0
Views
0
CrossRef citations to date
0
Altmetric
Research Article

Newer New Jersey work-based learning teachers during the COVID-19 pandemic: school safety regarding ventilation, trainings, and awareness of government agencies resources

, , , &
Received 30 Jan 2024, Accepted 05 Jul 2024, Published online: 14 Jul 2024

ABSTRACT

New Jersey (NJ) Safe Schools Program (NJSS) provides code-required trainings for NJ teachers supervising students in work-based learning (WBL) experiences. During the COVID-19 pandemic, increased use of chemical cleaning, sanitization, and disinfectant products (CSDPs) led to ventilation and other health concerns. NJSS conducted two surveys of newer NJ WBL teachers between October 2021 and June 2023, with a follow-up in fall 2022 for those who completed initial surveys before summer 2022. This study focused on questions regarding workspace ventilation; respirator and CSDPs trainings; awareness of government resources for safety and health (S&H); and demographics. Over 65% of participant classrooms have operable windows or ventilation systems, while 13% of school salons have ceiling fans. Half of participants didn’t receive training on handling CSDPs, although 90% were aware of government S&H resources. Data suggested teachers have well-ventilated workspaces and are aware of different resources available, which is important to continue post COVID-19.

Introduction

Due to the COVID-19 pandemic and heightened concern regarding disease spread, there was an increase of cleaning, sanitizing, and disinfecting products (CSDPs) used in primary and secondary schools in the United States (US) and worldwide (Koksoy Vayisoglu and Oncu Citation2021; Hilbert et al. Citation2021; Shaughnessy et al. Citation2022). CSDPs are considered a source of indoor pollution commonly used in bulk with varying frequency, timing, and intensity in schools. Other indoor air quality (IAQ) parameters discussed in the context of CSDPs include biological contaminants like mold, pollen, or dust mites found on hard surfaces like floors, desks, on and behind walls and dry erase boards; carbon dioxide; carbon monoxide; smoke; fine particulate matter; nitrogen oxides; volatile organic chemical compounds (VOCs); and formaldehyde (Jovanović et al. Citation2014).

Ventilation has been considered an important determinant for IAQ in schools since the early 1900’s (Duffield Citation1927; Rosbach et al. Citation2013). However, there have been studies that indicated school classrooms are not well ventilated (Daisey et al. Citation2003; Shendell et al. Citation2004, Citation2004b, Citation2004c; Mendell and Heath Citation2005; Fisk Citation2017; Bluyssen Citation2017). This is an issue because children spend a large amount of time in schools, and students, in addition to school personnel, are vulnerable to various environmental exposures such as indoor pollution or poor IAQ, emphasizing the importance of ventilation with filtration (Salthammer et al. Citation2016). IAQ is greatly affected by ventilation, where minor changes in airflow rates and pressure can noticeably affect IAQ (Vornanen-Winqvist et al. Citation2018). A 2010 study demonstrated that adding mechanical ventilation in classrooms improves IAQ by reducing indoor air concentrations of carbon dioxide (Rosbach et al. Citation2013).

Ventilation is also a crucial factor for reducing the risk of airborne infections and rates of asthma symptom episodes (Shendell et al. Citation2013; Jovanović et al. Citation2014; Jendrossek et al. Citation2023). This is especially true for cosmetology students in career and technical education (CTE) environments, as beauty salon environments – in schools and off-campus serving the general public – have large amounts of VOCs and formaldehyde present (Tsigonia et al. Citation2010; Shendell et al. Citation2013, Citation2018; Milich et al. Citation2017). A previous study done in NJ found that approximately 50% of the salons had ventilation systems or windows that they could open (Shendell et al. Citation2018). Various studies have established a link between ventilation and improved IAQ, which can impact both the attendance and academic performance of students in schools (Seppänen and Fisk Citation2004; Shendell et al. Citation2004, Citation2004b; Shaughnessy et al. Citation2006; Wargocki and Wyon Citation2013; Allen and Ibrahim Citation2021; Ahmed et al. Citation2022; United States Environmental Protection Agency Citation2023). One study done in Saudi Arabia found a strong association between IAQ and cognitive performance of female students aged 16 to 23 (Ahmed et al. Citation2022).

During the COVID-19 pandemic, some US K-12 public schools implemented ventilation improvements, which included replacing or upgrading existing ventilation systems, improving airflow, and installing filtration systems (Mark-Carew et al. Citation2023). Also, outside the US, for example, a study in the Netherlands reported schools had improved ventilation rates after the pandemic compared to before, mainly due to reducing student occupancy of individual classrooms in schools (Ding et al. Citation2023).

Ventilation is not the only thing that can help protect teachers and students from air pollutants. Training on how to use CSDPs safely and personal protective equipment (PPE) is also important. A US study reported that CTE laboratory accidents are reduced significantly when a teacher is comprehensively trained in PPE use (Love et al. Citation2023). Studies have found people who didn’t receive trainings in using cleaning chemicals properly were more likely to experience work-related asthma symptoms (Siracusa et al. Citation2013). Ventilation is important when using CSDPs in order to reduce the prevalence of reported asthma symptoms (United States Environmental Protection Agency Citation2024). There is not a lot of data regarding teacher-level trainings regarding PPE; however, in the private sector (including general industry, health care, and construction), between 13% and 15% of those who completed OSHA authorized trainings in the five years before the start of the COVID-19 pandemic in 2020 have had formal training regarding respiratory protection with PPE (Koshy et al. Citation2021).

Over the 2021–2022 and 2022–2023 school years (SY), New Jersey Safe Schools (NJSS) asked newer NJ CTE teachers who took the state-required work-based learning (WBL) supervisory teacher/administrator courses to answer an online safety and health (S&H) survey which included specific questions about ventilation, safety trainings, and awareness of federal and state government agency resources. The present study focuses on three major topics: to determine the type of ventilation teachers have in their classrooms, if they have received the required safety trainings for their respiratory protection (including information about respirators and different types of face masks), and if they are aware of federal and state government agency resources available to them throughout two of the three SY that were impacted by the COVID-19 pandemic. One study goal was to see if more targeted education is necessary for these topics among NJ CTE WBL teachers.

Methods

Between the 2021–2022 and 2022–2023 SY, NJSS provided 163 teachers statewide with free WBL training through an expanded special grant funded initiative with the NJ Department of Education-Office of Career Readiness. The goal of the special opportunity was to provide free WBL trainings to teachers in CTE in NJ via targeted recruitment. Interested teachers applied through a PsychData (Psych Data LLC, State College PA) form titled “Work-Based Learning Supervisor Trainings for Participating CTE Teacher Application Form” for review by NJSS staff. The application was announced and distributed through the NJSS monthly e-newsletter via Constant Contact (Constant Contact Inc., MA) and application submissions were managed in Microsoft Excel. Eligibility criteria required teachers to be endorsed (certification credentials) in CTE, agricultural education, business, human services-cosmetology, allied health, and/or family and consumer sciences, have less than 15 years of teaching experience (ideally <10 years in secondary schools), and were new to CTE. Eligible teachers represented the State of NJ, with equal opportunity by region (north, central, and south) and additional opportunity for teachers in larger urban/suburban populations serving historically underrepresented minority and low-middle income students. Those who were eligible were sent a registration link and an approval code for registration. This group of teachers paid an administration fee of $20 versus the full amount of ~$750± $10 US, the cost of the trainings in 2021–2023 as part of the regular training program. This training consisted of six online courses focusing on child labor laws and occupational S&H topics for teachers to consider while supervising their students in WBL, and a virtual live session with course trainers. The NJ Department of Education requires the completion of these courses for teachers, including those in CTE, who will be supervising students in WBL. NJSS is the only program in the state of NJ offering these courses to teachers to fulfill these requirements. After completion of the courses, teachers were asked to complete either two or three online surveys via PsychData. Across all surveys, a total of 205 submissions were completed or partially completed and received (n = 91 for survey one, n = 79 for survey two, and n = 35 for the follow-up survey/survey three). Both survey one and two were given to each participant one week after the completion of courses. Those who completed the trainings and initial surveys in the 2021–22 SY were asked to take a follow-up survey in the fall 2022 Survey one had different questions from survey two, while the follow-up survey/survey three included a combination of questions from both survey one and survey two. All survey results were combined for data analysis. Most questions in these surveys were adapted from previous federal surveys (e.g. US Census) and prior NJSS research surveys made by NJSS staff to target questions which were known to be important to NJ teachers (Milich et al. Citation2017; Shendell et al. Citation2018; Campbell et al. Citation2020).

The first survey asked questions about physical hazard concerns, built or physical school environment, S&H protocols and training, attitudes and attributes, perceptions on S&H, and products purchased for school use. The second survey consisted of questions on where teachers worked and when, S&H of the employee, any symptoms employees may have experienced in the school due to CSDPs, ventilation, use of PPE, trainings, awareness of government resources, personal nutrition, personal sleep hygiene, and personal physical and mental health. The follow-up survey/survey three was a combination of both surveys, and all surveys ended by asking demographic information. This paper focuses on survey questions and responses pertaining to ventilation, S&H protocols and trainings received in their schools, and awareness of government resources.

After data management and initial descriptive statistics were computed for each question/variable for the entire study population, data were stratified by the year WBL trainings were taken with NJSS, gender, race, and county of work. Data analyses were done using Microsoft Excel and SAS Analytics Software 9.4 (Cary, NC). All variables are categorical. Age was stratified as younger than 42 and 42 and above as 42 is the average age for teachers in the US (National teacher and principal survey NTPS Citation2020). Counties were stratified into three regions north NJ (N.NJ), central NJ (C.NJ), and south NJ (S.NJ) (Shendell et al. Citation2021). Categorical variables were summarized using percentages and compared between groups using Fisher’s exact test due to small sample sizes and Kruskal Wallis test. Missing data were excluded from the analyses. Calculated p-values below 0.05 were considered statistically significant.

This study was approved by the Institutional Review Board (IRB, or Ethics Committee) of Rutgers, the State University of New Jersey (IRB protocol code: 2021001559).

Results

For those who chose to answer the question pertaining to race, 59.1% identified as Non-Hispanic White (NHW), and 58.1% self-identified as female. The average birth year for these teachers was 1976 (standard deviation (SD): 9.5). Participants had an average of 6.2 (SD: 2.8) years of secondary (post-high school) education with 60.9% of participants having a master’s degree, 27.2% having a bachelor’s degree, 4.3% having a doctoral degree, and 7.6% having a different type of degree. Participants worked throughout NJ with 51.8% in N.NJ, 24.1% in C.NJ or Statewide, and 24.1% in S.NJ. Of the 21 NJ counties, 20 were represented. On average, participants have taught 12.6 (SD: 7.4) years in NJ and 13.2 (SD: 7.8) years overall ().

Table 1. Descriptive statistics: demographics.

Regarding physical school spaces in which teachers spend most of their time in (classrooms, workshops, or salons), many teachers had different elements implemented to filter air and help improve IAQ. About two-thirds of participants reported ventilation systems in their classrooms or workshop, with no differences in stratifications. Over 70.0% of the participants had windows that could be opened in the room they spend the most time in, with no differences in stratifications using either the Fisher’s exact test (when stratifying by gender or race) or the Kruskal Wallis test (when stratifying by county region of work). Of those who responded, in school salons, only 13.1% had ceiling fans while 78.7% did not (). Those who took the survey in the 2021–2022 SY were more likely to report no ceiling fan in their salons (86.3% 2021–2022 vs 40.0% 2022–2023, Fisher’s p = 0.01).

Table 2. Ventilation in classrooms and workspaces as reported by newer New Jersey public secondary school career-technical education teachers, 2021–2022 and 2022–2023 school years.

When asked if employees who wear respirators at their workplace(s) were trained and medically cleared to do so, 65.5% of those who answered indicated that they were. About two-thirds of participants did not have training from their schools/workplaces. It should be noted that this information was not included in the WBL trainings on how to clearly delineate the differences between cloth face coverings, surgical masks, filtering face pieces and respirators, with no differences in stratifications when using either the Fisher’s exact test or the Kruskal Wallis test ().

Figure 1. Training data reported by Newer New Jersey public secondary school career-technical education teachers, 2021–2022 and 2022–2023 school years.

Figure 1. Training data reported by Newer New Jersey public secondary school career-technical education teachers, 2021–2022 and 2022–2023 school years.

When participants were asked if any trainings were offered by their place of employment on how to handle CSDPs at work, 35.9% responded yes, 50.0% said no, and 14.1% were not sure (). When stratified by gender, race, and year WBL training was completed, there were no statistical differences when using the Fisher’s exact test or between the different county regions of work using the Kruskal Wallis test. Of those who answered yes, all participants received training in their primary language.

There is an abundance of different resources for S&H in NJ. This study asked how aware participants were of different S&H resources. When asked if they knew about federal resources from the United States Department of Labor-Occupational Safety and Health Administration (USDOL-OSHA), 92.0% indicated “yes.” When asked if they were aware of Hazard Communication Standard and/or Safety Data Sheets, 95.1% responded “yes.” This information was presented in the WBL training. When asked if they knew about the state-level resource, such as the NJ Safe Schools Program Cosmetology/Right to Know website pages, 69.1% responded “yes” (). Please note, however, explicit review of the NJ Safe Schools cosmetology course was not included in the trainings conducted in relation to the present study’s surveys. When stratified by gender, race, and year WBL training was completed, there were no statistical differences when using the Fisher’s exact test or between the different county regions of work using the Kruskal Wallis test.

Table 3. Awareness of government agency resources of Newer New Jersey public secondary school career-technical education teachers, 2021–2022 and 2022–2023 school years.

Discussion

This study provides valuable insight regarding trainings received, ventilation in schools and resource awareness of participating NJ secondary school teachers. Overall, this study did not find differences in most questions when stratified by the year in which the trainings were completed, gender, race, and county of work. This suggests uniformity throughout the State of NJ. The current study found that most teachers have ventilation in their classroom and are aware of different S&H resources. Most participants also have had trainings regarding respirators – ranging from N-95 masks to half- and full-face respirators – but many did not report being trained in distinguishing between different types of masks and how to properly, i.e. most safely, use CSDPs inside school classrooms. This study’s percentages for having received trainings can be compared to those who were trained in the five years prior to the start of the COVID-19 pandemic and then worked in the private sector (including general industry, construction, and health care workers) during year one of the pandemic in Region II (2), mainly NJ and New York City, but also other parts of New York State, Puerto Rico, and US Virgin Islands (Koshy et al. Citation2021). Among their 335 total participants, a majority (52%) stated their employer had a training component to formal COVID-19 pandemic response plans (6% did not know). Furthermore, a majority (53%) stated their employer’s training protocol clearly delineated differences among types of face coverings, masks (surgical vs. N-95), filtering face pieces and respirators (10% did not know), which is higher than in the present study (: among respondents, 61.4% no, 38.6% yes) (Koshy et al. Citation2021). This current study focused on newer CTE teachers who will supervise students in WBL in NJ across construction and general industry, while the Koshy et al. (Citation2021) study focused on newer employees in NJ and in New York City in their fields within general industry and/or construction during the COVID-19 pandemic. There are differences in the population as our participants were asked these questions closer to the date of completing their training than those in the Koshy et al. (Citation2021) study. Despite both study populations taking the OSHA trainings (whether in general industry or construction), participants in the private sector, specifically construction, may have stricter delineation on types of masks when compared to those in schools.

NJ has a code in the NJ Mechanical Code 2015, which governs the ventilation within buildings, specifically, Section 401 and then Section 403 (including Table 403.3.1.1) for required mechanical ventilation. In accordance with this statute, beauty and nail salons have the minimum exhaust airflow rate of 0.6 CFM (cubic feet per minute)/feet2, and a minimum outdoor airflow rate into the indoor occupied area, i.e. the occupant breathing zone, of 0.12 CFM/feet2. In salon areas, it is required to have mechanical exhaust, and it is prohibited to have recirculation of air in these areas.

A NJ salons study focused on workers (Shendell et al. Citation2018) reported over 50% of S&H trainings received, including materials provided, were not conducted in both English and in the primary language(s) of the salon workers (Shendell et al. Citation2018). This current study, however, found 100% of participants had training in their primary language. The previous NJ study concluded salon workers needed more trainings regarding PPE selection and fit (including both masks and gloves) (Shendell et al. Citation2018). The same can be said for those in the current study as less than 40.0% had trainings from their workplace/schools regarding the differences in types of masks and did not receive training regarding CSDP use.

This study had several strengths. First, the survey was distributed online which allowed data to be collected, stored, managed, and analyzed digitally. This method allowed teachers to complete the surveys at their own pace. Second, response anonymity allowed teachers to be open about their opinions as there would be no repercussions for honest responses. This study did voluntarily collect emails for e-gift card distribution; however, survey responses were not linked to emails.

This study had some limitations. First, this was a specific population of public NJ secondary school CTE teachers, and second there was the small sample size of 205 participants across two SY. Data cannot likely be generalized to broader general populations of K-12 teachers. Third, due to the cross-sectional approach to this study, we cannot determine causality, only suggest associations. Fourth, due to anonymity, we cannot determine if multiple people took surveys from the same secondary school computer available to teachers or if participants took the survey multiple times. We do know in this study that seven participants completed the survey multiple times due to several requests for e-gift cards, but we cannot determine which survey responses were theirs. Thus, all responses were included in this study. Finally, we could not guarantee each participant took every survey offered to them.

Conclusion

This study suggested that over two-thirds of participants had some type of mechanical ventilation systems in their secondary school classroom/workspace and had operable windows that could open to some degree. Less than a one-fifth of salons (cosmetology training classrooms within the school campus) had ceiling fans. This study also suggested most teachers do not have sufficiently rigorous trainings to delineate the differences between different types of face masks as personal protective equipment or PPE or regarding cleaning, sanitizing, and disinfecting products or CSDPs; this is a concern, given some CSDPs are known, probable, or possible carcinogens as well as environmental asthma triggers if they are present in the air in aerosolized form. Furthermore, in this study, teachers were aware of federal agency resources but not NJ or state agency specific resources. Finally, there were no differences between NJ region, age, gender identity, race/ethnic identity, or year the survey was taken. These results suggest uniformity in the state of NJ, i.e. no group is disproportionally affected by lack of training or access to proper ventilation.

This study suggests future research should be conducted with a larger population to represent the general K-12 public school population and with a more diverse population in terms of race/ethnicity or type of school teachers (including non-CTE teachers). We also suggest a study be done outside of NJ to examine if NJ data are consistent within the US and possibly internationally. This study also suggests teachers need more training regarding both PPE and on indoor CSDPs use. Teachers also need to have more ventilation in their classrooms, especially if they work in salons. We have three specific recommendations. First, schools provide more training for CSDPs along with trainings on different types of face coverings. Second, districts/schools provide properly sized air purifiers with filters for particles/aerosols and possibly volatile organic chemical compounds to rooms that are unable to get proper ventilation systems or windows that open. Finally, schools can make teachers more aware of local resources for S&H.

Geolocation  information

Participating teachers are from public schools across the state of New Jersey.

The office location for the authors is 683 Hoes Ln W, Piscataway, NJ 08854, USA.

Supplemental material

Supplemental Material

Download PDF (644.3 KB)

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data were obtained via surveys titles “Rutgers NJ Safe Schools Program New Work-Based Learning Supervising Teachers Cohort − 1st Survey (Parts I and II, and Demographics),” “Rutgers NJ Safe Schools Program New Work-Based Learning Supervising Teachers Cohort − 2nd Survey (Follow-up on Safety, Health and Wellness (physical and mental)),” and “Late 2022/2022–2023 School Year Follow-up (v.1 Aug 2021) Rutgers NJ Safe Schools Program New Work-Based Learning Supervising Teachers Cohort – Survey.”

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09603123.2024.2378097

Additional information

Funding

This research was supported by the New Jersey Department of Education, the Office of Career Readiness/State Vocational Education Aid, for the state fiscal years of 2021–2024, via three grants/contracts, as follows: 22-100-034-5062-032-H200-6030, 23-100-034-5062-032-H200-6030, and 24-100-034-5062-032-H200-6030. This study also received support from the U.S. Department of Education, Carl D. Perkins V Program Leadership Funds (CDFA 84.048A), as part of three NJDOE grants/contracts, in the state fiscal years of 2021–2024, as follows: 21-100-034-5062-118-H200-6030-2L01, 22-100-034-5062-118-H200-3610-2L02, and 23-100-034-5062-118-H200-3610-2L03.

References

  • Ahmed R, Mumovic D, Bagkeris E, Ucci M. 2022. Combined effects of ventilation rates and indoor temperatures on cognitive performance of female higher education students in a hot climate. Indoor Air. 32(2):e13004. doi: 10.1111/ina.13004.
  • Allen JG, Ibrahim AM. 2021. Indoor air changes and potential implications for SARS-CoV-2 transmission. JAMA. 325(20):2112–2113. doi: 10.1001/jama.2021.5053.
  • Bluyssen PM. 2017. Health, comfort and performance of children in classrooms – new directions for research. Indoor and Built Environ. 26(8):1040–1050. doi: 10.1177/1420326X16661866.
  • Campbell MLF, Sansone A, Gonzalez LN, Schroth RJ, Shendell DS. 2020. E-cigarette environmental and fire/life safety risks in schools reported by secondary school teachers. BMC Publ Health. 20(1):1215. doi: 10.1186/s12889-020-09319-8.
  • 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. doi: 10.1034/j.1600-0668.2003.00153.x.
  • Ding E, Zhang D, Hamida A, García-Sánchez C, Jonker L, de Boer AR, Bruijning PCJL, Linde KJ, Wouters IM, Bluyssen PM. 2023. Ventilation and thermal conditions in secondary schools in the Netherlands: effects of COVID-19 pandemic control and prevention measures. Building and Environ. 229(1):109922. doi: 10.1016/j.buildenv.2022.109922.
  • Duffield TJ. 1927. School ventilation. Its effect on the health of the pupil. Am J Public Health (NY). 17(12):1226–1229. doi: 10.2105/ajph.17.12.1226.
  • Fisk WJ. 2017. The ventilation problem in schools: literature review. Indoor Air. 27(6):1039–1051. doi: 10.1111/ina.12403.
  • Hilbert TJ, Brancato C, Carter K, Westneat S, Bush HM, Haynes EN. 2021. Disinfectant use by K-12 school staff to combat SARS-CoV-2. American J Infect Contrl. 49(11):1432–1434. doi: 10.1016/j.ajic.2021.08.023.
  • Jendrossek SN, Jurk LA, Remmers K, Cetin YE, Sunder W, Kriegel M, Gastmeier P. 2023. The influence of ventilation measures on the airborne risk of infection in schools: a scoping review. Int J Environ Res Publ Health. 20(4):3746. doi: 10.3390/ijerph20043746.
  • Jovanović M, Vučićević B, Turanjanin V, Živković M, Spasojević V. 2014. Investigation of indoor and outdoor air quality of the classrooms at a school in Serbia. Energy. 77:42–48. doi: 10.1016/j.energy.2014.03.080.
  • Koksoy Vayisoglu S, Oncu E. 2021. The use of cleaning products and its relationship with the increasing health risks during the COVID-19 pandemic. Int J Clin Pract. 75(10):e14534. doi: 10.1111/ijcp.14534.
  • Koshy K, Shendell DG, Presutti MJ. 2021. Perspectives of region II OSHA authorized safety and health trainers about initial COVID-19 response programs. Safety Sci. 138:105193. doi: 10.1016/j.ssci.2021.105193.
  • Love TS, Roy KR, Sirinides P. 2023. A national study examining safety factors and training associated with STEM education and CTE laboratory accidents in the United States. Safety Sci. 160:106058. doi: 10.1016/j.ssci.2022.106058.
  • Mark-Carew M, Kang G, Pampati S, Mead KR, Martin SB, Barrios L. 2023. Ventilation improvements among K–12 public school districts — United States, August–December 2022. MMWR Morb Mortal Wkly Rep. 72(14):372–376. https://www.cdc.gov/mmwr/volumes/72/wr/mm7214a4.htm.
  • Mendell MJ, Heath GA. 2005. Do indoor pollutants and thermal conditions in schools influence student performance? A critical review of the literature. Indoor Air. 15(1):27–52. doi: 10.1111/j.1600-0668.2004.00320.x.
  • Milich LJ, Shendell DG, Graber JM. 2017. Safety and health risk perceptions: a cross-sectional study of New Jersey hair and nail salon clients. J Chem Health Saf. 24(6):7–14. doi: 10.1016/j.jchas.2017.03.004.
  • National teacher and principal survey (NTPS). 2020. National center for education statistics (NCES) home page, a part of the US. Department of Education. [accessed 2023 Oct 23]. https://nces.ed.gov/surveys/ntps/estable/table/ntps/ntps2021_sflt02_t1s.
  • Rosbach JT, Vonk M, Duijm F, van Ginkel JT, Gehring U, Brunekreef B. 2013. A ventilation intervention study in classrooms to improve indoor air quality: the FRESH study. Environ Health. 12(1):110. doi: 10.1186/1476-069X-12-110.
  • Salthammer T, Uhde E, Schripp T, Schieweck A, Morawska L, Mazaheri M, Clifford S, He C, Buonanno G, Querol X, et al. 2016. Children’s well-being at schools: impact of climatic conditions and air pollution. Environ Int. 94:196–210. doi: 10.1016/j.envint.2016.05.009.
  • Seppänen OA, Fisk WJ. 2004. Summary of human responses to ventilation. Indoor Air. 14(Suppl s7):102–118. doi: 10.1111/j.1600-0668.2004.00279.x.
  • Shaughnessy R, Hernandez M, Haverinen-Shaughnessy U. 2022. Effects of classroom cleaning on student health: a longitudinal study. J Expo Sci Environ Epidemiol. 32(5):767–773. doi: 10.1038/s41370-022-00427-8.
  • Shaughnessy RJ, Haverinen-Shaughnessy U, Nevalainen A, Moschandreas D. 2006. A preliminary study on the association between ventilation rates in classrooms and student performance. Indoor Air. 16(6):465–468. doi: 10.1111/j.1600-0668.2006.00440.x.
  • Shendell DG, Aggarwal J, Campbell MLF, Gonzalez LN, Kaplun E, Koshy K, Mackie TI. 2021. Fall 2020 COVID-19 needs assessment among New Jersey secondary school educational professionals. Int J Environ Res Publ Health. 18(8):4083. doi: 10.3390/ijerph18084083.
  • Shendell DG, Barnett C, Boese S. 2004. Science-based recommendations to prevent or reduce potential exposure to biological, chemical, and physical agents in schools. J School Health. 74(10):390–396. doi: 10.1111/j.1746-1561.2004.tb06603.x.
  • Shendell DG, Graber JM, Milich LJ, Pratt ME. 2018. Assessing acute symptoms related to occupational exposures among nail salon technicians. J Occupat Environ Med. 60(4):343–349. doi: 10.1097/JOM.0000000000001210.
  • Shendell DG, Mapou AE, Kelly SW. 2013. Younger cosmetology workers and environmental and occupational asthma triggers at training sites and in salons. J Asthma Allergy Educat. 4(2):67–70. doi: 10.1177/2150129712474820.
  • Shendell DG, Prill R, Fisk WJ, Apte MG, Blake D, Faulkner D. 2004. Associations between classroom CO2 concentrations and student attendance in Washington and Idaho. Indoor Air. 14(5):333–341. doi: 10.1111/j.1600-0668.2004.00251.x.
  • Shendell DG, Winer AM, Weker R, Colome SD. 2004. Evidence of inadequate ventilation in portable classrooms: results of a pilot study in Los Angeles County. Indoor Air. 14(3):154–158. doi: 10.1111/j.1600-0668.2004.00235.x.
  • Siracusa A, De Blay F, Folletti I, Moscato G, Olivieri M, Quirce S, Raulf-Heimsoth M, Sastre J, Tarlo SM, Walusiak-Skorupa J, et al. 2013. Asthma and exposure to cleaning products - a European academy of allergy and clinical immunology task force consensus statement. Allergy. 68(12):1532–1545. doi: 10.1111/all.12279.
  • Tsigonia A, Lagoudi A, Chandrinou S, Linos A, Evlogias N, Alexopoulos EC. 2010. Indoor air in beauty salons and occupational health exposure of cosmetologists to chemical substances. Int J Environ Res Public Health. 7(1):314–324. doi: 10.3390/ijerph7010314.
  • U.S. Environmental Protection Agency. 2023. Indoor air quality in high performance schools | US EPA. [accessed 2024 May 1]. https://www.epa.gov/iaq-schools/indoor-air-quality-high-performance-schools.
  • U.S. Environmental Protection Agency. 2024. Ventilation and coronavirus (COVID-19). [accessed 2024 May 1]. https://www.epa.gov/indoor-air-quality-iaq/ventilation-and-coronavirus-covid-19.
  • Vornanen-Winqvist C, Järvi K, Toomla S, Ahmed K, Andersson MA, Mikkola R, Marik T, Kredics L, Salonen H, Kurnitski J. 2018. Ventilation positive pressure intervention effect on indoor air quality in a school building with moisture problems. Int J Environ Res Publ Health. 15(2):230. doi: 10.3390/ijerph15020230.
  • Wargocki P, Wyon D. 2013. Providing better thermal and air quality conditions in school classrooms would be cost-effective. Build Environ. 59:581–589. doi: 10.1016/j.buildenv.2012.10.007.