BACKGROUND:Household mold is a major problem in communities which face natural disasters such as hurricanes or flooding, and in homes with other sources of significant water intrusion; a biomarker for exposure to indoor mold could support public health investigations. METHODS:We analyzed serum from 132 children with asthma living in government-subsidized housing for six microbial volatile organic compounds (2-ethyl-1-hexanol, 2-heptanone, 2-hexanone, 3-methylfuran, 3-octanone, and geosmin) using GC-MS. Fewer than 10% of the samples for three compounds (2-ethyl-1-hexanol, 2-heptanone, and 2-hexanone) were quantified below the limit of detection. Associations between mold/water damage variables and microbial volatile organic compounds (mVOCs) were assessed via regression analyses, adjusting for urinary cotinine and self-reported home characteristics. RESULTS:Children with household mold (assessed by occupant report of visual mold, mold odor, or water damage) had 32% higher serum concentrations of 2-hexanone than those living in homes without reported mold or water damage. We investigated indoor tobacco use via urinary cotinine analysis of a "first morning void spot sample" (FMV) and found that children with higher urinary cotinine had significantly higher serum 2-ethyl-1-hexanol. We found that children in homes where residents reported tobacco smoking indoors had significantly higher serum 2-ethyl-1-hexanol compared with those without reported household smoke exposure. Tobacco smoke, indoor painting, gas stoves, and carpets were not confounders in the relationship between mVOCs and mold/water damage variables. CONCLUSION:2-hexanone, along with an index variable which included all detectable mVOCs in our panel, are promising biomarkers of recent mold exposure that could be used in concert with other detection methods.

Objective As extreme weather events become more pervasive due to climate change, identifying populations with lower access to resources becomes critical for timely mitigation efforts. Here we analyzed data from a survey conducted in Louisiana after Hurricane Ida to investigate demographic and housing characteristics of those vulnerable to home damage, flooding, and mold exposure after an extreme weather event. Methods The survey participants comprised a convenience sample of 167 total respondents, most of whom resided in the Greater New Orleans Area. Sociodemographic, housing, and geographic factors were considered that described the population reporting home damage, flooding, and/or mold due to Hurricane Ida compared with those who did not experience these outcomes from Hurricane Ida. Results Sociodemographic and housing factors predicting adverse impact from Hurricane Ida included race, retirement status, educational attainment, Social Vulnerability Index (SVI), type of home, and homeownership status. Of note, those whose homes had flooded prior to Ida had significantly higher odds of reporting home damage with Ida. Conclusions Of all the sociodemographic factors associated with Hurricane Ida damage including flooding and mold, a greater level of the SVI was most consistent and often had the strongest associations with these adverse outcomes. A public health focus on neighborhoods with higher SVI could help lead to strategies to mitigate and prevent exposure in future flood events.

OBJECTIVE:Research suggests that PPE is underused during mold cleanup after hurricanes, despite mold's association with adverse health outcomes. This study aims to improve understanding of decision-making around PPE use to shape messaging after natural disasters. METHODS:A convenience sample of adult residents and workers in Louisiana parishes affected by Hurricane Ida responded to closed- and open-ended questions about mold cleanup perceptions. Content analysis drew on the Health Belief Model (HBM). RESULTS:Qualitative findings indicate that perceived barriers to PPE use included discomfort and inconvenience. Many respondents understood important concepts related to respirator user seal checks and/or fit tests; some responses indicated misunderstandings. Many sample residents ( n = 150/238, 63%) and workers ( n = 40/68, 59%) had not encountered state-driven health messages about mold cleanup. CONCLUSIONS:Results could inform message development for promoting recommended PPE use in hurricane-affected areas.

Hurricane Ida, a Category 4 hurricane, made landfall in southern Louisiana in August of 2021, causing widespread wind damage and flooding. The objective of this study was to investigate knowledge, attitudes, and practices related to post-hurricane mold exposure and cleanup among residents and workers in areas of Louisiana affected by Hurricane Ida and assess changes in knowledge, attitudes, and practices that have occurred over the past 16 years since Hurricane Katrina. We conducted in-person interviews with 238 residents and 68 mold-remediation workers in areas in and around New Orleans to ask about their mold cleanup knowledge and practices, personal protective equipment use, and risk perceptions related to mold. Knowledge of recommended safety measures increased since the post-Katrina survey but adherence to recommended safety measures did not. Many residents and some workers reported using insufficient personal protective equipment when cleaning up mold despite awareness of the potential negative health effects of mold exposure.

Medicaid and commercial health insurance claims databases revealed disparities in patients assigned the ICD-10 code “Contact with and (suspected) exposure to mold (toxic)” by insurance type, age, and sex. Allergic rhinitis was the most common concomitant diagnosis.

Abstract Introduction: The avoidance of asthma triggers, like tobacco smoke, facilitates asthma management. Reliance upon caregiver report of their child’s environmental tobacco smoke (ETS) exposure may result in information bias and impaired asthma management. This analysis aimed to characterize the chronicity of ETS exposure, assess the validity of caregiver report of ETS exposure, and investigate the relationship between ETS exposure and asthma attack. Methods: A secondary data analysis was performed on data from a longitudinal study of 162 children aged 7–12 years with asthma living in federally subsidized housing in three US cities (Boston, Cincinnati, and New Orleans). Data were collected at three time points over 1 year. Results: Over 90% of children were exposed to ETS (≥0.25 ng/ml of urine cotinine (UC)). Exposure was consistent over 1 year. Questionnaire data had a sensitivity of 28–34% using UC ≥0.25 ng/ml as the gold standard. High ETS exposure (UC ≥ 30 ng/ml) was significantly associated with asthma attack (aOR 2.97, 0.93–9.52, p = 0.07). Lower levels (UC 0.25–30 ng/ml) were not statistically significant (aOR 1.76, 0.71– 4.38, p = 0.22). No association was found using caregiver-reported ETS exposure. Conclusion: Relying on questionnaire data to assess children’s exposure to tobacco smoke may lead to substantial information bias. For children with asthma, incorrect characterization may substantially impact asthma morbidity.

The Centers for Disease Control and Prevention's (CDC) Asthma and Community Health Branch has worked with the Department of Housing and Urban Development (HUD) and the Environmental Protection Agency (EPA) to co-brand an evidence-based home assessment training course that focuses on asthma triggers within the home. The training course was designed to be used by home visit staff in tandem with the 2018 Home Assessment Checklist (https://www.cdc.gov/asthma/pdfs/home_assess_checklist_P.pdf) to ensure unity within the message and corresponding action steps.

Background Children are potentially more susceptible to the adverse effects of pesticides due to more sensitive organ systems and lower capacity to metabolize and eliminate chemicals compared to adults. The health risks are particularly concerning children with asthma, living in low-income neighborhoods in multi-family housing because of their impaired respiratory health, and factors associated with low-income, multi-family environments. Objective To assess the association between pesticide exposure and asthma morbidity among children 7–12 years residing in low-income, multi-family housing. Methods The concentrations of seven urinary pesticide biomarkers: 3,5,6-trichloro-2-pyridinol (TCPy), 2-isopropyl-4-methyl-6-hydroxypyrimidine, para-nitrophenol (PNP), 3-phenoxybenzoic acid (3-PBA), 4-fluoro-3-phenoxybenzoic acid, trans-3-(2,2-dichlorovinyl)-2,2-dimethyl-cyclopropane-1-carboxylic acid, and 2,4-dichlorophenoxyacetic acid (2,4-D) were measured. Children ( n = 162) were followed for one year with three measures of pesticides biomarkers. Associations between individual biomarkers and asthma attack, asthma related health care utilization, and fraction of exhaled nitric oxide (FeNO), adjusting for demographic and household factors were examined with Generalized Estimating Equations (GEE). Weighted Quantile Sum (WQS) regression was used to examine the effect of pesticide mixture on asthma attacks and asthma-related health care utilization (HCU). Results In adjusted GEE models, positive non-significant associations were found between PNP and HCU (adjusted Odds Ratio(aOR):2.05 95% CI:0.76–5.52) and null associations for 3-PBA and HCU (aOR:1.07 95% CI: 0.88–1.29). Higher concentrations of PNP and 2,4-D were associated with significantly lower FeNO levels (PNP: −17.4%; 2,4-D:−19.74%). The mixture was positively associated with HCU in unadjusted (OR: 1.56 97.5% CI: 1.08–2.27) but not significant in adjusted models (aOR: 1.40 97.5% CI: .86–2.29). The non-specific pyrethroid biomarker 3-PBA at baseline contributed the greatest weight to the index (45%). Significance There were non-significant associations between pesticide biomarkers and respiratory outcomes in children with asthma. There was a suggestive association between urinary pesticide biomarkers and HCU. Further studies with larger sample sizes could help to confirm these findings. Impact statement Pesticide exposure among children in the urban environment is ubiquitous and there is a dearth of information on the impact of low-level chronic exposure in vulnerable populations. This study suggested that pesticide exposure at concentrations below the national average may not affect asthma morbidity in children. However, different biomarkers of pesticides showed different effects, but the mixture suggested increasing pesticide exposure results in asthma related HCU. The results may show that children with asthma may be at risk for negative health outcomes due to pesticides and the need to further examine this relationship.

OBJECTIVES:The condition of the home is a strong predictor of exposure to environmental contaminants, with low-income households being particularly vulnerable. Therefore, improving housing standards is a priority. Housing built to "green" standards, with improved building methods and materials, has been suggested to reduce contaminants. However, evidence is limited as to which contaminants are reduced. The Green Housing Study was conducted to address this issue. The study hypothesis was that housing built using green components has lower concentrations of environmental contaminants compared to conventional housing. METHODS:A repeated-measures, 12-month cohort study was performed in three U.S. cities. Data were collected in the home at three time points throughout a year. The level of contaminants were estimated using air samples for particulate matter and black carbon, dust samples for aeroallergens and pesticides, and resident or study staff reporting evidence of mold. To investigate source(s) of PM2.5 and black carbon, multivariable models using stepwise variable selection were developed. RESULTS:In adjusted generalized estimating equations (GEE) models, black carbon concentration (μg/m3) (β = -0.22, 95% CI = -0.38 to -0.06, p = 0.01), permethrin (OR = 0.28, 95% CI = 0.15-0.49, p < 0.0001), and reported mold (OR = 0.29, 95% CI = 0.13-0.68, p = 0.003) were significantly lower in green homes. Cockroach antigen was also lower in green homes (OR = 0.59, 95% CI = 0.33-1.08, p = 0.09), although not statistically significant. We found that 68% of PM2.5 was explained by dwelling type and smoking and 42% of black carbon was explained by venting while cooking and use of a gas stove. CONCLUSIONS:This study provides quantitative data suggesting benefits of incorporating green building practices on the level of numerous environmental contaminants known to be associated with health. Occupant behavior, particularly smoking, is an important contributor to indoor air pollution.

Background: Studies of thunderstorm asthma to understand risk factors using high-resolution climate data and asthma outcomes on a large scale are scarce. Moreover, thunderstorm asthma is not well studied in the United States. Objectives: We examined whether climate parameters involved in thunderstorms are associated with emergency department (ED) visits for acute asthma attacks in the United States. Methods: We analyzed 63,789 asthma-related, daily ED visits for all age groups, and thunderstorm-associated climate data in Louisiana during 2010 through 2012. We performed time-series analyses using quasi-Poisson regression models with natural cubic splines of date, parish, holiday, day of week, season, daily maximum concentrations of ozone (O3) and fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)], and daily mean pressure, precipitation, and temperature. Because of a significant interaction effect between temperature and lightning days on asthma-related visits, we performed stratified analyses by days with/without lightning or thunderstorm (defined by any lightning and precipitation). Results: On thunderstorm days, higher asthma-related ED visits were associated with higher daily mean precipitation [relative risk (RR)=1.145 per 1 g/m2/s (95% CI: 1.009, 1.300)] and lower daily mean temperature [RR=1.011 per 1°C change (1.000–1.021)] without carry-over effect to the next non-thunderstorm day. These higher risks were found mainly among children and adults <65 years of age. We observed similar results on lightning days. However, we did not find similar associations for non-thunderstorm or non-lightning days. Daily maximum O3 and PM2.5 levels were not significantly associated with asthma ED visits on thunderstorm days. Discussion: Higher precipitation and lower temperature on thunderstorm days appear to contribute to asthma attacks among people with asthma, suggesting they should consider taking precautions during thunderstorms. EDs should consider preparing for a potential increase of asthma-related visits and ensuring sufficient stock of emergency medication and supplies for forecasted severe thunderstorm days. https://doi.org/10.1289/EHP10440

Background Home-based swabbing has not been widely used. The objective of this analysis was to compare respiratory swabs collected by mothers of 7–12-year-olds living in low-income, multilingual communities in the United States with technician collected swabs. Methods Retrospective data analysis of respiratory samples collected at home by mothers compared to technicians. Anterior nasal and throat specimens collected using flocked swabs were combined in dry tubes. Test was done using TaqMan array cards for viral and bacterial pathogens. Cycle threshold (Ct) values of ribonuclease P (RNP) gene were used to assess specimen quality. Ct < 40 was interpreted as a positive result. Concordance of pathogen yield from mother versus technician collected swabs were analyzed using Cohen’s Kappa coefficients. Correlation analysis, paired t-test, and Wilcoxon signed-rank test for paired samples were used for RNP Ct values. Results We enrolled 36 households in Cincinnati (African American) and 44 (predominately Chinese or Latino) in Boston. In Cincinnati, eight of 32 (25%) mothers did not finish high school, and 11 (34%) had finished high school only. In Boston, 13 of 44 (30%) mothers had less than a high school diploma, 23 (52%) had finished high school only. Mother versus technician paired swabs ( n = 62) had similar pathogen yield (paired t-test and Wilcoxon signed rank test p -values = 0.62 and 0.63, respectively; 95% confidence interval of the difference between the two measurements = − 0.45–0.75). Median Ct value for RNP was 22.6 (interquartile range, IQR = 2.04) for mother-collected and 22.4 (IQR = 2.39) for technician-collected swabs ( p = 0.62). Agreement on pathogen yield between samples collected by mothers vs. technicians was higher for viruses than for bacterial pathogens, with high concordance for rhinovirus/enterovirus, human metapneumovirus, and adenovirus (Cohen’s kappa coefficients ≥80%, p < 0.0001). For bacterial pathogens, concordance was lower to moderate, except for Chlamydia pneumoniae , for which kappa coefficient indicated perfect agreement. Conclusion Mothers with a range of education levels from low-income communities were able to swab their children equally well as technicians. Home-swabbing using dry tubes, and less invasive collection procedures, could enhance respiratory disease surveillance.

There is growing concern about children’s chronic low-level pesticide exposure and its impact on health. Green building practices (e.g., reducing leakage of the thermal and pressure barrier that surrounds the structure, integrated pest management, improved ventilation) have the potential to reduce pesticide exposure. However, the potential impact of living in green housing on children’s pesticide exposure is unknown. To address this question, a longitudinal study of pyrethroid metabolites (3-phenoxybenzoic acid [3-PBA], 4-fluoro-3-phenoxybenzoic acid [4-F-3-PBA], trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid [trans-DCCA]) in first morning void urine, collected from 68 children from New Orleans, Louisiana residing in green and non-green housing was conducted. Children were followed for 1 year with three repeated measures of pesticide exposure. Generalized estimating equations examined associations between housing type (green vs. non-green) and urinary pyrethroid metabolite concentrations adjusting for demographic and household factors over the year. Ninety-five percent of samples had detectable concentrations of 3-PBA (limit of detection [LOD]: 0.1 μg/L); 8% of 4-F-3-PBA (LOD: 0.1 μg/L), and 12% of trans-DCCA (LOD: 0.6 μg/L). In adjusted models, green housing was not associated with statistically significant differences in children’s 3-PBA urinary concentrations compared to non-green housing.

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We examined mold clean-up practices in a general population (not selected on history of natural disaster). We used a population-based survey (n= 3,624) to assess associations between sociodemographic/ housing/ respiratory health variables and mold clean-up, PPE use, and cleaning agent use. Bleach was the most commonly used cleaning agent with approximately 90% of residents reporting using bleach alone or with other agents. More respondents used gloves (76%) than any other PPE. The use of PPE varied; 42% of bleach users wore a breathing mask/respirator compared with only 19% of soap and water users. Hispanic populations frequently reported mold clean-up. Bleach use was less likely in the West and among Asians. Although "Green" products were rarely used, Asians were more likely to use them. Bleach was the most commonly used cleaning agent for mold, and PPE use was common when using bleach, supporting the need for current CDC safe use recommendations.

Mouse allergen reduction is associated with improvements in asthma among sensitized and exposed children, but whether age modifies responsiveness to mouse allergen reduction is unclear. 350 mouse-sensitized and exposed asthmatic children (5-17y) were enrolled in a clinical trial of integrated pest management+education versus education alone. Symptoms (days/2 weeks), acute visits, and mouse allergen exposure were assessed every three months. Groups were combined for analyses because there were no differences in exposure or clinical outcomes. Analyses of relationships between mouse allergen and asthma outcomes were stratified at the median age (older vs. younger (≥9 vs <9y)). Mixed-effects generalized linear models were adjusted for gender, age, race, insurance, and included interaction terms (age*-log2(mouse allergen level)). Participants were predominantly low-income and minority (78% Black, 22% Hispanic), and had uncontrolled asthma. Among older participants, each 50% reduction in mouse allergen was associated with fewer symptom-days (IRR [95% CI]: maximal symptoms: 0.96 [0.94-0.99], cough/wheeze/chest tightness: 0.96 [0.93-0.99], running symptoms: 0.88 [0.85-0.91], cough: 0.92 [0.88-0.96], and rescue medication use 0.97 [0.95-0.99]). There was little effect of mouse allergen reduction on symptoms among younger participants (p-values >0.05). P-values for age*mouse allergen interactions were: maximal symptoms: 0.92, cough/wheeze/chest tightness: 0.17, running symptoms: <0.001, cough: 0.001, and rescue medication use: 0.001. Mouse allergen reduction was not associated with acute visits, stratified by age. Mouse allergen reduction was associated with greater improvement in some symptoms, but not acute visits, among older mouse-sensitized and exposed asthmatic children, suggesting that the effectiveness of allergen reduction on symptoms may vary by age.

Household endotoxin levels have been variably associated with asthma and atopy. We present a combined epidemiologic and mechanistic study of the relationship between endotoxin and food allergen sensitization. Logistic regression models were built using data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES, n=6963), a large cohort representative of the US population, to test for associations between house dust endotoxin (log-transformed) and sensitization to specific foods (milk, egg, and peanut). To characterize inflammatory responses to endotoxin in individuals with vs. without food allergen sensitization, peripheral blood mononuclear cells (PBMCs) were collected from 21 children mono-allergic to milk, egg, or peanut and non-allergic controls. Following stimulation with endotoxin, cytokines were measured using the Luminex platform. Among NHANES subjects, the geometric mean endotoxin level was 15.5 EU/mg (SE 0.5). Prevalence of food allergen sensitization (sIgE ≥0.35 kUA/L) varied by food: milk 5.7%, egg 4.0%, and peanut 7.9%. Household endotoxin level was associated with sensitization to milk (OR 1.7, 95%CI 1.2-2.1) and egg (OR 1.4, 95%CI 1.01-1.9), but not peanut (OR 0.98, 95%CI 0.8-1.2) in models adjusted for confounders. Interferon-gamma levels of endotoxin-stimulated PBMCs from individuals allergic to milk (mean 104.3 pg/ml) or egg (mean 44.4 pg/ml) but not peanut (mean 240.8 pg/ml) were significantly lower on day 5 compared to controls (mean 536.1 pg/ml) (P-values 0.007, 0.018, and 0.058, respectively). Higher household endotoxin is associated with higher odds of milk and egg sensitization. Altered responsiveness to endotoxin is also observed in PBMCs from individuals with milk and egg allergy.

Introduction In the United States, children in Puerto Rico and non-Hispanic black children in the mainland US have a higher burden of asthma than non-Hispanic white children in the mainland US. We examined indoor environmental control (IEC) practices that reduce asthma triggers, by race/ethnicity among children in the mainland US and Puerto Rico. Methods We used 2013 and 2014 data from the Behavioral Risk Factor Surveillance System Asthma Call-back Survey Child Questionnaire from 14 states and Puerto Rico to measure the association between race/ethnicity and IEC practices, adjusting for sociodemographic covariates, among children identified as ever receiving an asthma diagnosis. Racial/ethnic groups were compared in 14 US states using aggregated data. Separate analyses compared IEC practices for children diagnosed with asthma in Puerto Rico with children of all races/ethnicities diagnosed with asthma in 14 states. Results Among households in 14 US states that had a child with asthma, non-Hispanic black children were more likely than non-Hispanic white children to use an air purifier (36.8% vs 25.2%; adjusted odds ratio [aOR] = 2.0; 95% confidence interval [CI], 1.3-3.2) and avoid pets in the bedroom (87.9% vs 58.3%; aOR = 4.5; 95% CI, 2.3-8.8). Children in Puerto Rico were more likely than children in 14 states to use dust mite-impermeable pillow covers (53.7% vs 36.4%; aOR = 3.6; 95% CI, 1.8-7.1) and mattress encasements (60.3% vs 30.3%; aOR = 2.4; 95% CI, 1.2-4.8). Conclusion IEC practices such as using air purifiers, pillow covers, mattress encasements, and avoiding pets in the bedroom vary by race/ethnicity among children with asthma. These findings show that vulnerable populations are using IEC practices, but asthma prevention and control measures should continue to be assessed.

BACKGROUND:Household endotoxin levels have been variably associated with risk for asthma and atopy.METHODS:We studied participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES, n = 6963), a large cohort representative of the US population (aged 1-84 years). We built logistic regression models to test for associations between house dust endotoxin and sensitization to specific foods (milk, egg, and peanut). To experimentally explore the detected epidemiologic associations, peripheral blood mononuclear cells (PBMCs) were collected from 21 children (aged 1-19 years) mono-food allergic (ie, sensitized and clinically reactive) to milk, egg, or peanut and nonallergic controls for stimulation with endotoxin and secreted cytokine measurement. For each food allergy, linear mixed-effects models were built to test the association between endotoxin stimulation and cytokine level.RESULTS:Among NHANES subjects, the geometric mean household endotoxin level was 15.5 EU/mg (GSE 0.5). Prevalence of food allergen sensitization (sIgE ≥ 0.35 kUA /L) varied by food: milk 5.7%, egg 4.0%, and peanut 7.9%. In models adjusted for potential confounders (age, race, country of birth, total people per household, US region, and history of wheezing in the past year), household endotoxin level was associated with sensitization to milk (OR 1.7, 95% CI 1.2-2.1) and egg (OR 1.4, 95% CI 1.01-1.9), but not peanut (OR 0.98, 95% CI 0.8-1.2). Interferon-γ levels of endotoxin-stimulated PBMCs from children allergic to milk or egg, but not peanut, were significantly lower compared to controls in linear mixed-effects models adjusted for repeated measures, experimental variables, age, and inter-individual variability (P-values .007, .018, and .058, respectively).CONCLUSION:Higher household endotoxin is associated with increased odds of milk and egg sensitization. Altered cytokine responsiveness to endotoxin is also observed in PBMCs from individuals with milk and egg allergy.