Background: Third hand smoke (THS) forms when second hand smoke (SHS) tobacco toxins accumulate on surfaces such as walls, carpets and clothing and can result in adverse health effects. Objective: This study was designed to investigate the mechanism of THS-induced hepatic steatosis. Methodology: We used an in vivo exposure system that mimics exposure of humans to THS to investigate the effects of THS on hepatic lipid metabolism. THS-exposed mice were treated either with the liver-damaging drug, Nacetyl-p-aminophenol (APAP/Tylenol) to increase oxidative stress or with the antioxidants N-acetyl-cysteine and α-Tocopherol which decrease oxidative stress. Results: THS-exposed mice have higher levels of superoxide dismutase activity and H 2 O 2 levels. However, no significant changes in activity of the antioxidant enzymes catalase and glutathione peroxidase were found, implying the presence of high levels of hydrogen peroxide in the liver. Furthermore, THS-exposed mice also have a lower NADP+/NADPH ratio, indicating decreased ability of these mice to combat oxidative stress. THS-exposed mice show a decrease in ATP production, increase in aspartate aminotransferase (AST) activity, as well as increased molecular damage (lipid peroxidation, protein nitrosylation and DNA damage). Treating THS-exposed mice with APAP/Tylenol enhances the THS-induced damage whereas treating with antioxidants reduces the damage. THSexposed mice also have lower sirtuin 1 (SIRT1) levels compared to controls which decreased activation of 5' AMPactivated protein kinase (AMPK) and increased sterol regulatory element binding protein 1c (SREBP1c). Conclusion: THS-exposed mice on a normal diet have increased oxidative stress and damage mediated by oxidative stress, which results in alterations to the SIRT1/AMPK/SREPB1c signaling pathway. Increasing oxidative stress results in enhanced THS-induced damage whereas decreasing oxidative stress causes improvement in the THS-induced liver damage. Our results show that THS is a new risk factor contributing to the development of liver steatosis and highlight the danger of THS in general.