Third-hand smoke: an Emerging Healthcare Challenge

1. Third-hand smoke: an Emerging Healthcare Challenge Maher Mouzer Teresa Goncalves

2. Outline • Background • Underlying Dangers • Project focus and methods • Project plan • Future applications

3. Background – Harm to Smoker • In 1964 it was officially acknowledged the harmful effects of cigarette smoking • General belief was that the damaging effects of tobacco was restricted to the smoker

4. Background second-hand Smoke • In 1981, Japanese epidemiologist Takeshi Hirayama published a ground-breaking study relating an increased incidence of lung cancer among non-smoking women married to men who smoked - Second-hand smoking • Widespread denial from the tobacco industry • Hirayama’s work has stood the test of time and reinforced efforts to protect non-smokers from second-hand exposure to tobacco • Chemicals Identified for second hand smoke.

5. Background second-hand Smoke Statistics Canada (2008)

6. Background – Harm to Smoker • Tobacco-related illnesses will continue to be a leading cause of death worldwide (Jha, P., 2009) Nature Reviews Cancer 9, 655-664 (September 2009); doi:10.1038/nrc2703

7. Background third-hand Smoke • In 2009, investigators at the Mass General Hospital for Children in Boston devised a new term, • Third-hand smoke • Refers to the residual gas and particles that remain trapped on hair, skin, and surfaces long after a cigarette is extinguished

8. Underlying Dangers – High Exposure • Increased risk of exposure for non-smokers • Much higher than second hand smoking • Stay and accumulate indefinitely • Cannot be removed by ventilation and soap cleaners • Nicotine requires special detergents to be removed from surfaces • Volatile Organic Compounds (VOCs) can strongly bind to fabric and ceilings • Multiple Routes of entry • skin • breathing • ingestion • Infants are at high risk • Crawling and touching surfaces • Physical contact with parents that smoke

9. Underlying Dangers – toxic chemicals • Chemicals that may pose health risks in third-hand smoking are similar to second hand smoking like VOC’s, heavy metals, gases and radioactive material • Secondary potent cancer-causing compounds from tobacco-derived toxicants: • Accumulated nicotine on surfaces reacts with ambient nitrous acid generated by certain appliances to form carcinogenic tobacco-specific nitrosamines (TSNAs) (Sleiman M., 2010)

10. References • Rabin, R. C. (2009) A new cigarette hazard: Third-hand smoke. Accessed from http://www.nytimes.com/2009/01/03/health/research/03smoke.html?_r=1&, on March 22, 2013. • Matt GE, Quintana PJ, Hovell MF, Bernert JT, Song S, Novianti N, Juarez T, Floro J, Gehrman C, Garcia M, Larson S. (2004) Households contaminated by environmental tobacco smoke: sources of infant exposures. Tob Control. 13(1):29-37 • Sleiman, M., Gundel, L. A., Pankow, J. F., Peyton, J., Singer, B., Destaillats, H. (2010) Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards. PNAS Early Edition 1-6 • Winickoff, J. P., Friebely, J., Tanski, S. E., Sherrod, C., Matt, G.E., Hovell, M.F., McMille, R.C. (2009) Beliefs About the Health Effects of ''Thirdhand'' Smoke and Home Smoking Bans. Pediatrics 123:e73-e79 • Kuschner, W.G., Reddy, S., Mehrotra, N., Paintal, H.S. (2011) Electronic cigarettes and thirdhand tobacco smoke: two emerging healthcare challenges for the primary care provider. Int. J. of Gen. Med. 4:115-120

11. Thank you!!!