Healthy Indoor Environments: The Need for a Holistic Approach

Household indoor air quality in northeast China: On-site inspection and measurement in 399 Tianjin area residences

There has been an increased concern on indoor air quality (IAQ) in residences since the majority of individuals' time is mainly spent indoors. We inspected and measured indoor environmental parameters in 399 homes in northeast China in order to study IAQ. We systematically measured multilevel environmental parameters (physical, chemical, and biological) in children's bedrooms during all seasons. The results indicated that the median values for indoor temperature, relative humidity, total volatile organic compounds (TVOC), and formaldehyde concentrations throughout the year were within the Chinese national standards. However, the median carbon dioxide concentrations exceeded 1000 ppm during spring, autumn, and winter. In the same seasons, the air change rate (ACR) was below the minimum required level of 0.5 h-1. Di-2-ethylhexyl phthalate (DEHP), di-n-butyl phthalate (DnBP), and di-isobutyl phthalate (DiBP) were predominantly detected in settled dust, displaying median concentrations of 126.9, 41.5, and 16.3 μg/g, respectively. Notably, phthalate concentrations were significantly higher in urban houses as compared to rural houses. Furthermore, median concentrations of Dermatophagoides farinae (Der f) and endotoxin were 689.4 ng/g and 3689.1 EU/g, respectively, trending higher in winter than summer. There was a negative correlation between ACR and chemical pollutants (TVOC, formaldehyde, and DiBP). In conclusion, northeast Chinese homes had poor indoor air quality with ubiquitous exposure to modern chemical compounds and insufficient ventilation.

The impact of nursing sustainable prevention program on heat strain among agricultural elderly workers in the context of climate change

BACKGROUND

This study assesses a geriatric nursing-led sustainable heat prevention program for elderly agricultural workers. It targets those aged 60 and above, addressing the heightened risk of heat strain in the era of climate change.

METHODS

A community-based quasi-experimental design involved 120 elderly agricultural workers, divided into intervention and control groups. The program, spanning three months, included education on hydration, rest, protective clothing, and recognition of heat-related illnesses.

RESULTS

The intervention led by geriatric nursing professionals showed significant improvements in heat strain metrics. The Heat Strain Score Index (HSSI) and the Observational-Perceptual Heat Strain Risk Assessment (OPHSRA) Index indicated increased safety levels and reduced risk categories among participants.

CONCLUSIONS

The study demonstrates the effectiveness of a geriatric nursing-led, tailored prevention program in reducing heat strain among elderly agricultural workers. It highlights the crucial role of nursing in adapting healthcare practices to the challenges posed by climate change.

TRIAL REGISTRATION

ClinicalTrials.gov, ID NCT06192069 retrospectively registered.

Indoor air levels of polycyclic aromatic compounds (PAC) in public buildings with creosote impregnated constructions - A pilot case study using passive samplers

Creosote has been used in Sweden as a wood preservative in buildings since the 19th century. These buildings can function as workplaces, homes, and cultural buildings to which the public has access. Creosote contains polycyclic aromatic hydrocarbons (PAH) which are well known carcinogens. To understand exposure and risks in an indoor environment, it is important to determine air levels of parent PAHs as well as the more toxic nitrated and oxygenated PAH derivatives (NPAH, OPAH). This study aims to investigate indoor air levels of polycyclic aromatic compounds (PACs) e.g., PAH, NPAH, OPAH and dibenzothiophenes in buildings containing creosote sources and whether these levels pose a health risk. Four cultural buildings were studied, all located within a radius of 130 m. Two were known to have creosote sources, and two had not. Polyurethane foam passive air samplers (PUF-PAS) were used to indicate possible point sources. PUF-PAS measurements were performed for one month in each building winter and summer. Simultaneously, PAC outdoor level measurements were performed. Buildings with creosote impregnated constructions had notably higher indoor air levels of PAC (31-1200 ng m-3) compared to the two buildings without creosote sources (14-45 ng m-3). The PAH cancer potency (sum of benzo[a]pyrene equivalents (BaPeq)) was more than one order of magnitude higher in the buildings containing creosote impregnated wood compared to reference buildings. The highest value was 5.1 BaPeq ng m-3 which was significantly higher than the outdoor winter measurement (1.3 BaPeq ng m-3). Fluoranthene and phenanthrene, with significant distribution in gas phase, but also several particulate NPAHs contributed significantly to the total cancer risk. Thus, creosote containing buildings can still contaminate the indoor air with PACs despite being over a hundred years old. The PUF-PAS was shown to be a good tool providing quantitative/semiquantitative measures of PACs exposure in indoor microenvironments.

A systematic literature review: building window's influence on indoor circadian health

Light has been shown to have a non-visual impact on the biological aspects of human health, particularly on circadian rhythms. Building windows are a potential means of regulating daylight conditions for circadian health and well-being. As a result of advancements in window and glazing technologies and variations in outdoor solar/sky conditions, understanding daylight's spectral characteristics, which pass through building window systems, is complex. Therefore, a systematic review and summary of the knowledge and evidence available regarding windows' impact on human circadian health is necessary. This study provides an overview of research in this domain, compares approaches and evaluation metrics, and underscores the importance of window parameters' influence on circadian health. Published studies available on various online databases since 2012 were evaluated. The findings of this study define a holistic approach to the melanopic performance of windows and provide an overview of current knowledge regarding the effect of windows on circadian health. Additionally, this work identifies future research directions based on the studies reviewed. This research contributes to the growing body of knowledge on the impact of windows on circadian health, which has implications for the design and construction of buildings in ways that support indoor human health and well-being from the circadian light adequacy perspective.

Oceanaut's personal acoustic comfort prediction model and sound environment improvement method in the cabin of a Deep-Sea manned submersible

In this study, a personal acoustic comfort prediction model (PACPM) for exploring the acoustic comfort of oceanauts in a deep-sea manned submersible cabin was proposed, and an oceanauts' task performance model (OTPM) was constructed in this study. Based on oceanauts' comfort and task performance, the change characteristics in six different pure-noise environments (the sound pressure levels of the noise audio are 40 dB (A), 45 dB (A), 50 dB (A), 55 dB (A), 60 dB (A), and 65 dB (A) respectively) were analysed. An effective method for improving acoustic comfort was proposed. According to the analysis, personal comfort at 40 and 45 dB(A) was higher than that at other noise levels. The oceanaut's comfort and task performance of normal-weight people were significantly higher than those of thin people. Meanwhile, a comprehensive consideration of the demographic characteristics and physiological responses can effectively improve the prediction accuracy of the personnel acoustic comfort. Furthermore, the 45 dB (A) pure-noise environment overlaid with 40 dB(A) fast-paced light music effectively improves oceanauts' comfort. Practitioner summary: This study provides a convenient and available method for analysing acoustic comfort in the cabins of deep-sea manned submersibles, including a quantitative prediction model and an effective method for sound environment improvements. These can be used to improve the comfort, task performance, and working efficiency of manned submersibles.

The actual and ideal indoor soundscape for work, relaxation, physical and sexual activity at home: A case study during the COVID-19 lockdown in London

The period of home confinement during the COVID-19 pandemic made the importance of a high-quality surrounding environment even more evident than before. Several studies have been carried out to assess the (negative) impacts of noise on annoyance, particularly whilst working from home (WFH). The present study takes a step further by (1) investigating the positive and negative impacts of the "actual" acoustic environment on a range of activities, i.e., WFH, relaxation, physical, and sexual activities, and (2) identifying the characteristics of an "ideal" indoor soundscape. The study is based on the qualitative analysis of verbal descriptions collected from open-ended questions included in a survey administered in January 2021 to 464 respondents living in London, during the COVID-19 lockdown. The range of impacts in the actual scenario varied from no effect on task execution, to disruption, distraction, concern of disturbing others or being heard. Positive impacts included support of concentration, relaxation, motivation, freedom of sound expression, feeling of being connected to the surroundings and comforted by the presence of others, according to mechanisms described in the study. Negative appraisal could trigger coping strategies (e.g., controlling windows, playing music, wearing headphones) and behavioural changes (e.g., lowering the volume of the voice or music, muting oneself during call, changing workout type) that could in turn limit or enhance the freedom of behaviour, affect or foster wellbeing. Negative impacts were most frequently reported on WFH (by 55% of the participants), followed by relaxation activities (40.6%), sexual activities (30.1%), and home workout (20.1%). The ideal soundscape was described as a quiet, well-sound insulated environment, which guarantees access to positive sounds (i.e., natural sounds, music, urban background), thus resulting in privacy, intimacy, and a place where to express themselves without noise-related constraints. The study complements literature findings on housing design directions in light of the COVID-19 pandemic, by providing further evidence on the impacts of poor sound insulation at home, the potential benefits of nature-based solutions for positive indoor soundscapes, and opportunities for an activity-based design of domestic environments, inclusive of a broader set of home uses and household compositions.

Model for Health Risk Assessment in Portuguese Housing Spaces

Currently, people spend most of their time inside their homes. However, poor conditions in terms of comfort and quality of the indoor environment can pose high risks to the inhabitants’ health. Therefore, a good quality environment is essential, since, in addition to the hazards present in indoor air (e.g., particles, (S)VOCs, CO, radon and tobacco smoke), extreme temperatures, relative humidity levels, pests (e.g., mold, dust mites and bioaerosols), noise, airborne infectious agents (e.g., SARS-CoV-2) and contamination through water and soil can cause physical injuries, respiratory diseases, damage to multiple organ systems as well as harmful effects on the mental health of the occupants. Faced with this requirement, housing evaluation models were studied together with the main types of risk that could affect the health of the inhabitants, with the objective of proposing a new evaluation model for housing health and safety risks, fitted to the occupants, and especially suitable for Portuguese dwellings, although applicable in other geographical contexts. As a result of this analysis, this article proposes a new model for evaluating health and safety risks in housing, applicable in Portugal, supported by an inspection form and, as the main difference from the existing models, parameter measurements, providing complementary data for the evaluation. This model was created based on a set of functional and regulatory requirements that were identified for the healthy use of living spaces. Twenty-eight hazards were identified, and the respective risk factors were assessed using different processes and target demographics, including visual inspection, parameter measurements, occupants’ age and location and age of housing. In order to validate the model and determine its usefulness, it was applied to a set of houses with different construction dates, locations and occupants. This exercise enabled the identification of hazard classes and the calibration and fine tuning of the model application. Finally, proposals for future work are presented in order to create a base of evolution for the model.

Managing the Built Environment for Health Promotion and Disease Prevention With Maharishi Vastu Architecture: A Review

Background and objectives

The evolution of healthcare from 18th-century reductionism to 21st-century postgenomic holism has been described in terms of systems medicine, and the impact of the built environment on human health is the focus of investigation and development, leading to the new specialty of evidence-based, therapeutic architecture. The traditional system of Vāstu architecture-a design paradigm for buildings which is proposed to promote mental and physical health-has been applied and studied in the West in the last 20 years, and features elements absent from other approaches. This review critically evaluates the theory and research of a well-developed, standardized form of Vāstu-Maharishi Vastu® architecture (MVA). MVA's principles include development of the architect's consciousness, universal recommendations for building orientation, siting, and dimensions; placement of key functions; and occupants' head direction when sleeping or performing tasks. The effects of isolated Vāstu elements included in MVA are presented. However, the full value of MVA, documented as a systematic, globally applicable practice, is in the effect of its complete package, and thus this review of MVA includes evaluating the experience of living and working in MVA buildings.

Methods

The published medical and health-related literature was systematically surveyed for research on factors related to isolated principles applied in MVA as well as on the complete system.

Results

Published research suggests that incorporating MVA principles into buildings correlates with significant improvements in occupants' physical and mental health and quality of life: better sleep, greater happiness of children, and the experience of heightened sense of security and reduced stress. The frequency of burglaries, a social determinant of health, also correlates. Potential neurophysiological mechanisms are described.

Conclusions

Findings suggest that MVA offers an actionable approach for managing a key social determinant of health by using architectural design as preventive medicine and in public health.

Latest Trends in Pollutant Accumulations at Threatening Levels in Energy-Efficient Residential Buildings with and without Mechanical Ventilation: A Review

Improving the energy efficiency of buildings is a major target in developed countries toward decreasing their energy consumption and CO₂ emissions. To meet this target, a large number of countries have established energy codes that require buildings to be airtight. While such a retrofitting approach has improved health outcomes in areas with heavy traffic, it has worsened the health outcomes in Nordic countries and increased the risk of lung cancer in areas with high levels of radon emissions. This review highlights the importance of adapting the characteristics of energy-efficient residential buildings to the location, age, and health of inhabitants to guarantee healthy indoor pollutant levels. The implementation of mechanical ventilation in new energy-efficient buildings has solved some of these problems; however, for others, a decrease in the level of outdoor pollutants was still required in order to achieve a good indoor air quality. A good balance between the air exchange rate and the air humidity level (adapted to the location) is key to ensuring that exposure to the various pollutants that accumulate inside energy-efficient buildings is low enough to avoid affecting inhabitants′ health. Evidence of the protective effect of mechanical ventilation should be sought in dwellings where natural ventilation allows pollutants to accumulate to threatening levels. More studies should be carried out in African and Asian countries, which, due to their rapid urbanization, use massive volumes of unproven/unrated building materials for fast-track construction, which are frequent sources of formaldehyde and VOC emissions.

Relation between occupants' health problems, demographic and indoor environment subjective evaluations: A cross-sectional questionnaire survey study in Java Island, Indonesia

This study aimed to evaluate the link between health problems, demographic factors, and the indoor environment quality of residents in Indonesia. We conducted a cross-sectional design study through a questionnaire survey with 443 respondents aged between 12 and 81 years. The questionnaire was concerned with previous health problem occurrences associated with thermal discomfort experiences, indoor environments, economic conditions, and basic anthropometric factors. Logistic regression with the odds ratio (OR) was applied to evaluate the tendency of different respondent groups to suffer from certain health problems, when compared to reference groups. Furthermore, structural equation modelling (SEM) was used to incorporate certain factors (economic conditions, thermal discomfort experiences, and perceived indoor environments) into a single model to understand their direct and indirect effects on health conditions. The results indicate that economic conditions are the most significantly associated with health problems. Furthermore, we found that the low-income group was the most vulnerable to health problems, including coughing, puking, diarrhoea, odynophagia, headaches, fatigue, rheumatism, fidgeting, skin rashes, muscle cramps, and insomnia (OR: 1.94-6.04, p <0.05). Additionally, the SEM suggested that the respondents' economic conditions and thermal discomfort experiences had significant direct effects on their health problems with standardized estimates of -0.29 and 0.55, respectively. Additionally, perceived indoor environment quality, which is possible to cause thermal discomfort experience, indirectly affect health problems. These findings contribute an insightful and intuitive knowledge base which can aid health assessments associated with demographic and physical environments in developing sustainable and healthy environment strategies for the future.

Transdisciplinary Research on Indoor Environment and Health as a Social Process

Although issues concerning indoor environments and their interaction with humans span many disciplines, such as aerosol technology, environmental psychology, health, and building physics, they are often studied separately. This study describes a research project with the transdisciplinary aim of bridging such disciplinary boundaries. Semi-structured interviews were conducted with the twelve project members to explore their understanding of transdisciplinarity regarding the conceptual as well as social aspects of collective learning and leadership and the measures taken to achieve this. The interviews were coded in NVivo (QSR International, Doncaster, Australia), which was used to identify themes concerning notions associated with transdisciplinarity, collective leadership, collective intelligence, and learning. A shared understanding of transdisciplinarity meant that the researchers transcended their disciplinary boundaries by moving into each other’s fields. This collective learning process was facilitated by introductory lectures on each other’s fields, contributing to collective leadership and a safe atmosphere. We argue that a transdisciplinary approach is appropriate in order to address indoor environment issues as well other complex problems, for which additional time and resources should be allocated for individual and collective learning processes.

Pollen and Fungal Spores Evaluation in Relation to Occupants and Microclimate in Indoor Workplaces

Indoor air quality depends on many internal or external factors mutually interacting in a dynamic and complex system, which also includes indoor workplaces, where subjects are exposed to many pollutants, including biocontaminants such as pollen and fungal spores. In this context, the occupants interact actively with their environment through actions, modifying indoor environmental conditions to achieve their own thermal comfort. Actions such as opening/closing doors and windows and turning on/off air conditioning could have effects on workers’ health. The present study explored the contribution of human occupants to pollen and fungal spore levels in indoor workplaces, combining aerobiological, microclimate, and worker monitoring during summer and winter campaigns. We evaluated the overall time spent by the workers in the office, the workers’ actions regarding non-working days and working days, and non-working hours and working hours, during two campaigns of pollen and fungal spore monitoring. Our results showed that the biocontaminant values depend on many mutually interacting factors; hence, the role of all of the factors involved should be investigated. In this regard, aerobiological monitoring should be a valid tool for the management of occupational allergies, providing additional information to improve occupational health protection strategies.

Acoustic Comfort as a Salutogenic Resource in Learning Environments—A Proposal for the Design of a System to Improve the Acoustic Quality of Classrooms

This article addresses the topic of environmental comfort from a salutogenic and pedagogical point of view. It begins by presenting a wide framework aimed at describing the complexity and specificity of the acoustic issue and the need to integrate decibel-based metrics with knowledge and reflections which are inherent to non-measurable factors. The article then focuses its attention on educational spaces and presents the results of an investigation carried out in 52 classrooms of 19 primary schools in Florence. From this research and keeping in mind the current Italian legislation, the following results are deduced: (1) the layout of a typical classroom, (2) the average reverberation time and (3) the sound-absorbing surface required to improve the acoustic quality of the typical classroom with polystyrene fibre panels. Subsequently, after having briefly described the more appropriate typology of sound-absorbing solutions, a system for the acoustic correction of classrooms is presented. This system is composed of two parts. The first part is fixed and its realisation is entrusted to specialised personnel; the second, based on the concept of personalisation and transformation of the educational space, is modifiable through time and designed and applied by the students themselves.

Acoustics for Supportive and Healthy Buildings: Emerging Themes on Indoor Soundscape Research

The focus of the building industry and research is shifting from delivering satisfactory spaces to going beyond what is merely acceptable with a wave of new research and practice dedicated to exploring how the built environment can support task performance and enhance people’s health and well-being. The present study addresses the role of acoustics in this paradigm shift. Indoor soundscape research has recently emerged as an approach that brings a perceptual perspective on building and room acoustics in order to shape built environments that “sound good” according to building occupants’ preference and needs. This paper establishes an initial discussion over some of the open questions in this field of research that is still in an embryonic stage. A thematic analysis of structured interviews with a panel of experts offered a range of perspectives on the characterization, management, and design of indoor soundscapes and health-related outcomes. The discussion pointed out the importance of both perceptual and multisensory research and integrated participatory design practices to enable a holistic view regarding the complex building–user interrelations and the design of just cities. Soundscape methodologies tailored to the peculiarities of indoor soundscapes can help to measure and predict the human perceptual response to the acoustic stimuli in context, thus reducing the risk of mismatches between expected and real building experiences. This perceptual perspective is expected to widen the scientific evidence for the negative and positive impacts of the acoustic environment on human health, well-being, and quality of life. This will support prioritizing the role of acoustics in building design and challenge many current design practices that are based on a noise control approach.

Evaluation of School Building Energy Performance and Classroom Indoor Environment

Existing building stock represents potential for energy saving renovations. Energy savings and indoor climate comfort are key demands for sustainable building refurbishment. Especially in schools, indoor comfort is an extremely important issue. A case study of energy consumption in selected school buildings in temperate climatic conditions of Central Europe region was performed. The studied buildings are representatives of various school premises constructed throughout the last century. The evaluation was based on data analysis of energy audits. The goal was aimed at assessment of the school building envelopes and their influence on energy consumption. One of the studied schools was selected for detailed evaluation. The school classroom was monitored for indoor thermal and visual environments. The monitoring was performed to compare the current state and renovation scenarios. Results of the evaluation show that the school buildings are highly inefficient even if renovated. Indoor climate in classrooms is largely influenced by windows. Solar gains affect interior thermal stability and daylighting. Thermal insulation quality of building envelopes and efficient solar shading systems appear to be fundamental tasks of school renovation strategies.

Multi-Season Assessment of Occupant Responses to Manual Shading and Dynamic Glass in a Workplace Environment

The quality and controllability of the building façade can significantly contribute to building indoor environmental quality (IEQ) as well as the building’s energy efficiency. Advanced technologies that support a façade’s dynamic response to climatic changes, such as electrochromic (dynamic) glazing, have emerged as smart systems for IEQ and environmental sustainability. This research summarizes a four-season study of office workers moving from a floor with conventional blinds to work environments equipped with smart dynamic glazing which changes tint in response to weather condition to control daylighting levels. Multiple occupant environmental satisfaction surveys were conducted over one year to investigate differences in environmental and psychological responses to office settings with manual, and often static, facades as compared to offices with dynamic glazing. This research confirms that dynamic glazing significantly affected occupants’ environmental satisfaction—enhancing individuals’ environmental perceptions and psychological health—as compared to manual blinds. It reveals that the occupants in work environments with dynamic glazing reported 21.7% higher productivity gains, 24.8% increased ability to relax, 12.7% improved concentration, 25.3% better moods and 29.4% greater alertness than when they were in offices in the same building with manual shading devices. Also, the dynamic feature of the smart glazing showed a significant contribution to perceived work productivity while enhancing positive emotional responses by an average of 26%.

Household energy efficiency and health: Area-level analysis of hospital admissions in England

INTRODUCTION

Fuel poverty affects up to 35% of European homes, which represents a significant burden on society and healthcare systems. Draught proofing homes to prevent heat loss, improved glazing, insulation and heating (energy efficiency measures) can make more homes more affordable to heat. This has prompted significant investment in energy efficiency upgrades for around 40% of UK households to reduce the impact of fuel poverty. Despite some inconsistent evidence, household energy efficiency interventions can improve cardiovascular and respiratory health outcomes. However, the health benefits of these interventions have not been fully explored; this is the focus of this study.

METHODS

In this cross sectional ecological study, we conducted two sets of analyses at different spatial resolution to explore population data on housing energy efficiency measures and hospital admissions at the area-level (counts grouped over a 3-year period). Housing data were obtained from three data sets covering housing across England (Household Energy Efficiency Database), Energy Performance Certificate (EPC) and, in the South West of England, the Devon Home Analytics Portal. These databases provided data aggregated to Lower Area Super Output Area and postcode level (Home Analytics Portal only). These datasets provided measures of both state (e.g. EPC ratings) and intervention (e.g. number of boiler replacements), aggregated spatially and temporally to enable cross-sectional analyses with health outcome data. Hospital admissions for adult (over 18 years) asthma, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) were obtained from the Hospital Episode Statistics database for the national (1st April 2011 to 31st March 2014) and Devon, South West of England (1st April 2014 to 31st March 2017) analyses. Descriptive statistics and regression models were used to describe the associations between small area household energy efficiency measures and hospital admissions. Three main analyses were undertaken to investigate the relationships between; 1) household energy efficiency improvements (i.e. improved glazing, insulation and boiler upgrades); 2) higher levels of energy efficiency ratings (measured by Energy Performance Certificate ratings); 3) energy efficiency improvements and ratings (i.e. physical improvements and rating assessed by the Standard Assessment Procedure) and hospital admissions.

RESULTS

In the national analyses, household energy performance certificate ratings ranged from 37 to 83 (mean 61.98; Standard Deviation 5.24). There were a total of 312,837 emergency admissions for asthma, 587,770 for COPD and 839,416 for CVD. While analyses for individual energy efficiency metrics (i.e. boiler upgrades, draught proofing, glazing, loft and wall insulation) were mixed; a unit increase in mean energy performance rating was associated with increases of around 0.5% in asthma and CVD admissions, and 1% higher COPD admission rates. Admission rates were also influenced by the type of dwelling, tenure status (e.g. home owner versus renting), living in a rural area, and minimum winter temperature.

DISCUSSION

Despite a range of limitations and some mixed and contrasting findings across the national and local analyses, there was some evidence that areas with more energy efficiency improvements resulted in higher admission rates for respiratory and cardiovascular diseases. This builds on existing evidence highlighting the complex relationships between health and housing. While energy efficiency measures can improve health outcomes (especially when targeting those with chronic respiratory illness), reduced household ventilation rates can impact indoor air quality for example and increase the risk of diseases such as asthma. Alternatively, these findings could be due to the ecological study design, reverse causality, or the non-detection of more vulnerable subpopulations, as well as the targeting of areas with poor housing stock, low income households, and the lack of "whole house approaches" when retrofitting the existing housing stock.

CONCLUSION

To be sustainable, household energy efficiency policies and resulting interventions must account for whole house approaches (i.e. consideration of the whole house and occupant lifestyles). These must consider more alternative 'greener' and more sustainable measures, which are capable of accounting for variable lifestyles, as well as the need for adequate heating and ventilation. Larger natural experiments and more complex modelling are needed to further investigate the impact of ongoing dramatic changes in the housing stock and health.

STUDY IMPLICATIONS

This study supports the need for more holistic approaches to delivering healthier indoor environments, which must consider a dynamic and complex system with multiple interactions between a range of interrelated factors. These need to consider the drivers and pressures (e.g. quality of the built environment and resident behaviours) resulting in environmental exposures and adverse health outcomes.

The Living Environment and Thermal Behaviours of Older South Australians: A Multi-Focus Group Study

Ageing brings about physiological changes that affect people's thermal sensitivity and thermoregulation. The majority of older Australians prefer to age in place and modifications to the home environment are often required to accommodate the occupants as they age and possibly become frail. However, modifications to aid thermal comfort are not always considered. Using a qualitative approach this study aims to understand the thermal qualities of the existing living environment of older South Australians, their strategies for keeping cool in hot weather and warm in cold weather and to identify existing problems related to planning and house design, and the use of heating and cooling. Data were gathered via seven focus group sessions with 49 older people living in three climate zones in South Australia. The sessions yielded four main themes, namely 'personal factors', 'feeling', 'knowing' and 'doing'. These themes can be used as a basis to develop information and guidelines for older people in dealing with hot and cold weather.