Children’s Environmental Health in Michigan

Respiratory Health and Asthma

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Air contaminants in both the indoor and the outdoor environment can result in human health effects, particularly in children. Air contaminants with the strongest evidence of harm to children are explored in the chapters in this section. The chapters cover mold, VOC's, cleaning products, criteria air pollutants, second hand smoke, and diesel exhaust. This page provides a summary of concerns with both indoor and outdoor air contaminants for children's health.

Indoor Air

School-age children typically spend 80% to 90% of their time indoors (mostly at home and at school), and the concentration of pollutants indoors is typically higher than outdoors, sometimes by as much as 10 or even 100 times (Kats 2006). Indoor air quality studies in school buildings have shown the indoor air contaminants most commonly associated with asthma in children include formaldehyde (a type of VOC), other VOCs, and microbiological contaminants (including fungi, bacteria, and allergens) (Daisey et al. 2003). This section provides background information and policy analysis for common indoor air pollutants that have been linked to asthma symptoms in children, including mold, volatile organic compounds (VOCs), and cleaning products. The policy areas that will be discussed in this section include Green Building requirements, mold (remediation, reporting, and programs), and the use of less-toxic materials or cleaning products. Michigan policies will be analyzed for effectiveness in protecting children’s health, particularly through exposure prevention mechanisms. Best practices from other states will be noted, and recommendations to improve children’s protection from these exposures in Michigan will be provided.

Outdoor Air

Children are particularly vulnerable to outdoor air pollutants because they breathe more rapidly, take in more air per pound of body weight, have narrower airways that are more susceptible to irritation and obstruction, and tend to spend more time outdoors for physical activity than adults do (AAP 2003). In fact, one study found that, on average, children are engaged in outdoor physical activity up to five times longer than adults (Wiley et al. 1991a; Wiley et al. 1991b), thus increasing the potential for exposure to outdoor air pollutants compared to adults.

Recent studies have reported a significant association between various outdoor air pollutant levels and a diverse array of preventable respiratory illnesses such as reduced lung function, inflammation of the lungs, asthma attacks, which can lead to excess respiratory hospital admissions, and even premature death. Furthermore, some studies have found associations between health outcomes and pollution levels that are in compliance with current air quality standards (Gent et al. 2003; Trasande and Thurston 2005). Hospital admissions for asthma have been shown to increase when outdoor air pollution levels are elevated, especially in urban areas, and respiratory illnesses caused or exacerbated by exposure to outdoor air pollutants can result in increased school absenteeism (AAP 2003; Bener et al. 2007; Gilliland et al. 2001). In children, acute health effects that are associated with exposure to outdoor air pollution include wheezing, coughing, transient decreases in lung function, lower respiratory tract infections, and other negative effects on respiratory health. (AAP 2003; Tzivian 2011). Also, children with asthma are more susceptible to the effects of air pollution, and can experience more serious symptoms than other children. Residents in some parts of Michigan experience significantly worse air quality than residents in most other parts of the country due to air pollution. The chapters in this section discuss the agents known to be associated with respiratory harm, assess best practices nation-wide, and recommend policy action in Michigan.


American Academy of Pediatrics (AAP). 2003. Pediatric Environmental Health, 2nd ed. American Academy of Pediatrics. ISBN:1-58110-111-2. American Lung Association (ALA). 2007. State of the Air: 2007. Downloaded from:

Bener A, Ehlayel M, Sabbah A. 2007. The pattern and genetics of pediatric extrinsic asthma risk factors in polluted environment. European Annals of Allergy and Clinical Immunology 39(2): 58-63.

Daisey JM, Angell WJ, Apte MG. 2003. Indoor air quality, ventilation and health symptoms in schools: an analysis of existing information. Indoor Air 13(1):53–64.

Gent JF, Triche EW, Holford TR, et al. 2003. The Association of Low Level Ozone and Fine Particles with Respiratory Symptoms in Children with Asthma. Journal of the American Medical Association 290:1859-67.

Gilliland FD, Berhane K, Rappaport EB, Thomas DC, Avol E, Gauderman WJ, et al. 2001 The effects of ambient air pollution on school absenteeism due to respiratory illnesses. Epidemiology 12(1):43-54.

Tzivian L. 2011. Outdoor air pollution and asthma in children. Journal of Asthma 48(5): 470-81.

Trasande L, Thurston G. 2005. The Role of Air Pollution in Asthma and Other Pediatric Morbidities. Journal of Allergy and Clinical Immunology 115:689-99. United States Environmental Protection Agency. 2009. Particulate Matter. Accessed August 25, 2009 at:

Wiley JA, Robinson JP, Cheng YT, et al. Study of children’s activity patterns. Sacramento (CA): Survey Research Center, University of California, California Air Resources Board; 1991a. Final report contract no. A733–149.

Wiley JA, Robinson JP, Piazza T, et al. Activity patterns of California residents. Sacramento (CA): Survey Research Center, University of California, California Air Resources Board; 1991b. Final report contract no. A6-177-33-149.