Self-reported health impacts of do-it-yourself air cleaner use in a smoke-impacted community.

Background: Smoke exposure from wildfires or residential wood burning for heat is a public health problem for many communities. Do-It-Yourself (DIY) portable air cleaners (PACs) are promoted as affordable alternatives to commercial PACs, but evidence of their effect on health outcomes is limited. Objective: Pilot test an evaluation of the effect of DIY PAC usage on self-reported symptoms, and investigate barriers and facilitators of PAC use, among members of a tribal community that routinely experiences elevated concentrations of fine particulate matter (PM2.5) from smoke. Methods: We conducted studies in Fall 2021 ("wildfire study"; N = 10) and Winter 2022 ("wood stove study"; N = 17). Each study included four sequential one-to-two-week phases: 1) initial, 2) DIY PAC usage ≥8 h/day, 3) commercial PAC usage ≥8 h/day, and 4) air sensor with visual display and optional PAC use. We continuously monitored PAC usage and indoor/outdoor PM2.5 concentrations in homes. Concluding each phase, we conducted phone surveys about participants' symptoms, perceptions, and behaviors. We analyzed symptoms associated with PAC usage and conducted an analysis of indoor PM2.5 concentrations as a mediating pathway using mixed effects multivariate linear regression. We categorized perceptions related to PACs into barriers and facilitators of use. Results: No association was observed between PAC usage and symptoms, and the mediation analysis did not indicate that small observed trends were attributable to changes in indoor PM2.5 concentrations. Small sample sizes hindered the ability to draw conclusions regarding the presence or absence of causal associations. DIY PAC usage was low; loud operating noise was a barrier to use. Discussion: This research is novel in studying health effects of DIY PACs during wildfire and wood smoke exposures. Such research is needed to inform public health guidance. Recommendations for future studies on PAC use during smoke exposure include building flexibility of intervention timing into the study design.

Wildfire smoke exposure and early childhood respiratory health: a study of prescription claims data.

Wildfire smoke is associated with short-term respiratory outcomes including asthma exacerbation in children. As investigations into developmental wildfire smoke exposure on children's longer-term respiratory health are sparse, we investigated associations between developmental wildfire smoke exposure and first use of respiratory medications. Prescription claims from IBM MarketScan Commercial Claims and Encounters database were linked with wildfire smoke plume data from NASA satellites based on Metropolitan Statistical Area (MSA). A retrospective cohort of live infants (2010-2016) born into MSAs in six western states (U.S.A.), having prescription insurance, and whose birthdate was estimable from claims data was constructed (N = 184,703); of these, gestational age was estimated for 113,154 infants. The residential MSA, gestational age, and birthdate were used to estimate average weekly smoke exposure days (smoke-day) for each developmental period: three trimesters, and two sequential 12-week periods post-birth. Medications treating respiratory tract inflammation were classified using active ingredient and mode of administration into three categories:: 'upper respiratory', 'lower respiratory', 'systemic anti-inflammatory'. To evaluate associations between wildfire smoke exposure and medication usage, Cox models associating smoke-days with first observed prescription of each medication category were adjusted for infant sex, birth-season, and birthyear with a random intercept for MSA. Smoke exposure during postnatal periods was associated with earlier first use of upper respiratory medications (1-12 weeks: hazard ratio (HR) = 1.094 per 1-day increase in average weekly smoke-day, 95%CI: (1.005,1.191); 13-24 weeks: HR = 1.108, 95%CI: (1.016,1.209)). Protective associations were observed during gestational windows for both lower respiratory and systemic anti-inflammatory medications; it is possible that these associations may be a consequence of live-birth bias. These findings suggest wildfire smoke exposure during early postnatal developmental periods impact subsequent early life respiratory health.

Assessing barriers to patient acceptance of pharmacist-provided recommendations for international travel.

OBJECTIVES: The primary objectives of this study were to determine the percentage of travel recommendations accepted by individuals serviced at a university travel health clinic and to identify barriers to travel recommendation acceptance or implementation by travelers. A secondary objective was to use details regarding the identified barriers to refine travel clinic protocols. METHODS: This cross-sectional study utilized an 11-item questionnaire, conducted via telephone from February 2018 to April 2018. The survey was administered by a pharmacist employed at the travel clinic. The following data were collected: travel itinerary, content of pharmacist provided travel recommendation(s), acceptance of pharmacist travel recommendation(s) or reason for declining the recommendation(s), patient utilization of supplemental recommendations (e.g., traveler's diarrhea treatment flowchart, over-the-counter travel items, accessing medical care abroad), perceived usefulness of travel clinic resources, and the status of patient health during travel and upon return. Data was evaluated using descriptive statistics. RESULTS: A total of 205 travelers were screened to participate in the study; 85 surveys were completed, resulting in a 41% response rate. Of 349 travel vaccination recommendations made, 242 (69%) were accepted by patients. The vaccine recommendations with the lowest acceptance were Japanese Encephalitis (18%, n = 2/11), rabies (27%, n = 15/55), and influenza (51%, n = 41/80). The top reasons for declining included cost (40%, n = 34), lack of perceived necessity (37%, n = 31), and timing (16%, n = 14). In addition, 68% reported using travel clinic advice if they became ill during travel. CONCLUSION: This study showed a positive response to recommendations provided by this travel clinic. Cost and 'lack of perceived necessity' were identified as barriers to acceptance of recommendations. Travel clinic protocols will be refined to provide further education to travelers about unfamiliar disease states that may pose an increased risk during travel, aiming to increase acceptance of pharmacist-provided recommendations.