of the concept of third-hand smoke, and those who were married, and increased with education level (p<0.001). The Fagerström nicotine addiction level was low in 53.97% of the parents.

Results: It was determined that the awareness of third-hand smoke was higher in middle-aged, highly educated, ex-smokers, married and those who had heard third-hand smoke. It was found that the rate of parents smoking was high, third-hand smoke knowledge was insufficient and children were exposed to third-hand smoke, especially in their own homes. Education about third-hand smoke can reduce exposure by increasing awareness and encourage smoking cessation. This study can guide the fight against tobacco.

Keywords: Smoke, tobacco smoke pollution, awareness, parents

References

  1. Richardot WH, Hamzai L, Ghukasyan T, et al. Novel chemical contaminants associated with thirdhand smoke in settled house dust. Chemosphere 2024; 352: 141138. https://doi.org/10.1016/j.chemosphere.2024.141138
  2. Drehmer JE, Walters BH, Nabi-Burza E, et al. Guidance for the clinical management of thirdhand smoke exposure in the child health care setting. J Clin Outcomes Manag 2017;24 (12): 551-559.
  3. Matt GE, Greiner L, Record RA, et al. Policy-relevant differences between secondhand and thirdhand smoke: strengthening protections from involuntary exposure to tobacco smoke pollutants. Tob Control 2024; 33: 798-806. https://doi.org/10.1136/tc-2023-057971
  4. Salimoğlu S, Çağatay HT, Akdur R. Determining university students' smoking habits and awareness levels about thirdhand smoke. Addicta: The Turkish Journal on Addictions 2023; 10(1): 3-10 . https://doi.org/10.5152/ADDICTA.2023.22090
  5. Hang B, Wang P, Zhao Y, Chang H, Mao JH, Snijders AM. Thirdhand smoke: genotoxicity and carcinogenic potential. Chronic Dis Transl Med 2019; 6: 27-34. https://doi.org/10.1016/j.cdtm.2019.08.002
  6. Torres S, Samino S, Ràfols P, Martins-Green M, Correig X, Ramírez N. Unravelling the metabolic alterations of liver damage induced by thirdhand smoke. Environ Int 2021; 146: 106242. https://doi.org/10.1016/j.envint.2020.106242
  7. World Health Organization (WHO). WHO global report on trends in prevalence of tobacco use 2000-2025. 4th ed. İsviçre: World Health Organization, 2021. Available at: https://www.who.int/publications/i/item/9789240039322 (Accessed on Mar 19, 2025).
  8. Matt GE, Quintana PJE, Zakarian JM, et al. When smokers quit: exposure to nicotine and carcinogens persists from thirdhand smoke pollution. Tob Control 2016; 26: 548-556. https://doi.org/10.1136/tobaccocontrol-2016-053119
  9. Jacob P, Benowitz NL, Destaillats H, et al. Thirdhand smoke: new evidence, challenges, and future directions. Chem Res Toxicol 2017; 30: 270-294. https://doi.org/10.1021/acs.chemrestox.6b00343
  10. Vanzi V, Marti F, Cattaruzza MS. Thirdhand smoke knowledge, beliefs and behaviors among parents and families: a systematic review. Healthcare (Basel) 2023; 11: 2403. https://doi.org/10.3390/healthcare11172403
  11. U.S. EPA. Child-specific exposure factors handbook (2008, Final Report). Washington, DC.: U.S. Environmental Protection Agency, 2008. Available at: https://cfpub.epa.gov/ncea/risk/recordisplay.cfm?deid=199243 (Accessed on Mar 19, 2025).
  12. Mitro SD, Dodson RE, Singla V, et al. Consumer product chemicals in indoor dust: a quantitative meta-analysis of U.S. studies. Environ Sci Technol 2016; 50: 10661-10672. https://doi.org/10.1021/acs.est.6b02023
  13. Topçu S, Akın E, Ulukol B, Şimşek Orhon F, Başkan S. Awareness, attitudes and behaviors of parents for child exposure to tobacco smoke. Turkish J Fam Med Prim Care 2018; 12(1): 35-42. https://doi.org/10.21763/tjfmpc.399918
  14. Mahabee-Gittens EM, Matt GE, Hoh E, et al. Contribution of thirdhand smoke to overall tobacco smoke exposure in pediatric patients: study protocol. BMC Public Health 2019; 19: 491. https://doi.org/10.1186/s12889-019-6829-7
  15. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 1991; 86: 1119-1127. https://doi.org/10.1111/j.1360-0443.1991.tb01879.x
  16. Uysal MA, Kadakal F, Karsidag C, Bayram G, Uysal O, Yilmaz V. Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tüberküloz ve Toraks Derg 2004; 52(2): 115-121.
  17. Haardörfer R, Berg CJ, Escoffery C, Bundy ŁT, Hovell M, Kegler MC. Development of a scale assessing Beliefs About ThirdHand Smoke (BATHS). Tob Induc Dis 2017; 15: 4. https://doi.org/10.1186/s12971-017-0112-4
  18. Çadırcı D, Terzi NK, Terzi R, Cihan FG. Validity and reliability of Turkish version of Beliefs About Third-Hand Smoke Scale: BATHS-T. Cent Eur J Public Health 2021; 29: 56-61. https://doi.org/10.21101/cejph.a6578
  19. Kılıç S. Cronbach'ın alfa güvenirlik katsayısı. Journal of Mood Disorders 2016; 6(1): 47-48.
  20. Türkiye İstatistik Kurumu. Türkiye sağlık araştırması, 2022 [Internet]. 2022. Available at: https://data.tuik.gov.tr/Bulten/Index?p=Turkiye-Saglik-Arastirmasi-2022-49747 (Accessed on Mar 19, 2025).
  21. Mahabee-Gittens EM, Vidourek RA, King KA, Merianos AL. Disparities in neighborhood characteristics among U.S. children with secondhand and thirdhand tobacco smoke exposure. Int J Environ Res Public Health 2022; 19: 4266. https://doi.org/10.3390/ijerph19074266
  22. Xie Z, Chen M, Fu Z, et al. Thirdhand smoke beliefs and behaviors among families of primary school children in Shanghai. Tob Induc Dis 2021; 19: 10. https://doi.org/10.18332/tid/132289
  23. Odacı N, Kitiş Y. Üçüncü el sigara dumanına yönelik inançlar ölçeğinin Türkçe geçerlik ve güvenirlik çalışması. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2021; 8(3): 269-276. https://doi.org/10.31125/hunhemsire.1050335
  24. Esen AD, Arıca S. Sigarayı bırakmak için başvuranlarda nikotin bağımlılık düzeyi ve sosyodemografik özelliklerin değerlendirilmesi. AnkMedJ 2018; 18(3): 328-336.
  25. King BA, Patel R, Babb SD, Hartman AM, Freeman A. National and state prevalence of smoke-free rules in homes with and without children and smokers: two decades of progress. Prev Med 2016; 82: 51-58. https://doi.org/10.1016/j.ypmed.2015.11.010
  26. Northrup TF, Khan AM, Jacob P, et al. Thirdhand smoke contamination in hospital settings: assessing exposure risk for vulnerable paediatric patients. Tob Control 2016; 25: 619-623. https://doi.org/10.1136/tobaccocontrol-2015-052506
  27. Özcan L. Eskişehir'de bir makine imalat fabrikasında çalışan işçilerin üçüncü el sigara dumanı inançları ve ilişkili faktörlerin belirlenmesi [Discussion]. Eskişehir: Eskişehir Osmangazi Üniversitesi; 2022.
  28. Quispe-Cristóbal B, Lidón-Moyano C, Martín-Sánchez JC, et al. Knowledge and opinions of healthcare professionals about thirdhand smoke: a multi-national, cross-sectional study. Healthcare (Basel) 2022; 10: 945. https://doi.org/10.3390/healthcare10050945
  29. Oktar D, Özcan L, Onsuz MF, Metintaş S. Parental beliefs on the harmfull effects of third hand smoke: systematic review and meta-analysis. European Journal of Public Health 2021: 31(3): 431-432. https://doi.org/10.1093/eurpub/ckab165.247
  30. Shehab K, Ziyab AH. Beliefs of parents in Kuwait about thirdhand smoke and its relation to home smoking rules: a cross-sectional study. Tob Induc Dis 2021; 19: 66. https://doi.org/10.18332/tid/140090
  31. Walley SC, Chime C, Powell J, Walker K, Burczyk-Brown J, Funkhouser E. A brief inpatient intervention using a short video to promote reduction of child tobacco smoke exposure. Hosp Pediatr 2015; 5: 534-541. https://doi.org/10.1542/hpeds.2015-0042

Copyright and license

Copyright © 2025 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

Türkfiliz Demir, G. M., Albayrak, Z., & Acar, T. (2025). Parents’ awareness of third-hand smoke and smoking behaviors. Turkish Journal of Tobacco Control, 5(1), 37-46. https://tjtc.org/article/view/5