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Introduction <br />According to the United States Environmental <br />Protection Agency (EPA), a growing body of <br />scientific evidence indicates that, even in large <br />cities, indoor air in homes can be more <br />polluted than the outdoor air.' This is <br />particularly worrisome because children spend <br />more than 80% of their time indoors.' One <br />source of indoor air pollutants is cooking with <br />gas stove. Burning "natural" gas (hereafter <br />"gas") releases nitrogen dioxide (NO2), <br />particulate matter, formaldehyde, and other <br />pollutants. To better understand the risks for <br />children of cooking with gas, we conducted a <br />systematic review of the published literature. <br />Methods <br />We searched PubMed for articles including <br />U.S. populations using the search terms, "Gas <br />Stoves" with a human -only filter. The search <br />found 247 articles. We excluded articles for <br />the following reasons: the main topic was <br />burns; case studies of individual deaths; the <br />study population was entirely outside the <br />United States; the study group was infants or <br />adults. After applying these exclusions, we <br />found ten studies, including two meta- <br />analyses. Following our review, we searched <br />for studies of the biological plausibility of <br />nitrogen dioxide increasing the risk of <br />respiratory illnesses in children, the health <br />impacts of outdoor NO2, and interventions to <br />reduce the harms of cooking with a gas stove. <br />We informally asked healthcare workers and <br />others in Massachusetts if they knew about <br />the increase in asthma among kids in a home <br />with a gas cooking stove. <br />heet <br />We review the evidence of the associations <br />between: <br />• Cooking with a gas stove and nitrogen <br />dioxide levels in the home; <br />• Nitrogen dioxide levels in the home and <br />respiratory illnesses, including asthma, <br />among children living in the home; <br />• Cooking with a gas stove and <br />respiratory illnesses, including asthma <br />among children living in the home. <br />Cooking with a Gas Stove and Nitrogen <br />Dioxide Levels in the Home <br />Cooking with gas increases NO2 levels in the <br />home. Nitrogen dioxide levels are significantly <br />higher in homes with gas stoves than homes <br />with electric stove S.3,4 Nitrogen dioxide levels <br />are higher in homes where residents spend <br />more time cooking, have gas cook stoves with <br />pilot lights, using the gas cooking stove to heat <br />the home, and don't use exhaust fans to push <br />gas fumes outdoorsS,e,7,8 <br />Nitrogen Dioxide and Childhood Respiratory <br />Illnesses <br />Poor indoor air quality is associated with <br />increased risk of respiratory illness, including <br />asthma, and increased asthma severity.9-10 <br />According to the EPA, a growing body of <br />scientific evidence indicates that, even in large <br />cities, indoor air in homes can be more <br />polluted than the outdoor air." <br />Cooking with gas releases fumes into the <br />kitchen and the rest of the house. Both <br />unburned and burned gas release toxic <br />chemicals into indoor air. These chemicals <br />include lead, chromium, benzene, hexane, <br />formaldehyde, particulate matter less than 2.5 <br />AM <br />MMERSOUTMONT <br />