Air pollution and indoor settings

In Memoriam: Kirk R. Smith.

Environmental and occupational allergies

Brain Fog: Does Air Pollution Make Us Less Productive?

Indoor air pollution and its impact on the lungs.

Identifies household air pollution (HAP) as a major health risk, especially in poor countries which rely on biomass for cooking. Particulate matter concentration in indoor kitchens that use solid fuels for cooking account for an estimated 370,000 premature deaths globally based on 2014 data. Direct health impacts include chronic obstructive pulmonary disease, lung disease, and cataracts while children face acute lower respiratory infections. Interventions offer cleaner stoves through national stove programs and the development of standards and guidelines to promote only the cleanest devices, emphasizing the optimal use of electricity, natural gas, or LPG. Little benefit comes from converting individual users, so interventions need to target communities to become “smokeless” villages. Successful stove programs typically involve a public subsidy for the poor and because of savings on health care costs, its expense can be justified. Full adoption of a newer technology for clean cooking may not occur until generational change, with the present generation continuing to use the traditional methods despite the benefits to the family of the cleaner technology.

Improving air quality starts at home

TPS 722: Low and middle income countries: indoor air pollutants, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background/Aim: Air pollution is a major determinant of child health globally. Several studies have demonstrated associations between air pollution and childhood stunting, an important risk factor for early growth and development with lifelong health implications. While previous meta-analyses have reviewed these associations, until recently studies rarely included a specific focus on household air pollution (HAP) or pollution resulting from extreme air pollution episodes, both of which occur in regions with the greatest prevalence of stunting. We conducted a systematic review and meta-analysis of the peer-reviewed literature to assess the evidence of the associations. Methods: We systematically reviewed articles detailing associations between stunting, reported as height-for-age z-score, intrauterine growth restriction, or small for gestational age, and ambient air pollution (AAP) (e.g., PM2.5, PM10) or HAP, defined as the presence of household cooking with biomass fuels. Eligible studies had to be published in a peer-reviewed journal, include either primary or secondary data, and report at least one statistical measure. Results: The initial search identified 38 articles that met the inclusion criteria. A detailed screening excluded an additional 23 articles. The final list included 27 unique samples representing 18 countries and more than 1 million study participants. PM2.5 and PM10 exposures ranged from 10 to 72 and from 3 to 53 ug/m3 respectively. Significant risk estimates were found for those exposed to elevated concentrations of air pollution, ranging from 1.00 to 1.13 for AAP and from 1.21 to 1.90 for HAP. Conclusions: This review and meta-analysis identified up to a 13% and 90% increased risk of stunting in children exposed to increased levels of AAP and HAP respectively. This evidence suggests the importance of promoting clean air as part of an integrated approach to preventing stunting.

Letter from India.

Background:Household and ambient air pollution are jointly responsible for about 7 million premature deaths annually. Women living in slums, with unhealthy environment, both indoors and outdoors, particularly those living close to industrial and/or vehicular pollution zones due to multiple sources of air pollution, are at the higher risk of having impaired lung function tests.Objective:The aim of this study was to estimate the prevalence of abnormal lung functions and to identify the environmental risk factors associated with them among adult women of 18–59 years.Materials and Methods:A total of 550 women aged 18–59 years were approached in a representative urban slum. Five hundred consented to participate and 299 had prebronchodilator spirometry satisfying ATS standards. House visits to assess environmental conditions were conducted to determine their association with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Chi-square test was used to test the association of risk factors with lung functions. ANOVA was used to test the association of mean values of FEV1 and FVC with age.Results:Out of 299 participants with acceptable spirometric curves, 5% had reduced FEV1/FVC ratio than the normal and 26.8% and 17.4% had lower values than predicted for FVC and FEV1, respectively. Altered lung function was related to age, tobacco smoking, and history of respiratory disease.Conclusions:Both ambient and household air pollution have a deleterious pulmonary effect on long-term women residents of a representative urban slum in Delhi.

This study investigated the effect of household air pollution on pregnant women with GDM, and assessed the modifying effect of a healthy lifestyle on this relationship. Household solid fuel exposure was defined as using solid fuels (coal, crop residue, and wood) for cooking and heating. Four individually modifiable lifestyle factors were assessed in early pregnancy: body mass index, diet, sleep, and vitamin D supplementation. Multifactorial logistic regression modeling was used to assess the relationship between household air pollution and GDM. A stratified analysis and additive interaction tested the effects of healthy lifestyle scores. After adjusting for potential confounders, we found that using solid fuels for heating was significantly associated with an increased risk of GDM (adjusted OR = 1.60, 95% CI 1.18–2.18). GDM risk showed a decreasing trend in the medium versus the high score group when compared to the low score group, with a consistent trend regardless of household fuel type used (adjusted OR = 0.39, 95% CI 0.27–0.57) (adjusted OR = 0.12, 95% CI 0.05–0.28), respectively. Importantly, when the healthy lifestyle score increased, exposure to household air pollution was no longer associated with a higher GDM risk. There was a negative additive interaction between exposure to household solid fuels exposure and a healthy lifestyle (FERI: −5.10 [−16.48, −2.04]; AP: −1.29 [−2.80, −0.39]; SI: −0.37 [−0.20, −0.67]). We determined that exposure to household air pollution may be an important GDM risk factor. In addition, A healthy lifestyle may have a protective effect on women with GDM exposed to indoor fuel air pollution.

Environmental health risks especially affect women and children, because they are more vulnerable socially and because exposures to environmental contaminants create greater risks for children's developing bodies and cognitive functions. According to the 2016 World Health Organization (WHO) estimates, modifiable environmental risk factors cause about 1.7 million deaths in children younger than five years and 12.6 million total deaths every year. (1) Although the Global strategy for women's, children's and adolescents' health (2016-2030) (2) was launched during the United Nations Sustainable Development Summit 2015, governments rarely recognize the sustainable development agenda as a transformative factor for health. The sustainable development goals (SDGs) offer opportunities for countries to create healthier environments for women, children and adolescents. This paper explores how the SDGs can be used to reduce environmental health risks and enhance the health of women, children and adolescents. In particular, we focus on drivers for urbanization and sustainable development (e.g. transport, housing, urban design and energy provision) that can advance the global strategy, but have not traditionally been a focus of health policy-making. We frame the discussion around the three pillars of the global strategy: survive, thrive and transform, while recognizing the inevitable overlap between these objectives. Survive Since women and children are especially affected by the environment, intersectoral interventions that reduce environmental risks will improve early childhood survival as well as reducing risks of premature death throughout the life-course. For instance, household air pollution from dirty fuels and inefficient cookstove was estimated to have caused around 4 million premature deaths in 2012 and was responsible for more than half of deaths due to childhood pneumonia. (3) Among women, indoor exposures to household cookstove smoke were estimated to cause 34% (452 548/1336601) of chronic obstructive pulmonary disease deaths, 21% (732 937/3 476 815) of stroke deaths, 19% (93 537/489 390) of lung cancer deaths and 14% (479478/3425 835) of ischaemic heart disease deaths in 2012. (4,5) Improving access to reliable electricity and clean water in health-care facilities can also help reduce maternal and newborn mortality, as such infrastructure is a critical determinant of quality of care. (6) A review of health-care facilities in 11 sub-Saharan African countries showed that an average of 26% of facilities had no electricity whatsoever. (7) Another review of 54 low- and middle-income countries found that 38% (25 118/66 101) of health facilities lack a clean drinking water source. (8) Ensuring that health-care facilities have access to power and water is a minimum requirement for attracting women to facilities and guaranteeing quality services for safe childbirth. Thrive Housing and energy sector interventions that promote the transition to cleaner fuels and for domestic cooking, heating and lighting can not only reduce deaths but improve the health of the 3 billion people worldwide who are reliant upon inefficient and polluting cookstoves. For this reason, the monitoring framework of the Global strategy for women's, children's and adolescents' health (2016-2030) explicitly tracks an indicator for primary reliance on clean fuels and technologies in households as part of its thrive pillar. (9) Examples of cleaner fuels and include liquefied petroleum gas, biogas, ethanol and electricity including photovoltaic solar-power for lighting. Improving access to clean fuels and can also reduce the burden of childhood burns and poisonings due to the use of kerosene for cooking and lighting. While most of the estimated 3 million deaths annually from outdoor ambient air pollution are among adult populations, reducing such pollution exposures are also critical to improving children's health and development across the life-course. …

The Global Household Air Pollution (HAP) Measurements database, commissioned by the World Health Organization, provides an organized summary of data reported in the literature describing HAP microenvironments, methods and measurements. As of June 2018, the database contains measurements from 43 countries obtained from 196 studies published through 2016. The database includes information useful for understanding the range of household and personal air pollution measurements that have been collected in a country, as well as characteristics of the cooking environment, including primary cooking fuel type, stove type, heating fuel type and kitchen location. Quantitative particulate matter (PM) of various size fractions and/or carbon monoxide (CO) exposure measurements included in the database can be aggregated and analyzed to generate summary statistics (e.g. average sub-national, national, regional and global HAP exposures) to assess temporal and spatial relationships. The quantitative PM exposure measurements in the database have been used in global predictive modeling of HAP-PM2.5 exposures (“Global Estimation of Exposure to Fine Particulate Matter (PM2.5) from Household Air Pollution” (Shupler et al., 2018) [1])

Mitigating air pollution: planetary health awaits a cosmopolitan moment

Air pollution and respiratory health-Do we really need more evidence?

People generally spend most of their time indoors; thus, household air pollution (HAP), especially indoor air pollution, is of paramount importance. In this study, real‐time particulate matter (PM2.5) monitors were used to collect high temporal resolution concentrations of fine PM2.5 in different microenvironments from 104 urban and rural households in Guizhou Province to investigate the urban–rural difference in HAP and the contribution of cooking activity to HAP. Results showed that PM2.5 concentrations among different rural microenvironments varied largely, ranging from 26.10 ± 33.27 (mean ± standard deviation) in the bedroom to 69.20 ± 72.50 μg/m3 in the kitchen while varying slightly across various urban microenvironments, ranging from 32.30 ± 17.5 in the living room to 34.65 ± 16.37 μg/m3 in the kitchen. Cooking activity can rapidly increase PM2.5 concentrations in the kitchen, whose peaks were at least five times higher than baseline levels. The contribution of cooking to the kitchen PM2.5 was 18.43 ± 12.17% and 5.39 ± 4.15% in rural and urban homes, respectively. Biomass burning affected indoor PM2.5 concentrations significantly, where rural households using biomass had the highest PM2.5 levels than households burning other fuels. This study identified the urban–rural disparities in household PM2.5 pollution and the contributions of cooking activities to HAP, illustrating the importance of cooking activities to indoor air pollution, which can assist in controlling indoor air pollution.