Nassau Community College (NCC), located in Garden City, New York, is the largest two-year community college in the State of New York, employing over 1,200 full time faculty and staff in 40 different buildings on a 225 acre campus. On February 29, 2000, the National Institute for Occupational Safety and Health (NIOSH) received a formal request to conduct a health hazard evaluation (HHE) at the Nassau Community College. The request, submitted by the Nassau Community College Federation of Teachers (NCCFT), was concerned with indoor air quality-related health effects, including asthma, chronic sinusitis, hypersensitivity pneumonitis, respiratory infections, and dermatitis, within eight specified buildings on campus. On March 16, 2000, a second request was submitted from the President of NCCFT and the President of NCC amending the initial request to include all existing structures on campus. This request followed 20 years of reports and environmental investigations at the college of water incursions, relative humidity problems, mold growth, and ventilation problems, as well as reported respiratory symptoms. Most of these survey reports focused on environmental conditions within the academic buildings built in the late 1970s. On October 23-27 and December 4-8, 2000, NIOSH conducted an environmental assessment of buildings cited in the request using an 'Environmental Assessment Check Sheet' for visual assessment of water stains., visible mold, mold odor, and standing water or moisture in 724 offices and laboratories in 13 buildings. The 13 buildings included seven buildings, built in 1978, with a history of water damage and six others built either prior to, or after, 1978. On November 20,2000, NIOSH investigators mailed out health questionnaires on respiratory symptoms, supplemented with questions concerning demographic information, work history information, cigarette/cigar/pipe smoking habits, physician-diagnosed asthma, and use of latex gloves and sensitivity information, to all faculty and staff within 30 departments on campus. This was followed by attempts to increase participation and to assess respondent bias. The objectives of the investigation were: 1. to estimate the prevalence of reported respiratory symptoms, work-related symptoms, and post-hire onset of symptoms and to determine whether building-related excesses exist; 2. to assess the indoor environmental factors relating to potential fungal contamination in the campus buildings; 3. to examine the possible associations between reported work-related respiratory symptoms and environmental factors; and 4. to examine symptom rates among the Nursing Department faculty and staff, especially in relation to their move from Cluster F in February 2000. Findings from the environmental assessment showed clear differences between groups of buildings across the campus. Rooms within the Cluster buildings and the Library exhibited distinctly more evidence of water stains, visible mold, mold odor, and current moisture than any of the other buildings studied. The one new building examined, built in 1992, had the lowest scores for water-damage associated factors, while the older buildings, built in 1929, had levels which fell between those for the 1970s buildings and the new building. Of the 393 participants in the questionnaire survey (71 % participation), 328 were faculty and 65 were staff. Most were white and never smokers, average age 50 years, with about half being male. Overall, about one third of the participants reported symptoms of wheezing, chest tightness, shortness of breath, or attacks of coughing. About half reported anyone of these symptoms. Upper respiratory symptoms, such as nasal and sinus symptoms and throat irritation, and itchy or burning eyes were reported by half to two-thirds of the participants overall. Most of the reported symptoms had onset after starting work at NCC, and about half of those who reported symptoms noted them to be work-related (either less severe or required less medication away from work). Overall, 17% of the participants reported physician-diagnosed asthma, with about half of those noting it to be post-hire onset or exacerbated by work. The prevalence of diagnosed asthma reported by those aged 35-65 years among faculty and staff respondents was 18%, compared to 10% reported overall by New York state residents of that age range. Symptom prevalences by building group showed marked differences. Employees in the 1970s buildings (those with a history of water damage) reported substantially higher prevalences of both lower and upper respiratory symptoms that were post-hire and work-related. The prevalence of any chest symptoms post-hire was 44% for the, 1970s buildings versus 14% for the older buildings (p-value < 0.05) and 21 % for the new building (p-value < 0.05). Worked-related prevalences were 34, 3 and 19%, respectively (statistical significance for 1970s compared to older buildings, p-Value < 0.05). Post-hire upper respiratory symptoms were not greatly different across buildings, at 72,69 and 56%, respectively (statistical significance for 1970s compared to newer building, p-value < 0.05). However, the prevalence of work-related upper respiratory symptoms was higher in the 1970s buildings: 56% compared to 31 % for the older buildings (p-value < 0.05) and 35% for the newer building (p-value < 0.05). To explore the relationship between environmental factors in the rooms and reported symptoms and health complaints, we developed an exposure index based on reported time spent in the rooms and the assessments of stains, mold presence and odor, and moisture. Using statistical models that adjusted for employee status (faculty or staff), gender, age, cigarette smoking history, reported allergies, reported use of latex gloves, and the year of hire, we found clear evidence that symptom reporting was related to factors reflecting water damage and its sequelae. Significantly increased odds of having wheeze, chest tightness, shortness of breath, at least one chest symptom, and nasal and sinus symptoms were all related to recorded presence of visible mold (p-values < 0.05). Water stain also was associated with nasal and sinus symptoms and throat irritation (p-value < 0.05). Mold odor was associated with throat irritation and any upper respiratory symptoms or eye irritation (p-value < 0.05). Although elevated odds ratios were frequently found for moisture presence, none were statistically significant. For participating faculty and staff within the Nursing Department (N=26), 54% reported lower respiratory symptoms and 73% reported upper respiratory symptoms or eye irritation while they were working in Cluster F. After the Nursing Department moved out of Cluster F in the early months of the year 2000, 36% of those who reported having chest symptoms prior to the move reported that their symptoms or breathing problems had either lessened or disappeared after they moved. This improvement, however, was not reflected in the reporting of upper respiratory symptoms. Overall, the results show high prevalences of lower and upper respiratory symptoms among employees of Nassau Community College, including an excess of asthma compared to state rates. Much of the reported prevalence was likely work-related, either in terms of post-hire onset or exacerbation at work, and was confirmed by evidence from medical records of affected individuals. There were obvious differences in the environmental factors across buildings. Reduction in lower respiratory symptoms was observed among a small subset who moved from, the affected buildings. Finally, there was clear evidence of association of health conditions with environmental factors, including higher symptom prevalences in water-damaged buildings and in association with exposure indices based on factors related to water damage and mold growth. Together, these provide convincing evidence that building-related disease has occurred at Nassau Community College. We recommend the following for this workplace: 1. Promptly fix water leaks and replace material that has been wet for a day or longer. Doing so reduces the ~( potential for microbial growth. 2. Promptly remove visible mold and further evaluate potential hidden mold reservoirs in walls, especially within the classrooms and offices of the 1970s buildings, by obtaining services from a consulting firm with experience in planning how to remove mold, including hidden mold. 3. During construction or renovations, use containment measures to control exposures to dusts and other contaminants. 4. Involve a local occupational health clinic to determine whether persons with work-related symptoms in buildings with previous water damage have building-related conditions that may require relocation. Ongoing medical consultation and surveillance of the faculty and staff can help set priorities for remediation; prevent further illness from developing; and reassure employees when the risk decreases. Medical surveillance activities may involve repeat questionnaire administration, recording of potential cases seeking evaluation, and medical testing. 5. Disseminate the findings of this report to all faculty and staff so that A) they can become more aware of their working environment and promptly report any signs of water leaks, visible mold and odors to the physical plant managers, B) they may seek medical attention if they feel that their symptoms are work- related, and C) they can become involved in programs, such as a medical surveillance program. NIOSH documented that building-related respiratory problems were occurring among employees of Nassau Community College. Our assessments of environmental contamination showed positive associations with health outcomes. Prognosis for work-related asthma is improved by early recognition and exposure cessation. We recommend that medical surveillance be conducted for the early detection of work-related problems, both for appropriate clinical management and to show whether remediations have been effective in preventing new cases. Prompt remediation of water incursions and replacement of all wetted material that cannot be dried out in 24 hours should be carried out. During renovations, use containment measures that keep exposures to dusts and other contaminants of construction at a minimum.