Employing dynamical and chemical processes for contaminant mixtures outdoors to the indoor environment: the implications for total human exposure analysis and prevention

A pilot study of total personal exposure to volatile organic compounds among Hispanic female domestic cleaners

Cleaners have an elevated risk for the development or exacerbation of asthma and other respiratory conditions, possibly due to exposure to cleaning products containing volatile organic compounds (VOCs) leading to inflammation and oxidative stress. This pilot study aimed to quantify total personal exposure to VOCs and to assess biomarkers of inflammation and pulmonary oxidative stress in 15 predominantly Hispanic women working as domestic cleaners in San Antonio, Texas, between November 2019 and July 2020. In partnership with a community organization, Domésticas Unidas, recruited women were invited to attend a training session where they were provided 3M 3500 passive organic vapor monitors (badges) and began a 72-hr sampling period during which they were instructed to wear one badge during the entire period ("AT," for All the Time), a second badge only while they were inside their home ("INS," for INSide), and a third badge only when they were outside their home ("OUT," for OUTside). At the end of the sampling period, women returned the badges and provided blood and exhaled breath condensate (EBC) samples. From the badges, 30 individual VOCs were measured and summed to inform total VOC (TVOC) concentrations, as well as concentrations of the following VOC groups: aromatic hydrocarbons, alkanes, halogenated hydrocarbons, and terpenes. From the blood and EBC samples, concentrations of serum C-reactive protein (CRP) and EBC 8-isoprostane (8-ISP) and pH were quantified. Data analyses included descriptive statistics. The 72-hr average of personal exposure to TVOC was 34.4 ppb and ranged from 9.2 to 219.5 ppb. The most prevalent class of VOC exposures for most women (66.7%) was terpenes, specifically d-limonene. Overall, most women also experienced higher TVOC concentrations while outside their home (86.7%) as compared to inside their home. Serum CRP concentrations ranged from 0.3 to 20.3 mg/dL; 8-ISP concentrations ranged from 9.5 to 44.1 pg/mL; and EBC pH ranged from 7.1 to 8.6. Overall, this pilot study demonstrated personal VOC exposure among Hispanic domestic cleaners, particularly to d-limonene, which may result from the use of scented cleaning products.

Thirdhand smoke: when the danger is more than you can see or smell

Recent discussion has focused on another form of exposure to tobacco - thirdhand smoke (THS) - consisting of residual pollutants from cigarette smoke that remain in environments. The main concern with THS is based on the presence and persistence of many toxic compounds, some specific nitrosamines from tobacco that have carcinogenic activity. Little is known about THS, and few people are aware of its existence and potential health repercussions, thus highlighting the need to shed light on the subject and incorporate it into the public health debate, as was done with passive smoking several years ago. THS is a form of passive smoking, together with secondary or involuntary exposure to cigarette smoke. Recentemente, passou a ser discutida mais uma forma de exposição ao tabaco - thirdhand smoke (THS) - que consiste nos poluentes residuais da fumaça de cigarro que permanecem nos ambientes. A principal preocupação com o THS é embasada na presença e longa persistência de muitos compostos tóxicos, algumas nitrosaminas específicas do tabaco que têm atividade carcinogênica. Além de se saber pouco sobre o THS, poucos sabem de sua existência e preocupante repercussão na saúde. Coloca-se em destaque a necessidade de trazê-lo à luz e incluí-lo nas discussões, assim como foi feito com o tabagismo passivo alguns anos atrás, até mesmo porque o THS se caracteriza como uma forma de tabagismo passivo junto à exposição secundária ou involuntária da fumaça de cigarro.

Indoor inhalation intake fractions of fine particulate matter: review of influencing factors

Exposure to fine particulate matter (PM_2.5 ) is a major contributor to the global human disease burden. The indoor environment is of particular importance when considering the health effects associated with PM_2.5 exposures because people spend the majority of their time indoors and PM_2.5 exposures per unit mass emitted indoors are two to three orders of magnitude larger than exposures to outdoor emissions. Variability in indoor PM_2.5 intake fraction (iF_in,total ), which is defined as the integrated cumulative intake of PM_2.5 per unit of emission, is driven by a combination of building-specific, human-specific, and pollutant-specific factors. Due to a limited availability of data characterizing these factors, however, indoor emissions and intake of PM_2.5 are not commonly considered when evaluating the environmental performance of product life cycles. With the aim of addressing this barrier, a literature review was conducted and data characterizing factors influencing iF_in,total were compiled. In addition to providing data for the calculation of iF_in,total in various indoor environments and for a range of geographic regions, this paper discusses remaining limitations to the incorporation of PM_2.5 -derived health impacts into life cycle assessments and makes recommendations regarding future research.

Environmental tobacco smoke as a source of polycyclic aromatic hydrocarbons in settled household dust

Environmental tobacco smoke is a major contributor to indoor air pollution. Dust and surfaces may remain contaminated long after active smoking has ceased (called 'thirdhand' smoke). Polycyclic aromatic hydrocarbons (PAHs) are known carcinogenic components of tobacco smoke found in settled house dust (SHD). We investigated whether tobacco smoke is a source of PAHs in SHD. House dust was collected from 132 homes in urban areas of Southern California. Total PAHs were significantly higher in smoker homes than nonsmoker homes (by concentration: 990 ng/g vs 756 ng/g, p = 0.025; by loading: 1650 ng/m(2) vs 796 ng/m(2), p = 0.012). We also found significant linear correlations between nicotine and total PAH levels in SHD (concentration, R(2) = 0.105; loading, R(2) = 0.385). Dust collected per square meter (g/m(2)) was significantly greater in smoker homes and might dilute PAH concentration in SHD inconsistently. Therefore, dust PAH loading (ng PAH/m(2)) is a better indicator of PAH content in SHD. House dust PAH loadings in the bedroom and living room in the same home were significantly correlated (R(2) = 0.468, p < 0.001) suggesting PAHs are distributed by tobacco smoke throughout a home. In conclusion, tobacco smoke is a source of PAHs in SHD, and tobacco smoke generated PAHs are a component of thirdhand smoke.

Use of a robotic sampling platform to assess young children's exposure to indoor bioaerosols

Indoor exposures to allergens, mold spores, and endotoxin have been suggested as etiological agents of asthma; therefore, accurate determination of those exposures, especially in young children (6-36 months), is important for understanding the development of asthma. Because use of personal sampling equipment in this population is difficult, and in children <1 year of age impossible, we developed a personal sampling surrogate: the Pretoddler Inhalable Particulate Environmental Robotic (PIPER) sampler to better estimate their exposures. During sampling, PIPER simulates the activity patterns, speed of motion, and the height of the breathing zones of young children, and mechanically resuspends the deposited dust just as a young child does during running and crawling. The concentrations of allergens, mold spores, and endotoxin measured by PIPER were compared to those measured using traditional stationary air sampling method in 75 homes in central New Jersey, United States. Endotoxin was detected in all homes with median concentrations of 1.0 and 0.55 EU/m(3) for PIPER and stationary sampler, respectively. The difference in median concentrations obtained using the two methods was statistically significant for homes with carpeted floors (P = 0.0001) in the heating season. For such homes, the average ratio of endotoxin concentration measured by PIPER to the stationary sampler was 2.96 (95% CI 2.29-3.63). Fungal spores were detected in all homes, with median fungal concentrations of 316 and 380 spores/m(3) for PIPER and stationary sampler, respectively. For fungi, the difference between the two sampling methods was not statistically significant. For both sampling methods, the total airborne mold levels were statistically significantly higher in the non-heating season than in the heating season. Allergens were detected in ~15% of investigated homes. The data indicate that the traditional stationary air-sampling methods may substantially underestimate personal exposures to endotoxin, especially due to resuspension of dust from carpeted floor surfaces. A personal sampling surrogate, such as PIPER, is a feasible approach to estimate personal exposures in young children. PIPER should be seriously considered as the sampling platform for future exposure studies in young children.

PRACTICAL IMPLICATIONS

This study investigated potential indoor bioaerosol exposure of young children using a Pretoddler Inhalable Particulate Environmental Robotic (PIPER) sampler platform. The results show that the traditional stationary air-sampling methods can substantially underestimate personal exposures to resuspended material, and that a personal sampling surrogate, such as PIPER, offers a feasible surrogate for measuring personal inhalation exposures of young children.

Indoor environment and children's health: recent developments in chemical, biological, physical and social aspects

Much research is being carried out into indoor exposure to harmful agents. This review focused on the impact on children's health, taking a broad approach to the indoor environment and including chemical, microbial, physical and social aspects. Papers published from 2006 onwards were reviewed, with regards to scientific context. Most of publications dealt with chemical exposure. Apart from the ongoing issue of combustion by-products, most of these papers concerned semi volatile organic compounds (such as phthalates). These may be associated with neurotoxic, reprotoxic or respiratory effects and may, therefore, be of particular interest so far as children are concerned. In a lesser extent, volatile organic compounds (such as aldehydes) that have mainly respiratory effects are still studied. Assessing exposure to metals is still of concern, with increasing interest in bioaccessibility. Most of the papers on microbial exposure focused on respiratory tract infections, especially asthma linked to allergens and bio-aerosols. Physical exposure includes noise and electromagnetic fields, and articles dealt with the auditory and non auditory effects of noise. Articles on radiofrequency electromagnetic fields mainly concerned questions about non-thermal effects and papers on extremely low-frequency magnetic fields focused on the characterization of exposure. The impact of the indoor environment on children's health cannot be assessed merely by considering the effect of these different types of exposure: this review highlights new findings and also discusses the interactions between agents in indoor environments and also with social aspects.

DDT and malaria prevention: addressing the paradox

BACKGROUND

The debate regarding dichlorodiphenyltrichloroethane (DDT) in malaria prevention and human health is polarized and can be classified into three positions: anti-DDT, centrist-DDT, pro-DDT.

OBJECTIVE

We attempted to arrive at a synthesis by matching a series of questions on the use of DDT for indoor residual spraying (IRS) with literature and insights, and to identify options and opportunities.

DISCUSSION

Overall, community health is significantly improved through all available malaria control measures, which include IRS with DDT. Is DDT "good"? Yes, because it has saved many lives. Is DDT safe as used in IRS? Recent publications have increasingly raised concerns about the health implications of DDT. Therefore, an unqualified statement that DDT used in IRS is safe is untenable. Are inhabitants and applicators exposed? Yes, and to high levels. Should DDT be used? The fact that DDT is "good" because it saves lives, and "not safe" because it has health and environmental consequences, raises ethical issues. The evidence of adverse human health effects due to DDT is mounting. However, under certain circumstances, malaria control using DDT cannot yet be halted. Therefore, the continued use of DDT poses a paradox recognized by a centrist-DDT position. At the very least, it is now time to invoke precaution. Precautionary actions could include use and exposure reduction.

CONCLUSIONS

There are situations where DDT will provide the best achievable health benefit, but maintaining that DDT is safe ignores the cumulative indications of many studies. In such situations, addressing the paradox from a centrist-DDT position and invoking precaution will help design choices for healthier lives.

Chemistry in indoor environments: 20 years of research

In the two decades since the first issue of Indoor Air, there have been over 250 peer-reviewed publications addressing chemical reactions among indoor pollutants. The present review has assembled and categorized these publications. It begins with a brief account of the state of our knowledge in 1991 regarding 'indoor chemistry', much of which came from corrosion and art conservation studies. It then outlines what we have learned in the period between 1991 and 2010 in the context of the major reference categories: gas-phase chemistry, surface chemistry, health effects and reviews/workshops. The indoor reactions that have received the greatest attention are those involving ozone-with terpenoids in the gas-phase as well as with the surfaces of common materials, furnishings, and the occupants themselves. It has become clear that surface reactions often have a larger impact on indoor settings than do gas-phase processes. This review concludes with a subjective list of major research needs going forward, including more information on the decomposition of common indoor pollutants, better understanding of how sorbed water influences surface reactions, and further identification of short-lived products of indoor chemistry. Arguably, the greatest need is for increased knowledge regarding the impact that indoor chemistry has on the health and comfort of building occupants.

PRACTICAL IMPLICATIONS

Indoor chemistry changes the type and concentration of chemicals present in indoor environments. In the past, products of indoor chemistry were often overlooked, reflecting a focus on stable, relatively non-polar organic compounds coupled with the use of sampling and analytical methods that were unable to 'see' many of the products of such chemistry. Today, researchers who study indoor environments are more aware of the potential for chemistry to occur. Awareness is valuable, because it leads to the use of sampling methods and analytical tools that can detect changes in indoor environments resulting from chemical processes. This, in turn, leads to a more complete understanding of occupants' chemical exposures, potential links between these exposures and adverse health effects and, finally, steps that might be taken to mitigate these adverse effects.

Modelling inhalation exposure to combustion-related air pollutants in residential buildings: Application to health impact assessment

Buildings in developed countries are becoming increasingly airtight as a response to stricter energy efficiency requirements. At the same time, changes are occurring to the ways in which household energy is supplied, distributed and used. These changes are having important impacts on exposure to indoor air pollutants in residential buildings and present new challenges for professionals interested in assessing the effects of housing on public health. In many circumstances, models are the most appropriate way with which to examine the potential outcomes of future environmental and/or building interventions and policies. As such, there is a need to consider the current state of indoor air pollution exposure modelling. Various indoor exposure modelling techniques are available, ranging from simple statistical regression and mass-balance approaches, to more complex multizone and computational fluid dynamics tools that have correspondingly large input data requirements. This review demonstrates that there remain challenges which limit the applicability of current models to health impact assessment. However, these issues also present opportunities for better integration of indoor exposure modelling and epidemiology in the future. The final part of the review describes the application of indoor exposure models to health impact assessments, given current knowledge and data, and makes recommendations aimed at improving model predictions in the future.

DDT contamination from indoor residual spraying for malaria control

The insecticide DDT is still used in specific areas of South Africa for indoor residual spray (IRS) to control malaria vectors. Local residents could be exposed to residues of DDT through various pathways including indoor air, dust, soil, food and water. The aims of this study were to determine the levels of DDT contamination, as a result of IRS, in representative homesteads, and to evaluate the possible routes of human exposure. Two villages, exposed (DV) and reference (TV) were selected. Sampling was done two months after the IRS process was completed. Twelve homesteads were selected in DV and nine in TV. Human serum, indoor air, floor dust, outside soil, potable water, leafy vegetables, and chicken samples (muscle, fat and liver) were collected and analyzed for both the o,p'- and p,p'-isomers of DDT, DDD and DDE. DDT was detected in all the media analyzed indicating a combination of potential dietary and non-dietary pathways of uptake. DV had the most samples with detectable levels of DDT and its metabolites, and with the exception of chicken muscle samples, DV also had higher mean levels for all the components analyzed compared to TV. Seventy-nine percent of participants from DV had serum levels of DDT (mean [summation operator]DDT 7.3microg g(-1) lipid). These residues constituted mainly of p,p'-DDD and p,p'-DDE. [summation operator]DDT levels were detected in all indoor air (mean [summation operator]DDT 3900.0 ng m(-3)) and floor dust (mean [summation operator]DDT 1200.0 microg m(-2)) samples. Levels were also detected in outside soil (mean [summation operator]DDT 25.0 microg kg(-1)) and potable water (mean [summation operator]DDT 2.0 microg L(-1)). Vegetable sample composition (mean [summation operator]DDT 43.0 microg kg(-1)) constituted mainly p,p'-DDT and p,p'-DDD. Chicken samples were highly contaminated with DDT (muscle mean [summation operator]DDT 700.0 microg kg(-1), fat mean [summation operator]DDT 240,000.0 microg kg(-1), liver mean [summation operator]DDT 1600.0 microg kg(-1)). The results of the current study raise concerns regarding the potential health effects in residents living in the immediate environment following DDT IRS.

Identifying transfer mechanisms and sources of decabromodiphenyl ether (BDE 209) in indoor environments using environmental forensic microscopy

Although the presence of polybrominated diphenyl ethers (PBDEs) in house dust has been linked to consumer products, the mechanism of transfer remains poorly understood. We conjecture that volatilized PBDEs will be associated with dust particles containing organic matter and will be homogeneously distributed in house dust. In contrast, PBDEs arising from weathering or abrasion of polymers should remain bound to particles of the original polymer matrix and will be heterogeneously distributed within the dust. We used scanning electron microscopy and othertools of environmental forensic microscopy to investigate PBDEs in dust, examining U.S. and U.K. dust samples with extremely high levels of BDE 209 (260-2600 microg/g), a nonvolatile compound at room temperature. We found that the bromine in these samples was concentrated in widely scattered, highly contaminated particles. In the house dust samples from Boston (U.S.), bromine was associated with a polymer/organic matrix. These results suggest that the BDE 209 was transferred to dust via physical processes such as abrasion or weathering. In conjunction with more traditional tools of environmental chemistry, such as gas chromatography/mass spectrometry (GC/MS), environmental forensic microscopy provides novel insights into the origins of BDE 209 in dust and their mechanisms of transfer from products.

Multimedia modeling of polybrominated diphenyl ether emissions and fate indoors

We adapted an indoor multimedia fugacity model to consider emissions and fate of polybrominated diphenyl ethers (PBDEs) and to understand the variability of indoor concentrations. The model was applied to an office in which an 80% decrease in PBDE air concentration was observed after an old computer was exchanged with a newer one. PBDE-impregnated polyurethane foam (PUF) and carpet were treated as pseudo-steady-state components with specified fugacities derived from measured concentrations of 173 and 2140 ng x g(-1), respectively. Emission rates of 35 and 5.4 ng x h(-1), for the old and new computers, respectively, were calculated using the pseudo-steady-state approach. Particle movement (deposition and resuspension) dominates within-room transport processes, and dust removal (vacuuming) and air advection (ventilation) are the main loss processes. The most sensitive parameters to air concentrations and estimated emission rates are room temperature, particle concentrations and deposition velocity, and air exchange rates. The air exchange rates and bouncing on PUF furniture can alter whether the PUF and carpet are sources or sinks of PBDEs. Model results suggest that exposure via air can be reduced by removing dust, having a high air exchange rate, and low indoor temperatures.

Comparing water, bovine milk, and indoor residual spraying as possible sources of DDT and pyrethroid residues in breast milk

The presence of pollutants in human breast milk is of major concern, especially in malaria control areas where 1,1,1-trichloro-2,2-bis(4-chlorophenyl) ethane (DDT) is currently used as indoor residual spray (IRS). The levels of DDT and pyrethroids (PYR) were determined in breast milk, bovine milk, and drinking water from northern KwaZulu-Natal, South Africa. Both reference and exposed mothers used the same market food, but the DDT levels in the exposed mothers (mean SigmaDDT 10 microg/g milk fat [mf]) were much higher than for the reference mothers (mean SigmaDDT 1.3 microg/g milk fat). This difference in residue levels indicates uptake from IRS-applied DDT, most likely via air and skin contact, and excludes food as the main source of pollutants. DDT levels in bovine milk (mean SigmaDDT 0.15 microg/g mf) from the exposed area were less than levels in breast milk from the reference area, and lower than the 20 microg/L maximum residue limit (MRL) set by the Food and Agriculture Organization (FAO). Mean SigmaDDT in water was 0.0065 microg/L, much lower then the WHO limit of the sum of all metabolites in drinking water of 1 microg/L, and therefore highly unlikely to have contributed to any extent toward levels in breast milk. Permethrin in breast milk (mean 1.1-1.6 microg/g milk fat) was probably derived from home garden and indoor use, while the other PYR (cypermethrin and cyfluthrin) at lower concentrations were probably derived from food and agricultural exposure. It is postulated that a better understanding of the indoor dynamics of DDT and other insecticides, through a concept of Total Homestead Environment Approach (THEA), is crucial for investigating options of reducing human exposure and uptake under malaria control conditions.

Monitoring and reducing exposure of infants to pollutants in house dust

The health risks to babies from pollutants in house dust may be 100 times greater than for adults. The young ingest more dust and are up to ten times more vulnerable to such exposures. House dust is the main exposure source for infants to allergens, lead, and PBDEs, as well as a major source of exposure to pesticides, PAHs, Gram-negative bacteria, arsenic, cadmium, chromium, phthalates, phenols, and other EDCs, mutagens, and carcinogens. Median or upper percentile concentrations in house dust of lead and several pesticides and PAHs may exceed health-based standards in North America. Early contact with pollutants among the very young is associated with higher rates of chronic illness such as asthma, loss of intelligence, ADHD, and cancer in children and adults. The potential of infants, who live in areas with soil contaminated by automotive and industrial emissions, can be given more protection by improved home cleaning and hand washing. Babies who live in houses built before 1978 have a prospective need for protection against lead exposures; homes built before 1940 have even higher lead exposure risks. The concentration of pollutants in house dust may be 2-32 times higher than that found in the soil near a house. Reducing infant exposures, at this critical time in their development, may reduce lifetime health costs, improve early learning, and increase adult productivity. Some interventions show a very rapid payback. Two large studies provide evidence that home visits to reduce the exposure of children with poorly controlled asthma triggers may return more than 100% on investment in 1 yr in reduced health costs. The tools provided to families during home visits, designed to reduce dust exposures, included vacuum cleaners with dirt finders and HEPA filtration, allergy control bedding covers, high-quality door mats, and HEPA air filters. Infants receive their highest exposure to pollutants in dust at home, where they spend the most time, and where the family has the most mitigation control. Normal vacuum cleaning allows deep dust to build up in carpets where it can be brought to the surface and become airborne as a result of activity on the carpet. Vacuums with dirt finders allow families to use the three-spot test to monitor deep dust, which can reinforce good cleaning habits. Motivated families that receive home visits from trained outreach workers can monitor and reduce dust exposures by 90% or more in 1 wk. The cost of such visits is low considering the reduction of risks achieved. Improved home cleaning is one of the first results observed among families who receive home visits from MHEs and CHWs. We believe that proven intervention methods can reduce the exposure of infants to pollutants in house dust, while recognizing that much remains to be learned about improving the effectiveness of such methods.

Using environmental forensic microscopy in exposure science

Environmental forensic microscopy investigations are based on the methods and procedures developed in the fields of criminal forensics, industrial hygiene and environmental monitoring. Using a variety of microscopes and techniques, the environmental forensic scientist attempts to reconstruct the sources and the extent of exposure based on the physical evidence left behind after particles are exchanged between an individual and the environments he or she passes through. This article describes how environmental forensic microscopy uses procedures developed for environmental monitoring, criminal forensics and industrial hygiene investigations. It provides key references to the interdisciplinary approach used in microscopic investigations. Case studies dealing with lead, asbestos, glass fibers and other particulate contaminants are used to illustrate how environmental forensic microscopy can be very useful in the initial stages of a variety of environmental exposure characterization efforts to eliminate some agents of concern and to narrow the field of possible sources of exposure.

Development of a high-throughput method for the determination of organochlorinated compounds, nitromusks and pyrethroid insecticides in indoor dust

Investigation of chemical exposure inside the homes and offices where people spend the majority of their lives has only recently begun. These chemicals are degraded much more slowly than outdoor because they are more protected from sunlight, severe environmental conditions and microbial activity. Hence, indoor dust has been recognized as an important exposure pathway for organic contaminants. Pyrethroids are synthetic insecticides widely used in domestic environment for numerous applications and also in agriculture. Chlorobenzenes are a family of compounds used as intermediates in the production of a wide range of household consumer products. Nitromusks are a kind of synthetic musks used in the production of cleaning agents, detergents, and personal care products. A high-throughput method for the determination of these compounds in indoor dust samples has been developed. Microwave-assisted solvent extraction was used as the extraction technique whereas quantification of compounds was carried out by gas chromatography with micro-electron-capture detection. Several cleanup procedures were tested and finally a non-classical "on batch" procedure was selected, which allows increasing the throughput of the analysis while decreasing sample manipulation. Extraction conditions were optimized using a multifactorial experimental design approach. Quantitative recovery (84-103%) was achieved for all compounds and method precision was satisfactory. Limits of detection ranged from 0.22 ng g(-1) for lindane to 40 ng g(-1) for 1,4-dichlorobenzene. Standard reference material SRM 2585 was analyzed and the obtained values were in good agreement with the reported reference values for organochlorinated compounds and nitromusks. Pyrethroids and polychlorobenzenes have been analyzed for the first time in this reference material and some of them have been found. In addition, real samples collected in houses of north-western Spain have been analyzed by the proposed method and 17 of the 22 target compounds have been detected in the samples.

Current state of the science: health effects and indoor environmental quality

Our understanding of the relationship between human health and the indoor environment continues to evolve. Previous research on health and indoor environments has tended to concentrate on discrete pollutant sources and exposures and on specific disease processes. Recently, efforts have been made to characterize more fully the complex interactions between the health of occupants and the interior spaces they inhabit. In this article we review recent advances in source characterization, exposure assessment, health effects associated with indoor exposures, and intervention research related to indoor environments. Advances in source characterization include a better understanding of how chemicals are transported and processed within spaces and the role that other factors such as lighting and building design may play in determining health. Efforts are under way to improve our ability to measure exposures, but this remains a challenge, particularly for biological agents. Researchers are also examining the effects of multiple exposures as well as the effects of exposures on vulnerable populations such as children and the elderly. In addition, a number of investigators are also studying the effects of modifying building design, materials, and operations on occupant health. Identification of research priorities should include input from building designers, operators, and the public health community.