Residential Wood Smoke Interventions Improving Health in Native American Populations
Phase: NA
Conditions: Respiratory; Disorder, Functional, Impaired, Respiratory Infection Other
Sponsor: University of Montana

 
PROTOCOL TITLE: Residential Wood Smoke Interventions Improving Health in Native American Populations 
ClinicalTrials.gov Identifier: 
NCT02240069 
PRINCIPAL INVESTIGATOR(S): Curtis W. Noonan, Annie Belcourt and Tony J. Ward, School of Public and 
Community Health Sciences, University of Montana, 406-243-4957, curtis.noonan@umontana.edu 
RESEARCH LOCATION(S): Nimiipuu Health, Nez Perce Reservation; and Navajo Nation Environmental 
Protection Agency, Navajo Nation. 
DOCUMENT DATE: November 15, 2016 
PROTOCOL AND REVISION HISTORY: 
Version 
Approval 
Date, 
mm/dd/yyyy 
Summary of Change 
01/27/2014 
Original protocol IRB approval 
11/18/2014 
Protocol additions for blood pressure, heart rate, and saturated oxygen 
measures and for nicotine wipe sample to validate reporting of household 
smoking. 
09/09/2015 
The following change as made to the protocol due to request by tribal 
community partners: Removal of the bronchodilator portion of the spirometry 
measure 
11/10/2015 
The following changes were made: 
1. Revision of Household Characteristics question on household smoking 
2. Addition of an End of Winter Questionnaire 
10/27/2014 
Data collection protocols and forms 
10/31/2016 
Final version of instructions for Field Personnel 
 
ATTACHMENTS: 
Protocol Instructions for Field Personnel 
Data Collection Forms 
Statistical Analysis Plan 

 
Updated October 31, 2016 
1 
Elders Home Visit Protocol – Winter 1 
INITIAL CONSENT AND PAPERWORK VISIT  
Note: Complete the “Initial Consent & Paperwork Checklist” as you progress through the following tasks. 
1. When enrolling a home, assign a Home ID using the following scheme: 
a. Home Identification Example: NPE_5101. “NPE” refers to Nez Perce Elders. The “1” after the 
number 5 refers to the first cohort of EldersAIR homes enrolled. This number will be "2" in 
2015/2016. The “01” refers to this being the first home enrolled in the cohort, “02” the 
second, and so on. 
b. Participant Identification Example: NPE_5101a. To the home ID, we add a lowercase a, b, etc. 
for each participant residing within home NPE_5101. The first Elder is assigned “a,” and the 
next Elder “b”. 
2. Review the “Informed Consent” and study timeline with the participant(s). 
3. If the participant(s) agrees to participate, obtain the signed “Informed Consent.”  
4. Provide a copy of the “Informed Consent” to the participant(s) for their records. 
5. Explain the “HIPPA/Personal Health Information form” to the participant, and ask them to complete 
the form.  
6. Provide the “Demographics” and “Home Characteristic Data Sheet” to the participant(s) to complete. 
Note: a demographics form is needed for each participant.  
7. Complete the “Health History Form” by interview.  
8. Install the iButton on stove. 
a. If their stove has legs, attach the iButton’s ball-chain around the upper, back, right leg and 
secure. 
b. If it is a pedestal stove (or as needed), attach the button to the lower, right, backside of stove 
via magnet. 
c. Note the iButton’s location should be comfortably warm to the touch of the hand. 
9. Complete the appropriate sections of the “iButton Data Sheet.” 
10. Provide the “Study Contact Information” to the participant(s) and let them know they can contact you 
at anytime with questions.  
11. Complete the scheduling section of the “Initial Consent & Paperwork Checklist” by first asking if the 
participant(s) have had a respiratory tract infection in the last three weeks. If “YES,” the Sampling Set 
Up visit will need to be delayed accordingly (when possible). 
12. After the visit, request a copy of the participant’s medical record (all identifying information needs to 
be blacked out). 
EldersAIR Database: 
1. When you receive an “Informed Consent,” a “Demographics form,” and Contact Information from a 
household, select “Enroll Home” from the dashboard of the EldersAIR database. 
2. Complete the fields for the “Enroll Home” option and click “enroll” at the bottom.  
3. Next, select “Enroll Elder” from the “ELDERS” section of the home you just created. 

 
Updated October 31, 2016 
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4. Complete the fields using the information provided in the “Informed Consent,” “HIPPA/Personal 
Health Information form” and “Demographics form.”   
5. When multiple Elders are participating in a household, repeat steps 3-4 for each eEder. 
6. Return to the home’s main page by selecting “Show Home” from the top of the Elder’s page. 
7. Under the “SCHEDULE” section, select “Initial Visit” from the list. 
8. Enter the “Actual Date” and “Actual Time.” 
9. Click “Save.” 
10. Next, enter the appropriate forms for the household. 
a. Home Characteristics: Under the “FORMS” section of the home page, select “Home 
Characteristics” from the list. Enter the fields using the “Home Characteristics” form and select 
“Save.” 
b. iButton: Under the “FORMS” section of the home page, select “iButton” from the list. Enter 
the fields using the “iButton Data Sheet” and select “Save.” 
11. Next, enter the appropriate forms for each Elder. 
a. Select the appropriate Elder ID under the “ELDERS” section of the home.  
b. Demographics: Under the “FORMS” section of the Elder’s page, select “Demographics” from 
the list. Enter the fields using the “Demographics” form and select “Save.” 
c. Health History: Under the “FORMS” section of the Elder’s page, select “Health History.” Enter 
the fields using the “Health History” form and select “Save.” 
d. Repeat steps “a” through “c” for each participating Elder. 
e. Medical Record: Under the “FORMS” section of the Elder’s page, select “Medical Record.” 
Enter the fields and upload the deidentified file. Select “Save.” 
12. If you scheduled the Sampling Set Up Visit, return to the Home’s main page by selecting “Show Home” 
at the top of the Elder’s page. 
13. Under the “SCHEDULE” section, select “Sampling Visit 1” (or “Sampling Visit 2”) from the list. 
14. Enter the “Appointment Date” and “Appointment Time.” 
15. Click “Save.” 
 
 
SAMPLING SET UP VISIT 
Sampling is completed 2x per winter. When possible, the 2nd sampling visit should occur a minimum of 3 weeks 
after the 1st sampling visit. 
Note: Complete the “Sampling Set Up Checklist” as you progress through the following tasks. 
1. Find a place across the room from the stove to place the DustTrak (See “DustTrak Protocol” for 
programming the equipment prior to the visit).  
a. If they already have a table or surface to use, go for it. If not, set up the tv-tray where it won’t 
easily be knocked over by people or pets. 
b. The DustTrak needs to be plugged in to a working wall outlet. 
c. Turn the DustTrak on and start the program. 
d. Attach the Humidity Monitor to the DustTrak.  

 
Updated October 31, 2016 
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e. Complete the appropriate sections of the “DustTrak Data Sheet” and “Humidity Monitor 
Data Sheet.” 
2. Introduce the MicroPEM and holder. 
a. Clip the FitBit Zip to the MicroPEM pouch (see FitBit Zip Activity Monitor Protocol). 
b. Describe how to wear it. 
c. Inform them of when to wear it. 
d. Inform them that you will be calling to check in on the MicroPEM in 24 hours.  
e. Complete the appropriate sections of the “MicroPEM Data Sheet.” 
3. Sit down with the participant to go through the white binder contents. 
a. Describe how to fill out all the forms over the next 48 hours. 
i. “Home Activity Log” 
ii. “Wood Stove Usage Log” 
iii. “In-Home Log” (how often they’re in their house) 
4. Download the iButton data and complete the appropriate sections of the “iButton Data Sheet.” Note: 
the same “iButton Data Sheet” will be used at all visits. 
a. If using a PC to download the iButton, restart the mission with the software. Check to make 
sure that next to “Is Mission Active?” it says “true,” the “sampling rate” is equal to 25 
minutes,” and next to “roll over enabled?” it says “true.”  
5. 1ST Winter Visit ONLY: Take photos of the wood stove, stovepipe, etc. as detailed in the “Stove Photo 
Protocol.” 
6. Ask if you can take or trade a piece of wood so you can test the moisture content. Label the piece of 
wood with the home ID. 
7. Schedule the “Sampling Pick Up & Health Measures Visit” and review the health measures that will be 
completed. 
a. Complete the “Scheduling Spirometry” form via interview. See also “Scheduling Spirometry 
Protocol.” 
b. Explain any scheduling delays that will need to occur to account for medication usage and/or 
smoking.  
c. Schedule a time for the health measures when the appropriate time between use of 
medications and/or smoking will have the least impact.   
8. After the visit/at the office, split the piece of wood obtained from the homeowner and complete the 
“Wood Moisture Tracking Form.” Note: It is important to take the moisture reading from the inside of 
the wood to provide the most accurate measurement. 
EldersAIR Database: 
1. From the dashboard, select “View All Homes.” 
2. Select the appropriate Home ID from the list. 
3. Under the “SCHEDULE” section, select “Sampling Visit 1” (or “Sampling Visit 2” if second visit) from the 
list. 
4. Enter the “Actual Date” and “Actual Time.” 
5. Click “Save.” 
6. Next, enter the appropriate forms for the household. 

 
Updated October 31, 2016 
4 
a. Wood Moisture (1st Visit ONLY): Under the “FORMS” section of the home page, select “Wood 
Moisture” from the list. Enter the fields using the “Wood Moisture Tracking” form and select 
“Save.” 
b. Stove Photos (1st Visit ONLY): Under the “FORMS” section of the home page, select “Stove 
Photos” from the list. Upload the appropriate stove photos and select “Save.” Note:  You may 
want to save after each couple of photos.  The uploads are slow, and it may seem like it is not 
working if you try to upload all of the photos at once. 
c. iButton: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the home page, select 
“iButton Update” with the appropriate visit date listed next to it. Enter the fields using the 
“iButton Data Sheet” and select “Save.” 
7. Next, enter the appropriate forms for each Elder. 
a. Select the appropriate Elder ID under the “ELDERS” section of the home.  
b. Scheduling Spirometry: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the Elder’s 
page, select “Spiro Scheduling.” Enter the fields using the “Scheduling Spirometry” form and 
select “Save.” 
c. Repeat steps “a” and “b” for each participating Elder. 
8. Return to the Home within the database by selecting “Show Home” at the top of the Elder’s page. 
9. Enter the Sampling Pick Up & Health Measures Visit appointment. 
a. Under the “SCHEDULE” section, select “Pickup/Health Measures 1” (or “Pickup/Health 
Measures 2”) from the list. 
b. Enter the “Appointment Date” and “Appointment Time.” 
c. Click “Save.” 
 
 
SAMPLING CHECK IN CALL 
1. After 24 hours, call the participant(s) to check that the logs are being filled out and the MicroPEM is 
being worn. 
2. Remind the participant of the Health Measures Visit and the appropriate timeframes needed for 
medication usage and/or smoking. 
 
HEALTH MEASURES AND SAMPLING PICK UP VISIT 
Note: The “Health Measures and Sampling Pick Up Visit” occurs 48 hours from “Sampling Set Up.” These visits 
are completed 2x per winter. Complete the “Health Measures and Sampling Pick Up Checklist” as you 
progress through the following tasks. 
Complete the “Health Measures and Sampling Pick Up Checklist” as you progress through the following tasks. 
1. At the end of the 48 hours, return to the home to complete the Health Measures.  
a. Explain the health measures that will be collected.  
b. Complete the “Lung Function Screening Questionnaire” via interview.  

 
Updated October 31, 2016 
5 
i. Note that spirometry is medication and health dependent. Based on the results of 
the “Lung Function Screening Questionnaire,” determine if spirometry needs to be 
rescheduled (when possible). 
c. Complete the health measures and the “Health Measures Visit Sheet.” 
i. Pulse Oximeter - Saturated oxygen and heart rate (see “Pulse Oximeter Protocol” and 
“Referral Protocol for Health Measure Readings.”) 
ii. Blood Pressure (see “e-sphyg 2 BP Cuff Protocol” and “Referral Protocol for Health 
Measure Readings.”) 
iii. Demonstrate how to use the spirometer and complete Spirometry testing. 
1. Give breaks between efforts when needed. 
iv. Referral Section – notify PI (Curtis Noonan (406) 243-4957, 
curtis.noonan@umontana.edu or Tony Ward (406) 243-4092, 
tony.ward@umontana.edu) of any Urgent or Emergent referrals. 
d. Complete the “Additional Health Questions for Each Visit” questionnaire via interview. 
2. Complete the appropriate sections of the equipment data sheets. 
a. “DustTrak Data Sheet”  
b. “Humidity Monitor Data Sheet”  
c. “MicroPEM Data Sheet” 
3. Collect the sampling equipment and household binder. 
a. MicroPEM, FitBit, and MicroPEM holder 
b. DustTrak and case 
c. Humidity Monitor 
d. Binder and completed logs (review to ensure completeness). 
i. “Home Activity Log” 
ii. “Wood Stove Usage Log” 
iii. “In-Home Log” (how often they’re in their house) 
4. Download the iButton data and complete the appropriate sections of the “iButton Data Sheet.” Note: 
the same “iButton Data Sheet” will be used at all visits. 
a. If using a PC to download the iButton, restart the mission with the software. Check to make 
sure that next to “Is Mission Active?” it says “true,” the “sampling rate” is equal to 25 
minutes,” and next to “roll over enabled?” it says “true.”  
5. IF FIRST WINTER VISIT, schedule the next “Sampling Set Up Visit” when possible (minimum 3 weeks 
out; however more time in between visits is preferred when possible). 
6. IF SECOND WINTER VISIT, collect iButton after download. 
7. IF SECOND WINTER VISIT, collect a nicotine wipe sample (see “Nicotine Wipe Protocol”) and complete 
the appropriate sections of the “Nicotine Wipe Data Sheet.” 
8. Provide the participant reimbursement to the household ($50 for each health measures visit). 
EldersAIR Database: 
1. From the dashboard, select “View All Homes.” 
2. Select the appropriate Home ID from the list. 
3. Under the “SCHEDULE” section, select “Pickup/Health Measures 1” (or “Pickup/Health Measures 2”) 
from the list. 

 
Updated October 31, 2016 
6 
4. Enter the “Actual Date” and “Actual Time.” 
5. Click “Save.” 
6. Next, enter the appropriate forms for the household. 
a. iButton Update: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the home page, 
select “iButton Update” with the appropriate visit date listed next to it. Enter the fields using 
the “iButton Data Sheet” and select “Save.” 
b. DustTrak: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the home page, select 
“DustTrak” from the list. Enter the fields using the “DustTrak” datasheet and upload the 
TrackPro file. Select “Save.” 
c. Home Activity Log: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the home 
page, select “Home Activity – Day 1” from the list. Enter the fields using the appropriate 
“Home Activity Log” form and select “Save.” Repeat for Days 2-3. 
d. MicroPEM: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the home page, select 
“MicroPEM” from the list. Enter the fields using the “MicroPEM” datasheet and upload the 
MicroPEM and FitBit files. Select “Save.” 
e. Humidity: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the home page, select 
“Humidity” from the list. Enter the fields using the appropriate “Humidity Tracking” form and 
select “Save.”  
f. Wood Stove Usage: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the home 
page, select “Woodstove Usage” from the list. Enter the fields using the appropriate “Wood 
Stove Usage Log” and select “Save.”  
g. Nicotine (2nd Visit ONLY): Under the “VISIT 2 FORMS” section of the home page, select 
“Nicotine” from the list. Enter the fields using the “Nicotine Wipe Data Sheet” and select 
“Save.” 
7. Next, enter the appropriate forms for each Elder. 
a. Select the appropriate Elder ID under the “Elders” section of the home.  
b. In Home Log: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the Elder’s page, 
select “In Home Log – Day 1.” Enter the fields using the appropriate “In Home Log” form and 
select “Save.” Repeat for Days 2-3. 
c. Lung Function Screening Questionnaire: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) 
section of the home page, select “Lung Function” from the list. Enter the fields using the 
appropriate “Lung Function Screening Questionnaire” form and select “Save.”  
d. Health Measures: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) section of the home page, 
select “Health Measures” from the list. Enter the fields using the “Health Measures Visit” 
datasheet and upload the Spirometry file. Select “Save.” Note: If you were unable to complete 
the Spirometry, be sure to select “Yes” for “Spiro Failed.”  This will trigger the need for a Spiro 
Repeat. 
e. Additional Health Questions for Each Visit: Under the “VISIT 1 FORMS” (or “VISIT 2 FORMS”) 
section of the home page, select “Extra Health Questions” from the list. Enter the fields using 
the appropriate “Additional Health Questions for Each Visit” form and select “Save.” 
f. Repeat steps “a” through “e” for each participating Elder. 
8. IF 1ST WINTER VISIT AND you scheduled the next “Sampling Set Up Visit,” return to the Home’s main 
page in the database by selecting “Show Home” at the top of the Elder’s page. 
9. Under the “SCHEDULE” section, select “Sampling Visit 2” from the list. 

 
Updated October 31, 2016 
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10. Enter the “Appointment Date” and “Appointment Time.” 
11. Click “Save.” 
 
 
RESCHEDULING A FAILED SPIROMETRY TEST 
When a participant cannot complete the Spirometry measures or Dr. Paul Smith indicates that the Spirometry 
measures are invalid and need to be redone, a follow up Spirometry visit will be scheduled (when possible). 
1. Call the participant to review the health measures that will be completed. 
a. Complete the “Scheduling Spirometry” questions via interview.  
b. Explain any scheduling delays that will need to occur to account for medication usage and/or 
smoking.  
c. Schedule a time for the health measures when the appropriate time between use of 
medications and/or smoking will have the least impact.   
2. Return to the home to complete the Health Measures.  
a. Explain the health measures that will be collected.  
b. Complete the “Lung Function Screening Questionnaire” via interview.  
i. Note that spirometry is medication and health dependent. Based on the results of the 
“Lung Function Screening Questionnaire,” determine if spirometry needs to be 
rescheduled (when possible). 
c. Complete the health measures and the “Health Measures Visit Sheet.” 
i. Pulse Oximeter - Saturated oxygen and heart rate. 
ii. Blood Pressure. 
iii. Demonstrate how to use the spirometer and complete Spirometry testing. 
1. Give breaks between efforts when needed. 
iv. Referral Section – notify PI (Curtis Noonan (406) 243-4957, 
curtis.noonan@umontana.edu or Tony Ward (406) 243-4092, 
tony.ward@umontana.edu) of any Urgent or Emergent referrals. 
EldersAIR Database: 
1. When you enter a “YES” for “Failed Spiro” in the “Health Measures” form, the system will show either 
“Spiro Visit 1” or “Spiro Visit 2” (depending if it occurred during visit 1 or visit 2) under the Elder’s 
SCHEDULE section.  
2. Under the “SCHEDULE” section of the Elder’s page, select either “Spiro Visit 1” or “Spiro Visit 2.” 
3. Enter the “Appointment Date” and “Appointment Time” and click “Save.” 
4. Once the visit occurs, select either “Spiro Visit 1” or “Spiro Visit 2” under the Elder’s “SCHEDULE” 
section. 
5. Enter the “Actual Date” and “Actual Time” and click “Save.” 
6. New “Extra Health Questions,” “Health Measures,” “Lung Function,” and “Sprio Scheduling” forms will 
now show up under the “SPIRO 1 (OR 2) REDO FORMS” section. 
7. Open the forms, enter the applicable fields, and select “save” when finished. 
 

 
Updated October 31, 2016 
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Elders Home Visit Protocol – Winter 2 
CONTACT HOUSEHOLD FOR BEGINNING OF WINTER 2  
 
When it is time to begin scheduling households for winter 2, contact each household:  
1. Explain that you are calling to schedule the initial (intervention) visit for the EldersAIR study and what 
it will include (explain for assigned treatment – filtration (TX1, TX2) or best burn education (TX3)): 
a. Filtration (TX1 or TX2): Set up air filtration unit (Filter Unit) and complete paperwork. This visit 
will take approximately 30 minutes (schedule 1 hour). 
b. Best Burn Education (TX3): Administer KAB Education form first. Display within home the 
three short videos for review during the appointment.  At the visit, you will discuss the videos, 
review best burn techniques, and demonstrate the use of the moisture meter, fire starter, and 
thermometer.  You will then complete the initial paperwork. The visit should take 
approximately 30 minutes to 1 hour (schedule 1 hour).  
2. Provide options for dates and times for the Sampling Set Up visit.  
3. Finalize a date and time with the participant. 
4. Let the participant know you will call, text or email the day before the appointment with a reminder. 
Ask for preferred reminder method – call, text, or email. 
 
EldersAIR Database: 
Prior to the beginning of Year 2, UM will assign each household’s condition in the database. NOTE: It is 
important not to enter any additional data until the home has been assigned an intervention in the 
database! 
1. From the dashboard, select “View All Homes.” 
2. Select the appropriate Home ID from the list. 
3. Under the “SCHEDULE” section, select “Intervention” from the list. 
4. Enter the “Appointment Date” and “Intervention Time.” 
5. Click “Save.” 
 
 
INTERVENTION VISIT  
Note: Depending on the home assignment, complete either the “Filter Intervention Visit” or “Education 
Intervention Visit” checklist as you progress through the following tasks. 
1. Provide the “Demographics” and “Home Characteristic Data Sheet” to the participant(s) to complete. 
Note: A demographics form is needed for each participant.  
2. Install the iButton on stove. 
a. If their stove has legs, attach the iButton’s ball-chain around the upper, back, right leg and 
secure. 
b. If it is a pedestal stove (or as needed), attach the button to the lower, right, backside of stove 
via magnet. 

 
Updated October 31, 2016 
9 
c. Note the iButton’s location should be comfortably warm to the touch of the hand. 
3. Complete the appropriate sections of the “iButton Data Sheet.” 
4. Provide the “Study Contact Information” to the participant(s) and let them know they can contact you 
at anytime with questions.  
5. Filter Intervention:  
a. Locate an available outlet and space where the Filter unit can be located throughout the 
winter, where the participant spends the most amount of time. Note: The Filter unit for 
placebo (T2) homes will need to be taped closed prior to the visit so it is not possible to see 
into the filter compartment. Non-placebo units can also be taped (less extensively) to keep 
houses similar if they were to speak to each other. Winix brand filters also need the Air Quality 
Sensor lights taped over. Use black tape first, then cover with white.  
b. Install the KW (Kill-a-watt) meter and filter (see “Filter Unit Protocol”), and complete the 
“Filter Unit Tracking Form.” 
c. Turn the Tx1 Filter Unit on the “high” setting and the TX2 (placebo) Filter Unit unit on the 
“low” setting. 
d. Instruct the participant on the filter change lights (i.e., notify if they see a yellow or red light on 
the front of the Winix unit). 
6. Education Intervention: 
a. Complete the KAB Education form before starting the rest of the education visit. 
b. Watch the videos with the participant in their home. 
c. Review and complete the “Best Burn Education Tracking Form” as you progress through the 
best burn education training with the homeowner. 
d. Provide the moisture meter, wood stove thermometer, and fire starters to the homeowner 
and demonstrate how each tool is used. 
e. Provide a copy of the “Wood Stove Best Burn Summary” and the EldersAIR videos (3) to the 
homeowner. 
7. Schedule the Sampling Set Up Visit (minimum 2 weeks after intervention visit).  
a. Complete the scheduling section of the “Education Intervention Visit” checklist by first asking 
if the participant(s) have had a respiratory tract infection in the last three weeks. If “YES,” the 
Sampling Set Up Visit will need to be delayed accordingly (when possible). 
EldersAIR Database: 
1. From the dashboard, select “View All Homes.” 
2. Select the appropriate Home ID from the list. 
3. Under the “SCHEDULE” section, select “Intervention” from the list. 
4. Enter the “Actual Date” and “Actual Time” and click “Save.” 
5. Next, enter the appropriate forms for the household. 
a. Home Characteristics: Under the “FORMS” section of the home page, select “Home 
Characteristics” from the list. Enter the fields using the “Home Characteristics” form and select 
“Save.” 
b. iButton: Under the “FORMS” section of the home page, select “iButton” from the list. Enter 
the fields using the “iButton Data Sheet” and select “Save.” 
Filter Homes ONLY: 

 
Updated October 31, 2016 
10 
a. Filter Unit: Under the “FORMS” section of the home page, select “Filter Unit” from the list. 
Enter the fields using the “Filter Unit Tracking” form and select “Save.” 
 
 
 
Education Homes ONLY: 
a. Best Burn Education Tracking: Under the “FORMS” section of the home page, select 
“Education” from the list. Enter the fields using the “Best Burn Education Tracking” form and 
select “Save.” 
6. Next, enter the appropriate forms for each Elder. 
a. Select the appropriate Elder ID under the “ELDERS” section of the home.  
b. Demographics: Under the “FORMS” section of the Elder’s page, select “Demographics” from 
the list. Enter the fields using the “Demographics” form and select “Save.” 
c. Repeat steps “a” and “b” for each participating Elder. 
7. If you scheduled the Sampling Set Up Visit, return to the Home’s main page by selecting “Show Home” 
at the top of the Elder’s page. 
8. Under the “SCHEDULE” section, select “Sampling Visit 1” (or “Sampling Visit 2”) from the list. 
9. Enter the “Appointment Date” and “Appointment Time.” 
10. Click “Save.” 
 
 
SAMPLING SET UP VISIT  
Sampling is completed 2x per winter. The 1st sampling visit should occur a minimum of 2 weeks after the 
intervention. When possible, the 2nd sampling visit should occur a minimum of 3 weeks after the 1st sampling 
visit. 
Note: Complete the “Sampling Set Up Checklist” as you progress through the following tasks. 
1. Find a place across the room from the stove to place the DustTrak (See “DustTrak Protocol” for 
programming the equipment prior to the visit).  
a. If they already have a table or surface to use, go for it, if not, set up the tv-tray where it won’t 
easily be knocked over by people or pets. 
b. The DustTrak needs to be plugged in to a working wall outlet. 
c. Turn the DustTrak on and start the program. 
d. Attach the Humidity Monitor to the DustTrak.  
e. Complete the appropriate sections of the “DustTrak Data Sheet” and “Humidity Monitor Data 
Sheet.” 
2. Introduce the MicroPEM and holder. 
a. Clip the FitBit Zip to the MicroPEM pouch (see FitBit Zip Activity Monitor Protocol). 
b. Describe how to wear it. 
c. Inform them of when to wear it. 
d. Inform them that you will be calling to check in on the MicroPEM in 24 hours.  
e. Complete the appropriate sections of the “MicroPEM Data Sheet.” 
3. Sit down with the participant to go through the white binder contents. 

 
Updated October 31, 2016 
11 
a. Describe how to fill out all the forms over the next 48 hours. 
i. “Home Activity Log” 
ii. “Wood Stove Usage Log” 
iii. “In-Home Log” (how often they’re in their house) 
4. Download the iButton data and complete the appropriate sections of the “iButton Data Sheet.” Note: 
the same “iButton Data Sheet” will be used at all visits. 
a. If using a PC to download the iButton, restart the mission with the software. Check to make 
sure that next to “Is Mission Active?” it says “true,” the “sampling rate” is equal to 25 
minutes,” and next to “roll over enabled?” it says “true.”  
5. FILTER HOMES ONLY   
a. Record the KW meter reading and check the filter replacement light on Winix units to see if a 
filter change is required. Note: Placebo homes (TX2) do not require a filter or filter change.  
i. Verify that the active Filter unit is running on the “High” setting. If not, turn it up to the 
High setting.  
b. Complete the “Filter Unit Tracking Form.” Note: the same “Filter Unit Tracking Form” will be 
used at all visits. 
6. Education Homes ONLY:  
a. At each sampling set up visit, education homes will be asked about the top three best burn 
items that were identified during the intervention visit – one question per visit. Record the 
question/participant answer on the “Sampling Set Up” checklist (see bottom section). 
7. Ask if you can trade a piece of wood so you can test the moisture content. Label the piece of wood 
with the home ID. 
8. Review the health measures that will be completed in two days. 
a. Complete the “Scheduling Spirometry” questions via interview. See also “Scheduling 
Spirometry Protocol.” 
b. Explain any scheduling delays that will need to occur to account for medication usage and/or 
smoking.  
c. Schedule a time for the health measures when the appropriate time between use of 
medications and/or smoking will have the least impact.   
9. 1St Winter Visit ONLY (Year 2): After the visit/at the office, split the piece of wood obtained from the 
homeowner and complete the “Wood Moisture Tracking Form.”  It is important to take the moisture 
reading from the inside of the wood to provide the most accurate measurement. 
EldersAIR Database: 
1. From the dashboard, select “View All Homes.” 
2. Select the appropriate Home ID from the list. 
3. Under the “SCHEDULE” section, select “Sampling Visit 1” (or “Sampling Visit 2” if second visit) from the 
list. 
4. Enter the “Appointment Date” and “Appointment Time.” 
5. Click “Save.” 
6. Next, enter the appropriate forms for the household. 

 
Updated October 31, 2016 
12 
a. iButton: Under the “VISIT 1 FORMS” (or “Visit 2 Forms”) section of the home page, select 
“iButton Update” with the appropriate visit date listed next to it. Enter the fields using the 
“iButton Data Sheet” and select “Save.” 
b. Wood Moisture: Under the “FORMS” section of the home page, select “Moisture” from the 
list. Enter the fields using the “Wood Moisture Tracking” form and select “Save.” 
Filter Homes ONLY: 
c. Filter Unit: Under the “VISIT 1 FORMS” (or “Visit 2 Forms”) section of the home page, select 
“Filter Unit Update” with the appropriate visit date listed next to it. Enter the fields using the 
“Filter Unit Tracking” form and select “Save.” 
Education Homes ONLY: 
d. Ed Check: Under the “VISIT 1 FORMS” (or “Visit 2 Forms”) section of the home page, select “Ed 
Check” with the appropriate visit date listed next to it.  Select the question that was asked 
from the drop down menu and enter the response from the household in the “Answer” field. 
Select “Save.” 
7. Next, enter the appropriate forms for each Elder. 
a. Select the appropriate Elder ID under the “ELDER” section of the home.  
b. Scheduling Spirometry: Under the “VISIT 1 FORMS” (or “Visit 2 Forms”) section of the Elder’s 
page, select “Scheduling Spiro.” The Scheduling Spiro form should list the date that 
corresponds with your visit next to it. Enter the fields using the “Scheduling Spirometry” form 
and select “Save.” 
c. Repeat steps “a” and “b” for each participating Elder. 
8. Return to the Home’s main page within the database by selecting “Show Home” at the top of the 
Elder’s page. 
9. Enter the “Sampling Pick Up & Health Measures Visit” appointment. 
a. Under the “SCHEDULE” section, select ““Pickup/Health Measures 1” (or “Pickup/Health 
Measures 2”) from” from the list. 
b. Enter the “Appointment Date” and “Appointment Time.” 
c. Click “Save.” 
 
SAMPLING CHECK IN CALL 
1. After 24 hours, call the participant(s) to check that the logs are being filled out and the MicroPEM is 
being worn. 
2. Remind the participant of the Health Measures Visit and the appropriate timeframes needed for 
medication usage and/or smoking. 
 
HEALTH MEASURES AND SAMPLING PICK UP VISIT  
Note: The “Health Measures and Sampling Pick Up Visit” occurs 48 hours from “Sampling Set Up.” These visits 
are completed 2x per winter. Complete the “Health Measures and Sampling Pick Up Checklist” as you 
progress through the following tasks. 

 
Updated October 31, 2016 
13 
1. At the end of the 48 hours, return to the home to complete the Health Measures.  
a. Explain the health measures that will be collected.  
b. Complete the “Lung Function Screening Questionnaire” via interview.  
i. Note that spirometry is medication and health dependent. Based on the results of the 
“Lung Function Screening Questionnaire,” determine if spirometry needs to be 
rescheduled (when possible). 
c. Complete the health measures and the “Health Measures Visit Sheet.” 
i. Pulse Oximeter - Saturated oxygen and heart rate (see “Pulse Oximeter Protocol” and 
“Referral Protocol for Health Measure Readings.”) 
ii. Blood Pressure (see “e-sphyg 2 BP Cuff Protocol” and “Referral Protocol for Health 
Measure Readings.”) 
iii. Demonstrate how to use the spirometer and complete Spirometry testing. 
1. Give breaks between efforts when needed. 
iv. Referral Section – notify PI (Curtis Noonan (406) 243-4957, 
curtis.noonan@umontana.edu or Tony Ward (406) 243-4092, 
tony.ward@umontana.edu) of any Urgent or Emergent referrals. 
d. Complete the “Additional Health Questions for Each Visit” questionnaire via interview. 
2. Complete the appropriate sections of the equipment data sheets. 
a. “DustTrak Data Sheet”  
b. “Humidity Monitor Data Sheet”  
c. “MicroPEM Data Sheet” 
3. Collect the sampling equipment and household binder. 
a. MicroPEM, FitBit, and MicroPEM holder 
b. DustTrak and case 
c. Humidity Monitor 
d. Binder and completed logs (review to ensure completeness). 
i. “Home Activity Log” 
ii. “Wood Stove Usage Log” 
iii. “In-Home Log” (how often they’re in their house) 
4. Download the iButton data and complete the appropriate sections of the “iButton Data Sheet.” Note: 
the same “iButton Data Sheet” will be used at all visits. 
a. If using a PC to download the iButton, restart the mission with the software. Check to make 
sure that next to “Is Mission Active?” it says “true,” the “sampling rate” is equal to 25 
minutes,” and next to “roll over enabled?” it says “true.”  
5. FILTER HOMES ONLY   
a. Record the KW meter reading.  
i. Verify that the Filter is running on the “High” setting. If not, turn it up to the High 
setting. 
b. Complete the “Filter Unit Tracking Form.” Note: the same “Filter Unit Tracking Form” will be 
used at all visits. 
6. IF FIRST WINTER VISIT (Year 2), schedule the next “Sampling Set Up Visit” when possible (minimum 3 
weeks out; however more time in between visits is preferred when possible). 
7. Provide the participant reimbursement to the household ($50 for each health measures visit). 

 
Updated October 31, 2016 
14 
SECOND WINTER VISIT ONLY (i.e., Last visit in Year 2) 
8. Provide the “KAB Post Winter 2 Survey” and “Post Winter Questionnaire” to the household 
participant(s) to complete. Note: Use the correct version for Education and Filter homes. 
9. Collect iButton after download. 
10. Remove Placebo Filters and KW Meters/Surge Protectors. 
11. Collect a nicotine wipe sample (see “Nicotine Wipe Protocol”) and complete the appropriate sections 
of the “Nicotine Wipe Data Sheet.” 
12. Provide tools not originally received (moisture meter, firestarters, thermometer, and new filter Filter 
Unit homes and an active Filter unit for the education homes). 
13. FILTER HOMES ONLY: Provide the filter reimbursement to the household. 
EldersAIR Database: 
1. From the dashboard, select “View All Homes.” 
2. Select the appropriate Home ID from the list. 
3. Under the “SCHEDULE” section, select “Pickup/Health Measures 1” (or “Pickup/Health Measures 2”) 
from the list. 
4. Enter the “Actual Date” and “Actual Time.” 
5. Click “Save.” 
6. Next, enter the appropriate forms for the household. 
a. iButton Update: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the home page, 
select “iButton Update” with the appropriate visit date listed next to it. Enter the fields using 
the “iButton Data Sheet” and select “Save.” 
b. DustTrak: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the home page, select 
“DustTrak” from the list. Enter the fields using the “DustTrak” datasheet and upload the 
TrackPro file. Select “Save.” 
c. Home Activity Log: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the home page, 
select “Home Activity – Day 1” from the list. Enter the fields using the appropriate “Home 
Activity Log” form and select “Save.” Repeat for Days 2-6. 
d. MicroPEM: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the home page, select 
“MicroPEM” from the list. Enter the fields using the “MicroPEM” datasheet and upload the 
MicroPEM and FitBit files. Select “Save.” 
e. Humidity: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the home page, select 
“Humidity” from the list. Enter the fields using the appropriate “Humidity Tracking” form and 
select “Save.”  
f. Wood Stove Usage: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the home 
page, select “Woodstove Usage” from the list. Enter the fields using the appropriate “Wood 
Stove Usage Log” and select “Save.” 
g. End of Winter (Post Winter Questionnaire) (2nd/Final Visit ONLY): Under the “VISIT 2 FORMS” 
section of the home page, select “EOW” from the list. Enter the fields using either the “Post 
Winter Questionnaire Filter Homes” or “Post Winter Questionnaire Education Homes” survey. 
h. Post Winter KAB Assessment (2nd/Final Visit ONLY): Under the “VISIT 2 FORMS” section of the 
home page, select “KAB” from the list. Enter the fields using the “KAB Filter Homes Post 
Winter 2 Assessment” or the “KAB Educational Homes Post Winter 2 Assessment.”  

 
Updated October 31, 2016 
15 
i. 
Nicotine (2nd/Final Visit ONLY): Under the “VISIT 2 FORMS” section of the home page, select 
“Nicotine” from the list. Enter the fields using the “Nicotine Wipe Data Sheet” and select 
“Save.” 
Filter Homes ONLY: 
j. 
Filter Unit: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the home page, select 
“Filter Unit Update” with the appropriate visit date listed next to it. Enter the fields using the 
“Filter Unit Tracking” form and select “Save.” 
7. Next, enter the appropriate forms for each Elder. 
a. Select the appropriate Elder ID under the “Elders” section of the home.  
b. In Home Log: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the Elder’s page, 
select “In Home Log – Day 1.” Enter the fields using the appropriate “In Home Log” form and 
select “Save.” Repeat for Days 2-6. 
c. Lung Function Screening Questionnaire: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) 
section of the home page, select “Lung Function” from the list. Enter the fields using the 
appropriate “Lung Function Screening Questionnaire” form and select “Save.”  
d. Health Measures: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) section of the home page, 
select “Health Measures” from the list. Enter the fields using the “Health Measures Visit” 
datasheet and upload the Spirometry files. Select “Save.” 
e. Additional Health Questions for Each Visit: Under the “VISIT1 FORMS” (or “VISIT 2 FORMS”) 
section of the home page, select “Additional Health” from the list. Enter the fields using the 
appropriate “Additional Health Questions for Each Visit” form and select “Save.” 
f. Repeat steps “a” through “e” for each participating Elder. 
8. IF 1ST WINTER VISIT AND you scheduled the next “Sampling Set Up Visit,” return to the Home in the 
database by selecting “Show Home” at the top of the Elder’s page. 
9. Under the “SCHEDULE” section, select “Sampling Visit 2” from the list. 
10. Enter the “Appointment Date” and “Appointment Time.” 
11. Click “Save.” 
 
RESCHEDULING A FAILED SPIROMETRY TEST 
When a participant cannot complete the Spirometry measures or Dr. Paul Smith indicates that the Spirometry 
measures are invalid and need to be redone, a follow up Spirometry visit will be scheduled (when possible). 
1. Call the participant to review the health measures that will be completed. 
a. Complete the “Scheduling Spirometry” questions via interview.  
b. Explain any scheduling delays that will need to occur to account for medication usage and/or 
smoking.  
c. Schedule a time for the health measures when the appropriate time between use of 
medications and/or smoking will have the least impact.   
2. Return to the home to complete the Health Measures.  
a. Explain the health measures that will be collected.  
b. Complete the “Lung Function Screening Questionnaire” via interview.  

 
Updated October 31, 2016 
16 
i. Note that spirometry is medication and health dependent. Based on the results of 
the “Lung Function Screening Questionnaire,” determine if spirometry needs to be 
rescheduled (when possible). 
c. Complete the health measures and the “Health Measures Visit Sheet.” 
i. Pulse Oximeter - Saturated oxygen and heart rate. 
ii. Blood Pressure. 
iii. Demonstrate how to use the spirometer and complete Spirometry testing. 
1. Give breaks between efforts when needed. 
iv. Referral Section – notify PI (Curtis Noonan (406) 243-4957, 
curtis.noonan@umontana.edu or Tony Ward (406) 243-4092, 
tony.ward@umontana.edu) of any Urgent or Emergent referrals. 
EldersAIR Database: 
1. When you enter a “YES” for “Failed Spiro” in the “Health Measures” form, the system will show either 
“Spiro Visit 1” or “Spiro Visit 2” (depending if it occurred during visit 1 or visit 2) under the Elder’s 
SCHEDULE section.  
2. Under the “SCHEDULE” section of the Elder’s page, select either “Spiro Visit 1” or “Spiro Visit 2.” 
3. Enter the “Appointment Date” and “Appointment Time” and click “Save.” 
4. Once the visit occurs, select either “Spiro Visit 1” or “Spiro Visit 2” under the Elder’s “SCHEDULE” 
section. 
5. Enter the “Actual Date” and “Actual Time” and click “Save.” 
6. New “Extra Health Questions,” “Health Measures,” “Lung Function,” and “Sprio Scheduling” forms will 
now show up under the “SPIRO 1 (OR 2) REDO FORMS” section. 
7. Open the forms, enter the applicable fields, and select “save” when finished. 
 

1	  
	  
Health Measures and Sampling Visit: Elders study 
 
At entry (or first home visit) the following will be collected from each participant: 
 
• 
Signed Informed Consent (if not already collected) 
• 
Signed HIPAA Form (if not already collected) 
• 
Demographics Form 
• 
Health History Form 
• 
Home Characteristics Form 
 
 
At each of two visits per winter the following measures will be collected: 
 
• 
Saturated oxygen and heart rate (see Pulse Oximeter Protocol) 
• 
Blood Pressure (see e-sphyg 2 BP Cuff Protocol, see also Referral Protocol) 
• 
Spirometry (see Questionnaire and Spirometry Protocol, including ‘Additional Questions for each Health 
Visit’) 
 
 
At each visit, the following exposure assessment procedures will occur: 
 
• 
DustTrack sampling (48 hour) 
• 
MicroPEM personal sampler (48 hour) 
 
The DustTrak air sampling equipment will be placed by study personnel and will measure temperature and dust 
for 48 hours. The home participants will also be asked to wear a small device (MicroPEM personal sampler) 
that will measure the amount of wood smoke particles that they breathe. The device is about the size of a deck 
of cards. Participants will be asked to wear the device while they are awake during the 48 hour sampling period. 
 
During air sampling, the following data collection forms will be completed by a home resident: 
 
• 
Home activity log 
• 
In-home log 
• 
Wood stove tracking form 
• 
Wood stove usage form 
 
During one visit per winter, a nicotine wipe sample will be collected from the home by field personnel. 
 
• 
Nicotine Protocol 
• 
Nicotine Wipe Data Sheet 

2	  
	  
  
Demographic Questions for Resident 
 
 
 
Home ID:_____________ 
 
 
 
 
 
 
 
 
 
 Date: _______________ 
 
1.  Please circle one:  
Female 
 
Male 
 
2.   What is your age as of Nov 1?________________ 
 
3. Are you Hispanic or Latino? 
 
 
 
Yes 
 
No 
 
 
4.  What is your race? Circle one or more races to indicate what you consider yourself to be: 
 
 
American Indian/Alaskan Native 
 
 
Asian 
 
 
Native Hawaiian or Other Pacific Islander 
 
 
Black or African American 
 
 
White 
 
 
     More than one race 
 
5. Circle the category that best describes your household income?  
 
 
Less than $20,000 
 
$20,000 to $29,999 
 
$30,000 to $39,999 
 
$40,000 to $49,999 
 
$50,000 to $74,999 
 
$75,000 to $99,999 
 
$100,000 or more  
 
 
6. Circle the category that best describes your years of school completed: 
 
Less than high school 
 
High school diploma or GED 
 
Some college 
 
College degree 
 
7. How many total residents are in your home? 
 
 
 
 
8.  How many children under 18 reside in your home? 
 
 
 

3	  
	  
Health History 
Page 1 
 
 
We are interested in knowing whether or not you have been told and/or diagnosed by a medical 
health provider with any of the following conditions.  You are unlikely to recognize the names of 
any or all of these conditions unless you’ve been told you have them.  Have you ever been told by 
a doctor or other health care professional that you have any of the following conditions? 
 
 
 
 
 
 
 
            YES      NO       Not        Refused  
Date 
                                                                                       Sure                 
Diagnosed 
 
a.  Rheumatoid Arthritis 
 
       
o 
       o          o            o             _______   
 
b.  Lupus 
 
 
 
 
o 
       o          o            o             _______   
 
c. Scleroderma 
 
 
 
o 
       o          o            o             _______   
 
d.  Psoriasis 
 
 
 
 
o 
       o          o            o             _______   
 
e.  Asthma 
 
      
 
 
o 
       o          o            o             _______   
 
f.  Eczema 
 
 
 
 
o 
       o          o            o             _______   
 
g.  Emphysema                              
 
o 
       o          o            o             _______   
 
h. Chronic bronchitis  
 
 
o 
       o          o            o             _______   
 
i.  Chronic Obstructive Pulmonary Disease  o 
       o          o            o             _______   
 
j. Sarcoidosis  
 
 
 
o 
       o          o            o             _______   
 
k.  Hayfever 
 
 
 
 
o 
       o          o            o             _______   
 
l.  Allergies 
 
 
 
 
o 
       o          o            o             _______   
 
 
If you have been diagnosed with Allergies, what are you allergic to?  ________________ 
 
Have you been diagnosed with any other  
o 
       o          o            o             _______   
autoimmune disease: 
 
If so, what was the diagnosis? 
 
 
 
 
 
 
 
 
 

4	  
	  
 Health History 
Page 2 
 
Participant ID: 
 
CONTINUED 
 
 
 
 
 
 
 
      YES      NO       Not        Refused    Date 
                                                                                           Sure                       Diagnosed 
m. GERD (acid reflux) 
 
 
        o        o          o            o             _______   
 
n.  Chrohns Disease  
 
 
       o        o          o            o             _______ 
 
o.  Colitis (bloody, mucus stools) 
 
        o        o          o            o             _______ 
 
p. Sleep Apnea 
 
 
 
        o        o          o            o             _______ 
 
q.  Kidney failure 
 
 
 
        o        o          o            o             _______ 
 
r.  Pleural Effusion (fluid in chest/lung) 
        o        o          o            o             _______ 
 
s.  Pleurisy 
 
 
 
 
        o        o          o            o             _______ 
 
t.  Pneumonia  (diagnosed by MD) 
 
       o        o          o            o             _______ 
 
u.  Pneumothrorax (lung collapse)    
        o        o          o            o             _______ 
 
v.  Empyema (collection of pus in the space betweeno        o          o            o             _______ 
     the lung and the inside of the chest wall) 
 
w.  Broken or cracked ribs 
 
 
        o        o          o            o             _______ 
 
x.  Coronary artery disease 
 
 
        o        o          o            o             _______ 
 
y.  Angina 
 
 
 
 
        o        o          o            o             _______ 
 
z.  Heart Attack 
 
 
 
        o        o          o            o             _______ 
 
aa.  Congestive heart failure (CHF)  
        o        o          o            o             _______ 
 
bb.  Abnormal heart rhythm  
 
        o        o          o            o             _______ 
 
cc.  Pacemaker 
 
 
 
       o        o          o            o             _______ 
 
dd.  ICD (intraventricular cardiac defibrillator)       o        o          o            o             _______ 
 
ee.  Valve disease/heart murmur 
 
        o        o          o            o             _______ 
 
ff.  Hypertension (high blood pressure) 
        o        o          o            o             _______ 
 
gg.  Circulation problems in legs 
 
        o        o          o            o             _______ 
 
hh  Circulation problems in head/neck (Carotids)  o       o          o            o             _______ 
 

5	  
	  
 Health History 
Page 3 
 
 
 
 
 
 
 
    YES      NO       Not        Refused    Date 
                                                                                          Sure                        Diagnosed 
 
ii.  Stroke 
 
 
 
 
        o        o          o            o             _______ 
 
jj.  Diabetes 
 
 
 
 
        o        o          o            o             _______      
 
kk. Thyroid Disease  
 
 
        o        o          o            o             _______ 
 
ll.  Anemia (low blood count)  
                    o       o          o            o             _______   
 
 
 
 
Have you been diagnosed with cancer?     o       o          o            o             _______   
 
For each different type of cancer diagnosed, please select the corresponding code from the list below 
and write it in one of the boxes below. 
 
Cancer 1  ______ 
Cancer 6  ______ 
Cancer 11  ______ 
Cancer 2  ______ 
Cancer 7  ______ 
Cancer 12  ______ 
Cancer 3  ______ 
Cancer 8  ______ 
 
Cancer 4  ______ 
Cancer 9  ______ 
 
Cancer 5  ______ 
Cancer 10 ______ 
 
 
Code 
Location 
Code 
Location 
Code 
Location 
10 
Bladder 
24 
Melanoma 
35 
Stomach 
11 
Blood 
25  
Lymphoma/Hodgkin’s 
Disease 
36  
Testis 
(Testicular) 
12 
Bone 
42 
Mesothelioma 
37 
Thyroid 
13 
Brain 
26 
Mouth/Tongue/lip 
38 
Uterus 
(Uterine) 
14 
Breast 
41 
Nasal/sinus 
39 
Other 
15 
Cervix 
(Cervical) 
27 
Nervous System 
77 
Refused 
16 
Colon 
28 
Ovary (Ovarian) 
99 
Don’t Know 
17 
Esophagus 
(Esophageal) 
29 
Pancreas 
(Pancreatic) 
 
 
18 
Gallbladder 
40  
Pharyngeal/throat 
 
 
19  
Kidney 
30 
Prostate 
 
 
20 
Larynx/Voice 
Box 
31 
Rectum (Rectal) 
 
 
21 
Leukemia 
32 
Skin (non-melanoma)  
 
22 
Liver 
33 
Skin (don’t know 
what kind) 
 
 
23 
Lung 
34 
Soft Tissue (muscle 
or fat) 
 
 
 
 

6	  
	  
HOME CHARACTERISTICS DATA SHEET  
 
 
 
 
Technician:_______________  Home ID:_________  
Winter (1,2,3,etc.):________  
 
 
 
 
 
Sampling Dates:___________ Date form completed:________________ 
 
To be completed by resident once at the beginning of each winter. 
 
1. 
Number of total residents in home: ___________ 
 
2. 
Number of residents over 55 years of age: ___________  
 
 
3. 
Type of home: House       Mobile Home  
Duplex/Apt 
Other: _____________  
        
4. 
Year home built: ___________  
 
 
 
 
 
 
 
 
 
 
5. 
Square footage of home: ___________  
 
     
          
6. 
Number of floors (not incl. bsmnt): 
1 
2 
3 
 
 
7. 
Number of windows: ___________  
 
 
 
 
8. 
Number of bedrooms: ___________ 
 
 
    
       
9. 
Total number of pets: ___________  
 
 
 
 
10. 
Total number of “furry” pets: ___________ 
 
 
 
11. 
Type of primary heating (Please circle ONLY one choice that represents your most common practice):  
 
      
Wood stove      Electrical       Propane       Natural gas furnace 
  Oil 
Other:   
 
      
       
12. 
Type of secondary heating (Please circle ONLY one choice that represents your most common practice):   
 
    Wood stove      Electrical       Propane       Natural gas furnace   Oil 
None or Other:________ 
 
 
13. 
Existing appliance(s):   Fireplace 
    Wood stove      Furnace 
 Wood stove insert 
 
 
14. 
Wood stove model (If you have access, information is located on the back of the stove): 
 
 
15. 
Approximately how old is your wood stove:  
 
        
0-5 years old         6-10 years old 
11-15 years old   
16 + years old 
 
 
16. 
Is your wood stove EPA-certified?      Yes 
    No 
    
I don’t know 
 
 
17. 
When do you get your wood before burning? (Please circle ONLY one choice that  
 
represents your most common practice) 
 
A few days 
    
 
 
 
Between 1 week and 1 month 
 
 
 

7	  
	  
Between 1 month and 3 months  
 
Between 3 months and 6 months 
 
Between 6 months and 1 year 
 
 
More than 1year 
 
 
18. 
On average, how many cords of wood do you burn each year?  
_________ cords 
 
 
19. 
How do you usually acquire your wood? (Please circle ONLY one choice that represents your most 
common practice) 
 
 
Senior Wood Delivery Program    Harvest yourself   Purchase it    Other:_____________  
 
 
20. 
When was the last time you had your chimney cleaned? 
 
 Less than 6 months ago    6-12 months ago 
  12-18 months ago 
more than 18 months ago 
 
 
21. 
Within the last 12 months have you had wet or damp spots on surfaces inside your home other than in the 
basement (for example on walls, wall paper, ceilings or carpets)? 
 
      
 Yes 
    No 
    
I don’t know 
 
 
22. 
Has there been mold or mildew on any surfaces inside your home in the last 12 months? 
 
      
 Yes 
    No 
    
I don’t know 
 

8	  
	  
Pulse	  Oximeter	  Protocol	  
	  
1. Remove	  blue	  Pulse	  Oximeter	  (pulse-­‐ox)	  from	  blue	  carrying	  case.	  
2. Squeeze	  the	  end	  of	  the	  pulse-­‐ox	  that	  says	  PUSH	  to	  open	  the	  clip.	  
3. Place	  the	  participant’s	  index	  or	  thumb	  into	  the	  clip	  and	  release	  
the	  pulse-­‐ox	  so	  it	  gently	  squeezes	  the	  finger.	  
a. The	  fingernail	  should	  be	  facing	  up,	  toward	  the	  display.	  
Don’t	  put	  the	  pulse-­‐ox	  on	  upside	  down!	  
b. Make	  sure	  the	  participant	  is	  not	  moving	  and	  is	  at	  ease	  
during	  this	  process.	  
4. Press	  the	  white	  button	  on	  the	  top	  and	  it	  will	  turn	  on	  and	  start	  to	  
take	  a	  reading.	  
a. You’ll	  notice	  red	  LED	  lights	  show	  up	  on	  the	  display.	  
b. The	  reading	  will	  take	  a	  few	  seconds	  before	  it	  shows	  up	  on	  the	  display.	  
c. Once	  it’s	  ready,	  you	  will	  see	  two	  numbers:	  
i. The	  first	  number	  will	  appear	  about	  “PRbpm,”	  which	  is	  your	  current	  Heart	  Rate	  
ii. The	  second	  number	  appears	  above	  “%SpO2,”	  which	  is	  your	  oxygen	  percentage.	  
d. Wait	  at	  least	  10	  seconds	  after	  the	  first	  reading	  shows	  up	  before	  you	  record	  the	  numbers.	  
e. Write	  the	  two	  measurements	  down	  on	  the	  medical	  visit	  log	  form.	  	  
5. Gently	  press	  the	  PUSH	  end	  of	  the	  pulse-­‐ox	  again	  to	  open	  the	  clip	  and	  release	  the	  finger.	  	  
6. The	  pulse-­‐ox	  will	  turn	  off	  on	  its	  own.	  
7. Use	  an	  alcohol	  swab	  to	  gently	  clean	  the	  inside	  of	  the	  clip.	  
8. You	  can	  store	  it	  back	  in	  its	  blue	  carrying	  case.	  	  
	  
9. If	  the	  low	  battery	  icon	  shows	  up	  on	  the	  display,	  you	  need	  to	  switch	  out	  the	  batteries.	  
a. Flip	  the	  pulse-­‐ox	  over	  and	  slide	  off	  the	  blue	  battery	  cover.	  	  
b. Replace	  the	  two	  AAA	  batteries.	  
c. Replace	  the	  blue	  cover.	  
	  
	  

9	  
	  
e-­‐sphyg	  2	  Blood	  Pressure	  Protocol	  
1. Make	  sure	  your	  participant	  is	  comfortable	  and	  relaxed.	  
a. The	  participant	  should	  have	  been	  resting	  for	  at	  least	  5	  minutes	  prior	  to	  the	  test.	  
b. Make	  sure	  the	  participant	  does	  not	  move	  or	  talk	  during	  the	  test.	  
c. If	  you	  need	  to	  repeat	  a	  test,	  wait	  5	  minutes	  between	  tests.	  
2. Turn	  the	  device	  on	  by	  pressing	  the	  “I”	  side	  of	  the	  Main	  Power	  Switch.	  
3. Make	  sure	  the	  mode	  selector	  switch	  is	  down,	  set	  to	  AUTO.	  
4. Set	  the	  preset	  pressure	  value	  by	  turning	  the	  knob	  till	  the	  line	  is	  at	  180.	  
5. Apply	  the	  BP	  cuff	  to	  the	  participant’s	  arm.	  
a. Choose	  the	  cuff	  that	  fits	  best	  (most	  likely	  Adult)	  
b. Wrap	  it	  around	  the	  upper	  arm,	  just	  above	  the	  bend	  of	  the	  elbow.	  
c. The	  Artery	  Mark	  should	  be	  lined	  up	  over	  the	  brachial	  artery.	  
6. Press	  the	  Start	  button.	  
a. The	  cuff	  will	  automatically	  start	  to	  inflate.	  
b. The	  meter	  will	  stop	  inflating	  when	  it	  reaches	  the	  correct	  pressure	  (which	  may	  be	  higher	  or	  lower	  
than	  the	  pre-­‐set	  180	  value)	  
c. The	  “heart”	  symbol	  will	  flash	  on	  the	  screen	  when	  the	  pulse	  is	  detected.	  
d. The	  cuff	  will	  automatically	  deflate.	  
i. If	  the	  measurement	  needs	  to	  be	  interrupted,	  press	  the	  Stop	  button	  and	  the	  cuff	  will	  
exhaust	  air	  rapidly	  
7. The	  blood	  pressure	  and	  pulse	  rate	  will	  be	  displayed	  on	  the	  screen	  after	  the	  test	  is	  complete.	  
8. To	  check	  the	  status	  of	  the	  batteries,	  refer	  to	  the	  indicator	  light	  on	  the	  front	  of	  the	  meter.	  If	  you	  plug	  the	  
unit	  into	  an	  AC	  outlet,	  and	  the	  light	  is	  yellow,	  the	  battery	  is	  charging.	  If	  the	  light	  is	  green,	  you	  can	  unplug	  it	  
from	  the	  AC	  outlet	  because	  the	  battery	  is	  fully	  charged.	  The	  battery	  will	  charge	  whether	  the	  unit	  is	  on	  or	  
off.	  
9. Turn	  off	  the	  instrument	  by	  pressing	  the	  “O”	  side	  of	  the	  Main	  Power	  Switch.	  	  
	  
Note:	  Measurements	  obtained	  in	  Auto	  mode	  are	  kept	  in	  the	  meter’s	  memory,	  until	  the	  next	  measurement	  is	  
taken.	  To	  recall	  the	  result,	  press	  the	  “I”	  side	  of	  the	  Main	  Power	  Switch	  to	  turn	  the	  meter	  on,	  and	  make	  sure	  it	  is	  set	  
to	  Auto.	  Press	  the	  Set/Memory	  button	  and	  the	  last	  result	  will	  be	  displayed.	  
	  
See	  the	  user	  manual	  for	  Error	  Displays	  and	  Troubleshooting,	  page	  18.	  

10	  
	  
 
Referral Protocol for Blood Pressure Readings 
 
 
 
This chart below reflects blood pressure categories defined by the American Heart Association.  
Blood	  Pressure	  
Category	  
Systolic	  
mm	  Hg	  (upper	  #)	  
	  	  
Diastolic	  
mm	  Hg	  (lower	  #)	  
Normal	  
less	  than	  120	  
and	  
less	  than	  80	  
Prehypertension	  
120	  –	  139	  
or	  
80	  –	  89	  
High	  Blood	  Pressure	  
(Hypertension)	  Stage	  1	  
140	  –	  159	  
or	  
90	  –	  99	  
High	  Blood	  Pressure	  
(Hypertension)	  Stage	  2	  
160	  or	  higher	  
or	  
100	  or	  higher	  
Hypertensive	  Crisis	  
(Emergency	  care	  needed)	  
Higher	  than	  180	  
or	  
Higher	  than	  110	  
 
 
Field personnel will implement the following referral actions according to Blood Pressure Category and 
saturated oxygen (%SpO2) reading: 
 
 
If Normal BP Category and %SpO2 > 95%: No referral action. 
 
If Pre-hypertension BP Category OR %SpO2 is 90%-95%: Recommend that they discuss at their next visit 
with their primary care provider. 
 
If Hypertension BP Category (Stage 1 or 2) OR %SpO2 is 80% to < 90%: Recommend follow up with 
primary care provider within next day 
 
If (Hypertensive Crisis BP Category OR %SpO2 < 80%)  
BUT participant is NOT experiencing any of the following symptoms: 
chest pain, headaches, stroke like symptoms  
THEN: Recommend follow up with primary care provider within next day 
 
If (Hypertensive Crisis BP Category OR %SpO2 < 80%)  
AND participant is experiencing any of the following symptoms: 
chest pain, headaches, stroke like symptoms  
THEN: Call for immediate assistance to 911 or local EMS 
 

11	  
	  
 
Questionnaire and Spirometry Protocol for: Residential Wood Smoke Interventions Improving Health in 
Native American Populations 
 
Based on: THE EUROPEAN COMMUNITY RESPIRATORY HEALTH SURVEY II 
 
 
LUNG FUNCTION TESTS 
 
 
CRITERIA FOR TESTING 
 
 
Criteria for baseline spirometry 
 
The purpose of baseline spirometry is to record an accurate Forced Expiratory Volume in one second (FEV1) and Forced 
Vital Capacity (FVC). 
 
ACCEPTANCE CRITERIA: 
 
Eligible participants must: 
• Be a tribal member from one of the two study regions (i.e., Nez Perce or Navajo Reservation). 
• Be an elder, age 55 years or older. 
• Utilize a wood stove as the primary heating source.  
• Be capable and willing to record symptom data and wood stove usage data, as well as complete pulmonary function testing 
(i.e., spirometry).  
 
EXCLUSION CRITERIA: 
 
If the participant smokes: Lung function testing should be carried out at least one hour after the last cigarette has been 
smoked. 
 
If the participant has used an inhaler: Lung function testing should be carried out at least one hour after the use of any 
inhaler. 
 
If the participant has used an inhaler that is not a beta-2-agonist or an anticholinergic inhaler (see list below) in the last one 
to four hours: Lung function testing is carried out and the data recorded. 
 
If the participant has used an inhaler that is a long acting beta-2-agonist in the last 8 hours: Another appointment should be 
made at another time when they have not taken their lay acting Beta-2-agonist. HOWEVER – this may be difficult for them 
to do, in which case, testing should proceed and medication used should be recorded. 
 
If the participant has used an inhaler that is a beta-2-agonist or an anticholinergic inhaler in the last one to four hours: 
 
Another appointment should be made. HOWEVER – this may be difficult for them to do, in which case, testing should 
proceed and medication used should be recorded. 
 
If the participant has taken an oral beta-2-agonist or an oral theophylline or an oral antimuscarinic within the last eight 
hours: Another appointment should be made. HOWEVER – this may be difficult for them to do, in which case, testing 
should proceed and medication used should be recorded. 
 
If the participant has had a respiratory tract infection in the last three weeks: Another appointment should be made. 
HOWEVER – this may be difficult for them to do, in which case, testing should proceed.  The number of days elapsed since 
the end of the respiratory infection should be recorded. 
 
If, after a total of nine attempts, a participant is unable to produce a technically satisfactory maneuver, no FEV1 or FVC will 
be recorded. 

12	  
	  
Criteria for bronchodilator challenge 
 
The FEV1 and FVC will be measured following the administration of 400ug salbutamol by metered dose inhaler (MDI) via a 
Volumatic spacer. 
 
ACCEPTANCE CRITERIA: Any participant who fulfils all of the following criteria is accepted: 
 
1) has produced technically satisfactory FEV1 and FVC maneuvers (i.e., pre-bronchodilator measures),  
 
2) is not excluded by the following exclusion criteria.  
 
 
EXCLUSION CRITERIA: Any participant who fulfils any one of the following criteria is excluded: 
 
1) has had a heart attack in the last three months,  
 
2) has any heart disease for which he/she is taking medication,  
 
3) has epilepsy for which he/she is taking medication,  
 
4) is pregnant,  
 
5) is breast feeding,  
 
6) is taking a beta-blocker for any reason (including eye drops).  
 
These conditions will be assessed by the Lung Function Questionnaire. 

13	  
	  
 
Making the appointment for testing 
 
 
Ideally, lung function testing should be performed: 
 
1) more than four hours after the use of a beta-2-agonist or anticholinergic inhaler,  
 
2) more than eight hours after inhaled long acting beta-2-agonist, oral beta-2-agonist or theophylline or oral 
antimuscarinic.  
 
When the appointment for lung function testing is made the fieldworker should determine if the participant is 
taking any of the following medications: 
 
1) beta-2-agonist inhaler (short or long acting),  
 
2) anticholinergic inhaler,  
 
3) oral beta-2-agonist,  
 
4) oral theophylline,  
 
5) oral antimuscarinic.  
 
 
If the participant is taking any of these medications (or any other inhaler) an appointment time should be agreed 
that will cause the least disruption to the participant's normal dosing schedule. 
 
One simple way of ensuring compliance with these instructions is to: 
 
 
1) avoid early morning appointments for those using inhalers,  
 
 
2) fix a time for an appointment and then ask the participant to take their inhalers four hours before and oral 
medication eight hours before testing. Ask them to avoid taking their long acting beta-2-agonist if possible.  
 
The fieldworker should ensure that the participant has not had a respiratory tract infection in the three weeks prior 
to testing and should advise the participant not to smoke for one hour prior to coming to the testing centre.  
 

14	  
	  
Participants who have not followed guidelines 
 
Those who have had a cigarette in the last hour should have the lung function test delayed until one hour has 
elapsed. 
 
Those who have had an inhaler in the last four hours or oral medication (or long acting beta-2-agonist) in the last 
eight hours may fall into one or more of the following categories: 
 
1) misunderstood the instructions,  
 
2) forgot the instructions,  
 
3) ignored the instructions,  
 
4) may have symptoms too severe to follow the instructions.  
 
 
If an appointment cannot be rescheduled, lung function testing may still be carried out unless the participant is 
excluded for other reasons, and recent medication should be noted in the Lung Function Questionnaire. 
 

15	  
	  
LIST OF MEDICATIONS THAT MAY REQUIRE DELAYED SPIROMETRY TESTING 
 
 
 
1) beta-2-agonist inhaler (short or long acting) 
 
Generic Name 
Brand Name 
albuterol	  (short-­‐acting)	  
Proventil,	  Ventolin	  
arformoterol	  (long-­‐acting)	  
Brovana	  
formoterol	  (long-­‐acting)	  
Foradil,	  Perforomist	  
Indacaterol	  (long-­‐acting)	  
Arcapta	  Neohaler	  
levalbuterol	  (short-­‐acting)	  
Xopenex	  
metaproterenol	  (short-­‐acting)	  
Alupent	  
pirbuterol	  (short-­‐acting)	  
Maxair	  
salmeterol	  (long-­‐acting)	  
Serevent	  
bitolterol	  (short-­‐acting)	  
Tornalate	  
terbutaline	  (short-­‐acting)	  
Brethine,	  Bricanyl,	  Brethaire,	  Terbulin	  
 
 
2) anticholinergic inhaler,  
 
Generic Name 
Brand Name 
ipratropium	  bromide (short-acting) 
Atrovent 
oxitropium	  bromide (short-acting) 
Oxivent 
tiotropium (long-acting) 
Spiriva 
 
 
3) oral beta-2-agonist,  
 
Generic Name 
Brand Name 
pirbuterol	  	  
Maxair	  
carbuterol	    
bitolterol	  	  
Tornalate	  
procaterol	    
clenbuterol	  
Dilaterol,	  Spiropent,	  Ventipulmin	  
 
 
4) oral theophylline,  
 
Generic Name 
Brand Name 
theophylline 
Uniphyl;	  several	  other 
 
 
5) oral antimuscarinic.  
 

16	  
	  
General Guidelines for using EasyOne Spirometer 
 
Preparing the Participant 
 
Prepare for testing by having the participant loosen tight clothing, remove dentures, and relax. The participant may sit 
or stand. If standing you may want to perform testing in an area free of sharp table or counter edges, or have a chair 
handy as there is a slight possibility that the participant could faint during the strenuous spirometry maneuver. 
 
Explain that the purpose of the test is to determine how much air a persons lungs can hold and how quickly that air 
can be expelled with a forceful, maximal effort. Since the spirometry test requires active participation by the 
participant it is very important to demonstrate the maneuver for the participant. Emphasize the essential elements of 
the test: 
 
• 
filling lungs completely 
• 
sealing lips around the spirette so that there are no leaks, taking care not to block its opening with teeth or 
tongue or bite down excessively 
• 
blasting out as hard and fast as possible 
• 
continue blowing out until the lungs are completely empty 
 
Measuring the Forced Vital Capacity (FVC) 
 
• 
Choose “Perform Test” in the main menu and then NEW. Confirm with ENTER. The instrument will now 
allow you to enter the participant data. 
• 
Enter the corresponding participant data line by line. Use the keys as described in Chapter 4.3. Confirm with 
ENTER each time. 
• 
After entering the participant data, you then move on to the "Test selection" menu. Choose the FVC test and 
confirm with ENTER. 
• 
Insert a spirette into the instrument. Ensure that the arrow on the spirette is lined up with the arrow on the 
instrument. 
• 
Once again briefly prepare the participant for the test. When the participant is ready, press ENTER. You will 
now hear the sensor buzzing. 
• 
The instrument now prompts you to avoid air flow in the spirette since it is setting the baseline. It is 
advisable to block off the spirette on one end in order to ensure that the baseline is set precisely even if the 
room is draughty. An audible signal will sound when the baseline has been set. You will see prompt "Blast 
out" on the screen. 
• 
Hand the instrument to the participant. Ask the participant to breathe in deeply, insert the spirette correctly 
into his or her mouth. Now ask the participant to exhale as firmly and as quickly as possible, and continue 
exhaling until all air has been exhaled. 
• 
At the end of the maneuver, you will see a message on the display indicating whether the maneuver was 
acceptable. At least three acceptable maneuvers must have been performed before you see message "Session 
complete". 
 
Checking the Test Quality 
 
A quality grading from A to F is displayed at the end of the test. It provides information on the overall quality of the 
test. When interpreting the results, it is important to allow for the quality rating of the test. The quality ratings A to C 
indicate a reliable result. A quality rating between D and F indicates insufficient test quality. The result must then be 
interpreted with caution 
 
Bronchodilator challenge 
 
The salbutamol inhaler should be shaken and inserted into the volumatic. One puff should be activated and the 
participant asked to place their lips around the volumatic and to inhale and exhale five times. The salbutamol inhaler 
should be activated again and five inhalations/exhalations performed. This should be repeated two more times so that 
a total of 400ug of salbutamol has been delivered. Participants who are known asthmatics and familiar with 
Volumatic usage can self-administer this dose. 
 
The FEV1 and FVC are measured 10 minutes after the administration of bronchodilator. During the bronchodilator 
challenge FVC maneuvers will be used. Up to nine attempts may be made to obtain two technically satisfactory 
recordings after the inhalation of bronchodilator. 

17	  
	  
Screening Questionnaire 
ID Number 
 
 
  
Date  
 
 
 
 
 
BEFORE STARTING THIS QUESTIONNAIRE PLEASE ASK THE FOLLOWING 
QUESTIONS 
 
YES    NO 
 
Have you had a cigarette in the last hour? 
 
YES     NO 
 
Have you used an inhaler (puffer) in the last hour? 
 
IF ‘YES’ DELAY LUNG FUNCTION TESTS UNTIL ONE HOUR AFTER THE LAST 
CIGARETTE OR INHALER USE (RESPONSES DO NOT HAVE TO BE INCLUDED IN 
DATA RECORDER) 
 
 
NUMBER 
 
1. 
How many times have you been woken at night with shortness of breath in the 
last two weeks?  
 
2. During the last two weeks, has your breathing been 
TICK ONE 
BOX ONLY 
(a) worse than usual? 
1 
(b) same as usual? 
2 
(c) better than usual? 
3 
NO 
YES 
3. Have you had wheezing or whistling in your chest in the last 3 days?  
 
 
4. 
Have you woken up with a feeling of tightness in your chest 
in the last 3 days?  
 
5. 
Have you been woken by an attack of shortness of breath in the last 3 days?  
 
 
6. 
Have you been woken by an attack of coughing in the last 3 days?  
 
 
7. 
Have you had an attack of asthma in the last 3 days?  
 
 
8. 
Have you taken any medicine (including inhalers, aerosols or tablets)  
 
For asthma in the last 3 days? 
 
NO 
YES 
 
9. Have you had any symptoms of hay fever or nasal allergy in the last 3 days?  
10. Have you had a respiratory infection in the last 3 weeks? 
 

18	  
	  
 
IF ‘NO’ GO TO QUESTION 11 
 
IF ‘YES’ AND THE PARTICIPANT IS WILLING TO RESCHEDULE, STOP AND 
MAKE A NEW APPOINTMENT. IF NOT, PROCEDE WITH QUESTION 10.1 
 
DAYS 
 
10.1  How many days ago did it end? 
 
NO   YES 
 
11.    Have you used an inhaler in the last 24 hours? 
 
IF ‘NO’ GO TO QUESTION 12, IF ‘YES’ - : 
 
11.1   What inhaler(s) did you use and for how many hours did you use it? 
 
DRUG 
HOURS 
 
 
 
 
 
 
 
 
 
IF THE PARTICIPANT HAS USED A BETA-2-AGOINST INHALER OR AN 
ANTI-MUSCARINIC INHALER IN THE LAST FOUR HOURS, CONSIDER: - 
 
a) 
WAITING UNTIL FOUR HOURS SINCE LAST USE HAS ELASPED  
b) RESCHEDULING FOR ANOTHER DAY IF THE PARTICIPANT IS 
WILLING, IF NEITHER OF THESE IS POSSIBLE, PROCEED.  
 
 
12.    Have you used any other medicine (including pills, capsules or 
NO  
YES 
 
 
suppositories) to help your breathing, or any oral anti-muscarinic 
 
 
in the last 24 hours? 
 
IF ‘NO’ GO TO QUESTION 13, IF YES: - 
 
12.1  What medicine(s) did you take and how many hours ago did you take it? 
 
DRUG 
HOURS 

19	  
	  
 
 
 
 
 
 
IF THE PARTICIPANT HAS TAKEN AN ORAL BETA-2-AGOINST, AN ORAL 
THEOPHYLLINE OR AN ORAL ANTI-MUSCARINIC, CONSIDER 
RESCHEDULING FOR ANOTHER DAY IF THE PARTICIPANT IS WILLING, 
IF THIS IS NOT POSSIBLE, PROCEED. 
 
 
NO       YES 
 
13. Have you had a heart attack in the last three months?  
 
 
14. Are you currently taking any medicine(s) for your heart?  
 
 
15. Are you currently taking any medicines for epilepsy?  
 
 
16. Are you currently taking any medicine containing beta-blockers, 
including eye-drops?  
 
IF ‘YES’ TO ANY QUESTIONS 13-16 MEASURE BASELINE SPIROMETRY ONLY.  
 
For women only: 
 
NO       YES 
 
17. Are you pregnant?  
 
 
18. Are you breast feeding?  
 
IF ‘YES’ TO QUESTIONS 17 OR 18 MEASURE BASELINE SPIROMETRY ONLY. 
 
For all participants: 
 
NO 
YES 
 
19.    Would you like us to notify your health care provider of the results of any test? 
 
 

20	  
	  
 
Coding for lung function questionnaire 
 
 
The same general rules apply as for the main questionnaire. 
 
 
Questions with NO / YES 
 
1 
NO 
2 
YES 
 
 
Questions with ‘TICK ONE BOX ONLY’ instruction: 
 
The number of the box ticked is the code for that answer. 
 
 
QUESTION 11.1     Inhalers in the last 24 hours 
 
Drug grouping should be consistent with those used for main questionnaire. 
 
1 
Beta-2-agoinst (short acting)  
 
2 
Beta-2-agoinst (long acting)  
 
3 
Non-specific adrenoreceptor agonists  
 
4 
Anticholinergic inhalers  
 
5 
Inhaled steroids  
 
6 
Sodium cromoglycate  
 
7 
Nedocromil  
 
8 
Compound bronchodilators  
 
 
98 
Not coded  
 
99 
Not known  
 
 
QUESTION 12.1     Oral medications 
 
Drug grouping should be consistent with those used for main questionnaire. 
 
1 
Beta-2-agoinst  
 
2 
Non-specific adrenorecptor agonist  
 
3 
Oral anticholinergics/antimuscarinics  
 
4 
Oral methylxanthines  
 
5 
Oral steriods  
 
6 
Oral antihistamines  
 
7 
Oral compound bronchodilators  
 
8 
Oral-antileukotrienes  
 
 
98 
not coded  
 
99 
not known 
 
 

21	  
	  
Spirometry	  Datasheet	  
	  
Technician______________________	  
	  
	  
Date	  _____________________	  
	  
Participant	  ID_______________	  
	  
	  
Participant	  date	  of	  birth	  (mm/dd/yyyy):	  ____/____/_______	  	  	  
Age:	  
	  
	  
	  
Sex:	  	   □	  Female	  	  
	  
□	  Male	  
	  
	  
Height	  (In	  inches):	  ____________	  	  	  
Weight	  (In	  Pounds):	  ________________	  
	  
Measured	  Pre:	  
	  
FVC:	  _________	  	  FEV1:	  _________	  	  %	  FEV1:	  
	  
	  	  
	  
	  
Measured	  Post:	  
	  
FVC:	  _________	  	  FEV1:	  _________	  	  %	  FEV1:	  
	  
	  	  
	  
	  
%	  Predicted:	  
	  
FVC:	  _________	  	  FEV1:	  _________	  %FEV1:	  
	  
	  	  
	  
Session	  Quality:	  _______________	  
	  
	  
Comments:	  

22	  
	  
ADDITIONAL QUESTIONS FOR EACH HEALTH VISIT 
 
 
 
1.  
Have you had any of the following in the last two months:* 
 
 
Cold 
 
 
NO 
YES 
If yes, was it diagnosed by a physician?  N Y 
 
 
 
Flu 
 
 
NO 
YES  If yes, was it diagnosed by a physician?  N Y 
 
 
Throat infection 
NO 
YES  If yes, was it diagnosed by a physician?  N Y 
 
 
Pneumonia 
 
NO 
YES  If yes, was it diagnosed by a physician?  N Y 
 
 
Bronchiolitis  
NO 
YES  If yes, was it diagnosed by a physician?  N Y 
 
 
2. 
Have you used any antibiotic medication because of respiratory infections during the 
last two months?* 
 
 
 
 
NO 
YES 
 
3. 
Have you used any other medication because of respiratory infections during the last 
two months?* 
 
 
 
 
NO 
YES 
 
 
 
* If 2nd visit of winter, ask the above “since last visit” 
 
 

23	  
	  
HOME	  ACTIVITY	  LOG	  
	  
	  
Technician:_____________	  	  
	  
	  
Home	  ID:_________________	  	  
	  
Winter	  (1,2,3,etc.):	  _____________	  
	  
Sampling	  Date:	  _____________	  
	  
	  
	  
	  
	  
	  
	  
	  
1. Were	  any	  of	  the	  following	  heating	  appliances,	  other	  than	  your	  wood	  stove,	  	  
used	  in	  the	  home	  during	  the	  sampling	  period?	  
	  
•	  
Gas	  	  
	  
	  
	  
No	  
	  
Yes	  
	  
	  
•	  
Electrical	  
	  
	  
	  
No	  
	  
Yes	  
	  
	  
•	  
Propane	  
	  
	  
	  
No	  
	  
Yes	  
	  
	  
•	  
Oil	   	  
	  
	  
	  
No	  
	  
Yes	  
	  
	  
	  
	  
•	  
Other,	  specify:	  	  
	  
	  	  	  	  	  	  	  	  	  	  	  	  	   No	  
	  
Yes	  
	  
	  
	  
	  
	  
2. Did	  any	  of	  the	  following	  activities	  or	  conditions	  occur	  in	  the	  home	  during	  the	  	  
sampling	  period?	  
	  
•	  
Smoking	  by	  anyone	  in	  the	  
	  
home	  (cigarette,	  pipe,	  or	  other)	  
No	  
	  
Yes	  
	  
	  
•	  
Incense	  burning	  (or	  sweet	  grass	  
patosway,	  cedar,	  etc.)	  	  
	  
No	  
	  
Yes	  	  
	  
	  
	  
•	  
Candle	  burning	  
	  
	  
No	  
	  
Yes	  
	  
	  
•	  
Kerosene/oil	  lamp	  	   	  
	  
No	  
	  
Yes	  
	  
	  
•	  
Open	  windows	  
	  
	  
No	  
	  
Yes	  
	  
	  
•	  
Front	  door	  propped	  open	  	   	  
No	  
	  
Yes	  	  
	  
	  
•	  
Dusting/sweeping/vacuuming	  	  
No	  
	  
Yes	  	  
	  
	  
•	  
Boiling	  of	  Kouse	  Kouse	  	  
	  
No	  
	  
Yes	  	  
	  
	  
•	  
Smudging	  	   	  
	  
	  
No	  
	  
Yes	  	  
	  

24	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  	  
IN	  HOME	  LOG	  
	  
	  
	  
	  
	  
	  
Technician:	  _________________	  
	  
	  
Home	  ID:	  _________________	  
	  
Winter:	  _________________	  
	  
	  
	  
Sampling	  dates:	  _________________	  
	  
Sampling	  start	  time:	  _________________	  
	  
	  
	  
	  
	  
	  
	  
	  
To	  be	  completed	  by	  resident	  for	  both	  24	  hour	  sampling	  periods.	  
For each row, please mark the day of week (M, T, W, Th, F, Sa, Su) and if you were at home.	  
	  
Day	  
Day	  of	  
week	  
Time	  
At	  home?	  
1	  
	  	  
7:00	  AM	  
to	  
8:00	  AM	  
Y	  
N	  
1	  
	  	  
8:00	  AM	  
to	  
9:00	  AM	  
Y	  
N	  
1	  
	  	  
9:00	  AM	  
to	  
10:00	  AM	  
Y	  
N	  
1	  
	  	  
10:00	  AM	  
to	  
11:00	  AM	  
Y	  
N	  
1	  
	  	  
11:00	  AM	  
to	  
12:00	  PM	  
Y	  
N	  
1	  
	  	  
12:00	  PM	  
to	  
1:00	  PM	  
Y	  
N	  
1	  
	  	  
1:00	  PM	  
to	  
2:00	  PM	  
Y	  
N	  
1	  
	  	  
2:00	  PM	  
to	  
3:00	  PM	  
Y	  
N	  
1	  
	  	  
3:00	  PM	  
to	  
4:00	  PM	  
Y	  
N	  
1	  
	  	  
4:00	  PM	  
to	  
5:00	  PM	  
Y	  
N	  
1	  
	  	  
5:00	  PM	  
to	  
6:00	  PM	  
Y	  
N	  
1	  
	  	  
6:00	  PM	  
to	  
7:00	  PM	  
Y	  
N	  
1	  
	  	  
7:00	  PM	  
to	  
8:00	  PM	  
Y	  
N	  
1	  
	  	  
8:00	  PM	  
to	  
9:00	  PM	  
Y	  
N	  
1	  
	  	  
9:00	  PM	  
to	  
10:00	  PM	  
Y	  
N	  
1	  
	  	  
10:00	  PM	  
to	  
7:00	  AM	  
Y	  
N	  
2	  
	  	  
7:00	  AM	  
to	  
8:00	  AM	  
Y	  
N	  
2	  
	  	  
8:00	  AM	  
to	  
9:00	  AM	  
Y	  
N	  
2	  
	  	  
9:00	  AM	  
to	  
10:00	  AM	  
Y	  
N	  
2	  
	  	  
10:00	  AM	  
to	  
11:00	  AM	  
Y	  
N	  
2	  
	  	  
11:00	  AM	  
to	  
12:00	  PM	  
Y	  
N	  
2	  
	  	  
12:00	  PM	  
to	  
1:00	  PM	  
Y	  
N	  
2	  
	  	  
1:00	  PM	  
to	  
2:00	  PM	  
Y	  
N	  
2	  
	  	  
2:00	  PM	  
to	  
3:00	  PM	  
Y	  
N	  
2	  
	  	  
3:00	  PM	  
to	  
4:00	  PM	  
Y	  
N	  
2	  
	  	  
4:00	  PM	  
to	  
5:00	  PM	  
Y	  
N	  
2	  
	  	  
5:00	  PM	  
to	  
6:00	  PM	  
Y	  
N	  
2	  
	  	  
6:00	  PM	  
to	  
7:00	  PM	  
Y	  
N	  
2	  
	  	  
7:00	  PM	  
to	  
8:00	  PM	  
Y	  
N	  
2	  
	  	  
8:00	  PM	  
to	  
9:00	  PM	  
Y	  
N	  
2	  
	  	  
9:00	  PM	  
to	  
10:00	  PM	  
Y	  
N	  
2	  
	  	  
10:00	  PM	  
to	  
7:00	  AM	  
Y	  
N	  
	  

25	  
	  
	  
	  
Wood Stove Tracking Form 
 
Study Area: ________________________________ 
 
 
 
 
 
 
Home ID: __________________________________ 
 
Winter (1,2,3,etc.): ___________________________ 
 
 
 
The following parameters are recorded each time a home is visited: 
 
 
 
 
 
 
 
 
Date/Time  
Home Visited 
*Frequency 
of burning? 
**Moisture 
content of wood? 
***Stove 
thermometer 
used? 
iButton 
downloaded? 
Notes 
Tech. 
ID. 
 
  
  
 
 
 
 
 
  
  
 
 
 
 
 
  
  
 
 
 
 
 
  
  
 
 
 
 
 
*No burning, light burning, average burning, or heavy burning. 
**Also indicate if moisture content measured from freshly split wood. 
***Is thermometer being used by homeowner? 
	  
 
 
 
    
Revised November 6, 2014 
 

26	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  	  
WOOD	  STOVE	  USAGE	  LOG	  
	  
	  
	  
	  
	  
	  
Technician:	  ________________________	  
	  
Home	  ID:	  ________________________	  
	  
Winter	  (1,2,3,etc.):	  ________________________	  
	  
Sampling	  Dates:	  ________________________	  
	  
Date	  form	  completed:	  ________________________	  
	  
	  
	  
	  
1. During	  the	  sampling	  period,	  how	  would	  you	  describe	  the	  level	  of	  wood	  burning	  	  
compared	  to	  a	  typical	  winter	  day	  (circle	  one):	  
	  
No	  burning	  Light	  burning	  
	  
Average	  burning	  
Heavy	  burning	  
	  
	  
	  
2. What	  kind	  of	  wood	  was	  used	  or	  was	  used	  most	  frequently?	  Please	  choose	  ONLY	  one.	  	  
	  
Lodgepole	  Pine	  
	  
Ponderosa	  Pine	  	  
Fir	  
	  
Larch	  
	  
Tamarack	  
	  
	  
	  
[LIST	  OTHER	  COMMON	  TYPES]	  _____________________	  
	  
	  

27	  
	  
Nicotine Protocol 
 
Sample Collection 
• Before leaving for the home, prepare a fresh mixture of 0.1% ascorbic acid. This will 
stabilize the nicotine. 
o Measure out ____ g of ascorbic acid powder, and dispense into a small glass jar 
with lid. 
o Add ____ ml of DI water to the glass jar and screw on lid. 
o Gently invert the jar to mix the contents until all of the powder has dissolved.  
o Bring this jar to the field with you, along with a medicine dropper. 
• Bring a template of known area--typically a rigid paper sheet with a 10×10cm2 opening 
in the center that has been store in a smoke-free environment. 
• Wear a pair of clean gloves. 
• Choose a surface in the home that is very rarely cleaned—think tops of doors, ceiling 
fans, or tall book cases 
• Secure the edges of the template to the chosen surface with painters’ tape (also stored 
in a clean environment). 
• Take out a 100% cotton face wipe, and set inside a clean Petri dish. 
• Using the medicine dropper, draw up the 0.1% ascorbic acid solution and wet the wipe 
with it. 
• Firmly press the wipe over the entire template area in both directions. 
• Fold the wipe in half and insert into an amber, 20ml glass vial. 
• Screw the lid on the vial and label it with the house ID and date. 
• For every five samples, you will want to collect a field sample as well. 
o After you visit a home, remove one of the cotton face wipes from your kit (that 
you did not use!) and insert into a clean 20ml, amber vial. 
o Mark this with the word BLANK 1, 2, 3….etc. and the date. 
• Store all glass vials that contain wipes in a freezer at -20 degrees within 2 hours of 
collection. Keep them out of light.  
 

PROTOCOL TITLE: Residential Wood Smoke Interventions Improving Health in Native 
American Populations 
ClinicalTrials.gov Identifier: 
NCT02240069 
STATISTICAL ANALYSIS PLAN 
The primary aim of the statistical analysis is to evaluate the efficacy of education and filtration 
unit interventions in improving measures of pulmonary function and reducing respiratory 
symptoms and infections. A descriptive analysis will be conducted initially using T-tests, or Χ2 
tests as appropriate to assess whether treatment groups differ with respect to pertinent baseline 
demographic variables and home characteristics, despite the randomization strategy. To 
account for correlations between repeated observations on the same subjects and subjects 
within the same household, mixed effects linear regression models will be used to evaluate 
whether pre- to post-intervention changes in spirometry or blood pressure measures differ 
between treatment groups. Main analyses will follow the intention to treat approach and assume 
data are missing at random. Analysis will allow for the inclusion of more than one subject per 
household with random effects held at both the individual and household level.  
In the intent-to-treat (ITT) framework, with a given spirometry or blood pressure variable as the 
outcome of interest, we will include a 3-level fixed effect for treatment as the primary 
explanatory variable (levels = Placebo arm, Education arm, Filtration arm), a continuous fixed 
term for mean baseline (Winter 1) response measure, and a nested random effect to account for 
repeated measures (i.e., participant:home:cohort:area). The ITT models will utilize the study’s 
randomization and not adjust for potential confounding variables in the primary analyses. 
Sensitivity analyses will be conducted to include potential confounding variables into the ITT 
models to assess the effectiveness of the randomization in controlling for confounding. A similar 
strategy will be used to assess the study’s secondary outcome of change in indoor PM2.5 
concentration with respect to household treatment assignment. 
We will also conduct exposure-response (ER) analyses to evaluate associations between indoor 
PM2.5 measures and outcome measures outside of the RCT framework. The ER analyses will 
utilize a linear mixed model fit by restricted maximum likelihood (REML) with blood pressure or 
spirometry measures as the outcome and mean 48-hour indoor PM2.5 concentration as the 
exposure of interest. As with the ITT models, ER models will include a nested random term (i.e., 
participant:home:cohort:area) to account for repeated measures in the analysis as well as area-
level factors such as the wood yards. Because the ER models do not utilize the study’s 
randomization to help control for confounding, covariates will be included in the model to adjust 
for potential confounders, including age, gender, income, education, household resident 
smoking status, history of cardiovascular disease, and history of respiratory disease.  
Model assumptions will be evaluated in all analysis frameworks. Analysis will be conducted 
using R version 4.0.4 (The R Foundation for Statistical Computing, Austria).