Development of a scale assessing Beliefs About ThirdHand Smoke (BATHS)
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Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, USA
Regine Haardörfer   

Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
Publish date: 2017-01-17
Tob. Induc. Dis. 2017;15(January):4
Similarly to secondhand smoke (SHS), thirdhand smoke (THS) beliefs may be correlated with smoking behaviors and smokefree policies in the home. Thus, there is a need to develop and validate measures to assess beliefs about THS.

A list of 19 items related to THS were generated by an expert panel and tested in a pilot study. Based on results from an exploratory factor analysis, two factors emerged: THS persistence in the environment and THS impact on health. The scale was reduced to nine items, which showed no differential item functioning by smoking status or smoking ban status in the home. The nine items and the two factor structure were tested in a validation sample from a smoke-free homes intervention that included THS educational materials.

The 9-item scale showed excellent internal consistency. Confirmatory factor analysis indicated good model fit for the two factor solution in a low-income population. Tests of construct validity indicated differences due to exposure to the smoke-free homes intervention, by smoking status, whether participants own or rent their home, and smoking ban status in the home.

The BATHS scale offers researchers a valid and reliable tool to assess THS beliefs.

Karim ZA, Alshbool FZ, Vemana HP, et al. Third-hand smoke. J Cardiovasc Pharmacol. 2015;66:177–82. doi:10.1097/fjc.0000000000000260.
Scotland ASH. Third-hand smoke. 2011.
Becquemin MH, Bertholon JF, Bentayeb M, et al. Third-hand smoking: indoor measurements of concentration and sizes of cigarette smoke particles after resuspension. Tob Control. 2010;19:347–8. doi:10.1136/tc.2009.034694.
Sleiman M, Gundel LA, Pankow JF, et al. Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards. Proc Natl Acad Sci. 2010;107:6576–81. doi:10.1073/pnas.0912820107.
Sleiman M, Logue JM, Luo W, et al. Inhalable constituents of thirdhand tobacco smoke: chemical characterization and health impact considerations. Environ Sci Technol. 2014;48:13093–101. doi:10.1021/es5036333.
Thomas JL, Hecht SS, Luo X, et al. Thirdhand tobacco smoke: a tobacco-specific lung carcinogen on surfaces in smokers’ homes. Nicotine Tob Res. 2013;16:26–32. doi:10.1093/ntr/ntt110.
Matt GE, Quintana PJE, Zakarian JM, et al. When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure. Tob Control. 2010;20:e1. doi:10.1136/tc.2010.037382.
Dreyfuss JH. Thirdhand smoke identified as potent, enduring carcinogen. CA Cancer J Clin. 2010;60:203–4. doi:10.3322/caac.20079.
Burton A. Does the smoke ever really clear? Thirdhand smoke exposure raises new concerns. Environ Health Perspect. 2011;119:a70–4. doi:10.1289/ehp.119-a70.
Matt GE, Quintana PJE, Destaillats H, et al. Thirdhand tobacco smoke: emerging evidence and arguments for a multidisciplinary research agenda. Environ Health Perspect. 2011;119:1218–26. doi:10.1289/ehp.1103500.
Matt G, Quintana P, Hovell M, et al. Households contaminated by environmental tobacco smoke: sources of infant exposures. Tob Control. 2004;13:29–37.
Yolton K, Dietrich K, Auinger P, et al. Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents. Environ Health Perspect. 2004;113:98–103. doi:10.1289/ehp.7210.
Rehan VK, Sakurai R, Torday JS. Thirdhand smoke: a new dimension to the effects of cigarette smoke on the developing lung. Am J Physiol Lung Cell Mol Physiol. 2011;301:L1–8. doi:10.1152/ajplung.00393.2010.
Whitehead TP, Metayer C, Park JS, et al. Levels of nicotine in dust from homes of smokeless tobacco users. Nicotine Tob Res. 2013;15:2045–52. doi:10.1093/ntr/ntt096.
Schick S. Thirdhand smoke: here to stay. Tob Control. 2010;20:1–3. doi:10.1136/tc.2010.040279.
Escoffery C, Bundy L, Carvalho M, et al. Third-hand smoke as a potential intervention message for promoting smoke-free homes in low-income communities. Health Educ Res. 2013;28:923–30. doi:10.1093/her/cyt056.
Winickoff JP, Friebely J, Tanski SE, et al. Beliefs about the health effects of “thirdhand” smoke and home smoking bans. Pediatrics. 2009;123:e74–9. doi:10.1542/peds.2008-2184.
Drehmer JE, Ossip DJ, Rigotti NA, et al. Pediatrician interventions and thirdhand smoke beliefs of parents. Am J Prev Med. 2012;43:533–6. doi:10.1016/j.amepre.2012.07.020.
Kegler MC, Bundy L, Haardörfer R, et al. A minimal intervention to promote smoke-free homes among 2-1-1 Callers: a randomized controlled trial. Am J Public Health. 2015;105:530–7.
Drehmer JE, Ossip DJ, Nabi-Burza E, et al. Thirdhand smoke beliefs of parents. Pediatrics. 2014;133:e850–6. doi:10.1542/peds.2013-3392.
Hovell MF, Hughes SC. The behavioral ecology of secondhand smoke exposure: A pathway to complete tobacco control. Nicotine Tob Res. 2009;11:1254-64. doi:10.1093/ntr/ntp133.
Mullen P, Sava L, Bundy Ł, Haardörfer R, Hovell M, Fernández M, Monroy JA, Williams R, Kreuter M, Jobe D, Kegler M. Minimal Intervention Delivered by 2-1-1 Information and Referral Specialists Promotes Smoke-Free Homes among 2-1-1 Callers: A Texas Generalization Trial. Tob Contr. 2016;25:i10-i18. doi:10.1136/tobaccocontrol-2016-053045.
Hang B, Sarker AH, Havel C, et al. Thirdhand smoke causes DNA damage in human cells. Mutagenesis. 2013;28:381–91. doi:10.1093/mutage/get013.
Schick SF, Farraro KF, Perrino C, et al. Thirdhand cigarette smoke in an experimental chamber: evidence of surface deposition of nicotine, nitrosamines and polycyclic aromatic hydrocarbons and de novo formation of NNK. Tob Control. 2013;23:152–9. doi:10.1136/tobaccocontrol-2012-050915.
Schick SF, Glantz S. Concentrations of the carcinogen 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-butanone in sidestream cigarette smoke increase after release into indoor air: results from unpublished tobacco industry. Cancer Epidemiol Biomark Prev. 2007;16:1547–53. doi:10.1158/1055-9965.epi-07-0210.
Van Loy MD, Nazaroff WW, Daisey JM. Nicotine as a marker for environmental tobacco smoke: implications of sorption on indoor surface materials. J Air Waste Manag Assoc. 1998;48:959–68.
Van Loy MD, Riley WJ, Daisey JM, et al. Dynamic behavior of semivolatile organic compounds in indoor air. 2. nicotine and phenanthrene with carpet and wallboard. Environ Sci Technol. 2001;35:560–7. doi:10.1021/es001372a.
Matt GE, Quintana PJE, Fortmann AL, et al. Thirdhand smoke and exposure in California hotels: non-smoking rooms fail to protect non-smoking hotel guests from tobacco smoke exposure. Tob Control. 2013;23:264–72. doi:10.1136/tobaccocontrol-2012-050824.
Di Iorio CK. Measurement in health behavior : methods for research and education. San Francisco: Jossey-Bass; 2005.
Goodman PG, Haw S, Kabir Z, et al. Are there health benefits associated with comprehensive smoke-free laws. Int J Public Health. 2009;54:367–78. doi:10.1007/s00038-009-0089-8.
Hahn EJ. Smokefree legislation. Am J Prev Med. 2010;39:S66–76. doi:10.1016/j.amepre.2010.08.013.
King BA, Patel R, Babb SD. Prevalence of smokefree home rules—United States, 1992–1993 and 2010–2011. MMWR Morb Mortal Wkly Rep. 2014;63:765–9.
Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people’s intentions and behavior? A meta-analysis of experimental studies. Psychol Bull. 2014;140:511–43. doi:10.1037/a0033065.
Alamar BC, Glantz SA. Smoke-free ordinances increase restaurant profit and value. Contemp Econ Policy. 2004;22:520–5. doi:10.1093/cep/byh038.
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