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Sampling Plan Overview

Purpose: As a validation tool, we will seek to design a sampling plan which best reflects the true exposure of combustible wood smoke (in the home) among a sample of individual school age children residing in 4 villages in the Sichuan province in western China. Design Overview: Personal sampling (Criteria air pollutants PM2.5 and PM10), Indoor/Outdoor Sampling (in and outside home), GPS monitoring Sampling Focus (acute or long-term): In this study, our sampling focus will be in short-term exposures. Biologically, we make that distinction given the high susceptibility of young children to the effects of air pollution. In particular, respiratory and immune systems are rapidly developing in children during certain ages. Children also have a larger lung surface area relative to their body weight and breathe in approximately 50% more air per kilogram of body weight in comparison to adults.1 Along those same lines, children also spend more time with an elevated heart rate playing thus are breathing more outdoor and indoor air. Because of these factors, we deem it to be more critical to assess acute exposures in children initially before any lasting health effects could result. Fundamental Limitations In an effort to validate the results from the parent-report questionnaire, we will take into account the inherent limitations of the questionnaire design and attempt to account for them with the results of our sampling design. Specifically, three frames will be addressed; Respondent/Study Participation Questionnaire Recall Bias Sample Size Estimation and Power

Respondent/Study Participation In selecting this particular study base, we are acutely aware that language, socio-economic, cultural and educational constraints may have challenging affects on our sampling scope and access. Personal sampling techniques in conjunction with GPS monitoring devices are metrics of

different levels of privacy concerns relative to filling out a self-report questionnaire. The Sichuan province is an agricultural community and the villages are particularly close knit. Thus, we will attempt to isolate village elders/persons of authority within the village and demonstrate usefulness to the village by collecting samples. In any village, framing is exceptionally important. We will structure our argument for sampling alone the confines of protecting the children in the village; that of which we deem has been an effective strategy in previous validation studies. Questionnaire Recall Bias The ability of the parents to respond accurately to their childs potential sources of exposure is a major limitation of the questionnaire. Specifically for location, the discrepancies to where a child is reported to be located and their actual location is remarkably high, to the order of magnitude of roughly half the respondents in one study did accurately report where their children where at a given time. 2 As such, we will use GPS monitoring in our sampling design. Sample Size Estimation and Power Ideally, we would select a rejection level ( 0.05) and sample size large enough to achieve a power of 80% (0.8). We understand that typically, the more robust the sample size the lower the standard error and narrower the confidence interval is. In general, we determined our sample size by
considering the participation of our eligible families and cost of the study. In this case, we appropriately ask is our participating number of children enough to provide a clear answer to the true exposure of combustible wood smoke to children within the Sichuan province of China? Given our funding, we

deem that sampling half of our study base stratified by each village will provide us sufficient enough power to detect the exposure should the objective of the original study attempt to relate combustible wood smoke to incidences of asthma in the population. Design During a five day period of school and weekend days (Monday, Wednesday, Thursday and Saturday, Sunday) we will monitor 50 childrens (in each of the 4 villages) individual exposure over the course of an 11 week cycle during the fall and winter months. We are particularly concerned with winter months since we deem that is the time to which most children will be indoors and use of heating/cooking combustion sources will be at its optimum use. Essentially,

our primary goal is addressing the highest exposure to children over certain duration of time that of which corresponds to asthmatic symptoms the children may experience in the parent-recorded questionnaire. The criteria for the selection of families are as follows: Children aged 11-15 years old live in the home as a primary residence Household use combustion sources for their primary heating and cooking needs Parents or adults in the household are non-smokers

Sampling (During day) Personal sampling equipment will be used to assess PM10 and PM2.5 concentrations and other combustible bi-products for each child during the day at school. We will attach the sampler and pumps to a small book bag to which the children will wear during the course of the day. Since temporal associations will add to the strength of our validation study, we will also use GPS monitoring tracking of the childrenthat of which coordinate responds to each PM measurement in unit time. We will use GPS primarily because studies have shown that the parent-response on the questionnaire has a tendency to report the childs location inaccurately (Elgethun, et.al. 2003). The GPS tracking device will also be added to the small book bag along with the sampler and pumps. This book bag will weigh less than 2 pounds.

Sampling (Inside and Outside Home) No personal PM sampling of the child will be used within the home. Because of the variability in exposures via different rooms of the home, monitors will be placed in the living/center room and the room in which the child sleeps (if this is indeed a separate room). Generally, we wish to capture exposures in the room where the combustion sources are emitted (kitchen/living areas) in addition to where the child most frequents (living and sleeping area). Monitoring in the two different rooms of the home will hopefully create a more representative sample of the childs true exposure in the home. Sampling monitors will also be placed outside the homes and will run around the clock. Indoor sampling monitors are programmed to a timer that will begin sampling once the child enters the home.

References
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Overview of CCCEH Research Studies http://www.cumc.columbia.edu/dept/mailman/ccceh/conferencematerial/ccceh-studies.pdf 2 Elgethun K, Fenske RA, Yost MG, Palcisko GJ. Time-location analysis for exposure assessment studies of children using a novel global positioning system instrument. Environ Health Perspect. 2003 Jan;111(1):115-22. PubMed PMID: 12515689; PubMed Central PMCID: PMC1241315.