Environmental Relative Moldiness Index Research Articles

Higher mold levels found in in the deteriorated housing in the Sun Valley neighborhood of Denver, Colorado compared to other Denver housing and higher rates of health insurance claims for some diseases documented for the Sun Valley residents compared to other Denver residents.

The Sun Valley Homes public housing in Denver, Colorado (CO) will be replaced because of its deteriorated condition. Our goal was to document the mold contamination and particulate matter (PM2.5) concentrations in Sun Valley homes and the circulatory and respiratory health of Sun Valley compared to all Denver residents (total 2761 and 1,049,046, respectively) based on insurance claims data for 2015 to 2019. Mold contamination in Sun Valley homes (n=49) was quantified using the Environmental Relative Moldiness Index (ERMI) scale. Indoor PM2.5 concentrations were measured in Sun Valley homes (n=11) using time-integrated, filter-based samples and quantified using gravimetric analysis. Outdoor PM2.5 concentrations data were obtained from a near-by United States Environmental Protection Agency monitoring station. In Sun Valley homes, the average ERMI value was 5.25 compared to -1.25 for other Denver homes. The PM2.5 median concentration inside Sun Valley homes was 7.6μg/m3 (interquartile range - 6.4μg/m3). The ratio of indoor to outdoor concentrations of PM2.5 was 2.3 (interquartile range - 1.5). In the last five years, ischemic heart disease was significantly more likely for Denver compared to Sun Valley residents. However, acute upper respiratory infections, chronic lower respiratory diseases and asthma were all significantly more likely for Sun Valley than Denver residents. Since the process of replacing and occupying the new housing will take several years, the next phase of the study will not occur until that process is complete.

Impact of Hurricane Maria on mold levels in the homes of Piñones, Puerto Rico

Hurricane Maria struck Puerto Rico on September 20, 2017, severely impacting the island. In order to quantify the impact of the hurricane on the indoor air quality, we evaluated the fungal levels in households (n = 20) of the Piñones community for the period of 2018 and 2019. For each dust sample collected, the 36 Environmental Relative Moldiness Index (ERMI) molds were quantified using qPCR assays, and then Shannon Diversity Index (SDI) values for the fungal populations were calculated. Homes were in five separate regions, regarding their proximity in the studied area. We found that for regions with reported least water damage, the SDI values were similar for both sampled years, but for regions that reported mid-to-high level of damage region, the SDI values were significantly higher. Households that reported remediation actions between the two sampled years showed similar values for the second year as those that did not report any major impact. Our preliminary data provides insights into the significant impacts of hurricanes into indoor fungal environment.

Association of Mold Levels in Urban Children’s Homes With Difficult-to-control Asthma

To assess the association of overall and specific mold levels in homes of urban children and difficult-to-control asthma.The study included 265 children from the Asthma Phenotypes in the Inner-City (APIC) study, aged 6 to 17 years old with asthma, and living in 8 urban cities across the United States. The study used 265 frozen-dust samples previously collected from the homes of APIC study-enrolled participants for analysis of mold concentrations. Although a total of 465 samples were collected during the APIC study, only the 265 samples that remained were used for post hoc analysis.The study was a cross-sectional analysis of 2 asthma cohorts: children with either difficult-to-control (DTC) and easy-to-control (ETC) asthma. DTC asthma participants required daily therapy of greater than or equal to 500 mcg fluticasone (with or without a long-acting β-agonist), and ETC asthma participants required less than or equal to 100 mcg fluticasone. Quantitative polymerase chain reaction assays were performed on frozen-dust samples that were obtained by wiping above-floor surfaces in participants’ homes using a Swiffer cloth (Procter and Gamble, Cincinnati, Ohio). The Environmental Relative Moldiness Index (ERMI) metric was used to classify mold species into 2 groups: group 1 (26 molds indicative of water damage in the home) and group 2 (10 molds commonly found indoors, even in homes without water damage). Average ERMI values and average concentrations of each of the 36 molds were compared in homes of children with DTC versus ETC asthma.No significant differences were found in average ERMI or average mold concentrations between homes of children with DTC asthma and ETC asthma. Mucor was the only mold with significantly greater average concentration in homes of children with DTC versus ETC asthma (average of 295 vs 67 cell equivalents per mg dust, P < .001). In homes with window air-conditioning (AC) units, the study found that Mucor concentration increased the probability of having DTC asthma (22% increase; 1.6 odds ratio) compared with ETC asthma.This study found that Mucor concentration is a predictor of DTC asthma, and homes with window AC units were more likely to have higher Mucor levels.Previous studies have shown an association between mold exposures and asthma. This study found that Mucor exposure in urban homes is associated with DTC asthma in a pediatric cohort with high geographic representation. Additionally, the study showed the association between elevated Mucor concentration, window AC units in urban homes, and the probability of DTC asthma. Further studies are needed to assess the role of decreasing home Mucor levels in reducing DTC asthma.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1016/j.jaci.2021.07.047

HEPA filtration intervention in classrooms may improve some students’ asthma

Objective The School Inner-City Asthma Intervention Study 2 (SICAS 2) tested interventions to reduce exposures in classrooms of students with asthma. The objective of this post-hoc analysis was limited to evaluating the effect of high-efficiency particulate (HEPA) filtration interventions on mold levels as quantified using the Environmental Relative Moldiness Index (ERMI) and the possible improvement in the students’ asthma, as quantified by spirometry testing. Methods Pre-intervention dust samples were collected at the beginning of the school year from classrooms and corresponding homes of students with asthma (n = 150). Follow-up dust samples were collected in the classrooms at the end of the HEPA or Sham intervention. For each dust sample, ERMI values and the Group 1 and Group 2 mold levels (components of the ERMI metric) were quantified. In addition, each student’s lung function was evaluated by spirometry testing, specifically the percentage predicted forced expiratory volume at 1 sec (FEV1%), before and at the end of the intervention. Results For those students with a higher Group 1 mold level in their pre-intervention classroom than home (n = 94), the FEV1% results for those students was significantly (p < 0.05) inversely correlated with the Group 1 level in their classrooms. After the HEPA intervention, the average Group 1 and ERMI values were significantly lowered, and the average FEV1% test results significantly increased by an average of 4.22% for students in HEPA compared to Sham classrooms. Conclusions HEPA intervention in classrooms reduced Group 1 and ERMI values, which corresponded to improvements in the students’ FEV1% test results.

Assessment of mold contamination in hurricane-damaged homes in Houston, Texas after sanitization by volunteers.

The purpose of this pilot study was to evaluate the effectiveness of mold sanitation in homes that suffered hurricane-related water damage. After a home is flooded, sanitation of the structure for mold is necessary before the interior of the home can be rebuilt. In this study, homes (n = 6) in Houston, Texas that had been flooded by Hurricane Harvey were sanitized by volunteers. At either 6, 8, 15, 25, 34, or 56 days after the sanitation was completed, a Button™ sampler was used to collect a 48-hour air sample, so that the mold cells in the air could be quantified. Each air sample was then analyzed by quantitative PCR (qPCR) assays for the 36 molds in the Environmental Relative Moldiness Index (ERMI) panel of indicator molds. Quantifying the 36-ERMI molds in air samples results in "ERMI-like" values. The ERMI-like values in the sanitized homes were inversely correlated (Pearson p - value 0.04) with the log of the number of days after the sanitation was completed, an indication that it takes time after sanitation for the mold levels to stabilize. This pilot study demonstrated that the ERMI-like metric was useful in assessing post-sanitation mold levels in previously flooded homes.

Association of mold levels in urban children’s homes with difficult-to-control asthma

Mold sensitization and exposure are associated with asthma severity, but the specific species that contribute to difficult-to-control (DTC) asthma are unknown. We sought to determine the association between overall and specific mold levels in the homes of urban children and DTC asthma. The Asthma Phenotypes in the Inner-City study recruited participants, aged 6 to 17 years, from 8 US cities and classified each participant as having either DTC asthma or easy-to-control (ETC) asthma on the basis of treatment step level. Dust samples had been collected in each participant's home (n= 485), and any dust remaining (n= 265 samples), after other analyses, was frozen at -20oC. The dust samples (n= 265) were analyzed using quantitative PCR to determine the concentrations of the 36 molds in the Environmental Relative Moldiness Index. Logistic regression was performed to discriminate specific mold content of dust from homes of children with DTC versus ETC asthma. Frozen-dust samples were available from 54% of homes of children with DTC (139 of 253) and ETC asthma (126 of 232). Only the average concentration of the mold Mucor was significantly (P< .001) greater in homes of children with DTC asthma. In homes with window air-conditioning units, the Mucor concentration contributed about a 22% increase (1.6 odds ratio; 95% CI, 1.2-2.2) in the ability to discriminate between cases of DTC and ETC asthma. Mucor levels in the homes of urban youth were a predictor of DTC asthma, and these higher Mucor levels were more likely in homes with a window air-conditioner.

Asthma Prevalence and Mold Levels in US Northeastern Schools

Asthma is among the most common chronic diseases of children in the United States (US). Mold exposures have been linked to asthma development and exacerbation. In homes, mold exposures have been quantified using the Environmental Relative Moldiness Index (ERMI) and higher home ERMI values have been linked to occupant asthma. In this analysis of the School Inner-City Asthma Study 2 (SICAS 2), we aimed to evaluate the ERMI’s applicability to measuring mold in schools compared to homes, to assess the relationship between the prevalence of asthma in schools and mold levels, and to examine the prevalence of asthma in relationship to students’ demographics and the physical characteristics of school-buildings. Northeastern US schools (n=32) and homes (n=33) were selected and the 36-ERMI molds were quantified in a dust sample from each classroom or home. School building characteristics, student demographics and asthma prevalence data were collected from the SICAS 2 study or obtained from government websites. Linear regression and mixed models were fit to assess the association of current asthma prevalence and physical characteristics of the school, make-up of the student body and the ERMI metric. Levels of outdoor Group 2 molds were significantly (p<0.01) greater in schools compared to homes and higher Group 2 levels in schools were linked to higher asthma prevalence for their students. The presence of AC in school buildings correlated significantly (p=0.02) with lower asthma prevalence. Higher mold levels in northeastern US schools were associated with an increase in students’ asthma.

The Environmental Relative Moldiness Index reveals changes in mold contamination in United States homes over time

The Environmental Relative Moldiness Index (ERMI) is a scale created to compare mold contamination levels in U.S. homes. The ERMI was developed as a result of the Department of Housing and Urban Development’s (HUD) first American Healthy Homes Survey (AHHS I), which sampled 1,096 homes selected to be representative of the U.S. housing stock. In AHHS I, a dust sample from each home was analyzed using quantitative PCR assays (qPCR) for 36 common indoor molds: 26 Group 1 molds, which were associated with water damage in homes and 10 Group 2 molds, which primarily enter the home from the outside environment. In 2019, HUD completed AHHS II by sampling 695 homes. Because lead was banned from paint in 1978, a larger proportion of homes selected for AHHS II had been built before 1978 compared to AHHS I. The 36 ERMI molds were analyzed in AHHS II exactly as in AHHS I. For the 36-ERMI molds, the rates of detection, average concentrations, and geometric means were in significant concordance (p < 0.001) between AHHS I and II, indicating that the ERMI methodology was stable over time. However, the average ERMI value in AHHS II homes was greater than in AHHS I. The reason for the difference was investigated by examining the Group 1 and 2 mold populations. The average summed logs of Group 1 molds were significantly greater in homes built before 1978 than the average for homes built later. Conversely, the average summed logs of Group 2 mold populations were the same in homes built before 1978 and homes built later. Since the summed logs of Group 2 mold is subtracted from the summed logs of Group 1 molds in the ERMI calculation, the average ERMI value was higher in AHHS II homes than AHHS I. In conclusion, by using the ERMI metric, we were able to demonstrate that water damage and mold growth were more likely to occur as homes get older.

Asthma Prevalence and Mold Levels in US Northeastern Schools

Asthma is among the most common chronic diseases of children in the United States (US). Mold exposures have been linked to asthma development and exacerbation. In homes, mold exposures have been quantified using the Environmental Relative Moldiness Index (ERMI), and higher home ERMI values have been linked to occupant asthma. In this analysis of the School Inner-City Asthma Study (SICAS), we aimed to evaluate the ERMI's applicability to measuring mold in schools compared with homes and to examine the prevalence of asthma in relationship to students' demographics and the physical characteristics of school buildings. Northeastern US schools (n = 32) and homes (n = 33) were selected, and the 36 ERMI molds were quantified in a dust sample from each classroom (n = 114) or home. School building characteristics data were collected from SICAS. Asthma prevalence and student demographics data were obtained from government websites. Linear regression and mixed models were fit to assess the association of the current asthma prevalence and physical characteristics of the school, make-up of the student body, and the ERMI metric. Levels of outdoor group 2 molds were significantly (P < .01) greater in schools compared with homes. The presence of air-conditioning in school buildings correlated significantly (P = .02) with lower asthma prevalence. The prevalence of asthma in student bodies is associated with many factors in schools and homes.

Application of the Environmental Relative Moldiness Index in Indoor Marijuana Grow Operations.

Indoor marijuana grow operations (IMGOs) are increasing due to legalization of recreational and medicinal cannabis at the state level. However, the potential exposures of IMGO workers have not been well studied. Mold exposure has been identified as a major occupational health concern. Mold-specific quantitative polymerase chain reaction (MSQPCR) can provide quantitative exposure data for fungi at the species level. The purpose of this study was to characterize the airborne fungal burden using MSQPCR and to evaluate the applicability of an airborne Environmental Relative Moldiness Index (ERMI) in IMGOs. Air and dust samples were collected inside and outside the IMGOs and then analyzed via MSQPCR. These data were then used to calculate IMGO-specific ERMI scores. Culturable air samples were collected on agar plates and analyzed via microscopy. Differences were evaluated between indoor and outdoor concentrations, as well as between air and dust samples. The agreement between MSQPCR and culture-based methods was also evaluated. Based on the geometric means for non-zero values of each fungal species across all IMGOs, the total airborne concentration was approximately 9100 spore equivalent (SE) m-3 with an interquartile range (IQR) of 222 SE m-3. The indoor/outdoor ratio of geometric means across all 36 species per IMGO ranged from 0.4 to 6.2. Significantly higher indoor concentrations of fungal species, including Aspergillus spp., were observed. An average airborne ERMI score of 7 (IQR = 7.6) indicated a relatively high burden of mold across a majority of operations. The ERMI scores were driven by the high concentrations of Group 1 species with a mean of 15.8 and an IQR of 13. There were 63 additional species identified in the culturable air samples not included in the ERMI. High concentrations of airborne fungi were identified in IMGOs. Our evaluation of the ERMI based on MSQPCR as a rapid diagnostic and risk assessment tool for industrial hygienists in the IMGO setting is equivocal. ERMI did not identify all relevant fungal species associated with this specific occupational environment. We identified several issues with using the ERMI calculation. At this time, the catalog of fungal species needs to optimized for the occupational setting to ensure adequate coverage, especially for those species expected to be found in this burgeoning industry. Further research is necessary to elucidate the link between the ERMI score of airborne samples, worker exposure and health effects in grows to generate an acceptable index score for use in occupational exposure assessments.

Establishment and Application of an Environmental Relative Moldiness Index for Dwellings in Korea

This study aimed to develop a Korean version of the Environmental Relative Moldiness Index based on the specific distribution of fungal flora in Korea. A total of 126 dwellings were selected for mold sampling, and each was classified as, Flooded, Water leaks/condensation, or Non water-damaged. Dust on floors was sampled using a vacuum cleaner with a Dustream collector and analyzed by quantitative polymerase chain reaction for 36 types of molds included in the Environmental Relative Moldiness Index. The Environmental Relative Moldiness Index value was found to be 19.6 (-6.9–58.8) for flooded houses, 7.5 (-29.2–48.3) for water-damaged houses with leaks/condensation, and 0.8 (-29.2–37.9) for non-damaged dwellings. Significant differences were observed between flooded and non-water damaged dwellings (p<0.001) and between water-damaged and non-water damaged dwellings (p<0.032). The Korean Environmental Relative Moldiness Index consisted of 16 fungal species, which are very similar to those normally found in the Environmental Relative Moldiness Index in Korea (p=0.834). These findings indicate that Environmental Relative Moldiness Index values attributed to dust samples in Korea could be utilized for identification of flooded or water-damaged buildings. The Korean Environmental Relative Moldiness Index could also be a promising tool for inexpensive assessment of long-term fungal exposure in Korean dwellings.

Asthma Risk Associated with Indoor Mold Contamination in Hispanic Communities in Eastern Coachella Valley, California.

Indoor mold contamination has been associated in many studies with an increased risk of asthma and respiratory illness. This study investigated indoor mold contamination and the prevalence of asthma/respiratory illness in two low-income, Hispanic communities, Mecca and Coachella City, in the Eastern Coachella Valley (ECV) of California. The study consisted of a questionnaire to assess asthma/respiratory illness and the quantification of mold contamination in house dust samples using the Environmental Relative Moldiness Index (ERMI) scale. About 11% of the adults and 17% of the children in both Mecca and Coachella City met our definitions of asthma/respiratory illness. The average ERMI values in Mecca and Coachella City housing (10.3 and 6.0, respectively) are in the top 25% of ERMI values for the United States (US) homes. Overall, the homes surveyed in these ECV communities had an average prevalence of occupant asthma of 12.8% and an average ERMI value of 9.0. The prevalence of asthma/respiratory illness in the Hispanic communities of Mecca and Coachella City and the mold contamination in their homes appear to be greater than the averages for the rest of the US. The higher levels of mold contamination in their homes appear to be associated with a greater risk of asthma/respiratory illness for these low-income, Hispanic communities.

Quantification of mold contamination in multi-level buildings using the Environmental Relative Moldiness Index

ABSTRACTThe goal of this study was to evaluate the possible use of the Environmental Relative Moldiness Index (ERMI) to quantify mold contamination in multi-level, office buildings. Settled-dust samples were collected in multi-level, office buildings and the ERMI value for each sample determined. In the first study, a comparison was made between two identical four-story buildings. There were health complaints in one building but none in the other building. In the second study, mold contamination was evaluated on levels 6–19 of an office building with a history of water problems and health complaints. In the first study, the average ERMI value in the building with health complaints was 5.33 which was significantly greater than the average ERMI value, 0.55, in the non-complaint building. In the second study, the average ERMI values ranged from a low of −0.58 on level 8 to a high of 5.66 on level 17, one of the top five ranked levels for medical symptoms or medication use. The mold populations of ten (six Group 1 and four Group 2) of the 36-ERMI molds were in significantly greater concentrations in the higher compared to lower ERMI environments. The ERMI metric may be useful in the quantification of water-damage and mold growth in multi-level buildings.

Comparison of Mold Populations in Water-Damaged Homes in Australia and theUnited States

The goal of this study was to examine whether the Environmental Relative Moldiness Index (ERMI) scale created for United States (U.S.) homes was applicable in the assessment of mold contamination for Australian homes. Settled-dust samples were collected in south-eastern Australian homes (n=76) being investigated for possible water-damage and mold contamination. The 36 ERMI molds were quantified in each sample using mold specific quantitative PCR (MSQPCR) and the ERMI value for each home calculated. These homes were then matched to homes in the U.S. with nearly identical ERMI values and the average log10 concentration of each of the 36 molds statistically compared. Most of the 36 ERMI molds were found in Australian water-damaged homes in comparable concentrations to ERMI-matched U.S. homes. The U.S. ERMI scale might provide reasonable estimates of mold contamination in water-damaged Australian homes.

Comparison of indoor air sampling and dust collection methods for fungal exposure assessment using quantitative PCR.

Evaluating fungal contamination indoors is complicated because of the many different sampling methods utilized. In this study, fungal contamination was evaluated using five sampling methods and four matrices for results. The five sampling methods were a 48 hour indoor air sample collected with a Button™ inhalable aerosol sampler and four types of dust samples: a vacuumed floor dust sample, newly settled dust collected for four weeks onto two types of electrostatic dust cloths (EDCs) in trays, and a wipe sample of dust from above floor surfaces. The samples were obtained in the bedrooms of asthmatic children (n = 14). Quantitative polymerase chain reaction (qPCR) was used to analyze the dust and air samples for the 36 fungal species that make up the Environmental Relative Moldiness Index (ERMI). The results from the samples were compared by four matrices: total concentration of fungal cells, concentration of fungal species associated with indoor environments, concentration of fungal species associated with outdoor environments, and ERMI values (or ERMI-like values for air samples). The ERMI values for the dust samples and the ERMI-like values for the 48 hour air samples were not significantly different. The total cell concentrations of the 36 species obtained with the four dust collection methods correlated significantly (r = 0.64-0.79, p < 0.05), with the exception of the vacuumed floor dust and newly settled dust. In addition, fungal cell concentrations of indoor associated species correlated well between all four dust sampling methods (r = 0.68-0.86, p < 0.01). No correlation was found between the fungal concentrations in the air and dust samples primarily because of differences in concentrations of Cladosporium cladosporioides Type 1 and Epicoccum nigrum. A representative type of dust sample and a 48 hour air sample might both provide useful information about fungal exposures.

Use of Medicaid and housing data may help target areas of high asthma prevalence

ABSTRACTObjective: To determine if there was a significant difference between mold contamination and asthma prevalence in Detroit and non-Detroit Michigan homes, between newer and older homes, and if there is a correlation between mold contamination and measures of Medicaid use for asthma in the 25 Detroit zip codes. Methods: Settled dust was collected from homes (n = 113) of Detroit asthmatic children and from a representative group of Michigan homes (n = 43). The mold contamination for each home was measured using the Environmental Relative Moldiness Index (ERMI) scale and the mean ERMI values in Detroit and non-Detroit homes were statistically compared. Michigan Medicaid data (13 measures related to asthma) in each of the 25 zip codes in Detroit were tested for correlation to ERMI values for homes in those zip codes. Results: The mean ERMI value (14.5 ± 8.0) for Detroit asthmatic childrens' homes was significantly (Student's t-test, p < 0.001) greater than the mean ERMI value (2.1 ± 6.2) for the non-Detroit homes. Detroit homes > 60 years old had significantly (p = 0.01) greater mean ERMI values than Detroit homes ≤ 60 years old (15.87 vs. 11.25). The percentage of children that underwent spirometry testing for their persistent asthma (based on Medicaid data) was significantly, positively correlated with the mean ERMI values of the homes in the 25 zip codes. Conclusions: Applying Medicaid-use data for spirometry testing and locating a city's older housing stock might help find foci of homes with high ERMI values.

Populations of some molds in water-damaged homes may differ if the home was constructed with gypsum drywall compared to plaster

Starting in the 1940s, gypsum drywall began replacing plaster and lathe in the U.S. home construction industry. Our goal was to evaluate whether some mold populations differ in water- damaged homes primarily constructed with gypsum drywall compared to plaster. The dust samples from the 2006 Department of Housing and Urban Development's (HUD) American Health Homes Survey (AHHS) were the subject of this analysis. The concentrations of the 36 Environmental Relative Moldiness Index (ERMI) molds were compared in homes of different ages. The homes (n=301) were built between 1878 and 2005. Homes with ERMI values >5 (n=126) were defined as water-damaged. Homes with ERMI values >5 were divided in the years 1976 to 1977 into two groups, i.e., older (n=61) and newer (n=65). Newer water-damaged homes had significantly (p=0.002) higher mean ERMI values than older water-damaged homes, 11.18 and 8.86, respectively. The Group 1 molds Aspergillus flavus, Ammophilus fumigatus, Aspergillus ochraceus, Cladosporium sphaerospermum and Trichoderma viride were found in significantly higher concentrations in newer compared to older high-ERMI homes. Some mold populations in water-damaged homes may have changed after the introduction of gypsum drywall.

The relationship between environmental relative moldiness index values and asthma.

Indoor mold exposures have been qualitatively linked to asthma for more than 25 years. Our goal has been to turn this qualitative link into a quantitative assessment of asthma risk from mold exposures as estimated by the home's environmental relative moldiness index (ERMI) value. The home's ERMI value is derived from the quantitative PCR analysis of 36 molds in a dust sample. Six epidemiological studies of the relationship between ERMI values and asthma, in cities across the U.S., showed that both children and adults with asthma were living in homes with significantly higher ERMI values than the control or comparison homes. Based on these six studies, the accuracy of the ERMI value's link to occupant asthma was analyzed using receiver operating characteristic (ROC) curve and area under the curve (AUC) statistical analysis. The AUC was 0.69 which places the test accuracy in the "fair to good" range for a medical diagnostic test. A logistic regression analysis of the six studies was performed to generate an equation that can be used to predict occupant asthma at specific ERMI values. The ERMI metric may be a useful tool to link the quantification of mold contamination in U.S. homes to some asthma health effects.

Application of the Environmental Relative Moldiness Index in Finland.

The environmental relative moldiness index (ERMI) metric was previously developed to quantify mold contamination in U.S. homes. This study determined the applicability of the ERMI for quantifying mold and moisture damage in Finnish residences. Homes of the LUKAS2 birth cohort in Finland were visually inspected for moisture damage and mold, and vacuumed floor dust samples were collected. An ERMI analysis including 36 mold-specific quantitative PCR assays was performed on the dust samples (n = 144), and the ERMI metric was analyzed against inspection-based observations of moisture damage and mold. Our results show that the ERMI was significantly associated with certain observations of visible mold in Finnish homes but not with moisture damage. Several mold species occurred more frequently and at higher levels in Finnish than in U.S. homes. Modification of the ERMI toward Finnish conditions, using a subsample of LUKAS2 homes with and without moisture damage, resulted in a simplified metric based on 10 mold species. The Finnish ERMI (FERMI) performed substantially better in quantifying moisture and mold damage in Finnish homes, showing significant associations with various observations of visible mold, strongest when the damage was located in the child's main living area, as well as with mold odor and moisture damage. As shown in Finland, the ERMI as such is not equally well usable in different climates and geographic regions but may be remodeled to account for local outdoor and indoor fungal conditions as well as for moisture damage characteristics in a given country.

A Citizen-Science Study Documents Environmental Exposures and Asthma Prevalence in Two Communities.

A citizen-science study was conducted in two low-income, flood-prone communities in Atlanta, Georgia, in order to document environmental exposures and the prevalence of occupant asthma. Teams consisting of a public-health graduate student and a resident from one of the two communities administered a questionnaire, inspected residences for mold growth, and collected a dust sample for quantifying mold contamination. The dust samples were analyzed for the 36 molds that make up the Environmental Relative Moldiness Index (ERMI). Most residents (76%) were renters. The median duration of residence was 2.5 years. Although only 12% of occupants reported a history of flooding, 46% reported at least one water leak. Homes with visible mold (35%) had significantly (P < 0.05) higher mean ERMI values compared to homes without (14.0 versus 9.6). The prevalence of self-reported, current asthma among participants was 14%. In logistic regression models controlling for indoor smoking, among participants residing at their current residence for two years or less, a positive association was observed between asthma and the homes' ERMI values (adjusted odds ratio per unit increase in ERMI = 1.12, 95% confidence intervals (CI): 1.01–1.25; two-tailed P = 0.04). Documentation of the exposures and asthma prevalence has been presented to the communities and public officials. Community-based organizations have taken responsibility for planning and implementing activities in response to the study findings.