Environmental Questionnaire Instructions and Hypotheses, 6-7 Year Age Group

Instructions for completing the Environmental Questionnaire (EQ) 6-7 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:

Question 3. In the past 12 months how often, on average, did your child 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 first 12 months of your child's life, did you usually give paracetamol (e.g. Panadol, Pamol) for fever? Please also insert the local name that you use for paracetamol.

Question 9. In the past 12 months, how often, on average, have you given your child paracetamol (e.g. Panadol, Pamol)?: Please also insert the local name that you use for paracetamol.

Question 13. Was your child born in ________? Please insert the name of your country.

Question 14. How many years has your child lived in ________? Please insert the name of your country.

Question 15. What level of education has the child's 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 16. 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.

Question 23. In your child's first year of life did he/she have regular (at least once a week) contact with farm animals (e.g. cattle, pigs, goats, sheep or poultry)*?: To be adapted to local circumstances. The examples of animals that have been given, may not be as common is some countries as others and therefore the animals noted in this question may need to be changed.

Question 24. Has this child's Mother had regular (at least once a week) contact with farm animals (e.g. cattle, pigs, goats, sheep or poultry) while being pregnant with this child *?: To be adapted to local circumstances. The examples of animals that have been given, may not be as common is some countries as others and therefore the animals noted in this question may need to be changed.

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, Ed Mitchell, Alistair Stewart and Professor Richard Beasley (Phase Three Coordinator).

Hypotheses & Question Source for 6-7 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 & 9
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.
Antibiotic hypothesis Q10
That antibiotic use in the first year of life is associated with an increased risk of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema9.
Wickens et al have demonstrated an associated risk between symptoms of asthma, allergic rhinoconjunctivitis and atopic ezcema and the use of antibiotics in early childhood9.
Source of question: ISAAC Steering Committee
Analysis of variable. Associations with symptoms will be identified.
Parity hypothesis Q11 & 12
That increased household size is associated with a decreased risk of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema10.
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 al10.
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 Q13 & 14
That migrants to a country will adopt the prevalence of symptoms of asthma, allergic rhinoconjuncitivitis and atopic eczema of their new country over time11-16.
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 Q15
That increased socio-economic status is associated with increased risk of symptoms of asthma17.
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 characteristics17.
Source of question: Durkin et al17.
Analysis of variable. Associations with symptoms will be identified.
Traffic hypothesis Q16
That respiratory irritants such as sulphur dioxide (SO2) nitrogen oxides (NOX) and particulates from diesel combustion cause local respiratory inflammation, increasing tissue contact with inhaled allergens and the likelihood of an allergic response18,19.
Source of question: Weiland et al19.
Analysis of variable. Associations with symptoms will be identified.
Birth Weight hypothesis Q17
That low birth weight is associated with increased risk of symptoms of asthma, allergic rhinoconjuncitivitis and atopic eczema20.
A potential association between low birth weight and an increased risk of chronic obstructive lung disease has been identified20 and is worth further exploration.
Source of question: ISAAC Steering Committee.
Analysis of variable. Associations with symptoms will be identified.
Breast feeding hypothesis Q18
That breast feeding is associated with decreased risk of symptoms of asthma, allergic rhinoconjunctivitis or atopic eczema21.
Introduction of other milk at less than 4 months was found by Oddy et al21 to increase the risk of current wheeze 1.31 times (95% CI 1.05-1.64) when controlled for gestational age, sex, smoking in the household and childcare attendance in prospective birth cohort study of 2187 children in Western Australia. Rusconi et al22, found that breast feeding for six or more months was associated with a decreased risk of transient early wheeze (OR: 0.82 95% CI: 0.68-0.97). Breast feeding was also associated with an increased risk of late-onset wheezing (OR: 1.22, 95% CI: 0.99-1.5).
Source of question: Rusconi et al22.
Analysis of variable. Associations with symptoms will be identified.
Allergen hypothesis Q19 - 22
The literature is conflicting, there could be two hypotheses: 1. That exposure to allergens is associated with increased risk of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema23; 2. That early exposure to allergens is protective against allergy development9.
To support hypothesis 1, Roost et al23 concluded that current cat ownership represented a significant risk for sensitization to cat if cats were allowed indoors. They do, however also support hypothesis 2 by suggesting that childhood exposure to pets, including cats, might modulate immunologic mechanisms and reduce sensitization to cat in adulthood. Hesslemar et al10 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 al10.
Analysis of variables. Associations with symptoms will be identified. The questions allow identification of separate trigger and sensitisation effects.
Farm hypothesis Q 23 & 24
That contact in utero, or in the first year of life, with farm animals is protective against developing asthma and allergies in childhood.
Source of questions: Munich group, through ISAAC Steering Committee.
Analysis of variables. Associations with symptoms will be identified.
Tobacco smoke hypothesis Q25-28
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 asthmatics24.
Source of question: Jarvis24.
Analysis of variables. Associations with symptoms will be identified.

References

  1. Shaheen SO, Sterne JAC, Montgomery SM, Azima H. Birth weight, body mass index and asthma in young adults. Thorax 1999; 54(5): 396-402.

  2. Chor D, da Silva Freire Coutinho E, Laurenti R. Reliability of self reported weight and height among State bank emplyees. Revista de Saúde Pública 1999; 24(1): 96-9.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Wickens K, Pearce N, Crane J, Beasley R. Antibiotic use in early childhood and the development of asthma. Clinical and Experimental Allergy 1999; 29(6): 766-71.

  10. 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.

  11. Robertson CR, Dalton MF, Peat JK, Haby MM, Bauman A, Kennedy JD, Landau LI. Asthma and other atopic diseases in Australian children. Australian arm of the International Study of Asthma and Allergy in Childhood. Medical Journal of Australia 1998; 168: 434-8.

  12. Partridge MR, Gibson GJ, Pride NB. Asthma in Asian immigrants. Clinical Allergy 1979; 9: 289-94.

  13. Waite DA, Eyles EF, Tonkin SL, O'Donell TV. Asthma prevalence in Tokelauan children in two environments. Clinical Allergy 1980; 10: 71-5.

  14. Leung RC, Carlin JB, Burdon JGW, Czarny D. Asthma, allergy and atopy in Asian immigrants in Melbourne. Medical journal of Australia 1994; 161: 418-25.

  15. Powell CVE, Nolan TM, Carlin JB, Bennett CM, Johnson PDR. Respiratory symptoms and duration of residence in immigrant teenagers living in Melbourne, Australia. Archives of Disease in Childhood 1999; 81: 159-62.

  16. Ormerod LP, Myers P, Prescott RJ. Prevalence of asthma and 'problematic' asthma in the Asian population in Blackburn, U.K. Respiratory Medicine 1999; 93: 16-20.

  17. Durkin MS, Islam S, Hasan ZM, Zaman SS. Measures of socioeconomic status for child health research: Comparative resutls from Bangaldesh and Pakistan. Social Science and Medicine 1994; 38(9): 1289-97.

  18. Weiland SK, Mundt KA, Rückmann A, Keil U. Self-reported wheezing and allergic rhinitis in children and traffic density on street of residence. Annals of Epidemiology 1994; 4: 243-7.

  19. Duhme H, Weiland SK, Keil U, Kraemer B, Schmid M, Stender M, Chambless L. The association between self-reported symptoms of asthma and allergic rhinitis and self-reported traffic density on street of residence in adolescents. Epidemiology 1996; 7(6): 578-582.

  20. Barker DJ, Codfrey KM, Fall C, Osmond C, Winter PD, Shaheen S. Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease. British Medical Journal 1991; 303: 671-75.

  21. Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanlley FJ, Kendall GE, Burton PR. Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. British Medical Journal 1999; 319: 815-9.

  22. Rusconi F, Galassi C, Corbo GM, Forastiere F, Biggeri A, Ciccone G, Renzoni E, and the SIDRA Collaborative Group. Risk factors for early, persistent and late-onset wheezing in children. American Journal of Respiratory and Critical Care Medicine 1999; 160: 1617-22.

  23. Roost HP, Künzli N, Schindler C, Jarvis D, Chinn S, Perruchoud AP, Ackermann-Liebrich U, Burney P, Wüthrich B, for the European Community Respiratory Health Survey. Role of current and childhood exposure to cat and atopic sensitization. Journal of Allergy and Clinical Immunology 1999; 104: 941-7.

  24. Jarvis MJ. Children's exposure to passive smoking: survey methodology and monitoring trends. In: World Health Organization, Division of Noncommunicable Diseases, Tobacco Free Initiative. Background Papers: International Consultation on Environmental Tobacco Smoke (ETS) and Child Health. 1999. Pp130-46.

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