title: Domestic use of bleach and infections in children: a multicentre cross-sectional study.
abstract: OBJECTIVE
  To report the effects of bleach use at home on the frequency of infections in 9102 school-age children participating in the HITEA project.
  
  
  METHODS
  Parents of pupils aged 6-12 years from schools in Barcelona province (Spain), Utrecht province (the Netherlands) and Eastern and Central Finland were administered a questionnaire including questions on the frequency of infections (influenza, tonsillitis, sinusitis, otitis, bronchitis and pneumonia) in the past 12 months and bleach use at home. We developed multivariable mixed-effects multilogistic regression models to obtain relative risk ratios (RRR) and their 95% CI per country, and combined the RRR using random-effects meta-analyses.
  
  
  RESULTS
  Bleach use was common in Spain (72%, n=1945) and uncommon in Finland (7%, n=279). Overall, the prevalence of infections (recurrent or once) was higher among children of bleach users. Significant combined associations were shown for influenza only once (RRR=1.20, 95% CI 1.04 to 1.38), recurrent tonsillitis (RRR=1.35, 95% CI 1.07 to 1.71) and any infection (RRR=1.18, 95% CI 1.01 to 1.38).
  
  
  CONCLUSIONS
  Passive exposure to cleaning bleach in the home may have adverse effects on school-age children's health by increasing the risk of respiratory and other infections. The high frequency of use of disinfecting irritant cleaning products may be of public health concern, also when exposure occurs during childhood.
authors.affiliation: Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain University Pompeu Fabra (UPF), Barcelona, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Casas
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain University Pompeu Fabra (UPF), Barcelona, Spain Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Espinosa
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain University Pompeu Fabra (UPF), Barcelona, Spain.
authors.forename: Alícia
authors.initials: A
authors.lastname: Borràs-Santos
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
authors.forename: José
authors.initials: J
authors.lastname: Jacobs
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Krop
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
authors.affiliation: Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
authors.forename: Benoit
authors.initials: B
authors.lastname: Nemery
authors.affiliation: Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Pekkanen
authors.affiliation: Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland.
authors.forename: Anne
authors.initials: A
authors.lastname: Hyvärinen
authors.affiliation: Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland.
authors.forename: Martin
authors.initials: M
authors.lastname: Täubel
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Jan-Paul
authors.initials: JP
authors.lastname: Zock
mesh_terms: D001991:Bronchitis / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D004202:Disinfectants / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005387:Finland; D015386:Hazardous Substances / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000209:etiology*; D007251:Influenza, Human / Q000209:etiology*; D007509:Irritants / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D009426:Netherlands; D016017:Odds Ratio; D010031:Otitis / Q000209:etiology; D011014:Pneumonia / Q000209:etiology; D015995:Prevalence; D012852:Sinusitis / Q000209:etiology; D013030:Spain; D011795:Surveys and Questionnaires; D014069:Tonsillitis / Q000209:etiology*
chemical_list: D004202:Disinfectants; D015386:Hazardous Substances; D007509:Irritants