Original Article
Asthma Prevalence and Mold Levels in US Northeastern Schools

https://doi.org/10.1016/j.jaip.2020.10.012Get rights and content

Background

Asthma is among the most common chronic diseases of children in the United States (US). Mold exposures have been linked to asthma development and exacerbation. In homes, mold exposures have been quantified using the Environmental Relative Moldiness Index (ERMI), and higher home ERMI values have been linked to occupant asthma.

Objective

In this analysis of the School Inner-City Asthma Study (SICAS), we aimed to evaluate the ERMI's applicability to measuring mold in schools compared with homes and to examine the prevalence of asthma in relationship to students' demographics and the physical characteristics of school buildings.

Methods

Northeastern US schools (n = 32) and homes (n = 33) were selected, and the 36 ERMI molds were quantified in a dust sample from each classroom (n = 114) or home. School building characteristics data were collected from SICAS. Asthma prevalence and student demographics data were obtained from government websites. Linear regression and mixed models were fit to assess the association of the current asthma prevalence and physical characteristics of the school, make-up of the student body, and the ERMI metric.

Results

Levels of outdoor group 2 molds were significantly (P < .01) greater in schools compared with homes. The presence of air-conditioning in school buildings correlated significantly (P = .02) with lower asthma prevalence.

Conclusion

The prevalence of asthma in student bodies is associated with many factors in schools and homes.

Section snippets

Recruitment and data collection

The School Inner-City Asthma Intervention Study 2 (SICAS 2) is a randomized, controlled clinical trial using environmental interventions modeled from successful home-based interventions. The SICAS 2 study was approved by the Institutional Review Board of Boston Children's Hospital. The description of SICAS 2 study methods and data collection details have been previously published.14,15

This arm of the SICAS 2 study was limited to the investigation of 32 schools in school years 2014 through 2018,

Results

Table I presents the geometric means for each of 36 ERMI molds in the schools (n = 32) compared with homes (n = 33). In schools, 11.5% (3 of 26) of the group 1 molds were significantly higher than in homes, whereas in homes, 15.4% (4 of 26) of the group 1 molds were significantly higher than in schools. However, 60.0% (6 of 10) of the group 2 molds in schools were significantly higher than in homes, but only 10.0% (1 of 10) of the group 2 molds in homes were significantly higher than in schools.

Discussion

The ERMI metric was previously used in a study of 1 school in the northeast United States, Springfield, MA.28 This school was the subject of a Health Impact Assessment conducted by the US Environmental Protection Agency because the school had a long history of water problems. Visible mold growth was observed on the first level and wet carpeting was detected on the second and third levels of this school. High ERMI values, as well as high group 1 and group 2 mold levels, were measured in many of

Acknowledgments

We would like to thank the schools and families that participated in this study.

Notice

The US Environmental Protection Agency (EPA) through its Office of Research and Development collaborated in the research described here. Although this work was reviewed by the EPA and approved for publication, it may not necessarily reflect official EPA policy. Mention of trade names or commercial products does not constitute endorsement or recommendation by the EPA for use. Also, ATSDR does not endorse the

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    This work was supported by the National Institutes of Health; grant number (awardee); K23 AI123517 (P. Permaul), K23 AI143962 (L. M. Bartnikas), K23 AI104780 (W. J. Sheehan), R01 ES030100 (J. M. Gaffin), R01 AI144119 (P. S. Lai), R01 AI073964, R01 AI073964-02S1, K24 AI106822, U10 HL098102, U01 AI110397, R01 HL137192, and U19AR06952 (W. Phipatanakul). This work was also supported by the cooperative agreement award number 1 NU61TS000296-01-00 from the Agency for Toxic Substances and Disease Registry (ATSDR) (M. Hauptman). The US Environmental Protection Agency (EPA) supports the Pediatric Environmental Health Specialty Unit (PEHSU) by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701.

    Conflicts of interest: W. Phipatanakul is the consultant/advisor for Genentech/Novartis, Sanofi, Regeneron, and Astra Zeneca; and receives trial support from Genentech, Novartis, Sanofi, Regeneron, Merck, Circassia Alk Abello, Lincoln Diagnostics, Monaghen, and Thermo Fisher. The rest of the authors declare that they have no relevant conflicts of interest.

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