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(Maroni et al., 1995). ETS also elevates symptoms for
people who have asthma and may induce asthma in
some children (Jones, 1999). ETS exposure has also
been linked to lower respiratory tract illness (Somerville
et al., 1988). Children exposed to ETS are hospitalized
more often than children who are not exposed (Har-
lap and Davies, 1974). Janerich et al. (1990) found
that ETS may cause up to 17 percent of lung cancers
among nonsmokers. Rando et al. (1997) found a 30-
percent increase in the cancer risk to women whose
husbands smoked, and Ryan et al. (1992) linked brain
cancer tumors to ETS. Long-term exposure also results
in cardiovascular disease and pulmonary malfunction,
contributing to further mortality (e.g., Centers for Dis-
ease Control and Prevention, 2005; U.S. Department
of Health and Human Services, 2006). There is no low
threshold to the health effects of ETS (U.S. Department
of Health and Human Services, 2006).
occurring in children younger than 5 years (WHO,
2005). Indoor burning may also put half the world's
population at risk of air pollution-related disease or
mortality (WHO, 2008). Indoor PM levels during burn-
ing are ten to fifty times higher than recommended
safe values. Women and children are disproportionately
affected because they spend more time near the fires
than do adult men. Whereas indoor air pollution mor-
tality causes about 2.7 percent of all deaths worldwide
annually, it is responsible for about 3.7 percent of such
mortality in developing countries.
Most deaths from indoor fuel burning are due to pneu-
monia, chronic respiratory disease, and lung cancer.
Indoor smoke significantly increases the risk of pneu-
monia primarily among those 5 years old and younger.
Exposure to smoke doubles the risk of pneumonia; thus,
it triggers more than 900,000 of the world's 2 million
annual deaths from pneumonia (WHO, 2005). Indoor
smoke also strongly increases the risk of chronic respi-
ratory disease and lung cancer, primarily among adults
older than 30 years. In addition, women exposed to
indoor smoke have three times the chance of contract-
ing chronic obstructive pulmonary disease (COPD) ,
such as chronic bronchitis, than do women who cook
with cleaner fuels. Smoke exposure to men doubles
their risk of COPD. Indoor air pollution may cause
about 700,000 COPD-related deaths, whereas indoor
smoke may cause about 15,000 lung cancer deaths per
year. The link between biofuel smoke and cataracts and
tuberculosis is more uncertain.
The ultimate solution to the problems associated with
indoor fuel burning is to replace wood- and coal-burning
stoves and heaters with electric heaters and/or to ven-
tilate smoke exhaust better. This is not a technological
barrier to overcome, but an economic and social barrier,
because many societies are resistant to change.
9.1.14. Indoor Solid Biofuel and Coal Burning
One of the leading causes of death worldwide is the
indoor burning of solid biofuels and coal for home
heating and cooking (e.g., Figure 9.7). Such burning
is carried out by large segments of the population in
many developing countries. Solid biofuels used for
home heating and cooking are generally wood, grass,
agricultural waste, and dung. The use of solid bio-
fuels is often favored over the use of kerosene or other
fossil fuels due to the lower price or better availability
of biofuels, particularly in places such as sub-Saharan
Africa.
Indoor fuel burning kills about 1.6 million people
prematurely each year, with 56 percent of the deaths
9.2. Sick Building Syndrome
In some workplaces, employees experience an unusu-
ally high rate of headaches, nausea, nasal and chest
congestion, eye and throat problems, fatigue, fever,
muscle pain, dizziness, and dry skin. These symptoms,
present during working hours, often improve after a per-
son leaves work. The situation described is called sick
building syndrome (SBS) .The cause of SBS is not
certain, but it may be due to certain VOCs, inadequate
building ventilation systems, or molds. SBS may also
be caused by enhanced stress levels and heavy work-
loads, or a combination of psychological and chemical
factors (Jones, 1999).
Figure 9.7. Soot-blackened iron pot cooking over
an open fire in a rural kitchen, August 24, 2009.
C
Henrischmit/Dreamstime.com.
 
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