Nine workers in an Atlanta office
went to their employer three years ago complaining
about respiratory and sinus problems, wondering if their
workplace was making them sick.
An inspection found mold on a
wall and carpet and an air-handling unit that wasn't
bringing in fresh air. The property owner made
repairs. Complaints declined.
The employer? The federal Agency
for Toxic Substances and Disease Registry, based in
Atlanta. The agency's mission, in part, is "providing
trusted health information to prevent harmful exposures
and disease related to toxic substances."
The location may be a surprise,
but the story isn't.
Polluted indoor air causes illness
daily in offices, schools and homes across the country.
Evidence has been growing for
more than 20 years that the air we breathe indoors typically
is more polluted than outdoor air, even in
an area such as metro Atlanta with high levels
of outdoor air pollution. And most people spend 90 percent
of their time indoors.
Indoor air pollution is "the
environmental problem -- this is the one we should be
worrying about," said Wayne Ott, a Stanford University
engineering professor and former Environmental Protection
Everyone is exposed to air pollution
indoors. Contaminants include mold, chemicals such as
pesticides, and particulate matter. Poor ventilation,
a common problem, can push contamination to dangerous
Breathing bad indoor air can
cause respiratory infections; asthma and allergy attacks;
skin, eye, nose and throat irritations; damage to the
central nervous system; and cancer.
Although outdoor air quality
has improved as it received funding and publicity, indoor
air quality -- a more complicated problem -- has been
neglected and underfunded.
"With outdoor pollution, you
can see the sources," said Dr. Philip Landrigan of Mount
Sinai School of Medicine in New York, an expert on environment
and health. "By contrast, you are looking at
millions of individual sources [affecting indoor air].
It's a regulatory nightmare."
No federal agency has broad regulatory
authority to address indoor air, as the EPA does with
outdoor air. Medical schools barely touch on environmental
health, so many doctors know little about links between
illness and indoor pollution.
In the vacuum, employers, landlords,
school systems and public health agencies must
field complaints from people who suspect they are ill
from the air inside.
Costs of cleaning air grow
The cost of indoor pollution
Insurers paid $2.5 billion in
mold-related claims under homeowner policies in 2002,
up from $1.3 billion the year before. Rising mold claims
contributed to higher insurance rates. Medical
costs related to indoor air quality dwarf the costs
of sickness tied to outdoor air, say indoor air experts.
Consumers are spending more than
ever on home remedies: In the past four years, sales
of portable air cleaners increased 60 percent, and sales
of whole-house units rose 38 percent, says the National
Air Filtration Association, a trade group.
Research on the indoor environment
is still developing. Even medical experts find it is
often difficult to prove a link between an indoor contaminant
Nevertheless, there is growing
Mike Crowe and his Georgia Technology
Authority co-workers have endured a variety of pollutants
for years in their windowless basement office near the
Crowe has been treated for sinus
and respiratory problems that began after he started
work there as a programmer in the late 1980s. He blames
the illnesses on the air he breathes at work.
About 200 agency employees work
in the converted parking deck Crowe calls "a hellhole"
and "a dungeon."
Complaints from people who work
there have accumulated over the years. State records
show that as early as 1990, about 20 percent of the
employees complained of vehicle exhaust odors and soot
and symptoms including eye and sinus irritation, headaches
and fatigue. An inspection found ventilation problems,
high levels of volatile gases from solvents and cleaning
supplies, and carbon monoxide from vehicle exhaust.
Three years later, extensive
mold was found in the ventilation system. In 1994, a
memo by a state official described complaints about
exhaust fumes and chemical odors. The memo notes that
an employee had resigned, requesting unemployment benefits
"related to health hazards."
Crowe said workers' complaints
continued during the 1990s but were largely ignored.
This year, when a technology
authority employee switched workstations, movers uncovered
mold. Then there was another inspection, which found
water intrusion and leaks in the basement, making it
prone to mold and bacteria.
"There are a disproportionate
number of staff in this facility with breathing or sinus
problems," reported supervisor Derrick Wheeler, who
sought the inspection.
The agency and the Georgia Building
Authority, which owns the building, know they have a
problem, but remedial efforts haven't solved it. The
building authority removed the moldy walls and is monitoring
leaks and humidity problems.
The technology authority wants
to move the workers, in part because of the poor environment.
But budget constraints have put money for a new data
center on hold.
"Everybody works hard for the
citizens of Georgia, but we just can't breathe," said
Susan Mewherter, a technology authority employee who
has endured frequent coughing spells during the two
years she has worked in the basement.
The term "sick building syndrome"
emerged in the 1970s, when the national energy crisis
sparked a rush to trim power use. New buildings were
constructed tightly, with less fresh air coming in and
windows that didn't open. Cheaper synthetic building
materials and furniture were introduced, increasing
the chemical stew trapped inside.
In a series of studies in the
1980s, EPA researchers discovered that test subjects
inhaled carbon monoxide, pesticide vapors and chemical
gases such as cancer-causing benzene at levels that
were two to five times stronger indoors than outdoors,
regardless of where they lived.
Those startling findings didn't
inspire action. "Indoor air became the rock that no
one wanted to look under," said Lance Wallace, who headed
the EPA research team.
A serious effort to regulate
the indoor environment came in the mid-1990s, when the
Occupational Safety and Health Administration proposed
rules covering employers in about 6 million nonindustrial
The regulations targeted tobacco
smoke and would have required employers to ban smoking
or provide separately ventilated smoking areas. But
they also would have required employers to develop plans
to protect indoor air quality, inspect and maintain
heating and air conditioning systems, and keep records
of employee complaints.
Smoking dominated the debate.
OSHA received more than 100,000 pieces of mail.
"The tobacco industry orchestrated
quite an assault on OSHA, with 100 times as much written
comment on rules as OSHA had ever received on any rule-making,"
said James Repace, a former EPA indoor air specialist.
After protracted congressional hearings, the proposal
So indoor air oversight is spread
among a mishmash of agencies, each with a piece of the
puzzle, but none with enough funding or clout.
EPA, which spends 10 times as
much on clean air outdoors than indoors, has no regulatory
authority over indoor air.
Due to tight budgets, the National
Institute for Occupational Safety and Health investigates
fewer worker complaints about indoor air pollution than
it did 10 years ago. OSHA standards are for industrial
workers and cover specific substances, rather than indoor
air in general.
About half of the states have
created some kind of indoor air program, but others,
including Georgia, offer virtually nothing.
Because no one keeps comprehensive
records, it's impossible to tell how many buildings
are "sick" -- or whether the number is rising.
There are guesses: Using a 1999
U.S. Department of Education survey of 900 schools and
other data, the EPA estimates that 30 percent to 40
percent of the nation's schools have indoor air problems.
A study last year in the American
Journal of Public Health estimated that each week, 35
million to 60 million U.S. workers have symptoms of
illness related to their workplace. That's at least
40 percent of the 89 million nonindustrial indoor workers.
The National Institute for Occupational
Safety and Health has the only national public record
of indoor air problems. But the agency's complaint list
represents only a fraction of indoor problems, because
many aren't reported or even recognized as problems.
List of hazards long
Martha Eggleston was running
six to seven miles a day when she moved into a Buckhead
condominium in 2000.
Almost immediately she began
having respiratory problems.
She noticed dust buildup, dampness
and leaks in the condo. Ventilation was poor. But when
her mother suggested her condo might be causing her
ailments, Eggleston laughed. Her skepticism faded when
mold was found around the air conditioning vents and
she tested positive for allergies to substances including
Eggleston, 35, has developed
asthma and is taking six medications daily. "Now I feel
like I'm 60. I'm emotionally a wreck." She has moved
in with her parents. She doesn't run anymore.
After tobacco smoke, mold is
the indoor contaminant that has generated the most publicity
-- and fear. It has emptied office buildings and schools
and cost billions of dollars in home repairs.
But the list of indoor hazards
is long. It includes biologicals such as bacteria and
dust mites, metals such as lead, carbon monoxide from
unvented appliances and wood stoves, and volatile chemicals
from everyday sources such as dry-cleaned clothing,
paint, pesticides and air fresheners.
Contamination also comes from
surprising sources. Diesel fumes and carbon monoxide
may be sucked into office buildings from loading docks
or parking areas. And office machines, furniture and
renovations -- even carpet replacement -- can produce
Three years ago, about 25 AirTran
employees sought medical treatment after being overcome
by odor from a glue used to install carpet at a reservation
center near Hartsfield International Airport. Workers
complained of headaches, upper respiratory symptoms
and eye irritation.
Dr. Ramana Dhara, who treated
the employees at a nearby clinic, said gases emitted
from workers' clothing even caused symptoms in the clinic
The workers' ailments gradually
disappeared, said AirTran spokesman Tad Hutcheson. The
center recently replaced the carpet again, but, Hutcheson
said, "We closed the facility this time, and used a
different type of glue."
The AirTran exposure shows a
clear cause and effect. But in many cases, the connection
between sickness and indoor contaminants is hard to
That's because indoor pollution
affects individuals differently, and doesn't bother
some people at all. A building can contain multiple
contaminants; symptoms such as headaches can have many
sources and may develop slowly; and biological tests
to detect contaminants are limited. A few incidents
have even been blamed on psychosomatic illness.
Regardless of the medical challenges,
research shows there's a payoff for healthy air. A study
by Donald Milton of the Harvard School of Public Health
found that Polaroid Corp. in 1994 had 35 percent higher
sick leave rates in buildings that had lower ventilation.
But as with preventive medicine,
it's often hard to convince those paying the bills that
spending now can save money later.
"A lot of companies are afraid
of finding a problem and having to correct it," said
Michael Walters, who manages occupational health at
Polaroid. "If you pay attention to indoor air quality,
it's something you can cost-effectively manage."
Improved indoor environments
could save employers at least $7 billion annually from
reduced health care costs and higher productivity, said
William Fisk of the Department of Energy's Lawrence
Berkeley National Laboratory.
Children most susceptible
Among the most vulnerable to
indoor pollution are those who can do the least about
Children are more susceptible
to pollutants because they breathe in more air per pound
of body weight than adults, and their lungs are developing.
"The highest risk is for crawling
infants," said John Roberts, a research engineer in
Seattle who has studied toxins in house dust. "They
have one-sixth as much body weight as adults and eat
two times the dust."
An urban baby, crawling around
in his home every day, typically swallows as much of
the chemical compound benzo(a)pyrene, a suspected carcinogen,
as he would get by smoking three cigarettes, said Roberts.
Benzo(a)pyrene can come from wood-burning, smoking and
A Centers for Disease Control
and Prevention study released this year found that children's
blood and urine showed levels of a now restricted pesticide,
chlorpyrifos, and a nicotine product that were twice
as high as those in adults. The CDC research also found
children had high levels of phthalates, chemicals found
in plastic and consumer products and linked to reproductive
Exposure to indoor contaminants
has exacerbated the asthma epidemic among children.
Allergists see more indoor-related allergy and asthma
problems than 20 years ago, partly because people are
inside more, said Dr. Kathleen Sheerin of the
Atlanta Allergy and Asthma Clinic.
The incidence of asthma in children
has doubled in two decades to nearly one in 10. The
cause is unknown, but indoor exposure is being studied
for its role. And many indoor pollutants trigger asthma
The elderly and people with compromised
immune systems, or heart and lung disease, are also
more vulnerable to indoor air pollution and often spend
much of their time indoors. "A house is guilty till
proven innocent," said Dr. Robyn Levy, an Atlanta allergy
and asthma specialist who has seen dozens of patients
with mold problems.
Levy may perceive mold
as the likely cause of her patients' problems,
but many doctors wouldn't.
The medical profession and medical
educators have been slow to recognize indoor environmental
illness, say doctors who practice occupational and environmental
"Most cases of occupational asthma
go unrecognized," said Harvard's Milton. "It's an uphill
battle to get people who don't learn about it in medical
school to ask, 'What do you do for a job? Do your symptoms
change on weekends and vacations?' "
Doctors who see upper respiratory
symptoms typical of indoor air problems often diagnose
viral infections, said Dhara, the physician who treated
the AirTran workers and now practices at Snellville's
Emory Eastside Medical Center. "Most physicians are
trained on the basis of infectious disease, not environmental
Indoor problems can often be
traced to a simple condition: a lack of fresh air. Inadequate
ventilation can make indoor conditions much more dangerous.
Standards for fresh air, established in building codes
across the United States, are rarely enforced. Codes
require that buildings be designed to bring in 15 or
20 cubic feet of outside air per minute per occupant,
but building owners "don't have to operate it that way,"
said Mark Mendell of the Lawrence Berkeley lab. The
guidelines, he said, "are not taken seriously in this
country." Some buildings get less than half the recommended
The National Institute for Occupational Safety and
Health evaluated 104 buildings in 1992-93 and found
ventilation problems in 93 of them. A European study
of 800 students found that when carbon dioxide levels
are high, indicating poor ventilation, student scores
on concentration tests are low.
Two years ago, mysterious symptoms appeared in about
10 percent of teachers and students at a Fort Stewart
elementary school. The ailments included respiratory
illnesses, skin and eye irritation, headache, nausea
Parents were shocked and angry, said Kathy Jones, PTO
president at Brittin Elementary. "We didn't know what
was going on," she said. Jones' son had a rash on his
face and arms, and a daughter had red, itchy eyes.
Tests found that an air conditioning system in one
wing was bringing in no fresh air, which sent the carbon
dioxide level to nearly three times recommended limits
in one classroom. The level of formaldehyde was found
to exceed a federal standard. Formaldehyde and other
gases can build up when there's no outside fresh air.
Formaldehyde can irritate the upper respiratory tract
and exposed skin.
The school system closed the wing. Students were moved
into trailers, which, in turn, were shut down when mold
was found. Fourth, fifth and sixth grades finished the
year in a nearby youth center. The school got a $4 million
A case in Cobb
"The classroom environment is a dirty secret."
That stark assessment comes from John Lyons, a former
U.S. Department of Education facilities official who's
now a consultant. "There's a general assumption that
schools are maintained at a reasonable and safe level,
and that's not really the case," he said.
America's school systems, facing the budget squeeze,
often save money by cutting down on maintenance. But
less cleaning can create dust buildup, mold outbreaks,
ventilation problems from dirty air filters -- and health
Nationally, spending on maintenance and operations
as a percentage of school districts' expenditures has
decreased for the sixth straight year, according to
a survey by American School and University magazine.
The figure is the lowest in three decades.
The maintenance issue has riled some parents
and teachers in Cobb County.
Three years ago, Maggie Bailey, whose two children
attended Cobb's East Side Elementary, became so concerned
about her children's health that she brought her own
mold inspector into the school building. Bailey's son
and daughter were having respiratory problems, headaches
and sinus and digestive symptoms.
Bailey, a volunteer at the school near Marietta, walked
George Graham of the Tennessee Mold Lab into the school
to take samples. Graham found mold in the ducts and
carpeting in each child's classroom.
When Bailey made the findings public, the school system
fired janitors who had failed to properly clean the
building over the summer. The school was scrubbed and
a testing firm hired. Evaluations of three classrooms
found no visible mold, though tests showed signs of
past or current mold growth.
"The problem was dust, inadequate vacuuming, inappropriate
cleaning of carpets," said Roger Kubler, a Cobb assistant
superintendent. "No mold was identified in carpet or
ductwork." Bailey took her children out of East Side.
"We're low on janitors," said parent volunteer JoAnne
Lengyel. East Side's principal has cleaned bathrooms,
Lengyel said. The Cobb school system says this was a
single incident that occurred because a custodian was
Cobb schools spent $440 per child on maintenance and
operations in 2001-2002, below the state average of
$523 for schools. This past school year, the figure
was $453, vs. a state average of $556.
To save money, the system cut 29 custodial jobs
out of 495 two years ago, and teachers complained about
Liz Steiner, who teaches computer classes at Wheeler
High, said dust piles up in her classroom, vacuuming
goes undone and thermostats often don't work. "I am
stuffed up a lot and have headaches," she said. "Kids
are always coughing and sneezing in my classroom."
Kubler said school officials are concerned when complaints
arise but that some health problems are wrongly blamed
on classroom conditions. Teachers who complain "may
be ill-informed," he said.
Across metro Atlanta, school district records show
air quality problems and complaints in many classrooms,
including portable ones. Collier Heights Elementary
in Atlanta suffered such constant water intrusion and
mold infestation in basement classrooms that the school
was closed permanently in June.
There wasn't funding to fix the defects, said Jean
Dodd, an Atlanta school board member who represents
the Collier district.
Despite widespread school problems, a bill requiring
indoor air inspections of Georgia's schools died in
the 2002 General Assembly.
"DeKalb County schools and other school systems pitched
a fit about what it would cost them -- replacing air
systems, ductwork," said Rep. Mack Crawford (R-Concord),
the bill's sponsor, adding that he may reintroduce the
proposal in next year's session.
Government offices worst
Government buildings generally have more indoor air
problems than private ones because "there is never enough
money to do repairs," said former EPA indoor air specialist
Repace. "So many sick buildings are government buildings
-- colleges, courthouses, state and federal buildings."
Many state employees work in deteriorating 50-year-old
The Georgia Building Authority, which runs 51 state
buildings and parking decks, has fielded health complaints
about several of them. Workers are more aware of indoor
air quality and the number of complaints is increasing,
said Bob Satterfield, the authority's director of maintenance.
The Agriculture Department building has had three major
mold outbreaks in the past year, and employees have
complained of headaches from paint fumes and the shutoff
of an outdoor air fan. "The building is so old that
to correct the problems, it would take a lot of money,"
said Shirley King, who coordinates repairs for the department.
Partial repairs will cost $325,000.
Concern about air quality among Department of Audits
workers helped drive a $150,000 renovation of a parking
An employee at the Department of Transportation complained
about illnesses, and mold was found in a bathroom and
an air handler. Leaks in the building facade will require
$250,000 in repairs.
In five years, the state office building at 2 Peachtree
St. has drawn at least seven health-related complaints
from occupants,though the state has spent $112 million
renovating it in the last decade.
The condition of the building, a gift to the state,
"was deplorable," said Satterfield. The worst floors
were those housing the Department of Juvenile Justice,
he said. Several employees there complained about asthma
and other respiratory illnesses they linked to their
workplace. "There were mushrooms growing in the carpet
some years ago," said Juvenile Justice spokeswoman Jaci
Vickers. The department moved to Decatur this year,
citing air quality as one reason.
Mike Crowe hopes for the same outcome for the employees
in the Georgia Technology Authority building. "It's
not clean air there," he said.