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We studied time trends in home environment and sick building syndrome (SBS) symptoms in a repeat study in five cities in southern China. Moreover, we studied associations between home environment exposure and SBS symptoms. Parents from randomly selected day care centers were invited. One parent per family answered a questionnaire on the home environment and their own SBS symptoms. Data collection was performed in two surveys in 2010 and 2019 (27,292 participants in 2010 and 32,073 in 2019). We used two-level logistic regression to analyze health associations. Asthma decreased from 1.7% to 1.5% (P < 0.05) but allergic rhinitis increased from 6.5% to 16.4% (P < 0.001). All SBS symptoms decreased from 2010 to 2019 (all P < 0.001). Most aspects of the home environment improved from 2010 to 2019 but there were less cleaning, more cats, dogs, and urbanization in 2019. Redecoration, new furniture, and pests were associated with most types of SBS symptoms, similarly in 2010 and 2019. Environmental tobacco smoke (ETS) was associated with SBS symptoms in 2019 only. In conclusion, prevalence of SBS symptoms among young parents in southern China decreased from 2010 to 2019 but allergic rhinitis increased. Cockroaches, rats, mice, mosquitoes or flies can be consistent biological risk factors for SBS symptoms. Redecoration, buying new furniture and traffic air pollution are other risk factors for SBS symptoms. Daily cleaning, frequently putting bedding to sunshine, and having a fan in the bathroom can be protective factors. ETS is an emerging risk factor for SBS symptoms., The two first authors contributed equally to this work

We investigated associations between dampness in Chinese homes and sick building syndrome (SBS) symptoms and studied the role of climate, family size, cleaning and ventilation for dampness, mould and SBS. A questionnaire survey was done in 2019-2020 among adults in five cities (32349 participants) and data on outdoor climate was collected. Multilevel logistic regression was used to calculate adjusted odds ratios (ORs). In total, 2.2% had rhinitis, 1.8% eye, 1.6% throat and 2.9% skin symptoms, 2.1% headache and 8.7% fatigue (weekly symptoms). Overall, 12.1% reported indoor mould, 5.7% damp bedding, 5.3% mould odour and 33.8% humid air in current home. Mould was associated with all symptoms (ORs 1.86-2.15 for minor mold growth and 1.65-3.45 for major mould growth). Damp bedding was associated with all symptoms (ORs 2.18-2.80 for minor dampness and 2.51-8.03 for major dampness). Mould odour was associated with all symptoms (ORs 1.84-2.77 for sometimes odour and ORs 3.78-7.80 for weekly odour). Perception of humid air was associated with all symptoms. ORs increased by number of dampness signs. Precipitation, outdoor relative air humidity and temperature increased dampness, mould and SBS symptoms. Large family size increased dermal symptoms. Daily floor cleaning, airing in winter, putting bedding to sunshine and mechanical ventilation in the bathroom reduced dampness, mould and SBS symptoms. In conclusion, mould and dampness in Chinese homes can increase rhinitis and SBS-symptoms in a dose-response manner. A warmer and more humid climate can increase, and cleaning and ventilation in the home can decrease dampness, mould and SBS symptoms.

A questionnaire survey was performed in eight Chinese cities (40,279 adults participated; response rate 75%). There were questions on demographic information of the participants, allergic rhinitis, asthma, perceived odors and home environment. The majority were women (74.7%) and 12.2% were smokers; 6.6% reported allergic rhinitis and 1.6% reported asthma. Totally 38% reported stuffy odor; 24.6% unpleasant odor; 11.5% pungent odor and 10.4% mold odor. Reporting of condensation on window panes were common (62.1%); visible mold or dampness stains (21.9%) and water damage (14.7%) were less common. All dampness indicators were associated with allergic rhinitis and asthma (OR = 1.34–1.87) and all odors (OR = 1.79–6.17). All odors were associated with allergic rhinitis and asthma (OR = 1.23–4.51). Odor perception was partly a mediator of the effects of mold and dampness on allergic rhinitis (% of total effect mediated: 2.7–9.8%) and asthma (2.2–10.7%) when adjusting for other home environment factors. Increased mediation effects for allergic rhinitis (% of total effect mediated: 11.2–17.4%) and asthma (% of total effect mediated: 5.5–14.7%) were found for total odor score (0–8) as compared to the mediation effects for four single odors. In conclusion, mold and dampness in dwellings were associated with adult allergic rhinitis, asthma and odors. Different odors were related to allergic rhinitis and asthma. Some of the effects of mold/dampness on allergic rhinitis and asthma were indirect effect mediated by odors from damp buildings, but most of the effects were direct effects.

Building envelope dampness exposure is correlated with children's respiratory and allergic diseases. However, little research has compared the variation in the health impact of dampness exposure across multiple cities from a longitudinal perspective. A cross-sectional survey and a repeated one were conducted in children's residences in six cities: Chongqing, Shanghai, Nanjing, Wuhan, Changsha and Taiyuan, China, in 2010 (Phase I) and 2019 (Phase II). We selected 17,810 preschoolers during Phase I and 26,001 preschoolers during Phase II aged 3-6 years without changing residence since birth in the study. The proportion of residences with building envelope dampness exposure and the prevalence of respiratory and allergic diseases, except allergic rhinitis, in preschoolers significantly declined from Phase I to Phase II. Dampness exposure increased the risk for most childhood respiratory diseases in Phase II, with a 34% greater risk of lifetime-ever asthma in early residences and a 36% greater risk of current eczema in current residences. Most diseases showed a significantly positive exposureresponse relationship to the cumulative period of building envelope dampness exposure (p < 0.05). The risk of developing current eczema was approximately 1.35 and 1.73 times higher in children exposed to both early and current dampness in Phase I and Phase II, respectively, than in children who had never been exposed. These findings provide new insights into the respiratory and allergic diseases in Chinese preschoolers because of building envelope dampness exposure over the last decade. The increased risk in Phase II raises concerns about the household's dampness environment.