Indoor air pollution: an Italian Knowledge, Attitude and Practice (KAP) study among the general population
Keywords:
Indoor air pollution; KAP study; cross-sectional study; knowledge; attitudes; behaviorsAbstract
Background. Indoor air pollution negatively affects population health and the national health services in terms of socio-economic costs. The presence of indoor pollutants depends a lot on lifestyles.
Study design. The aim of this work is to evaluate knowledge, daily habits and the preventive behaviors in order to contrast the effects on health caused by indoor pollutants.
Methods. The study was conducted through the administration of questionnaires to the population resident in the metropolitan city of Messina (Italy), asking about sociodemographic characteristics, knowledge, daily habits and preventive behaviors.
Results. The questionnaire was filled by 894 subjects (46.8% M; 53.2% F). Regarding knowledge, 66.8% had heard of indoor air pollution and 94.9% knew what the most common indoor pollutants are; regarding daily habits they often aired out the house (91.9% in the morning and 71.4% after cleaning), 24.8% were smokers and 36.7 of them smoked indoors; regarding preventive behaviors, 41.6% chose the cleaning products based on habit and only 32.9% bought plants able to purify environments. Conclusions. Although the analyzed population had adequate knowledge of indoor air pollution, this did not strongly impact on the adoption of healthy lifestyles. Therefore, it becomes necessary to intervene on a social level with environmental education activities, starting from school age.
References
1. Italian Ministry of Health. Indoor air pollution. 2015. Available from: https://www.salute.gov.it/portale/temi/p2_6.jsp? lingua=italiano&id=4385&area=indor&menu=vuoto [Last accessed: 2024 Apr 23].
2. World Health Organization (WHO). WHO guidelines for indoor air quality: selected pollutants. 2010. Available from: https://www.who.int/publications/i/item/9789289002134 [Last accessed: 2024 Apr 23].
3. COMEAP. Associations of long-term average concentrations of nitrogen dioxide with mortality. 2018. Available from: https://www.gov.uk/government/publications/nitrogendioxide-effects-on-mortality/associations-of-long-termaverage-concentrations-of-nitrogen-dioxide-with-mortality2018-comeap-summary [Last accessed: 2024 Apr 23].
4. Zheng XY, Ding H, Jiang LN, Chen SW, Zheng JP, Qiu M, et al. Association between Air Pollutants and Asthma Emergency Room Visits and Hospital Admissions in Time Series Studies: A Systematic Review and Meta-Analysis. PLoS One. 2015 Sep 18;10(9):e0138146. doi: 10.1371/journal.pone.0138146. PMID: 26382947; PMCID: PMC4575194.
5. Mazaheri M, Clifford S, Yeganeh B, Viana M, Rizza V, Flament R, et al. Investigations into factors affecting personal exposure to particles in urban microenvironments using low-cost sensors. Environ Int. 2018 Nov;120:496-504. doi: 10.1016/j.envint.2018.08.033. Epub 2018 Aug 24. PMID: 30149341.
6. Balmes JR. Household air pollution from domestic combustion of solid fuels and health. J Allergy Clin Immunol. 2019 Jun; 143(6): 1979–1987. doi: 10.1016/j.jaci.2019.04.016. PMID: 31176380.
7. National Academies of Sciences, Engineering, and Medicine. Microbiomes of the Built Environment: A Research Agenda for Indoor Microbiology, Human Health, and Buildings. Washington, DC, USA:The National Academies Press; 2017.
8. Ni Y, Shi G, Qu J. Indoor PM2.5, tobacco smoking and chronic lung diseases: A narrative review. Environ Res. 2020 Feb;181:108910. doi: 10.1016/j.envres.2019.108910. Epub 2019 Nov 13. PMID: 31780052.
9. United Nations Economic Commission For Europe (UNECE). Protecting the Air We Breathe. 40 Years of Cooperation under the Convention on Long-Range Transboundary Air Pollution. 2019. Available from: https://unece.org/ environment-policy/publications/protecting-air-we-breathe [Last accessed: 2024 Apr 23].
10. Air Pollution Exposure is Shifting from Outdoor to Indoor— Here’s Why. 2021. Available from: https://theconversation. com/air-pollution-exposure-is-shifting-from-outdoor-toindoor-heres-why-163410 [Last accessed: 2024 Apr 23].
11. Kantipudi N, Patel V, Jones G, Kamath MV, Upton ARM. Air Pollution’s Effects on the Human Respiratory System.
Crit Rev Biomed Eng. 2016: 44(5): 383–395. doi: 10.1615/ CritRevBiomedEng.2017019757. PMID: 29199602.
12. Vardoulakis S, Giagloglou E, Steinle S, Davis A, Sleeuwenhoek A, Galea KS, et al. Indoor Exposure to Selected Air Pollutants in the Home Environment: A Systematic Review. Int J Environ Res Public Health. 2020 Dec 2;17(23): 8972. doi: 10.3390/ijerph17238972. PMID: 33276576; PMCID: PMC7729884.
13. The Battle for Breath—The Impact of Lung Disease in the UK; British Lung Foundation: London, UK, 2016. Available from: https://www.asthmaandlung.org.uk/battle-breathreport [Last accessed: 2024 Apr 23].
14. Moulton PV, Yang W. Air pollution, oxidative stress, and Alzheimer’s disease. J Environ Public Health. 2012;2012:472751. doi: 10.1155/2012/472751. Epub 2012 Mar 15. PMID: 22523504; PMCID: PMC3317180.
15. Rushton L. Health Impact of Environmental Tobacco Smoke in the Horne. Rev Environ Health. 2021 Feb 20;19(3-4):291-310. doi: 10.1515/reveh-2004-19-3-408. PMID: 34058084.
16. Gordon SB, Bruce NG, Grigg J, Hibberd PL, Kurmi OP, Lam KB, et al. Respiratory risks from household air pollution in low and middle income countries. Lancet Respir Med. 2014; 2(10):823–860. doi: 10.1016/S2213-2600(14)70168-7. Epub 2014 Sep 2. PMID: 25193349; PMCID: PMC5068561.
17. Raju S, Siddharthan T, McCormack MC. Indoor Air Pollution and Respiratory Health Clin Chest Med. 2020 Dec; 41(4): 825–843. doi: 10.1016/j.ccm.2020.08.014. PMID: 33153698; PMCID: PMC7665158.
18. Kurmi OP, Semple S, Simkhada P, Smith WCS, Ayres JG. COPD and chronic bronchitis risk of indoor air pollution from solid fuel: A systematic review and metaanalysis. Thorax. 2010 Mar;65(3): 221–228. doi: 10.1136/ thx.2009.124644. PMID: 20335290.
19. Bruce N. Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: A systematic review and meta-analysis. Bull World Health Organ. 2008 May; 86(5): 390–398. doi: 10.2471/ blt.07.044529. PMID: 18545742; PMCID: PMC2647443.
20. Royal College of Paediatrics and Child Health (RCPCH). Inside Story: Health Effects of Indoor Air Quality on Children and Young People. 2020. Available from: https://www. rcpch.ac.uk/resources/inside-story-health-effects-indoorair-quality-children-young-people [Last Accessed: 2024 Apr 23].
21. Jordan RE, Cheng KK, Miller MR, Adab P. Passive smoking and chronic obstructive pulmonary disease: cross-sectional analysis of data from the Health Survey for England. BMJ Open. 2011 Jan 1;1(2):e000153. doi: 10.1136/bmjopen2011-000153. PMID: 22021874; PMCID: PMC3191589.
22. Blanc PD, Eisner MD, Katz PP, Yen IH, Archea C, Earnest G, et al. Impact of the home indoor environment on adult asthma and rhinitis. J Occup Environ Med. 2005 Apr;47(4):36272. doi: 10.1097/01.jom.0000158708.32491.9d. PMID: 15824627.
23. World Health Organization (WHO). Environmental health inequalities in Europe: second assessment report. 2019. Available from: https://www.who.int/europe/publications/i/ item/9789289054157 [Last accessed: 2024 Apr 23].
24. Italian Ministry of Health. Main indoor pollutants and their sources. 2015. Available from: https://www.salute.gov.it/ portale/temi/p2_6.jsp?id=4389&area=indor&menu=vuot o [Last Accessed: 2024 Apr 23].
25. González-Martín J, Kraakman NJR, Pérez C, Lebrero R, Muñoz R. A state–of–the-art review on indoor air pollution and strategies for indoor air pollution control.
Chemosphere. 2021 Jan;262: 128376. doi: 10.1016/j. chemosphere.2020.128376. Epub 2020 Sep 17. PMID: 33182138.
26. Van Tran V, Park D, Lee Y-C. Indoor Air Pollution, Related Human Diseases, and Recent Trends in the Control and
Improvement of Indoor Air Quality. Int J Environ Res. Public Health. 2020 Apr 23; 17(8): 2927. doi: 10.3390/ijerph17082927. PMID: 32340311; PMCID: PMC7215772.
27. Arku RE, Adamkiewicz G, Vallarino J, Spengler JD, Levy DE. Seasonal variability in environmental tobacco smoke exposure in public housing developments. Indoor Air. 2015 Feb;25(1):13-20. doi: 10.1111/ina.12121. Epub 2014 May 14. PMID: 24750252; PMCID: PMC4201978.
28. Hamilton I, Milner J, Chalabi Z, Das P, Jones B, Shrubsole C, et al. Health effects of home energy efficiency interventions in England: a modelling study. BMJ Open. 2015 Apr 27;5(4):e007298. doi: 10.1136/bmjopen-2014-007298. Erratum in: BMJ Open. 2017 Apr 22;7(4):e007298corr1. PMID: 25916488; PMCID: PMC4420956.
29. Campagnolo D, Saraga DE, Cattaneo A, Spinazzè A, Mandin C, Mabilia R et al. VOCs and aldehydes source identification in European office buildings - The OFFICAIR study. Building and Environment 2017 Apr; 115: 18-24. https:// doi.org/10.1016/j.buildenv.2017.01.009.
30. Klein F, Baltensperger U, Prévôt ASH, El Haddad I. Quantification of the impact of cooking processes on indoor concentrations of volatile organic species and primary and secondary organic aerosols. Indoor Air. 2019 Nov;29(6):926-942. doi: 10.1111/ina.12597. Epub 2019 Sep 17. PMID: 31449696; PMCID: PMC6856830.
31. Michanowicz DR, Dayalu A, Nordgaard CL, Buonocore JJ, Fairchild MW, Ackley R, et al. Home is Where the Pipeline Ends: Characterization of Volatile Organic Compounds Present in Natural Gas at the Point of the Residential End User. Environ Sci Technol. 2022 Jul 19;56(14):10258-10268. doi: 10.1021/acs.est.1c08298. Epub 2022 Jun 28. PMID: 35762409; PMCID: PMC9301916.
32. Lee JH, Lee HS, Park MR, Park MR, Lee SW, Kim EH, et al. Relationship between indoor air pollutant levels and residential environment in children with atopic dermatitis. Allergy Asthma Immunol Res. 2014 Nov;6(6):517-24. doi: 10.4168/aair.2014.6.6.517. Epub 2014 Sep 11. PMID: 25374751; PMCID: PMC4214972.
33. Maung TZ, Bishop JE, Holt E, Turner AM, Pfrang C. Indoor Air Pollution and the Health of Vulnerable Groups: A Systematic Review Focused on Particulate Matter (PM), Volatile Organic Compounds (VOCs) and Their Effects on Children and People with Pre-Existing Lung Disease. Int J Environ Res Public Health. 2022 Jul 19;19(14):8752. doi: 10.3390/ijerph19148752. PMID: 35886604; PMCID: PMC9316830.
34. Rezende-Teixeira P, Dusi RG, Jimenez PC, Espindola LS, Costa-Lotufo LV. What can we learn from commercial insecticides? Efficacy, toxicity, environmental impacts, and future developments. Environ Pollut. 2022 May 1;300:118983. doi: 10.1016/j.envpol.2022.118983. Epub 2022 Feb 10. PMID:
35151812.
35. NRDC. Not Just Dirt: Toxic Chemicals in Indoor Dust. 2016. Available from: https://www.nrdc.org/resources/notjust-dirt-toxic-chemicals-indoor-dust [Last accessed: 2024 Apr 23].
36. Kendall GM, Miles JC, Rees D, Wakeford R, Bunch KJ, Vincent TJ, et al. Variation with socioeconomic status of indoor radon levels in Great Britain: The less affluent have less radon. J Environ Radioact. 2016 Nov;164:84-90. doi: 10.1016/j.jenvrad.2016.07.001. Epub 2016 Jul 19. PMID: 27442258.
37. Chiaramello E, Bonato M, Fiocchi S, Chiaramello E, Bonato M, Fiocchi S, et al. Radio Frequency Electromagnetic Fields Exposure Assessment in Indoor Environments: A Review. Int J Environ Res Public Health. 2019 Mar 17;16(6):955. doi: 10.3390/ijerph16060955. PMID: 30884917; PMCID: PMC6466609.
38. Genovese C, Mazzitelli F, Trimarchi G, D’Amato S, Squeri R, Venuto R, et al. Electromagnetic fields: a KAP study in a cohort of young adults. Euromediterranean Biomed J. 2023 Nov 5;18(28):135-140. doi: 10.3269/1970-5492 .2023.18.28.
39. Kim J. Urban Air Mobility Noise: Further Considerations on Indoor Space. Int J Environ Res Public Health. 2022 Sep 8;19(18):11298. doi: 10.3390/ijerph191811298. PMID: 36141570; PMCID: PMC9517258.
40. Sierra-Vargas MP, Teran LM. Air pollution: Impact and prevention. Respirology. 2012 Oct;17(7): 1031–1038. doi: 10.1111/j.1440-1843.2012.02213.x. PMID: 22726103; PMCID: PMC3532603.
41. Zhao S, Liu S, Hou X, Sun Y, Beazley R. Air pollution and cause-specific mortality: A comparative study of urban and rural areas in China. Chemosphere. 2021 Jan;262:127884. doi: 10.1016/j.chemosphere.2020.127884. Epub 2020 Aug 11. PMID: 33182102.
42. Boogaard H, Patton AP, Atkinson RW, Brook JR, Chang HH, Crouse DL, et al. Long-term exposure to traffic-related air pollution and selected health outcomes: A systematic review and meta-analysis. Environ Int. 2022 Jun;164:107262. doi: 10.1016/j.envint.2022.107262. Epub 2022 Apr 25. PMID: 35569389.
43. Tudi M, Daniel Ruan H, Wang L et al. Agriculture Development, Pesticide Application and Its Impact on the Environment. Int J Environ Res Public Health. 2021 Jan 27;18(3):1112. doi: 10.3390/ijerph18031112. PMID: 33513796; PMCID: PMC7908628.
44. Brilli F, Fares S, Ghirardo A, de Visser P, Calatayud V, Muñoz A, et al. Plants for Sustainable Improvement of
Indoor Air Quality. Trends Plant Sci. 2018 Jun;23(6):507512. doi: 10.1016/j.tplants.2018.03.004. Epub 2018 Apr 19. PMID: 29681504.
45. Han Y, Lee J, Haiping G, Kim KH, Wanxi P, Bhardwaj N, et al. Plant-based remediation of air pollution: A review. J Environ Manage. 2022 Jan 1;301:113860. doi: 10.1016/j.jenvman.2021.113860. Epub 2021 Oct 6. PMID: 34626947.
46. Prigioniero A, Zuzolo D, Niinemets Ü, Guarino C. Naturebased solutions as tools for air phytoremediation: A review
of the current knowledge and gaps. Environ Pollut. 2021 May 15;277:116817. doi: 10.1016/j.envpol.2021.116817. Epub 2021 Feb 25. PMID: 33711644.
47. Daniel L, Michot M, Esvan M, Guérin P, Chauvet G, Pelé F. Perceptions, Knowledge, and Practices Concerning Indoor Environmental Pollution of Parents or Future Parents. Int J Environ Res Public Health. 2020 Oct 21;17(20):7669. doi: 10.3390/ijerph17207669. PMID: 33096680; PMCID: PMC7589174.
48. Montuori P, Gioia M, Sorrentino M, Di Duca F, Pennino F, Messineo G, et al. Determinants Analysis Regarding Household Chemical Indoor Pollution. Toxics. 2023 Mar 13;11(3):264. doi: 10.3390/toxics11030264. PMID: 36977029; PMCID: PMC10059753.
49. Jansen T, Rademakers J, Waverijn G, Verheij R, Osborne R, Heijmans M. The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study. BMC Health Serv Res. 2018 May 31;18(1):394. doi: 10.1186/s12913-018-3197-4. PMID: 29855365; PMCID: PMC5984471.
50. Qian X, Xu G, Li L, Shen Y, He T, Liang Y, et al. Knowledge and perceptions of air pollution in Ningbo, China. BMC Public Health. 2016 Nov 5;16(1):1138. doi: 10.1186/s12889016-3788-0. PMID: 27816059; PMCID: PMC5097845.
51. Italian National Health Institute (ISS). Comunicato Stampa N°39/2022 - Fumo: in Italia circa 800mila fumatori in più rispetto al 2019. Triplicato il consumo di sigarette a tabacco riscaldato. 2022. Available from: https://www.iss. it/comunicati-stampa/-/asset_publisher/fjTKmjJgSgdK/ content/id/7146126 [Last accessed: 2024 Apr 23].
52. La Fauci V, Mondello S, Squeri R, Alessi V, Genovese C, Laudani N, et al. Family, lifestyles and new and old type of smoking in young adults: insights from an italian multiplecenter study. Ann Ig. 2021 Mar-Apr;33(2):131-140. doi: 10.7416/ai.2021.2419. PMID: 33570085.
53. La Fauci V, Squeri R, Spataro P, Genovese C, Laudani N, Alessi V. Young people, young adults and binge drinking. J Prev Med Hyg. 2019 Dec 20;60(4):E376-E385. doi: 10.15167/2421-4248/jpmh2019.60.4.1309. PMID: 31967096; PMCID: PMC6953446.
54. Clark LP, Millet DB, Marshall JD. National patterns in environmental injustice and inequality: outdoor NO2 air pollution in the United States. PLoS One. 2014 Apr 15;9(4):e94431. doi: 10.1371/journal.pone.0094431. PMID: 24736569; PMCID: PMC3988057.
55. Fairburn J, Schüle SA, Dreger S, Karla Hilz L, Bolte G. Social Inequalities in Exposure to Ambient Air Pollution: A Systematic Review in the WHO European Region. Int J Environ Res Public Health. 2019 Aug 28;16(17):3127. doi: 10.3390/ijerph16173127. PMID: 31466272; PMCID: PMC6747075.
56. Ferguson L, Taylor J, Davies M, Shrubsole C, Symonds P, Dimitroulopoulou S. Exposure to indoor air pollution across socio-economic groups in high-income countries: A scoping review of the literature and a modelling methodology. Environ Int. 2020 Oct;143:105748. doi: 10.1016/j. envint.2020.105748. Epub 2020 Jul 3. PMID: 32629198; PMCID: PMC7903144.
57. Milojevic A, Niedzwiedz CL, Pearce J, Milner J, MacKenzie IA, Doherty RM, et al. Socioeconomic and urban-rural differentials in exposure to air pollution and mortality burden in England. Environ Health. 2017 Oct 6;16(1):104. doi: 10.1186/s12940-017-0314-5. PMID: 28985761; PMCID: PMC6389046.
58. La Fauci V, Trimarchi G, Ceccio C, Mazzitelli F, Pappalardo R, Alessi V. Health literacy in Mediterranean general population. J Prev Med Hyg. 2022 Dec 31;63(4):E527-E532. doi: 10.15167/2421-4248/jpmh2022.63.4.2485. PMID: 36890997; PMCID: PMC9986981.
59. La Fauci V, Alessi V, Assefa DZ, Lo Giudice D, Calimeri S, Ceccio C, et al. Mediterranean diet: knowledge and adherence in Italian young people. Clin Ter. 2020 SepOct;171(5):e437-e443. doi: 10.7417/CT.2020.2254. PMID: 32901789.
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Copyright (c) 2025 Roberto Venuto, Roberta Pappalardo, Cristina Genovese, Giuseppe Trimarchi, Raffaele Squeri, Giuseppe La Spada, Vincenza La Fauci (Author)
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