Chemical composition and potential health risks of raw Arabian incense (Bakhour)

Assessment of Saudi Society's Awareness of the Hazards of Scented Candles and Air Fresheners

<b>Background and Objective:</b> Air fresheners and scented candles are dangerous for human health and the environment. They are associated with allergies and irritation for a weak respiratory system. This study was conducted to determine the extent of community awareness of the toxicity associated with scented candles and air fresheners. <b>Materials and Methods:</b> This study uses a questionnaire from March, 2023 to June, 2023. The study questionnaire, which was completed by 1667 participants, assesses the degree of knowledge, habits and diseases connected to scents and candles. Descriptive statistics, including percentages, were used. <b>Results:</b> It was discovered that, on average, 568 (34.1%) people are unaware that candles contain chemicals. As 1497 (89.8%) are prepared to replace them with natural and safer candles, while 163 (9.8%) consulted a doctor after exposure to candles because of respiratory allergies; 1093 (65.5%) do not care to check the ingredients before buying a candle and 854 (51.2%) are unaware that candles might cause long-term damage. <b>Conclusion:</b> A significant portion of participants were unaware of the dangers of scented candles and air fresheners. There is no link between respiratory allergies and the substances present in these candles, but it has been proven that most participants are ready to change and use natural alternatives.

A study to characterize the lead isotopic fingerprint in PM2.5 emitted from incense stick and cigarette burning

The incense sticks and cigarettes burning are key sources of particulate matter with a diameter of ≤ 2.5 μm (PM_2.5) in indoor and outdoor air. While lead (Pb) isotope ratios provide valuable insights into the origin of particle pollution, their applicability for investigating these source remains unclear. The Pb isotope ratios in the PM_2.5 emitted from these two sources were analyzed, and effects of brands or nicotine contents on the ratios were assessed. In addition, As, Cr, and Pb were analyzed to investigate whether Pb isotope ratios can serve as an indicator for the source investigation of these metals. We found that average ratios of ²⁰⁶Pb/²⁰⁴Pb, ²⁰⁶Pb/²⁰⁷Pb, and ²⁰⁸Pb/²⁰⁷Pb in cigarettes were heavier than those in incense sticks. Scatter plots of Pb isotope ratios indicated an overlap of values for incense sticks or cigarettes linked to different brands, in that ratios for cigarettes with high nicotine content were heavier than for those with low nicotine content. Scatter plots of As, Cr, or Pb concentration against Pb isotope ratios clearly distinguished the effects of cigarette burning versus incense sticks with respect to PM_2.5 of these metals. Results indicate that brand differences did not affect the determination of PM_2.5 in these two sources. We suggest that Pb isotope ratios can be a useful tool in investigating the influence of incense sticks and of cigarettes (with high or low nicotine content) burning to PM_2.5 and associated metals.

Extent of exposure to scented candles and prevalence of respiratory and non-respiratory symptoms amongst young university students

BACKGROUND

Incense burning such as scented candles are commonly used in Arabian Gulf regions as it is thought to produce relaxing effects on people's mood. This study is conducted to examine the prevalence of scented candles' usage, extent of exposure and its effects on individuals' health based on symptoms prevalence in young university students.

MATERIAL AND METHOD

A cross-sectional study was conducted on university students from different regions in Saudi Arabia. Data was collected in March 2020 using an online questionnaire survey adapted from The European Community Respiratory Health Survey-II (ECRHS-II). Inclusion criterion for recruitment was students with non-smoking status. Descriptive statistics were used to report demographic data on the extent of exposure to scented candles (in terms of frequency and duration) and the presence of symptoms. Multiple logistic regression analysis was used to assess the relationship between scented candles exposure and respiratory and other health-related problems.

RESULTS

The prevalence of scented candles usage was 65.7% (472/718) among the respondents. However, its pervasiveness was significantly higher in females than in male respondents (74.9% vs. 28.4%; p = 0.0001). Among the scented candle users, 34.8% of the respondents used the scented candles more than 4 times a month and 40.2% of the respondents lit the scented candles for 20-40 min. A total of 117 (24.8%) respondents reported health-related problem and the top three health problems were headache 72 (15.2%), shortness of breath 42 (8.9%) and cough 37 (7.8%). The scented candle usage 5-6 times a week showed significantly lower wheezing (OR = 0.10, 95%CI 0.02-0.54, p = 0.008). The duration of more than 60 min of scented candle exposure showed higher occurrence of headache 1.42 times (95% CI = 0.68-2.96), sneezing 1.29 times (95% CI = 0.42-4.00) and wheezing 1.23 times (95% CI = 0.48-3.13), though the association was not significant.

CONCLUSION

The results show that scented candle usage is more prevalent among female university students in Saudi Arabia. The common health-related problems associated with scented candle exposure were headache, shortness of breath and coughing.

Source identification and health risk assessments of heavy metals in indoor dusts of Ilorin, North central Nigeria

BACKGROUND AND PURPOSE

Exposure to heavy metals (HMs) in indoor dusts is a serious public concern that is linked to a myriad of deleterious health outcomes. The objectives of this study are to estimate the contamination levels of HMs in indoor dusts of different residential areas in Ilorin, Nigeria; identify HMs sources in different residential areas; and evaluate human health risks of HMs in selected residential areas.

METHODS

Indoor dust sampling was conducted in ten randomly selected from low, medium and high population density residential areas of Ilorin, Nigeria. Ten HMs concentration levels, their health risk implication and the associated potential ecological risks were evaluated.

RESULTS

The mean concentration levels measured for Fe, Pb, Zn, As, Co, Cr, Cu, Cd, Mn and Ni were 38.99, 5.74, 3.99, 0.08, 2.82, 2.13, 0.47, 0.60, 6.45 and 1.09 mg/kg, respectively. Positive Matrix Factorization (PMF) model was applied to ascertain sources of HMs in sampled indoor dust. Percentage contribution from oil-based cooking (29.82%) and transportation (29.77%) represented the highest source to HM concentrations among the six factors identified. The results of the various pollution indices employed showed that Pb, Zn, As, Co, Cr, Cu, Mn and Ni contributed moderately to HMs concentration levels in the sampled dusts. Cd had highest potential ecological risk factor E r i of between 160 and 320. The average values of Enrichment Factors (EFs) obtained aside from Fe used as the reference metal, ranged between 8.46 (As) and 2521.61(Cd). Health risk assessment results revealed that children are the most susceptible to the risks associated with HMs bound indoor dust than the adults. The percentage risk contributions of Hazard Quotient via ingestion route (HQ_ing) in Hazard Index (HI) for non-cancer risk of indoor HMs were 93.17% and 69.87% in children and adults, respectively. Likewise, the percentage cancer risks contribution through ingestion pathway (CR_ing) were higher than cancer risks through inhalation and dermal pathways (CR_inh and CR_dermal), accounting for 99.84% and 97.04% of lifetime cancer risk in children and adults, respectively. The contamination level of Cd recorded is of great concern and signifies very strong contribution from anthropogenic sources.

CONCLUSION

This study has further revealed the levels of HMs in typical African residential settings that could be used by relevant stakeholders and policy makers in developing lasting control measures.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40201-021-00778-8.

Health and Environmental Risks of Incense Smoke: Mechanistic Insights and Cumulative Evidence

Incense burning is practiced alongside many sacred rituals across different regions of the world. Invariable constituents of incense brands are 21% (by weight) herbal and wood powder, 33% bamboo stick, 35% fragrance material, and 11% adhesive powder. Major incense-combustion outputs include particulate matter (PM), volatile organic content, and polyaromatic hydrocarbons. The relative toxicity of these products is an implicit function of particle size and incomplete combustion, which in turn vary for a specific incense brand. Lately, the attention given to the Air Quality Index by international regulatory bodies has created concern about mounting PM toxicity. The uncharacteristically small physical dimensions of these entities complicates their detection, and with no effect of gravity PM fractions rapidly contribute to oxidative stress, enhancing random biochemical reactions upon being inhaled. Incense burning generates four times the PM extent (45 mg•g⁻¹) of cigarettes (~10 mg•g⁻¹). Several poisonous gases, such as CO, CO₂, NO₂, and SO₂, and the unavoidable challenge of disposing of the burnt incense ash further add to the toxicity. Taken together, these issues demonstrate that incense burning warrants prompt attention. The aim of this article is to highlight the toxicity of incense-combustion materials on the environment and human health. This discussion could be significant in framing future policy regarding ecofriendly incense manufacture and reduced usage.

Incense (bakhour) smoke exposure is associated with respiratory symptoms and impaired lung function among adults: A cross-sectional study in Eastern Province of Saudi Arabia

Burning incense (bakhour) is a common cultural practice in Saudi Arabia. However, its health risk assessment has rarely been studied. This study aims to investigate the association between exposure to incense smoke on lung function impairments and respiratory symptoms among young adults in Saudi Arabia. A community-based cross-sectional study was designed with a representative study sample (N = 125) in the Eastern Province of Saudi Arabia. Study participants, exposed group (n = 45), working in bakhour shop and matched control (n = 80), no history of occupational exposure to bakhour smoke, were recruited randomly from the population registry. Socio-demographic and respiratory symptom information were collected through a questionnaire developed based on European Community Respiratory Health Survey II (ECRHS II). Lung function measurements were conducted using a field spirometer. The overall prevalence of wheezing or whistling was 16.8%, with a higher prevalence in exposed group 35.5%. In adjusted models, exposed to incense smoke remained positively associated with respiratory symptoms: wheezing or whistling; breathlessness; chest tightness shortness of breath; woken up by an attack of coughing. Our study suggests that inhaled incense smoke in occupation or at home is a risk factor of lung function impairments among adult population in Saudi Arabia.

Human health-risk assessment based on chronic exposure to the carbonyl compounds and metals emitted by burning incense at temples

Health effects resulting from the smoke of carbonyl compounds (aldehydes and ketones) and metal-containing incense particles at temples during incense burning periods were evaluated at temple A (without incense reduction activities) and B (with incense reduction activities), Nantou County, in 2018. The predominant size fractions of particles were PM₁, PM_1-2.5, and PM_2.5-10 at both temples. The total particle mass at temple A was approximately 1.1 times that of temple B due to incense reduction at temple B. The most abundant metal elements in all particle size fractions at both temples were Fe, Al, and Zn. Metal species of incense smoke are divided into three groups by hierarchical cluster analysis and heatmaps, showing higher metal contents in groups PM₁, PM_18-10, and PM_18-2.5 at temple A. In contrast, higher metal contents were observed in PM_18-10 and PM_2.5-1 at temple B. Most of the carbonyl species were formaldehyde and acetaldehyde, released during incense burning periods, with concentrations ranging from 6.20 to 13.05 μg/m³ at both temples. The total deposited fluxes of particle-bound metals at temples A and B were determined to be 83.00% and 84.82% using the International Commission on Radiological Protection (ICRP) model. Health-risk assessments revealed that the risk values of metals and carbonyls were above recommended guidelines (10^-6) at temple A. Since worshippers and staff are exposed to incense burning environments with poor ventilation over a long period, these toxic organic compounds and metals increase health risks in the respiratory tract. Therefore, incense reduction is important to achieve healthy temple environments.

Exposition of respiratory ailments from trace metals concentrations in incenses

Selected trace metals of importance in different incense before and after the smoldering process were assessed based on the recent respiratory ailments. Marketed perfumed and non-perfumed incense from different countries was separately analyzed using an Inductive coupled Plasma-Mass Spectroscopy (ICP-MS). A particulate analyzer measured the dispersed particulates (PM_2.5) in the indoor environment. The analysis revealed higher mean metals concentrations in the smoldered perfumed incense (1.98 µg g^-1) than in the non-smoldered and non-perfumed incense (0.59 µg g^-1). Pilot-scale experiments included the smoke dispersed in different sized-rooms, and the distance between the inhaler and the smoldering incense. Simultaneously, a questionnaire distributed to 300 residents from six sampling areas revealed the exposure of incense to human health. This study indicated significant attributes on (a) the room size and incense volume, (b) the permissible inmate's number in a room, (c) the distance between the inmate vicinity and the point of smoldering incense, (d) selectivity of incense, besides the outdoor environmental influence. Furthermore, this study revealed the various categories of respiratory ailments in residents in relation to the frequency of burning incense, prolonged smoke exposure, and the impact of burners although, earlier beneficial effects of incenses were evidenced. This study recommends preventive measures to human respiratory ailments from smoldering incense.

Impact of building ventilation systems and habitual indoor incense burning on SARS-CoV-2 virus transmissions in Middle Eastern countries

Majority of countries across the globe have employed improving building ventilation, quarantine, social distancing, and disinfections as a general measure of preventing SARS-CoV-2 virus transmissions. However, arid Middle Eastern countries with hot climate (elevated outdoor temperature and humidity levels) are experiencing a different situation. Unfortunately, these harsh ambient climatic conditions in Middle Eastern countries make it impossible for most buildings to utilize natural/mechanical ventilation systems. Besides, indoor air temperatures of most buildings are very low due to overconsumption of air conditioning, thereby, it can be a potential factor of virus spread in most residential homes and public buildings. Most importantly, habitual indoor burning of incense which is the major source of coarse (PM10; aerodynamic diameter <10 μm) and fine (PM2.5; aerodynamic diameter <2.5 μm) particulate matters (PM) could facilitate the transmission of SARS-CoV-2 virus droplets and particles in indoor environments. In fact, it increases the spread of the virus via inhalation in these countries, especially where the wearing of masks is not regulated in public, commercial and residential buildings. It is therefore highly recommended for the relevant public health agencies to critically assess the role of poor indoor environmental conditions including the burning of incense on virus transmissions, which may help to develop control measures for the future viral outbreak effectively.

Indoor air pollution and exposure assessment of the gulf cooperation council countries: A critical review

Indoor air pollution is one of the human health threat problems in the Gulf Cooperation Council (GCC) countries. In these countries, due to unfavorable meteorological conditions, such as elevated ambient temperature, high relative humidity, and natural events such as dust storms, people spend a substantial amount of their time in indoor environments. In addition, production of physical and biological aerosols from air conditioners, cooking activities, burning of Arabian incense, and overcrowding due to pilgrimage programs are common causes of low quality indoor air in this region. Thus, due to infiltration of outdoor sources as well as various indoor sources, people living in the GCC countries are highly exposed to indoor air pollutants. Inhalation of indoor air pollutants causes mortalities and morbidities attributed to cardiorespiratory, pulmonary, and lung cancer diseases. Hence, the aim of this review study is to provide a summary of the major findings of indoor air pollution studies in different microenvironments in six GCC countries. These include characterization of detected indoor air pollutants, exposure concentration levels, source identifications, sustainable building designs and ventilation systems, and the mitigation strategies. To do so, >130 relevant indoor air pollution studies across the GCC countries were critically reviewed. Particulate matters (PM₁₀ and PM_2.5), total volatile organic compounds (TVOCs), carbon dioxide (CO₂), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and heavy metals were identified as the reported indoor air pollutants. Apart from them, indoor Radon and bioaerosols were studied only in specific GCC countries. Thus, future studies should also focus on the investigation of emerging indoor air pollutants, such as ultrafine and nanoparticles and their associated health effects. Furthermore, studies on the mitigation of indoor air pollution through the development of advanced air purification and ventilation systems could improve the indoor air quality (IAQ) in the GCC region.

Chemical characterization and safety assessment of dokha: An emerging alternative tobacco product

Dokha is known to be one of the most rapidly spreading alternative tobacco products (ATPs) in the Middle East and North Africa (MENA) region. It is smoked using a pipe known as Midwakh. There is no scientific research published on the chemical composition of dokha and only very little was done to investigate its impact on human health. Three different types of dokha were included in this study. The trace metals content in the dokha samples were analyzed using inductively-coupled plasma-optical emission spectroscopy and energy-dispersive X-ray spectroscopy-scanning electron microscope. Dokha smoke was generated using a device that simulates human smoking/puffing. The smoke samples were collected on Tenax and activated carbon adsorbent tubes followed by chemical analysis using thermal desorption-gas chromatography-mass spectrometry. The results showed the presence of toxic metals in dokha samples such as cobalt, cadmium, chromium, and lead in amounts classified as harmful to human health. In addition, the presence of several potentially harmful and even toxic organic compounds in dokha smoke was identified based on the available clinical data. These included 22 irritants, 3 known carcinogens, and 5 central nervous system (CNS) depressants in addition to several other compounds with miscellaneous effects. The findings of this work demonstrate evidence for the presence of potentially harmful and toxic metals and compounds in dokha tobacco as well as dokha smoke. More research is required to further investigate the clinical impact of dokha on human health.

The Association of Domestic Incense Burning with Hypertension and Blood Pressure in Guangdong, China

Domestic incense burning is a common activity in China. Although it generates serious air pollution and has been linked to various health outcomes, it remains unknown whether it is associated with blood pressure and hypertension. A community-based survey including 1153 hypertensive subjects and 4432 normotensive participants in Guangdong (China) was used to examine this question. Two-level logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI). The analyses showed that, compared with non-users, OR of hypertension was 1.24 (95% CI: 1.03–1.50) for users, and 1.37 (95% CI: 1.04–1.80) for daily users with a clear dose-response relationship. The estimated increases in systolic and diastolic blood pressures were 1.02 mmHg (95% CI: 0.06–1.99) and 1.26 mmHg (95% CI: 0.69–1.83) for users, 0.67 mmHg (95% CI: −0.35–1.68) and 1.25 mmHg (95% CI: 0.66–1.85) for occasional users, and 2.09 mmHg (95% CI: 0.79–3.39) and 1.28 mmHg (95% CI: 0.52–2.05) for daily users, respectively. The results remained after adjusting for potential confounders and more pronounced associations were found among females. This study suggests that domestic incense burning may increase the risk of hypertension and blood pressure in the study population, and women are more vulnerable to these effects than men.