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It is difficult to accurately measure the air exchange rate (AER) in residential and office buildings during occupation via on-site field measurement. The tracer gas method was widely applied to estimate the AER in these buildings, and human metabolic carbon dioxide (CO2) was often used as a tracer gas in different models. This study introduced three models (the ASHRAE model, the ASHRAE China-specific modified model, and the BMR model), which were proposed to estimate the AER based on exhaled CO2. We verified these models by comparing the exhaled CO2-based AER with AER from field measurements using sulfur hexafluoride (SF6) as a tracer gas. We also analyzed the potential factors that could affect the uniformity of the indoor tracer gas distribution. Our results indicate that the ASHRAE China-specific modified model has the best performance with an average deviation of −6.67% and a maximum deviation of −14.6% with multiple measurement points, a stable personnel activity, and proper Parameter settings in a single room in China. [ABSTRACT FROM AUTHOR]

Indoor radon exposure is thought to be associated with adverse health effect as lung cancer. Lung cancer incidences in China have been the highest worldwide during the past two decades. It is important to quantitively address indoor radon exposure and its health effect, especially in countries like China. In this paper, we have conducted a meta‐analysis based on indoor radon and its health effect studies from a systematic review between 2000 and 2020. A total of 8 studies were included for lung cancer. We found that the relative risk (RR) was 1.01 (95% CI: 1.01–1.02) per 10 Bq/m3 increase of indoor radon for lung cancer in China. The subgroup analysis found no significant difference between the conclusions from the studies from China and other regions. The health effect of indoor radon exposure is relatively consistent for the low‐exposure and high‐exposure groups in the subgroup analysis. With a better understanding of exposure level of indoor radon, the outcomes and conclusions of this study will provide supports for next phase of researches on estimation of environmental burden of disease by indoor radon exposures in countries like China. [ABSTRACT FROM AUTHOR]

China's profoundly rapid modernization in the past two decades has resulted in dramatic changes in indoor environmental exposures. Among these changes, exposure to phthalates has attracted increasing attention. We aimed to characterize indoor phthalate exposure and to estimate the disease burden attributable to indoor phthalate pollution from 2000 to 2017 in China. We integrated the national exposure level of indoor phthalates from literature through systematic review and Monte Carlo simulation. Dose‐response relationships between phthalate exposure and health outcomes were obtained by systematic review and meta‐analysis. Based on existing models for assessing probabilities of causation and a comprehensive review of available data, we calculated the disability‐adjusted life years (DALYs) among the general Chinese population resulting from exposure to indoor phthalate pollution. We found that DnBP, DiBP, and DEHP were the most abundant phthalates in indoor environments of residences, offices, and schools with medians of national dust phase concentration from 74.5 µg/g to 96.3 µg/g, 39.6 µg/g to 162.5 µg/g, 634.2 µg/g to 1,394.7 µg/g, respectively. The national equivalent exposure for children to phthalates in settled dust was higher than that of adults except for DiBP and DnOP. Dose‐response relationships associated with DEP, DiBP, DnBP, BBzP, and DEHP exposures were established. Between 2000 and 2017, indoor phthalate exposure in China has led to 3.32 million DALYs per year, accounting for 0.90% of total DALYs across China. The annual DALY associated with indoor phthalate pollution in China was over 2000 people per million, which is about 2~3 times of the DALY loss due to secondhand smoke (SHS) in six European countries or the sum of the DALY loss caused by indoor radon and formaldehyde in American homes. Our study indicates a considerable socioeconomic impact of indoor phthalate exposure for a modernizing human society. This suggest the need for relevant national standard and actions to reduce indoor phthalate exposure. [ABSTRACT FROM AUTHOR]

After decades of development, the indoor environment in China has changed. A systematic review was conducted from peer‐reviewed scientific papers with field test data of indoor radon in China from 2000 to 2020 for three types of buildings. The mean concentrations of indoor radon for dwellings, school buildings, and office buildings are 54.6, 56.1, and 54.9 Bq/m3. The indoor radon concentration was related to seasons, climate regions, ventilation, decoration, and other factors such as soil and outdoor air. Colder seasons, especially in severe colder areas of China, newer decorated buildings, closed windows, and doors were all associated with higher indoor radon concentrations. Variables like climate region and ventilation showed statistical significance in the correlation analysis. Regarding the increasing trend of indoor radon concentration in China during the last two decades, further study of indoor radon is necessary especially for school buildings and office buildings, and will help access its environmental burden of disease in China more accurately. [ABSTRACT FROM AUTHOR]

Indoor ammonia (NH3) pollution has been paid more and more attention in view of its health risk. However, few studies have investigated the exposure level in the non‐occupational environment in China. This study systematically reviewed the indoor ammonia exposure level in different regions, the equivalent exposure concentration of different populations, and the factors that influence indoor air ammonia in residences, offices, and schools in China. The literature published in 1980–2019 from main databases was searched and detailed screened, and finally, 56 related studies were selected. The results illustrated that the median concentration of indoor air ammonia in residences, offices, and school buildings was 0.21 mg/m3, 0.26 mg/m3, and 0.15 mg/m3. There were 46.4%, 71.4%, and 40% of these samples exceeding the NH3 standard, respectively. The national concentrations and the equivalent exposure levels of adults and children were calculated and found to be higher than 0.20 mg/m3. The concentration of ammonia varied greatly in different climate zones and economic development regions. Higher concentrations were found in the severe cold zone and the regions with higher economic level. This review reveals a high exposure risk of indoor air ammonia and the crucial impact of human emission, indoor air temperature, new concrete, and economic level, suggesting further investigation on indoor air ammonia evaluation and health effects. [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]

Few studies have illustrated the effects of residential environmental conditions on prevalence of allergic disease for adults. A cross-sectional study with 17898 valid samples from parents of preschool children was carried out during 2010-2011 in Shanghai, China. The allergic symptoms of these participants were surveyed; meanwhile the building characteristics, environmental exposures and lifestyle behaviors were all reported by the questionnaires. Pearson’s Chi-square (χ2), Gamma correlation analysis and logistic regression analysis were applied to investigate associations between building characteristics, lifestyle and their allergic symptoms. The results displayed that interior renovation or adding new furniture, home dampness-related indicators and the residential distance within 200 meters of the traffic trunk or highway, using incense and so on were the significant risk factors for allergic symptoms (p<0.05, AOR>1), while exposing the bedding to sunshine is a protective factor, so we can draw that controlling indoor air pollution and the residential dampness-related indicators, as well as changing the bad habits are the effective measures to prevent allergic symptoms. [ABSTRACT FROM AUTHOR]

Purposes: We aim to investigate associations of the child's individual characteristics, building characteristics, home environmental exposures, family lifestyle behaviors, and dietary habits on childhood eczema during lifetime-ever and in the last year before the survey. Methods: During April 2011-April 2012, we conducted a cross-sectional study and collected 13,335 parents-reported questionnaires of 4-6-year-old children from 72 kindergartens in Shanghai, China. Logistic regression model was used to investigate associations. Results: After adjusted for sex, age, family history of atopy, and questionnaire reporter, the factors which were strongly associated (increased odds >30% and p value <0.05) with lifetime-ever eczema included mother employed during pregnancy (adjusted OR 1.33), residence renovated during pregnancy (1.49) and in the child's first year of life (1.31), using laminate (1.58) and solid (1.42) wood as material of floor covering (compared to using cement), residence located in urban district (1.38), and dampness-related exposures in the early residence (mold spots/stains: 1.41; mold odor: 1.41) and in the current residence (water damage: 1.33; damp stains: 1.34; mold spots: 1.32; and windows pane condensation: 1.31). Parental smoking, pet-keeping, and incense-burning had no significant associations with childhood eczema. Similar associations were found for eczema in the last year before the survey. Families with sick children likely changed lifestyle behaviors and dietary habits. Conclusions: Childhood eczema could be influenced by many household environmental and non-environmental factors. Exposures during early lifetime likely have greater impact on childhood eczema than current exposures. Associations of lifestyle behaviors and dietary habits with childhood eczema could be modified by family avoidance behaviors. [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]

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]

Dampness-related exposures have been widely discovered in household, which are associated with childhood health. This study employed the Back-Propagation (BP) neural network to develop prediction models of overall dampness evaluation based on the on-site dampness inspection in 454 families. The trained models were then used to predict the overall dampness exposure in 15,266 families with five parent-reported dampness-related indicators. Two indices, including the overall-dampness- exposure-based (ODEB) score and combination-of parent-reported- based (CPRB) score, were introduced to reflect the household dampness exposure in Shanghai, and were used to build the relationship with different childhood respiratory diseases and allergies. The results indicated that the trained model of BP neural network had a reasonable accuracy with the coefficient of determination R2 greater than 0.5, and the standard deviation ratios were approaching 1.0. Both the ODEB score predicted by trained model and CPRB score were developed based on parent reported dampness indicators in the cross-sectional survey, and were significantly associated with childhood respiratory diseases after adjusting the confounders (AOR >1.3, p < 0.01, SDS factor >0). Exposure-response relationships were also found between the dampness exposure indices and health outcomes. A continuous dampness evaluation index with a reasonable accuracy was proposed based on BP neural network prediction of on-site dampness scoring, which was consistent with the CPRB score, showing an exposure-response relationship with childhood diseases. These findings provide us an approach to predict the household dampness and its related adverse health outcomes. • Dampness exposures are common in residential buildings in China. • Home dampness-related exposure is a risk for childhood allergies and respiratory diseases. • The parent-reported dampness can be linked to the inspector-observed dampness. • There are exposure-response relationships between dampness indicators and children health. • Two developed dampness indices can predict the dampness-related health outcomes. [ABSTRACT FROM AUTHOR]

Findings for impacts of outdoor air pollutants on birth outcomes were controversial. We performed a retrospective observational study in 2527 preschoolers of Shanghai, China and investigated associations of duration-averaged concentrations of outdoor sulphur dioxide (SO 2), nitrogen dioxide (NO 2), and particulate matter with an aerodynamic diameter ≤ 10 μm (PM 10) in different months and trimesters of gestation, with preterm birth (PB), low birth weight (LBW), term low birth weight (T-LBW), and small for gestational age (SGA). Daily concentrations of outdoor air pollutants were collected in each residence-located district. Parents reported health information. In the multivariate logistic regression analyses, exposures to outdoor NO 2 were consistently associated with the higher odds of LBW and T-LBW. These associations were generally stronger for early months than for later months of the gestation. Adjusted odds ratios generally were larger in multi-pollutant model than in single-pollutant model. Exposure to NO 2 in the first month of the gestation was significantly associated with T-LBW (adjusted OR, 95%CI: 1.91, 1.02–3.58 for increment of interquartile range (18.5 μg/m3); p -value = 0.044) in multi-pollutant model. This association was stronger in girls, renters, and children whose mothers ≥30 years-old, with household dampness-related exposures, and with parental smoking during pregnancy. Our results indicate that exposure to NO 2 during gestation perhaps is a risk factor for LBW and T-LBW, and effects of NO 2 exposures could be greater during early periods than during later periods of gestation. • A retrospective observational study in 2527 preschoolers was conducted. • Exposures to outdoor NO 2 consistently associated with LBW and T-LBW. • These associations were stronger for early months than for later months. • Adjusted ORs were larger in multi-pollutant than single-pollutant model. • No significant associations were found of SO 2 and PM 10 with all outcomes. [ABSTRACT FROM AUTHOR]

In order to investigate the relationship between outdoor air pollution and sick building syndrome (SBS) symptoms, the CCHH (China, Children, Home, Health) group in Shanghai conducted a cross-sectional survey on the current incidence of SBS symptoms among residents in five districts of Shanghai during April 2011–April 2012. It also collected the related outdoor air pollutants data from Shanghai environmental monitoring center (SEMC), including nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ) and particles with aerodynamic diameter less than 10 µm (PM 10 ). The logistic regression models were used in this paper to study the associations between air pollutants and SBS symptoms. Results were found that the daily mean concentrations of NO 2 and SO 2 met standard requirement, but that of PM 10 exceeded the limit values of the standard in China during this survey. The significant differences were found between the pollutants concentration in urban and suburban area. In addition, the incidences of three categories of SBS symptoms among residents were 79.1% for general symptoms (GS), 65.2% for mucous membrane symptoms (MS) and 35.7% for skin symptoms (SS), respectively. Multiple logistic regression analysis by two case studies illustrated that three outdoor air pollutants, both their concentration quartiles and equal increment, were all associated to and taken as the risk factors for SBS symptoms, for GS OR NO2  = 1.62 (1.18–2.22), MS OR NO2  = 1.58 (1.21–2.06) and SS OR PM10  = 1.21 (1.09–1.35). Furthermore, the new pollutants expressed as the mixtures of their combination were also significantly associated with part of the SBS symptoms. The synthetic air quality indexes of all surveyed residents were calculated as III-level, which represented mild pollution. Therefore, it would be an effective way to decrease the incidence of SBS symptoms in residence to reduce the outdoor air pollution and control the penetration from outdoor to indoor environment. [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]

Exposure to household phthalates has been reported to have adverse effects on children's health. In this paper, we used phthalate metabolites in the first morning urine as indicators of household phthalate exposures and examined their associations with residential characteristics, lifestyles and dietary habits among young children. During 2013–2014, we collected morning urines from children aged 5–10 years in Shanghai, China and obtained the related information about analyzed factors in this study by questionnaires. Urinary phthalate metabolites were analyzed by isotope dilution-high performance liquid chromatography (HPLC)-heated electrospray ionization source (HESI) coupled with a triple quadrupole mass spectrometry. ANOVA, the Mann-Whitney or Kruskai-Wallis rank tests, and multivariate linear regression analyses were used to examine the target associations. Ten metabolites of seven phthalates in 434 urine samples were analyzed. The detection rates of eight metabolites (MiBP, MnBP, MEHP, MECPP, MEHHP, MEOHP, MEP, and MMP) were > 90%, except for MBzP (51.2%), and MCHP with < 10.0% of detection rate was not included in analyses. By multivariate linear regression analyses, factors significantly associated with higher concentrations of metabolites included non-usage household air cleaners (MEP and MEHP), changing the child's pillowcase less than one time a week (DEHP metabolites), dusting furniture in the child's bedroom less than three times a week (MMP and MnBP), using more plastic toys (DEHP metabolites and MEP), often having soft drinks (DEHP metabolites) and candies (MiBP). Our results indicated that phthalate exposures were common among Shanghai children and residential characteristics had less significant associations with urinary phthalate metabolites compared with lifestyles and dietary habits. Using less plastic toys, having less candies and soft drinks, using household air cleaner, as well as frequently changing the child's pillowcase and dusting furniture in the child's bedroom could reduce phthalate exposures among children. [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]

The prevalence of children allergic rhinitis has been increasing in China and associated factors still are not clear. In the present paper, we selected 13,335 parent-reported questionnaires of 4-6 years-old children, in a cross-sectional study from April 2011 to April 2012 in Shanghai city, and investigated associations of various factors with parent-reported allergic rhinitis (doctor-diagnosed) and rhinitis symptoms in childhood. After adjusted by age, sex, family history of atopy, and respondent of questionnaire, we find that no siblings, mother in older age during pregnancy, shorter breastfeeding, using antibiotics in the first year, and home dampness-related exposures, had significant associations with increased prevalence of the studied diseases. Location, type, building area, decoration materials and construction period of the residence, also had significant associations with these diseases. Current parental smoking and pet-keeping had no significant associations with the studied diseases. Incense-burning and using mosquito coils had significant associations with reduced risk of allergic rhinitis and with increased risk of rhinitis symptoms. Using air cleaner and cleaning the residence in high frequency had associations with increased risk, but eating fast food and ice cream often had associations with the reduced risk, of the studied diseases. Families with children being diagnosed allergic rhinitis likely change their lifestyle behaviors. In conclusion, childhood rhinitis could be influenced by heredity and many "environmental exposures". Avoidance behaviors and reverse causation in parental smoking, pet-keeping, and dietary habits for childhood rhinitis should be carefully considered. [ABSTRACT FROM AUTHOR]

Phthalic acid esters (PAEs) have a negative impact on human health and are widely distributed in China. As part of the China, Children, Home, Health (CCHH) study, we investigated the associations between childhood asthmatic symptoms and PAEs in settled house dust in Shanghai, China. We found that di-2-ethylhexyl phthalate (DEHP), dibutyl phthalate (DBP), and diisobutyl phthalate (DiBP) were abundant in the indoor environment. A total of 27 % of children suffered from diagnosed asthma. The Mann-Whitney U test and multiple logistic regression were used to obtain the associations between PAEs and childhood asthmatic symptoms. Stratification analysis was performed to reveal the influence of gender on the associations between PAE exposure and target symptoms. Compared with low concentrations of PAEs, high concentrations of high molecular weight PAEs (HMW-PAEs) were significantly associated with childhood diagnosed asthma (adjusted odds ratios (AORs) > 1, P < 0.05). Moreover, significantly negative associations were found between high concentrations of DiBP and current cough (AORs<1, P < 0.05). All significantly positive associations were observed among girls, and most of the associations of dimethyl phthalate (DMP) and diethyl phthalate (DEP) exposure with the studied symptoms among girls were higher than those among boys. Exposure to PAEs may be a risk factor for asthmatic symptoms in children, especially in girls. • Phthalic acid esters are widely detected in household dust of residents in Shanghai, China. • Exposure to several kinds of PAEs would increase the risk of childhood wheeze and diagnosed asthma. • Significant higher concentration of DiBP is found in those families with children not suffered from current cough. • Significantly positive associations between PAEs and asthmatic symptoms are found only among girls. [ABSTRACT FROM AUTHOR]

Background: Several studies have reported that childhood prevalence of eczema has been increasing worldwide. However, none study quantitatively evaluated prevalence trends of eczema among children and adults in the last 30 years in China., Methods and Findings: Via a systematic review of literature databases in English and Chinese, we summarized all studies reporting eczema prevalences from 1985 to 2015 in China as well as diagramed prevalence and eczematous population trends against year for different age groups. A total of 93 studies and 17 studies (16 for children and one for adults) were selected for qualitative and quantitative synthesis, respectively. Childhood lifetime-ever eczema prevalences ranged from 10.0% to 30.0%. Prevalences among 3-12-year-olds children showed increasing trends in most specific cities, but national lifetime-ever eczema prevalences among 13-14-year-olds children decreased from 10.6% in 2001 to 8.6% in 2009 in mainland China. We estimated that about 1.5 million children aged 13-14-year-olds in 2009 and 15.5 million children aged 3-6-year-olds in 2012 had lifetime-ever eczema in mainland China. Similar studies were too few to ascertain time-trends of eczema prevalence among adults. About 39.4, 20.0, and 11.6 million adults aged 15-86-year-olds in 2010 had contact dermatitis, seborrheic dermatitis, and atopic dermatitis in the mainland China, respectively., Conclusions: The burden of eczema became heavier in young children, whereas perhaps had been reduced in adolescent in China. More studies for eczema prevalence in adults are warranted., (© 2022. The Author(s).)

Objective: Phthalate acid esters (PAEs) have been identified to be associated with children's health. Present study was conducted to assess associations between PAEs in household dust and childhood rhinitis., Methods: Based on phase II of CCHH study (China, Children, Home, Health) conducted in Shanghai, China, 266 indoor dust samples were collected from participants' families. Concentrations of PAEs in dust samples were measured by chemical treatment and gas chromatograph-mass spectrometer. Information about individuals and residences was surveyed by questionnaires. Logistic regression models were applied to obtain the associations between PAEs and childhood rhinitis., Results: Higher concentrations of benzyl butyl phthalate (BBP) were found in those families with children who had diagnosed rhinitis. Significantly higher concentrations of bis(2-ethylhexyl) phthalate (DEHP) and PAEs with high molecular weight (HMW-PAEs) were found in the positive group of lifetime rhinitis. Using the multiple and ordinal logistic regression models adjusted by covariates, dibutyl phthalate (DBP), DEHP, and HMW-PAEs were found to be significantly associated with diagnosed rhinitis. Boys who exposure to higher concentrations of DBP, DEHP, HMW-PAEs, and total PAEs have significant associations with diagnosed rhinitis compared with girls who exposure to lower concentration of PAEs., Conclusions: Present observational study indicated that exposure to high concentrations of DBP, DEHP, and HMW-PAEs in house settled dust was a risk factor for rhinitis for children, especially for boys., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Associations of household airborne fungi with allergies in childhood were inconsistent in the epidemiologic studies. During 2013-2014, we conducted a case-control study (phase two), which was nested in a cross-sectional study (phase one) during 2011-2012 in Shanghai, China. We inspected indoor air quality of 454 residences for 5-10 years old children. We defined cases as those children who were reported illnesses in the questionnaire of phase one or phase two and defined controls as those children who were not reported illnesses in both phases. A total of 436 living rooms and 445 bedrooms had valid data of household airborne fungi, and their mean concentrations were 301 cfu/m 3 and 310 cfu/m 3 , respectively. In the multiple logistic regression analyses with adjusting for potential confounders, most associations of 16 studied illnesses with airborne fungi concentration were not statistically significant. Taking children in the 1st quartile that was stratified according to airborne fungi concentration in the living room as reference, only children in the 3rd quartile were significantly associated with a higher odd of lifetime-ever ear infections (adjusted OR, 95% CI 3.05, 1.29-7.21), and children in the 4th quartile were significantly associated with a higher odd of lifetime-ever wheeze (2.72, 1.28-5.75); but children in the 3rd quartile (0.33, 0.17-0.68) and in the 4th quartile (0.47, 0.23-0.97) were significantly associated with a lower odd of rhinitis in the past 12 months prior to the home inspection. Our results indicate that exposures to indoor airborne fungi in low concentrations seemingly have no significant impacts on the risks of most allergic and airway illnesses in childhood. Since families with sick participants might pay more attention to improve indoor air quality, effects of "avoidance behavior" on associations between indoor pollutants and childhood health should be considered in the data analysis and design of the nested case-control study.

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.)

It's inconsistent about associations of early exposures to outdoor air pollutants with allergies and airway diseases in childhood. Here, we investigated associations of prenatal and postnatal exposures to outdoor nitrogen dioxide (NO 2 ), sulphur dioxide (SO 2 ), and PM 10 (particulate matter with an aerodynamic diameter ≤ 10 μm) with asthma, wheeze, hay fever, rhinitis, pneumonia, and eczema in childhood. We surveyed 3,177 preschoolers who never change residences since birth in Shanghai, China. Parents reported information regarding children's health status. Daily-averaged concentrations of these pollutants in the children's gestation and in the first year of lifetime for district where children lived were collected by Shanghai Environmental Monitoring Center. After adjusting for covariates, exposures to higher level of NO 2 during different trimesters of gestation and of the first year of lifetime had significant associations with the increased odds of asthma, hay fever, rhinitis, pneumonia, and eczema in childhood. Associations of NO 2 exposures in the early trimesters of gestation and of the first year of lifetime with pneumonia were stronger than in the later trimesters, whereas associations of NO 2 exposures in the early trimesters with hay fever and eczema were weaker than in the later trimesters. Our results indicated that prenatal and postnatal exposures to outdoor NO 2 could be risk factors for allergies and airway diseases in childhood. Both dose and duration were related with the influence degree of early NO 2 exposure on childhood allergies and airway diseases., 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 Ltd.. All rights reserved.)

Background : Associations of early antibiotics exposures with childhood asthma, allergies, and airway illnesses are debated. Objectives : We aimed to investigate associations of first-year antibiotics exposure with childhood asthma, allergies, and airway illnesses. Methods : A cross-sectional study was conducted among preschoolers in Shanghai, China during 2011-2012. A questionnaire regarding household environment and lifestyles and childhood health outcomes was reported by the child's parents. Results : In total, 13,335 questionnaires (response rate: 85.3%) were analyzed and 3049 (24.1%) children had first-year antibiotics exposure. In the multivariate logistic regression analyses, first-year antibiotics exposure had significant associations with the higher odds of lifetime-ever pneumonia (adjusted OR, 95% CI: 2.15, 1.95-2.37), croup (1.46, 1.24-1.73), wheeze (1.44, 1.30-1.60), asthma (1.38, 1.19-1.61), food allergy (1.29, 1.13-1.46), and allergic rhinitis (1.23, 1.07-1.41), and as well as current (one year before the survey) common cold (≥3 times) (1.38, 1.25-1.52), dry cough (1.27, 1.13-1.42), atopic dermatitis (1.25, 1.09-1.43), wheeze (1.23, 1.10-1.38), and rhinitis symptoms (1.15, 1.04-1.26). These associations were different in children with different individual characteristics (age, sex, family history of atopy, and district) and other early exposures (breastfeeding, home decoration, pet-keeping, and environmental tobacco smoke). Conclusions : Our results indicate that first-year antibiotics exposure could be a strong risk factor for childhood pneumonia, asthma, allergies, and their related symptoms. The individual characteristics and other early exposures may modify effects of early antibiotic exposure on childhood allergies and airway illnesses.

Findings are inconsistent in studies for impacts of outdoor air pollutants on airway health in childhood. In this paper, we collected data regarding airway and allergic symptoms in the past year before a survey in 13,335 preschoolers from a cross-sectional study. Daily averaged concentrations of ambient sulphur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and particulate matter with an aerodynamic diameter ≤10 μm (PM 10 ) in the past year before the survey were collected in the kindergarten-located district. We investigated associations of 12-month average concentrations of these pollutants with childhood airway and allergic symptoms. In the two-level (district-child) logistic regression analyses, exposure to higher level of NO 2 and of PM 10 increased odds of wheeze symptoms (adjusted OR, 95%CI: 1.03, 1.01-1.05 for per 3.0 μg/m 3 increase in NO 2 ; 1.22, 1.09-1.39 for per 7.6 μg/m 3 increase in PM 10 ), wheeze with a cold (1.03, 1.01-1.06; 1.22, 1.08-1.39), dry cough during night (1.05, 1.03-1.08; 1.23, 1.09-1.40), rhinitis symptoms (1.11, 1.08-1.13; 1.32, 1.07-1.63), rhinitis on pet (1.11, 1.05-1.18; 1.37, 0.95-1.98) and pollen (1.12, 1.03-1.21; 1.23, 0.84-1.82) exposure, eczema symptoms (1.09, 1.05-1.12; 1.22, 0.98-1.52), and lack of sleep due to eczema (1.12, 1.07-1.18; 1.58, 1.25-1.98). Exposures to NO 2 and PM 10 were also significantly and positively associated with the accumulative score of airway symptoms. Similar positive associations were found of NO 2 and of PM 10 with the individual symptoms and symptom scores among preschoolers from different kindergarten-located district. These results indicate that ambient NO 2 and PM 10 likely are risk factors for airway and allergic symptoms in childhood in Shanghai, China., Competing Interests: Declaration of competing interests 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 Elsevier Ltd. All rights reserved.)

We surveyed 40 010 three- to six-year-old children in seven Chinese cities (Beijing, Taiyuan, Urumqi, Shanghai, Nanjing, Changsha, and Chongqing) during 2010-2012 so as to investigate possible links between home renovation and childhood eczema. Their parents responded to questions on home renovation and childhood eczema. Multivariate and two-level (city-child) logistic regression analyses yielding odds ratios with 95% confidence intervals were performed. Sensitivity analyses stratifying data for region, climate, and income level were also performed. The prevalences of childhood eczema in children with different floor and wall covering materials were significantly different and were significantly higher with home renovation during early lifetime. Exposure to synthetic materials significantly increased the risk of childhood eczema by 20%-25%. The risks (AOR, 95% CI) of current eczema among children in families with solid wood flooring and oil paint wall covering were 1.25 (1.04-1.49) and 1.35 (1.14-1.60), respectively. Home renovation during pregnancy was related to children's lifetime and current eczema., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Few studies can be found on phthalate exposure in relation to childhood asthma and allergic symptoms from Mainland China, where a persistent increase in prevalence of childhood asthma and allergic disease has been observed., Objectives: This study aimed to assess the exposure levels to phthalates and its relationship with asthmatic and allergic symptoms among children in Shanghai, which has the highest prevalence of childhood asthma in Mainland China., Methods: A follow-up study (2013-2014) of 434 children aged 5-10 years was conducted, based on the China, Children, Homes, Health (CCHH) study (2011-2012) in Shanghai, China. Information on asthmatic and allergic symptoms (wheeze, rhinitis, and eczema) were collected using validated questionnaires. Ten phthalate metabolites in morning urine samples were analyzed by high-performance liquid chromatography with triple quadrupole tandem mass spectrometry (HPLC-MS/MS). Multivariable logistic regression was used to estimate the associations between symptoms and urinary phthalate metabolites controlling for demographics, family history of allergic diseases and other covariates., Results: Nine out of 10 phthalate metabolites were detected in all subjects (average detection rate of 93.2%). By multivariable logistic regression analyses, the 4th quartile of Mono‑n‑butyl phthalate (MnBP) (reference: 1st quartile) had adjusted prevalence odds ratios (aPOR S ) and 95% confidence intervals (95%CIs) of 2.27(1.06-4.88), 2.14(1.02-4.46) and 2.98(1.19-7.50) for wheeze, rhinitis and eczema, respectively, while those of Mono‑isobutyl phthalate (MiBP) were 2.23(1.08-4.62) and 2.96(1.02-8.60) for rhinitis and eczema, respectively. The highest quartile of mono‑2‑ethyl‑5‑hydroxyhexyl phthalate(MEHHP) and mono‑2‑ethyl‑5‑oxohexyl phthalate(MEOHP) had aPOR S and 95%CIs of 3.10(1.10-8.74) and 2.63(1.02-6.80) for eczema, respectively. By summing up the 4 low molecular weight metabolites (∑ 4 LMWP) and all 9 metabolites (∑ 9 Total), the highest quartiles of ∑ 4 LMWP and∑ 9 Total were significantly associated with all symptoms. In most of the above associations, a significantly increasing trend from the 1st to the 4th quartile was observed. Subjects with 2 or 3 concomitant symptoms (reference: no symptoms) had significant positive associations with a higher level (the 4th quartile) of phthalate metabolites., Conclusions: Low MW metabolites such as MnBP and MiBP, high MW DEHP and the total amount of phthalate metabolites might have adverse health effects on asthma and allergic symptoms in Chinese children., (Copyright © 2018. Published by Elsevier Ltd.)

From April 2011 to April 2012, we conducted a cross-sectional study in Shanghai, China. A total of 13,335 modified ISAAC questionnaires (response rate: 85.3%) were returned by parents or guardians for 4-6 year-old children. Six dampness-related indicators (visible mold spots, visible damp stains, damp bed clothing, water damage, window pane condensation, and moldy odor) were used to evaluate home dampness-related exposures. In the present study, we applied logistic regression model to reveal associations, dose-response relationships, and statistical interaction effects of these dampness-related exposures, with childhood eczema, during lifetime since birth (ever) and in the last 12 months before the questionnaire. The dampness-related indicators were frequently reported in the perinatal and current residences. Prevalences of eczema ever and in the last 12 months were 22.9% and 13.2%, respectively. The dampness-related indicators were robustly associated and dose-response related with increased risk of eczema ever and in the last 12 months in the logistic regression analyses, with adjusted for potential confounders. Specifically, in the perinatal residence, visible mold spots or damp stains could increase 46% (OR, 95% CI: 1.46, 1.29-1.66) odds of childhood eczema (ever); in the current residence, visible mold spots and visible damp stains could increase 34% (1.34, 1.14-1.58) and 38% (1.38, 1.22-1.56) odds of childhood eczema (ever), respectively. Associations were not appreciably different between boys and girls, nor were they different between children with and without parental history of atopy. In conclusion, perinatal and current dampness-related exposures in the residence perhaps are risk factors for childhood eczema., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of airway inflammation. Our aim was to analyze the interrelationship and differentiate the predicting effects of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) on the FeNO levels in children from mainland China., Methods: A case-control study with age- and gender matched 1:1 was designed based on a larger cross-sectional survey on asthma, AR, and AD in Shanghai. A self-administered questionnaire was used to collect information on children's health information. Children with positive reports on physician-diagnosed asthma and/or AR and/or AD were recruited as cases, and children with no report of any of the diseases were designated as controls. The FeNO measurement was performed online, using the NIOX MINO® instrument (Aerocrine AB, Solna, Sweden) at 50 ml/min., Results: A total of 130 subjects (65 cases and 65 controls, average age = 10 years) were recruited in this study. The average FeNO level was significantly higher in the cases (29.8 ± 1.9 ppb) than that in the controls (13.3 ± 1.7 ppb) (p < .001). Using multiple linear regression analysis controlling for confounding factors, including parental asthma/allergic diseases and home exposure, asthma (β = 0.330, p < .001) and AR (β = 0.157, p = .006) showed significant predicting effects for high FeNO levels, whereas AD was not related to the FeNO levels., Conclusions: Both asthma and AR could independently increase the FeNO levels in Chinese schoolchildren. Other diseases besides asthma should be considered when applying FeNO as a screening tool for asthma in Chinese children.