Perceived Accuracy Around Undetectable = Untransmitable Among Sexual and Gender Minorities Using Smartphones in India.

Sexual and gender minorities (SGM) using online venues in India are usually not reached by government HIV interventions, remaining an understudied yet important population. We investigated sociodemographic characteristics, sexual behaviours along with familiarity, knowledge, and correlated factors around perceived accuracy of the Undetectable = Untransmittable (U = U) slogan. Grindr users in India completed an online, cross-sectional survey in May-June 2022. We included individuals ≥ 18 years old who reported sex with men (excluding those who were born female and or identified as cis-gender female). Associations with perceived U = U accuracy were estimated using adjusted prevalence odds ratios (aPOR) with 95% confidence intervals (95% CI). The survey was completed by 3,126 eligible participants. The median age was 28 years and most participants lived in urban areas and had graduate or postgraduate education. HIV prevalence was 3.1%. Only 14% reported familiarity with the U = U slogan and after an explanation was provided, 25% perceived it as completely accurate. This was associated with knowing their HIV status (HIV Negative aPOR 1.37 [95%CI 1.1, 1.71], HIV Positive aPOR 3.39 [95%CI 2.11, 5.46]), having heard of PrEP (aPOR1.58 [95%CI 1.29,1.92]) or have used PrEP (aPOR1.56 [95%CI 1.15, 2.12]) along with use of party drugs (aPOR1.51 [95%CI 1.0 2.10]), being in touch with NGOs (aPOR 1.61 [95%CI 1.27, 2.02], p < .001) and having attended LGBTQIA + events (aPOR1.38 [95%CI 1.1, 1.73]). SGMs in India had low familiarity and low perceived accuracy around U = U. Education about U = U and innovating new strategies to reach this hidden population could reduce stigma around HIV in India.

RESUMEN: Las minorías sexuales y de género (MSG) que utilizan sitios en línea en la India, generalmente no son alcanzadas por el gobierno a través de sus intervenciones contra el VIH aunque siguen siendo una población importante, pero poco estudiada. Se investigaron las características sociodemográficas, el comportamiento sexual y, adicionalmente, la familiaridad, el conocimiento y la percepción de exactitud sobre el eslogan Indetectable = Intransmisible (I = I). Los usuarios indios de Grindr completaron una encuesta transversal en línea entre mayo y junio del 2022. Se incluyeron a personas ≥ 18 años que informaron haber tenido relaciones sexuales con hombres (se excluyeron aquellas asignadas como mujer al nacer y que se identificaron como mujeres cisgénero). Las asociaciones con la precisión percibida de I = I se estimaron con razones de probabilidad de prevalencia ajustadas (aPR) con intervalos de confianza a 95% (IC 95%). En total, 3,126 participantes elegibles completaron la encuesta. La mediana de edad fue de 28 años, la mayoría vivían en áreas urbanas y eran graduados o posgraduados. La prevalencia del VIH fue de 3.1%. Solo 14% informó que conocía el eslogan I = I, pero incrementó a 25% después de que se proporcionó una explicación y lo percibieron como completamente exacto. Esto se asoció con conocer su estado serológico (aPR VIH negativo = 1.37 [IC 95%: 1.1, 1.71]; aPR VIH positivo = 3.39 [IC 95%: 2.11, 5.46]), tener conocimiento de la profilaxis preexposición (PrEP) (aPR = 1.58 [IC 95%: 1.29,1.92]), haber usado la PrEP (aPR = 1.56 [IC 95% 1.15, 2.12]), usado drogas con fines recreativos (aPR = 1.51 [IC 95%: 1.0, 2.10]), estar en contacto con las ONG (aPOR 1.61 [95%CI 1.27, 2.02], p < .001) y haber asistido a eventos LGBTIQA+ (aPR = 1.38 [IC 95%: 1.0, 2.10]). Las MSG en India tuvieron poco conocimiento y poca percepción de exactitud sobre el eslogan I = I. La educación sobre I = I y otras estrategias innovadoras de prevención para el VIH en esta población podría ayudar a reducir el estigma en torno a esta enfermedad en la India.

Early Adoption of an Improved Household Energy System in Urban Rwanda.

Cooking with solid fuels and inefficient cookstoves has adverse consequences for health, environment, and human well-being. Despite the promise of improved cookstoves to reduce these impacts, adoption rates are relatively low. Using a 2-wave sample of 144 households from the baseline and first midline of an ongoing 4-year randomized controlled trial in Rwanda, we analyze the drivers and associations of early adoption of a household energy intervention marketed by a private sector firm. Households sign an annual contract to purchase sustainably produced biomass pellets and lease a fan micro-gasification cookstove with verified emissions reductions in laboratory settings. Using difference-in-differences and fixed effects estimation techniques, we examine the association between take-up of the improved cooking system and household fuel expenditures, health outcomes, and time use for primary cooks. Thirty percent of households adopted the pellet and improved cookstove system. Adopting households had more assets, lower per capita total expenditures and cooking fuel expenditures, and higher per capita hygiene expenditures. Households with married household heads and female cooks were significantly more likely to adopt. Adjusting for confounders, we find significant reduction in primary cooks' systolic blood pressure, self-reported prevalence of shortness of breath, an indicator of respiratory illness, time spent cooking, and household expenditures on charcoal. Our findings have implications for marketing of future clean fuel and improved cookstove programs in urban settings or where stoves and fuel are purchased. Analysis of follow-up surveys will allow for estimation of long-term impacts of adoption of interventions involving pellets and fan micro-gasification cookstoves.

Biomass Cooking Fuels and Health Outcomes for Women in Malawi.

In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy.

Pollen concentration and asthma exacerbations in Wake County, North Carolina, 2006-2012.

Pollen has been generally linked to an increased risk for asthma exacerbation. However, the delayed effect (lag), the length of effect duration, and the association heterogeneity by pollen types have not been well characterized. Short-term associations between ambient concentration of various pollen types (tree, grass, and weed) and emergency department (ED) visits for asthma were assessed using data in Wake County, North Carolina, during 2006-2012. Distributed lag nonlinear models (DLNM) were used to characterize the associations, while adjusting for air pollutants, meteorological, and temporal factors. A strong association between same-day tree pollen and asthma ED visits was detected. This association lasted four days, with a 4-day cumulative risk ratio (RR) up to 2.10 (3500 grains/m(3) vs. 0 grains/m(3), 95% confidence interval [CI]=1.21-3.65). The associations of asthma ED visits with weed pollen and grass pollen were weak, suggestively starting from lag 2 and lasting 3 days, with the strongest association a 3-day cumulative RR of 1.08 (32 grains/m(3) vs. 0 grains/m(3), 95% CI=1.01-1.15) and 1.05 (11 grains/m(3) vs. 0 grains/m(3), 95% CI=1.00-1.11). Our results indicate that the association of ambient pollen and asthma exacerbation vary by pollen type, both quantitatively and temporally. These findings have important implications for optimizing targeted allergic disease prevention and management, and helping understand the etiology of ambient exposure-induced allergic diseases.

The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project.

BACKGROUND: A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). METHODS: This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. RESULTS: Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021. CONCLUSION: The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.

Defining emergency department asthma visits for public health surveillance, North Carolina, 2008-2009.

INTRODUCTION: When using emergency department (ED) data sets for public health surveillance, a standard approach is needed to define visits attributable to asthma. Asthma can be the first (primary) or a subsequent (2nd through 11th) diagnosis. Our study objective was to develop a definition of ED visits attributable to asthma for public health surveillance. We evaluated the effect of including visits with an asthma diagnosis in primary-only versus subsequent positions. METHODS: The study was a cross-sectional analysis of population-level ED surveillance data. Of the 114 North Carolina EDs eligible to participate in a statewide surveillance system in 2008-2009, we used data from the 111 (97%) that participated during those years. Included were all ED visits with an ICD-9-CM diagnosis code for asthma in any diagnosis position (1 through 11). We formed 11 strata based on the diagnosis position of asthma and described common chief complaint and primary diagnosis categories for each. Prevalence ratios compared each category's proportion of visits that received either asthma- or cardiac-related procedure codes. RESULTS: Respiratory diagnoses were most common in records of ED visits in which asthma was the first or second diagnosis, while primary diagnoses of injury and heart disease were more common when asthma appeared in positions 3-11. Asthma-related chief complaints and procedures were most common when asthma was the first or second diagnosis, whereas cardiac procedures were more common in records with asthma in positions 3-11. CONCLUSION: ED visits should be defined as asthma-related when asthma is in the first or second diagnosis position.

A prospective examination of asthma symptom monitoring: provider, caregiver and pediatric patient influences on peak flow meter use.

OBJECTIVE: This study examined whether provider, caregiver and child communication predicted peak flow meter (PFM) use one month later. METHODS: Five practices, 35 providers and 296 children with persistent asthma and their caregivers comprised the study sample. Audio-recorded provider-caregiver-child communication during the baseline medical visit captured discussion of the PFM; and child and caregiver baseline interviews after the medical visit collected factors associated with PFM use. Child- and caregiver-reported PFM availability and use, and observed child use of PFM were collected one-month later in the family's home. RESULTS: During the medical visit, provider communication about PFM use was infrequent (10% maximum) and child- or caregiver-initiated communication was nearly absent (0%-2%). Despite this, children demonstrated good use of the PFM one month later. Children were significantly more likely to perform at least six PFM steps correctly one month later when there was more communication about PFM during the medical visit. Few other factors predicted availability and use. CONCLUSIONS: Few providers discussed use of a PFM; observed performance was predicted by having talked about it with the child's provider. Provider communication should be targeted in future interventions to improve asthma management skills.

Social ecology of asthma: engaging stakeholders in integrating health behavior theories and practice-based evidence through systems mapping.

This article describes a process for integrating health behavior and social science theories with practice-based insights using participatory systems thinking and diagramming methods largely inspired by system dynamics methods. This integration can help close the gap between research and practice in health education and health behavior by offering a systematic approach to bring together stakeholders across multiple domains. In this process we create a diagram using constructs from multiple health behavior theories at all levels of the social ecological framework as variables in causal loop diagrams. The goal of this process is to elucidate the reciprocal relationships between explanatory factors at various levels of the social ecological framework that render so many public health problems intractable. To illustrate, we detail a theory-based, replicable process for creating a qualitative diagram to enrich understanding of caregiver and provider behavior around adherence to pediatric asthma action plans. We describe how such diagramming can serve as the foundation for translating evidence into practice to address real-world challenges. Key insights gained include recognition of the complex, multilevel factors affecting whether, and how effectively, parents/caregivers and medical providers co-create an asthma action plan, and important "feedback" dynamics at play that can support or derail ongoing collaboration. Although this article applies this method to asthma action plan adherence in children, the method and resulting diagrams are applicable and adaptable to other health behaviors requiring continuous, daily action.

Active learning by design: an undergraduate introductory public health course.

Principles of active learning were used to design and implement an introductory public health course. Students were introduced to the breadth and practice of public health through team and individual-based activities. Team assignments covered topics in epidemiology, biostatistics, health behavior, nutrition, maternal and child health, environment, and health policy. Students developed an appreciation of the population perspective through an "experience" trip and related intervention project in a public health area of their choice. Students experienced several key critical component elements of a public health undergraduate major; they explored key public health domains, experience public health practice, and integrated concepts with their assignments. In this paper, course assignments, lessons learned, and student successes are described. Given the increased growth in the undergraduate public health major, these active learning assignments may be of interest to undergraduate public health programs at both liberal arts colleges and research universities.

How often do providers discuss asthma action plans with children? Analysis of transcripts of medical visits.

OBJECTIVE: To examine how often providers discussed asthma action plans with children and their caregivers and child, clinical, and provider characteristics that were associated with those discussions. METHOD: This was a cross-sectional analysis of audio-recorded visits between 35 general pediatric providers and 260 children (8-16 years old) with asthma and their caregivers. The visits were transcribed into text. The transcripts were coded for discussions about written asthma action plans. RESULTS: Providers discussed written asthma action plans with 21.0% of children and caregivers. Providers were significantly more likely to discuss asthma action plans when the child was enrolled in Medicaid, the visit was asthma related, the visit was longer, the provider was not White, or more provider education. CONCLUSION: In our sample, providers rarely discussed action plans with children and their caregivers. Providers should discuss asthma action plans with every child with persistent asthma and their caregivers and revise them regularly.

Nitrogen dioxide and allergic sensitization in the 2005-2006 National Health and Nutrition Examination Survey.

BACKGROUND: Allergic sensitization is a risk factor for asthma and allergic diseases. The relationship between ambient air pollution and allergic sensitization is unclear. OBJECTIVE: To investigate the relationship between ambient air pollution and allergic sensitization in a nationally representative sample of the US population. METHODS: We linked annual average concentrations of nitrogen dioxide (NO2), particulate matter ≤10 µm (PM10), particulate matter ≤2.5 µm (PM2.5), and summer concentrations of ozone (O3), to allergen-specific immunoglobulin E (IgE) data for participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES). In addition to the monitor-based air pollution estimates, we used the Community Multiscale Air Quality (CMAQ) model to increase the representation of rural participants in our sample. Logistic regression with population-based sampling weights was used to calculate adjusted prevalence odds ratios per 10 ppb increase in O3 and NO2, per 10 µg/m(3) increase in PM10, and per 5 µg/m(3) increase in PM2.5 adjusting for race, gender, age, socioeconomic status, smoking, and urban/rural status. RESULTS: Using CMAQ data, increased levels of NO2 were associated with positive IgE to any (OR 1.15, 95% CI 1.04, 1.27), inhalant (OR 1.17, 95% CI 1.02, 1.33), and indoor (OR 1.16, 95% CI 1.03, 1.31) allergens. Higher PM2.5 levels were associated with positivity to indoor allergen-specific IgE (OR 1.24, 95% CI 1.13, 1.36). Effect estimates were similar using monitored data. CONCLUSIONS: Increased ambient NO2 was consistently associated with increased prevalence of allergic sensitization.

Diet and carbohydrate food knowledge of multi-ethnic women: a comparative analysis of pregnant women with and without Gestational Diabetes Mellitus.

BACKGROUND: Diet therapy is the cornerstone for the management of gestational diabetes mellitus (GDM). Carbohydrate is the primary nutrient affecting postprandial blood glucose levels. Hence, knowledge of food containing carbohydrates can assist women with GDM optimize glycemic control. Despite that, there is a paucity of research on carbohydrate-related knowledge of women with GDM. The United Arab Emirates (UAE) has one of the highest prevalence of diabetes (19.2%) in the world. This study compared diet and knowledge of carbohydrate-containing foods among pregnant women with and without GDM in the UAE. METHODS: The sample consisted of multi-ethnic women with GDM (n = 94) and a control group of healthy pregnant women (n = 90) attending prenatal clinics in three hospitals in Al Ain, UAE. Data were collected using a questionnaire and a 24-hour recall. Knowledge of food sources of carbohydrate, dietary patterns, and nutrient intakes of the two groups were compared. RESULTS: There were no significant differences in the mean knowledge score of food sources of carbohydrate between women with GDM and that of pregnant women without GDM. Similarly, there were no significant differences in energy and nutrient intakes between the two groups with the exception of percent energy from protein. Women with GDM reported significantly lower intake of fruits and fruit juices (P = 0.012) and higher consumption of milk and yogurt (P = 0.004) compared to that of women without GDM. Twenty-two percent of women with GDM indicated they never visited a dietitian for counseling while 65% reported they visited a dietitian only once or twice during the pregnancy. Predictors of carbohydrate knowledge score were perceived knowledge of diet and GDM and parity among women with GDM and parity and educational level among those without GDM. CONCLUSION: The results of the study highlight the urgent need to provide nutrition education for women with GDM in the UAE.

Hospitalizations and return visits after chronic obstructive pulmonary disease ED visits.

PURPOSE: The aim of this study was to describe population-based patterns of chronic obstructive pulmonary disease (COPD)-related emergency department (ED) visits. METHODS: We analyzed all COPD-related ED visits made by North Carolina residents 45 years or older in 2008 to 2009 using statewide surveillance system data. Return visits were identified when patients returned to the same ED within 3 or 14 days of a prior COPD-related visit. We quantify the prevalence of hospitalization and return visits by age, sex, and payment method and describe ED disposition patterns. RESULTS: Nearly half (46.3%) of the 97 511 COPD-related ED visits resulted in hospital admission. The percent of visits preceded by another COPD-related visit within 3 and 14 days was 1.6% and 6.2%, respectively. Emergency department-related hospitalizations increased with age; there were no differences by sex. Hospitalizations were less likely for uninsured, Medicare, and Medicaid visits than for privately insured visits. In contrast, 3- and 14-day return visits were more likely to be uninsured, Medicare, and Medicaid visits than privately insured visits. Fourteen-day returns were more likely to be made by men. Return visits initially increased with age compared with the 45- to 49-year age group, then decreased steadily after age 65 years. When return visits were made, discharge at both visits was the most common disposition pattern. However, 33.7% of 3-day returns and 22.7% of 14-day returns were discharged at the first visit and hospitalized upon returning to the ED. CONCLUSIONS: Chronic obstructive pulmonary disease-related hospital admissions and short-term return ED visits were common and varied by age and insurance status. Chronic obstructive pulmonary disease management remains a critical area for intervention and quality improvement.

Public infrastructure disparities and the microbiological and chemical safety of drinking and surface water supplies in a community bordering a landfill.

The historically African-American Rogers-Eubanks community straddles unincorporated boundaries of two municipalities in Orange County, North Carolina, and predates a regional landfill sited along its border in 1972. Community members from the Rogers-Eubanks Neighborhood Association (RENA), concerned about deterioration of private wells and septic systems and a lack of public drinking water and sewer services, implemented a community-driven research partnership with university scientists and community-based organizations to investigate water and sewer infrastructure disparities and the safety of drinking and surface water supplies. RENA drafted memoranda of agreement with partners and trained community monitors to collect data (inventory households, map water and sewer infrastructure, administer household water and sewer infrastructure surveys, and collect drinking and surface water samples). Respondents to the surveys reported pervasive signs of well vulnerability (100%) and septic system failure (68%). Each 100-m increase in distance from the landfill was associated with a 600 most probable number/100 mL decrease in enterococci concentrations in surface water (95% confidence interval = -1106, -93). Pervasive private household water and sewer infrastructure failures and poor water quality were identified in this community bordering a regional landfill, providing evidence of a need for improved water and sanitation services.

High proportion of 6 to 18-year-old children and adolescents in the United Arab Emirates are not meeting dietary recommendations.

In the United Arab Emirates (UAE), overweight, obesity, and associated chronic diseases have recently emerged as major public health concerns among all age groups, including children and adolescents. We hypothesized that although energy needs might be met by the majority of Emirati children and adolescents, their diet quality and intakes of certain micronutrients may not meet recommendations. A cross-sectional design was used to assess dietary intakes of 253 children (6-10 years of age) and 276 adolescents (11-18 years of age) in the UAE. Trained dietitians collected a 24-hour food recall in the homes of the participants. Nutrient intakes were compared with the Dietary Reference Intakes, and food group consumption was compared with MyPyramid recommendations. Results showed that 9 to 13-year-old females consumed 206 kcal/d from candy and sweets and nearly 264 cal/d from sugar-sweetened beverages. The proportion of participants with percentage energy from saturated fat greater than the recommendation ranged from 27.6% (males 9-13 years) to 45.9% (males 6-8 years). Mean intakes of vitamins A, D, and E were lower than the Estimated Average Requirements for all the subgroups. Mean calcium intake was lower than recommendations for all age and sex subgroups. The proportions of participants whose intakes were less than the recommended number of servings from the food groups were substantial: more than 90% of each of the 6 subgroups for the milk group and 100% among 9 to 18-year-old males for vegetables. In conclusion, the results of this study indicate the need for interventions targeting 6 to 18-year-old children and adolescents in the UAE to improve their diet quality.

PROMIS Pediatric Peer Relationships Scale: development of a peer relationships item bank as part of social health measurement.

OBJECTIVE: This study's objective was to develop a measure of social health using item response theory as part of the Patient Reported Outcomes Measurement Information System (PROMIS). METHODS: After candidate items were generated from review of prior literature, focus groups, expert input, and cognitive interviews, items were administered to youth aged 8-17 as part of the PROMIS pediatric large scale testing. Exploratory and confirmatory factor analyses were used to assess dimensionality and to identify instances of local dependence. Items that met the unidimensionality criteria were subsequently calibrated using Samejima's Graded Response Model. Differential item functioning was examined by gender and age. RESULTS: The sample included 3,048 youth who completed the questionnaire (51.8% female, 60% white, and 22.7% with chronic illness). The initial conceptualization of social function and sociability did not yield unidimensional item banks. Rather, factor analysis revealed dimensions contrasting peer relationships and adult relationships. The analysis also identified dimensions formed by responses to positively versus negatively worded items. The resulting 15-item bank measures quality of peer relationships and has strong psychometric characteristics as a full bank or an 8-item short form. CONCLUSIONS: The PROMIS pediatric peer relationships scale demonstrates good psychometric characteristics and addresses an important aspect of child health.

The relationship between patient-provider communication and quality of life for children with asthma and their caregivers.

OBJECTIVE: This study examined whether patient-provider communication is associated with asthma-related quality of life (QOL) and asthma outcomes among children with asthma and their caregivers. METHODS: Children ages 8-16 years with asthma and their caregivers (n = 296) were recruited at five pediatric practices in North Carolina. Children and caregivers reported demographic and clinical characteristics immediately after an audio-taped medical visit with their health care provider. During a home visit that took place 1 month after the medical visit, children and caregivers reported asthma-related QOL, and caregivers reported child asthma outcomes, including asthma symptom days and missed school days. Generalized estimating equations were used to determine whether patient-provider communication during the medical visit was associated with child and caregiver QOL and child asthma outcomes 1 month later. RESULTS: On average, providers asked caregivers 4.5 questions and asked children 3 questions per visit, whereas caregivers and children asked less than 1 question per visit. Providers asked children more asthma-related questions, caregivers reported better QOL and fewer asthma symptom days 1 month later. Children and caregivers with higher asthma-management self-efficacy at the office visit reported better QOL 1 month later. CONCLUSIONS: Mirroring national guideline recommendations, our results suggest that providers should ask children about their asthma during medical visits. Future longitudinal studies should conduct mediation analyses to determine whether asking children asthma-related questions during medical visits increases children's asthma management self-efficacy and ultimately improve outcomes, such as QOL, health care utilization, symptom days and missed school days.

Hazard assessment of United Arab Emirates (UAE) incense smoke.

Incense burning inside the home, a common practice in Arabian Gulf countries, has been recognized as a potentially modifiable source of indoor air pollution. To better understand potential adverse effects of incense burning in exposed individuals, we conducted a hazard assessment of incense smoke exposure. The goals of this study were first to characterize the particles and gases emitted from Arabian incense over time when burned, and secondly to examine in vitro human lung cells responses to incense smoke. Two types of incense (from the United Arab Emirates) were burned in a specially designed indoor environmental chamber (22 m(3)) to simulate the smoke concentration in a typical living room and the chamber air was analyzed. Both particulate (PM) concentrations and sizes were measured, as were gases carbon monoxide (CO), sulfur dioxide (SO2), oxides of nitrogen (NOx), formaldehyde (HCHO), and carbonyls. During the burn, peak concentrations were recorded for PM (1.42 mg/m(3)), CO (122 pm), NOx (0.3 ppm), and HCHO (85 ppb) along with pentanal (71.9 µg/m(3)), glyoxal (84.8 µg/m(3)), and several other carbonyls. Particle sizes ranged from 20 to 300 nm with count median diameters ranging from 65 to 92 nm depending on time post burn-out. PM, CO, and NOx time-weighted averages exceeded current government regulation values and emissions seen previously from environmental tobacco smoke. Charcoal emissions were the main contributor to both the high CO and NOx concentrations. A significant cell inflammatory response was observed in response to smoke components formed from incense burning. Our hazard evaluation suggests that incense burning contributes to indoor air pollution and could be harmful to human health.