Dampness and mold in homes across China: Associations with rhinitis,ocular, throat and dermal symptoms,headache and fatigue among adults

We studied dampness and mold in China in relation to rhinitis, ocular, throat and dermal symptoms, headache and fatigue. A questionnaire study was performed in six cities including 36 541 randomized parents of young children. Seven self‐reported signs of dampness were evaluated. Multilevel logistic regression models were used to calculate odds ratios (ORs). Totally, 3.1% had weekly rhinitis, 2.8% eye, 4.1% throat and 4.8% skin symptoms, 3.0% headache and 13.9% fatigue. Overall, 6.3% of the homes had mold, 11.1% damp stains, 35.3% damp bed clothing, 12.8% water damage, 45.4% window pane condensation, 11.1% mold odor, and 37.5% humid air. All dampness signs were associated with symptoms (ORs from 1.2 to 4.6; P < 0.001), including rhinitis (ORs from 1.4 to 3.2; P < 0.001), and ORs increased by number of dampness signs. The strongest associations were for mold odor (ORs from 2.3 to 4.6) and humid air (ORs from 2.8 to 4.8). Associations were stronger among men and stronger in Beijing as compared to south China. In conclusion, dampness and mold are common in Chinese homes and associated with rhinitis and ocular, throat and dermal symptoms, headache and fatigue. Men can be more sensitive to dampness and health effects of dampness can be stronger in northern China.     

Onset and remission of rhinitis among students in relation to the home and school environment—A cohort study from Northern China

Few prospective studies exist on indoor and outdoor air pollution in relation to adolescent rhinitis. We studied associations between onset and remission of rhinitis among junior high school students in relation to the home and school environment. A 2‐year questionnaire cohort study was performed among 1325 students (11‐15 years) in eight schools in Taiyuan, Northern China. Climate and air pollution were measured by direct reading instruments and passive samplers inside and outside the schools at baseline. Associations were calculated by multilevel logistic regression. Two‐year onset of rhinitis and weekly rhinitis were 26.7% and 13.1%, respectively. RH (P < 0.001), CO₂ (P < 0.01) and PM₁₀ (P < 0.01) in the classrooms, PM₁₀ (P < 0.01) and NO₂ (P < 0.05) outside the schools, and redecoration (OR = 2.25) and dampness/indoor mold at home (OR = 2.04) were associated with onset of weekly rhinitis. RH (P < 0.05) and CO₂ (P < 0.05) in the classroom and dampness/indoor mold (OR = 0.67) and environmental tobacco smoke (ETS) at home (OR = 0.63) reduced remission of rhinitis. In conclusion, dampness/mold and chemical emissions from new materials at home can increase onset of rhinitis and ETS and dampness/mold can reduce the remission. PM₁₀, RH, CO₂, and NO₂ at school can increase the onset, and RH and CO₂ can reduce the remission of rhinitis.     

The home environment in a nationwide sample of multi-family buildings in Sweden: associations with ocular,nasal, throat and dermal symptoms,headache, and fatigue among adults

Risk factors at home for ocular, nasal, throat and dermal symptoms, headache, and fatigue were studied in a nationwide questionnaire survey in Sweden, the BETSI study in 2006. Totally, 5775 adults from a stratified random sample of multi-family buildings participated. Associations between home environment factors and weekly symptoms were analyzed by multi-level logistic regression. In total, 8.3% had ocular symptoms; 11.9% nasal symptoms; 7.1% throat symptoms; 11.9% dermal symptoms; 8.5% headache and 23.1% fatigue. Subjects in colder climate zones had more mucosal and throat symptoms but less fatigue and ocular symptoms. Rented apartments had poorer indoor environment than self-owned apartments. Those living in buildings constructed from 1961 to 1985 had most symptoms. Building dampness, mold and mold odor were risk factors, especially headache and ocular symptoms. Lack of mechanical ventilation system was another risk factor, especially for headache. Environmental tobacco smoke (ETS), electric radiators, and crowdedness were other risk factors. Oiled wooden floors, recent indoor painting, and new floor materials were negatively associated with symptoms. In conclusion, building dampness, mold, poor ventilation conditions, crowdedness, ETS, and emissions from electric radiators in apartments in Sweden can increase the risk of ocular, nasal, throat and dermal symptoms, headache, and fatigue.     

Associations of indoor carbon dioxide concentrations,air temperature,and humidity with perceived air quality and sick building syndrome symptoms in Chinese homes

The indoor environment influences occupants’ health. From March 1, 2018, to February 28, 2019, we continuously monitored indoor temperature (T), relative humidity (RH), and CO₂ concentration in bedrooms via an online system in 165 residences that covered all five climate zones of China. Meanwhile, we asked one specific occupant in each home to complete questionnaires about perceived air quality and sick building syndrome (SBS) symptoms at the end of each month. Higher CO₂ concentration was significantly associated with a higher percentage of perceived stuffy odor and skin SBS symptoms. Higher relative humidity was associated with higher percentage of perceived moldy odor and humid air, while lower RH was associated with a higher percentage of perceived dry air. Occupants who lived in residences with high RH were less likely to have mucosal and skin SBS symptoms (adjusted odds ratio (AOR): 0.73–0.78). However, the benefit of high humidity for perceived dry air and skin dryness symptoms is weaker if there is a high CO₂ concentration level.     

Home dampness,childhood asthma,hay fever,and airway symptoms in Shanghai,China: associations,dose‐response relationships,and lifestyle's influences

Numerous studies of associations between dampness and respiratory diseases have been conducted, but their implications remain inconclusive. In this study of 13,335 parent‐reported questionnaires (response rate: 85.3%), we analyzed associations between home dampness and asthma and related symptoms in 4‐ to 6‐year‐old children in a cross‐sectional study of Shanghai. Indicators of home dampness were strongly and significantly associated with dry cough, wheeze, and rhinitis symptoms. In the current residence, children with visible mold spots (VMS) exposure had 32% higher risk of asthma (adjusted OR, 95% CI: 1.32, 1.07–1.64); damp clothing and/or bedding (frequently) was strongly associated with dry cough (1.78, 1.37–2.30); condensation on windows was strongly associated with hay fever (1.60, 1.27–2.01). In the early‐life residence, VMS or damp stains (frequently) were strongly associated with dry cough (2.20, 1.55–3.11) and rhinitis ever (1.57, 1.11–2.21). Associations between dampness and diseases among children with or without family history of atopy were similar. The total number of dampness indicators had strong dose‐response relationships with investigated health outcomes. Actions, including opening windows of the child's room at night and cleaning the child's room frequently, could potentially mitigate 25% of home VMS, thereby preventing more than 1.5% of attributable risk of the studied symptoms.     

Breastfeeding modifies the effects of environment tobacco smoke exposure on respiratory diseases and symptoms in Chinese children: the Seven Northeast Cities Study

To evaluate the potential effect of interaction between breastfeeding and environmental tobacco smoke (ETS) exposure on respiratory health, we studied 31 049 children (aged 2–14 years) from 25 districts of seven cities in northeast China. Parents of the children completed standardized questionnaires that characterized the children's histories of respiratory symptoms and illness, feeding methods, ETS exposure, and other associated risk factors. Breastfeeding was defined as having been mainly breastfed for 3 months or more. The results showed that the association of ETS exposure with childhood respiratory conditions/diseases was modified by breastfeeding, and the association for nonbreastfed children was stronger than that for breastfed children. In particular, for nonbreastfed children, the odds ratios (ORs) for the effect of current ETS exposure asthma was 1.71 (95% CI: 1.43–2.05); however, the OR for breastfed children was 1.33 (95% CI: 1.20–1.48), indicating that the interactions between breastfeeding and current ETS exposure on asthma were statistically significant (P = 0.019). When stratified by school (kindergarten vs. elementary school), breastfeeding was more protective for asthma‐related symptoms among children from kindergarten. In conclusion, this study shows that breastfeeding is associated with smaller associations between ETS exposure and respiratory conditions in children, suggesting that breastfeeding reduces susceptibility to the respiratory effects of ETS.     

Effects of environmental tobacco smoke on respiratory health of boys and girls from kindergarten: results from 15 districts of northern China

The effects of childhood environmental tobacco smoke (ETS) exposure on respiratory symptoms were investigated in 6053 kindergarten-aged children residing in 15 districts of northern China. Responses to a self-administered questionnaire completed by parents of children from 30 kindergartens were used to ascertain children with persistent cough, persistent phlegm, asthma symptom, current asthma, wheeze and wheeze without asthma. In first 2 years ETS exposure and current ETS exposure were associated with increased prevalence of persistent cough, persistent phlegm, wheeze and wheeze without asthma. Among boys, ETS exposure was associated with more respiratory symptoms and diseases than in girls. ETS exposure during pregnancy was associated with asthma symptom [odds ratio (OR), 3.00; 95% confidence interval (CI): 1.28-7.03], current asthma (OR, 3.38; 95% CI: 1.25-9.14), persistent cough (OR, 1.64; 95% CI: 1.13-2.37), persistent phlegm (OR, 1.74; 95% CI: 1.01-3.01), wheeze (OR, 1.75; 95% CI: 1.15-2.68), and wheeze without asthma (OR, 1.46; 95% CI: 1.01-2.37) only among boys. In boys, the adjusted ORs for increased risk of asthma symptom and current asthma for household exposures (> or =10 cigarettes smoked per day vs. none smoked) during workday were 2.04 (95% CI: 1.01-3.89) and 2.76 (95% CI: 1.06-9.58), respectively. We conclude that ETS exposure increases the occurrence of respiratory symptoms and diseases during childhood. Boys may be more susceptible to ETS than girls. PRACTICAL IMPLICATIONS: Environmental tobacco smoke (ETS) is a highly prevalent respiratory irritant. In agreement with previous cross-sectional studies, our study indicates that exposure to ETS may increase the occurrence of respiratory symptoms and diseases in children, and the association of ETS exposure and respiratory health of children increased in strength with number of cigarettes smoked inside the house per day during workday and day-off. Boys may be more susceptible to ETS than girls. These findings support the view that measures should be taken to reduce ETS exposure for children.     

Asthma‐related outcomes associated with indoor air pollutants among schoolchildren from four informal settlements in two municipalities in the Western Cape Province of South Africa

The health impact of indoor air pollution in informal settlement households has not been extensively studied in South Africa. This cross‐sectional study investigated the association between asthma and common indoor exposures among schoolchildren from four informal settlements located in two municipalities in the Western Cape Province. A total of 590 children, aged 9‐11 years, were recruited. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered to caregivers. Pulmonary function assessment included spirometry and fractional exhaled nitric oxide (FeNO). Phadiatop test for atopy was done. The prevalence of doctor‐diagnosed asthma was 3.4% (n = 20) among whom only 50% were on treatment. The prevalence of current wheeze was 12.9%, and 17.6% had airway obstruction (FEV₁ < lower limit of normal), while 10.2% had airway inflammation (FeNO > 35 ppb). In adjusted logistic regression models, dampness, visible mold growth, paraffin use for cooking, and passive smoking were associated with a twofold to threefold increased risk in upper and lower airway outcomes. The strongest association was that of visible mold growth with rhinitis (adjusted odds ratio—aOR 3.37, 95% CI: 1.69‐6.71). Thus, there is a need for improved diagnosis of childhood asthma and Indoor Air Quality in informal settlement households.     

House characteristics and condition as determinants of visible mold and musty odor: Results from three New Zealand House Condition Surveys in 2005, 2010, and 2015

This study assessed associations between house characteristics and mold and musty odor, using data from three consecutive (2005, 2010, and 2015) New Zealand House Condition Surveys, involving a total of 1616 timber-framed houses. Mold, musty odor, and house characteristics were assessed by independent building inspectors. We used multivariate logistic regression analyses mutually adjusted for other house characteristics for each survey separately. Positive and independent associations were found with tenure, ventilation, insulation, and envelope condition for both mold in living and bedrooms and musty odor. In particular, we found significant dose-response associations with envelope condition, ventilation, and insulation. Odds of mold increased 2.4–15.9 times (across surveys) in houses with the worst building envelope condition (BEC; p < 0.05–0.001 for trend); optimal ventilation reduced the risk of mold by 60% and the risk of musty odor by 70%–90% (p < 0.01 for trend). Other factors associated with mold and musty odor included: tenure, with an approximate doubling of odds of mold across surveys; and insulation with consistent dose-response patterns in all outcomes and surveys tested (p < 0.05 for trend in two surveys with mold and one survey for odor). In conclusion, this study showed the importance of BEC, ventilation, and insulation to avoiding harmful damp-related exposures.     

Building-related respiratory symptoms can be predicted with semi-quantitative indices of exposure to dampness and mold

Using a semi-quantitative mold exposure index, the National Institute for Occupational Safety and Health (NIOSH) investigated 13 college buildings to examine whether building-related respiratory symptoms among employees are associated with environmental exposure to mold and dampness in buildings. We collected data on upper and lower respiratory symptoms and their building-relatedness, and time spent in specific rooms with a self-administered questionnaires. Trained NIOSH industrial hygienists classified rooms for water stains, visible mold, mold odor, and moisture using semi-quantitative scales and then estimated individual exposure indices weighted by the time spent in specific rooms. The semi-quantitative exposure indices significantly predicted building-related respiratory symptoms, including wheeze [odds ratio (OR) = 2.3; 95% confidence interval (CI) = 1.1-4.5], chest tightness (OR = 2.2; 95% CI = 1.1-4.6), shortness of breath (OR = 2.7; 95% CI = 1.2-6.1), nasal (OR = 2.5; 95% CI = 1.3-4.7) and sinus (OR = 2.2; 95% CI = 1.2-4.1) symptoms, with exposure-response relationships. We found that conditions suggestive of indoor mold exposure at work were associated with building-related respiratory symptoms. Our findings suggest that observational semi-quantitative indices of exposure to dampness and mold can support action to prevent building-related respiratory diseases. PRACTICAL IMPLICATIONS: Current air sampling methods have major limitations in assessing exposure to mold and other biological agents that may prevent the demonstration of associations of bioaerosol exposure with health. Our study demonstrates that semi-quantitative dampness/mold exposure indices, based solely on visual and olfactory observation and weighted by time spent in specific rooms, can predict existence of excessive building-related respiratory symptoms and diseases. Relative extent of water stains, visible mold, mold odor, or moisture can be used to prioritize remediation to reduce potential risk of building-related respiratory diseases. From a public health perspective, these observational findings justify action to correct water leaks and repair water damage in order to prevent building-related respiratory diseases. This approach can also be a basis for developing practical building-diagnostic tools for water-incursion.     

Association of Personal and Workplace Characteristics with Health,Comfort And Odor: A Survey of 3948 Office Workers in Three Buildings

A questionnaire on health symptoms, workplace conditions, and perceived indoor air quality was administered to 3948 employees of the Environmental Protection Agency in Washington, DC in the winter of 1989. The main goal was to determine the personal or workplace characteristics associated with health symptoms. A principal components analysis of 32 health symptoms identified 12 health factors. Each factor was generally associated with a particular body system (eyes, nose, throat, chest, central nervous system, etc.). The 12 health factors were regressed linearly on the 50-100 personal, workplace, and spatial characteristics identified from the questionnaire and building blueprints. Significant variables (p < 0.01) were included in a second logistic regression to determine a final model. Eleven variables were associated with multiple health factors. The main workplace variables were dust and glare. Personal characteristics of importance were mold allergies and sensitivity to chemicals. Among women, lack of a college degree was an important factor. Air quality factors of importance included hot stuffy air and dry air: The odor of paint and other chemicals, and the odor of cosmetics were also associated with four or more of the health factors. Two measures of stress – heavy workload and conflicting demands – were also associated with several health factors.     

Higher measured moisture in California homes with qualitative evidence of dampness

Relationships between measured moisture and qualitative dampness indicators (mold odor, visible mold, visible water damage, or peeling paint) were evaluated using data collected from California homes in a prospective birth cohort study when the infants were 6 or 12 months of age (737 home visits). For repeated visits, agreement between observation of the presence/absence of each qualitative indicator at both visits was high (71–87%, P < 0.0001). Among individual indicators, musty odor and visible mold were most strongly correlated with elevated moisture readings. Measured moisture differed significantly between repeated visits in opposite seasons (P < 0.0001), and dampness increased with the number of indicators in a home. Linear mixed‐effect models showed that 10‐unit increases in maximum measured moisture were associated with the presence of 0.5 additional dampness indicators (P < 0.001). Bedroom (BR) walls were damper than living room (LR) walls in the same homes (P < 0.0001), although both average and maximum readings were positively correlated across room type (r = 0.75 and 0.67, respectively, both P < 0.0001). Exterior walls were significantly damper than interior walls (P < 0.0001 in both LRs and BRs), but no differences were observed between maximum wall readings and measurements at either window corners or sites of suspected dampness.     

Microbial secondary metabolites in homes in association with moisture damage and asthma

We aimed to characterize the presence of microbial secondary metabolites in homes and their association with moisture damage, mold, and asthma development. Living room floor dust was analyzed by LC‐MS/MS for 333 secondary metabolites from 93 homes of 1‐year‐old children. Moisture damage was present in 15 living rooms. At 6 years, 8 children had active and 15 lifetime doctor‐diagnosed asthma. The median number of different metabolites per house was 17 (range 8–29) and median sum load 65 (4–865) ng/m². Overall 42 different metabolites were detected. The number of metabolites present tended to be higher in homes with mold odor or moisture damage. The higher sum loads and number of metabolites with loads over 10 ng/m² were associated with lower prevalence of active asthma at 6 years (aOR 0.06 (95% CI <0.001–0.96) and 0.05 (<0.001–0.56), respectively). None of the individual metabolites, which presence tended (P < 0.2) to be increased by moisture damage or mold, were associated with increased risk of asthma. Microbial secondary metabolites are ubiquitously present in home floor dust. Moisture damage and mold tend to increase their numbers and amount. There was no evidence indicating that the secondary metabolites determined would explain the association between moisture damage, mold, and the development of asthma.     

Chloroanisoles may explain mold odor and represent a major indoor environment problem in Sweden

Indoor mold odor is associated with adverse health effects, but the microbial volatiles underlying mold odor are poorly described. Here, chloroanisoles were studied as potential key players, being formed by microbial metabolism of chlorophenols in wood preservatives. Using a three‐stage approach, we (i) investigated the occurrence of chloroanisoles in buildings with indoor air quality problems, (ii) estimated their frequency in Sweden, and (iii) evaluated the toxicological risk of observed chloroanisole concentrations. Analyses of 499 building materials revealed several chloroanisole congeners in various types of buildings from the 1950s to 1970s. Evaluation of Swedish records from this time period revealed three coinciding factors, namely an unprecedented nationwide building boom, national regulations promoting wood preservatives instead of moisture prevention, and use of chlorophenols in these preservatives. Chlorophenols were banned in 1978, yet analysis of 457 indoor air samples revealed several chloroanisole congeners, but at median air levels generally below 15 ng/m³. Our toxicological evaluation suggests that these concentrations are not detrimental to human health per se, but sufficiently high to cause malodor. Thereby, one may speculate that chloroanisoles in buildings contribute to adverse health effects by evoking odor which, enhanced by belief of the exposure being hazardous, induces stress‐related and inflammatory symptoms.     

Wellbuilt for wellbeing: Controlling relative humidity in the workplace matters for our health

This study offers a new perspective on the role of relative humidity in strategies to improve the health and wellbeing of office workers. A lack of studies of sufficient participant size and diversity relating relative humidity (RH) to measured health outcomes has been a driving factor in relaxing thermal comfort standards for RH and removing a lower limit for dry air. We examined the association between RH and objectively measured stress responses, physical activity (PA), and sleep quality. A diverse group of office workers (n = 134) from four well-functioning federal buildings wore chest-mounted heart rate variability monitors for three consecutive days, while at the same time, RH and temperature (T) were measured in their workplaces. Those who spent the majority of their time at the office in conditions of 30%-60% RH experienced 25% less stress at the office than those who spent the majority of their time in drier conditions. Further, a correlational study of our stress response suggests optimal values for RH may exist within an even narrower range around 45%. Finally, we found an indirect effect of objectively measured poorer sleep quality, mediated by stress responses, for those outside this range.     

The effects of building‐related factors on classroom relative humidity among North Carolina schools participating in the ‘Free to Breathe,Free to Teach’ study

Both high and low indoor relative humidity (RH) directly impact Indoor Air Quality (IAQ), an important school health concern. Prior school studies reported a high prevalence of mold, roaches, and water damage; however, few examined associations between modifiable classroom factors and RH, a quantitative indicator of dampness. We recorded RH longitudinally in 134 North Carolina classrooms (n = 9066 classroom‐days) to quantify the relationships between modifiable classroom factors and average daily RH below, within, or above levels recommended to improve school IAQ (30–50% or 30–60% RH). The odds of having high RH (>60%) were 5.8 [95% Confidence Interval (CI): 2.9, 11.3] times higher in classrooms with annual compared to quarterly heating, ventilating, and air‐conditioning (HVAC) system maintenance and 2.5 (95% CI: 1.5, 4.2) times higher in classrooms with HVAC economizers compared to those without economizers. Classrooms with direct‐expansion split systems compared to chilled water systems had 2.7 (95% CI: 1.7, 4.4) times higher odds of low RH (<30%). When unoccupied, classrooms with thermostat setbacks had 3.7 (95% CI: 1.7, 8.3) times the odds of high RH (>60%) of those without setbacks. This research suggests actionable decision points for school design and maintenance to prevent high or low classroom RH.     

Building‐related health symptoms and classroom indoor air quality: a survey of school teachers in New York State

Most previous research on indoor environments and health has studied school children or occupants in non‐school settings. This investigation assessed building‐related health symptoms and classroom characteristics via telephone survey of New York State school teachers. Participants were asked about 14 building‐related symptoms and 23 classroom characteristics potentially related to poor indoor air quality (IAQ). Poisson regression analysis was used to assess the relationship between these symptoms and each classroom characteristic, controlling for potential confounders. About 500 teachers completed the survey. The most frequently reported classroom characteristics included open shelving (70.7%), food eaten in class (65.5%), dust (59.1%), and carpeting (46.9%). The most commonly reported symptoms included sinus problems (16.8%), headache (15.0%), allergies/congestion (14.8%), and throat irritation (14.6%). Experiencing one or more symptoms was associated most strongly with reported dust (relative risk (RR) = 3.67; 95% confidence interval (CI): 2.62–5.13), dust reservoirs (RR = 2.13; 95% CI: 1.72–2.65), paint odors (RR = 1.73; 95% CI: 1.40–2.13), mold (RR = 1.71; 95% CI: 1.39–2.11), and moldy odors (RR = 1.65 95% CI: 1.30–2.10). Stronger associations were found with increasing numbers of reported IAQ‐related classroom characteristics. Similar results were found with having any building‐related allergic/respiratory symptom. This research adds to the body of evidence underscoring the importance to occupant health of school IAQ.     

Meta-analyses of the associations of respiratory health effects with dampness and mold in homes

The Institute of Medicine (IOM) of the National Academy of Sciences recently completed a critical review of the scientific literature pertaining to the association of indoor dampness and mold contamination with adverse health effects. In this paper, we report the results of quantitative meta-analyses of the studies reviewed in the IOM report plus other related studies. We developed point estimates and confidence intervals (CIs) of odds ratios (ORs) that summarize the association of several respiratory and asthma-related health outcomes with the presence of dampness and mold in homes. The ORs and CIs from the original studies were transformed to the log scale and random effect models were applied to the log ORs and their variance. Models accounted for the correlation between multiple results within the studies analyzed. Central estimates of ORs for the health outcomes ranged from 1.34 to 1.75. CIs (95%) excluded unity in nine of 10 instances, and in most cases the lower bound of the CI exceeded 1.2. Based on the results of the meta-analyses, building dampness and mold are associated with approximately 30-50% increases in a variety of respiratory and asthma-related health outcomes. PRACTICAL IMPLICATIONS: The results of these meta-analyses reinforce the IOM's recommendation that actions be taken to prevent and reduce building dampness problems, and also allow estimation of the magnitude of adverse public health impacts associated with failure to do so.     

Associations between ventilation and children’s asthma and allergy in naturally ventilated Chinese homes

Building ventilation is important for occupants’ health. There are few studies of associations between home ventilation and occupant's health in China. During 2013-2016, we measured ventilation in 399 homes in Tianjin and Cangzhou, China, and surveyed the health history of children. Ventilation rates were measured using mass balance of occupant generated CO₂. The associations of home ventilation with children's asthma and allergy were analyzed in different strata of time and space. A low bedroom ventilation at night was significantly associated with an increased proportion of rhinitis among children (rhinitis current, adjusted odds ratio (AOR): 1.59; 95% confidence interval (CI): 1.01-2.49; diagnosed rhinitis, AOR: 3.02 (1.16-7.89)). Our findings suggest a dose-response relationship between ventilation rate at night in children's bedrooms and rhinitis current. The night-time ventilation rate in bedrooms has a greater association with rhinitis than the whole home ventilation rate during daytime.     

Indoor visible mold and mold odor are associated with new‐onset childhood wheeze in a dose‐dependent manner

Evidence is accumulating that indoor dampness and mold are associated with the development of asthma. The underlying mechanisms remain unknown. New Zealand has high rates of both asthma and indoor mold and is ideally placed to investigate this. We conducted an incident case‐control study involving 150 children with new‐onset wheeze, aged between 1 and 7 years, each matched to two control children with no history of wheezing. Each participant's home was assessed for moisture damage, condensation, and mold growth by researchers, an independent building assessor and parents. Repeated measures of temperature and humidity were made, and electrostatic dust cloths were used to collect airborne microbes. Cloths were analyzed using qPCR. Children were skin prick tested for aeroallergens to establish atopy. Strong positive associations were found between observations of visible mold and new‐onset wheezing in children (adjusted odds ratios ranged between 1.30 and 3.56; P ≤ .05). Visible mold and mold odor were consistently associated with new‐onset wheezing in a dose‐dependent manner. Measurements of qPCR microbial levels, temperature, and humidity were not associated with new‐onset wheezing. The association between mold and new‐onset wheeze was not modified by atopic status, suggesting a non‐allergic association.