The purpose of this study is to develop and test two self-report measures to evaluate the magnitude of indoor wood smoke exposure and associated symptoms of that exposure. Wood smoke (WS) exposure is documented to significantly increase the risk of irreversible, chronic respiratory disease. WS exposure has been primarily studied in under-developed countries where it has been found to be the leading cause of COPD. However, WS exposure and the resulting respiratory disease are not unique to these countries. In 2009, 12 million wood stoves were used in the U.S. A recent reported that in the U.S. a substantial risk (OR 5.74) for developing chronic respiratory disease from WS exists. While the odds are worse for those who smoke cigarettes, non-smokers are also at risk. Currently, there is no reliable or easy way to measure exposure to WS except by costly devices placed in the home or a lengthy interview developed by WHO for under-developed countries and requiring a trained person to administer. Without a cost-effective, easy to administer, and sensitive measure of the magnitude of WS exposure and the associated symptoms, the ability to decrease exposure and prevent chronic respiratory disease in individuals who have or still smoke will be limited.
The Specific Aims of this study are:
Aim 1 : Establish the psychometric properties of a self- report questionnaire-based Magnitude of Indoor WS Exposure Index (MIWSI);
Aim 2 : Establish the psychometric properties of the EXAcerbations of Chronic Pulmonary Disease Tool (EXACT) for detecting respiratory symptom increase or fluctuation in individuals currently exposed to WS The study will take place over a two-year period in the southwest U.S. and enroll 200 former or current smokers exposed to indoor WS to test the psychometric properties (reliability, construct and criterion validity) of the MIWSI and the EXACT. A subsample (n=30) will participate in test-retest reliability intra-class correlations and have in- home particular monitors placed for one week to obtain objective measures of daily particulate and levoglucosan levels (a known product of wood smoke combustion). The particulate and levoglucosan levels will be used to establish criterion validity of the MIWSI and in item evaluation for the EXACT to determine symptoms that respond to an increase in particulate or levoglucosan levels. Cronbach's alpha and Intraclass Correlations will be done on the total sample (n=200) to establish reliability in this population. Construct validity will be established through correlations and sensitivity analysis. Given the preventable nature of WS exposure and respiratory diseases, early identification and treatment is critical. Self- administered questionnaires provide an efficient means for health care personnel to evaluate these patients. These two measures will enhance our ability to evaluate the magnitude of WS exposure and the associated symptoms on a broader scale, thus helping us understand the public health burden of WS exposure.

Public Health Relevance

Many individuals may be unaware that their breathing difficulty is from wood smoke exposure until their lungs suffer irreparable harm. As the director of the National Institutes of Health, Dr. Collins stated in most people in developed countries don't realize that smoke from indoor fires are a terrible scourge upon the health of a large number of people. The purpose of this study is to test two questionnaires;one to assess the magnitude of wood smoke exposure and the other to assess the associated symptoms. These cost effective self-report questionnaires will allow health care providers to evaluate and intervene early to prevent further development and progression of chronic lung disease.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Academic Research Enhancement Awards (AREA) (R15)
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Special Emphasis Panel (ZRG1-RPHB-P (90))
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Punturieri, Antonello
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University of Colorado Denver
Schools of Nursing
United States
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