Study on Health Effects of Indoor Air Pollution in China Presented by Pan Xiao-chuan et al. Dept. of Occupational and Environmental Health Peking University School of Public Health Workshop in Oslo, Oct.17-19, 2004

Introduction The indoor air quality is concerned more and more by the government and the public in China nowadays and the health effects of indoor air pollution are becoming a serious challenge in both urban and rural areas of China. In order to further study the health effects of indoor air pollution and population exposure to them, it is very important for us to know clearly what the key pollutants is in the urban and rural areas of China. The indoor air quality is concerned more and more by the government and the public in China nowadays and the health effects of indoor air pollution are becoming a serious challenge in both urban and rural areas of China. In order to further study the health effects of indoor air pollution and population exposure to them, it is very important for us to know clearly what the key pollutants is in the urban and rural areas of China.

Key Indoor Air Pollutants from housing fitment and decoration: from housing fitment and decoration: Formaldehyde Formaldehyde Benzene, toluene and xylene Benzene, toluene and xylene Ammonia Ammonia VOCs VOCs Radon and dust mite Radon and dust mite

Key Indoor Air Pollutants From fuel combustion: From fuel combustion: Particular Matter Particular Matter SO2 SO2 CO CO Environmental Tobacco Smoke (ETS) Environmental Tobacco Smoke (ETS)

Part one: The Indoor Air Quality and Health Effects from Housing Fitment/Decoration in China

Approaches Indoor air monitoring: the average level of ammonia, formaldehyde, total volatile organic compounds (TVOC), house dust mites, moulds and other allergens in households in 6 provinces of China, which measured by the standard procedure and methods in Indoor air monitoring: the average level of ammonia, formaldehyde, total volatile organic compounds (TVOC), house dust mites, moulds and other allergens in households in 6 provinces of China, which measured by the standard procedure and methods in Case-control epidemiologic studies: asthma, leukemia and allergic rhinitis. Case-control epidemiologic studies: asthma, leukemia and allergic rhinitis.

Results

Fig.4 the average level of indoor air formaldehyde in 3 cities in summer

Fig. 6 The level of the indoor air ammonia in summer(mg/m3)

Fig. 7 the level of indoor air TVOC in 4 cities in winter(mg/m3)

Fig. 8 the average level of indoor air TVOC in 4 cities in winter

Fig. 9 the level of indoor air TVOC in 4 cities in summer(mg/m3)

Fig. 10 The average level of indoor air 17 VOCs Compounds in winter and summer

Tab.11 Level of the allergen from dust mite, bacteria and epiphyte in the office buildings

epidemiological study

Indoor environmental risk factors for allergic asthma in adults — a case-control study Yue Wei, Pan Xiao-chuan et al. Peking University School of Public health

1.Background  Allergic asthma is a kind of common disease. In recent years, it has an obviously increasing trend in our China. The prevalence in our China is about 1% ， in adults is about 0.5%.  To the epidemiological study about the adults’ allergic asthma, many researches have been done in foreign countries in recent 20 years. While in China, few researches have been reported, especially the researches between the adults’ allergic asthma and indoor environmental risk factors.  This study is to investigate the risk factors of adults’ allergic asthma or its onset, especially the indoor environmental risk factors. It is also one of the key research subjects in our China.

2. Methods: 102 cases 394 controls Asthma patients in adults from the Peking University affiliated Renmin Hospital. Age: 20 ～ 70y Gender: no limited Healthy residents from Beijing Xicheng district which is near the Renmin hospital. They all have no allergic or respiratory diseases. Ratio 1 ： 4 case-control study:  Questionnaire by face to face interview  Formaldehyde, NO2 and dust mite measure

3.Results: Tab.1 Single risk factors analysis of the allergic asthma in adults

Tab.2 Multiple risk factors logistic analysis of the allergic asthma in adults SAS stepwise Sle ＝ 0.10,Sls ＝ 0.10.

Table3 Correlative analysis between the different concentration of the indoor formaldehyde and allergic asthma in adults *: P value < 0.01 # the adjusted factors: age, sex, cigarette smoking, family history of the chronic bronchitis or asthma

4. Conclusion & Indication ： There were 6 risk factors correlated with the allergic asthma in adults in our study:  Vocational exposure to dust  Housing type  Drying Bedding in the sunshine  Floor type of the living room  Cooking oil smoke contamination indoors  Family history of the chronic bronchitis or asthma It indicated that the adults ’ allergic asthma is a kind of complicated disease caused by genetic and environmental multiple factors. Meanwhile, there is concentration-response relationship between the indoor air formaldehyde level and the adults ’ allergic asthma.

Ａ case-control study of the risk factors for adult leukemia DING Wen-qing, BAO li, HUANG xiao-jun, PAN Xiao-chuan. Peaking University School of Public Health and Second Hospital

Introduction With the increasing of the living standards of the residents, the problems caused by the indoor air pollution have been the hotspot in China recently. In recent years, the incidence of leukemia has the increasing tendency, some reports says it is probably related with the indoor decoration of the house. The purpose of this study was to ascertain primarily the relationship between the indoor decoration and other suspicious risk factors related with adult leukemia. With the increasing of the living standards of the residents, the problems caused by the indoor air pollution have been the hotspot in China recently. In recent years, the incidence of leukemia has the increasing tendency, some reports says it is probably related with the indoor decoration of the house. The purpose of this study was to ascertain primarily the relationship between the indoor decoration and other suspicious risk factors related with adult leukemia.

Methods A total of 127 cases (age years old) of Adult leukemia survivors were interviewed with health questionnaire by face to face,which included general conditions, living environment, harmful materials contact, living style, disease and family history,etc. The conditional Logistic regression model in univariate and multivariate analysis were used to seek the key risk factors, specially for adult leukemia.

Result In the single factor analysis,14 of 98 indexes were obviously significant<0.05)

Tab. The Single Factor Analysis Tab. The Single Factor Analysis Variables P value OR value Variables P value OR value 1 、 Occupation 、 Times of common cold in past two years two years 3 、 History of other blood diseases The degree of the indoor decoration Using indoor air-condition Flower planting in the house Frequently using pesticides for flower at home for flower at home

Variables P value OR value Variables P value OR value 8. Having factory nearby house (<500meters) (<500meters) 9. Using the cosmetic often Using perfume often Cigarette smoking Milk drinking frequently Over intake of salt Number of cigarette smoking

the multi-factor stepwise regression analysis There were 4 variables significantly associated with adult leukemia (P<0.05) There were 4 variables significantly associated with adult leukemia (P<0.05) Variables P value OR value Variables P value OR value 1 、 The degree of the indoor decoration 、 cigarette smoking 、 flower planting in house 、 Using indoor air-conditioner often

Conclusion It is suggested that the degree of the indoor decoration might be one of risk factors for adult leukemia. It is suggested that the degree of the indoor decoration might be one of risk factors for adult leukemia.

The Correlative relations between Indoor Air pollution and allergic rhinitis --a pilot case-control study Liu Ying, Pan Xiao-chuan et al. Peking University School of public health

Methods we chose 95 patients and 45 controls to perform case-control study. Patients were selected from Peking University affiliated hospitals, where they had been diagnosed as allergic rhinitis. Controls are patients from the same hospital but not suffer from allergic rhinitis. Block-paired design of Logistic regression was utilized to conduct multi-factor analysis. We use SPSS 11.0 to do the statistics. we chose 95 patients and 45 controls to perform case-control study. Patients were selected from Peking University affiliated hospitals, where they had been diagnosed as allergic rhinitis. Controls are patients from the same hospital but not suffer from allergic rhinitis. Block-paired design of Logistic regression was utilized to conduct multi-factor analysis. We use SPSS 11.0 to do the statistics.

results

Tab.3:the results of multi-factors analysis βS.E P value OR value age sex married Allergy history Passive smoking in family Passive smoking in office The cooking oil.031* The type of housing.874 Family history of allergy

Tab. Distribution of the Cooking oils in the subjects group Salad oil* Peanut oil othertotal case control total P=0.008, OR value=12.918( Logistic Regression) The results suggests that use of salad oil may cause the increase of the prevalence rate of allergic rhinitis.

The Indoor Air Quality and Health Effects from Fuel Combustion in China

INDOOR AIR POLLUTION AND RESPIRATORY HEALTH OF THE PEOPLES IN BEIJING: A COMMUNITY-BASED STUDY Dept. of Occupational and Environmental Health, Peking University School of Public Health, Beijing , P.R. China Xiao-chuan Pan, et.al.

INTRODUCTION In recent years the housing of Beijing peoples have been improved enormously with the fast development of the economy as well as living level. A lot of the new fitments, soft furnishings, fitted carpets and mechanical air ventilation systems are now introduced into more and more households in Beijing, especially in urban areas. In recent years the housing of Beijing peoples have been improved enormously with the fast development of the economy as well as living level. A lot of the new fitments, soft furnishings, fitted carpets and mechanical air ventilation systems are now introduced into more and more households in Beijing, especially in urban areas. How about indoor air quality caused by them? How about indoor air quality caused by them?

METHODS Participants: About 270 households, living in 3 communities of urban area were selected randomly for indoor air monitoring, about 3000 individuals aged from 18 – 65 yr. from the study households and their neighbors were interviewed by questionnaire for their respiratory health. Participants: About 270 households, living in 3 communities of urban area were selected randomly for indoor air monitoring, about 3000 individuals aged from 18 – 65 yr. from the study households and their neighbors were interviewed by questionnaire for their respiratory health. The mass concentration of particles smaller than 10 μ m/2.5 μ m in diameter （ PM 10 /PM 2.5 ） and sulphur dioxide (SO 2 ) was measured in the bedroom and kitchen of the study households in real time twice a day for two weeks, respectively in winter and summer. The mass concentration of particles smaller than 10 μ m/2.5 μ m in diameter （ PM 10 /PM 2.5 ） and sulphur dioxide (SO 2 ) was measured in the bedroom and kitchen of the study households in real time twice a day for two weeks, respectively in winter and summer.

METHODS 2 Health: The health questionnaire was based on that of the British Medical Respiratory Committee and revised according to the different status in Beijing. It consisted of age, gender, education, occupation, and general health status, living habits, exposure to indoor microenvironment factors, cooking, and smoking, respiratory symptoms and other daily activities. The trained students of a medical college conducted the health survey with the questionnaire by face-to-face interview. Health: The health questionnaire was based on that of the British Medical Respiratory Committee and revised according to the different status in Beijing. It consisted of age, gender, education, occupation, and general health status, living habits, exposure to indoor microenvironment factors, cooking, and smoking, respiratory symptoms and other daily activities. The trained students of a medical college conducted the health survey with the questionnaire by face-to-face interview.

METHODS 3 Determination and Data analysis: The determination of levels of PM 10, PM 2.5 and SO 2 was taken with standardized procedures. The t-test and X-square test were used for estimates of variances of the pollutants level. Effect size of various factors for respiratory symptoms and lung function were estimated with two models. First, is a linear model with an ordinary least-squares regression of symptoms rates. We accounted for clustering of observations in units of Household. Second, we used a logistic probability model y=F (X ×β +u): y, X, and β are defined as in the linear model; F=cumulative logistic distribution, F (z)=exp (z) divided by [1+exp (z)]. Determination and Data analysis: The determination of levels of PM 10, PM 2.5 and SO 2 was taken with standardized procedures. The t-test and X-square test were used for estimates of variances of the pollutants level. Effect size of various factors for respiratory symptoms and lung function were estimated with two models. First, is a linear model with an ordinary least-squares regression of symptoms rates. We accounted for clustering of observations in units of Household. Second, we used a logistic probability model y=F (X ×β +u): y, X, and β are defined as in the linear model; F=cumulative logistic distribution, F (z)=exp (z) divided by [1+exp (z)].

RESULTS

B: bedroom, K: kitchen. the same as below

Fig.2: The Indoor Air PM2.5 Level among Three Districts in Beijing(mcg/m3)

Fig3: The Indoor Air SO2 Level among Three Districts in Beijing(mcg/m3)

Graph1: PM10 Level in 24 Hours in A Bedroom in Haidian District in Beijing(in winter)

Graph2: PM2.5 Level in 24 Hours in A Bedroom in Haidian District in Beijing(in winter)

Graph3: PM10 Level in 24 Hours in A Kitchen in Shijingshan District in Beijing(in winter)

Graph4: PM2.5 Level in 24 Hours in A Kitchen in Shijingshan District in Beijing(in winter)

Table 4. Coefficients of Logistic Regression for Respiratory Symptoms and indoor air pollutants and other factors VariablesCoughPhlegmAsthmaBreathe short intercept ** PM PM SO Exp. To Occup. Dust **0.6822* Exp. To Chemicls0.5650** Smoking0.6498**1.0195** * Passive Smoking0.4653** * Much time to Cooking * * * smoke exhauster in kitch ** ** Cooking oil indoors * *: P<0.05, **: P<0.01

An Evaluation Of The Indoor Air Pollution And Respiratory Health Of Farmers in Anhui Province, China Cooperated with Harvard University of USA and World Bank and World Bank

INTRODUCTION more and more people living in urban areas of China spend the greater part of their time indoors, where concentrations of many air pollutants are higher than outdoors, and the health effects maybe the same as that in the urban areas. more and more people living in urban areas of China spend the greater part of their time indoors, where concentrations of many air pollutants are higher than outdoors, and the health effects maybe the same as that in the urban areas. But similar studies in China have scarcely counted indoor air pollution in rural areas and their adverse health effects. But similar studies in China have scarcely counted indoor air pollution in rural areas and their adverse health effects.

INTRODUCTION Now, more than 70 percent of China ’ s populations also live in rural areas and some of them have quite poor living conditions, where respiratory diseases are also the leading cause of death. Now, more than 70 percent of China ’ s populations also live in rural areas and some of them have quite poor living conditions, where respiratory diseases are also the leading cause of death. Nowadays the research on health effects of indoor air pollution in developing countries has been hindered by lack of detailed data about human exposure and adverse outcomes. The basic study should be conducted first. Nowadays the research on health effects of indoor air pollution in developing countries has been hindered by lack of detailed data about human exposure and adverse outcomes. The basic study should be conducted first. In the present study we measured the level of indoor air pollution and examined primarily the related health effects (respiratory symptoms) in rural areas of southeast China. In the present study we measured the level of indoor air pollution and examined primarily the related health effects (respiratory symptoms) in rural areas of southeast China.

Methods Participants Participants The study field covered more than 30 small towns of 4 counties, consisting of lake, plain, hill and mountain areas in Anhui province of China. 189 households (62 from the lake area, 74 from the plains and 53 from the mountain area) were selected randomly to represent various geographic and socioeconomic background of this area. They had similar tribal backgrounds, living habits, and diet. The study field covered more than 30 small towns of 4 counties, consisting of lake, plain, hill and mountain areas in Anhui province of China. 189 households (62 from the lake area, 74 from the plains and 53 from the mountain area) were selected randomly to represent various geographic and socioeconomic background of this area. They had similar tribal backgrounds, living habits, and diet. At the same time, about 500 individuals aged from 15 – 65 yr. from the study households were interviewed by questionnaire for their respiratory health conditions. At the same time, about 500 individuals aged from 15 – 65 yr. from the study households were interviewed by questionnaire for their respiratory health conditions.

Methods Exposure Exposure We did the research in the winter of The level of sulphur dioxide (SO 2 ), particulate matter smaller than 10 μ m in diameter （ PM 10 ） and carbon monoxide (CO) indoors were selected as the index of indoor air pollution for the study. We did the research in the winter of The level of sulphur dioxide (SO 2 ), particulate matter smaller than 10 μ m in diameter （ PM 10 ） and carbon monoxide (CO) indoors were selected as the index of indoor air pollution for the study. We monitored the level of these pollutants in the bedrooms, kitchens, courtyards and the farmlands of the study households in real-time measure, twice a day for two weeks. We monitored the level of these pollutants in the bedrooms, kitchens, courtyards and the farmlands of the study households in real-time measure, twice a day for two weeks. We also interviewed household members about household energy use technology and their time- activity patterns with questionnaire by face-to-face interview. We also interviewed household members about household energy use technology and their time- activity patterns with questionnaire by face-to-face interview.

RESULTS

Table 1. Demographic information of study group MaleFemaleTotal Sex Mean (SD) Age    Education (years) 6.73    4.4 Smokers

Table.2 The level of PM 10, SO 2 &CO indoors/outdoors (Mean  SD) KitchenBedroomYardFarmland N PM 10 (  g/m 3 )518  27*340  9287  9270  10 SO 2 (  g/m 3 )12.4     18 CO (mg/m 3 ) 2.0     4.5# *(t-test, P<0.01, kitchen/bedroom) ； # （ t-test, P<0.01 ， farmland/yard ）

Table.3 Level of indoor air pollutants during cooking and non-cooking time CookingNon-cookingP (T-test) N PM 10 (  g/m 3 )1251   10 <0.001 SO 2 (  g/m 3 )13.9   CO (mg/m 3 ) 3.0   5.5 <0.001

Table.4 the daily time-activity patterns for the subjects （ hours ） MaleFemalet-testP N Bedroom (  s.d)9.59   <0.01 Kitchen (  s.d)1.36   <0.01 Yard (  s.d)2.44   Farmland (  s.d)0.84   Others (  s.d)8.87   <0.01

Table.5 the factors associated with asthma, cough and phlegm (Logistic model) SymptomsVariablesOR95% CIP Asthma attack Using the pesticides often ～ Warming with the charcoal stove ～ 5.03 < PhlegmUsing the pesticides often ～ CoughRoom cleaning often ～ (N ＝ 467)

Table.6 Regression coefficient ( × 1000) of exposure indices to PM 10 and the lung functions Place FVC (n=324)  SE FEV1 (n=325)  SE FEV1% (n=324)  SE Bedroom -11  6-25  7 ** -6  1 ** Kitchen -4  6-2   1 Yard 11  27-2  6 Farmland -37   48-3  8 FVC: forced vital capacity; FEV1: forced expiratory volume in first second **: (P<0.01 ) FEV1%: percentage of forced expiratory volume in first second to forced vital capacity

CONCLUSION

There is quite serious indoor air pollution in the households of the rural areas of China, about 1/3 of them > 450 μ g/m 3 of PM 10. There is quite serious indoor air pollution in the households of the rural areas of China, about 1/3 of them > 450 μ g/m 3 of PM 10. Exposure indices to PM 10 in bedrooms were negatively associated with the level of lung functions of study subjects(P<0.01). Exposure indices to PM 10 in bedrooms were negatively associated with the level of lung functions of study subjects(P<0.01). The one cause of the indoor air pollution in the rural areas comes from the fuel combustion when cooking in kitchen as well as heating in winter. The one cause of the indoor air pollution in the rural areas comes from the fuel combustion when cooking in kitchen as well as heating in winter.

Household fuel Structure and Effect on Indoor Air Quality in Rural North Sichuan Province Cooperated with China Agriculture University in Beijing

Methods The questionnaire and indoor air monitoring were carried out at the same period from May 18 to June 9, 2004, in 3 villages, Shuanglong, Zhaoban, Sifangzui, in north Sichuan Province. The questionnaire and indoor air monitoring were carried out at the same period from May 18 to June 9, 2004, in 3 villages, Shuanglong, Zhaoban, Sifangzui, in north Sichuan Province. Twenty-four-hour averaged PM2.5 concentrations were obtained by using 1.5-liter- per-minute SKC universal sample pumps. 150 families were random selected to monitor the concentration of PM2.5 of kitchen in 5 counties of 3 Province (Sichuan, Hunan, Hubei) Twenty-four-hour averaged PM2.5 concentrations were obtained by using 1.5-liter- per-minute SKC universal sample pumps. 150 families were random selected to monitor the concentration of PM2.5 of kitchen in 5 counties of 3 Province (Sichuan, Hunan, Hubei)

Monitoring methods: PollutantsInstrumentsMonitoring time Sampling time CO XH-3050 Infrared CO Analyzer 9:00, 12:00, 15:00, 18:00 ―― HOBO CO HOBO CO logger 9:00 to next day’s 9:00 24 hours SO 2 QC-1 air sampling instrument 9:00, 12:00, 15:00. 18:00 20 min

PollutantsVillages Samples No. Average concentration Median (mg/m 3 ) Average (mg/m 3 ) Maximum (mg/m 3 ) SO 2 Shuanglong Zhaoban Sifangzui CO Shuanglong Zhaoban Sifangzui The pollution level of SO2 and CO in 3 villages

CountyN PM 2.5 concentration (ug/m 3 ) Temp. ℃ Humid. % air P. (Kpa) Langzhon g ± %96.5 Yilong30 123± %96.6 Nanbu ± %97.7 Enshi30 192± %95.5 Yongshun ± %95.2 Indoor air PM2.5 Level in Rural Areas of Sichuan Province in China (2004.5)

Daily energy consumption in three villages

Discussion Health effects of indoor air pollution should be considered as a factor in evaluation of environmental cost model. Health effects of indoor air pollution should be considered as a factor in evaluation of environmental cost model. Exposure-response relations: the population study on health effects of indoor air pollution remains in primary stage now and there is few on quantitative evaluation for it in China. Exposure-response relations: the population study on health effects of indoor air pollution remains in primary stage now and there is few on quantitative evaluation for it in China. the pollutants and microenvironment indoors are very complicated, so the health effects should be the integrated results caused by both pollutants and microclimates. the pollutants and microenvironment indoors are very complicated, so the health effects should be the integrated results caused by both pollutants and microclimates.

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