Healthy Homes

The Hidden Hazard of Third Hand Smoke

Tobacco use causes 20% of cancer deaths worldwide, and it is estimated that tobacco-related deaths will result in 10-million deaths annually by 2020. We've come a long way since the mid-1900's in understanding the negative health effects of tobacco to smokers.

More recently, we've learned that second hand smoke also has deleterious consequences for those who are exposed to it. Yet, the concept of third hand smoke goes largely unnoticed even though a study in 1953 first identified the problem.

What is third hand smoke?

• Third hand smoke is nicotine residue that remains on surfaces including walls, doors, drapery, carpets, clothes, furniture, flooring material, and acoustic tiles in ceilings. This pollutant also can be inhaled when it is re-emitted through dust in the air, and it can react with substances in the environment to create secondary pollutants on surfaces.
• People, especially seniors and children, and pets are affected by this under-appreciated health hazard through skin exposure, dust inhalation and ingestion.
• Some chemicals* found in third hand smoke are:
  -hydrogen cyanide (used in chemical weapons)
  -butane (used in lighter fluid)
  -toluene (found in paint thinners)
  -arsenic
  -lead
  -carbon monoxide
  -polonium-210, a highly radioactive carcinogen
• Research demonstrates that tobacco smoke is a toxic substance with no safe level of exposure, and that the risks from exposure are largely dose related.

*Visit the CDC’s Agency for Toxic Substances and Disease Registry for information on health risks associated with these chemicals. 

Who is affected by third hand smoke?

• Third hand smoke affects people who live in homes, hotels, or any indoor environment that was used long term by smokers. Even cars used by smokers can have third hand smoke residue.

• Babies, toddlers, and children are at greater risk of negative health effects because:

1) they inhale 40 times more than adults

2) they have greater hand/object/mouth contact so they absorb proportionately more through ingestion

3) have greater absorption through their skin

• Data show that individuals classified as low socio-economic status tend to live in more multi-unit housing where smoking may not be banned.
  If your neighbor smokes, it can get into your apartment through the ventilation system.
  Third hand smoke can be present in apartments even if they have been vacant for two months and are cleaned and prepared for new residents.

How can Environmental Health professionals help?

Third hand smoke is part of an individual’s built environment, which often they have little control over. Environmental health professionals seek to protect people against environmental factors that may adversely impact human health; they are instrumental in enforcing regulations and providing health education to limit third hand smoke exposure and associated disease outcomes.

Learn more about Tobacco and EH Professionals

Why have I never heard about third hand smoke before?

It took decades to develop the proponderance of evidence and prove that smoking causes lung cancer and a multitude of other adverse health effects. It took additional years to prove second hand smoke also kills.
It was only recently that scientists identified third hand smoke from tobacco combustion lingering on clothing, bedding, carpeting and furniture and attributed their contribution to adverse health effects.

What can be done to limit exposure of third hand smoke?

A 2010 study indicated that third-hand smoke accumulates in smokers' homes and persists even after homes have been vacant for two months and are cleaned and prepared for new residents.
This study also indicates that there is not much that can be done in terms of cleaning third hand smoke in affected places. Recommendations to minimize potential negative health effects are:

• Avoid any indoor environment that was used long-term by smokers.
• Insist that smokers go outdoors and do not smoke in homes or in cars.
• Support smoking bans and enforcement of them.
• In homes with long term smoke exposure consider replacing carpets, ventilation systems, furniture, etc.

While research needs to be done on how to clean up third hand smoke, it is best to simply avoid any indoor environment that was used long-term by smokers.

Smoke Free Places in the U.S.

To find local ordinances, maps, and resources for smoke-free venues, visit No-Smoke.org. 

Many of the following indoor places in the U.S. have become smoke free:

• Hospitals
• Nursing Homes
• Colleges and Universities
• Correctional facilities
• Hotels/motels
• Airports
• Major League Baseball, National Football League stadiums
• Multi-Unit housing
• Casinos and Gambling Facilities
• Pharmacies (CVS)
• Bars and restaurants
• Workplaces

Many outdoor areas are becoming smoke free in the U.S. as well, such as:

• Beaches
• Public Transit spaces
• Parks and zoos
• Outdoor patios

Maps at http://www.no-smoke.org/goingsmokefree.php?id=519#maps

Tobacco and Environmental Health Implications

Tobacco use causes 20% of cancer deaths worldwide, and it is estimated that tobacco-related deaths will result in 10-million deaths annually by 2020. We've come a long way since the mid-1900's in understanding the negative health effects of tobacco.  

NEHA celebrated World Environmental Health Day on September 26, along with the International Federation of Environmental Health (IFEH) and many other organizations to shed light on the important work of environmental health around the world. This year's theme is tobacco control and NEHA is focusing specifically on the negative health effects of second and third hand smoke to individuals and societies.
 
We invite you to raise awareness of World EH Day and the environmental health implications of the growth, sale, and use of tobacco products.

Learn More Tobacco and Environmental Health Implications

• Environmental Health and Tobacco
• Second Hand Smoke
• Third Hand Smoke
• Tobacco and EH Professionals 

World EH Day Toolkit

Check out our toolkit for World EH Day resources you can use to help spread the word to others.

Description of Award Categories

Award submissions will be considered in one of three categories described on this page. An organization may submit only a single application as the lead agency. Organizations may participate as partnering organizations in more than one application.

Public Housing/Multifamily Housing

• Eligible Applicants: Public Housing Authorities; Tribal Designated Housing Entities; multifamily housing owners and managers; and resident organizations (for example, tenant task forces) in public or private assisted housing.
• Nomination Examples: A Public Housing Authority’s universal adoption of smoke-free housing; adoption of integrated pest management policies; or tenant task force creating and implementing a resident health and energy program.
• Outcome Data Examples: Number of residents impacted by policy; number or rate of residents with improved health outcomes due to implementation of healthy homes activity; number or rate of reduction in asthmatic episodes among residents; or measurable reduction of indoor air pollutants related to policy.

Policy, Education and Research Innovation

• Eligible Applicants: State, County, City, Tribes, regional units of government (including legislative bodies); healthcare providers (including hospitals); universities and schools of higher education; nonprofit organizations; health insurance providers; advocacy organizations; university extension offices; schools at K-12 levels; faith-based organizations; labor unions; tribal associations; childcare providers; and disaster recovery organizations.
• Nomination Examples: Creating adopted local/state code enhancements with significant health outcomes or impacts; innovative programs in lead, asthma, radon, injury prevention, smoke-free housing/smoking cessation, maternal child health programs, and home visiting programs; developing a system for enhancing housing and/or code inspection efficiency and effectiveness; research related to environmental conditions, such as allergens, and resident health.
• Outcome Data Examples: Numbers of localities adopting public policy change(s); or number of residents directly and indirectly affected by the public policy change(s). Research Innovation applicants should have recent (or in process) peer-reviewed published articles. (See more information below under Research Innovation Applications.)

Cross Program Coordination

• Eligible Applicants: State, County, City, regional units of government; healthcare providers (including hospitals); housing providers; nonprofit organizations; health insurance providers; advocacy organizations; weatherization and inspectional services; entities associated with federal agencies such as National Association for State Community Services Programs (NASCSP); and organizations representing affordable housing developers and builders.
• Nomination Examples: Comprehensive cross-program coordination (for example, a county health department coordinating asthma interventions with Community Development Block Grant program and/or HOME program rehabilitation resources; a national or regional foundation creates and funds a healthy housing program based on cross sector coordination.)
• Outcome Data Examples: Number or rate of residents with improved health outcomes due to implementation of healthy homes activity (for example, reduction in asthmatic episodes among residents or falls in the home among elderly people).

Criteria for Judging

Applications will be judged on meeting eligibility criteria, completeness, timeliness, and employing the required format. Note: Previous year’s award winners are ineligible to apply for the award this year. Applications will be subject to a thorough screening and review of eligibility, program/technical, and impact/effectiveness. Applications will be evaluated by an independent panel of judges selected by NEHA.

The evaluation process includes, but is not limited to, an assessment of the criteria in the following list. Due to the wide variety of projects that can be considered, a project does not need to address each criterion. In the text of the application description section (the five-page maximum policy/program narrative), the application should describe:

• Policy/Program Innovation: Specific emphasis on the policy/program’s impact on a health/housing condition(s) previously unaddressed or specific improvements made to existing programs. Policies/programs do not necessarily need to address a new subject of concern, but all policies/programs discussed should demonstrate innovative aspects of addressing the concerns.
• Health Impact on Population: Data on the policy/program’s health outcomes including, where available, data on healthcare utilization (for example, emergency/urgent care visits, inpatient hospital stays, healthcare costs); absenteeism from school or work; data on self-reported or objectively reported symptom impact; and data on reduction of unhealthy resident activities (for example, use of tobacco products, proximity to those who smoke).
• Impact on Physical Environment: Data on the policy/program’s effect on reducing environmental hazards (for example, lead paint hazards, asbestos, combustion gases, toxic chemicals, asthma triggers/allergens); home safety hazards; and other impacts.
• Partnership/Collaboration: How the policy/program was developed and implemented and the role(s) that partnering organizations played. These partnering organizations do not necessarily need to be formal partners and may have played an important role in just one or a few phases of the development or implementation of the policy/program. The text should identify whether formal partnerships do exist and describe ongoing efforts to coordinate activities. Applicants should identify whether the policy/ program was or is supported by philanthropy, governmental, and/or other sources and what kind(s) of support was (were) provided.
• Economic Sustainability: How the policy/program will continue to have impact into the future. In cases of policy advances based on statutory or regulatory actions, a description of anticipated permanence; for example, lack of sunset provision in the legislation or demonstration of ongoing industry acceptance of policy, will suffice. For program sustainability, applicants should describe permanent and temporary sources of support.

Research Innovation Applications

Under the Research Innovation category, the applications identified as Research Innovation will be judged utilizing the criteria in the following list. Policy and Education Innovation applications, whether from public or private organizations, will be reviewed in accordance with the standards established under the Criteria for Judging section. The following criteria apply only to Research Innovation applications, and applications in this category will be judged solely on these criteria.

• The research innovation must have been published within the past two years or accepted for publication in a peer-reviewed journal. Ongoing research is not eligible. Applications should include an electronic copy of the publication or evidence of the research being accepted for publication.
• The research innovation should address a key data gap on an important healthy homes focus area (for example, a description of the importance of the research based on the health impact of the hazard/condition or the contribution of the hazard/condition to health disparities). The importance of the hazard/condition targeted by the research and any disparate impact on vulnerable populations should be supported by referencing objective data sources (for example, published literature).
• The application should describe how the research findings can be used for informing healthy homes programs or policies and the potential impact of the research in reducing indoor environmental hazards and ultimately improving health outcomes. (That is, address the extent to which the research findings can be translated into improved policy or practice and the resulting impact.)
• For research conducted in the field, the application should describe to what extent community members were involved in the project. Examples of community involvement include meetings with the community members to obtain community feedback, participation of community members on a research advisory board, formal partnerships with one or more community-based organizations, and training and hiring of community members to work on the study (for example, participating as community health workers).

Important Additional Information

• No confidential, trade-secret, or otherwise non-disclosable information may be submitted. Neither NEHA nor HUD will review an application that indicates that it contains such information.
• Applications from individuals or for profit organizations will not be reviewed.
• All applications become the property of NEHA, with HUD obtaining a license-free right to copy and distribute information in them. No fee is required to submit an entry or receive an award.

Tips for Completing the Application

Here are some helpful suggestions and reminders:

• The activities or policies nominated must show measurable benefits in the health of residents and be available to low-and/or moderate-income families.
• Organizations can submit only one application as the Applicant Organization, however they may be listed as partnering organizations in more than one application.
• Use relevant data to help communicate the value of your program, project or research.
• The following resources are available to help you complete your application:
  • Past award-winner descriptions and program profiles on HUD Secretary's Award for Healthy Homes website and
  • NEHA's HUD Secretary's Award for Healthy Homes website.

Apply for HUD Healthy Homes Award

The U.S. Department of Housing and Urban Development, in partnership with the National Environmental Health Association (NEHA), announces the annual Secretary’s Awards for Healthy Homes.

These awards recognize excellence in making indoor environments healthier through healthy homes research, education, and through program delivery, especially in diverse, low to moderate income communities.

The awards are presented at NEHA's Annual Educational Conference & Exhibition each year.

2015 Award Winners

Cross Porgram Coordination among Health, Environment, and Housing

Alaska Native Tribal Health Consortium

Children's Mercy Hospitals and Clinics in Kansas City, Missouri

Public Housing/Multifamily Supported Housing

Wisconsin Housing and Economic Development Authority

Public Policy

Breathe Easy Coalition of Maine, Smoke-Free Housing Coalition of Maine

2015 Press Releases and Announcements

2015 HUD Secretary’s Award for Healthy Homes Winners Announced: Alaska, Maine, Missouri, and Wisconsin programs cited as national models

2015 HUD Secretary’s Awards for Healthy Homes – All Program Descriptions

Follow-up on 2015 HUD Secretary’s Award for Healthy Homes Winners: The New HUD Secretary’s Awards for Healthy Homes, An Interview with Martin Nee

2015 Award Review Panel

Thank you! The review panel volunteered their expertise and many hours of their time. 

Rebecca Blocker, MS, HHS, Housing and Environmental Design Specialist, University of Missouri Extension, Farmington, MO

Sonja Koukel, PhD, Community and Environmental Health Specialist and Co-Director, Extension Family & Consumer Sciences, New Mexico State University, Las Cruces, NM

Stephan Ruckman, NEHA Technical Advisor for Schools, Environmental Health Manager, Worthington City Schools, Dublin, OH

Sandra Whitehead, MPA, PhD, NEHA Technical Advisor for Healthy Homes and Healthy Communities, Director of Healthy Community Design at NACCHO, Washington, DC

Felix Zemel, MCP, MPH, REHS/RS, CEHT, HHS, DAAS, NEHA Technical Advisor for Land Use Planning and Design, Building Commissioner, Zoning Code Enforcement, Town of Sherborn, Sherborn MA