The effect of portable HEPA filter air cleaners on indoor PM2.5 concentrations and second hand tobacco smoke exposure among pregnant women in Ulaanbaatar, Mongolia: The UGAAR randomized controlled trial

Prabjit Barn; Enkhjargal Gombojav; Chimedsuren Ochir; Bayarkhuu Laagan; Bolor Beejin; Gerel Naidan; Buyantushig Boldbaatar; Jargalsaikhan Galsuren; Tsogtbaatar Byambaa; Craig Janes; Patricia A Janssen; Bruce P Lanphear; Tim K Takaro; Scott A Venners; Glenys M Webster; Weiran Yuchi; Christopher D Palmer; Patrick J Parsons; Young Man Roh; Ryan W Allen

doi:10.1016/j.scitotenv.2017.09.291

The effect of portable HEPA filter air cleaners on indoor PM_2.5 concentrations and second hand tobacco smoke exposure among pregnant women in Ulaanbaatar, Mongolia: The UGAAR randomized controlled trial

Sci Total Environ. 2018 Feb 15:615:1379-1389. doi: 10.1016/j.scitotenv.2017.09.291. Epub 2017 Oct 17.

Authors

Prabjit Barn¹, Enkhjargal Gombojav², Chimedsuren Ochir³, Bayarkhuu Laagan⁴, Bolor Beejin⁵, Gerel Naidan⁶, Buyantushig Boldbaatar⁶, Jargalsaikhan Galsuren⁶, Tsogtbaatar Byambaa⁷, Craig Janes⁸, Patricia A Janssen⁹, Bruce P Lanphear¹⁰, Tim K Takaro¹¹, Scott A Venners¹², Glenys M Webster¹³, Weiran Yuchi¹⁴, Christopher D Palmer¹⁵, Patrick J Parsons¹⁶, Young Man Roh¹⁷, Ryan W Allen¹⁸

Affiliations

¹ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada. Electronic address: pkbarn@sfu.ca.
² School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia. Electronic address: enkhjargal@mnums.edu.mn.
³ School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia. Electronic address: chimedsuren@mnums.edu.mn.
⁴ Sukhbaatar District Health Center, 11 Horoo, Tsagdaagiin Gudamj, Sukhbaatar District, Ulaanbaatar, Mongolia.
⁵ Mongolian National Center for Public Health, Olympic Street 2, Ulaanbaatar, Mongolia. Electronic address: bolor@ncph.gov.mn.
⁶ School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia.
⁷ Mongolian National Center for Public Health, Olympic Street 2, Ulaanbaatar, Mongolia. Electronic address: tsogtbaatar@ncph.gov.mn.edu.mn.
⁸ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo N2L 3G1, Canada. Electronic address: craig.janes@uwaterloo.ca.
⁹ School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver V6T 1Z3, Canada. Electronic address: patti.janssen@ubc.ca.
¹⁰ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada. Electronic address: blanphear@sfu.ca.
¹¹ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada. Electronic address: ttakaro@sfu.ca.
¹² Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada. Electronic address: scott_venners@sfu.ca.
¹³ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada. Electronic address: glenys_webster@sfu.ca.
¹⁴ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada. Electronic address: wyuchi@sfu.ca.
¹⁵ New York State Department of Health, Wadsworth Center, Albany, NY, PO Box 509, 12201, USA; School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA. Electronic address: christopher.palmer@health.ny.gov.
¹⁶ New York State Department of Health, Wadsworth Center, Albany, NY, PO Box 509, 12201, USA; School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA. Electronic address: patrick.parsons@health.ny.gov.
¹⁷ College of Health Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
¹⁸ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada. Electronic address: allenr@sfu.ca.

PMID: 29751442
DOI: 10.1016/j.scitotenv.2017.09.291

Abstract

Background: Portable HEPA filter air cleaners can reduce indoor fine particulate matter (PM_2.5), but their use has not been adequately evaluated in high pollution settings. We assessed air cleaner effectiveness in reducing indoor residential PM_2.5 and second hand smoke (SHS) exposures among non-smoking pregnant women in Ulaanbaatar, Mongolia.

Methods: We randomized 540 participants to an intervention group receiving 1 or 2 HEPA filter air cleaners or a control group receiving no air cleaners. We followed 259 intervention and 253 control participants to the end of pregnancy. We measured one-week indoor residential PM_2.5 concentrations in early (~11weeks gestation) and late (~31weeks gestation) pregnancy and collected outdoor PM_2.5 data from centrally-located government monitors. We assessed blood cadmium in late pregnancy. Hair nicotine was quantified in a subset (n=125) to evaluate blood cadmium as a biomarker of SHS exposure. We evaluated air cleaner effectiveness using mixed effects and multiple linear regression models and used stratified models and interaction terms to evaluate potential modifiers of effectiveness.

Results: The overall geometric mean (GM) one-week outdoor PM_2.5 concentration was 47.9μg/m³ (95% CI: 44.6, 51.6μg/m³), with highest concentrations in winter (118.0μg/m³; 110.4, 126.2μg/m³). One-week indoor and outdoor PM_2.5 concentrations were correlated (r=0.69). Indoor PM_2.5 concentrations were 29% (21, 37%) lower in intervention versus control apartments, with GMs of 17.3μg/m³ (15.8, 18.8μg/m³) and 24.5μg/m³ (22.2, 27.0μg/m³), respectively. Air cleaner effectiveness was greater when air cleaners were first deployed (40%; 31, 48%) than after approximately five months of use (15%; 0, 27%). Blood cadmium concentrations were 14% (4, 23%) lower among intervention participants, likely due to reduced SHS exposure.

Conclusions: Portable HEPA filter air cleaners can lower indoor PM_2.5 concentrations and SHS exposures in highly polluted settings.

Keywords: Cadmium; HEPA; Intervention; PM(2.5); RCT; SHS.

Publication types

Randomized Controlled Trial

MeSH terms

Air Filters*
Air Pollutants / analysis*
Air Pollution / prevention & control*
Air Pollution / statistics & numerical data
Air Pollution, Indoor
Female
Filtration
Humans
Maternal Exposure / prevention & control
Maternal Exposure / statistics & numerical data*
Mongolia
Pregnancy
Tobacco Smoke Pollution / analysis
Tobacco Smoke Pollution / prevention & control
Tobacco Smoke Pollution / statistics & numerical data

Substances

Air Pollutants
Tobacco Smoke Pollution