Long-term exposure to indoor air pollution and risk of tuberculosis

Indoor air pollution (IAP) is a recognized risk factor for various diseases. This paper examines the role of indoor solid fuel exposure in the risk of mycobacterium tuberculosis (TB) in Delhi Metropolitan, India. Using a cross-sectional design, subjects were screened for a history of active TB and lifelong exposure to IAP sources, such as solid fuel burning and kerosene. The TB prevalence rate in the study area was 1117 per 100 000 population. Every year, increase in solid fuel exposure was associated with a three percent higher likelihood of a history of active TB. Subjects exposed to solid fuel and kerosene use for both heating home and cooking showed significant associations with TB. Age, household expenditure (a proxy of income), lung function, and smoking also showed significant associations with TB. Smokers and solid fuel–exposed subjects were four times more likely to have a history of active TB than non-smoker and unexposed subjects. These finding calls strategies to mitigate solid fuel exposure, such as use of clean cookstove and ventilation, to mitigate the risk of TB which aligns with the United Nations’ goal of “End TB by 2030.”     

Effect of Indoor air pollution from biomass and solid fuel combustion on symptoms of preeclampsia/eclampsia in Indian women

Available evidence concerning the association between indoor air pollution (IAP) from biomass and solid fuel combustion and preeclampsia/eclampsia is not available in developing countries. We investigated the association between exposure to IAP from biomass and solid fuel combustion and symptoms of preeclampsia/eclampsia in Indian women by analyzing cross‐sectional data from India's third National Family Health Survey (NFHS‐3, 2005–2006). Self‐reported symptoms of preeclampsia/eclampsia during pregnancy such as convulsions (not from fever), swelling of legs, body or face, excessive fatigue or vision difficulty during daylight, were obtained from 39 657 women aged 15–49 years who had a live birth in the previous 5 years. Effects of exposure to cooking smoke, ascertained by type of fuel used for cooking on preeclampsia/eclampsia risk, were estimated using logistic regression after adjusting for various confounders. Results indicate that women living in households using biomass and solid fuels have two times higher likelihood of reporting preeclampsia/eclampsia symptoms than do those living in households using cleaner fuels (OR = 2.21; 95%: 1.26–3.87; P = 0.006), even after controlling for the effects of a number of potentially confounding factors. This study is the first to empirically estimate the associations of IAP from biomass and solid fuel combustion and reported symptoms suggestive of preeclampsia/eclampsia in a large nationally representative sample of Indian women and we observed increased risk. These findings have important program and policy implications for countries such as India, where large proportions of the population rely on polluting biomass fuels for cooking and space heating. More epidemiological research with detailed exposure assessments and clinical measures of preeclampsia/eclampsia is needed in a developing country setting to validate these findings.     

Indoor air pollution and lung function growth among children in four Chinese cities

Ambient air pollution has been associated with decreased growth in lung function among children; but little is known about the impact of indoor air pollution. We examined relationships between indoor air pollution metrics and lung function growth, among children (n = 3273) aged 6-13 years living in four Chinese cities. Lung function parameters (FVC and FEV(1) ) were measured twice a year. Questionnaires were used to determine home coal burning and ventilation practices. Generalized estimating equations were used to examine associations. Use of coal as a household fuel was associated with 16.5 ml/year lower (33%, P < 0.001) and 20.5 ml/year lower (39%, P < 0.001) growth in children's FEV(1) and FVC, respectively. FEV(1) growth was 10.2 ml/year higher (20%, P = 0.009), and FVC growth was 17.0 ml/year higher (33%, P < 0.001) among children who lived in houses with the presence of a ventilation device. Among children living in houses where coal was used as a fuel and no ventilation devices were present, adjusted FVC and FEV(1) growth, respectively, were 37% and 61% that of the average growth per year in the full cohort. This suggests that household coal use may cause deficits in lung function growth, while using ventilation devices may be protective of lung development. PRACTICAL IMPLICATIONS: Nearly 3.4 billion people use solid fuels in homes for cooking and/or heating. We report the following findings from a longitudinal study: (i) household coal use is significantly associated with reduction in children's lung function growth and (ii) the use of household ventilation devices is significantly associated with higher lung function growth, particularly among children living in households where coal is used as a fuel. These findings not only provide evidence that indoor coal use impairs children's lung development but also point to the importance of improving ventilation conditions in reducing harmful effects of indoor air pollution sources.     

Air pollution and lung cancer risks in China--a meta-analysis

Lung cancer is a serious health problem in China, as in the rest of the world. Many studies have already proved that air pollution as well as other environmental factors can increase the risk of lung cancer. Based on epidemiological studies carried out in China, this paper proposes odds ratios (OR) to evaluate the risk of lung cancer from indoor air pollution for the Chinese population by applying the method of meta-analysis. For domestic coal use for heating and cooking, the pooled OR values are 1.83 (95% CI: 0.62-5.41) and 2.66 (1.39-5.07) for women and both sexes, respectively. For indoor exposure to coal dust, the OR values are 2.52 (95% CI: 1.94-3.28) and 2.42 (1.62-3.63) for women and both sexes, respectively. Cooking oil vapor is another factor increasing lung cancer risk. The OR values are 2.12 (95%CI: 1.81-2.47), 1.78 (1.50-2.12) and 6.20 (2.88-13.32) for nonsmoking women, women, and both sexes, respectively. Regarding environmental tobacco smoke, the pooled OR values are 1.70 (95% CI: 1.32-2.18) and 1.64 (1.29-2.07) for nonsmoking women and both sexes, respectively. Funnel plots with statistical test have been applied to examine the publication bias, and the results implied that the analysis of coal consumption and cooking oil pollution might be affected by publication bias. The meta-analysis results confirm the association between lung cancer and indoor air pollution for the Chinese population.     

Association of solid fuel use with risk of stunting in children living in China

Stunting adversely affects physical and mental outcomes of children. It has not been examined whether household air pollution from solid fuel combustion is a risk factor for stunting in children. In a total of 41,439 children aged 6-17 across China, height was measured using a unified protocol. Multivariable linear regression models and logistic regression models were used to assess the associations of solid fuel use for cooking/heating with stunting in children. Adjusted for covariates, cooking/heating with solid fuel was significantly associated with a lower z-score for height for age and sex (β = −0.21 [−0.32 to −0.09] and −0.17 [−0.31 to −0.03], respectively) and an increased risk of stunting with an estimated ORs of 1.34 [1.07~1.68] and 1.37 [1.02~1.83], respectively. The risk of stunting associated with solid fuel use was statistically significant in high-age children. And the effect was greater on girls than on boys, though the difference was not statistically significant. Our study suggested that Chinese children living in households using solid fuel had a significantly higher risk of stunting than those living in households using cleaner fuel.     

Lower tract respiratory infection in children younger than 5 years of age and adverse pregnancy outcomes related to household air pollution in Bariloche (Argentina) and Temuco (Chile)

The main objective of this study was to evaluate the association between household air pollution with lower tract respiratory infection (LRTI) in children younger than 5 years old and adverse pregnancy outcomes. This retrospective cohort study took place in two cities in Patagonia. Using systemic random sampling, we selected households in which at least one child <5 years had lived and/or a child had been born alive or stillborn. Trained interviewers administered the questionnaire. We included 926 households with 695 pregnancies and 1074 children. Household cooking was conducted indoors in ventilated rooms and the use of wood as the principal fuel for cooking was lower in Temuco (13% vs. 17%). In exposed to biomass fuel use, the adjusted OR for LRTI was 1.87 (95% CI 0.98–3.55; P = 0.056) in Temuco and 1.12 (95% CI 0.61–2.05; P = 0.716) in Bariloche. For perinatal morbidity, the OR was 3.11 (95% CI 0.86–11.32; P = 0.084) and 1.41 (95% CI 0.50–3.97; P = 0.518), respectively. However, none of the effects were statistically significant (P > 0.05). The use of biomass fuel to cook in traditional cookstoves in ventilated dwellings may increase the risk of perinatal morbidity and LRTI.     

Patterns and predictors of personal exposure to indoor air pollution from biomass combustion among women and children in rural China

Indoor air pollution (IAP) from domestic biomass combustion is an important health risk factor, yet direct measurements of personal IAP exposure are scarce. We measured 24-h integrated gravimetric exposure to particles < 2.5 μm in aerodynamic diameter (particulate matter, PM?.?) in 280 adult women and 240 children in rural Yunnan, China. We also measured indoor PM?.? concentrations in a random sample of 44 kitchens. The geometric mean winter PM?.? exposure among adult women was twice that of summer exposure [117 μg/m3 (95% CI: 107, 128) vs. 55 μg/m3 (95% CI: 49, 62)]. Children's geometric mean exposure in summer was 53 μg/m3 (95% CI: 46, 61). Indoor PM?.? concentrations were moderately correlated with women's personal exposure (r=0.58), but not for children. Ventilation during cooking, cookstove maintenance, and kitchen structure were significant predictors of personal PM?.? exposure among women primarily cooking with biomass. These findings can be used to develop exposure assessment models for future epidemiologic research and inform interventions and policies aimed at reducing IAP exposure. PRACTICAL IMPLICATIONS: Our results suggest that reducing overall PM pollution exposure in this population may be best achieved by reducing winter exposure. Behavioral interventions such as increasing ventilation during cooking or encouraging stove cleaning and maintenance may help achieve these reductions.     

Solid fuel use and cardiovascular events: A systematic review and meta-analysis of observational studies

Although solid fuel use has been increasingly linked to cardiovascular events (CVEs), conclusions have been inconsistent. We systematically searched 3 databases (PubMed, Embase, and Web of Science) up to July 3, 2020, to identify English language reports that assessed the association of solid fuel use with CVEs. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated with a random-effects model. Subgroup analyses and sensitivity analyses were conducted to explore the potential sources of heterogeneity and to test the stability of the results. We finally included 13 observational studies (8 cohort, 3 cross-sectional, and 2 case-control studies comprising 791,220 participants) in the meta-analysis. The risk of CVEs was increased 21% with the highest versus the lowest solid fuel use (highest/lowest, RR_pooled = 1.21, 95% CI: 1.10–1.34). As for the subgroup analyses on study design, the pooled RR for cohort studies, case-control studies, and cross-sectional studies were 1.11 (95%CI: 1.03–1.19), 4.80 (95%CI: 2.22–10.39), and 1.46 (95%CI: 0.82–2.62), respectively. The results of this study suggested that high solid fuel use was associated with increased CVE risk, and that reducing the use of solid fuel will be important for improving the health of the populations in developing countries.     

Solid cooking fuel use and cognitive decline among older Mexican adults

Studies of air pollution and cognition often rely on measures from outdoor environments. Many individuals in low- and middle-income countries are exposed to indoor air pollution from combustion of solid cooking fuels. Little is known about how solid cooking fuel use affects cognitive decline over time. This study uses data from the 2012, 2015, and 2018 Mexican Health and Aging Study (n = 14 245, age 50+) to assess how use of wood or coal for cooking fuel affects cognition of older adults relative to use of gas. It uses latent change score modeling to determine how using solid cooking fuel affected performance in Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency. Solid cooking fuel was used by 17% of the full sample but was more common in rural areas. Solid fuel users also had lower socioeconomic status. Compared to those using gas, solid fuel users had lower baseline scores and faster decline in Verbal Learning (β = −0.18, p < 0.05), Visual Scanning (β = −1.00, p < 0.001), and Verbal Fluency (β = −0.33, p < 0.001). Indoor air pollution from solid cooking fuels may represent a modifiable risk factor for cognitive decline. Policy should focus on facilitating access to clean cooking fuels.     

Particulate matter chemical component concentrations and sources in settings of household solid fuel use

Particulate matter (PM) air pollution derives from combustion and non‐combustion sources and consists of various chemical species that may differentially impact human health and climate. Previous reviews of PM chemical component concentrations and sources focus on high‐income urban settings, which likely differ from the low‐ and middle‐income settings where solid fuel (ie, coal, biomass) is commonly burned for cooking and heating. We aimed to summarize the concentrations of PM chemical components and their contributing sources in settings where solid fuel is burned. We searched the literature for studies that reported PM component concentrations from homes, personal exposures, and direct stove emissions under uncontrolled, real‐world conditions. We calculated weighted mean daily concentrations for select PM components and compared sources of PM determined by source apportionment. Our search criteria yielded 48 studies conducted in 12 countries. Weighted mean daily cooking area concentrations of elemental carbon, organic carbon, and benzo(a)pyrene were 18.8 μg m^?3, 74.0 μg m^?3, and 155 ng m^?3, respectively. Solid fuel combustion explained 29%‐48% of principal component/factor analysis variance and 41%‐87% of PM mass determined by positive matrix factorization. Multiple indoor and outdoor sources impacted PM concentrations and composition in these settings, including solid fuel burning, mobile emissions, dust, and solid waste burning.     

A survey on energy consumption in rural households in the fringes of Xian city

A survey, in the form of a questionnaire, of energy consumption patterns in residential households in the rural fringe of Xian city was undertaken during the winter of 2003/2004. More than 200 households were sampled during the survey. The status of fuel consumption, including the use of biomass fuels for cooking and space heating, was investigated. The types of stoves, purpose of the stove use, and characteristics of the residential houses and residents were also reported and analyzed.The purpose of the survey was to clarify the status of energy consumption and to estimate emissions of greenhouse gases and air pollutants in rural areas of China, from the environmental perspective of climate change and indoor to continental scale air pollution. In rural areas of China, biomass (wood and agricultural waste, such as stalks, corn canes and twigs, branches of wood) is the type of fuel most commonly used. It emits several air pollutants: particulate matter (PM), CO, NMHCs, CH₄ and high levels of black carbon (BC) – a greenhouse effect aerosol, and organic carbon (OC) – a cooling effect aerosol. However, CO₂ emissions from biomass burning are assumed to be zero because of carbon neutrality.From this survey it would then be possible to analyze the fundamentals of emission reduction potential, for air pollutants and greenhouse gases, from the rural household sector in China.     

Indoor air pollution and self-reported diseases - a case study of NCT of Delhi

People in modern societies often spend 80-90% of their time in indoor environments. It is, therefore, imperative to analyze indoor air quality (IAQ) and its determinants and to consider the contribution of IAQ to possible health outcomes at the household level. Based on empirical data collected from 5949 households from 35 wards of Delhi, it can be summarized that higher proportions of residents live in degraded indoor environmental conditions. The highest risks to health were attached to use of traditional fuels (64%), lack of a kitchen (59%), exposure to environmental tobacco smoke (ETS) (55%), and poor ventilation (55%). Acute respiratory infections (43%) were identified as one of the most prevalent health problems confronted by residents and are strongly associated with use of traditional fuels (adjusted OR 2.7, 95% CI 2.3-3.1). Asthma shows a significant relationship with the use of traditional fuels (adjusted OR 3.8, 95% CI 3.4-4.3), exposure to ETS (adjusted OR 2.5, 95% CI 2.2-2.7), and poor ventilation (adjusted OR 1.26, 95% CI 1.13-1.41). Lung cancer (adjusted OR 1.54, 95% CI 1.38-1.71) and cardiovascular diseases (adjusted OR 2.25, 95% CI 2.01-2.53) also show a strong relationship with ETS exposure. More research is needed. PRACTICAL IMPLICATIONS: The present study can help to create new insights in understanding the gravity of indoor air quality problems in Delhi and can therefore provide interesting material to social scientists, public health officers, planners, and decision makers. The information can be utilized to help formulate comprehensive policies and planning with a humanistic approach for proper urban indoor environments that will be applicable at all administrative levels, viz. local, national, and international, and will also provide an important background for additional research in this area.     

Outdoor,indoor, and personal black carbon exposure from cookstoves burning solid fuels

Black carbon (BC) emissions from solid fuel combustion are associated with increased morbidity and mortality and are important drivers of climate change. We studied BC measurements, approximated by particulate matter (PM_2.5) absorbance, in rural Yunnan province, China, whose residents use a variety of solid fuels for cooking and heating including bituminous and anthracite coal, and wood. Measurements were taken over two consecutive 24‐h periods from 163 households in 30 villages. PM_2.5 absorbance (PM_abs) was measured using an EEL 043 Smoke Stain Reflectometer. PM_abs measurements were higher in wood burning households (16.3 × 10^?5/m) than bituminous and anthracite coal households (12 and 5.1 × 10^?5/m, respectively). Among bituminous coal users, measurements varied by a factor of two depending on the coal source. Portable stoves (which are lit outdoors and brought indoors for use) were associated with reduced PM_abs levels, but no other impact of stove design was observed. Outdoor measurements were positively correlated with and approximately half the level of indoor measurements (r = 0.49, P < 0.01). Measurements of BC (as approximated by PM_abs) in this population are modulated by fuel type and source. This provides valuable insight into potential morbidity, mortality, and climate change contributions of domestic usage of solid fuels.     

Indoor air pollution from particulate matter emissions in different households in rural areas of Bangladesh

Indoor air pollution from the combustion of traditional biomass fuels (wood, cow dung, and crop wastes) is a significant public health problem predominantly for poor populations in many developing countries. It is particularly problematic for the women who are normally responsible for food preparation and cooking, and for infants/young children who spend time around their mothers near the cooking area. Airborne particulate matter (PM) samples were collected from cooking and living areas in homes in a rural area of Bangladesh to investigate the impact of fuel use, kitchen configurations, and ventilation on indoor air quality and to apportion the source contributions of the measured trace metals and BC concentrations. Lower PM concentrations were observed when liquefied petroleum gas (LPG) was used for cooking. PM concentrations varied significantly depending on the position of kitchen, fuel use and ventilation rates. From reconstructed mass (RCM) calculations, it was found that the major constituent of the PM was carbonaceous matter. Soil and smoke were identified as components from elemental composition data. It was also found that some kitchen configurations have lower PM concentrations than others even with the use of low-grade biomass fuels. Adoption of these kitchen configurations would be a cost-effective approach in reducing exposures from cooking in these rural areas.     

Indoor air pollution from biomass combustion and respiratory symptoms of women and children in a Zimbabwean village

Rural areas of developing countries are particularly reliant on biomass for cooking and heating. Women and children in these areas are often exposed to high levels of pollutants from biomass combustion that is associated with a range of respiratory symptoms. Domestic exposure to carbon monoxide (CO) and respirable particles (RSPs) in association with respiratory symptoms among women and children in Zimbabwe was investigated in 48 households. Health status and household characteristics were also recorded. In this study, indoor levels of CO and RSPs exceeded World Health Organization (WHO) air quality guidelines in over 95% of kitchens. The level of indoor air pollutants was associated with the area of kitchen windows and the length of cooking time combined with the level of fire combustion. Prevalence of respiratory symptoms was 94% for women and 77% for children. In addition, women reporting respiratory symptoms were exposed to higher levels of RSPs when compared with those reporting no respiratory symptoms. The study results indicated that levels of indoor air pollutants in rural Zimbabwe may contribute to respiratory symptoms in both women and children. PRACTICAL IMPLICATIONS: Levels of respirable particles and carbon monoxide in kitchens in rural Zimbabwe are unacceptably high and measures to reduce levels should be undertaken. Based on the study findings, recommendations for increasing the area of kitchen windows may be considered as a practical method of reducing indoor air pollutants in rural Zimbabwe.     

Personal inhalation exposure to polycyclic aromatic hydrocarbons in urban and rural residents in a typical northern city in China

Personal inhalation exposure samples were collected and analyzed for polycyclic aromatic hydrocarbons (PAHs) for 126 selected volunteers during heating and non‐heating seasons in a typical northern Chinese city, Taiyuan. Measured personal PAH exposure levels for the urban residents in the heating and non‐heating seasons were 690 (540–1051) and 404 (266–544) ng/m³, respectively, while, for the rural residents, they were 770 (504–1071) and 312 (201–412) ng/m³, respectively. Thus, rural residents are exposed to lower PAH contamination in comparison with the urban residents in the non‐heating seasons. In the heating season, personal PAH inhalation exposure levels were comparable between the urban and rural residents, in part owing to the large rate of residential solid fuel consumption in the rural area for household cooking and heating. The estimated incremental lifetime cancer risks (ILCR) due to PAH exposure in Taiyuan were 3.36 × 10^?5 and 2.39 × 10^?5 for the rural and urban residents, respectively, significantly higher than the literature‐reported national average level, suggesting an urgent need of PAH pollution control to protect human health.     

A randomized double‐blind crossover study of indoor air filtration and acute changes in cardiorespiratory health in a First Nations community

Few studies have examined indoor air quality in First Nations communities and its impact on cardiorespiratory health. To address this need, we conducted a crossover study on a First Nations reserve in Manitoba, Canada, including 37 residents in 20 homes. Each home received an electrostatic air filter and a placebo filter for 1 week in random order, and lung function, blood pressure, and endothelial function measures were collected at the beginning and end of each week. Indoor air pollutants were monitored throughout the study period. Indoor PM_2.5 decreased substantially during air filter weeks relative to placebo (mean difference: 37 μg/m³, 95% CI: 10, 64) but remained approximately five times greater than outdoor concentrations owing to a high prevalence of indoor smoking. On average, air filter use was associated with a 217‐ml (95% CI: 23, 410) increase in forced expiratory volume in 1 s, a 7.9‐mm Hg (95% CI: ?17, 0.82) decrease in systolic blood pressure, and a 4.5‐mm Hg (95% CI: ?11, 2.4) decrease in diastolic blood pressure. Consistent inverse associations were also observed between indoor PM_2.5 and lung function. In general, our findings suggest that reducing indoor PM_2.5 may contribute to improved lung function in First Nations communities.     

The effects of building‐related factors on classroom relative humidity among North Carolina schools participating in the ‘Free to Breathe,Free to Teach’ study

Both high and low indoor relative humidity (RH) directly impact Indoor Air Quality (IAQ), an important school health concern. Prior school studies reported a high prevalence of mold, roaches, and water damage; however, few examined associations between modifiable classroom factors and RH, a quantitative indicator of dampness. We recorded RH longitudinally in 134 North Carolina classrooms (n = 9066 classroom‐days) to quantify the relationships between modifiable classroom factors and average daily RH below, within, or above levels recommended to improve school IAQ (30–50% or 30–60% RH). The odds of having high RH (>60%) were 5.8 [95% Confidence Interval (CI): 2.9, 11.3] times higher in classrooms with annual compared to quarterly heating, ventilating, and air‐conditioning (HVAC) system maintenance and 2.5 (95% CI: 1.5, 4.2) times higher in classrooms with HVAC economizers compared to those without economizers. Classrooms with direct‐expansion split systems compared to chilled water systems had 2.7 (95% CI: 1.7, 4.4) times higher odds of low RH (<30%). When unoccupied, classrooms with thermostat setbacks had 3.7 (95% CI: 1.7, 8.3) times the odds of high RH (>60%) of those without setbacks. This research suggests actionable decision points for school design and maintenance to prevent high or low classroom RH.     

Particulate exposure and size distribution from wood burning stoves in Costa Rica

Biomass fuel is the most common energy source for cooking and space heating in developing countries. Biomass fuel combustion causes high levels of indoor air pollutants including particulates and other combustion by-products. We measured indoor air quality in 23 houses with a wood burning stove in rural residential areas of Costa Rica. Daily PM2.5, PM10 and CO concentrations, and particle size distribution were simultaneously measured in the kitchen. When a wood burning stove was used during the monitoring period, average daily PM2.5 and PM10 concentrations were 44 and 132 microg/m3, respectively. Average CO concentrations were between 0.5 and 3.3 ppm. All houses had a particle size distribution of either one or two peaks at around 0.7 and 2.5 microm aerodynamic diameters. The particulate levels increased rapidly during cooking and decreased quickly after cooking. The maximum peak particulate levels ranged from 310 to 8170 microg/m3 for PM2.5 and from 500 to 18900 microg/m3 for PM10 in all houses. Although the 24-h particulate levels in this study are lower than the National Ambient Air Quality Standards of PM2.5 and PM10, it is important to note that people, especially women and children, are exposed to extremely high levels of particulates during cooking.