It was almost lunchtime for the 4-year-olds in Nickole Foster’s class at Next Door Milwaukee, a child care center in Metcalfe Park. The toddlers were so excited for the midday break they hardly noticed what was happening in the corner, by the picture books.
Foster was helping Erin Lee, a board member of the asthma nonprofit Fight Asthma Milwaukee Allies, or FAM Allies, look for the perfect place to install an air quality monitor. They huddled by the bookshelf.
“Right behind here,” Foster said, pointing to a spot on the wall above the bookshelf. Out of reach of tiny, curious fingers. “They can’t reach the high books.”
Their efforts were part of a new project exploring indoor air quality at child care centers in Milwaukee, a collaboration between researchers from FAM Allies, the University of Wisconsin-Milwaukee, and the Medical College of Wisconsin, who aim to improve respiratory health outcomes for children.
Lee pulled the monitor out of its box, a small, alarm clock-like device. She mounted it onto the wall with command strips and checked her phone.
Data started coming in: temperature, humidity, carbon dioxide. And volatile organic compounds, which are gasses associated with smelly things like cleaning products and perfumes. The monitor also tracks particulate matter, which are microscopic particles from things like car emissions or gas stoves that can get trapped in the lungs.
That all impacts indoor air quality.
The air indoors can be as much as five times worse than outdoors since pollutants get trapped inside, especially if ventilation is lacking. Unhealthy indoor air quality is linked to poor respiratory health and asthma development in children. Asthma is the most common chronic disease in children and a leading cause of emergency department visits and school absences.
The researchers installed monitors at 50 child care centers throughout Milwaukee, with half on the north side and half on the south. They focused on classrooms with kids aged 2 to 6.
“That’s the age group that has the highest levels of hospitalizations in our city and nationwide,” said Lee, who is also a clinical research coordinator at the Medical College of Wisconsin. “It’s also the age group that has greater rates of asthma diagnoses.”
The monitors are collecting information on pollutants inside classrooms. Meanwhile, researchers are surveying parents about the children’s respiratory symptoms, including questions like whether their child has a cold or flu, or is coughing. Parents and child care providers will also receive educational materials on respiratory health and interventions to improve air quality.
Then, a couple months from now, the researchers will return to those same classrooms and install air-cleaning devices. The machines have two filters. One is similar to a vacuum cleaner filter, and the other is a charcoal filter, which is capable of catching virus-sized particles.
“We’ll be able to see what happens before we put the air-cleaning machine in and what happens after we put the machine in,” Lee said. “The parents will keep answering questions about the respiratory symptoms. We think we’ll see air quality get a little bit better, right? Very interested to see if the kids have fewer respiratory symptoms.”
Carolyn Porter, the director of operations at Next Door Milwaukee, was happy to see the monitor’s initial reading was in the green — meaning the air quality was good.
“The thing we’d be most eager to learn about is what is our air quality?” Porter said. “What does that mean? And then how do we continue to improve that for our students?”
The project follows a pilot study conducted in 2018, which, to the research team's knowledge, was the first air quality-monitoring project in a child care setting. The team took air quality measurements across 36 child care centers in Milwaukee before and after educating child care staff about pest management and green cleaning procedures, which avoid the use of commonly used store-bought cleaners that can act as asthma triggers.
"We didn't really see any change [in air quality] due to the education," Lee said. "But what we found was that all the child care centers were having exceedances for all of the different air quality items we were looking for. Carbon dioxide levels, volatile organic compounds, PM2.5. That was surprising."
That led the team to apply for additional funding to study how air-cleaning machines might improve the indoor environment. More than three years into the COVID-19 pandemic, many Americans have a newfound appreciation for the importance of clean air indoors.
"In 2018, we spent a lot of time doing recruitment. We had a hard time getting people to participate," Lee said. Then, the pandemic happened. "Recruitment for this particular study beat all records." She got 50 centers signed onto the project within two and a half months.
In a segregated city like Milwaukee, historic redlining has pushed people of color into neighborhoods with older housing stock and closer to emissions-producing highways, leading to health disparities. In Wisconsin, asthma disparities also exist along income lines.
Indoor air quality has been studied in primary schools and homes, but child care centers represent new ground. Anne Dressel, one of the project partners, said the data will help researchers establish a baseline.
“Air quality in child care centers is something that hasn’t been looked at,” said Dressel, an associate professor of nursing at the University of Wisconsin-Milwaukee. “In some cases, especially the populations we’re working with, kids can spend up to 10 hours each day in a child care center. This is a new area in an environment where a lot of kids spend a lot of their day.”
Young children are especially sensitive to poor air quality. As it is, according to the Environmental Protection Agency, most Americans spend about 90% of their time indoors.
“Their respiratory rate is much quicker than adults,” Dressel said. “They’re breathing much more rapidly than adults would. What’s in the air is coming into their lungs at a much more rapid pace.”
Dressel said it’s much more effective to prevent kids from developing disease in the first place, through such interventions as the air purifiers or new cleaning habits — rather than treating them one-by-one down the line.
FAM Allies hopes this project will help them push for policy solutions. There are no state or federal standards for indoor air quality. Lee said it’s probably unfeasible to require child care centers to meet certain standards, since conditions vary so much building to building.
But if the intervention works, it could at least lead to state-level discussion around providing air cleaners to places that serve young children.
