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. 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. http://www.nytimes.com/2009/01/03/health/research/03smoke.html?_r=1&  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!!!