Indoor exposure to phthalates and its burden of disease in China.

China's profoundly rapid modernization in the past two decades has resulted in dramatic changes in indoor environmental exposures. Among these changes, exposure to phthalates has attracted increasing attention. We aimed to characterize indoor phthalate exposure and to estimate the disease burden attributable to indoor phthalate pollution from 2000 to 2017 in China. We integrated the national exposure level of indoor phthalates from literature through systematic review and Monte Carlo simulation. Dose-response relationships between phthalate exposure and health outcomes were obtained by systematic review and meta-analysis. Based on existing models for assessing probabilities of causation and a comprehensive review of available data, we calculated the disability-adjusted life years (DALYs) among the general Chinese population resulting from exposure to indoor phthalate pollution. We found that DnBP, DiBP, and DEHP were the most abundant phthalates in indoor environments of residences, offices, and schools with medians of national dust phase concentration from 74.5 µg/g to 96.3 µg/g, 39.6 µg/g to 162.5 µg/g, 634.2 µg/g to 1,394.7 µg/g, respectively. The national equivalent exposure for children to phthalates in settled dust was higher than that of adults except for DiBP and DnOP. Dose-response relationships associated with DEP, DiBP, DnBP, BBzP, and DEHP exposures were established. Between 2000 and 2017, indoor phthalate exposure in China has led to 3.32 million DALYs per year, accounting for 0.90% of total DALYs across China. The annual DALY associated with indoor phthalate pollution in China was over 2000 people per million, which is about 2~3 times of the DALY loss due to secondhand smoke (SHS) in six European countries or the sum of the DALY loss caused by indoor radon and formaldehyde in American homes. Our study indicates a considerable socioeconomic impact of indoor phthalate exposure for a modernizing human society. This suggest the need for relevant national standard and actions to reduce indoor phthalate exposure.

Health effects of exposure to indoor volatile organic compounds from 1980 to 2017: A systematic review and meta-analysis.

Exposure to volatile organic compounds (VOCs) indoors is thought to be associated with several adverse health effects. However, we still lack concentration-response (C-R) relationships between VOC levels in civil buildings and various health outcomes. For this paper, we conducted a systematic review and meta-analysis of observational studies to summarize related associations and C-R relationships. Four databases were searched to collect all relevant studies published between January 1980 and December 2017. A total of 39 studies were identified in the systematic review, and 32 of these were included in the meta-analysis. We found that the pooled relative risk (RR) for leukemia was 1.03 (95% CI: 1.01-1.05) per 1 µg/m3 increase of benzene and 1.25 (95%CI: 1.14-1.37) per 0.1 µg/m3 increase of butadiene. The pooled RRs for asthma were 1.08 (95% CI: 1.02-1.14), 1.02 (95% CI: 1.00-1.04), and 1.04 (95% CI: 1.02-1.06) per 1 µg/m3 increase of benzene, toluene, and p-dichlorobenzene, respectively. The pooled RR for low birth weight was 1.12 (95% CI: 1.05-1.19) per 1 µg/m3 increase of benzene. Our findings provide robust evidence for associations between benzene and leukemia, asthma, and low birth weight, as well as for health effects of some other VOCs.

Indoor exposure levels and risk assessment of volatile organic compounds in residences, schools, and offices in China from 2000 to 2021: A systematic review.

The last two decades have witnessed rapid urbanization and economic growth accompanied by severe indoor air pollution of volatile organic compounds (VOCs) in China. However, indoor VOC pollution across China has not been well characterized and documented. This study is a systematic review of field measurements of eight target VOCs (benzene, toluene, xylenes, acetaldehyde, p-dichlorobenzene, butadiene, trichloroethylene, and tetrachloroethylene) in residences, offices, and schools in China from 2000 to 2021. The results show that indoor pollution of benzene, toluene, and xylenes has been more serious in China than in other countries. Spatiotemporal distribution shows lower indoor VOC levels in east and south-east regions and a declining trend from 2000 to 2021. Moving into a dwelling more than 1 year after decoration and improving ventilation could significantly reduce exposure to indoor VOCs. Reducing benzene exposure is urgently needed because it is associated with greater health risks (4.5 × 10-4 for lifetime cancer risk and 8.3 for hazard quotient) than any other VOCs. The present study enriches the database of indoor VOC levels and provides scientific evidence for improving national indoor air quality standards as well as estimating the attributable disease burden caused by VOCs in China.

Effects of Human Behavior Changes During the Coronavirus Disease 2019 (COVID-19) Pandemic on Influenza Spread in Hong Kong.

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to threaten human life worldwide. We explored how human behaviors have been influenced by the COVID-19 pandemic in Hong Kong, and how the transmission of other respiratory diseases (eg, influenza) has been influenced by human behavior. METHODS: We focused on the spread of COVID-19 and influenza infections based on the reported COVID-19 cases and influenza surveillance data and investigated the changes in human behavior due to COVID-19 based on mass transit railway data and the data from a telephone survey. We did the simulation based on a susceptible-exposed-infected-recovered (SEIR) model to assess the risk reduction of influenza transmission caused by the changes in human behavior. RESULTS: During the COVID-19 pandemic, the number of passengers fell by 52.0% compared with the same period in 2019. Residents spent 32.2% more time at home. Each person, on average, came into close contact with 17.6 and 7.1 people per day during the normal and pandemic periods, respectively. Students, workers, and older people reduced their daily number of close contacts by 83.0%, 48.1%, and 40.3%, respectively. The close contact rates in residences, workplaces, places of study, restaurants, shopping centers, markets, and public transport decreased by 8.3%, 30.8%, 66.0%, 38.5%, 48.6%, 41.0%, and 36.1%, respectively. Based on the simulation, these changes in human behavior reduced the effective reproduction number of influenza by 63.1%. CONCLUSIONS: Human behaviors were significantly influenced by the COVID-19 pandemic in Hong Kong. Close contact control contributed more than 47% to the reduction in infection risk of COVID-19.

Phthalates in Chinese vehicular environments: Source emissions, concentrations, and human exposure.

Phthalates are typical air pollutants in vehicular environment since numerous synthetic materials that might contain phthalates are widely used to fabricate vehicle interiors (e.g., seat cushions, floor mats and dashboards). Hitherto, the importance of phthalate pollution in vehicular environment is not well-recognized because people spend only a small portion (around 8%) of their time in vehicles. In this study, the mass fractions of six phthalates in nine materials commonly used in Chinese vehicles (floor mats and seat cushions) were measured. Two phthalates, di-n-butyl phthalate (DnBP) and di-2-ethylhexyl phthalate (DEHP), were identified in most materials (the other phthalates were not detected). The emission characteristics of DnBP and DEHP from these materials were further investigated. The measured emission parameters were used as input for a mass-transfer model to estimate DnBP and DEHP concentrations in cabin air. Finally, the ratios between human exposures (via inhalation and dermal absorption from the gas phase) in vehicular environment and the total exposures in typical indoor environments (e.g., residences and offices) were estimated to be up to 110% and 20% for DnBP and DEHP, respectively. Based on these results, the vehicular environment might be a considerable site for human exposure to airborne phthalates.

Formation behavior of PCDD/Fs during waste pyrolysis and incineration: Effect of temperature, calcium oxide addition, and redox atmosphere.

The clean and efficient utilization of municipal solid waste (MSW) has attracted increasing concerns in recent years. Pyrolysis of MSW is one of the promising options due to the production of high-value intermediates and the inhibition of pollutants at reducing atmosphere. Herein, the formation behavior of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) during MSW pyrolysis and incineration was experimentally investigated and compared. The influence of reaction temperature, CaO addition, and redox atmosphere on PCDD/Fs formation were compared and discussed. The results showed as the pyrolysis temperature increased, the mass concentration and international toxicity equivalence quantity of PCDD/Fs initially peaked at ∼750 °C before declining. Most of the generated PCDD/Fs were concentrated in the liquid and gaseous products, accounting for ∼90% of the total. Among liquid products, octachlorodibenzo-p-dioxin (O8CDD), 2,3,4,7,8-pentachlorodibenzofuran and 1,2,3,4,6,7,8-heptachlorodibenzofuran (H7CDF) were the most crucial mass concentration contributors, while in gas products, high-chlorinated PCDD/Fs, such as O8CDD, octachlorodibenzofuran (O8CDF) and 1,2,3,4,6,7,8-H7CDF were predominant. Compared to incineration, the formation of PCDD/Fs was 7-20 times greater than that from pyrolysis. This discrepancy can be attributed to the hydrogen-rich and oxygen-deficient atmosphere during pyrolysis, which effectively inhibited the Deacon reaction and the formation of C-Cl bonds, thereby reducing the active chlorine in the system. The addition of in-situ CaO additives also decreased the active chlorine content in the system, bolstering the inhibiting of PCDD/Fs formation during MSW pyrolysis.

The burden of disease attributable to indoor air pollutants in China from 2000 to 2017.

BACKGROUND: High-level exposure to indoor air pollutants (IAPs) and their corresponding adverse health effects have become a public concern in China in the past 10 years. However, neither national nor provincial level burden of disease attributable to multiple IAPs has been reported for China. This is the first study to estimate and rank the annual burden of disease and the financial costs attributable to targeted residential IAPs at the national and provincial level in China from 2000 to 2017. METHODS: We first did a systematic review and meta-analysis of 117 articles from 37 231 articles identified in major databases, and obtained exposure-response relationships for the candidate IAPs. The exposure levels to these IAPs were then collected by another systematic review of 1864 articles selected from 52 351 articles. After the systematic review, ten IAPs with significant and robust exposure-response relationships and sufficient exposure data were finally targeted: PM2·5, nitrogen dioxide, sulphur dioxide, ozone, carbon monoxide, radon, formaldehyde, benzene, toluene, and p-dichlorobenzene. The annual exposure levels in residences were then evaluated in all 31 provinces in mainland China continuously from 2000 to 2017, using the spatiotemporal Gaussian process regression model to analyse indoor originating IAPs, and the infiltration factor method to analyse outdoor originating IAPs. The disability-adjusted life-years (DALYs) attributable to the targeted IAPs were estimated at both national and provincial levels in China, using the population attributable fraction method. Financial costs were estimated by an adapted human capital approach. FINDINGS: From 2000 to 2017, annual DALYs attributable to the ten IAPs in mainland China decreased from 4620 (95% CI 4070-5040) to 3700 (3210-4090) per 100 000. Nevertheless, in 2017, IAPs still ranked third among all risk factors, and their DALYs and financial costs accounted for 14·1% (95% CI 12·3-15·6) of total DALYs and 3·45% (3·01-3·82) of the gross domestic product. Specifically, the rank of ten targeted IAPs in order of their contribution to DALYs in 2017 was PM2·5, carbon monoxide, radon, benzene, nitrogen dioxide, ozone, sulphur dioxide, formaldehyde, toluene, and p-dichlorobenzene. The DALYs attributable to IAPs were 9·50% higher than those attributable to outdoor air pollution in 2017. For the leading IAP, PM2·5, the DALYs attributable to indoor origins are 18·3% higher than those of outdoor origins. INTERPRETATION: DALYs attributed to IAPs in China have decreased by 20·0% over the past two decades. Even so, they are still much higher than those in the USA and European countries. This study can provide a basis for determining which IAPs to target in various indoor air quality standards and for estimating the health and economic benefits of various indoor air quality control approaches, which will help to reduce the adverse health effects of IAPs in China. FUNDING: The National Key Research and Development Program of China and the National Natural Science Foundation of China.

Identification of Phthalates from Artificial Products in Chinese Kindergarten Classrooms and the Implications for Preschool Children's Exposure Assessments.

Phthalates are typical chemical pollutants in kindergarten classrooms since numerous artificial products (e.g., polyvinyl chloride (PVC) floorings, soft polymers and plastic toys) that might contain phthalates are widely distributed in kindergarten classrooms. Although Chinese preschool children spend a considerable amount of their waking hours (>8 h/day) in kindergartens, phthalate exposure in such indoor environment has not been given much attention. In this study, the mass fractions of six phthalates in twenty-six artificial products (fifteen flat decoration materials and eleven plastic toys) commonly found in Chinese kindergarten classrooms were measured. Di-2-ethylhexyl phthalate (DEHP) was the most predominant compound in all materials. The emission characteristics of the DEHP from these materials were further investigated. The measured emission characteristics were used for predicting multi-phase DEHP concentrations in kindergarten classrooms by applying a mass transfer model. The modeled concentrations were comparable with those measured in the real environment, indicating that these products might be the major sources of DEHP in Chinese kindergarten classrooms. Preschool children's exposure to DEHP was found to be 0.42 µg/kg/day in kindergartens under baseline conditions, accounting for 18% of the total exposure to DEHP in Chinese indoor environments.

Experimental and simulated evaluations of airborne contaminant exposure in a room with a modified localized laminar airflow system.

The traditional mixing ventilation is not an energy effective approach to remove indoor air pollutants, maintain breath zone air quality, and control the airborne transmission. This study investigated the potential of a localized laminar airflow ventilation system to alleviate human exposure to pollutants. Breathing thermal manikins with sitting posture and supine posture were used to simulate the human. N2O was used as the tracer gas to simulate the indoor pollutant emission. The contaminant exposure index (εexp) and intake fraction index (IF) were used to assess the risk of human pollutant exposure for various supply air velocities given different emission source positions. Enhanced pollutant removal efficiency (Eff) (from the result) showed the qualification and desirability of the localized laminar airflow ventilation system in improving the breath zone air quality. The results showed that the CFD results could fit well with the experimental data and found out the interaction between thermal plume and supply air. The results also indicated a low εexp and IF, with over 90%, all of which were highly correlated with the supply velocity. Human's different breathing methods have little influence on the pollutant exposure so as to the location of the pollution source. This study found that localized laminar airflow ventilation system could efficiently provide fresh air to the breathing zone without sacrificing the thermal environment around human. It can be used for small region air quality control such as that in the bedroom and living room where desired air quality is favored.

Numerical modeling of ultrasonic cavitation by dividing coated microbubbles into groups.

Homogeneous cavitation models usually use an average radius to predict the dynamics of all bubbles. However, bubbles with different sizes may have quite different dynamic characteristics. In this study, the bubbles are divided into several groups by size, and the volume-weighted average radius is used to separately calculate the dynamics of each group using a modified bubble dynamics equation. In the validation part, the oscillations of bubbles with two sizes are simulated by dividing them into 2 groups. Comparing with the predictions by the Volume of Fluid (VOF) method, the bubble dynamics of each size are precisely predicted by the proposed model. Then coated microbubbles with numerous sizes are divided into several groups in equal quantity, and the influence of the group number is analyzed. For bubble oscillations at f = 0.1 MHz and 1 MHz without ruptures, the oscillation amplitude is obviously under-estimated by the 1-group model, while they are close to each other after the group number increases to 9. For bubble ruptures triggered by Gaussian pulses, the predictions are close to each other when more than 5 groups are used.

COVID-19 Vaccination Did Not Change the Personal Protective Behaviors of Healthcare Workers in China.

Personal protective behaviors of healthcare workers (HCWs) and dynamic changes in them are known to play a major role in the hospital transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, 1,499 HCWs in Chinese hospitals completed an online survey about their knowledge on SARS-CoV-2 transmission and their personal protective behaviors before and after coronavirus disease 2019 (COVID-19) vaccination. Of all the respondents, 89% were vaccinated at the time of the survey and 96% believed that the vaccine was effective or highly effective. Further, 88% of the vaccinated HCWs expressed that they would get revaccinated if the vaccination failed. Compared with HCWs with a lower education level, those with a higher education level had less fear of being infected with SARS-CoV-2 and reported a lower negative impact of the pandemic on how they treated patients. Physicians and nurses were willing to believe that short-range airborne and long-range fomite are possible transmission routes. HCWs with a higher education level had a better knowledge of COVID-19 but worse personal protective behaviors. The fact that HCWs with a longer work experience had worse personal protective behaviors showed that HCWs gradually relax their personal protective behaviors over time. Moreover, vaccination reduced the negative effects of the COVID-19 pandemic on how the HCWs treated patients. Importantly, the survey revealed that after vaccination, HCWs in China did not relax their personal protective behaviors, and it may bring a low potential risk for following waves of variant virus (e.g., delta).

Indoor polybrominated diphenyl ethers in urban China: An exposure and risk assessment based on settled dust from selected urban regions.

In this study, measurements of seven typical polybrominated diphenyl ethers (PBDEs) in indoor settled dust were summarized in selected urban regions of China. BDE-209 was the most dominant congener in settled dust (1.4-101 µg/g), with a mean contribution of 95%. Indoor exposures to PBDEs were estimated via inhalation, dust ingestion, and dermal absorption. The average daily intake of ΣPBDE was 4.9 to 19.1 ng/day/kg for all the population groups, with >80% of the total exposures from dust ingestion. Exposures in commuting environments (contributing 60%-80% of the total exposures) were higher than those in other microenvironments. The means of hazard indexes ranged from 1.66 × 10-3 to 5.26 × 10-3, which were mainly as a result of exposure to BDE-209, BDE-47, and BDE-99. The average lifetime cancer risks were from 0.03 × 10-9 to 2.37 × 10-9, which indicated the acceptable health risks resulting from indoor PBDE exposure for the Chinese population. The present study could provide valuable information that could be helpful for decision-makers, analysts and researchers to develop, implement and evaluate the effectiveness of interventions for the reduction of exposures to semi-volatile organic compounds (SVOCs) for large population groups in China.

Exposure to commonly-used phthalates and the associated health risks in indoor environment of urban China.

Rapid urbanization and modernization have increased exposures to phthalates from synthetic materials used indoors in China. However, exposure to phthalates from indoor environment and the associated health risks to the urban population have not been adequately characterized and documented. In this study, we summarized the recent measurements of five commonly-used phthalates in indoor environment in urban China and documented their distributions. Based on the activity patterns and exposure factors of Chinese population, Monte-Carlo simulation was used to derive their exposures. On average, the daily intake of all the targeted phthalates was 3.6 µg/kg/day for adults; and for children it ranged from 4.4 µg/kg/day to 8.1 µg/kg/day. For children, the total risk from exposures inside residences and offices was 32%-90% and 4%-19%, respectively. From commuting environments and other indoor environments, it was 5%-31%, and 3%-26%, respectively. For adults, the total risk from residences and offices was 26%-78% and 9%-35%. Additionally, from commuting environments and other indoor environments, it was 8%-35% and 5%-11%, respectively. The non-carcinogenic risk assessment was based on a cumulative Tolerable Daily Intake (TDIcum), with means ranging from 0.18 to 0.41, which was mainly as a result of exposure to DiBP and DnBP. The means for lifetime cancer risk resulting from DEHP exposure ranged from 0.4 × 10-6 to 2.0 × 10-6 for urban population groups. For 80% of working adults and 40%-75%% of children, their cancer risks exceeded the EPA's benchmark (1.0 × 10-6). The present study could provide important information for decision makers to reduce indoor phthalate exposures as well as the associated health risks for larger population groups in Chinese cities.

Risk assessment of inhalation exposure to VOCs in dwellings in Chongqing, China.

This paper investigated the concentrations of eight types of indoor VOCs - benzene, toluene, xylenes, butyl acetate, styrene, isopropylbenzene, undecane and formaldehyde. The tests were carried out in 50 dwellings in the main urban areas of Chongqing, China. According to the detected concentration, toluene was the most predominant among all the targeted compounds. Benzene and formaldehyde concentrations were lower than the reference levels regulated by the Chinese National Standard (GB/T 50325). Based on the activity patterns and exposure factors of adults in urban Chongqing, we used concentration data to estimate adults' inhalation exposures as well as health risks using Monte-Carlo simulations. The results indicated that the exposure doses of benzene and formaldehyde exceeded the benchmark. The highest hazard quotient (HQ) values were found in the case of formaldehyde (median = 0.293 for females and 0.292 for males) and the hazard index (HI) values were 0.326 and 0.325 for females and males, respectively. The highest lifetime cancer risk (LCR) values were found in formaldehyde (median = 7.16 × 10-5 for females; 6.56 × 10-5 for males). Formaldehyde was found to be the most important pollutant with relatively high toxic and carcinogenic risk levels, based on the exposure and health assessment. This was followed by benzene, toluene, xylenes and butyl acetate. This study can help us better understand the concentration levels of VOC contaminants in residential buildings, and help select appropriate decoration materials for buildings.

Indoor formaldehyde concentrations in urban China: Preliminary study of some important influencing factors.

The Huai River and Qingling Mountain divide (H-Q) divide China into north and south with respect to public policies for building construction and operation practises. China's building energy efficiency standard mandates that air exchange rates be 0.5h-1 north of the H-Q divide and 1h-1 south of the divide. China's heating policy allows space heating systems only north of the H-Q divide. Consequently, indoor temperature and humidity differ considerably between north and south. A theoretical model using indoor temperature, humidity, and air change rate was developed to predict indoor formaldehyde concentrations. Data for 39 cities were obtained from 42 studies. There was good agreement between the literature and modelling in a theoretical reference room. The United States Environmental Protection Agency (U.S.EPA) model was applied to estimate cancer risk from formaldehyde exposure indoors. The median indoor formaldehyde concentration for renovation ever from 2002 to 2015 in Chinese cities was 125µg/m3, which is higher than the WHO threshold, 100µg/m3. The median indoor formaldehyde concentrations in the north were higher than in the south (0.5 times higher for dwellings renovated within the past year and 0.2 times higher for renovation ever), driven by the much higher northern winter concentrations (40-1320%). The U.S.EPA model predicts that the lifetime formaldehyde related cancer risk for people living north of the H-Q divide is 1.2 times greater than for people living south. This can be partly explained by greater indoor exposure to formaldehyde for Chinese living north of the H-Q divide.