Asthma in school environments for students and staff

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Asthma in school environments for students and
staff

• Elise Pechter, MPH, CIH
• Industrial Hygienist, Occupational Health
  Surveillance Program
• Tolle Graham
• Healthy Schools Coordinator

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• NIOSH funded WRA surveillance in 4 states
• Mandated reporting of individual cases
• Information about industry, occupation and
  exposures
• AJIM 2008 51(1)47-59
• Diagnosis of asthma association with work

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SENSOR WRA Cases, MA, CA, MI, NJ, 19932000
(n2,995)
All other industries (1,703 56)
Transportation equipment manufacturing (556 19)
Educational services (265 9)
Health services (471 16)
Acknowledgement Jacek Mazurek, MD, MS
(NIOSH,DRDS)
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WRA Case Classification
Educational Services, 19932000 (N265)
Occupational Asthma (61)
RADS (8)
Unknown (lt 1)
Work-Aggravated Asthma (31)

Occupational Asthma RADS
New-Onset Asthma (69)
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WRA Case Occupation, Educational
Services, 19932000 (N265)

• Teachers and teachers aides
• Administrative support
• Janitors, cleaners, housekeepers
• Food preparation
• Health services
• Other professional
• Construction trades, machinists
• Librarians and library clerks
• Bus drivers
• Police, guards
• Other

144 42 31 10 9 9 6 5 5 3 2
54 16 12 4 3 3 2 2 2 1 1
Number of Cases
Percent
Occupation
Acknowledgement Jacek Mazurek, MD, MS
(NIOSH,DRDS)
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Damaged/Soiled Filters in Air Handling Unit
Picture Courtesy of MDPH, Bureau of Environmental
Health Indoor Air Quality Program
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Top Categories of Agents
Associated with WRA Cases,
Educational Services, 19932000
Poor indoor air quality or lack of ventilation
E.g., graffiti remover, floor strippers, bleach,
carpet cleaners, disinfectants, and ammonia
E.g., paint, acetone, asphalt
Mostly dust, NOS
Percent of cases
Cleaning products
Solvents, hydrocarbons
Mold
Indoor air pollutants
Mineral inorganic dust
Acknowledgement Jacek Mazurek, MD, MS
(NIOSH,DRDS)
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Idling Vehicle near Classroom Fresh Air Intake
Picture Courtesy of MDPH, Bureau of Environmental
Health Indoor Air Quality Program
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Consistent with other research

• Educational services workers more asthma than
  general working population (NHANES)
• Arif et al 2002 OEM 59505
• Arif et al 2003 AJIM 44368
• Wheezing in female teachersgtworking women
• Whelan et al 2003 OEM 60929
• Asthma in working adults in schools and colleges
  gt general working population (NHIS)
• Bang et al 2005 AJIM 47500
• Manitoba, teachers more asthma than other
  occupations
• Kraut et al 1997 AJIM32275

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Respiratory hazards in schools

• Dampness and mold
• Dust
• Construction related
• Cleaning products
• Arts materials
• Swimming pools
• Science laboratories
• Shops (wood dust, solvents, artificial nails)
• Cat allergen
• Cockroach, dust mites
• Pesticides, including disinfectants

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Water-damaged Ceiling Tiles Picture Courtesy of
MDPH, Bureau of Environmental Health Indoor Air
Quality Program

• Damp Indoor Spaces and Mold, Institute of
  Medicine http//www.iom.edu/CMS/3793/4703/20223.as
  px

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Dampness and mold

• Sahakian NM, et al. 2008 J School Health.
  Identification of mold and dampness-associated
  respiratory morbidity in 2 schools comparison of
  questionnaire survey responses to national data.
• Dangman KH et al 2005 Conn Med. Work-related
  asthma in teachers in Connecticut association
  with chronic water damage and fungal growth in
  schools.

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Cleaning Chemicals Found Under Classroom Sink
Picture Courtesy of MDPH, Bureau of Environmental
Health Indoor Air Quality Program
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Pilot Survey of Elementary School Staff In
Massachusetts Regarding Work-related Respiratory
Problems and School Building Exposures2004

• Document respiratory problems and exposures by
  questionnaire
• 17 schools, near Boston, union rep
  distributed/collected surveys
• 359 responses (43)
• Asthma prevalence not higher
• Attribution to work
• Observed leaks, mold, construction, pests and
  pesticides

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Prevalence of Asthma and Respiratory Problems
among Massachusetts Elementary School Staff (n
359)
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Prevalence of Environmental Risk Factors Observed
by School Staff in Their School Building in the
Last 12 Months (n 359)
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Prevalence of Self-Reported Exposures at School
-- Based on Qualitative Responses to the
Question What are your health concerns related
to exposures at your school? (n 142)
  1 IAQ includes concerns related to ventilation,
humidity, temperature, and air conditioning. 2
Chemical hazards category includes concerns
related to chipping paint, natural gas, asbestos,
pesticides, bus exhaust, pollen and chalk. 3
Pests category includes concerns related to ants,
wasps, mouse droppings and lice. 4 Other category
includes concerns related to stress, cutting
grass, electromagnetic fields, and construction.
Mold
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Staff respiratory problems and observed hazards
may indicate risks for students

• Asthma among staff
• Work-related asthma and respiratory problems
• Respiratory hazards
• Are children affected?
• Hazards
• At greater risk

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Environmental Public Health Tracking of asthma
among MA elementary school students

• Pediatric asthma rates monitored by MDPH
• 760 schools, 9 children with asthma (2002-3)
  Knorr et al 2004, Environ Health Perspect
  1121424
• 1880 schools, 86 of all schools, 10 children
  with asthma (2005-6)
• Found higher rates of asthma in schools with
  moisture or mold problems
• Not associated with higher CO2 or dust (PM2.5)
  levels
• http//www.cdc.gov/nceh/tracking/tracks06/pdfs/pre
  sentation46_condon.pdf

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Research about allergens in schools affecting
children

• Asthmagens in Baltimore schools, concentrations
  low
• Amr S et al 2003 Ann Allerg Asthma Immunol 9034
• Swedish studies MVOCs, plasticizer, horse, cat,
  dog allergens in schools
• Kim, Elfman et al Indoor Air3 articles
• Allergens in Birmingham, Detroit and Houston
  schools dust mites, cat, cockroach
• Abramson et al 2006 http//www.pubmedcentral.nih.g
  ov/picrender.fcgi?artid1599794blobtypepdf

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Cleaning products affect staff--children may be
affected

• Children have higher rate of asthma
• Physiological
• Faster breathing rate, more responsive
  immunologic system?
• Smaller body volume
• Behavioralhand to mouth, time on the ground,
  contact with cleaning chemicals
• Sensitizers and irritants

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From data to action

• Advocacy relies on facts/data for credibility
• Surveillance carries responsibility for action
• Collaboration provides opportunities
• Advocates have ammunition
• Surveillance relies on partners to use data
• Precaution action before absolute proof

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Advocating for Healthy Schools the Boston Urban
Asthma Coalitions Healthy Schools Platform

• Presented by Jean Zotter, BUAC and Tolle
  Graham, MassCOSH

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We know what the problem is and we have the
findings, so why does it take so long to get
repairs done? It should be about the health of
our children, yet why does it take so long? The
money should be in the budget to fix our
schools. - Mary White, BUAC Parent Leader,
parent of two BPS students, on fixing our school
buildings
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Boston Public Schools

• 144 schools 56,190 students
• 71 qualify for free or reduced school meals
• Asthma rate 7
• Range 0 - 27
• Teachers - 3rd most frequently observed
  occupation among cases of WRA in OHSP data in
  Mass.

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Student Body by Race
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Asthma in Boston

• Child asthma rate
• Hospitalization
• ? state average
• ? 44 since 1994
• Health disparities have not changed at all!

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• I got adult onset of asthma, I believe, from
  working in a sick school building with a roof
  that was leaking and mold all over. I went on
  daily medication to deal with my breathing
  problems. Now, three years away from that
  building and working in another school, I no
  longer need my asthma meds. School buildings
  that are not maintained are a health problem for
  students and staff.
• -Sue Trotz, Boston School Guidance Councilor

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Boston Urban Asthma Coalition

• The Boston Urban Asthma Coalition aims to promote
  collaboration between organizations and residents
  concerned about the various factors that affect
  asthma such as the environment, quality of health
  care, access to health care, and education. This
  Collaboration taps into the expertise and
  resources of these city residents and
  organizations through advocacy and educational
  projects. In addition, it strengthens, personally
  and professionally, the network of people
  addressing the severity, morbidity, and mortality
  of asthma.

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BUAC Healthy Schools Committee

• Chair, Tolle Graham of MassCOSH
• Parents
• BUAC Strengthening Voices Project
• Community Partners
• Boston Teachers Union
• Custodial Union
• City Councilor Chuck Turner

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BUAC School Platform

• Process 2002
• 1 planning year
• 8 town hall meetings
• Parent input key
• Open forum without fear of retaliation

• Focus
• Community platform own identity
• Open communication with city partners
• Tightrope activism and collaboration

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Platform Demands

• Comply with 1996 city inspection ordinance
• Support environmental committees
• Comply with state IPM law
• Use safer cleaning products and decent equipment
• Retrofit School Buses
• Have a nurse in every school
• Participate in Community/City Taskforce
• Prioritize repairs for health
• Conduct independent report on school conditions
  and cost

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BUACs reportWhos Sick at School Linking
Environmental Conditions and Health Disparities
for Bostons Children____________________________
___________

• Findings
• Higher asthma in schools with IAQ problems
• Cause unclear
• Schools with problems have vulnerable populations

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• One of the major concerns at the Curley is that
  the building needs to be pointed.  We have been
  on a list for 4 years and the project always gets
  postponed.  We have water that makes its way into
  the building causing leaks, paint to flake and
  fall on students and teachers, and dust to cover
  the radiators.  As a result many of our students
  with asthma are affected--so many have poor
  attendance because they are out a lot and as a
  result their grades suffer.
•  
• -Geraldo Martinez, Principal
• Mary E.Curley Middle School

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Top ten schools Ranked by percentage of rooms
with environmental problems
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Parents Speak at Boston City Council Hearing
about Leaks and Mold in their school.
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BUAC receives recognition from Boston City
Council for efforts to improve health conditions
in Boston schools.
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Looking Ahead

• Embed environmental health in infrastructure of
  school system
• Environmental Health Index
• Wellness Policies
• Whole School Improvement Plans
• Share model with others

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Keys to Success

• Keep community identity
• Provide open forum with no retaliation
• Maintain respect of city
• Challenge city but also advocate for resources
• Have city council ally

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Resources

• MA Healthy Schools Network www.masscosh.org
• Boston Urban Asthma Coalition www.buac.org
• National Healthy Schools Network
  www.healthyschools.org