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

Purpose: In the past 60 years, the prevalences of asthma and allergy among children have increased around the world. Neither genetic nor outdoor environmental factors can explain this increase. Methods: We performed a cross-sectional study of 7366 children in Tianjin, China, on associations of home environment and lifestyles with asthma and allergy. Results: The prevalences of diagnosed asthma, rhinitis and eczema among 0- to 8-year-old children in the Tianjin area were 4%, 9% and 39%. Home environment and lifestyle, together with infections, were strong risk factors. For asthma and allergy, the population attributable fraction (PAF) due to modern floors and wall coverings (i.e., laminated wooden floors and painted walls compared to tile floors and lime-coated walls) was 22%. Window condensation in winter and air conditioner use in summer, both of which are proxies for less ventilation, accounted for 7–17% of rhinitis and eczema. Cesarean delivery accounted for 10% of eczema symptoms. We developed a modern life index from appropriate home characteristics and lifestyle and food consumption habits and found it to have a clear dose–response relationship with asthma and allergy in Tianjin children. Conclusions: The results indicate that a "modern" home environment together with a modern lifestyle is associated with increased prevalences of asthma and allergies among children. Appropriate indoor environmental interventions and education of children's caregivers are important in the management of childhood asthma and allergy. [ABSTRACT FROM AUTHOR]

This study investigates associations of building dampness indicators, and perceptions of moldy odor, humidity and dryness (Dampness and Dryness, D&D) with children's asthma and allergies. Data were obtained from a cross-sectional study in Tianjin and Cangzhou, China from 2013 to 2014. Completed surveys were returned by 7366 families with children 0–8 years old. We studied D&D factors both in the current residence and the residence where the children lived immediately after birth. A total of 4.4% of the children had doctor-diagnosed asthma; 9.5% had doctor-diagnosed rhinitis; and 39.1% had doctor-diagnosed eczema. Most of the dampness indicators, perceptions of odors, and perceived dryness, were significantly associated with children's asthma and allergies. A reporting bias in parents (or guardians) who themselves had allergies was not found to be the reason for the associations between D&D and health effects. Compared with either previous or current exposure to D&D, continuous exposure to D&D was a greater risk for children's asthma and allergies. Perceived dryness was the most important studied risk factor for children's allergies in either current or previous homes. [ABSTRACT FROM AUTHOR]

This study aims to find out the relationship between pet keeping in childhood and asthma and allergy among children aged 0–8 years old in Tianjin, China. Parental or guardians reports of 7360 children were analyzed. 1490 (21.6%) families kept pets at the time of the survey (current), among them 4.0% cats, and 14.7% dogs. For the first year of life of children (early), 1196 (18.4%) families kept pets, and among them 3.2% cats, and 13.7% dogs. Exposure to a pet in early childhood significantly increased the risk of current wheeze, current dry cough, and diagnosed rhinitis. 17.9% of parents reported an avoidance behavior, i.e., had removed or refrained a pet due to asthma or allergy in the family. After adjustment for avoidance behavior, the negative effect of pet keeping on children’s health became even more obvious, with e.g. an AOR of 3.37 (1.58–7.19) for diagnosed asthma, 3.60 (2.07–6.27) for diagnosed rhinitis, 1.92 (1.31–2.81) for diagnosed eczema. A dose-response relationship between pet keeping at current and current wheeze, current eczema and diagnosed eczema was found. In conclusion, pet exposure in early life of children in Tianjin is a risk factor for asthma and allergies among children aged 0–8 years old. [ABSTRACT FROM AUTHOR]

The urbanization and industrialization in China is accompanied by bad air quality, and the prevalence of asthma in Chinese children has been increasing in recent years. To investigate the associations between ambient PM 2.5 levels and asthmatic and allergic diseases or symptoms in preschool children in China, we assigned PM 2.5 exposure data from the Global Burden of Disease (GBD) project to 205 kindergartens at a spatial resolution of 0.1° × 0.1° in six cities in China (Shanghai, Nanjing, Chongqing, Changsha, Urumqi, and Taiyuan). A hierarchical multiple logistical regression model was applied to analyze the associations between kindergarten-level PM 2.5 exposure and individual-level outcomes of asthmatic and allergic symptoms. The individual-level variables, including gender, age, family history of asthma and allergic diseases, breastfeeding, parental smoking, indoor dampness, interior decoration pollution, household annual income, and city-level variable-annual temperature were adjusted. A total of 30,759 children (average age 4.6 years, 51.7% boys) were enrolled in this study. Apart from family history, indoor dampness, and decoration as predominant risk factors, we found that an increase of 10 μg/m 3 of the annual PM 2.5 was positively associated with the prevalence of allergic rhinitis by an odds ratio (OR) of 1.20 (95% confidence interval [CI] 1.11, 1.29) and diagnosed asthma by OR of 1.10 (95% CI 1.03, 1.18). Those who lived in non-urban (vs. urban) areas were exposed to more severe indoor air pollution arising from biomass combustion and had significantly higher ORs between PM 2.5 and allergic rhinitis and current rhinitis. Our study suggested that long-term exposure to PM 2.5 might increase the risks of asthmatic and allergic diseases or symptoms in preschool children in China. Compared to those living in urban areas, children living in suburban or rural areas had a higher risk of PM 2.5 exposure. [ABSTRACT FROM AUTHOR]

Objectives: We investigated patterns of multimorbidities among asthma, allergies, and respiratory illnesses in preschool children. We investigated multimorbidities of lifetime asthma, allergic rhinitis, eczema, food allergy, pneumonia, and ear infections; and multimorbidities of current (in the last year before the survey) wheeze, dry cough, rhinitis, eczema, and common cold during childhood. We further analyzed whether prevalences of these multimorbidities were due to chance.Methods: A cross-sectional study was conducted in 72 kindergartens of Shanghai, China. Parents of preschool children were surveyed with a modified ISAAC questionnaire. Observed prevalences (OPs), expected prevalences (EPs), absolute excess comorbidities (AECs), and relative excess comorbidities (RECs) of various combinations of illnesses were calculated to indicate whether the combined illnesses were related.Results: We analyzed questionnaires for children aged 4–6 years, whose 13,335 questionnaires were the majority of the total 15,266 returned questionnaires (response rate: 85.3%). The studied illnesses were common. For children who had more than three lifetime or current illnesses, OPs tended to be higher than EPs. Most OPs and EPs were higher in boys than in girls, and were higher in children with a family history of atopy (FHA) than in children without FHA. AECs and RECs between boys and girls as well as between children with and without FHA were substantially different.Conclusions: Our findings suggest that multimorbidities among childhood asthma, allergies, and respiratory illnesses are likely not random, but rather share etiology. Specific patterns of childhood asthma multimorbidities perhaps differ between boys and girls and between children with and without FHA. [ABSTRACT FROM PUBLISHER]

Objectives: We investigated associations of breastfeeding (BF) durations and patterns and of timing of other dietary introductions with prevalence of asthma, wheeze, hay fever, rhinitis, pneumonia, and eczema among preschool children.Methods: During April 2011-April 2012, we conducted a cross-sectional study in 72 kindergartens from five districts of Shanghai, China and obtained 13,335 questionnaires of children 4–6-years-old. We used multiple logistic regression models to evaluate the target associations.Results: Compared to children who were never BF, children who were exclusively breastfed 3–6 months had the lowest risk of asthma (adjusted odds ratio and 95% confidence interval: 0.81, 0.72–0.91) and wheeze (0.93, 0.87–0.99); and exclusive BF >6 months was significantly associated with a reduced risk of hay fever (0.93, 0.89–0.97), rhinitis (0.97, 0.94–0.99), pneumonia (0.97, 0.94–0.99), and eczema (0.96, 0.93–0.99). No significant associations were found between time when fruits or vegetables were introduced and the studied diseases. Associations were independent of the child's sex and parent's ownership of the current residence. Longer duration BF was only significantly protective when there was no family history of atopy.Conclusions: This study suggests that heredity, but not sex and socioeconomic status, may negatively impact the effect of BF on childhood airway and allergic diseases. Our findings support China's national recommendation that mothers provide exclusive BF for the first four months, and continue partial BF for more than 6 months. [ABSTRACT FROM AUTHOR]

We analyzed perceptions of odors and dryness and their associations with asthma and allergic symptoms in 1–8 year-old children in Baotou, China. In this cross-sectional study, parents returned 4801 completed questionnaires. Odors reported frequently or sometimes were stuffy odor,45.2%; unpleasant odor,33.8%; pungent odor, 9.7%; moldy odor, 9.2%; tobacco smoke odor, 33.2%; dry air, 72.4% and humid air,22.5%.Perceptions of all odors and of dry air (POD)were strongly associated with the risk of children’s asthma and allergies but the perception of humid air was not. Dwelling owners reported significantly less odor perception than renters. Significant risk factors for POD were family history of asthma or allergies, living near a main road or highway, evidence of moisture related problems and never exposing bedding to sunshine. A higher proportion of women and allergic persons reported POD. The perception of dryness positively correlated with the use of humidifiers. We conclude that perception of odors and/or dryness can be proxies for indoor pollution, and as such, indicators of increased risk for children’s asthma and allergic symptoms. Reducing moisture related signs and keeping good sanitary habits, both of which can be at least partially accomplished by ventilation, are likely effective strategies for addressing odors and dryness problems in residences. [ABSTRACT FROM AUTHOR]

In China, the prevalence rates of asthma and allergies have been increasing in past 50 years. Several epidemiological investigations have indicated that dampness is associated with health effects such as respiratory infections, asthma and allergy. This study aims to find the associations between home dampness and asthma, rhinitis and eczema among children. A cross-sectional study on dampness and asthma and allergy at Tianjin was launched in 2013. Questionnaires were used to survey indoor dampness and health outcomes of occupants. 3.5% parents reported that they have noticed visible mildew/mold in child's rooms. The association between water leakage and asthma among children was seemingly strong (AOR: 3.29, 95% CI: 1.75-6.19). The dampness in home may have influence on asthma, rhinitis and eczema among children. [ABSTRACT FROM AUTHOR]

Background: The prevalence of asthma among Shanghai children has increased over time. This increase might be associated with changes in environmental exposures. Investigation of the time-trend of asthma and current prevalences is essential to understanding the causes. Objective: To estimate the current prevalences of asthma, allergies and other respiratory symptoms among Shanghai preschool children, and to investigate the time-trend of childhood asthma prevalence of from 1990 to 2011. Methods: From April 2011 to April 2012, the CCHH (China, Children, Homes, Health) cross-sectional study was conducted in Shanghai. Questionnaires were distributed to 17,898 parents or guardians of preschool children from 72 kindergartens in 5 districts. Previous similar studies were also summarized by a systematic literature review. Results: From a total of 14,884 questionnaires for 3–7 year old children, prevalences of the following diseases and symptoms were calculated: asthma 10.2%, wheeze (ever) 28.1%, pneumonia (ever) 33.5%, otitis media 11.0%, rhinitis (ever) 54.1%, hay fever 12.2%, eczema (ever) 22.7%, and food allergy 15.7%. Urban children had higher prevalences of most symptoms than suburban children. The prevalence of asthma has increased significantly, almost five-fold, from 2.1% in 1990 to 10.2% in the present study. The prevalence of asthma in boys was higher than in girls in the present study and in all reviewed studies. Conclusions: Asthma, allergy and airway symptoms are common among preschool children in Shanghai. The prevalence of childhood asthma in Shanghai has increased rapidly from 1990 to 2011. [ABSTRACT FROM AUTHOR]

To assess associations between home indoor air environments and asthma, allergies and pneumonia, children aged 1-8 years were surveyed from 12 kindergartens in the city of Xi'an. 2,020 questionnaires were responded with a response rate of 83.5 %. The prevalences of doctor diagnosed asthma, hay fever, and pneumonia were 2.9 %, 3.6 %, and 28.3 %, respectively. Living close to a highway was a risk factor for current rhinitis (AOR 1.5, 95 % CI 1.2-1.8), eczema (AOR 1.7, 95 % CI 1.2-2.5), and diagnosed pneumonia (AOR 1.3, 95 % CI 1.0-1.6). Dampness problems in the home were associated with 50 %-130 % increases in the prevalences of asthma and allergy. Airing bed linen under sun-shine was protective, especially against rhinitis. Pet avoidance was consistently and significantly associated with asthma and allergy (AOR 1.3-2.4). Decoration of the home during children's early life is a risk factor for current rhinitis (AOR 1.9, 95 % CI 1.3-2.9) and eczema (AOR 1.9, 95 % CI 1.1-3.6). Risk factors for pneumonia were living in an apartment (AOR 1.4, 95 % CI 1.1-1.8), latex wall paint (AOR 1.3, 95 % CI 1.0-1.7), dampness (AOR 1.4-1.5), breast feeding <3 months (AOR 1.3, 95 % CI 1.0-1.7), never airing bed linen in sunshine (AOR 1.3, 95 % CI 1.3-1.6), and cleaning children's room less frequently than once per day (AOR 1.4, 95 % CI 1.1-1.7). This study demonstrates that home indoor environmental and life style factors may influence the health of children in Xi'an. [ABSTRACT FROM AUTHOR]

Abstract: A cross-sectional study on the home environment and asthma and allergy in children was carried out among children 1–8 years old in Seoul, South Korea from 2009 to 2010. Questionnaires were distributed to 5107 parents through daycare centers and kindergartens; 2755 parents responded, a response rate of 54%. Seven percent and 23% of children were reported to have doctor-diagnosed asthma and hay fever, respectively. A majority (57%) of the families reported having PVC flooring in child's or parents' bedroom. More than 96% of homes used a floor heating system. PVC was used more often as a floor covering in single family houses than in apartments (67% vs. 49%, p < 0.001). PVC flooring was significantly associated with eczema in the previous 6 months (AOR 1.54, 95% CI 1.13–2.09) when adjusted for gender, age, family allergy, socioeconomic status and environmental tobacco smoke. Older buildings tended to have dampness problems, and, consequently, were positively correlated with the prevalence of wheeze. Floor moisture significantly increased the association between PVC and symptoms of wheezing (AOR 2.57, 95% CI 1.36–4.82) and eczema (AOR 1.97, 95% CI 1.18–3.28). Apartments without mechanical ventilation in bedrooms were associated with a slight increase in asthma and allergy among children. This study suggests that building characteristics and home exposure can partly explain recent increases in asthma and allergy among children in Seoul. [Copyright &y& Elsevier]

A China, Children, Homes, Health (CCHH) study was conducted in Shanghai to investigate the associations between residential characteristics and childhood asthma, wheeze and dry cough of 4- to 6-year-old children. In the present study, 13,335 children participated in the questionnaire survey, and the questionnaires were completed by children’s parents with a response rate of 85.3%. Multiple logistic regression analysis was the main method for analyses. Using wood as fuel for cooking was shown to have a strong positive association with asthma (adjusted odds ratio, 95% confidence interval: 2.84, 1.24–6.54). Existence of a highway within 200 m of the residence could have a positive association with wheeze ever (1.20, 1.02–1.41) and dry cough (1.22, 1.02–1.40). Children having suffered wheeze symptom ever was negatively associated with the use of fume exhaust ventilator in the kitchen (0.85, 0.73–0.99) and exhaust fan in the bathroom (0.86, 0.78–0.95) but positively associated with the use of home air purifier (1.22, 1.05–1.41). The results indicated that the residential characteristics such as surrounding environment and household equipments could have notable association with children’s health in Shanghai. Using clean fuel for home cooking, living far away from a highway or increasing home ventilation could possibly reduce the children’s risk of suffering asthmatic symptoms. [ABSTRACT FROM PUBLISHER]

The city of Chongqing has high outdoor temperatures and humidity throughout the year and consequently a high risk of dampness and mold problems in dwellings. As part of the China, Children, Homes, Health (CCHH), associations between home characteristics and children’s asthma, allergies, and related symptoms were investigated in Chongqing, China. A cross-sectional questionnaire survey on home characteristics including dampness and symptoms of asthma and allergies in 5299 children was performed. Data for 4754 children (3–6 years) and their homes were analyzed. Results showed that 35.1% of homes were reported to have “damp bedding”, 14.3% “condensation on window panes (higher than 5 cm)”, 11.6% “mouldy odor”, 9.3% “water leakage”, 8.3% “damp stains” and 5.3% “visible mould”. Wheezing and rhinitis ever were reported for 27.0% and 51.1% children respectively, and rhinitis, wheezing, cough at night and eczema in the last 12 months were reported for 38.1%, 20.5%, 18.9% and 13.2% respectively. Doctor-diagnosed asthma was reported for 8.3% of children, and doctor-diagnosed rhinitis for 6.2%. Dampness in homes was generally strongly associated with asthma and allergies among Chongqing children. The strongest association was found between “visible mould” and doctor-diagnosed rhinitis, and the adjusted Odds Ratio (OR A) was 2.27 (95% CI: 1.48, 3.49). “Damp bedding” was significantly associated with all asthma and allergic symptoms, but doctor-diagnosed asthma and rhinitis. The behavior of “putting bedding to sunshine” could effectively reduce the prevalence of asthma and allergic symptoms, and the risk of bedding affected with damp was reduced significantly when bedding was put to sunshine frequently. [ABSTRACT FROM AUTHOR]

Indoor environmental quality is suspected to be at least part of the cause of the increasing prevalence of childhood asthma and allergy. This study is part of the China, Children, Homes, Health (CCHH) project, which was designed to identify the risk factors indoors that are associated with prevalence of asthma and allergy among children in China. A cross-sectional questionnaire study was carried out in Wuhan in 2011. The questionnaire was a modified (to Chinese building characteristics) version of a questionnaire used first in Sweden. The parents of 2193 children, aged 1–8 years, replied, a response rate of 91.4% (2193/2400). Prevalences of asthma and allergic symptoms were calculated, and a Chi-square test and multiple logistic regression were used to identify risk factors. Prevalences of health outcomes are “wheezing last 12 months” 18.5%, “cough at night last 12 months” 15.4%, “doctor-diagnosed asthma” 6.0%, “rhinitis last 12 months” 48.7%, “doctor-diagnosed allergic rhinitis” 17.5%. Factors associated with increased risk for asthma, allergy and related symptoms include living in an urban area, dampness (significant), use of gas for cooking, new dwelling decoration (paint and furniture obtained during pregnancy), keeping pets and breast feeding less than 3 months. Factors associated with reduced risk as installing an exhaust fan in the bathroom. Home environmental factors are significantly associated with the prevalence of childhood asthma and rhinitis in Wuhan. Urbanization and dampness problems at home are significant risk factors for doctor diagnosed asthma and allergic rhinitis among children in Wuhan. [ABSTRACT FROM AUTHOR]

Prenatal and early life home environment might be related to children’s asthma or allergic diseases later in life. A cross-sectional epidemiological study was designed and a questionnaire survey was performed in 3700 preschool children in urban areas in Taiyuan, Shanxi Province, China. Questions on children’s asthma and allergic diseases from the International Study on Asthma and Allergies in Childhood (ISAAC) were integrated with questions on home environment from the Swedish Dampness in Buildings and Health (DBH) study, appropriately modified for Chinese life habits. By multivariate regression analyses controlling for age, gender, heredity, location in urban/suburban or rural areas, environmental tobacco smoke (ETS) and breastfeeding, we found that home new furniture (HNF) before birth (referring to 1 year before pregnancy and during pregnancy) was positively associated with wheezing ever (odds ratio(OR) 1.23 with 95% CI of 1.03–1.48) and wheezing last 12 months (1.24,1.00–1.54), allergic rhinitis (AR) (1.26,1.06–1.51), and eczema (1.42,1.01–1.99). HNF between 0–1 years old was also positively associated with wheezing last 12 months. Home new decoration (HND) during 0–1 years old was positively associated with AR symptoms and eczema symptoms, more in the last 12 months. Stronger positive associations were found for signs of home mold and dampness with almost all children’s asthmatic and allergic symptoms (OR ranging from 1.23–1.85, P<0.05). By mutual adjustment between HNF before children’s birth and home mold or dampness, all the significance remained unchanged. Prenatal HNF and home mold or dampness was independently associated with children’s asthmatic and allergic diseases later in life. [ABSTRACT FROM AUTHOR]

In order to evaluate the prevalence of childhood asthma, allergic diseases and pneumonia in Urumqi City, China, as well as its associations with housing and home characteristics, a cross-sectional study was performed in 4618 children (81.7% response rate, average age 4.7±0.9 year, boys accounting for 53.7%). Questions on children’s asthma and allergic diseases were from the International Study on Asthma and Allergies in Childhood (ISAAC) and were integrated with questions on the home environment from the Dampness in Buildings and Health (DBH) study, slightly modified to account for Chinese building characteristics and life habits. The prevalences of physician diagnosed asthma, allergic rhinitis (AR) and pneumonia were 3.6%, 8.7% and 40.9%, respectively. One fourth of children reported wheezing and more than 40% AR symptoms in the last 12 months. Controlling for confounding factors, positive associations were found for home mold/dampness and wheezing (adjusted odds ratio, aOR 1.33, 95% CI 1.07–1.66), AR symptoms (1.34, 1.09–1.64) last 12 months and physician diagnosed pneumonia (1.33, 1.09–1.62). Floor material by wood, PVC or carpeting; and walls by wallpaper, painting or wood material, were positively associated with AR symptoms. Home environmental tobacco smoke (ETS) was positively associated with wheezing (1.23, 1.04–1.46) and pneumonia (1.25, 1.07–1.45). In conclusion, there was a relatively high prevalence of asthmatic and AR symptoms and diagnosed pneumonia in preschool children in Urumqi. Home signs of mold growth or dampness, windowpane condensation, as well as ETS and interior surface materials emitting chemicals were risk factors for allergic symptoms and pneumonia. [ABSTRACT FROM AUTHOR]

Whether early pet-keeping is a risk factor for children’s asthma and allergies remains controversial. To investigate associations between asthma, allergies and airway symptoms among children and the indoor environment, a cross-sectional study was conducted in 5 districts of Shanghai. A number of 13335 questionnaires (response rate: 85.3%) of 4-6 year old children were analyzed. Families in urban areas have more pets except for dogs than families in suburbs. Fish are the most common pets in urban districts. The prevalence of doctor-diagnosed asthma was 10.3%, wheeze (ever) 28.3%, rhinitis (ever) 54.1%, doctor-diagnosed hay fever 12.6% and eczema (ever) 22.9%. In logistic regression analyses, early furred pet-keeping was positively associated with most of the symptoms and significantly with rhinitis (ever, adjusted OR=1.41, 95% CI=1.14–1.76) and doctor-diagnosed hay fever (1.38, 1.02–1.88). Current furred pet-keeping was significantly negatively associated with doctor-diagnosed asthma (0.57, 0.39–0.83). Persistent furred pet-keeping was significantly positively associated with rhinitis on pet or pollen exposure. However, current pet-keeping is not randomly distributed in the population. Children in families with “allergy” or with “pet avoidance behavior” (due to allergies in the family) have more symptoms, but have avoided cats and dogs, leading to the conclusion that such animals are “protective”, namely the “Healthy Pet-Keeping” effect. Moreover, rodents and birds are risks for children’s health. Fish-keeping is also seemingly a risk. This study indicates that early pet-keeping is a risk factor for asthma and allergies in families with a history of allergies, and part of residents in Shanghai have pet-avoidance behavior. [ABSTRACT FROM AUTHOR]

This study evaluated the prevalence and risk factors for asthma, allergy and related symptoms; and breastfeeding patterns and durations for 5479 Beijing children aged 3–6. Parents of children in randomly selected kindergartens wrote responses to a questionnaire used previously. The study aimed to evaluate trends in the prevalence of asthma and related illnesses, and to determine whether “more” breastfeeding, defined as exclusive, > 6 months, was associated with reduced prevalence. Asthma has increased in this age group between 1990 and 2011, with the steepest increase in the last 2–3 years. Of the total, 14.2% (779) children were breastfed exclusively for > 6 months. The efficacy of “more” breastfeeding was tested in a subset with two strong risk factors, positive family history (for asthma and/or allergy) and male gender. “More” breastfeeding was found to be significantly protective (aOR 0.42, P < 0.05) for this subset against Doctor-diagnosed asthma (D-asthma). Protection that did not reach statistical significance was also found for this subset against Wheeze ever, Cough at night, Rhinitis ever, Doctor-diagnosed rhinitis (D-rhinitis) and Eczema. The greatest protective effects were found for girls with no family history of asthma or allergy, reaching statistical significance for Wheeze ever (aOR 0.48, P < 0.01), Cough at night (aOR 0.47, P < 0.01), D-asthma (aOR 0.14, P < 0.01) and Rhinitis ever (aOR 0.67, P < 0.05). “More” breastfeeding was not consistently associated with either a protective or risk effect for Eczema. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between the length of use of feeding bottles or pacifiers during childhood and the prevalence of respiratory and allergic morbidities. A large-scale questionnaire survey was performed in day care centers and kindergartens (with children's ages ranging from 2 to 7 years) in southern Taiwan, and a total of 14,862 questionnaires completed by parents were finally recruited for data analysis. Effects of using feeding bottles on children's wheezing/asthma (adjusted OR: 1.05, 95% CI 1.00-1.09), allergic rhinitis (adjusted OR: 1.04, 95% CI 1.00-1.08), and eczema (adjusted OR: 1.07, 95% CI 1.01- 1.2) were found.Moreover, significant dose-dependent relationships were further established after an adjustment for confounders was performed that included children's ages, gender, gestational age, birth weight, length of breastfeeding, the age when first given infant formula or complementary foods, family history, parental educational levels, and smoking status, as well as the problem of indoor water damage. This study was the first to reveal the potential risk of using plastic consumer products such as feeding bottles on the reported health status of preschool children in Asian countries. [ABSTRACT FROM AUTHOR]

Objectives: To study the impact of daycare attendance on airways infections and 'allergic' symptoms of children aged 1-8 years in Northeast Texas. Methods: Self-administrated questionnaires were distributed to parents through Women, Infants and Children offices, daycare centers, elementary schools, clinic centers, hospitals, and churches. The health outcomes consisted of 'allergic' symptoms, and respiratory tract disorders. Questions on child care included; type of daycare settings (proxy for the number of children in daycare), time spent at daycare centers per week, and age of entry to a daycare center. Results: A total of 3766 children participated in this study, giving a response rate of 71%. Daycare attendance was associated with more frequent respiratory tract infections and 'allergic' symptoms, compared to home care. A dose-response relationship between time spent at daycare centers and prevalence of respiratory tract disorders and asthma and allergies was observed. Earlier age exposure at daycare centers was a risk factor for rhinitis up to 7-8 years. Conclusions: Daycare attendance had a substantial negative influence on health status of children aged 1-8 years in Northeast Texas. [ABSTRACT FROM AUTHOR]

Abstract: A high prevalence and racial disparities in asthma and allergy have been observed in American children. This study aimed to identify risk factors for asthma and allergy among children, and their contribution to racial disparities in allergy prevalence. A population-based cross-sectional study was carried out among children aged 1–8years in Northeast Texas 2008–2009. The health conditions, life style and home environment of 3766 children were surveyed by parental questionnaires through e.g. daycares, elementary school, and medical clinics. Among participants who indicated their ethnicity, 255 were Mexican-Americans, 178 Afro-Americans and 969 Caucasians. Afro-American children had a significantly higher prevalence of asthma and eczema. Caucasian had the highest prevalence of rhinitis. Compared to Mexican-American children, Afro-American and Caucasian children were breast fed shorter time, more often went to day care center, had pets and environmental tobacco smoke exposure at home more often. For all children, being at a day care center, being exposed to dampness and environmental tobacco smoke at home were strong risk factors for asthma and allergy. Central air conditioning system was associated with an increased prevalence of wheeze among Mexican-American children, while pets were associated with an increased risk of rhinitis among Afro-American and Caucasian children. Caucasian children were generally not healthier than relatively poor Mexican-American children. Differences in the prevalence of asthma and allergy between races cannot be explained by socioeconomic status only. Life style and home environmental exposures are important risk factors for asthma and allergy in Northeast Texas children. [Copyright &y& Elsevier]

The role of pet exposure in early childhood for allergy/ asthma later in life is still controversial. Recently it was shown that ‘avoidance behaviour’ is an important factor for the pet distribution in the population. The aim of the present work is to study the association between self-reported pet keeping at home and symptoms in airways, nose and skin among children 2–7 years of age, in a country where primary prevention strategies regarding allergies are not common. A cross-sectional survey on the association between allergy and asthma symptoms and home enviromental factors was conducted in two towns in Bulgaria in spring 2004 (the ALLHOME-1 study). Data for 4479 out of 12982 children was obtained. 21.3% of the parents reported having pets at the time of the questionnaire, and 23.3% for pet keeping at index child's birth. Parents of 3.3% of the children got rid of some of the pets and 10.6% refrained from having pets, due in both cases to allergic illness in the family. Keeping dogs or cats at the time of the survey or during the child's first years was associated with most of the symptoms (aOR 1.1–2.2). [ABSTRACT FROM AUTHOR]

Aim: Questionnaires are a cheap means of studying large populations but the information obtained from them is seldom validated. Earlier studies have reported both high and low levels of agreements between inspectors' observations and occupants' reports regarding home environmental factors that included moisture problems. The aim of this study was to validate information received from a questionnaire survey regarding building characteristics, mouldy odour, and signs of moisture problems in 390 Swedish homes. Method: In a case control study on the association between home environmental factors and asthma/allergy among children, 390 homes were visited by trained inspectors for ocular inspection of visible moisture damage and perceptions of mouldy odour. Their observations were then compared with questionnaire reports collected 18-24 months earlier from the families. Results: A high level of agreement was found between the inspectors' observations and the occupants' questionnaire reports on technical parameters. This included type of house, type of ventilation system, and foundation, particularly in single-family houses. There was low agreement regarding vinyl or linoleum floor coverings and indications of dampness and mouldy odour. However, the stronger the mouldy odour experienced by the inspector, the higher the level of agreement. Conclusions: The questionnaire was a quite reliable source regarding technical parameters of the home but not for dampness problems. The questionnaire was better for predicting buildings without problems than detecting problems of mouldy odour and visible indications of moisture. To increase the validity of future questionnaires, simple drawings or information on critical spots for dampness could be used. [ABSTRACT FROM AUTHOR]

Selection bias means a systematic difference between the characteristics of selected and non‐selected individuals in epidemiological studies. Such bias may be introduced if participants select themselves for a study. The present study aims at identifying differences in family characteristics, including health, building characteristics of the home, and socioeconomic factors between participating and non‐participating families in a nested case‐control study on asthma and allergy among children. Information was collected in a baseline questionnaire to the parents of 14,077 children aged 1–6 years in a first step. In a second step 2,156 of the children were invited to participate in a case‐control study. Of these, 198 cases and 202 controls were finally selected. For identifying potential selection bias, information concerning all invited families in the case‐control study was obtained from the baseline questionnaire. Results show that there are several possible biases due to self‐selection involved in an extensive study on the impact of the home environment on asthma and allergy among children. Factors associated with participating were high socioeconomic status of the family, more health problems in the case families, and health‐related lifestyle factors, such as non‐smoking parents. The overall conclusion of this study is that there are selection biases involved in studies that need close cooperation with the families involved. One solution to this problem is stratification, i.e. investigating associations between exposures and health in the same socioeconomic strata. [ABSTRACT FROM AUTHOR]

Global phthalate ester production has increased from very low levels at the end of' World War H to approximately 3.5 million metric tons/year. The aim of the present study was to investigate potential associations between persistent allergic symptoms in children, which have increased markedly in developed countries over the past three decades, and the concentration of phthalates in dust collected from their homes. This investigation is a case-control study nested within a cohort of' 10,852 children. From the cohort, we selected 198 cases with persistent allergic symptoms and 202 controls without allergic symptoms. A clinical and a technical team investigated each child and her or his environment. We found higher median concentrations of butyl benzyl phthalate (BBzP) in dust among cases than among controls (0.15 vs. 0.12 μg/g dust). Analyzing the case group by symptoms showed that BBzP was associated with rhinitis (p = 0.00 1) and eczema (p = 0.001), whereas di(2-ethylhexyl) phthalate (DEHP) was associated with asthma (p = 0.022). Furthermore, dose-response relationships for these associations are supported by trend analyses. This study shows that phthalates, within the range of what is normally found in indoor environments, are associated with allergic symptoms in children. We believe that the different associations of symptoms for the three major phthalates-BBzP, DEI-IP, and di-n-butyl phthalate-can be explained by a combination of chemical physical properties and toxicologic potential. Given the phthalate exposures of children worldwide, the results from this study of Swedish children have global implications. [ABSTRACT FROM AUTHOR]

Researcher Hesselmar B. and researcher Bjorksten B. agree that pet-keeping in families is largely explained by decisions in the family. That, and the problems this poses in analyzing epidemiological data, is really the main theme of the authors' article. It is reasonable, that if Hesselmar and Bjorksten argued that rhinitis on pet exposure are relatively uncommon among small children. The prevalence among children aged 1-2 years was 1.8% and among children aged 5-6 years, 5.6%. However, as is noted in the article, the reported associations were also found when the analysis was restricted to children 4-6 years of age. Hesselmar and Bjorksten refer to their own study of 402 children where they found that pet-keeping during the first year of life decreased the risk of asthma/sensitization at the age of 12-13 years. The avoidance was in their article handled by excluding children whose parents had actively decided to avoid pets. Such a treatment of data is not without objections as they exclude children at an elevated risk of pet-allergy from the analysis. In conclusion, pet-keeping is largely explained by avoidance behavior because of allergic problems in the family. A main question for the future is how to control for such phenomena when analyzing cross-sectional or cohort data.

Abstract During 2010–2012, we conducted an observational study on household environment and health outcomes among 40,010 preschool children from seven cities of China. Here we examined associations of six dampness-related indicators (visible mold spots, visible damp stains, damp clothing and/or bedding, water damage, condensation on windowpane, moldy odor) in the current residence and three dampness-related indicators (visible mold spots, condensation on windowpane, moldy odor) in the early residence with childhood asthma and rhinitis. In the multi-level logistic regression analyses, visible mold spots and visible damp stains in the current residence were significantly associated with the increased odds of doctor-diagnosed asthma and allergic rhinitis during lifetime-ever (adjusted odd ratios (AORs) range: 1.18–1.35). All dampness-related indicators were significantly associated with increased odds of wheeze and rhinitis during lifetime-ever and in the past 12 months (AORs range: 1.16–2.64). The cumulative numbers of damp indicators had positively dose-response relationships with the increased odds of the studied diseases. These associations for wheeze and rhinitis were similar between northern children and southern children. Similar results were found in the sensitive analyses among children without a family history of allergies and among children without asthma and allergic rhinitis. For 3–6 years-old children in mainland of China in 2011, we speculated that about 90,000 (2.02%) children with asthma and about 59,000 (1.09%) children with allergic rhinitis could be attributable to exposing to visible mold spots in the current residence. Our results suggested that early and lifetime exposures to household dampness indicators are risk factors for childhood asthma and rhinitis. Graphical abstract Unlabelled Image Highlights • We studied associations of dampness with asthma and rhinitis in children from seven cities. • Home dampness significantly associated and dose-response related with asthma and rhinitis. • The associations had no substantial differences in children from different climate zones. • We estimated burdens of the studied diseases attributable to home visible mold spots. [ABSTRACT FROM AUTHOR]

Abstract We studied indoor sources of indoor particulate matter (PM), outdoor air pollution and antibiotic use in relation to asthma, rhinitis and eczema among pre-school children and investigated synergistic effects between PM and antibiotics use. Children (3-6y) from randomly selected day care centres in seven cities across China were included (n = 39,782). Data on ambient temperature and air pollution were collected from local monitoring stations. Data on indoor PM sources (ETS, burning of incense or mosquito coils and biomass for cooking), antibiotics use and health (doctor diagnosed asthma and rhinitis, lifetime eczema, current wheeze and current rhinitis) were assessed by a parental questionnaire. Associations were calculated by multilevel logistic regression. Asthma diagnosis was associated with outdoor temperature, NO 2 and burning mosquito coils. Rhinitis diagnosis was associated with NO 2 , ETS, gas cooking and burning biomass for cooking. Lifetime eczema was associated with temperature, PM 10, NO 2 , ETS, biomass cooking and burning mosquito coils. Burning incense was associated with current wheeze and current rhinitis. Children using antibiotics had more asthma, wheeze, rhinitis, and eczema. Excluding children with respiratory infections did not change associations with antibiotics use. Antibiotics use enhanced the effects of ETS and PM 10 (a synergistic effect). In conclusion, a warmer climate, outdoor NO 2 and PM 10, ETS, gas cooking and burning biomass, incense and mosquito coils can increase the risk of asthma, wheeze, rhinitis and eczema among pre-school children in China. Antibiotics use is a risk factor for childhood asthma, wheeze, rhinitis and eczema and ETS and outdoor PM 10 can enhance the effect. Highlights • Burning incense and mosquito coils can increase asthma, rhinitis, wheeze and eczema. • Outdoor PM 10 can increase the risk of childhood eczema. • Traffic-related air pollution (NO 2) can increase the risk of asthma, rhinitis and eczema. • Early life antibiotics use can increase the risk of asthma, rhinitis and eczema. • PM10 and ETS can enhance the adverse health effects of antibiotics use. [ABSTRACT FROM AUTHOR]

Background Childhood asthma is prevalent in China. However, there is a lack of evidence on whether household renovation, including the materials used and the periods, are associated with the disease. Objectives To investigate the associations between household decoration materials and renovation periods, and childhood asthma and its related symptoms. Methods During 2010–2012, a retrospective cohort study was initiated in seven cities of China, and 40,010 children, aged 3–6 years, were recruited. Data on demographics, health status, and home decoration conditions were collected using a parent-administered questionnaire. Two-level (city-child) logistic regression analyses with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were performed to show the target associations. Sensitivity analysis was performed by stratifying data for children in the southern and northern cities. Results Children whose homes underwent renovation or the addition of new furniture within 1 year before pregnancy, during pregnancy, at age 0–1 year, and after age 1 year had significantly ( p  < 0.05) higher prevalence of childhood asthma and its related symptoms. The use of solid wood floors and wallpaper had significant associations (cement: AOR, 95% CI: 1.59, 1.17–2.17; lime: AOR, 95% CI: 1.31, 1.00–1.71) with an increased risk of lifetime asthma. Household renovation and the addition of new furniture during pregnancy had significant associations with lifetime asthma (renovation: AOR, 95% CI: 1.23, 1.01–1.51); lifetime wheeze (renovation: AOR, 95% CI: 1.21, 1.05–1.39; furniture: AOR, 95% CI: 1.24, 1.14–1.36), current wheeze (renovation: AOR, 95% CI, 1.21 1.05–1.40; furniture: AOR, 95% CI: 1.23, 1.12–1.34), and current dry cough (renovation: AOR, 95% CI: 1.41, 1.23–1.63; furniture: AOR, 95% CI: 1.28, 1.17–1.41). Similar associations were found between the addition of new furniture during early childhood and lifetime asthma and its related symptoms. Except for the association between lifetime wheeze and flooring materials, the studied associations were generally stronger among children from the northern cities. Conclusions We confirmed that using cellulose based materials in home decoration and renovation, and adding new furniture during early childhood and pregnancy could be risk factors for childhood asthma. The association between household decoration during early childhood and childhood asthma may be stronger in the northern cities of China. [ABSTRACT FROM AUTHOR]

Few studies were conducted for associations of home environment with childhood health by on-site inspection in China. During 2013–2014, we conducted a case-control study with home inspection among 454 children (186 asthma children and 268 non-asthma children) in Shanghai, China. In this paper, we detailedly described the inspected methods and analyzed the preliminarily collected data. Except in winter, most residences meet the national standard for indoor temperature and relative humidity. Most living rooms had ≤1000 ppm CO 2 , whereas over half of the child's bedrooms had slightly >1000 ppm CO 2 during night. Most residences had notably lower than 2500 cfu/m 3 airborne culturable fungi and ≤100 μg/m 3 formaldehyde. More than 70% of the child's bedrooms had ≤75 μg/m 3 PM 2.5 and ≤150 μg/m 3 PM 10 . Indoor and outdoor concentrations of particulate matters had strong linear correlations ( r =0.891–0.922; p -value <0.001). Most differences between cases and controls were not significant with respect to CO 2 , culturable fungi, formaldehyde, and particulate matters. Before and after adjusted for potential confounders, indoor averaged concentration of CO 2 and particulate matters generally had negative associations with childhood history of doctor-diagnosed asthma in spring, summer, and autumn. Only in winter, indoor CO 2 concentration was significantly associated with the increased odds of childhood asthma. Our results indicated that air quality among most residences in Shanghai could meet the national standard for indoor air quality in warm seasons; but household air quality and ventilation status in winter should be greatly improved. We suspected that those “unexpected” negative associations could exist due to changes in lifestyle behaviors regarding indoor air quality after the child being diagnosed asthma by a doctor. [ABSTRACT FROM AUTHOR]

Background Mounting evidence suggests that exposure to ambient air pollution is associated with the development of childhood allergic diseases, but the effect of prenatal exposure to air pollution on the risk of childhood asthma and allergy is unclear. Objectives We evaluated the association between maternal exposure to outdoor air pollution during different trimesters of pregnancy and incidence of asthma, allergic rhinitis, and eczema in 2598 preschool children aged 3–6 years in China. Methods Children's lifetime incidence of allergic diseases was obtained using questionnaire. Individual exposure to outdoor air pollutants during trimesters of pregnancy was estimated by an inverse distance weighted (IDW) method based on the measured concentrations at monitoring stations. We used multiple logistic regression method to estimate the odds ratio (OR) of asthma, allergic rhinitis, and eczema for per interquartile range (IQR) increase in the exposure to air pollutant in each trimester, which was adjusted for the effect of other air pollutants and its effect in other trimesters by a multi-pollutant/trimester model. Results Incidence of asthma (6.8%), allergic rhinitis (7.3%), and eczema (28.6%) in children was associated with maternal exposure to traffic-related pollutant NO 2 during entire pregnancy with OR (95% confidence interval [CI]) respectively 1.63 (0.99–2.70), 1.69 (1.03–2.77), and 1.37 (1.04–1.80). After adjustment for other pollutants and trimesters, we found the association was significant only in specific trimester: the first trimester for eczema (1.54, 1.14–2.09), the second trimester for asthma (1.72, 1.02–2.97), and the third trimester for allergic rhinitis (1.77, 1.09–2.89). Sensitivity analysis indicated that the trimester sensitive to the development of allergic diseases was stable. Conclusion Maternal exposure to traffic-related air pollutant NO 2 during pregnancy, especially in specific trimesters, is associated with an increased risk of developing asthma, rhinitis, and eczema in children. Our results support the hypothesis that childhood allergic diseases originate in fetal life and are triggered by traffic-related air pollution in sensitive trimesters. [ABSTRACT FROM AUTHOR]

Background Early life is suggested to be a critical time in determining subsequent asthma development, but the extent to which the effect of early-life exposure to ambient air pollution on childhood asthma is unclear. Objectives We investigated doctor-diagnosed asthma in preschool children due to exposure to ambient air pollution in utero and during the first year of life. Methods In total 2490 children aged 3–6 years participated in a questionnaire study regarding doctor-diagnosed asthma between September 2011 and January 2012 in China. Children’s exposure to critical air pollutants, sulfur dioxide (SO 2 ) as proxy of industrial air pollution, nitrogen dioxide (NO 2 ) as proxy of traffic pollution, and particulate matter≤10 µm in diameter (PM 10 ) as a mixture, was estimated from the concentrations measured at the ambient air quality monitoring stations by using an inverse distance weighted (IDW) method. Logistic regression analysis was employed to determine the relationship between early-life exposure and childhood asthma in terms of odds ratio (OR) and 95% confidence interval (CI). Results Association between early-life exposure to air pollutants and childhood asthma was observed. SO 2 and NO 2 had significant associations with adjusted OR (95% CI) of 1.45 (1.02–2.07) and 1.74 (1.15–2.62) in utero and 1.62 (1.01–2.60) and 1.90 (1.20–3.00) during the first year for per 50 µg/m 3 and 15 µg/m 3 increase respectively. Exposure to the combined high level of SO 2 and NO 2 in China significantly elevated the asthmatic risk with adjusted OR (95% CI) of 1.76 (1.18–2.64) in utero and 1.85 (1.22–2.79) during the first year compared to the low level exposure. The associations were higher for males and the younger children aged 3–4 than females and the older children aged 5–6. Conclusions Early-life exposure to ambient air pollution is associated with childhood asthma during which the level and source of air pollution play important roles. The high level and nature of combined industrial and traffic air pollution in China may contribute to the recent rapid increase of childhood asthma. [ABSTRACT FROM AUTHOR]

Abstract: Potential contributions of environmental chemicals and conditions to the etiology of Autism Spectrum Disorders are the subject of considerable current research and speculation. The present paper describes the results of a study undertaken as part of a larger project devoted to the connection between properties of the indoor environment and asthma and allergy in young Swedish children. The larger project, The Dampness in Buildings and Health (DBH) Study, began in the year 2000 with a questionnaire distributed to parents of all children 1–6 years of age in one Swedish county (DBH-I). A second, follow-up questionnaire (DBH-III) was distributed in 2005. The original survey collected information about the child, the family situation, practices such as smoking, allergic symptoms, type of residence, moisture-related problems, and type of flooring material, which included polyvinyl chloride (PVC). The 2005 survey, based on the same children, now 6–8 years of age, also asked if, during the intervening period, the child had been diagnosed with Autism, Asperger''s syndrome, or Tourette''s syndrome. From a total of 4779 eligible children, 72 (60 boys, 12 girls) were identified with parentally reported autism spectrum disorder. A random sample of 10 such families confirmed that the diagnoses had been made by medical professionals, in accordance with the Swedish system for monitoring children''s health. An analysis of the associations between indoor environmental variables in 2000 as well as other background factors and the ASD diagnosis indicated five statistically significant variables: (1) maternal smoking; (2) male sex; (3) economic problems in the family; (4) condensation on windows, a proxy for low ventilation rate in the home; (5) PVC flooring, especially in the parents’ bedroom. In addition, airway symptoms of wheezing and physician-diagnosed asthma in the baseline investigation (2000) were associated with ASD 5 years later. Results from the second phase of the DBH-study (DBH-II) indicate PVC flooring to be one important source of airborne phthalates indoors, and that asthma and allergy prevalence are associated with phthalate concentrations in settled dust in the children''s bedroom. Because these associations are among the few linking ASD with environmental variables, they warrant further and more extensive exploration. [Copyright &y& Elsevier]