1
|
Short M, Dobson J, Day G, Lefferts B, Singleton R, Keck J. "You can feel the fresh air … " Rural Alaska Native household perceptions of home air purifiers and health. Int J Circumpolar Health 2024; 83:2335702. [PMID: 38546171 PMCID: PMC10984226 DOI: 10.1080/22423982.2024.2335702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
Alaska Native and American Indian children experience frequent respiratory illness. Indoor air quality is associated with the severity and frequency of respiratory infections in children. High efficiency particulate air (HEPA) purifiers effectively improve indoor air quality and may protect respiratory health. In 2019, the Yukon-Kuskokwim Health Corporation implemented a pilot programme that provided education and HEPA purifiers to households of children with chronic lung conditions. The team evaluated HEPA purifier acceptability and use by interviewing representatives from 11 households that participated in the pilot programme. All interviewees reported improvement in their child's health, and some believed that the health of other household members was also improved because of the HEPA purifier. Interviewees reported that the HEPA purifiers were easy to use, quiet, and not expensive to run. Five of 11 households were still using the HEPA purifier at the time of the interview, which was about three years after receipt of the unit. The most common reasons for discontinuing use were equipment failure and lack of replacement filter, suggesting that programme support could increase sustainability. Our evaluation suggests that HEPA purifiers are acceptable and feasible for use in rural Alaska Native households.
Collapse
Affiliation(s)
- Madilyn Short
- WWAMI School of Medical Education, University of Alaska Anchorage, Anchorage, AK, USA
- Department of Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jennifer Dobson
- Department of Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
- Office of Environmental Health and Engineering, Yukon-Kuskokwim Health Corporation, Bethel, AK, USA
| | - Gretchen Day
- Department of Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Brian Lefferts
- Office of Environmental Health and Engineering, Yukon-Kuskokwim Health Corporation, Bethel, AK, USA
| | - Rosalyn Singleton
- Department of Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - James Keck
- WWAMI School of Medical Education, University of Alaska Anchorage, Anchorage, AK, USA
- Department of Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| |
Collapse
|
2
|
Traviss N, Allen G, Ahmadi M. Criteria, Greenhouse Gas, and Hazardous Air Pollutant Emissions Factors from Residential Cordwood and Pellet Stoves Using an Integrated Duty Cycle Test Protocol. ACS ES&T AIR 2024; 1:1190-1202. [PMID: 39295743 PMCID: PMC11406481 DOI: 10.1021/acsestair.4c00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 09/21/2024]
Abstract
Air pollution from residential wood heating (RWH) presents challenges at the intersection of climate and public health. With a revised National Ambient Air Quality Standard (NAAQS, at 9 μg/m3) for particulate matter (PM) in the United States (U.S.), the Environmental Protection Agency (EPA) will likely classify new non-attainment areas due primarily to emissions from RWH. Agencies will use emissions factors (EFs) to develop attainment strategies. Many will rely on EPA modeling platforms based on data from the National Emissions Inventory (NEI). The NEI uses RWH EFs based on data from mid-1990's in-situ studies and a speciation profile from a 2001 study of fireplace emissions. The NEI does not include greenhouse gas (GHG) emissions for this sector, which plays a key role when assessing climate reduction strategies for the buildings sector. Here, we tested seven wood stoves to determine EFs, representing various vintages and control technologies, using a novel test method that reflects in-use operational settings called the Integrated Duty Cycle. The study measured multiple pollutants concurrently: criteria pollutants (particulate matter [PM], CO, and NOx), nonmethane total hydrocarbons (NMTHCs), GHGs, black carbon (eBC), brown carbon (BrC), and multiple hazardous air pollutants (HAPs). We found no significant difference in PM EFs between uncertified and non-catalytic stove technologies. RWH EF results from this study exceeded 2020 NEI RWH EFs for NMTHC and multiple HAPs. Applying our study's EFs to the 2020 NEI suggests that RWH, compared to all other sources, ranks as the 2nd largest source category of formaldehyde; the 3rd largest of benzene, 1,3-butadiene, and acrolein; and the 4th largest of Pb emissions. RWH also emits more methane compared to natural gas or oil residential heating, raising questions about substitution of wood as a climate neutral heating fuel. However, compared to uncertified stoves, pellet stove EFs (except toxic metals) were significantly lower (p < 0.01). In summary, RWH appears to be an underestimated source of PM (non-catalytic technology), methane, NMTHC, toxic metals, and other HAPs, which has important implications for climate and public health policy in the U.S. and globally.
Collapse
Affiliation(s)
- Nora Traviss
- Northeast States Coordinated Air Use Management (NESCAUM), Boston, Massachusetts 02111, United States
- Keene State College, Keene, New Hampshire 03435, United States
| | - George Allen
- Northeast States Coordinated Air Use Management (NESCAUM), Boston, Massachusetts 02111, United States
| | - Mahdi Ahmadi
- Northeast States Coordinated Air Use Management (NESCAUM), Boston, Massachusetts 02111, United States
- University of North Texas, Denton, Texas 76203, United States
| |
Collapse
|
3
|
Noonan CW, Walker ES, Semmens EO, Belcourt A, Boulafentis J, Garcia C, Graham J, Hoskie N, Quintana E, Simpson J, Smith P, Teasley HL, Ware D, Weiler E, Ward TJ. Randomized trial in rural Native American homes heated with wood stoves: results from the EldersAIR study. AIR QUALITY, ATMOSPHERE, & HEALTH 2024; 17:967-978. [PMID: 39363883 PMCID: PMC11446504 DOI: 10.1007/s11869-023-01492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/19/2023] [Indexed: 10/05/2024]
Abstract
Residential wood burning has both practical and traditional value among many indigenous communities of the United States Mountain West, although household biomass burning also results in emissions that are harmful to health. In a household-level three-arm placebo-controlled randomized trial we tested the efficacy of portable filtration units and education interventions on improving pulmonary function and blood pressure measures among elder participants that use wood stoves for residential heating. A total of 143 participants were assigned to the Education (n=49), Filter (n=47), and Control (n=47) arms. Blood pressure and spirometry measures were collected multiple times during a per-intervention winter period and during a follow-up post-intervention winter period. Despite strong PM2.5 exposure reduction results with the Filter arm (50% lower compared to Control arm), neither this intervention nor the Education intervention translated to improvements in the selected health measures among this population with a mixture of chronic conditions. Intention to treat analysis failed to demonstrate evidence that either of the intervention arms had beneficial effects on the blood pressure or the spirometry measures. Post-hoc evaluation of effect modification for blood pressure and spirometry outcomes did not reveal any interaction influence on the outcomes according to sex, residential smoking, chronic disease history and study area.
Collapse
Affiliation(s)
- Curtis W Noonan
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Ethan S Walker
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Erin O Semmens
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Annie Belcourt
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | | | | | - Jon Graham
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Nolan Hoskie
- Navajo Nation Environmental Protection Agency, Window Rock, AZ, USA
| | - Eugenia Quintana
- Navajo Nation Environmental Protection Agency, Window Rock, AZ, USA
| | - Julie Simpson
- Nez Perce Tribe Air Quality Program, Lapwai, ID, USA
| | - Paul Smith
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Howard L Teasley
- Nez Perce Tribe Forestry and Fire Management Division, Lapwai, ID, USA
| | - Desirae Ware
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Emily Weiler
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Tony J Ward
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| |
Collapse
|
4
|
Cowan K, Semmens EO, Lee JY, Walker ES, Smith PG, Fu L, Singleton R, Cox SM, Faiella J, Chassereau L, Lawrence L, Ying J, Baldner J, Garza M, Annett R, Chervinskiy SK, Snowden J. Bronchiolitis recovery and the use of High Efficiency Particulate Air (HEPA) Filters (The BREATHE Study): study protocol for a multi-center, parallel, double-blind, randomized controlled clinical trial. Trials 2024; 25:197. [PMID: 38504367 PMCID: PMC10953277 DOI: 10.1186/s13063-024-08012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Acute viral bronchiolitis is the most common reason for hospitalization of infants in the USA. Infants hospitalized for bronchiolitis are at high risk for recurrent respiratory symptoms and wheeze in the subsequent year, and longer-term adverse respiratory outcomes such as persistent childhood asthma. There are no effective secondary prevention strategies. Multiple factors, including air pollutant exposure, contribute to risk of adverse respiratory outcomes in these infants. Improvement in indoor air quality following hospitalization for bronchiolitis may be a prevention opportunity to reduce symptom burden. Use of stand-alone high efficiency particulate air (HEPA) filtration units is a simple method to reduce particulate matter ≤ 2.5 µm in diameter (PM2.5), a common component of household air pollution that is strongly linked to health effects. METHODS BREATHE is a multi-center, parallel, double-blind, randomized controlled clinical trial. Two hundred twenty-eight children < 12 months of age hospitalized for the first time with bronchiolitis will participate. Children will be randomized 1:1 to receive a 24-week home intervention with filtration units containing HEPA and carbon filters (in the child's sleep space and a common room) or to a control group with units that do not contain HEPA and carbon filters. The primary objective is to determine if use of HEPA filtration units reduces respiratory symptom burden for 24 weeks compared to use of control units. Secondary objectives are to assess the efficacy of the HEPA intervention relative to control on (1) number of unscheduled healthcare visits for respiratory complaints, (2) child quality of life, and (3) average PM2.5 levels in the home. DISCUSSION We propose to test the use of HEPA filtration to improve indoor air quality as a strategy to reduce post-bronchiolitis respiratory symptom burden in at-risk infants with severe bronchiolitis. If the intervention proves successful, this trial will support use of HEPA filtration for children with bronchiolitis to reduce respiratory symptom burden following hospitalization. TRIAL REGISTRATION NCT05615870. Registered on November 14, 2022.
Collapse
Affiliation(s)
- Kelly Cowan
- Department of Pediatrics, Larner College of Medicine at the University of Vermont, 111 Colchester Ave, Smith 5, Burlington, VT, 05403, USA.
| | - Erin O Semmens
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Jeannette Y Lee
- University of Arkansas for Medical Sciences, 4301 West Markham, #781, Little Rock, AR, 72205, USA
| | - Ethan S Walker
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Paul G Smith
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Linda Fu
- National Institutes of Health Environmental Influences On Child, Health Outcomes (ECHO) Program, 11601, Landsdown Street, Rockville, MD, 20852, USA
| | - Rosalyn Singleton
- Alaska Native Tribal Health Consortium, AIP-CDC, 4055 Tudor Centre Drive, Anchorage, AK, 99508, USA
| | - Sara McClure Cox
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Jennifer Faiella
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Laurie Chassereau
- University of Vermont, Given C421, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Lora Lawrence
- IDeA States Pediatric Network Data Coordination and Operations Center, 13 Children's Way, Slot 512-35, Little Rock, AR, 72202, USA
| | - Jun Ying
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop F496, Academic Office One L15-3407, 12631 E 17th Avenue, Aurora, CO, 80045, USA
| | - Jaime Baldner
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA
| | - Maryam Garza
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA
| | - Robert Annett
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87106, USA
| | - Sheva K Chervinskiy
- Cook Children's Department of Immunology, 1500 Cooper St, Fort Worth, TX, 76104, USA
| | - Jessica Snowden
- IDeA States Pediatric Network Data Coordination and Operations Center, 13 Children's Way, Slot 512-35, Little Rock, AR, 72202, USA
| |
Collapse
|
5
|
Ebrahimifakhar A, Poursadegh M, Hu Y, Yuill DP, Luo Y. A systematic review and meta-analysis of field studies of portable air cleaners: Performance, user behavior, and by-product emissions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168786. [PMID: 38008326 DOI: 10.1016/j.scitotenv.2023.168786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
Indoor air quality is important for the health of building occupants, and public interest in controlling indoor airborne pathogens increased dramatically with the COVID-19 pandemic. Pollutant concentrations can be controlled locally using portable air cleaners (sometimes called air purifiers), which allow occupants to apply air cleaning technology to meet their needs in the location and times that they find appropriate. This paper provides a systematic review of scientific literature that describes field studies of the effectiveness of portable air cleaners. Over 500 papers were considered, and 148 were reviewed in detail, to extract 35 specific research results (e.g., particulate removal performance) or characteristics (e.g., type of building). These were aggregated to provide an overview of results and approaches to this type of research, and to provide meta-analyses of the results. The review includes: descriptions of the geographical location of the research; rate of publications over time; types of buildings and occupants in the field study; types of air cleaner technology being tested; pollutants being measured; resulting pollutant removal effectiveness; patterns of usage and potential barriers to usage by occupants; and the potential for by-product emissions in some air cleaner technologies. An example result is that 83 of the 148 papers measured reductions in fine particulates (PM2.5) and found a mean reduction of 49 % with standard deviation of 20 %. The aggregated results were approximately normally distributed, ranging from finding no significant reduction up to a maximum above 90 % reduction. Sixteen of the 148 papers considered gaseous pollutants, such as volatile organic compounds, nitrogen dioxide, and ozone; 36 papers considered biological pollutants, such as bacteria, viruses, pollen, fungi, etc. An important challenge, common to several studies, is that occupants run the air cleaners for shorter periods and on low airflow rate settings, because of concerns about noise, drafts, and electricity cost, which significantly reduces air cleaning effectiveness.
Collapse
Affiliation(s)
- Amir Ebrahimifakhar
- Delos Labs, Delos, New York, NY 10014, USA; Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Mehrdad Poursadegh
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Yifeng Hu
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA; Buildings and Transportation Science Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.
| | - David P Yuill
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Yu Luo
- Department of Applied Physics and Applied Mathematics, Columbia University, 500 W. 120th Street, New York, NY 10027, USA.
| |
Collapse
|
6
|
Walker ES, Noonan CW, Belcourt A, Boulafentis J, Garcia C, Graham J, Hoskie N, Quintana E, Semmens EO, Simpson J, Smith P, Teasley H, Ware D, Weiler E, Ward TJ. Efficacy of air filtration and education interventions on fine particulate matter among rural Native American homes heated with wood stoves: Results from the EldersAIR randomized trial. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 843:157029. [PMID: 35777562 PMCID: PMC9829403 DOI: 10.1016/j.scitotenv.2022.157029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Native Americans living in rural areas often rely upon wood stoves for home heating that can lead to elevated indoor concentrations of fine particulate matter (PM2.5). Wood stove use is associated with adverse health outcomes, which can be a particular risk in vulnerable populations including older adults. OBJECTIVES We assessed the impact of portable air filtration units and educational approaches that incorporated elements of traditional knowledge on indoor and personal PM2.5 concentrations among rural, Native American elder households with wood stoves. METHODS EldersAIR was a three-arm, pre-post randomized trial among rural households from the Navajo Nation and Nez Perce Tribe in the United States. We measured personal and indoor PM2.5 concentrations over 2-day sampling periods on up to four occasions across two consecutive winter seasons in elder participant homes. We assessed education and air filtration intervention efficacy using linear mixed models. RESULTS Geometric mean indoor PM2.5 concentrations were 50.5 % lower (95 % confidence interval: -66.1, -27.8) in the air filtration arm versus placebo, with similar results for personal PM2.5. Indoor PM2.5 concentrations among education arm households were similar to placebo, although personal PM2.5 concentrations were 33.3 % lower for the education arm versus placebo (95 % confidence interval: -63.2, 21.1). SIGNIFICANCE The strong partnership between academic and community partners helped facilitate a culturally acceptable approach to a clinical trial intervention within the study communities. Portable air filtration units can reduce indoor PM2.5 that originates from indoor wood stoves, and this finding was supported in this study. The educational intervention component was meaningful to the communities, but did not substantially impact indoor PM2.5 relative to placebo. However, there is evidence that the educational interventions reduced indoor PM2.5 in some subsets of the study households. More study is required to determine ways to optimize educational interventions within Native American communities.
Collapse
Affiliation(s)
- Ethan S Walker
- Center for Population Health Research, University of Montana, Missoula, MT, USA; School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.
| | - Curtis W Noonan
- Center for Population Health Research, University of Montana, Missoula, MT, USA; School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Annie Belcourt
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | | | | | - Jon Graham
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Nolan Hoskie
- Navajo Nation Environmental Protection Agency, Window Rock, AZ, USA
| | - Eugenia Quintana
- Navajo Nation Environmental Protection Agency, Window Rock, AZ, USA
| | - Erin O Semmens
- Center for Population Health Research, University of Montana, Missoula, MT, USA; School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Julie Simpson
- Nez Perce Tribe Air Quality Program, Lapwai, ID, USA
| | - Paul Smith
- Center for Population Health Research, University of Montana, Missoula, MT, USA; School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Howard Teasley
- Nez Perce Tribe Forestry and Fire Management Division, Lapwai, ID, USA
| | - Desirae Ware
- Center for Population Health Research, University of Montana, Missoula, MT, USA; School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Emily Weiler
- Center for Population Health Research, University of Montana, Missoula, MT, USA; School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Tony J Ward
- Center for Population Health Research, University of Montana, Missoula, MT, USA; School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| |
Collapse
|
7
|
White JD, Wyss AB, Hoang TT, Lee M, Richards M, Parks CG, Beane-Freeman LE, Hankinson JL, Umbach DM, London SJ. Residential Wood Burning and Pulmonary Function in the Agricultural Lung Health Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:87008. [PMID: 36006053 PMCID: PMC9406613 DOI: 10.1289/ehp10734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In low- and middle-income countries, burning biomass indoors for cooking or heating has been associated with poorer lung function. In high-income countries, wood, a form of biomass, is commonly used for heating in rural areas with increasing prevalence. However, in these settings the potential impact of chronic indoor woodsmoke exposure on pulmonary function is little studied. OBJECTIVE We evaluated the association of residential wood burning with pulmonary function in case-control study of asthma nested within a U.S. rural cohort. METHODS Using sample weighted multivariable linear regression, we estimated associations between some and frequent wood burning, both relative to no exposure, in relation to forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), their ratio (FEV 1 / FVC ), and fractional exhaled nitric oxide (FeNO). We examined effect modification by smoking or asthma status. RESULTS Among all participants and within smoking groups, wood burning was not appreciably related to pulmonary function. However, in individuals with asthma (n = 1,083 ), frequent wood burning was significantly associated with lower FEV 1 [β : - 164 mL ; 95% confidence interval (CI): - 261 , - 66 mL ], FVC (β : - 125 mL ; 95% CI: - 230 , - 20 mL ), and FEV 1 / FVC (β : - 2 % ; 95% CI: - 4 , - 0.4 % ), whereas no appreciable association was seen in individuals without asthma (n = 1,732 ). These differences in association by asthma were statistically significant for FEV 1 (p i n t e r a c t i o n = 0.0044 ) and FEV 1 / FVC (p i n t e r a c t i o n = 0.049 ). Frequent wood burning was also associated with higher FeNO levels in all individuals (n = 2,598 ; β : 0.1 ln ( ppb ) ; 95% CI: 0.02, 0.2), but associations did not differ by asthma or smoking status. DISCUSSION Frequent exposure to residential wood burning was associated with a measure of airway inflammation (FeNO) among all individuals and with lower pulmonary function among individuals with asthma. This group may wish to reduce wood burning or consider using air filtration devices. https://doi.org/10.1289/EHP10734.
Collapse
Affiliation(s)
- Julie D. White
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- GenOmics, Bioinformatics, and Translational Research Center, Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Annah B. Wyss
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Thanh T. Hoang
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Mikyeong Lee
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | | | - Christine G. Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Laura E. Beane-Freeman
- Occupational and Environmental Epidemiology Branch, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | | | - David M. Umbach
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Stephanie J. London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| |
Collapse
|
8
|
Harrar SW, Cui Y. Nonparametric methods for clustered data in pre-post intervention design. J Stat Plan Inference 2022. [DOI: 10.1016/j.jspi.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Walker ES, Semmens EO, Belcourt A, Boyer BB, Erdei E, Graham J, Hopkins SE, Lewis JL, Smith PG, Ware D, Weiler E, Ward TJ, Noonan CW. Efficacy of Air Filtration and Education Interventions on Indoor Fine Particulate Matter and Child Lower Respiratory Tract Infections among Rural U.S. Homes Heated with Wood Stoves: Results from the KidsAIR Randomized Trial. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:47002. [PMID: 35394807 PMCID: PMC8992966 DOI: 10.1289/ehp9932] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 05/24/2023]
Abstract
BACKGROUND Millions of rural U.S. households are heated with wood stoves. Wood stove use can lead to high indoor concentrations of fine particulate matter [airborne particles ≤2.5μm in aerodynamic diameter (PM2.5)] and is associated with lower respiratory tract infection (LRTI) in children. OBJECTIVES We assessed the impact of low-cost educational and air filtration interventions on childhood LRTI and indoor PM2.5 in rural U.S. homes with wood stoves. METHODS The Kids Air Quality Interventions for Reducing Respiratory Infections (KidsAIR) study was a parallel three-arm (education, portable air filtration unit, control), post-only randomized trial in households from Alaska, Montana, and Navajo Nation (Arizona and New Mexico) with a wood stove and one or more children <5 years of age. We tracked LRTI cases for two consecutive winter seasons and measured indoor PM2.5 over a 6-d period during the first winter. We assessed results using two analytical frameworks: a) intervention efficacy on LRTI and PM2.5 (intent-to-treat), and b) association between PM2.5 and LRTI (exposure-response). RESULTS There were 61 LRTI cases from 14,636 child-weeks of follow-up among 461 children. In the intent-to-treat analysis, children in the education arm [odds ratio (OR)=0.98; 95% confidence interval (CI): 0.35, 2.72] and the filtration arm (OR=1.23; 95% CI: 0.46, 3.32) had similar odds of LRTI vs. control. Geometric mean PM2.5 concentrations were similar to control in the education arm (11.77% higher; 95% CI: -16.57, 49.72) and air filtration arm (6.96% lower; 95% CI: -30.50, 24.55). In the exposure-response analysis, odds of LRTI were 1.45 times higher (95% CI: 1.02, 2.05) per interquartile range (25 μg/m3) increase in mean indoor PM2.5. DISCUSSION We did not observe meaningful differences in LRTI or indoor PM2.5 in the air filtration or education arms compared with the control arm. Results from the exposure-response analysis provide further evidence that biomass air pollution adversely impacts childhood LRTI. Our results highlight the need for novel, effective intervention strategies in households heated with wood stoves. https://doi.org/10.1289/EHP9932.
Collapse
Affiliation(s)
- Ethan S. Walker
- Center for Population Health Research, University of Montana, Missoula, Montana, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Erin O. Semmens
- Center for Population Health Research, University of Montana, Missoula, Montana, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Annie Belcourt
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Bert B. Boyer
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Alaska, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Esther Erdei
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jon Graham
- Center for Population Health Research, University of Montana, Missoula, Montana, USA
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Alaska, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Johnnye L. Lewis
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Paul G. Smith
- Center for Population Health Research, University of Montana, Missoula, Montana, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Desirae Ware
- Center for Population Health Research, University of Montana, Missoula, Montana, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Emily Weiler
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Tony J. Ward
- Center for Population Health Research, University of Montana, Missoula, Montana, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Curtis W. Noonan
- Center for Population Health Research, University of Montana, Missoula, Montana, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| |
Collapse
|
10
|
Gracia G, Guzman A, Forst L. A day in the life: Using contextual interviews to understand the health of home-based Mapuche weavers. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000353. [PMID: 36962221 PMCID: PMC10021899 DOI: 10.1371/journal.pgph.0000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022]
Abstract
The craft sector employs 305 million people worldwide, primarily women, rural and home-based workers. Home-based weavers, an understudied workforce, are subject to a range of hazards and adverse health effects related to their weaving work and domestic responsibilities (e.g., housework, farm work, childcare, eldercare). The Mapuche represent Chile's largest Indigenous group with about 20 percent residing in the Araucanía region, where agriculture and tourism, including craftwork, are important sources of income. Using a purposive sampling approach, we conducted Spanish-language contextual interviews (N = 10) with Mapuche weavers across four communities, allowing us to observe participants in their home settings, watching them weave and discussing tasks, decision-making, and behaviors during the work process. Participants ranged in age from 29-55 years. A combination of semi-structured, audio-recorded interviews, videos, photographs and written observations yielded a time-wheel of a typical day for each weaver; the types of weaving and non-weaving work (including hours per day); workspace visuals; self-reported health problems, causes and treatments; exposure hazards; and potential ergonomic interventions. In addition to weaving, housework (n = 10), farm work (n = 7), wool production (n = 7), natural and chemical dyeing (n = 7) and child-rearing (n = 4) were identified as work activities. The most commonly cited weaving-related health problems were eyestrain (n = 7) and pain in the back (n = 6), shoulder (n = 5), arm (n = 4), hand (n = 4), neck (n = 3), wrist (n = 3) and fingers (n = 3). When asked to identify potential improvements to their weaving workspace, participants identified the need to having a dedicated workspace for weaving (n = 7), improving their existing workspace with better seating (n = 4), lighting (n = 3), insulation (n = 2) and increasing the size of their workspace (n = 2). This methodology, blending traditional occupational health tools with qualitative methods, was instrumental in understanding the range of hazards associated with home-based work and identifying potential ergonomic interventions for this global workforce.
Collapse
Affiliation(s)
- Gabriela Gracia
- University of Illinois at Chicago, School of Public Health, Division of Environmental and Occupational Health Sciences, Chicago, IL, United States of America
- Research Consultant, Boston University, Boston, MA, United States of America
| | - Alison Guzman
- MAPLE Microdevelopment Chile, Villarica, Araucanía IX Region, Chile
| | - Linda Forst
- University of Illinois at Chicago, School of Public Health, Division of Environmental and Occupational Health Sciences, Chicago, IL, United States of America
| |
Collapse
|
11
|
Tassew D, Fort S, Mebratu Y, McDonald J, Chu HW, Petersen H, Tesfaigzi Y. Effects of Wood Smoke Constituents on Mucin Gene Expression in Mice and Human Airway Epithelial Cells and on Nasal Epithelia of Subjects with a Susceptibility Gene Variant in Tp53. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:17010. [PMID: 35072516 PMCID: PMC8785869 DOI: 10.1289/ehp9446] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Exposure to wood smoke (WS) increases the risk for chronic bronchitis more than exposure to cigarette smoke (CS), but the underlying mechanisms are unclear. OBJECTIVE The effect of WS and CS on mucous cell hyperplasia in mice and in human primary airway epithelial cells (AECs) was compared with replicate the findings in human cohorts. Responsible WS constituents were identified to better delineate the pathway involved, and the role of a tumor protein p53 (Tp53) gene polymorphism was investigated. METHODS Mice and primary human AECs were exposed to WS or CS and the signaling receptor and pathway were identified using short hairpin structures, small molecule inhibitors, and Western analyses. Mass spectrometric analysis was used to identify active WS constituents. The role of a gene variant in Tp53 that modifies proline to arginine was examined using nasal brushings from study participants in the Lovelace Smokers Cohort, primary human AECs, and mice with a modified Tp53 gene. RESULTS WS at 25-fold lower concentration than CS increased mucin expression more efficiently in mice and in human AECs in a p53 pathway-dependent manner. Study participants who were homozygous for p53 arginine compared with the proline variant showed higher mucin 5AC (MUC5AC) mRNA levels in nasal brushings if they reported WS exposure. The WS constituent, oxalate, increased MUC5AC levels similar to the whole WS extract, especially in primary human AECs homozygous for p53 arginine, and in mice with a modified Tp53 gene. Further, the anion exchange protein, SLC26A9, when reduced, enhanced WS- and oxalate-induced mucin expression. DISCUSSION The potency of WS compared with CS in inducing mucin expression may explain the increased risk for chronic bronchitis in participants exposed to WS. Identification of the responsible compounds could help estimate the risk of pollutants in causing chronic bronchitis in susceptible individuals and provide strategies to improve management of lung diseases. https://doi.org/10.1289/EHP9446.
Collapse
Affiliation(s)
- Dereje Tassew
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Fort
- Chronic Obstructive Pulmonary Disease Program, Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA
| | - Yohannes Mebratu
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob McDonald
- Applied Sciences, Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA
| | - Hong Wei Chu
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Hans Petersen
- Chronic Obstructive Pulmonary Disease Program, Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA
| | - Yohannes Tesfaigzi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Li X, Clark S, Floess E, Baumgartner J, Bond T, Carter E. Personal exposure to PM 2.5 of indoor and outdoor origin in two neighboring Chinese communities with contrasting household fuel use patterns. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 800:149421. [PMID: 34388646 DOI: 10.1016/j.scitotenv.2021.149421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 05/03/2023]
Abstract
The Chinese government is replacing high-polluting, household coal heating stoves with electricity- and natural gas-powered heaters to improve ambient air quality. The evaluation of the intervention impact on outdoor PM2.5 and personal exposure in community level are in their initial stages. We compared outdoor air pollution and personal exposure in two neighboring communities (~2 km) in northern China with contrasting household fuel use patterns: one where residents primarily used coal for cooking and heating ("coal village") and one where natural gas was the dominant fuel ("gas village"). We collected 24-h outdoor gravimetric PM2.5 samples in each village and concurrently measured 48-h integrated exposures among 71 participants from 41 and 30 households in the coal and gas villages, respectively. PM2.5 samples were analyzed for mass and chemical composition. Daily outdoor PM2.5 concentrations in the coal village (mean ± standard deviation: 109 ± 41 μg/m3) were, on average, 1.3 ± 0.2 times higher than in the gas village (88 ± 38 μg/m3). However, personal PM2.5 exposures were lower in the coal village (116 ± 121 μg/m3 versus 156 ± 106 μg/m3). PM2.5 species that can serve as tracers for residential coal combustion (e.g., S, Se, Zn, Pb, etc.) and dust (Al, Ca, Mg, Fe, Si and Ti) were higher in the coal village, and the proportion of personal PM2.5 of outdoor origin in the coal village was nearly 2 times higher than the gas village. Our results suggest that ambient PM2.5 and its chemical composition can vary at relatively small spatial scales and may reflect community-level differences in the household energy use. However, personal PM2.5 exposures may not mirror between-village differences in outdoor air pollution if only PM2.5 mass is evaluated. Individual chemical composition of PM2.5 exposure can provide important insight in future studies on the effectiveness of source-targeted air quality interventions.
Collapse
Affiliation(s)
- Xiaoying Li
- Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, CO 80521, USA; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada
| | - Sierra Clark
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada; Institute for Health and Social Policy, McGill University, Montreal, QC H3A 0G4, Canada; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1NY, UK
| | - Emily Floess
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada; Institute for Health and Social Policy, McGill University, Montreal, QC H3A 0G4, Canada
| | - Tami Bond
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80521, USA
| | - Ellison Carter
- Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, CO 80521, USA.
| |
Collapse
|
13
|
Children's Particulate Matter Exposure Characterization as Part of the New Hampshire Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212109. [PMID: 34831864 PMCID: PMC8620988 DOI: 10.3390/ijerph182212109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Abstract
As part of the New Hampshire Birth Cohort Study, children 3 to 5 years of age participated in a personal PM2.5 exposure study. This paper characterizes the personal PM2.5 exposure and protocol compliance measured with a wearable sensor. The MicroPEM™ collected personal continuous and integrated measures of PM2.5 exposure and compliance data on 272 children. PM2.5, black carbon (BC), and brown carbon tobacco smoke (BrC-ETS) exposure was measured from the filters. We performed a multivariate analysis of woodstove presence and other factors that influenced PM2.5, BC, and BrC exposures. We collected valid exposure data from 258 of the 272 participants (95%). Children wore the MicroPEM for an average of 46% of the 72-h period, and over 80% for a 2-day, 1-night period (with sleep hours counted as non-compliance for this study). Elevated PM2.5 exposures occurred in the morning, evening, and overnight. Median PM2.5, BC, and BrC-ETS concentrations were 8.1 μg/m3, 3.6 μg/m3, and 2.4 μg/m3. The combined BC and BrC-ETS mass comprised 72% of the PM2.5. Woodstove presence, hours used per day, and the primary heating source were associated with the children’s PM2.5 exposure and air filters were associated with reduced PM2.5 concentrations. Our findings suggest that woodstove smoke contributed significantly to this cohort’s PM2.5 exposure. The high sample validity and compliance rate demonstrated that the MicroPEM can be worn by young children in epidemiologic studies to measure their PM2.5 exposure, inform interventions to reduce the exposures, and improve children’s health.
Collapse
|
14
|
Zhu Y, Song X, Wu R, Fang J, Liu L, Wang T, Liu S, Xu H, Huang W. A review on reducing indoor particulate matter concentrations from personal-level air filtration intervention under real-world exposure situations. INDOOR AIR 2021; 31:1707-1721. [PMID: 34374125 DOI: 10.1111/ina.12922] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 05/28/2023]
Abstract
Improving air quality in indoor environments where people live is of importance to protect human health. In this systematic review, we assessed the effectiveness of personal-level use of air filtration units in reducing indoor particulate matters (PM) concentrations under real-world situations following systematic review guidelines. A total of 54 articles were included in the review, in which 20 randomized controlled/crossover trials that reported the changes in indoor fine PM (PM2.5 ) concentrations were quantitatively assessed in meta-analysis. Standardized mean differences (SMDs) were calculated for changes in indoor PM concentrations following air filtration interventions. Moderate-to-large reductions of 11%-82% in indoor PM2.5 concentrations were observed with SMD of -1.19 (95% CI: -1.50, -0.88). The reductions in indoor PM concentrations varied by geographical locations, filtration technology employed, indoor environmental characteristics, and air pollution sources. Most studies were graded with low-to-moderate risk of bias; however, the overall certainty of evidence for indoor PM concentration reductions was graded at very low level. Considering the effectiveness of indoor air filtration under practical uses, socio-economic disparities across study populations, and costs of air filter replacement over time, our results highlight the importance of reducing air pollution exposure at the sources.
Collapse
Affiliation(s)
- Yutong Zhu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Health Science Center, Peking University, Beijing, China
| | - Xiaoming Song
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Health Science Center, Peking University, Beijing, China
| | - Rongshan Wu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - Jiakun Fang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Health Science Center, Peking University, Beijing, China
| | - Lingyan Liu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Health Science Center, Peking University, Beijing, China
| | - Tong Wang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Health Science Center, Peking University, Beijing, China
| | - Shuo Liu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hongbing Xu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Health Science Center, Peking University, Beijing, China
| | - Wei Huang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Health Science Center, Peking University, Beijing, China
| |
Collapse
|
15
|
Hadeed SJ, O’Rourke MK, Canales RA, Joshweseoma L, Sehongva G, Paukgana M, Gonzalez-Figueroa E, Alshammari M, Burgess JL, Harris RB. Household and behavioral determinants of indoor PM 2.5 in a rural solid fuel burning Native American community. INDOOR AIR 2021; 31:2008-2019. [PMID: 34235761 PMCID: PMC8530885 DOI: 10.1111/ina.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/18/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Indoor and outdoor concentrations of PM2.5 were measured for 24 h during heating and non-heating seasons in a rural solid fuel burning Native American community. Household building characteristics were collected during the initial home sampling visit using technician walkthrough questionnaires, and behavioral factors were collected through questionnaires by interviewers. To identify seasonal behavioral factors and household characteristics associated with indoor PM2.5 , data were analyzed separately by heating and non-heating seasons using multivariable regression. Concentrations of PM2.5 were significantly higher during the heating season (indoor: 36.2 μg/m3 ; outdoor: 22.1 μg/m3 ) compared with the non-heating season (indoor: 14.6 μg/m3 ; outdoor: 9.3 μg/m3 ). Heating season indoor PM2.5 was strongly associated with heating fuel type, housing type, indoor pests, use of a climate control unit, number of interior doors, and indoor relative humidity. During the non-heating season, different behavioral and household characteristics were associated with indoor PM2.5 concentrations (indoor smoking and/or burning incense, opening doors and windows, area of surrounding environment, building size and height, and outdoor PM2.5 ). Homes heated with coal and/or wood, or a combination of coal and/or wood with electricity and/or natural gas had elevated indoor PM2.5 concentrations that exceeded both the EPA ambient standard (35 μg/m3 ) and the WHO guideline (25 μg/m3 ).
Collapse
Affiliation(s)
- Steven J. Hadeed
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health
| | - Mary Kay O’Rourke
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health
| | - Robert A. Canales
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | | | | | | | - Emmanuel Gonzalez-Figueroa
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health
| | - Modhi Alshammari
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health
| | - Jefferey L. Burgess
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health
| | - Robin B. Harris
- Department of Epidemiology and Biostatistics, University of Arizona, Mel and Enid Zuckerman College of Public Health
| |
Collapse
|
16
|
Assessing effectiveness of air purifiers (HEPA) for controlling indoor particulate pollution. Heliyon 2021; 7:e07976. [PMID: 34568599 PMCID: PMC8449022 DOI: 10.1016/j.heliyon.2021.e07976] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/04/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
The present study deals with an evaluation of the air purifier's effectiveness in reducing the concentration of different sized particulate matter (PM) and ions in the real-world indoor environment. Two types of air purifiers (API and APII) mainly equipped with High-Efficiency Particulate Air (HEPA) filters that differed in other specifications were employed in general indoor air and the presence of an external source (candles and incense). The gravimetric sampling of PM was carried out by SKC Cascade Impactor and further samples were analyzed for determining ions' concentration while real-time monitoring of different sized PM was done through Grimm Aerosol Spectrometer (1.109). The result showed that API reduced PM levels of different sizes ranged from 12-52% and 29–53% in general indoor air and presence of external source respectively. Concerning the APII, a higher decrease percent in PM level was explored in presence of an external source (52–68%) as compared to scenarios of general indoor air (37–64%). The concentrations of the ions were noticed to be decreased in all three size fractions but surprisingly some ions' (not specific) concentrations increased on the operation of both types of air purifiers. Overall, the study recommends the use of air purifiers with mechanical filters (HEPA) instead of those which release ions for air purification. Efficiency of air purifier (AP) in removing indoor air pollutants was observed. AP was more effective on small-sized particles than large ones. AP of large Clean Air Delivery Rate removed particulate and ions more effectively. APs with mechanical filters must be employed instead of ions generators.
Collapse
|
17
|
Walker ES, Noonan CW, Semmens EO, Ware D, Smith P, Boyer BB, Erdei E, Hopkins SE, Lewis J, Belcourt A, Ward TJ. Indoor fine particulate matter and demographic, household, and wood stove characteristics among rural US homes heated with wood fuel. INDOOR AIR 2021; 31:1109-1124. [PMID: 33620109 PMCID: PMC8217112 DOI: 10.1111/ina.12808] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 05/31/2023]
Abstract
Household heating using wood stoves is common practice in many rural areas of the United States (US) and can lead to elevated concentrations of indoor fine particulate matter (PM2.5 ). We collected 6-day measures of indoor PM2.5 during the winter and evaluated household and stove-use characteristics in homes at three rural and diverse study sites. The median indoor PM2.5 concentration across all homes was 19 µg/m3 , with higher concentrations in Alaska (median = 30, minimum = 4, maximum = 200, n = 10) and Navajo Nation homes (median = 29, minimum = 3, maximum = 105, n = 23) compared with Montana homes (median = 16, minimum = 2, maximum = 139, n = 59). Households that had not cleaned the chimney within the past year had 65% higher geometric mean PM2.5 compared to those with chimney cleaned within 6 months (95% confidence interval [CI]: -1, 170). Based on a novel wood stove grading method, homes with low-quality and medium-quality stoves had substantially higher PM2.5 compared to homes with higher-quality stoves (186% higher [95% CI: 32, 519] and 161% higher; [95% CI:27, 434], respectively). Our findings highlight the need for, and complex nature of, regionally appropriate interventions to reduce indoor air pollution in rural wood-burning regions. Higher-quality stoves and behavioral practices such as regular chimney cleaning may help improve indoor air quality in such homes.
Collapse
Affiliation(s)
- Ethan S. Walker
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Curtis W. Noonan
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Erin O. Semmens
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Desirae Ware
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Paul Smith
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Bert B. Boyer
- Center for Alaska Native Health Research, University of Alaska Fairbanks, AK, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Esther Erdei
- Community Environmental Health Program, University of New Mexico College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, University of Alaska Fairbanks, AK, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Johnnye Lewis
- Community Environmental Health Program, University of New Mexico College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA
| | - Annie Belcourt
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Tony J. Ward
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| |
Collapse
|
18
|
Cheek E, Guercio V, Shrubsole C, Dimitroulopoulou S. Portable air purification: Review of impacts on indoor air quality and health. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 766:142585. [PMID: 33121763 DOI: 10.1016/j.scitotenv.2020.142585] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 05/22/2023]
Abstract
A systematic literature review was carried out to examine the impact of portable air purifiers (PAPs) on indoor air quality (PM2.5) and health, focussing on adults and children in indoor environments (homes, schools and offices). Analysed studies all showed reductions in PM2.5 of between 22.6 and 92.0% with the use of PAPs when compared to the control. Associations with health impacts found included those on blood pressure, respiratory parameters and pregnancy outcomes. Changes in clinical biochemical markers were also identified. However, evidence for such associations was limited and inconsistent. Health benefits from a reduction in PM2.5 would be expected as the cumulative body of scientific evidence from various cohort studies shows positive impacts of long-term reduction in PM2.5 concentrations. The current evidence demonstrates that using a PAP results in short-term reductions in PM2.5 in the indoor environment, which has the potential to offer health benefits.
Collapse
Affiliation(s)
- Emily Cheek
- Air Quality and Public Health Group, Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Didcot, Oxfordshire, United Kingdom
| | - Valentina Guercio
- Air Quality and Public Health Group, Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Didcot, Oxfordshire, United Kingdom
| | - Clive Shrubsole
- Air Quality and Public Health Group, Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Didcot, Oxfordshire, United Kingdom
| | - Sani Dimitroulopoulou
- Air Quality and Public Health Group, Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Didcot, Oxfordshire, United Kingdom.
| |
Collapse
|
19
|
Can Public Spaces Effectively Be Used as Cleaner Indoor Air Shelters during Extreme Smoke Events? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084085. [PMID: 33924413 PMCID: PMC8070163 DOI: 10.3390/ijerph18084085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 01/05/2023]
Abstract
During extreme air pollution events, such as bushfires, public health agencies often recommend that vulnerable individuals visit a nearby public building with central air conditioning to reduce their exposure to smoke. However, there is limited evidence that these "cleaner indoor air shelters" reduce exposure or health risks. We quantified the impact of a "cleaner indoor air shelter" in a public library in Port Macquarie, NSW, Australia when concentrations of fine particulate matter (PM2.5) were elevated during a local peat fire and nearby bushfires. Specifically, we evaluated the air quality improvements with central air conditioning only and with the use of portable high efficiency particulate air (HEPA) filter air cleaners. We measured PM2.5 from August 2019 until February 2020 by deploying pairs of low-cost PM2.5 sensors (i) inside the main library, (ii) in a smaller media room inside the library, (iii) outside the library, and (iv) co-located with regulatory monitors located in the town. We operated two HEPA cleaners in the media room from August until October 2019. We quantified the infiltration efficiency of outdoor PM2.5 concentrations, defined as the fraction of the outdoor PM2.5 concentration that penetrates indoors and remains suspended, as well as the additional effect of HEPA cleaners on PM2.5 concentrations. The infiltration efficiency of outdoor PM2.5 into the air-conditioned main library was 30%, meaning that compared to the PM2.5 concentration outdoors, the concentrations of outdoor-generated PM2.5 indoors were reduced by 70%. In the media room, when the HEPA cleaners were operating, PM2.5 concentrations were reduced further with a PM2.5 infiltration efficiency of 17%. A carefully selected air-conditioned public building could be used as a cleaner indoor air shelter during episodes of elevated smoke emissions. Further improvements in indoor air quality within the building can be achieved by operating appropriately sized HEPA cleaners.
Collapse
|
20
|
Davison G, Barkjohn KK, Hagler GSW, Holder AL, Coefield S, Noonan C, Hassett-Sipple B. Creating Clean Air Spaces During Wildland Fire Smoke Episodes: Web Summit Summary. Front Public Health 2021; 9:508971. [PMID: 33681116 PMCID: PMC7928341 DOI: 10.3389/fpubh.2021.508971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/18/2021] [Indexed: 12/22/2022] Open
Abstract
Effective strategies to reduce indoor air pollutant concentrations during wildfire smoke events are critically needed. Worldwide, communities in areas prone to wildfires may suffer from annual smoke exposure events lasting from days to weeks. In addition, there are many areas of the world where high pollution events are common and where methods employed to reduce exposure to pollution may have relevance to wildfire smoke pollution episodes and vice versa. This article summarizes a recent virtual meeting held by the United States Environmental Protection Agency (EPA) to share research, experiences, and other information that can inform best practices for creating clean air spaces during wildland fire smoke events. The meeting included presentations on the public health impacts of wildland fire smoke; public health agencies' experiences and resilience efforts; and methods to improve indoor air quality, including the effectiveness of air filtration methods [e.g., building heating ventilation and air conditioning (HVAC) systems and portable, free-standing air filtration systems]. These presentations and related research indicate that filtration has been demonstrated to effectively improve indoor air quality during high ambient air pollution events; however, several research questions remain regarding the longevity and maintenance of filtration equipment during and after smoke events, effects on the pollution mixture, and degree to which adverse health effects are reduced.
Collapse
Affiliation(s)
- Gilliane Davison
- Air and Energy National Research Program, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - Karoline K. Barkjohn
- Oak Ridge Institute for Science Education Postdoctoral Fellow hosted by Center for Environmental Measurement and Modeling, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - Gayle S. W. Hagler
- Center for Environmental Measurement and Modeling, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - Amara L. Holder
- Center for Environmental Measurement and Modeling, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - Sarah Coefield
- Missoula City-County Health Department, Missoula, MT, United States
| | - Curtis Noonan
- Center for Population Health Research, University of Montana, Missoula, MT, United States
| | - Beth Hassett-Sipple
- Center for Environmental Measurement and Modeling, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| |
Collapse
|
21
|
Barkjohn KK, Norris C, Cui X, Fang L, Zheng T, Schauer JJ, Li Z, Zhang Y, Black M, Zhang JJ, Bergin MH. Real-time measurements of PM 2.5 and ozone to assess the effectiveness of residential indoor air filtration in Shanghai homes. INDOOR AIR 2021; 31:74-87. [PMID: 32649780 DOI: 10.1111/ina.12716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/08/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Abstract
Portable air cleaners are increasingly used in polluted areas in an attempt to reduce human exposure; however, there has been limited work characterizing their effectiveness at reducing exposure. With this in mind, we recruited forty-three children with asthma from suburban Shanghai and deployed air cleaners (with HEPA and activated carbon filters) in their bedrooms. During both 2-week filtration and non-filtration periods, low-cost PM2.5 and O3 air monitors were used to measure pollutants indoors, outdoors, and for personal exposure. Indoor PM2.5 concentrations were reduced substantially with the use of air cleaners, from 34 ± 17 to 10 ± 8 µg/m3 , with roughly 80% of indoor PM2.5 estimated to come from outdoor sources. Personal exposure to PM2.5 was reduced from 40 ± 17 to 25 ± 14 µg/m3 . The more modest reductions in personal exposure and high contribution of outdoor PM2.5 to indoor concentrations highlight the need to reduce outdoor PM2.5 and/or to clean indoor air in multiple locations. Indoor O3 concentrations were generally low (mean = 8±4 ppb), and no significant difference was seen by filtration status. The concentrations of pollutants and the air cleaner effectiveness were highly variable over time and across homes, highlighting the usefulness of real-time air monitors for understanding individual exposure reduction strategies.
Collapse
Affiliation(s)
| | - Christina Norris
- Civil and Environmental Engineering, Duke University, Durham, NC, USA
| | - Xiaoxing Cui
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Lin Fang
- School of Architecture, Tsinghua University, Beijing, China
| | - Tongshu Zheng
- Civil and Environmental Engineering, Duke University, Durham, NC, USA
| | - James J Schauer
- Civil and Environmental Engineering, University of Wisconsin at Madison, Madison, WI, USA
| | - Zhen Li
- Shanghai First People's Hospital, Shanghai Shi, China
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | | | - Junfeng Jim Zhang
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Michael H Bergin
- Civil and Environmental Engineering, Duke University, Durham, NC, USA
| |
Collapse
|
22
|
Abstract
Worldwide, more than 4 million deaths annually are attributed to indoor air pollution. This largely preventable exposure represents a key target for reducing morbidity and mortality worldwide. Significant respiratory health effects are observed, ranging from attenuated lung growth and development in childhood to accelerated lung function decline and is determined by chronic obstructive pulmonary disease later in life. Personal exposure to household air pollutants include household characteristics, combustion of solid fuels, cooking practices, and household pest allergens. This review outlines important sources of indoor air pollution, their respiratory health effects, and strategies to reduce household pollution and improve lung health across the globe.
Collapse
Affiliation(s)
- Sarath Raju
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA.
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA
| |
Collapse
|
23
|
Lowther SD, Deng W, Fang Z, Booker D, Whyatt DJ, Wild O, Wang X, Jones KC. How efficiently can HEPA purifiers remove priority fine and ultrafine particles from indoor air? ENVIRONMENT INTERNATIONAL 2020; 144:106001. [PMID: 32739515 DOI: 10.1016/j.envint.2020.106001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 05/27/2023]
Abstract
More than 1 million premature deaths in Asia annually are estimated to be associated with indoor air quality. HEPA (high-efficiency particulate air) filter air purifiers (APs) are widely used in urban Chinese residences by the growing middle class, as public awareness of air pollution increases. Currently, understanding of how particle size affects particle removal is inconsistent, and the rate at which different particle types are removed remains largely unknown. Therefore, this investigation aimed to determine the relationship between particle size and the removal efficiency of particles, and how efficiently ambient air is filtered compared to particle types which are typically used in standard tests (tobacco smoke, dust and pollen). Three of the most popular AP models in China were tested in China's largest indoor controlled chamber laboratory and the removal efficiencies of particles in the 18-514 nm range were identified. Each AP had a distinct profile of removal efficiency against particle size, but the three APs shared similarities in performance, with removal efficiency consistently lowest at 200-250 nm. This size fraction is important in an exposure context as these particles are abundant in ambient air in mega-cities, can penetrate through building shells effectively, remain airborne for long periods of time and can penetrate the deepest areas of the lungs. Ambient air particles were removed at a similar rate to test particles; this confirms that the Association of Home Appliance Manufacturers' (AHAM) standards are a suitable proxy for "real world" performance.
Collapse
Affiliation(s)
- Scott D Lowther
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, United Kingdom; State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, 511 Kehua Rd, Tianhe, Guangzhou 510640, China
| | - Wei Deng
- State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, 511 Kehua Rd, Tianhe, Guangzhou 510640, China
| | - Zheng Fang
- State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, 511 Kehua Rd, Tianhe, Guangzhou 510640, China
| | - Douglas Booker
- NAQTS, Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, United Kingdom
| | - Duncan J Whyatt
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, United Kingdom
| | - Oliver Wild
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, United Kingdom
| | - Xinming Wang
- State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, 511 Kehua Rd, Tianhe, Guangzhou 510640, China.
| | - Kevin C Jones
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, United Kingdom.
| |
Collapse
|
24
|
Kim S, Lee J, Park S, Rudasingwa G, Lee S, Yu S, Lim DH. Association between Peak Expiratory Flow Rate and Exposure Level to Indoor PM2.5 in Asthmatic Children, Using Data from the Escort Intervention Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207667. [PMID: 33096665 PMCID: PMC7589683 DOI: 10.3390/ijerph17207667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 12/23/2022]
Abstract
Various studies have indicated that particulate matter <2.5 μm (PM2.5) could cause adverse health effects on pulmonary functions in susceptible groups, especially asthmatic children. Although the impact of ambient PM2.5 on children’s lower respiratory health has been well-established, information regarding the associations between indoor PM2.5 levels and respiratory symptoms in asthmatic children is relatively limited. This randomized, crossover intervention study was conducted among 26 asthmatic children’s homes located in Incheon metropolitan city, Korea. We aimed to evaluate the effects of indoor PM2.5 on children’s peak expiratory flow rate (PEFR), with a daily intervention of air purifiers with filter on, compared with those groups with filter off. Children aged between 6–12 years diagnosed with asthma were enrolled and randomly allocated into two groups. During a crossover intervention period of seven weeks, we observed that, in the filter-on group, indoor PM2.5 levels significantly decreased by up to 43%. (p < 0.001). We also found that the daily or weekly unit (1 μg/m3) increase in indoor PM2.5 levels could significantly decrease PEFR by 0.2% (95% confidence interval (CI) = 0.1 to 0.5) or PEFR by 1.2% (95% CI = 0.1 to 2.7) in asthmatic children, respectively. The use of in-home air filtration could be considered as an intervention strategy for indoor air quality control in asthmatic children’s homes.
Collapse
Affiliation(s)
- Sungroul Kim
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
- Department of ICT Environmental Health System, Graduate School, Soonchunhyang University, Asan 31538, Korea;
- Correspondence: ; Tel.: +82-41-530-1266
| | - Jungeun Lee
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
| | - Sujung Park
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
| | - Guillaume Rudasingwa
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
| | - Sangwoon Lee
- Department of ICT Environmental Health System, Graduate School, Soonchunhyang University, Asan 31538, Korea;
| | - Sol Yu
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
| | - Dae Hyun Lim
- Department of Pediatrics, School of Medicine, Inha University, Incheon 22332, Korea;
| |
Collapse
|
25
|
Masterson EE, Younglove LB, Perez A, Torres E, Krenz JE, Tchong French MI, Riederer AM, Sampson PD, Metwali N, Min E, Jansen KL, Aisenberg G, Babadi RS, Farquhar SA, Thorne PS, Karr CJ. The home air in agriculture pediatric intervention (HAPI) trial: Rationale and methods. Contemp Clin Trials 2020; 96:106085. [PMID: 32721578 PMCID: PMC7494646 DOI: 10.1016/j.cct.2020.106085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data addressing air quality effects on children with asthma in rural U.S. communities are rare. Our community engaged research partnership previously demonstrated associations between neighborhood NH3 and ambient PM2.5 and asthma in the agricultural lower Yakima Valley of Washington. As a next step, the partnership desired an intervention approach to address concerns about pediatric asthma in this largely Latino immigrant, farm worker community. OBJECTIVE The Home Air in Agriculture Pediatric Intervention (HAPI) sought to examine the effectiveness of enrichment of an existing asthma education program with portable high-efficiency particulate air (HEPA) cleaners designed to reduce PM2.5 and NH3. We investigated the effect of this enriched approach on these exposures and asthma health measures. DESIGN We randomized children with poorly controlled asthma to a control arm (current asthma education program) or an intervention arm (current asthma education program + placement of two indoor air cleaners in the family's home). Outcomes included (1) 14-day integrated samples of indoor air contaminants (PM2.5 and NH3) at baseline and one-year follow-up and (2) child asthma health metrics at baseline, midpoint (4-6 months) and one-year follow-up. These included the Asthma Control Test, symptoms days, clinical utilization, oral corticosteroid use, pulmonary function, fractional exhaled nitric oxide, and urinary leukotriene E4 concentration. DISCUSSION To our knowledge, this is the first randomized HEPA cleaner intervention designed to assess NH3 as well as PM2.5 and to evaluate health outcomes of children with asthma in an agricultural region.
Collapse
Affiliation(s)
- Erin E Masterson
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America.
| | - Lisa B Younglove
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Adriana Perez
- Yakima Valley Farm Worker's Clinic, Toppenish, WA, United States of America
| | - Elizabeth Torres
- Northwest Communities Education Center, Radio KDNA, Granger, WA, United States of America
| | - Jennifer E Krenz
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Maria I Tchong French
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Anne M Riederer
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Paul D Sampson
- Department of Statistics, University of Washington, Seattle, WA, United States of America
| | - Nervana Metwali
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States of America
| | - Esther Min
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Karen L Jansen
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Gino Aisenberg
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Ryan S Babadi
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Stephanie A Farquhar
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America; Department of Health Services, University of Washington, Seattle, WA, United States of America
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States of America
| | - Catherine J Karr
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America; Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| |
Collapse
|
26
|
Moreno-Rangel A, Baek J, Roh T, Xu X, Carrillo G. Assessing Impact of Household Intervention on Indoor Air Quality and Health of Children with Asthma in the US-Mexico Border: A Pilot Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:6042146. [PMID: 32831855 PMCID: PMC7421793 DOI: 10.1155/2020/6042146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/29/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Abstract
Few studies have investigated household interventions to enhance indoor air quality (IAQ) and health outcomes in relatively low-income communities. This study aims to examine the impact of the combined intervention with asthma education and air purifier on IAQ and health outcomes in the US-Mexico border area. An intervention study conducted in McAllen, Texas, between June and November 2019 included 16 households having children with asthma. The particulate matter (PM2.5) levels were monitored in the bedroom, kitchen, and living room to measure the IAQ for 7 days before and after the intervention, respectively. Multiple surveys were applied to evaluate changes in children's health outcomes. The mean PM2.5 levels in each place were significantly improved. Overall, they significantly decreased by 1.91 μg/m3 on average (p < 0.05). All surveys showed better health outcomes; particularly, quality of life for children was significantly improved (p < 0.05). This pilot study suggests that the combined household intervention might improve IAQ in households and health outcomes for children with asthma and reduce health disparities in low-income communities. Future large-scale studies are needed to verify the effectiveness of this household intervention to improve IAQ and asthma management.
Collapse
Affiliation(s)
- Alejandro Moreno-Rangel
- Lancaster Institute of Contemporary Arts, Faculty of Arts and Social Science, Lancaster University, Bailrigg LA1 4YW, UK
| | - Juha Baek
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Taehyun Roh
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
- Program on Asthma Research and Education, Texas A&M School of Public Health, McAllen Campus, 2102 S. McColl Road, McAllen, TX 78503, USA
| |
Collapse
|
27
|
Fleisch AF, Rokoff LB, Garshick E, Grady ST, Chipman JW, Baker ER, Koutrakis P, Karagas MR. Residential wood stove use and indoor exposure to PM 2.5 and its components in Northern New England. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:350-361. [PMID: 31253828 PMCID: PMC6934936 DOI: 10.1038/s41370-019-0151-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/15/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Residential wood stove use has become more prevalent in high-income countries, but only limited data exist on indoor exposure to PM2.5 and its components. METHODS From 2014 to 2016, we collected 7-day indoor air samples in 137 homes of pregnant women in Northern New England, using a micro-environmental monitor. We examined associations of wood stove use with PM2.5 mass and its components [black carbon (BC), organic and elemental carbon and their fractions, and trace elements], adjusted for sampling season, community wood stove use, and indoor activities. We examined impact of stove age, EPA-certification, and wood moisture on indoor pollutants. RESULTS Median (IQR) household PM2.5 was 6.65 (5.02) µg/m3 and BC was 0.23 (0.20) µg/m3. Thirty percent of homes used a wood stove during monitoring. In homes with versus without a stove, PM2.5 was 20.6% higher [although 95% confidence intervals (-10.6, 62.6) included the null] and BC was 61.5% higher (95% CI: 11.6, 133.6). Elemental carbon (total and fractions 3 and 4), potassium, calcium, and chloride were also higher in homes with a stove. Older stoves, non-EPA-certified stoves, and wet or mixed (versus dry) wood were associated with higher pollutant concentrations, especially BC. CONCLUSIONS Homes with wood stoves, particularly those that were older and non-EPA-certified or burning wet wood had higher concentrations of indoor air combustion-related pollutants.
Collapse
Affiliation(s)
- Abby F Fleisch
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME, USA.
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.
| | - Lisa B Rokoff
- Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie T Grady
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Research and Development Service, VA Boston Healthcare System, Boston, MA, USA
| | | | - Emily R Baker
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA
| |
Collapse
|
28
|
Vicente ED, Vicente AM, Evtyugina M, Oduber FI, Amato F, Querol X, Alves C. Impact of wood combustion on indoor air quality. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 705:135769. [PMID: 31818582 DOI: 10.1016/j.scitotenv.2019.135769] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
The incomplete wood combustion in appliances operated in batch mode is a recognised source of both in- and outdoor airborne pollutants, especially particulate matter (PM). Data on pollutant levels and PM characteristics in households with wood burning devices in developed countries are scarce with most studies describing stove change out programmes or other intervention measures. The aim of the present study was to simultaneously evaluate indoor and outdoor concentrations of CO, CO2 and PM10 during the operation of wood burning appliances (open fireplace and woodstove) in unoccupied rural households. PM10 samples were analysed for water soluble inorganic ions, major and trace elements, organic carbon (OC), elemental carbon (EC), and detailed organic speciation. The CO 8-hour average concentrations did not exceed the protection limit despite the sharp increases observed in relation to background levels. During the open fireplace operation, PM10 levels rose up 12 times compared to background concentrations, while the airtight stove resulted in a 2-fold increase. The inhalation cancer risk of particulate bound PAHs in the room equipped with woodstove was estimated to be negligible while the long-term exposure to PAH levels measured in the fireplace room may contribute to the development of cancer. The excess lifetime cancer risk resulting from the particle-bound Cr(VI) exposure during the fireplace and woodstove operation was higher than 1.0 × 10-6 and 1.0 × 10-5, respectively. Levoglucosan was one of the most abundant individual species both indoors and outdoors. This study underlines air pollution hazards and risks arising from the operation of traditional wood burning appliances.
Collapse
Affiliation(s)
- E D Vicente
- Centre for Environmental and Marine Studies, Department of Environment and Planning, University of Aveiro, 3810-193 Aveiro, Portugal.
| | - A M Vicente
- Centre for Environmental and Marine Studies, Department of Environment and Planning, University of Aveiro, 3810-193 Aveiro, Portugal
| | - M Evtyugina
- Centre for Environmental and Marine Studies, Department of Environment and Planning, University of Aveiro, 3810-193 Aveiro, Portugal
| | - F I Oduber
- Department of Physics, IMARENAB University of León, 24071 León, Spain
| | - F Amato
- Institute of Environmental Assessment and Water Research, Spanish Research Council (IDÆA-CSIC), 08034 Barcelona, Spain
| | - X Querol
- Institute of Environmental Assessment and Water Research, Spanish Research Council (IDÆA-CSIC), 08034 Barcelona, Spain
| | - C Alves
- Centre for Environmental and Marine Studies, Department of Environment and Planning, University of Aveiro, 3810-193 Aveiro, Portugal
| |
Collapse
|
29
|
Noonan CW, Semmens EO, Ware D, Smith P, Boyer BB, Erdei E, Hopkins SE, Lewis J, Ward TJ. Wood stove interventions and child respiratory infections in rural communities: KidsAir rationale and methods. Contemp Clin Trials 2020; 89:105909. [PMID: 31838259 PMCID: PMC7242120 DOI: 10.1016/j.cct.2019.105909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute lower respiratory tract infections (LRTIs) account for >27% of all hospitalizations among US children under five years of age. Residential burning of biomass for heat leads to elevated indoor levels of fine particulate matter (PM2.5) that often exceed current health based air quality standards. This is concerning as PM2.5 exposure is associated with many adverse health outcomes, including a greater than three-fold increased risk of LRTIs. Evidence-based efforts are warranted in rural and American Indian/Alaska Native (AI/AN) communities in the US that suffer from elevated rates of childhood LRTI and commonly use wood for residential heating. DESIGN In three rural and underserved settings, we conducted a three-arm randomized controlled, post-only intervention trial in wood stove homes with children less than five years old. Education and household training on best-burn practices were introduced as one intervention arm (Tx1). This intervention was evaluated against an indoor air filtration unit arm (Tx2), as well as a control arm (Tx3). The primary outcome was LRTI incidence among children under five years of age. DISCUSSION To date, exposure reduction strategies in wood stove homes have been either inconsistently effective or include factors that limit widespread dissemination and continued compliance in rural and economically disadvantaged populations. As part of the "KidsAIR" study described herein, the overall hypothesis was that a low-cost, educational intervention targeting indoor wood smoke PM2.5 exposures would be a sustainable approach for reducing children's risk of LRTI in rural and AI/AN communities.
Collapse
Affiliation(s)
- Curtis W Noonan
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.
| | - Erin O Semmens
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Desirae Ware
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Paul Smith
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Bert B Boyer
- Center for Alaska Native Health Research, University of Alaska Fairbanks, AK, USA; Oregon Health Science University, Portland, OR, USA
| | - Esther Erdei
- Community Environmental Health Program, University of New Mexico College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA
| | - Scarlett E Hopkins
- Center for Alaska Native Health Research, University of Alaska Fairbanks, AK, USA; Oregon Health Science University, Portland, OR, USA
| | - Johnnye Lewis
- Community Environmental Health Program, University of New Mexico College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA
| | - Tony J Ward
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| |
Collapse
|
30
|
Singleton R, Salkoski AJ, Bulkow L, Fish C, Dobson J, Albertson L, Skarada J, Ritter T, Kovesi T, Hennessy TW. Impact of home remediation and household education on indoor air quality, respiratory visits and symptoms in Alaska Native children. Int J Circumpolar Health 2018; 77:1422669. [PMID: 29393004 PMCID: PMC5804775 DOI: 10.1080/22423982.2017.1422669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/22/2017] [Indexed: 11/12/2022] Open
Abstract
Alaska Native children experience high rates of lower respiratory tract infections (LRTIs) and lung conditions, which are associated with substandard indoor air quality (IAQ). We conducted an intervention of home remediation and education to assess the impact on IAQ, respiratory symptoms and LRTI visits. We enrolled households of children 1-12 years of age with lung conditions. Home remediation included improving ventilation and replacing leaky woodstoves. We provided education about IAQ and respiratory health. We monitored indoor airborne particles (PM2.5), CO2, relative humidity and volatile organic compounds (VOCs), and interviewed caregivers about children's symptoms before, and for 1 year after intervention. We evaluated the association between children's respiratory visits, symptoms and IAQ indicators using multiple logistic regression. A total of 60 of 63 homes completed the study. VOCs decreased (coefficient = -0.20; p < 0.001); however, PM2.5 (coeff. = -0.010; p = 0.89) did not decrease. Burning wood for heat, VOCs and PM2.5 were associated with respiratory symptoms. After remediation, parents reported decreases in runny nose, cough between colds, wet cough, wheezing with colds, wheezing between colds and school absences. Children had an age-adjusted decrease in LRTI visits (coefficient = -0.33; p = 0.028). Home remediation and education reduced respiratory symptoms, LRTI visits and school absenteeism in children with lung conditions.
Collapse
Affiliation(s)
- Rosalyn Singleton
- Division of Community Health Services, Alaska Native Tribal Health Consortium (ANTHC), Anchorage, AK, USA
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (AIP-CDC), Anchorage, AK, USA
| | | | | | - Chris Fish
- Division of Environmental Health and Engineering, ANTHC, Anchorage, AK, USA
| | - Jennifer Dobson
- Office of Environmental Health, Yukon Kuskokwim Health Corporation, Bethel, AK, USA
| | - Leif Albertson
- School of Natural Resources and Extension, University of Alaska, Fairbanks, Bethel, AK, USA
| | | | - Troy Ritter
- Division of Environmental Health and Engineering, ANTHC, Anchorage, AK, USA
| | - Thomas Kovesi
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | |
Collapse
|
31
|
Lowe AA, Bender B, Liu AH, Solomon T, Kobernick A, Morgan W, Gerald LB. Environmental Concerns for Children with Asthma on the Navajo Nation. Ann Am Thorac Soc 2018; 15:745-753. [PMID: 29485894 PMCID: PMC6207133 DOI: 10.1513/annalsats.201708-674ps] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Navajo children living on the reservation have high rates of asthma prevalence and severity. Environmental influences may contribute to asthma on the Navajo Nation and are inadequately understood. OBJECTIVES We performed a comprehensive, integrative literature review to determine the environmental factors that may contribute to increased asthma prevalence and severity among Navajo children living on the reservation. METHODS A systematic search was conducted in four databases regarding the environmental risk factors for asthma in Navajo children living on the reservation. Relevant studies between 1990 and 2017 were examined. Nonexperimental literature was also integrated into the review to describe the environmental injustices that have historically, disproportionately, and systematically affected the Navajo people, thus contributing to respiratory disparities among Navajo children. RESULTS Eight studies met inclusion criteria for systematic review; however, limited research regarding environmental risk factors specific to asthma and Navajo children living on the reservation was identified. Our integrative review indicated both indoor and outdoor environmental risk factors commonly found on the Navajo reservation appear to be important determinants of asthma. CONCLUSIONS Future research should examine indoor and outdoor air pollution from wood-burning stoves and cook stoves, coal combustion, tobacco and traditional ceremonial smoke, diesel exhaust exposure from long bus rides, indoor allergens, ambient pollutants, and regional dusts. Comprehensive mitigation efforts created in partnership with the Navajo Nation are necessary to address less-recognized risk factors as well as the common risk factors known to contribute to increased childhood asthma prevalence and severity.
Collapse
Affiliation(s)
- Ashley A. Lowe
- Asthma & Airway Disease Research Center, Tucson, Arizona
- University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Bruce Bender
- National Jewish Health, Denver, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
| | - Andrew H. Liu
- National Jewish Health, Denver, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
- Children’s Hospital Colorado, Aurora, Colorado
| | - Teshia Solomon
- University of Arizona Native American Training and Research Center, Tucson, Arizona
- University of Arizona College of Medicine, Tucson, Arizona; and
| | | | - Wayne Morgan
- Asthma & Airway Disease Research Center, Tucson, Arizona
- University of Arizona College of Medicine, Tucson, Arizona; and
| | - Lynn B. Gerald
- Asthma & Airway Disease Research Center, Tucson, Arizona
- University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| |
Collapse
|
32
|
Barn P, Gombojav E, Ochir C, Laagan B, Beejin B, Naidan G, Boldbaatar B, Galsuren J, Byambaa T, Janes C, Janssen PA, Lanphear BP, Takaro TK, Venners SA, Webster GM, Yuchi W, Palmer CD, Parsons PJ, Roh YM, Allen RW. The effect of portable HEPA filter air cleaners on indoor PM 2.5 concentrations and second hand tobacco smoke exposure among pregnant women in Ulaanbaatar, Mongolia: The UGAAR randomized controlled trial. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 615:1379-1389. [PMID: 29751442 DOI: 10.1016/j.scitotenv.2017.09.291] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Portable HEPA filter air cleaners can reduce indoor fine particulate matter (PM2.5), but their use has not been adequately evaluated in high pollution settings. We assessed air cleaner effectiveness in reducing indoor residential PM2.5 and second hand smoke (SHS) exposures among non-smoking pregnant women in Ulaanbaatar, Mongolia. METHODS We randomized 540 participants to an intervention group receiving 1 or 2 HEPA filter air cleaners or a control group receiving no air cleaners. We followed 259 intervention and 253 control participants to the end of pregnancy. We measured one-week indoor residential PM2.5 concentrations in early (~11weeks gestation) and late (~31weeks gestation) pregnancy and collected outdoor PM2.5 data from centrally-located government monitors. We assessed blood cadmium in late pregnancy. Hair nicotine was quantified in a subset (n=125) to evaluate blood cadmium as a biomarker of SHS exposure. We evaluated air cleaner effectiveness using mixed effects and multiple linear regression models and used stratified models and interaction terms to evaluate potential modifiers of effectiveness. RESULTS The overall geometric mean (GM) one-week outdoor PM2.5 concentration was 47.9μg/m3 (95% CI: 44.6, 51.6μg/m3), with highest concentrations in winter (118.0μg/m3; 110.4, 126.2μg/m3). One-week indoor and outdoor PM2.5 concentrations were correlated (r=0.69). Indoor PM2.5 concentrations were 29% (21, 37%) lower in intervention versus control apartments, with GMs of 17.3μg/m3 (15.8, 18.8μg/m3) and 24.5μg/m3 (22.2, 27.0μg/m3), respectively. Air cleaner effectiveness was greater when air cleaners were first deployed (40%; 31, 48%) than after approximately five months of use (15%; 0, 27%). Blood cadmium concentrations were 14% (4, 23%) lower among intervention participants, likely due to reduced SHS exposure. CONCLUSIONS Portable HEPA filter air cleaners can lower indoor PM2.5 concentrations and SHS exposures in highly polluted settings.
Collapse
Affiliation(s)
- Prabjit Barn
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
| | - Enkhjargal Gombojav
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia.
| | - Chimedsuren Ochir
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia.
| | - Bayarkhuu Laagan
- Sukhbaatar District Health Center, 11 Horoo, Tsagdaagiin Gudamj, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Bolor Beejin
- Mongolian National Center for Public Health, Olympic Street 2, Ulaanbaatar, Mongolia.
| | - Gerel Naidan
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia
| | - Buyantushig Boldbaatar
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia
| | - Jargalsaikhan Galsuren
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia
| | - Tsogtbaatar Byambaa
- Mongolian National Center for Public Health, Olympic Street 2, Ulaanbaatar, Mongolia.
| | - Craig Janes
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo N2L 3G1, Canada.
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver V6T 1Z3, Canada.
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
| | - Scott A Venners
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
| | - Glenys M Webster
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
| | - Weiran Yuchi
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
| | - Christopher D Palmer
- New York State Department of Health, Wadsworth Center, Albany, NY, PO Box 509, 12201, USA; School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA.
| | - Patrick J Parsons
- New York State Department of Health, Wadsworth Center, Albany, NY, PO Box 509, 12201, USA; School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA.
| | - Young Man Roh
- College of Health Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Ryan W Allen
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
| |
Collapse
|
33
|
Sood A, Assad NA, Barnes PJ, Churg A, Gordon SB, Harrod KS, Irshad H, Kurmi OP, Martin WJ, Meek P, Mortimer K, Noonan CW, Perez-Padilla R, Smith KR, Tesfaigzi Y, Ward T, Balmes J. ERS/ATS workshop report on respiratory health effects of household air pollution. Eur Respir J 2018; 51:51/1/1700698. [PMID: 29301918 DOI: 10.1183/13993003.00698-2017] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/08/2017] [Indexed: 12/18/2022]
Abstract
Exposure to household air pollution (HAP) from solid fuel combustion affects almost half of the world population. Adverse respiratory outcomes such as respiratory infections, impaired lung growth and chronic obstructive pulmonary disease have been linked to HAP exposure. Solid fuel smoke is a heterogeneous mixture of various gases and particulates. Cell culture and animal studies with controlled exposure conditions and genetic homogeneity provide important insights into HAP mechanisms. Impaired bacterial phagocytosis in exposed human alveolar macrophages possibly mediates several HAP-related health effects. Lung pathological findings in HAP-exposed individuals demonstrate greater small airways fibrosis and less emphysema compared with cigarette smokers. Field studies using questionnaires, air pollution monitoring and/or biomarkers are needed to better establish human risks. Some, but not all, studies suggest that improving cookstove efficiency or venting emissions may be associated with reduced respiratory symptoms, lung function decline in women and severe pneumonia in children. Current studies focus on fuel switching, stove technology replacements or upgrades and air filter devices. Several governments have initiated major programmes to accelerate the upgrade from solid fuels to clean fuels, particularly liquid petroleum gas, which provides research opportunities for the respiratory health community.
Collapse
Affiliation(s)
- Akshay Sood
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nour A Assad
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Churg
- University of British Columbia, Vancouver, BC, Canada
| | | | - Kevin S Harrod
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hammad Irshad
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | | | | | - Paula Meek
- University of Colorado at Denver, Denver, CO, USA
| | | | | | | | - Kirk R Smith
- University of California School of Public Health, Berkeley, CA, USA
| | | | - Tony Ward
- University of Montana, Missoula, MT, USA
| | - John Balmes
- University of California School of Public Health, Berkeley, CA, USA.,University of California, San Francisco, CA, USA
| |
Collapse
|
34
|
戴 颖, 黄 志, 刘 新, 王 启. [Risk factors for recurrence of large atherosclerotic cerebral infarction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1678-1682. [PMID: 29292265 PMCID: PMC6744025 DOI: 10.3969/j.issn.1673-4254.2017.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore the risk factors for recurrence of large atherosclerotic cerebral infarction in first?episode patients. METHODS The consecutive patients with acute cerebral infarction diagnosed in the Department of Neurology were screened for large atherosclerotic cerebral infarction by CTA/MRA examination, and all the confirmed patients were followed up for 1 year. The patients were divided into recurrent ischemic stroke group and non?recurrent group according to occurrence of cerebrovascular events during the follow?up. RESULTS A total of 256 eligible patients were included in this study, and all of them completed the follow?up. During the 1?year follow?up, 30 (11.7%) patients had ischemic cerebrovascular stroke events. Univariate analysis showed significant differences in alcohol drinking (P=0.028), smoking (P=0.007), high?density lipoprotein cholesterol (HDL; P=0.045), ischemic heart disease (P=0.002), antihypertensive agents (P=0.036) and statin use (P=0.016) between the recurrent group and non?recurrent group. Cox regression analysis showed that irregular use of statins (RR=0.410, P=0.043), smoking (RR=2.253, P=0.043), HDL (RR=0.327, P=0.029), and ischemic heart disease (RR=8.566, P<0.001) were correlated with recurrent ischemic stroke. CONCLUSION The first?episode patients with irregular use of statins, low HDL levels, smoking and ischemic heart disease are at higher risks for having ischemic stroke recurrence.
Collapse
Affiliation(s)
- 颖仪 戴
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 志新 黄
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 新通 刘
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 启章 王
- 广州医科大学附属深圳沙井医院,广东 深圳 518104Shenzhen Shajing Hospital Affiliated to Guangzhou Medical University, Shenzhen 518104, China
| |
Collapse
|
35
|
Noonan CW, Semmens EO, Smith P, Harrar SW, Montrose L, Weiler E, McNamara M, Ward TJ. Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:097010. [PMID: 28935614 PMCID: PMC5915210 DOI: 10.1289/ehp849] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Household air pollution due to biomass combustion for residential heating adversely affects vulnerable populations. Randomized controlled trials to improve indoor air quality in homes of children with asthma are limited, and no such studies have been conducted in homes using wood for heating. OBJECTIVES Our aims were to test the hypothesis that household-level interventions, specifically improved-technology wood-burning appliances or air-filtration devices, would improve health measures, in particular Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among children living with asthma in homes with wood-burning stoves. METHODS A three-arm placebo-controlled randomized trial was conducted in homes with wood-burning stoves among children with asthma. Multiple preintervention and postintervention data included PAQLQ (primary outcome), peak expiratory flow (PEF) monitoring, diurnal peak flow variability (dPFV, an indicator of airway hyperreactivity) and indoor particulate matter (PM) PM2.5. RESULTS Relative to placebo, neither the air filter nor the woodstove intervention showed improvement in quality-of-life measures. Among the secondary outcomes, dPFV showed a 4.1 percentage point decrease in variability [95% confidence interval (CI)=-7.8 to -0.4] for air-filtration use in comparison with placebo. The air-filter intervention showed a 67% (95% CI: 50% to 77%) reduction in indoor PM2.5, but no change was observed with the improved-technology woodstove intervention. CONCLUSIONS Among children with asthma and chronic exposure to woodsmoke, an air-filter intervention that improved indoor air quality did not affect quality-of-life measures. Intent-to-treat analysis did show an improvement in the secondary measure of dPFV. TRIAL REGISTRATION ClincialTrials.gov NCT00807183. https://doi.org/10.1289/EHP849.
Collapse
Affiliation(s)
- Curtis W Noonan
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Erin O Semmens
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Paul Smith
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
- Community Medical Center , Missoula, Montana, USA
| | - Solomon W Harrar
- Department of Statistics, University of Kentucky , Lexington, Kentucky, USA
- Department of Mathematical Sciences, University of Montana , Missoula, Montana, USA
| | - Luke Montrose
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Emily Weiler
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Marcy McNamara
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Tony J Ward
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| |
Collapse
|
36
|
Finn S, Herne M, Castille D. The Value of Traditional Ecological Knowledge for the Environmental Health Sciences and Biomedical Research. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:085006. [PMID: 28858824 PMCID: PMC5783664 DOI: 10.1289/ehp858] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 04/10/2017] [Accepted: 04/27/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND Traditional Ecological Knowledge (TEK) is a term, relatively new to Western science, that encompasses a subset of traditional knowledge maintained by Indigenous nations about the relationships between people and the natural environment. The term was first shared by tribal elders in the 1980s to help raise awareness of the importance of TEK. TEK has become a construct that Western scientists have increasingly considered for conducting culturally relevant research with Tribal nations. OBJECTIVES The authors aim to position TEK in relation to other emerging schools of thought, that is, concepts such as the exposome, social determinants of health (SDoH), and citizen science, and to explore TEK's relevance to environmental health research. This article provides examples of successful application of TEK principles in federally funded research when implemented with respect for the underlying cultural context and in partnership with Indigenous communities. DISCUSSION Rather than treating TEK as an adjunct or element to be quantified or incorporated into Western scientific studies, TEK can instead ground our understanding of the environmental, social, and biomedical determinants of health and improve our understanding of health and disease. This article provides historical and recent examples of how TEK has informed Western scientific research. CONCLUSIONS This article provides recommendations for researchers and federal funders to ensure respect for the contributions of TEK to research and to ensure equity and self-determination for Tribal nations who participate in research. https://doi.org/10.1289/EHP858.
Collapse
Affiliation(s)
- Symma Finn
- National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, Department of Health and Human Services , Research Triangle Park, North Carolina, USA
| | - Mose Herne
- Indian Health Service, Office of Research, Planning and Evaluation, Rockville, Maryland, USA
| | - Dorothy Castille
- National Institutes of Health, National Institute on Minority Health and Health Disparities, Department of Health and Human Services, Bethesda, Maryland, USA
| |
Collapse
|
37
|
McNamara ML, Thornburg J, Semmens EO, Ward TJ, Noonan CW. Reducing indoor air pollutants with air filtration units in wood stove homes. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 592:488-494. [PMID: 28320525 PMCID: PMC6394836 DOI: 10.1016/j.scitotenv.2017.03.111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND Biomass burning has been shown to be a major source of poor indoor air quality (IAQ) in developing and higher income countries across the world. Specifically, wood burning for cooking and heating contributes to high indoor concentrations of fine (particles with aerodynamic diameters<2.5μm; PM2.5) and coarse (particles with aerodynamic diameters <10μm and >2.5μm; PMc) particulate matter. Endotoxin, predominantly found within the coarse fraction of airborne particulate matter, is associated with proinflammatory effects and adverse outcomes among susceptible populations. The aim of this study was to assess the efficacy of air filter interventions in reducing indoor PM2.5, PMc, and PMc-associated endotoxin concentrations in homes using a wood stove for primary heating. RESULTS Homes (n=48) were randomized to receive in-room air filtration units with either a high efficiency filter (i.e. active) or a lower efficiency fiberglass filter (i.e., placebo). The active filter intervention showed a 66% reduction in indoor PM2.5 concentrations (95% CI: 42.2% to 79.7% reduction) relative to the placebo intervention. Both the active and the placebo filters were effective in substantially reducing indoor concentrations of PMc (63.3% and 40.6% average reduction for active and placebo filters, respectively) and PMc-associated endotoxin concentrations (91.8% and 80.4% average reductions, respectively). CONCLUSIONS These findings support the use of high efficiency air filtration units for reducing indoor PM2.5 in homes using a wood stove for primary heating. We also discovered that using lower efficiency, lower cost filter alternatives can be effective for reducing PMc and airborne endotoxin in homes burning biomass fuel.
Collapse
Affiliation(s)
- Marcy L McNamara
- Center for Environmental Health Sciences, Department of Biomedical Sciences, University of Montana, Missoula, MT 59801, USA.
| | | | - Erin O Semmens
- Center for Environmental Health Sciences, Department of Biomedical Sciences, University of Montana, Missoula, MT 59801, USA.
| | - Tony J Ward
- School of Public and Community Health Sciences, University of Montana, Missoula, MT 59801, USA.
| | - Curtis W Noonan
- Center for Environmental Health Sciences, Department of Biomedical Sciences, University of Montana, Missoula, MT 59801, USA.
| |
Collapse
|
38
|
Rokoff LB, Koutrakis P, Garshick E, Karagas MR, Oken E, Gold DR, Fleisch AF. Wood Stove Pollution in the Developed World: A Case to Raise Awareness Among Pediatricians. Curr Probl Pediatr Adolesc Health Care 2017; 47:123-141. [PMID: 28583817 PMCID: PMC5556683 DOI: 10.1016/j.cppeds.2017.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Use of wood for residential heating is regaining popularity in developed countries. Currently, over 11 million US homes are heated with a wood stove. Although wood stoves reduce heating costs, wood smoke may adversely impact child health through the emission of gaseous and particulate air pollutants. Our purpose is to raise awareness of this environmental health issue among pediatricians. To summarize the state of the science, we performed a narrative review of articles published in PubMed and Web of Science. We identified 36 studies in developed countries that reported associations of household wood stove use and/or community wood smoke exposure with pediatric health outcomes. Studies primarily investigated respiratory outcomes, with no evaluation of cardiometabolic or neurocognitive health. Studies found community wood smoke exposure to be consistently associated with adverse pediatric respiratory health. Household wood stove use was less consistently associated with respiratory outcomes. However, studies of household wood stoves always relied on participant self-report of wood stove use, while studies of community wood smoke generally assessed air pollution exposure directly and more precisely in larger study populations. In most studies, important potential confounders, such as markers of socioeconomic status, were unaccounted for and may have biased results. We conclude that studies with improved exposure assessment, that measure and account for confounding, and that consider non-respiratory outcomes are needed. While awaiting additional data, pediatricians can refer patients to precautionary measures recommended by the US Environmental Protection Agency (EPA) to mitigate exposure. These include replacing old appliances with EPA-certified stoves, properly maintaining the stove, and using only dry, well-seasoned wood. In addition, several studies have shown mechanical air filters to effectively reduce wood stove pollution exposure in affected homes and communities.
Collapse
Affiliation(s)
- Lisa B Rokoff
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Abby F Fleisch
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
| |
Collapse
|
39
|
Singleton R, Salkoski AJ, Bulkow L, Fish C, Dobson J, Albertson L, Skarada J, Kovesi T, McDonald C, Hennessy TW, Ritter T. Housing characteristics and indoor air quality in households of Alaska Native children with chronic lung conditions. INDOOR AIR 2017; 27:478-486. [PMID: 27317363 DOI: 10.1111/ina.12315] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
Alaska Native children experience high rates of respiratory infections and conditions. Household crowding, indoor smoke, lack of piped water, and poverty have been associated with respiratory infections. We describe the baseline household characteristics of children with severe or chronic lung disease participating in a 2012-2015 indoor air study. We monitored indoor PM2.5, CO2 , relative humidity %, temperature, and VOCs and interviewed caregivers about children's respiratory symptoms. We evaluated the association between reported children's respiratory symptoms and indoor air quality indicators using multiple logistic regression analysis. Compared with general US households, study households were more likely overcrowded 73% (62%-82%) vs 3.2% (3.1%-3.3%); had higher woodstove use as primary heat source 16% (9%-25%) vs 2.1% (2.0%-2.2%); and higher proportion of children in a household with a smoker 49% (38%-60%) vs 26.2% (25.5%-26.8%). Median PM2.5 was 33 μg/m3 . Median CO2 was 1401 ppm. VOCs were detectable in all homes. VOCs, smoker, primary wood heat, and PM2.5>25 μg/m3 were associated with higher risk for cough between colds; VOCs were associated with higher risk for wheeze between colds and asthma diagnosis. High indoor air pollutant levels were associated with respiratory symptoms in household children, likely related to overcrowding, poor ventilation, woodstove use, and tobacco smoke.
Collapse
Affiliation(s)
- R Singleton
- Division of Community Health Services, Alaska Native Tribal Health Consortium (ANTHC), Anchorage, AK, USA
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA
| | - A J Salkoski
- Community Environment and Health, ANTHC, Anchorage, AK, USA
| | - L Bulkow
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA
| | - C Fish
- Division of Environmental Health and Engineering, ANTHC, Anchorage, AK, USA
| | - J Dobson
- Office of Environmental Health, Yukon Kuskokwim Health Corporation, Bethel, AK, USA
| | - L Albertson
- School of Natural Resources and Extension, University of Alaska, Fairbanks, Bethel, AK, USA
| | - J Skarada
- Bristol Bay Area Health Corporation, Dillingham, AK, USA
| | - T Kovesi
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - C McDonald
- Community Environment and Health, ANTHC, Anchorage, AK, USA
| | - T W Hennessy
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA
| | - T Ritter
- Division of Environmental Health and Engineering, ANTHC, Anchorage, AK, USA
- CDC/ONDIEh/NCEH, Environmental Health Services Branch, Atlanta, GA, USA
| |
Collapse
|
40
|
Montrose L, Ward TJ, Semmens EO, Cho YH, Brown B, Noonan CW. Dietary intake is associated with respiratory health outcomes and DNA methylation in children with asthma. Allergy Asthma Clin Immunol 2017; 13:12. [PMID: 28261276 PMCID: PMC5327515 DOI: 10.1186/s13223-017-0187-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 02/17/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Asthma is an increasingly common chronic disease among children, and data point toward a complex mechanism involving genetic, environmental and epigenetic factors. Epigenetic modifications such as DNA hypo- or hyper-methylation have been shown to occur in response to environmental exposures including dietary nutrients. METHODS Within the context of the asthma randomized trial of indoor wood smoke (ARTIS) study, we investigated relationships between diet, asthma health measures, and DNA methylation. Asthma health measures included a quality of life instrument, diurnal peak flow variability (dPFV) and forced expiratory volume in the first second (FEV1). Dietary intake was assessed with a food frequency questionnaire. Methylation levels of LINE-1 repetitive element and two promoter CpG sites for interferon gamma (IFNγ, -186 and -54) from buccal cell DNA were measured using pyrosequencing assays. RESULTS Data were collected on 32 children with asthma living in western Montana who were recruited to the ARTIS study. Selenium and several methyl donor dietary nutrients were positively associated with the asthma quality of life measure. Intake of methyl donating nutrients including folate was positively associated LINE-1 methylation and negatively associated with IFNγ CpG-186. Higher levels of LINE-1 methylation were associated with greater dPFV. CONCLUSION We identified several nutrients that were associated with improved quality of life measures among children with asthma. The IFNγ promoter CpG site -186 but not -54 was associated with the intake of selected dietary nutrients. However, in this small population of children with asthma, the IFNγ promoter CpG sites were not associated with respiratory health measures so it remains unclear through which epigenetic mechanism these nutrients are impacting the quality of life measure. These findings add to the evidence that dietary nutrients, particularly foods containing methyl donors, may be important for epigenetic regulation as it pertains to the control of asthma. Trial registration ClincialTrials.gov NCT00807183. Registered 10 December 2008.
Collapse
Affiliation(s)
- L Montrose
- School of Public Health, University of Michigan, 1420 Washington Heights, Ann Arbor, MI 48109 USA
| | - T J Ward
- Center for Environmental Health Sciences, University of Montana, 32 Campus Drive-159 Skaggs, Missoula, MT 59812 USA
| | - E O Semmens
- Center for Environmental Health Sciences, University of Montana, 32 Campus Drive-159 Skaggs, Missoula, MT 59812 USA
| | - Y H Cho
- Center for Environmental Health Sciences, University of Montana, 32 Campus Drive-159 Skaggs, Missoula, MT 59812 USA
| | - B Brown
- Department of Health and Human Performance, University of Montana, 32 Campus Drive, Missoula, MT 59812 USA
| | - C W Noonan
- Center for Environmental Health Sciences, University of Montana, 32 Campus Drive-159 Skaggs, Missoula, MT 59812 USA
| |
Collapse
|