Benefits and costs of improved IEQ in U.S. offices

Human personal air pollution clouds in a naturally ventilated office during the COVID-19 pandemic

Personal cloud, termed as the difference in air pollutant concentrations between breathing zone and room sites, represents the bias in approximating personal inhalation exposure that is linked to accuracy of health risk assessment. This study performed a two-week field experiment in a naturally ventilated office during the COVID-19 pandemic to assess occupants' exposure to common air pollutants and to determine factors contributing to the personal cloud effect. During occupied periods, indoor average concentrations of endotoxin (0.09 EU/m³), TVOC (231 μg/m³), CO₂ (630 ppm), and PM₁₀ (14 μg/m³) were below the recommended limits, except for formaldehyde (58 μg/m³). Personal exposure concentrations, however, were significantly different from, and mostly higher than, concentrations measured at room stationary sampling sites. Although three participants shared the same office, their personal air pollution clouds were mutually distinct. The mean personal cloud magnitude ranged within 0-0.05 EU/m³, 35-192 μg/m³, 32-120 ppm, and 4-9 μg/m³ for endotoxin, TVOC, CO₂, and PM₁₀, respectively, and was independent from room concentrations. The use of hand sanitizer was strongly associated with an elevated personal cloud of endotoxin and alcohol-based VOCs. Reduced occupancy density in the office resulted in more pronounced personal CO₂ clouds. The representativeness of room stationary sampling for capturing dynamic personal exposures was as low as 28% and 5% for CO₂ and PM₁₀, respectively. The findings of our study highlight the necessity of considering the personal cloud effect when assessing personal exposure in offices.

Pursuing occupants' health and well-being in building management: Definition of new metrics based on indoor air parameters

The spread of COVID-19 has affected the lives of millions of people. Pandemic has made people more sensitive to health issues. In particular, the growing concern for the virus spread in confined spaces has promoted the necessity to improve indoor air quality. Literature is stressing how buildings must be designed and operated pursuing occupants' health and well-being, with a particular attention for indoor air parameters. This poses the challenge of monitoring and assessing these aspects through proper metrics. In this paper the approach towards a multi-step assessment procedure embedding in buildings assessment health and well-being related variables and indicators is elaborated. They are intended to inform a building manager of the potential influence of air conditions on human health and well-being. Moreover, a set of monetary metrics (i.e., impacts) is proposed to translate energy and indoor air related building performances into euros, putting the basis for a comprehensive economic evaluation. The application of the set of proposed metrics to an Italian hotel (i.e., Italian pilot of H2020 MOBISTYLE project), enabled to map some indoor air conditions causing health concerns, and to identify clusters of guests with best and worst indoor air conditions, to be targeted by new management strategies. Despite case study specific limitations, the application exemplified how the methodology can expand the traditional energy-based performance assessment for building management towards indoor air domain and the related economic impacts, with implication on results in terms of overall economic performance of the building from both a private and public perspective.

The impact of emissions from an essential oil diffuser on cognitive performance

Essential oil products are increasingly used in indoor environments and have been found to negatively contribute to indoor air quality. Moreover, the chemicals and fragrances emitted by those products may affect the central nervous system and cognitive function. This study uses a double-blind between-subject design to investigate the cognitive impact of exposure to the emissions from essential oil used in an ultrasonic diffuser. In a simulated office environment where other environmental parameters were maintained constant, 34 female and 25 male university students were randomly allocated into four essential oil exposure scenarios. The first two scenarios contrast lemon oil to pure deionized water, while the latter two focus on different levels of particulate matter differentiated by HEPA filters with non-scented grapeseed oil as the source. Cognitive function was assessed using a computer-based battery consisting of five objective tests that involve reasoning, response inhabitation, memory, risk-taking, and decision-making. Results show that exposure to essential oil emissions caused shortened reaction time at the cost of significantly worse response inhabitation control and memory sensitivity, indicating potentially more impulsive decision-making. The cognitive responses caused by scented lemon oil and non-scented grapeseed oil were similar, as was the perception of odor pleasantness and intensity.

Control of airborne infectious disease in buildings: Evidence and research priorities

The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs.

Assessment of Personal Relaxation in Indoor-Air Environments: Study in Real Full-Scale Laboratory Houses

The relationship between chemical concentrations in indoor air and the human sense of comfort and relaxation have been reported. We investigated the effect of the sum of volatile organic compounds (ΣVOCs; sum of 79 VOCs) on the level of relaxation in two laboratory houses with almost identical interior and exterior appearances. The electroencephalogram (EEG) was monitored to evaluate the degree of personal relaxation objectively. The experiments were conducted in laboratory houses (LH) A and B with lower and higher levels of ΣVOCs, respectively. A total of 168 healthy volunteers participated, who each performed the task for 20 min, followed by a 10-min break, and EEG was measured during the break. Simultaneously as subjective evaluations, the participants were asked to fill a questionnaire regarding the intensity of odor and preference for the air quality in each LH. The subjective evaluation showed a significant association between ΣVOCs and participants’ relaxation (OR: 2.86, 95%CI: 1.24–6.61), and the objective evaluation indicated that the participants were more relaxed in the LH with lower levels of ΣVOCs than that with higher levels (OR: 3.03, 95%CI: 1.23–7.50). Therefore, the reduction of ΣVOCs and odors in indoor air would have an effect, which is the promotion of relaxation.

Indoor CO2 concentrations and cognitive function: A critical review

Poor indoor air quality indicated by elevated indoor CO₂ concentrations has been linked with impaired cognitive function, yet current findings of the cognitive impact of CO₂ are inconsistent. This review summarizes the results from 37 experimental studies that conducted objective cognitive tests with manipulated CO₂ concentrations, either through adding pure CO₂ or adjusting ventilation rates (the latter also affects other indoor pollutants). Studies with varied designs suggested that both approaches can affect multiple cognitive functions. In a subset of studies that meet objective criteria for strength and consistency, pure CO₂ at a concentration common in indoor environments was only found to affect high-level decision-making measured by the Strategic Management Simulation battery in non-specialized populations, while lower ventilation and accumulation of indoor pollutants, including CO₂ , could reduce the speed of various functions but leave accuracy unaffected. Major confounding factors include variations in cognitive assessment methods, study designs, individual and populational differences in subjects, and uncertainties in exposure doses. Accordingly, future research is suggested to adopt direct air delivery for precise control of CO₂ inhalation, include brain imaging techniques to better understand the underlying mechanisms that link CO₂ and cognitive function, and explore the potential interaction between CO₂ and other environmental stimuli.

Self-reported mould and long-term sickness absences from work

Aims: The impact of indoor mould on employees’ long-term absence from sickness (more than 10 days of absence) is poorly understood. This paper examines whether self-reported mould was related to long-term absences from work between 1 and 3 years later. Methods: By using negative binomial modelling, we analysed a representative sample of the working-age population in Finland (N = 16,084) from the Finnish Quality of Work Life Surveys in 1997, 2003, 2008 and 2013 combined with the register-based follow-up data of participants’ long-term sickness absences covering a period of 1 to 3 years after the Finnish Quality of Work Life Surveys was collected. Results: After all necessary background, work- and health-related factors were included in the model, employees who reported mould in their work had 1.20 higher rates of long-term sickness absence than those who did not report mould (mould: estimated marginal mean = 13.45 days; no mould: estimated marginal mean = 11.23). If employees perceived that mould caused strain, they had 1.30 higher rates of long-term absence than those who did not report such strain (mould caused strain: estimated marginal mean = 14.64 days; mould did not cause strain: estimated marginal mean = 11.25). In total, 10% (N=1628) of employees reported mould in their workplace and 6% (N=987) reported that mould caused strain. Conclusions: Supervisors, occupational physicians and other authorities need to take employees’ complaints of mould in the workplace seriously.

The Impact of Indoor Malodor: Historical Perspective, Modern Challenges, Negative Effects, and Approaches for Mitigation

Malodors, odors perceived to be unpleasant or offensive, may elicit negative symptoms via the olfactory system’s connections to cognitive and behavioral systems at levels below the known thresholds for direct adverse events. Publications on harm caused by indoor malodor are fragmented across disciplines and have not been comprehensively summarized to date. This review examines the potential negative effects of indoor malodor on human behavior, performance and health, including individual factors that may govern such responses and identifies gaps in existing research. Reported findings show that indoor malodor may have negative psychological, physical, social, and economic effects. However, further research is needed to understand whether the adverse effects are elicited via an individual’s experience or expectations or through a direct effect on human physiology and well-being. Conversely, mitigating indoor malodor has been reported to have benefits on performance and subjective responses in workers. Eliminating the source of malodor is often not achievable, particularly in low-income communities. Therefore, affordable approaches to mitigate indoor malodor such as air fresheners may hold promise. However, further investigations are needed into the effectiveness of such measures on improving health outcomes such as cognition, mood, and stress levels and their overall impact on indoor air quality.

The Combined Effect of Poor Perceived Indoor Environmental Quality and Psychosocial Stressors on Long-Term Sickness Absence in the Workplace: A Follow-Up Study

Background: Poor perceived indoor environmental quality (IEQ) can generate conflicts and experiences of injustice in workplaces. Therefore we examined whether the combined effect of poor IEQ and self-reported psychosocial stressors (low social support from supervisors and experiences of injustice) increase the risk of employees’ long-term sickness absence (more than 10 days) in comparison to employees who report only poor perceived IEQ and no psychosocial stressors. Methods: Using negative binomial modelling, we analysed a representative sample of the working-age population in Finland (N = 16,084) from the Finnish Quality of Work Life Surveys (FQWLS) from 1997, 2003, 2008 and 2013, combined with register-based follow-up data on employees’ long-term absences covering a period of one to three years after each FQWLS was collected. Results: After background variables were included in the model, employees who reported poor IEQ and low social support had 1.18 (incidents rate ratios; 95% CI 1.05–1.33) higher rates of long-term absence than those who reported poor IEQ and high support. Similarly, employees who reported poor IEQ and experiences of injustice had 1.31(incidents rate ratios; 95% CI 1.15–1.48) higher rates of absence than those who reported poor IEQ and no injustice. Conclusions: Employees who reported poor perceived IEQ and a psychosocial stressor had higher rates of long-term sickness absence one to three years later, in comparison with those who report only poor perceived IEQ and no psychosocial stressors. These findings demonstrate the importance of taking account of psychosocial stressors as well, when resolving indoor environmental problems.

Exploring the science, safety, and benefits of air care products: perspectives from the inaugural air care summit

Seventy-one percent of US households purchase air care products. Air care products span a diverse range of forms, including scented aerosol sprays, pump sprays, diffusers, gels, candles, and plug-ins. These products are used to eliminate indoor malodors and to provide pleasant scent experiences. The use of air care products can lead to significant benefits as studies have shown that indoor malodor can cause adverse effects, negatively impacting quality of life, hygiene, and the monetary value of homes and cars, while disproportionately affecting lower income populations. Additionally, studies have also shown that scent can have positive benefits related to mood, stress reduction, and memory enhancement among others. Despite the positive benefits associated with air care products, negative consumer perceptions regarding the safety of air care products can be a barrier to their use. During the inaugural Air Care Summit, held on 18 May 2018 in the Washington, DC, metropolitan area, multidisciplinary experts including industry stakeholders, academics, and scientific and medical experts were invited to share and assess the existing data related to air care products, focusing on ingredient and product safety and the benefits of malodor removal and scent. At the Summit's completion, a panel of independent experts representing the fields of pulmonary medicine, medical and clinical toxicology, pediatric toxicology, basic science toxicology, occupational dermatology and experimental psychology convened to review the data presented, identify potential knowledge gaps, and suggest future research directions to further assess the safety and benefits of air care products.

Development of an Indoor Environmental Quality Assessment Tool for the Rating of Offices in Real Working Conditions

The Indoor Environmental Quality (IEQ) refers to the quality of indoor spaces in relation to the health and well-being of users. IEQ is a holistic concept considering various components of the overall indoor comfort: thermo-hygrometric, lighting, air quality and acoustics. Each component is described through specific performance indicators and benchmarks. The quality of the built environment is assessed at different stages from design to operational phase. The scientific literature reports several case studies related to the assessment of the individual components of the IEQ Tools aimed at the evaluation of the overall IEQ. The paper proposes an assessment tool based on the SB Method (Sustainable Building Method) and the Multi Criteria Analysis for the evaluation of IEQ during the operational phase of a building. Each component of IEQ is analysed through objective indicators and calculation methods. The tool provides two main outcomes: a global score expressing the overall performance of the building from the IEQ perspective; quantitative evaluations of all indoor comfort components through monitoring and measurement of the environmental variables. The above contributes to select intervention areas to optimize indoor design and to identify technologies aimed at ensuring the best IEQ levels for users at the operational stage. The system was applied to an open-plan working space of an office building. Monitoring activities and measurements are carried out to detect the indoor and outdoor variables affecting the IEQ. All aspects of IEQ were analysed and quantified so to evaluate the overall performance of the building and provide data to improve the working conditions.

Health impact assessment from building life cycles and trace metals in coarse particulate matter in urban office environments

This study intends to determine the health impacts from two office life cycles (St.1 and St.2) using life cycle assessment (LCA) and health risk assessment of indoor metals in coarse particulates (particulate matter with diameters of less than 10µm). The first building (St.1) is located in the city centre and the second building (St.2) is located within a new development 7km away from the city centre. All life cycle stages are considered and was analysed using SimaPro software. The trace metal concentrations were determined by inductively couple plasma-mass spectrometry (ICP-MS). Particle deposition in the human lung was estimated using the multiple-path particle dosimetry model (MPPD). The results showed that the total human health impact for St.1 (0.027 DALY m^-2) was higher than St.2 (0.005 DALY m^-2) for a 50-year lifespan, with the highest contribution from the operational phase. The potential health risk to indoor workers was quantified as a hazard quotient (HQ) for non-carcinogenic elements, where the total values for ingestion contact were 4.38E-08 (St.1) and 2.59E-08 (St.2) while for dermal contact the values were 5.12E-09 (St.1) and 2.58E-09 (St.2). For the carcinogenic risk, the values for dermal and ingestion routes for both St.1 and St.2 were lower than the acceptable limit which indicated no carcinogenic risk. Particle deposition for coarse particles in indoor workers was concentrated in the head, followed by the pulmonary region and tracheobronchial tract deposition. The results from this study showed that human health can be significantly affected by all the processes in office building life cycle, thus the minimisation of energy consumption and pollutant exposures are crucially required.

Advanced buffer materials for indoor air CO2 control in commercial buildings

In this study, we evaluated solid sorbents for their ability to passively control indoor CO₂ concentration in buildings or rooms with cyclic occupancy (eg, offices, bedrooms). Silica supported amines were identified as suitable candidates and systematically evaluated in the removal of CO₂ from indoor air by equilibrium and dynamic techniques. In particular, sorbents with various amine loadings were synthesized using tetraethylenepentamine (TEPA), poly(ethyleneimine) (PEI) and a silane coupling agent 3-aminopropyltriethoxysilane (APS). TGA analysis indicates that TEPA impregnated silica not only displays a relatively high adsorption capacity when exposed to ppm level CO₂ concentrations, but also is capable of desorbing the majority of CO₂ by air flow (eg, by concentration gradient). In 10 L flow-through chamber experiments, TEPA-based sorbents reduced outlet CO₂ by up to 5% at 50% RH and up to 93% of CO₂ adsorbed over 8 hours was desorbed within 16 hours. In 8 m³ flow-through chamber experiments, 18 g of the sorbent powder spread over a 2 m² area removed approximately 8% of CO₂ injected. By extrapolating these results to real buildings, we estimate that meaningful reductions in the CO₂ can be achieved, which may help reduce energy requirements for ventilation and/or improve air quality.

Socio-economic costs of indoor air pollution: A tentative estimation for some pollutants of health interest in France

An evaluation of the socio-economic costs of indoor air pollution can facilitate the development of appropriate public policies. For the first time in France, such an evaluation was conducted for six selected pollutants: benzene, trichloroethylene, radon, carbon monoxide, particles (PM_2.5 fraction), and environmental tobacco smoke (ETS). The health impacts of indoor exposure were either already available in published works or were calculated. For these calculations, two approaches were followed depending on the available data: the first followed the principles of quantitative health risk assessment, and the second was based on concepts and methods related to the health impact assessment. For both approaches, toxicological data and indoor concentrations related to each target pollutant were used. External costs resulting from mortality, morbidity (life quality loss) and production losses attributable to these health impacts were assessed. In addition, the monetary costs for the public were determined. Indoor pollution associated with the selected pollutants was estimated to have cost approximately €20 billion in France in 2004. Particles contributed the most to the total cost (75%), followed by radon. Premature death and the costs of the quality of life loss accounted for approximately 90% of the total cost. Despite the use of different methods and data, similar evaluations previously conducted in other countries yielded figures within the same order of magnitude.

Perceptions in the U.S. building industry of the benefits and costs of improving indoor air quality

How building stakeholders (e.g. owners, tenants, operators, and designers) understand impacts of Indoor Air Quality (IAQ) and associated energy costs is unknown. We surveyed 112 stakeholders across the United States to ascertain their perceptions of their current IAQ and estimates of benefits and costs of, as well as willingness to pay for, IAQ improvements. Respondents' perceived IAQ scores correlated with the use of high-efficiency filters but not with any other IAQ-improving technologies. We elicited their estimates of the impacts of a ventilation-filtration upgrade (VFU), that is, doubling the ventilation rate from 20 to 40 cfm/person (9.5 to 19 l/s/person) and upgrading from a minimum efficiency reporting value 6 to 11 filter, and compared responses to estimates derived from IAQ literature and energy modeling. Minorities of respondents thought the VFU would positively impact productivity (45%), absenteeism (23%), or health (39%). Respondents' annual VFU cost estimates (mean = $257, s.d. = $496, median = $75 per person) were much higher than ours (always <$32 per person), and the only yearly cost a plurality of respondents said they would pay for the VFU was $15 per person. Respondents holding green building credentials were not more likely to affirm the IAQ benefits of the VFU and were less likely to be willing to pay for it.

Energy and cost associated with ventilating office buildings in a tropical climate

Providing sufficient amounts of outdoor air to occupants is a critical building function for supporting occupant health, well-being and productivity. In tropical climates, high ventilation rates require substantial amounts of energy to cool and dehumidify supply air. This study evaluates the energy consumption and associated cost for thermally conditioning outdoor air provided for building ventilation in tropical climates, considering Singapore as an example locale. We investigated the influence on energy consumption and cost of the following factors: outdoor air temperature and humidity, ventilation rate (L/s per person), indoor air temperature and humidity, air conditioning system coefficient of performance (COP), and cost of electricity. Results show that dehumidification of outdoor air accounts for more than 80% of the energy needed for building ventilation in Singapore's tropical climate. Improved system performance and/or a small increase in the indoor temperature set point would permit relatively large ventilation rates (such as 25 L/s per person) at modest or no cost increment. Overall, even in a thermally demanding tropical climate, the energy cost associated with increasing ventilation rate up to 25 L/s per person is less than 1% of the wages of an office worker in an advanced economy like Singapore's. This result implies that the benefits of increasing outdoor air ventilation rate up to 25 L/s per person--which is suggested to provide for productivity increases, lower sick building syndrome symptom prevalence, and reduced sick leave--can be much larger than the incremental cost of ventilation.

Work-related symptoms in indoor environments: a puzzling problem for the occupational physician

PURPOSES

People who work indoors often manifest symptoms related to the work environment. Sick building syndrome (SBS) is a condition closely associated with sealed, air-conditioned workplaces and is especially frequent in countries with a cold climate. However, it is also present in Mediterranean countries where artificial ventilation accompanies the natural one. The significance of personal factors, air quality perception, and psychosocial work conditions in relation to SBS and other work-related symptoms needs to be clarified.

METHODS

Workers from 28 companies in the Latium region of Italy were invited to answer a questionnaire during their routine medical examination at the workplace. A total of 4,029 out of 4,129 took part in the survey, giving a response rate of 97.6 %.

RESULTS

A high percentage of workers (31.9 %) reported symptoms related to work, and two-thirds of the employees (65.4 %) complained of environmental problems. In logistic regression models, personal factors (gender, smoking habit, age, and atopy), anxiety and depression, environmental discomfort and job strain were associated both with symptoms of SBS and other work-related symptoms. There was a significant association between the perception of stuffy air, dry air, and electricity and cases of SBS. Some associations between symptoms and the work environment lacked biological plausibility.

CONCLUSIONS

The occupational physician's task is to systematically monitor workers' symptoms and their perception of the work environment in order to analyze this relationship and indicates the best mode of preventing illness/discomfort. This paper provides a method and reference values.

Markers of upper airway inflammation associated with microbial exposure and symptoms in occupants of a water-damaged building

BACKGROUND

Water damage in buildings has been associated with reports of upper airway inflammation among occupants.

METHODS

This survey included a questionnaire, allergen skin testing, nasal nitric oxide, and nasal lavage on 153 participants. We conducted exposure assessments of 297 workstations and analyzed collected dust for fungi, endotoxin, and (1 → 3)-β-D-glucan to create floor-specific averages.

RESULTS

Males had higher levels of nasal inflammatory markers, and females reported more symptoms. ECP, IL-8, and MPO were significantly associated with nasal symptoms, flu-like achiness, or chills. Fungi and glucan were positively associated with blowing out thick mucus. Endotoxin was significantly associated with ECP in overall models, and with ECP, IL-8, MPO, and neutrophils among non-atopic females.

CONCLUSIONS

In this study, we documented an association between endotoxin and nasal inflammatory markers among office workers. The results of our study suggest that a non-allergic response may contribute to symptoms occurring among occupants in this water-damaged building.

[Schools, office buildings, leisure settings: diversity of indoor air quality issues. Global review on indoor air quality in these settings]

This review provides a global overview of indoor air quality issues in schools, office buildings and recreational settings. It presents the most recent scientific publications and the on-going work conducted in France in the frame of the indoor air quality Observatory. Monitoring campaigns on indoor air quality in schools have been carried out in the recent years in Europe. However, few studies have specifically addressed the role of exposure in these buildings on children's health. Indoor air quality in office buildings has been little studied so far. However, some specificities, such as emissions from electronic devices, frequent cleaning, impossibility to open windows in high-rise buildings, for example, should be examined and their role on the health and comfort studied. Finally, even if the time spent in recreational settings is short, the quality of indoor air should also be considered because of specific pollution. This is the case of indoor swimming pools (exposure to chlorination byproducts) and ice-rinks (exposure to exhaust from machines used to smooth the ice).

A method to estimate the chronic health impact of air pollutants in U.S. residences

BACKGROUND

Indoor air pollutants (IAPs) cause multiple health impacts. Prioritizing mitigation options that differentially affect individual pollutants and comparing IAPs with other environmental health hazards require a common metric of harm.

OBJECTIVES

Our objective was to demonstrate a methodology to quantify and compare health impacts from IAPs. The methodology is needed to assess population health impacts of large-scale initiatives-including energy efficiency upgrades and ventilation standards-that affect indoor air quality (IAQ).

METHODS

Available disease incidence and disease impact models for specific pollutant-disease combinations were synthesized with data on measured concentrations to estimate the chronic heath impact, in disability-adjusted life-years (DALYs) lost, due to inhalation of a subset of IAPs in U.S. residences. Model results were compared with independent estimates of DALYs lost due to disease.

RESULTS

Particulate matter ≤ 2.5 μm in aerodynamic diameter (PM2.5), acrolein, and formaldehyde accounted for the vast majority of DALY losses caused by IAPs considered in this analysis, with impacts on par or greater than estimates for secondhand tobacco smoke and radon. Confidence intervals of DALYs lost derived from epidemiology-based response functions are tighter than those derived from toxicology-based, interspecies extrapolations. Statistics on disease incidence in the United States indicate that the upper-bound confidence interval for aggregate IAP harm is implausibly high.

CONCLUSIONS

The approach demonstrated in this study may be used to assess regional and national initiatives that affect IAQ at the population level. Cumulative health impacts from inhalation in U.S. residences of the IAPs assessed in this study are estimated at 400-1,100 DALYs lost annually per 100,000 persons.