EPA/600/Ar-93 /137
ASSOCIATION OF PERSONAL AND WORKPLACE CHARACTERISTICS WITH
REPORTED HEALTH SYMPTOMS OF 6771 GOVERNMENT EMPLOYEES IN
WASHINGTON, DC
Lance A. Wallace1, C. J. Nelson2, and Graham Glen3
1US EPA, Warrenton, VA
2US EPA, Research Triangle Park, NC
Lantech, Research Triangle Park, NC
ABSTRACT
An indoor air quality questionnaire was completed by 6771
employees of two government agencies. Regression analyses on
12 clusters of health symptoms indicated that both personal and
workplace characteristics were associated with symptoms. The
variables associated with the largest number of symptoms at
both agencies were DRY AIR/DUSTY OFFICE, CHEMICAL/PAINT ODORS,
HOT STUFFY AIR, and SENSITIVITY TO CHEMICALS. Other variables
that were often significantly associated with symptoms were
GLARE, CARPET/DRAPE ODOR, DUST/MOLD ALLERGY, CAREER
FRUSTRATION, and JOB PRESSURE/CONFLICT.
INTRODUCTION
A study of indoor air quality in four office buildings was
carried out in 19 8 9 near Washington, DC -(-1-^-2-)-. Three buildings
were used by the Environmental Protection Agency (EPA) and the
fourth by the Library of Congress (LOC). \ The sponsors of the
study were the EPA and the National Institute for Occupational
Safety and Health (NIOSH).
A questionnaire was provided to approximately 5000 employees of
the EPA and about 3500 employees of the LOC. An analysis ,of
3948 completed EPA questionnaires has been carried out (-3^-4).
The main objective of the present study was to perform
identical analyses on the EPA and LOC data sets separately to
determine "robust" relationships between symptoms and workplace
or personal characteristics. An additional objective was to
expand the analyses to include not only the "last year" health
symptoms but also the "last week" and job-related symptoms as
well. Finally, several questions concerning absenteeism and
productivity have been newly analyzed.
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"last year" and also "last week". They were asked whether the
symptom "got better, got worse, or stayed the same" after
leaving work; job-related symptoms might be expected to improve
on leaving work.
To reduce the number of variables, and also to increase the
orthogonality of remaining variables, principal components
analyses (PCA) were carried out on the health, comfort, odor,
and psychological questions, resulting in 12 health, four
comfort, six odor and four psychological factors. The 50
personal and workplace characteristics were also reduced to 40
variables, for a total of 54 independent variables. For each
of the 12 health factors, multiple regressions were performed
on the "last year", "last week" and •"job-related" data for the
EPA and LOC data sets separately, resulting in 72 regressions.
Association with workplace. One question asked if people
associated their symptoms with the workplace. More than half
the respondents did so. A multiple regression was carried out
on this question using the combined LOC and EPA data sets.
Productivity. Two questions dealt with productivity. The
first asked if respondents' ability to work was affected by
their symptoms. The second asked if respondents had left work
early or stayed home because of their symptoms. Pearson
correlation coefficients of the 32 health symptoms with the
answers to these questions were determined. A multiple
regression was carried out on these two questions using the
combined LOC and EPA data sets.
Spatial analysis. Multiple regressions adding eight "sectors"
(representing six contiguous sections of the main EPA building
plus the other two buildings) to the 54 independent variables
were carried out on each of the 12 health factors for the EPA
data set. Similar regressions were carried out using the eight
floors of the LOC building as spatial variables.
Gender effect. Since females had higher symptom prevalences
than males, an attempt was made to determine whether the
difference could be explained completely by other variables. A
binary variable for gender was added to the 54 independent
variables and the multiple regressions were repeated for all
health factors in the EPA and LOC data sets separately.
Dust. Since previous studies (3,4,5) have indicated the
importance of dust in building-related symptoms, correlations
of all variables with reported dustiness were determined.
Sensitivity to chemicals. Previous studies (3,4) determined
that sensitivity to chemicals was associated with a number of
symptoms. Therefore the correlations of all variables with
self-reported sensitivity to chemical fumes were calculated.
Comparison of building populations. Possible differences
between the EPA and LOC responses were investigated by
combining the two data sets and adding a binary variable
identifying the two sites. Multiple regressions were carried
out on the 12 health factors for the combined data set.
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RESULTS
The most common symptoms included headache, sinus congestion,
fatigue, runny nose, sore eyes, tension, dry skin, and
difficulty concentrating. About two/thirds of the positive
responses for each symptom were reported as job-related.
Multiple regression results were similar for the "last year",
"last week" and "job-related" analyses; therefore results from
a composite ranking are reported here.
Headache and nausea. DRY AIR/DUSTY OFFICE and HOT STUFFY AIR
were the variables most closely associated (p<0.001) with
headache and nausea. At the EPA, PAINT/CHEMICAL ODOR and JOB
PRESSURE were also significant (p<0.01). For men only at the
EPA, NEW CARPET ODOR was associated (p<0.001) with increased
symptom frequency. For females only at the LOC, DUST/MOLD
ALLERGY and PRINTING/COPYING ODOR were related (p<0.001).
Nasal symptoms. DRY AIR/DUSTY OFFICE and DUST/MOLD ALLERGY
were associated the most strongly (p<0.001) with sinus
congestion, runny nose and other nasal symptoms. HOT STUFFY
AIR was also associated (p<0.01) with these symptoms. At the
EPA, PAINT/CHEMICAL ODOR and NEW CARPET ODOR were associated
(p<0.01) with increased symptom frequency. At the LOC, COLD
DRAFTY AIR was related (p<0.01) to increased frequency.
Chest tightness, wheezing and shortness of breath. PRE-
EXISTING ASTHMA was strongly associated (p<0.001) with these
symptoms. At the EPA, PAINT/CHEMICAL ODOR (p<0.001) was
related to these symptoms. At the LOC, PRINTING/COPYING ODOR
was strongly associated (p<0.0001) with these symptoms. At the
EPA, NEW CARPET ODOR was associated (p<0.01) with increased
frequency. At the LOC, DUST/MOLD ALLERGY was related (p<0.01).
Eye irritation. DRY AIR/DUSTY OFFICE and GLARE were the
variables most strongly associated (p<0.001) with eye problems.
Persons who wore contact lenses were also more likely to report
eye problems (p<0.01). At the EPA, PAINT/CHEMICAL ODOR and NEW
CARPET ODOR were also associated (p<0.01) with this symptom.
At the LOC, HOT STUFFY AIR and DUST/MOLD ALLERGY were
associated (p<0.01) with eye irritation.
Bore throat, dry throat# hoarseness. DRY AIR/DUSTY OFFICE was
strongly associated (p<0.0001) with these symptoms. Two other
symptoms less strongly associated (p<0.01) with throat problems
were PAINT/CHEMICAL ODOR and HOT STUFFY AIR. At the EPA, NEW
CARPET ODOR was also associated (p<0.001) with throat problems.
At the LOC, DUST/MOLD ALLERGY was associated (p<0.01) with
throat problems.
Fatigue and sleepiness. HOT STUFFY AIR and DRY AIR/DUSTY
OFFICE were strongly associated (p<0.001) with unusual fatigue
and sleepiness. Also related (p<0.01) was the psychological
variable CAREER FRUSTRATION. At the EPA, PAINT/CHEMICAL ODOR
was also associated (p<0.01) with fatigue.
Chills and fever. COLD DRAFTY AIR was strongly associated
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(p<0.0001) with chills and fever, and DRY AIR/DUSTY OFFICE less
strongly associated (p<0.01). At the EPA, PAINT/CHEMICAL ODOR
was also associated (p<0.001) with chills.
Muscle aches, joint pain/ pain in neck, shoulder, back. DRY
AIR/DUSTY OFFICE, GLARE, and DISCOMFORT were the variables most
strongly associated (p<0.001) with these symptoms. At the EPA,
PAINT/CHEMICAL ODOR was also significant (p<0.001). At the
LOC, HOT STUFFY AIR was also significant (p<0.01).
Depression, tension, difficulty concentrating/remembering. The
three psychological variables UNDERUTILIZATION, CAREER
FRUSTRATION, and JOB PRESSURE/CONFLICT were all strongly
associated (p<0.0001) with these symptoms.
Dizziness. At the EPA, PAINT/CHEMICAL ODOR and NEW CARPET ODOR
were the variables most strongly associated (p<0.001) with this
symptom. At the LOC, DRY AIR/DUSTY OFFICE and DUST/MOLD
ALLERGY were significant (p<0.001).
Dry skin. DRY AIR/DUSTY OFFICE was strongly associated
(p<0.0001) with this symptom. PRE-EXISTING ECZEMA was also
associated (p<0.001) with dry skin.
Problems with contact lenses. DRY AIR/DUSTY OFFICE was
strongly associated (p<0.001) with this symptom.
Productivity. Two "comfort" variables (HOT STUFFY AIR and DRY
AIR/DUSTY OFFICE) were associated the most strongly (p<0.001)
with reports of reduced ability to work. Two different
variables (CHEMICAL/PAINT ODORS and CAREER FRUSTRATION) were
more likely to be associated (p<0.001) with leaving work early
or not coming to work. Other variables associated (p<0.01)
with absenteeism included SENSITIVITY TO CHEMICALS, NEW CARPET
ODOR (EPA only), and DUST AND MOLD ALLERGIES (LOC only).
Spatial analysis. No spatial variable at any of the buildings
was significantly associated with any health factor.
Gender effect. Gender was significantly associated with a
number of health factors, but was seldom among the top three
variables in terms of the strength of the association. One
exception was for headache and nausea, where being female was
one of the most important risk factors (p<0.001).
Comparison of building populations. Working at the LOC was
consistently associated with higher symptom prevalence, but the
differences were seldom statistically significant.
Dust. The characteristics showing the strongest correlations
with dusty offices were GLARE, CAREER FRUSTRATION, LIGHTS TOO
DIM, DESK AND CHAIR DISCOMFORT, and HEAVY WORKLOAD.
Sensitivity to chemicals. The variables showing the strongest
correlations with sensitivity to chemicals were DUST, GLARE,
CAREER FRUSTRATION, and JOB PRESSURE/CONFLICT. SMOKERS were
significantly less likely to report sensitivity to chemicals.
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DISCUSSION
Some variables appeared repeatedly in association with symptoms
at both the EPA and the LOC. These included "comfort" variables
(HOT STUFFY AIR, DRY AIR/DUSTY OFFICE) ; odors (CHEMICAL/PAINT
ODORS); workstation environment (GLARE); a possible measure of
susceptibility (SENSITIVITY TO CHEMICALS) ; and psychological (or
organizational) variables (JOB PRESSURE, CAREER FRUSTRATION).
These variables show consistent associations with symptoms in two
large and independent data sets and may therefore have a general
relation with health symptoms in other buildings. A number of
previous investigations (3,5) of health problems in buildings
have concluded that the problems are multifactorial; the results
of this study support that conclusion.
One variable appeared often in association with symptoms at the
EPA, but seldom at the LOC: NEW CARPET ODOR. The EPA had 17000
yards of new carpet installed one year prior to the study,
whereas little if any new carpet was present at the LOC. The
appearance of this variable in connection with symptoms at EPA
suggests that this new carpet or something connected with the
process of carpet installation could have affected the health of
some EPA employees.
Conversely, the variable DUST AND MOLD ALLERGIES appeared more
often in association with symptoms at the LOC than at the EPA.
It has been previously suggested that health problems at the
Madison Building could have been due to molds or fungi resulting
from the extensive greenery maintained in a central atrium.
However, concurrent measurements of bioaerosols showed no
elevated concentrations at the LOC building (1).
Comfort variables (HOT STUFFY AIR and DRY AIR/DUSTY OFFICE) were
most closely associated with reduced productivity on the job.
Absenteeism, on the other hand, was more closely associated with
medical conditions (DUST AND MOLD ALLERGIES, SENSITIVITY TO
CHEMICALS), apparent chemical exposure (CHEMICAL/PAINT ODORS, NEW
CARPET ODOR), or psychological variables (CAREER FRUSTRATION).
Preller (6) also found a strong effect of allergy and job
dissatisfaction on productivity. However, Preller's findings of
effects of work at video display units, age, and education were
not replicated in this study. Raw (7) found sharing an office
with four or more persons to have a negative effect on
productivity; our office sharing index, (private office, shared
enclosed office, and open area) displayed no such association.
Symptom frequencies appeared high. For example, over 4000
headaches were reported in one week by about 4 000 EPA employees.
This corresponds to about 250,000 headaches per year among the
5000 employees. Recent attempts to evaluate the cost of .
headaches and other minor symptoms have provided costs in the
range of $1.50 to $8.00 per headache. This would correspond to
an annual cost of $375,000 to $2,000,000 for this symptom alone.
Headache was the symptom most frequently mentioned (by 16% of EPA
respondents) as causing them to stay home or leave work early.
Thus steps to reduce the frequency of headache (and other minor
symptoms) could be cost-effective. Among the workplace variables
associated with headaches were glare, dust, hot stuffy air, and
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the odor of paint and chemicals. Improved cleaning and
ventilation procedures and steps to reduce glare (e.g., fitting
computers with glare-reducing screens) could improve
productivity. Other variables associated with headache were
measures of stress, such as conflicting demands on an employee's
time. Work on these problems could also improve productivity.
A question of interest is whether restricting symptoms to be job-
related will provide significantly different results from those
obtained by analyzing all responses. The present study suggests
that either type of analysis can be performed without
significantly different results, and that studies using one or
the other method of analysis can be appropriately compared.
REFERENCES
1.	EPA. Indoor Air Quality and Work Environment Survey: EPA
Headquarters Buildings. Volumes I, II, III. US EPA,
Washington, DC. 1989, 1990.
2.	NIOSH. Indoor Air Quality and Work Environment Study:
Library of Congress Madison Building. Vols I, II, III.
National Institute for Occupational Safety and Health.
Cincinnati, OH, 1990. HETA 88-364-2102.
3.	EPA. Indoor Air Quality and Work Environment Survey: EPA
Headquarters Buildings. Vol. IV. US EPA, Wash., DC, 1991.
4.	Wallace, LA, Nelson, CJ, and Glen, G. Effect of personal
and workplace characteristics on health, comfort and odor:
a statistical analysis of a survey of 3948 office workers in
three buildings. Submitted to Indoor Air.
5.	Skov, P., Valbjorn, 0., Pedersen, B.V., and the Danish
Indoor Climate Study Group. Influence of indoor climate on
the sick building syndrome in an office environment. Scand.
J. Work Environ. Health 1991;16:363-71.
6.	Preller, L, Zweers, T, Brunekreef, B and Boleij, J. Sick
leave due to work-related health complaints among office
workers in the Netherlands, in Walkinshaw, D. (ed) Indoor
Air '90: Proceedings of the 5th International Conference on
Indoor Air Quality and Climate. Canada Mortgage and Housing
Association, Ottawa, Canada. Vol. 1, 1990;227-30.
7.	Raw, G., Roys, M., and Leaman, A. (1990) "Further Findings
from Office Environment Survey: Productivity," in
Walkinshaw, D. (ed) Indoor Air '90: Proceedings of the 5th
International Conference on Indoor Air Quality and Climate.
Canada Mortgage and Housing Association, Ottawa, Canada.
Vol. 1 1990;231-36.
We thank Drs. A. Fidler and T. Wilcox of NIOSH for supplying the
LOC data. This paper has been reviewed in accordance with the
U.S. Environmental Protection Agency's peer and administrative
review policies and approved for presentation and publication.
Mention of trade names or commercial products does not constitute
endorsement or recommendation for use.
(A
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^ TECHNICAL REPORT DATA
(nttt* rttd Intinitlions oa tht rtrmt b*[on eompfi
|l. REPORT NO.
ERA/600/A-93/137
PB93- 212264
|4. .tITLI AMD SUBTITLE
8. REPORT QATt
ASSOCIATION OF PERSONAL AND WORKPLACE CHARACTERISTICS
WITH REPORTED HEALTH SYMPTOMS OF 6771 GOVERNMENT EMPLOfr
B. PtRFORMINO OROANIZATlON COOS
EES IN1WASHINGTON, DC
B. PtRFORMINO ORGANIZATION REPORT NO.
[7. AUfHOBISl
L.A. Wallace, C. J. Nelson, G. Glen
!>. PcnronMiNQ organization name and aooRKsi
Mantech
Research Triangle Park, NC 27711
6, prooaam element nb.
»i.eo*T»ue^apwwT ^6
68-DO-0106
[12. SPONSORING AOCNCV NAME AND ADDRESS
USEPA
RESEARCH TRIANGLE PARK, NC 27711
13. TYPE OF REPORT AND PeRlOO COVCMEO
1 /Q7-Q/Q9	
»ymi>.o.Rl|nn.r,hapr
H.VONSORINO AOENC
V CODE
110. SUPPLEMENTARY NOTES
•i. Abstract
AnTndoor air quality questionnaire was completed by6771
of two government agencies. Regression analyses on 12 cluste
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