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homes using exhaust fans with gas cooking stoves.24Another cross-sectional study, using NHANESIII data, found children under five were 76% more likely to have pneumonia if they lived in homes with gas cooking stoves where exhaust fans were not used compared to homes with gas stoves where exhaust fans were used (a0R = 1.76, Cl 1.04, 2.98). In families that both cooked and heated the home with gas cooking stoves, the adjusted odds ratio for pneumonia was three times higher than for those who lived in homes with gas stoves where an exhaust fan was used (aOR=3.06 Cl 1.29, 3.30). The study showed a dose -response relationship: children exposed to the most indoor gas fumes (from a combination of cooking and using the gas stove to heat the home) have the highest likelihood of pneumonia.25 Exposure to gas stoves is substantial: about one-third of households in the United States cook with gas stoves.26 Interventions that lower NO2 concentrations or remove gas cooking stoves may reduce the occurrence of and severity of these illnesses and reduce healthcare costs. A simulation study of building designs to reduce indoor air pollution and reduce pediatric asthma showed that some of the highest reductions in healthcare costs were from repairing exhaust fans and replacing gas stoves with electric ones.27 The health impact and health care cost savings could be substantial as asthma is one of the most common chronic childhood diseases across all socioeconomic classes and is the most frequent cause of hospitalization among children in the US.28 In Massachusetts, the estimated cost of environmentally attributable asthma is between $10 and $50 million per year.29 heet Implications for Public Health Practice A 2007 Expert Panel Report to the National Heart Lung and Blood Institute recommended that health care providers counsel patients with asthma to avoid the use of unvented gas stoves.30 The Centers for Disease Control and Prevention 31 and the Massachusetts Department of Public Health3z websites identify gas stoves as a trigger for asthma. However, informal questioning by the authors finds that many parents, Boards of Health, public health staff, teachers, and others know little or nothing about the association between gas stoves and childhood respiratory illnesses. Health care providers should ask families whose children have respiratory illnesses what kind of stove is used for cooking. They can encourage families who cook with gas stoves to: 1. Use electric appliances instead of cooking with the gas stove. Possible appliances include; microwaves, toaster ovens, rice cookers, crock -pots, or portable single, electric induction burners. 2. When cooking with a gas stove: • use the back burners • turn on the fan above the stove • and/or open a window. The fan above the stove works better at cleaning the air when it pushes the stove fumes outdoors. 3. When the gas stove needs to be replaced, consider replacing it with an electric or electric induction stove. MMERSOUMFRONf