Coarse particulate matter and airborne endotoxin within wood stove homes

Emissions from indoor biomass burning are a major public health concern in developing areas of the world. Less is known about indoor air quality, particularly airborne endotoxin, in homes burning biomass fuel in residential wood stoves in higher income countries. A filter‐based sampler was used to evaluate wintertime indoor coarse particulate matter (PM_10‐2.5) and airborne endotoxin (EU/m³, EU/mg) concentrations in 50 homes using wood stoves as their primary source of heat in western Montana. We investigated number of residents, number of pets, dampness (humidity), and frequency of wood stove usage as potential predictors of indoor airborne endotoxin concentrations. Two 48‐h sampling events per home revealed a mean winter PM_10‐2.5 concentration (± s.d.) of 12.9 (± 8.6) μg/m³, while PM_2.5 concentrations averaged 32.3 (± 32.6) μg/m³. Endotoxin concentrations measured from PM_10‐2.5 filter samples were 9.2 (± 12.4) EU/m³ and 1010 (± 1524) EU/mg. PM_10‐2.5 and PM_2.5 were significantly correlated in wood stove homes (r = 0.36, P < 0.05). The presence of pets in the homes was associated with PM_10‐2.5 but not with endotoxin concentrations. Importantly, none of the other measured home characteristics was a strong predictor of airborne endotoxin, including frequency of residential wood stove usage.     

Students' school-level symptoms mediate the relationship between a school's observed moisture problems and students’ subjective perceptions of indoor air quality

Moisture damage can influence the subjective assessment of indoor air quality (subjective IAQ) in various ways. We studied whether the frequency of symptoms reported across students at school level mediates the relationship between observed mold and dampness in a school building and students’ subjective IAQ. To answer this research question, we tested a multilevel path model. The analyzed data were created by merging two nationwide data sets: (a) survey data from students, including information on subjective IAQ (N = 24,786 students); (b) data from schools, including information on mold and dampness in a school building (N = 222). After the background variables were adjusted, schools’ observed mold and dampness were directly and significantly related to poor subjective IAQ (standardized beta (β)= 0.22, P = .002). In addition, in schools with mold and dampness, students reported significantly more symptoms (β = 0.22, P = .023) than in schools without; the higher the prevalence of symptoms at school level, the worse the students’ subjective IAQ (β = 0.60, P < .001). This indirect path was significant (P = .023). In total, schools’ observed mold and dampness and student-reported symptoms explained 52% of the between-school variance in subjective IAQ.     

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.     

Usage and impacts of the Envirofit HM‐5000 cookstove

Burning solid fuels to fulfill daily household energy needs results in chronic exposure to household air pollution (HAP), which is among the world's greatest health risks. This paper presents the results of a cross‐sectional study of cookstove usage, fuel consumption, and indoor PM_2.5 concentrations in rural and urban Honduran homes cooking with the Envirofit HM‐5000 metal plancha stove (n = 32) as compared to control households using baseline cooking technologies (n = 33). Temperature‐based stove usage measurements showed high HM‐5000 acceptance, with significant displacement of the traditional cookstoves at both the urban (99%, P < .05) and rural study sites (75%, P < .05). However, longer‐term usage data collected in peri‐urban households showed that participants cooked on the HM‐5000 more frequently during the 3‐day monitoring period than during the following 3 weeks. Average indoor PM_2.5 was 66% lower in HM‐5000 households as compared to control households (P < .05). Lower indoor PM_2.5 concentrations observed in participant homes as compared to control households, supported by high usage and traditional stove displacement, suggest the potential for the HM‐5000 to yield health improvements in adopting Honduran households.     

Classroom ventilation and indoor air quality—results from the FRESH intervention study

Inadequate ventilation of classrooms may lead to increased concentrations of pollutants generated indoors in schools. The FRESH study, on the effects of increased classroom ventilation on indoor air quality, was performed in 18 naturally ventilated classrooms of 17 primary schools in the Netherlands during the heating seasons of 2010–2012. In 12 classrooms, ventilation was increased to targeted CO₂ concentrations of 800 or 1200 ppm, using a temporary CO₂ controlled mechanical ventilation system. Six classrooms were included as controls. In each classroom, data on endotoxin, β(1,3)‐glucans, and particles with diameters of <10 μm (PM₁₀) and <2.5 μm (PM_2.5) and nitrogen dioxide (NO₂) were collected during three consecutive weeks. Associations between the intervention and these measured indoor air pollution levels were assessed using mixed models, with random classroom effects. The intervention lowered endotoxin and β(1,3)‐glucan levels and PM₁₀ concentrations significantly. PM₁₀ for instance was reduced by 25 μg/m³ (95% confidence interval 13–38 μg/m³) from 54 μg/m³ at maximum ventilation rate. No significant differences were found between the two ventilation settings. Concentrations of PM_2.5 and NO₂ were not affected by the intervention. Our results provide evidence that increasing classroom ventilation is effective in decreasing the concentrations of some indoor‐generated pollutants.     

Developing a predictive model for fine particulate matter concentrations in low socio‐economic households in Durban,South Africa

In low‐resource settings, there is a need to develop models that can address contributions of household and outdoor sources to population exposures. The aim of the study was to model indoor PM_2.5 using household characteristics, activities, and outdoor sources. Households belonging to participants in the Mother and Child in the Environment (MACE) birth cohort, in Durban, South Africa, were randomly selected. A structured walk‐through identified variables likely to generate PM_2.5. MiniVol samplers were used to monitor PM_2.5 for a period of 24 hours, followed by a post‐activity questionnaire. Factor analysis was used as a variable reduction tool. Levels of PM_2.5 in the south were higher than in the north of the city (P < .05); crowding and dwelling type, household emissions (incense, candles, cooking), and household smoking practices were factors associated with an increase in PM_2.5 levels (P < .05), while room magnitude and natural ventilation factors were associated with a decrease in the PM_2.5 levels (P < .05). A reasonably robust PM_2.5 predictive model was obtained with model R² of 50%. Recognizing the challenges in characterizing exposure in environmental epidemiological studies, particularly in resource‐constrained settings, modeling provides an opportunity to reasonably estimate indoor pollutant levels in unmeasured homes.     

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.     

Concurrent assessment of personal,indoor, and outdoor PM2.5 and PM1 levels and source contributions using novel low-cost sensing devices

The intensity, frequency, duration, and contribution of distinct PM_2.5 sources in Asian households have seldom been assessed; these are evaluated in this work with concurrent personal, indoor, and outdoor PM_2.5 and PM₁ monitoring using novel low-cost sensing (LCS) devices, AS-LUNG. GRIMM-comparable observations were acquired by the corrected AS-LUNG readings, with R² up to 0.998. Twenty-six non-smoking healthy adults were recruited in Taiwan in 2018 for 7-day personal, home indoor, and home outdoor PM monitoring. The results showed 5-min PM_2.5 and PM₁ exposures of 11.2 ± 10.9 and 10.5 ± 9.8 µg/m³, respectively. Cooking occurred most frequently; cooking with and without solid fuel contributed to high PM_2.5 increments of 76.5 and 183.8 µg/m³ (1 min), respectively. Incense burning had the highest mean PM_2.5 indoor/outdoor (1.44 ± 1.44) ratios at home and on average the highest 5-min PM_2.5 increments (15.0 µg/m³) to indoor levels, among all single sources. Certain events accounted for 14.0%-39.6% of subjects’ daily exposures. With the high resolution of AS-LUNG data and detailed time-activity diaries, the impacts of sources and ventilations were assessed in detail.     

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.     

Indoor air quality in schools of a highly polluted south Mediterranean area

This study aimed at surveying lower secondary schools in southern Italy, in a highly polluted area. A community close to an industrial area and three villages in rural areas was investigated. Indoor temperature, relative humidity (RH), gaseous pollutants (CO₂ and NO₂), selected biological pollutants in indoor dust, and the indoor/outdoor mass concentration and elemental composition of PM_2.5 were ascertained. Temperature and RH were within, or close to, the comfort range, while CO₂ frequently exceeded the threshold of 1000 ppm, indicating inadequate air exchange rate. In all the classrooms, median NO₂ levels were above the WHO threshold value. Dermatophagoides p. allergen concentration was below the sensitizing threshold, while high endotoxin levels were detected in the classrooms, suggesting schools may produce significant risks of endotoxin exposure. Concentration and solubility of PM_2.5 elements were used to identify the sources of indoor particles. Indoor concentration of most elements was higher than outdoors. Resuspension was responsible for the indoor increase in soil components. For elements from industrial emission (Cd, Co, Ni, Pb, Sb, Tl, V), the indoor concentration depended on penetration from the outside. For these elements, differences in rural vs industrial concentrations were found, suggesting industrial sources may influence indoor air quality nearby schools.     

Indoor mold levels and current asthma among school‐aged children in Saskatchewan,Canada

Current knowledge regarding the association between indoor mold exposures and asthma is still limited. The objective of this case–control study was to investigate the relationship between objectively measured indoor mold levels and current asthma among school‐aged children. Parents completed a questionnaire survey of health history and home environmental conditions. Asthma cases had a history of doctor‐diagnosed asthma or current wheeze without a cold in the past 12 months. Controls were age‐ and sex‐matched to cases. Vacuumed dust samples were collected from the child's indoor play area and mattress. Samples were assessed for mold levels and quantified in colony‐forming units (CFU). Sensitization to mold allergens was also determined by skin testing. Being a case was associated with family history of asthma, pet ownership, and mold allergy. Mold levels (CFU/m²) in the dust samples of children's mattress and play area floors were moderately correlated (r = 0.56; P < 0.05). High mold levels (≥30 000 CFU/m²) in dust samples from play [adjusted odds ratio (aOR) = 2.6; 95% CI: 1.03–6.43] and mattress (aOR) = 3.0; 95% CI: 1.11–8.00) areas were significantly associated with current asthma. In this study high levels of mold are a risk factor for asthma in children.     

Classroom conditions and CO2 concentrations and teacher health symptom reporting in 10 New York State Schools

This study assessed the relationship between teacher‐reported symptoms and classroom carbon dioxide (CO₂) concentrations. Previous studies have suggested that poor indoor ventilation can result in higher levels of indoor pollutants, which may affect student and teacher health. Ten schools (9 elementary, 1 combined middle/high school) in eight New York State school districts were visited over a 4‐month period in 2010. Carbon dioxide concentrations were measured in classrooms over 48‐h, and teachers completed surveys assessing demographic information and self‐reported symptoms experienced during the current school year. Data from 64 classrooms (ranging from 1 to 9 per school) were linked with 68 teacher surveys (for four classrooms, two surveys were returned). Overall, approximately 20% of the measured classroom CO₂ concentrations were above 1000 parts per million (ppm), ranging from 352 to 1591 ppm. In multivariate analyses, the odds of reporting neuro‐physiologic (i.e., headache, fatigue, difficulty concentrating) symptoms among teachers significantly increased (OR = 1.30, 95% CI = 1.02–1.64) for every 100 ppm increase in maximum classroom CO₂ concentrations and were non‐significantly increased in classrooms with above‐median proportions of CO₂ concentrations greater than 1000 ppm (OR = 2.26, 95% CI = 0.72–7.12).     

Modeling microbial growth in carpet dust exposed to diurnal variations in relative humidity using the “Time-of-Wetness” framework

Resuspension of microbes in floor dust and subsequent inhalation by human occupants is an important source of human microbial exposure. Microbes in carpet dust grow at elevated levels of relative humidity, but rates of this growth are not well established, especially under changing conditions. The goal of this study was to model fungal growth in carpet dust based on indoor diurnal variations in relative humidity utilizing the time-of-wetness framework. A chamber study was conducted on carpet and dust collected from 19 homes in Ohio, USA and exposed to varying moisture conditions of 50%, 85%, and 100% relative humidity. Fungal growth followed the two activation regime model, while bacterial growth could not be evaluated using the framework. Collection site was a stronger driver of species composition (P = 0.001, R² = 0.461) than moisture conditions (P = 0.001, R² = 0.021). Maximum moisture condition was associated with species composition within some individual sites (P = 0.001-0.02, R² = 0.1-0.33). Aspergillus, Penicillium, and Wallemia were common fungal genera found among samples at elevated moisture conditions. These findings can inform future studies of associations between dampness/mold in homes and health outcomes and allow for prediction of microbial growth in the indoor environment.     

Wood stove use and other determinants of personal and indoor exposures to particulate air pollution and ozone among elderly persons in a Northern Suburb

A six‐month winter‐spring study was conducted in a suburb of the northern European city of Kuopio, Finland, to identify and quantify factors determining daily personal exposure and home indoor levels of fine particulate matter (PM_2.5, diameter <2.5 µm) and its light absorption coefficient (PM_2.5abs), a proxy for combustion‐derived black carbon. Moreover, determinants of home indoor ozone (O₃) concentration were examined. Local central site outdoor, home indoor, and personal daily levels of pollutants were monitored in this suburb among 37 elderly residents. Outdoor concentrations of the pollutants were significant determinants of their levels in home indoor air and personal exposures. Natural ventilation in the detached and row houses increased personal exposure to PM_2.5, but not to PM_2.5abs, when compared with mechanical ventilation. Only cooking out of the recorded household activities increased indoor PM_2.5. The use of a wood stove room heater or wood‐fired sauna stove was associated with elevated concentrations of personal PM_2.5 and PM_2.5abs, and indoor PM_2.5abs. Candle burning increased daily indoor and personal PM_2.5abs, and it was also a determinant of indoor ozone level. In conclusion, relatively short‐lasting wood and candle burning of a few hours increased residents’ daily exposure to potentially hazardous, combustion‐derived carbonaceous particulate matter.     

Indoor fine particulate matter and demographic,household, and wood stove characteristics among rural US homes heated with wood fuel

Household heating using wood stoves is common practice in many rural areas of the United States (US) and can lead to elevated concentrations of indoor fine particulate matter (PM_2.5). We collected 6-day measures of indoor PM_2.5 during the winter and evaluated household and stove-use characteristics in homes at three rural and diverse study sites. The median indoor PM_2.5 concentration across all homes was 19 µg/m³, with higher concentrations in Alaska (median = 30, minimum = 4, maximum = 200, n = 10) and Navajo Nation homes (median = 29, minimum = 3, maximum = 105, n = 23) compared with Montana homes (median = 16, minimum = 2, maximum = 139, n = 59). Households that had not cleaned the chimney within the past year had 65% higher geometric mean PM_2.5 compared to those with chimney cleaned within 6 months (95% confidence interval [CI]: −1, 170). Based on a novel wood stove grading method, homes with low-quality and medium-quality stoves had substantially higher PM_2.5 compared to homes with higher-quality stoves (186% higher [95% CI: 32, 519] and 161% higher; [95% CI:27, 434], respectively). Our findings highlight the need for, and complex nature of, regionally appropriate interventions to reduce indoor air pollution in rural wood-burning regions. Higher-quality stoves and behavioral practices such as regular chimney cleaning may help improve indoor air quality in such homes.     

Controlled experiments measuring personal exposure to PM2.5 in close proximity to cigarette smoking

Few measurements of exposure to secondhand smoke (SHS) in close proximity to a smoker are available. Recent health studies have demonstrated an association between acute (<2 h) exposures to high concentrations of SHS and increased risk of cardiovascular and respiratory disease. We performed 15 experiments inside naturally ventilated homes and 16 in outdoor locations, each with 2–4 non‐smokers sitting near a cigarette smoker. The smoker's and non‐smokers' real‐time exposures to PM_2.5 from SHS were measured by using TSI SidePak monitors to sample their breathing zones. In 87% of the residential indoor experiments, the smoker received the highest average exposure to SHS, with PM_2.5 concentrations ranging from 50–630 μg/m³. During the active smoking period, individual non‐smokers sitting within approximately 1 m of a smoker had average SHS exposures ranging from negligible up to >160 μg/m³ of PM_2.5. The average incremental exposure of the non‐smokers was higher indoors (42 μg/m³, n = 35) than outdoors (29 μg/m³, n = 47), but the overall indoor and outdoor frequency distributions were similar. The 10‐s PM_2.5 averages during the smoking periods showed great variability, with multiple high concentrations of short duration (microplumes) both indoors and outdoors.     

Observational scores of dampness and mold associated with measurements of microbial agents and moisture in three public schools

We examined associations between observational dampness scores and measurements of microbial agents and moisture in three public schools. A dampness score was created for each room from 4‐point‐scale scores (0–3) of water damage, water stains, visible mold, moldy odor, and wetness for each of 8 room components (ceiling, walls, windows, floor, ventilation, furniture, floor trench, and pipes), when present. We created mixed microbial exposure indices (MMEIs) for each of 121 rooms by summing decile ranks of 8 analytes (total culturable fungi; total, Gram‐negative, and Gram‐positive culturable bacteria; ergosterol; (1→3)‐β‐D‐glucan; muramic acid; and endotoxin) in floor dust. We found significant (P ≤ 0.01) linear associations between the dampness score and culturable bacteria (total, Gram‐positive, and Gram‐negative) and the MMEIs. Rooms with dampness scores greater than 0.25 (median) had significantly (P < 0.05) higher levels of most microbial agents, MMEIs, and relative moisture content than those with lower scores (≤0.25). Rooms with reported recent water leaks had significantly (P < 0.05) higher dampness scores than those with historical or no reported water leaks. This study suggests that observational assessment of dampness and mold using a standardized form may be valuable for identifying and documenting water damage and associated microbial contamination.     

Factors influencing relationships between personal and ambient concentrations of gaseous and particulate pollutants

Previous exposure studies have shown considerable inter-subject variability in personal-ambient associations. This paper investigates exposure factors that may be responsible for inter-subject variability in these personal-ambient associations. The personal and ambient data used in this paper were collected as part of a personal exposure study conducted in Boston, MA, during 1999-2000. This study was one of a group of personal exposure panel studies funded by the U.S. Environmental Protection Agency's National Exposure Research Laboratory to address areas of exposure assessment warranting further study, particularly associations between personal exposures and ambient concentrations of particulate matter and gaseous co-pollutants. Twenty-four-hour integrated personal, home indoor, home outdoor and ambient sulfate, elemental carbon (EC), PM_2.5, ozone (O₃), nitrogen dioxide (NO₂) and sulfur dioxide were measured simultaneously each day. Fifteen homes in the Boston area were measured for 7 days during winter and summer. A previous paper explored the associations between personal-indoor, personal-outdoor, personal-ambient, indoor-outdoor, indoor-ambient and outdoor-ambient PM_2.5, sulfate and EC concentrations. For the current paper, factors that may affect personal exposures were investigated, while controlling for ambient concentrations. The data were analyzed using mixed effects regression models. Overall personal-ambient associations were strong for sulfate during winter (p < 0.0001) and summer (p < 0.0001) and PM_2.5 during summer (p < 0.0001). The personal-ambient mixed model slope for PM_2.5 during winter but was not significant at p = 0.10. Personal exposures to most pollutants, with the exception of NO₂, increased with ventilation and time spent outdoors. An opposite pattern was found for NO₂ likely due to gas stoves. Personal exposures to PM_2.5 and to traffic-related pollutants, EC and NO₂, were higher for those individuals living close to a major road. Both personal and indoor sulfate and PM_2.5 concentrations were higher for homes using humidifiers. The impact of outdoor sources on personal and indoor concentrations increased with ventilation, whereas an opposite effect was observed for the impact of indoor sources.     

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.     

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.