Air pollution, health status and public awareness of environmental problems in China.

Understanding public awareness of environmental problems is vital for effectively formulating sustainable policies. This paper aims to investigate the impacts of two perspectives-external air pollution and individual health status-on public awareness by leveraging panel data from two waves of the China Family Panel Studies (CFPS) conducted between 2018 and 2020. The model integrates provincial-level PM2.5 concentration indicators and SO2, PMs, and NOx emissions. The results reveal a significantly positive correlation between air pollution and public awareness of environmental problems in China. Additionally, this study examines the impact of self-assessed health shock by categorizing it into worse and better health. The influence of better health is insignificant. Conversely, when individuals experience worse health, they may perceive it as a psychological loss, leading to a significant increase in public awareness of environmental problems. This study provides valuable insights for mitigating air pollution and reinforcing public health in developing countries.

Application of the Industrial Byproduct Gypsum in Building Materials: A Review.

The industrial byproduct gypsum is a general term for byproducts discharged from industrial production with calcium sulfate as the main ingredient. Due to the high number of impurities and production volume, the industrial byproduct gypsum is underutilized, leading to serious environmental problems. At present, only desulfurization gypsum and phosphogypsum have been partially utilized in cementitious materials, cement retarders, etc., while the prospects for the utilization of other byproduct gypsums remain worrying. This paper mainly focuses on the sources and physicochemical properties of various types of gypsum byproducts and summarizes the application scenarios of various gypsums in construction materials. Finally, some suggestions are proposed to solve the problem of the industrial byproduct gypsum. This review is informative for solving the environmental problems caused by gypsum accumulation.

Insight into microplastics in the aquatic ecosystem: Properties, sources, threats and mitigation strategies.

Globally recognized as emergent contaminants, microplastics (MPs) are prevalent in aquaculture habitats and subject to intense management. Aquaculture systems are at risk of microplastic contamination due to various channels, which worsens the worldwide microplastic pollution problem. Organic contaminants in the environment can be absorbed by and interact with microplastic, increasing their toxicity and making treatment more challenging. There are two primary sources of microplastics: (1) the direct release of primary microplastics and (2) the fragmentation of plastic materials resulting in secondary microplastics. Freshwater, atmospheric and marine environments are also responsible for the successful migration of microplastics. Until now, microplastic pollution and its effects on aquaculture habitats remain insufficient. This article aims to provide a comprehensive review of the impact of microplastics on aquatic ecosystems. It highlights the sources and distribution of microplastics, their physical and chemical properties, and the potential ecological consequences they pose to marine and freshwater environments. The paper also examines the current scientific knowledge on the mechanisms by which microplastics affect aquatic organisms and ecosystems. By synthesizing existing research, this review underscores the urgent need for effective mitigation strategies and further investigation to safeguard the health and sustainability of aquatic ecosystems.

An Approach to Evaluate Pb Tolerance and Its Removal Mechanisms by Pleurotus opuntiae.

Widespread lead (Pb) contamination prompts various environmental problems and accounts for about 1% of the global disease burden. Thus, it has necessitated the demand for eco-friendly clean-up approaches. Fungi provide a novel and highly promising approach for the remediation of Pb-containing wastewater. The current study examined the mycoremediation capability of a white rot fungus, P. opuntiae, that showed effective tolerance to increasing concentrations of Pb up to 200 mg L-1, evidenced by the Tolerance Index (TI) of 0.76. In an aqueous medium, the highest removal rate (99.08%) was recorded at 200 mg L-1 whereas intracellular bioaccumulation also contributed to the uptake of Pb in significant amounts with a maximum of 24.59 mg g-1. SEM was performed to characterize the mycelium, suggesting changes in the surface morphology after exposure to high Pb concentrations. LIBS indicated a gradual change in the intensity of some elements after exposure to Pb stress. FTIR spectra displayed many functional groups including amides, sulfhydryl, carboxyl, and hydroxyl groups on the cell walls that led to binding sites for Pb and indicated the involvement of these groups in biosorption. XRD analysis unveiled a mechanism of biotransformation by forming a mineral complex as PbS from Pb ion. Further, Pb fostered the level of proline and MDA at a maximum relative to the control, and their concentration reached 1.07 µmol g-1 and 8.77 nmol g-1, respectively. High Pb concentration results in oxidative damage by increasing the production of ROS. Therefore, the antioxidant enzyme system provides a central role in the elimination of active oxygen. The enzymes, namely SOD, POD, CAT, and GSH, served as most responsive to clear away ROS and lower the stress. The results of this study suggested that the presence of Pb caused no visible adverse symptoms in P. opuntiae. Moreover, biosorption and bioaccumulation are two essential approaches involved in Pb removal by P. opuntiae and are established as worthwhile agents for the remediation of Pb from the environment.

Clarifying the driving forces behind our ecological crisis: a general model.

In order to solve our ecological crisis, it is crucial to have a fair understanding of its background. In this article I integrate the most important driving forces of human transformation of the biosphere into a general model. First, I show that it is the economic subsystem of society that produces nearly all human transformation of the biosphere. Then I differentiate between direct driving forces, which are the number of people/households, the economic output per capita/per household, the environmental impact of technologies, the structure of the economy and the geographical pattern of the economy; and indirect ones, which are the mind of people, social institutions, biological factors and physical geographical features. The behavior of individuals, groups of people and organizations mediates between indirect and direct driving forces. The model also shows us the basic strategies of environmental sustainability. Cultural changes are needed to attenuate the direct driving forces. In turn, these changes will happen only if those desiring them will have enough power to reshape social institutions and the mind of people.

Novel Approach in Biodegradation of Synthetic Thermoplastic Polymers: An Overview.

Biodegradation is necessary for water-soluble or water-immiscible polymers because they eventually enter streams which can neither be recycled nor incinerated. It is important to consider the microbial degradation of natural and synthetic polymers in order to understand what is necessary for biodegradation and the mechanisms involved. Low/high-density polyethylene is a vital cause of environmental pollution. It occurs by choking the sewer line through mishandling, thus posing an everlasting ecological threat. Environmental pollution due to the unscrupulous consumption of synthetic polymers derived from petroleum has an adverse impact on the environment since the majority of plastics do not degrade, and the further incineration of synthetic plastics generates CO2 and dioxin. This requires understanding the interactions between materials and microorganisms and the biochemical changes involved. Widespread studies on the biodegradation of plastics have been carried out in order to overcome the environmental problems associated with synthetic plastic waste. Awareness of the waste problem and its impact on the environment has awakened new interest in the area of degradable polymers through microbes viz., bacteria, fungi, and actinomycetes. The microbial degradation of plastics is caused by certain enzymatic activities that lead to a chain cleavage of polymers into oligomers and monomers. This review focuses on the biodegradation rate of plastics by fungal and bacterial communities and the mode of action of biodegradation.

Cultural, ethical, and religious perspectives on environment preservation.

This paper presents a review of articles on cultural, ethical, and religious perspectives on environmental preservation. Globally, the negative effects of the current environmental crisis on people's lives and livelihoods cannot be disputed. The mismanagement of the environment has resulted in extreme climate changes currently faced by the world. The situation has prompted environmentalists, governments, and other stakeholders to seek plausible ways of mitigating and preserving the environment for current and future generations. Through a review of some existing literature, this paper affirms the important role that culture, ethics, and religion play in environmental preservation strategies.

Green taxes as ecosystem conservation: an analysis of the industrial sector's view in Peru.

Background: Environmental problems are becoming more recurrent nowadays, which is why many countries have acted on the matter, through different forms, laws and taxes that can contribute and reduce the polluting impact of companies at the time of manufacturing their products. One of the reforms has been environmental taxes, which are not only aimed at raising money, but also at taking corrective action on the behavior of companies that damage both the environment and the health of the population. The research is intended to finding out the opinion and interest of managers of different companies in the industrial sector on environmental taxes, also known as green taxes, and whether they consider it necessary to add green taxes to the current tax system. Method: For data collection of the research, 120 managers of small and medium-sized enterprises in the industrial sector were questioned about whether green taxes could have an influence on ecosystem conservation and several other questions. Results: 63.3% of the managers surveyed agree that the application of an environmental tax is necessary. Conclusion: It is concluded that managers are in favor of green taxes and  approve that  such taxes should be given as part of ecosystem conservation and environmental protection for all businesses, and that they promote businesses that do not generate any side effects or transformations to the environmental balance, thus improving the quality of life of residents.

Food system resilience thinking: from digital to integral.

The current food system is directly influenced by the increase in environmental problems and nutritional inequality globally. Financial and political collapses, health crises, excessive urbanization, and rapid industrialization are some of the principal factors threatening the food supply's security. The food system needs a profound transformation to avoid ecosystem destabilization and a global food crisis. Concerning this transformation, we are certain that the first step for a successful food system change is global resilience thinking. To reach an integrated food system, we proposed introducing the resilient concept linked with other known concepts, such as circular economy and sustainability. A resilient food system can recover over time, ensuring the supply of sustainable and quality food and access to all. This would mean redesigning the value chains in the food system, re-educating consumers to implement a healthier diet, and introducing technology such as digital innovation. Re-evaluating these relevant points, redesigning the focus of the food system, not only for economic efficiency but also including significant trade-offs, or valuing other services in the food system, are essential to reaching the desired resilience. © 2021 Society of Chemical Industry.

Reverse Osmosis Concentrate: Physicochemical Characteristics, Environmental Impact, and Technologies.

This study's aim is to generate a complete profile of reverse osmosis concentrate (ROC), including physicochemical characteristics, environmental impact, and technologies for ROC treatment, alongside element recovery with potential valorization. A systematic literature review was used to compile and analyze scientific information about ROC, and systematic identification and evaluation of the data/evidence in the articles were conducted using the methodological principles of grounded data theory. The literature analysis revealed that two actions are imperative: (1) countries should impose strict regulations to avoid the contamination of receiving water bodies and (2) desalination plants should apply circular economies. Currently, synergizing conventional and emerging technologies is the most efficient method to mitigate the environmental impact of desalination processes. However, constructed wetlands are an emerging technology that promise to be a viable multi-benefit solution, as they can provide simultaneous treatment of nutrients, metals, and trace organic contaminants at a relatively low cost, and are socially accepted; therefore, they are a sustainable solution.

Conversion of Bivalve Shells to Monocalcium and Tricalcium Phosphates: An Approach to Recycle Seafood Wastes.

The search for sustainable resources remains a subject of global interest and the conversion of the abundantly available bivalve shell wastes to advanced materials is an intriguing method. By grinding, calcium carbonate (CaCO3) powder was obtained from each shell of bivalves (cockle, mussel, and oyster) as revealed by FTIR and XRD results. Each individual shell powder was reacted with H3PO4 and H2O to prepare Ca(H2PO4)2·H2O giving an anorthic crystal structure. The calcination of the mixture of each shell powder and its produced Ca(H2PO4)2·H2O, at 900 °C for 3 h, resulted in rhombohedral crystal ß-Ca3(PO4)2 powder. The FTIR and XRD data of the CaCO3, Ca(H2PO4)2·H2O, and Ca3(PO4)2 prepared from each shell powder are quite similar, showing no impurities. The thermal behaviors of CaCO3 and Ca(H2PO4)2·H2O produced from each shell were slightly different. However, particle sizes and morphologies of the same products obtained from different shells were slightly different-but those are significantly different for the kind of the obtained products. Overall, the products (CaCO3, Ca(H2PO4)2·H2O, and Ca3(PO4)2) were obtained from the bivalve shell wastes by a rapidly simple, environmentally benign, and low-cost approach, which shows huge potential in many industries providing both economic and ecological benefits.

Globalization and environment: Effects of international trade on emission intensity reduction of pollutants causing global and local concerns.

International trade's impact on the pollution reduction, especially varied reduction effects dealing with global or local pollutants has not been thoroughly researched empirically. We explored effects of international trade participation on both the carbon dioxide emission intensity and sulfur dioxide emission intensity with a panel data of 179 major countries during 20 years when globalization thrived. Carbon dioxide causing climate change is a global concern. While sulfur dioxide is one major air pollutant causing local health problems. Empirically, international trade participation mainly reduces carbon dioxide emission intensity but not sulfur dioxide emission intensity. Also, trade in goods form is more effective than in service form. However, international trade participation does little to improving a country's overall technology level, implying that regulation enhancement under international norm is the main mechanism. Compared with developed countries, developing countries can reduce both kinds of pollutant emission intensities more effectively by participating into international trade. A case study of China's entering into World Trade Organization (WTO)'s impact on pollutant reduction can provide more evidence. Also, developing countries with higher industrialization level experiences a bigger improvement in cleaner production. And developing countries with higher democratization level pay more attention to reduce local environmental concerns.

Plastic and its consequences during the COVID-19 pandemic.

During the pandemic outbreak of COVID-19, the important role of plastic becomes evident since vital equipment such as respirators have plastic parts, as well as personal protective equipment (PPE), which avoids the transmission of the SARS-CoV-2 virus, is made of plastic. So, plastic during a pandemic is considered a life savior in the struggle against the virus. However, the same material that is a protector becomes a polluter when inadequately disposed of in the environment, generating or worsening socio-environmental problems, such as pollution of water bodies by plastic. This work proposes a reflection about the role and the importance of plastic in our society, bringing an overview of its main applications and consequences during the COVID-19 pandemic, correlating its use with aspects related to environmental problems and public health. Some questions revolving around the concerns caused by plastic pollution are posed, and some possible solutions to the problems are outlined.

Impact of industrial agglomeration on environmental pollution from perspective of foreign direct investment-a panel threshold analysis for Chinese provinces.

In the course of China's rapid economic development, the coexistence of industrial development and dominant industrial agglomeration (AGG), along with growing environmental problems, has attracted widespread attention from scholars. Although the linear relationship between the two has been analyzed in depth in the research literature, a concomitant phenomenon, i.e., the gradual expansion in the scale of foreign direct investment (FDI), has been overlooked. By employing threshold panel regression model, this paper attempts to construct a theoretical model with embedded AGG and FDI, and incorporates other factors affecting environmental pollution (POL). For examining the mechanism of AGG on POL, we proposed a testable theoretical hypothesis, and conducted an empirical study by combining panel data of POL and AGG at the provincial level in China. The measurement index of a control variable was changed to check the robustness of our results, and the coefficient sign of each explanatory variable was not changed, confirming the robustness of main results. Overall, AGG improves regional POL, but the impact of FDI is stage-specific and roughly there are three stages. Specifically, the positive effect of AGG on POL is strong when FDI is at a low level. When the level of FDI crosses the first threshold and continues to rise, the positive effect of AGG on POL reaches its strongest; until the second threshold is crossed, the positive effect of AGG starts diminishing slowly. Concluding this, for promoting economic development and environmental protection in the region in parallel, government and enterprises should prioritize the increment in FDI, with an equalization of levels of AGG and FDI, in order to enhance the improvement effect of AGG on POL.

Conocimientos de la dimensión ambiental en estudiantes de medicina y residentes de medicina general integral / Knowledge about the Environmental Dimension in Medical Students and Family Medicine Residents

Introducción: El daño al medio ambiente es cada vez mayor, los problemas ambientales globales crecen por día, ya sea por causas naturales o antrópicas. Esto provoca la aparición y agravamiento de diversas enfermedades por lo que existe una relación entre los problemas ambientales y los problemas de salud. Por esta razón los médicos deben conocer profundamente dicha relación lo que permitirá desempeñar mejor sus variadas funciones y entre ellas las educativas. Objetivo: Evaluar el nivel de conocimientos sobre la dimensión ambiental en estudiantes de sexto año de la carrera de Medicina y residentes de primer año de Medicina General Integral. Métodos: Se aplicó una encuesta de conocimientos, a través de la plataforma Moodle, sobre conceptos, factores y problemas relacionados con el medio ambiente y sus vínculos con problemas de salud, a 32 estudiantes de sexto año terminado de la carrera de Medicina correspondiente al 35,55 por ciento del total de la matrícula, así como a 29 residentes de medicina general integral también con primer año de la residencia finalizado para un 55,76 por ciento de los matriculados. Las muestras pertenecientes a las facultades de ciencias médicas Manuel Fajardo y Salvador Allende se seleccionaron de forma aleatoria. Resultados: El resultado general de la encuesta fue de un 21,88 por ciento de aprobados para los estudiantes y de un 27,59 por ciento para los residentes. Estos concordaron con un bajo porciento de aciertos en diferentes preguntas, por ejemplo, las que exploraron conceptos importantes como medio ambiente y desarrollo sostenible, así como la de los problemas ambientales de Cuba y sus efectos, como el deterioro de la condición higiénico-sanitaria (ambientales) en los asentamientos humanos, entre otros. Conclusiones: El nivel de conocimiento mostrado por los estudiantes y los residentes, acerca de la dimensión ambiental, evidencia insuficiencias cognoscitivas en esta esfera y en su relación con la actividad profesional(AU)

Introduction: Environmental damage is increasing over time; global environmental problems are growing every day, whether due to natural or man-made causes. This brings about the appearance and worsening of various diseases, based on the relationship between environmental problems and health problems. For this reason, physicians must have deep understanding of this relationship, which will allow them to carry out their various functions better, including educational ones. Objective: To assess, in sixth-year medical students and in first-year residents of Family Medicine, their level of knowledge about the environmental dimension. Methods: A knowledge survey was applied, using the Moodle platform, about concepts, factors and problems related to the environment and their links with health problems. The respondents were 32 students in the sixth academic year of the Medicine major, a figure accounting for 35.55 percent of the total enrollment; as well as 29 Family Medicine residents also with the first academic year of their residency completed, which accounted for 55.76 percent of those enrolled. The samples belonging to Manuel Fajardo and Salvador Allende medical schools were randomly selected. Results: The general result of the survey was 21.88 percent of approved respondents for students and 27.59 percent for residents. These coincided with a low percentage of correct answers in different questions; for example, those that explored important concepts such as environment and sustainable development, as well as that of Cuba's environmental problems and their effects, such as the deterioration of the hygienic-sanitary condition (environmental) in human settlements, among others. Conclusions: The level of knowledge shown by students and residents about the environmental dimension shows cognitive deficiencies in this sphere and in its relationship with professional activity(AU)

Changes in pro-environmental behaviour and its determinants during long-term period in a transition country as Lithuania.

The changes in pro-environmental behaviour, whether people become more environmentally friendly or not, have been analysed very scarcely. Therefore, the aim of this paper was to analyse the changes in pro-environmental behaviour and its determinants in Lithuania as a transition European Union country comparing years 2011 and 2020. Applying Chi-Square and t test statistics, the results showed a significant increase in performance of pro-environmental behaviour in 2020. Waste sorting and purchase of environmentally friendly goods increased the most, meanwhile water and energy saving behaviour increased the least. Applying the value-belief-norm theory and leaner regression analysis, we analysed whether the same determinants influenced pro-environmental behaviour in 2011 and 2020. The results revealed that the impact of determinants differed. In 2020, the main factor of pro-environmental behaviour was the perception of environmental problems but not self-transcendence values dimension. Furthermore, self-enhancement values and awareness of behavioural consequences negatively influenced pro-environmental behaviour in 2020. Analysing the changes in these factors, an insignificant difference was observed in self-enhancement values. The changes in other factors were significant, particularly the changes in the level of environmental responsibility was the biggest. Therefore, implementation of environmental education and information programmes and various environmentally friendly public initiatives positively contributed to the enhancement of environmental awareness and pro-environmental behaviour.

Dampness and student-reported social climate: two multilevel mediation models.

BACKGROUND: Little previous research has analysed the relationship between schools' indoor air problems and schools' social climate. In this study, we analysed a) whether observed mould and dampness in a school building relates to students' perceptions of school climate (i.e. teacher-student relationships and class spirit) and b) whether reported subjective indoor air quality (IAQ) at the school level mediates this relationship. METHODS: The data analysed was created by merging two nationwide data sets: survey data from students, including information on subjective IAQ (N = 25,101 students), and data from schools, including information on mould and dampness in school buildings (N = 222). The data was analysed using multilevel mediational models. RESULTS: After the background variables were adjusted, schools' observed mould and dampness was not significantly related to neither student-perceived teacher-student relationships nor class spirit. However, our mediational models showed that there were significant indirect effects from schools' observed mould and dampness to outcome variables via school-level subjective IAQ: a) in schools with mould and dampness, students reported significantly poorer subjective IAQ (standardised ß = 0.34, p < 0.001) than in schools without; b) the worse the subjective IAQ at school level, the worse the student-reported teacher-student relationships (ß = 0.31, p = 0.001) and class spirit (ß = 0.25, p = 0.006). CONCLUSIONS: Problems in a school's indoor environment may impair the school's social climate to the degree that such problems decrease the school's perceived IAQ.

Environmental Problems: An Analysis of Students' Perceptions Towards Selective Waste Collection.

The reduction, reuse, collection and recovery of recyclable materials are sustainable behaviors and people's awareness of them plays an important role in implementing strategies and policies in this field. The quantitative analysis performed on a group of 816 students of Politehnica University of Timisoara, aimed at finding answers to important environmental concerns and observing the students' behaviors of reuse and selective collection of the waste resulted from plastic containers, paper, aluminum, batteries, iron packaging waste, electronic equipment, used cooking oil and printer toner. The research has shown that 'increased amounts of waste' (63.5%) is among the first three concerns Romania has to deal with, besides 'air pollution' (67.9%) and 'deforestation' (63.7%). Moreover, the study highlights the existence of the behavior toward the selective waste collection among students (plastic - 60.3%, paper - 57.8%, and glass - 55.3%). although there are some areas (e.g., selectively collecting used cooking oil or printer toner, their level of knowledge regarding the color code for the recycling bins, etc.) that students still need to be familiarized with through different campaigns, trainings, courses, etc. The results can be used in the development of institutional strategies or of strategic documents targeting environmental protection and sustainable development.

Soil salinization management for sustainable development: A review.

The expansion of irrigated agriculture is of paramount importance to feed the burgeoning global population. However, without proper management, this expansion can result in environmental problems of irrigation-induced soil salinization. A recent FAO estimate reported that a large portion of total global soil resources are degraded and this problem is persistently expanding. Many irrigated areas of the world are facing the twin problems of soil salinization and waterlogging and presently over 20% of the total global irrigated area is negatively affected by these problems. And, if left unattended, this problem could expand to over 50% of the total global irrigated areas by 2050. The proper management of the aforementioned soil salinization is imperative for achieving most of the Sustainable Development Goals (SDGs) of the United Nations. For example, soil salinization management is vital for achieving the 'Zero Hunger' (SDG2) and 'Life on Land' (SDG15) among other SDGs. This paper provides a comprehensive review of different measures used for managing the environmental problems of soil salinization. All the possible sources of related and up to date literature have been accessed and over 250 publications were collected and thoroughly analyzed for this review. The centrality of the environmental problems is provided. The background of the problems, managing rising water table to control soil salinization, the role of drainage frameworks, the conjunctive use of diverse water sources, utilization of numerical models, and the use of remote sensing and GIS systems are described. And the application of the aforementioned techniques and methods in various case study regions across the globe are discussed which is followed by discussion and research gaps. Derived from the literature analysis and based on the identified research gaps, some key recommendations for future research have been made which could be useful for the stakeholders. The literature analysis revealed that an all-inclusive approach for dealing with the aforesaid environmental problems has been barely considered in the previous studies. Similarly, the continuing impacts of growing salt-tolerant plants on soil characteristics and the environment in total have not been widely considered in the previous investigations. Likewise, better irrigation practices and improved cropping systems along with the long-term environmental impacts of a particular approach has not been extensively covered in these studies. Also, previous studies have scarcely incorporated economic, social, and environmental aspects of the salinization problem altogether in their analysis. The analysis suggested that an inclusive feedback-supported simulation model for managing soil salinization should be considered in future research as the existing models scarcely considered some vital aspects of the problem. It is also suggested to enhance the sensing methods besides retrieval systems to facilitate direct detection of salinization and waterlogging parameters at large-scales. The existing time-lag between occurrence and recording of various data is also suggested to improve in the future scenario by the usage of information from multiple satellites that lessens the problems of spatial resolution by increasing the system efficiency.

Students' school-level symptoms mediate the relationship between a school's observed moisture problems and students' subjective perceptions of indoor air quality.

Moisture damage can influence the subjective assessment of indoor air quality (subjective IAQ) in various ways. We studied whether the frequency of symptoms reported across students at school level mediates the relationship between observed mold and dampness in a school building and students' subjective IAQ. To answer this research question, we tested a multilevel path model. The analyzed data were created by merging two nationwide data sets: (a) survey data from students, including information on subjective IAQ (N = 24,786 students); (b) data from schools, including information on mold and dampness in a school building (N = 222). After the background variables were adjusted, schools' observed mold and dampness were directly and significantly related to poor subjective IAQ (standardized beta (ß)= 0.22, P = .002). In addition, in schools with mold and dampness, students reported significantly more symptoms (ß = 0.22, P = .023) than in schools without; the higher the prevalence of symptoms at school level, the worse the students' subjective IAQ (ß = 0.60, P < .001). This indirect path was significant (P = .023). In total, schools' observed mold and dampness and student-reported symptoms explained 52% of the between-school variance in subjective IAQ.