Nationally representative population-based studies were conducted across four countries—the United States (US), Australia (AU), the United Kingdom (UK), and Sweden (SE)—to investigate fragranced product emissions, exposures, and effects. The studies used cross-sectional surveys of adults ages 18–65, with a questionnaire in the native language as the survey instrument. Sample populations (n = 1137, 1098, 1100, 1100, respectively) were representative of the general populations according to age, gender, and region (confidence level = 95%, margin of error = 3% for all studies). Using randomized participant recruitment, the surveys drew upon large web-based panels (with over 5,000,000; 200,000; 900,000; 60,000 participants, respectively). In addition to the general population, the survey also investigated effects on vulnerable sub-populations, such as asthmatic individuals and autistic individuals. The surveys were performed in June 2016 (US, AU, UK) and June 2017 (SE). The survey response rates were 94%, 93%, 97%, and 92% (respectively), and all responses were anonymous. (For additional survey details, see Steinemann 2016, 2017a, 2018c, d, 2019b.)
The studies investigated the following types of fragrance products, exposures, and effects.
Fragranced products were categorized as follows: “(a) air fresheners and deodorizers (e.g., sprays, solids, oils, disks); (b) personal care products (e.g., soaps, hand sanitizer, lotions, deodorant, sunscreen, shampoos); (c) cleaning supplies (e.g., all-purpose cleaners, disinfectants, dishwashing soap); (d) laundry products (e.g., detergents, fabric softeners, dryer sheets); (e) household products (e.g., scented candles, restroom paper, trash bags, baby products); (f) fragrance (e.g., perfume, cologne, after-shave, essential oils); and (g) other.”
Exposure contexts included the following: “air fresheners or deodorizers used within indoor environments; scented laundry products coming from a dryer vent; being in a room after it was cleaned with scented cleaning products; being near someone wearing a fragranced product; and exposure to other types of fragranced consumer products.”
Health effects were categorized as follows: “(a) migraine headaches; (b) asthma attacks; (c) neurological problems (e.g., dizziness, seizures, head pain, fainting, loss of coordination); (d) respiratory problems (e.g., difficulty breathing, coughing, shortness of breath); (e) skin problems (e.g., rashes, hives, red skin, tingling skin, dermatitis); (f) cognitive problems (e.g., difficulties thinking, concentrating, or remembering); (g) mucosal symptoms (e.g., watery or red eyes, nasal congestion, sneezing); (h) immune system problems (e.g., swollen lymph glands, fever, fatigue); (i) gastrointestinal problems (e.g., nausea, bloating, cramping, diarrhea); (j) cardiovascular problems (e.g., fast or irregular heartbeat, jitteriness, chest discomfort); (k) musculoskeletal problems (e.g., muscle or joint pain, cramps, weakness); and (l) other.”
For fragrance sensitivity, the survey asked, “Do you experience any health problems when exposed to (specific fragranced product or exposure context)?” If the respondent answered yes, the survey then asked the respondent to specify which health problem(s) they experienced. An individual was considered to characterize fragrance sensitivity if they reported one or more types of health problems from exposure to one or more types of fragranced consumer products or exposure contexts.
The study also identified vulnerable populations, such as asthmatic individuals and autistic individuals.
For asthmatic individuals, the survey asked, “Has a doctor or health care professional ever told you that you have asthma or an asthma-like condition?” If the respondent answered yes, the survey then asked to specify which one or both. For this study, “asthmatic individuals” are considered to be medically diagnosed with asthma, an asthma-like condition, or both.
For autistic individuals, the survey asked, “Has a doctor or health care professional ever told you that you have autism or autism spectrum disorder?” If the respondent answered yes, the survey then asked to specify which one or both. For this study, “autistic individuals” are considered to be medically diagnosed with autism, an autism spectrum disorder, or both.
Results are provided below, with averages across the countries provided as single percentage, and with individual country results (US, AU, UK, SE) provided as a series of four percentages, respectively. Complete results with data and statistics, for each country, each sup-population, and each question, are provided in Steinemann (2016, 2017a, 2018a, b, c, d, 2019a, b, c).