{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:55:20Z","timestamp":1793386520314,"version":"4.5.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Institutes of Health (NIH): National Institute on Minority Health and Health Disparities","award":["P50MD010431"],"award-info":[{"award-number":["P50MD010431"]}],"id":[{"id":"https:\/\/ror.org\/0493hgw16","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["P2CES033415"],"award-info":[{"award-number":["P2CES033415"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH: NIEHS","award":["F32ES029786"],"award-info":[{"award-number":["F32ES029786"]}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K12HL143957"],"award-info":[{"award-number":["K12HL143957"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL164151"],"award-info":[{"award-number":["K23HL164151"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Rural regions of the United States now face a growing burden of chronic obstructive pulmonary disease (COPD). Early studies have suggested that this may in part be driven by unique environmental factors. The indoor environment remains an important and modifiable contributor to COPD morbidity; however, few studies have analyzed the impacts of the indoor environment on underserved rural communities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine if household air pollution is a significant contributor to COPD morbidity in 2 vulnerable areas of rural Appalachia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Longitudinal environmental cohorts were launched at 2 rural Appalachian sites (East Tennessee and Western Maryland) among former smokers with COPD. Study follow-up was over 6 months, with up to 3 paired clinical and environmental assessments to analyze associations between indoor pollutant concentrations (fine particulate matter [PM2.5] and nitrogen dioxide [NO2]) and COPD health measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy-four participants contributed 184 health and environmental assessments. Mean indoor PM2.5 concentrations were 9.7\u2009mg\/m3 (SD, 11.8), with only 14 (28%) homes having detectable NO2. Despite relatively low baseline concentrations, in adjusted analyses that accounted for demographics and lung function, every 2-fold increase in PM2.5 was associated with increased COPD morbidity as measured by the St. George\u2019s Respiratory Questionnaire (1.79 [95% CI, 0.74-2.79]; P\u2009=\u2009.001) and increased odds of significant dyspnea based on the modified Medical Research Council dyspnea scale (odds ratio, 1.34 [95% CI, 1.02-1.77]; P\u2009=\u2009.038). PM2.5 was additionally associated with an increase in measures of cough and sputum. No significant associations were observed between pollutants of interest and exacerbation risk in the study cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Indoor pollutant exposure, particularly PM2.5, is a significant contributor to respiratory morbidity for individuals with COPD living in rural communities and has potential as a modifiable target to address COPD morbidity. Future studies and public health initiatives are warranted to evaluate interventions to reduce indoor air pollution in rural regions and improve COPD morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag074","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T07:15:51Z","timestamp":1774509351000},"page":"1620-1628","source":"Crossref","is-referenced-by-count":1,"title":["Indoor air pollution and chronic obstructive pulmonary disease morbidity in rural Appalachian cohorts"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6724-7046","authenticated-orcid":false,"given":"Sheila E","family":"Enoh","sequence":"first","affiliation":[{"name":"Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, MD,","place":["United 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