सिक बिल्डिंग सिंड्रोम (Sick Building Syndrome )को बढ़ाने में अब अगरबत्ती (Incence stics ) की भूमिका

सिक बिल्डिंग सिंड्रोम (Sick Building Syndrome )को बढ़ाने में अब अगरबत्ती  (Incence stics ) की भूमिका भी खुलकर सामने आई है। समझा जाता है इससे  पैदा हमारी हवा के  प्रदूषण   की वजह इसमें प्रयुक्त बांस की महीन डंडी(Fine string ) बनती है।
एक अगरबत्ती एक सिगरेट के जलने के वनस्पित औसतन डेढ़ से  दो गुना ज्यादा हमारी हवा में विभिन्न कणीय प्रदूषक छोड़ती है।  

अलावा इसके ,इसके धुएं में 'फ़ेथलेट 'नाम का रसायन मिला है 'फ़ेथलेटिक एसिड  से व्युत्पन्न एक प्रदूषक है। इसके धुएं में मौजूद महीन कणों  में इटली के विज्ञानियों को न्यूरोटॉक्सिक और हिप्टोटोक्सिक कण भी  मिले हैं जो हमारी सेहत को नुक्सान पहुंचाते हैं महीन होने की वजह से इनकी पैठ फेफड़ों में जल्दी ही हो जाती है। हृदय और फेफड़ों की रुग्ड़ता(Cardiopulmonary Morbidity ) के अलावा इसके धुएं में  कई कैंसर पैदा करने वाले तत्व भी मौजूद हैं। सांस के मरीज़ों खाकर नौनिहालों में यह एलर्जिक रिएक्शन के एक असरदार ट्रिगर (उत्प्रेरक )का काम करते हैं।
हमारे घर दफ्तर की हवा की गुणवत्ता को पलीता लगाने वाले अन्यान्य कारण पहले से मौजूद रहे आये हैं मसलन रूम रिफ्रेशनर तरह तरह के डिटर्जेंट्स और इनके वाष्प भी यही काम करते हैं। हमारा आधुनिक घर रसायनों का घालमेल लिए रहता है हमारी हवा में।  
शिशु तो अपना अधिकाँश समय घरों के अंदर ही बिताते हैं। अब भले प्ले -स्कूल्ज आ गएँ हैं लेकिन वहां भी यही क्षीजना हवा की गुणवत्ता का देखा जा सकता है। जबकि अपना ९० फीसद तक समय हम घर दफ्तर में ही बिताते हैं। 

घर से दफ्तर ,दफ्तर से घर बस ,

इतनी परवाज़ ज़िंदगी ,

दफ्तर की मोहताज़ ज़िंदगी। 

हिन्दू जनमानस में पैठी कुछ सनातन मान्यताओं के अनुसार बांस को जलाना शास्त्रों में एक निषेध समझा गया है कहते हैं इससे पितृ दोष लगता है। इसीलिए बांस की लकड़ी का इस्तेमाल किसी भी विध जलावन लकड़ी के बतौर हिन्दू परम्पराओं में देखने को नहीं मिलता  है। आइये इंसेंस स्टिक में मौजूद प्रदूषक पैदा करने वाले तत्वों की कुछ और पड़ताल करें :

विस्तार के लिए यह मूल रिपोर्ट पढ़ें 

(1 )https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377255/

 (2)https://www.communitypractitioner.co.uk/resources/2016/03/health-risks-incense-use-home-underestimated-source-indoor-air-po

The health risks of incense use in the home: an underestimated source of indoor air pollution?

What are the potential health risks of burning incense indoors? Debbie Roberts and David Pontin take a look in this study.

Debbie Roberts MSc RGN/RSCN RSCPHN DN
Cert Health Visitor, Cardiff and Vale University Health Board

Professor David Pontin PhD RN RSCPHN
Aneurin Bevan Chair of Community Health, School of Care Sciences, Faculty of Life Science & Education, University of South Wales

Correspondence: deroberts@cardiff.gov.uk

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Key points

• Incense burning in the home is common in a number of cultures; however, it has received little attention in Western literature
• Home incense use can have significant adverse health effects; particularly on cardiopulmonary morbidity and mortality
• Young children, the elderly and those with pre-existing health conditions may be particularly at risk
• Health visitors can help families to limit their exposure to incense in the home.

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Abstract

The health impact of indoor air pollution is a growing area of interest for public health professionals. People typically spend up to 90 per cent of their time indoors, particularly women, young children and elders. Although the adverse health effects of second-hand tobacco smoke are well recognised, the impact of burning incense in the home has received little attention in Western literature.

Incense burning in the home is common in a number of cultures (particularly Asian, North African or Arabic). Many health visitors (HVs) work with communities who use incense regularly for religious/cultural reasons and it is a neglected area of study and research. The literature suggests that home incense use can have significant adverse health effects, particularly on cardiopulmonary morbidity and mortality.

Further research is needed to identify which individuals are most susceptible, which types of incense are most harmful, and whether any actions can be taken to minimise exposure.

Keywords: Incense, indoor air pollution, asthma, particulate matter, children

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Introduction

Clean air is a basic requirement of life and hazardous substances produced from human activities indoors, such as tobacco smoking, cooking or burning incense, can lead to a broad range of health problems (WHO, 2010). It is estimated that people spend up to 90 per cent of their time indoors, particularly young children, women and elders (Al-Rawas et al, 2009.) This makes indoor air pollution an important issue for public health workers.

Children’s vulnerability to tobacco smoke in the home has been well documented, and the UK government continues to promote rigorous measures to protect children from second-hand smoke (NICE, 2013). Burning incense in the home is common among many cultures, but the health effects have received little attention in Western literature. Many UK families burn incense regularly for religious or cultural reasons, particularly those from Asian, North African or Arabic backgrounds. A number of studies link incense burning to a variety of health conditions, ranging from cardiopulmonary problems, headaches, forgetfulness and allergies, to neoplasms (Huang et al, 2014; Al-Rawas, 2009).

This paper explores the practice of incense burning in the UK among ethnic minority communities, the chemical composition of the smoke and its potential effects on human health. It focuses on the health visitor’s role in promoting health and reducing health risks for children and families, while recognising the value of clients’ traditional practices and beliefs.

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Background

Modifiable environmental factors account for approximately 25 per cent of the global disease burden, and more than 33 per cent of the burden among children (Prüss and Corvalen, 2006). Public health strategies that consider environmental health interventions contribute to the overall wellbeing of communities and are often costeffective. In recent years there has been considerable public interest in understanding the health impacts of outdoor pollution, but less recognition of the importance of the indoor environment, and in particular indoor air quality, on health (WHO, 2010). According to the Global Burden of Disease 2010 study, particulate matter air pollution is responsible for 3.2 million premature deaths globally, making it the second biggest environmental and the ninth most important overall risk factor (Lozano et al, 2012). In contrast to the outdoor environment, people have a greater potential to modify their exposure to indoor environmental pollution, making indoor air pollution an appropriate target for health promotion and disease prevention.

Incense burning inside the home is a common practice in China, Taiwan, Singapore, India, North Africa and Middle Eastern nations (Tse et al, 2011; Wahab and Mostafa, 2007). Incense may be used as a traditional perfume or air freshener as part of religious rituals or to repel mosquitoes. When incense burns it emits smoke containing particulate matter, gas products such as carbon monoxide, sulphur dioxide, formaldehyde and other organic compounds. Incense burning is recognised as a source of indoor air pollution that can be modified (Wang et al, 2011); however, it is difficult to evaluate the evidence and draw out practice implications because of the variety of types of incense, the methods of burning and variation in research study designs.

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Types of Incense

Incense can be burnt in two ways: directly, eg incense (joss) sticks, or indirectly using charcoal or another combustion source. Using Chinese incense typically involves lighting a flame on a cored incense stick, which is then fanned out. The glowing ember smoulders and burns away the rest of the incense. In contrast, the most frequently used Arabian incense is resinbased. These include oud, bakhour and frankincense, which are derived from aromatic trees. Charcoal is typically used to help burn the blocks, or granules of resin.

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Ethnic Minorities in the UK

Data from the most recent census suggests that 7.5 per cent of the UK population self-identifies as Asian or Asian-British (including Chinese), 1.8 per cent as African and 0.4 per cent as Arabic (ONS, 2012). Many health visitors, particularly in urban areas, are likely to be working with diverse populations and may come across families who regularly burn incense in the home. Cultural sensitivity and appropriate responses to cultural issues are important aspects of health visiting work (Cowley et al, 2013).

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Aim

This literature review identifies and critiques the available evidence about potential health risks of incense use in the home and draws out implications for HV practice.

Method

A range of electronic databases, Google Scholar and the Cochrane database were searched using the search terms in Table 1. Reference lists of relevant studies were manually searched to capture all relevant literature sources on this topic. Relevant papers were then accessed. Inclusion/ exclusion criteria are outlined in Table 2. CASP UK (2013) critical appraisal tools were used to identify study validity, reliability and generalisability.

Results

Eleven studies met the eligibility criteria – these included two case control studies, four surveys, three cohort studies and two cross-sectional studies. The evidence was analysed using the headings of a number of potential health effects of incense burning (see Table 3), and the reliability, validity and generalisability of the studies was evaluated. The studies are summarised in an annotated bibliography in Table 4. No systematic reviews relevant to the research question were found.

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Potential Health Effects

Respiratory effects

When incense burns it releases particulates, gas products and other organic compounds. The adverse effects on health of particulates are well documented and there is no evidence of a safe level of exposure (WHO, 2013). Four of the studies found a link between frequency of incense burning and childhood asthma. Wahab and Mostafa (2007) carried out a case control study of 100 asthmatic children in Qatar and found there was statistically significantly higher exposure to Arabian incense in asthmatic children than among the controls. Similarly, Al-Rawas et al (2009) found that incense used more than twice a week was a common trigger of wheezing among asthmatic children.

Wang et al (2011) surveyed Taiwanese school children and found that the frequency of incense burning at home was associated with an increased risk of asthma and increased medication use. Furthermore, a Taiwanese cohort study examining the impact of genetic and environmental factors on childhood respiratory allergy found that regular incense burning alongside water damage in the house led to more than a ninefold increase in symptoms in children with a paternal history of asthma (Hsu et al, 2012). This demonstrates that when a number of risk factors coexist the individual may be more susceptible.

Alternatively, three studies noted a negative correlation between incense use and respiratory symptoms. Their authors suggest that the presence of a person within the household with respiratory problems was associated with an avoidance of incense burning; however, more study is needed to evaluate this hypothesis (Liu et al, 2013; Yeatts et al, 2012; Lee et al, 2005).

The association between burning incense and lung cancer is uncertain, and epidemiological evidence is limited. Tse et al (2011) conducted a case control study of male lung cancer sufferers in China and found that exposure to incense smoke in the home may increase the risk of lung cancer among smokers. The Singapore Chinese Health Study, a large cohort study of adults aged 45 to 75 years, noted that the use of incense in the home seemed to increase the risk of squamous cell carcinomas of the respiratory tract in a dose-dependent manner (Friborg et al, 2008).

Cardiovascular effects

The reviewers identified two studies that suggest burning incense in the home may be associated with increased cardiovascular mortality and morbidity. A non-randomised study of 50 Taiwanese housewives measured cardiac function and particulate exposure for 24 hours and found an association between stir-fry cooking and incense burning, which were associated with increased particulate pollution and reduced cardiac function (Huang et al, 2014). Although the sample size was small, its results are corroborated by data from the much larger Singapore Chinese Health Study. This found that long-term exposure to incense burning at home was associated with an increased risk of cardiovascular mortality in the study population. Compared with non-users, current users had a 12 per cent increased risk of cardiovascular mortality. This included both stroke and coronary heart disease, and the association was particularly strong in never-smokers and those without a history of cardiovascular disease at baseline (Pan et al, 2014).

Other health effects

Two of the studies identified additional health outcomes of burning incense. A cross-sectional study in the United Arab Emirates found that burning incense daily was associated with increased headaches, difficulty concentrating and forgetfulness (Yeatts et al, 2012). Hsu et al (2012) carried out a cohort study of paternal heredity and household characteristics and found that burning incense was associated with asthma and other allergic symptoms, such as itchy eyes and rhinitis in children with a family history of allergy. Finally, the fire risk from burning incense is not explored by any of the studies identified. This is an important consideration for families and the HVs who work with them.

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Discussion

Respiratory effects

The review evidence suggests that burning incense in the home presents a risk factor for asthma and possibly respiratory tract carcinomas; however, the evidence is equivocal. Families with members susceptible to respiratory symptoms may avoid or limit burning incense in their presence, making the evidence difficult to evaluate. Nevertheless, in vitro experiments have identified incense burning as a source of air pollution, releasing a range of compounds including known carcinogens, irritants and toxins (Elsayed et al, 2014). Some authors argue that burning incense can lead to higher levels of indoor pollution than tobacco smoking (Liu et al, 2013). The exact mechanism by which incense provokes respiratory symptoms is not fully understood. The complex mixture of gas, particulate and other organic compounds inhaled by people exposed to the smoke varies depending on the type of incense used, the combustion source (if any) and room ventilation.

Cardiovascular effects

There is growing evidence of the adverse cardiovascular effects of ambient air pollution, including premature mortality (WHO, 2013). Ultra-fine particulate from sources such as incense burning may translocate from the lungs into the blood causing vascular inflammation, clotting and the risk of myocardial infarction. Two studies that link cardiac outcomes to incense use were identified. Huang et al (2014) carried out a small, non-randomised survey with limited generalisability. The authors concede that medication use, comorbidities and other unmeasured indoor air pollutants may have confounded their findings. Nevertheless it is the first study to evaluate the impact of personal exposure to household particulate on acute changes in heart rate variability indices.