Bacteria in a water‐damaged building: associations of actinomycetes and non‐tuberculous mycobacteria with respiratory health in occupants

We examined microbial correlates of health outcomes in building occupants with a sarcoidosis cluster and excess asthma. We offered employees a questionnaire and pulmonary function testing and collected floor dust and liquid/sludge from drain tubing traps of heat pumps that were analyzed for various microbial agents. Forty‐nine percent of participants reported any symptom reflecting possible granulomatous disease (shortness of breath on exertion, flu‐like achiness, or fever and chills) weekly in the last 4 weeks. In multivariate regressions, thermophilic actinomycetes (median = 529 CFU/m²) in dust were associated with FEV₁/FVC [coefficient = ?2.8 per interquartile range change, P = 0.02], percent predicted FEF_25–75% (coefficient = ?12.9, P = 0.01), and any granulomatous disease‐like symptom [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.45?6.73]. Mycobacteria (median = 658 CFU/m²) were positively associated with asthma symptoms (OR = 1.5, 95% CI = 0.97?2.43). Composite score (median = 11.5) of total bacteria from heat pumps was negatively associated with asthma (0.8, 0.71?1.00) and positively associated with FEV₁/FVC (coefficient = 0.44, P = 0.095). Endotoxin (median score = 12.0) was negatively associated with two or more granulomatous disease‐like symptoms (OR = 0.8, 95% CI = 0.67?0.98) and asthma (0.8, 0.67?0.96). Fungi or (1→3)‐β‐D‐glucan in dust or heat pump traps was not associated with any health outcomes. Thermophilic actinomycetes and non‐tuberculous mycobacteria may have played a role in the occupants' respiratory outcomes in this water‐damaged building.     

Residential culturable fungi, (1‐3, 1‐6)‐β‐d‐glucan,and ergosterol concentrations in dust are not associated with asthma,rhinitis, or eczema diagnoses in children

Qualitative reporting of home indoor moisture problems predicts respiratory diseases. However, causal agents underlying such qualitative markers remain unknown. In the homes of 198 multiple allergic case children and 202 controls in Sweden, we cultivated culturable fungi by directly plating dust, and quantified (1‐3, 1‐6)‐β‐d ‐glucan and ergosterol in dust samples from the child's bedroom. We examined the relationship between these fungal agents and degree of parent or inspector‐reported home indoor dampness, and microbiological laboratory's mold index. We also compared the concentrations of these agents between multiple allergic cases and healthy controls, as well as IgE‐sensitization among cases. The concentrations of culturable fungal agents were comparable between houses with parent and inspector‐reported mold issues and those without. There were no differences in concentrations of the individual or the total summed culturable fungi, (1‐3, 1‐6)‐β‐d ‐glucan, and ergosterol between the controls and the multiple allergic case children, or individual diagnosis of asthma, rhinitis, or eczema. Culturable fungi, (1‐3, 1‐6)‐β‐d ‐glucan, and ergosterol in dust were not associated with qualitative markers of indoor dampness or mold or indoor humidity. Furthermore, these agents in dust samples were not associated with any health outcomes in the children.     

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.     

Building dampness and mold in European homes in relation to climate,building characteristics and socio‐economic status: The European Community Respiratory Health Survey ECRHS II

We studied dampness and mold in homes in relation to climate, building characteristics and socio‐economic status (SES) across Europe, for 7127 homes in 22 centers. A subsample of 3118 homes was inspected. Multilevel analysis was applied, including age, gender, center, SES, climate, and building factors. Self‐reported water damage (10%), damp spots (21%), and mold (16%) in past year were similar as observed data (19% dampness and 14% mold). Ambient temperature was associated with self‐reported water damage (OR=1.63 per 10°C; 95% CI 1.02‐2.63), damp spots (OR=2.95; 95% CI 1.98‐4.39), and mold (OR=2.28; 95% CI 1.04‐4.67). Precipitation was associated with water damage (OR=1.12 per 100 mm; 95% CI 1.02‐1.23) and damp spots (OR=1.11; 95% CI 1.02‐1.20). Ambient relative air humidity was not associated with indoor dampness and mold. Older buildings had more dampness and mold (P<.001). Manual workers reported less water damage (OR=0.69; 95% CI 0.53‐0.89) but more mold (OR=1.27; 95% CI 1.03‐1.55) as compared to managerial/professional workers. There were correlations between reported and observed data at center level (Spearman rho 0.61 for dampness and 0.73 for mold). In conclusion, high ambient temperature and precipitation and high building age can be risk factors for dampness and mold in homes in Europe.     

Quantifying the contribution of ambient and indoor‐generated fine particles to indoor air in residential environments

Indoor fine particles (FPs) are a combination of ambient particles that have infiltrated indoors, and particles that have been generated indoors from activities such as cooking. The objective of this paper was to estimate the infiltration factor (F_inf) and the ambient/non‐ambient components of indoor FPs. To do this, continuous measurements were collected indoors and outdoors for seven consecutive days in 50 non‐smoking homes in Halifax, Nova Scotia in both summer and winter using DustTrak (TSI Inc) photometers. Additionally, indoor and outdoor gravimetric measurements were made for each 24‐h period in each home, using Harvard impactors (HI). A computerized algorithm was developed to remove (censor) peaks due to indoor sources. The censored indoor/outdoor ratio was then used to estimate daily F_infs and to determine the ambient and non‐ambient components of total indoor concentrations. F_inf estimates in Halifax (daily summer median = 0.80; daily winter median = 0.55) were higher than have been reported in other parts of Canada. In both winter and summer, the majority of FP was of ambient origin (daily winter median = 59%; daily summer median = 84%). Predictors of the non‐ambient component included various cooking variables, combustion sources, relative humidity, and factors influencing ventilation. This work highlights the fact that regional factors can influence the contribution of ambient particles to indoor residential concentrations.     

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.     

Real‐time transformation of outdoor aerosol components upon transport indoors measured with aerosol mass spectrometry

Outdoor aerosols are transported indoors, where their component concentrations depend on aerosol size, physiochemical properties, indoor sources and losses, and cross‐environment gradients of temperature and relative humidity. We explored these dependencies by measuring real‐time outdoor and indoor non‐refractory, submicron (PM₁) aerosol component mass concentrations in a mixed‐use laboratory space with an Aerodyne mini‐aerosol mass spectrometer (AMS) and black carbon (BC) with an aethalometer. The median indoor/outdoor (I/O) ratios were 0.60 for sulfate, 0.25 for nitrate, 0.52 for ammonium, 0.73 for organics, and 0.61 for BC. Positive matrix factorization (PMF) on organic aerosol data identified hydrocarbon‐like (HOA), cooking (COA), and oxygenated (OOA) factors. By assuming sulfate was nonvolatile, lost only by mechanical processes, and without indoor sources, the transformations of other components i due to partitioning changes or indoor sources were parameterized by normalizing their I/O ratios by sulfate's I/O ratio, that is, (I/O)_i/SO4. Component‐specific behavior was quantified by regressions of (I/O)_i/SO4 to outdoor‐to‐indoor temperature differences. Nitrate and HOA strongly and OOA weakly showed losses with increasing temperatures indoors vs. outdoors, and HOA likely had an indoor source. To our knowledge, this is the first reported deployment of an AMS to analyze real‐time indoor aerosol composition and outdoor‐to‐indoor transformation.     

Organic compound characterization and source apportionment of indoor and outdoor quasi-ultrafine particulate matter in retirement homes of the Los Angeles Basin

Abstract Quasi‐ultrafine (quasi‐UF) particulate matter (PM_0.25) and its components were measured in indoor and outdoor environments at four retirement communities in Los Angeles Basin, California, as part of the Cardiovascular Health and Air Pollution Study (CHAPS). The present paper focuses on the characterization of the sources, organic constituents and indoor and outdoor relationships of quasi‐UF PM. The average indoor/outdoor ratios of most of the measured polycyclic aromatic hydrocarbons (PAHs), hopanes, and steranes were close to or slightly lower than 1, and the corresponding indoor–outdoor correlation coefficients (R) were always positive and, for the most part, moderately strong (median R was 0.60 for PAHs and 0.74 for hopanes and steranes). This may reflect the possible impact of outdoor sources on indoor PAHs, hopanes, and steranes. Conversely, indoor n‐alkanes and n‐alkanoic acids were likely to be influenced by indoor sources. A chemical mass balance model was applied to both indoor and outdoor speciated chemical measurements of quasi‐UF PM. Among all apportioned sources of both indoor and outdoor particles, vehicular emissions was the one contributing the most to the PM_0.25 mass concentration measured at all sites (24–47% on average).

Practical Implications

Although people (particularly the elderly retirees of our study) generally spend most of their time indoors, a major portion of the PM_0.25 particles they are exposed to comes from outdoor mobile sources. This is important because, an earlier investigation, also conducted within the Cardiovascular Health and Air Pollution Study (CHAPS), showed that indoor‐infiltrated particles from mobile sources are more strongly correlated with adverse health effects observed in the elderly subjects living in the studied retirement communities compared with other particles found indoors ( Delfino et al., 2008 ).     

Domestic exposure to endotoxin and respiratory morbidity in former smokers with COPD

Indoor air pollution has been linked to adverse chronic obstructive pulmonary disease (COPD) health, but specific causative agents have not yet been identified. We evaluated the role of indoor endotoxin exposure upon respiratory health in former smokers with COPD. Eighty‐four adults with moderate to severe COPD were followed longitudinally and indoor air and dust samples collected at baseline, 3 and 6 months. Respiratory outcomes were repeatedly assessed at each time point. The associations between endotoxin exposure in air and settled dust and health outcomes were explored using generalizing estimating equations in multivariate models accounting for confounders. Dust endotoxin concentrations in the main living area were highest in spring and lowest in fall, while airborne endotoxins remained steady across seasons. Airborne and dust endotoxin concentrations were weakly correlated with one another (r_s = +0.24, P = 0.005). Endotoxin concentrations were not significantly associated with respiratory symptoms, rescue medication use, quality of life, or severe exacerbations. In vitro whole‐blood assays of the pro‐inflammatory capacity of PM₁₀ filters with and without endotoxin depletion demonstrated that the endotoxin component of indoor air pollution was not the primary trigger for interleukin‐1β release. Our findings support that endotoxin is not the major driver in the adverse effects of indoor PM upon COPD morbidity.     

Observational scores of dampness and mold associated with measurements of microbial agents and moisture in three public schools

We examined associations between observational dampness scores and measurements of microbial agents and moisture in three public schools. A dampness score was created for each room from 4‐point‐scale scores (0–3) of water damage, water stains, visible mold, moldy odor, and wetness for each of 8 room components (ceiling, walls, windows, floor, ventilation, furniture, floor trench, and pipes), when present. We created mixed microbial exposure indices (MMEIs) for each of 121 rooms by summing decile ranks of 8 analytes (total culturable fungi; total, Gram‐negative, and Gram‐positive culturable bacteria; ergosterol; (1→3)‐β‐D‐glucan; muramic acid; and endotoxin) in floor dust. We found significant (P ≤ 0.01) linear associations between the dampness score and culturable bacteria (total, Gram‐positive, and Gram‐negative) and the MMEIs. Rooms with dampness scores greater than 0.25 (median) had significantly (P < 0.05) higher levels of most microbial agents, MMEIs, and relative moisture content than those with lower scores (≤0.25). Rooms with reported recent water leaks had significantly (P < 0.05) higher dampness scores than those with historical or no reported water leaks. This study suggests that observational assessment of dampness and mold using a standardized form may be valuable for identifying and documenting water damage and associated microbial contamination.     

Synergistic proinflammatory interactions of microbial toxins and structural components characteristic to moisture‐damaged buildings

Indoor exposure to microbes and their structural and metabolic compounds is notoriously complex. To study proinflammatory interactions between the multiple microbial agents, macrophages derived from human THP‐1 monocytic cells were exposed to several concentrations of microbial toxins alone (emodin, enniatin B, physcion, sterigmatocystin, valinomycin) and in combination with microbial structural components (bacterial lipopolysaccharide [LPS] or fungal β‐glucan). While the expression of proinflammatory cytokines TNFα and IL‐1β to single toxins alone was modest, low‐dose co‐exposure with structural components increased the responses of emodin, enniatin B, and valinomycin synergistically, both at the mRNA and protein level, as measured by RT‐qPCR and ELISA, respectively. Co‐exposure of toxins and β‐glucan resulted in consistent synergistically increased expression of several inflammation‐related genes, while some of the responses with LPS were also inhibitory. Co‐exposure of toxins with either β‐glucan or LPS induced also mitochondrial damage and autophagocytosis. The results demonstrate that microbial toxins together with bacterial and fungal structural components characteristic to moisture‐damaged buildings can have drastic synergistic proinflammatory interactions at low exposure levels.     

Acute effects of exposure to vapors of 3‐methyl‐1‐butanol in humans

The secondary alcohol 3‐methyl‐1‐butanol (3MB, isoamyl alcohol) is used, for example, as a solvent in a variety of applications and as a fragrance ingredient. It is also one of the microbial volatile organic compounds (MVOCs) found in indoor air. There are little data on acute effects. The aim of the study was to assess the acute effects of 3MB in humans. Thirty healthy volunteers (16 men and 14 women) were exposed in random order to 1 mg/m³ 3MB or clean air for 2 h at controlled conditions. Ratings with visual analogue scales revealed slightly increased perceptions of eye irritation (P = 0.048, Wilcoxon) and smell (P < 0.0001) compared with control exposure. The other ratings were not significantly affected (irritation in nose and throat, dyspnea, headache, fatigue, dizziness, nausea, and intoxication). No significant exposure‐related effects were found in blinking frequency, tear film break‐up time, vital staining of the eye, nasal lavage biomarkers, lung function, and nasal swelling. In conclusion, this study suggests that 3MB is not a causative factor for health effects in damp and moldy buildings.     

A SPME‐based method for rapidly and accurately measuring the characteristic parameter for DEHP emitted from PVC floorings

Semivolatile organic compounds (SVOCs) are present in many indoor materials. SVOC emissions can be characterized with a critical parameter, y₀, the gas‐phase SVOC concentration in equilibrium with the source material. To reduce the required time and improve the accuracy of existing methods for measuring y₀, we developed a new method which uses solid‐phase microextraction (SPME) to measure the concentration of an SVOC emitted by source material placed in a sealed chamber. Taking one typical indoor SVOC, di‐(2‐ethylhexyl) phthalate (DEHP), as the example, the experimental time was shortened from several days (even several months) to about 1 day, with relative errors of less than 5%. The measured y₀ values agree well with the results obtained by independent methods. The saturated gas‐phase concentration (y_sat) of DEHP was also measured. Based on the Clausius–Clapeyron equation, a correlation that reveals the effects of temperature, the mass fraction of DEHP in the source material, and y_sat on y₀ was established. The proposed method together with the correlation should be useful in estimating and controlling human exposure to indoor DEHP. The applicability of the present approach for other SVOCs and other SVOC source materials requires further study.     

Unexpected increase in indoor pollutants after the introduction of a smoke‐free policy in a correctional center

Correctional centers (prisons) are one of the few non‐residential indoor environments where smoking is still permitted. However, few studies have investigated indoor air quality (IAQ) in these locations. We quantified the level of inmate and staff exposure to secondhand smoke, including particle number (PN) count, and we assessed the impact of the smoking ban on IAQ. We performed measurements of indoor and outdoor PM_2.5 and PN concentrations, personal PN exposure levels, volatile organic compounds (VOCs), and nicotine both before and after a complete indoor smoking ban in an Australian maximum security prison. Results show that the indoor 24‐h average PM_2.5 concentrations ranged from 6 (±1) μg/m³ to 17 (±3) μg/m³ pre‐ban. The post‐ban levels ranged from 7 (±2) μg/m³ to 71 (±43) μg/m³. While PM_2.5 concentrations decreased in one unit post‐ban, they increased in the other two units. Similar post‐ban increases were also observed in levels of PN and VOCs. We describe an unexpected increase of indoor pollutants following a total indoor smoking ban in a prison that was reflected across multiple pollutants that are markers of smoking. We hypothesise that clandestine post‐ban smoking among inmates may have been the predominant cause.     

Seasonal variability in environmental tobacco smoke exposure in public housing developments

The risk of tobacco smoking and second‐hand smoke (SHS) exposure combined are the leading contributors to disease burden in high‐income countries. Recent studies and policies are focusing on reducing exposure to SHS in multiunit housing (MUH), especially public housing. We examined seasonal patterns of SHS levels within indoor common areas located on Boston Housing Authority (BHA) properties. We measured weekly integrated and continuous fine particulate matter (PM_2.5) and passive airborne nicotine in six buildings of varying building and occupant characteristics in summer 2012 and winter 2013. The average weekly indoor PM_2.5 concentration across all six developments was 9.2 μg/m³, higher during winter monitoring period (10.3 μg/m³) compared with summer (8.0 μg/m³). Airborne nicotine concentrations ranged from no detection to about 5000 ng/m³ (mean 311 ng/m³). Nicotine levels were significantly higher in the winter compared with summer (620 vs. 85 ng/m³; 95% CI: 72–998). Smoking‐related exposures within Boston public housing vary by season, building types, and resident smoking policy. Our results represent exposure disparities that may contribute to health disparities in low‐income communities and highlight the potential importance of efforts to mitigate SHS exposures during winter when outdoor–indoor exchange rates are low and smokers may tend to stay indoors. Our findings support the use of smoke‐free policy as an effective tool to eliminate SHS exposure and protect non‐smokers, especially residents of MUH.     

Home interventions are effective at decreasing indoor nitrogen dioxide concentrations

Nitrogen dioxide (NO₂), a by‐product of combustion produced by indoor gas appliances such as cooking stoves, is associated with respiratory symptoms in those with obstructive airways disease. We conducted a three‐armed randomized trial to evaluate the efficacy of interventions aimed at reducing indoor NO₂ concentrations in homes with unvented gas stoves: (i) replacement of existing gas stove with electric stove; (ii) installation of ventilation hood over existing gas stove; and (iii) placement of air purifiers with high‐efficiency particulate air (HEPA) and carbon filters. Home inspection and NO₂ monitoring were conducted at 1 week pre‐intervention and at 1 week and 3 months post‐intervention. Stove replacement resulted in a 51% and 42% decrease in median NO₂ concentration at 3 months of follow‐up in the kitchen and bedroom, respectively (P = 0.01, P = 0.01); air purifier placement resulted in an immediate decrease in median NO₂ concentration in the kitchen (27%, P < 0.01) and bedroom (22%, P = 0.02), but at 3 months, a significant reduction was seen only in the kitchen (20%, P = 0.05). NO₂ concentrations in the kitchen and bedroom did not significantly change following ventilation hood installation. Replacing unvented gas stoves with electric stoves or placement of air purifiers with HEPA and carbon filters can decrease indoor NO₂ concentrations in urban homes.     

Novel mold‐resistant building materials impregnated with thermally reduced nano‐silver

In this study, we evaluated the long‐term antifungal effectiveness of 3 types of interior building materials (gypsum board [GB], cement board [CB], and softwood plywood [S‐PW]) impregnated with thermally reduced silver nanoparticles supported by titanium dioxide (AgNPs/TiO₂) under 95% relative humidity for 4 weeks. AgNPs/TiO₂ was synthesized at 2 thermal reduction temperatures (TRTs, 120 and 200°C) with 2 different AgNP weight percentages (2 and 5 wt%). Four different silver‐loading levels (SLLs, 0.025, 0.05, and 0.5 μg/cm² and the critical concentration required to inhibit fungal growth on agar plates) and 3 fungal species (Aspergillus niger, Penicillium spinulosum, and Stachybotrys chartarum) were used in the experiments. Higher temperature reduced more ionic Ag⁺ to metallic Ag⁰ and increased the dispersion of Ag on TiO₂ surface. The 200°C thermally reduced AgNPs/TiO₂ demonstrated excellent antifungal efficiency: Mold growth was almost completely inhibited for 28 days at the low SLL of 0.5 μg/cm². Additionally, AgNPs/TiO₂ exhibited higher antifungal activity on GB and CB than on S‐PW. The stepwise regression results indicated that the TRT of AgNPs/TiO₂ (β = ?0.739 to ?0.51), the SLL (β = ?0.477 to ?0.269), and the Ag⁰ level in the AgNPs (β = ?0.379 to ?0.136) were the major factors influencing antifungal activity and TRT might be the most significant one.     

Classroom conditions and CO2 concentrations and teacher health symptom reporting in 10 New York State Schools

This study assessed the relationship between teacher‐reported symptoms and classroom carbon dioxide (CO₂) concentrations. Previous studies have suggested that poor indoor ventilation can result in higher levels of indoor pollutants, which may affect student and teacher health. Ten schools (9 elementary, 1 combined middle/high school) in eight New York State school districts were visited over a 4‐month period in 2010. Carbon dioxide concentrations were measured in classrooms over 48‐h, and teachers completed surveys assessing demographic information and self‐reported symptoms experienced during the current school year. Data from 64 classrooms (ranging from 1 to 9 per school) were linked with 68 teacher surveys (for four classrooms, two surveys were returned). Overall, approximately 20% of the measured classroom CO₂ concentrations were above 1000 parts per million (ppm), ranging from 352 to 1591 ppm. In multivariate analyses, the odds of reporting neuro‐physiologic (i.e., headache, fatigue, difficulty concentrating) symptoms among teachers significantly increased (OR = 1.30, 95% CI = 1.02–1.64) for every 100 ppm increase in maximum classroom CO₂ concentrations and were non‐significantly increased in classrooms with above‐median proportions of CO₂ concentrations greater than 1000 ppm (OR = 2.26, 95% CI = 0.72–7.12).     

The effects of bedroom air quality on sleep and next‐day performance

The effects of bedroom air quality on sleep and next‐day performance were examined in two field‐intervention experiments in single‐occupancy student dormitory rooms. The occupants, half of them women, could adjust an electric heater to maintain thermal comfort but they experienced two bedroom ventilation conditions, each maintained for 1 week, in balanced order. In the initial pilot experiment (N = 14), bedroom ventilation was changed by opening a window (the resulting average CO₂ level was 2585 or 660 ppm). In the second experiment (N = 16), an inaudible fan in the air intake vent was either disabled or operated whenever CO₂ levels exceeded 900 ppm (the resulting average CO₂ level was 2395 or 835 ppm). Bedroom air temperatures varied over a wide range but did not differ between ventilation conditions. Sleep was assessed from movement data recorded on wristwatch‐type actigraphs and subjects reported their perceptions and their well‐being each morning using online questionnaires. Two tests of next‐day mental performance were applied. Objectively measured sleep quality and the perceived freshness of bedroom air improved significantly when the CO₂ level was lower, as did next‐day reported sleepiness and ability to concentrate and the subjects' performance of a test of logical thinking.     

Impact of a cleaner‐burning cookstove intervention on blood pressure in Nicaraguan women

Few studies have evaluated the cardiovascular‐related effects of indoor biomass burning or the role of characteristics such as age and obesity status, in this relationship. We examined the impact of a cleaner‐burning cookstove intervention on blood pressure among Nicaraguan women using an open fire at baseline; we also evaluated heterogeneity of the impact by subgroups of the population. We evaluated changes in systolic and diastolic blood pressure from baseline to post‐intervention (range: 273–383 days) among 74 female cooks. We measured indoor fine particulate matter (PM_2.5; N = 25), indoor carbon monoxide (CO; N = 32), and personal CO (N = 30) concentrations. Large mean reductions in pollutant concentrations were observed for all pollutants; for example, indoor PM_2.5 was reduced 77% following the intervention. However, pollution distributions (baseline and post‐intervention) were wide and overlapping. Although substantial reductions in blood pressure were not observed among the entire population, a 5.9 mmHg reduction [95% confidence interval (CI): ?11.3, ?0.4] in systolic blood pressure was observed among women aged 40 or more years and a 4.6 mmHg reduction (95% CI: ?10.0, 0.8) was observed among obese women. Results from this study provide an indication that certain subgroups may be more likely to experience improvements in blood pressure following a cookstove intervention.