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Putus T, Vilén L, Atosuo J. The Association Between Work-related Stress, Indoor Air Quality and Voice Problems Among Teachers - Is There a Trend? J Voice 2024; 38:541.e21-541.e29. [PMID: 34642072 DOI: 10.1016/j.jvoice.2021.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Hoarseness and other voice problems are common in occupations where the person has to speak, sing or shout in a work environment containing dust, noise, gaseous or particulate irritants. In recent years, stress has often been associated with voice problems. OBJECTIVE The aim of this study was to examine trends over a period of time of the prevalence of voice problems and reported stress in Finnish school buildings. STUDY DESIGN School buildings from different parts of the country were studied for ten years using a similar questionnaire (N = 1721). Five schools participated before and after the remediation of an indoor air problem in the school buildings (n = 315). RESULTS In the pilot study (2007-2008), the reported work-related stress was on a very low level (3%) and the prevalence of hoarseness was 10%. After the economic crisis in 2008, the stress was observed to have increased. During the follow-up (2008-2017), the reported stress had continued to increase and in the latest surveys it was 21% and the prevalence of hoarseness 34%. Indoor air factors correlated significantly with hoarseness even when controlling for age, gender, owning pets and job satisfaction in a logistic regression model. In the school buildings where the remediation of the building was completed, the prevalence of hoarseness decreased but the level of stress increased. In general, the proportion of respondents reporting stress was lower than the proportion of respondents with hoarseness. Additionally, the reported stress also correlated with factors other than health in the education branch, especially economic resources and major changes in the core curriculum. CONCLUSION Hoarseness and work-related stress have, to a large extent, different risk factors. Over time, the proportion of individuals with stress has been at a lower level than the proportion of respondents with voice problems; hence, we conclude that it is quite unlikely that stress would be a causative risk factor for hoarseness. We recommend that irritant dust and gases should be reduced from the work environment of teachers to enable recovery from hoarseness and other voice problems. Coping with work-related stress should be alleviated with other measures.
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Affiliation(s)
- Tuula Putus
- Department of Clinical Medicine, Environmental Medicine and Occupational Health, University of Turku, Turku, Finland.
| | - Liisa Vilén
- Department of Clinical Medicine, Environmental Medicine and Occupational Health, University of Turku, Turku, Finland
| | - Janne Atosuo
- Department of Life Technologies, The Laboratory of Immunochemistry, University of Turku, Turku, Finland
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Howard A, Mansour A, Warren-Myers G, Jensen C, Bentley R. Housing typologies and asthma: a scoping review. BMC Public Health 2023; 23:1766. [PMID: 37697282 PMCID: PMC10494403 DOI: 10.1186/s12889-023-16594-8] [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: 05/26/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
Asthma is related to triggers within the home. Although it is recognised that triggers likely occur due to characteristics of housing, these characteristics have not been comprehensively reviewed, and there is a paucity of housing-focused interventions to reduce asthma and asthma symptoms. Following five steps identified by Arksey and O'Malley, we conducted a scoping review of published evidence on the associations between asthma and housing characteristics. We searched three electronic databases (PubMed, Scopus, Web of Science), identifying 33 studies that met our inclusion criteria. Through an iterative approach, we identified nine housing characteristics relevant to asthma onset or exacerbation, categorised as relating to the surrounding environment (location), the house itself (dwelling), or to conditions inside the home (occupancy). We conceptualise these three levels through a housing typologies framework. This facilitates the mapping of housing characteristics, and visualises how they can cluster and overlap to exacerbate asthma or asthma symptoms. Of the three levels in our framework, associations between asthma and locational features were evidenced most clearly in the literature reviewed. Within this category, environmental pollutants (and particularly air pollutants) were identified as a potentially important risk factor for asthma. Studies concerning associations between dwelling features and occupancy features and asthma reported inconsistent results, highlighting the need for greater research in these areas. Interpreting housing-related asthma triggers through this framework paves the way for the identification and targeting of typologies of housing that might adversely affect asthma, thus addressing multiple characteristics in tandem rather than as isolated elements.
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Affiliation(s)
- Amber Howard
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
| | - Adelle Mansour
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | | | - Christopher Jensen
- Melbourne School of Design, University of Melbourne, Victoria, Australia
| | - Rebecca Bentley
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Wang J, Janson C, Malinovschi A, Holm M, Franklin KA, Modig L, Johannessen A, Schlünssen V, Gislason T, Jogi NO, Norbäck D. Asthma, allergic rhinitis and atopic dermatitis in association with home environment - The RHINE study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 853:158609. [PMID: 36089044 DOI: 10.1016/j.scitotenv.2022.158609] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 06/15/2023]
Abstract
We studied home environment exposures in relation to asthma, allergic rhinitis and atopic dermatitis among offspring of participants (parents) in the Respiratory Health in Northern Europe (RHINE) study (age ≤ 30 y). Totally 17,881 offspring from Iceland, Norway, Sweden, Denmark and Estonia were included. Home environment exposures, including dampness and mold, type of dwelling, construction year and indoor painting were registered through a questionnaire answered by parents in the first follow up (RHINE II). The parents reported ten years later with in the frame of RHINE III offspring's birth year and offspring's asthma, allergic rhinitis, atopic dermatitis. They also reported dampness and mold at home from RHINE II to RHINE III. The prevalence of offspring's asthma before 10 y, asthma after 10 y, allergic rhinitis at any age and atopic dermatitis at any age were 9.7 %, 4.3 %, 15.6 % and 17.3 %, respectively. Asthma before 10 y was related to any indoor painting at RHINE II (OR = 1.14, 95%CI (1.02, 1.29)). Asthma after 10 y was associated with dampness/mold at home (OR = 1.33-1.62) and living in the newest buildings (constructed in 1986-2001) (OR = 1.30, 95%CI (1.02, 1.66)). Allergic rhinitis was associated with living in newer buildings (constructed in 1961-2001) (OR = 1.16-1.24). Atopic dermatitis was associated with visible mold (OR = 1.35, 95%CI(1.12, 1.62)), dampness/mold at home (OR = 1.18-1.38), living in apartments (OR = 1.22, 95%CI(1.10, 1.35)) and living in newer buildings (constructed in 1961-2001) (OR = 1.14-1.25). There were dose-response effects of dampness and mold on offspring's asthma after 10 y and atopic dermatitis (20 years exposure vs. 10 years exposure). Older offspring had increased risk of developing asthma after 10 y and atopic dermatitis. In conclusion, home dampness and mold, living in apartments, living in newer buildings and indoor painting were associated with offspring's asthma or allergic diseases. Stronger health effects were found among offspring with prolonged exposure of dampness/mold.
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Affiliation(s)
- Juan Wang
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Mathias Holm
- Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden
| | - Karl A Franklin
- Department of Surgical and Preoperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden
| | - Lars Modig
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Nils Oskar Jogi
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Dan Norbäck
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
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A Study on Transformation of Housing Typology and Its Environmental and Social Effects on the Living Conditions of Residents in Planned Residential Neighborhoods of Kabul City. URBAN SCIENCE 2022. [DOI: 10.3390/urbansci6030045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
This study examines the transformation in housing typology from low-rise to apartment buildings in the formal neighborhood of Kabul city. These formal neighborhoods were developed according to plans from 1978. The majority of these neighborhoods were designed with detached houses that had courtyards. Literature reviews, field visits, opinions of residents, and a planning organization provided data for this study. In this study, the transformation of housing in planned neighborhoods is analyzed in relation to their social and environmental impacts. Researchers determined how varying housing typologies affected residents’ health and quality of life in these planned neighborhoods. Initially, we assessed the physical characteristics of the study area and evaluated how much transformation volume is present in the study area. Second, we examined residents’ views of residential development and its impacts, as well as their daily lives. In order to identify the relationship between these two aspects, the study examined the characteristics of the area (variables) from the perspectives of privacy, natural light, shading, sound pollution, air pollution, and energy use. We used several criteria to evaluate the accuracy of the physical characteristics and the respondents’ opinions. Lastly, we provided some recommendations and solutions to improve the current situation.
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Wang C, Wang J, Norbäck D. A Systematic Review of Associations between Energy Use, Fuel Poverty, Energy Efficiency Improvements and Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127393. [PMID: 35742650 PMCID: PMC9223700 DOI: 10.3390/ijerph19127393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Abstract
Energy use in buildings can influence the indoor environment. Studies on green buildings, energy saving measures, energy use, fuel poverty, and ventilation have been reviewed, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The database PubMed was searched for articles published up to 1 October 2020. In total, 68 relevant peer-reviewed epidemiological or exposure studies on radon, biological agents, and chemicals were included. The main aim was to assess current knowledge on how energy saving measures and energy use can influence health. The included studies concluded that buildings classified as green buildings can improve health. More efficient heating and increased thermal insulation can improve health in homes experiencing fuel poverty. However, energy-saving measures in airtight buildings and thermal insulation without installation of mechanical ventilation can impair health. Energy efficiency retrofits can increase indoor radon which can cause lung cancer. Installation of a mechanical ventilation systems can solve many of the negative effects linked to airtight buildings and energy efficiency retrofits. However, higher ventilation flow can increase the indoor exposure to outdoor air pollutants in areas with high levels of outdoor air pollution. Finally, future research needs concerning energy aspects of buildings and health were identified.
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Wang J, Norbäck D. Subjective indoor air quality and thermal comfort among adults in relation to inspected and measured indoor environment factors in single-family houses in Sweden-the BETSI study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 802:149804. [PMID: 34455269 DOI: 10.1016/j.scitotenv.2021.149804] [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: 06/10/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
Totally 1160 adults living in single-family houses in Sweden participated in a questionnaire survey on subjective indoor air quality (SIAQ). Inspectors investigated the dwellings and performed home measurements (mean indoor temperature 21.4 °C, mean indoor air humidity 34.2%, mean indoor air exchange rate 0.36 ac/h and mean moisture load indoor 1.7 g/m3). Totally 15.5% perceived draught, 28.0% perceived too high room temperature, 42.4% unstable room temperature, 36.8% too low room temperature, 19.6% stuffy air, 19.8% dry air and 29.9% dust or dirt. Measured room temperature was related to perception of room temperature. Higher relative air humidity was related to perceived unstable room temperature (OR = 1.70) and too low room temperature (OR = 1.96). Higher absolute air humidity was related to too high room temperature (OR = 1.21), unstable room temperature (OR = 1.34) and too low room temperature (OR = 1.35). Higher measured relative humidity, absolute air humidity and moisture load were all associated with stuffy air and unpleasant odor (OR = 1.45-1.97). Higher air exchange rate was related to less perceived unstable room temperature (OR = 0.93). Higher U value was related to draught (OR = 1.17), too low room temperature (OR = 1.09), unpleasant odor (OR = 1.12) and dust and dirt (OR = 1.07). New concrete slab foundation was related to less stuffy air (OR = 0.39) (vs. basement). Damp foundation was associated with more stuffy air (OR = 1.44) and unpleasant odor (OR = 1.61). Window pane condensation was related to stuffy air (OR = 1.88). Moldy odor reported by inspector was related to stuffy air (OR = 1.73). Observed mold in the attic was associated with more stuffy air and unpleasant odor. In conclusion, complaints of room temperature can indicate poor thermal environment. Higher air exchange rate can create a more stable thermal sensation. Excess indoor humidity, lower degree of thermal insulation, presence of window pane condensation and indoor dampness/mold can impair SIAQ. Higher ventilation and concrete slab foundation with underlying thermal insulation can improve SIAQ.
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Affiliation(s)
- Juan Wang
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Dan Norbäck
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, SE-751 85 Uppsala, Sweden
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Yang Q, Wang J, Norbäck D. The home environment in a nationwide sample of multi-family buildings in Sweden: associations with ocular, nasal, throat and dermal symptoms, headache, and fatigue among adults. INDOOR AIR 2021; 31:1402-1416. [PMID: 33682978 DOI: 10.1111/ina.12787] [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: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
Risk factors at home for ocular, nasal, throat and dermal symptoms, headache, and fatigue were studied in a nationwide questionnaire survey in Sweden, the BETSI study in 2006. Totally, 5775 adults from a stratified random sample of multi-family buildings participated. Associations between home environment factors and weekly symptoms were analyzed by multi-level logistic regression. In total, 8.3% had ocular symptoms; 11.9% nasal symptoms; 7.1% throat symptoms; 11.9% dermal symptoms; 8.5% headache and 23.1% fatigue. Subjects in colder climate zones had more mucosal and throat symptoms but less fatigue and ocular symptoms. Rented apartments had poorer indoor environment than self-owned apartments. Those living in buildings constructed from 1961 to 1985 had most symptoms. Building dampness, mold and mold odor were risk factors, especially headache and ocular symptoms. Lack of mechanical ventilation system was another risk factor, especially for headache. Environmental tobacco smoke (ETS), electric radiators, and crowdedness were other risk factors. Oiled wooden floors, recent indoor painting, and new floor materials were negatively associated with symptoms. In conclusion, building dampness, mold, poor ventilation conditions, crowdedness, ETS, and emissions from electric radiators in apartments in Sweden can increase the risk of ocular, nasal, throat and dermal symptoms, headache, and fatigue.
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Affiliation(s)
- Qin Yang
- College of Civil Engineering, Guizhou University, Guiyang, China
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - Juan Wang
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
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Norbäck D, Zhang X, Tian L, Zhang Y, Zhang Z, Yang L, Chen X, Zeng Z, Lu C, Zhao Z. Prenatal and perinatal home environment and reported onset of wheeze, rhinitis and eczema symptoms in preschool children in Northern China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 774:145700. [PMID: 33609817 DOI: 10.1016/j.scitotenv.2021.145700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
Early life environment can affect asthma and allergies but few cohort studies on this issue are available from China. Our aim was to investigate reported onset of childhood wheeze, rhinitis and eczema symptoms in relation to prenatal, perinatal and postnatal home environment. Data on home environment and symptoms (ISAAC based questions) in first two years of life and in the past 12 months were reported by parents of the children (3-6 y) in a cross-sectional questionnaire survey in ten day care centers in Taiyuan, northern China (N = 3606). Changes of symptoms from the first 2 years of life to the past 12 months (recall period) were calculated retrospectively. Multilevel logistic regression analysis was applied. Reported onset of wheeze, rhinitis and eczema were 11.8%, 22.2% and 3.3%, respectively. Redecorating during pregnancy increased reported onset of rhinitis (OR = 2.29) and eczema (OR = 4.91). New furniture during pregnancy increased reported onset of rhinitis (OR = 1.47). Perinatal indoor mould increased reported onset of wheeze (OR = 1.51), rhinitis (OR = 1.65) and eczema (OR = 1.91). Perinatal mould odour increased reported onset of wheeze (OR = 1.85). Perinatal window pane condensation increased reported onset of wheeze (OR = 1.54) and rhinitis (OR = 1.24). Perinatal stuffy air and dry air in the home increased reported onset of all three symptoms (ORs 1.46-2.24). Dog keeping increased reported onset of wheeze (OR = 1.69) and eczema (OR = 2.13). Based on principal component analysis, four exposure scores were calculated (renovation, new furniture, mould and indoor air quality scores). Dose-response relationships were observed between these exposure scores and reported onset of symptoms. In conclusion, prenatal and postnatal exposure to emissions from renovation and new furniture can increase reported onset of childhood wheeze, rhinitis and eczema. Perinatal indoor mould, mould odour, condensation on window panes and impaired indoor air quality at home can be associated with reported development of wheeze, rhinitis and eczema in preschoolers in northern China.
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Affiliation(s)
- Dan Norbäck
- Institute of Environmental Science, Shanxi University, Taiyuan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Xin Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China.
| | - Li Tian
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Yifei Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Zefei Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Liu Yang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Xingyi Chen
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Zhaohua Zeng
- School of Public Health, Xiamen University, Xiamen, China
| | - Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Zhuohui Zhao
- School of Public Health, Fudan University, Shanghai, China
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Nazaroff WW. Residential air-change rates: A critical review. INDOOR AIR 2021; 31:282-313. [PMID: 33403728 DOI: 10.1111/ina.12785] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/13/2020] [Indexed: 05/26/2023]
Abstract
Air-change rate is an important parameter influencing residential air quality. This article critically assesses the state of knowledge regarding residential air-change rates, emphasizing periods of normal occupancy. Cumulatively, about 40 prior studies have measured air-change rates in approximately 10,000 homes using tracer gases, including metabolic CO2 . The central tendency of the air-change rates determined in these studies is reasonably described as lognormal with a geometric mean of 0.5 h-1 and a geometric standard deviation of 2.0. However, the geometric means of individual studies vary, mainly within the range 0.2-1 h-1 . Air-change rates also vary with time in residences. Factors influencing the air-change rate include weather (indoor-outdoor temperature difference and wind speed), the leakiness of the building envelope, and, when present, operation of mechanical ventilation systems. Occupancy-associated factors are also important, including window opening, induced exhaust from flued combustion, and use of heating and cooling systems. Empirical and methodological challenges remain to be effectively addressed. These include clarifying the time variation of air-change rates in residences during occupancy and understanding the influence of time-varying air-change rates on tracer-gas measurement techniques. Important opportunities are available to improve understanding of air-change rates and interzonal flows as factors affecting the source-to-exposure relationships for indoor air pollutants.
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Affiliation(s)
- William W Nazaroff
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
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Hou J, Sun Y, Wang P, Zhang Q, Kong X, Sundell J. Associations between ventilation and children's asthma and allergy in naturally ventilated Chinese homes. INDOOR AIR 2021; 31:383-391. [PMID: 32939827 DOI: 10.1111/ina.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/30/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
Building ventilation is important for occupants' health. There are few studies of associations between home ventilation and occupant's health in China. During 2013-2016, we measured ventilation in 399 homes in Tianjin and Cangzhou, China, and surveyed the health history of children. Ventilation rates were measured using mass balance of occupant generated CO2 . The associations of home ventilation with children's asthma and allergy were analyzed in different strata of time and space. A low bedroom ventilation at night was significantly associated with an increased proportion of rhinitis among children (rhinitis current, adjusted odds ratio (AOR): 1.59; 95% confidence interval (CI): 1.01-2.49; diagnosed rhinitis, AOR: 3.02 (1.16-7.89)). Our findings suggest a dose-response relationship between ventilation rate at night in children's bedrooms and rhinitis current. The night-time ventilation rate in bedrooms has a greater association with rhinitis than the whole home ventilation rate during daytime.
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Affiliation(s)
- Jing Hou
- Tianjin Key Lab. of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Yuexia Sun
- Tianjin Key Lab. of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Pan Wang
- Tianjin Key Lab. of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Qingnan Zhang
- Tianjin Key Lab. of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Xiangrui Kong
- Tianjin Key Lab. of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- Tianjin Key Lab. of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin, China
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Norbäck D, Wang J. Household air pollution and adult respiratory health. Eur Respir J 2021; 57:57/1/2003520. [PMID: 33446579 DOI: 10.1183/13993003.03520-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Dan Norbäck
- Dept of Medical Science, Occupational and Environmental Medicine, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Juan Wang
- Dept of Medical Science, Occupational and Environmental Medicine, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
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Wang J, Janson C, Jogi R, Forsberg B, Gislason T, Holm M, Torén K, Malinovschi A, Sigsgaard T, Schlünssen V, Svanes C, Johannessen A, Bertelsen RJ, Franklin KA, Norbäck D. A prospective study on the role of smoking, environmental tobacco smoke, indoor painting and living in old or new buildings on asthma, rhinitis and respiratory symptoms. ENVIRONMENTAL RESEARCH 2021; 192:110269. [PMID: 32997968 DOI: 10.1016/j.envres.2020.110269] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 06/11/2023]
Abstract
We studied associations between tobacco smoke, home environment and respiratory health in a 10 year follow up of a cohort of 11,506 adults in Northern Europe. Multilevel logistic regression models were applied to estimate onset and remission of symptoms. Current smokers at baseline developed more respiratory symptoms (OR = 1.39-4.43) and rhinitis symptoms (OR = 1.35). Starting smoking during follow up increased the risk of new respiratory symptoms (OR = 1.54-1.97) and quitting smoking decreased the risk (OR = 0.34-0.60). ETS at baseline increased the risk of wheeze (OR = 1.26). Combined ETS at baseline or follow up increased the risk of wheeze (OR = 1.27) and nocturnal cough (OR = 1.22). Wood painting at baseline reduced remission of asthma (OR 95%CI: 0.61, 0.38-0.99). Floor painting at home increased productive cough (OR 95%CI: 1.64, 1.15-2.34) and decreased remission of wheeze (OR 95%CI: 0.63, 0.40-0.996). Indoor painting (OR 95%CI: 1.43, 1.16-1.75) and floor painting (OR 95%CI: 1.77, 1.11-2.82) increased remission of allergic rhinitis. Living in the oldest buildings (constructed before 1960) was associated with higher onset of nocturnal cough and doctor diagnosed asthma. Living in the newest buildings (constructed 1986-2001) was associated with higher onset of nocturnal breathlessness (OR = 1.39) and rhinitis (OR = 1.34). In conclusion, smoking, ETS and painting indoor can be risk factors for respiratory symptoms. Wood painting and floor painting can reduce remission of respiratory symptoms. Smoking can increase rhinitis. Living in older buildings can be a risk factor for nocturnal cough and doctor diagnosed asthma. Living in new buildings can increase nocturnal dyspnoea and rhinitis.
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Affiliation(s)
- Juan Wang
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
| | - Christer Janson
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Mathias Holm
- Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Randi Jacobsen Bertelsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Oral Health Centre of Expertise, Western Norway, Bergen, Norway
| | - Karl A Franklin
- Department of Surgical and Preoperative Sciences, Surgery, Umeå University, SE-901 85, Umeå, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
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13
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Lu C, Norbäck D, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, Qian H, Wang J, Liu W, Yang X, Sun Y, Sundell J, Deng Q. Common cold among young adults in China without a history of asthma or allergic rhinitis - associations with warmer climate zone, dampness and mould at home, and outdoor PM 10 and PM 2.5. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141580. [PMID: 32841860 DOI: 10.1016/j.scitotenv.2020.141580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 05/09/2023]
Abstract
This paper studied associations between reported common cold and home dampness and mould, cleaning habits and ventilation, climate and outdoor air pollution in China among young adults without asthma or allergic rhinitis. Parents of children attending day care in eight Chinese cities answered a questionnaire on their health and home environment (75% response rate). We restricted the population to subject without asthma or allergic rhinitis (N = 37,275). Temperature and air pollution data was obtained from monitoring stations. Associations were estimated by multilevel logistic regression. Totally 12.5% reported common cold (≥3 colds) and 1.6% frequent common cold (≥5 colds) in the past 12 months. Female gender (OR = 1.53; 95% CI 1.37-1.71), residents in southern China (OR = 1.89; 95% CI 1.16-3.07) and living in homes with water leakage (OR = 1.32; 95% CI 1.16-1.50), mould odour (OR = 1.48; 95% CI 1.28-1.72), indoor mould (OR = 1.47; 95% CI 1.28-1.70), condensation on window panes (OR = 1.42; 95% CI 1.32-1.52) and damp bed clothing (OR = 1.19; 95% CI 1.11-1.28) were associated with common cold. Having many signs of dampness increased ORs. Daily cleaning (OR = 0.91; 95% CI 0.85-0.97) and mechanical ventilation in kitchen or bathroom (OR = 0.75; 95% CI 0.64-0.89) were protective. Higher mean ambient temperature (OR = 1.11 per °C; 95% CI 1.02-1.21), PM10 (OR = 1.17 per 10 μg/m3; 95% CI 1.14-1.21) and PM2.5 (OR = 1.28 per 10 μg/m3; 95% CI 1.20-1.37) were associated with common cold. The association with particulate air pollution was stronger in southern China. Similar associations were found for frequent common cold. In conclusion, indoor dampness and mould, a warmer climate and PM10 and PM2.5 can be associated with reported common cold. Further intervention and prospective studies are needed to verify causality of observed association in this cross-sectional study.
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Affiliation(s)
- Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Norbäck
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- Department of Environmental Health, Fudan University, Shanghai, China
| | - Chen Huang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy & Environment, Southeast University, Nanjing, China
| | - Juan Wang
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Wei Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Xu Yang
- College of Life Sciences, Central China Normal University, Wuhan, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Qihong Deng
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Energy Science and Engineering, Central South University, Changsha, Hunan, China.
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14
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Humphrey JL, Barton KE, Man Shrestha P, Carlton EJ, Newman LS, Dowling Root E, Adgate JL, Miller SL. Air infiltration in low-income, urban homes and its relationship to lung function. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:262-270. [PMID: 31641277 DOI: 10.1038/s41370-019-0184-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
Previous research has found increased home ventilation, which may affect health by altering the composition of indoor air, is associated with improvement of respiratory health, but evidence linking home ventilation to objectively measured lung function is sparse. The Colorado Home Energy Efficiency and Respiratory health (CHEER) study, a cross-sectional study of low-income, urban, nonsmoking homes across the Northern Front Range of Colorado, USA, focused on elucidating this link. We used a multipoint depressurization blower door test to measure the air tightness of the homes and calculate the annual average infiltration rate (AAIR). Lung function tests were administered to eligible participants. We analyzed data from 253 participants in 187 homes with two or more acceptable spirometry tests. We used generalized estimating equations to model forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC z-scores as a function of AAIR. AAIRs ranged from 0.10 to 1.98 air changes per hour. Mean z-scores for FEV1, FVC, and FEV1/FVC were -0.57, 0.32, and -0.43, respectively. AAIR was positively associated with increased FEV1/FVC z-scores, such that a 1-unit change in AAIR corresponded to a half of a standard deviation in lung function (β = 0.51, CI: 0.02-0.99). These associations were strongest for healthy populations and weaker for those with asthma and asthma-like symptoms. AAIR was not associated with FEV1 or FVC. Our study is the first in the United States to link home ventilation by infiltration to objectively measured lung function in low-income, urban households.
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Affiliation(s)
- Jamie L Humphrey
- Department of Mechanical Engineering, University of Colorado Boulder, 427 UCB, Boulder, CO, 80309-0427, USA
| | - Kelsey E Barton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, USA
| | - Prateek Man Shrestha
- Department of Mechanical Engineering, University of Colorado Boulder, 427 UCB, Boulder, CO, 80309-0427, USA
| | - Elizabeth J Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, USA
| | - Lee S Newman
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Place B119, Aurora, CO, 80045, USA
| | - Elisabeth Dowling Root
- Department of Geography and Division of Epidemiology, The Ohio State University, 1036 Derby Hall, 154 North Oval Mall, Columbus, OH, 43210, USA
| | - John L Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, USA
| | - Shelly L Miller
- Department of Mechanical Engineering, University of Colorado Boulder, 427 UCB, Boulder, CO, 80309-0427, USA.
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15
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Marquez E, Dodge Francis C, Gerstenberger S. Where I live: A qualitative analysis of renters living in poor housing. Health Place 2019; 58:102143. [PMID: 31174060 DOI: 10.1016/j.healthplace.2019.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 05/18/2019] [Accepted: 05/23/2019] [Indexed: 12/19/2022]
Abstract
This article examines the lived experiences of 17 renters residing in Clark County, Nevada. Using a phenomenological study design, we used semistructured interviews to investigate how renters navigate living in substandard housing. The qualitative analysis revealed four main themes: (a) housing serves as a mediator with one's sense of well-being and good health, (b) housing insecurity and displacement occur through various pathways, (c) housing quality can lead to a sense of powerlessness over where one lives, and (d) social networks are key in low-opportunity neighborhoods. The findings support numerous studies that connect housing quality and insecurity to health and well-being, but the findings also highlight the mediating factors to limited housing choices such as the landlord and tenant relationship. Studies of this nature are essential in identifying the various pathways by which housing inequities and disparities can occur, particularly among low-income communities.
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Affiliation(s)
- Erika Marquez
- Nevada Institute for Children's Research and Policy, University of Nevada, Las Vegas 4505 Maryland Parkway Box 453064 Las Vegas, NV, 89154-3030, USA.
| | - Carolee Dodge Francis
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas 4505 Maryland Parkway Box 453064 Las Vegas, NV, 89154-3064, USA
| | - Shawn Gerstenberger
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas 4505 Maryland Parkway Box 453064 Las Vegas, NV, 89154-3064, USA
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16
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Wang J, Pindus M, Janson C, Sigsgaard T, Kim JL, Holm M, Sommar J, Orru H, Gislason T, Johannessen A, Bertelsen RJ, Norbäck D. Dampness, mould, onset and remission of adult respiratory symptoms, asthma and rhinitis. Eur Respir J 2019; 53:13993003.01921-2018. [PMID: 30880288 DOI: 10.1183/13993003.01921-2018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/07/2019] [Indexed: 11/05/2022]
Abstract
STUDY QUESTION Is dampness and indoor mould associated with onset and remission of respiratory symptoms, asthma and rhinitis among adults? MATERIALS AND METHODS Associations between dampness, mould and mould odour at home and at work and respiratory health were investigated in a cohort of 11 506 adults from Iceland, Norway, Sweden, Denmark and Estonia. They answered a questionnaire at baseline and 10 years later, with questions on respiratory health, home and work environment. RESULTS Baseline water damage, floor dampness, mould and mould odour at home were associated with onset of respiratory symptoms and asthma (OR 1.23-2.24). Dampness at home during follow-up was associated with onset of respiratory symptoms, asthma and rhinitis (OR 1.21-1.52). Dampness at work during follow-up was associated with onset of respiratory symptoms, asthma and rhinitis (OR 1.31-1.50). Combined dampness at home and at work increased the risk of onset of respiratory symptoms and rhinitis. Dampness and mould at home and at work decreased remission of respiratory symptoms and rhinitis. THE ANSWER TO THE QUESTION Dampness and mould at home and at work can increase onset of respiratory symptoms, asthma and rhinitis, and decrease remission.
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Affiliation(s)
- Juan Wang
- Dept of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.,These authors contributed equally to this work
| | - Mihkel Pindus
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.,These authors contributed equally to this work
| | - Christer Janson
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Torben Sigsgaard
- Dept of Public Health, Section for Environment, Occupation and Health, Aarhus University, Danish Ramazzini Centre, Aarhus, Denmark
| | - Jeong-Lim Kim
- Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden
| | - Mathias Holm
- Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden
| | - Johan Sommar
- Occupational and Environmental Medicine, Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.,Occupational and Environmental Medicine, Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Ane Johannessen
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Dept of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Randi J Bertelsen
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Dept of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Dan Norbäck
- Dept of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
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17
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Carlton EJ, Barton K, Shrestha PM, Humphrey J, Newman LS, Adgate JL, Root E, Miller S. Relationships between home ventilation rates and respiratory health in the Colorado Home Energy Efficiency and Respiratory Health (CHEER) study. ENVIRONMENTAL RESEARCH 2019; 169:297-307. [PMID: 30500684 DOI: 10.1016/j.envres.2018.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND As societies adopt green building practices to reduce energy expenditures and emissions that contribute to climate change, it is important to consider how such building design changes influence health. These practices typically focus on reducing air exchange rates between the building interior and the outdoor environment to minimize energy loss, the health effects of which are not well characterized. This study aims to evaluate the relationship between air exchange rates and respiratory health in a multi-ethnic population living in low-income, urban homes. METHODS The Colorado Home Energy Efficiency and Respiratory Health (CHEER) study is a cross-sectional study that enrolled 302 people in 216 non-smoking, low-income single-family homes, duplexes and town-homes from Colorado's Northern Front Range. A blower door test was conducted and the annual average air exchange rate (AAER) was estimated for each home. Respiratory health was assessed using a structured questionnaire based on standard instruments. We estimated the association between AAER and respiratory symptoms, adjusting for relevant confounders. RESULTS Air exchange rates in many homes were high compared to prior studies (median 0.54 air changes per hour, range 0.10, 2.17). Residents in homes with higher AAER were more likely to report chronic cough, asthma and asthma-like symptoms, including taking medication for wheeze, wheeze that limited activities and dry cough at night. Allergic symptoms were not associated with AAER in any models. The association between AAER and asthma-like symptoms was stronger for households located in areas with high potential exposure to traffic related pollutants, but this was not consistent across all health outcomes. CONCLUSIONS While prior studies have highlighted the potential hazards of low ventilation rates in residences, this study suggests high ventilation rates in single-family homes, duplexes and town-homes in urban areas may also have negative impacts on respiratory health, possibly due to the infiltration of outdoor pollutants.
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Affiliation(s)
- Elizabeth J Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, United States.
| | - Kelsey Barton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, United States
| | - Prateek Man Shrestha
- Department of Mechanical Engineering, University of Colorado, 427 UCB, Boulder, CO 80309-0427, United States
| | - Jamie Humphrey
- Department of Mechanical Engineering, University of Colorado, 427 UCB, Boulder, CO 80309-0427, United States
| | - Lee S Newman
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, United States; Division of Pulmonary Science and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - John L Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, United States
| | - Elisabeth Root
- Department of Geography and Division of Epidemiology, The Ohio State University, 1036 Derby Hall, 154 North Oval Mall, Columbus, OH 43210, United States
| | - Shelly Miller
- Department of Mechanical Engineering, University of Colorado, 427 UCB, Boulder, CO 80309-0427, United States
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18
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Fisk WJ. How home ventilation rates affect health: A literature review. INDOOR AIR 2018; 28:473-487. [PMID: 29705988 DOI: 10.1111/ina.12469] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
This paper reviews studies of the relationships between ventilation rates (VRs) in homes and occupant health, primarily respiratory health. Five cross-sectional studies, seven case-control studies, and eight intervention studies met inclusion criteria. Nearly all studies controlled for a range of potential confounders and most intervention studies included placebo conditions. Just over half of studies reported one or more statistically significant (SS) health benefits of increased VRs. Wheeze was most clearly associated with VR. No health outcomes had SS associations with VRs in the majority of statistical tests. Most studies that reported SS health benefits from increased VRs also had additional health outcomes that did not improve with increased VRs. Overall, the number of SS improvements in health with increased VRs exceeded the anticipated chance improvements by approximately a factor of seven. The magnitude of the improvements in health outcomes with increased VRs ranged from 20% to several-fold improvements. In summary, the available research indicates a tendency for improvements in respiratory health with increased home VRs; however, health benefits do not occur consistently and other exposure control measures should be used together with ventilation. The research did not enable identification of a threshold VR below which adverse health effects occur.
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Affiliation(s)
- W J Fisk
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
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