A Third-Hand Look at Smoking

Third-hand smoke, the residual particulate matter of tobacco smoke remaining after a cigarette is extinguished, may represent an additional serious health hazard, particularly in the home. It has been found on surfaces, including furniture, carpeting, clothing, and even on an individual’s hair. The residual nicotine in this contamination has been found to react with atmospheric nitrous acid, forming carcinogenic substances referred to as tobacco-specific nitrosamines (Sleiman et al. Proc Natl Acad Sci USA. 2010;107[15]:6576). Third-hand smoke contains over 250 products, including the known toxins of butane, carbon monoxide, cyanide, ammonia, toluene, arsenic, lead, chromium, cadmium, and radioactive polonium-210 (Winickoff et al. Pediatrics. 2009;123[1]e:74). It therefore represents an insidious danger well after active smoking has stopped. For instance, nonsmokers moving into a home of a previous smoker had higher levels of skin nicotine and urine cotinine, even after the home had been vacant for 2 months (Tobacco Control. 2001;20:1-8).

Young children are particularly vulnerable to the effects of third-hand smoke exposure because they crawl or place contaminated objects in their mouths. A high serum cotinine level in children has been shown to be associated with lower scores in reading, mathematics, and block design skills (Environ Health Perspect. 2005;113[1]:98).

Although many individuals are aware of the health risks associated with first-and second-hand smoke, few are aware of third-hand smoke and its resultant danger. The knowledge that third-hand smoking is harmful was found to be an independent variable to home smoking bans (Winickoff et al. Pediatrics. 2009; 123[1]:e74). Patient education about third-hand smoke is an important way to counsel smokers on the multiple dangers of tobacco exposure and will help reduce the threat of tobacco-related diseases in our most vulnerable population.

Dr. Timothy B. Coyle; and
Dr. Daniel A. Gerardi, FCCP
NetWork Chair