Fragranced consumer products: effects on asthmatics

Fragranced consumer products, such as cleaning supplies, air fresheners, and personal care products, can emit a range of air pollutants and trigger adverse health effects. This study investigates the prevalence and types of effects of fragranced products on asthmatics in the American population. Using a nationally representative sample (n = 1137), data were collected with an on-line survey of adults in the USA, of which 26.8% responded as being medically diagnosed with asthma or an asthma-like condition. Results indicate that 64.3% of asthmatics report one or more types of adverse health effects from fragranced products, including respiratory problems (43.3%), migraine headaches (28.2%), and asthma attacks (27.9%). Overall, asthmatics were more likely to experience adverse health effects from fragranced products than non-asthmatics (prevalence odds ratio [POR] 5.76; 95% confidence interval [CI] 4.34–7.64). In particular, 41.0% of asthmatics report health problems from air fresheners or deodorizers, 28.9% from scented laundry products coming from a dryer vent, 42.3% from being in a room cleaned with scented products, and 46.2% from being near someone wearing a fragranced product. Of these effects, 62.8% would be considered disabling under the definition of the Americans with Disabilities Act. Yet 99.3% of asthmatics are exposed to fragranced products at least once a week. Also, 36.7% cannot use a public restroom if it has an air freshener or deodorizer, and 39.7% would enter a business but then leave as quickly as possible due to air fresheners or some fragranced product. Further, 35.4% of asthmatics have lost workdays or a job, in the past year, due to fragranced product exposure in the workplace. More than twice as many asthmatics would prefer that workplaces, health care facilities and health care professionals, hotels, and airplanes were fragrance-free rather than fragranced. Results from this study point to relatively simple and cost-effective ways to reduce exposure to air pollutants and health risks for asthmatics by reducing their exposure to fragranced products. Electronic supplementary material The online version of this article (10.1007/s11869-017-0536-2) contains supplementary material, which is available to authorized users.

IRB approval Ethics approval was obtained by the University of Melbourne, School of Engineering Human Ethics Advisory Group, application 1646894, on May 9, 2016. Informed consent Participants had already provided informed consent as part of the SSI web--based panel. For this survey, participants were given the following introduction: aims of the study; principal researcher name, affiliation, and contact information; human ethics approval; length of survey (less than 15 minutes to complete); assurance that participation is completely voluntary and that all data provided are confidential; assurance that participants can withdraw at any time; outputs of research (findings will be provided through journal articles and website, free of charge); university human ethics contact information; and a specific question to indicate consent: "If you would like to participate in this project, please click the next button to proceed ('Go To Survey')." Data protection Selected survey software and servers were used to ensure data protection. No personal information was linked to the survey results. The dataset (without any identifying information) is kept on password protected computers.

Development and pre--testing
Development and testing The survey instrument was a 35--item questionnaire, developed and tested over a two--year period, including cognitive testing with 10 individuals and piloting with over 100 individuals, before full implementation in June 2016. This article reports results from the sub--populations of asthmatics and non--asthmatics. Steinemann (2016) reports results from the general population.

Recruitment process and description of the sample having access to the questionnaire
The survey invitation is an open invitation, rather than a direct invite, to the pool of panelists available at the time. The pool is filtered to achieve a representative sample through a set of initial questions for basic demographic characteristics. Open survey versus closed survey Closed survey (only SSI participants), general population, random sample nationally representative of demographics.

Contact mode
The survey provider, SSI, provided an open invitation to potential participants. The survey targeted the general population rather than a specific cohort.

Advertising the survey
An open invitation was issued to randomly selected members of the web--based panel. The survey was not advertised.

Survey administration
Web/E--mail Overall, 36 to 44 pages were presented (including the introductory page), depending on responses to conditional items.

Completeness check
All questions were required to be completed. All questions provided non--response options such as "don't know/not sure" and "decline to answer." Only completed surveys were included for analysis.

Review step
Respondents were allowed one attempt per question, once they click "next" to review the next question; they are not allowed to go back to the previous questions or answers. This is a closed survey for SSI respondents only. Survey invite is mailed specifically to the e--mail address used upon joining survey and verified.

Analysis
Handling of incomplete questionnaires Only completed questionnaires were included in the final dataset for analysis. Questionnaires submitted with an atypical timestamp Minimum survey completion time was 5 minutes; average was 10 minutes. A small number of respondents were omitted for completing the items too quickly.

Statistical correction
All demographic subgroups obtained statistically valid numbers to ensure a national representativeness.