OBJECTIVE. There is no safe level of exposure to tobacco smoke. Thirdhand smoke is residual tobacco smoke contamination that remains after the cigarette is extinguished. Children are uniquely susceptible to thirdhand smoke exposure. The objective of this study was to assess health beliefs of adults regarding thirdhand smoke exposure of children and whether smokers and nonsmokers differ in those beliefs. We hypothesized that beliefs about thirdhand smoke would be associated with household smoking bans.
METHODS. Data were collected by a national random-digit-dial telephone survey from September to November 2005. The sample was weighted by race and gender within Census region on the basis of US Census data. The study questions assessed the level of agreement with statements that breathing air in a room today where people smoked yesterday can harm the health of children.
RESULTS. Of 2000 eligible respondents contacted, 1510 (87%) completed surveys, 1478 (97.9%) answered all questions pertinent to this analysis, and 273 (18.9%) were smokers. Overall, 95.4% of nonsmokers versus 84.1% of smokers agreed that secondhand smoke harms the health of children, and 65.2% of nonsmokers versus 43.3% of smokers agreed that thirdhand smoke harms children. Strict rules prohibiting smoking in the home were more prevalent among nonsmokers: 88.4% vs 26.7%. In multivariate logistic regression, after controlling for certain variables, belief that thirdhand smoke harms the health of children remained independently associated with rules prohibiting smoking in the home. Belief that secondhand smoke harms the health of children was not independently associated with rules prohibiting smoking in the home and car.
CONCLUSIONS. This study demonstrates that beliefs about the health effects of thirdhand smoke are independently associated with home smoking bans. Emphasizing that thirdhand smoke harms the health of children may be an important element in encouraging home smoking bans.
Comments
Response to Winickoff et al (1).
This article and the accompanying press releases are a particularly disturbing example of a cultural crusade masquerading as health science. As has been documented by many commentators (e.g., (2-5)), the research results did not show what the authors claimed and implied. Consequently, most of the media articles about one of the most heavily reported health science studies in recent memory were simply wrong. This is an embarrassment for everyone who believes that health science should be science, not just window dressing for a political agenda.
Though the study was only an opinion survey of lay people, it was cast as the discovery of a new health hazard. The media certainly bear the guilt for credulous coverage, and the ostensible experts who were interviewed bear the responsibility for claiming knowledge that they actually lack. These failures resulted in absurd statements like Illinois McLean County Health Director Bob Keller’s: “a cigarette does not have to be lit to release deadly toxins� (6). Perhaps partially as an artifact of uncritically accepting the press release (7), most reports mischaracterized the study as introducing and proving the toxicity of third hand smoke (e.g., (8- 26)). It should be noted that the high proportion of the letters from the public were more accurate than the original press reports.
Furthermore, it turns out that the study did not even represent valid survey research. The methods were those of "push polling" political campaigns that give survey research a very bad name. Such "surveys" attempt to persuade people about false or misleading claims by phrasing them as questions so they are not literal lies. This survey consisted of a series of questions about the hazards of smoking that were designed to cause subjects to think: "Wow, I should agree that each is a problem and that I am worried about it." By the time subjects reached the end and were asked about "third hand smoke", most would probably have expressed worry about anything the questions implicitly told them they should worry about. This is not surprising, given that the "survey" was not conducted by scientific researchers who are experts in finding out what people really think, but by anti-smoking activists whose mission is to persuade people about the evils of tobacco.
One example of the problems with this article a simple list of tobacco or tobacco smoke components (such as Polonium), followed by a negative association of its occurrence (as in the death of the Russian) was used to illustrate its implications in first, second or third hand smoke. This is common practice in anti-tobacco activist rhetoric, but it is inappropriate in publications disseminating science-based knowledge. It would be equally as misleading to use the presence of Polonium on broccoli to imply that ingesting the same via tobacco smoke was somehow healthy.
The reporting of this non-discovery (and its subsequent prominence in the media response to the article (9, 13, 14, 24, 25, 27-29)), further reinforces the public's failure to understand the difference between large risks and trivial ones. The most basic principle of toxicology is that the dose makes the poison, but in this case subjects were intentionally misled to believe that barely measurable quantities of toxins have demonstrable health effects, even if the actual hazard is trivial compared to what they should really be worrying about (diet, exercise, driving safely, and actual exposure to smoke).
If the authors are not aware of this principle, they should not be working in this area. If the authors are aware of the principle, then they are guilty of deliberately compounding existing fears, prejudices and ignorance in both the public and uninformed journalists. More importantly, Pediatrics should not have let this article go to press with this misinformation in place.
The authors, in the article, press release and subsequent interviews, argue the danger of third hand smoke, such that smokers are encouraged to change clothing and bathe before holding their children. And yet, the authors still encourage the smoker to breastfeed the innocent child, rather than substitute a tobacco-free bottle of milk or formula (6). This can only mean that, despite repeating the nonsensical mantra of “there is no safe level of exposure�, whatever this non-safe level of exposure is, it must be much lower than the toxicity of bottle-feeding. The authors also suggest, not in the article but in related interviews, that the nose is an accurate determiner of toxicity, an interesting but outdated pre-scientific method that cynically takes advantage of the lay population (8, 19, 24, 26).
Many educated readers already have a jaundiced view of what passes for epidemiological research, and this article not only justifies their attitude but serves as the epitome of sloppy science, of politics and opinion and desire masquerading as science. We predict that a decade from now, if books and blogs continue to claim that epidemiology is junk science, they will still be citing this article as a perfect example.
Let us reclaim some small semblance of virtue from this study and use it as a template or classroom example of how not to misrepresent research in the public sphere. Let us use it as a caution against how any research might be misinterpreted by those already possessing inadequate models of the world, and those who only look to the news for items which buttress their existing prejudices. If we need ever to apply the cautionary principle, this is the place.
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Pediatrics 2009, 123: e74-e79. (Available at: http://www.pediatrics.org/cgi/content/full/123/1/e74)
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17. MedHeadlines. Third-Hand Smoke Becomes Latest Cigarette Scare. MedHeadlines. Jan 6, 2009. (Available at:
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18. Bartosik M. 'Third-Hand Smoke' Dangerous to Kids, Scientists Find Experts warn of the dangers of smoke even after the cigarette is put out. NBC Chicago. Jan 5, 2009. (Available at:
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19. Rabin RC. A new cigarette hazard: 'third-hand smoke'. New York Times. Jan 2, 2009. (Available at:
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Conflict of Interest:
Potential competing interests: The authors' competing interests compete with each other. Most important, the authors are advocates of encouraging smokers to switch to low-risk sources of nicotine (see their website, TobaccoHarmReduction.org), and so have some incentive to favor exaggerations of the risks from tobacco smoke. Misplaced worry about "third hand smoke" would tend to encourage switching to non-combustion nicotine sources. However, the authors also have a strong interest in resisting attempts to turn epidemiology into a junk science, some of which relates to their tobacco harm reduction research. The authors have worked with and received support from some entities that likely benefit from the public fearing non-existant risks from tobacco smoke (including an unrestricted grant to the University of Alberta from U.S. Smokeless Tobacco Company) and by entities that would likely suffer because of it.
Compassion
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 not about hating smokers. It is about children and others who choose not to smoke being forcibly exposed to tobacco toxins.
Addiction is a brain disease. Yes, that first cigarette is a choice and if you never go there you never have to suffer trying to quit smoking. I firmly believe in free choice for smokers. It is their life, their choice. But, I believe even more strongly in protecting our children. If you want to smoke, do so. But, don't expose others to the toxins.
Research excellent or not, the bottom line bare naked truth is that when you light something on fire, (whether that is a cigar, cigarette, banana peel, joint, crack pipe or anything else for that matter), you are ripping, tearing and shredding your air sacs. Coughing and air pollution pop your air sacs. The number one way to pop so many you end up with emphysema is to light something on fire and suck it in to your lungs. If you don't believe their is such a thing as third hand smoke, just trying scrubbing your walls cupboards and counter tops and look at the rag.
Any addiction makes it the center of your universe and people do things to themselves and others when they are addicted to a substance that they would never do if they weren't addicted. Treatment works!
We all must have compassion for each other. We are all human beings. This world will become a better place only if we all work together to protect our children. They are our future leaders and our most valuable asset.
Conflict of Interest:
Our registered nurses use human organs to teach kids and parents about the power of positive choices in life around alcohol, tobacco, and other drug use, bullying, and compassion.
Research or Yellow Journalism?
The basic substance of this study actually seems fairly sound: the authors investigated to see if people who believed that children would be "threatened" by "toxins" in a room where a number of people had previously been smoking would be more likely to ban smoking in their homes.
The problem lay not in the basic research, but in its seemingly deliberate misrepresentation to the public as being fresh research on the "dangers" of something that had never been shown to be dangerous in any normal sense of the word to begin with. While researchers cannot be held responsible for every word and nuance that might be penned by an irresponsible reporter, their presentation of their research in their paper and their later presentation of that research in quotes to the media certainly set the stage for what is to come.
The authors seem to have cooperated fully with a headline-seeking press in creating a story designed to drive a wedge of fear and disruption within the structures of families and friendships based upon a belief that just barely passes the borderline between superstition and science. As I have shown elsewhere in writings on the web, despite the authors' evident emphasis on the danger of exposing children to the radioactivity of Polonium 210 in tobacco smoke, such exposure, even in extreme circumstances, would have to occur over the course of billions or even trillions of years to approach what the media compares it to.
Did the authors point out to the New York Times that a Russian KGB agent was killed two years ago by one of the "toxic poisons" in "third- hand smoke" ? Even if they did not explicitly mention such an irresponsible comparison they certainly plowed a field upon which yellow journalism would be fertilized and thrive through the first three sentences of the study proper: "There is no safe level of exposure to tobacco smoke. Thirdhand smoke is residual tobacco smoke contamination that remains after the cigarette is extinguished. Children are uniquely susceptible to thirdhand smoke exposure."
They clearly laid the foundations for parents to react in rank fear at the thought of a smoker, or perhaps even the child of a smoker, entering their homes or acting as host to their children's playtime elsewhere. Granny may no longer be welcome in many homes come next Christmas and her lonelyness will have had its roots here.
Even if the medical basis of the concern was something real and immediate, concerns about such social disruption should certainly have played a role in the editorial process. Given the phantasmagorical nature of the basis of the concerns the lack of such editorial oversight by Pediatrics, as well as by the larger news media, is irresponsible in the extreme and should swiftly act to correct this travesty by a followup correctional article accompanied by a level of attention to the media similar to that which attended the original.
Michael J. McFadden Author of "Dissecting Antismokers' Brains" Mid-Atlantic Director, Citizens Freedom Alliance Director, Pennsylvania Smokers Action Network
Conflict of Interest:
The writer is the author of a book in the field of concern and is an unpaid member of and activist with a number of citizens' groups fighting for Free Choice.
this is beyond junk science, it is very bad science
It's bad enough that 'thirdhand smoke' is junk science, like the vast majority of medical science studies and papers are these days, butt what's far worse is that the global news industry is reporting about it erroneously, which, terrifying to say, is far too commonly done, and getting worse daily. 'Thirdhand Smoke' is not a scientifically researched study claiming that 'thirdhand smoke' exists and is killing children, it is a survey of adults to find out how many would believe such a claim to be true, even when no such thing as thirdhand smoke even exists, in the expressed hope of using such a (false bogus) claim to ratchet up even more the anti-smoking (hatred) campaign, with what is obviously the intent of helping to bring about the criminalization and eradication of tobacco smoking world-wide based on said (bogus) claim. BUTT, far worse than this survey, the global news industry is reporting to the public that 'thirdhand smoke' is a new scientific study that says there is such a thing as 'thirdhand smoke' and also claiming that this paper claims 'thirdhand smoke' is killing children. There is no mention whatsoever by the global news industry of this paper being merely a survey to find out if adults would believe such claims, about something that does not even exist. Which is very scary in of itself, that the global news industry so commonly erroneously reports junk science, and makes it 10,000 times worse that it already is. BUTT, by doing so, the global news industry is proving the survey's conclusion to be right. Most adults, the vast majority, will believe bogus junk science claims about 'thirdhand smoke', just as most believe all the other junk science studies' claims about everything else, bought and paid for by profiteers, and those in need of a payoff. Junk science-for-a-buck is NOT just about tobacco. The bigger picture here is that the public should no longer believe anything that the global news industry reports, about anything. THAT is something worthy of being VERY afraid about.
Conflict of Interest:
None declared
Re: Thank you!!!!!!!!
Mary;
your comment leads the reader to believe you have a deep seated hatred of anyone who chooses to smoke a cigarette, supported by any scrap if insignificant diatribe and irrespective of the idea you believe them addicted.
This sends some very real and hypocritical signals; you are not offended by smoking, nearly as much as those sinners you feel entitled to control as subordinates.
The only escape from a life of second class citizenry, would be found by switching the choice of nicotine enhanced products they choose to use. Such an act of repentance would serve to place them back among the blessed ones. This sounds as preachy as it looks and all that is really missing is a bible waving lunatic, placed in the lobby of every hospital on the planet.
Hasn't the second hand chapter of "over reaching", entitled enough division and hatred?
Hitlers most significant entitlement of emotional blackmail was also found in "protecting the children" as is China's protection of Tibet.
Please reconsider your own position and respect of others before defiling the character and security of those around you. This isn't supposed to be about smokers, but smoking, remember?
Regards; Kevin Mulvina
Conflict of Interest:
None declared
Oy!
Dr. Winickoff and Ms. Carey:
Don't you realize how controversial the claims about the effects of secondhand smoke are? I have studied the topic for many years and am convinced that such claims are vastly exaggerated. Risks from "thirdhand smoke" are certainly somewhere between slim and none.
Conflict of Interest:
None declared
Thank you!!!!!!!!
I will be starting immediately to refer to your study as I continue to attempt to change the attitudes and behaviors of smoking parents. As a school nurse I see many children in my office with asthma, allergies and ear infections. It is especially upsetting to me when a parent, reeking of cigarette smoke, comes to the health office to pick up his or her ill child. I usually take them aside and ask the question, "Are you a smoker?" They acknowledge they do smoke but always seem to defensively add, "But I don't smoke around my children." This accommodation is what these parents seem to believe makes their smoking acceptable.
Your study alerts us to the reality that we need to be more aware of third-hand smoke, of particulate matter from tobacco smoke that layers toxins on hair, clothing, and household articles that children can have prolonged contact with each and every day. Raising the possibility "that even extremely low levels of these compounds may be neurotoxic" demands that we as child health care professionals enlighten parents so they can protect their children's health and intellectual development.
Mary E. Carey, RN,MN,SNT Smithtown, NY
Conflict of Interest:
None declared