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Health Risks of Indoor Exposure to Particulate Matter: Workshop Summary
David A. Butler, Guru Madhavan, and Joe Alper, Rapporteurs
Board on Population Health and Public Health Practice
Health and Medicine Division

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2016. Health risks of indoor exposure to particulate matter: Workshop summary.
Washington, DC: The National Academies Press. doi: 10.17226/23531.

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PLANNING COMMITTEE ON THE HEALTH RISKS OF INDOOR

EXPOSURE TO PARTICULATE MATTER WORKSHOP1
WILLIAM NAZAROFF (Chair), Daniel Tellep Distinguished Professor,

Department of Civil and Environmental Engineering, University of
California, Berkeley
TERRY BRENNAN, President, Camroden Associates, Inc.
RICHARD CORSI, Chair and Professor, Civil, Architectural, and
Environmental Engineering, The University of Texas at Austin
HOWARD KIPEN, Professor and Director of Clinical Research
and Occupational Medicine, Department of Environmental &
Occupational Health, Rutgers School of Public Health, Piscataway,
New Jersey
TIINA REPONEN, Professor, Department of Environmental Health,
University of Cincinnati College of Medicine and Visiting Professor,
Department of Environmental Sciences, University of Kuopio, Finland
Staff
DAVID A. BUTLER, Scholar
GURU MADHAVAN, Senior Program Officer
ANNA MARTIN, Senior Program Assistant
HOPE HARE, Administrative Assistant
DORIS ROMERO, Financial Associate
ROSE MARIE MARTINEZ, Senior Director, Board on Population
Health and Public Health Practice
REBECCA G. MORGAN, Senior Research Librarian
Consultant
JOE ALPER, Science Writer
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees

are solely responsible for organizing the workshop, identifying topics, and selecting speakers.
The responsibility for the published workshop summary rests with the workshop rapporteurs
and the institution.


Reviewers
T
his workshop summary has been reviewed in draft form by individu-
als chosen for their diverse perspectives and technical expertise. The
purpose of this independent review is to provide candid and critical
comments that will assist the institution in making its published workshop
summary as sound as possible and to ensure that the workshop summary
meets institutional standards for objectivity, evidence, and responsiveness
to the study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the process. We wish to thank the
following individuals for their review of this workshop summary:
George Gray, George Washington University

Petros Koutrakis, Harvard T.H. Chan School of Public Health
Barbara Turpin, University of North Carolina at Chapel Hill
Mark J. Utell, University of Rochester Medical Center
Lance Wallace, formerly U.S. Environmental Protection Agency and
National Institute of Standards and Technology
Although the reviewers listed above have provided many constructive

comments and suggestions, they did not see the final draft of the workshop
summary before its release. The review of this workshop summary was
overseen by Linda McCauley, Emory University. She was responsible for
making certain that an independent examination of this workshop sum-
mary was carried out in accordance with institutional procedures and that
all review comments were carefully considered. Responsibility for the final
content of this workshop summary rests entirely with the rapporteurs and
the institution.
vii


Contents
ACRONYMS AND ABBREVIATIONS xv
1 INTRODUCTION 1
EPA Indoor Environments Division, 3
Conduct of the Workshop, 4
Organization of the Summary, 4
2 SOURCES OF INDOOR PARTICULATE MATTER 7

Indoor Exposures to Outdoor Particulate Matter, 7
Indoor Sources of Airborne Allergens and Smoke, 14
Particle Resuspension in Indoor Environments, 17
Discussion, 22
3 PARTICLE DYNAMICS AND CHEMISTRY 25

A Building Science Perspective on Particle Size Dynamics and
Indoor Concentration, 25
Indoor Chemistry and Aerosols, 30
Composition of Indoor PM and the Influence of SVOC
Partitioning, 33
Discussion, 37
4 CHARACTERIZING INDOOR EXPOSURE LEVELS 41

PM2.5 Exposure Characterization Provides Insights into
Sources and Transformations, 41
Some Determinants of Indoor PM Concentrations and Exposure, 47
ix

x CONTENTS
Socioeconomic Determinants of Indoor PM Exposure, 51

Discussion, 58
5 EXPOSURE MITIGATION 59
Indoor Particle Mitigation with Filtration, 59
Methods and Approaches for Controlling Exposure to
Biological Aerosols, 64
Mitigating Particle Exposure in Low-Socioeconomic Households, 67
Discussion, 71
6 DISCUSSION AND SUMMARY OF DAY 1 73
7 POTENTIAL HEALTH CONCERNS 77

Indoor PM and Cardiovascular Health, 77
Ambient PM and Adverse Birth Outcomes, 82
Neurological and Psychiatric Disorders, 85
Discussion, 88
8 INTERVENTIONS AND RISK COMMUNICATION 93

The Challenge of Communicating Indoor PM Risk, 93
Empowering People to Reduce Indoor PM Exposures, 97
What Could Be Learned from a Benchmark Study, 101
Discussion, 104
REFERENCES 109
APPENDIXES
A Workshop Agenda 123
B Biographical Information: Workshop Speakers 129
C Biographical Information: Planning Committee and Staff 139

Figures and Tables
FIGURES
2-1 Experimental data distribution of indoor/outdoor particle ratios
from 77 studies, 9
2-2 Experimental data distribution of PM2.5 and PM10 infiltration
factors for homes in the United States and Europe, 9
2-3 Infiltration factors for UFPs in Windsor, Ontario, in summer and for
PM2.5 in Edmonton, Alberta, in winter, 10
2-4 Two-week average infiltration factors for PM2.5 in seven U.S. cities
and overall, 10
2-5 Secondhand smoke intrusion into two units above where a smoker
was smoking as measured by 3 personal aerosol monitors, 15
2-6 Sizes of different types of airborne allergens and PM from smoke, 16
2-7 Emission rates of various sources of indoor PM from selected
studies, 18
2-8 Mass concentration of airborne particles during resuspension due to
low- and high-level physical activity as a function of time; and the
suit used to collect the data, 20
2-9 Concentrations of microorganisms in carpet dust resuspended in the
infant breathing zone by a mechanical crawler, 21
3-1 The location and effectiveness of portable air cleaners in removing

indoor PM levels, 28
3-2 Air exchange rate in an unoccupied building over the course of
1 week, 28
xi

xii FIGURES AND TABLES
3-3 Decreasing efficiency of an air filter over time, 29

3-4 Typical chemical composition of indoor air by weight percent of
PM2.5, 34
3-5 Aerosol mass spectrometry data showing the composition of indoor
and outdoor PM, 35
4-1 Indoor and outdoor PM2.5 concentrations and compositions from

homes in Elizabeth, New Jersey, 42
4-2 Indoor-generated sources contributed the majority of PM2.5 in
households in New Jersey and in California, 43
4-3 Comparison of the cumulative probability of indoor concentrations
of indoor sulfate, elemental carbon, and organic carbon between
a mass-balance model assuming no indoor sources and RIOPA
measurements, 44
4-4 Infiltration factors representing the indoor proportion of outdoor
particles, effectively determining the indoor PM concentration in the
absence of indoor sources, 45
4-5 Indoor and outdoor PM10 and PM1 mass concentration
measurements at the roadside and inside a house as a function of
time, 48
4-6 Indoor-to-outdoor particle concentration ratios in Birmingham City
Centre offices by particle size, as characterized by Nano-DMA,
SMPS, and Lasair measuring systems, 49
4-7 Average value and standard error indoor and outdoor PM2.5 and
UFP levels in Bologna, Italy, during three monitoring periods, 50
4-8 Estimated contribution of indoor PM2.5 between the lowest and
highest quartile for categories of AER, smoking, and outdoor air
pollution, 56
4-9 Time spent in various microenvironments as a function of age and
home location, 57
4-10 Real-time PM2.5 levels in a smoker’s housing unit and adjacent
unoccupied unit, 57
5-1 Particle removal effectiveness as a function of filter efficiency, 61

5-2 Particle removal efficiency by filters of different MERV ratings, 62
5-3 Size ranges for different types of bioaerosol particles, 65
5-4 The effect of air sealing on PM2.5 infiltration, 69
7-1 Global public health burdens attributable to 20 leading risk factors

in 2010, 79
7-2 Biological pathways linking PM exposure with cardiovascular
diseases, 80

FIGURES AND TABLES xiii
7-3 Preterm birth rate in and outside the Utah Valley before, during,
and after the Utah Valley Steel Mill temporary close-down, 83
7-4 Effects of PM exposure on the central nervous system, 86
8-1 Risk perception factors influencing public concern, 95

8-2 The Planned Risk Information Seeking Model, 103
TABLES
2-1 Selected Indoor UFP Emission Rates for Combustion and Non-
Combustion Sources in Homes, 13
4-1 Drivers of Exposure Disparities in Indoor Environments, 52

4-2 Representative Housing Variables Associated with Indoor
Environmental Exposures by Household Income, 54
5-1 Characteristics of Continuously Operating HVAC and High-

Efficiency Standalone Filters, 63
5-2 Challenges to Reducing PM in Low-Socioeconomic Homes, 68


Acronyms and Abbreviations
3D three-dimensional
AER air exchange rate

ASHRAE American Society of Heating, Refrigerating, and Air-
Conditioning Engineers
EPA U.S. Environmental Protection Agency
Finf infiltration factor

FPR filter performance rating
HEPA high-efficiency particulate air/arrestor

HVAC heating, ventilating, and air conditioning
IAQ indoor air quality
MERV minimum efficiency reporting value

MPR micro-particle performance rating
NAAQS National Ambient Air Quality Standards
P penetration factor
PM particulate matter
PM2.5 particles less than 2.5 micrometers in diameter (fine
particles)
xv

xvi ACRONYMS AND ABBREVIATIONS
PM10 particles 2.5 to 10 micrometers in diameter (coarse

particles)
qPCR qualitative polymerase chain reaction
RIOPA Relationship of Indoor, Outdoor, and Personal Air (study)
SOA secondary organic aerosol

SVOC semivolatile organic compound
UFP ultrafine particle, particle less than 0.1 micrometers in

diameter
UV ultraviolet

Introduction1
T
he health effects of outdoor exposure to particulate matter (PM)
are the subject of both research attention and regulatory action.
Although much less studied to date, indoor exposure to PM is gain-
ing attention as a potential source of adverse health effects. Indoor PM
can originate from outdoor particles and also from various indoor sources,
including heating, cooking, and smoking. Levels of indoor PM have the
potential to exceed outdoor PM levels (Chen and Zhao, 2011).
The U.S. Environmental Protection Agency (EPA) defines PM as a mix-
ture of extremely small particles and liquid droplets comprising a number
of components, including “acids (such as nitrates and sulfates), organic
chemicals, metals, soil or dust particles, and allergens (such as fragments of
pollen and mold spores)” (EPA, 2003). When considering PM and health,
it is appropriate to consider particulate matter as a class or category rather
than as a single species, said William Nazaroff, the Daniel Tellep Distin-
guished Professor of civil and environmental engineering at the University
of California, Berkeley. Sorting PM along one or more of its important attri-
butes, he said, can assist in clarifying how sources and building parameters
influence exposures and health consequences. Among the possible attributes
useful for thinking about PM, he said, are its size, source, and composition.
1 The planning committee’s role was limited to planning the workshop, and the workshop
summary has been prepared by the workshop rapporteurs as a factual summary of what
occurred at the workshop. Statements, recommendations, and opinions expressed are those
of individual presenters and participants and are not necessarily endorsed or verified by the
National Academies of Sciences, Engineering, and Medicine, and they should not be construed
as reflecting any group consensus.

2 HEALTH RISKS OF INDOOR EXPOSURE TO PARTICULATE MATTER
Nazaroff said that a size classification might consider three clus-

ters: ultrafine particles (UFPs) that are less than 0.1 microns—or 100
nanometers—in diameter; fine particles that are less than 2.5 microns in
diameter (PM2.5); and coarse particles between 2.5 microns and 10 microns
in diameter (PM10). UFPs are found in greater quantities but have negligible
influence on mass concentrations. Outdoors, PM2.5 tends to be dominated
by primary aerosols2 (those that are emitted directly into the air, such as
diesel soot) and the conversion of gaseous species to particulate matter in
the atmosphere. In the latter case, the major air processes in the outdoor
environment include sulfur oxides becoming particulate sulfate, nitrogen
oxides becoming particulate nitrate, ammonia becoming ammonium in
combining with nitrate and sulfate, and organic gases that become oxidized
in the atmosphere into species with lower volatility and higher polarity.
Coarse particles tend to be mechanically generated from such sources as
crustal elements, tire and brake wear, and sea salt near the coasts (Masri
et al., 2015).
Some of the evidence regarding the health effects of PM exposure
derives from large-scale epidemiological studies, Nazaroff said in his intro-
ductory remarks. In the context of this workshop, he said, it is important
to consider the effects of indoor PM—particularly PM2.5—even though the
majority of studies have focused on outdoor PM levels and their impacts.
Understanding the major features and subtleties of indoor exposures to
particles of outdoor origin can improve our understanding of the exposure–
response relationship on which ambient air pollutant standards are based.
Other types of health risk studies also contribute to the overall state
of knowledge. One important category, Nazaroff said, involves studying
sources of PM. Examples include studies of the health risks of exposure to
environmental tobacco smoke, cooking aerosols, and bioaerosols. Nazaroff
said that most of the health-related exposure to PM is believed to occur
through inhalation, and he added that the physiologic response to PM
exposure is complex, nuanced, and involves much more than just the
respiratory tract.
Nazaroff said that another broad theme to consider is the nature of
indoor spaces and how these influence exposures and health risks associated
with indoor PM. The spaces themselves are diverse along many dimensions,
including the type of ventilation system, the density of occupancy, the types
of indoor sources, the presence and quality of particle filtration, and the
rates of particle deposition. In addition, individual behavior can play a pre-
dominant role in determining the ultimate exposure a person experiences,
Nazaroff said. Consequently, indoor conditions that pose a negligible risk
to one person can result in an adverse outcome for another.
2 An aerosol is a suspension of tiny particles or droplets in the air.

INTRODUCTION 3
As a concluding note in his opening remarks, Nazaroff said that the

features that might be considered for a rational public policy address-
ing indoor PM include public education, interventions targeting reduced
exposures for vulnerable populations, and standards or guidelines for the
design and operation of building factors that influence indoor PM levels
and exposures.
EPA INDOOR ENVIRONMENTS DIVISION

EPA does not regulate indoor air. David Rowson, the director of the
agency’s Indoor Environments Division, explained that his division, which
sponsored this workshop, is responsible for providing non-regulatory guid-
ance, technical assistance, outreach, and education programs to protect the
public from harmful exposure to indoor pollutants. This differs from EPA’s
outdoor programs, which work primarily, though not solely, in a regulatory
capacity. The division’s major priorities currently involve pollutants that
present high public health risks and include radon, indoor environmental
asthma triggers, secondhand smoke, mold, and moisture. The division is
also involved with addressing exposure to formaldehyde, polychlorinated
biphenyls, and other chemicals and biological contaminants found indoors.
The division’s non-regulatory activities focus on promoting voluntary inter-
ventions to reduce exposure to specific indoor pollutants of high concern.
Rowson said that the division works to develop solutions that are holistic in
nature and that are intended to address indoor air quality (IAQ) in homes,
schools, and commercial buildings by focusing on their design, construc-
tion, operations, and maintenance. These holistic approaches include an
important focus on PM.
“Providing information to the public on significant sources of indoor
PM and how to reduce exposures is part of our ongoing work,” Rowson
said. However, given the growing body of literature related to indoor PM
and because EPA was already aware that a number of indoor sources of PM
present public health risks, his office commissioned the National Academies
of Sciences, Engineering, and Medicine to hold a workshop examining the
issue of indoor exposure to PM more comprehensively and considering
both the health risks and possible intervention strategies. In particular, this
workshop was held to address the following task:
An ad hoc committee will convene a 1.5-day public workshop on the state
of the science regarding the health risks of indoor exposure to particu-
late matter. The committee will plan and organize the workshop, select
and invite speakers and discussants, and moderate the discussions. The
workshop will feature invited presentations and discussions regarding the
ailments that are most affected by particulate matter and the attributes
of the exposures that are of greatest concern, exposure modifiers, vulner-

able populations, exposure assessment, risk management, and gaps in

the science. An individually authored summary of the presentations and
discussions will be prepared by a designated rapporteur in accordance with
institutional guidelines.
EPA requested that the discussion of the consequences of indoor exposure

to PM give special attention to emerging health concerns and to the popula-
tions that it exercises responsibility for.
CONDUCT OF THE WORKSHOP

The workshop (see Appendix A for the agenda) was organized by an
independent planning committee in accordance with the procedures of the
National Academies of Sciences, Engineering, and Medicine. The planning
committee members were Terry Brennan, Richard Corsi, Howard Kipen,
William Nazaroff (Chair), and Tiina Reponen. The workshop took place
in Washington, DC, on February 10–11, 2016 and was broadcast live over
the Web.
About 60 people attended the workshop in person. The webcast ana-
lytics reported more than 400 unique viewers from 12 countries: Canada,
Finland, France, India, Indonesia, Iran, Ireland, Mexico, Saudi Arabia,
Sweden, the United Kingdom, and the United States (including 38 states and
the District of Columbia). All workshop presentations were subsequently
posted to the Web along with links to videos of the talks.3
ORGANIZATION OF THE SUMMARY

This publication summarizes the discussions that occurred throughout
the workshop. It is divided into seven additional chapters plus supporting
appendixes. Chapter 2 describes the major sources of indoor PM, while
Chapter 3 explores the chemistry and dynamics of PM. Chapter 4 discusses
issues related to exposure levels to indoor PM, and Chapter 5 describes some
of the strategies for mitigating exposure to indoor PM. Chapter 6 recounts
the discussion held among the workshop participants after the workshop’s
first day of presentations. Chapter 7 discusses some of the health risks asso-
ciated with exposure to PM, and Chapter 8 takes up the issue of how to
engage the public in matters related to the risks of exposure to indoor PM.
The workshop agenda is provided in Appendix A. Appendixes B and C pro-
vide biographic information on the speakers and on the planning committee
and staff.
3
See http://www.nationalacademies.org/hmd/Activities/PublicHealth/Health-Risks-Indoor-
Exposure-ParticulateMatter/2016-FEB-10.aspx (accessed July 28, 2016).

INTRODUCTION 5
In accordance with the policies of the National Academies of Sciences,

Engineering, and Medicine, the workshop did not attempt to establish any
conclusions or recommendations about needs and future directions, focus-
ing instead on issues identified by individual speakers and workshop partici-
pants. In addition, the organizing committee’s role was limited to planning
the workshop. The workshop summary was drafted by rapporteur Joe
Alper in collaboration with Academies staff members David A. Butler and
Guru Madhavan as a factual summary of what occurred at the workshop.


Sources of Indoor Particulate Matter
I
n the workshop’s first session, three panelists described some of the
major sources of indoor PM. Brent Stephens of the Illinois Institute
of Technology discussed outdoor air and non-combustion appliances
as important source of indoor PM, Lynn M. Hildemann of Stanford Uni-
versity reviewed the indoor sources of airborne allergens and smoke, and
Brandon E. Boor of Purdue University discussed the importance of particle
resuspension as a source of indoor airborne PM. An open discussion moder-
ated by William Nazaroff followed the three presentations.
INDOOR EXPOSURES TO OUTDOOR PARTICULATE MATTER1

The documented adverse health effects of exposure to outdoor PM
include stroke, heart disease, lung cancer, and chronic and acute respira-
tory diseases, including asthma, reduced lung function, and mortality (EPA,
2009), said Brent Stephens as an introduction to his presentation. These
effects, he added, are associated in varying degrees with the three broad
classes of PM that Nazaroff described in his introductory remarks to the
workshop—PM10, PM2.5, and UFPs—as well as with various chemical
components of PM.
A substantial body of evidence shows that exposure to PM2.5, both
1 This section is based on the presentation by Brent Stephens, assistant professor of civil,
architectural, and environmental engineering at Illinois Institute of Technology, and the
statements are not endorsed or verified by the National Academies of Sciences, Engineering,
and Medicine.

short-term and long-term, is of particular concern with regard to adverse

health effects (Shi et al., 2016). The strength of the underlying science var-
ies, though: some of the links between PM and adverse health effects are
well established, Stephens said, while suggestive evidence exists for others.
A 2012 study by EPA researchers estimated that there were some 130,000
premature deaths per year of exposure that are attributable to elevated
outdoor PM2.5 levels (Fann et al., 2012). Most Americans, however, spend
nearly 90 percent of their time indoors and about 70 percent of their day
at home (Klepeis et al., 2001), so indoor exposure to PM is likely to be an
important contributor to the adverse health effects caused by PM expo-
sure. Indeed, Stephens said, outdoor PM enters into buildings at varying
efficiencies, becoming indoor PM. Several studies have documented the
extent to which human exposure to outdoor PM occurs indoors, including
at home (Kearney et al., 2011; MacNeill et al., 2012, 2014; Meng et al.,
2004; Wallace and Ott, 2011). Outdoor PM enters buildings by infiltrat-
ing through cracks and gaps in the building envelope as well as via natural
ventilation and mechanical ventilation (Chen and Zhao, 2011). Mechani-
cal ventilation is likely to be a bigger source of outdoor PM in commercial
buildings than in homes. Important indoor sources of PM include combus-
tion, candles, and cooking (Isaxon et al., 2015).
A 2011 review of 77 studies covering more than 4,000 homes found
that the average ratio of indoor PM to outdoor PM—where the indoor PM
includes contributions from both indoor and outdoor sources—is approxi-
mately 1.0 for PM2.5 and approximately 0.8 for PM10 and UFPs (Chen and
Zhao, 2011) (see Figure 2-1). “On average in most buildings, the indoor
concentration of PM2.5 is roughly the same as outdoors, but there is signifi-
cant variability,” Stephens said. This same review also looked at the infiltra-
tion factor (Finf)—the ratio of indoor to outdoor PM considering outdoor
sources only—and found a mean value from about 1,000 homes in the
United States and 150 homes in Europe of 0.55 for PM2.5 (see Figure 2-2).
The mean infiltration factors for PM10 and UFPs were approximately 0.3,
though again there was significant variability from home to home for all
three classes of PM. In fact, studies of homes in Canada (Kearney et al.,
2011, 2014) (see Figure 2-3) and the United States (Allen et al., 2012) (see
Figure 2-4) have shown that the fraction of outdoor PM that infiltrates and
persists as indoor PM can range from less than 10 percent to almost 100
percent, depending on the home, the season, and the location.
Several key factors drive this variability in infiltration factors (Allen et al.,
2012; Chen et al., 2012; El Orch et al., 2014; MacNeill et al., 2012, 2014;
Williams et al., 2003). Stephens mentioned that these include ventilation,
either through infiltration, mechanical ventilation, or natural ventilation, and
the magnitude of the air exchange rate (AER), which is driven in part by
meteorological conditions. The airtightness and other characteristics of the

SOURCES OF INDOOR PARTICULATE MATTER 9
FIGURE 2-1 Experimental data distribution of indoor/outdoor (I/O) particle ratios

from 77 studies.
SOURCES: Stephens slide 7, adapted from Chen and Zhao (2011) Figure 2; re-
printed with permission from Elsevier.
FIGURE 2-2 Experimental data distribution of PM2.5 and PM10 infiltration factors
(Finf) for homes in the United States and Europe.
SOURCES: Stephens slide 8, adapted from Chen and Zhao (2011) Figures 3 and 4;
reprinted with permission from Elsevier.
building, as well as the design and operation of the heating, ventilating,

and air conditioning (HVAC) system, contribute to variability, too. Human
behavior is an important contributor—some people open their windows
more frequently than others, for example—and variability also depends on
the sizes and even components of PM. Stephens said there is a need for more
data to fully understand the relative importance of these drivers of infiltration
factor variability.

FIGURE 2-3 Infiltration factors for UFPs in Windsor, Ontario, in summer (left) and
for PM2.5 in Edmonton, Alberta, in winter (right).
SOURCES: Stephens slide 9, from Kearney et al. (2011) Figure 6c (left) and Kearney
et al. (2014) Figure 2 (right). Left figure reprinted with permission from Elsevier.
FIGURE 2-4 Two-week average infiltration factors for PM2.5 in seven U.S. cities
and overall.
SOURCE: Stephens slide 9, from Allen et al. (2012) Figure 1; reprinted with permis-
sion from Environmental Health Perspectives.
Stephens then addressed areas in which less is known about indoor

exposures to outdoor PM, starting with how infiltration factor variabil-
ity contributes to health effect estimates from epidemiology studies. One
modeling study (Chen et al., 2012) constructed a PM10 exposure coefficient
that tried to account for the likely variations in AERs across different
U.S. regions based on housing characteristics, climate conditions, seasons,
window opening behaviors, and HVAC runtime. This coefficient—which
represents the change in total PM10 exposure per unit change in outdoor
PM10 exposure—correlated reasonably well with estimates of the increase

in short-term mortality associated with a given increase in the concentration

of PM10 (PM10 mortality coefficients) derived from epidemiology studies,
Stephens said. “If you try to account for the underlying indoor exposure
to outdoor PM based on some key drivers of variability, you can explain
many of the differences in mortality coefficients.”
A 2013 study by Hodas and colleagues took a similar approach in order
to relate indoor levels of outdoor PM2.5 with acute myocardial infarction
based on a ranking of AERs derived from housing characteristics. These
investigators found a higher odds ratio in homes with higher AERs, which,
Stephens said, would have higher indoor levels of outdoor PM (Hodas et
al., 2013). Another study (Sarnat et al., 2013) that examined the relation-
ship between AERs, exposure to PM2.5, and emergency department visits in
Atlanta, Georgia, found that higher AERs were correlated to some extent
with the relative risks of PM2.5 exposure and emergency department visits.
What Stephens called the elephant in the room is the impact on AERs
of how often people open their windows. “You could not ask a simpler
question, but we do not have much data on this,” he said. Some investiga-
tors have conducted pilot studies (El Orch et al., 2014; Johnson and Long,
2004; Price and Sherman, 2006) in which they asked people how often
they opened their windows, but Stephens said these data are limited and
somewhat suspect. Nevertheless, his group and others have tried to use
these data to model what the distributions of window opening might be
and to estimate how AERs vary with open windows (Chen et al., 2012;
El Orch et al., 2014; Johnson and Long, 2004; Marr et al., 2012). The rule
of thumb from these analyses is that AERs are approximately two to four
times higher when windows are open, but Stephens said that these exchange
rates will depend on how open a window is, the difference between the
indoor and outdoor temperatures, and meteorological driving conditions
such as wind speed and direction.
More data are also needed to better understand the underlying mecha-
nisms governing infiltration factors for outdoor particles, Stephens said.
There are other factors that affect infiltration, such as the penetration fac-
tor (P), which describes how effective the building envelope is at prevent-
ing particle infiltration. When windows and doors are closed, and absent
mechanical ventilation, the penetration factor multiplied by the AER equals
the rate at which outdoor PM is delivered indoors. Particles are removed
from indoor air by a combination of air exchange and a variety of loss
mechanisms which include deposition to surfaces, phase changes, and con-
trol by filters and air cleaners. For conditions in which air exchange only
occurs through infiltration, the particle infiltration factor equals the product
of the AER and the penetration factor divided by the sum of the AER plus
and the other loss mechanisms:

P × AER
Fint = .
AER + Loss
Modeling work (Liu and Nazaroff, 2001) has defined some of the
physical parameters, such as particle size, that influence the penetration
factor. Subsequent studies have measured the relationship between particle
size and penetration (Rim et al., 2010; Stephens and Siegel, 2012) and have
shown that mid-size particles, around 0.3 microns in diameter, tend to
penetrate more efficiently than larger and smaller particles. Stephens cau-
tioned, though, that these data are highly variable and that they come from
fewer than 50 homes. In the case of PM2.5, the penetration factor has been
estimated in hundreds of homes but seldom, if ever, actually measured. He
said that the technology for measuring particle penetration is challenging
to use—one approach developed to measure UFP penetration, for example,
takes 2 days to complete a measurement in an unoccupied house (Rim et
al., 2010).
Other unknowns, Stephens said, include the associations between infil-
tration or penetration factors and building characteristics, though there
are some data for the association between air conditioner usage, year of
construction, and envelope tightness (Allen et al., 2012; MacNeill et al.,
2012; Stephens and Siegel, 2012). His research group is currently trying
to measure how the penetration factor changes after buildings undergo
retrofitting. Little is known about how chemical transformations, such as
evaporative losses, affect infiltration factors, and data are lacking concern-
ing the spatial and temporal resolution of outdoor PM size distributions
and outdoor size-resolved aerosol composition.
Summarizing research needs in the area of outdoor PM transport to
indoors, Stephens said that there is a need for more integration between
epidemiologists and exposure scientists, building scientists, and indoor air
scientists. This would help address exposure misclassification and improve
health effect estimates. He added that more data are needed on window
opening frequencies and their impact on air exchange rates. And, more field
measurements are needed for UFP and PM2.5 penetration factors and how
they are associated with building design characteristics.
Turning briefly to the subject of indoor sources of PM, Stephens said
that there are several non-combustion sources that emit mostly UFPs,
including vacuum cleaner bags, steam irons, laser printers, and desktop 3D
printers. Recently, researchers found that semivolatile organic compounds
(SVOCs) can be deposited on cooking pans and other surfaces, which when
heated will produce UFPs (Wallace et al., 2015). While it is good to know
the sources of indoor PM, it is more important to know the rates at which
these various sources emit PM, and a number of investigators (Afshari et

TABLE 2-1 Selected Indoor UFP Emission Rates for Combustion and
Non-Combustion Sources in Homes
Size Range Emission Rate
UFP Emitting Device (nm) (#/min) Reference
Flat iron with steam 20-1,000 6.0×109 Afshari et al. (2005)
Electric frying pan 10-400 1.1-2.7×1010 Buonnano et al. (2009)
3D printer w/PLA 10-100 ~2.0×1010 Stephens et al. (2013)
Vacuum cleaner 20-1,000 3.5×1010 Afshari et al. (2005)
Scented candles 20-1,000 8.8×1010 Afshari et al. (2005)
Gas stove 20-1,000 1.3×1011 Afshari et al. (2005)
3D printer w/ABS 10-100 ~1.9×1011 Stephens et al. (2013)
Cigarette 20-1,000 3.8×1011 Afshari et al. (2005)
Electric stove 20-1,000 6.8×1011 Afshari et al. (2005)
Frying meat 20-1,000 8.3×1011 Afshari et al. (2005)
Radiator 20-1,000 8.9×1011 Afshari et al. (2005)
Desktop 3D printers 10-100 ~108 – ~1012 Azimi et al. (2016)
Laser printers 6-3,000 4.3×109 – 3.3×1012 He et al. (2010)
Cooking on a gas stove 10-400 1.1-3.4×1012 Buonnano et al. (2009)
NOTES: Highlighted items are combustion-related; all other items are non-combustion
sources. PLA and ABS are thermoplastics used as 3D printer feedstock.
SOURCE: Stephens slide 21.
al., 2005; Buonanno et al., 2009; He et al., 2010) have measured emission
rates (see Table 2-1). For example, Stephens and his colleagues recently
measured the rate of PM and volatile organic compound emissions from
desktop 3D printers and found UFP emission rates of between 108 and 1012
particles per minute (Azimi et al., 2016).
In closing, Stephens said that researchers continue to find new sources
of indoor PM and that it is essential to continue to gather emission rate
data, including size-resolved emission rate data, for these and other sources.
In the future, it will also be important for the field to continue to explore
source control and strategies for mitigating exposure to indoor sources of
PM.

INDOOR SOURCES OF AIRBORNE ALLERGENS AND SMOKE2

Combustion is a major source of indoor PM, Lynn Hildemann said,
and the vast majority of combustion PM is submicron in size and includes
a substantial number of UFPs. Combustion PM consists of a wide variety
of organic compounds along with varying amounts of soot, depending on
the combustion process and source. Hildemann noted that the physical and
chemical characteristics of some sources of indoor PM—including cigarette
smoke (Fernandez et al., 2015), incense burning (Wang et al., 2006), and
wood combustion in stoves and fireplaces (Heringa et al., 2011)—have been
well characterized.
The combustion and heating sources of indoor PM that need more
study include cooking, natural gas stoves and ovens, and electronic ciga-
rettes. The indoor PM emission rate from cooking, for example, depends
greatly on the food being cooked, the cooking method (whether the food
is being grilled, fried, baked, or sautéed and the type of cooking oil being
used, for example), and the type of ventilation. Hildemann said that only
a fraction of the people who have ventilation fans above their stoves actu-
ally turn them on in a consistent manner. She added that burning food can
very quickly introduce large quantities of PM into the indoor environment.
Natural gas stoves and ovens emit mainly UFPs, but how long they persist
in indoor air is unclear, and their chemical composition is not well charac-
terized (Minutolo et al., 2008).
Electronic cigarettes are a relatively new source of indoor PM, and it
is clear from the literature, Hildemann said, that UFPs can form from the
condensation of the organic chemicals in electronic cigarette emissions
(Blair et al., 2015; Fernandez et al., 2015). The sizes and re-evaporation
rates of these particles depend on the dilution conditions, she said. One
shortcoming of available studies is that the measurements have been made
under controlled laboratory conditions. “I don’t think there is information
out there that I yet trust that reflects what might be seen if you were indoors
with someone smoking an electronic cigarette,” Hildemann said.
Secondhand smoke can be a significant source of indoor PM in multi-
unit housing, she said. “If you live in an apartment or condominium and
you have neighbors next door or underneath you who smoke, infiltration
of secondhand smoke into your unit can be quite substantial,” Hildemann
said. She explained that secondhand smoke can infiltrate from outdoor
areas, such balconies, patios, and open windows; through walls and ducts;
and via ducts that can move air from one residence to the next. For exam-
ple, in one study she and her colleagues collected PM from two units before,
2 This section is based on the presentation by Lynn Hildemann, a professor of civil and
environmental engineering at Stanford University, and the statements are not endorsed or
verified by the National Academies of Sciences, Engineering, and Medicine.

during, and after someone a floor below had smoked a cigarette (Dacunto
et al., 2013), and they were able to demonstrate that 98 to 100 percent of
the elevated PM2.5 was from secondhand smoke (see Figure 2-5).
One area that needs more study, Hildemann said, is the relationship
between exposure to combustion emissions and the proximity to the source.
When indoor combustion is occurring under conditions of natural ventila-
tion, PM will not disperse immediately throughout the indoor environment,
she explained. The question is, How bad is it to be close to an active com-
bustion source? One experiment found that exposure to PM within 1 meter
of the source can be 10- to 20-fold higher under normal conditions than
what the exposure would be in a well-mixed environment (Acevedo-Bolton
et al., 2012). Moreover, while the average concentration indoors is lower
with higher ventilation rates, the proximity enhancement is higher because
ventilation decreases the well-mixed average concentration of PM but has
a smaller effect on the cloud of emissions close to the combustion source.
FIGURE 2-5 Secondhand smoke intrusion into two units [A, M] above where a
smoker was smoking as measured by 3 personal aerosol monitors [SP6, SP7, SP8;
calibration factor (CF) = 0.3].
SOURCE: Hildemann slide 5, adapted from Dacunto et al. (2013) Figure 2; re-
printed with permission from Elsevier.

The proximity effect is particularly important, Hildemann said, for

short-duration sources, in cases where emissions consist mainly of large PM
that quickly settles out of the air before it can be transported, and with UFP
emissions, which are removed rapidly through coagulation. One implica-
tion of these physical phenomena, she said, is that standing close to a stove
in use will result in higher exposures to stovetop PM emissions than would
be the case for room-average conditions.
The indoor environment can also be a rich source of allergens,
Hildemann said. Pets can be a significant source of shed skin flakes, or
dander, which by itself can be an allergen because of its dog or cat saliva
content. Dander also contains bacteria that can be allergenic. Various com-
ponents of house dust, such as mold spores, bacteria, mite proteins, and
cockroach proteins, can be allergenic, and dust is readily resuspended by
vacuuming and other human activities. Damp surfaces can harbor molds
and bacteria that can be resuspended, and, Hildemann noted, the levels of
certain molds and fungi, such as those belonging to the genera Aspergillus
and Penicillium, tend to be higher indoors than outdoors.
Compared to smoke particles, airborne allergens span a large range of
sizes (see Figure 2-6). Mite allergen particles, for example, can come from
mite feces or pieces of molted exoskeleton. What this size variation means
as a practical matter, Hildemann explained, is that there will be a wide
range of airborne residence times for indoor allergens, and there will be
variability in terms of where these allergens deposit in human lungs. PM10,
she said, clears from the lungs in hours, whereas PM2.5 and UFPs can take
weeks to clear.
FIGURE 2-6 Sizes of different types of airborne allergens and PM from smoke.
SOURCE: Hildemann slide 10.

House dust is an important source of PM, Hildemann said, and vacu-

uming is good way to increase exposure to PM2.5. Unpublished work from
her laboratory found that PM2.5 levels increase two- to five-fold during
vacuuming, with the variation resulting largely from how well the exhaust
filter fits in the filter frame.
Addressing areas that need further research, Hildemann said that little
is known about the factors affecting the emission rates of bacteria and fungi
from damp surfaces. Airflow, vibration, and material type are thought to
play some role in determining the rate at which these organisms become
airborne from damp surface, but the main challenge in learning more about
these processes, she said, is that researchers are still not sure how to accu-
rately estimate emission rates from damp surfaces. Additional studies would
be useful to understanding how individual activity patterns and gender
influence exposure to allergens.
As a final thought, Hildemann said she wondered what the impact of
global climate change would be on indoor PM exposures. One concern
she has is that more homes will be sealed tightly to reduce the cost of air
conditioning, which would lower the AER and allow indoor PM emissions
to build up to higher levels. Homes that are more tightly sealed will also
have higher humidity levels, creating more hospitable conditions for molds,
some bacteria, and mites.
PARTICLE RESUSPENSION IN INDOOR ENVIRONMENTS3

Every person is surrounded by a cloud of particles, Brandon Boor
said, and the fundamental process for creating that cloud is resuspension.
Particles resuspend when they detach from surfaces; are exposed to various
removal forces, such as aerodynamic lift and drag, surface vibration forces,
and electrostatic forces; and then become airborne. Human-induced particle
resuspension, he said, is associated with various activity patterns and dif-
ferent types of movements—walking and crawling across a carpeted floor
will resuspend particles, as will turning over in bed—and the concentration
of resuspended particles is linked to the number of people in a room and
how much they move around. Occupants can be exposed to resuspended
particles as a result of resuspension they themselves cause or by resuspen-
sion induced by others in their workplace or home.
Particle resuspension from walking is an important indoor source of
PM, with PM10 emission rates ranging from 1 to 10 milligrams per min-
ute (Qian et al., 2014) (see Figure 2-7). To put that into perspective, Boor
3 This section is based on the presentation by Brandon E. Boor, assistant professor of civil
engineering at Purdue University, and the statements are not endorsed or verified by the
National Academies of Sciences, Engineering, and Medicine.

FIGURE 2-7 Emission rates of various sources of indoor PM from selected studies.
SOURCES: Boor slide 4, from Qian et al. (2014) Figure 1 [references in original
publication]; reprinted with permission from Elsevier.
estimated that, based on typical activity patterns, a typical person would

resuspend 10 to 100 kilograms of dust (PM10) over a lifetime. House dust,
as Hildemann discussed, is a significant source of various allergens, but
it is also a reservoir for many SVOCs, such as phthalates and organo-
phosphates. One area of concern that Boor mentioned was the exposure
of infants to PM in the near-floor environment as they crawl and play on
carpeted surfaces.
Boor said that seminal studies on particle resuspension over the past 20
years, including work by Thatcher and Layton (1995) and Qian and Ferro
(2008), have used a material-balance model to mechanistically evaluate
particle resuspension from indoor surfaces. Resuspension rates and frac-
tions can be determined by measuring the size-resolved concentration of
particles in the air and on a surface as well as the frequency of movement.
Resuspension is then linked to exposure through airborne particle transport
processes and airflow patterns that create some concentration of PM in the
breathing zone.
With regard to dust, Boor said that there are many studies in which
various sources of household dust have been collected and analyzed for its
microorganism content (Adams et al., 2015; Barberán et al., 2015) and
SVOC content (Blanchard et al., 2014; Dodson et al., 2015; Weschler and
Nazaroff, 2010). Some of these studies have calculated dust loads on indoor
surfaces, which can range from light dust loads of less than 0.1 gram per
square meter of surface from a mattress to as high as 100 grams per square
meter from carpeting or ventilation ducts. Few studies, however, charac-

terize the size distribution, either by number, volume, or mass fraction, of

settled dust particles—something that Boor said needs to be addressed by
future research to improve our mechanistic understanding of resuspension.
Collecting dust is not as simple as it sounds, Boor said. Dust often
consists of fragile agglomerates of smaller particles that can fall apart
during collection, which would shift the observed size distribution. Other
aspects of research on dust are also challenging. “The structure of dust is
complex and something we know little about,” Boor said. Dust deposits, he
added, can be compact or fluffy, depending at least in part on how they are
deposited on a surface and how they are altered by compression or clean-
ing activities. They can also agglomerate in myriad ways to form a variety
of shapes. Biological particles—such as single bacterial cells and aggregates
of bacterial cells, pollen grains and fragments, fungal spores and fungal
fragments, and abiotic particles (for example, mineral dust) with attached
microbes—come in a spectrum of shapes and sizes (aerodynamic diameter),
with complex surface features and varying electrostatic charge, Boor said.
Dust adhesion plays an important role in resuspension, yet most studies
have been narrowly focused on spherical particles adhering to flat surfaces,
and neither spherical particles nor flat surfaces reflect the indoor reality.
“Indoors, we have non-spherical particles and complex surfaces such as
fabric fibers, clothing, bedding material, and carpet fibers, and there are
very few data on particle adhesion to different types of fabric fibers,” Boor
said. Fabric fibers, for example, come in intimate contact with the human
body and accumulate moisture and skin lipids, which may affect particle
adhesion over time. Particles may become embedded to varying degrees
in different kinds of fibers, and little is known about the role that process
would play in resuspension. The loosely bound fibers of a shirt or pillow
cover also behave differently when exposed to movement, which may affect
resuspension processes in ways that are still largely unknown.
There is a better understanding of how different human activities
affect resuspension, Boor said. One study of walking, for example, used
a mechanical foot in a small test chamber to measure resuspension from
different types of flooring materials (Tian et al., 2014) and found that for
particles greater than 1 micron, more particles come off of carpet than
from hard flooring. Boor participated in a study that looked at the human-
induced resuspension of mattress dust particles as a function of dust load,
ventilation rates, and type and intensity of movement (Boor et al., 2015).
Movement on a bed stirs up dust, he said, and the breathing zone concen-
tration of dust particles remains elevated throughout the duration of the
movement and decays slowly, leading to exposures that last beyond the
period of movement—for example, as one falls asleep and lies still in bed.
He and his colleagues also found that the resuspension rate increases with
particle size, which he attributes to the increase in the magnitude of detach-

ment forces, such as aerodynamic lift and drag and surface vibration, that
accompanies an increase in particle size. The body mass of the volunteers
who participated in study had little effect on resuspension rates, though the
intensity of the movement, as characterized by surface vibrations, did have
a large effect on the resuspension rate.
Another route of exposure to dust is dust becoming detached from
clothing. One study found that as much as 25 percent of the particles depos-
ited on a cleanroom suit detached while a volunteer was dancing to an Irish
reel, which was considered a high-level of physical activity (McDonagh
and Byrne, 2014a). Particle detachment was some 10-fold lower when
the volunteer was engaged in a low-level physical activity (see Figure 2-8).
Larger particles were displaced more than smaller particles (McDonagh
and Byrne, 2014b).
As Boor had mentioned earlier, the effect of an infant crawling on the
near-floor microenvironment is not well characterized, so in a recently
completed study he and colleagues in Finland built a simplified mechanical
crawling infant and used it to measure airborne particle concentrations as
it scuttled across 12 area carpets borrowed from Helsinki residents. Boor
also sent samples of the collected real-world dust that had been resus-
pended from these carpets to a microbiologist, Martin Täubel, for analysis
using quantitative polymerase chain reaction (qPCR) and next-generation
genome sequencing. Optical measurements showed large bursts of particles
across the range of particle sizes (UFPs, PM2.5, and PM10) and indicated
that the particles remained suspended in the air for a significant amount of
time. The qPCR data revealed a large variation in the microbial concentra-
FIGURE 2-8 Mass concentration of airborne particles during resuspension due

to low- and high-level physical activity as a function of time; and the suit used to
collect the data.
SOURCES: Boor slide 22, from McDonagh and Byrne (2014a) Figures 1 and 2;
reprinted with permission from Elsevier.

FIGURE 2-9 Concentrations of microorganisms in carpet dust resuspended in the

infant breathing zone (BZ) by a mechanical crawler (qPCR data analyzed by M.
Täubel).
SOURCE: Boor slide 26.
tions and composition in the infant breathing zone (see Figure 2-9). Boor
proposed that there be more focus in characterizing this kind of cloud of
particles and microbes around infants as they crawl.
While qPCR data are useful, it requires hours of dust collection on a
filter to accumulate detectable amounts of microbial DNA. Another use-
ful technique, which has been applied in Nazaroff’s laboratory, is using
laser-induced fluorescence to characterize bioaerosol concentrations and
size distributions in real time. Boor and his colleagues in Finland used
this technique to show that both crawling and walking triggered a burst
of resuspended fluorescent particles from carpeting but that particle decay
occurred more quickly in the infant breathing zone after crawling than
in the adult breathing zone after walking. Boor mentioned some recent
work using fluorescent and optical signatures to distinguish among bac-
teria, fungi, and pollen in real time (Hernandez et al., 2016) and said he
thought it would be interesting to conduct that type of analysis on particles
resuspended by human activity. He also proposed using high-speed imag-
ing to follow the trajectories taken by individual dust particles as they are

dislodged by human activity from various indoor surfaces—something that

has been done with micrometer spherical glass beads (Kassab et al., 2013).
This type of work, Boor said, proves the importance of looking not
just at resuspension, but also as the transport of particles to the breathing
zone. As his work and that of others (Shalat et al., 2011) have shown,
concentrations of PM are much greater near the floor than they are at the
level of the typical stationary monitoring site used in indoor field measure-
ments. Boor also cited the results of a modeling study showing that, while
walking, shorter people will be exposed to more influenza virus particles in
dust resuspended into their breathing zones than will taller people (Khare
and Marr, 2015). What is needed to create a full, holistic picture of particle
resuspension, Boor said in closing, are integrated measurements of particle
resuspension to the breathing zone across all scales, from small-scale wind
tunnel and chamber studies to full-scale controlled chamber studies and
field measurements in offices and homes.
DISCUSSION
Nazaroff started the discussion by asking the panelists to offer their
opinions on what they see as the biggest gaps in two areas: the gap between
what is known and what needs to be known, and the gap between what
experts in the field know and what they actually do in practice. Hildemann
responded that she would like to see more attention paid to the roles that
building design in general and ventilation in particular play in influenc-
ing indoor air quality. Stephens said he believes that more information is
needed to understand how real-life exposures to PM relate to the epidemi-
ology of health effects in order to better inform practice and regulation.
Other priorities, he said, should be to develop approaches for reducing
exposures to PM within the nation’s large existing building stock and to
create a labeling scheme for devices—he specifically mentioned desktop 3D
printers—that would inform consumers what these devices are emitting into
the indoor environment. “There are ways that government and industry
consortia could help improve public knowledge,” Stephens said.
Boor agreed that translating research results into useful information for
the public is something the field needs to address, particularly with regard
to helping parents limit exposure of infants to PM and to various gaseous
species such as SVOCs. Barbara Turpin from the University of North Caro-
lina singled out the need for better advice for the public on when to increase
versus decrease ventilation in order to decrease PM exposure. Hildemann
added that the same could be said of vacuuming, and she said that one
question consumers could have is whether to vacuum more to reduce the
resuspension of particles between vacuuming or to vacuum less because
of the exposure to high concentrations of particles during vacuuming.

However, she said, the real solution would be to not have carpeting in the
home because hardwood and tiled floors are more efficiently cleaned and
the resuspension rates from walking on such flooring are much lower than
from walking on carpeting. Boor said that he had examined the effect of
vacuuming on particle resuspension in his mechanical infant crawling study
and found that vacuuming prior to crawling had little effect on particle
concentrations in the infant breathing zone.
Tiina Reponen from the University of Cincinnati, commenting on the
work on bioaerosols that Hildemann and Boor had discussed, reiterated
that bioaerosols are an important component of both indoor and outdoor
PM. She then said that there are studies of bioaerosols emitted from damp
surfaces showing that microbes are released more readily into dry air than
into humid air and that increased airflow and vibration increase microbial
release from surface. More importantly, she said, these studies have shown
that small fragments of microbes are also released, so it is important to
look for biological components in the smaller size fractions of PM as well
as in the large fractions.
Howard Kipen from Rutgers University noted that while EPA regulates
outdoor PM levels based on a substantial and sustained epidemiologic
database linking outdoor PM levels with a wide range of adverse health
effects, there needs to be work done to determine the health consequences
of outdoor PM translated to indoor exposures, given that Americans spend
90 percent of their time indoors and that 50 percent of indoor PM comes
from outdoor sources. “We need to do that to be able to decide whether
the interventions we can demonstrate are going to protect health,” Kipen
said. Charles Weschler from Rutgers University said he would argue that
since the bulk of exposure to outdoor PM particles occurs indoors, more
is known about the risk of indoor exposure to outdoor PM than is known
about the risk of outdoor exposure to outdoor PM or indoor exposure to
PM of indoor origin. Kipen replied that he agreed with Weschler but that
that fact is not actualized in regulation.
Boor, also responding to Kipen’s remarks, said that one opportunity
to get better data on indoor PM2.5 and UFPs would be to explore the use
of commercially available, relatively low-cost particle sensors on a broad
scale. Today, he said, relatively inexpensive optical monitors can detect
larger particles accurately, but work still remains to test the accuracy of
devices in measuring PM2.5 and UFPs and to develop portable devices that
could be used to create sampling networks in multiple environments. “If
we push in that direction,” he said, “we could build large-scale databases
of size-resolved PM levels.”
Joe Hughes from IAQ Radio said that from his perspective one of
the biggest gaps of knowledge concerns the value of mechanical systems
cleaning. He noted that the information being used to advise consumers on

whether to have their air ducts cleaned relies on a 1997 EPA report. Hughes
also supported Boor’s call to develop inexpensive ultrafine particle coun-
ters that could be deployed in the field. William Fisk from the Lawrence
Berkeley National Laboratory remarked that panelists had not addressed
three categories of indoor PM sources that need further study: the outdoor
air as a source of allergens and inflammatory agents; the wetted surfaces in
HVAC systems; and episodic outdoors sources such as wood combustion
and wildfires.
An online participant asked the panelists if there were data on the con-
tribution that cleaning product residues make to indoor PM and whether
these residues alter the resuspension of other particles. Boor said he did not
know of any studies looking at cleaning residues, and Hildemann said she
thought that more work is needed to answer those questions. She did say
that some proportion of the droplets produced by spray cleaning products
do not reach a surface and that as the carrier solvents evaporate, they leave
behind airborne particles of wax and other substances. She also explained
that the enzymes in laundry detergents can be detected in active form in
dryer lint after clothes have been washed and dried. As a result, in addition
to dust coming off of clothing, there may also be some allergenic material
in the form of active enzymes. Kipen added that one of the most interesting
findings in occupational asthma epidemiology research over the past decade
has been that people who do indoor cleaning for a living have increased
rates of asthma. He noted, too, that there are suggestions that this finding
extends to people who are non-occupational users of cleaning products.
Stephens said that the challenge is going to be to develop a connection
between knowledge of physics, chemistry, and biology and the epidemiol-
ogy pointing to adverse health effects.

Particle Dynamics and Chemistry
T
he workshop’s second session featured three presentations on the
transport, fate, and transformation of indoor PM. The session mod-
erator, Richard Corsi of The University of Texas at Austin, explained
that the discussions in this session would serve as a link between the first
session on sources and the following session on exposure. He noted that
mitigation strategies can have a huge effect on particle dynamics—an idea
relevant to the presentation of the first speaker, Jeffrey Siegel of the Uni-
versity of Toronto, who provided a building-science perspective on the
dynamics of particle size and concentration indoors. After Siegel’s presenta-
tion, Glenn Morrison of the Missouri University of Science and Technol-
ogy discussed indoor chemistry and aerosols, and then Charles Weschler
of Rutgers University described the composition of indoor PM and the
influence of SVOC partitioning on that composition. An open discussion
moderated by Corsi followed the three presentations.
A BUILDING SCIENCE PERSPECTIVE ON PARTICLE SIZE

DYNAMICS AND INDOOR CONCENTRATION1
Jeffery Siegel focused on how a building influences particle size and the
concentrations of PM indoors through its effects on particle sources and
sinks and on how little is known about these effects. “Our knowledge of the
1 This section is based on the presentation by Jeffrey Siegel, a professor of civil engineering
at the University of Toronto, and the statements are not endorsed or verified by the National
Academies of Sciences, Engineering, and Medicine.
25

fundamental characteristics of buildings is insufficient to fully understand

indoor aerosol exposure,” Siegel said. The main sources of indoor PM,
as discussed in the previous session, include combustion and heating pro-
cesses, resuspension from indoor activities, secondary organic aerosols, and
penetration from outdoors, and Siegel said that research on these sources
has produced a significant body of literature on the size distribution and
emission rate for these sources. Cooking on both gas and electric burners,
for example, has been well studied as a source of indoor PM (Wallace et
al., 2008). The four main sinks in a building are deposition, portable air
cleaning, ventilation and leakage, and HVAC air cleaning, Siegel said, and
these, too, have been the subject of extensive research. In related research,
investigators have developed size-resolved filtration efficiency curves for
many types of filters (Hanley et al., 1994; Stephens and Siegel, 2013).
There are four areas in which knowledge is emerging about how build-
ings influence PM levels: the impact of building surfaces, the effects of
HVAC systems, the heterogeneity of indoor concentrations, and the impact
of non-particle constituents. Buildings have many visible and unseen sur-
faces, both in terms of number and variety, and surfaces interact with
indoor PM and aerosols in meaningful ways, Siegel said. Researchers have
developed simple, idealized models of how particles are deposited on sur-
faces (Lai and Nazaroff, 2000), and they have extended that work to
more realistic environments containing real building materials (Afshari and
Reinhold, 2008). Investigators have also measured size-resolved PM depo-
sition rates for specific idealized conditions (Thatcher et al., 2002). Siegel
considers surface deposition to be an emerging area of knowledge because
it remains difficult to predict how specific particles, such as PM2.5, deposit
onto a surface because of the order-of-magnitude variations for deposition
rates, both modeled and measured, that have been reported in the litera-
ture. Improvements in modeling and measurements offer great promise for
characterizing particulate matter accumulation on surfaces and its influence
on resuspension. As Brandon Boor noted in the previous sessions, research-
ers have made progress in understanding the role that resuspension plays
in determining indoor PM concentrations (Boor et al., 2013; Kassab et al.,
2013; Mukai et al., 2009; Qian and Ferro, 2008). However, Siegel said,
what is still not well characterized is the interaction between particles on a
surface and the particles that then deposit on top of that initial layer and
how the nature of specific materials affects resuspension.
Forced air HVAC systems are ubiquitous in the United States; they exist
in nearly all commercial buildings and in 80 percent of residential buildings,
creating possibilities for interactions between indoor PM and these systems,
Siegel said. How the filters in a central forced system remove particles will
be affected by how often the system runs and how much air goes through
the filter. Leakage in such systems affects the efficiency of particle removal

PARTICLE DYNAMICS AND CHEMISTRY 27
and dispersal, and there can be deposition on the surfaces within the HVAC
system as well as resuspension from those surfaces. HVAC systems can
serve as sources of particles or of precursors to particles, such as ozone,
and they alter temperature, humidity, and indoor air mixing, which can in
turn affect indoor chemistry and particle formation. “If we really want to
understand indoor particles, we have to understand HVAC systems,” Siegel
said, “yet we are far behind in this area.”
To illustrate how little is known about key fundamental parameters
of HVAC systems, Siegel said that HVAC runtimes have been measured
in only 213 homes, all from the southeastern United States and only over
a few days to 1 week (Cetin and Novoselac, 2015; Stephens et al., 2011;
Thornburg et al., 2004). He noted that runtimes play an important role in
determining how much effective recirculation of air through a filter occurs.
“If runtimes are short, it does not matter what type of filter is in place
because air is not going through it,” Siegel said. Runtimes matter less if
the filter itself is not very good, which he said is the case in most homes.
(In fact, runtimes can be quite short, and short runtimes compromise the
ability to gain benefit from higher efficiency filters.) However, most of the
models of runtimes and recirculation assume these to be much higher than
those that actually take place in buildings.
Concerning the heterogeneity of indoor PM concentrations, Siegel said
that most exposure estimates for indoor PM assume that the indoor air is
mixed thoroughly because that makes the necessary calculations tractable.
However, as Lynn Hildemann noted in her presentation, local concentra-
tions near a particle source, such as a smoker or a stovetop, can be much
higher than in a well-mixed environment. At the same time, the sinks in a
building are also heterogeneous in terms of their effectiveness at removing
PM from the air. In one experiment, for example, Siegel and a colleague put
two different portable air cleaners at various places in a house, noting their
distance from a particle source (Novoselac and Siegel, 2009), and found
that both the location and the effectiveness of the particular device had a
marked influence on indoor PM concentrations (see Figure 3-1). Proximity
to a particle source also affects exposure, even at close distances, because
the complicated fluid dynamics of air around a human body can affect how
much is inhaled (Rim and Novoselac, 2009).
Having noted how little is known about HVAC systems, Siegel listed
several other knowledge gaps that need to be filled. For example, ventila-
tion dynamics (the AER, for example) can change dramatically over the
course of a day (see Figure 3-2), but little is known about how such varia-
tions drive the levels of indoor PM. Sinks can also be dynamic, Siegel said,
referring to the decreasing efficiencies of filters that occur over time (see
Figure 3-3). Many HVAC filters in the United States use an electrostatic
charge applied to the filter to remove particles, and this charge can decay

FIGURE 3-1 The location and effectiveness of portable air cleaners in removing
indoor PM.
NOTE: CADR = clean air delivery rate.
SOURCES: Siegel slide 15, adapted from Novoselac and Siegel (2009) Figures 1 and
4; reprinted with permission from Elsevier.
FIGURE 3-2 Air exchange rate (AER) in an unoccupied building over the course
of 1 week.
SOURCES: Siegel slide 19, from Dias Carrilho et al. (2015) Figure 4; reprinted with
permission from Elsevier.

FIGURE 3-3 Decreasing efficiency of an air filter over time.

SOURCES: Siegel slide 20, from Lehtimäki et al. (2005). © 2005, ASHRAE (www.
ashrae.org). Used with permission from ASHRAE (Investigation of mechanisms and
operating environments that impact the filtration efficiency of charged air filtration
media, RP-1189, 2005).
or be masked by particle deposition over time. “Even though this is well-

identified as a problem, we do not understand what is causing this decay
and why the decline is huge in some buildings and much less in other build-
ings,” Siegel said. As an example of the type of research that is needed,
he cited recent work looking at changes in filter efficiency and pressure
drop as a function of what is being deposited on the filter and the particle
structures that form there (Montgomery et al., 2015). “This kind of fun-
damental research that lets us understand how indoor PM sinks behave is
important,” Siegel added.
A final critical knowledge gap that Siegel addressed related to unseen
surfaces and spaces, such as the space above drop ceilings and between
walls and floors. The role that these spaces—which also include attics,
crawl spaces, basements, and knee wall spaces—play as sources and sinks
is largely unknown, Siegel said. Garages are perhaps the best studied of
these unseen spaces as sources of indoor air pollution, but he said that he
was aware of only one investigation of them that measured particle levels.
“Even though we know these spaces can be important from an exposure
perspective, they are largely unstudied,” he said.
As one step toward filling these knowledge gaps, Siegel suggested that
the field conduct what he called a “long-form building census” which
would address the key building science parameters needed to understand
and mitigate exposures to particles in buildings. Conducting such a census

would not only generate knowledge but also create an opportunity for citi-
zen science which might engage the people who work and live in buildings
to pay more attention to their indoor environments.
INDOOR CHEMISTRY AND AEROSOLS2

Glenn Morrison began by noting that chemical transformations that
take place in air, such as oxidation, photolysis, hydrolysis, oligomerization,
and acid-base reactions, can influence aerosol levels and particulate for-
mation. One well-studied atmospheric chemical reaction involves volatile
organic compounds reacting with an oxidant, such as ozone, nitrate, or
hydroxyl radical, to generate a variety of molecular products. The result-
ing sticky, polar molecules can serve as nuclei around which particles form,
or else the polar molecules can condense onto existing particles. These
particles can then agglomerate into larger masses. Together, the nuclei,
condensed particles, and agglomerates are called secondary organic aerosols
(SOAs). Sunlight is a major driver of this chemistry outdoors, but sunlight
is less intense indoors, which potentially slows the process. Also, because
of the short residence time indoors (hours or less) compared with outdoors
(days), SOAs generated inside a building are “fresher” than their outdoor
counterparts. Indoor surfaces play an important role in removing both
SOAs and their precursors from indoor air, but they can also emit some of
the precursors that eventually contribute to aerosol formation, and they can
also serve as reaction sites, facilitating oxidative chemistry that can lead to
SOA formation.
The indoor environment strongly influences precursor molecule levels,
Morrison said. Important indoor sources of precursors include cleaning sol-
vents, scented products, and foods. All three of these release large amounts
of chemicals called terpenes, which are readily oxidized in air. Indoor
oxidants levels are driven largely by outdoor ozone levels. Morrison said
that there is a significant body of research showing that SOAs are gener-
ated indoors, and he cited a study showing that when an air freshener
was introduced into a room with elevated ozone levels, there was a rapid
increase in the concentration of submicron particles that persisted in the
air for many hours (Sarwar and Corsi, 2007). A more recent study found
that new particles with an average diameter of 100 nanometers can form
indoors from paint solvents (Lazaridis et al., 2015).
The emerging science of indoor air chemistry is advancing on multiple
2 This section is based on the presentation by Glenn Morrison, a professor of civil, architec-
tural, and environmental engineering at Missouri University of Science and Technology, and
the statements are not endorsed or verified by the National Academies of Sciences, Engineer-
ing, and Medicine.

fronts, Morrison said. One advance is the ability to measure an increasing

number of oxidized species, Morrison said, and as an example he cited a
study in which the investigators were able to quantify levels of more than
three dozen different compounds in aerosols formed by oxidation of sol-
vents in household cleaners (Rossignol et al., 2013). Modeling is another
area where progress is occurring, he said, with researchers adapting models
developed for outdoor environments to account for the different surfaces
and precursors found indoors. One such study (Carslaw et al., 2012) pre-
dicted that organic peroxides and nitrates would be the predominant com-
pounds produced after a cleaning event but that the relative concentrations
of different classes of chemicals produced in aerosols would vary depending
on the amount of solvents released and the rate at which SOAs deposited on
surfaces. “There is still a great deal of uncertainty in the ability to use mod-
els to be predictive of not just the aerosol mass concentration but also the
composition,” Morrison said. Recent experimental work has demonstrated
that changing the indoor levels of ozone and terpenes, common constituents
of cleaning products, has a significant impact on the composition of the PM
that forms indoors (Khurshid et al., 2016). In particular, Morrison said, the
level of PM2.5-bound reactive oxygen species, which can irritate the lungs,
can increase by more than four-fold when indoor levels of both ozone and
terpenes are elevated.
Building operations can also influence aerosol chemistry. One recent
study that Morrison cited found a strong influence of AER on peak SOA
levels generated from select terpene compounds (Youssefi and Waring,
2015). “We still need to know about how buildings influence this chemis-
try,” he said.
Several studies have shown that ozone can react with organic molecules
deposited on surfaces to produce particles in the air above those surfaces
(Sleiman et al., 2010; Waring et al., 2011). Morrison and a colleague found
that this chemical reaction occurs much faster than would be expected if
it were happening in the air (Shu and Morrison, 2011). What this might
imply, Morrison said, is that many of the products of the chemistry that
take place on surfaces can be transferred to aerosols and dust that can be
resuspended and inhaled.
Room occupancy is an important factor in aerosol chemistry because
skin contains chemicals that react readily with ozone. Human and animal
bodies constantly shed skin in the indoor environment, and these skin cells
and the skin oils can adhere to indoor surfaces. As a result, surfaces in
occupied rooms are coated with chemicals waiting to react with airborne
ozone. “That is one reason why our indoor environments are so reactive
and why indoor ozone levels are lower than those outdoors,” Morrison
said. Another reason is that the humans in a room are also covered in these
reactive compounds, and, in fact, research has shown that ozone levels fall

when a human enters a test chamber designed to simulate an office environ-

ment (Fadeyi et al., 2013).
While the amount of sunlight indoors is much less than outdoors, it can
still be sufficient to trigger chemical reactions, Morrison said. One study,
for example, found that cooking produces nitrogen dioxide as a combus-
tion byproduct and that the nitrogen dioxide sticks to surfaces, reacts with
water in the air, and produces nitrous acid (Alvarez et al., 2014). Sunlight
entering a room through a window can enhance this reaction, especially
when surfaces are also coated with household cleaner residues. Nitrous acid
is volatile, and when released from the surface into the air it will react with
sunlight to produce hydroxyl radicals, one of the oxidants that can generate
SOAs. As a result, in one study, the levels of hydroxyl radical near a win-
dow were of the same order of magnitude as is found outdoors. Morrison
said that hydroxyl radical is indiscriminate, reacting with a wide range of
volatile organic compounds and not just with terpenes.
Morrison emphasized that the development of sensitive instruments
for monitoring outdoor air composition has created a great opportunity
to better understand indoor chemistry. These instruments include high-
resolution aerosol mass spectrometry for analyzing PM composition, fluo-
rescence assay by gas expansion for detecting hydroxyl radicals, cavity
ring-down spectroscopy for measuring nitrogen oxides, and direct analysis
in real-time mass spectrometry for the real-time characterization of surface
films. “Almost none of these instruments have been used indoors until very
recently,” Morrison said. One study using high-resolution aerosol mass
spectrometry, for example, showed that there were hundreds—and per-
haps thousands—of different compounds generated by oxidation chemistry
(Romonosky et al., 2015). While it may not be possible to identify all of
these compounds, Morrison suggested that this type of analysis can reveal
the many factors that influence indoor chemistry.
Another area where Morrison said he expects progress to be made is in
applying models of outdoor atmospheric chemistry to the indoor environ-
ment. Morrison said that the basic chemical reactions are well modeled,
but researchers need to better account for the surface phenomena as well
as building characteristics, occupancy, and human activity. Indoor surfaces,
he reiterated, are coated with a film of organic material that can transfer
material back and forth between aerosols and undergo chemical reactions.
These reactions, in turn, are influenced by the acidity of the environment,
which changes with human and animal activity. None of these processes
are accounted for in outdoor models. Integrating building characteristics
into models is challenging because of the sheer complexity and variety of
building environments, Morrison added, and doing so successfully will
require identifying those parameters of a building that are most important
with respect to chemistry.

COMPOSITION OF INDOOR PM AND THE

INFLUENCE OF SVOC PARTITIONING3
Given that buildings do a moderately good job keeping outdoor UFPs
and PM10 from entering buildings, Charles Weschler said, the chemical con-
stituents of these two classes of PM will be determined largely by chemical
processes occurring indoors. Indoor UFPs are produced primarily via com-
bustion, through gas-to-particle conversion, and via thermal desorption of
SVOCs. The primary sources of indoor coarse particles include skin flakes,
fibers, plastic wear particles, and soil and salt particles tracked indoors.
The chemical composition of PM2.5, however, is determined by chem-
istry that occurs both indoors and outdoors. Weschler said that comparing
the chemicals present in indoor and outdoor PM2.5 shows indoor PM2.5 that
are rich in chemicals additives used in products that are part of the indoor
environment, such as phthalate plasticizers, organophosphates, brominated
flame retardants, and fluorinated surfactants. By weight, indoor PM2.5 is
approximately 50 percent organic carbon, with elemental carbon account-
ing for only 3 percent of the total particle mass. Sulfates and nitrates
together account for nearly 30 percent of the weight, with ammonium ion
and water together contributing about 15 percent at typical indoor rela-
tive humidities (see Figure 3-4). The total metal content in indoor PM is
about 1 percent, with more than two-thirds of that being iron. Also present
are zinc, vanadium, titanium, silver, copper, manganese, and chromium.
Weschler explained that while small in amount, these metals may be rel-
evant to human health given the evidence suggesting that water-soluble PM,
which may be able to release those metals into the body, has a dispropor-
tionate effect on human health (Costa and Dreher, 1997).
Relative humidities above 25 percent have a measurable effect on the
water content of PM2.5. Depending on the composition of the particles—in
particular, the water-soluble salts and oxidized organic compounds—PM2.5
can be 10 to 40 percent water by weight when the relative humidity is
between 50 and 70 percent. The water content of PM10, with its lower sol-
uble salt and oxidized organic content, is lower than that of PM2.5. Water
content is important, Weschler said, because it affects the partitioning of
gases between air and particles and helps influence the chemical reactions
that can occur on or within the particle, which also affects the particle
composition (Lim et al., 2010). Weschler added that the water found in
these particles is likely coated by an organic film (Gill et al., 1983) which
can affect the transfer of gases into and out of the particle and partitioning.
3 This section is based on the presentation by Charles Weschler, an adjunct professor at

Rutgers, the State University of New Jersey, and a visiting professor at the Technical University
of Denmark and Tsinghua University, and the statements are not endorsed or verified by the
National Academies of Sciences, Engineering, and Medicine.

FIGURE 3-4 Typical chemical composition of indoor air by weight percent of

PM2.5.
SOURCE: Weschler slide 4.
The partitioning of SVOCs and various inorganic compounds between

the gas phase and the surface of airborne particles plays an important
role in determining the chemical composition of particles, Weschler said.
In one of the first applications of aerosol mass spectrometry to the study
of indoor PM, Michael Waring and his colleagues (Johnson et al., 2016)
simultaneously sampled indoor and outdoor PM on the Drexel Univer-
sity campus. This analysis showed that hydrocarbon-like organic aerosols
made up 19 percent of indoor PM, compared to 8 percent of outdoor PM
(see Figure 3-5). A large part of this increase, Weschler said, arose from
the partitioning that occurs because of the much higher concentrations of
SVOCs found indoors compared to outdoors. “When an outdoor particle
comes indoors, it will acquire phthalates, organophosphates, and per-
fluorinated surfactants from indoor air,” Weschler explained. At the same

time, the outdoor particles tend to lose polyaromatic hydrocarbons and

ammonium nitrate when they move indoors. Data from the Relationship of
Indoor, Outdoor, and Personal Air (RIOPA) study collected in Los Angeles,
California; Houston, Texas; and Elizabeth, New Jersey, showed a similar
increase in the organic content of indoor PM2.5 compared to outdoor PM2.5
(Polidori et al., 2006).
Increasing the level of SOAs affects SVOC partitioning in indoor envi-
ronments by increasing both the concentration of airborne particles and
the fraction of organic matter in the airborne particles, Weschler said.
These increases, in turn, increase the proportion of SVOC in the par-
ticle phase versus the gas phase in a multiplicative fashion (Weschler and
Nazaroff, 2008). In fact, he said, chamber experiments support this predic-
tion (Benning et al., 2013; Chen and Hopke, 2009).
As Morrison pointed out, the occupants of a building influence the
composition of indoor PM, and Weschler noted that humans shed their
entire outer layer of skin every 2 to 4 weeks at a rate of 200,000 to 600,000
skin flakes per minute (30 to 90 milligrams of skin flakes per hour). Human
skin is one of the very few sources of the chemical squalene in indoor envi-
ronments. A 1973 study of size-fractionated indoor PM collected from a
FIGURE 3-5 Aerosol mass spectrometry data showing the composition of indoor
and outdoor PM.
NOTE: BC = black carbon; COA = cooking organic aerosol; HOA = hydrocarbon-
like organic aerosol; OOA = oxygenated organic aerosol.
SOURCE: Weschler slide 10, from Johnson et al. (2016); reprinted with permission
from John Wiley & Sons, Inc. © 2016.

house, a laboratory corridor, and the London Underground found that the
squalene content was between 40 and 100 micrograms per unit gram of PM
(Clark and Shirley, 1973). From this number, the investigators calculated
that indoor PM is about 1 percent skin flakes by weight. Weschler said that
other studies conducted since then have arrived at similar values.
Occupants contribute more than just skin cells to indoor PM, he added;
they also shed bacteria and fungi along with their skin cells. One study of
the microbial content of indoor PM in a classroom found that the amount
of bacteria in indoor PM was 80 times higher and the amount of fungi 15
times higher when the room was occupied than when the classroom was
empty (Hospodsky et al., 2015). The particle mass was also nine-fold higher
in the occupied classroom. This study did not determine what fraction of
the microbial PM content was viable.
Indoor PM particles include thousands of organic species. “The com-
plexity is staggering,” Weschler said, adding that little work has been done
to characterize the organic molecules found in indoor PM versus outdoor
PM (Heald et al., 2010). Recently, investigators have shown that the com-
position of PM, both indoor and outdoor, influences the uptake of gases
onto the particles and the subsequent chemistry that can occur within the
particle (Morgan et al., 2015). Studies have also found that particles can
exist in liquid, semi-solid, and glassy phases and that multiple phases can
coexist in the same particle (Koop et al., 2011). This is important, Weschler
said, because water and gas partitioning depends on the phase, as does the
diffusion of molecules within the particle. For example, the amount of dif-
fusion within a particle is up to 10 million times smaller in the semi-solid
phase than in the liquid phase (Hodas et al., 2015), which, he pointed out,
would affect particle chemistry. Weschler said that most of the modeling
work on partitioning assumes that the organic content of PM is in the liquid
phase, so if this is not the case, there will be large errors in the output of
these models. What is not known, he said, is if this is a serious issue for
indoor PM.
Weschler said that in his view more information is needed about the
chemical form and oxidation state of the metals in PM, given the impor-
tant effects these have on the chemical reactivity and bioavailability of
metals. One study, for example, found that 25 percent of the iron in PM
from urban and rural sites in Georgia was in the Fe(II) oxide state and that
15 percent of the iron was in soluble form (Oakes et al., 2012a,b). What
remains to be characterized, he said, are the identities of the ions or mol-
ecules bound (coordinated) to the iron in these particles.
Another question Weschler said he would like to see addressed concerns
the timescale over which SVOCs desorb from inhaled PM and the residence
time of particles in the respiratory tract, which are important factors for
the potential health effects of breathing PM. Those times, he explained, will

depend on particle diameter and on the partition coefficient. His group has
tried to model this process despite the various technical complications, he
said. “We are fairly certain that some SVOCs in some particle size ranges
make it to the alveoli, while for other SVOCs and in other size ranges, the
SVOCs desorb fairly high in the respiratory tract.” Experimental studies, he
added, have proved to be even more challenging than the modeling efforts.
Weschler also questioned the role that reactive oxygen species associ-
ated with PM might play in triggering oxidative stress. It is known that
inhaling PM enriched in certain transition metals will induce oxidative
stress, so it might be the case that having reactive oxygen species present on
PM would increase the potential for harm. Studies have shown that reactive
oxygen species are present in indoor air (Khurshid et al., 2016) and that
they can remain active in air for many hours, with a decay half-life of 6 to
7 hours (Chen et al., 2011).
In summary, Weschler said, indoor PM is enriched in synthetic organic
chemicals such as plasticizers and flame retardants, metals, and microbes
from occupants, and as PM is transported from outdoors to indoors, the
chemical content can change substantially. “We need to know more about
the actual molecular nature of the chemicals present in indoor PM, both in
terms of the transition metal complexes and the organic species,” he said. “I
think a large number of people are unaware of the holes in our knowledge
when it comes to the chemical composition of indoor PM.”
DISCUSSION
Corsi launched the discussion by asking the panelists to comment on
the importance of unseen spaces to the topics they discussed. Siegel said that
those spaces are very important and, based on energy conservation studies,
are well connected to the rest of the building. As such, he said, he would
like to see more research to identify how much PM is in those spaces, both
airborne and deposited, and how that changes the distribution of particle
size and concentration coming in from outdoors. Morrison agreed that little
is known about the chemistry that occurs in interstitial spaces and said he
thought that the first place to start with regard to addressing that deficit
would be to collect samples using many of the new technologies used to
collect outdoor PM. “Just deploying those technologies indoors will lead to
a great deal of discovery,” he said. Weschler gave an example of what can
be learned from studying the PM in interstitial spaces. When he worked at
Bell Laboratories, he said, he and his colleagues sampled the PM that was
coming from the spaces under the raised floors in telephone data centers.
They found that PM was “grossly enriched” in phthalate esters, which
presumably came from the plasticizers present in the PVC insulation sur-
rounding communication cables running through the space under the floor.

Brent Stephens, noting that calculations of SVOC partitioning use the

total suspended particle mass as a measure of particle concentrations, asked
Weschler if the resulting estimates would be improved if the calculations
accounted for the size distribution of the particles. Weschler replied that the
estimates for partitioning that use total suspended particle mass are crude
and provide only order of magnitude–type results. “You would certainly
refine those estimates by looking at the fraction of organic matter in differ-
ent size ranges,” Weschler said.
An online participant said that she had seen significant spikes in indoor
PM levels associated with humidifiers, boiling water, and sometimes even
showering. She asked if anyone had studied particle emissions from water.
The answer, Weschler said, is yes, and those particles, sometimes referred
to as “gray dust,” emerge from water-soluble salts when aerosolized water
droplets evaporate. That is why it is important, he added, to use deionized
water in ultrasonic humidifiers. However, Gediminas Mainelis from Rutgers
University said that his group has observed that particles of unknown com-
position form when even the purest water is aerosolized. Morrison said that
certain types of evaporative coolers also produce high particulate loads for
the same reason. Siegel added that HVAC systems often generate a water
aerosol for the purpose of humidification or air cleaning, but the extent to
which this produces indoor PM has not been explored.
Another online participant proposed tapping into the data collected
by Internet-enabled home thermostats on temperature and HVAC run-
times. Siegel said he thought this was a “great idea,” particularly if those
data could be combined with information about the buildings associated
with those thermostats. Privacy issues could be a concern, he said, but he
expressed confidence that issue is resolvable.
Vito Ilacqua from EPA asked the panelists to suggest which parameters
of the indoor environment would be most important to have more data on
in order to better understand indoor PM behavior. Siegel said that acquir-
ing data on the amount of surface area in different types of buildings, the
nature of interstitial spaces, and HVAC operation parameters would be easy
and inexpensive to do and simply requires making that a priority and doing
it. More work is needed on advanced instrumentation to better character-
ize indoor PM composition, he added. Siegel also said that there are many
inexpensive and easy steps that could be taken today to protect people in
buildings from PM exposure without having to wait for better character-
ized buildings and particles. Offering one specific example of such a step,
he said, “It is a no-brainer for certain people in certain indoor environments
to be using better filtration or activated carbon filtration.”
Morrison agreed with Siegel that the presumption from a chemistry
perspective is that indoor exposure to SOA is not good. “That is an assump-
tion right now, and we do not know for sure what the direct health effects

are,” he said, “but if we make that assumption, it is relatively straightfor-

ward to remove ozone from indoor air, which is the main driver of SOA
levels.” Morrison added that, given the difficulty in changing behaviors that
lead to elevated exposures to indoor PM, it will be important to integrate
mechanisms to remove the main drivers of indoor PM exposure into build-
ing design.
Lynn Hildemann asked the panelists to comment on the possible effects
that humidity might play in the indoor environment. Morrison replied
that there are cases where the moisture content of the air influences the
chemistry on particles. Less is known, he added, about the influence of
humidity on ozone uptake at the particle surface. Siegel noted that every
HVAC system with an operating cooling coil has water-saturated air at
some point. “High humidity is a reality in many buildings much of the
time,” said Siegel.
David Young from INLOGIX asked for the panelists’ thoughts on the
challenges of conducting health investigations in residences with HVAC
systems equipped with ultraviolet (UV) light systems. Morrison said that
while UV lights can potentially deactivate certain microorganisms, they can
also produce high levels of ozone. Given what is known about ozone as a
lung irritant and its ability to generate the type of reaction products—which
he described in his presentation—Morrison said that he is not in favor of
anything that releases ozone into the home environment. Siegel added that
UV lights also contribute to the degradation of certain components and
insulating materials in HVAC systems. Corsi said that he has found UV
light systems in many animal shelters and has measured high ozone levels in
kennels in those shelters. Mainelis added that handheld hair dryers produce
high levels of ozone—as much as 10 parts per billion above the background
level—within the breathing zone of the user. Morrison said that hairdryers
and many other unregulated devices produce ozone unintentionally.


Characterizing Indoor Exposure Levels
T
he workshop’s third session focused on exposure levels from indoor
PM, including approaches for measuring exposure and some of the
factors that determine exposure levels. Barbara Turpin of the Uni-
versity of North Carolina Gillings School of Global Public Health discussed
how characterizing indoor air can provide insights into the sources of
indoor PM and the transformations that these particles can undergo. Roy
Harrison of the University of Birmingham addressed some of the determi-
nants of and exposure to indoor PM. Gary Adamkiewicz of the Harvard
T.H. Chan School of Public Health reviewed the socioeconomic factors that
can influence indoor PM exposures. An open discussion moderated by Terry
Brennan followed the three presentations.
PM2.5 EXPOSURE CHARACTERIZATION PROVIDES

INSIGHTS INTO SOURCES AND TRANSFORMATIONS1
As had been discussed in earlier workshop sessions, Barbara Turpin
said, indoor PM2.5 concentrations represent a balance between sources and
sinks, and the sources include indoor emissions of particles and outdoor-
to-indoor transport of particles. The sinks include the deposition of par-
ticles on indoor surfaces, filtration by HVAC systems, and exfiltration of
1 This section is based on the presentation by Barbara Turpin, a professor of environmental

sciences and engineering at the University of North Carolina Gillings School of Global Public
Health, and the statements are not endorsed or verified by the National Academies of Sciences,
Engineering, and Medicine.
41

FIGURE 4-1 Indoor and outdoor PM2.5 concentrations and compositions from
homes in Elizabeth, New Jersey.
NOTE: EC = elemental carbon; OM = organic matter.
SOURCE: Turpin slide 3, Reprinted by permission from Macmillan Publishers Ltd.:
Journal of Exposure Science and Environmental Epidemiology (Polidori et al.,
2006), adapted from Figure 3.
particles. Chemistry and partitioning also affect indoor PM2.5 concentra-

tion because of the changes that particles may undergo when moving from
the temperature and humidity conditions outdoors to different conditions
indoors.
Data from the RIOPA study, which was undertaken to evaluate the
contribution of outdoor sources of air pollutants to indoor concentra-
tions and personal exposures (Weisel et al., 2005), found that the mass of
organic matter in indoor household PM2.5 was more than twice the organic
matter in PM2.5 collected outside of the same house at the same time (see
Figure 4-1), while the masses of sulfates, elemental carbon, and soil mate-
rial were lower indoors. The additional organic matter in indoor PM has
to be coming from an indoor source, Turpin said, either emitted as PM or
produced via a phase change or a chemical reaction. She and her colleagues
measured the amount of particulate organic matter indoors versus outdoors
and calculated that, on average, 71 to 76 percent of the organic carbon in
indoor PM2.5 comes from indoor sources, with a lower bound estimate of
41 percent (Polidori et al., 2006).
Data from another study using an unoccupied home near Fresno, Cali-
fornia, showed that it is difficult to get particulate nitrate from outdoors
to indoors (Lunden et al., 2003), a finding that Turpin said makes sense
because nitrate is semivolatile and exists in equilibrium with the gaseous
nitric acid. When a nitrate-bearing particle and the equilibrium-associated
nitric acid gas moves from outdoors to indoors, Turpin explained, the nitric

CHARACTERIZING INDOOR EXPOSURE LEVELS 43
acid is scrubbed from the air, either because it cannot pass through the
building envelope or because it sticks to interior walls once it has made it
inside the building. Once the nitric acid is removed, the ammonium nitrate
has to re-equilibrate and it does so by turning into gaseous nitric acid. Cal-
culations using data collected in southern California show that at a typical
indoor air exchange rate, only approximately 12 percent of the outdoor
particulate nitrate is found indoors.
The degree to which the components of outdoor PM2.5 penetrate and
persist indoors vary broadly, from 4 percent for soil components to 78
percent for sulfate (Lunden et al., 2008; Meng et al., 2007; Polidori et al.,
2006). The observed differences are a function of the size distribution of the
diverse aerosol components within PM2.5 and changes in the gas–particle
partitioning of the components as the aerosol encounters indoor conditions.
“The fraction of outdoor PM that you find in indoor air varies significantly
depending on the PM species,” Turpin said. “In addition, the composition
of that PM changes when you bring outdoor PM indoors.” She also noted
that the composition of indoor PM of indoor origin is mostly organic (see
Figure 4-2).
FIGURE 4-2 Indoor-generated sources contributed the majority of PM2.5 in house-

holds in New Jersey (62% of the total) and in California (51% of the total). Chemi-
cally, indoor generation was found predominantly to be organic matter (77% in
New Jersey and 62% in California).
NOTE: EC = elemental carbon; OM = organic matter.
SOURCE: Turpin slide 9.

It is also possible to use a mass balance model to calculate the fraction

of indoor PM2.5 that are of outdoor origin. This calculation entails account-
ing for the species-resolved size distribution, for whether the windows in
the home were open or closed, and for what the losses from air conditioning
and filtration would be as well as taking into account measured variations
in AERs and the day-to-day particle composition (Hodas et al., 2014). For
elemental carbon and sulfate, the agreement between calculated and mea-
sured values was good, Turpin said, but it was not good for organic carbon
(see Figure 4-3). That latter result was not surprising, she said, given that
there is so much organic carbon generated indoors and that these modeled
values exclude indoor sources.
Turpin and her colleagues have used this model to take outdoor PM2.5
measurements and predict what would happen to these particles when they
transited indoors (see Figure 4-4). For a home near a major roadway in the
northeastern United States, at an AER that is typical of low-income homes
(0.90 per hour), the fraction of outdoor PM2.5 that makes it indoors and
remains suspended was estimated to be 62 percent, while in a southwestern
suburban home that is not near a roadway and has an AER typical of a
median-income home (0.45 per hour), that fraction would be 36 percent.
FIGURE 4-3 Comparison of the cumulative probability of indoor concentrations

of indoor sulfate, elemental carbon (EC), and organic carbon (OC) between a mass-
balance model assuming no indoor sources and RIOPA measurements.
SOURCE: Turpin slide 11, from Hodas et al. (2014) Figure 1; reprinted with per-
mission from Elsevier.

FIGURE 4-4 Infiltration factors (F) representing the indoor proportion of outdoor
particles, effectively determining the indoor PM concentration in the absence of
indoor sources.
The infiltration factors reported here were calculated from a model that considers
the particle size-dependence of the infiltration factor, the various particle size dis-
tributions of different chemical components of outdoor PM2.5 and the air exchange
rate for a typical [AER = 0.45 h–1] and low-income [AER = 0.90 h–1] U.S. residence.
NOTE: AER = air exchange rate; EC = elemental carbon; NE = Northeast; SW =
Southwest.
SOURCE: Turpin slide 12; reprinted by permission from Macmillan Publishers Ltd.:
Journal of Exposure Science and Environmental Epidemiology (Hodas et al., 2012),
adapted from Figure 3.

Turpin’s conclusion from this study is that there is “quite a bit of geo-
graphic and seasonal variability in the fraction of outdoor PM that makes
it indoors.”
As an aside, Turpin noted that there is also large variability in the
health effect estimates for outdoor PM2.5, and she cited studies (Bell et al.,
2009; Peng et al., 2009) showing that the increase in respiratory hospital
admissions per 10 microgram per m3 increase in PM2.5 was smaller in the
southwestern United States than in the Northeast. “Some of that difference
could be because the composition of aerosol is different in the southwest
than in the northeast,” Turpin said, “but some could be from exposure
error given that we are not measuring PM2.5 levels indoors where people
are spending most of their time and the fraction of PM that gets indoors
is different in different places.” In fact, a study conducted in China that
accounted for the fraction of outdoor PM that becomes indoor PM pro-
duced larger effect estimates, less inter-city heterogeneity, and a better fit
between daily mortality figures and model prediction (Chen et al., 2013).
To support the idea that gas-particle partitioning changes as particles
move from outdoors to indoors, Turpin used gas and particle phase poly-
cyclic aromatic hydrocarbon (PAH) measurements from the RIOPA study.
A significant amount of variability in the PAH gas-particle partitioning was
associated with changes in temperature going from indoors to outdoors,
which would affect the volatility of these compounds (Naumova et al.,
2003). Subsequent modeling studies for a more complex mixture of organic
compounds yielded similar results which correlated geographic differences
in temperature gradients, air conditioning and heating use, and indoor
organic matter emissions to indoor organic PM composition (Hodas and
Turpin, 2014).
More recently, Turpin and her colleagues have been measuring levels of
oxidized volatile organic compounds in both outdoor and indoor air. Mea-
surements from 13 homes show the indoor levels of water-soluble organic
compounds, which are presumed to be oxidized, are more than an order
of magnitude higher than the outdoor levels. Turpin and her colleagues are
currently working to determine the identity of those compounds. Expo-
sures to oxidized volatile organic compounds are poorly characterized, and
Turpin predicted that these compounds participate in further chemistry on
indoor surfaces in damp homes (for example, via hydrolysis, oxidation,
acid-catalyzed, or nucleophilic chemistry on walls, skin and wet aerosol
particles).

SOME DETERMINANTS OF INDOOR PM

CONCENTRATIONS AND EXPOSURE2
Over a decade ago, Roy Harrison and his colleagues measured the
flow of air pollutants from a busy road in London into an empty office
and found substantial wind-dependent penetration of pollutants indoors,
particularly PM2.5 (Riain et al., 2003). As Harrison told the workshop
audience, a detailed analysis of similar data from an empty office at the
University of Westminster showed that there was a lag of approximately
20 minutes between changes in the outdoor PM2.5 levels and indoor levels.
Measurements of PM10 and PM less than 1 micron in diameter (PM1) in
an occupied house found substantial reductions of both PM10 and PM1
indoors compared to roadside measurements, except when the occupants
were cooking or when someone entered the house (see Figure 4-5).
When the analysis focused on particle number instead of particle mass,
the results showed similar spikes for indoor-emitted PM reflecting human
activity. After accounting for the spikes, there was good correlation between
indoor and outdoor particle number levels, though there was a much big-
ger attenuation of the indoor concentrations for particle number than there
is for particle mass. “We see a substantial reduction in indoor particle
numbers compared to outdoors when we look solely at the penetration of
outdoor particles to the indoor environment,” Harrison said.
In another study, Harrison and his colleagues measured particle size
distributions both in an unoccupied, sealed walkway with little ventilation
above a busy highway and from the nearby roadside. When they plotted the
ratio of indoor to outdoor numbers by particle size, the results, as Harrison
recounted, were surprising in that there was a rapid decline in indoor-to-
outdoor ratio at larger diameters (see Figure 4-6). He said that he would
not expect such a large drop-off if the buildings were better ventilated, and
he did not expect these results to be typical of all buildings.
Harrison then discussed the results of a study conducted in Bologna,
Italy (Zauli Sajani et al., 2015) in which outdoor air was pumped into two
unoccupied rooms, one near a heavily trafficked location, the other in a
residential neighborhood, to look specifically at particle sinks (see Figure
4-7). This study found that there was a more substantial loss of UFPs than
of PM2.5 when moving from outdoors to indoors. An analysis of the chemi-
cal composition of the particles showed that approximately 95 percent of
the nitrate was lost moving from outdoors to indoors, with much smaller
losses of sulfate and organic carbon. Measurements showed there was rel-
2 This section is based on the presentation by Roy Harrison, the Queen Elizabeth II Birming-
ham Centenary Professor of Environmental Health at the University of Birmingham, and the
and Medicine.

FIGURE 4-5 Indoor and outdoor PM10 and PM1 mass concentration measurements
at the roadside and inside a house as a function of time.
SOURCES: Harrison slide 5; underlying research discussed in Jones et al., 2000.
atively little loss between outdoors and indoors for PM2.5 mass, but there
was a substantial loss of ultrafine particle numbers, which Harrison noted
was especially pronounced for rooms near road traffic.
There are many possible explanations for the heavy loss of UFPs,
Harrison said. One is that their deposition velocities are higher than for
larger particles. Modeling results suggest that coagulation of particles in the
30- to 50-nanometer range is likely to be rapid and that it may be a factor
when the concentration of particles is high. Evaporation of UFPs is a pos-
sible third mechanism, one Harrison believes to be important because the
walls of the unoccupied room were likely to serve as a sink for the SVOCs
that dominate the composition of traffic-generated UFPs.
Another study, also conducted in Bologna, measured indoor and out-
door PM at the front and back of two buildings—one on a heavily traf-
ficked street and a second on a low-traffic residential street—during hot
and cold seasons (Zauli Sajani et al., 2016). During the summer, there was
little difference in the PM2.5 levels at analogous measurement locations. In
winter, however, there was a significant difference between outdoors and
indoors at both the front and rear measurement locations, which Har-
rison believes arose because outdoor PM2.5 in the winter is likely to have
a higher nitrate content than outdoor PM2.5 in summer. The data from

FIGURE 4-6 Indoor-to-outdoor particle concentration ratio in Birmingham City

Centre (UK) offices by particle size, as characterized by Nano-DMA, SMPS, and
Lasair measuring systems.
SOURCE: Harrison slide 11.
this study also showed a substantial loss of smaller particles when moving
from outdoors to indoors, particularly for particles collected at the front
of the building. A study conducted in Prague named cooking and cleaning
materials as the largest contributors to indoor-generated PM. Incense burn-
ing, vacuuming, and smoking were other important sources of indoor PM
identified in this study, Harrison said.
Harrison then addressed the subject of exposure and, in particular, the
difference between measurements of personal exposure to PM versus the
results from static indoor monitoring. Data from one study showed that
personal exposure to carbon monoxide and nitrogen dioxide was well
reflected by a static room monitor, but the personal measurement for PM10
was always higher than that determined from the static measurement (Kim
et al., 2002). Harrison said that the larger personal exposure levels likely
resulted from a “personal cloud” of shed skin cells and dust from clothing.

FIGURE 4-7 Average value and standard error indoor and outdoor (a) PM2.5 and
(b) UFP levels in Bologna, Italy, during three monitoring periods.
SOURCES: Harrison slide 13, from Zauli Sajani et al. (2015) Figure 1; reprinted
with permission from Elsevier.

While the difference between the personal measurements and the static
room monitor for PM2.5 was smaller, Harrison said that the exposures to
these particles can also be significantly higher than would be reflected by
measured indoor concentrations because of this personal cloud effect.
Reflecting on the meaning of these findings with respect to health risk,
Harrison said that they point to a number of unresolved issues, starting
with the differential toxicity of particles from various sources or of those
with different compositions and sizes. He wondered if particles from indoor
origins such as cooking and resuspended house dust are as toxic as the out-
door pollutant mixtures measured in most epidemiological studies and if
the elemental carbon component of diesel particles is comparable in toxicity
to the organic component, which is largely from lubricating oil. He also
wondered if the fact that buildings are very protective for UFPs, SVOCs,
and nitrates matters in terms of health risk and what the determinants and
significance of the personal cloud of particles is for health.
SOCIOECONOMIC DETERMINANTS OF INDOOR PM EXPOSURE3

Gary Adamkiewicz began his presentation by stressing two points:
there are potential disparities in the exposure of individuals and communi-
ties to high levels of PM, and there are many instances where people are
exposed to high levels of indoor pollutants known to cause adverse health
effects, yet these issues have been largely ignored by policymakers. As an
example, he cited cooking and ventilation and said that there are certainly
disparities with regard to the type, age, and condition of ventilation equip-
ment installed in kitchens. He observed, though, that even if everyone in
the United States had the same stove and ventilation equipment, there
would still be disparities as a result of differences in the homes people live
in. His research has focused on public and low-income housing, where an
open kitchen and living room often form one primary living space. In such
homes, a family’s exposures to PM generated during cooking is likely to be
higher than in a middle- or upper-class home with a separate kitchen. But
even if everyone American lived in the same type of home, he added, there
would be disparities in exposures due to different levels of outdoor PM.
“All of this is to say that we need to take a multilevel view of the determi-
nants of exposure to indoor pollutants,” Adamkiewicz said. “We have to
look at how a household embeds within a building that embeds within a
neighborhood.”
3 This section is based on the presentation by Gary Adamkiewicz, an assistant professor

of environmental health and exposure disparities at the Harvard T.H. Chan School of Public

TABLE 4-1 Drivers of Exposure Disparities in Indoor Environments

Sources Indoor • Cooking • Air fresheners • Pesticides
Sources appliances • Personal care • Pollutant
• Tobacco smoke products reservoirs
• Cleaning • Furnishings • Water sources
products
Settings Outdoor • Traffic • Residential activity

Sources • Industrial • Contaminated soil
activity
Structure Physical • Age of • Mechanical ventilation

Structure structure • Size/design of structure
• Size of living • Single family versus multifamily
space • Leakage and/or air exchange
• Heating
systems
Behavior Source Use • Cooking • Smoking behavior

Patterns appliance use • Consumer product usage
• Cooking • Personal care product usage
practices
Activity • Time spent at • Interaction with sources
Patterns home • Influences on air exchange
SOURCE: Adapted from Adamkiewicz slide 4.
There are so many drivers of disparities—including different sources

of indoor PM, the settings in which people are exposed, the structures in
which they live and work, and individual behaviors and activity patterns
(see Table 4-1)—that eliminating or at least reducing the disparities can
seem intractable, Adamkiewicz said. Nonetheless, he continued, it is pos-
sible to approach them mechanistically and to identify the most important
ones that can be addressed using what is already known about buildings
and sources. One issue that he identified, though, is that these drivers are
not considered in most studies of exposure. For example, the multifamily
dwellings that house low-income families often have many deferred main-
tenance issues, including ventilation systems that do not function properly,
so standard assumptions about AERs may not apply to those residences.
There are many instances, too, where stoves are used not only for cooking
but also as a source of supplemental heat in low-income households, which
would potentially increase exposures to nitrogen oxides and PM beyond
what might be included in typical models of indoor exposure. Adamkiewicz
presented data for some of these housing-related variables (see Table 4-2).

Leakage and AER are two variables that are important to exposure
and that differ by socioeconomic status (Chan et al., 2005). Data from
single-family homes show, for example, that low-income homes have higher
normalized rates of leakage, which would be expected to decrease PM con-
centrations because of the important influence of indoor sources. However,
low-income homes are typically much smaller than middle- and upper-class
homes, and the smaller volume of low-income homes would be expected
to increase indoor PM concentrations, Adamkiewicz explained. “We need
a framework to understand how these different factors work together
mechanistically,” he said, referring to the fact that multiple determinants
of indoor air quality can add up in complex ways that affect exposures and
cumulative risk. He also emphasized the importance of considering PM
originating from both indoor and outdoor sources.
In a modeling study, Adamkiewicz and colleagues examined how vari-
ous inputs might affect indoor air quality (Adamkiewicz et al., 2011). They
started by taking 10 years of Boston outdoor air quality data, varied AERs,
sources, and ambient concentrations, and then took the ensemble of results
and divided the individual elements into quartiles of PM2.5 exposure level
(see Figure 4-8). As expected, Adamkiewicz said, they found that many
factors contributed to indoor PM levels, with air exchange and smoking
having the biggest effects. The most important finding, he said, was that
there were many more indoor factors than the outdoor pollution level that
affected indoor PM levels. “Even at very high outdoor air pollution levels
and high air exchange rates, the biggest impacts were from indoor factors,”
he said.
Time-activity patterns are another variable that can map onto socioeco-
nomic status (see Figure 4-9), which Adamkiewicz said points to the impor-
tance of understanding the make-up of a community and how its members
conduct their daily activities when thinking about exposure disparities. A
community with a large number of low-income seniors, for example, would
likely have relatively high exposures to indoor PM. “If you think about the
chain of events leading to health effects that we should care about, these are
important microenvironments to focus on,” Adamkiewicz said.
Numerous studies have shown that smoking, which is linked to socio-
economic status, can be a major contributor to indoor PM2.5 (Frey et
al., 2014; Russo et al., 2015). Adamkiewicz and colleagues, for example,
looked at PM2.5 and nicotine levels in common areas in multifamily housing
in Boston and found differences related to resident characteristics, smok-
ing policy, and season (Arku et al., 2015). The highest levels of PM2.5 and
nicotine were found in winter, in units housing the elderly and disabled, and
in buildings without smoke-free policies, suggesting that even elderly non-
smokers may be exposed to elevated levels of PM2.5 produced by smokers.

TABLE 4-2 Representative Housing Variables Associated with Indoor

Environmental Exposures by Household Income (data from the American
Housing Survey, 1999)
Income Category
< $30 K/Year $30 < $60 K/Year
Housing Variable (n = 25,647) (n = 25,840)
Built before 1980 (%) 71.56 65.72
Area of peeling paint larger than 8 × 11 in (%) 3.11 2.04
Any inside water leaks in past 12 mo (%) 9.14 8.67
Neighborhood with heavy street noise or traffic (%) 28.19 25.42
Industry or factory within half block (%) 6.90 5.50
Unit uncomfortably cold for ≥ 24 h (%) 10.70 9.67
Evidence of rodents in unit (%) 17.77 16.81
Mean floor area of unit (ft²) 1,524.00 1,762.00
Mean occupant density (no./1000 ft²) 2.78 2.59
Homes with cracks in floor, wall, or ceiling (%) 7.13 5.10
Homes with holes in floor (%) 1.85 1.03
SOURCE: Adapted from Adamkiewicz et al. (2011) Table 1; reprinted with permission from
The Sheridan Press.
Adamkiewicz noted that in most federally subsidized public housing, units

are divided typically into family housing and elderly/disabled housing.
The importance of smoking as a contributor to indoor PM2.5 was also
demonstrated in the Centers for Disease Control and Prevention (CDC)
Green Housing Study (Coombs et al., 2016). For families enrolled in the
Cincinnati study site, the investigators found that indoor levels of PM2.5
were not markedly lower in the renovated units than in control units. A
closer examination of the data showed that the green units happened to
have had a higher prevalence of smokers and use of air fresheners in the
home, which, Adamkiewicz said, sends an important message. “It is not just
about the buildings, but it is about the activity in the buildings, and fixing
buildings is not necessarily going to lower exposures,” he said.
As an example of the type of analysis he would like to see more of,
Adamkiewicz cited an effort that used American Housing Survey and cen-
sus data, combined with data on activities and smoking prevalence, to
model indoor PM2.5 concentrations (Chahine et al., 2011). Among the
results of this effort were predictions that the highest levels of exposure
would occur in the South and Midwest, among rural populations, and in

$60 < $100 K/Year ≥ $100 K/Year

(n = 24,000) (n = 22,842) Associated Exposure and Hazards
57.77 48.63 Lead paint; structural integrity
1.41 0.99 Lead paint
8.24 7.98 Mold and moisture; structural integrity
21.95 16.69 Outdoor air sources—mobile
3.54 1.74 Outdoor air sources—stationary
7.33 6.71 Supplemental heating; comfort
16.98 16.26 Allergen exposure; pesticide exposure
2,098.00 2,853.00 Exposure to indoor air pollutants
2.31 1.82 Indoor source strength—various
3.88 3.31 Allergen exposure (pests)
0.58 0.37 Allergen exposure (pests)
low-income households. While there are many caveats concerning the use of
this model, Adamkiewicz said that it does provide the ability to try various
what-if scenarios and start to develop an understanding of how exposures
may vary at a population level.
As a final example of research on the role that smoking plays in
determining indoor PM levels, Adamkiewicz described a study he and his
colleagues have been conducting using real-time data from in-unit public
housing sites (Russo et al., 2015). These data were collected from apart-
ments, adjoining hallways, and outdoors. In this study, which compares
PM2.5 levels in a smoker’s apartment with PM2.5 levels in an adjacent
unoccupied apartment, the smokers record every smoking event so that the
investigators can see the real-time effect that those events have on the air
quality in the neighboring apartment (see Figure 4-10). Such measurements
showed that the levels of PM2.5 in a neighboring apartment rise significantly
during and after recorded smoking events.
Adamkiewicz said that there are many studies that, like this one, mea-
sure indoor and personal levels of PM2.5 but that do not have disparities
as a primary or even a recognized focus of the research. However, embed-

FIGURE 4-8 Estimated contribution of indoor PM2.5 between the lowest (Q1) and
highest (Q4) quartile for categories of AER, smoking, and outdoor air pollution.
NOTE: ACH = air changes per hour.
SOURCE: Adamkiewicz et al. (2011) Figure 2b; reprinted with permission from
The Sheridan Press.
ded in many of these studies are data relevant to the issue that can be
mined with some effort to provide insights on disparities. He also said that
addressing the disparities that lead to increased levels of exposure is going
to require thinking not just about places, but about people, places, and
policies together. As an example, Adamkiewicz cited a green housing inter-
vention that he and his colleagues studied (Colton et al., 2014; Russo et
al., 2015) that combined better ventilation and a tighter building shell with
mandatory smoke-free policies. The interventions resulted in reductions
in PM2.5 and nitrogen dioxide levels as well as a 47 percent reduction in
respiratory symptoms. This study also found that within a small geographic
area there was significant between-household variability in PM2.5 levels that
depended on household behaviors and building age and design.
As a concluding thought, Adamkiewicz said he would like to see more
work aimed at understanding how household activities affect indoor PM
levels and how exposure disparities are related to conditions or activities

FIGURE 4-9 Time spent in various microenvironments as a function of age and

home location.
SOURCES: Adamkiewicz slide 11, from Matz et al. (2015) Figure 1; reprinted from
Environmental Health, published by BioMed Central.
FIGURE 4-10 Real-time PM2.5 levels in a smoker’s housing unit and adjacent unoc-
cupied unit.
SOURCES: Adamkiewicz slide 18, from Russo et al. (2015) Figure 2; reprinted with
permission from Oxford University Press.

that can be mitigated. There are needs, he said, to better understand the
links among energy, housing, and health; to recognize the importance of
subpopulations—rural versus urban, the elderly, and those in managed or
public housing, for example; and to take environmental justice into account
when designing studies to assess exposure to indoor PM. He added that he
believes a proposal from the U.S. Department of Housing and Urban Devel-
opment calling for all public housing in the United States to be smoke-free4
would be the biggest indoor PM2.5 intervention possible.
DISCUSSION
Richard Corsi asked Adamkiewicz if any comparisons are being made
between new conventional housing and new green housing because, he said,
in his mind it is not a fair comparison to pit new green housing against
existing housing. Adamkiewicz acknowledged Corsi’s point and said that
the only counter to that question is whether all new public housing should
be green. “I feel that green new construction is not going to be the answer
for all public housing in the United States, but that there are things we can
learn about the effect of green elements,” he said.
William Nazaroff asked the panelists to comment on the somewhat
conflicting evidence he had heard in the day’s presentations about whether
increasing ventilation was good or bad. Harrison responded that there is
no simple answer to this question given that good ventilation will increase
the amount of outdoor PM that gets indoors but will also decrease the
amount of indoor PM that remains in the house when there are significant
indoor sources of PM. Turpin added that ventilation itself will not address
concerns about indoor PM and PM precursors. The better answer, she said,
is to reduce indoor and outdoor emissions of PM. Jeffrey Siegel commented
that not all ventilation is equal and that the benefits of ventilation depend
on the pathway it takes in a building and whether a ventilation system takes
advantage of opportunities to mitigate PM levels. “I think it is more a ques-
tion of how we do ventilation rather than assessing whether ventilation is
good or bad,” Siegel said.
4 Docket FR 5597-P-02 Instituting Smoke-Free Public Housing, 180 FR 71762 (November

17, 2015).

Exposure Mitigation
A
fter considering various issues regarding exposure to PM, the work-
shop next explored several approaches to mitigating exposure as a
means of reducing risk from exposure to indoor PM. William Fisk of
the Lawrence Berkeley National Laboratory addressed the use of filtration
to remove airborne PM. Sergey Grinshpun of the University of Cincinnati
College of Medicine described several methods of controlling viable bio-
aerosol particles in indoor air. Brett Singer of Lawrence Berkeley National
Laboratory then discussed the challenges of mitigating PM exposure in
low-socioeconomic households. An open discussion moderated by Tiina
Reponen followed the three presentations.
INDOOR PARTICLE MITIGATION WITH FILTRATION1

Filtration can be effective in reducing indoor levels of PM, William Fisk
said, but current filtration practices are relatively ineffective even though
the cost of doing better using existing technology is not prohibitive. Indeed,
Fisk said, the filtration of incoming outdoor air and recirculated indoor air
should be the first approach taken to mitigate individual exposure to PM.
He added that there are also techniques, such as using ion generators and
increasing air movement, to enhance particle deposition on indoor surfaces.
Many particle filtration technologies exist today, with the use of fibrous
1 This section is based on the presentation by William Fisk, a senior scientist at Lawrence
Berkeley National Laboratory, and the statements are not endorsed or verified by the National
Academies of Sciences, Engineering, and Medicine.
59

filters or stretched membranes predominating. Other technologies include

electrostatic devices that charge particles and collect them on charged and
grounded plates, combination technologies such as ion generation and fil-
tration through fibrous materials, and combining a tight building envelope
with exhaust ventilation. While Fisk limited his remarks to fibrous filtra-
tion, he said that these other technologies have potential for wider use.
Several factors determine the performance of a filter: its rate of particle
removal, its energy use, the cost of filtration, the filter’s reliability, and
inadvertent pollutant production. The factors that affect particle removal
include the rate and duration of air flow, the particle removal efficiency as
a function of particle size, and the location of the filter relative to pollut-
ant sources and to the location of a building’s occupants. Factors affecting
energy and cost include airflow resistance, pressure drop, fan and motor
efficiency, and the particle-holding capacity as it relates to the filter’s life-
time. Fisk noted that there are three systems used in the United States to
rate filters:
1. Minimum efficiency reporting value (MERV), developed the Ameri-

can Society of Heating, Refrigerating, and Air-Conditioning Engi-
neers (ASHRAE), which rates filters on their minimum efficiency
within a set of particle size bins
2. Micro-Particle Performance Rating (MPR), developed by 3M,
which rates performance on removal of PM in the 0.3- to 1-micron
size range
3. Home Depot’s Filter Performance Rating system (FPR), which uses
a scale of 1 to 10 and a color code to rate filters based on large par-
ticle removal, small particle removal, and particle-holding capacity.
Fisk said that while filtration can be highly effective, the effectiveness
of filtration systems varies widely. One recent informative study of particle
filtration in nine southern California classrooms (Polidori et al., 2013)
resulted in the data displayed in Figure 5-1. This study compared filtration
in a baseline scenario, in which the HVAC system fitted with a MERV 7
filter runs continuously, to several other filtration alternatives. Adding a
standalone filtration unit with a MERV 16 filter produced a large increase
in removal effectiveness, Fisk said, though adding a MERV 16 filter in the
HVAC system itself was even more effective. None of the configurations
tested were able to maintain the indoor concentration of PM10 below
60 percent of the outdoor air PM10 concentration, probably because of high
indoor PM10 generation rates in classrooms. Many of the configurations
were quite effective at reducing the indoor concentration of PM2.5 and UFPs
relative to the baseline filtration system.

EXPOSURE MITIGATION 61
FIGURE 5-1 Particle removal effectiveness (%) as a function of filter efficiency.

NOTE: Bars indicate data averaged at all schools and in all classrooms sampled by
the authors; vertical lines represent standard deviations for each bar.
SOURCES: Fisk slide 6, from Polidori et al. (2013) Figure 3; reprinted with permis-
sion from John Wiley & Sons, Inc.
One limit to the impact that filtration currently has on reducing PM

exposure, Fisk said, is that the current ASHRAE standards for both resi-
dences and commercial building only require MERV 6 filters except in areas
of the country that are not in compliance with PM2.5 regulations (in which
case the standard for commercial buildings is MERV 11 filters). However,
MERV 6 filters remove less than 20 percent of the particles of most sizes
(see Figure 5-2). “So the filters that we commonly use have a low efficiency
for particles in the most interesting size range,” Fisk said. In homes, this
deficiency is compounded by the fact that HVAC systems run intermittently.
Given that approximately 55 percent of homes have filters with a rating of
MERV 6 or lower (El Orch et al., 2014), which will remove about 7 percent
of PM2.5 (Azimi et al., 2014), and that the HVAC in a typical home runs
approximately 20 percent of the time (Cetin and Novoselac, 2015) with
an air flow rate of approximately 4.4 air exchanges per hour (Jump et al.,
1996; Stephens et al., 2011), Fisk calculated that the total removal rate is
less than 10 percent of the indoor particle load per hour. “Those filters are
not bringing us much benefit, but that is what we use today,” he said.
Most filters sold today contain embedded charged fibers, which can
increase particle removal efficiency but only for a limited time (Raynor and
Chae, 2004). Studies in several settings have shown that PM in cigarette
smoke and diesel exhaust can quickly reduce the efficiency of charged fiber

FIGURE 5-2 Particle removal efficiency by filters of different MERV ratings.

SOURCES: Fisk slide 8, from El Orch et al. (2014) Figure 4; reprinted with permis-
sion from Elsevier.
filters (Lehtimäki and Heinonen, 1994; Raynor and Chae, 2004). “We do
not fully understand the physics behind this phenomenon,” Fisk said.
A growing trend, he said, is to add “nanofibers,” a term the filtra-
tion industry uses for fibers with diameters of less than 0.5 microns (as
compared with diameters of a few microns in the most common filters).
Experimental data suggest that these nanofiber filters can produce a higher
ratio of particle removal efficiency to air pressure drop (Ahn et al., 2006;
Leung et al., 2009; Wang et al., 2008).
Fisk explained that the energy used to remove particles with filters var-
ies dramatically depending on the system being used. His recent research
showed, for example, that a standalone high-efficiency filter can remove
particles for a fraction of the cost per gram compared to an HVAC system
(Fisk and Chan, 2016) (see Table 5-1).
Fisk then discussed the common belief that better filters will substan-
tially increase energy costs because they will increase airflow resistance.
“For many situations,” he said, “the data do not bear that out” (Walker et
al., 2013), and while better filters do cost more, he said he would argue that
the increase in costs is not so high as to be prohibitive. Deeper filters with
more pleating can reduce airflow resistance, which minimizes the effects on
the energy consumed by the HVAC system fan, he explained. Calculations
also show that for a system in a commercial building that has multiple

TABLE 5-1 Characteristics of Continuously Operating HVAC and High-

Efficiency Standalone Filters
Standalone
HVAC + HVAC with with
Low e Filter High e Filter High e Filter
Flow rate (h–1) 4.3 4.3 1
House volume (m3) 433 433 433
Watt per m3 s–1 1090* 1090* 600*
PM2.5 removal efficiency 0.12* 0.27* 0.9
Time 1 year 1 year 1 year
Electricity price $0.132/kWh $0.132/kWh $0.132/kWh
Home PM2.5 20 µg m–3 20 µg m–3 20 µg m–3
PM removed (g) 39 88 68
Electricity cost ($) $650 $650 $83
$ Elec. per gr. PM removed $16.7 $7.4 $1.2
Electricity Cost of operating a filtration system = flowrate ( )

Power
Flow
(time)
$
energy
Particle Mass Removed = flowrate efficiency time concentration
NOTE: Data marked with “*” are derived from Fisk and Chan, 2016.
SOURCE: Fisk slide 13.
filters and occupants, the increased life-cycle costs of a MERV 13 versus

MERV 8 filter works out to at most $3 per person per month (Montgomery
et al., 2012).
In 2013, Fisk reviewed the health benefits of filtration (Fisk, 2013) and
came to two main conclusions. The first was that filtration has only a minor
benefit with regard to reducing allergy and asthma outcomes. There is
some evidence of benefit in homes with large sources of allergens, but only
a fraction of health outcomes improved. The second conclusion was that
the greatest potential comes from using better filtration to reduce indoor
concentrations of outdoor PM, thus reducing the morbidity and mortality
associated with outdoor air PM. “The health benefits are predicted to far
exceed the costs for those interventions,” Fisk said. Other conclusions he
drew in his review included
• Systems that delivered filtered air to the breathing zone when indi-
viduals are sleeping appear to be more effective in reducing allergy
and asthma symptoms;

• Evidence of health benefits from filtration in homes, offices, and

schools in subjects without allergies and asthma is limited; and
• The reductions in markers of future adverse coronary events with
filtration support modeled health benefits of using filtration to
reduce particles from outdoor air.
Fisk concluded his presentation with a list of issues and challenges

relating to filtration, which included
• Quantifying, demonstrating, and communicating benefits to moti-

vate the use of better filters;
• Improving filtration effectiveness while reducing costs;
• Increasing minimum filtration efficiency requirements in standards;
• Limited expected effectiveness for locally resuspended coarse par-
ticles, such as some allergens;
• Pollutant generation by some electronic air cleaners;
• Soiled filters may emit pollutants and diminish perceived air quality;
• Many expensive and ineffective products are sold; and
• Empirical validation of predicted health benefits.
One of Fisk’s concerns relates to the trend of increasing the use of

natural ventilation in commercial buildings, which will increase exposure
to outdoor particles and ozone. He said that it will be important to identify
approaches for mitigating those exposures in naturally ventilated com-
mercial buildings. Fisk said he also believes that there is a need to better
understand the relative health risks of outdoor PM versus PM that is gen-
erated indoors and also how filtration can be a tool to differentially affect
exposures and risks.
METHODS AND APPROACHES FOR CONTROLLING

EXPOSURE TO BIOLOGICAL AEROSOLS2
One of the measurables that is specific to biological particles, Sergey
Grinshpun said, is the percentage of airborne organisms that are viable.
Viability is measured by counting colonies of microorganisms from col-
lected particles that grow on agar plates. Other ways of analyzing biological
materials include looking at antigens and allergens, quantifying molecules
specific to the cell wall or membranes, and assessing the presence of fungal
toxins, also known as mycotoxins. Biological particles appear in a wide
2 This section is based on the presentation by Sergey Grinshpun, a professor of environ-
mental health at the University of Cincinnati College of Medicine, and the statements are
not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

FIGURE 5-3 Size ranges for different types of bioaerosol particles.

SOURCE: Grinshpun slide 4.
range of sizes (see Figure 5-3). Viruses range in size from approximately
20 to 400 nanometers, the bacterial and fungal size range is approximately
0.5 to almost 10 micrometers, and pollen occupies the high end, from >10
to >100 micrometers in diameter. Air purification may not be an important
issue for pollen because pollen grains settle out of the air rapidly.
Grinshpun said that there are two main approaches to mitigating expo-
sure to biological particles. The first is to reduce the overall PM burden
from all sources via, for example, filtration or electrostatic precipitation.
While Fisk had already discussed filtration, Grinshpun pointed out that
every type of filter has a characteristic particle size for which its removal
efficiency is lowest. For the typical devices used for indoor air filtration,
this size ranges between <0.1 and 1 micrometer, which corresponds to the
sizes of larger viruses and many bacteria. Electrostatic precipitators have
been found to be good at removing bacterial aerosol particles (Mainelis et
al., 2002). While these precipitators are inexpensive and quiet to operate,
they are not commonly used against bioaerosols.
Ozone generation devices are available but Grinshpun questioned their
utility for removing indoor PM or reducing the viability of microorganisms
in indoor air. Grinshpun and his colleagues have shown that commercially
available ozone generators do not remove particles but instead create new
ones (Grinshpun et al., 2010). Ion emission devices work by generating ions

that attach to particles, causing the particles to migrate toward and stick
to indoor surfaces. Grinshpun and his colleagues evaluated this method in
a test chamber and found that it does have the potential for removing par-
ticles, albeit with lower efficiency than filtration. The main problem is that
most ion emitters also emit ozone, which, as Glenn Morrison had noted in
his presentation, can trigger the generation of UFPs.
A number of different methods, including heat, UV light, and cold
plasma, have been used to inactivate microorganisms. “With these methods,
we do not care about concentration, we just want to kill viable microorgan-
isms,” Grinshpun explained. He noted that some commercially available
air cleaners use ion emission, ozone generation, and photocatalytic oxida-
tion to inactivate microorganisms. The efficiency of these methods varies,
he said.
Thermal inactivation has potential as a means of inactivating microor-
ganisms, even stress-resistant bacterial spores such as anthrax spores. In one
experiment, Grinshpun and his colleagues showed that only 0.1 percent of
anthrax surrogate spores remained viable after passing through a thermal
inactivation device at 315°C (Grinshpun et al., 2010). The major limita-
tion to this technique, Grinshpun said, is being able to process enough air
through such a device. A group of investigators in South Korea performed
a study similar to what Grinshpun and his colleagues did with the anthrax
surrogate spores (Jung et al., 2009) and showed that short-term exposure
to high temperature changes the physical structure of aerosolized fungal
spores. Whether this change is responsible for the ultimate inactivation of
the spores is still unclear, Grinshpun said, “but the bottom line is that it is
quite efficient.” Viruses, he added, are readily inactivated at air tempera-
tures as low as 60°C.
The ability of UV irradiation to inactivate viable microorganisms has
been well studied, though not in aerosols. One study (Peccia et al., 2001)
found that the rate of inactivation of aerosolized bacteria using UV light
depended on the humidity. Other experiments have shown that the com-
bination of UV light and heat is more effective at inactivating bacteria in
indoor air environments and at lower temperatures than when heat alone
is used. The one caveat to the use of UV light, Grinshpun said, is that UV
lamps can generate ozone. Recently, Grinshpun and his colleagues have
been studying the use of atmospheric-pressure cold plasma to inactive
viable microorganisms, and they found that this method causes viruses to
fragment (Wu et al., 2015). They have not yet studied the effects of cold
plasma on other types of bioaerosol particles.
Viable microorganisms, Grinshpun said, can also be inactivated after
they have been collected on filters. Biocidal chemicals, such as iodine
(Eninger et al., 2008), have been shown to be effective at inactivating
microorganisms on filters, as have microwave and infrared irradiation (Lee

et al., 2009; Ratnesar-Shumate et al., 2008; Zhang et al., 2010). Alumina

nanofibers with a positive surface charge have been shown to strongly
retain virus particles, which are often naturally negatively charged (Li et
al., 2009).
As a final note, Grinshpun mentioned that filtering respirators can
reduce exposure to biological aerosols (Eninger et al., 2008; Grinshpun et
al., 2007) and are generally as effective as stationary air filters. Protection
may not be efficient, however, because of leakage between the respirator
and the user’s face. Grinshpun also expressed caution about the use of
so-called antimicrobial respirator filters, given that the risks of inhaling
biocidal agents or having them come in prolonged contact with skin are
not known.
MITIGATING PARTICLE EXPOSURE IN

LOW-SOCIOECONOMIC HOUSEHOLDS3
Low socioeconomic status is often equated with low income, Brett
Singer noted, but it also is correlated with low education and, more impor-
tantly, low status and low access to information, all of which are important
when it comes to thinking about changing behavior or practice. “When we
talk about these fixes,” he said, “something that will work for a family that
has it all together might not work for a family that is struggling just to get
through the day.”
There are physical, economic, and sociological challenges to reduc-
ing PM in low-socioeconomic homes, Singer said (see Table 5-2), many
of which Gary Adamkiewicz addressed in his earlier presentation. Singer
pointed out two items in particular. “When we talk about low-cost rem-
edies, what is low-cost for me is going to be different from what is low-cost
to a family of four living on $30,000 a year that has no credit or very costly
credit,” he said. “There’s also limited or no choice in their housing. They
cannot move or readily change it.” He also pointed to the importance of
low status, which often translates into a limited ability to demand repairs.
“They do not complain because they are worried about being thrown out
and they have no alternative place to live,” he said.
While the typical way to think about mitigation is to parse it into
source control, ventilation, and filtration, Singer said he uses a different
mental model, one that includes reducing PM from outdoor sources, reduc-
ing indoor sources, and accelerating the removal rate of indoor PM. The
first step, he said is to reduce PM from the outdoors, given that a large
3 This section is based on the presentation by Brett Singer, a staff scientist in the Indoor
Environment Group at Lawrence Berkeley National Laboratory, and the statements are not
endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

TABLE 5-2 Challenges to Reducing PM in Low-Socioeconomic Homes

Physical Challenges
• Smaller spaces, higher density, and occupied more
• Housing units in closer proximity; more exchange of air between units
• More mechanical equipment problems related to age, quality, and lack of servicing
• Closer to outdoor sources such as roadways, industry and ports
• Leakier buildings leads to more exposure to outdoor pollutants
• More smoking, mold, pests, and dust
• More use of odorants; may include candles, incense, and others
• Lack of thermal control leads to a need to open windows
Economic Challenges
• Limited or negative disposable income
• No credit or very costly credit
• Limited or no choice in housing
Sociological Challenges
• Limited status to demand repairs
• Language and digital divide limit access to knowledge
• Complicated co-habitation arrangements
• Cultural norms may limit source control options
SOURCES: Singer slides 6 and 7.
fraction of indoor PM originates outdoors (Allen et al., 2012; Meng et al.,

2004). In a series of experiments conducted in a moderately tight, empty
house located some 300 meters downwind of Interstate 80 in Sacramento,
California, Singer and his colleagues studied the effects of a number of dif-
ferent combinations of ventilation and filtration on PM2.5 levels (see Figure
5-4) and UFP levels inside the house. They found that a relatively tight
shell was very effective in reducing PM2.5 and UFP infiltration but was less
effective in keeping out carbon black particles. Levels fluctuate, however,
and the research observed times during the day when the indoor level of
carbon particles was higher than that outdoors.
Indoor PM levels were further reduced by filtration, Singer said, either
when a MERV 16 filter was used to filter the air supply coming into the
house or when a MERV 13 or better filter was used with a recirculating
HVAC system. “You can get very effective outdoor particle reductions with
a recirculating system,” Singer said. He noted that a simulation analysis
using measured parameters conducted by Brent Stephens and his colleagues
(Zhao et al., 2015) found that protecting the indoors from outdoor par-
ticles by sealing the envelope provides the biggest impact on reducing
in-home exposure to outdoor PM, while filtration does more for reducing
levels of indoor PM generated indoors. However, filtration was predicted
to have a significant impact on indoor PM in old homes with significant
infiltration of outdoor PM.

FIGURE 5-4 The effect of air sealing on PM2.5 infiltration.

SOURCE: Singer slide 10; from Singer et al., 2016.
Singer said that the air tightness of homes has improved over the years
(Chan et al., 2013) and that retrofitting measures do reduce air infiltration
in existing homes. Weatherization assistance programs, he said, are achiev-
ing median reductions in PM levels of 30 percent for single-family homes
and 28 percent for multifamily homes.
Indoor sources of PM2.5 and UFPs vary greatly by home and according
to the time of day (Wallace et al., 2003). If there is habitual smoking in the
house, that will typically be the most importance source, Singer said. He
noted that efforts to get smokers to stop smoking indoors have been suc-
cessful, particularly in low-socioeconomic homes, and that when smokers
stop smoking indoors, it does produce meaningful reductions in indoor lev-
els of PM2.5 (Semple et al., 2015; Wilson et al., 2012; Zhang et al., 2012).
Portable filters placed in children’s bedrooms reduce PM levels in the homes
of smokers and non-smokers alike (Batterman et al., 2012), though the
researchers who conducted this study found that filter use waned over time.
Cooking is an important PM source in most homes, as are candles
and incense in homes where these are used frequently. As had already
been discussed, hot surfaces, resuspension, and cleaning can be important
indoor sources of PM. With regard to cooking, range hoods can be effec-
tive at removing PM from indoor air, but only if they are used and only
if they are installed correctly. Some range hoods, for example, simply run
air through a charcoal filter and recirculate it back into the home. Singer

said that he and his colleagues at Lawrence Berkeley National Laboratory

are working with the voluntary consensus standards organization ASTM
International to develop a standard method of testing the efficiency with
which range hoods capture cooking pollutants. As part of that work, he has
found that the capture efficiency for cooking on the back burner is typically
greater than 70 percent but that the efficiency is highly variable for cook-
ing on the front burner (Delp and Singer, 2012). These measurements were
made under controlled conditions in the laboratory, Singer cautioned, and
the results were far worse when he went into the field and tested hoods in
homes (Singer et al., 2012). A study using self-reports found that one-third
of those responding to the survey used their hoods infrequently and that
10 percent reported they never used their hoods (Mullen and Singer, 2012).
Some 20 percent of homes surveyed in California did not have an exhaust
fan over their stoves.
With regard to costs, Singer said a quiet, energy-efficient, standalone
high-efficiency particulate air/arrestance (HEPA) filter unit may cost $400
to $500 to cover 500 square feet of living space, with a less efficient, noisier
unit costing perhaps half as much. The filters for the low-end units range
from $20 to $30 and those for the high-efficiency units from $80 to $100.
Low-income households are not likely to spend their limited funds on a
filtering device, Singer said. Central HVAC filters are less expensive, but
Singer said the landlord of a low-income housing unit is likely to think
twice about spending $20 to $30 on a MERV 13 filter for every unit. A
basic, noisy range hood can cost less than $50, but a quiet range hood with
sufficient power to efficiently remove PM can cost $200 to $300.
The best control, then, starts with a good building, Singer said in sum-
mary: one with an airtight envelope, a vented range hood that is also quiet
(so that it will be used), a central forced air HVAC system with an efficient
blower and a 2- to 5-inch filter slot, robust venting of combustion appli-
ances, and limited use of carpeting, except perhaps in the case of housing
for the elderly where slipping on uncarpeted surfaces can be hazardous.
Singer also suggested a number of actions that individuals can take to
reduce their exposure to PM, including closing windows to reduce the lev-
els of outdoor PM, particularly when pollution is bad or likely to be bad;
restricting smoking and burning candles and incense; using a range hood
and cooking on back burners; using a HEPA vacuum cleaner and ventilating
when cleaning; and investing in good filters and using filtration. As a final
thought, he said that PM is just one element of the indoor environment and
rather than worry about which elements of green housing are most impor-
tant, the key point is that providing good housing for people will provide
a great deal of benefits in many areas beyond reducing PM.

DISCUSSION
Tiina Reponen started the discussion by asking the three session speak-
ers to list the key questions that need answering with regard to mitigating
exposure to PM. Fisk responded that there is a need to identify appropriate
techniques to deal with airborne allergens or particles that are inflammatory
so as to help reduce the effects that these have on respiratory difficulties,
including asthma. Fisk also said he thought that while filtration is predicted
to produce large reductions in mortality and morbidity, empirical data are
needed to support those predictions even though acquiring such data will
be challenging. He did note that there are some data in the asthma mitiga-
tion literature indicating that a broad combination of approaches is more
effective at improving health than any single approach. Also, a subset of
studies that looked at the effects of using filtration systems to ventilate the
breathing zone of asthmatic individuals when they were sleeping found that
these systems produced more benefits more consistently than whole-house
measures (Fisk, 2013).
Grinshpun said that given the rapidly growing U.S. and European
markets for air purifiers, he would like to see more research to identify
the various byproducts produced by some of the methods for removing
bioaerosols from circulation and to determine the optimal condition under
which a given method is most efficient at reducing exposure without doing
any harm. He said in response to a question about ozone production from
ion generators that no device that emits ozone should be deployed and that
he has tested ion generators that do not emit any measurable ozone. How-
ever, he added, filter-based air purifiers are generally more efficient than ion
generators at removing indoor PM. Singer said that one of the big questions
for him is how to better communicate what is already known to the public
about the effectiveness of and issues associated with various mitigation
strategies so that the public, including building professionals, can make use
of information on how to best mitigate exposure to PM.
Grinshpun, responding to a question about the mechanism by which
cold plasma inactivates viruses, said that the mechanism is still not well
understood. With regard to thermal inactivation, he said that mechanical
disintegration of microorganisms may occur at 600 to 700°C, which is
where 100 percent inactivation has been observed, but the mechanism by
which lower temperatures produce moderate levels of inactivation is still
not adequately characterized.
When asked about the difficulty of retrofitting an HVAC system to
take deeper MERV 13 or MERV 16 filters, Fisk said that manufacturers are
now making filters with higher than MERV 7 efficiency that fit in standard
1-inch filter slots and that there are systems that can be installed over the
return grill instead of in the furnace system that are not hard to install. “In

many cases, you do not need to retrofit,” he said, “but having said that, a
home owner or renter in a low-income environment is not likely to have
the resources to make even modest improvements their highest priority.”
Singer said that adding more efficient filters to some older HVAC systems
could increase the pressure drop significantly, raising a legitimate concern
about whether a retrofit on an existing system is a good idea. With regard
to retrofitting kitchen exhaust hoods, Richard Corsi commented that many
range hoods, at least in Texas where he lives, get vented into attics, which
can lead to a buildup of chemically reactive unsaturated fatty acids on
surfaces in that space.
Terry Brennan said that while tightening the building envelope can pro-
duce large reductions in the transport of outdoor PM to the indoors, that
would also lead to increases in the levels of indoor PM from indoor sources.
Singer replied that the judicious use of indoor ventilation and reducing the
production of indoor PM through education have to go hand-in-hand with
envelope tightening. He also responded to a question about air quality in
net-zero energy homes by noting that such homes also need to make judi-
cious use of effective ventilation. The one criticism Singer had of some of
these homes is that they may forgo range hoods in the mistaken belief that
cooking on electric stoves does not produce UFPs, which in fact it does.
A possible solution, he said, would be to use high-efficiency filters in the
forced-air HVAC systems that are installed in at least some of these homes.

Discussion and Summary of Day 1
T
o conclude the workshop’s first day, William Nazaroff moderated a
discussion among the workshop participants. He opened the discus-
sion by summarizing the key messages he had heard, starting with
what he said he thought was a clear picture of the degree to which build-
ings protect their inhabitants from outdoor PM—which he said was not
very good for PM2.5, better for UFPs, and better still for PM10 and larger
particles. Buildings are also good, he said, for providing protection against
outdoor nitrate but not as good for organic carbon, particularly given
the evidence that indoor sources are the predominant contributors to the
organic carbon content of indoor PM.
The second key message Nazaroff said he heard concerned the lack
of data available to understand the nuances of what is a richly complex
system; that lack suggested a potential for using information technology
and the “Internet of things” to address the data deficit. Another important
message, he said, was the significant variability that exists with regard to
how the features of individual buildings and the activities taking place in
buildings affect indoor PM levels and their associated health effects. “We
are dealing with 100 million dwellings in the United States, tens of mil-
lions of commercial spaces, and each one has its own attributes even if the
governing principles are common,” Nazaroff said. Similarly, he said, the
variability of how people behave in the indoor environment has an impor-
tant influence, creating a huge challenge to understanding exposure and
mitigation but also an opportunity for progress through research.
Bob Thompson of EPA commented on the importance of distilling what
is known about indoor PM, mitigation approaches, and possible health
73

effects into a form that will help the program officers in EPA’s Office of
Research to make decisions about where future resources will go, given how
tight the research budget is today. “The more we can turn this information
into language [that] helps them clearly see its value, the better off we will
be from EPA’s perspective,” Thompson said. He also noted the importance
of putting terms such as “high cost” and “low cost” into a context of how
much value a given expense brings to the people who will be spending
money on these mitigations.
Steven Welty of Green Clean Air said that Hong Kong has an indoor
air quality rating system that participating buildings post, and he wondered
if there is a way to distill what is known about indoor air quality to create
such a rating system for use in U.S. commercial buildings or even homes.
Brett Singer said that while this is an interesting idea, it is important to
remember that indoor air quality will vary significantly over time, depend-
ing on how a building is operated and what the people inside it are doing.
What could be done, though, is to rate a building’s robustness in providing
good indoor air quality based on its HVAC system, how it is operated,
the type of filtration and ventilation installed, and other features that are
known to contribute to improved indoor air quality.
Richard Corsi remarked that an understudied area concerns the chemis-
try occurring in the breathing zone, where organic compounds in a person’s
breath can react with ozone. Barbara Turpin commented that consumer
products had not been discussed much, and she said she worried that
consumers place too much trust in the idea that a device is safe if used as
directed. William Hallman from Rutgers University asked if there were any
data on particle emissions from gas and electric clothes dryers. Nazaroff
responded there has been one paper published on UFPs produced by clothes
dryers (Wallace, 2005), and based on the results of that paper his group
looked for but could not find evidence that dryers in the homes they stud-
ied contributed to the UFP burden in those homes. Nazaroff noted that
Lynn Hildemann had said that laundry detergent enzymes are present in
dryer lint. Jeffrey Siegel added that there is emerging evidence that dryers
can transfer SVOCs deposited on clothing into the air. He also said that a
dryer vent produces a high-volume flow rate of air, and in buildings with
tight envelopes, that can create potentially serious problems in terms of
depressurization and pulling contaminants into the indoor environment
from particle-generating appliances.
Terry Brennan commented on the importance of intervening when a
building is being designed or completely gutted and rebuilt, noting that he
often goes into new buildings with horrible problems that could have been
easily avoided during design and construction. He said that one approach
to improve conditions in multifamily buildings could be to encourage
mortgage companies and banks to require PM-reducing interventions when

DISCUSSION AND SUMMARY OF DAY 1 75
owners refinance mortgages, which, he said, occurs every 10 to 15 years.

Another opportunity to intervene is when building owners retrofit HVAC
systems.
Glenn Morrison wondered if it would be more cost-effective as a nation
to spend money, perhaps via tax rebates, to retrofit buildings to remove
indoor PM than on making incremental reductions in outdoor PM levels.
William Fisk replied there have been a number of cost–benefit analyses for
the health benefits that would accrue from improving filtration systems
in buildings and the numbers look promising from a societal perspective.
What he has not seen, he said, is a comparison of the cost effectiveness of
improving health through traditional outdoor PM mitigation approaches
versus approaches that can be implemented in buildings.


Potential Health Concerns
W
hile the first day’s presentations and discussions focused on the
physical science and engineering aspects of indoor PM, the sec-
ond day’s presentations turned to what William Nazaroff called
the “So what?” and “What now?” topics—the associated health risks of
exposure to indoor PM and risk communication. In the first of the day’s
two sessions, Ryan Allen of Simon Fraser University discussed the effect
of indoor PM on cardiovascular health, David Rich from the University
of Rochester Medical Center presented emerging evidence linking ambi-
ent PM and adverse birth outcomes, and Marc Weisskopf of the Harvard
T.H. Chan School of Public Health addressed the role that PM may play
in neurological and psychiatric disorders. An open discussion moderated
by Howard Kipen of Rutgers University followed the three presentations.
INDOOR PM AND CARDIOVASCULAR HEALTH1

Ryan Allen began his presentation by noting that he was not going to
cover household air pollution from solid fuel combustion, which, he indi-
cated, is “arguably the most important environmental risk factor globally”
but isn’t generally an issue in high-income countries. After reiterating that
a significant percentage of indoor PM originates outdoors (Allen et al.,
2012), he stated that, in his view, the line between indoor and outdoor PM
1 This section is based on the presentation by Ryan Allen, an associate professor on the
faculty of health sciences at Simon Fraser University, and the statements are not endorsed or
verified by the National Academies of Sciences, Engineering, and Medicine.
77

is not as distinct as some might think. He said that while much of the early
research on PM and health focused on respiratory health, there have been
a growing number of studies over the past 15 years on the cardiovascular
effects of PM exposure (Bai et al., 2007; Brook et al., 2010; Crouse et al.,
2012; Koulova and Frishman, 2014; Kunzli and Tager, 2005; Simkhovich
et al., 2008; Sun et al., 2010). An important conclusion from these studies,
Allen said, is that exposure to PM has a causal effect on cardiovascular
health, not just a statistical association. In 2010, he noted, the American
Heart Association issued a statement declaring, “It is the opinion of the
writing group that the overall evidence is consistent with a causal relation-
ship between PM2.5 exposure and cardiovascular morbidity and mortality”
(Brook et al., 2010, p. 2365). He noted that the evidence backing this
statement came almost entirely from studies using outdoor measurements
and models.
The accumulated evidence also supports the finding that adverse car-
diovascular effects occur at the lowest levels that individuals encounter
(Crouse et al., 2012), said Allen, noting that “The evidence seems to sug-
gest the absence of a threshold or a safe exposure level.” In fact, he added,
the data seem to suggest that the relationship between PM exposure and
cardiovascular health outcomes is linear or even supralinear, where the
dose–response curve is steepest at the low end of the exposure distribution.
If this finding holds, the implication would be that there would be a health
benefit from further reductions in PM exposures.
Taken together, Allen said, these data show that exposure to ambient
PM is an important public health risk factor (see Figure 7-1) and that the
public health impacts from PM are driven largely by its effects on cardio-
vascular and circulatory diseases. “We still tend to think of PM as a respi-
ratory pollutant or toxicant, but in terms of its public health impacts it is
the cardiovascular and circulatory effects of PM that are driving the public
health burden,” he said.
Research suggests that there are three interrelated mechanisms linking
PM exposure with cardiovascular health (see Figure 7-2). The first, Allen
explained, involves an inflammatory response in the lungs to PM inhala-
tion which leads to the release of cytokines and other biomolecules into
the circulatory system. The second mechanism involves the activation of
the autonomic nervous system, which in turn affects blood vessels, heart
rhythm, heart variability, and other physiological systems. The third mecha-
nism involves direct transport of the smaller particles into the bloodstream,
where they interact with blood vessels and various blood cells.
The methods for investigating the role of indoor PM on cardiovascular
health include in vitro and epidemiologic studies. Epidemiologic studies,
Allen said, have some important limitations, given the lack of good models
for predicting indoor PM levels. “In most cases, we have to actually measure

POTENTIAL HEALTH CONCERNS 79
FIGURE 7-1 Global public health burdens attributable to 20 leading risk factors in
2010. The pink bar (far left) represents the contribution of respiratory infections;
the light blue bar, chronic lung diseases; the medium blue bar, cardiovascular and
circulatory diseases; and the dark blue bar (far right), cancer.
SOURCE: Allen slide 7, adapted from Lim et al. (2012) Figure 2C; reprinted with
permission from Elsevier.
indoor PM,” he said, “and because these measurements are time-consuming

and expensive, we end up studying relatively small populations that may
be non-representative, creating challenges extrapolating our results to the
broader general population.” The time and money constraints also lead to
studies being restricted to examining short-term effects, on the order of days
and weeks, rather than the years over which chronic disorders develop. The
other main limitation of these studies is that they look at relatively subtle
subclinical effects, such as changes in markers of inflammation and blood
vessel function, rather than the clinically relevant outcomes of heart attack
and stroke, among others.
As an illustration of the type of in vitro studies researchers perform,
Allen described one study in which researchers collected PM samples inside
and outside of homes in Boston, dosed rat lung macrophages with the
particles, and then measured the release of cytokines from these immune
system cells (Long et al., 2001). The results showed that there was a larger
inflammatory response to indoor PM than to outdoor PM. Allen stressed
that he did not want to overemphasize these data and that he was just using
them as an example of the tools that investigators are bringing to bear on
the challenge of understanding how indoor and outdoor PM affect inflam-
mation and other relevant health indicators.

FIGURE 7-2 Biological pathways linking PM exposure with cardiovascular dis-

eases. A question mark (?) indicates a pathway/mechanism with weak or mixed
evidence or a mechanism of likely yet primarily theoretical existence based on the
literature. [Abbreviations defined in source publication.]
SOURCE: Allen slide 9, from Brook et al. (2010) Figure 3; reprinted with permis-
sion from Wolters Kluwer Health, Inc.
Allen then discussed some of the intervention studies that have been
conducted. These studies use an air filter to reduce indoor PM levels, which,
he explained, allows researchers to isolate the effects of PM from the pol-
luting gases that may also be in the environment. In one study, Allen and
his colleagues divided the residents of a wood smoke–affected community
in the central part of British Columbia into two groups. Each participant
was observed for two consecutive 7-day periods, during which time por-
table HEPA filters were operated in the participants’ living rooms and bed-
rooms. HEPA filters were operated normally during one 7-day period and
without the internal filters in place (which was called “placebo filtration”)
during the other period, thus blinding participants to the filters’ status. The
order of filtration or non-filtration was random. Health measurements were
made again after another week. The data showed that the use of portable
HEPA filtration for 7 days, which reduced PM2.5 levels from 11 micro-

grams per cubic meter to 5 micrograms per cubic meter, was associated
with improved blood vessel function and decreased systemic inflammation
(Allen et al., 2011).
In a second study using the same design, Allen and his colleagues stud-
ied the differential effects of two different sources of PM: traffic emissions
and residential wood combustion (Kajbafzadeh et al., 2015). Using previ-
ously developed spatial models, he and his colleagues were able to identify
parts of Vancouver affected by traffic-related air pollution but not by wood
smoke, and vice versa. The data from this study revealed an association
between indoor PM2.5 and the blood levels of an inflammatory protein, but
only in the group exposed to traffic-generated PM. “The take-home mes-
sage,” Allen said, “is that indoor PM and its relation to health outcomes
depends on where the PM2.5 is coming from, and this one small study sug-
gests that particles produced by traffic may have some greater impacts than
wood smoke particles on inflammation.”
Other intervention studies have shown that air filtration improves
blood vessel function (Brauner et al., 2008; Karottki et al., 2013), reduces
blood pressure (Padro-Martinez et al., 2015; Weichenthal et al., 2013), and
reduces inflammatory and thrombogenic biomarkers (Chen et al., 2015).
Allen also noted that one study in Massachusetts found results that were
surprising and inconsistent in that filtration increased levels of a cytokine
related to inflammation but also decreased blood pressure (Padro-Martinez
et al., 2015). Allen said that the only cohort study of which he is aware,
which looked at long-term exposure to indoor PM, found that long-term
exposure to incense at home was associated with an increased risk of car-
diovascular mortality (Pan et al., 2014).
In summary, Allen said, PM is an established cardiovascular risk fac-
tor, and the global public health burden of PM is primarily a result of its
cardiovascular effects. Although the data are not entirely consistent, human
studies have found links between indoor PM levels and increased systemic
inflammation, blood vessel dysfunction, and increased blood pressure. The
study of indoor PM, he said, presents an important epidemiologic research
challenge, and more research is needed to better characterize the relative
toxicity of PM generated indoors and outdoors, of PM from specific indoor
and outdoor sources, and of PM2.5 versus UFP. Other knowledge gaps, he
said in closing, concern the role that bioaerosols play in generating the car-
diovascular effects of exposure to indoor PM and the relationship between
long-term exposure and actual clinical outcomes such as heart attack and
stroke.

AMBIENT PM AND ADVERSE BIRTH OUTCOMES2

The first indication that ambient PM levels might have an impact on
adverse birth outcomes, David Rich said, came from a 1995 study in China.
In this study (Xu et al., 1995), the investigators used the Beijing birth reg-
istry to identify all of the mothers living in one of two urban districts and
data collected from ambient monitors in the city to calculate an estimated
average pollutant concentration for the first, second, and third trimester
and over the course of the entire pregnancy. These data showed that the
mean pollutant concentration, as reflected by sulfur dioxide and total sus-
pended particulate levels, in the 7 days before birth was correlated with a
risk of preterm birth. The data from this study also revealed a significant
increase in the risk of having a baby with low birth weight when average
pollution levels rose during the third trimester (Wang et al., 1997). This
type of study, using existing datasets of birth outcomes, birth registry data,
and pollution levels, has been conducted in numerous locations around
the world to evaluate whether air pollution exposure during pregnancy
is associated with preterm birth, fetal growth restriction, and pregnancy
complications, Rich said.
Another type of study, which Rich called a “natural experiment,” takes
advantage of one-time events such as large sporting events, industrial facil-
ity closures, or government policies that drops ambient pollution levels for
a defined time period and thus becomes a community-wide or region-wide
intervention. One such study was conducted in the Utah Valley when a steel
mill there closed for some 13 months, leading to a dramatic reduction levels
of PM10 and other pollutants (Parker et al., 2008). The data from this study
showed that the preterm birth rate in the Utah Valley dropped significantly
during the period of the steel mill closure, whereas the preterm birth rate
outside of the Utah Valley remained constant (see Figure 7-3). The finding
that a drop in pollutant levels produced a beneficial health effect presents
a powerful complement to studies showing an increase in pollutant levels
produces a negative health effect, Rich said. “If this relationship is truly
causal, we should see the effects in both directions,” he explained.
Rich was involved in another natural experiment which looked at dif-
ferences in birth weight associated with the 2008 Beijing Olympics, when
the Chinese government mandated that, to improve air quality during the
event, industries were shut down for 47 days, cars were only to be driven
every other day, and several other pollution restrictions were put in place.
This resulted in PM2.5 levels dropping 40 percent, though they remained
markedly higher than U.S. levels. The study by Rich and his colleagues
2 This section is based on the presentation by David Rich, an associate professor of public
health sciences at the University of Rochester Medical Center, and the statements are not en-
dorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

FIGURE 7-3 Preterm birth rate in and outside the Utah Valley before, during, and
after the Utah Valley Steel Mill temporary close-down.
SOURCE: Rich slide 4, from Parker et al. (2008) Figure 1; reprinted with permission
from Wolters Kluwer Health, Inc.
found an increase in birth weight for babies whose 8th month of gestation
was during the Beijing Olympic Games period and its substantially lower
air pollution levels (Rich et al., 2015). A separate analysis examining a lon-
ger study period and more pregnancies than just immediately before, dur-
ing, and after the Beijing Olympic Games found that increases in 8th-month
PM2.5, nitrogen dioxide, sulfur dioxide, and carbon monoxide levels were
associated with decreased birth weight, which provided complementary
evidence of a late-pregnancy air pollution effect on birth weight.
A review of 12 studies examining the connection between fetal growth
and air pollution identified a number of methodological issues, Rich said
(Woodruff et al., 2009). The authors of this review noted that the limita-
tions to these studies included confounding by socioeconomic status and
maternal characteristics, inconsistent reporting of when during a preg-
nancy the exposures occurred, and a limited examination of exposures
and outcomes. The authors recommended increasing the use of natural
experiments, accounting for the socioeconomic indicators in the regions
being studied, using alternate outcome measures other than those in birth
registries, and measuring alternate surrogates of exposure.
One outcome from this review was that an international group of inves-
tigators, including Rich, each ran the same analyses on their datasets and

found that the data, though not in total agreement, were consistent with the
hypothesis that having a low-birthweight baby was associated with elevated
exposures to PM10 during pregnancy (Parker et al., 2011). A more recent
meta-analysis of these same studies’ data found that this relationship held
for both PM2.5 and PM10 at a low but statistically significant level (Dadvand
et al., 2013). “There is some evidence that air pollution causes or could
cause fetal growth restriction, though the data are not consistent across the
world and we do not yet fully understand mechanisms,” Rich said.
Rich then described a study in which researchers in Spain examined
the relationship between nitrogen dioxide levels and markers of fetal devel-
opment measured from ultrasound images. This analysis found that first-
trimester exposure to nitrogen dioxide levels correlated with measures of
fetal head size (Iñiguez et al., 2016). “The timing is not the same, but this
study again suggests that exposure to elevated levels of air pollution dur-
ing pregnancy can have an effect on fetal growth,” Rich said. One possible
explanation for these findings could be that air pollution has an effect on
the placenta that in turn affects fetal growth. To explore that possibility, a
group of researchers looked at markers of placental growth and function
and found that elevated levels of PM10 and nitrogen dioxide in the second
trimester and during the entire pregnancy were associated with adverse
changes in these markers (van den Hooven et al., 2012).
Pregnancy complications may also increase in frequency with elevated
exposures to air pollutants. One study in southern California cited by Rich
found an association between local traffic-generated air pollution—as mea-
sured by PM2.5 and nitrogen dioxide levels—and preeclampsia (Wu et al.,
2009). Another study in New Jersey found that PM2.5, nitrogen dioxide,
sulfur dioxide, and carbon monoxide levels were all correlated with an
increased risk of stillbirth (Faiz et al., 2013).
Up to this point the studies that Rich discussed all dealt with ambient,
or outdoor, PM, but he said that it should also be possible to study the
effects of indoor PM exposure on birth outcomes. Pregnancy cohort studies,
longitudinal panel studies that look at biomarkers throughout pregnancy,
and intervention studies involving indoor air pollution could be used to
study the effects of indoor PM on pregnancy outcomes, he suggested.
Such studies would require identifying internal dose markers of individual
exposures to indoor pollution and mechanistic biomarkers that could be
measured throughout pregnancy. Rich suggested that researchers would
need to determine when to make biomarker and pollutant measures, as well
as whom to study and where such studies should be done.
To illustrate how researchers are addressing these issues, Rich cited a
study now under way in Mexico City that enrolled non-smoking women
ages 18 and older who would agree to visit the hospital for testing every 4
weeks for assessment (O’Neill et al., 2013). The 800 women in this study

filled out extensive questionnaires that generated data on demographics,

time, and activity in order to estimate pollution exposure, food intake,
and GPS coordinates for home and work locations. Clinical data collected
included ultrasound images, a glucose tolerance test at 22 weeks of preg-
nancy, and blood, urine, and other samples for biomarker measurements.
At birth, the infant’s characteristics, gestational age, and the baby’s saliva
were collected, along with a blood sample from the mother and the umbili-
cal cord. Data collection is now complete, and analysis is under way to
determine if exposure to certain pollutants at different time points during
pregnancy is associated with the clinical outcome of preterm birth and with
increases in levels of markers of inflammation, said Rich.
The final study Rich discussed was conducted by Ryan Allen and
Enkhjargal Gombojav in Ulaanbaatar, Mongolia. It examined whether
removing indoor PM using a portable HEPA filtration unit would prevent
preterm birth. The researchers enrolled 465 women and collected data on
preterm birth, birth weight, and maternal blood pressure. They also col-
lected hair, whole blood, and blood spot samples for biomarker analysis.
Data collection for this study was completed in December 2015, Rich said,
and analysis is under way.
NEUROLOGICAL AND PSYCHIATRIC DISORDERS3

Researchers have begun studying the effects of air pollutants and PM
on neurological and psychiatric disorders, Marc Weisskopf said, because
of data showing that PM exposure has established consequences for car-
diovascular diseases. “Frankly, there is a great deal of interaction between
the vascular system and the brain, and many vascular risk factors are asso-
ciated with cognition, dementia, and late-onset depression,” he said. He
added that studies have shown that PM2.5 and UFPs can reach the brain,
either via the nose and olfactory nerve (Oberdorster et al., 2004) or via the
lungs and systemic circulation (Peters et al., 2006). The route through the
olfactory system is perhaps the most relevant, Weisskopf said, because the
olfactory nerve connects directly to important centers in the brain involved
in emotional regulation and memory as well as to the limbic system. Cross-
ing from the systemic circulation into the brain involves direct transport
or damage to the blood–brain barrier (Calderón-Garcidueñas et al., 2008).
There is evidence that whichever route PM takes into the brain (see
Figure 7-4), it alters neurotransmitter levels (Sirivelu et al., 2006) and trig-
3 This section is based on the presentation by Marc Weisskopf, an associate professor of en-
vironmental health and occupational epidemiology at the Harvard T.H. Chan School of Public

FIGURE 7-4 Effects of PM exposure on the central nervous system.

NOTE: BBB = blood-brain barrier; ROS = reactive oxygen species.
SOURCE: Weisskopf slide 4, adapted from Genc et al. (2012) Figure 1.
gers oxidative stress, inflammation, and other biochemical changes (Block

and Calderón-Garcidueñas, 2009; Campbell et al., 2005; Kleinman et al.,
2008), all of which can lead to neuronal degradation (Veronesi et al., 2005).
All of these suggested negative consequences of particular exposure are
evident in both human disorders and models of multiple neurodegenerative
and psychiatric disorders, Weisskopf said. As an example, he cited one
study in mice showing dramatic increases in the size of lateral ventricles—
the space where cerebrospinal fluid circulates in the brain—with exposure
to inhaled UFPs (Allen et al., 2015).
Experimental evidence suggesting involvement of the maternal inflam-
matory system in promoting autism-like behavior in mice (Choi et al.,
2016), prompting researchers to look for a possible link between maternal
PM exposure during pregnancy and autism. Using data from monitoring
networks, meteorological readings, and a set of geographic information
system–based predictors, Weisskopf and his colleagues created a time and
space model of average predicted PM10 and PM2.5 levels from 1988 to 2007
(Yanosky et al., 2014). They then used this model to analyze data from the

Nurses’ Health Study II to estimate maternal exposure to PM10 and PM2.5

for 9 months before pregnancy, during pregnancy, and for 9 months after
pregnancy and to identify those women who had children diagnosed with
autism. Compared with a matched set of women who did not give birth to
children who developed autism, there was an increased risk of autism in
mothers who had higher PM2.5 exposure during any of those time periods,
and particularly during the third trimester (Raz et al., 2015; Weisskopf et
al., 2015). Weisskopf noted that several other groups have made similar
observations (Becerra et al., 2013; Kalkbrenner et al., 2015; Talbott et al.,
2015; Volk et al., 2013). “It’s becoming quite consistent to see this associa-
tion between higher perinatal exposure to PM and increased risk of autism
in many different settings,” Weiskopf said.
He and his colleagues have also been examining a potential link between
PM exposure and anxiety. Data from the Nurses’ Health Study I showed
that 15 percent of the nurses in this study had elevated anxiety symptoms.
The researchers observed an association between elevated anxiety and
PM2.5 exposure—but not PM10 exposure—within the month preceding the
time at which the nurses filled out their questionnaires (Power et al., 2015).
Weisskopf said that his team’s most recent analysis suggests that “very
recent or maybe even daily exposure might affect anxiety levels.”
Other work from Weisskopf and his colleagues and other research
teams in both the United States and Europe have revealed what Weisskopf
called reasonably consistent results linking PM2.5 and UFP exposure to
changes in cognitive function, including the development of dementia,
Parkinson’s disease, and Alzheimer’s disease (Kioumourtzoglou et al., 2016;
Power et al., 2011). He added that a group in Spain has started looking
at the connection between PM and other pollutant levels near schools and
cognitive function in children.
Finally, Weisskopf addressed some potential methodological issues
that may confound the link between personal air pollutant exposure and
neurological and behavioral disorders. One issue, which is common to
epidemiologic studies, is that there may be others factor such as personal
behavior that are related to both exposure and effect. That may be less
of a concern with the aforementioned studies because the extensive work
modeling ambient air pollution levels show that the inputs are largely
independent of personal behaviors and many other factors that could also
be related to disease. However, that independence is not likely to be true
for indoor exposures to PM because personal behaviors are an impor-
tant determinant of exposure. “That does not mean you cannot do these
studies,” Weisskopf said, “but it raises concerns about bias issues that
we have to pay attention to.” He suggested that one approach to dealing
with this potential bias that could be applicable to studies of short-term
cognitive function and perhaps anxiety would be to assess performance

on various cognitive tasks in a controlled office environment in which

exposure levels could be adjusted.
DISCUSSION
To start the discussion, Howard Kipen commented that, in his opinion,
the real challenge for the research community will be to identify which
analyses will be useful to the regulating community in helping determine
whether particular adverse health effects stem from indoor exposures or
outdoor exposures. Rich said that the question becomes one of numbers
with regard to how many people must be studied in order to have adequate
statistical power to link outcomes with indoor PM exposure. He also said
that an inexpensive validated marker of different indoor PM sources would
be needed. Allen remarked that the epidemiologic studies that Weisskopf
and Rich described are, in a sense, already addressing indoor PM given that
people spend the majority of their time indoors. “So even when we see a
signal from ambient PM, that has real relevance to what is happening inside
people’s homes and in their workplaces,” he said.
This challenge, Allen said, is largely an exposure assessment issue, and
he said he wants data with which to develop a time-and-space model for
indoor PM in the same way that such models have been developed for out-
door PM. His group has tried to do that using property tax records to see
if there were variables such as the age of the home and location that would
allow them to predict PM infiltration. “It showed some promise, but it was
not good enough to use in an epidemiologic analysis,” he said. “Maybe
we can explore other data sources that will help us understand residences,
what is going on inside residences, and the infiltration of outdoor pollution
indoors.”
Weisskopf agreed with Allen’s idea but said that he thought it would
be difficult to find variables that will be good indoor predictors at the indi-
vidual level. He added that he believes that intervention studies, where PM
is removed from the indoor environment, could make possible the kind of
analysis Kipen would like to see for short-term effects. For larger prospec-
tive cohort studies, he suggested doing smaller validation studies to see if
there are simple questions that could be asked of study subjects that could
probe the link between indoor activities and indoor air particulate levels.
He mentioned the study on incense burning that Allen had described as
an example. William Fisk thought it would be difficult to study a large
enough population to get statistically meaningful data to link indoor PM
exposures to long-term health issues. Barbara Turpin said there have been
questionnaire-based studies in which 24- or 48-hour average PM levels were
measured at the same time, but for the most part there is not a strong asso-
ciation between indoor PM levels and particular activities and sources in the

home. Finding such associations will require real-time PM measurements or

a chronic exposure situation where an activity happens frequently every day.
Joseph Hughes from the IAQ Training Institute said that researchers
at the Carnegie Mellon University Robotics Institute have developed an
under-$200 device called Speck that measures and records PM2.5 levels in
real time and uploads data to the Web. Rich mentioned that researchers
at Clarkson University are trying to use some of these low-cost sensors to
measure PM both indoors and outdoors. Weisskopf then asked if there is
a filtration system that records how much PM is removed from circulated
air and if such data could be used to calculate exposure levels. William
Nazaroff replied that there are well-developed models for estimating indoor
exposure in a mechanically ventilated building that could provide useful
estimates for exposure at work, but this would still leave exposures at home
to be determined. He added that he is optimistic that collaborations among
members of the International Society of Environmental Epidemiology, the
International Society of Exposure Science, and the International Society
of Indoor Air Quality and Climate would provide a better mechanistic
understanding of how to take outdoor PM levels and provide estimates of
indoor exposures.
Arnold Schwartz from the Milken Institute of Public Health at the
George Washington University asked Weisskopf if there were any correla-
tions between pollution and olfactory nerve dysfunction. Weisskopf replied
that there is evidence relevant to that question in occupational exposure
settings and said that he and his research team are in the process of accu-
mulating a large enough dataset to look at the effect of ambient air pollu-
tion exposures on olfactory nerve dysfunction. Schwartz then asked Rich
if there is a correlation between inflammatory markers in placental tissue
and in blood and if there are morphological changes within the placenta
corresponding with those inflammatory markers. Rich replied that he is
not aware of studies that have looked specifically at whether inflammation
in the mother affects the placenta in a way that affects the fetus. He said
he is optimistic that such studies would be performed soon. Weisskopf
added that this is an important question for his work on autism because
it points to something happening during the pregnancy period that is not
tied to transport of particles to the fetal brain. “I think there is a maternal
component we should be examining,” Weisskopf said. Schwartz also asked
Allen if there are markers of indoor pollution that provide a linkage with
atherosclerosis. Allen said he was unaware of any research explicitly look-
ing at that link. He added, though, that inflammation is known to play an
important role in the development of atherosclerosis, so it would make
sense mechanistically that such a link might exist.
Paula Olsiewski from the Alfred P. Sloan Foundation asked if the
panelists knew of anybody who is studying the effect of PM on the human

microbiome. Kipen said his group is conducting some pilot studies toward
that end but not in the indoor air context. Rich said he has reviewed a
few grants proposals in that area but has not yet seen any research in the
literature.
Fisk said that there should be an explicit notice in the workshop sum-
mary that allergy and asthma were not addressed in this session on health
concerns. Kipen, who was on the workshop planning committee, acknowl-
edged the importance of allergy and asthma but said that the decision had
been made to focus on lesser-known and emerging health concerns in the
time available. Rich agreed that there is a large body of work on allergy and
asthma and said that in his mind there are fewer questions about whether
there is a relationship between those outcomes and PM exposure.
An online workshop participant asked if the neurological health effects
of PM exposure are thought to be caused by the irritant effect or by the
chemical composition of the particles, and Weisskopf replied that he would
guess that the answer is both. The irritant effect could trigger the inflamma-
tory cascade and activation of microglial cells that prune the connections
between nerve cells, he said, and if there were metal ions in the particles,
such as lead, they could certainly have direct adverse effects on nerve cells.
Lynn Hildemann said she is intrigued with idea of trying to identify
which PM sources have more or less effect on human health, and she asked
the panelists if studies of occupations could provide any relevant informa-
tion. For example, she said, a study of cooks might provide a good first
estimate of how important exposure to cooking emissions is in terms of
impacts on human health. Rich said that would be a good approach for
something such as birth outcomes where there is a defined event—birth—
with a well-defined date. “I think that is the kind of innovative, novel
idea to try to take first-pass stabs at whether or not these sources could
have important impacts,” Rich said. Weisskopf noted that such studies are
the foundation of classic occupational epidemiology. In fact, he said, he
is doing just such a study in Denmark, where there are records tracking
health outcomes and occupations for the entire population. What remains
to be done, he said, is working with industrial hygienists and occupational
epidemiologists to make measurements of indoor pollutant levels in various
occupational settings.
Kipen asked if it should be possible to add a reasonable set of ques-
tions to the annual Nurses’ Health Study that could be used to provide a
retrospective analysis of residential exposures. Rich responded that such an
approach could be a relatively inexpensive way to get preliminary data to
look at long-term exposures, but he said that it would not be very useful for
acute effects. Weisskopf said that the Nurses’ Health Study III is in the pro-
cess of recruitment and that it focuses specifically on younger women and
includes questions on reproductive outcomes. “What we need to know,”

he said, is, “What are the questions to ask about the home environment?
Which ones are the biggest drivers of changes in indoor particulate mat-
ter?” Developing those questions, he said, will require going into various
types of homes, performing detailed assessments, analyzing the data to
determine those factors that predict PM levels and account for the most
variance, and then deciding if those factors can be captured in a reasonably
simple question.
Allen added that it would be important to capture exposure variability.
“If everybody is exposed to the same level, you cannot do an epidemiologic
study,” he said. “You need the exposure contrast.” He also commented
that questionnaires are only going to be able to capture information on
the major sources of PM and said that there might not be sufficient vari-
ability in a specific population. “If everybody is cooking roughly the same
amount in a week, it is going to be more difficult to see associations with
health just because the exposure variability within the population will not
be there,” he said.
Laura Kolb from EPA asked the panel to offers their views on the
scope of indoor PM as a public health issue. Weisskopf replied that if
there is a link between PM exposure and anxiety, then this is a significant
public health problem. “I think environmental exposures have been under-
appreciated in that realm, and the fact is, particulate matter is ubiquitous,”
he said. “If it even has a subtle effect, across the population, I think, it could
be quite large. If you are knocking down IQ (intelligence quotient) by even
a few points or having a bad day in the office because of particulate matter,
that is a big impact on productivity.” He noted, though, that there is the
important question of how much exposure people are getting indoors over
the course of the entire day.
Allen said he agreed completely with Weisskopf, both in terms of
potential impact and the importance of determining indoor exposures, and
he said that, at least for outdoor exposures, there does not appear to be a
threshold in terms of dose–response level. “Any exposure seems to carry
some health risk,” he said. In the context of cardiovascular disease, he said
that because these are prevalent outcomes, increasing the risk by 5 or 10
percent adds a significant number of additional cases. The bottom line, he
said, is, “We do not know, but the potential is there for this to be a signifi-
cant public health issue.”
Rich agreed, adding that reproductive health outcomes were also a
public health issue internationally. The issue with air pollutants such as PM
is that everyone breathes, and so every pregnant woman is exposed to PM.
“I think the absolute risk for some of these outcomes could be substantial
simply because of the complete exposure everyone has,” Rich said.


Interventions and Risk Communication
T
he workshop’s final session featured three presentations on risk com-
munication. George Gray of Milken Institute School of Public Health
at the George Washington University discussed the challenge of com-
municating the risk of indoor PM exposure. William Hallman of Rutgers
University talked about the lessons learned from communicating about
other health risks. Lee Ann Kahlor spoke about what could be learned from
a benchmark study to gauge public understanding and information seek-
ing related to indoor PM risk. An open discussion moderated by William
Nazaroff concluded the workshop.
THE CHALLENGE OF COMMUNICATING INDOOR PM RISK1

Two important unanswered questions regarding indoor PM are what
to tell people about the associated risks and how to tell them, George Gray
said. “This is particularly important because persuasion is the only thing we
can do, as there are no regulatory avenues into the indoor environment,”
he explained. “What we have to do is help people understand the risks and
make decisions.” This challenge is compounded, he added, by the lack of
data definitely linking indoor PM exposures to specific health risks.
1 This section is based on the presentation by George Gray, a professor of environmental

and occupational health at Milken Institute School of Public Health at the George Washington
University, and the statements are not endorsed or verified by the National Academies of Sci-
ences, Engineering, and Medicine.
93

One of the first things the scientific community needs to understand

with regard to explaining risk, Gray said, is how the public feels about
risk because that attitude plays an important role in the way the public
receives information (IOM, 2001). Attitude is shaped by a number of fac-
tors, including the magnitude of the risk, whether the risk outcome is fatal
or not fatal, if the risk arises from a voluntary or involuntary behavior, if
it is controllable or uncontrollable, if it is manmade or natural, whether it
is observable or not, and if there is any benefit associated with the risk (see
Figure 8-1). These factors, Gray said, have been identified over the past 20
years or so from research in the field of cognitive psychology (Fischhoff et
al., 1993; Slovic et al., 2004). As an example of how benefits can affect
decisions about risk, he observed that people choose to drive even though
they know it is inherently risky because there is a tangible benefit.
Gray believes that getting the public to grasp the risk of indoor PM
exposure is going to be difficult because many of the most important
sources are familiar, voluntary, and linked to benefits. Cooking, for exam-
ple, is something that people do every day, and it produces food they enjoy
eating. Burning candles or incense is voluntary and makes the house smell
good or may be part of a cultural or religious experience that is important
to an individual.
There are, however, perception factors that might help with communi-
cating risk. Children, for example, could be at risk as could a developing
fetus, and those risks are controllable, sometimes through relatively simple
and even inexpensive actions. Some of the important sources of adverse
exposures are already areas of at least some concern among the public, such
as secondhand tobacco smoke and outdoor PM. A 20-year-old study (Slovic
et al., 1995) found that 80 percent of the Canadian public—as well as 80
percent of toxicologists—said that indoor air quality posed a slight, moder-
ate, or high risk, suggesting that the public (at least in Canada) is aware that
there may be a health risk associated with exposure to indoor pollutants.
Among the other challenges that the scientific community will face in
conveying the risk of indoor PM to the public is the need to understand
the magnitude of the risk before deciding how much to communicate about
it, Gray said. “Is this something that everybody needs to know about?” he
asked, noting the limited bandwidth that people have for thinking about
risks and taking action to mitigate them. He suggested that comparing a
risk to the risk associated with environmental tobacco smoke might be an
approach that would get the public’s attention, while comparing the risk of
indoor PM exposure to the risks of cooking on a gas stove would lead the
public to downplay the risks of indoor PM exposure.
It will be important too, Gray said, to communicate the relative contri-
butions of different sources, particularly indoor versus outdoor, and how
much of the exposure to these sources is under the individual’s control.

INTERVENTIONS AND RISK COMMUNICATION 95
FIGURE 8-1 Risk perception factors influencing public concern.

SOURCES: Gray slides 4, 5, and 6.

“One of the things that people want to know if you are going to talk to
them about risk is, What can I do?” he said. “Don’t just tell me to be
scared—tell me that there is something I can do.” He added that mitiga-
tion approaches that require changes in personal behavior are hard to sell,
either because people benefit from those behaviors or do not feel the risk is
big enough to warrant changing those behaviors. Another challenge, Gray
said, will involve sorting out the risk tradeoffs, such as ventilation versus
energy use, and explaining those to the public in a way that does not cause
them to take actions that actually increase risk.
There are examples of success from which the indoor PM field can
learn and borrow. Indoor radon is a close analog, Gray said, and it is an
area where effective risk communication has over time changed perception
and the actions that the public takes to mitigate that risk. One difference is
that radon exposure has no known benefits associated with it. Secondhand
smoke is an area in which there has been substantial behavioral change
over the past 20 years, and there are similarities to indoor PM with regard
to the risk to children and the voluntary nature of the activity. There is,
however, a different level of awareness, concern, and dread associated
with tobacco smoke, Gray said. The public has become more aware of the
risks associated with indoor pesticide use, and risk communication there
has focused on how to minimize the risks from exposure, particularly to
children. Indoor pesticide use is voluntary and does have benefits, making
it analogous to indoor PM, but it also comes with the connotation that, by
default, synthetic pesticides are bad. There may also be lessons that can be
applied from the evidence presented in various studies of indoor air quality
in the developing world relating largely to indoor activities such as cooking
with wood and other forms of biomass.
In closing, Gray said that if the field is to effectively communicate the
risk of indoor PM, it will need the research disciplines represented at this
workshop to produce data on the magnitude of the risks from exposure to
indoor PM. But success will also depend on developing a better understand-
ing of how the public thinks and feels about these risks, he said. “Maybe
we can borrow information from similar situations to help guide us think
about how we can be effective in communicating this information if and
when we decide it is the thing to do.”

EMPOWERING PEOPLE TO REDUCE INDOOR PM EXPOSURES2

Risk communication is integral to the risk analysis process, William
Hallman said, and it also involves more than just determining what to tell
people. “It is also about asking the right questions, which requires being
very clear about our particular goals,” he explained. Citing a 1989 report
from the National Research Council, Hallman listed three essential goals
for risk communication: education, advocacy or persuasion, and fostering
partnerships for decision making. All three of these goals, he added, are
implicit outcomes with regard to indoor PM.
Education aims to provide information and context so that people
can choose what they believe is the right action to take in the face of risk.
Advocacy or persuasion, in contrast, tries to change beliefs, attitudes, and
behaviors in order to convince people to adopt a particular position: to
take or not take an action. The goal of fostering partnerships, Hallman
said, is to collect and discuss information with stakeholders in a way that
leads to better collective decisions. He stressed the importance of involv-
ing stakeholders, manufacturers, and regulators early in this process to get
their perspectives on how to deal with the issues related to indoor PM.
Hallman added that simply alarming people is ethically problematic. “We
have to tell them not just what the problem is, but what to do about the
problem,” he said.
Interventions, Hallman said, can be focused on changing technology,
behavior, policy, or regulations. With regard to technology, it is important
to determine who has the responsibility and resources to make the necessary
technology choices, an issue that was raised in earlier discussions concern-
ing disadvantaged communities and individuals. One solution for these
communities—where the ability to get property owners to make changes to
HVAC systems is limited, for example—might be to provide incentives or
tax rebates for the purchase of portable HEPA filtration units.
The invisibility of PM matters, Hallman said, and it represents a key
issue in communicating the risk of indoor PM exposure. One approach to
discussing the risks, he said, is to use how people feel when other impose
risks on them. “You can harness strong feelings to try to get fairly rapid
changes in policies and regulations, and that is exactly what happened with
secondhand smoke,” he said. In contrast, when individuals are responsible
for their own exposures, it is easy to ignore them, particularly when the
problem is invisible. Radon is the prototypical example of the latter, and
Hallman described the work that he and his colleagues did with EPA in the
2 This section is based on the presentation by William Hallman, a professor and the chair
of the Department of Human Ecology at Rutgers, the State University of New Jersey, and the
and Medicine.

early 1990s trying without much success to persuade people to spend $7

on a carbon canister to test their homes for radon.
When a threat is invisible, people look for proxy indicators, such as
smoke detectors and carbon monoxide detectors. In the area of food safety,
which Hallman has studied, people use their sense of smell and taste as indi-
cators, or else they look for visual indicators, such as mold. The problem
with this particular mental model of food spoilage is that the bacteria that
cause spoilage are not necessarily pathogenic. Hallman has found that the
public perceives that a clean-looking home is a germ-free home (Hallman,
2008) and that the presence of mold, dust, filth, and bad smells are good
indicators of germs being present. “People are using proxies of things they
can see to represent things they cannot see,” Hallman said, “so one ques-
tion we need to ask is what are the proxies that people will use or are using
for indoor PM,” given that PM may have no taste or smell.
Hallman noted that while the size of PM is an important concern to
the scientific community, he believes that this will be of little concern to
the public and that it is not the place to start a communication effort. He
also said that the lack of a feedback loop matters and that it can be difficult
for people to make the link between an invisible cause and a later, visible
effect. He again used food safety as an example. People do not recognize
the symptoms of foodborne illness, and few people believe they have made
themselves or other sick because the most common mental model is that
eating contaminated food will make one sick immediately. “As a result,
they do not connect their poor food safety practices with ultimate illness,”
Hallman said. “I suspect we have a similar issue here, although we need
the research to show that.”
Hallman said if there was one key message he wanted to convey at
this workshop, it was that mental models matter. While it is important
to know what people know about an issue and what they want to know
about an issue, it is more important to know how they think about an
issue. Certainly, he said, answering the questions that people are most
interested in makes it more likely they will be willing to hear more of
the information the scientific community wants to convey. “But I would
also argue as a psychologist,” he said, “that it is important to understand
how people think about an issue, how they construct a ‘big picture’ or
world view about an issue.” In that context, Hallman said, the scientific
community needs to realize how much most Americans overestimate
their knowledge and understanding of science and technology. “Only 20
percent of Americans rate their understanding of science as poor, but ask
them any science question and most will get it wrong.” In fact, Hallman
added, Americans often exhibit false fluency, where they may have the
right vocabulary but not the right constructs. The lesson here, he said, is
that when conducting social science research, people in the field needs to

be careful to ask the right questions phrased in a way that will yield both
qualitative and quantitative data on how people think about indoor PM,
not just the facts they know about it.
The issue with mental models, Hallman said, is that people try to make
sense of the world by creating meaning based on whatever information they
have available and filling any gaps with misinformation or by inventing
information. This is a particular problem in the world of the Internet and
social media, he said. “A quick search on indoor PM issues suggests there is
already bad information available on indoor PM.” Hallman also explained
that people use analogies and metaphors to organize their mental models,
and he recounted some work that he did for CDC on how the public
thinks the immune system works. Without any prompting, the most com-
mon explanation people gave used a military metaphor with “good guy”
blood cells engaging in a war against “bad guy” germs or cancer. Then,
when asked how vaccines work, the most common answer was that a vac-
cine adds more troops to the germ fighters. “It is like the cavalry riding in,
which makes absolute sense, except that it is absolutely wrong,” Hallman
said, adding that his response as a risk communicator was to stick with the
military metaphor but explain that vaccination helps the germ fighters rec-
ognize the enemy and respond more quickly to them. “We need to identify
the metaphors we can use that will get into people’s heads relatively quickly
rather than trying to give them a lecture on PM2.5,” he said.
Acknowledging that he lacked data because no mental modeling
research appears to exist regarding indoor PM2.5, Hallman said that his
guess is that the mental models the public might use to understand indoor
PM would include the following:
• “Bad air” triggers asthma attacks, and since nobody in my family

has asthma, I do not have a problem.
• “Air pollution” is “outside,” and I keep my windows closed, so I
do not have a problem.
• “Air pollution” is caused by cars, factories, and power plants that
produce “smoke.”
• Sources of “indoor air pollution” have to do with combustion and
smoke, and because nobody in my house smokes, I do not have a
problem.
• Combustion is associated with open flames and not electricity, and
I have an electric stove, so I do not have a problem.
• My cooking produces pleasant aromas, not harmful PM, so I do
not have a problem.
• Candles produce small flames and so are not a significant source of
PM, so I do not have a problem.

• Water “washes things” and is clean, so my water is not a source of

PM.
• Air “fresheners” clean the air, so I do not have a problem.
• “Particulate matter” means “dust,” and I vacuum twice per week,
so I do not have a problem.
• Why is a filter rated 16 better than a filter rated 1? Isn’t being
number 1 the best?
Hallman also noted the importance of advertising claims to the forma-

tion of mental models and the need to look at the information being passed
to consumers through advertisements for air cleaning products and services.
He said that a quick search yields bad information associated with these
products, so the field will need to think about how to counter this misin-
formation and do so in a way that provides useful holistic advice. Simply
warning people does not work, Hallman said, but telling them what to do
and helping them do it by providing practical, effective, and affordable
advice can work. Consistency and dependability will be key to avoiding
the problem that the field of nutrition now has—i.e., as a result of ever-
changing dietary recommendations, many Americans lack trust in nutri-
tional advice. Hallman stressed the need to engage stakeholders—including
partner organizations involved in science, health, and engineering, as well
as appliance manufacturers and professionals in the building trades—to
develop consistent, credible messages for consumers.
Hallman concluded his presentation with a list of what people will
likely want to know about indoor PM:
• What causes indoor air pollution?

• Am I affected, how will I know, and who else is vulnerable?
• What are the immediate and long-term consequences?
• Does this explain my health issues?
• Can I do anything about it? Do I know what to do? Do I have what
I need? Can I do it by myself? Where should I start?
• Who is responsible for the problem, and can it be prevented?
• Who will solve the problem, how long will it take, how effective
will the solution be, who will pay for it, and how expensive will it
be?
• How will I know that the problem has been solved, and can I trust
that it has been solved?
Hallman said that not having all of the answers to these questions
does not preclude engaging in risk communication today, particularly given
that this conversation about exposure to particulate matter in indoor air is
already occurring. His prescription for communicating information in the

face of uncertainty is to acknowledge that uncertainty and say, “This is

what we know and do not know now. This is why it matters, this is what
we are doing to become more certain, and this is what you can do while
we continue to work on this particular problem.”
WHAT COULD BE LEARNED FROM A BENCHMARK STUDY3

In the workshop’s final presentation, Lee Ann Kahlor discussed the
desirability of gathering baseline data to jump start a risk communication
research agenda focused on PM. Such data are needed, she said, because
little is known about how the public perceives indoor environmental issues
broadly and the issues of PM in particular. “We need a current snapshot of
PM risk, knowledge, and attitudes but also data to give us direction about
how to make information more compelling, especially to audiences that are
uniquely vulnerable,” Kahlor said.
Communication, she continued, is about telling compelling stories to a
variety of audiences that need to hear those stories. When thinking about
stories and audiences, the research community must remind itself often that
it is a privileged group and that while only 29 percent of adults 25 years
of age and older have a 4-year college degree, the other 71 percent can
make important decisions about their health and their family’s health on
a moment’s notice when necessary. It is also important to remember that
43 percent of Americans live in rental housing, and therefore are limited in
the actions they can take, and that 15 percent live in poverty, which means
they cannot afford most of the remediation approaches described at this
workshop.
Each of the many audiences for information on PM needs to be reached
uniquely, in ways that respond to its members’ resources and values and
that take into account the competing threats to their health, safety, and
quality of life, Kahlor said. Mass communications research can identify the
psychological and social psychological factors unique to each audience, and
crafting narratives with these factors in mind will help develop a version of
the story that resonates in important ways with that unique audience. This
kind of research can also identify which of the many information chan-
nels that exist are best suited for conveying stories to specific audiences to
achieve a desired effect, which can be a change in attitude, knowledge, or
behavior. Kahlor said that one aspect of developing a strategic communica-
tion plan is understanding what the information source says and with what
intention. “So we as information creators want to be very honest about
3 This section is based on the presentation by Lee Ann Kahlor, associate professor in the Stan
Richards School of Advertising at The University of Texas at Austin, and the statements are
not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

our intention,” Kahlor said. “Why do we think we have this story to tell,
and why do we think it going to resonate with our audience?” Being self-
conscious about intentions is critical, she said.
From the presentations she had heard, Kahlor said she had developed
a list of research questions that could be part of a baseline study. These
included the following:
• Who is vulnerable to PM risks?

• What information do they have about PM risks, and what more do
they want to know?
• What risk messages about PM would be compelling for what
audiences?
• Who would be credible sources for messages about PM?
• What partnerships would be useful in getting messages out?
To answer these questions, Kahlor recommended using a risk-

information-seeking framework, one that focuses on people helping them-
selves to information outside of a formal education setting. She noted that
people do not simply absorb the information that the scientific community
generates, but rather, they must be engaged in such a way that they process
the information and make it meaningful in a way that makes sense person-
ally. “We need to think about what motivates people to seek information,”
Kahlor said. Such motivations might include social norms in terms of what
others in their social circle and community expect them to know about
topic; a sense of risk; existing knowledge that provides a mental model
through which new information flows; how much knowledge people think
they need; beliefs about seeking information and whether useful informa-
tion exists for them to use; and beliefs about the ability to get and process
information. Kahlor has organized these motivations in a model she calls
the Planned Risk Information Seeking Model (Kahlor, 2010), illustrated in
Figure 8-2. One motivation not included in this model, she said, is avoid-
ance, which refers to actively avoiding information. Avoidance can be
driven by both negative affect and a desire to maintain hope and feel happy.
Communicating risk is a complicated task, Kahlor said, because it is
affected by the fact that understanding is difficult when the audience lacks
a knowledge of basic science. “You are not just explaining your science,
you are explaining all of science so that you can provide some scaffolding
with which to process your information,” she explained. In that context, it
is important to decide what a person really needs to know in order to hear
a message and to make meaning from it. Other concepts of interest include
vulnerability indicators, such as age, life stage, overall health, community,
and place; trusted sources for health risk information; comparative social,

FIGURE 8-2 The Planned Risk Information Seeking Model. [Abbreviations defined
in source publication.]
SOURCE: Kahlor slide 13, adapted from Figure 1 in Kahlor (2010). From PRISM:
A Planned Risk Information Seeking Model, Kahlor, Health Communication, 2010,
Taylor & Francis, reprinted by permission of the publisher (Taylor & Francis Ltd.,
http://www.tandfonline.com).
economic, safety, and health risks in the environment; and existing risky
behaviors.
Kahlor said that in her opinion the best approach for getting data to
explore these questions and concepts would be to start with a survey that
produces generalizable data from a cross-section of Americans, with a spe-
cial effort to include vulnerable communities in the sample. For example,
because children are vulnerable and parents are natural information seekers
when it comes to their children, the survey might include a subset of parents
of children up to age 12. Residents of disadvantaged communities, identi-
fied by zip code or county, and the elderly could both be oversampled in
order to provide a sense of some of the challenges associated with getting
information into those communities.
To get a sense of how long it would take to conduct such a survey
and how much it would cost, Kahlor contacted a private company that
conducts probability-based online surveys for academia, government, and
nonprofit organizations. A 15-minute survey of 2,500 individuals, includ-

ing 500 parents of children up to age 12 and 500 residents of designated

disadvantaged communities—as a starting point—would take 2 months and
cost $65,000. This sum, she noted, did not include conducting the survey in
Spanish or sampling elderly and retired persons, which she thought would
be a good idea.
Kahlor observed that the data from this survey would provide infor-
mation on the social norms that would help or hinder getting information
out to audiences. It would also reveal patterns in perceived risk and related
worry and existing knowledge versus how much knowledge individuals
think they need. The data would help researchers understand beliefs about
the information available and attitudes toward that information, the abil-
ity to get and process information, and whether such information will
be accessible. The data would also identify trusted sources for conveying
information and the preferred channels for receiving information. It will be
important to distribute the data through multiple channels in order to reach
as many disciplines as possible, and this will require presenting the data in
multiple venues, including journals and conferences.
In summary, Kahlor said, once the data are available to illuminate
who the audiences for information on PM are and what information they
need, the challenge will be to focus on the stories that need to be told and
on tailoring those stories in ways that are meaningful to these audiences.
Partnerships will be critical to delivering those stories in a way that reso-
nate with place, time, and most critically, the people themselves.
DISCUSSION
To start off the final discussion, William Nazaroff asked the panel-
ists if their messages to the workshop would change if the audiences for
information were expanded beyond the general public to include architects,
members of the building trades, manufacturers of mitigation equipment,
professional associations, health care providers, and policy makers. Kahlor
said she thought the answer would be no, that stories would just be tailored
for each of these unique audiences. Gray added that, given the influence that
standards can have on the design of buildings and the products that go into
them, the standards community should be included as an important audience.
Hallman disagreed, however, saying that he believes talking to these other
audiences requires different conversations, not different messages, and direct-
ing those conversations requires answering different questions.
William Fisk asked if, given the invisibility of particles, communica-
tion should revolve around sources and approaches to mitigation and the
tangible actions that people can take. Gray said he thought that was a good
idea, but added that there will still be the need to get people to care about
why they need to make an investment in time and money or change some

aspect of their behavior. That, Gray said, is why the big challenge is mak-
ing the invisible visible, at least in a mental model. Howard Kipen asked
if getting hard data on the health effects of exposure to indoor PM—as
opposed to extrapolating from outdoor PM data—would help address this
challenge, and Hallman said that the answer was yes, that those data for
indoor PM are essential.
Brett Singer asked the panelists to comment on whether the precau-
tionary principle—the idea that knowing that something could be harmful
would warrant action if there is an easy way to reduce risk—would be a
useful framework in the absence of hard data. Kahlor responded that the
precautionary principle can be helpful, but the danger is that the media will
convert uncertainty into certainty. The argument, she said, has to be put
forward with care so that it gets to the intended audience in the right form.
Hallman suggested that this was the approach the field was taking today. “I
think the assumption around the room is that exposure to PM is not a good
thing at any level and we should try to reduce it,” he said. “Unfortunately,
in the United States we do not regulate on the precautionary principle very
often, and when we do it is called government overreach.” As a result, he
said, the goal should be to reduce exposures but not based on the precau-
tionary principle.
Gray noted that relying on the precautionary principle could have the
effect of increasing disparities because people with resources would be
more likely to take action than those whose resources are limited. Hallman
agreed with Gray’s assessment and said an additional complication is that
those without the resources to take action are often left feeling guilty about
not being able to protect their children and their families.
Brent Stephens asked about the challenge of communicating the type
of relative risks that were discussed in the prior session, and Hallman
responded that people often have a difficult time with very large and very
small numbers. The shorthand that the technical community uses to com-
municate within its members serves to alienate the public, he said, and so
trying to get the public to think like scientists and understand scientific
language and concepts will not work.
With regard to changing personal behavior, Marc Weisskopf asked
whether the message that PM could be influencing an individual’s energy
level might be a good secondary message, given that this is an effect that
people would experience every day and that does not take years to develop.
Kahlor replied by reiterating the need to picture what people would do
with that kind of information, and Weisskopf acknowledged that con-
cern but countered that there may be easy and inexpensive actions—using
the kitchen hood or opening the apartment windows at the appropriate
time—that would provide some benefit. “It would seem that people would
act on something if it was more likely to affect something they experience

every day,” he said. Gray cautioned that it is important that the message
be credible and that the subsequent action needs to produce a meaningful
benefit that will not be overwhelmed by all of the other things going on in
someone’s life. “That would hurt credibility,” he said.
Hallman cautioned that once people are convinced that indoor PM is
a problem and learn there are multiple sources, they will pick and choose
which ones to address. One lesson from nutrition research, he said, is that
people form an indulgence mental model in which somehow the apple
in their pocket cancels out the big breakfast they ate. With PM, people
could run their kitchen fans and then feel better about burning candles, he
suggested.
In response to an online question about how to improve compliance for
air cleaner and range hood use, Hallman said that the answer is to make
them automatic, to make “on” the default condition and to make them
quiet. Vito Ilacqua from EPA agreed with Hallman and suggested that the
way to get such automatic systems into homes would be to start with the
early adopters, the people willing to pay a higher price to get a market
started. As an analogy, Ilacqua noted that thermostats were a luxury item
at one time but are now standard in every home and apartment. Hallman
said that the idea had potential and suggested linking automatic systems
to the “Internet of things” that could provide remote sensor readings of
airborne PM to provide the necessary input. “These things are possible, and
they are not necessarily all that expensive,” Hallman said. “With research
dollars, it could happen.”
Along those same lines, Barbara Turpin asked if outfitting homes with
PM monitors that display real-time PM levels would change people’s behav-
iors, similar to the way that cars are now outfitted with fuel economy read-
outs. Gray and Hallman both said they thought that was a good idea, and
Hallman added that providing people with social norm data could also help
motivate behavior change, though it could also create anxiety.
Paula Olsiewski wondered if it was possible to frame the interventions
discussed at this workshop in terms of creating a healthier home. Kahlor
said she thought that could be a useful framework because it is general and
not tied to a specific risk factor. The key will be the rest of the message—
what an individual can do to create that healthier home. Gray agreed with
the importance of the “What next?” part of that message and added that
some of those what-next steps will be things that some stakeholders who
hold a different point of view will not want to have happen. Hallman added
that there is a science of science communication and methods for testing
these kinds of messages before putting them out to the world, and he said
that this is the kind of research needed once the baseline data are avail-
able. “We need programmatic research in this area and not just a couple

of studies,” he said. He noted, too, that EPA was the initial leader in the
federal government on risk communication.
Richard Corsi remarked that when he gives talks to the general public
about indoor PM, members of the public pay attention when he talks about
candles, and they then inquire where they can get more information. Corsi
said that the EPA and California Air Resources Board websites have good
information on them about indoor PM, and he asked the panelists if those
sources of information are important and if the public perceives the impor-
tance of getting that kind of information. Kahlor said that when experts
direct individuals to websites, they can be good sources of information,
but in some settings, such as a doctor’s office, a well-designed pamphlet
could be a more useful information source. Hallman added that when
people want health-related information, they typically go to the Internet
these days, and so it would behoove the experts to check what Wikipedia
and WebMD have to say about indoor PM to make sure they are providing
good information. Most members of the public, he said, are not likely to
think of going to the EPA website as their first source of information. He
also suggested that this community could create a website with an intuitive
name that would naturally draw people to good information.
Gediminas Mainelis asked if the panelists had any thoughts about how
to communicate information in a way that will not lead to people altering
their behavior in a way that negates any improvements that might make,
such as putting ionizers and filters in their homes and then smoking inside.
Hallman said risk homeostasis theory (Wilde, 1998) addresses this kind of
behavior. David Rowson from EPA then asked the panelists for ideas on
how to conduct non-regulatory risk communication around an issue that
involves promoting, encouraging, and suggesting behavior change rather
than requiring it and enforcing compliance. Hallman replied that the argu-
ment can be framed in terms of a gain—health will improve if indoor PM
levels are reduced—or a loss and that social norms can be used to encourage
positive behaviors. He added, though, that it is important to be realistic
about what risk communication alone can accomplish. “The idea that we
are going to encourage 90 percent of the public to do something based on
the information we provide is unrealistic, which is why regulations are
needed,” he said. Offering an example that he said was relevant to indoor
PM, he noted that getting New Jersey homeowners to test for radon only
happened when stakeholders insisted that radon tests be done before people
could get mortgages.
To end the discussion, Terry Brennan noted that when he was build-
ing single-family residences in the 1980s, he would violate manufacturer’s
warranties by wiring thermostats into the range hood so that they would
turn on automatically when someone was cooking, and he installed high-
efficiency filters in the HVAC systems. “That was easy for me to do as the

builder because I had control over what went into the building, and it was
an easy sell to the homeowner.” Since then, he said, he has worked with
builders who put up 5,000 houses per year. Making changes at that scale
would represent an important step, but doing so would require making
changes in standards, which he said is an uphill process, given that for every
group involved in the discussions that wants change there is another group
that does not. The key in that case, Hallman said, is to convince the policy
makers that the public wants these changes, which is where the data from
the study Kahlor proposed could help.

References
Acevedo-Bolton, V., K.-C. Cheng, R.-T. Jiang, W. R. Ott, N. E. Klepeis, and L. M. Hildemann.
2012. Measurement of the proximity effect for indoor air pollutant sources in two homes.
Journal of Environmental Monitoring 14(1):94–104.
Adamkiewicz, G., A. R. Zota, M. P. Fabian, T. Chahine, R. Julien, J. D. Spengler, and J. I.
Levy. 2011. Moving environmental justice indoors: Understanding structural influences
on residential exposure patterns in low-income communities. American Journal of Public
Health 101(Suppl 1):S238–S245.
Adams, R. I., Y. Tian, J. W. Taylor, T. D. Bruns, A. Hyvärinen, and M. Täubel. 2015. Passive
dust collectors for assessing airborne microbial material. Microbiome 3(1):1–11.
Afshari, A., and C. Reinhold. 2008. Deposition of fine and ultrafine particles on indoor surface
materials. Indoor and Built Environment 17(3):247–251.
Afshari, A., U. Matson, and L. E. Ekberg. 2005. Characterization of indoor sources of fine and
ultrafine particles: A study conducted in a full-scale chamber. Indoor Air 15(2):141–150.
Ahn, Y. C., S. K. Park, G. T. Kim, Y. J. Hwang, C. G. Lee, H. S. Shin, and J. K. Lee. 2006.
Development of high efficiency nanofilters made of nanofibers. Current Applied Physics
6(6):1030–1035.
Allen, J. L., G. Oberdorster, K. Morris-Schaffer, C. Wong, C. Klocke, M. Sobolewski, K.
Conrad, M. Mayer-Proschel, and D. A. Cory-Slechta. 2015. Developmental neurotoxicity
of inhaled ambient ultrafine particle air pollution: Parallels with neuropathological and
behavioral features of autism and other neurodevelopmental disorders. Neurotoxicology,
December 22. doi: 10.1016/j.neuro.2015.12.014.
Allen, R. W., C. Carlsten, B. Karlen, S. Leckie, S. v. Eeden, S. Vedal, I. Wong, and M. Brauer.
2011. An air filter intervention study of endothelial function among healthy adults in a
woodsmoke-impacted community. American Journal of Respiratory and Critical Care
Medicine 183(9):1222–1230.
Allen, R. W., S. D. Adar, E. Avol, M. Cohen, C. L. Curl, T. Larson, L. S. Liu, L. Sheppard,
and J. D. Kaufman. 2012. Modeling the residential infiltration of outdoor PM2.5 in the
Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air). Environmental
Health Perspectives 120:824–830.
109

Alvarez, E. G., M. Sörgel, S. Gligorovski, S. Bassil, V. Bartolomei, B. Coulomb, C. Zetzsch,

and H. Wortham. 2014. Light-induced nitrous acid (HONO) production from NO2
heterogeneous reactions on household chemicals. Atmospheric Environment 95:391–399.
Arku, R. E., G. Adamkiewicz, J. Vallarino, J. D. Spengler, and D. E. Levy. 2015. Seasonal
variability in environmental tobacco smoke exposure in public housing developments.
Indoor Air 25(1):13–20.
Azimi, P., D. Zhao, and B. Stephens. 2014. Estimates of HVAC filtration efficiency for fine and
ultrafine particles of outdoor origin. Atmospheric Environment 98:337–346.
Azimi, P., D. Zhao, C. Pouzet, N. E. Crain, and B. Stephens. 2016. Emissions of ultrafine
particles and volatile organic compounds from commercially available desktop three-
dimensional printers with multiple filaments. Environmental Science & Technology
50(3):1260–1268.
Bai, N., M. Khazaei, S. F. van Eeden, and I. Laher. 2007. The pharmacology of particulate
matter air pollution-induced cardiovascular dysfunction. Pharmacology & Therapeutics
113(1):16–29.
Barberán, A., R. R. Dunn, B. J. Reich, K. Pacifici, E. B. Laber, H. L. Menninger, J. M. Morton,
J. B. Henley, J. W. Leff, S. L. Miller, and N. Fierer. 2015. The ecology of microscopic life
in household dust. Proceedings of the Royal Society of London B: Biological Sciences
282(1814) doi: 10.1098/rspb.2015.1139.
Batterman, S., L. Du, G. Mentz, B. Mukherjee, E. Parker, C. Godwin, J. Y. Chin, A. O’Toole,
T. Robins, Z. Rowe, and T. Lewis. 2012. Particulate matter concentrations in residences:
An intervention study evaluating stand-alone filters and air conditioners. Indoor Air
22(3):235–252.
Becerra, T. A., M. Wilhelm, J. Olsen, M. Cockburn, and B. Ritz. 2013. Ambient air pollu-
tion and autism in Los Angeles County, California. Environmental Health Perspectives
121(3):380–386.
Bell, M. L., K. Ebisu, R. D. Peng, J. M. Samet, and F. Dominici. 2009. Hospital admissions
and chemical composition of fine particle air pollution. American Journal of Respiratory
and Critical Care Medicine 179(12):1115–1120.
Benning, J. L., Z. Liu, A. Tiwari, J. C. Little, and L. C. Marr. 2013. Characterizing gas–particle
interactions of phthalate plasticizer emitted from vinyl flooring. Environmental Science
& Technology 47(6):2696–2703.
Blair, S. L., S. A. Epstein, S. A. Nizkorodov, and N. Staimer. 2015. A real-time fast-flow tube
study of VOC and particulate emissions from electronic, potentially reduced-harm,
conventional, and reference cigarettes. Aerosol Science and Technology 49(9):816–827.
Blanchard, O., F. Mercier, O. Ramalho, C. Mandin, B. Le Bot, and P. Glorennec. 2014.
Measurements of semi-volatile organic compounds in settled dust: Influence of storage
temperature and duration. Indoor Air 24(2):125–135.
Block, M. L., and L. Calderón-Garcidueñas. 2009. Air pollution: Mechanisms of neuroinflam-
mation and CNS disease. Trends in Neurosciences 32(9):506–516.
Boor, B. E., J. A. Siegel, and A. Novoselac. 2013. Wind tunnel study on aerodynamic particle
resuspension from monolayer and multilayer deposits on linoleum flooring and galva-
nized sheet metal. Aerosol Science and Technology 47(8):848–857.
Boor, B. E., M. P. Spilak, R. L. Corsi, and A. Novoselac. 2015. Characterizing particle resus-
pension from mattresses: Chamber study. Indoor Air 25(4):441–456.
Brauner, E. V., L. Forchhammer, P. Moller, L. Barregard, L. Gunnarsen, A. Afshari, P. Wahlin,
M. Glasius, L. O. Dragsted, S. Basu, O. Raaschou-Nielsen, and S. Loft. 2008. Indoor
particles affect vascular function in the aged: An air filtration-based intervention study.
American Journal of Respiratory and Critical Care Medicine 177(4):419–425.

REFERENCES 111
Brook, R. D., S. Rajagopalan, C. A. Pope, 3rd, J. R. Brook, A. Bhatnagar, A. V. Diez-Roux,

F. Holguin, Y. Hong, R. V. Luepker, M. A. Mittleman, A. Peters, D. Siscovick, S. C.
Smith, Jr., L. Whitsel, and J. D. Kaufman. 2010. Particulate matter air pollution and
cardiovascular disease: An update to the scientific statement from the American Heart
Association. Circulation 121(21):2331–2378.
Buonanno, G., L. Morawska, and L. Stabile. 2009. Particle emission factors during cooking
activities. Atmospheric Environment 43(20):3235–3242.
Calderón-Garcidueñas, L., A. C. Solt, C. Henriquez-Roldan, R. Torres-Jardon, B. Nuse,
L. Herritt, R. Villarreal-Calderon, N. Osnaya, I. Stone, R. Garcia, D. M. Brooks, A.
Gonzalez-Maciel, R. Reynoso-Robles, R. Delgado-Chavez, and W. Reed. 2008. Long-
term air pollution exposure is associated with neuroinflammation, an altered innate
immune response, disruption of the blood-brain barrier, ultrafine particulate deposition,
and accumulation of amyloid beta-42 and alpha-synuclein in children and young adults.
Toxicologic Pathology 36(2):289–310.
Campbell, A., M. Oldham, A. Becaria, S. C. Bondy, D. Meacher, C. Sioutas, C. Misra, L. B.
Mendez, and M. Kleinman. 2005. Particulate matter in polluted air may increase bio-
markers of inflammation in mouse brain. Neurotoxicology 26(1):133–140.
Carslaw, N., T. Mota, M. E. Jenkin, M. H. Barley, and G. McFiggans. 2012. A significant
role for nitrate and peroxide groups on indoor secondary organic aerosol. Environmental
Science & Technology 46(17):9290–9298.
Cetin, K. S., and A. Novoselac. 2015. Single and multi-family residential central all-air HVAC
system operational characteristics in cooling-dominated climate. Energy and Buildings
96:210–220.
Chahine, T., B. Schultz, V. Zartarian, S. V. Subramanian, J. Spengler, J. Hammitt, and J. I.
Levy. 2011. Modeling geographic and demographic variability in residential concentra-
tions of environmental tobacco smoke using national data sets. Journal of Exposure
Science and Environmental Epidemiology 21(6):646–655.
Chan, W. R., W. W. Nazaroff, P. N. Price, M. D. Sohn, and A. J. Gadgil. 2005. Analyzing
a database of residential air leakage in the United States. Atmospheric Environment
39(19):3445–3455.
Chan, W. R., J. Joh, and M. H. Sherman. 2013. Analysis of air leakage measurements of U.S.
houses. Energy and Buildings 66:616–625.
Chen, C., and B. Zhao. 2011. Review of relationship between indoor and outdoor par-
ticles: I/O ratio, infiltration factor and penetration factor. Atmospheric Environment
45(2):275–288.
Chen, C., B. Zhao, and C. J. Weschler. 2012. Indoor exposure to “outdoor PM10”: Assessing
its influence on the relationship between PM10 and short-term mortality in U.S. cities.
Epidemiology 23(6):870–878.
Chen, R., B. Zhou, H. Kan, and B. Zhao. 2013. Associations of particulate air pollution and
daily mortality in 16 Chinese cities: An improved effect estimate after accounting for the
indoor exposure to particles of outdoor origin. Environmental Pollution 182:278–282.
Chen, R., A. Zhao, H. Chen, Z. Zhao, J. Cai, C. Wang, C. Yang, H. Li, X. Xu, S. Ha, T. Li,
and H. Kan. 2015. Cardiopulmonary benefits of reducing indoor particles of outdoor
origin: A randomized, double-blind crossover trial of air purifiers. Journal of the Ameri-
can College of Cardiology 65(21):2279–2287.
Chen, X., and P. K. Hopke. 2009. Secondary organic aerosol from α-pinene ozonolysis in
dynamic chamber system. Indoor Air 19(4):335–345.
Chen, X., P. K. Hopke, and W. P. L. Carter. 2011. Secondary organic aerosol from ozonolysis
of biogenic volatile organic compounds: Chamber studies of particle and reactive oxygen
species formation. Environmental Science & Technology 45(1):276–282.

Choi, G. B., Y. S. Yim, H. Wong, S. Kim, H. Kim, S. V. Kim, C. A. Hoeffer, D. R. Littman, and
J. R. Huh. 2016. The maternal interleukin-17a pathway in mice promotes autism-like
phenotypes in offspring. Science 351(6276):933–939.
Clark, R. P., and S. G. Shirley. 1973. Identification of skin in airborne particulate matter.
Nature 246(5427):39–40.
Colton, M. D., P. MacNaughton, J. Vallarino, J. Kane, M. Bennett-Fripp, J. D. Spengler, and
G. Adamkiewicz. 2014. Indoor air quality in green vs. conventional multifamily low-
income housing. Environmental Science & Technology 48(14):7833–7841.
Coombs, K. C., G. L. Chew, C. Schaffer, P. H. Ryan, C. Brokamp, S. A. Grinshpun, G.
Adamkiewicz, S. Chillrud, C. Hedman, and M. Colton. 2016. Indoor air quality in green-
renovated vs. non-green low-income homes of children living in a temperate region of
U.S. (Ohio). Science of the Total Environment 554:178–185.
Costa, D. L., and K. L. Dreher. 1997. Bioavailable transition metals in particulate matter medi-
ate cardiopulmonary injury in healthy and compromised animal models. Environmental
Health Perspectives 105(Suppl 5):1053–1060.
Crouse, D. L., P. A. Peters, A. van Donkelaar, M. S. Goldberg, P. J. Villeneuve, O. Brion, S.
Khan, D. O. Atari, M. Jerrett, C. A. Pope, M. Brauer, J. R. Brook, R. V. Martin, D. Stieb,
and R. T. Burnett. 2012. Risk of nonaccidental and cardiovascular mortality in relation
to long-term exposure to low concentrations of fine particulate matter: A Canadian
national-level cohort study. Environmental Health Perspectives 120(5):708–714.
Dacunto, P. J., K.-C. Cheng, V. Acevedo-Bolton, N. E. Klepeis, J. L. Repace, W. R. Ott, and
L. M. Hildemann. 2013. Identifying and quantifying secondhand smoke in multiunit
homes with tobacco smoke odor complaints. Atmospheric Environment 71:399–407.
Dadvand, P., J. Parker, M. L. Bell, M. Bonzini, M. Brauer, L. A. Darrow, U. Gehring, S. V.
Glinianaia, N. Gouveia, E. H. Ha, J. H. Leem, E. H. van den Hooven, B. Jalaludin,
B. M. Jesdale, J. Lepeule, R. Morello-Frosch, G. G. Morgan, A. C. Pesatori, F. H. Pierik,
T. Pless-Mulloli, D. Q. Rich, S. Sathyanarayana, J. Seo, R. Slama, M. Strickland, L.
Tamburic, D. Wartenberg, M. J. Nieuwenhuijsen, and T. J. Woodruff. 2013. Maternal
exposure to particulate air pollution and term birth weight: A multi-country evaluation
of effect and heterogeneity. Environmental Health Perspectives 121(3):267–373.
Delp, W. W., and B. C. Singer. 2012. Performance assessment of U.S. residential cooking ex-
haust hoods. Environmental Science & Technology 46(11):6167–6173.
Dias Carrilho, J., M. Mateus, S. Batterman, and M. Gameiro da Silva. 2015. Air exchange
rates from atmospheric CO2 daily cycle. Energy and Buildings 92:188–194.
Dodson, R. E., D. E. Camann, R. Morello-Frosch, J. G. Brody, and R. A. Rudel. 2015. Semi-
volatile organic compounds in homes: Strategies for efficient and systematic exposure
measurement based on empirical and theoretical factors. Environmental Science &
Technology 49(1):113–122.
El Orch, Z., B. Stephens, and M. S. Waring. 2014. Predictions and determinants of size-
resolved particle infiltration factors in single-family homes in the U.S. Building and
Environment 74:106–118.
Eninger, R. M., T. Honda, A. Adhikari, H. Heinonen-Tanski, T. Reponen, and S. A. Grinshpun.
2008. Filter performance of N99 and N95 facepiece respirators against viruses and ultra-
fine particles. Annals of Occupational Hygiene 52(5):385–396.
EPA (U.S. Environmental Protection Agency). 2003. Particle pollution and your health. Office
of Air and Radiation, Environmental Protection Agency. https://www3.epa.gov/airnow/
particle/pm-color.pdf (accessed May 28, 2016).
EPA. 2009. 2009 final report: Integrated science assessment for particulate matter. Washing-
ton, DC: U.S. Environmental Protection Agency.

REFERENCES 113
Fadeyi, M. O., C. J. Weschler, K. W. Tham, W. Y. Wu, and Z. M. Sultan. 2013. Impact of

human presence on secondary organic aerosols derived from ozone-initiated chemistry in
a simulated office environment. Environmental Science & Technology 47(8):3933–3941.
Faiz, A. S., G. G. Rhoads, K. Demissie, Y. Lin, L. Kruse, and D. Q. Rich. 2013. Does ambient
air pollution trigger stillbirth? Epidemiology 24(4):538–544.
Fann, N., A. D. Lamson, S. C. Anenberg, K. Wesson, D. Risley, and B. J. Hubbell. 2012.
Estimating the national public health burden associated with exposure to ambient PM2.5
and ozone. Risk Analysis 32(1):81–95.
Fernandez, E., M. Ballbe, X. Sureda, M. Fu, E. Salto, and J. M. Martinez-Sanchez. 2015.
Particulate matter from electronic cigarettes and conventional cigarettes: A systematic
review and observational study. Current Environmental Health Reports 2(4):423–429.
Fischhoff, B., A. Bostrom, and M. J. Quadrel. 1993. Risk perception and communication.
Annual Review of Public Health 14:183–203.
Fisk, W. J. 2013. Health benefits of particle filtration. Indoor Air 23(5):357–368.
Fisk, W. J., and W. R. Chan. 2016. Health benefits and costs of filtration interventions that
reduce indoor exposure to PM2.5 during wildfires. Indoor Air, February 4. doi: 10.1111/
ina.12285.
Frey, S. E., H. Destaillats, S. Cohn, S. Ahrentzen, and M. P. Fraser. 2014. Characterization of
indoor air quality and resident health in an Arizona senior housing apartment building.
Journal of the Air & Waste Management Association 64(11):1251–1259.
Genc, S., Z. Zadeoglulari, S. H. Fuss, and K. Genc. 2012. The adverse effects of air pollution
on the nervous system. Journal of Toxicology 2012:782462. http://www.hindawi.com/
journals/jt/2012/782462 (accessed June 26, 2016).
Gill, P. S., T. E. Graedel, and C. J. Weschler. 1983. Organic films on atmospheric aerosol
particles, fog droplets, cloud droplets, raindrops, and snowflakes. Reviews of Geophys-
ics 21(4):903–920.
Grinshpun, S. A., A. Adhikari, T. Honda, K. Y. Kim, M. Toivola, K. S. Ramchander Rao,
and T. Reponen. 2007. Control of aerosol contaminants in indoor air: Combining the
particle concentration reduction with microbial inactivation. Environmental Science &
Grinshpun, S. A., A. Adhikari, C. Li, M. Yermakov, L. Reponen, E. Johansson, and M. Trunov.
2010. Inactivation of aerosolized viruses in continuous air flow with axial heating. Aero-
sol Science and Technology 44(11):1042–1048.
Hallman, W. K. 2008. Communicating about microbial risks in foods. In Microbial risk
analysis of foods, edited by D. W. Schaffner. Washington, DC: ASM Press. Pp. 205–262.
Hanley, J. T., D. S. Ensor, D. D. Smith, and L. E. Sparks. 1994. Fractional aerosol filtration
efficiency of in-duct ventilation air cleaners. Indoor Air 4(3):169–178.
He, C., L. Morawska, H. Wang, R. Jayaratne, P. McGarry, G. Richard Johnson, T. Bostrom,
J. Gonthier, S. Authemayou, and G. Ayoko. 2010. Quantification of the relationship
between fuser roller temperature and laser printer emissions. Journal of Aerosol Science
41(6):523–530.
Heald, C. L., J. H. Kroll, J. L. Jimenez, K. S. Docherty, P. F. DeCarlo, A. C. Aiken, Q. Chen,
S. T. Martin, D. K. Farmer, and P. Artaxo. 2010. A simplified description of the evolu-
tion of organic aerosol composition in the atmosphere. Geophysical Research Letters
37(8). http://onlinelibrary.wiley.com/doi/10.1029/2010GL042737/epdf (accessed June
26, 2016).
Heringa, M. F., P. F. DeCarlo, R. Chirico, T. Tritscher, J. Dommen, E. Weingartner, R. Richter,
G. Wehrle, A. S. H. Prévôt, and U. Baltensperger. 2011. Investigations of primary and
secondary particulate matter of different wood combustion appliances with a high-
resolution time-of-flight aerosol mass spectrometer. Atmospheric Chemistry and Physics
11(12):5945–5957.

Hernandez, M., A. Perring, K. McCabe, G. Kok, G. Granger, and D. Baumgardner. 2016.

Composite catalogues of optical and fluorescent signatures distinguish bioaerosol classes.
Atmospheric Measurement Techniques 9(7):3283-3292.
Hodas, N., and B. J. Turpin. 2014. Shifts in the gas–particle partitioning of ambient or-
ganics with transport into the indoor environment. Aerosol Science and Technology
48(3):271–281.
Hodas, N., Q. Meng, M. M. Lunden, D. Q. Rich, H. Özkaynak, L. K. Baxter, Q. Zhang, and
B. J. Turpin. 2012. Variability in the fraction of ambient fine particulate matter found
indoors and observed heterogeneity in health effect estimates. Journal of Exposure Sci-
ence and Environmental Epidemiology 22(5):448–454.
Hodas, N., B. J. Turpin, M. M. Lunden, L. K. Baxter, H. Özkaynak, J. Burke, P. Ohman-
Strickland, K. Thevenet-Morrison, J. B. Kostis, and D. Q. Rich. 2013. Refined ambient
PM2.5 exposure surrogates and the risk of myocardial infarction. Journal of Exposure
Hodas, N., Q. Meng, M. M. Lunden, and B. J. Turpin. 2014. Toward refined estimates of
ambient PM2.5 exposure: Evaluation of a physical outdoor-to-indoor transport model.
Atmospheric Environment 83:229–236.
Hodas, N., A. Zuend, W. Mui, R. C. Flagan, and J. H. Seinfeld. 2015. Influence of particle–
phase state on the hygroscopic behavior of mixed organic–inorganic aerosols. Atmo-
spheric Chemistry and Physics 15(9):5027–5045.
Hospodsky, D., N. Yamamoto, W. W. Nazaroff, D. Miller, S. Gorthala, and J. Peccia. 2015.
Characterizing airborne fungal and bacterial concentrations and emission rates in six
occupied children’s classrooms. Indoor Air 25(6):641–652.
Iñiguez, C., A. Esplugues, J. Sunyer, M. Basterrechea, A. Fernandez-Somoano, O. Costa,
M. Estarlich, I. Aguilera, A. Lertxundi, A. Tardon, M. Guxens, M. Murcia, M. J.
Lopez-Espinosa, and F. Ballester. 2016. Prenatal exposure to NO2 and ultrasound mea-
sures of fetal growth in the Spanish INMA cohort. Environmental Health Perspectives
124(2):235–242.
IOM (Institute of Medicine). 2001. Science and risk communication: A mini-symposium spon-
sored by the Roundtable on Environmental Health Sciences, Research, and Medicine.
Washington, DC: Institute of Medicine.
Isaxon, C., A. Gudmundsson, E. Nordin, L. Lönnblad, A. Dahl, G. Wieslander, M. Bohgard,
and A. Wierzbicka. 2015. Contribution of indoor-generated particles to residential ex-
posure. Atmospheric Environment 106:458–466.
Johnson, A. M., M. S. Waring, and P. F. DeCarlo. 2016. Real-time transformation of outdoor
aerosol components upon transport indoors measured with aerosol mass spectrometry.
Indoor Air, March 23. doi: 10.1111/ina.12299.
Johnson, T., and T. Long. 2004. Determining the frequency of open windows in residences: A
pilot study in Durham, North Carolina during varying temperature conditions. Journal
of Exposure Analysis and Environmental Epidemiology 15(4):329–349.
Jones, N., C. Thornton, D. Mark, and R. Harrison. 2000. Indoor/outdoor relationships of
particulate matter in domestic homes with roadside, urban and rural locations. Atmo-
spheric Environment 34(16):2603–2612.
Jump, D. A., I. S. Walker, and M. P. Modera. 1996. Field measurements of efficiency and duct
retrofit effectiveness in residential forced air distribution systems. Washington, DC: Amer-
ican Council for an Energy-Efficient Economy. http://aceee.org/files/proceedings/1996/
data/papers/SS96_Panel1_Paper15.pdf (accessed May 28, 2016).
Jung, J. H., J. E. Lee, C. H. Lee, S. S. Kim, and B. U. Lee. 2009. Treatment of fungal bioaero-
sols by a high-temperature, short-time process in a continuous-flow system. Applied and
Environmental Microbiology 75(9):2742–2749.

REFERENCES 115
Kahlor, L. 2010. Prism: A planned risk information seeking model. Health Communication
25(4):345–356.
Kajbafzadeh, M., M. Brauer, B. Karlen, C. Carlsten, S. van Eeden, and R. W. Allen. 2015.
The impacts of traffic-related and woodsmoke particulate matter on measures of car-
diovascular health: A HEPA filter intervention study. Occupational and Environmental
Medicine 72(6):394–400.
Kalkbrenner, A. E., G. C. Windham, M. L. Serre, Y. Akita, X. Wang, K. Hoffman, B. P. Thayer,
and J. L. Daniels. 2015. Particulate matter exposure, prenatal and postnatal windows of
susceptibility, and autism spectrum disorders. Epidemiology 26(1):30–42.
Karottki, D. G., M. Spilak, M. Frederiksen, L. Gunnarsen, E. V. Brauner, B. Kolarik, Z. J.
Andersen, T. Sigsgaard, L. Barregard, B. Strandberg, G. Sallsten, P. Moller, and S. Loft.
2013. An indoor air filtration study in homes of elderly: Cardiovascular and respiratory
effects of exposure to particulate matter. Environmental Health 12:116.
Kassab, A. S., V. M. Ugaz, M. D. King, and Y. A. Hassan. 2013. High resolution study of
micrometer particle detachment on different surfaces. Aerosol Science and Technology
47(4):351–360.
Kearney, J., L. Wallace, M. MacNeill, X. Xu, K. VanRyswyk, H. You, R. Kulka, and A. J.
Wheeler. 2011. Residential indoor and outdoor ultrafine particles in Windsor, Ontario.
Atmospheric Environment 45(40):7583–7593.
Kearney, J., L. Wallace, M. MacNeill, M. E. Héroux, W. Kindzierski, and A. J. Wheeler.
2014. Residential infiltration of fine and ultrafine particles in Edmonton. Atmospheric
Khare, P., and L. C. Marr. 2015. Simulation of vertical concentration gradient of influenza
viruses in dust resuspended by walking. Indoor Air 25(4):428–440.
Khurshid, S. S., J. A. Siegel, and K. A. Kinney. 2016. Particulate reactive oxygen species on
total suspended particles—Measurements in residences in Austin, Texas. Indoor Air Nov
20. doi: 10.1111/ina.12269.
Kim, Y. M., S. Harrad, and R. M. Harrison. 2002. Levels and sources of personal inhala-
tion exposure to volatile organic compounds. Environmental Science and Technology
36(24):5405–5410.
Kioumourtzoglou, M. A., J. D. Schwartz, M. G. Weisskopf, S. J. Melly, Y. Wang, F. Dominici,
and A. Zanobetti. 2016. Long-term PM2.5 exposure and neurological hospital admissions
in the northeastern United States. Environmental Health Perspectives 124(1):23–29.
Kleinman, M. T., J. A. Araujo, A. Nel, C. Sioutas, A. Campbell, P. Q. Cong, H. Li, and S. C.
Bondy. 2008. Inhaled ultrafine particulate matter affects CNS inflammatory processes
and may act via map kinase signaling pathways. Toxicology Letters 178(2):127–130.
Klepeis, N. E., W. C. Nelson, W. R. Ott, J. P. Robinson, A. M. Tsang, P. Switzer, J. V. Behar,
S. C. Hern, and W. H. Engelmann. 2001. The National Human Activity Pattern Survey
(NHAPS): A resource for assessing exposure to environmental pollutants. Journal of
Exposure Analysis and Environmental Epidemiology 11(3):231–252.
Koop, T., J. Bookhold, M. Shiraiwa, and U. Poschl. 2011. Glass transition and phase state of
organic compounds: Dependency on molecular properties and implications for second-
ary organic aerosols in the atmosphere. Physical Chemistry Chemical Physics 13(43):
19238–19255.
Koulova, A., and W. H. Frishman. 2014. Air pollution exposure as a risk factor for cardiovas-
cular disease morbidity and mortality. Cardiology Reviews 22(1):30–36.
Kunzli, N., and I. B. Tager. 2005. Air pollution: From lung to heart. Swiss Medical Weekly
135(47–48):697–702.
Lai, A. C. K., and W. W. Nazaroff. 2000. Modeling indoor particle deposition from turbulent
flow onto smooth surfaces. Journal of Aerosol Science 31(4):463–476.

Lazaridis, M., N. Serfozo, S. E. Chatoutsidou, and T. Glytsos. 2015. New particle formation
events arising from painting materials in an indoor microenvironment. Atmospheric
Lee, J. H., C. Y. Wu, C. N. Lee, D. Anwar, K. M. Wysocki, D. A. Lundgren, S. Farrah, J.
Wander, and B. K. Heimbuch. 2009. Assessment of iodine-treated filter media for re-
moval and inactivation of MS2 bacteriophage aerosols. Journal of Applied Microbiology
107(6):1912–1923.
Lehtimäki, M., and K. Heinonen. 1994. Reliability of electret filters. Building and Environ-
ment 29(3):353–355.
Lehtimäki, M., A. Säämänen, and A. Taipale. 2005. Investigation of mechanisms and operating
environments that impact the filtration efficiency of charged air filtration media. Atlanta,
GA: American Society of Heating, Refrigerating, and Air-Conditioning Engineers.
Leung, W. W.-F., C.-H. Hung, and P.-T. Yuen. 2009. Experimental investigation on continuous
filtration of sub-micron aerosol by filter composed of dual-layers including a nanofiber
layer. Aerosol Science and Technology 43(12):1174–1183.
Li, H.-W., C.-Y. Wu, F. Tepper, J.-H. Lee, and C. N. Lee. 2009. Removal and retention of viral
aerosols by a novel alumina nanofiber filter. Journal of Aerosol Science 40(1):65–71.
Lim, S. S., T. Vos, A. D. Flaxman, G. Danaei, K. Shibuya, et al. 2012. A comparative risk
assessment of burden of disease and injury attributable to 67 risk factors and risk factor
clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease
Study 2010. Lancet 380(9859):2224–2260.
Lim, Y. B., Y. Tan, M. J. Perri, S. P. Seitzinger, and B. J. Turpin. 2010. Aqueous chemistry
and its role in secondary organic aerosol (SOA) formation. Atmospheric Chemistry and
Physics 10(21):10521–10539.
Liu, D.-L., and W. W. Nazaroff. 2001. Modeling pollutant penetration across building enve-
lopes. Atmospheric Environment 35(26):4451–4462.
Long, C. M., H. H. Suh, L. Kobzik, P. J. Catalano, Y. Y. Ning, and P. Koutrakis. 2001. A
pilot investigation of the relative toxicity of indoor and outdoor fine particles: In vitro
effects of endotoxin and other particulate properties. Environmental Health Perspectives
109(10):1019–1026.
Lunden, M. M., T. W. Kirchstetter, T. L. Thatcher, S. V. Hering, and N. J. Brown. 2008.
Factors affecting the indoor concentrations of carbonaceous aerosols of outdoor origin.
Atmospheric Environment 42(22):5660–5671.
MacNeill, M., L. Wallace, J. Kearney, R. W. Allen, K. VanRyswyk, S. Judek, X. Xu, and A.
J. Wheeler. 2012. Factors influencing variability in the infiltration of PM2.5 mass and its
components. Atmospheric Environment 61:518–532.
MacNeill, M., J. Kearney, L. Wallace, M. Gibson, M. E. Héroux, J. Kuchta, J. R. Guernsey,
and A. J. Wheeler. 2014. Quantifying the contribution of ambient and indoor-generated
fine particles to indoor air in residential environments. Indoor Air 24(4):362–375.
Mainelis, G., K. Willeke, A. Adhikari, T. Reponen, and S. A. Grinshpun. 2002. Design and
collection efficiency of a new electrostatic precipitator for bioaerosol collection. Aerosol
Science and Technology 36(11):1073–1085.
Marr, D., M. Mason, R. Mosley, and X. Liu. 2012. The influence of opening windows and
doors on the natural ventilation rate of a residential building. HVAC&R Research
18(1–2):195–203.
Masri, S., C.-M. Kang, and P. Koutrakis. 2015. Composition and sources of fine and coarse
particles collected during 2002–2010 in Boston, MA. Journal of the Air & Waste Man-
agement Association 65(3):287–297.
Matz, C. J., D. M. Stieb, and O. Brion. 2015. Urban–rural differences in daily time-activ-
ity patterns, occupational activity and housing characteristics. Environmental Health
14(1):1–11.

REFERENCES 117
McDonagh, A., and M. A. Byrne. 2014a. The influence of human physical activity and con-
taminated clothing type on particle resuspension. Journal of Environmental Radioactivity
127:119–126.
McDonagh, A., and M. A. Byrne. 2014b. A study of the size distribution of aerosol particles
resuspended from clothing surfaces. Journal of Aerosol Science 75:94–103.
Meng, Q. Y., B. J. Turpin, L. Korn, C. P. Weisel, M. Morandi, S., et al. 2004. Influence of
ambient (outdoor) sources on residential indoor and personal PM2.5 concentrations:
Analyses of RIOPA data. Journal of Exposure Analysis and Environmental Epidemiol-
ogy 15(1):17–28.
Meng, Q. Y., B. J. Turpin, J. H. Lee, A. Polidori, C. P. Weisel, M. Morandi, S. Colome, J.
Zhang, T. Stock, and A. Winer. 2007. How does infiltration behavior modify the com-
position of ambient PM2.5 in indoor spaces? An analysis of RIOPA data. Environmental
Science & Technology 41(21):7315–7321.
Minutolo, P., A. D’Anna, M. Commodo, R. Pagliara, G. Toniato, and C. Accordini. 2008.
Emission of ultrafine particles from natural gas domestic burners. Environmental Engi-
neering Science 25(10):1357–1364.
Montgomery, J. F., S. I. Green, S. N. Rogak, and K. Bartlett. 2012. Predicting the energy use
and operation cost of HVAC air filters. Energy and Buildings 47:643–650.
Montgomery, J. F., S. I. Green, and S. N. Rogak. 2015. Impact of relative humidity on HVAC
filters loaded with hygroscopic and non-hygroscopic particles. Aerosol Science and
Morgan, W. T., B. Ouyang, J. D. Allan, E. Aruffo, P. Di Carlo, O. J. Kennedy, D. Lowe, M. J.
Flynn, P. D. Rosenberg, P. I. Williams, R. Jones, G. B. McFiggans, and H. Coe. 2015.
Influence of aerosol chemical composition on N2O5 uptake: Airborne regional measure-
ments in northwestern Europe. Atmospheric Chemistry and Physics 15(2):973–990.
Mukai, C., J. A. Siegel, and A. Novoselac. 2009. Impact of airflow characteristics on particle
resuspension from indoor surfaces. Aerosol Science and Technology 43(10):1022–1032.
Mullen, N. A., and B. C. Singer. 2012. Impact of natural gas appliances on pollutant levels in
California homes. Berkeley, CA: Lawrence Berkeley National Laboratory.
Naumova, Y. Y., J. H. Offenberg, S. J. Eisenreich, Q. Meng, A. Polidori, et al. 2003. Gas/
particle distribution of polycyclic aromatic hydrocarbons in coupled outdoor/indoor
atmospheres. Atmospheric Environment 37(5):703–719.
Novoselac, A., and J. A. Siegel. 2009. Impact of placement of portable air cleaning devices
in multizone residential environments. Building and Environment 44(12):2348–2356.
NRC (National Research Council). 1989. Improving risk communication. Washington, DC:
National Academy Press.
Oakes, M., E. D. Ingall, B. Lai, M. M. Shafer, M. D. Hays, Z. G. Liu, A. G. Russell, and R. J.
Weber. 2012a. Iron solubility related to particle sulfur content in source emission and
ambient fine particles. Environmental Science & Technology 46(12):6637–6644.
Oakes, M., R. J. Weber, B. Lai, A. Russell, and E. D. Ingall. 2012b. Characterization of iron
speciation in urban and rural single particles using XANES spectroscopy and micro
X-ray fluorescence measurements: Investigating the relationship between speciation and
fractional iron solubility. Atmospheric Chemistry and Physics 12(2):745–756.
Oberdorster, G., Z. Sharp, V. Atudorei, A. Elder, R. Gelein, W. Kreyling, and C. Cox.
2004. Translocation of inhaled ultrafine particles to the brain. Inhalation Toxicology
16(6–7):437–445.
O’Neill, M. S., A. Osornio-Vargas, M. A. Buxton, B. N. Sánchez, L. Rojas-Bracho, M.
Castillo-Castrejon, I. B. Mordhukovich, D. G. Brown, and F. Vadillo-Ortega. 2013. Air
pollution, inflammation and preterm birth in Mexico City: study design and methods.
Science of the Total Environment 448:79–83.

Padro-Martinez, L. T., E. Owusu, E. Reisner, W. Zamore, M. C. Simon, M. Mwamburi, C. A.

Brown, M. Chung, D. Brugge, and J. L. Durant. 2015. A randomized cross-over air
filtration intervention trial for reducing cardiovascular health risks in residents of public
housing near a highway. International Journal of Environmental Research and Public
Health 12(7):7814–7838.
Pan, A., M. L. Clark, L. W. Ang, M. C. Yu, J. M. Yuan, and W. P. Koh. 2014. Incense use and
cardiovascular mortality among Chinese in Singapore: The Singapore Chinese Health
Study. Environmental Health Perspectives 122(12):1279–1284.
Parker, J. D., P. Mendola, and T. J. Woodruff. 2008. Preterm birth after the Utah Valley steel
mill closure: A natural experiment. Epidemiology 19(6):820–823.
Parker, J. D., D. Q. Rich, S. V. Glinianaia, J. H. Leem, D. Wartenberg, M. L. Bell, M. Bonzini,
M. Brauer, L. Darrow, U. Gehring, N. Gouveia, P. Grillo, E. Ha, E. H. van den Hooven,
B. Jalaludin, B. M. Jesdale, J. Lepeule, R. Morello-Frosch, G. G. Morgan, R. Slama,
F. H. Pierik, A. C. Pesatori, S. Sathyanarayana, J. Seo, M. Strickland, L. Tamburic, and
T. J. Woodruff. 2011. The International Collaboration on Air Pollution and Pregnancy
Outcomes: Initial results. Environmental Health Perspectives 119(7):1023–1028.
Peccia, J., H. M. Werth, S. Miller, and M. Hernandez. 2001. Effects of relative humidity on
the ultraviolet induced inactivation of airborne bacteria. Aerosol Science and Technology
35(3):728–740.
Peng, R. D., M. L. Bell, A. S. Geyh, A. McDermott, S. L. Zeger, J. M. Samet, and F.
Dominici. 2009. Emergency admissions for cardiovascular and respiratory diseases and
the chemical composition of fine particle air pollution. Environmental Health Perspec-
tives 117(6):957–963.
Peters, A., B. Veronesi, L. Calderon-Garciduenas, P. Gehr, L. C. Chen, M. Geiser, W. Reed,
B. Rothen-Rutishauser, S. Schurch, and H. Schulz. 2006. Translocation and potential
neurological effects of fine and ultrafine particles: A critical update. Particle and Fibre
Toxicololgy 3:13.
Polidori, A., B. Turpin, Q. Y. Meng, J. H. Lee, C. Weisel, M. Morandi, S. Colome, T. Stock, A.
Winer, J. Zhang, J. Kwon, S. Alimokhtari, D. Shendell, J. Jones, C. Farrar, and S. Maberti.
2006. Fine organic particulate matter dominates indoor-generated PM2.5 in RIOPA
homes. Journal of Exposure Science and Environmental Epidemiology 16(4):321–331.
Polidori, A., P. M. Fine, V. White, and P. S. Kwon. 2013. Pilot study of high-performance air
filtration for classroom applications. Indoor Air 23(3):185–195.
Power, M. C., M. G. Weisskopf, S. E. Alexeeff, B. A. Coull, A. Spiro, 3rd, and J. Schwartz.
2011. Traffic-related air pollution and cognitive function in a cohort of older men. En-
vironmental Health Perspectives 119(5):682–687.
Power, M. C., M. A. Kioumourtzoglou, J. E. Hart, O. I. Okereke, F. Laden, and M. G.
Weisskopf. 2015. The relation between past exposure to fine particulate air pollution
and prevalent anxiety: Observational cohort study. BMJ 350:h1111.
Price, P. N., and M. H. Sherman. 2006. Ventilation behavior and household characteristics in
new California houses. Lawrence Berkeley National Laboratory. http://eetd.lbl.gov/sites/
all/files/lbnl-59620.pdf (accessed June 11, 2016).
Qian, J., and A. R. Ferro. 2008. Resuspension of dust particles in a chamber and associated
environmental factors. Aerosol Science and Technology 42(7):566–578.
Qian, J., J. Peccia, and A. R. Ferro. 2014. Walking-induced particle resuspension in indoor
environments. Atmospheric Environment 89:464–481.
Ratnesar-Shumate, S., C.-Y. Wu, J. Wander, D. A. Lundgren, S. Farrah, and J.-H. Lee. 2008.
Evaluation of physical capture efficiency and disinfection capability of an iodinated bio-
cidal filter medium. Aerosol and Air Quality Research 8(1):1–18.
Raynor, P. C., and S. J. Chae. 2004. The long-term performance of electrically charged filters in
a ventilation system. Journal of Occupational and Environmental Hygiene 1(7):463–471.

REFERENCES 119
Raz, R., A. L. Roberts, K. Lyall, J. E. Hart, A. C. Just, F. Laden, and M. G. Weisskopf. 2015.
Autism spectrum disorder and particulate matter air pollution before, during, and after
pregnancy: A nested case-control analysis within the Nurses’ Health Study II cohort.
Environmental Health Perspectives 123(3):264–270.
Riain, C. N., D. Mark, M. Davies, R. Harrison, and M. Byrne. 2003. Averaging periods for
indoor–outdoor ratios of pollution in naturally ventilated non-domestic buildings near a
busy road. Atmospheric Environment 37(29):4121–4132.
Rich, D. Q., K. Liu, J. Zhang, S. W. Thurston, T. P. Stevens, Y. Pan, C. Kane, B. Weinberger,
P. Ohman-Strickland, T. J. Woodruff, X. Duan, V. Assibey-Mensah, and J. Zhang.
2015. Differences in birth weight associated with the 2008 Beijing Olympics air pollu-
tion reduction: Results from a natural experiment. Environmental Health Perspectives
123(9):880–887.
Rim, D., and A. Novoselac. 2009. Transport of particulate and gaseous pollutants in the vicin-
ity of a human body. Building and Environment 44(9):1840–1849.
Rim, D., L. Wallace, and A. Persily. 2010. Infiltration of outdoor ultrafine particles into a test
house. Environmental Science & Technology 44(15):5908–5913.
Romonosky, D. E., A. Laskin, J. Laskin, and S. A. Nizkorodov. 2015. High-resolution
mass spectrometry and molecular characterization of aqueous photochemistry prod-
ucts of common types of secondary organic aerosols. Journal of Physical Chemistry A
119(11):2594–2606.
Rossignol, S., C. Rio, A. Ustache, S. Fable, J. Nicolle, A. Même, B. D’Anna, M. Nicolas, E.
Leoz, and L. Chiappini. 2013. The use of a housecleaning product in an indoor environ-
ment leading to oxygenated polar compounds and soa formation: Gas and particulate
phase chemical characterization. Atmospheric Environment 75:196–205.
Russo, E. T., T. E. Hulse, G. Adamkiewicz, D. E. Levy, L. Bethune, J. Kane, M. Reid, and
S. N. Shah. 2015. Comparison of indoor air quality in smoke-permitted and smoke-free
multiunit housing: Findings from the Boston Housing Authority. Nicotine & Tobacco
Research 17(3):316–322.
Sarnat, S. E., J. A. Sarnat, J. Mulholland, V. Isakov, H. Özkaynak, H. H. Chang, M. Klein,
and P. E. Tolbert. 2013. Application of alternative spatiotemporal metrics of ambient air
pollution exposure in a time-series epidemiological study in Atlanta. Journal of Exposure
Sarwar, G., and R. Corsi. 2007. The effects of ozone/limonene reactions on indoor secondary
organic aerosols. Atmospheric Environment 41(5):959–973.
Semple, S., A. Apsley, T. Azmina Ibrahim, S. W. Turner, and J. W. Cherrie. 2015. Fine particu-
late matter concentrations in smoking households: Just how much secondhand smoke
do you breathe in if you live with a smoker who smokes indoors? Tobacco Control
24(e3):e205–e211.
Shalat, S. L., A. A. Stambler, Z. Wang, G. Mainelis, O. H. Emoekpere, M. Hernandez, P. J.
Lioy, and K. Black. 2011. Development and in-home testing of the Pretoddler Inhalable
Particulate Environmental Robotic (PIPER MK IV) sampler. Environmental Science &
Technology 45(7):2945–2950.
Shi, L., A. Zanobetti, I. Kloog, B. A. Coull, P. Koutrakis, S. J. Melly, and J. D. Schwartz.
2016. Low-concentration PM2.5 and mortality: Estimating acute and chronic effects in a
population-based study. Environmental Health Perspectives 124(1):46–52.
Shu, S., and G. C. Morrison. 2011. Surface reaction rate and probability of ozone and alpha-
terpineol on glass, polyvinyl chloride, and latex paint surfaces. Environmental Science
& Technology 45(10):4285–4292.
Simkhovich, B. Z., M. T. Kleinman, and R. A. Kloner. 2008. Air pollution and cardiovascular
injury epidemiology, toxicology, and mechanisms. Journal of the American College of
Cardiology 52(9):719–726.

Singer, B. C., W. W. Delp, P. N. Price, and M. G. Apte. 2012. Performance of installed cooking
exhaust devices. Indoor Air 22(3):224–234.
Singer, B. C., W. W. Delp, D. R. Black, H. D. Destaillats, and I. S. Walker. 2016. Reducing
in-home exposures to air pollutants. Final report for California Air Resources Board.
Contract 11-311.
Sirivelu, M. P., S. M. MohanKumar, J. G. Wagner, J. R. Harkema, and P. S. MohanKumar.
2006. Activation of the stress axis and neurochemical alterations in specific brain areas
by concentrated ambient particle exposure with concomitant allergic airway disease.
Environmental Health Perspectives 114(6):870–874.
Sleiman, M., H. Destaillats, J. D. Smith, C.-L. Liu, M. Ahmed, K. R. Wilson, and L. A. Gundel.
2010. Secondary organic aerosol formation from ozone-initiated reactions with nicotine
and secondhand tobacco smoke. Atmospheric Environment 44(34):4191–4198.
Slovic, P., T. Malmfors, D. Krewski, C. K. Mertz, N. Neil, and S. Bartlett. 1995. Intuitive
toxicology. II. Expert and lay judgments of chemical risks in Canada. Risk Analysis
15(6):661–675.
Slovic, P., M. L. Finucane, E. Peters, and D. G. MacGregor. 2004. Risk as analysis and risk
as feelings: Some thoughts about affect, reason, risk, and rationality. Risk Analysis
24(2):311–322.
Stephens, B., and J. A. Siegel. 2012. Penetration of ambient submicron particles into sin-
gle-family residences and associations with building characteristics. Indoor Air 22(6):
501–513.
Stephens, B., and J. A. Siegel. 2013. Ultrafine particle removal by residential heating, ventilat-
ing, and air-conditioning filters. Indoor Air 23(6):488–497.
Stephens, B., J. A. Siegel, and A. Novoselac. 2011. Operational characteristics of residential
and light-commercial air-conditioning systems in a hot and humid climate zone. Building
and Environment 46(10):1972–1983.
Sun, Q., X. Hong, and L. E. Wold. 2010. Cardiovascular effects of ambient particulate air
pollution exposure. Circulation 121(25):2755–2765.
Talbott, E. O., V. C. Arena, J. R. Rager, J. E. Clougherty, D. R. Michanowicz, R. K. Sharma,
and S. L. Stacy. 2015. Fine particulate matter and the risk of autism spectrum disorder.
Environmental Research 140:414–420.
Thatcher, T. L., A. C. K. Lai, R. Moreno-Jackson, R. G. Sextro, and W. W. Nazaroff. 2002. Ef-
fects of room furnishings and air speed on particle deposition rates indoors. Atmospheric
Environment 36(11):1811–1819.
Thornburg, J. W., C. E. Rodes, P. A. Lawless, C. D. Stevens, and R. W. Williams. 2004. A pilot
study of the influence of residential HAC duty cycle on indoor air quality. Atmospheric
Environment 38(11):1567–1577.
Tian, Y., K. Sul, J. Qian, S. Mondal, and A. R. Ferro. 2014. A comparative study of walking-
induced dust resuspension using a consistent test mechanism. Indoor Air 24(6):592–603.
van den Hooven, E. H., F. H. Pierik, Y. de Kluizenaar, A. Hofman, S. W. van Ratingen, P. Y.
Zandveld, H. Russcher, J. Lindemans, H. M. Miedema, E. A. Steegers, and V. W. Jaddoe.
2012. Air pollution exposure and markers of placental growth and function: The Genera-
tion R Study. Environmental Health Perspectives 120(12):1753–1759.
Veronesi, B., O. Makwana, M. Pooler, and L. C. Chen. 2005. Effects of subchronic exposures
to concentrated ambient particles: VII. Degeneration of dopaminergic neurons in Apo
E-/- mice. Inhalation Toxicology 17(4–5):235–241.
Volk, H. E., F. Lurmann, B. Penfold, I. Hertz-Picciotto, and R. McConnell. 2013. Traffic-
related air pollution, particulate matter, and autism. JAMA Psychiatry 70(1):71–77.
Walker, I. S., D. Dickerhoff, and F. David. 2013. Energy implications of in-line filtration in
California homes. ASHRAE Transactions 119(2):399–417.

REFERENCES 121
Wallace, L. A. 2005. Ultrafine particles from a vented gas clothes dryer. Atmospheric Environ-
ment 39(32):5777–5786.
Wallace, L., and W. Ott. 2011. Personal exposure to ultrafine particles. Journal of Exposure
Wallace, L. A., H. Mitchell, G. T. O’Connor, L. Neas, M. Lippmann, M. Kattan, J. Koenig,
J. W. Stout, B. J. Vaughn, D. Wallace, M. Walter, K. Adams, L.-J. S. Liu, and S. Inner-City
Asthma. 2003. Particle concentrations in inner-city homes of children with asthma: The
effect of smoking, cooking, and outdoor pollution. Environmental Health Perspectives
111(9):1265–1272.
Wallace, L. A., F. Wang, C. Howard-Reed, and A. Persily. 2008. Contribution of gas and
electric stoves to residential ultrafine particle concentrations between 2 and 64 nm: Size
distributions and emission and coagulation rates. Environmental Science & Technology
42(23):8641–8647.
Wallace, L. A., W. R. Ott, and C. J. Weschler. 2015. Ultrafine particles from electric appliances
and cooking pans: Experiments suggesting desorption/nucleation of sorbed organics as
the primary source. Indoor Air 25(5):536–546.
Wang, B., S. C. Lee, and K. F. Ho. 2006. Chemical composition of fine particles from incense
burning in a large environmental chamber. Atmospheric Environment 40(40):7858–7868.
Wang, J., S. C. Kim, and D. Y. H. Pui. 2008. Figure of merit of composite filters with microm-
eter and nanometer fibers. Aerosol Science and Technology 42(9):722–728.
Wang, X., H. Ding, L. Ryan, and X. Xu. 1997. Association between air pollution and low birth
weight: A community-based study. Environmental Health Perspectives 105(5):514–520.
Waring, M. S., J. R. Wells, and J. A. Siegel. 2011. Secondary organic aerosol formation from
ozone reactions with single terpenoids and terpenoid mixtures. Atmospheric Environ-
ment 45(25):4235–4242.
Weichenthal, S., G. Mallach, R. Kulka, A. Black, A. Wheeler, H. You, M. St-Jean, R.
Kwiatkowski, and D. Sharp. 2013. A randomized double-blind crossover study of indoor
air filtration and acute changes in cardiorespiratory health in a First Nations community.
Indoor Air 23(3):175–184.
Weisel, C. P., J. Zhang, B. J. Turpin, M. T. Morandi, S. Colome, T.H. Stock, D. M. Spektor,
L. Korn, A. Winer, S. Alimokhtari, J. Kwon, K. Mohan, R. Harrington, R. Giovanetti,
W. Cui, M. Afshar, S. Maberti, and D. Shendell. 2005. Relationship of Indoor, Outdoor
and Personal Air (RIOPA) study: Study design, methods and quality assurance/control
results. Journal of Exposure Analysis and Environmental Epidemiology 15(2):123–137.
Weisskopf, M. G., M. A. Kioumourtzoglou, and A. L. Roberts. 2015. Air pollution and au-
tism spectrum disorders: Causal or confounded? Current Environmental Health Reports
2(4):430–439.
Weschler, C. J., and W. W. Nazaroff. 2008. Semivolatile organic compounds in indoor environ-
ments. Atmospheric Environment 42(40):9018–9040.
Weschler, C. J., and W. W. Nazaroff. 2010. SVOC partitioning between the gas phase and
settled dust indoors. Atmospheric Environment 44(30):3609–3620.
Wilde, G. J. 1998. Risk homeostasis theory: An overview. Injury Prevention 4(2):89–91.
Williams, R., J. Suggs, A. Rea, K. Leovic, A. Vette, C. Croghan, L. Sheldon, C. Rodes, J.
Thronburg, A. Ejire, M. Herbst, and W. Sanders Jr., 2003. The Research Triangle Park
particulate matter panel study: PM mass concentration relationships. Atmospheric En-
vironment 37(38):5349–5363.
Wilson, T., F. Shamo, K. Boynton, and J. Kiley. 2012. The impact of Michigan’s Dr. Ron Davis
smoke-free air law on levels of cotinine, tobacco-specific lung carcinogen and severity of
self-reported respiratory symptoms among non-smoking bar employees. Tobacco Control
21(6):593–595.

Woodruff, T. J., J. D. Parker, L. A. Darrow, R. Slama, M. L. Bell, H. Choi, S. Glinianaia, K. J.

Hoggatt, C. J. Karr, D. T. Lobdell, and M. Wilhelm. 2009. Methodological issues in stud-
ies of air pollution and reproductive health. Environmental Research 109(3):311–320.
Wu, J., C. Ren, R. J. Delfino, J. Chung, M. Wilhelm, and B. Ritz. 2009. Association between
local traffic-generated air pollution and preeclampsia and preterm delivery in the south
coast air basin of California. Environmental Health Perspectives 117(11):1773–1779.
Wu, Y., Y. Liang, K. Wei, W. Li, M. Yao, J. Zhang, and S. A. Grinshpun. 2015. MS2 virus
inactivation by atmospheric-pressure cold plasma using different gas carriers and power
levels. Applied and Environmental Microbiology 81(3):996–1002.
Xu, X., H. Ding, and X. Wang. 1995. Acute effects of total suspended particles and sulfur
dioxides on preterm delivery: A community-based cohort study. Archives of Environ-
mental Health 50(6):407–415.
Yanosky, J. D., C. J. Paciorek, F. Laden, J. E. Hart, R. C. Puett, D. Liao, and H. H. Suh. 2014.
Spatio-temporal modeling of particulate air pollution in the conterminous United States
using geographic and meteorological predictors. Environmental Health 13(1):63.
Youssefi, S., and M. S. Waring. 2015. Indoor transient soa formation from ozone + α-pinene
reactions: Impacts of air exchange and initial product concentrations, and comparison
to limonene ozonolysis. Atmospheric Environment 112:106–115.
Zauli Sajani, S., I. Ricciardelli, A. Trentini, D. Bacco, C. Maccone, S. Castellazzi, P. Lauriola,
V. Poluzzi, and R. M. Harrison. 2015. Spatial and indoor/outdoor gradients in urban
concentrations of ultrafine particles and PM2.5 mass and chemical components. Atmo-
spheric Environment 103:307–320.
Zauli Sajani, S., A. Trentini, S. Rovelli, I. Ricciardelli, S. Marchesi, C. Maccone, D. Bacco,
S. Ferrari, F. Scotto, C. Zigola, A. Cattaneo, D. M. Cavallo, P. Lauriola, V. Poluzzi, and
R. M. Harrison. 2016. Is particulate air pollution at the front door a good proxy of
residential exposure? Environmental Pollution 213:347–358.
Zhang, Q., B. Damit, J. Welch, H. Park, C.-Y. Wu, and W. Sigmund. 2010. Microwave as-
sisted nanofibrous air filtration for disinfection of bioaerosols. Journal of Aerosol Science
41(9):880–888.
Zhang, X., A. P. Martinez-Donate, D. Kuo, N. R. Jones, and K. A. Palmersheim. 2012. Trends
in home smoking bans in the USA, 1995–2007: Prevalence, discrepancies and disparities.
Tobacco Control 21(3):330–336.
Zhao, D., P. Azimi, and B. Stephens. 2015. Evaluating the long-term health and economic
impacts of central residential air filtration for reducing premature mortality associated
with indoor fine particulate matter (PM2.5) of outdoor origin. International Journal of
Environmental Research and Public Health 12(7):8448.

Appendix A
Workshop Agenda
Workshop on the Health Risks of
Indoor Exposure to Particulate Matter
500 Fifth Street NW, Washington, DC 20001
WEDNESDAY, FEBRUARY 10, 2016

8:30 a.m. Welcome, Workshop Goals, and Introductions
William Nazaroff, Ph.D., Chair
8:40 a.m. Sponsor Remarks

David Rowson, M.S.
U.S. Environmental Protection Agency
9:00 a.m. SESSION I: SOURCES OF INDOOR PARTICULATE

MATTER
Moderated by: William Nazaroff, Ph.D.
Outdoor Air and Appliances as Sources of Indoor

Particulate Matter
Brent Stephens, Ph.D.
Assistant Professor of Architectural Engineering,
Illinois Institute of Technology
Indoor Sources of Airborne Allergens and Smoke

Lynn M. Hildemann, Ph.D.
Professor of Civil and Environmental Engineering,
Stanford University
123

Surrounded by a Cloud of Dust: Particle Resuspension in

Indoor Environments
Brandon E. Boor, Ph.D.
Assistant Professor of Civil Engineering, Purdue
University
10:30 a.m. Break
10:45 a.m. S ESSION II: PARTICLE DYNAMICS AND

CHEMISTRY
Moderated by: Richard Corsi, Ph.D., P.E.
Indoor Chemistry and Aerosols

Glenn Morrison, Ph.D.
Professor of Civil, Architectural, and Environmental
Engineering, Missouri University of Science and
Technology
Dynamics of Particle Size and Concentration Indoors:

A Building Science Perspective
Jeffrey Siegel, Ph.D.
Professor of Civil Engineering, University of Toronto
omposition of Indoor PM, Including the Influence of

C
SVOC Partitioning
Charles Weschler, Ph.D.
Adjunct Professor, Rutgers University; Visiting
Professor, Technical University of Denmark and
Tsinghua University
12:15 p.m. Lunch
1:15 p.m. S ESSION III: EXPOSURE LEVELS AND

CHARACTERIZATION
Moderated by: Terry Brennan, M.S.
Fine PM Exposure Characterization Provides Insights

into Sources and Transformations
Barbara Turpin, Ph.D.
Professor of Environmental Sciences and Engineering,
University of North Carolina Gillings School of
Global Public Health

APPENDIX A 125
Some Determinants of Indoor Concentrations and

Exposures to Particulate Matter
Roy Harrison, Ph.D., D.Sc. (presenting via web
conference)
Queen Elizabeth II Birmingham Centenary Professor
of Environmental Health, University of Birmingham
Socioeconomic Determinants of Indoor PM Exposure:

Understanding Sources, Structures and Settings
Gary Adamkiewicz, Ph.D., M.P.H.
Assistant Professor of Environmental Health and
Exposure Disparities, Harvard T.H. Chan School of
Public Health
2:45 p.m. Break
3:00 p.m. SESSION IV: EXPOSURE MITIGATION

Moderated by: Tiina Reponen, Ph.D.
Indoor Particle Mitigation with Filtration

William Fisk, M.S.
Senior Scientist, Indoor Environment Group,
Lawrence Berkeley National Laboratory
Methods and Approaches for Controlling Exposure to

Biological Aerosols
Sergey A. Grinshpun, Ph.D.
Professor of Environmental Health, University of
Cincinnati College of Medicine
Indoor PM Exposure Mitigation in Low-Socioeconomic

Status Households
Brett C. Singer, Ph.D.
Staff Scientist, Residential Building Systems, Indoor
Environment Group, Lawrence Berkeley National
Laboratory
4:30 p.m. General Discussion and Summary

THURSDAY, FEBRUARY 11, 2016

8:30 a.m. Welcome
8:35 a.m. SESSION V: IDENTIFIED AND EMERGING HEALTH

CONCERNS
Moderated by: Howard Kipen, M.D., M.P.H.
Indoor Particulate Matter Air Pollution and

Cardiovascular Health
Ryan Allen, Ph.D. (presenting via web conference)
Associate Professor, Faculty of Health Sciences, Simon
Fraser University
Ambient Particulate Matter (PM) Air Pollution and

Adverse Birth Outcomes: Targets for Studies on Health
Effects of Indoor PM
David Rich, Sc.D., M.P.H.
Associate Professor of Public Health Sciences,
University of Rochester Medical Center
Particulate Matter Air Pollution: Neurological and

Psychiatric Disorders
Marc Weisskopf, Ph.D., Sc.D.
Associate Professor of Environmental and
Occupational Epidemiology, Harvard T.H. Chan
School of Public Health
10:05 a.m. Break
10:20 a.m. SESSION VI: INTERVENTIONS AND RISK

COMMUNICATION
Moderated by: William Nazaroff, Ph.D.
The Challenge of Communicating Indoor PM Risk

George Gray, Ph.D.
Professor of Environmental and Occupational Health,
Milken Institute School of Public Health at the George
Washington University

APPENDIX A 127
Empowering People to Reduce Indoor Exposures

to Particulate Matter: What Can We Learn from
Communicating About Other Health Risks?
William K. Hallman, Ph.D.
Professor and Chair, Department of Human Ecology,
Rutgers University
Public Understanding and Information Seeking Related

to Indoor PM Risk: The Need for a Benchmark Study
Lee Ann Kahlor, Ph.D.
Associate Professor, Stan Richards School of
Advertising, The University of Texas at Austin
11:50 a.m. Closing Remarks

12:00 p.m. Adjourn


Appendix B
Biographical Information:
Workshop Speakers
Gary Adamkiewicz, Ph.D., M.P.H., is an assistant professor of environ-

mental health and exposure disparities at the Harvard T.H. Chan School of
Public Health, where much of his work focuses on the connections between
housing and health and on understanding disparities in environmental
exposure. His research has included studies of indoor environmental con-
ditions within the homes of children with asthma and studies that aim to
understand the factors that contribute to specific exposures such as pesti-
cides and other chemicals, allergens, secondhand smoke, particulate matter,
and other combustion by-products. He has worked with national, state, and
local agencies on projects that aim to reduce the burden of disease from
indoor environmental issues. Dr. Adamkiewicz is a member of the Science
Advisory Committee for the National Center for Healthy Housing and has
served on the U.S. Environmental Protection Agency’s Environmental Jus-
tice Technical Guidance Review Panel, under the auspices of the agency’s
Science Advisory Board. He has also served as an advisor to the World
Health Organization’s effort to establish indoor air quality guidelines. He
also serves as the Healthy Cities Program Leader at the Harvard Center
for Health and the Global Environment. In 2012 the American Journal
of Public Health awarded Dr. Adamkiewicz a Paper of the Year honor for
his work on housing as an environmental justice issue. Dr. Adamkiewicz
holds a Ph.D. in chemical engineering from the Massachusetts Institute of
Technology and an M.P.H. from Harvard.
Ryan Allen, Ph.D., is an associate professor of environmental health in the

Faculty of Health Sciences at Simon Fraser University. He holds a master’s
129

degree in environmental engineering and a Ph.D. in environmental health

sciences, both from the University of Washington in Seattle. Dr. Allen
completed a postdoctoral training in environmental epidemiology as part
of the U.S. Environmental Protection Agency–funded MESA Air study,
which focused on the link between long-term air pollution exposure and
the progression of subclinical cardiovascular disease. Dr. Allen’s current
research focuses include air pollution exposure assessment methods, the
cardiovascular effects of air pollution, the evaluation of interventions to
reduce air pollution exposures and health effects, and the impacts of early-
life air pollution exposure on childhood growth and development. In 2010
Dr. Allen was awarded the Joan M. Daisey Outstanding Young Scientist
Award by the International Society of Exposure Science.
Brandon E. Boor, Ph.D., is an assistant professor of civil engineering and

environmental and ecological engineering (by courtesy) at Purdue Univer-
sity. He leads the Indoor Aerosol and Exposure Laboratory at Purdue and
is a member of the Center for High Performance Buildings at the Ray W.
Herrick Laboratories. Dr. Boor’s research focuses on characterizing the
dynamics of airborne particles in buildings and human exposure to indoor
and urban air pollutants. He has previously worked with research groups
at the University of Helsinki, Finnish Institute of Occupational Health,
and VTT Technical Research Centre in Finland as well as the National
Institute of Standards and Technology in Maryland. He has received
various fellowships, including a National Science Foundation Gradu-
ate Research Fellowship, U.S. Environmental Protection Agency STAR
Fellowship, ASHRAE Grant-In-Aid, and a Fulbright doctoral grant to
Finland. Dr. Boor received his Ph.D. from the Department of Civil, Archi-
tectural, and Environmental Engineering at The University of Texas (UT)
at Austin. He also holds an M.S.E. in environmental and water resources
engineering from UT Austin and a B.S. in mechanical engineering from
York College of Pennsylvania. While at UT Austin, Dr. Boor participated
in the interdisciplinary National Science Foundation Integrative Graduate
Education and Research Traineeship program in indoor environmental
science and engineering.
William Fisk, M.S., is a senior scientist at the Lawrence Berkeley National

Laboratory. His research focuses primarily on energy efficient methods of
maintaining and improving ventilation and indoor environmental quality
(IEQ) in commercial buildings and on quantifying the impacts of build-
ing ventilation and IEQ on health and performance. He has more than 30
years of experience in research on the interrelated issues of building energy
performance, ventilation, IEQ, and occupant health and performance. Mr.
Fisk is a fellow of ASHRAE and a member of the Academy of Indoor Air

APPENDIX B 131
Sciences, and he serves as an associate editor of the journal Indoor Air.

He is an author of approximately 115 refereed archival journal articles or
book chapters. He has B.S. and M.S. degrees in mechanical engineering.
Mr. Fisk was a member of the Institute of Medicine Committee on Damp
Indoor Spaces and Health and the Committee on the Assessment of Asthma
and Indoor Air Quality.
George Gray, Ph.D., is a professor of environmental and occupational health

at the Milken Institute School of Public Health at the George Washington
University. Dr. Gray’s primary research interests are risk characterization,
risk communication, and the role of science in policy making. Particular
areas of emphasis include the role of risk analysis in sustainability deci-
sions, characterizing the risks of sparsely tested chemicals, and improving
the use of scientific information in regulatory decisions. Earlier, he served
as assistant administrator for the Office of Research and Development at
the U.S. Environmental Protection Agency (EPA) and as the agency science
advisor, promoting scientific excellence in EPA research, advocating for the
continuing evolution of the agency’s approach to analysis, and encourag-
ing programs that provide academic research to support EPA’s mission. His
areas of focus included nanotechnology, ecosystem research, the influence
of toxicology advances on testing and risk assessment, and sustainability.
Dr. Gray has his M.S. in toxicology and Ph.D. from the University of Roch-
ester School of Medicine and Dentistry.
Sergey A. Grinshpun, Ph.D., is a professor in the Department of Environ-

mental Health and the director of the Center for Health-Related Aerosol
Studies at the University of Cincinnati College of Medicine. He has been
involved in experimental and theoretical research on aerosol sampling,
analysis, real-time detection, and characterization. At the University of
Cincinnati since 1991, he has been engaged in the laboratory and field
studies of aerosol transport in indoor and outdoor environments, aerosol
exposure assessment, and the development and evaluation of respiratory
protection and indoor air purification techniques with a focus on bio-
logical aerosols. He is also extensively engaged in the bio-defense and
counter-terrorism research. Dr. Grinshpun’s program has been supported
by government agencies and international organizations as well as major
industries. He has served on panels convened by the National Academies of
Sciences, Engineering, and Medicine; the Council of Canadian Academies;
and several federal agencies. He has also served on the editorial boards of
eight scientific journals. Dr. Grinshpun received his M.S. degree in physics
in 1982 and Ph.D. degree in thermophysics (aerosol science) in 1987 from
Odessa University in Ukraine.

William K. Hallman, Ph.D., is a professor in and the chair of the Depart-

ment of Human Ecology and the former director of the Food Policy Insti-
tute at Rutgers, the State University of New Jersey. He holds a B.S. (biology,
psychology) from Juniata College and a Ph.D. in experimental psychology
from the University of South Carolina. He is a member of the graduate
faculties of psychology, nutritional sciences, and planning and public policy
at Rutgers. An expert in risk perception and risk communication, he has
written extensively on food safety, food security, and public perceptions of
controversial issues concerning food, technology, health, and the environ-
ment. Dr. Hallman has served as a member of several National Academies’
committees focused on food safety and as the chair of the Risk Communica-
tion Advisory Committee of the U.S. Food and Drug Administration, and
he recently co-authored a handbook on risk communication applied to food
safety for the Food and Agriculture Organization of the United Nations
and the World Health Organization. He currently serves on the executive
committee of the Risk Communication Specialty Group of the Society for
Risk Communication and as a member of the National Academies’ ad hoc
Committee on the Science of Science Communication.
Roy Harrison, Ph.D., D.Sc., is the Queen Elizabeth II Birmingham Cente-

nary Professor of Environmental Health at the University of Birmingham’s
School of Geography, Earth, and Environmental Sciences. Dr. Harrison
started his academic career as a chemist and then undertook postdoc-
toral work at Imperial College in the Department of Civil Engineering,
working on air pollution by heavy metals. He moved to the University of
Birmingham in 1991 to take up the newly created post of Queen Elizabeth II
Birmingham Centenary Professor of Environmental Health, becoming the
director of the Institute of Public and Environmental Health and the head
of the Division of Environmental Health and Risk Management. He has
served as the chair of the Quality of Urban Air Review Group for the
Department of Environment and of the Airborne Particles Expert Group
for the Department of Environment, Transport and the Regions, and he
was subsequently a member of the Department for Environment, Food &
Rural Affairs (DEFRA) Science Advisory Council. He is a member of the
Department of Health Committee on the Medical Effects of Air Pollutants,
the DEFRA Air Quality Expert Group, and the Department of Health Com-
mittee on Toxicity. He has advised the World Health Organization on both
the 2005 update of the Air Quality Guidelines and the 2010 Guidelines for
Indoor Air Quality. He has both his Ph.D. and D.Sc. from the University
of Birmingham.
Lynn M. Hildemann, Ph.D., is a professor of civil and environmental engi-

neering at Stanford University, where she has also served as an associate

APPENDIX B 133
department chair, chaired the University Committee on Judicial Affairs, and

been elected (twice) to the University Faculty Senate. Her current research
areas include indoor sources of particulate matter, the factors affecting their
dispersion within and between rooms, and assessment of human exposure
to particulate toxins and airborne allergens indoors. She has served on
advisory committees for the Bay Area Air Quality Management District and
the California Air Resources Board and as an associate editor for Environ-
mental Science & Technology and Aerosol Science and Technology. She is
currently on the advisory board for Environmental Science & Technology.
Her honors include Young Investigator Awards from the National Science
Foundation and the Office of Naval Research, the Kenneth T. Whitby
Award from the American Association for Aerosol Research, and Stanford’s
Gores Award for Teaching Excellence (2013); she also was a co-recipient
of Atmospheric Environment’s Haagen-Smit Outstanding Paper Award
(2001). Professor Hildemann received her M.S. and Ph.D. degrees in envi-
ronmental engineering science from the California Institute of Technology.
Lee Ann Kahlor, Ph.D., is an associate professor in the Stan Richards

School of Advertising at The University of Texas at Austin. Her primary
research interest is in health and environmental risk communication with
an emphasis on information seeking and processing. A secondary interest
is in cultural and racial norms related to health behaviors and message
processing. Her work has been funded by the National Science Founda-
tion, the Alfred P. Sloan Foundation, the State of Texas, and the St. David’s
Center for Health Promotion and Disease Prevention Research. She has
won awards from the International Communication Association and the
Association for Education in Journalism and Mass Communication for her
research on science communication and television viewing, and recently,
she was awarded her college’s highest honor for undergraduate teaching.
She is also her school’s minority liaison, working extensively with students
from disadvantaged backgrounds. Prior to entering academia Dr. Kahlor
worked in journalism as a freelance writer and as communication officer for
a Robert Wood Johnson Foundation program office. Dr. Kahlor earned an
M.A. in journalism from Marquette University and a Ph.D. in mass com-
munication from University of Wisconsin–Madison.
Glenn Morrison, Ph.D., is a professor of civil, architectural, and envi-

ronmental engineering at Missouri University of Science and Technology
(S&T). He joined Missouri S&T in 2001 and has been a professor since
2013. He is currently the president of the International Society of Indoor
Air Quality and Climate (ISIAQ) and an associate editor for Indoor Air.
Dr. Morrison teaches courses in environmental engineering and studies air
pollution, primarily in indoor environments. His research interests include

indoor air pollution, human exposure to air pollution, building science,

indoor air and surface chemistry. He received his B.S. in chemical engi-
neering from the University of California, San Diego, in 1988 and worked
for 6 years as a chemical engineer for Catalytica. He received his M.S.
and Ph.D. in environmental engineering from the University of California,
Berkeley, and then studied atmospheric chemistry at the National Oceanic
and Atmospheric Administration (NOAA) in Boulder, Colorado, before
joining Missouri S&T.
David Rich, Sc.D., M.P.H., is an associate professor in the Department of

Public Health Sciences and in the Department of Environmental Medicine,
and the associate director of the Center for Energy and Environment at the
University of Rochester Medical Center. Dr. Rich’s research interests focus
on the cardiovascular, respiratory, and reproductive health effects of expo-
sures to environmental agents such as ambient air pollution, phthalates,
bisphenol A, and perchlorate as well as controlled exposures to ozone and
ultrafine particles. He is an environmental epidemiologist whose research is
directed at understanding not only if specific environmental agents impact
health, but also by what mechanism and in what potentially suscepti-
ble subgroup of the population. He also examines the utility of different
methodological approaches to address these environmental epidemiology
research questions. He received his Sc.D. in epidemiology and environmen-
tal health from Harvard T.H. Chan School of Public Health and his M.P.H.
in epidemiology and quantitative methods from the Rutgers University
(formerly University of Medicine and Dentistry of New Jersey) School of
Public Health.
David Rowson, M.S., is the director of the Indoor Environments Division at

the U.S. Environmental Protection Agency (EPA). During his approximately
30-year career at EPA, Mr. Rowson has led several important public health
initiatives, including initiatives on radon, healthy schools, and asthma and
international programs on indoor air. Mr. Rowson is an alumnus of the
University of Virginia where he earned his undergraduate and graduate
degrees in environmental sciences and meteorology. He also worked in
state-level water pollution control programs prior to joining EPA.
Jeffrey Siegel, Ph.D., is a professor of civil engineering at the University of

Toronto and a member of the university’s Building Engineering Research
Group. His research interests including healthy and sustainable buildings,
ventilation and indoor air quality in residential and commercial build-
ings, control of indoor particulate matter, secondary impacts of control
technologies and strategies, aerosol dynamics in indoor environments, and
HVAC systems. Dr. Siegel is an active member of the International Society

APPENDIX B 135
of Indoor Air Quality and Climate, ASHRAE, and other organizations. He

teaches courses in indoor air quality, sustainable buildings, and sustainable
energy systems. Prior to his position at the University of Toronto, Dr. Siegel
was an associate professor at The University of Texas. He holds an M.S.
and Ph.D. in mechanical engineering from the University of California,
Berkeley.
Brett C. Singer, Ph.D., is a staff scientist and the group leader of indoor
environment in the Energy Analysis and Environmental Impacts Division
of Lawrence Berkeley National Laboratory. He is also a principal investiga-
tor in the Whole Building Systems Group in the Building Technologies and
Urban Systems Division. Dr. Singer conceives and leads research projects
related to air pollutant emissions and physical-chemical processes in both
outdoor and indoor environments, aiming to understand real-world pro-
cesses and systems that affect air pollutant exposures. The recent focus of
Dr. Singer’s work has been indoor environmental quality and risk reduc-
tion in high performance homes, with the goal of accelerating adoption of
indoor air quality, comfort, durability and sustainability measures into new
homes and retrofits of existing homes. Key focus areas of this work are low-
energy systems for filtration, smart ventilation, and mitigation approaches
to indoor pollutant sources including cooking. Dr. Singer co-developed the
population impact assessment modeling framework (PIAMF). He holds
a Ph.D. in civil and environmental engineering from the University of
California, Berkeley.
Brent Stephens, Ph.D., is an assistant professor of architectural engineer-

ing at Illinois Institute of Technology (IIT). He is an expert in the fate and
transport of indoor pollutants, building energy and environmental mea-
surements, HVAC filtration, human exposure assessment, building energy
simulation, and energy efficient building design. Dr. Stephens runs the Built
Environment Research Group at IIT, which consists of undergraduate stu-
dents, graduate students, and postdoctoral researchers conducting research
on energy efficiency and indoor air quality in buildings. His recent research
projects include improving and applying methods to measure the infiltra-
tion of outdoor particulate matter and reactive gases into homes; measuring
gas and particle emissions from desktop three-dimensional printers and
evaluating emission control devices; measuring the in-situ particle removal
efficiency of HVAC filters in real environments; developing a suite of inex-
pensive, open source devices based on the Arduino platform for measuring
and recording long-term indoor environmental and building operational
data; and characterizing the energy and air quality impacts of higher-
efficiency HVAC filters in central residential air-conditioning systems. Dr.

Stephens holds a Ph.D. in civil engineering and an M.S.E. in environmental

and water resources engineering from The University of Texas at Austin.
Barbara Turpin, Ph.D., is a professor of environmental sciences and engi-

neering at the University of North Carolina Gillings School of Global Public
Health. Dr. Turpin’s research is focused on revealing fundamental processes
needed to accurately predict human exposures and the effects of airborne
particles from precursor emissions. She is best known for her work on the
formation of organic particulate matter through aqueous chemistry (for
example, in clouds), organic sampling artifacts, and modification of the
ambient air pollution mix with outdoor-to-indoor transport. Her work
seeks to facilitate communication among atmospheric, exposure, and health
scientists with the ultimate goal of effective public health protection. She is
an associate editor of Environmental Science and Technology and a fellow
of the American Geophysical Union, American Association for Aerosol Sci-
ence, and American Association for the Advancement of Science. Dr. Turpin
earned a B.S. in engineering and applied science with a focus in mechani-
cal/environmental engineering research from the California Institute of
Technology and a Ph.D. in environmental science and engineering from the
Oregon Health & Science University.
Marc G. Weisskopf, Ph.D., Sc.D., is an associate professor of environ-

mental and occupational epidemiology at Harvard’s T.H. Chan School of
Public Health. His research is focused on how environmental factors affect
the nervous system as well as the epidemiology of neurologic disorders.
Current areas of work include how environmental exposures relate to
autism spectrum disorders; mental health; cognitive function/Alzheimer’s
disease; Parkinson’s disease; and amyotrophic lateral sclerosis (ALS). Some
examples of his current work include exploring how exposure to toxicants
(for example, lead, manganese, and air pollution) affect cognitive function
and psychiatric symptoms, how air pollution and other toxicants relate to
autism spectrum disorder, and how formaldehyde and lead exposure relate
to the development of ALS. Dr. Weisskopf received his Ph.D. in neurosci-
ence from the University of California, San Francisco (1994), and his Sc.D.
in epidemiology from the Harvard School of Public Health in 2006. He
joined the school’s faculty in 2007 and is a faculty member of both the
Department of Environmental Health and the Department of Epidemiology.
Charles Weschler, Ph.D., is an adjunct professor in the Environmental

and Occupational Health Sciences Institute (EOHSI) at Rutgers, the State
University of New Jersey, and a visiting professor at the Technical Uni-
versity of Denmark and Tsinghua University (China). His research areas
include chemicals present in indoor air, their sources and their fate; factors

APPENDIX B 137
that influence the concentrations, transport, and surface accumulations

of indoor pollutants; human exposure to these pollutants, including the
contribution of indoor pollutant exposures to total pollutant exposures
and the consequent health effects; chemical reactions among indoor pol-
lutants, with an emphasis on ozone-initiated chemistry, the production of
secondary organic aerosols and ozone reactions with skin oils; semi-volatile
organic compounds (SVOCs); and gas/particle and gas/surface partitioning
of SVOCs indoors. He served as a researcher at Bell Laboratories and its
successor institutions before accepting positions at EOHSI and the Inter-
national Centre for Indoor Environment and Energy, Technical University
of Denmark. Dr. Weschler has served as a member of several National
Academies’ committees and from 1999 to 2005 was a member of the
U.S. Environmental Protection Agency’s Science Advisory Board. He is an
elected member of the International Academy of Indoor Air Sciences and
has received the Pettenkofer Award, its highest honor. Dr. Weschler earned
his Ph.D. in chemistry from the University of Chicago.


Appendix C
Biographical Information:
Planning Committee and Staff
PLANNING COMMITTEE
William Nazaroff, Ph.D. (Chair), is the Daniel Tellep Distinguished Profes-
sor of Engineering in the Department of Civil and Environmental Engineer-
ing at the University of California, Berkeley. Dr. Nazaroff’s research focuses
on the physics and chemistry of air pollutants in proximity to people,
especially in indoor environments. His research also involves the domain of
exposure science, stressing the development and application of methods to
better understand mechanistically the relationship between emission sources
and human exposure to pollutants. Dr. Nazaroff is the editor-in-chief of
the journal Indoor Air. He is the former president of the Academy of Fel-
lows in the International Society of Indoor Air Quality and Climate, and
also served as president of the American Association for Aerosol Research.
Dr. Nazaroff received his master’s in electrical engineering and computer
science from the University of California, Berkeley, and holds a Ph.D. in
environmental engineering sciences from California Institute of Technology.
He is co-author of Environmental Engineering Science and has served on
the National Academies’ Committee on the Effect of Climate Change on
Indoor Air Quality and Public Health (2011) and the Committee on Air
Quality in Passenger Cabins of Commercial Aircraft (2001).
Terry Brennan, M.S., is a building scientist, educator, and the president

of the consulting firm Camroden Associates, Inc. He has studied buildings
since the 1970s. Mr. Brennan has provided research, training, curriculum
development, and program support for the U.S. Environmental Protec-
139

tion Agency, building owners and managers, individual homeowners, and

several state health departments. He is a member of ASHRAE 62.2 com-
mittee on ventilation for low-rise residential buildings and the ASTM E06
Committee on the Performance of Buildings, and he chairs the Air Bar-
rier Association of America Whole Building Testing Committee (ASTM
WK35913 Collaboration New Standard—Whole Building Enclosure Air
Tightness Compliance). Mr. Brennan served as a consultant to the National
Academies’ Committee on Damp Indoor Spaces and Health and presented
testimony to the Committee on the Effect of Climate Change on Indoor Air
Quality and Public Health. He holds a master’s degree in environmental
studies from Antioch–New England Graduate School.
Richard Corsi, Ph.D., P.E., is the chair and ECH Bantel Professor of
Practice in the Department of Civil, Architectural, and Environmental
Engineering at The University of Texas (UT) at Austin. Dr. Corsi’s gen-
eral areas of expertise include the sources, fate, human exposure to, and
control of indoor air pollution. His research foci are on homogeneous
and heterogeneous chemistry that occur indoors, the novel use of build-
ing materials to sequester indoor chemistry, and links between building
energy use and indoor air quality. He has been honored as a Distinguished
Alumnus of Humboldt State University and of the College of Engineering
at the University of California, Davis, and he has been elected to the UT
Academy of Distinguished Teachers. His work has been featured in the
media, from the CBC (Canada) television series The Nature of Things,
to The Economist, Business Week, and National Geographic. Dr. Corsi
received his M.S. and Ph.D. degrees in civil engineering from the Univer-
sity of California, Davis.
Howard Kipen, M.D., M.P.H., is a professor in the Environmental &

Occupational Health Department of the Rutgers School of Public Health.
He is also the director of the Clinical Research and Occupational Medicine
Division of the Environmental & Occupational Health Sciences Institute at
Rutgers University. Dr. Kipen’s research focuses on clinical and epidemio-
logical studies of the health effects of ambient air pollution. He received his
M.D. from the University of California, San Francisco, and holds an M.P.H.
from Columbia University. He is the chair of NASA Human Research
Program’s Advanced Environmental Health/Advanced Food Technology
Standing Review Panel; a governor’s appointee of the Public Employees
Occupational Safety and Health Review Commission, New Jersey Depart-
ment of Labor; and a member of the Public Health Scientific Advisory
Board, New Jersey Department of Environmental Protection. He has served
on several committees of the National Academies of Sciences, Engineering,
and Medicine.

APPENDIX C 141
Tiina Reponen, Ph.D., is a professor in the Department of Environmental

Health at the University of Cincinnati, College of Medicine. Dr. Reponen
is also director of the National Institute for Occupation Safety and Health–
funded University of Cincinnati Education and Research Center, which
includes graduate programs related to occupational health from three col-
leges: medicine, nursing, and applied science and engineering. She is also
a visiting professor at the University of Eastern Finland and a recipient of
Finland Distinguished Professor award. Dr. Reponen is an editor for the
journal Aerosol Science and Technology, an associate editor for Indoor
Air, and a member of the editorial advisory board of Science of the Total
Environment. Dr. Reponen received both her M.S. and her Ph.D. from the
University of Kuopio, Finland. She has served on the board of directors of
the American Association of Aerosol Research and the International Society
of Indoor Air Quality, of which she is a fellow.
NATIONAL ACADEMIES OF SCIENCES,

ENGINEERING, AND MEDICINE STAFF
David A. Butler, Ph.D., is a scholar in and the director of the Medical
Follow-up Agency in the Health and Medicine Division of the National
Academies of Sciences, Engineering, and Medicine. He received his B.S.
and M.S. in engineering from the University of Rochester and his Ph.D.
in public policy analysis from Carnegie Mellon University. Before join-
ing the Academies, Dr. Butler served as an analyst for the U.S. Congress
Office of Technology Assessment, was a research associate in the Depart-
ment of Environmental Health of the Harvard School of Public Health,
and performed research at Harvard’s Kennedy School of Government.
He has directed several Academies studies on environmental health and
risk assessment topics, including ones that produced Climate Change, the
Indoor Environment, and Health; Damp Indoor Spaces and Health; Clear-
ing the Air: Asthma and Indoor Air Exposures; and the series Character-
izing the Exposure of Veterans to Agent Orange and Other Herbicides
Used in Vietnam. Dr. Butler was also a co-editor of Systems Engineering to
Improve Traumatic Brain Injury Care in the Military Health System. He
was awarded the Cecil Award, the highest distinction for a staff member
of the Institute of Medicine.
Guru Madhavan, Ph.D., is a senior program officer with the Board on

Population Health and Public Health Practice of the National Academies
of Sciences, Engineering, and Medicine. He is a co-developer of SMART
Vaccines—a novel multi-stakeholder software tool to help prioritize new
vaccine development. Dr. Madhavan received his M.S. and Ph.D. in bio-
medical engineering and an M.B.A. from the State University of New

York. He has worked in the medical device industry as a research scientist

developing cardiac surgical catheters for ablation therapy and has been a
strategic consultant for technology startup firms and nonprofit organiza-
tions. Dr. Madhavan is a vice-president of IEEE-USA and was a founding
member of the Global Young Academy. Among numerous honors, he has
been named as a distinguished young scientist by the World Economic
Forum. Dr. Madhavan has also received the Innovator Award and the Cecil
Award from the presidents of the National Academies of Sciences, Engineer-
ing, and Medicine.
Anna Martin, B.A., is a senior program assistant in the Board on Popu-

lation Health and Public Health Practice of the National Academies of
Sciences, Engineering, and Medicine. She has worked on three consensus
studies at the Academies: Community Based Solutions to Promote Health
Equity in the United States; the Public Health Impact of Raising the Mini-
mum Age for Purchasing Tobacco Products; and the Assessment of Agent-
Based Models to Inform Tobacco Product Regulation. She also staffs the
Roundtable on the Promotion of Health Equity and the Elimination of
Health Disparities. Prior to joining the Academies, Ms. Martin worked at
the National Museum of Women in the Arts. She received a B.A. in art his-
tory and studio art from McDaniel College.
Rose Marie Martinez, Sc.D., is the senior director of the Board on Popula-
tion Health and Public Health Practice in the Health and Medicine Divi-
sion of the National Academies of Sciences, Engineering, and Medicine.
Under her leadership, the board has examined such topics as the safety
of childhood vaccines, pandemic influenza preparedness, the revival of
civilian immunization against smallpox, the health effect of environmental
exposures, the capacity of governmental public health to respond to health
crises, systems for evaluating and ensuring drug safety post-marketing,
the soundness and ethical conduct of clinical trials to reduce mother-to-
child transmission of HIV/AIDS, and chronic disease prevention. Prior
to joining the Academies, Dr. Martinez was a senior health researcher at
Mathematica Policy Research, where she conducted research on the impact
of health system change on the public health infrastructure, access to care
for vulnerable populations, managed care, and the health care workforce.
Dr. Martinez is a former assistant director for health financing and policy
with the U.S. General Accounting Office, where she directed evaluations
and policy analysis in the area of national and public health issues. Her
experience also includes directing research studies for the Regional Health
Ministry of Madrid, Spain. Dr. Martinez received her Sc.D. from the Johns
Hopkins University School of Hygiene and Public Health. She is also a
recipient of the Cecil Award.

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THE NATIONAL ACADEMIES PRESS

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Health Risks of Indoor Exposure to Particulate Matter:

158 pages | 6 x 9 | PAPERBACK

– Access to free PDF downloads of thousands of scientiﬁc reports

Copyright © National Academy of Sciences. All rights reserved.

David A. Butler, Guru Madhavan, and Joe Alper, Rapporteurs

Board on Population Health and Public Health Practice

Health and Medicine Division

Copyright © National Academy of Sciences. All rights reserved.

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

International Standard Book Number-13: 978-0-309-44362-3

Copyright 2016 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine.

Copyright © National Academy of Sciences. All rights reserved.

The National Academy of Sciences was established in 1863 by an Act of Congress,

The National Academy of Medicine (formerly the Institute of Medicine) was

Copyright © National Academy of Sciences. All rights reserved.

Copyright © National Academy of Sciences. All rights reserved.

PLANNING COMMITTEE ON THE HEALTH RISKS OF INDOOR

WILLIAM NAZAROFF (Chair), Daniel Tellep Distinguished Professor,

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees

Copyright © National Academy of Sciences. All rights reserved.

Copyright © National Academy of Sciences. All rights reserved.

George Gray, George Washington University

Although the reviewers listed above have provided many constructive

Copyright © National Academy of Sciences. All rights reserved.

Copyright © National Academy of Sciences. All rights reserved.

ACRONYMS AND ABBREVIATIONS xv

2 SOURCES OF INDOOR PARTICULATE MATTER 7

3 PARTICLE DYNAMICS AND CHEMISTRY 25

4 CHARACTERIZING INDOOR EXPOSURE LEVELS 41

Copyright © National Academy of Sciences. All rights reserved.

Socioeconomic Determinants of Indoor PM Exposure, 51

6 DISCUSSION AND SUMMARY OF DAY 1 73

7 POTENTIAL HEALTH CONCERNS 77

8 INTERVENTIONS AND RISK COMMUNICATION 93

Copyright © National Academy of Sciences. All rights reserved.

Figures and Tables

3-1 The location and effectiveness of portable air cleaners in removing

Copyright © National Academy of Sciences. All rights reserved.

xii FIGURES AND TABLES

3-3 Decreasing efficiency of an air filter over time, 29

4-1 Indoor and outdoor PM2.5 concentrations and compositions from

5-1 Particle removal effectiveness as a function of filter efficiency, 61

7-1 Global public health burdens attributable to 20 leading risk factors

Copyright © National Academy of Sciences. All rights reserved.

FIGURES AND TABLES xiii

8-1 Risk perception factors influencing public concern, 95

4-1 Drivers of Exposure Disparities in Indoor Environments, 52

5-1 Characteristics of Continuously Operating HVAC and High-

Copyright © National Academy of Sciences. All rights reserved.

Copyright © National Academy of Sciences. All rights reserved.

Acronyms and Abbreviations

AER air exchange rate

EPA U.S. Environmental Protection Agency

Finf infiltration factor

HEPA high-efficiency particulate air/arrestor

IAQ indoor air quality