Are classroom thermal conditions, lighting, and acoustics related to teacher health symptoms?

Over half of schools surveyed in the United States reported one environmental problem affecting Indoor Air Quality. This study investigated environmental concerns in schools, teacher-reported symptoms, and performance in relation to thermal environment, lighting, and noise conditions in New York State classrooms. This cross-sectional study consisted of telephone surveys among teachers from 428 NYS public schools. Survey contents included teacher demographics, employment characteristics, and environmental factors. Unconditional logistic regression analyses were used to estimate odds ratios (OR) of health symptoms for classroom conditions including thermal environment, lighting, and acoustics. Although too dry, too hot, or cold were major thermal concerns, 78% of the teachers reported that they cannot control temperature through thermostat. Over 50% of NYS teachers reported almost all health symptoms worsening during workdays. We found the top five most common health symptoms reported by NYS teachers are all allergy-related symptoms. Additionally, all extreme thermal factors were significantly associated with work-related symptoms in teachers. "Too dry" had the highest risk for allergic symptoms (OR: 2.49, 95% CI: 2.01-3.10), and then followed by any noise (OR: 2.46, 95% CI: 1.80-3.36) associated with voice-related health, and "lighting too dim" (OR: 2.38, 95% CI: 1.77-3.19). Future studies are needed to confirm these findings.

Risk factors of different congenital heart defects in Guangdong, China.

BACKGROUND: Limited studies have evaluated the risk factors for congenital heart defects (CHDs) in China and compared them for different types of CHDs. This study examined risk factors between isolated and multiple CHDs as well as among CHDs subtypes in Guangdong, Southern China. METHODS: This population-based case-control study included 4,034 pairs of case and control infants enrolled in the Guangdong Registry of CHD study, 2004-2013. Multivariate logistic regression was used to compute adjusted odds ratios (ORs) while simultaneously controlling for confounders. RESULTS: Multiple maternal environmental exposures, including living in newly renovated rooms, residential proximity to main traffic, paternal smoking, and maternal occupation as manual worker, were significantly associated with CHDs with ORs ranging 1.30-9.43. Maternal perinatal diseases (including maternal fever, diabetes, influenza, and threatened abortion), maternal medication use (antibiotic use), advanced maternal age, low socioeconomic status, and paternal alcohol intake were also significantly associated with CHDs, with ORs ranging 1.60-3.96. Isolated CHDs and multiple defects have different profiles of risk factors, while subtype of CHD shares common risk factors. CONCLUSION: These results suggest that maternal environmental exposures/occupation and perinatal diseases/medication use were dominant risk factors associated with CHDs in Southern China. Isolated and multiple CHDs may have different etiologic factors.

Maternal periconceptional occupational exposure to pesticides and selected musculoskeletal birth defects.

This population-based U.S. study investigated the association between major musculoskeletal malformations and periconceptional maternal occupational pesticide exposure for a wide range of occupations. We conducted a multi-site case-control analysis using data from the National Birth Defects Prevention Study among employed women with due dates from October 1, 1997 through December 31, 2002. Cases included 871 live-born, stillborn, or electively terminated fetuses with isolated craniosynostosis, gastroschisis, diaphragmatic hernia, or transverse limb deficiencies. Controls included 2857 live-born infants without major malformations. Using self-reported maternal occupational information, an industrial hygienist used a job-exposure matrix and expert opinion to evaluate the potential for exposure to insecticides, herbicides or fungicides for each job held during one month pre-conception through three months post-conception. Exposures analyzed included any exposure (yes/no) to pesticides, to insecticides only, to both insecticides and herbicides (I+H) and to insecticides, herbicides and fungicides (I+H+F). We used logistic regression to evaluate the association between exposures and defects, controlling for infant and maternal risk factors. Occupational exposure to I+H+F was associated with gastroschisis among infants of women aged 20 years or older (adjusted odds ratio [aOR]=1.88; 95% confidence interval [CI]: 1.16-3.05), but not for women under age 20 (aOR=0.48; 95% CI: 0.20-1.16). We found no significant associations for the other defects. Additional research is needed to validate these findings in a separate population.

Comparison of indoor air quality management strategies between the school and district levels in New York State.

BACKGROUND: Good school indoor air quality (IAQ) can affect the health and functioning of school occupants. Thus, it is important to assess the degree to which schools and districts employ strategies to ensure good IAQ management. We examined and compared the patterns of IAQ management strategies between public elementary schools and their school districts in New York State. METHODS: District-level information obtained from surveys of district facilities managers in 326 districts was described and stratified by district size and socioeconomic status. School-level information obtained from surveys of head custodians in 770 elementary schools was then compared with the district-level information in 241 districts. RESULTS: About 47% of participating school districts reported having a district-wide IAQ program, with a large range in the prevalence of specific IAQ management strategies. Airing out newly painted areas was the most commonly reported (92%) and having a classroom animal policy was the least commonly reported (29%). Larger districts and districts with a district-wide IAQ program were more likely to report certain IAQ strategies than other districts. Elementary schools and their districts were most likely to report airing out newly painted areas (76%). The most common area of disagreement was construction after hours (50%). The top strategy not reported at either level was having an IAQ coordinator (53%). CONCLUSIONS: Many school districts lack key IAQ management strategies, and differences exist between district-level policy and school-level practice. Districts and schools should work together to formalize and expand existing IAQ policies and inform stakeholders about these strategies.

The impact of school building conditions on student absenteeism in Upstate New York.

OBJECTIVES: We investigated Upstate New York school building conditions and examined the associations between school absenteeism and building condition problems. METHODS: We merged data from the 2005 Building Condition Survey of Upstate New York schools with 2005 New York State Education Department student absenteeism data at the individual school level and evaluated associations between building conditions and absenteeism at or above the 90th percentile. RESULTS: After adjustment for confounders, student absenteeism was associated with visible mold (odds ratio [OR]=2.22; 95% confidence interval [CI]=1.34, 3.68), humidity (OR=3.07; 95% CI=1.37, 6.89), poor ventilation (OR=3.10; 95% CI=1.79, 5.37), vermin (OR=2.23; 95% CI=1.32, 3.76), 6 or more individual building condition problems (OR=2.97; 95% CI=1.84, 4.79), and building system or structural problems related to these conditions. Schools in lower socioeconomic districts and schools attended by younger students showed the strongest associations between poor building conditions and absenteeism. CONCLUSIONS: We found associations between student absenteeism and adverse school building conditions. Future studies should confirm these findings and prioritize strategies for school condition improvements.

Concentrations of selected organochlorines and chlorobenzenes in the serum of former Love Canal residents, Niagara Falls, New York.

BACKGROUND: Love Canal, in Niagara Falls, NY is among the earliest and most significant hazardous waste sites in the USA, but no study has ever measured chemical body burdens in nearby residents to document that human exposure occurred. This study measured concentrations of selected organochlorines and chlorinated benzenes in archived serum samples collected from former Love Canal residents. METHODS: We analyzed serum samples collected from 373 former residents in 1978-1979 for compounds disposed of at Love Canal, and we compared their concentrations according to surrogate indicators of exposure such as residential proximity, adjusting for potential confounders. RESULTS: Three compounds were detectable in the serum of most participants: 1,2,4-trichlorobenzene (1,2,4-TCB), beta-hexachlorocyclohexane (beta-HCH) and 1,2-dichlorobenzene (1,2-DCB). Concentrations of 1,2,4-TCB and 1,2-DCB were 2-14 times greater among persons who at the time their blood was collected lived closest to the Canal compared to those living further away. We found no consistent trends for beta-HCH with respect to any exposure definition. CONCLUSIONS: These results provide evidence that residential proximity to Love Canal contributed to the body burden of certain contaminants, and helps validate the use of surrogate exposure measures in health effect studies. Further surveillance of the Love Canal cohort is warranted.

Cancer incidence among former Love Canal residents.

BACKGROUND: The Love Canal was a rectangular 16-acre, 10-ft-deep chemical waste landfill situated in a residential neighborhood in Niagara Falls, New York. This seriously contaminated site came to public attention in 1978. Only one prior study examined cancer incidence in former residents of the Love Canal neighborhood (LC). OBJECTIVE: In this study we aimed to describe cancer incidence in former LC residents from 1979 to 1996 and to investigate whether it differs from that of New York State (NYS) and Niagara County (NC). METHODS: From 1978 to 1982, we interviewed 6,181 former residents, and 5,052 were eligible to be included in this study. In 1996, we identified 304 cancer diagnoses in this cohort using the NYS Cancer Registry. We compared LC cancer incidence with that of NYS and NC using standardized incidence ratios (SIRs), and we compared risks within the LC group by potential exposure to the landfill using survival analysis. RESULTS: SIRs were elevated for cancers of the bladder [SIR(NYS) = 1.44; 95% confidence interval (CI), 0.91-2.16] and kidney (SIR(NYS) = 1.48; 95% CI, 0.76-2.58). Although CIs included 1.00, other studies have linked these cancers to chemicals similar to those found at Love Canal. We also found higher rates of bladder cancer among residents exposed as children, based on two cases. CONCLUSIONS: In explaining these excess risks, the role of exposure to the landfill is unclear given such limitations as a relatively small and incomplete study cohort, imprecise exposure measurements, and the exclusion of cancers diagnosed before 1979. Given the relatively young age of the cohort, further surveillance is warranted.

Asthma prevalence, management, and education in New York State elementary schools: a survey of school nurses.

A survey of school nurses was conducted in New York State elementary schools to assess asthma and asthma management in students. The survey contained questions about asthma morbidity, management and education, obstacles to management, and school indoor air quality. The reported prevalence of asthma among students was 8.5%. Of the students with asthma, 64% visited the health office, 26% were absent from school, 20% had physical limitations, and 7% needed urgent care. Only 28% had a written management plan at school, less than 25% of schools used asthma self-management programs, and obstacles to management included lack of time and funding. More than 25% rated school indoor air quality as "fair" or "poor." Schools need to adopt key components of asthma management, and school nurses should be encouraged to work with others in the school setting to address indoor air quality problems that might be affecting health.

Asthma hospitalization rates among children, and school building conditions, by New York State school districts, 1991-2001.

School-age children spend a significant portion of their day at school where they can be exposed to asthma triggers, but little information exists regarding potential relationships between childhood asthma and school environmental factors. This study examined patterns of asthma hospitalization and possible factors contributing to asthma hospitalizations, including sociodemographics and school environmental factors, among school-age children (5-18 years) in New York State (NYS) over an 11-year period (1991-2001). Asthma hospitalization data from the Statewide Planning and Research Cooperative System and the 1990 and 2000 census population files were geocoded into NYS school districts statewide, and school district asthma hospitalization rates were then calculated. Building Condition Survey for each school was then utilized to create summary measures of school building conditions for each school district. Hospitalization rates were linked to district school building conditions by using logistic regression analysis that controlled for poverty. Calculation of time trends revealed overall declines in asthma rates among school-age children for NYS from 1991 to 2001. This general decline was found in each sociodemographic group. The mean rate for NYS from 1991 to 2001 was 27/10,000. Poorly rated building systems that were significantly associated with increased school district asthma hospitalization rates were roofing (odds ratio [OR] = 1.76; 95% confidence interval [CI(95)] = 1.13-2.74), windows (OR = 1.66; CI(95)= 1.08-2.54), exterior walls (OR = 2.24; CI(95)= 1.31-3.83), floor finishes (OR = 1.75; CI(95)= 1.14-2.69), and boiler/furnace (OR = 1.71; CI(95)= 1.99-2.94). This does not indicate a definite link between these systems and asthma hospitalizations since the available building system information is very general and crude.

Childhood asthma hospitalization rates, childhood asthma prevalence, and their relationships in Erie County, New York.

We estimated asthma hospitalization rates, prevalence, and their relationships for children under age 15 in Erie County, New York. Information on hospitalizations was obtained from hospital discharge data, and prevalence was estimated through a mailed survey of 9271 children. The hospitalization rate was 2.3 per 1000, the lifetime prevalence was 14.1%, and the hospitalization-to-prevalence ratio was 16.3 per 1000 prevalent cases. Hospitalization rates and hospitalization-to-prevalence ratios were higher among young children relative to older children; and hospitalization rates, prevalence, and hospitalization-to-prevalence ratios were higher among males, blacks, and Buffalo residents, suggesting greater severity, poorer management, and/or less access to care among these groups. The hospitalization-to-prevalence ratio may be useful in estimating prevalence from more easily available hospitalization data.

Childhood asthma hospitalizations and ambient air sulfur dioxide concentrations in Bronx County, New York.

The association between asthma hospitalizations and ambient sulfur dioxide (SO2) concentrations was examined in a case-control study in Bronx County, New York. Cases comprised 2629 children aged 0-14 yr who were admitted to hospitals for asthma. There were 2236 controls who were admitted for reasons other than asthma. Daily ambient SO2 concentrations were categorized into quartiles of both average and maximum levels and various exposure windows (i.e., day of admission and 1-, 2-, and 3-d lags). Cases were exposed to higher daily average concentrations of SO2 than controls. The authors compared the highest exposure quartile with the lowest, and the odds ratios were 1.66, 1.90, 2.05, and 2.21 (all p < 0.01 for same-day, 1-, 2-, and 3-d lags, respectively), with a similar finding for daily SO2 maximum exposure. The results suggest a consistent positive association between SO2 exposure and hospitalizations for childhood asthma.

Visualization of the spatial scan statistic using nested circles.

We propose a technique for the display of results of Kulldorff's spatial scan statistic and related cluster detection methods that provides a greater degree of informational content. By simultaneously considering likelihood ratio and relative risk, it is possible to identify focused sub-clusters of higher (or lower) relative risk among broader regional excesses or deficits. The result is a map with a nested or contoured appearance. Here the technique is applied to prostate cancer mortality data in counties within the contiguous United States during the period 1970-1994. The resulting map shows both broad and localized patterns of excess and deficit, which complements a choropleth map of the same data.