Report of the 

Surgeon General’s Workshop on 

Healthy Indoor Environment 

January 12–13, 2005, National Institutes of Health, Bethesda, MD 

Department of Health and Human Services

Table of Contents 

Introduction ................................................................................................................... 1

Workshop Proceedings ................................................................................................ 2

Welcome..................................................................................................................................... 2

RADM Robert C. Williams, P.E., DEE, U.S. Public Health Service Chief Engineer.....................2

Charge and Goals...................................................................................................................... 2

VADM Richard H. Carmona, M.D., M.P.H., F.A.C.S., U.S. Surgeon General ..............................2

What is the scientific evidence for health problems associated with the indoor 

environment?............................................................................................................................. 4

Overview..............................................................................................................................................4

John D. Spengler, Ph.D., Harvard University School of Public Health...........................................4

Asthma and Allergic Effects................................................................................................................5

Thomas A. E. Platts-Mills, M.D., Ph.D., University of Virginia Asthma and Allergic Disease 

Center...............................................................................................................................................5

Non-Asthma and Allergic Building-Related Health Effects................................................................6

Clifford S. Mitchell, M.S., M.D., M.P.H., Johns Hopkins University Bloomberg School of 

Public Health....................................................................................................................................6

Michael Hodgson, M.D., M.P.H., Department of Veterans Affairs ................................................6

Building-Related Health Effects and Potential Economic Impact .......................................................8

Eileen Storey, M.D., M.P.H., University of Connecticut Health Center........................................8

Questions and Comments.....................................................................................................................8

What are the challenges to bringing about health-promoting changes in indoor 

environments? ......................................................................................................................... 10

William J. Fisk, B.S., M.S., Lawrence Berkeley National Laboratory.........................................10

Eileen Storey, M.D., M.P.H., University of Connecticut Health Center......................................11

Peyton A. Eggleston, M.D., Johns Hopkins University................................................................12

Hal Levin, B.Arch., ASHRAE Fellow, Building Ecology Research Group..................................13

James E. Woods, Ph.D., P.E., ASHRAE Fellow The Building Diagnostics Research Institute, 

Inc. .................................................................................................................................................14

Questions and Comments...................................................................................................................15

What are the research needs related to public health and the indoor environment? ...... 18

Research Needs from the National Academy of Sciences’ Institute of Medicine Report, 

Damp Indoor Spaces and Health .......................................................................................................18

Noreen Clark, Ph.D., University of Michigan School of Public Health .......................................18

Peyton A. Eggleston, M.D., Johns Hopkins University................................................................19

Priority Research Needs for Improving the Health of Workers in Indoor Environments..................20

Jean Cox-Ganser, Ph.D., National Institute for Occupational Safety and Health, CDC................20

Energy-Related Indoor Environmental Quality Research: A Priority Agenda .................................22

Vivian Loftness, B.S., M. Arch., F.A.I.A., Carnegie Mellon University .....................................22

CDC’s Agenda for Research, Training, and Outreach to Minimize Adverse Exposures in Indoor 

Environments .....................................................................................................................................23

Clive Brown, M.B.B.S., M.Sc., M.P.H., National Center for Environmental Health, CDC ........23

i
Questions and Comments...................................................................................................................24

The Importance of Collaborative Efforts between the Building, Medical and Public 

Health Communities to Achieve Health-Promoting Changes in Indoor Environments.. 27

Jonathan Samet, M.D., M.S., Johns Hopkins University Bloomberg School of Public Health....27

John Girman, M.S., Office of Radiation and Indoor Air, EPA.....................................................27

Questions and Comments...................................................................................................................29

Review of Federal Research and Development and Outreach Activities: 

A Federal Agency Panel ......................................................................................................... 32

Henry Falk, M.D., M.P.H., Centers for Disease Control and Prevention.....................................32

Samuel H. Wilson, M.D., National Institutes of Health ...............................................................33

Elizabeth Cotsworth, B.A., M.A., U.S. Environmental Protection Agency .................................34

Jerome Dion, M.S., Department of Energy....................................................................................35

Kevin Kampschroer, General Services Administration.................................................................36

David Jacobs, Ph.D., CIH, Department of Housing and Urban Development ..............................37

James E. Hill, Ph.D., National Institute of Standards and Technology ........................................39

Questions and Comments...................................................................................................................39

Review of Federal Research and Development and Outreach Activities: 

Questions for the Federal Agency Panel............................................................................... 41

Questions and Comments...................................................................................................................42

Vision for the Future .............................................................................................................. 45

Kathleen Kreiss, M.D., National Institute for Occupational Safety and Health, CDC..................45

CAPT Stephen Redd, M.D., National Center for Environmental Health, CDC............................45

Closing and Action Steps........................................................................................................ 58

VADM Richard H. Carmona, M.D., M.P.H., F.A.C.S., U.S. Surgeon General ...........................58

Appendix A: Speaker Biographies 

Appendix B: Participant List 

Appendix C: Acknowledgments 

ii
List of Acronyms 

Acronyms 

ETS environmental tobacco smoke 

HVAC heating, ventilation, and air conditioning 

IAP indoor air pollution 

IAQ indoor air quality 

MCS multiple chemical sensitivity 

RADS reactive airways dysfunction syndrome

VE Value Engineering 

Organizations 

AAAAI American Academy of Allergy Asthma and Immunology 

AAEE American Academy of Environmental Engineers 

AARST American Association of Radon Scientists and Technologists 

AFE Association of Facility Engineers 

AIA American Institute of Architects 

AIACOTE American Institute of Architects Committee on the Environment 

ALA American Lung Association 

APHA American Public Health Association 

APRHB Air Pollution and Respiratory Health Branch 

ARTI Advanced Research and Technology Institute 

ASCE American Society of Civil Engineers 

ASHRAE American Society of Heating, Refrigerating and Air-Conditioning

Engineers 

ASTM American Society for Testing and Materials 

ATS American Thoracic Society 

ATSDR Agency for Toxic Substances and Disease Registry 

BASE Building Assessment Survey and Evaluation Study 

BEIR IV Committee on the Biological Effects of Ionizing Radiation 

BIDSTM Building Investment Decisions Support 

BOMA Building Owners and Managers Association 

Cal/OSHA California Division of Occupational Safety and Health 

CDC Centers for Disease Control and Prevention 

CIAQ Committee on Indoor Air Quality 

CMU Carnegie Mellon University 

CPSC Consumer Products Safety Commission 

DARPA Defense Advanced Research Projects Agency 

DHHS Department of Health and Human Services 

DOC Department of Commerce 

DoE Department of Education 

iii
DOE Department of Energy 

DRDS Division of Respiratory Disease Studies 

EPA U.S. Environmental Protection Agency

EPAC Engineer Professional Advisory Committee 

FEMA Federal Emergency Management Agency 

FEMAC Federal Energy Management Advisory Council 

FFC Federal Facilities Council 

GAO General Accountability Office 

GSA General Services Administration 

HHE Health Hazard Evaluation 

HIE Healthy Indoor Environment 

HUD Department of Housing and Urban Development 

IBI Integrated Business Institute 

IDCE International Design Center for the Environment 

IIDA International Interior Design Association’s 

IOM Institute of Medicine 

ISEA International Society of Exposure Assessment 

ISIAQ International Society of Indoor Air Quality and Climate 

ISWG Interagency Sustainability Working Group 

JCAHO Joint Commission on Accreditation of Healthcare Organizations 

LEED Leadership in Energy and Environmental Design 

NAEPP National Asthma Education and Prevention Program 

NAHB National Association of Home Builders 

NAS National Academy of Sciences 

NCEH National Center for Environmental Health 

NCHS National Center for Health Statistics 

NCICAS National Cooperative Inner City Asthma Study 

NFPA National Fire Protection Association 

NHANES National Health and Nutrition Examination Survey 

NHLBI National Heart, Lung, and Blood Institute 

NIAID National Institute of Allergy and Infectious Diseases 

NIBS National Institute of Building Sciences 

NIEHS National Institute of Environmental Health Sciences 

NIH National Institutes of Health 

NIOSH National Institute for Occupational Safety and Health 

NIST National Institute of Standards and Technology 

NORA National Occupational Research Agenda 

NRC National Research Council 

NSF National Science Foundation 

NSLAH National Survey of Lead and Allergens in Housing 

ORIA Office of Radiation and Indoor Air 

iv
ORISE Oak Ridge Institute for Science and Education 

OSG Office of the Surgeon General 

OSHA Occupational Safety and Health Administration 

OSTP Office of Science Technology and Policy 

OSW Office of Solid Waste 

PBS Public Buildings Service 

PHS Public Health Service 

PNIER Program Needs for Indoor Environment Research 

SAME Society of American Military Engineers 

SSPC Standing Standard Project Committee 

TISP The Infrastructure Security Partnership 

TSAC Technical and Scientific Advisory Committee 

USDA U.S. Department of Agriculture 

USGBC U.S. Green Building Council 

WHO World Health Organization 

v
Introduction 

The 2005 Surgeon General’s Workshop on Healthy Indoor Environment was conducted to: 

• Enhance understanding of the public health consequences of the non-industrial indoor 

environment (e.g., homes, schools, office buildings); 

• Provide information to the U.S. Surgeon General, the public, the medical community, and 

the public health community; and 

• Provide the building design, construction, and ownership community with a better understanding of public health issues as they relate to the indoor environment. 

The workshop included presentations from experts in healthy indoor environment, federal 

officials, and advocacy organizations. 

The stated goals and objectives of the workshop were to: 

1. Seek collaboration throughout the public health community in reducing indoor environmentally related communicable respiratory infections, asthma, hypersensitivity pneumonitis, and allergic diseases; and 

2. Gain a better understanding of public health issues and research needs on this topic. 

The Surgeon General’s Workshop on Healthy Indoor Environment was the first activity to take 

place under the 2005 Year of The Healthy Child (YOTHC) agenda set by the Surgeon General. 

The YOTHC agenda provides for a year of examining issues surrounding the health and well 

being of children throughout the Nation and the world. Under this extremely comprehensive and 

aggressive single year agenda, the Office of the Surgeon General has taken a holistic approach, 

focusing efforts on the body, mind and spirit of the growing children. As a child grows, so do 

their health needs. The Office of the Surgeon General will address such issues as immunizations, childhood obesity, physical activity, illness and injury prevention, and the healthy indoor 

environment. 

1
Workshop Proceedings 

This document summarizes the views and issues addressed by invited speakers and discussants at 

the Surgeon General’s Workshop on Healthy Indoor Environment. The views expressed in these 

Proceedings reflect the opinions of the individual participants at the Workshop and do not

necessarily reflect the official position of the Office of the Surgeon General, the Department of 

Health and Human Services, or other federal entities. 

Welcome 

RADM Robert C. Williams, P.E., DEE 

U.S. Public Health Service Chief Engineer 

The Surgeon General’s Workshop on Healthy Indoor Environment (HIE) was called to order on 

January 12, 2005 by Rear Admiral (RADM) Robert C. Williams. RADM Williams welcomed 

participants and outlined the first day’s sessions, which would review scientific evidence showing a need for HIE, present information about HIE factors and their impact on health, and 

identify gaps in information that need to be assigned priorities so that action can be taken to 

promote pubic health and well-being. He then introduced the Surgeon General, Vice Admiral 

(VADM) Richard H. Carmona, who set the charge and goals for the workshop. 

Charge and Goals 

VADM Richard H. Carmona, M.D., M.P.H., F.A.C.S. 

U.S. Surgeon General 

VADM Richard Carmona emphasized the role of health literacy for success in addressing

priority health areas. The Surgeon General and public health professionals must disseminate their 

wealth of knowledge to both the public and practitioners in as timely a fashion as possible to 

effect behavioral change and improve the health of the populations they serve. The Surgeon 

General defined indoor environments as built, non-industrial structures. This includes workplaces, schools, offices, houses, and apartment buildings.

He also stated that the data clearly indicate the need for this workshop. According to a recent 

study, we Americans spend 85%–95% of our time indoors (Rauh VA, Chew GR and Garfinkel RS. 

Deteriorated Housing Contributes to High Cockroach Allergen Levels in Inner-City Households. Environmental Health Perspectives 2002,110(Supplemental 2):323–7). So while we need to be cognizant 

of and concerned about our outdoor environment, including pollution and smog, we must put at 

least equal emphasis on the long-overlooked issue of indoor environment. 

In just the past 25 years, the percentage of Health Hazard Evaluations (HHE) that the National 

Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and

Prevention (CDC) has conducted related to indoor air quality has increased from 0.5% of all 

evaluations in 1978 to 52% of all evaluations since 1990. This means that in those years, the 

evaluations related to air quality concerns have increased from one of every 200 evaluations to 

one of every two. 

2
The problem is adversely affecting our children’s health: the General Accountability Office

(GAO) has indicated that one in five schools in America has indoor air quality (IAQ) problems

(GAO 1995, 1996, and 1999). This can trigger various allergies and asthma. Asthma alone

accounts for 14 million missed school days each year. The rate of asthma in young children has 

risen by 160% in the past 15 years, and today one of every 13 school-age children has asthma. 

Asthma alone costs the United States economy at least $11 billion annually. 

VADM Carmona presented three major goals for the workshop: 

1. Identify relevant scientific data that establish a basis for assessing and interpreting indoor 

environment hazards. 

2. Identify research needs and areas where scientific information is lacking or inconclusive. 

3. Establish common goals for implementing measures that are known to be effective for

improving indoor environmental quality. 

Beyond these specific goals, he stated that it is important to illuminate HIE issues in the context 

of larger public health concerns and related issues such as lead paint toxicity, and to move the

public health agenda forward using sound scientific evidence. 

3
Day 1: First Morning Session 

What is the scientific evidence for health problems 

associated with the indoor environment? 

The morning presentations described the scientific evidence for health problems associated with 

the indoor environment. In the course of the presentations and the audience’s response to them, 

many issues relevant to the Surgeon General’s goals were made evident. 

Overview 

John D. Spengler, Ph.D. 

Harvard University School of Public Health 

The first speaker, Dr. John Spengler, provided an overview of research on toxic agents in the 

indoor environment and how modern building practices affect the health of building occupants. 

As Winston Churchill said, “we shape our buildings and, in time, our buildings shape us.” It is 

often difficult to anticipate indoor environmental quality problems since prevailing building 

materials and construction practices change faster than scientists are able to evaluate their

potential health impacts. For example, we are finding that fiberglass ductwork cannot be cleaned 

as effectively as sheet metal ducts. In addition, new synthetics and glues release novel types of 

organic compounds into the air that may cause allergic symptoms; and emulsifiers used for the 

new generation of high-resolution inkjet printers introduce complex new compounds into the 

indoor environment of offices. Added to this are relatively well understood toxic agents (such as

radon, nitrogen dioxide, and carbon monoxide) that are often concentrated in the indoor air 

environment as an unintended consequence of energy conservation practices or inadequate

ventilation. 

In a study conducted in public housing during the heating season, the increased frequency of 

respiratory symptoms among infants at risk for asthma was correlated with increased indoor 

levels of nitrogen dioxide, which reached levels that exceeded U.S. Environmental Protection

Agency (EPA) outdoor standards. Another study measured personal exposures to volatile

organics with known carcinogenic risk potential in New York City and Los Angeles. It showed 

that contributions from the indoor air environment greatly exceeded those from outdoor exposure. Problems due to high levels of mold in indoor environments, currently a “hot” issue because of media attention, are often exacerbated by modern building practices. Use of building 

materials such as vinyl siding, aluminum studs, gypsum, and synthetic wood products reduce the

water-holding capacity of homes. Inadequate ventilation and drainage practices can trap moisture behind siding, encouraging mold growth. Increased manufacture and use of synthetic 

organic compounds have increased the presence of these compounds in the environment worldwide, and have also increased their concentration in indoor air and dust samples (88 different 

compounds were found in samples from 120 homes in one study). 

The indoor environment also presents some unique problems. For example, DDT levels were 

still found to be high in indoor dust samples taken recently in Cape Cod, even though DDT has

declined in the outdoor environment since the ban on its use in the 1970s. This is because DDT

4
does not break down rapidly indoors in the absence of ultraviolet (UV) light exposure. Significant concentrations of many potentially toxic chemicals are found in the indoor environment. 

These include pesticides, phthalates (used as plasticizers and emulsifiers), O-phenylphenols 

(disinfectant), 4-nonylphenol (detergent metabolite), 4-t-butylphenol (adhesive), and polybrominated diphenyl ethers (a class of chemicals with flame retardant properties that may act as 

endocrine disruptors via thyroid hormone, and bioaccumulate and concentrate in breast milk). A 

study conducted in Sweden highlighted the significance of phthalates that may be found in the 

indoor environment (Bornehag C-G, Sundell J, Weschler CJ, Sigsgaard T, Lundgren B, Hasselgren M, and Hägerhed-Engman L. The association between asthma and allergic symptoms in 

children and phthalates in house dust: a nested case-control study. Environmental Health Perspectives, 2004:112: 1393–1397.). 

Asthma and Allergic Effects 

Thomas A. E. Platts-Mills, M.D., Ph.D. 

University of Virginia Asthma and Allergic Disease Center 

Dr. Thomas Platts-Mills discussed indoor environment quality factors responsible for increased 

asthma incidence, particularly among urban African-American children, a trend reflected in the 

20-fold increase in hospital admissions for acute asthma attacks between 1958 and 1997. 

Asthma is an allergic reaction causing constriction of smooth muscle, reducing patency of the

bronchioles. Determining the most important allergens to prioritize from a public health standpoint can be difficult because of the complexity of allergic responses, individual differences in 

susceptibility, and complicated dose-response patterns for specific indoor air allergens due to 

sensitization and desensitization effects. Dr. Platts-Mills pointed out the difficulties in addressing asthma incidence and severity as a public health issue. For example, children in New Zealand

have very high mite exposure whereas children in Sweden have very little or none; the prevalence of wheezing in New Zealand (21%) is more than twice that in Sweden (8%). Recent 

evidence suggests that asthma is in large part attributable to the allergic response to dust mites. 

Dust mite, cockroach, and Alternaria (fungal) allergens have strong positive associations with

asthma. Higher exposure to such allergens generally leads to both higher sensitization and higher 

prevalence of asthmatic symptoms. Dog and cat allergens, on the other hand, can induce asthmatic reactions, but when present at higher levels for longer periods of time, also seem to induce

tolerance. The presence of multiple cats and dogs in a house, particularly when children are 

exposed during the first year of life, can significantly reduce asthma risk. 

U.S. asthma mortality rates by quintile of median income show the highest mortality for asthma

in the poorest segment of the population in 1987–1989 National Center for Health Statistics 

(NCHS) data, but not in 1969–1972 data, indicating that something has changed over that time

interval (it is not clear what). Cockroach allergen may be more important in certain parts of the 

country. In Northern low-humidity cities (e.g., Boston, Chicago, New York), dust samples from 

public housing have cockroach allergens but virtually no dust mite allergens or pet dander (since 

pets are not allowed). In the South (e.g., Atlanta), however, dust mite and mold allergens are just 

as important as cockroaches. In rural areas, asthma incidence is substantially reduced by the 

presence of cows kept in a barn near the house. While there is good evidence that the effect of 

cows is attributable to endotoxin, this does not explain the tolerance induced by cats or dogs. 

Indeed, measurements of airborne endotoxin show lower levels in homes with a cat. The pres5
ence of IgE antibody to cats is lower in countries where a large proportion of homes have cats, 

suggesting that development of tolerance to cat allergens may be a primary protective factor. 

Similarly, the “hygiene hypothesis” has also been advanced to explain the historical asthma

increase. It suggest that factors such as decreased exposure to soil mycobacterium and changes 

in bacteria colonizing the gut have contributed to a population with increased sensitization to 

other common allergens. However, changes in hygiene do not adequately explain the scale, time

course, or consistency of the historical asthma increase over the period 1960–1995. 

Dr. Platts-Mills emphasized the observation that increased body weight and decreased physical 

activity have been associated with increased inflammation and wheezing among allergic children. In this case, the time course of increasing inactivity and obesity is more closely coincident 

with the increase in asthma. This is an interesting association from a public health point of view 

because interventions to reduce obesity and increase physical activity may also reduce asthma

morbidity and mortality.

Non-Asthma and Non-Allergic Building-Related Health Effects 

Clifford S. Mitchell, M.S., M.D., M.P.H. 

Johns Hopkins University Bloomberg School of Public Health 

Michael Hodgson, M.D., M.P.H. 

Department of Veterans Affairs 

Dr. Clifford Mitchell gave a presentation developed by Dr. Michael Hodgson and himself. He

discussed non-asthma and non-allergic adverse health effects associated with the indoor environment. This presentation, covering a broad range of agents, interactive factors, and health 

endpoints, concentrated on defining the complexity of interacting factors that impact on taking a 

public health approach to indoor environment issues. 

Dr. Mitchell presented a model of building-related health effects that is based on understanding 

the complex relationships between the building, building systems and contents, and building 

occupants. Hazards within the built environment may be related to: 

• Building structure and/or design (e.g., the permeability of the envelope to moisture); 

• Mechanical systems within the building (e.g., ventilation and heating systems); 

• Furnishings within the building (fabrics, adhesives, paints, etc.); 

• Human occupants of the building; and 

• Other sources both inside and outside the building. 

All of these can give rise to potential health hazards and modify the risk associated with hazards. 

These potential hazards include: 

• Chemicals such as formaldehyde offgassing from carpets or building envelope materials; 

• Biological agents such as bacteria and fungi in condensed water in air conditioning systems; 

• Particulates generated from building materials or occupant activity within the building; 

• Physical agents including noise and ergonomic hazards; and 

• Psychological stressors. 

Some of the hazards, such as carbon monoxide (which accounts for more than 100 fatalities per 

year), or Legionella bacteria, may be intrinsically associated with building systems. Others may 

be associated with building design (for example, hazards that may contribute to the risk of falls

6
from heights). Health and comfort can also be affected by physical factors, such as lighting and 

heat, and by the physical organization of the space. The ultimate health consequences of these 

hazards depend not only on building-related factors, but also on characteristics of the population 

and various effect modifiers. For example, transmission of infectious viral agents within a

building may be influenced by airflow, temperature, and humidity. However, the spread of 

infectious agents also depends on demographic features of the building occupants, including 

their genetic susceptibility and health history, and could also potentially be modified by other 

exposures inside and outside the building. 

The health effects that have been associated with buildings are quite diverse. Buildingassociated infections include Legionella and fungal infections. Other infectious agents, although 

not necessarily unique to building systems, may nonetheless be either contained or disseminated

by conditions within the building. For example, in at least one case, a tuberculosis species has

been shown to be released during building demolition. Also of current concern is the deliberate 

release of toxic or infective agents in buildings as an act of terrorism. Non-infectious pulmonary 

effects include hypersensitivity pneumonitis and inhalation fevers. There is also great interest in 

understanding more about the potential non-infectious pulmonary effects of mold exposures. In 

addition, there is increasing awareness of various irritation phenomena related to chemical, 

physical, and biological exposures, and the extent to which these irritation phenomena may play 

an important role in conditions such as reactive airways dysfunction syndrome (RADS). Building air-handling systems play a critical role in the distribution of and exposure to physical, 

chemical, and biological agents. The air-handling systems can affect the amount of moisture in a 

building and thereby prevalence of upper respiratory tract symptoms. Evidence suggests that 

irradiating the coils of heating, ventilation, and air conditioning (HVAC) units with ultraviolet 

light (UV), even without cleaning them, can significantly reduce microbial load and resulting 

irritation symptoms. This has been verified in blinded studies where building occupants were 

not aware whether the UV was on or off. 

Dr. Mitchell described a few additional risk factors about which research is just getting underway. Two such areas are the relationship between obesity and building design and cancer in 

relation to lighting and hormone levels. Lighting is known to affect circadian rhythms and 

hormone levels, but little is known about the health implications of changes in lighting spectrum

and levels. Building design, operation, and maintenance can all have critical impacts on worker 

health and well-being, and some interventions have been found to improve health. However, 

there is little understanding of why or how these mechanisms reduce exposure. Still, it is clear 

that many problems that are recognized are associated with well-characterized building system

failures and could have been prevented had basic engineering and obvious health considerations

been taken into account. It is important to understand the role of susceptible populations in 

evaluating the impact of building changes and to address the need of more sensitive populations, 

such as children and the immunocompromised. 

7
Building-Related Health Effects and Potential Economic Impact 

Eileen Storey, M.D., M.P.H. 

University of Connecticut Health Center 

Dr. Eileen Storey discussed the potential economic impacts of health problems related to indoor 

environment quality problems, important both as a socioeconomic issue in itself and as a potential source of “leverage” for encouraging employers and building owners to implement changes 

to benefit the health of building occupants. Even in the absence of serious health effects and 

morbidity, discomfort of building occupants because of temperature or can translate into lower 

productivity, reduced job satisfaction, increased employee turnover, and greater work loss due to 

illness. On the other hand, remediation efforts can be hampered by short-term disruption costs,

relocation costs, and labor relations issues. Although productivity issues related to building 

comfort can be difficult to quantify, one blinded study of typing speed showed a 4%–6% loss of 

measurable work output when old carpeting was present in the environment. Office building

managers respond to a loss of tenants and property value as a primary motivator in taking on the 

costs of assessment and remediation. Employers may be less aware of more subtle effects on 

productivity. As people are made more sensitive to these issues, the economic implications

should increase. School buildings serve as a primary focus for indoor environmental issues 

because of strong teacher and parent awareness and involvement. However, remediation programs can cause substantial diversion of attention and resources that will not always be productive unless the efforts are well directed. Asthma is a leading chronic disease causing lost school 

days, but the relationship of indoor environment quality problems to other symptoms, such as 

headaches and fatigue (reported by staff and students in association with particular halls and

classrooms), has rarely received the type of follow-up attention that might be useful in identifying and correcting subtle building problems before they result in major health problems. 

Questions and Comments 

This first series of presentations stimulated a large number of questions and comments, many 

focused on the school environment. One “healthy schools” advocate maintained that schools 

should be given priority over office environments because they have a higher concentration of 

more vulnerable people in closer physical proximity. Several participants pointed to particular 

problems associated with investigating and mitigating indoor environment issues in schools,

including: 

• Overcoming fears of unwelcome publicity and getting approval from school boards and 

administrators; 

• Building problems within a school district can vary greatly among individual schools because of great variation in building age and, consequently, construction characteristics; 

• Curriculum trends that have reduced or eliminated recess and physical education during 

the school day, leading to the type of increase in inactivity cited by Dr. Platts-Mills as a 

possible asthma risk factor; 

• The location of school facilities on land with poor drainage or a high water table (the

least desirable land in a development, donated by the developer for public use); and 

• Budget constraints, which may result in deferred maintenance that can create and exacerbate moisture problems. 

8
While dampness is recognized as a problem, several people commented on the lack of standards

for what can be considered a “dry” or “wet” building environment. There are no clear quantitative data on how humidity affects mucosal symptoms (in the case of dryness) on one hand, and 

mold and other dampness-related problems on the other. 

An audience member raised the issue of multiple chemical sensitivity (MCS), considering the 

role of highly allergic or chemically sensitive individuals as a sentinel population. Other countries have given more attention to this issue. Canadian and Swedish demonstration projects have 

shown that it is possible to build for hypersensitive people, but also that it is very hard to remediate problems for them after construction. A Japanese conference on indoor air quality emphasized MCS, and an extensive bibliography on the subject is available. Dr. Mitchell pointed out 

that prevention of MCS symptoms ties into many of the same concerns and approaches used to 

address asthma and allergy issues, so the problem can be dealt with in a practical way regardless

of how valid one finds claims of MCS. He stressed that a quality remediation approach (rather 

than just covering up problems) can improve many health problems, including MCS. 

Highlights of the Scientific Evidence for Health Problems 

Associated with the Indoor Environment Session 

There is good scientific evidence that allergies, asthma, and the spread of respiratory 

infections are influenced by the indoor environment.

There is a need for better understanding of the influence of agents such as mold

species and chemicals on respiratory diseases, immunological and cognitive disorders, and other health endpoints. 

The relationship between the indoor environment and health is complex. It encompasses a broad range of chemical, physical, and biological agents; interactive factors; individual susceptibilities; and health endpoints. 

Some of the indoor environmental control and remediation techniques used to deal

with asthma and allergy issues will likely address some of the other indoor environment health issues. 

New building materials and construction practices are being introduced with little 

understanding of their impact on the indoor environment and the health of the

occupants. Data are also lacking on dose-effect relationships for many of the known

toxic indoor agents and the interplay of genetic and other health risk factors, making

it difficult to predict the effectiveness of control and remediation techniques with 

precision. 

9
Day 1: Second Morning Session 

What are the challenges to bringing about healthpromoting changes in indoor environments? 

William J. Fisk, B.S., M.S. 

Lawrence Berkeley National Laboratory 

Mr. William Fisk introduced the topic of how to release market forces to influence building 

professionals and decision makers to make their buildings more health-protective. Most building 

designers and managers focus on immediate functional requirements (space requirements, 

temperature ranges, and attractive design), meeting building-code requirements at minimum cost, 

and providing a facility that is marketable and will attract a good rental return. The impact of 

design considerations on indoor environment quality, occupant health, and productivity is

generally not emphasized. This places primary importance on first costs, perhaps tempered by 

measures that will reduce long-term maintenance costs; indoor environmental quality is a secondary consideration. Building professionals are often isolated from the consequences of decisions 

that result in suboptimal indoor environment quality. Overcoming this type of barrier to change

requires providing incentives (benefits) or demonstrating the economic penalties of ignoring 

indoor environment quality issues. 

Mr. Fisk’s key points included the following: 

• In office work, salaries are by far the greatest employer cost, so even a small increase in 

productivity (due to an improved work environment) can provide a favorable return on 

investment; 

• A speculative developer has little responsibility for indoor environment quality unless it 

is bad enough to result in litigation (i.e., there is a disconnect between a developer who 

assumes the development costs and an employer who obtains the benefits of long-term 

improvements in indoor environment quality); 

• Health insurance costs are not directly tied to indoor environment quality even if illness 

can be linked to a poor indoor environment; and 

• In residential settings, poor maintenance practices that often account for poor indoor environment quality are often found in low-income housing, where resources and motivation of the tenant or owner to correct problems are often lacking. 

There is a need to convey the economic implications of improved practices and provide scientific 

evidence that intervention is effective. As an example, Mr. Fisk discussed economizer control 

module system technology, an energy-efficient approach that increases ventilation rates during 

mild weather to reduce the need for mechanical cooling. Economizer systems are rarely used in 

small office buildings and almost never in residential settings. It has been estimated that use of

an economizer control module system could result in energy savings of approximately 

$26/person/year in the climate of Washington, DC. These estimates are usually used as a basis 

for determining whether the energy savings (benefit) exceed technology cost. Frequently 

building professionals believe that the economic returns are insufficient. However, because 

economizers increase average ventilation rates, they can be shown to reduce levels of infectious 

10
airborne particles in the building and therefore could decrease respiratory illnesses. Mr. Fisk 

recommended that these systems be used more broadly. Calculations predict that sick-leave 

reductions worth approximately $200/person/year occur in addition to the energy savings. Mr. 

Fisk emphasized that developing and testing economic incentives for engineering healthprotective buildings can provide a sound economic basis for investing much more in practices 

that assure good indoor environmental quality. He concluded with the following specific recommendations: 

• Establishing lease and contract terms that reward indoor environment quality efforts; 

• Rewarding facility managers of office and public housing properties for better indoor environment quality; 

• Establishing a program of building labeling (analogous to EPA’s Energy Star program)

that allows consumers to recognize structures that have realized superior indoor environment quality in their design and construction; 

• Tying HMO rates to indoor environmental quality protective practices of employers; and 

• Linking professional liability insurance rates to indoor environmental quality training and 

practices. 

Eileen Storey, M.D., M.P.H. 

University of Connecticut Health Center 

Dr. Eileen Storey expanded on general points made in her earlier presentation, using two ultimately successful case studies to illustrate how difficulties in initiating effective indoor environment air quality improvements in schools can be overcome. If administrators do not understand

the health effects and risks involved, they may tend to stigmatize those reporting adverse health 

symptoms as disgruntled employees or overly “sensitive” individuals and dismiss the need for

remediation. Alternatively, if those reporting problems are treated as “index cases,” they can

provide an opportunity to effectively address problems before they become too expensive to 

correct. Among the challenges to assessing the true risk is that carbon dioxide levels are often 

taken as a surrogate for effective air exchange, and no qualitative assessment is made of biological agents, which may have a great impact on health issues even when air exchange appears to be

“adequate.” The EPA’s Indoor Air Quality Tools for Schools program has proved to be a very 

effective mechanism for identifying and correcting building problems in schools by establishing 

a building team directed toward applying relatively inexpensive solutions to IAQ problems. The

same model could be applied to office buildings. 

Some remediation efforts prove to be more successful than others. In her case studies, Dr. 

Storey indicated the complexity of issues that can arise. She first described a middle school in 

the Northeast, built in the 1950s with later additions. Staff and children were reporting a range 

of symptoms, including headaches. One teacher developed respiratory illness. Remediation of 

her classroom served as a starting point for more extensive evaluation of building problems.

Since time was needed to plan and fund systematic remediation, sensitive individuals were 

removed from the area. An engineer was hired to evaluate the building and to make recommendations. Survey results indicated that irritant and discomfort symptoms extended over a larger 

area of the school than the area where people were reporting acute respiratory symptoms. For 

financial reasons, remediation efforts began with the classroom in which the teacher developed

respiratory illness. Carpeting was removed from the classroom, which introduced an additional 

11
problem because the underlying asbestos floor tile also had to be removed. A roof leak causing

moldy partition and wet insulation problems above the deck was addressed initially by patching 

the leak and increasing ventilation under the roof, but these measures only enabled moldy air to 

spread through the school. The eventual solution, motivated in part by extensive public attention 

and involvement, required isolating and closing parts of the building while applying effective

remediation measures sequentially. The multi-year remediation program included repeated staff 

and student health surveys and monitoring of air quality, with suitable measures to protect 

occupants during construction. 

The second case was a late 19th-century Hartford, Connecticut, elementary school with a 15%

asthma prevalence as compared the national prevalence of 5%. The building was heated by a 

centrally located boiler and the only ventilation was provided by windows. Water leakage linked 

to health problems for students and staff could be traced to primary structural problems, which

were scheduled for needed repairs. In this school, the principal took a primary role in pushing 

the health improvement initiative using the Tools for Schools approach. Problem areas (“hot 

spots”) identified on the basis of student and staff symptoms were the focus of systematic

interventions. The effectiveness of the repairs was evaluated by closely monitoring the health of 

students before and after repairs were made. The principal stressed the role of the faculty in the

prevention of asthma in their students. Dr. Storey indicated that this high level of involvement 

by the key school administrator was the major factor in the success of the program in this school.

Peyton A. Eggleston, M.D. 

Johns Hopkins University 

Dr. Peyton Eggleston discussed challenges facing those trying to reduce airborne allergens and 

toxins in inner-city areas, particularly as they affect the health of children. Respiratory morbidity 

can be seen as a consequence of a complex series of interacting factors. The primary causal 

sequence for asthma can be attributed to environmental allergens causing immunologic sensitization, resulting in asthmatic airway constriction. Secondary factors include toxic air pollutants 

that can affect general health status; susceptibility factors (inflammation, bronchial hyperresponsiveness); and underlying social factors (low income, stress, poor access to medical care, 

lack of education, etc.) that may impede both effective environmental solutions and medical

treatment. 

Results of the National Cooperative Inner City Asthma Study (NCICAS), conducted in eight

urban centers in two stages (a cross-sectional study in 1992–1993 and a randomized intervention 

trial in 1994–1996) provided the primary basis for discussing environmental problems and 

impediments to their solution. Some of the problems in indoor environmental quality can be 

related to the problems of low-income housing conditions, such as the following: 

• Using a gas stove for heating in the winter (source of nitrogen oxides [NOx]);

• Homes with windows painted shut, preventing their use for ventilation; 

• Roofing that is poorly maintained by landlords, resulting in leakage; 

• Occupied rental homes located next to abandoned row homes with severe water leakage 

and pest problems; 

• Inadequate cash flow to permit proper maintenance and capital improvements; and 

12
• Accumulation of trash in the home or nearby, encouraging pests and inhibiting effective 

pest extermination. 

Many indoor air quality problems can be related to lifestyle characteristics that residents do not 

necessarily see as harmful, but which are contributing factors for asthma problems. For example, Dr. Eggleston indicated that the NCICAS study found that a cigarette smoker was a caregiver in 69% of the homes and that some significant contributions to indoor air particulates were 

a consequence of cultural preferences, such as burning incense. Other problems are a secondary

effect of other social problems (e.g., neighborhood violence and drug dealing may keep children 

confined to the home for their safety, increasing their indoor environment exposure and reducing 

opportunities for outdoor exercise). 

Hal Levin, B.Arch., ASHRAE Fellow 

Building Ecology Research Group 

Mr. Hal Levin discussed architectural and engineering performance standards that impact the 

design of healthier indoor environments. For the most part, there are few standards or agent limit 

values that can be applied to indoor environment pollutants. Only light levels, noise and acoustics, and temperature range are addressed in clearly established standards, although the California 

Division of Occupational Safety and Health (Cal/OSHA) has adopted moisture control regulations. Mr. Levin suggested that there is strong industry opposition to setting mandatory standards. In the current anti-regulatory political climate, adequate indoor environment regulations

are unlikely in the near term. Building permitting is only partially effective for addressing 

indoor environment issues because it regulates only initial building design and construction, and 

has limited impact over the total life of the building. 

To “fill the gaps” in indoor environment regulation (or guidance, in the absence of enforceable

standards), it is necessary to establish concentration limits for indoor pollutants of concern and

devise cost-effective methods for realizing them. Mr. Levin reported that indoor air experts 

agree that source control is more effective than dilution by increased ventilation rates. Although 

the quality of outdoor air used for ventilation can also be a factor, air filtering is typically limited 

to protection of mechanical and electronic equipment or to reduce housekeeping costs, not to 

improve health. In general, most buildings are “run blind” with respect to monitoring ventilation, indoor environment quality, and the effectiveness of air treatment technology. There is an 

absence of data that can be used to evaluate products and services claiming to improve indoor air 

quality, such as portable air cleaners or duct cleaning services. A lack of clear standards also 

complicates evaluation of the effectiveness of any measures taken. 

A comparison of symptom prevalence as a function of ventilation rate in building studies shows 

up to 10-fold variations in individual sensitivity at a given ventilation rate, as well as some

general trends such as a gender difference (women generally showing higher sensitivity). There 

is no single “correct” ventilation rate for all buildings or for all individuals, and “applying 

conclusions from aggregated data obtained in multi-building studies can be hazardous to someone’s health.” Furthermore, in an era of increasing global energy use and cost and diminishing 

supplies, increasing ventilation will not be the preferred solution to indoor air pollution problems. Mr. Levin stressed the importance of diverse individual responses by designating the 

13
potency of an environmental agent as a function of “exposure” (defined as the product of concentration, time, and dose) and susceptibility factors (genetics, exposure history, health status, 

and age), which generally vary significantly in a population, often in unpredictable ways. There 

is inherent resistance in the building community to changing established building practices and

techniques, or to making changes that might increase building costs. As a solution, Mr. Levin 

advocated taking an integrated or “ecological” approach, considering the full range of interdependent factors that produce the indoor “ecosystem,” with an emphasis on formulating cooperative efforts to solving indoor environment problems. 

James E. Woods, Ph.D., P.E, ASHRAE Fellow. 

The Building Diagnostics Research Institute, Inc. 

Dr. James Woods addressed the engineering challenges in ensuring healthy levels of performance from environmental control systems. Buildings are designed to provide safe, secure, and 

healthy conditions under both normal and extraordinary conditions. Standards and guidelines

generally focus on safety or system performance issues, not on health protection or well-being of 

the occupants. Most codes and standards are enforced during design and construction stages, not 

during operations. Different categories of buildings have different requirements and issues. 

While most engineering interest centers on large public buildings (educational, health care 

facilities, office and mercantile, public assembly and worship – industrial buildings being 

excluded from this discussion), most buildings are small and most of our time is spent in residential and other small buildings. 

Dr. Woods defined six barriers to improving building performance from a health standpoint: 

1. The disaggregated history of building practice and reliance on established practices work 

against a consensus approach to introducing health-protective features and practices. 

2. There is a lack of accountability for the health consequences of design and construction

decisions; occupant health is often specifically excluded from contracts and is avoided in 

project documentation. 

3. While there are little credible scientific data that relate exposures to health consequences, 

there are many speculative and anecdotal reports, making it difficult to get clear 

cost/benefit information. Most available health data concern residential structures, and 

there is little information regarding commercial buildings. It is not easy to get cooperation to do such studies because of liability/litigation issues. 

4. Misapplication of Value Engineering (VE) management practices to reduce first costs 

only (rather than achieve the long-term values realized by improved performance and 

beneficial health consequences) may increase occupant health and safety risks. 

5. Deferred maintenance and other cost reduction policies (such as premature occupancy or 

occupancy during interventions) may increase health risks. 

6. Liability and threat of litigation present major impediments to professionally attacking 

health issues; obtaining insurance to cover health issues or engineering to address health 

issues is extraordinarily costly, and many insurance policies have exclusion clauses for

indoor environmental health issues. 

Dr. Woods identified accountability as a key issue in making buildings healthier. He described 

the “healthy building cycle” (an approach similar to the life-cycle analysis approach), which is 

14
used by organizations such as the Healthy Building Network to evaluate environmental and 

health impacts of a material, building practice, or a service throughout its life cycle. In the cycle 

of addressing building problems (diagnosis, intervention, evaluation of the effectiveness in 

reaching a healthy building status), an accountable person must be identified who is empowered 

to ensure building performance and trained to know how to provide adequate performance and 

occupant protection in each phase in the building’s life. In Dr. Woods’ experience, 90% of 

problem buildings can be attributed to poor functioning of their control systems. 

Questions and Comments 

Many questions and comments followed these presentations. While most comments were in 

general agreement with the points outlined by the speakers, many reflected individual differences 

among participants as to how to weight priorities, assess the impact of different environmental 

agents, and promote research to provide a more solid scientific basis for action. Many advocated 

taking more precautionary actions based on limited indications of potential risk. 

One environmental consultant commented on issues of route of exposure, suggesting that while 

indoor air quality issues are important, 60–80% of exposures are through non-inhalation routes 

of exposure such as hand contact. Mr. Levin stated that CDC has done work indicating the 

importance of skin absorption and hand-to-mouth transmission of pentachlorophenol in children, 

but that more still needs to be done. Mr. Fisk commented on building cleaning practices and how 

they can reduce exposures. For example, integrated pest management generally results in lower 

pesticide levels and reduced opportunity for contact exposure. Dr. Woods commented that 

health care facilities research suggests that half of nosocomial (hospital acquired) infections 

occur by contact and that cleaning practices are critical in reducing the rates. 

Dr. Spengler raised the issue of conflicting practices, such as having fire code and security 

objectives that run counter to healthy indoor environment objectives. All implications of solutions for performance problems, such as energy conservation, must always be considered. Dr. 

Woods suggested that a bigger problem is legacy construction, meaning that any innovations, no 

matter how good, will take some time to affect the health of a majority of the population. He

estimated that 80% of existing buildings will still be in use 20 years from now. 

Mr. Levin commented that the EPA’s Indoor Air Quality Tools for Schools material is a model 

for what can be done to inform individuals on how to improve their home environment. Mr. Fisk 

mentioned Finland’s outreach program discussed at the Healthy Building 2000 Conference. 

Several participants emphasized the need to educate the public on practices that can improve 

indoor environment quality rather than waiting for more definitive research information to

establish stronger cost-benefit arguments. Dr. Eggleston pointed out that low-income-housing 

residents have limited ability to resolve issues such as roof leaks and that the landlord population 

can be a particularly tough group to motivate and educate. A federal legislative aide in the 

audience discussed a pending toxic mold bill (there have been several in previous legislative

sessions and a number of state bills have passed) and stressed the public health needs conveyed 

to him by individuals describing their personal health problems. He suggested that the scientific

community work with legislators to address the issue. A participant indicated that the National 

Academy of Sciences’ (NAS) Institute of Medicine (IOM) report, Damp Indoor Spaces and 

15
Health (2004), conveyed the impression that mold problems are not so serious. Others stated 

that the report had identified the problem clearly, and suggested that the alternative view is 

perhaps a misunderstanding based on the type of cautious language scientists use when dealing 

with possibly causal associations that are not firmly established (see the following section for 

more discussion on this report). 

Several participants discussed the economic impact of health problems attributable to poor 

indoor environment quality and how to motivate health payers to take a more active role in 

effecting changes. Some HMOs and employee health providers are ready to invest in an environmental approach, but some still need a business plan to persuade them it is in their best longterm interests to do so. Some participants mentioned that the economic impact of health problems attributable to poor indoor environment could support this kind of intervention for Medicare patients.

Some participants suggested that proof for the effectiveness of environmental measures seems to

be held to a higher standard than that used for medical interventions. This resulted in considerable back-and-forth discussion on the limited ability of intervention research to provide convincing data supporting the cost-effectiveness of environmental intervention in solving health issues.

It was also mentioned that there is a high cost to conducting good field studies that are sufficiently large enough to generalize the results for policy decisions and that there are few sources

of funding available for these types of interventional studies. 

16
Highlights from Challenges to Bringing about Health-Promoting Changes

 in Indoor Environments Session

Non-inhalation routes of exposure to indoor contaminants can be just as important

as inhalation. 

Some health problems associated with the indoor environment can be related to the

problems of low-income housing conditions.

The lack of comprehensive standards for indoor environmental criteria, especially for 

indoor air pollutant concentrations, is a barrier to establishing standards for healthy

building materials, ventilation, and other critical factors.

Building professionals are generally isolated from the consequences of decisions that 

result in suboptimal indoor environment quality.

Applying market forces by demonstrating favorable cost-benefit ratios requires

better data on health and productivity benefits that result from specific measures to

improve indoor environment quality. 

Current market forces are heavily weighted toward initial costs, whereas making 

buildings more health-protective requires good practices through the entire building

life cycle. 

A significant portion of existing buildings will still be in use 20 years or more from 

now. Healthy indoor environment activities will need to address both existing and

new building issues.

There is a need to convey the economic implications of improving the indoor environment and of ignoring indoor environment problems, and to provide scientific 

evidence that intervention is effective. 

17
Day 1: Afternoon Session 

What are the research needs related to public health and 

the indoor environment? 

Research Needs from the National Academy of Sciences’ Institute of 

Medicine Report, Damp Indoor Spaces and Health

Noreen Clark, Ph.D. 

University of Michigan School of Public Health 

Dr. Noreen Clark, who chaired of the NAS IOM committee that wrote the Damp Indoor Spaces 

and Health report, discussed findings of the final report, published in 2004 by the National 

Academies Press (http://www.iom.edu/CMS/3793/4703/20223.aspx ). The NAS committee 

found that there was sufficient evidence to conclude that there is an association between the 

presence of mold and the following health effects: 

• Upper respiratory tract symptoms, 

• Wheeze, 

• Cough, 

• Asthma symptoms in sensitized persons, and 

• Hypersensitivity pneumonitis in susceptible persons. 

Building dampness was associated with the same health outcomes, except hypersensitivity 

pneumonitis (which has been studied in relation to various indoor exposures but not dampness in 

general). The committee also found suggestive evidence that excessive indoor dampness might 

be associated with development of asthma, but alternative explanations for the association could 

not be ruled out with confidence. Similarly, limited evidence was found for an association 

between excessive indoor dampness and two other conditions: shortness of breath and lower 

respiratory illness in children. Although the committee found no association of dampness to a 

wide range of other symptoms or conditions, given existing evidence, the committee found 

ample scientific justification to conclude that dampness is a public health problem. It therefore 

makes sense to adopt a widespread approach to correcting the condition rather than to take a 

clinical approach to treating the symptoms. Although dampness can occur in many communities, low-income and substandard housing encourage poor building design, construction, and 

maintenance practices, making dampness a particular problem for these residences.

There are still unresolved research issues that have practical implications in addressing respiratory health problems. It is not clear what constitutes “safe” levels of dampness or appropriate 

levels of dampness reduction; the magnitude of the risk produced by dampness and where it 

ranks among other health risk factors is not clear; and, with few exceptions, the relationship 

between particular causal agents (such as specific species of mold) and specific adverse health 

effects has not been established. When Saegert et al. reviewed 72 intervention studies, they 

found that technological interventions were most effective in reducing dampness-related health 

problems when they were inexpensive, simple, durable, and required little effort to maintain or 

use (Saegert SC, Klitzman S, Freudenberg N, Cooperman-Mroczek J, Nassar S. Healthy hous18
ing: a structured review of published evaluations of United States interventions to improve health 

by modifying housing in the United States, 1990–2001. American Journal of Public Health 

2003;93[9]:1471–7). In addition, a set of studies by Krieger et al. showed that high-intensity 

education and support for low-income families, including dampness control measures, resulted in 

significantly decreased asthma symptoms. 

Dr. Clark outlined several specific research needs identified by the committee: 

• Define metrics of exposure and dose; 

• Determine health benefits and associated medical cost savings of interventions; 

• Conduct longitudinal studies to assess the long-term benefits of interventions; 

• Evaluate various alternative and complementary approaches such as building code 

changes, economic incentives, and education programs; 

• Assess economic gains from remediation and prevention efforts that result from extending the useful life of buildings; and 

• Conduct studies to assess the effectiveness of communication instruments designed for 

various audiences, including specific segments of the public and health professionals. 

The committee also noted a need to develop dampness control guidelines with multidisciplinary 

input from a range of stakeholders so that they are applicable to a variety of situations and are 

soundly based on scientific evidence and professional judgment. 

Peyton A. Eggleston, M.D. 

Johns Hopkins University 

Dr. Peyton Eggleston discussed research needs identified in the Damp Indoor Spaces and Health

report associated with exposure to mold. Comparing results of two major epidemiologic studies

of the association between asthma symptoms and exposure to a damp indoor environment, Dr. 

Eggleston noted that one study found a higher association with self-reported dampness in a 

subject’s previous home than in the subject’s present home, and discussed mechanistic implications of such findings. Mold produces health problems through three mechanisms: 

1. Acute infection, 

2. Toxic disease, and/or 

3. Immune-mediated disease. 

As illustrations of infection, he discussed fungal diseases such as athlete’s foot and ringworm,

and respiratory fungal infections such as histoplasmosis. In the case of histoplasmosis, endemic 

areas associated with large river valleys can be mapped by positive skin tests. Opportunistic 

fungal infections can occur in sensitive populations, for example, Aspergillus or Candida infections in immunodeficient AIDS patients. In these cases, the infecting organism can usually be 

identified. Toxic diseases are produced by an agent of the fungal organism, tend to be selflimited, and do not result in antibodies to the fungi causing the problem. An example is organic 

dust toxic syndrome occurring in farm workers 4–8 hours after exposure to moldy hay. Immunemediated diseases follow a typical pattern of initial sensitization at some time prior to presenting 

with symptoms, often followed by increasing symptoms with repeated exposure, with indicators

of immune system reactivity. Examples include hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis, and allergies. 

19
Dr. Eggleston outlined immune-system responses and their diagnostic indicators (IgE, IgG, and 

T-cell levels). He emphasized the prevalence of immunological sensitivities in the United States 

population: 38% is affected by allergic rhinitis and 8%–10% are affected by asthma. Some

major unanswered research questions have implications for effectively controlling asthma: 

• The role of microorganisms in the development and exacerbation of diseases for occupants of damp indoor environments; 

• How indoor spores are aerosolized, transported, resuspended, and tracked for measuring 

exposure; 

• What specific mold organisms are most important for disease effects; 

• What physical factors increase the effects (e.g., relative importance of aerosol versus 

dermal or oral contact); 

• Which toxins produced by mold are important; and 

• Whether spores have to be viable to induce disease. 

Similarly, there are research needs in some technical areas: 

• Specific and sensitive detection methods for exposure assessment of molds, particularly 

improved non-culture techniques; 

• Methods for rapid and accurate detection of allergens, endotoxins, extracellular polysaccharides, and spores; 

• Techniques for detecting toxins in tissues and specific tissue effects of toxins (both for

understanding the mechanisms of action and for routine diagnostic purposes); and 

• Dose-response information to establish safe levels of exposure. 

Priority Research Needs for Improving the Health of Workers in Indoor

Environments 

Jean Cox-Ganser, Ph.D. 

National Institute for Occupational Safety and Health, CDC 

Dr. Jean Cox-Ganser discussed research needs in the context of occupational indoor environmental issues. About 70% of today’s 89 million workers are employed in non-industrial indoor 

environments, including schools. Average Health Hazard Evaluation (HHE) requests per year 

related to indoor air quality issues increased between 1978 and 2002, peaking in 1993–1997 as a 

consequence of heightened “sick building syndrome” press coverage. HHE requests in schools 

increased steadily during the same period, as did requests related to asthma health complaints. 

Dr. Cox-Ganser discussed results of work from a NIOSH project on building-related asthma in 

indoor environments. She described an HHE of building-related asthma in a community college 

conducted in 2000. The college consisted of 40 buildings built in the 1920s, 1970s, and 1990s 

with 1,200 full-time faculty and staff. A number of the buildings had a history of water incursions, high humidity and mold contamination. The primary aims of the HHE were to obtain 

semi-quantitative measures of dampness and to determine exposure-response relationships 

between them and work-related symptoms. The study evaluated 721 rooms for indications of 

present dampness (moist materials or standing water) and signs of past damage (water stains, 

visible mold, and mold odor). Staff time spent in various rooms was documented and used 

20
together with the semi-quantitative scores to create indices of exposure against which selfreported health symptoms were modeled. There were exposure-response associations between 

exposure indices and work-related symptoms such as wheezing, chest tightness, shortness of

breath, throat irritation, and nasal and sinus symptoms. 

Another study, performed in a health care facility, compared two hospitals. One of the hospitals 

had six new-onset asthma cases on a top floor where there was a history of water incursions and 

evidence of fungal contamination in the walls and ceiling. Symptoms correlated with semiquantitative indices of water damage and mold, as well as with air particle count, air fungal spore 

count, and Penicillium/Aspergillus (cultured fungi and extracellular polysaccharide levels) in

chair and floor dust. A third study surveyed work-related symptoms and health concerns 

(asthma, hypersensitivity pneumonitis, and sarcoidosis) for 1,300 people occupying a 20-floor 

building with a history of water incursions. There were 900 participants in the cross-sectional 

survey. Results indicated increased prevalence ratios (2.7 to 4.7) for respiratory symptoms

compared to an EPA study of United States office workers, and a 7.5-fold increase in asthma

incidence density since building occupancy (66 of 103 adult onset asthma cases arose after 

building occupancy). These increases were reflected in increases for various objective measures 

of symptoms (such as higher rates of abnormal lung function tests and asthma medication use in 

symptomatic employees as compared to asymptomatic employees, and increased use of sick 

leave). Symptom clusters are sometimes ascribed to “disgruntled employees,” but an assessment

of job stress and job satisfaction indicated similar levels of satisfaction in the respiratory case

group and in asymptomatic comparison workers (87% were very or somewhat satisfied with 

their job in the respiratory group, 93% in the comparison group) and only a small increase in the 

percentage of workers who thought they were required to work hard frequently or very often 

(51% of respiratory cases, 45% of the comparison group). 

Dr. Cox-Ganser described an HHE carried out in a school, and indicated that NIOSH had plans 

to continue indoor environmental quality studies in schools by applying a strategy to prioritize 

environmental interventions in relation to dampness and mold. The strategy is to use a standardized semi-quantitative environmental assessment linked to information on the prevalence and 

distribution of symptoms within buildings. 

Dr. Cox-Ganser also discussed the NORA (National Occupational Research Agenda) Indoor 

Environment Team white paper which recommends priority research needs (Mendell MJ, Fisk 

WJ, Kreiss K, Levin H, Alexander D, Cain WS, et al. Improving the health of workers indoor 

environments: priority research needs for a national occupational research agenda. American 

Journal of Public Health 2002;92:1430–1440). These include establishing priorities to: 

• Identify critical indoor exposures and their relationship to adverse health effects typical 

of “sick building syndrome” (mucus membrane irritation, headaches, and fatigue), communicable respiratory illnesses (influenza, common cold), and building-related allergies

and asthma; 

• Develop prevention strategies for these adverse health effects; 

• Understand how the design, operation, and maintenance of buildings and the activities of 

occupants affect concentrations of indoor air pollutants; and 

• Identify strategies to reduce barriers and increase incentives for undertaking healthprotective building practices. 

21
Energy-Related Indoor Environmental Quality Research: 

A Priority Agenda 

Vivian Loftness, B.S., M.Arch., F.A.I.A. 

Carnegie Mellon University 

Ms. Vivian Loftness discussed health- and energy-related aspects of the built environment from

an architectural perspective. She focused on which physical aspects of a building tend to result 

in indoor environmental quality problems, and how to get people to invest in buildings that better 

promote the health and well-being of occupants. As previous speakers had pointed out, costs 

associated with salary far outweigh expenses related to rent, energy usage, or technology. The

financial impact of health insurance and lost productivity related to diseases and symptoms

associated with indoor air quality (eye problems, upper respiratory symptoms, allergies, asthma)

constitute a substantial proportion of the total cost, although there are other single factors, such 

as musculoskeletal problems, that are also significant. She related that the annual relocation rate 

of 40% has associated costs of dissatisfaction with environmental conditions, including poor 

indoor air quality. While increased ventilation rates can contribute to improved health and 

productivity, energy costs must be managed through innovations such as task air (delivering air 

quality control to the worker’s desk) or air-to-air heat exchangers. Since such measures require 

more engineering expertise and a break with the status quo (an economic penalty), there is a need 

to document the cost/benefits accurately. 

Professor Loftness suggested that the most important building attributes for both energy efficiency and health are air, thermal control, lighting quality, access to nature, ergonomics, and

material quality (considered both in relation to toxins released in the workplace and material

longevity or reuse, as well as land use and mobility). While improvements in these factors have 

associated costs, they can be offset by economic gains in increased health and individual productivity, as documented in numerous studies. Design approaches that maximize the use of natural

daylight without introducing glare can increase productivity, worker health, and energy savings. 

UV and sunlight, coupled with good air flow, may be among the best strategies for reducing

mold growth. Seated views of the outdoor environment for every worker, and windows that 

open, have health and motivational benefits, and can also impact indoor environment quality.

New concerns about security and blast-resistant building as anti-terrorist measures, however, 

may negatively impact the design and engineering for improved indoor environmental quality in

new and retrofit projects. 

Ms. Loftness concluded by noting that there is a need to focus research on links between the built

environment, human health, and productivity. She identified the e-BIDS (energy and building 

investment decision support) tool from Carnegie Mellon University (CMU) as a reference 

(http://cbpd.arc.cmu.edu/ebids) for information on what CMU is doing to promote building 

practices that optimize productivity, health, energy use, and organizational objectives. 

22
CDC’s Agenda for Research, Training, and Outreach to Minimize Adverse Exposures in Indoor Environments 

Clive Brown, M.B.B.S., M.Sc., M.P.H. 

National Center for Environmental Health, CDC 

Dr. Clive Brown discussed CDC’s agenda for research, training and outreach to minimize 

adverse exposures in indoor environments. CDC’s Healthy Homes program and other CDC 

activities address many indoor environment issues such as lead, carbon monoxide, and environmental tobacco smoke (ETS), but dampness and allergic fungal disease constitute a major 

portion of their public response activity. Approximately 60%–80% of the 100 calls per month 

received by the Air Pollution and Respiratory Health Branch (APRHB) involve dampnessrelated issues. A large proportion of the population is affected by mold allergies and about 10% 

have a positive skin test for fungal extracts; upwards of 80% of people with respiratory allergy 

symptoms are sensitized to fungi. 

Reviewing some of the major points of the Damp Indoor Spaces and Health report (which was 

commissioned by CDC), Dr. Brown noted there is no agreed upon definition of dampness, and 

the report’s findings of “sufficient evidence of an association” for many symptoms and diseases 

mean that causal relationships are implicated but not proven. Defining exposure to mold is

difficult because multiple species of molds are found everywhere. Results will vary depending

on sampling and analysis methods. As there are no recognized standards for sampling mold or 

for analyzing and interpreting sampling data, it is difficult to know what level of mold presence 

is acceptable. There is a need for better quantitative biomarkers to clearly define the link between indoor microbial and mold growth and adverse health effects, and between specific

chemical markers (such as mycotoxins and glucans for mold, or endotoxins for bacteria) and 

levels of microbial agents. There is also a need to evaluate potential interactions between 

environmental exposures to other toxic agents and the role of genetic susceptibilities in health 

effects. 

Hill’s Criteria of Causation (the minimal conditions needed to establish a causal relationship

between two items) suggest certain characteristics that should be present if an association is to be 

considered causal (temporality of exposure preceding symptoms, high strength of association 

indicated by a large risk ratio, clear dose-response relationship, consistency of association in 

repeated studies, specificity of association, biologic plausibility). However, many environmental 

studies are unable to satisfy these criteria and to clearly relate exposure to disease outcome. One

indirect approach used by epidemiologists is to do intervention studies to demonstrate reversibility, i.e., does an intervention that corrects the suspected risk factor result in an improvement in 

the health condition? However, the chain of causal events can be complicated: a study performed in Atlanta in 1998–2000 showed a significant decline in cockroach and house dust mite 

antigen levels after appropriate interventions but no corresponding improvement in asthma

severity. If we extrapolate to mold, similar results in other studies led the 2000 IOM report on 

asthma, Clearing the Air, to conclude that although there is evidence that fungal removal measures reduce levels of fungi, there was insufficient evidence that fungal control measures improve 

lung function. There are social and institutional barriers to effective interventions, notably:

poverty, compromised dampness control measures in construction to save costs, and lack of

23
awareness of long-term benefits and health advantages of addressing dampness issues promptly. 

This suggests the need for training about dampness, its prevention, and its consequences, among

those who design, build and maintain buildings, and also among individual homeowners. 

Current and planned APRHB activities related to damp indoor environments include: 

• Scientific reviews and original studies of health effects associated with damp/moldy indoor environments, including school-based studies; 

• Developing appropriate science-based material for responding to the public about damp 

indoor problems; and 

• Capacity building, i.e., determining how state and local agencies (health departments)

respond to mold-related health concerns and developing their capacity to deal with these 

issues effectively. 

If it is determined that it is appropriate for CDC to develop a program for Healthy Indoor Environments, APRHB’s plan would include activities which: 

• Promote intramural and extramural research and develop standard investigative and laboratory practices; 

• Provide a public health response that includes investigating outbreaks/clusters, strengthening state and local capacity, conducting surveillance and intervention activities, and

public health promotion and education; and 

• Establish partnerships with building community stakeholders, federal and local government agencies, researchers, and industry to better address knowledge gaps and recommend better design and construction practices. 

The Damp Indoor Spaces and Health report contained some specific research recommendations, 

such as a study of environmental factors associated with pulmonary hemorrhage in infants; 

studies of the cost-effectiveness of prevention and mold remediation strategies; economic 

evaluations of the benefits of economic incentive programs and implementation of mold-related

legislation; and interaction with other important indoor environment issues (such as carbon 

monoxide, allergens, and combustion products including environmental tobacco smoke and 

nitrogen oxides). 

Despite the gaps in the science to appropriately address this issue, the report also concluded that 

“the high prevalence of dampness suggest that what is known about its causes and prevention is 

not consistently applied in building design, construction, maintenance, and use.” Dr. Brown 

stressed that even as we plan etiologic studies to define exposures and health outcomes related to 

mold and as we design effective remediation strategies, we need to focus on prevention, making 

use of current knowledge to implement measures that reduce indoor dampness and mold growth. 

Questions and Comments 

The questions and comments following these presentations focused on addressing the interrelated issues raised by the speakers. Several people commented on the particular needs of lowincome housing and the need to communicate risk effectively so that people are motivated to 

take effective measures and are not just alarmed because they have neither the money nor the 

24
ability to mitigate. A free radon mitigation program run through Home Depot could serve as a 

model for a similar program to address mold issues. Many building problems are traced to poor 

initial construction practices (such as badly applied stucco), so quality assurance programs may 

help to prevent a lot of future problems. Some problems can be traced to poor design; for 

example, buildings often have indoor air quality problems that can be traced to a design that

places parking spaces near air intakes for the buildings. 

A journalist commented on press coverage of the Damp Indoor Spaces and Health report and 

how it may have misled many people by over- or under-emphasizing (depending on the publication) committee conclusions regarding the seriousness of the health concern. Dr. Clark indicated 

that they made every effort to help the media cover the report effectively, but acknowledged that

accurate media messages may not have reached the public. A health activist suggested that some

responses to the report may have resulted partly from things that were not evaluated, contending

that the report was primarily a respiratory study and that non-infectious health effects such as 

headaches and fatigue were not really examined. Mold hypersensitivity and autoimmune-like 

symptoms have been reported by some people, but have not been adequately recognized by 

scientists or by physicians. One participant suggested a need for an anecdotal reporting center 

for such cases, indicating that there is too much emphasis on determining causation and not 

enough on finding effective treatment or training physicians to be sensitive to the needs of these 

patients. In reply, Dr. Clark indicated that the report did not consider only respiratory symptoms, 

but that these were the symptoms for which associations were strongest. She noted that “absence 

of evidence is not evidence of absence,” and said that the report did not intend to dismiss the 

possibility of effects for which the existing evidence of association was not strong or for which 

evidence was not available. 

A building technology representative commented on damage produced during the recent Florida 

hurricane season, where there were cases of extensive water leakage without structural damage, 

providing an opportunity for large-scale studies of dampness-related health problems under these 

changing conditions. Dr. Brown responded that during post-disaster situations people generally 

have more pressing needs than to participate in such studies. Another person involved in building design questioned the reliability of self-reported symptoms when used as health effects

endpoints. Dr. Cox-Ganser indicated that, in their community college study, they did some

quality assurance as a test for reporting bias, surveying non-participants and finding that the 

prevalence of asthma and some lower respiratory symptoms was similar in those who agreed to

participate. Dr. Eggleston commented that there are no good objective measures of respiratory 

disease endpoints (even lung volume is not very accurate), and most studies around the world use 

questionnaires with similar questions. Ms. Loftness indicated that this may be the only practical 

way to collect large amounts of health information from many sites inexpensively. 

Several speakers commented on indoor environment issues in schools. One participant suggested that the U.S. Department of Education (DoE) should be more involved in this type of 

research and thought more effort should be devoted to programs to monitor health and the 

success of interventions rather than waiting for funding for good scientific studies. One speaker 

commented at length on his experience with school remediation efforts in southern Maine, 

where, in spite of financial constraints, there was a well-run program to inform the public and 

respond to parental concerns about health issues, as well as to address practical repair and 

25
remediation issues. EPA’s Indoor Air Quality Tools for Schools material points out some smallscale improvements that can be made at relatively low cost even in school systems where funds 

are very limited. Several speakers returned to the problem of defining “dampness” and providing guidelines for people to determine how pressing the need for action is. One speaker suggested developing guidelines for categorizing a school building situation as low/medium/highrisk for health concerns. 

Highlights from Research Needs Related to 

Public Health and the Indoor Environment Session

There is ample scientific justification to conclude that damp conditions found indoors

are a public health problem. 

There is strong scientific evidence for an association between buildings with mold

growth and upper respiratory tract symptoms, asthma symptoms in sensitized 

persons, hypersensitivity pneumonitis in susceptible persons, wheeze, and cough in

occupants. There is limited scientific evidence that links moisture problems indoors

with asthma development, shortness of breath, and lower respiratory illness in

children.

There are inexpensive, simple, and durable intervention measures that are effective

in reducing dampness-related health problems. 

There are achievable energy-efficient building design solutions that provide a healthy 

indoor environment with good lighting, access to nature, good ergonomic working

conditions, and improved indoor air quality.

The financing of building and health care is not managed or conducted in a manner

that would permit direct cost-benefit analysis. 

Healthy indoor environment risk communication should be conducted so as to

empower, motivate, and inform people about how to improve indoor environmental 

conditions.

There are social and institutional barriers to effective interventions. 

There is a need for continued research to better define the public health implications 

of the indoor environment. Some organizations have outlined their suggestions for 

high-priority research (e.g., IOM, CDC-NIOSH/NCEH, and EPA). 

26
The Importance of Collaborative Efforts between the 

Building, Medical and Public Health Communities to 

Achieve Health-Promoting Changes in Indoor Environments 

Jonathan Samet, M.D., M.S. 

Johns Hopkins University Bloomberg School of Public Health 

Dr. Jonathan Samet initiated a discussion of the collaborative efforts needed to reduce the public 

health burden related to inadequate indoor environment quality and pollution. He noted that 

reducing the public health burden related to inadequate indoor air quality and indoor air pollution 

(IAP) inherently involves multiple professional disciplines. The occurrence of exposures to IAP 

reflects many decisions made in the design of a building, choice of materials, uses of the building, and the operation of the building. Health care professionals and researchers are involved in 

establishing linkages between exposures in the indoor environment and adverse health effects, 

but problem mitigation is likely to involve indoor environment specialists as well as other 

building professionals. Thus, some of the professionals involved in preventing and solving 

health problems arising from IAP include architects, engineers, industrial hygienists, physicians

and other health professionals, and indoor environment specialists. Unfortunately, professional 

disciplines tend to follow their disciplinary interests and establish “silos” of focus on the specific 

concerns of their constituents. Interactions among groups have been limited, both among the

relevant professional organizations and among individual practitioners around specific buildings 

or health problems. A physician dealing with health outcomes may be interested in understanding etiology to affect a long-term solution, but his or her primary focus is on treatment of the

patient’s specific symptoms. 

The need for cooperative effort was recognized at a 1995 American Thoracic Society (ATS) 

Workshop (Achieving Healthy Indoor Air. Report of the ATS Workshop: Santa Fe, New Mexico, November 16–19, 1995. American Journal of Respiratory and Critical Care Medicine, 

1997;156:33S–64S.). Among other recommendations, participants at that meeting suggested that 

some organization should: 

• Take the lead in addressing indoor air quality-related health effects; 

• Encourage interdisciplinary participation in developing solutions; and 

• Assemble a body of successful and non-successful case studies to help determine viable 

approaches to correcting indoor air quality problems. 

Studies of second-hand smoke provide an example of one such case study, demonstrating the 

lack of health benefits from separating smokers and non-smokers in the same air space. 

John Girman, M.S. 

Office of Radiation and Indoor Air, EPA 

Mr. John Girman followed with a discussion of a successful case study describing collaborative 

efforts to address the problem of indoor radon as an etiologic factor in lung cancer from the 

1970s to the present. Radon is estimated as the second leading cause of lung cancer after smoking, accounting for approximately 20,000 lung cancer deaths per year. The problem was recog27
nized in the late 1970s as winter weatherization programs tightened up homes and reduced 

natural air exchange. The initial focus was on building materials as a radon source, but the 

Department of Energy (DOE) quickly realized that soil gas (such as in the Reading Prong 

Physiographic Province in Pennsylvania and other regions) was a major source. Understanding 

the problem and how to address it involved building scientists, geologists, physicists, and state 

agencies. The EPA, DOE, and Canadian agencies were instrumental in developing mitigation

methods. By the mid-1980s, public guidance was provided by EPA, the Department of Health 

and Human Services (DHHS), and CDC with publication of A Citizen’s Guide to Radon (now on 

the web in the May 2004 revision, http://www.epa.gov/radon/pubs/citguide.html ). 

Through the 1980s, a number of collaborative activities refined approaches to dealing with radon 

issues and made the public aware of the need for action. A federal interagency Committee on

Indoor Air Quality (CIAQ) was established with the participation of EPA, DOE, NIOSH, Occupational Safety and Health Administration (OSHA), and the Consumer Products Safety Commission (CPSC). The Voluntary Radon Measurement Proficiency Program (involving DOE, EPA, 

and the radon industry) was established to guide residential measurement and mitigation.

Additional collaborative efforts for informing the public through public service announcements 

(involving the Ad Council) and promoting remediation practices included public health officials 

at federal, state, and local levels, physical scientists, engineers, and the American Association of 

Radon Scientists and Technologists (AARST; http://www.aarst.org/ ), a radon industry association. The National Research Council’s (NRC) Committee on the Biological Effects of Ionizing 

Radiation (BEIR IV) established a firm scientific basis for assessing health effects associated

with radon. Continuing action through the late 1980s and 1990s included the U.S. Surgeon 

General’s radon warning to the public, Radon Training Centers and State Indoor Radon Grants 

Program (established by EPA), publication of radon potential maps of the United States, and new 

construction standards developed for reduced radon exposure. The real estate industry and home 

inspection have become the primary point of action for radon testing and remediation at the time 

of home sales. 

As a result of these collaborative efforts, an estimated 1.2 million homes have been built with

radon-resistant construction since 1990; about 0.5 million homes have installed active radon 

mitigation systems (as of 2003); and radon standards have been adopted into building codes 

(National Fire Protection Association [NFPA] 5000, International Residential Code). The main 

conclusions that can be drawn from this case history are that: 

• Many disciplines need to interact to define the problem and develop effective solutions; 

• Many stakeholders need to be involved in implementation of solutions (epidemiologists, 

realtors, the radon industry, residential construction industry, building scientists, communications specialists, and code officials, for example); and 

• Government agencies need to provide the stimulus to develop information and serve as 

an “honest broker” of that information. 

Mr. Girman listed several other areas where similar collaborative efforts could be applied: 

environmental tobacco smoke (ETS), mold/moisture, indoor air toxics, asthmagens and triggers, 

human performance/productivity, and green buildings and green building management. He 

suggested that the Damp Indoor Spaces and Health report provides enough information for

taking action, noting that an EPA study of office buildings indicated that 45% have leaks and 

28
34% have leaks in occupied spaces. In addition, the EPA study found that a high percentage of 

workers may be frequently exposed to indoor air toxins (resulting from pesticides, paint fumes, 

new carpets, etc.). In another report by the IOM entitled Clearing the Air, the section on asthma

triggers indicated that fewer than 50% of asthma patients state that their doctors have suggested 

environmental management. The EPA Office of Air and Radiation has proposed collaborative 

efforts in its Healthy Buildings, Healthy People report (http://www.epa.gov/iaq/hbhp/ ). The

public is willing to pay for better air quality, as indicated by the approximately $1 billion spent 

per year on stand-alone air cleaners and more spent on cleaning heating and air conditioning 

ductwork. This occurs in spite of a lack of evidence that these are effective approaches to 

improving the indoor environment.

Questions and Comments 

The discussion following these presentations continued with several topics raised earlier. One 

audience member discussed the importance of people with MCS. The heightened allergic 

responses of people with MCS due to other exposures may make them sentinel indicators of 

more subtle indoor environment problems. Dr. Samet commented that researchers do tend to 

oversimplify problems by focusing on one or two elements, and a broader, more ecologic approach may be needed to address issues such as MCS. 

The issue of defining levels of dampness was raised again. Dr. Cox-Ganser said that NIOSH has

used ranking based on semi-quantitative environmental assessments to compare locations within

a study area. Dr. Eggleston and Mr. Fisk suggested that while 40%–50% relative humidity is 

generally considered optimal, there is no humidity standard used to define “damp.” It is also not 

clear whether damp spots (i.e., local damp areas that can produce mold in an indoor environment 

where the overall indoor humidity is within normal limits) are as harmful to health as more 

generalized dampness. One function of a workshop such as this might be to propose a standard 

that could be tested. A consultant questioned Mr. Girman’s statement that the government was 

perceived as an “honest broker,” indicating that industry does not see dampness as a major health 

problem and does not want to fund research that could be used to generate restrictive standards. 

There needs to be more effort to involve industry, since at present they will only reluctantly fund 

research to resist regulation or block litigation. Mr. Girman replied that he thinks the public sees 

government as an honest broker, but perhaps industry less so. Industry is involved in the guidance process and Mr. Girman believes that EPA is responsive to industry concerns, but perhaps 

the agency could do better. One commenter suggested that industry gets involved too late in the

process, after regulations or guidelines are already proposed, and it ends up taking a defensive 

position. Local governments sometimes pass restrictive regulations that have a poor scientific 

basis, placing government and industry in an adversarial position. 

Commenting on how government can lead the way, one audience member described a major

study conducted in Hong Kong to monitor 50 buildings for 12 indoor air quality parameters. The 

study resulted in a voluntary program that allowed building owners to certify their buildings and 

advertise them as meeting indoor air quality standards. The participant suggested that a similar 

standard could be prepared based on current World Health Organization (WHO), Nordic, and 

Canadian recommendations to establish a certification program that would “pull people into the

program rather than pushing them.” Mr. Girman responded that there might be problems in 

29
agreeing exactly on target levels for various agents; moreover, EPA lacks a legislatively mandated authority to establish such a program. A federal Congressional aide in the audience

encouraged people attending the workshop to work with his office and with some of the Representatives who have strong interests in improving the indoor environment. Ms. Loftness commented on her experience in trying to inform Congressional decision-making about funding for 

health and productivity research in relation to building quality. She suggested that there is 

opportunity through National Science Foundation (NSF) and National Institutes of Health (NIH) 

to provide collaborative teams with the resources they need to investigate these issues. Dr. 

Samet pointed out that radon is an example of a health concern that caught the interest of Congress and resulted in targeted funding, which led to a coordinated inter-agency effort of research 

and development that had a very favorable outcome. 

A consultant suggested there are missed opportunities in not involving the building cleaning 

industry, a group that has already developed expertise in improving conditions in buildings and

is highly motivated to maintain a healthy indoor environment. Dr. Samet commented that he did 

not mean to exclude cleaning professionals from his list of stakeholders. He also noted, however, 

that there is a lack of research on the effectiveness of cleaning practices in terms of health 

effects. The same applies to the air cleaning industry. Ms. Loftness mentioned observations

made in several government office buildings that when cleaning was moved to daytime hours as

an economy measure, there was an increased pest problem in the building as a consequence of 

late afternoon food remnants being left in trash containers overnight. Therefore, unintended 

consequences of cost-cutting in cleaning practices need to be monitored and evaluated. Another 

participant commented on generally lax practices in the residential building industry, where most 

homes are not individually designed by architects and most contractors are not educated about 

the best available practices. This individual suggested a need to work with the trades (roofers,

plumbers, and remodelers, as well as builders) to encourage practices that would reduce water 

penetration problems in buildings. 

Dr. Woods expressed concern that the afternoon panel consisted of only researchers and no 

members of the general public or industry representatives. Returning to a theme of his earlier 

presentation, he suggested that dampness is a source problem for which there are already good 

solutions that can be applied once accountability is established. Dr. Eggleston disagreed, indicating that there is still important research issues involved in linking dampness to health effects. 

Reports of health effects are inconsistent in part because there are no standard ways of describing

degrees of water incursion into a building. While there are clear recommendations on how to

avoid sources of water or how to correct water problems, there are no standards that can be used 

to evaluate successful remediation from a health effects standpoint. 

30
Highlights from Importance of Collaborative Efforts between the Building,

Medical, and Public Health Communities to Achieve Health-Promoting 

Changes in Indoor Environments Session

Building design and operation involves a large number of diverse professions with

different interests and priorities. Collaboration is the key to improving the indoor

environment. Bringing affected stakeholders (e.g., the public and industry associations) into the process early is advantageous. 

There is a lack of research on the effectiveness of many building and cleaning

practices and technologies that claim to improve the indoor environment. 

The successful program of radon testing and remediation serves as a model that can

be applied to other indoor environmental problems. The evolving programs and 

efforts to reduce exposure to ETS could also serve as models. 

31
Day 2: First Morning Session 

Review of Federal Research and Development and 

Outreach Activities: A Federal Agency Panel 

RADM Robert Williams began with a summation of the first day’s activities and introduced the 

Federal Agency Panel assembled to review and discuss federal research and development and 

outreach activities, summarizing goals, scope, and efforts. 

Mr. William Fisk introduced the session, acknowledging that it was not possible to include 

representatives from every federal agency with stakeholder interest in the indoor environment at 

this workshop (such as the U.S. Department of Education, for example), but that the involvement

and coordination of all agencies is still valued and encouraged. The session was structured in

two parts: (1) presentations by each panel member on indoor environment issues addressed by 

his or her agency; and (2) individual responses to a series of questions presented on slides that 

Mr. Fisk wanted panel members to address from the perspective of the agency they represented.

Henry Falk, M.D., M.P.H. 

Centers for Disease Control and Prevention 

Dr. Henry Falk suggested that indoor environment problems are likely be solved by many small 

steps, rather than with a single sweeping action like removing lead from gasoline. Indoor 

environment issues tend to occur in all areas of the neighborhood/community environment, from 

the home to related problems in schools, workplaces, health care facilities (such as hospitals and 

nursing homes), and recreational and travel facilities. Indoor environment issues encompass 

factors that impact on asthma (such as mold, dust, pollen, animal and insect allergens, cigarette

smoke, and volatile organic chemicals), pesticides and toxicants, lead and mercury (in paint,

dust, and vapor), radon, vapor intrusion (from landfills or Superfund sites), carbon monoxide

injuries and poisonings, and infectious diseases. There are more than 6 million substandard

housing units nationwide and a critical need to address the public health problems that stem from

these units; the Healthy People 2010 program goals call for a 52% improvement in reducing the 

number of occupied substandard housing units. CDC’s Healthy Homes Initiative includes 

development of guidance documents for housing inspection and risk evaluation, integrated pest 

management and field surveys for rodent control, and the National Healthy Homes Training 

Center and Network. Asthma prevalence shows minority group disparities related to housing 

conditions. 

CDC takes a traditional public health approach, linked to NIH medical information and EPA 

environmental surveillance activities. Science-based CDC-funded intervention programs, such 

as the Inner City Asthma Intervention (based on research funded by the National Institute of 

Allergy and Infectious Diseases [NIAID]), are complemented by additional activities based on 

cooperative agreements with many state agencies. Dr. Falk discussed the evaluations reported in 

the Damp Indoor Spaces and Health report and the Second National Report on Human Exposure

to Environmental Chemicals (released January 2003). CDC has been monitoring exposure of the 

United States population to ETS and has documented the effects of decreased exposure to 

32
second-hand smoke by a decrease in 50th percentile serum cotinine levels from 0.20 ng/ml to 

0.05 ng/ml, comparing population samples taken in 1999–2000 to a comparable group evaluated 

in 1988–1991. The next National Report will look at an expanded list of chemicals, including

volatiles from water use and groundwater. NIOSH HHEs assess potential health concerns in the 

workplace; about 30% of the 12,378 requests received through fiscal 2003 were related to indoor 

air quality issues. Common problems related to heating and air conditioning system maintenance 

and operation occur often. 

Dr. Falk concluded by discussing CDC’s international outreach program, which includes indoor 

environment issues in developing countries. There is an “energy ladder,” moving from the least 

expensive fuels (animal dung, crop by-products, wood) to more expensive and complex fuel

sources (natural gas and electricity) that provide increasing cleanliness and convenience in 

parallel with increasing cost. Low-quality fuels introduce more particulates into the air; but even 

without fuel changes, dramatic reductions in indoor air particulates can be achieved by introducing simple and inexpensive technology, such as replacing a traditional open fireplace with a 

wood stove and chimney. 

Samuel H. Wilson, M.D. 

National Institutes of Health 

Dr. Samuel Wilson said his agency’s focus since around 1998 has been on health effects of the 

built environment. In the view of NIH, the built environment essentially defines “indoor” 

exposures that not only contribute directly to human disease but also interact indirectly with 

social and lifestyle factors that can result in health problems. For example, in looking at the 

increased incidence of asthma, the built environment may increase human exposure to indoor 

allergens and other agents through poor air quality, and may also increase time spent indoors and 

decrease physical activity, possibly contributing to the health risk. A poorly designed built

environment also contributes to resource waste and environmental degradation. The National 

Institute of Environmental Health Sciences (NIEHS) has a strong interest in the possible contribution of biological factors to health problems. 

Asthma is not only a serious health concern but also represents a $13 billion annual cost for the 

United States health care system. NIH supports research on asthma in three focus areas: genetic 

predisposition (susceptibility), environmental factors (e.g., indoor allergens, endotoxin, ETS, 

viral infections, outdoor pollution), and allergy and asthma responses. The agency supports both 

observational and interventional studies. Dr. Wilson described the complex sequence of epithelial and immune system cellular and biochemical responses involved in asthma. Various steps in 

these reactive pathways suggest potential molecular targets for medical intervention. Studies of

environmental factors offer other opportunities for intervention. However, because most previous 

indoor allergen and endotoxin exposure studies have been small and geographically localized, 

they have limited application to other regions or different socioeconomic groups. In collaboration with the Department of Housing and Urban Development (HUD), NIH has added allergen

exposure levels to a nationwide study of lead exposure in housing (National Survey of Lead and 

Allergens in Housing [NSLAH]) to identify prevalence, to establish correlates for identifying 

problem homes, and to begin to examine the relationship between indoor allergen exposure and 

disease (allergy and asthma). 

33
Another collaborative effort is the allergy and asthma component of the National Health and 

Nutrition Examination Survey (NHANES). In this study, funded by NIEHS and conducted in 

collaboration with investigators from NIAID and CDC, data from 5,000–6,000 subjects per year 

will be collected from 2005 to 2008. The allergy assessment will involve analysis of blood 

samples for serum total IgE, and for specific IgE (antibodies) to 19 indoor, outdoor, and food 

allergens. In parallel environmental sampling, vacuumed dust samples from two home locations 

will be collected and tested for markers of specific allergens (endotoxin and markers of cat and 

dog, cockroach, dust mite, two genera of fungi, and rodents). Information will be collected by

questionnaire on housing characteristics, pet ownership, diagnosed allergy and related diseases, 

exposure to tobacco smoke, diet and nutrition, and occupational exposures. In conclusion, Dr. 

Wilson indicated that a series of conferences on the built environment played a key role in 

stimulating interest in indoor environment issues and developing objectives for each institution 

involved in these studies. The resulting cooperative studies indicated what can be done by taking 

a broad holistic approach.

Elizabeth Cotsworth, B.A., M.A. 

U.S. Environmental Protection Agency 

Ms. Elizabeth Cotsworth described her agency’s indoor environment activities, emphasizing that 

EPA’s current program is the cumulative response to limited statutory authority. EPA co-chairs 

and is a major participant in the CIAQ, along with the CPSC, DOE, OSHA, and NIOSH. 

EPA works with other agencies to identify unique, high-impact niches that it can fill related to 

overall agency mission and strategic priority decisions. In addition to well-established regulatory programs on lead and asbestos, Ms. Cotsworth indicated that EPA’s indoor environment 

program largely provides sound science and technology-based information related to any and all 

indoor issues, including carbon monoxide poisoning in homes, mold in schools, product use in 

commercial office buildings, and reducing indoor cooking smoke in developing countries. EPA

has sponsored reviews assessing the effects of low-level ionizing radiation, such as the NAS 

Biological Effects of Ionizing Radiation BEIR VI Committee review (1999). 

EPA currently focuses its major investments on a high-priority set of issues in which behavioral 

changes to reduce public health risks in indoor environments are promoted. These priority 

investment areas are: indoor radon, environmental management of indoor asthma triggers, 

childhood exposure to ETS, and indoor air quality in schools. EPA has established quantitative 

national goals in these four areas and tracks progress against these goals. For example, EPA set

an objective of reducing ETS exposure levels by 12% for children lees than 6 years of age, and 

has now achieved a level of 11%. EPA’s model for addressing each of these areas involves

defining a sound scientific rationale, raising public and stakeholder awareness of the issue, 

recommending (in some cases developing) mitigation measures, leveraging resources with the

use of cooperative partners and “train the trainer” approaches, and seeking institutionalization of 

the issues through non-federal means (local building codes, mortgage company requirements, 

etc.). For example, EPA played a key role in the development of standards for radon-resistant 

new homes and practices in the radon mitigation industry. For environmental management of 

indoor asthma triggers, EPA’s primary objective is to motivate people to take essential actions to 

reduce their exposures by providing culturally appropriate information. An example of this type 

of audience-focused information is the Tools for Schools material such as Managing Asthma in 

34
the School Environment (http://www.epa.gov/iaq/schools/asthma/ ). Approximately 30% of 

schools have adopted an EPA indoor air plan. EPA also supported a University of Michigan 

School of Public Health study of best intervention practices. EPA has classified secondhand 

smoke as a Group A carcinogen, and has established voluntary programs to encourage smokefree homes and day care centers (e.g., http://www.epa.gov/smokefree/index.html). 

Ms. Cotsworth also described EPA’s development of a strategic vision (EPA’s Healthy Buildings, Healthy People: A Vision for the 21st Century, published in 2001) for the future of healthy 

indoor environments in consultation with a broad set of stakeholders. This document serves as 

the basis for an informed discussion on public policy, health, building sciences, product manufacturing, and environmental research. The Healthy Buildings, Healthy People initiative is based

on six strategies for producing improvements: 

1. Partnership, 

2. Technologies, 

3. Market incentives, 

4. Research and development, 

5. Legislation/standards, and 

6. Public information. 

EPA is involved in identifying knowledge gaps related to indoor air quality, particularly in the 

areas of pollution sources, building design, and homeland security needs. To help achieve its 

vision, EPA recently completed a more than year-long effort to codify its indoor environmental 

research and development needs. The draft Program Needs for Indoor Environment Research

(PNIER) document will be released soon and posted on the EPA Web site. Ms. Cotsworth 

indicated that EPA has already started to market those needs inside and outside the agency

through various channels. 

Jerome Dion, M.S. 

Department of Energy 

Mr. Jerome Dion, substituting for Richard Moorer, summarized the impact of his agency’s

activities on indoor environment issues. DOE has a $1.3 billion research and development

budget with components that include energy-efficiency programs and low-income home weatherization. Research targeted toward the achievement of Zero Net Energy buildings (buildings 

that produce on average as much energy as they use) has a goal of reducing energy use by 50% 

by 2015. Three strategies have been developed for addressing indoor air quality issues in this 

energy conservation program:

1. Reducing the need for dilution air in buildings; 

2. Source control (reducing pollutants from building materials); and 

3. Cleaning recirculated air.

These strategies recognize the need to address health and safety concerns while promoting 

reduced and more economic energy use. Activities are closely coordinated with HUD’s Healthy 

Homes and EPA’s Energy Star programs. There are research and development programs (budgeted at about $3.5 million per year) involving Lawrence Berkeley National Laboratory, the 

National Institute of Standards and Technology (NIST), and the National Center for Energy

Management and Building Technology. 

35
Some of the technical pathways being investigated include: 

• Developing new methods for determining the amount of outdoor air needed in buildings; 

• Improving controls and equipment to supply outdoor air; 

• Improving techniques for measuring and monitoring the quality of air supplied to buildings; 

• Finding ways to reduce pollutant emissions from building materials; and 

• Finding ways to clean recirculated building air. 

The technological challenge in maintaining environmental quality in tight buildings is to ensure

that energy-efficient buildings are healthy buildings by good design and operation. To this end, 

DOE is developing a “best practices” guide for energy efficiency in hot/humid climates, to be

followed by similar material for conditions applicable to other regions of the country. DOE’s

current unmet research and development needs include getting better information on building 

performance and its impact on health, and defining better minimum ventilation requirements. 

The agency is currently using American Society of Heating, Refrigerating and Air-Conditioning

Engineers (ASHRAE) standards as guidance. Mr. Dion explained that DOE depends on other

agencies to identify potential health problems and counts on other agencies concerned primarily 

with health issues to promote solutions that are as energy-efficient as possible. 

Kevin Kampschroer 

General Services Administration 

Mr. Kevin Kampschroer described General Services Administration (GSA) workplace initiatives

designed to provide the “best value” for customer agencies and taxpayers. His perspective on 

indoor environment issues was primarily economic, particularly with respect to justifying 

improvements and motivating changes. Responsible asset management at GSA (“the nation’s 

landlord”) requires research to know how the built environment can affect work, and to define

and deliver what is really best while taking into account all factors, including the health and

productivity of employees. 

Workplace quality is a major factor in attracting and retaining good employees; this will be a

particular problem for the federal government as up to 70% of the federal workforce becomes 

eligible for retirement by 2005. Factors such as providing an opportunity for contact with nature 

or aesthetic and sensory variability should be considered from an economic as well as a humanistic perspective in the effort to attract new workers. GSA places 60,000 government workers per 

year into new office space (mainly due to lease turnover). A healthy indoor environment is 

usually assumed to be a feature of rented office space, but is often not addressed beyond making 

sure that the work environment is comfortable. Factors that promote psychological well-being 

and cognitive functioning are important for a workforce composed primarily of “knowledge 

workers,” and need to be included in a workplace evaluation. Mr. Kampschroer indicated that he 

would like GSA to develop a way to rate the environmental quality of a building, such as the 

Hong Kong building certification system discussed the previous day. The acoustic environment 

is often most troubling to people, but air flow and temperature are most often the subject of 

worker complaints, perhaps because most people do not think noise problems can be solved. 

GSA developed the Workplace 20•20 program to address issues of economic pressures, demo36
graphic shifts, and technological opportunities, and to evaluate their consequences on workers’ 

performance, resource constraints, and human capital challenges. The program uses a scorecard 

to evaluate four domains important to knowledge workers. They have limited experimental work 

underway (11 projects for 2005) to measure changes in performance factors after changes are 

made in the workplace. 

Mr. Kampschroer discussed potential improvements to the office environment as analogous to 

improvements in modern zoo design. He showed a four-panel slide that depicted the old system 

of small barred cages compared to the newer design of large naturalistic environmental enclosures, and a typical windowless office with cubicle work stations compared to a blank space with

a question mark. The point made was that just as zoos are trying to look beyond simple survival 

to an animal’s well-being by giving the animal more control over its behaviors and environment, 

we should try to give offices more aesthetic and sensory variety, provide places to be alone or 

work together as appropriate, and allow more control over our environment. 

There are many emerging challenges for GSA in accommodating changing technology and work 

patterns, but the economic leverage of GSA real estate management activities provides an 

opportunity to advocate for and promote workplaces with good environmental quality. Economic concerns and productivity outcomes (evaluated with behavioral research methods) form a

substantial portion of GSA’s concerns, but workplace environment (including issues like levels 

of carbon dioxide, particulates, volatiles, formaldehyde, and mold and mildew) is part of that 

evaluation. 

David Jacobs, Ph.D., CIH 

Department of Housing and Urban Development 

Dr. David Jacobs described HUD’s efforts to address indoor environment issues in the context of 

providing quality affordable housing in the United States. He discussed the history of public 

health interest in housing, starting from the late 19th century, when substantial improvements in 

tuberculosis and typhoid morbidity were achieved by successful efforts to reduce crowding, 

improve sanitation, and bring more light and fresh air to urban housing. Physical characteristics 

of housing have an impact on the social and psychological characteristics of the home’s occupants, and, at a broader level, the neighborhoods. In the United States, half of the lowest-income

households spend 50% or more of their incomes on housing, nearly 2 million live in severely 

inadequate housing, and 2.5–3.5 million people are homeless at some time during any given 

year. These factors result in a segment of the population that is at much higher risk for asthma

and infectious diseases. 

Lead toxicity has been recognized for over a century, as illustrated by a paint advertisement from 

1897, which claims it is “not made with lead and is non-poisonous.” Lead abatement programs

have reduced the percentage of 1- to 5-year old children with blood lead levels at or above 10 

μg/dL from 88.2% in 1976–1980 to 2.2% in 1999–2000. However, as of 2000, there were still an 

estimated 38 million houses containing lead paint and 434,000 children with elevated blood lead

levels. Lessons learned from dealing with lead paint might be applied to other housing-related 

diseases and injuries, specifically diseases caused by mold and allergens in indoor air, exposure 

to neurotoxicants, carbon monoxide fatalities, and fall and trip hazards. Progress on residential 

37
lead hazard control was made by (1) assessing the magnitude of the problem in existing housing, 

with studies like the NHANES dust lead survey and the National Survey of Lead and Allergens 

in Housing; and (2) establishing mandated standards and guidelines for hazard assessment and 

abatement. Exposure assessment is feasible, but hazard levels are not currently well established

for mold and allergens. 

HUD’s primary focus is on low-income homes and community development. In this context,

improvements made for one purpose can produce other unrecognized health benefits. For 

example, moving people to more stable, mixed-income neighborhoods results in significant 

improvements in the physical condition of housing, as well as in mental health and reduced 

obesity, according to HUD’s Moving to Opportunity for Fair Housing experiment. Window 

replacement programs remove a major source of lead paint and lead-contaminated dust in lowincome housing and also address energy conservation and moisture infiltration. New windows

can impact indoor air quality by improving ventilation because they can be opened and closed

more easily. While it is recognized that energy conservation offsets the cost of windows over a 

5- to 10-year period, the health benefits are generally not recognized in the market value of 

housing, although they may be even more substantial in terms of reduced medical and other 

health care costs. 

Dr. Jacobs pointed to the need to make the economic benefits of improved indoor environment 

more evident so as to use market pressures to favor interventions. At present, many home

improvements that would address health issues are not carried out because they would be economically irrational from a homeowner’s point of view. When we improve our homes with a 

new furnace or roof, we anticipate at least a partial return on investment in the form of increased 

market value when that home is sold, but measures taken to produce health benefits like radon or 

lead abatement generally are not reflected in the market value of the home. In dollar terms, 

health benefits may greatly outweigh the value of improvements in other areas, but most improvements that affect health generally do not affect the market value of homes. Dr. Jacobs

suggested that we need to find a way to articulate the cost of not making health-based housing 

improvements and to document the cost-shifting to the medical sector that results from allowing 

substandard housing, and the illnesses associated with it, to persist. 

Dr. Jacobs concluded by mentioning the HUD publication Basic Healthy Housing Reference 

Manual, which is being reissued in collaboration with CDC. He discussed a list of specific 

research needs and national and international policy objectives with respect to healthy housing 

and other indoor environments that have been formulated at recent international conferences. He

recommended that the Surgeon General and others work with WHO to advance these objectives. 

Several of these recommendations are focused on developing a specific way of assessing policy 

effectiveness (e.g., research to develop better housing-hazard measurement technologies, to

determine the interactions of specific housing conditions and physical and mental health, and to

measure interactions with confounding variables). He stressed the importance of not focusing on 

hazards individually, but rather taking an integrated approach to establishing healthy conditions

by looking at housing systems and integrated housing and community intervention. It is important to assess how variables interact, and how social conditions impact on health issues (e.g., 

obesity). There is a need to partner with the private sector in marketing healthy home improvements. Window and door manufacturers market primarily on aesthetics and energy conservation 

38
and typically do not consider advertising the health aspects of their products. He suggested a 

program, analogous to EPA’s Energy Star program, for labeling new and existing homes and 

products that contribute to improved indoor environment design. Looking at marketing techniques would be a key research need. There is a need to formulate policy and develop technology for developing healthy housing on contaminated sites that often provide low-cost real estate

in urban areas. Finally, he noted that unique ethical issues arise in intervention research on 

substandard housing, which must be taken into account when planning studies. We should not 

be using our children as detectors of substandard housing; we have technologies and techniques

we can use to provide America’s families with decent, safe, and affordable housing.

James E. Hill, Ph.D. 

National Institute of Standards and Technology 

Dr. James Hill discussed NIST’s engineering and technology perspective on indoor environment

issues. The agency’s primary mandate is to strengthen the technological innovation infrastructure 

in the United States for the occupational sector, but to do so with attention to public safety and 

security while maintaining quality of life and jobs. NIST conducts and supports extramural air 

quality and ventilation research to improve indoor environmental conditions in a cost-effective 

manner, which is done through development of measurement and design procedures and simulation programs for air and contaminant transport in buildings. Ventilation research is a $2 million-per-year program carried out with 10 permanent staff members plus students and guest 

researchers and supported by the Air Conditioning and Refrigeration Technology Institute, 

California Energy Commission, DOE, EPA, HUD, and the U.S. Navy. As with DOE’s program, 

NIST is looking for technology that improves indoor air quality without substantially increasing

energy costs. Addressing indoor environment issues should be a routine aspect of engineering

and should be included in computerized design tools. There is a need to understand healtheffects studies at a level where useful information is provided that can be used by engineers

(“what to do and what not to do”). Also, standards cannot be too complicated if firms are expected to implement them. 

NIST works on many issues that impact on the indoor environment, such as developing test 

methods and standards for contaminant emissions (e.g., sulfur in fossil fuels), gaseous air cleaner 

performance, alternative refrigerants, volatile organic compound emission rates into indoor air, 

and residential and office building ventilation technology. NIST activities have expanded 

recently to include security issues, and the CONTAM modeling program is being used in research supported by the Defense Advanced Research Projects Agency (DARPA) on enhancing 

the software to analyze the impact of protective measures and analyze chemical/biological agent 

transport in buildings. Dr. Hill stressed the need to develop practices that can be implemented 

quickly and easily, because otherwise there is a tendency to “keep building new buildings like 

the last building.” 

Questions and Comments 

In audience comments following these presentations, one participant indicated disappointment at 

the lack of progress made in determining adequate ventilation rates for homes to ensure indoor 

air quality, noting that the ASHRAE standard used in the United States is about one third or one

39
half the rate used in the rest of the industrialized world. Fundamental research to understand the 

health implications of this has not been carried out. Day care centers and schools may require 

even higher ventilation rates than common workplace settings to reduce infection rates. There is 

also a lack of research information on the basic spread of infectivity and ventilation. Several 

people from the audience commented on points made in the presentations from the perspective of 

their particular public health interests. One participant commented that HUD housing should be 

able to accommodate those with MCS; another suggested a need for better environmental health 

education for health professionals, particularly with regard to mental health problems. Several

audience members reinforced points made by the speakers regarding health care costs associated

with inadequate indoor environment practices. Ms. Cotsworth responded that EPA works with 

the health insurance industry and providers to try to understand management of environmental 

triggers, and Dr. Falk indicated that CDC is also promoting these programs. 

Highlights from Federal Research and Development

and Outreach Activities Session

Many federal agencies conduct research and operate health intervention programs 

that involve agents in the indoor environment. 

Federal agencies work collaboratively to identify and address common problems in

the indoor environment. These collaborative efforts include sharing expertise for

research design and evaluation, co-funding basic research and needs assessment 

studies, and cooperative programs to inform the public and promote behavioral 

changes that reduce public health risks associated with poor indoor environment 

conditions. HUD’s Healthy Homes and EPA’s Energy Star programs are examples of 

programs that have promoted public behavioral changes. 

There is lack of research on certain basic scientific questions, such as understanding 

how infective agents are spread in the indoor environment.

Federal agencies work together to develop building technology solutions that meet

multiple objectives, such as producing a healthier indoor environment without

compromising energy efficiency or substantially increasing costs of managing 

government facilities. 

There is a need to understand health effects research at a level that can be applied

by engineers. 

40
Day 2: Second Morning Session 

Review of Federal Research and Development and Outreach 

Activities: Questions for the Federal Agency Panel 

In the second session, each panel member was asked in turn to respond to and discuss some

specific questions: 

Question 1: Is federal indoor environment research and outreach commensurate with 

need? 

Most panel members indicated additional areas where more studies should be conducted. Ms. 

Cotsworth noted the resource limitations for her agency and suggested that it is important to 

encourage non-federal entities to contribute and leverage available resources. Dr. Falk noted that 

concerns evolve, and that it is important to coordinate and prioritize efforts to obtain the best

results given these changing interests. Dr. Wilson noted substantial information gaps in understanding disease-exposure relationships and the magnitude and prevalence of exposures. More

coordinated research is needed in these areas. Mr. Dion indicated that DOE is mostly on the 

receiving end of indoor environment health effects research and needs help in making the best 

use of it to design and implement technical changes in building practices (they need it “translated 

from the health domain into the engineering domain”). Mr. Kampschroer noted that the building 

industry is very fragmented, with many small companies involved in architecture and construction, and it is difficult to move big research forward. He estimated that the industry spends less 

than 0.5% of gross receipts on research. He suggested that the Surgeon General could take the 

lead in motivating and coordinating more high-quality industry-funded research. Dr. Jacobs 

suggested that we have not fully articulated the needs. We do not know what fraction of disease 

is caused by indoor environment factors or the costs of addressing these issues. He pointed to 

lead, and the efforts made to address it as a health issue, as a model of what needs to be done 

with indoor environment issues in order to define environmental hazards and the cost-benefit of 

cleanup. Dr. Hill and Mr. Fisk indicated that there is not enough funding to address the realworld problems that have already been identified. 

Question 2: What can we do to improve responses to indoor environment problems? 

Ms. Cotsworth emphasized coordination and communication, suggesting that educational 

activities and science must be shared across agencies. She advocated leverage and partnerships 

between agencies while still fulfilling individual agency missions, and stressed the role of the 

CIAQ in facilitating this kind of collaboration. Dr. Falk stressed two main points: (1) much

more collaboration is needed, including working with agencies at the state and local level, and

(2) public health agencies should be more visible in this coordinated action. Using lead abatement as an example, he noted that regulation can eliminate major sources (e.g., in gasoline and 

paint), but remediation still has to be addressed on a house-by-house basis. Dr. Wilson suggested that visibility of health aspects of the built environment is too low. He suggested establishing some way of indicating health status, such as a “scorecard” for homes and communities

that would be analogous to rating homes for energy efficiency and could be a driver to achieving 

41
more visibility. Mr. Dion pointed out the need for a single federal entity to take the lead in a

collaborative effort, and that this function could be filled by the Surgeon General. It is hard to 

address these issues one pollutant at a time, and an integrated approach is more likely to be 

successful. 

Mr. Kampschroer thought that combining health research with engineering research is the key to 

more effective responses. Dr. Jacobs noted the central role of housing in dealing with any public 

health issues, and suggested revitalizing the President’s Task Force on Environmental Health 

Risks and Safety Risks to Children (1997), building on asthma and lead safety reports already 

produced. He felt that a Cabinet-level initiative is needed to drive an effective program. Dr. Hill 

again stressed a need for collaboration to make the best use of scarce resources. Mr. Fisk, noting 

how often collaboration has come up in the discussion, asked for specifics. Dr. Hill stressed the 

role of interagency committees to plan budget initiatives and research. Mr. Dion stressed the 

need for more communication at lower levels, with technical people from the agencies working 

with each other and with state and local experts. Dr. Falk also supported including more locallevel collaborations. Ms. Cotsworth thought a President’s commission focused on asthma might 

be a good model. It is more defined in scope and objectives, she said, and therefore more likely 

to result in a productive collaboration than other indoor environment areas where hazards and

consequences are not as well understood or objectives are too far-reaching. 

Question 3: What is the role for regulations, standards, and guidelines? 

Dr. Hill suggested that there are pros and cons for efforts such as these. Industry standards are 

generally developed by a consensus process that may not satisfy those at either end of the 

spectrum. However, the consensus process produces a set of standards that everyone has 

“bought into” and is able to meet (the ASHRAE standards, for example). Federal regulations 

may not have to deal with a consensus process, but are often difficult to implement (EPA’s

attempts to tighten air standards, for example). Dr. Jacobs pointed out that there must be authority to enforce standards for them to be effective. Mr. Kampschroer considered the long time 

needed to establish industry standards by consensus to be a significant problem because building 

materials and practices change too quickly for consensus to catch up with current practices. 

Market forces provide an alternative to regulatory action that can often move faster to establish

best practices. Mr. Dion suggested that standards are called for when the market fails to respond, 

which is not all that uncommon. He indicated that it may be necessary to do research first to

establish best practices, and then get them out into the marketplace. Dr. Falk indicated that 

regulations can be helpful for certain issues, but indoor environment problems such as dust mites 

and cockroach allergens are not easily regulated. In these cases, education and guidelines to

produce behavioral changes may be more productive. Ms. Cotsworth indicated the need for a 

wide ranging “toolbox” of approaches to cover various health issues, suggesting that more can be 

achieved by education and marketing than through regulation alone. 

Questions and Comments 

Mr. Fisk then asked for audience comments on the issue of coordination among federal agencies. 

One consultant responded that when the objective is change, information alone may not be

enough. Since the federal government is the single biggest building owner in the United States, 

42
actions taken by the government regarding its own built space could have a strong market

impact. Collaboration with agencies that manage and use property (but have no direct mission 

that includes indoor environment health effects) could be useful in this regard. An audience 

member with connections to GSA pointed to senior-level collaborative efforts for energy accounting, and suggested that a similar approach could be applied to health or green building 

issues by developing a green building measurement tool. Responding to this point, Mr. Kampschroer indicated that there is a structural impediment to life-cycle costing (favoring green 

building) in that the costs and benefits go to different parties. It can be difficult to move from 

theory to practice, but energy-efficiency labels that may produce marketing pressure are one idea 

of how to accomplish this. The financial community must be brought into the process, for 

example by providing lower mortgage rates for healthy homes. Dr Jacobs underscored this 

accounting problem, using window replacement as an illustration of the disconnect that can

occur between who pays and who benefits. On the other hand, market forces can work. The

lead paint disclosure rule helped to solve the lead problem in many homes without mandating 

any specific corrective measures: there was improvement to over 150,000 housing units just 

from disclosure. An audience member who had real estate experience in California agreed that 

the disclosure rule has been very helpful in that state, but in order to act on the disclosed information, people still need to know why it is a health problem and what they can do to correct it. 

Tenants should also be required to disclose water infiltration problems to their landlord so they 

can be corrected promptly. This audience member stressed two needs: to raise public awareness 

of hazards and the need for disclosure. 

An audience member with a background in community health and nursing indicated that she is 

now in the private sector, evaluating homes for potential health problems. She observed that as 

lead paint abatement programs were more successful, problems with mold increased because

lead is toxic to mold. She described home building as “manufacturing in the field,” suggesting it 

is inherently more complex and difficult to regulate than other manufacturing activities. In her

work, she looks to government to set some standards and criteria for what constitutes an acceptable healthy home, focusing on the total environment rather than on individual agents and issues. 

Several participants commented on the government’s role in leading corrective efforts. One

participant suggested that information on good practices should be distributed through as many 

different routes as possible to reach the audience of all those who can effect change. Builders

will look to the government to provide credible guidelines and practices that they can use to

produce healthy homes. Acceptable standards will cut across the differing concerns of individual 

agencies. A Congressional legislative aide in the audience suggested a joint multi-agency (NIH, 

CDC, EPA, and HUD) study on the health and economic impact of mold, funded under a Congressional mandate, to result in a set of model standards or regulations. Citizens affected by

mold problems find it difficult to get help from the government because of gaps between agencies. However, he indicated that no matter how collaborative the process, there should ultimately be a single government resource to answer questions from the public in order to avoid 

confusion. Dr. Falk responded that the need for more study and agency collaboration is clear, 

but there may be too many objectives to address in a single study. He suggested that a task 

group from this workshop could explore the specifics of what to address first and make recommendations. Dr. Wilson commented that this was an excellent suggestion, and that he would be

interested in following up to see if it could be implemented. 

43
In a similar context, a representative of the building technology industry spoke as a consultant to 

the National Institute of Building Sciences (NIBS) to represent their interests at this workshop. 

He indicated that the financial and insurance industries are very interested in having a mold

standard, which they could use to address risk and protect their commercial interests. A group of 

key stakeholders in the home ownership industry (including mortgage companies like Fannie 

Mae and Freddy Mac) met at a 2002 NIBS workshop on mold and are vitally interested in 

addressing health and liability issues associated with mold. They have started to form a building-and-mold alliance with the objective of developing guidelines for new and old construction 

based on the existing knowledge base. Some federal agencies, such as GSA, DOE, the U.S. 

Army Corps of Engineers, and the Veterans Administration, are starting to work with them. This

group has had two meetings as a council of NIBS, and would be happy to serve as a vehicle for

establishing this kind of program. 

Highlights from Federal Panel Discussion Session

The Surgeon General could take the lead in motivating and coordinating healthy 

indoor environment initiatives.

More effective collaboration between federal, state, and local government and nongovernment agencies can help to improve the indoor environment, and public health

agencies should take a more visible role in this coordinated effort.

Collaboration of all stakeholders will likely result in sound guidelines and be more

effective than regulations. 

There are many unmet research and program needs; specifically in understanding

disease-exposure relationships, determining the magnitude and prevalence of

exposures, documenting cost-benefits of intervention strategies, and developing

cost-effective technologies for improving indoor environmental quality in new and

existing buildings.

Best practices to improve the indoor environment should be specifically developed 

and distributed to many different audiences so that change can be effected. 

A definition of a “healthy home” is needed. 

A task force should be formed to identify and prioritize indoor environment issues. 

A mixed approach combining public information, applied market forces, and standards setting and regulatory actions is likely to be more effective than any single 

approach (e.g., public-private partnership in Hong Kong).

44
Day 2: Afternoon Session 

Vision for the Future 

Kathleen Kreiss, M.D., National Institute for Occupational Safety and Health, CDC 

CAPT Stephen Redd, M.D., National Center for Environmental Health, CDC 

Dr. Kathleen Kreiss and CAPT Stephen Redd facilitated a discussion session entitled “Vision for

the Future,” intended to provide workshop coordinators, speakers, and audience members with 

an opportunity to discuss possible conclusions and recommendations to appear in the Workshop 

Summary Report. 

CAPT Redd began by restating the importance of the problems and difficulties that can arise in 

addressing indoor environment problems. He made four primary points related to the importance 

of this issue:

1. Health issues can be hard to define and the impact of indoor environment risk factors 

hard to measure. From the perspective of promoting well being rather than just the absence of disease, a perspective of the CDC Futures Initiative, measuring health impact 

can be even more difficult. 

2. As work goes on, we are likely to identify more hazards associated with the indoor environment and we need to have a comprehensive strategy in place to deal with them effectively. 

3. There is already a gap between knowledge of hazards and remediation practice and action; i.e., there are things we know how to do that are just not getting done. 

4. There is a sense of urgency in responding to these problems and providing knowledge 

that members of the community need to improve their health. 

Dr. Kreiss stressed the value of building on the multi-disciplinary approach of this workshop. 

Workshop organizers may want to refine some of the suggestions made by presenters and 

members to produce a Workshop Report, she said. To this end, Dr. Kreiss presented a set of 

questions and asked the group to respond to them (also calling on certain audience members 

whom she knew have expressed ideas on these topics). 

Question 1: What can be done to ensure that the momentum of the multidisciplinary and 

multi-agency approach of this workshop is sustained? 

There are two good models of large successful programs that address health effects from agents

in the indoor environment (as described in Mr. Girman’s presentation): radon and ETS. Members of the audience suggested several other programs to serve as models of collaborative multiagency efforts. A representative of a regional EPA office in New York mentioned a collaborative 

effort between her office and a CDC Asthma Partnership in New Jersey. EPA funds them to 

reduce environmental triggers to asthma, but she noted that if they got full state implementation

funding, this program could do a lot more in medical management (and allow CDC money to go 

to organizations outside the state’s implementation plan). An audience member spoke about the 

National Children’s Study, a longitudinal study of 10,000 children in the United States from

before birth to age 21, including examination of schools, homes and day care centers to evaluate 

45
many outcomes and environmental factors, including those related to the indoor environment. 

This study will be an important vehicle for gaining insight into child health in relation to the 

indoor environment. The program is at the stage of developing protocols and issuing RFPs for

participating organizations. The Web site for this project is www.nationalchildrensstudy.gov 

and the contact is ncs@mail.nih.gov. 

Audience members suggested some additional organizations with multidisciplinary programs in 

and outside the government that could serve as partners or provide models for collaborative 

indoor environment programs: 

• Building industry organizations, such as the National Association of Home Builders

(NAHB), which has a research program. 

• State cooperative extension services, an arm of the U.S. Department of Agriculture 

(USDA), located at state land grant colleges. They conduct community-level education 

and outreach and have had indoor air quality programs since 1993. This structure also 

serves as a good model of how to provide information and advice to the public. 

• Interagency committees on green building issues and indoor environment quality such as 

the Interagency Sustainability Working Group (ISWG), the Committee on Indoor Air 

Quality (CIAQ), the Federal Facilities Council (FFC), the Federal Green Building Council, and the White House Task Force on Waste Prevention and Recycling. 

• Professional societies, such as the Association of Heating, Refrigeration and AirConditioning Engineers (ASHRAE) and the American Institute of Architects. 

• Building maintenance organizations and industry representatives, such as the Association 

of Facility Engineers (AFE) and the Building Owners and Managers Association 

(BOMA). 

A physician suggested that the solution to indoor air quality issues lies in the materials used for 

building and renovating. He noted that outgassing from materials used in building construction, 

which can be a major problem for asthmatics, determines how much ventilation is needed. He 

recommended the book Less-Toxic Alternatives, by Carolyn Gorman, as a good resource on this 

topic. Most asthmatics already know what products they can and cannot tolerate, and this serves 

as a starting point to determine what components are dangerous to health. There needs to be

more cooperation with groups like the American Institute of Architects (AIA) and building 

material manufacturers to make use of this body of experience from a community of people who 

have greater sensitivity to environmental pollutants than does the general population. 

Mr. Fisk strongly advocated for more federal agency collaboration. Individual agencies are

themselves fairly multi-disciplinary, but they can still benefit from combining their resources and

expertise. He supported the specific suggestion made by Dr. Hill, and sustained by Dr. Wilson, 

to establish a committee in the Office of Science Technology and Policy (OSTP) to serve as the 

key agency for organizing and promoting a coordinated effort on the indoor environment, noting 

this office’s role in joint planning for research and budget needs. OSTP is in the Office of the 

President and functions by setting up committees, subcommittees and task groups in various 

areas of science and technology, populated by representatives of all agencies involved in that 

particular area, and charged with developing joint planning for research. OSTP also defines 

research funding levels (or has in prior administrations), and was responsible for setting the 

research priority for fuel cells. This would be a good venue in which to bring together the 

46
agencies involved in the workshop, as well as to draw in other agencies not represented at this 

workshop. The mechanism for this would be asking the Surgeon General to contact John H. 

Marburger, OSTP Director. Mr. Fisk suggested that this is the critical place in the government to 

“put a lever.” 

 

The moderator asked how the existing CIAQ would fit with an OSTP committee. An audience 

member noted another executive branch interagency group: The White House Task Force on 

Waste Prevention and Recycling, in the Office of the Federal Environmental Executive, formed a

Federal Green Building Council about a year ago. This is another interagency group concerned 

with indoor environmental quality. An audience member from the CPSC who served on CIAQ

spoke about its history and the present activities of the group. Initially, CIAQ served as a way to 

coordinate research funding, but as funds to the member agencies have dried up in recent years,

it has not been as active. They are still a group that is well informed on what research is going 

on in each agency, and they review each other’s protocols and provide technical support among 

agencies. 

A participant from HUD’s Office of Healthy Homes and Lead Hazard Control suggested issuing

joint RFPs to address specific indoor environment problems that multiple agencies agree are 

important topics. HUD could apply their funds to the research infrastructure that exists in other 

agencies to examine, for example, the cost/benefit of integrated pest management, under the 

HUD Healthy Homes initiatives. There are many small issues that have not been well researched. For example, asthmatics are advised to remove carpeting from their homes, but there 

is no scientific evidence on how effective that is. A participant suggested the need for a multidisciplinary approach to school issues, including research on green schools and sustainable 

technology, and health effects for teachers and students. 

Question 2: What are the best strategies for implementing the things that we already know 

need to be done? 

The moderator pointed out that strategies must be developed; for example, we know enough 

about the harmful effects of damp buildings to begin to take action, so what would be the best 

way to proceed? One participant indicated that, in spite of comments that there has been failure

to effectively apply OSHA standards and ASHRAE 62 standards to indoor air quality issues in 

industry; there is one example of a “success story.” Under the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), there are architects’ guidelines on dealing with 

aerosols. Since JCAHO determines whether hospitals can bill for their services, they have great 

leverage in effecting change. They inspect hospitals and require plans and protocols to protect 

patient safety. It is currently not possible to facilitate construction in hospitals without a plan for 

control of particulates and bioaerosols. Similarly, there are requirements for plans to address 

normal maintenance and water damage issues. Having a quasi-regulatory agency forcing health 

care facilities to maintain indoor environment standards has been very effective, and may be the 

only “success story” for a regulatory approach in the last 10 years. 

Another participant underscored the need to address the chemically sensitive in any interagency

effort, pointing out overlapping concerns for issues like pesticide use. A participant from the 

NRC stressed collaborative efforts, mentioning the Green Schools program being set up in 

47
collaboration with the Commonwealth of Massachusetts. The program will be looking at sustainable technology and its effects on student health and productivity. This individual also 

stressed the need to move ahead with available technology without waiting for more basic

research. 

An audience member suggested that a fundamental problem with current building practices is the 

standard of care used in construction and the use of a “punch list” approach of correcting problems after the fact: “We find that you can’t fix everything effectively, and, consequently, the 

majority of new buildings have poor indoor air quality.” This individual pointed out a need to 

document and approve construction at each stage (foundation, backfill, etc.) when it is still 

possible to take effective corrective measures for good indoor environment as the building is

constructed. This has been done for school buildings and hotels, resulting in better indoor 

environments in the final product. A panel member suggested possibly including indoor environment standards in building codes, but the audience member indicated that most correct 

procedures are already in the code: the problem is lack of oversight. The same individual also 

indicated a simple solution for indoor air quality issues during renovations: set a requirement to 

use negative air pressure to restrict movement of dust into occupied areas. A panel member

commented on construction issues, noting that they illustrate the complexity of dealing with 

indoor environment issues because they impact on so many different interests and professional 

concerns (architects, construction trades, building owners, insurance industry, medical care 

providers, etc.) even when focusing only on a single issue, such as water intrusion. As the 

number-one strategy, he suggested using the Office of the Surgeon General to issue a document

that frames the debate on indoor environment, as was done for second-hand smoke. Just choosing one issue to begin with (e.g., dampness) would start to move public policy actions, beginning 

with changes such as keeping insurance companies from writing policy exclusions for mold. 

Dr. Mitchell suggested “changing the metric” for success to focus more on the health of building 

occupants rather than on the building itself, using the Tools for Schools approach as a model. By 

assessing occupant health and comfort, it is possible to move away from debating issues such as 

the relative importance of maintenance or initial construction and direct attention to the outcome

of good practices in both. The Surgeon General can suggest in his report that focusing on the

health of the occupants is an indicator of whether the building is working well. 

Another participant discussing implementation strategy pointed out that schools represent a large 

business with considerable market leverage: it should be possible to motivate businesses to 

market green materials to schools. In turn, schools have a strong influence on the community of 

parents and the public at large. Guidelines are needed to allow businesses to know what to

market. An industrial hygienist in the audience mentioned the U.S. Green Building Council’s 

LEED (Leadership in Energy and Environmental Design) Green Building Rating System®, 

which has improved building performance; indoor air quality is part of the rating. Their certified 

and registered products and assessment strategies provide an example of using marketplace 

forces and increasing consumer awareness of good building practices. 

Question 3: Is it appropriate to organize stakeholder input and plans for action by type of 

building (i.e., differentiating between schools, offices, and residences)? What stakeholders

may be brought into the mix by considering buildings other than residences and schools? 

48
Ms. Loftness, who serves on the board of LEED, thought this would be a good strategy. She 

suggested that it may be better not to address schools as a separate category since their construction varies considerably by age and location (climate). She pointed out that hospitals, nursing 

homes, and laboratories are other building types that are hard to include in categories because

their construction and operation is often very different from other buildings. There would be

some issues involving particular stakeholders, that would be limited to their particular type of 

building, but other issues, such as diagnostic techniques might cut across all types of buildings. 

Labeling spaces for certain levels of moisture and damage might be a way to cut across various

building types. 

Dr. Woods thought that a more important issue, from the perspective of accountability, would be 

building ownership: for example, schools may be privately or publicly owned. Offices may be

private, owned by the state, or owned at the federal level, etc. He suggested using the public

sector to lead the way in taking health initiatives. In terms of strategy, there are already federal 

regulations in place (e.g., Code of Federal Regulations, Title 10, Parts 434 and 435) that require 

energy budgets be set for a building; an analogous mandate for health-quality levels would be 

relatively easy to put in place. He felt that government agencies could do more to lead by

example in the buildings directly under their control. 

Drawing from experience with a Maryland task force on indoor air quality, one panel member 

suggested that a government agency that leases space and writes contract requirements has the 

most opportunity to specify operational requirements. Mr. Kampschroer agreed that GSA could 

do more to use their building management activities to set an example, but also pointed out the 

need to couple good practices with research to demonstrate the effectiveness of any methods that 

are advocated. There should be continued effort to proving economic and health advantages 

with demonstration projects. He also pointed out that GSA holds only 40% of the buildings used 

by federal government agencies, so the other owner agencies could have a substantial impact

with their properties as well. Dr. Kreiss agreed, noting that there are also logistical advantages to

involving the military and other government groups in outcomes research: cooperation may be

greater than in studies conducted in the private sector, and clearances required for federal studies 

with regard to public burden do not apply. She mentioned a military indoor air quality study

performed in the early 1980s that showed that basic trainees housed in new, tight, energyefficient barracks had a much higher rate of infectious respiratory disease than those housed in 

older, leaky barracks, and consequently greater time lost to illness, which required them to begin 

basic training again. (Brundage JF, Scott RM, Lednar WM, Smith DW, Miller RN. Buildingassociated risk of febrile acute respiratory diseases in Army trainees. Journal of the American 

Medical Association. 1988:259(14):2108–2112.) 

Question 4: How do we unleash market forces to improve indoor environments? 

An audience member enumerated some of the organizations that can be approached to apply 

market forces: ASHRAE, CDC, DHHS, DOE, DoE, EPA, GSA, HUD, and NIH. It is also 

important to include building operators and maintainers among stakeholders who bring a lifecycle perspective. This commenter advocated a Call to Action from the Surgeon General, as it 

should be clear that there is a problem, both with regard to public health criteria of scope and to 

49
number of people affected. Another audience member who had worked with GSA indicated that, 

in his experience, government branches that lease and rent space have much more latitude to 

specify operations and maintenance provisions in their contracts than branches that build them 

outright. Leasing and renting is one area that could be used to unleash market forces. Another 

audience member, who had experience working on federal buildings using UV radiation and 

cleaning air coils for improving indoor air quality and energy use, suggested worker productivity 

as a primary economic “lever.” The government is able to run their program under orders to 

improve energy efficiency, and they can show that the same measures that make the building

more energy-efficient can make it healthier at the same time. Executive Order 13123 requires 

energy savings in federal buildings. There has been a lot of research recently on the economic

impact of improving the health of building occupants. He suggested the term “presenteeism,”

meaning that the worker is physically there, but is unable to work effectively or productively due

to health issues. Labor savings from decreased presenteeism and increased worker productivity 

can be a substantial market force. The moderator pointed out that this is partly a knowledge 

issue, making companies aware of the potential impact of indoor environment on presenteeism, 

but it is also an accounting issue, since, as pointed out in the morning presentations, employers 

must see the cost/benefit effects of their actions. 

A consultant commented on the role of GSA in buying huge amounts of goods and services, 

which acts as a huge “economic motor,” but suggested there is some confusion due to conflicting 

or uncertain claims and standards for healthy building products. He suggested that a certification 

program is needed to guide purchasing decisions to products that truly enhance the indoor 

environment. Another audience member suggested making sure that insurance adjustors, especially those paying for reconstruction after flood damage, ensure that good practices are being 

followed when buildings are rebuilt. What insurance adjustors say, goes, unless someone wants

to take them to court to force better practices. With large private-sector owners (real estate

investment funds, pension funds, partnerships, etc.), there can be a disconnect between risk 

managers (who deal with fear) and facilities managers (who desire to keep operations costs to a

minimum), so there is a need to work at the ownership level to be sure that the communication 

takes place and “market forces,” such as fear of litigation, are applied. 

Question 5: How can we assure that interventions are rigorously evaluated? 

One participant commented that if you want rigorous evaluation, you need to be sure that people 

at the building site have the right tools and the right information. There is a need to reach out to 

building remodelers and their associations as well as to new home builders to encourage best

practices. There should be input to the media and trade press to ensure accurate reporting and 

follow-up of positive and negative results of research into innovative building practices and

hazards. CAPT Redd pointed out that people responsible for building do not necessarily have

the research expertise to determine best practices. In radon control, for example, collaborative 

efforts with physicists were needed to move the program forward. An audience member from 

HUD noted the importance of good investigative practices, such as adequate sample size and 

good measures of change with multiple endpoints. Some small asthma intervention studies never 

had the statistical power to demonstrate anything. 

50
Dr. Mitchell pointed out two barriers he has experienced to conducting good quality, wellevaluated research: (1) the need to identify agencies with specific mandates to fund studies

concerning indoor environment (to put in place adequate funding for large-scale, high-quality

studies), and (2) fear of liability on the part of building owners, operators, and contractors. Each

time he has tried to conduct research in this area; it has been stopped by legal concerns within 

either the private or public sector (e.g., local government or school boards). Any time ideas are 

raised about linking health to a building, liability issues are also raised. The legal department 

puts up obstacles that can severely limit access to the building and its occupants. The moderator

asked how that has been overcome. Dr. Mitchell responded that it has not been overcome. Lack

of access to the indoor environment and its occupants is a huge impediment. He suggested that if 

this workshop can address that issue, that would be the single most valuable contribution it could 

make to further research on indoor environment issues. 

An occupational health consultant pointed to the success of NORA and the interest and expertise 

that NIOSH has in evaluating intervention effectiveness. This process could serve as a model for 

making some progress in setting priorities in indoor environment concerns. Intervention effectiveness is a research priority for NIOSH, and for the international company senior health and

safety managers with whom this consultant works. NIOSH must evaluate interventions in very

complex, multi-variable occupational environments. The commenter also indicated the value of

case studies and other designs based on social sciences models, suggesting that you do not need 

double-blind case-control studies to answer every research question. 

A safety engineer consultant discussed his experience with a Blue Ribbon Panel in Washington 

State charged with monitoring school health and safety. The panel used funds allocated to 

schools by DoE to triage the needs for correcting structural and operational problems presented 

by individual schools in the state and to give advice on the most effective intervention. While he 

agreed with Dr. Mitchell that there are legal barriers (because the schools are afraid of confessing 

or disclosing problems), with $100,000 awards per school district, they were able to get 100% 

participation in the program. The panel came up with the top 96 projects and evaluated them

with architects, engineers, school nurses, and environmental health professionals. That evaluation, which is available from the Washington State Superintendent of Public Instruction Office, 

could be used as a model for a national program. Another audience member suggested a specific 

project: a request for proposals (RFP) should be issued to evaluate changes in GSA-controlled 

buildings. NIEHS has already suggested that they might be interested in doing this, but it should 

be a limited and very specific RFP. 

Question 6: How can the barriers for implementing widely accepted interventions, such as 

remediation of water intrusion, be overcome?

The barriers to implementing interventions include issues such as cost, and, in some situations, 

opposing market forces. Several audience members pointed to the issue of lack of public awareness of the ill-health consequences and the greater long-term costs of not addressing problems

promptly. Required disclosure at time of sale in the real estate industry provides one good model 

of how to overcome this barrier by using market forces. The seller becomes aware of the problem and has to deal with it. Another audience member commented that the elderly on fixed 

incomes and low-income renters often face financial barriers in meeting the costs of remediation, 

51
and lenders are often not responsive to the needs of these people. Weatherization programs that 

use vouchers and low-interest loans provide one model of how to overcome this barrier. Tax 

breaks also work for those with enough income to pay taxes. This person also suggested working backwards from the homeowner, dealing with agencies that work with homeowners such as 

realtors, housing inspectors, code officials, HUD, etc. She also recommended the informational 

pamphlets produced in English and Spanish by HUD to raise the public’s level of awareness. 

Mr. Levin suggested that the Surgeon General should use his position to frequently raise consciousness on indoor environment issues at all levels of society. The interests touched by indoor 

environment concerns are broad and affect every level of society and income level. Having 

worked in the field since 1978, he believes that no single action will correct the problems, but 

that each effort motivates the next action by increasing public awareness and by building public 

and government support for taking indoor environment problems seriously. An audience member referred to an employee relocation program that moves 30,000–40,000 people a year and 

often deals with mold cases, in Texas and elsewhere. They could not sell old properties affected

by mold, and that situation added to the cost of the program. As a reaction to this problem in

Texas, J.C. Penney Company, Inc. mounted a proactive videoconference program on operational

maintenance, showing that it is financially more advantageous to make repairs on your house to 

prevent problems than to pay $5,000 later for mold abatement. Twenty thousand people responded to the program and the company saw a 25% reduction in their costs in 6 months. 

Another audience member stressed financial limitations as an overriding concern: school collecting water in buckets from a leaking roof certainly understands that there is a problem and how to

correct it. Funding issues in the public sector might best be addressed with some sort of escrow 

strategy, establishing a funding source based on holding back a small percentage of new construction funding so that in 20–30 years, funds will be available to allow repairs to be made 

quickly. The moderator commented that California (through Cal/OSHA) has declared mold in a 

building as a sanitation issue in the occupational setting, indicated that it is not acceptable, and

issues fines to employers who do not repair water damage. This is a simple and effective solution, but only operative in California at present. 

Question 7: What are the areas of research for which we have an inadequate knowledge 

base? 

The moderators suggested some candidate areas for research: 

• The role of indoor environment in transmission of respiratory infections; 

• Ventilation standards and their impact on health; 

• Exposure assessment methods for health studies; 

• How to get researchers to do multidisciplinary work in linking health risks with environmental measures; and 

• The nature of residential exposures. 

Dr. Spengler used the SARS outbreak as an illustration. There were articles in the New England 

Journal of Medicine describing how one incident case on a flight to Hong Kong led to 20 subsequent cases and an apparent example of residential transmission of disease from an incident case

on the eighth floor of a tower apartment building to an adjacent apartment building, based on

52
ambient airflow patterns. However, basic information is lacking about the spread of viral vectors 

through ventilation systems and the survival of disease organisms on various surfaces, so the 

apartment infection pattern cannot be analyzed with precision. There is a fundamental lack of 

knowledge about how we are infected in our buildings, especially in schools and day care 

centers, which can be a major factor in spreading disease. This is a major multidisciplinary

research problem that needs to involve medicine, engineering, and public health expertise. The 

infectious disease community, the building science community, and the epidemiology community would have to join forces, and there is no agency that does this at present. 

Dr. Woods pointed out that exposures and ventilation are often considered separately, but 

ventilation is a flow rate, and is just an engineering tool to achieve indoor air quality. Research

is needed to understand loads and emission rates of contaminants so that ventilation rates can be 

calculated. We can get by with about one cubic foot per minute (cfm) per person (or 2–3 

cfm/person in submarines) because the respiratory rate is about a 10th of a cfm/person, but we

need to know a lot more about optimal rates. He mentioned Finnish and Danish Institute studies 

as examples of the kind of research that is needed to calculate ventilation rates. Mr. Fisk mentioned the need for research on how indoor chemical exposures affect allergy and asthma outcomes, for which there is only European research. Other research needs include determining 

how people are exposed to bioaerosols, and how classroom ventilation rates affect health. 

Finally, better exposure assessment for bioaerosols in relation to the health effects associated 

with damp and mold growth is a research need. 

Another audience member mentioned neurotoxicology as an endpoint, specifically for toxins

such as organophosphates. More basic information is needed on neurotransmitter physiology

and immune system function in relation to indoor environment factors, specifically to understand 

their interaction in health status. Another participant suggested that a better understanding of 

guideline effectiveness is needed to determine whether guidelines are adequately protective with 

a high probability. Many research studies are carried out to answer scientific questions, but the 

answers are hard to apply to operational use. For example, it is necessary to reduce SARS 

studies to a practical level regarding issues such as how diseases are actually transmitted in the 

office environment. Another audience member pointed to open questions about the relationship 

between building material properties and their impact on the indoor environment. For example, 

research is currently lacking to guide the choice of building products in terms of their ability to 

support mold growth. Basic information on material properties, such as the capacity of wallboard to hold water, is often not available even from the manufacturer. 

Dr. Storey commented on the need to assess the burden of disease attributed to the indoor 

environment, which would provide some measure of the impact of changes in building conditions over time. While green building innovations are very exciting, the point was already made

that 80% of our building stock will still be with us in 20 years, so change in our communities 

will have to be incremental. She suggested a need to give good advice about dealing with

current buildings, and suggested that agencies should give grants only to programs that are 

seriously multidisciplinary and address components of exposure, mechanisms of disease causation, disease burden, and intervention. 

53
One audience member addressed the element of exposure, pointing out that many indoor pollutants undergo chemical transformations in the indoor environment, and the resulting reaction 

products may be more toxic than their precursors. NIOSH sponsored a workshop on this topic, 

Indoor Chemistry and Health (held at the University of California, Santa Cruz, July 12–15, 

2004). Information from the workshop will be available on the NORA Indoor Environment 

Team Web page, and a workshop summary will be published in Environmental Health Perspectives. 

Damp buildings may be a particular concern because dampness causes hydrolysis reactions, or 

favors microbial growth that changes the pH of building materials, favoring certain chemical 

transformations. The moderator commented that we often do not know exactly what these toxic

agents are, and therefore what to measure, although it still may be possible to solve a lot of 

problems by mitigating dampness. In this context, Ms. Loftness suggested classifying specific 

human health effects that are impacted by the physical environment by human organs or systems

– vision, skin, respiratory, digestive, etc. This exploration would support building material and 

systems research and their impact on short- and long-term health problems. She also suggested 

that the importance of access to nature should be in the equation because of its interaction with 

mental and physical well-being. One participant noted that there are four Japanese environmental medicine units, and they often focus on susceptible populations. She suggested that we 

should be using this approach as a model for what we do in the United States. The moderator 

noted the large number of agency programs related to indoor environment discussed or mentioned during the comments, and underscored the evident need for coordinated, integrated federal 

research effort with more stakeholder input. 

Question 8: What are the key economic issues? What provides the cost-benefit rationale 

for health care payers?

These economic issues are important areas with potential for driving change. One participant 

suggested that there is great interest among corporate health and safety managers and human 

resource managers in enhanced productivity as a key economic benefit of improved employee

health. An audience member affiliated with a state health department indicated that health care 

coverage costs were very “disaggregated” from building management costs, making it hard to 

unite costs and benefits in the analysis (referred to as “the disaggregation problem”) and suggested that there must be a way of reversing this. He used the example of the automobile industry as a model: without market and regulatory pressure, most of the improvements in safety and 

fuel efficiency would not have come about. Similar pressures now need to be applied to the 

building industry. Disaggregated stakeholders are a major barrier to progress. If GSA really 

understood and acted on health care and productivity loss costs attributed to indoor environment

issues, it would serve as a good example to motivate change. The moderator returned to the 

suggestion of commissioning a NAS report on the economic consequences of indoor environment issues as a way of moving people to action. 

An audience member from a regional EPA office suggested the need to better inform Medicare, 

as well as private health care payers, about the economic impact of indoor environment issues. 

Since private insurers only cover what the contracts say they should cover, the federal government should lead the way in determining what federal health benefits programs cover. Another 

54
audience member indicated that Social Security (as insurers of last resort) and state disability 

programs should take on these costs, and should be included in discussions. State Social Security agencies can consider environmental illness on a case-by-case basis and may dismiss “sick 

building syndrome” cases as psychosomatic somatoform disorders rather than bill back the costs 

as work-related disabilities. Changing this practice would bring about a strong economic incentive to make indoor environment improvements. 

Another audience member disagreed, suggesting that the slide from Ms. Loftness’ presentation 

was very convincing from the perspective of a large employer in indicating that the economic

impact of health-related productivity improvements resulting from indoor air quality were minor 

compared to ergonomic and other factors. He predicted that productivity increases associated 

with indoor environment quality would be too small to be a prime motivator in industry. In

addition, the “charge-back” process and use of market controls are inefficient and ineffective in 

practice, even for changes with a clearly highly beneficial cost/benefit. The clearest example is 

the automobile industry, where market forces were insufficient without government regulatory 

pressure to improve automobile safety. An analogous situation occurs during building construction where basic quality flaws (like poor flashing) result in only minor market pressures on the 

builder because they are hard to monitor and enforce, but have major long-term negative effects 

down the line. Quality improvement procedures rather than market forces are needed to effect 

better building practices. 

Another audience member commented on application of life-cycle cost theory: she agreed that 

market pressures are not very effective in dealing with such issues without regulations and 

standards enforcement that provide more immediate penalties. It is the federal government’s

responsibility to apply tools such as life-cycle management to the problem. 

Mr. Fisk suggested that economics may be a stronger incentive than these views indicate, and he 

advocated using both economic incentive and regulatory action. He suggested that any business 

that can save money in health care costs will be well motivated because such costs will surely 

increase. Another participant also disagreed that cost savings associated with improved indoor 

air quality were too small to be effective, citing statistics from the Washington Business Group 

on Health and the Integrated Business Institute (IBI) that calculated costs based on employee loss 

of productivity. The cost of allergy was estimated at $250 per affected employee per year, $100 

for each employee with asthma, and $125 for each employee with respiratory infections. As 

health care costs are escalating each year, there is good potential here for return on investment. 

Question 9: What are the best ways to reach the public and those responsible for the

performance of buildings? 

The moderator mentioned Mr. Levin’s recommendation for a “homeowner’s instruction manual”

and indications by others that such materials have already been produced by some agencies.

Audience members cited various educational publications, such as Inspecting a House from 

Cornell University Cooperative Extension Service. The USDA Cooperative Extension Service 

was suggested as a means for outreach to the public. EPA, HUD, and CDC have all produced 

good materials. There may be more need for training materials on the building practices side. 

Another commenter recommended the U.S. Green Building Council’s publications on sustain55
ability as a good model of public education. Audience members suggested that there is a need to 

inventory and evaluate existing manuals and similar material to see what is already available 

before producing new educational tools. 

Several audience members supported the idea of using a Surgeon General’s Report to elevate the 

public’s awareness of indoor environment as a health concern, while others spoke to the need for 

instructional materials targeted to the interests of specific groups. Based on his 30-year history 

of interest in these issues, Dr. Woods spoke to the need to educate the professions (such as 

architects and architectural engineers on one hand, and health professionals on the other) to take 

indoor environment issues seriously. He noted that only 2% of engineering/architecture schools 

have any component of the curriculum dealing with health issues. On the other hand, he asked, 

how many health professionals study building materials and performance issues? One audience 

member mentioned the American Lung Association’s Health House: Builder Guidelines and 

described her own experience with an environmental illness and the problems she had in finding 

a contractor willing to build to those guidelines. She suggested that while some people are in

“desperate need” of housing constructed to high indoor environment standards, they may have 

difficulty finding informed and willing contractors. This indicates a need for material aimed at 

builders and remodelers. The Surgeon General’s Report from this workshop could provide 

support to contractors with an interest – pioneers are needed! 

Several audience members discussed reaching segments of the public in support of economic 

incentives. One suggested that different classes of commercial buildings are not uniform; they 

have different standards and fiduciary requirements, so it may be necessary to explain health 

benefits in different ways to different business interests. In addition, one architect/engineer

suggested the model of the U.S. Green Buildings Council, implying the potential value of a 

similar “Healthy Buildings Council.” An audience member who works at a local health department mentioned that he finds checklists and basic information on issues like water intrusion are 

effective. Renters and landlords of small properties need to be approached differently from large 

housing agencies; well thought-out guidelines are helpful. 

Dr. Spengler wrapped up discussion of the questions by stressing the need for supporting research and education, suggesting that if well documented toxic effects are found for a particular 

building product, manufacturers will eliminate it from the market (an example being pdicholorobenzene, which was recognized as a carcinogen and is no longer used in building 

materials and now rarely turns up in assessments). Programs such as the EPA’s Toxic Release 

Inventory help to remove such materials from the outdoor environment, but such a labeling 

requirement does not extend too many products that go into our homes. 

Finally, Mr. Levin urged the Surgeon General to take the lead in encouraging and facilitating

collaborations among federal government agencies as well as encouraging private sector research 

and public information programs. Mr. Levin said that the Surgeon General was ideally positioned to raise public awareness and provide the basis for broader application of current knowledge as well as development of the necessary new understanding of the importance of the indoor 

environment for public health and welfare. 

56
Highlights from Vision for the Future Session

A committee established under the Office of Science Technology and Policy could 

serve as the key to coordination and collaboration on improving the indoor environment. 

Multidisciplinary programs to improve indoor environmental quality exist in and 

outside government, providing models and partners for new collaborative efforts. 

One focus of any indoor environment activities should be improving the health of the 

occupants. 

Good applied research is needed to demonstrate the effectiveness of various building

management activities and technologies. Federal government buildings could be 

used as demonstration projects to model both innovative technology and the use of

market forces and contract requirements to motivate better practices. 

The Surgeon General should continue to advocate action to improve the indoor 

environment as a public health policy priority.

To advance healthy indoor environment research, both funding and liability issues 

need to be addressed. Liability concerns often severely limit a researcher’s access to 

a building and its occupants.

The public is generally not aware that delays in improving their indoor environment

conditions, can result in potential long-term costs that can have an impact on their

health. 

Health care coverage costs are “disaggregated” from building management costs: 

Medicare and private health care payers need to be made aware that failure to

improve the indoor environment can increase long-term health care costs. 

How the indoor environment influences the transmission of respiratory infections is 

poorly understood. Intervention studies may play an important role in clarifying

these influences. 

If improvements to the indoor environment can reduce the occurrence of asthma, 

allergic responses, and respiratory infections, the cost savings will be significant.

Programs yielding new approaches must be balanced with programs to apply or 

enforce known best practices. This approach will produce the greatest incremental 

health improvement for residential and office building occupants. 

As the nation’s doctor, the Surgeon General is uniquely situated to advocate for and 

help to coordinate collaboration to promote healthy indoor environments. 

Broad outreach is needed to educate homeowners, builders, maintenance personnel,

architects, and planners about healthy indoor environment issues. 

A coordinated, integrated federal research effort with more input from stakeholders 

is needed. 

57
Closing and Action Steps 

VADM Richard H. Carmona, M.D., M.P.H., F.A.C.S. 

U.S. Surgeon General 

The Surgeon General, VADM Richard Carmona, closed the workshop with his impression of 

what was said over the past 2 days. He indicated that the workshop presentations have made the 

case that the time has come to take action in this area. Some workshop participants have spent 

25–30 years doing anonymous indoor environment research and advocacy. The Surgeon General complimented those who have worked so hard for their passion and dedication to making the 

world a better place in which to live. The indoor environment, where we spend 85%–95% of our 

time, is a complex, multifactorial issue that requires a multidisciplinary approach. He indicated 

that the time has come for moving forward on this issue. 

He noted that presentations at this workshop are like “preaching to the choir.” For the public at 

large, however, indoor environment issues are not widely recognized or understood. In dealing 

with other environmental and health issues, he has come to feel that our society is mostly “health

illiterate.” He stated that what we really need to do for the public is to provide clear information 

that will effect behavioral changes. More research is indeed needed, but there is already enough 

good information that can be used to make practical improvements in the indoor environment. 

What we are lacking is the “translational element” needed to overcome health illiteracy. The 

outcome we are seeking is to effect behavioral changes that improve morbidity and mortality and

reduce health care costs. This task is made more complex because, for indoor environmental 

issues, the public this group is trying to reach is not only the home owner but also the builder, the 

maintenance staff, the architect, and the city planner; therefore, a very broad outreach is needed. 

The next action step will be determined by a continuum of processes that starts with the issuance 

of the Summary Report for this workshop. Based upon the discussions that occurred during 

these 2 days, the Summary Report, and guidance from various federal, state, and local public 

health stakeholders, a Surgeon General’s Call to Action may be the appropriate next step. A 

Surgeon General’s Call to Action helps to focus the nation’s attention on issues that impact 

health. As we move forward with trying to achieve a healthy indoor environment, there may be

the development of a Surgeon General’s Report, which takes greater effort and commitment of 

resources than what it took to develop this workshop. 

VADM Carmona closed the workshop by thanking the workshop participants. He indicated his 

commitment and his feeling that this is the right issue at the right time. 

58
Appendix A 

Speaker Biographies 

Surgeon General's Workshop on Healthy Indoor Environment 

Clive Brown, M.B.B.S., M.Sc., M.P.H. 

Clive Brown, M.B.B.S, M.Sc., M.P.H., is a Medical Epidemiologist with the Field Section of the 

Air Pollution and Respiratory Health Branch (APRHB), National Center for Environmental

Health at the Centers for Disease Control and Prevention (CDC). He completed his medical 

training in Jamaica in 1987 where he served as the Medical Officer of Health for the Parish of St. 

James. He joined the CDC’s Epidemic Intelligence Service program in 1993 and completed his 

preventive medicine residency at CDC in 1996, where he worked on getting asthma onto the 

CDC agenda. He has an M.P.H. degree in Epidemiology from Columbia University and a M.Sc. 

degree in Health Systems Management from the London School of Hygiene and Tropical

Medicine. 

Dr. Brown is CDC’s main contact for issues related to non-occupational indoor air quality and 

for the investigation of pulmonary hemorrhage in infants. He also does research on asthma. He

has served as a consultant to the Pan American Health Organization where he was assigned to

the Caribbean Epidemiology Center. Dr. Brown is also an Associate Professor for Epidemiology 

at the University of Technology in Jamaica and Clark Atlanta University in Atlanta, Georgia. 

VADM Richard H. Carmona, M.D., M.P.H., F.A.C.S. 

Vice Admiral (VADM) Richard H. Carmona, M.D., M.P.H. F.A.C.S., was sworn in as the 17th 

Surgeon General of the United States Public Health Service on August 5, 2002. Prior to being 

named Surgeon General, he was the chairman of the State of Arizona Southern Regional Emergency Medical System, a professor of surgery, public health and family and community medicine at the University of Arizona, and the Pima County Sheriff’s Department surgeon and deputy 

sheriff. 

VADM Carmona has worked in various positions in the medical field including paramedic, 

registered nurse and physician. VADM Carmona completed a surgical residency at the University of California, San Francisco, and a National Institutes of Health-sponsored fellowship in 

trauma, burns and critical care. He is a Fellow of the American College of Surgeons, and is also 

certified in correctional health care and in quality assurance. 

VADM Carmona has held progressive positions of responsibility as chief medical officer, 

hospital chief executive officer, public health officer, and finally chief executive officer of the 

Pima county health care system. He has also served as a medical director of police and fire 

Appendix A Page 1
departments and is a fully-qualified peace officer with expertise in special operations and emergency preparedness, including weapons of mass destruction. 

VADM Carmona has published extensively and received numerous awards, decorations, and 

local and national recognition for his achievements. A strong supporter of community service, he

has served on community and national boards and provided leadership too many diverse organizations. 

Born and raised in New York City, VADM Carmona dropped out of high school and enlisted in 

the U.S. Army in 1967. While enlisted, he received his Army General Equivalency Diploma, 

joined the Army’s Special Forces, ultimately becoming a combat-decorated Vietnam veteran, 

and began his career in medicine. After leaving active duty, VADM Carmona attended Bronx 

Community College of the City University of New York, where he earned his Associate of Arts 

degree. He later attended and graduated from the University of California, San Francisco, with a 

Bachelor of Science degree (1977) and medical degree (1979). At the University of California 

Medical School, VADM Carmona was awarded the prestigious gold-headed cane as the top 

graduate. He also earned a Masters of Public Health from the University of Arizona in 1998. 

Noreen M. Clark, Ph.D. 

Noreen M. Clark, Ph.D., is Dean of the University of Michigan School of Public Health, Marshall H. Becker Professor of Public Health, and Professor of Pediatrics, University of Michigan

Medical School. She is interested in systems, policies and programs that promote health, prevent 

illness, and enable individuals to manage disease.

Dr. Clark has served in numerous leadership positions. She serves as National Program Director 

for the Robert Wood Johnson Foundation Allies Against Asthma Program. From 1999–2002, she

was a member of the Advisory Council of the National Institute of Environmental Health Sciences. She has been president of the Society for Public Health Education and chair of the Public 

Health Education Section of the American Public Health Association (APHA). She has served 

as chair of the Behavioral Science Section of the American Thoracic Society, as a member of the

Pulmonary Diseases Advisory Committee for the National Heart, Lung, and Blood Institute, and

as a member of the Institute’s Advisory Committee on Prevention, Education, and Control. Dr. 

Clark is a member of the Coordinating Council of the National Asthma Education and Prevention Program and of its Science Base Committee, and has chaired the American Lung Association (ALA) Technical Advisory Group on Asthma, and the Lung Diseases Care and Education 

Committee. She has served on both the Board and Council of the ALA. She chaired the Institute 

of Medicine Committee on Damp Indoor Spaces and Health. She is the former editor of Health

Education and Behavior and is currently Associate Editor of Annual Reviews of Public Health. 

Among other honors, she is the recipient of the Distinguished Fellow Award, the highest honor 

bestowed by the Society for Public Health Education; the Derryberry Award for outstanding 

contribution to health education in behavioral science given by the APHA; the Health Education

Research Award conferred by the National Asthma Education Program for leadership and 

research contributions; the Distinguished Career Award in Health Education and Promotion 

given by the APHA; the Behavioral Science Lifetime Achievement Award of the American

Appendix A Page 2
Thoracic Society; and the Healthtrac Education Prize. She is a member of the Institute of 

Medicine of the National Academy of Sciences. 

Dr. Clark’s primary research specialty is management of disease, and she has conducted many 

large-scale program evaluations. She is attempting to identify the elements of self-regulation, 

and uses management of asthma and heart disease as models for examining constructs. Her

studies of self-management have contributed to the research literature and the field of practice by

demonstrating that educational interventions can decrease asthma hospitalizations and medical 

emergencies. Her work has resulted in an archetype educational program for health care facilities distributed by the National Institutes of Health and used in hundreds of clinics nationally and

internationally. A program developed in subsequent research to adapt the model for use in

public schools is being disseminated by the ALA and has to date reached almost 500,000 American school children. Other model programs for management of asthma and heart disease by 

patients, clinicians, and communities are currently being evaluated by Dr. Clark and her research

team. 

Dr. Clark has extensive international experience. Her research has focused on development and 

testing of interventions designed to improve health status, quality of life, and collaborative

activity among rural people in Kenya and in the Philippines. In addition, she has been a consultant for a wide range of organizations working around the world, including the Ethiopian 

Women’s Welfare Association, the Ministry of Education in Nepal, the Asia Foundation in 

Pakistan, the Directorate of Health in Portugal, the World Bank, the United Nations Development Program, the Synergos Institute, the Community Health Authority of Madrid, and the

Beijing Heart, Lung and Vessel Institute, among others. She serves on the board of directors of 

World Education Inc. and of Family Care International. Dr. Clark is a member of the Council on 

Foreign Relations, has served on the Overseas Development Council, and is on the board of the 

Aaron Diamond Foundation. 

Elizabeth A. Cotsworth, B.A., M.A. 

Elizabeth A. Cotsworth, B.A., M.A., is currently the Office Director of the U. S. Environmental 

Protection Agency’s Office of Radiation and Indoor Air (ORIA). Ms. Cotsworth provides 

national direction for protecting people and the environment from harmful and avoidable exposure to radiation, as well as protective measures and guidance for indoor air environments. Prior 

to joining ORIA, Ms. Cotsworth was the Office Director of the Office of Solid Waste (OSW)

from 1997 to 2002, after holding a series of positions managing national hazardous and solid

waste programs. She entered the Agency as a Management Intern in 1973. She holds a B.A.

degree from Chatham College in History and an M.A. degree from the University of Virginia in

Government and Foreign Affairs. 

Jean M. Cox-Ganser, Ph.D. 

Jean Cox-Ganser, Ph.D., is Research Team Leader for the Field Studies Branch of the Division 

of Respiratory Disease Studies (DRDS) of the National Institute for Occupational Safety and 

Health (NIOSH). She is a primary investigator in a 5-year NIOSH research program on WorkAppendix A Page 3
Related Asthma in Office Buildings and Schools, and is currently involved in planning for 

continued work on Indoor Environmental Quality work in schools. Dr. Cox-Ganser is also team

leader for the NIOSH National Occupational Research Agenda (NORA) Indoor Environment 

(IE) team. The goal of the NORA IE team is to focus and facilitate research that will improve 

the health of workers in indoor environments. 

Dr. Cox-Ganser has served as Acting Deputy Director of DRDS and Acting Team Leader of the 

Epidemiology Team at DRDS. She was a member of the editorial committee for the World 

Health Organization (WHO) proposed document Guidance for Biological Agents in the Indoor 

Environment and was program leader for the NIOSH NORA project “Work-related Asthma in

Offices and Schools.” At West Virginia University, she has served as Post-Doctoral Research 

Fellow in the Department of Animal Science, as Bio-Statistician in the Department of Community Medicine, and as Adjunct Assistant Professor, Department of Community Medicine. 

Dr. Cox-Ganser received a B.Sc. degree in Animal Behavior and Immunology and B.Sc. and 

M.Sc. degrees in Biological Sciences from the University of Natal, South Africa. She earned her 

Ph.D. degree in Animal Science and an M.S. degree in Statistics from West Virginia University. 

Jerome P. Dion, M.S. 

Jerome P. Dion is the Supervisor of Research and Development for the Building Technologies 

Program in the Office of Energy Efficiency and Renewable Energy of the Department of Energy 

(DOE). Mr. Dion has served in a variety of capacities in Efficiency and Renewables over the 

past 13 years, including Corporate Planning Lead, and Senior Advisor in the Federal Energy 

Management Program and Office of Building Technologies, State and Community Programs 

(predecessor organization to the Building Technology Program). Prior to joining DOE, he 

served the Arizona Energy Office for 10 years, leaving as Planning and Policy Program Manager. Mr. Dion holds a Master of Urban Planning degree from the State University of New York 

at Buffalo. 

Peyton A. Eggleston, M.D. 

Peyton A. Eggleston, M.D., is the Director of the Center for Children’s Environmental Health at 

the Johns Hopkins University, one of a network of Centers of Excellence sponsored by the 

National Institute of Environmental Health Sciences and the U.S. Environmental Protection 

Agency. He is currently directing several clinical trials of the effect of allergen abatement on 

chronic asthma. 

After graduation from the University of Virginia medical school, Dr. Eggleston received training 

in Pediatrics and in Allergy-Immunology at the University of Washington. He returned to the 

University of Virginia faculty in 1972, and then joined the Johns Hopkins University in 1981, 

where he is now a Professor of Pediatrics in the School of Medicine and of Environmental 

Health Sciences in the School of Public Health. His research interest has been in the area of the 

contribution of IgE-mediated inflammation to chronic asthma. He participated in immunotherapy

trials in pediatric asthma and in the use of Fel d 1 peptides. Most of his work has addressed the 

Appendix A Page 4
characterization of home environmental allergens and their relation to acute and chronic airway 

disease, especially the acute effects of airborne animal allergens and the chronic effects of 

cockroach and dust mite allergens. He participated in the National Cooperative Inner City 

Asthma Study that described the effect of cockroach and rodent allergen exposure on chronic 

asthma morbidity in inner city populations. 

Dr. Eggleston’s Curriculum Vitae lists over 190 publications. He serves on the editorial board of 

the Journal of Allergy and Clinical Immunology. He was a member of the American Board of 

Allergy and Immunology and has been an active member of the Academy of Asthma, Allergy 

and Immunology for most of his career. 

Henry Falk, M.D., M.P.H. 

Henry Falk, M.D, M.P.H., currently heads two organizations spearheading the Department of 

Health and Human Services’ work in environmental health. He serves as Director of both the 

National Center for Environmental Health (NCEH) and the Agency for Toxic Substances and 

Disease Registry (ATSDR). In 2003, these two entities consolidated to form NCEH/ATSDR. At

NCEH, Dr. Falk heads the federal government’s efforts in preventing and controlling environment-related diseases, illness, and deaths. He previously served at NCEH for 14 years as director

of the Division of Environmental Hazards and Health Effects. At ATSDR, which was created by 

the 1980 Superfund legislation, Dr. Falk leads the federal agency whose mission is to protect 

public health against toxic substances in the environment. 

Dr. Falk earned his medical degree from the Albert Einstein College of Medicine in 1968. He 

received a master’s degree from the Harvard School of Public Health in 1976. He is board

certified in Pediatrics as well as Public Health and General Preventive Medicine. Dr. Falk arrived 

at the Centers for Disease Control and Prevention (CDC) in 1972. He is also a 30-year veteran of 

the U.S. Public Health Service Commissioned Corps. This service culminated with his being

named rear admiral and an appointment as Assistant U.S. Surgeon General. 

Throughout his career at CDC, Dr. Falk has brought learning and leadership to myriad public

health projects around the country and the world. His work includes contributions to the federal 

responses to Three Mile Island, Mount St. Helens, Hurricanes Hugo and Andrew, and the 

terrorist attacks of September 11, 2001. 

Dr. Falk has written or co-written more than 100 publications in a variety of subjects, including 

vinyl chloride-induced liver cancer, prevention of lead poisoning, and health effects of environmental hazards. Widely recognized for his distinguished work and service, his honors include 

the Vernon Houk Award for Leadership in Preventing Childhood Lead Poisoning and the Homer 

C. Calver Award from the American Public Health Association. He has also received CDC’s

William C. Watson Jr. Medal of Excellence, as well as the Distinguished Service Award from 

the U.S. Public Health Service. 

Appendix A Page 5
William J. Fisk, B.S., M.S. 

William J. Fisk, B.S., M.S., is a Senior Staff Scientist and the Department Head of the Indoor 

Environment Department at the Lawrence Berkeley National Laboratory, managed by the 

University of California. The Department staff of 60 conducts research on building ventilation, 

indoor environmental quality, energy use, exposure and risk assessment, and the relationship of

indoor environmental quality to health and work performance. In addition to department leadership since 2000, Mr. Fisk has conducted research for 25 years at Lawrence Berkeley National 

Laboratory on indoor environmental quality. His current research focuses on technologies for 

ventilating and controlling indoor air quality, on the relationships of indoor air quality and 

related building characteristics with health, and on the economic consequences of indoor environmental quality. 

Mr. Fisk serves on the Editorial Board for the journal Indoor Air, was elected to the international 

Academy of Indoor Air Sciences in 1999, and has served on National Academy of Sciences – 

Institute of Medicine committees on Asthma and Indoor Air Quality and on Damp Buildings, 

Mold and Health. He also served for several years on the National Occupational Research

Agenda – Indoor Environment Team and has been active in the American Society of Heating, 

Refrigerating, and Air Conditioning Engineers (ASHRAE). 

Mr. Fisk received his M.S. and B.S. degrees in mechanical engineering from the University of

California, Berkeley and the University of New Mexico, respectively. 

John R. Girman, M.S. 

John R. Girman is the Center Director for the U. S. Environmental Protection Agency (EPA) 

Indoor Environments Division Center for Analysis and Studies. His Center is responsible for the 

technical analysis and content of reports and guidance documents on indoor air quality, as well 

as for providing technical input into policy decisions and developing research agendas for indoor 

air quality. The Center is currently developing priorities for research on indoor air quality, 

developing criteria for good indoor air quality in homes, examining economic considerations for 

indoor air quality, analyzing data from a major national survey of baseline indoor air quality and 

occupant perceptions in office buildings (the BASE Study) and developing a strategy for Indoor 

Air Toxics. 

Previously, Mr. Girman was the Deputy Manager of California’s Indoor Air Quality Program 

and a Group Leader in Lawrence Berkeley Laboratory’s Indoor Environment Program. He has

worked on indoor air quality for more than 25 years, including research on combustion appliance 

emissions, volatile organic emissions from building materials and consumer products, instrument 

development and protocols, study design and risk assessment. Mr. Girman has authored or coauthored more than 60 publications and reports on indoor air quality. He is a founding member

of the International Society of Indoor Air Quality and Climate (ISIAQ) and has served as its Vice 

President (Policy) and as a Trustee. He also served as an Editorial Advisor for the journal Indoor 

Air, as a Councilor for the International Society of Exposure Assessment (ISEA) and a member

of the American Society of Heating, Refrigerating and Air-Conditioning Engineers’ (ASHRAE) 

Appendix A Page 6
Environmental Health Committee. He has been elected to the International Academy of Indoor 

Air Quality Sciences. 

Some of his accomplishments include initiating and conducting EPA’s Building Assessment 

Survey and Evaluation Study (BASE) and supervising development of the EPA guidance for 

improving indoor air in schools, IAQ Tools for Schools. He also supervised the laboratory

development and a comparative field validation of a commercially successful formaldehyde

passive sampler and directed research to determine and model the organic emissions from 

consumer products, including comparisons of average concentrations and breathing-zone concentrations and a field validation of a model. He also conducted an epidemiologic study of

carbon monoxide poisonings in California and a major field study of residential radon concentrations. He was co-chair of the committee that developed California’s Minimum Ventilation

Standard, the first state-operational ventilation standard, and he conducted a chamber emissions 

and modeling study for the California Attorney General in support of Proposition 65 that led to a 

national consumer product recall and reformulation and a substantial financial settlement for the 

State of California. 

James E. Hill, Ph.D. 

James E. Hill, Ph.D., joined the National Institute of Standards and Technology (NIST, formerly

the National Bureau of Standards [NBS]) as a Mechanical Engineer in the Thermal Engineering 

Section, Center for Building Technology, in September 1972. He served as Leader of the 

Thermal Solar Group from 1978 to 1980 and Chief of the Building Equipment Division from

June 1980 until October 1986 when the Division was expanded and reorganized as the Building 

Environment Division. During 1983, Dr. Hill served as a Program Analyst in the NBS Office of 

the Director. Dr. Hill resumed his duties as Division Chief in January 1984. From 1994 to 1997, 

Dr. Hill was on a part-time assignment in the NIST Advanced Technology Program administering a three-year program on Refrigeration Technology. Dr. Hill served as Deputy Director of the 

Building and Fire Research Laboratory from February 1999 to October 2003. His responsibilities included strategic planning, program and professional development for the Laboratory. In

October 2003, he was appointed Director of the Building and Fire Research Laboratory. Dr. Hill 

was Assistant Professor of Mechanical Engineering at the University of Maryland for 3 years 

before joining NBS in 1972. 

Dr. Hill is a member of the American Society of Heating, Refrigerating and Air-Conditioning 

Engineers (ASHRAE), has held numerous positions on committees and councils of the Society 

since 1972, and was the Society’s President in 1996–1997. He was named a Fellow of ASHRAE

in 1992 and received their Distinguished Service Award in 1995. He held student memberships 

in Tau Beta Pi, Pi Tau Sigma, Omicron Delta Kappa, and Phi Kappa Phi. He is listed in the 11th

edition of American Men of Science. He received the Crosby Field Award from ASHRAE for 

the best overall Technical Paper in 1975 and received an additional ASHRAE award in 1976 for 

the Best Technical Paper presented at the 1976 Seattle Annual Meeting. He received the 1976 

Department of Commerce (DOC) Silver Medal for “significant national and international contributions to the development of efficient solar energy systems.” He has authored over 60 technical 

papers in the building research/solar energy area. 

Appendix A Page 7
In 1988 and 1998, the President of the United States conferred the rank of Meritorious Executive 

in the Senior Executive Service on Dr. Hill. From 1985–1991, Dr. Hill served on the advisory 

committee for the Architectural and Engineering Department at the Pennsylvania State University and is currently on the advisory committee for the Mechanical Engineering Department of 

Georgia Institute of Technology and the Environmental Energy Technologies Division of the 

Lawrence Berkeley Laboratory. In 1994, Dr. Hill was named DOC-NIST Engineer of the Year 

and received the DOC Gold Medal for “significant technical leadership in mechanical engineering research to improve environmental systems of buildings.” 

Dr. Hill received a B.S. degree in Mechanical Engineering (1963) from Virginia Polytechnic 

Institute and M.S. and Ph.D. degrees in Mechanical Engineering (1971, 1973) from Georgia 

Institute of Technology. 

Michael Hodgson, M.D., M.P.H. 

Michael Hodgson, M.D., M.P.H., is Director, Occupational Health Program, Office of Public 

Health and Environmental Hazards, Veterans Health Administration. Dr. Hodgson began work 

on health and the built environment in 1981 as an Epidemic Intelligence Service Officer for the 

Centers for Disease Control (CDC), investigating outbreaks of disease in wet and “moldy” 

buildings, leading the National Institute for Occupational Safety and Health (NIOSH)/CDC’s 

1984 guidance on moisture control in the workplace. He has studied objective health outcomes, 

symptoms, and exposures in a wide variety of settings (schools, office buildings, homes, and 

health care) focused on moisture and bioaerosols and on volatile emissions. He has worked on 

novel strategies to document health effects, on questionnaire use, and on causal relationships

between symptoms and a wide variety of exposures (humidity, volatile organic compounds, 

bioaerosols, work organization/stress, and thermal comfort). 

Dr. Hodgson has been active in the American Society of Heating, Refrigerating, and AirConditioning Engineers, Inc. (ASHRAE) since 1985 and was a member of several ASHRAE 

committees: he was chair of the Environmental Health Committee for 3 years, a voting and nonvoting member of the Standing Standards Project Committee 62 (Ventilation for Acceptable Air 

Quality), and a corresponding member for Thermal Comfort. He was also on the steering 

committee for several of the International Conferences on Indoor Air Quality and Climate. 

Additional formal research interests have included metabolic bone disease in uremia and calcium 

homeostasis, the effects of organic solvents on the liver and brain, low-level environmental 

exposures on chronic diseases of adults, and healthcare worker hazards. 

Dr. Hodgson attended medical school at the Universities of Wuerzburg, Heidelberg, and Frankfurt, where he obtained his M.D. degree in 1975. He obtained an M.P.H. in epidemiology from 

the University of Pittsburgh School of Public Health in 1985. Dr. Hodgson is board-certified in 

internal medicine (residency at DC General Hospital and the Washington, DC Veterans Administration Medical Center and in occupational medicine (CDC/NIOSH). He served as a commissioned officer in the Epidemic Intelligence Service, Public Health Service, CDC (1981–1983); 

was director of the Occupational and Environmental Medicine Program in the Department of 

Medicine at the University of Pittsburgh School of Medicine (1986–1991); and established and 

directed a residency program in occupational medicine at the University of Connecticut (1991–

Appendix A Page 8
1998). In 1998 and 1999, he served as a Senior Scientist in the Office of the Director, NIOSH, 

before moving to the Veterans Health Administration. 

David E. Jacobs, Ph.D., CIH 

David Jacobs, Ph.D., is with the Office of Community Planning and Development at the U.S. 

Department of Housing and Urban Development (HUD). He has worked on lead-based paint 

and healthy homes issues, and related research, public education, regulatory, enforcement and 

training activities. He has testified before Congress on several occasions and has published 

numerous scientific papers and other articles. He holds degrees in Environmental Engineering, 

Science and Technology Policy, Environmental Health, and Political Science and is a boardcertified industrial hygienist. He is a principal author of the President’s Task Force report on 

childhood lead poisoning prevention, the HUD Guidelines for the Evaluation and Control of 

Lead-Based Paint Hazards in Housing, and several reports to Congress. 

Kevin Kampschroer 

Kevin Kampschroer is the Director of Research Expert Services for the General Services Administration’s (GSA) Public Buildings Service (PBS). Focusing on the relationships among the 

physical environment, individual and group behavior and organizational performance, Mr. 

Kampschroer has developed a framework—of building + behavior + business—tested in real 

office conditions, that is unique. His research team’s goal is a fundamental re-thinking of the

practice of workplace making. To support this ground-breaking effort, he has forged alliances

with key forward-thinking companies, and developed collaborations with leading universities, 

including Carnegie Mellon, University of California at Berkeley, Georgia Institute of Technology, University of Michigan, and MIT. 

Before establishing PBS’ research and workplace innovations initiatives, Mr. Kampschroer

served in a variety of GSA regional and headquarters positions. He contributed to the creation of 

real estate portfolio management, establishment of performance measures linked to pay and 

budget, and he developed an overall information technology strategy for a re-engineered real 

estate business in GSA. He was the project manager for the Ronald Reagan Federal Building 

and Trade Center, then the second largest office building in the United States. He has been

employed by GSA since 1975. Mr. Kampschroer is a graduate of Yale University. 

Mr. Kampschroer has lectured at Harvard, MIT, Johns Hopkins and Georgia Institute of Technology and frequently presents for various industry groups such as CoreNet Global. He is the

Research Chair for the Advanced Building Systems Integration Consortium (at Carnegie Mellon 

University) and the Industry Partner Chair for the Center for the Built Environment (at the 

University of California at Berkeley), and the recipient of the International Interior Design

Association’s (IIDA) Star Award for 2004. 

In creating the WorkPlace 20•20 program, Mr. Kampschroer and his team have applied all the

research completed to date, together with best practices in the field to create a new process that

emphasizes organizational performance before design. In its pilot stage, Workplace 20•20 will 

Appendix A Page 9
develop and deliver between 25 and 40 projects for federal customers over the next 3–4 years. 

Each project couples the new workplace-making process with research in the ultimate effectiveness of spatial objectives to influence productivity and organizational performance. 

Kathleen Kreiss, M.D. 

Kathleen Kreiss, M.D., is Branch Chief for the Field Studies Branch of the Division of Respiratory Disease Studies (DRDS) of the National Institute for Occupational Safety and Health 

(NIOSH). She is also Adjunct Professor, Department of Community Health, West Virginia

University School of Medicine. From 1992 to 1996, she served as Residency Director, Occupational and Environmental Medicine Residency/Fellowship at the University of Colorado School 

of Medicine. 

Dr. Kreiss was Director, Occupational and Environmental Medicine Division, Department of 

Medicine, National Jewish Center for Immunology and Respiratory Medicine in Denver, CO, as 

well as Assistant Associate (1989) and Full (1995) Professor, Department of Preventive Medicine and Biometrics Department of Medicine, University of Colorado School of Medicine. 

She received her M.D. degree from Harvard University and completed her internship at San 

Francisco General Hospital and residencies at Beth Israel Hospital, Boston, and the Centers for 

Disease Control and Prevention (CDC). She received a B.A. degree in Biology from Radcliffe

College. At CDC, she served as Epidemic Intelligence Service Officer, Center for Environmental 

Health, and Acting Chief, Special Studies Branch, Chronic Diseases Division. 

Dr. Kreiss is co-author of “Improving the health of workers in indoor environments: priority 

research needs for a national occupational research agenda,” published in the American Journal 

of Public Health (2002), and author of “Building-related asthma,” published in Clearing the Air,

Asthma and Indoor Air Exposures; Institute of Medicine: Committee on the Assessment of 

Asthma and Indoor Air (2000), as well as many other publications. 

Hal Levin, B.Arch., ASHRAE Fellow

Hal Levin, B.Arch., ASHRAE Fellow, is a Research Architect with Building Ecology Research 

Group, Santa Cruz, California, and Scientist, Indoor Environment Department, Lawrence Berkeley National Laboratory. Mr. Levin has conducted research on the impact of buildings on 

occupant health and comfort as well as on the larger environment. For more than 26 years, he has

been involved in research that includes the integration of knowledge about indoor and outdoor 

air pollution and other risk factors into the design of residential, educational, and commercial 

buildings and communities. He has been involved in many efforts to design buildings with

minimal negative impact on occupants or the larger environment from ventilation design, building materials selection, energy consumption, and total environmental quality. He has been a

strong proponent of life-cycle analysis and risk assessment as indicators of the sustainability of

alternative designs, practices and buildings. 

Appendix A Page 10
In addition to his academic and research activities, Mr. Levin has been active in professional

education workshops and short courses on topics that include pollution prevention and indoor 

environmental quality management for schools, offices, and residences. He is a contributor to 

chapters in several books including Indoor Air Quality Handbook (McGraw-Hill, 2001). He is an 

Associate Editor of the journal Indoor Air, and serves on the Editorial Board of the journal 

Building Research and Information. He served as Vice-President (1997–2000) of the International Society of Indoor Air Quality and Climate (ISIAQ) and was founding chairman (1984–

present) of American Society for Testing and Materials (ASTM) Subcommittee D22.05 on 

Indoor Air. He was the founding editor of the newsletter Indoor Air Quality Update and the 

founding editor and publisher of the newsletter Indoor Air Bulletin. 

Mr. Levin is a member of the Air & Waste Management Association, the International Society of 

Indoor Air Quality and Climate (founding member), the International Society of Exposure 

Analysis (founding member), the American Chemical Society, the North American Solar Energy 

Society, and Society for Environmental Toxicology and Chemistry. Currently, Mr. Levin is 

chairman of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers

(ASHRAE)’s Guideline Project Committee 10P, Criteria for Achieving Acceptable Indoor 

Environments, and a member of ASHRAE Standing Standard Project Committee (SSPC) 55, 

Thermal Conditions for Human Occupancy. Mr. Levin served for 10 years as a member of 

ASHRAE SSPC62, Ventilation and Indoor Air Quality, and for two 4-year terms as a member of 

ASHRAE’s Environmental Health Committee. He also serves as a voting member of ASHRAE 

Technical Committee 2.1, Physiology and the Human Environment. He serves as a consultant to 

European Regional Office for Health of the World Health Organization on Children’s Health and 

the Environment. He has consulted to government agencies in Denmark, Canada, and Australia 

among others, and he has lectured extensively in North America, Europe, Japan, and Australia. 

Mr. Levin was chosen by the International Academy of Indoor Air Sciences to serve as President 

of the 9th International Conference on Indoor Air Quality and Climate, Indoor Air 2002, held in 

Monterey, California. He also organized and serves as President of the non-profit Indoor Air 

2002 Inc. which, in addition to being responsible for administration of Indoor Air 2002, has also 

prepared and is publishing five post-conference journal special issues or supplements with papers 

expanded from the Indoor Air 2002 conference papers. He has served as an international advisor

to Indoor Air ’90, Indoor Air ’93, Indoor Air ’96, and Indoor Air ’99. He has also served on the 

advisory committees of several “Healthy Buildings” conferences including HB2006 (Lisbon) and 

Indoor Air 2005 (Beijing), and is Convener for the Indoor Environment section of Sustainable

Buildings 2005 (Tokyo). 

Mr. Levin received a B.A. degree in English and a B. Architecture degree from the University of

California, Berkeley. From 1978 to 1989, he was Research Specialist at the College of Environmental Design, and from 1978 to 1983, Lecturer in the Department of Architecture, University of 

California, Berkeley. From 1979 to 1983, he was Lecturer in the Board of Studies in Environmental Studies, University of California, Santa Cruz. 

Appendix A Page 11
Vivian Loftness, B.S., M.Arch., F.A.I.A. 

Vivian Loftness, B.S., M.Arch., FAIA, is Professor of Architecture at Carnegie Mellon University, Pittsburgh, PA, and recently completed 10 years as Head of the School of Architecture. She 

also serves as Senior Researcher of the Center for Building Performance and Diagnostics at 

Carnegie Mellon. She is an internationally renowned researcher, author, and educator with over 

30 years of focus on environmental design and sustainability, advanced building systems and 

systems integration, and climate and regionalism in architecture, as well as design for performance in the workplace of the future. 

Supported by a university-building industry partnership, the Advanced Building Systems Integration Consortium, she is a key contributor to the development of the Intelligent Workplace, a

living laboratory of commercial building innovations for performance. She has authored a range 

of publications on international advances in the workplace. She has served on six National 

Academy of Science panels, is a member of the Academy’s Board on Infrastructure and the

Constructed Environment, and has given three Congressional testimonies on sustainable design. 

Her work has influenced both national policy and building projects, including the Adaptable 

Workplace Lab at the U.S. General Services Administration and the Laboratory for Cognition at 

Electricité de France. 

Over the past 5 years, Ms. Loftness has led the BIDSTM (Building Investment Decisions Support) 

research effort, with over 150 case studies linking environment, health, and productivity to lifecycle decision-making and the quality of the built environment. As a result of her research, 

teaching, and professional consulting, she received the 2002 National Educator Honor Award 

from the American Institute of Architecture Students and a 2003 “Sacred Tree” Award from the 

U.S. Green Building Council (USGBC). 

Ms. Loftness has Bachelors of Science and Masters of Architecture degrees from the Massachusetts Institute of Technology. She is on the National Board of the USGBC, American Institute of 

Architects Committee on the Environment (AIACOTE) (2005 national chair), Technical and 

Scientific Advisory Committee (TSAC), Advanced Research and Technology Institute (ARTI), 

International Design Center for the Environment (IDCE), and the Department of Energy’s 

Federal Energy Management Advisory Council (FEMAC). She is a Leadership in Energy and 

Environmental Design (LEED)-accredited registered architect, and a Fellow of the American 

Institute of Architects. 

Clifford S. Mitchell, M.S., M.D., M.P.H. 

Clifford S. Mitchell, M.S., M.D., M.P.H., is an Associate Professor of Environmental Health

Sciences at the Johns Hopkins Bloomberg School of Public Health. A graduate of Williams

College, he attended medical school at Case Western Reserve University and holds Masters 

degrees in Technology and Policy from MIT and in Public Health from Johns Hopkins University. He is board certified in both Internal Medicine and Preventive (Occupational) Medicine 

and has been on the faculty of the School of Public Health since 1992. He currently serves as 

Director of the Occupational Medicine Residency, and his research and clinical practice focus on

the health effects of indoor environmental exposures. 

Appendix A Page 12
Thomas A. E. Platts-Mills, M.D., Ph.D. 

Thomas A. E. Platts-Mills, M.D., Ph.D., is the Oscar Swineford Jr. Professor of Medicine and 

Head of the Asthma and Allergic Disease Center at the University of Virginia. Dr. Platts-Mills is 

vice president of the American Academy of Allergy Asthma and Immunology (AAAAI) and has 

been active in educational efforts nationally for 20 years. He has published over 300 papers and 

has been a member of the Editorial Board of more than 10 journals. In addition, he was a 

member of the Immunological Sciences Study Section for the National Institutes of Health and in 

2003 was chairman of the special interest study section on Asthma and Allergic disease for the 

National Institute of Allergy and Infectious Diseases (NIAID).

Dr. Platts-Mills has also served on the National Asthma Education and Prevention Program 

(NAEPP) for the National Heart, Lung, and Blood Institute (NHLBI). He has trained more than 

twenty specialists in Allergic Disease and has supervised eight Ph.D. candidates. He received his 

degree in Animal Physiology from Oxford University (1963) and received an M.D. degree from 

St. Thomas Hospital. In 1981 he was made a member of the Royal College of Physicians in 

London and become a fellow in 1982. He did his training in Allergy and Immunology with Dr. 

Ishizaka and Dr. Lichtenstein at Johns Hopkins (1971–1974) and in 1983 received a Ph.D. in 

Immunology from London University. 

Dr. Platts-Mills has carried out research in many different aspects of the role of indoor allergens

in asthma. Starting with the characterization of the major dust mite allergen (Der p 1) his group 

developed the first assays for mite allergen and defined the form in which dust mite allergen 

becomes airborne. In addition, their assays were used to define the evidence for allergen exposure in the development of asthma and the scientific basis for allergen avoidance in the treatment

of asthma. Those studies have been extended to the investigation of risk factors for acute episodes of asthma, focusing on emergency room and hospitalized patients. The results provided 

better evidence about the relevance of indoor allergens and also about the relevance of different 

allergens in different communities. 

CAPT Stephen C. Redd, M.D. 

Captain Stephen C. Redd, M.D., is Chief of the Air Pollution and Respiratory Health Branch of 

the National Center for Environmental Health, Centers for Disease Control and Prevention. Since 

assuming this position in 1997, Captain Redd has overseen development of a three-part branch 

strategy to reduce the health burden from asthma in the United States. The components of the 

strategy call for improving asthma tracking activities, implementing scientifically proven programs, and working in partnership. Captain Redd also serves as Co-chair of the Asthma Priority

Area Workgroup, President’s Task Force on Environmental Health Risks and Safety Risks to 

Children. He is a member of the National Advisory Council for two asthma initiatives sponsored 

by the Robert Wood Johnson Foundation: Improving Asthma Care for Children, and Allies

Against Asthma. Over the past several years, the Air Pollution and Respiratory Health Branch 

has become increasingly involved in indoor air issues, particularly examining the health effects

of exposure to indoor mold. 

Appendix A Page 13
Jonathan M. Samet, M.D., M.S. 

Jonathan M. Samet, M.D., M.S., is Professor and Chairman of the Department of Epidemiology 

of the Johns Hopkins University Bloomberg School of Public Health and the Jacob I. and Irene

B. Fabrikant Professor in Health, Risk, and Society. Dr. Samet received a Bachelors degree in

Chemistry and Physics from Harvard College, an M.D. degree from the University of Rochester 

School of Medicine and Dentistry, and a Master of Science degree in Epidemiology from the

Harvard School of Public Health. He is trained as a clinician in the specialty of Internal Medicine

and in the subspecialty of Pulmonary Diseases. From 1978 through 1994, he was a member of 

the Department of Medicine at the University of New Mexico. 

At the Johns Hopkins University Bloomberg School of Public Health, he is Director of the 

Institute for Global Tobacco Control and Co-Director of the Risk Sciences and Public Policy 

Institute. His research has addressed the effects of inhaled pollutants in the general environment

and in the workplace. He has written widely on the health effects of active and passive smoking 

and has served as Consulting Editor and Senior Editor for Reports of the Surgeon General on 

Smoking and Health and the National Cancer Institute’s Monographs on Tobacco Control. He

has edited books on the epidemiology of lung cancer and on indoor and outdoor air pollution, 

including Indoor Air Pollution: A Health Perspective (1991) and The Indoor Air Quality Handbook (2000). He has served on the Science Advisory Board for the U.S. Environmental Protection Agency and was Chairman of the Biological Effects of Ionizing Radiation Committee VI 

and the Committee on Research Priorities for Airborne Particulate Matter of the National Research Council. He presently chairs the Board on Environmental Studies and Toxicology of the

National Research Council. He was elected to the Institute of Medicine of the National Academy 

of Sciences in 1997. 

Dr. Samet is a member of the Society for Epidemiologic Research (President 1989–90), the

American Thoracic Society, the American College of Epidemiology (President 2000–01), the 

International Society of Indoor Air Quality and Climate, the International Epidemiological 

Association, and the American Public Health Association. He also served as Chair of the Working Group on Smoking and Involuntary Smoking for the International Agency for Research on 

Cancer of the World Health Organization. He served as Chairman of the Epidemiology Cancer 

Study Section of the National Institutes of Health from 2002–2004 and is presently an Editor for 

Epidemiology. Dr. Samet serves as a member of the Awards Assembly of the General Motors

Cancer Research Foundation and the Epidemiology Review Board of the I.E. duPont de Nemours and Company, Inc. Dr. Samet served as an expert witness in tobacco litigation brought by 

the state of Minnesota against the tobacco industry and recently served as an expert witness for 

the U.S. Department of Justice in the government’s case against the tobacco industry. Dr. Samet 

served as the Senior Scientific Editor, as well as a chapter author, on the 2004 Report of the 

Surgeon General: The Health Consequences of Smoking. He is also serving as Senior Scientific 

Editor for the upcoming Surgeon General’s Report on secondhand smoke. 

Dr. Samet has received numerous awards for his research and public health service, including the 

Surgeon General’s Medallion (1990), the Alumni Award of Merit, Harvard School of Public

Health (2001), the Joseph W. Cullen Memorial Award from the American Society of Preventive 

Appendix A Page 14
Oncology (2002), and the Dr. William Cahan Distinguished Professor Award from the Flight 

Attendant Medical Research (2003). 

John D. Spengler, Ph.D. 

John D. Spengler, Ph.D., is the Akira Yamaguchi Professor of Environmental Health and Human 

Habitation in the Exposure, Epidemiology and Risk Program, Department of Environmental 

Health, at Harvard University’s School of Public Health, Boston, Massachusetts. 

Professor Spengler has conducted research in the areas of personal monitoring, air pollution 

health effects, aerosol characterization, indoor air pollution and air pollution meteorology. More 

recently, he has been involved in research that includes the integration of knowledge about 

indoor and outdoor air pollution as well as other risk factors into the design of housing, buildings

and communities. Several new efforts are underway to investigate housing design and its effects

on ventilation rates, building materials selection, energy consumption, and total environmental 

quality in homes. The tools of life-cycle analysis and risk assessment and activity-based costing 

are being used as indicators to measure the sustainable attributes of alternative designs, practices

and community development. 

Professor Spengler has been active in professional education workshops and short courses on

topics that include pollution prevention and indoor environmental quality management for

schools, offices and hospitals, and distance learning courses (http://courses.dce.harvard.edu/ 

~environment/). He is co-editor of three books: Indoor Air Quality Handbook (McGraw-Hill, 

2001); Particles in Our Air: Concentrations and Health Effects (distributed by Harvard University Press, 1996); and Indoor Air Pollution: A Health Perspective (Johns Hopkins University 

Press, 1991). He is on the editorial board of the journal Indoor Air, and he is the President

(2002–2005) of the International Academy of Indoor Air Sciences. 

Professor Spengler is a member of the Air & Waste Management Association, the International 

Society of Indoor Air Quality and Climate (founding member), the International Society of 

Exposure Analysis (founding member), the American Meteorological Society, and the American 

Chemical Society. Currently, Professor Spengler is a member of the American Society of 

Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE)’s Environmental Health

Committee. Recently, he served as a member of the National Research Council/National Academy of Sciences’ Committee on Air Quality in Passenger Cabins of Commercial Aircraft (2000–

2001). He has also served on the American Lung Association’s National Air Conservation 

Commission (1997–1998) and on the Scientific Advisory Panel of the Mickey Leland National 

Urban Air Toxics Research Center (1995–1998). He serves as an advisor to the World Health 

Organization on indoor air pollution, personal exposure and air pollution epidemiology, and he 

has served as either a member or consultant on various U.S. Environmental Protection Agency 

Science Advisory Board committees. In 2003, Professor Spengler received a Heinz Award for 

the Environment. 

Along with Dr. Douglas Dockery, Professor Spengler was a co-organizer of the international 

1998 ISEE/ISEA Conference, held in Boston, MA (August 1998). From 1981, when the first 

Appendix A Page 15
International Conference on Indoor Air Quality and Climates was held in Amherst, MA, to the 

present, Professor Spengler has served as a chair or co-chair for various technical sessions. 

Professor Spengler received a B.S. degree in physics (1966) from the University of Notre Dame, 

a Ph.D. degree in atmospheric sciences (1971) from the State University of New York-Albany,

and a M.S. degree in environmental health sciences (1973) from Harvard University. 

Eileen Storey, M.D., M.P.H. 

Eileen Storey, M.D., M.P.H., is the Co-Director of the Center for Public Health and Health 

Policy at the University of Connecticut, Chief of the Division of Occupational and Environmental Medicine, and Director of the Center for Indoor Environments and Health at the University of Connecticut Health Center. An occupational medicine physician and internist, she works 

with a team of physicians, nurses, industrial hygienists, and environmental health specialists to 

evaluate the impact of indoor environments on health, particularly respiratory conditions. Her 

research focuses on the spectrum of respiratory disease associated with indoor environments, 

with particular interest in the relationship between building-related upper respiratory syndromes

(rhinitis, sinusitis) and the development of lower respiratory syndromes (asthma, hypersensitivity 

pneumonitis). Her team is working to develop exposure assessment tools that will help to better 

characterize indoor risk factors. The Center for Indoor Environments and Health provides 

support and consultation to employees, employers, building owners, school districts, and public 

health agencies to promote efforts at prevention and remediation in buildings. 

Dr. Storey was a Fellow with the Oak Ridge Institute for Science and Education (ORISE), 

assigned to the Division of Respiratory Disease Studies at the National Institute for Occupational 

Safety and Health (NIOSH) in 2001–2002. She is Co-Leader of the National Occupational 

Research Agenda (NORA) Indoor Environment Team. She serves on the Executive Committee 

of the Asthma Regional Council in New England. 

Dr. Storey provides clinical services for individuals with concerns about occupational and 

environmental exposure. Her group recently published a book in cooperation with the U.S.

Environmental Protection Agency (EPA): Guidance for Clinicians on the Recognition and 

Management of Health Effects Related to Mold Exposure and Moisture Indoors. 

(oehc.uchc.edu/clinser/indoor.atm) 

Dr. Storey completed her medical degree at the Harvard Medical School (1978), a Master of 

Public Health at the Harvard School of Public Health (1978), and Internal Medicine training at 

West Virginia University in Morgantown, WV (1981). She is board certified in Internal Medicine and Occupational Medicine. 

RADM Robert C. Williams, P.E., DEE 

Rear Admiral Robert C. Williams has more than 25 years of experience in environmental engineering. He is the Chief Engineer of the U.S. Public Health Service, providing advice and 

consultation on public health engineering matters to the Surgeon General and to over 1200 

Appendix A Page 16
engineers in the Public Health Service. He is also is the Chief of Staff, Office of the Surgeon 

General (OSG). Prior to his assignment to the OSG in 2004, he served as the Director, Division 

of Health Assessment and Consultation of the Agency for Toxic Substances and Disease Registry (ATSDR) since 1989. He received his B.S. in Civil Engineering and M. Eng. in Environmental Engineering from Texas A&M University and has continued his postgraduate education 

with courses in public health. 

Rear Admiral Williams is a Registered Professional Engineer and serves, or has served, as an 

officer and member of national committees for several professional organizations including 

American Water Works Association, Water Environment Federation, American Society of Civil 

Engineers (ASCE Fellow Grade), Society of American Military Engineers (SAME Fellow) and 

the Commissioned Officers Association of the U.S. Public Health Service. He has been a 

Diplomate since 1992 and has served in various positions with the American Academy of 

Environmental Engineers (AAEE), including the Board of Trustees and his current position on 

the Certification by Eminence Committee. Rear Admiral Williams served on the Governing

Board of the ASCE Environmental and Water Resources Institute from its inception until 2004. 

He currently serves on the Board of Directors of the Society of American Military Engineers. 

He is an Adjunct Associate Professor at the Texas A&M University School of Rural Public 

Health and a member of the Emory University Academic Advisory Council, responsible for 

developing the University’s environmental health curriculum. He has authored and presented

more than 100 publications on a wide variety of environmental health issues, including the coediting of four books. 

Rear Admiral Williams received the Stanley Kappe Award from the AAEE in 2004. He has 

received the CFEE Federal Environmental Engineer of the Year, USPHS Engineer of the Year, 

and NSPE Top Ten Federal Engineers. He received the Gorgas Medal from the Association of 

Military Surgeons of the United States and the ASCE Government Engineer of the Year in 2003. 

He is the recipient of the USPHS Meritorious Service Medal, two Outstanding Service Medals,

three Commendation Medals, an Achievement Medal, Crisis Response Service Award, and ten 

Unit Commendation Medals. He has received several group awards including the DHHS Secretary’s Distinguished Service Award, SAME Cumming Plaque, and ATSDR/CDC Honor Awards 

for Public Health Practice. He has also received several awards from professional organizations 

(e.g., ASCE Best Practice Paper) for his efforts in environmental engineering. 

Samuel H. Wilson, M.D. 

Samuel H. Wilson, M.D., is Deputy Director of the National Institute of Environmental Health 

Sciences (NIEHS), National Institutes of Health (NIH), Research Triangle Park, NC. A biochemist, he began his career as a Principal Investigator in 1970 at the NIH and remained there until 

1991 when he moved to the extramural community to found a center focused in the area of 

genetic toxicology, structural biology, and functional genomics. Dr. Wilson moved to NIEHS as

Deputy Director in 1996, where he has been instrumental in helping develop NIEHS programs in 

genetic susceptibility, functional genomics, children’s health, minority institutions’ research,

health disparities research, and community involvement. Dr. Wilson has strengthened partnerships between NIEHS and other federal agencies concerned with environmental health and with 

Appendix A Page 17
the private sector. He has worked with the Institute of Medicine, National Academies of Science, to develop a Roundtable promoting discussions on long-term planning and a broader 

definition of environmental health, and he has worked with the National Research Council to

develop a Committee addressing issues relevant to the applications of toxicogenomics. 

Dr. Wilson has a long-term research interest in mammalian DNA metabolism. Over the past 15 

years, he and his associates have focused their efforts on the mammalian base excision DNA 

repair pathway. Their work has improved our understanding of maintenance of genomic stability 

in mammalian cells. Dr. Wilson has authored and co-authored 300 research publications and has 

been editor of four reference volumes. 

Dr. Wilson’s recent activities include membership on numerous federal agency advisory groups.

He has served as a scientific advisor to several private foundations involved in biomedical

research. He was chair of the 2001 Mammalian DNA Repair Gordon Research Conference and 

co-chair of the 2002/2004 US-Japan and 2003 US-EU international conferences on DNA Repair. 

He is Associate Editor of DNA Repair and a member of the editorial board of the Annual Review 

of Medicine. 

Dr. Wilson received a Bachelor of Arts degree in Chemistry from the University of Denver in 

1961. He received his graduate and postdoctoral training in medicine and biochemistry at Harvard Medical School and the NIH, respectively. 

James E. Woods, Ph.D., P.E., ASHRAE Fellow

James E. Woods, Ph.D., P.E., is the Executive Director of The Building Diagnostics Research 

Institute, Inc., in Chevy Chase, Maryland. In 1997 he retired as the William E. Jamerson Professor of Building Construction at Virginia Polytechnic Institute and State University. Previously, 

he served as Senior Engineering Manager and Senior Staff Scientist at Honeywell, and was

Professor of Mechanical Engineering and Architecture at Iowa State University. He has over 40 

years of experience in energy and environmental analyses and has been responsible for more

than 25 research projects and 200 investigations related to indoor environmental quality and 

human responses in residences, office buildings, public assembly and monumental buildings, 

hospitals, schools, laboratories, and commercial aircraft. 

Dr. Woods has authored or co-authored six books and more than 200 technical papers and is the 

co-holder of two patents. He has served as a consultant or advisor to many private and public 

agencies, including design engineering and architectural firms, insurance companies, law firms,

utility companies, state energy agencies, the U.S. General Services Administration, the U.S. 

Department of Energy, the National Institute of Standards and Technology, the U.S. Environmental Protection Agency, the U.S. Department of State, the Architect of the Capitol, the National Energy Management Institute, the National Center for Energy Management and Building 

Technology, the American Hospital Association, the American Lung Association, and the 

American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). 

Dr. Woods is an ASHRAE Fellow and Life Member. He has chaired and served on numerous

ASHRAE committees related to indoor air quality, environmental health, industrial air conditionAppendix A Page 18
ing, physiology and human environment, thermal conditions for human occupancy, and ventilation and infiltration requirements. He has served as a Director-at-Large of ASHRAE and as 

chairman of the ASHRAE Presidential Ad Hoc Committee on Building Health and Safety Under 

Extraordinary Incidents. He is currently serving on the ASHRAE Standards and Environmental 

Health Committees, continues to serve as a member of the ASHRAE Presidential Committee on 

Homeland Security, and is serving as the ASHRAE representative to The Infrastructure Security 

Partnership (TISP) where he chairs the TISP Standards Subcommittee. He has testified in Senate 

and Congressional Hearings five times in the last 15 years regarding research needs for building 

environments, and has served as an expert witness in 29 administrative hearings and various 

court cases, including 15 depositions and six jury trials regarding environmental control, indoor 

air quality, and occupant exposure within buildings. 

A Founding Member of the International Society of Indoor Air Quality and Climate (ISIAQ), Dr. 

Woods chaired the Organizing Committee for the international conference Healthy Buildings/Indoor Air Quality 97 at Natcher Center, and is a Member of the International Academy of 

Indoor Air Sciences. He has served on the Science Advisory Board for the EPA, on the Technical Advisory Committee for the American Lung Association, on the Science Advisory Board for 

the Center for Indoor Air Research, and on several committees of the National Research Council. 

Dr. Woods received his M.S. in Physiological Sciences (1971) and his Ph.D. in Mechanical 

Engineering (1974) from Kansas State University, and his B.S. in Mechanical Engineering 

(1962) from the University of New Mexico. He has maintained his professional registration as a 

Mechanical Engineer in Iowa since 1978. 

Appendix A Page 19
Appendix B 

Participant List 

Surgeon General’s Workshop on Healthy Indoor Environment 

Darryl L. Alexander 

Director

American Federation of Teachers 

Health and Safety 

555 New Jersey Avenue, NW

Washington, DC 20001 

Phone: 202-393-5674 

E-mail:dalexand@aft.org 

Bridget K. Ambrose, M.P.H. 

Emerging Leaders Fellow 

Centers for Disease Control and Prevention 

906 Briarcliff Road #2 

Atlanta, GA 30306 

Phone: 404-639-5125 

E-mail:cvz3@cdc.gov 

Jeremy S. Ames 

Environmental Protection Specialist 

U.S. Environmental Protection Agency 

Indoor Environment 

1200 Pennsylvania Avenue, NW

Washington, DC 20460 

Phone: 202-343-9615 

Fax: 202-343-2394 

E-mail:ames.jeremy@epa.gov 

Marjory E. Anderson, A.S.P. 

Safety Engineer 

Architect of the Capitol 

Safety and Occupational Health Branch 

2nd & D Streets, SW

Ford House Office Building 

Washington, DC 20515 

Phone: 202-226-3416 

Fax: 202-226-9915 

E-mail:manderso@aoc.gov 

Norman T. Anderson, M.S.P.H. 

Research Coordinator 

American Lung Association of Maine 

122 State Street 

Augusta, ME 04330 

Phone: 207-622-6394 

E-mail:nanderson@mainelung.org 

Stephen P. Ashkin 

President 

The Ashkin Group 

3644 Tamarron Drive 

Bloomington, IN 47408 

Phone: 812-332-7950 

Fax: 812-332-7965 

E-mail:SteveAshkin@AshkinGroup.com

Peter J. Ashley, Dr.P.H. 

Environmental Scientist 

U.S. Department of Housing and 

Urban Development 

Office of Healthy Homes 

451 7th Street, SW, Room P3206 

Washington, DC 20410 

Phone: 202-755-1785 x115 

Fax: 202-755-1000 

E-mail:peter_j._ashley@hud.gov 

Michael B. Atkinson 

Program Expert/Architect 

U.S. General Services Administration 

Office of Governmentwide Policy 

Innovative Workplaces Division (MPW) 

1800 F Street, NW, Suite 6213, MPW 

Washington, DC 20405 

Phone: 202-439-1251 

Fax: 202-273-4670 

E-mail:michael.atkinson@gsa.gov 

Appendix B Page 1
Laura E. Bailey 

Senior Environmental Scientist 

U.S. Environmental Protection Agency 

Antimicrobials Division 

1200 Pennsylvania Avenue, NW, MS7510C 

Washington, DC 20460 

Phone: 703-308-6212 

Fax: 703-308-6467 

E-mail:bailey.laura@epa.gov 

Marion Balsam, M.D., F.A.A.P. 

Research Partnerships Program Director 

National Institutes of Health 

National Institute of Child Health 

and Human Development 

The National Children’s Study 

6100 Executive Boulevard, Suite 5C01 

Bethesda, MD 20892-7510 

Phone: 301-435-7679 

Fax: 301-480-1222 

E-mail:balsamm@nih.gov 

Jim Jian Bao, Ph.D. 

Microbiology Laboratory Director 

EMSL Analytical, Inc. 

10768 Baltimore Avenue 

Beltsville, MD 20705 

Phone: 301-937-5700 

Fax: 301-937-5701 

E-mail:jbao@emsl.com

Claire L. Barnett, M.B.A. 

Executive Director 

Healthy Schools Network, Inc. 

773 Madison Avenue, 1st floor 

Albany, NY 12208 

Phone: 518-462-0632 

Fax: 518-462-0433 

E-mail:cbarnett@healthyschools.org 

LT Jason E. Barr, C.I.H. 

National Institutes of Health 

Building 13, Room 3K04 

13 South Drive, MSC 5760 

Bethesda, MD 20892-5760 

Phone: 301-451-5818 

Fax: 301-402-0313 

E-mail:jbarr@nih.gov 

CAPT Richard F. Barror, Ph.D., M.P.H. 

Senior Engineer 

U.S. Food and Drug Administration 

Office of the Commissioner, P.O. Box 1273 

Rockville, MD 20849 

Phone: 301-827-8799 

Fax: 301-827-0017 

E-mail:richard.barror@fda.gov 

Carol M. Bass, Ph.D. 

Environmental Engineer 

5736 Buckhaven Court 

Alexandria, VA 22315 

Phone: 703-924-0681 

Fax: 703-924-0690 

E-mail:bass.carol@epa.gov 

Charlene W. Bayer, Ph.D. 

Principal Research Scientist/Branch Head 

Georgia Tech Research Institute 

EOEML/SHETD 

925 Dalney Street, MC 0820 

Atlanta, GA 30332-0820 

Phone: 404-894-5361 

Fax: 404-894-3946 

E-mail:charlene.bayer@gtri.gatech.edu 

Edward S. Belcastro, P.E. 

Mechanical Engineer 

National Institutes of Health 

Office of Research Facilities 

Division of Property Management 

Facilities Technical Support Team

10 Center Drive, MSC 1901, Room 12B19 

Bethesda, MD 20892-1901 

Phone: 301-496-0819 

Fax: 301-402-0225 

E-mail:belcaste@mail.nih.gov 

Appendix B Page 2
LCDR Lisa G. Benaise, M.D., M.P.H. 

Epidemic Intelligence Service Officer 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

Division of Respiratory Disease Studies 

1095 Willowdale Road, Suite H-2800 

Morgantown, WV 26505 

Phone: 304-285-6139 

Fax: 304-285-5820 

E-mail:aju6@cdc.gov 

Sheri Bernstein 

Branch Chief, Policy 

National Institutes of Health 

Office of Research Facilities 

Division of Policy and Program Assessment 

Building 13, Room 201 

Bethesda, MD 20892 

Phone: 301-594-9506 

E-mail:sb387u@nih.gov 

Tobie Bernstein, J.D. 

Senior Attorney 

Environmental Law Institute 

2000 L Street, NW, Suite 620 

Washington, DC 20036 

Phone: 202-939-3869 

Fax: 202-939-3868 

E-mail:bernstein@eli.org 

Kristen A. Bertram 

Community Services Associate 

National Association of Counties 

Community Services Association 

440 First Street, NW

Washington, DC 20001 

Phone: 202-942-4292 

Fax: 202-661-8871 

E-mail:kbertram@NACO.org 

James R. Biasco, P.E. 

Director

Indian Health Service 

Division of Facilities Operations 

12300 Twinbrook Parkway, 600B 

Rockville, MD 20852 

Phone: 301-443-8027 

E-mail:james.biasco@ihs.hhs.gov 

Irwin H. Billick, Ph.D.

President 

WEC Consulting 

10408 Crossing Creek Road 

Potomac, MD 20854 

Phone: 301-299-5302 

E-mail:wecltd@comcast.net 

Randey A. Bloom, C.P.M.M. 

Postal Maintenance Specialist 

U.S. Postal Service 

Engineering 

8403 Lee Highway 

Dewey Building 

Merrifield, VA 22082-8101 

Phone: 703-280-7918 

Fax: 703-280-8415 

E-mail:randey.a.bloom@usps.gov 

Fred Blosser 

Public Affairs Officer 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

200 Independence Ave., SW

Washington, DC 20201 

Phone: 202-260-8519 

Fax: 202-260-1898 

E-mail:fbb0@cdc.gov 

Catherine C. Bobenhausen, C.I.H., 

L.E.E.D.A.P., C.S.P. 

54 Ashley Road 

Hastings-on-Hudson, NY 10706 

Phone: 914-584-8094 

Fax: 914-478-1676 

E-mail:cbobenhausen@sdcollab.com

Appendix B Page 3
Gerald G Bowen 

Occupational Safety & Health Specialist 

U.S. Department of Agriculture 

Office of Operations 

1400 Independence Avenue, SW

Mail Stop 9877 

Washington, DC 20817 

Phone: 202-720-0426 

Fax: 202-720-9976 

E-mail:Becky.Garbarino@usda.gov 

Jerry Bowen 

Safety and Environmental Specialist 

U.S. Department of Agriculture 

Protective Operations Division 

Safety and Environmental Branch 

Office of Operations 

1400 Independence Avenue, SW

Washington, DC 20250-9377 

Phone: 202-720-0426 

Fax: 202-720-9976 

E-mail:geraldg.bowen@usda.gov 

Gina L. Bowler 

Special Assistant 

U.S. Environmental Protection Agency 

Indoor Environment 

1200 Pennsylvania Avenue, NW

Mail Code 6609J 

Washington, DC 20460 

Phone: 202-343-9206 

Fax: 202-343-2394 

E-mail:bowler.gina@epa.gov 

Percival S. Brereton, M.S. 

Industrial Hygienist 

National Institutes of Health 

Office of Research Services 

Division of Occupational Health and Safety 

Building 13, Room 3K04 

Bethesda, MD 20892-5760 

Phone: 301-451-5801 

Fax: 301-402-0313 

E-mail:Breretop@ORS.od.nih.gov 

Catherine A. Broad 

Architect 

General Services Administration 

Public Buildings Service

10024 Pratt Place 

Silver Spring, MD 20910 

Phone: 202-439-7250 

E-mail:catherine.broad@gsa.gov 

Ann Brockhaus, M.P.H. 

Occupational Health Consultant

ORC Worldwide 

1800 K Street, NW

Washington, DC 20006 

Phone: 202-293-2980 

Fax: 202-293-2915 

E-mail:brockhaus@orc-dc.com

William Brodt, M.S.E. 

Experimental Facilities Engineer 

National Aeronautics and Space Administration 

Facilities Engineering and Real Property 

Division 

300 E Street, SW

Washington, DC 20546 

Phone: 202-358-1117 

Fax: 202-358-3848 

E-mail:wbrodt@nasa.gov 

Barbara A. Brooks, M.P.H., R.N., 

C.I.A.Q.P., C.O.H.N.-S. 

Industrial Hygienist 

National Security Agency 

Occupational Health & Safety 

9800 Savage Road, Suite 6404 

Fort Meade, MD 20755-6000 

Phone: 410-854-7121 

Fax: 301-688-2423 

E-mail:babrook@nsa.gov 

Appendix B Page 4
Cherie M. Brown, M.P.A. 

Analyst 

U.S. General Services Administration 

Office of Governmentwide Policy 

1800 F Street, NW, Suite 6213 

Washington, DC 20405 

Phone: 202-208-6771 

Fax: 202-273-4670 

E-mail:cherie.mcclambrown@gsa.gov 

Clive M. Brown, M.B.B.S., M.Sc., M.P.H. 

Medical Epidemiologist 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

Division of Environmental Hazards and 

Health Effects 

Air Pollution and Respiratory Health Branch 

1600 Clifton Road 

MS-E17 

Atlanta, GA 30333 

Phone: 404-498-1000 

E-mail:cmb8@cdc.gov 

Sharunda Buchanan, Ph.D. 

Branch Chief 

Centers for Disease Control & Prevention 

National Center for Environmental Health 

Division of Emergency and Environmental 

Health Services 

4770 Buford Highway, NE 

Mailstop F-28 

Atlanta, GA 30341 

Phone: 770-488-7362 

E-mail:SBuchanan@cdc.gov 

Nathaniel Burden 

Fidelity Inspection & Consulting Service 

626 Jacksonville Road, Suite 200 

Warminster, PA 18974 

Phone: 215-953-9200 

E-mail:nburden@ficservices.com 

David A. Butler, Ph.D. 

Senior Program Officer 

National Academy of Sciences 

Institute of Medicine 

500 Fifth Street, NW, Keck 872 

Washington, DC 20001 

Phone: 202-334-2000 

E-mail:mold@nas.edu 

Richard Callan 

ASPH-EPA Fellow 

U.S. Environmental Protection Agency 

ORD/NCER, Mail Code 8723F 

1025 F Street NW, Room 3125G 

Washington, DC 20004 

Phone: 202-343-9637 

E-mail:callan.richard@epa.gov 

VADM Richard H. Carmona, M.D., 

M.P.H., F.A.C.S. 

United States Surgeon General 

Office of the Surgeon General 

U.S. Public Health Service 

5600 Fishers Lane 

Parklawn Building, Room 18-67 

Rockville, MD 20857 

Phone: 301-443-4000 

E-mail:rcarmona@osophs.dhhs.gov 

Joseph P. Carrier 

Industrial Hygienist 

Johns Hopkins University 

Applied Physics Laboratory 

Environmental Health and Safety 

11100 Johns Hopkins Road 

Laurel, MD 20723-6099 

Phone: 443-778-4190 

Fax: 443-778-6250 

E-mail:joseph.carrier@jhuapl.edu 

Jennifer L. Carter 

Art Consultant 

Maple Avenue, Takoma Park, MD 20912 

Phone: 301-891-3214 

Fax: 301-270-1441 

E-mail:sanghacafe@starpower.net 

Appendix B Page 5
Daniel W. Cautley, P.E. 

Cautley Engineering 

3611 39th Street, NW, Apartment C327 

Washington, DC 20016 

Phone: 202-244-2488 

E-mail:dwcautley@mindspring.com

John C. Chah, Ph.D. 

President 

Global BioTech, LLP 

1984 Lancashire Drive 

Potomac, MD 20854 

Phone: 301-424-8720 

Fax: 301-424-0300 

E-mail:sbrjchah@fastmail.fm

Jae Chang 

Professor 

University of Kansas 

Architecture 

1465 Jayhawk Boulevard 

416 Marvin Hall 

Lawrence, KS 66045 

Phone: 785-864-1446 

E-mail:jdchang@ku.edu 

Helen T. Chatham, M.S.N. 

Nurse Practitioner 

U.S. Department of Defense 

Occupational Health and Environmental 

Safety 

8621 Concord Drive 

Jessup, MD 20794 

Phone: 301-617-2631 

E-mail:irishpride0703@comcast.net 

Harry F. Chisholm 

IAQ Manager 

National Security Agency 

Facilities 

9800 Savage Road 

Fort Meade, MD 20755-6000 

Phone: 301-688-7824 

Fax: 301-688-2423 

E-mail:hfchish@nsa.gov 

Kevin Choe, M.P.H., Ph.D. 

IAQ Professional 

Q Air Systems, Inc. 

52 Edgefield Drive 

Morris Plains, NJ 07950 

Phone: 973-656-9833 

E-mail:choek@optonline.net 

Mary E. Clancy Czarnecki, R.N., C.I.E., 

C.M.R. 

Director of Environmental Health 

EDDI 

Environmental Assessment & Analysis 

168 Magnolia Road 

Sterling, VA 20164 

Phone: 703-450-9460, 703-431-3014 

Fax: 703-406-8807 

E-mail:maryclancy@earthlink.net 

Noreen M. Clark, Ph.D. 

Dean 

University of Michigan School of Public 

Health 

Marshall H. Becker Professor of Public Health 

109 South Observatory Street 

Ann Arbor, MI 48109-2029 

Phone: 734-763-5454 

Fax: 734-763-5455 

E-mail:nmclark@umich.edu 

Anthony Clifford 

Chief Engineer 

National Institutes of Health 

Office of Research Facilities 

Office of the Director

NIH, Building 13, Suite 201 

MSC 5759 

Bethesda, MD 20892-0158 

Phone: 301-594-0999 

Fax: 301-496-7172 

E-mail:Cliffort@ors.od.nih.gov

Appendix B Page 6
Katy Coleman 

Associate Editor 

Environmental Education Foundation 

CM/Cleaning & Maintenance Management 

Magazine

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Sara Coley 

Project Manager 

E. Roberts Alley & Associates, Inc. 

1931 Central Parkway SW 

Decatur, AL 35601 

Phone: 256-351-0121 

Fax: 256-351-0151 

E-mail:sarac@eralley.com

David Anthony Collins

Research Associate 

Johns Hopkins University 

Clinical Immunology 

2801 Bayonne Avenue 

Baltimore, MD 21214 

Phone: 410-550-2560 

E-mail:dcollin8@jhmi.edu 

Pedro I. Colon 

Architect, Project Executive 

Smithsonian Institution 

Office of Planning & Project Management 

750 9th Street NW, Suite 5200 

Washington, DC 20560-0908 

Phone: 202-275-0236 

Fax: 202-275-0889 

E-mail:colonp@si.edu 

CAPT Susan M. Conrath, Ph.D., M.P.H. 

U.S. Environmental Protection Agency 

Indoor Environment 

1200 Pennsylvania Avenue, NW

Washington, DC 20460 

Phone: 202-343-9389 

Fax: 202-343-2393 

E-mail:conrath.susan@epa.gov 

Leslie R. Cook 

U.S. Environmental Protection Agency 

Pollution Prevention 

USEPA Headquarters, MC 7409-M 

EPA East 

1200 Pennsylvania Avenue, NW

Washington, DC 20460 

Phone: 202-564-8838 

Fax: 202-564-8899 

E-mail:cook.leslie@epa.gov 

Elizabeth Cotsworth 

Office Director 

U.S. Environmental Protection Agency 

Radiation and Indoor Air 

1200 Pennsylvania Avenue, NW

Mail Code 6609J 

Washington, DC 20460 

Phone: 202-343-9320 

Fax: 202-343-2394 

E-mail:cotsworth.elizabeth@epa.gov 

Michele Courville 

Program Manager 

Montgomery County Department of 

Environmental Protection 

Indoor Environments 

255 Rockville Pike, Suite 120 

Rockville, MD 20850 

Phone: 240-777-7757 

Fax: 240-777-7752 

E-mail: michele.courville@montgomerycountymd.gov

Jean Cox-Ganser, Ph.D. 

Supervisory Research Epidemiologist 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

Division of Respiratory Disease Studies 

Field Studies Branch 

1095 Willowdale Road 

MS 2800 

Morgantown, WV 26505 

Phone: 304-285-5751 

Fax: 304-285-5820 

E-mail:jjc8@cdc.gov 

Appendix B Page 7
LCDR David B. Cramer, R.S., M.P.H. 

Institutional Environmental Health Resident 

Indian Health Service 

Office of Environmental Health 

12300 Twinbrook Parkway, Suite 610 

Rockville, MD 20852 

Phone: 301-443-1054 

Fax: 301-443-7538 

E-mail:david.cramer@ihs.gov 

Neil C. Davis, C.I.H., M.S., M.P.H. 

Senior Industrial Hygienist 

U.S. Department of Labor 

Occupational Safety and Health Administration 

Directorate of Standards and Guidance 

1 Kentbury Way 

Bethesda, MD 20814 

Phone: 202-693-2281 

E-mail:Davis.Neil@DOL.gov 

Roy Deitchman 

VP - Environment Health & Safety 

Amtrak 

60 Massachusetts Avenue, NE 

Washington, DC 20002 

Phone: 202-906-3278 

Fax: 202-906-3500 

E-mail:deitchr@amtrak.com

Richard Denbow

Metropolitan Washington Council of 

Governments 

206 North Center Street 

Vienna, VA 22180 

Phone: 703-319-9300 

E-mail:rdenbow@earthlink.net 

Jim E. Dennison, Ph.D., C.I.H. 

Colorado State University 

ERHS 

CETT 

1690 Campus Delivery 

Fort Collins, CO 80523 

Phone: 970-491-8867 

Fax: 970-491-8304 

E-mail:dennison@colostate.edu

Jen Desimone 

Ozone Action Days Coordinator/Environmental Planner 

Metropolitan Washington Council of Governments

Department of Environmental Programs 

777 North Capitol Street, NE, Suite 300 

Washington, DC 20002-4239 

Phone: 202-962-3360 

Fax: 202-962-3203 

E-mail:jdesimone@mwcog.org 

CDR Danielle Devoney, Ph.D. 

U.S. Environmental Protection Agency 

Office of Research and Development 

1200 Pennsylvania Avenue, NE, 8601D 

Washington, DC 20460 

Phone: 202-564-3352 

E-mail:devoney.danielle@epa.gov 

Thomas S. Dietsche 

Program Manager 

U.S. Green Building Council 

LEED Department 

1015 18th Street NW, Suite 508 

Washington, DC 20036 

Phone: 202-828-1136 

E-mail:tdietsche@usgbc.org 

John DiFazio, J.D., M.P.A. 

Assistant General Counsel 

Consumer Specialty Products Association 

900 17th Street NW, #300 

Washington, DC 20006 

Phone: 202-872-8110 

Fax: 202-872-8114 

E-mail:jdifazio@cspa.org 

Appendix B Page 8
Jerome P. Dion 

Supervisor, Research 

U.S. Department of Energy 

Building Technologies Program

Energy Efficiency and Renewable Energy 

1000 Independence Avenue, SW

Washington, DC 20585-0121 

Phone: 202-586-9470 

Fax: 202-586-4617 

E-mail:jerry.dion@ee.doe.gov 

Eleanor Dixon-Terry, M.P.H., C.H.E.S. 

Director, Professional Development 

Society for Public Health Education 

750 First Street, NE, Suite 910 

Washington, DC 20002 

Phone: 202-408-9804 

Fax: 202-408-9815 

E-mail:edixon-terry@sophe.org

Jason Dobranic, Ph.D., R.I.A.Q.M. 

Environmental Education Foundation 

EMSL Analytical

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Marc Donate, Assoc. A.I.A., A.S.A.I. 

Bernardon Haber Holloway Architects, PC 

425 McFarlan Road, Suite 200 

Kennett Square, PA 19348 

Phone: 610-444-2900 

E-mail:MDonate@bernardon.com

Ken F. Doolan, C.I.H. 

U.S. Department of State 

M/OBO/OM/SHEM 

Washington, DC 20522-0611 

Phone: 703-812-2315 

Fax: 703-516-1958 

E-mail:doolankf@state.gov 

Heidi Dudik 

National Heart, Lung, and Blood Institute 

9000 Rockville Pike 

Bethesda, MD 20892 

Phone: 301-451-8264 

E-mail:dudikh@nhlbi.nih.gov 

Kevin H. Dunn, C.I.H. 

Industrial Hygienist/Engineer 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

Division of Environmental Hazards 

and Health Effects 

1600 Clifton Road, NE 

MS E-17 

Atlanta, GA 30333 

Phone: 404-498-2153 

Fax: 404-498-1088 

E-mail:kdunn@cdc.gov 

CDR Scott Earnest, Ph.D., P.E. 

Acting Branch Chief 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

Division of Applied Research and Technology 

4676 Columbia Parkway 

Cincinnati, OH 45241 

Phone: 513-841-4539 

Fax: 513-841-4506 

E-mail:GEarnest@cdc.gov 

John P. Eberhard, F.A.I.A. 

Executive Director 

Academy of Neuroscience for Architecture 

1249 F Street, Suite 222 

San Diego, CA 92101 

Phone: 619-235-0221 

E-mail:John@ANFArch.org 

Appendix B Page 9
Peyton A. Eggleston, M.D. 

Professor of Pediatrics and Immunology 

Johns Hopkins University 

School of Medicine 

600 North Wolfe Street, CMSC 1102 

Baltimore, MD 21287-3200 

Phone: 410-955-5883 

Fax: 410-955-0229 

E-mail:pegglest@jhmi.edu 

Vanessa N. Elharrar, M.D., M.P.H. 

U.S. Department of Health and Human 

Services 

Office of the Secretary 

Office of Public Health and Science 

Office of Disease Prevention and Health 

Promotion 

2208 Washington Ave #302 

Silver Spring, MD 20910 

Phone: 240-453-6112 

E-mail:velharra@jhsph.edu 

Byron A. Ellis 

Engineer 

U.S. Postal Service 

USPS Engineering 

8403 Lee Highway 

Merrifield, VA 22030-8101 

Phone: 703-280-7954 

E-mail:Byron.A.Ellis@usps.gov

Richard E. Ellis, J.D., R.E.H.S. 

Environmental Health Specialist 

The Ashkin Group, LLC 

Green Cleaning 

E. 2910 57th, Suite 5, # 318 

Spokane, WA 99223 

Phone: 360 280-0930 

E-mail:RichandPam_7@hotmail.com

Michele R. Evans, Dr.P.H. 

Environmental Safety Officer 

National Institutes of Health 

Clinical Center 

Office of the Director

Building 10, Room 62551 

Bethesda, MD 20892 

Phone: 301-496-5281 

E-mail:me55f@nih.gov 

Henry Falk, M.D., M.P.H. 

Rear Admiral, U.S. Public Health Service 

(Retired) 

Director, National Center for Environmental 

Health/Agency for Toxic Substances & 

Disease Registry 

Director, Coordinating Center for Environmental & Occupational Health & Injury 

Prevention 

Mailstop E28 

1600 Clifton Road, NE 

Atlanta, GA 30333 

E-mail:HXF1@CDC.GOV 

Tina L. Faul, R.N., C.O.H.N.-S. 

Clinical Services Coordinator 

U.S. Department of Defense 

Occupational Health Services 

9800 Savage Road 

Fort Meade, MD 20755 

Phone: 301-688-8598 

Fax: 301-688-3900 

E-mail:tlfaul@nsa.gov 

Ilise L. Feitshans, J.D., Sc.M. 

Author and Adjunct Faculty 

George Washington University - School of 

Public Health & Health Services 

Department of Occupational and Environmental Health 

120 Warwick Road 

Haddonfield, NJ 08033 

Phone: 856-428-0605 

E-mail:ilise@prodigy.net 

Appendix B Page 10
Alfred J. Ferruggiaro, C.I.H. 

Industrial Hygienist 

National Institutes of Health 

Office of Research Services 

Division of Occupational Health and Safety 

Building 13, Room 3K04 

9000 Rockville Pike 

Bethesda, MD 20892 

Phone: 301-496-3353 

Fax: 301-402-0313 

E-mail:ferrugga@mail.nih.gov 

LT Stephen T. Fields 

Industrial & Systems Engineer 

U.S. Environmental Protection Agency 

Architecture & Engineering Branch 

1200 Pennsylvania Avenue, NW, MC: 

3204R 

Washington, DC 20460 

Phone: 202-564-2418 

Fax: 202-564-8234 

E-mail:fields.stephen@epa.gov 

Nancy D. Firestone, M.Div. 

The Reverend 

Health Environment and Relationships 

53 Numer Road 

Newport, PA 17074 

Phone: 717-576-0717 

E-mail:nfire@pa.net 

William J. Fisk, M.S., P.E. 

Staff Scientist & Department Head 

Lawrence Berkeley National Laboratory 

Indoor Environment 

1 Cyclotron Road, MS 90-3058 

Berkeley, CA 94720 

Phone: 510-486-5910 

Fax: 510-486-6658 

E-mail:wjfisk@lbl.gov 

Susan L. Q. Flaherty 

Roha & Flaherty 

2121 K Street, NW

Suite 800 

Washington, DC 20037-1801 

Phone: 202-833-0033 

E-mail:slqflaherty-ngolaw@juno.com

Caroline Freeman, M.P.H. 

Director

U.S. Department of Labor 

Occupational Safety and Health Administration 

Office of Biological Hazards 

200 Constitution Avenue, NW, Room 

N3718 

Washington, DC 20210 

Phone: 202-693-1950 

E-mail:freeman.caroline@dol.gov 

Katherine R. French, R.N., C.O.H.N.-S. 

Occupational Health Case Management 

Coordinator 

U.S. Department of Defense 

Occupational Health Services 

9800 Savage Road, Suite 6404 

Fort Meade, MD 20755-6404 

Phone: 301-688-0286 

Fax: 443-479-3325 

E-mail:krfrenc@nsa.gov 

John Gallagher, R.E.E.W. 

President 

Environmental Education Foundation 

Gallagher Design & Development 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Appendix B Page 11
Paul L. Garbe, D.V.M., M.P.H. 

Associate Director for Science 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

Division of Environmental Hazards and 

Health Effects 

1600 Clifton Road, MS E-17 

Atlanta, GA 30333 

Phone: 404-498-1829 

Fax: 404-498-1088 

E-mail:pgarbe@cdc.gov 

Suzanne M. Gaynor, Dr.P.H., R.N., 

M.B.A. 

Environmental Public Health Specialist 

U.S. Department of Housing and Urban 

Development 

Office of Healthy Homes and Lead Hazard 

Control 

451 7th Street, SW, Room 3206 

Washington, DC 20410 

Phone: 202-755-1785 x127 

Fax: 202-755-1000 

E-mail:Suzanne_M._Gaynor@hud.gov 

Michael Geary 

President 

Mold Scan 

2 Wisconsin Circle, Suite 700 

Chevy Chase, MD 20815 

Phone: 240-235-6011 

E-mail:moldscan@aol.com

Mark D. Gibson, B.S., M.S., C.I.H. 

Industrial Hygienist 

National Institutes of Health 

Office of Research Services 

Division of Occupational Health and Safety 

Building 13, Room 3K04 

13 South Drive, MSC 5760 

Bethesda, MD 21703-5760 

Phone: 301-496-3457 

E-mail:gibsomar@ors.od.nih.gov 

John Girman, M.S. 

Director of Center for Analysis & Studies 

U.S. Environmental Protection Agency 

Indoor Environments 

1200 Pennsylvania Avenue, NW

Mail Code 6609J 

Washington, DC 20460 

Phone: 202-343-9317 

Fax: 202-343-2394 

E-mail:girman.john@epa.gov 

Craig Goodrich 

Project Manager 

LB&B Associates 

O&M Contractor 

12201 Sunrise Valley Drive 

Reston, VA 20192 

Phone: 703-648-7500 

Fax: 703-648-7527 

E-mail:lbbprojectmanager@usgs.gov 

Ronald E. Gots, M.D., Ph.D. 

Chief Executive Officer 

ICTM International Center for Toxicology 

2301 Research Boulevard 

Suite 210 

Rockville, MD 20850-3204 

Phone: 301-519-0300 

Fax: 301-519-1307 

E-mail:regots@ictm.com

Brian Gumm

Writer and Researcher 

Alliance for Healthy Homes 

227 Massachusetts Avenue, NE, Suite 200 

Washington, DC 20002 

Phone: 202-543-1147 

Fax: 202-543-4466 

E-mail:bgumm@afhh.org 

Appendix B Page 12
Vijay Gupta, P.E. 

Senior Mechanical Engineer 

U.S. General Services Administration 

Office of the Chief Architect 

1800 F Street, NW, Suite 3341 

Washington, DC 20405 

Phone: 202-501-0628 

Fax: 202-501-3393 

E-mail:vijay.gupta@gsa.gov 

Sandra H. Handon, M.E. 

Environmental Engineer 

District of Columbia Department of Health 

Air Quality Division 

51 N Street, 5th Floor 

Washington, DC 20001 

Phone: 202-535-1722 

Fax: 202-535-1371 

E-mail:sandra.handon@dc.gov 

Bryan D. Hardin, Ph.D. 

GlobalTox, Inc. 

33 Office Park Road 

4A PMB 344 

Hilton Head Island, SC 29928 

Phone: 843-363-9466 

Fax: 843-363-9465 

E-mail:bhardin@globaltox.com

David B. Hattis, M.Arch. 

President 

Building Technology Inc. 

1109 Spring Street 

Silver Spring, MD 20910 

Phone: 301-588-5020 

Fax: 301-587-5154 

E-mail:dbhattis@bldgtechnology.com

Vickie R. Hawkins, M.S., CIE, CIH 

Industrial Hygienist 

U.S. Army Center for Health Promotion and 

Preventive Medicine 

5158 Blackhawk Road 

MCHB-TS-OFS 

APG, MD 21010-5403 

Phone: 410-436-3118 

Fax: 410-436-5471 

E-mail:vickie.hawkins@amedd.army.mil 

Paul D. Hawver 

Mechanical Engineering Technician

National Institutes of Health 

Office of Research Facilities 

Division of Policy and Program Assessment 

Construction Oversite Group 

9000 Rockville Pike, Building 13, Room

201 

Bethesda, MD 20892 

Phone: 301-402-5140 

Fax: 301-496-7172 

E-mail:Paul_Hawver@nih.gov 

Dave H. Haynes, B.S.E.H. 

Industrial Hygienist 

Department of Army

EOIR Contractor, Safety Office 

10221 Burbeck Road 

Fort Belvoir, VA 22060-5806 

Phone: 703-704-3682 

Fax: 703-704-3431 

E-mail:david.haynes@nvl.army.mil 

Jerry Hershovitz

Acting Deputy Director/Associate Director

for Program Development 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

Division of Emergency and Environmental 

Health Services 

4770 Buford Highway, NE, Mail Stop F-30 

Atlanta, GA 30341-3717 

Phone: 770-488-4542 

Fax: 770-488-4820 

E-mail:JHershovitz@cdc.gov 

Appendix B Page 13
Jonathan Herz, A.I.A. 

Architect 

Innovative Workplaces Division 

GSA Office of Governmentwide Policy 

1800 F Street NW, (MPW) 

Washington, DC 20405 

Phone: 202-501-3476 

E-mail:jonathan.herz@gsa.gov 

Marian L. Heyman, M.P.H. 

Epidemiologist/Industrial Hygienist 

Connecticut Department of Public Health 

Environmental & Occupational Health 

Assessment 

410 Capitol Avenue, MS# 11CHA 

P.O. Box 340308 

Hartford, CT 06134-0308 

Phone: 860-509-7742 

Fax: 860-509-7785 

E-mail:marian.heyman@po.state.ct.us

Daniel L. Hightower, A.I.A. 

Director

BBH Design 

Programming and Planning 

P.O. Box 12697 

Research Triangle Park, NC 27709 

Phone: 919-460-6700 

Fax: 919-460-6733 

E-mail:dhightower@bbh-design.com

James E. Hill, Ph.D. 

National Institute of Standards and Technology 

100 Bureau Drive, Stop 8600 

Building 226, Room B216 

Gaithersburg, MD 20899 

Phone: 301-975-4032 

Fax: 301-975-4032 

E-mail:james.hill@nist.gov 

Michael Hodgson, M.D. 

U.S. Department of Veterans Affairs 

810 Vermont Avenue 

Washington, DC 20201 

E-mail:muh7@va.gov 

Deana J. Holmes 

Scientist 

U.S. Department of Labor 

Occupational Safety and Health Administration 

200 Constitution Avenue, NW, Room 

N3718 

Washington, DC 20210 

Phone: 202-639-1950 

E-mail:holmes.deana@dol.gov 

Ernie B. Hood 

Reporter 

National Institutes of Health 

National Institute of Environmental Health 

Sciences 

P.O. Box 12233 

Research Triangle Park, NC 27709 

Phone: 919-544-5700 

Fax: 919-544-6992 

E-mail:bkthrough@aol.com

Donald R. Horn, A.I.A. 

Director, Sustainable Design Program 

U.S. General Services Administration 

Office of Applied Science 

1800 F Street, NW

Room 4046 

Washington, DC 20405 

Phone: 202-501-4525 

Fax: 202-501-3203 

E-mail:donald.horn@gsa.gov 

Glenn C. Hourahan, P.E. 

VP, Research & Technology 

Air Conditioning Contractors of America 

2800 Shirlington Road, Suite 300 

Arlington, VA 22206 

Phone: 703-824-8865 

E-mail:glenn.hourahan@acca.org 

Appendix B Page 14
Jennifer M. Houser 

Industrial Hygienist 

U.S. Department of Defense 

Washington Headquarters Services 

Defense Facilities Directorate 

1155 Defense Pentagon 

Washington, DC 20301-1155 

Phone: 703-693-3683 

Fax: 703-614-9671 

E-mail:Jennifer.Houser@whs.mil 

Keith Howell, Ph.D. 

Associate Dean for Research 

University of North Carolina at Greensboro 

School Health and Human Performance 

229 HHP Building 

Greensboro, NC 27402 

Phone: 336-256-2475 

Fax: 336-334-3238 

E-mail:howellk@uncg.edu 

Allen L. Ingling, R.I.A.Q.M. 

Environmental Education Foundation 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

David E. Jacobs, Ph.D. 

U.S. Department of Housing and Urban 

Development 

Community Planning and Development 

451 7th Street, SW, Room 7208 

Washington, DC 20410 

Phone: 202-708-0614 x5647 

E-mail:david_e._jacobs@hud.gov 

Dawn Jacobson, M.D., M.P.H. 

Senior Clinical Advisor 

U.S. Department of Health and Human 

Services 

Office of Public Health and Science 

Office of Disease Prevention and Health 

Promotion 

1101 Wootton Parkway 

Suite LL100, Room 120 

Rockville, MD 20852 

Phone: 240-453-8251 

Fax: 240-453-8281 

E-mail:djacobso@osophs.dhhs.gov 

Philip P. Jalbert 

Executive Secretary CIAQ 

U.S. Environmental Protection Agency 

Indoor Environments Division 

1200 Pennsylvania Avenue, NW

Washington, DC 20460 

Phone: 202-343-9431 

E-mail:jalbert.philip@epa.gov 

Alison K. Johnson 

Chair 

Chemical Sensitivity Foundation 

Author, Video Producer/Director 

3 Larrabee Farm Road 

Brunswick, ME 04011 

Phone: 207-725-8570 

E-mail:alisonjmcs@aol.com

Barbara A. Jones, M.S.P.H., M.S.W. 

DHHS Emerging Leader 

U.S. Department of Health and Human 

Services 

Office of the Secretary 

Office of Public Health and Science 

Office of Disease Prevention and Health 

Promotion 

1101 Wootton Parkway, Suite LL100 

Rockville, MD 20852 

Phone: 240-453-8271 

E-mail:bjones2@osophs.dhhs.gov 

Appendix B Page 15
Julie B. Kacergis, C.I.H. 

Industrial Hygienist 

Smithsonian Institution 

Office of Safety and Environmental Management 

750 9th Street, NW

Suite 9100 

Washington, DC 20013-7012 

Phone: 202-275-0734 

Fax: 202-275-0746 

E-mail:kacergisj@si.edu 

Kevin Kampschroer 

U.S. General Services Administration 

Public Buildings Service

Research and Expert Services 

1800 F Street, NW, 4015 

Washington, DC 20405-0001 

Phone: 202-501-4411 

Fax: 202-219-2072 

E-mail:kevin.kampschroer@gsa.gov 

Adam Kautz 

K9 Dog Handler 

BCRSK9 Mold Detection Service 

K9 Mold Inspection Service 

P.O. Box 508 

New Windsor, MD 21776 

Phone: 888-289-0162 

Fax: 410-635-6020 

E-mail:bobcat1088@juno.com 

Joseph D. Kelly, M.D., M.S. 

National Institutes of Health 

Office of Research Services 

Division of Occupational Health and Safety 

Building 13, Room 3K04 

Bethesda, MD 20892 

Phone: 301-496-3353 

E-mail:kellyjoe@mail.nih.gov 

Tom Kelly 

Director

U.S. Environmental Protection Agency 

Indoor Environments 

1200 Pennsylvania Avenue, NW

Mail Code 6609J 

Washington, DC 20460 

Phone: 202-343-9370 

Fax: 202-343-2394 

E-mail:kelly.tom@epa.gov 

Woodie Kessel, M.D., M.P.H. 

Assistant Surgeon General 

U.S. Department of Health and Human 

Services 

Office of the Secretary 

Office of Public Health and Science 

Office of Disease Prevention and Health 

Promotion 

1101 Wootton Parkway LL100 

Rockville, MD 20852 

Phone: 240-453-8256 

E-mail:wkessel@osophs.dhhs.gov 

Naseeb Kibria 

Manager, Childhood Asthma Programs 

American Lung Association 

Research and Program Services 

1150 18th Street, NW, Suite 900 

Washington, DC 20036 

Phone: 202-785-3355 

Fax: 202-452-1805 

E-mail:nkibria@lungusadc.org 

Larainne G. Koehler 

Radon & Indoor Air Coordinator 

U.S. Environmental Protection Agency - 

Region 2 

Radiation & Indoor Air Branch 

290 Broadway 

New York, NY 10007-1866 

Phone: 212-637-4005 

Fax: 212-637-4942 

E-mail:koehler.larainne@epa.gov 

Appendix B Page 16
Pamela Kogan 

Program Analyst 

U.S. Environmental Protection Agency 

Office of Radiation and Indoor Air 

1200 Pennsylvania Avenue, NW

Mail Code 6609J 

Washington, DC 20460 

Phone: 202-343-9564 

E-mail:kogan.pamela@epa.gov 

Laura Kolb 

U.S. Environmental Protection Agency 

Indoor Environment 

10818 Orchard Street 

Fairfax, VA 22030 

Phone: 202-343-9438 

Fax: 202-343-2394 

E-mail:kolb.laura@epa.gov 

Tracy Kolian 

800 I Street, NW

Washington, DC 20001 

Phone: 202-777-2435 

E-mail:tracy.kolian@apha.org 

Brian Kong, P.E. 

National Institutes of Health 

13 South Drive, Room 210 

Bethesda, MD 20892 

Phone: 301-402-4742 

E-mail:sungbriankong@yahoo.com

Sharon N. Kramer 

Realtor 

Mycotic Disease Awareness/ MDAwareness 

P.O. Box 676327 

Rancho Santa Fe, CA 92067 

Phone: 760-822-8026 

E-mail:snk1955@aol.com

Kathleen Kreiss, M.D.

Branch Chief 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

Division of Respiratory Disease Studies 

Field Studies Branch 

1095 Willowdale Road, MS 2800 

Morgantown, WV 26505 

Phone: 304-285-5751 

Fax: 304-285-5820 

E-mail:kxk2@cdc.gov 

Satish Kumar, Ph.D. 

Scientist 

Lawrence Berkeley National Laboratory 

Energy Analysis Program 

901 D Street, SW, Suite 950 

Washington, DC 20024 

Phone: 202-646-7953 

Fax: 202-646-7800 

E-mail:SKumar@lbl.gov 

Celia Kuperszmid Lehrman 

Senior Editor 

Consumers Union 

Consumer Reports 

101 Truman Avenue 

Yonkers, NY 10703 

Phone: 914-378-2012 

E-mail:lehrce@consumer.org 

Christopher S. Lafferty 

U.S. Environmental Protection Agency 

109 TW Alexander Drive 

Mail Drop C60405 

Research Triangle Park 

Durham, NC 27711 

Phone: 919-541-1957 

Fax: 919-541-2570 

E-mail:lafferty.shawn@epa.gov 

Appendix B Page 17
Charles J. Lamielle 

National Center for Environmental Health 

Strategies 

1100 Rural Avenue 

Voorhees, NJ 08043 

Phone: 856-429-5358 

E-mail:ncehs@ncehs.org 

Mary D. Lamielle 

Executive Director 

National Center for Environmental Health 

Strategies 

1100 Rural Avenue 

Voorhees, NJ 08043 

Phone: 856-429-5358 

E-mail:ncehs@ncehs.org 

Stephanie A. Lamster 

Environmental Protection Specialist 

U.S. Environmental Protection Agency 

Indoor Environments Division 

1200 Pennsylvania Avenue, NW

Mail Code 6609J 

Washington, DC 20460 

Phone: 202-343-9614 

Fax: 202-343-2393 

E-mail:Lamster.stephanie@epa.gov 

Michael J. Langone 

Building Management Specialist 

U.S. Department of Defense 

Washington Headquarters Services 

Real Estate and Facility

1155 Defense Pentagon 

RDF 1J702 

Washington, DC 20301-1155 

Phone: 703-695-7968 

Fax: 703-601-2296 

E-mail:michael.langone@whs.mil 

Stephen Langone 

Building Operations Specialist 

U.S. Geological Survey 

Facilities Maintenance Branch 

12201 Sunrise Valley Drive 

Reston, VA 20192 

Phone: 703-648-7502 

Fax: 703-648-7527 

E-mail:slangone@usgs.gov 

Kiyoung Lee 

Assistant Professor 

University of Kentucky 

Environmental Health 

121 Washington Avenue 

Lexington, KY 40536 

Phone: 859-257-5678 x82243 

E-mail:kiyoung@uky.edu 

Marc Leftwich, R.I.A.Q.M. 

Environmental Education Foundation 

AMT Mold Testing & Consulting

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Bill Lehmann, R.I.A.Q.M. 

National Sales 

Environmental Education Foundation 

Point Source Solution 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Bob Lehmann, R.I.A.Q.M. 

National Marketing 

Environmental Education Foundation 

Point Source Solution 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Appendix B Page 18
Monique Lester, M.P.H. 

Environmental Scientist 

U.S. Environmental Protection Agency 

2301 Glenallen Avenue 

Apartment 310 

Silver Spring, MD 20906 

Phone: 202-564-1342 

E-mail:lester.monique@epa.gov

Hal Levin, B.Arch. 

Building Ecology Research Group 

2548 Empire Grade 

Santa Cruz, CA 95060 

Phone: 831-425-3946 

Fax: 831-426-6522 

E-mail:hal.levin@buildingecology.com

James S. Lewis, P.E. 

Mechanical Engineer 

National Institutes of Health 

Division of Policy & Program Assessment 

Building 13, Room 201, 13 South Drive 

Bethesda, MD 20802 

Phone: 301-435-2047 

Fax: 301-496-7172 

E-mail:lewisj@mail.nih.gov 

James W. Lewis, C.I.H., C.S.P. 

Program Manager 

Maryland Department of the Environment 

Air & Radiation Management Administration 

1800 Washington Boulevard, Suite 750 

Baltimore, MD 21230 

Phone: 410-537-3300 

Fax: 410-537-3198 

E-mail:jlewis@mde.state.md.us 

Kevin M. Leyden, Ph.D. 

Director

West Virginia University 

Institute for Public Affairs 

301-B Woodburn Hall 

Morgantown, WV 26506-6317 

Phone: 304-293-5432 

E-mail:Kleyden@wvu.edu 

Patricia Liegey 

Occupational Safety and Health Program Mgr. 

U.S. Department of Homeland Security 

Citizen and Immigration Service 

20 Massachusetts Avenue, NW

Washington, DC 20529 

Phone: 202-272-1354 

Fax: 202-272-1352 

E-mail:patricia.liegey@dhs.gov 

Ed N. Light, C.I.H. 

Building Dynamics 

1216 Ashton Road 

Ashton, MD 20861 

Phone: 301-924-6264 

Fax: 703-450-4649 

E-mail:Elight@building-dynamics.com

Maureen K. Little, M.P.H. 

New York City Department of Health and 

Mental Hygiene 

253 Broadway, Room 402, CN-34C 

New York, NY 10007 

Phone: 212-227-3740 

E-mail:mlittle@health.nyc.gov 

Vivian Loftness, M. Arch. 

Professor 

Carnegie Mellon University 

Department of Architecture 

Pittsburgh, PA 15213-3890 

Phone: 412-268-1539 

E-mail:loftness@andrew.cmu.edu 

Boyd Long, R.I.A.Q.M. 

Environmental Education Foundation 

Medallion Healthy Homes 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Appendix B Page 19
Rebecca Love 

Associate 

National Environmental Education and 

Training Foundation 

Health & Environment Programs 

1707 H Street, NW

Washington, DC 20006 

Phone: 202-261-6475 

E-mail:love@neetf.org 

Athanasia I. Mantzouranis 

Team Leader 

U.S. Food and Drug Administration 

ORPS/Division of Engineering Services 

5630 Fishers Lane, Room 2051A 

Rockville, MD 20857 

Phone: 301-827-9811 

Fax: 301-827-7019 

E-mail:athanasia.mantzouranis@fda.gov 

Larry L. Marcum, J.D., M.P.A. 

Manager Government Affairs 

National Environmental Health Association 

R&D/GA 

720 S Colorado Blvd., South Tower, Suite 

970 

Denver, CO 80246 

Phone: 303-756-9090 x303 

Fax: 303-691-9490 

E-mail:LMARCUM@neha.org 

Jayne Mardock 

American Lung Association 

National Policy and Advocacy 

1150 18th Street, NW, Suite 900 

Washington, DC 20912 

Phone: 202-785-3355 

Fax: 202-452-1805 

E-mail:jmardock@lungusadc.org 

Michelle L. Markley 

Safety Training Program Manager 

National Institutes of Health 

Office of Research Services 

Division of Occupational Health and Safety 

13 South Drive, MSC 5760 

Bethesda, MD 20892 

Phone: 301-451-5824 

E-mail:mmark@mail.nih.gov 

Marcia F. Marks, A.C.S.W. 

Environmental-Health/Policy Consultant 

5317 Cardinal Court 

Bethesda, MD 20816-2908 

Phone: 301-229-6466 

Fax: 301-320-3189 

E-mail:fragermark@mindspring.com

Joanna M. Matheson, Ph.D. 

Toxicologist 

U.S. Consumer Product Safety Commission 

Health Sciences Division 

4330 East West Highway 

Bethesda, MD 20814 

Phone: 301-504-7043 

Fax: 301-504-0079 

E-mail:jmatheson@cpsc.gov 

CDR Wade B. McConnell, M.S.E.H. 

Chief 

U.S. Coast Guard 

Environmental Health Division 

Office of Health and Safety, G-WKS-3 

2100 2nd Street SW

Washington, DC 20593 

Phone: 202-267-1388 

Fax: 202-267-4355 

E-mail:wmcconnell@comdt.uscg.mil 

Richard A. McCrone 

Senior Operations Engineer 

U.S. Department of Veterans Affairs 

810 Vermont Avenue 

Washington, DC 20420 

Phone: 202-273-5880 

E-mail:Richard.McCrone@hq.med.va.gov 

Appendix B Page 20
Leyla E. McCurdy, M.Phil. 

Senior Director 

National Environmental Education and 

Training Foundation 

Health & Environment Programs 

1707 H Street, NW, Suite 900 

Washington, DC 

Phone: 202-261-6488 

E-mail:mccurdy@neetf.org 

Stephen A. McFadden, M.S. 

Independent Scientific Research Advocates 

5521 Greenville Avenue, #104-608 

Dallas, TX 75206 

Phone: 301-897-9614 

E-mail:isra@dfwonline.net 

Terry M. McFarland, R.N., C.O.H.N.-S., 

C.I.A.Q.P. 

Industrial Hygienist 

National Security Agency 

Occupational Health & Safety 

9800 Savage Road, Suite 6404 

Fort Meade, MD 20755-6000 

Phone: 301-688-7824 

Fax: 301-688-2423 

E-mail:tlmcfa1@nsa.gov 

Paul W. McHam 

CMR, Mold Across America 

Consulting Board 

P.O. Box 770991 

Lakewood, OH 44107 

Phone: 877-280-6653 

Fax: 216-221-1942 

E-mail:info@moldacrossamerica.org 

Farhad Memarzadeh, Ph.D. 

Director

National Institutes of Health 

Division of Policy & Program Assessment 

Building 13, Room 201 

Bethesda, MD 

Phone: 301-435-8746 

E-mail:memarzaf@ors.od.nih.gov 

Mark J. Mendell, Ph.D. 

Epidemiologist 

Lawrence Berkeley National Laboratory 

Indoor Environment Department 

1 Cyclotron Road, MS 90-3058 

Berkeley, CA 94720 

Phone: 510-486-5762 

Fax: 510-486-6658 

E-mail:mjmendell@lbl.gov 

Suzanne Mikuljan 

Public Health Sanitarian

Nassau County Department of Health 

240 Old Country Road 

Mineola, NY 11501 

Phone: 516-571-3232 

Fax: 516-571-3828 

E-mail:eessjbo@health.co.nassau.ny.us 

Victor Miller, R.Ph. 

Information Specialist 

U.S. Environmental Protection Agency 

Health Effects Division 

9300 Brookville Road 

Silver Spring, MD 20910 

Phone: 301-346-6501 

Fax: 703-305-5147 

E-mail:cri@ix.netcom.com

M. Deborah Millette, M.P.H. 

Assistant Director for Program Development 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

Division of Emergency and Environmental 

Health Services 

4770 Buford Highway, NE, Mail Stop F-30 

Atlanta, GA 30341-3717 

Phone: 770-488-7177 

Fax: 770-488-4820 

E-mail:DMillette@cdc.gov 

Appendix B Page 21
Wesley E. Mills, R.E.H.S. 

Environmental Health Specialist 

United States Congress 

Office of Attending Physician 

B-344 Rayburn HOB 

Washington, DC 20015 

Phone: 202-225-7993 

Fax: 202-226-8718 

E-mail:wmills@aoc.gov 

Clifford S. Mitchell, M.S., M.D., M.P.H. 

Associate Professor Environmental Health 

Sciences 

Johns Hopkins University 

Division of Occupational & Environmental 

Health 

School of Hygiene & Public Health 

Room 7041 

615 North Wolfe Street 

Baltimore, MD 21205 

Phone: 410-955-4076 

Fax: 410-955-1811 

E-mail:cmitchel@jhsph.edu 

Daniel L. Moberly 

IAQ Resident Practitioner 

Association of School Business Officials 

P.O. Box 1418 

Ocean Shores, WA 98569 

Phone: 360-289-8040 

E-mail:dmoberly2003@yahoo.com

Ronald L. Moolenaar, M.D., M.P.H. 

Medical Epidemiologist 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

1600 Clifton Road, NE, MS E-17 

Atlanta, GA 30333 

Phone: 404-498-1017 

E-mail:rlm8@cdc.gov 

Rebecca L. Morley, M.P.P. 

Executive Director 

National Center for Healthy Housing 

10227 Woncopin Circle, Suite 100 

Columbia, MD 21045 

Phone: 410-772-2774 

E-mail:rmorley@centerforhealthyhousing.org 

Cole Murphy, P.E. 

Senior Mechanical Engineer 

National Institutes of Health 

Office of Research Facilities 

Division of Capital Project Management 

McKissack & McKissack 

Building 10, Room B1C27A 

Bethesda, MD 20892-1057 

Phone: 301-402-5141 

E-mail:cole_murphy@nih.gov 

CAPT Ernestine W. Murray, R.N., 

B.S.N., M.A.S. 

Senior Health Policy Analyst 

Agency for Healthcare Research and Quality 

Center for Outcomes and Evidence 

540 Gaither Road 

Rockville, MD 20850-6649 

Phone: 301-427-1630 

E-mail:emurray@ahrq.gov 

Ian Nazarenko, R.I.A.Q.M., R.M.I. 

Environmental Consultant 

Environmental Education Foundation 

EMCOR Facilities Services 

320 23rd Street South, Suite 100 

Arlington, VA 22202 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Luke Nicholson, P.E. 

Adjunct Professor 

University of Florida 

M.E. Rinker School of Building Construction 

304 Rinker Hall, P.O. Box 115703 

Gainesville, FL 32611-5703 

Phone: 828-230-6664 

E-mail:luken@ufl.edu 

Appendix B Page 22
Shirley M. Niemeyer, Ph.D. 

Extension Specialist 

Cooperative Extension-USDA 

University, Department UNL 

Room 205, HE Building, East Campus, UNL 

Lincoln, NE 68583-0804 

Phone: 402-472-6319 

Fax: 402-472-0640 

E-mail:sniemeyer2@unl.edu 

Janice E. Nolen, M.S. 

Director, National Policy

American Lung Association 

1150 18th Street, NW, Suite 900 

Washington, DC 20036 

Phone: 202-785-3355 

Fax: 202-452-1805 

E-mail:jnolen@lungusadc.org 

John B. Ochwat 

Public Health Sanitarian II 

Nassau County Department of Health 

240 Old Country Road 

Mineola, NY 11501 

Phone: 516-571-3232 

Fax: 516-571-3828 

E-mail:eessjbo@health.co.nassau.ny.us 

Elena Page, M.D., M.P.H. 

Medical Officer 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

4676 Columbia Parkway, Mailstop R-10 

Cincinnati, OH 45226 

Phone: 513-458-7144 

E-mail:epage@cdc.gov 

Ju-Hyeong Park, Sc.D., C.I.H. 

Senior Service Fellow 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

Division of Respiratory Disease Studies 

1095 Willowdale Road 

Morgantown, WV 26505 

Phone: 304-285-5967 

Fax: 304-285-5820 

E-mail:gzp8@cdc.gov 

Paul Parrish, M.D. 

Occupational Medicine Consultant 

U.S. Air Force Institute for Operational 

Health 

Health and Safety Division 

AFIOH/RSH 

2513 Kennedy Circle 

Brooks City-Base, TX 78235-5116 

Phone: 210-536-6115 

E-mail:Paul.Parrish@brooks.af.mil 

Sharon L. Pate, M.S., C.H.M.M. 

Industrial Hygienist 

Blanchfield Army Community Hospital 

PM, IHS 

6903 Desert Storm Avenue 

Fort Campbell, KY 42223 

Phone: 270-798-8695 

E-mail:sharon.pate@se.amedd.army.mil 

Priti R. Patel, M.D., M.P.H. 

Maryland Department of Health and Mental 

Hygiene 

201 W. Preston Street, Room 317 

Baltimore, MD 21201 

Phone: 410-767-5597 

Fax: 410-333-5233 

E-mail:ppatel@cdc.gov 

Appendix B Page 23
Henry F. Pauley, C.I.H. 

Senior Officer Industrial Hygiene 

Amtrak 

Environmental Health & Safety 

60 Massachusetts Avenue, NE 

Washington, DC 20002 

Phone: 202-906-3271 

Fax: 202-906-3721 

E-mail:pauleyh@amtrak.com

Terri A. Pearce, Ph.D. 

Industrial Hygienist 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

Division of Respiratory Disease Studies 

Field Studies Branch 

1095 Willowdale Road, MS 2800 

Morgantown, WV 26505 

Phone: 304-285-6211 

Fax: 304-285-5820 

E-mail:TPearce@cdc.gov 

Nicholas Peneff, Dr.P.H., C.I.H. 

Public Health & Safety, Inc. 

112 Lawn Place 

Rockford, IL 61104 

Phone: 815-961-9239 

Fax: 815-961-9242 

E-mail:phsinc3@prodigy.net 

CAPT Edward A. Pfister, R.E.H.S. 

Environmental Compliance Officer 

National Institutes of Health 

Office of Research Facilities Development 

and Operations 

Division of Environmental Protection 

Building 13, Room 2W64, MSC 5746 

9000 Rockville Pike 

Bethesda, MD 20892-5746 

Phone: 301-496-7775 

Fax: 301-480-8056 

E-mail:pfistere@mail.nih.gov 

Melanie S. Pickett, M.P.H. 

CDC/ATPM Research Fellow 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

Division of Health and Nutrition Examination Surveys 

3311 Toledo Road, Room 4216 

Hyattsville, MD 20782 

Phone: 301-458-4809 

E-mail:mpickett@cdc.gov 

Thomas Platts-Mills, M.D., M.P.H. 

University of Virginia Health System

P.O. Box 801355, Room 5086, MR-4 

Charlottesville, VA 22908 

Phone: 434-924-2209 

E-mail:tap2z@virginia.edu 

Lawrence A. Plumlee, M.D. 

Editor 

American Academy of Environmental 

Medicine 

The Environmental Physician 

5717 Beech Avenue 

Bethesda, MD 20817-2563 

Phone: 301-897-9614 

E-mail:laplumlee@pol.net 

Doug Podolsky 

Senior Editor 

Consumer Reports 

1666 Connecticut Ave., NW, Suite 310 

Washington, DC 20009 

Phone: 202-462-6262 

E-mail:dpodolsky@consumer.org 

Joseph T. Ponessa, Ph.D. 

Professor, Indoor Environments & Health 

Rutgers Cooperative Extension 

Department of Human Ecology 

71 Lipman Drive 

New Brunswick, NJ 08901 

Phone: 732-932-9349 

Fax: 732-932-3126 

E-mail:ponessa@aesop.rutgers.edu 

Appendix B Page 24
Marc Pressman, C.M.R., C.E.M., C.M.A., 

C.T.S. 

Certified Environmental Inspector

The Original Basement Rx Waterproofing 

Company -- Mold Remediation 

2951 Philmont Avenue 

Huntingdon Valley, PA 19006 

Phone: 215-913-4400 

Bradley E. Provancha, S.E.S., C.H.E., 

C.P.M. 

Deputy Director 

U.S. Department of Defense 

Washington Headquarters Services 

Defense Facilities Directorate, Room 4A111 

The Pentagon

Washington, DC 20301-1155 

Phone: 703-697-7241 

Fax: 703-695-9330 

E-mail:bradley.provancha@whs.mil 

Michael A. Purviance 

Safety and Occupational Health Manager 

U.S. Office of Personnel Management 

Safety and Facilities Services 

113 Oaklawn Road 

Stafford, VA 22554 

E-mail:mpurvian@opm.gov 

Anita Pustelnik, M.H.S., C.I.H. 

Akva, Inc. 

2506 Poplar Drive 

Baltimore, MD 21207 

Phone: 410-944-3309 

Fax: 410-944-1907 

E-mail:anita@akva-inc.com

John M. Putnam, C.T.A.B., C.I.E., 

C.M.R. 

CEO / CTO 

EDDI 

Environmental Technology & Remediation 

168 Magnolia Road 

Sterling, VA 20164 

Phone: 703-450-9460, 703-819-9460 

Fax: 703-406-8807 

E-mail:edyn@earthlink.net 

Wade A. Raines, P.E. 

Team Leader 

U.S. Postal Service 

Engineering, Maintenance Policies 

8403 Lee Highway 

Merrifield, VA 22082-8101 

Phone: 703-280-7896 

E-mail:wade.a.raines@usps.gov 

Carol Rao, Sc.D. 

Health Scientist 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

200 Independence Avenue, MS P-12 

Washington, DC 20201 

Phone: 202-401-0879 

E-mail:cnr3@cdc.gov 

CAPT Edward H. Rau, M.S., R.S., 

C.H.S.P. 

Environmental Health Officer 

National Institutes of Health 

Office of Research Facilities Development 

and Operations 

Division of Environmental Protection 

13 South Drive, Room 2W64, MSC 5746 

Bethesda, MD 20892-5746 

Phone: 301-496-7775 

Fax: 301-480-8056 

E-mail:raue@mail.nih.gov 

CAPT Stephen C. Redd, M.D. 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

Division of Environmental Hazards 

and Health Effects 

1600 Clifton Road 

MS-E17 

Atlanta, GA 30333 

E-mail:sredd@cdc.gov 

Appendix B Page 25
Thomas A. Reed 

Maintenance Engineering Analyst 

U.S. Postal Service 

8403 Lee Highway 

Merryfield, VA 22082 

Phone: 703-280-7387 

Fax: 703-280-8404 

E-mail:thomas.a.reed@usps.gov 

Audrey S. Regan, M.P.P. 

Program Administrator 

Maryland Department of Health and Mental 

Hygiene 

Center for Maternal and Child Health 

201 W. Preston Street, Room 317 

Baltimore, MD 21201 

Phone: 410-767-3431 

Fax: 410-333-5233 

E-mail:aregan@dhmh.state.md.us 

Rick Regan, R.I.A.Q.M. 

Environmental Education Foundation 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Rip Rice, Ph.D., R.I.A.Q.M. 

Executive VP of Environmental Compliance 

Environmental Education Foundation 

SCO Medallion Healthy Homes 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 301-774-9133 

E-mail:info@enviro-ed.org 

Dena Richardson 

Mechanical Engineer 

U.S. Department of State 

OBO/PE/DE/MEB SA-6 

Washington, DC 20522-0611 

Phone: 703-516-1622 

E-mail:richardsond@state.gov 

Denise C. Richardson, C.I.H. 

Industrial Hygienist 

U.S. Postal Service Headquarters 

Safety Performance Management 

475 L’Enfant Plaza, SW 

Washington, DC 20260 

Phone: 202-268-3686 

Fax: 202-268-2206 

E-mail:denise.c.richardson@usps.gov 

Michael J. Richen, C.I.H. 

Indoor Air Quality Coordinator 

Boulder County Public Health 

Environmental Health Division 

3450 Broadway 

Boulder, CO 80304 

Phone: 303-441-1566 

Fax: 303-441-1468 

E-mail:mrichen@co.boulder.co.us; 

m.richen@comcast.net 

James Rifenburg 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

Division of Environmental Hazards 

and Health Effects 

1600 Clifton Road, MS E-17 

Atlanta, GA 30333 

Phone: 404-498-1021 

E-mail:jar4@cdc.gov 

Lloyd C. Roberts 

Safety and Occupational Health Manager 

U.S. Department of Defense 

Defense Contract Management Agency 

Human Resources 

6350 Walker Lane, Suite 300 

Alexandria, VA 22310-1504 

Phone: 703-428-1333 

Fax: 703-428-1504 

E-mail:lloyd.roberts@dcma.mil

Appendix B Page 26
CAPT Sven E. Rodenbeck, Sc.D., P.E., 

BCEE 

Coordinator, Surgeon General’s Workshop 

on Healthy Indoor Environment 

Agency for Toxic Substances and Disease 

Registry 

Division of Health Assessment and Consultation 

Mailstop E-32 

1600 Clifton Road, NE 

Atlanta, GA 30333 

Phone: 404-498-0439 

E-mail:srodenbeck@cdc.gov 

Ian Rosenblum 

Industrial Hygienist 

U.S. Department of the Interior 

National Business Center 

1849 C Street, NW, Room 1222-MIB 

Washington, DC 20240-0001 

Phone: 202-208-5795 

Fax: 202-208-3777 

E-mail:Ian_M_Rosenblum@nbc.gov 

Betsy F. Rosenfeld, J.D. 

Deputy Regional Health Administrator - 

Region I (New England) 

U.S. Department of Health and Human 

Services 

Office of the Secretary 

Office of Public Health and Science 

JFK Federal Building, Suite 2100 

Boston, MA 02203 

Phone: 617-565-1505 

Fax: 617-565-1491 

E-mail:brosenfeld@osophs.dhhs.gov 

Don T. Ryan, M.U.R.P.

Executive Director 

Alliance for Healthy Homes 

227 Massachusetts Avenue, NE, Suite 200 

Washington, DC 20002 

Phone: 202-543-1147 

Fax: 202-543-4466 

E-mail:dryan@afhh.org 

DeAnn Ryberg, M.P.H. 

Epidemiologist 

Centers for Disease Control and Prevention 

National Center for Environmental Health 

Division of Environmental Hazards 

and Health Effects 

Air Pollution and Respiratory Health Branch 

1600 Clifton Road, NE, MS E-17 

Atlanta, GA 30333 

Phone: 404-498-2144 

Fax: 404-498-1088 

E-mail:ayx3@cdc.gov 

LCDR Nancy M. Sahakian, M.D., M.P.H. 

Medical Officer 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

Division of Respiratory Disease Studies 

1095 Willowdale Road, MS-2800 

Morgantown, WV 26505 

Phone: 304-285-6383 

E-mail:nks6@cdc.gov 

Robert Salas, R.A. 

Project Executive 

Hammes Company 

4900 Seminary Road, Suite 670 

Alexandria, VA 22311 

Phone: 703-998-2400 

Fax: 703-998-2040 

E-mail:bsalas@hammesco.com

Lori E. Saltzman, M.S. 

Director

U.S. Consumer Product Safety Commission 

Division of Health Sciences 

4330 East West Highway 

Bethesda, MD 

Phone: 301-504-7238 

E-mail:lsaltzman@cpsc.gov 

Appendix B Page 27
Jonathan M. Samet, M.D. 

Professor and Chairman 

Johns Hopkins University 

Department of Epidemiology 

Bloomberg School of Public Health 

615 North Wolfe Street, Suite W6041 

Baltimore, MD 21205 

Phone: 410-955-3286 

Fax: 410-614-0467 

E-mail:jsamet@jhsph.edu 

Ken G. Sandler 

Co-Chair 

U.S. Environmental Protection Agency 

Green Building Work Group 

Mail Code 6609J 

1200 Pennsylvania Avenue, NW

Washington, DC 20460 

Phone: 202-343-6907 

Fax: 202-343-2394 

E-mail:sandler.ken@epa.gov 

Steve P. Sauer 

Editor 

Indoor Environment Connections 

12339 Carroll Avenue 

Rockville, MD 20852 

Phone: 301-230-9606 

Fax: 301-230-9631 

E-mail:iecnews@aol.com

Paula Schenck, M.P.H. 

Assistant Director, Center for Indoor Environments and Health 

University of Connecticut Health Center 

Division of Occupational and Environmental 

Medicine 

263 Farmington Avenue 

Farmington, CT 06013 

Phone: 860-679-2368 

Fax: 860-679-1349 

E-mail:schenck@nso2.uchc.edu

Hans W. Schleibinger, Ph.D. 

Senior Research Officer 

Indoor Environment Research Program 

1200 Montreal Road, M-24 

Ottawa, ON K1A 0R6 

Canada 

Phone: 613-993-9702 

Fax: 613-954-3733 

E-mail:Hans.Schleibinger@nrc-cnrc.gc.ca 

Sherryl A. Schultz, Ph.D., C.I.H., C.S.P. 

Industrial Hygienist 

Searchlight Safety LLC 

1349 Gordon Lane 

McLean, VA 22102 

Phone: 703-472-5384 

E-mail:sschultz8@cox.net 

Charles E. Seaman, B.S.N., M.P.H., 

R.I.A.Q.M. 

Environmental Education Foundation 

Charles E. Seaman Home Inspection Service 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Cheryl Ann Seaman, B.S.N., M.P.H., 

R.I.A.Q.M. 

Environmental Education Foundation 

Charles E. Seaman Home Inspection Service 

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Joel Segal 

Office of Congressman John Conyers, Jr. 

2426 Rayburn Building 

Washington, DC 20515 

Phone: 202-225-5126 

Appendix B Page 28
Katherine J. Seikel, M.B.A. 

Communications Coordinator 

U.S. Environmental Protection Agency 

Office of Pesticide Programs

1200 Pennsylvania Avenue, NW

Washington, DC 20460 

Phone: 703-308-8272 

Fax: 703-305-5558 

E-mail:seikel.kathy@epa.gov 

Alayne Senior 

Risk Coordinator 

Vermont Department of Health 

Division of Health Protection 

108 Cherry Street 

P.O. Box 70 

Burlington, VT 05402 

Phone: 802-865-7737 

Fax: 802-865-7745 

E-mail:asenior@vdh.state.vt.us

Jennifer Y. Sheen 

Project Assistant 

Association of Clinicians for the Underserved 

Pediatric Asthma

1420 Spring Hill Road, Suite 600 

Tysons Corner, VA 22102 

Phone: 703-448-8528 

Fax: 703-749-5348 

E-mail:jsheen@clinicians.org 

William A. Shortencarrier 

Industrial Hygienist 

Letterkenny Army Depot 

Department of the Army

Letterkenny Army Depot #90, (MCXR-LKIH) 

Chambersburg, PA 17201 

Phone: 717-267-8822 

E-mail:william.a.shortencarrier@us.army.mil 

Karla K. Simon, M.S.P.H. 

Industrial Hygienist 

Center for Health Promotion and Preventive 

Medicine 

Department of the Army

5158 Black Hawk Road 

Building 5170, IHFS 

Aberdeen Proving Ground, MD 21010 

Phone: 410-436-5463 

E-mail:karla.simon@amedd.army.mil 

Daniel J. Smigal 

Industrial Hygienist 

National Institutes of Health 

Office of Research Services 

Division of Occupational Health and Safety 

13 South Drive, Building 13, Room 3K04 

Bethesda, MD 20892 

Phone: 301-496-3353 

Fax: 301-402-0313 

E-mail:smigald@mail.nih.gov 

Alisa M. Smith, Ph.D. 

U.S. Environmental Protection Agency 

Indoor Environments Division 

1200 Pennsylvania Avenue, NW, 6609J 

Washington, DC 20460 

Phone: 202-343-9372 

E-mail:smith.alisa@epa.gov 

Jack Spengler, Sc.D. 

Professor of Environmental Health & 

Human Habitat 

Harvard University 

Department of Environmental Health 

Landmark Center 

4th Floor West, Room 406A 

401 Park Drive 

Boston, MA 02215 

Phone: 617-384-8810 

Fax: 617-384-8819 

E-mail:spengler@hsph.harvard.edu 

Appendix B Page 29
Lynda L. Stanley 

Director

National Research Council 

Federal Facilities Council 

500 Fifth Street, NW, Room 944 

Washington, DC 20001 

Phone: 202-334-3374 

Fax: 202-334-3370 

E-mail:lstanley@nas.edu 

John G. Staudt, P.E. 

Environmental Engineer 

U.S. Department of Veterans Affairs 

Veterans Health Administration 

810 Vermont Avenue 

Washington, DC 20420 

Phone: 202-273-5863 

Fax: 202-273-7071 

E-mail:jack.staudt@hq.med.va.gov 

Laurie R. Stillman, M.M.H.S. 

Executive Director 

Asthma Regional Council of New England 

The Medical Foundation 

622 Washington Street, 2nd floor 

Dorchester, MA 02124 

Phone: 617 451-0049x 504 

Fax: 617-282-3950 

E-mail:lstillman@tmfnet.org 

William S. Stokes, D.V.M., D.A.C.L.A.M. 

Director, NTP Interagency Center for the 

Evaluation of Alternative Toxicological 

Methods (NICEATM) 

National Institutes of Health 

National Institute of Environmental Health 

Sciences 

Environmental Toxicology Program 

P.O. Box 12233, EC-17 

Research Triangle Park, NC 27709 

Phone: 919-541-7997 

Fax: 919-541-0947 

E-mail:stokes@niehs.nih.gov 

Eileen Storey, M.D., M.P.H. 

University of Connecticut Health Center 

263 Farmington Avenue 

Farmington, CT 06030-6210 

Phone: 617-384-8823 

E-mail:storey@nso.uchc.edu 

LT Mark T. Strauss, M.P.H., R.E.H.S. 

Institutional Environmental Health Research 

Indian Health Service 

Department of Environmental Health 

Services 

7227 Minter Place 

Takoma Park, MD 20912 

Phone: 301-402-9364 

E-mail:ms873u@nih.gov 

Greg Tate 

Occupational Safety and Health Specialist 

National Institutes of Health 

Office of Research Services 

Division of Occupational Health and Safety 

13 South Drive, Building 13, Room 3k04 

Bethesda, MD 20892 

Phone: 301-402-8046 

E-mail:tateg@mail.nih.gov 

Joseph A. Terra, C.I.H. 

Senior Program Manager 

Federal Occupational Health 

4550 Montgomery Avenue, Suite 950 

Bethesda, MD 20814 

Phone: 301-594-4883 

Fax: 301-594-4991 

E-mail:jterra@psc.gov 

Kenneth D. Thayer 

Building Operations Specialist 

U.S. Geological Survey 

Facilities Maintenance Branch 

12201 Sunrise Valley Drive 

Reston, VA 20192 

Phone: 703-648-7517 

Fax: 703-648-7527 

E-mail:kthayer@usgs.gov 

Appendix B Page 30
Linda T. Thomas-Houston 

Regional Asthma Coordinator 

U.S. Environmental Protection Agency - 

Region 4 

Indoor Environment 

61 Forsyth Street 

Atlanta, GA 30303 

Phone: 404-562-9152 

Fax: 404-562-9059 

E-mail:thomas.linda@epa.gov 

COL Ronald Torgerson, U.S.A.F. (Ret.), 

P.E., C.H.S.-III 

VP, Federal Solutions 

Versar, Inc 

11990 Grant St., Ste. 500 

Northglenn, CO 80233 

Phone: 303-452-5700 

E-mail:torgeron@versar.com

Alberto Treves, R.E.F.P. 

Assistant Director, International Cooperation Program 

Council of Educational Facility Planners 

International 

4977 Battery Lane # 808 

Bethesda, MD 20814 

Phone: 301-654-3976 

Fax: 202-478-2183 

E-mail:treves@ed-space.com

Susan M. Trinter 

Director

Trinternational 

2020 Pennsylvania Avenue, NW, #375 

Washington, DC 20006 

Phone: 202-296-1034 

E-mail:strinter@trinternatl.com

Feng C. Tsai, Ph.D., M.S. 

Research Scientist 

California Department of Health Services 

Indoor Air Quality Program

850 Marina Bay Parkway, MS G365 

Richmond, CA 94804 

Phone: 510-620-2861 

Fax: 510-620-2825 

E-mail:ftsai@dhs.ca.gov 

Alyce L. Tucker 

Research Assistant 

Emory University 

Behavioral Sciences and Health Education 

1525 Clifton Road 

Atlanta, GA 30322 

Phone: 267-971-5128 

E-mail:atucke2@sph.emory.edu 

Margaret R. Umfress 

U.S. Air Force Institute for Operational 

Health 

Health and Safety Division 

RSHI 

2513 Kennedy Circle 

Brooks City-Base, TX 78235-5116 

Phone: 210-536-3386 

E-mail:margaret.umfress@brooks.af.mil 

Ravi Valluripalli 

American College of Preventive Medicine 

1307 New York Avenue, NW, Suite 200 

Washington, DC 20005 

Phone: 202-207-0701 

E-mail:rv@acpm.org 

Emilia W. Vandenbroek 

Miles & Stockbridge 

Litigation Department 

10 Light Street 

Baltimore, MD 21202 

Phone: 410-385-3467 

Fax: 410-385-3700 

E-mail:evandenbroek@milesstockbridge.com

Appendix B Page 31
Ronald Varsaci, M.P.H. 

Environmental Health Officer 

U.S. Food and Drug Administration 

Center for Devices and Radiologic Health 

9200 Corporate Boulevard, HFZ-020 

Rockville, MD 20850 

Phone: 301-827-0346 

Fax: 301-827-4947 

E-mail:ronald.varsaci1@fda.hhs.gov 

Jed Waldman, Ph.D. 

Chief, California Indoor Air Quality Program

California Department of Health Services 

Environmental Health Laboratory 

850 Marina Bay Parkway, (EHL) 

Richmond, CA 94804 

Phone: 510-620-2864 

Fax: 916-440-5855 

E-mail:jwaldman@dhs.ca.gov 

Kenneth M. Wallingford, C.I.H. 

IEQ Research Coordinator 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety 

and Health 

4676 Columbia Parkway, (R-11) 

Cincinnati, OH 45226 

Phone: 513-841-4327 

Fax: 513-458-7147 

E-mail:KWallingford@cdc.gov 

Greg Weatherman 

aerobioLogical Solutions Inc. 

1300 Army Navy Drive, #1020 

Arlington, VA 22202-2020 

Phone: 703-920-6653 

Fax: 703-229-1234 

E-mail:gw@aerobiological.com 

Richard P. Weiblinger, M.P.H. 

Food and Drug Administration 

9200 Corporate Boulevard 

Rockville, MD 20850 

Phone: 310-594-1307 x160 

E-mail:richard.weiblinger@fda.hhs.gov 

Steve A. Weil 

Board Chairman 

Coalition for Environmentally Safe Communities 

P.O. Box 535 

Olney, MD 20830 

Phone: 301-924-5490 

Fax: 301-924-0265 

E-mail:weilcm2@comcast.net 

Martin Weiland, P.E. 

Manager of Government Outreach 

American Society of Heating, Refrigerating 

and Air-Conditioning Engineers 

Washington Office 

1830 L Street, NW, Suite 906 

Washington, DC 20036 

Phone: 202-833-1830 

Fax: 202-833-0118 

E-mail:mweiland@ashrae.org 

Charles J. Weiler, B.Arch. 

Architect 

120 Warwick Road 

Haddonfield, NJ 08033-3707 

Phone: 856-428-0605 

Fax: 856-428-0605 

E-mail:cthew@aol.com

Steven Welty, C.I.E., C.A.F.S. 

President 

Germ Safe Air 

1251 Weatherstone Court 

Reston, VA 20194 

Phone: 703-927-7532 

Fax: 703-904-8112 

E-mail:GermSafeAir@aol.com

Appendix B Page 32
Eric D. Werling, M.S. 

Environmental Engineer 

U.S. Environmental Protection Agency 

Office of Air and Radiation 

Indoor Environments Division 

1200 Pennsylvania Avenue, NW

Mail code: 6609J 

Washington, DC 20460 

Phone: 202-343-9495 

Fax: 202-343-2394 

E-mail:werling.eric@epa.gov 

Charles J. Weschler, Ph.D. 

Professor 

UMDNJ-Robert Wood Johnson Medical 

School 

Environmental and Community Medicine 

161 Richdale Road 

Colts Neck, NJ 07722 

Phone: 732-530-0961 

Fax: 732-530-1453 

E-mail:weschlch@umdnj.edu 

Lois Wessel, C.F.N.P. 

Asthma Program Manager 

Association of Clinicians for the Underserved 

7005 Westmoreland Avenue 

Takoma Park, MD 

Phone: 301-213-6733 

E-mail:lwessel@igc.org 

Sherri P. White, M.P.A. 

Program Analyst 

U.S. Environmental Protection Agency 

Office of Radiation and Indoor Air 

1200 Pennsylvania Avenue, NW, MS 6609J 

Washington, DC 20460 

Phone: 202-343-9655 

Fax: 202-343-2393 

E-mail:white.sherri@epa.gov 

Thomas G. Wilcox, M.D., M.S. 

Senior Scientist 

SOMA Group, Inc. 

839 Quince Orchard Boulevard, Suite E 

Gaithersburg, MD 20878 

Phone: 301-519-6880 

E-mail:Twilcox@somaonline.com

Vernon Wilkes, C.I.H. 

Industrial Hygienist 

U.S. Department of Veterans Affairs 

Veterans Health Administration 

810 Vermont Avenue, VHA - 10NB 

Washington, DC 20420 

Phone: 202-273-5870 

E-mail:wilkesv@va.gov 

RADM Robert C. Williams, P.E., BCEE

Chief Engineer, USPHS 

Office of the Surgeon General 

U.S. Public Health Service 

5600 Fishers Lane 

Parklawn Building, Room 18-55 

Rockville, MD 20857 

Phone: 301-443-4000 

E-mail:rwilliams@osophs.dhhs.gov 

Samuel H. Wilson, M.D. 

Deputy Director 

National Institutes of Health 

National Institute of Environmental Health 

Sciences 

111 T.W. Alexander Drive, P.O. Box 12233 

Research Triangle Park, NC 27709-2233 

Phone: 919-541-3267 

Fax: 919-541-3592 

E-mail:wilson5@niehs.nih.gov 

James Woods, Ph.D., P.E. 

Executive Director 

The Building Diagnostics Research Institute, 

Inc. 

5630 Wisconsin Avenue 

Suite 706 

Chevy Chase, MD 20815-4455 

E-mail:jewoods3@aol.com

Appendix B Page 33
Robert Woodward, R.I.A.Q.M. 

Environmental Education Foundation 

AMT Mold Testing & Consulting

724 E. Iris Drive 

Gilbert, AZ 85296 

Phone: 480-659-9356 

E-mail:info@enviro-ed.org 

Sky Woodward 

Attorney 

Miles & Stockbridge P.C. 

Litigation Department 

10 Light Street 

Baltimore, MD 21202 

Phone: 410-385-3606 

E-mail:swoodward@milesstockbridge.com

Felicia Wu, Ph.D. 

Assistant Professor 

University of Pittsburgh

Graduate School of Public Health 

1337 Shady Avenue 

Pittsburgh, PA 15217 

Phone: 412-422-0263 

E-mail:fwu@eoh.pitt.edu 

Appendix B Page 34
Appendix C 

Acknowledgments 

Surgeon General’s Workshop on Healthy Indoor Environment 

The Surgeon General expresses his sincere appreciation to all who contributed time, experience, 

and knowledge to support the development of the Surgeon General’s Workshop on Healthy 

Indoor Environment and this report. The Surgeon General would especially like to acknowledge 

the following: 

THE ENGINEER PROFESSIONAL ADVISORY COMMITTEE

The Engineer Professional Advisory Committee (EPAC) provides advice and consultation to the 

U.S. Public Health Service (PHS) Chief Engineer, who in turn reports to the Surgeon General on 

matters relating to professional engineering issues. As part of its efforts to advance public health 

engineering and improve the health status of Americans, the various members of the Building

and Design Subcommittee, EPAC, have worked diligently for several years to foster the development of this workshop. Their dedication to this initiative truly reflects the PHS Engineering 

Category motto of Machinatores Vitae (Engineering for Life). 

THE PUBLIC

Approximately 300 people attended the Surgeon General’s Workshop on Healthy Indoor Environment. The participants provided valuable insight concerning the indoor environment, which 

help guide the development of this report. 

GOVERNMENT AGENCIES

The Surgeon General’s Workshop on Healthy Indoor Environment was sponsored by the following government agencies in the Department of Health and Human Services: 

• Agency for Toxic Substances and Disease Registry 

• Centers for Disease Control and Prevention 

• National Institutes of Health 

In addition, the following federal agency and federal council sponsored the workshop: 

• U.S. Environmental Protection Agency 

• National Science and Technology Council 

Appendix C Page 1
PLANNING AND COORDINATION GROUP

The Surgeon General would especially like to recognize the following individuals for their

assistance in organizing the workshop and preparing this report. 

Workshop Coordinator 

CAPT Sven E. Rodenbeck, Sc.D., P.E., BCEE 

Group Members 

CAPT (ret) Bill Brodt 

Clive Brown, M.B.B.S., M.Sc., M.P.H. 

CAPT Susan Conrath, Ph.D., M.P.H. 

Jean Cox-Ganser, Ph.D. 

Allen Dearry, Ph.D. 

CDR Margaret M. Kitt, M.D., M.P.H. 

Brian Kong, P.E. 

CAPT Allan Noonan, M.D., M.P.H. 

CAPT Stephen Redd, M.D. 

Jim Rifenburg 

RADM Robert C. Williams, P.E., BCEE 

Appendix C Page 2