Source: http://wiki.mnceh.org/index.php/Respiratory_Health_and_Asthma:_Mold_and_VOCs
Timestamp: 2017-07-28 14:52:15
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Matched Legal Cases: ['§ 22', '§ 22', '§ 22', '§ 25', '§ 254', '§ 254', '§ 321', '§ 321', '§ 8', '§ 15', '§ 39619', '§ 16', '§ 16', '§ 1742', '§ 15', '§ 17070']

Air contaminants in the indoor environment, can result in human health effects, particularly in children. School-age children typically spend 80% to 90% of their time indoors (mostly at home and at school), and the concentration of pollutants indoors is typically higher than outdoors, sometimes by as much as 10 or even 100 times (Kats 2006). Indoor air quality studies in school buildings have shown that the indoor air contaminants most commonly associated with asthma in children include formaldehyde (a type of VOC), other VOCs, and microbiological contaminants (including fungi, bacteria, and allergens) (Daisey et al. 2003). This section provides background information and policy analysis for common indoor air pollutants that have been linked to asthma symptoms in children, including mold, volatile organic compounds (VOCs), and cleaning products. The policy areas that will be discussed in this section include Green Building requirements, mold (remediation, reporting, and programs), and the use of less-toxic materials or cleaning products. Michigan policies will be analyzed for effectiveness in protecting children’s health, particularly through exposure prevention mechanisms. Best practices from other states will be noted, and recommendations to improve children’s protection from these exposures in Michigan will be provided. Contents
In a review of available data, the Institutes of Medicine evaluated the association between mold, damp indoor environments and asthma, and classified them by the strength of the evidence. The report concluded there was good evidence linking damp indoor environments and mold to asthma symptoms in people with asthma (IOM, 2000). VOCs
While some chemical disinfectants and sanitizers are essential to controlling germs and preventing communicable diseases in schools, childcare centers, and homes, some cleaning products can also be potentially hazardous, particularly in concentrated forms (AAP 2003). Cleaning products can contain many ingredients that are potentially hazardous, including monoethanolamine surfactants and ammonium quaternary compounds used as disinfectants (Quirce and Barranco 2010; Savonius et al. 1994; Nielsen et al. 2007). Traditional cleaning products can also contain carcinogens, asthmagens and substances associated with reproductive organ damage, birth defects, kidney damage, neurological damage and other serious health impacts. Other Indoor Air Pollutants
The major routes of exposure to mold include inhalation and dermal contact (AAP 2003). Children are exposed to mold when they inhale air contaminated with mold spores or when they touch surfaces on which mold is deposited (AAP 2003). Dampness and mold are frequent problems in U.S. school buildings, particularly in older buildings or those with poor ventilation. Many schools throughout the country are in need of major repairs or renovation; approximately 28% of U.S. schools have inadequate ventilation, which could potentially lead to dampness and mold (Sahakian et al. 2008). VOCs
A study of VOCs in elementary and middle schools in Michigan found that some of the most prevalent VOCs in indoor school environments were benzene, ethylbenzene, toluene, xylene, and limonene. Benzene, ethylbenzene, and toluene have been associated with asthma development in children. The sources of VOCs tended to be art and science classrooms, as well as indoor pools; the study concluded that improving ventilation systems, such as introducing dedicated ventilation systems for VOC sources might prevent the spread of VOCs from these special-use areas into the rest of the school facilities. Indoor concentrations usually exceeded outdoor levels. The study also found that ventilation was inadequate in many school rooms (Godwin and Batterman 2007). The primary exposure route for VOCs is via direct inhalation; inhalation accounts for more than 99% of exposure to many VOCs (AAP 2003). The primary source of VOC exposures are from indoor air sources (see other sections of this chapter).
The primary routes of exposure to cleaning products are inhalation and dermal exposure, although accidental ingestion is also a concern for young children. Cleaning products are used in homes, schools, and other indoor buildings, thus there is significant potential for childhood exposure. Cleaning products used in small, unventilated spaces, such as windowless bathrooms, may lead to high levels of cleaning chemicals in indoor air (Gorman 2007). The U.S. market for household cleaning products is quite large, over $14 billion in 2005 alone. It is a rapidly expanding market, driven predominantly by the growth in popularity of disinfectant products (Gorman 2007). Several chemical ingredients found in household and industrial cleaning products have been associated with asthma. These include:
Quaternary ammonium compounds (quats): used as disinfectants, detergents, and fabric-softening agents. Phthalates (phthalate esters): while most commonly used to soften plastic in consumer products, some phthalates are also used as carriers of fragrance in glass cleaners, laundry detergents, deodorizers, and fabric softeners. Phthalates may be often included under the generic ingredient ‘fragrance(s)’ and therefore may not be listed as an ingredient, due to fragrances being considered trade secrets. In addition to exposure from cleaners, humans can come into contact with phthalates used in polyvinyl chloride (PVC) plastics, which can leach out into air, dust, soils, and food, as the phthalates are not chemically bound to the plastic molecules (Jaakkola and Knight 2008). Phthalate exposure has also been associated with reproductive effects, although these effects are out of the scope of this chapter (Jurewicz and Hanke, 2011).
The most common illnesses associated with exposure to mold are allergic rhinitis and asthma. For people who are sensitive to molds, inhaling mold spores can cause an asthma attack (EPA 2009A). In the upper airways, the early allergic response to mold can produce symptoms such as clear rhinorrhea (runny nose), nasal congestion, sneezing, post-nasal drip with sore throat, coughing, and hoarseness (Storey et al. 2004). The late phase allergic reaction can cause nasal obstruction and hyper-responsiveness to allergens. Hyper-responsiveness makes the airway very sensitive to an allergen or other stimulant. Subsequent exposure to the allergen can cause an extreme reaction in a hyper-responsive airway; this lung hyper-responsiveness is very typical of asthmatics (Glaser 2005). Mold can trigger allergic responses in the lower airways of sensitized individuals, resulting in bronchospasms, chest tightness, and shortness of breath. On a molecular level, these hypersensitivity reactions occur after an initial exposure to an allergen, which triggers an immune response that favors the sensitization of mast cells, the major mediators of allergic response (Storey et al. 2004). These cells accumulate in the interstitial space of the respiratory tract. Re-exposure to the allergen, in this case, mold, causes the mast cells to release histamine and other chemicals that cause inflammation (Storey et al. 2004). In a review of available data, the Institutes of Medicine evaluated the association between mold, damp indoor environments and asthma. They classified the strength of the evidence, summarized in Figure 1. The report concluded there was good evidence linking damp indoor environments and mold to asthma symptoms in people with asthma (IOM, 2000). Figure 1 – Summary of Two Key Institute of Medicine Reports regarding Asthma, Indoor Air Quality, Damp Indoor Spaces, and Mold (National Academies Press, 2004)
VOCs may have short- and long-term adverse health effects (EPA 2007). VOCs may induce acute asthma attacks in sensitive individuals, due to nonspecific irritation of the airways. Additionally, exposure to VOCs may result in upper respiratory tract and eye irritation, rhinitis, nasal congestion, rash, pruritus (itch), headache, nausea, and vomiting (AAP 2003). A few studies have linked exposures to VOCs (measured in classroom floor dust) with asthma and other respiratory symptoms in children (Daisey et al. 2003). A 2004 study of children in Perth, Australia found that exposure to VOCs in the home may increase the risk of having childhood asthma. Children with asthma were found to be exposed to significantly higher levels of VOCs in their homes than children without asthma. Most of the individual VOCs measured in households were associated with asthma risk. Among these, benzene, ethylbenzene, and toluene -- chemicals used as industrial solvents but also present in a variety of products, including paints and cleaners -- were associated with the highest increase in odds of a child having asthma. Additionally, the researchers found that the levels of VOCs associated with an increased risk of childhood asthma were below advisory goals set by an Australian health advisory group (Rumchev et al. 2004). There are currently no EPA guidelines for levels of these and other VOCs in the home environment.
Acute exposure to cleaning chemicals can lead to skin, eye, and lung irritation. In 2005, household cleaners were the third largest category of substances associated with calls to poison controls centers, with over 218,000 calls. Over half of these calls involved children under the age of six (Gorman 2007). Generally, exposure to household cleaners has been associated with an increased risk of developing asthma, allergies, and other respiratory symptoms in children and adults (Choi et al. 2010; Zock et al. 2007). Furthermore, a study in the U.K. found an association between frequent use of household cleaning products during pregnancy and persistent wheezing in pre-school aged children, supporting an association between prenatal exposure to cleaners and asthma symptoms in childhood (Sherriff et al. 2005). Several chemical ingredients found in household and industrial cleaning products have been associated with asthma. These include:
Quaternary ammonium compounds (quats): used as disinfectants, detergents, and fabric-softening agents that adults and children may be exposed to via inhalation. As with MEA, exposure to some of these compounds has been associated with occupational asthma in exposed workers, although the underlying mechanism for this association remains unclear (Quirce and Barranco 2010). Recently, a study of French occupational health departments found that occupational exposure to quats was strongly associated with the development of work-related asthma (Paris et al. 2012). Phthalates (phthalate esters): while often used to soften plastic in many consumer products, some phthalates are also used as carriers of fragrance in glass cleaners, laundry detergents, deodorizers, and fabric softeners. Exposure to certain phthalates has been linked to asthma, allergies, and other respiratory symptoms in children (Bornehag and Nanberg 2010). Furthermore, phthalates may not be listed as ingredients in many cosmetic and cleaning products because they are used in fragrances, and are therefore not subject to disclosure. In addition to exposure from cleaners, humans can come into contact with phthalates used in polyvinyl chloride (PVC) plastics, which can leach out into air, dust, soils, and food Jaakkola and Knight 2008). Thus far, the association between phthalate exposure and asthma development has not been extensively studied in humans, however, animal studies demonstrate a potential link between early life and prenatal exposure to phthalates and asthma development. However, the clinical relevance of typical levels of phthalate exposure has yet to be elucidated (Bornehag and Nanberg, 2010). The presence of PVC flooring has been associated with childhood bronchial obstruction in case-control studies. Similar studies have also discovered associations between the presence of d-(2-ethylhexyl) phthalate (DEHP), one of the most commonly used phthalate types, in household dust with childhood asthma (Tsai et al. 2012). Moreover, a study of a cohort of Swedish children found that PVC flooring in the bedrooms of children and parents’ bedroom when the children were 1-3 years old was significantly associated with the incidence of asthma in those children 5 years later (Larsson et al. 2010). These associations demonstrate that more research needs to be conducted into the level and types of phthalate exposures that can lead to asthma exacerbation and asthma development. More research is also needed around the mechanisms by which they may influence asthma development, as there is a possibility that other, confounding factors. Furthermore, there is some indication that frequent exposure to chlorination products, such as chlorinated cleaners (ex. products containing chlorine bleach), may be associated with the development or exacerbation of allergic diseases such as asthma (Bernard, 2007).
The U.S. Green Building Council (USGBC) has created the Leadership in Energy and Environmental Design (LEED) Green Building Rating System™, which is the “nationally accepted benchmark for the design, construction, and operation of high performance green buildings” (USGBC 2007). Improving the quality of indoor environments is an important emphasis in the LEED standards. There are several LEED rating systems for different types of building projects including new office/institutional construction, schools, homes, and commercial interiors. The rating systems have various categories of green design; and within each category, there are specific measures of sustainability that earn points on the rating system. The categories of green design include: sustainable sites, water efficiency, energy and atmosphere, materials and resources, indoor environmental quality, and innovation & design process. Compliance with American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE) ventilation for indoor air quality standards (62.1-2007) is a prerequisite for LEED certification, and increases in ventilation rates beyond the prerequisite standards can account for additional points. The ventilation rate of indoor air is an important determinant of indoor air quality and the health of individuals spending their time indoors. A review of 27 scientific studies on indoor ventilation rates and health found evidence of an association between an increase in ventilation rates and a decreasing frequency of asthma symptoms, allergies, and communicable respiratory infections; however, the strongest association found was in decreases in sick building syndrome (Sundell et al. 2011). In an analysis of multiple studies on indoor air quality and child health, Daisey et al. found that many schools do not have ventilation rates which meet ASHRAE standards (2003). Furthermore, four studies of ventilation rates in Scandinavian homes suggest an association between low ventilation rates and conditions such as asthma and allergic rhinitis in children (Sundell et al. 2011). As such, prioritizing adequate ventilation rates in areas where children spend lots of time, such as schools and day-care centers, should be prioritized as a means of minimizing asthma and other respiratory symptoms in children. One policy method used by many other states which achieves this goal is having provisions requiring or incentivizing LEED certification in new and renovated buildings. These and other policy measures are discussed below.
Other states have passed legislation that encourages or requires the use of a green building rating system, such as LEED (or a comparable system), in new building construction or building improvement projects: Arkansas legislation encourages state funded public buildings to use LEED or Green Globes rating systems; it establishes an “award system” for meeting green standards; and it also creates a Legislative Task Force on Sustainable Building Design and Practices, which is charged with reviewing issues on sustainable design, monitoring and evaluating performance, and education; and which is authorized to ask for a review of sustainable building designs and practices by state agencies (A.C.A. § 22-3-1805, A.C.A. § 22-3-1804, A.C.A. § 22-3-1806).
A New Mexico EO established a "Public Schools Clean Energy Task Force" to issue recommendations about energy efficiency and green building in public schools (Executive Order 2006-001). Pennsylvania requires the Dept of Education to increase payments made for school buildings that receive LEED silver, gold, or platinum certification ($470 per pupil for elementary schools, $620 per pupil for secondary, or a proportionate amount for both) (24 P.S. § 25-2574[c.4]).
Evaluation and Recommendations Michigan should tie state dollars to LEED certification (or comparable standards like the Green Guide for Healthcare) for all newly constructed and renovated primary and secondary schools. Michigan should also strongly consider providing tax credits for construction of new, private green buildings. In addition, Michigan should consider specific legislation that institutes a green building standard for any new schools, using LEED certification (or comparable standards).
No enacted Michigan policy meets our specific criteria to address indoor air quality. Analysis and Policy Highlights from Other States
New Hampshire requires the Department of Health and Human Services to investigate poor indoor air quality complaints, inspect buildings and dwellings for presence of indoor air health hazards, and, in conjunction with the University of New Hampshire, provide education, consultation, and recommendations for abating those hazards (RSA 125:9.X). Wisconsin requires the Health Department to investigate illnesses or diseases thought to have been caused by indoor air quality problems; if it is determined that indoor air quality is the cause of such illnesses, the Department is required to assist local agencies in establishing control measures (Wis. Stat. § 254.22). Wisconsin requires the Department to assist local health departments in adopting regulations to establish indoor air quality standards for public buildings to "protect the occupants from adverse health effects due to exposure to chemical or biological contaminants." The statute also requires the Department to train and support local health departments in conducting indoor air quality testing and investigations (Wis. Stat. § 254.22).
Hawaii established an indoor air quality program in the Department of Health, which must (1) provide information regarding indoor air quality to the managers, owners, and occupants of publicly owned buildings, (2) assist in identifying and correcting problems (it can provide the same to non-public buildings) and (3) coordinate an indoor air quality assessment network comprised of state agencies and managers of publicly owned buildings to identify and correct problems (HRS § 321-412, § 321-413). Some states have set indoor air quality standards in conjunction with green building standards (see Green Building section for more information):
Louisiana (La. R.S. 33:4547.1) Missouri (§ 8.231 R.S.Mo.)
Arizona requires school boards to do an environmental health assessment before approving new school buildings, and not approve the building if the plans do not have acceptable indoor air quality guidelines (A.R.S. § 15-2132). California requires the California Air Resources Board (CARB) to assess indoor air quality in portable school classrooms (Cal Health & Saf Code § 39619.6).
Indiana permits the State Department of Health (DOH) to issue rules regarding instituting indoor air quality in schools’ inspection and evaluation programs. The DOH must inspect a school if it receives a complaint about the quality of air in the school (Burns Ind. Code Ann. § 16-41-37.5-2). In addition, Indiana created a "School Air Panel," to identify and inform schools of best operating practices for indoor air quality in schools and assist the State Department of Health in developing plans to improve air quality conditions found in inspections (see above) (Burns Ind. Code Ann. § 16-41-37.5-3). Maine requires the Department of Administrative and Financial Services to provide "indoor air quality assessment and mitigation oversight services for public schools and state facilities"(5 M.R.S. § 1742-E).
Arizona requires the School Facilities Board to provide school districts with information about improving and maintaining "indoor environmental quality" in school buildings (A.R.S. § 15-2002). California permits "indoor air quality" improvements to be used as a criteria for receiving school funding (Cal Ed Code § 17070.96).
Consider including indoor air quality improvements in criteria for state funding, via grants, loans, or tax credits. Pursue the setting of specific indoor air quality standards for school buildings and consider policies to determine a standard method for investigating indoor air quality complaints in school buildings. Volatile Organic Compounds (VOCs): Indoor Pollution
No Michigan policy met our specific criteria to address the use of less toxic cleaning products. Analysis and Policy Highlights from Other States
Connecticut requires that by July 1, 2011 each local and regional board of education establish a green cleaning program and that no cleaning product be used in a school unless it meets the environmental standard set by a national or international certification program approved by the Department of Administrative Services. These certification programs include “Green Seal” and “Ecologo” certification. This requirement, however, does not apply for disinfectant products. Additionally, copies of the program shall be distributed to staff members and, upon request, parents and guardians of children at the school (P.A. 81). Illinois requires that the Illinois Green Government Coordinating Council (IGGCC) establish guidelines for "environmentally-sensitive cleaning and maintenance products for use in school facilities." Within 90 days of the issuing of the guidelines, all elementary and secondary schools with more than 50 students must establish a green cleaning policy and exclusively purchase products that meet guidelines (with an exception for previously purchased supplies) if "economically feasible." Schools must provide annual written notice if the green cleaning program is deemed not “economically feasible” (105 ISL 140/10). Maine requires the Department of Education (DOE) to promote implementation of green cleaning programs in schools. The Department is required to compile a list of cleaning products that either meet "health-based criteria" by an independent agency or are listed as "environmentally preferred janitorial products" by the Maine Bureau of General Services. A list detailing these products is to be provided to schools every year. The DOE is also required to compile a list of disinfectants that have been evaluated using "acceptable criteria" for preferred janitorial products and registered with the Board of Pesticide control; this list is also to be distributed to each school district annually. Additionally the statute requires the DOE to (1) develop cleaning procedure recommendations that reduce the use of toxic chemicals and improve indoor air quality while maintaining cleanliness performance standards and (2) disseminate these "green cleaning procedures" to school districts. The statute authorizes the DOE to compile and maintain a list of school districts that committed to implementing the green cleaning program, and to make that list available to the public (LD 88 (SP32) 2007).
To better protect children from harmful exposures indoors, Michigan should strongly consider implementing the following policy measures: Establish monitoring and/or assessment programs of indoor air quality, especially in public buildings, similar to those in California, Hawaii, Indiana, Florida, Maine, Texas, and Washington State.
Establish programs for education and outreach, like Hawaii and Texas. Allocate state funds for indoor air quality improvement, like Hawaii and Maine.
Investigate indoor air quality complaints in school buildings, as done in West Virginia and Wisconsin. Set ‘high-performance school’ construction standards for schools, as is done in Vermont and Rhode Island, and incentivize newly constructed schools to follow these standards by increasing state funding towards projects that do. This would include require building material that have been tested and certified as emitting low levels of VOCs, for instance.
Set guidelines for VOC emissions from indoor materials or consumer products, as done in California, Maine, New York, Rhode Island, and Virginia. Ban the sale or manufacture of products with VOC levels greater than set standards, as done in Maine and Rhode Island. For schools, require air quality testing and/or requiring building material with low levels of VOCs, as done in Connecticut and Maryland.
Gorman A. 2007. Household Hazards: Potential hazards of home cleaning products. Women’s Voices for the Earth. Available at: http://www.womenandenvironment.org/campaignsandprograms/SafeCleaning/HazardsReport.pdf. Scorecard, The Pollution Information Source, 2005. Emissions of Criteria Air Pollutants. Environmental Defense. http://www.scorecard.org/env-releases/cap/rank-states-emissions.tcl.
Michigan Department of Environmental Quality (MDEQ) 2006. Michigan Toxic Release Inventory, 2006. http://www.deq.state.mi.us/tri/06chemical.asp. Moglia D, Smith A, MacIntosh DL, et al. 2006. Prevalence and Implementation of IAQ Programs in U.S. Schools. Health Perspectives@114@1@2006 Environmental Health Perspectives 114(1):141-146.
Sahakian NM, White SK, Park JH, et al. 2008. Identification of mold and dampness- associated respiratory morbidity in 2 schools: Comparison of questionnaire survey responses to national data. Journal of School Health 78(1): 32-38. Savonius B, H Keskinen, M Tuppurainen, Kanerva L 1994. Occupational asthma caused by ethanolamines. Allergy 49: 877-81.
United States Environmental Protection Agency (EPA). 2009b. 1970 - 2008 Average annual emissions, all criteria pollutants. National Emissions Inventory (NEI) Air Pollutant Emissions Trends Data. http://www.epa.gov/ttn/chief/trends/index.html. United States Environmental Protection Agency (EPA). 2007. Introduction to Indoor Air Quality: Organic Gases. Accessed July 24, 2007 at: http://www.epa.gov/iaq/voc.html
United States Environmental Protection Agency (EPA). 2001. Mold Remediation in Schools and Commercial Buildings. EPA Publication 402-K-01-001. http://www.epa.gov/mold/intro.html. United States Green Building Council (USGBC). 2007. Leadership in Energy and Environmental Design. Accessed August 2, 2007 at: http://www.usgbc.org/DisplayPage.aspx?CategoryID=19.
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