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April 2004, Vol 94, No. 4 | American Journal of Public Health 560-562
© 2004 American Public Health Association

RESEARCH AND PRACTICE

Asthma, Wheezing, and Allergies in Russian Schoolchildren in Relation to New Surface Materials in the Home

Jouni J. K. Jaakkola, MD, DSc, PhD, Helen Parise, PhD, Victor Kislitsin, MSc, Natalia I. Lebedeva, MD, DSc and John D. Spengler, PhD

Jouni J. K. Jaakkola is with the Institute of Occupational Health, The University of Birmingham, Edgbaston, Birmingham, UK, and the Department of Public Health, University of Helsinki, Helsinki, Finland. Helen Parise is with the Department of Mathematics and Statistics, Boston University, Boston, Mass. Victor Kislitsin and Natalia I. Lebedeva are with the Center for the Preparation and Implementation of International Technical Assistance Projects, Moscow, Russian Federation. John D. Spengler is with the Environmental Science and Engineering Program, Harvard School of Public Health, Boston, Mass.

Correspondence: Requests for reprints should be sent to Jouni J. K. Jaakkola, MD, DSc, PhD, Institute of Occupational Health, The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom (e-mail: j.jaakkola{at}bham.ac.uk).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 

In a cross-sectional study of 5951 Russian 8–12-year-old schoolchildren, risks of current asthma, wheezing, and allergy were related to recent renovation and the installation of materials with potential chemical emissions. New linoleum flooring, synthetic carpeting, particleboard, wall coverings, and furniture and recent painting were determinants of 1 or several of these 3 health outcomes. These findings warrant further attention to the type of materials used in interior design.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
The Soviet era has been followed by increased activity in construction and renovation of housing in the Russian Federation, as well as an introduction of new building technology and new materials used in interior design, furniture, and textiles. Two recent studies indicated that exposure to plastic flooring and wall materials may increase the risk of respiratory conditions in children.1,2 As part of a cross-sectional study of air pollution and respiratory health in Russia in 1996 to 1997,3,4 we tested a hypothesis that the risks of children’s asthma and allergic diseases are related to recent renovation, especially newly installed synthetic surface materials, furniture, and painting.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
The study population included 5951 children in second to fifth grade (8–12 years old) in 8 Russian cities in the Sverdlovsk Oblast region and the city of Cherepovets in the Upper Volga Oblast.3 The participation rate in schools varied from 96% to 98%. The questionnaire, modified from previous European and North American questionnaires for the Russian conditions,5,6 inquired about the child’s personal characteristics, health information, and socioeconomic factors. Local elementary schoolteachers were trained to conduct the interviews, and parents and guardians were invited to meetings after the school day was finished. After signing an informed consent form, a parent completed the questionnaire.

The current study focused on asthma, wheezing, and allergy. Current asthma was defined as a history of doctor-diagnosed asthma and symptoms, signs, or medication of asthma during the past 12 months. Current wheezing was defined as wheezing during the past 12 months. Any allergy was defined as any history of doctor-diagnosed allergy or parental-reported hay fever or pollinosis.

Exposure assessment was based on the following question: "Have you conducted any of the following renovations in your home within the past 12 months or earlier?" The choices were installation of linoleum floor, painting, particleboard, new furniture, synthetic carpet, wall covering, and suspended ceiling.

We used the odds ratio (OR) as a measure of effect and logistic regression analysis to adjust for age, gender, preterm birth, low birthweight, parental atopy, maternal smoking during pregnancy, exposure to environmental tobacco smoke at home (at ages 0–1 years, ages 2–6 years, and currently), and mother’s and father’s education.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Of the children, 1.5% had current asthma, 13.4% had current wheezing, and 33.2% had an allergy. Table 1Go shows the occurrence of the potential sources of emissions.


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  		TABLE 1—— New Surface Materials, Furniture, and Recent Painting in Russian Homes
 
The risks of current wheezing (adjusted OR = 1.36; 95% confidence interval [CI] = 1.00, 1.86) and allergy (adjusted OR = 1.31; 95% CI = 1.05, 1.65) were significantly related to the installation of linoleum flooring during the past 12 months (Table 2Go). The corresponding risk estimates were slightly lower when focusing on exposure earlier than 12 months ago. There was a general pattern of positive association between installation of synthetic carpet during the past 12 months and the 3 outcomes (adjusted ORs from 1.39 to 1.84), although for asthma, the association was not statistically significant. The effect estimates for the past 12 months were greater than those for earlier installation. The adjusted odds ratios for new wall covering during the past 12 months (from 1.20 to 1.25) and earlier (from 1.12 to 1.22) were lower. The odds ratios for recent painting were elevated for current wheezing and allergy. The odds ratios for new particleboard were substantially elevated for all the studied relations except for recent installation of particleboard and the risk of current asthma. The adjusted odds ratios for current asthma (1.33; 95% CI = 0.57, 3.06), current wheezing (1.32; 95% CI = 0.99, 1.77), and any allergy (1.43; 95% CI = 1.16, 1.75) were increased in relation to new furniture during the past 12 months but weaker in relation to new furniture installed earlier.


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  		TABLE 2—— Adjusted Odds Ratios (ORs) and 95% Confidence Intervals (CIs) for Current Asthma, Current Wheezing, and Presence of Any Allergy According to Recent Installation of Surface Materials and Furniture
 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
Consistent with our hypothesis, the risks of current asthma and wheezing and allergic diseases were related to installation of materials with potential chemical emissions.

Two previous studies provided evidence of the role of polyvinyl chlorides and other plastic surface materials.1,2 We asked about installation of linoleum flooring to identify polyvinyl chloride materials. In line with the Norwegian study, the risks of asthma and wheezing in the current study were related to installation of linoleum floors. Linoleum in colloquial Russian represents a large heterogeneous group of synthetic floor materials with an unknown proportion of polyvinyl chlorides; therefore, the exposure parameter was rather nonspecific.

Substantial evidence indicates that in the working-age population (13–65 y), painters have an increased risk for developing asthma and asthma-related and other respiratory symptoms.7–9 Paints used in home renovation are likely to emit similar chemical substances as the paints used by professional painters, although exposure levels in occupational settings are much higher than in the home environments after renovation. In the homes, the exposure levels are the highest during and shortly after painting, but low levels of exposure may remain for several months. Wooden furniture and also painted or varnished and new furniture are likely to emit chemical substances. Also, synthetic carpets, furniture, painting, and wall covering used as exposure indicators constitute a heterogeneous group of potential emitting materials.

The current findings warrant further attention to the type of materials used in interior design.


   Acknowledgments
 
This study was supported by a World Bank loan to the Russian Federation and administered under the Environmental Epidemiology Component, the Center for Preparation and Implementation of International Technical Assistance Projects.

We are indebted to our colleagues in the Ural Region Environmental Epidemiology Center who, under the direction of Dr Sergey Kuzmin, conducted a successful comprehensive study of air pollution and children’s health in 9 Russian cities.

Human Participant Protection
Parents were informed that participation was voluntary. Questionnaires were completed by parents and returned in sealed envelopes. No personal identifiers were used in our data files and all questionnaires have been destroyed. Data were not collected from children.


   Footnotes
 
Contributors
J. J. K. Jaakkola conceived the hypothesis, participated in the planning of the study and statistical analyses and in the interpretation of the results, and wrote the brief. H. Parise conducted the statistical analyses and contributed to the interpretation of the results. V. Kislitsin and N. I. Lebedeva participated in the planning of the study and contributed to the writing of the brief. J. D. Spengler participated in planning of the study and statistical analyses and in the interpretation of the results and provided input on the writing of the brief.

Peer Reviewed

Accepted for publication April 8, 2003.


   References
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Jaakkola JJK, Øie L, Nafstad P, Botten G, Samuelsen SO, Magnus P. Interior surface materials in the home and the development of bronchial obstruction in young children in Oslo, Norway. Am J Public Health. 1999;89:188–192.[Abstract/Free Full Text]

2. Jaakkola JJK, Verkasalo PA, Jaakkola N. Plastic wall materials in the home and respiratory health in young children. Am J Public Health. 2000;90:797–799.[Abstract/Free Full Text]

3. Spengler JD, Jaakkola JJK, Parise H, et al. Housing characteristics and children’s respiratory health in the Russian Federation. Am J Public Health. 2004;94:657–662.[Abstract/Free Full Text]

4. Jaakkola JJK, Cherniack M, Spengler JD, et al. Use of health information systems in the Russian Federation in the assessment of environmental health effects. Environ Health Perspect. 2000;108:589–594.[ISI][Medline]

5. Ferris BG. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis. 1978;118:1–120.[ISI][Medline]

6. Jaakkola JJK, Jaakkola N, Ruotsalainen R. Home dampness and molds as determinants of respiratory symptoms and asthma in pre-school children. J Expo Anal Environ Epidemiol. 1993;3(suppl 1):129–142.

7. Wieslander G, Janson C, Norback D, Bjornsson E, Staleheim G, Edling C. Occupational exposure to water-based paints and self-reported asthma, lower airway symptoms, bronchial hyperresponsiveness, and lung function. Int Arch Occup Environ Health. 1994;66:261–267.[Medline]

8. Mastrangelo G, Paruzzolo P, Mapp C. Asthma due to isocyanates: a mail survey in a 1% sample of furniture workers in the Vento region, Italy. Med Lav. 1995;86:503–510.[Medline]

9. Ucgun I, Ozdemir N, Metintas S, Erginel S, Kolsuz M. Prevalence of occupational asthma among automobile and furniture painters in the center of Eskisehir (Turkey): the effects of atopy and smoking habits on occupational asthma. Allergy. 1998;53:1096–1100.[Medline]




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