Environmental Questionnaire Instructions and Hypotheses, 13-14 Year Age Group

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Environmental Questionnaire Instructions and Hypotheses, 13-14 Year Age Group

Instructions for completing the Environmental Questionnaire (EQ) 13-14 years

The EQ has been developed by the ISAAC Steering Committee. We encourage all Phase Three centres to use the EQ for both age groups, however it is not compulsory to do so.

If the EQ is used:

It must come after the core ISAAC asthma, rhinitis and eczema questions, but before the video questionnaire.
If it is translated into the local language, it must be treated in the same manner as the core questionnaires as per the instructions for translations on page 43 of the ISAAC Phase Three Manual, and a copy of the translation is to be sent to the ISAAC International Data Centre in Auckland New Zealand. A back translation to English must also be undertaken.
Not every centre will wish to use every question in the EQ. Centres may wish to shorten the EQ to adapt to local conditions.
It may be necessary to insert the local terminology for some questions. These questions are identified below.
If a centre is considering any environmental questions we encourage them to use the question from the EQ rather than composing their own.
Most questions are self explanatory, however there are some questions that need further explanation and these are discussed below.

Question 3. In the past 12 months how often, on average, did you eat or drink the following? If there are foods listed that are not applicable to your country you may delete them. Similarly, if you consider the list too comprehensive, you may delete some of the foods. For MEAT, we include examples that would be applicable for New Zealand. Other countries may like to delete our examples and include relevant examples for their country.

Question 8. In the past 12 months, how often, on average, have you taken paracetamol (e.g. Panadol, Pamol)?: Please insert the local name that you use for paracetamol.

Question 11. Were you born in ________? Please insert the name of your country.

Question 12. How many years have you lived in ________? Please insert the name of your country.

Question 13. What level of education has your Mother received? Please insert your local wording for the levels of education using 3 levels. For example, in New Zealand we would delete College as College is another term for Secondary school. If the wording is changed, the IIDC would appreciate clarification, such as: Primary school = 5 years of age to 12 years of age (or years 1 - 7). This will ensure a more accurate analysis of this question. The categories you use would ideally cover the following area: Education during childhood (approx up to 12 years of age); Education during adolescence (approx 13 to 17 years of age); and advanced education.

Question 14. How often do trucks pass through the street where you live, on weekdays?: The word 'truck' can be change to an alternative word e.g. Lorry.

If you have further questions please do not hesitate to contact the ISAAC International Data Centre. Fax 64 9 373 7602. Phone 64 9 373 7599 ext 86451. Email: p.ellwood@auckland.ac.nz

Very best wishes from the IIDC. Philippa Ellwood, Innes Asher, Tadd Clayton, Nancy Williams, Ed Mitchell, Alistair Stewart and Professor Richard Beasley (Phase Three Coordinator).

Hypotheses & Question Source for 13-14 Year Age Group Environmental Questionnaire, November 2000

Overweight hypothesis Q1 & 2

We speculate, that if a child's weight is excessive in comparison with their height, this could be associated with increased risk of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema¹.
No sample questions were identified from literature. Some papers commented about inaccuracies of self reporting, however another paper found insignificant differences between self reported and measured height and weight in bank employees².
Source of questions: ISAAC Steering Committee.
Analysis of variables. The Body Mass Index (BMI), weight ÷ height² will be calculated for each individual and the BMI used as the variable for analyses. All weight data will be converted to Kg and height data converted to Metres.

Diet hypothesis Q3

That a plant based diet is protective against asthma and allergies and a "Western" diet is positively associated with asthma and allergies³.
Protective and aggravating factors found in the ISAAC Diet ecological analysis³ include starch, cereals, rice, vegetables, fish, other seafood, fibre, fruit, nuts, olive oil (protective); trans fatty acids, fast foods (aggravating). Other foods considered include, eggs, animal fats, milk, polyunsaturated fatty acids. All dietary surveys in the literature are lengthy questionnaires and either interviewer administered or adult self-completed. There are two types identified - food frequency questionnaires either prospective diary or retrospective recall (7 day, 3 months, 12 months) or "dietary history" which is generally a recalled food frequency questionnaire. No short diet questions suitable for inclusion in the EQ were identified.
Source of question: ISAAC Steering Committee.
Analysis of diet variables.
A Plant based diet will be determined by "three or more times a week" of:

Fruit

Vegetables

Pulses

Cereal

Pasta

Rice

Nuts

Potatoes

AND "never or occasionally; once or twice per week" of:

Meat

Butter

Milk

Eggs

Burgers/Fast food

The detailed combinations of these have yet to be developed for analyses
The key factors for a "Western" diet positively associated with asthma and allergies are:
margarine, dairy products, fat of ruminant animals.
margarine, fast food/burgers "three or more times a week".
Fish is protective against asthma or allergies
Seafood (including fish) "three or more times a week".
Egg is a positive risk factor for eczema
Egg, "three or more times a week".
Individual components can be analysed.

Exercise hypothesis Q4 & 5

That regular exercise and physical fitness are protective against asthma.
Possible aggravating factors: Being sedentary and lack of physical fitness. An assessment of physical activity in adolescents has been undertaken by Aaron et al⁴ but was not undertaken in relationship to asthma and allergies.
Source of questions: Aaron et al⁴ and Kohl et al⁵.
Analysis of variables. Combination of these two questions will allow classification of participants into groups based on their level of exercise and whether they are sedentary.

Gas cooking hypothesis Q6 & 7

That gas cooking is associated with increased risk of symptoms of asthma⁶.
Gas cooking has shown mixed effect in epidemiological studies. Kerkhof et al⁶ showed increased bronchial responsiveness among persons with high total IgE levels who use gas for cooking suggesting that atopic subjects are sensitive to adverse effects of gas cooking on respiratory health. However, Moran et al⁷ in their study, concluded that the use of gas for cooking was unlikely to be a major influence on respiratory morbidity in young adults.
Source of questions: ISAAC Steering Committee.
Analysis of variables. Associations in the symptoms will be identified. Combinations of the variables may be used to identify severe exposure to gas combustion products.

Paracetamol hypothesis Q8

That frequent paracetamol use is associated with an increased risk of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema⁸.
Newson et al⁸ reported, in a recent ecological analyses, a positive association between paracetamol consumption and prevalence of asthma, allergic rhinoconjunctivitis and atopic eczema symptoms in children. They speculate that paracetamol may influence atopic disease by depleting glutathione in the airways and in immune cells.
Source of questions: ISAAC Steering Committee.
Analysis of variables. Associations with symptoms will be identified.

Parity hypothesis Q9 & 10

That increased household size is associated with a decreased risk of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema⁹.
A decrease in the cumulative incidence and prevalence of allergic rhinitis and the cumulative incidence of asthma with increasing number of siblings was reported by Hesselmar et al⁹.
Aggravating factors could be small family size and early birth order.
Source of question: ISAAC Steering Committee.
Analysis of variables. Associations with symptoms will be identified. The questions allow identification of separate effects of birth order and number of siblings.

Migration Hypothesis Q11 & 12

That migrants to a country will adopt the prevalence of symptoms of asthma, allergic rhinoconjuncitivitis and atopic eczema of their new country over time^10-15.
There is conflicting evidence in the literature regarding the health of immigrants. Robertson et al reported that symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema were more common in children born in Australia compared with children born in other countries but resident in Australia¹¹. Leung et al¹⁴ reported that prevalence of hayfever and asthma increased with length of stay among Asian immigrants to Australia.
Source of question: ISAAC Steering Committee.
Analysis of variables. Associations with symptoms will be identified. The questions allow assessment of the effect of time spent in the country.

Socio economic status hypothesis Q13

That increased socio-economic status is associated with increased risk of symptoms of asthma¹⁶.
Studies of the relationship between socio-economic status (SES) and health have shown that SES is multidimensional, incorporating elements of occupational characteristics, education, income, wealth and residential characteristics¹⁶.
Source of question: Durkin et al¹⁶.
Analysis of variable. Associations with symptoms will be identified.

Traffic hypothesis Q14

That respiratory irritants such as sulphur dioxide (SO₂) nitrogen oxides (NO_X) and particulates from diesel combustion cause local respiratory inflammation, increasing tissue contact with inhaled allergens and the likelihood of an allergic response^17,18.
Source of question: Weiland et al¹⁷.
Analysis of variable. Associations with symptoms will be identified.

Allergen hypothesis Q15 & 16

That exposure to allergens is associated with increased risk of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema^9,19.
Roost et al¹⁹ concluded that current cat ownership represented a significant risk for sensitization to cat if cats were allowed indoors. They do, however also support the hypothesis that childhood exposure to pets, including cats, might modulate immunologic mechanisms and reduce sensitization to cat in adulthood. Hesslemar et al⁹ found that exposure to cat or dog during the first year of life was associated with a lower prevalence of allergic rhinitis and asthma in school children.
Source of questions: Hesselmar et al⁹.
Analysis of variables. Associations with symptoms will be identified. The questions allow identification of separate trigger and sensitisation effects.

Tobacco smoke hypothesis Q17 - 19

That exposure to tobacco smoke in early life is associated with increased risk of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema. That exposure to tobacco smoke is a trigger for asthma attacks for asthmatics²⁰.
Source of question: Jarvis²⁰.
Analysis of variables. Associations with symptoms will be identified.

References

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Ellwood PE, Asher MI, Björkstén B, Burr M, Pearce N, Robertson C and the ISAAC Phase One Study Group. Diet and Asthma, Allergic Rhinoconjunctivitis and Atopic Eczema symptom prevalence: An ecological analysis of the International Study of Asthma and Allergies in Childhood (ISAAC) data. European Respiratory Journel. In Press.
Aaron DJ, Kriska AM, Dearwater SR, Cauley JA, Metz KF, LaPorte RE. Reproducibility and validity of an epidemiologic questionnaire to assess past year physical activity in adolescents. American Journal of Epidemiology 1995; 142: 191-201.
Kohl HW, Blair SN, Paffenbarger RS Jr, Macera CA, Dronenfield JJ. A mail survey of physical activity habits as related to measured physical fitness. American Journal of Epidemiology 1988; 127(6): 1228-39.
Kerkhof M, de Monchy JGR, Rijken B, Schouten. The effect of gas cooking on bronchial hyperresponsiveness and the role of immunoglobin E. European Respiratory Journal 1999; 14: 839-44.
Moran SE, Strachan DP, Johnston IDA and Anderson HR. Effects of exposure to gas cooking in childhood and adulthood on respiratory symptoms, allergic sensitization and lung function in young British adults. Clinical and Experimental Allergy 1999; 29: 1033-41.
Newson RB, Shaheen SO, Burney PGJ. Paracetamol sales and prevalence of childhood atopic disease: Ecological analysis of ISAAC data. Poster 916 presented at the American Thoracic Society Annual Meeting, Toronto, 2000.
Hesselmar B, Åberg N, Åberg O, Eriksson B, Björkstén B. Does early exposure to cat or dog protect against later allergy development? Clinical and Experimental Allergy 1999; 29: 611-7.
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