Grantee Research Project Results

2018 Progress Report: Assess school environmental effects on children's health and performance and strengthen state/community capacity to create a healthy and safe learning environment

EPA Grant Number: R835636
Title: Assess school environmental effects on children's health and performance and strengthen state/community capacity to create a healthy and safe learning environment
Investigators: Lin, Shao , Thurston, George D. , Hwang, Syni-An
Institution: Health Research, Inc. / NYS Dept. of Health
EPA Project Officer: Hahn, Intaek
Project Period: December 18, 2014 through December 17, 2018 (Extended to July 31, 2020)
Project Period Covered by this Report: December 18, 2017 through December 17,2018
Project Amount: $1,000,000
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:

Overview of Project Aims: Aim 1: Assess if children's exposure to contaminants in school environment is individually or jointly associated with adverse health outcomes and performance. Aim 2: Examine if school environmental factors changed over time and their relationships to outcomes modified by SES, neighborhood and meteorological factors. Aim 3: Identify potential factors mediating school environment on various outcomes and develop new methodologies to assess multiple exposures. Aim 4: Identify sustainable and best school practices and evaluate environmental policies or programs' impacts on school building and children's health.

Progress Summary:

Specific Aim 1: Children's exposure to school contaminants and health/performance

Association between school environment and student's respiratory health: For general building characteristics,the studyfound a positive relationship between the number of floors and student's number of Emergency Department (ED) visits due to respiratory diseases (PR=1.06, 1.02-1.09). Positive associations with similar magnitude were also observed when using asthma or pneumonia ED rates (Appendix 2). Increasing the number of custodians working at schools was associated with a significant reduction of respiratory ED visits (PR=0.99, 0.98-0.99). However, these effects become non-significant in the sensitivity analysis among schools from districts with <10% non-public enrollment. Among individual system and health/comfort related conditions, schools reporting inadequate conditions in heating fuel systems had a 40% increase in respiratory ED visits compared schools rated adequate. The impacts of a poor heating fuel systems were also observed for ED visits due to both respiratory subtypes but with a stronger effect seen on pneumonia (PR=1.68, 1.23-2.29). In addition, significant positive associations between high levels of ozone and pneumonia ED visits were observed (PR=1.15 and 1.23, 2^nd and 4^th quartile respectively).

Specific Aim 2. Effect modification of school urbanicity and school type

Results from the stratified analysis were presented. When stratified by school urbanicity,the studyobserved stronger impacts on respiratory health from taller school buildings (PR=1.08, 95%CI: 1.03, 1.14) and inadequate heating fuel systems (PR=1.71, 95%CI: 1.25, 2.33) in urban schools only. On the other hand, significantly increased numbers of custodian and fair rating of IAQ were associated with lower respiratory ED visits (PR ranged from 0.81 to 0.96). Potential effect modifications were seen for urbanicity in the associations between IAQ rating and student's respiratory health. The impact of heating fuel system conditions, IAQ rating, and fuel types on students' respiratory health differed across school types. In summary, findings in school environmental studies without information on important school SES indicators is likely undermined due to the extremely strong influence of SES on student's health. Individual building parameters like heating system or perceived IAQ rating may be more influential on students' respiratory health than the overall building rating.

Specific Aim 3 : Identify factors mediating the effect of school environment on various Outcomes
The studyhas assessed the mediation effects for all school risk factors based on prior studies, such as appearance, molds, ventilation, moisture, and > 6 systems failure.The researchersfound that the mediator (school attendance rate) is related to the outcome variable (poor academic performance) after controlling for the predictor variable, SBC. The relationship between SBC (appearance) and natural science (Algebra I, Trigonometry, Chemistry, Geometry, Earth Science, and Physics) were fully mediated by attendance. Also, the relationship between SBC (appearance) and social science (English, Global History, Living Environment and US history) were partially mediated by attendance. In addition, when the predictor variable was replaced by other risk factors, i.e., different Regents Test, subjects were partially mediated by attendance rate.

Specific Aim 4:

The studyhas selected 49 biologically plausible variables from the 2015 Building Conditions Survey to determine if the EPA's Tools for School (TfS) Program or other environmental programs had any significant improvements in building conditions for 2015. Compared to those schools without TfS Program,thestudy'sanalysis showed significant improvements in 16 variables out of 28 school environmental variables selected among those schools with TfS implemented (ORs ranged from 1.16 - 2.01). Schools that used other environmental health policies compared to schools that did not use policy, showed 12 variables out of 28 school environmental variables which had significant improvements. The top five school building variables with the largest improvement related to TfS are good moisture/humidity conditions (OR:2.01, 95%CI: 1.23-3.28), use of HVAC controls (OR: 1.83, 95%CI: 1.45 - 2.32), use of a heating system (OR:1.63, 95%CI: 1.16 - 2.29), overall building rating (OR:1.57, 95%CI: 1.32 - 1.88), and air intakes free of blockage (OR:1.53, 95%CI: 1.21 - 1.94). The top five school building variables with the largest improvement related to other environmental policies are air intakes free of blockage (OR:2.12, 95%CI: 1.58- 2.85), good indoor air quality conditions (OR:2.07, 95%CI: 1.44 - 2.99), good air conditioner conditions (OR: 2.00, 95%CI: 1.41 - 2.82), good skylight conditions (OR:1.85, 95%CI: 1.23 - 2.78), and use of a heating system (OR:1.83, 95%CI: 1.22 - 2.75). By comparing the 2005, 2010, and 2015 BCS,the studyfound that the number of schools using the TfS or other programs has decreased overtime.

Future Activities:

Planned activities for next reporting period: 1)The researcherswill complete the analysis regarding school air conditioner use and ventilation on children's health/test scores during this coming summer; 2) A predictive model will be developed to assess total school environment on children's health and performance; 3)The studywill identify the best school practices by completing two manuscripts regarding green building attributes on students' asthma, attendance and test scores; 4) The analyses of mediation effects of school building factors and attendance on test scores will be completed; 5)The studywill finish papers assessing the impacts of EPA TfS and other environmental programs on SBC; 6) The analyses of mediating effects how TfS or other programs improved students' test scores or attendances via changing school environment will be continued.

Journal Articles on this Report : 3 Displayed | Download in RIS Format

Publications Views
Other project views:	All 24 publications	11 publications in selected types	All 11 journal articles

Publications
Type	Citation	Project	Document Sources
Journal Article	Lawrence WR, Yang M, Lin S, Wang SQ, Liu Y, Ma H, Chen DH, Yang BY, Zeng XW, Hu LW, Dong GH (2018). Pet exposure in utero and postnatal decreases the effects of air pollutants on hypertension in children:A large population-based cohort study. Environ Pollut. 238:177-185.	R835636 (2018)	Abstract from PubMed Full-text: Science Direct - Full Text HTML Exit Other: Science Direct - Full Text PDF Exit
Journal Article	Lu Y, Lin S, Lawrence WR, Lin Z, Gurzau E, Csobod E, Neamtiu IA. Evidence from SINPHONIE project: impact of home environmental exposures on respiratory health among school-age children in Romania. Science of the Total Environment 2018;621:75-84.	R835636 (2016) R835636 (2017) R835636 (2018)	Abstract from PubMed Full-text: Science Direct-Full Text HTML Exit Abstract: Science Direct-Abstract Exit Other: Science Direct-Full Text PDF Exit
Journal Article	Palumbo JR, Lin S, Lin Z, Neamtiu IA, Zhang W, Csobod E, Gurzau ES. Assessing associations between indoor environment and health symptoms in Romanian school children: an analysis of data from the SINPHONIE project. Environmental Science and Pollution Research International 2018;25(9):9186-9193.	R835636 (2016) R835636 (2017) R835636 (2018)	Abstract from PubMed Abstract: SpringerLink-Abstract Exit

Supplemental Keywords:

EPA School IAQ Tools

Progress and Final Reports:

Original Abstract

The 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.