A review of comfort, health, and energy use

(1)

Delft University of Technology

A review of comfort, health, and energy use

Understanding daily energy use and wellbeing for the development of a new approach to

study comfort

Ortiz Sanchez, Marco; Kurvers, Stanley R.; Bluyssen, P.M.

DOI

10.1016/j.enbuild.2017.07.060

Publication date

2017

Document Version

Final published version

Published in

Energy and Buildings

Citation (APA)

Ortiz Sanchez, M., Kurvers, S. R., & Bluyssen, P. M. (2017). A review of comfort, health, and energy use:

Understanding daily energy use and wellbeing for the development of a new approach to study comfort.

Energy and Buildings, 152, 323-335. https://doi.org/10.1016/j.enbuild.2017.07.060

Important note

To cite this publication, please use the final published version (if applicable).

Please check the document version above.

Copyright

Other than for strictly personal use, it is not permitted to download, forward or distribute the text or part of it, without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license such as Creative Commons. Takedown policy

Please contact us and provide details if you believe this document breaches copyrights. We will remove access to the work immediately and investigate your claim.

This work is downloaded from Delft University of Technology.

(2)

Contents lists available atScienceDirect

Energy

and

Buildings

j o u r n a l h o m e p a g e :w w w . e l s e v i e r . c o m / l o c a t e / e n b u i l d

Review

A

review

of

comfort,

health,

and

energy

use:

Understanding

daily

energy

use

and

wellbeing

for

the

development

of

a

new

approach

to

study

comfort

Marco

A. Ortiz

∗

,

Stanley

R. Kurvers,

Philomena

M. Bluyssen

ChairIndoorEnvironment,FacultyofArchitecture,DelftUniversityofTechnology,Julianalaan134,2628BL,Delft,TheNetherlands

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received15December2016 Receivedinrevisedform9June2017 Accepted19July2017

Availableonline23July2017 Keywords: Energyconsumption Habits Controllability Comfortbehaviours Health Designthinking

a

b

s

t

r

a

c

t

Thereisaneedforreducingdwellings’energyconsumptionwhilemaintainingacomfortableandhealthy indoorenvironment.Thisreviewwasperformedtoprovideasteppingstoneforidentifyingnewmethods forstudyingeverydayhomeenergyuseandcomfort.First,anoverviewofcomfortisgivenasseenfrom differentdisciplines,depictingthesubjectiveandmultidimensionalnatureofcomfort.Thisisfollowedby thebiologicalcomponentofcomfort,reﬂectedasanemotional,behavioural,andphysiologicalreaction toenvironmentalstimuli.Subsequently,linksbetweencomfort,health,andwellbeingareintroduced. Thesecondpartofthereviewfocusesonenergyandbuildings,withtheconnectionbetweenenergy andbehaviours-detailingpossibleexplanationsofperformancegaps,andthepathwaysfromenergyto health.

Toconclude,humansensationofcomfortismorecomplexthantheperceptionofthermal,acoustical, visualstimuli,orairqualityenvironment.Comfortisareactiontotheenvironmentthatisstrongly influencedbycognitiveandbehaviouralprocesses.Habitsandcontrollabilityhavebeenidentifiedas paramountinthelinksbetweencomfortandenergyconsumption.Inthisholisticviewofcomfortlinked tohealth,comfortisreferredtoas‘wellbeing’.Thefirststepsfornewdirectionsofthestudyofcomfort andenergyarepresented.

(http://creativecommons.org/licenses/by/4.0/).

Contents

1. Introduction...324

2. Materialsandmethods...324

3. Results...324

3.1. Comfort...324

3.1.1. Comfortdeﬁnitionsbydiscipline...324

3.1.2. Evolutionarybiology,emotions,andbehaviour...325

3.1.3. Environmentandhealth...326

3.2. Energyinbuildings...326

3.2.1. Energyandbehaviours...327

3.2.2. Healthandenergy...327

4. Discussionandﬁndings...328

4.1. Narrowviewofcomfort...328

4.2. Gapsinknowledge...328

5. Newdirections ... 328

5.1. Conceptualframework ... 329

5.2. Methodologicalframework...329

∗ Correspondingauthor.

E-mailaddress:M.A.OrtizSanchez@tudelft.nl(M.A.Ortiz). http://dx.doi.org/10.1016/j.enbuild.2017.07.060

(3)

6. Limitations...329 Acknowledgements...330 AppendixA...?? References...334

1. Introduction

Comforthastraditionallybeenstudiedfromtheperspectiveof

thephysicsoftheenvironmentandthephysiologyofthe

occu-pant,intermsoffourfactors:thermalcomfort,acousticalquality,

airquality,andvisualquality.Codesandstandardsforeachofthe

factorshavebeenestablished,andtechnologiesandsystemsare

beingengineeredinordertosatisfysuchstandardsina

presum-ablyenergyefﬁcientmanner.Thechallengewithsuchanapproach

isthatindividualstandardsforeachofthefactorsarenotmeant

tobeusedashuman’sglobalexperienceofcomfort,whichcauses

challengesandrisks[1].

Additionally,thereisaneedtoprovideenergyefﬁcientbuildings

that are also healthy;which is not always the case [2].

Occu-pant behaviours seem to be responsible for the discrepancies

betweenactualandtheoreticalenergyconsumption(i.e.rebound

effects,performancesgaps)[3].Asaresult,itwasfound

neces-sarytoperformaliteraturestudyonthelinksbetweenenergyuse,

comfort-making,andhealth,inordertoidentifyapotentialnew

approachinthestudyoftheinteractionsbetweenthosetopics.

2. Materialsandmethods

Anextensiveliteraturereviewwasperformedinthetopicsof

health,comfort,andenergyuse,withafocusontheinteractions

betweentheoccupant and theenvironment. Threetopics form

thefocus ofthis literature review:theﬁrst beingcomfort as a

cognitive-behaviouralprocess,speciﬁcallyreﬂectedwiththe

con-ceptsofsenseofcontrol,habits,andemotions.Thesecondtopic

dealswithenergyin buildings:ﬁrst providing thecurrent

con-sumptiontrendsintheNetherlands–chosenasacountry–speciﬁc

case-study–,followedbyadiscussiononthereboundeffectand

performancegaps;thethird,discussinghumanfactorsintermsof

energyhabitsandtherelationwithhealth.

Theaimofthispaperistoprovidebetterunderstandingofthe

severalfactorsinﬂuencingenergyusage,fromaperspectiveofthe

psychologicalandbehaviouralinteractionsoftheoccupantandits

environment.Manyoftheseinteractions–whetherconsciousor

unconscious– areperformedto achieve homeostasis(i.e.

com-fort,neutralstate,lessdiscomfort,etc.).Thesebehavioursarehere

referredtoas‘comfort-makingactivities’,andhavebeen

speciﬁ-callyidentiﬁedascontrollingtheenvironmentandhabitualactions

–actionsthatenablepsychosocialhomeostasis.Byunderstanding

theenergyusethroughthisapproach,itisintendedtosetforward

aconceptualframeworkfortheresearchofenergyuse.

The review wasperformed by searching in engines suchas

GoogleScholar,ScienceDirect,andWebofScience.Theselection

oftheliteraturewaslimitedtoarticlesfrompeer-reviewed

jour-nalsandconferenceproceedings. Forthehealthsection,a table

wasmadeinwhichthearticlesarecategorizedaccordingtotheir

strengthofevidence.Datafromacademicallypublishedbooksand

Dutchwebsitesofenergyandeconomicaffairswerealsoincluded.

Becauseoftheinterdisciplinarynatureofthereview,inorderto

findthesametopicbutindifferentfields,thefieldinquestionwas

addedinthesearchinquotationmarks(i.e.“nursing”,

“psychol-ogy”).Thedifferenttagsusedfortheresearchﬁeldsareshownin

thefollowingtable:

Thecollectionofinformationwasusedtoillustratethecurrent

situationinthedomainsofhealthandcomfortinthebuilt

environ-mentandtherelationshipwithenergyusefromamultidisciplinary

perspective.Bybeingacquaintedwiththecurrentsituation,

inter-ventionpointswereidentiﬁedforthestudyofcomfortandenergy,

inordertosuggestapossiblenewapproachfortheunderstanding

ofresidentialcomfortandenergyexpenditure.

3. Results

3.1. Comfort

3.1.1. Comfortdeﬁnitionsbydiscipline

Duetothesubjectivenatureofcomfort,individualﬁeldsthat

needtoinvestigatecomforthavedevelopedtheirowndeﬁnitionsof

theconcept.Togainamultidisciplinaryandcomprehensive

under-standingofwhatcomfortis,thedeﬁnitionsontheﬁeldsofIEQ,

healthcare,andergonomicsarepresented,alongwitha‘domestic’

andaholisticdeﬁnitionwhichhavebeenputforth.

3.1.1.1. IEQ. In the IEQ literature, comfort is viewed from a

physiological-technologicalperspectiveanddescribedthroughthe

following parameters: visual (with aspects such as view,

illu-minance, and reﬂection), thermal (air velocity, humidity, and

temperature), acoustical(controlofunwanted noise, vibrations,

andreverberations),andairquality(smells,irritants,outdoorair,

(4)

standards(forafewchemicalsubstances)andguidelinesare

avail-ableforIEQfactors.Energyconsumingsystemsandproductsare

developedsothat theycan contributetoachievethestandards

or guidelines. For thermal comfort, the adaptive approach has

beenproposed;comprisingamodelforstudyingthermalcomfort

throughtheadaptiveprinciple:“ifachangeoccurssuchastoproduce

discomfort,peoplereactinwaysthattendtorestoretheircomfort.”

Thisisachievedthrough“adaptiveactions”enabledby“adaptive

opportunities”[5,6].

3.1.1.2. Healthcare. Inthehealthcareliterature,comfortisdeﬁned

asaconceptoftwodimensions[7].Theﬁrstdimensionconsistsof

threestates:‘relief’,‘ease’,and‘transcendence’,whichhavetobe

experiencedbyapatienttobecomfortable.Reliefisthefeelingof

havinghadspeciﬁcneedsmet,easeisthestateofcalmand

con-tentment,andtranscendencereferstothestatewherethepatient

goesbeyondproblemsorpain.Theseconddimensionofcomfort

dealswiththecontextwherecomforthappens.Thecontextcanbe

physical–relatingtobodilyfeelings–,itcanbepsychospiritual–

relatingtotheinnerself-,itcanbesocial–relatingtofamilyor

cul-turalrelationships,oritcanbeenvironmental–dealingwithlight,

noise,temperatures,sensations[7].

3.1.1.3. Ergonomics. Due to the wide scope of the domain of

ergonomics,severaldeﬁnitionsexist.Ageneraldeﬁnitionisthat

whenaproductiscomfortable,performanceincreases:comfortis

“aneaseandcontentmentwiththeenvironmentorproductthat

facil-itatesperformance”[8].Theliteratureofergonomicsandcomfort

isdominatedbyseatingcomfort.Forchairergonomics,comfortis

deﬁnedwithfactorsrelatedto“aestheticsand plushness,

relax-ation,well-being,andreliefandenergy”[9].

3.1.1.4. Holistic. Someauthorshaveputforth integrative

deﬁni-tionsof comfort which also include a cognitivedimension; for

exampleSlaterhasproposed“apleasantstateofphysiological,

psy-chologicaland physicalharmony between ahuman being andits

environment”[10].DeLoozeetal.[11]haveidentiﬁedthatin

com-fortdeﬁnitionsacrossdisciplines,threeelementsarecertainand

recurring:1-comfortisaconstructofasubjectivelydeﬁned

per-sonalnature;2-itisaffectedbyfactorsofavariousnature(physical,

physiological,psychological);and3-itisareactiontothe

environ-ment.

3.1.1.5. Domestic:. HeijsandStringer[12]havealsoproposed

spe-ciﬁcelementsofcomfort inthedomestic context,implyingthe

placeofresidence.Theseareperceptual,interactive, facilitative,

andpersonalizationcomfort[12].Theseelementsarerelatedto

contextualaffordancesthatenabletheoccupanttocarryoutthe

behaviours accordingtotheirsocial and personal needsandto

givemeaningtotheplacethroughemotionalattachmentand

self-identiﬁcation.

Forageneraloverviewofthescopeofenvironmentalfactors

andhumanfactorscoveredbycomfortindifferentdomains,refer

toAppendixA,TableA1:Scopeofcomfortbydisciplineandbyhuman

andenvironmentalfactors.

3.1.2. Evolutionarybiology,emotions,andbehaviour

Toshowthelinkbetweencomfortandenergyconsumptions,in

thissection,thebiologicaloriginsofcomfortarepresented,along

withtherelationshipbetweenthecomfortandemotions,andthat

ofemotionsandbehaviours.

3.1.2.1. Evolutionary biology.Humansaretheresult ofa several

million year evolutionary process in the East African savanna.

Therefore,therearestillphysiological,cognitive,andbehavioural

legaciesoftheevolutionpresentinmodernhuman.The

physiolog-icalcharacteristicsofhumansreﬂectitsevolutioninthesavanna;

anenvironmentwithrainfalls,grasslandsandforestmix,mild

vari-atingtemperatures,andpredators.Thetransitionfromthesavanna

lifestyletotoday’senvironmentoccurredinanevolutionarilytoo

briefofaperiodforchangestooccur,renderingmodernhumans

physiologicallyandpsychologicallyidenticaltotheirﬁrsthuman

ancestors [13].As a result, humans are in many respects

mal-adaptedtotheirenvironment.Inspiteofnothavinganymodern

technologies,earlyhumansdispersedaroundtheglobeand

man-agedtolivefrompolartodesertregions,duetotwobasicstrategies:

appropriateclothing–thesecondskin–andappropriateshelter–

thethirdskin.Theseextraskinshaveallowedcompensatingfor

and adapting tothemoreextreme climaticconditionsand still

achievingacceptableconditions[13,14].

3.1.2.2. Emotions. One of theresultsof evolution are emotions.

Emotionsarespeciﬁcstatesthatincreasetheadaptabilityand

abil-ity ofa persontocopewitha speciﬁcsituation,which maybe

athreatorabeneﬁttotheirwellbeing.Onemodelthatexplains

emotionelicitationisthethree-levelprocessingmodel[1,15].The

modelexplainsthatthefeelingofanemotionemergesfromthree

reactions:reactive,routine,andreﬂective;eachofwhichiselicited

bydifferentaspectsoftheenvironmentalstimulus.Thereactive

reactiondealswithimmediatelyperceptiblesensory

characteris-ticsofthestimulus:appearances.Thisisabiology-drivenreaction,

inwhichreasoningdoesnothappen:itallowstounconsciously

assessingthestimulusasathreatorabeneﬁt.Theroutinereaction

involvesautomatisms,suchashabits,fromlong-termmemoryand

expectationsduringactiveinteractionwiththestimulus:the

pre-dictabilityoftheperformanceandusage.Finally,thereﬂectivelevel

involvesthefully-feltemotion:theconsciousappraisaland

ratio-nalizationofwhatthestimulusandeventmeanstotheperson,in

termsofrelatednesstothevalues,beliefs,andneedsoftheperson

[1].

3.1.2.3. Behaviours. Emotionsaretightlylinkedtobehavioursand

decision-making.Feelingemotionsenablesmakingdecisionsand

motivatingbehaviours.Ithasbeenshownthatpeoplewithlesions

affecting theiremotional systemare unable to make decisions

or behave accordingly, in spite of being psychologically and

behaviourallynormalineveryotheraspect[16,17].Sometypesof

behavioursarecontrollingtheenvironment(controllability)and

exercisinghabitualactions(habits).

Habitsarepartoftheroutinelevelofresponse,andaredeﬁned

as “learned sequences of acts that have become an automatic

responsetospeciﬁccuesandarefunctionalinobtainingcertain

goalorendstates”[18].Theyaretheresultofassociative

learn-ingfromenvironmentalorcontextualcuesandofrespondingto

suchcuesthroughproceduralmemory.Thus,habitsareatypeof

behaviourthatisunconsciousandautomatic,andthatarerepeated

whenaparticularstimulusisperceived[19].Habitsareformedby

theinitialmotivationtoachieveagoalwithinacontextandwith

cues.Withrepetition,perceivingthecueelicitsautomaticallythe

behaviouralresponsetomind,whichisnormallyperformed.

Fur-therrepeatingthehabitstrengthensit,andevenwhentheoriginal

goalorrewardisnotneeded,habitswillstillbetriggeredbythe

contextualcues.Thisoccurssincecarryingoutahabitactivatesthe

dopaminesystems,reducingcortisol,whichasaresultstrengthens

thehabitsfurther,duetotheexperiencedpleasure.Thus,

perform-ingahabitonlybyitselfproducesfeelingsofpleasure.Inaddition,

habitsallowtheindividualtoachievegoalsinaquickand

effec-tivewaythatrequiresminimalthought[19–21].Manyelementsof

habitsoverlapwiththoseofcomfort,suchaseliminationof

nega-tiveaffect,reductionofthestresshormone,andcontrollabilityof

(5)

cuesthatelicithabitsalsoindicatethedegreeoffeelingincontrol

overenvironment.

Controllabilityencompassestheconceptsof“perceived”control

and“actual”control;perceivedcontrolbeingthelevelofcontrola

personbelievestohave,whiletheactualcontrolisthebehavioural

exertionofcontrolbytheindividual.Controllabilityevolvedfrom

theneedof protectionagainstpredators.In evolutionaryterms,

shadows,movements,shapesthatcouldbeathreattothehuman’s

lifewereuncontrollableandcausedaﬁght-or-ﬂightresponse[13].

Tothisdaystimulireminiscentofthreatsstillelicitthechainof

hor-monalreactions,culminatingintheﬁght-or-ﬂightresponse.This

responsemakesthehumanreadytoﬁghtagainstthethreatorﬂee

fromit,whichwouldtypicallylastfromafewsecondstominutes,

andthenthephysiologyandhormoneswouldgobacktoa

nor-malstate.Inthemodernlifestyle,manyordinarystimuliassociated

withnotfeelingincontrol,stilltriggertheﬁght-or-ﬂightresponse,

however,inmostcases,thepersoncannotrationallyﬂeeorﬁght

themodernstressor(i.e.lockedwindows,neighbours,debts,leaks,

etc.)[13].Thus,thestressorbecomesa‘constantthreat’,andasa

result,thehormonalandimmunesystemscomeoutofbalancedue

tochronicstress(allostaticload).Studieshaveshownthatthereis

anassociationbetweenthelackofsenseofcontrolanddiverse

stress-relatedhealthproblems,suchasdepression,anxiety,high

bloodpressure,andweakenedimmunefunctioning[22].The

feel-ingofbeingincontrolnotonlyreducesstress-relatedhealthissues,

italsoincreasesthefeelingofcomfort,itmakespeoplefeelmore

satisﬁed,and in theworkspace,workers feelmoreappreciated.

Choicesofferedbytheenvironment(i.e.operabilityofwindows,

decorating,privacyandsocialinteraction,cooking,etc.)affordthe

occupanttohaveafeelingofbeingincontrol.Theneedfor

con-trolandchoicearecloselyrelated.Thepresenceofenvironmental

choicesenablesapersontoexercisecontrolortoincreasetheir

per-ceptionofcontrolovertheirenvironment,throughbehavioursthat

avoidundesirableresultsorthroughthosethatachievedesirable

ones[23].Thus,whenapersonhaschoicesandisabletodecide,

theymayfeellessstressedandmorecomfortable[24–27].

3.1.3. Environmentandhealth

Thissectiondealswiththeexistingevidenceof

environmen-talinﬂuencesinmentalhealth,particularlyfromtheperspective

ofpsychoneuroimmunology(PNI).Oneoftheproposedpathways

inwhichtheenvironmentinﬂuencesmentalandphysicalhealth

isthroughtheemotionalresponsestheenvironmentelicitsinthe

occupant.Intheirturn,theemotionsinﬂuencementalandphysical

health,asexplainedinthesection.Theﬁrstpart,‘From

Environ-ment toEmotions’, dealswith thecurrent evidenceas to how

theenvironmentinﬂuencesemotions.Examplesinhealthcareand

ofﬁcesettingsareprovided,sinceresearchintheresidentialcontext

islacking.Thesecondpart,‘FromEmotionstoHealth’,showsthe

nextpartoftheaforementionedprocessbetween

“environment-emotions-health”.Itpresentsthebiologicalprocessesthatoccur

whenpositiveemotionsarepresentand theireffectsonmental

andphysicalhealth.

The environment provides stimuli that elicit an emotional

responseintheperson,whichhelpsthepersontocopewiththe

situation.Therefore,environmentshavethepotentialofcausing

stress,buttheycanalsohaverestorativeeffects,inﬂuencing

well-being[28–30].PNIstudiestheinteractionsbetweenhealth,mind,

andenvironment,withthefocusontheinﬂuenceofpsychological

andsocialfactorsonhumanphysiology,andthus,itexaminesthe

linksbetweentheenvironment,brain,behaviour,andtheimmune

system[31].

3.1.3.1. Fromenvironmenttoemotions. Mostoftheevidencelinking

environmentto healthand wellbeing comesfrom

environmen-talpsychologystudies,healthcareenvironment design,and sick

buildingsyndromeresearch.Theevidenceinsuchstudiesisbased

ontheprevalenceof physiological symptoms, evidenceof

pos-itivehealth outcomes,naturerestoration theory,cortisollevels,

depression,immuneregulation,andattentionrestorationtheory

[32–38].Healthcaredesignaimsatmakingpatientsfeelbetterto

healfasterbyreducingstressandincreasingcomfort,via

environ-mentalfeatures,whileintheofﬁcesetting,productivity,creativity,

andphysicalandmentalhealtharethetargettoimprove.Insuch

studiesitisshownthatenvironmentalaspectshaveaneffecton

themoodofpatients,workers.

3.1.3.2. Fromemotionstohealth. Thereisnotonlyalinkbetween

environmentalcuesandemotions,butalsoonebetweenemotions

andhealth[39].Evidenceindicatesthatpositiveemotionshavean

inﬂuenceonbothhealthandlongevity[40].Positiveemotionshave

beenassociatedwithlowerbloodpressurelevels,aswellasreduced

inﬂammatoryprocessesandneuroendocrine,cardiovascularand

immunestrengthening,whilenegativeemotionscancausestress,

anxiety,depression,andeventuallydamagingchangesinthe

car-diovascularsystem[41–44].Similarly,negativemoodscontribute

todelayedhealingfromwoundand infection,whileithasbeen

documentedthatangrypeoplehaveweakerimmuneresponsesto

vaccines,asopposedtooptimists.Likewise,theprevalenceof

self-reportedrhinitishasbeenfoundtobehigheramongststudents

withrecentnegativelifeevents[45].Oneofthepathwaysfrom

emotionstohealthoccurssincenegativeemotionsstimulatethe

productionofpro-inﬂammatorycytokines,whichleadto

inﬂam-mation.Initsturn,inﬂammationunbalanceshormonalproduction

anddamagesthehealthyreproductionofcells,linkingthiswith

cancersandavarietyofdiseases[46].

Therefore,humansreacttostimuliintheirenvironment.This

reactionisﬁrstemotional,thenbehavioural.Theemotionguides

thebehaviour–negativeemotions(stress/discomfort/displeasure)

willtriggerbehaviourswhosepurposeistoeliminateorreduce

thenegativestimulusoftheenvironment.Thebehaviour–either

throughcontrolorhabit-servesasa tooltobring homeostasis:

toreducethestress(discomfort/unbalance)causedbythe

envi-ronment,andtobringtheindividual’sstatebacktoaneutralone

(comfort/lack ofdiscomfort).Finally,theaforementionedstudies

suggestthestrongconnectionbetweentheenvironment,human

emotions,behaviours,andhealth.However,thesetypesofstudies

arepredominantlydoneintheofﬁceandhospitalcontexts,leaving

aknowledgegapregardingthedomesticcontext.

3.2. Energyinbuildings

Traditionally, energy technologies and occupants’ behaviour

have beentreated as separate actorsin thedomains of indoor

environment,energyengineering,andsocialﬁelds[47]:inspiteof

morerecenteffortstolinkthem,byviewingenergyconsumption

assomethingperformedbyindividualratherthansolely

technolo-gies,inacontextofinterrelationshipsbetweenusers,technologies,

skills, social contexts.In theengineering ﬁelds, thefocus is on

thedevelopmentofefﬁcienttechnologies–reducinggreenhouse

gases,reducingcost,etc.[50,51].Inthesocialﬁelds,thefocusis

onbehaviouralchangesthroughcampaigns,awareness,and

infor-mation[48,49].Asa result,ontheone hand,governments and

energypoliciescarry outcampaigns withﬁnes, public

informa-tion,etc.,totrytostimulatehouseholders’behaviouralchanges.

Ontheotherhand,thebuildingandtechnologyindustrystrives

toproducemoreairtighthouses,morestabletemperatures,and

lessenergy-consumingtechnologies[52–55].Thefactthatthetwo

domainsworkindependentlytoachievelowerenergyuse,couldbe

theunderlyingreasonleadingtodiscrepanciesobservedbetween

(6)

Fig.1.DutchelectricityconsumptionandappliancebreakdownandGasconsumption(adaptedfrommilieucentraal[57]andMajcen[56]).

3.2.1. Energyandbehaviours

3.2.1.1. Theoretical vs. actual consumption. While theoretical

energy consumption calculations tend to ignore the part of

the energy expenditure determined by the occupant’s lifestyle

(behaviouraldeterminants),actualenergyconsumptionisobtained

fromﬁnalenergy billsandmetersofthehouseholdbuildingin

question, reﬂecting the consumption of every single appliance

andbehaviour.In 2002inEurope,theEuropeanPerformanceof

Buildings Directive was passed, introducing theEnergy

Perfor-manceCertiﬁcation(EPC) labelingforresidential buildings.The

EPCmodeliscalculatedaccordingtoamethodologythatconsiders

insulation,heating,hotwaterandventilationssystems,andfuels

used; therefore ignoring appliance use and human behaviour

[56].Thedifferencebetweenthepredictedconsumptionandthe

actualoneiscalled“performancegap”.Inastudyperformedby

Majcenas shown inFig. 1,for electricity consumption, electric

appliances are an ignored variable when making theoretical

calculations. Accordingtomilieucentraal.nl, in theNetherlands,

suchappliancesrepresent about 32.4%of the household’s total

electricityconsumption[57].Whileforgasusage,themainignored

variableintheoreticalestimationsis‘cookingbehaviours’.From

thetotal energyconsumptionofaDutchhousehold,onaverage

gasaccountsfor 67.3% of thetotal actualenergy consumption,

whileelectricityaccountsfor32.7%[56,57].

Inthe1980sitwasestimatedthathumanfactors,suchas

atti-tudesofresidentstowardsenergybasedonprices,environmental

concerns,healthconcerns,andcomfort,couldinﬂuenceupto5%of

thevariationofconsumption[58].Recently,atinternationallevel,

theIEAidentiﬁed three majorcausesof performance gaps:

cli-matefactors,buildingfactors,andhuman[3]behaviour.Different

studiesperformedinEPClabelleddwellingshaveshownthat

occu-pantbehaviourheavilyinﬂuencesenergyconsumption,andithas

beenshownthatactualenergyconsumptionisineverycasehigher

thanthepredictedone[59–61].Such behaviouraldeterminants

ofconsumption areinteractionswithservicesand technologies,

asmotivatedbyoccupancypatterns,attitudes,andbeliefs;allof

whicharecorrelatedwiththeoccupant’sbehaviours.Thefactthat

suchvariablesarenotconsideredinestimationsislikelyduetothe

factthattheengineeringanddesignprocessofbuildings,systems,

andtechnologies(frommicrotomacroscales,i.e.:knobs,buttons,

interfaces,layout,spaces,automations,services,etc.)alsotendsto

excludesuchhumanfactors:users’needshavetobeunderstood

byinvolvingtheuserintheprocess[4,62–65].YaoandSteemers

[66]proposethatoccupancypatterns(numberofoccupants,sleep

andwaketimes,anddailyoccupancytime)inﬂuenceenergy

con-sumption.Thesepatternsinﬂuencebothphysicalandbehavioural

determinantsofconsumption.Physicaldeterminantsarefactors

suchasheating,cooling,lighting, determinedbycharacteristics

suchasdwellingsize,design,systems,services,andclimate,while

behaviouraldeterminantsarefactorssuchasfrequencyofuseof

appliances,systems[66].

Similarly,thesocialpracticetheorycontendsthatthecentreof

energyconsumptionis guidedbysocialdynamicsasorderedin

time[67,68].Inotherwords,certainsocialpracticesareperformed

atspeciﬁctimes,andthefactofcarryingthemout,asasociety,

bringsenergydemandtoapeakinacertainplace.Socialpractices

canbehabitssuchasworking,cooking,washing,orwatchingTV,

eachofwhichisgenerallyperformedatspeciﬁctimesinsimilar

societies.Therefore,itisadvocatedthattounderstandenergy

con-sumption,itisindispensabletounderstandsuchsocialpractices

andtheirtiming[68].

3.2.1.2. Energyandwellbeing. Therelationshipsbetweenenergy

andwellbeingarecomplexandinvolvemanyvariables.However,

generally by Western standards a ‘good life’ at home tends to

translateintohigherenergyusage[69].Oneofthelinksbetween

wellbeingandenergyuseinhouseholdsisrelatedtostandardof

liv-ingandqualityoflife:severalenergy-consumingactivitiesimprove

wellbeing,suchasmaintainingliveabletemperatures,refrigerating

perishables,cooking,hotwateraccess,lighting,andother

technolo-giesthatbringconveniencetooccupants[70].Ithasbeenestimated

thatinlessthanonegeneration,expectationsofcomfortviacentral

heatingandairconditioninghavebecomeanorm[71].However,it

hasbeenproposedthatenergysavingscanbeachievedwhilestill

maintainingahighqualityoflifeandwellbeingprovidedbythe

energyconsumingservices.

3.2.1.3. Energy and habits. Recent ﬁndings show that most of

everydaybehavioursareguidedbyhabits,especiallywhen

inter-actingwithtechnologysincetechnologyactsasacontextualcue

thattriggersthehabit[72–74].Intheresidentialcontext

replen-ishedwithenergyappliances,itisassumedthatitismoreprobable

thathumanswilluse“simpleheuristics”orhabits;sinceitisan

environmentwithcuesthatdonotrequirecognitiveeffort[74,75].

Anotherreasonwhyhabitsarestronginthedomesticcontext,is

because,‘home’providescuesthatarephysical,social,and

tem-poral,allofwhichenablehabitcreationandstrengthening[76].

Additionally,as inmostcases,energyconsumption is‘invisible’

fortheoccupant,whichstrengthenspossibleunsustainablehabits

[77]. Thesehabitualinteractions occurwithappliancesbut also

withinterfacesofsystems–thermostats,lights,equipment,etc.

–andthoseofthebuildingenvelope–windows,shades.

Becauseoftheunconsciousandautomaticnatureofhabits,they

havebeenshowntopreventawillingpersontochangeinto

pro-environmentalormoreefﬁcientbehaviours,andthus,habitscould

makepeopleactinwaysthatareoppositetotheirintentions[77],

withoutnoticing[21,71].Finally,becauseoftheirunconsciousness,

habitshavebeeneitheroverlookedorunderstudiedinenergy

con-sumptionresearch[21].Furthermore,inordertochangehabits

into moresustainableones, itis suggested thatpolicies should

tacklethetangibleenvironmentalcuesthattriggerthehabits

them-selves[76,78].Thisisbecausetheenvironmentalcharacteristics

havehigherimpactonenergyconsumptionthanothervariables,

(7)

3.2.2. Healthandenergy

Thestudyoftherelationshipsbetweenhomeenergyandhealth

iscomplex,sincethereareseverallinkingpathways,measurement

ofexposures,dosages,longtermeffects,aswellasthemultiple

interacting,dynamic,andinterdependentbuildingandoccupant

factors[80–85].Asaresult,thereisstilldebateabouttheimpactson

healthofenergyefﬁcienthomes.Thereisevidencethatenergy

efﬁ-cienthomes,measures,orinterventionsmodestlyimprovesome

aspectsofphysicalhealthofoccupants[86–90].Althoughresearch

hasbeendoneontheeffectsofclimatechangeandoutdoor

tem-peratureoncertainpopulations,thisreviewfocusessolelyonthe

indoorenvironmentandtemperatures.Ithasbeenreviewedthat

thermalcomfortimprovementsinhomesseemtogeneratehealth

improvements,speciﬁcallyin those whosuffer chronic

respira-torydiseases.Inasimilarvein,householdscapableofheatingtheir

homesarealsolinkedtobetterhealthandsocialrelationships,and

lowerschoolabsenteeism[91].Thelimitationsofsuchstudiesare

thattheyfocusonstart-andendpointswithoutconsideringthe

net-workoffactors,causes,andeffects[39].Forafulloverviewofthose

studies,refertoAppendixA,TableA2.Effectsofenergyefﬁcient

measuresonhealthofoccupants.

AirtightnesshasbeenencouragedbytheEuropeancommission

inordertosatisfyenergystandards.However,withairtightness,

the indoor air quality of the dwelling could be at risk. High

airtightnessneedsadequateventilation ratesand system

main-tenance.Inadequateventilation inanairtighthomecanleadto

increaseddampness and humidity,and thus higher

concentra-tionsofbiological,chemical,andphysicalcontaminants(CO,NO2,

CO2,formaldehyde,VOCs,radon,PMs,mites,moulds,etc.).These

pollutantshavebeenassociatedwithseveralhealthrisks,

espe-ciallywiththeprevalenceofrespiratoryandallergiceffectsbothin

childrenandadults[39,89,92–94].Nevertheless,airtightbuildings

withproperlymaintainedmechanicalventilationsystems,

espe-ciallyfor itsefﬁciencyinﬁlteringambientparticles,couldoffer

modestimprovementsinsymptomsorhealthoutcomes[95,96].In

theHOPEprojectitwasfoundthatthereisacorrelationbetween

perceived comfort variables themselves, and between Building

SymptomIndexvariablesandcomfortvariables;suggestingthat

energy-efﬁcientbuildingswithgoodindoorenvironmentalquality

andhealthyoccupantsarepossible,but theoppositealsoexists

[2,97]. In theEuropeanAudit project, it was concludedthat to

improveindoorairqualitywithoutconsumingmoreenergy,source

controlshouldbeappliedtomaterials,systems,andpolluting

activ-ities;thus,reducingpollutantswhilemaintaininglowventilation

rates[98].

4. Discussionandﬁndings

4.1. Narrowviewofcomfort

Inattemptingtofollow‘standards’,theIEQperspectiveof

com-fort tends to fall short when unavoidably combined with the

standardsrequiredforenergyefﬁciency,duetobeinglimitedto

single parameters of the four IEQ factors (airquality, thermal,

acoustical,visual)ignoringpossibleinteractionsaswellas

differ-encesamongpeople.Theliteraturereviewshowsthatcomfortis

awideranddeeperphenomenonofsubjectivenatureand

contex-tualdynamism.Takingthisintoaccount,inthisreview,itmaybe

bettertorefertoitas‘wellbeing’.Thisisbecause–asmentioned

earlier-comfort-makingactivitiesareequivalenttotheattainment

ofhomeostasis,andthusimplythereductionofstressand

conse-quently,theimprovementofhealth.Holisticanddomesticcomfort

deﬁnitionshavealsobeenputforward.Comfortismorethan a

physiologicalreaction;itisasubjectivereactiontoenvironmental

stimuli,whichcanbebehavioural,social,physiological,

psycholog-ical,andphysical,andthatindicatesharmonyandneutralitywith

thestimuli.

ThesefurtherdimensionsofcomfortaremissingfromtheIEQ

perspective.InIEQitseemsthatthecurrentdeﬁnitiondoesnot

provideenoughknowledgeaboutcomfort’sbehaviouralquality:

acrucialaspectwhenstudyingenergyuse.Althoughanadaptive

modelforthermalqualityexists,in-depthanalysesoftheproposed

“adaptiveactions”seemtobelackingandarerestrictedtoﬁvetypes

ofactions:heatgenerationandloss(physiologically),regulatingthe

thermalenvironment,selectingadifferentthermalenvironment,

ormodifyingthebody’sphysiologicalcomfortconditions(moving,

adjustlayers,etc.)[5].Asaresult,thismodelfallsshortbothin

depthand broadness,beingconﬁnedtothermalcomfortandto

theaforementionedtypes,whileignoringtheinvestigationofthe

actual“adaptiveactivities”and“adaptivechoices”.

Fromtheliteraturereviewfourmainpointscanbeconcluded:

ﬁrstly,generallyhumansavoiddiscomfortandunpleasant

expe-riences,andhencetheyarealwaysstriving(whetherconsciously

orunconsciously)tochangetheirpresentstatetowardsa

homeo-staticstate–thusamoreneutralorcomfortableone.Asaresult,

many of the actions we do are wellbeing-driven: actions that

can have effects onboth health and comfort. Secondly,

house-holdenergyconsumingtechnologiesaretoolsthatallowoccupants

toachievesuchcomfortandwellbeingbyperformingthe

activi-ties.Thirdly,energyconsumptionoccurswhenoccupantsinteract

withsuchtechnologieswhentheysearchfor‘wellbeing’.Fourthly,

habitsandcontrolactionsaretypesofbehavioursthatparticularly

consumeenergy,andtheyare,toanextentandamongstother

fac-tors,inﬂuencedbytheperson’s(energy)attitudesandemotions.

Theseattitudestowardsenergyvaryfrompersontoperson,and

hence,behaviours aredifferentamongstdifferentpeople,while

personaldifferencesofcomfortperceptionsandthresholdsexist.

Asaresult,thereisaneedtounderstandenergyconsumptionfrom

abehaviouralperspective,inrelationtothe‘wellbeing’motivations

ofsuchbehaviours.

4.2. Gapsinknowledge

Humansexperiencetheirenvironmentviamanymechanisms,

includingthesimpliﬁedsequenceof‘senses-emotions-behaviours’.

Behavioursenabletheindividualtochangetheircurrentemotional

state:anegativeaffectwillmotivatebehaviourtochange

some-thingintheirenvironmentandapositiveonewillmotivatethem

toencouragetheircurrentbehaviour.Thebehavioursthatare

per-tinenttowellbeingandenergyaresenseofcontrolandhabits,in

that,inthehomeenvironment,theytendtohaveasasecondary

effectoftheexpenditureofenergy.Moreover,thefactofexercising

controlandcarryingouthabitualroutinesisinandofitselfstress

relieving;affectingthusboththeshorttermfeelingofcomfortand

thelongtermhealth.

Habitshave been identiﬁed as theprimary cause of

perfor-mance gaps; however, they have seldom been studied due to

theirunconsciousnessandautomaticity.Nevertheless,inorderto

reduceenergyconsumption,theIEQandenergyengineeringﬁelds

wouldneedtoinvestigatesuchtypesofbehaviourwithinthe

con-textof‘comfort’sothattechnologiesaredesignedbyconsidering

occupantsneeds.Senseofcontrolisanothertypeofbehaviourof

relevancetowellbeingandenergy;sincebeingincontrolmeansto

givechoicestotheuser,choicesthatgenerallywillinﬂuencethe

ﬁnalenergyoutput.

5. Newdirections

Inthisreview,evidencesuggeststheneedforanewapproachin

(8)

mul-Fig.2.ConceptualModel:Lossofhomeostasis(discomfort,distress)triggerstheoccupanttoﬁndagainamoreneutralstate(i.e.comfort).Thisisperformedbymanipulating theirenvironment(viainteractionwithappliances,systems)throughbehaviours(habitsorcontrol).Behaviorsaretoanextentguidedbyemotionsandattitudes.Finally, whenhomeostasisisachieved,healthandwellbeingareachievedinthelongterm.Theinteractionwiththeenvironmentresultsinenergyuse.

tidimensionalandsubjectiveconstructthatvariesacrosscontexts;

however,bylookingatit froma biologicalperspective,comfort

isthemaintenance ofhomeostasis –a reactiontothe

environ-mentindicatingtheabsenceofenvironmentalstressorsandwhich

isstronglyrelatedtohealth.

5.1. Conceptualframework

Fromtheresultsofthis review,aconceptualframework has

beendeveloped,proposingthat energyuseisa consequenceof

tryingtoattainhomeostasis(comfort,neutralstate,lackofstress).

Consequently, in this framework, the focus lies on the

behaviouralexpressionsofcomfort(Fig.2).Thelinkbetween

com-fortandenergyconsumptionliesintheactiveinteractionofan

occupantwithenergyconsumingproducts,whentryingtoachieve

thiscomfort –inparticular throughtheexerciseof controland

habits.Behaviourisstronglyinﬂuenced–amongstother

factors-byemotionsandattitudes,andtherefore,thesevariableshavebeen

includedintheframework.Thisisalsodonesince,aspresentedin

thisreview,habitsarehighlyemotional(emergingfromthe

rou-tinelevelofemotions)andalsocounter-attitudinal(duetotheir

unconsciousnature).

The feeling of being in control arises by exercising choice,

enabledbythepresenceofenvironmentalchoices,whilehabits

areautomatic,unconscious,and repetitivebehaviours triggered

byenvironmentalcues.Suchbehavioursnotonlyallowthe

per-sontocopewithstressorsandmodulatetheiremotionalstatus

towardsamoredesirableone,butexercisinghabitsandcontrolis

alsorewardingbyitself.“Comfort”asseenfromthiswider

perspec-tiveencompassesthesubjectivefeelingofpositiveemotionsand

reductionofstress,andasaresultitisbeneﬁcialtotheindividual’s

generalwellbeing.However,healthisalsoinﬂuencedbyseveral

factorsintheindoorenvironment, especiallyinenergyefﬁcient

homes.

5.2. Methodologicalframework

Fromtheconceptualframework,itisproposedtotackle

well-being (comfort and its links to health) and energy from the

perspectiveoftheoccupant,andmorespeciﬁcally,their

comfort-makingbehaviours.Becausenotalloccupantshavethesameneeds,

values,behaviours,orcomfortlevels,asaﬁrststep,itisproposedto

conductaspecializedsurvey.Thepurposeofthissurveyistoﬁnd

outdifferentoccupantproﬁles,basedontheircomfortandenergy

behaviours,andespeciallythekeytypesofbehaviourpinpointed

inthisreview:habitsandcontrol.

Toachieveso,thesurveyhastoincludequestionsabout

occu-pants’emotions(sincetheyguidebehaviour),attitudes,andhealth

status. Thisshouldbecontinuedby questionsaboutoccupants’

energy-consuminghabitsandthestrengthofsuchhabits.Finally,

ithastoincludethelevelsofcontrolthatoccupantsneedtohave

overtheirhomeenvironment.

Byunderstandingtheseﬁvefactors(attitudes,emotions,health,

control,andhabits),whicharefactorsthatinﬂuencebehaviours

andthatcomposeimportantdimensionsof‘wellbeing’,itshould

bepossibletoshedonlightonwhethertherearedifferenttypesof

occupants,andwherethedifferenceslie.

Thecontributionofsuchanapproachistofacilitatethe

iden-tiﬁcationofoccupanttypesfortheﬁrststepsoftheengineering

processofresidentialenergyconsumingtechnologies(appliances,

controlsystems)butalsotocontributetoamorecomprehensive

understandingofcomfortforIEQ.Thegoalofthisistobeable

pro-videresidentialenvironments–includingsystemsandappliances

–thatsupportspeciﬁctypeofusers,intermsoftheirbehaviours

andneeds,sothatenergyconsumptionisreduced,whileproviding

‘customized’andoptimizedwellbeing–comfortandhealth-.

6. Limitations

Thelimitationstothisreviewcanbecategorizedasboth

prac-ticalandmethodological.Thepracticallimitationslieinthefact

thatasitisbasedonthedisciplinesofthesocialsciences,namely

behaviouralpsychology,thetheoriesexplainedarenotrigidand

deﬁnite,buttheyarebasedontendencies.Themethodological

limi-tationslieinthefactthatthereisalackofresearchofthetopicinthe

residentialcontext.Theoriessuchasthatofthe“three-levelof

(9)

330 M.A. Ortiz et al. / Energy and Buildings 152 (2017) 323–335 the psychoneuroimmunological approach to wellbeing is as of now non-existent in the home context. Therefore, as social sciences are based on tendencies, changing the ‘context’ variable might alter the expected and known outcomes of the current tendencies. This is however, the reason why this review was performed, as well as why a new research approach is presented in the form of a methodological framework. Acknowledgements This work was supported by Saint Gobain Research as part of the PhD project “User Experiences and Energy Consumption in Homes” at the Technical University of Delft under the chair of Indoor Envi-ronment at the Faculty of Architecture and the Built Environment. Appendix A. TableA1

Scopeofcomfortbydisciplineandbyhumanandenvironmentalfactors.

IEQ Nursing/Healthcare Ergonomics Popular Evolutionary Domestic Holistic

Environmentalfactors Airquality + +Olfaction/irritation

Temperature + + +

Visual + + +

Acoustical + + +

Size/layout +

Interiordesign(colour, greenery,....)

+‘Positivestimuli’ +Generalenvironment +Environmentalstimuli + +Generalenvironment

Otheraffordances + Contextualcues +

Humanfactors Physiological + + + + + +

Psychological +Psycho-spiritual + + +Privacy/security +

Social +Support + +Interaction

Physical + + + + Emotional + + + +Identiﬁcation/ Attach-ment/Expression Behavioural +Adaptive + + + + Postural + +

+Factorisincludedinthatdiscipline.

(10)

M.A. Ortiz et al. / Energy and Buildings 152 (2017) 323–335 331

Effectsofenergyefﬁcientmeasuresonhealthofoccupants.

Reference Evidencelevel Countryanddate Variablesorindicators Buildingtype Population Effectonhealthof

variables/indicators–Mainresults

Indicator Health

[89] 1(systematicreviewof experimentalstudies)

Varied,from1887to2007 Warmthmeasures Respiratory,general, mental

Varied Varied Positive

[91] 1(systematicreviewof experimentalstudies)

Varied,from1887to2012 Housing

investments/interventions (warmthmeasures)

Generalhealth

(respiratory,absenteeism), illness,wellbeing

Allphysicalhousetypes Alltypesofparticipants Positive

[84] 3(systematicreviewof correlationalor qualitativestudies)

Varied Light,temperature,air,

acoustical

Stress Laboratory,ofﬁces,

residences

Varied Negative

[87] 1(meta-analysisof experimentalstudies)

Varied Insulation,heating,glazing, Generalhealth;respiratory Varied 36studies/33000

participants

Positivemarginaleffects.Improve overtime

[99] 1(reviewof epidemiologic evidence)

Varied dampnessormold multipleallergicand

respiratoryeffects

Varied Varied negative

[82] 2(Communitybased, cluster,singleblinded randomizedstudy)

NewZealand Insulation(temperature,

humidity,energy consumption)

Self-reported,wheezing, daysoff,GPvisits, hospitalization

1350lowincome households,uninsulated dwellings.

4407participantsof householdswithprevious respiratoryhistory.

Positive(reducedoddsofpoor effects)

[85] 6(narrativesynthesis) England,Wales,Scotland, NewZealand,USA (2000–2009)

Fuelpoverty(coldand damphousing)

Mental,physicalhealth Households 5studieswithmorethan

2000householdseach. Infantsandadults

Modesteffectsinadults,more signiﬁcantininfants. [88] 6(singledescriptive

qualitativestudy)

Boston,Chicago,newYork city(2009–2012) insulation,heating equipment,ventilation improvements self-reportedgeneral, respiratory,cardiovascular, andmentalhealth

248Households 248adults,75children Positiveeffectonsinusitis,general health,andasthmamedication. [100] 1(quantitative

meta-analyses

Varied dampnessandmold respiratoryand

asthma-relatedhealth outcomes

Homes maleadults,femaleadults,

children(Age<18),and infants.

Negative(30%-50%increasesin respiratoryandasthmarelated healthoutcomes)

[96] 4(case-controlstudy with telephone-administered questionnaire)

NewBrunswickandNova Scotia,Canada(1998)

Newhomeswithheat recoveryventilators

Respiratorysymptoms, diagnosedasthma,chronic obstructivelungdisease, heartcondition, medicationuse.

53newhomes 149occupants Positiveeffectsover1year.

[101] 2–3(Randomized controlledtrial,with randomization embeddedinstudy database)

Baltimore,USA PMs,airnicotine,urine cotinineconcentrations

Symptomfreedays JohnsHopkinsHospital Children’sCenterand homesofchildren

Childrenwithasthma, residingwithasmoker, randomlyassignedto interventionsconsistingof aircleanersonly(n=41), aircleanersplusahealth coach(n=41),ordelayed aircleaner(control) (n=44).

AircleanersreducePM concentrationsandincrease symptom-freedays.SHSexposure notprevented

[102] 6(self-administered postalquestionnaire)

Sweden Multiplebuilding

characteristics

Asthma,allergyand eczema,hayfever.

472multifamilybuildings 7554participants Asthma,allergiesoreczemamore commonwithlessuseofenergy forspaceheating,inlarger buildingsandindwellingswith redecoration,moldodor, dampnessandhumidair. [92] 6 (descriptive-cross-sectional study) NortheastTexas (2008–2009) housingcharacteristics, homeinteriorsurface materials,dampness

wheeze,drycough, rhinitis,eczema

Trailersandapartments. 2819parentsofchildren Livingintrailerswasrelatedto diagnosedasthmaanddiagnosed hayfever.CentralA/Csystems associatedwithanincrementof allergicsymptoms,especially rhinitis.

(11)

M.A. Ortiz et al. / Energy and Buildings 152 (2017) 323–335 TableA2(Continued)

Indicator Health

[103] 3(cross-sectional, correlational)

Sweden Waterleakage,visible

dampness,ﬂoormoisture, windowcondensation

Wheeze,cough,eczema, rhinitis,asthma

8918homes. 10,851children(1–6years) Dampnessindiceswereassociated tohigherprevalenceofsymptoms [81] 2(randomizedto

waitinglist)

DevonUK Upgradinghouses

(includingcentralheating, ventilation,rewiring, insulation,andre-rooﬁng)

GeneralhealthRespiratory health.Musculoskeletal health.Healthservice contacts.Hospital admissions.

119councilownedhouses 480residentsofthese houses.

lesseningofasthmasymptomsin adultsandappearstoprotect againstnon-asthmarespiratory conditionsinadultsandchildren

[94] 6(Postal

questionnaire)

UnitedKingdom householdenergy

efﬁciency

Asthmaoutcomes 3867socialhousing properties

944participants Increasedenergyefﬁciencymay increaseriskofcurrentasthma. Moldy/mustyodorassociatedwith riskofasthma

[95] 1(systematicreview) varied particleﬁltration Self-reportedhealthand

measuredallergy,asthma, inﬂammation,respiratory systemperformance,lung function,bloodpressure, heartrate.

Non-industrialbuildings (homes,schools,and ofﬁces)

Varied Particleﬁltrationmodesteffectin

reductionallergyandasthma outcomes.Notveryeffectivein reducingacutehealthsymptomsin non-allergics/asthmatics. Morbidityandmortalityassociated withparticleexposureisreduced. [104] 2(double-blind,

randomizedtrial)

areasurrounding Cincinnati,USA

Airnicotinelevels,tobacco smokeexposure,indoor airborneparticlelevels, andexhalednitric-oxide levels

unscheduledasthmavisits andsymptoms

Homesofparticipants. 225children(6–12y.o.) withasthma,exposedto SHS

HEPAaircleanersmayreduce asthmamorbidity

[80] 1(Systematicreviewof experimentaland non-experimental)

Varied interventionstoimprove

housing(rehousing, refurbishment,andenergy efﬁciencymeasures)

healtheffects Varied Varied Moststudiesfoundsomehealth

gains,butinconclusiveevidence duetosmallsamples. [90] 1(systematicreviewof

interventionstudies)

Varied energyefﬁciency

interventions(warmth, affordabilityoffuel, psycho-socialfactors, indoorairquality)

Physiological,social, psychologicalhealth.

Residences Varied EEIimprovedwinterwarmthand

loweredrelativehumiditywith beneﬁtsforcardiovascularand respiratoryhealth.

[105] 6(narrativesynthesis) UK energy-efﬁcientmeasures Generalhealth UKhomes Varied Poorventilation,overheating,poor

IAQmayaffecthealth. [106] 1(systematicreview) USAandUK thermalexposures obesityprevalence domesticsetting Adults Plausiblecausallinkbetween

increasedtimespentinthermal comfortandincreasedadiposityin thepopulation [107] 3(systematicreviewof correlational; qualitativestudies,RCT orquasi-experimental studies)

Varied Climatechange;indoor

exposures;changesinthe building.

Generalhealth Varied Varied Healtheffectsofclimatechange

willresultfromindoorexposures. Climate-relatedhealtheffectscan bereducedbychangesto buildings.Changestobuildings willimprovehealthirrespectiveof climatechange.Changesto buildingswillsaveenergyand reduceCO2emissions. [108] 3(descriptive

correlationalstudy)

England(2001–2003) Warmfrontenergy efﬁcientmeasures (insulationandinsulation)

Temperaturesin household.

DwellingswithWarm Frontmeasures

Varied Temperaturesinﬂuencedby

propertycharacteristics(age, thermalefﬁciency,numberof people,ageoftheheadof household).Warmfrontmeasures improveliving-andbedroom temperatures

(12)

M.A. Ortiz et al. / Energy and Buildings 152 (2017) 323–335 333

Indicator Health [86] 3(systematicreviewof correlational; qualitativestudies,RCT orquasi-experimental studies)

Varied Indoorenvironmental

factors

Healthoutcomes (communicablerespiratory illnesses;allergyand asthmasymptoms;sick buildingsyndrome symptoms)

Varied Varied Characteristicsofbuildingsand

indoorenvironmentsinﬂuence SBS,respiratory,andallergyand asthmasymptoms.Marginally adequateindoorenvironment provisioncanbereplacedbyhealth promotingIE

[109] 3(Descriptive correlationalstudy)

NineEuropeancountries buildingenergy performance;building characteristicsandIE

Feelingandperceptionof IE;SBS

Apartmentandofﬁce buildings

Dwellersandofﬁce workers

LowEnergybuildingswithgoodIE exist.

NineEuropeancountries buildingenergy performance;building characteristicsandIE

Feelingandperceptionof IE;SBS

Apartmentandofﬁce buildings

Dwellersandofﬁce workers

LowEnergybuildingswithgoodIE exist.

Europeancountries perceivedindoorair quality.;pollutionsources; ventilationratesand performance;energy consumption

symptoms/complaints ofﬁcebuildings Ofﬁceworkers OccupantsacceptabilityandBRS

showsnocorrelationwith perceivedIAQ

Netherlands Coldacclimatization BATproduction,NST

thermogenesis.

Laboratory 17healthymenand

women

Repeatedintermittentcold exposuresrecruitedbrownadipose tissue;accompaniedbyanincrease innon-shiveringthermogenesis [113] 3(Descriptive

correlationalstudy)

Netherlands Thermoneutralconditions

(22C)andmildcold exposure(16C)

Bodycompositionand energyexpenditure; Brown-adipose-tissue activity

Laboratory 24healthymen(10normal

weight-14overweightor obese)

BATactivityisreducedyetpresent inmostoverweightorobesemen, thusmaybeatargetforthe treatmentofobesity [83] 6(longitudinal

questionnaire–single descriptivequalitative study)

Japan – Chronicbackpain;

Satisfactionwithliving environment;Stressand fatigue

– Japanesewomen3054 Causaleffect:“stressandfatigue”

–>“chronicbackpain”.Second causaleffect:“satisfactionofliving environment”−>“stressand fatigue.”Thus,suggestionthat “satisfactionofliving environment”inﬂuences“stress andfatigue”whichismanifestedas “chroniclowbackpain”. [114] 5(systematicreviews

ofdescriptiveand qualitativestudies.)

Varied indoorairpollution;

energy-efﬁcienthomes

Generalhealth Varied Varied Evidenceofeffectsofindoorair

pollutionandhealthlinksisstrong andpartlyquantiﬁed.Effectsof energy-efﬁcienthomesonhealth, evidenceismeagre.

[115] (5(systematicreviews ofdescriptiveand qualitativestudies.)

Varied housingquality,housing

characteristics

asthmaexpression; psychologicalstress

Varied Children Increasingevidencehaslinked

psychologicalstressandnegative affectivestatestoasthma expression

+Factorisincludedinthatdiscipline.

Writtencontent:sub-elementoftheenvironmentalorhumanfactorstudiedwithinthediscipline. Theevidencelevelsofthefollowingtablearedeterminedby:

[1]G.Guyatt,D.Rennie,M.Meade,D.Cook,Users’GuidestotheMedicalLiterature,Chicago:AMAPress,2002.

[2]R.P.Harris,M.Helfand,S.H.Woolf,K.N.Lohr,C.D.Mulrow,S.M.Teutsch,D.Atkins,M.W.G.T.U.Preventive,S.T.Force,CurrentmethodsoftheUSPreventiveServicesTaskForce:areviewoftheprocess,Americanjournalof preventivemedicine,20(3)(2001)21–35.

(13)

References

[1]A.Ortony,D.Norman,W.Revelle,AffectandProto-AffectinEffective Functioning,WhoNeedsEmotions,2005,pp.173–202.

[2]C.-A.Roulet,F.Flourentzou,F.Foradini,P.Bluyssen,C.Cox,C.Aizlewood, Multicriteriaanalysisofhealth,comfortandenergyefﬁciencyinbuildings, Build.Res.Inf.34(5)(2006)475–482.

[3]IEA,EBCAnnex53TotalEnergyUseinBuildings:Analysis&Evaluation Methods,InternationalEnergyAgency,2013.

[4]P.M.Bluyssen,TheIndoorEnvironmentHandbook:HowtoMakeBuildings HealthyandComfortable,Earthscan,2009.

[5]F.Nicol,M.Humphreys,S.Roaf,AdaptiveThermalComfort:Principlesand Practice,Routledge,2012.

[6]G.S.Brager,R.deDear,Climate,Comfort&NaturalVentilation:ANew AdaptiveComfortStandardforASHRAEStandard55,2001.

[7]K.Y.Kolcaba,Atheoryofholisticcomfortfornursing,J.Adv.Nurs.19(6) (1994)1178–1184.

[8]K.Y.Kolcaba,Ataxonomicstructurefortheconceptcomfort,Image:J.Nurs. Scholarsh.23(4)(1991)237–240.

[9]M.G.Helander,Forgetaboutergonomicsinchairdesign?Focuson aestheticsandcomfort!,Ergonomics46(13–14)(2003)1306–1319. [10]K.Slater,HumanComfort,CCThomas,Springﬁeld,Ill.,USA,1985. [11]M.P.DeLooze,L.F.Kuijt-evers,J.VanDieën,Sittingcomfortanddiscomfort

andtherelationshipswithobjectivemeasures,Ergonomics46(10)(2003) 985–997.

[12]W.Heijs,P.Stringer,Comfortasapropertyofthedwelling:aconceptual analysis,NetherlandsJ.Hous.Environ.Res.2(4)(1987)331–356. [13]R.R.Dunn,TheWildLifeofOurBodies:Predators,Parasites,andPartners

ThatShapeWhoWeAreToday,Harper,2011.

[14]M.Fuchs,M.Hegger,T.Stark,M.Zeumer,EnergyManual:Sustainable Architecture,WalterdeGruyter,2008.

[15]D.A.Norman,A.Ortony,D.M.Russell,Affectandmachinedesignlessonsfor thedevelopmentofautonomusmachines—affectmattersamodelofaffect andcognition,Behav.ThreeLevelsProcess.(2002)1–10.

[16]A.R.Damasio,Descartes’errorandthefutureofhumanlife,Sci.Am.271(4) (1994)144.

[17]A.Bechara,Theroleofemotionindecision-making:evidencefrom neurologicalpatientswithorbitofrontaldamage,BrainCogn.55(1)(2004) 30–40.

[18]B.Verplanken,H.Aarts,Habit,attitude,andplannedbehaviour:ishabitan emptyconstructoraninterestingcaseofgoal-directedautomaticity?Eur. Rev.Soc.Psychol.10(1)(1999)101–134.

[19]W.Wood,D.Rünger,Psychologyofhabit,Psychology67(2016). [20]T.Field,M.Hernandez-Reif,M.Diego,S.Schanberg,C.Kuhn,Cortisol

decreasesandserotoninanddopamineincreasefollowingmassagetherapy, Int.J.Neurosci.115(10)(2005)1397–1413.

[21]K.Maréchal,Anevolutionaryperspectiveontheeconomicsofenergy consumption:thecrucialroleofhabits,J.Econ.Issues43(1)(2009)69–88. [22]S.O.Marberry,InnovationsinHealthcareDesign:SelectedPresentations

fromtheFirstFiveSymposiaonHealthcareDesign,JohnWiley&Sons,1995. [23]L.A.Leotti,S.S.Iyengar,K.N.Ochsner,Borntochoose:theoriginsandvalue

oftheneedforcontrol,TrendsCogn.Sci.14(10)(2010)457–463. [24]P.Vink,ComfortandDesign:PrinciplesandGoodPractice,CRCpress,2004. [25]P.Leather,M.Pyrgas,D.Beale,C.Lawrence,Windowsintheworkplace

sunlight,view,andoccupationalstress,Environ.Behav.30(6)(1998) 739–762.

[26]J.Li,H.DeRidder,A.Vermeeren,C.Conrado,C.Martella,DesignforCrown Well-Being:NeedsandDesignsuggestions,InternationalConferenceon PlanningandDesign,Taiwan,2013.

[27]B.L.Ong,BeyondEnvironmentalComfort,Routledge,2013.

[28]R.Russell,A.D.Guerry,P.Balvanera,R.K.Gould,X.Basurto,K.M.Chan,S. Klain,J.Levine,J.Tam,Humansandnature:howknowingandexperiencing natureaffectwell-being,Annu.Rev.Environ.Resour.38(2013)473–502. [29]S.R.Kellert,BuildingforLife:DesigningandUnderstandingthe

Human-NatureConnection,IslandPress,2012.

[30]S.Kaplan,Therestorativebeneﬁtsofnature:towardanintegrative framework,J.Environ.Psychol.15(3)(1995)169–182.

[31]R.Zachariae,Psychoneuroimmunology:abio-psycho-socialapproachto healthanddisease,Scand.J.Psychol.50(6)(2009)645–651.

[32]S.M.Williams,EnvironmentandMentalHealth,JohnWiley&SonLimited, 1994.

[33]K.Anthony,DesigningPsychotherapists’Ofﬁces:Reﬂectionsofan Environment-behaviorResearcher,AmericanPsychologicalAssociation Convention,SanFrancisco,1998.

[34]S.Cohen,G.W.Evans,D.Stokols,D.S.Krantz,Behavior,Health,and EnvironmentalStress,SpringerScience&BusinessMedia,2013. [35]R.Parsons,L.G.Tassinary,R.S.Ulrich,M.R.Hebl,M.Grossman-Alexander,

Theviewfromtheroad:implicationsforstressrecoveryandimmunization, J.Environ.Psychol.18(2)(1998)113–140.

[36]D.Stokols,J.G.Grzywacz,S.McMahan,K.Phillips,Increasingthehealth promotivecapacityofhumanenvironments,Am.J.HealthPromot.18(1) (2003)4–13.

[37]H.Cox,I.Burns,S.Savage,Multisensoryenvironmentsforleisure: promotingwell-beinginnursinghomeresidentswithdementia,J.Gerontol. Nurs.30(2)(2004)37–45.

[38]H.Frumkin,EnvironmentalHealth:FromGlobaltoLocal,JohnWiley&Sons, 2005.

[39]P.M.Bluyssen,TheHealthyIndoorEnvironment:HowtoAssessOccupants’ WellbeinginBuildings,Routledge,2014.

[40]E.Diener,M.Y.Chan,Happypeoplelivelonger:subjectivewell-being contributestohealthandlongevity,Appl.Psychol.:HealthWell-Being3(1) (2011)1–43.

[41]A.Steptoe,J.Wardle,M.Marmot,Positiveaffectandhealth-related neuroendocrine,cardiovascular,andinﬂammatoryprocesses,Proc.Natl. Acad.Sci.U.S.A.102(18)(2005)6508–6512.

[42]Y.Chida,A.Steptoe,Positivepsychologicalwell-beingandmortality:a quantitativereviewofprospectiveobservationalstudies,Psychosom.Med. 70(7)(2008)741–756.

[43]S.C.Segerstrom,S.E.Sephton,Optimisticexpectanciesandcell-mediated immunitytheroleofpositiveaffect,Psychol.Sci.21(3)(2010)448–455. [44]R.M.Sapolsky,Theinﬂuenceofsocialhierarchyonprimatehealth,Science

308(5722)(2005)648–652.

[45]P.M.Bluyssen,M.Ortiz-Sanchez,C.Roda,Self-reportedrhinitisofstudents fromdifferentuniversitiesintheNetherlandsanditsassociationwiththeir homeenvironment,Build.Environ.110(2016)36–45.

[46]J.K.Kiecolt-Glaser,L.McGuire,T.F.Robles,R.Glaser,

Psychoneuroimmunology:psychologicalinﬂuencesonimmunefunction andhealth,J.Consult.Clin.Psychol.70(3)(2002)537.

[47]M.Moezzi,L.Lutzenhiser,What’sMissinginTheoriesoftheResidential EnergyUser,ACEEESummerStudyonEnergyEfﬁciencyinBuildings, AmericanCouncilforanEnergyEfﬁcientEconomy,Washington,DC,2010. [48]P.-P.Verbeek,A.Slob,UserBehaviorandTechnologyDevelopment,

Springer,2006.

[49]H.Wilhite,Newthinkingontheagentiverelationshipbetweenend-use technologiesandenergy-usingpractices,EnergyEfﬁc.1(2)(2008)121–130. [50]J.Grin,J.Rotmans,J.Schot,TransitionstoSustainableDevelopment:New

DirectionsintheStudyofLongTermTransformativeChange,Routledge, 2010.

[51]F.W.Geels,Thedynamicsoftransitionsinsocio-technicalsystems:a multi-levelanalysisofthetransitionpathwayfromhorse-drawncarriages toautomobiles(1860–1930),Technol.Anal.Strateg.Manage.17(4)(2005) 445–476.

[52]B.Dahlbom,ChangingEnergyBehaviour:GuidelinesforBehaviouralChange Programmes,IDAE,2009.

[53]A.-D.Barbu,N.Griffiths,G.Morton,AchievingEnergyEfficiencyThrough BehaviourChange:WhatDoesItTake?PublicationsOffice,2013. [54]D.McKenzie-Mohr,Fosteringsustainablebehaviorthrough

community-basedsocialmarketingAm.Psychol.55(5)(2000)531. [55]T.Chatterton,AnIntroductiontoThinkingabout‘EnergyBehaviour’:A

Multi-ModelApproach,2011,December.

[56]D.Majcen,PredictingEnergyConsumptionandSavingsintheHousing Stock:APerformanceGapAnalysisintheNetherlands,DelftUniversityof Technology,TUDelft,2016.

[57]milieucentraal,Gemiddeldenergieverbruik,2016.

[58]W.F.VanRaaij,T.M.Verhallen,Patternsofresidentialenergybehavior,J. Econ.Psychol.4(1)(1983)85–106.

[59]B.Bordass,R.Cohen,M.Standeven,A.Leaman,Assessingbuilding performanceinuse3:energyperformanceoftheProbebuildings,Build.Res. Inf.29(2)(2001)114–128.

[60]B.Bordass,Energyperformanceofnon-domesticbuildings:closingthe credibilitygap,in:ProceedingsOfthe2004ImprovingEnergyEfﬁciencyof CommercialBuildingsConference,Citeseer,2004.

[61]C.Demanuele,T.Tweddell,M.Davies,BridgingtheGapBetweenPredicted andActualEnergyPerformanceinSchools,WorldRenewableEnergy CongressXI,UAEAbuDhabi,2010,pp.25–30.

[62]P.H.G.Berkhout,J.C.Muskens,J.W.Velthuijsen,Deﬁningthereboundeffect, EnergyPolicy28(6–7)(2000)425–432.

[63]T.Dietz,P.C.Stern,E.U.Weber,Reducingcarbon-basedenergyconsumption throughchangesinhouseholdbehavior,Daedalus142(1)(2013)78–89. [64]N.Huijts,E.Molin,L.Steg,Psychologicalfactorsinﬂuencingsustainable

energytechnologyacceptance:areview-basedcomprehensiveframework, Renew.Sustain.EnergyRev.16(1)(2012)525–531.

[65]C.J.Midden,Sustainabletechnologyorsustainableusers?in:UserBehavior andTechnologyDevelopment,Springer,2006,pp.191–200.

[66]R.Yao,K.Steemers,Amethodofformulatingenergyloadproﬁlefor domesticbuildingsintheUKEnergyBuild.37(6)(2005)663–671. [67]E.Shove,Efﬁciencyandconsumption:technologyandpractice,Energy

Environ.15(6)(2004)1053–1065.

[68]J.Torriti,Understandingthetimingofenergydemandthroughtimeuse data:timeofthedaydependenceofsocialpractices,EnergyRes.SocialSci. 25(2017)37–47.

[69]M.Aune,M.Ryghaug,Å.Godbolt,Comfort,consciousnessand costs—transitionsinNorwegianenergyculture1991–2010,Energy EfﬁciencyFirst:theFoundationofaLow-CarbonSociety,Proceedingsofthe ECEEE(2011).

[70]T.Dietz,Altruism,self-interest,andenergyconsumption,Proc.Natl.Acad. Sci.U.S.A.112(6)(2015)1654–1655.

[71]S.Waite-Chuah,Livinginthecomfortzone:atwhatcost?Sustain.:J.Record 5(6)(2012)386–390.

[72]K.Maréchal,Notirrationalbuthabitual:theimportanceofbehavioural lock-ininenergyconsumption,Ecol.Econ.69(5)(2010)1104–1114.

(14)

[73]J.Pierce,D.J.Schiano,E.Paulos,Home,habits,andenergyexamining domesticinteractionsandenergyconsumption,in:Proceedingsofthe SIGCHIConferenceonHumanFactorsinComputingSystems,ACM,2010, pp.1985–1994.

[74]K.Ehrhardt-Martinez,Changinghabits,lifestylesandchoices:the behavioursthatdrivefeedback-inducedenergysavings,in:Proceedingsof the2011ECEEESummerStudyonEnergyEfﬁciencyinBuildings,Toulon, France,2011,pp.6–11.

[75]W.Jager,BreakingBadHabits:ADynamicalPerspectiveonHabitFormation andChange,HumanDecision-MakingandEnvironmental

Perception-UnderstandingandAssistingHumanDecision-MakinginReal LifeSettings,UniversityofGroningen,LiborAmicorumforCharlesVlek, Groningen,2003.

[76]M.F.Ji,W.Wood,Purchaseandconsumptionhabits:notnecessarilywhat youintend,J.Consum.Psychol.17(4)(2007)261–276.

[77]M.Martiskaïnen,HouseholdEnergyconsumptionandbehavioural change—theUKperspective,ProceedingsoftheSCORE2008Conference SustainableConsumptionandProduction:FrameworkforAction(2008) 73–90.

[78]B.Verplanken,W.Wood,Interventionstobreakandcreateconsumerhabits, J.PublicPolicyMark.25(1)(2006)90–103.

[79]G.M.Huebner,J.Cooper,K.Jones,Domesticenergyconsumption—whatrole docomfort,habit,andknowledgeabouttheheatingsystemplay?Energy Build.66(2013)626–636.

[80]H.Thomson,M.Petticrew,D.Morrison,Healtheffectsofhousing improvement:systematicreviewofinterventionstudies,BMJ323(7306) (2001)187–190.

[81]A.Barton,M.Basham,C.Foy,K.Buckingham,M.Somerville,TheWatcombe HousingStudy:theshorttermeffectofimprovinghousingconditionsonthe healthofresidents,J.Epidemiol.CommunityHealth61(9)(2007)771–777. [82]P.Howden-Chapman,A.Matheson,J.Crane,H.Viggers,M.Cunningham,T.

Blakely,C.Cunningham,A.Woodward,K.Saville-Smith,D.O’Dea,Effectof insulatingexistinghousesonhealthinequality:clusterrandomisedstudyin thecommunity,BMJ334(7591)(2007)460.

[83]N.Nagasawa,R.Yamaguchi,R.Kato,T.Shin-ichi,Longitudinalstudyof housingforthepromotionofhealthandwell-being,J.Environ.Eng.(Japan) 80(709)(2015)279–287.

[84]M.Rashid,C.Zimring,Areviewoftheempiricalliteratureonthe relationshipsbetweenindoorenvironmentandstressinhealthcareand ofﬁcesettingsproblemsandprospectsofsharingevidence,Environ.Behav. 40(2)(2008)151–190.

[85]C.Liddell,C.Morris,Fuelpovertyandhumanhealth:areviewofrecent evidence,EnergyPolicy38(6)(2010)2987–2997.

[86]W.J.Fisk,Healthandproductivitygainsfrombetterindoorenvironments andtheirrelationshipwithbuildingenergyefﬁciency,Annu.Rev.Energy Environ.25(1)(2000)537–566.

[87]C.D.Maidment,C.R.Jones,T.L.Webb,E.A.Hathway,J.M.Gilbertson,The impactofhouseholdenergyefﬁciencymeasuresonhealth:ameta-analysis, EnergyPolicy65(2014)583–593.

[88]J.Wilson,S.L.Dixon,D.E.Jacobs,J.Breysse,J.Akoto,E.Tohn,M.Isaacson,A. Evens,Y.Hernandez,Watts-to-wellbeing:doesresidentialenergy conservationimprovehealth?EnergyEfﬁc.7(1)(2014)151–160. [89]H.Thomson,S.Thomas,E.Sellstrom,M.Petticrew,Thehealthimpactsof

housingimprovement:asystematicreviewofinterventionstudiesfrom 1887to2007,Am.J.PublicHealth99(S3)(2009)S681–S692.

[90]N.Willand,I.Ridley,C.Maller,Towardsexplainingthehealthimpactsof residentialenergyefﬁciencyinterventions—arealistreview.Part1: pathways,Soc.Sci.Med.133(2015)191–201.

[91]H.Thomson,S.Thomas,E.Sellstrom,M.Petticrew,HousingImprovements forHealthandAssociatedSocio-EconomicOutcomes,TheCochraneLibrary, 2013.

[92]Y.Sun,J.Sundell,Onassociationsbetweenhousingcharacteristics, dampnessandasthmaandallergiesamongchildreninNortheastTexas, IndoorBuiltEnviron.22(4)(2013)678–684.

[93]M.J.Mendell,J.M.Macher,K.Kumagai,Indoordampnessandmoldas indicatorsofrespiratoryhealthrisks,part3:asynthesisofpublisheddata onindoormeasuredmoistureandrespiratoryhealth,ProceedingsofIndoor Air(2014).

[94]R.A.Sharpe,C.R.Thornton,V.Nikolaou,N.J.Osborne,Higherenergyefﬁcient homesareassociatedwithincreasedriskofdoctordiagnosedasthmaina UKsubpopulation,Environ.Int.75(2015)234–244.

[95]W.J.Fisk,Healthbeneﬁtsofparticleﬁltration,IndoorAir23(5)(2013) 357–368.

[96]J.Leech,M.Raizenne,J.Gusdorf,Healthinoccupantsofenergyefﬁcientnew homes,IndoorAir14(3)(2004)169–173.

[97]C.-A.Roulet,N.Johner,F.Foradini,P.Bluyssen,C.Cox,E.DeOliveira Fernandes,B.Müller,C.Aizlewood,Perceivedhealthandcomfortinrelation toenergyuseandbuildingcharacteristics,Build.Res.Inf.34(5)(2006) 467–474.

[98]P.Bluyssen,E.DeOliveiraFernandes,P.Fanger,L.Groes,G.Glausen,C. Roulet,C.Bernhard,O.Valbjorn,Europeanauditprojecttooptimizeindoor airqualityandenergyconsumptioninofﬁcebuildings,No.

LESO-PB-REPORT-2008-006,1995.

[99]M.J.Mendell,A.G.Mirer,K.Cheung,J.Douwes,Respiratoryandallergic healtheffectsofdampness,mold,anddampness-relatedagents:areviewof theepidemiologicevidence,Environ.HealthPerspect.119(6)(2011)748. [100]W.J.Fisk,Q.Lei-Gomez,M.J.Mendell,Meta-analysesoftheassociationsof respiratoryhealtheffectswithdampnessandmoldinhomes,IndoorAir17 (4)(2007)284–296.

[101]A.M.Butz,E.C.Matsui,P.Breysse,J.Curtin-Brosnan,P.Eggleston,G.Diette, D.A.Williams,J.Yuan,J.T.Bernert,C.Rand,Arandomizedtrialofaircleaners andahealthcoachtoimproveindoorairqualityforinner-citychildrenwith asthmaandsecondhandsmokeexposure,Arch.Pediatr.Adolesc.Med.165 (8)(2011)741–748.

[102]D.Norbäck,E.Lampa,K.Engvall,Asthma,allergyandeczemaamongadults inmultifamilyhousesinstockholm(3-HEstudy)—associationswith buildingcharacteristics,homeenvironmentandenergyuseforheating, PLoSOne9(12)(2014)e112960.

[103]C.-G.Bornehag,J.Sundell,L.Hagerhed-Engman,T.Sigsggard,S.Janson,N. Aberg,‘Dampness’athomeanditsassociationwithairway,nose,andskin symptomsamong10,851preschoolchildreninSweden:across-sectional study,IndoorAir15(s10)(2005)48–55.

[104]B.P.Lanphear,R.W.Hornung,J.Khoury,K.Yolton,M.Lierl,A.Kalkbrenner, EffectsofHEPAaircleanersonunscheduledasthmavisitsandasthma symptomsforchildrenexposedtosecondhandtobaccosmoke,Pediatrics 127(1)(2011)93–101.

[105]A.Bone,V.Murray,I.Myers,A.Dengel,D.Crump,Willdriversforhome energyefﬁciencyharmoccupanthealth?Perspect.PublicHealth130(5) (2010)233–238.

[106]F.Johnson,A.Mavrogianni,M.Ucci,A.Vidal-Puig,J.Wardle,Couldincreased timespentinathermalcomfortzonecontributetopopulationincreasesin obesity?Obes.Rev.12(7)(2011)543–551.

[107]W.J.Fisk,Reviewofsomeeffectsofclimatechangeonindoorenvironmental qualityandhealthandassociatedno-regretsmitigationmeasures,Build. Environ.86(2015)70–80.

[108]T.Oreszczyn,S.H.Hong,I.Ridley,P.Wilkinson,TheWarmFrontStudy Group,Determinantsofwinterindoortemperaturesinlowincome householdsinEngland,EnergyBuild.38(3)(2006)245–252.

[109]C.-A.Roulet,P.M.Bluyssen,C.Cox,F.Foradini,Relationsbetweenperceived indoorenvironmentcharacteristicsandwellbeingofoccupantsat individuallevel,HealthyBuild.2006(2006).

[110]P.M.Bluyssen,EPIQRandIEQ:indoorenvironmentqualityinEuropean apartmentbuildings,EnergyBuild.31(2)(2000)103–110.

[111]P.Bluyssen,E.deOliveiraFernandes,P.Fanger,L.Groes,G.Glausen,C. Roulet,C.Bernhard,O.Valbjorn,EuropeanAuditProjecttoOptimizeIndoor AirQualityandEnergyConsumptioninOfﬁceBuildings,1995.

[112]A.A.vanderLans,J.Hoeks,B.Brans,G.H.Vijgen,M.G.Visser,M.J.Vosselman, J.Hansen,J.A.Jörgensen,J.Wu,F.M.Mottaghy,Coldacclimationrecruits humanbrownfatandincreasesnonshiveringthermogenesis,J.Clin.Invest. 123(8)(2013)3395–3403.

[113]W.D.vanMarkenLichtenbelt,J.W.Vanhommerig,N.M.Smulders,J.M. Drossaerts,G.J.Kemerink,N.D.Bouvy,P.Schrauwen,G.J.Teule,

Cold-activatedbrownadiposetissueinhealthymen,NewEngl.J.Med.360 (15)(2009)1500–1508.

[114]P.Wilkinson,K.R.Smith,S.Beevers,C.Tonne,T.Oreszczyn,Energy,energy efﬁciency,andthebuiltenvironment,Lancet370(9593)(2007)1175–1187. [115]M.Sandel,R.J.Wright,Whenhomeiswherethestressis:expandingthe

dimensionsofhousingthatinﬂuenceasthmamorbidity,Arch.Dis.Child.91 (11)(2006)942–948.