Assessing the Feasibility of Indoor Air Quality Monitoring in Low-Income Housing Among Black Adults With Uncontrolled Asthma in New York City

Assessing the Feasibility of Indoor Air Quality Monitoring in Low-Income Housing Among Black Adults With Uncontrolled Asthma in New York City | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing the Feasibility of Indoor Air Quality Monitoring in Low-Income Housing Among Black Adults With Uncontrolled Asthma in New York City Maureen George, Rhea Kaur Khurana, Jean-Marie Bruzzese, Marija Zeremski, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9390070/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Indoor air quality (IAQ) plays a critical role in respiratory health, particularly among individuals with asthma. This study evaluated the feasibility of collecting and characterizing IAQ in the homes of Black adults with uncontrolled asthma in New York City. Methods Home environmental audits were conducted at the time that ultrasonic personal air sampling (UPAS v2+) devices were deployed, which continuously collected both time-resolved and integrated air samples over an initial target runtime of two-weeks based on the amp-hours of the external battery. Post-trial interviews were conducted. Results Thirty devices were successfully deployed and returned; all but five provided sufficient data for analysis for getting a multi-day exposure estimates defined as more than 4 consecutive days of data) for analysis. Average runtime was 13.4 days and mean PM 2.5 was 72 µg/m 3 which is double the Environmental Protection Agency’s cutoff of 35.5 µg/m 3 , a 24-hour average used to assess exposure and risk. Exposure to household environmental triggers was common. Study procedures were acceptable to participants, demonstrating the feasibility of collecting indoor air samples in apartments of adults with uncontrolled asthma. Conclusions Elevated indoor PM 2.5 levels and frequent exposure to environmental triggers were common and may contribute to poor asthma control. Trial registration This feasibility study was conducted in NYC, New York, as an administrative supplement to a randomized controlled trial (RCT) (#NCT05685381; registered 1/5/23). Environmental audit particulate matter respiratory health disparities urban health Figures Figure 1 Background Increasing evidence identifies fine particulate matter (PM 2.5 ), nitrogen-based air pollutants, and ozone (O₃), as hazardous to human health, primarily due to their role in driving airway inflammation and hyperresponsiveness. Fine particulate matter (PM 2.5 ), which consists of hundreds of chemical constituents, can penetrate deep into the lungs and represents one of the greatest risks to respiratory health ( 1 ). Indoor air quality (IAQ) is particularly important to health as 90% of time is spent indoors ( 2 ) and remediation can be effective ( 3 ). Methane, a potent greenhouse gas (GHG), is the primary component of natural gas ( 4 ) and gas appliances are the main residential source of PM 2.5 ( 5 ). While appliances can be vented outdoors, gas stoves are largely unvented. More than 40% of all homes in the United States use either natural gas or propane as their stove’s fuel source ( 6 ), with use in New York City (NYC) being much higher (> 62%) ( 7 , 8 ). Those most vulnerable to indoor air pollution are those who live in homes with gas appliances that are inadequately vented ( 9 ). Although NYC enacted a natural gas ban for new housing in December 2021 ( 10 ), this will have little effect on the older housing stock that dominates NYC residential living spaces. Older apartment buildings commonly feature kitchens that open directly into living areas and lack properly functioning, externally vented range hoods, which may contribute to poor indoor air quality. Combustion of natural gas, particularly in the presence of other combustible sources such as environmental tobacco or marijuana smoke, incense or candle burning, and the use of aromatherapy diffusers generates a range of indoor air pollutants. Public housing apartments frequently experience additional indoor air quality challenges—including inadequate ventilation, moisture and mold, pest infestations, environmental tobacco smoke and pollutant transfer between units—all of which may exacerbate asthma symptoms ( 11 ) ( 12 ). Indoor pollutants may also originate from outdoor sources that infiltrate the home through open windows or building leakage ( 12 ). Individuals with respiratory conditions such as asthma are particularly susceptible to adverse health effects from poor indoor air quality (IAQ), which may be exacerbated by gas stoves and other indoor environmental triggers. Poor IAQ is a well-documented cause of suboptimal pediatric respiratory health ( 12 , 13 ). However, less is known about the impact of poor IAQ on adults with uncontrolled asthma. Asthma is a common chronic condition affecting more than 20 million American adults. Those living below the poverty level have higher asthma prevalence relative to those living above the poverty level ( 14 ). Relative to non-Hispanic White and Hispanic adults, Black adults have the highest asthma prevalence (8.5% v. 11.5% v. 12.8%, respectively) ( 14 ). While nearly 40% of all adults with asthma have uncontrolled disease ( 15 ), more than 90% of those with severe asthma do not have controlled asthma ( 16 ). This leads to a high ED visit rate of adults with asthma of 27.8 per 10,000 individuals( 15 ). Black adults experience more severe disease and higher rates of uncontrolled asthma compared to other racial and ethnic groups ( 17 – 19 ). With this greater disease burden, it is unsurprising that Black adults die from asthma at a much higher rate than White and Hispanic adults (22.7 v. 8.1 v. 7.1/million, respectively) ( 15 ). Adults also die from asthma at nearly six times the rate of children with asthma ( 20 ). Despite higher asthma prevalence and mortality among adults, prior IAQ studies have largely focused on children’s exposures in homes and schools ( 21 – 32 )Therefore, the primary aim of this feasibility study was to sample and characterize IAQ triggers in low-income NYC residences of Black adults with uncontrolled asthma. Methods Study location This feasibility study was conducted in NYC, New York, as an administrative supplement to a randomized controlled trial (RCT) (#NCT05685381). Recruitment Participants were recruited if they had participated in a pre-trial interview or were screened and determined to be eligible for participation in the parent RCT. Eligibility criteria included ( 1 ) aged 18 or older, ( 2 ) self-identified Black race (African American (AA), Black or AA/ Black and Hispanic or other race), ( 3 ) uncontrolled asthma as measured by an Asthma Control Questionnaire [ACQ] score ≥ 1.5 ( 33 ), and ( 4 ) receiving asthma care at a Federally Qualified Health Center (FQHC) in NYC that are members of Clinical Directors Network (CDN) primary care practice-based research network (PBRN). Methods The study components included a two-week period of home IAQ monitoring, an environmental audit of indoor triggers, and a post-monitoring interview. UPAS v2 + Deployment An Ultrasonic Personal Air Sampler v2+ (UPAS v2+; Access Sensor Technologies, Fort Collins, CO) was deployed by study personnel in the primary living area of the participants’ residence to measure small particulate matter (PM 2.5 µg/m³) among other IAQ components. The UPAS v2 + continuously estimates PM 2.5 concentrations using a light-scattering optical sensor and includes an integrated filter that allows calibration of the continuous measurements to the gravimetrically derived integrated PM 2.5 levels ( 1 , 34 ). An accelerometer in the UPAS v2 + can determine activity level and location compliance e.g., the device’s movement after deployment and low-cost sensors measure other components of indoor air e.g., carbon dioxide, nitrogen dioxide, and volatile organic compounds. Earlier prototypes of the monitor have been validated for PM 2.5 ( 35 – 37 ). The UPAS v2 + is a lightweight, cell-phone sized unit that is easier to deploy and maintain compared to earlier models. A combination of plug-in and battery-powered units were used in this study. For the original plug-in units and the battery-operated units, a 3-d printed holder was constructed to secure the UPAS v2 + upright and conceal the on/off button so that participant families could not turn the UPAS v2 + off. For the battery-operated unit, a plastic box enclosed a 67 AmpHr external battery to extend the runtime of the monitor whose internal battery of 6.7 AmpHr allows 48-hour run time at 20% duty cycle on the filter. When the external battery failed to meet the 2-week target runtime, it was eventually modified to allow charging of the external battery during deployment periods such that the external battery was acting as an uninterruptable power supply that could cover 8 days of power outage. Home Environmental Audit A home environmental audit was conducted at the time of UPAS v2 + deployment and included a visual inspection of the residence to document the presence and type of stoves and ovens (gas or electric), their functionality, and the presence of exhaust fans or range hoods. An investigator-developed survey included objective assessments of the home conducted by the research staff and self-reported answers to staff administered questions, such as self-reported frequency of gas stove use, presence of environmental tobacco smoke (ETS), use of aromatherapy diffusers, incense or scented candles, and the location and opening of windows facing major or minor roadways (see Supplemental Table 1 ). Post-monitoring Interview A semi-structured interview, guided by constructs from the Theoretical Framework of Acceptability—including burden, user experience, attitudes, and participation intentions—was conducted via a HIPAA-compliant Zoom dial-in conference call (audio-only) following UPAS v2 + retrieval to evaluate participant satisfaction with and acceptability of the IAQ monitoring protocol. All interviews were audio-recorded for analysis. Post-trial protocol amendment Because several apartments had elevated PM 2.5 levels, the study team implemented a post-trial protocol amendment to return results to participants, consisting of a grade-school reading level handout on free or low-cost strategies to improve IAQ, local and state remediation resources, as well as a prototype infographic illustrating their home air quality levels relative to established safe exposure thresholds. Quantitative analysis Field blanks were taken when deploying devices in three participants’ homes to confirm that the samples were free from contamination. To confirm the precision of the samplers, duplicate samples were taken in three study team members’ homes. Filters from UPAS v2 + underwent gravimetric analysis using pre- and post-weighed filters to accurately determine the mass of particulate matter (citation). The raw PM 2.5 score was then multiplied by a gravimetric correction ratio, which is the gravimetric PM 2.5 concentration based on the difference in weight of filter before and after sampling divided by the volume of air passing through the filter, divided by the average of the sensor-based PM 2.5 . The normal distribution assumption was checked, and non-parametric methods were applied to skewed distributions, therefore associations between PM 2.5 levels and exposure to household environmental triggers were tested using the Mann-Whitney U test. Qualitative analysis All audio files were transcribed. Directed coding to identify constructs of the Theoretical Framework of Acceptability ( 38 ) was performed. Ethical review and compensation The study was approved by WCG IRB (Tracking ID: 20211166). All participants provided informed consent in accordance with institutional review board–approved procedures. Participants received $ 40 at time of deployment and completion of the home environmental audit and $ 60 at the time of UPAS v2 + retrieval (total payment $ 100). Interviews were conducted using Zoom conference call feature initiated by either the study staff at the time of UPAS v2 + retrieval or by the research team within one week of retrieval. Results Sample The sample consisted of 30 participants (90% female) with a mean age of 53 years (SD = 13, range 26–70). Mean Asthma Control Questionnaire (ACQ) score was 2.9 (SD = 0.93; scale = 0–6; uncontrolled asthma is ≥ 1.5). See Table 1 for additional details. Table 1 Characteristics of participants’ homes Home Type N (n = 30) Percent (%) Apartment 27 90 Brownstone 2 7 Single Family Home 1 3 Height from street (floor #)* 0–2 10 33 3–5 9 30 6–8 8 27 Stove Type and Function Gas, working 22 73 Gas, not working 1 3 Electric, working 7 23 Electric, not working 0 0 Kitchen ventilation present (function not assessed) 15 50 Kitchen contiguous with living area 27 90 Windows facing minor arteries 0–1 23 77 2–3 7 23 Windows facing major arteries 0–1 15 50 2–3 7 23 4+ 8 27 Years living in the home 0–1 years 2 7 2–3 years 5 17 4+ 23 76 *missing data Twenty-seven (90%) participants lived in apartments and 10 (33%) lived in subsidized housing (New York City Housing Authority – NYCHA). NYCHA, who provides housing to economically disadvantaged households, also known as Section 8 housing), administers the largest Section 8 program in the United States with over 25,000 property owners and 177,565 apartments across 2,410 buildings( 39 ). Feasibility trial All participants completed all three components of the study: two weeks of IAQ home monitoring, a home environmental audit, and post-monitoring interview (100% retention). UPAS v2 + performance The goal was to collect a minimum of four days of usable data. At the start of the study, engineering units, powered by a wall socket, were the primary UPAS v2 + unit used for the study. The plug-in units were occasionally disconnected from power by the participants. Therefore, after the seventh deployment, the team began to deploy battery-powered units to address accidental unplugging and/or unexpected unit failure. Twenty-five units provided usable data and five did not (83% IAQ data collection completion). The average run time for the IAQ monitors was 13.4 days. IAQ sampling Field blanks had a net mass change of 2.3 µg which represented 1.2% of the median mass of PM2.5 collected on the sample filters and less than 6% of smallest mass collected. The average gravimetric PM 2.5 levels from the 25 units providing usable data (median run time of 13.4 days) was 72.2 µg/m 3 (SD = 46.1), well above the Environmental Protection Agency’s (EPA) 24-hour guideline value of 35 µg/m 3 and 8 times higher than the annual average standard of 9 µg/m 3 ( 40 ). Using the EPA’s Air Quality Index as a guideline for interpreting 24-hour fine particulate matter exposure ( 40 ), a cutoff of 35.5 µg/m 3 was selected to indicate poor indoor air quality for sensitive groups. Using this threshold, 15 participants (60%) had unhealthy household PM 2.5 levels, with 3 of these homes having their deployment period average PM 2.5 concentrations > 125 ug/m 3 (placing them in the unhealthy or hazardous categories). Using the annual standard, 100% or all of the participants homes had elevated levels. PM 2.5 measurements categorized by EPA Air Quality Index levels are presented in Table 2 . Table 2 Household average PM2.5 categorized by EPA air quality index guidelines (n = 25) PM 2.5 range (µg/m 3 ) Levels of concern n (%) 0.0–12.0 Good 2 ( 8 ) 12.1–35.4 Moderate 8 ( 32 ) 35.5–55.4 Unhealthy for sensitive groups 7 ( 28 ) 55.5-125.4 Unhealthy 5 ( 20 ) 125.5-225.5 Very unhealthy 2 ( 8 ) 225.5+ Hazardous 1 ( 4 ) The continuous PM 2.5 sensor data was corrected by multiplying each value of a deployment by its gravimetric correction ratio. The distribution of gravimetrically corrected continuous sensor data for PM2.5 measured inside each home is shown in Fig. 1. The data displays the large range in 30 second average concentrations with many homes seeing repeated concentration peaks in the hundreds of µg/m 3 and a few homes seeing average concentrations across the entire deployment period in the hundreds of µg/m 3 . Household environmental triggers As shown in Table 3 , participants reported multiple sources of indoor PM 2.5 . Frequent use of gas stoves and frequent opening of windows facing major arterial roadways were common, each reported by more than 50% of participants. Incense or candle burning was reported by nine participants (30%), and exposure to environmental tobacco smoke (ETS) was reported by ten (33%). A significant association was observed between household PM 2.5 levels and the use of aromatherapy products in the home (p = 0.007). Table 3 Prevalence of environmental household triggers and its association with PM2.5 levels (n = 25) Triggers N out of 30 participants (%) N out of 25 with ≥ 4 days of IAQ data (%) Mean PM 2.5 (µg/m 3 ) SD IQR U statistic † p-value † Frequent use of gas stove 19 (63) 15 (60) 48.43 25.46 39.7 74.00 .956 Aromatherapy/scented candles/essential oil use 9 ( 30 ) 8 ( 32 ) 134.11 159.95 101.25 22.00 .007* Environmental Tobacco Smoke 10 ( 33 ) 8 ( 32 ) 56.15 39.76 42.25 66.00 .907 Frequent window-opening facing major artery 16 ( 53 ) 15 (60) 59.57 54.53 62.2 71.00 .824 *p < 0.05 † Mann-Whitney U Test Post-monitoring interviews Most participants (n = 21; 93%) found the IAQ sampling protocol acceptable. Concerns included potential surreptitious recording (n = 2; 7%) and minor device issues (n = 5; 17%). Receiving IAQ results was considered valuable by 24 participants (80%), and 20 (67%) reported study benefits such as increased awareness of asthma triggers, reduced smoking, and compensation. All but two participants (93%) would recommend the study to others with asthma. Six participants (20%) linked IAQ to climate change, while most (n = 16; 53%) associated it only to asthma control. Two individuals cited unconventional explanations for climate change. Post-trial protocol amendment A post-trial protocol amendment enabled the study team to provide participants living in homes with high PM 2.5 levels (i.e., > 35.5 µg/m³) with their results, low literacy educational materials, including a prototype infographic of their indoor PM 2.5 levels, as well as free or low-cost strategies to improve indoor air quality, and references to local and state remediation resources. Of the 15 participants who had unhealthy household PM 2.5 levels, 13 (87%) consented to receive their results. All 13 received the infographic and the educational/resource sheet and nine (60%) scheduled a counseling session about their results with the Principal Investigator. During these sessions, participants reported substantially higher exposure to indoor triggers than initially indicated on the environmental audit intake form. Two participants with exceptionally high PM 2.5 levels in their homes (> 200 µg/m³) were offered a second two-week UPAS v2 + sampling period, and both agreed. Both homes showed improvements in PM 2.5 concentrations compared to the initial measurements. Although both homes continued to have unhealthy PM 2.5 levels, one participant’s mean PM 2.5 decreased from 212.0 µg/m³ to 69.0 µg/m³, while the second participant’s mean PM 2.5 decreased from 505.6 µg/m³ to 161.5 µg/m³. One participant reported that the initial IAQ monitoring increased her sensitivity to environmental tobacco smoke (ETS) and led her to reduce secondhand smoke exposure in her home, a possible explanation for the reduced PM 2.5 seen. Discussion To the best of our knowledge, the indoor air quality of low-income households in NYC among Black adults with uncontrolled asthma has not been previously studied. This study demonstrated the feasibility of conducting IAQ monitoring in this population. Participants found the study procedures acceptable and wanted to know their IAQ results despite there being no plan to return results in the original feasibility trial. Our findings found high PM 2.5 levels and exposure to environmental triggers in these homes, highlighting the need for larger studies focused on mitigating these hazards. Our study participants had an average indoor PM 2.5 level of 72.24 µg/m³, which is alarmingly high compared with the NYC average outdoor 24-hour PM 2.5 level of under 35 µg/m³, as measured through a combination of street-level and rooftop monitors ( 41 ). The higher-than-average PM 2.5 levels observed in this study were anticipated, given prior research showing that high-poverty neighborhoods in NYC often experience increased health risks ( 42 , 43 ), including PM 2.5 -attributable asthma emergency department visits 4.5 times higher in low-income neighborhoods compared to wealthier areas ( 44 ). Pediatric asthma studies have previously demonstrated that elevated indoor PM 2.5 exposure is associated with reduced peak expiratory flow rate, an increase in uncontrolled asthma and a higher number of asthma-related emergency visits ( 45 – 50 ). To the best of our knowledge, this is the first study to explore PM 2.5 levels in the homes of urban, low-income Black adults with uncontrolled asthma. Participants’ were exposed to numerous household environmental triggers, such as unvented gas stove use and environmental tobacco smoke, aligns with previous findings involving low-income housing and sociocultural practices contributing to indoor air pollution ( 51 , 52 ). A few studies in pediatric settings have highlighted certain household characteristics e.g., fungi diversity, dust, stove type that exacerbate asthma symptoms, suggesting a likely parallel in adult populations ( 46 , 53 – 55 ). By identifying significant associations between triggers and elevated particulate matter, our study extends the insights from children to adults. National guidelines ( 56 ) and global expert reports ( 57 ) outline critical components of asthma self-management education that largely focus on individual behaviors such as the use of controller medication, monitoring and response to symptoms, and avoidance and remediation of allergic environmental factors. If further evidence confirms the impact of indoor air quality on uncontrolled asthma, these triggers could become new targets for intervention and education that clinical guidelines could address. Participants expressed strong interest in receiving their IAQ results, which can be leveraged to support better asthma self-management and informed decision-making through reducing in-home triggers. Educational programs aimed at increasing awareness of practical strategies to mitigate indoor air pollutants would be particularly valuable for this population. As a first step, we developed a handout with local and state IAQ resources designed for individuals with lower health literacy, along with a prototype infographic to be further developed using participatory design principles. The success of conducting IAQ monitoring in this population underscores an opportunity for more comprehensive IAQ datasets, potentially providing more insight into IAQ’s role in disparities in adult asthma outcomes. Currently, there are consumer-grade low-cost indoor air quality monitors that allow for identifying air quality trends (i.e., increase in PM2.5 while cooking, or decrease in PM2.5 when using air purification), however IAQ monitors with filters that can provide real-time, gravimetrically corrected data are often costly( 58 , 59 ). Future research could support policies that prioritize air quality standards in residential buildings such as requiring installation, maintenance, and monitoring of working kitchen ventilation systems. Findings from this study also suggest that there is a unique opportunity for public health stakeholders to collaborate with public housing stakeholders to address indoor air quality as an important social determinant of health. Cross-sector partnerships may lead to more focused public awareness campaigns on practical steps to improve IAQ for Black adults with asthma. This study has several limitations. As a feasibility trial with only 30 participants, reported associations between household environmental triggers and PM 2.5 should be interpreted cautiously. These triggers were self-reported, and participants were not able to specify the type of aromatherapy used, if any, which may have been useful in further identifying contributors to PM 2.5 levels. Selection bias is possible, as participants were recruited from the same pool as our parent trial and may have been more willing to engage in research and/or had higher levels of poor IAQ. Additionally, unexpected malfunctions of the UPAS v2 + units resulted in variability in the amount of data collected per participant. While these technological issues were quickly resolved, this may limit the reproducibility of the protocol in other settings. Conclusions Our study demonstrated that collecting indoor air quality samples and characterizing household environmental triggers in NYC homes of low-income Black adults with uncontrolled asthma was both feasible and acceptable to participants. Future research should focus on larger cohort studies to establish more definitive associations between indoor air quality, household environmental triggers, asthma outcomes, and the impact of returning results along with actionable recommendations, as well as exploring the implementation of periodic IAQ monitoring by Medicaid and other insurers who would benefit from reducing emergency department visits due to poor IAQ. Abbreviations PM 2.5 Fine particulate matter with diameters of ≤ 2.5 micrometers IAQ Indoor air quality GHG Greenhouse gas NYC New York City ED Emergency department RCT Randomized controlled trial ACQ Asthma Control Questionnaire FQHC Federally Qualified Health Center UPAS v2+ Ultrasonic Personal Air Sampler, version 2+ ETS Environmental Tobacco Smoke SD Standard deviation NYCHA New York City Housing Authority EPA Environmental Protection Agency Declarations Author Contributions Maureen George: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resource Supervision, Validation, Writing- original draft, Writing- reviewing & editing; Rhea K. Khurana: Data curation, Project administration, Formal analysis, Writing – original draft, Writing- reviewing & editing; Jean-Marie. Bruzzese: Conceptualization, writing – reviewing & editing Marija Zeremski: Data curation, Investigation, Methodology, Project administration, Writing – reviewing & editing; Emily DiMango : Conceptualization, Investigation, Supervision, Validation, Writing- reviewing & editing; Aisha Naseem: Formal analysis, Writing – reviewing & editing , Andrea Cassells: Conceptualization, Data curation, Project administration, Resources, Supervision, Writing – review & editing ; Jonathan N. Tobin: Data curation, Investigation, Methodology, Project administration, Resources, Supervision, Writing- review & editing; Eunice Mak: Data curation, Project administration, Writing- original draft, Writing- review & editing; Steven Chillrud: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resource Supervision, Validation, Writing- original draft, Writing- reviewing & editing Funding This study was funded by a grant from the National Institutes of Health (NIH) (3R01NR0192 75-02S1, PI George). The content of this manuscript is the original work and solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Western Institutional Review Board (protocol # 20211166, initial approval 3/22/21). The study also received administrative approval by the Institutional Review Board of Columbia University (protocol #: AAAT0939, initial approval 4/22/22). Informed consent was obtained from all subjects involved in this study. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors report no conflicts of interest. Acknowledgements We wish to acknowledge the contribution of Mr. Anthony Rhabb who conducted all home visits and Dr. Nat Benda to the development of the IAQ infographic prototypes used in this study. We also wish to acknowledge James Ross and Shams Uddin Al Azad who assisted with IAQ analyses. References Zhang T, Chillrud SN, Ji J, Chen Y, Pitiranggon M, Li W, et al. Comparison of PM2.5 Exposure in Hazy and Non-Hazy Days in Nanjing, China. Aerosol Air Qual Res. 2017;17(9):2235–46. 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Measuring personal exposure to fine particulate matter (PM(2.5)) among rural Honduran women: A field evaluation of the Ultrasonic Personal Aerosol Sampler (UPAS). Environ Int. 2019;123:50–3. Wendt Hess J, Bachler G, Momin F, Sexton K. Assessing Agreement in Exposure Classification between Proximity-Based Metrics and Air Monitoring Data in Epidemiology Studies of Unconventional Resource Development. Int J Environ Res Public Health. 2019;16(17). Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. New York City Housing Authority, About NYCHA. [Available from: https://www.nyc.gov/site/nycha/about/developments.page United States Environmental Protection Agency. Particulate Matter (PM) Pollution 2025 [Available from: https://www.epa.gov/pm-pollution NYC.gov. Real-Time Air Quality: PM2.5 in NYC 2025 [Available from: https://a816-dohbesp.nyc.gov/IndicatorPublic/data-features/realtime-air-quality/ Colton MD, MacNaughton P, Vallarino J, Kane J, Bennett-Fripp M, Spengler JD, et al. Indoor Air Quality in Green Vs Conventional Multifamily Low-Income Housing. Environ Sci Technol. 2014;48(14):7833–41. Adamkiewicz G, Zota AR, Fabian MP, Chahine T, Julien R, Spengler JD, et al. Moving Environmental Justice Indoors: Understanding Structural Influences on Residential Exposure Patterns in Low-Income Communities. Am J Public Health. 2011;101(S1):S238–45. Kheirbek I, Wheeler K, Walters S, Kass D, Matte T. PM(2.5) and ozone health impacts and disparities in New York City: sensitivity to spatial and temporal resolution. Air Qual Atmos Health. 2013;6(2):473–86. Kim S, Lee J, Park S, Rudasingwa G, Lee S, Yu S et al. Association between Peak Expiratory Flow Rate and Exposure Level to Indoor PM2.5 in Asthmatic Children, Using Data from the Escort Intervention Study. Int J Environ Res Public Health [Internet]. 2020; 17(20). Singleton R, Salkoski AJ, Bulkow L, Fish C, Dobson J, Albertson L, et al. Housing characteristics and indoor air quality in households of Alaska Native children with chronic lung conditions. Indoor Air. 2017;27(2):478–86. Li Z, Xu X, Thompson LA, Gross HE, Shenkman EA, DeWalt DA, et al. Longitudinal Effect of Ambient Air Pollution and Pollen Exposure on Asthma Control: The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Study. Acad Pediatr. 2019;19(6):615–23. Mazenq J, Dubus J-C, Gaudart J, Charpin D, Nougairede A, Viudes G, et al. Air pollution and children’s asthma-related emergency hospital visits in southeastern France. Eur J Pediatrics. 2017;176(6):705–11. Pennington AF, Strickland MJ, Klein M, Zhai X, Bates JT, Drews-Botsch C, et al. Exposure to Mobile Source Air Pollution in Early-life and Childhood Asthma Incidence: The Kaiser Air Pollution and Pediatric Asthma Study. Epidemiology. 2018;29(1):22–30. Zhang Y, Yin X, Zheng X. The relationship between PM2.5 and the onset and exacerbation of childhood asthma: a short communication. Front Pediatr. 2023;11:1191852. Kadiri K, Turcotte D, Gore R, Bello A, Woskie SR. Determinants of Indoor NO(2) and PM(2.5) Concentration in Senior Housing with Gas Stoves. Toxics. 2024;12(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;17(23). Cochran SJ, Acosta L, Divjan A, Lemons AR, Rundle AG, Miller RL, et al. Fungal diversity in homes and asthma morbidity among school-age children in New York City. Environ Res. 2023;239(Pt 1):117296. Cochran SJ, Acosta L, Divjan A, Lemons AR, Rundle AG, Miller RL et al. Spring is associated with increased total and allergenic fungal concentrations in house dust from a pediatric asthma cohort in New York City. Build Environ. 2022;226. Cornell AG, Chillrud SN, Mellins RB, Acosta LM, Miller RL, Quinn JW, et al. Domestic airborne black carbon and exhaled nitric oxide in children in NYC. J Expo Sci Environ Epidemiol. 2012;22(3):258–66. National Heart Lung and Blood Institute. Guidelines for the Diagnosis and Management of Asthma 2007 (EPR-3) [Available from: https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma Global Strategy for. Asthma Management and Prevention. Global Initiatives for Asthma. 2022. Zamora ML, Rice J, Koehler K. One Year Evaluation of Three Low-Cost PM(2.5) Monitors. Atmos Environ (1994). 2020;235. Wang Z, Calderón L, Patton AP, Sorensen Allacci M, Senick J, Wener R, et al. Comparison of real-time instruments and gravimetric method when measuring particulate matter in a residential building. J Air Waste Manag Assoc. 2016;66(11):1109–20. Additional Declarations No competing interests reported. Supplementary Files Supplementaltable1final.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 29 Apr, 2026 Reviewers agreed at journal 26 Apr, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor assigned by journal 18 Apr, 2026 Editor invited by journal 17 Apr, 2026 Submission checks completed at journal 16 Apr, 2026 First submitted to journal 16 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9390070","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631919013,"identity":"8d0927f0-c1ae-445d-9025-4829becdd197","order_by":0,"name":"Maureen George","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYFAC9oOPf1TYwHgWDAwSjA1ABjMeLTzJxgxn0mA8CWK0MJgJM7YcRtYCZuDWotu/II25sOG8vMG1ww8YflRIJK6d3dz4gaHCOrEBlxU3Hh57PHPHbcMNt9MMGHvOSCRuu3OwWYLhTDoeLQfSDXjP3E4wuJ3DwMzYBtRyI7FBgrHtMD4tZhK8bedQtDT/YPyHR8v5BjNp3rYDKFragIGGzxaeZMMZZ5INZwL9chDoF2OgX9osEo6lG+O25fjBBx8q7OT5bic/fACMU9ltt9sf3/hQYy2LSwuDRAKCfQDOSkBXhgz4D+CTHQWjYBSMglEABABz4mcRuFM/ZgAAAABJRU5ErkJggg==","orcid":"","institution":"Columbia University","correspondingAuthor":true,"prefix":"","firstName":"Maureen","middleName":"","lastName":"George","suffix":""},{"id":631919014,"identity":"ab84c894-5146-492f-a84f-4c34751ffb9a","order_by":1,"name":"Rhea Kaur Khurana","email":"","orcid":"","institution":"Columbia University","correspondingAuthor":false,"prefix":"","firstName":"Rhea","middleName":"Kaur","lastName":"Khurana","suffix":""},{"id":631919015,"identity":"f8778714-7147-4aa0-94db-e18f094d1e9b","order_by":2,"name":"Jean-Marie Bruzzese","email":"","orcid":"","institution":"Columbia University","correspondingAuthor":false,"prefix":"","firstName":"Jean-Marie","middleName":"","lastName":"Bruzzese","suffix":""},{"id":631919016,"identity":"2d11d9b6-665c-44d4-9c6a-3da5a44b8159","order_by":3,"name":"Marija Zeremski","email":"","orcid":"","institution":"Clinical Directors Network","correspondingAuthor":false,"prefix":"","firstName":"Marija","middleName":"","lastName":"Zeremski","suffix":""},{"id":631919017,"identity":"977762a7-63ad-46b3-ae1c-ab70d5a1ca35","order_by":4,"name":"Emily DiMango","email":"","orcid":"","institution":"Columbia University Irving Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Emily","middleName":"","lastName":"DiMango","suffix":""},{"id":631919018,"identity":"2805fea1-5182-4386-9719-57e8a4b165e6","order_by":5,"name":"Aisha Naseem","email":"","orcid":"","institution":"Columbia University","correspondingAuthor":false,"prefix":"","firstName":"Aisha","middleName":"","lastName":"Naseem","suffix":""},{"id":631919019,"identity":"d482f973-8d3c-4b1d-ad0e-8db030ef09ef","order_by":6,"name":"Andrea Cassells","email":"","orcid":"","institution":"Clinical Directors Network","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Cassells","suffix":""},{"id":631919020,"identity":"6af95aaa-21dd-4bd6-b722-bb401cb1bb7c","order_by":7,"name":"Eunice Mak","email":"","orcid":"","institution":"Clinical Directors Network","correspondingAuthor":false,"prefix":"","firstName":"Eunice","middleName":"","lastName":"Mak","suffix":""},{"id":631919021,"identity":"da59bae8-9f86-49c5-aa89-66eee3fa8e06","order_by":8,"name":"Jonathan N Tobin","email":"","orcid":"","institution":"Clinical Directors Network","correspondingAuthor":false,"prefix":"","firstName":"Jonathan","middleName":"N","lastName":"Tobin","suffix":""},{"id":631919022,"identity":"b996e876-142a-44ab-abfe-36bbf57bf53b","order_by":9,"name":"Steven Chillrud","email":"","orcid":"","institution":"Lamont-Doherty Earth Observatory","correspondingAuthor":false,"prefix":"","firstName":"Steven","middleName":"","lastName":"Chillrud","suffix":""}],"badges":[],"createdAt":"2026-04-11 18:38:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9390070/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9390070/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108398625,"identity":"9d209256-a126-4fa2-9938-978220da7a0f","added_by":"auto","created_at":"2026-05-04 08:34:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":411347,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9390070/v1/f730f13c915dc96c6bcb34ea.jpg"},{"id":108492471,"identity":"97e6971c-2ee1-4827-aa3e-a4993bcb5382","added_by":"auto","created_at":"2026-05-05 09:57:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":790018,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9390070/v1/c593d216-351f-41f1-907e-7a8407469a56.pdf"},{"id":108398624,"identity":"2ccc82a6-94a0-440f-91f2-cbce2316a097","added_by":"auto","created_at":"2026-05-04 08:34:17","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22034,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaltable1final.docx","url":"https://assets-eu.researchsquare.com/files/rs-9390070/v1/5da9bf722e5a0884cb0ad874.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the Feasibility of Indoor Air Quality Monitoring in Low-Income Housing Among Black Adults With Uncontrolled Asthma in New York City","fulltext":[{"header":"Background","content":"\u003cp\u003eIncreasing evidence identifies fine particulate matter (PM\u003csub\u003e2.5\u003c/sub\u003e), nitrogen-based air pollutants, and ozone (O₃), as hazardous to human health, primarily due to their role in driving airway inflammation and hyperresponsiveness. Fine particulate matter (PM\u003csub\u003e2.5\u003c/sub\u003e), which consists of hundreds of chemical constituents, can penetrate deep into the lungs and represents one of the greatest risks to respiratory health (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndoor air quality (IAQ) is particularly important to health as 90% of time is spent indoors (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and remediation can be effective (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Methane, a potent greenhouse gas (GHG), is the primary component of natural gas (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and gas appliances are the main residential source of PM\u003csub\u003e2.5\u003c/sub\u003e (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). While appliances can be vented outdoors, gas stoves are largely unvented. More than 40% of all homes in the United States use either natural gas or propane as their stove\u0026rsquo;s fuel source (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), with use in New York City (NYC) being much higher (\u0026gt;\u0026thinsp;62%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Those most vulnerable to indoor air pollution are those who live in homes with gas appliances that are inadequately vented (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Although NYC enacted a natural gas ban for new housing in December 2021 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), this will have little effect on the older housing stock that dominates NYC residential living spaces. Older apartment buildings commonly feature kitchens that open directly into living areas and lack properly functioning, externally vented range hoods, which may contribute to poor indoor air quality. Combustion of natural gas, particularly in the presence of other combustible sources such as environmental tobacco or marijuana smoke, incense or candle burning, and the use of aromatherapy diffusers generates a range of indoor air pollutants. Public housing apartments frequently experience additional indoor air quality challenges\u0026mdash;including inadequate ventilation, moisture and mold, pest infestations, environmental tobacco smoke and pollutant transfer between units\u0026mdash;all of which may exacerbate asthma symptoms (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Indoor pollutants may also originate from outdoor sources that infiltrate the home through open windows or building leakage (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndividuals with respiratory conditions such as asthma are particularly susceptible to adverse health effects from poor indoor air quality (IAQ), which may be exacerbated by gas stoves and other indoor environmental triggers. Poor IAQ is a well-documented cause of suboptimal pediatric respiratory health (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, less is known about the impact of poor IAQ on adults with uncontrolled asthma.\u003c/p\u003e \u003cp\u003eAsthma is a common chronic condition affecting more than 20\u0026nbsp;million American adults. Those living below the poverty level have higher asthma prevalence relative to those living above the poverty level (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Relative to non-Hispanic White and Hispanic adults, Black adults have the highest asthma prevalence (8.5% v. 11.5% v. 12.8%, respectively) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). While nearly 40% of all adults with asthma have uncontrolled disease (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), more than 90% of those with severe asthma do not have controlled asthma (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This leads to a high ED visit rate of adults with asthma of 27.8 per 10,000 individuals(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Black adults experience more severe disease and higher rates of uncontrolled asthma compared to other racial and ethnic groups (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). With this greater disease burden, it is unsurprising that Black adults die from asthma at a much higher rate than White and Hispanic adults (22.7 v. 8.1 v. 7.1/million, respectively) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Adults also die from asthma at nearly six times the rate of children with asthma (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite higher asthma prevalence and mortality among adults, prior IAQ studies have largely focused on children\u0026rsquo;s exposures in homes and schools (\u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)Therefore, the primary aim of this feasibility study was to sample and characterize IAQ triggers in low-income NYC residences of Black adults with uncontrolled asthma.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy location\u003c/h2\u003e \u003cp\u003eThis feasibility study was conducted in NYC, New York, as an administrative supplement to a randomized controlled trial (RCT) (#NCT05685381).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRecruitment\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited if they had participated in a pre-trial interview or were screened and determined to be eligible for participation in the parent RCT. Eligibility criteria included (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) aged 18 or older, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) self-identified Black race (African American (AA), Black or AA/ Black and Hispanic or other race), (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) uncontrolled asthma as measured by an Asthma Control Questionnaire [ACQ] score\u0026thinsp;\u0026ge;\u0026thinsp;1.5 (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) receiving asthma care at a Federally Qualified Health Center (FQHC) in NYC that are members of Clinical Directors Network (CDN) primary care practice-based research network (PBRN).\u003c/p\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cp\u003eThe study components included a two-week period of home IAQ monitoring, an environmental audit of indoor triggers, and a post-monitoring interview.\u003c/p\u003e\n\u003ch3\u003eUPAS v2 + Deployment\u003c/h3\u003e\n\u003cp\u003eAn Ultrasonic Personal Air Sampler v2+ (UPAS v2+; Access Sensor Technologies, Fort Collins, CO) was deployed by study personnel in the primary living area of the participants\u0026rsquo; residence to measure small particulate matter (PM\u003csub\u003e2.5\u003c/sub\u003e \u0026micro;g/m\u0026sup3;) among other IAQ components. The UPAS v2\u0026thinsp;+\u0026thinsp;continuously estimates PM\u003csub\u003e2.5\u003c/sub\u003e concentrations using a light-scattering optical sensor and includes an integrated filter that allows calibration of the continuous measurements to the gravimetrically derived integrated PM\u003csub\u003e2.5\u003c/sub\u003e levels (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). An accelerometer in the UPAS v2\u0026thinsp;+\u0026thinsp;can determine activity level and location compliance e.g., the device\u0026rsquo;s movement after deployment and low-cost sensors measure other components of indoor air e.g., carbon dioxide, nitrogen dioxide, and volatile organic compounds. Earlier prototypes of the monitor have been validated for PM\u003csub\u003e2.5\u003c/sub\u003e (\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The UPAS v2\u0026thinsp;+\u0026thinsp;is a lightweight, cell-phone sized unit that is easier to deploy and maintain compared to earlier models. A combination of plug-in and battery-powered units were used in this study. For the original plug-in units and the battery-operated units, a 3-d printed holder was constructed to secure the UPAS v2\u0026thinsp;+\u0026thinsp;upright and conceal the on/off button so that participant families could not turn the UPAS v2\u0026thinsp;+\u0026thinsp;off. For the battery-operated unit, a plastic box enclosed a 67 AmpHr external battery to extend the runtime of the monitor whose internal battery of 6.7 AmpHr allows 48-hour run time at 20% duty cycle on the filter. When the external battery failed to meet the 2-week target runtime, it was eventually modified to allow charging of the external battery during deployment periods such that the external battery was acting as an uninterruptable power supply that could cover 8 days of power outage.\u003c/p\u003e\n\u003ch3\u003eHome Environmental Audit\u003c/h3\u003e\n\u003cp\u003eA home environmental audit was conducted at the time of UPAS v2\u0026thinsp;+\u0026thinsp;deployment and included a visual inspection of the residence to document the presence and type of stoves and ovens (gas or electric), their functionality, and the presence of exhaust fans or range hoods. An investigator-developed survey included objective assessments of the home conducted by the research staff and self-reported answers to staff administered questions, such as self-reported frequency of gas stove use, presence of environmental tobacco smoke (ETS), use of aromatherapy diffusers, incense or scented candles, and the location and opening of windows facing major or minor roadways (see \u003cb\u003eSupplemental Table\u0026nbsp;1\u003c/b\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePost-monitoring Interview\u003c/h2\u003e \u003cp\u003e A semi-structured interview, guided by constructs from the Theoretical Framework of Acceptability\u0026mdash;including burden, user experience, attitudes, and participation intentions\u0026mdash;was conducted via a HIPAA-compliant Zoom dial-in conference call (audio-only) following UPAS v2\u0026thinsp;+\u0026thinsp;retrieval to evaluate participant satisfaction with and acceptability of the IAQ monitoring protocol. All interviews were audio-recorded for analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePost-trial protocol amendment\u003c/h3\u003e\n\u003cp\u003eBecause several apartments had elevated PM\u003csub\u003e2.5\u003c/sub\u003e levels, the study team implemented a post-trial protocol amendment to return results to participants, consisting of a grade-school reading level handout on free or low-cost strategies to improve IAQ, local and state remediation resources, as well as a prototype infographic illustrating their home air quality levels relative to established safe exposure thresholds.\u003c/p\u003e\n\u003ch3\u003eQuantitative analysis\u003c/h3\u003e\n\u003cp\u003eField blanks were taken when deploying devices in three participants\u0026rsquo; homes to confirm that the samples were free from contamination. To confirm the precision of the samplers, duplicate samples were taken in three study team members\u0026rsquo; homes. Filters from UPAS v2\u0026thinsp;+\u0026thinsp;underwent gravimetric analysis using pre- and post-weighed filters to accurately determine the mass of particulate matter (citation). The raw PM\u003csub\u003e2.5\u003c/sub\u003e score was then multiplied by a gravimetric correction ratio, which is the gravimetric PM\u003csub\u003e2.5\u003c/sub\u003e concentration based on the difference in weight of filter before and after sampling divided by the volume of air passing through the filter, divided by the average of the sensor-based PM\u003csub\u003e2.5\u003c/sub\u003e. The normal distribution assumption was checked, and non-parametric methods were applied to skewed distributions, therefore associations between PM\u003csub\u003e2.5\u003c/sub\u003e levels and exposure to household environmental triggers were tested using the Mann-Whitney \u003cem\u003eU\u003c/em\u003e test.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQualitative analysis\u003c/h2\u003e \u003cp\u003eAll audio files were transcribed. Directed coding to identify constructs of the Theoretical Framework of Acceptability (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) was performed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEthical review and compensation\u003c/h2\u003e \u003cp\u003eThe study was approved by WCG IRB (Tracking ID: 20211166). All participants provided informed consent in accordance with institutional review board\u0026ndash;approved procedures. Participants received \u003cspan\u003e$\u003c/span\u003e40 at time of deployment and completion of the home environmental audit and \u003cspan\u003e$\u003c/span\u003e60 at the time of UPAS v2\u0026thinsp;+\u0026thinsp;retrieval (total payment \u003cspan\u003e$\u003c/span\u003e100). Interviews were conducted using Zoom conference call feature initiated by either the study staff at the time of UPAS v2\u0026thinsp;+\u0026thinsp;retrieval or by the research team within one week of retrieval.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSample\u003c/h2\u003e \u003cp\u003eThe sample consisted of 30 participants (90% female) with a mean age of 53 years (SD\u0026thinsp;=\u0026thinsp;13, range 26\u0026ndash;70). Mean Asthma Control Questionnaire (ACQ) score was 2.9 (SD\u0026thinsp;=\u0026thinsp;0.93; scale\u0026thinsp;=\u0026thinsp;0\u0026ndash;6; uncontrolled asthma is \u0026ge;\u0026thinsp;1.5). See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for additional details.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eCharacteristics of participants\u0026rsquo; homes\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHome Type\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApartment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrownstone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle Family Home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight from street (floor #)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStove Type and Function\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGas, working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGas, not working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElectric, working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElectric, not working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKitchen ventilation present (function not assessed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKitchen contiguous with living area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWindows facing minor arteries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWindows facing major arteries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears living in the home\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*missing data\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTwenty-seven (90%) participants lived in apartments and 10 (33%) lived in subsidized housing (New York City Housing Authority \u0026ndash; NYCHA). NYCHA, who provides housing to economically disadvantaged households, also known as Section 8 housing), administers the largest Section 8 program in the United States with over 25,000 property owners and 177,565 apartments across 2,410 buildings(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFeasibility trial\u003c/h2\u003e \u003cp\u003eAll participants completed all three components of the study: two weeks of IAQ home monitoring, a home environmental audit, and post-monitoring interview (100% retention).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eUPAS v2\u0026thinsp;+\u0026thinsp;performance\u003c/h2\u003e \u003cp\u003eThe goal was to collect a minimum of four days of usable data. At the start of the study, engineering units, powered by a wall socket, were the primary UPAS v2\u0026thinsp;+\u0026thinsp;unit used for the study. The plug-in units were occasionally disconnected from power by the participants. Therefore, after the seventh deployment, the team began to deploy battery-powered units to address accidental unplugging and/or unexpected unit failure. Twenty-five units provided usable data and five did not (83% IAQ data collection completion). The average run time for the IAQ monitors was 13.4 days.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eIAQ sampling\u003c/h2\u003e \u003cp\u003eField blanks had a net mass change of 2.3 \u0026micro;g which represented 1.2% of the median mass of PM2.5 collected on the sample filters and less than 6% of smallest mass collected.\u003c/p\u003e \u003cp\u003eThe average gravimetric PM\u003csub\u003e2.5\u003c/sub\u003e levels from the 25 units providing usable data (median run time of 13.4 days) was 72.2 \u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e (SD\u0026thinsp;=\u0026thinsp;46.1), well above the Environmental Protection Agency\u0026rsquo;s (EPA) 24-hour guideline value of 35 \u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e and 8 times higher than the annual average standard of 9 \u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Using the EPA\u0026rsquo;s Air Quality Index as a guideline for interpreting 24-hour fine particulate matter exposure (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), a cutoff of 35.5 \u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e was selected to indicate poor indoor air quality for sensitive groups. Using this threshold, 15 participants (60%) had unhealthy household PM\u003csub\u003e2.5\u003c/sub\u003e levels, with 3 of these homes having their deployment period average PM\u003csub\u003e2.5\u003c/sub\u003e concentrations\u0026thinsp;\u0026gt;\u0026thinsp;125 ug/m\u003csup\u003e3\u003c/sup\u003e (placing them in the unhealthy or hazardous categories). Using the annual standard, 100% or all of the participants homes had elevated levels. PM\u003csub\u003e2.5\u003c/sub\u003e measurements categorized by EPA Air Quality Index levels are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHousehold average PM2.5 categorized by EPA air quality index guidelines (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePM\u003csub\u003e2.5\u003c/sub\u003e range (\u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLevels of concern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.0\u0026ndash;12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12.1\u0026ndash;35.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35.5\u0026ndash;55.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnhealthy for sensitive groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e55.5-125.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnhealthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e125.5-225.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery unhealthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e225.5+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHazardous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe continuous PM\u003csub\u003e2.5\u003c/sub\u003e sensor data was corrected by multiplying each value of a deployment by its gravimetric correction ratio. The distribution of gravimetrically corrected continuous sensor data for PM2.5 measured inside each home is shown in Fig.\u0026nbsp;1. The data displays the large range in 30 second average concentrations with many homes seeing repeated concentration peaks in the hundreds of \u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e and a few homes seeing average concentrations across the entire deployment period in the hundreds of \u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eHousehold environmental triggers\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, participants reported multiple sources of indoor PM\u003csub\u003e2.5\u003c/sub\u003e. Frequent use of gas stoves and frequent opening of windows facing major arterial roadways were common, each reported by more than 50% of participants. Incense or candle burning was reported by nine participants (30%), and exposure to environmental tobacco smoke (ETS) was reported by ten (33%). A significant association was observed between household PM\u003csub\u003e2.5\u003c/sub\u003e levels and the use of aromatherapy products in the home (p\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of environmental household triggers and its association with PM2.5 levels (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriggers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN out of 30 participants (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN out of 25 with \u0026ge;\u0026thinsp;4 days of IAQ data (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean PM\u003csub\u003e2.5\u003c/sub\u003e (\u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIQR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eU\u003c/em\u003e statistic\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequent use of gas stove\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e74.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAromatherapy/scented candles/essential oil use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e134.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e159.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e101.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e22.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e.007*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnvironmental Tobacco Smoke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e66.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequent window-opening facing major artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e62.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e71.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.824\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eMann-Whitney U Test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePost-monitoring interviews\u003c/h2\u003e \u003cp\u003eMost participants (n\u0026thinsp;=\u0026thinsp;21; 93%) found the IAQ sampling protocol acceptable. Concerns included potential surreptitious recording (n\u0026thinsp;=\u0026thinsp;2; 7%) and minor device issues (n\u0026thinsp;=\u0026thinsp;5; 17%). Receiving IAQ results was considered valuable by 24 participants (80%), and 20 (67%) reported study benefits such as increased awareness of asthma triggers, reduced smoking, and compensation. All but two participants (93%) would recommend the study to others with asthma. Six participants (20%) linked IAQ to climate change, while most (n\u0026thinsp;=\u0026thinsp;16; 53%) associated it only to asthma control. Two individuals cited unconventional explanations for climate change.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePost-trial protocol amendment\u003c/h2\u003e \u003cp\u003eA post-trial protocol amendment enabled the study team to provide participants living in homes with high PM\u003csub\u003e2.5\u003c/sub\u003e levels (i.e., \u0026gt;\u0026thinsp;35.5 \u0026micro;g/m\u0026sup3;) with their results, low literacy educational materials, including a prototype infographic of their indoor PM\u003csub\u003e2.5\u003c/sub\u003e levels, as well as free or low-cost strategies to improve indoor air quality, and references to local and state remediation resources. Of the 15 participants who had unhealthy household PM\u003csub\u003e2.5\u003c/sub\u003e levels, 13 (87%) consented to receive their results. All 13 received the infographic and the educational/resource sheet and nine (60%) scheduled a counseling session about their results with the Principal Investigator. During these sessions, participants reported substantially higher exposure to indoor triggers than initially indicated on the environmental audit intake form.\u003c/p\u003e \u003cp\u003eTwo participants with exceptionally high PM\u003csub\u003e2.5\u003c/sub\u003e levels in their homes (\u0026gt;\u0026thinsp;200 \u0026micro;g/m\u0026sup3;) were offered a second two-week UPAS v2\u0026thinsp;+\u0026thinsp;sampling period, and both agreed. Both homes showed improvements in PM\u003csub\u003e2.5\u003c/sub\u003e concentrations compared to the initial measurements. Although both homes continued to have unhealthy PM\u003csub\u003e2.5\u003c/sub\u003e levels, one participant\u0026rsquo;s mean PM\u003csub\u003e2.5\u003c/sub\u003e decreased from 212.0 \u0026micro;g/m\u0026sup3; to 69.0 \u0026micro;g/m\u0026sup3;, while the second participant\u0026rsquo;s mean PM\u003csub\u003e2.5\u003c/sub\u003e decreased from 505.6 \u0026micro;g/m\u0026sup3; to 161.5 \u0026micro;g/m\u0026sup3;. One participant reported that the initial IAQ monitoring increased her sensitivity to environmental tobacco smoke (ETS) and led her to reduce secondhand smoke exposure in her home, a possible explanation for the reduced PM\u003csub\u003e2.5\u003c/sub\u003e seen.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, the indoor air quality of low-income households in NYC among Black adults with uncontrolled asthma has not been previously studied. This study demonstrated the feasibility of conducting IAQ monitoring in this population. Participants found the study procedures acceptable and wanted to know their IAQ results despite there being no plan to return results in the original feasibility trial. Our findings found high PM\u003csub\u003e2.5\u003c/sub\u003e levels and exposure to environmental triggers in these homes, highlighting the need for larger studies focused on mitigating these hazards.\u003c/p\u003e \u003cp\u003eOur study participants had an average indoor PM\u003csub\u003e2.5\u003c/sub\u003e level of 72.24 \u0026micro;g/m\u0026sup3;, which is alarmingly high compared with the NYC average outdoor 24-hour PM\u003csub\u003e2.5\u003c/sub\u003e level of under 35 \u0026micro;g/m\u0026sup3;, as measured through a combination of street-level and rooftop monitors (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The higher-than-average PM\u003csub\u003e2.5\u003c/sub\u003e levels observed in this study were anticipated, given prior research showing that high-poverty neighborhoods in NYC often experience increased health risks (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), including PM\u003csub\u003e2.5\u003c/sub\u003e-attributable asthma emergency department visits 4.5 times higher in low-income neighborhoods compared to wealthier areas (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Pediatric asthma studies have previously demonstrated that elevated indoor PM\u003csub\u003e2.5\u003c/sub\u003e exposure is associated with reduced peak expiratory flow rate, an increase in uncontrolled asthma and a higher number of asthma-related emergency visits (\u003cspan additionalcitationids=\"CR46 CR47 CR48 CR49\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). To the best of our knowledge, this is the first study to explore PM\u003csub\u003e2.5\u003c/sub\u003e levels in the homes of urban, low-income Black adults with uncontrolled asthma.\u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; were exposed to numerous household environmental triggers, such as unvented gas stove use and environmental tobacco smoke, aligns with previous findings involving low-income housing and sociocultural practices contributing to indoor air pollution (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). A few studies in pediatric settings have highlighted certain household characteristics e.g., fungi diversity, dust, stove type that exacerbate asthma symptoms, suggesting a likely parallel in adult populations (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). By identifying significant associations between triggers and elevated particulate matter, our study extends the insights from children to adults.\u003c/p\u003e \u003cp\u003eNational guidelines (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e) and global expert reports (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e) outline critical components of asthma self-management education that largely focus on individual behaviors such as the use of controller medication, monitoring and response to symptoms, and avoidance and remediation of allergic environmental factors. If further evidence confirms the impact of indoor air quality on uncontrolled asthma, these triggers could become new targets for intervention and education that clinical guidelines could address. Participants expressed strong interest in receiving their IAQ results, which can be leveraged to support better asthma self-management and informed decision-making through reducing in-home triggers. Educational programs aimed at increasing awareness of practical strategies to mitigate indoor air pollutants would be particularly valuable for this population. As a first step, we developed a handout with local and state IAQ resources designed for individuals with lower health literacy, along with a prototype infographic to be further developed using participatory design principles.\u003c/p\u003e \u003cp\u003eThe success of conducting IAQ monitoring in this population underscores an opportunity for more comprehensive IAQ datasets, potentially providing more insight into IAQ\u0026rsquo;s role in disparities in adult asthma outcomes. Currently, there are consumer-grade low-cost indoor air quality monitors that allow for identifying air quality trends (i.e., increase in PM2.5 while cooking, or decrease in PM2.5 when using air purification), however IAQ monitors with filters that can provide real-time, gravimetrically corrected data are often costly(\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). Future research could support policies that prioritize air quality standards in residential buildings such as requiring installation, maintenance, and monitoring of working kitchen ventilation systems. Findings from this study also suggest that there is a unique opportunity for public health stakeholders to collaborate with public housing stakeholders to address indoor air quality as an important social determinant of health. Cross-sector partnerships may lead to more focused public awareness campaigns on practical steps to improve IAQ for Black adults with asthma.\u003c/p\u003e \u003cp\u003eThis study has several limitations. As a feasibility trial with only 30 participants, reported associations between household environmental triggers and PM\u003csub\u003e2.5\u003c/sub\u003e should be interpreted cautiously. These triggers were self-reported, and participants were not able to specify the type of aromatherapy used, if any, which may have been useful in further identifying contributors to PM\u003csub\u003e2.5\u003c/sub\u003e levels. Selection bias is possible, as participants were recruited from the same pool as our parent trial and may have been more willing to engage in research and/or had higher levels of poor IAQ. Additionally, unexpected malfunctions of the UPAS v2\u0026thinsp;+\u0026thinsp;units resulted in variability in the amount of data collected per participant. While these technological issues were quickly resolved, this may limit the reproducibility of the protocol in other settings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e Our study demonstrated that collecting indoor air quality samples and characterizing household environmental triggers in NYC homes of low-income Black adults with uncontrolled asthma was both feasible and acceptable to participants. Future research should focus on larger cohort studies to establish more definitive associations between indoor air quality, household environmental triggers, asthma outcomes, and the impact of returning results along with actionable recommendations, as well as exploring the implementation of periodic IAQ monitoring by Medicaid and other insurers who would benefit from reducing emergency department visits due to poor IAQ.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePM\u003c/b\u003e\u003csub\u003e\u003cb\u003e2.5\u003c/b\u003e\u003c/sub\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFine particulate matter with diameters of \u0026le;\u0026thinsp;2.5 micrometers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIAQ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIndoor air quality\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGHG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGreenhouse gas\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNYC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew York City\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eED\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRCT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eACQ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAsthma Control Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFQHC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFederally Qualified Health Center\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUPAS v2+\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUltrasonic Personal Air Sampler, version 2+\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eETS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEnvironmental Tobacco Smoke\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNYCHA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew York City Housing Authority\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEPA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEnvironmental Protection Agency\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaureen George:\u0026nbsp;\u003c/strong\u003eConceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resource Supervision, Validation, Writing- original draft, Writing- reviewing \u0026amp; editing;\u003cstrong\u003e\u0026nbsp;Rhea K. Khurana:\u0026nbsp;\u003c/strong\u003eData curation, Project administration, Formal analysis, Writing – original draft, Writing- reviewing \u0026amp; editing; \u003cstrong\u003eJean-Marie. Bruzzese:\u0026nbsp;\u003c/strong\u003eConceptualization, writing – reviewing \u0026amp; editing\u003cstrong\u003e\u0026nbsp;Marija Zeremski:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Methodology, Project administration, Writing – reviewing \u0026amp; editing;\u003cstrong\u003e\u0026nbsp;Emily DiMango\u003c/strong\u003e: Conceptualization, Investigation, Supervision, Validation, Writing- reviewing \u0026amp; editing;\u003cstrong\u003e\u0026nbsp; Aisha Naseem:\u0026nbsp;\u003c/strong\u003eFormal analysis, Writing – reviewing \u0026amp; editing\u003cstrong\u003e, Andrea Cassells:\u0026nbsp;\u003c/strong\u003eConceptualization, Data curation, Project administration, Resources, Supervision, Writing – review \u0026amp; editing\u003cstrong\u003e; Jonathan N. Tobin:\u0026nbsp;\u003c/strong\u003eData curation, Investigation, Methodology, Project administration, Resources, Supervision, Writing- review \u0026amp; editing; \u003cstrong\u003eEunice Mak:\u0026nbsp;\u003c/strong\u003eData curation, Project administration, Writing- original draft, Writing- review \u0026amp; editing;\u003cstrong\u003e\u0026nbsp;Steven Chillrud:\u0026nbsp;\u003c/strong\u003eConceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resource Supervision, Validation, Writing- original draft, Writing- reviewing \u0026amp; editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by a grant from the National Institutes of Health (NIH) (3R01NR0192 75-02S1, PI George). The content of this manuscript is the original work and solely the responsibility of the authors and does not necessarily represent the official views of the NIH.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Western Institutional Review Board (protocol # 20211166, initial approval 3/22/21). The study also received administrative approval by the Institutional Review Board of Columbia University (protocol #: AAAT0939, initial approval 4/22/22). Informed consent was obtained from all subjects involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to acknowledge the contribution of Mr. Anthony Rhabb who conducted all home visits and Dr. Nat Benda to the development of the IAQ infographic prototypes used in this study. We also wish to acknowledge James Ross and Shams Uddin Al Azad who assisted with IAQ analyses.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZhang T, Chillrud SN, Ji J, Chen Y, Pitiranggon M, Li W, et al. Comparison of PM2.5 Exposure in Hazy and Non-Hazy Days in Nanjing, China. Aerosol Air Qual Res. 2017;17(9):2235\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited States Environmental Protection Agency. Climate Change and Indoor Air Quality.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaulin LM, Diette GB, Scott M, McCormack MC, Matsui EC, Curtin-Brosnan J, et al. Home interventions are effective at decreasing indoor nitrogen dioxide concentrations. Indoor Air. 2014;24(4):416\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited States Environmental Protection Agency. 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J Air Waste Manag Assoc. 2016;66(11):1109\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Environmental audit, particulate matter, respiratory health disparities, urban health","lastPublishedDoi":"10.21203/rs.3.rs-9390070/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9390070/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIndoor air quality (IAQ) plays a critical role in respiratory health, particularly among individuals with asthma. This study evaluated the feasibility of collecting and characterizing IAQ in the homes of Black adults with uncontrolled asthma in New York City.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHome environmental audits were conducted at the time that ultrasonic personal air sampling (UPAS v2+) devices were deployed, which continuously collected both time-resolved and integrated air samples over an initial target runtime of two-weeks based on the amp-hours of the external battery. Post-trial interviews were conducted.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThirty devices were successfully deployed and returned; all but five provided sufficient data for analysis for getting a multi-day exposure estimates defined as more than 4 consecutive days of data) for analysis. Average runtime was 13.4 days and mean PM\u003csub\u003e2.5\u003c/sub\u003e was 72 \u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e which is double the Environmental Protection Agency\u0026rsquo;s cutoff of 35.5 \u0026micro;g/m\u003csup\u003e3\u003c/sup\u003e, a 24-hour average used to assess exposure and risk. Exposure to household environmental triggers was common. Study procedures were acceptable to participants, demonstrating the feasibility of collecting indoor air samples in apartments of adults with uncontrolled asthma.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eElevated indoor PM\u003csub\u003e2.5\u003c/sub\u003e levels and frequent exposure to environmental triggers were common and may contribute to poor asthma control.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrial registration\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis feasibility study was conducted in NYC, New York, as an administrative supplement to a randomized controlled trial (RCT) (#NCT05685381; registered 1/5/23).\u003c/p\u003e","manuscriptTitle":"Assessing the Feasibility of Indoor Air Quality Monitoring in Low-Income Housing Among Black Adults With Uncontrolled Asthma in New York City","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 08:34:07","doi":"10.21203/rs.3.rs-9390070/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-29T16:19:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179239601370541348566853692277266353408","date":"2026-04-26T18:44:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67596302671916301960864480924918847648","date":"2026-04-22T18:25:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T00:24:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-18T07:37:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-17T14:33:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-16T18:24:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-04-16T18:19:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bbe4e212-000f-4a52-9cb7-2a55fb1357f9","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T08:34:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 08:34:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9390070","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9390070","identity":"rs-9390070","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}