title: Modeling Associations between Principals' Reported Indoor Environmental Quality and Students' Self-Reported Respiratory Health Outcomes Using GLMM and ZIP Models.
abstract: BACKGROUND
  The aim of this paper was to examine associations between school building characteristics, indoor environmental quality (IEQ), and health responses using questionnaire data from both school principals and students.
  
  
  METHODS
  From 334 randomly sampled schools, 4248 sixth grade students from 297 schools participated in a questionnaire. From these schools, 134 principals returned questionnaires concerning 51 IEQ related questions of their school. Generalized linear mixed models (GLMM) were used to study the associations between IEQ indicators and existence of self-reported upper respiratory symptoms, while hierarchical Zero Inflated Poisson (ZIP)-models were used to model the number of symptoms.
  
  
  RESULTS
  Significant associations were established between existence of upper respiratory symptoms and unsatisfactory classroom temperature during the heating season (ORs 1.45 for too hot and cold, and 1.27 for too cold as compared to satisfactory temperature) and dampness or moisture damage during the year 2006-2007 (OR: 1.80 as compared to no moisture damage), respectively. The number of upper respiratory symptoms was significantly associated with inadequate ventilation and dampness or moisture damage. A higher number of missed school days due to respiratory infections were reported in schools with inadequate ventilation (RR: 1.16).
  
  
  CONCLUSIONS
  The school level IEQ indicator variables described in this paper could explain a relatively large part of the school level variation observed in the self-reported upper respiratory symptoms and missed school days due to respiratory infections among students.
authors.affiliation: National Institute for Health and Welfare, Kuopio FI-70701, Finland. oluyemi.toyinbo@thl.fi.
authors.forename: Oluyemi
authors.initials: O
authors.lastname: Toyinbo
authors.affiliation: National Institute for Health and Welfare, Kuopio FI-70701, Finland. manmat@utu.fi.|Faculty of Medicine, Occupational Health Care Unit, University of Turku, Turku 20014, Finland. manmat@utu.fi.
authors.forename: Markus
authors.initials: M
authors.lastname: Matilainen
authors.affiliation: National Institute for Health and Welfare, Kuopio FI-70701, Finland. mari.turunen@thl.fi.
authors.forename: Mari
authors.initials: M
authors.lastname: Turunen
authors.affiliation: Faculty of Medicine, Occupational Health Care Unit, University of Turku, Turku 20014, Finland. tuula.putus@utu.fi.
authors.forename: Tuula
authors.initials: T
authors.lastname: Putus
authors.affiliation: Indoor Air Program, the University of Tulsa, Tulsa, OK 74104, USA. rjstulsau@aol.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Shaughnessy
authors.affiliation: National Institute for Health and Welfare, Kuopio FI-70701, Finland. ulla.haverinen-shaughnessy@thl.fi.
authors.forename: Ulla
authors.initials: U
authors.lastname: Haverinen-Shaughnessy
mesh_terms: D002648:Child; D005387:Finland / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012574:Schools / Q000706:statistics & numerical data*; D057566:Self Report; D013334:Students / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013696:Temperature; D014691:Ventilation
keywords: IEQ; health; questionnaire; schools; symptoms