Impact of home remediation and household education on indoor air quality, respiratory visits and symptoms in Alaska Native children

"You can feel the fresh air … " Rural Alaska Native household perceptions of home air purifiers and health

Alaska Native and American Indian children experience frequent respiratory illness. Indoor air quality is associated with the severity and frequency of respiratory infections in children. High efficiency particulate air (HEPA) purifiers effectively improve indoor air quality and may protect respiratory health. In 2019, the Yukon-Kuskokwim Health Corporation implemented a pilot programme that provided education and HEPA purifiers to households of children with chronic lung conditions. The team evaluated HEPA purifier acceptability and use by interviewing representatives from 11 households that participated in the pilot programme. All interviewees reported improvement in their child's health, and some believed that the health of other household members was also improved because of the HEPA purifier. Interviewees reported that the HEPA purifiers were easy to use, quiet, and not expensive to run. Five of 11 households were still using the HEPA purifier at the time of the interview, which was about three years after receipt of the unit. The most common reasons for discontinuing use were equipment failure and lack of replacement filter, suggesting that programme support could increase sustainability. Our evaluation suggests that HEPA purifiers are acceptable and feasible for use in rural Alaska Native households.

Social determinants of respiratory health from birth: still of concern in the 21st century?

Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.

How Schools Can Help Address Social Determinants of Health in Asthma Management

Schools are in a unique position to address social determinants of health (SDOHs) in pediatric asthma management because of their potential to provide resources and facilitate collaboration with health care providers and services for children at risk within their community. SDOHs include economic factors, educational attainment and health literacy, neighborhood factors and the built environment, social and community aspects including discrimination and racism, and health care access and quality. These factors have a significant impact on asthma health in children, and certain populations such as minoritzed populations and those living in high-poverty environments have been shown to be at greater risk for adverse effects of SDOHs on asthma outcomes. School-based asthma programs address several SDOHs including health literacy, the built environment, and health care quality and access and have been shown to improve asthma outcomes. Key components include connection between the school and the health care team, self-management education, and directly observed therapy. School nurses play a key role in directing and managing effective programs because they can evaluate and support a student's health while considering the effect of SDOHs at interpersonal, institutional, community, and policy levels.

Exposure to indoor and outdoor air pollution from solid fuel combustion and respiratory outcomes in children in developed countries: a systematic review and meta-analysis

Epidemiological studies have shown a positive association between exposure to outdoor and indoor solid fuel combustion and adverse health effects. We reviewed the epidemiological evidence from Europe, North America, Australia and New Zealand on the association between outdoor and indoor exposure to solid fuel combustion and respiratory outcomes in children. We performed a systematic review and meta-analysis. Pooled relative risks (RRs) and 95% confidence intervals (CI) were calculated using random-effects models. We identified 74 articles. Due to limited evidence on other exposures and outcomes, we performed meta-analyses on the association between indoor wood burning exposure and respiratory outcomes. The RR for the highest vs the lowest category of indoor wood exposure was 0.90 (95% CI 0.77-1.05) considering asthma as an outcome. The corresponding pooled RRs for lower respiratory infection (LRI) and upper respiratory infection (URI) were 1.11 (95% CI 0.88, 1.41) and 1.11 (95% CI 0.85, 1.44) respectively. No association was found between indoor wood burning exposure and risk of wheeze and cough. Inconsistent and limited results were found considering the relationship between indoor wood burning exposure and other respiratory outcomes (rhinitis and hay fever, influenza) as well as indoor coal burning exposure and respiratory outcomes in children. Results from epidemiological studies that evaluated the relationship between the exposure to outdoor emissions derived from indoor combustion of solid fuels are too limited to allow firm conclusions. We found no association between indoor wood burning exposure and risk of asthma. A slight, but not significant, increased risk of LRI and URI was identified, although the available evidence is limited. Epidemiological studies evaluating the relationship between indoor coal burning exposure and respiratory outcomes, as well as, studies considering exposure to outdoor solid fuels, are too limited to draw any firm conclusions.

Particulate Matter Monitoring and Assessment through Internet of Things: a Health Information System for Enhanced Living Environments

People spend most of their time inside buildings. Therefore, indoor air quality monitoring contributes to improve health and well-being. Several studies focus on the critical impact of particulate matter on residential air quality. In 2016, particulate matter caused 412 thousand premature deaths in 41 European countries. This paper presents the development of an affordable health information system for enhanced living environments. The authors propose a cost-effective, modular, scalable, and easy installation solution for particulate matter monitoring. The system is connected to ThingSpeak. It can be installed in any type of building. It requires only a power source and a Wi-Fi network with internet access. The main contribution of this paper is to present the detailed architecture and testing results. The particulate matter monitoring system was installed for one week in a domestic kitchen with an open fireplace. The results showed impact of the biomass burning on indoor air quality. The mean values per day ranged from: 10.53 to 50.62 μg/m³ for PM_1.0, 15.35 to 69.37 μg/m³ for PM_2.5, and 20.1 to 90.69 μg/m³ for PM₁₀. The maximum values per hour were registered at 13:00: 72.14 μg/m³ for PM_1.0, 99.70 μg/m³ for PM_2.5, and 132.13 μg/m³ for PM₁₀. Cost-effective sensors do not have the accuracy level of industrial equipment. Therefore, they should not be used for numerical and in-depth accurate characterization of the environment. Nevertheless, continuous particulate matter monitoring provides consistent data series for analysis of indoor air quality evolution.

Environmental Health Consults in Children Hospitalized with Respiratory Infections

Indoor air pollutants contribute to respiratory infections and asthma exacerbations in children. Rural Alaska Native children experience some of the highest U.S. rates of respiratory hospitalizations, which are associated with lack of in-home running water, household crowding, and woodstove use. In our previous study, in-home education and modifications reduced respiratory symptoms, and medical visits. In this study, we evaluated the feasibility of providing in-hospital environmental health consults for parents/guardians of children < 5 years old hospitalized at the Alaska Native Medical Center with respiratory infections or asthma. Environmental health specialists conducted 92 in-hospital consults and mailed Healthy Homes Toolkits to households. Local housing authorities completed low-cost home modifications in 47 eligible households. Participants reported changes in household behaviors that were specifically addressed in the consult or included in the Toolkit (e.g. allergen-impermeable pillow covers). Reported respiratory symptoms were decreased at the 6-month follow-up. Over a 2 year period the median overall medical costs for respiratory illness in study children were $70,500. Children with in-home piped water had half the daily overall medical costs than children without in-home piped water ($74 compared to $144). In this study, we demonstrate that it is feasible to provide environmental consults, mail Toolkits, and arrange home modifications to the homes of children hospitalized with respiratory illness. These findings, along with the high costs of medical care for these children, suggest in-hospital environmental health consults are a cost-effective intervention.

Indoor Air Quality Monitoring Systems for Enhanced Living Environments: A Review toward Sustainable Smart Cities

Smart cities follow different strategies to face public health challenges associated with socio-economic objectives. Buildings play a crucial role in smart cities and are closely related to people’s health. Moreover, they are equally essential to meet sustainable objectives. People spend most of their time indoors. Therefore, indoor air quality has a critical impact on health and well-being. With the increasing population of elders, ambient-assisted living systems are required to promote occupational health and well-being. Furthermore, living environments must incorporate monitoring systems to detect unfavorable indoor quality scenarios in useful time. This paper reviews the current state of the art on indoor air quality monitoring systems based on Internet of Things and wireless sensor networks in the last five years (2014–2019). This document focuses on the architecture, microcontrollers, connectivity, and sensors used by these systems. The main contribution is to synthesize the existing body of knowledge and identify common threads and gaps that open up new significant and challenging future research directions. The results show that 57% of the indoor air quality monitoring systems are based on Arduino, 53% of the systems use Internet of Things, and WSN architectures represent 33%. The CO2 and PM monitoring sensors are the most monitored parameters in the analyzed literature, corresponding to 67% and 29%, respectively.