vvEPA
United States
Environmental Protection
Agency
Indoor Environments Division
Office of Radiation and
Indoor Air
Revised August 2003
402-K-03-006
-^J ^ ^^ < «^ + •* 1 ^ ^ -^ f
Student Performance
Revised1
The Problem
How Does Indoor Air Quality Affect a Child's Ability to Learn?
Evidence continues to emerge showing that poor indoor air quality (IAQ) can cause illness
requiring absence from school, and can cause acute health symptoms that decrease performance
while at school. In addition, recent data suggest that poor IAQ may directly reduce a person's
ability to perform specific mental tasks requiring concentration, calculation, or memory.
The Cause
Air in most indoor environments contains a variety of particles and gaseous contaminants. These
contaminants are commonly referred to as indoor pollutants when they affect human health and
performance. Indoor temperature and relative humidity can also affect health and performance
directly, and can affect human performance indirectly by influencing the airborne level of molds
and bacteria.
Most often, poor indoor air quality results from the failure to follow practices that help create and
maintain a healthy indoor environment. Common examples include failure to:
>• control pollution sources such as art supplies and laboratory activities
>• control temperature and humidity
>• control moisture and clean up spills
>• ventilate each classroom adequately
>• adequately perform housekeeping and maintenance
>• use integrated pest management to minimize the use of pesticides
Schools should be designed, built, and maintained in ways to minimize and control sources of
pollution, provide adequate exhaust and outdoor air ventilation by natural and mechanical
means, maintain proper temperature and humidity conditions, and be responsive to students and
staff with particular sensitivities such as allergies or asthma. Failure to deal adequately with any of
these issues may go unnoticed, but can and often does take its toll on health, comfort, and
performance of teachers and students in school.
Specific Evidence
Illnesses Resulting from Poor Indoor Air Quality Increase School Absences
Evidence from schools that various environmental conditions are closely associated with the
incidence of objectively measurable adverse health effects is rapidly emerging. Indoor air quality
'Substantial portions of this revised document are based on a literature review funded by the Environmental Protection
Agency. The literature review was conducted by Mark Mendellfrom Lawrence Berkeley National Laboratory, and Garvin
Heath from the University of California at Berkeley. Evidence of the association between indoor environmental quality
and human performance is taken from school settings wherever possible, but it is supplemented by similar evidence in
other environments where information from school environments is lacking.
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Indoor Air Quality and Student Performance
Recent data
suggest that
poor Z4Q can
reduce a
person's ability
to perform
specific mental
tasks requiring
concentration,
calculation or
memory.
problems can result in increased absences because of respiratory infections, allergic diseases from
biological contaminants, or adverse reactions to chemicals used in schools. Building factors or
pollution in buildings most frequently and consistently associated with respiratory health effects
are the presence of moisture, water damage, and microbiological pollutants;1'2 animal and other
biological allergens;3 and combustion products,4 including nitrogen dioxide.5'6 Other risk factors
for respiratory health effects include: moisture or dirt in HVAC systems;7'8 low ventilation rates;9'10
formaldehyde;6'11"15 chemicals in cleaning products;16'17 and outdoor pollutants or vehicle
exhaust.18"20
Children's overall performance decreases due to sickness or absence from school.21"24 Building-
associated health effects can increase student or teacher absences from school and degrade the
performance of children or teachers while in school. Respiratory health effects, such as respiratory
infections and asthma, are the illnesses most closely associated with increased absenteeism. In fact,
asthma-related illness is one of the leading causes of school absenteeism, accounting for over 14
million missed school days per year.25
Measured Loss in Performance from Indoor Pollution Sources or Inadequate Ventilation
Recent studies relate direct performance measurements to changes in indoor air quality. For
example, a European study of 800 students from 8 schools provides data on indoor air quality,
health symptoms, and students' ability to concentrate.26 In the study, carbon dioxide measurements
were taken in the classrooms and students were given a health symptom questionnaire. A
computer-based program scored their ability to concentrate. The main source of carbon dioxide in
buildings is exhaled breath. Carbon dioxide itself is not a health threat at levels typically found
indoors, but when outdoor air ventilation rates are low, carbon dioxide levels and other pollution
levels are not diluted as much and therefore also tend to be high. In the study, student scores on
the concentration test were lower and their health symptom responses to the questionnaire were
inferior when carbon dioxide levels increased. This finding, which was statistically significant,
suggests that reduced ventilation rates (and higher indoor pollution) is associated with a decreased
ability to concentrate along with increased adverse health symptoms. Another study27 of students
shows similar results when using subjective reports of performance, while laboratory studies of the
effects of a mixture of VOC on adults shows that elevated volatile organic compounds (VOCs) can
decrease performance of sensitive adults,28 though not necessarily on those that are not sensitive.29
Studies of adults in office settings generally support these associations. In a controlled study of 30
female adults working in an office environment, a 20-year old used carpet, which served as a
pollution source, was periodically introduced on racks behind a screen so that subjects had no way
of knowing when the carpet was present.30 The subjects were tested in typing, arithmetic, logical
reasoning, memory, and creative thinking during several trials with and without the carpet present.
These tasks are similar to the kinds teachers and students perform in school. During the trials
without the carpet, the subjects' performance improved in all tasks by 2 — 6 percent. When the
carpet was present, the prevalence of headaches during tasks requiring concentration increased,
suggesting that at least part of the effect on performance was from pollution-related adverse health
effects. In a later study using the same procedure, increasing ventilation rates with the carpet
present resulted in statistically significant improvements in performance.31
In a similar although more limited study of typing performance and perceptions of air quality,
computers were used as the pollution source. Computers can emit a variety of VOCs as internal
temperatures of various components rises. In this study, the air was perceived to be fresher and
typing performance improved in the absence of the computers.
Evidence is increasing that health, comfort, and performance of adults improve at higher
ventilation rates.32"36 In addition, a recent controlled study in office buildings found that short-
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Indoor Air Quality and Student Performance
Asthma-related
illness is one of
the leading
causes of school
absenteeism,
accounting for
over 14 million
missed school
days per year.
term sick leave, often associated with respiratory illness, was significantly associated with low
ventilation rates.10 A subsequent study to test the hypothesis that the sick leave reflected increased
respiratory illness failed.37 The latter study, however, examined a much narrower range of ventilation
rates, and related ventilation rates only with sick leave taken during the following week. An
alternative explanation supported by sick leave data from this and other studies is that poor indoor
air quality increases the probability that individuals will take sick leave even for minor ailments, and
delay returning to work during recovery.38
Ventilation rates in most schools are below recommended levels, both in the United States and in
Europe.39"44 In fact, in a California study,39 one third of the schools had ventilation rates that were
less than half the recommended levels. Thus, the prevalence of low ventilation rates, combined with
the continually growing evidence of the positive impact that outdoor air ventilation has on health
and human performance, suggests a clear opportunity for improving IAQ design and management
of school facilities. The availability of energy recovery technology in ventilation systems, and the
availability of software tools to evaluate the financial implications of this technology,45 may facilitate
acceptance of higher ventilation rates.
Thus, the evidence is increasing in studies of both schools and other settings that indoor pollution
or inadequate ventilation can decrease student and teacher performance. These studies reinforce
others that relate degradation in indoor air quality with increased frequency of adverse health
symptoms or absenteeism. IAQ management in schools, including pollutant source control and
provisions for adequate ventilation, appears to provide a healthy indoor environment conducive to
improved student and teacher health, higher school attendance, increased school funding, and
improved student performance. Furthermore, the pervasive problem of inadequate ventilation in
schools provides a significant opportunity to improve school conditions that leads to improved
performance of teachers and students.
Effects from Mild Symptoms of Distress
What about people who do not have a diagnosable illness, but simply do not feel well? People may
report feeling lethargic, having headaches, having a mild sore throat or itchy eyes, or they may have
a sense that the air is "stale," "stuffy," or "too dry."
Motivation can often overcome small burdens of environmental stress so that children's
demonstrated performance may not decline. Evidence from adults, however, suggests that continued
environmental stress can drain a person's physical and mental resources and ultimately affect their
performance. For example, evidence from office workers suggests that, when individuals experience
just two symptoms of discomfort (e.g., dry eyes, itchy or watery eyes, dry throat, lethargy, headache,
chest tightness), they begin to perceive a reduction in their own performance. That perception
increases as the number of symptoms increases, averaging a 3-percent loss with three symptoms, and
an 8-percent loss with five symptoms.46 This suggests that when large numbers of students and staff
experience signs of discomfort related to the air inside their school, teaching and learning
performance will degrade over time.
Effects of Temperature and Humidity
In addition to indoor pollution and ventilation, studies suggest that various activities such as typing
or driving a vehicle are diminished when people are demonstrably too cold or too hot. Maintaining
temperature at the warm end of the comfort zone tends to increase adverse health symptoms, while
temperatures at the cool end of the comfort zone tend to reduce symptoms. Similarly, individuals
perceive the quality of the indoor air to be better when humidity is at the low end of the comfort
zone.
47-49
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Indoor Air Quality and Student Performance
Continued
environmental
stress can drain
children's
physical and
mental
resources and
ultimately
affect their
perfo
rmance.
There is also good evidence that moderate changes in room temperature, even within the comfort
zone, affect children's abilities to perform mental tasks requiring concentration, such as addition,
multiplication, and sentence comprehension. Overall, warmer temperatures tend to reduce
performance, while colder temperatures reduce manual dexterity and speed.50 In general, the need
to avoid extreme conditions and to provide for as much individual temperature control as possible
is strongly supported.51"52
Will Performance Be Affected Even If No One Is Complaining?
Performance can certainly be expected to suffer if conditions are serious enough for people to
complain. The lack of complaints, however, is not an indication that performance cannot be
improved. For example, in the above studies, symptoms were solicited through questionnaires (as
opposed to complaints), and tests were performed on individuals in typical school and office
environments. That is, the reductions in performance were recorded under circumstances that
easily could have gone unnoticed because of the absence of complaints.
Filtration, Housekeeping, and HVAC Maintenance
One study in schools and several with adult subjects also suggest relationships between health
symptoms and airborne or surface-level dust27'53"55 and between health benefits and good
housekeeping protocols that thoroughly remove dust from surfaces.56'57 Some studies show health
and comfort benefits from efforts to reduce airborne particles.58'59 One such study in an office
building showed a statistically significant reduction in mental confusion when 95 percent of
airborne particles between 0.3 and 0.5 microns in size were removed by filtration.60 The study also
showed reduced fatigue and improved productivity, although these results were not statistically
significant.
Early studies in schools have found that air conditioning is associated with lower absentee rates61 or
improved performance,62 and that schools with humidification systems are also associated with
lower absentee rates. More recent and more rigorous studies in offices, however, show the opposite
to be true. This discrepancy may be explained by the fact that, while air conditioning and
humidification systems are designed to control temperature and humidity (a positive effect), they
may also become contaminated with biological pollutants (a negative effect) if they are not
judiciously maintained. A review of building investigation reports also suggests significant benefits
to health and performance from good HVAC maintenance.63 Presumably, these benefits result
because properly maintained HVAC systems can provide consistently good thermal and ventilation
control while also reducing the risk of biological contamination.
Overall, the evidence suggests that good housekeeping designed to control surface dust plus care
and maintenance of the HVAC system, including provisions for good filtration performance, are
important aspects of school operating protocols designed to improve student health and
performance.
Outdoor Pollution
A major component of an IAQ management plan is the control of pollutants that may enter the
school from the outdoors. Studies provide evidence of increased school absenteeism from outdoor
pollutants such as carbon monoxide64 and particles.64"67 This evidence suggests that particular
attention to potential exposures from school bus exhausts and other vehicle exhausts and that
improved filtration of particles in locations with high levels of outdoor pollution may be advisable.
The Solution
What You Can Do
Because poor indoor air quality results from failure to follow practices that help create and
maintain a healthy indoor environment, being proactive in managing potential IAQ hazards will
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Indoor Air Quality and Student Performance
References
assist with maintaining the indoor environment of a school facility. School systems should take
advantage of available programs to improve and maintain good indoor environmental quality, and
specifically, good indoor air quality in their schools. Programs can be targeted to the maintenance
of existing school facilities and to new school construction.
The U.S. Environmental Protection Agency has published voluntary guidance that addresses
indoor air quality in schools. By applying no-cost or low-cost approaches outlined in the IAQ Tools
for Schools (IAQ TfS) Action Kit, schools can find cost-effective approaches toward making the
school environment more conducive to improved health and performance of teachers and students.
The IAQ TfS Kit is free to schools and school districts who make the request on school letterhead.
To order the Kit contact the IAQ Information Clearinghouse:
IAQ Info
P.O. Box 37133
Washington, D.C. 20013-7133
Call: 1-800-438-4318, Fax: 703-356-5386, or Email: iaqinfo@aol.com
When requesting the IAQ TfS Kit, specify EPA document number 402-K-95-001.
Visit the IAQ Tools for Schools Web site and download the Kit, learn about training
opportunities, and read about schools around the country that are using the Kit.
www.epa.gov/iaq/schools
Additional Resources
A searchable bibliography of studies dealing with indoor health and productivity (including
abstracts of many of the references cited below) is available through the Indoor Health and
Productivity (IHP) project. To view, visit http://www.IHPcentral.org
1. Institute of Medicine. Committee on the
Assessment of Asthma and Indoor Air. 2000.
Clearing the Air: Asthma and Indoor Exposures.
Washington, DC, National Academy Press.
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"Dampness in buildings and health: Nordic
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Indoor Air: International Journal of Indoor Air
Quality and Climate 11(2)72-86.
3. Platts-Mills, T.A.E. 2000.
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F. McCarthy. New York, McGraw-Hill:43.1-
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conditions." Applied Occupational and
Environmental Hygiene 11(12):! 387-92.
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Indoor Air Quality and Student Performance
9. Menzies, R., R. Tamblyn, et al. 1993.
"The effect of varying levels of outdoor-air
supply on the symptoms of sick building
syndrome." New England Journal of Medicine
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10. Milton, O.K., P.M. Glencross, et al. 2000.
"Risk of sick leave associated with outdoor air
supply rate, humidification, and occupant
complaints." Indoor Air 10(4):212-21.
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"Changes in nasal lavage fluid due to
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"Exposure to gaseous formaldehyde induces IgE-
mediated sensitization to formaldehyde in
school-children." Clinical and Experimental
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13. Smedje, G., D. Norback, et al. 1997.
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relation to the school environment." Clinical and
Experimental Allergy 27(11): 1270-8.
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54(4):330-7.
15. Franklin, P.J., P.W. Dingle, et al. 2000.
"Formaldehyde exposure in homes is associated
with increased levels of exhaled nitric oxide in
healthy children." Healthy Buildings 2000:
Exposure, Human Responses and Building
Investigations, Espoo, Finland, SIY Indoor Air
Information Oy, Helsinki, Finland.
16. McCoach, J.S., A.S. Robertson, et al. 1999.
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Indoor Air Quality and Student Performance
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ft ft ' r
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7
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Indoor Air Quality and Student Performance
54. Gravesen, S., P. Skov, et al. H. 1990.
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