A framework for estimating the US mortality burden of fine particulate matter exposure attributable to indoor and outdoor microenvironments

Practical considerations for using low-cost sensors to assess wildfire smoke exposure in school and childcare settings

BACKGROUND

More frequent and intense wildfires will increase concentrations of smoke in schools and childcare settings. Low-cost sensors can assess fine particulate matter (PM2.5) concentrations with high spatial and temporal resolution.

OBJECTIVE

We sought to optimize the use of sensors for decision-making in schools and childcare settings during wildfire smoke to reduce children's exposure to PM2.5.

METHODS

We measured PM2.5 concentrations indoors and outdoors at four schools in Washington State during wildfire smoke in 2020-2021 using low-cost sensors and gravimetric samplers. We randomly sampled 5-min segments of low-cost sensor data to create simulations of brief portable handheld measurements.

RESULTS

During wildfire smoke episodes (lasting 4-19 days), median hourly PM2.5 concentrations at different locations inside a single facility varied by up to 49.6 µg/m3 (maximum difference) during school hours. Median hourly indoor/outdoor ratios across schools ranged from 0.22 to 0.91. Within-school differences in concentrations indicated that it is important to collect measurements throughout a facility. Simulation results suggested that making handheld measurements more often and over multiple days better approximates indoor/outdoor ratios for wildfire smoke. During a period of unstable air quality, PM2.5 over the next hour indoors was more highly correlated with the last 10-min of data (mean R2 = 0.94) compared with the last 3-h (mean R2 = 0.60), indicating that higher temporal resolution data is most informative for decisions about near-term activities indoors.

IMPACT STATEMENT

As wildfires continue to increase in frequency and severity, staff at schools and childcare facilities are increasingly faced with decisions around youth activities, building use, and air filtration needs during wildfire smoke episodes. Staff are increasingly using low-cost sensors for localized outdoor and indoor PM2.5 measurements, but guidance in using and interpreting low-cost sensor data is lacking. This paper provides relevant information applicable for guidance in using low-cost sensors for wildfire smoke response.

Health and equity implications of individual adaptation to air pollution in a changing climate

Future climate change can cause more days with poor air quality. This could trigger more alerts telling people to stay inside to protect themselves, with potential consequences for health and health equity. Here, we study the change in US air quality alerts over this century due to fine particulate matter (PM2.5), who they may affect, and how they may respond. We find air quality alerts increase by over 1 mo per year in the eastern United States by 2100 and quadruple on average. They predominantly affect areas with high Black populations and leakier homes, exacerbating existing inequalities and impacting those less able to adapt. Reducing emissions can offer significant annual health benefits ($5,400 per person) by mitigating the effect of climate change on air pollution and its associated risks of early death. Relying on people to adapt, instead, would require them to stay inside, with doors and windows closed, for an extra 142 d per year, at an average cost of $11,000 per person. It appears likelier, however, that people will achieve minimal protection without policy to increase adaptation rates. Boosting adaptation can offer net benefits, even alongside deep emission cuts. New adaptation policies could, for example: reduce adaptation costs; reduce infiltration and improve indoor air quality; increase awareness of alerts and adaptation; and provide measures for those working or living outdoors. Reducing emissions, conversely, lowers everyone's need to adapt, and protects those who cannot adapt. Equitably protecting human health from air pollution under climate change requires both mitigation and adaptation.

An updated systematic review and meta-analysis on portable air cleaners and blood pressure: Recommendations for users and manufacturers

Fine particulate matter (PM2.5) air pollution is a leading contributor to the global burden of cardiovascular disease (CVD). One important underlying mechanism is an increase in blood pressure (BP). A growing number of studies have reported a beneficial effect of portable air cleaners (PACs) on systolic and diastolic BP; SBP and DBP. We conducted an updated systematic review and meta-analysis of studies using true versus sham mode filtration reporting the effects on BP. Of 214 articles identified up to February 5, 2023, seventeen (from China, USA, Canada, South Korea and Denmark) enrolling approximately 880 participants (484 female) met the inclusion criteria for meta-analyses. Aside from studies conducted in China, research on PACs and BP has been conducted in relatively low pollution settings. Mean indoor PM2.5 concentrations during the active and sham mode purification were 15.9 and 41.2 µg/m3, respectively. The mean efficiency of PACs against indoor PM2.5 was 59.8 % (ranging from 23 % to 82 %). True mode filtration was associated with a pooled mean difference of - 2.35 mmHg (95 % confidence interval [CI]: - 4.5, - 0.2) and - 0.81 mmHg (95 % CI: - 1.86, 0.24) in SBP and DBP, respectively. After removing the studies with high risk of bias, the magnitude of the pooled benefits on SBP and DBP increased to - 3.62 mmHg (95 % CI: - 6.69, - 0.56) and - 1.35 mmHg (95 % CI: - 2.29, - 0.41), respectively. However, there are several barriers to the use of PACs, specifically in low- and middle-income countries (LMICs), such as the initial purchase cost and filter replacements. There may be several avenues to help overcome these economic burdens and improve cost effectiveness, such as implementing government or other subsidized programs to distribute PACs targeting vulnerable and higher-risk individuals. We propose that environmental health researchers and healthcare providers should be better trained to educate the public regarding the use of PACs to reduce the impacts of PM2.5 on cardiometabolic diseases globally.

Long-term exposure and health risk assessment from air pollution: impact of regional scale mobility

BACKGROUND

The negative effect of air pollution on human health is widely reported in recent literature. It typically involves urbanized areas where the population is concentrated and where most primary air pollutants are produced. A comprehensive health risk assessment is therefore of strategic importance for health authorities.

METHODS

In this study we propose a methodology to perform an indirect and retrospective health risk assessment of all-cause mortality associated with long-term exposure to particulate matter less than 2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) in a typical Monday to Friday working week. A combination of satellite-based settlement data, model-based air pollution data, land use, demographics and regional scale mobility, allowed to examine the effect of population mobility and pollutants daily variations on the health risk. A Health Risk Increase (HRI) metric was derived on the basis of three components: hazard, exposure and vulnerability, utilizing the relative risk values from the World Health Organization. An additional metric, the Health Burden (HB) was formulated, which accounts for the total number of people exposed to a certain risk level.

RESULTS

The effect of regional mobility patterns on the HRI metric was assessed, resulting in an increased HRI associated with all three stressors when considering a dynamic population compared to a static one. The effect of diurnal variation of pollutants was only observed for NO2 and O3. For both, the HRI metric resulted in significantly higher values during night. Concerning the HB parameter, we identified the commuting flows of the population as the main driver in the resulting metric.

CONCLUSIONS

This indirect exposure assessment methodology provides tools to support policy makers and health authorities in planning intervention and mitigation measures. The study was carried out in Lombardy, Italy, one of the most polluted regions in Europe, but the incorporation of satellite data makes our approach valuable for studying global health.

Joint effect of indoor size-fractioned particulate matters and black carbon on cardiopulmonary function and relevant metabolic mechanism: A panel study among school children

Indoor particulate matter (PM) and black carbon (BC) are associated with adverse cardiopulmonary effect. However, the cumulative and interactive effects of the mixture of size-fractioned PMs and BC on cardiopulmonary function are not well understood, and the underlying biological mechanisms remain unclear. This repeated-measure study was conducted to assess the joint cardiopulmonary effect and metabolic mechanisms of multiple-size particles and BC among 46 children. PM_0.5, PM₁, PM_2.5, PM₅, PM₁₀ and BC were monitored for 5 weekdays. Cardiorespiratory function measurements and urine samples collection were conducted three times. Untargeted-metabolomics and meet-in-metabolite approach were applied to mechanism investigation. Bayesian machine kernel regression was adopted to analyze associations among PMs, cardiopulmonary function and metabolites. Lung function and heart rate variability significantly decreased with the increased PMs and BC co-exposure (p < 0.05). The effective particles were BC, PM_1-2.5 and PM_0.5 in turn. No interaction effects of different particles on cardiopulmonary function were observed at different lag days. BC-related glucose and fatty acid increase, and PM_1-2.5-related branched-chain amino acid degradation were primarily observed. Other metabolisms were successively disturbed. The greatest joint effects of PMs and BC on metabolism were mainly at lag0 and lag01 day. They occurred earlier than the strongest effects on cardiopulmonary function, which were at lag01 and lag02 day. BC, PM_1-2.5 and PM_0.5 were mainly associated with cardiorespiratory indices by disturbing amino acids, glucose, lipid, isoflavone and purine metabolism. Mitochondrial productivity and antioxidation reduction are pivotal to the relevant metabolic alterations. More attention should be paid to BC and smaller-size PMs to control indoor PM pollution and its adverse effect on children.

Survey of residential indoor particulate matter measurements 1990-2019

We surveyed literature on measurements of indoor particulate matter in all size fractions, in residential environments free of solid fuel combustion (other than wood for recreation or space heating). Data from worldwide studies from 1990 to 2019 were assembled into the most comprehensive collection to date. Out of 2752 publications retrieved, 538 articles from 433 research projects met inclusion criteria and reported unique data, from which more than 2000 unique sets of indoor PM measurements were collected. Distributions of mean concentrations were compiled, weighted by study size. Long-term trends, the impact of non-smoking, air cleaners, and the influence of outdoor PM were also evaluated. Similar patterns of indoor PM distributions for North America and Europe could reflect similarities in the indoor environments of these regions. Greater observed variability for all regions of Asia may reflect greater heterogeneity in indoor conditions, but also low numbers of studies for some regions. Indoor PM concentrations of all size fractions were mostly stable over the survey period, with the exception of observed declines in PM2.5 in European and North American studies, and in PM10 in North America. While outdoor concentrations were correlated with indoor concentrations across studies, indoor concentrations had higher variability, illustrating a limitation of using outdoor measurements to approximate indoor PM exposures.

Radiation exposure due to 222Rn, 220Rn and their progenies in three metropolises in China and Japan with different air quality levels

Radiation exposure due to radon contributes most of the ionizing radiation exposure to people among natural radiation sources. This research measured the ²²²Rn, ²²⁰Rn by the RADUET and their progeny concentrations by the improved deposition based ²²²Rn and ²²⁰Rn progeny monitor, and the contribution of outdoor PM_2.5 concentrations to indoors by a modified steady-state mass balance model in Beijing, Changchun, China and Aomori, Japan. Based on these results, we preliminarily explored the relevance between the city level outdoor PM_2.5 exposure and indoor ²²²Rn, ²²⁰Rn inhalation exposure in these three metropolises with different air quality levels. The average equilibrium equivalent radon concentration (EERC) and equilibirum equivalent thoron concentration (EETC) indoor were 17.2 and 1.1 Bq m^-3 in Beijing, 19.4 and 1.3 Bq m^-3 in Changchun, and 10.8 and 0.9 Bq m^-3 in Aomori, respectively. The indoor EERC and EETC in Beijing showed 1.4 and 2.2 times as high as that measured in 2006. The indoor radiation dose due to inhalation presented in a descending order as Changchun, Beijing and Aomori, which were in accordance with their outdoor ²²²Rn concentrations. The indoor radiation doses due to ²²⁰Rn contributed 30% of the total dose in the three cities, indicating that ²²⁰Rn cannot be neglected when evaluating indoor radiation dose. It should be noted that, the indoor PM_2.5 concentrations of outdoor origin presented strong correlation (r = 0.772) with indoor EETC and moderate correlation (r = 0.663) with indoor EERC, indicating that the PM_2.5 of outdoor origin can break the concentration balance of the indoor PM_2.5, then affect the indoor ²²²Rn and ²²⁰Rn behaviors, and further affect the inhalation exposure of radon.

Indoor air quality impacts of residential mechanical ventilation system retrofits in existing homes in Chicago, IL

Mechanical ventilation systems are used in residences to introduce ventilation air and dilute indoor-generated pollutants. A variety of ventilation system types can be used in home retrofits, influencing indoor air quality (IAQ) in different ways. Here we describe the Breathe Easy Project, a >2-year longitudinal, pseudo-randomized, crossover study designed to assess IAQ and adult asthma outcomes before and after installing residential mechanical ventilation systems in 40 existing homes in Chicago, IL. Each home received one of three types of ventilation systems: continuous exhaust-only, intermittent powered central-fan-integrated-supply (CFIS), or continuous balanced system with an energy recovery ventilator (ERV). Homes with central heating and/or cooling systems also received MERV 10 filter replacements. Approximately weeklong field measurements were conducted at each home on a quarterly basis throughout the study to monitor environmental conditions, ventilation operation, and indoor and outdoor pollutants, including size-resolved particles (0.3-10 μm), ozone (O₃), nitrogen dioxide (NO₂), carbon dioxide (CO₂), carbon monoxide (CO), and indoor formaldehyde (HCHO). Mean reductions in indoor/outdoor (I/O) ratios across all systems after the intervention were approximately 12% (p = 0.001), 10% (p = 0.008), 42% (p < 0.001), 39% (p = 0.002), and 33% (p = 0.007), for CO₂, NO₂, and estimated PM₁, PM_2.5, and PM₁₀, respectively. There was a reduction in I/O ratios for all measured constituents with each type of system, on average, but with varying magnitude and levels of statistical significance. The magnitudes of mean differences in I/O pollutant concentrations ratios were generally largest for most pollutants in the homes that received continuous balanced with ERV and smallest in the homes that received intermittent CFIS systems, with apparent benefits to providing ventilation continuously rather than intermittently. All ventilation system types maintained similar indoor temperatures during pre- and post-intervention periods.

Personal Interventions to Reduce Exposure to Outdoor Air Pollution

Unhealthy levels of air pollution are breathed by billions of people worldwide, and air pollution is the leading environmental cause of death and disability globally. Efforts to reduce air pollution at its many sources have had limited success, and in many areas of the world, poor air quality continues to worsen. Personal interventions to reduce exposure to air pollution include avoiding sources, staying indoors, filtering indoor air, using face masks, and limiting physical activity when and where air pollution levels are elevated. The effectiveness of these interventions varies widely with circumstances and conditions of use. Compared with upstream reduction or control of emissions, personal interventions place burdens and risk of adverse unintended consequences on individuals. We review evidence regarding the balance of benefits and potential harms of personal interventions for reducing exposure to outdoor air pollution, which merit careful consideration before making public health recommendations with regard to who should use personal interventions and where, when, and how they should be used. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Aerosol dynamics modeling of sub-500 nm particles during the HOMEChem study

We spend most of our time in built environments. The cumulative exposure to particulate matter (PM) occurring in these built environments can potentially be comparable to or even exceed that occurring outdoors. Therefore, it is critical to understand the sources, dynamics, and fate of PM in built environments. This work focuses on aerosol dynamics modeling (including coagulation, deposition, and exfiltration) of sub-500 nm particles measured inside a test house during the HOMEChem campaign while performing prescribed cooking activities. Deposition characteristics of the test house, emission rates and factors, and the fate of particles are presented. Number emission rates calculated for two different heat sources (stove and hot plate) and the various meals cooked on them were highest for sub-10 nm particles. Coagulation and deposition contributed comparably to the particle number concentration decay. Most of the PM (90% number-based and 70% mass-based) deposited within the house while the remaining fraction left the test house volume via exfiltration. Simulation results show that while increased air exchange rate reduces indoor PM mass concentration, it can lead to increased number concentration. An increase from 0.5 to 5 ACH (comparable to the equivalent air change rate from running a well-dimensioned portable air cleaner) would result in a 70% reduction in PM mass-based exposure while a further increase from 5 to 20 ACH would only result in an additional 21% reduction.

Emissions Control Scenarios for Transport in Greater Cairo

Air pollution is a major cause of premature death in Greater Cairo, but studies on emission control are limited. We used local and international data to predict the impact of transport emission control measures on sector parameters including congestion. The International Vehicle Emission model accordingly estimated quantities of criteria, toxic and global warming emissions produced by on-road vehicles. Emissions were estimated for 2019 base case (2019-BC) and projected for 2030 under the 'do nothing' scenario (2030-DNS) and five scenarios: fuel subsidy removal (2030-FSR), road expansions (2030-RE), public transport improvements (2030-PTI), inspection and maintenance (I/M) programs (2030-I/MP), and fuel enhancements (2030-FE). The 2030-FSR would reduce emissions by 11.2% versus 2030-DNS. The 2030-RE resulted in an average increase of 37% in emissions compared with 2030-DNS since it induces more traffic. The 2030-PTI provides alternatives to car travel; hence, cars result in an average drop of 32.8% for all emission types compared with 2030-DNS. The 2030-I/MP exhibited reductions in PM₁₀ and toxic pollutants, of 35-54.8% compared with 2030-DNS. The 2030-FE reduced SO_x, benzene and N₂O emissions by 91.8%, 81% and 39.1%, respectively, compared with 2030-DNS. The 2030-I/MP is most effective in reducing health damaging pollutants while 2030-PTI positively impacts commuters' lifestyle.

Particle release and transport from human skin and clothing: A CFD modeling methodology

Particle release from human skin and clothing has been identified as an important contributor to particulate matter burden indoors. However, knowledge about modeling the coarse particle release from skin and clothing is limited. This study developed a new empirically validated CFD modeling methodology for particle release and transport from seated occupants in an office setting. We tested three modeling approaches for particle emissions: Uniform; Uniform + Localized; and Uniform + Localized with Body Motion; applied to four office scenarios involving a single occupant and two occupants facing each other at 1- and 2-m distances. Uniform particle emissions from skin and clothing underpredicted personal inhalation exposure by as much as 55%-80%. Combining uniform with localized emissions from the armpits drastically reduced the error margin to <10%. However, this modeling approach heavily underestimated particle mass exchange (cross-contamination) between the occupants. Accounting for the occupant's body motion-by applying the momentum theory method-yielded the most accurate personal exposure and cross-contamination results, with errors below 12%. The study suggests that for accurate modeling of particle release and transport from seated occupants indoors, localized body emissions in combination with simplified bodily movements need to be taken into account.

Analysis of spatial factors, time-activity and infiltration on outdoor generated PM2.5 exposures of school children in five European cities

Atmospheric particles are a major environmental health risk. Assessments of air pollution related health burden are often based on outdoor concentrations estimated at residential locations, ignoring spatial mobility, time-activity patterns, and indoor exposures. The aim of this work is to quantify impacts of these factors on outdoor-originated fine particle exposures of school children. We apply nested WRF-CAMx modelling of PM_2.5 concentrations, gridded population, and school location data. Infiltration and enrichment factors were collected and applied to Athens, Kuopio, Lisbon, Porto, and Treviso. Exposures of school children were calculated for residential and school outdoor and indoor, other indoor, and traffic microenvironments. Combined with time-activity patterns six exposure models were created. Model complexity was increased incrementally starting from residential and school outdoor exposures. Even though levels in traffic and outdoors were considerably higher, 80-84% of the exposure to outdoor particles occurred in indoor environments. The simplest and also commonly used approach of using residential outdoor concentrations as population exposure descriptor (model 1), led on average to 26% higher estimates (15.7 μg/m³) compared with the most complex model (# 6) including home and school outdoor and indoor, other indoor and traffic microenvironments (12.5 μg/m³). These results emphasize the importance of including spatial mobility, time-activity and infiltration to reduce bias in exposure estimates.

The climate and health benefits from intensive building energy efficiency improvements

Intensive building energy efficiency improvements can reduce emissions from energy use, improving outdoor air quality and human health, but may also affect ventilation and indoor air quality. This study examines the effects of highly ambitious, yet feasible, building energy efficiency upgrades in the United States. Our energy efficiency scenarios, derived from the literature, lead to a 6 to 11% reduction in carbon dioxide emissions and 18 to 25% reductions in particulate matter (PM2.5) emissions in 2050. These reductions are complementary with a carbon pricing policy on electricity. However, our results also point to the importance of mitigating indoor PM2.5 emissions, improving PM2.5 filtration, and evaluating ventilation-related policies. Even with no further ventilation improvements, we estimate that intensive energy efficiency scenarios could prevent 1800 to 3600 premature deaths per year across the United States in 2050. With further investments in indoor air quality, this can rise to 2900 to 5100.

Fates and spatial variations of accumulation mode particles in a multi-zone indoor environment during the HOMEChem campaign

Studying the indoor dynamics that impact particles is crucial in order to understand indoor air chemistry and assess overall human exposure to particles. This work investigates spatial gradients in particle concentration, caused by indoor transport and loss mechanisms. We conducted a variety of cooking experiments during the House Observations of Microbial and Environmental Chemistry (HOMEChem) campaign in June 2018 that allowed us to probe these mechanisms. We measured size-resolved (0.06-1 μm and 0.13-3 μm) particle number concentrations from cooking experiments using optical instruments at four locations throughout the house simultaneously. The particle number concentration in the kitchen was 40 ± 10% and 70 ± 10% higher than the concentrations in the living room and the bedroom, respectively. There was a minor size dependence, with larger differences in the smaller sizes of the accumulation mode (0.1-2.5 μm) than the larger end of the range. Dilution accounts for the majority of these concentration differences. Surface deposition was the dominant fate of particles within a zone, with observed deposition velocities ranging from 0.1 to 0.6 m h-1.

Portable HEPA filter air cleaner use during pregnancy and children's behavior problem scores: a secondary analysis of the UGAAR randomized controlled trial

BACKGROUND

Developmental exposure to particulate matter (PM) air pollution may impair children's behaviors. Our objectives were to quantify the impact of reducing indoor PM using portable HEPA filter air cleaners during pregnancy on behavioral problems in children and to assess associations between indoor fine PM (PM_2.5) concentrations during pregnancy and children's behavior.

METHODS

This is a secondary analysis of a single-blind parallel-group randomized controlled trial in which we randomly assigned 540 non-smoking pregnant women to receive 1 or 2 HEPA filter air cleaners or no air cleaners. We administered the Behavior Assessment System for Children (BASC-3) to caregivers when children were a mean age of 23 months, and again at a mean age of 48 months. Primary outcomes were the four BASC-3 composite scales: externalizing problems, internalizing problems, adaptive skills, and the behavioral symptoms index. We imputed missing data using multiple imputation with chained equations. The primary analysis was by intention-to-treat. In a secondary analysis, we evaluated associations between BASC-3 composite indices and modeled trimester-specific PM_2.5 concentrations inside residences.

RESULTS

We enrolled participants at a median of 11 weeks gestation. After excluding miscarriages, still births and neonatal deaths, our analysis included 478 children (233 control and 245 intervention). We observed no differences in the mean BASC-3 scores between treatment groups. An interquartile increase (20.1 µg/m³) in first trimester PM_2.5 concentration was associated with higher externalizing problem scores (2.4 units, 95% CI: 0.7, 4.1), higher internalizing problem scores (2.4 units, 95% CI: 0.7, 4.0), lower adaptive skills scores (-1.5 units, 95% CI: -3.0, 0.0), and higher behavior symptoms index scores (2.3 units, 95% CI: 0.7, 3.9). Third trimester PM_2.5 concentrations were also associated with some behavioral indices at age 4, but effect estimates were smaller. No significant associations were observed with PM_2.5 concentrations during the second trimester or for any of the BASC indices when children were 2 years old.

CONCLUSION

We found no benefit of reducing indoor particulate air pollution during pregnancy on parent-reported behaviors in children. Associations between indoor PM_2.5 concentrations in the first trimester and behavioral scores among 4-year old children suggest that it may be necessary to intervene early in pregnancy to protect children, but these exploratory findings should be interpreted cautiously.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01741051.

Can Public Spaces Effectively Be Used as Cleaner Indoor Air Shelters during Extreme Smoke Events?

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 (PM_2.5) 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 PM_2.5 from August 2019 until February 2020 by deploying pairs of low-cost PM_2.5 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 PM_2.5 concentrations, defined as the fraction of the outdoor PM_2.5 concentration that penetrates indoors and remains suspended, as well as the additional effect of HEPA cleaners on PM_2.5 concentrations. The infiltration efficiency of outdoor PM_2.5 into the air-conditioned main library was 30%, meaning that compared to the PM_2.5 concentration outdoors, the concentrations of outdoor-generated PM_2.5 indoors were reduced by 70%. In the media room, when the HEPA cleaners were operating, PM_2.5 concentrations were reduced further with a PM_2.5 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.

Predicting U.S. Residential Building Energy Use and Indoor Pollutant Exposures in the Mid-21st Century

The extent to which climate change and other factors will influence building energy use and population exposures to indoor pollutants is not well understood. Here, we develop and apply nationally representative residential energy and indoor pollutant model sets to estimate energy use, indoor pollutant concentrations, and associated chronic health outcomes across the U.S. residential building stock in the mid-21st century. The models incorporate expected changes in meteorological and ambient air quality conditions associated with IPCC RCP 8.5 and assumptions for changes in housing characteristics and population movements while keeping other less predictable factors constant. Site and source energy consumption for residential space-conditioning are predicted to decrease by ∼37-43 and ∼20-31%, respectively, in the 2050s compared to those in a 2010s reference scenario. Population-average indoor concentrations of pollutants of ambient origin are expected to decrease, except for O₃. Holding indoor emission factors constant, indoor concentrations of pollutants with intermittent indoor sources are expected to decrease by <5% (PM_2.5) to >30% (NO₂); indoor concentrations of pollutants with persistent indoor sources (e.g., volatile organic compounds (VOCs)) are predicted to increase by ∼15-45%. We estimate negligible changes in disability-adjusted life-years (DALYs) lost associated with residential indoor pollutant exposures, well within uncertainty, although the attribution among pollutants is predicted to vary.

Impacts of implementing Healthy Building guidelines for daily PM2.5 limit on premature deaths and economic losses in urban China: A population-based modeling study

Given a large fraction of people's exposure to urban PM_2.5 occur indoors, reducing indoor PM_2.5 levels may offer a more feasible and immediate way to save substantial lives and economic losses attributable to PM_2.5 exposure. We aimed to estimate the premature mortality and economic loss reductions associated with achieving the newly established Chinese indoor air guideline and a few hypothetical indoor PM_2.5 guideline values. We used outdoor PM_2.5 concentrations from 1497 monitoring sites in 339 Chinese cities in 2015, coupled with a steady-state mass balance model, to estimate indoor concentrations of outdoor-infiltrated PM_2.5. Using province-specific time-activity patterns for urban residents, we estimated outdoor and indoor exposures to PM_2.5 of outdoor origin. We then proceeded to use localized census-based concentration-response models and the value of statistical life estimates to calculate premature deaths and economic losses attributable to PM_2.5 exposure across urban China. Finally, we estimated potentially avoidable mortality and corresponding economic losses by meeting the current 24-hour based guideline and various hypothetical indoor limits for PM_2.5. In 2015 in urban areas of mainland China, the city-specific annual mean outdoor and indoor PM_2.5 concentrations ranged 9-108 μg/m³ and 5-56 μg/m³, respectively. Indoor exposures contributed 62%-91% daily and 68%-83% annually to the total time-weighted exposures. The potential reductions in total deaths and economic losses for the scenario in which daily indoor concentrations met the current guideline of 75 μg/m³, 37.5 μg/m³, and 25 μg/m³ were 16.9 (95% CI: 0.7-62.1) thousand, 87.7 (95% CI: 9.7-197.7) thousand, and 165.5 (95% CI: 30.8-304.0) thousand, respectively. The corresponding reductions in economic losses were 5.7 (95% CI: 0.2-34.8) billion, 29.4 (95% CI: 2.4-109.6) billion, and 55.2 (95% CI: 7.7-168.0) billion US Dollars, respectively. Deaths and economic losses would be reduced exponentially within the range of 0-75 μg/m³ for hypothetical indoor PM_2.5 limits. The findings demonstrate the effectiveness of reducing indoor concentrations of outdoor-originated PM_2.5 in saving substantial lives and economic losses in China. The analysis provides quantitative evidence to support the implementation of an indoor air quality guideline or standard for PM_2.5.

Individual- and Household-Level Interventions to Reduce Air Pollution Exposures and Health Risks: a Review of the Recent Literature

PURPOSE OF REVIEW

We reviewed recent peer-reviewed literature on three categories of individual- and household-level interventions against air pollution: air purifiers, facemasks, and behavior change.

RECENT FINDINGS

High-efficiency particulate air/arresting (HEPA) filter air purifier use over days to weeks can substantially reduce fine particulate matter (PM2.5) concentrations indoors and improve subclinical cardiopulmonary health. Modeling studies suggest that the population-level benefits of HEPA filter air purification would often exceed costs. Well-fitting N95 and equivalent respirators can reduce PM2.5 exposure, with several randomized crossover studies also reporting improvements in subclinical cardiovascular health. The health benefits of other types of face coverings have not been tested and their effectiveness in reducing exposure is highly variable, depends largely on fit, and is unrelated to cost. Behavior modifications may reduce exposure, but there has been little research on health impacts. There is now substantial evidence that HEPA filter air purifiers reduce indoor PM2.5 concentrations and improve subclinical health indicators. As a result, their use is being recommended by a growing number of government and public health organizations. Several studies have also reported subclinical cardiovascular health benefits from well-fitting respirators, while evidence of health benefits from other types of facemasks and behavior changes remains very limited. In situations when emissions cannot be controlled at the source, such as during forest fires, individual- or household-level interventions may be the primary option. In most cases, however, such interventions should be supplemental to emission reduction efforts that benefit entire communities.

Influence of methodology on the estimation of the particle surface area dose received by a population in all-day activities

In everyday life, people are exposed to different concentrations of airborne particles depending on the microenvironment where they perform their different activities. Such exposure can lead to high sub-micron particle doses. The received dose depends on particle concentration to which people are exposed (typically expressed in terms of number or surface area), time spent in each activity or microenvironment (time activity pattern) and amount of air inhaled (inhalation rate). To estimate an actual value of the received dose, all these parameters should be measured under real-life conditions; in fact, the concentrations should be measured on a personal scale (i.e. through a direct exposure assessment), whereas time activity patterns and inhalation rates specific to the activity performed should be considered. The difficulties in obtaining direct measurements of these parameters usually lead to adopt time activity patterns and inhalation rates already available in scientific literature for typical populations, and local outdoor particle concentrations measured with fixed monitoring stations and extrapolated for all the other microenvironments. To overcome these limitations, we propose a full-field method for estimating the received dose of a population sample, in which all the parameters (concentration levels, time activity patterns and inhalation rates) are measured under real-life conditions (also including the inhalation rates, that were evaluated on the basis of the measured heart rates). Specifically, 34 volunteers were continuously monitored for seven days and the data of sub-micron particle concentrations, activities performed, and inhalation rates were recorded. The received dose was calculated with the proposed method and compared with those obtained from different simplified methodologies that consider typical data of particle concentrations, time activity patterns and inhalation rates obtained from literature. The results show that, depending on the methodology used, the differences in the received daily dose can be significant, with a general underestimation of the most simplified method.

Biomarkers and indoor air quality: A translational research review

Introduction:

Air pollution is linked to mortality and morbidity. Since humans spend nearly all their time indoors, improving indoor air quality (IAQ) is a compelling approach to mitigate air pollutant exposure. To assess interventions, relying on clinical outcomes may require prolonged follow-up, which hinders feasibility. Thus, identifying biomarkers that respond to changes in IAQ may be useful to assess the effectiveness of interventions.

Methods:

We conducted a narrative review by searching several databases to identify studies published over the last decade that measured the response of blood, urine, and/or salivary biomarkers to variations (natural and intervention-induced) of changes in indoor air pollutant exposure.

Results:

Numerous studies reported on associations between IAQ exposures and biomarkers with heterogeneity across study designs and methods. This review summarizes the responses of 113 biomarkers described in 30 articles. The biomarkers which most frequently responded to variations in indoor air pollutant exposures were high sensitivity C-reactive protein (hsCRP), von Willebrand Factor (vWF), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and 1-hydroxypyrene (1-OHP).

Conclusions:

This review will guide the selection of biomarkers for translational studies evaluating the impact of indoor air pollutants on human health.

Indoor Particulate Matter during HOMEChem: Concentrations, Size Distributions, and Exposures

It is important to improve our understanding of exposure to particulate matter (PM) in residences because of associated health risks. The HOMEChem campaign was conducted to investigate indoor chemistry in a manufactured test house during prescribed everyday activities, such as cooking, cleaning, and opening doors and windows. This paper focuses on measured size distributions of PM (0.001-20 μm), along with estimated exposures and respiratory-tract deposition. Number concentrations were highest for sub-10 nm particles during cooking using a propane-fueled stovetop. During some cooking activities, calculated PM_2.5 mass concentrations (assuming a density of 1 g cm^-3) exceeded 250 μg m^-3, and exposure during the postcooking decay phase exceeded that of the cooking period itself. The modeled PM respiratory deposition for an adult residing in the test house kitchen for 12 h varied from 7 μg on a day with no indoor activities to 68 μg during a simulated day (including breakfast, lunch, and dinner preparation interspersed by cleaning activities) and rose to 149 μg during a simulated Thanksgiving day.

Quantifying the Health Burden Misclassification from the Use of Different PM2.5 Exposure Tier Models: A Case Study of London

Exposure to PM_2.5 has been associated with increased mortality in urban areas. Hence, reducing the uncertainty in human exposure assessments is essential for more accurate health burden estimates. Here, we quantified the misclassification that occurred when using different exposure approaches to predict the mortality burden of a population using London as a case study. We developed a framework for quantifying the misclassification of the total mortality burden attributable to exposure to fine particulate matter (PM_2.5) in four major microenvironments (MEs) (dwellings, aboveground transportation, London Underground (LU) and outdoors) in the Greater London Area (GLA), in 2017. We demonstrated that differences exist between five different exposure Tier-models with incrementally increasing complexity, moving from static to more dynamic approaches. BenMap-CE, the open source software developed by the U.S. Environmental Protection Agency, was used as a tool to achieve spatial distribution of the ambient concentration by interpolating the monitoring data to the unmonitored areas and ultimately estimating the change in mortality on a fine resolution. Indoor exposure to PM_2.5 is the largest contributor to total population exposure concentration, accounting for 83% of total predicted population exposure, followed by the London Underground, which contributes approximately 15%, despite the average time spent there by Londoners being only 0.4%. After incorporating housing stock and time-activity data, moving from static to most dynamic metric, Inner London showed the highest reduction in exposure concentration (i.e., approximately 37%) and as a result the largest change in mortality (i.e., health burden/mortality misclassification) was observed in central GLA. Overall, our findings showed that using outdoor concentration as a surrogate for total population exposure but ignoring different exposure concentration that occur indoors and time spent in transit, led to a misclassification of 1174–1541 mean predicted mortalities in GLA. We generally confirm that increasing the complexity and incorporating important microenvironments, such as the highly polluted LU, could significantly reduce the misclassification of health burden assessments.

Reducing Indoor Levels of "Outdoor PM2.5" in Urban China: Impact on Mortalities

This study estimates adult mortalities attributed to PM_2.5 across urban China in 2015 and the corresponding mortalities that might be avoided by meeting the yearly averaged indoor PM_2.5 threshold in the newly established Assessment Standard for Healthy Building (ASHB) and seven other potential thresholds. We use outdoor PM_2.5 concentrations from ∼1500 monitoring sites in 339 Chinese cities, coupled with a detailed exposure model, to estimate outdoor and indoor exposures to PM_2.5 originating outdoors. We proceed to calculate premature mortality attributable to PM_2.5 exposure using an integrated exposure-response model. Results indicate that indoor exposures accounted for 66%-87% of total exposure to PM_2.5 of outdoor origin and 81% (95% confidence interval (CI), 71%-87%), i.e., 316 000 (95% CI, 176 000-435 000), of the 389 000 (95% CI, 245 000-501 000) mortalities attributable to "outdoor PM_2.5" for the urban population ≥25 years of age in China in 2015. Potentially 14 000 (95% CI, 8000-20 000) deaths might be avoided if indoor PM_2.5 of outdoor origin met the ASHB guideline of 35 μg/m³ for annual mean indoor PM_2.5, and 162 000 (95% CI, 79 000-237 000) deaths might be avoided by meeting a 10 μg/m³ threshold. The analysis in this work should be helpful in formulating indoor air quality policies.