Indoor air pollution, physical and comfort parameters related to schoolchildren's health: Data from the European SINPHONIE study

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Highlights

  • Indoor air physical and comfort parameters in 114 schools across 23 European countries were measured.

  • PM2.5, radon and carbon dioxide concentrations were higher compared to air quality guidelines.

  • VOCs, particulate matter and physical parameters were positively and negatively associated with different disorders.

Abstract

Substantial knowledge is available on the association of the indoor school environment and its effect among schoolchildren. In the same context, the SINPHONIE (School indoor pollution and health: Observatory network in Europe) conducted a study to collect data and determine the distribution of several indoor air pollutants (IAPs), physical and thermal parameters and their association with eye, skin, upper-, lower respiratory and systemic disorder symptoms during the previous three months. Finally, data from 115 schools in 54 European cities from 23 countries were collected and included 5175 schoolchildren using a harmonized and standardized protocol. The association between exposures and the health outcomes were examined using logistic regression models on the environmental stressors assessed in classroom while adjusting for several confounding factors; a VOC (volatile organic compound) score defined as the sum of the number of pollutants to which the children were highly exposed (concentration > median of the distribution) in classroom was also introduced to evaluate the multiexposure – outcome association. Schoolchildren while adjusting for several confounding factors. Schoolchildren exposed to above or equal median concentration of PM2.5, benzene, limonene, ozone and radon were at significantly higher odds of suffering from upper, lower airways, eye and systemic disorders. Increased odds were also observed for any symptom (sick school syndrome) among schoolchildren exposed to concentrations of limonene and ozone above median values. Furthermore, the risks for upper and lower airways and systemic disorders significantly increased with the VOCs score. Results also showed that increased ventilation rate was significantly associated with decreased odds of suffering from eye and skin disorders whereas similar association was observed between temperature and upper airways symptoms. The present study provides evidence that exposure to IAPs in schools is associated with various health problems in children. Further investigations are needed to confirm our findings.

Introduction

Children are more vulnerable than adults to environmental risks because of a number of factors: children are constantly growing, they breathe more air, consume more food, and drink more water than adults do, in proportion to their weight (WHO | Environmental Risks, n.d.). Their developing respiratory and immune systems and different responses to environmental exposure puts children at increased risk of developing various diseases including respiratory and allergic symptoms compared to adults (Scientific Committee on Health and Environmental Risks (SCHER), 2007). Many studies have reported that the overall indoor environment in schools can cause or contribute to acute and chronic health problems such as rhino conjunctivitis, and other allergic and general symptoms (Annesi-Maesano et al., 2012; Daisey et al., 2003; Hulin et al., 2012; Ramachandran et al., 2005; Siskos et al., 2001). In industrialized countries, people spend around 90% of their time indoors, where both the number and the concentrations of air pollutants can be higher than those outdoors (Klepeis et al., 2001; C.-Y. Lu et al., 2018). Additionally, surrounding outdoor air pollution is also a matter of concern indoors as it can contribute to the indoor environment by entering through windows, doors and other openings (Jantunen et al., 2011), thus compromising the indoor air quality (IAQ) further.

In school environments, and in particular primary schools, children are likely to be exposed to poor IAQ (Annesi-Maesano et al., 2012). A review published on the impact of indoor air pollution and its sources in the school's environment showed that higher concentrations of indoor air pollutants in schools can be related to various adverse health outcomes, namely allergic and respiratory symptoms and diseases (Annesi-Maesano et al., 2013). Furthermore, decreases in learning performance and academic execution were seen in schoolchildren as a result of exposure to various socio-demographic factors and indoor air pollutants in classroom (Grineski et al., 2016). While evidence exists, there is still a lack of comprehensive and accurate information as based on a standardized protocol about indoor air environments in schools and their effects on health, existing data are heterogeneous and there have been few studies with similar case definitions. Previously, no study used a large comprehensive and multi-perspective standardized protocol (Bentayeb et al., 2013).

In order to overcome those shortcomings, the European Schools Indoor Pollution and Heath: Observatory Network in Europe (SINPHONIE) study aimed to broaden the knowledge on the health status of schoolchildren in relation to the school environment in a large sample of European schools by applying the same standardized and comprehensive protocol. The primary aims of the study were using a standardized protocol: i) to measure levels of particulate matter (PM), volatile organic compounds (VOCs), ozone, carbon monoxide (CO) and radon and physical and comfort parameters; ii) to investigate the associations between the assessed air pollutants and comfort parameters in schools and the recorded health outcomes in children taking as reference the last 3 months.

Section snippets

Overview and study design

SINPHONIE was a two-year multidisciplinary cross-sectional study conducted in European schools, in which data on schoolchildren, parents/guardians, teachers, surrounding outdoor environments and indoor air quality of schools were collected using standardized and harmonized procedures and protocols. More detailed information about the SINPHONIE study and its methodology is provided elsewhere (www.sinphonie.rec.org, Csobod et al., 2014).

Study population

The SINPHONIE study targeted 115 schools in 54 cities of 23

Description of population, health outcomes and air pollutants, physical and comfort parameters

Overall, 5175 schoolchildren in 319 classrooms from 115 schools across 23 European countries were ultimately included after obtaining consent from their parents/guardians, corresponding to a participation rate of 73%. The schoolchildren had a mean age of 8.91 years (SD = 1.53) for females and 8.98 years (SD = 1.51) for males. Population characteristics are shown in Table 1.

The Caucasian ethnic group was the most frequent. Most parents/guardians were highly educated and fully employed. Of the

Key findings

The main objective of our study was to investigate the relationship between indoor air quality and comfort conditions in classrooms and health among European schoolchildren. In our sample, schoolchildren were excessively exposed to elevated concentrations of several air pollutants. Of note, the mean concentrations of benzene, limonene, PM2.5 and CO2 exceeded the WHO and/or EU air quality guidelines (World Health Organization, 2010; World Health Organization. Occupational and Environmental

Conclusion

Overall, the SINPHONIE data suggest that in Europe i) children are exposed to a variety of air pollutants with levels above the recommended standards at school; ii) exposures to elevated concentrations of several indoor air pollutants, including VOCs, and comfort parameters in the classroom, are adversely associated with various adverse health outcomes among schoolchildren and iii) there is a significant potential protective effect of some physical and comfort parameters (temperature and

Funding

SINPHONIE project was funded by the European Parliament with cooperation from the Directorate-General for Health and Food Safety (DG SANTE) of European Union (SANCO/2009/C2/04, contract SI2.570742).

Credit author statement

All authors contributed equally in conception of this study.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

We are indebted to the partners and the participants. The SINPHONIE project attracted >80 participants for the training from 39 environmental and health institutions from across 25 European countries for the successful completion of the project.

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