Grantee Research Project Results
2014 Progress Report: Assess the Linkage Between School-Related Environment, Children’s School Performance/Health, and Environmental Policies Through Environmental Public Health Tracking
EPA Grant Number: R834787Title: Assess the Linkage Between School-Related Environment, Children’s School Performance/Health, and Environmental Policies Through Environmental Public Health Tracking
Investigators: Lin, Shao
Institution: The State University of New York
EPA Project Officer: Hahn, Intaek
Project Period: February 1, 2011 through January 31, 2014 (Extended to January 31, 2017)
Project Period Covered by this Report: February 1, 2014 through January 31,2015
Project Amount: $500,000
RFA: Exploring Linkages Between Health Outcomes and Environmental Hazards, Exposures, and Interventions for Public Health Tracking and Risk Management (2009) RFA Text | Recipients Lists
Research Category: Human Health
Objective:
The objective of this project is to develop new and improve existing Environmental Public Health Indicators (EPHIs) related to the school environment in order to evaluate the linkage between school environment, children's health and performance as well as the impact of state and local environmental policy intervention. The ultimate goals are to identify school-related EPHIs that can be used for routine and long-term environmental public health tracking and surveillance, planning appropriate interventions, and protecting children's health.
Progress Summary:
We advanced all activities planned in Year 4 (as shown in the timetable below) and are on schedule for tasks designated for Year 5. More specifically, we successfully completed the development of indicators and statistical methods for analysis, completed several hazard-outcome analyses, and completed most intervention analyses. The main challenge has been a delay (task H) in receiving health data because the office that handles data requests was under-staffed and had a back-log of requests. Despite facing this challenge during Year 1 and Year 2, we eventually received data access to hospital and emergency room data for school-aged children in Year 3. We have used these health data to further our analyses. Other components of this project are on or ahead of schedule, including completing several analyses, and writing and publishing manuscripts for tasks F, G, H and I. In general, the goals of the project have not changed, and we have made significant progress toward achieving our project’s objective and main aims as described in detail below.
Indicator development and evaluation (Task F): Staff have identified potential indicators and their sources, developed methodologic procedures to evaluate these indicators, conducted exposure assessment, and provided evidence-based information on selecting the most important indicators. We evaluated each potential indicator in terms of its scientific validity and relevance, analysis soundness and feasibility, interpretation, and utility. For each potential indicator, staff systematically evaluated its data sources/completeness, geographic coverage, temporal availability, and data quality issues. Staff also used principal components analysis (PCA) to assess correlation and linear uncorrelated components to screen and select the best indicator. A manuscript describing this study will be completed by summer 2015.
Develop statistical models (Task G): Statistical models and methods developed in Year 1 were incorporated in analyses in Years 2 through 5.
Hazard-outcome analysis (Task H):
1) School Environment & Student Performance: A study of unfavorable school building conditions and student performance found that, after adjustment for socioeconomic status (SES), urbanicity, and presence of high school students, both English and Math performance were associated with ventilation problems and having more than six concerning building conditions. The strength of the association was stronger in schools of lower-SES. A manuscript for a study demonstrating associations between school ventilation problems and student test scores, a major deliverable used to rate school quality and determine funding, was submitted for journal publication.
2) School Building Conditions Over Time: In Year 3, NYS school building conditions were assessed comparing 2000, 2005, and 2010 BCS data using a combination of descriptive statistics and logistic regression. In general, we found reported unfavorable conditions peaked in 2005, followed by a downward trend in 2010. For example, the percentage of schools that had no indoor air quality (IAQ) management plan decreased in 2010. Other improvements include a reduction in the number of schools with a poor rating for ventilation/IAQ or showing signs of stains, mold or water damage, and leaks in roofs or plumbing. Approximately one-third of schools had overall building condition ratings that stayed bad or got worse from 2005 to 2010 and approximately two-thirds got better or stayed good. Over 20% of schools whose overall building condition stayed bad had high minority enrollment. Finally, overall building rating staying bad or getting worse over time was significantly associated with having no IAQ plan in place after controlling for minority enrollment and geographic location. Analysis is complete and manuscript preparation is underway. Completion is expected by June.
3) School Environment and Student Attendance: Also in Year 4, the association of NYS building conditions and student attendance rates were further assessed using 2010 BCS data, 2010 School Report Card (SRC) data, and 2010 proximity of schools to Toxics Release Inventory (TRI) sites, traffic, and airports data. Staff completed matching of the outdoor data with the school data during Year 4. After controlling for SES, upstate vs. downstate, and presence of high school students, poor attendance was directly associated with lack of walk off matts (OR 1.48 95% CI: 1.15, 1.91), poor acoustics (OR 2.45, 95% CI: 0.97, 6.18), poor air filter condition (OR 2.943.07, 95% CI 1.094, 8.6232) and poor ventilation and indoor air quality (OR 2.86, 95% CI: 1.73, 4.73), proximity to traffic (within 200, 300, 500 m, respectively: 1.428 (1.04, 1.97); 1.33 (0.97, 1.81); 1.36 (1.07, 1.73)), proximity to TRI sites (within 0.5, 1, and 5 miles, respectively: (1.99 (1.30, 3.03); 1.47 (1.07, 2.02); 1.26 (0.99, 1.60)), and was indirectly associated with gypsum/cellulose surfaces (OR 0.78, 95% CI: 0.62, 0.98) and pesticides used on grounds (OR 0.769, 95% CI: 0.653, 0.925). This study found associations between school building attributes, outdoor environmental indicators, and student attendance rates, another deliverable used to rate school quality and determine funding. As a first step in assessing the role of outdoor environmental health indicators, the BCS database is being linked to the appropriate outdoor environmental datasets.
4) School Environment and Respiratory Hospital Admissions: An analysis of emergency department visits and inpatient hospitalizations in relation to school indoor and outdoor exposures and urbanicity has been completed during Year 4. The study found several environmental factors were significantly associated with respiratory inpatient and emergency department admissions: residences within 200 meters of traffic, schools within 1 mile of industrial facilities and airports, schools with air intake not free of blockage, rural schools with air intakes near truck delivery areas, and schools with two or more outdoor and indoor exposures.
5) Teacher Survey Results: This study used data from a telephone survey of NYS school teachers to assess teacher health and classroom IAQ. The relationship between health symptoms and each classroom condition was assessed using a Poisson regression analysis, controlling for demographics and home exposures. The most frequently reported classroom conditions/practices included open shelving (70.7%), eating food (65.5%), dust (59.1%), and carpeting (46.9%). The most commonly reported health symptoms included sinus problems (22.2%) and allergies/congestion (21.4%). Experiencing one or more symptoms at work was significantly associated with reported dust (RR = 2.79), paint odors (RR = 1.69), mold (RR = 1.59), moldy odors (RR = 1.57), and dust reservoirs (RR = 1.86). Stronger associations were found with increasing numbers of adverse conditions. A manuscript describing this analysis was accepted for publication in the journal Indoor Air in 2014. A second analysis has found significant associations between several teacher health symptoms and classroom climate and the ability to control it, inability to control glare, excessively dim lighting, excessive noise from all sources, and echo. Analysis now is complete and a manuscript is being written for journal submission.
6) Classroom Carbon Dioxide (CO2) and Teacher Health Symptoms: This study assessed the relationship between teacher-reported symptoms and classroom CO2 concentrations among 10 NYS school districts in 2010. CO2 was measured in classrooms over 48-hours and linked to teacher surveys assessing demographic and health symptom information. Approximately 20% of the measured classroom CO2 concentrations were > 1000 parts per million (ppm). In multivariate analyses, neuro-physiologic (i.e., headache, fatigue, difficulty concentrating) symptoms among teachers were significantly associated with maximum classroom CO2 (OR = 1.30) and were non-significantly increased in classrooms with above-median proportions of CO2 concentrations greater than 1000 ppm. A manuscript describing this analysis was accepted for publication in the journal Indoor Air in 2014.
Policy impact assessment (Task I):
1) NOx SIP Call: Summertime ambient ozone concentrations significantly declined statewide during the NOx SIP call post-intervention period. After adjusting for temporal trends, particulate matter (PM2.5), and meteorological variables, an overall decrease (-14.7%, 95% CI: -34.1%, 10.5%, not statistically significant) of asthma hospital admissions was found in NYS after the NOx SIP policy implementation. More specifically, significant declines in respiratory admissions for children 5-17 years old were observed following NOx SIP call implementation in Long Island (-11.1%, 95% CI: -20.0%, -1.3%), NYC Metro (-21.7%, 95% CI: -24.5%, -18.7%), Upper Hudson (-21.3%, 95% CI:-34.2%, -5.8%), Eastern Ontario (-23.1%, 95% CI: -36.3%, -7.2%), and Central (-35.3%, 95% CI:-44.3%, -24.9%) regions. Stratified analyses suggest that these hospitalizations declined the most among white and other races, those covered by self-payer insurance, and those covered by Medicaid.
2) Bus Retrofitting: We also evaluated the effectiveness of environmental policy by assessing the emissions reduction program that consisted of retrofitting diesel school buses with state of the art pollution control technologies and idling reduction programs on asthma hospital admissions among school children in NYS. We received 2003-2010 new data (Inpatients Data N = 54,619) that include cases (N = 31,855) and controls (N = 22,764). The preliminary results show increased risk of asthma hospital admissions (Adj. OR = 1.20, 95% CI = 1.12, 1.30) for school districts that did not retrofit their buses with new technologies, compared to those that did. A descriptive analysis showed that respiratory admissions seemed to decrease since 2005, the year of retrofitting.
Future Activities:
Indicator development and evaluation (Task F): Analysis for indicator development and evaluation was completed as planned. A manuscript describing our results will be completed and submitted for peer review and journal publication.
Develop statistical models (Task G): We have finished model development and will continue to utilize statistical models to inform ongoing analysis.
Hazard-outcome analyses (Task H): Analyses for research areas in this component are mostly complete, although we experienced a significant delay in data access in Years 1 and 2. We will complete analyses of school building conditions and environment in relation to student attendance. We will continue to prepare and submit manuscripts for publication, including: an assessment of school building condition changes over time, 2005-2010; an analysis of respiratory ED and hospital visits and school indoor and outdoor environmental factors; and an analysis of teacher health symptoms and classroom climate, lighting, and acoustics.
Intervention analyses (Task I): We have finalized the policy evaluation component of the project and will draft a manuscript to report our findings in the next grant period.
Report/Data Sharing (Task J): We will continue to report our findings by submitting manuscripts to peer-reviewed journals. We have six manuscripts in progress, including (1) school indicator development; (2) NYS building condition changes over time; (3) building conditions and attendance; (4) health impact after policy intervention; (5) teacher health symptoms and classroom climate, lighting, and acoustics; and (6) respiratory hospital visits and school indoor/outdoor environmental exposures. We aim to increase awareness by disseminating our findings by preparing information sheets for stakeholders, presenting findings at meetings and conferences to EPA, NYS Education Department, and the NYS Department of Health, and completing the final grant report.
Enhance NYS EPHT (Task K): We plan to integrate new or enhance old school environmental public health indicators into the NYS EPHT system.
Journal Articles on this Report : 5 Displayed | Download in RIS Format
Other project views: | All 22 publications | 5 publications in selected types | All 5 journal articles |
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Kielb C, Lin S, Muscatiello N, Hord W, Rogers-Harrington J, Healy J. Building-related health symptoms and classroom indoor air quality: a survey of school teachers in New York State. Indoor Air 2015;25(4):371-380. |
R834787 (2013) R834787 (2014) R834787 (2015) R834787 (Final) R835636 (2016) R835636 (2017) |
Exit Exit |
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Lin S, Jones R, Munsie JP, Nayak SG, Fitzgerald EF, Hwang SA. Childhood asthma and indoor allergen exposure and sensitization in Buffalo, New York. International Journal of Hygiene and Environmental Health 2012;215(3):297-305. |
R834787 (2012) R834787 (2013) R834787 (2014) R834787 (2015) R834787 (Final) |
Exit Exit |
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Lin S, Kielb CL, Reddy AL, Chapman BR, Hwang S-A. Comparison of indoor air quality management strategies between the school and district levels in New York State. Journal of School Health 2012;82(3):139-146. |
R834787 (2012) R834787 (2013) R834787 (2014) R834787 (2015) R834787 (Final) |
Exit Exit Exit |
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Lin S, Jones R, Pantea C, Ozkaynak H, Rao ST, Hwang S-A, Garcia VC. Impact of NOx emissions reduction policy on hospitalizations for respiratory disease in New York State. Journal of Exposure Science & Environmental Epidemiology 2013;23(1):73-80. |
R834787 (2012) R834787 (2013) R834787 (2014) R834787 (2015) R834787 (Final) |
Exit Exit Exit |
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Muscatiello N, McCarthy A, Kielb C, Hsu W-H, Hwang S-A, Lin S. Classroom conditions and CO2 concentrations and teacher health symptom reporting in 10 New York State schools. Indoor Air 2015;25(2):157-167. |
R834787 (2013) R834787 (2014) R834787 (2015) R834787 (Final) R835636 (2016) R835636 (2017) |
Exit Exit 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
- Final Report
- 2015 Progress Report
- 2013 Progress Report
- 2012 Progress Report
- 2011 Progress Report
- Original Abstract
5 journal articles for this project