Embed Size (px)
Citation preview
SEARCH School Environment And
Respiratory health of CHildren
an international research project
within the “Indoor Air Quality in European Schools.
Preventing and reducing respiratory diseases”
Programme
Péter Rudnai, Éva Vaskövi, Mihály János Varró, Margherita
Neri, Éva Csobod
National Institute of Environmental Health, Budapest, Hungary,
Regional Environmental Center for Central and Eastern Europe,
Country Office Hungary, Szentendre, Hungary
OBJECTIVES to identify the exposure level in
combination with building characteristics and occupants’ behaviour and activities
to evaluate the relationship between measured concentrations and possible emission sources
to assess the children’s respiratory health to assess the associations between the
school environment and the children’s (respiratory) health
to make recommendations for improving the quality of school environment
STUDY DESIGN: cross-sectional
Exposure assessment measurement of the indoor air quality in the school questionnaire on the class-room and the time spent
there questionnaire on the school building and its
maintenance questionnaire on the home environment
Health assessment symptom questionnaire (cough, wheeze, asthma dg,
allergy)
with questions on confounding factors (environmental tobacco smoke, previous health problems, home environment, life-style and socio-economic status of the family, etc.)
lung function measurement
ALBANIABOSNIA - HERZEGOVINA
HUNGARYITALY
SERBIASLOVAKIA
Coordination: REC and NIEH, Budapest
PARTICIPATING COUNTRIES
Country Town number
School number
Class number
Albania 3 10 35Bosnia 3 10 40Hungary 4 10 43
Italy 9 13 45
Serbia 7 10 44
Slovakia 2 10 40
Total: 28 63 247
SAMPLING SITES
INDOOR classroom, in the breathing zone
OUTDOOR ambient air, closest to the window of the classroom
SAMPLING PLACES
Country Beginning date
End date
Albania 22/01/2008 04/04/2008
Bosnia 24/12/2007 17/04/2008
Hungary 05/11/2007 29/02/2008
Italy 11/02/2008 23/04/2008
Serbia 28/01/2008 09/05/2008
Slovakia 03/12/2007 14/03/2008
SAMPLING PERIOD
INDOOR AIR MEASUREMENTS
CHEMICAL:
CO2 , CO, PM10 (real-time monitoring during school-time, 1 day/classroom)
NO2 , BTEX, HCHO (integrated (passive) sampling for 3-5 days, depending on the
number of classrooms)
PHYSICAL:
T, RH (real-time monitoring during school-time, 1 day/classroom)
Protocol for field work Training and consultation The same portable monitors and passive
samplers Blank samples Passive samples were collected by the
countries and analysed by one laboratory Samples transportation were performed in
compliance with the same protocol
QUALITY ASSURANCE
0
20
40
60
80
100
120
ALB BOS HUN ITA SERB SLO
aver
age
con
cen
trat
ion
, µg
/m3
PM10
Benzene
Toluene
Ethyl-benzene
Xylenes
NO2
HCHO
INDOOR CONCENTRATIONS
0
50
100
150
200
250
Albania Bosnia Hungary Italy Serbia Slovakia
aver
age
con
cen
trat
ion
, µg
/m3
Indoor
outdoor
PM10
0
5
10
15
20
25
30
35
40
45
Albania Bosnia Hungary Italy Serbia Slovakia
av
era
ge
co
nc
en
tra
tio
n, µ
g/m
3
Indoor
Outdoor
NO2
0
5
10
15
20
25
30
35
Albania Bosnia Hungary Italy Serbia Slovakia
aver
age
conc
entr
atio
n, µ
g/m
3
Indoor
outdoor
HCHO
0
1
2
3
4
5
6
7
8
9
Albania Bosnia Hungary Italy Serbia Slovakia
aver
age
con
cen
trat
ion
, µg
/m3
Indoor
Outdoor
BENZENE
0
5
10
15
20
25
30
35
Albania Bosnia Hungary Italy Serbia Slovakia
aver
age
con
cen
trat
ion
, µg
/m3
Indoor
Outdoor
TOLUENE
0
1
1
2
2
3
3
4
Albania Bosnia Hungary Italy Serbia Slovakia
av
era
ge
co
nc
en
tra
tio
n, µ
g/m
3
Indoor
Outdoor
ETHYL-BENZENE
0
5
10
15
20
25
Albania Bosnia Hungary Italy Serbia Slovakia
av
era
ge
co
nc
en
tra
tio
n, µ
g/m
3
Indoor
Outdoor
XYLENES
Prevalence of respiratory symptoms and allergy among 5,242 school
children in the 6 countries
20,822,8
5,7
19,4
9,7
23,3
7,2
17,5
6,5
16,9
3,7
23,7
11,8
23,4
7,9
17,5
9,9
22,9
9,3
17,4
11
23,9
6,3
28,5
0
5
10
15
20
25
30
Day/ night cough Any asthmaticsymptom (<1yr)
Asthma treatment inthe last 12 months
Diagnosed allergy
%
Albania (n=1019) Bosnia-Herzegovina (n=975) Hungary (n=704)Italy (n=915) Serbia (n=735) Slovakia (n=894)
Distribution of children and Distribution of children and classes in schools with various classes in schools with various
traffic density nearbytraffic density nearby
9%
43%31%
17% light trafficmedium trafficheavy trafficvery heavy traffic
19%
42%
26%
13%
Distribution of children Distribution of classes
Percentage of children in schools Percentage of children in schools with polluting establishments in the with polluting establishments in the
neighbourhoodneighbourhood
14,1
3,4
1,5
0
2
4
6
8
10
12
14
16
%
Industry Power plant Waste deposit
Prevalence of symptomatic children Prevalence of symptomatic children in schools with or without industry in in schools with or without industry in
the neighbourhoodthe neighbourhood
11,3
14,2*
11,5
15,4**16,3
19,1~
0
2
4
6
8
10
12
14
16
18
20
%
Day/ night cough Ear-ache Irritability
No industryIndustry <500m
aOR= 1.34 (95% CI.:1.03-1.75) aOR=1.36 (95% CI.:1.04-1.78) aOR=1.32 (95% CI.: 1.04-1.69)
adjusted for age, gender, country, industry close to home
Prevalence of children with chronic ear-Prevalence of children with chronic ear-ache in schools with industry and/or ache in schools with industry and/or
heavy traffic aroundheavy traffic around
10,2
13** (p<0.01)
13
16,7*** (p<0.001)
0
2
4
6
8
10
12
14
16
18
%
Ear-ache
Light traffic/No industryHeavy traffic/No industryLight traffic/ IndustryHeavy traffic/ Industry
*aOR=1.61 (1.15-2.25)
*Adjusted for age, gender, traffic and industry near home and country
Prevalence of children with or Prevalence of children with or without regular without regular
day / night cough in classes with PMday / night cough in classes with PM1010 concentrations concentrations ≤≤80 µg/m80 µg/m33 or above or above
11,6
14*
0
3
6
9
12
15%
PM10 ≤ 80 µg/ m3 PM10 >80 µg/ m3
* p<0.05
** aOR = 1.32 (1.06 – 1.66)
** adjusted for age, gender, parental chronic bronchitis, serious chest disease in the first 2 years of life and country
Prevalence of children woken up by Prevalence of children woken up by wheeze at night and mean benzene wheeze at night and mean benzene
concentrations measured in the concentrations measured in the classroomclassroom
4,8
7,6***
0
1
2
3
4
5
6
7
8
%
0 - 5 ug/ m3 > 5 ug/ m3
benzene concentration
*** p<0.001
aOR* = 1.47 (1.04-2.08)
*adjusted for age, gender, parental asthma, smoking during pregnancy, serious chest diseases in the first 2 years of life and country
Mean concentrations of pollutants in Mean concentrations of pollutants in classrooms with or without water-classrooms with or without water-
resistant paint on the wallresistant paint on the wall
3,9
5,0*
1,32,0*
5,6
9,4*
0
1
2
3
4
5
6
7
8
9
10
mic
rogr
am/m
3
Benzene Ethyl-benzene Xylenes
No water-resistant paintWater resistant paint
* p<0.05
Prevalence of children with doctor-Prevalence of children with doctor-diagnosed allergy or recently treated for diagnosed allergy or recently treated for
asthma visiting classrooms with wall asthma visiting classrooms with wall painted with water resistant (WR) paintspainted with water resistant (WR) paints
19,6
23,1**
6,38,5**
0
5
10
15
20
25
%
Allergy dg Asthma treatment
No WR paintWR paint
** p<0.01
+aOR= 1.19 (1.001-1.41) ++ aOR= 1.36 (1.04-1.79) + adjusted for age, gender, parental allergy, water resistant paint at home, country++ adjusted for age, gender, parental asthma, water resistant paint at home, country
Prevalence of children with doctor-Prevalence of children with doctor-diagnosed allergies in classrooms diagnosed allergies in classrooms
with or without plastic floorwith or without plastic floor
18,7
24,2***
9,8
14,7***
5,9
8.0**
0
5
10
15
20
25
%
Any allergy dg Pollen allergy Animal fur/ featherallergy
No plastic floorPlastic floor
+aOR: 1.30 (1.09-1.56) 1.33 (1.06-1.68) 1.56 (1.15-2.11)
+ adjusted for age, gender, parental allergy, plastic floor at home, country
Mean concentrations of ethyl-benzene and Mean concentrations of ethyl-benzene and xylenes in classrooms with or without open xylenes in classrooms with or without open
windows during cleaningwindows during cleaning
1,4 2,4***
6,4
10,8***
0
2
4
6
8
10
12
mic
rogr
am/m
3
Ethyl-benzene Xylenes
Windows openWindows closed
***p<0.001
Mean, maximum and minimum Mean, maximum and minimum floor surface area per child by floor surface area per child by
countrycountry
1,26
1,83 2,06 2,082,5 2,68
0
1
2
3
4
5
6
7
Albania Bosnia-Herzegovina
Hungary Italy Serbia Slovakia
m2
per c
hild
MinMeanMax
Mean concentrations of some Mean concentrations of some pollutants by crowdedness pollutants by crowdedness
categoriescategories
17,6
19,8*** 19,6***
3,94,7***
6*** 6,7 8,3*** 8,7***
0
5
10
15
20
mic
rogr
am/m
3
CO2 (x100) Benzene PM10 (x10)
Lower 31%Middle 43 %Upper 26%
***p<0.001
Prevalence of children with chronic Prevalence of children with chronic respiratory symptoms in well or poorly respiratory symptoms in well or poorly
ventilated classrooms ventilated classrooms
23,2
39,7***
10,1
16,6***
10,2
24,8***
13,2
17,4***
0
5
10
15
20
25
30
35
40
%
Overall bronchiticsymptoms
Day/ night cough Cough withphlegm
Dry cough atnight
Well ventilated
Poorly ventilated***p<0.001
+ aOR= 1.30 (1.10-1.54) 1.29 (1.03-1.60) 1.32 (1.06-1.63) 1.39 (1.13-1.72)
+ adjusted for age, gender, serious chest disease in the first 2 years of life and country
Prevalence of children with skin rash and Prevalence of children with skin rash and house-dust mite allergy among children in house-dust mite allergy among children in
classrooms cleaned with bleachclassrooms cleaned with bleach
11,8
14,9*
12
9,5*
0
2
4
6
8
10
12
14
%
Skin rash, eczema House dust mite allergy dg
No bleachMop with bleach
*p<0.05
+ aOR = 1.27 (0.99-1.61) 0.71 (0.53-0.95)
+ adjusted for age, gender, parental allergy and country
Prevalence of children with chronic Prevalence of children with chronic bronchitic symptoms in classrooms with bronchitic symptoms in classrooms with
(4.1%)(4.1%) or without air conditioners or without air conditioners 29,8
13,2*** 13,4
7,9*
12,8
5,2**
16
4,8***
0
5
10
15
20
25
30
%
Overall bronchiticsymptoms
Morning cough Day/ Night cough Cough withphlegm
No air-conditioner
Air conditioner
*p<0.05; **p<0.01; ***p<0.001
+ aOR = 0.44 (0.28-0.69) 0.58 (0.33-1.04) 0.43 (0.22-0.87) 0.43 (0.20-0.94)
+ adjusted for age, gender, serious chest disease during the first 2 years of life and country
CONCLUSIONS 1Site of the school
• Heavy traffic in the close neighbourhood of the
school had an adverse effect on the children’s
exposure to most of the measured pollutants
• Industry in the close neighbourhood of the school
had an adverse effect on the children’s exposure to
most of the measured pollutants, too.
• Both heavy traffic and industry in the close
neighbourhood of the school were independent
determinants of decreased lung function
CONCLUSIONS 2Sources of indoor air pollutants in the classroom
• Plastic floor was associated with increased prevalence of
doctor-diagnosed allergies and decreased lung function.
• Increased levels of the measured volatile organic compounds
and nitrogen-dioxide were found in classrooms with carpets on
the floor and these classrooms were associated with increased
prevalence of children with woken up by wheeze at night.
• Increased levels of benzene, xylene and ethylbenzene were
measured in classrooms painted with water-resistant paints
and these classrooms were associated with increased
prevalence of allergies diagnosed and treated by a physician
during the last 12 months.
CONCLUSIONS 3
Sources of indoor air pollutants in the classroom: CLEANING
• Broom use for cleaning the classrooms was associated
with increased prevalence of children with chronic cough
with phlegm and decreased lung function.
• Use of mop for cleaning was found to be associated with
increased prevalence of reported chronic conjunctivitis
and decreased lung function.
• Use of mop with bleach was associated with increased
prevalence of skin rash and eczema.
CONCLUSIONS 4. Occupancy of the classroom and ventilation
• Crowdedness was associated with increased levels of carbon-dioxide (CO2), PM10 and benzene measured in the classrooms as well as with higher prevalence of chronic ear-ache among children.
• Poor natural ventilation during teaching hours was associated with increased levels of CO2 and formaldehyde measured in the classrooms and with increased prevalence of chronic bronchitis and asthmatic symptoms.
• Decreased prevalence of chronic bronchitis was found among children visiting classrooms equipped with air conditioner
RECOMMENDATIONS
• Schools should be built in places not directly affected by heavy traffic or industry or any other polluting establishments in the neighbourhood.• Crowdedness should be avoided in the classrooms.• Appropriate ventilation regime of the classrooms should be introduced in order to provide good indoor air quality during the whole period of teaching hours.• Floor coverings of the classrooms should be chosen with particular cautiousness to avoid any adverse effects on the respiratory health of children.• Use of water-resistant paints in the classrooms should be avoided.• Clear instructions for good cleaning practice in schools should be provided and appropriate control should be exerted over their implementation.
