Interactions between diesel emissions and gaseous copollutants in photochemical air pollution: Some health implications

A complete assessment of the health effects of diesel emissions must take into account the possible chemical transformations (and associated biological impacts) of particulate organic matter (POM) due to reactions with the many gaseous copollutants which have now been unambiguously demonstrated to be present in atmospheres burdened by photochemical air pollution. These copollutants include the “trace” species, nitric (HNO₃) and nitrous (HONO) acids, the nitrate radical (NO₃), formaldehyde (H₂CO) and formic acid (HCOOH), as well as the criteria pollutants, ozone (O₃) and nitrogen dioxide (NO₂). Techniques for establishing the atmospheric concentrations of the trace pollutants (and their spatial and temporal variations) are briefly described, and we present results of investigations into the reactions of polycyclic aromatic hydrocarbons (PAH) coated on filters and exposed to ambient concentrations of O₃ and NO₂. Environmental health implications of these results are discussed and include the potential for sampling “artifacts” and their possible effects on the correlation (or lack thereof) between ambient PAH levels and urban lung cancer rates, as well as the problems associated with understanding the appropriate POM “dose” to be employed in animal testing and assessments of impacts on human health.     

Modeling indoor air pollution of outdoor origin in homes of SAPALDIA subjects in Switzerland

Given the shrinking spatial contrasts in outdoor air pollution in Switzerland and the trends toward tightly insulated buildings, the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) needs to understand to what extent outdoor air pollution remains a determinant for residential indoor exposure. The objectives of this paper are to identify determining factors for indoor air pollution concentrations of particulate matter (PM), ultrafine particles in the size range from 15 to 300 nm, black smoke measured as light absorbance of PM (PM_absorbance) and nitrogen dioxide (NO₂) and to develop predictive indoor models for SAPALDIA. Multivariable regression models were developed based on indoor and outdoor measurements among homes of selected SAPALDIA participants in three urban (Basel, Geneva, Lugano) and one rural region (Wald ZH) in Switzerland, various home characteristics and reported indoor sources such as cooking. Outdoor levels of air pollutants were important predictors for indoor air pollutants, except for the coarse particle fraction. The fractions of outdoor concentrations infiltrating indoors were between 30% and 66%, the highest one was observed for PM_absorbance. A modifying effect of open windows was found for NO₂ and the ultrafine particle number concentration. Cooking was associated with increased particle and NO₂ levels. This study shows that outdoor air pollution remains an important determinant of residential indoor air pollution in Switzerland.     

Concentrations and determinants of outdoor, indoor and personal nitrogen dioxide in pregnant women from two Spanish birth cohorts

Determinants of outdoor, indoor and personal concentrations of nitrogen dioxide (NO₂) were assessed in a subset of pregnant women of the Spanish INMA (Environment and Childhood) Study. Home indoor and outdoor NO₂ concentrations were measured during 48 h with passive samplers for 50 and 58 women from the INMA cohorts of Valencia and Sabadell, respectively. Women from Sabadell also carried personal NO₂ samplers during the same period. Data on time–activity patterns, socio-economic characteristics, and environmental exposures were obtained through questionnaires. Multiple linear regression models were developed to predict NO₂ levels.In Valencia, median outdoor NO₂ levels (42 µg/m³) were higher than median indoor levels (36 µg/m³). In Sabadell, personal NO₂ showed the highest median levels (40 µg/m³), followed by indoor (32 µg/m³) and outdoor (29 µg/m³) levels. Personal exposure to NO₂ correlated best with the indoor NO₂ levels. Temporal and traffic-related variables were significant predictors for outdoor NO₂ levels. Thirty-two percent of the indoor NO₂ variability in the two cohorts was explained by outdoor NO₂ levels and the use of the gas appliances. The model for personal exposure accounted for 59% of the variance in NO₂ levels in Sabadell with four predictor variables (outdoor and indoor NO₂ levels, time spent in outdoor environments and time exposed to a gas cooker). No significant association was found between personal or indoor NO₂ levels and exposure to environmental tobacco smoke (ETS) at home.Personal NO₂ levels were found to be strongly influenced by indoor NO₂ concentrations. The study supports the use of time–activity patterns along with indoor measurements to predict personal exposure to traffic-related air pollution.     

Effect of cigarette smoking on residential NO2 levels

Two studies evaluating the levels and sources of nitrogen dioxide in approximately 90 employee homes in the Richmond area with continuous sampling during the weeks of August 5, 1980, and February 9, 1981, were performed using samplers in the living room, bedroom, kitchen, and outdoors. Additional data were collected concerning appliance usage, heating/cooling plant, ventilation and cigarette smoking. Results were analyzed using BMDP routines. The largest contributor to NO₂ concentration was found to be gas-fired kitchen appliances. The mean kitchen level for homes with gas appliances during the winter study was 188 μg/m³. Excluding participants with gas kitchens, incremental influence due to cigarette smoking was detected. The 7-day, 3-room average level of NO₂ in the homes of nonsmokers and smokers without gas-fired appliances was 12 and 15 μg/m³, respectively, in the summer. The corresponding winter values were 19 and 22 μg/m³. Furthermore, the individual levels of NO₂ in the homes of smokers were generally below both the adjacent outdoor level and the National Ambient Air Quality Standard limit for annual exposure.     

Inflammatory markers in relation to long-term air pollution

Long-term exposure to ambient air pollution can lead to chronic health effects such as cancer, cardiovascular and respiratory disease. Systemic inflammation has been hypothesized as a putative biological mechanism contributing to these adverse health effects. We evaluated the effect of long-term exposure to air pollution on blood markers of systemic inflammation.We measured a panel of 28 inflammatory markers in peripheral blood samples from 587 individuals that were biobanked as part of a prospective study. Participants were from Varese and Turin (Italy) and Umea (Sweden). Long-term air pollution estimates of nitrogen oxides (NO_x) were available from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Linear mixed models adjusted for potential confounders were applied to assess the association between NO_x and the markers of inflammation.Long-term exposure to NO_x was associated with decreased levels of interleukin (IL)-2, IL-8, IL-10 and tumor necrosis factor-α in Italy, but not in Sweden. NO_x exposure levels were considerably lower in Sweden than in Italy (Sweden: median (5th, 95th percentiles) 6.65 μg/m³ (4.8, 19.7); Italy: median (5th, 95th percentiles) 94.2 μg/m³ (7.8, 124.5)). Combining data from Italy and Sweden we only observed a significant association between long-term exposure to NO_x and decreased levels of circulating IL-8.We observed some indication for perturbations in the inflammatory markers due to long-term exposure to NO_x. Effects were stronger in Italy than in Sweden, potentially reflecting the difference in air pollution levels between the two cohorts.     

Estimation of exposure to atmospheric pollutants during pregnancy integrating space–time activity and indoor air levels: Does it make a difference?

Studies of air pollution effects during pregnancy generally only consider exposure in the outdoor air at the home address. We aimed to compare exposure models differing in their ability to account for the spatial resolution of pollutants, space–time activity and indoor air pollution levels. We recruited 40 pregnant women in the Grenoble urban area, France, who carried a Global Positioning System (GPS) during up to 3 weeks; in a subgroup, indoor measurements of fine particles (PM_2.5) were conducted at home (n = 9) and personal exposure to nitrogen dioxide (NO₂) was assessed using passive air samplers (n = 10). Outdoor concentrations of NO₂, and PM_2.5 were estimated from a dispersion model with a fine spatial resolution. Women spent on average 16 h per day at home. Considering only outdoor levels, for estimates at the home address, the correlation between the estimate using the nearest background air monitoring station and the estimate from the dispersion model was high (r = 0.93) for PM_2.5 and moderate (r = 0.67) for NO₂. The model incorporating clean GPS data was less correlated with the estimate relying on raw GPS data (r = 0.77) than the model ignoring space–time activity (r = 0.93). PM_2.5 outdoor levels were not to moderately correlated with estimates from the model incorporating indoor measurements and space–time activity (r = − 0.10 to 0.47), while NO₂ personal levels were not correlated with outdoor levels (r = − 0.42 to 0.03). In this urban area, accounting for space–time activity little influenced exposure estimates; in a subgroup of subjects (n = 9), incorporating indoor pollution levels seemed to strongly modify them.     

Low-infiltration housing in Rochester, New York: A study of air-exchange rates and indoor air quality

A sample of 58 occupied homes in Rochester, NY, most of which incorporated special builder-designed weatherization components, were studied to assess (1) the effectiveness of construction techniques designed to reduce air leakage; (2) the indoor air quality and air-exchange rates in selected airtight houses, and (3) the impact on indoor air quality of mechanical ventilation systems employing air-to-air heat exchangers. The “specific leakage area” was measured in each house using the fan pressurization technique. Houses built with polyethylene vapor barriers and joint-sealing were as a group 50% tighter than a similar group of houses without such components. Mechanical ventilation systems with air-to-air heat exchangers were installed in nine relatively airtight houses, some of which had gas stoves and/or tobacco smoking occupants. Air-exchange rates and indoor concentrations of radon (Rn), formaldehyde (HCHO), nitrogen dioxide (NO₂), and humidity were measured in each house for 1-week periods with and without mechanical ventilation. More detailed measurements, including concentrations of carbon monoxide and inhalable particulates, were made in two of these houses by a mobile laboratory. In all nine houses, air-exchange rates were relatively low (0.2–0.5 ach) without mechanical ventilation, and yet indoor concentrations of Rn, HCHO, and NO₂ were below existing guidelines. Mechanical ventilation systems were effective in further reducing indoor contaminant concentrations. We conclude that when contaminant source strengths are low, acceptable indoor air quality can be compatible with low air-exchange rates.     

Exposure to long-term air pollution and road traffic noise in relation to cholesterol: A cross-sectional study

BackgroundExposure to traffic noise and air pollution have both been associated with cardiovascular disease, though the mechanisms behind are not yet clear.ObjectivesWe aimed to investigate whether the two exposures were associated with levels of cholesterol in a cross-sectional design.MethodsIn 1993–1997, 39,863 participants aged 50–64 year and living in the Greater Copenhagen area were enrolled in a population-based cohort study. For each participant, non-fasting total cholesterol was determined in whole blood samples on the day of enrolment. Residential addresses 5-years preceding enrolment were identified in a national register and road traffic noise (L_den) were modeled for all addresses. For air pollution, nitrogen dioxide (NO₂) was modeled at all addresses using a dispersion model and PM_2.5 was modeled at all enrolment addresses using a land-use regression model. Analyses were done using linear regression with adjustment for potential confounders as well as mutual adjustment for the three exposures.ResultsBaseline residential exposure to the interquartile range of road traffic noise, NO₂ and PM_2.5 was associated with a 0.58 mg/dl (95% confidence interval: − 0.09; 1.25), a 0.68 mg/dl (0.22; 1.16) and a 0.78 mg/dl (0.22; 1.34) higher level of total cholesterol in single pollutant models, respectively. In two pollutant models with adjustment for noise in air pollution models and vice versa, the association between air pollution and cholesterol remained for both air pollution variables (NO₂: 0.72 (0.11; 1.34); PM_2.5: 0.70 (0.12; 1.28) mg/dl), whereas there was no association for noise (− 0.08 mg/dl). In three-pollutant models (NO₂, PM_2.5 and road traffic noise), estimates for NO₂ and PM_2.5 were slightly diminished (NO₂: 0.58 (− 0.05; 1.22); PM_2.5: 0.57 (− 0.02; 1.17) mg/dl).ConclusionsAir pollution and possibly also road traffic noise may be associated with slightly higher levels of cholesterol, though associations for the two exposures were difficult to separate.     

Air quality management in the WHO European Region — Results of a quality assurance and control programme on air quality monitoring (1994–2004)

Since the last decade the WHO Collaborating Centre for Air Quality Management and Air Pollution Control, Berlin, Germany, operates a quality assurance and control (QA/QC) programme on air quality monitoring in the WHO European Region. As main activity Intercomparison workshops have been established for air monitoring network laboratories on a regular basis to harmonise air quality measurements, analysis and calibration techniques. 36 air hygiene laboratories of public health and environmental institutions of 24 countries participated in twelve Intercomparisons between 1994 and 2004. The majority was carried out for NO, NO₂, SO₂ and O₃. The results were predominantly satisfactory for automatic methods. The results of manual methods were mainly in a good, and for several concentration levels partly very good accordance with the data obtained by the monitors.     

Changing air quality in Delhi,India: determinants,trends, and policy implications

Air pollution is a major environmental problem in urban areas worldwide. Delhi, the capital city of India, is no exception to the universal pattern of deteriorating urban air quality with concentration of pollutants being well above the recommended WHO levels. The magnitude and urgency of the problem as a global environmental issue needs a systematic understanding of the potential causes of pollution and their contribution to air quality. In the present study, ambient air quality data (1987–2006) of SO₂, NO₂, SPM, and RSPM were analyzed to asses the changing air quality in the study area and to evaluate the effect of measures taken to control it. The primary data were collected from 1,583 households to examine the relationship between outdoor and indoor pollution level. Based on the data, the current study concludes that despite the implementation of different pollution-controlling measures, the pollutants, especially the particulate pollutants, were well above the standard limits set by CPCB. Integration between technological and social approach of urban planning is required to mitigate and manage urban environmental problems in sustainable manner.     

Personal exposure monitoring to nitrogen dioxide

Measurement of personal exposure to nitrogen dioxide for short and long term was made with a sensitive NO₂ passive sampler by volunteer housewives and office workers in different seasons. These measurements were compared with the simultaneous measurement of outdoor and indoor concentration of the participants. A common result over all the measurements is the potential effect of using an unvented space heater to increase personal exposure. Mean personal exposure and indoor concentration are higher than outdoor levels elevated by the samples exposed to pollutant produced from the heater. Without an NO₂ source indoors, the mean outdoor concentrations are always highest among the data of measurement. A time-weighted indoor/outdoor activity model gives modestly improved estimates of personal exposure over those predicted from measured indoor concentrations alone.     

Outdoor air pollution and term low birth weight in Japan

IntroductionEvidence has accumulated on the association between ambient air pollution and adverse birth outcomes. However, most of the previous studies were conducted in geographically distinct areas and suffer from lack of important potential covariates. We examined the effect of ambient air pollution on term low birth weight (LBW) using data from a nationwide population-based longitudinal survey in Japan that began in 2001.MethodsWe restricted participants to term singletons (n = 44,109). Air pollution concentrations during the 9 months before birth were obtained at the municipality level and were assigned to the participants who were born in the corresponding municipality. We conducted multilevel logistic regression analyses adjusting for individual and municipality-level variables.ResultsWe found that air pollution exposure during pregnancy was positively associated with the risk of term LBW. In the fully adjusted models, odds ratios following one interquartile range increase in each pollutant were 1.09 (95% confidence interval: 1.00, 1.19) for suspended particulate matter (SPM), 1.11 (0.99, 1.26) for nitrogen dioxide (NO₂), and 1.71 (1.18, 2.46) for sulfur dioxide (SO₂). Specifically, effect estimates for SPM and NO₂ exposure at the first trimester were higher than those at other trimesters, while SO₂ was associated with the risk at all trimesters. Nonsmoking mothers were more susceptible to SPM and NO₂ exposure compared with smoking mothers.ConclusionsAmbient air pollution increases the risk of term LBW in a nationally representative sample in Japan.     

Long-term air pollution exposure and diabetes in a population-based Swiss cohort

Air pollution is an important risk factor for global burden of disease. There has been recent interest in its possible role in the etiology of diabetes mellitus. Experimental evidence is suggestive, but epidemiological evidence is limited and mixed. We therefore explored the association between air pollution and prevalent diabetes, in a population-based Swiss cohort.We did cross-sectional analyses of 6392 participants of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults [SAPALDIA], aged between 29 and 73 years. We used estimates of average individual home outdoor PM₁₀ [particulate matter <10 μm in diameter] and NO₂ [nitrogen dioxide] exposure over the 10 years preceding the survey. Their association with diabetes was modeled using mixed logistic regression models, including participants' study area as random effect, with incremental adjustment for confounders.There were 315 cases of diabetes (prevalence: 5.5% [95% confidence interval (CI): 2.8, 7.2%]). Both PM₁₀ and NO₂ were associated with prevalent diabetes with respective odds ratios of 1.40 [95% CI: 1.17, 1.67] and 1.19 [95% CI: 1.03, 1.38] per 10 μg/m³ increase in the average home outdoor level. Associations with PM₁₀ were generally stronger than with NO₂, even in the two-pollutant model. There was some indication that beta blockers mitigated the effect of PM₁₀. The associations remained stable across different sensitivity analyses.Our study adds to the evidence that long term air pollution exposure is associated with diabetes mellitus. PM₁₀ appears to be a useful marker of aspects of air pollution relevant for diabetes. This association can be observed at concentrations below air quality guidelines.     

Assessment of ambient air quality in Eskişehir, Turkey

This paper presents an assessment of air quality of the city Eskişehir, located 230 km southwest to the capital of Turkey. Only five of the major air pollutants, most studied worldwide and available for the region, were considered for the assessment. Available sulphur dioxide (SO₂), particulate matter (PM), nitrogen dioxide (NO₂), ozone (O₃), and non-methane volatile organic carbons (NMVOCs) data from local emission inventory studies provided relative source contributions of the selected pollutants to the region.The contributions of these typical pollution parameters, selected for characterizing such an urban atmosphere, were compared with the data established for other cities in the nation and world countries. Additionally, regional ambient SO₂ and PM concentrations, determined by semi-automatic monitoring at two sites, were gathered from the National Ambient Air Monitoring Network (NAAMN). Regional data for ambient NO₂ (as a precursor of ozone as VOCs) and ozone concentrations, through the application of the passive sampling method, were provided by the still ongoing local air quality monitoring studies conducted at six different sites, as representatives of either the traffic-dense-, or coal/natural gas burning residential-, or industrial/rural-localities of the city. Passively sampled ozone data at a single rural site were also verified with the data from a continuous automatic ozone monitoring system located at that site. Effects of variations in seasonal-activities, newly established railway system, and switching to natural gas usage on the temporal changes of air quality were all considered for the assessment. Based on the comparisons with the national [AQCR (Air Quality Control Regulation). Ministry of Environment (MOE), Ankara. Official Newspaper 19269; 1986.] and a number of international [WHO (World Health Organization). Guidelines for Air Quality. Geneva; 2000. Downloaded in January 2006, website: http://www.who.int/peh/; EU (European Union). Council Directive 1999/30/EC relating to limit values for sulfur dioxide, nitrogen dioxide and lead in ambient air. Of J Eur Communities L 163: 14–30; 29.6.1999; EU (European Union). Council Directive 2002/3/EC relating to ozone in ambient air. Of J Eur Communities. L 67: 14–30; 9.3.2002.; USEPA (U.S. Environmental Protection Agency). National Ambient Air Quality Standards (NAAQS). Downloaded in January 2006, website: http://www.epa.gov/ttn/naaqs/] ambient air standards, among all the pollutants studied, only the annual average SO₂ concentration was found to exceed one specific limit value (EU limit for protection of the ecosystem). A part of the data (VOC/NO_x ratio), for determining the effects of photochemical interactions, indicated that VOC-limited regime was prevailing throughout the city.     

A badge-type personal sampler for measurement of personal exposure to NO2 and NO in ambient air

A badge-type personal sampler was developed for measuring personal exposure to nitrogen dioxide (NO₂). An absorbent sheet containing triethanolamine (TEA) solution absorbed NO₂ which diffused through five layers of hydrophobic fiber filter. Wind effects on absorption rate were suppressed by these filter layers. NO₂ was measured by the sampler with a sensitivity of 124.8 μg h/m³ (66 ppb h) and an accuracy of within ± 20%. It could be used for measuring personal exposure to NO₂ without interfering with the wearer's daily activities. Nitric oxide (NO) could be measured after a small modification to the sampler provided oxidation ability to the layers of diffusion filter. Three layers of hydrophobic fiber filter were replaced by 12 layers of glass fiber filter containing chromium trioxide solution. NO was oxidized to NO₂ in the oxidation layers and absorbed by the absorbent sheet together with the coexisting NO₂. Sensitivity and accuracy of the sampler for NO were nearly equal to that for NO₂.     

Air infiltration measurements in a home using a convenient perfluorocarbon tracer technique

Using miniature perfluorocarbon tracer (PFT) sources and miniature passive samplers, both about the size of a cigarette, tests conducted in the laboratory and in a typical home successfully demonstrated the utility of the PFT kit as a means for implementing wide-scale infiltration measurements in homes. The PFT diffusion plug source, an elastomer containing a dissolved perfluorocarbon compound, was shown to emit vapors at the rate of about 0.1 to 5 nL/min, providing steady-state concentrations in a home of about 1 to 10 pL/L, i.e., parts per trillion by volume, when one source is deployed for each 300–500 ft² (28–46 m²) of living space. The emission rate from the diffusion source was predictable, but its dependence on both temperature and time suggested the development of alternative approaches. One such alternative, a liquid PFT permeation source, had emission rates which could be tailored over the range 10–20 nL/min, were independent of age for as long as the liquid remained ( 5 yr), and had significantly lower temperature dependence. A number of passive adsorption tube samplers performed reproducibly and identically (to within ±2%–3%) in laboratory tests. Together with a programmable tracer sampler, the miniature diffusion sources and samplers were deployed in a typical home; six PFT sources were uniformly deployed, three on each level of a two-story house. Multiple location sampling, as well as sampling in rooms with and without a miniature source, demonstrated that even in a house without forced-air circulation, a well-mixed modeling approach is justified. Analyses of the tracer samplers were performed back in the laboratory with an automatic electron-capture gas-chromatography system. The effects of the inside/outside temperature differential, as well as that of an open fireplace compared with a wood-burning stove, on the measured air infiltration rates were clearly demonstrated. Comparisons of the PFT tracer method with that of the SF₆ tracer decay approach showed the results of the two methods to be identical within experimental precision. With this miniature source and sampling tracer kit, infiltration rates in the range 0.2–5 air changes per hour can be measured over time-averaged periods of as little as 1 day up to several years.     

An appraisal of emissions control requirements in the California South Coast Air Basin

The purpose of this study is to evaluate the effect of reductions of reactive organic gases (ROG) and NO_x emissions on short-term O₃ and NO₂ concentrations and annual average NO₂ concentrations in the California South Coast Air Basin. Short-term air quality predictions were obtained by applying the Systems Applications Airshed Model to summer O₃ and autumn NO₂ episodes. Effects of emission controls on annual NO₂ concentrations were estimated using CDM and a new parcel tracking model NOXTRAK. Results for the summer O₃ episode indicate that ROG emission reduction in an effective means for reducing peak O₃ concentrations. NO_x emission reduction imposed in addition to ROG emission reductions are counterproductive in reducing peak O₃ concentrations. The modeling results also suggest that attainment of the 1-h federal O₃ standard requires ROG emission reductions on the order of 80% from 1987 levels. Results for the autumn NO₂ episode indicate that NO_x emission reductions approximating those recommended in a proposed Air Quality Management Plan (about 22%) will result in only small (about 5%) reductions in the peak NO₂ concentrations. ROG emission reduction may be more effective than NO_x emission reduction in reducing the peak NO₂ concentration. For the episode studied, a reduction of 36% in ROG emissions is estimated to result in a reduction in peak NO₂ concentrations commensurate with that required to attain the 1-h state NO₂ standard. Model calculations also indicate that the federal NO₂ standard may not be meet by 1987 at one or two stations, but may blosely approached.     

Recent advances in SO2, NOx, and O3 personal monitoring

Since the air pollution as measured by stationary monitoring stations is a poor indicator of the population exposure, personal monitors are indispensible to health effects studies. This article reviews the current research on the development of personal monitors. Although most of the analytical methods reviewed in this study appear to be sensitive to the levels of the target pollutants NO₂, SO₂, and O₃ generally encountered in indoor and outdoor air, they lack the desired performance characteristics for a personal monitoring device, such as user safety and ease of operation, weight, and maintenance. Electrochemical transducers/sensors, which have not yet been exploited, are attractive candidates for the application to personal monitoring. This technique has an added feature of generating real-time measurements. A few research models and commercially attractive devices that can be used in field studies are included.     

Relationships among personal,indoor and outdoor NO2 measurements

Using integrating NO₂ diffusion dosimeters, personal, indoor and outdoor exposures were measured for nine families in Topeka, Kansas. NO₂ exposures in homes that used gas for cooking were clearly different from those in homes that used electricity. The gas-cooking homes had indoor levels three times the outdoor levels. Members of the gas-cooking households had levels twice those of electric-cooking families and twice the outdoor levels. A linear model that includes outdoor concentrations and stove types explains 77% of the variance in observed NO₂ exposure. The differential NO₂ exposures in homes with and without gas stoves should be considered in epidemiologic studies of the health effects of air pollution.