Grantee Research Project Results
Final Report: Baltimore Healthy Schools: Impact of Indoor Air Quality on Health and Performance
EPA Grant Number: R835639Title: Baltimore Healthy Schools: Impact of Indoor Air Quality on Health and Performance
Investigators: McCormack, Meredith , Leaf, Phillip , Curriero, Frank , Connolly, Faith , Koehler, Kirsten
Institution: The Johns Hopkins University , Baltimore City Schools , Baltimore Education Research Consortium
EPA Project Officer: Hahn, Intaek
Project Period: December 18, 2014 through October 31, 2018 (Extended to October 31, 2019)
Project Amount: $997,822
RFA: Healthy Schools: Environmental Factors, Children’s Health and Performance, and Sustainable Building Practices (2013) RFA Text | Recipients Lists
Research Category: Children's Health , Human Health
Objective:
The objective of this research is to assess the impact that indoor and outdoor air quality can have on student achievement, student health and overall school climate and to document that impact on indoor air quality and school performance indicators associated with modernization of school facilities in Baltimore City.
Summary/Accomplishments (Outputs/Outcomes):
Phase I
In Year 1 of the study we focused our efforts on planning and organizational meetings. We completed IRB review and approvals from Johns Hopkins and Baltimore City Schools.
In Year 2 of the study we focused our Phase I efforts on analyzing existing de-identified student outcomes data through Baltimore Education Research Consortium’s Memorandum of Understanding with Baltimore City Schools. We finalized our analytical models, ran our final analyses, and prepared a manuscript that was published in Year 3.
In Year 3 of the study we focused our Phase I efforts on analyzing existing de-identified student outcomes data through Baltimore Education Research Consortium’s Memorandum of Understanding with Baltimore City Schools. We finalized our analytical models, ran our final analyses, and prepared a manuscript which is now published at International Journal of Hygiene and Environmental Health.
In Year 4 of the study we established the process to secure Medicaid data and to perform the data linkages with Baltimore City Schools data. This included resubmission of IRB applications to Baltimore City Schools, Johns Hopkins University, State of Maryland. We also began a data use agreement among these three entities.
In Year 5 we gained IRB approval from Baltimore City Schools, Johns Hopkins University, and State of Maryland and executed the data use agreement among these three entities. We received the data and have begun analyses to investigate the association between school environment and asthma healthcare use.
Phase II
During the first year of the award period, the study team began planning and meeting with Baltimore City School leadership and 21st Century School Buildings representatives. We purchased equipment and pilot tested set-ups and monitoring protocols that would work well in the school environment.
Since receiving IRB approval from Baltimore City Public Schools in July 2015, baseline environmental monitoring have been conducted in 29 schools. For each school we aimed to conduct two weeks of monitoring in each of the fall, winter, and spring seasons. During each two-week monitoring period we deployed equipment in a classroom, a common space, and outdoors in school property. For some schools we were not able to measure at all three time points during a given school years. This was due to the beginning of the award period (missing fall in some of the first wave), unexpected weather considerations, and holiday schedules. In these instances we were typically able to perform additional assessment during the subsequent school year. We have performed environmental monitoring in nine Baltimore City Schools postrenovation and have monitored five schools throughout a second school year, which serve as controls. We are continuing to monitor schools during the 2019-2020 school year. We have engaged with schools to create forms that communicate study findings to provide back to school communities.
We have published findings regarding building characteristics and neighborhood environmental characteristics that are associated with school indoor air quality. We are completing laboratory analyses of environmental samples currently.
Grant funding
Meghan Davis received a Bloomberg American Health Initiative Spark award, “Inner-city schools: a locus for health disparities in minority communities”, for a substudy nested in the Baltimore Healthy Schools Study. Meredith McCormack submitted an R01 application to the NIH to implement an asthma intervention program, and the proposal was based on relationships formed through the Baltimore Health Schools Study.
Community Engagement and Outreach
The Lung Health Ambassador Program was launched to provide education about lung health including effects of air pollution and education about asthma.
b. Outcomes
There is growing evidence that school indoor air quality (IAQ) and other environmental conditions (temperature, humidity, noise, and lighting) may affect the health and productivity of students, teachers, and school staff. We have conducted analysis on school air quality and environmental conditions, academic performance, and absenteeism, with the following preliminary results:
School Environmental Conditions and Academic Performance and Absenteeism (Phase I)School
Facilities, environment, and perceptions of safety and learning have been individually investigated for their impact on child development. However, it is important to consider how the environment influences academic performance and attendance after controlling for school and community factors. Poor school building conditions are common in Baltimore City, because Baltimore schools were built decades ago and high exposure to industrial pollution (RSEI) may be present in the southern city region. School building conditions and perceptions of safety strongly influenced both academic achievement and absenteeism. RSEI was associated with increased absenteeism, but not academics, which may indicate chronic health effects of air pollution exposures. No significant association was observed between roadway density and either absenteeism or academic performance. These findings provide evidence that community and school environment are associated with academic achievement and attendance. Investment in building infrastructure and safety promotes healthy school environments that may improve academic performance and provide long-term benefits.
Air Quality (Phase II)
We monitored each school for a period of two weeks in four different locations. Measurements were repeated during three seasons. Variables measured included nitrogen dioxide (NO2), carbon monoxide (CO), and fine particulate matter (PM2.5). We observed higher NO2 exposures than previously reported in schools, whereas PM2.5 and CO levels were generally lower compared to the other reported results. Higher indoor NO2 and CO exposures were observed in fall and winter and are believed to be associated with inadequate ventilation. Higher air pollution in schools with physical defects such as broken windows and cracks in the walls were observed. Characteristics related to the school surroundings, such as proximity to roads and industrial facilities as well as traffic density, had a significant impact on indoor NO2 and CO exposures.
Figure 1.
School Temperature (Phase II)
School districts often have older buildings with less modern HVAC systems that can be associated with worse air quality. Indoor air quality, including temperature, was longitudinally assessed in 29 schools over three seasons. Sampling strategy included in one-minute intervals in two classrooms and two common spaces and in ten-minute intervals outdoors over a 2-week period.
Figure 2.
Temperature in classrooms and common spaces were similar within season and between seasons, with no relationship to outdoor temperature. Preliminary results demonstrated that schools were too warm or too cold indoors for approximately two-thirds of the monitored time.
A small proportion of schools had median indoor daytime temperatures in excess of 90°F. The proportion of school days that were out of range based on EPA recommendations was similar across seasons.
Preliminary Findings regarding settled dust allergen concentrations (Phase II)
We completed assessment of 165 samples from 17 schools (range 1-27 samples per school). The following table details the results generated to date. Findings suggest that school mouse allergen concentrations were elevated and typically exceed clinically relevant thresholds.
Allergen | Median (range) | Clinicallyrelevantthreshold | Below Detection Limit ( | Quantity Not Sufficient | Not tested |
Mouse (Mus m 1 in ng/g) | 1,868 ( | 500 | 1 | 0 | 0 |
Cockroach (Bla g 1 in U/g) | 0.5 ( | 2 | 89 | 1 | 1 |
Cat(Fel d 1 in ng/g) | 188 ( | 1000-2000 | 1 | 1 | 6 |
Dog (Can f 1 in ng/g) | 69 ( | 1000-2000 | 9 | 2 | 6 |
Dust mite(Der f 1 in ng/g) | 6 ( | 1000-2000 | 75 | 4 | 18 (pend) |
Post renovation schools had significantly lower concentrations of pest allergens than schools pre-renovation for mouse and cockroach, but not for dog or cat allergen (mouse allergen shown here).
Figure 3.
Preliminary Findings regarding pre and post-renovation (Phase II)
The box plots below illustrate pre- vs. post-renovation comparison of PM 2.5, Temp, CO2, and CO weekly (visit) averages. For temperature, CO and CO2; the average includes only days with at least 4 hours of daytime data (8AM-4PM). The temperature box plot is by season and renovation type
(“winter"=Nov-Feb; “summer"=Mar-Oct).
Figure 4.
Conclusions:
School building condition and surrounding environment were associated with student academic performance and chronic absences. School building factors and outdoor environment are associated with indoor air quality. Indoor air exceeded guideline recommendations for PM2.5, NO2, and CO2 more frequently in the winter months. School temperature was outside of recommended ranges for performance 2/3 of the time. Pest allergen concentrations were elevated and mouse allergen was typically well above clinically relevant thresholds.
Preliminary findings suggest that renovation was associated in improvements in air quality and reduction in pest allergen. These findings suggest that school environment is associated with student performance and health, and improvements in building conditions likely reduce exposures that are known to be harmful to health. Final results will provide more definitive conclusions.
Journal Articles on this Report : 3 Displayed | Download in RIS Format
Other project views: | All 20 publications | 5 publications in selected types | All 5 journal articles |
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Wu T, Zaeh S, Eakin M, Koehler K, Davis M, Wohn C, Diibor I, Psoter K, Cronister C, Connolly F, Stein M, McCormack M. Association of School Infrastructure on Health and Achievement Among Children With Asthma. ACADEMIC PEDIATRICS 2023;23(4):814-820. |
R835639 (Final) R836152 (Final) |
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Zaeh S, McCormack M, Eakin M. Key policies to support asthma medication management for children. ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY 2019;123(5):428-429 |
R835639 (Final) R836152 (Final) |
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Zaeh S, Koehler K, Eakin M, WOhn C, Diibor I, Eckmann T, Wu T, Clemons-Erby D, Gummerson C, Green T, Wood M, Majid E, Stein M, Rule A, Davis M, McCormack M. Indoor Air Quality Prior to and Following School Building Renovation in a Mid-Atlantic School District. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021;18(22). |
R835639 (Final) R836152 (Final) |
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Supplemental Keywords:
children’s respiratory health, community partnership, school practice, mediators, particulates, surveys, test scores, attendance.Relevant Websites:
Baltimore Healthy Schools JHU Exit
Progress and Final Reports:
Original AbstractThe perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.
Project Research Results
- 2018 Progress Report
- 2017 Progress Report
- 2016 Progress Report
- 2015 Progress Report
- Original Abstract
5 journal articles for this project