1. Building-related health effects: what do we know? Ted Schettler MD, MPH Science and Environmental Health Network Institute of Medicine Jan. 10, 2006

2. Outline The indoor environment Building-related health/illness Building-determinants of indoor environmental quality, comfort, health Health impacts beyond the building

3. The indoor environment Determinants of comfort and health: –Temperature, temperature gradients –Humidity –Light –Noise –Chemical pollutants, odors –Personal health –Job/activity requirements –Psychosocial factors

4. The indoor environment Heterogeneous; many microenvironments Gradients—chemical pollutants, temperature, humidity Vary over space and time

5. Building-related health effects Building related illness—e.g., Legionnaire’s disease Building-related symptoms Sick-building syndrome Perceptions of unacceptable indoor environment Sensitive occupants—e.g., multiple chemical sensitivity (heightened sensitivity to often poorly defined but “ordinary” contaminant levels)

6. Sick-building syndrome Building occupants experience acute health and comfort symptoms that appear to be linked to time spent in the building, but often no specific cause can be identified. Complaints may be localized, in a zone, or widespread

7. Common symptoms of SBS Headache and nausea Nasal and chest congestion; wheezing Eye problems (dry, itching, tearing, or sore eyes, blurry vision, burning eyes, problems with contact lenses) Sore throat, hoarseness, dry throat Fatigue Chills and fever Muscle pain Neurological symptoms (difficulty remembering or concentrating, depression, tension, or nervousness) Dizziness Dry skin

8. A summary of the context Heterogeneity of environment; micro- environments Heterogeneity of building occupants Variability of symptoms, illnesses Result: Difficult to study and understand –Interactions among multiple factors –Bias in cross-sectional surveys –Need for new statistical techniques; e.g., principal component analysis

9. Determinants of indoor environmental quality Primary building material emissions –VOCs: Aliphatic hydrocarbons, aromatic hydrocarbons, halogenated hydrocarbons, alcohols, ketones, aldehydes, esters, ethers, terpenes Generally highest after manufacture and construction

10. Indoor sources of VOCs Consumer and commercial products—cleaning agents, pesticides, office supplies, etc. Paints and associated supplies Adhesives Building materials Furnishings and clothing Combustion appliances Outdoor air pollutants

11. Determinants of indoor environmental quality Secondary material emissions –e.g., due to moisture –alkali (in concrete) degradation of PVC/DEHP (correlation with asthma symptoms) –ozone from copiers or laser printers, outdoors and nitrogen oxides can react with VOCs –cleaning materials can react with surfaces Secondary emissions may be a chronic problem

12. Determinants of indoor environmental quality Surface materials: –PVC flooring, synthetic carpet, particleboard, wall coverings, furniture –PVC flooring, wall coverings, phthalate levels and asthma, wheezing, allergic symptoms (Jaakkola, 2004; Oie, 1999; Bornehag, 2004; Tuomainen, 2004) –Choice of surface material determines cleaning requirements

13. Determinants of indoor environmental quality Temperature; temperature gradients Ventilation: important but limited effectiveness to solve complex problems Dampness and humidity: influence mold growth, material emissions Particulate air pollution: outdoor sources, high speed floor polishing Landscaping; indoor/outdoor pesticide use

14. Conclusions Low emitting materials Avoid materials that might support mold growth Avoid potential for moisture accumulation Consider cleaning requirements Low emission materials, ventilation, humidity control, surface temperatures all work together to influence environmental quality Life cycle impacts of materials

15. Health impacts beyond the building Public, occupational, environmental health impacts: –Water and energy use –Materials extraction, manufacturing, transport, disposal Health care activities provided in buildings