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THE MERRY-GO-ROUND OF DAMPNESS AND HEALTH Kevin Kennedy, MPH, CIEC 1 Carl Grimes, HHS, CIEC National Healthy.

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Presentation on theme: "THE MERRY-GO-ROUND OF DAMPNESS AND HEALTH Kevin Kennedy, MPH, CIEC 1 Carl Grimes, HHS, CIEC National Healthy."— Presentation transcript:

1 THE MERRY-GO-ROUND OF DAMPNESS AND HEALTH Kevin Kennedy, MPH, CIEC Kkennedy@cmh.Edu 1 Carl Grimes, HHS, CIEC cgrimes@haywardhealthyhome.com National Healthy Homes Conference Nashville, May 28-30, 2014

2 Indoor Environmental Health & Management are part of upstream healthcare Are you an Upstreamist?

3 PATHWAYS LINKING SOURCES OF DAMPNESS WITH HEALTH From- WHO Guidelines for IAQ: Dampness & Mold, p.4-5, 2009

4 THE GOAL IS EXPOSURE REDUCTION

5 HOW DO YOU DEFINE DAMPNESS? 5

6 6 Our Homes, and How to Make Them Healthy, Shirley Forster Murphy, Cassell & Company, Ltd., London, 1883.

7 Women, plumbers, and doctors: Household sanitation Mrs. H.M. Plunkett, d. Appleton & Company, New York, 1885. 7

8 8 Bowditch, Henry, Public Hygiene in America, Boston: Little, Brown, and Company; 1877.

9 9 Plumbing and Household Sanitation, John Pickering, Doubleday, Page & Co. 1911.

10 10 Sir John Floyer, A treatise on asthma Pub. 1698

11 11 Vitruvius on Architecture 50 BCE Hippocrates 150 BCE

12 MODERN HISTORY OF DAMPNESS Institute of Medicine, Damp Indoor Spaces And Health, 2004 Did not define dampness Newer research has not provided consistent or consensus agreement on dampness. No description, definition, or measurement of dampness has been proposed. 12

13 LITERATURE REVIEW- DAMPNESS & CHILDREN’S HEALTH 2010 – 2013* Literature on health outcomes in children and dampness as described by various metrics: How was dampness defined and/or described 13 *Kennedy, K, C. Grimes, Indoor Water and Dampness and the Health Effects on Children: A Review, Curr. Allergy Asthma Rep. (2013) 13:672–680.

14 SYSTEMATIC REVIEWS AND META- ANALYSES Additional reviews and meta-analyses showing association between dampness and mold by various metrics and: Upper respiratory tract symptoms, cough, wheeze, asthma development, current asthma and ever diagnosed asthma, bronchitis, allergic sensitization, hay fever, cough, wheeze, and allergic respiratory symptoms 14 Fisk WJ, et.al., Association of residential dampness and mold with respiratory tract infections and bronchitis: a meta-analysis. Environ Health. 2010; 15; 9:72 1476-069. Tischer C G, et.al. Metaanalysis of mould and dampness exposure on asthma and allergy in eight European birth cohorts: an ENRIECO initiative. Allergy. 2011;66 (12) 1570–1579.

15 Health Outcome IOM 2004 conclusion WHO 2008 conclusion Mendel (2011)Additional evidence (None) Sufficient evidence of a causal relationship (None) asthma exacerbationSufficient evidence of association More studies of strong design (suggestive of causation) CoughSufficient evidence of association Many new studies, some of strong design WheezeSufficient evidence of association Many new studies, many of strong design Upper respiratory tract symptoms Sufficient evidence of association Many new studies, some of strong design Asthma development Limited or suggestive evidence of association Sufficient evidence of association More studies of strong design DyspneaLimited or suggestive evidence of association Sufficient evidence of association More studies Initial evaluation Current asthmaNot evaluatedSufficient evidence of association Initial evaluation Ever-diagnosed asthmaNot evaluated Initial evaluation Respiratory infections Not evaluatedSufficient evidence of association Initial evaluation BronchitisNot evaluatedLimited or suggestive evidence of association Initial evaluation Allergic rhinitisNot evaluatedLimited or suggestive evidence of association Initial evaluation EczemaNot evaluated Initial evaluation Common coldNot evaluated Limited or suggestive evidence of association Initial evaluation Allergy/atopyNot evaluated Initial evaluation Altered lung function (Association based on clinical evidence) Inadequate or insufficient evidence to determine whether an association exists (None) Hypersensitivity pneumonitis Sufficient evidence of association 15 *Mendell MJ, et.al., Mold and Dampness-related agents: A Review of the epidemiologic evidence, Environ Health Perspect., 2011 (6):748–756

16 WHO 2009 and The Latest Key Findings Still relatively large number of studies that have failed to demonstrate a direct association between bioaerosol concentrations and health effects in damp indoor environments. 16 WHO Guidelines for Indoor Air Quality: Dampness and Mould. Geneva. World Health Organization, 2009.

17 From Population & Case-control Studies Presence of visible molds and perceived mold odor were shown to be independently and significantly associated with the incidence of asthma in children Early-onset childhood asthma was found to be significantly associated with a number of environmental exposures including visible mold, mildew odors, cockroaches, carpet, pets and environmental tobacco smoke. Reported exposure to mildew odors was shown to have a great influence on early-onset asthma 17 Jaakkola JJ, et. al. Home dampness and molds as determinants of allergic rhinitis in childhood: a 6-year, population-based cohort study. Am J Epidemiol. 2010;172(4) 451–459 Chen YC, et.al. Early-life indoor environmental exposures increase the risk of childhood asthma. Int. J Hyg Environ Health. 2011;215(1):19–25.21. Hwang BF, et. al. Molds, parental atopy and pediatric incident asthma. Indoor Air. 2011; 21(6) 472–478

18 From Quantitative Measurement Studies Majority of recent studies that used quantitative measures of indoor dampness and mold did not find a significant association with health. For example, no association was found between doctor- diagnosed asthma/allergy in children and indoor mold spore exposure (colony-forming unit) and different indexes of visible signs of dampness and/or indoor moldy odor, either observed by professional inspectors or reported by parents 18 Dales R, et. al. Residential fungal growth and incidence of acute respiratory illness during the first two years of life. Environ Res. 2010; 110(7) 692–698. Holme J et.al. Culturable mold in indoor air and its association with moisture-related problems and asthma and allergy among Swedish children. IndoorAir. 2010;20(4):329–40.

19 Research Methods To Characterize Dampness 19

20 Research Methods To Characterize Dampness 20

21 It Is A Composite Of… Water in liquid, solid, or gaseous form. In air, on surfaces, absorbed beneath a surface Extent – S500 class 1, 2, and 3. Time – how long has it been there? Type of water – s500 category 1, 2, 3, special. Temperature – how warm or cold? 21 Dampness is Not a “Thing”

22 WHO 2009 IAQ And Dampness And Mold Observation Survey Role of measurements - are there measurements and how to interpret? 22 Key Components to Assessment:

23 23 Erratic Agreement Between Occupant And Trained Assessor’s Perception  WHO discussion (page 9)-  Occupants reported more dampness than the trained surveyors (bornehag et al., 2001),  Some studies showed that occupants reported less dampness (williamson et al., 1997; nevalainen et al., 1998).  Other studies showed poor agreement between self-reported and inspectors’ observations of dampness and moldy odor. (Engman, bornehag and sundell (2007) and sun, sundhell and zhang (2007). From- WHO Guidelines for IAQ: Dampness & Mold, p.8, 2009

24 AIHA “GREEN BOOK” Indoor exposures are a complex mixture of molds, bacteria, fragments of both types of organisms; their multiple toxic products; and biologically derived small particles, gases and other air pollutants. Effects, depending on the susceptibility of the exposed occupants and their degree of exposure, can be combinations of allergic response, inflammation and its consequences, and other toxic responses. This complex exposure and effect picture is not addressed by risk assessment focused on spores or individual toxins.* The implications of this research are that prevention of unwanted moisture, and removal of filth caused by moisture, is necessary to prevent disease.** (Emphasis added) 24 *Chapter 1, Section 1.3.5, Recognition, Evaluation, and Control of Indoor Mold, AIHA, 2008. **Chapter 1, Section 1.3.5, Recognition, Evaluation, and Control of Indoor Mold, AIHA, 2008.

25 Remember The Truth About Relative Humidity Relative humidity is measure of energy taken up by water to convert it to a gas, not holding capacity… Warm air evaporates more water because there is more thermal energy available to do the work of evaporation 25

26 Remember Psychrometrics Is… The study of the physical and thermodynamic properties of air-water vapor mixtures. Atmospheric gases and water vapor (gas) exist in the same spaces all around us and can be looked at as a mixture of dry air and water vapor.

27 Temperature Isn’t Comfort, Its Energy 27 Higher Temp., more Kinetic Energy 40˚ F 80˚ F

28 Relative Humidity Is A Dynamic Value A relative humidity of 50% means half the available energy has been used to evaporate water from surfaces and anywhere else, and 50% of the energy is still available to do more evaporation 28

29 USED WITH PERMISSION FROM LEW HARRIMAN, MASON GRANT CONSULTING 29

30 ALTERNATE DAMPNESS MEASUREMENTS? Moisture content Surface temp and relative humidity Absolute humidity Water activity (A W ) 30

31 ASHRAE MOLD POSITION STATEMENT This position document provides help in understanding some of the complex interactions and decisions that lead to indoor dampness. However, professionals and the public need to know, with greater certainty than at present, when a building is “dry enough” to avoid dampness-related health risks. 31

32 ASHRAE MOLD POSITION STATEMENT ASHRAE recommends further health-related building research to develop and publish a practical, quantitative, and effective definition and measurement technique for whole-building dampness … the goal should be to develop and publish a quantitative definition of a “damp building,” together with an economically practical measurement technique. 32

33 ASHRAE MOLD POSITION STATEMENT To be useful in the real world of building design, construction and operation, such a definition and measurement technique must allow determination (with reasonable and repeatable certainty) of a building that is “dry enough” to avoid dampness- related health risks. 33

34 Retain The Term “Dampness,” But… Dampness is a familiar, colloquial, generic term that easily and quickly communicates a complex situation. But, neither studies nor building assessments should attempt to measure it. Because “it” can’t be measured. However, the various components can be. 34

35 THE MERRY-GO-ROUND OF DAMPNESS AND HEALTH Kevin Kennedy, MPH, CIEC Kkennedy@cmh.Edu 35 Carl Grimes, HHS, CIEC cgrimes@haywardhealthyhome.com National Healthy Homes Conference Nashville, May 28-30, 2014

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