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House dust mites produce well‐known allergens for asthma and allergy among children. To study house dust mite allergen exposure level in northeast China and characterize its association with indoor environmental factors and cleaning habits, we inspected 399 homes in Tianjin area and collected dust from mattresses. Dermatophagoides farinae (Der f) and Dermatophagoides pteronyssinus (Der p) were detected by the enzyme‐linked immunosorbent assay (ELISA) method. The medians of total allergen concentrations for spring, summer, autumn, and winter were 524 ng/g, 351 ng/g, 1022 ng/g, and 1010 ng/g. High indoor air relative humidity (RH), low air change rate, indoor dampness, and frequent changing of quilt cover/bedsheet/pillow case were significantly associated with high house dust mite allergen concentration (relative risk [RR]: RH, 1.18–1.34; air change rate, 0.97–1.00; dampness, 2.92–3.83; changing quilt cover/bedsheet/pillow case, 0.66–0.75). The decrease in the absolute humidity gradient between indoors and outdoors that occurs with increased air change rate may explain why a high ventilation reduces house dust mite allergen concentration. The findings of this study show the importance of ventilation and cleaning for controlling house dust mite allergens. We found that the decrease in additional absolute humidity (e.g., humidity indoor‐humidity outdoor) with increased air change rate may be the main reason that a high ventilation rate reduces house dust mite allergen concentration. Ventilation and cleaning should be both considered for creating a healthy home environment. [ABSTRACT FROM AUTHOR]

A questionnaire survey on dermal symptoms and home environment was performed in eight Chinese cities (40 279 participants). Data on city level temperature, precipitation, PM10, NO2, and gross domestic product (GDP) per capita were collected. In total, 2.2% had eczema, 2.4% facial erythema (FE) and 2.6% seborrheic dermatitis symptoms (SD). Higher temperature was associated with eczema (OR = 1.09). Higher GDP per capita was related to less SD. Higher PM10 was related to SD. Suburban living was protective for eczema (OR = 0.77) (vs. urban). Living in old buildings (built before 1991) was related to eczema (OR = 1.42). Living near heavily trafficked roads was related to FE (OR = 1.33) and SD (OR = 1.35). Having new furniture was related to all symptoms (OR = 1.26–1.47). Burning mosquito coils (OR = 1.37–1.57) and incense (OR = 1.33–1.37) were associated with eczema, FE, or SD. Presence of cockroaches and rats/mice was associated with FE or SD (OR = 1.31–1.40). Using air conditioner, daily cleaning and frequently exposing bedding to sunshine were protective (OR = 0.60–0.83). In conclusion, higher temperature, higher PM10, urban living, living near heavily trafficked roads, old buildings, new furniture, burning mosquito coils and incense, and presence of cockroaches/rats/mice increased the risk of eczema, FE, or SD. Higher GDP, air conditioner, daily cleaning, and exposing bedding to sunshine were protective. [ABSTRACT FROM AUTHOR]

The ventilation modalities in most Chinese residences are infiltration and opening windows. We measured infiltration rates and air change rates at night, with no attempt to change occupants' behaviors, of urban residences in five climate zones of China during four seasons. Using the CO2 decay method, we found the median infiltration rate for 294 residences to be 0.34 h−1. Using occupant‐generated CO2 as tracer gas, we determined air change rates over the course of 1 year in 46 bedrooms at night from mass balance considerations. In 54% of the measurements, windows were closed, so ventilation was only by infiltration. Windows were mainly closed when the outdoor temperature was below 15°C and above 26°C. The median infiltration rates did not differ appreciably among seasons and climate zones and were always less than 0.45 h−1. [ABSTRACT FROM AUTHOR]

From October 2010 to April 2012, we conducted a cross‐sectional study of associations between household environments and childhood health among preschool children in eight Chinese cities. Here, we analyze associations of early household renovation with preterm birth (PTB), low birthweight (LBW), term low birthweight (Term‐LBW), and small for gestational age (SGA). Parents responded to questions about household renovation and their children's gestational age and birthweight. In the multivariate logistic regression analyses, household renovation in the year before pregnancy was significantly associated with LBW (sample size: N = 25 813; adjusted odds ratio (OR) with 95% confidence intervals (CIs): 1.23, 1.01‐1.50) and Term‐LBW (N = 24 823; 1.29, 1.01‐1.67). Household renovation during pregnancy was significantly associated with PTB (N = 25 202; 1.28, 1.01‐1.69). These significant associations were also found in the two‐level (city‐child) logistic regression analyses and in the sensitivity analyses among 21 009 children with complete data in all studied variates. Stronger associations were found in certain subgroups. Our findings indicate that household renovation within one year before pregnancy might be a risk factor for LBW and Term‐LBW, while household renovation during pregnancy could be a risk factor for PTB. [ABSTRACT FROM AUTHOR]

This study investigated the association of building characteristics and occupant behaviours with building dampness indicators. Data were from a cross-sectional study in urban Tianjin and rural Cangzhou, China, from 2013 to 2014. We studied two fundamental types of Chinese dwellings: bungalows typical of rural locales and apartments in low- and high-rise buildings typical of urban settings. Occupants of bungalows reported more dampness indicators than apartment dwellers. Risk factors for one or more dampness indicators included natural ventilation without fans, older dwellings and coal stove or Kang heating system (a brick bed installed in the bedroom for heating and sleeping). All these factors were typical of bungalows, which generally used older building technologies including non-insulated external walls, wooden frame windows, electric fans for cooling and no exhaust fan ventilation. Occupant behaviours that decreased the risk for dampness indicators included frequent window opening and daily cleaning, regardless of the type of dwelling. Indoor dampness was highly correlated with mouldy and humid odour, and paradoxically (although not a new finding) with the perception of air dryness. [ABSTRACT FROM AUTHOR]

We studied dampness and mold in China in relation to rhinitis, ocular, throat and dermal symptoms, headache and fatigue. A questionnaire study was performed in six cities including 36 541 randomized parents of young children. Seven self‐reported signs of dampness were evaluated. Multilevel logistic regression models were used to calculate odds ratios (ORs). Totally, 3.1% had weekly rhinitis, 2.8% eye, 4.1% throat and 4.8% skin symptoms, 3.0% headache and 13.9% fatigue. Overall, 6.3% of the homes had mold, 11.1% damp stains, 35.3% damp bed clothing, 12.8% water damage, 45.4% window pane condensation, 11.1% mold odor, and 37.5% humid air. All dampness signs were associated with symptoms (ORs from 1.2 to 4.6; P < 0.001), including rhinitis (ORs from 1.4 to 3.2; P < 0.001), and ORs increased by number of dampness signs. The strongest associations were for mold odor (ORs from 2.3 to 4.6) and humid air (ORs from 2.8 to 4.8). Associations were stronger among men and stronger in Beijing as compared to south China. In conclusion, dampness and mold are common in Chinese homes and associated with rhinitis and ocular, throat and dermal symptoms, headache and fatigue. Men can be more sensitive to dampness and health effects of dampness can be stronger in northern China. [ABSTRACT FROM AUTHOR]

Air change rate data for dwellings in China are scarce. We carried out a study of ventilation rates in 399 homes in Tianjin and Cangzhou, China. Carbon dioxide concentration was continuously measured for 24 h in bedrooms and living rooms. The air change rate at night was calculated using a single zone mass balance model. In the whole home, the median air change rates during sleeping time for spring, summer, autumn and winter were 0.27 h −1 , 1.11 h −1 , 0.29 h −1 , 0.30 h −1 . In the child's bedroom with closed window and door, the median air change rates during sleeping time for spring, summer, autumn and winter were 0.25 h −1 , 0.25 h −1 , 0.30 h −1 , 0.37 h −1 . Air change rates in homes with open windows were significantly higher than those in homes with closed windows ( p  = 0.000). [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]

Air change rate is an important factor in indoor environment with regards to occupants’ health. In order to study the association of air change rate in homes and building characteristics, a large scale air change rate measurements were carried out during Sept. 2013-Jan. 2016 in Tianjin, China. 410 homes were investigated and indoor environment were measured. Carbon dioxide concentration in homes was continuously measured for 24 hours. Air change rate was calculated by using CO 2 produced by occupants as tracer gas. In the whole home, air change rates during sleeping time averaged 0.61±1.05 h -1 (median=0.32 h -1 , n=340). In the bedrooms, air change rate during sleeping time were substantially higher, averaging 0.81±1.33 h -1 (median=0.43 h -1 , n=390). Months trends of whole home and bedroom air change rates differed. Air change rates were higher in smaller homes. Formaldehyde and TVOC concentration in homes with higher air change rate were lower. [ABSTRACT FROM AUTHOR]

This study aimed to find out the relationship between pets keeping in the first year of life (early life) and asthma and allergy among young children aged 0-8 years old in Tianjin, China. It investigated 7366 children and used logistical regression to analyse the self-reported questionnaires containing the questions on asthma, asthma-related and other allergic symptoms and completed by children’s parents. And it shows the highest prevalence of the allergic symptoms was found in urban area, followed by countryside and people in rural area showed the healthiest. However, the rate of pets keeping was contrary, people from rural area keep the most pets. Most importantly, it revealed that exposure to a pet in the early life was positively associated with asthma and allergy in Tianjin, especially for urban area. In conclusion, this study revealed that pet exposure in early in Tianjin was a risk factor for children’s health in later life. [ABSTRACT FROM AUTHOR]

Indoor air quality is significantly associated with ventilation. In China, natural ventilation system is the norm in residential buildings. In China this means only leakage and opening of windows, doors. The present study developed a practical and feasible method to measure air change rate in residential buildings. The air change rates in residential buildings were calculated by using CO 2 produced by occupants as tracer gas. Portable CO 2 monitors were located in representative rooms and measured CO 2 concentration for 24 hours continuously. Single zone model and multiple zone model were developed to calculate air change rates. 266 dwellings were measured. The air change rates in 40% dwellings were calculated as single zone since the CO 2 concentration differences in representative rooms were less than 10%. [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]

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]

Whether indoor environmental smoke is harmful for preschool children’s respiratory health in a society where female smoking is rare has not been determined. This study is part of a cross-sectional study (CCHH study-phase one in Shanghai) and investigated associations between parental smoking and incense-burning and respiratory symptoms among 4–6 year old children in Shanghai, China. A number of 13335 valid questionnaires (response rate: 85.3%) were analyzed. A number of 56.1% (as reported by a parent) of preschool children in Shanghai are exposed to environmental tobacco smoke (ETS). A number of 40.3% of fathers and 0.9% of mothers are smokers. A number of 53.7% and 12.6% of Shanghai residents have used mosquito-repellent incense and incensation respectively. Children exposed to any parental smoking have higher prevalence of wheeze and croup than those not exposed. Current maternal smoking has a significant and positive association with wheeze (in the last 12 months, AOR, 95% CI: 1.83, 1.11–2.99). However, paternal smoking either currently or at child’s birth had only weak associations with wheeze and croup. Incense-burning (mosquito-repellent incense and incensation) had significant and negative association with doctor-diagnosed asthma (AOR, 95% CI: 0.85, 0.73–0.99) and hay fever (AOR, 95% CI: 0.80, 0.70–0.93). The results indicate that maternal smoking perhaps is a stronger risk factor for children’s respiratory health than paternal smoking. [ABSTRACT FROM AUTHOR]

Atopic eczema is a common health problem in children. The prevalence has increased in the past decades. Besides a genetic predisposition, lifestyle factors, dietary habits and indoor environments are thought to be related to its high prevalence. A cross-sectional questionnaire study was carried out in 2011 in the Wuhan area to study associations between home environments and children’s health. The questionnaires were replied to by parents of 2193 children 1–8 years old and the response rate was 91.4% (2193/2400). The results show: (1) The prevalence of “eczema symptom ever that lasted for 6 months” was 23.2%; “eczema symptom in the last 12 months” 7.4% and “awake at night due to itchy rash” 3.4%. (2) Risk factors: Closer to business area (AOR 1.4), moisture related problems (AOR 1.3–2.2), moldy and stuffy odor perception (AOR 1.5), mice observed (AOR 1.8), pet keeping (AOR 1.3), exposure to environmental tobacco smoke (AOR 1.3) and incense (AOR 1.8) were significant risk factors for atopic eczema symptoms ever. Living in an apartment, compared to single family house, was related to more eczema symptom in the last 12 months. Damp clothing/bed sheets and perception of stuffy odor were risk factors for both “eczema symptom in the last 12 months” and “awake due to itchy rash (severe eczema)”. The odds ratio of mice observed for severe eczema was 3.1 (95% CI: 1.4–6.7). It suggests that urbanization, life style and dampness problems at home were significant risk factors for eczema symptoms among children in Wuhan, China. [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]

The prevalence and risk factors of sick building syndrome (SBS) symptoms in domestic environments were studied by a questionnaire survey on the home environment. Parents of 5299 3-6 years old children from randomly selected kindergartens in Chongqing, China returned completed questionnaires between December 2010 and April 2011. The prevalence of parents’ SBS symptoms (often (every week) compared with never) were: 11.4% for general symptoms, 7.1% for mucosal symptoms and 4.4% for skin symptoms. Multiple logistic regressions were applied controlling for gender and asthma/allergic rhinitis/eczema. Living near a main road or highway was a strong risk factor for general symptoms (adjusted odds ratio, aOR=2.16, P<0.001), skin symptoms (aOR=2.69, P<0.001), and mucosal symptoms (aOR=1.63, P<0.01). Redecoration was a risk factor for general symptoms (aOR=2.00, P<0.001), skin symptoms (aOR=1.66, P<0.01), and mucosal symptoms (aOR=1.66, P<0.05). New furniture was a risk factor for general symptoms (aOR=2.16, P<0.001) and skin symptoms (aOR=1.67, P<0.01). Dampness related problems (mould spot, damp stain, water damage and condensation) were all risk factors for SBS symptoms, as was the presence of cockroaches, rats, and mosquitoes/flies and use of incense. Protective factors include cleaning the child’s bedroom every day and frequently exposing bedding to sunshine. In conclusion, adults’ SBS symptoms were related to factors of the home environment. [ABSTRACT FROM AUTHOR]

Prevalence of allergic rhinitis has rapidly increased among Chinese children, but the reasons are unclear. Recent findings have suggested that exposure to outdoor air pollutants may increase the risk of allergic rhinitis, but the results were inconsistent. This study further investigated the effect of outdoor air pollutants on allergic rhinitis among preschool children. A standardized questionnaire on health, home and environmental factors was conducted for 4988 children aged 1–8 in the city of Changsha, and the concentrations of PM 10 (particle diameter ⩽10 μm), sulfur dioxide (SO 2) and nitrogen dioxide (NO 2) during 2006–2011 were acquired from the official web of Changsha Environmental Protection Agency. Results showed that the prevalence of children’s doctor diagnosed rhinitis was 8.4% (95% confidence interval [CI] 7.0%–10.0%). It was found that the prevalence of rhinitis was not associated with site-specific background concentrations of air pollutants, but significantly positively correlated with age-related accumulative personal exposure of PM 10, SO 2 and NO 2. We conclude that age-related accumulative personal exposure to ambient air pollution may play an important role in the development of rhinitis. [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]

Pneumonia is a major cause of childhood morbidity in China. Many studies of rural areas have found an association between pneumonia and air pollution from burning of bio-mass. The present study is of children living in urban, modern homes without burning of bio-mass. In order to investigate potential home risk factors associated with children’s pneumonia, China Child Home Health (CCHH) questionnaires were randomly distributed to parents of 6461 children in 23 kindergartens in all 11 districts of Nanjing, covering urban, suburban, and industrial areas. The 4014 valid questionnaires (response rate 65.7%) were returned and have been analyzed. The lifetime incidence of pneumonia in Nanjing children 1–8 years old is 26.7%. The incidence of croup, asthma and frequent common colds was strongly associated with pneumonia, as was a history of allergies in the family, and persons other than parents (for example grandparents or nanny) taking care of the child. Several home environmental factors, namely, dampness, lack of ventilation, using coal or natural gas (electricity as reference) for cooking, new furniture, and “modern” floor and wall covering materials were also significantly associated with pneumonia. The indoor environment typical of modern apartments in China was a risk factor for pneumonia among children. [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]

The prevalence of perceptions of odors and sensations of air humidity and sick building syndrome symptoms in domestic environments were studied using responses to a questionnaire on the home environment. Parents of 4530 1–8 year old children from randomly selected kindergartens in Chongqing, China participated. Stuffy odor, unpleasant odor, pungent odor, mold odor, tobacco smoke odor, humid air and dry air in the last three month (weekly or sometimes) was reported by 31.4%, 26.5%, 16.1%, 10.6%, 33.0%, 32.1% and 37.2% of the parents, respectively. The prevalence of parents’ SBS symptoms (weekly or sometimes) were: 78.7% for general symptoms, 74.3% for mucosal symptoms and 47.5% for skin symptoms. Multi-nominal regression analyses for associations between odors/sensations of air humidity and SBS symptoms showed that the odds ratio for “weekly” SBS symptoms were consistently higher than for “sometimes” SBS symptoms. Living near a main road or highway, redecoration, and new furniture were risk factors for perceptions of odors and sensations of humid air and dry air. Dampness related problems (mold spots, damp stains, water damage and condensation) were all risk factors for perceptions of odors and sensations of humid air and dry air, as was the presence of cockroaches, rats, and mosquitoes/flies, use of mosquito-repellent incense and incense. Protective factors included cleaning the child’s bedroom every day and frequently exposing bedding to sunshine. In conclusion, adults’ perceptions of odors and sensations of humid air and dry air are related to factors of the home environment and SBS symptoms are related to odor perceptions. [ABSTRACT FROM AUTHOR]

Objective: To test whether the incidence of common colds among college students in China is associated with ventilation rates and crowdedness in dormitories. Methods: In Phase I of the study, a cross-sectional study, 3712 students living in 1569 dorm rooms in 13 buildings responded to a questionnaire about incidence and duration of common colds in the previous 12 months. In Phase II, air temperature, relative humidity and CO2 concentration were measured for 24 hours in 238 dorm rooms in 13 buildings, during both summer and winter. Out-to indoor air flow rates at night were calculated based on measured CO2 concentrations. Results: In Phase I, 10% of college students reported an incidence of more than 6 common colds in the previous 12 months, and 15% reported that each infection usually lasted for more than 2 weeks. Students in 6-person dorm rooms were about 2 times as likely to have an incidence of common colds ≥6 times per year and a duration ≥2 weeks, compared to students in 3-person rooms. In Phase II, 90% of the measured dorm rooms had an out-to indoor air flow rate less than the Chinese standard of 8.3 L/s per person during the heating season. There was a dose-response relationship between out-to indoor air flow rate per person in dorm rooms and the proportion of occupants with annual common cold infections ≥6 times. A mean ventilation rate of 5 L/(s·person) in dorm buildings was associated with 5% of self reported common cold ≥6 times, compared to 35% at 1 L/(s·person). Conclusion: Crowded dormitories with low out-to indoor airflow rates are associated with more respiratory infections among college students. [ABSTRACT FROM AUTHOR]

SBS (Sick Building Syndrome) has been studied since the 1970s, mostly in workplaces. To comprehensively characterize associations between the home environment and SBS, we performed a study in the Tianjin area, China. Seven thousand eight hundred and sixty-five (7865) families with infants participated in a questionnaire survey. Information on their lifestyles, home environment and health outcomes was obtained. Fourteen percent (14%) of parents reported general symptoms, followed by 11% for mucosal symptoms and 9% for skin symptoms. There was no gender difference in reports of SBS symptoms. People living in apartments, compared to Pingfang, reported more SBS symptoms. Indoor risk factors for SBS symptoms were perceived dry air (AOR:2.71–3.85), condensation on windows (AOR:1.44–2.11), less frequent window opening (AOR:1.71–1.73) and dampness (AOR:1.44–1.93). Our findings suggest that the home environment impacts occupants' health. • A comprehensive analysis of sick building syndrome (SBS) symptoms in homes. • There was no gender difference for SBS symptoms. • Dry air perception, not due to physical dryness, was a strong and consistent risk factor for SBS symptoms. • Low ventilation and dampness were also risks for SBS symptoms. [ABSTRACT FROM AUTHOR]

The prevalence of asthma and allergic diseases has increased rapidly in urban China since 2000. There has been limited study of associations between home environmental and lifestyle factors with asthma and symptoms of allergic disease in China. In a cross-sectional analysis of 2214 children in Beijing, we applied a two-step hybrid Least Absolute Shrinkage and Selection Operator (LASSO) algorithm to identify environmental and lifestyle-related factors associated with asthma, rhinitis and wheeze from a wide range of candidates. We used group LASSO to select variables, using cross-validation as the criterion. Effect estimates were then calculated using adaptive LASSO. Model performance was assessed using Area Under the Curve (AUC) values. We found a number of environmental and lifestyle-related factors significantly associated with asthma, rhinitis or wheeze, which changed the probability of asthma, rhinitis or wheeze from −5.76% (95%CI: −7.74%, −3.79%) to 27.4% (95%CI: 16.6%, 38.3%). The three factors associated with the largest change in probability of asthma were short birth length, carpeted floor and paternal allergy; for rhinitis they were maternal smoking during pregnancy, paternal allergy and living close to industrial area; and for wheeze they were carpeted floor, short birth length and maternal allergy. Other home environmental risk factors identified were living close to a highway, industrial area or river, sharing bedroom, cooking with gas, furry pets, cockroaches, incense, printer/photocopier, TV, damp, and window condensation in winter. Lifestyle-related risk factors were child caretakers other than parents, and age<3 for the day-care. Other risk factors included use of antibiotics, and mother's occupation. Major protective factors for wheeze were living in a rural/suburban region, air conditioner use, and mother's occupation in healthcare. Our findings suggest that changes in lifestyle and indoor environments associated with the urbanization and industrialization of China are associated with asthma, rhinitis, and wheeze in children. Image 1 • We investigated home environmental and lifestyle factors associated with children's allergy. • We used a global variable procedure (LASSO) to select potential influencing factors. • We assessed associated factors in common for asthma, wheeze and rhinitis. • We calculated the probability change due to each risk factor. • Our model has sufficient statistic power and strong predicting performance. [ABSTRACT FROM AUTHOR]

Focuses on the conferences on indoor air sciences that were held in Singapore and Shanghai, China in 2003. Theme of the conferences; Relation of indoor air to health, comfort and productivity problems.

To study the association of indoor air quality and ventilation in Chinese homes with occupants' sick building syndrome (SBS) symptoms, we performed a study in 32 homes over four seasons in Tianjin, China. Measured indoor environmental parameters were ventilation rate, and concentrations of volatile organic compounds (VOCs), formaldehyde, PM 2.5 , ultrafine particle and ozone. Occupants reported any sick building syndrome symptoms for the previous three months. Ventilation rates at night in bedrooms were 0.35 h−1, 0.78 h−1, 0.37 h−1 and 0.41 h−1 in spring, summer, autumn and winter, respectively. A low ventilation rate at night (below the median value of 0.45 h−1) significantly increased the risk (adjusted odds ratio, aOR) of mucosal symptom to 2.65 (95% Confidence Interval (CI): 1.16–6.06). The aOR of ultrafine particle for mucosal symptom was 2.37 (95% CI: 1.02–5.49) and for dermal symptoms 3.96 (95% CI: 1.63–9.60). The aOR of ozone for dermal symptoms was 5.86 (95% CI: 1.19–28.99). Dry air perception that indicated a polluted indoor environment was a risk factor for SBS symptoms in Chinese homes. [ABSTRACT FROM AUTHOR]

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 Background Biomass burning is associated with childhood pneumonia but few studies exist on other indoor factors. Aim To study pneumonia in relation to pre-natal and post-natal exposure among children across China. Methods Children (3–6 y) (n = 39,782) from randomized day care centres in seven cities in China. Information on pneumonia and pre-natal and post-natal exposure to home environment factors were assessed by a parental questionnaire. Life-time outdoor temperature and GDP per capita were assessed on city level. Associations were calculated by multilevel logistic regression adjusting for fourteen co-variates. Results Totally 32.0% had ever had pneumonia diagnosed by a physician. Children of farmer mothers (OR = 0.65), with breastfeeding (OR = 0.91) and living in rural (OR = 0.85) or suburban (OR = 0.90) areas had less pneumonia. Buying new furniture one year before conception (OR = 1.11) and after first year of life (OR = 1.10) increased the risk. Redecoration one year before conception (OR = 1.20), during pregnancy (OR = 1.18) and after first year of life (OR = 1.17) increased pneumonia risk. Children with mould (OR = 1.17), window pane condensation (WPC) (OR = 1.20) and mould odour (OR = 1.15) at home at birth only had a higher risk of pneumonia. Similar associations were seen for dampness and mould in the current home. Children in the oldest and newest homes had less pneumonia. Cockroaches (OR = 1.08), mosquitos or flies in the current home (OR = 1.18), an exhaust fan in the bathroom (OR = 1.10) and higher economic development level, measured as GDP per capita on city level (OR 1.11 per 10,000 RMB/year) were associated with childhood pneumonia. Conclusions Perinatal and postnatal exposure to mould, mould odour and window pane condensation at home can be early life risk factors for childhood pneumonia in China. Moreover, pre-natal and post-natal exposure to chemical emissions from new furniture and renovation could increase the risk of childhood pneumonia. Breastfeeding, farm exposure, and living in rural or suburban areas could be protective. Highlights • Childhood pneumonia can be influenced by prenatal and perinatal indoor exposure. • Mould and window condensation at birth is a risk factor for childhood pneumonia. • Prenatal exposure to redecoration and new furniture can increase the risk. • Cockroaches, mosquitos and flies are other risk factors in the home environment. • Farm exposure, breastfeeding and suburban or rural environment can be protective. [ABSTRACT FROM AUTHOR]

Background Children's pneumonia is a heavy health burden. Few studies have been carried out on residential risk factors for pneumonia in children. Potential risks associated with dwelling characteristics are still unknown. Methods A cross-sectional study was conducted among children in 8 cities in China during 2010–2011 and 41,176 valid data on children aged 3–8 years old were used in this analysis. To obtain the lifetime-ever incidence of pneumonia in children and identify associations between pneumonia and residential risk factors, chi -square analysis and logistic regression methods were employed. Adjusted odds ratios were used as measures of effect with a 95% confidence interval. Confounding variables in the regression model include children's gender, birthweight, breastfeeding duration, parental smoking and family history of atopy. Results The average lifetime-ever incidence of childhood pneumonia was 32.3%. Urban children (33.6%) had more pneumonia than suburban (29.9%) and rural children (24.9%). More residential risk factors were found in urban-dwellings. Boys, low birthweight (<2500 g), breastfeeding duration <6 months, family allergic history, and exposure to parental smoking were found to be associated with higher pneumonia lifetime-ever incidences. Various indicators of dampness, including visible mold spots, damp stains, water damage, water condensation, damp clothing or bedding and mold odor, were also positively associated with pneumonia. Pneumonia incidence increased as the number of dampness indicators increased. Both natural gas and solid cooking fuels were positively associated with pneumonia compared with electricity. Compared with cement, construction materials including synthetic fiber, laminated wood, real wood, paint, emulsion paint and wall paper were positively associated with pneumonia. Daily living habits such as putting bedding to sunshine frequently and cleaning the child's bedroom every day could be effective preventive strategies. A dose-response relationship between the number of residential risk factors and pneumonia was observed when the risk factors number ranged from 7 to 11. Residences with more risk factors had higher lifetime-ever pneumonia odds ratios. Conclusions Indoor environmental factors including dampness, use of solid fuels or natural gas for cooking and use of new construction materials are risk factors for childhood pneumonia. This study gives evidence for the importance of home environment exposures in the occurrence of childhood pneumonia. Actions against the residential risk factors described in this study may help to prevent pneumonia in children. [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]

Background Otitis media (OM) is a common infection in early childhood with repeated attacks that lead to long-term complications and sequelae, but its etiology still remains unclear. Objective To examine the association between early life exposure to air pollution and childhood OM, with the purpose of identifying critical windows of exposure and key components of air pollution in the development of OM. Methods We conducted a prospective cohort study of 1617 children aged 3–4 years in Changsha, China (2011–2012). The prevalence of OM was assessed by a questionnaire administered by the parents. Individual exposures to nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ) and particulate matter with an aerodynamic diameter ≤ 10 μm (PM 10 ) during prenatal, postnatal, and current windows were estimated using the measured concentrations at monitoring stations. We used logistic regression model to examine the OM risk in terms of odds ratio (OR) and 95% confidence interval (CI) for exposure to different air pollutants during different timing windows, adjusting for covariates, multi-pollutants, and multi-windows. Results Life-time prevalence of doctor-diagnosed OM in preschool children in Changsha was 7.3%. Childhood OM was associated only with prenatal exposure to the industrial air pollution with adjusted OR (95% CI) = 1.44 (1.09–1.88) for a 27 μg/m3 increase in SO 2 , particularly during the first trimester of pregnancy. We further found that prenatal SO 2 exposure was not associated with the repeated attacks but was associated with the onset of OM, adjusted OR (95% CI) = 1.47 (1.10–1.96). The association between prenatal SO 2 exposure and early childhood OM was robust after adjusting for other pollutants and windows. Sensitivity analysis indicated that the association was stronger in females, children with parental atopy, and children living in houses with cockroaches, new redecoration, and condensation on window pane during winter. Conclusion We provide new evidence that prenatal exposure to industrial air pollution is associated with early childhood OM in China and may contribute to the onset of childhood OM. Our findings are helpful in developing more effective preventative strategies for childhood OM. [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]

Numerous questionnaire-based studies were conducted to investigate associations of home environment with childhood health, whereas few studies confirmed validity of parents-reported questionnaire regarding dwelling characteristics and dampness-related indicators. According to data obtained by standard questions regarding these items via on-site inspection in 454 residences with young children during 2013–2014, and data collected for these items from their parents-reported questionnaires in cross-sectional survey during 2011–2012 in Shanghai, China, this paper validated consistencies of information for these items between the two phases, thus to confirm validity of parents-reported questionnaire regarding these items. According to Kappa ( k ) values, parents and inspectors had moderate/substantial consistencies regarding dwelling characteristics ( k = 0.212–0.894), but had slight consistencies regarding dampness-related indicators and indoor odors (absolute k = 0.019–0.144). However, according to the observed, positive, and negative proportional agreement (P o , P pos , and P neg ), parents and inspectors had substantial/prefect consistencies in most of the studied items (P o = 0.45–0.96). These trends of consistencies for different items had no notable differences, regardless of father or mother as the questionnaire-reporter, and among the residences inspected in different seasons. This study suggests parents-reported questionnaire could be a reliable and valid method to indicate the overall status of dwelling characteristics and home dampness-related exposures. [ABSTRACT FROM AUTHOR]

Indoor environment is associated with the sick building syndrome (SBS), but little is known about the contribution of outdoor air pollution and meteorological conditions to SBS. We studied associations between outdoor air pollution, meteorological parameters and selected indoor exposure and building characteristics at home and weekly SBS symptoms in a standardized questionnaire study among 3485 randomly selected adults in China. Outdoor factors included particulate matters with diameter < 10 μm (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), outdoor temperature (T), relative air humidity (RH), and wind speed (WS) during last three months. Multiple logistic regression was applied calculating odds ratios (OR) with 95% confidence interval (95% CI). Asthma or allergic rhinitis (atopy) was associated with all types of SBS symptoms except fatigue. Indoor factors played a major role in SBS symptoms. Mold/dampness on the floor/ceiling was associated with fatigue OR = 1.60 (1.11–2.30) and headache OR = 1.80 (1.07–3.04). Moldy odor was associated with fatigue OR = 1.59 (1.07–2.37) and dermal symptoms OR = 1.91 (1.21–3.02). Window pane condensation in winter was associated with fatigue OR = 1.73 (1.30–2.31) and throat symptoms OR = 1.53 (1.01–2.31). Damp bed clothing was related with throat symptom OR = 1.62 (1.09–2.40). Home redecoration was associated with fatigue OR = 1.49 (1.07–2.06). Frequent window opening was associated with less nose symptoms OR = 0.54 (0.36–0.82) and mechanical ventilation in the bathroom reduced dermal symptoms OR = 0.66 (0.44–0.99). Females were more susceptible to redecoration and window pane condensation than men. No associations with SBS were observed for outdoor air pollutants or meteorological parameters in the final models combining indoor and outdoor factors, although SO 2 , T, and RH were associated with some SBS symptoms (fatigue, eyes and nose symptoms) in the separate outdoor models. In conclusion, indoor mold/dampness, air pollution from redecoration and poorer ventilation conditions in dwellings can be risk factors for SBS symptoms in an adult Chinese population, especially among females. [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]

• Prenatal air pollution (PM 2.5 and PM 10) can increase furry pet related symptoms among pre-school children in China. • Indoor mould, dampness and window pane condensation can increase furry pet related symptoms and diagnosed rhinitis. • Early life cat and dog keeping can increase furry pet related symptoms and diagnosed rhinitis. • Prenatal farm exposure and living in less urbanized areas can protect against rhinitis not related to furry pets. Few Chinese population studies exist on early life risk factors for furry pet allergy. We studied childhood respiratory symptoms when in contact with furry pets in relation to early life exposure. Moreover, we studied similar environmental associations for rhinitis not related to furry pets. Children aged 3–6 y from day care centres in seven Chinese cities participated (N = 39,782). Parents answered a questionnaire on home environment and children's health, including rhinoconjunctivitis and wheeze when in contact with furry pets, and diagnosed rhinitis. Prenatal and postnatal outdoor temperature, PM 2.5 , PM 10 , and NO 2 were calculated using data from monitoring stations. Associations were estimated by multilevel logistic regression. Totally 2% had cats, 4% dogs, and 3.2% had rhinoconjunctivitis or wheeze when in contact with furry pets (FP symptoms). Moreover, 1.1% had furry pet related diagnosed rhinitis and 7.5% had diagnosed rhinitis not related to furry pets (other diagnosed rhinitis). Prenatal PM 2.5 and PM 10 , especially in second trimester, and a colder climate were risk factors for FP symptoms. ETS, dampness and mould, condensation on windows in wintertime, and cats and dog keeping were associated with FP symptoms. Breast feeding and frequent window opening were protective. Similar indoor associations were found for furry pet related diagnosed rhinitis. ETS, dampness and mould, window condensation, urbanization and mechanical exhaust ventilation were risk factors for other diagnosed rhinitis. Cooking with an electric stove and early life exposure to animals (cats, dogs, farm environment during pregnancy) were protective for diagnosed rhinitis not related to furry pets. Prenatal outdoor PM 10 and PM 2.5 can be risk factors for symptoms suggestive of furry pet allergy. Early life dampness and mould can be risk factors for rhinitis related and not related to furry pets. Exposure to animals (cats, dogs, farm environment) may reduce diagnosed rhinitis not related to furry pets. [ABSTRACT FROM AUTHOR]

The main aim was to study associations between asthma, allergic rhinitis and eczema among adults across China and dampness and mold at home. Young adults (N = 40,279) in eight cities in China answered a questionnaire in 2010–2012 (response rate 75.0%). Data on asthma, allergic rhinitis, eczema and the home environment was assessed by the questionnaire. Climate data was obtained from China Meteorological Administration and the website of Weather Underground. Health associations were analyzed by two-level logistic regression models, adjusting for covariates. Totally 1.6% had asthma, 6.6% allergic rhinitis and 2.2% eczema. Mold odor was associated with asthma (OR = 1.90) and allergic rhinitis (OR = 1.25–1.44). Window pane condensation in winter was associated with asthma (OR = 1.39), allergic rhinitis (OR = 1.26–1.58) and eczema (OR = 1.36–1.77). Presence of mold spots or damp stains was related to asthma (OR = 1.58–2.49), allergic rhinitis (OR = 1.35–1.76) and eczema (OR = 1.47–1.70). Water damage was related to asthma (OR = 1.69–1.82), allergic rhinitis (OR = 1.40–1.45) and eczema (OR = 1.44–1.96). Damp bed clothing was related to asthma (OR = 1.23), allergic rhinitis (OR = 1.23) and eczema (OR = 1.35). A higher dampness score was associated with increased odds ratios for diseases. Those living in older buildings had more asthma (OR = 1.39–1.76) and allergic rhinitis (OR = 1.16–1.21). Those living in suburban or rural areas had less asthma, allergic rhinitis and eczema as compared to those living in urban areas (OR values from 0.24 to 0.66). Stronger health associations with dampness and mold were found in southern China and in newer buildings (constructed after 2005). In conclusion, dampness and mold at home can be risk factors for asthma, allergic rhinitis and eczema among adults in China. Living in older buildings can be risk factors for asthma or allergic rhinitis while living in less urbanized areas can be protective. • Dampness/mold can be risk factors for adult asthma, allergic rhinitis or eczema. • Living in old buildings can be a risk factor for adult asthma and allergic rhinitis. • Less urbanized areas have less adult asthma, allergic rhinitis and eczema. • High ambient temperature and high precipitation can influence eczema. [ABSTRACT FROM AUTHOR]

Objectives: Student dormitory rooms in China are characterized by small space and high occupancy. This study aims to investigate infection rates for common colds and influenza among college students in a Chinese university and their association with the dormitory environment., Methods: This study involved two phases. In Phase I, 2978 students living in 998 dorm rooms in 12 buildings responded to a questionnaire survey on infections in four seasons. In Phase II, based on the data obtained from the questionnaire survey, we selected 242 dorm rooms to measure air temperature, relative humidity and CO 2 concentration in both summer and winter. Ventilation rates at night were calculated based on measured CO 2 concentrations., Results: We found that students had infections more often in winter, and in rooms with higher occupancy and dampness problems. The median value of the ventilation rate in dorm rooms in summer was 10.7 L/s per person, while it was 4.10 L/s per person in winter. There were significant associations between ventilation rate per person at night and common cold and influenza both in summer and winter (p < 0.05). A combination of dampness and low ventilation rate significantly increased the risk of common colds (adjusted odds ratios, AOR: 1.26-1.91) and influenza (AOR: 1.49-2.20)., Conclusion: College students living in a crowded dormitory room with low ventilation and dampness problems had more common colds and influenza infections., Competing Interests: 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., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Asthma, rhinitis, and eczema are becoming increasingly prevalent among children in China. Studies have shown that the perinatal period is critical and impacts children's health. However, research on the associations between perinatal factors and childhood allergic diseases in China are few. We investigated 7366 children of ages 0-8 years old. The childhood asthma and allergies were surveyed by distributing questionnaires, modelled after Dampness in Buildings and Health (DBH) study in Sweden and had been validated. To determine the prevalence of the allergic conditions, explore for potential confounders, and analyze the associations between the allergies and the home environmental factors, chi-square test and binary logistic regression models (enter method) were employed. The prevalence of children's doctor-diagnosed asthma, rhinitis, and eczema were 4.4%, 9.5%, and 39.1%, respectively. After adjusting for sociodemographic factors, the negative effect of dampness/humidity on children's health became more obvious, with odd ratios (aORs) of up to 1.70 (95% confidence interval (CI): 1.12-2.57) for doctor-diagnosed asthma (DDA), 2.12 (95% CI: 1.38-3.25) for doctor-diagnosed rhinitis (DDR) and 1.79 (95% CI: 1.46-2.21) for doctor-diagnosed eczema (DDE). With parental smoking, aORs of up to 4.66 (95% CI: 1.99-10.92) for DDA and 1.74 (95%: 1.00-3.02) for DDE. Renovation exhibited aORs of up to 1.67 (95% CI: 1.13-2.47) for DDR. Although they showed no significant associations with some of the health outcomes, contact with animals, in general, were risk factors for the allergic conditions. Generally, the indoor environmental factors around the perinatal period were significant risk factors for the doctor-diagnosed allergic conditions discussed in this study.

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 CO 2 . 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., (© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

We investigated associations between prenatal and postnatal environmental factors and onset and remission of preschool childhood eczema across China. The study population was preschoolers in randomized day care centers in seven cities (N = 39,782). Data on eczema and prenatal and postnatal indoor and outdoor environment were obtained from a cross-sectional questionnaire sent to parents or other guardians. Reports on eczema in the first 2 years and in the past year was used to retrospectively calculate onset and remission (changes of reported eczema). Prenatal and postnatal outdoor temperature, NO 2 and PM 10 were modelled from official air pollution data. Associations were estimated by two-level logistic regression. Calculated onset rate was 3.2%/y and remission rate 29.2%/y. Exposure to NO 2 during pregnancy was associated with onset of eczema, similarly for all trimesters. Postnatal PM 10 and NO 2 were related to decreased remission. Postnatal outdoor temperature was associated with onset of eczema. Pre-natal and current redecoration or buying new furniture, and perinatal as well as current dampness and indoor mould, were associated with increased onset and decreased remission. Cockroaches in current home was another indoor risk factors. Prenatal exposure to farm environment and large family size were all negatively associated with eczema. In conclusion, a warmer climate and prenatal NO 2 can be associated with increased onset of eczema in Chinese preschoolers. Postnatal PM 10 and NO 2 can be associated with reduced remission. Perinatal and current dampness, indoor mould and cockroaches may increase onset and decrease remission. Exposure to chemical emissions from indoor materials after first year of life may increase onset. Prenatal exposure to farm environment and large family size could be protective., Competing Interests: 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., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

We estimated associations between ambient air pollution, home environment and asthma as well as rhinitis among adults across China. A total of 40,279 young adults from eight Chinese cities participated in a questionnaire survey (participation rate 75%). There were questions on health and home environment. Information on city level gross domestic product (GDP) per capita, ambient temperature and PM 10 and NO 2 were collected from registers. Two-level logistic regression models were used to study health associations. Totally 1.6% reported asthma and 6.6% reported allergic rhinitis (AR). Higher temperature was associated with more asthma but less AR. Higher GDP was associated with less asthma but more AR. Higher degree of urbanization, higher level of NO 2 and living near heavily trafficked road were risk factors for asthma and AR. Participants in older buildings reported more asthma. Redecoration and buying new furniture were related to more asthma and AR (OR = 1.15-1.91). Using natural gas (OR = 1.34) and biomass (OR = 1.35) for cooking were risk factors for AR. Burning mosquito coils and incense increased the risk of asthma and AR. Cat keeping (OR = 2.88), dog keeping (OR = 2.04), cockroaches (OR = 1.54) and rats or mice (OR = 1.46) were associated with asthma. Cockroaches increased the risk of AR (OR = 1.22). Air humidifier and air cleaner were linked to asthma and AR. Frequent cleaning and exposing bedding to sunshine were protective. In conclusion, urbanization, NO 2 and traffic exhaust can increase the risk of adult asthma and AR. Higher ambient temperature was related to more asthma but less AR. Indoor animals such as cats, dogs, rats/mice and presence of cockroaches were associated with asthma or AR. Indoor chemical sources such as redecoration and new furniture were other risk factors. Cooking with natural gas or biomass and burning mosquito coils and incense were associated with asthma or AR. Frequent cleaning and exposing bedding to sunshine were protective., Competing Interests: Declaration of competing interest The authors declare that they have no known competing interest., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

This paper studied associations between reported common cold and home dampness and mould, cleaning habits and ventilation, climate and outdoor air pollution in China among young adults without asthma or allergic rhinitis. Parents of children attending day care in eight Chinese cities answered a questionnaire on their health and home environment (75% response rate). We restricted the population to subject without asthma or allergic rhinitis (N = 37,275). Temperature and air pollution data was obtained from monitoring stations. Associations were estimated by multilevel logistic regression. Totally 12.5% reported common cold (≥3 colds) and 1.6% frequent common cold (≥5 colds) in the past 12 months. Female gender (OR = 1.53; 95% CI 1.37-1.71), residents in southern China (OR = 1.89; 95% CI 1.16-3.07) and living in homes with water leakage (OR = 1.32; 95% CI 1.16-1.50), mould odour (OR = 1.48; 95% CI 1.28-1.72), indoor mould (OR = 1.47; 95% CI 1.28-1.70), condensation on window panes (OR = 1.42; 95% CI 1.32-1.52) and damp bed clothing (OR = 1.19; 95% CI 1.11-1.28) were associated with common cold. Having many signs of dampness increased ORs. Daily cleaning (OR = 0.91; 95% CI 0.85-0.97) and mechanical ventilation in kitchen or bathroom (OR = 0.75; 95% CI 0.64-0.89) were protective. Higher mean ambient temperature (OR = 1.11 per °C; 95% CI 1.02-1.21), PM 10 (OR = 1.17 per 10 μg/m 3 ; 95% CI 1.14-1.21) and PM 2.5 (OR = 1.28 per 10 μg/m 3 ; 95% CI 1.20-1.37) were associated with common cold. The association with particulate air pollution was stronger in southern China. Similar associations were found for frequent common cold. In conclusion, indoor dampness and mould, a warmer climate and PM 10 and PM 2.5 can be associated with reported common cold. Further intervention and prospective studies are needed to verify causality of observed association in this cross-sectional study., Competing Interests: 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., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

During 2010-2012, we surveyed 40,010 3- to 6-year-old children in seven Chinese cities (Beijing, Taiyuan, Urumqi, Shanghai, Nanjing, Changsha, and Chongqing). Their parents reported information on household renovation, including the timing of renovation and the choice of materials for walls and floors in the child's room, and the incidence of their child's rhinitis. Multivariate and two-level (city-child) logistic regression analyses yielding adjusted odds ratios (AOR) with 95% confidence intervals were performed. Sensitivity analyses stratifying data for location and economic level were also performed. About 48.0% of the children had ever had allergic rhinitis, 41.2% had current allergic rhinitis, and 9.0% had had doctor-diagnosed rhinitis. Exposure to household renovation during early lifetime (birth to 1-year-old) had an AOR of 1.43 (1.04-1.9) for allergic rhinitis. The incidence of allergic rhinitis was significantly different in children exposed to different floor and wall covering materials. Floor or wall covering material composed of organic materials significantly increased the risk of childhood allergic rhinitis compared with tile flooring or lime wall covering. Oil paint had an AOR of 1.66 (1.28-2.14) for diagnosed rhinitis compared with lime wall covering. Adding new furniture the year before pregnancy was associated with an AOR of 1.18 (1.10-1.27) and 1.18 (1.11-1.25) for lifetime and current rhinitis. Solid wood or tiles/ceramic as floor materials, and using wallpaper, oil paint, or emulsion panels as wall materials were risk factors for doctor-diagnosed rhinitis. Sensitivity analyses showed that children living in southern or higher economic level China cities were more likely to have allergic rhinitis with household renovation., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Children spend most of their indoors time at home, which may have substantial influence on their health. We conducted a cross-sectional study in the Tianjin area, China to quantify the incidence of respiratory infections among children, and its association with home environments and lifestyles. The lifetime-ever incidences of croup, pneumonia and ear infection among children aged 0-8 in Tianjin area was 9.2%, 28.7% and 11.6%, respectively. The incidence of common cold infections more than twice per year was 31.3%. Home environments and lifestyles included strong risk factors for childhood respiratory infections. Perceived dry air had the greatest association with childhood common colds (population attributable fraction (PAF = 15.0%). Modern floor covering had the greatest association with croup (PAF = 14.7%) and ear infection (PAF = 34.5%), while infrequent bedding sun-curing had the greatest association with pneumonia (PAF = 18.7%). Condensation (a proxy of poor ventilation) accounted for 12.2% of the incidence of croup (PAF = 12.2%) and frequent common colds (PAF = 8.4%). Our findings indicate that factors related to "modern" home environments and lifestyles are risks for childhood respiratory infections. Modifying such factors might reduce the incidence of respiratory infections among children.

The extensive literature has reported adverse effects on environmental tobacco smoke (ETS) on children's health. We aim to analyze associations of ETS with dry night cough, croup, pneumonia, and frequent common cold and to disentangle the effects of prenatal, infancy and childhood exposure by multilevel logistic regression. A cross-sectional study was conducted among 41,176 children aged 3-8 years in 8 major cities of China during 2010-2011, and obtained demographic information, smoke exposure information, and respiratory outcomes. Parents' smoking habit and indoor tobacco smoke odor were considered as two indicators of ETS. The prevalences of respiratory outcomes were 6.0% for croup, 9.5% for frequency common cold, 17.1% for dry night cough and 32.3% for pneumonia respectively in the study. The associations between respiratory outcomes and parental smoking were not obvious, while indoor tobacco smoke odor was clearly and strongly associated with most respiratory outcomes, with adjusted odds ratios ranging from 1.06 to 1.95. Both infancy and childhood exposure to tobacco smoke odor were independent risk factors, but infancy exposure had a higher risk. The results explore that ETS increased the risk of respiratory outcomes in children, highlighting the need for raising awareness about the detrimental effects of tobacco smoke exposure.

Few studies exist from China on associations between home environment and adult health. We studied associations between home environment factors (other than dampness and mould) and rhinitis, throat and dermal symptoms and headache and fatigue among young parents in six cities across China (N = 36,541). They were recruited as parents from day care centers selected randomly and answered a questionnaire on medical symptoms and the home environment. Odds ratios (OR) were calculated by multilevel logistic regression adjusting for gender, atopy, smoking, home size and dampness/mould. Overall, 4.8% had skin symptoms 3.1% rhinitis, 2.8% eye, 4.1% throat symptoms, 3.0% headache and 13.9% had fatigue (all as weekly symptoms). Redecoration was associated with rhinitis, eye and skin symptoms, headache and fatigue. New furniture was associated with eye, throat and skin symptoms and fatigue. Gas cooking was associated with eye and throat symptoms, headache and fatigue. Biomass cooking was associated with eye and throat symptoms and headache. Burning incense was associated with eye, throat and skin symptoms, headache and fatigue. Presence of cockroaches and mosquitos or flies was associated with all six symptoms. Rats or mice were associated with eye and dermal symptoms. Cat keeping was associated with eye symptoms while dog keepers had less fatigue. Living near major roads was associated with rhinitis, eye, throat and skin symptoms and fatigue. Daily cleaning, a mechanical ventilation system in the kitchen or in the bathroom, living in older buildings and living in less urbanized areas were protective factors. In conclusion, urbanization, traffic exhaust, indoor emissions from redecoration and new furniture, gas cooking and air pollution from burning incense and biomass may cause dermal and mucosal symptoms, headache and fatigue among adults in China. Indoor animals (cats, mice/rats, cockroaches) were other risk factors. Daily cleaning, mechanical ventilation and living in older buildings can be protective., (Copyright © 2019. Published by Elsevier B.V.)