The feasibility of an air purifier and secondhand smoke education intervention in homes of inner city pregnant women and infants living with a smoker

Abstract

Objectives Secondhand smoke (SHS) and other air pollutants adversely affect the health of pregnant women and infants. A feasibility study aimed at reducing air pollution in homes of pregnant women or infants living with a smoker was completed. Methods In collaboration with the Baltimore City Health Department, women ≥ 18 years of age and either pregnant nonsmokers, or post-partum (any smoking status) with an infant age 0–12 months were recruited. Homes had at least one smoker. Intervention included two air purifiers and secondhand smoke education. Outcomes included feasibility, change in fine particulate matter (PM2.5), air nicotine, and salivary cotinine pre- and post-intervention. Results Fifty women were enrolled (mean age 27 years, 92% African American, 71% single, 94% Medicaid eligible, 34% reported smoking) and 86% completed the study. Of the 50 women, 32 had infants and 18 were pregnant at time of enrollment. Post- intervention, 70% of participants reported smokers were less likely to smoke indoors, and 77% had at least one air purifier turned on at the final visit. Participant satisfaction was high (91%) and 98% would recommend air purifiers. Indoor PM2.5 was significantly decreased (P < 0.001). Salivary cotinine was significantly decreased for non-smoking women (P < 0.01) but not infants, and no significant change in air nicotine occurred (P = 0.6). Conclusions Air purifiers with SHS education is a feasible intervention in homes of women and infants. These data demonstrate reduction in indoor PM2.5 and salivary cotinine in non-smoking adults. Air purifiers are not an alternative for smoking cessation and a home/car smoking ban. Smoking cessation should be strongly encouraged for all pregnant women, and nonsmoking mothers with infants should be counseled to completely avoid SHS exposure. This study provides support for a future intervention evaluating clinical endpoints.

Impact of road proximity on infants and children with bronchopulmonary dysplasia

“…In addition, most infants and young children spend a high proportion of time indoors, and while we did assess for secondhand smoke exposure, we did not assess for other forms of indoor air pollution, such as combustion byproducts from gas stoves or heat. Other studies completed locally in Baltimore have shown that indoor levels of pollution are often higher than simultaneously measured ambient concentrations . Our analysis also assumes that subjects spent their time at their listed residence and does not account for time spent at other relatives’ homes or daycare.…”

“…Other studies completed locally in Baltimore have shown that indoor levels of pollution are often higher than simultaneously measured ambient concentrations. 31,32 Our analysis also assumes that subjects spent their time at their listed residence and does not account for time spent at other relativesʼ homes or daycare. Another substantial limitation is that our study does not account for subjects moving within the follow-up period, which could certainly change their exposure.…”

Improving indoor air quality, health and performance within environments where people live, travel, learn and work

“…A trend towards an improvement in childhood asthma control test scores and mean evening peak flow rates was also reported. Investigations focusing on the effectiveness of air purifiers to remove secondhand smoke (SHS) has begun with a pilot study deploying HEPA air purifiers in conjunction with SHS education into the homes of nonsmoking pregnant women or post-partum mothers (any smoking status) with infants (0-12 months) 89 . The homes had at least one smoker and the study reported significantly deceased indoor PM 2.5 concentrations and salivary cotinine levels in nonsmoking women (but not infants) but no change in air nicotine concentrations.…”

Residential indoor air quality interventions through a social‐ecological systems lens: A systematic review

“…In such cases, occupants could be conditioned to mitigate the harmful IAQ impacts of cooking by employing natural ventilation (eg, opening windows) in the absence of safety concerns 37 or utilizing local exhaust, if present. 30,54 Community-based organizations can further help enhance such practices through educational interventions for IAQ improvement, as illustrated in Krieger et al 37 and Rice et al 33 Regarding physical strategies, the reviewed articles suggest that poor building characteristics, such as insufficient ventilation and air filtration, limited insulation, and, thus, excessive building envelope infiltration when combined with poor outdoor air quality, contribute to deteriorated IAQ. In Thomas et al, 16 New York apartments that were missing more than 5% of insulation in their exterior wall had a significantly higher ultrafine particle concentration and their indoor/outdoor ratio.…”

“…Individual occupant behaviors have a significant impact on IAQ, which may be adaptive or maladaptive and are mediated by the built environment. Known behaviors that are significant for IAQ include smoking, use of incense and candles, and cooking combined with poor ventilation 16,30‐33 . At times, these behaviors are predicated on the presence (or lack) of building and site affordances, as in the case of building ventilation.…”