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Incense smoke: Clinical, structural and molecular effects on airway disease


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In Asian countries where the Buddhism and Taoism are mainstream religions, incense burning is a daily practice. A typical composition of stick incense consists of 21% (by weight) of herbal and wood powder, 35% of fragrance material, 11% of adhesive powder, and 33% of bamboo stick. Incense smoke (fumes) contains particulate matter (PM), gas products and many organic compounds. On average, incense burning produces particulates greater than 45 mg/g burned as compared to 10 mg/g burned for cigarettes. The gas products from burning incense include CO, CO2, NO2, SO2, and others. Incense burning also produces volatile organic compounds, such as benzene, toluene, and xylenes, as well as aldehydes and polycyclic aromatic hydrocarbons (PAHs). The air pollution in and around various temples has been documented to have harmful effects on health. When incense smoke pollutants are inhaled, they cause respiratory system dysfunction. Incense smoke is a risk factor for elevated cord blood IgE levels and has been indicated to cause allergic contact dermatitis. Incense smoke also has been associated with neoplasm and extracts of particulate matter from incense smoke are found to be mutagenic in the Ames Salmonella test with TA98 and activation. In order to prevent airway disease and other health problem, it is advisable that people should reduce the exposure time when they worship at the temple with heavy incense smokes, and ventilate their house when they burn incense at home.
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BioMed Central
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Clinical and Molecular Allergy
Open Access
Incense smoke: clinical, structural and molecular effects on airway
Ta-Chang Lin*1,2, Guha Krishnaswamy3 and David S Chi3
Address: 1Department of Environmental Engineering, National Cheng Kung University, Tainan, Taiwan, 2Sustainable Environment Research
Center, National Cheng Kung University, Tainan, Taiwan and 3Department of Internal Medicine, James H. Quillen College of Medicine, East
Tennessee State University, Johnson City, TN, USA
Email: Ta-Chang Lin* -; Guha Krishnaswamy -; David S Chi -
* Corresponding author
In Asian countries where the Buddhism and Taoism are mainstream religions, incense burning is a
daily practice. A typical composition of stick incense consists of 21% (by weight) of herbal and wood
powder, 35% of fragrance material, 11% of adhesive powder, and 33% of bamboo stick. Incense
smoke (fumes) contains particulate matter (PM), gas products and many organic compounds. On
average, incense burning produces particulates greater than 45 mg/g burned as compared to 10 mg/
g burned for cigarettes. The gas products from burning incense include CO, CO2, NO2, SO2, and
others. Incense burning also produces volatile organic compounds, such as benzene, toluene, and
xylenes, as well as aldehydes and polycyclic aromatic hydrocarbons (PAHs). The air pollution in and
around various temples has been documented to have harmful effects on health. When incense
smoke pollutants are inhaled, they cause respiratory system dysfunction. Incense smoke is a risk
factor for elevated cord blood IgE levels and has been indicated to cause allergic contact dermatitis.
Incense smoke also has been associated with neoplasm and extracts of particulate matter from
incense smoke are found to be mutagenic in the Ames Salmonella test with TA98 and activation.
In order to prevent airway disease and other health problem, it is advisable that people should
reduce the exposure time when they worship at the temple with heavy incense smokes, and
ventilate their house when they burn incense at home.
Encyclopedia Britannica states that incense was employed
to counteract disagreeable odors, drive away demons,
manifest the presence of gods, and to gratify gods. Incense
burning has been practiced for centuries. Early Christian
churches used incense in the Eucharistic ceremony, in
which it symbolized the ascent of the prayers of the faith-
ful and the merits of the saints. Later, incense was
employed sporadically in the Church of England. Else-
where in both Eastern and Western Catholic Christen-
dom, its use during divine worship and during
processions has been continuous [1]. In Asian countries
where the Buddhism and Taoism are mainstream reli-
gions, such as China, Thailand, and Taiwan, incense burn-
ing is a daily practice.
In Taiwan, about half of its population (23 million) is
Buddhist or Taoist. Most of them burn incense daily when
they worship at home. The people in Taiwan also worship
with incenses at temples regularly. In 2003, the Environ-
mental Protection Agency in Taiwan reported that a total
of 28.7 metric tons of incense was burned in 92 temples
Published: 25 April 2008
Clinical and Molecular Allergy 2008, 6:3 doi:10.1186/1476-7961-6-3
Received: 3 January 2008
Accepted: 25 April 2008
This article is available from:
© 2008 Lin et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinical and Molecular Allergy 2008, 6:3
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in Kao-Hsiong City [2]. It is equivalent to 0.86 kg/temple/
day. Currently, there are 11,503 registered temples in Tai-
wan [3]. It is estimated that at least a total of 3,580 tons of
incense is consumed yearly in the temples in Taiwan. Dur-
ing the Lunar New Year and other religious festivals, a
huge amount of incense is burned in temples (Figure 1).
If household incense burning is included, the incense
consumption in Taiwan may even double or triple that
estimated amount and it may indicate an environmental
hazardous situation.
The air pollution in and around various temples has been
documented [4-12]. The effects of incense smoke on air-
way disease and health also have been reported. This arti-
cle will review: the nature of incenses and incense
burning, pollutants emitted from incense burning, and
effects of incense smoke on airway disease and health.
The nature of incenses and incense burning
There are various forms of incenses, including sticks, joss
sticks, cones, coils, powders, rope, rocks/charcoal, and
smudge bundles [13]. The main difference between the
first two forms is that the former has a slender bamboo
base, onto which the mixture of incense ingredients is
attached, while the latter is without a central base. Figure
2 shows five major forms of Asian incense, among them
stick incense is the most popular in Taiwan.
Depending on its makers and local custom, incense sticks
have several commercially available types, such as Chen
Shan (Shan means incense), Gui Shan, Hsing Shan, Lao
Shan, and Liao Shan. However, the physical characteris-
tics of these incenses, such as length and diameter of the
bamboo stick (average 39.5 and 0.4 cm, respectively),
length and diameter of the incense coated part (average
28.5 and 2.7 cm, respectively), and weight of the whole
stick (average 1.3 gm), are very similar [14]. While the
exact content of incense sticks is a commercial secret, most
incense is made from a combination of fragrant gums, res-
ins, wood powders, herbs and spices.
A typical composition of stick incense consists of 21% (by
weight) of herbal and wood powder, 35% of fragrance
material, 11% of adhesive powder, and 33% of bamboo
stick [15]. Herbal and wood powders used in incense
making include Glycyrrhiza uralensis Fisch. (Legumi-
nosae), Cinnamomum cassia Bl. (Lauraceae), Nar-
dostachys chinensis Bastal. (Valerianaceae), Foeniculum
vulgare Mill. (Umbelliferae), Rheum officinale Baill.
(Polygonaceae), Radix Aucklandia. (Compositae),
Asarum siebolidii Miq. (Aristolochiaceae), Magnolia lilii-
flora Desr. (Magnoliaceae), Eugenia caryophyllata
Thumb. (Myrtaceae), and Ocimum basilicum L. (Labia-
tae) [15]. Some of these materials are also used in Chinese
traditional medicine. Fragrance materials used in incense
source from Lysimachia foenum-graecum. (Primulaceae),
Juniperus chinensis L. var. Kaizuka Hort. (Cupressaceae),
Liquidambar formosana Hance. (Hamamelidaceae), San-
talum album L. (Santalaceae), Musk ambrette, musk
ketone, and musk xylene. Adhesive Powder is from the
bark of Machilus nanmu Hemsl. (Lauraceae). To make
incenses, one end of a bamboo stick is first soaked in
adhesive materials before it is coated with a mixture of fra-
grance, herbal and wood powders. This coating process is
repeated two more times. Incenses are then dried under
the sun.
Traditionally, incense burning usually involves three or
more sticks simultaneously. It will take from 50 to 90
minutes to burn a stick of incense. When incense is burn-
ing, it emits smoke (fumes) containing particulate matter
(PM), gas products and other organic compounds. Once
the incense coating section has burned completely, the
burning extinguishes itself at the tip of the bare bamboo
part of the stick. The gas products from burning incense
include CO, CO2, NO2, SO2, and others. Incense burning
also produces volatile organic compounds, such as ben-
zene, toluene, and xylenes, as well as aldehydes and poly-
cyclic aromatic hydrocarbons (PAHs), which mostly are
absorbed on particle matter.
Major types of air pollutants in incense smoke
and their toxicological effects
People who are exposed to incense fumes always inhale
the whole complex mixture that contains particulate mat-
ter, gas products and many organic compounds. It is
therefore difficult, if not impossible, to single out the
Incense burning during Lunar New Year in the Long-Shang Temple in Taipei, TaiwanFigure 1
Incense burning during Lunar New Year in the Long-
Shang Temple in Taipei, Taiwan. Apaprently, the dense
incense smoke inflicted irritation in the eyes of a worshiper
(photo by T. C. Lin).
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health effects contributed by a certain component in the
fumes. For example, there hasn't been any report about
the ill effects on human health directly caused by the par-
ticles per se in the incense smoke.
Nevertheless, it's still helpful to know the composition of
incense smoke in terms of types of pollutants and the cor-
responding toxicological effects – even though these cited
effects were obtained from non-incense studies on air pol-
lutants in general.
1. Particulate matter (PM)
From practical considerations of the health effects, air par-
ticulates are usually categorized according to how deep
they can penetrate into the human respiratory system.
Coarse particles are those greater than 10 µm in diameter.
They are too large to enter the human respiratory system,
hence causing no immediate threat. Particles less than 10
µm in diameter (PM10) pose a health concern because
when inhaled they can accumulate in the respiratory sys-
tem. Particles in the range 10 to 2.5 µm are known as the
thoracic coarse particles (PM10-2.5) [16]. Particles less than
2.5 µm in diameter (PM2.5) are referred to as fine particles
and are believed to pose the largest health risks because
they can go as deep as the alveoli [17,18]. Particles less
than 0.1 µm are called ultrafine particles [19].
Since people who are exposed to incense smoke always
inhale a complex mixture of both gaseous and particulate
products from the incense, it is difficult to single out the
health effects of incense particles alone. So far, there
hasn't been any report about the ill effects on human
health directly caused by the particles per se in the incense
smoke. Epidemiological studies have reported associa-
tions between air particulate matter (especially the fine
particles) and several acute health effects, including mor-
tality, hospital admissions, respiratory symptoms, and
lung dysfunction [20-25]. The USEPA 2004 Air Quality
Criteria for Particulate Matter conclusion states that PM10-
2.5 exposure was associated with respiratory morbidity
The combustion of incense, wood, cigarette, and candles
is important or even major sources of residential indoor
particulate matter, especially in the 2.5 µm size range and
below [4-6,4,13,28-30]. Mannix et al. reported that burn-
ing incense could generate large quantities of PM. On
average, it produces PM greater than 45 mg/g burned, as
compared to 10 mg/g burned for the cigarettes [31]. Lin et
al. measured 1,316 and 73 µg/m3, respectively, for the
mean indoor and outdoor total suspended particulate
(TSP) concentrations at one Taiwanese temple [7]. In a
study of the indoor air pollution in Taiwan, Liao et al. [32]
found that incense burning had size integrated source
emission rates of 0.038 ± 0.026 particles/second. For
indoor particles ranging from 0.5 to 5 µm, 62–92% is
from indoor sources, including cooking, incense burning,
and other residential activities. It is important to know
Forms of incenseFigure 2
Forms of incense. Major forms of incense are shown, including powder, coil, cone, joss stick, and stick. (photo by T. C. Lin).
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that addition of calcium carbonate in incense can effec-
tively suppress the particulate emission by as much as
40%; hence calcium carbonate may make the incense
safer to use [14].
2. Gaseous emissions
2.1. Carbon monoxide (CO)
Carbon monoxide is a colorless, odorless, tasteless, yet
poisonous gas generally formed during incomplete com-
bustion of organic substances, such as hydrocarbons,
wood, incense, cigarette, and fossil fuels. CO combines
with haemoglobin much more readily than oxygen, by a
factor of 200–300, hence reduces the blood's capacity to
transport oxygen. Inhalation of CO in low concentrations
can cause headaches, dizziness, weakness and nausea,
while high concentrations can be fatal [33].
2.2. Sulfur dioxide (SO2) and nitrogen dioxide (NO2)
Health effects of exposures to sulfur dioxide, and nitrogen
dioxide can include reduced work capacity, aggravation of
existing cardiovascular diseases, effects on pulmonary
function, respiratory illnesses, lung irritation, and altera-
tions in the lung's defense system [34].
2.3. Volatile organic compounds
Volatile organic compounds (VOCs) are chemicals that
have low boiling points and therefore evaporate easily at
room temperature. Common VOCs include benzene, tol-
uene, xylenes, and isoprene. Acute symptoms of VOC
exposures are: eye irritation/watering, nose irritation,
throat irritation, headaches, nausea/vomiting, dizziness,
and asthma exacerbation. Chronic symptoms of VOC
exposure are: cancer, liver damage, kidney damage, cen-
tral nervous system damage [35].
Löfroth et al. [28] found that smoking and incense burn-
ing generates CO, isoprene and benzene. Lee et al. [36]
burned incense in a large environmental chamber. They
found that, while the benzene and toluene levels recom-
mended by the Indoor Air Quality Objectives for Office
Buildings in Hong Kong (HKIAQO, 1999) are 16.1 and
1,092 µg/m3, respectively, the measured benzene concen-
trations of all tested incense were significantly higher than
the standard.
2.4. Aldehydes
Most materials produce aldehydes and ketones during
combustion. Burning incense is also known to generate
aerosols and formaldehyde [37-39,36,40]. Lin and Tang
investigated the content of particulates in Chinese incense
smoke and found that acrolein, formaldehyde and acetal-
dehyde were predominantly adsorbed on particulates,
especially those particulates with size of 3.3–4.7 µm and
2.1–3.3 µm. [39].
Aldehydes are volatile organic compounds typically char-
acterized by their irritating properties, especially the low
molecular weight, the halogenated aliphatic, and the
unsaturated aldehydes. In addition to irritating skin, eyes
and the upper respiratory tract, aldehydes also affect nasal
mucous membranes and oral passages, producing a burn-
ing sensation, bronchial constriction, choking, and
coughing [41].
Exposures to formaldehyde are of concern because for-
maldehyde is a potent sensory irritant and is classified as
a probable human carcinogen [42]. Black et al. reported
that both wood dust and formaldehyde can impair muco-
ciliary clearance [43]. Epidemiological studies have corre-
lated wood dust and formaldehyde with nasal cancer
[44,45]. Wood dust that carries formaldehyde enhances
the toxicity of formaldehyde when the wood dust is inter-
cepted and dissolved in water in the nasal cavity [46].
2.5. Polycyclic aromatic hydrocarbons
The smoke emitted by incense burning has been found to
contain polycyclic aromatic hydrocarbons (PAHs)
[7,8,14,47-52]. In Taiwan, temples are typically heavily
polluted by incense smoke, especially during special festi-
vals, such as the Chinese New Year or the birthdays of
worshiped gods. A temple was reported to have mean
total-PAH concentrations of 6,258 ng/m3 and 231 ng/m3
in its indoor and outdoor air, respectively; indicating that
PAH concentrations of the temple's inside air were 27
times higher than that of its outside air. The top five indi-
vidual PAHs having the highest concentrations (particle-
bound + gas phase) were identified as acenaphthylene
(3,583 ng/m3), naphthalene (1,264 ng/m3), acenaph-
thene (349 ng/m3), fluoranthene (243 ng/m3) and phen-
anthrene (181 ng/m3) [7]. In a study of one Swiss church,
in which incense was burned, PAHs were found in sedi-
mented dusts, indicating that incense was possibly the
most significant source [53]. It also has been shown that
burning incense is associated with increased levels of
PAHs in homes [47,54]. In a comparison study of incense
burning, Lung and Hu reported that two kinds of incense
sticks generated, 17.1 ug and 25.2 ug of particle-bound
PAHs, and 19.8 mg and 43.6 mg of particles per gram of
incense burned, respectively [55]. It appears that different
types of incense produce various amounts of PAHs.
2.6. Diethylphthalate (DEP)
In India, diethylphthalate is used extensively in the
incense stick industry as a binder of perfumes. It can be
emitted into the air during incense burning. Eggert and
Hansen reported that DEP emission from various incense
could be as high as 16,365 µg/m3 in concentration and
13,582 µg/unit of incense [56].
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Diethylphthalate (DEP), used as a plasticizer and a deter-
gent base, is a suspect carcinogen. Sonde et al. studied the
interactive toxicity of DEP with ethyl alcohol (EtOH) in
young male Sprague-Dawley rats. The rats were given 50
ppm DEP (w/v), 5% EtOH (v/v), or a combined dose of
50 ppm DEP (w/v) + EtOH (5% v/v) in water ad libitum
for a period of 120 days and were maintained on normal
diet. The controlled rats received normal diet and plain
water. No interaction of DEP with EtOH was found. How-
ever, significantly altered lipid and enzyme levels in the
liver and serum were found in the DEP-fed group. It was
concluded that DEP alone leads to severe impairment of
lipid metabolism coupled with toxic injury to the liver
Effects of incense smoke on airway disease and
Like second hand smoke, pollutants emitted from incense
burning in a close environment are harmful to human
health. As mentioned above, particulate matters, and
some of volatile organic compounds, musk ketones, musk
xylenes, and musk ambrette, aldehydes, polycyclic aro-
matic hydrocarbons, diethylphthalate (DEP) are toxic to
the lung and allergenic to the skin and eyes. While it is rel-
atively difficult to directly study the effect of incense
smoke pollutants on health, several epidemiological stud-
ies have suggested that they do cause health problems.
1. Airway dysfunction
Most obviously, when incense smoke pollutants are
inhaled, they will cause respiratory dysfunction. In 1966,
Sturton et al reported a high incidence of nasopharyngeal
carcinoma in Hong Kong in male patients who burn
incense as compared with the other malignant cases that
were used as controls. They found that 74.5% of the stud-
ied nasopharyngeal cancer cases and 52% of all other
malignant cases were exposed to incense smoke and sug-
gested the possibility that incense smoke may be a factor
in the etiology of this malignant disease [58].
In order to determine whether indoor environmental fac-
tors affected respiratory dysfunction, Yang et al. have sur-
veyed 4,164 elementary school children in several rural
areas in Kaohsiung, Taiwan. They found that, among the
other chemical factors, incense burning and mosquito
repellant burning were significantly associated with cough
symptoms [59]. Since people working in temples may be
exposed to high levels of air pollutants from incense burn-
ing, Ho et al. have investigated the prevalence of chronic
respiratory symptoms and acute irritative symptoms
among 109 temple workers in Kaohsiung, Taiwan. They
concluded that working in a temple increases the risk for
the development of acute irritative respiratory symptoms,
including nose and throat irritation [60]. The adjusted
odds ratios calculated for acute irritative symptoms in
temple workers relative to the controls are 4.5 for throat
irritation and 4.14 for nose irritation. Furthermore,
chronic cough symptoms were significantly more com-
mon among the temple workers than those from the non-
incense burning church, the control group.
Alarifi et al. have used rats to study the effect of incense
smoke on the lung. Rats were exposed to Arabian mix
incense, Ma'amoul, for 14-weeks at a rate of 4 grams/day
in the exposure chamber. At the end of the exposure
period, lung tissues were removed and processed for elec-
tron microscopy. It was noticed that alveolar pneumo-
cytes of the exposed animals had significant
ultrastructural changes which involved the cell organelles
and surfactant material of type II cells. Neutrophil infiltra-
tion into the alveolar lumena was found to accompany
degenerative and necrotic changes of the alveolar lining
cells. Alveolar walls also revealed deposition of collagen
fibrils which contributed in its thickening. They con-
cluded that exposure to Ma'amoul incense could induce
ultrastructural pulmonary changes which may imply com-
promised respiratory efficiency [61]. Similar ultrastruc-
tural pulmonary changes have also been reported in rats
exposed to Bakhour, an Arabian incense [62].
It is interesting to note that in several epidemiological
studies, incense burning had shown no harmful effect. In
their study of the association of indoor and outdoor envi-
ronmental exposures and physician-diagnosed asthma,
Lee et al. surveyed 35,036 6- to 15-year-old school chil-
dren in Taiwan. They reported that daily cigarette con-
sumption in families and incense burning at home
showed negative effects to the occurrence of childhood
asthma. They proposed a possible explanation for their
finding; cigarette smoking and incense use might have
been decreased in families with children with atopic dis-
ease and thus had less atopic asthma [63]. In another
study, Koo et al., analyzed data from an air pollution
cross-sectional study of 346 primary school children and
their 293 non-smoking mothers, and a lung cancer case-
control study of 189 female patients and 197 district
matched controls. They found that there was no associa-
tion between exposure to incense burning and respiratory
symptoms like chronic cough, chronic sputum, chronic
bronchitis, runny nose, wheezing, asthma, allergic rhini-
tis, or pneumonia among the primary school children,
their non-smoking mothers, or district matched controls.
Incense burning also did not affect lung cancer risk among
non-smokers, but it significantly reduced risk among
smokers, even after adjusting for lifetime smoking
amount. They suggested a likely explanation for this unex-
pected finding: incense burning was associated with cer-
tain dietary habits, i.e. more fresh fish, more retinol, and
less alcohol, which have been associated with lower lung
cancer risk in this population. Thus, their results indicate
Clinical and Molecular Allergy 2008, 6:3
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that diet can be a significant confounder of epidemiolog-
ical studies on air pollution and respiratory health [64].
2. Allergy and Dermatological Effects
Lin et al. studied umbilical cord blood IgE (cIgE) in 334
mother and neonate pairs. They found that incense burn-
ing was a risk factor for elevated cIgE [65]. Lead exposure
could stimulate the IgE production [66]. The concentra-
tions of lead have been detected at 0.14 and 0.21 mg/g in
PM2.5 and PM2.5–10 in the sample collected at one temple
in Taiwan, respectively. It is speculated that lead emitted
from incense burning could be absorbed on PM2.5 and
PM2.5–10 and subsequently transferred to fetal blood and
modulated the fetal immune system with IgE production.
However, the authors have not yet proved the relation-
ships between incense burning, cord blood lead, and cord
blood IgE levels [65].
As indicated in the previous section, incense smoke cause
morphological changes of alveolar pneumocytes and
infiltration of neutrophils into alveolar lumena in experi-
mental rats [61,62]. Activation of resident and recruited
inflammatory cells can lead to elaboration of a plethora of
mediators, culminating in airway inflammation and
remodeling. Recent studies suggest that a dominance of
the Th2 type cytokines (IL-4, IL-5, IL-10 and IL-13) may
be pivotal to asthma pathogenesis [67-71]. Th2 cytokines
by regulating IgE class switching as well as inducing
humoral immunity, would aggravate allergic respiratory
disease. While cytokines such as IL-4 and IL-13 are crucial
to production of IgE by B lymphocytes, others such as IL-
5 are essential to eosinophil hematopoiesis, activation
and survival in tissue. Numerous factors, including
incense smoke, may contribute to the development of the
Th1-Th2 imbalance [72-75], and the interaction between
the innate and adaptive immune systems may lead to
inflammatory changes and airway remodeling [76].
Incense burning smoke has also been associated with der-
matological problems. Hayakawa et al. reported a 63-
year-old patient, who had practiced incense ceremony for
about 15 years, and was found to have itchy depigmented
macules on his dorsum manus, left shoulder and abdo-
men. A 48 h closed path testing revealed perfume in the
incense was the cause. It was suggested that the perfume
and airborne particles from the burning incense contacted
the skin and caused the allergic contact dermatitis accom-
panied by depigmentation [77]. In addition, the same
group also reported cases of contact dermatitis due to
long-term exposure to musk ambrette vaporized from
incense burning [78].
3. Neoplasm
Extracts of particulate matter from incense smoke are
found to be mutagenic in the Ames Salmonella test with
TA98 and activation. This suggests that incense burning
can cause indoor air pollution and thus cancer akin to that
from cigarette smoking [28]. To study the causes of leuke-
mia, Lowengart et al. investigated a group of children of
ages 10 years and under in Los Angeles County. The moth-
ers and fathers of acute leukemia cases and their individu-
ally matched controls were interviewed regarding specific
occupational and home exposures as well as other poten-
tial risk factors associated with leukemia. Analysis of the
data from the 123 matched pairs showed an increased risk
of leukemia for children whose parents burned incense at
home. Furthermore, the risk was greater for more frequent
users [79].
Incense smoke contains various N-nitroso compounds,
which have been shown to be potent nervous system car-
cinogens, particularly when animals are exposed transpla-
centally [80]. Preston-Martin et al. studied mothers of 209
young brain tumor patients and 209 control subjects.
They found that increased brain tumor risk was associated
with maternal contact with nitrosamine-containing sub-
stances such as burning incense, side-stream cigarette
smoke, and face makeup [81]. However, conflicting data
on the effect of incense burning smoke on neoplasm have
also been reported.
Several studies have shown there is no association
between incense smoke and cancer. In studying risk fac-
tors associated with lung cancer in Hong Kong, Chan-
Yeung et al. found that smoking was the most important
risk factor associated with lung cancer, while exposure to
incense smoke and frying pan fumes were not significant
risk factors [82]. Similarly, McCredie et al. carried out a
population-based case-control study of perinatal and
early postnatal risk factors for malignant brain tumors in
New South Wales children, and reported that no associa-
tion was found between childhood brain tumors and
incense burning [83]. A similar conclusion was reported
by Koo et al. when they conducted four epidemiological
studies in Hong Kong over 15 years. They found that,
although incense was identified as a major source of expo-
sure to nitrogen dioxide and airborne carcinogens, it had
no effect on lung cancer risk among nonsmokers and,
more intriguingly, it significantly reduced risk among the
smokers [84]. They attributed the findings to the relatively
healthy diets among smoking women who burned
incense versus those who did not. Bunin et al. investigated
risk factors for the two most common types of brain
tumors in children, astrocytic glioma and primitive neur-
oectodermal tumor (PNET) and found that among the
products (including incense) studied that contain N-
nitroso compounds, only beer was associated with a sig-
nificantly increased risk of either tumor type [85]. Simi-
larly, Ger et al. investigated the relationship between
various risk factors and lung cancer by histological types.
Clinical and Molecular Allergy 2008, 6:3
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They reported that, while occupational exposures to
asbestos and working as a cook were significant risk fac-
tors associated with adenocarcinoma of the lung, an
inverse association between incense burning and the ade-
nocarcinoma was noted [85].
Incense burning emits smoke containing particulate mat-
ter, gas products and other organic compounds and
causes air pollution, airway disease and health problems.
When incense smoke pollutants are inhaled, they cause
airway dysfunction. Incense smoke is a risk factor for ele-
vated cord blood IgE levels and has been indicated to
cause allergic contact dermatitis. Incense smoke also has
been associated with neoplasm. However, several conflict-
ing reports have also been documented. The effect of
incense smoke on health and the mechanism behind it
needs to be further studied in an animal model. To obtain
further conclusive results, more epidemiological studies
with better controls and a longer time period are needed.
Meanwhile, it is a good practice to keep the room well
ventilated when burning incense. It will effectively dilute
the indoor air pollutants and hence reduce the risk of
List of abbreviations used
DEP: diethylphthalate; PAH: polycyclic aromatic hydro-
carbon; PM: particulate matter; PM10: particulate matter
less than 10 µm in diameter; VOC: volatile organic com-
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
T–CL, GK and DSC have all been involved in drafting the
article or revising it critically for important intellectual
content and have given final approval of the version to be
We would like to thank Dr. Jim Kelley and Mr. Kenton Hall for their cri-
tique and proofreading of the manuscript. This study was supported by the
National Science Council of Taiwan (grants NSC94-2211-006-095, NSC95-
2918-I-006-002, and NSC95-EPA-Z-006-003), and the Research Develop-
ment Committee and the Ruth Harris Endowment of East Tennessee State
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... Incense sticks (IS) are commonly used in temples, churches, houses, and other religious places (Goel et al., 2017;Yadav et al., 2021a). In Taiwan alone, 3580 tonnes of incense sticks are consumed yearly in temples and if household burning is also considered, then this value may double or triple and may indicate an environmentally hazardous situation (Lin et al., 2008). While in India approximately 3-4 million tonnes (MTs) of incense sticks are consumed in religious places and houses. ...
Incense sticks ash contains nearly 49-55% which acts as a potential candidate as a raw material for calcium carbonate. The synthesis of CCMPs, from ISA, involves pretreatment that includes: the extraction of ferrous particles, and the removal of aluminum and silica. The synthesized CCMPs were characterized by sophisticated instruments for detailed information where UV-Vis spectroscopy (UV-Vis), exhibited absorption peaks for calcium carbonate at 210 nm, while dynamic light scattering (DLS) was shown that the average particle size is 1280 nm. Fourier transform infrared (FTIR) and x-ray diffraction (XRD) confirmed the microcrystalline nature of the particles, where FTIR showed bands in the 1800-700 cm-1 range. Both FESEM and TEM revealed the rhombohedral shape of the CCMPs whose size varied from 0.5 µm to 6 µm and purity was 94-96%. Finally, calcium carbonate particles efficiency was analyzed for the remediation of methyl red dye from the aqueous solution and about 48% dye was removed within one hour only.
... Incense sticks are used to generate smoke. Smoke is majorly a combination of Carbon Monoxide, Carbon Dioxide, Nitrogen Dioxide and Sulfur Dioxide as well as other gases in small quantity [23]. ...
Full-text available
The detection of gas leakages is a crucial aspect to be considered in the chemical industries, coal mines, home applications, etc. Early detection and identification of the type of gas is required to avoid damage to human lives and the environment. The MultimodalGasData presented in this paper is a novel collection of simultaneous data samples taken using seven different gas-detecting sensors and a thermal imaging camera. The low-cost sensors are generally less sensitive and less reliable; hence, they are unable to detect the gases from a longer distance. A thermal camera that can sense the temperature changes is also used while collecting the present multimodal dataset to overcome the drawback of using only the sensors for detecting gases. This multimodal dataset has a total of 6400 samples, including 1600 samples per class for smoke, perfume, a mixture of smoke and perfume, and a neutral environment. The dataset is helpful for the researchers and system developers to develop and train the state-of-the-art artificial intelligence models and systems.
... However, it is possible to find studies with higher particles concentrations, such as the one developed by Chao and Wong (2002) where PM 2.5 (mean) levels of 45 μg/m 3 were measured due to smoking, cooking, and burning incense practices. Lin et al. (2008) showed that incense burning generates PM>45 mg/g compared to 10 mg/g from cigarette burning. A review study revealed relationships between PM emissions and some important cooking variables as cooking method, cooking oil employed, cooking pan, food being cooked, cooking temperature, energy source, additives, and source surface area (Amouei Torkmahalleh et al. 2017). ...
... One such highly underestimated material is incense sticks ash (ISA), which is the residual product of incense sticks generated after combustion at religious places and houses. India secures 4th position in exporting incense sticks and 3rd position in consumption of incense sticks [9,10]. The black-colored incense sticks have coal or charcoal powder, as a burning agent for the incense sticks [4]. ...
Full-text available
Incense stick ash (ISA) has traces of toxic heavy metals which have an adverse effect on the environment. Every year, tonnes of ISA are disposed of in rivers and other water bodies which leads to water pollution and affects the natural water resources. ISA has several value-added minerals which could be modified or functionalized for environmental cleanup. Here, in the current research work, ISA was transformed into a flower-like noble porous material by mixing ISA and NaOH in a 1 : 1 ratio followed by calcination at 600°C for six hours in a muffle furnace. The developed material was analyzed by sophisticated instruments for the identification of the properties. The microscopic techniques revealed the micron-sized flower-like structure, while the XRD showed peaks at 30–33° which indicates the transformation of the calcite and silicate phases into new-phase mineral. FTIR also revealed bands in regions of 500–1200 cm−1 and new bands near 450 cm−1. EDS confirmed the presence of Na in the sintered product and the transformation of the ISA. Finally, the sintered product potential was assayed for the removal of methylene blue dye from wastewater using an adsorption mechanism. The removal efficiency of dye reached up to 70% within one hour only. It was found that the ISA sintered product has the potential to remove MB dye efficiently from wastewater and also reduce solid waste pollution. Microculture tetrazolium assay (MTT) and lactate dehydrogenase (LDH) assays were performed to evaluate the cytotoxicity of the sintered incense stick ash product on RTG-2 cells. The sintered incense stick ash product induced cytotoxicity on RTG-2 cells in a dose-dependent manner. Sintered ISA products have the potential to remove methylene blue dye efficiently from wastewater and reduce solid waste pollution.
... The overall results was confirmed that C, O and N are three elements on the contaminated air PM surface and that the PM surface contained 58.5% carbon, 36.1% oxygen and 5.4% nitrogen, respectively. Chong et al. 41 reported that three elements had PM 2.5 capture surfaces. ...
Full-text available
In recent years, introducing electrospun airfilters to enhance the removal of PM2.5 and PM10–2.5 has received much interest. In this study, a novel poly-(vinyl) alcohol (PVA)/carbon nanoparticle (CNP)/tea leaf extract (TLE), functionalized nanofibrous air filter (FNA) was fabricated using an electrospinning method. Novelty of the unique work in the blending of CNP and TLE, first of its kind, for the preparation of FNA. Polysaccharide crosslinked FNA has a carbon complex with two monosaccharide units to produce the intrinsic properties of the PM2.5 and PM10–2.5 removal efficiency. The FNA had promising traits of UV protection. The prepared FNA was characterized using physicochemical, mechanical, antimicrobial activity, etc., in addition to its PM2.5 and PM10–2.5 removal efficiency. Pore size and distribution study using the capillary flow porometry method has proved the structure of FNA. FNA exhibited excellent low pressure drop (110 Pa), which are promising characteristics for air purification. FNA from PVA: CNP: TLE exhibited high PM2.5 and PM10–2.5 removal efficiencies of 99.25% and 99.29%, respectively. Hence, the study proved.
The recent Coronavirus Disease 2019 pandemic has highlighted the importance of indoor ventilation. In particular, ventilation is crucial in residential spaces and workspaces, where people spent most of their day. Natural ventilation is a cost-effective method for improving indoor ventilation. It can provide safe and comfortable residential and working environments without additional energy consumption. In this study, the ventilation performance was experimentally studied by measuring the concentration of ultrafine particulate matter according to the opening conditions of the windows and door of an office model in a wind tunnel. Furthermore, the internal flow structure in the office model was quantitatively analyzed through particle image velocimetry to determine the factors that affected the ventilation performance. The mean velocity inside the model and the ventilation performance increased with the opening angle of the windows. In particular, the opening condition of the door strongly affected the ventilation performance. This study is expected to provide a guideline for effectively improving the ventilation performance in indoor spaces.
Incense burning is common in Asia including China. Research investigating the association between household incense burning and children's neurodevelopment is scarce. We aimed to examine this association in Chinese children. In 2019, we randomly enrolled 8293 children aged 6–12 years from 5 elementary schools in Guangzhou, southern China. Information on duration and frequency of household incense burning was collected using a questionnaire. Children's executive function was evaluated using the parental report of the Behavioral Rating Inventory of Executive Function. A general linear model was used to assess the associations between incense burning and executive function. Children who occasionally and frequently exposed to incense burning exhibited worse performance on executive function. For example, frequent incense burning was associated with increases in behavioral regulation index (BRI) of 1.77 (95%CI: 0.97, 2.58) points and metacognition index (MI) of 1.40 (95%CI: 0.60, 2.20) points, compared to never incense burning group. Parental smoking and household income were significant modifiers of the associations, with the stronger associations were observed in children having smoking parent(s) and poorer household income. The findings suggest that household incense burning was associated with poorer executive function, especially in children whose parent(s) were smokers and in those with low household income.
Full-text available
Sustainability entails addressing our demands without jeopardizing future generations' ability to meet their own needs. In September 2015, 193 United Nations Member States adopted the 17 Sustainable Development Goals (SDGs), also known as the Global Goals, as a universal call for action to eradicate poverty, safeguard the environment, and ensure that all people experience peace and prosperity by 2030. These 17 interconnected global goals and 169 targets will be tracked and reviewed using a set of global indicators that will serve as a "blueprint for achieving a better and more sustainable future for everybody." Sustainability is all about the effective management of natural resources. These resources are limited and critical to maintaining ecological balance. There is a range of ways that can be used to attain these goals, including climate-smart agriculture, various means for achieving food security for zero hunger, adoption of local food diversity and education for zero poverty, and the removal of environmental toxins from land. A collective effort is required to balance our socio-economic needs with environmental needs. As a result, the effort to generate work that covers all aspects of sustainability, as is the case here, must come from a diverse set of experts. This permits each discipline of study to provide its unique perspective to a very complex and vital subject that could otherwise be intractable. In the prologue, the writers remind readers that the text does not always convey a self-contained set of ideas. Rather, within the broader documentation of Sustainability and Science, a degree of variability is accepted. This is unusual for an academic text, yet it is required in this case. The reason for this is that contemporary environmental issues are both time-sensitive and dynamic, and a perfect understanding does not exist and may never exist. However, the difficulties must be handled in good faith, on time, and with the best science available. As humanity fights to understand and tackle the great environmental concerns of our day, it is my sincerest hope that this effort, which is freely and extensively shared, will serve as an educational milestone. Furthermore, the text Strategies to Achieve Sustainable Development Goals (SDGs): A Road Map for Global Development contributes to the intellectual foundation that will enable students to become the engines that will propel and maintain society on the path of sustainability and sustainable development through the difficult process of change alluded in “Our Common Future’’. A brief chapter-by-chapter description is as follows: In Chapter 1, Thakur Prasad Yadav, Rajani Srivastava and Kalpana Awasthi have presented an innovative and sustainable approach for E-waste management through mechanical milling. E-waste is something that contains harmful compounds that, if not properly controlled, could harm human health and the environment. They also discussed various methods for recovering metals from e-waste. Manish Mathur and Preet Mathur in Chapter 2 discussed land restoration as key to sustainable prosperity and provide holistic information on different aspects of halophytes, specifically regarding the genus Haloxylon. Chapter 3 discusses cyanobacteria, a third-generation renewable energy resource that does not conflict with our food supply. It helps attain UN-SDGs especially goal 7 i.e., access to affordable, reliable, sustainable and modern energy for all. Chapter 4, written by Sonam Gupta and Pradeep Kumar, describes the current state of biodiversity, the reasons for the decline and the interconnections between biodiversity and food security. It also discusses the importance of soil biodiversity as well as how the agricultural system contributes to biodiversity loss. Chapter 5 deals with microbial biomass and suggests it as a sustainable approach to restoring degraded soil. Microorganisms present in soil can bio-mineralize or bio-transform the contaminants into simpler, less toxic, or immobile forms. This chapter is written by Gitanjali. Anupriya Singh and others have given their research output in Chapter 6. Their study provides comprehensive information about Arbuda (cancer) and its probable remedy through Ayurveda and fulfilling the SDG 3. Chapter 7 describes combating the menace of indoor air pollution for sustainable life. The authors emphasized the replacement of conventional stoves and fuel with much more efficient ones. Chapter 8 represents the development of natural farming systems as eco-tourism, a newly emerging concept in tourism, fusing environmental protection, cultural awareness, and low impact travel with the provisioning of employment generation. Mishra and coauthors in their chapter presented agro-eco-tourism models to improve the farm income and the socio-economic status of the farmers of rural areas is required while preserving the biodiversity and ensuring sustainable growth. Chapter 9 covers the wide area of the impact of crop residue/stubble burning on human, environment and soil health along with its possible management. According to Siddique and Sai Mentada in their chapter, crop residue can be utilized efficiently as a source of biofuel, biochar, bio-oil and cattle feed. In Chapter 10, Dwivedi, Srivastava and Vijai Krishna give an overview of sustainable plant nutrition and soil carbon sequestration. They reviewed the basic mechanism leading to carbon stabilization in soils and new practices and technological developments in agricultural and cropland sciences for carbon sequestration. Chapter 11 intends to offer insight into the underpinnings of ‘place making’ through exploring diverse perspectives related to the concept. This chapter also seeks to identify the nexus between placemaking and urban tourism and attempt to recognize major ways in which it can contribute to achieving the goals of sustainability. Ranjana Tiwari in Chapter 12 emphasized that a healthy and long life is the first requirement of humans. She stresses the outlook of health from a psychological perspective and according to her, good mental health and well-being are strategies to attain sustainability. Chapter 13 gives an overview of the potentiality of cyanobacteria and its application in wastewater management. According to Tripti Kanda and coauthors, cyanobacteria can be used as an innovative solution for a sustainable ecosystem. Gender equality is an important goal among 17 SDGs; Chapter 14 discussed this in the Indian context. Chapter 15 is presented by Rekha Srivastava, where she discussed challenges of mental health and prevention, the importance of healthy life and achieving SDGs. Chapter 16 explores the field of biofortification, innovative technology and strategies to remove malnutrition and achieve different UN-SDGs like Goal 2 (Zero hunger), Goal 3 (good health and well-being), Goal 12 (responsible consumption and production) and Goal 13 (Climate Action). This strategy will not only reduce the number of severely malnourished people who require complementary interventions but will also assist them in maintaining their improved nutritional status. Chapter 17 discussed the efficiency of ecotourism. According to the author, it should promote sustainable development by establishing a long-term productive base that benefits both residents and ecotourism providers. Srishti, Alok and Gopal Nath in Chapter 18 presented phage therapy, a new way for the treatment of multidrug-resistant bacteria. According to them, phage therapy might be a good alternative to antimicrobial chemotherapy and helpful in achieving good health and well-being which is goal 3 of UN-SDGs.
Ambient air pollution is one of the treacherous and malign problems facing humanity and other living beings on the earth today. Although the air pollutants such as particulate matters (PM) and microscopic contaminants have been associated with widespread morbidity and mortality, studies have also indicated those pollutants as a potential synergist to respiratory infirmities in both adults and children. Many viral contaminants have also been reported as potential detriments of respiratory distresses. Exposure to poor grades of ambient air can lead to numerous health consequences, such as adverse effects on the lung, heart, and other vital organs. In recent years, many studies infer that pollution along with viral contaminants impart substantial worldwide burden of diseases on human beings. Excessive air suspended pollutants such as micro or nanoparticulate matters bring down the life expectancy of human beings in many ways. Regardless of the passage of entry, fine and ultrafine PM that enter into systemic circulation affect vascular endothelial cells by producing local oxidative stress and have the capacity to cross biological barriers, thereby creating numerous deleterious effects on vital organs. Pollution-induced systemic inflammation is mediated by proinflammatory cytokines such as interleukin-6, interleukin-1 β, and tumor necrotic factor-α. These systemic inflammatory mediators are implicated in causing or exacerbating many complications in the human body. This article is an attempt to accentuate the pollution-linked health impediments, as well as the fountainheads of ambient air pollution so that some effective strategies can be developed to manage this global peril.
Background Previous shreds of evidence have suggested that ambient air pollution is negatively associated with cognitive health among older adults, but whether indoor air pollutants such as cooking fuel, tobacco smoke, and incense burning exposure affect the cognitive score is unknown, especially in limited-resource areas. Method The study has utilized the recently released data from the Longitudinal Ageing Study of India (LASI), Wave 1, conducted from 2017 to 2018. A total of 63,883 (≥45 years) older adults was considered for the analysis. Descriptive statistics and bivariate analysis and ordinary least squares regression were employed in the study. Results The estimated mean cognitive score was 25.4 and the percentage of solid fuel users was 45.6 in India. The cognitive score gap between the two groups was more remarkable in Tamil Nadu (clean fuels: 29.7; solid fuels: 23.9). A significant cognitive score gap was observed for all indoor air pollutants, i.e., cooking fuel (clean: 29.7 and solid fuels: 23.9), exposed to tobacco smoke (not exposed: 24.4 and exposed: 19.8), and exposed to daily incense burning (not exposed: 23.6 and exposed: 22.6). The unadjusted model found that a one-unit increase of using charcoal/lignite/coal reduces the cognitive score by 5 (95% CI: −5.36, −4.61). A similar effect of exposed to tobacco smoke (β = −0.79, 95% CI: −0.89, −0.68) and incense burning (β = −0.28, 95% CI: −0.30, −0.26) was explored in the study. After adjusting socioeconomic and demographic characteristics, indoor air pollution was found to be a significant determinant of cognitive health. Conclusions The study has identified exposure to indoor air pollution as a risk factor for cognitive impairment among older adults. Therefore, we suggest an urgent need of promoting existing schemes like the Pradhan Mantri Ujjwala Yojana and making awareness about the adverse effects of indoor air pollutants for a better future.
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This article summarizes epidemiological evidence of health effects of particulate air pollution. Acute exposure to elevated levels of particulate air pollution has been associated with increased cardiopulmonary mortality, increased hospitalization for respiratory disease, exacerbation of asthma, increased incidence and duration of respiratory symptoms, declines in lung function, and restricted activity. Small deficits in lung function, higher risk of chronic respiratory disease and symptoms, and increased mortality have also been associated with chronic exposure to respirable particulate air pollution. Health effects have been observed at levels common to many U.S. cites and at levels below current US. National Ambient Air Quality Standards. Although the biological mechanisms involved are poorly understood, recent epidemiological evidence supports the hypothesis that respirable particulate air pollution is an important risk factor for respiratory disease and cardiopulmonary mortality.
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Burning incense to pay homage to deities is common in Chinese homes and temples. Air samples were collected and analyzed for carbonyls from a home and a temple in Hong Kong where incense burning occurs on a daily basis. Carbonyls in the air were trapped on a solid sorbent coated with O-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine, followed by thermal desorption and subsequent GC/MS analysis. The carbonyls identified include formaldehyde, acetaldehyde, acrolein, 2-furfural, benzaldehyde, glyoxal, and methylglyoxal. The levels of the above carbonyls correlate with the intensity of the incense-burning activities. The total mixing ratios of the carbonyls in the temple exceed those in the ambient air outside the temple by 11–23 times. Formaldehyde is the most abundant species, contributing to approximately 55% of the total carbonyl mixing ratios in both the temple and the home environments during incense burning. The mixing ratio of formaldehyde ranges from 108 to 346 ppbv in the temple and averages 103 ppbv in the home during incense burning. These values exceed the World Health Organization (WHO) air quality guideline of 100 µg m−3 (88 ppbv) for formaldehyde. The highest formaldehyde level in the temple exceeds the WHO guideline by 3 times at peak incense burning hours. The mixing ratio of acrolein in the temple ranges from 20 to 99 ppbv, approaching or exceeding the WHO air quality guideline of 50 µg m−3 (22 ppbv) for acrolein. Our measurements indicate that incense burning significantly elevates the concentrations of a number of carbonyls, most notably formaldehyde and acrolein, in the surrounding environments. This study provides preliminary insights on indoor air quality problems created by incense burning.
The effects of environmental lead exposure on the human immune system were examined in a population of young children from SpringfieldGreens county, Missouri. A survey of selected parameters is in progress; reported here are data from 202 children with blood lead levels ranging from 1-45 /jg/dl. Cell populations have been examined for distribution and levels of activation markers; serum has been analyzed for IgE, specific titers to vaccines, SCD25, and IL4, Variation of parameters with age was considered in statistical analysis of data. The previously reported statistically significant difference in levels of IgE is affirmed in this larger population (p=0.0004); as blood lead (PbB) level increases, IgE level increases. No other statistically significant differences were found. Preliminary evaluation of levels of the cytokine IL4 in a subgroup of this population showed no correlations with IgE or PbB. This suggests that lead may be acting directly at the level of the B cell.
Conference Paper
The paper gives results of testing five types of candles, purchased from local stores, for fine particulate matter (PM) emissions under close-to-realistic conditions in a research house. The test method allows for determination of both the emission and deposition rates. Most test revealed low PM emission rates: in only two was there excessive sooting, with thye PM concentration approaching 1000 micrograms per cubic meter with six and nine burning wocks. Wax breakthrough significantly increased the emissions rate. Smoldering generated more fine PM than several hours of normal burning, causing very high concentrations in a short period of time, which raises concern with potentially acute health effects, especially for children and the elderly. A simple source model is proposed to represent both the stable PM emissions during normal combustion conditions and the sudden concentration surge following flame extinction.
The concentration of carcinogens in the airborne dust of 33 homes in Hong Kong was studied to identify the sources and measure the amounts of 7 polynuclear aromatic hydrocarbons (PAH) including benzo(a)pyrene. The 24 hr samples were collected from kitchens and living rooms of working class homes and analyzed by HPLC. The mean levels of PAH in air and dust were comparatively low, with cooking fires and incense associated with significant increases, and window ventilating fans with significant decreases in PAH concentrations. Perceived pollution sources like water heaters, cigarette smoke, and stir‐fry cooking, led to reduced airborne PAH levels because human responses to these emission sources were to increase natural and mechanical ventilation. The data indicated that compensation behaviours can over‐ride the effects of emission sources, and help explain why measures of increased ventilation from open windows and doors were generally associated with higher PAH levels. The results of this study show that indoor air quality in homes varies with cultural practices, behavioural responses, and climate.
Incense is a common source of indoor air pollution, especially in Asian homes where it is burned for religious reasons. In previous studies in Hong Kong, it was found to be the major source of airborne carcinogens in the home, and a significant contributor to personal exposures to nitrogen dioxide among wom en. To evaluate its effects on respiratory health, data from an air pollution cross-sectional study of 346 primary school children and their 293 non-smok ing mothers, and a lung cancer case-control study of 189 female patients and 197 district matched controls who had ever been married were analysed. No association was found between exposure to incense burning and respiratory symptoms like chronic cough, chronic sputum, chronic bronchitis, runny nose, wheezing, asthma, allergic rhinitis, or pneumonia among the three popu lations studied: i.e. primary school children, their non-smoking mothers, or a group of older non-smoking female controls. Incense burning did not affect lung cancer risk among non-smokers, but it significantly reduced risk among smokers, even after adjusting for lifetime smoking amount. A possible expla nation for this unexpected finding is that incense burning was associated with certain dietary habits, i.e. more fresh fish, more retinol, and less alcohol, which have been associated with lower lung cancer risk in this population. These results indicate that diet can be a significant confounder of epidemiological studies on air pollution and respiratory health.