Unveiling the hidden threats: second-hand and thirdhand smoke's impact on health – a systematic review
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20261048Keywords:
Secondhand smoke, Thirdhand smoke, Tobacco control, Public health risk, Vulnerability of children, Smoke-free policiesAbstract
Cigarette smoking remains a significant global public health concern, contributing substantially to morbidity and mortality worldwide. This article examines the evolving understanding of the smoking epidemic, with particular emphasis on India, the world’s second-largest consumer of tobacco. Despite notable progress in tobacco control initiatives, substantial challenges persist. Exposure to secondhand smoke (SHS) and the emerging concept of thirdhand smoke (THS) present serious health risks, especially within domestic environments. Drawing on a synthesis of existing research, this paper explores perceptions of THS among the Indian population and identifies demographic factors influencing these perceptions. The findings indicate that older adults, females, individuals with higher levels of education, and non-smokers are more likely to recognize the adverse health effects associated with THS. Furthermore, the study highlights the significant public health risks posed by exposure to SHS and THS, emphasizing the heightened vulnerability of children. These findings underscore the urgent need for comprehensive smoke-free policies. The article recommends the implementation of targeted educational interventions, the strengthening of smoke-free regulations, and further research to better understand the health impacts of THS. Addressing THS alongside conventional tobacco control measures can enable policymakers and public health authorities to reduce tobacco smoke exposure and promote healthier environments for all.
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References
Perez-Warnisher MT, De Miguel MDPC, Seijo LM. Tobacco Use Worldwide: Legislative Efforts to Curb Consumption. Ann Glob Health. 2018;84(4):571-9. DOI: https://doi.org/10.29024/aogh.2362
Samet JM. Tobacco smoking: the leading cause of preventable disease worldwide. Thorac Surg Clin. 2013;23(2):103-12. DOI: https://doi.org/10.1016/j.thorsurg.2013.01.009
Lahoti S, Dixit P. Declining trend of smoking and smokeless tobacco in India: A decomposition analysis. PLoS ONE. 2021;16(2):e0247226. DOI: https://doi.org/10.1371/journal.pone.0247226
Jha P, Beyer J, Heller PS. Finance and Development | F&D. Finance and Development. Available at: https://www.imf.org/external/pubs/ft/fandd/1999/12/jha.htm. Accessed on 24 January 2026.
Centers for Disease Control and Prevention. CDCTobaccoFree. Health Effects of Smoking and Tobacco Use. 2022. Available at: https://www.cdc. gov/tobacco/basic_information/health_effects/index.htm. Accessed on 24 January 2026.
Mishra GA, Pimple SA, Shastri SS. An overview of the tobacco problem in India. Indian J Med Paediatr Oncol Off J Indian Soc Med Paediatr Oncol. 2012;33(3):139-45. DOI: https://doi.org/10.4103/0971-5851.103139
Intarut N, Thronsao M, Pukdeesamai P. Promoting Smoke-Free Environments: The Impact of Thirdhand Smoke Awareness on Smoking Bans at Home. Asian Pac J Cancer Prev APJCP. 2023;24:2917-21. DOI: https://doi.org/10.31557/APJCP.2023.24.8.2917
Singh SK, Kumar S, Kashyap GC. Tobacco Use and Cessation among a Nationally Representative Sample of Men in India, 2019–2021. J Smok Cessat. 2023;2023:4292647. DOI: https://doi.org/10.1155/2023/4292647
MOHFW. Global Adult Tobacco Survey Second Round-India-2016-2017. Available at: https://ntcp. mohfw.gov.in/assets/document/surveys-reports-publications/Global-Adult-Tobacco-Survey-Second-Round-India-2016-2017.pdf. Accessed on 24 January 2026.
Lubick N. Smoking and secondhand smoke: Global Estimate of SHS Burden. Environ Health Perspect. 2011;119(2):A66-7. DOI: https://doi.org/10.1289/ehp.119-a66
Fong GT, Hyland A, Borland R, Hammond D, Hastings G, McNeill A, et al. Reductions in tobacco smoke pollution and increases in support for smoke‐free public places following the implementation of comprehensive smoke‐free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tob Control. 2006;15(Suppl 3):iii51-8. DOI: https://doi.org/10.1136/tc.2005.013649
Nanninga S, Lhachimi SK, Bolte G. Impact of public smoking bans on children’s exposure to tobacco smoke at home: a systematic review and meta-analysis. BMC Public Health. 2018;18:749. DOI: https://doi.org/10.1186/s12889-018-5679-z
Myers V, Rosen LJ, Zucker DM, Shiloh S. Parental Perceptions of Children's Exposure to Tobacco Smoke and Parental Smoking Behaviour. Int J Environ Res Public Health. 2020;17(10):3397. DOI: https://doi.org/10.3390/ijerph17103397
National Cancer Institute. Cigarette Smoking: Health Risks and How to Quit. 2023. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/quit-smoking-pdq. Accessed on 24 January 2026.
Bonnie RJ, Stratton K, Kwan LY. The Effects of Tobacco Use on Health. In: Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. National Academies Press (US). 2015. Available at: https://www.ncbi. nlm.nih.gov/books/NBK310413/. Accessed on 24 January 2026. DOI: https://doi.org/10.17226/18997
Chandran MP, Madhavan A. A cross-sectional study on beliefs about thirdhand smoke among the general population in Bangalore city, India. Int J Community Med Public Health. 2022;9(10):3694-700. DOI: https://doi.org/10.18203/2394-6040.ijcmph20222558
Indumathy M, Pradeep Kumar R, Meignana Arumugam I. Knowledge and awareness of thirdhand smoke among smokers and non-smokers: A comparative cross-sectional study. J Contemp Issues Bus Gov. 2020;26(2). DOI: https://doi.org/10.47750/cibg.2020.26.02.256
Çoşğun İG, Çilekar Ş, Balcı A, Köymen BN, Moral S, Nur B, et al. The beliefs of medical faculty students about thirdhand smoke. Tob Induc Dis. 2023;21(1):1-8. DOI: https://doi.org/10.18332/tid/157202
St.Helen G, Bernert JT, Hall DB, Sosnoff CS, Xia Y, Balmes JR, et al. Exposure to Secondhand Smoke Outside of a Bar and a Restaurant and Tobacco Exposure Biomarkers in Nonsmokers. Environ Health Perspect. 2012;120(7):1010-6. DOI: https://doi.org/10.1289/ehp.1104413
Alzahrani SH. Levels and factors of knowledge about the related health risks of exposure to secondhand smoke among medical students: A cross-sectional study in Jeddah, Saudi Arabia. Tob Induc Dis. 2020;18:88. DOI: https://doi.org/10.18332/tid/128317
Farrell KR, Weitzman M, Karey E, Lai TKY, Gordon T, Xu S. Passive exposure to e-cigarette emissions is associated with worsened mental health. BMC Public Health. 2022;22:1138. DOI: https://doi.org/10.1186/s12889-022-13470-9
Schiavone S, Anderson C, Mons U, Winkler V. Prevalence of second-hand tobacco smoke in relation to smoke-free legislation in the European Union. Prev Med. 2022;154:106868. DOI: https://doi.org/10.1016/j.ypmed.2021.106868
Flor LS, Anderson JA, Ahmad N, Aravkin A, Carr S, Dai X, et al. Health effects associated with exposure to secondhand smoke: a Burden of Proof study. Nature Med. 2024;30:149-67. DOI: https://doi.org/10.1038/s41591-023-02743-4
American Lung Association. 9 of the Worst Diseases You Can Get from Secondhand Smoke | State of Tobacco Control. Available at: https://www.lung. org/research/sotc/by-the-numbers/9-diseases-secondhand-smoke. Accessed on 24 January 2026.
Skipina TM, Upadhya B, Soliman EZ. Exposure to secondhand smoke is associated with increased left ventricular mass. Tob Induc Dis. 2021;19:43. DOI: https://doi.org/10.18332/tid/136415
Lee CC, Middaugh NA, Howie SRC, Ezzati M. Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial Carriage: A Systematic Review and Meta-analysis. PLOS Med. 2010;7(12):e1000374. DOI: https://doi.org/10.1371/journal.pmed.1000374
Tang ZR, Xu XL, Deng SL, Lian ZX, Yu K. Oestrogenic Endocrine Disruptors in the Placenta and the Fetus. Int J Mol Sci. 2020;21(4):1519. DOI: https://doi.org/10.3390/ijms21041519
Woods L, Perez-Garcia V, Hemberger M. Regulation of Placental Development and Its Impact on Fetal Growth—New Insights From Mouse Models. Front Endocrinol. 2018;9:570. DOI: https://doi.org/10.3389/fendo.2018.00570
Lin L, Xu SL, Wu QZ, Zhou Y, Ma HM, Chen DH, et al. Exposure to second-hand smoke during early life and subsequent sleep problems in children: a population-based cross-sectional study. Environ Health. 2021;18:20. DOI: https://doi.org/10.1186/s12940-021-00793-0
Chang CW, Chang CH, Chuang HY, Cheng HY, Lin CI, Chen HT, et al. What is the association between secondhand smoke (SHS) and possible obstructive sleep apnea: a meta-analysis. Environ Health. 2022;21:58. DOI: https://doi.org/10.1186/s12940-022-00868-6
Wang K, Wang Y, Zhao R, Gong L, Wang L, He Q, et al. Relationship between childhood secondhand smoke exposure and the occurrence of hyperlipidaemia and coronary heart disease among Chinese non-smoking women: a cross-sectional study. BMJ Open. 2021;11(7):e048590. A DOI: https://doi.org/10.1136/bmjopen-2020-048590
Raghuveer G, White DA, Hayman LL, Woo JG, Villafane J, Celermajer D, et al. Cardiovascular Consequences of Childhood Second Hand Tobacco Smoke Exposure. Circulation. 2016;134(16):e336-59. DOI: https://doi.org/10.1161/CIR.0000000000000443
Fan HC, Chen CY, Hsu YC, Chou RH, Teng CLJ, Chiu CH, et al. Increased risk of incident nasopharyngeal carcinoma with exposure to air pollution. PLoS ONE. 2018;13(9):e0204568. DOI: https://doi.org/10.1371/journal.pone.0204568
Hajar R. Risk Factors for Coronary Artery Disease: Historical Perspectives. Heart Views Off J Gulf Heart Assoc. 2017;18(3):109-14. DOI: https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_106_17
Mariano LC, Warnakulasuriya S, Straif K, Monteiro L. Secondhand smoke exposure and oral cancer risk: a systematic review and meta-analysis. Tob Control. 2022;31(5):597-607. DOI: https://doi.org/10.1136/tobaccocontrol-2020-056393
Wang A, Kubo J, Luo J, Desai M, Hedlin H, Henderson M, et al. Active and passive smoking in relation to lung cancer incidence in the Women’s Health Initiative Observational Study prospective cohort. Ann Oncol. 2015;26(1):221-30. DOI: https://doi.org/10.1093/annonc/mdu470
Lovelina Francis D, Sampoornam Pape Reddy S. The silent assassin: Third hand smoking. J Glob Health. 2022;12:03079. DOI: https://doi.org/10.7189/jogh.12.03079
Lee E, Kim KY. The Association between Secondhand Smoke and Stress, Depression, and Suicidal Ideation in Adolescents. Healthcare. 2021;9(1):39. DOI: https://doi.org/10.3390/healthcare9010039
Hahad O, Beutel M, Gilan DA, Michal M, Schulz A, Pfeiffer N, et al. The association of smoking and smoking cessation with prevalent and incident symptoms of depression, anxiety, and sleep disturbance in the general population. J Affect Disord. 2022;313:100-9. DOI: https://doi.org/10.1016/j.jad.2022.06.083
Schiliro M, Vogel ER, Paolini L, Pabelick CM. Cigarette Smoke Exposure, Pediatric Lung Disease, and COVID-19. Front Physiol. 2021;12:652198. DOI: https://doi.org/10.3389/fphys.2021.652198
Tattan-Birch H, Jarvis MJ. Children's exposure to second-hand smoke 10 years on from smoke-free legislation in England: Cotinine data from the Health Survey for England 1998-2018. Lancet Reg Health Eur. 2022;15:100315. DOI: https://doi.org/10.1016/j.lanepe.2022.100315
Li K, Ricker K, Tsai FC, Hsieh CJ, Osborne G, Sun M, et al. Estimated Cancer Risks Associated with Nitrosamine Contamination in Commonly Used Medications. Int J Environ Res Public Health. 2021;18(18):9465. DOI: https://doi.org/10.3390/ijerph18189465
Kishore S, Shah V, Bera OP, Venkatesh U, Kakkar R, Aggarwal P, et al. Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case–control study. Front Public Health. 2023;11:1210102. DOI: https://doi.org/10.3389/fpubh.2023.1210102
Vissing NH, Larsen JM, Rasmussen MA, Chawes BLK, Thysen AH, Bønnelykke K, et al. Susceptibility to Lower Respiratory Infections in Childhood is Associated with Perturbation of the Cytokine Response to Pathogenic Airway Bacteria. Pediatr Infect Dis J. 2016;35(5):561-6. DOI: https://doi.org/10.1097/INF.0000000000001092
Arfaeinia H, Ghaemi M, Jahantigh A, Soleimani F, Hashemi H. Secondhand and thirdhand smoke: a review on chemical contents, exposure routes, and protective strategies. Environ Sci Pollut Res. 2023;30(32):78017-29. DOI: https://doi.org/10.1007/s11356-023-28128-1
Pitten L, Brüggmann D, Dröge J, Braun M, Groneberg DA. Impact of different ventilation conditions on tobacco smoke-associated particulate matter emissions in a car cabin using the TAPaC platform. Sci Rep. 2023;13:8216. DOI: https://doi.org/10.1038/s41598-023-35208-2
Calo WA, Krasny SE. Environmental determinants of smoking behaviors: The role of policy and environmental interventions in preventing smoking initiation and supporting cessation. Curr Cardiovasc Risk Rep. 2013;7(6):446-52. DOI: https://doi.org/10.1007/s12170-013-0344-7
Barnoya J, Navas-Acien A. Protecting the world from secondhand tobacco smoke exposure: where do we stand and where do we go from here? Nicotine Tob Res. 2013;15(4):789-804. DOI: https://doi.org/10.1093/ntr/nts200
Jacob P, Benowitz NL, Destaillats H, Gundel L, Hang B, Martins-Green M, et al. Thirdhand Smoke: New Evidence, Challenges, and Future Directions. Chem Res Toxicol. 2017;30(1):270-94. DOI: https://doi.org/10.1021/acs.chemrestox.6b00343
Fan Z, Lioy P, Weschler C, Fiedler N, Kipen H, Zhang J. Ozone-Initiated Reactions with Mixtures of Volatile Organic Compounds under Simulated Indoor Conditions. Environ Sci Technol. 2003;37:1811-21. DOI: https://doi.org/10.1021/es026231i
Matt G, Greiner L, Record R, Wipfli H, Long J, Dodder N, et al. Policy-relevant differences between secondhand and thirdhand smoke: strengthening protections from involuntary exposure to tobacco smoke pollutants. Tob Control. 2023;tc-2023. DOI: https://doi.org/10.1136/tc-2023-057971
World Health Organization. Policy recommendations on protection from exposure to second-hand tobacco smoke. Available at: https://www.who.int/ publications-detail-redirect/9789241563413. Accessed on 24 January 2026.
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