"AN OUNCE OF
                        PREVENTION IS WORTH
                        A POUND OF CURE"
           for Schools Program:
           Benefits of Improving
           Air Quality in the School Environment

The IAQ Tools for Schools Kit
helps schools across the
nation improve their indoor
air quality. This one-stop
resource provides step-by-
step guidance to ensure a
healthy, comfortable
environment for students and
staff. To order this EPA
publication at no cost, call the
IAQ INFO Clearinghouse
at (800) 438-4318.

'IAQ Tools for
 Schools develops
 awareness for
 evaluating mold
 problems in schools.
 Early intervention is
 the key to preventing
 a problem like mold
 growth from spiraling
 out of control/'
 —Dr. Bill Smith, Program
  Director for Facilities,
  Okaloosa County School
  District, FL

"The IAQ TfS Kit prompted
 us to track our student
 health problems, like
 asthma and allergies, and
 try to relate them to our
 past IAQ improvements.
 We've really noticed the
 number of student absences
 decreasing since the IAQ
 improvements were
 —Art Benton, Facilities and
  Maintenance Supervisor, Clear Creek
  School District, CO


                        is increasingly an important issue in our nation's
     J                  schools. Approximately 20 percent of the U.S. population—
                ^^^^  nearly 55 million people—spend their days inside elementary
    and secondary schools. In 1999, indoor air quality (IAQ) was reported to be
    unsatisfactory in about one in five public schools in the United States, while
    ventilation was reported as unsatisfactory in about one-quarter of public schools,
    according to the National Center for Education Statistics of the Department of
    Education. The health of students and staff in these schools is a cause for great
    concern, particularly the negative effects of poor IAQ on asthma and other
    respiratory illnesses.

    The U.S. Environmental Protection Agency (EPA) developed the Indoor Air Quality
    Tools for Schools (IAQ TfS) Program to help schools prevent, identify, and resolve their
    IAQ problems. Through simple, low-cost measures, schools can:

        • Reduce lAQ-related health risks and triggers for asthma.
        • Identify sources of mold.
        • Improve comfort and performance levels.
        • Avoid costly repairs.
        • Avoid negative publicity and loss of parent and community trust.
        • Avoid liability problems.
    Economic data and scientific studies on the health impacts of poor IAQ provide
    additional evidence of the benefits that may be associated with implementing the
    IAQ TfS Program.

    "Good indoor air quality  contributes to a favorable learning

     environment.  The IAQ Tools for Schools Program is a common-

     sense guide to help prevent and solve the majority of indoor air

     problems affecting many of our nation's schools."

     —Christie Whitman, Administrator, U.S. Environmental Protection Agency


           Poor IAQ can lead to a large variety of health problems and potentially affect
           comfort, concentration, and student and staff performance. Sources of poor
    IAQ in school facilities range from inadequate air ventilation systems to fumes from
    pesticides and cleaning agents. The IAQ Tools for Schools Kit helps schools pinpoint the
    sources of poor IAQ that often have simple and cost-effective remedies.

                                               Successful Schools
                                               Schools across the country have
                                               observed many health-related
                                               benefits from implementing the
                                               IAQ TfS Kit:

                                               • Improvements in comfort levels
                                                and a decrease in lAQ-related
                                                complaints (King-Murphy
                                                Elementary School, Colorado).
                                               • A reduction in IAQ complaints
                                                from  one per month to three per
                                                year since 1997 (Shamona Creek
                                                Elementary School, Pennsylvania).
     l A dramatic decrease in absenteeism, fewer reported bronchitis cases reported by
      school staff, an increase  in comfort, and a 2 5-percent reduction in the number of
      visits to the school nurse with complaints of stomachaches and headaches within
      the first 5 months of implementing the Kit (Little Harbour School, New Hampshire).
     l A decrease in the number of complaints from staff and students of headaches
      and sinus infections, the number of trips to the school nurse for asthma and
      asthma treatments, the use and storage of student inhalers at school, and
      symptoms of chronic respiratory illnesses (Hamden Public Schools, Connecticut).
     l A 50-percent reduction in visits to the office for the use of asthma inhalers
      (G.W. Carver Elementary School, California).
     l A reduction from 75 complaints related to health and faulty equipment in 1994
      to fewer than 15 in 1999  (Okaloosa County School District, Florida).

In addition to health benefits, schools have saved thousands of dollars with the help
of the IAQ TfS Program:
 I Since implementing the program in 1998, the Hillsborough County Public
  School District in Florida has spent only $400 on IAQ consultants, as compared
  to an estimated $250,000 prior to 1997.
 l The Janvier Elementary School in New Jersey spent nearly $100,000 to correct
  mold and flooding problems before beginning the program, after which minimal
  investment solved IAQ problems uncovered while implementing the IAQ TfS Kit.
 l Nearly all IAQ complaints were resolved in-house at Monmouth Junction
  Elementary School in New Jersey at a total cost of less than $1,000. The
  improvements focused on preventive maintenance, integrated pest
  management, and the use of environmentally preferable cleaners.
"We received some great press from implementing the Kit—the local
 newspapers wrote several articles about our Healthy Schools Team/'

 —Robin Chappell, District Health Official, Boston, MA
          ACTION        ITEMS
                                   Be proactive in investigating IAQ problems in
                                   your school.
                                   Be alert to the symptoms of IAQ problems in
                                   your school.
                                   Use IAQ TfS checklists to assess your school's
                                   indoor air quality.
                                  • Fix IAQ problems as soon as they are
                                   discovered to avoid future costly repairs.


     "IAQ Tools for Schools is the driving force of our preventive
      maintenance program in the Piano School District/'

      —Robert Sands, Executive Director of Facilities, Piano Independent School District, TX
     Cost Savings and Maintenance
     The IAQ TfS Program can help schools maintain their facilities and good IAQ to
     avoid expensive repairs.

     • In a demonstration project in the District of Columbia, an analysis showed that if
      an elementary school had spent $364 per year on preventive maintenance, $1.6
      million in repairs could have been avoided.
     • The General Accounting Office reports that one-third of schools (housing about
      14 million students) have one or more buildings in need of extensive repair or
     • The average public school is 42 years old, and school buildings begin rapid
      deterioration after 40 years if not properly maintained.7

     Studies on the Effects of Poor IAQ
     Studies have shown that poor IAQ can have a negative impact
     on the health of students and faculty members. By
     implementing the IAQ TfS Program, schools can minimize
     problems associated with poor IAQ.
     l Higher levels of nitrogen dioxide (a byproduct of combustion sources**) in
      schools have been associated with increased student absences, even at levels
      within existing health standards.3 Similarly, increased absences were also found
      to be associated with higher levels of outdoor pollution. 4- 5' 6
     '' Combustion sources can include kerosene heaters and unvented gas stoves and heaters.


                                            Mo/cf on joist, photo by Daniel Fn
"We keep a log of student visits to our health room and, even
 during allergy season, student visits declined dramatically.
 We attribute this to the IAQ TfS Kit"
 —Leigh Abbott, Principal, Shamona Creek Elementary School, PA

    • Respiratory effects have been
      associated with chemical pollutants
      that can be found in schools, such as
      formaldehyde7 and chemicals in
      cleaning compounds.8' 9

    Studies on Performance
    Studies have shown that schools can
    help maintain or even improve the
    comfort and performance levels of
    students and faculty members by
    enhancing IAQ.

    • For students, lower concentrations of
      carbon dioxide (higher ventilation rates)
      were associated with higher scores on
      computerized tests for reaction time.10
    • There is a significant relationship
      between facility condition and
      student achievement, based on test
      scores in 139 public schools in
      Milwaukee, Wisconsin, in math,
      science, language, and social studies.11
    m A statistically significant reduction in
      perceived mental performance among
      students was associated with increased
      indoor pollutant concentrations and
      lower ventilation rates.12
m Office workers perceived a reduction
  in their performance with two or
  more symptoms of discomfort.
  Average performance reduction:
  3 percent with three symptoms,
  8 percent with five symptoms.73
• Controlling pollutant concentrations
  by removing pollutant sources or
  by increasing ventilation improved
  the measured performance of
  office workers.14

Studies on Temperature and Humidity
Studies suggest that fluctuations in
temperature and humidity can have an
impact on comfort and concentration
levels of students and staff.

• Indoor air is perceived to be better
  when temperature and/or humidity
  are toward the low end of the
  comfort zone.15' 16' 17
• While evidence is mixed, it tends
  to suggest an association between
  improved performance and lower
  temperatures within the comfort
  Zone.i8, 19,20
    "The most noticeable improvements [as a result of implementing the
     IAQ TfS Kit] came from our portable classrooms. The CO2 levels
     dropped considerably, and the school nurse noticed fewer complaints
     from students that were housed in those outside classrooms."
     —Mike Riddle, Facilities and Grounds Manager, Sedro-Woolley School District, WA


                        "The Kit's information helped to identify and
                         explain potential IAQ problems while also
                         providing legitimacy to the complaints submitted
                         to the Board of Health"
                        —Todd Dresser, Environmental Engineer, Burlington Board of Health, MA
                        Mold behind wallboard and water damage to subflooring in a New York City building,
                        photo by Daniel I

                                    MOLD   AND  SCHOOLS

  Hold Remediition
  in Schools and
While the IAQ TfS Kit

helps schools learn how

to prevent mold growth, EPA's

"Mold Remediation in Schools

and Commercial Buildings"

document provides detailed

information on how to

investigate, evaluate, and

remediate moisture and mold

problems. To order

this EPA publication at no

cost, call the IAQ INFO

Clearinghouse at

(800) 438-4318.
   ^  chools have become increasingly
^^f  concerned about indoor exposure to
mold, which can lead to a variety of health
effects, including allergic reactions. Not
isolated to "humid" states, mold problems have
caused school closings across the nation from
Arizona to Maine, California to Florida. The
IAQ Tools for Schools Program can help schools
identify potential sources of mold before they
become severe.

Schools with Mold
• El Paso Independent School District in Texas
  used the IAQ TfS Program to identify and
  eliminate a significant mold problem, including
  mold in the heating, ventilation, and air
  conditioning ducts.
• St. Cloud Area School District in Minnesota
  found mold infestations in some schools
  during the walkthroughs, which are a key
  aspect of the IAQ TfS Program. The schools are
  cleaner and healthier after implementing the
  Kit and repairing water-damaged areas.

"If we'd had IAQ Tools for Schools

  in place for the past ten years, none of

  [our severe problems with carbon dioxide

  and mold] would have happened."

 —Diane Ethier, Co-Chair of the IAQ Tools for Schoo/s Team,
   Plainfield High School, CT

     Minimizing Cost of Mold Remediation

     Schools can avoid significant, costly repairs by implementing the IAQ TfS Program
     to help prevent mold problems or address them before they become severe.

     • School districts have spent from $200,000 to $13.1 million to remediate a school
      with a severe mold problem, so it is important to identify the problem in its early
      stages when damage is limited.
         ^ An elementary school in El Paso Independent School District, Texas, spent
           $300,000 in repair work due to mold.
           Saline Middle School in Washtenaw County, Michigan, spent $500,000 to
           solve the mold problem associated with their ceiling tiles.
         ^ District 303 spent $13.1 million on the mold cleanup and repair project at
           St. Charles East High School, Illinois, after closing the school due to mold
         ^ Bedford County School Board in Florida spent $750,000 to replace Jefferson
           Forest High School's roof, but another $1.6 million was needed to
           remediate the mold problem at the school.
          * Yuma High School, Arizona, spent more than $5 million to clean up its
           mold problem.
         ^ Washington Elementary School, Michigan, spent more than $200,000 to
           clean up its mold problem.

     • To relocate students from moldy schools in Portland, Maine, the school district
      spent $100,000 every three months to rent rooms in downtown buildings.
  Be alert to signs of water damage near windows,
  on ceilings, and on walls in classrooms and hallways.
  Use the IAQ Tools for Schools Kit to conduct walkthroughs
  to help identify mold problems before they become severe.

  Look for visible signs of mold or moldy odors throughout
  your school.

Schools can reduce
triggers for asthma by
following the guidance
presented in EPA's document,
"IAQ Tools  for Schools—
Managing Asthma in the
School Environment."
To order this EPA publication
at no cost, call the
IAQ INFO Clearinghouse
at (800) 438-4318.
Mold on ceiling in a Georgia elementary school,
photo by Daniel Friedman

Studies on Mold and on Dampness

Studies have found an association between mold
and a variety of adverse health effects. For example,
mold is a known asthma trigger.

• Controlling dampness in buildings is extremely
  important in that dampness has been consistently
  associated with respiratory symptoms, asthma,
  and allergies, and therefore represents a risk
  factor for respiratory problems. 21'22
• Dampness or mold in the home have been
  associated with wheezing, prolonged cough,
  fatigue, and headache among children without
  diagnosed asthma.23


      I  T  sthma affects about 15 million people of all ages, including 1 out of every
    JL  JL 13 school-age children. Asthma has become increasingly common in children,
    particularly in 5- to 6-year olds. Schools can decrease children's exposure to triggers
    for asthma, such as animal dander, cockroaches, mold, and dust mites, by
    implementing the IAQ Tools for Schools Program.

    m Asthma is a primary cause of school absenteeism, accounting for 10 million missed
      school days per year. Absenteeism directly affects school funding, which is often
      based on attendance.
    • Asthma is the most common and costly chronic illness in the United States,
      estimated at $11.3 billion in 1998.

    Studies on Asthma
    • Exposure to mold has been associated with increased severity of asthma symptoms. 24
    • Asthma prevalence in schools has been associated with higher relative air humidity,
      higher concentrations of volatile organic  compounds,  and mold or bacteria. 7
    • Reported asthmatic symptoms were less  common in schools that had installed a new
      ventilation system. The new system resulted in higher air-exchange rates, lower
      concentrations of several airborne pollutants, and lower relative humidity.25
                   ACTION        ITEMS
Encourage the school nurse to alert school
administrators about an increase in health
problems such as asthma, wheezing, and
persistent coughing.

Use the IAQ Tools for Schools Kit to identify
triggers for asthma and minimize children's
risk of developing respiratory problems.

Minimize all asthma triggers in schools such
as mold, dust mites, animals, and cockroaches.

"We saw a significant decrease
 in the absenteeism rates of
 children, especially for a child
 with severe asthma attending
 the school, since we completed
 the IAQ upgrades/'
 —Priscilla Santiago,
  School Nurse, Little Harbour School, NH
                                     "Fewer students keep
                                      asthma medicine and
                                      inhalers at school, and
                                      asthma episodes are less
                                      frequent even though the
                                      number of students with
                                      asthma has not changed.'
                                       —School Health Programs
                                        Department, San Francisco
                                        Unified School District, CA

                                       O     N
7  Lyons J.B. 2001. Do School Facilities Really
   Impact a Child's Education? Issuetrak, CEFPI
   Brief. November 2001.
                             An estimated 8,000 to
                             26,000 new asthma
                             cases arise in
                             children each year.

                             Nearly 1 in 13
                             children of school-
                             age has asthma.
                             The percentages
                             are rising more
                             rapidly in preschool-
                             age children than in
                             any other group.

                             Deaths related to
                             asthma in children
                             have nearly tripled
                             over the last 15

                             and Hispanic
                             populations are
                             more likely to
                             have asthma.
3  Pilotto L.S., Douglas R.M., Attewell R.G., and
   Wilson S.R. 1997. Respiratory effects associated
   with indoor nitrogen dioxide exposure in
   children. IntJEpidemiol, 26(4):788-96.

4  Romieu I., Lugo M.C., Velasco S.R., Sanchez S.,
   Meneses R, and Hernandez M. 1992. Air-
   Pollution and School Absenteeism among
   Children in Mexico City. American Journal of
   Epidemiology, 136(12):1524-1531.

5  Makino K. 2000. Association of school absence
   with air pollution in areas around arterial
   roads. J Epidemiol, 10(5):292-9.

6  Chen L., Jennison B.L., Yang W., and Omaye
   S.T. 2000. Elementary school absenteeism and
   air pollution. InhalToxicol, 12(11):997-1016.

7  Smedje G., Norback D., and Edling C. 1997.
   Asthma among secondary schoolchildren in
   relation to the school environment, din Exp
   Allergy, 27(ll):1270-8.

8  McCoach A.S. and Burge P.S. 1999. Floor
   cleaning materials as a cause of occupational
   asthma. The 8th International Conference on
   Indoor Air Quality and Climate. Edinburgh,
   Scotland: Construction Research
   Communications Ltd, 459-63.

9  Zock M., Sunyer J., Almar E., Muniozguren N.,
   Payo F, Sanchez J.L., and Anto J.M. 2001.
   Asthma Risk, Cleaning Activities and use of
   Specific Cleaning Products Among Spanish
   Indoor Cleaners. ScandJWork Environ Health,

10 Myhrvold E. and Lauridsen O. 1996. Indoor
   environment in schools - Pupils health and
   performance in regard to CC>2 concentrations.
   The 7th International Conference on Indoor Air
   Quality and Climate. Nagoya, Japan, 369-74.

7 7 CEFPI. 2000. Where Children Learn: Facilities
   Conditions and Student Test Performance in
   the Milwaukee Public Schools. Issuetrak.
   December 2000.

72 Smedje D. and Edling C. 1996. Mental
   performance by secondary school pupils in
   relation to the quality of indoor air. The Seventh
   International Conference on Indoor Air Quality and
   Climate. Nagoya, Japan, 413-19.

13 Raw G.H., Roy M.S., and Leaman A.  1990.
   Further Findings from Office of Environment
   Survey: Productivity. Indoor Air '90. The Fifth
   International Conference on Indoor Air Quality and
   Climate, 1:231-236.

14  Wargocki P.W. and Fanger P.O. 2000. Pollution
    source control and ventilation improve health,
    comfort and productivity. Cold Climate HVAC.
    Sapporo, Japan.

75  Fang L, Clausen G., and Fanger P.O. 1998.
    Impact of Temperature and Humidity on the
    Perception of Indoor Air Quality. Indoor Air,

76  Fang L., Clausen G., and Fanger P.O. 1998.
    Impact of Temperature and Humidity on the
    Perception of Indoor Air Quality During
    Immediate and Longer Whole-Body
    Exposures. Indoor Air, 8(4):276-284.

77  Fang L., Wargocki P., WittersehT, Clausen G.,
    and Fanger P.O. 1999. Field Study on the
    Impact of Temperature, Humidity, and
    Ventilation on Perceived Air Quality. Indoor Air
    99. The Eighth International Conference on Indoor
    Air Quality and Climate, 2:107-112.

18  Schoer L. and Shaffran J. 1973. A combined
    evaluation of three separate research projects
    on the effects of thermal environment on
    learning and performance. ASHRAE
    Transactions 79:97-108.

79  Mendell M.J., Fisk W.J., Petersen M, Hines
    C.H., Faulkner D., Dong M.X., Deddens J.A.,
    Ruder A.M., Sulivan D., and Boeniger M.F.
    2002. Enhanced particle filtration in a non-
    problem office environment: preliminary
    results from a double-blind crossover
    intervention study. Epidemiology (in press).

20  Wyon D.P., Andersen I, and Lundqvist G.R.
    1979. The effects of moderate heat stress  on
    mental performance. Scand] Work Environ
    Health 5(4):352-61.

21  Bornehag G.,  Gyntelberg F, Jarholm B.,
    Malmberg P.,  Nordvall L., Nielsen A.,
    Pershagen G., and Sundell J. 2001. Dampness
    in Buildings and Health. Nordic
    Interdisciplinary Review of the Scientific
    Evidence on Associations between Exposure to
    "Dampness" in Buildings and Health Effects
    (NORDDAMP). International Journal of Indoor
    Air Quality & Climate, ll(2):72-86.

22  Peat J.K., Dickerson J., and Li J. 1998. Effects of
    damp and mould in the home on respiratory
    health: a review of the  literature. Allergy, 53(2):120-8.

23  MaierW.C., Arrighi  H.M., Morray B.L.C., and
    Redding G.J. 1997. Indoor Risk Factors for
    Asthma and Wheezing Among Seattle's
    Children. Environ Health Perspect, 105(2):208-14.

24  National Academy of Sciences, Committee on
    the Assessment of Asthma and Indoor Air.
    2000 Clearing the Air: Asthma and Indoor Air
    Exposures. National Academy Press.
    Washington, DC.

25  Smedje G. and Norback D. 2000. New
    Ventilation Systems  at Select Schools in
    Sweden-Effects on Asthma and Exposure. Arch
    Environ Health, 55(l):18-25.

Other useful resources
for schools (available at
no cost) include:

Indoor Air Quality:
• Indoor Air Quality and Student
• Indoor Air Quality Tools for
  Schools Case Studies
• Indoor Air Quality Tools for
  Schools Roadmap
• Indoor Air Quality Tools for
  Schools Bulletins
• Pesticides: Uses, Effects and
  Alternatives to Pesticides in

• Clear Your Home Of Asthma
  Triggers: Your Children Will
  Breathe Easier
• Children and Secondhand Smoke
• Respiratory Health Effects of
  Passive Smoking: Lung Cancer
  and Other Disorders
• Setting the Record Straight:
  Secondhand Smoke is a
  Preventable Health Risk
• Secondhand Smoke: What
  You Can Do As Parents,
  Decisionmakers, and Building

• Radon in Schools Brochure
• Reducing Radon in Schools:
  A Team Approach
• Radon Measurement in Schools
• Radon Prevention in the Design
  and Construction of Schools,
  Other Large Buildings

For a complete listing of
available resources, or to order
any of these documents, call the
IAQ INFO Clearinghouse at
(800) 438-4318.

     EPA offers many resources at no cost. Some of these include:
         m The IAQ Tools for Schools Kit

         m Mold Remediation in Schools and Commercial Buildings

         m Managing Asthma in the School Environment

     For a complete list of EPA's resources, visit http://www.epa.gov/iaq.
     To order a document, call the IAQ INFO Clearinghouse at
     (800) 438-4318, fax (703) 356-5386, or e-mail iaqinfo@aol.com.
_. .ited States
Environmental Protection
Office of Air and Radiation
Indoor Environments Division
EPA 402-K-02-005
October 2002